Relating to the issuance of a single license for a hospital and a mobile stroke unit of the hospital.
ModeratePlan for compliance
Low Cost
Effective:2025-06-20
Enforcing Agencies
Department of State Health Services (DSHS) • Health and Human Services Commission (HHSC)
01
Compliance Analysis
Key implementation requirements and action items for compliance with this legislation
Implementation Timeline
Effective Date:June 20, 2025 (Note: This legislation passed with a 2/3 supermajority, triggering immediate effect and superseding the standard September 1 date).
Compliance Deadline:Immediate. Hospitals must include MSU data in their next scheduled license renewal or update. Accreditation must be secured *before* applying for the single license inclusion.
Agency Rulemaking: HHSC is mandated to adopt rules "as soon as practicable." Expect a "regulatory gray zone" between June 20 and the publication of updated DSHS licensing forms. During this interim, operate under the statute's authority and maintain accreditation proofs.
Immediate Action Plan
1.Verify Accreditation: Immediately audit your MSU's status. If it is not accredited by a CMS-approved body, initiate the process today; you cannot utilize this license structure without it.
2.Update Insurance: Contact your malpractice carrier to confirm the MSU is defined as "insured premises" under the hospital's general professional liability policy, distinct from auto liability.
3.Prepare Filing: If your hospital license renewal is imminent, prepare to attach MSU accreditation proofs. If forms are not yet updated by DSHS, submit a cover letter citing HB4743.
4.Review Ownership: If the MSU is a joint venture, consult legal counsel to restructure "control" provisions to ensure the unit qualifies as being "of the hospital" for licensing purposes.
Operational Changes Required
Contracts
Vendor/Lease Agreements: If your MSU is leased or operated by a third party, amend the Master Services Agreement (MSA). You must insert a clause requiring the vendor to maintain operational standards that satisfy your specific CMS-approved accrediting body (e.g., The Joint Commission, DNV).
Accreditation Agreements: Review your contract with your accrediting body to ensure the MSU is explicitly listed as a surveyable site/asset.
Hiring/Training
Credentialing Alignment: Ensure clinical staff operating within the MSU are credentialed specifically under the hospital’s primary license. The legal distinction between the "field" and the "hospital" has been removed for these units.
Reporting & Record-Keeping
Proof of Accreditation: You must obtain and file a distinct certificate or formal attestation of accreditation for the MSU. This document is now a mandatory attachment for your DSHS license application.
Asset Ledger: Update the hospital's organizational chart and asset ledger to reflect the MSU as a department of the hospital, not an affiliate, to satisfy the "of the hospital" statutory language.
Fees & Costs
Fee Exemption: The law explicitly exempts MSUs from the additional per-premise licensing fees typically charged for multiple locations under one license. There is no added state licensing fee for consolidating the MSU.
Strategic Ambiguities & Considerations
Geographic Radius: Current statute requires hospital buildings to be within 30 miles of the main campus to share a license. While logic dictates this should not apply to a *mobile* unit, the statute does not explicitly exempt MSUs from the 30-mile rule. Watch for HHSC rulemaking to clarify if the MSU must be "garaged" within 30 miles of the main hospital.
Definition of "Of the Hospital": The phrase "mobile stroke unit of the hospital" is undefined. Joint ventures or timeshare arrangements where ownership is split between multiple hospital systems are legally risky until HHSC defines the required level of ownership or control.
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According to the CDC, stroke is one of the leading causes of death and long-term disability in the United States, with Texans experiencing higher than average rates of stroke deaths in the nation. The bill author has informed the committee that rapid diagnosis and treatment are critical for improving survival rates and reducing the long-term impact of strokes, and that mobile stroke units (MSUs) offer a promising solution for minimizing stroke severity, which can additionally decrease long-term health care costs, and extending critical care access to rural and remote areas where timely treatment is often unavailable. The bill author has further informed the committee that MSUs are specialized ambulances equipped with a CT scanner and staffed by a team capable of diagnosing and treating stroke patients on-site, allowing them to quickly administer lifesaving interventions such as tissue plasminogen activator, which has been shown to improve patient outcomes and prevent lasting loss of function. A 2022 study, "Comparison of Mobile Stroke Unit With Usual Care for Acute Ischemic Stroke Management," indicates that MSUs significantly increase the chances of patients receiving treatment within the first hour of symptom onset, resulting in substantially better recovery outcomes and reduced long-term disability. H.B. 4743 seeks to address these issues by allowing the Texas Department of State Health Services to license accredited MSUs under the license of a hospital.
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 in SECTION 2 of this bill.
ANALYSIS
H.B. 4743 amends the Health and Safety Code to authorize the Department of State Health Services to issue one license for a hospital and a mobile stroke unit of the hospital if the mobile stroke unit is accredited by a health care accreditation organization approved by the Centers for Medicare and Medicaid Services. The bill requires the executive commissioner of the Health and Human Services Commission to adopt rules necessary to implement this authorization as soon as practicable after the bill's effective date.
H.B. 4743 makes the requirement for a hospital license to be posted in a conspicuous place on the licensed premises inapplicable to a license issued to a mobile stroke unit of a hospital under the bill's provisions.
HB4743 amends the Texas Health and Safety Code to allow hospitals to include Mobile Stroke Units (MSUs) under their existing single hospital license, effective June 20, 2025. This eliminates the need for separate licensure but strictly requires the MSU to be accredited by a CMS-approved health care accreditation organization. Implementation Timeline Effective Date: June 20, 2025 (Note: This legislation passed with a 2/3 supermajority, triggering immediate effect and superseding the standard September 1 date).
Q
Who authored HB4743?
HB4743 was authored by Texas Representative Greg Bonnen during the Regular Session.
Q
When was HB4743 signed into law?
HB4743 was signed into law by Governor Greg Abbott on June 20, 2025.
Q
Which agencies enforce HB4743?
HB4743 is enforced by Department of State Health Services (DSHS) and Health and Human Services Commission (HHSC).
Q
How urgent is compliance with HB4743?
The compliance urgency for HB4743 is rated as "moderate". Businesses and organizations should review the requirements and timeline to ensure timely compliance.
Q
What is the cost impact of HB4743?
The cost impact of HB4743 is estimated as "low". This may vary based on industry and implementation requirements.
Q
What topics does HB4743 address?
HB4743 addresses topics including hospitals, health & human services commission, health and health--other diseases & medical conditions.
Legislative data provided by LegiScanLast updated: November 25, 2025
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