Texas 2025 - 89th Regular

Texas Senate Bill SB699 Compare Versions

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Old	New	Differences
1	1	89R639 MPF-D
2	2	By: West S.B. No. 699
3	3
4	4
5	5
6	6
7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to the licensing and regulation of inpatient
10	10	rehabilitation facilities; imposing fees; providing civil and
11	11	administrative penalties; creating criminal offenses.
12	12	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
13	13	SECTION 1. This Act shall be known as the Eddie Bernice
14	14	Johnson Inpatient Rehabilitation Facility Regulatory Act of 2025.
15	15	SECTION 2. Section 166.004(a), Health and Safety Code, is
16	16	amended to read as follows:
17	17	(a) In this section, "health care provider" means:
18	18	(1) a hospital;
19	19	(2) an institution licensed under Chapter 242,
20	20	including a skilled nursing facility;
21	21	(3) a home and community support services agency;
22	22	(4) an assisted living facility; [and]
23	23	(5) a special care facility; and
24	24	(6) an inpatient rehabilitation facility licensed
25	25	under Chapter 260E.
26	26	SECTION 3. Section 241.003(15), Health and Safety Code, is
27	27	amended to read as follows:
28	28	(15) "Special hospital" means an establishment, other
29	29	than an inpatient rehabilitation facility licensed under Chapter
30	30	260E, that:
31	31	(A) offers services, facilities, and beds for use
32	32	for more than 24 hours for two or more unrelated individuals who are
33	33	regularly admitted, treated, and discharged and who require
34	34	services more intensive than room, board, personal services, and
35	35	general nursing care;
36	36	(B) has clinical laboratory facilities,
37	37	diagnostic X-ray facilities, treatment facilities, or other
38	38	definitive medical treatment;
39	39	(C) has a medical staff in regular attendance;
40	40	and
41	41	(D) maintains records of the clinical work
42	42	performed for each patient.
43	43	SECTION 4. Section 260A.001(5), Health and Safety Code, is
44	44	amended to read as follows:
45	45	(5) "Facility" means:
46	46	(A) an institution as that term is defined by
47	47	Section 242.002;
48	48	(B) an assisted living facility as that term is
49	49	defined by Section 247.002; [and]
50	50	(C) a prescribed pediatric extended care center
51	51	as that term is defined by Section 248A.001; and
52	52	(D) an inpatient rehabilitation facility
53	53	licensed under Chapter 260E.
54	54	SECTION 5. Subtitle B, Title 4, Health and Safety Code, is
55	55	amended by adding Chapter 260E to read as follows:
56	56	CHAPTER 260E. INPATIENT REHABILITATION FACILITIES
57	57	SUBCHAPTER A. GENERAL PROVISIONS
58	58	Sec. 260E.0101. DEFINITIONS. In this chapter:
59	59	(1) "Assisted living facility" means a facility
60	60	licensed under Chapter 247.
61	61	(2) "Commission" means the Health and Human Services
62	62	Commission.
63	63	(3) "Controlling person" means a person described by
64	64	Section 260E.0102.
65	65	(4) "Executive commissioner" means the executive
66	66	commissioner of the commission.
67	67	(5) "Hospital" means a hospital licensed under Chapter
68	68	241.
69	69	(6) "Inpatient rehabilitation facility" means a
70	70	freestanding establishment or unit within an acute care hospital or
71	71	assisted living facility that primarily provides an intensive
72	72	rehabilitation program for patients and has the capacity to provide
73	73	three hours of intense rehabilitation services per day to patients
74	74	admitted to the facility.
75	75	Sec. 260E.0102. CONTROLLING PERSON. (a) A person is a
76	76	controlling person of an inpatient rehabilitation facility if the
77	77	person has the ability, acting alone or in concert with others, to
78	78	directly or indirectly influence, direct, or cause the direction of
79	79	the management, expenditure of money, or policies of the facility
80	80	or other person affiliated with the facility.
81	81	(b) For purposes of this chapter, "controlling person"
82	82	includes:
83	83	(1) a management company, landlord, or other business
84	84	entity that operates, or enters into a contract with another person
85	85	for the operation of, an inpatient rehabilitation facility;
86	86	(2) any person who is a controlling person of a
87	87	management company or other business entity that operates the
88	88	facility or enters into a contract with another person for the
89	89	operation of the facility; and
90	90	(3) any other individual who, because of a personal,
91	91	familial, or other relationship with the owner, manager, landlord,
92	92	tenant, or health care provider of the facility, is in a position of
93	93	actual control or authority with respect to the facility, without
94	94	regard to whether the individual is formally named as an owner,
95	95	manager, director, officer, provider, consultant, contractor, or
96	96	employee of the facility.
97	97	(c) Notwithstanding this section, for purposes of this
98	98	chapter, a controlling person of an inpatient rehabilitation
99	99	facility or of a management company or other business entity
100	100	described by Subsection (b)(1) that is a publicly traded
101	101	corporation or is controlled by a publicly traded corporation means
102	102	an officer or director of the corporation. The term does not
103	103	include a shareholder or lender of the corporation.
104	104	(d) A controlling person described by Subsection (b)(3)
105	105	does not include an individual, including an employee, lender,
106	106	secured creditor, or landlord, who does not exercise any influence
107	107	or control, whether formal or actual, over the operation of an
108	108	inpatient rehabilitation facility.
109	109	(e) The executive commissioner may adopt rules to define the
110	110	ownership interests and other relationships that qualify a person
111	111	as a controlling person of an inpatient rehabilitation facility.
112	112	Sec. 260E.0103. ADMISSIBILITY OF CERTAIN EVIDENCE IN CIVIL
113	113	ACTIONS. (a) The following information is not admissible as
114	114	evidence in a civil action:
115	115	(1) a commission determination that an inpatient
116	116	rehabilitation facility is in violation of this chapter or a rule
117	117	adopted under this chapter; or
118	118	(2) the assessment against or payment by the facility
119	119	of a penalty assessed under this chapter.
120	120	(b) This section does not apply in an enforcement action in
121	121	which this state or an agency or political subdivision of this state
122	122	is a party.
123	123	(c) Notwithstanding this section, evidence described by
124	124	Subsection (a) is admissible as evidence in a civil action only if:
125	125	(1) the evidence relates to a material violation of
126	126	this chapter or a rule adopted under this chapter or assessment of a
127	127	monetary penalty with respect to:
128	128	(A) the particular incident and the particular
129	129	individual whose personal injury is the basis of the civil action
130	130	claim; or
131	131	(B) a commission determination directly
132	132	involving substantially similar conduct that occurred at the
133	133	inpatient rehabilitation facility in the year preceding the date of
134	134	the particular incident on which the civil action claim is based;
135	135	(2) the evidence of a material violation has been
136	136	affirmed by a final adjudicated and unappealable commission order
137	137	after formal appeal; and
138	138	(3) the record is otherwise admissible under the Texas
139	139	Rules of Evidence.
140	140	SUBCHAPTER B. LICENSING, FEES, AND INSPECTIONS
141	141	Sec. 260E.0201. LICENSE REQUIRED. A person, acting
142	142	severally or jointly with any other person, may not establish,
143	143	conduct, or maintain an inpatient rehabilitation facility in this
144	144	state unless the person holds a license issued under this chapter.
145	145	Sec. 260E.0202. APPLICATION FOR LICENSE OR LICENSE RENEWAL.
146	146	(a) An applicant for a license or license renewal shall submit to
147	147	the commission in the form and manner the commission requires a
148	148	complete application accompanied by the license fee.
149	149	(b) An applicant for a license or license renewal shall
150	150	provide with the application evidence that affirmatively
151	151	establishes the applicant's ability to comply with:
152	152	(1) minimum standards of medical care, rehabilitation
153	153	care, nursing care, and financial condition; and
154	154	(2) any other applicable state or federal standards.
155	155	(c) In reviewing an application under this section, the
156	156	commission shall evaluate the background and qualifications of:
157	157	(1) the applicant;
158	158	(2) a partner, officer, director, or managing employee
159	159	of the applicant;
160	160	(3) a person who owns or who controls the owner of the
161	161	premises in which the inpatient rehabilitation facility operates or
162	162	is to operate; and
163	163	(4) a controlling person with respect to the inpatient
164	164	rehabilitation facility for which the application is submitted.
165	165	(d) For purposes of the evaluation required by Subsection
166	166	(c), the commission shall require an applicant to file a sworn
167	167	affidavit of a satisfactory compliance history and any other
168	168	information the commission requires to substantiate a satisfactory
169	169	compliance history relating to each inpatient rehabilitation
170	170	facility the applicant or a person described by Subsection (c)
171	171	operated in this state or outside of this state at any time
172	172	preceding the date the application is submitted. The executive
173	173	commissioner by rule shall determine the requirements for a
174	174	satisfactory compliance history. The commission may:
175	175	(1) consider and evaluate the compliance history of
176	176	the applicant and each person described by Subsection (c) for any
177	177	period during which the applicant or person operated an inpatient
178	178	rehabilitation facility in this state or outside this state; and
179	179	(2) require the applicant to provide information
180	180	relating to the financial history of the applicant and each person
181	181	described by Subsection (c) for an inpatient rehabilitation
182	182	facility the applicant or person operated outside this state at any
183	183	time preceding the date the application is submitted.
184	184	(e) Information the commission obtains under this section
185	185	regarding an applicant's financial history is confidential and may
186	186	not be disclosed to the public.
187	187	Sec. 260E.0203. ISSUANCE AND RENEWAL OF LICENSE. (a) After
188	188	the commission receives an application for a license or license
189	189	renewal and the fee, the commission shall issue to the applicant a
190	190	license if, after inspection and investigation, the commission
191	191	determines that:
192	192	(1) the applicant and each person described by Section
193	193	260E.0202(c) satisfy the requirements under this chapter and rules
194	194	or standards adopted under this chapter; and
195	195	(2) the inpatient rehabilitation facility for which
196	196	the application is submitted complies with this chapter and rules
197	197	or standards adopted under this chapter.
198	198	(b) Except as provided by Subsection (g), a license for an
199	199	inpatient rehabilitation facility may be renewed every three years
200	200	after:
201	201	(1) an inspection is completed;
202	202	(2) the applicant submits a completed application that
203	203	complies with Section 260E.0202 and pays the required license fee;
204	204	and
205	205	(3) the applicant submits to the commission and the
206	206	commission approves a report that complies with commission rules
207	207	specifying:
208	208	(A) the date the report must be submitted;
209	209	(B) the information the report must contain; and
210	210	(C) the form of the report.
211	211	(c) Except as provided by Subsection (d), the commission may
212	212	issue a license only:
213	213	(1) to the person named in an application and for the
214	214	premises of an inpatient rehabilitation facility specified in the
215	215	application; and
216	216	(2) for the maximum number of beds specified in the
217	217	application.
218	218	(d) The commission may issue one license for multiple
219	219	inpatient rehabilitation facilities if:
220	220	(1) each building in which patients receive services
221	221	from the facilities included in the license are subject to the
222	222	control and direction of the same governing body;
223	223	(2) each building in which patients receive services
224	224	are within a 30-mile radius of the applicant's primary physical
225	225	address;
226	226	(3) the organized medical staff of each facility
227	227	included in the license are integrated;
228	228	(4) each facility employs the same chief executive
229	229	officer who:
230	230	(A) reports directly to the governing body; and
231	231	(B) has administrative authority to exercise
232	232	control and surveillance over all administrative activities of the
233	233	facility;
234	234	(5) each facility employs the same chief medical
235	235	officer who:
236	236	(A) reports directly to the governing body; and
237	237	(B) is responsible for all medical staff
238	238	activities of the facility;
239	239	(6) each facility building included in the license
240	240	that is geographically separate from other buildings of the same
241	241	facility contains at least one inpatient nursing unit, unless only
242	242	diagnostic, laboratory services, or a combination of diagnostic and
243	243	laboratory services are provided to facility patients in the
244	244	building; and
245	245	(7) each facility included in the license complies
246	246	with the emergency services standards for a special hospital, as
247	247	that term is defined by Section 241.003.
248	248	(e) The commission may waive the requirement under
249	249	Subsection (d)(7) for an inpatient rehabilitation facility if
250	250	another facility included in the license:
251	251	(1) complies with the emergency services standards for
252	252	a general hospital, as that term is defined by Section 241.003; and
253	253	(2) is in close geographic proximity to the facility.
254	254	(f) The executive commissioner by rule shall establish
255	255	procedures for granting a waiver under Subsection (e). The rules
256	256	must require the commission to determine that granting the waiver:
257	257	(1) will facilitate the creation or operation of the
258	258	inpatient rehabilitation facility seeking the waiver; and
259	259	(2) is in the best interest of the individuals served
260	260	or to be served by the facility.
261	261	(g) An initial license issued for an inpatient
262	262	rehabilitation facility under this chapter is a probationary
263	263	license and is valid only until the first anniversary of the date of
264	264	issuance. On expiration of the probationary license, the
265	265	commission shall issue a regular license only if:
266	266	(1) the commission determines the license holder and
267	267	each person described by Section 260E.0202(c) satisfy the
268	268	requirements established under this chapter and rules or standards
269	269	adopted under this chapter;
270	270	(2) an inspection is completed;
271	271	(3) the license holder pays the license fee; and
272	272	(4) the license holder submits and the commission
273	273	approves the report required under Subsection (b)(3).
274	274	(h) The executive commissioner by rule shall adopt a system
275	275	under which an appropriate number of licenses the commission issues
276	276	under this chapter expire on staggered dates occurring in each
277	277	three-year period. If the expiration date of a license changes as a
278	278	result of this subsection, the commission shall prorate the license
279	279	fee for that license as appropriate.
280	280	(i) A license may not be transferred or assigned without the
281	281	commission's written approval.
282	282	(j) A license holder shall post the license in a conspicuous
283	283	place on the premises of the inpatient rehabilitation facility.
284	284	Sec. 260E.0204. LIST OF FACILITIES WITH EXCELLENT OPERATING
285	285	RECORDS; CHANGE OF OWNERSHIP; EXPEDITED LICENSE ISSUANCE. (a) The
286	286	commission shall maintain a current list of license holders for
287	287	inpatient rehabilitation facilities in this state that the
288	288	commission determines have excellent operating records based on the
289	289	information available to the commission. The executive
290	290	commissioner by rule shall establish specific criteria for the
291	291	commission's use in determining whether to include a license holder
292	292	on the list.
293	293	(b) The commission shall establish a procedure under which a
294	294	license holder included on the list described by Subsection (a) who
295	295	submits to the commission an application for a change of ownership
296	296	to operate an existing inpatient rehabilitation facility may obtain
297	297	a license for that facility on an expedited basis. The procedure
298	298	may allow a license holder to submit to the commission an affidavit
299	299	demonstrating the license holder satisfies the criteria necessary
300	300	for inclusion on the list and the requirements under Subsection
301	301	(c).
302	302	(c) An applicant for an expedited license under this section
303	303	must satisfy each applicable requirement that an applicant for a
304	304	license renewal must satisfy under this chapter, including Section
305	305	260E.0202(c), and rules adopted under this chapter. A requirement
306	306	relating to inspections or to an accreditation review applies only
307	307	to inpatient rehabilitation facilities operated by an applicant at
308	308	the time the applicant submits the application for a change of
309	309	ownership.
310	310	Sec. 260E.0205. TEMPORARY LICENSE FOR CHANGE OF OWNERSHIP.
311	311	(a) For purposes of this section, a temporary license is a 90-day
312	312	license for a temporary change of ownership issued to an applicant
313	313	who proposes to become the new operator of an inpatient
314	314	rehabilitation facility existing on the date the application is
315	315	submitted.
316	316	(b) After receiving an application for a temporary change of
317	317	ownership, the commission shall issue a temporary license to the
318	318	applicant if, after investigation, the commission determines the
319	319	applicant and each person described by Section 260E.0202(c)
320	320	satisfy:
321	321	(1) the requirements under Section 260E.0202(b); and
322	322	(2) the commission's requirements for the background
323	323	and qualifications of the persons described by Sections
324	324	260E.0202(c) and (d).
325	325	(c) Except as provided by Subsection (d), the commission may
326	326	not issue a temporary license to an applicant before the 31st day
327	327	after the date the commission receives both:
328	328	(1) the application for a temporary change of
329	329	ownership; and
330	330	(2) written notice from the current license holder of
331	331	the inpatient rehabilitation facility for which the application is
332	332	submitted of that license holder's intent to transfer operation of
333	333	the facility to the applicant beginning on a date the applicant
334	334	specifies.
335	335	(d) The executive commissioner by rule shall establish
336	336	criteria under which the commission may waive the 30-day
337	337	requirement or the notification requirement under Subsection (c).
338	338	The criteria may include a forcible entry and detainer, death,
339	339	divorce, or any other event that affects a current license holder's
340	340	ownership of an inpatient rehabilitation facility.
341	341	(e) After the commission receives an application for a
342	342	temporary change of ownership or written notice under Subsection
343	343	(c), the commission may place a hold on payments to the current
344	344	license holder for an inpatient rehabilitation facility in an
345	345	amount not to exceed the average of the monthly vendor payments paid
346	346	to the facility, as the commission determines. The commission:
347	347	(1) shall disburse the payments not later than the
348	348	120th day after the date the final reporting requirements are
349	349	satisfied and any resulting informal reviews or formal appeals are
350	350	resolved; and
351	351	(2) may reduce the amount disbursed by the amount the
352	352	former license holder owes to the commission under a Medicaid
353	353	contract or license.
354	354	(f) The executive commissioner by rule shall define the
355	355	factors constituting a change of ownership for an inpatient
356	356	rehabilitation facility. In adopting the rules, the executive
357	357	commissioner shall consider:
358	358	(1) the proportion of ownership interest being
359	359	transferred to another person;
360	360	(2) the addition or removal of a stockholder, partner,
361	361	owner, or other controlling person;
362	362	(3) the reorganization of a license holder into a
363	363	different type of business entity; and
364	364	(4) the death or incapacity of a stockholder, partner,
365	365	or owner.
366	366	(g) The executive commissioner may adopt rules requiring a
367	367	license holder to notify the commission of any change, including a
368	368	change that does not constitute a change of ownership, as that term
369	369	is defined by commission rules. This section does not prohibit the
370	370	commission from acting under Section 260E.0301 or any other
371	371	provision of this chapter.
372	372	(h) The commission shall issue or deny a temporary license
373	373	not later than the 31st day after the date the commission receives a
374	374	completed application for a temporary change of ownership. The
375	375	effective date of a temporary license issued under this section is
376	376	the date requested in the application unless:
377	377	(1) the commission does not receive the application
378	378	and written notice described by Subsection (c) at least 30 days
379	379	before that date; and
380	380	(2) the commission did not waive those requirements in
381	381	accordance with Subsection (d).
382	382	(i) If the commission does not receive an application for a
383	383	temporary change of ownership and written notice under Subsection
384	384	(c) at least 30 days before the effective date requested in the
385	385	application and the commission did not waive those requirements in
386	386	accordance with Subsection (d), the effective date of the temporary
387	387	license is the 31st day after the date the commission receives both
388	388	the application and the notice.
389	389	(j) Except as provided by Subsection (k), after the
390	390	commission issues a temporary license to an applicant, the
391	391	commission shall, as soon as reasonably possible, conduct an
392	392	inspection or survey of the inpatient rehabilitation facility for
393	393	which the license is issued in accordance with Section 260E.0213.
394	394	During the period between the date a temporary license is issued and
395	395	the date the facility is inspected or surveyed under Section
396	396	260E.0213 or desk reviewed under Subsection (k), the commission may
397	397	not place a hold on vendor payments to the temporary license holder.
398	398	(k) The executive commissioner by rule shall establish
399	399	criteria under which the commission may substitute a desk review of
400	400	an inpatient rehabilitation facility's compliance with applicable
401	401	requirements for the on-site inspection or survey under Subsection
402	402	(j).
403	403	(l) After the commission conducts an inspection or survey
404	404	under Subsection (j) or a desk review under Subsection (k) of an
405	405	inpatient rehabilitation facility, the commission shall issue a
406	406	license under Section 260E.0203 to the temporary license holder if
407	407	the facility passes the inspection, survey, or desk review and the
408	408	applicant meets the requirements under that section. If the
409	409	facility fails to pass the inspection, survey, or desk review or the
410	410	temporary license holder fails to meet the requirements under that
411	411	section, the commission may:
412	412	(1) place a hold on vendor payments to the temporary
413	413	license holder; and
414	414	(2) take any other action authorized by this chapter.
415	415	(m) If a license holder meets the requirements under Section
416	416	260E.0203 and the inpatient rehabilitation facility passes an
417	417	initial or subsequent inspection, a survey, or a desk review before
418	418	the temporary license expires, the license issued under Section
419	419	260E.0203 is considered effective on the date the commission
420	420	determines under Subsection (h) or (i).
421	421	(n) A temporary license issued under this section expires on
422	422	the 90th day after the effective date of the license established
423	423	under Subsection (h) or (i).
424	424	Sec. 260E.0206. LICENSE FEES. (a) The commission shall
425	425	charge each inpatient rehabilitation facility a license fee for an
426	426	initial license or a license renewal.
427	427	(b) The executive commissioner by rule shall adopt the
428	428	license fees in amounts as prescribed by Section 12.0111 and in
429	429	accordance with a schedule under which the fee amount is determined
430	430	by the number of beds in an inpatient rehabilitation facility. A
431	431	minimum license fee may be established.
432	432	(c) The amount of a license fee adopted under this chapter
433	433	must be based on the estimated cost to and effort expended by the
434	434	commission to issue or renew the license.
435	435	(d) All license fees collected shall be deposited in the
436	436	state treasury to the credit of the commission to administer and
437	437	enforce this chapter.
438	438	(e) Notwithstanding Subsection (d), to the extent money
439	439	received from the license fees collected under this chapter exceeds
440	440	the commission's costs, the commission may use the money to
441	441	administer Chapter 324 and similar laws that require the commission
442	442	to provide information related to inpatient rehabilitation care to
443	443	the public. The executive commissioner may not consider the costs
444	444	of administering Chapter 324 or similar laws in establishing the
445	445	amount of a license fee.
446	446	Sec. 260E.0207. GRADING OF FACILITIES. (a) The executive
447	447	commissioner may adopt by rule and publish and the commission may
448	448	enforce minimum standards relating to the grading of an inpatient
449	449	rehabilitation facility to identify the facilities that provide
450	450	above the minimum level of services and personnel as the executive
451	451	commissioner establishes.
452	452	(b) An inpatient rehabilitation facility recognized with a
453	453	superior grade, as the executive commissioner determines by rule,
454	454	shall prominently display the grade in an area of the facility that
455	455	is accessible to the public.
456	456	(c) As an incentive to obtain the superior grade, an
457	457	inpatient rehabilitation facility may advertise the facility's
458	458	grade, except the facility may not advertise a superior grade that
459	459	has been revoked.
460	460	(d) The commission may not award a superior grade to an
461	461	inpatient rehabilitation facility that, during the year preceding
462	462	the grading inspection, violated a state or federal law or rule
463	463	relating to:
464	464	(1) the health, safety, or welfare of the facility's
465	465	patients;
466	466	(2) patient funds;
467	467	(3) the confidentiality of a patient's records;
468	468	(4) the financial practices of the facility; or
469	469	(5) the control of medication in the facility.
470	470	(e) The commission shall revoke an inpatient rehabilitation
471	471	facility's superior grade if the facility:
472	472	(1) does not meet the criteria established for a
473	473	superior grade; or
474	474	(2) violates a state or federal law or rule described
475	475	by Subsection (d).
476	476	Sec. 260E.0208. RULES; MINIMUM STANDARDS. (a) The
477	477	executive commissioner by rule shall establish and the commission
478	478	shall enforce rules and minimum standards to implement this
479	479	chapter, including rules and minimum standards relating to quality
480	480	of life, quality of care, and patients' rights.
481	481	(b) In adopting rules, the executive commissioner shall:
482	482	(1) consider the conditions of participation for
483	483	certification under Title XVIII of the Social Security Act (42
484	484	U.S.C. Section 1395 et seq.) and the Joint Commission's standards;
485	485	and
486	486	(2) attempt to achieve consistency with those
487	487	conditions and standards.
488	488	(c) The rules and standards the executive commissioner
489	489	adopts under this chapter:
490	490	(1) may be more stringent than the standards imposed
491	491	by federal law for certification for participation in the state
492	492	Medicaid program; and
493	493	(2) may not be less stringent than the Medicaid
494	494	certification standards and regulations imposed under the Omnibus
495	495	Budget Reconciliation Act of 1987 (OBRA), Pub. L. No. 100-203, for
496	496	an inpatient rehabilitation facility that is a unit of a nursing
497	497	facility or an assisted living facility.
498	498	(d) To implement Sections 260E.0202(c) and (d), the
499	499	executive commissioner by rule shall adopt minimum standards for
500	500	the background and qualifications of each person described by
501	501	Section 260E.0202(c). The commission may not issue or renew a
502	502	license if a person described by Section 260E.0202(c) does not meet
503	503	the minimum standards adopted under this section.
504	504	(e) In addition to other standards or rules required by this
505	505	chapter, the executive commissioner shall adopt and publish and the
506	506	commission shall enforce minimum standards relating to:
507	507	(1) the construction of an inpatient rehabilitation
508	508	facility, including plumbing, heating, lighting, ventilation, and
509	509	other housing conditions, to ensure the patients' health, safety,
510	510	comfort, and protection from fire hazard;
511	511	(2) the regulation of the number and qualification of
512	512	all personnel, including management and nursing personnel,
513	513	responsible for any part of the care provided to patients;
514	514	(3) requirements for in-service education of all
515	515	employees who have any contact with patients;
516	516	(4) training on the care of individuals with
517	517	Alzheimer's disease and related disorders for employees who work
518	518	with those individuals;
519	519	(5) sanitary and related conditions in a facility and
520	520	the facility's surroundings, including water supply, sewage
521	521	disposal, food handling, and general hygiene, to ensure the
522	522	patients' health, safety, and comfort;
523	523	(6) the nutritional needs of each patient according to
524	524	good nutritional practice or the recommendations of the health care
525	525	provider attending the patient;
526	526	(7) equipment essential to the patients' health and
527	527	welfare;
528	528	(8) the use and administration of medication in
529	529	conformity with applicable law and rules;
530	530	(9) care and treatment of patients and any other
531	531	matter related to patient health, safety, and welfare;
532	532	(10) licensure of facilities;
533	533	(11) compliance with other state and federal laws
534	534	affecting the health, safety, and rights of patients;
535	535	(12) compliance with nursing peer review under
536	536	Subchapter I, Chapter 301, Occupations Code, and Chapter 303,
537	537	Occupations Code, and the rules of the Texas Board of Nursing
538	538	relating to peer review; and
539	539	(11) implementation of this chapter.
540	540	(f) The executive commissioner shall adopt and publish and
541	541	the commission shall enforce minimum standards requiring
542	542	appropriate training in geriatric care for each individual who
543	543	provides services to geriatric patients in an inpatient
544	544	rehabilitation facility and who holds a license or certificate
545	545	issued by a state agency that authorizes the individual to provide
546	546	the services. The minimum standards may require each licensed or
547	547	certified individual to complete an appropriate program of
548	548	continuing education or in-service training, as determined by
549	549	commission rule, on a schedule determined by commission rule.
550	550	(g) To administer the surveys for provider certification
551	551	provided for by federal law and rules, the commission shall
552	552	identify each area of care subject to both federal certification
553	553	and state licensing requirements. For each area of care subject to
554	554	the same standard under both federal certification and state
555	555	licensing requirements, an inpatient rehabilitation facility in
556	556	compliance with the federal certification standard is considered to
557	557	be in compliance with the same state licensing requirement.
558	558	(h) The minimum standards the executive commissioner adopts
559	559	under this section must require each inpatient rehabilitation
560	560	facility, as part of an existing training program, to provide each
561	561	registered nurse, licensed vocational nurse, nurse aide, and
562	562	nursing assistant who provides nursing services in the facility at
563	563	least one hour of training each year in caring for persons with
564	564	dementia.
565	565	(i) The commission by order may waive or modify a
566	566	requirement under this chapter or a minimum standard the commission
567	567	adopts by rule under this section for a particular inpatient
568	568	rehabilitation facility if the commission determines the waiver or
569	569	modification will facilitate the creation or operation of the
570	570	facility and the waiver or modification is in the best interests of
571	571	the individuals served or to be served by the facility.
572	572	(j) The executive commissioner by rule shall establish
573	573	procedures and criteria for issuing a waiver or modification order
574	574	under Subsection (i). The criteria must include at a minimum an
575	575	assessment of the appropriateness of the waiver or modification
576	576	compared to the best interests of the individuals served or to be
577	577	served by the facility.
578	578	(k) If the commission orders a waiver or modification under
579	579	Subsection (i), the commission shall document the waiver or
580	580	modification order in the licensing record of the inpatient
581	581	rehabilitation facility granted the waiver or modification. The
582	582	executive commissioner by rule shall specify the type and
583	583	specificity of the documentation that must be included in the
584	584	licensing record.
585	585	(l) An inpatient rehabilitation facility must contain an
586	586	emergency treatment room but is not required to have an emergency
587	587	department.
588	588	Sec. 260E.0209. PATIENT TRANSFERS. (a) The executive
589	589	commissioner shall adopt rules on:
590	590	(1) the transfer of patients between inpatient
591	591	rehabilitation facilities that have not executed a transfer
592	592	agreement; and
593	593	(2) services not included in a transfer agreement.
594	594	(b) The rules the executive commissioner adopts under
595	595	Subsection (a) must:
596	596	(1) ensure a patient transfer between inpatient
597	597	rehabilitation facilities is accomplished in accordance with
598	598	facility policies resulting in medically appropriate transfers
599	599	from health care provider to health care provider and from facility
600	600	to facility by providing that:
601	601	(A) the facility receiving the patient is
602	602	notified before the patient transfer and confirms the patient meets
603	603	the facility's admissions criteria relating to appropriate bed,
604	604	provider, and other services necessary to treat the patient;
605	605	(B) the patient is stabilized before and during
606	606	the patient transfer using medically appropriate life support
607	607	measures that a reasonable and prudent health care provider
608	608	exercising ordinary care in the same or a similar locality would
609	609	use;
610	610	(C) appropriate personnel and equipment are used
611	611	for the patient transfer in accordance with the care a reasonable
612	612	and prudent health care provider exercising ordinary care in the
613	613	same or a similar locality would use for the transfer;
614	614	(D) all necessary records for the patient's
615	615	continuing care are transferred to the facility receiving the
616	616	patient; and
617	617	(E) the patient transfer is not predicated on
618	618	arbitrary, capricious, or unreasonable discrimination because of
619	619	race, religion, national origin, age, sex, physical condition, or
620	620	economic status;
621	621	(2) ensure an inpatient rehabilitation facility may
622	622	not transfer a patient who is experiencing an emergency medical
623	623	condition that has not been stabilized unless:
624	624	(A) the patient or a legally responsible person
625	625	acting on the patient's behalf, after being informed of the
626	626	facility's obligations under this section and of the risk of
627	627	transfer, in writing requests transfer to another facility;
628	628	(B) a licensed physician signs a certification,
629	629	which includes a summary of the risks and benefits based on the
630	630	information available at the time of transfer, that the medical
631	631	benefits reasonably expected from the provision of appropriate
632	632	medical treatment at another facility outweigh the increased risks
633	633	to the patient and, in the case of a pregnant patient in labor, to
634	634	the unborn child from effecting the transfer; or
635	635	(C) if a licensed physician is not physically
636	636	present in the emergency treatment room or department at the time a
637	637	patient is transferred, a qualified medical professional signs a
638	638	certification described by Paragraph (B) after a licensed
639	639	physician, in consultation with the professional, makes the
640	640	determination described by that paragraph and subsequently
641	641	countersigns the certificate;
642	642	(3) require a public inpatient rehabilitation
643	643	facility to accept a patient transfer of an eligible patient if the
644	644	facility has appropriate facilities, services, and staff available
645	645	for providing care to the patient;
646	646	(4) require an inpatient rehabilitation facility to
647	647	take all reasonable steps to secure the informed refusal of a
648	648	patient, or of a person acting on the patient's behalf, to a
649	649	transfer or to related examination and treatment; and
650	650	(5) recognize any contractual, statutory, or
651	651	regulatory obligations that may exist between a patient and a
652	652	designated or mandated health care provider as those obligations
653	653	apply to the transfer of emergency or nonemergency patients.
654	654	Sec. 260E.0210. FIRE SAFETY REQUIREMENTS. (a) The
655	655	executive commissioner shall adopt rules necessary to specify the
656	656	edition of the Life Safety Code of the National Fire Protection
657	657	Association to be used in establishing the life safety requirements
658	658	for an inpatient rehabilitation facility licensed under this
659	659	chapter.
660	660	(b) The executive commissioner shall adopt the edition of
661	661	the Life Safety Code of the National Fire Protection Association
662	662	for fire safety as designated by federal law and rules for an
663	663	inpatient rehabilitation facility or portion of a facility
664	664	constructed after September 1, 1993, and for a facility or portion
665	665	of a facility operating or approved for construction on or before
666	666	September 1, 1993.
667	667	(c) The executive commissioner may not require more
668	668	stringent fire safety standards than those required by federal law
669	669	and rules. The rules adopted under this section may not prevent an
670	670	inpatient rehabilitation facility licensed under this chapter from
671	671	voluntarily conforming to fire safety standards that are compatible
672	672	with, equal to, or more stringent than those the executive
673	673	commissioner adopts.
674	674	(d) An inpatient rehabilitation facility that exists on
675	675	September 1, 2025, may continue the facility's use or occupancy
676	676	that existed on that date if the facility complies with fire safety
677	677	standards and ordinances in effect on that date.
678	678	(e) Notwithstanding this section, a municipality may enact
679	679	additional and more stringent fire safety standards applicable to
680	680	new construction on or after September 1, 2025.
681	681	(f) The executive commissioner shall adopt rules to
682	682	implement an expedited inspection process to allow an applicant for
683	683	an initial license or a license renewal to obtain a life safety code
684	684	and physical plant inspection not later than the 15th day after the
685	685	date the applicant submits the request. The commission may charge a
686	686	fee to recover the cost of the expedited inspection. The rules must
687	687	allow the commission to charge different fee amounts based on the
688	688	size of the inpatient rehabilitation facility.
689	689	Sec. 260E.0211. REGISTRATION WITH TEXAS INFORMATION AND
690	690	REFERRAL NETWORK. (a) An inpatient rehabilitation facility
691	691	licensed under this chapter shall register with the Texas
692	692	Information and Referral Network under Section 526.0004,
693	693	Government Code, to assist this state in identifying individuals
694	694	needing assistance if an area is evacuated because of a disaster or
695	695	other emergency.
696	696	(b) An inpatient rehabilitation facility is not required to
697	697	identify individual patients who may require assistance in an
698	698	evacuation or to register individual patients with the Texas
699	699	Information and Referral Network for evacuation assistance.
700	700	(c) An inpatient rehabilitation facility shall notify each
701	701	patient and the patient's next of kin or guardian regarding the
702	702	steps necessary to register for evacuation assistance with the
703	703	Texas Information and Referral Network.
704	704	Sec. 260E.0212. REQUIRED POSTING OF CERTAIN DOCUMENTS. (a)
705	705	Each inpatient rehabilitation facility shall prominently and
706	706	conspicuously post for display in a public area of the facility that
707	707	is readily available to patients, employees, and visitors:
708	708	(1) the license issued under this chapter;
709	709	(2) a sign the commission prescribes specifying
710	710	complaint procedures established under this chapter or rules
711	711	adopted under this chapter and the steps necessary to register a
712	712	complaint with the commission;
713	713	(3) a notice in a form the commission prescribes
714	714	stating that licensing inspection reports and other related reports
715	715	detailing deficiencies the commission cites are available at the
716	716	facility for public inspection and providing the commission's
717	717	toll-free telephone number to be used to obtain information
718	718	concerning the facility;
719	719	(4) a concise summary of the most recent inspection
720	720	report relating to the facility;
721	721	(5) notice of the availability of commission summary
722	722	reports relating to the quality of care, recent investigations,
723	723	litigation, and other aspects of the facility's operation;
724	724	(6) notice that the commission, if applicable, can
725	725	provide information about the facility administrator;
726	726	(7) any notice or written statement required to be
727	727	posted under Section 260E.0314(c);
728	728	(8) notice that informational materials relating to
729	729	the facility's compliance history are available for inspection at a
730	730	location in the facility specified by the sign;
731	731	(9) notice that employees, other staff, patients,
732	732	volunteers, and family members and guardians of patients are
733	733	protected from discrimination or retaliation as provided by
734	734	Sections 260A.014 and 260A.015; and
735	735	(10) a sign requiring reporting of suspected abuse,
736	736	neglect, and exploitation as described by Section 260A.006(a).
737	737	(b) The notice required by Subsection (a)(8) must also be
738	738	posted at each door providing ingress to and egress from an
739	739	inpatient rehabilitation facility. The facility shall ensure the
740	740	informational materials described by that subsection:
741	741	(1) are maintained in a well-lighted accessible
742	742	location; and
743	743	(2) include a statement in the form the commission
744	744	requires of the facility's record of compliance with this chapter
745	745	and the rules and standards adopted under this chapter that is
746	746	updated not less than twice a month and that reflects the record of
747	747	compliance during the year preceding the date the statement is last
748	748	updated.
749	749	(c) The notice required by Subsection (a)(9) must be posted
750	750	in English and a second language as required by commission rule.
751	751	(d) The commission shall post detailed compliance
752	752	information regarding each inpatient rehabilitation facility the
753	753	commission licenses, including the information a facility is
754	754	required to post under Subsection (b), on the commission's Internet
755	755	website. The commission shall update the information every month
756	756	to provide the most recent compliance information on each facility.
757	757	Sec. 260E.0213. INSPECTIONS. (a) The commission or the
758	758	commission's representative may conduct any inspection, including
759	759	an unannounced inspection or follow-up inspection, survey, or
760	760	investigation that the commission considers necessary and may enter
761	761	the premises of an inpatient rehabilitation facility at reasonable
762	762	times to conduct an inspection, survey, or investigation in
763	763	accordance with commission rules.
764	764	(b) The commission is entitled to access books, records, and
765	765	other documents maintained by or on behalf of an inpatient
766	766	rehabilitation facility to the extent necessary to enforce this
767	767	chapter and the rules adopted under this chapter.
768	768	(c) A license holder or an applicant for a license is
769	769	considered to have consented to entry and inspection of the
770	770	inpatient rehabilitation facility by a representative of the
771	771	commission in accordance with this chapter.
772	772	(d) The commission shall establish procedures to preserve
773	773	all relevant evidence of conditions found during an inspection,
774	774	survey, or investigation that the commission reasonably believes
775	775	threaten the health and safety of a patient, including photography
776	776	and photocopying of relevant documents, including a license
777	777	holder's notes, a physician's orders, and pharmacy records, for use
778	778	in any legal proceeding.
779	779	(e) When photographing a patient, the commission:
780	780	(1) shall respect the privacy of the patient to the
781	781	greatest extent possible; and
782	782	(2) may not disclose the patient's identity to the
783	783	public.
784	784	(f) An inpatient rehabilitation facility, an officer or
785	785	employee of the facility, and a patient's attending physician are
786	786	not civilly liable for surrendering confidential or private
787	787	material under this section, including physician's orders,
788	788	pharmacy records, notes and memoranda of a state office, and
789	789	patient files.
790	790	(g) The commission shall establish in clear and concise
791	791	language a form to summarize each inspection report and complaint
792	792	investigation report.
793	793	(h) The executive commissioner shall establish proper
794	794	procedures to ensure that copies of all forms and reports under this
795	795	section are made available to consumers, service recipients, and
796	796	the relatives of service recipients as the executive commissioner
797	797	considers proper.
798	798	Sec. 260E.0214. UNANNOUNCED INSPECTIONS. (a) The
799	799	commission shall annually conduct at least one unannounced
800	800	inspection of each inpatient rehabilitation facility.
801	801	(b) If an inpatient rehabilitation facility is a unit within
802	802	an assisted living facility, for at least one unannounced annual
803	803	inspection of the facility, the commission shall invite at least
804	804	one individual as a citizen advocate from:
805	805	(1) the AARP;
806	806	(2) the Texas Senior Citizen Association;
807	807	(3) the commission's Certified Long-term Care
808	808	Ombudsman; or
809	809	(4) another statewide organization for the elderly.
810	810	(c) The commission shall randomly select a number of
811	811	inpatient rehabilitation facilities for unannounced inspections to
812	812	be conducted between 5 p.m. and 8 a.m. in a percentage amount the
813	813	commission determines sufficient to ensure continuous compliance.
814	814	The inspections must be cursory to avoid to the greatest extent
815	815	feasible any disruption of the patients.
816	816	(d) The commission may require additional inspections.
817	817	Sec. 260E.0215. FOLLOW-UP INSPECTIONS. (a) The commission
818	818	or the commission's representative may conduct a follow-up
819	819	inspection of an inpatient rehabilitation facility after
820	820	conducting an inspection, survey, or investigation of the facility
821	821	under Section 260E.0213 or 260E.0214 to:
822	822	(1) evaluate and monitor the determinations of the
823	823	initial inspection, survey, or investigation; and
824	824	(2) ensure the commission is citing and punishing
825	825	deficiencies consistently across the state.
826	826	(b) If an inpatient rehabilitation facility corrects a
827	827	deficiency cited during a follow-up inspection within the time
828	828	specified by commission rule, the commission may not impose
829	829	additional punitive actions for the deficiency.
830	830	Sec. 260E.0216. REPORTING OF VIOLATIONS. (a) The
831	831	commission or the commission's representative conducting an
832	832	inspection, survey, or investigation under Section 260E.0213 or
833	833	260E.0214 shall:
834	834	(1) list each violation of a law or rule on a form the
835	835	commission designs for inspections; and
836	836	(2) identify the specific law or rule an inpatient
837	837	rehabilitation facility violates.
838	838	(b) If the commission or the commission's representative
839	839	conducting an inspection, survey, or investigation under Section
840	840	260E.0213 or 260E.0214 identifies a violation that constitutes
841	841	immediate jeopardy to the health or safety of a patient:
842	842	(1) the commission shall immediately notify the
843	843	inpatient rehabilitation facility's management of the violation;
844	844	and
845	845	(2) a commission representative shall remain in or be
846	846	accessible to the facility until the commission receives the
847	847	facility's plan of removal related to the violation.
848	848	(c) At the conclusion of an inspection, survey, or
849	849	investigation under Section 260E.0213 or 260E.0214, the commission
850	850	or the commission's representative conducting the inspection,
851	851	survey, or investigation shall discuss the violations with the
852	852	inpatient rehabilitation facility's management in an exit
853	853	conference. The commission or the commission's representative
854	854	shall leave a written list of the violations with the facility at
855	855	the time of the exit conference. If the commission or the
856	856	commission's representative discovers any additional violations
857	857	during the review of field notes or preparation of the official
858	858	final list, the commission or the commission's representative shall
859	859	give the facility an additional exit conference regarding the
860	860	additional violations. An additional exit conference must be held
861	861	in person and may not be held by telephone, e-mail, or facsimile
862	862	transmission.
863	863	(d) An inpatient rehabilitation facility that receives
864	864	notice of a violation under this section shall submit a plan to
865	865	correct the violations to the regional director of the public
866	866	health region in which the facility is located not later than the
867	867	10th working day after the date the facility receives the final
868	868	official statement of violations.
869	869	Sec. 260E.0217. DISCLOSURE OF UNANNOUNCED INSPECTIONS;
870	870	CRIMINAL PENALTY. (a) Except as expressly provided by this
871	871	chapter, a person commits an offense if the person intentionally
872	872	discloses to an unauthorized person the date, time, or any other
873	873	information about an unannounced inspection of an inpatient
874	874	rehabilitation facility before the inspection occurs.
875	875	(b) In this section, "unauthorized person" does not
876	876	include:
877	877	(1) the commission;
878	878	(2) the office of the attorney general;
879	879	(3) an ombudsman or representative of the commission;
880	880	(4) a representative of an agency or organization when
881	881	a Medicare or Medicaid survey is made concurrently with a licensing
882	882	inspection; or
883	883	(5) any other person or entity authorized by law to
884	884	make an inspection or to accompany an inspector.
885	885	(c) An offense under this section is a third degree felony.
886	886	(d) A person convicted under this section is not eligible
887	887	for state employment.
888	888	Sec. 260E.0218. OPEN HEARING. (a) The commission shall
889	889	hold an open hearing in a licensed inpatient rehabilitation
890	890	facility if the commission has taken a punitive action against the
891	891	facility in the preceding 12 months or if the commission receives a
892	892	complaint from an ombudsman, advocate, patient, or relative of a
893	893	patient relating to a serious or potentially serious problem in the
894	894	facility and the commission has reasonable cause to believe the
895	895	complaint is valid. The commission is not required to hold more
896	896	than one open meeting for a particular inpatient rehabilitation
897	897	facility in each year.
898	898	(b) The commission shall give notice of the time, place, and
899	899	date of a hearing under this section to:
900	900	(1) the inpatient rehabilitation facility at which the
901	901	meeting will be held;
902	902	(2) a patient or the designated closest living
903	903	relative or legal guardian of a patient, as applicable, who
904	904	received rehabilitation services from the facility during the 12
905	905	months preceding the date of the meeting; and
906	906	(3) appropriate state or federal agencies that work
907	907	with the facility.
908	908	(c) The commission may exclude an inpatient rehabilitation
909	909	facility's administrators and personnel from a hearing held under
910	910	this section.
911	911	(d) The commission shall notify the inpatient
912	912	rehabilitation facility at which a meeting under this section is
913	913	held of any complaints received at the hearing and, without
914	914	identifying the source of the complaints, provide a summary of the
915	915	complaints to the facility.
916	916	(e) The commission shall determine and implement a
917	917	mechanism to confidentially notify a complainant of the results of
918	918	the complaint investigation.
919	919	SUBCHAPTER C. GENERAL ENFORCEMENT
920	920	Sec. 260E.0301. DENIAL, SUSPENSION, OR REVOCATION OF
921	921	LICENSE. (a) In this section:
922	922	(1) "Abuse" has the meaning assigned by Section
923	923	260A.001.
924	924	(2) "Immediate threat to health and safety" means a
925	925	situation in which immediate corrective action is necessary because
926	926	an inpatient rehabilitation facility's noncompliance with one or
927	927	more requirements has caused, or is likely to cause, serious
928	928	injury, harm, impairment, or death to a patient.
929	929	(3) "Neglect" has the meaning assigned by Section
930	930	260A.001.
931	931	(b) The commission, after providing notice and opportunity
932	932	for a hearing to a license holder or license applicant, may deny,
933	933	suspend, or revoke a license if the commission determines the
934	934	license holder, applicant, or a person described by Section
935	935	260E.0202(c) has:
936	936	(1) violated this chapter or a rule, standard, or
937	937	order adopted or license issued under this chapter in either a
938	938	repeated or substantial manner; or
939	939	(2) committed an act described by Section
940	940	260E.0306(a)(2), (3), (4), (5), or (6).
941	941	(c) Except as provided by Subsection (d), the executive
942	942	commissioner shall revoke a license under Subsection (b) if the
943	943	commission determines that:
944	944	(1) the license holder has committed in a 24-month
945	945	period three violations described by Subsection (b) that constitute
946	946	an immediate threat to health and safety related to the abuse or
947	947	neglect of a patient; and
948	948	(2) each of the violations described by Subdivision
949	949	(1) is reported in connection with a separate survey, inspection,
950	950	or investigation visit that occurred on separate entrance and exit
951	951	dates.
952	952	(d) The executive commissioner may not revoke a license
953	953	under Subsection (c) based on a violation described by Subsection
954	954	(c)(1) if:
955	955	(1) the violation and the determination of immediate
956	956	threat to health and safety are not included on the written list of
957	957	violations left with the facility at the time of the initial exit
958	958	conference under Section 260E.0216(c) for a survey, inspection, or
959	959	investigation;
960	960	(2) the violation is not included on the final
961	961	statement of violations described by Section 260E.0216; or
962	962	(3) the violation has been reviewed under the informal
963	963	dispute resolution process established by Section 526.0202,
964	964	Government Code, and a determination was made that:
965	965	(A) the violation should be removed from the
966	966	license holder's record; or
967	967	(B) the violation is reduced in severity so that
968	968	the violation is no longer cited as an immediate threat to health
969	969	and safety related to the abuse or neglect of a patient.
970	970	(e) The status of a person as an applicant for a license or a
971	971	license holder is preserved until final disposition of the
972	972	contested matter, except as the court having jurisdiction of a
973	973	judicial review of the matter may order in the public interest for
974	974	the welfare and safety of the patients.
975	975	(f) In a license revocation case under Subsection (c), to
976	976	ensure the health and safety of inpatient rehabilitation facility
977	977	patients, the commission may:
978	978	(1) assist with obtaining a new operator for the
979	979	facility; or
980	980	(2) assist with the relocation of patients to another
981	981	facility.
982	982	(g) A court having jurisdiction of a judicial review of the
983	983	matter may not order arbitration, whether on motion of any party or
984	984	on the court's own motion, to resolve a dispute involving the
985	985	denial, suspension, or revocation of a license under this section
986	986	or the conduct with respect to which the denial, suspension, or
987	987	revocation of the license is sought.
988	988	(h) The executive commissioner may stay a license
989	989	revocation required by Subsection (c) if the executive commissioner
990	990	determines the stay would not jeopardize the health and safety of
991	991	the inpatient rehabilitation facility patients or place the
992	992	patients at risk of abuse or neglect. The executive commissioner by
993	993	rule shall establish criteria under which a license revocation may
994	994	be stayed under this subsection. The executive commissioner shall
995	995	follow negotiated rulemaking procedures prescribed by Chapter
996	996	2008, Government Code, for the adoption of rules establishing the
997	997	criteria. The criteria established must authorize the executive
998	998	commissioner to stay a license revocation of a facility for which
999	999	the commission has deployed a rapid response team under Section
1000	1000	255.004, if the facility has cooperated with the rapid response
1001	1001	team and demonstrated improvement in quality of care, as determined
1002	1002	by the rapid response team.
1003	1003	Sec. 260E.0302. EMERGENCY SUSPENSION OR CLOSING ORDER. (a)
1004	1004	The commission shall suspend an inpatient rehabilitation
1005	1005	facility's license or order an immediate closing of part of the
1006	1006	facility if:
1007	1007	(1) the commission determines the facility is
1008	1008	operating in violation of the standards prescribed by this chapter;
1009	1009	and
1010	1010	(2) the violation creates an immediate threat to the
1011	1011	health and safety of a patient.
1012	1012	(b) The executive commissioner by rule shall provide for the
1013	1013	placement of patients during an inpatient rehabilitation
1014	1014	facility's suspension or closing to ensure their health and safety.
1015	1015	(c) An order suspending a license or closing a part of an
1016	1016	inpatient rehabilitation facility under this section is
1017	1017	immediately effective on the date on which the license holder
1018	1018	receives written notice or a later date specified in the order.
1019	1019	(d) An order suspending a license or ordering the immediate
1020	1020	closure of a part of an inpatient rehabilitation facility is valid
1021	1021	until the 10th day following the effective date of the order.
1022	1022	(e) A court having jurisdiction of a judicial review of the
1023	1023	matter may not order arbitration, whether on motion of any party or
1024	1024	on the court's own motion, to resolve a dispute involving an
1025	1025	emergency suspension or closing order under this section or the
1026	1026	conduct with respect to which the emergency suspension or closing
1027	1027	order is sought.
1028	1028	Sec. 260E.0303. INJUNCTION. (a) The commission may
1029	1029	petition a district court for:
1030	1030	(1) a temporary restraining order to restrain a person
1031	1031	from a violation or threatened violation of the standards
1032	1032	prescribed by this chapter or any other law affecting inpatient
1033	1033	rehabilitation facility patients if the commission reasonably
1034	1034	believes the violation or threatened violation creates an immediate
1035	1035	threat to the health and safety of a patient; and
1036	1036	(2) an injunction to restrain a person from a
1037	1037	violation or threatened violation of the standards prescribed by
1038	1038	this chapter or any other law affecting facility patients if the
1039	1039	commission reasonably believes the violation or threatened
1040	1040	violation creates a threat to the health and safety of a patient.
1041	1041	(b) A district court, on petition of the commission, may by
1042	1042	injunction:
1043	1043	(1) prohibit a person from violating the standards or
1044	1044	licensing requirements prescribed by this chapter;
1045	1045	(2) restrain or prevent the establishment, conduct,
1046	1046	management, or operation of an inpatient rehabilitation facility
1047	1047	without a license issued under this chapter; or
1048	1048	(3) grant the injunctive relief warranted by the facts
1049	1049	on a finding by the court that a person is violating or threatening
1050	1050	to violate the standards or licensing requirements prescribed by
1051	1051	this chapter.
1052	1052	(c) The attorney general, on the commission's request,
1053	1053	shall bring and conduct in the name of this state an action
1054	1054	authorized by this section.
1055	1055	(d) An action for a temporary restraining order or other
1056	1056	injunctive relief must be brought in the county in which the alleged
1057	1057	violation occurs or is threatened to occur.
1058	1058	Sec. 260E.0304. LICENSE REQUIREMENT; CRIMINAL PENALTY. (a)
1059	1059	A person commits an offense if the person violates Section
1060	1060	260E.0201.
1061	1061	(b) An offense under this section is punishable by a fine of
1062	1062	not more than $1,000 for the first offense and not more than $500
1063	1063	for each subsequent offense.
1064	1064	(c) Each day of a continuing violation after conviction
1065	1065	constitutes a separate offense.
1066	1066	Sec. 260E.0305. CIVIL PENALTY. (a) In this section,
1067	1067	"affiliate" means:
1068	1068	(1) with respect to a partnership other than a limited
1069	1069	partnership, each partner of the partnership;
1070	1070	(2) with respect to a corporation:
1071	1071	(A) an officer;
1072	1072	(B) a director;
1073	1073	(C) a stockholder who owns, holds, or has the
1074	1074	power to vote at least 10 percent of any class of securities issued
1075	1075	by the corporation, regardless of whether the power is of record or
1076	1076	beneficial; and
1077	1077	(D) a controlling individual;
1078	1078	(3) with respect to an individual:
1079	1079	(A) each partnership and each partner in the
1080	1080	partnership in which the individual or any other affiliate of the
1081	1081	individual is a partner; and
1082	1082	(B) each corporation or other business entity in
1083	1083	which the individual or another affiliate of the individual is:
1084	1084	(i) an officer;
1085	1085	(ii) a director;
1086	1086	(iii) a stockholder who owns, holds, or has
1087	1087	the power to vote at least 10 percent of any class of securities
1088	1088	issued by the corporation, regardless of whether the power is of
1089	1089	record or beneficial; and
1090	1090	(iv) a controlling individual;
1091	1091	(4) with respect to a limited partnership:
1092	1092	(A) a general partner; and
1093	1093	(B) a limited partner who is a controlling
1094	1094	individual;
1095	1095	(5) with respect to a limited liability company:
1096	1096	(A) an owner who is a manager as described by the
1097	1097	Texas Limited Liability Company Law, as described by Section
1098	1098	1.008(e), Business Organizations Code; and
1099	1099	(B) each owner who is a controlling individual;
1100	1100	and
1101	1101	(6) with respect to any other business entity, a
1102	1102	controlling individual.
1103	1103	(b) A person who violates or causes a violation of this
1104	1104	chapter or a rule adopted under this chapter is liable for a civil
1105	1105	penalty of not less than $1,000 or more than $20,000 for each act of
1106	1106	violation if the commission determines the violation threatens the
1107	1107	health and safety of a patient.
1108	1108	(c) In determining the amount of a penalty to be awarded
1109	1109	under this section, the trier of fact shall consider:
1110	1110	(1) the seriousness of the violation;
1111	1111	(2) the history of violations committed by the person
1112	1112	or the person's affiliate, employee, or controlling person;
1113	1113	(3) the amount necessary to deter future violations;
1114	1114	(4) the efforts made to correct the violation;
1115	1115	(5) any misrepresentation made to the commission or to
1116	1116	another person regarding:
1117	1117	(A) the quality of services rendered or to be
1118	1118	rendered to patients;
1119	1119	(B) the compliance history of the inpatient
1120	1120	rehabilitation facility or any facilities owned or controlled by an
1121	1121	owner or controlling person of the facility; or
1122	1122	(C) the identity of an owner or controlling
1123	1123	person of the facility;
1124	1124	(6) the culpability of the person who committed the
1125	1125	violation; and
1126	1126	(7) any other matter that should, as a matter of
1127	1127	justice or equity, be considered.
1128	1128	(d) Each day of a continuing violation constitutes a
1129	1129	separate ground for recovery under this section.
1130	1130	(e) Any party to an action brought under this section may
1131	1131	request a jury.
1132	1132	(f) If a person who is liable under this section fails to pay
1133	1133	any amount the person is obligated to pay under this section, this
1134	1134	state may seek satisfaction from any owner, other controlling
1135	1135	person, or affiliate of the person found liable. The owner, other
1136	1136	controlling person, or affiliate may be found liable in the same
1137	1137	action or in another action on a showing by this state that the
1138	1138	amount to be paid has not been paid or otherwise legally discharged.
1139	1139	The executive commissioner by rule may establish a method for
1140	1140	satisfying an obligation imposed under this section from an
1141	1141	insurance policy, letter of credit, or other contingency fund.
1142	1142	(g) On the commission's request, the attorney general may
1143	1143	bring an action in a district court to collect a civil penalty under
1144	1144	this section. The attorney general may recover reasonable expenses
1145	1145	incurred in bringing an action under this section, including court
1146	1146	costs, reasonable attorney's fees, investigative costs, witness
1147	1147	fees, and deposition costs.
1148	1148	(h) A payment submitted to satisfy an obligation under this
1149	1149	section is not an allowable cost for reimbursement under Medicaid.
1150	1150	(i) A civil penalty awarded under this section constitutes a
1151	1151	fine, penalty, or forfeiture payable to and for the benefit of a
1152	1152	government unit and is not compensation for actual pecuniary loss.
1153	1153	Sec. 260E.0306. ADMINISTRATIVE PENALTY. (a) The
1154	1154	commission may assess an administrative penalty against a person
1155	1155	who:
1156	1156	(1) violates this chapter or a rule, standard, or
1157	1157	order adopted or license issued under this chapter;
1158	1158	(2) makes a false statement, that the person knows or
1159	1159	should know is false, of a material fact:
1160	1160	(A) on an application for an initial license or
1161	1161	license renewal or in an attachment to the application; or
1162	1162	(B) with respect to a matter under investigation
1163	1163	by the commission;
1164	1164	(3) refuses to allow a representative of the
1165	1165	commission to inspect:
1166	1166	(A) a book, record, or file required to be
1167	1167	maintained by an inpatient rehabilitation facility; or
1168	1168	(B) any portion of the premises of a facility;
1169	1169	(4) wilfully interferes with the work of a
1170	1170	representative of the commission or the enforcement of this
1171	1171	chapter;
1172	1172	(5) wilfully interferes with a representative of the
1173	1173	commission preserving evidence of a violation of this chapter or a
1174	1174	rule, standard, or order adopted or license issued under this
1175	1175	chapter;
1176	1176	(6) fails to pay a penalty assessed by the commission
1177	1177	under this chapter not later than the 10th day after the date the
1178	1178	assessment of the penalty becomes final; or
1179	1179	(7) fails to notify the commission of a change of
1180	1180	ownership before the effective date of the change of ownership.
1181	1181	(b) Except as provided by Subsection (f) and Section
1182	1182	260E.0308(d), the penalty may not exceed $10,000 a day for each
1183	1183	violation.
1184	1184	(c) Each day of a continuing violation constitutes a
1185	1185	separate violation.
1186	1186	(d) The executive commissioner shall establish gradations
1187	1187	of penalties in accordance with the relative seriousness of the
1188	1188	violation.
1189	1189	(e) In determining the amount of a penalty, the commission
1190	1190	shall consider any matter that justice may require, including:
1191	1191	(1) the gradations of penalties established under
1192	1192	Subsection (d);
1193	1193	(2) the seriousness of the violation, including the
1194	1194	nature, circumstances, extent, and gravity of the prohibited act
1195	1195	and the hazard or potential hazard created by the act to the health
1196	1196	or safety of the public;
1197	1197	(3) the history of previous violations;
1198	1198	(4) deterrence of future violations; and
1199	1199	(5) efforts to correct the violation.
1200	1200	(f) The penalty for a violation of Section 260E.0314(c) may
1201	1201	not exceed $1,000 a day for each violation.
1202	1202	(g) The persons against whom an administrative penalty may
1203	1203	be assessed under Subsection (a) include:
1204	1204	(1) an applicant for a license under this chapter;
1205	1205	(2) a license holder;
1206	1206	(3) a partner, officer, director, or managing employee
1207	1207	of a license holder or applicant; and
1208	1208	(4) a controlling person.
1209	1209	(h) A penalty assessed under Subsection (a)(6) is in
1210	1210	addition to the penalty previously assessed and not timely paid.
1211	1211	(i) The commission shall develop and use a system to record
1212	1212	and track the scope and severity of each violation of this chapter
1213	1213	or a rule, standard, or order adopted under this chapter for the
1214	1214	purpose of assessing an administrative penalty for the violation or
1215	1215	taking some other enforcement action against the appropriate
1216	1216	inpatient rehabilitation facility to deter future violations. The
1217	1217	system:
1218	1218	(1) must be comparable to the system used by the
1219	1219	Centers for Medicare and Medicaid Services to categorize the scope
1220	1220	and severity of violations for a facility; and
1221	1221	(2) may be modified, as appropriate, to reflect
1222	1222	changes in industry practice or changes made to the system used by
1223	1223	the Centers for Medicare and Medicaid Services.
1224	1224	Sec. 260E.0307. VIOLATION OF LAW RELATING TO ADVANCE
1225	1225	DIRECTIVES. (a) The commission shall assess an administrative
1226	1226	penalty under this subchapter against an inpatient rehabilitation
1227	1227	facility that violates Section 166.004.
1228	1228	(b) Notwithstanding Sections 260E.0305(b) and (c):
1229	1229	(1) a penalty assessed in accordance with this section
1230	1230	must be $500; and
1231	1231	(2) a separate penalty may not be assessed for a
1232	1232	separate day of a continuing violation.
1233	1233	(c) Section 260E.0308 does not apply to a penalty assessed
1234	1234	in accordance with this section.
1235	1235	Sec. 260E.0308. RIGHT TO CORRECT. (a) In this section:
1236	1236	(1) "Actual harm" means a negative outcome that
1237	1237	compromises a patient's physical, mental, or emotional well-being.
1238	1238	(2) "Immediate threat to the health or safety of a
1239	1239	patient" means a situation that causes, or is likely to cause,
1240	1240	serious injury, harm, or impairment to or the death of a patient.
1241	1241	(3) "Pattern of violation" means repeated, but not
1242	1242	pervasive, failures of an inpatient rehabilitation facility to
1243	1243	comply with this chapter or a rule, standard, or order adopted under
1244	1244	this chapter that:
1245	1245	(A) result in a violation; and
1246	1246	(B) are found throughout the services provided by
1247	1247	the facility or that affect or involve the same patients or facility
1248	1248	employees.
1249	1249	(4) "Widespread in scope" means a violation of this
1250	1250	chapter or a rule, standard, or order adopted under this chapter
1251	1251	that:
1252	1252	(A) is pervasive throughout the services
1253	1253	provided by the inpatient rehabilitation facility; or
1254	1254	(B) represents a systemic failure by the facility
1255	1255	affecting or having the potential to affect a large portion of or
1256	1256	all of the facility patients.
1257	1257	(b) The commission may not collect an administrative
1258	1258	penalty against an inpatient rehabilitation facility under this
1259	1259	subchapter if, not later than the 45th day after the date the
1260	1260	facility receives notice under Section 260E.0309(c), the facility
1261	1261	corrects the violation.
1262	1262	(c) Subsection (b) does not apply:
1263	1263	(1) to a violation that the commission determines:
1264	1264	(A) represents a pattern of violation that
1265	1265	results in actual harm;
1266	1266	(B) is widespread in scope and results in actual
1267	1267	harm;
1268	1268	(C) is widespread in scope, constitutes a
1269	1269	potential for actual harm, and relates to:
1270	1270	(i) patients' rights;
1271	1271	(ii) treatment of patients;
1272	1272	(iii) patient behavior and inpatient
1273	1273	rehabilitation facility practices;
1274	1274	(iv) quality of care;
1275	1275	(v) medication errors;
1276	1276	(vi) standard menus and nutritional
1277	1277	adequacy;
1278	1278	(vii) physician visits;
1279	1279	(viii) infection control;
1280	1280	(ix) life safety from fire; or
1281	1281	(x) emergency preparedness and response;
1282	1282	(D) constitutes an immediate threat to the health
1283	1283	or safety of a patient; or
1284	1284	(E) substantially limits the facility's capacity
1285	1285	to provide care;
1286	1286	(2) to a violation described by Section
1287	1287	260E.0306(a)(2), (3), (4), (5), (6), or (7);
1288	1288	(3) to a violation of Section 260A.014 or 260A.015; or
1289	1289	(4) to a second or subsequent violation of Section
1290	1290	326.002 that occurs before the second anniversary of the date of the
1291	1291	first violation.
1292	1292	(d) An inpatient rehabilitation facility that corrects a
1293	1293	violation under Subsection (b) must maintain the correction. If
1294	1294	the facility fails to maintain the correction until at least the
1295	1295	first anniversary of the correction date, the commission may assess
1296	1296	an administrative penalty under this subchapter for the subsequent
1297	1297	violation. A penalty assessed under this subsection shall be equal
1298	1298	to three times the amount of the penalty assessed but not collected
1299	1299	under Subsection (b). The commission is not required to provide the
1300	1300	facility an opportunity to correct the subsequent violation under
1301	1301	this section.
1302	1302	Sec. 260E.0309. REPORT RECOMMENDING ADMINISTRATIVE
1303	1303	PENALTY. (a) The commission may issue a preliminary report stating
1304	1304	the facts on which the commission concludes that a violation of this
1305	1305	chapter or a rule, standard, or order adopted or license issued
1306	1306	under this chapter has occurred if the commission has:
1307	1307	(1) examined the possible violation and facts
1308	1308	surrounding the possible violation; and
1309	1309	(2) concluded that a violation has occurred.
1310	1310	(b) The report may recommend a penalty under Section
1311	1311	260E.0311 and the amount of the penalty.
1312	1312	(c) Not later than the 10th day after the date on which the
1313	1313	report is issued, the commission shall give written notice of the
1314	1314	report to the person charged with the violation. The notice must
1315	1315	include:
1316	1316	(1) a brief summary of the charges;
1317	1317	(2) a statement of the recommended penalty amount;
1318	1318	(3) a statement of whether the violation is subject to
1319	1319	correction under Section 260E.0308 and, if the violation is subject
1320	1320	to correction under that section, a statement of:
1321	1321	(A) the date on which the inpatient
1322	1322	rehabilitation facility must file with the commission a plan of
1323	1323	correction to be approved by the commission; and
1324	1324	(B) the date on which the plan of correction must
1325	1325	be completed to avoid assessment of the penalty; and
1326	1326	(4) a statement that the person charged has a right to
1327	1327	a hearing on the occurrence of the violation, the amount of the
1328	1328	penalty, or both.
1329	1329	(d) Not later than the 20th day after the date on which the
1330	1330	notice under Subsection (c) is sent, the person charged may:
1331	1331	(1) provide to the commission written consent to the
1332	1332	commission's report, including the recommended penalty;
1333	1333	(2) submit a written request for a hearing; or
1334	1334	(3) if the violation is subject to correction under
1335	1335	Section 260E.0308, submit a plan of correction to the commission
1336	1336	for approval.
1337	1337	(e) If the violation is subject to correction under Section
1338	1338	260E.0308 and the person reports to the commission that the
1339	1339	violation has been corrected, the commission shall inspect the
1340	1340	correction or take another step necessary to confirm the violation
1341	1341	has been corrected and shall notify the person that:
1342	1342	(1) the correction is satisfactory and that a penalty
1343	1343	is not assessed; or
1344	1344	(2) the correction is not satisfactory and that a
1345	1345	penalty is recommended.
1346	1346	(f) Not later than the 20th day after the date on which a
1347	1347	notice under Subsection (e)(2) is sent, the person charged may:
1348	1348	(1) provide to the commission written consent to the
1349	1349	commission's report, including the recommended penalty; or
1350	1350	(2) submit a written request for a hearing.
1351	1351	(g) If the person charged with the violation consents to the
1352	1352	administrative penalty the commission recommends, does not timely
1353	1353	respond to a notice sent under Subsection (c) or (e), or fails to
1354	1354	correct the violation to the commission's satisfaction, the
1355	1355	commission shall assess the recommended administrative penalty.
1356	1356	(h) If the commission assesses the recommended penalty, the
1357	1357	commission shall give written notice to the person charged of the
1358	1358	decision and the person shall pay the penalty.
1359	1359	Sec. 260E.0310. HEARINGS ON ADMINISTRATIVE PENALTIES. (a)
1360	1360	An administrative law judge of the State Office of Administrative
1361	1361	Hearings shall order a hearing and the commission shall give notice
1362	1362	of the hearing if a person charged under Section 260E.0309(c)
1363	1363	requests a hearing.
1364	1364	(b) The hearing must be held before an administrative law
1365	1365	judge.
1366	1366	(c) The administrative law judge shall make findings of fact
1367	1367	and conclusions of law regarding the occurrence of a violation of
1368	1368	this chapter or a rule or order adopted or license issued under this
1369	1369	chapter.
1370	1370	(d) Based on the findings of fact and conclusions of law,
1371	1371	the administrative law judge by order shall find:
1372	1372	(1) a violation has occurred and assess an
1373	1373	administrative penalty; or
1374	1374	(2) a violation has not occurred.
1375	1375	(e) Proceedings under this section are subject to Chapter
1376	1376	2001, Government Code.
1377	1377	Sec. 260E.0311. NOTICE AND PAYMENT OF ADMINISTRATIVE
1378	1378	PENALTY; INTEREST; REFUND. (a) The commission shall provide
1379	1379	notice of the decision taken under Section 260E.0310(d) to the
1380	1380	person charged. If the commission determines a violation has
1381	1381	occurred and assesses an administrative penalty, the commission
1382	1382	shall provide to the person charged written notice of:
1383	1383	(1) the determination;
1384	1384	(2) the amount of the penalty;
1385	1385	(3) the rate of interest payable with respect to the
1386	1386	penalty and the date on which interest begins to accrue;
1387	1387	(4) whether payment of the penalty or other action
1388	1388	under Section 260E.0313 is required; and
1389	1389	(5) the person's right to judicial review of the order.
1390	1390	(b) Not later than the 30th day after the date on which the
1391	1391	commission's order becomes final, the person charged with the
1392	1392	penalty shall:
1393	1393	(1) pay the full amount of the penalty; or
1394	1394	(2) file a petition for judicial review contesting the
1395	1395	occurrence of the violation, the amount of the penalty, the failure
1396	1396	to correct the violation to the commission's satisfaction, or all
1397	1397	of the above.
1398	1398	(c) Notwithstanding Subsection (b), the commission may
1399	1399	permit the person to pay the penalty in installments or may require
1400	1400	the person to use the amount of the penalty under the commission's
1401	1401	supervision in accordance with Section 260E.0313.
1402	1402	(d) If the person does not pay the penalty within the 30-day
1403	1403	period:
1404	1404	(1) the penalty is subject to interest; and
1405	1405	(2) the commission may refer the matter to the
1406	1406	attorney general for collection of the penalty and interest.
1407	1407	(e) If a penalty is reduced or not assessed, the commission
1408	1408	shall:
1409	1409	(1) remit to the person charged the appropriate amount
1410	1410	of any penalty payment plus accrued interest; or
1411	1411	(2) execute a release of the supersedeas bond if one
1412	1412	has been posted.
1413	1413	(f) Accrued interest on amounts remitted by the commission
1414	1414	under Subsection (e)(1) must be paid:
1415	1415	(1) at a rate equal to the rate charged on loans to
1416	1416	depository institutions by the New York Federal Reserve Bank; and
1417	1417	(2) for the period beginning on the date the penalty is
1418	1418	paid under Subsection (b) and ending on the date the penalty is
1419	1419	remitted.
1420	1420	(g) Interest under Subsection (d) must be paid:
1421	1421	(1) at a rate equal to the rate charged on loans to
1422	1422	depository institutions by the New York Federal Reserve Bank; and
1423	1423	(2) for the period beginning on the date the notice of
1424	1424	the commission's order is received by the person and ending on the
1425	1425	date the penalty is paid.
1426	1426	Sec. 260E.0312. APPLICATION OF OTHER LAW. The commission
1427	1427	may not assess more than one monetary penalty under this chapter and
1428	1428	Chapter 32, Human Resources Code, for a violation arising out of the
1429	1429	same act or failure to act, except as provided by Section
1430	1430	260E.0308(d). The commission may assess the greater of a monetary
1431	1431	penalty under this chapter or a monetary penalty under Chapter 32,
1432	1432	Human Resources Code, for the same act or failure to act.
1433	1433	Sec. 260E.0313. AMELIORATION OF VIOLATION. (a) In this
1434	1434	section, "immediate jeopardy to health and safety" means a
1435	1435	situation in which immediate corrective action is necessary because
1436	1436	an inpatient rehabilitation facility's noncompliance with one or
1437	1437	more requirements has caused, or is likely to cause, serious
1438	1438	injury, harm, impairment, or death to a patient receiving care in
1439	1439	the facility.
1440	1440	(b) In lieu of demanding payment of an administrative
1441	1441	penalty assessed under Section 260E.0306, the commission may, in
1442	1442	accordance with this section, allow the person to use, under the
1443	1443	commission's supervision, any portion of the penalty to ameliorate
1444	1444	the violation or to improve services, other than administrative
1445	1445	services, in the inpatient rehabilitation facility affected by the
1446	1446	violation.
1447	1447	(c) The commission shall offer amelioration to a person for
1448	1448	a charged violation if the commission determines that the violation
1449	1449	does not constitute immediate jeopardy to the health and safety of a
1450	1450	facility patient.
1451	1451	(d) The commission may not offer amelioration to a person
1452	1452	if:
1453	1453	(1) the person has been charged with a violation that
1454	1454	is subject to correction under Section 260E.0308; or
1455	1455	(2) the commission determines the charged violation
1456	1456	constitutes immediate jeopardy to the health and safety of an
1457	1457	inpatient rehabilitation facility patient.
1458	1458	(e) The commission shall offer amelioration to a person
1459	1459	under this section not later than the 10th day after the date the
1460	1460	person receives from the commission a final notice of assessment of
1461	1461	administrative penalty that is sent to the person after an informal
1462	1462	dispute resolution process but before an administrative hearing
1463	1463	under Section 260E.0310.
1464	1464	(f) A person to whom the commission offers amelioration
1465	1465	shall file a plan for amelioration not later than the 45th day after
1466	1466	the date the person receives the amelioration offer. In submitting
1467	1467	the plan, the person must agree to waive the person's right to an
1468	1468	administrative hearing under Section 260E.0310 if the commission
1469	1469	approves the plan.
1470	1470	(g) At a minimum, a plan for amelioration must:
1471	1471	(1) propose changes to the management or operation of
1472	1472	the inpatient rehabilitation facility that will improve services to
1473	1473	or quality of care of facility patients;
1474	1474	(2) identify, through measurable outcomes, the ways in
1475	1475	which and the extent to which the proposed changes will improve
1476	1476	services to or quality of care of facility patients;
1477	1477	(3) establish clear goals to be achieved through the
1478	1478	proposed changes;
1479	1479	(4) establish a timeline for implementing the proposed
1480	1480	changes; and
1481	1481	(5) identify specific actions necessary to implement
1482	1482	the proposed changes.
1483	1483	(h) A plan for amelioration may include proposed changes to:
1484	1484	(1) improve staff recruitment and retention;
1485	1485	(2) offer or improve rehabilitation services for
1486	1486	patients; and
1487	1487	(3) improve the overall quality of care for patients.
1488	1488	(i) The commission may require an amelioration plan to
1489	1489	propose changes that would result in conditions exceeding the
1490	1490	requirements of this chapter or the rules adopted under this
1491	1491	chapter.
1492	1492	(j) The commission shall approve or deny an amelioration
1493	1493	plan not later than the 45th day after the date the commission
1494	1494	receives the plan. On approval of a person's plan, the commission
1495	1495	shall deny a pending request for a hearing submitted by the person
1496	1496	under Section 260E.0309(d).
1497	1497	(k) The commission may not offer amelioration to a person:
1498	1498	(1) more than three times in a two-year period; or
1499	1499	(2) more than one time in a two-year period for the
1500	1500	same or similar violation.
1501	1501	Sec. 260E.0314. OTHER REMEDIES. (a) If the commission
1502	1502	finds that an inpatient rehabilitation facility has committed an
1503	1503	act for which a civil penalty may be imposed under Section
1504	1504	260E.0305, the commission may, as appropriate under the
1505	1505	circumstances, order the facility to immediately suspend
1506	1506	admissions.
1507	1507	(b) A suspension of admissions ordered under Subsection (a)
1508	1508	is effective on the date a representative of the inpatient
1509	1509	rehabilitation facility receives notice of the order and of the
1510	1510	manner in which the order may be appealed. Not later than the 14th
1511	1511	day after the date the suspension becomes effective, the commission
1512	1512	must provide an opportunity for a hearing with respect to an appeal
1513	1513	of the order.
1514	1514	(c) During the period that an inpatient rehabilitation
1515	1515	facility is ordered to suspend admissions, the facility shall post
1516	1516	a notice of the suspension on all doors providing ingress to and
1517	1517	egress from the facility. The notice must be posted in the form the
1518	1518	commission requires.
1519	1519	(d) A person commits an offense if the person knowingly:
1520	1520	(1) violates Subsection (c); or
1521	1521	(2) removes a notice posted under Subsection (c)
1522	1522	before the inpatient rehabilitation facility is allowed to admit
1523	1523	patients.
1524	1524	(e) An offense under Subsection (d) is a Class C
1525	1525	misdemeanor.
1526	1526	(f) A court having jurisdiction of a judicial review of the
1527	1527	matter may not order arbitration, whether on motion of any party or
1528	1528	on the court's own motion, to resolve a dispute involving an order
1529	1529	suspending admissions under this section or the conduct with
1530	1530	respect to which the order suspending admissions is sought.
1531	1531	SECTION 6. (a) As soon as practicable after the effective
1532	1532	date of this Act but not later than January 1, 2026, the executive
1533	1533	commissioner of the Health and Human Services Commission shall
1534	1534	adopt rules as required by this Act.
1535	1535	(b) Notwithstanding Chapter 260E, Health and Safety Code,
1536	1536	as added by this Act, a person is not required to hold a license
1537	1537	under that chapter until September 1, 2026.
1538	1538	SECTION 7. This Act takes effect September 1, 2025.