BG C.S.H.B. 1787 75(R) BILL ANALYSIS PUBLIC HEALTH C.S.H.B. 1787 By: Coleman 4-2-97 Committee Report (Substituted) BACKGROUND Texas entered the Intermediate Care Facility for the Mentally Retarded (ICF/MR)Medicaid program in 1974 to improve staff ratios in state schools and draw in federal revenue. Originally, the ICF/MR program was affiliated with the nursing home program as a large facility-based long term service for persons with mental retardation. State statutes governing the ICF/MR program were incorporated under Chapter 242, which also governs personal care facilities, maternity homes, and nursing homes. Over the years, national trends and philosophy regarding services to persons with mental retardation have changed significantly. The ICF/MR program has moved away from large, congregate settings to small, home-like settings of six beds or less; and no longer shares common characteristics with the nursing home program. Emphasis is placed on training individuals to attain maximum independence, to facilitate greater community involvement, and greater quality of life. Currently, there are 773 community-based ICF/MR homes serving, 4,624 individuals located in neighborhoods across the state. In contrast, services to residents in nursing facilities have changed little over the years, with the major focus being the provision of medical care and treatment in large, congregate settings. Although Chapter 242 governed nursing facilities, ICFs/MR, maternity homes, and personal care facilities, differences recognized in services provided by the latter two programs led to legislative actions which moved personal care facilities and maternity homes into their own sections. ICF/MR services have similarly changed and thus also require their own chapter. PURPOSE CSHB 1787 moves the Intermediate Care Facility for the Mentally Retarded (ICF/MR) program to its own Chapter of the Health and Safety Code to support current best practices in the field of mental retardation. RULEMAKING AUTHORITY It is the committee's opinion that this bill expressly grants rulemaking authority in SECTION 1 (Subtitle B, Title 4, Health and Safety Code, Chapter 252). Rulemaking authority is granted to the Texas Department of Human Services (TDHS) and any designee of TDHS in Sec. 252.007(a) and to TDHS in Secs. 252.008, 252.033(e), 252,065(b), and 252.151. Rulemaking authority granted to TDHS is referenced in Sec. 252.122(a). Rulemaking authority is granted to the Texas Board of Human Services (board) in Secs. 252.034(a), 252.037, 252.038(b), 252.061(b), 252.066, 252.129(b), 252.153(c), and 252.182(b). Rulemaking authority granted to the board or designated agency is referenced in Sec. 252.126. Rulemaking authority granted to the board is referenced in Secs. 252.040(a), 252.134(d), Sec. 252.185. SECTION BY SECTION ANALYSIS SECTION 1. Amends Subtitle B, Title 4, Health and Safety Code, by adding Chapter 252, entitled "Intermediate Care Facilities for the Mentally Retarded," as follows: SUBCHAPTER A. GENERAL PROVISIONS Sec. 252.001. Purpose. Establishes that the purpose of this chapter is to promote public health, safety and welfare through standards for intermediate care facilities for the mentally retarded as specified. Sec. 252.002. Definitions. Provides definitions of certain terms, as specified. Sec. 252.003. Exemptions. Establishes that this chapter does not apply to specified establishments, except as otherwise provided. Sec. 252.004 Allocated Federal Money. Allows TDHS to accept and use federally allocated money for administrative expenses. Sec. 252.005. Language Requirements Prohibited. Prohibits a facility from prohibiting a resident or employee from communicating in their native language as specified. Sec. 252.006. Rights of Residents. Requires each facility to implement and enforce Chapter 102, Human Resources Code. Sec. 252.007. Paperwork Reduction Rules. Requires TDHS and its designees to adopt rules to reduce paperwork amounts as specified. Requires TDHS, its designees and each facility to work together to review rules and propose changes in paperwork requirements. Sec. 252.008. Requires TDHS to adopt rules related to the administration and implementation of this chapter. Sec. 252.009. Consultation and Coordination. Requires TDHS to use state and local agencies in carrying out functions as specified. Allows TDHS to cooperate with local health officials and delegate power to make inspections and recommendations as specified. Allows TDHS to coordinate personnel and facilities with a local agency as specified and advise the municipality or county as specified. Sec. 252.010. Change of Administrators; Fee. Requires a facility that hires a new administrator or other person as specified to notify TDHS in writing as specified and pay a $20.00 administrative fee. Sec. 252.011. Prohibition of Renumeration. Prohibits a facility from receiving renumeration from a person or agency that furnishes services or materials for a fee. SUBCHAPTER B. LICENSING, FEES, AND INSPECTIONS. Sec. 252.031. License Required. Prohibits establishing, conducting, or maintaining a facility in this state without a licensed issued under this chapter. Sec. 252.032. License Application. Establishes that license applications are to be made to TDHS as specified and must contain information that TDHS requires. Allows TDHS to require affirmative evidence of ability to comply with rules and standards. Sec. 252.033. Issuance and Renewal of License. (a) requires TDHS, after an application is received, to issue a license if inspection and investigation finds that requirements are met. Subsection (b) allows TDHS to issue a license only for the premises, persons, or governmental units named and for the maximum number of beds specified. Subsection (c) prohibits transference or assignment of a license. Subsection (d) establishes license renewability on the second anniversary of issuance or renewal after an inspection; approved renewal report; and fee payment. Subsection (e) establishes that the renewal report must be filed in accordance with rules as specified. Subsection (f) prohibits TDHS from issuing a license for new beds or expansion of an existing facility unless the addition is included in the HHSC approved plan as specified. Subsection (g) establishes that a fee imposed under this chapter is an allowable cost for Medicaid reimbursement. Requires an increase in fee to be reflected in prospective rates. Sec. 252.034. License Fees. (a) allows the Texas Board of Human Services (board) by rule, to adopt a fee, not to exceed $150 plus $5 for each unit of capacity or bed space, for a license. Subsection (b) stipulates that the fee must be paid with each application as specified. Subsection (c) exempts state operated facilities from the fee payment requirement. Subsection (d) allows the board to adopt an additional fee for increased bed space approval. Subsection (e) requires all collected license fees to be deposited in the state treasury to the credit of TDHS. Allows for appropriation to TDHS as specified. Sec. 252.035. Denial, Suspension, or Revocation of License. (a) allows TDHS to deny, suspend, or revoke a license as specified, after providing notice and opportunity for a hearing. Subsection (b) establishes that the applicant's status is preserved until final deposition, except as specified in public interest court orders. Sec. 252.036. Minimum Standards. Allows the board to adopt, publish, and enforce minimum standards relating to factors as specified. Sec. 252.037. Reasonable Time to Comply. Requires the board, by rule, to give an operating facility reasonable time to comply with an adopted rule or standard. Sec. 252.038. Fire Safety Requirements (a) requires a facility to comply with requirements established under this section. Subsection (b) requires the board to adopt, by rule, applicable fire safety standards as specified. Subsection (c) establishes that a facility legally licensed on September 1. 1997 must comply with standards as specified. Subsection (d) provides that licensed facilities are not prevented from conforming voluntarily to a fire safety standard compatible with, equal to, or more stringent than those adopted by the board. Subsection (e) allows a municipality to enact additional fire safety standards applicable to new construction as specified, notwithstanding any other provision of this section. Sec. 252.039. Posting. Requires each facility to display in a public area as specified the issued license; a sign, as specified, regarding complaint procedure; a notice, as specified, stating that inspection and related reports are available to the public to see and providing TDHS's toll free telephone number that may be used to obtain information on the facility; and a summary of the most recent inspection report. Sec. 252.040. Inspections. (a) allows TDHS or its designee to make any inspection, survey, or investigation it considers necessary and to enter the premise of a facility, at reasonable times, in accordance with board rules. Subsection (b) entitles TDH to have access to facility books, records, and other documents as specified. Subsection (c) establishes that a license holder or applicant is considered to have consented to entry and inspection by TDHS as specified. Subsection (d) requires that TDHS establish procedures to preserve evidence, as specified, that is reasonably believed to threaten the health and safety of a resident. Allows procedures to include photography or photocopying as specified. Subsection (e) requires TDHS to respect the privacy of residents to the greatest extent possible and not make public their identity when photographing residents. Subsection (g) requires TDHS to establish forms, as specified, to summarize each inspection and complaint investigation report. Subsection (h) requires TDHS to establish proper procedures to ensure that copies of forms and reports are made available to consumers and service recipients as specified. Sec. 252.041. Unannounced Inspections. (a) requires TDHS to conduct at least two unannounced inspections of each facility each licensing period. Subsection (b) requires TDHS to randomly select facilities, as specified, for unannounced cursory inspections, as specified, to be conducted between 5 p.m. and 8 a.m. in order to ensure continuous compliance. Subsection (c) allows TDHS to require additional inspections. Subsection (d) allows TDHS to invite, as appropriate, at least one person as a citizen advocate, as specified, to participate in inspections. Sec. 252.042. Disclosure of Unannounced Inspections; Criminal Penalty. (a) establishes that a person who intentionally, knowingly, or recklessly discloses facts to an unauthorized person about an unannounced inspection before it occurs commits an offense. Subsection (b) provides that "unauthorized person" in this section does not include TDH, the office of the attorney general, an agency or organizational representative when a concurrent Medicaid survey is made, or any other person or entity authorized by law to make inspections or accompany an inspector. Subsection (c) establishes that an offense made under this section is a Class B misdemeanor. Subsection (d) establishes that a person convicted under this section is not eligible for state employment. Sec. 252.043. Licensing Surveys. Requires TDHS to provide a team to conduct surveys to validate licensing findings in order to assure that teams throughout the state survey in a fair and consistent manner. Establishes that a facility cited by the validation team must correct deficiencies, but is not subject to punitive action for those deficiencies. SUBCHAPTER C. GENERAL ENFORCEMENT Sec. 252.061. Emergency Suspension, or Closing Order. (a) requires TDHS to suspend a facility's license or order immediate closing of part of the facility if the facility is found to be operating in violation of prescribed standards and the violation creates an immediate threat to the health and safety of a resident. Subsection (b) requires the board, by rule, to provide for the placement of residents during suspension or closing as specified. Subsection (c) provides that an order suspending or closing a part of a facility is immediately effective when written notice is received or a later date as specified in the order. Subsection (d) provides that an order suspending a license or ordering an immediate closing is valid for 10 days after the effective date. Sec. 252.062. Injunction. (a) allows TDH to petition a district court for a temporary restraining order as specified. Subsection (b) allows a district court, upon petition of TDHS, to order injunctions as specified. Subsection (c) requires the attorney general , upon request of TDHS, to bring a suit as specified. Subsection (d) establishes that a suit for injunctive relief must be brought in the county in which the alleged violation occurred. Sec. 252.063. License Requirements: Criminal Penalty. Establishes that a person commits an offense if the person violates Sec. 252.031. Provides that an offense is punishable by a fine of not more than $1,000 for the first offense and not more than $500 for each subsequent offense. Provides that each day of a continuing violation after conviction is a separate offense. Sec. 252.064. Civil Penalty. (a) establishes that a person who violates this chapter is liable for a civil penalty of not less than $100 or more than $10,000 for each violation if TDHS determines that the health and safety of a resident is threatened. Subsection (b) establishes that each day of a continuing violation constitutes separate grounds for recovery. Subsection (c) requires the attorney general, on request of TDHS to bring a suit to collect a civil penalty. Requires that any collected money be remitted to the comptroller for deposit to the general revenue fund. Sec. 252.065. Administrative Penalty. (a) allows TDHS to assess an administrative penalty against a facility in violation as specified. Subsection (b) requires TDHS, by rule, to establish gradations and amounts of penalties. Subsection (c) requires TDHS to consider specified factors in determining the amount of a penalty. Subsection (d) prohibits the penalty from exceeding $5,000 for each violation, as specified. Subsection (e) prohibits TDHS from assessing a penalty under both this Subchapter and Section 32.021, Human Resources Code, for a violation arising out of the same act or failure to act. Sec. 252.066. Rules Regarding Administrative Penalty. (a) requires the board to adopt rules governing the assessment of administrative penalties, including procedures for giving notice of a violation to a facility, payment and refund of a penalty, and hearings and appeals. Subsection (b) requires rules adopted under this section to include specific and objective criteria that describe the scope and severity of a violation as specified. Establishes that a penalty must be appropriate to the violation and may only be imposed when a violation presents an immediate and serious threat as specified. Subsection (c) provides that the rules must establish a system to ensure standard and consistent application of penalties across different areas of the state. Subsection (d) allows TDHS to prescribed a per diem penalty as specified. Subsection (e) defines "immediate and serious threat" for purposes of this section as specified. SUBCHAPTER D. TRUSTEES Sec. 252.091. Findings and Purpose. (a) provides the legislative finding that under some circumstances, closing a facility for a violation may have an adverse effect as specified. Subsection (b) provides that the purpose of this chapter is to provide for appointment of a trustee to assume operations as specified and a fund to assist a court-ordered trustee meet basic resident needs. Sec. 252.092. Appointment by Agreement (a) allows a person holding a controlling interest in a facility to request TDHS to assume the operation of the facility through the appointment of a trustee. Subsection (b) allows TDH to enter into an agreement, as specified, if TDHS considers the appointment desirable. Subsection (c) stipulates that an agreement specify the terms and conditions of the trustee's appointment and authority and preserve the legal rights of the residents. Subsection (d) establishes that the agreement terminates when specified by the parties or when either party notifies the other in writing. Sec. 252.093. Involuntary Appointment. (a) allows TDHS to request the attorney general to bring an action on behalf of the state for the appointment of a trustee if specified conditions exist. Subsection (b) allows a trustee appointed under Subsection (a) (5) only to ensure relocation of the residents as specified. Subsection (c) requires a court to appoint a trustee to take charge of a facility after a hearing in which it is found that involuntary appointment is necessary. Subsection (d) requires the court to appoint as trustee an individual whose background includes mental retardation service administration, if possible. Subsection (e) stipulates that an action under this section must be brought in Travis County. Sec. 252.094. Fee; Released Funds. Establishes that an appointed trustee is entitled to a reasonable fee as determined by the court and allows the trustee to petition the court to order the release to the trustee of any payment owed the trustee for care and services provided to the residents if the payment has been withheld, including payments as specified. Sec. 252.095. Emergency Assistance Fee. (a) allows TDHS to collect an annual fee to be used to make emergency assistance money available, in addition to collected licensing and renewals as specified. Subsection (b) requires fees collected under this section to be in the amount prescribed by Section 242.097(b) and deposited to the credit of the nursing and convalescent home trust fund as specified. Subsection (c) allows TDH to disburse money to a trustee for a licensed facility to alleviate an immediate threat to the health or safety of the residents as specified. Subsection (d) allows a court to order TDHS to disburse emergency assistance money as specified. Sec. 252.096. Reimbursement. (a) requires a facility receiving emergency assistance money to reimburse TDHS for amounts received plus interest. Subsection (b) establishes interest accrual and rates as specified. Subsection (c) provides that reimbursement responsibility is with the facility owner when the trustee is appointed. Subsection (d) establishes delinquent reimbursements as specified and allows TDMHMR to determine that the facility is Medicaid ineligible. Subsection (e) requires TDHS to deposit reimbursements and interest to the credit of the nursing and convalescent home trust fund. Subsection (f) requires the attorney general to institute an action to collect money due at the request of TDHS. Establishes that an action under this section must be brought in Travis County. Sec. 252.097. Notification of Closing; Criminal Penalty. (a) requires a facility that is closing temporarily or permanently to notify the residents and make reasonable efforts to notify in writing each resident's nearest relative or support person as specified. Subsection (b) requires the facility to give notification orally or in writing, immediately upon receiving notice of a TDHS closure order as specified. Subsection (c) requires the facility to give notice not later than one week after a decision is made to close voluntarily. Sec. 252.098. Criminal Penalty for Failure to Notify. Establishes that a Class A misdemeanor is committed if the facility knowingly fails to comply with Section 252.097. SUBCHAPTER E. REPORTS OF ABUSE AND NEGLECT Sec. 252.121. Definition. Defines "designated agency" as used in this subchapter. Sec. 252.122. Reporting of Abuse and Neglect. (a) requires a person who has cause to believe that the physical or mental health or welfare of a resident has been or may be adversely affected as specified to report the abuse or neglect to TDHS, to a designated agency, or to both as specified in TDHS rules. Subsection (b) requires each facility to require, as specified, each employee to sign a statement that the employee realizes failure to report abuse or neglect may make them criminally liable. Subsection (c) requires a person to make an oral report immediately upon learning of abuse or neglect. Requires the person to make a written report to the same agency not later than five days after the oral report is made. Sec. 252.123. Contents of Report. Establishes that a report of abuse or neglect is nonaccusatory and reflects the reporting person's belief as specified. Provides that the report must contain certain information, as specified. Sec. 252.124. Anonymous Reports of Abuse or Neglect. Requires an anonymous report, as specified, to be received and acted on in the same manner as an acknowledged report. Requires a receiving law enforcement agency to refer the report to TDHS or the designated agency. Sec. 252.125. Investigation and Report of Receiving Agency. (a) requires TDHS or the designated agency to make a thorough investigation as specified. Subsection (b) establishes that the investigation's primary purpose is resident protection. Subsection (c) requires TDHS or designated agency to determine circumstance and information as specified, in the investigation. Subsection (d) allows for an investigative visit to the resident's facility and an interview with the resident, if considered appropriate. Subsection (e) requires a probate or county court to order the person responsible for the resident's care or the person in charge of a place where the resident is located to allow admission for the investigation and any interview as specified. Subsection (f) requires TDHS to file a petition for temporary care and protection if it is determined that immediate removal is necessary as specified. Subsection (g) requires TDHS or the designated agency to make and submit a complete written report and recommendations to the district attorney and appropriate law enforcement agency and if necessary and requested to TDHS. Sec. 252.126. Confidentiality. Establishes that a report, record, or working paper used or developed in an investigation is confidential. Allows disclosure only as specified. Sec. 252.127. Immunity. Provides that a person reporting an abusive or negligent act is immune from civil or criminal liability as specified. Establishes that such immunity extends to participation in resultant judicial proceedings. Sec. 252.128. Privileged Communications. Except for attorney-client, prohibits the exclusion of evidence on the grounds of privileged communication, in a proceeding regarding abuse or neglect as specified. Sec. 252.129. Central Registry. (a) requires TDHS to maintain a central registry of reported cases of resident abuse or neglect as specified. Requires TDHS to include the registry in the registry maintained under Section 242.130. Subsection (b) allows the board to adopt rules necessary to carry out this section. Subsection (c) requires the rules to provide for the cooperation with hospitals and clinics in the exchange of reports as specified. Sec. 252.130. Failure to Report; Criminal Penalty. Establishes that a person commits a Class A misdemeanor if the person has cause to believe that a resident's physical or mental health or welfare has been or may be adversely affected as specified and fails to report as specified. Sec. 252.131. Bad Faith, Malicious, or Reckless Reporting; Criminal Penalty. Provides that a person commits a Class A misdemeanor if the person reports under this subchapter in bad faith, maliciously or recklessly. Establishes that the criminal penalty provided is in addition to any civil penalties for which the person may be liable. Sec. 252.132. Suit for Retaliation. (a) prohibits a facility from suspending, terminating, disciplining or otherwise discriminate against an employee for making a report, as specified, about the abuse or neglect of a resident. Subsection (b) establishes that a facility in violation of Subsection (a) is liable to the person who as discriminated against. Allows the person discriminated against to sue for injunctive relief, damages, or both. Subsection (c) delineates amounts that may be recovered by a plaintiff prevailing in such a suit. Subsection (d) establishes that the petitioner must bring suit or notify the Texas Workforce Commission as specified, not later than 90 days after suspension or termination. Provides that a petitioner who notifies the Texas Workforce Commission as specified, must bring suit not later than 90 days after notice was delivered to the commission. Requires the commission to notify the facility as specified, upon receipt of notice. Subsection (f) establishes that the petitioner has the burden of proof, except as specified. Subsection (g) allows a suit to be brought in the district court of the county in which the plaintiff resides, was employed by the defendant, or where the defendant conducts business. Subsection (h) requires each facility to require each employee to sign a statement, as specified, about understanding their rights under this section. Provides that the statement must be part of the statement required under Section 252.122(b). Stipulates that if a facility does not require an employee to read and sign the statement, the periods prescribed by subsection (e) do not apply, and the petitioner must bring suit not later than the date as specified. Sec. 252.133. Suit for Retaliation Against Resident. (a) prohibits a facility from retaliating or discriminating against a resident if the resident, the resident's guardian, or any other person reports abuse or neglect in accordance with this subchapter. Subsection (b) establishes that a resident against whom a facility retaliates or discriminates as specified is entitled to sue for relief and damages as specified. Subsection (c) provides that a resident seeking relief under this section must report the alleged violation not later than 180 days after it occurred or was discovered as specified. Subsection (d) allows such a suit to be brought in the district court of the county in which the facility is located or in a district court of Travis County. Sec. 252.134. Reports Relating to Resident Deaths; Statistical Information. (a) requires a licensed facility to submit a report to TDHS concerning the death of a facility resident, and a former resident that occurs within 24 hours of transferring from the facility. Subsection (b) establishes that the report must be submitted not later than 10 working days after the last day of each month in which a facility resident dies. Provides that the report must be made on a form prescribed by the department, and must contain the name and social security number of the deceased. Subsection (c) requires TDHS to correlate reports under this section with death certificate information to develop data as specified. Subsection (d) provides that a record under this section is confidential and not subject to provisions of Chapter 552, Government Code, unless specified by board rule. Subsection (e) requires TDHS to develop statistical information on official causes of death as specified. Establishes that information developed under this subsection is not confidential. Subsection (f) requires a licensed facility to make historical statistics on all required information available on the request of an applicant or an applicant's representative. SUBCHAPTER F. MEDICAL CARE Sec. 252.151. Administration of Medication. Requires TDHS to adopt rules relating to the administration of medication in intermediate care facilities. Sec. 252.152. Required Medical Examination. Requires TDHS to require each resident to be given at least one medical examination annually. Requires TDHS to specify details of the examination. Sec. 252.153. Emergency Medication Kit. Entitles a licensed institution to maintain a supply of controlled substances, to be labeled in accordance with all applicable food and drug laws as specified in an emergency medication kit. Requires the board to adopt rules governing the amount, type, and procedure for controlled substance use. Provides that the storage of the controlled substances in the kit is under supervision of the consultant pharmacist and requires the administration of the controlled substances to comply with all applicable laws. SUBCHAPTER G. RESPITE CARE Sec. 252.181. Definitions. Provides definitions for "plan of care" and "respite care." Sec. 252.182. Respite Care. Allows a licensed facility to provide respite care as specified. Allows the board to adopt rules for the regulation of respite care by a licensed facility. Sec. 252.183. Plan of Care. (a) establishes that the facility and the person arranging the care must agree on the plan of care and that the plan must be filed at the facility before the person is admitted. Subsection (b) establishes that the plan of care must be signed as specified. Subsection (c) prohibits a facility from keeping an agreed plan of care for more than six months. Requires the facility to review and update the plan after each admission. Allows the facility to admit the person as frequently as is needed and as accommodations are available during the period. Sec. 252.184. Notification. Requires a facility that offers respite care to so notify TDHS in writing. Sec. 252.185. Inspections. Requires TDHS to inspect a facility's records of respite care services, physical accommodations as specified, and plan of care records to ensure compliance with licensing standards and adopted rules as specified. Sec. 252.186. Suspension. Allows TDHS to require a facility to cease providing respite care if it is determined that required standards are not met as specified. Allows TDHS to suspend the license of a facility that continues to provide respite care after receiving a written order to cease from TDHS. SECTION 2. Amends Section 242.002(6), Health and Safety Code, to conform to the new Chapter 252 by omitting references to ICF/MR facilities as "institutions" regulated under Chapter 242. SECTION 3. Amends Section 242.003, Health and Safety Code, to add "a facility licensed under Chapter 252 or exempt from licensure under Section 252.003" to the list of facilities exempt from regulation under Chapter 242. SECTION 4. Establishes that the general effective date for the bill is to be September 1, 1997, except for Section 2 which will take effect on January 1, 1998. SECTION 5. Provides a transition process for facilities currently licensed under Chapter 242 which must become licensed under new Chapter 252 by January 1, 1998. Specifies that facilities licensed under Chapter 242 on the September 1, 1997 effective date of the act may continue to operate under that license until January 1, 1998 or until that license expires prior to January 1, 1998, and further provides that a facility licensed under new Chapter 252 is not subject to Chapter 48, Human Resources Code. SECTION 6. Emergency clause. COMPARISON OF ORIGINAL TO SUBSTITUTE CSHB 1787 amends the definition of the word "facility" in the proposed Section 252.002(4) of HB 1787 to specify that the new Chapter 252 applies only to IFC/MR and HCS program residential facilities, and not to other programs such as adult day facilities, as requested by the Texas Department of Mental Health/Mental Retardation. CSHB 1787 inserts the words "or providing" in proposed Section 252.005 of HB 1787 to specify that a facility employee may communicate in the person's native language for the purpose of providing care, training, or treatment and conform the language of the section to the language of the analogous Section 242.011 of Chapter 242. CSHB 1787 inserts the phrase "After receiving the application," in subsection (a) of the proposed Section 252.033 of HB 1787, to clarify the procedure governing issuance of a license under new Chapter 252 and conform the language of the section to the language of the analogous Section 242.033 of Chapter 242. CSHB 1787 revises the language of subsection (f) of the proposed Section 252.033 of HB 1787 to clarify that the department is authorized to refuse to issue a license only to applicants for new beds or the expansion of an existing facility which are not included in the state's plan for long-term care facilities for persons with mental retardation under Section 533.062, Health and Safety Code. CSHB 1787 adds the language "and may be appropriated to the department to administer and enforce this chapter" to subsection (e) of the proposed Section 252.034 of HB 1787 to authorize the appropriation of funds derived from license fees to carry out the responsibilities imposed upon the department by Chapter 252 and conform the language of the section to the language of the analogous Section 242.033 of Chapter 242. CSHB 1787 revises the language regarding administrative penalties of proposed Sections 252.065 and 252.066 of HB 1787 to retain the basic structure of the due process safeguards and the department's general rulemaking authority governing administrative penalties and procedures, while conforming the language to that of a settlement agreement secured in recent litigation between certain private providers of ICF/MR services and the department. CSHB 1787 revises subsection (b) of proposed Section 252.094 of HB 1787 to delete redundant language referring to the withholding of certain payments of funds to a trustee appointed to assume the operations of a facilities where such funds where "withheld by the department at the recommendation of the department." CSHB 1787 substitutes the words "Texas Department of Mental Health and Mental Retardation" for the word "department" (which refers to the Texas Department of Human Services) in subsection (d) of proposed Section 252.096 because TDMH/MR, not TDHS, is the agency responsible for determining whether an ICF/MR facility is ineligible for a Medicaid provider contract. CSHB 1787 adds a sentence in subsection (a) of proposed Section 252.129 of HB 1787 to specify that a central registry of reported cases of abuse or neglect of a resident of an ICF/MR facility regulated under Chapter 252 shall be included in the central registry of reported cases of abuse or neglect of a resident of a nursing facility regulated under Chapter 242, to avoid the unnecessary duplication and costs of maintaining separate registries. CSHB 1787 adds new subsection (e) and (f), and an appropriate change in the section heading, to proposed Section 252.134 of HB 1787 to authorize the department to develop statistical information relating to incidents of death among residents of ICF/MR facilities and to make such information public and available to applicants for ICF/MR services, and conform the language of the section to the language of analogous Section 242.134. CSHB 1787 revises the language of proposed Section 252.152 (Application of Other Law) and adds a new proposed Section 252.153 to HB 1787 to set forth in proposed Chapter 252 all of those provisions of Chapter 242 which currently apply to residents of ICF/MR facilities (other than those provisions relating to the administration of medication, which will be governed by rules adopted by the department under proposed Section 252.151), including the requirements of an annual medical examination of residents and the presence in each facility of an emergency medication kit. CSHB 1787 amends section 3 of the HB 1787, which amends subdivision (8) of Section 242.003, Health and Safety Code, regarding exemptions from the nursing facility regulation under Chapter 242, to correct two erroneous citations to other sections of the Code, and clarify the exemption of facilities licensed under Chapter 251 (end stage renal disease facilities) or proposed Chapter 252 (ICF/MR facilities).