Current through Reg. 50, No. 13; March 28, 2025
(a) Enforcement is
a process by which a sanction is proposed, and if warranted, imposed on an
applicant or licensee regulated by the Texas Health and Human Services
Commission (HHSC) for failure to comply with applicable statutes, rules, or
orders.
(b) HHSC has jurisdiction
to enforce violations of Texas Health and Safety Code (HSC) Chapter 241
(relating to Hospitals) and this chapter. HHSC may deny, suspend, or revoke a
license or impose an administrative penalty on a limited services rural
hospital (LSRH) for the following reasons:
(1) failure to comply with any applicable
provision of the HSC, including Chapters 241, 311 (relating to Powers and
Duties of Hospitals), and 327 (relating to Disclosure of Prices);
(2) failure to comply with any provision of
this chapter or any other applicable laws;
(3) the LSRH, or any of its employees,
commits an act which causes actual harm or risk of harm to the health or safety
of a patient;
(4) the LSRH, or any
of its employees, materially alters any license issued by HHSC;
(5) failure to comply with minimum standards
for licensure;
(6) failure to
provide a complete license application;
(7) failure to comply with an order of the
executive commissioner or another enforcement procedure under HSC Chapters 241,
311, or 327;
(8) a history of
failure to comply with the applicable rules relating to patient environment,
health, safety, and rights that reflects more than nominal
noncompliance;
(9) the LSRH has
aided, committed, abetted or permitted the commission of an illegal
act;
(10) the LSRH, or any of its
employees, commits fraud, misrepresentation, or concealment of a material fact
on any documents an LSRH is required to submit to HHSC or required to maintain
pursuant to HSC Chapter 241, 311, or 327, and the provisions of this
chapter;
(11) failure to comply
with other state and federal laws affecting the health, safety, and rights of
LSRH patients;
(12) failure to
timely pay an assessed administrative penalty as required by HHSC;
(13) failure to submit an acceptable plan of
correction (POC) for cited deficiencies within the timeframe required by
HHSC;
(14) failure to timely
implement POCs for deficiencies cited by HHSC within the dates designated in
the POC;
(15) failure to comply
with applicable requirements within a designated probation period; or
(16) if the LSRH is participating under Title
XVIII and the Centers for Medicare & Medicaid Services terminates the
LSRH's Medicare provider agreement.
(c) HHSC has jurisdiction to enforce
violations of HSC Chapters 241, 311, and 327 and this chapter. HHSC may deny a
license if the applicant:
(1) fails to provide
timely and sufficient information required by HHSC that is directly related to
the application;
(2) has had the
following actions taken against the applicant within the two-year period
preceding the application:
(A) decertification
or cancellation of its contract under the Medicare or Medicaid program in any
state;
(B) federal Medicare or
state Medicaid sanctions or penalties;
(C) unsatisfied federal or state tax
liens;
(D) unsatisfied final
judgments;
(E) eviction involving
any property or space used as an LSRH or health care facility in any
state;
(F) unresolved federal
Medicare or state Medicaid audit exceptions;
(G) denial, suspension, or revocation of an
LSRH license, a private psychiatric hospital license, or a license for any
health care facility in any state; or
(H) a court injunction prohibiting ownership
or operation of an LSRH.
(d) Following notice and opportunity for
hearing, the executive commissioner of HHSC or a person designated by the
executive commissioner may issue an emergency order in relation to the
operation of an LSRH licensed under this chapter if the executive commissioner
or the executive commissioner's designee determines that the LSRH is violating
this chapter, a rule adopted pursuant to this chapter, a special license
provision, injunctive relief, an order of the executive commissioner or the
executive commissioner's designee, or another enforcement procedure permitted
under this chapter and the provision, rule, license provision, injunctive
relief, order, or enforcement procedure relates to the health or safety of the
LSRH's patients.
(1) HHSC shall send written
notice of the hearing and shall include within the notice the time and place of
the hearing. The hearing must be held within 10 days after the date of the
LSRH's receipt of the notice.
(2)
The hearing shall be held in accordance with HHSC's informal hearing
rules.
(3) The order shall be
effective on delivery to the LSRH or at a later date specified in the
order.
(e) In lieu of
denying, suspending, or revoking the license, HHSC may place the LSRH on
probation for a period of not less than 30 days, if the LSRH is found in
repeated noncompliance with these rules or HSC Chapter 241 and the LSRH's
noncompliance does not endanger the health and safety of the public.
(1) HHSC shall provide notice to the LSRH of
the probation and of the items of noncompliance not later than the 10th day
before the probation period begins.
(2) During the probation period, the LSRH
must correct the items that were in noncompliance and report the corrections to
HHSC for approval.
(3) HHSC has
jurisdiction to impose an administrative penalty against an LSRH licensed or
regulated under this chapter for violations of HSC Chapters 241, 311, and 327
and this chapter. The imposition of an administrative penalty shall be in
accordance with the provisions of HSC §241.059 (relating to Administrative
Penalty), §241.060 (relating to Administrative Penalty for Mental Health,
Chemical Dependency, or Rehabilitation Services), and §327.008 (relating
to Administrative Penalty).
(f) HHSC may deny a person or entity a
license or suspend or revoke an existing license on the grounds that the person
or entity has been convicted of a felony or misdemeanor that directly relates
to the duties and responsibilities of the ownership or operation of an LSRH.
HHSC shall apply the requirements of Texas Occupations Code Chapter 53
(relating to Consequences of Criminal Conviction).
(1) HHSC is entitled under Texas Government
Code Chapter 411 (relating to Department of Public Safety of the State of
Texas) to obtain criminal history information maintained by the Texas
Department of Public Safety, the Federal Bureau of Investigation, or any other
law enforcement agency to investigate the eligibility of an applicant for an
initial or renewal license and to investigate the continued eligibility of a
licensee.
(2) The following
felonies and misdemeanors directly relate because these criminal offenses
indicate an inability or a tendency for the person to be unable to own or
operate an LSRH:
(A) a misdemeanor violation
of HSC Chapter 241;
(B) a
misdemeanor or felony involving moral turpitude;
(C) a misdemeanor or felony relating to
deceptive business practices;
(D) a
misdemeanor or felony of practicing any health-related profession without a
required license;
(E) a misdemeanor
or felony under any federal or state law relating to drugs, dangerous drugs, or
controlled substances;
(F) a
misdemeanor or felony under the Texas Penal Code (TPC) Title 5, involving a
patient or a client of any health care facility, a home and community support
services agency, or a health care professional; or
(G) a misdemeanor or felony under the TPC:
(i) Title 4, relating to offenses of
attempting or conspiring to commit any of the offenses in this
clause;
(ii) Title 5, relating to
offenses against the person;
(iii)
Title 7, relating to offenses against property;
(iv) Title 8, relating to offenses against
public administration;
(v) Title 9,
relating to offenses against public order and decency;
(vi) Title 10, relating to offenses against
public health, safety and morals; or
(vii) Title 11, relating to offenses
involving organized crime.
(g) Offenses listed in subsection (f)(2) of
this section are not exclusive in that HHSC may consider similar criminal
convictions from other state, federal, foreign, or military jurisdictions that
indicate an inability or tendency for the person or entity to be unable to own
or operate an LSRH.
(h) HHSC shall
revoke a license on the licensee's conviction of a felony or revocation of
community supervision.
(i) If HHSC
proposes to deny, suspend or revoke a license, place on probation, or impose an
administrative penalty, HHSC shall send a notice of the proposed action by
certified mail, return receipt requested, at the address shown in the current
records of HHSC. The notice to deny, suspend, or revoke a license, place on
probation, or impose an administrative penalty, shall state the alleged facts
or conduct to warrant the proposed action, provide an opportunity to
demonstrate or achieve compliance, and shall state that the applicant or
license holder has an opportunity for a hearing before taking the
action.
(j) Within 20 calendar days
after receipt of the notice, the applicant or licensee may notify HHSC, in
writing, of acceptance of HHSC's determination or request a hearing. Receipt of
the notice is presumed to occur on the third day after the date the notice is
mailed by HHSC to the last known address of the applicant or
licensee.
(k) A hearing shall be
conducted pursuant to Texas Government Code Chapter 2001 and Texas
Administrative Code Title 1 Chapter 357, Subchapter I (relating to Hearings
under the Administrative Procedure Act).
(l) If the applicant or licensee fails to
timely respond to the notice or does not request a hearing, in writing, within
30 calendar days after receipt of the notice, HHSC shall refer the matter to
the State Office of Administrative Hearings.
(m) HHSC shall send the licensee or applicant
a copy of HHSC's decision for denial, suspension, or revocation of license or
imposition of an administrative penalty by certified mail, which shall include
the findings of fact and conclusions of law on which HHSC based its
decision.
(n) On HHSC's
determination to suspend or revoke a license, the license holder may not admit
new patients until the license is reissued.
(o) When HHSC's decision to suspend or revoke
a license is final, the licensee shall immediately cease operation, unless a
stay of such action is issued by the district court.
(p) On suspension, revocation, or non-renewal
of the license, the original license shall be returned to HHSC within 30
calendar days of HHSC's notification.
(q) One year after HHSC's decision to deny or
revoke, or the voluntary surrender of a license by an LSRH while enforcement
action is pending, an LSRH may petition HHSC, in writing, for a license.
Expiration of a license prior to HHSC's decision becoming final shall not
affect the one-year waiting period required before a petition may be submitted.
(1) HHSC may allow a reapplication for
licensure if there is proof that the reasons for the original action no longer
exist.
(2) HHSC may deny
reapplication for licensure if HHSC determines that:
(A) the reasons for the original action
continues;
(B) the petitioner has
failed to offer sufficient proof that conditions have changed; or
(C) the petitioner has demonstrated a
repeated history of failure to provide patients a safe environment or has
violated patient rights.
(3) If HHSC allows a reapplication for
licensure, the petitioner shall be required to meet the requirements as
described in §
511.12 of this chapter (relating
to Application and Issuance of Initial License).
(r) An LSRH whose license expires during a
suspension period may not reapply for license renewal until the end of the
suspension period.
(s) In the event
that enforcement, as defined in this subsection, is pending or reasonably
imminent, the surrender of an LSRH license shall not deprive HHSC of
jurisdiction in regard to enforcement against the LSRH.
