SRC-CDH C.S.S.B. 190 75(R)BILL ANALYSIS


Senate Research CenterC.S.S.B. 190
By: Zaffirini
Health & Human Services
3-20-97
Committee Report (Substituted)


DIGEST 

Currently, there are approximately 90,000 residents in nursing homes in
Texas; roughly 23 percent of the state's annual $5.57 billion Medicaid
budget is spent on nursing facility care; and the number of aging Texans
who will need nursing facility care is steadily increasing as babyboomers
reach retirement age.  These facts, along with testimony and newspaper
articles concerning alarming conditions in some nursing homes and the
cumbersome regulatory processes that exist today, raise the need for
nursing home reform. 

S.B. 190 protects nursing home residents and makes homes accountable to
the public by ensuring that nursing homes are regulated in four basic
ways:  1)  provide the highest possible quality of care; 2) strictly
monitor all factors relating to the health, safety, welfare, and dignity
of each resident; 3) impose prompt and effective penalties for
noncompliance with licensing standards; and 4) provide the public with
information concerning the operation of institutions in this state. 

PURPOSE

As proposed, C.S.S.B. 190 establishes regulation for nursing homes and
similar facilities while providing penalties for violations of those
regulations. 

RULEMAKING AUTHORITY

Rulemaking authority is granted to the Texas Department of Human Services
(department) in SECTION 1.09 (Section 242.037(a), Health and Safety Code),
SECTION 1.14 (Section 242.065(e), Health and Safety Code), SECTION 1.22
(Section 242.126(d), Health and Safety Code), and SECTION 1.29 (Sections
242.403(a) and 242.501(a), Health and Safety Code); and to the Texas Board
of Human Services in SECTION 1.09 (Section 242.037(d), Health and Safety
Code) and SECTION 1.21 (Section 242.1225(a), Health and Safety Code) of
this bill.   

SECTION BY SECTION ANALYSIS

SECTION 1.01. Amends Section 242.001, Health and Safety Code, as follows:

Sec. 242.001. New heading:  SCOPE, PURPOSE, AND IMPLEMENTATION.  Provides
that it is the goal of this chapter to ensure that institutions in this
state deliver the highest possible quality of care.  Sets forth the terms
by which each institution licensed under this chapter is required to
provide quality care in accordance with this chapter and the rules and
standards.  Establishes the stringency and application of the rules and
standards adopted under this chapter.  Provides that the legislature finds
that the construction, maintenance, and operation of institutions are
required to be regulated in a manner that protects the residents by
providing certain standards of care.  Provides that it is the
legislature's intent that this chapter accomplish these goals, and
requires this chapter to be construed broadly to accomplish the purposes
set forth in this section.  Deletes existing section.   

SECTION 1.02. Amends Section 242.002, Health and Safety Code, to define
"commissioner," "facility," and "home."  Redefines "person."  Makes
conforming changes.    

SECTION 1.03. Amends Chapter 242A, Health and Safety Code, by adding
Section 242.0021, as follows: 
 
Sec. 242.0021.  CONTROLLING PERSON.  Sets forth the conditions under which
a person is a controlling person of an institution and lists the persons
and entities which qualify as controlling persons.    
  
SECTION 1.04. Amends Section 242.005, Health and Safety Code, as follows:

Sec. 242.005.  New heading:  PERFORMANCE REPORTS.  Sets forth the terms by
which the department and the attorney general, rather than the department,
are each required to annually prepare a report of the operation and
administration of their respective responsibilities.  Requires the
Legislative Budget Board and the state auditor to jointly prescribe the
form and contents of the reports.  Makes conforming changes.          

SECTION 1.05. Amends Chapter 242A, Health and Safety Code, by adding
Sections 242.015242.017, as follows: 

Sec. 242.015. DOCUMENTS PUBLIC.  Provides that subject to Sections
242.126, 242.127, 242.552, and 242.553, a document received or used by the
Texas Department of Human Services (department) in connection with this
chapter is public information for purposes of Chapter 552, Government
Code.   

Sec. 242.016. LICENSED ADMINISTRATOR.  Requires each institution to have a
licensed nursing facility administrator.  Requires the administrator to
manage the institution; be responsible for delivery of quality care and
implementation of the institutional policies; and work at least 40 hours
per week on administrative duties.   

Sec. 242.017.  FEES AND PENALTIES.  Requires a fee or penalty collected by
or on behalf of the department to be deposited to the credit of the
general revenue fund; and authorizes such fees or penalties to be
appropriated only to the department to administer and enforce this
chapter, with certain exceptions.  Prohibits investigation and attorney's
fees from being assessed or collected by or on behalf of the department or
other state agency unless the department or other state agency assesses
and collects a penalty described under this chapter.  
SECTION 1.06. Amends Section 242.032, Health and Safety Code, as follows:

Sec. 242.032. New heading:  LICENSE OR RENEWAL APPLICATION.  Provides that
an application for a license renewal is made to the department on a form
provided by the department and must  be accompanied by the license fee.
Requires the applicant or license holder to furnish evidence to
affirmatively establish the applicant's or license holder's ability to
comply with minimum standards of medical care, nursing care, and financial
condition, and any other applicable state or federal standard.  Sets forth
the terms by which the department is required to consider the background
and qualifications of certain applicants and require the applicant or
license holder to file a sworn affidavit of a satisfactory compliance
history and any other information required by the department to
substantiate a satisfactory compliance history.  Authorizes the department
to require a person described by Subsection (d) to file information
relating to the history of the person's financial condition with respect
to an institution operated in another state or jurisdiction.  Makes
conforming changes.   

SECTION 1.07. Amends Section 242.033(a), Health and Safety Code, to
authorize, rather than require, the department to issue a license if,
after inspection and investigation, it finds that the applicant or license
holder, and any other relevant person, meet the established requirements.
Makes conforming changes. 

SECTION 1.08. Amends Section 242.034, Health and Safety Code, to prohibit
a license fee from exceeding a set amount.  Authorizes the Texas Board of
Human Services (board) to establish a background examination fee in an
amount necessary to defray the department's expenses in administering
background and qualification checks of applicants and license holders.
Deletes the provision regarding the method for depositing license fee
collections.  Makes conforming changes. 

 SECTION 1.09. Amends Section 242.037, Health and Safety Code, as amended
by Chapters 583 and 1049, Acts of the 74th Legislature, 1995, as follows: 

Sec. 242.037. New heading:  RULES; MINIMUM STANDARDS.  Requires the
department to make and enforce rules and minimum standards to implement
this chapter, including those relating to quality of life, quality of
care, and residents' rights.  Sets forth the stringency of the rules and
standards adopted under this chapter.  Establishes the provisions by which
the board is required, rather than authorized, to adopt, publish, and
enforce certain minimum institutional standards, including those related
to nutritional needs of residents; care and treatment of residents;
licensure of institutions; and implementation of this chapter.  Sets forth
the conditions by which the department is required, in order to administer
the Provider Certification Survey, to identify each area of care that is
subject to both state licensing and federal certification requirements.
Makes conforming changes. 

SECTION 1.10. Amends Chapter 242B, Health and Safety Code, by amending
Section 242.042 and adding Section 242.0421, as follows: 

Sec. 242.042.  POSTING.  Requires each institution to  conspicuously post
for display in a public and visible area of the institution notice stating
that licensing inspection reports and other related reports which show
deficiencies cited by the department are available; notice that the
department can provide summary reports relating to the quality of care,
recent investigations, litigation, and other aspects of the operation of
the institution; notice that the Texas Board of Nursing Facility
Administrators can provide information about the nursing facility
administrator; and any notice or written statement required to be posted
under Section 242.072(b).  

Sec. 242.0421.  AVAILABILITY OF REPORTS.  Sets forth the terms by which a
facility is required to make licensing inspection reports and other
reports which show deficiencies cited by the department available.   

SECTION 1.11. Amends Section 242.061, Health and Safety Code, by amending
Subsection (a) and adding Subsection (c), to set forth the terms by which
the department is authorized to deny, suspend, or revoke the license of a
person described by Section 242.032(d) or of an institution. Makes
conforming changes.  

SECTION 1.12.  Amends Chapter 242C, Health and Safety Code, by adding
Section 242.0615, as follows: 

Sec. 242.0615.  EXCLUSION.  Sets forth the terms by which the department
is authorized to exclude a person from eligibility for a license.   

SECTION 1.13. Amends Section 242.063(a), Health and Safety Code, to
authorize the department to petition a district court for a temporary
restraining order or an injunction to restrain a person from a violation
or threatened violation of certain standards or laws if the health and
safety of a resident is threatened.  Makes conforming changes.   

SECTION 1.14. Amends Section 242.065, Health and Safety Code, to provide
that a person who violates or causes a violation of this chapter, or a
rule adopted under this chapter, is liable for a civil penalty of not less
than $1,000, rather than $100, or more than $25,000, rather than $10,000,
for each violation which threatens the health and safety of a resident.
Requires the trier of fact to make certain considerations in determining
the amount of the penalty to be awarded.  Provides that each resident who
suffers directly because of the violation constitutes a separate ground
for recovery. Establishes the conditions by which the state is authorized
to seek satisfaction if a person who is liable fails to pay the obligated
amount.  Authorizes the department, by rule, to establish a method for
satisfying an obligation from an insurance policy, letter of credit, or
other contingency fund.  Sets forth the terms by which a payment is not an
allowable cost for reimbursement under the state Medicaid program; and a
civil penalty is not compensation for actual pecuniary loss.       

SECTION 1.15. Amends Section 242.066, Health and Safety Code, by amending
Subsections (a)  and (b), and adding Subsections (f)-(h), to authorize the
department to assess an administrative, rather than a civil penalty,
against a person who takes certain actions.  Sets forth the penalties for
violations under Section 242.072(b) or a right of a resident adopted under
Subchapter L.  Sets forth the persons against whom an administrative
penalty may be assessed.  Establishes that a penalty assessed for late
payment of a previous penalty is in addition to the previous penalty.
Makes conforming changes. 

SECTION 1.16. Amends Chapter 242C, Health and Safety Code, by adding
Section 242.0665, as follows: 

Sec. 242.0665.  RIGHT TO CORRECT.  Prohibits the department from assessing
an administrative penalty against an institution if, not later than the
60th day after the date the institution receives notice under Section
242.067(c), the institution corrects the violation. Provides exceptions in
cases involving certain violations.  Requires an institution that corrects
a violation to maintain the correction.  Sets forth the terms by which the
department is authorized to assess a penalty for a subsequent violation,
but establishes that the department is not required to provide the
institution an opportunity to correct the subsequent violation under this
section.   

SECTION 1.17. Amends Sections 242.067- 242.070, Health and Safety Code, as
follows: 

Sec. 242.067. REPORT RECOMMENDING ADMINISTRATIVE PENALTY.  Requires
written notice of a preliminary report to include a statement of whether
the violation is subject to correction and if so, the date on which the
institution must file with the department a plan of correction and the
deadline for corrective measures.  Authorizes the person charged, not
later than the 20th day after the date on which the notice is sent, to
submit a plan of correction to the department for approval if the
violation is subject to correction under Section 242.0665.  Sets forth the
terms under which the department is required to inspect a correction and
notify the appropriate person of the results.  Sets forth the terms by
which the commissioner of human services or the commissioner's designee is
required to assess the administrative penalty recommended by the
department.  Deletes the provision requiring the commissioner to order a
hearing under certain circumstances.  Makes conforming changes.  
Sec. 242.068.  HEARING.  Requires an administrative law judge to order and
give notice of a hearing if a person charged under this chapter requests a
hearing.  Deletes the provision requiring the commissioner to order and
give notice of a hearing if the commissioner or the commissioner's
designee orders a hearing.  Requires the hearing to be held before an
administrative law judge, rather than by a hearing examiner designated by
the commissioner. Requires the administrative law judge to make findings
of fact and conclusions of law, rather than requiring the hearing examiner
to make findings of fact and issue the commissioner a written decision and
recommendation.  Requires the judge, by order, to find that a violation
has occurred and assess an administrative penalty, or that a violation has
not occurred. Deletes the existing provision  regarding the commissioner's
finding whether or not a violation has occurred.   

Sec. 242.069. New heading:  NOTICE AND PAYMENT OF ADMINISTRATIVE PENALTY;
INTEREST; REFUND.  Sets forth the terms by which the commissioner is
required to give written notice of the payment and interest rate due for
administrative penalties, and is authorized to permit certain methods of
payment.  Sets forth the conditions under which the person charged with
the penalty is required to file a petition for judicial review by a
certain date.  Sets forth the repercussions for a person who fails to pay
the penalty by a certain date.  Deletes the existing provisions regarding
judicial review.  Sets forth the terms by which accrued interest on
certain amounts are required to be paid.  Deletes the provision regarding
the deposit of a penalty collected under this section.  Makes conforming
changes. 
  
Sec. 242.070. APPLICATION OF OTHER LAW.  Prohibits the department from
assessing more than one monetary penalty under this chapter, rather than 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,
except as provided by Section 242.0665(c).  Provides that this section
does not prohibit the department from assessing a monetary penalty under
this chapter and Chapter 32, Human Resources Code, for the same act or
failure to act.     

SECTION 1.18. Amends Chapter 242C, Health and Safety Code, by adding
Sections 242.071242.073, as follows: 

Sec. 242.071.  AMELIORATION OF VIOLATION.  Sets forth the terms by which
the commissioner is authorized to require a person to use any portion of a
penalty to ameliorate the violation or to improve services in the
institution affected by the violation.  

Sec. 242.072.  OTHER REMEDIES.  Sets forth the terms by which the
commissioner is authorized to suspend admissions.  Requires an institution
that is ordered to suspend admissions to post notice in the form required
by the department on all doors providing ingress to and egress from the
institution.  Establishes that a person commits a Class C misdemeanor if
the person knowingly fails to post notice in the manner required or
removes a posted notice prematurely. 

Sec. 242.073.  LEGAL ACTION BY THE ATTORNEY GENERAL.  Requires the
department and the attorney general to work in close cooperation
throughout any legal proceedings requested by the department.  Requires
the commissioner to approve any settlement agreement to a suit brought
under this chapter or any other law relating to the health and safety of
residents in institutions.   

SECTION 1.19. Amends Section 242.096(e), Health and Safety Code, to
require any unencumbered amount in the nursing and convalescent home trust
fund in excess of $500,000, rather than $100,000, to be transferred to the
general revenue fund.  Authorizes the same amount to be appropriated only
to the department. 

SECTION 1.20.  Amends Section 242.097, Health and Safety Code, to require
the department, in addition to the license fee provided by Section
242.034, to adopt an annual fee if the amount of the nursing and
convalescent home trust fund is less than $500,000, rather than $100,000.
Makes a conforming change. 

SECTION 1.21.  Amends Chapter 242E, Health and Safety Code, by adding
Section 242.1225, as follows: 

Sec. 242.1225.  ADDITIONAL REPORTING REQUIREMENT.  Sets forth the terms by
which the board is required to adopt rules requiring any person required
to report abuse or neglect under Section 242.122 to report other conduct
or conditions.   

SECTION 1.22. Amends Section 242.126, Health and Safety Code, as follows: 

Sec. 242.126. New heading:  INVESTIGATION AND REPORT OF DEPARTMENT OR
DESIGNATED AGENCY.  Establishes the conditions under which the department
or designated agency is required to make a thorough investigation after
receiving a report of abuse or neglect.  Requires the department to adopt
rules governing the conduct of investigations, including the dissemination
of certain information.  Sets forth the terms by which the investigator
for the agency is required to conduct the investigation, interview each
relevant witness, and prepare the written investigation report.  Requires
the department to make the investigation report available to the public,
provided the names of certain persons are deleted from the public copy.
Sets forth the terms by which the department or a designated agency is
required to submit a final report.  Makes conforming changes. 

SECTION 1.23. Amends Section 242.127, Health and Safety Code, to make
conforming changes. 

SECTION 1.24. Amends Section 242.133(a), Health and Safety Code, to
establish that a person has a cause of action against an institution, or
the owner or employee of the institution, that retaliates against the
person for making a report under this subchapter, for reporting the abuse
or neglect, or  for initiating or cooperating in any governmental
investigation.  Makes conforming changes. 

SECTION 1.25. Amends Section 242.1335(a), Health and Safety Code, to
prohibit an institution from retaliating or discriminating against a
resident for making a complaint or filing a grievance concerning the
facility.  Makes a conforming change.   

SECTION 1.26. Redesignates Chapter 242H, Health and Safety Code, as
Chapter 242J, and amends the subchapter heading as follows:  

SUBCHAPTER J.  ARBITRATION OF CERTAIN DISPUTES  

SECTION 1.27.  Amends Section 242.253(c), Health and Safety Code, to
require the party that elects arbitration, rather than the department, to
pay the cost of the arbitration. 

SECTION 1.28. Amends Chapter 242H, Health and Safety Code, redesignated as
Subchapter J by SECTION 1.26 of this Act, by amending Section 242.267 and
242.268, and adding Section 242.269, as follows: 

Sec. 242.267.  COURT VACATING ORDER.  Sets forth the terms by which a
court is required to vacate an arbitrator's order with respect to an
arbitration conducted at the election of the department or institution.
Makes conforming changes.   

Sec. 242.268. New heading:  NO ARBITRATION IN CASE OF EMERGENCY ORDER OR
CLOSING ORDER.  Provides that this subchapter does not apply to an order
issued under Section 242.062, and establishes that neither the department
nor the institution may elect to arbitrate a dispute if the subject matter
of the dispute is part of the basis for suspension of admission, or
revocation, denial, or suspension of an institution's license or issuance
of a closing order under Section 242.062.   

Sec. 242.269.  NO ARBITRATION OF CIVIL PENALTY UNDER SECTION 242.065
WITHOUT CERTIFICATION OF THE DEPARTMENT AND ATTORNEY GENERAL. Sets forth
the terms by which this subchapter does not apply to a civil penalty under
Section 242.065 unless the commissioner and the attorney general certify
that the material of the findings by the department justify the
arbitration.  Provides that certification does not imply an election of
arbitration by the state.    

SECTION 1.29. Amends Chapter 242, Health and Safety Code, by redesignating
Subchapter F as Subchapter N and adding new Subchapters F, K, L, M, and O,
as follows:  

SUBCHAPTER F.  MEDICAL, NURSING, AND DENTAL SERVICES OTHER THAN
ADMINISTRATION OF MEDICATION   

Sec. 242.151. PHYSICIAN SERVICES.  Requires an institution to have at
least one medical director who is licensed as a physician in this state.
Provides that the attending physician is responsible for a resident's
assessment and comprehensive plan of care, and is required to review,
revise, and sign orders relating to any medication or treatment in the
plan of care. Authorizes the responsibilities imposed on the attending
physician to be performed by an advanced practice nurse or a physician
assistant, pursuant to certain protocols.  Establishes that each resident
has the right to choose a personal attending physician. 

Sec. 242.152. PHYSICIAN SERVICES FOR RESIDENTS YOUNGER THAN 18 YEARS OF
AGE.  Sets forth the conditions by which an institution is required to use
appropriate pediatric consultative services for a resident younger than 18
years of age, and requires a pediatrician or other suitable physician to
participate in all aspects of a resident's medical care.   

Sec. 242.153. DIRECTOR OF NURSING SERVICES.  Requires an institution to
have a director of nursing services who is a registered nurse, and sets
forth the director's responsibilities.  Authorizes the department to grant
a waiver requested by the facility from  the requirement that the director
of nursing be a registered nurse.       

Sec. 242.154. NURSING SERVICES.  Requires an institution to provide the
nursing care required to allow each resident to achieve and maintain the
highest possible degree of function and independence medically possible.
Requires the institution to maintain sufficient nursing staff to ensure
appropriate resident care. 

Sec. 242.155. PEDIATRIC NURSING SERVICES.  Requires an institution to
ensure that nursing services for a resident younger than 18 years of age
are provided by a staff member who has been instructed and has
demonstrated competence in the care of children, and consultative
pediatric nursing services are available to the staff if the institution
has a resident younger than 18 years of age.   

Sec. 242.156. REQUIRED MEDICAL EXAMINATION.  Requires the department,
except as required by federal law, to require that each resident be given
at least one medical examination each year subject to departmental
specification. 

Sec. 242.157. DENTAL EXAMINATION.   Sets forth the conditions by which the
department is required to ensure that each institution supervises the
dental care needs of its residents. 

SUBCHAPTER K.  QUALITY OF CARE

Sec. 242.401. QUALITY OF LIFE.  Requires an institution to care for its
residents in a manner and in an environment that promotes maintenance or
enhancement of each resident's quality of life.  Requires an institution
that admits a resident who is younger than 18 years of age to meet the
resident's unique needs.  

Sec. 242.402. QUALITY OF CARE.  Requires an institution to provide any
care or service needed to enable a resident to attain and maintain the
highest practicable level of physical, emotional, and social well-being,
in accordance with each resident's individual assessment and comprehensive
plan of care. 

Sec. 242.403. STANDARDS FOR QUALITY OF LIFE AND QUALITY OF CARE. Requires
the department to adopt standards to implement Sections 242.401 and
242.402 which address resident quality of life and care.  Authorizes the
department to adopt additional standards to implement Sections 242.401 and
242.402.   

Sec. 242.404. POLICIES, PROCEDURES, AND PRACTICES FOR QUALITY OF CARE AND
QUALITY OF LIFE.  Requires each institution to comply with the standards
adopted under this subchapter and develop written operating policies to
implement those standards. Requires these policies to be available to each
physician, staff member, resident, resident's next of kin or guardian, and
the public. 
  
SUBCHAPTER L.  RIGHTS OF RESIDENTS 

Sec. 242.501. RESIDENT'S RIGHTS.  Requires the department, by rule, to
adopt a statement of the rights of a resident consistent with Chapter 102,
Human Resources Code. Sets forth the terms by which the statement of a
resident's rights is required to address, at minimum, the resident's
constitutional, civil, and legal rights, as well as certain other rights.
Authorizes the department to adopt additional resident rights. 

Sec. 242.502. RIGHTS CUMULATIVE.  Provides that the rights established
under this subchapter are cumulative of the rights established under
Chapter 102, Human Resources Code, and any other law. 

Sec. 242.503. DUTIES OF INSTITUTION.  Requires an institution to develop
and implement policies to protect resident rights.  Prohibits an
institution and the staff from violating a right adopted under this
subchapter. 
 
Sec. 242.504. INFORMATION ABOUT RESIDENT'S RIGHTS AND VIOLATIONS. Requires
an institution to inform and explain to each resident and the resident's
next of kin or guardian of the rights adopted under this subchapter.  Sets
forth the terms by which an institution is required to provide, maintain,
and post a written statement of the resident's rights to certain persons.  

SUBCHAPTER M. COMPLAINT INSPECTIONS

Sec. 242.551. COMPLAINT REQUESTING INSPECTION.  Sets forth the terms by
which a person is authorized to request an inspection of an institution,
and requires the department to encourage a person who makes an oral
complaint to submit a written, signed complaint.  

Sec. 242.552. DISCLOSURE OF SUBSTANCE OF COMPLAINT.  Prohibits the
department from providing information to the institution relating to the
substance of a complaint made under this subchapter before an on-site
inspection.   

Sec. 242.553. CONFIDENTIALITY.  Provides that the name of the person
making the complaint is confidential and may not be released unless the
person making the complaint requests release. 

Sec. 242.554. PRELIMINARY REVIEW OF COMPLAINT; INSPECTION.  Sets forth the
terms by which the department is required to make a preliminary review of
a complaint, conduct an on-site inspection, and notify the person making
the complaint of the department's course of action and the reasons for
that action. 

SUBCHAPTER N.  New heading:  ADMINISTRATION OF MEDICATION

Sec. 242.601. MEDICATION ADMINISTRATION.  Sets forth the terms by which an
institution is required to establish proper medication administration
procedures, and requires these procedures to comply with this subchapter
and the rules adopted by the board under Section 242.608.   

Sec. 242.602. PHARMACIST SERVICES.  Requires an institution to employ a
licensed pharmacist and to contract, in writing, with a licensed
pharmacist to advise the institution on certain matters.  Requires the
institution to allow residents to choose their pharmacy provider from any
qualified pharmacy. 

Sec. 242.603. STORAGE AND DISPOSAL OF MEDICATIONS.  Requires an
institution to store medications in certain places and under appropriate
conditions of sanitation, temperature, light, moisture, ventilation,
segregation, and security.  Requires an institution to properly dispose of
certain medications.  Requires a discontinued medication that has not been
destroyed to be reinstated if reordered.  Sets forth the terms by which an
institution is required to release the medications of a resident who is
transferred or discharged.   

Sec. 242.604. REPORTS OF MEDICATION ERRORS AND ADVERSE REACTIONS. Requires
an institution's nursing staff to report medication and adverse reactions
to the resident's physician in a timely manner and record the errors and
reactions in the resident's clinical record.   

Sec. 242.605. MEDICATION REFERENCE SOURCES.  Sets forth the terms by which
an institution is required to maintain updated medication reference texts
or sources. 

Sec. 242.606. PERMITS TO ADMINISTER MEDICATION.  Redesignated from
existing Section 242.151.  Makes a conforming change. 

Sec. 242.607. EXEMPTIONS FOR NURSING STUDENTS AND MEDICATION AIDE
TRAINEES.  Redesignated from existing Section 242.1511.  Makes a
conforming change. 

 Sec. 242.608. RULES FOR ADMINISTRATION OF MEDICATION.  Redesignated from
existing Section 242.152.   

Sec. 242.609. TRAINING PROGRAMS TO ADMINISTER MEDICATION.  Redesignated
from existing Section 242.153.  Makes a conforming change.   

Sec. 242.610. ISSUANCE AND RENEWAL OF PERMIT TO ADMINISTER MEDICATION.
Redesignated from existing Section 242.154.  Makes a conforming change.  
Sec. 242.611. FEES FOR ISSUANCE AND RENEWAL OF PERMIT TO ADMINISTER
MEDICATION.  Redesignated from existing Section 242.155.  Deletes the
provision authorizing fees received to only be appropriated to the
department to defray costs incurred under this section. 

Sec. 242.612. VIOLATION OF PERMITS TO ADMINISTER MEDICATION. Redesignated
from existing Section 242.156.  Makes a conforming change. 

Sec. 242.613. EMERGENCY SUSPENSION OF PERMITS TO ADMINISTER MEDICATION.
Redesignated from existing Section 242.157.   

Sec. 242.614. ADMINISTRATION OF MEDICATION; CRIMINAL PENALTY. Redesignated
from existing Section 242.158.  Deletes existing Sections 242.159 and
242.160.   

Sec. 242.615. EMERGENCY MEDICATION KIT.  Redesignated from existing
Section 242.161.   

SUBCHAPTER O.  LEGISLATIVE OVERSIGHT

Sec. 242.651.  DEFINITION; SUNSET DATE.  Defines "committee."  Provides
that the committee is subject to Chapter 325, Government Code (Texas
Sunset Act), and unless continued in existence as provided by that
chapter, will be abolished September 1, 2001. 

Sec. 242.652.  COMPOSITION OF COMMITTEE; PRESIDING OFFICER.  Sets forth
the composition of the committee, and the method by which the lieutenant
governor and speaker of the house shall appoint the presiding officer for
a certain term.  Provides that a member of the committee serves at the
pleasure of the appointing official.   

Sec. 242.653.  COMMITTEE POWERS AND DUTIES.  Set forth the powers and
duties of the committee, including the responsibility to monitor the
effectiveness and efficiency of the nursing facility regulatory system of
this state.  Authorizes the committee to request reports and other
information from the department and the attorney general regarding certain
issues. Requires the committee to use the existing staff resources of the
senate and house of representatives to assist the committee in performing
its duties.   

Sec. 242.654.  REPORT.  Sets forth the terms by which the committee is
required to report to the governor, lieutenant governor, and speaker of
the house of representatives.  Sets forth the contents of the report.   

SECTION 1.30. Amends Section 222.0255, Health and Safety Code, by adding
Subsection (e), to provide that Chapter 242 establishes the minimum
licensing standards for an institution.  Requires the licensing standards
adopted by the department under this chapter to be adopted subject to
Section 242.037(b), and to comply with Section 242.037(c) and the other
provisions of Chapter 242.  

SECTION 1.31. Repealer:  Section 242.012, Health and Safety Code (Rights
of Residents).    

SECTION 1.32. Requires the board to adopt rules as necessary to implement
the change in law made by this article not later than January 1, 1998.   

 SECTION 1.33. Makes application of this Act prospective to January 1,
1998. 

ARTICLE 2.  GOVERNMENT FUNDING OF NURSING SERVICES

SECTION 2.01. Amends Section 32.021, Human Resources Code, by amending
Subsections (d) and (h)-(k), and adding Subsections (l) and (m), to set
forth the terms by which the department is required, rather than
authorized, to include penalties for violations in its contracts for the
delivery of medical assistance by nursing facilities, provided that the
department shall provide for an informal dispute resolution process in the
department's central office to perform certain functions.  Deletes the
provision requiring the establishment of a penalties and sanctions
advisory committee.  Requires Medicaid nursing facilities to also comply
with state licensure rules, which may be more stringent than the
requirements for certification.  Deletes the provision prohibiting rules
adopted by the department for certification of nursing facilities from
being different from the standards imposed by federal law.  Requires the
department to use appropriate civil, administrative, or criminal remedies
with respect to a facility that is in violation of a certification or
licensing requirement.  Deletes the provision requiring rules adopted to
provide for an informal dispute resolution process.  Establishes the
provisions regarding the admissibility of certain surveys, investigations,
and surveyor or investigator testimony as evidence in a civil action to
prove an institutional violation.  Prohibits the department from including
as a reimbursable item to a nursing facility certain administrative or
civil penalties.  Sets forth the terms by which the department is required
to terminate a nursing facility's provider agreement.  Deletes the
provision making an assessment of monetary penalties subject to
arbitration.  Makes conforming changes. 

SECTION 2.02.  Amends Section 32.034(c), Human Resources Code, to provide
that this section does not apply if federal matching funds are not
available to pay the facility whose contract is being cancelled.
Establishes that if federal matching funds cannot be used, no state funds
may be used to pay the facility.  Deletes the previous provision regarding
the inapplicability of this section. 

ARTICLE 3.  EFFECTIVE DATE; EMERGENCY

SECTION 3.01. Effective date:  September 1, 1997.

SECTION 3.02. Emergency clause.

SUMMARY OF COMMITTEE CHANGES

Amends SECTION 1.02, Section 242.002, Health and Safety Code, to define
"facility" and "home." Redefines "person."  Deletes the definition for
"restraints." 

Amends SECTION 1.03, Section 242.0021, Health and Safety Code, to set
forth the conditions under which a person is the controlling person of an
institution, rather than by which a person controls an institution. 

Amends SECTION 1.04, Section 242.005, Health and Safety Code, to set forth
the terms by which the department and the attorney general are each
required to annually prepare performance reports.  
Amends SECTION 1.05, by adding Section 242.017, Health and Safety Code, to
establish the method of deposit and appropriation for a fee or penalty
collected by the department.  Prohibits investigation and attorneys fees
from being assessed by the department or other state agency, unless those
entities collect a penalty.     

Amends SECTION 1.06, Section 242.032, Health and Safety Code, to authorize
the department to require an applicant or license holder to file
information relating to the history of the person's financial condition
regarding an institution operated in another state or jurisdiction. 

Amends SECTION 1.07, Section 242.033(a), Health and Safety Code, to delete
the provision regarding the deposit and appropriation of license fees.   

Amends SECTION 1.09, Section 242.037, Health and Safety Code, to require
the department to  make and enforce rules regarding quality of life,
quality of care, and residents' rights.  Requires the board to adopt,
publish, and enforce minimum standards relating to care and treatment of
residents, licensure of institutions, and implementation of this chapter. 

Amends SECTION 1.10, Section 242.042, Health and Safety Code, to require
institutional postings to include a notice regarding licensing inspection
reports showing deficiencies in the institution, and deletes the provision
regarding a notice required under Section 242.504.  Adds Section 242.0421,
Health and Safety Code, regarding availability of reports. 

Amends SECTION 1.11, Section 242.061, Health and Safety Code, to authorize
the department to deny, suspend, or revoke the license of an institution
if certain persons have been excluded from holding a license. 

Amends SECTION 1.12, by adding Section 242.0615, Health and Safety Code,
to authorize the department to exclude certain persons from eligibility
for a license.   

Amends SECTION 1.13, Section 242.063, Health and Safety Code, to set forth
the terms by which the department is authorized to petition a district
court for a temporary restraining order or an injunction to restrain a
person from a violation of certain standards or laws. 

Amends SECTION 1.14, Section 242.065, Health and Safety Code, to provide
that a person who violates this chapter or a rule adopted is liable for a
civil penalty of not less than $1,000 or more than $25,000 for each
violation.  Raises the civil penalties for all violations under this
chapter.  Sets forth the procedure for determining a penalty award.
Authorizes the state to seek satisfaction from certain other persons or
entities if a person found liable fails to pay the obligated amount.
Provides that a payment made to satisfy an obligation is not an allowable
cost for reimbursement under the state Medicaid program; and a civil
penalty is not compensation for actual pecuniary loss.   

Amends SECTION 1.15, Section 242.066, Health and Safety Code, to delete
the provision authorizing the department to assess an administrative
penalty against a person who operates an institution without a valid
license.  Deletes the provision regarding the penalty for a violation of
Section 242.1225, and changes the maximum penalty, with certain
exceptions.   

Amends SECTION 1.16, Section 242.0665, Health and Safety Code, to delete
the provision making a violation of Section 242.1225 an exception to
Subsection (a).  Changes the maximum penalty for a subsequent violation. 

Deletes former SECTION 1.14.  

Amends SECTION 1.17, Section 242.067, Health and Safety Code, to require
the notice of the report recommending administrative penalty to contain a
statement of certain information if the violation is subject to
correction.  Authorizes a person to consent to the report, request a
hearing, or submit a plan of correction not later than the 20th, rather
than the 60th, day after the day the notice was sent. Deletes the
provision requiring the commissioner to order a hearing on the findings
and recommendations in the report under certain circumstances.  Deletes
the provision requiring the commissioner to assess an administrative
penalty if a person fails to correct a violation to the department's
satisfaction.  Amends Section 242.068, Health and Safety Code, to require
an administrative law judge, rather than the commissioner, to order and
give notice of a hearing under certain circumstances.  Requires the
hearing to be held before an administrative law judge, rather than by a
hearing examiner designated by the commissioner.  Amends Section 242.069,
Health and Safety Code, to delete the provision requiring a penalty
collected under this section to be deposited to the credit of the nursing
and convalescent home trust fund.   Deletes the provisions regarding the
matters to be contested in a petition for judicial review by a certain
date.  Deletes the provisions authorizing a person to stay enforcement of
a penalty, the department to file a contest to the affidavit, and the
court to hold a hearing.  Amends Section 242.070, Health and Safety Code,
to prohibit the department from assessing more than one monetary penalty
under this chapter, with certain exceptions.  

Amends SECTION 1.18, by adding Section 242.073, Health and Safety Code, to
provide the terms  under which the department and the attorney general
will work in close cooperation throughout any legal proceedings. 

Deletes former SECTIONS 1.18 and 1.19 and SECTION 1.20, Section 242.125.  

Amends SECTION 1.19, by adding Section 242.096(e), Health and Safety Code,
to require any unencumbered amount in the nursing and convalescent home
trust fund in excess of $500,000, rather than $100,000, to be transferred
to the general revenue fund.  Authorizes the amount to be appropriated
only to the department.   

Amends SECTION 1.20, by adding Section 242.097, Health and Safety Code, to
require the department to adopt an annual fee to be charged and collected
if the amount of the nursing and convalescent home trust fund is less than
$500,000, rather than $100,000.   

Amends SECTION 1.21, Section 242.1255, Health and Safety Code, to assign a
new heading entitled, "ADDITIONAL REPORTING REQUIREMENT."  Requires the
board to adopt rules requiring any person required to report abuse or
neglect under Section 242.122 to report other conduct or conditions
specified by the rules.  Deletes the provision requiring certain persons
or entities to report any suspected violation of state law, department
rules, or federal law; or any unsatisfactory conditions.    

Amends SECTION 1.22, Section 242.126, Health and Safety Code, to require a
designated agency to begin an investigation of abuse or neglect within 24,
rather than two, hours of receipt of the report. Requires the department
to adopt rules governing the conduct of investigations.  Deletes the
provisions regarding completion of an initial status report by an
investigating agency.  Requires preparation of a written report no later
than the 30th, rather than the fifth, day after the investigation
completion date.  Provides an exception to the provision requiring the
department to delete the name of any resident from a report.    

Amends SECTION 1.24, Section 242.133(a), Health and Safety Code, to
provide that a person has a cause of action against an institution that
terminates the employment of, or otherwise discriminates or retaliates
against, the person for cooperating in a government investigation relating
to care, services, or conditions at the institution.    

Amends SECTION 1.25, Section 242.1335(a), Health and Safety Code, to
prohibit an institution from retaliating or discriminating against a
resident who makes a complaint or files a grievance concerning the
facility. 

Amends SECTION 1.27, by adding Section 242.253, Health and Safety Code, to
require the party that elects arbitration, rather than the department, to
pay the cost of the arbitration. 

Amends SECTION 1.28, by adding Section 242.269, regarding certification of
eligibility for arbitration by the department and the attorney general.   

Amends SECTION 1.29, as follows:

_Amends Section 242.151, Health and Safety Code, to require an institution
to have at least one medical director, rather than one attending
physician, who is licensed as a physician in the state.  Set forth the
terms by which the attending physician has certain responsibilities.  
_Amends Section 242.153 to require an institution to have a director of
nursing services who is a registered nurse, rather than a registered nurse
or advanced registered nurse practitioner, and makes an exception.  
_Amends Section 242.154 to require an institution to maintain sufficient
nursing staff to ensure appropriate resident care, rather than
specifically outlining nurse-patient ratios and daily duty hours.   
_Amends Section 242.156 to require the department to require resident
medical exams once yearly, except as required by federal law.   
_Amends Section 242.157 to replace references to "nursing home or
custodial care home" with "institution."   
 _Amends Section 242.403 to require standards for quality of care and life
to address appropriate use of chemical and physical restraints and
nutrition services, and to refrain from being overly prescriptive.   
_Deletes former Section 242.404, relating to the use of restraints.
Amends present Section 242.404, to delete the provision requiring the
department to adopt standards governing certain policies and procedures. 
_Amends Section 242.501, regarding a resident 's right to be free from
chemical and physical restraints.   
_Amends Section 242.504 to delete the provision requiring institutions
cited for a violation to post a notice of the citation on certain doors.  
_Deletes the provision which sets forth the way in which a resident's
rights may be restricted.  
_Amends the heading for Subchapter M to read, "COMPLAINT INSPECTIONS."  
_Deletes Section 242.555, regarding persons who may accompany an inspector
during an onsite inspection.   
_Amends Section 242.601, regarding administration of medication by nurse
or physician assistant's order.   
_Amends Section 242.611 to delete the provision providing that fees
received under this section may only be appropriated to the department to
defray costs incurred.   
_Adds Subchapter O, regarding legislative oversight of nursing facility
rules and regulations through the long-term care legislative oversight
committee. 

Amends SECTION 1.30, Section 222.0255, Health and Safety Code, to delete
the provisions regarding standards for the licensing of nursing homes. 

Amends SECTION 2.01, Section 32.021, Human Resources Code, to replace
"contract violations" with "violations."  Sets forth the terms by which
the department is required to provide for an informal dispute resolution
process, and by which Medicaid nursing facilities are required to comply
with state licensure rules.  Delete the provisions prohibiting department
rules from being different from standards imposed by federal law, and
regarding the institution of a reimbursement system to compensate nursing
facilities for their investment in property.  
 
Adds SECTION 2.02, to amend Section 32.034(c), Human Resources Code, to
provide that this section does not apply if federal matching funds are not
available to pay the facility whose contract is being cancelled.
Establishes that if these funds cannot be used, no state funds may be used
to pay the facility.