S.B. No. 304
 
 
 
 
AN ACT
  relating to certain violations committed by long-term care
  facilities, including violations that constitute the abuse and
  neglect of residents.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  (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 executive commissioner 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), (e), and (e-1) 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-1), the
  executive commissioner 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) is reported in connection with a separate survey, inspection,
  or investigation visit that occurred on separate entrance and exit
  dates.
         (a-3)  The executive commissioner may not revoke a license
  under Subsection (a-2) due to a violation described by Subsection
  (a-2)(1), if:
               (1)  the violation and the determination of immediate
  threat to health and safety are 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)  assist with obtaining a new operator for the
  institution; or
               (3)  assist with the relocation of residents to another
  institution.
         (e)  The executive commissioner may stay a license
  revocation required by Subsection (a-2) if the executive
  commissioner determines that the stay 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 license revocation
  may be stayed under this subsection. The executive commissioner
  shall follow negotiated rulemaking procedures prescribed by
  Chapter 2008, Government Code, for the adoption of rules
  establishing the criteria. The criteria established must permit
  the executive commissioner to stay a license revocation of a
  nursing facility for which the department has deployed a rapid
  response team under Section 255.004, if the facility has cooperated
  with the rapid response team and demonstrated improvement in
  quality of care, as determined by the rapid response team.
         (e-1)  The executive commissioner may stay a license
  revocation required by Subsection (a-2) 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 2.  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 3.  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 4.  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 5.  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 6.  (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 7.  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 8.  (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.
 
 
 
 
 
  ______________________________ ______________________________
     President of the Senate Speaker of the House     
 
         I hereby certify that S.B. No. 304 passed the Senate on
  March 30, 2015, by the following vote: Yeas 30, Nays 0; and that
  the Senate concurred in House amendment on May 28, 2015, by the
  following vote: Yeas 31, Nays 0.
 
 
  ______________________________
  Secretary of the Senate    
 
         I hereby certify that S.B. No. 304 passed the House, with
  amendment, on May 23, 2015, by the following vote: Yeas 138,
  Nays 1, one present not voting.
 
 
  ______________________________
  Chief Clerk of the House   
 
 
 
  Approved:
 
  ______________________________ 
              Date
 
 
  ______________________________ 
            Governor