(a) A limited services rural hospital (LSRH) shall adopt, implement, and enforce administrative policies and procedures to ensure the orderly and efficient management of the LSRH. An LSRH's administrative policies and procedures shall include the following administrative responsibilities:
  (1) enforcing policies delegated by the governing body;
  (2) employing qualified management personnel;
  (3) long-range and short-range planning for the LSRH's needs, as determined by the governing body;
  (4) using methods of communicating and reporting, designed to ensure the orderly flow of information within the LSRH;
  (5) controlling the purchase, maintenance, and distribution of the LSRH's equipment, materials, and facilities;
  (6) establishing lines of authority, accountability, and personnel supervision;
  (7) establishing controls relating to the custody of the LSRH's official documents; and
  (8) maintaining the confidentiality, security, and physical safety of data on patients and staff.
(b) The LSRH shall adopt, implement, and enforce personnel policies to facilitate the LSRH attaining its mission, goals, and objectives. The LSRH's personnel policies shall:
  (1) define and delineate functional responsibilities and authority;
  (2) require LSRH personnel to have qualifications commensurate with their job responsibilities and authority, including appropriate licensure or certification;
  (3) require documented periodic appraisal of each person's job performance;
  (4) specify employment responsibilities and privileges;
  (5) be made known to employees at the time of employment; and
  (6) provide and document adequate orientation and training to familiarize all personnel with the LSRH's policies, procedures, equipment, and facilities.
(c) An LSRH shall include all employee categories in personnel policies and shall develop appropriate job descriptions for each position.

Source Note: The provisions of this §511.43 adopted to be effective October 5, 2023, 48 TexReg 5668