When you run a healthcare facility in Texas, you are responsible for ensuring the people you hire will treat patients safely and with respect. That is why every provider covered under Texas law must check the Employee Misconduct Registry (EMR) annually and before bringing on new staff.
At Nichols Weitzner Thomas LLP, we guide healthcare organisations through every layer of state and federal regulation. Here is what Texas providers need to know about the EMR, how it affects hiring, and what steps to take to stay audit ready.
What Is the Employee Misconduct Registry?
The Employee Misconduct Registry is maintained by the Texas Health and Human Services Commission under Chapter 253 of the Texas Health and Safety Code.
The EMR lists unlicensed personnel who have committed reportable conduct such as abuse, neglect, or exploitation while working in certain care settings.
If someone is listed in the EMR, they cannot be hired for most direct care positions in long term care or home and community based service programs.
Checking this registry is not optional. It is a legal obligation for Texas healthcare providers.
Why It Matters
Hiring someone listed in the EMR can result in serious consequences.
- Regulatory penalties and sanctions
- Loss of Medicaid or Medicare eligibility
- Civil liability if harm occurs
- Reputational damage to your organisation
Under Texas Health and Safety Code Section 253.008, facilities must check the EMR before hiring and at least once every year after.
Who Must Check the Registry
You must check the EMR if you operate or employ under any of the following.
- Home and Community Support Services Agencies
- Nursing facilities and intermediate care facilities
- Adult foster care providers
- Residential care providers licensed under Chapter 252
- Individual employers in Consumer Directed Services programs
If you are unsure whether your organisation falls under Chapter 253, our Texas healthcare lawyers can confirm your obligations.
How to Check the Employee Misconduct Registry
1. Search Before Hiring
Before making an offer, search the following registries.
- Employee Misconduct Registry
- Texas Nurse Aide Registry, if applicable
2. Conduct Annual Rechecks
The law requires a new EMR check every 12 months for each direct care employee, even if your staff has not changed.
3. Use the Correct Portal
Searches must be completed through the Texas Unified Licensure Information Portal. Keep proof of each search with a visible timestamp.
4. Document and Retain Proof
- Date of search
- Employee name and identifiers
- Search results
- Saved or printed confirmation
- Reviewer name and signature
5. If a Record Is Found
- Do not hire or continue employment in a covered role
- Reassign or terminate as required
- Contact legal counsel immediately
Our healthcare compliance attorneys can guide your next steps.
Common Compliance Mistakes
- Relying only on background checks
- Skipping annual EMR reviews
- Failing to document no record results
- Overlooking contract or agency staff
- Losing documentation during audits
Best Practices for Providers
- Embed registry checks into onboarding SOPs
- Automate annual reminders
- Require verification from vendors and subcontractors
- Review compliance processes yearly with counsel
Learn how these requirements align with Texas Administrative Code Section 253 and related licensure rules.
We also provide outside general counsel services for healthcare providers.
Staying Vigilant in a Changing Compliance Landscape
Compliance in Texas healthcare requires consistent action. EMR checks protect patients, staff, and your organisation while demonstrating good faith to regulators.
For help updating hiring procedures, preparing for audits, or building a compliance program, Talk to a Healthcare Compliance Attorney today.
