By: Hinojosa, et al.	S.B. No. 204

	A BILL TO BE ENTITLED
	AN ACT
	relating to the functions and operations of the Department of Aging
	and Disability Services; increasing penalties.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
	SECTION 1.  Section 81.042(e), Health and Safety Code, is
	amended to read as follows:
	(e)  The following persons shall report to the local health
	authority or the department a suspected case of a reportable
	disease and all information known concerning the person who has or
	is suspected of having the disease if a report is not made as
	required by Subsections (a)-(d):
	(1)  a professional registered nurse;
	(2)  an administrator or director of a public or
	private temporary or permanent child-care facility;
	(3)  an administrator or director of a nursing home,
	personal care home, adult respite care center, or day activity and
	health services program or facility [adult day-care center];
	(4)  an administrator of a home health agency;
	(5)  an administrator or health official of a public or
	private institution of higher education;
	(6)  an owner or manager of a restaurant, dairy, or
	other food handling or processing establishment or outlet;
	(7)  a superintendent, manager, or health official of a
	public or private camp, home, or institution;
	(8)  a parent, guardian, or householder;
	(9)  a health professional;
	(10)  an administrator or health official of a penal or
	correctional institution; or
	(11)  emergency medical service personnel, a peace
	officer, or a firefighter.
	SECTION 2.  Subchapter A, Chapter 142, Health and Safety
	Code, is amended by adding Section 142.0125 to read as follows:
	Sec. 142.0125.  PROGRESSIVE SANCTIONS.  (a)  The executive
	commissioner by rule shall create a matrix of progressive sanctions
	that the department must use to assess penalty amounts and impose
	disciplinary actions under this chapter appropriately and fairly
	for a violation of a law, rule, standard, or order adopted or
	license issued under this chapter or for a violation of other law
	for which this chapter provides a sanction.
	(b)  The matrix of progressive sanctions adopted under this
	section must provide for increases in amounts of administrative
	penalties based on type, frequency, and seriousness of violations
	and must provide guidance for determining appropriate and graduated
	administrative penalties to assess under this chapter to deter
	future violations, including guidance on considering the factors
	listed in this chapter for determining the amount of a penalty.
	(c)  The matrix of progressive sanctions adopted under this
	section must provide for imposing stronger sanctions, including
	license suspension or revocation, for more serious violations or
	for repeated violations as appropriate to deter future serious or
	repeated violations. The matrix of progressive sanctions must
	describe appropriate time frames to be used in determining whether
	a home and community support services agency has committed repeated
	violations or has engaged in a pattern of repeated violations, such
	as repeated violations found in consecutive regular inspections.
	SECTION 3.  Sections 142.017(b) and (j), Health and Safety
	Code, are amended to read as follows:
	(b)  The penalty shall be not less than $100 or more than
	$5,000 [$1,000] for each violation. Each day of a violation that
	occurs before the day on which the person receives written notice of
	the violation from the department does not constitute a separate
	violation and shall be considered to be one violation. Each day of
	a continuing violation that occurs after the day on which the person
	receives written notice of the violation from the department
	constitutes a separate violation.
	(j)  The executive commissioner by rule shall define the
	types of minor violations an agency may correct under Subsection
	(e) before the department may assess an administrative penalty.
	The executive commissioner shall ensure that all other violations
	are not subject to a right to correct [The department may assess an
	administrative penalty without providing a reasonable period of
	time to the agency to correct the violation if the violation:
	[(1)  results in serious harm or death;
	[(2)  constitutes a serious threat to health or safety;
	[(3)     substantially limits the agency's capacity to
	provide care;
	[(4)  is a violation in which a person:
	[(A)     makes a false statement, that the person
	knows or should know is false, of a material fact:
	[(i)     on an application for issuance or
	renewal of a license or in an attachment to the application; or
	[(ii)     with respect to a matter under
	investigation by the department;
	[(B)     refuses to allow a representative of the
	department to inspect a book, record, or file required to be
	maintained by an agency;
	[(C)     wilfully interferes with the work of a
	representative of the department or the enforcement of this
	chapter;
	[(D)     wilfully interferes with a representative
	of the department preserving evidence of a violation of this
	chapter or a rule, standard, or order adopted or license issued
	under this chapter;
	[(E)     fails to pay a penalty assessed by the
	department under this chapter not later than the 10th day after the
	date the assessment of the penalty becomes final; or
	[(F)  fails to submit:
	[(i)     a plan of correction not later than the
	10th day after the date the person receives a statement of licensing
	violations; or
	[(ii)     an acceptable plan of correction not
	later than the 30th day after the date the person receives
	notification from the department that the previously submitted plan
	of correction is not acceptable;
	[(5)  is a violation of Section 142.0145; or
	[(6)     involves the rights of the elderly under Chapter
	102, Human Resources Code].
	SECTION 4.  Section 164.003(5), Health and Safety Code, as
	amended by S.B. No. 219, Acts of the 84th Legislature, Regular
	Session, 2015, is amended to read as follows:
	(5)  "Mental health facility" means:
	(A)  a "mental health facility" as defined by
	Section 571.003;
	(B)  a residential treatment facility, other than
	a mental health facility, in which persons are treated for
	emotional problems or disorders in a 24-hour supervised living
	environment; and
	(C)  a day activity and health services [an adult
	day-care] facility as defined by Section 103.003, Human Resources
	Code.
	SECTION 5.  (a)  It is the intent of the legislature that
	Section 242.061, Health and Safety Code, as amended by this
	section, establish a ceiling or maximum number of violations
	related to the abuse and neglect of a resident that a facility can
	commit before the Department of Aging and Disability Services is
	required to revoke the facility's license.  The changes in law made
	by this section are not intended to limit or diminish the
	department's permissive authority to revoke a license under Chapter
	242, Health and Safety Code.
	(b)  Section 242.061, Health and Safety Code, is amended by
	amending Subsection (a) and adding Subsections (a-1), (a-2), (a-3),
	(c-1), and (e) to read as follows:
	(a)  In this section:
	(1)  "Abuse" has the meaning assigned by Section
	260A.001.
	(2)  "Immediate threat to health and safety" means a
	situation in which immediate corrective action is necessary because
	the facility's noncompliance with one or more requirements has
	caused, or is likely to cause, serious injury, harm, impairment, or
	death to a resident.
	(3)  "Neglect" has the meaning assigned by Section
	260A.001.
	(a-1)  The department, after providing notice and
	opportunity for a hearing to the applicant or license holder, may
	deny, suspend, or revoke a license if the department finds that the
	applicant, the license holder, or any other person described by
	Section 242.032(d) has:
	(1)  violated this chapter or a rule, standard, or
	order adopted or license issued under this chapter in either a
	repeated or substantial manner;
	(2)  committed any act described by Sections
	242.066(a)(2)-(6); or
	(3)  failed to comply with Section 242.074.
	(a-2)  Except as provided by Subsection (a-3) or (e), the
	department shall revoke a license under Subsection (a-1) if the
	department finds that:
	(1)  the license holder has committed three violations
	described by Subsection (a-1), within a 24-month period, that
	constitute an immediate threat to health and safety related to the
	abuse or neglect of a resident; and
	(2)  each of the violations described by Subdivision
	(1) are reported in connection with separate surveys, inspections,
	or investigation visits.
	(a-3)  The department may not revoke a license under
	Subsection (a-2) due to a violation described by Subsection
	(a-2)(1), if:
	(1)  the violation is not included on the written list
	of violations left with the facility at the time of the initial exit
	conference under Section 242.0445(b) for a survey, inspection, or
	investigation;
	(2)  the violation is not included on the final
	statement of violations described by Section 242.0445; or
	(3)  the violation has been reviewed under the informal
	dispute resolution process established by Section 531.058,
	Government Code, and a determination was made that:
	(A)  the violation should be removed from the
	license holder's record; or
	(B)  the violation is reduced in severity so that
	the violation is no longer cited as an immediate threat to health
	and safety related to the abuse or neglect of a resident.
	(c-1)  In the case of revocation of a license under
	Subsection (a-2), to ensure the health and safety of residents of
	the institution, the department may:
	(1)  request the appointment of a trustee to operate
	the institution under Subchapter D;
	(2)  obtain a new operator for the institution; or
	(3)  assist with the relocation of residents to another
	institution.
	(e)  The executive commissioner may waive a license
	revocation required by Subsection (a-2) if the executive
	commissioner determines that the waiver would not jeopardize the
	health and safety of the residents of the facility or place the
	residents at risk of abuse or neglect.  The executive commissioner
	by rule shall establish criteria under which a waiver may be granted
	as provided by this subsection.  The executive commissioner may
	provide a waiver for a veterans home, as defined by Section 164.002,
	Natural Resources Code, if the Veterans' Land Board contracts with
	a different entity to operate the veterans home than the entity that
	operated the home during the period in which the violations
	described by Subsection (a-2) occurred.
	SECTION 6.  Subchapter C, Chapter 242, Health and Safety
	Code, is amended by adding Section 242.0613 to read as follows:
	Sec. 242.0613.  PROGRESSIVE SANCTIONS. (a)  The executive
	commissioner by rule shall create a matrix of progressive sanctions
	that the department must use to assess penalty amounts and impose
	disciplinary actions under this chapter appropriately and fairly
	for a violation of a law, rule, standard, or order adopted or
	license issued under this chapter or for a violation of other law
	for which this chapter provides a sanction.
	(b)  The matrix of progressive sanctions adopted under this
	section must provide for increases in amounts of administrative
	penalties based on type, frequency, and seriousness of violations
	and must provide guidance for determining appropriate and graduated
	administrative penalties to assess under this chapter to deter
	future violations, including guidance on considering the factors
	listed in this chapter for determining the amount of a penalty.
	(c)  The matrix of progressive sanctions adopted under this
	section must provide for imposing stronger sanctions, including
	license suspension or revocation, for more serious violations or
	for repeated violations as appropriate to deter future serious or
	repeated violations. The matrix of progressive sanctions must
	describe appropriate time frames to be used in determining whether
	a facility has committed repeated violations or has engaged in a
	pattern of repeated violations, such as repeated violations found
	in consecutive regular inspections.
	SECTION 7.  Section 242.0615(a), Health and Safety Code, is
	amended to read as follows:
	(a)  The department, after providing notice and opportunity
	for a hearing, may exclude a person from eligibility for a license
	under this chapter if the person or any person described by Section
	242.032(d) has substantially failed to comply with this chapter and
	the rules adopted under this chapter. The authority granted by this
	subsection is in addition to the authority to deny issuance of a
	license under Section 242.061(a-1) [242.061(a)].
	SECTION 8.  Section 242.0665(b), Health and Safety Code, is
	amended to read as follows:
	(b)  The executive commissioner by rule shall define types of
	minor violations a facility may correct under Subsection (a) before
	the department may assess an administrative penalty. The executive
	commissioner shall ensure that all other violations are not subject
	to a right to correct [Subsection (a) does not apply:
	[(1)  to a violation that the department determines:
	[(A)     results in serious harm to or death of a
	resident;
	[(B)     constitutes a serious threat to the health
	or safety of a resident; or
	[(C)     substantially limits the institution's
	capacity to provide care;
	[(2)     to a violation described by Sections
	242.066(a)(2)-(7);
	[(3)     to a violation of Section 260A.014 or 260A.015;
	or
	[(4)     to a violation of a right of a resident adopted
	under Subchapter L].
	SECTION 9.  Subchapter C, Chapter 247, Health and Safety
	Code, is amended by adding Section 247.0415 to read as follows:
	Sec. 247.0415.  PROGRESSIVE SANCTIONS. (a)  The executive
	commissioner by rule shall create a matrix of progressive sanctions
	that the department must use to assess penalty amounts and impose
	disciplinary actions under this chapter appropriately and fairly
	for a violation of a law, rule, standard, or order adopted or
	license issued under this chapter or for a violation of other law
	for which this chapter provides a sanction.
	(b)  The matrix of progressive sanctions adopted under this
	section must provide for increases in amounts of administrative
	penalties based on type, frequency, and seriousness of violations
	and must provide guidance for determining appropriate and graduated
	administrative penalties to assess under this chapter to deter
	future violations, including guidance on considering the factors
	listed in this chapter for determining the amount of a penalty.
	(c)  The matrix of progressive sanctions adopted under this
	section must provide for imposing stronger sanctions, including
	license suspension or revocation, for more serious violations or
	for repeated violations as appropriate to deter future serious or
	repeated violations. The matrix of progressive sanctions must
	describe appropriate time frames to be used in determining whether
	an assisted living facility has committed repeated violations or
	has engaged in a pattern of repeated violations, such as repeated
	violations found in consecutive regular inspections.
	SECTION 10.  Section 247.0451(b), Health and Safety Code, is
	amended to read as follows:
	(b)  Except as provided by Section 247.0452(c), the penalty
	may not exceed $5,000 [$1,000] for each violation.  Each day a
	violation occurs or continues is a separate violation for purposes
	of imposing a penalty.
	SECTION 11.  Section 247.0452(b), Health and Safety Code, is
	amended to read as follows:
	(b)  The executive commissioner by rule shall define the
	types of minor violations an assisted living facility may correct
	under Subsection (a) before the department may assess an
	administrative penalty. The executive commissioner shall ensure
	that all other violations are not subject to a right to
	correct [Subsection (a) does not apply:
	[(1)     to a violation that the department determines
	results in serious harm to or death of a resident;
	[(2)     to a violation described by Sections
	247.0451(a)(2)-(7) or a violation of Section 260A.014 or 260A.015;
	[(3)  to a second or subsequent violation of:
	[(A)     a right of the same resident under Section
	247.064; or
	[(B)     the same right of all residents under
	Section 247.064; or
	[(4)     to a violation described by Section 247.066,
	which contains its own right to correct provisions].
	SECTION 12.  Section 247.051(a), Health and Safety Code, as
	amended by S.B. No. 219, Acts of the 84th Legislature, Regular
	Session, 2015, is amended to read as follows:
	(a)  The executive commissioner by rule shall establish an
	informal dispute resolution process to address disputes between a
	facility and the department concerning a statement of violations
	prepared by the department in accordance with this section. The
	process must provide for adjudication by an appropriate
	disinterested person of disputes relating to a statement of
	violations. The informal dispute resolution process must require:
	(1)  the assisted living facility to request informal
	dispute resolution not later than the 10th day after the date of
	notification by the department of the violation of a standard or
	standards;
	(2)  that the [commission to complete the] process be
	completed not later than the 90th day after the date of receipt of a
	request from the assisted living facility for informal dispute
	resolution;
	(3)  that, not later than the 10th business day after
	the date an assisted living facility requests an informal dispute
	resolution, the department forward to the assisted living facility
	a copy of all information that is referred to in the disputed
	statement of violations or on which a citation is based in
	connection with the survey, inspection, investigation, or other
	visit, excluding:
	(A)  the name of any complainant, witness, or
	informant;
	(B)  any information that would reasonably lead to
	the identification of a complainant, witness, or informant;
	(C)  information obtained from or contained in the
	records of the facility;
	(D)  information that is publicly available; or
	(E)  information that is confidential by law;
	(4)  that [the commission to give] full consideration
	is given to all [factual] arguments raised during the informal
	dispute resolution process that:
	(A)  are supported by references to specific
	information that the facility or department relies on to dispute or
	support findings in the statement of violations; and
	(B)  are provided by the proponent of the argument
	[to the commission] and the opposing party;
	(5)  that full consideration is given during the
	informal dispute resolution process [staff give full
	consideration] to the information provided by the assisted living
	facility and the department;
	(6)  that ex parte communications concerning the
	substance of any argument relating to a survey, inspection,
	investigation, visit, or statement of violations under
	consideration not occur between the informal dispute resolution
	staff and the assisted living facility or the department; and
	(7)  that the assisted living facility and the
	department be given a reasonable opportunity to submit arguments
	and information supporting the position of the assisted living
	facility or the department and to respond to arguments and
	information presented against them.
	SECTION 13.  Section 250.001(3), Health and Safety Code, as
	amended by S.B. No. 219, Acts of the 84th Legislature, Regular
	Session, 2015, is amended to read as follows:
	(3)  "Facility" means:
	(A)  a nursing facility, custodial care home, or
	other institution licensed by the Department of Aging and
	Disability Services under Chapter 242;
	(B)  an assisted living facility licensed by the
	Department of Aging and Disability Services under Chapter 247;
	(C)  a home and community support services agency
	licensed under Chapter 142;
	(D)  a day activity and health services [an adult
	day care] facility licensed by the Department of Aging and
	Disability Services under Chapter 103, Human Resources Code;
	(E)  an ICF-IID licensed under Chapter 252;
	(F)  an adult foster care provider that contracts
	with the Department of Aging and Disability Services;
	(G)  a facility that provides mental health
	services and that is operated by or contracts with the Department of
	State Health Services;
	(H)  a local mental health authority designated
	under Section 533.035 or a local intellectual and developmental
	disability authority designated under Section 533.035;
	(I)  a person exempt from licensing under Section
	142.003(a)(19);
	(J)  a special care facility licensed by the
	Department of State Health Services under Chapter 248;
	(K)  a mental health service unit of a hospital
	licensed under Chapter 241; or
	(L)  a prescribed pediatric extended care center
	licensed by the Department of Aging and Disability Services under
	Chapter 248A.
	SECTION 14.  Subchapter C, Chapter 252, Health and Safety
	Code, is amended by adding Section 252.0615 to read as follows:
	Sec. 252.0615.  PROGRESSIVE SANCTIONS. (a)  The executive
	commissioner by rule shall create a matrix of progressive sanctions
	that the department must use to assess penalty amounts and impose
	disciplinary actions under this chapter appropriately and fairly
	for a violation of a law, rule, standard, or order adopted or
	license issued under this chapter or for a violation of other law
	for which this chapter provides a sanction.
	(b)  The matrix of progressive sanctions adopted under this
	section must provide for increases in amounts of administrative
	penalties based on type, frequency, and seriousness of violations
	and must provide guidance for determining appropriate and graduated
	administrative penalties to assess under this chapter to deter
	future violations, including guidance on considering the factors
	listed in this chapter for determining the amount of a penalty.
	(c)  The matrix of progressive sanctions adopted under this
	section must provide for imposing stronger sanctions, including
	license suspension or revocation, for more serious violations or
	for repeated violations as appropriate to deter future serious or
	repeated violations. The matrix of progressive sanctions must
	describe appropriate time frames to be used in determining whether
	a facility has committed repeated violations or has engaged in a
	pattern of repeated violations, such as repeated violations found
	in consecutive regular inspections.
	SECTION 15.  Section 252.065, Health and Safety Code, is
	amended by amending Subsection (b) and Subsection (e), as amended
	by S.B. 219, Acts of the 84th Legislature, Regular Session, 2015, to
	read as follows:
	(b)  The penalty for a facility with fewer than 60 beds shall
	be not less than $100 or more than $1,000 for each violation. The
	penalty for a facility with 60 beds or more shall be not less than
	$100 or more than $5,000 for each violation. [The total amount of
	the penalty assessed for a violation continuing or occurring on
	separate days under this subsection may not exceed $5,000 for a
	facility with fewer than 60 beds or $25,000 for a facility with 60
	beds or more.] Each day a violation occurs or continues is a
	separate violation for purposes of imposing a penalty.
	(e)  The executive commissioner by rule shall provide the
	facility with a reasonable period of time, not less than 45 days,
	following the first day of a violation to correct the violation
	before the department may assess an administrative penalty if a
	plan of correction has been implemented. The executive
	commissioner by rule shall define the types of minor violations a
	facility may correct before the department may assess an
	administrative penalty. The executive commissioner shall ensure
	that all other violations are not subject to a right to correct
	[This subsection does not apply to a violation described by
	Subsections (a)(2)-(8) or to a violation that the department
	determines:
	[(1)     has resulted in serious harm to or the death of a
	resident;
	[(2)     constitutes a serious threat to the health or
	safety of a resident; or
	[(3)     substantially limits the institution's capacity
	to provide care].
	SECTION 16.  Section 255.003, Health and Safety Code, is
	amended by amending Subsections (b), (e), and (j) and adding
	Subsections (b-1) and (i-1) to read as follows:
	(b)  Monitoring [Priority for monitoring] visits shall be
	given to long-term care facilities:
	(1)  with a history of patient care deficiencies; or
	(2)  that are identified as medium risk through the
	department's early warning system.
	(b-1)  A long-term care facility may request a monitoring
	visit under this section.
	(e)  Quality-of-care monitors shall assess:
	(1)  the overall quality of life in the long-term care
	facility; and
	(2)  specific conditions in the facility directly
	related to patient care, including conditions identified through
	the long-term care facility's quality measure reports based on
	Minimum Data Set Resident Assessments.
	(i-1)  The department shall schedule a follow-up visit not
	later than the 45th day after the date of an initial monitoring
	visit conducted under this section.
	(j)  Conditions observed by the quality-of-care monitor that
	create an immediate threat to the health or safety of a resident
	shall be reported immediately to the long-term care facility
	administrator, to the regional office supervisor for appropriate
	action, and, as appropriate or as required by law, to law
	enforcement, adult protective services, other divisions of the
	department, or other responsible agencies.
	SECTION 17.  Section 255.004, Health and Safety Code, is
	amended by amending Subsection (a) and adding Subsections (a-1) and
	(a-2) to read as follows:
	(a)  In this section:
	(1)  "Abuse" has the meaning assigned by Section
	260A.001.
	(2)  "Immediate threat to health and safety" means a
	situation in which immediate corrective action is necessary because
	the facility's noncompliance with one or more requirements has
	caused, or is likely to cause, serious injury, harm, impairment, or
	death to a resident.
	(3)  "Neglect" has the meaning assigned by Section
	260A.001.
	(a-1)  The department shall create rapid response teams
	composed of health care experts that can visit a long-term care
	facility that:
	(1)  is [facilities] identified as high risk through
	the department's early warning system; or
	(2)  if the long-term care facility is a nursing
	institution, has committed three violations described by Section
	242.061(a-1), within a 24-month period, that constitute an
	immediate threat to health and safety related to the abuse or
	neglect of a resident.
	(a-2)  A long-term care facility shall cooperate with a rapid
	response team deployed under this section to improve the quality of
	care provided at the facility.
	SECTION 18.  Subchapter B, Chapter 533A, Health and Safety
	Code, as added by S.B. 219, Acts of the 84th Legislature, Regular
	Session, 2015, is amended by adding Section 533A.044 to read as
	follows:
	Sec. 533A.044.  CRISIS INTERVENTION TEAMS. (a)  In this
	section, "crisis intervention team" means a team of individuals
	specially trained to provide services and support to persons with
	an intellectual or developmental disability who have behavioral
	health needs and who are at risk of institutionalization.
	(b)  The department shall evaluate the effectiveness of
	various models of crisis intervention teams that are funded under a
	waiver under Section 1115 of the federal Social Security Act (42
	U.S.C. Section 1315) and operated by a local intellectual and
	developmental disability authority.
	(c)  Not later than March 1, 2016, the department shall
	select for implementation one or more models for crisis
	intervention teams the department determines best provide
	comprehensive, cost-effective support.
	(d)  The department shall determine the areas in this state
	in which local intellectual and developmental disability
	authorities do not operate crisis intervention teams and, subject
	to available funding, shall implement in each area a team that
	operates in accordance with a model selected for implementation
	under this section.
	SECTION 19.  Chapter 555, Health and Safety Code, is amended
	by adding Subchapter F to read as follows:
	SUBCHAPTER F.  STATE SUPPORTED LIVING CENTER RESTRUCTURING AND
	CLOSURES
	Sec. 555.201.  STATE SUPPORTED LIVING CENTER RESTRUCTURING
	COMMISSION. (a)  In this subchapter, "restructuring commission"
	means the state supported living center restructuring commission.
	(b)  The restructuring commission consists of five members
	appointed by the governor and the following three nonvoting ex
	officio members:
	(1)  the executive commissioner or the executive
	commissioner's designee;
	(2)  the executive director of the Texas Facilities
	Commission or the executive director's designee; and
	(3)  the commissioner of the General Land Office or the
	commissioner's designee.
	(c)  The restructuring commission is established to evaluate
	each state supported living center in the state to determine
	whether closure of the center is recommended to maintain only the
	number of centers necessary to meet the level of need in the state.
	In evaluating each state supported living center, the restructuring
	commission shall consider:
	(1)  the quality of services provided by the center,
	including the center's most recent certification inspections and
	the center's ability to meet the minimum ICF-IID standards;
	(2)  the costs of operating the center;
	(3)  the center's compliance with the 2009 settlement
	agreement between the department and the United States Department
	of Justice regarding services provided to individuals with an
	intellectual or developmental disability in state-operated
	facilities;
	(4)  the availability of community service providers in
	the area served by the center;
	(5)  the specialty services provided at the center,
	including the ability of the center to serve alleged offenders or
	high-risk residents;
	(6)  the availability of employment opportunities for
	center employees if the center closes;
	(7)  any infrastructure deficiency costs relating to
	the center;
	(8)  the property value of, the market demand for, and
	any deed restrictions applicable to property and facilities of the
	center;
	(9)  whether closure of the center would adversely
	affect the geographic distribution of centers in the state;
	(10)  the availability and capacity of service
	providers and resources in the community capable of delivering the
	quality and level of care each resident of the center would require
	following the center's closure; and
	(11)  any other criteria the restructuring commission
	considers appropriate.
	(d)  Not later than December 1, 2016, the restructuring
	commission shall submit to the governor, the lieutenant governor,
	the speaker of the house of representatives, and the presiding
	officers of the standing committees of the senate and house of
	representatives having primary jurisdiction over intellectual and
	developmental disability issues a report detailing the
	restructuring commission's evaluation of each state supported
	living center and, if applicable, proposing the closure of certain
	centers.
	(e)  A member of the restructuring commission may not:
	(1)  have a direct or indirect interest in any contract
	or proposed contract with a licensed provider of ICF-IID services,
	or other provider of services to individuals with an intellectual
	or developmental disability;
	(2)  acquire a direct or indirect pecuniary interest in
	any provider of ICF-IID services, or other provider of services to
	individuals with an intellectual or developmental disability; or
	(3)  have a financial interest in the closure of a state
	supported living center.
	(f)  The restructuring commission is abolished and this
	section expires January 1, 2017.
	Sec. 555.202.  RECOMMENDED CLOSURES OF STATE SUPPORTED
	LIVING CENTERS. (a)  If the restructuring commission proposes the
	closure of one or more state supported living centers, the 85th
	Legislature shall consider legislation proposing the closure of the
	centers recommended for closure. In considering the proposed
	legislation described by this subsection, members of the
	legislature may not propose amendments to the legislation.
	(b)  If the legislation described by Subsection (a) is
	enacted and becomes law, the department shall ensure that each
	state supported living center approved by the legislature for
	closure under Subsection (a) is closed not later than August 31,
	2025.
	(c)  This subchapter expires September 1, 2025.
	Sec. 555.203.  CLOSURE OF AUSTIN STATE SUPPORTED LIVING
	CENTER. (a)  The department shall establish a closure plan for the
	Austin State Supported Living Center. The plan must provide for
	closure of the facility and operations of the Austin State
	Supported Living Center not later than August 31, 2017.
	(b)  The closure plan must provide procedures to transition
	to the community each resident for whom:
	(1)  the resident's care team recommends a community
	placement;
	(2)  a community placement is available for the
	resident; and
	(3)  a community placement is the choice of the
	resident.
	(c)  The department may award one-time retention bonuses to
	each direct support professional, qualified intellectual
	disability professional, social worker, and case manager who agrees
	to continue to provide services at the Austin State Supported
	Living Center until the center is closed.
	(d)  The proceeds from the closure, including from the sale
	or lease of facilities or other property, may be appropriated only
	for services for persons with an intellectual or developmental
	disability, including persons with a dual diagnosis of an
	intellectual or developmental disability and mental illness.
	(e)  Not later than August 31, 2018, the department shall
	evaluate the closure process, including how well the closure plan
	worked, and, if appropriate, establish policies for improving the
	closure process for future closures of other state supported living
	centers.
	(f)  This section expires September 1, 2018.
	SECTION 20.  Section 531.0318, Government Code, is amended
	by adding Subsections (b-1), (d), and (e) to read as follows:
	(b-1)  The information for consumers required by this
	section must include for each provider of long-term care services:
	(1)  a rating assigned by the Department of Aging and
	Disability Services indicating the quality of the care provided or,
	alternatively, a link to a rating assigned a provider on an Internet
	website maintained by the federal government;
	(2)  information concerning quality of care, as that
	information becomes available;
	(3)  staffing information, if available, including for
	each year the number of staff members who began employment with the
	provider during that year and the number of staff members who ceased
	employment with the provider during that year;
	(4)  the ratio of staff members to residents; and
	(5)  the provider's regulatory performance, as
	available.
	(d)  The Department of Aging and Disability Services shall
	immediately post notice on the department's Internet website when a
	provider of long-term care services loses its Medicaid
	certification.
	(e)  The Department of Aging and Disability Services shall
	periodically solicit input regarding the content of the information
	required under this section and the usability and accessibility of
	the website on which the information is located from consumers,
	consumer advocates, long-term care services providers, and the
	general public.
	SECTION 21.  Section 531.058(a), Government Code, as amended
	by S.B. No. 219, Acts of the 84th Legislature, Regular Session,
	2015, and Section 531.058(c), Government Code, are amended to read
	as follows:
	(a)  The executive commissioner by rule shall establish an
	informal dispute resolution process in accordance with this
	section. The process must provide for adjudication by an
	appropriate disinterested person of disputes relating to a proposed
	enforcement action or related proceeding of the commission under
	Section 32.021(d), Human Resources Code, or the Department of Aging
	and Disability Services under Chapter 242, 247, or 252, Health and
	Safety Code. The informal dispute resolution process must require:
	(1)  an institution or facility to request informal
	dispute resolution not later than the 10th calendar day after
	notification by the commission or department, as applicable, of the
	violation of a standard or standards; and
	(2)  the completion of [commission to complete] the
	process not later than:
	(A)  the 30th calendar day after receipt of a
	request from an institution or facility, other than an assisted
	living facility, for informal dispute resolution; or
	(B)  the 90th calendar day after receipt of a
	request from an assisted living facility for informal dispute
	resolution.
	(c)  The commission may not delegate its responsibility to
	administer the informal dispute resolution process established by
	this section to another state agency. This section does not apply
	to the informal dispute resolution process established by Section
	247.051, Health and Safety Code, applicable to assisted living
	facilities licensed under Chapter 247, Health and Safety Code.
	SECTION 22.  Section 531.058, Government Code, is amended by
	adding Subsection (a-1) to read as follows:
	(a-1)  As part of the informal dispute resolution process
	established under this section, the commission shall contract with
	an appropriate disinterested person who is a nonprofit organization
	to adjudicate disputes between an institution or facility licensed
	under Chapter 242, Health and Safety Code, and the Department of
	Aging and Disability Services concerning a statement of violations
	prepared by the department in connection with a survey conducted by
	the department of the institution or facility. Section 2009.053
	does not apply to the selection of an appropriate disinterested
	person under this subsection.  The person with whom the commission
	contracts shall adjudicate all disputes described by this
	subsection.
	SECTION 23.  Section 531.951(a), Government Code, is amended
	to read as follows:
	(a)  This subchapter applies only to the final licensing,
	listing, or registration decisions of a health and human services
	agency with respect to a person under the law authorizing the agency
	to regulate the following types of persons:
	(1)  a youth camp licensed under Chapter 141, Health
	and Safety Code;
	(2)  a home and community support services agency
	licensed under Chapter 142, Health and Safety Code;
	(3)  a hospital licensed under Chapter 241, Health and
	Safety Code;
	(4)  an institution licensed under Chapter 242, Health
	and Safety Code;
	(5)  an assisted living facility licensed under Chapter
	247, Health and Safety Code;
	(6)  a special care facility licensed under Chapter
	248, Health and Safety Code;
	(7)  an intermediate care facility licensed under
	Chapter 252, Health and Safety Code;
	(8)  a chemical dependency treatment facility licensed
	under Chapter 464, Health and Safety Code;
	(9)  a mental hospital or mental health facility
	licensed under Chapter 577, Health and Safety Code;
	(10)  a child-care facility or child-placing agency
	licensed under or a family home listed or registered under Chapter
	42, Human Resources Code; or
	(11)  a day activity and health services [an adult
	day-care] facility licensed under Chapter 103, Human Resources
	Code.
	SECTION 24.  Subchapter D, Chapter 48, Human Resources Code,
	is amended by adding Section 48.15221 to read as follows:
	Sec. 48.15221.  REPORTS CONCERNING DAY HABILITATION
	SERVICES PROVIDERS. (a)  In this section, "day habilitation
	services" and "day habilitation services provider" have the
	meanings assigned by Section 161.401.
	(b)  The department shall prepare and submit to the
	Department of Aging and Disability Services an annual report of the
	number of investigations arising from a report of abuse, neglect,
	or exploitation of a person with an intellectual or developmental
	disability that was allegedly committed by or on the premises of a
	day habilitation services provider, and whether the investigation
	concluded that the report of alleged abuse, neglect, or
	exploitation was confirmed, unconfirmed, inconclusive, or
	unfounded.
	(c)  The duty to prepare and submit a report under Subsection
	(b) does not affect the duty of the department to investigate and
	hold accountable a community-based intellectual and developmental
	disabilities services provider or intermediate care facility for
	any abuse, neglect, or exploitation of a person who receives day
	habilitation services from the provider.
	SECTION 25.  The heading to Chapter 103, Human Resources
	Code, is amended to read as follows:
	CHAPTER 103. DAY ACTIVITY AND HEALTH SERVICES PROGRAMS [ADULT DAY
	CARE]
	SECTION 26.  Section 103.001, Human Resources Code, as
	amended by S.B. No. 219, Acts of the 84th Legislature, Regular
	Session, 2015, is amended to read as follows:
	Sec. 103.001.  PURPOSE. It is the purpose of this chapter to
	establish programs of quality day activity and health services
	[adult day care and day health care] that will enable persons with
	disabilities who have medical or functional impairments and elderly
	persons to maintain maximum independence and to prevent premature
	or inappropriate institutionalization.  It is the purpose of this
	chapter to provide adequately regulated supervision for elderly
	persons and persons with disabilities while enabling them to remain
	in a family environment and affording the family a measure of
	normality in its daily activities.  The legislature intends to
	provide for the development of policies and programs that will:
	(1)  provide alternatives to institutionalization;
	(2)  establish facilities for day activity and health
	services programs [adult day care and day health care] throughout
	the state that offer services and are accessible to economically
	disadvantaged persons; and
	(3)  prevent inappropriate institutionalization.
	SECTION 27.  Section 103.002, Human Resources Code, is
	amended to read as follows:
	Sec. 103.002.  SHORT TITLE. This chapter may be cited as the
	Day Activity and Health Services [Adult Day Care] Act.
	SECTION 28.  Section 103.003(1), Human Resources Code, as
	amended by S.B. No. 219, Acts of the 84th Legislature, Regular
	Session, 2015, is amended to read as follows:
	(1)  "Day activity and health services facility"
	["Adult day-care facility"] means a facility that provides services
	under a day activity and health services [an adult day-care]
	program on a daily or regular basis but not overnight to four or
	more elderly persons or persons with disabilities who are not
	related by blood, marriage, or adoption to the owner of the
	facility.
	SECTION 29.  Section 103.003(2), Human Resources Code, is
	amended to read as follows:
	(2)  "Day activity and health services program" ["Adult
	day-care program"] means a structured, comprehensive program that
	is designed to meet the needs of adults with functional impairments
	through an individual plan of care by providing health, social, and
	related support services in a protective setting.
	SECTION 30.  Section 103.0041(a), Human Resources Code, is
	amended to read as follows:
	(a)  A person may not operate a day activity and health
	services [an adult day-care] facility without a license issued
	under this chapter.
	SECTION 31.  Section 103.006(a), Human Resources Code, is
	amended to read as follows:
	(a)  The department shall issue a license to operate a day
	activity and health services [an adult day-care] facility to a
	person who has met the application requirements and received
	approval after an on-site inspection.
	SECTION 32.  Section 103.007(a), Human Resources Code, is
	amended to read as follows:
	(a)  An applicant for a license to operate a day activity and
	health services [an adult day-care] facility must file an
	application on a form prescribed by the department together with a
	license fee of $50.
	SECTION 33.  Section 103.0075(a), Human Resources Code, as
	amended by S.B. No. 219, Acts of the 84th Legislature, Regular
	Session, 2015, is amended to read as follows:
	(a)  The executive commissioner by rule shall adopt a
	procedure under which a person proposing to construct or modify a
	day activity and health services [an adult day-care] facility may
	submit building plans to the department for review for compliance
	with the department's architectural requirements before beginning
	construction or modification. In adopting the procedure, the
	executive commissioner shall set reasonable deadlines by which the
	department must complete review of submitted plans.
	SECTION 34.  Chapter 103, Human Resources Code, is amended
	by adding Section 103.0085 to read as follows:
	Sec. 103.0085.  PROGRESSIVE SANCTIONS. (a)  The executive
	commissioner by rule shall create a matrix of progressive sanctions
	that the department must use to assess penalty amounts and impose
	disciplinary actions under this chapter appropriately and fairly
	for a violation of a law, rule, standard, or order adopted or
	license issued under this chapter or for a violation of other law
	for which this chapter provides a sanction.
	(b)  The matrix of progressive sanctions adopted under this
	section must provide for increases in amounts of administrative
	penalties based on type, frequency, and seriousness of violations
	and must provide guidance for determining appropriate and graduated
	administrative penalties to assess under this chapter to deter
	future violations, including guidance on considering the factors
	listed in this chapter for determining the amount of a penalty.
	(c)  The matrix of progressive sanctions adopted under this
	section must provide for imposing stronger sanctions, including
	license suspension or revocation, for more serious violations or
	for repeated violations as appropriate to deter future serious or
	repeated violations. The matrix of progressive sanctions must
	describe appropriate time frames to be used in determining whether
	a day activity and health services facility has committed repeated
	violations or has engaged in a pattern of repeated violations, such
	as repeated violations found in consecutive regular inspections.
	SECTION 35.  Section 103.0091(a), Human Resources Code, is
	amended to read as follows:
	(a)  The department may petition a district court for a
	temporary restraining order to restrain a continuing violation of
	the standards or licensing requirements provided under this chapter
	if the department finds that the violation creates an immediate
	threat to the health and safety of the day activity and health
	services facility [adult day-care] residents.
	SECTION 36.  Section 103.0092(a), Human Resources Code, is
	amended to read as follows:
	(a)  If the department finds a day activity and health
	services [an adult day-care] facility operating in violation of the
	standards prescribed by this chapter and the violations create an
	immediate threat to the health and safety of a resident in the
	facility, the department shall suspend the license or order
	immediate closing of all or part of the facility.
	SECTION 37.  Section 103.011, Human Resources Code, is
	amended to read as follows:
	Sec. 103.011.  RIGHTS OF THE ELDERLY. (a)  In addition to
	other rights an individual attending a day activity and health
	services [an adult day care] facility has as a citizen, an
	individual who is 55 years of age or older has the rights prescribed
	by Chapter 102 of this code.
	(b)  The department shall require each day activity and
	health services [adult day care] facility to implement and enforce
	the applicable provisions of Chapter 102 of this code.
	SECTION 38.  Section 103.012(a), Human Resources Code, is
	amended to read as follows:
	(a)  The department may assess an administrative penalty
	against a person who:
	(1)  violates this chapter, a rule, standard, or order
	adopted under this chapter, or a term of a license issued under this
	chapter;
	(2)  makes a false statement of a material fact that the
	person knows or should know is false:
	(A)  on an application for issuance or renewal of
	a license or in an attachment to the application; or
	(B)  with respect to a matter under investigation
	by the department;
	(3)  refuses to allow a representative of the
	department to inspect:
	(A)  a book, record, or file required to be
	maintained by a day activity and health services [an adult
	day-care] facility; or
	(B)  any portion of the premises of a day activity
	and health services [an adult day-care] facility;
	(4)  wilfully interferes with the work of a
	representative of the department or the enforcement of this
	chapter;
	(5)  wilfully interferes with a representative of the
	department preserving evidence of a violation of this chapter, a
	rule, standard, or order adopted under this chapter, or a term of a
	license issued under this chapter;
	(6)  fails to pay a penalty assessed under this chapter
	not later than the 30th day after the date the assessment of the
	penalty becomes final; or
	(7)  fails to notify the department of a change of
	ownership before the effective date of the change of ownership.
	SECTION 39.  Section 103.013, Human Resources Code, is
	amended to read as follows:
	Sec. 103.013.  RIGHT TO CORRECT BEFORE IMPOSITION OF
	ADMINISTRATIVE PENALTY. (a)  The department may not collect an
	administrative penalty from a day activity and health services [an
	adult day-care] facility under Section 103.012 if, not later than
	the 45th day after the date the facility receives notice under
	Section 103.014(c), the facility corrects the violation.
	(b)  The executive commissioner of the Health and Human
	Services Commission by rule shall define types of minor violations
	a day activity and health services facility may correct under
	Subsection (a) before assessing an administrative penalty. The
	executive commissioner shall ensure that all other violations are
	not subject to a right to correct [Subsection (a) does not apply to:
	[(1)  a violation that the department determines:
	[(A)     results in serious harm to or death of a
	person attending the facility;
	[(B)     constitutes a serious threat to the health
	and safety of a person attending the facility; or
	[(C)     substantially limits the facility's
	capacity to provide care;
	[(2)     a violation described by Sections
	103.012(a)(2)-(7); or
	[(3)  a violation of Section 103.011].
	(c)  A day activity and health services [An adult day-care]
	facility that corrects a violation must maintain the correction.
	If the facility fails to maintain the correction until at least the
	first anniversary after the date the correction was made, the
	department may assess and collect an administrative penalty for the
	subsequent violation.  An administrative penalty assessed under
	this subsection is equal to three times the amount of the original
	penalty assessed but not collected.  The department is not required
	to provide the facility with an opportunity under this section to
	correct the subsequent violation.
	SECTION 40.  Sections 103.014(c) and (e), Human Resources
	Code, are amended to read as follows:
	(c)  The department shall give written notice of the report
	to the person charged with the violation not later than the 10th day
	after the date on which the report is issued.  The notice must
	include:
	(1)  a brief summary of the charges;
	(2)  a statement of the amount of penalty recommended;
	(3)  a statement of whether the violation is subject to
	correction under Section 103.013 and, if the violation is subject
	to correction under that section, a statement of:
	(A)  the date on which the day activity and health
	services [adult day-care] facility must file a plan of correction
	with the department that the department shall review and may
	approve, if satisfactory; and
	(B)  the date on which the plan of correction must
	be completed to avoid assessment of the penalty; and
	(4)  a statement that the person charged has a right to
	a hearing on the occurrence of the violation, the amount of the
	penalty, or both.
	(e)  If the violation is subject to correction under Section
	103.013, the day activity and health services [adult day-care]
	facility shall submit a plan of correction to the department for
	approval not later than the 10th day after the date on which the
	notice under Subsection (c) is received.
	SECTION 41.  Section 161.080, Human Resources Code, is
	amended by adding Subsection (c) to read as follows:
	(c)  The executive commissioner by rule shall establish a
	list of services a state supported living center may provide under a
	contract described by Subsection (a) and a schedule of fees the
	state supported living center may charge for those services. In
	establishing the schedule of fees for services, the executive
	commissioner shall use the reimbursement rate for the applicable
	service under the Medicaid program.
	SECTION 42.  Chapter 161, Human Resources Code, is amended
	by adding Subchapter J to read as follows:
	SUBCHAPTER J. POWERS AND DUTIES RELATING TO DAY HABILITATION
	SERVICES PROVIDERS
	Sec. 161.401.  DEFINITIONS. In this subchapter:
	(1)  "Day habilitation services" means services to
	assist persons with an intellectual or developmental disability in
	acquiring, retaining, and improving the self-help, socialization,
	and adaptive skills necessary to reside successfully in the
	community, including prevocational, educational, and supported
	employment services.
	(2)  "Day habilitation services provider" means a
	person who contracts with a community-based intellectual and
	developmental disabilities services provider or intermediate care
	facility to provide federally funded Medicaid day habilitation
	services authorized under Section 1915(c) of the federal Social
	Security Act (42 U.S.C. Section 1396n(c)).
	Sec. 161.402.  DAY HABILITATION SERVICES PROVIDER
	INFORMATION TRACKING. (a)  Each community-based intellectual and
	developmental disabilities services provider and intermediate care
	facility shall annually submit to the department a report
	providing:
	(1)  an estimate of the number of clients receiving day
	habilitation services for each month of that year;
	(2)  the physical address of each day habilitation
	services provider that provided those services;
	(3)  the services provided to those clients; and
	(4)  an estimate of monthly expenditures for the
	provision of those services to those clients.
	(b)  The department shall maintain information obtained
	during a department inspection of a day habilitation services
	provider concerning conduct or conditions that would constitute a
	violation of federal or state law or of department rules applicable
	to the community-based intellectual and developmental disabilities
	services provider or intermediate care facility with which the day
	habilitation services provider contracts.
	(c)  The department shall maintain information concerning an
	investigation of abuse, neglect, or exploitation concerning a day
	habilitation services provider that the department receives from
	the Department of Family and Protective Services under Section
	48.15221.
	Sec. 161.403.  DAY HABILITATION PROGRAM ADVISORY COMMITTEE.
	(a)  Not later than September 1, 2015, the department shall
	establish a day habilitation program advisory committee composed of
	members that represent community-based waiver providers, owners of
	day habilitation services providers, and advocates for persons with
	an intellectual or developmental disability.
	(b)  The day habilitation program advisory committee shall
	consider and make recommendations concerning whether the provision
	of day habilitation services in this state should be redesigned and
	whether day habilitation services providers should be subject to
	regulation, including by licensure or certification.
	(c)  In considering the redesign of the provision of day
	habilitation services in this state, the day habilitation program
	advisory committee shall examine whether day habilitation service
	providers currently comply with the requirements of 42 C.F.R.
	Section 441.301.
	(d)  The day habilitation program advisory committee shall
	also consider and make recommendations concerning issues relevant
	to the provision of day habilitation services, including the
	appropriate funding for services, reimbursable settings and
	services, staff-to-client ratio requirements, safety requirements,
	and other required or applicable standards.
	(e)  Not later than September 1, 2016, the day habilitation
	program advisory committee shall submit to the governor, the
	lieutenant governor, the speaker of the house of representatives,
	and the presiding officers of the standing committees of the senate
	and house of representatives having primary jurisdiction over
	intellectual and developmental disability issues a report
	containing the committee's recommendations concerning the redesign
	of the provision of day habilitation services in this state and the
	necessity for regulation, licensure, or certification of day
	habilitation services providers.
	(f)  The day habilitation program advisory committee is
	abolished and this section expires December 31, 2016.
	SECTION 43.  Section 247.051(b), Health and Safety Code, is
	repealed.
	SECTION 44.  Section 101A.158, Human Resources Code, as
	added by S.B. 219, Acts of the 84th Legislature, Regular Session,
	2015, is repealed.
	SECTION 45.  (a)  Not later than September 1, 2016, the
	executive commissioner of the Health and Human Services Commission
	shall adopt by rule the matrices of progressive sanctions required
	by Sections 142.0125, 242.0613, 247.0415, and 252.0615, Health and
	Safety Code, and Section 103.0085, Human Resources Code, as added
	by this Act.
	(b)  Not later than September 1, 2015, the governor shall
	appoint five members of the state supported living center
	restructuring commission, as required by Section 555.201, Health
	and Safety Code, as added by this Act.
	(c)  Not later than September 1, 2016, the executive
	commissioner of the Health and Human Services Commission shall
	adopt the rule listing services a state supported living center may
	provide under a contract and the schedule of fees for those services
	as required by Section 161.080, Human Resources Code, as amended by
	this Act.
	SECTION 46.  (a)  As soon as possible after the effective
	date of this Act, the Department of Aging and Disability Services or
	the Health and Human Services Commission, as appropriate, shall
	apply for any waiver or other authorization from a federal agency
	that is necessary to implement this Act.  The department and
	commission may delay implementing this Act until the waiver or
	authorization is granted.
	(b)  As soon as practicable after the effective date of this
	Act:
	(1)  the executive commissioner of the Health and Human
	Services Commission shall adopt the rules necessary to implement
	Section 531.058(a-1), Government Code, as added by this Act; and
	(2)  the Department of Aging and Disability Services
	and the Health and Human Services Commission shall, as appropriate,
	revise or enter into a memorandum of understanding as required by a
	federal agency that is necessary to implement Section 531.058(a-1),
	Government Code, as added by this Act.
	SECTION 47.  Sections 242.061(a-2) and (a-3), Health and
	Safety Code, as added by this Act, apply only to a violation
	committed on or after September 1, 2016.  A violation committed
	before September 1, 2016, is governed by the law in effect on the
	date the violation was committed, and the former law is continued in
	effect for that purpose. For purposes of this section, a violation
	was committed before September 1, 2016, if any element of the
	violation occurred before that date.
	SECTION 48.  (a)  Except as provided by Subsection (b) of
	this section, this Act takes effect immediately if it receives a
	vote of two-thirds of all the members elected to each house, as
	provided by Section 39, Article III, Texas Constitution.  If this
	Act does not receive the vote necessary for immediate effect, this
	Act takes effect September 1, 2015.
	(b)  Sections 242.061(a-2) and (a-3), Health and Safety
	Code, as added by this Act, take effect September 1, 2016.