Texas 2017 - 85th Regular

Texas House Bill HB2766 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	85R21159 LED-F
2		-	By: Sheffield, Zerwas, Miller, White, et al. H.B. No. 2766
3		-	Substitute the following for H.B. No. 2766:
4		-	By: Rose C.S.H.B. No. 2766
	1	+	By: Sheffield, et al. (Senate Sponsor - Hinojosa) H.B. No. 2766
	2	+	(In the Senate - Received from the House May 12, 2017;
	3	+	May 18, 2017, read first time and referred to Committee on Health &
	4	+	Human Services; May 23, 2017, reported adversely, with favorable
	5	+	Committee Substitute by the following vote: Yeas 6, Nays 3;
	6	+	May 23, 2017, sent to printer.)
	7	+	Click here to see the committee vote
	8	+	COMMITTEE SUBSTITUTE FOR H.B. No. 2766 By: Schwertner
5	9
6	10
7	11		A BILL TO BE ENTITLED
8	12		AN ACT
9		-	relating to the creation and administration of a reinvestment
10		-	allowance for certain long-term care facilities.
	13	+	relating to the regulation of certain long-term care facilities.
11	14		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	15		SECTION 1. Chapter 242, Health and Safety Code, is amended
13	16		by adding Subchapter P to read as follows:
14	17		SUBCHAPTER P. REINVESTMENT ALLOWANCE
15	18		Sec. 242.701. DEFINITIONS. In this subchapter:
16	19		(1) "Gross receipts" means the gross inpatient revenue
17	20		received by a facility from services provided to facility
18	21		residents. Gross receipts exclude revenue from nonresident care,
19	22		including beauty and barber services, vending facilities,
20	23		interest, charitable contributions, the sale of meals, and
21	24		outpatient services.
22	25		(2) "Non-Medicare patient day" means a day on which
23	26		the primary payer for a facility resident is not Medicare Part A or
24	27		a Medicare Advantage or special needs plan.
25	28		Sec. 242.702. APPLICABILITY. This subchapter does not
26		-	apply to a state-owned veterans nursing facility.
	29	+	apply to:
	30	+	(1) a state-owned veterans nursing facility; or
	31	+	(2) a facility that provides on a single campus a
	32	+	combination of services, which may include independent living
	33	+	services, licensed assisted living services, or licensed nursing
	34	+	facility care services, and that either:
	35	+	(A) holds a certificate of authority to operate a
	36	+	continuing care retirement community under Chapter 246; or
	37	+	(B) had during the previous 12 months a combined
	38	+	number of patient days of service provided to independent living
	39	+	and assisted living residents, excluding services provided to
	40	+	persons occupying facility beds in a licensed nursing facility,
	41	+	that exceeded the number of patient days of service provided to
	42	+	nursing facility residents.
27	43		Sec. 242.703. REINVESTMENT ALLOWANCE; COMPUTATION. (a)
28	44		The commission shall impose a reinvestment allowance on each
29	45		facility licensed under this chapter. The reinvestment allowance
30	46		is:
31	47		(1) the product of the amount established under
32	48		Subsection (b) multiplied by the number of a facility's
33	49		non-Medicare patient days calculated under Section 242.704;
34	50		(2) payable monthly; and
35	51		(3) in addition to other amounts imposed under this
36	52		chapter.
37	53		(b) The executive commissioner shall establish for each
38	54		non-Medicare patient day an amount for use in calculating the
39	55		reinvestment allowance sufficient to produce annual revenues from
40	56		all facilities not to exceed the maximum amount that may be assessed
41	57		within the indirect guarantee threshold provided under 42 C.F.R.
42	58		Section 433.68(f)(3)(i).
43	59		(c) The commission shall determine the amount described by
44	60		Subsection (b) using non-Medicare patient days and gross receipts:
45	61		(1) reported to the commission; and
46	62		(2) covering a period of at least six months.
47	63		(d) A facility may not list the reinvestment allowance as a
48	64		separate charge on a resident's billing statement or otherwise
49	65		directly or indirectly attempt to charge the reinvestment allowance
50	66		to a resident.
51	67		Sec. 242.704. PATIENT DAYS. For each calendar day, a
52	68		facility shall determine the number of non-Medicare patient days by
53	69		adding:
54	70		(1) the number of non-Medicare residents occupying a
55	71		bed in the facility immediately before midnight of that day plus the
56	72		number of residents admitted that day, less the number of residents
57	73		discharged that day, except a resident is included in the count
58	74		under this subdivision if:
59	75		(A) the resident is admitted and discharged on
60	76		the same day; or
61	77		(B) the resident is discharged that day because
62	78		of the resident's death; and
63	79		(2) the number of beds that are on hold that day and
64	80		that have been placed on hold for a period not to exceed three
65	81		consecutive calendar days during which a resident is:
66	82		(A) in the hospital; or
67	83		(B) on therapeutic home leave.
68	84		Sec. 242.705. COLLECTION AND REPORTING. (a) The
69	85		commission shall collect the reinvestment allowance.
70	86		(b) Not later than the 25th day after the last day of a
71	87		month, each facility shall:
72	88		(1) file with the commission a report stating the
73	89		total non-Medicare patient days for the month; and
74	90		(2) pay the reinvestment allowance.
75	91		Sec. 242.706. RULES; ADMINISTRATIVE PENALTY. (a) The
76	92		executive commissioner shall adopt rules to administer this
77	93		subchapter, including rules related to imposing and collecting the
78	94		reinvestment allowance.
79	95		(b) Notwithstanding Section 242.066, an administrative
80	96		penalty assessed under that section for a violation of this
81	97		subchapter may not exceed the greater of:
82	98		(1) one-half of the amount of the facility's
83	99		outstanding reinvestment allowance; or
84	100		(2) $20,000.
85	101		(c) An administrative penalty assessed for a violation of
86	102		this subchapter is in addition to the facility's outstanding
87	103		reinvestment allowance.
88	104		Sec. 242.707. NURSING FACILITY REINVESTMENT ALLOWANCE
89	105		TRUST FUND. (a) The nursing facility reinvestment allowance trust
90	106		fund is established as a trust fund to be held by the comptroller
91	107		outside of the state treasury and administered by the commission as
92	108		trustee. Interest and income from the assets of the trust fund
93	109		shall be credited to and deposited in the trust fund. The commission
94	110		may use money in the fund only as provided by Section 242.708.
95	111		(b) The commission shall remit the reinvestment allowance
96	112		collected under this subchapter and federal matching funds received
97	113		by this state to the comptroller for deposit in the trust fund.
98	114		Sec. 242.708. REIMBURSEMENT OF FACILITIES. (a) The
99	115		commission may use money in the nursing facility reinvestment
100	116		allowance trust fund, including any federal matching funds, only
101	117		for the following purposes:
102	118		(1) paying any commission cost to develop and
103	119		administer systems for managing the reinvestment allowance;
104	120		(2) reimbursing the Medicaid share of the reinvestment
105	121		allowance as an allowable cost in the Medicaid daily rate; and
106	122		(3) increasing reimbursement rates paid under the
107	123		state Medicaid program to facilities.
108	124		(b) The commission shall allocate 50 percent of the money
109	125		described by Subsection (a)(3) for increased reimbursement rate
110	126		payments based on the total rating of the Centers for Medicare and
111	127		Medicaid Services five-star quality rating system.
112	128		(c) The commission shall devise a formula by which amounts
113	129		received under this subchapter increase the reimbursement rates
114	130		paid to facilities under the state Medicaid program, including a
115	131		phase-in of the program described by Subsection (b) beginning on
116	132		September 1, 2018. The commission must include in the formula
117	133		consideration of the total rating described by Subsection (b).
118	134		(d) Money in the nursing facility reinvestment allowance
119	135		trust fund may not be used to expand Medicaid eligibility under the
120	136		Patient Protection and Affordable Care Act (Pub. L. No. 111-148) as
121	137		amended by the Health Care and Education Reconciliation Act of 2010
122	138		(Pub. L. No. 111-152).
123	139		Sec. 242.709. INVALIDITY; FEDERAL FUNDS. If any provision
124	140		of or procedure under this subchapter is held invalid by a final
125	141		court order that is not subject to appeal, or if the commission
126	142		determines that the imposition of the reinvestment allowance and
127	143		the expenditure of amounts collected as prescribed by this
128	144		subchapter will not entitle the state to receive federal matching
129		-	funds under the Medicaid program, the commission shall:
	145	+	funds under the Medicaid program or will be inconsistent with the
	146	+	objectives described by Section 537.002(b)(7), Government Code,
	147	+	the commission shall:
130	148		(1) stop collection of the reinvestment allowance; and
131	149		(2) not later than the 30th day after the date
132	150		collection is stopped, return to each facility, in proportion to
133	151		the total amount paid by the facility, any money deposited to the
134	152		credit of the nursing facility reinvestment allowance trust fund
135	153		but not spent.
136	154		Sec. 242.710. AUTHORITY TO ACCOMPLISH PURPOSES OF
137	155		SUBCHAPTER. The executive commissioner by rule may adopt a
138	156		definition, a method of computation, or a rate that differs from
139	157		those expressly provided by or expressly authorized by this
140	158		subchapter to the extent the difference is necessary to accomplish
141	159		the purposes of this subchapter.
142	160		Sec. 242.711. ANNUAL REPORT. Not later than January 1 of
143	161		each year, the commission shall prepare and deliver to the
144	162		governor, the lieutenant governor, and the speaker of the house of
145	163		representatives a report relating to the status of the nursing
146	164		facility reinvestment allowance program, including fees collected,
147	165		federal funding applied for and received, quality-based payments
148	166		made, information on the overall quality of care in the Texas
149	167		nursing home system, whether quality-based payments are
150	168		contributing to quality improvements, and any other relevant
151	169		information necessary for assessing the effectiveness of the
152	170		nursing facility reinvestment allowance program. The report should
153	171		include any information associated with the role of the comptroller
154	172		and the Medicaid managed care participating plans. The report must
155	173		be posted on the commission's Internet website.
156	174		Sec. 242.712. PROGRAM EVALUATION. Not later than November
157	175		1, 2020, the commission shall prepare and deliver to the governor,
158	176		the lieutenant governor, and the speaker of the house of
159	177		representatives a report that assesses whether and to what degree
160	178		payments associated with quality-based care are resulting in
161	179		improvements to overall nursing home quality.
162	180		Sec. 242.713. EXPIRATION. This subchapter expires August
163	181		31, 2021.
164		-	SECTION 2. (a) As soon as practicable after the effective
	182	+	SECTION 2. (a) Sections 531.058(a) and (a-1), Government
	183	+	Code, are amended to read as follows:
	184	+	(a) The executive commissioner by rule shall establish an
	185	+	informal dispute resolution process in accordance with this
	186	+	section. The process must provide for adjudication by an
	187	+	appropriate disinterested person of disputes relating to a proposed
	188	+	enforcement action or related proceeding of the commission under
	189	+	Section 32.021(d), Human Resources Code, or the Department of Aging
	190	+	and Disability Services or its successor agency under Chapter 242,
	191	+	247, or 252, Health and Safety Code. The informal dispute
	192	+	resolution process must require:
	193	+	(1) an institution or facility to request informal
	194	+	dispute resolution not later than the 10th calendar day after
	195	+	notification by the commission or department, as applicable, of the
	196	+	violation of a standard or standards; and
	197	+	(2) the commission to complete the process not later
	198	+	than:
	199	+	(A) the 30th calendar day after receipt of a
	200	+	request from an institution or facility, other than an assisted
	201	+	living facility, for informal dispute resolution; or
	202	+	(B) the 90th calendar day after receipt of a
	203	+	request from an assisted living facility for informal dispute
	204	+	resolution.
	205	+	(a-1) As part of the informal dispute resolution process
	206	+	established under this section, the commission shall contract with
	207	+	an appropriate disinterested person [who is a nonprofit
	208	+	organization] to adjudicate disputes between an institution or
	209	+	facility licensed under Chapter 242 or 247, Health and Safety Code,
	210	+	and the Department of Aging and Disability Services or its
	211	+	successor agency concerning a statement of violations prepared by
	212	+	the department in connection with a survey conducted by the
	213	+	department of the institution or facility. Section 2009.053 does
	214	+	not apply to the selection of an appropriate disinterested person
	215	+	under this subsection. The person with whom the commission
	216	+	contracts shall adjudicate all disputes described by this
	217	+	subsection.
	218	+	(b) Subchapter B, Chapter 531, Government Code, is amended
	219	+	by adding Section 531.0585 to read as follows:
	220	+	Sec. 531.0585. ISSUANCE OF MATERIALS TO CERTAIN LONG-TERM
	221	+	CARE FACILITIES. The executive commissioner shall review the
	222	+	commission's methods for issuing informational letters, policy
	223	+	updates, policy clarifications, and other related materials to an
	224	+	entity licensed under Chapter 103, Human Resources Code, or Chapter
	225	+	242, 247, 248A, or 252, Health and Safety Code, and develop and
	226	+	implement more efficient methods to issue those materials as
	227	+	appropriate.
	228	+	(c) Section 242.066, Health and Safety Code, is amended by
	229	+	amending Subsections (a) and (e) and adding Subsection (i) to read
	230	+	as follows:
	231	+	(a) The commission [department] may assess an
	232	+	administrative penalty against a person who:
	233	+	(1) violates this chapter or a rule, standard, or
	234	+	order adopted or license issued under this chapter;
	235	+	(2) makes a false statement, that the person knows or
	236	+	should know is false, of a material fact:
	237	+	(A) on an application for issuance or renewal of
	238	+	a license or in an attachment to the application; or
	239	+	(B) with respect to a matter under investigation
	240	+	by the commission [department];
	241	+	(3) refuses to allow a representative of the
	242	+	commission [department] to inspect:
	243	+	(A) a book, record, or file required to be
	244	+	maintained by an institution; or
	245	+	(B) any portion of the premises of an
	246	+	institution;
	247	+	(4) wilfully interferes with the work of a
	248	+	representative of the commission [department] or the enforcement of
	249	+	this chapter;
	250	+	(5) wilfully interferes with a representative of the
	251	+	commission [department] preserving evidence of a violation of this
	252	+	chapter or a rule, standard, or order adopted or license issued
	253	+	under this chapter;
	254	+	(6) fails to pay a penalty assessed by the commission
	255	+	[department] under this chapter not later than the 10th day after
	256	+	the date the assessment of the penalty becomes final; or
	257	+	(7) fails to notify the commission [department] of a
	258	+	change of ownership before the effective date of the change of
	259	+	ownership.
	260	+	(e) In determining the amount of a penalty, the commission
	261	+	[department] shall consider any matter that justice may require,
	262	+	including:
	263	+	(1) the gradations of penalties established under
	264	+	Subsection (d);
	265	+	(2) the seriousness of the violation, including the
	266	+	nature, circumstances, extent, and gravity of the prohibited act
	267	+	and the hazard or potential hazard created by the act to the health
	268	+	or safety of the public;
	269	+	(3) the history of previous violations;
	270	+	(4) deterrence of future violations; and
	271	+	(5) efforts to correct the violation.
	272	+	(i) The commission shall develop and use a system to record
	273	+	and track the scope and severity of each violation of this chapter
	274	+	or a rule, standard, or order adopted under this chapter for the
	275	+	purpose of assessing an administrative penalty for the violation or
	276	+	taking some other enforcement action against the appropriate
	277	+	institution to deter future violations. The system:
	278	+	(1) must be comparable to the system used by the
	279	+	Centers for Medicare and Medicaid Services to categorize the scope
	280	+	and severity of violations for nursing homes; and
	281	+	(2) may be modified, as appropriate, to reflect
	282	+	changes in industry practice or changes made to the system used by
	283	+	the Centers for Medicare and Medicaid Services.
	284	+	(d) Section 242.0665, Health and Safety Code, is amended to
	285	+	read as follows:
	286	+	Sec. 242.0665. RIGHT TO CORRECT. (a) The commission
	287	+	[department] may not collect an administrative penalty against an
	288	+	institution under this subchapter if, not later than the 45th day
	289	+	after the date the institution receives notice under Section
	290	+	242.067(c), the institution corrects the violation.
	291	+	(b) Subsection (a) does not apply:
	292	+	(1) to a violation that the commission [department]
	293	+	determines:
	294	+	(A) represents a pattern of violation that
	295	+	results in actual [serious] harm [to or death of a resident];
	296	+	(B) is widespread in scope and results in actual
	297	+	harm;
	298	+	(C) is widespread in scope, constitutes a
	299	+	potential for actual harm, and relates to:
	300	+	(i) residents' rights;
	301	+	(ii) treatment of residents;
	302	+	(iii) resident behavior and institution
	303	+	practices;
	304	+	(iv) quality of care;
	305	+	(v) medication errors;
	306	+	(vi) standard menus and nutritional
	307	+	adequacy;
	308	+	(vii) physician visits;
	309	+	(viii) infection control;
	310	+	(ix) life safety from fire; or
	311	+	(x) emergency preparedness and response;
	312	+	(D) [(B)] constitutes an immediate [a serious]
	313	+	threat to the health or safety of a resident; or
	314	+	(E) [(C)] substantially limits the institution's
	315	+	capacity to provide care;
	316	+	(2) to a violation described by Sections
	317	+	242.066(a)(2)-(7);
	318	+	(3) to a violation of Section 260A.014 or 260A.015; or
	319	+	(4) to a violation of a right of a resident adopted
	320	+	under Subchapter L.
	321	+	(c) An institution that corrects a violation under
	322	+	Subsection (a) must maintain the correction. If the institution
	323	+	fails to maintain the correction until at least the first
	324	+	anniversary of the date the correction was made, the commission
	325	+	[department] may assess an administrative penalty under this
	326	+	subchapter for the subsequent violation. A penalty assessed under
	327	+	this subsection shall be equal to three times the amount of the
	328	+	penalty assessed but not collected under Subsection (a). The
	329	+	commission [department] is not required to provide the institution
	330	+	an opportunity to correct the subsequent violation under this
	331	+	section.
	332	+	(d) In this section:
	333	+	(1) "Actual harm" means a negative outcome that
	334	+	compromises a resident's physical, mental, or emotional
	335	+	well-being.
	336	+	(2) "Immediate threat to the health or safety of a
	337	+	resident" means a situation that causes, or is likely to cause,
	338	+	serious injury, harm, or impairment to or the death of a resident.
	339	+	(3) "Pattern of violation" means repeated, but not
	340	+	pervasive, failures of an institution to comply with this chapter
	341	+	or a rule, standard, or order adopted under this chapter that:
	342	+	(A) result in a violation; and
	343	+	(B) are found throughout the services provided by
	344	+	the institution or that affect or involve the same residents or
	345	+	institution employees.
	346	+	(4) "Widespread in scope" means a violation of this
	347	+	chapter or a rule, standard, or order adopted under this chapter
	348	+	that:
	349	+	(A) is pervasive throughout the services
	350	+	provided by the institution; or
	351	+	(B) represents a systemic failure by the
	352	+	institution that affects or has the potential to affect a large
	353	+	portion of or all of the residents of the institution.
	354	+	(e) Section 247.023, Health and Safety Code, is amended to
	355	+	read as follows:
	356	+	Sec. 247.023. ISSUANCE AND RENEWAL OF LICENSE. (a) The
	357	+	commission [department] shall issue a license if, after inspection
	358	+	and investigation, it finds that the applicant, the assisted living
	359	+	facility, and all controlling persons with respect to the applicant
	360	+	or facility meet the requirements of this chapter and the standards
	361	+	adopted under this chapter. The license expires on the third
	362	+	[second] anniversary of the date of its issuance. The executive
	363	+	commissioner by rule shall [may] adopt a system under which
	364	+	licenses expire on staggered [various] dates during each [the]
	365	+	three-year [two-year] period. The commission shall prorate the
	366	+	license fee as appropriate if the expiration date of a license
	367	+	changes as a result of this subsection [For the year in which a
	368	+	license expiration date is changed, the department shall prorate
	369	+	the license fee on a monthly basis. Each license holder shall pay
	370	+	only that portion of the license fee allocable to the number of
	371	+	months during which the license is valid. A license holder shall
	372	+	pay the total license renewal fee at the time of renewal].
	373	+	(b) To renew a license, the license holder must submit to
	374	+	the commission [department] the license renewal fee.
	375	+	(c) The commission [department] may require participation
	376	+	in a continuing education program as a condition of renewal of a
	377	+	license. The executive commissioner shall adopt rules to implement
	378	+	this subsection.
	379	+	(f) Sections 247.024(a), (d), and (e), Health and Safety
	380	+	Code, are amended to read as follows:
	381	+	(a) The executive commissioner by rule shall set license
	382	+	fees imposed by this chapter:
	383	+	(1) on the basis of the number of beds in assisted
	384	+	living facilities required to pay the fee; and
	385	+	(2) in amounts reasonable and necessary to defray the
	386	+	cost of administering this chapter, but not to exceed $2,250
	387	+	[$1,500].
	388	+	(d) Investigation fees or attorney's fees may not be
	389	+	assessed against or collected from an assisted living facility by
	390	+	or on behalf of the commission [department] or another state agency
	391	+	unless the commission [department] or other state agency assesses
	392	+	and collects a penalty authorized by this chapter from the
	393	+	facility.
	394	+	(e) An applicant who submits a license renewal later than
	395	+	the 45th day before the expiration date of a current license is
	396	+	subject to a late fee in accordance with commission [department]
	397	+	rules.
	398	+	(g) Section 247.027, Health and Safety Code, is amended to
	399	+	read as follows:
	400	+	Sec. 247.027. INSPECTIONS. (a) In addition to the
	401	+	inspection required under Section 247.023(a), the commission:
	402	+	(1) shall [department may] inspect each [an] assisted
	403	+	living facility at least every two years following the initial
	404	+	inspection required under Section 247.023(a); [annually] and
	405	+	(2) may inspect a facility at other reasonable times
	406	+	as necessary to assure compliance with this chapter.
	407	+	(b) The commission [department] shall establish an
	408	+	inspection checklist based on the minimum standards that describes
	409	+	the matters subject to inspection. The commission [department]
	410	+	shall use the inspection checklist in conducting inspections under
	411	+	this section and Section 247.023(a).
	412	+	(h) Section 247.0451, Health and Safety Code, is amended by
	413	+	amending Subsections (a), (b), (d), and (f) and adding Subsections
	414	+	(g) and (h) to read as follows:
	415	+	(a) The commission [department] may assess an
	416	+	administrative penalty against a person who:
	417	+	(1) violates this chapter or a rule, standard, or
	418	+	order adopted under this chapter or a term of a license issued under
	419	+	this chapter;
	420	+	(2) makes a false statement, that the person knows or
	421	+	should know is false, of a material fact:
	422	+	(A) on an application for issuance or renewal of
	423	+	a license or in an attachment to the application; or
	424	+	(B) with respect to a matter under investigation
	425	+	by the commission [department];
	426	+	(3) refuses to allow a representative of the
	427	+	commission [department] to inspect:
	428	+	(A) a book, record, or file required to be
	429	+	maintained by an assisted living facility; or
	430	+	(B) any portion of the premises of an assisted
	431	+	living facility;
	432	+	(4) wilfully interferes with the work of a
	433	+	representative of the commission [department] or the enforcement of
	434	+	this chapter;
	435	+	(5) wilfully interferes with a representative of the
	436	+	commission [department] preserving evidence of a violation of this
	437	+	chapter or a rule, standard, or order adopted under this chapter or
	438	+	a term of a license issued under this chapter;
	439	+	(6) fails to pay a penalty assessed under this chapter
	440	+	not later than the 30th day after the date the assessment of the
	441	+	penalty becomes final; or
	442	+	(7) fails to notify the commission [department] of a
	443	+	change of ownership before the effective date of the change of
	444	+	ownership.
	445	+	(b) Except as provided by Section 247.0452(c), the penalty
	446	+	may not exceed:
	447	+	(1) $5,000 for each violation that:
	448	+	(A) represents a pattern of violation that
	449	+	results in actual harm or is widespread in scope and results in
	450	+	actual harm; or
	451	+	(B) constitutes an immediate threat to the health
	452	+	or safety of a resident; or
	453	+	(2) $1,000 for each other violation.
	454	+	(d) In determining the amount of a penalty, the commission
	455	+	[department] shall consider any matter that justice may require,
	456	+	but must consider each of the following and make a record of the
	457	+	extent to which each of the following was considered:
	458	+	(1) the gradations of penalties established under
	459	+	Subsection (c);
	460	+	(2) the seriousness of the violation, including the
	461	+	nature, circumstances, extent, and gravity of the prohibited act
	462	+	and the hazard or potential hazard created by the act to the health
	463	+	or safety of the public;
	464	+	(3) the history of previous violations;
	465	+	(4) deterrence of future violations;
	466	+	(5) efforts to correct the violation; and
	467	+	(6) the size of the facility and of the business entity
	468	+	that owns the facility.
	469	+	(f) The commission [department] may not assess a penalty
	470	+	under this section against a resident of an assisted living
	471	+	facility unless the resident is also an employee of the facility or
	472	+	a controlling person.
	473	+	(g) The commission shall develop and use a system to record
	474	+	and track the scope and severity of each violation of this chapter
	475	+	or a rule, standard, or order adopted under this chapter for the
	476	+	purpose of assessing an administrative penalty for the violation or
	477	+	taking some other enforcement action against the appropriate
	478	+	assisted living facility to deter future violations. The system:
	479	+	(1) must be comparable to the system used by the
	480	+	Centers for Medicare and Medicaid Services to categorize the scope
	481	+	and severity of violations for nursing homes; and
	482	+	(2) may be modified, as appropriate, to reflect
	483	+	changes in industry practice or changes made to the system used by
	484	+	the Centers for Medicare and Medicaid Services.
	485	+	(h) In this section, "actual harm," "immediate threat to the
	486	+	health or safety of a resident," "pattern of violation," and
	487	+	"widespread in scope" have the meanings assigned by Section
	488	+	247.0452.
	489	+	(i) Section 247.0452, Health and Safety Code, is amended to
	490	+	read as follows:
	491	+	Sec. 247.0452. RIGHT TO CORRECT. (a) The commission
	492	+	[department] may not collect an administrative penalty from an
	493	+	assisted living facility under Section 247.0451 if, not later than
	494	+	the 45th day after the date the facility receives notice under
	495	+	Section 247.0453(c), the facility corrects the violation.
	496	+	(b) Subsection (a) does not apply:
	497	+	(1) to a violation that the commission [department]
	498	+	determines represents a pattern of violation that results in actual
	499	+	[serious] harm [to or death of a resident];
	500	+	(2) to a violation that the commission determines is
	501	+	widespread in scope and results in actual harm;
	502	+	(3) to a violation that the commission determines is
	503	+	widespread in scope, constitutes a potential for actual harm, and
	504	+	relates to:
	505	+	(A) resident assessment;
	506	+	(B) staffing, including staff training;
	507	+	(C) administration of medication;
	508	+	(D) infection control;
	509	+	(E) restraints; or
	510	+	(F) emergency preparedness and response;
	511	+	(4) to a violation that the commission determines
	512	+	constitutes an immediate threat to the health or safety of a
	513	+	resident;
	514	+	(5) [(2)] to a violation described by Sections
	515	+	247.0451(a)(2)-(7) or a violation of Section 260A.014 or 260A.015;
	516	+	(6) [(3)] to a second or subsequent violation of:
	517	+	(A) a right of the same resident under Section
	518	+	247.064; or
	519	+	(B) the same right of all residents under Section
	520	+	247.064; or
	521	+	(7) [(4)] to a violation described by Section 247.066,
	522	+	which contains its own right to correct provisions.
	523	+	(c) An assisted living facility that corrects a violation
	524	+	must maintain the correction. If the facility fails to maintain the
	525	+	correction until at least the first anniversary of the date the
	526	+	correction was made, the commission [department] may assess and
	527	+	collect an administrative penalty for the subsequent violation. An
	528	+	administrative penalty assessed under this subsection is equal to
	529	+	three times the amount of the original penalty assessed but not
	530	+	collected. The commission [department] is not required to provide
	531	+	the facility with an opportunity under this section to correct the
	532	+	subsequent violation.
	533	+	(d) In this section:
	534	+	(1) "Actual harm" means a negative outcome that
	535	+	compromises a resident's physical, mental, or emotional
	536	+	well-being.
	537	+	(2) "Immediate threat to the health or safety of a
	538	+	resident" means a situation that causes, or is likely to cause,
	539	+	serious injury, harm, or impairment to or the death of a resident.
	540	+	(3) "Pattern of violation" means repeated, but not
	541	+	pervasive, failures of an assisted living facility to comply with
	542	+	this chapter or a rule, standard, or order adopted under this
	543	+	chapter that:
	544	+	(A) result in a violation; and
	545	+	(B) are found throughout the services provided by
	546	+	the facility or that affect or involve the same residents or
	547	+	facility employees.
	548	+	(4) "Widespread in scope" means a violation of this
	549	+	chapter or a rule, standard, or order adopted under this chapter
	550	+	that:
	551	+	(A) is pervasive throughout the services
	552	+	provided by the assisted living facility; or
	553	+	(B) represents a systemic failure by the assisted
	554	+	living facility that affects or has the potential to affect a large
	555	+	portion of or all of the residents of the facility.
	556	+	(j) Section 248A.053, Health and Safety Code, is amended to
	557	+	read as follows:
	558	+	Sec. 248A.053. INITIAL OR RENEWAL LICENSE TERM; RENEWAL;
	559	+	NOTIFICATION. (a) An initial or renewal license issued under this
	560	+	chapter expires on the third [second] anniversary of the date of
	561	+	issuance. The executive commissioner by rule shall adopt a system
	562	+	under which licenses expire on staggered dates during each
	563	+	three-year period. The commission shall prorate the license fee as
	564	+	appropriate if the expiration date of a license changes as a result
	565	+	of this subsection.
	566	+	(b) A person applying to renew a center license shall:
	567	+	(1) submit a renewal application to the commission
	568	+	[department] on a [the form] prescribed form [by the department] at
	569	+	least 60 days but not more than 120 days before expiration of the
	570	+	license;
	571	+	(2) submit the renewal fee in the amount required by
	572	+	agency [department] rule; and
	573	+	(3) comply with any other requirements specified by
	574	+	agency [department] rule.
	575	+	(c) The commission [department] shall assess a $50 per day
	576	+	late fee to a license holder who submits a renewal application after
	577	+	the date required by Subsection (b)(1), except that the total
	578	+	amount of a late fee may not exceed the lesser of 50 percent of the
	579	+	license renewal fee or $500.
	580	+	(d) At least 120 days before expiration of a center license,
	581	+	the commission [department] shall notify the owner or operator of
	582	+	the center of the license expiration.
	583	+	(k) Subchapter F, Chapter 248A, Health and Safety Code, is
	584	+	amended by adding Section 248A.2515 to read as follows:
	585	+	Sec. 248A.2515. SYSTEM FOR ASSESSMENT OF PENALTY. The
	586	+	commission shall develop and use a system to record and track the
	587	+	scope and severity of each violation of this chapter or a rule or
	588	+	standard adopted or order issued under this chapter for the purpose
	589	+	of assessing an administrative penalty for the violation or taking
	590	+	some other enforcement action against the appropriate center to
	591	+	deter future violations. The system:
	592	+	(1) must be comparable to the system used by the
	593	+	Centers for Medicare and Medicaid Services to categorize the scope
	594	+	and severity of violations for nursing homes; and
	595	+	(2) may be modified, as appropriate, to reflect
	596	+	changes in industry practice or changes made to the system used by
	597	+	the Centers for Medicare and Medicaid Services.
	598	+	(l) Sections 252.033(a), (b), (d), (f), and (h), Health and
	599	+	Safety Code, are amended to read as follows:
	600	+	(a) After receiving the application, the commission
	601	+	[department] shall issue a license if, after inspection and
	602	+	investigation, it finds that the applicant and facility meet the
	603	+	requirements established under this chapter.
	604	+	(b) The commission [department] may issue a license only
	605	+	for:
	606	+	(1) the premises and persons or governmental unit
	607	+	named in the application; and
	608	+	(2) the maximum number of beds specified in the
	609	+	application.
	610	+	(d) A license is renewable on the third [second] anniversary
	611	+	of issuance or renewal of the license after:
	612	+	(1) an inspection;
	613	+	(2) filing and approval of a renewal report; and
	614	+	(3) payment of the renewal fee.
	615	+	(f) The commission [department] may not issue a license for
	616	+	new beds or an expansion of an existing facility under this chapter
	617	+	unless the addition of new beds or the expansion is included in the
	618	+	plan approved by the commission in accordance with Section
	619	+	533A.062.
	620	+	(h) The executive commissioner by rule shall:
	621	+	(1) define specific, appropriate, and objective
	622	+	criteria on which the commission [department] may deny an initial
	623	+	license application or license renewal or revoke a license; and
	624	+	(2) adopt a system under which:
	625	+	(A) licenses expire on staggered dates during
	626	+	each three-year period; and
	627	+	(B) the commission prorates the license fee as
	628	+	appropriate if the expiration date of a license changes as a result
	629	+	of the system adopted under Paragraph (A).
	630	+	(m) Sections 252.034(a), (e), and (f), Health and Safety
	631	+	Code, are amended to read as follows:
	632	+	(a) The executive commissioner by rule may adopt a fee for a
	633	+	license issued under this chapter. The fee may not exceed $225
	634	+	[$150] plus $7.50 [$5] for each unit of capacity or bed space for
	635	+	which the license is sought.
	636	+	(e) All license fees collected under this section shall be
	637	+	deposited in the state treasury to the credit of the commission
	638	+	[department] and may be appropriated to the commission [department]
	639	+	to administer and enforce this chapter.
	640	+	(f) An applicant who submits an application for license
	641	+	renewal later than the 45th day before the expiration date of a
	642	+	current license is subject to a late fee in accordance with
	643	+	commission [department] rules.
	644	+	(n) Section 252.041, Health and Safety Code, is amended to
	645	+	read as follows:
	646	+	Sec. 252.041. UNANNOUNCED INSPECTIONS. (a) Each
	647	+	licensing period, the commission [department] shall conduct at
	648	+	least three [two] unannounced inspections of each facility.
	649	+	(b) In order to ensure continuous compliance, the
	650	+	commission [department] shall randomly select a sufficient
	651	+	percentage of facilities for unannounced inspections to be
	652	+	conducted between 5 p.m. and 8 a.m. Those inspections must be
	653	+	cursory to avoid to the greatest extent feasible any disruption of
	654	+	the residents.
	655	+	(c) The commission [department] may require additional
	656	+	inspections.
	657	+	(d) As considered appropriate and necessary by the
	658	+	commission [department], the commission [department] may invite at
	659	+	least one person as a citizen advocate to participate in
	660	+	inspections. The invited advocate must be an individual who has an
	661	+	interest in or who is employed by or affiliated with an organization
	662	+	or entity that represents, advocates for, or serves individuals
	663	+	with an intellectual disability or a related condition.
	664	+	(o) Section 252.065, Health and Safety Code, is amended by
	665	+	amending Subsections (a), (b), (e), (f), (i), and (j) and adding
	666	+	Subsections (l) and (m) to read as follows:
	667	+	(a) The commission [department] may assess an
	668	+	administrative penalty against a person who:
	669	+	(1) violates this chapter or a rule, standard, or
	670	+	order adopted or license issued under this chapter;
	671	+	(2) makes a false statement, that the person knows or
	672	+	should know is false, of a material fact:
	673	+	(A) on an application for issuance or renewal of
	674	+	a license or in an attachment to the application; or
	675	+	(B) with respect to a matter under investigation
	676	+	by the commission [department];
	677	+	(3) refuses to allow a representative of the
	678	+	commission [department] to inspect:
	679	+	(A) a book, record, or file required to be
	680	+	maintained by the institution; or
	681	+	(B) any portion of the premises of an
	682	+	institution;
	683	+	(4) wilfully interferes with the work of a
	684	+	representative of the commission [department] or the enforcement of
	685	+	this chapter;
	686	+	(5) wilfully interferes with a representative of the
	687	+	commission [department] preserving evidence of a violation of this
	688	+	chapter or a rule, standard, or order adopted or license issued
	689	+	under this chapter;
	690	+	(6) fails to pay a penalty assessed by the commission
	691	+	[department] under this chapter not later than the 10th day after
	692	+	the date the assessment of the penalty becomes final;
	693	+	(7) fails to submit a plan of correction within 10 days
	694	+	after receiving a statement of licensing violations; or
	695	+	(8) fails to notify the commission [department] of a
	696	+	change in ownership before the effective date of that change of
	697	+	ownership.
	698	+	(b) The penalty for a facility with fewer than 60 beds shall
	699	+	be not less than $100 or more than $1,000 for each violation. The
	700	+	penalty for a facility with 60 beds or more shall be not less than
	701	+	$100 or more than $5,000 for each violation. [The total amount of
	702	+	the penalty assessed for a violation continuing or occurring on
	703	+	separate days under this subsection may not exceed $5,000 for a
	704	+	facility with fewer than 60 beds or $25,000 for a facility with 60
	705	+	beds or more.] Each day a violation occurs or continues is a
	706	+	separate violation for purposes of imposing a penalty.
	707	+	(e) The executive commissioner by rule shall provide the
	708	+	facility with a reasonable period of time, not less than 45 days,
	709	+	following the first day of a violation to correct the violation
	710	+	before the commission [department] may assess an administrative
	711	+	penalty if a plan of correction has been implemented. This
	712	+	subsection does not apply to a violation described by Subsections
	713	+	(a)(2)-(8) or to a violation that the commission [department]
	714	+	determines:
	715	+	(1) represents a pattern of violation that results
	716	+	[has resulted] in actual [serious] harm [to or the death of a
	717	+	resident];
	718	+	(2) is widespread in scope and results in actual harm;
	719	+	(3) is widespread in scope, constitutes a potential
	720	+	for actual harm, and relates to:
	721	+	(A) staff treatment of a resident;
	722	+	(B) active treatment;
	723	+	(C) client behavior and facility practices;
	724	+	(D) health care services;
	725	+	(E) drug administration;
	726	+	(F) infection control;
	727	+	(G) food and nutrition services; or
	728	+	(H) emergency preparedness and response;
	729	+	(4) [(2)] constitutes an immediate [a serious] threat
	730	+	to the health or safety of a resident; or
	731	+	(5) [(3)] substantially limits the facility's
	732	+	[institution's] capacity to provide care.
	733	+	(f) The commission [department] may not assess an
	734	+	administrative penalty for a minor violation if the person corrects
	735	+	the violation not later than the 46th day after the date the person
	736	+	receives notice of the violation.
	737	+	(i) The commission [department] may not assess an
	738	+	administrative penalty against a state agency.
	739	+	(j) Notwithstanding any other provision of this section, an
	740	+	administrative penalty ceases to be incurred on the date a
	741	+	violation is corrected. The administrative penalty ceases to be
	742	+	incurred only if the facility:
	743	+	(1) notifies the commission [department] in writing of
	744	+	the correction of the violation and of the date the violation was
	745	+	corrected; and
	746	+	(2) shows later that the violation was corrected.
	747	+	(l) The commission shall develop and use a system to record
	748	+	and track the scope and severity of each violation of this chapter
	749	+	or a rule, standard, or order adopted under this chapter for the
	750	+	purpose of assessing an administrative penalty for the violation or
	751	+	taking some other enforcement action against the appropriate
	752	+	facility to deter future violations. The system:
	753	+	(1) must be comparable to the system used by the
	754	+	Centers for Medicare and Medicaid Services to categorize the scope
	755	+	and severity of violations for nursing homes; and
	756	+	(2) may be modified, as appropriate, to reflect
	757	+	changes in industry practice or changes made to the system used by
	758	+	the Centers for Medicare and Medicaid Services.
	759	+	(m) In this section:
	760	+	(1) "Actual harm" means a negative outcome that
	761	+	compromises a resident's physical, mental, or emotional
	762	+	well-being.
	763	+	(2) "Immediate threat to the health or safety of a
	764	+	resident" means a situation that causes, or is likely to cause,
	765	+	serious injury, harm, or impairment to or the death of a resident.
	766	+	(3) "Pattern of violation" means repeated, but not
	767	+	pervasive, failures of a facility to comply with this chapter or a
	768	+	rule, standard, or order adopted under this chapter that:
	769	+	(A) result in a violation; and
	770	+	(B) are found throughout the services provided by
	771	+	the facility or that affect or involve the same residents or
	772	+	facility employees.
	773	+	(4) "Widespread in scope" means a violation of this
	774	+	chapter or a rule, standard, or order adopted under this chapter
	775	+	that:
	776	+	(A) is pervasive throughout the services
	777	+	provided by the facility; or
	778	+	(B) affects or has the potential to affect a
	779	+	large portion of or all of the residents of the facility.
	780	+	(p) Section 103.003, Human Resources Code, is amended by
	781	+	amending Subdivision (1) and adding Subdivisions (1-a) and (4-b) to
	782	+	read as follows:
	783	+	(1) "Commission" means the Health and Human Services
	784	+	Commission.
	785	+	(1-a) "Day activity and health services facility"
	786	+	means a facility that provides services under a day activity and
	787	+	health services program on a daily or regular basis but not
	788	+	overnight to four or more elderly persons or persons with
	789	+	disabilities who are not related by blood, marriage, or adoption to
	790	+	the owner of the facility.
	791	+	(4-b) "Facility" means a day activity and health
	792	+	services facility.
	793	+	(q) Sections 103.006(a) and (b), Human Resources Code, are
	794	+	amended to read as follows:
	795	+	(a) The commission [department] shall issue a license to
	796	+	operate a day activity and health services facility to a person who
	797	+	has met the application requirements and received approval after an
	798	+	on-site inspection.
	799	+	(b) The license expires three [two] years from the date of
	800	+	its issuance. The executive commissioner by rule shall [may] adopt
	801	+	a system under which licenses expire on staggered [various] dates
	802	+	during the three-year [two-year] period. The commission shall
	803	+	prorate the license fee as appropriate if the expiration date of a
	804	+	license changes as a result of this subsection [For the year in
	805	+	which a license expiration date is changed, the department shall
	806	+	prorate the license fee on a monthly basis. Each license holder
	807	+	shall pay only that portion of the license fee allocable to the
	808	+	number of months for which the license is valid. A license holder
	809	+	shall pay the total license renewal fee at the time of renewal].
	810	+	(r) Section 103.007, Human Resources Code, is amended to
	811	+	read as follows:
	812	+	Sec. 103.007. LICENSE APPLICATION. (a) An applicant for a
	813	+	license to operate a day activity and health services facility must
	814	+	file an application on a form prescribed by the commission
	815	+	[department] together with a license fee of $75 [$50].
	816	+	(b) The applicant must provide evidence of:
	817	+	(1) the ability to comply with the requirements of the
	818	+	commission [department];
	819	+	(2) responsible management; and
	820	+	(3) qualified professional staff and personnel.
	821	+	(c) A person who operates a facility that is licensed under
	822	+	this chapter must file an application for a renewal license not
	823	+	later than the 45th day before the expiration date of the current
	824	+	license on a form prescribed by the commission [department]
	825	+	together with a renewal fee of $50.
	826	+	(d) An applicant for a license renewal who submits an
	827	+	application later than the 45th day before the expiration date of
	828	+	the license is subject to a late fee in accordance with commission
	829	+	[department] rules.
	830	+	(s) Section 103.008, Human Resources Code, is amended to
	831	+	read as follows:
	832	+	Sec. 103.008. INSPECTIONS. (a) In addition to the
	833	+	inspection required under Section 103.006(a), the commission:
	834	+	(1) shall inspect each facility every two years
	835	+	following the initial inspection required under Section
	836	+	103.006(a); and
	837	+	(2) [The department] may inspect [enter the premises
	838	+	of] a facility at other reasonable times as [and make an inspection]
	839	+	necessary to ensure compliance with this chapter [issue a license
	840	+	or renew a license].
	841	+	(b) Any person may request an inspection of a facility by
	842	+	notifying the commission [department] in writing of an alleged
	843	+	violation of a licensing requirement. The complaint shall be as
	844	+	detailed as possible and signed by the complainant. The commission
	845	+	[department] shall perform an on-site inspection as soon as
	846	+	feasible but no later than 30 days after receiving the complaint
	847	+	unless after an investigation the complaint is found to be
	848	+	frivolous. The commission [department] shall respond to a
	849	+	complainant in writing. The commission [department] shall also
	850	+	receive and investigate anonymous complaints.
	851	+	(t) Section 103.012, Human Resources Code, is amended by
	852	+	amending Subsections (a) and (e) and adding Subsection (g) to read
	853	+	as follows:
	854	+	(a) The commission [department] may assess an
	855	+	administrative penalty against a person who:
	856	+	(1) violates this chapter, a rule, standard, or order
	857	+	adopted under this chapter, or a term of a license issued under this
	858	+	chapter;
	859	+	(2) makes a false statement of a material fact that the
	860	+	person knows or should know is false:
	861	+	(A) on an application for issuance or renewal of
	862	+	a license or in an attachment to the application; or
	863	+	(B) with respect to a matter under investigation
	864	+	by the commission [department];
	865	+	(3) refuses to allow a representative of the
	866	+	commission [department] to inspect:
	867	+	(A) a book, record, or file required to be
	868	+	maintained by a day activity and health services facility; or
	869	+	(B) any portion of the premises of a day activity
	870	+	and health services facility;
	871	+	(4) wilfully interferes with the work of a
	872	+	representative of the commission [department] or the enforcement of
	873	+	this chapter;
	874	+	(5) wilfully interferes with a representative of the
	875	+	commission [department] preserving evidence of a violation of this
	876	+	chapter, a rule, standard, or order adopted under this chapter, or a
	877	+	term of a license issued under this chapter;
	878	+	(6) fails to pay a penalty assessed under this chapter
	879	+	not later than the 30th day after the date the assessment of the
	880	+	penalty becomes final; or
	881	+	(7) fails to notify the commission [department] of a
	882	+	change of ownership before the effective date of the change of
	883	+	ownership.
	884	+	(e) In determining the amount of a penalty, the commission
	885	+	[department] shall consider any matter that justice may require,
	886	+	including:
	887	+	(1) the gradations of penalties established under
	888	+	Subsection (d);
	889	+	(2) the seriousness of the violation, including the
	890	+	nature, circumstances, extent, and gravity of the prohibited act
	891	+	and the hazard or potential hazard created by the act to the health
	892	+	or safety of the public;
	893	+	(3) the history of previous violations;
	894	+	(4) the deterrence of future violations; and
	895	+	(5) the efforts to correct the violation.
	896	+	(g) The commission shall develop and use a system to record
	897	+	and track the scope and severity of each violation of this chapter
	898	+	or a rule, standard, or order adopted under this chapter for the
	899	+	purpose of assessing an administrative penalty for the violation or
	900	+	taking some other enforcement action against the appropriate
	901	+	facility to deter future violations. The system:
	902	+	(1) must be comparable to the system used by the
	903	+	Centers for Medicare and Medicaid Services to categorize the scope
	904	+	and severity of violations for nursing homes; and
	905	+	(2) may be modified, as appropriate, to reflect
	906	+	changes in industry practice or changes made to the system used by
	907	+	the Centers for Medicare and Medicaid Services.
	908	+	(u) Section 103.013, Human Resources Code, is amended to
	909	+	read as follows:
	910	+	Sec. 103.013. RIGHT TO CORRECT BEFORE IMPOSITION OF
	911	+	ADMINISTRATIVE PENALTY. (a) The commission [department] may not
	912	+	collect an administrative penalty from a day activity and health
	913	+	services facility under Section 103.012 if, not later than the 45th
	914	+	day after the date the facility receives notice under Section
	915	+	103.014(c), the facility corrects the violation.
	916	+	(b) Subsection (a) does not apply to:
	917	+	(1) a violation that the commission [department]
	918	+	determines:
	919	+	(A) represents a pattern of violation that
	920	+	results in actual [serious] harm [to or death of a person attending
	921	+	the facility];
	922	+	(B) is widespread in scope and results in actual
	923	+	harm;
	924	+	(C) is widespread in scope, constitutes a
	925	+	potential for actual harm, and relates to:
	926	+	(i) staffing, including staff training,
	927	+	ratio, and health;
	928	+	(ii) administration of medication; or
	929	+	(iii) emergency preparedness and response;
	930	+	(D) [(B)] constitutes an immediate [a serious]
	931	+	threat to the health or [and] safety of an elderly person or a
	932	+	person with a disability receiving services at a [a person
	933	+	attending the] facility; or
	934	+	(E) [(C)] substantially limits the facility's
	935	+	capacity to provide care;
	936	+	(2) a violation described by Sections
	937	+	103.012(a)(2)-(7); or
	938	+	(3) a violation of Section 103.011.
	939	+	(c) A day activity and health services facility that
	940	+	corrects a violation must maintain the correction. If the facility
	941	+	fails to maintain the correction until at least the first
	942	+	anniversary after the date the correction was made, the commission
	943	+	[department] may assess and collect an administrative penalty for
	944	+	the subsequent violation. An administrative penalty assessed under
	945	+	this subsection is equal to three times the amount of the original
	946	+	penalty assessed but not collected. The commission [department] is
	947	+	not required to provide the facility with an opportunity under this
	948	+	section to correct the subsequent violation.
	949	+	(d) In this section:
	950	+	(1) "Actual harm" means a negative outcome that
	951	+	compromises the physical, mental, or emotional well-being of an
	952	+	elderly person or a person with a disability receiving services at a
	953	+	facility.
	954	+	(2) "Immediate threat to the health or safety of an
	955	+	elderly person or a person with a disability" means a situation that
	956	+	causes, or is likely to cause, serious injury, harm, or impairment
	957	+	to or the death of an elderly person or a person with a disability
	958	+	receiving services at a facility.
	959	+	(3) "Pattern of violation" means repeated, but not
	960	+	pervasive, failures of a facility to comply with this chapter or a
	961	+	rule, standard, or order adopted under this chapter that:
	962	+	(A) result in a violation; and
	963	+	(B) are found throughout the services provided by
	964	+	the facility or that affect or involve the same elderly persons or
	965	+	persons with disabilities receiving services at the facility or the
	966	+	same facility employees.
	967	+	(4) "Widespread in scope" means a violation of this
	968	+	chapter or a rule, standard, or order adopted under this chapter
	969	+	that:
	970	+	(A) is pervasive throughout the services
	971	+	provided by the facility; or
	972	+	(B) represents a systemic failure by the facility
	973	+	that affects or has the potential to affect a large portion of or
	974	+	all of the elderly persons or persons with disabilities receiving
	975	+	services at the facility.
	976	+	(v) Section 247.0025, Health and Safety Code, is repealed.
	977	+	(w) The changes in law made by this section apply only to
	978	+	actions taken by the Health and Human Services Commission and
	979	+	license holders under Chapter 103, Human Resources Code, and
	980	+	Chapters 242, 247, 248A, and 252, Health and Safety Code, on or
	981	+	after the effective date of this section. An action taken before
	982	+	the effective date of this section is governed by the law in effect
	983	+	at that time, and the former law is continued in effect for that
	984	+	purpose.
	985	+	(x) This section takes effect September 1, 2017.
	986	+	SECTION 3. (a) As soon as practicable after the effective
165	987		date of this Act, the executive commissioner of the Health and Human
166	988		Services Commission shall:
167	989		(1) adopt the rules necessary to implement Subchapter
168	990		P, Chapter 242, Health and Safety Code, as added by this Act; and
169	991		(2) notwithstanding Section 242.703, Health and
170	992		Safety Code, as added by this Act, establish the amount of the
171	993		initial reinvestment allowance imposed under Subchapter P, Chapter
172	994		242, Health and Safety Code, as added by this Act, based on
173	995		available revenue and patient day information.
174	996		(b) The amount of the initial reinvestment allowance
175	997		established under Subsection (a) of this section remains in effect
176	998		until the Health and Human Services Commission obtains the
177	999		information necessary to set the amount of the reinvestment
178	1000		allowance under Section 242.703, Health and Safety Code, as added
179	1001		by this Act.
180		-	SECTION 3. If before implementing any provision of this Act
	1002	+	SECTION 4. If before implementing any provision of this Act
181	1003		a state agency determines that a waiver or authorization from a
182	1004		federal agency is necessary for implementation of that provision,
183	1005		the agency affected by the provision shall request the waiver or
184	1006		authorization and may delay implementing that provision until the
185	1007		waiver or authorization is granted.
186		-	SECTION 4. Notwithstanding any other law, a reinvestment
	1008	+	SECTION 5. Notwithstanding any other law, a reinvestment
187	1009		allowance may not be imposed under Section 242.703, Health and
188	1010		Safety Code, as added by this Act, or collected under Section
189	1011		242.705, Health and Safety Code, as added by this Act, until:
190	1012		(1) an amendment to the state Medicaid plan that
191	1013		increases the rates paid to long-term care facilities licensed
192	1014		under Chapter 242, Health and Safety Code, for providing services
193	1015		under the state Medicaid program is approved by the Centers for
194	1016		Medicare and Medicaid Services or another applicable federal
195	1017		government agency; and
196		-	(2) long-term care facilities licensed under Chapter
197		-	242, Health and Safety Code, have been compensated retroactively at
198		-	the increased rate for services provided under the state Medicaid
199		-	program for the period beginning with the effective date of this
200		-	Act.
201		-	SECTION 5. The Health and Human Services Commission shall
	1018	+	(2) the executive commissioner of the Health and Human
	1019	+	Services Commission certifies to the Legislative Budget Board that
	1020	+	the imposition and collection of a reinvestment allowance will not
	1021	+	negatively impact the budget neutrality requirement of a waiver
	1022	+	under Section 1115 of the federal Social Security Act (42 U.S.C.
	1023	+	Section 1315) agreed to by the commission and the Centers for
	1024	+	Medicare and Medicaid Services.
	1025	+	SECTION 6. The Health and Human Services Commission shall
	1026	+	retroactively compensate long-term care facilities licensed under
	1027	+	Chapter 242, Health and Safety Code, at the increased rate for
	1028	+	services provided under the state Medicaid program:
	1029	+	(1) beginning on the date the state Medicaid plan
	1030	+	amendment is approved by the Centers for Medicare and Medicaid
	1031	+	Services or another applicable federal government agency; and
	1032	+	(2) only for the period for which the reinvestment
	1033	+	allowance has been imposed and collected pursuant to the approval
	1034	+	described by Subdivision (1).
	1035	+	SECTION 7. The Health and Human Services Commission shall
202	1036		discontinue the reinvestment allowance imposed under Subchapter P,
203	1037		Chapter 242, Health and Safety Code, as added by this Act, if the
204	1038		commission reduces Medicaid reimbursement rates, including rates
205	1039		that increased due to funds from the nursing facility reinvestment
206	1040		allowance trust fund or federal matching funds, below the rates in
207	1041		effect on September 1, 2017.
208		-	SECTION 6. This Act takes effect immediately if it receives
	1042	+	SECTION 8. This Act takes effect immediately if it receives
209	1043		a vote of two-thirds of all the members elected to each house, as
210	1044		provided by Section 39, Article III, Texas Constitution. If this
211	1045		Act does not receive the vote necessary for immediate effect, this
212	1046		Act takes effect September 1, 2017.
	1047	+	* * * * *