Amend CSSB 414 as follows:
      (1)  Following Section 166.003, Health and Safety Code, as
added by SECTION 1.02 of the bill (page 2, between lines 31 and
32), insert the following:
      Sec. 166.004.  STATEMENT RELATING TO ADVANCE DIRECTIVE. (a)
A health care provider shall maintain written policies regarding
the implementation of advance directives. The policies must include
a clear and precise statement of any procedure the health care
provider is unwilling or unable to withhold in accordance with an
advance directive.
      (b)  The health care provider shall provide written notice to
an individual of the written policies described by Subsection (a).
The notice must be provided at the earlier of:
            (1)  the time the individual is admitted to receive
services from the health care provider; or
            (2)  the time the health care provider begins providing
care to the individual.
      (c)  If, at the time notice is to be provided under
Subsection (b), the individual is incompetent or otherwise
incapacitated and unable to receive the notice required by this
section, the provider shall provide the required written notice, in
the following order of preference, to:
            (1)  the individual's legal guardian;
            (2)  the individual's adult child;
            (3)  the individual's parent;
            (4)  the person admitting the individual; or
            (5)  another person responsible for the health care
decisions of the individual.
      (d)  If Subsection (c) applies and except as provided by
Subsection (e), if a health care provider is unable, after diligent
search, to locate an individual listed by Subsection (c), the
health care provider is not required to provide the required
notice.
      (e)  If an individual who was incompetent or otherwise
incapacitated and unable to receive the notice required by this
section at the time notice was to be provided under Subsection (b)
later becomes able to receive the notice, the health care provider
shall provide the written notice at the time the individual becomes
able to receive the notice.
      (f)  In this section, health care provider means:
            (1)  a hospital, including a rural primary care
hospital;
            (2)  an institution licensed under Chapter 242,
including  skilled nursing facilities;
            (3)  a home and community support services agency;
            (4)  a personal care facility; and
            (5)  a special care facility.
      (2)  In Article 2 of the bill, following Section 2.01 (page
23, between lines 66 and 67), insert the following:
      SECTION 2.02. Subchapter A, Chapter 142, Health and Safety
Code, is amended by adding Section 142.0145 to read as follows:
      Sec. 142.0145.  VIOLATION OF LAW RELATING TO ADVANCE
DIRECTIVES. (a)  The department shall assess an administrative
penalty against a home and  community support services agency that
violates Section 166.004.
      (b)  A penalty assessed under this section shall be $500.
      (c)  The penalty shall be assessed in accordance with
department rules. The rules must provide for notice and an
opportunity for a hearing.
      SECTION 2.03. Sections 241.059(a) and (c), Health and Safety
Code, are amended to read as follows:
      (a)  The commissioner of health may assess an administrative
penalty against a hospital that violates this chapter, a rule
adopted pursuant to this chapter, a special license provision, an
order or emergency order issued by the commissioner or the
commissioner's designee, or another enforcement procedure permitted
under this chapter. The commissioner shall assess an administrative
penalty against a hospital that violates Section 166.004.
      (c)  The penalty may not exceed $1,000 for each violation,
except that the penalty for a violation of Section 166.004 shall be
$500.  Each day of a continuing violation, other than a violation
of Section 166.004, may be considered a separate violation.
      SECTION 2.04. Subchapter C, Chapter 242, Health and Safety
Code, is amended by adding Section 242.071 to read as follows:
      Sec. 242.071.  VIOLATION OF LAW RELATING TO ADVANCE
DIRECTIVES. The commissioner shall assess an administrative penalty
under this subchapter against an institution that violates Section
166.004. Notwithstanding Sections 242.066(b) and (c), a penalty
assessed in accordance with this section shall be $500 and a
separate penalty may not be assessed for a separate day of a
continuing violation.
      SECTION 2.05. Subchapter C, Chapter 247, Health and Safety
Code, is amended by adding Section 247.0455 to read as follows:
      Sec. 247.0455.  VIOLATION OF LAW RELATING TO ADVANCE
DIRECTIVES. (a)  The department shall assess an administrative
penalty against a personal care facility that violates Section
166.004.
      (b)  A penalty assessed under this section shall be $500.
      (c)  The penalty shall be assessed in accordance with
department rules. The rules must provide for notice and an
opportunity for a hearing.
      SECTION 2.06. Subchapter C, Chapter 248, Health and Safety
Code, is amended by adding Section 248.0545 to read as follows:
      Sec. 248.0545. VIOLATION OF LAW RELATING TO ADVANCE
DIRECTIVES. (a)  The department shall assess an administrative
penalty against a special care facility that violates Section
166.004.
      (b)  A penalty assessed under this section shall be $500.
      (c)  The penalty shall be assessed in accordance with
department rules. The rules must provide for notice and an
opportunity for a hearing.