The change came through Texas Senate Bill 463. Texas already had a workplace violence prevention law, but the way the original language was written limited its application among Home and Community Support Services Agencies to agencies providing home health services. The Texas Senate’s analysis of SB 463 explains that the change was intended to correct that limitation and extend the protections across service categories under the HCSSA license. Texas law defines an HCSSA as an organization providing home health, hospice, habilitation, or personal assistance services, so hospice is clearly included.
There is one important threshold hospice leaders need to understand. Chapter 331 defines a covered HCSSA as one licensed, or licensed and certified, under Chapter 142 that employs at least two registered nurses. If your Texas hospice meets that definition, I would not assume that a generic workplace violence policy you already had in place satisfies these requirements. I would actually pull the policy, plan, committee documentation, training records, incident procedures, and governing-body documentation and compare them against the law. ( Texas Constitution and Statutes)
This Requires an Actual Workplace Violence Prevention Committee
The first requirement is a workplace violence prevention committee. The law allows an organization to establish a new committee or authorize an existing committee to perform this function, but the committee has specific membership requirements. It must include at least one registered nurse who provides direct patient care. It also generally requires a Texas-licensed physician who provides direct care, although the statute contains an exception for an HCSSA that does not have such a physician on staff. If the organization has an employee who provides security services, that employee is also included when applicable and practicable. (Texas Constitution and Statutes)
For hospice organizations with multiple locations, there is some flexibility. A health care system operating more than one covered facility may establish one committee for the system, but that committee must develop a workplace violence prevention plan for each facility, and the violence-prevention data must remain separately identifiable for each facility. In other words, having one corporate committee does not mean every location can simply disappear into one generic corporate process. (Texas Constitution and Statutes)
I would also make sure this is a functioning committee and not simply a list of names sitting in a policy binder. The committee has responsibilities under the law, including involvement in the prevention plan and its ongoing evaluation. If you are surveyed, you want to be able to demonstrate that the committee exists, meets its responsibilities, and is actively involved in the program.
You Need Both a Written Policy and a Written Prevention Plan
This is an important distinction because the law requires both. Chapter 331 requires a written workplace violence prevention policy and a written workplace violence prevention plan. Those are not necessarily the same document, although the plan is allowed to reference other internal policies and documents to satisfy some of its requirements. (Texas Constitution and Statutes)
The written policy must protect health care providers and employees from violent behavior and threats of violent behavior. It must also encourage employees and providers to give the committee confidential information about workplace violence and include a process protecting employees from retaliation when they provide that information.
The prevention plan gets much more specific. Texas requires the plan to be based on the actual practice setting. I think that phrase is especially important for hospice. A hospice workplace violence plan should make sense for hospice. Our clinicians are providing care in private homes, assisted living facilities, nursing facilities, and other environments that the hospice does not control. A policy written around hospital hallways, security departments, and controlled entrances may not adequately address what happens when a hospice nurse is standing alone inside someone’s home.
The statute defines workplace violence broadly enough to include an act or threat of physical force that causes or is likely to cause physical injury or psychological trauma. It also includes an incident involving a firearm or another dangerous weapon, regardless of whether anyone is actually injured. (Texas Constitution and Statutes )
For a hospice, I would make sure the plan answers the questions that clinicians actually encounter in the field. What happens when a nurse arrives and there are weapons visible in the home? What happens when a family member is intoxicated or threatening? What happens when there is escalating domestic conflict? What does the clinician do if an uncontrolled animal creates a safety threat? Who does the employee call? When should the employee leave? How is the home flagged for future visits? When should another clinician accompany the employee? When should law enforcement become involved? Those examples are practical applications I would consider when building a hospice-specific plan, rather than additional situations separately listed in the statute.
Your Plan Needs a Reporting and Investigation Process
The law requires the prevention plan to establish a system for responding to and investigating both violent incidents and potentially violent incidents. It also requires the plan to address physical security and safety. Employees must have a way to report workplace violence through the organization’s existing occurrence-reporting system, and the organization must solicit information from employees and health care providers when developing and implementing the plan. (Justia Law)
That means the process should begin before someone is physically injured. If a clinician reports that a situation feels threatening or potentially violent, there needs to be a process for that information to go somewhere and for someone to act on it. Waiting until an employee has actually been assaulted defeats much of the purpose of a prevention program.
I would also make the reporting process extremely clear to employees. A policy that says “report workplace violence according to agency procedure” is not particularly helpful to a nurse sitting in their car after a frightening encounter. Staff should know exactly who to contact, how to document the event, what happens after the report is made, and how the agency will determine whether additional precautions are necessary for future visits.
Annual Workplace Violence Education Is Required
Covered organizations must provide workplace violence prevention training or education at least annually to health care providers and employees who provide direct patient care. The law allows that education to be incorporated into other required training, so it does not necessarily have to be a completely separate annual course. (Justia Law)
I would still make the education meaningful. This is one of those areas where checking a box once a year is not going to help the nurse who finds themselves in an unsafe situation. Employees need to understand what the agency considers workplace violence, how to recognize escalating risk, what the agency expects them to do, how to report a threat or incident, and what support is available afterward.
For hospice organizations, I would make sure the education reflects field-based care. The situations your nurses, social workers, aides, chaplains, and other clinicians encounter are very different from those experienced by someone working inside a controlled health care facility.
Texas Specifically Addresses Sending a Caregiver Back
This may be one of the most important provisions in the law from a hospice nurse advocacy standpoint. The prevention plan must require the organization, to the extent practicable, to adjust patient-care assignments so that a health care provider or employee is not required to continue treating or providing services to a patient who has intentionally physically abused or threatened that employee. (Justia Law)
I think hospice leaders need to look closely at that requirement. We have all heard some version of, “That’s still your patient,” or, “We don’t have anybody else to send.” Texas is now requiring covered organizations to have a process that addresses exactly this situation when reassignment is practicable.
That does not mean a hospice can simply abandon a patient because there has been a difficult interaction. Hospices still have obligations to their patients. But employee safety cannot be dismissed either. Leadership needs a thoughtful process for balancing continuity of patient care with the safety of the clinician who has been intentionally threatened or physically abused.
There Are Requirements After an Incident Too
The organization’s responsibility does not end when the employee gets out of the home. Following an incident of workplace violence, the facility must at minimum offer immediate post-incident services to employees and health care providers directly involved. Those services must include any necessary acute medical treatment. (Justia Law)
The law also specifically says the organization cannot discourage an employee or health care provider from contacting or filing a report with law enforcement about workplace violence. An employee also cannot be disciplined, discriminated against, suspended, terminated, or otherwise retaliated against for making a good-faith report or for advising another employee of their right to report an incident. (Texas Legislature Online)
Those protections should be clearly reflected in your policy, but they also need to be reflected in your culture. If employees technically have the right to report violence but believe they will be viewed as difficult, weak, or unwilling to do their jobs if they speak up, you do not have an effective prevention program.
The Committee Has an Ongoing Job
This is not something the hospice can create once and put on a shelf. At least annually, the workplace violence prevention committee must review and evaluate the prevention plan and report the results of that evaluation to the organization’s governing body. Employees and health care providers are also entitled to receive an electronic or printed copy of the plan upon request, although information may be redacted if the committee determines that releasing it would create a security threat. (Justia Law)
For compliance purposes, I would document all of this. Document the committee membership. Document its meetings and activities. Document the annual review. Document the findings of that review. Document that the results were reported to the governing body. Document annual education. And when incidents occur, make sure the organization’s response is documented as well.
Remember that this is now part of the organization’s licensing compliance. Chapter 331 allows the appropriate licensing agency to take disciplinary action for violations as though the organization violated an applicable licensing law. (Texas Legislature Online)
Why Texas Hospices Are Newly Paying Attention to This
The original workplace violence legislation, Senate Bill 240, became law in 2023. The problem was that its wording limited which HCSSAs were included. The Texas Senate’s analysis of SB 463 explains that HHSC had determined the original language applied only to home health services and unintentionally left other HCSSA service categories outside that coverage. SB 463 removed that limiting language.
SB 463 itself became effective September 1, 2025, but newly covered HCSSAs were given until September 1, 2026 to comply with Chapter 331. That deadline has now passed.
So if you operate a Texas hospice, the first question I would ask is very simple: Does our licensed HCSSA employ at least two registered nurses? If the answer is yes, I would immediately review your workplace violence prevention program against Chapter 331 rather than assuming an existing HR policy covers it.
What I Would Have Ready If I Were Surveyed Tomorrow
If I were running a Texas hospice subject to this law, I would want to be able to immediately produce evidence of my workplace violence prevention committee and its required membership, my written workplace violence prevention policy, my written hospice-specific prevention plan, annual education records, my reporting and investigation procedure, my post-incident response process, my anti-retaliation protections, my process for adjusting assignments following intentional threats or physical abuse when practicable, and documentation showing the committee’s annual review and report to the governing body.
I would also want my staff to know what those documents actually say. A perfect policy binder is not much protection if a field nurse has no idea what to do when they feel unsafe.
This is one of the reasons I continue telling hospice leaders that compliance is much bigger than the medical record. Eligibility and documentation remain incredibly important, but survey and regulatory exposure can also come from the systems surrounding the people who provide the care. Protecting those employees is now an explicit compliance responsibility for covered Texas hospices.
At The Amity Group, our Audit Protection & Compliance Division helps hospice organizations look beyond individual charts and evaluate the broader compliance systems that can create risk for the organization. If you are a Texas hospice and are unsure whether your workplace violence prevention program meets these requirements, this is something I would review now rather than waiting for a surveyor to identify the gaps.
For anyone who wants to read the requirements directly, I recommend starting with the official Texas Health and Safety Code Chapter 331. You can also review the Texas Legislature’s SB 463 bill information and analysis, which explains why the law was expanded and confirms the September 1, 2026 compliance deadline for newly covered HCSSAs. Texas HHSC has also published workplace-violence compliance guidance explaining the underlying Chapter 331 requirements. (Texas Health and Human Services)
The deadline has passed. If your Texas hospice employs at least two RNs, I would make sure you can prove that your committee, policy, plan, education, response process, and governing-body oversight are not only written down, but actually functioning.
Shelley Henry, RN
President, The Amity Group, Inc.
AmityStaffing.com
