By McDonald, et al.                                   H.B. No. 1551
                                 A BILL TO BE ENTITLED
    1-1                                AN ACT
    1-2  relating to home care and community support services.
    1-3        BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
    1-4        SECTION 1.  The chapter heading of Chapter 142, Health and
    1-5  Safety Code, is amended to read as follows:
    1-6    CHAPTER 142.  HOME CARE AND COMMUNITY SUPPORT <HEALTH> SERVICES
    1-7        SECTION 2.  The heading of Subchapter A, Chapter 142, Health
    1-8  and Safety Code, is amended to read as follows:
    1-9        SUBCHAPTER A.  HOME CARE AND COMMUNITY SUPPORT <HEALTH>
   1-10                           SERVICES LICENSES
   1-11        SECTION 3.  Section 142.001, Health and Safety Code, is
   1-12  amended to read as follows:
   1-13        Sec. 142.001.  Definitions.  In this chapter:
   1-14              (1)  "Certified agency" means a person who:
   1-15                    (A)  provides a home health service; and
   1-16                    (B)  is certified by an official of the United
   1-17  States Department of Health and Human Services as in compliance
   1-18  with conditions of participation in Title XVIII, Social Security
   1-19  Act (42 U.S.C. Section 1395 et seq.).
   1-20              (2)  "Council" means the Home Care and Community
   1-21  Support <Health Services> Advisory Council.
   1-22              (3)  "Home health <Health> service" means provision of
   1-23  one or more of the following health services required by an
   1-24  individual within a residence or independent living environment:
    2-1                    (A)  nursing;
    2-2                    (B)  physical, occupational, speech, or
    2-3  respiratory therapy;
    2-4                    (C)  a medical social service;
    2-5                    (D)  services provided by unlicensed personnel
    2-6  under the delegation of a registered nurse or physical therapist
    2-7  <the service of a home health aide>;
    2-8                    (E)  the furnishing of medical equipment and
    2-9  supplies, excluding drugs and medicines; or
   2-10                    (F)  nutritional counseling.
   2-11              (4)  "Home care and community support <health> agency"
   2-12  means a place of business<, including a hospice,> that provides <a>
   2-13  home health or personal assistance service for pay or other
   2-14  consideration in a client's residence or independent living
   2-15  environment <service>.
   2-16              (5)  "Hospice" is a specialized concept of care that
   2-17  uses an interdisciplinary approach to deliver medical, social,
   2-18  psychological, emotional, spiritual, and bereavement care to the
   2-19  terminally ill client and the client's family <"Home health
   2-20  service" means the provision, for pay or other consideration, of a
   2-21  health service in a patient's residence.  The term does not include
   2-22  the provision of care under an attendant care program administered
   2-23  by the Texas Department of Human Services>.
   2-24              (6)  "Independent living environment" means:
   2-25                    (A)  a client's individual residence, which may
   2-26  include a group home or foster home; and
   2-27                    (B)  other settings in which the client
    3-1  participates in activities including, but not limited to, school,
    3-2  work, or church.
    3-3              (7)  "Person" means an individual, partnership,
    3-4  corporation, or association.
    3-5              (8)  "Personal assistance service" means routine
    3-6  ongoing care or services required by an individual in a residence
    3-7  or independent living environment to engage in the activities of
    3-8  daily living or to perform the physical functions required for
    3-9  independent living, including respite services.  The term includes
   3-10  health-related services performed under circumstances defined as
   3-11  not constituting the practice of professional nursing by the Board
   3-12  of Nurse Examiners through a memorandum of understanding with the
   3-13  department in accordance with Section 142.016 and health-related
   3-14  tasks provided by unlicensed personnel under the delegation of a
   3-15  registered nurse.
   3-16              (9) <(7)>  "Place of business" means an office of a
   3-17  home care and community support <health> agency that maintains
   3-18  client <patient> records or directs home health or personal
   3-19  assistance services.  The term includes a suboffice, a branch
   3-20  office, a workroom, or any other subsidiary location.
   3-21              (10) <(8)>  "Residence" means a place where a person
   3-22  resides and includes a home, a nursing home, or a convalescent home
   3-23  <for the disabled or aged>.
   3-24              (11)  "Respite services" are any support options
   3-25  provided on a short-term basis for the purpose of relief to the
   3-26  primary caregiver in providing care to individuals of all ages with
   3-27  disabilities or children or adults at risk of abuse or neglect.
    4-1        SECTION 4.  Section 142.002(a), Health and Safety Code, is
    4-2  amended to read as follows:
    4-3        (a)  A person may not engage in the business of providing
    4-4  home health or personal assistance  services without an appropriate
    4-5  license issued by the department for each place of business from
    4-6  which the <home health> services are directed.  A certified agency
    4-7  must have a Class A license, and any other person must have a Class
    4-8  B license.
    4-9        SECTION 5.  Section 142.0025, Health and Safety Code, is
   4-10  amended to read as follows:
   4-11        Sec. 142.0025.  Temporary License.  If a person is in the
   4-12  process of becoming certified by the United States Department of
   4-13  Health and Human Services to qualify as a certified agency, the
   4-14  department may issue a temporary Class A home care and community
   4-15  support <health> service license to the person.  A temporary
   4-16  license is effective as provided by board rules.
   4-17        SECTION 6.  Section 142.003, Health and Safety Code, is
   4-18  amended to read as follows:
   4-19        Sec. 142.003.  Exemptions From Licensing Requirement.  The
   4-20  following persons need not be licensed under this chapter:
   4-21              (1)  a physician, dentist, registered nurse, or
   4-22  physical therapist licensed under the laws of this state who
   4-23  provides home health services to a patient only as a part of and
   4-24  incidental to that person's private office practice;
   4-25              (2)  a registered nurse, licensed vocational nurse,
   4-26  physical therapist, occupational therapist, speech therapist,
   4-27  medical social worker, or any other health care professional as
    5-1  determined by the department who provides home health services as a
    5-2  sole practitioner;
    5-3              (3)  a <nonprofit> registry <operated by a national or
    5-4  state professional association or society of licensed health care
    5-5  practitioners, or a subdivision of the association or society,>
    5-6  that operates solely as a clearinghouse to put consumers in contact
    5-7  with persons who provide home health or personal assistance
    5-8  services <licensed health care practitioners who give care in a
    5-9  patient's residence> and that does not maintain official client
   5-10  <patient> records, <or> direct client <patient> services, or
   5-11  compensate the person providing the service;
   5-12              (4)  an individual whose permanent residence is in the
   5-13  client's <patient's>  residence;
   5-14              (5)  an employee of a person licensed under this
   5-15  chapter who provides home health or personal assistance services
   5-16  only as an employee of the license holder and who receives no
   5-17  benefit for providing the services, other than wages from the
   5-18  license holder;
   5-19              (6)  a home, nursing home, convalescent home, personal
   5-20  care facility, or other institution for individuals who are elderly
   5-21  or who have disabilities <the disabled or aged> that provides home
   5-22  health or personal assistance services only to residents of the
   5-23  home or institution;
   5-24              (7)  a person who provides one health service through a
   5-25  contract with a person licensed under this chapter;
   5-26              (8)  a durable medical equipment supply company;
   5-27              (9)  a pharmacy or wholesale medical supply company
    6-1  that does not furnish services, other than supplies, to a person at
    6-2  the person's house;
    6-3              (10)  a hospital or other licensed health care facility
    6-4  that serves only inpatient residents;
    6-5              (11)  a person providing home health or personal
    6-6  assistance services to an injured employee under the Texas Workers'
    6-7  Compensation Act (Article 8308-1.01 et seq., Vernon's Texas Civil
    6-8  Statutes); <workers' compensation laws of this state (Article 8306
    6-9  et seq., Revised Statutes); or>
   6-10              (12)  a visiting nurse service that:
   6-11                    (A)  is conducted by and for the adherents of a
   6-12  well-recognized church or religious denomination; and
   6-13                    (B)  provides nursing services by a person exempt
   6-14  from licensing by Article 4528, Revised Statutes, because the
   6-15  person furnishes nursing care in which treatment is only by prayer
   6-16  or spiritual means;
   6-17              (13)  an individual hired and paid directly by the
   6-18  client or the client's family or legal guardian to provide home
   6-19  health or personal assistance services;
   6-20              (14)  a business, school, camp, or other organization
   6-21  that provides home health or personal assistance services solely to
   6-22  its employees, students, or persons with a similar relationship to
   6-23  the business, camp, or school;
   6-24              (15)  a person or organization providing
   6-25  sitter/companion services or chore or household services and not
   6-26  involving personal care or health or health-related services; and
   6-27              (16)  state agencies and each mental retardation
    7-1  authority and mental health authority providing the direct delivery
    7-2  of home health or personal assistance services.  This provision is
    7-3  in effect until August 31, 1995.
    7-4        SECTION 7.  Section 142.004, Health and Safety Code, is
    7-5  amended to read as follows:
    7-6        Sec. 142.004.  License Application.  (a)  An applicant for a
    7-7  license to provide a home health or personal assistance service
    7-8  must:
    7-9              (1)  file a written application on a form prescribed by
   7-10  the department;
   7-11              (2)  file with the application:
   7-12                    (A)  the name of the owner of the service or a
   7-13  list of the names of persons who own an interest in the service;
   7-14  and
   7-15                    (B)  a list of any businesses with which the
   7-16  service subcontracts and in which the owner or owners of the
   7-17  service hold at least five percent of the ownership;
   7-18              (3)  cooperate with any inspections required by the
   7-19  department for a license; and
   7-20              (4)  pay the license fee prescribed by this chapter.
   7-21        (b)  In addition to the requirements of Subsection (a), if
   7-22  the applicant is a certified agency when the application for a
   7-23  Class A license is filed, the applicant must maintain its Medicare
   7-24  certification.  If the applicant is not a certified agency when the
   7-25  application for a Class A license is filed, the applicant must
   7-26  establish that it is in the process of receiving its certification
   7-27  from the United States Department of Health and Human Services.
    8-1        (c)  The board by rule shall require that, at a minimum,
    8-2  before the department may approve a license application, other than
    8-3  an application for renewal or branch office license, the applicant
    8-4  must provide to the department:
    8-5              (1)  documentation establishing that, at a minimum, the
    8-6  applicant has sufficient financial resources to provide the
    8-7  services required by this chapter and by the department during the
    8-8  term of the license;
    8-9              (2)  a list of the management personnel for the
   8-10  proposed home care and community support <health> agency, a
   8-11  description of personnel qualifications, and a plan for providing
   8-12  continuing training and education for the personnel during the term
   8-13  of the license;
   8-14              (3)  documentation establishing that the applicant is
   8-15  capable of meeting the minimum standards established by the board
   8-16  relating to the quality of care; and
   8-17              (4)  a plan that provides for the orderly transfer of
   8-18  care of the applicant's clients if the applicant cannot maintain or
   8-19  deliver home health or personal assistance services under the
   8-20  license.
   8-21        SECTION 8.  Section 142.005(a), Health and Safety Code, is
   8-22  amended to read as follows:
   8-23        (a)  If an applicant for a license, other than a renewal or
   8-24  branch office license, proposes to operate a home care and
   8-25  community support <health> agency through a partnership,
   8-26  corporation, or other business entity that includes members that
   8-27  are not individuals, or through a corporation in which any of the
    9-1  shares <of which> are owned by another corporation, the applicant
    9-2  must:
    9-3              (1)  establish a corporation under the laws of this
    9-4  state if the applicant is not a corporation organized under the
    9-5  laws of this state;
    9-6              (2)  allow the department to review the competence and
    9-7  financial resources of any shareholder who holds at least 10
    9-8  percent of the shares of the Texas corporation;
    9-9              (3)  allow the department to review the history and
   9-10  financial resources of each parent or health-related subsidiary of
   9-11  the Texas corporation;
   9-12              (4)  grant the Texas corporation full authority to
   9-13  operate the home care and community support <health>  agency and
   9-14  any subsequent home care and community support <health> agencies
   9-15  for which the applicant may seek licensing under this chapter;
   9-16              (5)  disclose to the department any information the
   9-17  department needs to conduct the reviews authorized by this
   9-18  subsection; and
   9-19              (6)  establish a registered agent as required by
   9-20  Article 2.09, Texas Business Corporation Act, to receive service of
   9-21  process in this state.
   9-22        SECTION 9.  Section 142.006, Health and Safety Code, is
   9-23  amended by amending Subsection (a) and adding Subsections (c), (d),
   9-24  and (e) to read as follows:
   9-25        (a)  The department shall issue a Class A or Class B home
   9-26  care and community support <health> service license for each place
   9-27  of business to each applicant who:
   10-1              (1)  qualifies for the type of license requested;
   10-2              (2)  submits an application and license fee as required
   10-3  by this chapter; and
   10-4              (3)  complies with all licensing standards required or
   10-5  adopted by the board under this chapter.
   10-6        (c)  The department may find that a home care and community
   10-7  support agency has satisfied the requirements for license renewal
   10-8  if the agency is accredited by a national organization, such as the
   10-9  Joint Commission on Accreditation of Health Organizations or the
  10-10  Community Health Care Accreditation Program, and the department
  10-11  finds that the accreditation organization has standards that meet
  10-12  or exceed the requirements for licensure under this chapter.  A
  10-13  renewal fee is required of the home care and community support
  10-14  agency at the time of license renewal.
  10-15        (d)  The department may find that a home care and community
  10-16  support agency has satisfied the requirements for license renewal
  10-17  if the agency is certified by any state agency that has
  10-18  certification standards that meet or exceed the requirements for
  10-19  licensure under this chapter.
  10-20        (e)  The license must designate the type of services that the
  10-21  place of business is authorized to perform.
  10-22        SECTION 10.  Section 142.007, Health and Safety Code, is
  10-23  repealed.
  10-24        SECTION 11.  Section 142.009, Health and Safety Code, is
  10-25  amended by amending Subsections (b), (c), (d), and (e) and adding
  10-26  Subsections (f) and (g) to read as follows:
  10-27        (b)  A home care and community support <health> agency shall
   11-1  provide each person who receives home health or personal assistance
   11-2  services with a written statement that contains the name, address,
   11-3  and telephone number of the department and a statement that informs
   11-4  consumers that a complaint against a home care and community
   11-5  support <health> agency may be directed to the department.
   11-6        (c)  The department or its authorized representative shall
   11-7  investigate each complaint received regarding the provision of home
   11-8  health or personal assistance services and may, as a part of the
   11-9  investigation:
  11-10              (1)  conduct an unannounced inspection of a place of
  11-11  business, including an inspection of medical and personnel records,
  11-12  if the department has reasonable cause to believe that the place of
  11-13  business is in violation of this chapter or a rule adopted under
  11-14  this chapter;
  11-15              (2)  conduct an interview with a recipient of home
  11-16  health or personal assistance services, which may be conducted in
  11-17  the recipient's home if the recipient consents; or
  11-18              (3)  interview a physician or other health care
  11-19  practitioner, including a member of the personnel of a home care
  11-20  and community support <health> agency, who cares for a recipient of
  11-21  home health or personal assistance services.
  11-22        (d)  The reports, records, and working papers used or
  11-23  developed in an investigation made under this section are
  11-24  confidential and may not be released or made public except as
  11-25  follows:
  11-26              (1)  to state and federal agencies;
  11-27              (2)  to federal, state, or local law enforcement
   12-1  personnel;
   12-2              (3)  with the consent of each person identified in the
   12-3  information released;
   12-4              (4)  in civil or criminal litigation matters or
   12-5  licensure proceedings as otherwise allowed by law or judicial rule;
   12-6  or
   12-7              (5)  on a form developed by the department that
   12-8  identifies the deficiencies found, if any, without identifying any
   12-9  person, other than the agency.
  12-10        (e)  The department's representative shall hold a conference
  12-11  with the person in charge of the home care and community support
  12-12  <health> agency before beginning the on-site inspection to explain
  12-13  the nature and scope of the inspection.  When the inspection is
  12-14  completed, the department's representative shall hold a conference
  12-15  with the person who is in charge of the agency and shall identify
  12-16  any records that were duplicated.  Agency records may be removed
  12-17  from an agency only with the agency's consent.
  12-18        (f)  An agency licensed by the department as a home care and
  12-19  community support agency is not subject to additional licensure
  12-20  inspections relative to home health or personal assistance services
  12-21  while the agency maintains accreditation for the applicable
  12-22  service(s) from the Joint Commission for Accreditation of Health
  12-23  Care Organizations (JCAHO), Community Health Accreditation Program
  12-24  (CHAP), or other national accreditation organizations that meet or
  12-25  exceed the regulations under the Home Care and Community Support
  12-26  Act.  Documentation from the accrediting body indicating that the
  12-27  provider is accredited must be submitted to the department at the
   13-1  time of the initial licensure and annually on license renewal.
   13-2        (g)  The department and other state agencies under the Health
   13-3  and Human Services Commission contracting with home care and
   13-4  community support agencies to deliver services covered under this
   13-5  chapter shall execute a memorandum of understanding that
   13-6  establishes procedures to eliminate or reduce duplication of
   13-7  standards or conflicts between standards and in functions in
   13-8  license, certification, or compliance surveys and complaint
   13-9  investigations.  The Health and Human Services Commission shall
  13-10  approve the memorandum of understanding and review the
  13-11  recommendations of the Home Care and Community Support Services
  13-12  Advisory Council pertaining to the memorandum of understanding
  13-13  before its approval.
  13-14        SECTION 12.  Section 142.010, Health and Safety Code, is
  13-15  amended by amending Subsection (a) and adding Subsection (c) to
  13-16  read as follows:
  13-17        (a)  The board shall set the home care and community support
  13-18  <health> service license fees in amounts that are reasonable to
  13-19  meet the costs of administering this chapter, except that the fees
  13-20  may not be:
  13-21              (1)  less than $200 <$600> or more than $1,000 <$1,200>
  13-22  for an initial Class A or Class B license; or
  13-23              (2)  less than $200 or more than $300 for renewal of a
  13-24  branch office license.
  13-25        (c)  The board shall consider the size of the home care and
  13-26  community support agency, the number of clients served, and other
  13-27  accreditation documentation when determining the initial and
   14-1  renewal license fee.
   14-2        SECTION 13.  Section 142.011(c), Health and Safety Code, is
   14-3  amended to read as follows:
   14-4        (c)  The department may suspend or revoke the license of a
   14-5  Class A home care and community support <health> agency that fails
   14-6  to maintain its certification qualifying the agency as a certified
   14-7  agency.  A Class A <home health> agency that submits a request for
   14-8  a hearing as provided by Subsection (d) is subject to the
   14-9  requirements of this chapter relating to a Class B <home health>
  14-10  agency until the suspension or revocation is finally determined by
  14-11  the department or, if the license is suspended or revoked, until
  14-12  the last day for seeking review of the department order or a later
  14-13  date fixed by order of the reviewing court.
  14-14        SECTION 14.  Sections 142.012(a), (b), and (d), Health and
  14-15  Safety Code, are amended to read as follows:
  14-16        (a)  The board with recommendations of the Home Care and
  14-17  Community Support Advisory Council shall adopt rules necessary to
  14-18  implement this chapter.
  14-19        (b)  The board by rule shall set minimum standards for home
  14-20  care and community support <health> agencies licensed under this
  14-21  chapter that relate to:
  14-22              (1)  qualifications for professional and
  14-23  nonprofessional personnel;
  14-24              (2)  supervision of professional and nonprofessional
  14-25  personnel;
  14-26              (3)  the provision and coordination of treatment and
  14-27  services;
   15-1              (4)  the management, ownership, and organizational
   15-2  structure, including lines of authority and delegation of
   15-3  responsibility;
   15-4              (5)  clinical and business records;
   15-5              (6)  financial ability to carry out the functions as
   15-6  proposed; and
   15-7              (7)  any other aspects of home health or personal
   15-8  assistance services as necessary to protect the public.
   15-9        (d)  The department shall require each person or home care
  15-10  and community support <health> agency providing home health or
  15-11  personal assistance services to implement and enforce the
  15-12  applicable provisions of Chapter 102, Human Resources Code.
  15-13        SECTION 15.  Section 142.014(a), Health and Safety Code, is
  15-14  amended to read as follows:
  15-15        (a)  A person who operates a home care and community support
  15-16  <health> agency without a license issued under this chapter
  15-17  authorizing it to perform such services is liable for a civil
  15-18  penalty of not less than $100 or more than $500 for each day of
  15-19  violation.
  15-20        SECTION 16.  Section 142.015(a), Health and Safety Code, is
  15-21  amended to read as follows:
  15-22        (a)  The Home Care and Community Support <Health> Services
  15-23  Advisory Council is composed of the following 12 <11> members,
  15-24  appointed by the governor:
  15-25              (1)  three consumer representatives <one representative
  15-26  of the department>;
  15-27              (2)  one representative of the Texas Association for
   16-1  Home Care, Incorporated, or its successor <two representatives of
   16-2  consumers of home health agency and hospice services>;
   16-3              (3)  two representatives of Class A agencies providing
   16-4  home health services <one representative of the Texas Department of
   16-5  Human Services>;
   16-6              (4)  two representatives of Class B agencies providing
   16-7  home health services <one representative of the Texas Association
   16-8  of Home Health Agencies, Incorporated>;
   16-9              (5)  two representatives of agencies providing hospice
  16-10  services <one representative of private nonprofit home health
  16-11  agencies>; and
  16-12              (6)  two representatives of agencies providing personal
  16-13  assistance services <one representative of voluntary nonprofit home
  16-14  health agencies;>
  16-15              <(7)  one representative of proprietary home health
  16-16  agencies;>
  16-17              <(8)  one representative of an official department home
  16-18  health agency;>
  16-19              <(9)  one member to represent Medicare-certified Class
  16-20  A hospice providers affiliated with a home health agency, hospital,
  16-21  or other health service provider; and>
  16-22              <(10)  one member to represent Medicare-certified Class
  16-23  A hospice providers not affiliated with a home health agency,
  16-24  hospital, or other health service provider>.
  16-25        SECTION 17.  Subchapter A, Chapter 142, Health and Safety
  16-26  Code, is amended by adding Section 142.016 to read as follows:
  16-27        Sec. 142.016.  MEMORANDUM OF UNDERSTANDING RELATING TO
   17-1  NURSING SERVICES; GUIDELINES.  (a)  The Board of Nurse Examiners
   17-2  and the department shall adopt a memorandum of understanding
   17-3  governing the circumstances under which the provision of
   17-4  health-related tasks or services does not constitute the practice
   17-5  of professional nursing.  The agencies shall annually review and
   17-6  renew or modify the memorandum as necessary.
   17-7        (b)  In developing, modifying, or renewing the memorandum of
   17-8  understanding, the Board of Nurse Examiners and the department
   17-9  shall consult with an advisory committee appointed by the board and
  17-10  the department and composed of at least the following:
  17-11              (1)  one representative from the Board of Nurse
  17-12  Examiners and one representative from the Texas Department of
  17-13  Health to serve as cochair;
  17-14              (2)  one representative from the Texas Department of
  17-15  Mental Health and Mental Retardation;
  17-16              (3)  one representative from the Texas Department of
  17-17  Human Services;
  17-18              (4)  one representative from the Texas Nurses
  17-19  Association;
  17-20              (5)  one representative from the Texas Association of
  17-21  Home Care, Incorporated;
  17-22              (6)  one representative of the Texas Respite Resource
  17-23  Network; and
  17-24              (7)  two representatives of organizations that advocate
  17-25  for clients in community-based settings (e.g., the Personal
  17-26  Assistance Task Force, the Disability Policy Consortium).
  17-27        (c)  The department shall prepare guidelines based on the
   18-1  memorandum of understanding for agencies licensed under this
   18-2  chapter to use in providing personal assistance services to
   18-3  clients.
   18-4        SECTION 18.  Section 142.021, Health and Safety Code, is
   18-5  amended to read as follows:
   18-6        Sec. 142.021.  ADMINISTRATION OF <Permits to Administer>
   18-7  Medication.  A person may not administer medication to a client
   18-8  <patient> of a home care and community support <health> agency
   18-9  unless the person:
  18-10              (1)  holds a license under state law that authorizes
  18-11  the person to administer medication;
  18-12              (2)  holds a permit issued under Section 142.025 and
  18-13  acts under the delegated authority of a person who holds a license
  18-14  under state law that authorizes the person to administer
  18-15  medication; <or>
  18-16              (3)  performs duties as a qualified dialysis technician
  18-17  within the scope authorized by board rules;
  18-18              (4)  administers a medication to a client in accordance
  18-19  with rules of the Board of Nurse Examiners permitting the
  18-20  delegation of the administration to persons not holding permits
  18-21  under Section 142.025; or
  18-22              (5)  administers noninjectable medication under
  18-23  circumstances defined by the memorandum of understanding adopted
  18-24  under Section 142.016 as not constituting the practice of
  18-25  professional nursing.
  18-26        SECTION 19.  Section 142.023, Health and Safety Code, is
  18-27  amended to read as follows:
   19-1        Sec. 142.023.  Rules for Administration of Medication.  The
   19-2  board by rule shall establish:
   19-3              (1)  minimum requirements for the issuance, denial,
   19-4  renewal, suspension, emergency suspension, and revocation of a
   19-5  permit to a home health <administer> medication aide <to a patient
   19-6  of a home health agency>;
   19-7              (2)  curricula to train a home health <persons to
   19-8  administer> medication aide <to a patient of a home health agency>;
   19-9              (3)  minimum standards for the approval of home health
  19-10  medication aide training programs <to train persons to administer
  19-11  medication to patients of home health agencies> and for rescinding
  19-12  approval;
  19-13              (4)  the acts and practices that are allowed or
  19-14  prohibited to a permit holder; and
  19-15              (5)  minimum standards for on-site supervision of a
  19-16  permit holder by a registered nurse.
  19-17        SECTION 20.  Section 142.024, Health and Safety Code, is
  19-18  amended to read as follows:
  19-19        Sec. 142.024.  HOME HEALTH MEDICATION AIDE Training Programs
  19-20  <to Administer Medication>.  (a)  An application for the approval
  19-21  of a home health medication aide training program must be made to
  19-22  the department on a form and under rules prescribed by the board.
  19-23        (b)  The department shall approve a home health medication
  19-24  aide training program that meets the minimum standards adopted
  19-25  under Section 142.023.  The department may review the approval
  19-26  annually.
  19-27        SECTION 21.  Section 142.025, Health and Safety Code, is
   20-1  amended to read as follows:
   20-2        Sec. 142.025.  Issuance and Renewal of HOME HEALTH MEDICATION
   20-3  AIDE Permit <to Administer Medication>.  (a)  To be issued or to
   20-4  have renewed a home health medication aide permit <to administer
   20-5  medication>, a person shall apply to the department on a form
   20-6  prescribed and under rules adopted by the board.
   20-7        (b)  The department shall prepare and conduct an examination
   20-8  for the issuance of a permit.
   20-9        (c)  The department shall require a permit holder to
  20-10  satisfactorily complete a continuing education course approved by
  20-11  the department for renewal of the permit.
  20-12        (d)  The department shall issue a permit or renew a permit to
  20-13  an applicant who:
  20-14              (1)  meets the minimum requirements adopted under
  20-15  Section 142.023;
  20-16              (2)  successfully completes the examination or the
  20-17  continuing education requirements; and
  20-18              (3)  pays a nonrefundable application fee determined by
  20-19  the board.
  20-20        (e)  A permit is valid for one year and is not transferable.
  20-21        SECTION 22.  The section heading to Section 142.026, Health
  20-22  and Safety Code, is amended to read as follows:
  20-23        Sec. 142.026.  Fees for Issuance and Renewal of HOME HEALTH
  20-24  MEDICATION AIDE Permit <to Administer Medication>.
  20-25        SECTION 23.  The section heading to Section 142.027, Health
  20-26  and Safety Code, is amended to read as follows:
  20-27        Sec. 142.027.  Violation of HOME HEALTH MEDICATION AIDE
   21-1  Permits <to Administer Medication>.
   21-2        SECTION 24.  The section heading to Section 142.028, Health
   21-3  and Safety Code, is amended to read as follows:
   21-4        Sec. 142.028.  Emergency Suspension of HOME HEALTH MEDICATION
   21-5  AIDE Permits <to Administer Medication>.
   21-6        SECTION 25.  Section 142.029(a), Health and Safety Code, is
   21-7  amended to read as follows:
   21-8        (a)  A person commits an offense if the person knowingly
   21-9  administers medication to a client <patient> of a home care and
  21-10  community support <health> agency and the person is not authorized
  21-11  to administer medication under Section 142.021 or 142.022<:>
  21-12              <(1)  does not hold a license under state law that
  21-13  authorizes the person to administer medication; or>
  21-14              <(2)  does not hold a permit issued by the department
  21-15  under Section 142.025>.
  21-16        SECTION 26.  Section 142.030(a), Health and Safety Code, is
  21-17  amended to read as follows:
  21-18        (a)  A person authorized by this subchapter to administer
  21-19  medication to a client <patient> of a home care and community
  21-20  support <health> agency may not dispense dangerous drugs or
  21-21  controlled substances without complying with the Texas Pharmacy Act
  21-22  (Article 4542a-1, Vernon's Texas Civil Statutes).
  21-23        SECTION 27.  Section 248.003, Health and Safety Code, is
  21-24  amended to read as follows:
  21-25        Sec. 248.003.  Exemptions.  This chapter does not apply to:
  21-26              (1)  a home care and community <health> agency required
  21-27  to be licensed under Chapter 142;
   22-1              (2)  a person required to be licensed under Chapter 241
   22-2  (Texas Hospital Licensing Law);
   22-3              (3)  an institution required to be licensed under
   22-4  Chapter 242;
   22-5              (4)  an ambulatory surgical center required to be
   22-6  licensed under Chapter 243 (Texas Ambulatory Surgical Center
   22-7  Licensing Act);
   22-8              (5)  a birthing center required to be licensed under
   22-9  Chapter 244 (Texas Birthing Center Licensing Act);
  22-10              (6)  a facility required to be licensed under Chapter
  22-11  245 (Texas Abortion Facility Reporting and Licensing Act); or
  22-12              (7)  a person providing medical or nursing care or
  22-13  services under a license or permit issued under other state law.
  22-14        SECTION 28.  (a)  The changes in law made to Sections 142.029
  22-15  and 142.030, Health and Safety Code, by this Act apply only to an
  22-16  offense committed on or after July 1, 1994.
  22-17        (b)  An offense committed before the effective date of this
  22-18  Act is covered by the law in effect when the offense was committed,
  22-19  and the former law is continued in effect for this purpose.
  22-20        SECTION 29.  The change made by this Act in the
  22-21  qualifications of members of the Home Care and Community Support
  22-22  Advisory Council (formerly the Home Health Services Advisory
  22-23  Council) does not affect the ability of a member serving
  22-24  immediately before the effective date of this Act to continue to
  22-25  serve for the term for which the member was appointed.
  22-26        SECTION 30.  Not later than January 31, 1994, the Board of
  22-27  Nurse Examiners and the Texas Department of Health shall adopt the
   23-1  initial memorandum of understanding required by Section 142.016,
   23-2  Health and Safety Code, as added by this Act.
   23-3        SECTION 31.  The changes in law made by this Act do not
   23-4  affect the validity of a license or a permit to administer
   23-5  medication issued by the Texas Department of Health before the
   23-6  effective date of this Act.  Regardless of the changes in law made
   23-7  by this Act, the department shall continue to issue licenses to
   23-8  qualified home health agencies, and the prior law is continued in
   23-9  effect for that purpose until final rules to implement this Act are
  23-10  adopted by the department and  become effective.  On or following
  23-11  the effective date of the rules and on renewal of a license or
  23-12  permit to administer medication issued by the department under
  23-13  Chapter 142, Health and Safety Code, the license or permit shall be
  23-14  conformed to the requirement of Chapter 142, Health and Safety
  23-15  Code, as amended by this Act.
  23-16        SECTION 32.  The Texas Department of Health shall propose
  23-17  rules to implement this Act by January 1, 1994.  The department
  23-18  shall adopt rules to implement this Act by June 1, 1994.
  23-19        SECTION 33.  The Texas Department of Health and other state
  23-20  agencies under the Health and Human Services Commission shall
  23-21  distribute to interested persons a draft of the memorandum of
  23-22  understanding required by Section 142.009(g), Health and Safety
  23-23  Code, as added by this Act, by January 1, 1994, and shall execute
  23-24  the initial memorandum of understanding required by that section by
  23-25  June 1, 1994.
  23-26        SECTION 34.  The changes in law made to Section 142.014,
  23-27  Health and Safety Code, by this Act apply only to violations
   24-1  occurring on or after July 1, 1994.
   24-2        SECTION 35.  A license as a home care and community support
   24-3  agency providing home health or personal assistance services shall
   24-4  not be required under Section 142.002, Health and Safety Code, as
   24-5  amended by this Act, until July 1, 1994.
   24-6        SECTION 36.  This Act takes effect September 1, 1993.
   24-7        SECTION 37.  The importance of this legislation and the
   24-8  crowded condition of the calendars in both houses create an
   24-9  emergency and an imperative public necessity that the
  24-10  constitutional rule requiring bills to be read on three several
  24-11  days in each house be suspended, and this rule is hereby suspended.