By: Hinojosa, et al. S.B. No. 204

A BILL TO BE ENTITLED

AN ACT

relating to the functions and operations of the Department of Aging and Disability Services; increasing penalties.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Section 81.042(e), Health and Safety Code, is amended to read as follows:

(e) The following persons shall report to the local health authority or the department a suspected case of a reportable disease and all information known concerning the person who has or is suspected of having the disease if a report is not made as required by Subsections (a)-(d):

(1) a professional registered nurse;

(2) an administrator or director of a public or private temporary or permanent child-care facility;

(3) an administrator or director of a nursing home, personal care home, adult respite care center, or day activity and health services program or facility [adult day-care center];

(4) an administrator of a home health agency;

(5) an administrator or health official of a public or private institution of higher education;

(6) an owner or manager of a restaurant, dairy, or other food handling or processing establishment or outlet;

(7) a superintendent, manager, or health official of a public or private camp, home, or institution;

(8) a parent, guardian, or householder;

(9) a health professional;

(10) an administrator or health official of a penal or correctional institution; or

(11) emergency medical service personnel, a peace officer, or a firefighter.

SECTION 2. Subchapter A, Chapter 142, Health and Safety Code, is amended by adding Section 142.0125 to read as follows:

Sec. 142.0125. PROGRESSIVE SANCTIONS. (a) The executive commissioner by rule shall create a matrix of progressive sanctions that the department must use to assess penalty amounts and impose disciplinary actions under this chapter appropriately and fairly for a violation of a law, rule, standard, or order adopted or license issued under this chapter or for a violation of other law for which this chapter provides a sanction.

(b) The matrix of progressive sanctions adopted under this section must provide for increases in amounts of administrative penalties based on type, frequency, and seriousness of violations and must provide guidance for determining appropriate and graduated administrative penalties to assess under this chapter to deter future violations, including guidance on considering the factors listed in this chapter for determining the amount of a penalty.

(c) The matrix of progressive sanctions adopted under this section must provide for imposing stronger sanctions, including license suspension or revocation, for more serious violations or for repeated violations as appropriate to deter future serious or repeated violations. The matrix of progressive sanctions must describe appropriate time frames to be used in determining whether a home and community support services agency has committed repeated violations or has engaged in a pattern of repeated violations, such as repeated violations found in consecutive regular inspections.

SECTION 3. Sections 142.017(b) and (j), Health and Safety Code, are amended to read as follows:

(b) The penalty shall be not less than $100 or more than $5,000 [$1,000] for each violation. Each day of a violation that occurs before the day on which the person receives written notice of the violation from the department does not constitute a separate violation and shall be considered to be one violation. Each day of a continuing violation that occurs after the day on which the person receives written notice of the violation from the department constitutes a separate violation.

(j) The executive commissioner by rule shall define the types of minor violations an agency may correct under Subsection (e) before the department may assess an administrative penalty. The executive commissioner shall ensure that all other violations are not subject to a right to correct [The department may assess an administrative penalty without providing a reasonable period of time to the agency to correct the violation if the violation:

[(1) results in serious harm or death;

[(2) constitutes a serious threat to health or safety;

[(3) substantially limits the agency's capacity to provide care;

[(4) is a violation in which a person:

[(A) makes a false statement, that the person knows or should know is false, of a material fact:

[(i) on an application for issuance or renewal of a license or in an attachment to the application; or

[(ii) with respect to a matter under investigation by the department;

[(B) refuses to allow a representative of the department to inspect a book, record, or file required to be maintained by an agency;

[(C) wilfully interferes with the work of a representative of the department or the enforcement of this chapter;

[(D) wilfully interferes with a representative of the department preserving evidence of a violation of this chapter or a rule, standard, or order adopted or license issued under this chapter;

[(E) fails to pay a penalty assessed by the department under this chapter not later than the 10th day after the date the assessment of the penalty becomes final; or

[(F) fails to submit:

[(i) a plan of correction not later than the 10th day after the date the person receives a statement of licensing violations; or

[(ii) an acceptable plan of correction not later than the 30th day after the date the person receives notification from the department that the previously submitted plan of correction is not acceptable;

[(5) is a violation of Section 142.0145; or

[(6) involves the rights of the elderly under Chapter 102, Human Resources Code].

SECTION 4. Section 164.003(5), Health and Safety Code, as amended by S.B. No. 219, Acts of the 84th Legislature, Regular Session, 2015, is amended to read as follows:

(5) "Mental health facility" means:

(A) a "mental health facility" as defined by Section 571.003;

(B) a residential treatment facility, other than a mental health facility, in which persons are treated for emotional problems or disorders in a 24-hour supervised living environment; and

(C) a day activity and health services [an adult day-care] facility as defined by Section 103.003, Human Resources Code.

SECTION 5. (a) It is the intent of the legislature that Section 242.061, Health and Safety Code, as amended by this section, establish a ceiling or maximum number of violations related to the abuse and neglect of a resident that a facility can commit before the Department of Aging and Disability Services is required to revoke the facility's license. The changes in law made by this section are not intended to limit or diminish the department's permissive authority to revoke a license under Chapter 242, Health and Safety Code.

(b) Section 242.061, Health and Safety Code, is amended by amending Subsection (a) and adding Subsections (a-1), (a-2), (a-3), (c-1), and (e) to read as follows:

(a) In this section:

(1) "Abuse" has the meaning assigned by Section 260A.001.

(2) "Immediate threat to health and safety" means a situation in which immediate corrective action is necessary because the facility's noncompliance with one or more requirements has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident.

(3) "Neglect" has the meaning assigned by Section 260A.001.

(a-1) The department, after providing notice and opportunity for a hearing to the applicant or license holder, may deny, suspend, or revoke a license if the department finds that the applicant, the license holder, or any other person described by Section 242.032(d) has:

(1) violated this chapter or a rule, standard, or order adopted or license issued under this chapter in either a repeated or substantial manner;

(2) committed any act described by Sections 242.066(a)(2)-(6); or

(3) failed to comply with Section 242.074.

(a-2) Except as provided by Subsection (a-3) or (e), the department shall revoke a license under Subsection (a-1) if the department finds that:

(1) the license holder has committed three violations described by Subsection (a-1), within a 24-month period, that constitute an immediate threat to health and safety related to the abuse or neglect of a resident; and

(2) each of the violations described by Subdivision (1) are reported in connection with separate surveys, inspections, or investigation visits.

(a-3) The department may not revoke a license under Subsection (a-2) due to a violation described by Subsection (a-2)(1), if:

(1) the violation is not included on the written list of violations left with the facility at the time of the initial exit conference under Section 242.0445(b) for a survey, inspection, or investigation;

(2) the violation is not included on the final statement of violations described by Section 242.0445; or

(3) the violation has been reviewed under the informal dispute resolution process established by Section 531.058, Government Code, and a determination was made that:

(A) the violation should be removed from the license holder's record; or

(B) the violation is reduced in severity so that the violation is no longer cited as an immediate threat to health and safety related to the abuse or neglect of a resident.

(c-1) In the case of revocation of a license under Subsection (a-2), to ensure the health and safety of residents of the institution, the department may:

(1) request the appointment of a trustee to operate the institution under Subchapter D;

(2) obtain a new operator for the institution; or

(3) assist with the relocation of residents to another institution.

(e) The executive commissioner may waive a license revocation required by Subsection (a-2) if the executive commissioner determines that the waiver would not jeopardize the health and safety of the residents of the facility or place the residents at risk of abuse or neglect. The executive commissioner by rule shall establish criteria under which a waiver may be granted as provided by this subsection. The executive commissioner may provide a waiver for a veterans home, as defined by Section 164.002, Natural Resources Code, if the Veterans' Land Board contracts with a different entity to operate the veterans home than the entity that operated the home during the period in which the violations described by Subsection (a-2) occurred.

SECTION 6. Subchapter C, Chapter 242, Health and Safety Code, is amended by adding Section 242.0613 to read as follows:

Sec. 242.0613. PROGRESSIVE SANCTIONS. (a) The executive commissioner by rule shall create a matrix of progressive sanctions that the department must use to assess penalty amounts and impose disciplinary actions under this chapter appropriately and fairly for a violation of a law, rule, standard, or order adopted or license issued under this chapter or for a violation of other law for which this chapter provides a sanction.

(b) The matrix of progressive sanctions adopted under this section must provide for increases in amounts of administrative penalties based on type, frequency, and seriousness of violations and must provide guidance for determining appropriate and graduated administrative penalties to assess under this chapter to deter future violations, including guidance on considering the factors listed in this chapter for determining the amount of a penalty.

(c) The matrix of progressive sanctions adopted under this section must provide for imposing stronger sanctions, including license suspension or revocation, for more serious violations or for repeated violations as appropriate to deter future serious or repeated violations. The matrix of progressive sanctions must describe appropriate time frames to be used in determining whether a facility has committed repeated violations or has engaged in a pattern of repeated violations, such as repeated violations found in consecutive regular inspections.

SECTION 7. Section 242.0615(a), Health and Safety Code, is amended to read as follows:

(a) The department, after providing notice and opportunity for a hearing, may exclude a person from eligibility for a license under this chapter if the person or any person described by Section 242.032(d) has substantially failed to comply with this chapter and the rules adopted under this chapter. The authority granted by this subsection is in addition to the authority to deny issuance of a license under Section 242.061(a-1) [242.061(a)].

SECTION 8. Section 242.0665(b), Health and Safety Code, is amended to read as follows:

(b) The executive commissioner by rule shall define types of minor violations a facility may correct under Subsection (a) before the department may assess an administrative penalty. The executive commissioner shall ensure that all other violations are not subject to a right to correct [Subsection (a) does not apply:

[(1) to a violation that the department determines:

[(A) results in serious harm to or death of a resident;

[(B) constitutes a serious threat to the health or safety of a resident; or

[(C) substantially limits the institution's capacity to provide care;

[(2) to a violation described by Sections 242.066(a)(2)-(7);

[(3) to a violation of Section 260A.014 or 260A.015; or

[(4) to a violation of a right of a resident adopted under Subchapter L].

SECTION 9. Subchapter C, Chapter 247, Health and Safety Code, is amended by adding Section 247.0415 to read as follows:

Sec. 247.0415. PROGRESSIVE SANCTIONS. (a) The executive commissioner by rule shall create a matrix of progressive sanctions that the department must use to assess penalty amounts and impose disciplinary actions under this chapter appropriately and fairly for a violation of a law, rule, standard, or order adopted or license issued under this chapter or for a violation of other law for which this chapter provides a sanction.

(b) The matrix of progressive sanctions adopted under this section must provide for increases in amounts of administrative penalties based on type, frequency, and seriousness of violations and must provide guidance for determining appropriate and graduated administrative penalties to assess under this chapter to deter future violations, including guidance on considering the factors listed in this chapter for determining the amount of a penalty.

(c) The matrix of progressive sanctions adopted under this section must provide for imposing stronger sanctions, including license suspension or revocation, for more serious violations or for repeated violations as appropriate to deter future serious or repeated violations. The matrix of progressive sanctions must describe appropriate time frames to be used in determining whether an assisted living facility has committed repeated violations or has engaged in a pattern of repeated violations, such as repeated violations found in consecutive regular inspections.

SECTION 10. Section 247.0451(b), Health and Safety Code, is amended to read as follows:

(b) Except as provided by Section 247.0452(c), the penalty may not exceed $5,000 [$1,000] for each violation. Each day a violation occurs or continues is a separate violation for purposes of imposing a penalty.

SECTION 11. Section 247.0452(b), Health and Safety Code, is amended to read as follows:

(b) The executive commissioner by rule shall define the types of minor violations an assisted living facility may correct under Subsection (a) before the department may assess an administrative penalty. The executive commissioner shall ensure that all other violations are not subject to a right to correct [Subsection (a) does not apply:

[(1) to a violation that the department determines results in serious harm to or death of a resident;

[(2) to a violation described by Sections 247.0451(a)(2)-(7) or a violation of Section 260A.014 or 260A.015;

[(3) to a second or subsequent violation of:

[(A) a right of the same resident under Section 247.064; or

[(B) the same right of all residents under Section 247.064; or

[(4) to a violation described by Section 247.066, which contains its own right to correct provisions].

SECTION 12. Section 247.051(a), Health and Safety Code, as amended by S.B. No. 219, Acts of the 84th Legislature, Regular Session, 2015, is amended to read as follows:

(a) The executive commissioner by rule shall establish an informal dispute resolution process to address disputes between a facility and the department concerning a statement of violations prepared by the department in accordance with this section. The process must provide for adjudication by an appropriate disinterested person of disputes relating to a statement of violations. The informal dispute resolution process must require:

(1) the assisted living facility to request informal dispute resolution not later than the 10th day after the date of notification by the department of the violation of a standard or standards;

(2) that the [commission to complete the] process be completed not later than the 90th day after the date of receipt of a request from the assisted living facility for informal dispute resolution;

(3) that, not later than the 10th business day after the date an assisted living facility requests an informal dispute resolution, the department forward to the assisted living facility a copy of all information that is referred to in the disputed statement of violations or on which a citation is based in connection with the survey, inspection, investigation, or other visit, excluding:

(A) the name of any complainant, witness, or informant;

(B) any information that would reasonably lead to the identification of a complainant, witness, or informant;

(C) information obtained from or contained in the records of the facility;

(D) information that is publicly available; or

(E) information that is confidential by law;

(4) that [the commission to give] full consideration is given to all [factual] arguments raised during the informal dispute resolution process that:

(A) are supported by references to specific information that the facility or department relies on to dispute or support findings in the statement of violations; and

(B) are provided by the proponent of the argument [to the commission] and the opposing party;

(5) that full consideration is given during the informal dispute resolution process [staff give full consideration] to the information provided by the assisted living facility and the department;

(6) that ex parte communications concerning the substance of any argument relating to a survey, inspection, investigation, visit, or statement of violations under consideration not occur between the informal dispute resolution staff and the assisted living facility or the department; and

(7) that the assisted living facility and the department be given a reasonable opportunity to submit arguments and information supporting the position of the assisted living facility or the department and to respond to arguments and information presented against them.

SECTION 13. Section 250.001(3), Health and Safety Code, as amended by S.B. No. 219, Acts of the 84th Legislature, Regular Session, 2015, is amended to read as follows:

(3) "Facility" means:

(A) a nursing facility, custodial care home, or other institution licensed by the Department of Aging and Disability Services under Chapter 242;

(B) an assisted living facility licensed by the Department of Aging and Disability Services under Chapter 247;

(C) a home and community support services agency licensed under Chapter 142;

(D) a day activity and health services [an adult day care] facility licensed by the Department of Aging and Disability Services under Chapter 103, Human Resources Code;

(E) an ICF-IID licensed under Chapter 252;

(F) an adult foster care provider that contracts with the Department of Aging and Disability Services;

(G) a facility that provides mental health services and that is operated by or contracts with the Department of State Health Services;

(H) a local mental health authority designated under Section 533.035 or a local intellectual and developmental disability authority designated under Section 533.035;

(I) a person exempt from licensing under Section 142.003(a)(19);

(J) a special care facility licensed by the Department of State Health Services under Chapter 248;

(K) a mental health service unit of a hospital licensed under Chapter 241; or

(L) a prescribed pediatric extended care center licensed by the Department of Aging and Disability Services under Chapter 248A.

SECTION 14. Subchapter C, Chapter 252, Health and Safety Code, is amended by adding Section 252.0615 to read as follows:

Sec. 252.0615. PROGRESSIVE SANCTIONS. (a) The executive commissioner by rule shall create a matrix of progressive sanctions that the department must use to assess penalty amounts and impose disciplinary actions under this chapter appropriately and fairly for a violation of a law, rule, standard, or order adopted or license issued under this chapter or for a violation of other law for which this chapter provides a sanction.

(b) The matrix of progressive sanctions adopted under this section must provide for increases in amounts of administrative penalties based on type, frequency, and seriousness of violations and must provide guidance for determining appropriate and graduated administrative penalties to assess under this chapter to deter future violations, including guidance on considering the factors listed in this chapter for determining the amount of a penalty.

(c) The matrix of progressive sanctions adopted under this section must provide for imposing stronger sanctions, including license suspension or revocation, for more serious violations or for repeated violations as appropriate to deter future serious or repeated violations. The matrix of progressive sanctions must describe appropriate time frames to be used in determining whether a facility has committed repeated violations or has engaged in a pattern of repeated violations, such as repeated violations found in consecutive regular inspections.

SECTION 15. Section 252.065, Health and Safety Code, is amended by amending Subsection (b) and Subsection (e), as amended by S.B. 219, Acts of the 84th Legislature, Regular Session, 2015, to read as follows:

(b) The penalty for a facility with fewer than 60 beds shall be not less than $100 or more than $1,000 for each violation. The penalty for a facility with 60 beds or more shall be not less than $100 or more than $5,000 for each violation. [The total amount of the penalty assessed for a violation continuing or occurring on separate days under this subsection may not exceed $5,000 for a facility with fewer than 60 beds or $25,000 for a facility with 60 beds or more.] Each day a violation occurs or continues is a separate violation for purposes of imposing a penalty.

(e) The executive commissioner by rule shall provide the facility with a reasonable period of time, not less than 45 days, following the first day of a violation to correct the violation before the department may assess an administrative penalty if a plan of correction has been implemented. The executive commissioner by rule shall define the types of minor violations a facility may correct before the department may assess an administrative penalty. The executive commissioner shall ensure that all other violations are not subject to a right to correct [This subsection does not apply to a violation described by Subsections (a)(2)-(8) or to a violation that the department determines:

[(1) has resulted in serious harm to or the death of a resident;

[(2) constitutes a serious threat to the health or safety of a resident; or

[(3) substantially limits the institution's capacity to provide care].

SECTION 16. Section 255.003, Health and Safety Code, is amended by amending Subsections (b), (e), and (j) and adding Subsections (b-1) and (i-1) to read as follows:

(b) Monitoring [Priority for monitoring] visits shall be given to long-term care facilities:

(1) with a history of patient care deficiencies; or

(2) that are identified as medium risk through the department's early warning system.

(b-1) A long-term care facility may request a monitoring visit under this section.

(e) Quality-of-care monitors shall assess:

(1) the overall quality of life in the long-term care facility; and

(2) specific conditions in the facility directly related to patient care, including conditions identified through the long-term care facility's quality measure reports based on Minimum Data Set Resident Assessments.

(i-1) The department shall schedule a follow-up visit not later than the 45th day after the date of an initial monitoring visit conducted under this section.

(j) Conditions observed by the quality-of-care monitor that create an immediate threat to the health or safety of a resident shall be reported immediately to the long-term care facility administrator, to the regional office supervisor for appropriate action, and, as appropriate or as required by law, to law enforcement, adult protective services, other divisions of the department, or other responsible agencies.

SECTION 17. Section 255.004, Health and Safety Code, is amended by amending Subsection (a) and adding Subsections (a-1) and (a-2) to read as follows:

(a) In this section:

(1) "Abuse" has the meaning assigned by Section 260A.001.

(2) "Immediate threat to health and safety" means a situation in which immediate corrective action is necessary because the facility's noncompliance with one or more requirements has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident.

(3) "Neglect" has the meaning assigned by Section 260A.001.

(a-1) The department shall create rapid response teams composed of health care experts that can visit a long-term care facility that:

(1) is [facilities] identified as high risk through the department's early warning system; or

(2) if the long-term care facility is a nursing institution, has committed three violations described by Section 242.061(a-1), within a 24-month period, that constitute an immediate threat to health and safety related to the abuse or neglect of a resident.

(a-2) A long-term care facility shall cooperate with a rapid response team deployed under this section to improve the quality of care provided at the facility.

SECTION 18. Subchapter B, Chapter 533A, Health and Safety Code, as added by S.B. 219, Acts of the 84th Legislature, Regular Session, 2015, is amended by adding Section 533A.044 to read as follows:

Sec. 533A.044. CRISIS INTERVENTION TEAMS. (a) In this section, "crisis intervention team" means a team of individuals specially trained to provide services and support to persons with an intellectual or developmental disability who have behavioral health needs and who are at risk of institutionalization.

(b) The department shall evaluate the effectiveness of various models of crisis intervention teams that are funded under a waiver under Section 1115 of the federal Social Security Act (42 U.S.C. Section 1315) and operated by a local intellectual and developmental disability authority.

(c) Not later than March 1, 2016, the department shall select for implementation one or more models for crisis intervention teams the department determines best provide comprehensive, cost-effective support.

(d) The department shall determine the areas in this state in which local intellectual and developmental disability authorities do not operate crisis intervention teams and, subject to available funding, shall implement in each area a team that operates in accordance with a model selected for implementation under this section.

SECTION 19. Chapter 555, Health and Safety Code, is amended by adding Subchapter F to read as follows:

SUBCHAPTER F. STATE SUPPORTED LIVING CENTER RESTRUCTURING AND

CLOSURES

Sec. 555.201. STATE SUPPORTED LIVING CENTER RESTRUCTURING COMMISSION. (a) In this subchapter, "restructuring commission" means the state supported living center restructuring commission.

(b) The restructuring commission consists of five members appointed by the governor and the following three nonvoting ex officio members:

(1) the executive commissioner or the executive commissioner's designee;

(2) the executive director of the Texas Facilities Commission or the executive director's designee; and

(3) the commissioner of the General Land Office or the commissioner's designee.

(c) The restructuring commission is established to evaluate each state supported living center in the state to determine whether closure of the center is recommended to maintain only the number of centers necessary to meet the level of need in the state. In evaluating each state supported living center, the restructuring commission shall consider:

(1) the quality of services provided by the center, including the center's most recent certification inspections and the center's ability to meet the minimum ICF-IID standards;

(2) the costs of operating the center;

(3) the center's compliance with the 2009 settlement agreement between the department and the United States Department of Justice regarding services provided to individuals with an intellectual or developmental disability in state-operated facilities;

(4) the availability of community service providers in the area served by the center;

(5) the specialty services provided at the center, including the ability of the center to serve alleged offenders or high-risk residents;

(6) the availability of employment opportunities for center employees if the center closes;

(7) any infrastructure deficiency costs relating to the center;

(8) the property value of, the market demand for, and any deed restrictions applicable to property and facilities of the center;

(9) whether closure of the center would adversely affect the geographic distribution of centers in the state;

(10) the availability and capacity of service providers and resources in the community capable of delivering the quality and level of care each resident of the center would require following the center's closure; and

(11) any other criteria the restructuring commission considers appropriate.

(d) Not later than December 1, 2016, the restructuring commission shall submit to the governor, the lieutenant governor, the speaker of the house of representatives, and the presiding officers of the standing committees of the senate and house of representatives having primary jurisdiction over intellectual and developmental disability issues a report detailing the restructuring commission's evaluation of each state supported living center and, if applicable, proposing the closure of certain centers.

(e) A member of the restructuring commission may not:

(1) have a direct or indirect interest in any contract or proposed contract with a licensed provider of ICF-IID services, or other provider of services to individuals with an intellectual or developmental disability;

(2) acquire a direct or indirect pecuniary interest in any provider of ICF-IID services, or other provider of services to individuals with an intellectual or developmental disability; or

(3) have a financial interest in the closure of a state supported living center.

(f) The restructuring commission is abolished and this section expires January 1, 2017.

Sec. 555.202. RECOMMENDED CLOSURES OF STATE SUPPORTED LIVING CENTERS. (a) If the restructuring commission proposes the closure of one or more state supported living centers, the 85th Legislature shall consider legislation proposing the closure of the centers recommended for closure. In considering the proposed legislation described by this subsection, members of the legislature may not propose amendments to the legislation.

(b) If the legislation described by Subsection (a) is enacted and becomes law, the department shall ensure that each state supported living center approved by the legislature for closure under Subsection (a) is closed not later than August 31, 2025.

(c) This subchapter expires September 1, 2025.

Sec. 555.203. CLOSURE OF AUSTIN STATE SUPPORTED LIVING CENTER. (a) The department shall establish a closure plan for the Austin State Supported Living Center. The plan must provide for closure of the facility and operations of the Austin State Supported Living Center not later than August 31, 2017.

(b) The closure plan must provide procedures to transition to the community each resident for whom:

(1) the resident's care team recommends a community placement;

(2) a community placement is available for the resident; and

(3) a community placement is the choice of the resident.

(c) The department may award one-time retention bonuses to each direct support professional, qualified intellectual disability professional, social worker, and case manager who agrees to continue to provide services at the Austin State Supported Living Center until the center is closed.

(d) The proceeds from the closure, including from the sale or lease of facilities or other property, may be appropriated only for services for persons with an intellectual or developmental disability, including persons with a dual diagnosis of an intellectual or developmental disability and mental illness.

(e) Not later than August 31, 2018, the department shall evaluate the closure process, including how well the closure plan worked, and, if appropriate, establish policies for improving the closure process for future closures of other state supported living centers.

(f) This section expires September 1, 2018.

SECTION 20. Section 531.0318, Government Code, is amended by adding Subsections (b-1), (d), and (e) to read as follows:

(b-1) The information for consumers required by this section must include for each provider of long-term care services:

(1) a rating assigned by the Department of Aging and Disability Services indicating the quality of the care provided or, alternatively, a link to a rating assigned a provider on an Internet website maintained by the federal government;

(2) information concerning quality of care, as that information becomes available;

(3) staffing information, if available, including for each year the number of staff members who began employment with the provider during that year and the number of staff members who ceased employment with the provider during that year;

(4) the ratio of staff members to residents; and

(5) the provider's regulatory performance, as available.

(d) The Department of Aging and Disability Services shall immediately post notice on the department's Internet website when a provider of long-term care services loses its Medicaid certification.

(e) The Department of Aging and Disability Services shall periodically solicit input regarding the content of the information required under this section and the usability and accessibility of the website on which the information is located from consumers, consumer advocates, long-term care services providers, and the general public.

SECTION 21. Section 531.058(a), Government Code, as amended by S.B. No. 219, Acts of the 84th Legislature, Regular Session, 2015, and Section 531.058(c), Government Code, are amended to read as follows:

(a) The executive commissioner by rule shall establish an informal dispute resolution process in accordance with this section. The process must provide for adjudication by an appropriate disinterested person of disputes relating to a proposed enforcement action or related proceeding of the commission under Section 32.021(d), Human Resources Code, or the Department of Aging and Disability Services under Chapter 242, 247, or 252, Health and Safety Code. The informal dispute resolution process must require:

(1) an institution or facility to request informal dispute resolution not later than the 10th calendar day after notification by the commission or department, as applicable, of the violation of a standard or standards; and

(2) the completion of [commission to complete] the process not later than:

(A) the 30th calendar day after receipt of a request from an institution or facility, other than an assisted living facility, for informal dispute resolution; or

(B) the 90th calendar day after receipt of a request from an assisted living facility for informal dispute resolution.

(c) The commission may not delegate its responsibility to administer the informal dispute resolution process established by this section to another state agency. This section does not apply to the informal dispute resolution process established by Section 247.051, Health and Safety Code, applicable to assisted living facilities licensed under Chapter 247, Health and Safety Code.

SECTION 22. Section 531.058, Government Code, is amended by adding Subsection (a-1) to read as follows:

(a-1) As part of the informal dispute resolution process established under this section, the commission shall contract with an appropriate disinterested person who is a nonprofit organization to adjudicate disputes between an institution or facility licensed under Chapter 242, Health and Safety Code, and the Department of Aging and Disability Services concerning a statement of violations prepared by the department in connection with a survey conducted by the department of the institution or facility. Section 2009.053 does not apply to the selection of an appropriate disinterested person under this subsection. The person with whom the commission contracts shall adjudicate all disputes described by this subsection.

SECTION 23. Section 531.951(a), Government Code, is amended to read as follows:

(a) This subchapter applies only to the final licensing, listing, or registration decisions of a health and human services agency with respect to a person under the law authorizing the agency to regulate the following types of persons:

(1) a youth camp licensed under Chapter 141, Health and Safety Code;

(2) a home and community support services agency licensed under Chapter 142, Health and Safety Code;

(3) a hospital licensed under Chapter 241, Health and Safety Code;

(4) an institution licensed under Chapter 242, Health and Safety Code;

(5) an assisted living facility licensed under Chapter 247, Health and Safety Code;

(6) a special care facility licensed under Chapter 248, Health and Safety Code;

(7) an intermediate care facility licensed under Chapter 252, Health and Safety Code;

(8) a chemical dependency treatment facility licensed under Chapter 464, Health and Safety Code;

(9) a mental hospital or mental health facility licensed under Chapter 577, Health and Safety Code;

(10) a child-care facility or child-placing agency licensed under or a family home listed or registered under Chapter 42, Human Resources Code; or

(11) a day activity and health services [an adult day-care] facility licensed under Chapter 103, Human Resources Code.

SECTION 24. Subchapter D, Chapter 48, Human Resources Code, is amended by adding Section 48.15221 to read as follows:

Sec. 48.15221. REPORTS CONCERNING DAY HABILITATION SERVICES PROVIDERS. (a) In this section, "day habilitation services" and "day habilitation services provider" have the meanings assigned by Section 161.401.

(b) The department shall prepare and submit to the Department of Aging and Disability Services an annual report of the number of investigations arising from a report of abuse, neglect, or exploitation of a person with an intellectual or developmental disability that was allegedly committed by or on the premises of a day habilitation services provider, and whether the investigation concluded that the report of alleged abuse, neglect, or exploitation was confirmed, unconfirmed, inconclusive, or unfounded.

(c) The duty to prepare and submit a report under Subsection (b) does not affect the duty of the department to investigate and hold accountable a community-based intellectual and developmental disabilities services provider or intermediate care facility for any abuse, neglect, or exploitation of a person who receives day habilitation services from the provider.

SECTION 25. The heading to Chapter 103, Human Resources Code, is amended to read as follows:

CHAPTER 103. DAY ACTIVITY AND HEALTH SERVICES PROGRAMS [ADULT DAY

CARE]

SECTION 26. Section 103.001, Human Resources Code, as amended by S.B. No. 219, Acts of the 84th Legislature, Regular Session, 2015, is amended to read as follows:

Sec. 103.001. PURPOSE. It is the purpose of this chapter to establish programs of quality day activity and health services [adult day care and day health care] that will enable persons with disabilities who have medical or functional impairments and elderly persons to maintain maximum independence and to prevent premature or inappropriate institutionalization. It is the purpose of this chapter to provide adequately regulated supervision for elderly persons and persons with disabilities while enabling them to remain in a family environment and affording the family a measure of normality in its daily activities. The legislature intends to provide for the development of policies and programs that will:

(1) provide alternatives to institutionalization;

(2) establish facilities for day activity and health services programs [adult day care and day health care] throughout the state that offer services and are accessible to economically disadvantaged persons; and

(3) prevent inappropriate institutionalization.

SECTION 27. Section 103.002, Human Resources Code, is amended to read as follows:

Sec. 103.002. SHORT TITLE. This chapter may be cited as the Day Activity and Health Services [Adult Day Care] Act.

SECTION 28. Section 103.003(1), Human Resources Code, as amended by S.B. No. 219, Acts of the 84th Legislature, Regular Session, 2015, is amended to read as follows:

(1) "Day activity and health services facility" ["Adult day-care facility"] means a facility that provides services under a day activity and health services [an adult day-care] program on a daily or regular basis but not overnight to four or more elderly persons or persons with disabilities who are not related by blood, marriage, or adoption to the owner of the facility.

SECTION 29. Section 103.003(2), Human Resources Code, is amended to read as follows:

(2) "Day activity and health services program" ["Adult day-care program"] means a structured, comprehensive program that is designed to meet the needs of adults with functional impairments through an individual plan of care by providing health, social, and related support services in a protective setting.

SECTION 30. Section 103.0041(a), Human Resources Code, is amended to read as follows:

(a) A person may not operate a day activity and health services [an adult day-care] facility without a license issued under this chapter.

SECTION 31. Section 103.006(a), Human Resources Code, is amended to read as follows:

(a) The department shall issue a license to operate a day activity and health services [an adult day-care] facility to a person who has met the application requirements and received approval after an on-site inspection.

SECTION 32. Section 103.007(a), Human Resources Code, is amended to read as follows:

(a) An applicant for a license to operate a day activity and health services [an adult day-care] facility must file an application on a form prescribed by the department together with a license fee of $50.

SECTION 33. Section 103.0075(a), Human Resources Code, as amended by S.B. No. 219, Acts of the 84th Legislature, Regular Session, 2015, is amended to read as follows:

(a) The executive commissioner by rule shall adopt a procedure under which a person proposing to construct or modify a day activity and health services [an adult day-care] facility may submit building plans to the department for review for compliance with the department's architectural requirements before beginning construction or modification. In adopting the procedure, the executive commissioner shall set reasonable deadlines by which the department must complete review of submitted plans.

SECTION 34. Chapter 103, Human Resources Code, is amended by adding Section 103.0085 to read as follows:

Sec. 103.0085. PROGRESSIVE SANCTIONS. (a) The executive commissioner by rule shall create a matrix of progressive sanctions that the department must use to assess penalty amounts and impose disciplinary actions under this chapter appropriately and fairly for a violation of a law, rule, standard, or order adopted or license issued under this chapter or for a violation of other law for which this chapter provides a sanction.

(b) The matrix of progressive sanctions adopted under this section must provide for increases in amounts of administrative penalties based on type, frequency, and seriousness of violations and must provide guidance for determining appropriate and graduated administrative penalties to assess under this chapter to deter future violations, including guidance on considering the factors listed in this chapter for determining the amount of a penalty.

(c) The matrix of progressive sanctions adopted under this section must provide for imposing stronger sanctions, including license suspension or revocation, for more serious violations or for repeated violations as appropriate to deter future serious or repeated violations. The matrix of progressive sanctions must describe appropriate time frames to be used in determining whether a day activity and health services facility has committed repeated violations or has engaged in a pattern of repeated violations, such as repeated violations found in consecutive regular inspections.

SECTION 35. Section 103.0091(a), Human Resources Code, is amended to read as follows:

(a) The department may petition a district court for a temporary restraining order to restrain a continuing violation of the standards or licensing requirements provided under this chapter if the department finds that the violation creates an immediate threat to the health and safety of the day activity and health services facility [adult day-care] residents.

SECTION 36. Section 103.0092(a), Human Resources Code, is amended to read as follows:

(a) If the department finds a day activity and health services [an adult day-care] facility operating in violation of the standards prescribed by this chapter and the violations create an immediate threat to the health and safety of a resident in the facility, the department shall suspend the license or order immediate closing of all or part of the facility.

SECTION 37. Section 103.011, Human Resources Code, is amended to read as follows:

Sec. 103.011. RIGHTS OF THE ELDERLY. (a) In addition to other rights an individual attending a day activity and health services [an adult day care] facility has as a citizen, an individual who is 55 years of age or older has the rights prescribed by Chapter 102 of this code.

(b) The department shall require each day activity and health services [adult day care] facility to implement and enforce the applicable provisions of Chapter 102 of this code.

SECTION 38. Section 103.012(a), Human Resources Code, is amended to read as follows:

(a) The department may assess an administrative penalty against a person who:

(1) violates this chapter, a rule, standard, or order adopted under this chapter, or a term of a license issued under this chapter;

(2) makes a false statement of a material fact that the person knows or should know is false:

(A) on an application for issuance or renewal of a license or in an attachment to the application; or

(B) with respect to a matter under investigation by the department;

(3) refuses to allow a representative of the department to inspect:

(A) a book, record, or file required to be maintained by a day activity and health services [an adult day-care] facility; or

(B) any portion of the premises of a day activity and health services [an adult day-care] facility;

(4) wilfully interferes with the work of a representative of the department or the enforcement of this chapter;

(5) wilfully interferes with a representative of the department preserving evidence of a violation of this chapter, a rule, standard, or order adopted under this chapter, or a term of a license issued under this chapter;

(6) fails to pay a penalty assessed under this chapter not later than the 30th day after the date the assessment of the penalty becomes final; or

(7) fails to notify the department of a change of ownership before the effective date of the change of ownership.

SECTION 39. Section 103.013, Human Resources Code, is amended to read as follows:

Sec. 103.013. RIGHT TO CORRECT BEFORE IMPOSITION OF ADMINISTRATIVE PENALTY. (a) The department may not collect an administrative penalty from a day activity and health services [an adult day-care] facility under Section 103.012 if, not later than the 45th day after the date the facility receives notice under Section 103.014(c), the facility corrects the violation.

(b) The executive commissioner of the Health and Human Services Commission by rule shall define types of minor violations a day activity and health services facility may correct under Subsection (a) before assessing an administrative penalty. The executive commissioner shall ensure that all other violations are not subject to a right to correct [Subsection (a) does not apply to:

[(1) a violation that the department determines:

[(A) results in serious harm to or death of a person attending the facility;

[(B) constitutes a serious threat to the health and safety of a person attending the facility; or

[(C) substantially limits the facility's capacity to provide care;

[(2) a violation described by Sections 103.012(a)(2)-(7); or

[(3) a violation of Section 103.011].

(c) A day activity and health services [An adult day-care] facility that corrects a violation must maintain the correction. If the facility fails to maintain the correction until at least the first anniversary after the date the correction was made, the department may assess and collect an administrative penalty for the subsequent violation. An administrative penalty assessed under this subsection is equal to three times the amount of the original penalty assessed but not collected. The department is not required to provide the facility with an opportunity under this section to correct the subsequent violation.

SECTION 40. Sections 103.014(c) and (e), Human Resources Code, are amended to read as follows:

(c) The department shall give written notice of the report to the person charged with the violation not later than the 10th day after the date on which the report is issued. The notice must include:

(1) a brief summary of the charges;

(2) a statement of the amount of penalty recommended;

(3) a statement of whether the violation is subject to correction under Section 103.013 and, if the violation is subject to correction under that section, a statement of:

(A) the date on which the day activity and health services [adult day-care] facility must file a plan of correction with the department that the department shall review and may approve, if satisfactory; and

(B) the date on which the plan of correction must be completed to avoid assessment of the penalty; and

(4) a statement that the person charged has a right to a hearing on the occurrence of the violation, the amount of the penalty, or both.

(e) If the violation is subject to correction under Section 103.013, the day activity and health services [adult day-care] facility shall submit a plan of correction to the department for approval not later than the 10th day after the date on which the notice under Subsection (c) is received.

SECTION 41. Section 161.080, Human Resources Code, is amended by adding Subsection (c) to read as follows:

(c) The executive commissioner by rule shall establish a list of services a state supported living center may provide under a contract described by Subsection (a) and a schedule of fees the state supported living center may charge for those services. In establishing the schedule of fees for services, the executive commissioner shall use the reimbursement rate for the applicable service under the Medicaid program.

SECTION 42. Chapter 161, Human Resources Code, is amended by adding Subchapter J to read as follows:

SUBCHAPTER J. POWERS AND DUTIES RELATING TO DAY HABILITATION

SERVICES PROVIDERS

Sec. 161.401. DEFINITIONS. In this subchapter:

(1) "Day habilitation services" means services to assist persons with an intellectual or developmental disability in acquiring, retaining, and improving the self-help, socialization, and adaptive skills necessary to reside successfully in the community, including prevocational, educational, and supported employment services.

(2) "Day habilitation services provider" means a person who contracts with a community-based intellectual and developmental disabilities services provider or intermediate care facility to provide federally funded Medicaid day habilitation services authorized under Section 1915(c) of the federal Social Security Act (42 U.S.C. Section 1396n(c)).

Sec. 161.402. DAY HABILITATION SERVICES PROVIDER INFORMATION TRACKING. (a) Each community-based intellectual and developmental disabilities services provider and intermediate care facility shall annually submit to the department a report providing:

(1) an estimate of the number of clients receiving day habilitation services for each month of that year;

(2) the physical address of each day habilitation services provider that provided those services;

(3) the services provided to those clients; and

(4) an estimate of monthly expenditures for the provision of those services to those clients.

(b) The department shall maintain information obtained during a department inspection of a day habilitation services provider concerning conduct or conditions that would constitute a violation of federal or state law or of department rules applicable to the community-based intellectual and developmental disabilities services provider or intermediate care facility with which the day habilitation services provider contracts.

(c) The department shall maintain information concerning an investigation of abuse, neglect, or exploitation concerning a day habilitation services provider that the department receives from the Department of Family and Protective Services under Section 48.15221.

Sec. 161.403. DAY HABILITATION PROGRAM ADVISORY COMMITTEE. (a) Not later than September 1, 2015, the department shall establish a day habilitation program advisory committee composed of members that represent community-based waiver providers, owners of day habilitation services providers, and advocates for persons with an intellectual or developmental disability.

(b) The day habilitation program advisory committee shall consider and make recommendations concerning whether the provision of day habilitation services in this state should be redesigned and whether day habilitation services providers should be subject to regulation, including by licensure or certification.

(c) In considering the redesign of the provision of day habilitation services in this state, the day habilitation program advisory committee shall examine whether day habilitation service providers currently comply with the requirements of 42 C.F.R. Section 441.301.

(d) The day habilitation program advisory committee shall also consider and make recommendations concerning issues relevant to the provision of day habilitation services, including the appropriate funding for services, reimbursable settings and services, staff-to-client ratio requirements, safety requirements, and other required or applicable standards.

(e) Not later than September 1, 2016, the day habilitation program advisory committee shall submit to the governor, the lieutenant governor, the speaker of the house of representatives, and the presiding officers of the standing committees of the senate and house of representatives having primary jurisdiction over intellectual and developmental disability issues a report containing the committee's recommendations concerning the redesign of the provision of day habilitation services in this state and the necessity for regulation, licensure, or certification of day habilitation services providers.

(f) The day habilitation program advisory committee is abolished and this section expires December 31, 2016.

SECTION 43. Section 247.051(b), Health and Safety Code, is repealed.

SECTION 44. Section 101A.158, Human Resources Code, as added by S.B. 219, Acts of the 84th Legislature, Regular Session, 2015, is repealed.

SECTION 45. (a) Not later than September 1, 2016, the executive commissioner of the Health and Human Services Commission shall adopt by rule the matrices of progressive sanctions required by Sections 142.0125, 242.0613, 247.0415, and 252.0615, Health and Safety Code, and Section 103.0085, Human Resources Code, as added by this Act.

(b) Not later than September 1, 2015, the governor shall appoint five members of the state supported living center restructuring commission, as required by Section 555.201, Health and Safety Code, as added by this Act.

(c) Not later than September 1, 2016, the executive commissioner of the Health and Human Services Commission shall adopt the rule listing services a state supported living center may provide under a contract and the schedule of fees for those services as required by Section 161.080, Human Resources Code, as amended by this Act.

SECTION 46. (a) As soon as possible after the effective date of this Act, the Department of Aging and Disability Services or the Health and Human Services Commission, as appropriate, shall apply for any waiver or other authorization from a federal agency that is necessary to implement this Act. The department and commission may delay implementing this Act until the waiver or authorization is granted.

(b) As soon as practicable after the effective date of this Act:

(1) the executive commissioner of the Health and Human Services Commission shall adopt the rules necessary to implement Section 531.058(a-1), Government Code, as added by this Act; and

(2) the Department of Aging and Disability Services and the Health and Human Services Commission shall, as appropriate, revise or enter into a memorandum of understanding as required by a federal agency that is necessary to implement Section 531.058(a-1), Government Code, as added by this Act.

SECTION 47. Sections 242.061(a-2) and (a-3), Health and Safety Code, as added by this Act, apply only to a violation committed on or after September 1, 2016. A violation committed before September 1, 2016, is governed by the law in effect on the date the violation was committed, and the former law is continued in effect for that purpose. For purposes of this section, a violation was committed before September 1, 2016, if any element of the violation occurred before that date.

SECTION 48. (a) Except as provided by Subsection (b) of this section, this Act takes effect immediately if it receives a vote of two-thirds of all the members elected to each house, as provided by Section 39, Article III, Texas Constitution. If this Act does not receive the vote necessary for immediate effect, this Act takes effect September 1, 2015.

(b) Sections 242.061(a-2) and (a-3), Health and Safety Code, as added by this Act, take effect September 1, 2016.