BILL ANALYSIS

C.S.H.B. 2187

By: Howard

Public Health

Committee Report (Substituted)

BACKGROUND AND PURPOSE

According to the Texas Nurses Association, nurses identify hospital staffing problems as the primary cause of nurse burnout, which leads nurses to leave their profession. The association reports that nurse staffing committees are fundamental for ensuring that safety and working conditions in the hospital are optimized for patient care. Under current state law applicable to nurse staffing policies, hospitals must report compliance with the statute to DSHS. However, the bill author has informed the committee that a challenge to implementation is that while the compliance reporting is made to DSHS, the actual regulation of hospitals is conducted by HHSC and that there is no current mechanism for sharing the data between the two agencies, which, as the author further informed the committee, means that any nurse who has concerns about the operation of the nurse staffing committee is forced to report their employer to the regulatory agency before any review can be conducted. C.S.H.B. 2187 seeks to address this issue by requiring DSHS to develop a mandatory reporting and data exchange process between HHSC and DSHS. The bill also prohibits retaliation against a nurse who provides information to an applicable nurse staffing committee or who reports violations of the law regarding nurse staffing policies or any violation of the law prohibiting mandatory nurse overtime to an applicable hospital's management or to HHSC.

CRIMINAL JUSTICE IMPACT

It is the committee's opinion that this bill does not expressly create a criminal offense, increase the punishment for an existing criminal offense or category of offenses, or change the eligibility of a person for community supervision, parole, or mandatory supervision.

RULEMAKING AUTHORITY

It is the committee's opinion that rulemaking authority is expressly granted to the executive commissioner of the Health and Human Services Commission in SECTION 7 of this bill.

ANALYSIS

Reporting of Nurse Staffing Information

C.S.H.B. 2187 amends the Health and Safety Code to require the chief nursing officer of each general hospital or special hospital, as those terms are defined under the Texas Hospital Licensing Law, including a hospital maintained or operated by the state, or a mental hospital licensed under the Texas Mental Health Code, to attest to the accuracy of information reported by state law in the requisite annual report of nurse staffing information submitted to the Department of State Health Services (DSHS) and requires DSHS to provide the reported data to the Health and Human Services Commission (HHSC).

Prohibited Retaliation for Reporting

Nurse Staffing

C.S.H.B. 2187 prohibits such a hospital from retaliating against a nurse who provides information to a nurse staffing committee or reports violations of state law regarding nurse staffing to hospital management or HHSC.

Mandatory Overtime

C.S.H.B. 2187 prohibits such a hospital from suspending, terminating, or otherwise disciplining or discriminating against a nurse who reports violations of state law prohibiting mandatory overtime for nurses to hospital management or HHSC.

Enforcement; Complaint Resolution

Enforcement

C.S.H.B. 2187 requires HHSC to enforce provisions governing nurse staffing and to enforce provisions governing the prohibition against mandatory overtime of nurses as follows:

·with respect to enforcement against a hospital licensed under the Texas Hospital Licensing Law, in accordance with the enforcement provisions of the Texas Hospital Licensing Law as if the hospital violated that chapter;

·with respect to enforcement against private mental hospitals and other mental health facilities licensed under the Texas Mental Health Code, in accordance with that code as if the hospital violated that code and rules adopted under that code that relate to the following:

orules and standards considered necessary to ensure the proper care and treatment of patients in such a facility; and

oinvestigations of those facilities considered necessary and proper to obtain compliance with the Texas Mental Health Code and rules and standards of DSHS; and

·in accordance with the rules adopted under the Texas Hospital Licensing Law with regard to minimum standards applicable to the following:

ostaffing by physicians and nurses;

ohospital services relating to patient care;

ofire prevention, safety, and sanitation requirements in hospitals;

opatient care and a patient bill of rights;

ocompliance with other state and federal laws affecting the health, safety, and rights of hospital patients; and

ocompliance with nursing peer review under the Nursing Practice Act and the rules of the Texas Board of Nursing relating to peer review.

Complaint Resolution

C.S.H.B. 2187 requires HHSC to establish a process to provide prompt review and timely resolution of each complaint relating to nurse staffing or mandatory overtime prohibitions. The bill requires HHSC to do the following:

·develop a procedure, or designate an existing procedure, through which a party may submit a written or verbal complaint;

·establish a time to review and respond to the complaint; and

·provide the complainant written notice of HHSC's decision regarding the complaint, including:

othe contact information of the HHSC employee responsible for the complaint;

oHHSC actions in reviewing, evaluating, or investigating the complaint;

othe results of the HHSC's review of the complaint;

ofor each reviewed complaint for which an investigation is not conducted, an explanation of the reason HHSC resolved the complaint without investigation; and

othe date the complaint is resolved.

The bill establishes that all information and materials in the possession of or obtained or compiled by HHSC in connection with a complaint and investigation are confidential and not subject to disclosure in accordance with the following:

·the applicable provision of the Texas Hospital Licensing Law providing for the applicable confidentiality and nondisclosure of such information and materials under state public information law for a complaint submitted against a hospital licensed under that law; or

·the applicable provision of the Texas Mental Health Code providing for the applicable limited disclosure of such information and materials under state public information law for a complaint submitted against a hospital licensed under that code.

Rules for Implementation

C.S.H.B. 2187 requires the executive commissioner of HHSC, not later than December 31, 2025, to adopt any rules necessary to implement these provisions.

EFFECTIVE DATE

September 1, 2025.

COMPARISON OF INTRODUCED AND SUBSTITUTE

While C.S.H.B. 2187 may differ from the introduced in minor or nonsubstantive ways, the following summarizes the substantial differences between the introduced and committee substitute versions of the bill.

Reporting of Nurse Staffing Information to DSHS

Whereas the introduced required DSHS to provide nurse staffing data to HHSC, the substitute requires DSHS to provide nurse staffing information to HHSC. The substitute does not include the introduced version's specification that the applicable provision be for enforcement purposes. The substitute but not the introduced requires that the chief nursing officer of each hospital attest to the accuracy of the reported information. The substitute does not require the introduced version's provision amending the provision requiring DSHS to collect nurse staffing data as part of a survey to instead require DSHS to develop a mandatory reporting process to collect the nurse staffing data.

Prohibited Retaliation With Respect to Nurse Staffing

Both the substitute and the introduced prohibit a hospital from retaliating against a nurse who provides information to the nurse staffing committee of a hospital or reports violations of the Texas Hospital Licensing Law to hospital management or to HHSC. However, the introduced, in a provision absent from the substitute, specified that a violation of this provision constitutes a violation under the statutory provision that currently prohibits retaliation against an employee of a hospital, mental health facility, or treatment facility for reporting a violation of any law, including a violation of applicable state law regarding public health provisions, a rule adopted under those provisions, or a rule of another agency and authorizing a nurse to seek any appropriate remedy provided by that provision.

Prohibited Retaliation With Respect to Mandatory Overtime Prohibition

The substitute includes a provision absent from the introduced that prohibits a hospital from suspending, terminating, or otherwise disciplining or discriminating against a nurse who reports violations of state law prohibiting mandatory overtime for nurses to hospital management or HHSC.

Enforcement and Complaints

Both the substitute and the introduced provide for the enforcement of their respective provisions regarding nurse staffing and prohibited mandatory overtime by nurses and provide a mechanism for submitting reports of applicable violations. However, their method of enforcement and reporting complaints differs. Whereas the introduced provided procedures whereby HHSC is required to develop and maintain a web page accessible on the HHSC website through which a nurse may report a nurse staffing violation or a violation relating to mandatory overtime prohibitions, investigate each report of an alleged violation, develop procedures to notify a hospital of an alleged violation and provide due process during an investigation, and issue a corrective action plan and any appropriate penalties under the bill's provisions, the substitute does not include those provisions for enforcement or complaints nor does it include the introduced version's provision that, as follows:

·authorized HHSC to impose an administrative penalty on an applicable hospital that knowingly submits false information to DSHS under the requisite report on nurse staffing or that violates applicable state law regarding nurse staffing or regarding the prohibition on mandatory overtime for nurses or rules adopted under those state law;

·required the executive commissioner of HHSC by rule to develop an administrative penalty schedule for penalties based on the impact of the violation on patient care, nurse satisfaction, and the public interest; and

·authorized the attorney general to sue to collect those penalties.

Rather, the substitute provides for the enforcement of its provisions in accordance with both general and specific provisions, and rules adopted under those provisions, of the Texas Hospital Licensing Law and the Texas Mental Health Code with respect to the applicable hospitals and facilities. In addition, the substitute establishes a complaint process whereby a party submits an applicable written or verbal complaint to HHSC and then HHSC promptly reviews and timely resolves each complaint submitted. Moreover, the substitute provides for the confidentiality and exception from disclosure under state public information law of information and materials in the possession of or obtained or compiled by HHSC in connection with an applicable complaint and investigation.