Form 3249, Hospital Waiver Request

Instructions

Updated: 8/2024

Purpose

Form 3249 is used to request a waiver or exception from complying with a requirement of a particular provision of Texas Health and Safety Code (HSC) Chapter 241, the Texas Hospital Licensing Law or a minimum standard adopted by HHSC at Texas Administrative Code (25 TAC) Chapter 133, Hospital Licensing.

When to Prepare

An applicant for a hospital statute or rule waiver, other than the physical plant and construction requirements listed in Form 3250, must submit Form 3249 and other documents to the Texas Health and Human Services Commission (HHSC) as required by HSC Section 241.026(c) and 25 TAC Section 133.81.

Before requesting a waiver the applicant must review HSC Section 241.026(c) and 25 TAC Section 133.81 and hold an active hospital license or have submitted an initial application and applicable fee for licensure.

If the applicant requests waivers for multiple hospital statutes or rules, the applicant must submit a separate Form 3249 for each statute or rule.

HHSC must approve all required application materials received before HHSC will issue a statute or rule waiver or exception to the applicant.

For Health Care Regulation contact information, visit the Health Care Facilities Regulation Contact Us webpage.

Hospital Statute and Rule Waiver or Exception Request

An applicant must submit the following to HHSC:

• A completed Form 3249 for only one requirement of a particular provision of Texas Health and Safety Code (HSC) Chapter 241, the Texas Hospital Licensing Law or a minimum standard adopted by HHSC at Texas Administrative Code (25 TAC) Chapter 133, Hospital Licensing.
• Documentation to support the waiver request explanations in Form 3249 Section 3 as necessary.
• When an applicant requests a waiver of 25 TAC Section 133.41(e)(2)(C)(i) or 25 TAC Section 133.163(f)(1)(A)(ii)(I), the information listed in the Hospital Emergency Services Waiver or Exception Request section below.

Hospital Emergency Services Waiver or Exception Request

In addition to the documents required for a hospital statute and rule waiver or exception request, an applicant for a waiver of 25 TAC Section 133.41(e)(2)(C)(i) or 25 TAC Section 133.163(f)(1)(A)(ii)(I) must also submit the following to HHSC:

• The trauma designation of the applicant, if applicable.
• The names and locations of alternative sites near the facility that provide emergent care. Include the distance in miles from the facility to the alternative locations, the estimated peak travel drive time, and the alternative locations' trauma designations if applicable in the following format.

• The qualifications of the staff members who will be on duty to provide emergency medical care when no physician is available or on duty in the emergency treatment area. This includes at least one RN or mid-level with advanced cardiovascular life support and pediatric advanced life support certification.
• The average daily emergency department census within at least the hospital’s last 12 months.
• The names of any general hospitals licensed under HSC Chapter 241 the applicant's hospital has a patient transfer agreement with. Include the effective date of the agreements.

The applicant may also submit letters of support from the health care community such as:

• Other hospitals
• Community health leaders
• Emergency Medical Services
• Regional Advisory Council leaders

Receiving HHSC Response to Waiver Application

HHSC provides written approval or denial of the waiver application upon its review of all required waiver application materials.

• The hospital must hold a current license or submit an initial license application and licensing application fee before the waiver is considered and processed.
• Form 3249 is processed in queue. HHSC does not expediate waiver requests.
• HHSC will contact the person listed on Form 3249 to request further documentation when more information or details is required to support the waiver request.
• HHSC will not process the waiver request when Form 3249 is incomplete. HHSC will contact the person listed on the form and request a revised Form 3249 be emailed to the mailbox in the section below.

The hospital must not remove or substitute any requirements the hospital requested be waived when HHSC denies the waiver request.

Important Items to Note

• The applicant must submit a separate Form 3249 for each hospital statute or rule the applicant requests a waiver for.
• The applicant must complete Form 3250, Hospital Statute and Rule Waiver Request Application for Facility Physical Plant and Construction Requirements if they request a waiver or exception from complying with one of the following physical plant and construction requirements:
  • 25 TAC Section 133.162(d)(4)(A)(i) Regarding the domestic water distribution system piping within buildings
  • 25 TAC Section 133.162(d)(4)(A)(viii)(I)
  • 25 TAC Section 133.162(t)(1)(F)(viii)
  • 25 TAC Section 133.163(u)(1)(K) Regarding the nursery infant station count
  • 25 TAC Section 133.163(u)(1)(L)(i)
  • 25 TAC Section 133.163(ff)(2)(B)(i) Excluding the soiled workroom requirement
  • 25 TAC Section 133.164(b)(2)(A)-(D)

Mailing Address for Waiver Applications:

Submit requests to Health Care Regulation, Health Facility Licensing at healthfacilitylicensing@hhs.texas.gov or by regular mail:

HHSC Regulatory Licensing Unit

Health Facility Licensing, Mail Code 1868

P.O. Box 149347

Austin, TX 78714