Bill Text: TX HB2025 | 2017-2018 | 85th Legislature | Enrolled


Bill Title: Relating to the regulation of certain long-term care facilities, including facilities that provide care to persons with Alzheimer's disease or related disorders; authorizing an administrative penalty.

Spectrum: Bipartisan Bill

Status: (Passed) 2017-06-15 - Effective on 9/1/17 [HB2025 Detail]

Download: Texas-2017-HB2025-Enrolled.html
 
 
  H.B. No. 2025
 
 
 
 
AN ACT
  relating to the regulation of certain long-term care facilities,
  including facilities that provide care to persons with Alzheimer's
  disease or related disorders; authorizing an administrative
  penalty.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Sections 531.058(a) and (a-1), Government Code,
  are amended to read as follows:
         (a)  The executive commissioner by rule shall establish an
  informal dispute resolution process in accordance with this
  section.  The process must provide for adjudication by an
  appropriate disinterested person of disputes relating to a proposed
  enforcement action or related proceeding of the commission under
  Section 32.021(d), Human Resources Code, or the Department of Aging
  and Disability Services or its successor agency under Chapter 242,
  247, or 252, Health and Safety Code. The informal dispute
  resolution process must require:
               (1)  an institution or facility to request informal
  dispute resolution not later than the 10th calendar day after
  notification by the commission or department, as applicable, of the
  violation of a standard or standards; and
               (2)  the commission to complete the process not later
  than:
                     (A)  the 30th calendar day after receipt of a
  request from an institution or facility, other than an assisted
  living facility, for informal dispute resolution; or
                     (B)  the 90th calendar day after receipt of a
  request from an assisted living facility for informal dispute
  resolution.
         (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 or 247, Health and Safety Code,
  and the Department of Aging and Disability Services or its
  successor agency 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 2.  Subchapter B, Chapter 531, Government Code, is
  amended by adding Section 531.0585 to read as follows:
         Sec. 531.0585.  ISSUANCE OF MATERIALS TO CERTAIN LONG-TERM
  CARE FACILITIES. The executive commissioner shall review the
  commission's methods for issuing informational letters, policy
  updates, policy clarifications, and other related materials to an
  entity licensed under Chapter 103, Human Resources Code, or Chapter
  242, 247, 248A, or 252, Health and Safety Code, and develop and
  implement more efficient methods to issue those materials as
  appropriate.
         SECTION 3.  Section 242.066, Health and Safety Code, is
  amended by amending Subsections (a) and (e) and adding Subsection
  (i) to read as follows:
         (a)  The commission [department] may assess an
  administrative penalty against a person who:
               (1)  violates this chapter or a rule, standard, or
  order adopted or license issued under this chapter;
               (2)  makes a false statement, that the person knows or
  should know is false, of a material fact:
                     (A)  on an application for issuance or renewal of
  a license or in an attachment to the application; or
                     (B)  with respect to a matter under investigation
  by the commission [department];
               (3)  refuses to allow a representative of the
  commission [department] to inspect:
                     (A)  a book, record, or file required to be
  maintained by an institution; or
                     (B)  any portion of the premises of an
  institution;
               (4)  wilfully interferes with the work of a
  representative of the commission [department] or the enforcement of
  this chapter;
               (5)  wilfully interferes with a representative of the
  commission [department] preserving evidence of a violation of this
  chapter or a rule, standard, or order adopted or license issued
  under this chapter;
               (6)  fails to pay a penalty assessed by the commission
  [department] under this chapter not later than the 10th day after
  the date the assessment of the penalty becomes final; or
               (7)  fails to notify the commission [department] of a
  change of ownership before the effective date of the change of
  ownership.
         (e)  In determining the amount of a penalty, the commission
  [department] shall consider any matter that justice may require,
  including:
               (1)  the gradations of penalties established under
  Subsection (d);
               (2)  the seriousness of the violation, including the
  nature, circumstances, extent, and gravity of the prohibited act
  and the hazard or potential hazard created by the act to the health
  or safety of the public;
               (3)  the history of previous violations;
               (4)  deterrence of future violations; and
               (5)  efforts to correct the violation.
         (i)  The commission shall develop and use a system to record
  and track the scope and severity of each violation of this chapter
  or a rule, standard, or order adopted under this chapter for the
  purpose of assessing an administrative penalty for the violation or
  taking some other enforcement action against the appropriate
  institution to deter future violations.  The system:
               (1)  must be comparable to the system used by the
  Centers for Medicare and Medicaid Services to categorize the scope
  and severity of violations for nursing homes; and
               (2)  may be modified, as appropriate, to reflect
  changes in industry practice or changes made to the system used by
  the Centers for Medicare and Medicaid Services.
         SECTION 4.  Section 242.0665, Health and Safety Code, is
  amended to read as follows:
         Sec. 242.0665.  RIGHT TO CORRECT. (a)  The commission
  [department] may not collect an administrative penalty against an
  institution under this subchapter if, not later than the 45th day
  after the date the institution receives notice under Section
  242.067(c), the institution corrects the violation.
         (b)  Subsection (a) does not apply:
               (1)  to a violation that the commission [department]
  determines:
                     (A)  represents a pattern of violation that
  results in actual [serious] harm [to or death of a resident];
                     (B)  is widespread in scope and results in actual
  harm;
                     (C)  is widespread in scope, constitutes a
  potential for actual harm, and relates to:
                           (i)  residents' rights;
                           (ii)  treatment of residents;
                           (iii)  resident behavior and institution
  practices;
                           (iv)  quality of care;
                           (v)  medication errors;
                           (vi)  standard menus and nutritional
  adequacy;
                           (vii)  physician visits;
                           (viii)  infection control;
                           (ix)  life safety from fire; or
                           (x)  emergency preparedness and response;
                     (D) [(B)]  constitutes an immediate [a serious]
  threat to the health or safety of a resident; or
                     (E) [(C)]  substantially limits the institution's
  capacity to provide care;
               (2)  to a violation described by Sections
  242.066(a)(2)-(7);
               (3)  to a violation of Section 260A.014 or 260A.015;
  [or]
               (4)  to a violation of a right of a resident adopted
  under Subchapter L; or
               (5)  to a second or subsequent violation of Section
  326.002 that occurs before the second anniversary of the date of the
  first violation.
         (c)  An institution that corrects a violation under
  Subsection (a) must maintain the correction. If the institution
  fails to maintain the correction until at least the first
  anniversary of the date the correction was made, the commission 
  [department] may assess an administrative penalty under this
  subchapter for the subsequent violation. A penalty assessed under
  this subsection shall be equal to three times the amount of the
  penalty assessed but not collected under Subsection (a). The
  commission [department] is not required to provide the institution
  an opportunity to correct the subsequent violation under this
  section.
         (d)  In this section:
               (1)  "Actual harm" means a negative outcome that
  compromises a resident's physical, mental, or emotional
  well-being.
               (2)  "Immediate threat to the health or safety of a
  resident" means a situation that causes, or is likely to cause,
  serious injury, harm, or impairment to or the death of a resident.
               (3)  "Pattern of violation" means repeated, but not
  pervasive, failures of an institution to comply with this chapter
  or a rule, standard, or order adopted under this chapter that:
                     (A)  result in a violation; and
                     (B)  are found throughout the services provided by
  the institution or that affect or involve the same residents or
  institution employees.
               (4)  "Widespread in scope" means a violation of this
  chapter or a rule, standard, or order adopted under this chapter
  that:
                     (A)  is pervasive throughout the services
  provided by the institution; or
                     (B)  represents a systemic failure by the
  institution that affects or has the potential to affect a large
  portion of or all of the residents of the institution.
         SECTION 5.  Section 247.023, Health and Safety Code, is
  amended to read as follows:
         Sec. 247.023.  ISSUANCE AND RENEWAL OF LICENSE.  (a)  The
  commission [department] shall issue a license if, after inspection
  and investigation, it finds that the applicant, the assisted living
  facility, and all controlling persons with respect to the applicant
  or facility meet the requirements of this chapter and the standards
  adopted under this chapter.  The license expires on the third
  [second] anniversary of the date of its issuance.  The executive
  commissioner by rule shall [may] adopt a system under which
  licenses expire on staggered [various] dates during each three-year 
  [the two-year] period.  The commission shall prorate the license
  fee as appropriate if the expiration date of a license changes as a
  result of this subsection [For the year in which a license
  expiration date is changed, the department shall prorate the
  license fee on a monthly basis.   Each license holder shall pay only
  that portion of the license fee allocable to the number of months
  during which the license is valid.   A license holder shall pay the
  total license renewal fee at the time of renewal].
         (b)  To renew a license, the license holder must submit to
  the commission [department] the license renewal fee.
         (c)  The commission [department] may require participation
  in a continuing education program as a condition of renewal of a
  license.  The executive commissioner shall adopt rules to implement
  this subsection.
         SECTION 6.  Sections 247.024(a), (d), and (e), Health and
  Safety Code, are amended to read as follows:
         (a)  The executive commissioner by rule shall set license
  fees imposed by this chapter:
               (1)  on the basis of the number of beds in assisted
  living facilities required to pay the fee; and
               (2)  in amounts reasonable and necessary to defray the
  cost of administering this chapter, but not to exceed $2,250
  [$1,500].
         (d)  Investigation fees or attorney's fees may not be
  assessed against or collected from an assisted living facility by
  or on behalf of the commission [department] or another state agency
  unless the commission [department] or other state agency assesses
  and collects a penalty authorized by this chapter from the
  facility.
         (e)  An applicant who submits a license renewal later than
  the 45th day before the expiration date of a current license is
  subject to a late fee in accordance with commission [department]
  rules.
         SECTION 7.  Section 247.027, Health and Safety Code, is
  amended to read as follows:
         Sec. 247.027.  INSPECTIONS. (a)  In addition to the
  inspection required under Section 247.023(a), the commission:
               (1)  shall [department may] inspect each [an] assisted
  living facility at least every two years following the initial
  inspection required under Section 247.023(a); [annually] and
               (2)  may inspect a facility at other reasonable times
  as necessary to assure compliance with this chapter.
         (b)  The commission [department] shall establish an
  inspection checklist based on the minimum standards that describes
  the matters subject to inspection. The commission [department]
  shall use the inspection checklist in conducting inspections under
  this section and Section 247.023(a).
         SECTION 8.  Section 247.0451, Health and Safety Code, is
  amended by amending Subsections (a), (b), (d), and (f) and adding
  Subsections (g) and (h) to read as follows:
         (a)  The commission [department] may assess an
  administrative penalty against a person who:
               (1)  violates this chapter or a rule, standard, or
  order adopted under this chapter or a term of a license issued under
  this chapter;
               (2)  makes a false statement, that the person knows or
  should know is false, of a material fact:
                     (A)  on an application for issuance or renewal of
  a license or in an attachment to the application; or
                     (B)  with respect to a matter under investigation
  by the commission [department];
               (3)  refuses to allow a representative of the
  commission [department] to inspect:
                     (A)  a book, record, or file required to be
  maintained by an assisted living facility; or
                     (B)  any portion of the premises of an assisted
  living facility;
               (4)  wilfully interferes with the work of a
  representative of the commission [department] or the enforcement of
  this chapter;
               (5)  wilfully interferes with a representative of the
  commission [department] preserving evidence of a violation of this
  chapter or a rule, standard, or order adopted under this chapter or
  a term of a license issued under this chapter;
               (6)  fails to pay a penalty assessed under this chapter
  not later than the 30th day after the date the assessment of the
  penalty becomes final; or
               (7)  fails to notify the commission [department] of a
  change of ownership before the effective date of the change of
  ownership.
         (b)  Except as provided by Section 247.0452(c), the penalty
  may not exceed:
               (1)  $5,000 for each violation that:
                     (A)  represents a pattern of violation that
  results in actual harm or is widespread in scope and results in
  actual harm; or
                     (B)  constitutes an immediate threat to the health
  or safety of a resident; or
               (2)  $1,000 for each other violation.
         (d)  In determining the amount of a penalty, the commission
  [department] shall consider any matter that justice may require,
  but must consider each of the following and make a record of the
  extent to which each of the following was considered:
               (1)  the gradations of penalties established under
  Subsection (c);
               (2)  the seriousness of the violation, including the
  nature, circumstances, extent, and gravity of the prohibited act
  and the hazard or potential hazard created by the act to the health
  or safety of the public;
               (3)  the history of previous violations;
               (4)  deterrence of future violations;
               (5)  efforts to correct the violation; and
               (6)  the size of the facility and of the business entity
  that owns the facility.
         (f)  The commission [department] may not assess a penalty
  under this section against a resident of an assisted living
  facility unless the resident is also an employee of the facility or
  a controlling person.
         (g)  The commission shall develop and use a system to record
  and track the scope and severity of each violation of this chapter
  or a rule, standard, or order adopted under this chapter for the
  purpose of assessing an administrative penalty for the violation or
  taking some other enforcement action against the appropriate
  assisted living facility to deter future violations.  The system:
               (1)  must be comparable to the system used by the
  Centers for Medicare and Medicaid Services to categorize the scope
  and severity of violations for nursing homes; and
               (2)  may be modified, as appropriate, to reflect
  changes in industry practice or changes made to the system used by
  the Centers for Medicare and Medicaid Services.
         (h)  In this section, "actual harm," "immediate threat to the
  health or safety of a resident," "pattern of violation," and
  "widespread in scope" have the meanings assigned by Section
  247.0452.
         SECTION 9.  Section 247.0452, Health and Safety Code, is
  amended to read as follows:
         Sec. 247.0452.  RIGHT TO CORRECT.  (a)  The commission
  [department] may not collect an administrative penalty from an
  assisted living facility under Section 247.0451 if, not later than
  the 45th day after the date the facility receives notice under
  Section 247.0453(c), the facility corrects the violation.
         (b)  Subsection (a) does not apply:
               (1)  to a violation that the commission [department]
  determines represents a pattern of violation that results in actual
  [serious] harm [to or death of a resident];
               (2)  to a violation that the commission determines is
  widespread in scope and results in actual harm;
               (3)  to a violation that the commission determines is
  widespread in scope, constitutes a potential for actual harm, and
  relates to:
                     (A)  resident assessment;
                     (B)  staffing, including staff training;
                     (C)  administration of medication;
                     (D)  infection control;
                     (E)  restraints; or
                     (F)  emergency preparedness and response;
               (4)  to a violation that the commission determines
  constitutes an immediate threat to the health or safety of a
  resident;
               (5) [(2)]  to a violation described by Sections
  247.0451(a)(2)-(7) or a violation of Section 260A.014 or 260A.015;
               (6) [(3)]  to a second or subsequent violation of:
                     (A)  a right of the same resident under Section
  247.064; or
                     (B)  the same right of all residents under Section
  247.064; [or]
               (7) [(4)]  to a violation described by Section 247.066,
  which contains its own right to correct provisions; or
               (8)  to a second or subsequent violation of Section
  326.002 that occurs before the second anniversary of the date of the
  first violation.
         (c)  An assisted living facility that corrects a violation
  must maintain the correction. If the facility fails to maintain the
  correction until at least the first anniversary of the date the
  correction was made, the commission [department] may assess and
  collect an administrative penalty for the subsequent violation. An
  administrative penalty assessed under this subsection is equal to
  three times the amount of the original penalty assessed but not
  collected. The commission [department] is not required to provide
  the facility with an opportunity under this section to correct the
  subsequent violation.
         (d)  In this section:
               (1)  "Actual harm" means a negative outcome that
  compromises a resident's physical, mental, or emotional
  well-being.
               (2)  "Immediate threat to the health or safety of a
  resident" means a situation that causes, or is likely to cause,
  serious injury, harm, or impairment to or the death of a resident.
               (3)  "Pattern of violation" means repeated, but not
  pervasive, failures of an assisted living facility to comply with
  this chapter or a rule, standard, or order adopted under this
  chapter that:
                     (A)  result in a violation; and
                     (B)  are found throughout the services provided by
  the facility or that affect or involve the same residents or
  facility employees.
               (4)  "Widespread in scope" means a violation of this
  chapter or a rule, standard, or order adopted under this chapter
  that:
                     (A)  is pervasive throughout the services
  provided by the assisted living facility; or
                     (B)  represents a systemic failure by the assisted
  living facility that affects or has the potential to affect a large
  portion of or all of the residents of the facility.
         SECTION 10.  Section 248A.053, Health and Safety Code, is
  amended to read as follows:
         Sec. 248A.053.  INITIAL OR RENEWAL LICENSE TERM; RENEWAL;
  NOTIFICATION.  (a)  An initial or renewal license issued under this
  chapter expires on the third [second] anniversary of the date of
  issuance.  The executive commissioner by rule shall adopt a system
  under which licenses expire on staggered dates during each
  three-year period.  The commission shall prorate the license fee as
  appropriate if the expiration date of a license changes as a result
  of this subsection.
         (b)  A person applying to renew a center license shall:
               (1)  submit a renewal application to the commission
  [department] on a [the form] prescribed form [by the department] at
  least 60 days but not more than 120 days before expiration of the
  license;
               (2)  submit the renewal fee in the amount required by
  agency [department] rule; and
               (3)  comply with any other requirements specified by
  agency [department] rule.
         (c)  The commission [department] shall assess a $50 per day
  late fee to a license holder who submits a renewal application after
  the date required by Subsection (b)(1), except that the total
  amount of a late fee may not exceed the lesser of 50 percent of the
  license renewal fee or $500.
         (d)  At least 120 days before expiration of a center license,
  the commission [department] shall notify the owner or operator of
  the center of the license expiration.
         SECTION 11.  Subchapter F, Chapter 248A, Health and Safety
  Code, is amended by adding Section 248A.2515 to read as follows:
         Sec. 248A.2515.  SYSTEM FOR ASSESSMENT OF PENALTY. The
  commission shall develop and use a system to record and track the
  scope and severity of each violation of this chapter or a rule or
  standard adopted or order issued under this chapter for the purpose
  of assessing an administrative penalty for the violation or taking
  some other enforcement action against the appropriate center to
  deter future violations.  The system:
               (1)  must be comparable to the system used by the
  Centers for Medicare and Medicaid Services to categorize the scope
  and severity of violations for nursing homes; and
               (2)  may be modified, as appropriate, to reflect
  changes in industry practice or changes made to the system used by
  the Centers for Medicare and Medicaid Services.
         SECTION 12.  Sections 252.033(a), (b), (d), (f), and (h),
  Health and Safety Code, are amended to read as follows:
         (a)  After receiving the application, the commission
  [department] shall issue a license if, after inspection and
  investigation, it finds that the applicant and facility meet the
  requirements established under this chapter.
         (b)  The commission [department] may issue a license only
  for:
               (1)  the premises and persons or governmental unit
  named in the application; and
               (2)  the maximum number of beds specified in the
  application.
         (d)  A license is renewable on the third [second] anniversary
  of issuance or renewal of the license after:
               (1)  an inspection;
               (2)  filing and approval of a renewal report; and
               (3)  payment of the renewal fee.
         (f)  The commission [department] may not issue a license for
  new beds or an expansion of an existing facility under this chapter
  unless the addition of new beds or the expansion is included in the
  plan approved by the commission in accordance with Section
  533A.062.
         (h)  The executive commissioner by rule shall:
               (1)  define specific, appropriate, and objective
  criteria on which the commission [department] may deny an initial
  license application or license renewal or revoke a license; and
               (2)  adopt a system under which:
                     (A)  licenses expire on staggered dates during
  each three-year period; and
                     (B)  the commission prorates the license fee as
  appropriate if the expiration date of a license changes as a result
  of the system adopted under Paragraph (A).
         SECTION 13.  Sections 252.034(a), (e), and (f), Health and
  Safety Code, are amended to read as follows:
         (a)  The executive commissioner by rule may adopt a fee for a
  license issued under this chapter.  The fee may not exceed $225
  [$150] plus $7.50 [$5] for each unit of capacity or bed space for
  which the license is sought.
         (e)  All license fees collected under this section shall be
  deposited in the state treasury to the credit of the commission
  [department] and may be appropriated to the commission [department]
  to administer and enforce this chapter.
         (f)  An applicant who submits an application for license
  renewal later than the 45th day before the expiration date of a
  current license is subject to a late fee in accordance with
  commission [department] rules.
         SECTION 14.  Section 252.041, Health and Safety Code, is
  amended to read as follows:
         Sec. 252.041.  UNANNOUNCED INSPECTIONS. (a)  Each
  licensing period, the commission [department] shall conduct at
  least three [two] unannounced inspections of each facility.
         (b)  In order to ensure continuous compliance, the
  commission [department] shall randomly select a sufficient
  percentage of facilities for unannounced inspections to be
  conducted between 5 p.m. and 8 a.m.  Those inspections must be
  cursory to avoid to the greatest extent feasible any disruption of
  the residents.
         (c)  The commission [department] may require additional
  inspections.
         (d)  As considered appropriate and necessary by the
  commission [department], the commission [department] may invite at
  least one person as a citizen advocate to participate in
  inspections. The invited advocate must be an individual who has an
  interest in or who is employed by or affiliated with an organization
  or entity that represents, advocates for, or serves individuals
  with an intellectual disability or a related condition.
         SECTION 15.  Section 252.065, Health and Safety Code, is
  amended by amending Subsections (a), (b), (e), (f), (i), and (j) and
  adding Subsections (l) and (m) to read as follows:
         (a)  The commission [department] may assess an
  administrative penalty against a person who:
               (1)  violates this chapter or a rule, standard, or
  order adopted or license issued under this chapter;
               (2)  makes a false statement, that the person knows or
  should know is false, of a material fact:
                     (A)  on an application for issuance or renewal of
  a license or in an attachment to the application; or
                     (B)  with respect to a matter under investigation
  by the commission [department];
               (3)  refuses to allow a representative of the
  commission [department] to inspect:
                     (A)  a book, record, or file required to be
  maintained by the institution; or
                     (B)  any portion of the premises of an
  institution;
               (4)  wilfully interferes with the work of a
  representative of the commission [department] or the enforcement of
  this chapter;
               (5)  wilfully interferes with a representative of the
  commission [department] preserving evidence of a violation of this
  chapter or a rule, standard, or order adopted or license issued
  under this chapter;
               (6)  fails to pay a penalty assessed by the commission
  [department] under this chapter not later than the 10th day after
  the date the assessment of the penalty becomes final;
               (7)  fails to submit a plan of correction within 10 days
  after receiving a statement of licensing violations; or
               (8)  fails to notify the commission [department] of a
  change in ownership before the effective date of that change of
  ownership.
         (b)  The penalty for a facility with fewer than 60 beds shall
  be not less than $100 or more than $1,000 for each violation. The
  penalty for a facility with 60 beds or more shall be not less than
  $100 or more than $5,000 for each violation. [The total amount of
  the penalty assessed for a violation continuing or occurring on
  separate days under this subsection may not exceed $5,000 for a
  facility with fewer than 60 beds or $25,000 for a facility with 60
  beds or more.] Each day a violation occurs or continues is a
  separate violation for purposes of imposing a penalty.
         (e)  The executive commissioner by rule shall provide the
  facility with a reasonable period of time, not less than 45 days,
  following the first day of a violation to correct the violation
  before the commission [department] may assess an administrative
  penalty if a plan of correction has been implemented. This
  subsection does not apply to a violation described by Subsections
  (a)(2)-(8) or to a violation that the commission [department]
  determines:
               (1)  represents a pattern of violation that results
  [has resulted] in actual [serious] harm [to or the death of a
  resident];
               (2)  is widespread in scope and results in actual harm;
               (3)  is widespread in scope, constitutes a potential
  for actual harm, and relates to:
                     (A)  staff treatment of a resident;
                     (B)  active treatment;
                     (C)  client behavior and facility practices;
                     (D)  health care services;
                     (E)  drug administration;
                     (F)  infection control;
                     (G)  food and nutrition services; or
                     (H)  emergency preparedness and response;
               (4) [(2)]  constitutes an immediate [a serious] threat
  to the health or safety of a resident; or
               (5) [(3)]  substantially limits the facility's
  [institution's] capacity to provide care.
         (f)  The commission [department] may not assess an
  administrative penalty for a minor violation if the person corrects
  the violation not later than the 46th day after the date the person
  receives notice of the violation.
         (i)  The commission [department] may not assess an
  administrative penalty against a state agency.
         (j)  Notwithstanding any other provision of this section, an
  administrative penalty ceases to be incurred on the date a
  violation is corrected. The administrative penalty ceases to be
  incurred only if the facility:
               (1)  notifies the commission [department] in writing of
  the correction of the violation and of the date the violation was
  corrected; and
               (2)  shows later that the violation was corrected.
         (l)  The commission shall develop and use a system to record
  and track the scope and severity of each violation of this chapter
  or a rule, standard, or order adopted under this chapter for the
  purpose of assessing an administrative penalty for the violation or
  taking some other enforcement action against the appropriate
  facility to deter future violations. The system:
               (1)  must be comparable to the system used by the
  Centers for Medicare and Medicaid Services to categorize the scope
  and severity of violations for nursing homes; and
               (2)  may be modified, as appropriate, to reflect
  changes in industry practice or changes made to the system used by
  the Centers for Medicare and Medicaid Services.
         (m)  In this section:
               (1)  "Actual harm" means a negative outcome that
  compromises a resident's physical, mental, or emotional
  well-being.
               (2)  "Immediate threat to the health or safety of a
  resident" means a situation that causes, or is likely to cause,
  serious injury, harm, or impairment to or the death of a resident.
               (3)  "Pattern of violation" means repeated, but not
  pervasive, failures of a facility to comply with this chapter or a
  rule, standard, or order adopted under this chapter that:
                     (A)  result in a violation; and
                     (B)  are found throughout the services provided by
  the facility or that affect or involve the same residents or
  facility employees.
               (4)  "Widespread in scope" means a violation of this
  chapter or a rule, standard, or order adopted under this chapter
  that:
                     (A)  is pervasive throughout the services
  provided by the facility; or
                     (B)  that affects or has the potential to affect a
  large portion of or all of the residents of the facility.
         SECTION 16.  Subtitle G, Title 4, Health and Safety Code, is
  amended by adding Chapter 326 to read as follows:
  CHAPTER 326. STAFFING REQUIREMENTS FOR FACILITIES PROVIDING CARE TO
  PERSONS WITH ALZHEIMER'S DISEASE OR RELATED DISORDERS
         Sec. 326.001.  DEFINITIONS. In this chapter:
               (1)  "Commission" means the Health and Human Services
  Commission.
               (2)  "Facility" means:
                     (A)  a nursing facility licensed under Chapter
  242;
                     (B)  a continuing care facility regulated under
  Chapter 246;
                     (C)  an assisted living facility licensed under
  Chapter 247;
                     (D)  a day activity and health services facility
  licensed under Chapter 103, Human Resources Code; 
                     (E)  an establishment subject to Chapter 105,
  Human Resources Code;
                     (F)  a community home qualified under Chapter 123,
  Human Resources Code; and
                     (G)  an adult foster care provider that contracts
  with the commission.
         Sec. 326.002.  WRITTEN POLICY REQUIRED. A facility shall
  adopt, implement, and enforce a written policy that:
               (1)  requires a facility employee who provides direct
  care to a person with Alzheimer's disease or a related disorder to
  successfully complete training in the provision of care to persons
  with Alzheimer's disease and related disorders; and
               (2)  ensures the care and services provided by a
  facility employee to a person with Alzheimer's disease or a related
  disorder meet the specific identified needs of the person relating
  to the person's diagnosis of Alzheimer's disease or a related
  disorder.
         Sec. 326.003.  ENFORCEMENT. (a) The commission may assess
  an administrative penalty against a facility for a violation of
  Section 326.002. 
         (b)  The commission is not required to provide a facility an
  opportunity to correct a second or subsequent violation of Section
  326.002 that occurs before the second anniversary of the date of the
  first violation.
         (c)  A violation of Section 326.002 constitutes a violation
  of the law regulating a facility, and the commission may initiate
  for the violation any other enforcement action authorized by that
  law against the facility, including an adult foster care facility
  with three or fewer beds.
         Sec. 326.004.  RULES. The executive commissioner shall
  adopt rules related to the administration and implementation of
  this chapter.
         SECTION 17.  Section 103.003, Human Resources Code, is
  amended by amending Subdivision (1) and adding Subdivisions (1-a)
  and (4-b) to read as follows:
               (1)  "Commission" means the Health and Human Services
  Commission.
               (1-a)  "Day activity and health services facility"
  means a facility that provides services under a day activity and
  health services program on a daily or regular basis but not
  overnight to four or more elderly persons or persons with
  disabilities who are not related by blood, marriage, or adoption to
  the owner of the facility.
               (4-b)  "Facility" means a day activity and health
  services facility.
         SECTION 18.  Sections 103.006(a) and (b), Human Resources
  Code, are amended to read as follows:
         (a)  The commission [department] shall issue a license to
  operate a day activity and health services facility to a person who
  has met the application requirements and received approval after an
  on-site inspection.
         (b)  The license expires three [two] years from the date of
  its issuance. The executive commissioner by rule shall [may] adopt
  a system under which licenses expire on staggered [various] dates
  during the three-year [two-year] period. The commission shall
  prorate the license fee as appropriate if the expiration date of a
  license changes as a result of this subsection [For the year in
  which a license expiration date is changed, the department shall
  prorate the license fee on a monthly basis. Each license holder
  shall pay only that portion of the license fee allocable to the
  number of months for which the license is valid. A license holder
  shall pay the total license renewal fee at the time of renewal].
         SECTION 19.  Section 103.007, Human Resources Code, is
  amended to read as follows:
         Sec. 103.007.  LICENSE APPLICATION. (a)  An applicant for a
  license to operate a day activity and health services facility must
  file an application on a form prescribed by the commission
  [department] together with a license fee of $75 [$50].
         (b)  The applicant must provide evidence of:
               (1)  the ability to comply with the requirements of the
  commission [department];
               (2)  responsible management; and
               (3)  qualified professional staff and personnel.
         (c)  A person who operates a facility that is licensed under
  this chapter must file an application for a renewal license not
  later than the 45th day before the expiration date of the current
  license on a form prescribed by the commission [department]
  together with a renewal fee of $50.
         (d)  An applicant for a license renewal who submits an
  application later than the 45th day before the expiration date of
  the license is subject to a late fee in accordance with commission
  [department] rules.
         SECTION 20.  Section 103.008, Human Resources Code, is
  amended to read as follows:
         Sec. 103.008.  INSPECTIONS. (a)  In addition to the
  inspection required under Section 103.006(a), the commission:
               (1)  shall inspect each facility every two years
  following the initial inspection required under Section
  103.006(a); and
               (2)  [The department] may inspect [enter the premises
  of] a facility at other reasonable times as [and make an inspection]
  necessary to ensure compliance with this chapter [issue a license
  or renew a license].
         (b)  Any person may request an inspection of a facility by
  notifying the commission [department] in writing of an alleged
  violation of a licensing requirement. The complaint shall be as
  detailed as possible and signed by the complainant. The commission
  [department] shall perform an on-site inspection as soon as
  feasible but no later than 30 days after receiving the complaint
  unless after an investigation the complaint is found to be
  frivolous. The commission [department] shall respond to a
  complainant in writing. The commission [department] shall also
  receive and investigate anonymous complaints.
         SECTION 21.  Section 103.012, Human Resources Code, is
  amended by amending Subsections (a) and (e) and adding Subsection
  (g) to read as follows:
         (a)  The commission [department] may assess an
  administrative penalty against a person who:
               (1)  violates this chapter, a rule, standard, or order
  adopted under this chapter, or a term of a license issued under this
  chapter;
               (2)  makes a false statement of a material fact that the
  person knows or should know is false:
                     (A)  on an application for issuance or renewal of
  a license or in an attachment to the application; or
                     (B)  with respect to a matter under investigation
  by the commission [department];
               (3)  refuses to allow a representative of the
  commission [department] to inspect:
                     (A)  a book, record, or file required to be
  maintained by a day activity and health services facility; or
                     (B)  any portion of the premises of a day activity
  and health services facility;
               (4)  wilfully interferes with the work of a
  representative of the commission [department] or the enforcement of
  this chapter;
               (5)  wilfully interferes with a representative of the
  commission [department] preserving evidence of a violation of this
  chapter, a rule, standard, or order adopted under this chapter, or a
  term of a license issued under this chapter;
               (6)  fails to pay a penalty assessed under this chapter
  not later than the 30th day after the date the assessment of the
  penalty becomes final; or
               (7)  fails to notify the commission [department] of a
  change of ownership before the effective date of the change of
  ownership.
         (e)  In determining the amount of a penalty, the commission
  [department] shall consider any matter that justice may require,
  including:
               (1)  the gradations of penalties established under
  Subsection (d);
               (2)  the seriousness of the violation, including the
  nature, circumstances, extent, and gravity of the prohibited act
  and the hazard or potential hazard created by the act to the health
  or safety of the public;
               (3)  the history of previous violations;
               (4)  the deterrence of future violations; and
               (5)  the efforts to correct the violation.
         (g)  The commission shall develop and use a system to record
  and track the scope and severity of each violation of this chapter
  or a rule, standard, or order adopted under this chapter for the
  purpose of assessing an administrative penalty for the violation or
  taking some other enforcement action against the appropriate
  facility to deter future violations.  The system:
               (1)  must be comparable to the system used by the
  Centers for Medicare and Medicaid Services to categorize the scope
  and severity of violations for nursing homes; and
               (2)  may be modified, as appropriate, to reflect
  changes in industry practice or changes made to the system used by
  the Centers for Medicare and Medicaid Services.
         SECTION 22.  Section 103.013, Human Resources Code, is
  amended to read as follows:
         Sec. 103.013.  RIGHT TO CORRECT BEFORE IMPOSITION OF
  ADMINISTRATIVE PENALTY. (a)  The commission [department] may not
  collect an administrative penalty from a day activity and health
  services facility under Section 103.012 if, not later than the 45th
  day after the date the facility receives notice under Section
  103.014(c), the facility corrects the violation.
         (b)  Subsection (a) does not apply to:
               (1)  a violation that the commission [department]
  determines:
                     (A)  represents a pattern of violation that
  results in actual [serious] harm [to or death of a person attending
  the facility];
                     (B)  is widespread in scope and results in actual
  harm;
                     (C)  is widespread in scope, constitutes a
  potential for actual harm, and relates to:
                           (i)  staffing, including staff training,
  ratio, and health;
                           (ii)  administration of medication; or
                           (iii)  emergency preparedness and response;
                     (D) [(B)]  constitutes an immediate [a serious]
  threat to the health or [and] safety of an elderly person or a
  person with a disability receiving services at a [a person
  attending the] facility; or
                     (E) [(C)]  substantially limits the facility's
  capacity to provide care;
               (2)  a violation described by Sections
  103.012(a)(2)-(7); [or]
               (3)  a violation of Section 103.011; or
               (4)  a second or subsequent violation of Section
  326.002, Health and Safety Code, that occurs before the second
  anniversary of the date of the first violation.
         (c)  A day activity and health services facility that
  corrects a violation must maintain the correction. If the facility
  fails to maintain the correction until at least the first
  anniversary after the date the correction was made, the commission
  [department] may assess and collect an administrative penalty for
  the subsequent violation. An administrative penalty assessed under
  this subsection is equal to three times the amount of the original
  penalty assessed but not collected. The commission [department] is
  not required to provide the facility with an opportunity under this
  section to correct the subsequent violation.
         (d)  In this section:
               (1)  "Actual harm" means a negative outcome that
  compromises the physical, mental, or emotional well-being of an
  elderly person or a person with a disability receiving services at a
  facility.
               (2)  "Immediate threat to the health or safety of an
  elderly person or a person with a disability" means a situation that
  causes, or is likely to cause, serious injury, harm, or impairment
  to or the death of an elderly person or a person with a disability
  receiving services at a facility.
               (3)  "Pattern of violation" means repeated, but not
  pervasive, failures of a facility to comply with this chapter or a
  rule, standard, or order adopted under this chapter that:
                     (A)  result in a violation; and
                     (B)  are found throughout the services provided by
  the facility or that affect or involve the same elderly persons or
  persons with disabilities receiving services at the facility or the
  same facility employees.
               (4)  "Widespread in scope" means a violation of this
  chapter or a rule, standard, or order adopted under this chapter
  that:
                     (A)  is pervasive throughout the services
  provided by the facility; or
                     (B)  represents a systemic failure by the facility
  that affects or has the potential to affect a large portion of or
  all of the elderly persons or persons with disabilities receiving
  services at the facility.
         SECTION 23.  Section 247.0025, Health and Safety Code, is
  repealed.
         SECTION 24.  The changes in law made by this Act apply only
  to actions taken by the Health and Human Services Commission and
  license holders under Chapter 103, Human Resources Code, and
  Chapters 242, 247, 248A, and 252, Health and Safety Code, on or
  after the effective date of this Act.  An action taken before the
  effective date of this Act is governed by the law in effect at that
  time, and the former law is continued in effect for that purpose.
         SECTION 25.  Chapter 326, Health and Safety Code, as added by
  this Act, does not affect the terms of a contract entered into
  before the effective date of this Act, except that if the contract
  is renewed, modified, or extended on or after the effective date of
  this Act, Chapter 326 applies to the contract beginning on the date
  of renewal, modification, or extension.
         SECTION 26.  This Act takes effect September 1, 2017.
 
 
  ______________________________ ______________________________
     President of the Senate Speaker of the House     
 
 
         I certify that H.B. No. 2025 was passed by the House on May 9,
  2017, by the following vote:  Yeas 132, Nays 13, 2 present, not
  voting; and that the House concurred in Senate amendments to H.B.
  No. 2025 on May 26, 2017, by the following vote:  Yeas 139, Nays 5,
  2 present, not voting.
 
  ______________________________
  Chief Clerk of the House   
 
         I certify that H.B. No. 2025 was passed by the Senate, with
  amendments, on May 24, 2017, by the following vote:  Yeas 31, Nays
  0.
 
  ______________________________
  Secretary of the Senate   
  APPROVED: __________________
                  Date       
   
           __________________
                Governor       
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