By:  Moncrief, et al.                                   S.B. No. 94
                                A BILL TO BE ENTITLED
                                       AN ACT
 1-1     relating to home health services; providing administrative
 1-2     penalties.
 1-3           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
 1-4           SECTION 1.  Section 142.001, Health and Safety Code, is
 1-5     amended to read as follows:
 1-6           Sec. 142.001.  DEFINITIONS.  In this chapter:
 1-7                 (1)  "Administrative support site" means a facility or
 1-8     site where a home and community support services agency performs
 1-9     administrative and other support functions but does not provide
1-10     direct home health, hospice, or personal assistance services.
1-11                 (2)  "Alternate delivery site" means a facility or
1-12     site, including a residential unit or an inpatient unit:
1-13                       (A)  that is owned or operated by a hospice;
1-14                       (B)  that is not the hospice's principal place of
1-15     business;
1-16                       (C)  that is located in the geographical area
1-17     served by the hospice; and
1-18                       (D)  from which the hospice provides hospice
1-19     services.
1-20                 (3)  "Bereavement" means the process by which a
1-21     survivor of a deceased person mourns and experiences grief.
1-22                 (4)  "Bereavement services" means support services
1-23     offered to a family during bereavement.
1-24                 (5)  "Branch office" means a facility or site in the
 2-1     geographical area served by a home and community support agency
 2-2     where home health or personal assistance services are delivered or
 2-3     active client records are maintained.
 2-4                 (6)  "Certified agency" means a home and community
 2-5     support services agency that:
 2-6                       (A)  provides a home health service; and
 2-7                       (B)  is certified by an official of the
 2-8     Department of Health and Human Services as in compliance with
 2-9     conditions of participation in Title XVIII, Social Security Act (42
2-10     U.S.C. Section 1395 et seq.).
2-11                 (7)  "Certified home health services" means home health
2-12     services that are provided by a certified agency.
2-13                 (8)  "Chief financial officer" means an individual who
2-14     is responsible for supervising and managing all financial
2-15     activities for a home and community support services agency.
2-16                 (9)  "Controlling person" means a person who controls a
2-17     home and community support services agency or other person as
2-18     described by Section 142.0012.
2-19                 (10)  "Council" means the Home and Community Support
2-20     Services Advisory Council.
2-21                 (11) [(10)]  "Counselor" means an individual qualified
2-22     under Medicare standards to provide counseling services, including
2-23     bereavement, dietary, spiritual, and other counseling services, to
2-24     both the client and the family.
2-25                 (12) [(11)]  "Home and community support services
2-26     agency" means a person who provides home health, hospice, or
 3-1     personal assistance services for pay or other consideration in a
 3-2     client's residence, an independent living environment, or another
 3-3     appropriate location.
 3-4                 (13) [(12)]  "Home health service" means the provision
 3-5     of one or more of the following health services required by an
 3-6     individual in a residence or independent living environment:
 3-7                       (A)  nursing;
 3-8                       (B)  physical, occupational, speech, or
 3-9     respiratory therapy;
3-10                       (C)  medical social service;
3-11                       (D)  intravenous therapy;
3-12                       (E)  dialysis;
3-13                       (F)  service provided by unlicensed personnel
3-14     under the delegation of a licensed health professional;
3-15                       (G)  the furnishing of medical equipment and
3-16     supplies, excluding drugs and medicines; or
3-17                       (H)  nutritional counseling.
3-18                 (14) [(13)]  "Hospice" means a person licensed under
3-19     this chapter to provide hospice services, including a person who
3-20     owns or operates a residential unit or an inpatient unit.
3-21                 (15) [(14)]  "Hospice services" means services,
3-22     including services provided by unlicensed personnel under the
3-23     delegation of a registered nurse or physical therapist, provided to
3-24     a client or a client's family as part of a coordinated program
3-25     consistent with the standards and rules adopted under this chapter.
3-26     These services include palliative care for terminally ill clients
 4-1     and support services for clients and their families that:
 4-2                       (A)  are available 24 hours a day, seven days a
 4-3     week, during the last stages of illness, during death, and during
 4-4     bereavement;
 4-5                       (B)  are provided by a medically directed
 4-6     interdisciplinary team; and
 4-7                       (C)  may be provided in a home, nursing home,
 4-8     residential unit, or inpatient unit according to need.  These
 4-9     services do not include inpatient care normally provided in a
4-10     licensed hospital to a terminally ill person who has not elected to
4-11     be a hospice client.
4-12                 (16) [(15)]  "Inpatient unit" means a facility that
4-13     provides a continuum of medical or nursing care and other hospice
4-14     services to clients admitted into the unit and that is in
4-15     compliance with:
4-16                       (A)  the conditions of participation for
4-17     inpatient units adopted under Title XVIII, Social Security Act (42
4-18     U.S.C. Section 1395 et seq.); and
4-19                       (B)  standards adopted under this chapter.
4-20                 (17) [(16)]  "Independent living environment" means:
4-21                       (A)  a client's individual residence, which may
4-22     include a group home or foster home; or
4-23                       (B)  other settings where a client participates
4-24     in activities, including school, work, or church.
4-25                 (18) [(17)]  "Interdisciplinary team" means a group of
4-26     individuals who work together in a coordinated manner to provide
 5-1     hospice services and must include a physician, registered nurse,
 5-2     social worker, and counselor.
 5-3                 (19) [(18)]  "Investigation" means an inspection or
 5-4     survey conducted by a representative of the department to determine
 5-5     if a licensee is in compliance with this chapter.
 5-6                 (20) [(19)]  "Palliative care" means intervention
 5-7     services that focus primarily on the reduction or abatement of
 5-8     physical, psychosocial, and spiritual symptoms of a terminal
 5-9     illness.
5-10                 (21) [(20)]  "Person" means an individual, corporation,
5-11     or association.
5-12                 (22) [(21)]  "Personal assistance service" means
5-13     routine ongoing care or services required by an individual in a
5-14     residence or independent living environment that enable the
5-15     individual to engage in the activities of daily living or to
5-16     perform the physical functions required for independent living,
5-17     including respite services.  The term includes health-related
5-18     services performed under circumstances that are defined as not
5-19     constituting the practice of professional nursing by the Board of
5-20     Nurse Examiners through a memorandum of understanding with the
5-21     department in accordance with Section 142.016 and health-related
5-22     tasks provided by unlicensed personnel under the delegation of a
5-23     registered nurse.
5-24                 (23) [(22)]  "Place of business" means an office of a
5-25     home and community support services agency that maintains client
5-26     records or directs home health, hospice, or personal assistance
 6-1     services.  The term does not include an administrative support
 6-2     site.
 6-3                 (24) [(23)]  "Residence" means a place where a person
 6-4     resides and includes a home, a nursing home, a convalescent home,
 6-5     or a residential unit.
 6-6                 (25) [(24)]  "Residential unit" means a facility that
 6-7     provides living quarters and hospice services to clients admitted
 6-8     into the unit and that is in compliance with standards adopted
 6-9     under this chapter.
6-10                 (26) [(25)]  "Respite services" means support options
6-11     that are provided temporarily for the purpose of relief for a
6-12     primary caregiver in providing care to individuals of all ages with
6-13     disabilities or at risk of abuse or neglect.
6-14                 (27) [(26)]  "Social worker" means an individual
6-15     licensed [certified] as a social worker under Chapter 50, Human
6-16     Resources Code.
6-17                 (28) [(27)]  "Support services" means social,
6-18     spiritual, and emotional care provided to a client and a client's
6-19     family by a hospice.
6-20                 (29) [(28)]  "Terminal illness" means an illness for
6-21     which there is a limited prognosis if the illness runs its usual
6-22     course.
6-23                 (30) [(29)]  "Volunteer" means an individual who
6-24     provides assistance to a home and community support services agency
6-25     without compensation other than reimbursement for actual expenses.
6-26           SECTION 2.  Subchapter A, Chapter 142, Health and Safety
 7-1     Code, is amended by adding Sections 142.0011 and 142.0012 to read
 7-2     as follows:
 7-3           Sec. 142.0011.  SCOPE, PURPOSE, AND IMPLEMENTATION.  (a)  The
 7-4     purpose of this chapter is to ensure that home and community
 7-5     support services agencies in this state deliver the highest
 7-6     possible quality of care.  This chapter and the rules adopted under
 7-7     this chapter establish minimum standards for acceptable quality of
 7-8     care, and a violation of a minimum standard established or adopted
 7-9     under this chapter is a violation of law.  For purposes of this
7-10     chapter, components of quality of care include:
7-11                 (1)  client independence and self-determination;
7-12                 (2)  humane treatment;
7-13                 (3)  continuity of care;
7-14                 (4)  coordination of services;
7-15                 (5)  professionalism of service providers;
7-16                 (6)  quality of life; and
7-17                 (7)  client satisfaction with services.
7-18           (b)  The department shall protect clients of home and
7-19     community support services agencies by regulating those agencies
7-20     and:
7-21                 (1)  adopting rules relating to quality of care and
7-22     quality of life;
7-23                 (2)  strictly monitoring factors relating to the
7-24     health, safety, welfare, and dignity of each client;
7-25                 (3)  imposing prompt and effective remedies for
7-26     violations of this chapter and rules and standards adopted under
 8-1     this chapter;
 8-2                 (4)  enabling agencies to provide services that allow
 8-3     clients to maintain the highest possible degree of independence and
 8-4     self-determination; and
 8-5                 (5)  providing the public with helpful and
 8-6     understandable information relating to agencies in this state.
 8-7           Sec. 142.0012.  CONTROLLING PERSON.  (a)  A person is a
 8-8     controlling person if the person, acting alone or with others, has
 8-9     the ability to directly or indirectly influence, direct, or cause
8-10     the direction of the management, expenditure of money, or policies
8-11     of a home and community support services agency or other person.
8-12           (b)  For purposes of this chapter, "controlling person"
8-13     includes:
8-14                 (1)  a management company or other business entity that
8-15     operates or contracts with others for the operation of a home and
8-16     community support services agency;
8-17                 (2)  a person who is a controlling person of a
8-18     management company or other business entity that operates a home
8-19     and community support services agency or that contracts with
8-20     another person for the operation of a home and community support
8-21     services agency; and
8-22                 (3)  any other individual who, because of a personal,
8-23     familial, or other relationship with the owner, manager, or
8-24     provider of a home and community support services agency, is in a
8-25     position of actual control or authority with respect to the agency,
8-26     without regard to whether the individual is formally named as an
 9-1     owner, manager, director, officer, provider, consultant,
 9-2     contractor, or employee of the agency.
 9-3           (c)  A controlling person described by Subsection (b)(3) does
 9-4     not include an employee, lender, secured creditor, or other person
 9-5     who does not exercise formal or actual influence or control over
 9-6     the operation of a home and community support services agency.
 9-7           (d)  The department may adopt rules that specify the
 9-8     ownership interests and other relationships that qualify a person
 9-9     as a controlling person.
9-10           SECTION 3.  Subsection (a), Section 142.003, Health and
9-11     Safety Code, is amended to read as follows:
9-12           (a)  The following persons need not be licensed under this
9-13     chapter:
9-14                 (1)  a physician, dentist, registered nurse, or
9-15     physical therapist licensed under the laws of this state who
9-16     provides home health services to a client only as a part of and
9-17     incidental to that person's private office practice;
9-18                 (2)  a registered nurse, licensed vocational nurse,
9-19     physical therapist, occupational therapist, speech therapist,
9-20     medical social worker, or any other health care professional as
9-21     determined by the department who provides home health services as a
9-22     sole practitioner;
9-23                 (3)  a registry that operates solely as a clearinghouse
9-24     to put consumers in contact with persons who provide home health,
9-25     hospice, or personal assistance services and that does not maintain
9-26     official client records, direct client services, or compensate the
 10-1    person who is providing the service;
 10-2                (4)  an individual whose permanent residence is in the
 10-3    client's residence;
 10-4                (5)  an employee of a person licensed under this
 10-5    chapter who provides home health, hospice, or personal assistance
 10-6    services only as an employee of the license holder and who receives
 10-7    no benefit for providing the services, other than wages from the
 10-8    license holder;
 10-9                (6)  a home, nursing home, convalescent home, assisted
10-10    living [personal care] facility, special care facility, or other
10-11    institution for individuals who are elderly or who have
10-12    disabilities that provides home health or personal assistance
10-13    services only to residents of the home or institution;
10-14                (7)  a person who provides one health service through a
10-15    contract with a person licensed under this chapter;
10-16                (8)  a durable medical equipment supply company;
10-17                (9)  a pharmacy or wholesale medical supply company
10-18    that does not furnish services, other than supplies, to a person at
10-19    the person's house;
10-20                (10)  a hospital or other licensed health care facility
10-21    that provides home health or personal assistance services only to
10-22    inpatient residents of the hospital or facility;
10-23                (11)  a person providing home health or personal
10-24    assistance services to an injured employee under Title 5, Labor
10-25    Code [the Texas Workers' Compensation Act (Article 8308-1.01 et
10-26    seq., Vernon's Texas Civil Statutes)];
 11-1                (12)  a visiting nurse service that:
 11-2                      (A)  is conducted by and for the adherents of a
 11-3    well-recognized church or religious denomination; and
 11-4                      (B)  provides nursing services by a person exempt
 11-5    from licensing by Article 4528, Revised Statutes, because the
 11-6    person furnishes nursing care in which treatment is only by prayer
 11-7    or spiritual means;
 11-8                (13)  an individual hired and paid directly by the
 11-9    client or the client's family or legal guardian to provide home
11-10    health or personal assistance services;
11-11                (14)  a business, school, camp, or other organization
11-12    that provides home health or personal assistance services,
11-13    incidental to the organization's primary purpose, to individuals
11-14    employed by or participating in programs offered by the business,
11-15    school, or camp that enable the individual to participate fully in
11-16    the business's, school's, or camp's programs;
11-17                (15)  a person or organization providing
11-18    sitter-companion services or chore or household services that do
11-19    not involve personal care, health, or health-related services;
11-20                (16)  a licensed health care facility that provides
11-21    hospice services under a contract with a hospice;
11-22                (17)  a person delivering residential acquired immune
11-23    deficiency syndrome hospice care who is licensed and designated as
11-24    a residential AIDS hospice under Chapter 248; or
11-25                (18)  the Texas Department of Criminal Justice.
11-26          SECTION 4.  Subsections (c) and (d), Section 142.004, Health
 12-1    and Safety Code, are amended to read as follows:
 12-2          (c)  The board by rule shall require that, at a minimum,
 12-3    before the department may approve a license application, the
 12-4    applicant must provide to the department:
 12-5                (1)  documentation establishing that, at a minimum, the
 12-6    applicant has sufficient financial resources to provide the
 12-7    services required by this chapter and by the department during the
 12-8    term of the license;
 12-9                (2)  a list of the management personnel for the
12-10    proposed home and community support services agency, a description
12-11    of personnel qualifications, and a plan for providing continuing
12-12    training and education for the personnel during the term of the
12-13    license;
12-14                (3)  documentation establishing that the applicant is
12-15    capable of meeting the minimum standards established by the board
12-16    relating to the quality of care;
12-17                (4)  a plan that provides for the orderly transfer of
12-18    care of the applicant's clients if the applicant cannot maintain or
12-19    deliver home health, hospice, or personal assistance services under
12-20    the license; [and]
12-21                (5)  identifying information on the home and community
12-22    support services agency owner, administrator, and chief financial
12-23    officer to enable the department to conduct criminal background
12-24    checks on those persons;
12-25                (6)  identification of any controlling person with
12-26    respect to the applicant; and
 13-1                (7)  documentation relating to any controlling person
 13-2    identified under Subdivision (6), if requested by the department
 13-3    and relevant to the controlling person's compliance with any
 13-4    applicable licensing standard required or adopted by the board
 13-5    under this chapter.
 13-6          (d)  Information received by the department relating to the
 13-7    competence and financial resources of the applicant or a
 13-8    controlling person with respect to the applicant is confidential
 13-9    and may not be disclosed to the public.
13-10          SECTION 5.  Subchapter A, Chapter 142, Health and Safety
13-11    Code, is amended by adding Section 142.005 to read as follows:
13-12          Sec. 142.005.  COMPLIANCE RECORD IN OTHER STATES.  The
13-13    department may require an applicant or license holder to provide
13-14    the department with information relating to compliance by the
13-15    applicant, the license holder, or a controlling person with respect
13-16    to the applicant or license holder with regulatory requirements in
13-17    any other state in which the applicant, license holder, or
13-18    controlling person operates or operated a home and community
13-19    support services agency.
13-20          SECTION 6.  Subsection (a), Section 142.006, Health and
13-21    Safety Code, is amended to read as follows:
13-22          (a)  The department shall issue a home and community support
13-23    services agency license to provide home health, hospice, or
13-24    personal assistance services for each place of business to an
13-25    applicant if:
13-26                (1)  the [each] applicant [who]:
 14-1                      (A) [(1)]  qualifies for the license to provide
 14-2    the type of service that is to be offered by the applicant;
 14-3                      (B) [(2)]  submits an application and license fee
 14-4    as required by this chapter; and
 14-5                      (C) [(3)]  complies with all applicable licensing
 14-6    standards required or adopted by the board under this chapter; and
 14-7                (2)  any controlling person with respect to the
 14-8    applicant complies with all applicable licensing standards required
 14-9    or adopted by the board under this chapter.
14-10          SECTION 7.  Subsection (d), Section 142.009, Health and
14-11    Safety Code, is amended to read as follows:
14-12          (d)  The reports, records, and working papers used or
14-13    developed in an investigation made under this section are
14-14    confidential and may not be released or made public except:
14-15                (1)  to a state or federal agency;
14-16                (2)  to federal, state, or local law enforcement
14-17    personnel;
14-18                (3)  with the consent of each person identified in the
14-19    information released;
14-20                (4)  in civil or criminal litigation matters or
14-21    licensing proceedings as otherwise allowed by law or judicial rule;
14-22    [or]
14-23                (5)  on a form developed by the department that
14-24    identifies any deficiencies found without identifying a person,
14-25    other than the home and community support services agency;
14-26                (6)  on a form required by a federal agency if:
 15-1                      (A)  the information does not reveal the identity
 15-2    of an individual, including a patient or a physician or other
 15-3    medical practitioner;
 15-4                      (B)  the service provider subject to the
 15-5    investigation had a reasonable opportunity to review the
 15-6    information and offer comments to be included with the information
 15-7    released or made public; and
 15-8                      (C)  the release of the information complies with
 15-9    any other federal requirement; or
15-10                (7)  as provided by Section 142.0092.
15-11          SECTION 8.  Subchapter A, Chapter 142, Health and Safety
15-12    Code, is amended by adding Sections 142.0091, 142.0092, 142.0093,
15-13    and 142.0094 to read as follows:
15-14          Sec. 142.0091.  SURVEYOR TRAINING.  (a)  The department shall
15-15    provide specialized training to representatives of the department
15-16    who survey home and community support services agencies.  The
15-17    training must include information relating to:
15-18                (1)  the conduct of appropriate surveys that do not
15-19    focus exclusively on medical standards under an acute care model;
15-20    and
15-21                (2)  acceptable delegation of nursing tasks.
15-22          (b)  In developing and updating the training required by this
15-23    section, the department shall consult with and include providers of
15-24    home health, hospice, and personal assistance services, recipients
15-25    of those services and their family members, and representatives of
15-26    appropriate advocacy organizations.
 16-1          Sec. 142.0092.  CONSUMER COMPLAINT DATA.  (a)  The department
 16-2    shall maintain records or documents relating to complaints directed
 16-3    to the department by consumers of home health, hospice, or personal
 16-4    assistance services.  The department shall organize the records or
 16-5    documents according to standard, statewide categories as determined
 16-6    by the department.  In determining appropriate categories, the
 16-7    department shall make distinctions based on factors useful to the
 16-8    public in assessing the quality of services provided by a home and
 16-9    community support services agency, including whether the complaint:
16-10                (1)  was determined to be valid or invalid;
16-11                (2)  involved significant physical harm or death to a
16-12    patient;
16-13                (3)  involved financial exploitation of a patient; or
16-14                (4)  resulted in any sanction imposed against the
16-15    agency.
16-16          (b)  The department shall make the information maintained
16-17    under this section available to the public in a useful format that
16-18    does not identify individuals implicated in the complaints.
16-19          Sec. 142.0093.  RETALIATION PROHIBITED.  (a)  A person
16-20    licensed under this chapter may not retaliate against another
16-21    person for filing a complaint, presenting a grievance, or providing
16-22    in good faith information relating to home health, hospice, or
16-23    personal assistance services provided by the license holder.
16-24          (b)  This section does not prohibit a license holder from
16-25    terminating an employee for a reason other than retaliation.
16-26          Sec. 142.0094.  USE OF REGULATORY SURVEY REPORTS AND OTHER
 17-1    DOCUMENTS.  (a)  Except as otherwise provided by this section, a
 17-2    survey report or other document prepared by the department that
 17-3    relates to regulation of a home and community support services
 17-4    agency is not admissible as evidence in a civil action to prove
 17-5    that the agency violated a standard prescribed under this chapter.
 17-6          (b)  Subsection (a) does not:
 17-7                (1)  apply to the admissibility as evidence of
 17-8    department survey reports or other documents in an enforcement
 17-9    action in which the state or an agency or political subdivision of
17-10    the state is a party, including:
17-11                      (A)  an action seeking injunctive relief under
17-12    Section 142.013;
17-13                      (B)  an action seeking imposition of a civil
17-14    penalty under Section 142.014;
17-15                      (C)  a contested case hearing involving
17-16    imposition of an administrative penalty under Section 142.017; and
17-17                      (D)  a contested case hearing involving denial,
17-18    suspension, or revocation of a license issued under this chapter;
17-19                (2)  apply to the admissibility as evidence of
17-20    department survey reports or other documents that are offered:
17-21                      (A)  to establish warning or notice to a home and
17-22    community support services agency of a relevant department
17-23    determination; or
17-24                      (B)  under any rule or evidentiary predicate of
17-25    the Texas Rules of Evidence;
17-26                (3)  prohibit or limit the testimony of a department
 18-1    employee, in accordance with the Texas Rules of Evidence, as to
 18-2    observations, factual findings, conclusions, or determinations that
 18-3    a home and community support services agency violated a standard
 18-4    prescribed under this chapter if the observations, factual
 18-5    findings, conclusions, or determinations were made in the discharge
 18-6    of the employee's official duties for the department; or
 18-7                (4)  prohibit or limit the use of department survey
 18-8    reports or other documents in depositions or other forms of
 18-9    discovery conducted in connection with a civil action if use of the
18-10    survey reports or other documents appears reasonably calculated to
18-11    lead to the discovery of admissible evidence.
18-12          SECTION 9.  Subsection (a), Section 142.011, Health and
18-13    Safety Code, is amended to read as follows:
18-14          (a)  The department may deny a license application or suspend
18-15    or revoke the license of a person who:
18-16                (1)  fails to comply with the rules or standards for
18-17    licensing required by this chapter; or
18-18                (2)  engages in conduct that violates Section 161.091.
18-19          SECTION 10.  Subsections (a) and (d), Section 142.017, Health
18-20    and Safety Code, are amended to read as follows:
18-21          (a)  The department may assess an administrative penalty
18-22    against a person who violates:
18-23                (1)  this chapter or a rule adopted under this chapter;
18-24    or
18-25                (2)  Section 161.091, if the violation relates to the
18-26    provision of home health, hospice, or personal assistance services.
 19-1          (d)  The department by rule shall establish a schedule of
 19-2    appropriate and graduated penalties for each violation based on:
 19-3                (1)  the seriousness of the violation, including the
 19-4    nature, circumstances, extent, and gravity of the violation and the
 19-5    hazard or safety of clients;
 19-6                (2)  the history of previous violations by the person
 19-7    or a controlling person with respect to that person;
 19-8                (3)  whether the affected home and community support
 19-9    services agency had identified the violation as a part of its
19-10    internal quality assurance process and had made appropriate
19-11    progress on correction;
19-12                (4)  the amount necessary to deter future violations;
19-13                (5)  efforts made to correct the violation; and
19-14                (6)  any other matters that justice may require.
19-15          SECTION 11.  Subchapter A, Chapter 142, Health and Safety
19-16    Code, is amended by adding Sections 142.018 and 142.019 to read as
19-17    follows:
19-18          Sec. 142.018.  REPORTS OF ABUSE, EXPLOITATION, OR NEGLECT.
19-19    (a)  In this section, "abuse," "exploitation," and "neglect" have
19-20    the meanings assigned by Section 48.002, Human Resources Code.
19-21          (b)  A home and community support services agency that has
19-22    cause to believe that a person receiving services from the agency
19-23    has been abused, exploited, or neglected by an employee of the
19-24    agency shall report the information to:
19-25                (1)  the department; and
19-26                (2)  the Department of Protective and Regulatory
 20-1    Services or other appropriate state agency as required by Sections
 20-2    48.036 and 48.082, Human Resources Code.
 20-3          (c)  This section does not affect the duty or authority of
 20-4    any state agency to conduct an investigation of alleged abuse,
 20-5    exploitation, or neglect as provided by other law.
 20-6          Sec. 142.019.  CERTAIN PHYSICIAN REFERRALS PROHIBITED.  A
 20-7    physician may not refer a patient to a home and community support
 20-8    services agency if the referral violates 42 U.S.C. Section 1395nn
 20-9    and its subsequent amendments.
20-10          SECTION 12.  Subchapter C, Chapter 48, Human Resources Code,
20-11    is amended by adding Section 48.0381 to read as follows:
20-12          Sec. 48.0381.  NOTIFICATION OF LICENSING OR CONTRACTING
20-13    AGENCY.  (a)  On determining after an investigation that an elderly
20-14    or disabled person has been abused, exploited, or neglected by an
20-15    employee of a home and community support services agency licensed
20-16    under Chapter 142, Health and Safety Code, the department shall:
20-17                (1)  notify the state agency responsible for licensing
20-18    the home and community support services agency of the department's
20-19    determination;
20-20                (2)  notify any health and human services agency, as
20-21    defined by Section 531.001, Government Code, that contracts with
20-22    the home and community support services agency for the delivery of
20-23    health care services of the department's determination; and
20-24                (3)  provide to the licensing state agency and any
20-25    contracting health and human services agency access to the
20-26    department's records or documents relating to the department's
 21-1    investigation.
 21-2          (b)  Providing access to a confidential record or document
 21-3    under this section does not constitute a waiver of confidentiality.
 21-4          SECTION 13.  If, before implementing any provision of this
 21-5    Act, a state agency determines that a waiver or authorization from
 21-6    a federal agency is necessary for implementation of that provision,
 21-7    the agency affected by the provision shall request the waiver or
 21-8    authorization and may delay implementing that provision until the
 21-9    waiver or authorization is granted.
21-10          SECTION 14.  To the extent of any conflict, this Act prevails
21-11    over another Act of the 76th Legislature, Regular Session, 1999,
21-12    relating to nonsubstantive additions to and corrections in enacted
21-13    codes.
21-14          SECTION 15.  (a)  This Act takes effect September 1, 1999.
21-15          (b)  Subsection (a), Section 142.011, and Subsections (a) and
21-16    (d), Section 142.017, Health and Safety Code, as amended by this
21-17    Act, apply only to conduct occurring on or after the effective date
21-18    of this Act.  Conduct occurring before the effective date of this
21-19    Act is covered by the law in effect when the conduct occurred, and
21-20    the former law is continued in effect for that purpose.
21-21          SECTION 16.  The importance of this legislation and the
21-22    crowded condition of the calendars in both houses create an
21-23    emergency and an imperative public necessity that the
21-24    constitutional rule requiring bills to be read on three several
21-25    days in each house be suspended, and this rule is hereby suspended.