    HEALTH AND SAFETY CODE
    TITLE 4. HEALTH FACILITIES
    SUBTITLE B. LICENSING OF HEALTH FACILITIES
    CHAPTER 255. QUALITY ASSURANCE EARLY WARNING SYSTEM FOR LONG-TERM CARE FACILITIES;  RAPID RESPONSE TEAMS
    Sec. 255.001.  DEFINITIONS.  In this chapter:(1)  "Department" means the Department of Aging and Disability Services.(2)  "Long-term care facility" means a nursing institution, an assisted living facility, or an ICF-IID licensed under Chapter 242, 247, or 252, or certified under Chapter 32, Human Resources Code.(3)  "Quality-of-care monitor" means a registered nurse, pharmacist, or nutritionist who:(A)  is employed by the department;(B)  is trained and experienced in long-term care facility regulation, standards of practice in long-term care, and evaluation of patient care;  and(C)  functions independently of other divisions of the department.
    Added by Acts 2001, 77th Leg., ch. 1284, Sec. 7.03, eff. June 15, 2001.Amended by: Acts 2005, 79th Leg., Ch. 837 (S.B. 874), Sec. 1, eff. September 1, 2005.Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 3.0817, eff. April 2, 2015.

    Sec. 255.002.  EARLY WARNING SYSTEM.  The department shall establish an early warning system to detect conditions that could be detrimental to the health, safety, and welfare of residents.  The early warning system shall include analysis of financial and quality-of-care indicators that would predict the need for the department to take action.
    Added by Acts 2001, 77th Leg., ch. 1284, Sec. 7.03, eff. June 15, 2001.

    Sec. 255.003.  QUALITY-OF-CARE MONITORS.  (a)  The department shall establish regional offices with one or more quality-of-care monitors, based on the number of long-term care facilities in the region, to monitor the facilities in the region on a regular, aperiodic basis, including nights, evenings, weekends, and holidays.  A monitoring visit conducted under this chapter may be announced or unannounced.(b)  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.(c)  Quality-of-care monitors may not be deployed by the department as a part of the regional survey team in the conduct of routine, scheduled surveys.(d)  A quality-of-care monitor may not interfere with, impede, or otherwise adversely affect the performance of the duties of a surveyor, inspector, or investigator of the department.(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.(f)  The quality-of-care monitor shall include in a monitoring visit:(1)  observation of the care and services rendered to residents; and(2)  formal and informal interviews with residents, family members, facility staff, resident guests, volunteers, other regulatory staff, and representatives of a human rights advocacy committee.(g)  The identity of a resident or a family member of a resident interviewed by a quality-of-care monitor as provided by Subsection (f)(2) shall remain confidential and may not be disclosed to any person under any other provision of this section.(h)  The findings of a monitoring visit, both positive and negative, shall be provided orally and in writing to the long-term care facility administrator or, in the absence of the facility administrator, to the administrator on duty or the director of nursing.(i)  The quality-of-care monitor may recommend to the long-term care facility administrator procedural and policy changes and staff training to improve the care or quality of life of facility residents.(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.
    Added by Acts 2001, 77th Leg., ch. 1284, Sec. 7.03, eff. June 15, 2001.Amended by: Acts 2005, 79th Leg., Ch. 837 (S.B. 874), Sec. 2, eff. September 1, 2005.Acts 2015, 84th Leg., R.S., Ch. 1142 (S.B. 304), Sec. 3, eff. June 19, 2015.

    Sec. 255.004.  RAPID RESPONSE TEAMS.  (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 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.(b)  Rapid response teams may visit long-term care facilities that request the department's assistance.  A visit under this subsection may not occur before the 60th day after the date of an exit interview following an annual or follow-up survey or inspection.(c)  The rapid response teams may not be deployed for the purpose of helping a long-term care facility prepare for a regular inspection or survey conducted under Chapter 242, 247, or 252 or in accordance with Chapter 32, Human Resources Code.
    Added by Acts 2001, 77th Leg., ch. 1284, Sec. 7.03, eff. June 15, 2001.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1142 (S.B. 304), Sec. 4, eff. June 19, 2015.

    Sec. 255.005.  REPORT.  (a)  The Health and Human Services Commission shall assess and evaluate the effectiveness of the quality assurance early warning system and shall report its findings annually to the governor, the lieutenant governor, and the speaker of the house of representatives.(b)  The Health and Human Services Commission shall submit the report required under this section with the report required under Section 543A.0008, Government Code.
    Added by Acts 2001, 77th Leg., ch. 1284, Sec. 7.03, eff. June 15, 2001.Amended by: Acts 2023, 88th Leg., R.S., Ch. 738 (H.B. 3265), Sec. 3, eff. September 1, 2023.Acts 2025, 89th Leg., R.S., Ch. 204 (H.B. 1620), Sec. 9.001, eff. September 1, 2025.