Health Facility Guidance Letters (RE: COVID-19)

31 Mar 2020, Posted by Jaime Pacilio in Events, Healthcare Facility Rules

What began as a simple recommendation to wash your hands more thoroughly has now developed into something indescribable.  We now work new terms like “flatten the curve” and “social distancing” into our daily conversations.  In a bold move, Governor Abbott announced a key decision to allow hospitals to quickly add capacity in order to care for the burgeoning population affected by the virus.  We knew this would mean the adoption of emergency rules or waving existing rules for general hospitals during the COVID-19 pandemic, so we began to check with our associates at the Health Department.

SBL Architecture’s Kellye Johnson is now receiving notification when each new Health Facility Licensing Guidance Letter is being issued and is maintaining contact with Rebecca Reed and/or Angel Alvarez with the Health Care Facilities Regulation Architectural Review Group of HHSC.  Knowing that your time is valuable, she has taken the time to summarize the documents.


[UPDATE #1] GL 20-1001 and GL-20-1001A Regarding Expansion of Bed Capacity during COVID-19 Outbreak

Summary: A hospital experiencing surge capacity may (1) “re-purpose” beds used under its license for a different type of patient care to treat COVID-19 patients and (2) temporarily increase their bed capacity by using “unlicensed patient beds in patient treatment areas” without a fee or application.  Note: Inpatient psychiatric beds of a general or special hospital are not included in this waiver; HHSC’s approval would be required for their conversion.

Copy of Amended Guidance Letter:  GL-20-1001-A_Temp Susp. of State Licensure Requirements on Exceeding Bed Capacity During COVID-19_Amended (This .pdf contains links to the rules and statutes that are suspended.)

As of 04/01/2020 at 5:00 PM CST, the referenced document is not appearing on the site. It is possible that they are in the process of replacing it. We will keep you posted.

As of 04/02/2020 at 5:15 PM CST, the reference document has been restored to the site.


[UPDATE #2] GL 20-2010-A Amended Temporary Suspension of Spacial Requirements in Patient Rooms in General and Special Hospitals

Summary: This waiver allows a hospital to temporarily increase the number of beds in existing multi-bed patient areas/rooms within the Emergency Department, Intermediate Care Suite, and Nursing Units without having to meet clearances normally required around patient beds or modify the medical gas or nurse call systems.  Note: (1) This waiver does not include Private Rooms. (2) The normal requirement for 1 Airborne Infection Isolation Suite per 30 acute care beds or fraction thereof is suspended temporarily under this waiver.

Copy of Amended Guidance Letter:  GL-20-2010-A_ Amended Temp. Susp. of Spatial Requirements in Patient Rms in General and Special Hospitals


[UPDATE #3] GL 20-1002 and GL-20-1002A Regarding Temporary Suspension for Fire Marshall Approval during COVID-19 Outbreak

Summary: In areas where the local municipality is not performing fire inspections during the facility’s licensure renewal period, a currently licensed facility applying for licensure renewal may temporarily forgo the fire marshal inspection requirement. An approved fire marshal report must be submitted at a later date.  Note: This waiver applies to General and Special Hospitals, Private Psychiatric Hospitals, ESRD’s and FEMC’s.

Copy of Amended Guidance Letter:  GL-20-1002_A Temp Susp of State Licensure Requirements for Fire Marshall Approval During COVID-19_Amended


[UPDATE #4]  Temporary Suspension of 30-mile Radius Limit for Multiple Hospitals Under a Single License during COVID-19 Outbreak

Summary: This Guidance Letter contains two primary suspensions. First, a currently licensed hospital (general or specialty) may temporarily provide treatment to patients at multiple locations that are greater than 30 miles from the hospital’s main address. Second, general and special hospitals and ambulatory surgical centers (ASC’s) may temporarily be licensed for the same premises.

Copy of Amended Guidance Letter: GL-20-1004-A_Temp. Suspension of 30-Mile Radius Limit for Multiple Hospitals under a Single License_3.31.2020
(This .pdf contains links to the rules and statutes that are suspended.)


[UPDATE #5] Health Facility Guidance Letter GL 20 -1003-A-2 Regarding Emergency Off-site Locations in Response to COVID-19

Summary: Under Emergency rule §500.1, inpatient care may be provided at an off-site facility by an existing licensed hospital upon approval from HHSC prior to using the off-site facility for inpatient care.

1.  Facilities that are currently licensed (under their appropriate Health and Safety Code) or licensed within the past 36 months or a facility with a pending application that has passed its final architectural review inspection include:

  • Inpatient hospice unit (licensed under Chapter 142)
  • Nursing facility or other institution (licensed under Chapter 242)
  • Ambulatory Surgical Center (licensed under Chapter 243)
  • Assisted Living Facility (licensed under Chapter 247)
  • Freestanding Emergency Medical Care Facility (Chapter 254)
  • Mental Hospital (Chapter 577)

2.  Hospital no longer licensed under Chapter 241 that closed within the past 36 months or a facility with a pending application that has passed its final architectural review inspection
3.  Hospital exempt from licensure under Chapter 241
4.  Mobile, transportable, or relocatable unit defined under and compliant with 25 TAC § 133.166
5.  Outpatient facility operated by the hospital, either currently or within the past 36 months.

Prior to using any of the above-listed facilities, hospitals must apply to operate such a facility under these restrictions and receive approval from HHSC. HHSC may require an inspection or additional documentation; HHSC may also withdraw its approval at any time.

Copy of Amended Guidance Letter: GL-20-1003-A2_Emergency Hospital Off-site Locations in Response to COVID-19_Amended_327-2020
(This .pdf contains links to the application form 3220 as well as the emergency rule.)


[UPDATE #6] Additional Guidance Letter Information

In addition to the summaries for the Guidance Letters from the Texas Health and Human Services Commission that relate to planning related issues for hospitals, there are 8 others that have been posted to date on their website that do not have architectural implications for hospitals but are instead focused more on operational issues or other types of healthcare facilities. These letters may be found on the Home Page for Heath Care Facilities Regulation at or by clicking on the specific number below.

GL 20-2008 Discharge Assessment Form for Patient Transfers from Hospitals to Long-term Care Facilities 3-21-2020

GL 20-2007-A2 Infection Control and Emergency Preparedness: Prohibition of Nonessential Visitors (Amended) 3-27-2020

GL 20-2012 ASC Services and Reporting Requirements 3-27-2020

GL 20-3003 Infection Control and Emergency Preparedness in Narcotic Treatment Programs 3-31-2020

GL 20-3001 Infection Control and Emergency Preparedness in Chemical Dependency Treatment Facilities 3-31-2020

GL 20-2016 Emergency Rule for Facility Response (Psych Hospital and (CSU) 4-6-2020

GL 20-2015 Emergency Rule for Facility Response (General and Special Hospitals) 4-6-2020

GL 20-1005 Emergency ESRD Off-site Locations 4-7-2020


The document is a work-in-progress, evolving as the need evolves, and as HHS continues to post Guidance Letters.


If you have any questions regarding these temporary code requirements or if you need any assistance, please reach out to Kellye Johnson directly (817-247-6552) or  Hopefully, we can help healthcare providers, in some fashion, because all of you are so important during these unprecedented times.