reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 417 - AGENCY AND FACILITY RESPONSIBILITIES › Subchapter K - ABUSE, NEGLECT, AND EXPLOITATION IN TDMHMR FACILITIES › Section 417.508 - Responsibilities of the Head of the Facility

Current through Reg. 49, No. 28; July 12, 2024
(a) All allegations are investigated in accordance with Chapter 711 of
											  Title 40 (concerning Investigations in TDMHMR Facilities and Related Programs).
(b) Immediately upon notification of an allegation by the APS investigator,
											  the head of the facility takes measures to ensure the safety of the alleged victim(s), including the
											  following actions:
(1) As necessary, the head of the facility ensures
											  immediate and on-going medical attention is provided to the alleged victim and any other person served
											  involved in the incident (e.g., examination for and treatment of injuries, screening and treatment for
											  sexually transmitted diseases). The examination and treatment of abuse/neglect-related injuries is documented
											  on the client injury assessment, with a copy submitted to the APS investigator. All issues relating to
											  clinical practice are referred to the medical/clinical director for consultation.
(2) The head of the facility ensures the protection of the alleged victim.
											  Action taken to ensure the protection of the alleged victim must be appropriate within the context of the
											  allegation and may include:
(A) reassigning the employee/agent to a
											  non-direct care area in accordance with the Human Resources Operating Instruction 407-12;
(B) allowing the employee/agent to remain in his or her current position
											  pending investigation;
(C) granting the employee emergency leave
											  in accordance with the Human Resources Operating Instruction 407-12; or
(D) suspending the agent pending investigation.
(3) As necessary, the head of the facility ensures psychological attention
											  is provided to the alleged victim and any other person served who may have witnessed or been affected by the
											  incident. The psychological attention shall be provided in a timely manner while preserving the integrity of
											  the investigation.
(4) If the alleged perpetrator is known but is
											  not an employee/agent (e.g., family member, friend, guest), the head of the facility imposes a restriction on
											  the alleged perpetrator's access to the alleged victim pending investigation. The restriction should be
											  documented in the record of the alleged victim.
(5) Immediately,
											  but in no case later than 24 hours after notification of an allegation, the head of the facility notifies the
											  following individuals of the allegation:
(A) the alleged victim (if
											  appropriate); and
(B) the alleged victim's guardian or primary
											  contact (as defined), or parent if the alleged victim is a child.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 417 - AGENCY AND FACILITY RESPONSIBILITIES › Subchapter K - ABUSE, NEGLECT, AND EXPLOITATION IN TDMHMR FACILITIES › Section 417.509 - Peer Review

Current through Reg. 49, No. 28; July 12, 2024
(a) If the allegation involves the actions of a physician, dentist,
											  pharmacist, registered nurse, or licensed vocational nurse, then a determination of whether the allegation
											  involves the clinical practice, as defined in §
										417.503 of this title (relating to Definitions), of
											  the physician, dentist, pharmacist, registered nurse, or licensed vocational nurse is made by the head of the
											  facility, the APS investigator, and the facility medical\dental\nursing\pharmacy director, as appropriate to
											  the discipline involved.
(1) If the allegation does not involve clinical
											  practice the APS investigator pursues an investigation.
(2) If
											  the allegation does involve clinical practice the APS investigator refers the allegation to the head of the
											  facility, who immediately refers the allegation to the facility medical\dental\nursing\pharmacy director, as
											  appropriate to the discipline involved, for review for possible peer review as follows:
(A) for allegations involving physicians, pharmacists, and dentists,
											  Investigative Medical Peer Review Operating Instruction 417-19; and
(B) for allegations involving registered nurses and licensed vocational
											  nurses, Investigative Nursing Peer Review Operating Instruction 408-1.
(3) If the allegation involves clinical practice and non-clinical issues,
											  then the allegation is referred to peer review in accordance with paragraph (2) of this subsection and is
											  investigated by the APS investigator.
(4) If a determination of
											  whether the allegation involves clinical practice cannot be made, then:
(A)
											  the allegation is referred to peer review in accordance with paragraph (2) of this subsection and is
											  investigated by the APS investigator; or
(B) the regional APS
											  program administrator and the head of the facility jointly agree to use a previously mutually agreed-upon
											  physician/dental/nursing/pharmacy consultant, as appropriate to the discipline involved, to make the final
											  determination within 24 hours. The facility is responsible for the costs of the consultant's
											  services.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 417 - AGENCY AND FACILITY RESPONSIBILITIES › Subchapter K - ABUSE, NEGLECT, AND EXPLOITATION IN TDMHMR FACILITIES › Section 417.510 - Completion of the Investigation

Current through Reg. 49, No. 28; July 12, 2024
(a) The APS investigator sends a copy of the
											  investigative report to the head of the facility in accordance with Chapter 711, Subchapter G of Title 40
											  (concerning Release of Report and Findings). The investigative report includes:
(1) a statement of the allegation(s);
(2) a summary of the investigation;
(3) an analysis of the evidence, including:
(A) factual information related to what occurred;
(B) how the evidence was weighed; and
(C) what testimony was considered credible;
(4) a finding that the allegation is confirmed, unconfirmed, inconclusive,
											  or unfounded;
(5) recommendations resulting from the
											  investigation;
(6) the name of the perpetrator or alleged
											  perpetrator or the designation of "perpetrator unknown";
(7) a
											  recommended classification for each allegation as described in §
											417.512(a)
											  of this title (relating to Classifications and Disciplinary Actions);
(8) the exam and treatment of abuse/neglect-related injuries documented on
											  the client injury assessment;
(9) photographs relevant to the
											  investigation, including photographs showing the existence of injuries or the non-existence of injuries, when
											  appropriate;
(10) all witness statements and supporting
											  documents; and
(11) a signed and dated Client Abuse and Neglect
											  Report (AN-1-A) form, referenced as Exhibit E in §
											417.516 of this title (relating to Exhibits),
											  reflecting the information contained in paragraphs (4), (6), and (7) of this section.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 417 - AGENCY AND FACILITY RESPONSIBILITIES › Subchapter K - ABUSE, NEGLECT, AND EXPLOITATION IN TDMHMR FACILITIES › Section 417.511 - Confidentiality of Investigative Process and Report

Current through Reg. 49, No. 28; July 12, 2024
(a) The reports, records, and working papers used by or developed in the
											  investigative process, and the resulting investigative report, are confidential and may be disclosed only as
											  allowed by law or Chapter 711 of Title 40 (concerning Investigations in TDMHMR Facilities and Related
											  Programs).
(b) Upon request, the head of the facility will
											  provide a copy of the investigative report to the (alleged) victim or guardian with the identities of other
											  persons served and any information determined confidential by law concealed. The head of the facility may
											  charge a reasonable fee for providing a copy of the investigative report.
(c) Advocacy, Inc. is entitled to access the records of the (alleged)
											  victim in accordance with 42 USC §10805(a)(4)
											  (Protection and Advocacy for Mentally Ill Individuals) or
											  42 USC
											  §15043(a)(2)(I) (Protection and Advocacy of
											  Individual Rights).
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 417 - AGENCY AND FACILITY RESPONSIBILITIES › Subchapter K - ABUSE, NEGLECT, AND EXPLOITATION IN TDMHMR FACILITIES › Section 417.512 - Classifications and Disciplinary Actions

Current through Reg. 49, No. 28; July 12, 2024
(a) The APS investigator recommends a classification for each allegation as
											  follows:
(1) Class I Abuse, if the allegation involves:
(A) physical abuse which caused or may have caused serious physical injury;
											  or
(B) sexual abuse.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 417 - AGENCY AND FACILITY RESPONSIBILITIES › Subchapter K - ABUSE, NEGLECT, AND EXPLOITATION IN TDMHMR FACILITIES › Section 417.513 - Contractors

Current through Reg. 49, No. 28; July 12, 2024
The head of the facility is responsible for requiring that all of
													 the facility's contractors comply with this subchapter with the exception of §
										417.512 of this title
													 (relating to Classifications and Disciplinary Actions) and §
										417.514 of this title
													 (relating to TDMHMR Administrative Responsibilities). The head of the facility shall ensure that each
													 contractor is provided a copy of TDPRS's rules governing investigations in TDMHMR facilities and related
													 programs, 40 TAC Chapter 711. Each contract shall describe the procedural responsibilities of the facility
													 and the contractor regarding at least the following:
(1) the
											  reporting of allegations of abuse, neglect, and exploitation;
(2)
											  the safety and protection of persons served involved in allegations;
(3) the facilitation of proper investigations/peer reviews and the
											  preservation of the integrity of investigations/peer reviews;
(4)
											  the notification of appropriate licensing authorities and other individuals regarding issues relating to
											  allegations;
(5) taking proper disciplinary action or other
											  appropriate action; and
(6) staff training in identifying,
											  reporting, and preventing abuse, neglect, and exploitation.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 417 - AGENCY AND FACILITY RESPONSIBILITIES › Subchapter K - ABUSE, NEGLECT, AND EXPLOITATION IN TDMHMR FACILITIES › Section 417.514 - TDMHMR Administrative Responsibilities

Current through Reg. 49, No. 28; July 12, 2024
TDMHMR will implement systems to ensure that:
(1) former employees with confirmed Class I Abuse and former employees who
											  were dismissed because of confirmed abuse or neglect and whose dismissal is upheld at a grievance hearing or
											  who fail to request a grievance hearing are not eligible for reemployment at any facility; and
(2) former employees with confirmed abuse, neglect, or exploitation
											  regardless of classification are not eligible for reemployment at any TDMHMR-operated ICF/MR
											  facility.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 417 - AGENCY AND FACILITY RESPONSIBILITIES › Subchapter K - ABUSE, NEGLECT, AND EXPLOITATION IN TDMHMR FACILITIES › Section 417.515 - Staff Training in Identifying, Reporting, and Preventing Abuse, Neglect, and Exploitation

Current through Reg. 49, No. 28; July 12, 2024
(a) This subchapter shall be thoroughly and periodically explained to all
											  employees/agents of each facility as follows:
(1) All new employees/agents
											  who will provide direct services to persons served and all new employees/agents who will routinely perform
											  job duties in proximity to persons served shall receive training on the contents of this subchapter prior to
											  performing their duties and annually thereafter. The training will include:
(A) an explanation and examples of the acts and signs of possible abuse,
											  neglect, and exploitation;
(B) the effects of abuse, neglect, and
											  exploitation;
(C) an explanation that abuse, neglect, and
											  exploitation of persons served is prohibited;
(D) the
											  disciplinary consequences for:
(i) committing abuse, neglect, and
											  exploitation; and
(ii) failure to cooperate with an
											  investigation;
(E) the procedures for reporting
											  allegations of abuse, neglect, and exploitation;
(F) a definition
											  of retaliatory action, an explanation that retaliatory action is prohibited, and an explanation of the
											  consequences of retaliatory action;
(G) practices and attitudes
											  that support the prevention of abuse, neglect, and exploitation; and
(H) PMAB.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 417 - AGENCY AND FACILITY RESPONSIBILITIES › Subchapter K - ABUSE, NEGLECT, AND EXPLOITATION IN TDMHMR FACILITIES › Section 417.516 - Exhibits

Current through Reg. 49, No. 28; July 12, 2024
The following exhibits referenced in this subchapter are available
													 from the Texas Department of Mental Health and Mental Retardation, Office of Policy Development, P.O. Box
													 12668, Austin, TX 78711-2668.
(1) Exhibit A--Texas Civil Practice
											  and Remedies Code, §
										81.001 and
											  §
										81.006;
(2) Exhibit B--"Guidelines for Securing Evidence";
(3) Exhibit C--Memorandum of Understanding between TDMHMR, TDHS, and TDPRS
											  concerning Reportable Incidents in State Schools, State Centers, State Operated Community-based MHMR
											  Services, and Community MHMR Centers with Intermediate Care Facilities for the Mentally Retarded
											  (ICF/MR);
(4) Exhibit D--Memorandum of Understanding between
											  TDPRS, Texas Board of Medical Examiners, and TDMHMR concerning Mandatory Reporting of Physician Misconduct or
											  Malpractice;
(5) Exhibit E--Client Abuse and Neglect Report
											  (AN-1-A) form;
(6) Exhibit F--"Procedures in Facility Abuse,
											  Neglect, and Exploitation Investigations and
Thurston
Rebuttal Proceedings"; and
(7) Exhibit G--"Therapeutic Reconciliation."
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 417 - AGENCY AND FACILITY RESPONSIBILITIES › Subchapter K - ABUSE, NEGLECT, AND EXPLOITATION IN TDMHMR FACILITIES › Section 417.517 - References

Current through Reg. 49, No. 28; July 12, 2024
Reference is made to the following statutes, rules, and TDMHMR
													 operating instructions:
(1) Texas Health and Safety Code, Chapters
											  242, 481, and 577;
(2) Probate Code, Chapter 13;
(3) Whistleblower Act, Texas Civil Statutes, Article 6252-16a;
(4) Texas Penal Code, §§
										22.011,
											  22.021,
											  43.01, and
											  43.21;
(5) Texas Family Code, Chapter 31;
(6) Chapter 404, Subchapter E of this title (relating to Rights of Persons
											  Receiving Mental Health Services);
(7) Chapter 405, Subchapter F
											  of this title (relating to Voluntary and Involuntary Behavioral Interventions in Mental Health
											  Programs;
(8) Chapter 405, Subchapter H of this title (relating
											  to Behavior Management--Facilities Serving Persons With Mental Retardation);
(9) Chapter 711 of Title 40 (concerning Investigations in TDMHMR Facilities
											  and Related Programs).
(10) Human Resources Operating Instruction
											  407-12;
(11) Investigative Medical Peer Review Operating
											  Instruction, 417-19;
(12) Investigative Nursing Peer Review
											  Operating Instruction, 408-1;
(13) Texas Civil Practice and
											  Remedies Code, §
										81.006;
											  and
(14)
										42 USC
											  §10805(a)(4) and §
										15043(a)(2)(I).
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 417 - AGENCY AND FACILITY RESPONSIBILITIES › Subchapter K - ABUSE, NEGLECT, AND EXPLOITATION IN TDMHMR FACILITIES › Section 417.518 - Distribution

Current through Reg. 49, No. 28; July 12, 2024
(a) This subchapter will be distributed to:
(1) members of the Texas Mental Health and Mental Retardation
											  Board;
(2) members of the Board of the Texas Department of
											  Protective and Regulatory Services;
(3) Central Office executive,
											  management, and program staff;
(4) the head of each
											  facility;
(5) advocacy organizations;
(6) the Texas Board of Medical Examiners;
(7) the State Board of Dental Examiners;
(8) the Board of Nurse Examiners for the State of Texas;
(9) the Board of Vocational Nurse Examiners; and
(10) the Texas State Board of Pharmacy.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 419 - MENTAL HEALTH SERVICES - MEDICAID STATE OPERATING AGENCY RESPONSIBILITIES › Subchapter J - INSTITUTIONS FOR MENTAL DISEASES › Section 419.371 - Purpose and Application

Current through Reg. 49, No. 28; July 12, 2024
The purpose of this subchapter is to describe the criteria used to
													 determine whether a provider is eligible to receive Medicaid reimbursement for inpatient hospital services to
													 people aged 65 and older in an institution for mental diseases (IMD) and to describe the methods by which
													 patient and provider eligibility are established and reimbursement for covered services is accomplished. This
													 subchapter applies to all IMD providers.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 419 - MENTAL HEALTH SERVICES - MEDICAID STATE OPERATING AGENCY RESPONSIBILITIES › Subchapter J - INSTITUTIONS FOR MENTAL DISEASES › Section 419.373 - 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) Department--The Department of State Health Services or its
											  designee.
(2) HHSC--The Health and Human Services Commission or
											  its designee.
(3) Inpatient hospital services--Services provided
											  under the supervision of a physician in an IMD that meets the requirements for psychiatric hospitals in
											  42 CFR §482.60(b),
											  (c), and (d) and meets utilization review requirements in
											  42 CFR §482.30(a), (b), (d),
											  and (e) unless the utilization review requirements have been waived
											  pursuant to §1903(i)(4) of the Social Security Act and 42 CFR Part 456, Subpart H.
(4) Institution for mental diseases (IMD)--A hospital of more than 16 beds
											  that is primarily engaged in providing psychiatric diagnosis, treatment, and care of individuals with mental
											  diseases, including medical care, nursing care, and related services.
(5) IMD provider--An IMD that has an agreement with the department to
											  provide IMD services.
(6) IMD services--Inpatient hospital
											  services provided by an IMD provider for the care and treatment (including room and board) of individuals
											  with mental diseases including, but not limited to:
(A) initiation,
											  titration, or change in medication;
(B) monitoring and assessing
											  by qualified mental health professionals;
(C) suicide
											  precautions;
(D) redirection of inappropriate behaviors and/or
											  reinforcement of appropriate behaviors;
(E) group and individual
											  therapies;
(F) structured skills training activities;
											  and
(G) nursing services.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 419 - MENTAL HEALTH SERVICES - MEDICAID STATE OPERATING AGENCY RESPONSIBILITIES › Subchapter J - INSTITUTIONS FOR MENTAL DISEASES › Section 419.374 - Eligible Population

Current through Reg. 49, No. 28; July 12, 2024
(a) IMD provider reimbursement is limited to IMD services provided to
											  individuals:
(1) who are age 65 years or older;
(2) who have one or more mental disease;
(3) who have no acceptable alternate placement as determined by the
											  individual's treatment team;
(4) who are eligible for
											  participation in the Texas Medicaid program;
(5) who are not
											  eligible for medical compensation from other payment sources;
(6)
											  who have been certified by a licensed physician to need inpatient hospitalization for the care and treatment
											  of a mental disease;
(7) who meet all other federal, state, and
											  local regulations applicable to admission to a mental hospital; and
(8) for whom the department has authorized IMD services based on medical
											  necessity, as follows:
(A) Requests for initial authorization for IMD
											  services must be submitted to the department within seven calendar days after the first day for which
											  Medicaid reimbursement for the provision of IMD services will be requested.
(B) Requests for authorization of continued stay must be submitted no later
											  than seven calendar days prior to the end date of the initial and all subsequent authorizations. Initial and
											  continued stay authorizations are valid for up to 31 calendar days.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 419 - MENTAL HEALTH SERVICES - MEDICAID STATE OPERATING AGENCY RESPONSIBILITIES › Subchapter J - INSTITUTIONS FOR MENTAL DISEASES › Section 419.375 - IMD Provider Eligibility for Reimbursement

Current through Reg. 49, No. 28; July 12, 2024
(a) To be eligible for reimbursement for IMD
											  services, an IMD provider must:
(1) submit an approved application for
											  enrollment through means established by the department, to include evidence that the provider:
(A) meets the Medicare conditions of participation referenced in
											  42 CFR
											  §482.60(b);
(B) is accredited by the Joint Commission on Accreditation of Healthcare
											  Organizations (JCAHO);
(C) if applicable, licensed as a mental
											  hospital under the Texas Health and Safety Code, Chapter 577; and
(D) has a consistent historical pattern of accepting persons involuntarily
											  committed for inpatient mental health treatment as evidenced by having provided mental health services to a
											  minimum of 20 persons, 65 years of age or older, involuntarily committed for inpatient mental health
											  treatment under the Texas Health and Safety Code, Chapters 573 and 574, during the two-year period
											  immediately preceding the date of application for participation.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 419 - MENTAL HEALTH SERVICES - MEDICAID STATE OPERATING AGENCY RESPONSIBILITIES › Subchapter J - INSTITUTIONS FOR MENTAL DISEASES › Section 419.376 - IMD Provider Reimbursement and Termination

Current through Reg. 49, No. 28; July 12, 2024
(a) Reimbursement for IMD services provided to
											  eligible individuals begins on the date established by written notice from the department and is contingent
											  upon validation of evidence of IMD provider eligibility as described in §
										419.375(c)
											  of this title (relating to IMD Provider Eligibility for Reimbursement).
(b) An IMD provider's agreement with the department is subject to
											  termination with written notice on the date that any of the following occurs:
(1) loss of Medicare and/or JCAHO certification;
(2) if applicable, loss of licensure as a psychiatric hospital;
(3) failure to meet requirements specified in
											  42
											  CFR §440.140(a) pertaining to providers of inpatient
											  hospital services in institutions for mental diseases;
(4)
											  demonstrated noncompliance with those provisions of the Texas Administrative Code, Title 25, Part I, that
											  relate to patient care and treatment in inpatient mental health facilities, or with state laws governing
											  admission and treatment of persons with mental illness;
(5)
											  breach of the written provider agreement described in §
											419.375(a)(2)
											  of this title (relating to IMD Provider Eligibility for Reimbursement);
(6) termination of participation as a Medicaid provider by HHSC;
											  or
(7) evidence of noncompliance with the rules in this
											  subchapter or a corrective action plan that is based on findings made by the department in a review described
											  in §
											419.375(c)
											  of this title.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 419 - MENTAL HEALTH SERVICES - MEDICAID STATE OPERATING AGENCY RESPONSIBILITIES › Subchapter J - INSTITUTIONS FOR MENTAL DISEASES › Section 419.377 - Discharge Criteria

Current through Reg. 49, No. 28; July 12, 2024
IMD providers must be in compliance with the following rules, as
													 applicable, regarding discharge of individuals receiving IMD services:
(1) Chapter 412, Subchapter D of this title (relating to Mental Health
											  Services--Admission, Continuity and Discharge; and
(2) Chapter
											  411, Subchapter J of this title (relating to Standards of Care and Treatment in Psychiatric
											  Hospitals).
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 419 - MENTAL HEALTH SERVICES - MEDICAID STATE OPERATING AGENCY RESPONSIBILITIES › Subchapter J - INSTITUTIONS FOR MENTAL DISEASES › Section 419.379 - Distribution

Current through Reg. 49, No. 28; July 12, 2024
This subchapter shall be distributed to:
(1) executive management, and program staff of Central Office;
(2) chief executive officers of all IMD providers; and
(3) advocacy organizations.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 421 - HEALTH CARE INFORMATION › Subchapter A - COLLECTION AND RELEASE OF HOSPITAL DISCHARGE DATA › Section 421.2 - Collection of Hospital Discharge Data

Current through Reg. 49, No. 28; July 12, 2024
(a) All hospitals in operation for all or any of the reporting periods
											  described in §
										421.3 of this title
											  (relating to Schedule for Filing Discharge Reports) shall submit discharge claims as specified in §
										421.9 of this
											  title (relating to Discharge Reports--Records, Data Fields and Codes) on all discharged inpatients to DSHS.
											  To the extent the admission, treatment, or discharge is made by a health professional, other than a
											  physician, data elements specified in §421.9(d)(36) - (41) of this title shall be filled accordingly or
											  data elements (38) or (41) shall be marked with one of DSHS approved temporary "Physician" or "Other health
											  professional" code numbers and data elements (36)(A) - (C) or (39)(A) - (C) may be left blank. Hospitals
											  owned by the federal government and hospitals exempted may submit hospital discharge claim.
(b) All inpatient discharges shall be reported. Except as noted in
											  paragraphs (1) - (4) of this subsection, one or more discharge claims shall be submitted for each patient for
											  each discharge covering all services and charges from admission through discharge.
(1) Separate discharge claims shall be submitted for mothers and
											  newborns.
(2) Hospitals shall either submit separate discharge
											  claims corresponding to each interim, revised, or final discharge claims or submit a single consolidated
											  final discharge claim for each discharged patient.
(3) For all
											  patients for which the hospital prepares one or more bills for inpatient services, the hospital shall submit
											  a discharge claim corresponding to each bill containing the data elements required by §
											421.9 of this
											  title. For all patients for which the hospital does not prepare a bill for inpatient services, the hospital
											  shall submit a discharge claim containing the required minimum data set.
(4) For all patients that are covered by
											  42 USC §
												290dd-2 and 42 CFR Part 2.1, a hospital shall submit a discharge claim
											  containing the required data elements specified by §
											421.9 of this
											  title. The hospital shall replace the patient identifying information with the default values specified in
											  §
											421.9(f)
											  of this title or submit the patient identifying information if release of patient identifying information is
											  authorized in writing by the patient or patient's guardian.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 421 - HEALTH CARE INFORMATION › Subchapter A - COLLECTION AND RELEASE OF HOSPITAL DISCHARGE DATA › Section 421.3 - Schedule for Filing Discharge Reports

Current through Reg. 49, No. 28; July 12, 2024
(a) Hospitals shall file discharge reports according to the following
											  schedule as shown in paragraphs (1) - (4) of this subsection unless a hospital has received an exemption
											  letter from DSHS.
(1) Each discharge report covering inpatient discharges
											  occurring between January 1 and March 31, inclusive, shall be submitted no later than June 1 of the calendar
											  year in which the discharge occurred.
(2) Each discharge report
											  covering inpatient discharges occurring between April 1 and June 30, inclusive, shall be submitted no later
											  than September 1, of the calendar year in which the discharge occurred.
(3) Each discharge report covering inpatient discharges occurring between
											  July 1 and September 30, inclusive, shall be submitted no later than December 1 of the calendar year in which
											  the discharge occurred.
(4) Each discharge report covering
											  inpatient discharges occurring between October 1 and December 31, inclusive, shall be submitted no later than
											  March 1 of the year following the year in which the discharge occurred.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 421 - HEALTH CARE INFORMATION › Subchapter A - COLLECTION AND RELEASE OF HOSPITAL DISCHARGE DATA › Section 421.4 - Instructions for Filing Discharge Reports

Current through Reg. 49, No. 28; July 12, 2024
(a) Portable Data Storage Media. A discharge report may be filed on
											  computer diskettes, USB flash drive, or other portable data storage media approved by DSHS. All discharges
											  shall be reported using the same file and record formats specified in §
										421.9 of this
											  title (relating to Discharge Reports--Records, Data Fields and Codes) regardless of medium.
(1) Media specifications are:
(A) Optical
											  Media: Devices or disc that uses digital optical disc data storage format, for example Compact Disc (CD) or
											  Digital Video Disc (DVD): MS-DOS formatted; PC Text file (ASCII).
(B) Universal Serial Bus (USB) flash drive: portable data memory device
											  using flash memory with a USB interface.
(C) Other electronic,
											  magnetic or other portable data storage media: Discharge reports may be filed on other data storage media
											  only with the prior written approval of DSHS. DSHS will not normally approve any medium which DSHS is not
											  currently equipped to read.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 421 - HEALTH CARE INFORMATION › Subchapter A - COLLECTION AND RELEASE OF HOSPITAL DISCHARGE DATA › Section 421.6 - Acceptance of Discharge Reports and Correction of Errors

Current through Reg. 49, No. 28; July 12, 2024
(a) To verify the accuracy of all discharge
											  claims prior to public release, DSHS shall establish procedures for the review of all discharge reports to
											  determine whether the report is acceptable, as required by Health and Safety Code, §
										108.011.
(b) Upon receipt of a discharge report, DSHS shall determine if it
											  satisfies minimum criteria for processing. If it does not, DSHS shall return the discharge report in the same
											  submission format and media that is approved for that provider and state the deficiencies in writing within
											  ten calendar days of receipt. The hospital shall resubmit the report within ten calendar days of notification
											  by DSHS. A discharge report does not meet minimum standards for processing under the following circumstances
											  as shown in paragraphs (1) - (3) of this subsection.
(1) The physical media
											  and labeling do not conform to the specifications in §
											421.4 of this title
											  (relating to Instructions for Filing Discharge Reports).
(2) The
											  physical media are unreadable due to physical damage.
(3) The
											  file structure does not conform to the specifications in §
											421.9 of this
											  title (relating to Discharge Reports--Records, Data Fields and Codes), unless the hospital has received a
											  letter from DSHS authorizing filing in another format.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 421 - HEALTH CARE INFORMATION › Subchapter A - COLLECTION AND RELEASE OF HOSPITAL DISCHARGE DATA › Section 421.8 - Hospital Discharge Data Creation

Current through Reg. 49, No. 28; July 12, 2024
(a) DSHS records are public records under Government Code, Chapter 552,
											  except as specifically exempted by Health and Safety Code, §
										108.010
											  and §
										108.013. Copies of
											  such records may be obtained upon request and upon payment of user fees established by DSHS. The public use
											  data files shall be available for public inspection during normal business hours within ten business days of
											  a written or oral request. Discharge claims in the original format as submitted to DSHS are not available to
											  the public, are not stored at DSHS' office and are exempt from disclosure pursuant to Health and Safety Code,
											  §
										108.010
											  and §
										108.013, and shall
											  not be released. Likewise, patient and physician identifying data collected by DSHS through editing of
											  hospital data shall not be released.
(b) Creation of codes and
											  identifiers. DSHS shall develop the following codes and identifiers, as listed in paragraphs (1) - (2) of
											  this subsection, required for creation of the public use data file and for other purposes.
(1) The executive director shall create a process for assigning uniform
											  patient identifiers, uniform physician identifiers and uniform other health professional identifiers using
											  data elements collected. This process is confidential and not subject to public disclosure. Any documents or
											  records produced describing the process or disclosing the person associated with an identifier are
											  confidential and not subject to public disclosure.
(2) The
											  executive director shall create a process for assigning geographic identifiers to each discharge
											  record.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 421 - HEALTH CARE INFORMATION › Subchapter B - COLLECTION AND REPORTING OF HEALTH PLAN EMPLOYER DATA AND INFORMATION SET (HEDIS) FROM HEALTH MAINTENANCE ORGANIZATIONS (HMOS) › Section 421.21 - Purpose

Current through Reg. 49, No. 28; July 12, 2024
The purpose of these sections is to establish a data collection and
													 reporting system for health maintenance organizations (HMOs) in the State of Texas.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 421 - HEALTH CARE INFORMATION › Subchapter B - COLLECTION AND REPORTING OF HEALTH PLAN EMPLOYER DATA AND INFORMATION SET (HEDIS) FROM HEALTH MAINTENANCE ORGANIZATIONS (HMOS) › Section 421.22 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this chapter, shall have
													 the following meanings, unless the context clearly indicates otherwise.
(1) Council--The Texas Health Care Information Council.
(2) Executive director--The chief administrative officer of the Council,
											  or, in the event the Council is without an executive director, the person designated by the chairperson of
											  the Council to perform the functions and exercise the authority of the executive director.
(3) HEDIS--An acronym for the Health Plan Employer Data and Information
											  Set, published by the National Committee for Quality Assurance. HEDIS is a set of standardized performance
											  measures, designed to allow for the reliable comparison of the performance of managed care health plans.
											  HEDIS covers a broad range of areas: effectiveness of care, accessibility/availability of care, satisfaction
											  with the experience of care, cost of care, stability of the health plan, informed health care choices, use of
											  services, and plan descriptive information. HEDIS is a registered trademark of NCQA.
(4) HEDIS data--The information the health maintenance organization
											  collects and reports to the Council in accordance with the provisions of this chapter. Data are collected
											  from January 1st through December 31st annually.
(5) HEDIS
											  Guidelines - The version of the HEDIS reporting guidelines as specified by the Council.
(6) HMO--A health maintenance organization as defined in Texas Health
											  Maintenance Organization Act, Texas Insurance Code, Article 20A.02(j), Texas Civil Statutes.
(7) NCQA--The National Committee for Quality Assurance, 2000 L Street,
											  N.W., Suite 500, Washington, D.C.20036.
(8) Reporting set
											  measures--Those measures specified as "Reporting Set Measures" in the HEDIS Guidelines.
(9) Service area- as defined in 28 TAC, Part 1, Chapter 11 Subchapter A
											  §11.2(b)
(10) Service area division - An operation of a HMO
											  corporation that meets one of the following conditions:
(A) a distinct and
											  separate operation of a HMO corporation as opposed to other operations of the corporation serving other
											  distinct and separate geographical service areas;
(B) a separate
											  geographical area whereby the geographical location of an enrollee or a group contract holder is used in
											  determining charges or rates; or
(C) a service area that crosses
											  state lines or international boundaries is considered to have a separate divisional operation in each state
											  or country and requires separate cost centers and reports.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 421 - HEALTH CARE INFORMATION › Subchapter B - COLLECTION AND REPORTING OF HEALTH PLAN EMPLOYER DATA AND INFORMATION SET (HEDIS) FROM HEALTH MAINTENANCE ORGANIZATIONS (HMOS) › Section 421.24 - Verification of Data

Current through Reg. 49, No. 28; July 12, 2024
(a) The entire subset of HEDIS data specified by the Council on November
											  15th of the year for which the data are collected, and reported by the HMO to the Council shall be
											  verified.
(b) HEDIS data shall be verified by HMOs at their own
											  expense.
(c) Verification of HEDIS data shall be by an
											  independent auditor using guidelines as developed by the National Committee for Quality Assurance (NCQA) in
											  effect on November 15th of the year for which the data are collected. If no guidelines have been released by
											  NCQA, the data will be verified in accordance with auditing procedures as specified by the Council. These
											  auditing procedures shall be specified by the Council by November 15th of the year for which the data are
											  collected.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 421 - HEALTH CARE INFORMATION › Subchapter B - COLLECTION AND REPORTING OF HEALTH PLAN EMPLOYER DATA AND INFORMATION SET (HEDIS) FROM HEALTH MAINTENANCE ORGANIZATIONS (HMOS) › Section 421.25 - Civil Penalty

Current through Reg. 49, No. 28; July 12, 2024
Failure to timely report verified HEDIS data is punishable by a
													 civil penalty of not less than $1,000 nor more than $10,000 for each violation as set forth in Health and
													 Safety Code, §
										108.014.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 421 - HEALTH CARE INFORMATION › Subchapter C - RULES RELATING TO REPORTS, DATA REQUESTS AND DATA FEES › Section 421.41 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this subchapter, shall
													 have the following meanings, unless the context clearly indicates otherwise.
(1) DSHS--Department of State Health Services.
(2) Director--Director of the Center for Health Statistics.
(3) Executive Leaders--Executive leaders with the classification of
											  Assistant Deputy Commissioner or above.
(4) Health care
											  facility--
(A) A hospital;
(B)
											  An ambulatory surgical center licensed under Chapter 243;
(C) A
											  chemical dependency treatment facility licensed under Chapter 464;
(D) A renal dialysis facility;
(E) A birthing center;
(F) A
											  rural health clinic;
(G) A federally qualified health center as
											  defined by 42 U.S.C. §
												1396d(l)(2)(B); or
(H) A freestanding emergency medical care facility, as defined by Texas
											  Health and Safety Code, Section 108.002(10)(I).
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 421 - HEALTH CARE INFORMATION › Subchapter C - RULES RELATING TO REPORTS, DATA REQUESTS AND DATA FEES › Section 421.42 - Procedures for Provider Level Public Information Reports

Current through Reg. 49, No. 28; July 12, 2024
(a) One or more executive leaders of DSHS shall
											  issue a charge to DSHS' staff to produce a provider level public information report.
(b) DSHS staff shall provide a written description of the charge to the
											  executive leader assigning the charge. Clarification of the charge shall be made at this time, if
											  required.
(c) DSHS staff shall submit the written description of
											  the charge to the affected staff member.
(d) DSHS staff shall
											  research, investigate, deliberate or reconcile the charge and generate the outcome or draft of the product
											  requested in the charge.
(e) Upon completion of subsection (d) of
											  this section DSHS staff shall submit this to any additional DSHS staff for recommendations as required by the
											  charge or Chapter 108, Health and Safety Code.
(f) DSHS staff
											  shall submit a report or arrange for a presentation to the executive leader or director, after DSHS staff
											  have made their recommendations or produced the report.
(g) The
											  executive leader may review, discuss, deliberate, or take action on the report or presentation. If the
											  executive leader approves the report or presentation, a recommendation to the director for approval shall be
											  made. If further modifications are required for the report or presentation, the executive leader shall issue
											  a new charge and subsections (a) - (g) of this section shall be followed until a recommendation is approved
											  or is disapproved.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 421 - HEALTH CARE INFORMATION › Subchapter C - RULES RELATING TO REPORTS, DATA REQUESTS AND DATA FEES › Section 421.43 - Technical Documentation regarding Provider Level Public Information Reports

Current through Reg. 49, No. 28; July 12, 2024
(a) The provider level public information report
											  shall provide contact and website information to obtain the technical documentation regarding the provider
											  level public information report.
(b) The provider level public
											  information report technical documentation shall be available to providers reviewing the provider level
											  public information report as required by Health and Safety Code, §
										108.010(e)
											  or §
										108.011(f)
											  and (g).
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 421 - HEALTH CARE INFORMATION › Subchapter C - RULES RELATING TO REPORTS, DATA REQUESTS AND DATA FEES › Section 421.44 - Timeline Requirements for Release of Technical Documentation and Provider Level Public Information Reports

Current through Reg. 49, No. 28; July 12, 2024
(a) DSHS will
											  make available the technical documentation regarding the provider level public information report no less
											  than 7 days prior to the masked provider level public information report being made available to providers
											  for review and comment.
(b) DSHS shall provide access to a paper
											  copy or an electronic copy of the provider level public information report to each hospital named in the
											  report. In providing a copy of the provider level public information report to each named provider, DSHS
											  shall mask the identities of the other providers in the report.
(c) Providers may submit comments regarding the provider level public
											  information report to DSHS.
(1) Any comments shall be submitted to and
											  received by DSHS, on or prior to the date specified by DSHS, which shall not be less than 60 calendar days
											  after notification is sent from DSHS.
(2) Comments shall be
											  submitted on a form created by DSHS .
(3) Comments shall be
											  returned to DSHS in an electronic format specified by DSHS.
(4)
											  Comments received by DSHS shall be posted on DSHS' website with each release of the provider level public
											  information reports.