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, and orders.(1) Denial, suspension or revocation of a license or imposition of an administrative penalty. HHSC has jurisdiction to enforce violations of the Act or the rules adopted under this chapter. HHSC may deny, suspend, or revoke a license or impose an administrative penalty for the following:(A) failure to comply with any applicable provision of the Texas Health and Safety Code (HSC), including Chapters 241, 311, and 327;(B) failure to comply with any provision of this chapter or any other applicable laws;(C) the hospital, or any of its employees, committing an act which causes actual harm or risk of harm to the health or safety of a patient;(D) the hospital, or any of its employees, materially altering any license issued by HHSC;(E) failure to comply with minimum standards for licensure; (F) failure to provide a complete license application;(G) failure to comply with an order of the HHSC executive commissioner or another enforcement procedure under HSC Chapters 241, 311, or 327;(H) a history of failure to comply with the applicable rules relating to patient environment, health, safety, and rights that reflect more than nominal noncompliance;(I) the hospital aiding, committing, abetting, or permitting the commission of an illegal act;(J) the hospital, or any of its employees, committing fraud, misrepresentation, or concealment of a material fact on any documents required to be submitted to HHSC or required to be maintained by the hospital pursuant to HSC Chapter 241 and the provisions of this chapter;(K) failure to comply with other state and federal laws affecting the health, safety, and rights of hospital patients;(L) failure to timely pay an assessed administrative penalty as required by HHSC;(M) failure to submit an acceptable plan of correction for cited deficiencies within the timeframe required by HHSC;(N) failure to timely implement plans of corrections to deficiencies cited by HHSC within the dates designated in the plan of correction;(O) failure to comply with applicable requirements within a designated probation period; or(P) if the hospital is participating under Title XVIII of the Social Security Act, 42 United States Code (USC), §1395 et seq, the Centers for Medicare & Medicaid Services terminating the hospital's Medicare provider agreement.(2) Denial of a license. HHSC has jurisdiction to enforce violations of HSC Chapters 241, 311, and 327 and this chapter. HHSC may deny a license if the applicant:(A) fails to provide timely and sufficient information required by HHSC that is directly related to the application; or(B) has had the following actions taken against the applicant within the two-year period preceding the application:(i) decertification or cancellation of its contract under the Medicare or Medicaid program in any state;(ii) federal Medicare or state Medicaid sanctions or penalties;(iii) unsatisfied federal or state tax liens;(iv) unsatisfied final judgments;(v) eviction involving any property or space used as a hospital in any state;(vi) unresolved federal Medicare or state Medicaid audit exceptions;(vii) denial, suspension, or revocation of a hospital license, a private psychiatric hospital license, or a license for any health care facility in any state; or(viii) a court injunction prohibiting ownership or operation of a facility.(3) Emergency suspension. Following notice and opportunity for hearing, the executive commissioner of HHSC or a person designated by the executive commissioner may issue an emergency order in relation to the operation of a hospital licensed under this chapter if the executive commissioner or the executive commissioner's designee determines that the hospital is violating this chapter, a rule adopted pursuant to this chapter, a special license provision, injunctive relief, an order of the executive commissioner or the executive commissioner's designee, or another enforcement procedure permitted under this chapter and the provision, rule, license provision, injunctive relief, order, or enforcement procedure relates to the health or safety of the hospital's patients.(A) HHSC shall send written notice of the hearing and shall include within the notice the time and place of the hearing. The hearing must be held within 10 days after the date of the hospital's receipt of the notice.(B) The hearing shall be held in accordance with HHSC's informal hearing rules.(C) The order shall be effective on delivery to the hospital or at a later date specified in the order.(4) Probation. In lieu of denying, suspending, or revoking the license, HHSC may place the hospital on probation for a period of not less than 30 days, if HHSC finds that the hospital is in repeated noncompliance with these rules or HSC Chapter 241, and the hospital's noncompliance does not endanger the public's health and safety.(A) HHSC shall provide notice to the hospital of the probation and of the items of noncompliance not later than the 10th day before the probation period begins.(B) During the probation period, the hospital shall correct the items of noncompliance and report the corrections to HHSC for approval.(5) Administrative penalty. HHSC has jurisdiction to impose an administrative penalty against a hospital licensed or regulated under this chapter for violations of HSC Chapters 241, 311, and 327 and this chapter. The imposition of an administrative penalty shall be in accordance with the provisions of HSC §241.059, §241.060, and §327.008.(6) Licensure of persons or entities with criminal backgrounds. 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 hospital. HHSC shall apply the requirements of Texas Occupations Code Chapter 53.(A) HHSC is entitled under Texas Government Code Chapter 411 to obtain criminal history information maintained by the Texas Department of Public Safety, the Federal Bureau of Investigation, or any other law enforcement agency to investigate the eligibility of an applicant for an initial or renewal license and to investigate the continued eligibility of a licensee.(B) In determining whether a criminal conviction directly relates, HHSC shall apply the requirements and consider the provisions of Texas Occupations Code Chapter 53.(C) The following felonies and misdemeanors directly relate to the duties and responsibilities of the ownership or operation of a health care facility because these criminal offenses indicate an ability or a tendency for the person to be unable to own or operate a hospital:(i) a misdemeanor violation of HSC Chapter 241;(ii) a misdemeanor or felony involving moral turpitude;(iii) a misdemeanor or felony relating to deceptive business practices;(iv) a misdemeanor or felony of practicing any health-related profession without a required license;(v) a misdemeanor or felony under any federal or state law relating to drugs, dangerous drugs, or controlled substances;(vi) a misdemeanor or felony under Texas Penal Code (TPC),