Law:Title 4. Health Facilities. Subtitle B. Licensing Of Health Facilities from Chapter 254. Freestanding Emergency Medical Care Facilities (Texas)

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Subtitle B. Licensing Of Health Facilities

Contents

Chapter 254. Freestanding Emergency Medical Care Facilities

Chapter 254 was added by Acts 2009, 81st Leg., R.S., Ch. 1273, Sec. 1.

For another Chapter 254 added by Acts 2009, 81st Leg., R.S., Ch. 1106, Sec. 1, see other Chapter 254.


Subchapter A. General Provisions

Section 254.001.  Definitions.

In this chapter:

(1)  "Department" means the Department of State Health Services.

(2)  "Emergency care" has the meaning assigned by Sections 843.002 and 1301.155, Insurance Code.

(3)  "Executive commissioner" means the executive commissioner of the Health and Human Services Commission.

(4)  "Facility" means a freestanding emergency medical care facility.

(5)  "Freestanding emergency medical care facility" means a facility, structurally separate and distinct from a hospital that receives an individual and provides emergency care, as defined by Subsection (2).

Added by Acts 2009, 81st Leg., R.S., Ch. 1273, Sec. 1, eff. September 1, 2009.



Subchapter B. Licensing

Section 254.051.  License Required.

(a) Except as provided by Section 254.052, a person may not establish or operate a freestanding emergency medical care facility in this state without a license issued under this chapter.

(b)  Except as provided by Section 254.052, a facility or person may not hold itself out to the public as a freestanding emergency medical care facility or use any similar term, as defined by department rule, that would give the impression that the facility or person is providing emergency care unless the facility or person holds a license issued under this chapter.  The use of the term "emergency" or a similar term is also subject to Section 254.152.

(c)  Each separate facility location must have a separate license.

(d)  A license issued under this chapter is not transferable or assignable.

(e)  The executive commissioner by rule shall establish a classification for a facility that is in continuous operation 24 hours per day and 7 days per week and a classification for a facility that is in operation 7 days per week and at least 12 hours per day.

(f)  A facility that is not in continuous operation 24 hours per day and 7 days per week cannot be issued a license with a term that extends beyond August 31, 2013.

Added by Acts 2009, 81st Leg., R.S., Ch. 1273, Sec. 1, eff. September 1, 2009.



Section 254.052.  Exemptions From Licensing Requirement.

The following facilities are not required to be licensed under this chapter:

(1)  an office or clinic owned and operated by a manufacturing facility solely for the purposes of treating its employees and contractors;

(2)  temporary emergency clinics in disaster areas;

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

(4)  a licensed nursing home;

(5)  a licensed hospital;

(6)  a hospital that is owned and operated by this state;

(7)  a facility located within or connected to a hospital described by Subsection (5) or (6);

(8)  a facility that is owned or operated by a hospital described by Subsection (5) or (6) and is:

(A)  surveyed as a service of the hospital by an organization that has been granted deeming authority as a national accreditation program for hospitals by the Centers for Medicare and Medicaid Services; or

(B)  granted provider-based status by the Centers for Medicare and Medicaid Services; or

(9)  a licensed ambulatory surgical center.

Added by Acts 2009, 81st Leg., R.S., Ch. 1273, Sec. 1, eff. September 1, 2009.



Section 254.053.  License Application And Issuance.

(a) An applicant for a license under this chapter 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 executive commissioner.

(c)  The application must contain evidence that there is at least one physician and one nurse on the staff of the facility who are licensed by the appropriate state licensing board.

(d)  The application must contain evidence that the facility meets the minimum standards and requirements specified in Section 254.151.

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

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

Added by Acts 2009, 81st Leg., R.S., Ch. 1273, Sec. 1, eff. September 1, 2009.



Subchapter C. Executive Commissioner And Department Powers And Duties

Section 254.101.  Adoption Of Rules.

The executive commissioner shall adopt rules necessary to implement this chapter, including requirements for the issuance, renewal, denial, suspension, and revocation of a license to operate a facility.

Added by Acts 2009, 81st Leg., R.S., Ch. 1273, Sec. 1, eff. September 1, 2009.



Section 254.102.  Fees.

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

Added by Acts 2009, 81st Leg., R.S., Ch. 1273, Sec. 1, eff. September 1, 2009.



Section 254.103.  Inspections.

The department may inspect a facility at reasonable times as necessary to ensure compliance with this chapter.

Added by Acts 2009, 81st Leg., R.S., Ch. 1273, Sec. 1, eff. September 1, 2009.



Section 254.104.  Freestanding Emergency Medical Care Facility Licensing Fund.

All fees collected under this chapter shall be deposited in the state treasury to the credit of the freestanding emergency medical care facility licensing fund and may be appropriated to the department only to administer and enforce this chapter.

Added by Acts 2009, 81st Leg., R.S., Ch. 1273, Sec. 1, eff. September 1, 2009.



Subchapter D. Regulation Of Facilities

Section 254.151.  Minimum Standards.

(a) The executive commissioner shall adopt rules necessary to implement this chapter, including minimum standards for:

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

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

(3)  the administration of the facility;

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

(5)  the sanitary and hygienic conditions within the facility and its surroundings;

(6)  the requirements for the contents, maintenance, and release of medical records;

(7)  the minimal level of care and standards for denial of care;

(8)  the provision of laboratory and radiological services;

(9)  the distribution and administration of drugs and controlled substances;

(10)  a quality assurance program for patient care;

(11)  disclosure, if applicable, of the following:

(A)  the name and social security number of the sole proprietor, if the facility is a sole proprietor;

(B)  the name and social security number of each general partner who is an individual, if the facility is a partnership;

(C)  the name and social security number of any individual who has an ownership interest of more than 25 percent in the corporation, if the facility is a corporation; and

(D)  the name and license numbers of any physicians licensed by the Texas Medical Board who have a financial interest in the facility or any entity which has an ownership interest in the facility;

(12)  transfer protocols for patients requiring advanced medical care at a hospital; and

(13)  any other aspect of the operation of a facility that the executive commissioner considers necessary to protect the facility's patients and the public.

(b)  In adopting the rules required under Subsection (a) concerning transfer protocols, the executive commissioner must consult with physicians who provide emergency care, medical consultant organizations, and organizations representing hospitals licensed in this state.

(c)  The minimum standards under this section shall apply to facilities operating 24 hours a day and 7 days per week and facilities operating less than 24 hours a day and 7 days per week.

Added by Acts 2009, 81st Leg., R.S., Ch. 1273, Sec. 1, eff. September 1, 2009.



For expiration of this section, see Subsection (d).

Section 254.152.  Facilities Not In Continuous Operation.

(a) A facility that is not in continuous operation shall display a clearly visible sign that:

(1)  indicates whether the facility is open or closed;

(2)  provides information regarding the facility's operating hours; and

(3)  provides clear instructions directing a patient to an emergency room in a licensed hospital or a freestanding emergency room classified as a facility that is in continuous operation within 10 miles of the facility that is not in continuous operation.

(b)  A facility that is not in continuous operation may not advertise, market, or otherwise promote the services provided by the facility using the term "emergency" or any similar term defined by department rule.

(c)  Notwithstanding Subsection (b), a facility that is not in continuous operation is not required to comply with Subsection (b) until the earlier of the second anniversary of the date the facility is issued a license under this chapter or September 1, 2012.  This subsection expires January 1, 2013.

(d)  This section expires August 31, 2013.

Added by Acts 2009, 81st Leg., R.S., Ch. 1273, Sec. 1, eff. September 1, 2009.



Section 254.153.  Facility Care Requirements.

(a) A facility shall provide to each facility patient, without regard to the individual's ability to pay, an appropriate medical screening, examination, and stabilization within the facility's capability, including ancillary services routinely available to the facility, to determine whether an emergency medical condition exists and any necessary stabilizing treatment.

(b)  Before a facility accepts any patient for treatment or diagnosis, the facility shall enter into a referral, transmission, or admission agreement with a hospital licensed in this state.

Added by Acts 2009, 81st Leg., R.S., Ch. 1273, Sec. 1, eff. September 1, 2009.



Section 254.154.  Complaints.

A person may file a complaint with the department against a facility licensed under this chapter.

Added by Acts 2009, 81st Leg., R.S., Ch. 1273, Sec. 1, eff. September 1, 2009.



Subchapter E. Enforcement And Penalties

Section 254.201.  Denial, Suspension, Probation, 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.

(c)  If the department finds that a facility is in repeated noncompliance with this chapter or rules adopted under this chapter but that the noncompliance does not endanger public health and safety, the department may schedule the facility for probation rather than suspending or revoking the facility's license.  The department shall provide notice to the facility of the probation and of the items of noncompliance not later than the 10th day before the date the probation period begins.  The department shall designate a period of not less than 30 days during which the facility remains under probation.  During the probation period, the facility must correct the items that were in noncompliance and report the corrections to the department for approval.

(d)  The department may suspend or revoke the license of a facility that does not correct items that were in noncompliance or that does not comply with this chapter or the rules adopted under this chapter within the applicable probation period.

Added by Acts 2009, 81st Leg., R.S., Ch. 1273, Sec. 1, eff. March 1, 2010.



Section 254.202.  Emergency Suspension.

(a) The department may issue an emergency order to suspend a license issued under this chapter if the department has reasonable cause to believe that the conduct of a license holder creates an immediate danger to the public health and safety.

(b)  An emergency suspension under this section is effective immediately without a hearing on notice to the license holder.

(c)  On written request of the license holder, the department shall conduct a hearing not earlier than the 10th day or later than the 30th day after the date the hearing request is received to determine if the emergency suspension is to be continued, modified, or rescinded.

(d)  A hearing and any appeal under this section are governed by the department's rules for a contested case hearing and Chapter 2001, Government Code.

Added by Acts 2009, 81st Leg., R.S., Ch. 1273, Sec. 1, eff. March 1, 2010.



Section 254.203.  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 a facility.

(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 a facility 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 facility is located or in Travis County.

Added by Acts 2009, 81st Leg., R.S., Ch. 1273, Sec. 1, eff. March 1, 2010.



Section 254.204.  Criminal Penalty. (a)

A person commits an offense if the person violates Section 254.051.

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

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

Added by Acts 2009, 81st Leg., R.S., Ch. 1273, Sec. 1, eff. September 1, 2010.



Section 254.205.  Imposition Of Administrative Penalty.

(a) The department may impose an administrative penalty on a person licensed under this chapter who violates this chapter or a rule or order adopted under this chapter.  A penalty collected under this section or Section 254.206 shall be deposited in the state treasury in the general revenue fund.

(b)  A proceeding to impose the penalty is considered to be a contested case under Chapter 2001, Government Code.

(c)  The amount of the penalty may not exceed $1,000 for each violation, and each day a violation continues or occurs is a separate violation for purposes of imposing a penalty.  The total amount of the penalty assessed for a violation continuing or occurring on separate days under this subsection may not exceed $5,000.

(d)  The amount shall be based on:

(1)  the seriousness of the violation, including the nature, circumstances, extent, and gravity of the violation;

(2)  the threat to health or safety caused by the violation;

(3)  the history of previous violations;

(4)  the amount necessary to deter a future violation;

(5)  whether the violator demonstrated good faith, including when applicable whether the violator made good faith efforts to correct the violation; and

(6)  any other matter that justice may require.

(e)  If the department initially determines that a violation occurred, the department shall give written notice of the report by certified mail to the person.

(f)  The notice under Subsection (e) must:

(1)  include a brief summary of the alleged violation;

(2)  state the amount of the recommended penalty; and

(3)  inform the person of the person's right to a hearing on the occurrence of the violation, the amount of the penalty, or both.

(g)  Within 20 days after the date the person receives the notice under Subsection (e), the person in writing may:

(1)  accept the determination and recommended penalty of the department; or

(2)  make a request for a hearing on the occurrence of the violation, the amount of the penalty, or both.

(h)  If the person accepts the determination and recommended penalty or if the person fails to respond to the notice, the commissioner of state health services by order shall approve the determination and impose the recommended penalty.

(i)  If the person requests a hearing, the commissioner of state health services shall refer the matter to the State Office of Administrative Hearings, which shall promptly set a hearing date and give written notice of the time and place of the hearing to the person.  An administrative law judge of the State Office of Administrative Hearings shall conduct the hearing.

(j)  The administrative law judge shall make findings of fact and conclusions of law and promptly issue to the commissioner of state health services a proposal for a decision about the occurrence of the violation and the amount of a proposed penalty.

(k)  Based on the findings of fact, conclusions of law, and proposal for a decision, the commissioner of state health services by order may:

(1)  find that a violation occurred and impose a penalty; or

(2)  find that a violation did not occur.

(l)  The notice of the order under Subsection (k) that is sent to the person in accordance with Chapter 2001, Government Code, must include a statement of the right of the person to judicial review of the order.

Added by Acts 2009, 81st Leg., R.S., Ch. 1273, Sec. 1, eff. March 1, 2010.



Section 254.206.  Payment And Collection Of Administrative Penalty; Judicial Review.

(a) Within 30 days after the date an order of the commissioner of state health services under Section 254.205(k) that imposes an administrative penalty becomes final, the person shall:

(1)  pay the penalty; or

(2)  file a petition for judicial review of the commissioner's order contesting the occurrence of the violation, the amount of the penalty, or both.

(b)  Within the 30-day period prescribed by Subsection (a), a person who files a petition for judicial review may:

(1)  stay enforcement of the penalty by:

(A)  paying the penalty to the court for placement in an escrow account; or

(B)  giving the court a supersedeas bond approved by the court that:

(i)  is for the amount of the penalty; and

(ii)  is effective until all judicial review of the commissioner's order is final; or

(2)  request the court to stay enforcement of the penalty by:

(A)  filing with the court a sworn affidavit of the person stating that the person is financially unable to pay the penalty and is financially unable to give the supersedeas bond; and

(B)  sending a copy of the affidavit to the executive commissioner by certified mail.

(c)  If the commissioner of state health services receives a copy of an affidavit under Subsection (b)(2), the commissioner may file with the court, within five days after the date the copy is received, a contest to the affidavit.  The court shall hold a hearing on the facts alleged in the affidavit as soon as practicable and shall stay the enforcement of the penalty on finding that the alleged facts are true.  The person who files an affidavit has the burden of proving that the person is financially unable to pay the penalty or to give a supersedeas bond.

(d)  If the person does not pay the penalty and the enforcement of the penalty is not stayed, the penalty may be collected.  The attorney general may sue to collect the penalty.

(e)  If the court sustains the finding that a violation occurred, the court may uphold or reduce the amount of the penalty and order the person to pay the full or reduced amount of the penalty.

(f)  If the court does not sustain the finding that a violation occurred, the court shall order that a penalty is not owed.

(g)  If the person paid the penalty and if the amount of the penalty is reduced or the penalty is not upheld by the court, the court shall order, when the court's judgment becomes final, that the appropriate amount plus accrued interest be remitted to the person within 30 days after the date that the judgement of the court becomes final.  The interest accrues at the rate charged on loans to depository institutions by the New York Federal Reserve Bank.  The interest shall be paid for the period beginning on the date the penalty is paid and ending on the date the penalty is remitted.

(h)  If the person gave a supersedeas bond and the penalty is not upheld by the court, the court shall order, when the court's judgment becomes final, the release of the bond.  If the person gave a supersedeas bond and the amount of the penalty is reduced, the court shall order the release of the bond after the person pays the reduced amount.

Added by Acts 2009, 81st Leg., R.S., Ch. 1273, Sec. 1, eff. March 1, 2010.


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