(a) This section applies to the following waiver programs established under Section 1915(c), Social Security Act (42 U.S.C. Section 1396n(c)), and administered by the commission to serve persons with an intellectual or developmental disability:
(1) the home and community-based services (HCS) waiver program; and
(2) the Texas home living (TxHmL) waiver program.
(b) The commission may assess and collect an administrative penalty against a provider who participates in a program to which this section applies for a violation of a law or rule relating to the program. If the commission assesses an administrative penalty against a provider for a violation of a law or rule, the commission may not impose a payment hold against or otherwise withhold contract payments from the provider for the same violation of a law or rule.
Terms Used In Texas Human Resources Code 161.089
- Contract: A legal written agreement that becomes binding when signed.
- Justice: when applied to a magistrate, means justice of the peace. See Texas Government Code 312.011
- Person: includes corporation, organization, government or governmental subdivision or agency, business trust, estate, trust, partnership, association, and any other legal entity. See Texas Government Code 311.005
- Rule: includes regulation. See Texas Government Code 311.005
(c) After consulting with appropriate stakeholders, the executive commissioner shall develop and adopt rules regarding the imposition of administrative penalties under this section. The rules must:
(1) specify the types of violations that warrant imposition of an administrative penalty;
(2) establish a schedule of progressive administrative penalties in accordance with the relative type, frequency, and seriousness of a violation;
(3) prescribe reasonable amounts to be imposed for each violation giving rise to an administrative penalty, subject to Subdivision (4);
(4) authorize the imposition of an administrative penalty in an amount not to exceed $5,000 for each violation;
(5) provide that a provider commits a separate violation each day the provider continues to violate the law or rule;
(6) ensure standard and consistent application of administrative penalties throughout the state;
(7) provide for an administrative appeals process to adjudicate claims and appeals relating to the imposition of an administrative penalty under this section that is in accordance with Chapter 2001, Government Code; and
(8) ensure standard and consistent interpretation of service delivery rules and consistent application of administrative penalties throughout this state.
(c-1) On adoption of the rules under Subsection (c), the executive commissioner shall develop interpretative guidelines for regulatory staff and providers regarding the imposition of administrative penalties under this section.
(d) In determining the types of violations that warrant imposition of an administrative penalty and in establishing the schedule of progressive administrative penalties and penalty amounts under Subsection (c), the executive commissioner must consider:
(1) the seriousness of a violation, including:
(A) the nature, circumstances, extent, and gravity of the violation; and
(B) the hazard to the health or safety of recipients resulting from the violation;
(2) the provider’s history of previous violations;
(3) whether the provider:
(A) had prior knowledge of the violation, including whether the provider identified the violation through the provider’s internal quality assurance process; and
(B) made any efforts to mitigate or correct the identified violation;
(4) the penalty amount necessary to deter future violations; and
(5) any other matter justice may require.
(e) Except as provided by Subsection (f), the executive commissioner by rule shall provide to a provider who has implemented a plan of correction a reasonable period of time following the date the commission sends notice to the provider of the violation to correct the violation before the commission may assess an administrative penalty. The period may not be less than 45 days.
(f) The commission may assess an administrative penalty without providing a reasonable period of time to a provider to correct the violation if the violation:
(1) represents a pattern of violation that results in actual harm;
(2) is widespread in scope and results in actual harm;
(3) is widespread in scope and constitutes a potential for actual harm;
(4) constitutes an immediate threat to the health or safety of a recipient;
(5) substantially limits the provider’s ability to provide care; or
(6) is a violation in which a provider:
(A) wilfully interferes with the work of a representative of the commission or the enforcement of a law relating to a program to which this section applies;
(B) fails to pay a penalty assessed by the commission under this section not later than the 10th day after the date the assessment of the penalty becomes final, subject to Section 161.0891; or
(C) fails to submit a plan of correction not later than the 10th day after the date the provider receives a statement of the violation.
(g) Notwithstanding any other provision of this section, an administrative penalty ceases to be incurred on the date a violation is corrected.
(h) In this section:
(1) “Actual harm” means a negative outcome that compromises a recipient’s physical, mental, or emotional well-being.
(2) “Immediate threat to the health or safety of a recipient” means a situation that causes, or is likely to cause, serious injury, harm, or impairment to or the death of a recipient.
(3) “Pattern of violation” means repeated, but not pervasive, failures of a provider to comply with a law relating to a program to which this section applies that:
(A) result in a violation; and
(B) are found throughout the services provided by the provider or that affect or involve the same recipients or provider employees or volunteers.
(4) “Recipient” means a person served by a program to which this section applies.
(5) “Widespread in scope” means a violation of a law relating to a program to which this section applies that:
(A) is pervasive throughout the services provided by the provider; or
(B) represents a systemic failure by the provider that affects or has the potential to affect a large portion of or all of the recipients.