By: Noble (Senate Sponsor - Miles) H.B. No. 4696
         (In the Senate - Received from the House May 3, 2023;
  May 5, 2023, read first time and referred to Committee on Health &
  Human Services; May 21, 2023, reported adversely, with favorable
  Committee Substitute by the following vote:  Yeas 8, Nays 0;
  May 21, 2023, sent to printer.)
Click here to see the committee vote
 
  COMMITTEE SUBSTITUTE FOR H.B. No. 4696 By:  Miles
 
 
 
  COMMITTEE VOTE
 
 
         YeaNayAbsentPNV
         KolkhorstX
         PerryX
         BlancoX
         HallX
         HancockX
         HughesX
         LaMantiaX
         MilesX
         SparksX
 
 
A BILL TO BE ENTITLED
 
AN ACT
 
  relating to the reporting and investigation of certain allegations
  of abuse, neglect, and exploitation, the making and investigation
  of complaints alleging violations of certain health facility
  licensing requirements, and the content of the employee misconduct
  registry.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 261.005, Family Code, is amended to read
  as follows:
         Sec. 261.005.  REFERENCE TO EXECUTIVE COMMISSIONER OR
  COMMISSION.  Unless otherwise provided by a provision of this
  chapter, in [In] this chapter:
               (1)  a reference to the executive commissioner or the
  executive commissioner of the Health and Human Services Commission
  means the commissioner of the department; and
               (2)  a reference to the Health and Human Services
  Commission means the department.
         SECTION 2.  Section 261.105(c-1), Family Code, is amended to
  read as follows:
         (c-1)  Notwithstanding Subsections (b) and (c), if a report
  under this section relates to a child with an intellectual
  disability receiving services in a state supported living center as
  defined by Section 531.002, Health and Safety Code, or the ICF-IID
  component of the Rio Grande State Center, the department shall
  immediately notify the commission and the commission shall proceed
  with the investigation of the report as provided by Section
  261.404. Notwithstanding Section 261.005, in this subsection,
  "commission" means the Health and Human Services Commission.
         SECTION 3.  Section 261.404, Family Code, is amended by
  amending Subsections (a), (a-1), (a-2), (a-3), (b), (c), and (d)
  and adding Subsection (a-4) to read as follows:
         (a)  Notwithstanding Section 261.005, in this section:
               (1)  "Commission" means the Health and Human Services
  Commission.
               (2)  "Executive commissioner" means the executive
  commissioner of the Health and Human Services Commission.
         (a-1)  The commission [department] shall investigate a
  report of abuse, neglect, or exploitation of a child receiving
  services from a provider, as those terms are defined by Section
  48.251, Human Resources Code, or as otherwise defined by rule.  The
  commission [department] shall also investigate, under Subchapter
  F, Chapter 48, Human Resources Code, a report of abuse, neglect, or
  exploitation of a child receiving services from an officer,
  employee, agent, contractor, or subcontractor of a home and
  community support services agency licensed under Chapter 142,
  Health and Safety Code, if the officer, employee, agent,
  contractor, or subcontractor is or may be the person alleged to have
  committed the abuse, neglect, or exploitation.
         (a-2) [(a-1)]  For an investigation of a child living in a
  residence owned, operated, or controlled by a provider of services
  under the home and community-based services waiver program
  described by Section 534.001(11)(B), Government Code, the
  department, in accordance with Subchapter E, Chapter 48, Human
  Resources Code, may provide emergency protective services
  necessary to immediately protect the child from serious physical
  harm or death and, if necessary, obtain an emergency order for
  protective services under Section 48.208, Human Resources Code.
         (a-3) [(a-2)]  For an investigation of a child living in a
  residence owned, operated, or controlled by a provider of services
  under the home and community-based services waiver program
  described by Section 534.001(11)(B), Government Code, regardless
  of whether the child is receiving services under that waiver
  program from the provider, the department shall provide protective
  services to the child in accordance with Subchapter E, Chapter 48,
  Human Resources Code.
         (a-4) [(a-3)]  For purposes of this section, Subchapters E
  and F, Chapter 48, Human Resources Code, apply to an investigation
  of a child and to the provision of protective services to that child
  in the same manner those subchapters apply to an investigation of an
  elderly person or person with a disability and the provision of
  protective services to that person.
         (b)  The commission [department] shall investigate a [the]
  report under this section under rules developed by the executive
  commissioner.
         (c)  If a report under this section relates to a child with an
  intellectual disability receiving services in a state supported
  living center or the ICF-IID component of the Rio Grande State
  Center, the commission [department] shall, within 24 hours [one
  hour] of receiving the report, notify the facility in which the
  child is receiving services of the allegations in the report.
         (d)  If, during the course of the commission's [department's]
  investigation of reported abuse, neglect, or exploitation, a
  caseworker of the commission [department] or the caseworker's
  supervisor has cause to believe that a child with an intellectual
  disability described by Subsection (c) has been abused, neglected,
  or exploited by another person in a manner that constitutes a
  criminal offense under any law, including Section 22.04, Penal
  Code, the caseworker shall immediately notify the commission's
  [Health and Human Services Commission's] office of inspector
  general and promptly provide the commission's office of inspector
  general with a copy of the commission's [department's]
  investigation report.
         SECTION 4.  Section 142.009(j), Health and Safety Code, is
  amended to read as follows:
         (j)  Except as provided by Subsections (h) and (l), a [an
  on-site] survey may [must] be conducted within 18 months after a
  survey for an initial license. After that time, an on-site survey
  must be conducted at least every 36 months.
         SECTION 5.  Section 142.018(b), Health and Safety Code, is
  amended to read as follows:
         (b)  A home and community support services agency that has
  cause to believe that a person receiving services from the agency
  has been abused, exploited, or neglected by an employee of the
  agency shall report the information to[:
               [(1)]  the commission [department; and
               [(2)  the Department of Family and Protective Services
  or other appropriate state agency as required by Section 48.051,
  Human Resources Code].
         SECTION 6.  Section 252.039, Health and Safety Code, is
  amended to read as follows:
         Sec. 252.039.  POSTING. Each facility shall prominently and
  conspicuously post for display in a public area of the facility that
  is readily available to residents, employees, and visitors:
               (1)  the license issued under this chapter;
               (2)  a sign prescribed by the commission [department]
  that specifies complaint procedures established under this chapter
  or rules adopted under this chapter and that specifies how
  complaints may be registered with the commission [department];
               (3)  a notice in a form prescribed by the commission
  [department] stating that inspection and related reports are
  available at the facility for public inspection and providing the
  commission's [department's] toll-free telephone number that may be
  used to obtain information concerning the facility;
               (4)  a concise summary of the most recent inspection
  report relating to the facility;
               (5)  a notice providing instructions for reporting an
  allegation of abuse, neglect, or exploitation to the commission
  [Department of Family and Protective Services]; and
               (6)  a notice that employees, other staff, residents,
  volunteers, and family members and guardians of residents are
  protected from discrimination or retaliation as provided by
  Sections 252.132 and 252.133.
         SECTION 7.  Section 252.121(a), Health and Safety Code, is
  amended to read as follows:
         (a)  A person, including an owner or employee of a facility,
  who has cause to believe that a resident is being or has been
  subjected to abuse, neglect, or exploitation shall report the
  suspected abuse, neglect, or exploitation to the commission
  [Department of Family and Protective Services, as required by
  Chapter 48, Human Resources Code, or Chapter 261, Family Code, as
  appropriate].  The commission [Department of Family and Protective
  Services] shall investigate the allegation of abuse, neglect, or
  exploitation in the manner prescribed by the commission [provided
  by Chapter 48, Human Resources Code, or Section 261.404, Family
  Code, as applicable].
         SECTION 8.  Section 252.125, Health and Safety Code, is
  amended to read as follows:
         Sec. 252.125.  IMMEDIATE REMOVAL TO PROTECT RESIDENT.
  Before the completion of the investigation by the commission
  [Department of Family and Protective Services], the commission
  [department] shall file a petition for temporary care and
  protection of a resident if the commission [department]
  determines[, based on information provided to the department by the
  Department of Family and Protective Services,] that immediate
  removal is necessary to protect the resident from further abuse,
  neglect, or exploitation.
         SECTION 9.  Sections 253.001(1) and (4), Health and Safety
  Code, are amended to read as follows:
               (1)  "Commission" means the Health and Human Services
  Commission ["Commissioner" means the commissioner of aging and
  disability services].
               (4)  "Facility" means:
                     (A)  a nursing facility[:
                           [(i)]  licensed by the commission under
  Chapter 242 [department]; [or]
                     (B)  an intermediate care facility for
  individuals with an intellectual disability [(ii)] licensed by the
  commission under Chapter 252;
                     (C) [(B)]  an adult foster care provider that
  contracts with the commission [department];
                     (D) [(C)]  a home and community support services
  agency licensed by the commission [department] under Chapter 142;
  [or]
                     (E) [(D)]  a prescribed pediatric extended care
  center licensed by the commission under Chapter 248A;
                     (F)  an assisted living facility licensed by the
  commission under Chapter 247;
                     (G)  a day activity and health services facility
  licensed by the commission under Chapter 103, Human Resources Code;
                     (H)  a residential child-care facility as defined
  by Section 42.002, Human Resources Code, at which an elderly person
  or an adult with a disability resides or is in the facility's care;
                     (I)  a provider who provides home and
  community-based services under the home and community-based
  services (HCS) waiver program or the Texas home living (TxHmL)
  waiver program; or
                     (J)  a facility that is exempt from licensure
  under Section 252.003.
         SECTION 10.  Section 260A.001, Health and Safety Code, is
  amended by adding Subdivision (1-a) to read as follows:
               (1-a)  "Commission" means the Health and Human Services
  Commission.
         SECTION 11.  Section 260A.002, Health and Safety Code, is
  amended by amending Subsections (a-1) and (c) and adding Subsection
  (d) to read as follows:
         (a-1)  Notwithstanding any other provision of this chapter,
  a report made under this section that a provider is or may be
  alleged to have committed abuse, neglect, or exploitation of a
  resident of a facility other than a prescribed pediatric extended
  care center shall be investigated by the commission [Department of
  Family and Protective Services] in accordance with Subchapter F,
  Chapter 48, Human Resources Code, and this chapter does not apply to
  that investigation. In this subsection, "facility" and "provider"
  have the meanings assigned by Section 48.251, Human Resources Code.
         (c)  A person shall make an oral or electronic report
  immediately on learning of the abuse, neglect, or exploitation [and
  shall make a written report to the department not later than the
  fifth day after the oral report is made].
         (d)  A facility or provider shall submit a provider
  investigation report to the commission not later than the fifth day
  after the date the facility or provider makes the oral or electronic
  report under Subsection (c).
         SECTION 12.  Section 260A.007, Health and Safety Code, is
  amended by amending Subsection (e) and adding Subsection (e-1) to
  read as follows:
         (e)  In investigating the report of abuse, neglect,
  exploitation, or other complaint, the investigator for the
  commission [department] shall:
               (1)  conduct [make] an unannounced investigation
  [visit to the facility] to determine the nature and cause of the
  alleged abuse, neglect, or exploitation of the resident;
               (2)  interview each available witness, including the
  resident who suffered the alleged abuse, neglect, or exploitation
  if the resident is able to communicate or another resident or other
  witness identified by any source as having personal knowledge
  relevant to the report of abuse, neglect, exploitation, or other
  complaint;
               (3)  [personally] inspect any physical circumstance
  that is relevant and material to the report of abuse, neglect,
  exploitation, or other complaint and that may be objectively
  observed;
               (4)  if an on-site investigation is conducted, make a
  photographic record of any injury to a resident, subject to
  Subsection (n);
               (5)  write an investigation report that includes:
                     (A)  the investigator's personal observations;
                     (B)  a review of relevant documents and records;
                     (C)  a summary of each witness statement,
  including the statement of the resident that suffered the alleged
  abuse, neglect, or exploitation and any other resident interviewed
  in the investigation; and
                     (D)  a statement of the factual basis for the
  findings for each incident or problem alleged in the report or other
  allegation; and
               (6)  for a resident of an institution or assisted
  living facility, inspect any court order appointing a guardian of
  the resident who was the subject of the alleged abuse, neglect, or
  exploitation that is maintained in the resident's medical records
  under Section 242.019 or 247.070.
         (e-1)  In addition to the requirements under Subsection (e),
  the commission shall make an unannounced visit to a facility to
  conduct an investigation of abuse or neglect.
         SECTION 13.  Section 48.0021, Human Resources Code, is
  amended to read as follows:
         Sec. 48.0021.  REFERENCE TO COMMISSION OR EXECUTIVE
  COMMISSIONER.  Unless otherwise provided by a provision of this
  chapter, in [In] this chapter:
               (1)  a reference to the Health and Human Services
  Commission means the Department of Family and Protective Services;
  and
               (2)  a reference to the executive commissioner means
  the commissioner of the Department of Family and Protective
  Services.
         SECTION 14.  Section 48.051, Human Resources Code, is
  amended by adding Subsection (b-1) and amending Subsection (c) to
  read as follows:
         (b-1)  This subsection applies only to a provider under the
  home and community-based services (HCS) waiver program or the Texas
  home living (TxHmL) waiver program, an intermediate care facility
  licensed under Chapter 252, Health and Safety Code, a state
  supported living center as defined by Section 531.002, Health and
  Safety Code, or a home and community support services agency
  licensed under Chapter 142, Health and Safety Code. Except as
  provided by Subsections (a) and (b), a person, including an
  officer, employee, agent, contractor, or subcontractor of a
  facility or provider subject to this subsection, having cause to
  believe that an individual receiving services from the facility or
  provider is in the state of abuse, neglect, or exploitation shall
  immediately report to the commission the information required by
  Subsection (d). Notwithstanding Section 48.0021, in this
  subsection "commission" means the Health and Human Services
  Commission.
         (c)  The duty imposed by Subsections (a), (b), and (b-1)
  [(b)] applies without exception to a person whose knowledge
  concerning possible abuse, neglect, or exploitation is obtained
  during the scope of the person's employment or whose professional
  communications are generally confidential, including an attorney,
  clergy member, medical practitioner, social worker, employee or
  member of a board that licenses or certifies a professional, and
  mental health professional.
         SECTION 15.  Section 48.251(a), Human Resources Code, is
  amended by adding Subdivisions (1-a) and (2-a) and amending
  Subdivision (3) to read as follows:
               (1-a)  "Commission" means the Health and Human Services
  Commission, notwithstanding Section 48.0021.
               (2-a)  "Executive commissioner" means the executive
  commissioner of the Health and Human Services Commission,
  notwithstanding Section 48.0021.
               (3)  "Facility" means:
                     (A)  a facility listed in Section 532.001(b) or
  532A.001(b), Health and Safety Code, [including community services
  operated by the Department of State Health Services or Department
  of Aging and Disability Services,] as described by those sections,
  or a person contracting with a health and human services agency to
  provide inpatient mental health services; [and]
                     (B)  a facility licensed under Chapter 252, Health
  and Safety Code;
                     (C)  a residential child-care facility as defined
  by Section 42.002 at which an elderly person or an adult with a
  disability resides or is in the facility's care; and
                     (D)  a home and community support services agency
  licensed under Chapter 142, Health and Safety Code.
         SECTION 16.  Sections 48.252(b) and (c), Human Resources
  Code, are amended to read as follows:
         (b)  The department may not investigate under this
  subchapter reports of abuse, neglect, or exploitation alleged or
  suspected to have been committed by a provider that is operated,
  licensed, certified, or registered by a state agency that has
  authority under this chapter or other law to investigate reports of
  abuse, neglect, or exploitation of an individual by the provider.  
  The department shall forward any report of abuse, neglect, or
  exploitation alleged or suspected to have been committed by a
  provider described by this subsection to the commission
  [appropriate state agency] for investigation.
         (c)  The commission [department] shall receive and
  investigate under this subchapter reports of abuse, neglect, or
  exploitation of:
               (1)  an individual who lives in a residence that is
  owned, operated, or controlled by a provider who provides home and
  community-based services under the home and community-based
  services waiver program described by Section 534.001(11)(B),
  Government Code, regardless of whether the individual is receiving
  services under that waiver program from the provider; and
               (2)  an elderly person or an adult with a disability who
  lives in or is in the care of a residential child-care facility as
  defined by Section 42.002.
         SECTION 17.  Sections 48.253(a), (b), and (c), Human
  Resources Code, are amended to read as follows:
         (a)  On receipt by the commission [department] of a report of
  alleged abuse, neglect, or exploitation under this subchapter, the
  commission [department] shall initiate a prompt and thorough
  investigation as needed to evaluate the accuracy of the report and
  to assess the need for emergency protective services, unless the
  commission [department], in accordance with rules adopted under
  this subchapter, determines that the report:
               (1)  is frivolous or patently without a factual basis;
  or
               (2)  does not concern abuse, neglect, or exploitation.
         (b)  After receiving a report that alleges that a provider is
  or may be the person who committed the alleged abuse, neglect, or
  exploitation, the commission [department] shall notify the
  provider [and the appropriate health and human services agency] in
  accordance with rules adopted by the executive commissioner.
         (c)  The provider identified under Subsection (b) shall:
               (1)  cooperate completely with an investigation
  conducted under this subchapter; and
               (2)  provide the commission [department] complete
  access during an investigation to:
                     (A)  all sites owned, operated, or controlled by
  the provider; and
                     (B)  clients and client records.
         SECTION 18.  Sections 48.254(a) and (c), Human Resources
  Code, are amended to read as follows:
         (a)  The executive commissioner by rule shall establish
  procedures for the commission [department] to use to forward a copy
  of the initial intake report and a copy of the completed provider
  investigation report relating to alleged or suspected abuse,
  neglect, or exploitation to the appropriate provider [and health
  and human services agency].
         (c)  A provider that receives the findings of an [a
  completed] investigation from the commission report under
  Subsection (a) shall forward the findings [report] to the managed
  care organization with which the provider contracts for services
  for the alleged victim.
         SECTION 19.  Sections 48.255(a) and (b), Human Resources
  Code, are amended to read as follows:
         (a)  The executive commissioner shall adopt rules to:
               (1)  prioritize investigations conducted under this
  subchapter with the primary criterion being whether there is a risk
  that a delay in the investigation will impede the collection of
  evidence in that investigation; and
               (2)  [establish procedures for resolving disagreements
  between the department and health and human services agencies
  concerning the department's investigation findings; and
               [(3)]  provide for an appeals process by the commission
  [department] for the alleged victim of abuse, neglect, or
  exploitation.
         (b)  A confirmed investigation finding by the commission
  [department] may not be changed by the administrator of a facility,
  a community center, a local mental health authority, or a local
  intellectual and developmental disability authority.
         SECTION 20.  Sections 48.256(a), (b), and (c), Human
  Resources Code, are amended to read as follows:
         (a)  The executive commissioner shall adopt rules that
  prescribe the appropriate manner in which [health and human
  services agencies and] managed care organizations provide the
  commission [department] with information necessary to facilitate
  the:
               (1)  identification of individuals receiving services
  from providers; and
               (2)  [to facilitate] notification of providers by the
  commission [department].
         (b)  The executive commissioner shall adopt rules requiring
  a provider to provide information [to the administering health and
  human services agency] necessary to facilitate the:
               (1)  identification by the commission [department] of
  individuals receiving services from providers; and
               (2)  [to facilitate] notification of providers by the
  commission [department].
         (c)  A provider of home and community-based services under
  the home and community-based services waiver program described by
  Section 534.001(11)(B), Government Code, shall post in a
  conspicuous location inside any residence owned, operated, or
  controlled by the provider in which home and community-based waiver
  services are provided, a sign that states:
               (1)  the name, address, and telephone number of the
  provider;
               (2)  the effective date of the provider's contract with
  the commission [applicable health and human services agency] to
  provide home and community-based services; and
               (3)  the name of the legal entity that contracted with
  the commission [applicable health and human services agency] to
  provide those services.
         SECTION 21.  Sections 48.258(a) and (b), Human Resources
  Code, are amended to read as follows:
         (a)  The commission [health and human services agencies]
  shall[, at the direction of the executive commissioner, jointly]
  develop and implement a system to track reports and investigations
  under this subchapter.
         (b)  To facilitate implementation of the system, the
  commission [health and human services agencies] shall use
  appropriate methods of measuring the number and outcome of reports
  and investigations under this subchapter.
         SECTION 22.  Section 103.008(b), Human Resources Code, is
  amended to read as follows:
         (b)  Any person may request an inspection of a facility by
  notifying the commission in writing of an alleged violation of a
  licensing requirement.  The complaint shall be as detailed as
  possible and signed by the complainant.  The commission shall:
               (1)  if the complaint alleges abuse, neglect, or
  exploitation, perform an [on-site] inspection as soon as feasible
  but not [no] later than the 14th day [30 days] after the date the
  commission receives [receiving] the complaint, unless after an
  investigation the complaint is found to be frivolous;[.  The
  commission shall respond to a complainant in writing.]
               (2)  if the complaint does not allege abuse, neglect,
  or exploitation, investigate the complaint not later than the 45th
  day after the date the commission receives the complaint;
               (3)  respond to a complainant in writing; and
               (4)  [The commission shall also] receive and
  investigate anonymous complaints.
         SECTION 23.  The following provisions are repealed:
               (1)  Section 252.121(b), Health and Safety Code;
               (2)  Section 252.126(b), Health and Safety Code;
               (3)  Section 48.252(a), Human Resources Code; and
               (4)  Section 48.254(b), Human Resources Code.
         SECTION 24.  (a)  As soon as practicable after the effective
  date of this Act, but not later than December 1, 2024, the
  commissioner of the Department of Family and Protective Services
  shall transfer any department funds and resources, including
  information technology, documents, and personnel allocated for the
  investigation of reports under Subchapter F, Chapter 48, Human
  Resources Code, to the Health and Human Services Commission to
  allow the commission to perform the functions described under
  Subchapter F, Chapter 48, Human Resources Code, as amended by this
  Act.
         (b)  Notwithstanding the effective date of this Act, the
  Health and Human Services Commission is not required to comply with
  changes in law made by this Act until the transfer required by
  Subsection (a) of this section is completed.
         SECTION 25.  If before implementing any provision of this
  Act a state agency determines that a waiver or authorization from a
  federal agency is necessary for implementation of that provision,
  the agency affected by the provision shall request the waiver or
  authorization and may delay implementing that provision until the
  waiver or authorization is granted.
         SECTION 26.  This Act takes effect September 1, 2023.
 
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