Limited Services Rural Hospitals

As defined by Texas Health and Safety Code Section 241.301 and Texas Administrative Code Title 26 Section 511.2 a limited services rural hospital is a general or special hospital that is or was licensed under Texas Health and Safety Code under Chapter 241 and that:

• is:
  • located in a rural area, as defined by:
    • Texas Health and Human Services Commission rule; or
    • 42 U.S.C. Section 1395ww(d)(2)(D), or
  • designated by the Centers for Medicare & Medicaid Services as a critical access hospital, rural referral center, or sole community hospital, and
• otherwise meets the requirements to be designated as a rural emergency hospital under Code of Federal Regulations Title 42 Part 485, Subpart E.

Texas Health and Safety Code Chapter 241, Subchapter K establishes the state licensing requirements for LSRHs. Under state law, HHSC is responsible for the licensing and regulation of LSRHs in Texas, and the Regulatory Services Division within HHSC carries out these duties.

HHSC adopts rules for LSRHs including establishing standards for:

• Licensing procedures and fees
• License denial, probation, suspension, and revocation
• Requirements for staffing by physicians and nurses
• LSRH services relating to patient care
• Fire prevention, safety, and sanitation requirements in LSRHs
• Patient care and a patient bill of rights
• Compliance with other state and federal laws affecting the health, safety, and rights of LSRH patients
• Inspection, investigation, and enforcement procedures

Laws and Rules

Texas Laws

• Health and Safety Code Chapter 241, Subchapter K, Limited Services Rural Hospital
• Per Texas Health and Safety Code Section 241.154(e), an LSRH must adjust the fee for providing health care information under Section 241.154 based on the most recent changes to the consumer price index as published by the Bureau of Labor Statistics of the United States Department of Labor that measures the average changes in prices of goods and services purchased by urban wage earners and clerical workers' families and single workers living alone.

Rules and Regulations

• Texas Administrative Code Title 26 Part 1, Chapter 511, Limited Services Rural Hospitals
• Medical Disclosure Laws and Rules
• Federal Regulations:
  • Code of Federal Regulations Title 42 Chapter IV, Subchapter G, Part 485, Subpart E, Conditions of Participation for Rural Emergency Hospitals
  • Code of Federal Regulations Title 42 Chapter IV, Subchapter G, Part 489, Provider Agreements and Supplier Approval (Specifically Sections 489.20 and 489.24)

Senate Bill 1137 Hospital Price Transparency Information

• Hospital Price Transparency Online Reporting Form
• Hospital Price Transparency (SB 1137) Required Information (PDF)
• Senate Bill 1137 Hospital Price Transparency Frequently Asked Questions (FAQ) (PDF)
• Hospital Price Transparency Recorded Webinar
• Hospital Price Transparency Recorded Webinar PowerPoint Slides (PDF)

Find or Verify a License

• Verify a facility license by searching the Online Licensing System 
• View the accessible version of the Directory of Limited Services Rural Hospitals (Excel)

Licensing

An applicant seeking an LSRH license must submit a complete application, license fee, and other applicable documents to HHSC. The Health Facility Licensing Unit will not process an application until after HHSC Accounts Receivable receives and posts the license fee.

Refer to the application or instructions linked in this section for specific requirements.

HHSC must review and approve all required application materials received before issuing a license to an applicant.

Initial Licensure Applications

• Form 3240, Application for a License to Operate a Limited Services Rural Hospital 

Change of Ownership Applications

• Change of Ownership Instructions (PDF)
• Form 3240, Application for a License to Operate a Limited Services Rural Hospital

Relocation Applications

• Form 3240, Application for a License to Operate a Limited Services Rural Hospital

Supporting Forms and Documents

• Disclosure and Consent Forms for Medical and Surgical Procedures
• ER Handout for Psychiatric Patients (PDF)
• ER Handout for Psychiatric Patients- Spanish (PDF)

Architectural Review Information and Forms

Refer to the Architectural Information page.

Complaint and Incident Submission Information

• Incidents Submission Portal for Health Care Regulation Providers
• File a Complaint for a Health Facility

Inspection Components

HHSC conducts health compliance on-site inspections to determine compliance with the provisions of the Health and Safety Code and associated rules listed in the Laws and Rules section of this page. During the inspection, HHSC staff generally perform the following activities:

• Conduct an entrance and an exit conference with applicable facility personnel
• Explain the inspection process and answer questions
• Review clinical records
• Review facility and personnel records
• Review facility policies and procedures
• Review quality assurance activities
• Interview staff
• Assess the facility's compliance with applicable statutes and rules
• Discuss final inspection findings with applicable facility personnel

Human Trafficking Resources

• HB 2552 Background Information (PDF)
• Human Trafficking Sign – English (PDF)
• Human Trafficking Sign – Spanish (PDF)
• Texas Human Trafficking Resource Center

Abortion Reporting

As defined by Texas Health and Safety Code Section 245.002, an abortion facility is a place where abortions are performed. 

Texas Health and Safety Code Chapters 245 and 171 require abortion facilities and physicians that provide abortion services to report to HHSC certain information about abortion procedures the provider performs. HHSC must follow strict confidentiality provisions in the law regarding any information about an abortion facility. The law does allow HHSC to release statistical information reported to HHSC by abortion providers. The HHSC Office of Data, Analytics, and Performance (DAP) compiles this statistical information and publishes it on HHSC’s Induced Termination of Pregnancy Statistics webpage.

Abortion Reporting Forms

The following forms are required to be submitted by the physician to DAP:

• Induced Abortion Report Form
• Medical Emergency Abortion Incident Reporting Form
• Third Trimester Induced Abortion Certification Form
• Abortion Complications Reporting Form

The following form is required to be submitted by the facility to DAP:

• Abortion Complications Reporting Form

Contact Health Care Regulation’s Policies and Rules Unit with questions regarding the statutory and regulatory abortion reporting requirements.

For assistance completing the online forms, for technical support, or to provide feedback on the user experience, email ITOP Reporting.

Provider Certification

The Secretary of the United States Department of Health and Human Services directs state health agencies or other appropriate agencies to determine whether health care entities meet federal standards. This helping function is termed "provider certification." Health Care Regulation staff are responsible for providing certification oversight on behalf of CMS for LSRHs.

For more information on the certification process, refer to our Centers for Medicare and Medicaid Services Information page, or contact your regional office (PDF).

Accreditation

LSRHs may be accredited.

Clinical Laboratory Improvement Amendments Information  

Refer to our CLIA information page. For more information on CLIA, contact your regional office (PDF).  

Contact Information  

Health Care Regulation Contact Information  

For Health Care Regulation contact information, visit our Contact Us page.  

Health Care Facility Enforcement  

Phone: 512-438-5439    
Fax: 512-438-3697    
Email: Health.Facilities.Enforcement@hhsc.state.tx.us    
Mailing Address:    
Texas Health and Human Services Commission    
Regulatory Services Division    
Health Care Facility Enforcement, MC 1866    
P.O. Box 149347    
Austin, TX 78714-9347  

Open Records Requests  

Texas Health and Human Services is committed to providing full access to public information. For information on how to submit an open records request, visit the Open Records Policy and Procedures webpage.