The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise.
  (1) Act--Texas Health and Safety Code Chapter 254, titled Freestanding Emergency Medical Care Facilities.
  (2) Action plan--A written document that includes specific measures to correct identified problems or areas of concern; identifies strategies for implementing system improvements; and includes outcome measures to indicate the effectiveness of system improvements in reducing, controlling, or eliminating identified problem areas.
  (3) Administrator--A person who is a physician, is a registered nurse, has a baccalaureate or postgraduate degree in administration or a health-related field, or has one year of administrative experience in a health-care setting.
  (4) Advanced practice registered nurse (APRN)--A registered nurse authorized by the Texas Board of Nursing to practice as an advanced practice registered nurse in Texas. The term includes a nurse practitioner, nurse midwife, nurse anesthetist, and clinical nurse specialist. The term is synonymous with "advanced nurse practitioner."
  (5) Adverse event--An event that results in unintended harm to the patient by an act of commission or omission rather than by the underlying disease or condition of the patient.
  (6) Applicant--A person who seeks a freestanding emergency medical care facility license from the Texas Health and Human Services Commission (HHSC) and who is legally responsible for operation of the freestanding emergency medical care facility, whether by lease or ownership.
  (7) Certified registered nurse anesthetist (CRNA)--A registered nurse who has current certification from the Council on Certification of Nurse Anesthetists and is currently authorized to practice as an advanced practice registered nurse by the Texas Board of Nursing.
  (8) Change of ownership--Change in the person legally responsible for operation of the facility, whether by lease or by ownership.
  (9) Designated provider--A provider of health care services selected by a health maintenance organization, a self-insured business corporation, a beneficial society, the Veterans Administration, TRICARE, a business corporation, an employee organization, a county, a public hospital, a hospital district, or any other entity to provide health care services to a patient with whom the entity has a contractual, statutory, or regulatory relationship that creates an obligation for the entity to provide the services to the patient.
  (10) Disposal--Discharge, deposit, injection, dumping, spilling, leaking, or placing any solid waste or hazardous waste (containerized or uncontainerized) into or on any land or water so that solid waste or hazardous waste, or any constituent thereof, may enter the environment or be emitted into the air or discharge into any waters, including groundwaters.
  (11) Emergency care--Health care services provided in a freestanding emergency medical care facility to evaluate and stabilize medical conditions of a recent onset and severity, including severe pain, that would lead a prudent layperson possessing an average knowledge of medicine and health to believe that the person's condition, sickness, or injury is of such a nature that failure to get immediate medical care could result in:
    (A) placing the person's health in serious jeopardy;
    (B) serious impairment to bodily functions;
    (C) serious dysfunction of a bodily organ or part;
    (D) serious disfigurement; or
    (E) in the case of a pregnant woman, serious jeopardy to the health of the woman or fetus.
  (12) Facility--A freestanding emergency medical care facility.
  (13) Freestanding emergency medical care facility--A facility that is structurally separate and distinct from a hospital and which receives an individual and provides emergency care as defined in this section.
  (14) Freestanding emergency medical care facility administration--The administrative body of a freestanding emergency medical care facility headed by an individual who has the authority to represent the facility and who is responsible for operation of the facility according to the policies and procedures of the facility's governing body.
  (15) Governing body--The governing authority of a freestanding emergency medical care facility that is responsible for a facility's organization, management, control, and operation, including appointment of the medical staff; and includes the owner or partners for a freestanding emergency medical care facility owned or operated by an individual or partners or corporation.
  (16) HHSC--Texas Health and Human Services Commission.
  (17) Legally authorized representative (LAR)--Means:
    (A) a parent or legal guardian if the patient is a minor;
    (B) a legal guardian if the patient has been adjudicated incapacitated to manage the patient's personal affairs;
    (C) an agent of the patient authorized under a medical power of attorney;
    (D) an attorney ad litem appointed for the patient;
    (E) a person authorized to consent to medical treatment on behalf of the patient under Texas Health and Safety Code Chapter 313;
    (F) a guardian ad litem appointed for the patient;
    (G) a personal representative or heir of the patient, as defined by Texas Estates Code Chapter 22, if the patient is deceased;
    (H) an attorney retained by the patient or by the patient's legally authorized representative; or
    (I) a person exercising a power granted to the person in the person's capacity as an attorney-in-fact or agent of the patient by a statutory durable power of attorney that is signed by the patient as principal.
  (18) Licensed vocational nurse (LVN)--A person who is currently licensed by the Texas Board of Nursing as a licensed vocational nurse.
  (19) Licensee--The person or governmental unit named in the application for issuance of a facility license.
  (20) Medical director--A physician who is board certified or board eligible in emergency medicine, or board certified in primary care with a minimum of two years of emergency care experience.
  (21) Medical staff--A physician or group of physicians, podiatrist or group of podiatrists, and dentist or group of dentists who by action of the governing body of a facility are privileged to work in and use the facility.
  (22) Owner--One of the following persons or governmental unit that will hold, or does hold, a license issued under the Act in the person's name or the person's assumed name:
    (A) a corporation;
    (B) a governmental unit;
    (C) a limited liability company;
    (D) an individual;
    (E) a partnership, if a partnership name is stated in a written partnership agreement, or an assumed name certificate;
    (F) all partners in a partnership if a partnership name is not stated in a written partnership agreement, or an assumed name certificate; or
    (G) all co-owners under any other business arrangement.
  (23) Patient--An individual who presents for diagnosis or treatment.
  (24) Person--An individual, firm, partnership, corporation, association, or joint stock company, including a receiver, trustee, assignee, or other similar representative of such an entity.
  (25) Physician--An individual licensed by the Texas Medical Board and authorized to practice medicine in the state of Texas.
  (26) Physician assistant--An individual licensed as a physician assistant by the Texas State Board of Physician Assistant Examiners.
  (27) Practitioner--A health care professional licensed in the state of Texas, other than a physician, podiatrist, or dentist. A practitioner shall practice in a manner consistent with their underlying practice act.
  (28) Prelicensure conference--A conference held between HHSC staff and the applicant or the applicant's representative to review licensure rules and survey documents and provide consultation before the on-site licensure inspection.
  (29) Premises--A building where patients receive emergency services from a freestanding emergency medical care facility.
  (30) Quality assessment and performance improvement (QAPI)--An ongoing program that measures, analyzes, and tracks quality indicators related to improving health outcomes and patient care emphasizing a multidisciplinary approach. The program implements improvement plans and evaluates the implementation until resolution is achieved.
  (31) Registered nurse (RN)--An individual who is currently licensed by the Texas Board of Nursing as a registered nurse.
Cont'd...
(32) Sexual assault survivor--An individual who is a victim of a sexual assault, regardless of whether a report is made, or a conviction is obtained in the incident.
  (33) Stabilize--To provide necessary medical treatment of an emergency medical condition to ensure, within reasonable medical probability, that the condition is not likely to deteriorate materially from or during the transfer of the individual from a facility.
  (34) Transfer--Movement (including the discharge) of an individual outside a facility at the direction of and after personal examination and evaluation by the facility physician. Transfer does not include movement outside a facility of an individual who has been declared dead or who leaves the facility against the advice of a physician.
  (35) Transfer agreement--A referral, transmission, or admission agreement with a hospital.
  (36) Universal precautions--Procedures for disinfecting and sterilizing reusable medical devices and appropriate use of infection control, including hand washing, use of protective barriers, and use and disposal of needles and other sharp instruments, as those procedures are defined by the Centers for Disease Control and Prevention (CDC) of the United States Department of Health and Human Services. This term includes standard precautions as defined by CDC, which are designed to reduce the risk of transmission of bloodborne and other pathogens in healthcare facilities.
  (37) Violation--Failure to comply with the Act, another statute relating to the licensure or operation of a freestanding emergency medical care facility, a rule or standard, or an order issued by the executive commissioner of HHSC or the executive commissioner's designee, adopted or enforced under the Act.

Source Note: The provisions of this §509.2 adopted to be effective December 4, 2023, 48 TexReg 7064