reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 304 - DIAGNOSTIC ASSESSMENT › Subchapter A - GENERAL PROVISIONS › Section 304.102 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this chapter,
					 have the following meanings, unless the context clearly indicates
					 otherwise.
(1) ABL--Adaptive behavior
				  level. The categorization of an individual's functioning level of adaptive
				  behavior into one of five levels ranging from minimal limitations (0) through
				  profound limitations (IV).
(2)
				  Adaptive behavior--The effectiveness with or degree to which an individual
				  meets the standards of personal independence and social responsibility expected
				  of the individual's age and cultural group as assessed by a standardized
				  measure.
(3) ASD--Autism spectrum
				  disorder. As described in the most current Diagnostic and Statistical Manual of
				  Mental Disorders (DSM), a disorder characterized by persistent impairment in
				  reciprocal social communication and social interaction and restricted,
				  repetitive patterns of behavior, interests, or activities. These symptoms are
				  present from early childhood and limit or impair everyday
				  functioning.
(4) Asperger
				  disorder--A neurodevelopmental disorder characterized by severe, sustained,
				  clinically significant impairment of social interaction or communication skills
				  and restricted, repetitive, and stereotyped patterns of behavior or interests.
				  Symptoms may present later during the individual's development. Since the
				  expanded definition of ASD in the DSM, effective 2013, Asperger disorder is
				  subsumed under the diagnosis of ASD.
(5) Authorized provider--A person who is:
(A) a physician licensed to practice in
				  Texas;
(B) a psychologist licensed
				  to practice in Texas; or
(C) a
				  certified authorized provider.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 304 - DIAGNOSTIC ASSESSMENT › Subchapter B - PURPOSE OF THE DETERMINATION OF INTELLECTUAL DISABILITY › Section 304.201 - Use of Information from a DID or Diagnostic Assessment

Current through Reg. 49, No. 28; July 12, 2024
(a) A LIDDA uses information from a DID
				  report or a diagnostic assessment report endorsed as a DID that was conducted
				  in accordance with Subchapter D of this chapter (relating to Determination of
				  Intellectual Disability) to determine an individual's eligibility for LIDDA
				  services.
(b) HHSC uses information
				  from a DID report or a diagnostic assessment report endorsed as a DID that was
				  conducted in accordance with Subchapter D of this chapter to determine an
				  individual's eligibility for certain services and supports provided through
				  HHSC.
(c) An individual may receive
				  the following time-limited services without first being determined to be a
				  person with an intellectual disability:
(1)
				  emergency services provided in accordance with THSC, §593.027 or
				  §593.0275; and
(2) respite
				  care in a residential care facility provided in accordance with THSC,
				  §593.028.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 304 - DIAGNOSTIC ASSESSMENT › Subchapter B - PURPOSE OF THE DETERMINATION OF INTELLECTUAL DISABILITY › Section 304.202 - Request for a Determination of Intellectual Disability

Current through Reg. 49, No. 28; July 12, 2024
(a) An individual or the individual's LAR may
				  make a written request for a DID on a form provided by HHSC to:
(1) the SSLC or LIDDA serving the area in
				  which the individual resides; or
(2) a psychologist licensed to practice in
				  Texas; or
(3) a physician licensed
				  to practice in Texas.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 304 - DIAGNOSTIC ASSESSMENT › Subchapter B - PURPOSE OF THE DETERMINATION OF INTELLECTUAL DISABILITY › Section 304.203 - Right to an Independent Determination of Intellectual Disability or Administrative Hearing

Current through Reg. 49, No. 28; July 12, 2024
If the DID is conducted at a LIDDA or SSLC, the LIDDA or
					 SSLC must:
(1) inform the person who
				  requested the DID and the person assessed, orally and in writing, of the right
				  to:
(A) an additional, independent DID to be
				  conducted at the person's expense if the person questions the validity or
				  results of the DID; and
(B) an
				  administrative hearing to contest the findings concerning ID, as described in
				  40 TAC Chapter 4, Subchapter D (relating to Administrative Hearings under Texas
				  Health and Safety Code, Title 7, Subtitle D); and
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 304 - DIAGNOSTIC ASSESSMENT › Subchapter C - AUTHORIZED PROVIDERS › Section 304.301 - Qualifications and Requirements for an Authorized Provider

Current through Reg. 49, No. 28; July 12, 2024
(a) An authorized provider employed by or
				  contracting with an SSLC may conduct a DID only for an individual receiving
				  services from that SSLC.
(b) At a
				  LIDDA or an SSLC, a person conducting a DID must be:
(1) a psychologist licensed to practice in
				  Texas who is employed by or contracting with the LIDDA or SSLC and who has
				  completed:
(A) graduate course work in
				  assessing intellectual and adaptive behavior for individuals with an ID or
				  developmental disability; or
(B)
				  one year of supervised experience in assessing intellectual and adaptive
				  behavior for individuals with an ID or developmental disability;
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 304 - DIAGNOSTIC ASSESSMENT › Subchapter C - AUTHORIZED PROVIDERS › Section 304.302 - Certified Authorized Provider

Current through Reg. 49, No. 28; July 12, 2024
(a) To
				  designate an employee or contractor of the LIDDA or SSLC who is not a licensed
				  psychologist or physician as a certified authorized provider, a LIDDA or SSLC
				  may submit a request to HHSC, in accordance with HHSC procedures, available on
				  the HHSC website.
(b) A level I
				  certified authorized provider must:
(1) be a
				  current employee of the LIDDA or SSLC;
(2) be:
(A)
				  a provisionally licensed psychologist;
(B) a licensed psychological associate (LPA),
				  other than an LPA authorized to practice independently (LPA-IP);
(C) a licensed specialist in school
				  psychology (LSSP); or
(D)
				  recognized as a certified authorized provider prior to September 1, 2013 as
				  provided per written approval by Texas Department of Mental Health and Mental
				  Retardation (TDMHMR) or Department of Aging and Disability Services (DADS)
				  prior to September 1, 2013, to conduct a Determination of Mental Retardation
				  (DMR) or DID;
(3) have
				  supervised experience or successful completion of graduate course work in
				  assessing intellectual and adaptive behavior for individuals with an ID or
				  developmental disability; and
(4)
				  have one year of employment, internship, or practicum in the field of
				  ID.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 304 - DIAGNOSTIC ASSESSMENT › Subchapter D - DETERMINATION OF INTELLECTUAL DISABILITY › Section 304.401 - Conducting a Determination of Intellectual Disability

Current through Reg. 49, No. 28; July 12, 2024
(a) In conducting a DID, an authorized
				  provider employed by or contracting with a LIDDA or SSLC must:
(1) adhere to the Determination of
				  Intellectual Disability (DID): Best Practice Guidelines, available on the HHSC
				  website;
(2) interview and observe
				  the individual in-person or in real time using audio-visual technology;
				  and
(3) perform a diagnostic
				  assessment that, at a minimum, includes:
(A) a
				  standardized measure of the individual's intellectual functioning using an
				  appropriate test based on the characteristics of the individual;
(B) a standardized measure of the
				  individual's adaptive abilities and deficits reported as the individual's
				  ABL;
(C) a review of evidence
				  supporting the origination of ID during the individual's developmental period,
				  which includes but is not limited to, as available:
(i) reports concerning the cause of the
				  suspected ID;
(ii) results of all
				  relevant assessments;
(iii) types
				  of services the individual has received or is receiving;
(iv) reports by other people, including the
				  individual's family members and friends; and
(v) educational records; and
(D) a review of the individual's
				  previous and current psychological and psychiatric treatments and diagnoses, as
				  available.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 304 - DIAGNOSTIC ASSESSMENT › Subchapter D - DETERMINATION OF INTELLECTUAL DISABILITY › Section 304.402 - The Determination of Intellectual Disability Report

Current through Reg. 49, No. 28; July 12, 2024
(a) An authorized provider employed by or
				  contracting with a LIDDA or SSLC must complete a written report of the DID that
				  is dated, signed, and includes the license number or, when applicable, the
				  certification number of the authorized provider. The written DID report must
				  contain:
(1) background information
				  summarizing the individual's:
(A)
				  developmental history, including a description of the evidence of origination
				  of ID during the individual's developmental period; and
(B) previous and current psychological and
				  psychiatric evaluations, treatments and diagnoses;
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 304 - DIAGNOSTIC ASSESSMENT › Subchapter D - DETERMINATION OF INTELLECTUAL DISABILITY › Section 304.403 - Review and Endorsement of a Determination of Intellectual Disability Report

Current through Reg. 49, No. 28; July 12, 2024
(a) An individual
				  or the individual's LAR may make a written or oral request to the LIDDA serving
				  the area in which the individual resides for a review of an existing DID report
				  or a diagnostic assessment that reflects current functioning to determine
				  eligibility. An authorized provider may:
(1)
				  endorse the DID report;
(2) endorse
				  the diagnostic assessment report;
(3) conduct additional testing to determine
				  eligibility; or
(4) conduct a new
				  DID.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 304 - DIAGNOSTIC ASSESSMENT › Subchapter D - DETERMINATION OF INTELLECTUAL DISABILITY › Section 304.404 - Elements of a Transfer

Current through Reg. 49, No. 28; July 12, 2024
(a) When an
				  individual relocates from one local service area or SSLC to another local
				  service area or SSLC, the sending LIDDA or SSLC must ensure the following
				  documentation is provided to the receiving LIDDA or SSLC:
(1) previous and current psychological and
				  psychiatric evaluations;
(2)
				  documents regarding treatments and diagnoses;
(3) available diagnostic assessments and
				  previous DIDs; and
(4) any other
				  information requested by the receiving LIDDA or SSLC.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 304 - DIAGNOSTIC ASSESSMENT › Subchapter E - INTELLECTUAL DISABILITY AND RELATED CONDITIONS › Section 304.502 - Related Condition

Current through Reg. 49, No. 28; July 12, 2024
(a) If an individual
				  is determined not to have an ID, an authorized provider employed by or
				  contracting with a LIDDA may use information from the DID report to assist in
				  establishing the individual's eligibility for certain Medicaid services based
				  on the existence of a related condition on the current HHSC-approved list of
				  related conditions and § 261.238 of this title (relating to ICF/MR Level
				  of Care I Criteria) or § 261.239 of this title (relating to ICF/MR Level
				  of Care VIII Criteria).
(b) The DID
				  report must include information about the date of onset and a description of
				  the individual's deficits, skills, behaviors, and current functioning
				  level.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 304 - DIAGNOSTIC ASSESSMENT › Subchapter E - INTELLECTUAL DISABILITY AND RELATED CONDITIONS › Section 304.503 - Autism Spectrum Disorder

Current through Reg. 49, No. 28; July 12, 2024
(a) If
				  an individual is determined not to have an ID, an authorized provider employed
				  by or contracting with a LIDDA may use information from the DID report to
				  assist in establishing the individual's eligibility for LIDDA services based on
				  the existence of ASD.
(b) The DID
				  report must include information about the date of onset and a description of
				  the individual's deficits, skills, behaviors, and current functioning level
				  that support the criteria for ASD described in the current DSM.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 306 - BEHAVIORAL HEALTH DELIVERY SYSTEM › Subchapter A - STANDARDS FOR SERVICES TO INDIVIDUALS WITH CO-OCCURRING PSYCHIATRIC AND SUBSTANCE USE DISORDERS (COPSD) › Section 306.1 - Purpose

Current through Reg. 49, No. 28; July 12, 2024
The purpose of this subchapter is to improve existing
					 mental health services provided by the entities defined in §
										306.5 of this title (relating to
					 Definitions) by establishing standards to ensure the effective and coordinated
					 provision of services to individuals who require specialized support or
					 treatment due to co-occurring psychiatric and substance use disorders
					 (COPSD).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 306 - BEHAVIORAL HEALTH DELIVERY SYSTEM › Subchapter A - STANDARDS FOR SERVICES TO INDIVIDUALS WITH CO-OCCURRING PSYCHIATRIC AND SUBSTANCE USE DISORDERS (COPSD) › Section 306.3 - Application

Current through Reg. 49, No. 28; July 12, 2024
(a) The provisions of this subchapter apply
				  to entities defined in §
										306.5 of this title (relating to
				  Definitions).
(b) The provisions of
				  this subchapter are in addition to requirements contained in other DSHS rules.
				  This subchapter does not supercede other DSHS rules that may also apply to the
				  provision of services to individuals as defined in §
										306.5 of this title.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 306 - BEHAVIORAL HEALTH DELIVERY SYSTEM › Subchapter A - STANDARDS FOR SERVICES TO INDIVIDUALS WITH CO-OCCURRING PSYCHIATRIC AND SUBSTANCE USE DISORDERS (COPSD) › Section 306.5 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this
					 subchapter, have the following meanings, unless the context clearly indicates
					 otherwise.
(1) Access--An individual's
				  ability to obtain the psychiatric and substance use disorder services
				  needed.
(2) Adolescent--A person
				  who is 13 through 17 years of age.
(3) Adult--A person who is 18 years of age or
				  older.
(4) Child--A person who is 3
				  through 12 years of age.
(5)
				  Contract--A legally enforceable written agreement for the purchase of
				  services.
(6) Co-occurring
				  psychiatric and substance use disorders (COPSD)--The co-occurring diagnoses of
				  psychiatric disorders and substance use disorders.
(7)
Diagnostic and Statistical Manual
				  of Mental Disorders
(DSM)--The most recent edition of the American
				  Psychiatric Association's official classification of mental
				  disorders.
(8) Entity or
				  entities--The terms used to refer to the following:
(A) local mental health authorities
				  (LMHAs);
(B) Managed care
				  organizations (MCOs);
(C) state
				  mental health facilities (SMHF); and
(D) Medicaid providers who are required to
				  comply with Chapter 419, Subchapter L of this title, governing Mental Health
				  Rehabilitative Services, or Chapter 306, Subchapter E of this title, governing
				  Mental Health Case Management Services.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 306 - BEHAVIORAL HEALTH DELIVERY SYSTEM › Subchapter A - STANDARDS FOR SERVICES TO INDIVIDUALS WITH CO-OCCURRING PSYCHIATRIC AND SUBSTANCE USE DISORDERS (COPSD) › Section 306.7 - Services to Individuals with COPSD

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Entities, entities' contracted providers, and each of their respective staff
				  providing service to an individual with COPSD shall ensure that services are
				  provided in compliance with applicable licensure, scope of practice and other
				  law and:
(1) address both psychiatric and
				  substance use disorders;
(2) are
				  provided within established practice guidelines for this population;
				  and
(3) facilitate individuals or
				  LARs in accessing available services they need and choose, including self-help
				  groups.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 306 - BEHAVIORAL HEALTH DELIVERY SYSTEM › Subchapter A - STANDARDS FOR SERVICES TO INDIVIDUALS WITH CO-OCCURRING PSYCHIATRIC AND SUBSTANCE USE DISORDERS (COPSD) › Section 306.9 - Responsibility for Compliance

Current through Reg. 49, No. 28; July 12, 2024
(a) Entities
				  must comply with this subchapter.
(b) Entities that are LMHAs, MCOs, or SMHFs
				  must require providers, by contract, to comply with §
										306.7 of this title (relating to
				  Services to Individuals with COPSD), §
										306.13 of this title (relating to
				  Access to Services), §
										306.15 of this title (relating to
				  Specialty Competencies of Staff Providing Services to Individuals with COPSD),
				  and §
										306.19 of this title (relating to
				  Screening, Assessment, and Treatment Planning).
(c) Entities must monitor staff and contract
				  providers who provide services to an individual with COPSD for compliance with
				  the applicable provisions of §§
										306.13-
				  306.19 of this title.
(d) An entity that is an MCO must comply and
				  must require staff to comply with Chapter 404, Subchapter E of this title,
				  governing Rights of Persons Receiving Mental Health Services.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 306 - BEHAVIORAL HEALTH DELIVERY SYSTEM › Subchapter A - STANDARDS FOR SERVICES TO INDIVIDUALS WITH CO-OCCURRING PSYCHIATRIC AND SUBSTANCE USE DISORDERS (COPSD) › Section 306.11 - DSHS Responsibilities

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  DSHS must make available training resources for the competencies identified in
				  §
										306.15 of this title (relating to
				  Specialty Competencies of Staff Providing Services to Individuals with
				  COPSD).
(b) DSHS must require LMHAs
				  and SMHFs to develop quality management systems that ensure an appropriate
				  integrated assessment for each individual and the appropriate delivery of
				  services.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 306 - BEHAVIORAL HEALTH DELIVERY SYSTEM › Subchapter A - STANDARDS FOR SERVICES TO INDIVIDUALS WITH CO-OCCURRING PSYCHIATRIC AND SUBSTANCE USE DISORDERS (COPSD) › Section 306.13 - Access to Services

Current through Reg. 49, No. 28; July 12, 2024
(a) In determining
				  an individual's initial and ongoing eligibility for any service, an entity may
				  not exclude an individual based on the following factors:
(1) the individual's past or present mental
				  illness or substance use diagnosis or services;
(2) medications prescribed to the individual
				  in the past or present;
(3) the
				  presumption of the individual's inability to benefit from treatment;
(4) the specific substance used by the
				  individual;
(5) the individual's
				  continued substance use; or
(6) the
				  individual's level of success in prior treatment episodes.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 306 - BEHAVIORAL HEALTH DELIVERY SYSTEM › Subchapter A - STANDARDS FOR SERVICES TO INDIVIDUALS WITH CO-OCCURRING PSYCHIATRIC AND SUBSTANCE USE DISORDERS (COPSD) › Section 306.15 - Specialty Competencies of Staff Providing Services to Individuals with COPSD

Current through Reg. 49, No. 28; July 12, 2024
(a) Entities must
				  ensure that services to individuals are age and culturally appropriate and are
				  provided by staff within their scope of practice who have the following minimum
				  knowledge, technical, and interpersonal competencies prior to providing
				  services.
(1) Knowledge competencies:
(A) knowledge of the fact that psychiatric
				  and substance use disorders are potentially recurrent relapsing disorders, and
				  that although abstinence is the goal, relapses can be opportunities for
				  learning and growth;
(B) knowledge
				  of the impact of substance use disorders on developmental, social, and physical
				  growth and development of children and adolescents;
(C) knowledge of interpersonal and family
				  dynamics and their impact on individuals;
(D) knowledge of the current
Diagnostic and Statistical Manual of Mental Disorders
diagnostic criteria for psychiatric disorders and substance use disorders and
				  the relationship between psychiatric disorders and substance use
				  disorders;
(E) knowledge regarding
				  the increased risks of self-harm, suicide, and violence in
				  individuals;
(F) knowledge of the
				  elements of an integrated treatment plan and community support plan for
				  individuals;
(G) basic knowledge of
				  pharmacology as it relates to individuals;
(H) basic understanding of the
				  neurophysiology of addiction;
(I)
				  basic knowledge of withdrawal symptoms and their potential risk factors to
				  clients;
(J) knowledge of the
				  phases of recovery for individuals;
(K) knowledge of the relationship between
				  COPSD and Axis III disorders; and
(L) basic knowledge of self-help in
				  recovery.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 306 - BEHAVIORAL HEALTH DELIVERY SYSTEM › Subchapter A - STANDARDS FOR SERVICES TO INDIVIDUALS WITH CO-OCCURRING PSYCHIATRIC AND SUBSTANCE USE DISORDERS (COPSD) › Section 306.17 - Quality Management

Current through Reg. 49, No. 28; July 12, 2024
(a) The LMHAs and
				  MCOs must develop and implement a plan for quality management of services to
				  individuals with COPSD as required in §
										301.333 (relating to Quality
				  Management) of this title, governing Mental Health Community Services
				  Standards.
(b) The SMHFs must
				  develop and implement a plan for quality management of services to individuals.
				  The plan must be incorporated into the Improving Organizational Performance
				  System (IOPS) and must identify clinical measures. The plan must describe the
				  following:
(1) activities for measuring,
				  assessing, and improving processes for delivering services in accordance with
				  this subchapter; and
(2) methods
				  for evaluating and improving outcomes for individuals receiving
				  services.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 306 - BEHAVIORAL HEALTH DELIVERY SYSTEM › Subchapter A - STANDARDS FOR SERVICES TO INDIVIDUALS WITH CO-OCCURRING PSYCHIATRIC AND SUBSTANCE USE DISORDERS (COPSD) › Section 306.19 - Screening, Assessment, and Treatment Planning

Current through Reg. 49, No. 28; July 12, 2024
(a) Screening and assessment. When a
				  screening determines an assessment is necessary, an integrated assessment must
				  be conducted to consider relevant past and current medical, psychiatric, and
				  substance use information, including:
(1)
				  information from the individual (and LAR on the individual's behalf) regarding
				  the individual's strengths, needs, natural supports, responsiveness to previous
				  treatment, as well as preferences for and objections to specific
				  treatments;
(2) the needs and
				  desire of the individual for family member involvement in treatment and
				  services if the individual is an adult without an LAR; and
(3) recommendations and conclusions regarding
				  treatment needs and eligibility for services for individuals.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 306 - BEHAVIORAL HEALTH DELIVERY SYSTEM › Subchapter B - STANDARDS OF CARE IN CRISIS STABILIZATION UNITS › Division 1 - GENERAL REQUIREMENTS › Section 306.41 - Purpose

Current through Reg. 49, No. 28; July 12, 2024
The purpose of this subchapter is to establish standards
						to ensure the proper care and treatment of individuals with a mental illness or
						serious emotional disturbance who are receiving services in crisis
						stabilization units licensed in accordance with Chapter 510 of this title
						(relating to Private Psychiatric Hospitals and Crisis Stabilization Units) and
						Texas Health and Safety Code Chapter 577.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 306 - BEHAVIORAL HEALTH DELIVERY SYSTEM › Subchapter B - STANDARDS OF CARE IN CRISIS STABILIZATION UNITS › Division 1 - GENERAL REQUIREMENTS › Section 306.43 - Application

Current through Reg. 49, No. 28; July 12, 2024
This subchapter applies to crisis stabilization units
						licensed in accordance with Chapter 510 of this title (relating to Private
						Psychiatric Hospitals and Crisis Stabilization Units) and Texas Health and
						Safety Code Chapter 577.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 306 - BEHAVIORAL HEALTH DELIVERY SYSTEM › Subchapter B - STANDARDS OF CARE IN CRISIS STABILIZATION UNITS › Division 1 - GENERAL REQUIREMENTS › Section 306.47 - General Provisions

Current through Reg. 49, No. 28; July 12, 2024
(a) The CSU must be
					 open and provide services to individuals 24-hours a day, seven days a week,
					 including admissions, based on the CSU's capability and capacity.
(b) The CSU must develop, and the medical
					 director must approve, the CSU's written policies and procedures that ensure
					 the CSU's compliance with this subchapter.
(c) All staff members must comply with this
					 subchapter and the policies and procedures of the CSU.
(d) A CSU administrator, or administrator's
					 designee must take appropriate measures to ensure a staff member's compliance
					 with this subchapter and the policies and procedures of the CSU.
(e) A CSU nursing supervisor must ensure all
					 orders issued by a physician, or physician-delegated PA or APRN, for an
					 individual are appropriately implemented pursuant to state nursing licensure
					 requirements.
(f) Except as
					 provided by § 306.51 of this subchapter (relating to Admission Criteria)
					 or applicable state law, a physician may delegate any of the medical services
					 described in this subchapter in accordance with Texas Occupations Code Chapter
					 157, Subchapter A.
(g) A CSU must
					 comply with the following HHSC rules:
(1)
					 Chapter 510 of this title (relating to Private Psychiatric Hospitals and Crisis
					 Stabilization Units);
(2) 25 TAC
					 Chapter 404, Subchapter E (relating to Rights of Persons Receiving Mental
					 Health Services);
(3) 25 TAC
					 Chapter 415, Subchapter A (relating to Prescribing Psychoactive
					 medication);
(4) 25 TAC Chapter
					 415, Subchapter F (relating to Interventions in Mental Health
					 Services);
(5) 25 TAC Chapter 414,
					 Subchapter I (relating to Consent to Treatment with Psychoactive
					 Medication--Mental Health Services);
(6) 25 TAC Chapter 417, Subchapter K
					 (relating to Abuse, Neglect and Exploitation in TDMHMR Facilities);
					 and
(7) 22 TAC Chapter 174,
					 Subchapter B (relating to Mental Health Services).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 306 - BEHAVIORAL HEALTH DELIVERY SYSTEM › Subchapter B - STANDARDS OF CARE IN CRISIS STABILIZATION UNITS › Division 2 - ADMISSION › Section 306.51 - Admission Criteria

Current through Reg. 49, No. 28; July 12, 2024
A CSU must develop and implement written admission
						criteria that:
(1) the CSU medical
					 director approves;
(2) uniformly
					 applies to all individuals;
(3)
					 permits the voluntary admission of an individual only if the following criteria
					 are met:
(A) the individual is authorized to
					 do so in accordance with Texas Health and Safety Code §
												572.001;
(B) the individual has a mental illness or
					 SED;
(C) the services provided in
					 the CSU may reduce the individual's acute symptoms; and
(D) the CSU provides clinically appropriate
					 environmental restrictions and levels of monitoring, described in § 306.87
					 of this subchapter (relating to Protection of an Individual Receiving Crisis
					 Stabilization Unit Services), that:
(i)
					 ensures the safety of the individual; and
(ii) prevent the individual from causing
					 serious harm to self or others;
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 306 - BEHAVIORAL HEALTH DELIVERY SYSTEM › Subchapter B - STANDARDS OF CARE IN CRISIS STABILIZATION UNITS › Division 2 - ADMISSION › Section 306.53 - Pre-Admission Screening and Assessment

Current through Reg. 49, No. 28; July 12, 2024
(a)
					 Pre-admission screening and assessment.
(1)
					 Before admission to a CSU, an individual must meet clinical criteria for
					 admission, as determined by pre-admission screening and assessment.
(2) An individual who voluntarily presents to
					 the CSU may leave the CSU at any time during the pre-admission screening and
					 assessment process before the individual's admission.
(3) Pre-admission screening and assessment of
					 an individual must:
(A) occur either in the
					 CSU or in the community at any location where mental health crisis services are
					 provided; and
(B) be provided by a
					 QMHP-CS or LPHA trained in accordance with HHSC screening and assessment
					 requirements policy and displaying competency in all domains of crisis
					 screening and assessment in accordance with § 301.331(b) of this title
					 (relating to Competency and Credentialing).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 306 - BEHAVIORAL HEALTH DELIVERY SYSTEM › Subchapter B - STANDARDS OF CARE IN CRISIS STABILIZATION UNITS › Division 2 - ADMISSION › Section 306.55 - Voluntary Admission Criteria and Intake Process

Current through Reg. 49, No. 28; July 12, 2024
(a) CSU staff members, trained in accordance
					 with §306.83(h) - (i) of this subchapter (relating to Staff Training),
					 must conduct the intake and admission process in accordance with Texas Health
					 and Safety Code §
											572.0025(e)
					 and §
											572.0025(h)(3).
(b) Voluntary admission into a CSU may be
					 requested by:
(1) an individual 16 years of
					 age or older, in accordance with Texas Health and Safety Code §
												572.001;
(2) the parent, managing conservator, or
					 guardian of an individual younger than 18 years of age, in accordance with
					 Texas Health and Safety Code §
												572.001
					 or Texas Family Code Chapter 35A;
(3) the adult caregiver of an individual, who
					 has obtained an order under Texas Family Code Chapter 35A when the individual
					 is younger than 18 years of age; or
(4) an individual with capacity to
					 consent.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 306 - BEHAVIORAL HEALTH DELIVERY SYSTEM › Subchapter B - STANDARDS OF CARE IN CRISIS STABILIZATION UNITS › Division 2 - ADMISSION › Section 306.57 - Involuntary Admission Criteria and Intake Process

Current through Reg. 49, No. 28; July 12, 2024
(a) Criteria for involuntary admission under
					 order of emergency detention. In accordance with Texas Health and Safety Code
					 §
											573.021,
					 a CSU administrator may accept an individual for a preliminary examination who
					 is:
(1) apprehended, and transported to the
					 CSU by a peace officer, in accordance with Texas Health and Safety Code §
												573.001(a)
					 and §
												573.005;
					 or
(2) an adult who is transported
					 to the CSU by the individual's family member or LAR in accordance with Texas
					 Health and Safety Code §
												573.003.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 306 - BEHAVIORAL HEALTH DELIVERY SYSTEM › Subchapter B - STANDARDS OF CARE IN CRISIS STABILIZATION UNITS › Division 2 - ADMISSION › Section 306.59 - Voluntary Treatment Following Involuntary Admission

Current through Reg. 49, No. 28; July 12, 2024
A CSU may provide crisis stabilization services to an
						individual who was involuntarily admitted in accordance with §306.57(a)
						and (f) of this division (relating to Involuntary Admission Criteria and Intake
						Process) if:
(1) the individual no
					 longer meets the involuntary treatment criteria described in § 306.79 of
					 this subchapter (relating to Discharge of an Involuntarily-Admitted
					 Individual);
(2) the individual
					 submits a written request to the CSU treating physician for voluntary crisis
					 stabilization services, as described in §306.55 of this division (relating
					 to Voluntary Admission Criteria and Intake Process); and
(3) the individual's treating physician
					 examines the individual and, based on that examination, writes an order for
					 voluntary crisis stabilization services that meets the requirements of
					 §306.51 of this division (relating to Admission Criteria).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 306 - BEHAVIORAL HEALTH DELIVERY SYSTEM › Subchapter B - STANDARDS OF CARE IN CRISIS STABILIZATION UNITS › Division 3 - SERVICE REQUIREMENTS › Section 306.61 - Crisis Stabilization Unit Medical Services

Current through Reg. 49, No. 28; July 12, 2024
(a) A CSU physician, or physician-delegated
					 PA or APRN, must provide an individual with the medical services documented in
					 the individual's recovery or treatment plan developed in accordance with
					 §306.65 of this division (relating to Crisis Stabilization Services and
					 Recovery or Treatment Planning).
(b) A CSU must have a medical director who
					 directs, monitors, and evaluates the psychiatric services provided.
(c) A CSU administrator, or administrator's
					 designee, must assign a treating physician to each individual and document the
					 assignment in the individual's medical record at the time the CSU
					 administrator, or administrator's designee, admits the individual.
(d) A physician, PA, APRN, or RN must perform
					 an individual's initial physical health assessment within 24 hours after the
					 individual's presentation, as ordered. The physical assessment includes:
(1) an evaluation and documentation of the
					 presence or absence of cognitive signs suggesting delirium and the need for
					 emergency intervention;
(2) a
					 general medical history that addresses conditions that may affect the
					 individual's current condition, including a review of symptoms focused on
					 conditions (such as a history of trauma) that may present with psychiatric
					 symptoms or cause cognitive impairment;
(3) a review of medical conditions that may
					 cause similar psychiatric symptoms or complicate the individual's condition;
					 and
(4) access to phlebotomy and
					 laboratory results.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 306 - BEHAVIORAL HEALTH DELIVERY SYSTEM › Subchapter B - STANDARDS OF CARE IN CRISIS STABILIZATION UNITS › Division 3 - SERVICE REQUIREMENTS › Section 306.63 - Crisis Stabilization Unit Nursing Services

Current through Reg. 49, No. 28; July 12, 2024
(a) Nursing services in treatment plan. CSU
					 nursing staff must provide nursing services to an individual in accordance with
					 the individual's recovery or treatment plan developed in accordance with
					 §306.65 of this division (relating to Crisis Stabilization Services and
					 Recovery or Treatment Planning).
(b) Nursing supervisor. A CSU must have a
					 nursing supervisor who is an RN and who directs, monitors, and evaluates the
					 nursing services provided.
(c)
					 Assessment. An RN must conduct and complete an individual's initial
					 comprehensive nursing assessment within eight hours before or after the
					 individual's admission.
(d)
					 Evaluation or reassessment.
(1) An individual
					 must receive a documented nursing evaluation or reassessment based on the
					 individual's needs:
(A) at least 12 hours
					 following the initial comprehensive nursing assessment required in subsection
					 (c) of this section; and
(B) at
					 recurring 12-hour intervals until the individual's discharge.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 306 - BEHAVIORAL HEALTH DELIVERY SYSTEM › Subchapter B - STANDARDS OF CARE IN CRISIS STABILIZATION UNITS › Division 3 - SERVICE REQUIREMENTS › Section 306.65 - Crisis Stabilization Services and Recovery or Treatment Planning

Current through Reg. 49, No. 28; July 12, 2024
(a) A CSU staff member must provide an
					 individual crisis stabilization services under the direction of a physician and
					 in accordance with the individual's recovery or treatment plan and the service
					 requirements. Such treatment includes medical services and nursing services
					 described in §306.61 of this division (relating to Crisis Stabilization
					 Unit Medical Services) and §306.63 of this division (relating to Crisis
					 Stabilization Unit Nursing Services).
(b) Nursing staff must develop and implement
					 an initial or preliminary nursing care plan within the first 24 hours after
					 admission. This plan must be based on the findings of the initial comprehensive
					 nursing assessment and any pre-admission assessment information that is
					 available at the time of admission.
(c) The IDT must collaborate in developing
					 the individual's recovery or treatment plan based on the findings of:
(1) the individual's physical examination
					 identified in §306.63 of this division;
(2) the individual's psychiatric evaluation
					 identified in §306.61 of this division;
(3) the individual's initial comprehensive
					 nursing assessment identified in §306.63 of this division;
(4) an assessment of the individual's risk of
					 harm to self or others, identified in § 306.53 of this subchapter
					 (relating to Pre-Admission Screening and Assessment); and
(5) the psychosocial assessment identified in
					 § 306.53 of this subchapter.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 306 - BEHAVIORAL HEALTH DELIVERY SYSTEM › Subchapter B - STANDARDS OF CARE IN CRISIS STABILIZATION UNITS › Division 3 - SERVICE REQUIREMENTS › Section 306.67 - Additional Standards of Care for Children and Adolescents

Current through Reg. 49, No. 28; July 12, 2024
(a) In addition to the service requirements
					 in this division, a child or adolescent must receive additional assessments,
					 including a developmental assessment and history of trauma assessment,
					 performed by an LPHA with appropriate training and experience in the assessment
					 and treatment of children in a crisis setting. The assessments must:
(1) be administered in person or through
					 telehealth or telemedicine medical services; and
(2) include the individual's parents, LAR, or
					 adult caregiver, as applicable and as clinically appropriate according to the
					 child's or adolescent's age, functioning, and current living
					 situation.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 306 - BEHAVIORAL HEALTH DELIVERY SYSTEM › Subchapter B - STANDARDS OF CARE IN CRISIS STABILIZATION UNITS › Division 4 - DISCHARGE › Section 306.71 - Discharge Planning

Current through Reg. 49, No. 28; July 12, 2024
(a) A QMHP-CS or
					 LPHA must begin discharge planning for an individual at the time of the
					 individual's admission.
(1) Discharge
					 planning must involve the individual, the IDT, the individual's LAR or adult
					 caregiver, as applicable, and any other person authorized by the individual and
					 the individual's adult caregiver or LAR if applicable, unless clinically
					 contraindicated.
(2) Discharge
					 planning must be provided in accordance with §
												510.41(m)(3)
					 of this title (relating to Facility Functions and Services) and include:
(A) the IDT recommendations for services and
					 supports, including placement needs, that should be provided after
					 discharge;
(B) the IDT arrangements
					 for the recommended services and supports;
(C) a PASRR screening, as required by
					 paragraph (3) of this subsection; and
(D) the IDT post-discharge care information
					 provided in a language and format easily understandable to the individual, and
					 the individual's LAR or adult caregiver, if applicable.
(3) An individual considered for discharge
					 from the CSU to a Medicaid-certified nursing facility must have a PASRR Level I
					 screening completed, in accordance with the Code of Federal Regulations, Title
					 42, Part 483, Subpart B (relating to Requirements for Long-Term Care
					 Facilities) before discharge; and
(4) if the screening indicates that the
					 individual has a mental illness, ID, or DD, the CSU staff member coordinating
					 the individual's transfer must contact and arrange for the designated LMHA,
					 LBHA, or LIDDA to conduct a PASRR Level II evaluation of the individual before
					 CSU discharge, in accordance with Chapter 303 of this title (relating to
					 Preadmission Screening and Resident Review (PASRR)).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 306 - BEHAVIORAL HEALTH DELIVERY SYSTEM › Subchapter B - STANDARDS OF CARE IN CRISIS STABILIZATION UNITS › Division 4 - DISCHARGE › Section 306.73 - Discharge Notices

Current through Reg. 49, No. 28; July 12, 2024
(a) The CSU staff
					 member coordinating the individual's discharge must notify the parent, LAR, or
					 adult caregiver of the pending discharge of a child or adolescent, unless
					 clinically contraindicated, in accordance with § 568.82(b) of this title
					 (relating to Discharge Notices and Release of Minors). If the treatment team
					 believes notifying the individual's parent, LAR, or adult caregiver is
					 clinically contraindicated, CSU staff must notify Texas Department of Family
					 Protective Services.
(b) In
					 accordance with Texas Health and Safety Code §
											576.007,
					 before discharging any adult, the CSU staff member coordinating the
					 individual's discharge must make a reasonable effort to notify the individual's
					 LAR, adult caregiver, and others authorized by the individual and LAR or adult
					 caregiver, of the discharge if the individual, LAR, or adult caregiver grants
					 permission for the notification.
(c) Upon discharge, the CSU staff member
					 coordinating the individual's discharge must provide the individual with
					 written notification of the existence, purpose, telephone number, and address
					 of the protection and advocacy system established in Texas, in accordance with
					 25 TAC Chapter 404, Subchapter E (relating to Rights of Persons Receiving
					 Mental Health Services) and required by Texas Health and Safety Code §
											576.008.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 306 - BEHAVIORAL HEALTH DELIVERY SYSTEM › Subchapter B - STANDARDS OF CARE IN CRISIS STABILIZATION UNITS › Division 4 - DISCHARGE › Section 306.75 - Discharge of a Voluntarily-Admitted Individual

Current through Reg. 49, No. 28; July 12, 2024
(a) In accordance with 25 TAC Chapter 404,
					 Subchapter E, all individuals voluntarily admitted to a CSU for treatment of
					 mental illness or SED have the right to be discharged within four hours of a
					 request for release unless the individual's treating physician, (or another
					 physician, if the treating physician, is not available) determines that there
					 is cause to believe the individual might meet the criteria for emergency
					 detention.
(b) When a CSU staff
					 member is informed that a voluntarily-admitted individual wants to leave the
					 CSU, or the individual's LAR or adult caregiver requests the individual be
					 discharged, the CSU staff member must, in accordance with Texas Health and
					 Safety Code §
											572.004 and 25 TAC
					 Chapter 404, Subchapter E:
(1) inform the
					 individual, and the individual's LAR or adult caregiver, if applicable, that
					 the request must be in writing and signed, timed, and dated by the requestor;
					 if the request for discharge is verbal, then the four hours begins at the time
					 of a verbal request and must be documented in the medical record. Inform the
					 individual or the individual's LAR of the potential four-hour delay from the
					 time of the verbal request;
(2)
					 assist the individual as soon as possible, with documenting the verbal request
					 for discharge or creating a written request for discharge and presenting the
					 request to the individual for the individual's signature; and
(3) inform the LAR or adult caregiver to
					 submit written approval to the CSU administrator, or administrator's designee,
					 for the CSU treating physician to discharge an individual younger than 18 years
					 of age if the LAR or adult caregiver signed for the individual's admission to
					 the CSU.