reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 511 - LIMITED SERVICES RURAL HOSPITALS › Subchapter C - OPERATIONAL REQUIREMENTS › Section 511.60 - Staffing and Staff Responsibilities

Current through Reg. 49, No. 28; July 12, 2024
(a) The LSRH must have a professional health
				  care staff that includes one or more physicians, and may include one or more
				  physician assistants, or advanced practice registered nurses (APRN).
(b) Any ancillary personnel are supervised by
				  the professional staff.
(c) There
				  shall be a written delineation of functions, qualifications, and patient care
				  responsibilities for all categories of personnel.
(d) The LSRH shall maintain documentation of
				  evidence that all personnel are trained prior to treatment of
				  services.
(e) The staff shall be
				  sufficient to provide the services essential to the operation of the
				  LSRH.
(f) A nurse shall be on duty
				  whenever the LSRH has one or more patients receiving emergency care or
				  observation care.
(g) If the LSRH
				  provides outpatient services, the services shall meet the needs of the patients
				  in accordance with acceptable standards of practice.
(1) The LSRH shall assign an individual to be
				  responsible for outpatient services.
(2) The LSRH shall have appropriate
				  physicians on staff and other professional and nonprofessional personnel
				  available.
(3) The physician must:
(A) provide medical direction for the LSRH's
				  health care activities and consultation for, and medical supervision of, the
				  health care staff;
(B) participate,
				  in conjunction with any physician assistant or nurse practitioner members, in
				  developing, executing, and periodically reviewing the LSRH's written policies
				  governing the services it furnishes;
(C) review periodically, in conjunction with
				  any physician assistant or nurse practitioner members, the LSRH patient
				  records, provide medical orders, and provide medical care services to the
				  patients of the LSRH; and
(D)
				  review periodically and sign a sample of outpatient records of patients cared
				  for by APRN or physician assistants only to the extent where state law requires
				  record reviews or co-signatures, or both, by a collaborating
				  physician.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 511 - LIMITED SERVICES RURAL HOSPITALS › Subchapter C - OPERATIONAL REQUIREMENTS › Section 511.61 - Nursing Services

Current through Reg. 49, No. 28; July 12, 2024
(a) A
				  limited services rural hospital (LSRH) shall have a well-organized nursing
				  service with a plan of administrative authority and delineation of
				  responsibilities for patient care and provides 24-hour nursing services as
				  needed.
(b) An LSRH shall provide
				  nursing services in accordance with current recognized standards or recommended
				  practices.
(c) Nursing services
				  shall be under the administrative authority of a chief nursing officer (CNO)
				  who is a registered nurse (RN).
(1) The CNO
				  shall be responsible for the operation of nursing services, including
				  determining the types and numbers of nursing personnel and staff necessary to
				  provide nursing care for all areas of the LSRH.
(2) The CNO shall report directly to the
				  individual who has authority to represent the LSRH and who is responsible for
				  the operation of the LSRH according to the policies and procedures of the
				  LSRH's governing board.
(3) The CNO
				  shall participate with the governing body, medical staff, and clinical areas,
				  in planning, promoting and conducting performance improvement
				  activities.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 511 - LIMITED SERVICES RURAL HOSPITALS › Subchapter C - OPERATIONAL REQUIREMENTS › Section 511.62 - Discharge Planning

Current through Reg. 49, No. 28; July 12, 2024
(a) A
				  limited services rural hospital (LSRH) shall have an effective, ongoing,
				  discharge planning process that facilitates the provision of follow-up care and
				  focuses on the patient's goals and treatment preferences and includes the
				  patient and their caregivers or support persons as active partners in the
				  discharge planning for post-discharge care.
(b) The discharge planning process and the
				  discharge plan shall be consistent with the patient's goals for care and their
				  treatment preferences, ensure an effective transition of the patient from the
				  LSRH to post-discharge care, and reduce the factors leading to preventable LSRH
				  admissions or readmissions.
(c) An
				  LSRH's discharge planning process shall identify, at an early stage of the
				  provision of services, those patients who are likely to suffer adverse health
				  consequences on discharge in the absence of adequate discharge planning and
				  must provide a discharge planning evaluation for those patients so identified
				  as well as for other patients upon the request of the patient, patient's
				  legally authorized representative, or patient's physician.
(d) Any discharge planning evaluation must be
				  made on a timely basis to ensure appropriate arrangements for post-LSRH care
				  will be made before discharge and to avoid unnecessary delays in
				  discharge.
(e) A discharge planning
				  evaluation must include:
(1) an evaluation of
				  a patient's likely need for appropriate services following those furnished by
				  the LSRH, including:
(A) hospice care
				  services;
(B) post-LSRH extended
				  care services;
(C) home health
				  services;
(D) non-health care
				  services; and
(E) community-based
				  care providers;
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 511 - LIMITED SERVICES RURAL HOSPITALS › Subchapter C - OPERATIONAL REQUIREMENTS › Section 511.64 - Quality Assessment and Performance Improvement Program

Current through Reg. 49, No. 28; July 12, 2024
(a) A limited services rural hospital (LSRH)
				  shall develop, implement, and maintain an effective, ongoing, LSRH-wide,
				  data-driven quality assessment and performance improvement (QAPI)
				  program.
(b) An LSRH's governing
				  body shall ensure the QAPI program is individualized to ensure the LSRH
				  complies with the requirements of this section, reflects the complexity of the
				  LSRH's organization and services, involves all LSRH departments and services
				  (including those services furnished under contract or arrangement), and focuses
				  on indicators related to improved health outcomes and the prevention and
				  reduction of medical errors. The LSRH must maintain and demonstrate evidence of
				  its QAPI program.
(c) The LSRH
				  shall measure, analyze, and track quality indicators, including adverse patient
				  events, staffing, and other aspects of performance to evaluate processes of
				  care, including LSRH service and operations.
(d) The QAPI program shall:
(1) include an ongoing program that shows
				  measurable improvement in indicators for which there is evidence that it will
				  improve health outcomes and identify and reduce medical errors;
(2) incorporate quality indicator data,
				  including patient care data, and other relevant data, to achieve the goals of
				  the QAPI program;
(3) evaluate all
				  LSRH departments and services, including services furnished under contract or
				  arrangement;
(4) evaluate health
				  care associated infections;
(5)
				  evaluate medication therapy;
(6)
				  evaluate all medical and surgical services performed in the LSRH as they relate
				  to appropriateness of diagnosis and treatment;
(7) measure, analyze, and track quality
				  indicators, including adverse patients' events, and other aspects of
				  performance that assess processes of care, LSRH services, and operations;
				  and
(8) use the data collected to
				  monitor the effectiveness and safety of service and quality of care, and to
				  identify opportunities for changes that will lead to improvement.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 511 - LIMITED SERVICES RURAL HOSPITALS › Subchapter C - OPERATIONAL REQUIREMENTS › Section 511.65 - Patient Transfer Policy

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  The governing body of each limited services rural hospital (LSRH) shall adopt,
				  implement, and enforce a policy relating to patient transfers consistent with
				  this section and contains each of the requirements in subsection (b) of this
				  section. The policy shall identify LSRH staff that has authority to represent
				  the LSRH and the physician regarding transfers from the LSRH.
(b) The LSRH's governing body shall adopt the
				  transfer policy after consultation with the medical staff. The policy shall
				  apply to patient transfers to general and special hospitals licensed under
				  Texas Health and Safety Code (HSC) Chapter 241 (relating to Hospitals) and
				  private psychiatric hospitals licensed under HSC Chapter 577 (relating to
				  Private Mental Hospitals and Other Mental Health Facilities), as well as
				  transfers to general, special, and private psychiatric hospitals that are
				  exempt from licensing.
(c) The
				  LSRH's transfer policy shall govern transfers not covered by a transfer
				  agreement.
(d) The LSRH's transfer
				  policy shall include a written operational plan to provide for patient transfer
				  transportation services if the LSRH does not provide its own patient transfer
				  transportation services.
(e) The
				  LSRH's governing body, after consultation with the medical staff, shall
				  implement its transfer policy by adopting transfer agreements with hospitals in
				  accordance with this section.
(f)
				  The LSRH's transfer policy shall recognize and comply with the requirements HSC
				  Chapter 61 §§61.030 - 61.032 and §§61.057 - 61.059
				  (relating to Indigent Health Care and Treatment Act).
(g) The LSRH's transfer policy shall
				  acknowledge contractual obligations and comply with statutory or regulatory
				  obligations that may exist concerning a patient and a designated
				  provider.
(h) The LSRH's transfer
				  policy shall require the LSRH to take all reasonable steps to secure the
				  written informed consent of a patient, or a person acting on a patient's
				  behalf, when refusing a transfer or related examination and treatment.
				  Reasonable steps include:
(1) providing a
				  factual explanation regarding:
(A) the
				  increased medical risks to the patient reasonably expected from not being
				  transferred, examined, or treated at the transferring hospital;
(B) any increased risks to the patient from
				  not effecting the transfer; and
(C)
				  the medical benefits reasonably expected from the provision of appropriate
				  treatment at another hospital; and
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 511 - LIMITED SERVICES RURAL HOSPITALS › Subchapter C - OPERATIONAL REQUIREMENTS › Section 511.66 - Patient Transfer Agreements

Current through Reg. 49, No. 28; July 12, 2024
(a) A limited services rural hospital (LSRH)
				  shall have in effect an agreement with at least one general hospital that is a
				  level I or level II trauma center as designated by the Texas Department of
				  State Health Services (DSHS), certified by the Centers for Medicare &
				  Medicaid Services for the referral and transfer of patients requiring emergency
				  medical care beyond the capabilities of the LSRH, and is:
(1) licensed under Texas Health and Safety
				  Code (HSC) Chapter 241;
(2)
				  maintained or operated by the state or an agency of the federal government and
				  exempt from licensure under HSC Chapter 241; or
(3) maintained or operated by the federal
				  government or an agency of the federal government and exempt from licensure
				  under HSC Chapter 241.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 511 - LIMITED SERVICES RURAL HOSPITALS › Subchapter C - OPERATIONAL REQUIREMENTS › Section 511.67 - Medical Records

Current through Reg. 49, No. 28; July 12, 2024
(a) A
				  limited services rural hospital (LSRH) shall maintain a medical records system
				  in accordance with the LSRH's written policies and procedures, which must:
(1) contain procedures for collecting,
				  processing, maintaining, storing, retrieving, authenticating, and distributing
				  patient medical records; and
(2)
				  require the medical records to be:
(A)
				  legible;
(B) completely and
				  accurately documented, dated, and timed;
(C) authenticated by the person responsible
				  for providing or evaluating the service provided no later than 48 hours after
				  the patient's discharge;
(D)
				  systematically organized according to a predetermined and uniform medical
				  record format;
(E) confidential,
				  secure, and safely stored; and
(F)
				  readily accessible, including that all a patient's relevant clinical
				  information is readily available to physicians or practitioners involved in
				  that patient's care, and an individual's records are timely retrievable upon
				  request.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 511 - LIMITED SERVICES RURAL HOSPITALS › Subchapter C - OPERATIONAL REQUIREMENTS › Section 511.68 - Emergency Preparedness

Current through Reg. 49, No. 28; July 12, 2024
(a) A
				  limited services rural hospital (LSRH) shall develop, adopt, implement,
				  enforce, and maintain a written emergency preparedness plan. The LSRH shall
				  review and update the plan at least every two years. The plan shall:
(1) be based on and include a documented,
				  facility-based and community-based risk assessment, using an all-hazards
				  approach;
(2) include strategies
				  for addressing emergency events identified by the risk assessment;
(3) identify the services the LSRH has the
				  ability to provide in an emergency and include strategies for addressing and
				  serving the patient population;
(4)
				  include the use of a Texas Health and Human Services Commission (HHSC)-approved
				  process to update patient station availability as requested by HHSC during a
				  public health emergency or state-declared disaster;
(5) include continuity of operations,
				  including delegations of authority and succession plans;
(6) include a process for cooperation and
				  collaboration with local, tribal, regional, state, and federal emergency
				  preparedness officials' efforts to maintain an integrated response during a
				  disaster or emergency situation; and
(7) incorporate applicable information listed
				  in subsection (e) of this section and the State of Texas Emergency Management
				  Plan. Information regarding the State of Texas Emergency Management Plan is
				  available from the city or county emergency management coordinator.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 511 - LIMITED SERVICES RURAL HOSPITALS › Subchapter C - OPERATIONAL REQUIREMENTS › Section 511.69 - Skilled Nursing Facility as a Distinct Unit

Current through Reg. 49, No. 28; July 12, 2024
When a limited services rural hospital provides skilled
					 nursing facility services, the services shall be provided in a unit that is in
					 a distinct part, according to Code of Federal Regulations Title 42
					 §485.546 (Relating to Skilled Nursing Facility Distinct Part Unit), that
					 is separately licensed as a nursing facility under Texas Health and Safety Code
					 Chapter 242 (relating to Convalescent and Nursing Facilities and Related
					 Institutions), certified by the Centers for Medicaid & Medicare Services,
					 and comply with the requirements of participation for long-term care facilities
					 specified in the Code of Federal Regulations Title 42 Part 483, Subpart B
					 (relating to Requirements for Long Term Care Facilities).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 511 - LIMITED SERVICES RURAL HOSPITALS › Subchapter C - OPERATIONAL REQUIREMENTS › Section 511.70 - Respiratory Care Services

Current through Reg. 49, No. 28; July 12, 2024
(a) If a limited services rural hospital
				  (LSRH) provides respiratory care as an outpatient service, the services shall
				  meet the needs of the patients in accordance with acceptable standards of
				  practice and shall comply with this section.
(b) The LSRH shall adopt, implement, and
				  enforce policies and procedures that describe respiratory care services
				  provision in the LSRH.
(c) The LSRH
				  shall provide respiratory care services only on, and in accordance with, a
				  physician's orders.
(d) The LSRH
				  shall organize respiratory care services to ensure they are appropriate to the
				  scope and complexity of the services offered.
(e) The LSRH shall have a medical director or
				  clinical director of respiratory care services who is a physician with the
				  knowledge, experience, and capabilities to supervise and administer the
				  services properly. The medical director or clinical director may serve on
				  either a full-time or part-time basis.
(f) The LSRH shall ensure the LSRH has an
				  adequate number of respiratory therapists, respiratory therapy technicians, and
				  other personnel who meet the qualifications specified by the medical staff,
				  consistent with state law.
(g) The
				  LSRH shall designate, in writing, personnel qualified to perform specific
				  procedures and the amount of supervision required for personnel to carry out
				  specific procedures.
(h) When
				  respiratory care services staff perform blood gases or other clinical
				  laboratory tests, the respiratory care staff shall comply with the Clinical
				  Laboratory Improvement Amendments of 1988 (CLIA 1988) and the CLIA 1988
				  regulations at Code of Federal Regulations Title 42 CFR Part 493 (relating to
				  Laboratory Requirements).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 511 - LIMITED SERVICES RURAL HOSPITALS › Subchapter C - OPERATIONAL REQUIREMENTS › Section 511.71 - Waste and Waste Disposal

Current through Reg. 49, No. 28; July 12, 2024
(a) A
				  limited services rural hospital (LSRH) shall comply with the requirements set
				  forth by the Texas Commission on Environmental Quality (TCEQ) in Texas
				  Administrative Code Title 30 (30 TAC) Chapter 326 (relating to Medical Waste
				  Management).
(b) An LSRH shall
				  dispose of all sewage and liquid wastes in a municipal sewerage system or a
				  septic tank system permitted by TCEQ in accordance with 30 TAC Chapter 285
				  (relating to On-Site Sewage Facilities).
(c) An LSRH shall comply with 25 TAC Chapter
				  1, Subchapter K (relating to the Definition, Treatment, and Disposition of
				  Special Waste from Health Care-Related Facilities).
(d) An LSRH shall make waste receptacles
				  conveniently available in all toilet rooms, patient areas, staff work areas,
				  and waiting rooms. The LSRH shall ensure receptacles are routinely emptied of
				  their contents at a central location or locations into closed
				  containers.
(e) An LSRH shall
				  properly clean waste receptacles with soap and hot water, followed by treatment
				  of inside surfaces of the receptacles with a germicidal agent.
(f) An LSRH shall ensure all containers for
				  other municipal solid waste are leak-resistant, have tight-fitting covers, and
				  are rodent-proof.
(g) An LSRH shall
				  ensure non-reusable containers are of suitable strength to minimize animal
				  scavenging or rupture during collection operations.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 511 - LIMITED SERVICES RURAL HOSPITALS › Subchapter C - OPERATIONAL REQUIREMENTS › Section 511.72 - Linen and Laundry Services

Current through Reg. 49, No. 28; July 12, 2024
(a) A
				  limited services rural hospital (LSRH) shall provide sufficient clean linen to
				  ensure the patient's comfort.
(b)
				  An LSRH, whether it operates its own laundry or uses commercial service, shall
				  ensure the following.
(1) LSRH employees
				  involved in transporting, processing, or otherwise handling clean or soiled
				  linen are given initial and follow-up in-service training to ensure a safe
				  product for patients and to safeguard employees in their work.
(2) Clean linen is handled, transported, and
				  stored by methods that will ensure its cleanliness.
(3) All contaminated linen is placed and
				  transported in bags or containers labeled or color-coded.
(4) LSRH employees who have contact with
				  contaminated linen wear gloves and other appropriate personal protective
				  equipment.
(5) Contaminated linen
				  is handled as little as possible and with a minimum of agitation and is not
				  sorted or rinsed in patient care areas.
(6) All contaminated linen is bagged or put
				  into carts at the location where it was used.
(A) Bags containing contaminated linen are
				  closed before transport to the laundry.
(B) Whenever contaminated linen is wet and
				  presents a reasonable likelihood of soak-through of or leakage from the bag or
				  container, the linen is deposited and transported in bags that prevent leakage
				  of fluids to the exterior.
(C) All
				  linen placed in chutes is bagged.
(D) If chutes are not used to convey linen to
				  a central receiving or sorting room, then adequate space is allocated on the
				  various nursing units for holding the bagged contaminated linen.
(7) Linen is processed as follows.
(A) When using hot water, the LSRH shall wash
				  the linen with detergent in the water with a temperature of at least 71 degrees
				  Centigrade (160 degrees Fahrenheit) for 25 minutes. The LSRH shall meet the hot
				  water requirements specified in Table 5 of §
												511.169(e) of
				  this chapter (relating to Tables).
(B) When using low-temperature (less than or
				  equal to 70 degrees Centigrade) (158 degrees Fahrenheit) laundry cycles, the
				  LSRH shall use chemicals suitable for low-temperature washing at proper use
				  concentration.
(C) Commercial dry
				  cleaning of fabrics soiled with blood also renders these items free of the risk
				  of pathogen transmission.
(D) The
				  LSRH shall not use flammable liquids to process laundry, but may use flammable
				  liquids for equipment maintenance.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 511 - LIMITED SERVICES RURAL HOSPITALS › Subchapter C - OPERATIONAL REQUIREMENTS › Section 511.73 - Sterilization

Current through Reg. 49, No. 28; July 12, 2024
(a) A
				  limited services rural hospital (LSRH) staff qualified by education, training,
				  and experience shall supervise all supplies and equipment sterilization in an
				  LSRH. An LSRH shall ensure:
(1) staff
				  responsible for sterilizing supplies and equipment participate in a documented
				  continuing education program;
(2)
				  new employees receive initial orientation and on-the-job training;
				  and
(3) staff using chemical
				  disinfectants received training on their use.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 511 - LIMITED SERVICES RURAL HOSPITALS › Subchapter C - OPERATIONAL REQUIREMENTS › Section 511.74 - Sanitary Conditions and Hygienic Practices

Current through Reg. 49, No. 28; July 12, 2024
(a) A limited services rural hospital (LSRH)
				  shall follow universal precautions for all patient care activities in
				  accordance with Code of Federal Regulations Title 29 §1910.1030(d)(1) -
				  (3) (relating to Bloodborne Pathogens) and Texas Health and Safety Code Chapter
				  85, Subchapter I (relating to Prevention of Transmission of HIV and Hepatitis B
				  Virus by Infected Health Care Workers).
(b) An LSRH shall develop, implement, and
				  enforce policies and procedures to provide and actively monitor a safe,
				  functional, comfortable, and sanitary environment that minimizes or prevents
				  transmission of infectious diseases for all patients, visitors, and the public.
(1) The LSRH shall clean blood spills
				  immediately or as soon as is practical with a disposable cloth and an
				  appropriate chemical disinfectant.
(2) The surface shall be subjected to
				  intermediate-level disinfection in accordance with the manufacturer's
				  directions for use, if a commercial liquid chemical disinfectant is
				  used.
(3) When a solution of
				  chlorine bleach (sodium hypochlorite) is used, the solution shall be at least
				  1:100 sodium hypochlorite and mixed in accordance with the manufacturer's
				  directions for use. The surface to be treated shall be compatible with this
				  type of chemical treatment.
(4) The
				  LSRH shall use dedicated cleaning supplies (i.e., mop, bucket) for the cleaning
				  of blood spills.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 511 - LIMITED SERVICES RURAL HOSPITALS › Subchapter C - OPERATIONAL REQUIREMENTS › Section 511.75 - Limited Services Rural Hospital Billing

Current through Reg. 49, No. 28; July 12, 2024
(a) A limited services rural hospital (LSRH)
				  shall adopt, implement, and enforce a policy to ensure that the hospital
				  complies with the Texas Health and Safety Code (HSC) §311.002 (relating to
				  Itemized Statement of Billed Services).
(b) An LSRH shall adopt, implement, and
				  enforce a policy to ensure that the LSRH complies with HSC §311.0025
				  (relating to Audits of Billing).
(c) An LSRH may not violate a law that
				  prohibits the hospital from billing a patient who is an insured, participant,
				  or enrollee in a managed care plan an amount greater than an applicable
				  copayment, coinsurance, and deductible under the insured's, participant's, or
				  enrollee's managed care plan or that imposes a requirement related to that
				  prohibition.
(d) An LSRH shall
				  comply with Senate Bill 1264, 86th Legislature, Regular Session, 2019, and with
				  related Texas Department of Insurance rules at 28 Texas Administrative Code
				  (TAC) Chapter 21, Subchapter OO (relating to Disclosures by Out-of-Network
				  Providers) to the extent that subchapter applies to the LSRH.
(e) A complaint submitted to the Texas Health
				  and Human Services Commission's (HHSC's) Complaint and Incident Intake relating
				  to billing must specify the patient for whom the bill was submitted.
(1) Upon receiving a complaint warranting an
				  investigation, HHSC shall send the complaint to the LSRH and request the LSRH
				  to conduct an internal investigation. Within 30 days of the LSRH's receipt of
				  the complaint, the LSRH shall submit to HHSC:
(A) a report outlining the LSRH's
				  investigative process;
(B) the
				  resolution or conclusions reached by the LSRH with the patient, third party
				  payor, or complainant; and
(C)
				  corrections, if any, in the LSRH's policies or protocols that were made as a
				  result of its investigative findings.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 511 - LIMITED SERVICES RURAL HOSPITALS › Subchapter C - OPERATIONAL REQUIREMENTS › Section 511.76 - Patient Visitation

Current through Reg. 49, No. 28; July 12, 2024
(a) A
				  limited services rural hospital (LSRH) shall adopt, implement, and enforce
				  written policies and procedures regarding patient visitation rights, including
				  those setting forth any clinically necessary or reasonable restriction or
				  limitation that the LSRH may need to place on such rights and the reasons for
				  the clinical restriction or limitation.
(b) An LSRH shall:
(1) inform each patient (or support person,
				  where appropriate) of their visitation rights, including any clinical
				  restriction or limitation on such rights, when they are informed of their other
				  rights under §
											511.63 of this subchapter
				  (relating to Patient's Rights);
(2)
				  inform each patient of the LSRH's visitation policy;
(3) inform each patient (or support person,
				  where appropriate) of the right, subject to their consent, to receive the
				  visitors whom they designate, including a spouse, a domestic partner (including
				  a same-sex domestic partner), another family member, or a friend, and their
				  right to withdraw or deny such consent at any time;
(4) not restrict, limit, or otherwise deny
				  visitation privileges on the basis of race, color, national origin, religion,
				  sex, gender identity, sexual orientation, or disability;
(5) ensure all visitors enjoy full and equal
				  visitation privileges consistent with patient preferences; and
(6) record any clinically justified
				  visitation restrictions in the patient's medical record.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 511 - LIMITED SERVICES RURAL HOSPITALS › Subchapter C - OPERATIONAL REQUIREMENTS › Section 511.77 - Hospital Price Transparency Reporting and Enforcement

Current through Reg. 49, No. 28; July 12, 2024
(a) A limited services rural hospital (LSRH)
				  shall comply with the disclosure and reporting requirements of Texas Health and
				  Safety Code (HSC) Chapter 327 (relating to Disclosure of Prices) as described
				  in this section.
(b) An LSRH shall
				  make the information required by HSC Chapter 327 available in a prominent
				  location on the home page of its publicly accessible website or accessible by
				  selecting a dedicated link that is prominently displayed on the home page of
				  its publicly accessible website. If the LSRH operates multiple locations and
				  maintains a single website, the homepage must contain a link to the list
				  containing the links to each location the LSRH operates in a manner that
				  clearly associates the list with the applicable location of the LSRH.
(c) Each time an LSRH updates a list as
				  required by HSC §327.003 and §327.004, it shall submit the updated
				  list to the Texas Health and Human Services Commission (HHSC) in the manner
				  specified by HHSC on its website.
(d) HHSC has jurisdiction to impose an
				  administrative penalty against a hospital licensed under this chapter for
				  violations of HSC Chapter 327 and this section. An administrative penalty
				  imposed under this section shall be in accordance with the provisions of HSC
				  §327.008.
(e) In determining
				  the amount of any penalty sought pursuant to HSC §327.008, HHSC shall
				  consider:
(1) previous violations by the
				  hospital's operator;
(2) the
				  seriousness of the violation;
(3)
				  the demonstrated good faith of the hospital's operator; and
(4) any other matters that justice may
				  require.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 511 - LIMITED SERVICES RURAL HOSPITALS › Subchapter C - OPERATIONAL REQUIREMENTS › Section 511.78 - Restraint and Seclusion

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  All patients have the right to be free from restraint or seclusion, of any
				  form, imposed as a means of coercion, discipline, convenience, or retaliation
				  by staff. Restraint or seclusion may only be imposed to ensure the immediate
				  physical safety of the patient, a staff member, or others and must be
				  discontinued at the earliest possible time.
(b) A limited services rural hospital (LSRH)
				  may only use restraint or seclusion when less restrictive interventions have
				  been determined to be ineffective to protect the patient, a staff member, or
				  others from harm.
(c) The type or
				  technique of restraint or seclusion used must be the least restrictive
				  intervention that will be effective to protect the patient, a staff member, or
				  others from harm.
(d) The LSRH
				  shall have written policies and procedures regarding the use of restraint and
				  seclusion that are consistent with current standards of practice.
(e) An LSRH may only seclude a patient for
				  the management of violent or self-destructive behavior.
(f) The patient has the right to safe
				  implementation of restraint or seclusion by trained staff.
(1) The LSRH shall provide patient-centered
				  competency-based training and education on the use of restraint and seclusion
				  to LSRH personnel and staff, including medical staff and, as applicable,
				  personnel providing contracted services in the LSRH.
(2) The training must include de-escalation
				  techniques and other alternatives to the use of restraint or
				  seclusion.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 511 - LIMITED SERVICES RURAL HOSPITALS › Subchapter D - INSPECTIONS AND INVESTIGATIONS › Section 511.111 - Integrity of Inspections and Investigations

Current through Reg. 49, No. 28; July 12, 2024
(a) In order to preserve the integrity of the
				  Texas Health and Human Services Commission's (HHSC's) inspection and
				  investigation process, a limited services rural hospital (LSRH):
(1) shall not record, listen to, or eavesdrop
				  on any HHSC interview with LSRH staff or patients that the LSRH staff knows
				  HHSC intends to keep confidential as evidenced by HHSC taking reasonable
				  measures to prevent from being overheard; or
(2) shall not record, listen to, or eavesdrop
				  on any HHSC internal discussions outside the presence of LSRH staff when HHSC
				  has requested a private room or office or distanced themselves from LSRH staff
				  and the LSRH obtains HHSC written approval before beginning to record or listen
				  to the discussion.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 511 - LIMITED SERVICES RURAL HOSPITALS › Subchapter D - INSPECTIONS AND INVESTIGATIONS › Section 511.112 - Inspections

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  The Texas Health and Human Services Commission (HHSC) may inspect a limited
				  services rural hospital (LSRH) before issuing or renewing an LSRH license.
(1) An LSRH is not subject to additional
				  annual licensing inspections after HHSC issues the initial license while the
				  LSRH maintains:
(A) certification under Title
				  XVIII of the Social Security Act, 42 United States Code (USC), §§1395
				  et seq; or
(B) accreditation from
				  The Joint Commission, the American Osteopathic Association, or other national
				  accreditation organization for the offered services.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 511 - LIMITED SERVICES RURAL HOSPITALS › Subchapter D - INSPECTIONS AND INVESTIGATIONS › Section 511.113 - Complaint Investigations

Current through Reg. 49, No. 28; July 12, 2024
(a) A
				  limited services rural hospital (LSRH) shall provide each patient and
				  applicable consenter at the time of admission with a written statement
				  identifying the Texas Health and Human Services Commission (HHSC) as the agency
				  responsible for investigating complaints against the LSRH.
(1) The statement shall inform persons that
				  they may direct a complaint to HHSC's Complaint and Incident Intake (CII) and
				  include current CII contact information, as specified by HHSC.
(2) The LSRH shall prominently and
				  conspicuously post this information in each patient common area, visitor area,
				  and waiting room so that it is readily visible to patients, employees, and
				  visitors. The information shall be in English and in a second language
				  appropriate to the demographic makeup of the community served.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 511 - LIMITED SERVICES RURAL HOSPITALS › Subchapter D - INSPECTIONS AND INVESTIGATIONS › Section 511.114 - Notice

Current through Reg. 49, No. 28; July 12, 2024
(a) A
				  limited service rural hospital (LSRH) is deemed to have received any Texas
				  Health and Human Services Commission (HHSC) correspondence on the date of
				  receipt, or three business days after sending, whichever is earlier.
(b) When deficiencies are found:
(1) HHSC sends the LSRH a written Statement
				  of Deficiencies (SOD) within 10 business days after the exit conference by U.S.
				  Postal Service or electronic mail.
(2) Within 10 calendar days after the LSRH
				  receives the SOD, the LSRH shall return a written Plan of Correction (POC) to
				  HHSC that addresses each cited deficiency, including timeframes for
				  corrections, with any additional evidence of compliance.
(A) HHSC determines if a POC and proposed
				  timeframes are acceptable, and, if accepted, notifies the LSRH in
				  writing.
(B) If HHSC does not
				  accept the POC, HHSC notifies the LSRH, in writing, and requests the LSRH
				  submit a modified POC and any additional evidence no later than 10 business
				  days after HHSC notifies the LSRH in writing.
(C) The LSRH shall correct the identified
				  deficiencies and submit evidence to HHSC verifying the LSRH implemented all
				  corrective actions within the timeframes set forth in the POC, or as otherwise
				  specified by HHSC.
(3)
				  Regardless of the LSRH's compliance with this subsection or HHSC's acceptance
				  of an LSRH's POC, HHSC may, at any time, propose to take enforcement action as
				  appropriate under this chapter in accordance with §
											511.121 of this chapter (relating
				  Enforcement).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 511 - LIMITED SERVICES RURAL HOSPITALS › Subchapter D - INSPECTIONS AND INVESTIGATIONS › Section 511.115 - Professional Conduct

Current through Reg. 49, No. 28; July 12, 2024
In addition to any enforcement action under this chapter,
					 the Texas Health and Human Services Commission refers, in writing, any issue or
					 complaint relating to the conduct of a licensed professional, intern, or
					 applicant for professional licensure to the appropriate licensing
					 board.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 511 - LIMITED SERVICES RURAL HOSPITALS › Subchapter D - INSPECTIONS AND INVESTIGATIONS › Section 511.116 - Complaint Against an HHSC Representative

Current through Reg. 49, No. 28; July 12, 2024
(a) A limited services rural hospital (LSRH)
				  may register a complaint against a Texas Health and Human Services Commission
				  (HHSC) representative who conducts an inspection or investigation under this
				  subchapter by contacting the HHSC Health Facility Compliance Regional Director
				  for the region in which the LSRH is located.
(b) HHSC shall register all complaints
				  against an HHSC representative with HHSC leadership.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 511 - LIMITED SERVICES RURAL HOSPITALS › Subchapter E - ENFORCEMENT › Section 511.121 - Enforcement

Current through Reg. 49, No. 28; July 12, 2024
(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.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 511 - LIMITED SERVICES RURAL HOSPITALS › Subchapter F - FIRE PREVENTION AND SAFETY › Section 511.141 - Fire Prevention and Protection

Current through Reg. 49, No. 28; July 12, 2024
(a) Fire inspections.
(1) Annual inspection. A limited services
				  rural hospital (LSRH) shall obtain approval of the fire protection of the LSRH
				  by an individual certified by the Texas Commission on Fire Protection as a
				  prerequisite for licensure.
(2)
				  Hazardous or dangerous conditions or materials. Whenever any of the officers,
				  members, or inspectors of the Texas Commission on Fire Protection find in any
				  building or upon any premises dangerous or hazardous conditions or materials,
				  removal or remedy of dangerous conditions or materials shall be carried out in
				  a manner specified by the head of the local fire department.
(3) Access for inspection. At all reasonable
				  hours, the LSRH shall allow the chief of the fire department, the chief of the
				  bureau of fire prevention, or any of the fire inspectors to enter any LSRH
				  building or premises for the purpose of making an inspection or investigation
				  that may be deemed necessary under the provisions of these
				  rules.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 511 - LIMITED SERVICES RURAL HOSPITALS › Subchapter F - FIRE PREVENTION AND SAFETY › Section 511.142 - General Safety

Current through Reg. 49, No. 28; July 12, 2024
(a) Safety
				  committee. A limited services rural hospital (LSRH) shall have a
				  multidisciplinary safety committee. The LSRH chief executive officer (CEO)
				  shall appoint the chairman and members of the safety committee.
(1) Safety officer. The CEO shall appoint a
				  safety officer who is knowledgeable in safety practices in health care
				  facilities. The safety officer shall be a member of the safety committee, and
				  shall carry out the functions of the safety program.
(2) Safety committee meetings. The safety
				  committee shall meet as required by the chairman, but not less than quarterly.
				  The committee shall retain written minutes for each meeting for at least one
				  year.
(3) Safety activities.
(A) Incident reports. The safety committee
				  shall establish an incident reporting system that includes a mechanism to
				  ensure that all incidents recorded in safety committee minutes are evaluated,
				  and documentation is provided to show follow-up and corrective
				  actions.
(B) Safety policies and
				  procedures. Safety policies and procedures for each department or service shall
				  be developed, implemented, and enforced.
(C) Safety training and continuing education.
				  Safety training shall be established as part of new employee orientation and in
				  the continuing education of all employees.
(4) Written authority. The authority of the
				  safety committee to take action when conditions exist that are a possible
				  threat to life, health, or building damage, shall be defined, in writing, and
				  approved by the governing body.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 511 - LIMITED SERVICES RURAL HOSPITALS › Subchapter F - FIRE PREVENTION AND SAFETY › Section 511.143 - Handling and Storage of Gases, Anesthetics, and Flammable Liquids

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Flammable germicides. If flammable germicides, including alcohol-based
				  products, are used for preoperative surgical skin preparation in a limited
				  services rural hospital (LSRH), the LSRH must:
(1) use only self-contained, single-use,
				  pre-measured applicators to apply the surgical skin preparations;
(2) follow all manufacturer product safety
				  warnings and guidelines;
(3)
				  develop, implement, and enforce written policies and procedures outlining the
				  safety precautions required related to the use of the products, which, at a
				  minimum, must include minimum drying times, prevention and management of
				  product pooling, parameters related to draping and the use of ignition sources,
				  staff responsibilities related to ensuring safe use of the product, and
				  documentation requirements sufficient to evaluate compliance with the written
				  policies and procedures;
(4) ensure
				  that all staff working in the surgical environment where flammable surgical
				  skin preparation products are in use have received training on product safety
				  and the facility policies and procedures related to the use of the
				  product;
(5) develop, implement,
				  and enforce an interdisciplinary team process for the investigation and
				  analysis of all surgical suite fires and alleged violations of the policies;
				  and
(6) report all occurrences of
				  surgical suite fires to the Texas Health and Human Services Commission as soon
				  as possible but not later than 10 calendar days after the occurrence, and
				  complete an investigation of the occurrence and develop and implement a
				  corrective action plan within 30 days after a surgical suite fire.