Texas SB 240: Healthcare Workplace Violence Compliance

Texas surprised the national healthcare compliance community in 2023. A state not typically associated with expansive workplace safety regulation passed one of the most comprehensive healthcare workplace violence prevention mandates in the country — covering more facility types than California, Ohio, or Virginia, with a compliance deadline that passed on September 1, 2024.

Senate Bill 240, now codified as Chapter 331 of the Texas Health & Safety Code, was signed by Governor Greg Abbott on May 15, 2023. It passed the Texas Legislature with overwhelming bipartisan support, backed by both the Texas Nurses Association and the Texas Hospital Association. The compliance deadline was September 1, 2024. That was over a year ago.

Healthcare facilities in Texas that do not have a compliant workplace violence prevention policy, plan, and committee in place are currently out of compliance. There is no grace period remaining. Licensing consequences are the enforcement mechanism. This article explains what the law requires, who it covers, and what non-compliant facilities should do now. For a structured reference covering the full Chapter 331 requirements alongside Kestralis’s assessment approach, see our Texas compliance guide.

Why Texas Passed This Law

The data driving SB 240 was stark. Nurses in Texas face workplace violence at nearly four times the rate of workers in other industries. A Texas Hospital Association survey in late 2022 found that 98% of Texas hospitals reported workplace violence had worsened or stayed the same during the COVID-19 pandemic. 61% reported increased severity. 64% reported reduced services and fewer beds attributable to nurse staffing shortages driven in part by violence-related attrition.

A Press Ganey report found that more than two nurses were assaulted in the United States every hour in the second quarter of 2022 — roughly 57 assaults per day. The Texas Legislature had actually tasked the Texas Center for Nursing Workforce Studies with researching the problem years earlier, in the 84th Regular Session. SB 240 completed legislative work that had been building for years.

A shooting at Methodist Dallas Medical Center that took the lives of two hospital employees underscored the urgency. The bill passed with the kind of bipartisan momentum that rarely attaches to workplace safety legislation in Texas.

SB 240 was also accompanied by Senate Bill 840, signed into law at the same time, which elevated the criminal penalty for assaulting a healthcare worker on hospital property to a third-degree felony. The pairing of a prevention mandate and a criminal penalty enhancement reflects the legislature’s intent to address the problem from both the institutional and individual deterrent angles simultaneously.

Who SB 240 Covers — and Why the Breadth Matters

The defining characteristic of Texas SB 240 — the feature that makes it the broadest healthcare workplace violence mandate currently in force — is the range of facility types it covers. Unlike Ohio HB 452, which applies to hospitals only, Texas SB 240 — as amended by SB 463 (2025) and HHSC’s implementing rules — covers eight distinct facility categories:

• Licensed hospitals and hospitals maintained or operated by a Texas state agency that are exempted from licensing
• Licensed private psychiatric hospitals — separate category under SB 463 and HHSC rules
• Limited services rural hospitals — separate category under SB 463 and HHSC rules
• Licensed nursing facilities 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
• Home and community support services agencies (HCSSAs) — licensed or licensed and certified to provide home health services, employing at least two registered nurses. SB 463 consolidated hospice organizations (formerly cited under Chapter 142) into the HCSSA category, subject to the same two-RN threshold.

For multi-state health systems, this breadth is operationally significant. A health system that complied with Ohio HB 452 for its hospital operations may not have addressed SB 240 for its Texas ambulatory surgery centers, home health agencies, or hospice operations — all of which are separately covered. The compliance question is not just whether the hospital has a program. It is whether every covered facility type within the Texas footprint has a program.

The two-registered-nurse threshold for nursing facilities and home health agencies is a low bar. Most licensed nursing facilities and home health agencies employ at least two RNs. The practical effect is that the threshold does not meaningfully limit coverage — it is a drafting mechanism, not a substantive carve-out.

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 function as a system-wide generic document applied uniformly to a hospital, an ASC, and a home health agency without differentiation.

What SB 240 Requires

A Written Workplace Violence Prevention Policy

Every covered facility must adopt, implement, and enforce a written workplace violence prevention policy. The policy must require the facility to:

• Give significant consideration to the recommendations of the workplace violence prevention committee — the committee is not advisory in name only
• Allow healthcare providers and employees to provide confidential information about workplace violence to the committee
• Protect those who provide such information from retaliation — explicitly and enforceably
• Comply with Texas Health and Human Services Commission rules relating to workplace violence

A Written Workplace Violence Prevention Plan

The plan must be developed by the facility’s workplace violence prevention committee and based on the facility’s specific conditions, hazards, and incident history. Generic plans not tailored to the specific facility do not satisfy this requirement. The plan must:

• Require healthcare providers and employees to report incidents of workplace violence through the facility’s existing occurrence reporting systems
• 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

The patient care reassignment provision is unique to Texas among current state mandates. No comparable requirement appears in California SB-553, Ohio HB 452, or Virginia’s healthcare mandate. It reflects the Texas Legislature’s recognition that workers should not be required to continue treating patients who have assaulted or threatened them.

A Workplace Violence Prevention Committee

Every covered facility must establish — or designate an existing committee to serve as — a workplace violence prevention committee. The committee must include at least one registered nurse who provides direct patient care at the facility and, if applicable and practicable, at least one facility employee who provides security services.

The committee must review and evaluate the plan at least annually and report the results of that evaluation to the facility’s governing body. This governing body reporting requirement is one of the most consequential elements of the statute from a liability perspective. Once the governing body has received the committee’s annual report and been informed of program deficiencies, it has documented knowledge of the problem. A governing body that receives that report, identifies gaps, and takes no corrective action has created the factual foundation for a negligent retention or failure-to-act claim in any subsequent litigation.

Each facility must make an electronic or printed copy of its plan available on request to every healthcare provider and employee. The plan is not a confidential compliance document — it is a resource that employees are entitled to access.

Post-Incident Services

SB 240 requires each covered facility to respond to workplace violence incidents by providing immediate post-incident services to affected employees, including at minimum any necessary acute medical treatment. This requirement distinguishes Texas from most comparable state mandates, which focus on prevention and reporting but say little about the immediate institutional response when violence occurs.

Annual Training

Annual training for all healthcare providers and employees is required. The training must be appropriate to the facility type and the roles of those being trained — a requirement that a single generic online module applied uniformly across clinical and administrative staff may not satisfy. Documentation of training completion must be maintained.

Enforcement: Licensing, Not Fines

Texas SB 240 does not include an explicit citation and penalty schedule. There is no defined fine per violation of the kind found in California SB-553, which carries penalties up to $162,851 per willful violation. The enforcement mechanism is licensing: the Texas Health and Human Services Commission and other applicable licensing agencies have authority to take disciplinary action against facilities that fail to comply with Chapter 331 requirements.

This enforcement structure is less predictable than a defined penalty schedule. A covered facility cannot calculate its maximum exposure and make a risk-adjusted decision to remain non-compliant. A licensing action can range from a notice of deficiency to revocation depending on the severity of the gap, the history of the facility, and the discretion of the licensing authority. For a licensed hospital, ambulatory surgery center, or hospice organization, a licensing action is an existential consequence, not a financial one that can be absorbed as a cost of doing business.

The Joint Commission’s workplace violence prevention standards, adopted in 2022, apply independently to accredited facilities. Most Texas acute care hospitals are Joint Commission accredited. Non-compliance with SB 240 and non-conformance with Joint Commission standards creates compounding regulatory exposure from two independent sources.

The Litigation Exposure That Outlasts Regulatory Risk

Regulatory enforcement is one dimension of non-compliance risk. Civil litigation is another — and for most covered facilities, it is the larger concern.

Texas SB 240 establishes the standard of care. A healthcare facility that experienced a workplace violence incident without having a compliant SB 240 program in place faces a plaintiff’s attorney who can cite the statute, the compliance deadline, and the facility’s failure to meet it. The average civil jury verdict in a workplace violence negligence case is approximately $3 million. Individual verdicts have reached substantially higher.

The governing body reporting requirement compounds this exposure in a specific way. A facility whose committee identified program gaps in an annual review, reported those gaps to the governing body, and took no corrective action has created documented evidence of institutional knowledge. Plaintiffs’ attorneys look for exactly that sequence of events. The governing body report is not an administrative formality — it is potentially the most important document in a post-incident litigation file.

For facilities that have not yet built compliant programs, the legal risk is worst in the window between now and full compliance. The longer the gap continues, the harder it becomes to argue that non-compliance was inadvertent rather than knowing. For a deeper look at employer liability frameworks in workplace violence litigation, see our article on negligent security and workplace violence negligence.

What Texas Healthcare Facilities Should Do Now

For facilities that are not yet compliant, the remediation path is defined by the statute’s requirements:

• Assess current program status against each requirement. Does a written policy exist, and does it contain all required elements? Has a committee been established with a direct care RN member? Has the committee developed a facility-specific plan? Has the plan been reviewed and the results reported to the governing body? Are post-incident services documented? Is annual training current and documented?
• Address committee composition and documentation first. The interdisciplinary committee requirement — including a direct care RN — is the element most likely to have been handled informally. If the committee was not properly constituted or if participation was not documented, the development process needs to be reconstructed with proper membership and records.
• Review the plan for facility-specific content.SB 240 explicitly requires the plan to be based on the specific facility’s conditions, hazards, and history. A system-wide template applied uniformly across different facility types does not satisfy this requirement. Each covered facility type — hospital, ASC, home health, hospice — needs a plan that reflects its specific environment.
• Document the patient reassignment provision. This is unique to Texas and requires an explicit policy and documented procedure. The plan must show how the facility will handle requests for assignment adjustment following an incident of intentional abuse or threat.
• Engage legal counsel before finalizing programs. Chapter 331 compliance should be reviewed by counsel familiar with Texas healthcare regulatory requirements before attestation or formal adoption. The absence of a defined penalty schedule does not reduce the legal risk of getting the compliance posture wrong.

Texas in the National Healthcare Compliance Picture

Texas SB 240 is the broadest-coverage healthcare workplace violence mandate currently in force in the United States. After SB 463 (2025) and HHSC’s implementing rules, its eight covered facility categories cover a healthcare system’s entire operational footprint in a way that hospital-only mandates do not. But Texas is one of more than twenty states with active healthcare mandates.

Multi-state health systems operating in Texas and California simultaneously are subject to two of the most demanding mandates in the country. Health systems also operating in Ohio or Virginia are operating under three or four active mandates with different requirements, different committee structures, different enforcement mechanisms, and different documentation standards.

The efficient approach is a coordinated multi-state framework — one program architecture built to the most demanding standard in each state, with state-specific configurations for requirements that differ. The Texas SB 240 framework is the right starting point for multi-state healthcare systems because its coverage breadth means a Texas-compliant program already addresses the full range of facility types. California’s requirements add the Violent Incident Log, the four-type violence classification, and the annual interactive training requirement. Ohio adds the interdisciplinary planning team and the state attestation process. Virginia is actively expanding hospital incident reporting requirements through 2026 legislation, including HB 1489 signed in April 2026.

For a full picture of the national healthcare mandate landscape, see our national healthcare compliance guide.

Primary Sources and Resources

The full text of Texas SB 240 is codified at Chapter 331, Texas Health & Safety Code. The Texas Hospital Association has published member resources on SB 240 compliance. The Texas Nurses Association, a primary advocate for the legislation, maintains advocacy and compliance resources for nurses navigating the law.

For enforcement questions and licensing compliance, the Texas Health and Human Services Commission is the primary regulatory authority for most covered facility types. Facility-specific licensing agencies govern ambulatory surgery centers, hospice organizations, and home health agencies under their respective licensing chapters.