H.B. No. 1551
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 heading of Chapter 142, Health and Safety
1-5 Code, is amended to read as follows:
1-6 CHAPTER 142. HOME 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 AND COMMUNITY SUPPORT <HEALTH> SERVICES
1-10 LICENSE <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) "Administrative support site" means a facility or
1-15 site where a home and community support services agency performs
1-16 administrative and other support functions but does not provide
1-17 direct home health, hospice, or personal assistance services.
1-18 (2) "Alternate delivery site" means a facility or
1-19 site, including a residential unit or an inpatient unit:
1-20 (A) that is owned or operated by a hospice;
1-21 (B) that is not the hospice's principal place of
1-22 business;
1-23 (C) that is located in the geographical area
1-24 served by the hospice; and
2-1 (D) from which the hospice provides hospice
2-2 services.
2-3 (3) "Bereavement" means the process by which a
2-4 survivor of a deceased person mourns and experiences grief.
2-5 (4) "Bereavement services" means support services
2-6 offered to a family during bereavement.
2-7 (5) "Branch office" means a facility or site in the
2-8 geographical area served by a home and community support agency
2-9 where home health or personal assistance services are delivered or
2-10 active client records are maintained.
2-11 (6) "Certified agency" means a home and community
2-12 support services agency that <person who>:
2-13 (A) provides a home health service; and
2-14 (B) is certified by an official of the
2-15 Department of Health and Human Services as in compliance with
2-16 conditions of participation in Title XVIII, Social Security Act (42
2-17 U.S.C. Section 1395 et seq.).
2-18 (7) "Certified home health services" means home health
2-19 services that are provided by a certified agency.
2-20 (8) <(2)> "Council" means the Home and Community
2-21 Support <Health> Services Advisory Council.
2-22 (9) "Counselor" means an individual qualified under
2-23 Medicare standards to provide counseling services, including
2-24 bereavement, dietary, spiritual, and other counseling services, to
2-25 both the client and the family.
2-26 <(3) "Health service" means:>
2-27 <(A) nursing;>
3-1 <(B) physical, occupational, speech, or
3-2 respiratory therapy;>
3-3 <(C) a medical social service;>
3-4 <(D) the service of a home health aide;>
3-5 <(E) the furnishing of medical equipment and
3-6 supplies, excluding drugs and medicines; or>
3-7 <(F) nutritional counseling.>
3-8 (10) <(4)> "Home and community support services
3-9 <health> agency" means a person who provides home health, hospice,
3-10 or personal assistance services for pay or other consideration in a
3-11 client's residence, an independent living environment, or another
3-12 appropriate location <place of business, including a hospice, that
3-13 provides a home health service>.
3-14 (11) <(5)> "Home health service" means the provision
3-15 of one or more of the following health services required by an
3-16 individual in a residence or independent living environment:
3-17 (A) nursing;
3-18 (B) physical, occupational, speech, or
3-19 respiratory therapy;
3-20 (C) medical social service;
3-21 (D) intravenous therapy;
3-22 (E) dialysis;
3-23 (F) service provided by unlicensed personnel
3-24 under the delegation of a licensed health professional;
3-25 (G) the furnishing of medical equipment and
3-26 supplies, excluding drugs and medicines; or
3-27 (H) nutritional counseling<, for pay or other
4-1 consideration, of a health service in a patient's residence. The
4-2 term does not include the provision of care under an attendant care
4-3 program administered by the Texas Department of Human Services>.
4-4 (12) "Hospice" means a person licensed under this
4-5 chapter to provide hospice services, including a person who owns or
4-6 operates a residential unit or an inpatient unit.
4-7 (13) "Hospice services" means services, including
4-8 services provided by unlicensed personnel under the delegation of a
4-9 registered nurse or physical therapist, provided to a client or a
4-10 client's family as part of a coordinated program consistent with
4-11 the standards and rules adopted under this chapter. These services
4-12 include palliative care for terminally ill clients and support
4-13 services for clients and their families that:
4-14 (A) are available 24 hours a day, seven days a
4-15 week, during the last stages of illness, during death, and during
4-16 bereavement;
4-17 (B) are provided by a medically directed
4-18 interdisciplinary team; and
4-19 (C) may be provided in a home, nursing home,
4-20 residential unit, or inpatient unit according to need. These
4-21 services do not include inpatient care normally provided in a
4-22 licensed hospital to a terminally ill person who has not elected to
4-23 be a hospice client.
4-24 (14) "Inpatient unit" means a facility that provides a
4-25 continuum of medical or nursing care and other hospice services to
4-26 clients admitted into the unit and that is in compliance with:
4-27 (A) the conditions of participation for
5-1 inpatient units adopted under Title XVIII, Social Security Act (42
5-2 U.S.C. Section 1395 et seq.); and
5-3 (B) standards adopted under this chapter.
5-4 (15) "Independent living environment" means:
5-5 (A) a client's individual residence, which may
5-6 include a group home or foster home; or
5-7 (B) other settings where a client participates
5-8 in activities, including school, work, or church.
5-9 (16) "Interdisciplinary team" means a group of
5-10 individuals who work together in a coordinated manner to provide
5-11 hospice services and must include a physician, registered nurse,
5-12 social worker, and counselor.
5-13 (17) "Investigation" means an inspection or survey
5-14 conducted by a representative of the department to determine if a
5-15 licensee is in compliance with this chapter.
5-16 (18) "Palliative care" means intervention services
5-17 that focus primarily on the reduction or abatement of physical,
5-18 psychosocial, and spiritual symptoms of a terminal illness.
5-19 (19) <(6)> "Person" means an individual, corporation,
5-20 or association.
5-21 (20) "Personal assistance service" means routine
5-22 ongoing care or services required by an individual in a residence
5-23 or independent living environment that enable the individual to
5-24 engage in the activities of daily living or to perform the physical
5-25 functions required for independent living, including respite
5-26 services. The term includes health-related services performed
5-27 under circumstances that are defined as not constituting the
6-1 practice of professional nursing by the Board of Nurse Examiners
6-2 through a memorandum of understanding with the department in
6-3 accordance with Section 142.016 and health-related tasks provided
6-4 by unlicensed personnel under the delegation of a registered nurse.
6-5 (21) <(7)> "Place of business" means an office of a
6-6 home and community support services <health> agency that maintains
6-7 client <patient> records or directs home health, hospice, or
6-8 personal assistance services. The term does not include an
6-9 administrative support site <includes a suboffice, a branch office,
6-10 a workroom, or any other subsidiary location>.
6-11 (22) <(8)> "Residence" means a place where a person
6-12 resides and includes a home, a nursing home, <or> a convalescent
6-13 home, or a residential unit <for the disabled or aged>.
6-14 (23) "Residential unit" means a facility that provides
6-15 living quarters and hospice services to clients admitted into the
6-16 unit and that is in compliance with standards adopted under this
6-17 chapter.
6-18 (24) "Respite services" means support options that are
6-19 provided temporarily for the purpose of relief for a primary
6-20 caregiver in providing care to individuals of all ages with
6-21 disabilities or at risk of abuse or neglect.
6-22 (25) "Social worker" means an individual certified as
6-23 a social worker under Chapter 50, Human Resources Code.
6-24 (26) "Support services" means social, spiritual, and
6-25 emotional care provided to a client and a client's family by a
6-26 hospice.
6-27 (27) "Terminal illness" means an illness for which
7-1 there is a limited prognosis if the illness runs its usual course.
7-2 (28) "Volunteer" means an individual who provides
7-3 assistance to a home and community support services agency without
7-4 compensation other than reimbursement for actual expenses.
7-5 SECTION 4. Section 142.002, Health and Safety Code, is
7-6 amended to read as follows:
7-7 Sec. 142.002. License Required. (a) Except as provided by
7-8 Section 142.003, a <A> person, including a health care facility
7-9 licensed under this code, may not engage in the business of
7-10 providing home health, hospice, or personal assistance services, or
7-11 represent to the public that the person is a provider of home
7-12 health, hospice, or personal assistance services for pay <services>
7-13 without a home and community support services agency license
7-14 authorizing the person to perform those services <an appropriate
7-15 license> issued by the department for each place of business from
7-16 which home health, hospice, or personal assistance services are
7-17 directed. A certified agency must have a <Class A> license to
7-18 provide certified home health services<, and any other person must
7-19 have a Class B license>.
7-20 (b) A person who is not licensed to provide home health
7-21 services under this chapter may not indicate or imply that the
7-22 person is licensed to provide home health services by the use of
7-23 the words "home health services" or in any other manner.
7-24 (c) A person who is not licensed to provide hospice services
7-25 under this chapter may not use the word "hospice" in a title or
7-26 description of a facility, organization, program, service provider,
7-27 or services or use any other words, letters, abbreviations, or
8-1 insignia indicating or implying that the person holds a license to
8-2 provide hospice services under this chapter.
8-3 (d) A license to provide hospice services issued under this
8-4 chapter authorizes a hospice to own or operate a residential unit
8-5 or inpatient unit at the licensed site in compliance with the
8-6 standards and rules adopted under this chapter.
8-7 (e) <(b)> A license issued under this chapter may not be
8-8 transferred to another person, but may be transferred from one
8-9 location to another location. A change of ownership or location
8-10 shall be reported to <with the approval of> the department. <The
8-11 board by rule shall prescribe criteria for the approval of the
8-12 relocation of a license.>
8-13 SECTION 5. Section 142.0025, Health and Safety Code, is
8-14 amended to read as follows:
8-15 Sec. 142.0025. Temporary License. If a person is in the
8-16 process of becoming certified by the Department of Health and Human
8-17 Services to qualify as a certified agency, the department may issue
8-18 a temporary <Class A> home and community support services agency
8-19 <health service> license to the person authorizing the person to
8-20 provide certified home health services. A temporary license is
8-21 effective as provided by board rules.
8-22 SECTION 6. Section 142.003, Health and Safety Code, is
8-23 amended to read as follows:
8-24 Sec. 142.003. Exemptions From Licensing Requirement. (a)
8-25 The following persons need not be licensed under this chapter:
8-26 (1) a physician, dentist, registered nurse, or
8-27 physical therapist licensed under the laws of this state who
9-1 provides home health services to a client <patient> only as a part
9-2 of and incidental to that person's private office practice;
9-3 (2) a registered nurse, licensed vocational nurse,
9-4 physical therapist, occupational therapist, speech therapist,
9-5 medical social worker, or any other health care professional as
9-6 determined by the department who provides home health services as a
9-7 sole practitioner;
9-8 (3) a <nonprofit> registry <operated by a national or
9-9 state professional association or society of licensed health care
9-10 practitioners, or a subdivision of the association or society,>
9-11 that operates solely as a clearinghouse to put consumers in contact
9-12 with persons who provide home health, hospice, or personal
9-13 assistance services <licensed health care practitioners who give
9-14 care in a patient's residence> and that does not maintain official
9-15 client <patient> records, <or> direct client <patient> services
9-16 compensate the person who is providing the service;
9-17 (4) an individual whose permanent residence is in the
9-18 client's <patient's> residence;
9-19 (5) an employee of a person licensed under this
9-20 chapter who provides home health, hospice, or personal assistance
9-21 services only as an employee of the license holder and who receives
9-22 no benefit for providing the services, other than wages from the
9-23 license holder;
9-24 (6) a home, nursing home, convalescent home, personal
9-25 care facility, special care facility, or other institution for
9-26 individuals who are elderly or who have disabilities that provides
9-27 home health or personal assistance <the disabled or aged that
10-1 provides health> services only to residents of the home or
10-2 institution;
10-3 (7) a person who provides one health service through a
10-4 contract with a person licensed under this chapter;
10-5 (8) a durable medical equipment supply company;
10-6 (9) a pharmacy or wholesale medical supply company
10-7 that does not furnish services, other than supplies, to a person at
10-8 the person's house;
10-9 (10) a hospital or other licensed health care facility
10-10 that provides home health or personal assistance services <serves>
10-11 only to inpatient residents of the hospital or facility;
10-12 (11) a person providing home health or personal
10-13 assistance services to an injured employee under the Texas Workers'
10-14 Compensation Act (Article 8308-1.01 et seq., Vernon's Texas Civil
10-15 <workers' compensation laws of this state (Article 8306 et seq.,
10-16 Revised> Statutes); <or>
10-17 (12) a visiting nurse service that:
10-18 (A) is conducted by and for the adherents of a
10-19 well-recognized church or religious denomination; and
10-20 (B) provides nursing services by a person exempt
10-21 from licensing by Article 4528, Revised Statutes, because the
10-22 person furnishes nursing care in which treatment is only by prayer
10-23 or spiritual means;
10-24 (13) an individual hired and paid directly by the
10-25 client or the client's family or legal guardian to provide home
10-26 health or personal assistance services;
10-27 (14) a business, school, camp, or other organization
11-1 that provides home health or personal assistance services,
11-2 incidental to the organization's primary purpose, to individuals
11-3 employed by or participating in programs offered by the business,
11-4 school, or camp that enable the individual to participate fully in
11-5 the business's, school's, or camp's programs;
11-6 (15) a person or organization providing
11-7 sitter-companion services or chore or household services that do
11-8 not involve personal care, health, or health-related services;
11-9 (16) a licensed health care facility that provides
11-10 hospice services under a contract with a hospice;
11-11 (17) a person delivering residential acquired immune
11-12 deficiency syndrome hospice care who is licensed and designated as
11-13 a residential AIDS hospice under Chapter 248; or
11-14 (18) until August 31, 1995, a state agency, mental
11-15 retardation authority, or mental health authority providing the
11-16 direct delivery of home health, hospice, or personal assistance
11-17 services.
11-18 (b) A home and community support services agency that owns
11-19 or operates an administrative support site is not required to
11-20 obtain a separate license under this chapter for the administrative
11-21 support site.
11-22 (c) A hospice that operates or provides hospice services to
11-23 an inpatient unit under a contract with a licensed health care
11-24 facility is not required to obtain an alternate delivery site
11-25 license for that inpatient unit.
11-26 SECTION 7. Section 142.004, Health and Safety Code, is
11-27 amended to read as follows:
12-1 Sec. 142.004. License Application. (a) An applicant for a
12-2 license to provide <a> home health, hospice, or personal assistance
12-3 services <service> must:
12-4 (1) file a written application on a form prescribed by
12-5 the department indicating the type of service the applicant wishes
12-6 to provide;
12-7 (2) file with the application:
12-8 (A) the name of the owner of the applicant
12-9 <service> or a list of the names of persons who own at least a 10
12-10 percent <an> interest in the applicant <service>; and
12-11 (B) a list of any businesses with which the
12-12 applicant <service> subcontracts and in which the owner or owners
12-13 of the applicant <service> hold at least five percent of the
12-14 ownership; or
12-15 (C) if the applicant is a direct or indirect
12-16 subsidiary of a publicly held corporation, the name of that
12-17 publicly held corporation and the names of each subsidiary of the
12-18 publicly held corporation that owns an interest in the applicant;
12-19 (3) cooperate with any surveys <inspections> required
12-20 by the department for a license; and
12-21 (4) pay the license fee prescribed by this chapter.
12-22 (b) In addition to the requirements of Subsection (a), if
12-23 the applicant is a certified agency when the application for a
12-24 <Class A> license to provide certified home health services is
12-25 filed, the applicant must maintain its Medicare certification. If
12-26 the applicant is not a certified agency when the application for a
12-27 <Class A> license to provide certified home health services is
13-1 filed, the applicant must establish that it is in the process of
13-2 receiving its certification from the United States Department of
13-3 Health and Human Services.
13-4 (c) The board by rule shall require that, at a minimum,
13-5 before the department may approve a license application, other than
13-6 an application for a renewal or branch office or alternate delivery
13-7 site license, the applicant must provide to the department:
13-8 (1) documentation establishing that, at a minimum, the
13-9 applicant has sufficient financial resources to provide the
13-10 services required by this chapter and by the department during the
13-11 term of the license;
13-12 (2) a list of the management personnel for the
13-13 proposed home and community support services <health> agency, a
13-14 description of personnel qualifications, and a plan for providing
13-15 continuing training and education for the personnel during the term
13-16 of the license;
13-17 (3) documentation establishing that the applicant is
13-18 capable of meeting the minimum standards established by the board
13-19 relating to the quality of care; and
13-20 (4) a plan that provides for the orderly transfer of
13-21 care of the applicant's clients if the applicant cannot maintain or
13-22 deliver home health, hospice, or personal assistance services under
13-23 the license.
13-24 (d) Information received by the department relating to the
13-25 competence and financial resources of the applicant is confidential
13-26 and may not be disclosed to the public.
13-27 SECTION 8. Section 142.006, Health and Safety Code, is
14-1 amended to read as follows:
14-2 Sec. 142.006. License Issuance; Term. (a) The department
14-3 shall issue a <Class A or Class B> home and community support
14-4 services agency <health service> license to provide home health,
14-5 hospice, or personal assistance services for each place of business
14-6 to each applicant who:
14-7 (1) qualifies for the <type of> license to provide the
14-8 type of service that is to be offered by the applicant <requested>;
14-9 (2) submits an application and license fee as required
14-10 by this chapter; and
14-11 (3) complies with all licensing standards required or
14-12 adopted by the board under this chapter.
14-13 (b) A license issued under this chapter expires one year
14-14 after the date of issuance. The department may issue an initial
14-15 license for a term of less than one year to conform expiration
14-16 dates for a locality or an applicant. The department, in
14-17 accordance with board rules, may issue a temporary license to an
14-18 applicant for an initial license.
14-19 (c) The department may find that a home and community
14-20 support services agency has satisfied the requirements for
14-21 licensing if the agency is accredited by an accreditation
14-22 organization, such as the Joint Commission on Accreditation of
14-23 Healthcare Organizations or the Community Health Accreditation
14-24 Program, and the department finds that the accreditation
14-25 organization has standards that meet or exceed the requirements for
14-26 licensing under this chapter. A license fee is required of the
14-27 home and community support services agency at the time of a license
15-1 application.
15-2 (d) The department may find that a home and community
15-3 support services agency has satisfied the requirements for
15-4 licensing if the agency is certified by a state agency that has
15-5 certification standards that meet or exceed the requirements for
15-6 licensing under this chapter. A license fee is required at the
15-7 time of a license application.
15-8 (e) The license must designate the types of services that
15-9 the home and community support services agency is authorized to
15-10 provide at or from the designated place of business.
15-11 SECTION 9. Subchapter A, Chapter 142, Health and Safety
15-12 Code, is amended by adding Section 142.0065 to read as follows:
15-13 Sec. 142.0065. DISPLAY OF LICENSE. A license issued under
15-14 this chapter shall be displayed in a conspicuous place in the
15-15 designated place of business and must show:
15-16 (1) the name and address of the licensee;
15-17 (2) the name of the owner or owners, if different from
15-18 the information provided under Subdivision (1);
15-19 (3) the license expiration date; and
15-20 (4) the types of services authorized to be provided
15-21 under the license.
15-22 SECTION 10. Section 142.008, Health and Safety Code, is
15-23 amended to read as follows:
15-24 Sec. 142.008. Branch Office. (a) The department may issue
15-25 a branch office license to a person who holds a <Class A or Class
15-26 B> license to provide home health or personal assistance services.
15-27 (b) The board by rule shall establish eligibility
16-1 requirements for a branch office license.
16-2 (c) A branch office license expires on the same date as the
16-3 <Class A or Class B> license to provide home health or personal
16-4 assistance services held by the applicant for the branch office
16-5 license <that person>.
16-6 SECTION 11. Subchapter A, Chapter 142, Health and Safety
16-7 Code, is amended by adding Section 142.0085 to read as follows:
16-8 Sec. 142.0085. ALTERNATE DELIVERY SITE LICENSE. (a) The
16-9 department shall issue an alternate delivery site license to a
16-10 qualified hospice.
16-11 (b) The board by rule shall establish standards required for
16-12 the issuance of an alternate delivery site license.
16-13 (c) An alternate delivery site license expires on the same
16-14 date as the license to provide hospice services held by the
16-15 hospice.
16-16 SECTION 12. Section 142.009, Health and Safety Code, is
16-17 amended to read as follows:
16-18 Sec. 142.009. SURVEYS <INSPECTIONS>; CONSUMER COMPLAINTS.
16-19 (a) The department or its representative may enter the premises of
16-20 a license applicant or license holder at reasonable times to
16-21 conduct a survey <an inspection> incidental to the issuance of a
16-22 license and at other times as the department considers necessary to
16-23 ensure compliance with this chapter and the rules adopted under
16-24 this chapter.
16-25 (b) A home and community support services <health> agency
16-26 shall provide each person who receives home health, hospice, or
16-27 personal assistance services with a written statement that contains
17-1 the name, address, and telephone number of the department and a
17-2 statement that informs the recipient <consumers> that a complaint
17-3 against a home and community support services <health> agency may
17-4 be directed to the department.
17-5 (c) The department or its authorized representative shall
17-6 investigate each complaint received regarding the provision of home
17-7 health, hospice, or personal assistance services and may, as a
17-8 part of the investigation:
17-9 (1) conduct an unannounced survey <inspection> of a
17-10 place of business, including an inspection of medical and personnel
17-11 records, if the department has reasonable cause to believe that the
17-12 place of business is in violation of this chapter or a rule adopted
17-13 under this chapter;
17-14 (2) conduct an interview with a recipient of home
17-15 health, hospice, or personal assistance services, which may be
17-16 conducted in the recipient's home if the recipient consents; <or>
17-17 (3) conduct an interview with a family member of a
17-18 recipient of home health, hospice, or personal assistance services
17-19 who is deceased or other person who may have knowledge of the care
17-20 received by the deceased recipient of the home health, hospice, or
17-21 personal assistance services; or
17-22 (4) interview a physician or other health care
17-23 practitioner, including a member of the personnel of a home and
17-24 community support services <health> agency, who cares for a
17-25 recipient of home health, hospice, or personal assistance services.
17-26 (d) The reports, records, and working papers used or
17-27 developed in an investigation made under this section are
18-1 confidential and may not be released or made public except:
18-2 (1) to a state or federal agency;
18-3 (2) to federal, state, or local law enforcement
18-4 personnel;
18-5 (3) with the consent of each person identified in the
18-6 information released;
18-7 (4) in civil or criminal litigation matters or
18-8 licensing proceedings as otherwise allowed by law or judicial rule;
18-9 or
18-10 (5) on a form developed by the department that
18-11 identifies any deficiencies found without identifying a person,
18-12 other than the home and community support services agency.
18-13 (e) The department's representative shall hold a conference
18-14 with the person in charge of the home and community support
18-15 services <health> agency before beginning the on-site survey
18-16 <inspection> to explain the nature and scope of the survey
18-17 <inspection>. When the survey <inspection> is completed, the
18-18 department's representative shall hold a conference with the person
18-19 who is in charge of the agency and shall identify any records that
18-20 were duplicated. Agency records may be removed from an agency only
18-21 with the agency's consent.
18-22 (f) The department shall fully inform the person who is in
18-23 charge of the home and community support services agency of the
18-24 preliminary findings of the survey and shall give the person a
18-25 reasonable opportunity to submit additional facts or other
18-26 information to the department's authorized representative in
18-27 response to those findings. The response shall be made a part of
19-1 the record of the survey for all purposes.
19-2 (g) After a survey of a home and community support services
19-3 agency by the department, the department shall provide to the chief
19-4 executive officer of the agency:
19-5 (1) specific and timely written notice of the
19-6 preliminary findings of the survey, including:
19-7 (A) the specific nature of the survey;
19-8 (B) any alleged violations of a specific statute
19-9 or rule;
19-10 (C) the specific nature of any finding regarding
19-11 an alleged violation or deficiency; and
19-12 (D) if a deficiency is alleged, the severity of
19-13 the deficiency;
19-14 (2) information on the identity, including the
19-15 signature, of each department representative conducting, reviewing,
19-16 or approving the results of the survey and the date on which the
19-17 department representative acted on the matter; and
19-18 (3) if requested by the agency, copies of all
19-19 documents relating to the survey maintained by the department or
19-20 provided by the department to any other state or federal agency
19-21 that are not confidential under state law.
19-22 (h) Except for the investigation of complaints, a home and
19-23 community support services agency licensed by the department under
19-24 this chapter is not subject to additional surveys relating to home
19-25 health, hospice, or personal assistance services while the agency
19-26 maintains accreditation for the applicable service from the Joint
19-27 Commission for Accreditation of Healthcare Organizations, the
20-1 Community Health Accreditation Program, or other accreditation
20-2 organizations that meet or exceed the regulations adopted under
20-3 this chapter. Each provider must submit to the department
20-4 documentation from the accrediting body indicating that the
20-5 provider is accredited when the provider is applying for the
20-6 initial license and annually when the license is renewed.
20-7 (i) Except as provided by Subsections (h) and (k), an
20-8 on-site survey must be conducted within 18 months after a survey
20-9 for an initial license. After that time, an on-site survey must be
20-10 conducted at least every 36 months.
20-11 (j) If a person is renewing or applying for a license to
20-12 provide more than one type of service under this chapter, the
20-13 surveys required for each of the services the license holder or
20-14 applicant seeks to provide shall be completed during the same
20-15 surveyor visit.
20-16 (k) The department and other state agencies that are under
20-17 the Health and Human Services Commission and that contract with
20-18 home and community support services agencies to deliver services
20-19 for which a license is required under this chapter shall execute a
20-20 memorandum of understanding that establishes procedures to
20-21 eliminate or reduce duplication of standards or conflicts between
20-22 standards and of functions in license, certification, or compliance
20-23 surveys and complaint investigations. The Health and Human
20-24 Services Commission shall review the recommendation of the council
20-25 relating to the memorandum of understanding before considering
20-26 approval. The memorandum of understanding must be approved by the
20-27 commission.
21-1 SECTION 13. Section 142.010, Health and Safety Code, is
21-2 amended to read as follows:
21-3 Sec. 142.010. Fees. (a) The board shall set <the home
21-4 health service> license fees for home and community support
21-5 services agencies in amounts that are reasonable to meet the costs
21-6 of administering this chapter, except that the fees may not be less
21-7 than $200 or more than $1,000 for a license to provide home health,
21-8 hospice, or personal assistance services<:>
21-9 <(1) less than $600 or more than $1,200 for an initial
21-10 Class A or Class B license; or>
21-11 <(2) less than $200 or more than $300 for renewal of a
21-12 branch office license>.
21-13 (b) The board shall consider the size of the home and
21-14 community support services agency, the number of clients served,
21-15 the number of services provided, and the necessity for review of
21-16 other accreditation documentation in determining the amount of
21-17 initial and renewal license fees.
21-18 (c) A fee charged under this section is nonrefundable.
21-19 SECTION 14. Sections 142.011(b) and (c), Health and Safety
21-20 Code, are amended to read as follows:
21-21 (b) The department may immediately suspend or revoke a
21-22 license when the health and safety of persons are threatened. If
21-23 the department issues an order of immediate suspension or
21-24 revocation, the department shall immediately give the chief
21-25 executive officer of the home and community support services agency
21-26 adequate notice of the action taken, the legal grounds for the
21-27 action, and the procedure governing appeal of the action. A person
22-1 whose license is suspended or revoked under this subsection is
22-2 entitled to a hearing not later than the seventh day after the
22-3 effective date of the suspension or revocation.
22-4 (c) The department may suspend or revoke a home and
22-5 community support services agency's license to provide certified
22-6 home health services if the agency <the license of a Class A home
22-7 health agency that> fails to maintain its certification qualifying
22-8 the agency as a certified agency. A home and community support
22-9 services agency that is licensed to provide certified home health
22-10 services and <Class A home health agency> that submits a request
22-11 for a hearing as provided by Subsection (d) is subject to the
22-12 requirements of this chapter relating to a home and community
22-13 support services agency that is licensed to provide home health
22-14 services, but not certified home health services, <Class B home
22-15 health agency> until the suspension or revocation is finally
22-16 determined by the department or, if the license is suspended or
22-17 revoked, until the last day for seeking review of the department
22-18 order or a later date fixed by order of the reviewing court.
22-19 SECTION 15. Section 142.012, Health and Safety Code, is
22-20 amended to read as follows:
22-21 Sec. 142.012. Powers and Duties. (a) The board, with the
22-22 recommendations of the council, shall adopt rules necessary to
22-23 implement this chapter.
22-24 (b) The board by rule shall set minimum standards for home
22-25 and community support services <health> agencies licensed under
22-26 this chapter that relate to:
22-27 (1) qualifications for professional and
23-1 nonprofessional personnel, including volunteers;
23-2 (2) supervision of professional and nonprofessional
23-3 personnel, including volunteers;
23-4 (3) the provision and coordination of treatment and
23-5 services, including support and bereavement services, as
23-6 appropriate;
23-7 (4) the management, ownership, and organizational
23-8 structure, including lines of authority and delegation of
23-9 responsibility and, as appropriate, the composition of an
23-10 interdisciplinary team;
23-11 (5) clinical and business records;
23-12 (6) financial ability to carry out the functions as
23-13 proposed; <and>
23-14 (7) safety, fire prevention, and sanitary standards
23-15 for residential units and inpatient units; and
23-16 (8) any other aspects of home health, hospice, or
23-17 personal assistance services as necessary to protect the public.
23-18 (c) The initial minimum standards adopted by the board under
23-19 Subsection (b) for hospice services must be at least as stringent
23-20 as the conditions of participation for a Medicare certified
23-21 provider of hospice services in effect on April 30, 1993, under
23-22 Title XVIII, Social Security Act (42 U.S.C. Section 1395 et seq.).
23-23 (d) The department shall prescribe forms necessary to
23-24 perform its duties.
23-25 (e) <(d)> The department shall require each person or home
23-26 and community support services <health> agency providing home
23-27 health, hospice, or personal assistance services to implement and
24-1 enforce the applicable provisions of Chapter 102, Human Resources
24-2 Code.
24-3 SECTION 16. Section 142.014, Health and Safety Code, is
24-4 amended to read as follows:
24-5 Sec. 142.014. Civil Penalty. (a) A person who engages in
24-6 the business of providing home health, hospice, or personal
24-7 assistance service, or represents to the public that the person is
24-8 a provider of home health, hospice, and personal assistance
24-9 services for pay, <operates a home health agency> without a license
24-10 issued under this chapter authorizing the services that are being
24-11 provided is liable for a civil penalty of not less than $1,000
24-12 <$100> or more than $2,500 <$500> for each day of violation.
24-13 Penalties may be appropriated only to the department and to
24-14 administer this chapter.
24-15 (b) An action to recover a civil penalty is in addition to
24-16 an action brought for injunctive relief under Section 142.013 or
24-17 any other remedy provided by law. The attorney general shall bring
24-18 suit on behalf of the state to collect the civil penalty.
24-19 SECTION 17. Sections 142.015(a) and (d), Health and Safety
24-20 Code, are amended to read as follows:
24-21 (a) The Home and Community Support <Health> Services
24-22 Advisory Council is composed of the following 13 <11> members,
24-23 appointed by the governor:
24-24 (1) three consumer representatives <one representative
24-25 of the department>;
24-26 (2) two representatives of agencies that are licensed
24-27 to provide certified home health services <consumers of home health
25-1 agency and hospice services>;
25-2 (3) two representatives of agencies that are licensed
25-3 to provide home health services but are not certified home health
25-4 services <one representative of the Texas Department of Human
25-5 Services>;
25-6 (4) three representatives of agencies that are
25-7 licensed to provide hospice services, with one representative
25-8 appointed from:
25-9 (A) a community-based non-profit provider of
25-10 hospice services;
25-11 (B) a community-based proprietary provider of
25-12 hospice services; and
25-13 (C) a hospital-based provider of hospice
25-14 services; and <one representative of the Texas Association of Home
25-15 Health Agencies, Incorporated;>
25-16 (5) three representatives of agencies that are
25-17 licensed to provide personal assistance services <one
25-18 representative of private nonprofit home health agencies;>
25-19 <(6) one representative of voluntary nonprofit home
25-20 health agencies;>
25-21 <(7) one representative of proprietary home health
25-22 agencies;>
25-23 <(8) one representative of an official department home
25-24 health agency;>
25-25 <(9) one member to represent Medicare-certified Class
25-26 A hospice providers affiliated with a home health agency, hospital,
25-27 or other health service provider; and>
26-1 <(10) one member to represent Medicare-certified Class
26-2 A hospice providers not affiliated with a home health agency,
26-3 hospital, or other health service provider>.
26-4 (d) Members of the council serve staggered two-year terms,
26-5 with the terms of seven <six> members expiring on January 31 of
26-6 each even-numbered year and the terms of six <five> members
26-7 expiring on January 31 of each odd-numbered year.
26-8 SECTION 18. Subchapter A, Chapter 142, Health and Safety
26-9 Code, is amended by adding Section 142.016 to read as follows:
26-10 Sec. 142.016. MEMORANDUM OF UNDERSTANDING RELATING TO
26-11 NURSING SERVICES; GUIDELINES. (a) The Board of Nurse Examiners
26-12 and the department shall adopt a memorandum of understanding
26-13 governing the circumstances under which the provision of
26-14 health-related tasks or services do not constitute the practice of
26-15 professional nursing. The agencies annually shall review and shall
26-16 renew or modify the memorandum as necessary.
26-17 (b) The Board of Nurse Examiners and the department shall
26-18 consult with an advisory committee in developing, modifying, or
26-19 renewing the memorandum of understanding. The advisory committee
26-20 shall be appointed by the Board of Nurse Examiners and the
26-21 department and at a minimum shall include:
26-22 (1) one representative from the Board of Nurse
26-23 Examiners and one representative from the department to serve as
26-24 cochairmen;
26-25 (2) one representative from the Texas Department of
26-26 Mental Health and Mental Retardation;
26-27 (3) one representative from the Texas Department of
27-1 Human Services;
27-2 (4) one representative from the Texas Nurses
27-3 Association;
27-4 (5) one representative from the Texas Association for
27-5 Home Care, Incorporated, or its successor;
27-6 (6) one representative from the Texas Hospice
27-7 Organization, Incorporated, or its successor;
27-8 (7) one representative of the Texas Respite Resource
27-9 Network or its successor; and
27-10 (8) two representatives of organizations such as the
27-11 Personal Assistance Task Force or the Disability Consortium that
27-12 advocate for clients in community-based settings.
27-13 (c) The department shall prepare guidelines according to the
27-14 memorandum of understanding required by Subsection (a) for licensed
27-15 home and community support services agencies in providing personal
27-16 assistance services to clients.
27-17 SECTION 19. Section 142.021, Health and Safety Code, is
27-18 amended to read as follows:
27-19 Sec. 142.021. ADMINISTRATION OF <PERMITS TO ADMINISTER>
27-20 MEDICATION. A person may not administer medication to a client
27-21 <patient> of a home and community support services <health> agency
27-22 unless the person:
27-23 (1) holds a license under state law that authorizes
27-24 the person to administer medication;
27-25 (2) holds a permit issued under Section 142.025 and
27-26 acts under the delegated authority of a person who holds a license
27-27 under state law that authorizes the person to administer
28-1 medication; <or>
28-2 (3) performs duties as a qualified dialysis technician
28-3 within the scope authorized by board rules;
28-4 (4) administers a medication to a client of a home and
28-5 community support service agency in accordance with rules of the
28-6 Board of Nurse Examiners that permit delegation of the
28-7 administration of medication to a person not holding a permit under
28-8 Section 142.025; or
28-9 (5) administers noninjectable medication under
28-10 circumstances authorized by the memorandum of understanding adopted
28-11 under Section 142.016.
28-12 SECTION 20. Section 142.023, Health and Safety Code, is
28-13 amended to read as follows:
28-14 Sec. 142.023. Rules for Administration of Medication. The
28-15 board by rule shall establish:
28-16 (1) minimum requirements for the issuance, denial,
28-17 renewal, suspension, emergency suspension, and revocation of a
28-18 permit to a home health medication aide <administer medication to a
28-19 patient of a home health agency>;
28-20 (2) curricula to train a home health medication aide
28-21 <persons to administer medication to a patient of a home health
28-22 agency>;
28-23 (3) minimum standards for the approval of home health
28-24 medication aide training programs <programs to train persons to
28-25 administer medication to patients of home health agencies> and for
28-26 rescinding approval;
28-27 (4) the acts and practices that are allowed or
29-1 prohibited to a permit holder; and
29-2 (5) minimum standards for on-site supervision of a
29-3 permit holder by a registered nurse.
29-4 SECTION 21. Section 142.024, Health and Safety Code, is
29-5 amended to read as follows:
29-6 Sec. 142.024. HOME HEALTH MEDICATION AIDE TRAINING PROGRAMS
29-7 <TO ADMINISTER MEDICATION>. (a) An application for the approval
29-8 of a home health medication aide training program must be made to
29-9 the department on a form and under rules prescribed by the board.
29-10 (b) The department shall approve a home health medication
29-11 aide training program that meets the minimum standards adopted
29-12 under Section 142.023. The department may review the approval
29-13 annually.
29-14 SECTION 22. The heading of Section 142.025, Health and
29-15 Safety Code, is amended to read as follows:
29-16 Sec. 142.025. ISSUANCE AND RENEWAL OF HOME HEALTH MEDICATION
29-17 AIDE PERMIT <TO ADMINISTER MEDICATION>.
29-18 SECTION 23. Section 142.025(a), Health and Safety Code, is
29-19 amended to read as follows:
29-20 (a) To be issued or to have renewed a home health medication
29-21 aide permit <to administer medication>, a person shall apply to the
29-22 department on a form prescribed and under rules adopted by the
29-23 board.
29-24 SECTION 24. The heading of Section 142.026, Health and
29-25 Safety Code, is amended to read as follows:
29-26 Sec. 142.026. FEES FOR ISSUANCE AND RENEWAL OF HOME HEALTH
29-27 MEDICATION AIDE PERMIT <TO ADMINISTER MEDICATION>.
30-1 SECTION 25. The heading of Section 142.027, Health and
30-2 Safety Code, is amended to read as follows:
30-3 Sec. 142.027. VIOLATION OF HOME HEALTH MEDICATION AIDE
30-4 PERMITS <TO ADMINISTER MEDICATION>.
30-5 SECTION 26. The heading of Section 142.028, Health and
30-6 Safety Code, is amended to read as follows:
30-7 Sec. 142.028. EMERGENCY SUSPENSION OF HOME HEALTH MEDICATION
30-8 AIDE PERMITS <TO ADMINISTER MEDICATION>.
30-9 SECTION 27. Section 142.029(a), Health and Safety Code, is
30-10 amended to read as follows:
30-11 (a) A person commits an offense if the person knowingly
30-12 administers medication to a client <patient> of a home and
30-13 community support services <health> agency and the person is not
30-14 authorized to administer the medication under Section 142.021 or
30-15 142.022<:>
30-16 <(1) does not hold a license under state law that
30-17 authorizes the person to administer medication; or>
30-18 <(2) does not hold a permit issued by the department
30-19 under Section 142.025>.
30-20 SECTION 28. Section 142.030(a), Health and Safety Code, is
30-21 amended to read as follows:
30-22 (a) A person authorized by this subchapter to administer
30-23 medication to a client <patient> of a home and community support
30-24 services <health> agency may not dispense dangerous drugs or
30-25 controlled substances without complying with the Texas Pharmacy Act
30-26 (Article 4542a-1, Vernon's Texas Civil Statutes).
30-27 SECTION 29. Section 248.003, Health and Safety Code, is
31-1 amended to read as follows:
31-2 Sec. 248.003. Exemptions. This chapter does not apply to:
31-3 (1) a home and community support services <health>
31-4 agency required to be licensed under Chapter 142;
31-5 (2) a person required to be licensed under Chapter 241
31-6 (Texas Hospital Licensing Law);
31-7 (3) an institution required to be licensed under
31-8 Chapter 242;
31-9 (4) an ambulatory surgical center required to be
31-10 licensed under Chapter 243 (Texas Ambulatory Surgical Center
31-11 Licensing Act);
31-12 (5) a birthing center required to be licensed under
31-13 Chapter 244 (Texas Birthing Center Licensing Act);
31-14 (6) a facility required to be licensed under Chapter
31-15 245 (Texas Abortion Facility Reporting and Licensing Act); or
31-16 (7) a person providing medical or nursing care or
31-17 services under a license or permit issued under other state law.
31-18 SECTION 30. Section 248.002, Health and Safety Code, is
31-19 amended by adding Subdivisions (9)-(14) to read as follows:
31-20 (9) "Bereavement services" has the meaning assigned by
31-21 Section 142.001.
31-22 (10) "Palliative care" has the meaning assigned by
31-23 Section 142.001.
31-24 (11) "Support services" has the meaning assigned by
31-25 Section 142.001.
31-26 (12) "Residential AIDS hospice" means a facility
31-27 licensed and designated as a residential AIDS hospice under this
32-1 chapter.
32-2 (13) "Residential AIDS hospice care" means hospice
32-3 services provided in a residential AIDS hospice.
32-4 (14) "AIDS" means acquired immune deficiency syndrome.
32-5 SECTION 31. Subchapter B, Chapter 248, Health and Safety
32-6 Code, is amended by adding Section 248.029 to read as follows:
32-7 Sec. 248.029. RESIDENTIAL AIDS HOSPICE DESIGNATION. (a)
32-8 The board by rule shall adopt standards for the designation of a
32-9 special care facility licensed under this chapter as a residential
32-10 AIDS hospice. Those standards shall be consistent with other
32-11 standards adopted under this chapter and consistent with the
32-12 purposes for which special care facilities are created.
32-13 (b) In adopting the standards, the board shall consider
32-14 rules adopted for the designation of a hospice under Chapter 142
32-15 and shall establish specific standards requiring:
32-16 (1) the provision of exclusively palliative care by a
32-17 facility;
32-18 (2) the provision of bereavement services;
32-19 (3) the provision of support services to the family of
32-20 a client;
32-21 (4) the participation of a registered nurse in the
32-22 development of an initial plan of care for a client and periodic
32-23 review of the plan of care by an interdisciplinary team of the
32-24 facility; and
32-25 (5) clinical and medical review of patient care
32-26 services by a physician who acts as a medical consultant.
32-27 (c) A special care facility licensed under this chapter that
33-1 satisfies the standards adopted under this section shall be
33-2 designated as a residential AIDS hospice.
33-3 (d) Notwithstanding Chapter 142, a special care facility
33-4 licensed and issued a designation as a residential AIDS hospice
33-5 under this chapter may use the term "residential AIDS hospice" or a
33-6 similar term or language in its title or in a description or
33-7 representation of the facility if the similar term or language
33-8 clearly identifies the facility as a facility regulated under this
33-9 chapter and clearly distinguishes the facility from a hospice
33-10 regulated under Chapter 142.
33-11 (e) A special care facility licensed under this chapter on
33-12 July 1, 1994, on notice to the department that it is in compliance
33-13 with the standards adopted for designation as a residential AIDS
33-14 hospice, shall be issued that designation by the department, and
33-15 that designation is valid until the date the license of the
33-16 facility expires or is renewed.
33-17 SECTION 32. Sections 142.005 and 142.007, Health and Safety
33-18 Code, are repealed.
33-19 SECTION 33. (a) The changes in law made by this Act apply
33-20 only to an offense or a violation committed on or after July 1,
33-21 1994.
33-22 (b) An offense or violation committed before July 1, 1994,
33-23 is covered by the law in effect when the offense or violation was
33-24 committed, and the former law is continued in effect for that
33-25 purpose.
33-26 SECTION 34. Not later than January 1, 1994, the Board of
33-27 Nurse Examiners and the Texas Department of Health shall adopt the
34-1 initial memorandum of understanding required by Section 142.016,
34-2 Health and Safety Code, as added by this Act.
34-3 SECTION 35. The changes in law made by this Act do not
34-4 affect the validity of a license or of a permit to administer
34-5 medication issued by the Texas Department of Health under Chapter
34-6 142, Health and Safety Code, before the effective date of this Act.
34-7 Regardless of the changes in law made by this Act, the department
34-8 shall continue to issue licenses to qualified home health agencies
34-9 and permits to administer medication under Chapter 142, Health and
34-10 Safety Code, as it existed immediately before the effective date of
34-11 this Act, and that law is continued in effect for that purpose
34-12 until July 1, 1994.
34-13 SECTION 36. The Texas Department of Health shall propose
34-14 rules to implement this Act on or before January 1, 1994. The
34-15 department shall adopt rules to implement this Act on or before
34-16 June 1, 1994.
34-17 SECTION 37. The Texas Department of Health and other state
34-18 agencies under the Health and Human Services Commission shall
34-19 distribute to interested persons a draft of the memorandum of
34-20 understanding required by Section 142.009(k), Health and Safety
34-21 Code, as added by this Act, on or before January 1, 1994, and shall
34-22 execute the initial memorandum of understanding required by that
34-23 section on or before June 1, 1994.
34-24 SECTION 38. A home and community support services agency
34-25 providing home health, hospice, or personal assistance services is
34-26 not required to obtain a license under this Act until July 1, 1994.
34-27 SECTION 39. After the effective date of this Act, a
35-1 reference to a home health agency in law is a reference to a home
35-2 and community support services agency.
35-3 SECTION 40. A person who, on the effective date of this Act,
35-4 is serving a term as a member of the Home Health Services Advisory
35-5 Council shall continue to serve on the Home and Community Support
35-6 Services Advisory Council until January 31, 1994. At that time, in
35-7 accordance with Section 142.015, Health and Safety Code, as amended
35-8 by this Act, the governor shall appoint the 13 members to the
35-9 council. After the appointment of the new council in 1994, at the
35-10 first meeting of the council the new members shall draw lots to
35-11 determine their initial terms. Seven members shall serve for a
35-12 term expiring January 31, 1995, and six members shall serve for a
35-13 term expiring January 31, 1996.
35-14 SECTION 41. This Act takes effect September 1, 1993.
35-15 SECTION 42. The importance of this legislation and the
35-16 crowded condition of the calendars in both houses create an
35-17 emergency and an imperative public necessity that the
35-18 constitutional rule requiring bills to be read on three several
35-19 days in each house be suspended, and this rule is hereby suspended.