(a) The Texas Health and Human Services Commission (HHSC) may impose one or more of the following sanctions against a licensee for a violation listed in §555.54 of this subchapter (relating to Rule or Statutory Violations) or §555.55 of this subchapter (relating to Violations of Standards of Conduct):      
        (1) license revocation;       
        (2) license suspension;       
        (3) denial of application for license renewal;       
        (4) assessment of an administrative penalty;       
        (5) written letter of reprimand;       
        (6) participation in continuing education;       
        (7) probation;       
        (8) denial of preceptor's initial or renewal application; or       
        (9) revocation of preceptor status.       
      (b) If a sanction is probated, HHSC may require the licensee to:      
        (1) report regularly to HHSC on matters that are the basis of the probation;       
        (2) limit practice to the areas prescribed by HHSC;       
        (3) practice under the direct supervision or guidance of a HHSC certified preceptor, as specified in §555.14 of this chapter (relating to Preceptor Requirements); or       
        (4) complete prescribed continuing education until the licensee attains a degree of skill satisfactory to HHSC in those areas that are the basis of the probation.       
      (c) Civil penalties may result from a referral to the Office of Attorney General not to exceed $1,000 per violation per day for each day the violation continues.     
      (d) Administrative penalties may not exceed $1,000 per violation per day for each day the violation continues.     
      (e) The amount of the administrative penalty is assessed is based on:      
        (1) the seriousness of the violation, including:                  (A) the nature, circumstances, extent, and gravity of prohibited acts; and                   (B) the hazard or potential hazard created to the health, safety, or economic welfare of the public;         
        (2) economic harm to property or environment;       
        (3) history of previous violations;       
        (4) amount necessary to deter future violations;       
        (5) efforts to correct the violations;       
        (6) the severity level of the violation:                  (A) Level I--$500 to $1,000 for violations that have or had an adverse impact on nursing facility resident health or safety that includes serious harm, permanent injury, or death to a nursing facility resident;                   (B) Level II--$250 to $500 for violations that have or had a potential or adverse impact on the health or safety of a nursing facility resident, but less impact than Level I; or                   (C) Level III--$250 or less for violations having minimal or no significant impact on nursing facility resident health or safety; and         
        (7) any other matter that justice may require.       
      (f) HHSC may deny, suspend, or revoke a license to practice in Texas if the licensee fails to meet and comply with all terms of an HHSC order or settlement agreement, or fails to complete any final sanction imposed against the licensee's license, including, satisfactory and timely completion of any continuing education requirements, suspension, probated suspension under a certified preceptor, or timely payment in full of administrative penalties.     
     Source Note:        The provisions of this §555.57 adopted to be effective June 1, 2004, 29 TexReg 4233; amended to be effective June 1, 2009, 34 TexReg 2795; transferred effective May 1, 2019, as published in the Texas Register April 12, 2019, 44 TexReg 1880; amended to be effective November 14, 2021, 46 TexReg 7791