PART 1. DEPARTMENT OF STATE HEALTH SERVICES
CHAPTER 133. HOSPITAL LICENSING
SUBCHAPTER C. OPERATIONAL REQUIREMENTS
The Texas Health and Human Services Commission (HHSC) adopts new §133.55, concerning Workplace Violence Prevention.
New §133.55 is adopted with changes to the proposed text as published in the May 3, 2024, issue of the Texas Register (49 TexReg 2931). This rule will be republished.
BACKGROUND AND JUSTIFICATION
The new section is necessary to implement Texas Health and Safety Code (HSC) Chapter 331, added by Senate Bill (S.B.) 240, 88th Legislature, Regular Session, 2023.
The new section requires general and special hospitals to establish a workplace violence prevention committee or authorize an existing committee to develop the hospital's workplace violence prevention plan. The new section specifies the required membership for a committee. The new section requires a hospital to adopt, implement, and enforce a written workplace violence prevention policy and plan to protect health care providers and employees from violent behavior and threats of violent behavior occurring at the hospital.
The new section requires the committee to annually evaluate the written workplace violence prevention plan and report the results of the evaluation to the hospital's governing body. The new section requires each hospital to make a copy of the hospital's workplace violence prevention plan available to each hospital health care provider or employee while providing protection from the release of information in the plan that would pose a security threat if made public.
The new section establishes minimum requirements for a hospital to respond to workplace violence incidents and creates protections for individuals with respect to reporting incidents of workplace violence.
COMMENTS
The 31-day comment period ended June 3, 2024.
During this period, HHSC received comments regarding the proposed rule from the Texas Hospital Association (THA). A summary of comments relating to the rule and HHSC's responses follows.
Comment: THA stated it supported HHSC rulemaking efforts to implement SB 240.
Response: HHSC acknowledges this comment.
Comment: THA recommended HHSC revise §133.55 to require a hospital to comply with the requirements in HSC Chapter 331 instead of detailing the requirements in the rule.
Response: HHSC declines to revise §133.55 because stating the requirements facilitates understanding of and compliance with the rule for those not familiar with the statute and where the statute is located.
Comment: Regarding §133.55(b)(2), THA asked how HHSC would enforce the physician requirement for the membership committee if a hospital is unable to successfully encourage, after exhausting all good faith efforts, a physician to participate on the workplace violence committee.
Response: HHSC acknowledges this comment and notes HHSC would use its enforcement authority under HSC Chapter 241 to ensure compliance.
Comment: THA requested HHSC revise §133.55(c), regarding the establishment or delegation of the workplace violence committee, to clarify the rule does not seek to limit HSC §331.002(d) and allows a health care system to establish a single committee for all its facilities. THA noted SB 240 was specifically drafted to limit the administrative burden of multi-facility systems to comply with these important reforms.
Response: HHSC revises §133.55(c) to state, "A health care system that owns or operates more than one facility, as that term is defined by HSC §331.001, which includes a hospital, may establish a single workplace violence prevention committee for all of the system's facilities if:" for consistency with the statute. HHSC also changes "hospital" to "facility" throughout this subsection for consistency.
STATUTORY AUTHORITY
The new section is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies; HSC §241.026, which requires HHSC to develop, establish, and enforce standards for the construction, maintenance, and operation of licensed hospitals; and HSC Chapter 331, which requires licensed hospitals to adopt a workplace violence prevention policy and adopt and implement a workplace violence prevention plan in accordance with that chapter.
§133.55.Workplace Violence Prevention.
(a) In accordance with Texas Health and Safety Code (HSC) §331.002, a hospital shall establish a workplace violence prevention committee or authorize an existing hospital committee to develop a workplace violence prevention plan.
(b) A hospital shall ensure the committee includes at least:
(1) one registered nurse who provides direct care to the hospital's patients;
(2) one physician licensed to practice medicine in Texas who provides direct care to the hospital's patients; and
(3) one hospital employee who provides security services for the hospital if any and if practicable.
(c) A health care system that owns or operates more than one facility, as that term is defined by HSC §331.001, which includes a hospital, may establish a single workplace violence prevention committee for all of the system's facilities if:
(1) the committee develops a violence prevention plan for implementation at each facility in the system; and
(2) data related to violence prevention remains distinctly identifiable for each facility in the system.
(d) A hospital shall adopt, implement, and enforce a written workplace violence prevention policy to protect health care providers and employees from violent behavior and threats of violent behavior occurring at the hospital. In accordance with HSC §331.003, the policy shall:
(1) require the hospital to:
(A) provide significant consideration of the violence prevention plan recommended by the hospital's committee; and
(B) evaluate any existing hospital violence prevention plan;
(2) encourage health care providers and employees to provide confidential information on workplace violence to the committee;
(3) include a process to protect from retaliation health care providers or employees who provide information to the committee; and
(4) comply with HHSC rules relating to workplace violence.
(e) A hospital shall adopt, implement, and enforce a written workplace violence prevention plan developed by the committee. In accordance with HSC §331.004, the plan shall:
(1) be based on a hospital setting;
(2) adopt a definition of "workplace violence" that includes:
(A) an act or threat of physical force against a health care provider or employee that results in, or is likely to result in, physical injury or psychological trauma; and
(B) an incident involving the use of a firearm or other dangerous weapon, regardless of whether a health care provider or employee is injured by the weapon;
(3) require the hospital to at least annually provide workplace violence prevention training or education that may be included in other required training or education provided to the health care providers and employees who provide direct patient care;
(4) prescribe a system for responding to and investigating violent incidents or potentially violent incidents at the hospital;
(5) address physical security and safety;
(6) require the hospital to solicit information from the health care providers and employees when developing and implementing a workplace violence prevention plan;
(7) allow health care providers and employees to report workplace violence incidents through the hospital's existing occurrence reporting systems; and
(8) require the hospital to adjust patient care assignments, to the extent practicable, to prevent a health care provider or employee from treating or providing services to a patient who has intentionally physically abused or threatened the provider or employee.
(f) The written workplace violence prevention plan may satisfy the requirements of subsection (e) of this section by referencing other internal hospital policies and documents.
(g) At least annually after the date a hospital adopts a written workplace violence prevention plan required by subsection (e) of this section, the committee shall:
(1) review and evaluate the workplace violence prevention plan; and
(2) report the results of the evaluation to the hospital's governing body.
(h) Each hospital shall make available on request an electronic or printed copy of the hospital's workplace violence prevention plan to each health care provider or employee. If the committee determines the plan contains information that would pose a security threat if made public, the committee may redact that information before providing the plan.
(i) In accordance with HSC §331.005, after an incident of workplace violence occurs, a hospital shall offer immediate post-incident services, including any necessary acute medical treatment for each hospital health care provider or employee who is directly involved in the incident.
(j) In accordance with HSC §331.005, a hospital may not discourage a health care provider or employee from exercising the provider's or employee's right to contact or file a report with law enforcement regarding a workplace violence incident.
(k) In accordance with HSC §331.005, a hospital shall prohibit hospital personnel from disciplining, including by suspension or termination of employment, discriminating against, or retaliating against another person who:
(1) in good faith reports a workplace violence incident; or
(2) advises a health care provider or employee of the provider's or employee's right to report a workplace violence incident.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on September 24, 2024.
TRD-202404581
Karen Ray
Chief Counsel
Department of State Health Services
Effective date: October 21, 2024
Proposal publication date: May 3, 2024
For further information, please call: (512) 834-4591
SUBCHAPTER A. OPERATING REQUIREMENTS FOR AMBULATORY SURGICAL CENTERS
The Texas Health and Human Services Commission (HHSC) adopts new §135.31, concerning Workplace Violence Prevention. New §135.31 is adopted with changes to the proposed text as published in the May 3, 2024, issue of the Texas Register (49 TexReg 2933). This rule will be republished.
BACKGROUND AND JUSTIFICATION
The new section is necessary to implement Texas Health and Safety Code (HSC) Chapter 331, added by Senate Bill (S.B) 240, 88th Legislature, Regular Session, 2023.
The new section requires ambulatory surgical centers (ASCs) to establish a workplace violence prevention committee or authorize an existing committee to develop the ASC's workplace violence prevention plan. The new section specifies the required membership for a committee. The new section requires an ASC to adopt, implement, and enforce a written workplace violence prevention policy and plan to protect health care providers and employees from violent behavior and threats of violent behavior occurring at the ASC.
The new section requires the committee to annually evaluate the written workplace violence prevention plan and report the results of the evaluation to the ASC's governing body. The new section requires each ASC to make a copy of the ASC's workplace violence prevention plan available to each ASC health care provider or employee while providing protection from the release of information in the plan that would pose a security threat if made public.
The new section establishes minimum requirements for an ASC to respond to workplace violence incidents and creates protections for individuals with respect to reporting incidents of workplace violence.
COMMENTS
The 31-day comment period ended June 3, 2024.
During this period, HHSC did not receive any comments regarding the proposed rule.
HHSC revises §135.31(c) to state, "A health care system that owns or operates more than one facility, as that term is defined by HSC §331.001, which includes an ASC, may establish a single workplace violence prevention committee for all of the system's facilities if:" for consistency with the statute and edits made to another rule within this rule project in response to a stakeholder's comment. HHSC also changes "ASC" to "facility" throughout this subsection for consistency.
STATUTORY AUTHORITY
The new section is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies; HSC §243.009, which authorizes HHSC to adopt rules regarding ASCs; and HSC Chapter 331, which requires licensed ASCs to adopt a workplace violence prevention policy and adopt and implement a workplace violence prevention plan in accordance with that chapter.
§135.31.Workplace Violence Prevention.
(a) In accordance with Texas Health and Safety Code (HSC) §331.002, an ambulatory surgical center (ASC) shall establish a workplace violence prevention committee or authorize an existing ASC committee to develop a workplace violence prevention plan.
(b) An ASC shall ensure the committee includes at least:
(1) one registered nurse who provides direct care to the ASC's patients;
(2) one physician licensed to practice medicine in Texas who provides direct care to the ASC's patients; and
(3) one ASC employee who provides security services for the ASC if any and if practicable.
(c) A health care system that owns or operates more than one facility, as that term is defined by HSC §331.001, which includes an ASC, may establish a single workplace violence prevention committee for all of the system's facilities if:
(1) the committee develops a violence prevention plan for implementation at each facility in the system; and
(2) data related to violence prevention remains distinctly identifiable for each facility in the system.
(d) An ASC shall adopt, implement, and enforce a written workplace violence prevention policy to protect health care providers and employees from violent behavior and threats of violent behavior occurring at the ASC. In accordance with HSC §331.003, the policy shall:
(1) require the ASC to:
(A) provide significant consideration of the violence prevention plan recommended by the ASC's committee; and
(B) evaluate any existing ASC violence prevention plan;
(2) encourage health care providers and employees to provide confidential information on workplace violence to the committee;
(3) include a process to protect from retaliation health care providers or employees who provide information to the committee; and
(4) comply with HHSC rules relating to workplace violence.
(e) An ASC shall adopt, implement, and enforce a written workplace violence prevention plan developed by the committee. In accordance with HSC 331.004, the plan shall:
(1) be based on an ASC setting;
(2) adopt a definition of "workplace violence" that includes:
(A) an act or threat of physical force against a health care provider or employee that results in, or is likely to result in, physical injury or psychological trauma; and
(B) an incident involving the use of a firearm or other dangerous weapon, regardless of whether a health care provider or employee is injured by the weapon;
(3) require the ASC to at least annually provide workplace violence prevention training or education that may be included in other required training or education provided to the ASC's health care providers and employees who provide direct patient care;
(4) prescribe a system for responding to and investigating violent incidents or potentially violent incidents at the ASC;
(5) address physical security and safety;
(6) require the ASC to solicit information from health care providers and employees when developing and implementing a workplace violence prevention plan;
(7) allow health care providers and employees to report workplace violence incidents through the ASC's existing occurrence reporting systems; and
(8) require the ASC to adjust patient care assignments, to the extent practicable, to prevent a health care provider or employee from treating or providing services to a patient who has intentionally physically abused or threatened the provider or employee.
(f) The written workplace violence prevention plan may satisfy the requirements of subsection (e) of this section by referencing other internal ASC policies and documents.
(g) At least annually after the date an ASC adopts a written workplace violence prevention plan required by subsection (e) of this section, the committee shall:
(1) review and evaluate the workplace violence prevention plan; and
(2) report the results of the evaluation to the ASC's governing body.
(h) Each ASC shall make available on request an electronic or printed copy of the ASC's workplace violence prevention plan to each health care provider or ASC employee. If the committee determines the plan contains information that would pose a security threat if made public, the committee may redact that information before providing the plan.
(i) In accordance with HSC §331.005, after an incident of workplace violence occurs, an ASC shall offer immediate post-incident services, including any necessary acute medical treatment for each ASC health care provider or employee who is directly involved in the incident.
(j) In accordance with HSC §331.005, an ASC may not discourage a health care provider or employee from exercising the provider's or employee's right to contact or file a report with law enforcement regarding a workplace violence incident.
(k) In accordance with HSC §331.005, an ASC shall prohibit ASC personnel from disciplining, including by suspension or termination of employment, discriminating against, or retaliating against another person who:
(1) in good faith reports a workplace violence incident; or
(2) advises a health care provider or employee of the provider's or employee's right to report a workplace violence incident.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on September 24, 2024.
TRD-202404582
Karen Ray
Chief Counsel
Department of State Health Services
Effective date: October 21, 2024
Proposal publication date: May 3, 2024
For further information, please call: (512) 834-4591