    HEALTH AND SAFETY CODE
    TITLE 4. HEALTH FACILITIES
    SUBTITLE A.  FINANCING, CONSTRUCTING, REGULATING, AND INSPECTING
    HEALTH FACILITIES
    CHAPTER 222.  HEALTH CARE FACILITY SURVEY, CONSTRUCTION, INSPECTION, AND REGULATION
    SUBCHAPTER A.  SURVEY AND CONSTRUCTION OF HOSPITALS
    Sec. 222.001.  SHORT TITLE.  This subchapter may be cited as the Texas Hospital Survey and Construction Act.
    Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 3.0566, eff. April 2, 2015.

    Sec. 222.002.  DEFINITIONS.  In this subchapter:(2)  "Commissioner" means the commissioner of state health services.(3)  "Department" means the Department of State Health Services.(3-a)  "Executive commissioner" means the executive commissioner of the Health and Human Services Commission.(4)  "Hospital" includes a public health center, a general hospital, or a tuberculosis, mental, chronic disease, or other type of hospital, and related facilities such as a laboratory, outpatient department, nurses' home and training facility, or central service facility operated in connection with a hospital.(5)  "Public health center" means a publicly owned facility for providing public health services and includes related facilities such as a laboratory, clinic, or administrative office operated in connection with a facility for providing public health services.
    Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 3.0566, eff. April 2, 2015.

    Sec. 222.003.  EXCEPTION.  This subchapter does not apply to a hospital furnishing primarily domiciliary care.
    Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 3.0566, eff. April 2, 2015.

    Sec. 222.005.  SURVEY, PLANNING, AND CONSTRUCTION OF HOSPITALS.  (a)  The department is the only agency of the state authorized to make an inventory of existing hospitals, survey the need for construction of hospitals, and develop a program of hospital construction as provided by the federal Hospital Survey and Construction Act (42 U.S.C. Section 291 et seq.).(b)  The executive commissioner may adopt rules to meet the requirements of the federal Hospital Survey and Construction Act relating to survey, planning, and construction of hospitals and public health centers. The executive commissioner shall adopt other rules the executive commissioner considers necessary.(c)  The commissioner may establish methods of administration and shall:(1)  require reports and make inspections and investigations as the commissioner considers necessary; and(2)  take other action that the commissioner considers necessary to carry out the federal Hospital Survey and Construction Act and the regulations adopted under that Act.
    Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 3.0566, eff. April 2, 2015.

    Sec. 222.006.  FUNDING.  (a)  The department shall accept, on behalf of the state, a payment of federal funds or a gift or grant made to assist in meeting the cost of carrying out the purpose of this subchapter, and may spend the payment, gift, or grant for that purpose.(b)  The department shall deposit the payment, gift, or grant in the state treasury to the credit of the hospital construction fund.(c)  The department shall deposit to the credit of the hospital construction fund money received from the federal government for a construction project approved by the surgeon general of the United States Public Health Service.  The department shall use the money only for payments to applicants for work performed and purchases made in carrying out approved projects.
    Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 3.0566, eff. April 2, 2015.

    Sec. 222.007.  AGREEMENTS FOR USE OF FACILITIES AND SERVICES OF OTHER ENTITIES.  To the extent the department considers desirable to carry out the purposes of this subchapter, the department may enter into an agreement for the use of a facility or service of another public or private department, agency, or institution.
    Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 3.0566, eff. April 2, 2015.

    Sec. 222.008.  EXPERTS AND CONSULTANTS.  The department may contract for services of experts or consultants, or organizations of experts or consultants, on a part-time or fee-for-service basis.  The contracts may not involve the performance of administrative duties.
    Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 3.0566, eff. April 2, 2015.

    Sec. 222.009.  REPORT.  (a)  The department annually shall report to the executive commissioner on activities and expenditures under this subchapter.(b)  The department shall include in the report recommendations for additional legislation that the department considers appropriate to furnish adequate hospital, clinic, and similar facilities to the public.
    Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 3.0566, eff. April 2, 2015.

    SUBCHAPTER B.  LIMITATION ON INSPECTION AND OTHER REGULATION OF HEALTH CARE FACILITIES
    Sec. 222.022.  DEFINITIONS.  In this subchapter:(1)  "Executive commissioner" means the executive commissioner of the Health and Human Services Commission.(2)  "Health care facility" means a public or private hospital, skilled nursing facility, intermediate care facility, ambulatory surgical center, family planning clinic that performs ambulatory surgical procedures, rural or urban health initiative clinic, end stage renal disease facility, and inpatient rehabilitation facility.  The term does not include the office of physicians or practitioners of the healing arts practicing individually or in groups or a chemical dependency treatment facility licensed by the Department of State Health Services under Chapter 464.(3)  "Inspection" includes a survey, inspection, investigation, or other procedure necessary for a state agency to carry out an obligation imposed by federal and state laws, rules, and regulations.
    Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 3.0566, eff. April 2, 2015.Acts 2025, 89th Leg., R.S., Ch. 636 (H.B. 3801), Sec. 9, eff. September 1, 2025.

    Sec. 222.023.  LIMITATION ON INSPECTIONS.  (a)  A state agency may make or require only those inspections necessary to carry out obligations imposed on the agency by federal and state laws, rules, and regulations.(b)  Instead of making an on-site inspection, a state agency shall accept an on-site inspection by another state agency charged with making an inspection if the inspection substantially complies with the accepting agency's inspection requirements.(c)  A state agency shall coordinate its inspections within the agency and with inspections required of other agencies to ensure compliance with this section.
    Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 3.0566, eff. April 2, 2015.

    Sec. 222.024.  CERTIFICATION OR ACCREDITATION INSTEAD OF INSPECTION.  (a)  Except as provided by Subsection (c), a hospital licensed by the Department of State Health Services is not subject to additional annual licensing inspections before the department issues the hospital a license while the hospital maintains:(1)  certification under Title XVIII of the Social Security Act (42 U.S.C. Section 1395 et seq.); or(2)  accreditation from The Joint Commission, the American Osteopathic Association, or other national accreditation organization for the offered services.(b)  If the Department of State Health Services licenses a hospital exempt from an annual licensing inspection under Subsection (a), the department shall issue a renewal license to the hospital if the hospital annually:(1)  submits a complete application required by the department;(2)  remits any applicable fees;(3)  submits a copy of documentation from the certification or accreditation body showing that the hospital is certified or accredited; and(4)  submits a copy of the most recent fire safety inspection report from the fire marshal in whose jurisdiction the hospital is located.(c)  The Department of State Health Services may conduct an inspection of a hospital exempt from an annual licensing inspection under Subsection (a) 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 the department determines that an inspection of the hospital by the certification or accreditation body is not scheduled within 60 days.
    Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.  Amended by Acts 1993, 73rd Leg., ch. 584, Sec. 16, eff. Sept. 1, 1993;  Acts 1997, 75th Leg., ch. 223, Sec. 1, eff. Sept. 1, 1997.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 3.0566, eff. April 2, 2015.

    Sec. 222.026.  COMPLAINT INVESTIGATIONS AND ENFORCEMENT AUTHORITY.  (a)  Section 222.024 does not affect the authority of the Department of State Health Services to implement and enforce the provisions of Chapter 241 (Texas Hospital Licensing Law) to:(1)  reinspect a hospital if a hospital applies for the reissuance of its license after a final ruling upholding the suspension or revocation of a hospital's license, the assessment of administrative or civil penalties, or the issuance of an injunction against the hospital for violations of provisions of the licensing law, rules adopted under the licensing law, special license conditions, or orders of the commissioner of state health services; or(2)  investigate a complaint against a hospital and, if appropriate, enforce the provisions of the licensing law on a finding by the Department of State Health Services that reasonable cause exists to believe that the hospital has violated provisions of the licensing law, rules adopted under the licensing law, special license conditions, or orders of the commissioner of state health services; provided, however, that the Department of State Health Services shall coordinate with the federal Centers for Medicare and Medicaid Services and its agents responsible for the inspection of hospitals to determine compliance with the conditions of participation under Title XVIII of the Social Security Act (42 U.S.C. Section 1395 et seq.), so as to avoid duplicate investigations.(b)  The executive commissioner shall by rule establish a procedure for the acceptance and timely review of complaints received from hospitals concerning the objectivity, training, and qualifications of the persons conducting the inspection.
    Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.  Amended by Acts 1991, 72nd Leg., ch. 14, Sec. 64, eff. Sept. 1, 1991;  Acts 1993, 73rd Leg., ch. 584, Sec. 17, eff. Sept. 1, 1993.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 3.0566, eff. April 2, 2015.

    Sec. 222.027.  PHYSICIAN ON SURVEY TEAM.  The Department of State Health Services shall ensure that a licensed physician involved in direct patient care as defined by the Texas Medical Board is included on a survey team sent under Title XVIII of the Social Security Act (42 U.S.C. Section 1395 et seq.) when surveying the quality of services provided by physicians in hospitals.
    Added by Acts 1991, 72nd Leg., ch. 14, Sec. 63, eff. Sept. 1, 1991.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 3.0566, eff. April 2, 2015.

    SUBCHAPTER C.  SURVEYS OF INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY
    Sec. 222.041.  DEFINITIONS.  In this subchapter:(1)   "Commissioner" means the commissioner of aging and disability services.(2)  "Department" means the Department of Aging and Disability Services.(3)  "Executive commissioner" means the executive commissioner of the Health and Human Services Commission.(4)  "ICF-IID" means the medical assistance program serving individuals with an intellectual or developmental disability who receive care in intermediate care facilities.
    Added by Acts 1991, 72nd Leg., ch. 14, Sec. 65, eff. Sept. 1, 1991.  Amended by Acts 1995, 74th Leg., ch. 76, Sec. 8.080, eff. Sept. 1, 1995.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 3.0566, eff. April 2, 2015.

    Sec. 222.042.  LICENSING OF BEDS AND FACILITIES.  The department may not license or approve as meeting licensing standards new ICF-IID beds or the expansion of an existing ICF-IID facility unless the new beds or the expansion was included in the plan approved by the Health and Human Services Commission in accordance with Section 533.062.
    Added by Acts 1991, 72nd Leg., ch. 14, Sec. 65, eff. Sept. 1, 1991.  Amended by Acts 1993, 73rd Leg., ch. 646, Sec. 1, eff. Aug. 30, 1993;  Acts 1993, 73rd Leg., ch. 747, Sec. 26, eff. Sept. 1, 1993.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 3.0566, eff. April 2, 2015.

    Sec. 222.044.  FOLLOW-UP SURVEYS.  (a)  The department shall conduct follow-up surveys of ICF-IID facilities to:(1)  evaluate and monitor the findings of the certification or licensing survey teams; and(2)  ensure consistency in deficiencies cited and in punitive actions recommended throughout the state.(b)  A provider shall correct any additional deficiency cited by the department.  The department may not impose an additional punitive action for the deficiency unless the provider fails to correct the deficiency within the period during which the provider is required to correct the deficiency.
    Added by Acts 1991, 72nd Leg., ch. 14, Sec. 65, eff. Sept. 1, 1991.  Amended by Acts 1995, 74th Leg., ch. 76, Sec. 8.082, eff. Sept. 1, 1995.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 3.0566, eff. April 2, 2015.

    Sec. 222.046.  SURVEYS OF ICF-IID FACILITIES.  (a)  The department shall ensure that each survey team sent to survey an ICF-IID facility includes a qualified intellectual disabilities professional, as that term is defined by federal law.(b)  The department shall require that each survey team sent to survey an ICF-IID facility conduct a final interview with the provider to ensure that the survey team informs the provider of the survey findings and that the survey team has requested the necessary information from the provider.  The survey team shall allow the provider to record the interview.  The provider shall immediately give the survey team a copy of any recording.
    Added by Acts 1991, 72nd Leg., ch. 14, Sec. 65, eff. Sept. 1, 1991.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 3.0566, eff. April 2, 2015.