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’s 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’s 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 (HHSC) under Chapter 253 of the Texas Health and Safety Code.
The EMR lists unlicensed personnel (i.e., persons not already regulated via licensing boards) who have committed “reportable conduct” while working in certain care settings such as abuse, neglect, or exploitation of people receiving services.
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 isn’t optional, it’s part of your legal obligation as a healthcare provider in Texas.
Why It Matters
Hiring someone who’s listed in the EMR can have serious consequences:
- Regulatory penalties and sanctions from HHSC or other agencies
- Loss of Medicaid or Medicare eligibility for non-compliance
- Civil liability if harm occurs under your supervision
- Reputational damage to your organisation and leadership
Under Texas Health & Safety Code § 253.008, facilities and individual employers must check the EMR before hiring and at least once a year thereafter.
If your team hasn’t built that step into your onboarding process, now is the time.
Who Must Check the Registry
You are required to check the EMR if you operate or employ under any of these categories:
- Home and Community Support Services Agencies (HCSSAs)
- Nursing facilities and intermediate care facilities
- Adult foster care providers
- Residential care providers licensed under Chapter 252
- Individual employers participating in Consumer Directed Services (CDS) programs
If you’re unsure whether your organisation falls under Chapter 253, our Texas healthcare lawyers can review your structure and confirm your obligations.
How to Check the Employee Misconduct Registry
1. Search Before Hiring
Before making any employment offer, search both:
- The Employee Misconduct Registry (EMR), and
- The Texas Nurse Aide Registry, if applicable.
If the person appears in either registry for abuse, neglect, or exploitation, you cannot hire them for a covered position.
2. Conduct Annual Re-Checks
Even if your team doesn’t change, the law requires you to check the EMR every 12 months for each direct-care employee to ensure continued compliance. In other words, it’s no excuse that your employee may have committed misconduct at another facility during their employment.
3. Use the Correct Portal
HHSC now requires searches to be completed through the Texas Unified Licensure Information Portal (TULIP).
Keep printed or digital proof of each search, including a timestamp or screenshot that shows “no record found.”
4. Document and Retain Proof
Create a clear internal checklist:
- Date of search
- Name and identifying details used
- Registry results
- Printed or saved copy of the search
- Name and signature of the reviewer
Keep these records in the employee’s personnel file for the duration of employment and as required by law.
5. If a Record Is Found
If you discover a listing in the EMR:
- Do not hire or continue employing the person in a covered role.
- Reassign or terminate as needed based on the scope of your services.
- Contact counsel immediately to ensure your response and documentation meet HHSC requirements.
Our healthcare compliance attorneys can review your findings and help determine next steps.
Common Compliance Mistakes
- Relying only on background checks – these are separate from registry searches.
- Skipping or delaying the annual check.
- Failing to document “no record found” results.
- Ignoring contract or agency staff who fall under your responsibility.
- Losing search documentation during audits.
A single missing record can cause HHSC to cite your facility for non-compliance. Consistent documentation keeps you protected.
Best Practices for Providers
- Integrate EMR and Nurse Aide Registry checks into your onboarding SOPs.
- Schedule annual re-checks with calendar alerts or HR software.
- Include registry verification in all vendor and subcontractor agreements.
- Review your processes at least once a year with outside counsel.
To understand how these rules connect with the Texas Administrative Code § 253 and other licensure obligations, speak with our team about developing a compliance framework tailored to your organisation.
Our firm provides ongoing outside general counsel services for healthcare providers who want to maintain compliance without building an in-house legal department.
Staying Vigilant in a Changing Compliance Landscape
In Texas healthcare, compliance is never a one-time task. The Employee Misconduct Registry is just one of many safeguards designed to protect patients and preserve public trust but it’s also a reminder that every hiring decision carries regulatory weight.
By embedding EMR checks into your onboarding and annual review processes, you protect more than just your license. You protect your staff, your patients, and the integrity of your organisation. Regular, well-documented compliance practices also demonstrate to regulators that your facility takes its obligations seriously, a crucial factor in maintaining funding, accreditation, and reputation.
At Nichols Weitzner Thomas LLP, we know that healthcare providers don’t need more red tape, they need clear, defensible systems that fit into real operations. Our team brings the insight of Big Law veterans and the focus of a boutique firm, giving you access to seasoned healthcare compliance counsel who understand both the law and the day-to-day pressures of running a facility.
Whether you need to update your hiring procedures, strengthen your audit readiness, or build a compliance program from the ground up, we’ll help you make compliance a foundation for confidence and not fear.
