Texas

Submitting a Complaint Against Substance Abuse (Chemical Dependency) or Narcotic or Opioid Treatment Facilities

Complaint hotline: 1-800-458-9858, Option 6.
Email: cii.sa@hhs.texas.gov.
Fax: 833-709-5735.
Mailing address: Health and Human Services Commission. Complaint and Incident Intake. Mail Code E-249. P.O. Box 149030.

How to File a Complaint

If you have knowledge that an acute health care facility regulated by the Texas Health and Human Services Commission has provided substandard care to its patients or clients, you may file a complaint with HHSC.

Information to Provide When Making a Complaint

Before filing a complaint with HHSC, please be prepared to provide the following information:

Your name, mailing address, email, and daytime telephone number, (unless you choose to remain anonymous)
Your relationship to the person on whose behalf you are making the complaint
Name and address of the facility involved in your complaint
How you became aware of the situation, including if you witnessed the event or if you heard about it from another person
The name, address, telephone number, and date of birth or age of all patients or clients referenced in the complaint
Dates, times, and locations of all incidents
All facts directly related to all incidents you are reporting

Please note, HHS keeps your name and the names of others involved in the complaint confidential, unless required to release it by law under the Public Information Act. If you choose to remain anonymous, HHS will not be able to provide you the results of the investigation.

Submitting a Complaint Against Psychiatric Treatment Facilities and Crisis Stabilization Units

(e) Submission of complaints. A complaint made under this section may be submitted in writing or verbally to the Health Facility Licensing and Compliance Division, Texas Department of Health, 1100 West 49th Street, Austin, Texas 78756-3199, telephone, (888) 973-0022.
(f) Notification.
- (1) For complaints such as abuse or neglect of a child, and abuse, neglect or exploitation of an elderly or disabled person, the department shall provide notification according to the following:
  - (A) The department shall notify the reporter, if known, in writing of the outcome of the complete investigation.
  - (B) The department shall notify the alleged victim, and his or her parent or guardian if a minor, in writing of the outcome of the completed investigation.
- (2) For complaints such as abuse and neglect of individuals with mental illness, and illegal, unethical, and unprofessional conduct , the department shall inform, in writing, the complainant who identifies themselves by name and address of the following:
  - (A) the receipt of the complaint;
  - (B) if the complainant's allegations are potential violations of this chapter warranting an investigation;
  - (C) whether the complaint will be investigated by the department;
  - (D) whether and to whom the complaint will be referred; and
  - (E) the findings of the complaint investigation.

Substance Use Disorder (SUD) Regulations

Retaliation Standards - 161.134 - 161.135

161.134. RETALIATION AGAINST EMPLOYEES PROHIBITED
- (a) A hospital, mental health facility, or treatment facility may not suspend or terminate the employment of or discipline or otherwise discriminate against an employee for reporting to the employee's supervisor, an administrator of the facility, a state regulatory agency, or a law enforcement agency a violation of law, including a violation of this chapter, a rule adopted under this chapter, or a rule of another agency.
- (b) A hospital, mental health facility, or treatment facility that violates Subsection (a) is liable to the person discriminated against. A person who has been discriminated against in violation of Subsection (a) may sue for injunctive relief, damages, or both.
- (c) A plaintiff who prevails in a suit under this section may recover actual damages, including damages for mental anguish even if an injury other than mental anguish is not shown.
- (d) In addition to an award under Subsection (c), a plaintiff who prevails in a suit under this section may recover exemplary damages and reasonable attorney fees.
- (e) In addition to amounts recovered under Subsections (c) and (d), a plaintiff is entitled to, if applicable:
  - (1) reinstatement in the plaintiff's former position;
  - (2) compensation for lost wages; and
  - (3) reinstatement of lost fringe benefits or seniority rights.
- (f) A plaintiff suing under this section has the burden of proof, except that it is a rebuttable presumption that the plaintiff's employment was suspended or terminated, or that the employee was disciplined or discriminated against, for making a report related to a violation if the suspension, termination, discipline, or discrimination occurs before the 60th day after the date on which the plaintiff made a report in good faith.
- (g) A suit under this section may be brought in the district court of the county in which:
  - (1) the plaintiff was employed by the defendant; or
  - (2) the defendant conducts business.
- (h) A person who alleges a violation of Subsection (a) must sue under this section before the 180th day after the date the alleged violation occurred or was discovered by the employee through the use of reasonable diligence.
- (i) This section does not abrogate any other right to sue or interfere with any other cause of action.
- (j) Each hospital, mental health facility, and treatment facility shall prominently and conspicuously post for display in a public area of the facility that is readily available to patients, residents, employees, and visitors a statement that employees and staff are protected from discrimination or retaliation for reporting a violation of law. The statement must be in English and in a second language.
161.135. RETALIATION AGAINST NONEMPLOYEES PROHIBITED

Client Grievances - 564.702

(a) The facility shall have a written client grievance procedure.
(b) Staff shall give each client and consenter a copy of the grievance procedure within 24 hours of admission and explain it in clear, simple terms that the client understands.
(c) The grievance procedure shall tell clients that they can:
- (1) file a grievance about any violation of client rights or Commission rules;
- (2) submit a grievance in writing and get help writing it if they are unable to read or write; and
- (3) request writing materials, postage, and access to a telephone for the purpose of filing a grievance.
(d) The procedure shall also inform clients that they can submit a complaint directly to the Commission at any time and include the current mailing address and toll-free telephone number of the Commission's investigations division.
(e) The facility shall have a written procedure for staff to follow when responding to client grievances. The facility shall:
- (1) evaluate the grievance thoroughly and objectively, obtaining additional information as needed;
- (2) provide a written response to the client within seven days of receiving the grievance;
- (3) take action to resolve all grievances promptly and fairly; and
- (4) document all grievances, including the final disposition, and keep the documentation in a central file.
(f) The facility shall not:
- (1) retaliate against clients who try to exercise their rights or file a grievance; or
- (2) restrict, discourage, or interfere with client communication with an attorney or with the Commission for the purposes of filing a grievance.

Crisis Stabilization and Private Psychiatric Hospitals

Department Inspections, Investigations, Corrective Actions, Penalties, and Denials - 510.46(d); 510.81 - 510.84; 510.86 - 510.87

(d) Investigations. A complaint under this subsection will be investigated or referred by the department as follows.
- (1) Allegations under subsection (b) of this section will be investigated in accordance with TAC § 1.205 of Title 25 (relating to Reports and Investigations of Children or Elderly or Disabled Persons) and TAC § 1.206 of Title 25 (relating to Completion of Investigation).
- (2) Allegations under subsection (c) of this section will be investigated in accordance with § 510.81 of Title 40 (relating to Survey and Investigation Procedures). Allegations concerning a health care professional's failure to report abuse and neglect or illegal, unprofessional, or unethical conduct will not be investigated by the department but will be referred to the individual's licensing board for appropriate disciplinary action.
- (3) Allegations under both subsections (b) and (c) will be investigated in accordance with TAC §§ 1.205 and 1.206 of Title 25 except as noted in paragraph (2) of this subsection concerning a health care professional's failure to report.

510.81 - Survey and Investigation Procedures

(a) Routine surveys. The department may conduct a survey of a facility prior to the issuance or renewal of a license.
- (1) A hospital is not subject to routine surveys subsequent to the issuance of the initial license while the hospital maintains:
  - (A) certification under Title XVIII of the Social Security Act, 42 United States Code (USC), § 1395 et seq; or
  - (B) accreditation by the Joint Commission on Accreditation of Healthcare Organizations or by the American Osteopathic Association.
- (2) The department may conduct a survey of a hospital exempt from an annual licensing survey under paragraph (1) of this subsection before issuing a renewal license to the hospital if the certification or accreditation body has not conducted an on-site survey of the hospital in the preceding three years and the department determines that a survey of the hospital by the certification or accreditation body is not scheduled within 60 days.
(b) Complaint investigations.
- (1) Complaint investigations are generally unannounced and are conducted to ensure compliance of the facility with the provisions of Health and Safety Code (HSC), Chapter 577, this chapter, special license conditions, or orders of the commissioner of health (commissioner).
- (2) Complaints received by the department concerning abuse and neglect, or illegal, unprofessional, or unethical conduct will be investigated or referred in accordance with § 510.46(d) of Title 40 (relating to Abuse and Neglect Issues).
- (3) Complaint investigations are coordinated with the federal Centers for Medicare and Medicaid Services and its agents responsible for the survey of hospitals to determine compliance with the conditions of participation under Title XVIII of the Social Security Act, (42 USC, § 1395 et seq), so as to avoid duplicate investigations.
- (4) If an individual wishes to report an alleged violation of the Act or this chapter, the individual shall notify the department by telephone at (888)973-0022 or by writing the department at 1100 West 49th Street, Austin, Texas 78756-3199, by personal visit, or electronic medium. The department may notify the parties to a complaint of the status of the complaint.
(c) Resurvey.
- (1) Resurveys may be conducted by the department if a facility applies for the reissuance of its license after the suspension or revocation of the facility's license, the assessment of administrative or civil penalties, or the issuance of an injunction against the facility for violations of HSC Chapter 577, this chapter, a special license condition, or an order of the commissioner.
- (2) A resurvey may be conducted to ascertain compliance with either health or construction requirements or both.
(d) General.
- (1) The department may make any survey, or investigation that it considers necessary. A department representative(s) may enter the premises of a facility at any reasonable time to make a survey or an investigation to ensure compliance with or prevent a violation of HSC, Chapter 577, this chapter, an order or special order of the commissioner, a special license provision, a court order granting injunctive relief, or other enforcement procedures. Ensuring compliance includes permitting photocopying of any records or other information by or on behalf of the department as necessary to determine or verify compliance with the statute or rules adopted under the statute, except that the department may not photocopy, reproduce, remove or dictate from any part of the root cause analysis or action plan required under § 510.47 of Title 40 (relating to Patient Safety Program).
- (2) The department representative(s) is entitled to access to all books, records, or other documents maintained by or on behalf of the facility to the extent necessary to enforce HSC, Chapter 577, this chapter, an order or special order of the commissioner, a special license provision, a court order granting injunctive relief, or other enforcement procedures. The department shall maintain the confidentiality of facility records under federal or state law.
- (3) By applying for or holding a facility license, the facility consents to entry and survey or investigation of the facility by the department in accordance with HSC, Chapter 577 and this chapter.
(e) Survey and investigation protocol.
- (1) The department representative(s) shall hold a conference with the facility administrator or designee before beginning the on-site survey or investigation to explain the nature, scope, and estimated time schedule of the survey or investigation.
- (2) The department representative(s) may conduct interviews with any person with knowledge of the facts.
- (3) The department representative(s) shall inform the facility administrator or designee of the preliminary findings of the survey or investigation and shall give the person a reasonable opportunity to submit additional facts or other information to the department representative in response to those findings.
- (4) Following a survey or investigation of a facility by the department, the department representative(s) shall hold an exit conference with the facility administrator or designee and other invited staff and provide the following to the facility administrator or designee:
  - (A) the nature of the survey or investigation;
  - (B) an overview of the findings regarding alleged violations or deficiencies identified by the department representative(s);
  - (C) identity of any records that were duplicated;
  - (D) if there are no deficiencies found, a verbal statement indicating this fact.
- (5) If deficiencies are cited, the facility shall provide a plan of correction (POC) to the department either at the time of the exit conference or within 10 calendar days following the facility's receipt of a statement of deficiencies (SOD).
  - (A) The POC shall include the facility's planned action to correct the deficiency and the expected completion date. The POC shall be specific and realistic, stating exactly how the deficiency was or will be corrected. The POC must be signed by the administrator or their designee.
  - (B) A facility may refute the accuracy of a cited deficiency or survey finding.
    - (i) Objections may be recorded on the SOD form, however, a POC is still required to be submitted; or
    - (ii) A facility may record an objection on the SOD form and not submit a POC, however, the facility must submit a convincing argument and documented evidence that the cited deficiency or survey finding is invalid.
    - (iii) Should the department agree with the supporting documentation, the cited deficiency or survey finding shall be deleted from the SOD form.
    - (iv) Should the department sustain the cited deficiency, the department will inform the facility in writing that a POC is required. The facility shall submit a POC to the department within 10 calendar days of the facility's receipt of the department's decision.
- (6) The department representative(s) shall inform the administrator or their designee of the facility's right to an informal administrative review when there is disagreement with the representative's findings and recommendations or when additional information bearing on the findings is available.
- (7) If the department determines that the POC is not acceptable, the department shall notify the facility in writing that it is responsible to provide the department an acceptable POC. The facility shall submit the new POC within 10 calendar days of the facility's receipt of the department's written notice.
- (8) Responses to the department may be submitted by facsimile.
- (9) The facility shall come into compliance by the completion date provided on the POC.
- (10) The department may verify the correction of deficiencies either in writing or by an on-site survey or investigation.
- (11) Acceptance of a POC does not preclude the department from taking enforcement action under § 510.83 of Title 40 (relating to Enforcement).
- (12) Facility complaints against a department representative shall be submitted in accordance with § 510.82 of Title 40 (relating to Complaint Against a Texas Department of Health Representative).
(f) Release of information by the department.
- (1) Upon written request, the department shall provide information on the identity of each department representative conducting, reviewing, or approving the results of the survey or investigation, and the date on which the department representative acted on the matter.
- (2) All information and materials obtained or compiled by the department in connection with a complaint and investigation concerning a facility licensed under this chapter are confidential and not subject to disclosure, discovery, subpoena, or other means of legal compulsion for their release to anyone other than the department or its employees or agents involved in the enforcement action except that this information may be disclosed to:
  - (A) persons involved with the department in the enforcement action against the facility;
  - (B) the facility that is the subject of the enforcement action, or the facility's authorized representative;
  - (C) appropriate state or federal agencies that are authorized to inspect, survey, or investigate licensed mental facility services;
  - (D) law enforcement agencies; and
  - (E) persons engaged in bona fide research, if all individual-identifying information and information identifying the facility has been deleted.
- (3) The following information is subject to disclosure in accordance with Government Code, § 552.001 et seq.
  - (A) a notice of alleged violation against the facility, which notice shall include the provisions of law which the facility is alleged to have violated, and the nature of the alleged violation;
  - (B) the pleadings in the administrative proceeding; and
  - (C) final decision or order by the department.

510.82 - Inspections

(a) The Texas Health and Human Services Commission (HHSC) may conduct an inspection of a facility prior to the issuance or renewal of a license.
- (1) A hospital is not subject to additional annual licensing inspections subsequent to the issuance of the initial license while the hospital 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.
- (2) HHSC may conduct an inspection of a hospital exempt from an annual licensing inspection under paragraph (1) of this subsection before issuing a renewal license to the hospital if the certification or accreditation body has not conducted an on-site inspection of the hospital in the preceding three years and HHSC determines that an inspection of the hospital by the certification or accreditation body is not scheduled within 60 days of the license expiration date.
(b) 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 HHSC 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.
(c) An applicant or licensee, by applying for or holding a license, consents to entry and inspection of any of its facilities by HHSC.
(d) HHSC inspections to evaluate a facility's compliance may include:
- (1) initial, change of ownership, or relocation inspections for the issuance of a new license;
- (2) inspections related to changes in status, such as new construction or changes in services, designs, or bed numbers;
- (3) routine inspections, which may be conducted without notice and at HHSC's discretion, or prior to renewal;
- (4) follow-up on-site inspections, conducted to evaluate implementation of a plan of correction for previously cited deficiencies;
- (5) inspections to determine if an unlicensed facility is offering or providing, or purporting to offer or provide, treatment; and
- (6) entry in conjunction with any other federal, state, or local agency's entry.
(e) A facility shall cooperate with any HHSC inspection and shall permit HHSC to examine the facility's grounds, buildings, books, records, video surveillance, and other documents and information maintained by or on behalf of the facility, unless prohibited by law.
(f) A facility shall permit HHSC access to interview members of the governing body, personnel, and patients, including the opportunity to request a written statement.
(g) A facility shall permit HHSC to inspect and copy any requested information, unless prohibited by law. If it is necessary for HHSC to remove documents or other records from the facility, HHSC provides a written description of the information being removed and when it is expected to be returned. HHSC makes a reasonable effort, consistent with the circumstances, to return any records removed in a timely manner.
(h) Upon entry, HHSC holds an entrance conference with the facility's designated representative to explain the nature, scope, and estimated duration of the inspection.
(i) During the inspection, the HHSC representative gives the facility representative an opportunity to submit information and evidence relevant to matters of compliance being evaluated.
(j) When an inspection is complete, the HHSC representative holds an exit conference with the facility representative to inform the facility representative of any preliminary findings of the inspection, including any possible health and safety concerns. The facility may provide any final documentation regarding compliance during the exit conference.
(k) HHSC shall maintain the confidentiality of facility records as applicable under state or federal law. Except as provided by subsection (l) of this section, all information and materials in the possession of or obtained or compiled by HHSC in connection with an inspection are confidential and not subject to disclosure, discovery, subpoena, or other means of legal compulsion for their release to anyone other than HHSC or its employees or agents involved in the enforcement action except that this information may be disclosed to:
- (1) persons involved with HHSC in the enforcement action against the facility;
- (2) the facility that is the subject of the enforcement action, or the facility's authorized representative;
- (3) appropriate state or federal agencies that are authorized to inspect, survey, or investigate licensed mental health facility services;
- (4) law enforcement agencies as allowed by law; and
- (5) persons engaged in bona fide research, if all individual-identifying information and information identifying the facility has been deleted.
(l) The following information is subject to disclosure in accordance with Texas Government Code Chapter 552, only to the extent that all personally identifiable information of a patient or health care provider is omitted from the information:
- (1) a notice of the facility's alleged violation, which must include the provisions of law the facility is alleged to have violated, and a general statement of the nature of the alleged violation;
- (2) the number of investigations HHSC conducted of the facility;
- (3) the pleadings in any administrative proceeding to impose a penalty against the facility for the alleged violation;
- (4) the outcome of each investigation HHSC conducted of the facility, including:
  - (A) reprimand issuance;
  - (B) license denial or revocation;
  - (C) corrective action plan adoption; or
  - (D) administrative penalty imposition and the penalty amount;
- (5) a final decision, investigative report, or order issued by HHSC to address the alleged violation; and
- (6) any other information required by law to be disclosed under public information laws.
(m) Within 90 days after the date HHSC issues a final decision, investigative report, or order to address a facility's alleged violation, HHSC posts certain information on the HHSC website in accordance with Texas Health and Safety Code §577.013.

510.84 - Notice

(a) A facility is deemed to have received any Texas Health and Human Services Commission (HHSC) correspondence on the date of receipt, or three business days after mailing, whichever is earlier.
(b) When HHSC finds deficiencies:
- (1) HHSC provides the facility with a written Statement of Deficiencies (SOD) within 10 business days after the exit conference via U.S. Postal Service or electronic mail.
- (2) Within 10 calendar days after the facility's receipt of the SOD, the facility shall return to HHSC a written Plan of Correction (POC) that addresses each cited deficiency, including timeframes for corrections, together with any additional evidence of compliance.
  - (A) HHSC determines if a POC and proposed timeframes are acceptable, and, if accepted, notifies the facility in writing.
  - (B) If HHSC does not accept the POC, HHSC notifies the facility in writing and requests the facility submit a modified POC and any additional evidence of compliance no later than 10 business days after HHSC notifies the facility in writing.
  - (C) The facility shall correct the identified deficiencies and submit to HHSC evidence verifying implementation of corrective action within the timeframes set forth in the POC, or as otherwise specified by HHSC.
- (3) Regardless of a facility's compliance with this subsection or HHSC's acceptance of a facility's POC, HHSC may, at any time, propose to take enforcement action as appropriate under this chapter.

510.86 - Complaint Against an HHSC Representative

A facility may register a complaint against a Texas Health and Human Services Commission (HHSC) representative who conducts an inspection or investigation under this subchapter by following the procedure listed on the HHSC website.

510.87 - Enforcement

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, and orders.
- (1) Denial, suspension or revocation of a license or imposition of an administrative penalty. HHSC has jurisdiction to enforce violations of Texas Health and Safety Code (HSC) Chapters 571 through 578 or the rules adopted under these chapters. HHSC may deny, suspend, or revoke a license or impose an administrative penalty for:
  - (A) failure to comply with any applicable provision of the HSC, including Chapters 161, 321, 322, and 571 through 578;
  - (B) failure to comply with any provision of this chapter or any other applicable laws;
  - (C) the facility, or any of its employees, committing an act which causes actual harm or risk of harm to the health or safety of a patient;
  - (D) the facility, or any of its employees, materially altering any license issued by HHSC;
  - (E) failure to comply with minimum standards for licensure;
  - (F) failure to provide a complete license application;
  - (G) failure to comply with an order of the executive commissioner or another enforcement procedure under HSC Chapters 571 through 578;
  - (H) a history of failure to comply with the applicable rules relating to patient environment, health, safety, and rights;
  - (I) the facility aiding, committing, abetting, or permitting the commission of an illegal act;
  - (J) the facility, or any of its employees, committing fraud, misrepresentation, or concealment of a material fact on any documents required to be submitted to HHSC or required to be maintained by the facility pursuant to HSC Chapters 571 through 578 and the provisions of this chapter;
  - (K) failure to timely pay an assessed administrative penalty as required by HHSC;
  - (L) failure to submit an acceptable plan of correction for cited deficiencies within the timeframe required by HHSC;
  - (M) failure to timely implement plans of corrections to deficiencies cited by HHSC within the dates designated in the plan of correction;
  - (N) failure to comply with applicable requirements within a designated probation period; or
  - (O) if the facility is participating under Title XVIII of the Social Security Act, 42 United States Code (USC), §1395 et seq., the Centers for Medicare & Medicaid Services terminating the facility's Medicare provider agreement.
- (2) Denial of a license. HHSC has jurisdiction to enforce violations of HSC Chapters 571 through 578 or the rules adopted under this chapter. HHSC may deny a license if the applicant:
  - (A) fails to provide timely and sufficient information required by HHSC that is directly related to the license application; or
  - (B) has had the following actions taken against the applicant within the two-year period preceding the license application:
    - (i) decertification or cancellation of its contract under the Medicare or Medicaid program in any state;
    - (ii) federal Medicare or state Medicaid sanctions or penalties;
    - (iii) unsatisfied federal or state tax liens;
    - (iv) unsatisfied final judgments;
    - (v) eviction involving any property or space used as a hospital in any state;
    - (vi) unresolved federal Medicare or state Medicaid audit exceptions;
    - (vii) denial, suspension, or revocation of a hospital license, a private psychiatric hospital license, or a license for any health care facility in any state; or
    - (viii) a court injunction prohibiting ownership or operation of a facility.
- (3) Order for immediate license suspension. HHSC may suspend a license for 10 days pending a hearing if after an investigation HHSC finds that there is an immediate threat to the health or safety of the patients or employees of a licensed facility. HHSC may issue necessary orders for the patients' welfare.
- (4) Probation. In lieu of denying, suspending, or revoking a license, HHSC may place a facility on probation for a period of not less than 30 days, if HHSC finds that the facility is in repeated non-compliance with this chapter or HSC Chapters 571 through 578 and the facility's noncompliance does not endanger the public's health and safety.
  - (A) HHSC shall provide notice to the facility of the probation and of the items of noncompliance not later than the 10th day before the date the probation period begins.
  - (B) During the probation period, the facility shall correct the items of noncompliance and report the corrections to HHSC for approval.
- (5) Administrative penalty. HHSC has jurisdiction to impose an administrative penalty against a person licensed or regulated under this chapter for violations of applicable chapters of the HSC or this chapter. The imposition of an administrative penalty shall be in accordance with the provisions of HSC §571.025.
- (6) Licensure of persons or entities with criminal backgrounds. HHSC may deny a person or entity a license or suspend or revoke an existing license on the grounds that the person or entity has been convicted of a felony or misdemeanor that directly relates to the duties and responsibilities of the ownership or operation of a facility. HHSC shall apply the requirements of Texas Occupations Code Chapter 53.
  - (A) HHSC is entitled under Texas Government Code Chapter 411 to obtain criminal history information maintained by the Texas Department of Public Safety, the Federal Bureau of Investigation, or any other law enforcement agency to investigate the eligibility of an applicant for an initial or renewal license and to investigate the continued eligibility of a licensee.
  - (B) In determining whether a criminal conviction directly relates, HHSC shall apply the requirements and consider the provisions of Texas Occupations Code Chapter 53 (relating to Consequences of Criminal Conviction).
  - (C) The following felonies and misdemeanors directly relate to the duties and responsibilities of the ownership or operation of a health care facility because these criminal offenses indicate an ability or a tendency for the person to be unable to own or operate a facility:
    - (i) a misdemeanor violation of HSC Chapter 571;
    - (ii) a misdemeanor or felony involving moral turpitude;
    - (iii) a misdemeanor or felony relating to deceptive business practices;
    - (iv) a misdemeanor or felony of practicing any health-related profession without a required license;
    - (v) a misdemeanor or felony under any federal or state law relating to drugs, dangerous drugs, or controlled substances;
    - (vi) a misdemeanor or felony under Texas Penal Code (TPC), Title 5, involving a patient or a client of any health care facility, a home and community support services agency, or a health care professional; or
    - (vii) a misdemeanor or felony under TPC:
    - (I) Title 4;
    - (II) Title 5;
    - (III) Title 7;
    - (IV) Title 8;
    - (V) Title 9;
    - (VI) Title 10; or
    - (VII) Title 11.
- (7) Offenses listed in paragraph (6)(C) of this section are not exclusive in that HHSC may consider similar criminal convictions from other state, federal, foreign or military jurisdictions that indicate an inability or tendency for the person or entity to be unable to own or operate a facility.
- (8) HHSC shall revoke a license on the licensee's imprisonment following a felony conviction, felony community supervision revocation, revocation of parole, or revocation of mandatory supervision.
- (9) Notice. If HHSC proposes to deny, suspend, or revoke a license, or impose an administrative penalty, HHSC shall send a notice of the proposed action by certified mail, return receipt requested, at the address shown in the current records of HHSC or HHSC may personally deliver the notice. The notice to deny, suspend, or revoke a license, or impose an administrative penalty, shall state the alleged facts or conduct to warrant the proposed action, provide an opportunity to demonstrate or achieve compliance, and shall state that the applicant or license holder has an opportunity for a hearing before taking the action.
- (10) Acceptance. Within 20 calendar days after receipt of the notice described in paragraph (9) of this section, the applicant or licensee shall notify HHSC, in writing, of acceptance of HHSC's determination or request a hearing.
- (11) Hearing request.
  - (A) A request for a hearing by the applicant or licensee shall be in writing and submitted to HHSC within 20 calendar days after receipt of the notice described in paragraph (9) of this section. Receipt of the notice is presumed to occur on the third day after the date HHSC mails the notice to the last known address of the applicant or licensee.
  - (B) A hearing shall be conducted pursuant to Texas Government Code Chapter 2001, and Texas Administrative Code Title 1 Chapter 357, Subchapter I (relating to Hearings under the Administrative Procedure Act).
- (12) No response to notice. If an applicant or licensee does not request a hearing in writing within 20 calendar days after receiving notice of the proposed action, the applicant or licensee is deemed to have waived the opportunity for a hearing and HHSC takes the proposed action.
- (13) Notification of HHSC's final decision. HHSC shall send the licensee or applicant a copy of HHSC's decision for denial, suspension or revocation of license or imposition of an administrative penalty by certified mail, which shall include the findings of fact and conclusions of law on which HHSC based its decision.
- (14) Admission of new patients upon suspension or revocation. Upon HHSC's determination to suspend or revoke a license, the license holder may not admit new patients until the license is reissued.
- (15) Decision to suspend or revoke. When HHSC's decision to suspend or revoke a license is final, the licensee must immediately cease operation, unless a stay of such action is issued by the district court.
- (16) Return of original license. Upon suspension, revocation or non-renewal of the license, the original license shall be returned to HHSC within 30 calendar days of HHSC's notification.
- (17) Reapplication following denial or revocation.
  - (A) One year after HHSC's decision to deny or revoke, or the voluntary surrender of a license by a facility while enforcement action is pending, a facility may petition HHSC, in writing, for a license. Expiration of a license prior to HHSC's decision becoming final shall not affect the one-year waiting period required before a petition can be submitted.
  - (B) HHSC may allow a reapplication for licensure if there is proof that the reasons for the original action no longer exist.
  - (C) HHSC may deny reapplication for licensure if HHSC determines that:
    - (i) the reasons for the original action continues;
    - (ii) the petitioner has failed to offer sufficient proof that conditions have changed; or
    - (iii) the petitioner has demonstrated a repeated history of failure to provide patients a safe environment or has violated patient rights.
  - (D) If HHSC allows a reapplication for licensure, the petitioner shall be required to meet the requirements as described in §510.22 of this chapter (relating to Application and Issuance of Initial License).
- (18) Expiration of a license during suspension. A facility whose license expires during a suspension period may not reapply for license renewal until the end of the suspension period.
- (19) Surrender of a license. In the event that enforcement, as defined in this subsection, is pending or reasonably imminent, the surrender of a facility license shall not deprive HHSC of jurisdiction in regard to enforcement against the facility.

Mental Health

Sexual Exploitation Brochure - 161.136

(a) A state health care regulatory agency by rule may require a mental health services provider licensed by that agency to provide a standardized written brochure, in wording a patient can understand, that summarizes the law prohibiting sexual exploitation of patients. The brochure must be available in English and in a second language.
(b) The brochure shall include:
- (1) procedures for filing a complaint relating to sexual exploitation, including any toll-free telephone number available; and
- (2) the rights of a victim of sexual exploitation.
(c) In this section, "mental health services provider" has the meaning assigned by Section 81.001, Civil Practice and Remedies Code.

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