Texas HSC Chapter 331
Is My Facility Covered by Texas HSC Chapter 331?
A decision guide to whether your Texas healthcare facility is covered by HSC Chapter 331 (SB 240) — by facility class and the two-RN trigger for nursing facilities and HCSSAs.
Texas HSC Chapter 331 covers general and special hospitals, mental hospitals, ambulatory surgical centers, and freestanding emergency medical care facilities outright. It covers nursing facilities and home health and hospice agencies (HCSSAs) only when they employ two or more registered nurses. Private physician practices are excluded.
Coverage is the first question every Texas healthcare operator should answer, because the entire compliance program — committee, plan, training, annual evaluation — hinges on it. This guide walks the decision class by class. For the requirements that follow once you are covered, see Texas SB 240 explained and our pillar, Texas SB 240 & HSC Chapter 331 compliance.
#The covered-facility classes
Chapter 331 defines "facility" by reference to existing Texas licensing chapters. The covered classes are:
| Facility class | Licensing reference | Covered? |
|---|---|---|
| General & special hospitals | HSC Ch. 241 | Yes — always |
| Mental hospitals | HSC Ch. 577 | Yes — always |
| Ambulatory surgical centers (ASCs) | HSC Ch. 243 | Yes — always |
| Freestanding emergency medical care facilities (FSEDs) | — | Yes — always |
| Nursing facilities | HSC Ch. 242 | Only if ≥ 2 employed RNs |
| Home & community support services agencies (HCSSAs) — home health + hospice | HSC Ch. 142 | Only if ≥ 2 employed RNs |
| Private physician practices | — | No — excluded |
(Source: Texas HSC Chapter 331; SB 240, 88th Leg., 2023.)
#Hospitals, ASCs, and FSEDs: covered, full stop
If you operate a general or special hospital, a mental hospital, an ASC, or a freestanding emergency center, you are covered with no headcount test. Hospitals are additionally subject to the HHSC implementing rule, 26 TAC §133.55, adopted in the Texas Register on October 11, 2024, which checks Chapter 331 compliance at the licensure survey. ASCs and FSEDs should review their class-specific obligations on our ambulatory surgery centers and emergency departments pages.
#Nursing facilities and HCSSAs: the two-RN trigger
This is where coverage is most often misjudged. Nursing facilities (HSC Ch. 242) and HCSSAs — home health and hospice agencies (HSC Ch. 142) — are covered only if they employ two or more registered nurses.
For home health and hospice, the governing instrument is HHSC Provider Letter PL 2024-10 (Revised), which applies SB 240 to HCSSAs at the two-RN threshold. PL 2024-10 also clarifies what "employed RN" means: a person holding a current RN license in a W-2 employment relationship, regardless of their actual job duties. A nurse who never touches direct care still counts toward the threshold if they are W-2 employed and licensed.
The practical implication: an agency or facility that assumes it is exempt because "our nurses are contractors" or "our RN is in administration" may be misreading the trigger. Confirm the headcount before concluding you are out of scope. See our pages for long-term care and nursing facilities and home health and hospice (HCSSA) for the class-specific build.
#Private physician practices: excluded
Private physician practices are not covered by Chapter 331. That said, exclusion from the statute does not eliminate every obligation:
- OSHA's General Duty Clause (§5(a)(1)) still applies to all employers and treats workplace violence as a recognized hazard in healthcare.
- Joint Commission workplace violence requirements (effective Jan. 1, 2022 for hospitals) apply to accredited organizations.
So a practice that is technically outside Chapter 331 may still benefit from a best-practice WVP program. Our clinics and medical groups page addresses this directly.
#A quick decision path
Use this sequence to settle coverage:
- Are you a hospital, mental hospital, ASC, or FSED? If yes, you are covered — proceed to building the program.
- Are you a nursing facility or an HCSSA (home health / hospice)? Count your employed, W-2, currently licensed RNs. Two or more → covered. Fewer than two → not covered today, but recount whenever you hire.
- Are you a private physician practice? You are excluded from Chapter 331, but consider OSHA and accreditor expectations.
Because the RN threshold can change with a single hire, nursing facilities and HCSSAs near the line should treat coverage as a monitored status, not a one-time determination.
#Once you confirm coverage
The moment you are covered, the six Chapter 331 requirements apply: a WVP committee with the required members, a facility-specific written plan, annual training, a confidential reporting and anti-retaliation policy, post-incident response, and an annual plan evaluation reported to the governing body.
The fastest way to translate "we're covered" into "we're ready" is a survey-readiness audit — a scored gap report against the Chapter 331, 26 TAC §133.55, and PL 2024-10 checklist — or the Chapter 331 compliance checklist you can run yourself.
Sources: Texas Health & Safety Code Chapter 331 (SB 240, 88th Leg., 2023); 26 TAC §133.55; HHSC Provider Letter PL 2024-10. This article is general compliance information, not legal advice.