reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 509 - FREESTANDING EMERGENCY MEDICAL CARE FACILITIES › Subchapter B - LICENSING REQUIREMENTS › Section 509.30 - Fees

Current through Reg. 49, No. 28; July 12, 2024
(a) The fee for an initial license (includes
				  change of ownership or relocation) is $14,820. The license term is two
				  years.
(b) The fee for a renewal
				  license is $6,070. The license term is two years.
(c) An application is not complete until the
				  applicant pays the entire application fee and submits the application
				  form.
(d) Fees paid to the Texas
				  Health and Human Services Commission (HHSC) are not refundable, except as
				  indicated in §
										509.29 of this subchapter
				  (relating to Time Periods for Processing and Issuing Licenses).
(e) All fees shall be paid to HHSC.
(f) HHSC collects subscription and
				  convenience fees, in amounts determined by the Texas Online Authority, to
				  recover costs associated with application and renewal application processing
				  through Texas Online, in accordance with Texas Government Code §
										2054.111 (relating to
				  Use of State Electronic Internet Portal Project) and §2054.252 (State
				  Electronic Internet Portal Project).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 509 - FREESTANDING EMERGENCY MEDICAL CARE FACILITIES › Subchapter C - OPERATIONAL REQUIREMENTS › Section 509.43 - Administration

Current through Reg. 49, No. 28; July 12, 2024
(a) The facility administration shall adopt,
				  implement, and enforce administrative policies, procedures, and controls to
				  ensure orderly and efficient management of the facility. Administrative
				  responsibilities shall include:
(1) enforcing
				  policies delegated by the governing body;
(2) employing qualified management
				  personnel;
(3) long- and
				  short-range planning for the needs of the facility, as determined by the
				  governing body;
(4) using methods
				  of communicating and reporting, designed to ensure orderly flow of information
				  within the facility;
(5)
				  controlling purchase, maintenance, and distribution of the equipment,
				  materials, and facilities of the facility;
(6) establishing lines of authority,
				  accountability, and supervision of personnel;
(7) establishing controls relating to custody
				  of the official documents of the facility; and
(8) maintaining confidentiality, security,
				  and physical safety of data on patients and staff.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 509 - FREESTANDING EMERGENCY MEDICAL CARE FACILITIES › Subchapter C - OPERATIONAL REQUIREMENTS › Section 509.44 - Medical Director

Current through Reg. 49, No. 28; July 12, 2024
(a) The medical
				  director shall be on-site at the facility when necessary to fulfill the
				  responsibilities of the position, as described by this chapter and the
				  governing body.
(b) Notwithstanding
				  subsection (a) of this section, each facility's medical director shall be
				  on-site at the facility for at least 12 hours per month.
(c) The medical director's responsibilities
				  shall include:
(1) organizing the emergency
				  services to be provided at the facility;
(2) supervising and overseeing the infection
				  control program and quality assessment and performance improvement (QAPI)
				  program; and
(3) regularly
				  attending meetings of the infection control program and QAPI program.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 509 - FREESTANDING EMERGENCY MEDICAL CARE FACILITIES › Subchapter C - OPERATIONAL REQUIREMENTS › Section 509.45 - Medical Staff

Current through Reg. 49, No. 28; July 12, 2024
(a) The medical
				  staff shall periodically conduct appraisals of its members according to medical
				  staff bylaws.
(b) The medical staff
				  shall examine credentials of candidates for medical staff membership and make
				  recommendations to the governing body on the appointment of the
				  candidate.
(c) The medical staff
				  shall be well-organized and accountable to the governing body for the quality
				  of the medical care provided to patients.
(1)
				  The medical staff shall be organized in a manner approved by the governing
				  body.
(2) If the medical staff has
				  an executive committee, the members of the committee shall be doctors of
				  medicine or osteopathy.
(3) The
				  facility shall maintain records of medical staff meetings.
(4) The governing body shall assign
				  responsibility for organization and conduct of the medical staff only to an
				  individual physician.
(5) Each
				  medical staff member shall sign a statement signifying they will abide by
				  medical staff and facility policies.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 509 - FREESTANDING EMERGENCY MEDICAL CARE FACILITIES › Subchapter C - OPERATIONAL REQUIREMENTS › Section 509.46 - Facility Staffing and Training

Current through Reg. 49, No. 28; July 12, 2024
(a) A facility shall
				  have personnel qualified to operate emergency equipment and to provide
				  emergency care to patients that is on site and available at all
				  times.
(b) A facility shall comply
				  with the following nursing services staffing and training requirements.
(1) There shall be an organized nursing
				  service under the direction of a qualified registered nurse (RN). The facility
				  shall be staffed to ensure the nursing needs of all patients are met.
(2) There shall be a written plan of
				  administrative authority for all nursing services with responsibilities and
				  duties of each category of nursing personnel delineated and a written job
				  description for each category. The scope of nursing services shall be limited
				  to nursing care rendered to patients as authorized by Texas Occupations Code
				  Chapter 301 (relating to Nurses).
(A) The
				  responsible individual for nursing services shall be a qualified RN whose
				  responsibility and authority shall be clearly defined and shall include
				  supervision of both personnel performance and patient care.
(B) There shall be a written delineation of
				  functions, qualifications, and patient care responsibilities for all categories
				  of nursing personnel.
(C) Nursing
				  services shall be provided in accordance with current recognized standards or
				  recommended practices.
(3) There shall be an adequate number of RNs
				  on duty to meet minimum staff requirements, including supervisory and staff
				  RNs, to ensure the immediate availability of an RN for emergency care or for
				  any patient when needed.
(4) There
				  shall be other nursing personnel in sufficient numbers to provide nursing care
				  not requiring the service of an RN. An RN shall assign the nursing care of each
				  patient to other nursing personnel in accordance with the patient's needs and
				  the preparation and qualifications of the nursing staff available.
(5) An RN qualified, at a minimum, with
				  current certification in advanced cardiac life support and pediatric advanced
				  life support shall be on duty at the facility at all times whenever patients
				  are present in the facility.
(6)
				  All direct care staff members shall maintain current certification and
				  competency in basic cardiac life support.
(7) The facility shall establish a nursing
				  peer review committee to conduct nursing peer review, to the extent required by
				  Texas Occupations Code Chapter 303 (relating to Nursing Peer Review).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 509 - FREESTANDING EMERGENCY MEDICAL CARE FACILITIES › Subchapter C - OPERATIONAL REQUIREMENTS › Section 509.47 - Emergency Services

Current through Reg. 49, No. 28; July 12, 2024
(a) A facility shall provide to each 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) The organization of
				  emergency services shall be appropriate to the scope of the services offered.
				  The services shall be organized under the direction of a qualified physician
				  member of the medical staff who is the medical director or clinical
				  director.
(c) A facility shall
				  maintain patient medical records for all emergency patients. The medical
				  records shall contain patient identification, complaints, name of physician,
				  name of nurse, time admitted to the emergency suite, treatment, time
				  discharged, and disposition.
(d) A
				  facility shall comply with the following personnel requirements.
(1) There shall be adequate medical and
				  nursing personnel qualified in emergency care to meet the written emergency
				  procedures and needs anticipated by the facility.
(2) As determined by the medical staff, there
				  must always be at least one person qualified and at least one nurse with
				  current advanced cardiac life support and pediatric advanced life support
				  certification on duty and on-site a to initiate immediate appropriate
				  lifesaving measures.
(3) Qualified
				  personnel shall always be physically present in the emergency treatment
				  area.
(4) One or more physicians
				  shall always be on-site during facility hours of operation.
(5) A facility shall maintain schedules,
				  names, and telephone numbers of all physicians and others on emergency call
				  duty, including alternates. The facility shall retain the schedules for at
				  least one year.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 509 - FREESTANDING EMERGENCY MEDICAL CARE FACILITIES › Subchapter C - OPERATIONAL REQUIREMENTS › Section 509.48 - Anesthesia

Current through Reg. 49, No. 28; July 12, 2024
(a) If a facility furnishes anesthesia
				  services, the facility shall provide these services in a well-organized manner
				  under the medical direction of a physician approved by the governing body and
				  qualified in accordance with Texas Occupations Code Title 3, Subtitle B
				  (relating to Physicians) and Texas Occupations Code Chapter 301 (relating to
				  Nurses), as appropriate.
(b) A
				  facility that furnishes anesthesia services shall comply with Texas Occupations
				  Code Chapter 162, Subchapter C (relating to Anesthesia in Outpatient Setting),
				  unless the facility is exempt under Texas Occupations Code §
										162.103 (relating to
				  Applicability).
(c) A facility is
				  responsible for and shall document all anesthesia services administered in the
				  facility.
(d) Anesthesia services
				  provided in the facility shall be limited to those that are recommended by the
				  medical staff and approved by the governing body, which may include the
				  following.
(1) Topical anesthesia--An
				  anesthetic agent applied directly or by spray to the skin or mucous membranes,
				  intended to produce transient and reversible loss of sensation to the
				  circumscribed area.
(2) Local
				  anesthesia--Administering an agent that produces a transient and reversible
				  loss of sensation to a circumscribed portion of the body.
(3) Regional anesthesia--Anesthetic injected
				  around a single nerve, a network of nerves, or vein that serves the area
				  involved in a surgical procedure to block pain.
(4) Minimal sedation (anxiolysis)--A
				  drug-induced state during which patients respond normally to oral commands.
				  Although cognitive function and coordination may be impaired, ventilatory and
				  cardiovascular functions are unaffected.
(5) Moderate sedation or analgesia
				  ("conscious sedation")--A drug-induced depression of consciousness during which
				  patients respond purposefully to oral commands, either alone or accompanied by
				  light tactile stimulation. No interventions are required to maintain a patent
				  airway, and spontaneous ventilation is adequate. Cardiovascular function is
				  usually maintained. (Reflex withdrawal from a painful stimulus is not
				  considered a purposeful response.)
(6) Deep sedation or analgesia--A
				  drug-induced depression of consciousness during which patients cannot be easily
				  aroused but respond purposefully following repeated or painful stimulation. The
				  ability to independently maintain ventilatory function may be impaired.
				  Patients may require assistance in maintaining a patent airway, and spontaneous
				  ventilation may be inadequate. Cardiovascular function is usually maintained.
				  (Reflex withdrawal from a painful stimulus is not considered a purposeful
				  response.)
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 509 - FREESTANDING EMERGENCY MEDICAL CARE FACILITIES › Subchapter C - OPERATIONAL REQUIREMENTS › Section 509.49 - Laboratory and Pathology Services

Current through Reg. 49, No. 28; July 12, 2024
(a) A facility shall
				  maintain directly, or have immediately available on the premises, adequate
				  laboratory services to meet the needs of its patients.
(b) Laboratory services shall comply with the
				  Clinical Laboratory Improvement Amendments of 1988 (CLIA 1988), in accordance
				  with the requirements specified in Code of Federal Regulations, Title 42 (42
				  CFR), Part 493 (relating to Laboratory Requirements). CLIA 1988 applies to all
				  facilities with laboratories that examine human specimens for the diagnosis,
				  prevention, or treatment of any disease or impairment, or for health
				  assessment.
(c) A facility shall
				  ensure that all laboratory services provided to its patients through a
				  contractual agreement are performed in a facility certified in the appropriate
				  specialties and subspecialties of service in accordance with the requirements
				  specified in 42 CFR Part 493 to comply with CLIA 1988.
(d) Emergency laboratory services shall be
				  available on the premises during hours of operation, including:
(1) assays for cardiac markers;
(2) hematology;
(3) chemistry; and
(4) pregnancy testing.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 509 - FREESTANDING EMERGENCY MEDICAL CARE FACILITIES › Subchapter C - OPERATIONAL REQUIREMENTS › Section 509.50 - Pharmaceutical Services

Current through Reg. 49, No. 28; July 12, 2024
(a) The facility
				  shall be licensed as required by the Texas State Board of Pharmacy.
(b) The facility shall adopt, implement, and
				  enforce policy and procedures for pharmaceutical services.
(c) The facility shall provide drugs,
				  controlled substances, and biologicals in a safe and effective manner in
				  accordance with professional practices and comply with all state and federal
				  laws and regulations regarding pharmaceutical services.
(d) The facility may make pharmaceutical
				  services available through contractual agreement. Pharmaceutical services
				  provided under contract shall meet the same ethical practices, professional
				  practices, and legal requirements that would be required if those services were
				  provided directly by the facility.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 509 - FREESTANDING EMERGENCY MEDICAL CARE FACILITIES › Subchapter C - OPERATIONAL REQUIREMENTS › Section 509.51 - Radiology

Current through Reg. 49, No. 28; July 12, 2024
(a) The facility shall adopt, implement, and
				  enforce policies and procedures for emergency radiological
				  procedures.
(b) The facility shall
				  provide radiological services that are immediately available on the premises to
				  meet the emergency needs of patients and to adequately support the facility's
				  clinical capabilities, including plain film X-ray.
(c) The facility shall provide computed
				  tomography (CT) scan services and ultrasound services that are immediately
				  available on the premises.
(d) A
				  physician or other practitioner within the scope of their license and education
				  shall read, date, sign, and authenticate all examination reports.
(e) The radiology department shall meet all
				  applicable federal, state, and local laws, codes, standards, rules,
				  regulations, and ordinances.
(f)
				  Procedure manuals shall include procedures for all examinations performed,
				  infection control in the facility, treatment and examination rooms, personnel
				  dress code, and equipment cleaning.
(g) Policies shall address the quality
				  aspects of radiology services, including:
(1)
				  performing radiology services only on the written order of a physician,
				  podiatrist, dentist, or other practitioner, who is practicing within the scope
				  of their license and education, (such orders shall be accompanied by a concise
				  statement of the reason for the examination); and
(2) limiting the use of any radioactive
				  sources in the facility to physicians who have been granted privileges for such
				  use based on their training, experience, and current competence.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 509 - FREESTANDING EMERGENCY MEDICAL CARE FACILITIES › Subchapter C - OPERATIONAL REQUIREMENTS › Section 509.52 - Respiratory Services

Current through Reg. 49, No. 28; July 12, 2024
(a) The facility shall meet the respiratory
				  needs of the patients in accordance with acceptable standards of
				  practice.
(b) The facility shall
				  adopt, implement, and enforce policies and procedures that describe the
				  provision of respiratory care services in the facility.
(c) The organization of the respiratory care
				  services shall be appropriate to the scope and complexity of the services
				  offered.
(d) Personnel qualified to
				  perform specific procedures and the amount of supervision required for
				  personnel to carry out specific procedures shall be designated in
				  writing.
(e) If blood gases or
				  other clinical laboratory tests are performed, staff shall comply with Clinical
				  Laboratory Improvement Amendments of 1988 in accordance with the requirements
				  specified in Code of Federal Regulations, Title 42, Part 493 (relating to
				  Laboratory Services).
(f)
				  Respiratory services shall be provided only on, and in accordance with, the
				  orders of a physician, or other practitioner practicing within the scope of
				  their license.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 509 - FREESTANDING EMERGENCY MEDICAL CARE FACILITIES › Subchapter C - OPERATIONAL REQUIREMENTS › Section 509.53 - Surgical Services within the Scope of the Practice of Emergency Medicine

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Surgical procedures performed in the facility shall be limited to those
				  emergency procedures that are approved by the governing body on the
				  recommendation of medical staff.
(b) Adequate supervision of surgical
				  procedures conducted in the facility shall be a responsibility of the governing
				  body, recommended by medical staff, and provided by appropriate medical
				  staff.
(c) Surgical procedures
				  shall be performed only by physicians, podiatrists, dentists, or other
				  practitioners, who are practicing within the scope of their license and
				  education, who are licensed to perform surgical procedures in Texas and who
				  have been granted privileges to perform those procedures by the governing body,
				  on the recommendation of the medical staff, and after medical review of the
				  physician's, podiatrist's, dentist's, or practitioner's documented education,
				  training, experience, and current competence.
(d) Surgical procedures to be performed in
				  the facility shall be reviewed periodically as part of the peer review portion
				  of the facility's quality assessment and performance improvement
				  program.
(e) An appropriate
				  history, physical examination, and per tinent preoperative diagnostic studies
				  shall be incorporated into the patient's medical record before a surgical
				  procedure.
(f) Unless otherwise
				  provided by law, the necessity or appropriateness of the proposed surgical
				  procedure, as well as any available alternative treatment techniques, shall be
				  discussed with the patient, or if applicable, with the patient's legal
				  representative before the surgical procedure.
(g) Licensed nurses and other personnel
				  assisting in the provision of surgical services shall be appropriately trained
				  and supervised and available in sufficient numbers for the surgical care
				  provided.
(h) Each treatment or
				  examination room shall be designed and equipped so that the types of surgical
				  procedures conducted can be performed in a manner that protects the lives and
				  ensures the physical safety of all persons in the area.
(1) If flammable agents are present in a
				  treatment or examination room, the room shall be constructed and equipped in
				  compliance with standards established by the National Fire Protection
				  Association (NFPA 99, Annex 2, Flammable Anesthetizing Locations, 1999) and
				  with applicable state and local fire codes.
(2) If nonflammable agents are present in a
				  treatment or examination room, the room shall be constructed and equipped in
				  compliance with standards established by the National Fire Protection
				  Association (NFPA 99, Chapters 4 and 8, 1999) and with applicable state and
				  local fire codes.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 509 - FREESTANDING EMERGENCY MEDICAL CARE FACILITIES › Subchapter C - OPERATIONAL REQUIREMENTS › Section 509.54 - Medical Records

Current through Reg. 49, No. 28; July 12, 2024
(a) The facility
				  shall develop and maintain a system for collecting, processing, maintaining,
				  storing, retrieving, authenticating, and distributing patient medical
				  records.
(b) The facility shall
				  establish an individual medical record for each patient.
(c) All clinical information relevant to a
				  patient shall be readily available to physicians or practitioners involved in
				  the care of that patient.
(d)
				  Except when otherwise required or permitted by law, any record that contains
				  clinical, social, financial, or other data on a patient shall be strictly
				  confidential and shall be protected from loss, tampering, alteration, improper
				  destruction, and unauthorized or inadvertent disclosure.
(e) The facility shall designate a person to
				  be in charge of medical records. The person's responsibilities include:
(1) confidential, secure, and safe storage of
				  medical records;
(2) timely
				  retrieval of individual medical records on request;
(3) specific identification of each patient's
				  medical record;
(4) supervision of
				  collecting, processing, maintaining, storing, retrieving, and distributing
				  medical records; and
(5)
				  maintenance of a predetermined organized medical record format.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 509 - FREESTANDING EMERGENCY MEDICAL CARE FACILITIES › Subchapter C - OPERATIONAL REQUIREMENTS › Section 509.55 - Infection Control

Current through Reg. 49, No. 28; July 12, 2024
(a) The facility shall provide a sanitary
				  environment to avoid sources and transmission of infections and communicable
				  diseases. The facility shall have an infection control program for prevention,
				  control, and surveillance of infections and communicable diseases.
(1) The facility shall designate an infection
				  control professional. The facility shall adopt, implement, and enforce policies
				  governing prevention, control, and surveillance of infections and communicable
				  diseases.
(2) The facility shall
				  have a system for identifying, reporting, investigating, and controlling health
				  care-associated infections and communicable diseases between patients and
				  personnel.
(3) The infection
				  control professional shall maintain a log of all reportable diseases and health
				  care-associated infections designated as epidemiologically significant
				  according to the facility's infection control policies.
(4) The facility shall adopt, implement, and
				  enforce a written policy for reporting all reportable diseases to the local
				  health authority and the Texas Department of State Health Services Infectious
				  Disease Prevention Section, in accordance with 25 TAC Chapter 97 (relating to
				  Communicable Diseases).
(5) The
				  infection control program shall include active participation by the medical
				  staff, nursing staff, pharmacist, and other practitioners as
				  appropriate.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 509 - FREESTANDING EMERGENCY MEDICAL CARE FACILITIES › Subchapter C - OPERATIONAL REQUIREMENTS › Section 509.56 - Sanitary Conditions and Hygienic Practices

Current through Reg. 49, No. 28; July 12, 2024
(a) General
				  infection control measures. Universal precautions shall be followed in the
				  facility 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) Physical
				  environment.
(1) A facility 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 and visitors and
				  the public.
(2) Blood spills shall
				  be cleaned immediately or as soon as is practical with a disposable cloth and
				  an appropriate chemical disinfectant.
(A) If a
				  commercial liquid chemical disinfectant is used, the surface shall be subjected
				  to intermediate-level disinfection in accordance with the manufacturer's
				  directions for use.
(B) If 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.
(C) The facility shall use dedicated cleaning
				  supplies (i.e., mop, bucket) for cleaning blood spills.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 509 - FREESTANDING EMERGENCY MEDICAL CARE FACILITIES › Subchapter C - OPERATIONAL REQUIREMENTS › Section 509.57 - Sterilization

Current through Reg. 49, No. 28; July 12, 2024
(a) A person qualified by education,
				  training, and experience shall supervise the sterilization of all supplies and
				  equipment. Staff responsible for sterilizing supplies and equipment shall
				  participate in a documented continuing education program. New employees shall
				  receive initial orientation and on-the-job training. Staff using chemical
				  disinfectants shall have received training on their use.
(b) The facility shall adopt, implement, and
				  enforce written policies and procedures for decontamination and sterilization
				  activities. Policies shall include receiving, cleaning, decontaminating,
				  disinfecting, preparing, and sterilizing reusable items, as well as assembling,
				  wrapping, storing, distributing, and quality control of sterile items and
				  equipment. The infection control practitioner or committee shall review and
				  approve these written policies at least every other year.
(c) Every facility shall provide equipment
				  adequate for sterilizing supplies and equipment, as needed. Equipment shall be
				  maintained and operated to accurately sterilize the various materials
				  required.
(d) Where cleaning,
				  preparation, and sterilization functions are performed in the same room or
				  unit, the physical facilities, equipment, and policies and procedures for their
				  use, shall effectively separate soiled or contaminated supplies and equipment
				  from clean or sterilized supplies and equipment. Hand-washing facilities shall
				  be provided, and a separate sink shall be provided for safe disposal of liquid
				  waste.
(e) All containers for
				  solutions, drugs, flammable solvents, ether, alcohol, and medicated supplies
				  shall be clearly labeled to indicate contents. Containers that are sterilized
				  by the facility shall be labeled to be identifiable before and after
				  sterilization. Sterilized items shall have a load control identification that
				  indicates the sterilizer used, the cycle or load number, and the sterilization
				  date.
(f) A facility shall comply
				  with the following sterilizer requirements.
(1) Steam sterilizers (saturated steam under
				  pressure) shall be used to sterilize heat- and moisture-stable items. Steam
				  sterilizers shall be used according to manufacturer's written
				  instructions.
(2) Ethylene oxide
				  (EO) sterilizers shall be used for processing heat- and moisture-sensitive
				  items. EO sterilizers and aerators shall be used and vented according to the
				  manufacturer's written instructions.
(3) Flash sterilizers shall be used only for
				  emergency sterilization of clean, unwrapped instruments and porous
				  items.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 509 - FREESTANDING EMERGENCY MEDICAL CARE FACILITIES › Subchapter C - OPERATIONAL REQUIREMENTS › Section 509.58 - Linen and Laundry Services

Current through Reg. 49, No. 28; July 12, 2024
(a) The facility
				  shall adopt, implement, and enforce policies to provide sufficient clean linen
				  to ensure the comfort of the patient.
(b) For purposes of this subsection,
				  contaminated linen is linen that has been soiled with blood or other
				  potentially infectious materials or may contain sharps. Other potentially
				  infectious materials means:
(1) the following
				  human body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial
				  fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid,
				  saliva in dental procedures, any body fluid that is visibly contaminated with
				  blood, and all body fluids in situations where it is difficult or impossible to
				  differentiate between body fluids;
(2) any unfixed tissue or organ (other than
				  intact skin) from a human (living or dead); and
(3) Human Immunodeficiency Virus
				  (HIV)-containing cell or tissue cultures, organ cultures, and HIV or Hepatitis
				  B Virus (HBV)-containing culture medium or other solutions; and blood, organs,
				  or other tissues from experimental animals infected with HIV or HBV.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 509 - FREESTANDING EMERGENCY MEDICAL CARE FACILITIES › Subchapter C - OPERATIONAL REQUIREMENTS › Section 509.59 - Waste and Waste Disposal

Current through Reg. 49, No. 28; July 12, 2024
(a) Special waste
				  and liquid or sewage waste management.
(1)
				  Facilities shall comply with the requirements set forth by the Texas Commission
				  on Environmental Quality (TCEQ) in 30 TAC Chapter 326 (relating to Medical
				  Waste Management).
(2) All sewage
				  and liquid wastes shall be disposed of in a municipal sewerage system or a
				  septic tank system permitted by the TCEQ in accordance with 30 TAC Chapter 285
				  (relating to On-Site Sewage Facilities).
(3) Facilities shall comply with the
				  requirements set forth in 25 TAC Chapter 1, Subchapter K (relating to
				  Definition, Treatment, and Disposition of Special Waste from Health
				  Care-Related Facilities).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 509 - FREESTANDING EMERGENCY MEDICAL CARE FACILITIES › Subchapter C - OPERATIONAL REQUIREMENTS › Section 509.60 - Patient Rights

Current through Reg. 49, No. 28; July 12, 2024
(a) Patients shall
				  be treated with respect, consideration, and dignity.
(b) Patients shall be provided appropriate
				  privacy.
(c) Patient records shall
				  be treated confidentially. Patients shall be given the opportunity to approve
				  or refuse release of patient records, except when release of the records is
				  authorized by law.
(d) Patients
				  shall be provided, to the degree known, appropriate information concerning
				  their diagnosis, treatment, and prognosis. When it is medically inadvisable to
				  give such information to a patient, the information shall be provided to a
				  person designated by the patient or a legally authorized person.
(e) Patients shall be given the opportunity
				  to participate in decisions involving their health care, except when the
				  patient's participation is contraindicated for medical reasons.
(f) The facility shall provide information to
				  patients and staff concerning:
(1) patient
				  rights, including those specified in subsections (a) - (e) of this
				  section;
(2) patient conduct and
				  responsibilities;
(3) services
				  available at the facility;
(4) fees
				  for services provided;
(5) payment
				  policies; and
(6) methods for
				  expressing complaints and suggestions to the facility.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 509 - FREESTANDING EMERGENCY MEDICAL CARE FACILITIES › Subchapter C - OPERATIONAL REQUIREMENTS › Section 509.61 - Abuse and Neglect

Current through Reg. 49, No. 28; July 12, 2024
(a) The following
				  words and terms, when used in this section, shall have the following meanings,
				  unless the context clearly indicates otherwise.
(1) Abuse--The negligent or willful
				  infliction of injury, unreasonable confinement, intimidation, or cruel
				  punishment, including pain or sexual abuse, that adversely affects the
				  physical, mental, or emotional welfare of a patient.
(2) Exploitation--The use of a patient's
				  resources for monetary or personal benefit, profit, or gain without the
				  informed consent of the patient.
(3) Illegal conduct--Conduct prohibited by
				  law.
(4) Neglect--The failure to
				  provide goods or services that are necessary to avoid adversely affecting the
				  physical, mental, or emotional welfare of a patient.
(5) Unethical conduct--Conduct prohibited by
				  the ethical standards adopted by state or national professional organizations
				  for their respective professions or by rules established by the state licensing
				  agency for the respective profession.
(6) Unprofessional conduct--Conduct
				  prohibited under rules adopted by the state licensing agency for the respective
				  profession.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 509 - FREESTANDING EMERGENCY MEDICAL CARE FACILITIES › Subchapter C - OPERATIONAL REQUIREMENTS › Section 509.62 - Reporting Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) A facility shall report the following
				  incidents to the Texas Health and Human Services Commission (HHSC):
(1) the death of a patient while under the
				  care of the facility;
(2) a patient
				  stay exceeding 23 hours; and
(3)
				  9-1-1 activation or the emergency transfer of a patient from the facility to a
				  hospital by ambulance.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 509 - FREESTANDING EMERGENCY MEDICAL CARE FACILITIES › Subchapter C - OPERATIONAL REQUIREMENTS › Section 509.63 - Quality Assessment and Performance Improvement

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Each facility shall develop, implement, maintain, and evaluate an effective,
				  ongoing, facility-wide, data-driven, interdisciplinary quality assessment and
				  performance improvement (QAPI) program. The program shall be individualized to
				  the facility and meet the criteria and standards described in this
				  section.
(b) The program shall
				  reflect the complexity of the facility's organization and services involved.
				  All facility services (including services furnished under contract or
				  arrangement) shall focus on indicators related to improved health outcomes and
				  prevention and reduction of medical errors.
(c) The program shall include an ongoing
				  program that achieves measurable improvement in health outcomes and reduction
				  of medical errors by using indicators or performance measures associated with
				  improved health outcomes and with the identification and reduction of medical
				  errors.
(d) The facility shall
				  demonstrate that facility staff, including the medical, nursing, and pharmacy
				  staff, evaluate the provision of emergency care and patient services, set
				  treatment goals, identify opportunities for improvement, develop and implement
				  improvement plans, and evaluate the implementation until resolution is
				  achieved.
(e) The facility shall
				  measure, analyze, and track quality indicators, or other aspects of performance
				  that the facility adopts or develops, that reflect processes of care and
				  facility operations.
(f) The
				  facility shall provide evidence supporting that the facility continuously
				  reviews aggregate patient data, including identification and tracking of
				  patient infections, for trends.
(g)
				  Core staff members, including the medical, nursing, and pharmacy staff, shall
				  actively participate in the QAPI activities, including QAPI meetings.
(1) QAPI meetings shall be held monthly, or
				  more often as necessary, to identify or correct problems.
(2) QAPI meetings shall be
				  documented.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 509 - FREESTANDING EMERGENCY MEDICAL CARE FACILITIES › Subchapter C - OPERATIONAL REQUIREMENTS › Section 509.64 - Safety and Preparedness

Current through Reg. 49, No. 28; July 12, 2024
(a) The facility
				  shall follow the requirements in 25 TAC Chapter 131, Subchapter F (relating to
				  Fire Prevention and Safety Requirements).
(b) The facility shall submit emergency and
				  disaster information to the Texas Health and Human Services Commission (HHSC)
				  using the HHSC Emergency/Disaster Notification form located on HHSC's
				  website.
(c) The facility shall
				  obtain an annual fire safety inspection from the local fire authority in whose
				  jurisdiction the facility is based.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 509 - FREESTANDING EMERGENCY MEDICAL CARE FACILITIES › Subchapter C - OPERATIONAL REQUIREMENTS › Section 509.66 - Patient Transfer Agreements

Current through Reg. 49, No. 28; July 12, 2024
(a) General
				  provisions.
(1) Patient transfer agreements
				  between a facility and hospitals are mandatory.
(2) The facility shall submit the transfer
				  agreement to the Texas Health and Human Services Commission (HHSC) for review
				  to determine if the agreement meets the requirements of subsection (b) of this
				  section.
(3) Multiple transfer
				  agreements may be entered into by a facility based upon the type or level of
				  medical services available at other hospitals.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 509 - FREESTANDING EMERGENCY MEDICAL CARE FACILITIES › Subchapter C - OPERATIONAL REQUIREMENTS › Section 509.67 - Balance Billing

Current through Reg. 49, No. 28; July 12, 2024
(a) A facility may
				  not violate a law that prohibits the facility 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.
(b) A
				  facility shall comply with Senate Bill 1264, 86th Legislature, Regular Session,
				  2019, and with related Texas Department of Insurance rules at 28 TAC Chapter
				  21, Subchapter OO §§21.4901 - 21.4904 (relating to Disclosures by
				  Out-of-Network Providers) to the extent this subchapter applies to the
				  facility.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 509 - FREESTANDING EMERGENCY MEDICAL CARE FACILITIES › Subchapter C - OPERATIONAL REQUIREMENTS › Section 509.68 - Miscellaneous Policies and Protocols

Current through Reg. 49, No. 28; July 12, 2024
A licensed freestanding emergency medical care facility
					 shall not discriminate based on a patient's disability and shall comply with
					 Texas Health and Safety Code Chapter 161, Subchapter S (relating to Allocation
					 of Kidneys and Other Organs Available for Transplant).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 509 - FREESTANDING EMERGENCY MEDICAL CARE FACILITIES › Subchapter C - OPERATIONAL REQUIREMENTS › Section 509.69 - Fees and Prices

Current through Reg. 49, No. 28; July 12, 2024
(a) In this
				  section, "unconscionable price" means a price that is more than 200 percent of
				  the average price for the same or a substantially similar product or service
				  provided to other individuals by health care facilities located in the same or
				  nearest county to the county in which the freestanding emergency medical care
				  facility is located, as applicable, according to data collected by the Texas
				  Department of State Health Services under Texas Health and Safety Code (HSC)
				  Chapter 108 (relating to Health Care Data Collection).
(b) In accordance with HSC §254.160
				  (relating to Prohibited Practices During Declared State of Disaster), during a
				  state of disaster declared by the Governor under Texas Government Code Chapter
				  418 (relating to Emergency Management), a facility may not:
(1) charge an individual an unconscionable
				  price for a product or service provided at the facility; or
(2) knowingly or intentionally charge a
				  third-party payor, including a health benefit plan insurer, a price higher than
				  the price charged to an individual for the same product or service based on the
				  payor's liability for payment or partial payment of the product or
				  service.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 509 - FREESTANDING EMERGENCY MEDICAL CARE FACILITIES › Subchapter D - INSPECTION AND INVESTIGATION PROCEDURES › Section 509.81 - 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 facility:
(1) shall not record, listen to, or eavesdrop
				  on any HHSC interview with facility staff or patients that the facility 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 facility staff when
				  HHSC has requested a private room or office or distanced themselves from
				  facility staff and the facility 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 509 - FREESTANDING EMERGENCY MEDICAL CARE FACILITIES › Subchapter D - INSPECTION AND INVESTIGATION PROCEDURES › Section 509.82 - Inspections

Current through Reg. 49, No. 28; July 12, 2024
(a) The Texas Health and Human Services
				  Commission (HHSC) may conduct an unannounced, on-site inspection of a facility
				  at any reasonable time, including when treatment services are provided, to
				  inspect, investigate, or evaluate compliance with or prevent a violation of:
(1) any applicable statute or rule;
(2) a facility's plan of
				  correction;
(3) an order or special
				  order of the executive commissioner or the executive commissioner's
				  designee;
(4) a court order
				  granting injunctive relief; or
(5)
				  for other purposes relating to regulation of the facility.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 509 - FREESTANDING EMERGENCY MEDICAL CARE FACILITIES › Subchapter D - INSPECTION AND INVESTIGATION PROCEDURES › Section 509.83 - Complaint Investigations

Current through Reg. 49, No. 28; July 12, 2024
(a) Upon initial
				  triage, a facility shall provide each patient and applicable legally authorized
				  representative with a written statement identifying the Texas Health and Human
				  Services Commission (HHSC) as the agency responsible for investigating
				  complaints against the facility.
(1) The
				  statement shall inform persons that they may direct a complaint to HHSC
				  Complaint and Incident Intake (CII) and include current CII contact
				  information, as specified by HHSC.
(2) The facility shall prominently and
				  conspicuously post this statement in patient common areas and in visitor's
				  areas and waiting rooms 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.