Texas

The grounds, as Texas describes them

PL 2022-25, section 2.1, "Reasons for Discharge Permitted by Rule" (hhs.texas.gov, PDF, September 29, 2022, retrieved 2026-08-30), states that the facility "must allow a resident to remain in the facility and may not involuntarily discharge the resident unless", in the letter's own order:

"the transfer or discharge is necessary for the resident's welfare, and the resident's needs cannot be met in the facility;"

"the transfer or discharge is appropriate because the resident's health has improved sufficiently so the resident no longer needs the services provided by the facility;"

"the safety of individuals in the facility is endangered due to the clinical or behavioral status of the resident;"

"the health of other individuals in the facility would otherwise be endangered;"

"the resident has failed, after reasonable and appropriate notice, to pay for (or to have paid under Medicare or Medicaid) a stay at the facility. Nonpayment applies if the resident does not submit the necessary paperwork for third party payment or after the third party, including Medicare or Medicaid, denies the claim and the resident refuses to pay for the resident's stay. For a resident who becomes eligible for Medicaid after admission to a facility, the facility may charge a resident only allowable charges under Medicaid;"

"the resident or resident representative requests a voluntary transfer or discharge; or"

"the facility ceases to operate as a nursing facility and no longer provides resident care."

The letter's footnote for the section cites 26 TAC §554.502(a) and related subsections of the same rule; the rule itself, "Transfer and Discharge in Medicaid-certified Facilities", is listed by the Secretary of State's TAC portal under 26 TAC Chapter 554, Subchapter F.

The published process

Requesting the hearing

PL 2022-25, section 2.4: "Regardless of the reason for discharge, a resident has the right to appeal a discharge within 90 days of a discharge notice." The pendency statement follows: "If the resident appeals before the discharge date, the facility may not discharge the resident while the appeal is pending. A NF is required to allow the resident to remain in the facility until the hearing officer makes a final determination unless" one of six quoted circumstances applies, among them endangerment of safety or health of individuals in the facility, nonpayment as stated, and "a resident has not resided in the facility for 30 days." The hearing is a fair hearing under "HHSC's Uniform Fair Hearings rules" (1 TAC Chapter 357, Subchapter A); the notice must carry "information on how to obtain an appeal form and assistance in completing the form and submitting the fair hearing request". On the outcome, section 2.6: "If a hearing officer determines the discharge is inappropriate, the facility, upon written notification by the hearing officer, must readmit the resident immediately to the facility or to the next available bed." No standing street address for filing is stated in the sources reviewed; the route the sources publish runs through the appeal form described in the notice and the contacts "listed on the hearing notice".

The notice's required contents

The Fair and Fraud Hearings Handbook, section 1323, quotes 26 TAC Section 554.502: "Contents of the notice. For nursing facilities, the written notice specified in subsection (d) of this section must include the following:" the reason, the effective date, and the location of the transfer or discharge; "a statement of the resident's appeal rights", including that "the resident has the right to appeal the action as outlined in HHSC's Fair and Fraud Hearings Handbook by requesting a hearing within 90 days after the date of the notice" and that "if the resident requests the hearing before the discharge date, the resident has the right to remain in the facility until the hearing officer makes a final determination unless failure to transfer or discharge would endanger the health or safety of the resident or individuals in the facility. The facility must document the danger failure to discharge would present"; "the name, address, email address, and telephone number of the managing local ombudsman and the toll-free number of the Ombudsman Program"; and, where applicable, the state mental health authority and the protection and advocacy contacts for residents with an intellectual or developmental disability. PL 2022-25 adds that the toll-free number for the Long-Term Care Ombudsman Program "is 1-800-252-2412", and that the notice goes to the resident, the representative, and "a representative of the Long-Term Care Ombudsman Program".

Bed-hold and return

The Secretary of State's TAC portal lists rule 26 TAC §554.503, "Notice of Bed-Hold Policy and Return To Medicaid-certified Facilities", in the same subchapter as the discharge rule. Its text is not quoted here: the portal serves rule body text only through a session-bound frame that refuses direct capture, and no other first-party statement of the bed-hold notice or of a Medicaid bed-hold payment policy was found in the sources reviewed (searched: hhs.texas.gov provider letters, the Medicaid for the Elderly and People with Disabilities Handbook, the Nursing Facility Requirements handbook — removed per its own notice — and the TMHP long-term-care user guide). Not stated in the sources reviewed. On return after a hearing, PL 2022-25's readmission statement is quoted above; the federal bed-hold floor is quoted on [the federal page](../federal.html) and is not restated here.

The three rows above hoist the questions a facility's counsel answers in the first fifteen minutes. They are quotations from Texas's published sources, not a determination that any of them applies to any situation.

Notice periods and deadlines, as stated in the sources

All quoted; none calculated.

30 days' advance notice — PL 2022-25, section 2.2: written notification of the discharge to the resident, the representative if applicable, and a representative of the Long-Term Care Ombudsman Program, "at least 30 days before the intended discharge date". The letter states the facility "must provide a discharge notice as soon as practicable before the 30-day period described above if" one of five quoted circumstances applies.

90 days to request the hearing — PL 2022-25, section 2.4, quoted in full above; the handbook's quotation of the rule states the same period as "within 90 days after the date of the notice".

Five business days for the evidence packet — PL 2022-25, section 2.5: facilities "are encouraged to send it no less than five business days before the hearing date"; the letter states there are "no federal or state regulations regarding how far ahead of the hearing to send the packet".

30 days of residence — PL 2022-25: the as-soon-as-practicable notice circumstances and the pendency exceptions each include that "the resident has not resided in the facility for 30 days."

What any of these periods means for a particular case is for the hearing office to determine.

Source map

Captured: all four, in tools/packets/texas-packet.txt. Pending: the full rule texts of 26 TAC 554.502 and 554.503 from the Secretary of State's portal, and any first-party Medicaid bed-hold payment statement — per the packet's pending list.

Change log

2026-08-30 — Page built from the first Texas packet. Findings: (1) The Secretary of State's TAC portal serves rule body text only inside a session-bound frame that returns HTTP 403 to direct capture; the rule texts of 26 TAC 554.502 and 554.503 are therefore capture-pending, and the notice-contents text of 554.502 is carried through HHSC's own verbatim quotation of it in the Fair and Fraud Hearings Handbook. (2) Texas's grounds list in PL 2022-25 includes a voluntary-request bullet the federal regulation's six-item enumeration does not; both stand as published, reconciled nowhere. (3) No first-party statement of a Medicaid bed-hold payment policy was found; the bed-hold row states the absence and what was searched. (4) The ombudsman program's page states no date of its own. (5) PL 2022-25's section 2.6 sentence on recoupment reads "Medicaid must recoup any payments made on behalf of the resident after the date of discharge or decision, whichever is later, must be recouped." — the publisher's own wording, reproduced as published. Capture pending: per the source map. Internet Archive: not yet submitted. Reviewer: Carrie Schluter, reviewed 2026-08-30. Corrections: hello@fieldassembly.net.