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Instruction
Updated: 8/2024
Purpose
Form 3250 is used to 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)
If the applicant seeks a waiver for a rule not listed on Form 3250, the applicant must complete Form 3249, Hospital Waiver Request.
When to Prepare
An applicant for a waiver of one of the physical plant and construction requirements listed above must submit Form 3250 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 of a physical plant and construction requirement listed above, 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.
Hospital Facility Physical Plant and Construction Rule Waiver or Exception Request
An applicant must submit the following to HHSC:
- A completed and signed Form 3250 for only one of the physical plant and construction requirements listed under the Purpose Section in this document.
- Documentation to support the waiver request explanations in Form 3250 Section 3.
If the applicant requests waivers for multiple physical plant and construction requirements at one hospital location, the applicant must submit a separate Form 3250 for each rule requested to be waived.
For Health Care Regulation contact information, visit the Health Care Facilities Regulation Contact Us webpage.
Receiving HHSC Response to Waiver Application:
HHSC shall provide written approval or written denial of the waiver application upon review of all required waiver application materials.
- Form 3250 is processed in queue. HHSC does not expedite waiver requests.
- HHSC will contact the person listed on Form 3250 for more documentation when more information or details are required to support the waiver request.
- HHSC will not process the waiver request when Form 3250 is incomplete. When HHSC receives an incomplete Form 3250, HHSC will contact the person listed on Form 3250 and request a revised Form 3250 to be emailed to the mailbox listed in the section below.
- The hospital shall not remove or substitute the physical plant and construction requirement listed on the Form 3250 at the location listed on the Form 3250 until HHSC grants approval of the waiver.
The hospital must not remove or substitute the physical plant and construction requirement that the hospital requested to be waived when HHSC denies the waiver request.
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