CHAPTER 222. HEALTH CARE FACILITY SURVEY, CONSTRUCTION, INSPECTION, AND REGULATION
HEALTH AND SAFETY CODE
TITLE 4. HEALTH FACILITIES
SUBTITLE A. FINANCING, CONSTRUCTING, AND INSPECTING HEALTH
FACILITIES
CHAPTER 222. HEALTH CARE FACILITY SURVEY, CONSTRUCTION,
INSPECTION, AND REGULATION
SUBCHAPTER A. SURVEY AND CONSTRUCTION OF HOSPITALS
Sec. 222.001. SHORT TITLE. This subchapter may be cited as the
Texas Hospital Survey and Construction Act.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 222.002. DEFINITIONS. In this subchapter:
(1) "Board" means the Texas Board of Health.
(2) "Commissioner" means the commissioner of health.
(3) "Department" means the Texas Department of Health.
(4) "Hospital" includes a public health center, a general
hospital, or a tuberculosis, mental, chronic disease, or other
type of hospital, and related facilities such as a laboratory,
outpatient department, nurses' home and training facility, or
central service facility operated in connection with a hospital.
(5) "Public health center" means a publicly owned facility for
providing public health services and includes related facilities
such as a laboratory, clinic, or administrative office operated
in connection with a facility for providing public health
services.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 222.003. EXCEPTION. This subchapter does not apply to a
hospital furnishing primarily domiciliary care.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 222.004. DIVISION OF HOSPITAL SURVEY AND CONSTRUCTION. (a)
The division of hospital survey and construction is a division
of the department.
(b) The division is administered by a full-time salaried
director appointed by the commissioner and under the supervision
and direction of the board.
(c) The commissioner shall appoint other personnel of the
division.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 222.005. SURVEY, PLANNING, AND CONSTRUCTION OF HOSPITALS.
(a) The department, through the division of hospital survey and
construction, is the only agency of the state authorized to make
an inventory of existing hospitals, survey the need for
construction of hospitals, and develop a program of hospital
construction as provided by the federal Hospital Survey and
Construction Act (42 U.S.C. Section 291 et seq.).
(b) The board may establish methods of administration and adopt
rules to meet the requirements of the federal Hospital Survey and
Construction Act relating to survey, planning, and construction
of hospitals and public health centers.
(c) The commissioner shall:
(1) require reports, make inspections and investigations, and
prescribe rules as the commissioner considers necessary; and
(2) take other action that the commissioner considers necessary
to carry out the federal Hospital Survey and Construction Act and
the regulations adopted under that Act.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 222.006. FUNDING. (a) The commissioner shall accept, on
behalf of the state, a payment of federal funds or a gift or
grant made to assist in meeting the cost of carrying out the
purpose of this subchapter, and may spend the payment, gift, or
grant for that purpose.
(b) The commissioner shall deposit the payment, gift, or grant
in the state treasury to the credit of the hospital construction
fund.
(c) The commissioner shall deposit to the credit of the hospital
construction fund money received from the federal government for
a construction project approved by the surgeon general of the
United States Public Health Service. The commissioner shall use
the money only for payments to applicants for work performed and
purchases made in carrying out approved projects.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 222.007. AGREEMENTS FOR USE OF FACILITIES AND SERVICES OF
OTHER ENTITIES. To the extent the commissioner considers
desirable to carry out the purposes of this subchapter, the
commissioner may enter into an agreement for the use of a
facility or service of another public or private department,
agency, or institution.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 222.008. EXPERTS AND CONSULTANTS. The commissioner may
contract for services of experts or consultants, or organizations
of experts or consultants, on a part-time or fee-for-service
basis. The contracts may not involve the performance of
administrative duties.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 222.009. COMMISSIONER'S REPORT. (a) The commissioner
annually shall report to the board on activities and expenditures
under this subchapter.
(b) The commissioner shall include in the report recommendations
for additional legislation that the commissioner considers
appropriate to furnish adequate hospital, clinic, and similar
facilities to the public.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
SUBCHAPTER B. LIMITATION ON INSPECTION AND OTHER REGULATION OF
HEALTH CARE FACILITIES
Sec. 222.021. PURPOSE. The purpose of this subchapter is to
require that state agencies that perform inspections of health
care facilities, including the Texas Department of Health, the
Texas Department of Human Services, the Texas Department of
Mental Health and Mental Retardation, and other agencies with
which each of those agencies contracts, do not duplicate their
procedures or subject health care facilities to duplicative
rules.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 222.022. DEFINITIONS. In this subchapter:
(1) "Health care facility" has the meaning assigned by Section
104.002, except that the term does not include a treatment
facility licensed by the Texas Commission on Alcohol and Drug
Abuse.
(2) "Inspection" includes a survey, inspection, investigation,
or other procedure necessary for a state agency to carry out an
obligation imposed by federal and state laws, rules, and
regulations.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 222.023. LIMITATION ON INSPECTIONS. (a) A state agency
may make or require only those inspections necessary to carry out
obligations imposed on the agency by federal and state laws,
rules, and regulations.
(b) Instead of making an on-site inspection, a state agency
shall accept an on-site inspection by another state agency
charged with making an inspection if the inspection substantially
complies with the accepting agency's inspection requirements.
(c) A state agency shall coordinate its inspections within the
agency and with inspections required of other agencies to ensure
compliance with this section.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 222.024. CERTIFICATION OR ACCREDITATION INSTEAD OF
INSPECTION. (a) Except as provided by Subsection (c), a
hospital licensed by the Texas Department of Health is not
subject to additional annual licensing inspections before the
department issues the hospital a license while the hospital
maintains:
(1) certification under Title XVIII of the Social Security Act
(42 U.S.C. Section 1395 et seq.); or
(2) accreditation from the Joint Commission on Accreditation of
Healthcare Organizations, the American Osteopathic Association,
or other national accreditation organization for the offered
services.
(b) If the department licenses a hospital exempt from an annual
licensing inspection under Subsection (a), the department shall
issue a renewal license to the hospital if the hospital annually:
(1) submits a complete application required by the department;
(2) remits any applicable fees;
(3) submits a copy of documentation from the certification or
accreditation body showing that the hospital is certified or
accredited; and
(4) submits a copy of the most recent fire safety inspection
report from the fire marshal in whose jurisdiction the hospital
is located.
(c) The department may conduct an inspection of a hospital
exempt from an annual licensing inspection under Subsection (a)
before issuing a renewal license to the hospital if the
certification or accreditation body has not conducted an on-site
inspection of the hospital in the preceding three years and the
department determines that an inspection of the hospital by the
certification or accreditation body is not scheduled within 60
days.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 1993, 73rd Leg., ch. 584, Sec. 16, eff. Sept. 1,
1993; Acts 1997, 75th Leg., ch. 223, Sec. 1, eff. Sept. 1, 1997.
Sec. 222.025. LIMITATION OF OTHER REGULATION. (a) The Texas
Department of Human Services, the Texas Department of Health, and
the Texas Department of Mental Health and Mental Retardation each
by rule shall execute a memorandum of understanding that
establishes procedures to eliminate or reduce duplication of
functions in certifying or licensing hospitals, nursing homes, or
other facilities under their jurisdiction for payments under the
requirements of Chapter 32, Human Resources Code, and federal law
and regulations relating to Titles XVIII and XIX of the Social
Security Act (42 U.S.C. Sections 1395 et seq. and 1396 et seq.).
The procedures must provide for use by each agency of information
collected by the agencies in making inspections for certification
purposes and in investigating complaints regarding matters that
would affect the certification of a nursing home or other
facility under their jurisdiction.
(b) The Texas Department of Health shall coordinate all
licensing or certification procedures conducted by the state
agencies covered by this section.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 222.0255. NURSING HOMES. (a) The Texas Department of
Human Services shall develop one set of standards for nursing
homes that apply to licensing and to certification for
participation in the medical assistance program under Chapter 32,
Human Resources Code.
(b) The standards must comply with federal regulations. If the
federal regulations at the time of adoption are less stringent
than the state standards, the department shall keep and comply
with the state standards.
(c) The department by rule shall adopt the standards and any
amendments to the standards.
(d) The department shall maintain a set of standards for nursing
homes that are licensed only.
(e) Chapter 242 establishes the minimum licensing standards for
an institution. The licensing standards adopted by the department
under this chapter shall be adopted subject to Section 242.037(b)
and must comply with Section 242.037(c) and the other provisions
of Chapter 242.
Added by Acts 1991, 72nd Leg., ch. 14, Sec. 64, eff. Sept. 1,
1991. Amended by Acts 1995, 74th Leg., ch. 76, Sec. 8.079, eff.
Sept. 1, 1995; Acts 1997, 75th Leg., ch. 1159, Sec. 1.32, eff.
Sept. 1, 1997.
Sec. 222.026. COMPLAINT INVESTIGATIONS AND ENFORCEMENT
AUTHORITY. (a) Sections 222.024, 222.025, and 222.0255 do not
affect the authority of the Texas Department of Health to
implement and enforce the provisions of Chapter 241 (Texas
Hospital Licensing Law) to:
(1) reinspect a hospital if a hospital applies for the
reissuance of its license after a final ruling upholding the
suspension or revocation of a hospital's license, the assessment
of administrative or civil penalties, or the issuance of an
injunction against the hospital for violations of provisions of
the licensing law, rules adopted under the licensing law, special
license conditions, or orders of the commissioner of health; or
(2) investigate a complaint against a hospital and, if
appropriate, enforce the provisions of the licensing law on a
finding by the department that reasonable cause exists to believe
that the hospital has violated provisions of the licensing law,
rules adopted under the licensing law, special license
conditions, or orders of the commissioner of health; provided,
however, that the department shall coordinate with the federal
Health Care Financing Administration and its agents responsible
for the inspection of hospitals to determine compliance with the
conditions of participation under Title XVIII of the Social
Security Act (42 U.S.C. Section 1395 et seq.), so as to avoid
duplicate investigations.
(b) The department shall by rule establish a procedure for the
acceptance and timely review of complaints received from
hospitals concerning the objectivity, training, and
qualifications of the persons conducting the inspection.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 1991, 72nd Leg., ch. 14, Sec. 64, eff. Sept. 1,
1991; Acts 1993, 73rd Leg., ch. 584, Sec. 17, eff. Sept. 1, 1993.
Sec. 222.027. PHYSICIAN ON SURVEY TEAM. The Texas Department of
Health shall ensure that a licensed physician involved in direct
patient care as defined by the Texas State Board of Medical
Examiners is included on a survey team sent under Title XVIII of
the Social Security Act (42 U.S.C. Section 1395 et seq.) when
surveying the quality of services provided by physicians in
hospitals.
Added by Acts 1991, 72nd Leg., ch. 14, Sec. 63, eff. Sept. 1,
1991.
SUBCHAPTER C. SURVEYS OF INTERMEDIATE CARE FACILITIES FOR
MENTALLY RETARDED
Sec. 222.041. DEFINITIONS. In this subchapter:
(1) "Board" means the Texas Board of Human Services.
(2) "Commissioner" means the commissioner of human services.
(3) "Department" means the Texas Department of Human Services.
(4) "ICF-MR" means the medical assistance program serving
persons receiving care in intermediate care facilities for
mentally retarded persons.
Added by Acts 1991, 72nd Leg., ch. 14, Sec. 65, eff. Sept. 1,
1991. Amended by Acts 1995, 74th Leg., ch. 76, Sec. 8.080, eff.
Sept. 1, 1995.
Sec. 222.042. LICENSING OF ICF-MR BEDS AND FACILITIES. The
department may not license or approve as meeting licensing
standards new ICF-MR beds or the expansion of an existing ICF-MR
facility unless the new beds or the expansion was included in the
plan approved by the Health and Human Services Commission in
accordance with Section 533.062.
Added by Acts 1991, 72nd Leg., ch. 14, Sec. 65, eff. Sept. 1,
1991. Amended by Acts 1993, 73rd Leg., ch. 646, Sec. 1, eff. Aug.
30, 1993; Acts 1993, 73rd Leg., ch. 747, Sec. 26, eff. Sept. 1,
1993.
Sec. 222.043. REVIEW OF ICF-MR SURVEYS. (a) The board by rule
shall establish policies and procedures as prescribed by this
section to conduct an informal review of ICF-MR surveys when the
survey findings are disputed by the provider. The board shall
provide that the procedure may be used only if the deficiencies
cited in the survey report do not pose an imminent threat of
danger to the health or safety of a resident.
(b) The department shall designate at least one employee to
conduct on a full-time basis the review provided by this section.
The person must be impartial and may not be directly involved in
or supervise any initial or recertification surveys. The person
may participate in or direct follow-up surveys for quality
assurance purposes only at the discretion of the commissioner or
the commissioner's designated representative or under Chapter
242.
(c) The employee designated under Subsection (b) should have
current knowledge of applicable federal laws and survey
processes. The employee reports directly to the commissioner or
the commissioner's designated representative.
(d) If a provider disputes the findings of a survey team or
files a complaint relating to the conduct of the survey, the
employee designated under Subsection (b) shall conduct an
informal review as soon as possible, but before the 45th day
after the date of receiving the request for a review or the
expiration of the period during which the provider is required to
correct the alleged deficiency, whichever is sooner.
(e) The employee conducting the review shall sustain, alter, or
reverse the original findings of the survey team after consulting
with the commissioner or the commissioner's designated
representative.
Added by Acts 1991, 72nd Leg., ch. 14, Sec. 65, eff. Sept. 1,
1991. Amended by Acts 1995, 74th Leg., ch. 76, Sec. 8.081, eff.
Sept. 1, 1995.
Sec. 222.044. FOLLOW-UP SURVEYS. (a) The department shall
conduct follow-up surveys of ICF-MR facilities to:
(1) evaluate and monitor the findings of the certification or
licensing survey teams; and
(2) ensure consistency in deficiencies cited and in punitive
actions recommended throughout the state.
(b) A provider shall correct any additional deficiency cited by
the department. The department may not impose an additional
punitive action for the deficiency unless the provider fails to
correct the deficiency within the period during which the
provider is required to correct the deficiency.
Added by Acts 1991, 72nd Leg., ch. 14, Sec. 65, eff. Sept. 1,
1991. Amended by Acts 1995, 74th Leg., ch. 76, Sec. 8.082, eff.
Sept. 1, 1995.
Sec. 222.046. SURVEYS OF ICF-MR FACILITIES. (a) The department
shall ensure that each survey team sent to survey an ICF-MR
facility includes a qualified mental retardation professional, as
that term is defined by federal law.
(b) The department shall require that each survey team sent to
survey an ICF-MR facility conduct a final interview with the
provider to ensure that the survey team informs the provider of
the survey findings and that the survey team has requested the
necessary information from the provider. The survey team shall
allow the provider to record the interview. The provider shall
immediately give the survey team a copy of any recording.
Added by Acts 1991, 72nd Leg., ch. 14, Sec. 65, eff. Sept. 1,
1991.