1. (a) Enforcement is a process by which a sanction is proposed, and if warranted, imposed on an applicant or licensee regulated by the Texas Health and Human Services Commission (HHSC) for failure to comply with applicable statutes, rules, or orders.

2. (b) HHSC has jurisdiction to enforce violations of Texas Health and Safety Code Chapter 251 (relating to End Stage Renal Disease Facilities) and this chapter. HHSC may deny, suspend, or revoke a license or impose an administrative penalty for:

   1. (1) failure to comply with any applicable provision of Texas Health and Safety Code, including Chapter 251;
   2. (2) failure to comply with any provision of this chapter or any other applicable laws;
   3. (3) the facility, or any of its employees, committing an act that causes actual harm or risk of harm to the health or safety of a patient;
   4. (4) the facility, or any of its employees, materially altering any license issued by HHSC;
   5. (5) failure to comply with minimum standards for licensure;
   6. (6) failure to provide a complete license application;
   7. (7) failure to comply with an order of the executive commissioner or another enforcement procedure under Texas Health and Safety Code Chapter 251;
   8. (8) a history of failure to comply with the applicable rules relating to patient environment, health, safety, and rights that reflects more than nominal noncompliance;
   9. (9) the facility aiding, committing, abetting, or permitting the commission of an illegal act;
   10. (10) the facility, or any of its employees, committing fraud, misrepresentation, or concealment of a material fact on any documents a facility is required to submit to HHSC or required to maintain pursuant to Texas Health and Safety Code Chapter 251, and the provisions of this chapter;
   11. (11) failure to comply with other state and federal laws affecting the health, safety, and rights of facility patients;
   12. (12) failure to timely pay an assessed administrative penalty as required by HHSC;
   13. (13) failure to submit an acceptable plan of correction (POC) for cited deficiencies within the timeframe required by HHSC;
   14. (14) failure to timely implement a POC for deficiencies cited by HHSC within the dates designated in the POC;
   15. (15) failure to comply with applicable requirements within a designated probation period; or
   16. (16) if the facility is participating under Title XVIII, and the CMS terminates the facility's Medicare provider agreement.

3. (c) HHSC has jurisdiction to enforce violations of Texas Health and Safety Code Chapter 251 and this chapter. HHSC may deny a license if the applicant:

   1. (1) fails to provide timely and sufficient information or fees required by HHSC that is directly related to the application;

   2. (2) has had the following actions taken against the applicant within the two-year period preceding the application:

      1. (A) decertification or cancellation of its contract under the Medicare or Medicaid program in any state;
      2. (B) federal Medicare or state Medicaid sanctions or penalties;
      3. (C) unsatisfied federal or state tax liens;
      4. (D) unsatisfied final judgments;
      5. (E) eviction involving any property or space used as an end stage renal disease (ESRD) facility or health care facility in any state;
      6. (F) unresolved federal Medicare or state Medicaid audit exceptions;
      7. (G) denial, suspension, or revocation of an ESRD facility license, a private psychiatric hospital license, or a license for any health care facility in any state; or
      8. (H) a court injunction prohibiting ownership or operation of an ESRD facility.

4. (d) HHSC may deny a person or entity a license or suspend or revoke an existing license on the grounds that the person or entity has been convicted of a felony or misdemeanor that directly relates to the duties and responsibilities of the ownership or operation of a facility. HHSC applies the requirements of Texas Occupations Code Chapter 53 (relating to Consequences of Criminal Conviction).

   1. (1) In determining whether a criminal conviction directly relates, HHSC considers the provisions of Texas Occupations Code §53.022 (relating to Factors in Determining Whether Conviction Directly Relates to Occupation) and Texas Occupations Code §53.023 (relating to Additional Factors for Licensing Authority to Consider After Determining Conviction Directly Relates to Occupation).

   2. (2) The following felonies and misdemeanors directly relate to the duties and responsibilities of a licensed facility because these criminal offenses indicate an inability or a tendency for the person to be unable to own or operate a facility:

      1. (A) a misdemeanor violation of Texas Health and Safety Code Chapter 251;
      2. (B) a misdemeanor or felony involving moral turpitude;
      3. (C) a misdemeanor or felony relating to deceptive business practices;
      4. (D) a misdemeanor or felony of practicing any health-related profession without a required license;
      5. (E) a misdemeanor or felony under any federal or state law relating to drugs, dangerous drugs, or controlled substances;
      6. (F) a misdemeanor or felony under Texas Penal Code (TPC) Title 5 (relating to Offenses Against the Person), involving a patient, resident, or client of any health care facility, a home and community support services agency, or a health care professional; or

      7. (G) a misdemeanor or felony under TPC:

         1. (i) Title 4 (relating to Inchoate Offenses);
         2. (ii) Title 7 (relating to Offenses Against Property);
         3. (iii) Title 8 (relating to Offenses Against Public Administration);
         4. (iv) Title 9 (relating to Offenses Against Public Order and Decency);
         5. (v) Title 10 (relating to Offenses Against Public Health, Safety, and Morals); or
         6. (vi) Title 11 (relating to Organized Crime).
      8. (H) Offenses listed in this paragraph are not exclusive in that HHSC may consider similar criminal convictions from other state, federal, foreign, or military jurisdictions that indicate an inability or tendency for the person or entity to be unable to own or operate a facility.
   3. (3) HHSC revokes a license on the licensee's imprisonment following a felony conviction, felony community supervision revocation, revocation of parole, or revocation of mandatory supervision.

5. (e) If HHSC proposes to deny, suspend, or revoke a license, HHSC sends a notice of the proposed action by certified mail, return receipt requested, at the address shown in the current records of HHSC or HHSC may personally deliver the notice. The notice to deny, suspend, or revoke a license, or impose an administrative penalty, states the alleged facts or conduct to warrant the proposed action, provide an opportunity to demonstrate or achieve compliance, and states that the applicant or license holder has an opportunity for a hearing before taking the action.

   1. (1) The facility must request a hearing within 30 calendar days after receipt of the notice. Receipt of the notice is presumed to occur on the third business day after the notice is mailed by HHSC to the applicant's or licensee's last known address.
   2. (2) The request for a hearing shall be in writing and submitted to the Texas Health and Human Services Commission, Enforcement Unit, Regulatory Services Division.
   3. (3) A hearing shall be conducted pursuant to Texas Government Code Chapter 2001 (relating to Administrative Procedure) and Texas Administrative Code, Title 1 Chapter 357, Subchapter I (relating to Hearings Under the Administrative Procedure Act).
   4. (4) If the facility does not request a hearing in writing within 30 calendar days after receiving the notice, the facility is deemed to have waived the opportunity for hearing, and the proposed action shall be taken.
   5. (5) If the facility fails to appear or be represented at the scheduled hearing, the facility has waived the right to a hearing, and the proposed action shall be taken.

6. (f) If HHSC suspends a license, the suspension shall remain in effect until HHSC determines that the reason for suspension no longer exists. An authorized representative of HHSC investigates before making a determination.

   1. (1) During the time of suspension, the suspended license holder shall return the license to HHSC.
   2. (2) If a suspension overlaps a renewal date, the suspended license holder shall comply with the renewal procedures in this chapter; however, HHSC may not renew the license until HHSC determines that the reason for suspension no longer exists.
7. (g) If HHSC revokes or does not renew a license, a person may reapply for a license by complying with the requirements and procedures in this chapter at the time of reapplication. HHSC may refuse to issue a license if the reason for revocation or nonrenewal continues to exist.
8. (h) Upon revocation or nonrenewal, a license holder shall return the license to HHSC within 30 calendar days after notification from HHSC.

9. (i) In lieu of denying, suspending, or revoking the license, HHSC may place the facility on probation for a period of not less than 30 calendar days if the facility is found in repeated noncompliance and the facility's noncompliance does not endanger the public's health and safety.

   1. (1) HHSC provides the facility notice of probation and the items of noncompliance at least 10 calendar days before the probation period begins.
   2. (2) During the probation period, the facility must correct the items of noncompliance and report corrections to HHSC for approval.

Source Note:The provisions of this §507.90 adopted to be effective December 23, 2025, 50 TexReg 8289.