CHAPTER 243.  AMBULATORY SURGICAL CENTERS

Sec. 243.001.  Short Title.

         This chapter may be cited as the Texas Ambulatory Surgical
Center Licensing Act.

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

Sec. 243.002.  Definitions.

         In this chapter:

                       (1) "Ambulatory surgical center" means a facility that
         operates primarily to provide surgical services to patients who
         do not require overnight hospital care.

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

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

                       (4) "Person" means an individual, firm, partnership,
         corporation, or association.

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

Sec. 243.003.  License Required.

         (a) Except as provided by Section 243.004, a person may not
establish or operate an ambulatory surgical center in this state
without a license issued under this chapter.

         (b) Each ambulatory surgical center must have a separate
license.

         (c) A license is not transferable or assignable.

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

Sec. 243.004.  Exemptions From Licensing Requirement.

         The following facilities need not be licensed under this
chapter:

                       (1) an office or clinic of a licensed physician, dentist, or
         podiatrist; 

                       (2) a licensed nursing home; or

                       (3) a licensed hospital.

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

Sec. 243.005.  License Application and Issuance.

         (a) An applicant for an ambulatory surgical center license must
submit an application to the department on a form prescribed by
the department.

         (b) Each application must be accompanied by a nonrefundable
license fee in an amount set by the board.

         (c) The application must contain evidence that there is at
least one physician, dentist, or podiatrist on the staff of the
center who is licensed by the appropriate state licensing board.

         (d) The department shall issue a license if, after inspection
and investigation, it finds that the applicant and the center
meet the requirements of this chapter and the standards adopted
under this chapter.

         (e) The license fee must be paid annually on renewal of the
license.

         (f) The department shall issue a renewal license to a center
certified under Title XVIII of the Social Security Act (42 U.S.C.
Section 1395 et seq.) when the center:

                       (1) remits any annual license fee; and

                       (2) submits the inspection results or the inspection results
         report from the certification body.

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

Sec. 243.006.  Inspections.

         (a) The department may inspect an ambulatory surgical center at
reasonable times as necessary to assure compliance with this
chapter.

         (b) An ambulatory surgical center licensed by the department
and certified under Title XVIII of the Social Security Act (42
U.S.C. Section 1395 et seq.) is not subject to additional
licensing inspections under this chapter while the center
maintains the certification.

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

Sec. 243.007.  Fees.

         The board shall set fees imposed by this chapter in amounts
reasonable and necessary to defray the cost of administering this
chapter.

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

Sec. 243.008.  Ambulatory Surgical Center Licensing Fund.

         All fees collected under this chapter shall be deposited in the
state treasury to the credit of the ambulatory surgical center
licensing fund and may be appropriated to the department only to
administer and enforce this chapter.

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

Sec. 243.009.  Adoption of Rules.

         The board shall adopt rules necessary to implement this
chapter, including requirements for the issuance, renewal,
denial, suspension, and revocation of a license to operate an
ambulatory surgical center.

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

Sec. 243.010.  Minimum Standards.

         (a) The rules must contain minimum standards applicable to an
ambulatory surgical center and for:

                       (1) the construction and design, including plumbing,
         heating, lighting, ventilation, and other design standards
         necessary to ensure the health and safety of patients; 

                       (2) the qualifications of the professional staff and other
         personnel; 

                       (3) the equipment essential to the health and welfare of the
         patients; 

                       (4) the sanitary and hygienic conditions within the center
         and its surroundings; and

                       (5) a quality assurance program for patient care.

         (b) Standards set under this section may not exceed the minimum
standards for certification of ambulatory surgical centers under
Title XVIII of the Social Security Act (42 U.S.C. Section 1395 et
seq.).

         (c) This section does not authorize the board to:

                       (1) establish the qualifications of a licensed practitioner;
         or

                       (2) permit a person to provide health care services who is
         not authorized to provide those services under another state
         law.

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

Sec. 243.011.  Denial, Suspension, or Revocation of License.

         (a) The department may deny, suspend, or revoke a license for a
violation of this chapter or a rule adopted under this chapter.

         (b) The denial, suspension, or revocation of a license by the
department and the appeal from that action are governed by the
procedures for a contested case hearing under Chapter 2001,
Government Code.

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

Amended by Acts 1995, 74th Leg., ch. 76, Sec. 5.95(49), eff.
Sept. 1, 1995.

Sec. 243.012.  Injunction.

         (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 patients of an
ambulatory surgical center.

         (b) A district court, on petition of the department and on a
finding by the court that a person is violating the standards or
licensing requirements provided under this chapter, may by
injunction:

                       (1) prohibit a person from continuing a violation of the
         standards or licensing requirements provided under this
         chapter; 

                       (2) restrain or prevent the establishment or operation of an
         ambulatory surgical center without a license issued under this
         chapter; or

                       (3) grant any other injunctive relief warranted by the
         facts.

         (c) The attorney general shall institute and conduct a suit
authorized by this section at the request of the department.

         (d) Venue for a suit brought under this section is in the
county in which the ambulatory surgical center is located or in
Travis County.

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

Sec. 243.013.  Criminal Penalty.

         (a) A person commits an offense if the person violates Section
243.003(a).

         (b) An offense under this section is a Class C misdemeanor.

         (c) Each day of a continuing violation constitutes a separate
offense.

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

Sec. 243.014.  Civil Penalty.

         (a) A person who violates this chapter or who fails to comply
with a rule adopted under this chapter is liable for a civil
penalty of not less than $100 or more than $500 for each
violation if the department determines the violation threatens
the health and safety of a patient.

         (b) Each day of a continuing violation constitutes a separate
ground for recovery.

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