Texas Compliance
Texas Healthcare Workplace Violence Prevention — The Deadline Was September 2024
Texas SB 240 required covered healthcare facilities to have a compliant workplace violence prevention policy, plan, and committee in place by September 1, 2024. That deadline passed more than a year ago. Non-compliant facilities face licensing consequences.
— Texas SB 240 / Chapter 331, Texas Health & Safety Code
A broader mandate than most states — and an older one.
Texas Senate Bill 240 was signed into law by Governor Greg Abbott on May 15, 2023 — making Texas one of the earliest states in the nation to enact a comprehensive healthcare workplace violence prevention mandate. The law took effect September 15, 2023 and required full compliance by September 1, 2024. It is incorporated into Chapter 331 of the Texas Health and Safety Code.
SB 240 passed the Texas Legislature with overwhelming bipartisan support, sponsored by Senator Donna Campbell, MD (R-New Braunfels), and supported by both the Texas Nurses Association and the Texas Hospital Association — two organizations that had been advocating for legislative action for years in response to a documented surge in violence against healthcare workers. Attacks against medical professionals grew 67 percent between 2011 and 2018. A 2022 survey found that 98 percent of Texas hospitals reported workplace violence had increased or remained constant in the preceding three years.
What distinguishes Texas SB 240 from several other state mandates is its breadth of covered facility types. The law applies not only to hospitals but to a wide range of healthcare settings — making it the most broadly applicable healthcare workplace violence prevention mandate currently in force in the country.
— Covered Facilities
Six categories of healthcare facility. Most Texas healthcare employers are covered.
Texas SB 240 applies to the following healthcare facility types:
- Licensed hospitals and hospitals maintained or operated by a Texas state agency that are exempted from licensing.
- Licensed nursing facilities that employ at least two registered nurses.
- Home and community support services agencies that are licensed or licensed and certified to provide home health services and that employ at least two registered nurses.
- Ambulatory surgery centers licensed under Chapter 243 of the Texas Health and Safety Code.
- Freestanding emergency medical care facilities licensed under Chapter 254 of the Texas Health and Safety Code.
- Hospice organizations licensed under Chapter 142 of the Texas Health and Safety Code.
The breadth of coverage is the most significant differentiator between Texas SB 240 and comparable state mandates. Ohio's HB 452 covers hospitals only. Texas covers hospitals, nursing facilities, ambulatory surgery centers, freestanding emergency centers, home health agencies, and hospice organizations.
For multi-facility health systems, SB 240 permits a single workplace violence prevention committee to serve all facilities within the system, provided the resulting plan is distinctly identifiable for each facility — meaning the plan must address the specific conditions and hazards of each location, not serve as a system-wide generic document.
September 1, 2024
Compliance deadline — over one year ago
6 Facility Types
Broadest healthcare coverage of any current state mandate
Annual
Required review and report to governing body
— Compliance Requirements
Policy, plan, committee, training, and post-incident response. All required.
Texas SB 240 imposes five distinct compliance obligations on covered facilities.
A written workplace violence prevention policy, adopted, implemented, and enforced. The policy must require the facility to provide significant consideration to the recommendations of the workplace violence prevention committee, allow healthcare providers and employees to provide confidential information about workplace violence to the committee, protect those who provide such information from retaliation, and comply with Texas Department of Health and Human Services rules relating to workplace violence.
A written workplace violence prevention plan, developed by the facility's workplace violence prevention committee and based on the facility's specific conditions, hazards, and incident history. The plan must require healthcare providers and employees to report incidents of workplace violence through the facility's existing occurrence reporting systems, and must require the facility to adjust patient care assignments — to the extent practicable — to prevent a healthcare provider or employee from treating or providing services to a patient who has intentionally physically abused or threatened that provider or employee.
A workplace violence prevention committee, established or designated by the facility to develop, review, and evaluate the plan. The committee must include at least one registered nurse who provides direct care to patients of the facility and at least one facility employee who provides security services, if applicable and practicable. The committee's recommendations must receive significant consideration — the law does not permit the committee to be advisory in name only.
Annual training for all healthcare providers and employees. SB 240 requires annual training — not initial training only. The training must be appropriate to the facility type and the roles of those being trained. Live, in-person training tailored to the specific environment has been shown to produce better preparedness outcomes than generic online modules, though the law does not mandate a specific format.
Immediate post-incident services following any workplace violence incident. The facility must at a minimum offer immediate post-incident services to the healthcare provider or employee, including any necessary acute medical treatment for those directly involved. Facilities may not discourage providers or employees from contacting law enforcement and may not discipline an employee for reporting a workplace violence incident.
— Penalties and Licensing Risk
No citation penalty — but licensing consequences are real.
Texas SB 240 does not include an explicit citation and penalty structure of the kind found in California's SB-553 (up to $158,727 per willful violation) or Ohio's HB 452. There is no defined fine per violation.
This does not mean non-compliance is without consequences. The Texas Department of Health and Human Services has authority to take disciplinary action against a facility's license for failure to comply with Chapter 331 requirements. For a licensed hospital, ambulatory surgery center, nursing facility, or home health agency, a licensing action is an existential threat — not a financial penalty that can be managed as a cost of doing business.
The licensing enforcement path is less predictable than a defined penalty schedule, which cuts both ways. A facility cannot calculate its maximum exposure and make a risk-adjusted decision to remain non-compliant. The consequence depends on the severity of the deficiency, the history of the facility, and the discretion of the licensing authority — which is a harder posture to defend before a governing board or legal counsel than “we addressed it before the penalty triggered.”
The Joint Commission workplace violence prevention standards, adopted in 2022, apply independently to accredited hospitals. Most Texas acute care hospitals are Joint Commission accredited and are therefore subject to those standards regardless of SB 240. A facility that is both non-compliant with SB 240 and out of conformance with Joint Commission standards faces compounding risk.
— Senate Bill 840
Assaulting a hospital worker in Texas is now a third-degree felony.
Texas SB 240 was accompanied by Senate Bill 840, also signed into law in 2023 and supported by the Texas Hospital Association. SB 840 enhanced the criminal penalty for assaulting a healthcare worker on hospital property to a third-degree felony — a significant escalation from prior law, which treated many such assaults as misdemeanors.
The pairing of SB 240 (prevention mandate) and SB 840 (criminal penalty enhancement) reflects the Texas Legislature's approach to the problem: establishing both an institutional obligation for prevention and an individual deterrent for perpetrators.
For facilities, SB 840's significance is in documentation and reporting. A facility that has a functioning incident reporting system and can demonstrate that it reported appropriate incidents to law enforcement is in a materially different position in a post-incident investigation than one that handled violent incidents internally without law enforcement involvement. SB 240's explicit prohibition on discouraging employees from contacting law enforcement reinforces this posture.
— Operationalizing the Mandate
The committee is the program. Not a checkbox.
The most operationally demanding element of Texas SB 240 is the workplace violence prevention committee requirement — and specifically, the requirement that the committee's recommendations receive significant consideration from facility leadership.
This is not a committee that meets once, produces a document, and disbands. SB 240 requires annual review and evaluation of the plan by the committee, with results reported to the facility's governing body. The governing body is therefore on notice — at least annually — of the state of the facility's workplace violence prevention program and any gaps identified by the committee.
That governing body visibility is one of the most important elements of the statute from a liability perspective. A board or governing body that has received the committee's annual report, been informed of identified deficiencies, and taken no action has a documented knowledge of the problem. The legal exposure that creates — in a subsequent workplace violence incident — is exactly the negligent retention and failure to act pattern that drives the largest verdicts in workplace violence litigation.
For multi-facility health systems, the single-committee structure the law permits is efficient, but the requirement that the plan be distinctly identifiable for each facility imposes real work. A system-level plan that does not address the specific conditions and hazards of each location is not compliant — regardless of how thorough it is at the system level.
— The Broader Picture
Texas leads on healthcare breadth. The national trajectory continues.
| California SB-553 | Ohio HB 452 | Texas SB 240 | |
|---|---|---|---|
| Industries covered | All industries | Hospitals only | Hospitals, nursing facilities, ASCs, home health, hospice, freestanding EDs |
| Employer threshold | Most employers | All hospitals | Facility-type dependent (most require 2+ RNs) |
| Effective date | July 1, 2024 | April 9, 2025 | September 15, 2023 |
| Compliance deadline | July 1, 2024 | July 9, 2025 | September 1, 2024 |
| Written plan required | Yes — site-specific WVPP | Yes — security plan | Yes — policy and plan |
| Committee required | TAT recommended | Interdisciplinary team | Yes — RN and security staff required |
| Annual training | Yes | Yes | Yes |
| Post-incident services | Not specified | Not specified | Immediate services required |
| Patient reassignment | Not specified | Not specified | Required where practicable |
| Anti-retaliation | Yes | Yes | Yes — no discouraging law enforcement contact |
| Annual governing body report | Annual review | Annual review | Yes — committee reports to governing body |
| Penalty structure | Up to $158,727 willful | Not specified | No explicit penalty — licensing action |
| Criminal companion | No | Civil immunity for self-defense | SB 840 — assault on hospital worker is third-degree felony |
— Free Resource
Operating in multiple states?
Download our Multi-State Compliance Checklist — Texas SB 240, Ohio HB 452, California SB-553, New York, and Virginia mapped side by side.
— Next step
Texas healthcare facility? The deadline was September 2024.
If your facility does not have a compliant workplace violence prevention policy, plan, and functioning committee with governing body reporting in place, you have been out of compliance for over a year. Licensing consequences are real. A 30-minute consultation is the fastest way to assess the gap and build a remediation plan before the next licensing review.