2005 Texas Health & Safety Code CHAPTER 222. HEALTH CARE FACILITY SURVEY, CONSTRUCTION, INSPECTION, AND REGULATION

HEALTH & SAFETY CODE

CHAPTER 222. HEALTH CARE FACILITY SURVEY, CONSTRUCTION, 
INSPECTION, AND REGULATION

SUBCHAPTER A. SURVEY AND CONSTRUCTION OF HOSPITALS


	§ 222.001. SHORT TITLE.  This subchapter may be cited as 
the Texas Hospital Survey and Construction Act.

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


	§ 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, § 1, eff. Sept. 1, 1989.                    


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

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


	§ 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, § 1, eff. Sept. 1, 1989.                    


	§ 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, § 1, eff. Sept. 1, 1989.                    


	§ 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, § 1, eff. Sept. 1, 1989.                    


	§ 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, § 1, eff. Sept. 1, 1989.                    


	§ 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, § 1, eff. Sept. 1, 1989.                    


	§ 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, § 1, eff. Sept. 1, 1989.                    

SUBCHAPTER B. LIMITATION ON INSPECTION AND OTHER REGULATION OF 
HEALTH CARE FACILITIES


	§ 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, § 1, eff. Sept. 1, 1989.                    


	§ 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, § 1, eff. Sept. 1, 1989.                    


	§ 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, § 1, eff. Sept. 1, 1989.                    


	§ 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, § 1, eff. Sept. 1, 1989.  Amended 
by Acts 1993, 73rd Leg., ch. 584, § 16, eff. Sept. 1, 1993;  Acts 
1997, 75th Leg., ch. 223, § 1, eff. Sept. 1, 1997.


	§ 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, § 1, eff. Sept. 1, 1989.                    


	§ 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, § 64, eff. Sept. 1, 1991.  
Amended by Acts 1995, 74th Leg., ch. 76, § 8.079, eff. Sept. 1, 
1995;  Acts 1997, 75th Leg., ch. 1159, § 1.32, eff. Sept. 1, 
1997.


	§ 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, § 1, eff. Sept. 1, 1989.  Amended 
by Acts 1991, 72nd Leg., ch. 14, § 64, eff. Sept. 1, 1991;  Acts 
1993, 73rd Leg., ch. 584, § 17, eff. Sept. 1, 1993.


	§ 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, § 63, eff. Sept. 1, 1991.           

SUBCHAPTER C. SURVEYS OF INTERMEDIATE CARE FACILITIES FOR MENTALLY 
RETARDED


	§ 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, § 65, eff. Sept. 1, 1991.  
Amended by Acts 1995, 74th Leg., ch. 76, § 8.080, eff. Sept. 1, 
1995.


	§ 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, § 65, eff. Sept. 1, 1991.  
Amended by Acts 1993, 73rd Leg., ch. 646, § 1, eff. Aug. 30, 
1993;  Acts 1993, 73rd Leg., ch. 747, § 26, eff. Sept. 1, 1993.


	§ 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, § 65, eff. Sept. 1, 1991.  
Amended by Acts 1995, 74th Leg., ch. 76, § 8.081, eff. Sept. 1, 
1995.


	§ 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, § 65, eff. Sept. 1, 1991.  
Amended by Acts 1995, 74th Leg., ch. 76, § 8.082, eff. Sept. 1, 
1995.


	§ 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, § 65, eff. Sept. 1, 1991.