CHAPTER 222.  HEALTH CARE FACILITY SURVEY, CONSTRUCTION,
INSPECTION, AND
REGULATION
SUBCHAPTER A.  SURVEY AND CONSTRUCTION OF HOSPITALS

Sec. 222.001.  Short Title.

         This subchapter may be cited as the Texas Hospital Survey and
Construction Act.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Sec. 222.002.  Definitions.

         In this subchapter:

                       (1) "Board" means the Texas Board of Health.

                       (2) "Commissioner" means the commissioner of health.

                       (3) "Department" means the Texas Department of Health.

                       (4) "Hospital" includes a public health center, a general
         hospital, or a tuberculosis, mental, chronic disease, or other
         type of hospital, and related facilities such as a laboratory,
         outpatient department, nurses' home and training facility, or
         central service facility operated in connection with a
         hospital.

                       (5) "Public health center" means a publicly owned facility
         for providing public health services and includes related
         facilities such as a laboratory, clinic, or administrative
         office operated in connection with a facility for providing
         public health services.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Sec. 222.003.  Exception.

         This subchapter does not apply to a hospital furnishing
primarily domiciliary care.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Sec. 222.004.  Division of Hospital Survey and Construction.

         (a) The division of hospital survey and construction is a
division of the department.

         (b) The division is administered by a full-time salaried
director appointed by the commissioner and under the supervision
and direction of the board.

         (c) The commissioner shall appoint other personnel of the
division.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Sec. 222.005.  Survey, Planning, and Construction of Hospitals.

         (a) The department, through the division of hospital survey and
construction, is the only agency of the state authorized to make
an inventory of existing hospitals, survey the need for
construction of hospitals, and develop a program of hospital
construction as provided by the federal Hospital Survey and
Construction Act (42 U.S.C. Section 291 et seq.).

         (b) The board may establish methods of administration and adopt
rules to meet the requirements of the federal Hospital Survey and
Construction Act relating to survey, planning, and construction
of hospitals and public health centers.

         (c) The commissioner shall:

                       (1) require reports, make inspections and investigations,
         and prescribe rules as the commissioner considers necessary;
         and

                       (2) take other action that the commissioner considers
         necessary to carry out the federal Hospital Survey and
         Construction Act and the regulations adopted under that Act.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Sec. 222.006.  Funding.

         (a) The commissioner shall accept, on behalf of the state, a
payment of federal funds or a gift or grant made to assist in
meeting the cost of carrying out the purpose of this subchapter,
and may spend the payment, gift, or grant for that purpose.

         (b) The commissioner shall deposit the payment, gift, or grant
in the state treasury to the credit of the hospital construction
fund.

         (c) The commissioner shall deposit to the credit of the
hospital construction fund money received from the federal
government for a construction project approved by the surgeon
general of the United States Public Health Service.  The
commissioner shall use the money only for payments to applicants
for work performed and purchases made in carrying out approved
projects.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Sec. 222.007.  Agreements for Use of Facilities and Services of Other
Entities.

         To the extent the commissioner considers desirable to carry out
the purposes of this subchapter, the commissioner may enter into
an agreement for the use of a facility or service of another
public or private department, agency, or institution.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Sec. 222.008.  Experts and Consultants.

         The commissioner may contract for services of experts or
consultants, or organizations of experts or consultants, on a
part-time or fee-for-service basis.  The contracts may not
involve the performance of administrative duties.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Sec. 222.009.  Commissioner's Report.

         (a) The commissioner annually shall report to the board on
activities and expenditures under this subchapter.

         (b) The commissioner shall include in the report
recommendations for additional legislation that the commissioner
considers appropriate to furnish adequate hospital, clinic, and
similar facilities to the public.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
SUBCHAPTER B.  LIMITATION ON INSPECTION AND OTHER REGULATION OF
                             HEALTH
                        CARE FACILITIES
                                
                    Sec. 222.021.  Purpose.
                                
The purpose of this subchapter is to require that state agencies
that perform inspections of health care facilities, including the
   Texas Department of Health, the Texas Department of Human
   Services, the Texas Department of Mental Health and Mental
Retardation, and other agencies with which each of those agencies
 contracts, do not duplicate their procedures or subject health
             care facilities to duplicative rules.
                                
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Sec. 222.022.  Definitions.

         In this subchapter:

                       (1) "Health care facility" has the meaning assigned by
         Section 104.002, except that the term does not include a
         treatment facility licensed by the Texas Commission on Alcohol
         and Drug Abuse.

                       (2) "Inspection" includes a survey, inspection,
         investigation, or other procedure necessary for a state agency
         to carry out an obligation imposed by federal and state laws,
         rules, and regulations.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Sec. 222.023.  Limitation on Inspections.

         (a) A state agency may make or require only those inspections
necessary to carry out obligations imposed on the agency by
federal and state laws, rules, and regulations.

         (b) Instead of making an on-site inspection, a state agency
shall accept an on-site inspection by another state agency
charged with making an inspection if the inspection substantially
complies with the accepting agency's inspection requirements.

         (c) A state agency shall coordinate its inspections within the
agency and with inspections required of other agencies to ensure
compliance with this section.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Sec. 222.024.  Certification or Accreditation Instead of Inspection.

         (a) Except as provided by Subsection (c), a hospital licensed
by the Texas Department of Health is not subject to additional
annual licensing inspections before the department issues the
hospital a license while the hospital maintains:

                       (1) certification under Title XVIII of the Social Security
         Act (42 U.S.C. Section 1395 et seq.); or

                       (2) accreditation from the Joint Commission on Accreditation
         of Healthcare Organizations, the American Osteopathic
         Association, or other national accreditation organization for
         the offered services.

         (b) If the department licenses a hospital exempt from an annual
licensing inspection under Subsection (a), the department shall
issue a renewal license to the hospital if the hospital annually:

                       (1) submits a complete application required by the
         department;

                       (2) remits any applicable fees;

                       (3) submits a copy of documentation from the certification
         or accreditation body showing that the hospital is certified or
         accredited; and

                       (4) submits a copy of the most recent fire safety inspection
         report from the fire marshal in whose jurisdiction the hospital
         is located.

         (c) The department may conduct an inspection of a hospital
exempt from an annual licensing inspection under Subsection (a)
before issuing a renewal license to the hospital if the
certification or accreditation body has not conducted an on-site
inspection of the hospital in the preceding three years and the
department determines that an inspection of the hospital by the
certification or accreditation body is not scheduled within 60
days.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Amended by Acts 1993, 73rd Leg., ch. 584, Sec. 16, eff. Sept. 1,
1993; Acts 1997, 75th Leg., ch. 223, Sec. 1, eff. Sept. 1, 1997.

Sec. 222.025.  Limitation of Other Regulation.

         (a) The Texas Department of Human Services, the Texas
Department of Health, and the Texas Department of Mental Health
and Mental Retardation each by rule shall execute a memorandum of
understanding that establishes procedures to eliminate or reduce
duplication of functions in certifying or licensing hospitals,
nursing homes, or other facilities under their jurisdiction for
payments under the requirements of Chapter 32, Human Resources
Code, and federal law and regulations relating to Titles XVIII
and XIX of the Social Security Act (42 U.S.C. Sections 1395 et
seq. and 1396 et seq.).  The procedures must provide for use by
each agency of information collected by the agencies in making
inspections for certification purposes and in investigating
complaints regarding matters that would affect the certification
of a nursing home or other facility under their jurisdiction.

         (b) The Texas Department of Health shall coordinate all
licensing or certification procedures conducted by the state
agencies covered by this section.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Sec. 222.0255.  Nursing Homes.

         (a) The Texas Department of Human Services shall develop one
set of standards for nursing homes that apply to licensing and to
certification for participation in the medical assistance program
under Chapter 32, Human Resources Code.

         (b) The standards must comply with federal regulations.  If the
federal regulations at the time of adoption are less stringent
than the state standards, the department shall keep and comply
with the state standards.

         (c) The department by rule shall adopt the standards and any
amendments to the standards.

         (d) The department shall maintain a set of standards for
nursing homes that are licensed only.

         (e) Chapter 242 establishes the minimum licensing standards for
an institution.  The licensing standards adopted by the
department under this chapter shall be adopted subject to Section
242.037(b) and must comply with Section 242.037(c) and the other
provisions of Chapter 242.

Added by Acts 1991, 72nd Leg., ch. 14, Sec. 64, eff. Sept. 1,
1991.

Amended by Acts 1995, 74th Leg., ch. 76, Sec. 8.079, eff. Sept.
1, 1995; Acts 1997, 75th Leg., ch. 1159, Sec. 1.32, eff. Sept. 1,
1997.

Sec. 222.026.  Complaint Investigations and Enforcement Authority.

         (a) Sections 222.024, 222.025, and 222.0255 do not affect the
authority of the Texas Department of Health to implement and
enforce the provisions of Chapter 241 (Texas Hospital Licensing
Law) to:

                       (1) reinspect a hospital if a hospital applies for the
         reissuance of its license after a final ruling upholding the
         suspension or revocation of a hospital's license, the
         assessment of administrative or civil penalties, or the
         issuance of an injunction against the hospital for violations
         of provisions of the licensing law, rules adopted under the
         licensing law, special license conditions, or orders of the
         commissioner of health; or

                       (2) investigate a complaint against a hospital and, if
         appropriate, enforce the provisions of the licensing law on a
         finding by the department that reasonable cause exists to
         believe that the hospital has violated provisions of the
         licensing law, rules adopted under the licensing law, special
         license conditions, or orders of the commissioner of health;
         provided, however, that the department shall coordinate with
         the federal Health Care Financing Administration and its agents
         responsible for the inspection of hospitals to determine
         compliance with the conditions of participation under Title
         XVIII of the Social Security Act (42 U.S.C. Section 1395 et
         seq.), so as to avoid duplicate investigations.

         (b) The department shall by rule establish a procedure for the
acceptance and timely review of complaints received from
hospitals concerning the objectivity, training, and
qualifications of the persons conducting the inspection.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989. 
Amended by Acts 1991, 72nd Leg., ch. 14, Sec. 64, eff. Sept. 1,
1991.

Amended by Acts 1993, 73rd Leg., ch. 584, Sec. 17, eff. Sept. 1,
1993.

Sec. 222.027.  Physician on Survey Team.

         The Texas Department of Health shall ensure that a licensed
physician involved in direct patient care as defined by the Texas
State Board of Medical Examiners is included on a survey team
sent under Title XVIII of the Social Security Act (42 U.S.C.
Section 1395 et seq.) when surveying the quality of services
provided by physicians in hospitals.

Added by Acts 1991, 72nd Leg., ch. 14, Sec. 63, eff. Sept. 1,
1991.
   SUBCHAPTER C.  SURVEYS OF INTERMEDIATE CARE FACILITIES FOR
                            MENTALLY
                            RETARDED
                                
                  Sec. 222.041.  Definitions.
                                
                      In this subchapter:
                                
      (1) "Board" means the Texas Board of Human Services.
                                
  (2) "Commissioner" means the commissioner of human services.
                                
 (3) "Department" means the Texas Department of Human Services.
                                
(4) "ICF-MR" means the medical assistance program serving persons
  receiving care in intermediate care facilities for mentally
                       retarded persons.
                                
Added by Acts 1991, 72nd Leg., ch. 14, Sec. 65, eff. Sept. 1,
1991.

Amended by Acts 1995, 74th Leg., ch. 76, Sec. 8.080, eff. Sept.
1, 1995.

Sec. 222.042.  Licensing of ICF-MR Beds and Facilities.

         The department may not license or approve as meeting licensing
standards new ICF-MR beds or the expansion of an existing ICF-MR
facility unless the new beds or the expansion was included in the
plan approved by the Health and Human Services Commission in
accordance with Section 533.062.

Added by Acts 1991, 72nd Leg., ch. 14, Sec. 65, eff. Sept. 1,
1991.

Amended by Acts 1993, 73rd Leg., ch. 646, Sec. 1, eff. Aug. 30,
1993; Acts 1993, 73rd Leg., ch. 747, Sec. 26, eff. Sept. 1, 1993.

Sec. 222.043.  Review of ICF-MR Surveys.

         (a) The board by rule shall establish policies and procedures
as prescribed by this section to conduct an informal review of
ICF-MR surveys when the survey findings are disputed by the
provider.  The board shall provide that the procedure may be used
only if the deficiencies cited in the survey report do not pose
an imminent threat of danger to the health or safety of a
resident.

         (b) The department shall designate at least one employee to
conduct on a full-time basis the review provided by this section. 
The person must be impartial and may not be directly involved in
or supervise any initial or recertification surveys.  The person
may participate in or direct follow-up surveys for quality
assurance purposes only at the discretion of the commissioner or
the commissioner's designated representative or under Chapter
242.

         (c) The employee designated under Subsection (b) should have
current knowledge of applicable federal laws and survey
processes.  The employee reports directly to the commissioner or
the commissioner's designated representative.

         (d) If a provider disputes the findings of a survey team or
files a complaint relating to the conduct of the survey, the
employee designated under Subsection (b) shall conduct an
informal review as soon as possible, but before the 45th day
after the date of receiving the request for a review or the
expiration of the period during which the provider is required to
correct the alleged deficiency, whichever is sooner.

         (e) The employee conducting the review shall sustain, alter, or
reverse the original findings of the survey team after consulting
with the commissioner or the commissioner's designated
representative.

Added by Acts 1991, 72nd Leg., ch. 14, Sec. 65, eff. Sept. 1,
1991.

Amended by Acts 1995, 74th Leg., ch. 76, Sec. 8.081, eff. Sept.
1, 1995.

Sec. 222.044.  Follow-up Surveys.

         (a) The department shall conduct follow-up surveys of ICF-MR
facilities to:

                       (1) evaluate and monitor the findings of the certification
         or licensing survey teams; and

                       (2) ensure consistency in deficiencies cited and in punitive
         actions recommended throughout the state.

         (b) A provider shall correct any additional deficiency cited by
the department.  The department may not impose an additional
punitive action for the deficiency unless the provider fails to
correct the deficiency within the period during which the
provider is required to correct the deficiency.

Added by Acts 1991, 72nd Leg., ch. 14, Sec. 65, eff. Sept. 1,
1991.

Amended by Acts 1995, 74th Leg., ch. 76, Sec. 8.082, eff. Sept.
1, 1995.

Sec. 222.046.  Surveys of ICF-MR Facilities.

         (a) The department shall ensure that each survey team sent to
survey an ICF-MR facility includes a qualified mental retardation
professional, as that term is defined by federal law.

         (b) The department shall require that each survey team sent to
survey an ICF-MR facility conduct a final interview with the
provider to ensure that the survey team informs the provider of
the survey findings and that the survey team has requested the
necessary information from the provider.  The survey team shall
allow the provider to record the interview.  The provider shall
immediately give the survey team a copy of any recording.

Added by Acts 1991, 72nd Leg., ch. 14, Sec. 65, eff. Sept. 1,
1991