1-1 By: McDonald, et al. (Senate Sponsor - Zaffirini) H.B. No. 1551
1-2 (In the Senate - Received from the House May 5, 1993;
1-3 May 6, 1993, read first time and referred to Committee on Health
1-4 and Human Services; May 20, 1993, reported adversely, with
1-5 favorable Committee Substitute by the following vote: Yeas 7, Nays
1-6 0; May 20, 1993, sent to printer.)
1-7 COMMITTEE VOTE
1-8 Yea Nay PNV Absent
1-9 Zaffirini x
1-10 Ellis x
1-11 Madla x
1-12 Moncrief x
1-13 Nelson x
1-14 Patterson x
1-15 Shelley x
1-16 Truan x
1-17 Wentworth x
1-18 COMMITTEE SUBSTITUTE FOR H.B. No. 1551 By: Zaffirini
1-19 A BILL TO BE ENTITLED
1-20 AN ACT
1-21 relating to home care and community support services.
1-22 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-23 SECTION 1. The heading of Chapter 142, Health and Safety
1-24 Code, is amended to read as follows:
1-25 CHAPTER 142. HOME AND COMMUNITY SUPPORT <HEALTH> SERVICES
1-26 SECTION 2. The heading of Subchapter A, Chapter 142, Health
1-27 and Safety Code, is amended to read as follows:
1-28 SUBCHAPTER A. HOME AND COMMUNITY SUPPORT <HEALTH> SERVICES
1-29 LICENSE <LICENSES>
1-30 SECTION 3. Section 142.001, Health and Safety Code, is
1-31 amended to read as follows:
1-32 Sec. 142.001. DEFINITIONS. In this chapter:
1-33 (1) "Administrative support site" means a facility or
1-34 site where a home and community support services agency performs
1-35 administrative and other support functions but does not provide
1-36 direct home health, hospice, or personal assistance services.
1-37 (2) "Alternate delivery site" means a facility or
1-38 site, including a residential unit or an inpatient unit:
1-39 (A) that is owned or operated by a hospice;
1-40 (B) that is not the hospice's principal place of
1-41 business;
1-42 (C) that is located in the geographical area
1-43 served by the hospice; and
1-44 (D) from which the hospice provides hospice
1-45 services.
1-46 (3) "Bereavement" means the process by which a
1-47 survivor of a deceased person mourns and experiences grief.
1-48 (4) "Bereavement services" means support services
1-49 offered to a family during bereavement.
1-50 (5) "Branch office" means a facility or site in the
1-51 geographical area served by a home and community support agency
1-52 where home health or personal assistance services are delivered or
1-53 active client records are maintained.
1-54 (6) "Certified agency" means a home and community
1-55 support services agency that <person who>:
1-56 (A) provides a home health service; and
1-57 (B) is certified by an official of the
1-58 Department of Health and Human Services as in compliance with
1-59 conditions of participation in Title XVIII, Social Security Act (42
1-60 U.S.C. Section 1395 et seq.).
1-61 (7) "Certified home health services" means home health
1-62 services that are provided by a certified agency.
1-63 (8) <(2)> "Council" means the Home and Community
1-64 Support <Health> Services Advisory Council.
1-65 (9) "Counselor" means an individual qualified under
1-66 Medicare standards to provide counseling services, including
1-67 bereavement, dietary, spiritual, and other counseling services, to
1-68 both the client and the family.
2-1 <(3) "Health service" means:>
2-2 <(A) nursing;>
2-3 <(B) physical, occupational, speech, or
2-4 respiratory therapy;>
2-5 <(C) a medical social service;>
2-6 <(D) the service of a home health aide;>
2-7 <(E) the furnishing of medical equipment and
2-8 supplies, excluding drugs and medicines; or>
2-9 <(F) nutritional counseling.>
2-10 (10) <(4)> "Home and community support services
2-11 <health> agency" means a person who provides home health, hospice,
2-12 or personal assistance services for pay or other consideration in a
2-13 client's residence, an independent living environment, or another
2-14 appropriate location <place of business, including a hospice, that
2-15 provides a home health service>.
2-16 (11) <(5)> "Home health service" means the provision
2-17 of one or more of the following health services required by an
2-18 individual in a residence or independent living environment:
2-19 (A) nursing;
2-20 (B) physical, occupational, speech, or
2-21 respiratory therapy;
2-22 (C) medical social service;
2-23 (D) intravenous therapy;
2-24 (E) dialysis;
2-25 (F) service provided by unlicensed personnel
2-26 under the delegation of a licensed health professional;
2-27 (G) the furnishing of medical equipment and
2-28 supplies, excluding drugs and medicines; or
2-29 (H) nutritional counseling<, for pay or other
2-30 consideration, of a health service in a patient's residence. The
2-31 term does not include the provision of care under an attendant care
2-32 program administered by the Texas Department of Human Services>.
2-33 (12) "Hospice" means a person licensed under this
2-34 chapter to provide hospice services, including a person who owns or
2-35 operates a residential unit or an inpatient unit.
2-36 (13) "Hospice services" means services, including
2-37 services provided by unlicensed personnel under the delegation of a
2-38 registered nurse or physical therapist, provided to a client or a
2-39 client's family as part of a coordinated program consistent with
2-40 the standards and rules adopted under this chapter. These services
2-41 include palliative care for terminally ill clients and support
2-42 services for clients and their families that:
2-43 (A) are available 24 hours a day, seven days a
2-44 week, during the last stages of illness, during death, and during
2-45 bereavement;
2-46 (B) are provided by a medically directed
2-47 interdisciplinary team; and
2-48 (C) may be provided in a home, nursing home,
2-49 residential unit, or inpatient unit according to need.
2-50 (14) "Inpatient unit" means a facility that provides a
2-51 continuum of medical or nursing care and other hospice services to
2-52 clients admitted into the unit and that is in compliance with:
2-53 (A) the conditions of participation for
2-54 inpatient units adopted under Title XVIII, Social Security Act (42
2-55 U.S.C. Section 1395 et seq.); and
2-56 (B) standards adopted under this chapter.
2-57 (15) "Independent living environment" means:
2-58 (A) a client's individual residence, which may
2-59 include a group home or foster home; or
2-60 (B) other settings where a client participates
2-61 in activities, including school, work, or church.
2-62 (16) "Interdisciplinary team" means a group of
2-63 individuals who work together in a coordinated manner to provide
2-64 hospice services and must include a physician, registered nurse,
2-65 social worker, and counselor.
2-66 (17) "Investigation" means an inspection or survey
2-67 conducted by a representative of the department to determine if a
2-68 licensee is in compliance with this chapter.
2-69 (18) "Palliative care" means intervention services
2-70 that focus primarily on the reduction or abatement of physical,
3-1 psychosocial, and spiritual symptoms of a terminal illness.
3-2 (19) <(6)> "Person" means an individual, corporation,
3-3 or association.
3-4 (20) "Personal assistance service" means routine
3-5 ongoing care or services required by an individual in a residence
3-6 or independent living environment that enable the individual to
3-7 engage in the activities of daily living or to perform the physical
3-8 functions required for independent living, including respite
3-9 services. The term includes health-related services performed
3-10 under circumstances that are defined as not constituting the
3-11 practice of professional nursing by the Board of Nurse Examiners
3-12 through a memorandum of understanding with the department in
3-13 accordance with Section 142.016 and health-related tasks provided
3-14 by unlicensed personnel under the delegation of a registered nurse.
3-15 (21) <(7)> "Place of business" means an office of a
3-16 home and community support services <health> agency that maintains
3-17 client <patient> records or directs home health, hospice, or
3-18 personal assistance services. The term does not include an
3-19 administrative support site <includes a suboffice, a branch office,
3-20 a workroom, or any other subsidiary location>.
3-21 (22) <(8)> "Residence" means a place where a person
3-22 resides and includes a home, a nursing home, <or> a convalescent
3-23 home, or a residental unit <for the disabled or aged>.
3-24 (23) "Residential unit" means a facility that provides
3-25 living quarters and hospice services to clients admitted into the
3-26 unit and that is in compliance with standards adopted under this
3-27 chapter.
3-28 (24) "Respite services" means support options that are
3-29 provided temporarily for the purpose of relief for a primary
3-30 caregiver in providing care to individuals of all ages with
3-31 disabilities or at risk of abuse or neglect.
3-32 (25) "Social worker" means an individual certified as
3-33 a social worker under Chapter 50, Human Resources Code.
3-34 (26) "Support services" means social, spiritual, and
3-35 emotional care provided to a client and a client's family by a
3-36 hospice.
3-37 (27) "Terminal illness" means an illness for which
3-38 there is a limited prognosis if the illness runs its usual course.
3-39 (28) "Volunteer" means an individual who provides
3-40 assistance to a home and community support services agency without
3-41 compensation other than reimbursement for actual expenses.
3-42 SECTION 4. Section 142.002, Health and Safety Code, is
3-43 amended to read as follows:
3-44 Sec. 142.002. License Required. (a) Except as provided by
3-45 Section 142.003, a <A> person, including a health care facility
3-46 licensed under this code, may not engage in the business of
3-47 providing home health, hospice, or personal assistance services, or
3-48 represent to the public that the person is a provider of home
3-49 health, hospice, or personal assistance services for pay <services>
3-50 without a home and community support services agency license
3-51 authorizing the person to perform those services <an appropriate
3-52 license> issued by the department for each place of business from
3-53 which home health, hospice, or personal assistance services are
3-54 directed. A certified agency must have a <Class A> license to
3-55 provide home health services<, and any other person must have a
3-56 Class B license>.
3-57 (b) A person who is not licensed to provide home health
3-58 services under this chapter may not indicate or imply that the
3-59 person is licensed to provide home health services by the use of
3-60 the words "home health services" or in any other manner.
3-61 (c) A person who is not licensed to provide hospice services
3-62 under this chapter may not use the word "hospice" in a title or
3-63 description of a facility, organization, program, service provider,
3-64 or services or use any other words, letters, abbreviations, or
3-65 insignia indicating or implying that the person holds a license to
3-66 provide hospice services under this chapter.
3-67 (d) A license to provide hospice services issued under this
3-68 chapter authorizes a hospice to own or operate a residential unit
3-69 or inpatient unit at the licensed site in compliance with the
3-70 standards and rules adopted under this chapter.
4-1 (e) <(b)> A license issued under this chapter may not be
4-2 transferred to another person, but may be transferred from one
4-3 location to another location. A change of ownership or location
4-4 shall be reported to <with the approval of> the department. <The
4-5 board by rule shall prescribe criteria for the approval of the
4-6 relocation of a license.>
4-7 SECTION 5. Section 142.0025, Health and Safety Code, is
4-8 amended to read as follows:
4-9 Sec. 142.0025. Temporary License. If a person is in the
4-10 process of becoming certified by the Department of Health and Human
4-11 Services to qualify as a certified agency, the department may issue
4-12 a temporary <Class A> home and community support services agency
4-13 <health service> license to the person authorizing the person to
4-14 provide certified home health services. A temporary license is
4-15 effective as provided by board rules.
4-16 SECTION 6. Section 142.003, Health and Safety Code, is
4-17 amended to read as follows:
4-18 Sec. 142.003. Exemptions From Licensing Requirement.
4-19 (a) The following persons need not be licensed under this chapter:
4-20 (1) a physician, dentist, registered nurse, or
4-21 physical therapist licensed under the laws of this state who
4-22 provides home health services to a client <patient> only as a part
4-23 of and incidental to that person's private office practice;
4-24 (2) a registered nurse, licensed vocational nurse,
4-25 physical therapist, occupational therapist, speech therapist,
4-26 medical social worker, or any other health care professional as
4-27 determined by the department who provides home health services as a
4-28 sole practitioner;
4-29 (3) a <nonprofit> registry <operated by a national or
4-30 state professional association or society of licensed health care
4-31 practitioners, or a subdivision of the association or society,>
4-32 that operates solely as a clearinghouse to put consumers in contact
4-33 with persons who provide home health, hospice, or personal
4-34 assistance services <licensed health care practitioners who give
4-35 care in a patient's residence> and that does not maintain official
4-36 client <patient> records, <or> direct client <patient> services
4-37 compensate the person who is providing the service;
4-38 (4) an individual whose permanent residence is in the
4-39 client's <patient's> residence;
4-40 (5) an employee of a person licensed under this
4-41 chapter who provides home health, hospice, or personal assistance
4-42 services only as an employee of the license holder and who receives
4-43 no benefit for providing the services, other than wages from the
4-44 license holder;
4-45 (6) a home, nursing home, convalescent home, personal
4-46 care facility, special care facility, or other institution for
4-47 individuals who are elderly or who have disabilities that provides
4-48 home health or personal assistance <the disabled or aged that
4-49 provides health> services only to residents of the home or
4-50 institution;
4-51 (7) a person who provides one health service through a
4-52 contract with a person licensed under this chapter;
4-53 (8) a durable medical equipment supply company;
4-54 (9) a pharmacy or wholesale medical supply company
4-55 that does not furnish services, other than supplies, to a person at
4-56 the person's house;
4-57 (10) a hospital or other licensed health care facility
4-58 that provides home health or personal assistance services <serves>
4-59 only to inpatient residents of the hospital or facility;
4-60 (11) a person providing home health or personal
4-61 assistance services to an injured employee under the Texas Workers'
4-62 Compensation Act (Article 8308-1.01 et seq., Vernon's Texas Civil
4-63 <workers' compensation laws of this state (Article 8306 et seq.,
4-64 Revised> Statutes); <or>
4-65 (12) a visiting nurse service that:
4-66 (A) is conducted by and for the adherents of a
4-67 well-recognized church or religious denomination; and
4-68 (B) provides nursing services by a person exempt
4-69 from licensing by Article 4528, Revised Statutes, because the
4-70 person furnishes nursing care in which treatment is only by prayer
5-1 or spiritual means;
5-2 (13) an individual hired and paid directly by the
5-3 client or the client's family or legal guardian to provide home
5-4 health or personal assistance services;
5-5 (14) a business, school, camp, or other organization
5-6 that provides home health or personal assistance services,
5-7 incidental to the organization's primary purpose, to individuals
5-8 employed by or participating in programs offered by the business,
5-9 school, or camp that enable the individual to participate fully in
5-10 the business's, school's, or camp's programs;
5-11 (15) a person or organization providing
5-12 sitter-companion services or chore or household services that do
5-13 not involve personal care, health, or health-related services;
5-14 (16) a licensed health care facility that provides
5-15 hospice services under a contract with a hospice;
5-16 (17) a person delivering residential acquired immune
5-17 deficiency syndrome hospice care who is licensed and designated as
5-18 a residential AIDS hospice under Chapter 248; or
5-19 (18) until August 31, 1995, a state agency, mental
5-20 retardation authority, or mental health authority providing the
5-21 direct delivery of home health, hospice, or personal assistance
5-22 services.
5-23 (b) A home and community support services agency that owns
5-24 or operates an administrative support site is not required to
5-25 obtain a separate license under this chapter for the administrative
5-26 support site.
5-27 (c) A hospice that operates or provides hospice services to
5-28 an inpatient unit under a contract with a licensed health care
5-29 facility is not required to obtain an alternate delivery site
5-30 license for that inpatient unit.
5-31 SECTION 7. Section 142.004, Health and Safety Code, is
5-32 amended to read as follows:
5-33 Sec. 142.004. License Application. (a) An applicant for a
5-34 license to provide <a> home health, hospice, or personal assistance
5-35 services <service> must:
5-36 (1) file a written application on a form prescribed by
5-37 the department indicating the type of service the applicant wishes
5-38 to provide;
5-39 (2) file with the application:
5-40 (A) the name of the owner of the applicant
5-41 <service> or a list of the names of persons who own at least a 10
5-42 percent <an> interest in the applicant <service>; <and>
5-43 (B) a list of any businesses with which the
5-44 applicant <service> subcontracts and in which the owner or owners
5-45 of the applicant <service> hold at least five percent of the
5-46 ownership; and
5-47 (C) if the applicant is a direct or indirect
5-48 subsidiary of a publicly held corporation, the name of that
5-49 publicly held corporation and the names of each subsidiary of the
5-50 publicly held corporation that owns an interest in the applicant;
5-51 (3) cooperate with any surveys <inspections> required
5-52 by the department for a license; and
5-53 (4) pay the license fee prescribed by this chapter.
5-54 (b) In addition to the requirements of Subsection (a), if
5-55 the applicant is a certified agency when the application for a
5-56 <Class A> license to provide certified home health services is
5-57 filed, the applicant must maintain its Medicare certification. If
5-58 the applicant is not a certified agency when the application for a
5-59 <Class A> license to provide certified home health services is
5-60 filed, the applicant must establish that it is in the process of
5-61 receiving its certification from the United States Department of
5-62 Health and Human Services.
5-63 (c) The board by rule shall require that, at a minimum,
5-64 before the department may approve a license application, other than
5-65 an application for a renewal or branch office or alternate delivery
5-66 site license, the applicant must provide to the department:
5-67 (1) documentation establishing that, at a minimum, the
5-68 applicant has sufficient financial resources to provide the
5-69 services required by this chapter and by the department during the
5-70 term of the license;
6-1 (2) a list of the management personnel for the
6-2 proposed home and community support services <health> agency, a
6-3 description of personnel qualifications, and a plan for providing
6-4 continuing training and education for the personnel during the term
6-5 of the license;
6-6 (3) documentation establishing that the applicant is
6-7 capable of meeting the minimum standards established by the board
6-8 relating to the quality of care; and
6-9 (4) a plan that provides for the orderly transfer of
6-10 care of the applicant's clients if the applicant cannot maintain or
6-11 deliver home health, hospice, or personal assistance services under
6-12 the license.
6-13 (d) Information received by the department relating to the
6-14 competence and financial resources of the applicant is confidential
6-15 and may not be disclosed to the public.
6-16 SECTION 8. Section 142.006, Health and Safety Code, is
6-17 amended to read as follows:
6-18 Sec. 142.006. License Issuance; Term. (a) The department
6-19 shall issue a <Class A or Class B> home and community support
6-20 services agency <health service> license to provide home health,
6-21 hospice, or personal assistance services for each place of business
6-22 to each applicant who:
6-23 (1) qualifies for the <type of> license to provide the
6-24 type of service that is to be offered by the applicant <requested>;
6-25 (2) submits an application and license fee as required
6-26 by this chapter; and
6-27 (3) complies with all licensing standards required or
6-28 adopted by the board under this chapter.
6-29 (b) A license issued under this chapter expires one year
6-30 after the date of issuance. The department may issue an initial
6-31 license for a term of less than one year to conform expiration
6-32 dates for a locality or an applicant. The department, in
6-33 accordance with board rules, may issue a temporary license to an
6-34 applicant for an initial license.
6-35 (c) The department may find that a home and community
6-36 support services agency has satisfied the requirements for
6-37 licensing if the agency is accredited by an accreditation
6-38 organization, such as the Joint Commission on Accreditation of
6-39 Health Organizations or the Community Health Care Accreditation
6-40 Program, and the department finds that the accreditation
6-41 organization has standards that meet or exceed the requirements for
6-42 licensing under this chapter. A license fee is required of the
6-43 home and community support services agency at the time of a license
6-44 application.
6-45 (d) The department may find that a home and community
6-46 support services agency has satisfied the requirements for
6-47 licensing if the agency is certified by a state agency that has
6-48 certification standards that meet or exceed the requirements for
6-49 licensing under this chapter. A license fee is required at the
6-50 time of a license application.
6-51 (e) The license must designate the types of services that
6-52 the home and community support services agency is authorized to
6-53 provide at or from the designated place of business.
6-54 SECTION 9. Subchapter A, Chapter 142, Health and Safety
6-55 Code, is amended by adding Section 142.0065 to read as follows:
6-56 Sec. 142.0065. DISPLAY OF LICENSE. A license issued under
6-57 this chapter shall be displayed in a conspicuous place in the
6-58 designated place of business and must show:
6-59 (1) the name and address of the licensee;
6-60 (2) the name of the owner or owners, if different from
6-61 the information provided under Subdivision (1);
6-62 (3) the license expiration date; and
6-63 (4) the types of services authorized to be provided
6-64 under the license.
6-65 SECTION 10. Section 142.008, Health and Safety Code, is
6-66 amended to read as follows:
6-67 Sec. 142.008. Branch Office. (a) The department may issue
6-68 a branch office license to a person who holds a <Class A or Class
6-69 B> license to provide home health or personal assistance services.
6-70 (b) The board by rule shall establish eligibility
7-1 requirements for a branch office license.
7-2 (c) A branch office license expires on the same date as the
7-3 <Class A or Class B> license to provide home health or personal
7-4 assistance services held by the applicant for the branch office
7-5 license <that person>.
7-6 SECTION 11. Subchapter A, Chapter 142, Health and Safety
7-7 Code, is amended by adding Section 142.0085 to read as follows:
7-8 Sec. 142.0085. ALTERNATE DELIVERY SITE LICENSE. (a) The
7-9 department shall issue an alternate delivery site license to a
7-10 qualified hospice.
7-11 (b) The board by rule shall establish standards required for
7-12 the issuance of an alternate delivery site license.
7-13 (c) An alternate delivery site license expires on the same
7-14 date as the license to provide hospice services held by the
7-15 hospice.
7-16 SECTION 12. Section 142.009, Health and Safety Code, is
7-17 amended to read as follows:
7-18 Sec. 142.009. SURVEYS <INSPECTIONS>; CONSUMER COMPLAINTS.
7-19 (a) The department or its representative may enter the premises of
7-20 a license applicant or license holder at reasonable times to
7-21 conduct a survey <an inspection> incidental to the issuance of a
7-22 license and at other times as the department considers necessary to
7-23 ensure compliance with this chapter and the rules adopted under
7-24 this chapter.
7-25 (b) A home and community support services <health> agency
7-26 shall provide each person who receives home health, hospice, or
7-27 personal assistance services with a written statement that contains
7-28 the name, address, and telephone number of the department and a
7-29 statement that informs the recipient <consumers> that a complaint
7-30 against a home and community support services <health> agency may
7-31 be directed to the department.
7-32 (c) The department or its authorized representative shall
7-33 investigate each complaint received regarding the provision of home
7-34 health, hospice, or personal assistance services and may, as a
7-35 part of the investigation:
7-36 (1) conduct an unannounced survey <inspection> of a
7-37 place of business, including an inspection of medical and personnel
7-38 records, if the department has reasonable cause to believe that the
7-39 place of business is in violation of this chapter or a rule adopted
7-40 under this chapter;
7-41 (2) conduct an interview with a recipient of home
7-42 health, hospice or personal assistance services, which may be
7-43 conducted in the recipient's home if the recipient consents; <or>
7-44 (3) conduct an interview with a family member of a
7-45 recipient of home health, hospice, or personal assistance services
7-46 who is deceased or other person who may have knowledge of the care
7-47 received by the deceased recipient of the home health, hospice, or
7-48 personal assistance services; or
7-49 (4) interview a physician or other health care
7-50 practitioner, including a member of the personnel of a home and
7-51 community support services <health> agency, who cares for a
7-52 recipient of home health, hospice, or personal assistance services.
7-53 (d) The reports, records, and working papers used or
7-54 developed in an investigation made under this section are
7-55 confidential and may not be released or made public except:
7-56 (1) to a state or federal agency;
7-57 (2) to federal, state, or local law enforcement
7-58 personnel;
7-59 (3) with the consent of each person identified in the
7-60 information released;
7-61 (4) in civil or criminal litigation matters or
7-62 licensing proceedings as otherwise allowed by law or judicial rule;
7-63 or
7-64 (5) on a form developed by the department that
7-65 identifies any deficiencies found without identifying a person,
7-66 other than the home and community support services agency.
7-67 (e) The department's representative shall hold a conference
7-68 with the person in charge of the home and community support
7-69 services <health> agency before beginning the on-site survey
7-70 <inspection> to explain the nature and scope of the survey
8-1 <inspection>. When the survey <inspection> is completed, the
8-2 department's representative shall hold a conference with the person
8-3 who is in charge of the agency and shall identify any records that
8-4 were duplicated. Agency records may be removed from an agency only
8-5 with the agency's consent.
8-6 (f) The department shall fully inform the person who is in
8-7 charge of the home and community support services agency of the
8-8 preliminary findings of the survey and shall give the person a
8-9 reasonable opportunity to submit additional facts or other
8-10 information to the department's authorized representative in
8-11 response to those findings. The response shall be made a part of
8-12 the record of the survey for all purposes.
8-13 (g) After a survey of a home and community support services
8-14 agency by the department, the department shall provide to the chief
8-15 executive officer of the agency:
8-16 (1) specific and timely written notice of the
8-17 preliminary findings of the survey, including:
8-18 (A) the specific nature of the survey;
8-19 (B) any alleged violations of a specific statute
8-20 or rule;
8-21 (C) the specific nature of any finding regarding
8-22 an alleged violation or deficiency; and
8-23 (D) if a deficiency is alleged, the severity of
8-24 the deficiency;
8-25 (2) information on the identity, including the
8-26 signature, of each department representative conducting, reviewing,
8-27 or approving the results of the survey and the date on which the
8-28 department representative acted on the matter; and
8-29 (3) if requested by the agency, copies of all
8-30 documents relating to the survey maintained by the department or
8-31 provided by the department to any other state or federal agency
8-32 that are not confidential under state law.
8-33 (h) Except for the investigation of complaints, a home and
8-34 community support services agency licensed by the department under
8-35 this chapter is not subject to additional surveys relating to home
8-36 health, hospice, or personal assistance services while the agency
8-37 maintains accreditation for the applicable service from the Joint
8-38 Commission for Accreditation of Health Care Organizations, the
8-39 Community Health Accreditation Program, or other national
8-40 accreditation organizations that meet or exceed the regulations
8-41 adopted under this chapter. Each provider must submit to the
8-42 department documentation from the accrediting body indicating that
8-43 the provider is accredited when the provider is applying for the
8-44 initial license and annually when the license is renewed.
8-45 (i) Except as provided by Subsections (h) and (k), an
8-46 on-site survey must be conducted within 18 months after a survey
8-47 for an initial license. After that time, an on-site survey must be
8-48 conducted at least every 36 months.
8-49 (j) If a person is renewing or applying for a license to
8-50 provide more than one type of service under this chapter, the
8-51 surveys required for each of the services the license holder or
8-52 applicant seeks to provide shall be completed during the same
8-53 surveyor visit.
8-54 (k) The department and other state agencies that are under
8-55 the Health and Human Services Commission and that contract with
8-56 home and community support services agencies to deliver services
8-57 for which a license is required under this chapter shall execute a
8-58 memorandum of understanding that establishes procedures to
8-59 eliminate or reduce duplication of standards or conflicts between
8-60 standards and of functions in license, certification, or compliance
8-61 surveys and complaint investigations. The Health and Human
8-62 Services Commission shall review the recommendation of the council
8-63 relating to the memorandum of understanding before considering
8-64 approval. The memorandum of understanding must be approved by the
8-65 commission.
8-66 SECTION 13. Section 142.010, Health and Safety Code, is
8-67 amended to read as follows:
8-68 Sec. 142.010. Fees. (a) The board shall set <the home
8-69 health service> license fees for home and community support
8-70 services agencies in amounts that are reasonable to meet the costs
9-1 of administering this chapter, except that the fees may not be less
9-2 than $200 or more than $1,000 for a license to provide home health,
9-3 hospice, or personal assistance services<:>
9-4 <(1) less than $600 or more than $1,200 for an initial
9-5 Class A or Class B license; or>
9-6 <(2) less than $200 or more than $300 for renewal of a
9-7 branch office license>.
9-8 (b) The board shall consider the size of the home and
9-9 community support services agency, the number of clients served,
9-10 the number of services provided, and the necessity for review of
9-11 other accreditation documentation in determining the amount of
9-12 initial and renewal license fees.
9-13 (c) A fee charged under this section is nonrefundable.
9-14 SECTION 14. Sections 142.011(b) and (c), Health and Safety
9-15 Code, are amended to read as follows:
9-16 (b) The department may immediately suspend or revoke a
9-17 license when the health and safety of persons are threatened. If
9-18 the department issues an order of immediate suspension or
9-19 revocation, the department shall immediately give the chief
9-20 executive officer of the home and community support services agency
9-21 adequate notice of the action taken, the legal grounds for the
9-22 action, and the procedure governing appeal of the action. A person
9-23 whose license is suspended or revoked under this subsection is
9-24 entitled to a hearing not later than the seventh day after the
9-25 effective date of the suspension or revocation.
9-26 (c) The department may suspend or revoke a home and
9-27 community support services agency's license to provide certified
9-28 home health services if the agency <the license of a Class A home
9-29 health agency that> fails to maintain its certification qualifying
9-30 the agency as a certified agency. A home and community support
9-31 services agency that is licensed to provide certified home health
9-32 services and <Class A home health agency> that submits a request
9-33 for a hearing as provided by Subsection (d) is subject to the
9-34 requirements of this chapter relating to a home and community
9-35 support services agency that is licensed to provide home health
9-36 services, but not certified home health services, <Class B home
9-37 health agency> until the suspension or revocation is finally
9-38 determined by the department or, if the license is suspended or
9-39 revoked, until the last day for seeking review of the department
9-40 order or a later date fixed by order of the reviewing court.
9-41 SECTION 15. Section 142.012, Health and Safety Code, is
9-42 amended to read as follows:
9-43 Sec. 142.012. Powers and Duties. (a) The board, with the
9-44 recommendations of the council, shall adopt rules necessary to
9-45 implement this chapter.
9-46 (b) The board by rule shall set minimum standards for home
9-47 and community support services <health> agencies licensed under
9-48 this chapter that relate to:
9-49 (1) qualifications for professional and
9-50 nonprofessional personnel, including volunteers;
9-51 (2) supervision of professional and nonprofessional
9-52 personnel, including volunteers;
9-53 (3) the provision and coordination of treatment and
9-54 services, including support and bereavement services, as
9-55 appropriate;
9-56 (4) the management, ownership, and organizational
9-57 structure, including lines of authority and delegation of
9-58 responsibility and, as appropriate, the composition of an
9-59 interdisciplinary team;
9-60 (5) clinical and business records;
9-61 (6) financial ability to carry out the functions as
9-62 proposed; <and>
9-63 (7) safety, fire prevention, and sanitary standards
9-64 for residential units and inpatient units; and
9-65 (8) any other aspects of home health, hospice, or
9-66 personal assistance services as necessary to protect the public.
9-67 (c) The initial minimum standards adopted by the board under
9-68 Subsection (b) for hospice services must be at least as stringent
9-69 as the conditions of participation for a Medicare certified
9-70 provider of hospice services in effect on April 30, 1993, under
10-1 Title XVIII, Social Security Act (42 U.S.C. Section 1395 et seq.).
10-2 (d) The department shall prescribe forms necessary to
10-3 perform its duties.
10-4 (e) <(d)> The department shall require each person or home
10-5 and community support services <health> agency providing home
10-6 health, hospice, or personal assistance services to implement and
10-7 enforce the applicable provisions of Chapter 102, Human Resources
10-8 Code.
10-9 SECTION 16. Section 142.014, Health and Safety Code, is
10-10 amended to read as follows:
10-11 Sec. 142.014. Civil Penalty. (a) A person who engages in
10-12 the business of providing home health, hospice, or personal
10-13 assistance service, or represents to the public that the person is
10-14 a provider of home health, hospice, and personal assistance
10-15 services for pay, <operates a home health agency> without a license
10-16 issued under this chapter authorizing the services that are being
10-17 provided is liable for a civil penalty of not less than $1,000
10-18 <$100> or more than $2,500 <$500> for each day of violation.
10-19 Penalties may be appropriated only to the department and to
10-20 administer this chapter.
10-21 (b) An action to recover a civil penalty is in addition to
10-22 an action brought for injunctive relief under Section 142.013 or
10-23 any other remedy provided by law. The attorney general shall bring
10-24 suit on behalf of the state to collect the civil penalty.
10-25 SECTION 17. Sections 142.015(a) and (d), Health and Safety
10-26 Code, are amended to read as follows:
10-27 (a) The Home and Community Support <Health> Services
10-28 Advisory Council is composed of the following 13 <11> members,
10-29 appointed by the governor:
10-30 (1) three consumer representatives <one representative
10-31 of the department>;
10-32 (2) two representatives of agencies that are licensed
10-33 to provide certified home health services <consumers of home health
10-34 agency and hospice services>;
10-35 (3) two representatives of agencies that are licensed
10-36 to provide home health services but are not certified home health
10-37 services <one representative of the Texas Department of Human
10-38 Services>;
10-39 (4) three representatives of agencies that are
10-40 licensed to provide hospice services, with one representative
10-41 appointed from:
10-42 (A) a community-based non-profit provider of
10-43 hospice services;
10-44 (B) a community-based proprietary provider of
10-45 hospice services; and
10-46 (C) a hospital-based provider of hospice
10-47 services; and <one representative of the Texas Association of Home
10-48 Health Agencies, Incorporated;>
10-49 (5) three representatives of agencies that are
10-50 licensed to provide personal assistance services <one
10-51 representative of private nonprofit home health agencies;>
10-52 <(6) one representative of voluntary nonprofit home
10-53 health agencies;>
10-54 <(7) one representative of proprietary home health
10-55 agencies;>
10-56 <(8) one representative of an official department home
10-57 health agency;>
10-58 <(9) one member to represent Medicare-certified Class
10-59 A hospice providers affiliated with a home health agency, hospital,
10-60 or other health service provider; and>
10-61 <(10) one member to represent Medicare-certified Class
10-62 A hospice providers not affiliated with a home health agency,
10-63 hospital, or other health service provider>.
10-64 (d) Members of the council serve staggered two-year terms,
10-65 with the terms of seven <six> members expiring on January 31 of
10-66 each even-numbered year and the terms of six <five> members
10-67 expiring on January 31 of each odd-numbered year.
10-68 SECTION 18. Subchapter A, Chapter 142, Health and Safety
10-69 Code, is amended by adding Section 142.016 to read as follows:
10-70 Sec. 142.016. MEMORANDUM OF UNDERSTANDING RELATING TO
11-1 NURSING SERVICES; GUIDELINES. (a) The Board of Nurse Examiners
11-2 and the department shall adopt a memorandum of understanding
11-3 governing the circumstances under which the provision of
11-4 health-related tasks or services do not constitute the practice of
11-5 professional nursing. The agencies annually shall review and shall
11-6 renew or modify the memorandum as necessary.
11-7 (b) The Board of Nurse Examiners and the department shall
11-8 consult with an advisory committee in developing, modifying, or
11-9 renewing the memorandum of understanding. The advisory committee
11-10 shall be appointed by the Board of Nurse Examiners and the
11-11 department and at a minimum shall include:
11-12 (1) one representative from the Board of Nurse
11-13 Examiners and one representative from the department to serve as
11-14 cochairmen;
11-15 (2) one representative from the Texas Department of
11-16 Mental Health and Mental Retardation;
11-17 (3) one representative from the Texas Department of
11-18 Human Services;
11-19 (4) one representative from the Texas Nurses
11-20 Association;
11-21 (5) one representative from the Texas Association of
11-22 Home Care, Incorporated, or its successor;
11-23 (6) one representative from the Texas Hospice
11-24 Organization, Incorporated, or its successor;
11-25 (7) one representative of the Texas Respite Resource
11-26 Network; and
11-27 (8) two representatives of organizations such as the
11-28 Personal Assistance Task Force or the Disability Consortium that
11-29 advocate for clients in community-based settings.
11-30 (c) The department shall prepare guidelines according to the
11-31 memorandum of understanding required by Subsection (a) for licensed
11-32 home and community support services agencies in providing personal
11-33 assistance services to clients.
11-34 SECTION 19. Section 142.021, Health and Safety Code, is
11-35 amended to read as follows:
11-36 Sec. 142.021. ADMINISTRATION OF <PERMITS TO ADMINISTER>
11-37 MEDICATION. A person may not administer medication to a client
11-38 <patient> of a home and community support services <health> agency
11-39 unless the person:
11-40 (1) holds a license under state law that authorizes
11-41 the person to administer medication;
11-42 (2) holds a permit issued under Section 142.025 and
11-43 acts under the delegated authority of a person who holds a license
11-44 under state law that authorizes the person to administer
11-45 medication; <or>
11-46 (3) performs duties as a qualified dialysis technician
11-47 within the scope authorized by board rules;
11-48 (4) administers a medication to a client of a home and
11-49 community support service agency in accordance with rules of the
11-50 Board of Nurse Examiners that permit delegation of the
11-51 administration of medication to a person not holding a permit under
11-52 Section 142.025; or
11-53 (5) administers noninjectable medication under
11-54 circumstances authorized by the memorandum of understanding adopted
11-55 under Section 142.016.
11-56 SECTION 20. Section 142.023, Health and Safety Code, is
11-57 amended to read as follows:
11-58 Sec. 142.023. Rules for Administration of Medication. The
11-59 board by rule shall establish:
11-60 (1) minimum requirements for the issuance, denial,
11-61 renewal, suspension, emergency suspension, and revocation of a
11-62 permit to a home health medication aide <administer medication to a
11-63 patient of a home health agency>;
11-64 (2) curricula to train a home health medication aide
11-65 <persons to administer medication to a patient of a home health
11-66 agency>;
11-67 (3) minimum standards for the approval of home health
11-68 medication aide training programs <programs to train persons to
11-69 administer medication to patients of home health agencies> and for
11-70 rescinding approval;
12-1 (4) the acts and practices that are allowed or
12-2 prohibited to a permit holder; and
12-3 (5) minimum standards for on-site supervision of a
12-4 permit holder by a registered nurse.
12-5 SECTION 21. Section 142.024, Health and Safety Code, is
12-6 amended to read as follows:
12-7 Sec. 142.024. HOME HEALTH MEDICATION AIDE TRAINING PROGRAMS
12-8 <TO ADMINISTER MEDICATION>. (a) An application for the approval
12-9 of a home health medication aide training program must be made to
12-10 the department on a form and under rules prescribed by the board.
12-11 (b) The department shall approve a home health medication
12-12 aide training program that meets the minimum standards adopted
12-13 under Section 142.023. The department may review the approval
12-14 annually.
12-15 SECTION 22. The heading of Section 142.025, Health and
12-16 Safety Code, is amended to read as follows:
12-17 Sec. 142.025. ISSUANCE AND RENEWAL OF HOME HEALTH MEDICATION
12-18 AIDE PERMIT <TO ADMINISTER MEDICATION>.
12-19 SECTION 23. Section 142.025(a), Health and Safety Code, is
12-20 amended to read as follows:
12-21 (a) To be issued or to have renewed a home health medication
12-22 aide permit <to administer medication>, a person shall apply to the
12-23 department on a form prescribed and under rules adopted by the
12-24 board.
12-25 SECTION 24. The heading of Section 142.026, Health and
12-26 Safety Code, is amended to read as follows:
12-27 Sec. 142.026. FEES FOR ISSUANCE AND RENEWAL OF HOME HEALTH
12-28 MEDICATION AIDE PERMIT <TO ADMINISTER MEDICATION>.
12-29 SECTION 25. The heading of Section 142.027, Health and
12-30 Safety Code, is amended to read as follows:
12-31 Sec. 142.027. VIOLATION OF HOME HEALTH MEDICATION AIDE
12-32 PERMITS <TO ADMINISTER MEDICATION>.
12-33 SECTION 26. The heading of Section 142.028, Health and
12-34 Safety Code, is amended to read as follows:
12-35 Sec. 142.028. EMERGENCY SUSPENSION OF HOME HEALTH MEDICATION
12-36 AIDE PERMITS <TO ADMINISTER MEDICATION>.
12-37 SECTION 27. Section 142.029(a), Health and Safety Code, is
12-38 amended to read as follows:
12-39 (a) A person commits an offense if the person knowingly
12-40 administers medication to a client <patient> of a home and
12-41 community support services <health> agency and the person is not
12-42 authorized to administer the medication under Section 142.021 or
12-43 142.022<:>
12-44 <(1) does not hold a license under state law that
12-45 authorizes the person to administer medication; or>
12-46 <(2) does not hold a permit issued by the department
12-47 under Section 142.025>.
12-48 SECTION 28. Section 142.030(a), Health and Safety Code, is
12-49 amended to read as follows:
12-50 (a) A person authorized by this subchapter to administer
12-51 medication to a client <patient> of a home and community support
12-52 services <health> agency may not dispense dangerous drugs or
12-53 controlled substances without complying with the Texas Pharmacy Act
12-54 (Article 4542a-1, Vernon's Texas Civil Statutes).
12-55 SECTION 29. Section 248.003, Health and Safety Code, is
12-56 amended to read as follows:
12-57 Sec. 248.003. Exemptions. This chapter does not apply to:
12-58 (1) a home and community support services <health>
12-59 agency required to be licensed under Chapter 142;
12-60 (2) a person required to be licensed under Chapter 241
12-61 (Texas Hospital Licensing Law);
12-62 (3) an institution required to be licensed under
12-63 Chapter 242;
12-64 (4) an ambulatory surgical center required to be
12-65 licensed under Chapter 243 (Texas Ambulatory Surgical Center
12-66 Licensing Act);
12-67 (5) a birthing center required to be licensed under
12-68 Chapter 244 (Texas Birthing Center Licensing Act);
12-69 (6) a facility required to be licensed under Chapter
12-70 245 (Texas Abortion Facility Reporting and Licensing Act); or
13-1 (7) a person providing medical or nursing care or
13-2 services under a license or permit issued under other state law.
13-3 SECTION 30. Section 248.002, Health and Safety Code, is
13-4 amended by adding Subdivisions (9)-(14) to read as follows:
13-5 (9) "Bereavement services" has the meaning assigned by
13-6 Section 142.001.
13-7 (10) "Palliative care" has the meaning assigned by
13-8 Section 142.001.
13-9 (11) "Support services" has the meaning assigned by
13-10 Section 142.001.
13-11 (12) "Residential AIDS hospice" means a facility
13-12 licensed and designated as a residential AIDS hospice under this
13-13 chapter.
13-14 (13) "Residential AIDS hospice care" means hospice
13-15 services provided in a residential AIDS hospice.
13-16 (14) "AIDS" means acquired immune deficiency syndrome.
13-17 SECTION 31. Subchapter B, Chapter 248, Health and Safety
13-18 Code, is amended by adding Section 248.029 to read as follows:
13-19 Sec. 248.029. RESIDENTIAL AIDS HOSPICE DESIGNATION.
13-20 (a) The board by rule shall adopt standards for the designation of
13-21 a special care facility licensed under this chapter as a
13-22 residential AIDS hospice. Those standards shall be consistent with
13-23 other standards adopted under this chapter and consistent with the
13-24 purposes for which special care facilities are created.
13-25 (b) In adopting the standards, the board shall consider
13-26 rules adopted for the designation of a hospice under Chapter 142
13-27 and shall establish specific standards requiring:
13-28 (1) the provision of exclusively palliative care by a
13-29 facility;
13-30 (2) the provision of bereavement services;
13-31 (3) the provision of support services to the family of
13-32 a client;
13-33 (4) the participation of a registered nurse in the
13-34 development of an initial plan of care for a client and periodic
13-35 review of the plan of care by an interdisciplinary team of the
13-36 facility; and
13-37 (5) clinical and medical review of patient care
13-38 services by a physician who acts as a medical consultant.
13-39 (c) A special care facility licensed under this chapter that
13-40 satisfies the standards adopted under this section shall be
13-41 designated as a residential AIDS hospice.
13-42 (d) Notwithstanding Chapter 142, a special care facility
13-43 licensed and issued a designation as a residential AIDS hospice
13-44 under this chapter may use the term "residential AIDS hospice" or a
13-45 similar term or language in its title or in a description or
13-46 representation of the facility if the similar term or language
13-47 clearly identifies the facility as a facility regulated under this
13-48 chapter and clearly distinguishes the facility from a hospice
13-49 regulated under Chapter 142.
13-50 (e) A special care facility licensed under this chapter on
13-51 July 1, 1994, on notice to the department that it is in compliance
13-52 with the standards adopted for designation as a residential AIDS
13-53 hospice, shall be issued that designation by the department, and
13-54 that designation is valid until the date the license of the
13-55 facility expires or is renewed.
13-56 SECTION 32. Sections 142.005 and 142.007, Health and Safety
13-57 Code, are repealed.
13-58 SECTION 33. (a) The changes in law made by this Act apply
13-59 only to an offense or a violation committed on or after July 1,
13-60 1994.
13-61 (b) An offense or violation committed before July 1, 1994,
13-62 is covered by the law in effect when the offense or violation was
13-63 committed, and the former law is continued in effect for that
13-64 purpose.
13-65 SECTION 34. Not later than January 1, 1994, the Board of
13-66 Nurse Examiners and the Texas Department of Health shall adopt the
13-67 initial memorandum of understanding required by Section 142.016,
13-68 Health and Safety Code, as added by this Act.
13-69 SECTION 35. The changes in law made by this Act do not
13-70 affect the validity of a license or of a permit to administer
14-1 medication issued by the Texas Department of Health under Chapter
14-2 142, Health and Safety Code, before the effective date of this Act.
14-3 Regardless of the changes in law made by this Act, the department
14-4 shall continue to issue licenses to qualified home health agencies
14-5 and permits to administer medication under Chapter 142, Health and
14-6 Safety Code, as it existed immediately before the effective date of
14-7 this Act, and that law is continued in effect for that purpose
14-8 until July 1, 1994.
14-9 SECTION 36. The Texas Department of Health shall propose
14-10 rules to implement this Act on or before January 1, 1994. The
14-11 department shall adopt rules to implement this Act on or before
14-12 June 1, 1994.
14-13 SECTION 37. The Texas Department of Health and other state
14-14 agencies under the Health and Human Services Commission shall
14-15 distribute to interested persons a draft of the memorandum of
14-16 understanding required by Section 142.009(k), Health and Safety
14-17 Code, as added by this Act, on or before January 1, 1994, and shall
14-18 execute the initial memorandum of understanding required by that
14-19 section on or before June 1, 1994.
14-20 SECTION 38. A home and community support services agency
14-21 providing home health, hospice, or personal assistance services is
14-22 not required to obtain a license under this Act until July 1, 1994.
14-23 SECTION 39. After the effective date of this Act, a
14-24 reference to a home health agency in law is a reference to a home
14-25 and community support services agency.
14-26 SECTION 40. A person who, on the effective date of this Act,
14-27 is serving a term as a member of the Home Health Services Advisory
14-28 Council shall continue to serve on the Home and Community Support
14-29 Services Advisory Council until January 31, 1994. At that time, in
14-30 accordance with Section 142.015, Health and Safety Code, as amended
14-31 by this Act, the governor shall appoint the 13 members to the
14-32 council. After the appointment of the new council in 1994, at the
14-33 first meeting of the council the new members shall draw lots to
14-34 determine their initial terms. Seven members shall serve for a
14-35 term expiring January 31, 1995, and six members shall serve for a
14-36 term expiring January 31, 1996.
14-37 SECTION 41. This Act takes effect September 1, 1993.
14-38 SECTION 42. The importance of this legislation and the
14-39 crowded condition of the calendars in both houses create an
14-40 emergency and an imperative public necessity that the
14-41 constitutional rule requiring bills to be read on three several
14-42 days in each house be suspended, and this rule is hereby suspended.
14-43 * * * * *
14-44 Austin,
14-45 Texas
14-46 May 20, 1993
14-47 Hon. Bob Bullock
14-48 President of the Senate
14-49 Sir:
14-50 We, your Committee on Health and Human Services to which was
14-51 referred H.B. No. 1551, have had the same under consideration, and
14-52 I am instructed to report it back to the Senate with the
14-53 recommendation that it do not pass, but that the Committee
14-54 Substitute adopted in lieu thereof do pass and be printed.
14-55 Moncrief,
14-56 Acting Chair
14-57 * * * * *
14-58 WITNESSES
14-59 FOR AGAINST ON
14-60 ___________________________________________________________________
14-61 Name: Anita Bradberry x
14-62 Representing: Tx Asso Home Care Inc.
14-63 City: Austin
14-64 -------------------------------------------------------------------
14-65 Name: Kay Hollers x
14-66 Representing: Outreach Health Services
14-67 City: Austin
14-68 -------------------------------------------------------------------
14-69 Name: Vincent Sadowski x
14-70 Representing: Dir Asso of Tx Centers Ind
15-1 City: Austin
15-2 -------------------------------------------------------------------
15-3 Name: Buddy Calvert x
15-4 Representing: Tx Hospice Organization
15-5 City: Kerrville
15-6 -------------------------------------------------------------------
15-7 Name: James Willman x
15-8 Representing: Tx Nurses Asso
15-9 City: Austin
15-10 -------------------------------------------------------------------
15-11 Name: Bob Kafka x
15-12 Representing: Personal Attendent Services
15-13 City: Austin
15-14 -------------------------------------------------------------------
15-15 Name: Jennifer Cernoch x
15-16 Representing: Self
15-17 City: San Antonio
15-18 -------------------------------------------------------------------
15-19 Name: Ann Calvert x
15-20 Representing: Heart of the Hills Hospice
15-21 City: Ingram
15-22 -------------------------------------------------------------------
15-23 Name: Donna Loflin x
15-24 Representing: Tx Dept on Aging
15-25 City: Austin
15-26 -------------------------------------------------------------------
15-27 Name: Liz Newhouse x
15-28 Representing: Self
15-29 City: San Antonio
15-30 -------------------------------------------------------------------
15-31 Name: Barrett Markland x
15-32 Representing: Advocacy, Inc
15-33 City: Austin
15-34 -------------------------------------------------------------------
15-35 Name: Mary Jo Magruder x
15-36 Representing: Tx Planning Council Develop
15-37 City: Austin
15-38 -------------------------------------------------------------------
15-39 Name: Robin Herskowitz x
15-40 Representing: Private Provider Asso of Tx
15-41 City: Austin
15-42 -------------------------------------------------------------------