(a) A limited services rural hospital (LSRH) shall protect and promote each patient's rights.
(b) An LSRH shall adopt, implement, and enforce a policy to ensure patients' rights are upheld within the limits of law. The LSRH's written patient's rights policy shall include the following:
  (1) the right to participate in the development and implementation of their plan of care;
  (2) the right to make informed decisions regarding their care, including being informed of their health status, and being able to request or refuse treatment;
  (3) the right to formulate advance directives and to have LSRH staff and practitioners who provide care in the LSRH comply with these directives, in accordance with Code of Federal Regulations Title 42 (42 CFR) §§489.100 (relating to Definitions), 489.102 (relating to Requirement for Providers), and 489.104 (relating to Effective Dates) and Texas Health and Safety Code Chapter 166 (relating to Advance Directives);
  (4) the right to have personal privacy;
  (5) the right to receive medical standard of care in a safe setting;
  (6) the right to be free from all forms of abuse, neglect, exploitation, and harassment;
  (7) the right to have confidentiality of their medical records;
  (8) the right to the LSRH's reasonable response to the patient's requests and needs for treatment or service, within the LSRH's capacity, stated mission, and applicable law and regulation;
  (9) the right to considerate and respectful care, which includes:
    (A) the care of the patient includes consideration of the psychosocial, spiritual, and cultural variables that influence perceptions of illness; and
    (B) the care of a dying patient optimizes the comfort and dignity of the patient through;
      (i) treating primary and secondary symptoms that respond to treatment as desired by the patient or surrogate decision maker;
      (ii) effectively managing pain; and
      (iii) acknowledging the psychosocial and spiritual concerns of the patient and the family regarding dying and the expression of grief by the patient and family;
  (10) the right of the patient or their legally authorized representative (LAR) to, in collaboration with the patient's physician, make decisions involving their health care, including:
    (A) the right to accept medical care or to refuse treatment to the extent permitted by law and to be informed of the medical consequences of such refusal; and
    (B) the right to formulate advance directives and to appoint a surrogate to make health care decisions on their behalf to the extent permitted by law;
  (11) a mechanism to ascertain the existence of, and, as appropriate, assist in the development of advance directives at the time of the patient's admission;
  (12) the right to not have the provision of care conditioned on the existence of an advance directive;
  (13) the right of a patient to the information necessary to enable them to make treatment decisions reflecting their wishes;
  (14) the right of a patient to receive at the time of admission information about the LSRH's patient rights policy or policies and the mechanism for the initiation, review, and, when possible, resolution of patient complaints concerning the quality of care;
  (15) the right to receive information about the patient's rights in advance of receiving or discontinuing patient care whenever possible;
  (16) the right of the patient or the patient's legally authorized representative to participate in the consideration of ethical issues that arise in the care of a patient;
  (17) a mechanism for the consideration of ethical issues arising in the care of patients and to provide education to care givers and patients on ethical issues in health care;
  (18) the right of the patient to be informed of and consent to any human experimentation or other research or educational projects affecting their care or treatment;
  (19) the right of the patient or the patient's legally authorized representative to access the information contained in the patient's medical record, on oral or written request; and
  (20) the right of the patient's guardian, next of kin, or LAR to exercise, to the extent permitted by law, the rights delineated on behalf of the patient if the patient:
    (A) has been adjudicated incompetent in accordance with the law;
    (B) is found by their physician to be medically incapable of understanding the proposed treatment or procedure;
    (C) is unable to communicate their wishes regarding treatment; or
    (D) is a minor.
(c) An LSRH must post the patient bill of rights prominently and conspicuously for display in a public area of the LSRH that is readily available to patients, residents, employees, and visitors.
  (1) In addition to these patient bill of rights requirements, an LSRH that provides chemical dependency services shall comply with this section and Texas Administrative Code Title 25 (25 TAC) §448.701 (relating to Client Bill of Rights) applicable to patients who receive such services.
  (2) In addition to these patient bill of rights requirements, an LSRH that provides mental health services shall comply with this section and 25 TAC Chapter 404, Subchapter E (relating to Rights of Persons Receiving Mental Health Services) applicable to patients who receive such services.
  (3) The patient bill of rights posted for display shall be in English and in a second language appropriate to the demographic makeup of the community served.
(d) An LSRH's medical staff and governing body shall adopt, implement, and enforce a policy on informed decision making that is consistent with any legal requirements.
(e) An LSRH shall establish a process for prompt resolution of patient complaints and inform each patient whom to contact to file a complaint. The LSRH's governing body or responsible individual shall approve and be responsible for the effective operation of the complaint process and shall review and resolve complaints, unless it delegates the responsibility, in writing, to a complaint committee. The complaint process shall include a mechanism for timely referral of patient concerns regarding quality of care or premature discharge to the appropriate Utilization and Quality Control Quality Improvement Organization.
  (1) The LSRH shall establish a clearly explained procedure for the submission of a patient's written or verbal complaint to the LSRH.
  (2) The complaint process shall specify timeframes for review of the complaint and the provision of a response.
  (3) In its resolution of the complaint, the LSRH shall provide the patient with written notice of its decision that contains the name of the LSRH contact person, the steps taken on behalf of the patient to investigate the complaint, the results of the complaint process, and the date of completion.
(f) Notwithstanding subsection (b) of this section, an LSRH may deny treatment or services deemed medically unnecessary or inappropriate.

Source Note: The provisions of this §511.63 adopted to be effective October 5, 2023, 48 TexReg 5668