Emergency Sections An agency may adopt a new or amended section or repeal an existing section on an emergency basis if it determines that such action is necessary for the public health, safety, or welfare of this state. The section may become effective immediately upon filing with the Texas Register, or on a stated date less than 20 days after filing, for no more than 120 days. The emergency action is renewable once for no more than 60 days. Symbology in amended emergency sections. New language added to an existing section is indicated by the use of bold text. [Brackets] indicate deletion of existing material within a section. TITLE 22. EXAMINING BOARD Part VIII. Texas Appraiser Licensing and Certification Board Chapter 151. Practice and Procedure 22 TAC sec.sec.151.1-151.30 The Texas Appraiser Licensing and Certification Board is renewing the effectiveness of the emergency adoption of new sec.sec.151.1-151.30, for a 60- day period effective January 2, 1992. The text of new sec.sec.151.1-151.30 was originally published in the September 13, 1991, issue of the Texas Register (16 TexReg 5015). Issued in Austin, Texas, on December 3, 1991. TRD-9115122 Renil C. Liner Commissioner Texas Appraiser Licensing and Certification Board Effective date: January 2, 1992 Expiration date: March 2, 1992 For further information, please call: (512) 465-3950 Chapter 153. Provisions of the Texas Appraiser Licensing and Certification Act 22 TAC sec.sec.153.1, 153.3, 153.5, 153.7, 153.9, 153.11, 153.13, 153.15, 153.17, 153.21, 153.23 The Texas Appraiser Licensing and Certification Board is renewing the effectiveness of the emergency adoption of new sec.sec.153.1, 153.3, 153.5, 153.7, 153.9, 153.11, 153.13, 153.15, 153.17, 153.21, and 153.23, for a 60-day period effective January 2, 1992. The text of new sec.153.1, 153.3, 153.5, 153.7, 153.9, 153.11, 153.13, 153.15, 153.17, 153.21, and 153.23 was originally published in the September 13, 1991, issue of the Texas Register (16 TexReg 5017). Issued in Austin, Texas, on December 3, 1991. TRD-9115123 Renil C. Liner Commissioner Texas Appraiser Licensing and Certification Board Effective date: January 2, 1991 Expiration date: March 2, 1992 For further information, please call: (512) 465-3950 22 TAC sec.153.9 The Texas Appraiser Licensing and Certification Board is renewing the effectiveness of the emergency adoption of amended sec.153.9, for a 60-day period effective January 2, 1992. The text of amended sec.153.9 was originally published in the November 12, 1991, issue of the Texas Register (16 TexReg 6521). Issued in Austin, Texas, on December 3, 1991. TRD-9115126 Renil C. Liner Commissioner Texas Appraiser Licensing and Certification Board Effective date: January 2, 1992 Expiration date: March 2, 1992 For further information, please call: (512) 465-3950 22 TAC sec.153.15 The Texas Appraiser Licensing and Certification Board is renewing the effectiveness of the emergency adoption of amended sec.153.15, for a 60-day period effective January 2, 1992. The text of amended sec.153.15 was originally published in the October 8, 1991, issue of the Texas Register (16 TexReg 5545). Issued in Austin, Texas, on December 3, 1991. TRD-9115125 Renil C. Liner Commissioner Texas Appraiser Licensing and Certification Board Effective date: January 2, 1992 Expiration date: March 2, 1992 For further information, please call: (512) 465-3950 Chapter 155. Standards of Practice 22 TAC sec.155.1 The Texas Appraiser Licensing and Certification Board is renewing the effectiveness of the emergency adoption of new sec.155.1, for a 60-day period effective January 2, 1992. The text of new sec.155.1 was originally published in the September 13, 1991, issue of the Texas Register (16 TexReg 5022). Issued in Austin, Texas, on December 3, 1991. TRD-9115124 Renil C. Liner Commissioner Texas Appraiser Licensing and Certification Board Effective date: January 2, 1992 Expiration date: March 2, 1992 For further information, please call: (512) 465-3950 TITLE 25. HEALTH SERVICES Part II. Texas Department of Mental Health and Mental Retardation Chapter 401. System Administration Subchapter J. Licensure of Private Psychiatric Hospitals 25 TAC sec.sec.401.581-401.592 The Texas Department of Mental Health and Mental Retardation (TXMHMR) adopts on an emergency basis the repeal of sec. s401.581-401.592, concerning licensure of private psychiatric hospitals. The action is taken on an emergency basis because of imminent peril to public health, welfare, and safety. The subchapter is repealed in order to be replaced with new sections by the same title which respond directly to widespread public allegations of violations of state law and patient rights in Texas. The new subchapter is also adopted on an emergency basis in this issue of the Texas Register. The repeals are adopted on an emergency basis under Texas Civil Statutes, Article 6252-13a, sec.5(d), which provide emergency rulemaking powers; under the Texas Health and Safety Code, s532.015 (Texas Civil Statutes, Article 5547-202, sec.2.11), which provides the Texas Department of Mental Health and Mental Retardation with broad rulemaking powers; and under the Texas Health and Safety Code, sec.577.010 (Texas Mental Health Code, Article 5547-95), which provides rulemaking powers specific to private psychiatric hospitals. sec.40l.58l. Purpose. sec.40l.582. Application. sec.40l.583. Definitions. sec.40l.584. Submission of Plans and Specifications. sec.40l.585. Construction and Inspections. sec.40l.586. License Application Process. sec.40l.587. Requirements for Licensure. sec.40l.588. Patient Rights. sec.401.589. Reporting Requirements. sec.401.590. Denial, Suspension, or Revocation of License. sec.401.591. Distribution. sec.40l.592. References. Issued in Austin, Texas, on December 3, 1991. TRD-9115155 Ann K. Utley Chairman Texas Board of Mental Health and Mental Retardation Effective date: December 4, 1991 Expiration date: April 2, 1992 For further information, please call: (512) 465-4670 25 TAC sec.sec.401.581-401.593 The Texas Department of Mental Health and Mental Retardation (TXMHMR) adopts on an emergency basis new sec.sec.401.581-401.593, concerning licensure of private psychiatric hospitals. The action is taken on an emergency basis because of imminent peril to public health, welfare, and safety. In a series of public hearings in a number of locations in Texas in recent weeks, a large number of citizens, including patients, their families, and healthcare professionals, have given oral and written testimony alleging widespread violations of state laws governing the treatment of individuals who are considering, seeking, and receiving mental health services at private psychiatric hospitals. The volume of complaints and the egregiousness of the alleged offenses requires immediate action by the mental health authority of the State of Texas. Since 1983, the ability of the state to ensure the safety of its citizens has been limited by the Texas Health and Safety Code, sec.222.024, which provides that a hospital licensed by the Texas Department of Mental Health and Mental Retardation is not subject to additional licensing inspections while the hospital maintains Medicare certification or accreditation from the Joint Commission on Accreditation of Healthcare Organizations, the American Osteopathic Association, or other national accreditation organizations for the offered services. The code further provides that the Texas Department of Mental Health and Mental Retardation must issue a license to any hospital if the hospital remits applicable fees and submits a copy of the most recent inspection results from the certification or accreditation body. The intent of the legislation, in part, was to reduce duplicative and cumbersome reviews. The unintended effect has been to enable numerous violations of state and federal laws to go undetected, without providing necessary recourse and protection to the citizens of Texas. Also at issue is the ability of national accrediting and certifying bodies to effectively evaluate compliance with state and federal laws since the focus of such outside inspections is on issues of clinical and programmatic care. Further, the appropriate enforcement agency for such state and federal law is not a private organization which private psychiatric hospitals pay for the service of accreditation, nor is the appropriate enforcement authority for state law the agent for federal programs. The appropriate enforcement agency for state laws and rules is the mental health authority for the State of Texas. In order to effect immediate relief to the citizens of this state, the Texas Department of Mental Health and Mental Retardation interprets this legislation to prohibit the redundant review of the same matters by both outside accrediting and certifying agencies and the Texas Department of Mental Health and Mental Retardation except to the extent that such matters involve state or federal law, or the additional requirements of this department necessary to ensure public health, welfare, and safety. An attorney general's opinion is being sought in support of this position until such time as the Health and Safety Code, sec.222. 024 can be considered by the Texas Legislature. The new rule is adopted on an emergency basis contemporaneously with its regular proposal in this issue of the Texas Register and with the emergency and proposed repeal of the rule it would replace, which is also known as Chapter 401, Subchapter J. The new sections are adopted on an emergency basis under Texas Civil Statutes, Article 6252-13a, sec.5(d), which provide emergency rulemaking powers; under the Texas Health and Safety Code, s532.015 (Texas Civil Statutes, Article 5547-202, sec.2.11), which provides the Texas Department of Mental Health and Mental Retardation with broad rulemaking powers; and under the Texas Health and Safety Code, sec.577.010 (Texas Mental Health Code, Article 5547-95), which provides rulemaking powers specific to private psychiatric hospitals. sec.401.581. Purpose. The purpose of this subchapter is to ensure proper care and treatment of patients in private psychiatric hospitals. sec.401.582. Application. The provisions of this subchapter apply to: (1) persons operating private psychiatric hospitals in Texas; and (2) applicants for licensure as private psychiatric hospitals in Texas. sec.401.583. Definitions. The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise. Applicant-A person who is seeking licensure for a private psychiatric hospital from the Texas Department of Mental Health and Mental Retardation. Community center -A community mental health center or a community mental health and mental retardation center administered by a board of trustees pursuant to the Texas Health and Safety Code, Chapter 534 (Texas Mental Health and Mental Retardation Act, Texas Civil Statutes, Article 5547-201 et seq) . Department-The Texas Department of Mental Health and Mental Retardation. License-The permission granted to a person by the department to operate a private psychiatric hospital. Licensee-A person who has been granted a current valid license by the Texas Department of Mental Health and Mental Retardation. Person-Any individual, partnership, corporation, association, political subdivision, or public or private organization of any character other than department. Private psychiatric hospital-An establishment offering inpatient services, including treatment, facilities, and beds for use beyond 24 hours, for the primary purpose of providing psychiatric assessment and diagnostic services and psychiatric inpatient care and treatment for mental illness. Such services must be more intensive than room, board, personal services, and general medical and nursing care. Although substance abuse services may be offered, a majority of beds must be dedicated to the treatment of mental illness in adults and/or children. Services other than those of an inpatient nature are not licensed or regulated by the department and are considered only to the extent that they affect the stated resources for the inpatient components. Programmatic licensing review-Review to ascertain compliance with general standards of care as established by national accrediting or certifying agencies. Standards of care which are also reflected in state and federal law and are specifically enumerated in this subchapter will be subject to statutory review as well. Special treatment procedures-Those procedures which include the use of any of the following: restraint; seclusion; electroconvulsive therapy; psychosurgery; behavior modification; unusual, investigational, and experimental drugs or therapy; maintenance drugs that have abuse potential; and research projects that involve inconvenience or risk to the patient. Statutory review -Review by the Texas Department of Mental Health or Mental Retardation or its duly authorized agent(s) to ascertain compliance with state and federal laws and the provisions of this subchapter. sec.401.584. Submission of Plans and Specifications. (a) Prior to construction, all plans and specifications for new or replacement buildings and facilities, additions to existing private psychiatric hospitals, or renovation or conversion of existing structures, shall be submitted to the department for review and approval. Plans for minor alterations or remodeling changes need not be submitted if they do not: (1) involve alterations to load bearing members or partitions; (2) change functional operation; (3) affect fire safety; or (4) add beds or services for which the hospital is licensed. (b) Plans and specifications shall be submitted in stages as described in the "Minimum Requirements for Construction and Equipment for Private Psychiatric Hospitals Licensed by the Texas Department of Mental Health and Mental Retardation," which is herein adopted by reference as Exhibit A and is available from the Texas Department of Mental Health and Mental Retardation, P.O. Box 12668, Austin, Texas 78711. (c) The first stage submittal of such plans and specifications shall be accompanied by a fee of $650 and a letter of intent to apply for license to operate a private psychiatric hospital. The letter of intent should indicate the proposed name, ownership, address, and number of beds by type of service at the proposed hospital. (d) All final stage plans and specifications shall be sealed and signed by a registered architect and professional engineer licensed by the State of Texas. (e) Upon approval of final (third stage) plans and specifications, the department shall issue a letter granting approval to begin construction. Such authorization does not release the applicant from the requirements contained in this subchapter. Any contract modifications which affect the function, design, or designated use of an area shall be submitted to the department for approval prior execution. (f) Routine use of nonhospital space for ongoing programming for inpatients requires TXMHMR approval. sec.401.585. Construction and Inspections. (a) Adequate provision shall be made for the safety and comfort of patients whenever an approved construction or renovation project takes place in or near occupied areas. (b) After construction has commenced, progress reports shall be submitted to the department by the hospital/owner. (c) Two or more construction progress and/or final inspections of the facility will be scheduled for the purpose of verifying compliance with licensing requirements, plans, and specifications. The department shall determine the number of required inspections necessary to complete all proposed construction projects. (d) A fee of $650 for each inspection shall be submitted to the Texas Department of Mental Health and Mental Retardation prior to any inspections conducted by the staff of the department. All fees shall be paid by check or money order made payable to the Texas Department of Mental Health and Mental Retardation. (e) No facility shall occupy any new structure, or building addition, or renovation space until the appropriate permission has been received from the local building and fire authorities and the department. (f) Each private psychiatric hospital is required to have an approved fire safety inspection from a local fire marshal. Inspections will be performed at least on an annual basis. Documentation must be provided if the local fire marshal will not perform the required inspections. Fire detection systems, including sprinklers and alarms, shall be installed by a company certified by the state fire marshal and shall be inspected and tested accordingly. sec.401.586. License Application Process. (a) A person requesting a license to operate a private psychiatric hospital must submit the application which is herein adopted by reference as Exhibit B and which is available from the Texas Department of Mental Health and Mental Retardation, P.O. Box 12668, Austin, Texas 78711. The application shall contain all information elicited by the application form and such other information as shall be required by the department for the proper administration and enforcement of the Texas Health and Safety Code, Subtitle C, Chapters 571-577 (Texas Mental Health Code, Texas Civil Statutes, Article 5547-l et seq). (b) The original and one copy of the application must be submitted to the department. Written material relating to the application must also be submitted in duplicate. (c) An application for a license to operate a private psychiatric hospital must be accompanied by an initial license fee of $250. The annual license renewal fee payable each year thereafter is $250. All fees shall be paid by check or money order made payable to the Texas Department of Mental Health and Mental Retardation. (d) Each application for a license to operate a private psychiatric hospital shall be reviewed and a determination made within 10 working days after the date of its receipt whether the application is complete and complies with all applicable laws, rules, and regulations. (e) If the application contains all requested information and complies with all applicable laws, rules, and regulations, the department shall notify the applicant in writing of formal acceptance of the application. (f) If the application does not contain all requested information or does not comply with all applicable laws, rules, and regulations, the department shall notify the applicant in writing of the rejection of the application and provide a list of deficiencies for correction. Failure of the applicant to submit corrections to the stated deficiencies within 60 days from the date of the letter of notification may result in the administrative withdrawal of the application and forfeiture of the application fee. (g) After formal acceptance of proper application for license and the required fees, the department shall make such investigation as it deems necessary. If the department finds that the premises are suitable and that the applicant is qualified to operate a psychiatric hospital in accordance with the requirements and standards established by law and by the department, the department shall issue a license authorizing the designated licensee to operate a psychiatric hospital on the premises described and for the bed capacity specified in the license. (h) The department may grant a provisional license for a period not to exceed 12 months in order for the facility to demonstrate operational procedures which are in substantial compliance with this subchapter. No provisional license shall be granted to a newly established hospital which is not in substantial compliance with provisions of this subchapter relating to the structural or physical condition of the hospital. (i) Within 12 months of the time a provisional license is granted, private psychiatric hospitals awarded accreditation by the Joint Commission on Accreditation of Healthcare Organizations or certification by Medicare as a psychiatric hospital will be exempt from an onsite programmatic review by the department and shall be awarded a permanent license. Those private psychiatric hospitals not seeking or not awarded such JCAHO accreditation or Medicare certification shall receive a programmatic review by the department and shall be awarded a two-year license upon demonstration of substantial compliance with the requirements of sec.401.587 of this title (relating to Patient Care Requirements for Licensure). (j) The license shall be posted in a conspicuous place on the licensed premises. A license remains in effect until suspended or revoked by the department or surrendered by the licensee. sec.401.587. Patient Care Requirements for Licensure. (a) In order to be eligible for licensure as a private psychiatric hospital, a proposed facility must: (1) meet the definition of a private psychiatric hospital as delineated in sec.401.583 of this title (relating to Definitions); (2) be in substantial compliance with the standards as described in subsections (b) and (c) of this section; and (3) be in compliance with applicable state and federal laws and the provisions of this subchapter, including, but not limited to, the requirement contained in sec.401.588 of this title (relating to Patient Rights). (b) Each private psychiatric hospital shall provide overall operations, a physical plant, and all services and treatment in a manner consistent with recognized hospital standards. (1) For purposes of licensure, private psychiatric hospitals, other than those operated by community centers, shall be in substantial compliance with inpatient standards set forth by the Joint Commission on Accreditation of Healthcare Organizations; that is, the standards for inpatient settings in the current edition of the Accreditation Manual for Hospitals. Additionally, such hospitals shall comply with standards set forth by the Joint Commission on Accreditation of Healthcare Organizations in the current edition of the Consolidated Standards Manual for: (A) special treatment procedures; and (B) patient rights. (2) In keeping with accreditation policies currently set forth by the Joint Commission on Accreditation of Healthcare Organizations for inpatient programs of community centers, private psychiatric hospitals operated by community centers shall be in substantial compliance with inpatient standards set forth by the Joint Commission on Accreditation of Healthcare Organizations in the current edition of the Consolidated Standards Manual. Additionally, such hospitals shall provide nursing, medical, and pharmacy services in accordance with standards set forth in the current edition of the Accreditation Manual for Hospitals. (c) The following provisions are requisite to obtaining and maintaining licensure by the Texas Department of Mental Health and Mental Retardation. (1) All admissions, voluntary or involuntary, must be clinically justified. (A) Prior to admission, persons presenting for services on a voluntary basis must either: (i) have been evaluated on a face-to-face basis by the treating physician within the previous 72 hours; or (ii) have been evaluated on a face-to-face basis by the admitting psychiatrist or admitting physician within the previous 24 hours. (B) The physician must document the clinical justification for hospitalization in the patient record. (C) No person shall be admitted to the hospital for emergency detention unless such admission is supported by a written statement in the patient record by the admitting physician who has examined the person and who has determined that the person meets the criteria for admission outlined in the Texas Health and Safety Code, s573.022 (Texas Mental Health Code, Article 5547-27). Submission of an application for voluntary admission prior to the evaluation for admission for emergency detention does not negate the requirements for the evaluation under the Texas Health and Safety Code s573.022 (Texas Mental Health Code, Article 5547-27). (2) Financial remuneration, in-kind gifts or services, or other compensation of any kind are prohibited from being offered or accepted by any person for illegally securing patients or patronage, including, but not limited to, securing patients or patronage in violation of the Health and Human Safety Code, Chapter 161, Subchapter I, sec.161.091. (3) Charges for services must be billed using clear, itemized, easy to understand descriptions. (4) Any voluntary patient expressing a request for release shall be given an explanation of the process for requesting release and afforded the opportunity to request the release in writing. When a written request for release is signed or presented to any direct care staff of the hospital it should be witnessed and timed and dated. Oral statements of the desire to be discharged shall be treated as written requests for release and shall be reduced to writing by staff, if necessary. (A) As soon as possible, but no more than 24 hours after receipt of the request for release, the patient should be examined face-to-face and assessed for discharge readiness by the patient's physician, with input from the members of the treatment team. (B) Any instance in which a patient is detained must be supported by documentation that clearly describes the clinical rationale for detention and plans for disposition. (5) Threats intended to influence a voluntary patient's decision to exercise the right to request discharge are strictly prohibited. Allegations will be considered potential Class III abuse as defined in Chapter 404, Subchapter C of this title (relating to Patient Abuse in Private Psychiatric Hospitals), and will be investigated as such. Substantiated allegations will be grounds for licensure review and possible revocation. (6) All medications shall be administered by licensed nurses or licensed physicians. All medication administration procedures performed by licensed nurses shall be under the direct supervision of a registered nurse. (7) Each private psychiatric hospital shall adopt policies and procedures consistent with the standards of care established in rules of the Texas Department of Mental Health and Mental Retardation for state hospitals in the areas of: (A) prescribing practices for medications, including the use of polypharmacy, maximum dosage levels, and consent to medication; (B) procedures for electroconvulsive therapy; and (C) procedures for restraint and seclusion. sec.401.588. Patient Rights. (a) Each patient of a private psychiatric hospital shall have the rights as delineated in the "Patient's Bill of Rights," which is identified as Exhibit C and contained in this subsection as follows. Copies of the "Patient's Bill of Rights" must be displayed prominently at all times in all areas frequented by persons receiving services (e.g., dayrooms, recreational rooms, waiting rooms, lobby areas). A sufficient number of copies will be kept on hand in each of these areas in order that a copy may be readily available to anyone requesting one. insert page 2 [graphic] (b) Prior to admission, one copy of the "Patient's Bill of Rights" shall be given to each person, whether voluntarily admitted or committed, and, as appropriate, to his or her family member, guardian, or friend. A duplicate copy of the "Patient's Bill of Rights," signed by the person to be voluntarily admitted or committed and witnessed by his or her family member, guardian, or friend, shall be filed in the patient record. If a family member, guardian, or friend is not available to witness, a staff member shall witness. (c) Each patient of a private psychiatric hospital shall be protected from abuse and neglect and any allegation of such shall be reported and actions taken in accordance with Chapter 404, Subchapter C of this title (relating to Patient Abuse in Private Psychiatric Hospitals). sec.401.589. Statutory Review: Enforcement of Laws. (a) Without regard to programmatic licensing review and accreditation by the Joint Commission on Accreditation of Healthcare Organizations or certification by Medicare, TXMHMR may make such investigations as it deems necessary and proper to obtain compliance with the provisions of state law and TXMHMR rules. Each private psychiatric hospital must: (1) comply with the provisions of this subchapter; (2) correct in timely fashion any deficiencies cited by the department with regard to the requirements of this subchapter; (3) cooperate with investigations conducted by the department or its agents of reports of abuse, neglect, violation of patient rights, or other deficiency in the operation of the facility; and (4) cooperate with investigations conducted by the department or its agents concerning compliance with state or federal laws or this subchapter. (b) Any duly authorized agent of the department may at any time enter upon the premises of any private psychiatric hospital to inspect the facility and conditions, to observe the program for care and treatment, to question employees and patients of the hospital, or to take other action deemed necessary to ascertain compliance state or federal laws or this subchapter. Any such duly authorized agent may have access for the purposes of examination and transcription to such records and documents as the agent deems relevant to the investigation. (c) The department may maintain an action in the name of the State of Texas for injunction or any other process against any person or political subdivision to restrain the unlicensed operation of a psychiatric hospital or to restrain the operation of a hospital that has violated or is violating the laws of the State of Texas or the United States. sec.401.590. Reporting Requirements. (a) The authorized bed capacity may be increased at any time upon approval by the department and may be reduced at any time by notifying the department. (b) Each private psychiatric hospital shall report to the department within one working day all deaths occurring in the hospital when a patient dies within 24 hours after admission to the hospital, or as a result of the following: (1) a violent act; (2) a suicide attempt or act; (3) an accident; (4) poisoning; (5) an alcohol or drug related incident; or (6) unknown cause or otherwise questionable circumstances. (c) Each private psychiatric hospital shall report to the department within five days all fires occurring in the hospital. (d) Each private psychiatric hospital shall report all alleged incidents of patient abuse and neglect in accordance with Chapter 404, Subchapter C of this title (relating to Patient Abuse in Private Psychiatric Hospitals). (e) The governing board of each private psychiatric hospital shall furnish to the department the name and address of its administrative officer within 30 days after appointment. (f) A license issued by the department is not transferable or assignable. Each private psychiatric hospital shall provide written notification to the department within 60 days prior to the change of ownership, control, and/or relocation of the facility. If a hospital continues to meet these licensing standards, a new license will be issued effective the day the change occurs. Full disclosure of hospital ownership and control is required. (g) The department may require every licensee to make annual, periodic, and special reports and to keep such records as it considers necessary to ensure compliance with the provision of the Texas Health and Safety Code (Texas Mental Health Code) and such rules, regulations, and standards as the department prescribes. sec.401.591. Denial, Suspension, or Revocation of License. (a) The department shall deny, suspend, or revoke a hospital's license if the department finds that there has been a substantial failure by the applicant or licensee to comply with the rules of the department or the provisions of the Texas Health and Safety Code, Subtitle C, Chapters 571-577 (Texas Mental Health Code, Texas Civil Statutes, Article 5547-l et seq). (b) If the department determines that an application should be denied or a license should be suspended or revoked, the department shall notify the applicant or licensee of its determination and shall advise the applicant or licensee of his right to a hearing before the department. Such notification by the department shall be sent to the applicant or licensee by certified or registered mail. (c) To secure the right to a hearing before the department, the applicant or licensee shall send, within 30 days of the date of notification by the department of its determination, a letter of protest in conformity with the requirements of sec.403.401 of this title (relating to Form and Content of Pleadings) to the commissioner, protesting the department's determination and requesting a hearing pursuant to the provisions of Chapter 403, Subchapter O of this title (relating to Practice and Procedure With Respect to Administrative Hearings of the Department in Contested Cases). (d) If the applicant or licensee timely sends a proper letter of protest to the commissioner within 30 days after notification by the department of its determination, as provided in subsection (c) of this section, the commissioner will treat the matter as a contested case, and the provisions of Chapter 403, Subchapter O of this title (relating to Practice and Procedure With Respect to Administrative Hearings of the Department in Contested Cases) shall apply. (e) After giving the applicant or licensee an opportunity to demonstrate or achieve compliance, and after notice and opportunity for hearing, the department may deny the application or suspend or revoke the license if it finds substantial failure by the applicant or licensee to comply with the rules of the department or the provisions of the Texas Health and Safety Code, Subtitle C, Chapters 571-577 (Texas Mental Health Code, Texas Civil Statutes, Article 5547-l et seq). (f) No revocation or suspension of a license is effective unless, prior to the institution of department proceedings, the department gave notice by personal service or by registered or certified mail to the licensee of the facts or conduct alleged to warrant the intended action, and the licensee was given an opportunity to show compliance with all requirements of law for the retention of the license. (g) If the department finds that there is immediate threat to health or safety of patients or employees of a private psychiatric hospital, the department may temporarily suspend a license for 10 days pending a hearing or the suspension order, and may issue orders necessary for the welfare of the patients. (h) Nothing in this section shall affect in any way the provision of the Texas Health and Safety Code (Texas Mental Health Code) requiring annual renewal of the license or any other substantive provision of the Texas Health and Safety Code (Texas Mental Health Code) concerning the licensing of private psychiatric hospitals. sec.401.592. Distribution. (a) The provisions of this subchapter shall be distributed to the Texas Board of Mental Health and Mental Retardation; medical director, deputy commissioners, assistant deputy commissioners, and directors of Central Office; and to private psychiatric hospital licensees and applicants. (b) Each private psychiatric hospital licensee shall ensure distribution of this subchapter to all appropriate staff. sec.401.593. References. Reference is made in this subchapter to the following laws, rules, and standards: (1) Texas Health and Safety Code, Subtitle C, Chapters 571-577 (Texas Mental Health Code, Texas Civil Statutes, Article 5547-1 et seq); (2) Chapter 404, Subchapter C of this title (relating to Patient Abuse in Private Psychiatric Hospitals); (3) Chapter 403, Subchapter O of this title (relating to Practice and Procedure With Respect to Administrative Hearings of the Department in Contested Cases); (4) The Joint Commission on Accreditation of Healthcare Organizations Accreditation Manual for Hospitals, most recent edition; and (5) The Joint Commission on Accreditation of Healthcare Organizations Consolidated Standards Manual, most recent edition. Issued in Austin, Texas, on December 3, 1991. TRD-9115153 Ann K. Utley Chairman Texas Board of Mental Health and Mental Retardation Effective date: December 4, 1991 Expiration date: April 2, 1992 For further information, please call: (512) 465-4670 TITLE 31. NATURAL RESOURCES AND CONSERVATION Part IX. Texas Water Commission Chapter 334. Underground and Aboveground Storage Tanks Subchapter H. Interim Reimbursement Program 31 TAC sec.sec.334.12-334.16 The Texas Water Commission is renewing the effectiveness of the emergency adoption of repealed sec.sec.334.12-334.16, for a 60-day period effective December 3, 1991. The text of repealed sec.sec.334.12-334.16 was originally published in the August 9, 1991, issue of the Texas Register (16 TexReg 4315). Issued in Austin, Texas, on December 3, 1991. TRD-9115064 John Vay Director, Legal Services Texas Water Commission Effective date: December 3, 1991 Expiration date: February 1, 1992 For further information, please call: (512) 463-8069