Texas Administrative Code Title 40

Social Services and Assistance: As effective August 6, 2010

Table of Contents

Part 1

Chapter 1

Subchapter A

§1.1

§1.2

§1.3

§1.4

§1.8

§1.20

§1.21

Subchapter D

§1.151

§1.152

§1.153

§1.154

§1.155

§1.156

§1.157

§1.158

§1.159

§1.160

§1.162

§1.163

Subchapter G

§1.301

§1.302

§1.303

§1.304

§1.305

§1.306

§1.307

§1.308

§1.309

§1.310

§1.311

§1.312

§1.313

§1.314

§1.315

§1.316

Subchapter I

§1.401

§1.402

§1.403

§1.404

§1.405

§1.407

§1.409

§1.411

Chapter 2

Subchapter A

§2.46

Subchapter B

§2.51

§2.52

§2.53

§2.54

§2.55

§2.56

§2.57

§2.58

§2.59

§2.60

§2.61

§2.62

§2.63

§2.64

Subchapter C

§2.101

§2.102

§2.103

§2.105

§2.106

§2.107

§2.108

§2.109

§2.110

§2.111

§2.112

Subchapter D

§2.151

§2.152

Subchapter F

Division 1

§2.251

§2.252

§2.253

§2.254

Division 2

§2.255

§2.256

§2.257

§2.258

§2.259

§2.260

§2.261

§2.262

§2.263

§2.264

§2.265

§2.266

§2.267

§2.268

§2.269

§2.270

Division 3

§2.271

§2.272

§2.273

Division 4

§2.274

§2.275

§2.276

§2.277

§2.278

Division 5

§2.279

§2.280

§2.281

Division 6

§2.282

Division 7

§2.283

Subchapter G

§2.301

§2.302

§2.303

§2.305

§2.307

§2.309

§2.311

§2.313

§2.315

Subchapter L

§2.551

§2.552

§2.553

§2.554

§2.555

§2.556

§2.557

§2.558

§2.559

§2.560

§2.561

§2.562

Chapter 4

Subchapter A

§4.1

§4.2

§4.3

§4.4

§4.5

§4.6

§4.7

§4.8

Subchapter C

§4.101

§4.103

§4.105

§4.107

§4.109

§4.111

§4.113

§4.115

§4.117

§4.119

§4.121

Subchapter D

§4.151

§4.152

§4.153

§4.154

§4.155

§4.156

§4.157

§4.158

§4.159

§4.160

§4.161

§4.162

Subchapter K

§4.501

§4.502

§4.503

§4.504

§4.505

§4.506

§4.507

§4.508

§4.509

Subchapter L

§4.551

§4.552

§4.553

§4.554

§4.555

§4.556

§4.557

§4.558

§4.559

§4.560

§4.561

§4.562

§4.563

§4.564

Subchapter P

§4.751

§4.752

§4.753

§4.754

§4.755

§4.756

§4.757

§4.758

§4.759

§4.760

§4.761

§4.762

§4.763

§4.764

§4.765

Chapter 5

Subchapter A

§5.1

§5.2

§5.3

§5.4

§5.5

§5.6

§5.7

§5.8

§5.9

§5.10

§5.11

§5.12

§5.13

§5.14

Subchapter C

§5.101

§5.102

§5.103

§5.104

§5.105

§5.106

§5.107

§5.108

§5.109

§5.110

§5.111

§5.112

§5.113

§5.114

Subchapter D

§5.151

§5.152

§5.153

§5.154

§5.155

§5.156

§5.157

§5.158

§5.159

§5.160

§5.161

§5.162

§5.163

Subchapter H

§5.351

§5.352

§5.353

§5.354

§5.355

§5.356

§5.357

§5.358

§5.359

§5.360

§5.361

§5.362

§5.363

§5.364

§5.365

§5.366

Subchapter I

§5.401

§5.402

§5.403

§5.404

§5.405

§5.406

§5.407

§5.408

§5.409

§5.410

§5.411

§5.412

Subchapter J

§5.451

§5.452

§5.453

§5.454

§5.455

§5.456

§5.457

§5.458

Chapter 6

Subchapter B

§6.64

§6.65

§6.66

§6.67

Subchapter H

§6.351

§6.352

§6.357

§6.370

Chapter 7

Subchapter A

§7.1

§7.3

§7.6

§7.7

§7.9

§7.14

§7.15

§7.23

§7.27

§7.28

§7.29

§7.33

§7.34

§7.38

Subchapter B

§7.51

§7.52

§7.53

§7.54

§7.55

§7.56

§7.57

§7.58

§7.59

§7.60

§7.61

§7.62

§7.63

§7.64

§7.65

Subchapter C

§7.101

§7.102

§7.103

§7.104

§7.105

§7.106

§7.107

§7.108

§7.109

§7.110

Subchapter D

§7.151

§7.152

§7.153

§7.154

§7.155

§7.156

§7.157

§7.158

§7.159

§7.160

Subchapter K

§7.501

§7.502

§7.503

§7.504

§7.505

§7.507

§7.508

§7.509

§7.510

§7.511

§7.512

§7.513

§7.514

§7.515

§7.516

§7.517

§7.518

Subchapter S

Division 1

§7.901

§7.902

§7.903

§7.904

§7.905

Division 2

§7.906

§7.907

§7.908

§7.909

§7.910

§7.911

§7.912

§7.913

§7.914

§7.915

Division 3

§7.916

§7.917

§7.918

§7.919

§7.920

§7.921

§7.922

§7.923

§7.924

§7.925

Chapter 8

Subchapter C

§8.51

§8.52

§8.53

§8.54

§8.55

§8.56

§8.57

§8.58

§8.59

§8.60

§8.61

§8.62

§8.63

Subchapter I

§8.201

§8.202

§8.203

§8.204

§8.205

§8.206

§8.207

§8.208

§8.209

Subchapter K

§8.261

§8.262

§8.263

§8.264

§8.265

§8.266

§8.267

§8.268

§8.269

§8.270

§8.271

§8.272

§8.273

§8.274

§8.275

§8.276

§8.277

§8.279

Subchapter L

§8.281

§8.282

§8.283

§8.284

§8.285

§8.286

§8.287

§8.288

§8.289

§8.290

§8.291

§8.292

§8.293

§8.294

§8.295

§8.296

§8.297

Chapter 9

Subchapter B

§9.31

§9.32

§9.33

§9.34

§9.35

Subchapter D

§9.151

§9.152

§9.153

§9.154

§9.155

§9.156

§9.157

§9.158

§9.159

§9.160

§9.161

§9.162

§9.163

§9.164

§9.165

§9.166

§9.167

§9.168

§9.169

§9.170

§9.171

§9.172

§9.173

§9.174

§9.177

§9.178

§9.179

§9.185

§9.186

§9.187

§9.188

§9.189

§9.190

§9.191

Subchapter E

Division 1

§9.201

§9.202

§9.203

Division 2

§9.206

§9.207

§9.208

Division 3

§9.211

§9.212

§9.213

§9.214

§9.215

§9.216

§9.217

§9.218

§9.219

Division 4

§9.221

§9.222

§9.223

§9.224

§9.225

§9.226

§9.227

§9.228

Division 5

§9.236

§9.237

§9.238

§9.239

§9.240

§9.241

§9.242

§9.243

§9.244

§9.245

§9.246

§9.247

§9.248

§9.249

§9.250

Division 6

§9.251

§9.252

§9.253

§9.254

§9.255

§9.256

§9.257

§9.258

§9.259

§9.260

§9.261

Division 7

§9.266

§9.267

§9.268

§9.269

Division 8

§9.273

Division 9

§9.274

Division 10

§9.281

§9.282

§9.283

§9.284

§9.285

§9.286

§9.287

§9.288

§9.289

§9.290

§9.291

§9.292

§9.293

§9.294

§9.295

Subchapter G

§9.301

Subchapter N

§9.551

§9.552

§9.553

§9.554

§9.555

§9.556

§9.557

§9.558

§9.559

§9.560

§9.561

§9.562

§9.563

§9.566

§9.567

§9.568

§9.569

§9.570

§9.571

§9.572

§9.573

§9.574

§9.575

§9.576

§9.577

§9.578

§9.579

§9.580

§9.582

§9.583

Subchapter Q

§9.701

§9.702

§9.703

§9.704

§9.705

§9.706

§9.707

§9.708

§9.709

§9.710

§9.711

§9.712

Chapter 10

Subchapter A

§10.101

§10.103

Subchapter B

§10.201

§10.203

§10.205

Subchapter C

§10.301

§10.303

§10.305

§10.307

§10.309

§10.311

§10.313

§10.315

§10.317

§10.319

§10.321

§10.323

§10.325

§10.327

§10.329

§10.331

Subchapter D

§10.401

§10.403

§10.405

Subchapter E

§10.501

§10.503

§10.505

§10.507

§10.509

Chapter 11

§11.1

§11.2

§11.3

§11.4

§11.5

§11.6

§11.7

§11.8

§11.9

Chapter 16

§16.1

§16.2

§16.3

§16.4

Chapter 17

§17.101

§17.103

§17.105

Chapter 18

Subchapter A

§18.1

§18.2

§18.3

§18.4

Subchapter B

§18.11

§18.12

§18.13

§18.14

§18.15

§18.16

Subchapter C

§18.31

§18.32

§18.33

§18.34

§18.35

§18.36

§18.37

§18.38

§18.39

§18.40

§18.41

Subchapter D

§18.51

§18.52

§18.53

§18.54

§18.55

§18.56

§18.57

Chapter 19

Subchapter A

§19.1

Subchapter B

§19.101

Subchapter C

§19.201

§19.202

§19.204

§19.205

§19.206

§19.208

§19.209

§19.210

§19.211

§19.212

§19.214

§19.215

§19.216

§19.218

§19.219

§19.220

Subchapter D

§19.300

§19.301

§19.302

§19.303

§19.304

§19.305

§19.306

§19.307

§19.308

§19.309

§19.310

§19.311

§19.312

§19.313

§19.314

§19.315

§19.316

§19.317

§19.318

§19.319

§19.320

§19.321

§19.322

§19.323

§19.324

§19.325

§19.326

§19.330

§19.331

§19.332

§19.333

§19.334

§19.335

§19.336

§19.337

§19.338

§19.339

§19.340

§19.341

§19.342

§19.343

§19.344

Subchapter E

§19.401

§19.402

§19.403

§19.404

§19.405

§19.406

§19.407

§19.408

§19.409

§19.410

§19.411

§19.412

§19.413

§19.414

§19.415

§19.416

§19.417

§19.418

§19.419

§19.420

§19.421

§19.422

§19.423

Subchapter F

§19.501

§19.502

§19.503

§19.504

§19.505

Subchapter G

§19.601

§19.602

§19.604

§19.606

Subchapter H

§19.701

§19.702

§19.703

§19.704

§19.705

§19.706

Subchapter I

§19.801

§19.802

§19.803

§19.804

§19.805

Subchapter J

§19.901

§19.910

§19.911

Subchapter K

§19.1001

§19.1002

§19.1004

§19.1006

§19.1010

§19.1011

§19.1012

Subchapter L

§19.1101

§19.1102

§19.1103

§19.1104

§19.1107

§19.1108

§19.1109

§19.1110

§19.1111

§19.1113

§19.1115

Subchapter M

§19.1201

§19.1202

§19.1203

§19.1204

§19.1205

§19.1206

§19.1207

§19.1208

§19.1210

Subchapter N

§19.1301

§19.1302

§19.1303

§19.1304

§19.1306

Subchapter O

§19.1401

§19.1402

Subchapter P

§19.1501

§19.1502

§19.1503

§19.1504

§19.1506

§19.1507

§19.1508

§19.1509

§19.1510

Subchapter Q

§19.1601

§19.1602

Subchapter R

§19.1701

Subchapter T

§19.1901

§19.1902

§19.1903

§19.1904

§19.1905

§19.1906

§19.1907

§19.1908

§19.1909

§19.1910

§19.1911

§19.1912

§19.1913

§19.1914

§19.1915

§19.1916

§19.1917

§19.1918

§19.1919

§19.1920

§19.1921

§19.1922

§19.1923

§19.1924

§19.1925

§19.1926

§19.1928

§19.1929

§19.1930

§19.1934

Subchapter U

§19.2002

§19.2004

§19.2006

§19.2008

§19.2009

§19.2010

§19.2011

Subchapter V

Division 1

§19.2102

Division 2

§19.2103

§19.2104

§19.2106

§19.2108

§19.2110

§19.2111

§19.2112

§19.2114

§19.2115

§19.2116

§19.2118

§19.2119

Division 3

§19.2120

§19.2121

§19.2129

§19.2144

§19.2146

§19.2147

§19.2148

§19.2149

§19.2150

§19.2151

Subchapter W

§19.2204

§19.2206

§19.2208

Subchapter X

§19.2301

§19.2302

§19.2304

§19.2306

§19.2308

§19.2310

§19.2312

§19.2314

§19.2316

§19.2318

§19.2320

§19.2322

§19.2324

§19.2326

Subchapter Y

§19.2401

§19.2403

§19.2405

§19.2407

§19.2413

Subchapter Z

§19.2500

Subchapter AA

§19.2601

§19.2602

§19.2603

§19.2604

§19.2605

§19.2606

§19.2607

§19.2608

§19.2609

§19.2610

§19.2611

§19.2612

§19.2613

§19.2614

§19.2615

Chapter 30

Subchapter A

§30.2

§30.4

Subchapter B

§30.10

§30.12

§30.14

§30.16

§30.18

§30.20

Subchapter C

§30.30

§30.32

§30.34

§30.36

Subchapter D

§30.40

Subchapter E

§30.50

§30.52

§30.54

Subchapter F

§30.60

§30.62

Subchapter G

§30.70

Subchapter H

§30.80

§30.82

§30.84

Subchapter I

§30.90

§30.92

Subchapter J

§30.100

Chapter 39

§39.1

§39.2

§39.4

§39.6

§39.8

§39.10

§39.12

§39.14

§39.16

Chapter 40

§40.1

Chapter 41

Subchapter A

§41.101

§41.103

§41.105

§41.107

§41.109

§41.111

Subchapter B

§41.201

§41.203

§41.205

§41.207

§41.209

§41.211

§41.213

§41.215

§41.217

§41.219

§41.221

§41.223

§41.225

§41.227

§41.229

§41.231

§41.233

§41.235

§41.237

§41.239

§41.241

§41.243

Subchapter C

§41.301

§41.303

§41.305

§41.307

§41.309

§41.311

§41.313

§41.315

§41.317

§41.319

§41.321

§41.323

§41.325

§41.327

§41.329

§41.331

§41.333

§41.335

§41.337

§41.339

Subchapter D

§41.401

§41.403

§41.405

§41.407

§41.409

Subchapter E

§41.501

§41.503

§41.505

§41.507

§41.509

§41.511

Subchapter F

§41.601

§41.603

§41.605

Subchapter G

§41.701

Subchapter H

§41.801

Chapter 42

Subchapter A

§42.101

§42.102

§42.103

§42.104

§42.105

Subchapter B

Division 1

§42.201

§42.202

Division 2

§42.211

§42.212

§42.213

§42.214

§42.215

§42.216

§42.217

Division 3

§42.221

§42.222

§42.223

Division 4

§42.231

§42.232

Division 5

§42.241

§42.242

§42.243

§42.244

§42.245

§42.246

§42.247

§42.248

§42.249

Division 6

§42.251

§42.252

Subchapter C

§42.301

Subchapter D

§42.401

§42.402

§42.403

§42.404

§42.405

§42.406

§42.407

Subchapter E

§42.501

§42.502

§42.503

§42.504

§42.505

§42.506

§42.507

§42.508

§42.509

§42.510

§42.511

Subchapter F

Division 1

§42.601

§42.602

§42.603

§42.604

§42.605

§42.606

Division 2

§42.611

§42.612

§42.613

§42.614

§42.615

§42.616

§42.617

§42.618

§42.619

§42.620

Division 3

§42.621

§42.622

§42.623

§42.624

§42.625

§42.626

§42.627

§42.628

§42.629

§42.630

§42.631

§42.632

Division 4

§42.641

Chapter 43

Subchapter A

§43.1

§43.2

§43.3

§43.4

Subchapter B

§43.11

§43.12

§43.13

§43.14

§43.15

§43.16

§43.17

§43.18

§43.19

Subchapter C

§43.21

§43.22

Subchapter D

§43.31

§43.32

§43.33

Subchapter E

§43.41

§43.42

Subchapter F

§43.51

Subchapter G

§43.61

Subchapter H

§43.71

Chapter 44

Subchapter A

§44.1

§44.2

§44.3

§44.4

Subchapter B

Division 1

§44.11

Division 2

§44.21

Division 3

§44.31

§44.32

§44.33

Division 4

§44.41

§44.42

§44.43

Division 5

§44.51

§44.52

Division 6

§44.61

§44.62

§44.63

§44.64

§44.65

Division 7

§44.71

§44.72

Subchapter C

§44.81

§44.82

§44.83

Subchapter D

§44.91

§44.92

§44.93

§44.94

Subchapter E

§44.101

§44.102

§44.103

§44.104

§44.105

§44.106

§44.107

Subchapter F

§44.111

§44.112

Chapter 45

Subchapter C

§45.301

§45.303

§45.305

§45.307

§45.309

§45.311

§45.313

§45.317

§45.319

§45.321

§45.323

§45.325

§45.327

§45.329

§45.331

§45.333

§45.335

§45.337

§45.339

§45.341

§45.343

Subchapter D

§45.401

§45.403

Subchapter E

Division 1

§45.501

§45.503

§45.505

Division 2

§45.521

§45.522

§45.523

§45.524

§45.525

Division 3

§45.531

§45.533

Chapter 46

Subchapter A

§46.1

§46.3

Subchapter B

§46.11

§46.13

§46.15

§46.17

§46.19

§46.21

§46.23

§46.25

Subchapter C

§46.31

§46.33

§46.35

§46.37

§46.39

§46.41

§46.43

§46.45

§46.47

§46.49

§46.51

§46.53

Subchapter D

§46.61

§46.63

§46.65

§46.67

§46.69

§46.71

Chapter 47

Subchapter A

§47.1

§47.3

Subchapter B

§47.11

Subchapter C

§47.21

§47.23

§47.25

Subchapter D

§47.41

§47.43

§47.45

§47.47

§47.49

Subchapter E

§47.57

§47.59

§47.61

§47.63

§47.65

§47.67

§47.69

§47.71

§47.72

§47.73

§47.75

Subchapter F

§47.81

§47.83

§47.85

§47.87

§47.89

Subchapter G

§47.91

Chapter 48

Subchapter A

§48.1201

Subchapter B

§48.1301

Subchapter C

§48.2101

§48.2102

§48.2103

§48.2104

§48.2105

§48.2106

§48.2109

§48.2111

§48.2113

§48.2115

§48.2117

§48.2119

§48.2121

Subchapter D

§48.2301

§48.2302

§48.2303

§48.2304

§48.2305

Subchapter F

§48.2701

§48.2702

§48.2703

§48.2704

§48.2705

§48.2706

§48.2707

§48.2708

§48.2709

§48.2710

§48.2711

§48.2721

§48.2722

§48.2723

§48.2724

§48.2725

Subchapter H

§48.2901

§48.2902

§48.2903

§48.2904

§48.2905

§48.2906

§48.2907

§48.2908

§48.2910

§48.2911

§48.2912

§48.2913

§48.2914

§48.2915

§48.2917

§48.2918

§48.2919

§48.2920

§48.2921

§48.2922

§48.2923

§48.2924

§48.2928

§48.2929

§48.2931

Subchapter I

§48.3901

§48.3902

§48.3903

§48.3904

§48.3905

§48.3906

Subchapter J

§48.6001

§48.6002

§48.6003

§48.6005

§48.6006

§48.6007

§48.6008

§48.6009

§48.6010

§48.6011

§48.6015

§48.6020

§48.6021

§48.6022

§48.6023

§48.6024

§48.6026

§48.6028

§48.6030

§48.6031

§48.6032

§48.6040

§48.6050

§48.6052

§48.6054

§48.6056

§48.6058

§48.6060

§48.6062

§48.6066

§48.6068

§48.6070

§48.6072

§48.6074

§48.6076

§48.6078

§48.6080

§48.6082

§48.6084

§48.6086

§48.6088

§48.6090

§48.6092

§48.6094

§48.6096

§48.6098

§48.6100

§48.6102

§48.6104

§48.6106

§48.6108

Subchapter K

§48.8901

§48.8902

§48.8903

§48.8904

§48.8905

§48.8906

§48.8907

Chapter 49

Subchapter A

§49.1

Subchapter B

§49.11

§49.12

§49.13

§49.14

§49.15

§49.16

§49.17

§49.18

§49.19

§49.20

Subchapter C

§49.31

§49.32

§49.33

Subchapter D

§49.41

§49.42

Subchapter E

§49.51

§49.52

§49.53

§49.54

Subchapter F

§49.61

§49.62

§49.63

Chapter 50

§50.1

§50.2

§50.4

§50.6

§50.8

§50.10

§50.12

§50.14

§50.16

§50.18

§50.20

§50.22

§50.24

§50.26

§50.28

§50.30

§50.32

§50.34

§50.36

§50.38

§50.40

§50.42

§50.44

§50.46

Chapter 51

Subchapter A

§51.101

§51.103

Subchapter B

Division 1

§51.201

§51.203

§51.205

§51.207

Division 2

§51.211

§51.213

§51.215

§51.217

§51.219

§51.221

Division 3

§51.231

§51.233

§51.235

§51.237

§51.241

§51.243

Division 4

§51.251

Subchapter C

Division 1

§51.301

§51.303

§51.305

§51.307

§51.309

Division 2

§51.321

§51.323

§51.325

§51.327

§51.329

§51.331

Subchapter D

Division 1

§51.401

§51.403

§51.405

§51.407

§51.409

Division 2

§51.411

§51.413

§51.415

§51.417

§51.419

Division 3

§51.421

Division 4

§51.431

§51.433

Division 5

§51.441

Division 6

§51.451

Division 7

§51.461

§51.463

§51.465

Division 8

§51.471

§51.473

§51.475

§51.477

§51.479

Subchapter E

§51.501

§51.503

§51.505

§51.507

§51.509

§51.511

§51.513

§51.515

Chapter 52

Subchapter A

§52.101

§52.103

Subchapter B

§52.201

§52.203

Subchapter C

§52.301

§52.303

Subchapter D

§52.401

§52.403

§52.405

§52.407

§52.409

§52.411

§52.413

§52.415

§52.417

§52.419

§52.421

Subchapter E

§52.501

§52.503

Chapter 53

Subchapter A

§53.101

§53.103

§53.105

§53.107

§53.109

§53.111

§53.113

Subchapter B

§53.201

§53.203

§53.205

§53.209

§53.211

§53.213

Subchapter C

§53.301

Subchapter D

§53.401

§53.403

§53.405

§53.407

§53.409

§53.411

§53.413

§53.415

§53.417

Subchapter E

§53.501

Subchapter F

§53.601

§53.603

§53.605

§53.607

§53.609

§53.611

§53.613

§53.615

§53.617

§53.619

Subchapter G

Division 1

§53.701

§53.703

§53.705

§53.707

§53.709

§53.711

§53.713

§53.715

§53.717

Division 2

§53.731

§53.733

§53.735

§53.737

§53.739

§53.741

§53.743

§53.745

§53.747

§53.749

§53.751

§53.753

§53.755

Division 3

§53.761

§53.763

Division 4

§53.771

Division 5

§53.781

§53.783

Division 6

§53.791

§53.793

§53.795

§53.797

§53.799

§53.801

Division 7

§53.811

Division 8

§53.821

Division 9

§53.831

Division 10

§53.841

§53.843

§53.845

§53.847

§53.849

§53.851

Division 11

§53.861

§53.863

§53.865

§53.867

§53.869

§53.871

§53.873

§53.875

§53.877

§53.879

§53.881

§53.883

Division 12

§53.891

§53.893

Division 13

§53.901

§53.903

§53.905

§53.907

§53.909

§53.911

Division 14

§53.921

§53.923

§53.925

§53.927

§53.929

Division 15

§53.931

Division 16

§53.941

Subchapter H

§53.1001

§53.1003

§53.1005

§53.1007

§53.1009

§53.1011

Subchapter I

§53.1101

§53.1103

§53.1105

§53.1107

§53.1109

§53.1111

§53.1113

§53.1115

§53.1117

§53.1119

Subchapter J

§53.1201

§53.1203

§53.1205

§53.1207

§53.1209

§53.1211

Chapter 55

§55.1

§55.3

§55.5

§55.7

§55.9

§55.11

§55.13

§55.15

§55.17

§55.19

§55.21

§55.23

§55.25

§55.27

§55.29

§55.31

§55.33

§55.35

§55.37

§55.39

§55.41

§55.43

Chapter 58

Subchapter A

§58.1

§58.3

Subchapter B

§58.11

§58.13

§58.15

Subchapter C

§58.21

§58.23

§58.25

§58.27

§58.29

§58.31

§58.33

§58.35

§58.37

Subchapter D

§58.41

§58.43

§58.45

§58.47

§58.49

§58.51

§58.53

§58.55

§58.57

§58.59

§58.61

Subchapter E

§58.71

§58.73

§58.75

§58.77

§58.79

Subchapter F

§58.91

§58.93

§58.95

§58.97

§58.99

§58.101

§58.103

Subchapter G

§58.111

§58.113

§58.115

Subchapter H

§58.121

§58.123

Subchapter I

§58.131

§58.133

§58.135

§58.137

Chapter 60

§60.2

§60.4

§60.6

§60.8

§60.10

§60.12

§60.14

§60.16

§60.18

§60.20

§60.22

§60.24

§60.26

Chapter 61

§61.101

§61.102

§61.103

§61.104

§61.105

§61.106

§61.107

Chapter 62

Subchapter A

§62.1

§62.3

§62.5

Subchapter B

§62.11

Subchapter C

§62.21

Subchapter D

§62.31

§62.33

Subchapter E

§62.41

§62.43

Chapter 69

Subchapter A

§69.1

§69.2

§69.3

§69.4

Subchapter B

§69.11

§69.12

§69.13

§69.14

§69.15

§69.16

§69.17

§69.18

§69.19

Subchapter C

§69.31

§69.32

§69.33

§69.34

§69.35

§69.36

§69.37

§69.38

§69.39

§69.40

Subchapter D

§69.51

§69.52

§69.53

§69.54

§69.55

Subchapter E

§69.71

§69.72

§69.73

Subchapter F

§69.81

Subchapter G

§69.91

§69.92

§69.93

Subchapter H

§69.101

§69.102

§69.103

Subchapter I

§69.111

§69.112

§69.113

§69.114

§69.115

§69.116

§69.117

§69.118

Subchapter J

§69.131

§69.132

§69.133

§69.134

§69.135

§69.136

§69.137

§69.138

§69.139

Subchapter K

§69.151

§69.152

§69.153

§69.154

§69.155

§69.156

§69.157

§69.158

§69.159

§69.160

Subchapter L

§69.171

§69.172

§69.173

§69.174

§69.175

§69.176

§69.177

§69.178

§69.179

§69.180

§69.181

§69.182

§69.183

§69.184

§69.185

§69.186

Chapter 71

Subchapter A

§71.101

§71.102

§71.103

Subchapter B

§71.201

§71.202

§71.203

§71.204

§71.205

§71.206

Subchapter C

§71.301

§71.302

§71.303

§71.304

§71.305

§71.306

§71.307

§71.308

§71.309

§71.310

Subchapter D

§71.401

§71.402

§71.403

§71.404

§71.405

Chapter 72

Subchapter A

§72.101

§72.102

§72.103

§72.104

Subchapter B

§72.201

§72.202

§72.203

§72.204

§72.205

§72.206

§72.207

§72.208

§72.209

§72.210

§72.211

§72.212

Subchapter C

§72.301

Subchapter D

§72.401

Subchapter E

§72.501

Subchapter F

§72.601

Subchapter G

§72.801

Subchapter H

§72.1001

Subchapter I

§72.2001

Subchapter J

§72.4001

Subchapter L

§72.5001

Subchapter M

§72.5002

Subchapter N

§72.5003

Chapter 73

Subchapter A

§73.1

§73.2

Subchapter B

§73.100

§73.101

Subchapter C

§73.200

§73.201

§73.202

§73.203

§73.204

§73.205

§73.206

§73.207

§73.208

§73.209

§73.210

§73.211

§73.212

Subchapter D

§73.300

§73.301

§73.302

Subchapter E

§73.400

§73.401

§73.402

§73.403

§73.404

§73.405

§73.406

§73.407

§73.408

§73.409

§73.410

§73.411

§73.412

§73.413

Subchapter F

§73.500

§73.501

Subchapter G

§73.600

Chapter 77

Subchapter A

§77.1

§77.2

Subchapter B

§77.11

§77.12

§77.13

§77.14

§77.15

§77.16

§77.17

Subchapter C

§77.31

§77.32

§77.33

§77.34

§77.35

§77.36

§77.37

§77.38

§77.39

§77.40

§77.41

§77.42

§77.43

§77.44

Chapter 79

Subchapter E

§79.401

§79.402

§79.403

§79.404

§79.406

Subchapter S

§79.1801

§79.1802

§79.1803

§79.1804

§79.1805

§79.1806

Chapter 80

§80.3

Chapter 81

§81.9

§81.11

§81.13

§81.15

§81.17

§81.19

§81.21

§81.23

Chapter 82

§82.39

Chapter 83

§83.3

§83.4

§83.15

§83.17

§83.19

Chapter 85

Subchapter A

§85.2

Subchapter C

§85.201

§85.202

§85.208

Subchapter D

§85.301

§85.302

§85.303

§85.304

§85.305

§85.306

§85.307

§85.308

§85.309

§85.310

Subchapter E

§85.401

Chapter 90

Subchapter A

§90.2

§90.3

Subchapter B

§90.11

§90.12

§90.13

§90.14

§90.15

§90.16

§90.17

§90.18

§90.19

§90.20

§90.21

§90.22

Subchapter C

§90.42

Subchapter D

§90.60

§90.61

§90.62

§90.63

§90.64

§90.65

§90.66

§90.67

§90.68

§90.69

§90.70

§90.71

§90.72

§90.73

§90.74

§90.75

Subchapter F

§90.191

§90.192

Subchapter G

§90.211

§90.212

§90.213

§90.214

§90.215

§90.216

§90.217

Subchapter H

§90.231

§90.232

§90.233

§90.234

§90.235

§90.236

§90.237

§90.238

§90.239

§90.240

§90.241

Subchapter J

§90.281

§90.282

§90.283

§90.284

§90.285

§90.286

§90.287

Subchapter L

§90.321

§90.323

§90.324

§90.325

§90.326

§90.327

§90.328

Chapter 92

Subchapter A

§92.1

§92.2

§92.3

§92.4

§92.5

§92.6

Subchapter B

§92.11

§92.12

§92.13

§92.14

§92.15

§92.16

§92.17

§92.18

§92.19

§92.20

Subchapter C

§92.41

§92.51

§92.53

§92.54

Subchapter D

§92.61

§92.62

§92.63

§92.64

§92.71

§92.72

Subchapter E

§92.81

§92.82

Subchapter F

§92.101

§92.102

§92.103

§92.105

§92.106

Subchapter G

§92.123

§92.124

§92.125

§92.126

§92.127

§92.129

Subchapter H

Division 1

§92.151

§92.152

Division 2

§92.201

§92.202

§92.203

§92.204

§92.205

§92.206

§92.207

§92.208

§92.209

§92.210

§92.211

§92.212

§92.213

§92.214

§92.215

§92.216

§92.217

§92.218

§92.219

§92.220

Division 3

§92.251

§92.252

§92.253

§92.254

§92.255

§92.256

§92.257

§92.258

§92.259

§92.260

§92.261

§92.262

§92.263

§92.264

§92.265

§92.266

§92.267

Division 4

§92.301

§92.302

Division 5

§92.351

§92.352

§92.353

§92.354

§92.355

§92.356

§92.357

§92.358

§92.359

§92.360

§92.361

§92.362

§92.363

§92.364

§92.365

§92.366

§92.367

§92.368

§92.369

§92.370

§92.371

§92.372

§92.373

§92.374

Division 6

§92.401

§92.402

Division 7

§92.451

§92.452

§92.453

§92.454

§92.455

§92.456

Division 8

§92.501

§92.502

§92.503

§92.504

§92.505

§92.506

Division 9

§92.551

Subchapter I

§92.801

Chapter 93

§93.1

§93.2

§93.3

§93.4

§93.5

§93.6

§93.7

§93.8

§93.9

Chapter 94

§94.1

§94.2

§94.3

§94.4

§94.5

§94.6

§94.7

§94.8

§94.9

§94.10

§94.11

Chapter 95

§95.101

§95.103

§95.105

§95.107

§95.109

§95.111

§95.113

§95.115

§95.117

§95.119

§95.121

§95.123

§95.125

§95.127

§95.128

Chapter 96

§96.1

§96.2

§96.3

§96.4

§96.5

§96.6

§96.7

§96.8

Chapter 97

Subchapter A

§97.1

§97.2

§97.3

Subchapter B

§97.11

§97.13

§97.15

§97.17

§97.19

§97.21

§97.23

§97.25

§97.27

§97.29

§97.31

Subchapter C

Division 1

§97.201

Division 2

§97.210

§97.211

§97.212

§97.213

§97.214

§97.215

§97.216

§97.217

§97.218

§97.219

§97.220

§97.222

Division 3

§97.241

§97.242

§97.243

§97.244

§97.245

§97.246

§97.247

§97.248

§97.249

§97.250

§97.251

§97.252

§97.253

§97.254

§97.255

§97.256

§97.257

§97.259

§97.260

Division 4

§97.281

§97.282

§97.283

§97.284

§97.285

§97.286

§97.287

§97.288

§97.289

§97.290

§97.291

§97.292

§97.293

§97.294

§97.295

§97.296

§97.297

§97.298

§97.299

§97.300

§97.301

§97.302

§97.303

Division 5

§97.321

§97.322

Subchapter D

§97.401

§97.402

§97.403

§97.404

§97.405

§97.406

§97.407

Subchapter E

Division 1

§97.501

§97.502

§97.503

§97.505

§97.507

§97.509

Division 2

§97.521

§97.523

§97.525

§97.527

Subchapter F

§97.601

§97.602

§97.603

§97.604

Subchapter G

§97.701

Chapter 98

Subchapter A

§98.1

§98.2

Subchapter B

§98.11

§98.12

§98.13

§98.14

§98.15

§98.16

§98.17

§98.18

§98.19

§98.20

§98.21

§98.22

§98.23

Subchapter C

§98.41

§98.42

§98.43

§98.44

Subchapter D

§98.61

§98.62

§98.63

Subchapter E

§98.81

§98.82

§98.83

§98.84

Subchapter F

§98.91

§98.92

§98.93

§98.94

§98.95

Subchapter G

§98.102

§98.103

§98.104

Subchapter H

§98.201

§98.202

§98.203

§98.204

§98.205

§98.206

§98.207

§98.208

§98.209

§98.210

§98.211

§98.212

Chapter 99

§99.1

§99.2

Chapter 100

Subchapter A

§100.22

Subchapter B

§100.51

§100.52

§100.53

§100.54

§100.55

§100.57

§100.58

§100.64

§100.75

Subchapter C

§100.151

§100.152

§100.153

§100.154

§100.155

§100.156

§100.157

§100.158

§100.159

§100.160

§100.161

§100.162

§100.163

§100.164

§100.165

§100.166

§100.167

§100.168

§100.169

Subchapter F

§100.251

§100.252

§100.253

§100.254

§100.255

§100.256

§100.257

§100.258

§100.259

§100.260

§100.261

§100.262

§100.263

§100.264

§100.265

§100.266

§100.267

Subchapter H

§100.353

§100.354

§100.355

§100.356

§100.358

§100.359

§100.360

§100.361

§100.362

§100.363

§100.364

§100.365

§100.366

§100.367

§100.368

§100.369

§100.371

§100.372

§100.373

§100.374

§100.375

§100.376

§100.377

§100.378

§100.379

§100.380

§100.381

Part 2

Chapter 101

Subchapter A

§101.101

§101.103

§101.105

§101.107

§101.109

§101.111

§101.113

§101.115

§101.117

§101.119

§101.121

§101.123

§101.131

Subchapter B

§101.201

§101.203

§101.209

§101.211

§101.213

Subchapter C

§101.551

§101.553

§101.555

§101.557

Subchapter D

§101.601

§101.603

§101.605

Subchapter F

§101.1001

§101.1003

§101.1005

§101.1007

§101.1009

§101.1011

Subchapter I

Division 3

§101.5751

§101.5753

§101.5755

§101.5757

§101.5759

Subchapter J

Division 1

§101.7001

§101.7003

§101.7005

§101.7007

§101.7009

§101.7011

§101.7013

§101.7015

§101.7017

§101.7019

§101.7021

§101.7023

§101.7025

§101.7027

§101.7029

§101.7031

§101.7033

§101.7035

§101.7037

§101.7039

§101.7041

§101.7043

§101.7045

§101.7047

§101.7049

Division 2

§101.7051

§101.7053

§101.7055

§101.7057

§101.7059

§101.7061

§101.7063

§101.7065

§101.7067

§101.7069

§101.7071

§101.7073

Division 3

§101.8011

§101.8013

§101.8015

Division 4

§101.8051

§101.8053

§101.8055

§101.8057

§101.8059

§101.8061

§101.8063

§101.8065

§101.8067

§101.8069

§101.8071

§101.8073

§101.8075

§101.8077

§101.8079

Chapter 104

Subchapter C

§104.251

§104.253

§104.255

§104.257

§104.259

§104.261

§104.263

Subchapter J

§104.301

Chapter 105

Subchapter A

§105.1001

§105.1003

Subchapter B

§105.1011

§105.1013

§105.1015

§105.1017

§105.1019

Subchapter C

§105.1101

Subchapter D

§105.1201

§105.1203

§105.1205

§105.1207

Subchapter E

§105.1301

§105.1305

§105.1307

§105.1309

§105.1311

§105.1313

§105.1315

§105.1317

Subchapter F

§105.1401

§105.1403

§105.1405

§105.1407

§105.1409

§105.1411

§105.1413

§105.1415

§105.1417

§105.1419

§105.1421

§105.1423

§105.1425

Subchapter G

§105.1501

Chapter 106

Subchapter B

Division 1

§106.302

§106.303

Subchapter C

Division 1

§106.503

§106.505

§106.507

§106.509

§106.513

Division 2

§106.521

§106.523

§106.525

§106.527

§106.529

§106.531

§106.533

§106.535

Division 3

§106.551

§106.553

§106.555

§106.557

§106.559

§106.561

§106.562

§106.564

§106.566

§106.568

§106.572

§106.574

§106.576

§106.578

§106.580

§106.582

Division 4

§106.601

§106.603

§106.605

Division 5

§106.621

§106.623

§106.625

§106.627

§106.629

§106.631

§106.633

Division 6

§106.651

Division 7

§106.661

Division 8

§106.671

§106.673

§106.675

Subchapter D

Division 1

§106.851

§106.853

§106.855

§106.859

Division 2

§106.871

§106.873

§106.875

§106.877

§106.879

§106.881

Division 3

§106.901

§106.903

Division 5

§106.931

§106.933

§106.935

§106.937

§106.939

§106.941

§106.943

Division 6

§106.965

Subchapter F

§106.1101

§106.1103

§106.1105

§106.1107

Subchapter G

§106.1201

§106.1203

§106.1205

§106.1207

§106.1209

§106.1211

§106.1213

§106.1215

§106.1217

§106.1219

§106.1221

§106.1223

§106.1225

§106.1227

§106.1229

§106.1231

§106.1233

Subchapter I

Division 1

§106.1401

§106.1403

§106.1407

§106.1409

§106.1411

§106.1413

Division 2

§106.1421

§106.1423

§106.1425

§106.1427

§106.1429

§106.1431

§106.1433

Division 3

§106.1445

§106.1447

§106.1449

§106.1451

§106.1453

§106.1455

§106.1457

§106.1461

§106.1463

Division 4

§106.1475

Division 5

§106.1485

§106.1487

§106.1489

Division 6

§106.1501

§106.1503

§106.1505

§106.1507

Subchapter K

§106.1601

§106.1607

Subchapter L

§106.1703

Subchapter M

§106.1801

§106.1803

§106.1805

§106.1807

§106.1809

§106.1811

§106.1813

§106.1815

Chapter 107

Subchapter B

Division 1

§107.101

§107.105

§107.107

§107.109

§107.111

§107.113

§107.115

§107.117

§107.119

§107.121

§107.123

§107.125

§107.127

§107.129

§107.131

§107.133

§107.135

§107.137

§107.139

Division 2

§107.151

§107.153

Division 3

§107.171

§107.173

§107.175

Division 4

§107.191

§107.193

§107.195

§107.197

§107.199

Division 5

§107.215

§107.217

§107.219

§107.221

§107.223

§107.225

Subchapter F

§107.801

§107.803

§107.805

§107.806

§107.807

§107.809

§107.811

Subchapter L

§107.1201

§107.1203

§107.1205

§107.1207

§107.1209

Subchapter N

§107.1601

§107.1603

§107.1605

Chapter 108

Subchapter A

§108.1

§108.3

§108.5

§108.7

§108.9

§108.11

§108.13

§108.15

§108.17

§108.19

§108.71

§108.73

§108.75

§108.77

Subchapter B

§108.101

§108.103

§108.105

§108.107

§108.109

§108.111

§108.113

§108.115

§108.117

§108.119

§108.121

§108.123

§108.125

§108.127

§108.129

§108.131

§108.133

§108.135

§108.137

§108.139

Subchapter C

§108.301

§108.303

§108.305

§108.307

§108.309

§108.311

§108.313

§108.315

§108.317

§108.319

§108.321

Subchapter D

§108.401

§108.403

§108.405

§108.407

§108.409

§108.411

§108.413

§108.415

Subchapter E

§108.501

§108.503

§108.505

Subchapter F

§108.601

§108.603

Subchapter G

§108.701

§108.703

§108.705

§108.707

§108.709

§108.711

Chapter 109

Subchapter A

§109.101

§109.103

§109.105

§109.107

Subchapter B

§109.203

§109.205

§109.207

§109.221

§109.223

§109.225

§109.227

§109.228

§109.229

§109.231

§109.233

§109.235

§109.237

Subchapter C

§109.303

§109.305

§109.311

§109.323

§109.325

§109.337

§109.339

§109.361

§109.363

§109.365

§109.367

§109.371

§109.373

Subchapter D

§109.401

§109.403

§109.405

§109.407

§109.409

§109.411

§109.413

§109.415

§109.417

Subchapter E

§109.501

§109.503

Part 5

Chapter 175

Subchapter A

§175.1

§175.2

§175.3

§175.4

§175.5

§175.6

§175.7

§175.8

§175.9

§175.10

§175.11

§175.12

§175.13

§175.14

§175.15

§175.16

§175.17

§175.18

§175.19

§175.20

§175.21

§175.22

§175.23

Subchapter B

§175.51

§175.52

§175.53

§175.54

§175.55

§175.56

§175.57

§175.58

§175.59

§175.60

§175.61

§175.62

Subchapter C

§175.100

§175.101

§175.102

§175.103

§175.104

§175.105

§175.106

§175.107

§175.108

§175.109

§175.110

§175.111

Chapter 176

§176.1

§176.2

§176.3

§176.4

§176.5

§176.6

§176.7

§176.8

§176.9

§176.10

§176.11

Chapter 177

§177.1

§177.2

§177.3

§177.4

§177.5

§177.6

§177.7

§177.8

§177.9

§177.10

§177.11

§177.12

§177.13

§177.14

Chapter 178

§178.1

§178.2

§178.3

§178.4

§178.5

§178.6

Part 7

Chapter 189

§189.1

§189.2

§189.3

§189.4

§189.5

§189.6

§189.7

§189.8

§189.9

§189.10

§189.11

§189.12

§189.13

Part 12

Chapter 361

§361.1

Chapter 362

§362.1

Chapter 363

§363.1

Chapter 364

§364.1

§364.2

§364.3

§364.4

Chapter 367

§367.1

§367.2

§367.3

Chapter 368

§368.1

Chapter 369

§369.1

§369.2

§369.3

Chapter 370

§370.1

§370.2

Chapter 371

§371.1

§371.2

Chapter 372

§372.1

Chapter 373

§373.1

§373.2

§373.3

Chapter 374

§374.1

§374.2

§374.3

§374.4

Chapter 375

§375.1

Chapter 376

§376.1

§376.2

§376.3

§376.4

§376.5

§376.6

§376.7

§376.8

§376.9

§376.10

Part 15

Chapter 450

§450.1

§450.3

§450.5

Chapter 451

§451.1

§451.3

Chapter 452

§452.1

§452.2

§452.3

§452.4

§452.5

§452.6

§452.7

Chapter 453

§453.1

Chapter 454

§454.1

§454.2

§454.3

§454.4

§454.5

§454.6

Chapter 455

§455.1

§455.2

§455.3

§455.4

§455.5

Chapter 456

§456.1

§456.2

§456.3

§456.4

§456.5

§456.6

§456.7

§456.8

§456.9

§456.10

§456.11

§456.12

§456.13

§456.14

§456.15

§456.16

§456.17

Chapter 457

§457.1

Chapter 458

§458.1

§458.2

§458.3

Chapter 459

§459.1

§459.2

§459.3

§459.4

§459.5

§459.6

Part 17

Chapter 601

§601.1

§601.20

§601.30

§601.40

§601.50

§601.60

Chapter 603

§603.1

§603.20

§603.30

§603.40

§603.50

§603.60

Chapter 604

§604.1

Chapter 605

§605.1

§605.3

Part 19

Chapter 700

Subchapter A

§700.104

§700.105

§700.106

Subchapter B

§700.201

§700.202

§700.203

§700.204

§700.205

§700.206

§700.207

§700.209

Subchapter C

§700.308

§700.309

§700.310

§700.311

§700.312

§700.313

§700.314

§700.315

§700.316

§700.317

§700.318

§700.319

§700.320

§700.321

§700.323

§700.324

§700.325

§700.327

§700.328

§700.329

§700.330

§700.331

§700.332

§700.333

§700.345

§700.346

Subchapter D

§700.401

§700.402

§700.403

§700.404

§700.405

§700.406

§700.407

§700.408

§700.409

§700.410

§700.411

§700.412

Subchapter E

§700.501

§700.502

§700.503

§700.504

§700.505

§700.506

§700.507

§700.508

§700.509

§700.510

§700.511

§700.512

§700.513

§700.514

§700.515

§700.516

§700.517

§700.518

§700.519

§700.520

§700.521

§700.523

Subchapter F

§700.601

§700.602

§700.603

§700.604

§700.605

Subchapter G

§700.701

§700.702

§700.703

§700.704

§700.705

§700.706

Subchapter H

Division 1

§700.801

§700.802

§700.803

§700.804

§700.806

§700.807

Division 2

§700.820

§700.821

§700.822

§700.823

§700.824

§700.825

Division 3

§700.840

§700.841

§700.842

§700.843

§700.844

§700.845

§700.846

§700.847

§700.848

§700.850

§700.851

Division 4

§700.860

§700.861

§700.862

§700.863

Division 5

§700.880

§700.881

Division 6

§700.890

§700.891

§700.892

§700.893

§700.894

Subchapter I

§700.901

§700.902

§700.903

§700.904

Subchapter J

Division 1

§700.1001

§700.1002

§700.1003

§700.1005

§700.1007

§700.1009

§700.1011

§700.1013

§700.1015

§700.1017

Division 2

§700.1025

§700.1027

§700.1029

§700.1031

§700.1033

§700.1035

§700.1037

§700.1039

§700.1041

§700.1043

§700.1045

§700.1047

§700.1049

§700.1051

§700.1053

§700.1055

§700.1057

Subchapter K

§700.1101

§700.1102

§700.1103

§700.1104

§700.1105

§700.1106

§700.1107

§700.1108

§700.1109

§700.1110

§700.1111

Subchapter L

§700.1201

§700.1202

§700.1204

§700.1205

§700.1206

§700.1208

Subchapter M

§700.1301

§700.1302

§700.1320

§700.1321

§700.1322

§700.1323

§700.1330

§700.1331

§700.1332

§700.1333

§700.1334

§700.1340

§700.1342

§700.1343

§700.1350

§700.1351

§700.1352

§700.1353

§700.1354

§700.1355

Subchapter N

§700.1401

§700.1402

§700.1403

§700.1404

§700.1405

§700.1406

Subchapter O

§700.1501

§700.1502

§700.1503

§700.1504

§700.1505

§700.1506

Subchapter P

Division 1

§700.1601

§700.1602

§700.1603

§700.1604

Division 2

§700.1611

§700.1613

§700.1615

§700.1617

§700.1619

§700.1621

§700.1623

§700.1625

Division 3

§700.1630

Subchapter Q

§700.1701

§700.1702

§700.1703

§700.1704

§700.1705

§700.1706

§700.1707

§700.1711

§700.1712

§700.1713

§700.1714

§700.1715

§700.1716

§700.1717

§700.1718

§700.1726

§700.1727

§700.1728

§700.1729

§700.1730

§700.1731

§700.1732

§700.1733

§700.1734

§700.1735

§700.1736

§700.1761

§700.1762

§700.1763

Subchapter R

§700.1801

§700.1802

§700.1803

§700.1804

§700.1805

§700.1806

§700.1807

Subchapter S

§700.1901

§700.1902

Subchapter W

Division 1

§700.2301

§700.2303

Division 2

§700.2321

§700.2323

Division 3

§700.2341

§700.2343

Division 4

§700.2361

§700.2363

Division 5

§700.2381

§700.2383

§700.2385

Subchapter Y

§700.2501

§700.2502

§700.2505

Subchapter Z

§700.2701

§700.2703

§700.2705

Chapter 702

Subchapter A

§702.1

§702.5

Subchapter C

§702.201

§702.205

§702.209

§702.213

§702.217

§702.221

Subchapter D

§702.301

§702.303

§702.305

§702.307

§702.309

§702.311

§702.313

§702.315

§702.317

Subchapter E

§702.401

§702.405

§702.409

§702.417

§702.421

§702.425

Subchapter G

§702.601

§702.605

§702.609

§702.613

§702.617

§702.618

§702.621

Subchapter I

Division 1

§702.801

Division 2

§702.811

§702.813

§702.815

§702.817

§702.819

§702.821

§702.823

§702.825

Division 3

§702.841

§702.843

§702.845

§702.847

§702.849

Subchapter K

§702.1001

Subchapter M

§702.1201

§702.1203

Chapter 704

Subchapter A

§704.1

§704.3

Subchapter C

§704.201

§704.203

§704.205

§704.207

§704.209

Subchapter G

§704.601

§704.603

Subchapter H

§704.701

§704.703

Subchapter I

§704.801

§704.803

Chapter 705

Subchapter A

§705.1001

Subchapter D

§705.2915

§705.2916

§705.2940

Subchapter G

§705.3101

§705.3102

Subchapter J

§705.4101

Subchapter K

§705.5101

Subchapter L

§705.6101

Subchapter M

§705.7101

§705.7103

§705.7105

§705.7107

§705.7109

§705.7111

§705.7113

§705.7115

§705.7117

§705.7119

§705.7121

§705.7123

Subchapter N

§705.8101

Chapter 708

Subchapter A

§708.1

§708.2

§708.3

§708.4

Chapter 711

Subchapter A

§711.1

§711.3

§711.5

§711.7

§711.9

§711.11

§711.13

§711.15

§711.17

§711.19

§711.21

§711.23

Subchapter C

§711.201

Subchapter E

§711.401

§711.403

§711.405

§711.407

§711.409

§711.411

§711.413

§711.415

§711.417

§711.419

§711.421

§711.423

§711.425

Subchapter G

§711.601

§711.603

§711.605

§711.607

§711.609

§711.611

§711.613

Subchapter I

§711.801

§711.802

Subchapter K

§711.1001

§711.1002

§711.1003

§711.1005

§711.1007

§711.1009

§711.1011

§711.1013

Subchapter M

§711.1201

§711.1203

§711.1205

§711.1207

Subchapter O

§711.1401

§711.1403

§711.1405

§711.1407

§711.1409

§711.1411

§711.1413

§711.1415

§711.1417

§711.1419

§711.1421

§711.1423

§711.1425

§711.1427

§711.1429

§711.1431

§711.1433

§711.1435

Chapter 720

Subchapter D

§720.206

Subchapter E

§720.236

Subchapter F

§720.308

§720.320

§720.321

Subchapter G

§720.369

§720.373

Subchapter I

§720.602

§720.604

Chapter 727

Subchapter A

§727.101

§727.103

§727.105

§727.107

§727.109

§727.111

Subchapter B

§727.201

§727.203

§727.205

§727.207

Subchapter C

§727.301

§727.303

§727.305

Subchapter D

§727.401

§727.403

§727.405

§727.407

§727.409

§727.411

Chapter 730

Subchapter B

§730.101

§730.102

§730.103

§730.104

§730.105

Subchapter C

§730.201

§730.202

§730.203

§730.204

§730.205

§730.206

§730.207

§730.208

§730.209

§730.210

Subchapter D

§730.301

§730.302

§730.303

§730.304

§730.305

Subchapter E

§730.401

§730.402

§730.403

§730.405

§730.406

Subchapter L

§730.1101

§730.1102

§730.1103

§730.1104

§730.1105

Subchapter M

§730.1201

§730.1202

§730.1203

§730.1204

§730.1206

§730.1207

Subchapter N

§730.1301

§730.1302

§730.1303

§730.1304

§730.1305

§730.1306

§730.1307

§730.1308

§730.1309

§730.1310

§730.1311

§730.1312

§730.1313

§730.1314

§730.1315

§730.1317

Subchapter O

§730.1401

§730.1402

Subchapter Q

§730.1601

§730.1602

§730.1603

§730.1604

§730.1605

§730.1606

§730.1607

§730.1608

§730.1609

§730.1610

§730.1611

§730.1612

§730.1613

§730.1614

Subchapter R

§730.1701

§730.1702

§730.1703

§730.1704

§730.1705

§730.1706

§730.1707

§730.1708

§730.1709

§730.1710

§730.1711

§730.1712

§730.1713

§730.1714

§730.1715

§730.1716

Subchapter S

§730.1801

§730.1802

§730.1803

§730.1804

§730.1805

§730.1806

§730.1807

Subchapter U

§730.2001

§730.2003

§730.2005

§730.2007

§730.2009

§730.2011

Subchapter W

§730.2201

§730.2202

Chapter 732

Subchapter A

§732.101

§732.103

§732.105

§732.107

§732.109

§732.111

§732.113

§732.115

Subchapter L

§732.201

§732.202

§732.203

§732.204

§732.205

§732.206

§732.207

§732.208

§732.209

§732.210

§732.211

§732.212

§732.213

§732.214

§732.215

§732.216

§732.217

§732.218

§732.219

§732.220

§732.221

§732.222

§732.223

§732.224

§732.225

§732.226

§732.227

§732.228

§732.229

§732.237

§732.238

§732.239

§732.240

§732.241

§732.242

§732.243

§732.244

§732.245

§732.246

§732.247

§732.248

§732.249

§732.250

§732.251

§732.252

§732.253

§732.254

§732.255

§732.257

§732.258

§732.259

§732.260

§732.261

§732.262

§732.263

§732.265

§732.266

§732.267

§732.268

§732.269

§732.270

§732.271

§732.272

§732.273

§732.274

§732.275

§732.276

§732.277

§732.280

§732.282

§732.284

§732.286

§732.288

§732.290

Subchapter M

§732.301

§732.302

§732.303

§732.304

§732.305

Subchapter N

§732.401

§732.403

§732.405

§732.407

§732.409

§732.411

§732.413

§732.415

§732.417

§732.419

§732.421

§732.423

§732.425

§732.427

§732.429

§732.431

Chapter 745

Subchapter A

Division 1

§745.1

Division 2

§745.11

Division 3

§745.21

Subchapter B

§745.31

§745.33

§745.35

§745.37

§745.39

§745.41

Subchapter C

Division 1

§745.101

Division 2

§745.111

§745.113

§745.115

§745.117

§745.119

§745.121

§745.123

§745.125

§745.127

§745.129

§745.131

§745.133

§745.135

§745.137

§745.139

§745.141

§745.143

Subchapter D

Division 1

§745.201

Division 2

§745.211

§745.213

§745.215

Division 3

§745.241

§745.243

§745.245

§745.247

§745.249

§745.251

§745.253

Division 4

§745.271

§745.273

§745.275

§745.277

§745.279

§745.281

Division 5

§745.301

§745.303

Division 6

§745.321

§745.323

§745.325

§745.327

Division 7

§745.341

§745.343

§745.345

§745.347

§745.349

§745.351

§745.353

Division 8

§745.371

§745.373

§745.375

§745.379

§745.381

§745.383

§745.385

Division 9

§745.401

§745.403

§745.405

§745.407

Division 10

§745.429

§745.431

§745.433

§745.435

§745.437

§745.439

Division 11

§745.461

§745.463

§745.465

§745.467

Subchapter E

§745.501

§745.503

§745.505

§745.507

§745.509

§745.511

§745.513

§745.515

§745.517

§745.519

§745.521

§745.523

Subchapter F

Division 1

§745.601

Division 2

§745.611

§745.613

§745.615

§745.617

§745.619

§745.621

§745.623

§745.625

§745.626

§745.629

§745.630

§745.631

§745.633

§745.635

§745.637

Division 3

§745.651

§745.653

§745.655

§745.657

§745.659

§745.661

§745.663

Division 4

§745.681

§745.683

§745.685

§745.687

§745.689

§745.691

§745.693

§745.695

§745.697

§745.699

§745.701

§745.703

§745.705

§745.707

§745.709

§745.711

Division 5

§745.731

§745.733

§745.735

Division 6

§745.751

§745.753

Subchapter G

§745.901

§745.903

§745.905

§745.907

§745.909

§745.911

§745.913

§745.915

Subchapter H

Division 2

§745.4025

§745.4031

§745.4033

§745.4035

§745.4037

§745.4039

§745.4041

§745.4043

Division 3

§745.4063

§745.4065

§745.4067

§745.4075

Division 5

§745.4121

§745.4123

§745.4125

§745.4127

Division 6

§745.4151

Division 7

§745.4201

§745.4203

§745.4205

Subchapter I

§745.8001

§745.8003

Subchapter J

§745.8301

§745.8303

§745.8305

§745.8307

§745.8309

§745.8311

§745.8313

§745.8315

§745.8317

§745.8319

Subchapter K

Division 1

§745.8401

§745.8403

§745.8405

§745.8407

§745.8409

§745.8411

§745.8413

§745.8415

§745.8417

§745.8419

§745.8421

§745.8423

§745.8425

Division 2

§745.8441

§745.8443

§745.8445

§745.8447

§745.8449

§745.8451

§745.8453

§745.8455

Division 3

§745.8481

§745.8483

§745.8485

§745.8487

§745.8489

§745.8491

§745.8493

Division 4

§745.8511

§745.8513

§745.8515

§745.8517

§745.8519

§745.8521

§745.8523

§745.8525

§745.8527

§745.8529

§745.8531

§745.8533

Division 5

§745.8551

§745.8553

§745.8555

§745.8557

§745.8559

Subchapter L

Division 1

§745.8601

§745.8603

§745.8605

§745.8607

§745.8609

§745.8611

§745.8613

Division 2

§745.8631

§745.8633

§745.8635

Division 3

§745.8651

§745.8653

§745.8655

§745.8657

§745.8659

§745.8661

Division 4

§745.8681

§745.8683

§745.8685

§745.8687

Division 5

§745.8711

Subchapter M

Division 1

§745.8801

§745.8803

§745.8805

§745.8806

§745.8807

§745.8809

§745.8813

§745.8815

§745.8817

Division 2

§745.8831

§745.8833

§745.8835

§745.8837

§745.8839

§745.8841

§745.8843

§745.8845

§745.8847

§745.8849

§745.8851

§745.8853

§745.8855

Division 3

§745.8871

§745.8873

§745.8875

§745.8877

§745.8879

§745.8881

Subchapter N

Division 1

§745.8901

§745.8903

§745.8905

§745.8907

§745.8909

§745.8911

§745.8913

§745.8915

§745.8917

§745.8919

§745.8921

Division 2

§745.8931

§745.8933

§745.8935

Division 3

§745.8951

§745.8955

§745.8957

§745.8959

§745.8961

§745.8963

§745.8965

§745.8967

§745.8969

Division 4

§745.8991

§745.8993

§745.8995

§745.8997

§745.8999

§745.9001

§745.9003

§745.9005

§745.9007

§745.9009

§745.9011

§745.9013

§745.9015

§745.9017

§745.9019

§745.9021

§745.9023

Division 5

§745.9031

§745.9033

§745.9035

§745.9037

§745.9039

Subchapter O

Division 1

§745.9060

§745.9061

§745.9063

Division 2

§745.9065

§745.9067

§745.9068

Division 3

§745.9069

§745.9070

§745.9071

§745.9073

§745.9075

§745.9077

§745.9079

§745.9081

§745.9083

§745.9085

§745.9087

§745.9089

§745.9090

Division 4

§745.9091

§745.9092

§745.9093

§745.9094

§745.9095

§745.9096

§745.9097

Division 5

§745.9100

Subchapter P

§745.9101

§745.9103

§745.9105

§745.9107

§745.9109

§745.9111

§745.9113

§745.9115

§745.9117

§745.9119

§745.9121

§745.9123

§745.9125

§745.9127

§745.9129

§745.9131

§745.9133

§745.9135

§745.9137

§745.9139

§745.9141

§745.9143

§745.9145

§745.9147

§745.9149

§745.9151

§745.9153

§745.9155

§745.9157

§745.9159

§745.9161

Chapter 746

Subchapter A

§746.101

§746.103

§746.105

§746.107

§746.109

Subchapter B

Division 1

§746.201

Division 2

§746.301

§746.303

§746.305

§746.307

Division 3

§746.401

§746.403

§746.405

Division 4

§746.501

§746.503

§746.505

§746.507

Subchapter C

Division 1

§746.601

§746.603

§746.605

§746.607

§746.609

§746.611

§746.613

§746.615

§746.617

§746.619

§746.621

§746.623

§746.625

§746.627

§746.629

§746.631

Division 2

§746.701

§746.703

§746.705

§746.707

§746.709

Division 3

§746.801

§746.803

Division 4

§746.901

§746.903

§746.905

§746.907

§746.909

Subchapter D

Division 1

§746.1001

§746.1003

§746.1005

§746.1007

§746.1009

§746.1011

§746.1013

§746.1015

§746.1017

§746.1019

§746.1021

§746.1023

§746.1025

§746.1027

§746.1029

§746.1031

§746.1033

§746.1035

§746.1037

§746.1039

§746.1041

§746.1043

§746.1045

§746.1047

§746.1049

§746.1051

§746.1053

§746.1055

§746.1057

§746.1059

§746.1061

§746.1063

Division 2

§746.1101

§746.1103

§746.1105

§746.1107

§746.1109

§746.1111

§746.1113

§746.1115

Division 3

§746.1201

§746.1203

§746.1205

Division 4

§746.1301

§746.1303

§746.1305

§746.1307

§746.1309

§746.1311

§746.1313

§746.1315

§746.1316

§746.1317

§746.1319

§746.1321

§746.1323

§746.1325

§746.1327

§746.1329

Division 5

§746.1401

§746.1403

Subchapter E

Division 1

§746.1501

§746.1503

§746.1505

§746.1507

Division 2

§746.1601

§746.1603

§746.1605

§746.1607

§746.1609

§746.1611

§746.1613

§746.1615

§746.1617

Division 3

§746.1701

§746.1703

§746.1705

§746.1707

§746.1709

§746.1711

Division 4

§746.1801

§746.1803

§746.1805

Division 5

§746.1901

§746.1903

§746.1905

Division 6

§746.2001

Division 7

§746.2101

§746.2103

§746.2105

§746.2107

§746.2109

§746.2111

§746.2113

§746.2115

§746.2117

Subchapter F

§746.2201

§746.2203

§746.2205

§746.2207

§746.2209

§746.2211

Subchapter G

§746.2301

Subchapter H

§746.2401

§746.2403

§746.2405

§746.2407

§746.2409

§746.2411

§746.2413

§746.2415

§746.2417

§746.2419

§746.2421

§746.2423

§746.2425

§746.2427

§746.2429

§746.2431

Subchapter I

§746.2501

§746.2503

§746.2505

§746.2507

§746.2509

Subchapter J

§746.2601

§746.2603

§746.2605

§746.2607

Subchapter K

§746.2701

§746.2703

§746.2705

§746.2707

Subchapter L

§746.2801

§746.2803

§746.2805

§746.2807

§746.2809

§746.2811

§746.2813

Subchapter M

§746.2901

§746.2903

§746.2905

§746.2907

§746.2909

§746.2911

Subchapter N

§746.3001

§746.3003

§746.3005

Subchapter O

§746.3101

§746.3103

§746.3105

§746.3107

§746.3109

§746.3111

§746.3113

§746.3115

§746.3117

§746.3119

§746.3121

§746.3123

Subchapter P

§746.3201

§746.3203

§746.3205

§746.3207

§746.3209

Subchapter Q

§746.3301

§746.3303

§746.3305

§746.3307

§746.3309

§746.3311

§746.3313

§746.3315

§746.3317

§746.3319

§746.3321

Subchapter R

Division 1

§746.3401

§746.3403

§746.3405

§746.3407

§746.3409

§746.3411

§746.3413

§746.3415

§746.3417

§746.3419

§746.3421

§746.3423

§746.3425

§746.3427

§746.3429

§746.3431

§746.3433

Division 2

§746.3501

§746.3503

§746.3505

Division 3

§746.3601

§746.3603

§746.3605

§746.3607

Subchapter S

Division 1

§746.3701

§746.3703

§746.3705

§746.3707

§746.3709

Division 2

§746.3801

§746.3803

§746.3805

§746.3807

§746.3809

§746.3811

Division 3

§746.3901

§746.3903

§746.3905

Division 4

§746.4001

§746.4003

Division 5

§746.4101

§746.4103

Division 6

§746.4131

§746.4133

§746.4135

Subchapter T

Division 1

§746.4201

§746.4203

§746.4205

§746.4207

§746.4213

§746.4215

§746.4217

Division 2

§746.4301

§746.4305

§746.4307

§746.4309

§746.4311

§746.4313

§746.4315

Division 3

§746.4401

§746.4403

§746.4405

§746.4407

§746.4409

§746.4411

§746.4417

§746.4419

§746.4421

Division 4

§746.4501

§746.4503

§746.4505

§746.4507

§746.4509

§746.4511

Subchapter U

Division 1

§746.4601

§746.4603

§746.4605

§746.4607

§746.4609

Division 2

§746.4701

§746.4703

§746.4705

Division 4

§746.4801

§746.4803

§746.4805

§746.4807

§746.4809

§746.4811

§746.4813

§746.4815

Division 5

§746.4901

§746.4903

§746.4905

§746.4907

§746.4909

§746.4911

§746.4913

Subchapter V

§746.5001

§746.5003

§746.5005

§746.5007

§746.5009

§746.5011

§746.5013

§746.5015

§746.5017

Subchapter W

Division 1

§746.5101

§746.5103

§746.5105

Division 2

§746.5201

§746.5203

§746.5205

§746.5207

§746.5209

§746.5211

Division 3

§746.5301

§746.5303

§746.5305

§746.5307

§746.5309

§746.5311

§746.5313

§746.5315

§746.5317

§746.5319

Division 4

§746.5401

§746.5403

§746.5405

§746.5407

Division 5

§746.5501

Division 6

§746.5531

§746.5533

§746.5535

§746.5537

Subchapter X

§746.5601

§746.5603

§746.5605

§746.5607

§746.5609

§746.5611

§746.5613

§746.5615

§746.5617

§746.5619

§746.5621

Chapter 747

Subchapter A

§747.101

§747.103

§747.105

§747.107

§747.109

§747.111

§747.113

Subchapter B

Division 1

§747.201

§747.203

§747.205

§747.207

§747.209

Division 2

§747.301

§747.303

§747.305

Division 3

§747.401

§747.403

Division 4

§747.501

§747.503

§747.505

Subchapter C

Division 1

§747.601

§747.603

§747.605

§747.607

§747.609

§747.611

§747.613

§747.615

§747.617

§747.619

§747.621

§747.623

§747.625

§747.627

§747.629

§747.631

§747.633

§747.635

Division 2

§747.701

§747.703

§747.705

§747.707

§747.709

Division 3

§747.801

§747.803

Division 4

§747.901

§747.903

§747.905

§747.907

§747.909

§747.911

§747.913

§747.915

Subchapter D

Division 1

§747.1001

§747.1003

§747.1005

§747.1007

§747.1009

§747.1013

§747.1015

Division 2

§747.1101

§747.1103

§747.1105

§747.1107

§747.1109

§747.1113

§747.1115

§747.1117

§747.1119

§747.1121

§747.1123

§747.1125

§747.1127

§747.1129

§747.1131

§747.1133

§747.1135

§747.1137

§747.1139

§747.1141

§747.1143

§747.1145

§747.1147

§747.1149

§747.1151

§747.1153

Division 3

§747.1201

§747.1203

§747.1205

§747.1207

§747.1209

§747.1211

§747.1213

§747.1215

§747.1217

§747.1219

Division 4

§747.1301

§747.1303

§747.1305

§747.1307

§747.1309

§747.1311

§747.1313

§747.1314

§747.1315

§747.1317

§747.1319

§747.1321

§747.1323

§747.1325

§747.1327

Division 5

§747.1401

§747.1403

§747.1405

Division 6

§747.1501

§747.1503

Subchapter E

Division 1

§747.1601

§747.1603

§747.1605

§747.1607

§747.1609

Division 2

§747.1701

§747.1703

Division 3

§747.1801

§747.1803

§747.1805

§747.1807

Division 4

§747.1901

§747.1903

Division 5

§747.2001

§747.2003

§747.2005

§747.2007

§747.2009

§747.2011

§747.2013

§747.2015

§747.2017

Subchapter F

§747.2101

§747.2103

§747.2105

§747.2107

Subchapter G

§747.2201

Subchapter H

§747.2301

§747.2303

§747.2305

§747.2307

§747.2309

§747.2311

§747.2313

§747.2315

§747.2317

§747.2319

§747.2321

§747.2323

§747.2325

§747.2327

§747.2329

§747.2331

Subchapter I

§747.2401

§747.2403

§747.2405

§747.2407

Subchapter J

§747.2501

§747.2503

§747.2505

§747.2507

Subchapter K

§747.2601

§747.2603

§747.2605

§747.2607

Subchapter L

§747.2701

§747.2703

§747.2705

§747.2711

§747.2713

§747.2715

Subchapter M

§747.2801

§747.2803

§747.2805

§747.2807

§747.2809

§747.2811

Subchapter N

§747.2901

§747.2903

§747.2907

Subchapter P

§747.3001

§747.3003

§747.3005

§747.3007

§747.3009

Subchapter Q

§747.3101

§747.3103

§747.3105

§747.3107

§747.3109

§747.3111

§747.3113

§747.3115

§747.3117

§747.3119

§747.3121

Subchapter R

Division 1

§747.3201

§747.3203

§747.3205

§747.3207

§747.3209

§747.3211

§747.3213

§747.3215

§747.3217

§747.3219

§747.3221

§747.3223

§747.3225

§747.3227

§747.3229

Division 2

§747.3301

§747.3303

§747.3307

Division 3

§747.3401

§747.3403

§747.3405

§747.3407

Subchapter S

Division 1

§747.3501

§747.3503

§747.3505

§747.3507

Division 2

§747.3601

§747.3603

§747.3605

§747.3607

§747.3609

§747.3611

Division 3

§747.3701

§747.3703

§747.3705

Division 4

§747.3801

§747.3803

Division 5

§747.3901

§747.3903

Division 6

§747.3931

§747.3933

§747.3935

Subchapter T

Division 1

§747.4001

§747.4003

§747.4005

§747.4007

§747.4009

§747.4011

§747.4013

§747.4015

Division 2

§747.4101

§747.4103

§747.4105

§747.4107

§747.4109

§747.4111

§747.4113

§747.4115

§747.4117

Division 3

§747.4201

§747.4203

§747.4205

§747.4207

§747.4209

§747.4211

Division 4

§747.4301

§747.4303

§747.4305

§747.4307

§747.4309

§747.4311

Subchapter U

Division 1

§747.4401

§747.4403

§747.4405

§747.4407

Division 2

§747.4501

§747.4503

§747.4505

Division 3

§747.4601

§747.4603

§747.4605

§747.4607

§747.4609

§747.4611

§747.4613

§747.4615

Division 4

§747.4707

§747.4709

§747.4711

Subchapter V

§747.4801

§747.4803

§747.4805

§747.4807

§747.4809

§747.4811

§747.4813

§747.4815

§747.4817

Subchapter W

Division 1

§747.4901

Division 2

§747.5001

§747.5003

§747.5005

§747.5007

§747.5009

§747.5011

§747.5013

§747.5015

Division 3

§747.5101

§747.5103

§747.5105

§747.5107

§747.5109

§747.5111

§747.5113

§747.5115

§747.5117

Division 4

§747.5201

Division 5

§747.5301

Division 6

§747.5331

§747.5333

§747.5335

§747.5337

Subchapter X

§747.5401

§747.5403

§747.5405

§747.5407

§747.5409

§747.5411

§747.5413

§747.5415

§747.5417

§747.5419

§747.5421

Chapter 748

Subchapter A

§748.1

§748.3

Subchapter B

Division 1

§748.41

§748.43

Division 2

§748.61

§748.63

§748.65

§748.67

§748.69

§748.71

§748.73

§748.75

Subchapter C

Division 1

§748.101

§748.103

§748.105

§748.107

§748.109

§748.111

Division 2

§748.131

§748.133

Division 3

§748.161

§748.163

Division 4

§748.191

Division 5

§748.231

§748.233

§748.235

§748.237

§748.239

Subchapter D

Division 1

§748.301

§748.303

§748.305

§748.307

§748.309

§748.311

§748.313

§748.315

Division 2

§748.341

Division 3

§748.361

§748.363

Division 4

§748.391

§748.393

§748.395

§748.397

§748.399

§748.401

Division 5

§748.431

§748.433

§748.435

Subchapter E

Division 1

§748.501

§748.503

§748.505

§748.507

§748.509

Division 2

§748.531

§748.533

§748.535

§748.537

§748.539

Division 3

§748.561

§748.563

§748.565

§748.567

§748.569

§748.571

§748.573

§748.575

Division 4

§748.601

§748.603

§748.605

§748.607

Division 5

§748.681

§748.683

§748.685

Division 6

§748.721

§748.723

§748.725

§748.727

§748.729

§748.731

Subchapter F

Division 1

§748.801

Division 2

§748.831

§748.833

Division 3

§748.861

§748.863

§748.865

§748.867

§748.869

Division 4

§748.881

§748.883

§748.885

Division 5

§748.901

§748.903

Division 6

§748.931

§748.935

§748.937

§748.939

§748.941

§748.943

§748.945

§748.947

§748.949

Division 7

§748.981

§748.983

§748.985

§748.987

§748.989

Subchapter G

§748.1001

§748.1003

§748.1005

§748.1007

§748.1009

§748.1011

§748.1013

§748.1015

§748.1017

§748.1019

§748.1021

§748.1023

Subchapter H

§748.1101

§748.1103

§748.1105

§748.1107

§748.1109

§748.1111

§748.1113

§748.1115

§748.1117

§748.1119

Subchapter I

Division 1

§748.1201

§748.1203

§748.1205

§748.1207

§748.1209

§748.1211

§748.1213

§748.1215

§748.1217

§748.1219

§748.1221

§748.1223

§748.1225

§748.1227

Division 2

§748.1261

§748.1263

§748.1265

§748.1269

§748.1271

Division 3

§748.1301

§748.1303

§748.1305

Division 4

§748.1331

§748.1333

§748.1335

§748.1337

§748.1339

§748.1341

§748.1343

§748.1345

§748.1347

§748.1349

§748.1351

Division 5

§748.1381

§748.1383

§748.1385

§748.1387

§748.1389

Division 6

§748.1431

§748.1433

§748.1435

§748.1437

§748.1439

§748.1441

§748.1443

§748.1445

Division 7

§748.1481

Subchapter J

Division 1

§748.1501

§748.1503

§748.1505

Division 2

§748.1531

§748.1533

§748.1535

§748.1539

§748.1541

§748.1543

§748.1545

§748.1547

§748.1549

§748.1551

Division 3

§748.1581

§748.1583

Division 4

§748.1611

§748.1613

§748.1615

§748.1617

Division 5

§748.1631

§748.1633

§748.1635

Division 6

§748.1661

Division 7

§748.1691

§748.1693

§748.1695

§748.1697

§748.1699

§748.1701

§748.1703

§748.1705

§748.1707

§748.1709

Division 8

§748.1741

§748.1743

§748.1745

§748.1747

§748.1749

§748.1751

§748.1753

§748.1755

§748.1757

§748.1759

§748.1761

§748.1763

§748.1765

Division 9

§748.1791

§748.1793

§748.1795

Division 10

§748.1821

§748.1823

§748.1825

Subchapter K

Division 1

§748.1901

Division 2

§748.1931

§748.1933

§748.1935

§748.1937

§748.1939

§748.1941

§748.1943

§748.1945

Subchapter L

Division 1

§748.2001

§748.2003

§748.2005

§748.2009

Division 2

§748.2051

§748.2053

Division 3

§748.2101

§748.2103

Division 4

§748.2151

Division 5

§748.2201

§748.2203

§748.2205

Division 6

§748.2231

§748.2233

Division 7

§748.2253

§748.2255

§748.2257

§748.2259

§748.2261

Subchapter M

§748.2301

§748.2303

§748.2305

§748.2307

§748.2309

§748.2311

Subchapter N

Division 1

§748.2401

Division 2

§748.2451

§748.2453

§748.2455

§748.2459

§748.2461

§748.2463

Division 3

§748.2501

§748.2503

§748.2505

§748.2507

Division 4

§748.2551

§748.2553

Division 5

§748.2601

§748.2603

§748.2605

Division 6

§748.2651

§748.2653

Division 7

§748.2701

§748.2703

§748.2705

Division 8

§748.2751

§748.2753

§748.2755

§748.2757

Division 9

§748.2801

§748.2803

§748.2805

§748.2807

Division 10

§748.2851

§748.2853

§748.2855

Division 11

§748.2901

§748.2903

§748.2905

§748.2907

§748.2909

Division 12

§748.2951

§748.2953

Subchapter O

Division 1

§748.3001

§748.3003

§748.3005

§748.3007

§748.3009

§748.3011

§748.3013

§748.3015

§748.3017

§748.3019

§748.3021

Division 2

§748.3061

§748.3063

§748.3065

Division 3

§748.3101

§748.3103

§748.3105

§748.3107

§748.3109

§748.3111

§748.3113

§748.3115

§748.3117

§748.3119

Division 4

§748.3161

Division 5

§748.3191

§748.3193

§748.3195

Division 6

§748.3231

§748.3233

§748.3235

§748.3237

§748.3239

Division 7

§748.3271

§748.3273

Subchapter P

Division 1

§748.3301

§748.3303

§748.3305

§748.3307

§748.3309

§748.3311

§748.3313

§748.3315

§748.3317

Division 2

§748.3351

§748.3353

§748.3355

§748.3357

§748.3359

§748.3361

§748.3363

§748.3365

§748.3367

§748.3369

Division 3

§748.3391

§748.3393

§748.3395

§748.3397

§748.3399

Division 4

§748.3421

Division 5

§748.3441

§748.3443

Division 6

§748.3471

§748.3473

§748.3475

§748.3477

§748.3479

§748.3481

Division 7

§748.3521

§748.3523

§748.3525

§748.3527

§748.3529

§748.3531

§748.3533

§748.3535

Division 8

§748.3561

§748.3563

§748.3565

§748.3567

Division 9

§748.3601

§748.3603

§748.3605

§748.3607

Subchapter Q

Division 1

§748.3701

§748.3703

§748.3705

§748.3707

§748.3709

§748.3711

§748.3713

§748.3715

§748.3717

§748.3719

Division 2

§748.3751

§748.3753

§748.3755

§748.3757

§748.3759

§748.3761

§748.3763

§748.3765

§748.3767

Division 3

§748.3801

§748.3803

§748.3805

§748.3807

Division 4

§748.3841

§748.3843

§748.3845

§748.3847

§748.3849

§748.3851

§748.3853

§748.3855

§748.3857

§748.3859

§748.3861

Division 5

§748.3891

§748.3893

Division 6

§748.3931

§748.3933

§748.3935

§748.3937

Subchapter R

Division 1

§748.4001

§748.4003

§748.4005

§748.4007

§748.4009

§748.4011

§748.4013

Division 2

§748.4041

§748.4043

§748.4045

§748.4047

Division 3

§748.4081

§748.4083

Division 4

§748.4111

Subchapter S

Division 1

§748.4201

§748.4203

§748.4205

§748.4207

§748.4209

§748.4211

§748.4213

Division 2

§748.4231

Division 3

§748.4261

§748.4263

§748.4265

§748.4267

§748.4269

Subchapter T

Division 1

§748.4301

Division 2

§748.4331

Division 3

§748.4361

§748.4363

§748.4365

§748.4369

§748.4371

Division 4

§748.4391

§748.4393

§748.4395

§748.4397

Subchapter U

Division 1

§748.4401

§748.4403

Division 2

§748.4431

Division 3

§748.4461

§748.4463

§748.4465

§748.4467

§748.4469

§748.4471

§748.4473

Chapter 749

Subchapter A

§749.1

§749.3

Subchapter B

Division 1

§749.41

§749.43

Division 2

§749.61

§749.63

§749.65

§749.67

§749.69

§749.71

Subchapter C

Division 1

§749.101

§749.103

§749.105

§749.107

Division 2

§749.131

§749.133

Division 3

§749.161

§749.163

§749.165

Division 4

§749.191

§749.193

§749.195

§749.197

§749.199

Division 5

§749.231

§749.233

§749.235

§749.237

§749.239

§749.241

§749.243

§749.245

Division 6

§749.271

§749.273

Division 7

§749.301

§749.303

Division 8

§749.331

§749.333

§749.335

§749.337

§749.339

§749.341

§749.343

§749.345

§749.347

§749.349

§749.351

§749.353

§749.355

§749.357

§749.359

Division 9

§749.421

§749.423

§749.425

Subchapter D

Division 1

§749.501

§749.503

§749.505

§749.507

§749.509

§749.511

§749.513

§749.515

Division 2

§749.531

§749.533

§749.535

§749.537

Division 3

§749.551

§749.553

§749.555

Division 4

§749.571

§749.573

§749.575

§749.577

§749.579

§749.581

§749.583

§749.585

§749.587

Subchapter E

Division 1

§749.601

§749.603

§749.605

§749.607

§749.609

Division 2

§749.631

§749.633

§749.635

§749.637

Division 3

§749.661

§749.663

§749.665

§749.667

§749.669

§749.671

§749.673

§749.675

§749.677

§749.679

Division 4

§749.721

§749.723

§749.725

§749.727

Division 5

§749.741

§749.743

Division 6

§749.761

§749.763

§749.767

§749.769

§749.771

Subchapter F

Division 1

§749.801

Division 2

§749.831

§749.833

Division 3

§749.861

§749.863

§749.865

§749.867

§749.869

Division 4

§749.881

§749.883

§749.885

Division 5

§749.901

§749.903

Division 6

§749.931

§749.933

§749.935

§749.937

§749.939

§749.941

§749.945

§749.947

§749.949

Division 7

§749.981

§749.983

§749.985

§749.987

§749.989

Subchapter G

§749.1001

§749.1003

§749.1005

§749.1007

§749.1009

§749.1011

§749.1013

§749.1015

§749.1017

§749.1019

§749.1021

Subchapter H

Division 1

§749.1101

§749.1103

§749.1105

§749.1107

§749.1109

§749.1111

§749.1113

§749.1115

Division 2

§749.1131

§749.1133

§749.1135

§749.1137

Division 3

§749.1151

§749.1153

§749.1155

Division 4

§749.1181

§749.1183

§749.1185

§749.1187

§749.1189

Division 5

§749.1251

§749.1253

§749.1255

Division 6

§749.1281

Subchapter I

Division 1

§749.1301

§749.1305

§749.1307

§749.1309

§749.1311

§749.1313

§749.1315

§749.1317

§749.1319

§749.1321

§749.1323

Division 2

§749.1331

§749.1333

§749.1335

§749.1337

§749.1339

Division 3

§749.1361

§749.1363

§749.1365

§749.1367

§749.1369

§749.1371

§749.1373

§749.1375

§749.1377

§749.1379

Subchapter J

Division 1

§749.1401

§749.1403

§749.1405

§749.1409

§749.1411

§749.1413

§749.1415

§749.1417

§749.1421

§749.1423

§749.1425

§749.1427

§749.1429

§749.1431

§749.1433

§749.1435

Division 2

§749.1461

§749.1463

§749.1469

Division 3

§749.1501

§749.1503

Division 4

§749.1521

§749.1523

Division 5

§749.1541

§749.1543

§749.1545

Division 6

§749.1561

§749.1563

§749.1565

Division 7

§749.1581

§749.1583

Division 8

§749.1603

§749.1605

§749.1607

§749.1609

§749.1611

Division 9

§749.1641

§749.1643

§749.1645

§749.1647

Division 10

§749.1671

§749.1673

§749.1675

Subchapter K

Division 1

§749.1801

§749.1803

§749.1805

§749.1807

§749.1809

§749.1811

§749.1813

§749.1815

§749.1817

§749.1819

Division 2

§749.1841

Division 3

§749.1861

§749.1863

§749.1865

Division 4

§749.1891

§749.1893

§749.1895

Division 5

§749.1921

§749.1923

§749.1925

§749.1927

Division 6

§749.1951

§749.1953

§749.1955

§749.1957

§749.1959

§749.1961

Subchapter L

Division 1

§749.2001

Division 2

§749.2051

§749.2053

§749.2055

§749.2059

§749.2061

§749.2063

Division 3

§749.2101

§749.2103

§749.2105

§749.2107

Division 4

§749.2151

§749.2153

Division 5

§749.2201

§749.2203

§749.2205

Division 6

§749.2231

§749.2233

Division 7

§749.2281

§749.2283

Division 8

§749.2301

§749.2303

§749.2305

Division 9

§749.2331

§749.2333

§749.2335

§749.2337

§749.2339

Division 10

§749.2381

§749.2383

Subchapter M

Division 1

§749.2401

§749.2403

§749.2405

Division 2

§749.2441

§749.2443

§749.2445

§749.2447

§749.2449

§749.2451

Division 3

§749.2471

§749.2473

§749.2475

§749.2477

§749.2479

§749.2481

§749.2483

§749.2485

§749.2487

§749.2489

§749.2491

§749.2493

Division 4

§749.2521

§749.2523

§749.2525

Division 5

§749.2551

§749.2553

§749.2555

§749.2557

§749.2559

§749.2561

§749.2563

§749.2565

§749.2567

Division 6

§749.2591

§749.2593

§749.2595

§749.2597

§749.2599

Division 7

§749.2621

§749.2623

§749.2625

§749.2627

§749.2629

§749.2631

§749.2633

§749.2635

Division 8

§749.2651

§749.2653

§749.2655

Subchapter N

§749.2801

§749.2803

§749.2805

§749.2807

§749.2809

§749.2811

§749.2813

§749.2815

§749.2817

§749.2819

§749.2821

§749.2823

§749.2825

Subchapter O

Division 1

§749.2901

§749.2903

§749.2905

§749.2907

§749.2909

§749.2911

§749.2913

§749.2915

§749.2917

Division 2

§749.2931

Division 3

§749.2961

§749.2963

§749.2965

§749.2967

Division 4

§749.3021

§749.3023

§749.3025

§749.3027

§749.3029

§749.3031

§749.3033

§749.3035

§749.3037

§749.3039

§749.3041

Division 5

§749.3061

§749.3063

§749.3065

§749.3067

§749.3069

§749.3071

§749.3073

§749.3075

§749.3077

§749.3079

§749.3081

Division 6

§749.3101

§749.3103

§749.3105

§749.3107

§749.3109

§749.3111

Division 7

§749.3131

§749.3133

§749.3135

§749.3137

§749.3139

§749.3141

§749.3143

§749.3145

§749.3147

§749.3149

Subchapter P

Division 1

§749.3201

§749.3203

Division 2

§749.3221

Subchapter Q

Division 1

§749.3301

Division 2

§749.3321

§749.3323

§749.3325

§749.3327

Division 3

§749.3341

§749.3343

§749.3345

§749.3347

§749.3349

§749.3351

§749.3353

Division 4

§749.3371

§749.3373

Division 5

§749.3391

§749.3393

§749.3395

Division 6

§749.3421

§749.3423

§749.3425

§749.3427

§749.3429

§749.3431

Division 7

§749.3461

§749.3463

§749.3465

Subchapter R

Division 1

§749.3501

§749.3503

Division 2

§749.3521

§749.3523

Division 3

§749.3571

§749.3573

Subchapter S

Division 1

§749.3601

Division 2

§749.3621

§749.3623

§749.3624

§749.3625

§749.3627

§749.3629

§749.3631

§749.3633

Division 3

§749.3661

§749.3663

Division 4

§749.3691

§749.3693

Division 5

§749.3721

§749.3725

§749.3727

§749.3729

Division 6

§749.3741

Division 7

§749.3761

Subchapter T

Division 1

§749.3801

Division 2

§749.3831

Division 3

§749.3861

§749.3863

§749.3865

§749.3869

§749.3871

Division 4

§749.3891

§749.3893

§749.3895

§749.3897

Chapter 750

Subchapter A

§750.1

§750.3

§750.5

Subchapter B

Division 1

§750.41

§750.43

Division 2

§750.61

Subchapter C

Division 1

§750.101

§750.103

§750.105

§750.107

Division 2

§750.121

§750.123

Division 3

§750.131

§750.133

Division 4

§750.151

§750.153

§750.155

§750.157

§750.159

§750.161

§750.163

§750.165

§750.167

§750.169

§750.171

Division 5

§750.181

§750.183

§750.185

Subchapter D

Division 1

§750.201

Division 2

§750.231

§750.233

§750.235

§750.237

§750.239

§750.241

§750.243

§750.245

Subchapter E

Division 1

§750.301

Division 2

§750.331

§750.333

Division 3

§750.351

§750.353

§750.355

Division 4

§750.371

§750.373

Subchapter F

§750.401

§750.403

Subchapter G

§750.451

§750.453

§750.455

Subchapter H

§750.501

Subchapter I

§750.601

Subchapter J

§750.701

Subchapter K

§750.801

Subchapter L

§750.901

Subchapter M

§750.1001

§750.1003

§750.1005

§750.1007

§750.1009

Subchapter N

§750.1101

Subchapter O

§750.1201

Part 20

Chapter 800

Subchapter A

§800.1

§800.2

§800.3

§800.4

§800.5

§800.6

§800.7

§800.8

§800.9

Subchapter B

§800.51

§800.52

§800.53

§800.54

§800.57

§800.58

§800.63

§800.65

§800.66

§800.67

§800.71

§800.72

§800.73

§800.74

§800.75

§800.76

§800.77

Subchapter C

§800.81

§800.83

Subchapter D

§800.101

§800.102

§800.103

§800.104

§800.105

§800.106

§800.107

§800.108

Subchapter E

§800.151

§800.152

§800.161

§800.171

§800.172

§800.174

§800.175

§800.176

§800.181

§800.191

§800.192

§800.193

§800.194

§800.195

§800.196

§800.197

§800.198

§800.199

§800.200

Subchapter F

§800.201

§800.202

§800.203

§800.204

§800.205

Subchapter G

§800.251

§800.252

§800.253

§800.254

§800.255

Subchapter H

§800.301

§800.302

§800.303

§800.304

§800.305

§800.306

§800.307

§800.308

§800.309

Subchapter I

§800.351

§800.352

§800.353

§800.354

§800.355

§800.357

§800.358

§800.359

§800.360

Subchapter K

§800.451

§800.452

§800.453

§800.454

§800.455

§800.456

§800.461

§800.462

§800.463

§800.471

§800.472

§800.473

§800.481

§800.482

§800.491

§800.492

Chapter 801

Subchapter A

§801.1

§801.2

§801.11

§801.12

§801.13

§801.16

§801.17

Subchapter B

§801.21

§801.22

§801.23

§801.24

§801.25

§801.27

§801.28

§801.29

§801.31

Subchapter C

§801.51

§801.52

§801.53

§801.54

§801.55

§801.56

Chapter 803

Subchapter A

§803.1

§803.2

§803.3

Subchapter B

§803.11

§803.12

§803.13

§803.14

§803.15

Subchapter C

§803.31

§803.32

Chapter 807

Subchapter A

§807.1

§807.2

§807.3

§807.4

§807.6

§807.7

Subchapter B

§807.11

§807.12

§807.13

§807.14

§807.15

§807.16

§807.17

Subchapter C

§807.31

§807.32

§807.33

§807.34

§807.35

§807.36

§807.37

Subchapter D

§807.51

§807.52

§807.53

Subchapter E

§807.61

§807.62

§807.63

§807.64

§807.65

§807.66

Subchapter F

§807.81

§807.82

§807.83

§807.84

Subchapter G

§807.101

§807.102

§807.103

Subchapter H

§807.121

§807.122

§807.123

§807.124

§807.125

§807.126

§807.127

§807.128

§807.129

§807.130

§807.131

§807.132

§807.133

§807.134

Subchapter I

§807.151

§807.152

§807.153

Subchapter J

§807.171

§807.172

§807.173

§807.174

§807.175

§807.176

Subchapter K

§807.191

§807.192

§807.193

§807.194

§807.195

§807.196

§807.197

Subchapter L

§807.221

§807.222

§807.223

§807.224

Subchapter M

§807.241

§807.242

§807.243

§807.244

§807.245

Subchapter N

§807.261

§807.262

§807.263

§807.264

Subchapter O

§807.281

§807.282

§807.283

§807.284

Subchapter P

§807.301

§807.302

Subchapter Q

§807.321

§807.322

§807.323

§807.324

§807.325

Subchapter R

§807.341

§807.342

Subchapter S

§807.361

§807.362

§807.363

§807.364

§807.365

§807.366

Subchapter T

§807.381

§807.382

§807.383

§807.384

§807.385

§807.386

§807.387

§807.388

§807.389

§807.390

§807.391

§807.392

§807.393

§807.394

§807.395

Chapter 809

Subchapter A

§809.1

§809.2

§809.3

Subchapter B

§809.11

§809.12

§809.13

§809.14

§809.15

§809.16

§809.17

§809.18

§809.19

§809.20

§809.21

Subchapter C

§809.41

§809.42

§809.43

§809.44

§809.45

§809.46

§809.47

§809.48

§809.49

§809.50

§809.51

§809.53

§809.54

Subchapter D

§809.71

§809.72

§809.73

§809.74

§809.75

§809.76

§809.77

Subchapter E

§809.91

§809.92

§809.93

§809.94

Subchapter F

§809.111

§809.112

§809.113

§809.114

§809.115

§809.116

§809.117

Chapter 811

Subchapter A

§811.1

§811.2

§811.3

§811.4

§811.5

Subchapter B

§811.11

§811.12

§811.13

§811.14

§811.15

§811.16

Subchapter C

§811.21

§811.22

§811.23

§811.24

§811.25

§811.26

§811.27

§811.28

§811.29

§811.30

§811.31

§811.32

§811.33

§811.34

Subchapter D

§811.41

§811.42

§811.43

§811.44

§811.45

§811.46

§811.48

§811.49

§811.50

§811.51

Subchapter E

§811.61

§811.62

§811.63

§811.64

§811.65

§811.66

§811.67

Chapter 813

Subchapter A

§813.1

§813.2

§813.3

§813.4

§813.5

Subchapter B

§813.11

§813.12

§813.13

§813.14

Subchapter C

§813.22

Subchapter D

§813.31

§813.32

§813.33

§813.34

Subchapter E

§813.41

Subchapter F

§813.53

Chapter 815

Subchapter A

§815.1

§815.2

§815.3

Subchapter B

§815.10

§815.12

§815.15

§815.16

§815.17

§815.18

§815.19

§815.20

§815.21

§815.22

§815.23

§815.24

§815.25

§815.26

§815.27

§815.28

§815.32

Subchapter C

§815.101

§815.102

§815.103

§815.104

§815.105

§815.106

§815.107

§815.108

§815.109

§815.111

§815.112

§815.113

§815.114

§815.115

§815.116

§815.119

§815.128

§815.129

§815.130

§815.131

§815.132

§815.133

§815.134

§815.135

Subchapter D

§815.150

Subchapter E

§815.161

§815.162

§815.163

§815.164

§815.165

§815.166

§815.167

§815.168

Subchapter F

§815.170

§815.171

§815.172

§815.173

§815.174

Chapter 817

Subchapter A

§817.1

§817.2

§817.3

§817.4

§817.5

§817.6

Subchapter B

§817.21

§817.22

§817.23

§817.24

Subchapter C

§817.31

§817.32

§817.33

Chapter 819

Subchapter A

§819.1

§819.2

§819.3

Subchapter B

§819.10

§819.11

§819.12

Subchapter C

§819.21

§819.22

§819.23

§819.24

§819.25

§819.26

Subchapter D

§819.41

§819.42

§819.43

§819.44

§819.45

§819.46

§819.47

§819.48

§819.49

§819.50

§819.51

§819.52

Subchapter E

§819.71

§819.72

§819.73

§819.74

§819.75

§819.76

Subchapter F

§819.91

§819.92

§819.93

Subchapter G

§819.111

§819.112

Subchapter H

§819.121

§819.122

§819.123

§819.124

§819.125

§819.126

§819.127

§819.128

§819.129

§819.130

§819.131

§819.132

§819.133

§819.134

§819.135

Subchapter I

§819.151

§819.152

§819.153

§819.154

§819.155

§819.156

Subchapter J

§819.171

§819.172

Subchapter K

§819.191

§819.192

§819.193

§819.194

§819.195

§819.196

§819.197

§819.198

§819.199

§819.200

§819.201

Subchapter L

§819.221

Chapter 821

Subchapter A

§821.1

§821.2

§821.3

§821.4

§821.5

§821.6

Subchapter B

§821.21

§821.22

§821.25

§821.26

§821.27

§821.28

Subchapter C

§821.41

§821.42

§821.43

§821.44

§821.45

§821.46

§821.47

Subchapter D

§821.61

§821.62

§821.63

Subchapter E

§821.81

Chapter 823

Subchapter A

§823.1

§823.2

§823.3

§823.4

Subchapter B

§823.10

§823.11

§823.12

§823.13

§823.14

Subchapter C

§823.20

§823.21

§823.22

§823.23

§823.24

§823.25

§823.26

§823.27

Subchapter D

§823.30

§823.31

§823.32

§823.33

Chapter 833

Subchapter A

§833.1

Subchapter C

§833.31

§833.32

§833.33

Chapter 835

Subchapter A

§835.1

§835.2

§835.3

§835.4

Subchapter B

§835.11

§835.12

§835.13

§835.14

§835.15

Subchapter C

§835.31

§835.32

§835.33

§835.34

Chapter 837

Subchapter A

§837.1

§837.2

Subchapter B

§837.21

§837.22

§837.23

§837.24

§837.25

§837.26

§837.27

Subchapter C

§837.41

§837.42

Chapter 841

Subchapter A

§841.1

§841.2

Subchapter B

§841.11

Subchapter C

§841.31

§841.32

§841.33

§841.34

§841.35

§841.36

§841.37

§841.38

§841.39

§841.40

§841.41

§841.42

§841.43

§841.44

§841.45

§841.46

§841.47

Subchapter E

§841.94

Subchapter F

§841.201

§841.202

§841.203

§841.204

§841.205

§841.206

§841.207

§841.208

§841.209

§841.210

§841.211

§841.212

§841.213

§841.214

§841.215

Chapter 843

Subchapter A

§843.1

§843.2

Chapter 845

Subchapter A

§845.1

§845.2

Subchapter B

§845.11

§845.12

§845.13

Chapter 847

Subchapter A

§847.1

§847.2

§847.3

Subchapter B

§847.11

§847.12

Subchapter C

§847.21

§847.22

Subchapter D

§847.31

Subchapter E

§847.41

Subchapter F

§847.51

Chapter 849

Subchapter A

§849.1

§849.2

§849.3

Subchapter B

§849.11

§849.12

Subchapter C

§849.21

§849.22

§849.23

Subchapter D

§849.41

Subchapter E

§849.51

§849.52

Part 21

Chapter 876

§876.1

§876.2

§876.3

§876.4

§876.5

§876.6

§876.7

§876.8

§876.9

§876.10

§876.11

§876.12

Chapter 877

§877.1

§877.2

§877.3

§877.4

§877.5

Part 22

Chapter 901

§901.1

§901.2

Part 1

Chapter 1

Subchapter A

§1.1: Purpose

The purpose of this subchapter is to state the purposes, tasks, duration, and reporting requirements of advisory committees of the Texas Department of Mental Health and Mental Retardation (TDMHMR) as required by the Texas Government Code, Chapter 2110.

Comments

Source Note: The provisions of this §1.1 adopted to be effective February 17, 2000, 25 TexReg 1108; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§1.2: Application

This subchapter applies to the operations of the Texas Department of Mental Health and Mental Retardation.

Comments

Source Note: The provisions of this §1.2 adopted to be effective February 17, 2000, 25 TexReg 1108; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§1.3: Definitions

The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:

(1) Board--The Texas Board of Mental Health and Mental Retardation.

(2) Department--The Texas Department of Mental Health and Mental Retardation (TDMHMR).

(3) Facility--Any state hospital, state school, state center, or state-operated services (SOCS) operated by the department.

(4) Local authority--An entity to which the Texas Board of Mental Health and Mental Retardation delegates its authority and responsibility within a specified region for the planning, policy development, coordination, resource development and allocation, and/or for supervising and ensuring the provision of mental health community services to people with mental illness and/or mental retardation services to persons with mental retardation in one or more local service areas.

Comments

Source Note: The provisions of this §1.3 adopted to be effective February 17, 2000, 25 TexReg 1108; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§1.4: Advisory Committee Requirements

(a) Reporting.

(1) On or before March 1 of each year, the chair of each advisory committee shall submit a report to the board outlining:

(A) the committee's work for the calendar year, including any specific recommendations, products, and accomplishments;

(B) the costs related to the committee's existence for the calendar year, including the cost of department staff time spent in support of the committee's activities; and

(C) the work and costs of the committee for the previous calendar year.

(2) The chair of each advisory committee shall submit additional reports to the board as required by state statute or TDMHMR rules and as requested by the board.

(b) Membership.

(1) In accordance with the Texas Government Code, §2110.002, and notwithstanding other law, an advisory committee may have no more than 24 members. The composition of the committee must provide a balanced representation between:

(A) industries or occupations regulated or directly affected by the advised state agency; and

(B) consumers of services provided either by the advised state agency or by industries or occupations regulated by the agency.

(2) This subsection does not apply to advisory committees that must be composed in a manner which is inconsistent with this subsection under federal law or for federal funding purposes.

Comments

Source Note: The provisions of this §1.4 adopted to be effective February 17, 2000, 25 TexReg 1108; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§1.8: Mental Retardation Planning and Advisory Council

(a) The purpose of the Mental Retardation Planning and Advisory Council is to provide advice on issues and initiatives regarding mental retardation services.

(b) Tasks of the Mental Retardation Planning and Advisory Council include:

(1) submitting recommendations for strategic planning;

(2) developing recommendations for improved services; and

(3) developing recommendations for policy revisions.

(c) This advisory committee shall be abolished on January 1, 2012, unless abolished on an earlier date or reauthorized.

Comments

Source Note: The provisions of this §1.8 adopted to be effective February 17, 2000, 25 TexReg 1108; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§1.20: References

The following laws and rules are referenced in this subchapter:

(1) Texas Government Code, Chapter 2110; and

(2) Texas Health and Safety Code, §532.021, §532.020(a), §571.027, and §533.0351.

Comments

Source Note: The provisions of this §1.20 adopted to be effective February 17, 2000, 25 TexReg 1108; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§1.21: Distribution

This subchapter shall be distributed to:

(1) the members of the Texas Board of Mental Health and Mental Retardation;

(2) executive, management, and program staff of TDMHMR Central Office;

(3) superintendents/directors of all TDMHMR facilities; and

(4) advocacy organizations.

Comments

Source Note: The provisions of this §1.21 adopted to be effective February 17, 2000, 25 TexReg 1108; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

Subchapter D

§1.151: Purpose

The purpose of this subchapter governing administrative hearings of the department in contested cases is:

(1) to provide a simple, efficient, and uniform set of procedures for all departmental administrative hearings involving contested cases, which will adequately protect the rights of all parties involved and will be consistent with due process requirements of the Texas and federal constitutions;

(2) to provide and to ensure uniform standards, practices, and procedures with respect to hearings held in connection with such administrative procedures;

(3) to provide a procedure which will result in fair and expeditious determination of causes governed by this subchapter and adequately protect the procedural rights of all parties; and

(4) to fulfill the requirements of the Administrative Procedure Act, Texas Government Code, Chapter 2001.

Comments

Source Note: The provisions of this §1.151 adopted to be effective September 28, 1998, 23 TexReg 9550; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§1.152: Applicability and Scope of Rules

(a) The provisions of this subchapter shall apply in all contested cases.

(b) The provisions of this subchapter shall not be construed so as to enlarge, diminish, modify, or alter the jurisdiction, powers, or authority of the department or the substantive rights of any person.

(c) The provisions of this subchapter shall be given a liberal interpretation in order that a just, fair, equitable, and impartial judgment of the rights of the parties under the established principles of substantive law, as determined by appropriate statutes or department rules, may be attained in a timely manner and at the least expense to all parties.

Comments

Source Note: The provisions of this §1.152 adopted to be effective September 28, 1998, 23 TexReg 9550; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§1.153: Definitions

The following words and terms, when used in this subchapter, have the following meanings unless the context clearly indicates otherwise:

(1) Administrative hearing or adjudicated hearing--An oral proceeding before the department in which the rights and duties of particular persons are judged after notice and opportunity to be heard.

(2) Administrative law judge or ALJ--The attorney designated or appointed by the commissioner to conduct and preside over an administrative hearing.

(3) Commission to examine witnesses--A commission issued to direct the taking of depositions of witnesses.

(4) Commissioner--The commissioner of the Texas Department of Mental Health and Mental Retardation or designee.

(5) Contested case--A proceeding granted by statute for which procedures are not otherwise provided for in applicable department rules, including rate making or licensing proceedings, in which the legal rights, duties, or privileges of a party are to be determined by the department after an opportunity for an adjudicated hearing, except in matters related solely to the internal personnel policies and procedures of the department.

(6) Days--Calendar days, unless otherwise specified.

(7) Decision--A decision made by the ALJ regarding the administrative hearing over which the ALJ is presiding.

(8) Default judgment--A judgment entered against a party who has failed to appear at the administrative hearing.

(9) Department--The Texas Department of Mental Health and Mental Retardation (TXMHMR) or its designee.

(10) Exception--A party's objection to an order or ruling.

(11) Findings of fact--Determinations from the evidence submitted in the case concerning facts asserted by one party and denied by another.

(12) Hearings Office--The Legal Services Division of the department's central office.

(13) Interrogatories--A discovery device consisting of written questions about the proceeding submitted by one party to another party or witness.

(14) Motion--A request made to the administrative law judge for the purpose of obtaining a ruling or order directing some act to be done in favor of the movant.

(15) Movant--The party making a motion.

(16) Order--A command for action by the administrative law judge as a result of a ruling or decision.

(17) Party--Each person or agency named or admitted as a party, pursuant to department rules and statutes under which such hearings are requested or held.

(18) Person--An individual, partnership, corporation, association, governmental subdivision, or a public or private organization of any character other than the department.

(19) Person receiving services or person served by the department--A person who is receiving mental health or mental retardation services funded by or through the department.

(20) Pleadings--Written statements filed by parties concerning their respective positions, claims, and rights in administrative hearings (e.g., applications, objections, petitions, complaints, answers, replies, motions, etc.).

(21) Preponderance of the evidence--Evidence which is of greater weight or more convincing than the evidence which is offered in opposition to it.

(22) Proceeding--The regular and orderly progress in form of law, including all possible steps in an action from its beginning to the final decision. A proceeding includes, but is not limited to, the initiating document, certificates of service, pleadings, motions, orders, prehearing conference, hearing, the record, rulings, decisions, evidence, testimony, and exhibits.

(23) Proposed findings of fact--Findings of fact as proposed by a party.

(24) Texas Rules of Civil Procedure--Those rules adopted by the Texas Supreme Court which govern procedure in state courts involving all civil suits.

(25) Texas Rules of Civil Evidence--Those rules adopted by the Texas Supreme Court which govern the admissibility of evidence in state courts involving all civil suits.

(26) Privileged information--Information (i.e., communications, written or verbal, made by persons with a protected relationship such as husband/wife, attorney/client, doctor/patient, priest/penitent, etc.) which the law protects from forced disclosure at the option of the spouse, client, patient, penitent, etc.

(27) Ruling--A judicial determination by the administrative law judge of the admissibility of evidence, allowance of a motion, etc.

(28) Serve, serve upon, serve notice, service--To mail or deliver a copy of a designated document to a party or to the party's attorney/representative, if any.

(29) Statute--State or federal law.

(30) Summary judgment--A judgment entered when there is no genuine issue of material fact and a party is entitled to judgment as a matter of law.

(31) Trial de novo--A new trial held as if no administrative hearing had been held.

(32) With prejudice--Refusal of the ALJ to accept the refiling of a pleading or request for an administrative hearing.

Comments

Source Note: The provisions of this §1.153 adopted to be effective September 28, 1998, 23 TexReg 9550; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§1.154: Administrative Law Judge

An administrative law judge is an attorney appointed by the commissioner or designee who conducts the proceeding. An attorney who has, directly or indirectly, participated in or given advice on issues that are the basis for a particular hearing may not be the administrative law judge in that hearing.

Comments

Source Note: The provisions of this §1.154 adopted to be effective September 28, 1998, 23 TexReg 9550; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§1.155: Hearing Guidelines

(a) Requesting an administrative hearing. A written request for an administrative hearing must be filed with the Hearings Office addressed to: Hearings Office, TXMHMR, P.O. Box 12668, Austin, TX 78711-2668. Upon the receipt of the written request for an administrative hearing which complies with this subchapter as to form and content, the Hearings Office shall docket the document as a pending proceeding.

(b) Administrative hearing date. If the ALJ determines that the written request was filed within the time frames specified in applicable department rules and statutes, the ALJ shall select an administrative hearing date.

(1) The administrative hearing date shall be no sooner than 20 days nor later than 45 days after the written request is received by the Hearings Office, unless otherwise provided in department rules or statutes.

(2) After the administrative hearing date has been set, the ALJ may subsequently postpone or continue the administrative hearing date until a later date if, in the ALJ's discretion, good cause requires a later date. Good cause includes, but is not limited to, the consideration that a later date will result in a fairer and more just determination of the issues and that the welfare of any person served by the department will not be substantially endangered by reason of the postponement. The ALJ is not precluded from ordering a postponement or continuance of the hearing upon the showing of good cause.

(c) Notice of an administrative hearing. In a contested case all parties shall be afforded an opportunity for an administrative hearing after reasonable notice. At least 20 days before the administrative hearing date, the ALJ must serve written notification to the department and the party who requested the hearing. A copy of this subchapter must accompany the written notification sent to the parties involved in the administrative hearing. The ALJ may mail notice by certified or registered mail to the last known place of address of the person entitled to receive such notice or may hand-deliver such notice. Notice shall be delivered in the manner most likely to assure prompt receipt. Notice shall include:

(1) a statement of the time, place, and nature of the administrative hearing;

(2) a statement of the legal authority and jurisdiction under which the hearing is to be held;

(3) reference to the particular sections of the statutes and rules involved; and

(4) a short and plain statement of the action complained of by the party requesting the administrative hearing.

(d) Statement of issues. After a timely written motion from the department's representative, the ALJ may require the party requesting the administrative hearing to deliver to the department representative a concise written statement of the issues, statutes, and rules asserted by that party. This statement must be delivered at least 10 days before the administrative hearing date.

(e) Nature of the administrative hearing. All hearings conducted in any proceedings shall be opened to the public, but may be ordered to be closed upon a finding of the ALJ of possible breach of confidentiality of persons receiving services.

(f) Location of the administrative hearing. All hearings shall be held in Austin, Texas, in the case of proceedings arising out of actions, events, or omissions alleged to have been taken by the central office of TXMHMR; and at the location of each facility of the department, in the case of proceedings arising out of actions, events, or omissions alleged to have been taken by that facility, unless for good and sufficient cause, in which case the ALJ, in the ALJ's discretion, shall designate another place to hold the hearing which would be in the interest of the public.

(g) Representation.

(1) Parties may appear on their own behalf, be represented by an attorney, or by a lay representative of the party's choosing.

(2) The commissioner shall appoint an attorney and/or appropriate program staff to represent the department in contested cases.

(h) Filing of Documents. All documents relating to any proceeding which is pending must be submitted to the ALJ with a copy served upon each party under a certificate of service as described in subsection (l) of this section. The documents shall be considered filed only when actually received by the ALJ accompanied by the filing fee, if any, required by statute or department rules.

(i) Agreements between parties. No stipulation or agreement between the parties, their attorneys/representatives, with regard to any matter involved in any proceeding, shall be in force unless:

(1) it is in writing and signed by the parties involved or their attorneys/representatives; or

(2) it has been dictated into the record by the parties involved during the course of a hearing; or incorporated in an order with their written approval. This subsection does not limit a party's ability to waive, modify, or stipulate any right or privilege provided by this subchapter.

(j) Pleadings. Pleadings shall be submitted to the ALJ.

(1) Pleadings shall be typewritten or printed with exhibits, if any, attached. Copies of pleadings are acceptable, provided all copies are clear and permanently legible. The original of every pleading shall:

(A) be signed in ink by the party filing the pleading or by the party's attorney/representative;

(B) contain the address of the party filing it; and

(C) contain the name, telephone number, and business address of the party's attorney/representative, if any.

(2) Pleadings shall include:

(A) the name of the party requesting the administrative hearing;

(B) the names of any other known parties;

(C) a statement of the pleading's objective which contains a concise statement of facts in support of the objective;

(D) the relief, action, or order sought by the pleader and the specific reasons and grounds for such;

(E) any matter required by other rules of the department with respect to the proceeding;

(F) the certificate of service as described in subsection (l) of this section; and

(G) an affidavit(s) if based upon matters which do not appear on the record.

(3) Upon submission of any pleading to the ALJ, it shall be examined by the ALJ to determine its sufficiency under this subchapter. While a liberal interpretation shall be to be given to all pleadings, if the pleading does not comply with this subchapter, it shall be returned to the person filing it along with the statement by the ALJ of the reason for rejecting it. A corrected pleading may then be filed if it will not unduly delay the hearing. Regardless of any error in the identification of a pleading, its true status shall be recognized.

(4) In order to amend its pleading, a party must file a motion, no later than five days before a hearing, and obtain a ruling by the ALJ.

(5) Any party who submits a pleading to the ALJ after a request for an administrative hearing has been filed must, at the same time, serve a copy of the pleading upon all other parties or their attorney/representative, if any, under a certificate of service. The willful failure of any party to make such service shall be sufficient grounds for the ALJ to enter an order striking the pleading from the record.

(6) All pleadings must be filed no less than five days prior to the administrative hearing date.

(7) Any pleading may adopt and incorporate by specific reference any part of any document or entry in the official files and records of the department.

(k) The ALJ may direct that one or more of the following be transmitted by each party to all other parties or their attorney/representative, and to the ALJ, by the date established by the ALJ:

(1) a list of witnesses the party desires to testify and a brief narrative summary of their expected testimony;

(2) a written statement of the disputed issues for consideration at the hearing;

(3) a copy of any written statements to be offered at the hearing; or

(4) a copy of other written testimony or documentary evidence the party intends to use at the hearing.

(l) Certificate of service. A certificate by the party or the party's attorney/representative who submits a pleading stating that it has been served upon the other parties or their attorney/representative will be sufficient proof of such service. The following form of certificate is sufficient: "I hereby certify that I have, on this __________ day of __________, 19__, served copies of the attached document upon all other parties to this proceeding by _______________ (state herethe type of delivery/service). _______________ (signature)"

(m) Computing timeframes. The following procedure is to be used to compute any period of time governing hearings procedures and which is allowed or prescribed by this subchapter or by order of the ALJ: the period shall begin on the day after the act, event, default, or controversy and conclude on the last day of such computed period, unless that day is a Saturday, Sunday, or legal holiday, in which case the period runs until the end of the next day which is neither a Saturday, Sunday, nor legal holiday.

(n) Extension of timeframes. The time for the doing of any act may be extended by order of the ALJ, upon written motion submitted to the ALJ prior to the expiration of the period of time for the doing of such act, showing that there is good cause for such extension of time and that the need is not caused by neglect, indifference, or lack of diligence of the movant. A copy of the written motion shall be served upon all other parties to the proceeding at the same time that it is submitted to the ALJ.

Comments

Source Note: The provisions of this §1.155 adopted to be effective September 28, 1998, 23 TexReg 9550; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§1.156: Conduct of Hearings--General Requirements

(a) The ALJ shall be in charge of proceedings. The ALJ has the authority to:

(1) administer oaths or affirmations;

(2) examine witnesses;

(3) issue subpoenas and commissions;

(4) rule on admissibility of evidence and amendments to pleadings;

(5) conduct hearings on motions and other pleadings;

(6) establish reasonable time limits for conducting hearings;

(7) request additional information; and

(8) issue any orders necessary to enforce the ALJ's rulings, which include, but are not limited to:

(A) exclusion of evidence or witnesses;

(B) exclusion of oral argument;

(C) continuance or dismissal of the hearing with or without prejudice; and

(D) summary or default judgment on any issues.

(b) The department has the burden of proof in all contested cases.

(c) At the discretion of the ALJ, a hearing may be conducted by telephone/teleconference.

(d) Subject to the ALJ's rulings and orders, opportunity shall be given to all parties to respond to and present evidence and argument on all issues involved.

(e) Subject to limits set by the ALJ, all parties shall have an opportunity to call any witnesses desired.

(f) If a party or the party's attorney/representative is notified of the hearing and neither is present at the hearing, all matters stated in evidence introduced at the hearing may be considered as undisputed by the party failing to appear.

(g) The ALJ may entertain motions for the dismissal of a contested case without a hearing for any of the following reasons:

(1) failure of the party who requested the administrative hearing to go forward with the proceeding within a reasonable period of time;

(2) unnecessary duplication of proceedings;

(3) withdrawal from the proceeding by the party who requested the administrative hearing;

(4) moot issues; and

(5) lack of departmental jurisdiction.

(h) A record shall be made of the proceedings and include:

(1) all pleadings, motions, and intermediate rulings;

(2) evidence received or considered;

(3) a statement of matters officially noticed;

(4) objections and the rulings on them;

(5) proposed findings of fact and exceptions;

(6) any decision, order, opinion, or report made by the ALJ; and

(7) all department staff memoranda or data submitted to or considered by the ALJ in making the final decision.

(i) Exhibits.

(1) The original of each exhibit offered shall be submitted to the ALJ for identification and a copy served to each party.

(2) In the event an exhibit has been identified, objected to, and excluded, the ALJ shall return the exhibit to the offering party.

(3) No exhibit will be permitted to be submitted after the conclusion of the hearing, unless specifically directed by the ALJ. In the event the ALJ allows the exhibit to be submitted after the completion of the hearing, copies of the late-filed exhibit shall be served upon all parties.

(j) All hearings shall be recorded either stenographically or electronically at the department's expense. The ALJ shall decide whether a stenographic record or an electronic recording will be made and shall make the necessary recording arrangements accordingly. If requested by the ALJ, the hearing must be transcribed, at the department's expense, with a transcript given to the ALJ. The costs associated with recording the hearing may be assessed to one or more parties if a recording method, other than the one chosen by the ALJ, is requested by the party or parties. If a party wants a transcript of the hearing, that party must pay all costs associated with providing the transcript.

(k) Parties to the hearing may conduct cross-examination for a full and true disclosure of the facts.

(l) Before or during the hearing, the ALJ may call or request any party to call a witness or witnesses the ALJ believes necessary to make the final decision.

(m) The ALJ may not communicate directly or indirectly in connection with any issue of fact or law with any person, party, or their attorney/representative, except after serving notice which provides an opportunity for all parties to participate. The ALJ may communicate with other members of the department who have not participated in the proceeding of the contested case for the purpose of utilizing the special skills or knowledge of the department's staff in evaluating the evidence in accordance with the Texas Government Code, §2001.061 and §411.158(a)(4) of this title (relating to Evidence and Depositions).

(n) In all procedural matters not specifically governed by these sections, the Texas Rules of Civil Procedure shall apply unless the ALJ determines there is good cause for waiving any and all such rules.

(o) Records of the hearing shall be kept in department files for four years after a final decision is made or until any subsequent litigation arising from the hearing has been resolved.

(p) In any hearing or other proceedings conducted by the department, the identity of an individual with mental illness or mental retardation shall be not be revealed or made a matter of public record in any way unless the person who has the right of confidentiality waives that right in open hearing or the party or person desiring or attempting to reveal the identity of such individual has:

(1) established to the satisfaction of the ALJ that the identity of the individual with mental illness or mental retardation is relevant and material to an issue in the hearing; and

(2) secured from the individual with mental illness or mental retardation or the person legally authorized to give consent for such individual written consent to reveal, for the purposes of the proceeding, the identity of such individual, and the specific information to be revealed is set forth in such written consent, and such written consent has been filed with the ALJ.

(q) If consent to reveal the identity of an individual with mental illness or mental retardation cannot be obtained due to the individual's incompetence or lack of a legal guardian, then:

(1) the ALJ must close the hearing to the public; and

(2) any transcript of the record may not identify such individual, but may contain a pseudonym to refer to the individual.

(r) Any attempt by a party to circumvent the requirements of subsection (p) of this section shall be sufficient grounds for the ALJ to strike the pleading of the party from the record or to dismiss the hearing with prejudice.

(s) At all hearings, each party, witness, attorney/representative, or other person must show proper dignity, courtesy, and respect for the ALJ and others participating in or observing the hearing. The ALJ is authorized to act as the ALJ considers necessary and appropriate to maintain proper decorum and conduct. Actions may include, but are not limited to, recessing the hearing to be reconvened at another time or place or excluding from the hearing any party, witness, attorney/representative, or other person for a period and under the conditions that the ALJ considers fair and just. The ALJ, attorneys of parties shall observe and practice the standards of ethical behavior prescribed for attorneys at law by the State Bar of Texas.

Comments

Source Note: The provisions of this §1.156 adopted to be effective September 28, 1998, 23 TexReg 9550; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§1.157: Prehearing Procedure

(a) Prehearing conference.

(1) In any proceeding governed by this subchapter, the ALJ, on the ALJ's own motion or on the motion of any party, may direct the parties or their attorneys/representatives to appear before the ALJ or participate by telephone/teleconference at a specified time and place for a conference prior to the administrative hearing date for the purpose of considering:

(A) the possibility of making admissions of facts or stipulations to avoid the unnecessary introduction of proof;

(B) the simplification of issues;

(C) the procedure at the hearing;

(D) the limitation, when possible, of the number of witnesses; and

(E) such other matters as may aid in the simplification of the proceedings and the disposition of the matters in controversy, including settlement of such issues as are in dispute.

(2) Actions taken at the conference shall be recorded in an order by the ALJ unless the parties enter into a written agreement, incorporating issues addressed at the prehearing conference, signed by the parties involved or their attorney/representative.

(b) Joint hearing. A motion for the consolidation of two or more proceedings shall be in writing, signed by the party making the motion or that party's attorney/representative, and submitted to the ALJ at least five days prior to the administrative hearing date. Two or more proceedings may not be consolidated or heard jointly without the agreement of all parties to such proceedings, unless the ALJ finds that:

(1) the two or more proceedings involve common questions of law and fact; and

(2) separate hearings would result in unwarranted expense, delay, or substantial injustice.

(c) Discovery and production of documents and things for inspection, copying, or photographing. In all discovery matters not specifically governed by these sections, the Texas Rules of Civil Procedure shall be followed.

(1) Upon the timely motion of any party showing good cause, with notice served upon all other parties, and subject to any limitation provided for discovery under the Texas Rules of Civil Procedure, the ALJ may order any party to:

(A) produce and permit the inspection and copying or photographing by or on behalf of the movant any of the following items that are in the party's possession, custody, or control and not considered privileged information, as defined in §411.153 of this title (relating to Definitions), which constitute or contain, or are reasonably calculated to lead to the discovery of, evidence material to any matter involved in the action:

(i) documents;

(ii) papers;

(iii) books;

(iv) accounts;

(v) letters;

(vi) photographs;

(vii) objects; and

(viii) tangible things.

(B) permit entry upon designated land or other property in the party's possession or control for the purpose of inspecting, measuring, surveying, or photographing the property or any specific object or operation which may be relevant to any matter involved in the action.

(2) The ALJ shall limit the order described in paragraph (1) of this subsection, as justice may require, to protect any party or witness from undue annoyance, embarrassment, oppression, or expense. The order must specify the time, place, and manner of making the inspection, measurement, or survey and taking the copies and photographs and may prescribe such terms and conditions as are just.

(3) The identity and location of any potential party or witness may be obtained from any communication or other paper in a party's possession, custody, or control. Any party may be required to produce and permit the inspection and copying of reports, including factual observations and opinions of an expert to be called as a witness. The rights granted in this paragraph may not extend to other written statements of witnesses or other written communication passing between agents, representatives, or the employees of any party to the proceeding or to other communications between any party and the party's agents, representatives, or other employees, that were made subsequent to the occurrence or transaction upon which the proceeding is based, and made in connection with the prosecution, investigation, or defense of such claim or the circumstances out of which the claim arose.

(d) Statement previously made. Any person, whether or not a party, shall be entitled to obtain, upon request, a copy of any statement that person has previously made concerning the occurrence or transaction upon which the proceeding is based which is in the possession, custody, or control of any party. If the request is refused, the person may make a motion for a departmental order to obtain a copy of the statement. For the purposes of this subsection, a statement previously made is:

(1) a written statement signed or otherwise adopted or approved by the person making it; or

(2) a stenographic, mechanical, electrical, or other recording or a transcription of the same statement, which is a substantially verbatim recital of an oral statement by the person making it and which is recorded at the same time.

(e) Admission of facts and of genuineness of documents. After a request for an administrative hearing has been filed any party may deliver or have delivered to any other party a written request for admission of facts and genuineness of documents. The provisions of Rule 169 of the Texas Rules of Civil Procedure govern, except that filing and enforcing shall be controlled by the ALJ.

(f) Interrogatories to parties. After a request for an administrative hearing has been filed any party may serve interrogatories upon any other party. The provisions of Rule 168 of the Texas Rules of Civil Procedure govern, except that filing and enforcing shall be controlled by the ALJ.

Comments

Source Note: The provisions of this §1.157 adopted to be effective September 28, 1998, 23 TexReg 9550; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§1.158: Evidence and Depositions

(a) Evidentiary procedures.

(1) The Texas Rules of Civil Evidence shall apply except as follows:

(A) Irrelevant, immaterial, or unduly repetitious evidence shall be excluded.

(B) Evidence inadmissible under those rules may be admitted if the evidence is:

(i) necessary to ascertain facts not reasonably susceptible of proof under those rules;

(ii) not precluded by statute; and

(iii) of a type on which a reasonably prudent person commonly relies in the conduct of the person's affairs.

(C) Any part of the evidence may be received in written form if a hearing will be expedited and if the parties' interest will not be substantially prejudiced.

(2) Objections to offers of evidence may be made and shall be noted in the record.

(3) The prepared testimony of a witness upon direct examination, either in narrative or question-and-answer form, may be incorporated in the record as if read or received as an exhibit after the witness has been sworn and has identified that the prepared testimony is as true and accurate as the witness's oral testimony would be. The witness is subject to clarifying questions and to cross-examination. The prepared testimony may not be stricken from the record in whole or in part.

(4) Documentary or written evidence may be received in the form of copies or excerpts if the original is not readily available. On request, parties shall be given an opportunity to compare the copy with the original.

(5) Official notice may be taken of all facts judicially known. In addition, notice may be taken of generally recognized facts within the area of the department's specialized knowledge. Parties shall be notified either before or during the hearing, or by reference in preliminary reports or otherwise, of the material officially noticed, including any staff memoranda or data. Parties shall be given an opportunity to contest the material so noticed.

(6) All testimony in a hearing by a witness shall be taken under oath or affirmation as prescribed by law.

(7) The department or any other party may apply for permission to obtain the testimony of a witness by telephone when it is impossible or impractical to obtain the physical presence of a witness in the hearing room due to the witness's age, illness, custodial restrictions, or residence more than 100 miles from the site of the hearing.

(A) Application for permission to secure testimony by telephone shall be submitted to the ALJ with a copy sent to other parties at least 10 days prior to the hearing. The application must state the reasons for the request. If the ALJ finds that good cause exists to permit testimony to be obtained by telephone, the ALJ must grant the application and immediately advise the parties. The ALJ must rule on the application at least five days prior to the hearing.

(B) If testimony by telephone is allowed, the hearing room must be equipped with a speaker phone or other telephone equipment which will allow everyone present to hear the testimony of the witness simultaneously and will also allow the witness to hear all parties and the ALJ. The testimony by telephone provided by a witness shall be taken under oath or affirmation as if the witness were physically present at the hearing.

(8) If a party or witness is deaf, the department shall provide an interpreter whose qualifications are approved by the State Commission for the Deaf and Hearing Impaired to interpret the proceedings for that party or witness. In this paragraph, "person who is deaf" means a person who has a hearing impairment, whether or not the person also has a speech impairment, that inhibits the person's comprehension of the proceedings or communication with others.

(9) If a party or witness speaks a language other than English, the department shall provide an interpreter of the language spoken by the party or witness.

(b) Subpoenas. The department shall have the powers of subpoena granted under the Texas Government Code, §2001.089. The department shall, on its own motion or on the written motion of any party, on a showing of good cause, and on the monetary deposit of sums which will reasonably ensure payment of the amounts estimated to accrue, issue a subpoena in accordance with law to require the attendance of witnesses and the production of documents as may be necessary and proper for the purposes of the proceedings before it.

(c) Commissions/depositions. The issuance of commissions to examine witnesses and the taking of depositions shall be in accordance with the provisions of the Texas Government Code, §§2001.094-.103.

(d) Requests for commissions or subpoenas. Requests for commissions or subpoenas shall be submitted to the ALJ.

Comments

Source Note: The provisions of this §1.158 adopted to be effective September 28, 1998, 23 TexReg 9550; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§1.159: Deliberation

After all evidence has been heard, the ALJ shall adjourn the hearing. Within 60 days from the date of adjournment, the ALJ shall make a final decision in the contested case. The ALJ may prescribe a longer period of time within which the final decision or order shall be issued, but such extension, if so prescribed, shall be announced at the completion of the hearing, but in no event shall be longer than 90 days unless a longer period of time is agreed on by all parties to the proceeding.

Comments

Source Note: The provisions of this §1.159 adopted to be effective September 28, 1998, 23 TexReg 9550; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§1.160: Decisions

(a) The administrative hearing decision of the ALJ shall be based solely upon the record of the contested case. The decision shall be in writing and include the findings of fact and conclusions of law separately stated.

(b) Issues must be proven by a preponderance of the evidence.

(c) Findings of fact must be accompanied by a concise and explicit statement of the underlying facts supporting the findings.

(d) Findings of fact must be based exclusively on the evidence and on matters officially noticed. If a party submits a proposed finding of fact, the decision must include a ruling on each proposed finding.

(e) The ALJ shall enter into the record orders that are necessary to implement the administrative hearing decision. The ALJ may also make other recommendations as the ALJ considers appropriate.

(f) The following provisions determine when an administrative hearing decision in a contested case is final.

(1) If a motion for a rehearing is not filed in the time frame as described in subsection (h) of this section, the administrative hearing decision is final on the expiration of the period for filing a motion for a rehearing.

(2) If a motion for a rehearing is filed in the time frame described in subsection (h) of this section, the administrative hearing decision is final on the date:

(A) the order overruling the motion for a rehearing is made; or

(B) the motion is overruled by operation of law.

(3) If the ALJ finds that an imminent peril to the public health, safety, or welfare requires immediate effect of a decision, the administrative hearing decision is final on the date the decision is made. In this event, the ALJ must recite or record into the record the finding of such imminent peril as well as the fact that the decision is final and effective on the date recited or recorded into the record.

(4) A decision in a contested case is final on the date specified in the order for a case in which all parties agree to the specified date in writing or on the record, if the specified date is not before the date the order is signed or later than the 20th day after the order was made.

(g) The ALJ shall send the administrative hearing decision by first class certified mail, return receipt requested, to the attorneys/representatives, or, if a party is not represented by an attorney/representative, to that party. The ALJ shall keep an appropriate record of that mailing. A party or attorney/representative notified by mail of an administrative hearing decision is presumed to have been notified on the date such notice is mailed.

(h) Any party may file a written motion for rehearing. The motion must be addressed to the ALJ and must be filed so that it is received by the ALJ within 20 days after the date the administrative hearing decision was mailed to the party or the party's attorney/representative. Replies to a motion for rehearing from other parties involved must be filed so as to be received by the ALJ within 30 days after the date of mailing of the administrative hearing decision. The ALJ shall either grant or deny the motion for rehearing within 45 days after the date the administrative hearing decision was mailed. If the ALJ does not rule on the motion for rehearing, the motion is overruled by operation of law 45 days after the date the administrative hearing decision was mailed.

(i) The period of time for the filing of motions for rehearing and replies may be extended by written order of the ALJ but such extension may not extend the period for action beyond 90 days after the date the administrative hearing decision was mailed. In the event of extension, if the ALJ does not rule on a motion for a rehearing, the motion for rehearing is overruled by operation of law on the date prescribed in the extension order, or in the absence of a prescribed date, 90 days after the date the administrative hearing decision was mailed.

Comments

Source Note: The provisions of this §1.160 adopted to be effective September 28, 1998, 23 TexReg 9550; amended to be effective March 10, 2004, 29 TexReg 2316; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§1.162: References

Reference is made to the following statutes:

(1) Texas Government Code, Chapter 2001;

(2) Texas Rules of Civil Procedure; and

(3) Texas Rules of Civil Evidence.

Comments

Source Note: The provisions of this §1.162 adopted to be effective September 28, 1998, 23 TexReg 9550; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§1.163: Distribution

This subchapter governing administrative hearings of the department in contested cases shall be distributed to:

(1) members of the Texas Board of Mental Health and Mental Retardation;

(2) executive, management, and program staff at Central Office;

(3) superintendents/directors of all department facilities;

(4) persons designated as administrative law judges;

(5) any party to an administrative hearing conducted under this subchapter; and

(6) advocacy organizations.

Comments

Source Note: The provisions of this §1.163 adopted to be effective September 28, 1998, 23 TexReg 9550; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

Subchapter G

§1.301: Purpose

The purpose of this subchapter is to describe requirements by which community mental health and mental retardation centers are established and operated by a local agency with a plan approved by the Texas Mental Health and Mental Retardation Board in accordance with the Texas Health and Safety Code, §534.001(e).

Comments

Source Note: The provisions of this §1.301 adopted to be effective May 25, 2000, 25 TexReg 4540; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§1.302: Application

This subchapter applies to local agencies desiring to establish a new community mental health and mental retardation center or affiliate with an existing center and to all existing community mental health and mental retardation centers established under the Texas Health and Safety Code, Title 7, Chapter 534.

Comments

Source Note: The provisions of this §1.302 adopted to be effective May 25, 2000, 25 TexReg 4540; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§1.303: Definitions

The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:

(1) Board of trustees - A body of not less than five nor more than nine persons selected and appointed in accordance with Texas Health and Safety Code, Title 7, §534.002 or §534.003, and §534.004, §534.005, and §534.0065, which has responsibility for the effective administration of a community center.

(2) Commissioner - The commissioner of the Texas Department of Mental Health and Mental Retardation.

(3) Community center - A center established under the Texas Health and Safety Code, Title 7, Chapter 534, Subchapter A.

(4) Current plan - The most recently approved initial, updated, or modified plan.

(5) Department - The Texas Department of Mental Health and Mental Retardation (TDMHMR).

(6) Facility - Any state hospital, state school, or state center.

(7) Initial plan - The plan developed by a board of trustees to establish a new community center.

(8) Local agency - A county, municipality, hospital district, school district, or any organizational combination of two or more of these which may establish and operate a community center.

(9) Local contribution - Funds or in-kind contribution by each local agency to a community center in the amount approved by the department, which includes local match if the center is a local authority.

(10) Local authority - An entity to which the Texas Mental Health and Mental Retardation Board delegates its authority and responsibility within a specified region for the planning, policy development, coordination, resource development and allocation, and for supervising and ensuring the provision of mental health services to persons with mental illness and/or mental retardation services to persons with mental retardation in one or more local service areas.

(11) Local match - In accordance with the Texas Health and Safety Code, §534.066, those funds or in-kind support from a local authority that are required to match some or all of the state funds the local authority receives pursuant to a contract with the department.

(12) Local service area - A geographic area composed of one or more Texas counties delimiting the population which may receive services from a local authority.

(13) Mental health services - All services concerned with research, prevention, and detection of mental disorders and disabilities and all services necessary to treat, care for, supervise, and rehabilitate persons with a severe and persistent mental illness which may be accompanied by chemical dependency or mental retardation.

(14) Mental retardation services - All services concerned with research, prevention, and detection of mental retardation and all services related to the education, training, habilitation, care, treatment, and supervision of persons with mental retardation, except the education of school-age persons that the public educational system is authorized to provide.

(15) Region - The area within the boundaries of the local agencies participating in the operation of a community center established under the Texas Health and Safety Code, Chapter 534, Subchapter A.

(16) State-operated community services (SOCS) - Community residential and nonresidential programs operated by the Texas Department of Mental Health and Mental Retardation.

Comments

Source Note: The provisions of this §1.303 adopted to be effective May 25, 2000, 25 TexReg 4540; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§1.304: Philosophy

(a) To realize the purpose and policy for community centers in Texas as described in the Texas Health and Safety Code, §534.0015, the provisions of this subchapter are intended to promote an effective relationship between state and local government in the form of local boards of trustees of community centers; these provisions recognize the importance of local initiatives and control in the development and expansion of community services.

(b) The advantage for a local agency in forming a new community center or affiliating with an existing community center is the greater degree of local ownership and control of the services provided. The department recognizes the importance of local control vested in a community center. Therefore, the department encourages and supports the affiliation of local agencies with community centers. The following principles are important in the development of local services.

(1) Persons receiving services, as well as their families and friends, should have a prominent role in determining which services best meet their needs.

(2) Persons with mental illness or mental retardation should have the opportunity for integration into the activities and social fabric of the local community.

(3) Decisions by the board of trustees of a community center should be made openly with consideration of the view of those affected by its decisions.

(4) Local communities, persons receiving services and their families, community centers, and other service providers should work together to identify service delivery needs and plan a system that meets these needs.

(5) Mental health and mental retardation services are of the best value for the public funds expended.

Comments

Source Note: The provisions of this §1.304 adopted to be effective May 25, 2000, 25 TexReg 4540; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§1.305: Process to Establish a New Community Center

(a) Letter of intent. If a local agency decides to establish a new community center, then the local agency submits a letter of intent to the commissioner outlining the proposed new center's region, governing structure, and other information pertinent to the formation of the proposed new center.

(1) If the local agency submitting the letter of intent is not a county or counties, the letter must be accompanied by a letter of endorsement from the appropriate county judge or judges.

(2) The commissioner designates staff who are knowledgeable of community center operations to review the letter of intent using the following criteria:

(A) the rationale clearly supports the benefits of establishing a new center over affiliation with an existing center and the establishment of a new center is consistent with the department's mission for the development of community services in Texas;

(B) the population of the region of the proposed new center is at least 200,000 or large enough to support a center;

(C) comprehensive array of mental health and mental retardation services will be provided;

(D) the extent of the local contribution supports the intent; and

(E) providing services efficiently is financially viable.

(3) The commissioner's response to the local agency's letter of intent is based on the review described in paragraph (2) of this subsection and is sent to the local agency by certified mail, return receipt requested.

(A) If the commissioner approves the letter of intent, the response includes notification of such approval.

(B) If the commissioner does not approve the letter of intent, the response includes the reasons for disapproval.

(b) Appointment of board of trustees. If the local agency receives approval of its letter of intent, then it prescribes the criteria and procedures for the appointment of members of a board of trustees as described in the Texas Health and Safety Code, §534.002 or §534.003, and §534.004, §534.005, and §534.0065. The local agency prescribes and makes available for public review the elements listed in the Texas Health and Safety Code, §534.004(a). If more than one agency is involved, the local agencies shall enter into a contract of interlocal agreement that stipulates the number of board members and the group from which the members are chosen, as provided in the Texas Health and Safety Code, §534.003(c). The local agencies may renegotiate or amend the contract of interlocal agreement as necessary to change the:

(1) method of choosing the board of trustees members; or

(2) membership of the board of trustees to more accurately reflect the ethnic and geographical diversity of the region's population.

(c) Initial plan.

(1) Submission. The board of trustees develops and submits to the commissioner an initial written plan to provide effective mental health and mental retardation services to the residents of the proposed region. The board of trustees shall appoint a mental health planning advisory council and a mental retardation planning advisory council, each with at least 50% representation of persons who have received or are receiving services or their family members, to assist in developing the initial plan. The board of trustees shall also seek input through a public process (e.g., public hearings, focus groups, town meetings) from the citizens in the proposed region regarding local needs and priorities. The initial plan must include the following elements:

(A) a comprehensive service description, which includes:

(i) a statement of the mission, vision, values, and principles which provide the foundation of the proposed community center's local service delivery system;

(ii) a definition of all populations to be served;

(iii) a description of relevant internal and external assessments and evaluations which may provide direction for the local strategic planning process;

(iv) a statement of local service needs and priorities to be addressed through a combination of resource development, expansion, reduction, and termination with the local service delivery system with the rationales for these selections;

(v) a summary of needs assessment data and processes used in the determination of local service needs and priorities;

(vi) identified gaps in services and supports in the local service delivery system which may assist in the determination of local service needs and priorities;

(vii) a description of existing local mental health and mental retardation resources and planned resource development activities;

(viii) a statement regarding innovative services considered and how these affect the local strategic planning process;

(ix) a statement of management needs and priorities to support an effective and efficient local service delivery system; and

(x) plan objectives, strategies, and outcomes.

(B) a charter in the format shown in "Charter To Be a Community MHMR Center," referenced as Exhibit A of §411.314 of this title (relating to Exhibits).

(C) a prospectus, which describes:

(i) any proposed transfer of funds, assets, liabilities, personnel, and consumer and administrative records/information from state-operated community services (SOCS) or other community centers and the time frames for transfer;

(ii) any identified additional available funds;

(iii) the arrangements for uninterrupted delivery of services; and

(iv) the impact, and resolution if warranted, of current contractual obligations.

(2) Review. The commissioner designates staff who are knowledgeable of community center operations to review the initial plan. The designated staff may verify the information contained in the initial plan. If additional information or changes are required for the commissioner to recommend approval, then the commissioner will notify in writing the board of trustees and specify requirements for resubmission, including time frames.

(3) Notification of intended recommendation. The department notifies the board of trustees of the commissioner's intention to recommend approval or disapproval of the initial plan to the Texas MHMR Board. If the commissioner intends to recommend disapproval or partial disapproval, then:

(A) the board of trustees may request an administrative hearing "proposal for decision" in accordance with §§411.153 - 411.158 of Chapter 411, Subchapter D of this title (relating to Administrative Hearings of the Department in Contested Cases). The hearing is not a hearing of a contested case under the Administrative Procedures Act and is limited to issues related to the initial plan. After all evidence has been heard, the administrative law judge closes the hearing. Within 30 days from the date the hearing closed, the administrative law judge submits a written proposal for decision to the commissioner;

(B) the commissioner will accept the administrative law judge's recommendation in the proposal for decision unless the commissioner finds that the recommendation is not supported by substantial evidence; and

(C) the department notifies the board of trustees of the commissioner's decision to recommend approval or disapproval of the initial plan to the Texas MHMR Board. If disapproval will be recommended, then no other appeal process is available.

(4) Approval or disapproval. The commissioner recommends approval or disapproval of the initial plan to the Texas MHMR Board. The commissioner may recommend approval of portions of the initial plan and disapproval of other portions. The commissioner's recommendation shall include a written assessment of the initial plan by staff. A recommendation of approval requires that the assessment confirms that the initial plan properly fulfills the requirements of paragraph (1) of this subsection to provide a comprehensive array of mental health and mental retardation services, including screening and continuing care services in accordance with the Texas Health and Safety Code, §534.016.

(A) If the Texas MHMR Board approves the initial plan in its entirety, then the department issues a certificate of recognition as a community center.

(B) If the Texas MHMR Board approves portions of the initial plan and such approved portions properly fulfill the requirements of paragraph (1) of this subsection, then it instructs the official record to reflect such portions as the approved initial plan in its entirety and the department issues a certificate of recognition as a community center.

(C) If the Texas MHMR Board does not approve the initial plan, then the department provides written notification to the board of trustees in a timely manner of the reasons for disapproval and the requirements for resubmission, including time frames.

(5) Community center operations. A community center may perform and operate only for the purposes and functions defined in its current plan.

Comments

Source Note: The provisions of this §1.305 adopted to be effective May 25, 2000, 25 TexReg 4540; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§1.306: Updating a Community Center's Current Plan

(a) Submission. On an assigned three-year cycle, or as requested by the Texas MHMR Board, or as necessary, the board of trustees of a community center shall submit to the commissioner an update of its current plan, which reflects the center's purposes and functions. The updated plan shall be in the format shown in "Charter To Be a Community MHMR Center," referenced as Exhibit A of §411.314 of this title (relating to Exhibits).

(b) Review. The commissioner designates staff who are knowledgeable of community center operations to review the updated plan. The designated staff may verify the information contained in the updated plan. If additional information or changes are required for the commissioner to recommend approval, then the commissioner will notify in writing the board of trustees and specify requirements for resubmission, including time frames.

(c) Notification of intended recommendation. The department notifies the board of trustees of the commissioner's intention to recommend approval or disapproval of the updated plan to the Texas MHMR Board. If the commissioner intends to recommend disapproval or partial disapproval, then:

(1) the board of trustees may request an administrative hearing "proposal for decision" in accordance with §§411.153 - 411.158 of Chapter 411, Subchapter D of this title (relating to Administrative Hearings of the Department in Contested Cases). The hearing is not a hearing of a contested case under the Administrative Procedures Act and is limited to issues related to the updated plan. After all evidence has been heard, the administrative law judge closes the hearing. Within 30 days from the date the hearing closed, the administrative law judge submits a written proposal for decision to the commissioner;

(2) the commissioner will accept the administrative law judge's recommendation in the proposal for decision unless the commissioner finds that the recommendation is not supported by substantial evidence; and

(3) the department notifies the board of trustees of the commissioner's decision to recommend approval or disapproval of the updated plan to the Texas MHMR Board. If disapproval will be recommended, then no other appeal process is available.

(d) Approval or disapproval. The commissioner recommends approval or disapproval of the updated plan to the Texas MHMR Board. The commissioner may recommend approval of portions of the updated plan and disapproval of other portions. The commissioner's recommendation shall include a written assessment of the updated plan by staff. A recommendation of approval requires that the assessment confirm that the updated plan properly fulfills the requirements contained in "Charter To Be a Community MHMR Center," referenced as Exhibit A of §411.314 of this title (relating to Exhibits), to provide a comprehensive array of mental health and mental retardation services, including screening and continuing care services in accordance with the Texas Health and Safety Code, §534.016.

(1) If the Texas MHMR Board approves the updated plan in its entirety, then the department issues an updated a certificate of recognition as a community center.

(2) If the Texas MHMR Board approves portions of the updated plan and such approved portions properly fulfill the requirements contained in "Charter To Be a Community MHMR Center," referenced as Exhibit A of §411.314 of this title (relating to Exhibits), then it instructs the official record to reflect such portions as the approved updated plan in its entirety and the department issues an updated certificate of recognition as a community center.

(3) If the Texas MHMR Board does not approve the updated plan, then the department provides written notification to the board of trustees in a timely manner of the reasons for disapproval and the requirements for resubmission, if any, including time frames and the functions the community center may perform pending approval. If the Texas MHMR Board does not provide requirements for resubmission then the department no longer recognizes the entity as a community center.

(e) Community center operations. A community center may perform and operate only for the purposes and functions defined in its current plan or as provided for in subsection (d)(3) of this section.

Comments

Source Note: The provisions of this §1.306 adopted to be effective May 25, 2000, 25 TexReg 4540; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§1.307: Modifying a Community Center's Current Plan

(a) Submission. Within the assigned three-year cycle for updating its current plan as described in §411.306 of this title (relating to Updating a Community Center's Current Plan), the board of trustees of a community center shall submit a modification of its current plan in accordance with this section as frequently as necessary to reflect material changes in the community center's local agencies, functions, or region. The modified plan shall be in the format shown in "Charter To Be a Community MHMR Center," referenced as Exhibit A of §411.314 of this title (relating to Exhibits).

(1) If a local agency wants to affiliate with an existing community center and the existing center agrees, then the board of trustees of the existing center will submit to the commissioner for approval a modification of the center's current plan to reflect such affiliation, including:

(A) any proposed expansion of the center's region;

(B) a copy of the new contract of interlocal agreement; and

(C) official documentation (e.g., resolution) confirming such intent to affiliate from each present local agency and the proposed affiliated local agency.

(2) If a local agency wants to terminate its organizational combination with another local agency and end its affiliation with an existing community center, then the appointing authorities of the local agencies must terminate the original contract of interlocal agreement and enter into a new contract of interlocal agreement if more than one local agency remains. The board of trustees of the existing center submits a modification of the center's current plan to reflect the termination of such affiliation to the commissioner for approval, including:

(A) any change of the center's region;

(B) a copy of the new contract of interlocal agreement, if applicable; and

(C) official documentation (e.g., resolution) from the local agency confirming its intent to terminate affiliation with the center.

(3) If an existing community center wants to expand or reduce its functions or region, or otherwise substantially amend its functions, (e.g., changing the population served, the services provided, or its name; or creating or operating a non-profit corporation), then the board of trustees of the center submits a modification of the center's current plan to reflect such changes to the commissioner for approval.

(b) Review. The commissioner designates staff who are knowledgeable of community center operations to review the modified plan. The designated staff may verify the information contained in the modified plan. If additional information or changes are required for staff to recommend approval, then staff will notify in writing the board of trustees and specify requirements for resubmission, including time frames.

(c) Approval or disapproval. Staff recommends approval or disapproval of the modified plan to the commissioner. Staff may recommend approval of portions of the modified plan and disapproval of other portions. Staff may also recommend that the modified plan be submitted as an updated plan for approval by the Texas MHMR Board.

(1) If the commissioner approves the modified plan, then the department notifies the board of trustees in writing of the approval in a timely manner.

(2) If the commissioner approves portions of the modified plan then the commissioner instructs the official record to reflect such portions as the approved modified plan. The department shall notify the board of trustees in writing of the portions included in the approved modified plan in a timely manner.

(3) If the commissioner does not approve the modified plan, then the department provides written notification to the board of trustees in a timely manner of the reasons for disapproval and the requirements for resubmission, if any, including time frames. The requirement for resubmission may be submission as an updated plan for approval by the Texas MHMR Board.

(d) Community center operations. A community center may perform and operate only for the purposes and functions defined in its current plan.

Comments

Source Note: The provisions of this §1.307 adopted to be effective May 25, 2000, 25 TexReg 4540; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§1.308: Dissolution or Merger of Community Centers

(a) Dissolution. If a community center decides to cease operations and dissolve, the center's board of trustees and each local agency shall inform the commissioner in writing of such a decision. The department, the board of trustees, and each local agency shall agree to a plan of dissolution that addresses at least the following factors:

(1) the center's assets and liabilities (including personnel);

(2) necessary audits to be conducted;

(3) closure activities, including arrangements for uninterrupted delivery of services;

(4) the transfer, archival, and security of records and information; and

(5) the future plans for the region's service delivery system (e.g., affiliation with an existing center, establishment of a new center, reliance upon a state-operated community services (SOCS)).

(b) Merger. If two or more existing community centers agree to merge into a new community center, then the boards of trustees of the involved centers submit to the commissioner an initial plan in accordance with §411.305(c) of this title (relating to Process to Establish a New Community Center). The initial plan must represent the services to be provided in the combined expanded region and include a copy of the new contract of interlocal agreement and official documentation (e.g., resolution) confirming intent to merge from each local agency involved.

Comments

Source Note: The provisions of this §1.308 adopted to be effective May 25, 2000, 25 TexReg 4540; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§1.309: Appointment of Manager or Management Team

(a) The commissioner may appoint a manager or management team to manage and operate a community center in accordance with the Texas Health and Safety Code, §§534.038, 534.039, and 534.040.

(b) A community center may appeal the commissioner's decision to appoint a manager or management team in accordance with this subsection. The filing of a notice of appeal stays the appointment unless the commissioner based the appointment on a finding under §534.038(a)(2) or (4) of the Texas Health and Safety Code, (i.e., the commissioner finds that the community center or an officer or employee of the center misused state or federal money or endangers or may endanger the life, health, or safety of a person served by the center).

(1) The community center may appeal the appointment of a manager or management team by filing a notice of appeal requesting an administrative hearing "proposal for decision" in accordance with §§411.153 - 411.158 of Chapter 411, Subchapter D of this title (relating to Administrative Hearings of the Department in Contested Cases). The hearing is not a hearing of a contested case under the Administrative Procedures Act and is limited to issues related to the finding(s) under §534.038(a) of the Texas Health and Safety Code for which the manager or management team was appointed. After all evidence has been heard, the administrative law judge will close the hearing. Within 30 days from the date the hearing closed, the administrative law judge will submit a written proposal for decision to the commissioner.

(2) The commissioner will accept the administrative law judge's recommendation in the proposal for decision unless the commissioner finds that the recommendation is not supported by substantial evidence.

(3) The department will notify the community center of the commissioner's decision to uphold or reverse the original decision to appoint a manager or management team. If the decision is to uphold the original decision, then no other appeal process is available.

Comments

Source Note: The provisions of this §1.309 adopted to be effective May 25, 2000, 25 TexReg 4540; amended to be effective September 1, 2003, 28 TexReg 6876; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§1.310: Standards of Administration for Boards of Trustees

(a) Each board of trustees is accountable to the department, pursuant to the Texas Health and Safety Code, §534.033, for its programs that:

(1) use department funds or local match;

(2) provide core or required services;

(3) provide services to former consumers of a department facility; or

(4) are affected by litigation in which the department is a defendant.

(b) Each board of trustees is responsible for:

(1) assuring the submission of periodic financial information and performance reports to the department if required by the department;

(2) instituting effective management procedures which assure the maximum utilization of all funds and facilitates the achievement of the goal of delivering services of high quality in a cost effective manner;

(3) complying with the Texas Health and Safety Code, §534.022, when financing property and improvements;

(4) retaining all financial records, supporting documents, statistical records, and any other documents pertinent to its community center budgets, contracts, performance/workload measure, and persons served for a period of five years. If audit discrepancies have not been resolved at the end of five years, the records must be retained until resolution;

(5) complying with the Open Meetings Act, Texas Government Code, Chapter 551;

(6) requiring depositories of community center funds to secure deposits through the Federal Deposit Insurance Corporation or the Federal Savings and Loan Insurance Corporation, or to secure deposits using collateral in a manner that protects the deposited funds;

(7) submitting a copy of the approved minutes of board of trustees meetings to the department and to each local agency in accordance with the Texas Health and Safety Code, §534.009(d);

(8) ensuring community center staff abide by applicable laws, department rules, and standards; and

(9) assuring the department has unrestricted access to all facilities, records, data, and other information under control of the community center or its contractors as necessary to enable the department to audit, monitor, and review all financial and programmatic activities and services associated with the center's:

(A) use of department funds or local match;

(B) provision of core or required services;

(C) provision of services to former consumers of a department facility;

(D) programs that are affected by litigation in which the department is a defendant; or

(E) fiscal controls.

(c) Each board of trustees is accountable to the department and to each local agency for receiving appropriate training as required by the Texas Health and Safety Code, §534.006, and this subsection.

(1) Before assuming office, new members must receive initial training, including, but not limited to:

(A) the importance of local planning and the roles and functions of the board of trustees, planning advisory committees, community center staff, and other service organizations;

(B) the enabling legislation that created the community center;

(C) the current philosophies and program principles on which service delivery systems are founded, information about the service and support needs of people with mental illnesses, mental retardation, and related conditions, and the range of environments in which those services may be delivered;

(D) an overview of mental illnesses, mental retardation, and related conditions;

(E) an overview of the current local and state service delivery system, including descriptions of the types of mental health and mental retardation services provided by the community center;

(F) the community center's budget for the current program year;

(G) the results of the most recent formal audit of the community center;

(H) the requirements of the Open Meetings Act, Texas Government Code, Chapter 551, and the Open Records Act, Texas Government Code, Chapter 552;

(I) the requirements of laws concerning conflict of interest and other laws relating to public officials;

(J) any ethics policies adopted by the community center; and

(K) applicable state and federal laws, rules, standards, and regulations.

(2) Utilizing input from persons who have received or are receiving services, their family members, and advocates, the training programs must provide orientation in the perspectives and issues of persons receiving services.

(3) Annual training must be provided for current board of trustees members, which is administered by the professional staff of the community center, including the center's legal counsel.

(4) Guidelines for training are developed and updated as necessary by an advisory committee for the department, which includes representatives of advocacy organizations broadly representative of the interests of persons with mental illness or mental retardation and their families, and representatives of boards of trustees. The current guidelines are referenced as Exhibit B in §411.314 of this title (relating to Exhibits).

(d) Each board of trustees may accept special funds for long-range projects and plans. These funds must be kept separate from the community center's operating budget and may not be used as local match. An annual accounting of these reserve funds (center trust, endowment, or foundation resources) must be made to the department

(e) Each board of trustees must obtain department approval for any building alterations, renovation, or repair maintenance expenses exceeding $50,000 for each project per fiscal year per community center if department funds or local match are to be used. In accordance with the review process and to avoid undue delays, a board of trustees must seek advance written approval from the department at least 30 days prior to the release of the project for competitive bids.

(f) Each board of trustees must ensure that its community center receives written approval from the department prior to purchase, lease-purchase, or any other transaction which will result in the community center's ownership of real property, including buildings, if any department funds or local match are involved. In addition, for acquisition of nonresidential property, the community center must notify each local agency not later than the 31st day before it enters into a binding obligation to acquire the property. A community center must provide written notification to the department and each local agency not later than the 31st day before it enters into a binding obligation to acquire real property, including a building, if the acquisition does not involve the use of department funds or local match. Upon request, the commissioner may waive the 30-day requirement to notify the department on a case-by-case basis. Notification of the department is not required for donations of real or personal property under the Texas Health and Safety Code, Title 7, §534.018 or §534.019, that do not require the expenditure of any funds by the community center and that have been approved by the board of trustees.

(1) All notices and requests for approval are submitted on the TXMHMR Property Review Form and accompanied by supporting information including, but not necessarily limited to:

(A) the reason for purchasing the property or a brief explanation of the purpose it will serve;

(B) a summary of the plan for paying for the property, including a statement regarding whether department funds or local match will be used either directly or in the retirement of any debt associated with the acquisition;

(C) if unimproved, an assessment of the suitability of the property for construction purposes or, if improved, an assessment of the current condition of the buildings;

(D) an independent appraisal of the real estate the community center intends to purchase conducted by an appraiser certified by the Texas Appraiser Licensing and Certification Board; however, the board of trustees may waive this requirement if the purchase price is less than the value listed for the property by the local appraisal district and the property has been appraised by the local appraisal district within the past two years;

(E) a statement that the board of trustees and executive staff are not participating financially in the transaction and will derive no personal benefit from the transaction; and

(F) a statement detailing the need to waive the 30-day requirement if a waiver is being requested.

(2) A community center may not purchase or lease-purchase property for an amount that is greater than the property's appraised value unless;

(A) the purchase or lease-purchase of that property at that price is necessary;

(B) the board of trustees documents in the official minutes the reasons why the purchase or lease-purchase is necessary at that price; and

(C) a majority of the board approves the transaction.

Comments

Source Note: The provisions of this §1.310 adopted to be effective May 25, 2000, 25 TexReg 4540; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§1.311: Civil Rights

Each community center shall provide services in compliance with the Civil Rights Act of 1964, as amended, and the Americans With Disabilities Act (ADA) of 1990, and shall require the same of entities with which it contracts.

Comments

Source Note: The provisions of this §1.311 adopted to be effective May 25, 2000, 25 TexReg 4540; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§1.312: Fiscal Controls

Pursuant to the Texas Health and Safety Code, §534.035, each community center must comply with the following review and audit procedures to provide reasonable assurance that the community center has adequate and appropriate fiscal controls.

(1) Audit procedures.

(A) Each board of trustees must ensure an annual financial and compliance audit of its accounts is conducted by a certified public accountant or public accountant licensed by the Texas State Board of Public Accountancy. At a minimum, the audit must be conducted in accordance with Government Auditing Standards. The board of trustees must submit eight copies of the audit to the department no later than the first day of February. If the board of trustees declines to approve the audit, it will attach to each copy of the audit a statement detailing its reason for disapproving the audit.

(B) The department may conduct on-site audits of a community center as determined by the department's financial risk analysis of the center.

(2) Review procedures.

(A) The department will conduct a desk review of each community center's annual audit to determine audit quality and to identify findings and questioned costs.

(B) The department will perform a financial risk analysis of each community center based on the center's annual audit and/or any financial information that the center is required to submit in accordance with §411.310(b)(1) of this title (relating to Standards of Administration for Boards of Trustees).

Comments

Source Note: The provisions of this §1.312 adopted to be effective May 25, 2000, 25 TexReg 4540; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§1.313: Determination of Salaries of Community Center Employees

Pursuant to the Texas Health and Safety Code, Title 7, §534.011, the board of trustees of a community center that does not have a contract with the department must determine the salaries of its employees utilizing only one of the methods described in paragraphs (1)-(3) of this section. The method for determining salaries of community center employees described in a contract between a community center and the department supersedes the requirements in this section.

(1) Market analysis. If the board of trustees chooses to determine salaries and benefits with a market analysis, documentation must be maintained on which studies are being used and the positions to which they pertain. Documentation must be updated every two years. Records maintenance must include:

(A) the current position documentation which describes the actual work being performed in the positions; and

(B) evidence of an approximate job match between the community center position and the documentation obtained in the job market.

(2) Internal study. If the board of trustees chooses to determine salaries and benefits with an internal salary study, the pay structure must be designed to recognize the internal relationships among jobs of the center. The internal salary study must also take into consideration market demands that permit the community center to compete with other employers for available and desirable human resources. The internal salary study process must include the:

(A) current position documentation which describes the actual work being performed in the positions;

(B) a method of establishing the internal relationships of jobs which may be either whole job ranking or point-factor job evaluation methodologies;

(C) identification of competitive markets that are appropriate for various types of positions, such as:

(i) state salaries;

(ii) local government salaries;

(iii) private sector salaries; and

(iv) geographic considerations (i.e., local area, regional or national issues);

(D) compensation comparisons which include both cash compensation and benefits to identify the community center's competitive posture in all reward areas; and

(E) proposed compensation adjustments which consider current market competitive posture versus desired position and general wage increase trends.

(3) State Classification Plan. If the board of trustees chooses to use the State Classification Plan to determine salaries, the community center must:

(A) compare current classification specifications with state classification plan job specifications;

(B) compare current salaries used with the salary schedule in Article IX, of the current appropriations act. All Steps 01 through 08 may be used within pay groups. Amounts less than Step 01 may be authorized by the board of trustees as well; and

(C) select an appropriate classification to determine the compensation for each position. If a similar position cannot be found in the State Classification Plan, the board of trustees may utilize the previously described market analysis or internal salary study to determine the compensation for the position. In lieu of these two methods, a board of trustees may petition the commissioner to exclude such a position, at a specific rate, from the State Classification Plan by submitting:

(i) a written proposal for an exemption for the position needed, stating the salary;

(ii) current position documentation which describes the actual work being performed in the position; and

(iii) a statement of the level of compensation sought.

Comments

Source Note: The provisions of this §1.313 adopted to be effective May 25, 2000, 25 TexReg 4540; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§1.314: Exhibits

The following exhibits referenced in this subchapter are available by contacting TDMHMR, Policy Development, P.O. Box 12668, Austin, TX 78711-2668:

(1) Exhibit A - "Charter To Be a Community MHMR Center".

Attached Graphic

(2) Exhibit B - Guidelines for Board of Trustees Training.

Comments

Source Note: The provisions of this §1.314 adopted to be effective May 25, 2000, 25 TexReg 4540; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§1.315: References

Reference is made in this subchapter to the following federal and state laws and rules:

(1) Texas Health and Safety Code, Chapter 534, Subchapter A, §534.001, §534.0015, §§534.002-534.006, §534.0065, §534.009; §534.011, §534.018, §534.019, §534.022, §534.033, §534.035, §§534.038-534.040, and §534.066;

(2) Texas Government Code, Chapters 551 and 552;

(3) Civil Rights Act of 1964;

(4) Americans With Disabilities Act(ADA) of 1990; and

(5) Chapter 411, Subchapter D of this title (relating to Administrative Hearings of the Department in Contested Cases).

Comments

Source Note: The provisions of this §1.315 adopted to be effective May 25, 2000, 25 TexReg 4540; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§1.316: Distribution

This subchapter will be distributed to:

(1) members of the Texas MHMR Board;

(2) executive, management, and program staff of Central Office;

(3) chairpersons, boards of trustees, and executive directors of community centers;

(4) executive directors of state-operated community services (SOCS); and

(5) advocacy organizations.

Comments

Source Note: The provisions of this §1.316 adopted to be effective May 25, 2000, 25 TexReg 4540; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

Subchapter I

§1.401: Purpose

The purpose of this subchapter is to describe the requirements for administering the IHFS-MR Program, pursuant to Chapter 535, Texas Health and Safety Code.

Comments

Source Note: The provisions of this §1.401 adopted to be effective November 1, 2009, 34 TexReg 7653

§1.402: Application

This subchapter applies to an MRA that administers the IHFS-MR Program.

Comments

Source Note: The provisions of this §1.402 adopted to be effective November 1, 2009, 34 TexReg 7653

§1.403: Definitions

The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:

(1) Assistance--A subsidy granted under the IHFS-MR Program to a person or family to spend on an item that meets the criteria described in §1.404(a) of this subchapter (relating to In-Home and Family Support-Mental Retardation Program--Criteria, Purpose, and Limitations).

(2) Co-payment percentage--The percentage of the cost of an item for which a recipient must pay.

(3) DADS--The Department of Aging and Disability Services.

(4) Date of eligibility--The documented date that an MRA determines a person is eligible for assistance in accordance with §1.407 of this subchapter (relating to Eligibility Determination).

(5) Day--A calendar day.

(6) Developmental delay--In accordance with §108.23(9) of this title (relating to Definitions), a significant variation in normal development in one or more of the following areas, as measured and determined by appropriate diagnostic instruments or procedures administered by an interdisciplinary team and by informed clinical opinion:

(A) cognitive development;

(B) physical development, including vision and hearing, gross and fine motor skills, and nutrition status;

(C) communication development;

(D) social and emotional development; and

(E) adaptive development.

(7) Emergency--A documented:

(A) situation that places the health and safety of a person at risk;

(B) impending out-of-home placement of a person; or

(C) other crisis situation, as determined by an MRA (e.g., natural disaster, house fire).

(8) Family--A group that consists of a person with a mental disability and that person's parent, sibling, spouse, child, legal guardian and others who live with the person in the person's natural home.

(9) IHFS-MR Program--The DADS In-Home and Family Support-Mental Retardation Program.

(10) Legal guardian--An individual appointed by a court of competent jurisdiction to be guardian of the person in accordance with the Texas Probate Code, Chapter XIII.

(11) Mental disability--Mental retardation, pervasive developmental disorder, or developmental delay.

(12) Mental retardation--Pursuant to the Texas Health and Safety Code, §591.003, significantly sub-average general intellectual functioning existing concurrently with deficits in adaptive behavior and originating during the developmental period.

(13) MRA--Mental retardation authority. An entity designated by the executive commissioner of the Health and Human Services Commission in accordance with the Texas Health and Safety Code, §533.035(a).

(14) Natural home--The place a person lives or intends to live in the community, either independently (with or without roommates) or with his or her family, in which a natural support system, such as family, friends, and services available to the general population, is available to the person.

(15) Other support program--Any form of local, state, or federal support or service, or any support or service provided with public or private funds to people with mental or physical disabilities or their families, other than assistance provided through the IHFS-MR Program.

(16) Parent--A natural, foster, surrogate, or adoptive parent.

(17) Person--As appropriate to the context in which the term is used, an individual with a mental disability:

(A) who lives independently and who intends to apply or who has applied for assistance; or

(B) whose family intends to apply for or has applied for assistance.

(18) Pervasive developmental disorder--A disorder beginning in childhood, including autism, that meets the criteria for pervasive developmental disorder established in the most recent edition of the Diagnostic and Statistical Manual (DSM).

(19) Physical disability--A physical impairment that:

(A) is likely to continue indefinitely;

(B) results in substantial functional limitations in one or more of the following areas of major life activity:

(i) self-care;

(ii) receptive and expressive language;

(iii) learning;

(iv) mobility;

(v) self-direction;

(vi) capacity for independent living; and

(vii) economic self-sufficiency; and

(C) reflects the need for care, treatment, services or supports, which are of lifelong or extended duration and which are individually planned and coordinated.

(20) Recipient--A person or family who is receiving assistance.

(21) Third-party resource--Funding available to a person or family (e.g., public or private insurance, foster care reimbursements, trust, court settlement) that is not from any other support program.

Comments

Source Note: The provisions of this §1.403 adopted to be effective November 1, 2009, 34 TexReg 7653

§1.404: In-Home and Family Support-Mental Retardation Program--Criteria, Purpose, and Limitations

(a) The IHFS-MR Program, developed pursuant to the Texas Health and Safety Code, Chapter 535, provides assistance to an eligible person or family to spend on an item that meets the criteria in this subsection.

(1) The item must meet a need that exists solely because of the person's mental disability or co-occurring physical disability and the item must:

(A) directly support the person to live in his or her natural home;

(B) integrate the person into the community; or

(C) promote the person's self-sufficiency.

(2) The item must not be paid for in full or reimbursed in full by a third-party resource.

(b) The IHFS-MR Program provides assistance to eligible persons and families in accordance with this subchapter and to the extent funds are available.

(c) The IHFS-MR Program does not provide assistance solely to improve the living conditions of eligible persons or families living at or below the poverty level. Assistance is neither an entitlement nor an income supplement.

(d) The IHFS-MR Program is a program of last resort; therefore, assistance may not be used to replace items available to an eligible person or family through any other support program or third-party resource.

(e) Assistance may be used to augment items provided through any other support program or paid for or reimbursed by a third-party resource except assistance may not be used to augment items that are available to a person through the Texas Home Living Program or Medically Dependent Children Program. For an eligible person enrolled in the Texas Home Living Program or Medically Dependent Children Program, assistance may be used to acquire an item only if the item meets the criteria described in subsection (a) of this section and it is not in the program's array of services and supports.

(f) Assistance may be used to assist eligible persons and families who are waiting for an item to be provided through any other support program.

Comments

Source Note: The provisions of this §1.404 adopted to be effective November 1, 2009, 34 TexReg 7653

§1.405: Provision of Assistance

Assistance may be used to pay for an item described in this section if the item meets the criteria described in §1.404(a) of this subchapter (relating to In-Home and Family Support-Mental Retardation Program--Criteria, Purpose, and Limitations):

(1) the purchase or lease of special equipment or architectural modifications of a home to improve or facilitate the care, treatment, therapy, or access of the person;

(2) medical, surgical, therapeutic, diagnostic, and other health services related to the person's mental disability or co-occurring physical disability;

(3) counseling or training programs that assist a family in providing proper care for the person or assist the person who lives independently, and that provide for the special needs of the person or family;

(4) attendant care, home health aid services, homemaker services, and chore services that provide support with training, routine body functions, dressing, preparation and consumption of food, and ambulation;

(5) respite support for a family;

(6) transportation services for a person;

(7) transportation, room, and board costs incurred by a person or family during evaluation or treatment of the person if such costs are pre-approved by the MRA; and

(8) any other item agreed to by the person or family and by the MRA.

Comments

Source Note: The provisions of this §1.405 adopted to be effective November 1, 2009, 34 TexReg 7653

§1.407: Eligibility Determination

(a) A person is eligible for assistance if the MRA determines that the requirements of the diagnosis, residency, financial, and need factors as described in this subsection are met. The MRA must re-determine a person's eligibility each fiscal year that the person or family receives assistance.

(1) Diagnosis factor. A person must:

(A) have a diagnosis of mental retardation;

(B) have a diagnosis of pervasive developmental disorder; or

(C) be younger than four years of age and:

(i) have a diagnosis of a developmental delay that is documented within the previous 12 months; or

(ii) determined to be eligible for early childhood intervention services.

(2) Residency factor.

(A) A person must be living in his or her natural home in the MRA's local service area or the person must be leaving an institutional setting and moving into his or her natural home in the MRA's local service area.

(B) The person's natural home may not be:

(i) an establishment, including a foster care setting, that furnishes room, board, and general supervision in which four or more individuals who are unrelated to the proprietor of the establishment reside;

(ii) a residential facility certified or licensed to provide services that include, but are not limited to, 24-hour supervision, meals, transportation, and social and recreational activities (e.g., Intermediate Care Facility for Persons with Mental Retardation (ICF/MR), state mental retardation facility, nursing facility);

(iii) an inpatient facility (e.g., state mental health facility, general or psychiatric hospital); or

(iv) an assisted living facility.

(3) Financial factor.

(A) The financial factor is based on the current gross income of:

(i) the person who is 18 years of age or older and the person's spouse, if any; or

(ii) the parents of a person who is under 18 years of age.

(B) A person or family applying for assistance meets the requirements of the financial factor if the current gross income is less than 150% of the current Texas median income level, as determined by appropriate documentation (e.g., previous year's federal income tax return, current pay stubs).

(C) A person or family whose income is at or below the median income level for the family size has no co-payment. A person who receives Supplemental Security Income (SSI) has no co-payment. A person or family whose income is at or greater than 105% of the median income level is assessed a co-payment. The co-payment percentage begins at 10% of the cost of the item and increases in 10% increments until 100% of the cost of item is reached, at which point the income is 150% of the median income level and the person or family is not eligible.

(4) Need factor.

(A) The person or family may not be receiving funds through the other In-Home and Family Support Program that serves persons with a physical disability pursuant to the Texas Human Resources Code, Chapter 35, and the person may not be enrolled in a Medicaid waiver program except the Texas Home Living Program or Medically Dependent Children Program.

(B) The person or family must have a need that can be met with an item:

(i) that is listed in §1.405 of this subchapter (relating to Provision of Assistance);

(ii) that meets the criteria described in §1.404(a) of this subchapter (relating to In-Home and Family Support-Mental Retardation Program--Criteria, Purpose, and Limitations); and

(iii) that is not currently available from any other support program.

(b) The MRA staff may provide assistance to a person or family in an emergency (as defined) without first determining if the person meets every eligibility factor. Assistance provided in an emergency is limited to the extent necessary to resolve that emergency.

Comments

Source Note: The provisions of this §1.407 adopted to be effective November 1, 2009, 34 TexReg 7653

§1.409: Administrative Implementation

(a) Applying for assistance. A family, or a person with a mental disability who lives independently, may apply for assistance.

(b) Determining eligibility. Within 30 days after a person or family applies for assistance, the MRA must determine if the person is eligible for assistance in accordance with §1.407 of this subchapter (relating to Eligibility Determination). The person or family must provide all necessary information for the MRA to determine eligibility in a timely manner.

(c) Waiting list. If IHFS-MR Program funds are not available on a person's date of eligibility, then the person's name is placed on a waiting list in chronological order according to a person's date of eligibility as defined in §1.403(4) of this subchapter (relating to Definitions). If more than one person has the same date of eligibility, then chronological order is further based on the date of application.

(d) Written plan. When IHFS-MR Program funds are available, the MRA staff must identify the person or family with the earliest date of eligibility and ensure a written plan is developed and approved for the person or family. A written plan covers the fiscal year in which it is developed. The written plan describes how assistance will be used and the responsibilities of the recipient and the MRA.

(e) Disbursement of assistance. After approving the written plan, the MRA must disburse assistance in accordance with the written plan. The amount of assistance is based on the cost of the item minus the required co-payment amount, but not to exceed the maximum amount of assistance for the program as determined by DADS. The eligible person may qualify for one or both of the following categories of assistance:

(1) a fiscal-year amount for items approved in the written plan; and

(2) a one-time grant for architectural modifications and the purchase or lease of special equipment in the approved written plan.

(f) Follow-up evaluation. The MRA must conduct a follow-up evaluation after completion of the written plan to determine if the recipient's stated goal and outcome have been achieved and if an additional need has been identified by the recipient.

(g) Change in a recipient's eligibility factor. A recipient must notify the MRA within 10 days after an eligibility factor changes (i.e., diagnosis, residency, financial, or need), as described in §1.407(a) of this subchapter. If notified that an eligibility factor has changed, the MRA must determine, within 30 days after notification, if the recipient continues to be eligible for assistance in accordance with §1.407 of this subchapter. If the MRA determines that the recipient is not eligible for assistance, then the MRA must terminate assistance. A recipient whose assistance has been terminated in accordance with this subsection is entitled to appeal the determination of ineligibility in accordance with §1.411 of this subchapter (relating to Appeal).

(h) Penalty.

(1) The MRA may impose one or more of the following penalties on a recipient if the recipient does not comply with his or her written plan:

(A) immediate termination of assistance;

(B) restitution of assistance received; and

(C) ineligibility for further assistance.

(2) A recipient who has been penalized in accordance with paragraph (1) of this subsection is entitled to appeal the determination to impose a penalty in accordance with §1.411 of this subchapter.

Comments

Source Note: The provisions of this §1.409 adopted to be effective November 1, 2009, 34 TexReg 7653

§1.411: Appeal

(a) Determinations subject to appeal. Only the following MRA determinations may be appealed:

(1) the determination to deny assistance for a specific item that is permitted under §1.405 of this subchapter (relating to Provision of Assistance);

(2) the determination that a person is not eligible for assistance under §1.407 of this subchapter (relating to Eligibility Determination);

(3) the determination that a recipient is no longer eligible for assistance under §1.409(g) of this subchapter (relating to Administrative Implementation); and

(4) the determination to impose a penalty under §1.409(h) of this subchapter.

(b) Written notification. Within 14 days after making a determination described in subsection (a) of this section, the MRA must provide written notification to the person or family that includes:

(1) the MRA's determination and the reason for the determination;

(2) a statement that the person or family may appeal the determination;

(3) the procedures for requesting an appeal, including the required information;

(4) a statement that the request for appeal must be received within 30 days after receipt of the written notification; and

(5) a description of the appeal and review process.

(c) Appeal and review process.

(1) The appeal is conducted in accordance with §2.46(g) of this title (relating to Notification and Appeals Process) and includes a review of this subchapter and policies governing the IHFS-MR Program. The MRA must notify the appellant in writing of the appeal decision in accordance with §2.46(h) of this title.

(2) The MRA must take action consistent with the appeal decision.

Comments

Source Note: The provisions of this §1.411 adopted to be effective November 1, 2009, 34 TexReg 7653

Chapter 2

Subchapter A

§2.46: Notification and Appeals Process

(a) The TXMHMR service system is dedicated to providing mental health and mental retardation services/supports which are viewed as satisfactory by persons receiving those services/supports and their legally authorized representatives. Therefore, local authorities and their contractors shall take steps to assure that these persons:

(1) have a method to express their concerns or dissatisfaction;

(2) are assisted to do so in a constructive way; and

(3) have their concerns or dissatisfaction addressed through a review process.

(b) A request to review decisions described in this section may be made by the person requesting or receiving services/supports, the person's legal representative, or any other individual with the person's consent.

(c) At the time of admission into services and on an annual basis thereafter, the local authority and its contractors shall provide to persons who receive services/supports and their legally authorized representatives written notification in a language and/or method understood by the individual of the local authority or its contractor's policy for addressing concerns or dissatisfaction with services/supports. The notification shall explain:

(1) an easily understood process for persons and legally authorized representatives to request a review of their concerns or dissatisfaction by the local authority or its contractor, whichever is appropriate;

(2) how the person may receive assistance in requesting the review;

(3) the timeframes for the review; and

(4) the method by which the person is informed of the outcome of that review.

(d) Local authorities and their contractors shall notify persons and legally authorized representatives in writing in a language and/or method understood by the individual of the following decisions and of the process to appeal by requesting a review of those decisions:

(1) a decision to deny the person services/supports at the conclusion of a local authority's procedure which determines whether the person meets the criteria for the priority population; and

(2) a decision to terminate services/supports and follow-along from the local authority or its contractor, if appropriate.

(e) The written notification referred to in subsection (d) of this section must:

(1) be given or mailed to the person and the legally authorized representative within ten working days of the date the decision was made;

(2) state the reason for the decision;

(3) explain that the person and legally authorized representative may contact either the local authority or its contractor, whichever is appropriate, within 30 days of receipt of notification if dissatisfied with the decision and request that the decision be reviewed in accordance with subsection (g) of this section; and

(4) include name(s), phone number(s) and address(es) of one or more accessible staff to contact during office hours.

(f) If a person or legally authorized representative believes that the local authority or its contractor has made a decision to involuntarily reduce services by changing the amount, duration, or scope of services/supports provided and is dissatisfied with that decision, then the person may request in writing that the decision be reviewed in accordance with subsection (g) of this section.

(g) The review by the local authority or its contractor shall:

(1) begin within ten working days of receipt of the request for a review and be completed within ten working days of the time it begins unless an extension is granted by the CEO of the local authority or its contractor, whichever is appropriate;

(2) begin immediately upon receipt of the request and be completed within five working days if the decision is related to a crisis service;

(3) be conducted by an individual(s) who was not involved in the initial decision;

(4) include a review of the original decision which led to the person's dissatisfaction;

(5) result in a decision to uphold, reverse, or modify the original decision; and

(6) provide the person an opportunity to express his or her concerns in person or by telephone to the individual reviewing the decision. The review shall also allow the person to:

(A) have a representative talk with the reviewer; or

(B) submit his or her concerns in writing, on tape, or in some other fashion.

(h) Following a review, either the local authority or its contractor, whichever is appropriate, shall explain to the person and legally authorized representative in writing and also in person or by telephone, if requested, the action it will take or, if no action will be taken, why it will not change the decision or believes such action would not be in the person's best interest. This is the final step in the review process.

(i) The notification and review process described in this section:

(1) is applicable only to services/supports funded by TXMHMR and provided or contracted for by its local authorities;

(2) does not preclude a person or legally authorized representative's right to reviews, appeals, or other actions that accompany other funds administered through a local authority or its contractors, or to other appeals processes provided for by other state and federal laws, e.g., Texas Health and Safety Code, Title 7, Chapter 593 (Persons with Mental Retardation Act); 42 USC §1396 (Medicaid statute); and Texas Human Resources Code, Chapter 73 (Chapter 621 of this title (relating to Early Childhood Intervention)), Early Childhood Intervention programs as funded by the Texas Interagency Council for Early Childhood Intervention.

Comments

Source Note: The provisions of this §2.46 adopted to be effective February 11, 1994, 19 TexReg 591; amended to be effective January 3, 1997, 21 TexReg 12402; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

Subchapter B

§2.51: Purpose

The purpose of this subchapter is to comply with the Texas Health and Safety Code, §534.052, §534.055, and §534.065.

Comments

Source Note: The provisions of this §2.51 adopted to be effective April 22, 2001, 26 TexReg 2845; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§2.52: Application

This subchapter applies to all contracts for goods and services awarded by a local authority.

Comments

Source Note: The provisions of this §2.52 adopted to be effective April 22, 2001, 26 TexReg 2845; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§2.53: Definitions

The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:

(1) Application--Documents prepared by a respondent in response to a request for applications.

(2) Best value--The optimum combination of economy and quality that is the result of fair, efficient, and practical procurement decision-making and which achieves the following objectives:

(A) promote fairness and competition for local authority contracts;

(B) support the delivery of services and benefits that best meets the needs of clients of programs administered by the local authority;

(C) promote timely, high quality, and responsive performance by contractors; and

(D) encourage and reward the continuing participation of quality contractors.

(3) Business entity--A sole proprietorship, partnership, firm, corporation, holding company, joint-stock company, receivership, trust, or any other entity recognized by law.

(4) Consumer--A person in the priority population or otherwise designated in the performance contract as eligible for community services.

(5) Contract--A written agreement, including a purchase order, between a local authority and a business entity that obligates the entity to provide goods or services in exchange for money or other valuable consideration.

(6) Contract management--Initiating, procuring, awarding, monitoring, and enforcing a contract.

(7) Contract term--The period of time during which a contract is in effect, identified by a starting and ending date.

(8) Contractor--A business entity that has a contract for goods or services with a local authority.

(9) Goods--Tangible personal property and intellectual property.

(10) Intellectual property--Any intangible asset that consists of human knowledge and ideas (e.g., software).

(11) Local authority--An entity designated by the TDMHMR commissioner in accordance with the Texas Health and Safety Code, §533.035(a).

(12) Local service area--A geographic area composed of one or more Texas counties delimiting the population which may receive community services from a local authority.

(13) Participated--To have taken action as an officer or employee through decision, approval, disapproval, recommendation, giving advice, investigation, or similar action.

(14) Particular matter--A specific investigation, application, request for a ruling or determination, proceeding related to the development of policy, contract, claim, charge, accusation, arrest, or judicial or other proceeding.

(15) Performance contract--The contract between TDMHMR and a local authority in which TDMHMR agrees to pay the local authority a specified sum and in which the local authority agrees to provide local match, for, at a minimum, ensuring and/or monitoring the provision of specified mental health and mental retardation services in a local service area.

(16) Priority population--Those groups of persons with mental illness and mental retardation identified in TDMHMR's current strategic plan as being most in need of mental health and mental retardation services.

(17) Proposal--Documents prepared by a respondent in response to a request for proposals.

(18) Respondent--A business entity that submits an oral, written, or electronic response to a solicitation. The term is intended to include "applicant," "offeror," "proposer," and other similar terminology to describe a business entity that responds to a solicitation.

(19) Response--An oral, written, or electronic "offer," "proposal," "quote," "application," or other applicable expression of interest to a solicitation.

(20) Services--

(A) Community services--Mental health and mental retardation services required to be available in each local service area pursuant to the Texas Health and Safety Code, §534.053(a), for which TDMHMR contracts through the performance contract as well as all other services specified in the performance contract.

(B) Non-community services--All services other than community services.

(21) Solicitation--A notification of the local authority's intent to purchase community services (e.g., request for proposals and request for applications).

(22) TDMHMR--The Texas Department of Mental Health and Mental Retardation.

Comments

Source Note: The provisions of this §2.53 adopted to be effective April 22, 2001, 26 TexReg 2845; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§2.54: Accountability

(a) All purchases of goods and services must be made pursuant to a contract.

(b) Conflicts of interests and standards of conduct for local authority employees and officers.

(1) Conflicts of interest. Local authority employees and officers may not have a conflict of interest in contracts management. An employee or officer has a conflict of interest when the employee, officer, a partner of the employee or officer, or a person related within the second degree of consanguinity or affinity to the employee or officer, has or intends to have:

(A) employment with a respondent or contractor;

(B) paid consultation with a respondent or contractor;

(C) membership on a respondent's or contractor's board of directors;

(D) ownership of 10% or more of the voting stock of shares of a respondent or contractor;

(E) ownership of 10% or more or $5,000 or more of the fair market value of a respondent or contractor; or

(F) income from a respondent or contractor in excess of 10% of the employee's, officer's, or related person's gross income for the previous year.

(2) Standards of conduct. The local authority must develop and enforce standards of conduct governing its employees' and officers' who participate in contracts management, which prohibits such employees and officers from:

(A) accepting or soliciting any gift, favor, service, or benefit from a business entity, respondent, or contractor that might reasonably tend to influence the employee or officer in the discharge of official duties relating to contract management, or that the employee or officer knows or should know is being offered with the intent to influence the employee's or officer's official duties; or

(B) intentionally or knowingly soliciting, accepting, or agreeing to accept any benefit for having exercised official powers or for having performed official duties in favor of another business entity, respondent, or contractor.

(c) Conflicts of interests and standards of conduct for a respondent and its officers and employees.

(1) Conflict of interest. A respondent and its officers and employees responsible for development of a response or performance of a contract for which the respondent is submitting a response may not be related within the second degree of consanguinity or affinity to a local authority employee or officer participating in the contract management for the contract for which the respondent is submitting a response.

(2) Standards of conduct.

(A) A respondent and its officers and employees may not attempt to induce any business entity to submit or not to submit a response.

(B) A respondent and its officers and employees must arrive at its response independently and without consultation, communication, or agreement for the purposes of restricting competition.

(C) A respondent and its officers and employees may not have a relationship with any person, at the time of submitting the response or during the contract term, that may interfere with fair competition.

(D) A respondent and its officers and employees may not participate in the development of specific criteria for award of the contract, nor participate in the selection of the response to be awarded the contract.

(d) The local authority may not contract with a former officer or employee of the local authority if the contract relates to a particular matter (as defined) in which the former officer or employee participated (as defined) during the period of employment, either through personal involvement or because the case or proceeding was a matter within the officer's or employee's official responsibility, unless:

(1) the former employee was compensated on the last day of service or employment below the amount prescribed by the General Appropriations Act for salary group 17, Schedule A, or salary group 9, Schedule B, of the position classification salary schedule; or

(2) the former officer or employee is employed by a state agency or another local authority.

(e) The local authority must ensure that its contractors comply with all contract provisions regardless of whether a contractor subcontracts some or all of the contract.

(f) A local authority may make advance payments to a contractor provided the payments meet a public purpose, ensure adequate consideration, and sufficient controls are in place to ensure accomplishment of the public purpose. With the exception of contracts paid on a capitated basis, at the end of each contract term the contractor must return to the local authority any state or federal funds received from or through TDMHMR which have not been encumbered.

(g) The local authority is prohibited from contracting with a business entity that is currently:

(1) held in abeyance or barred from the award of a federal or state contract; or

(2) is not in good standing for state tax, pursuant to the Texas Business Corporation Act, Texas Civil Statutes, Article 2.45.

(h) The local authority must ensure each contractor is provided information relating to the local authority's policies and procedures that are relevant to the contractor.

(i) The local authority shall ensure quality community services are provided to consumers, including during the transition from one contractor to another.

(j) When purchasing goods and services, the local authority shall comply with the Uniform Grant and Contracts Management Standards (UGMS) promulgated by the Governor's Office of Budget and Planning (pursuant to the Texas Government Code, Chapter 783, and 1 TAC, Part 1, Chapter 5, Subchapter A, Division 4), except to the extent that any provision in §412.55(a)(2) of this title (relating to Contract Procurement) conflicts with UGMS, Part III (State Uniform Administrative Requirements for Grants and Cooperative Agreements), Subpart C (Post-Award Requirements; Changes Property, and Subawards), Section __.36(d) (Procurement), then §412.55(a)(2) of this title (relating to Contract Procurement) shall control. In UGMS:

(1) the terms "recipient" and "grantee" apply to TDMHMR;

(2) the terms "subrecipient" and "subgrantee" apply to the local authority; and

(3) the terms "vendor" and "subcontractor" apply to a contractor (as defined in this subchapter), unless the contractor operates as a "subgrantee" as defined under UGMS, Part III (State Uniform Administrative Requirements for Grants and Cooperative Agreements), Subpart A (General), Section __.3 (Definitions).

Comments

Source Note: The provisions of this §2.54 adopted to be effective April 22, 2001, 26 TexReg 2845; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§2.55: Procurement

(a) Procurement method. The local authority must develop and enforce procurement procedures that comply with this subchapter.

(1) Goods and non-community services. The local authority must acquire goods and non-community services by any procurement method described in the Uniform Grant and Contracts Management Standards (UGMS), Section __.36(d), that provides the best value to the local authority.

(2) Community services. The local authority must acquire community services by a procurement method described in this subchapter that provides the best value to the local authority. All community services must be procured competitively in accordance with §412.58 of this title (relating to Competitive Procurement of Community Services Contracts) unless the local authority determines that the community service(s):

(A) can be procured non-competitively in accordance with §412.59 of this title (relating to Non-competitive Procurement of Community Services Contracts); or

(B) should be procured through open enrollment in accordance with §412.60 of this title (relating to Open Enrollment).

(b) Relevant factors. The local authority must consider all relevant factors in determining best value, which may include:

(1) any installation cost;

(2) the delivery terms;

(3) the quality and reliability of the respondent's goods or services;

(4) the extent to which the goods or services meet the local authority's needs;

(5) indicators of probable respondent performance under the contract, such as past offeror performance, the respondent's financial resources and ability to perform, the respondent's experience and responsibility, and the respondent's ability to provide reliable maintenance agreements;

(6) the impact on the ability of the local authority to comply with laws and rules relating to historically underutilized businesses or relating to the procurement of goods and services from persons with disabilities;

(7) the total long term cost to the local authority of acquiring the respondent's goods or services;

(8) the cost of any employee training associated with the acquisition;

(9) the effect of an acquisition on the local authority's productivity;

(10) the acquisition price;

(11) whether the respondent can perform the contract or provide the service(s) within the contract term, without delay or interference;

(12) the respondent's history of compliance with the laws relating to its business operations and the affected service(s) and whether it is currently in compliance;

(13) whether the respondent's financial resources are sufficient to perform the contract and to provide the service(s);

(14) whether necessary or desirable support and ancillary services are available to the respondent;

(15) the character, responsibility, integrity, reputation, and experience of the respondent;

(16) the quality of the facilities and equipment available to or proposed by the respondent;

(17) the ability of the respondent to provide continuity of services;

(18) the ability of the respondent to meet all applicable written policies, principles, and regulations; and

(19) any other factor relevant to determining the best value for the local authority in the context of a particular acquisition.

(c) Award. All contracts must be awarded based on best value, as determined by considering all relevant factors.

(d) Renewal of community services contracts. The local authority may renew a community services contract only if the contract meets best value as determined by considering all relevant factors.

Comments

Source Note: The provisions of this §2.55 adopted to be effective April 22, 2001, 26 TexReg 2845; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§2.56: Community Services Contracting Requirements

(a) The local authority is prohibited from amending a community services contract:

(1) to increase the contract amount by more than 25%; or

(2) to add a new community service unless the contract was procured through open enrollment.

(b) Upon written request by an unsuccessful respondent, the local authority must provide information concerning why the respondent's response was not selected for award.

(c) The local authority must develop written procedures that provide respondents an opportunity to protest a contract award.

(1) The procedures must allow respondents to protest matters relating to:

(A) alleged conflict of interests;

(B) alleged failure of the local authority to comply with statute or rule; and

(C) alleged failure of the local authority to comply with its procurement procedures.

(2) The procedures must describe the local authority's process for reviewing and resolving protests.

(d) The local authority must maintain for five years or until the end of any litigation concerning the contract the following contract management documentation:

(1) justification for non-competitive procurement as permitted in §412.59(a) of this title (relating to Non-competitive Procurement of Community Services Contracts), if applicable;

(2) the solicitation and any modifications or revisions made to the solicitation;

(3) all responses to the solicitation and any modifications or revisions made to such responses;

(4) the evaluations of all responses and evidence that the local authority considered all relevant factors;

(5) written correspondence between the local authority and respondents prior to contract award;

(6) optional or required credentials (certifications, licenses, accreditations), if any;

(7) written protests, if any, and their disposition;

(8) the executed contract;

(9) written correspondence between the local authority and the contractor concerning the contractor's performance; and

(10) copies of any audits performed or required by the local authority.

Comments

Source Note: The provisions of this §2.56 adopted to be effective April 22, 2001, 26 TexReg 2845; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§2.57: Provisions for Community Services Contracts

(a) The local authority must ensure that all its community services contracts are consistent with the local authority's performance contract and with the model contracts designed by TDMHMR as required by the Texas Health and Safety Code, §534.055(c).

(b) The local authority must include in all of its community services contracts that are funded by TDMHMR provisions stating:

(1) the contract term;

(2) the community service(s) to be purchased;

(3) the identification of all parties;

(4) the total allowable payment or, if the community service is procured through open enrollment or is on a capitated basis, the rate of payment;

(5) the method of payment;

(6) that the contractor must comply with all applicable federal and state laws, rules, and regulations, including:

(A) Title VI of the Civil Rights Act of 1964;

(B) Section 504 of the Rehabilitation Act of 1973;

(C) the Americans with Disabilities Act of 1990 (ADA); and

(D) the Age Discrimination in Employment Act of 1967;

(7) that if, as a result of a change to a TDMHMR rule or state or federal law, the contractual obligations of the contractor are materially changed or a significant financial burden is placed on the contractor, then the parties may renegotiate in good faith to amend the contract;

(8) that no consumer will be excluded from participation in, denied the benefits of, or unlawfully discriminated against, in any program or activity funded by the contract on the grounds of race, color, ethnicity, national origin, religion, sex, age, disability, or political affiliation in accordance with applicable laws;

(9) that all documents pertinent to the contract, including consumer records, will be retained by the contractor for a period of five years;

(10) that all consumer-identifying information will be maintained by the contractor as confidential in accordance with applicable law and Chapter 414, Subchapter A of this title (relating to Client-Identifying Information);

(11) that the contractor, its licensed staff, and other appropriate staff (such as QMHP-CS) will be credentialed before services are delivered to consumers by such contractor and staff;

(12) a dispute resolution process;

(13) the clearly defined performance expectations which directly relate to the community service's objectives, including goals, outputs, and measurable outcomes, and that the contractor must provide services in accordance with such expectations;

(14) that any allegation of abuse, neglect, or exploitation of a consumer under the contract will be reported in accordance with applicable law, TDMHMR rules, and Texas Department of Protective and Regulatory Services rules;

(15) that AIDS/HIV workplace guidelines, similar to those adopted by TDMHMR and AIDS/HIV confidentiality guidelines and consistent with state and federal law, will be adopted and implemented by the contractor;

(16) that the contractor will comply with the relevant TDMHMR rules, certifications, accreditations, and licenses, that are specified in the contract;

(17) that services will be provided in accordance with consumers' treatment plans;

(18) that pursuant to Texas Health and Safety Code, §534.061, TDMHMR, the local authority, and their designees, including independent financial auditors, shall have, with reasonable notice, unrestricted access to all facilities, records, data, and other information under the control of the contractor as necessary to enable the local authority to audit, monitor, and review all financial and programmatic activities and services associated with the contract;

(19) any sanctions and remedies the local authority may take in response to the contractor's failure to comply with the contract provisions; and

(20) that the contractor will immediately notify the local authority of any change, or potential change, in its status that could affect its inclusion in the provider network.

(c) The local authority must include in all of its community services contracts for residential services that are funded by TDMHMR provisions stating:

(1) that the contractor shall provide evidence of criminal history record information on the contractor's applicants, employees, and volunteers, pursuant to the Texas Health and Safety Code, §533.007 and Chapter 250; the Texas Government Code, §411.115; and Chapter 414, Subchapter K of this title (relating to Criminal History Clearances); and

(2) that if an applicant, employee, or volunteer of the contractor has a criminal history relevant to his or her employment as described in Chapter 414, Subchapter K of this title (relating to Criminal History Clearances), then the contractor will take appropriate action with respect to the applicant, employee, or volunteer, including terminating or removing the employee or volunteer from direct contact with consumers served by the contractor.

(d) Community services contracts that require the contractor to assume responsibility for the funds of a consumer must contain provisions requiring the contractor to have and abide by a written policy, which is subject to approval by the local authority, for protecting and accounting for such funds in accordance with generally accepted accounting principles.

Comments

Source Note: The provisions of this §2.57 adopted to be effective April 22, 2001, 26 TexReg 2845; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§2.58: Competitive Procurement Methods for Community Services

Competitive procurement methods for community services are as follows.

(1) Informal solicitation.

(A) Determination. The local authority may competitively procure community services through informal solicitation if the contract amount does not exceed $25,000.

(B) Solicitation.

(i) The local authority must solicit business entities that provide the type of community service(s) being procured and attempt to obtain at least three responses for the service's specifications. Solicitation and responses may be oral, written, or electronic.

(ii) Documentation for informal solicitation must include:

(I) the names and telephone numbers of the business entities contacted and the date of contact;

(II) the specifications for the community service(s); and

(III) all responses.

(C) Award. The award of a contract procured through informal solicitation is made in accordance with §412.55(c) of this title (relating to Contract Procurement).

(2) Request for proposals (RFP).

(A) Determination. The local authority may competitively procure community services through an RFP.

(B) Solicitation.

(i) The local authority must make a reasonable effort to give notice of its intent to contract for community services to providers of the community service(s) in the authority's local service area. The local authority must publish an RFP Notice in a local newspaper or professional association newsletter or announce by direct mail to all known providers of those community service(s) at least 10 calendar days, but not more than 90 calendar days, prior to the due date for the submission of proposals. An RFP Notice must include:

(I) the contract term;

(II) a general description of the community service(s) to be purchased;

(III) the geographic area to be served;

(IV) any limitations on who may submit a proposal;

(V) the procedures for obtaining an RFP; and

(VI) the date and time by which proposals must be received by the local authority.

(ii) The local authority must provide an RFP to each business entity that requests one. The local authority may not restrict competition by unreasonably eliminating or limiting participation in the procurement process. An RFP must include:

(I) a detailed description of the community service(s) to be purchased, the consumer eligibility criteria, and all other information included in the RFP Notice;

(II) the approximate number of consumers to be served pursuant to the contract;

(III) method of payment;

(IV) a detailed description of information to be included in a proposal;

(V) instructions for the submission of questions concerning the procurement;

(VI) instructions for the submission of proposals;

(VII) respondent eligibility requirements for contract award (e.g., credentials for providing the community service(s), such as applicable certifications, licenses; evidence of compliance or ability to comply with relevant TDMHMR rules; evidence of accessibility; evidence of financial solvency; and evidence of liability insurance);

(VIII) assurances that:

(-a-) the respondent has no conflict of interest and meets the standards of conduct requirements pursuant to §412.54(c) of this title (relating to Accountability);

(-b-) the respondent is not currently held in abeyance or barred from the award of a federal or state contract; and

(-c-) the respondent is not delinquent in a tax owed the state under Chapter 171, Tax Code, pursuant to the Texas Business Corporation Act, Texas Civil Statutes, Article 2.45;

(IX) the criteria for evaluation of proposals and contract award; and

(X) all relevant factors the local authority will use to determine best value.

(iii) A proposal must include:

(I) the respondent's name, address, telephone number, and type of business entity; and

(II) all information required in paragraphs (2)(B)(ii)(IV), (VII), and (VIII) of this subsection.

(iv) Changes to an RFP may be made by the local authority prior to the date designated for submission of proposals if everyone who has obtained an RFP is notified of the changes and is provided equal opportunity to respond.

(v) The local authority must keep all information contained in proposals confidential until a contract has been awarded.

(vi) Any changes to a proposal must be made by the respondent in writing and must be received by the local authority prior to the submission date and time.

(vii) The local authority may validate any information in a proposal by using outside sources or materials.

(C) Award.

(i) For a proposal to be considered for award, the respondent must follow the instructions and meet the requirements specified in the RFP.

(ii) After the proposal submission date, the local authority may obtain clarification or confirmation of information submitted in a proposal if such information is necessary to complete the award process; however, no respondent may be given information which would give that respondent a competitive advantage over any other respondent.

(iii) Negotiations may be conducted with a respondent to complete the procurement process or to complete an evaluation of a proposal.

(I) If only one proposal is received that may be considered for award, the local authority and the respondent may negotiate the contract requirements as necessary to complete the procurement process.

(II) If more than one proposal is received that may be considered for award, the local authority may negotiate to further evaluate proposals and to select one or more respondents for award; however, no respondent may be given information which will give that respondent a competitive advantage over any other respondent.

(iv) The award of a contract procured through an RFP must be made in accordance with §412.55(c) of this title (relating to Contract Procurement).

(v) The local authority may cancel an RFP without award.

Comments

Source Note: The provisions of this §2.58 adopted to be effective April 22, 2001, 26 TexReg 2845; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§2.59: Non-competitive Procurement of Community Services

(a) Determination. The local authority may procure community services non-competitively only if:

(1) the procurement is pursuant to the Texas Health and Safety Code, §533.017;

(2) the services are proprietary to a single source or only one source can or will provide the service;

(3) the services will be provided by a governmental entity;

(4) there exists an emergency situation in which a delay may result in harm to a consumer who is to receive the community service;

(5) the services are for less than $5000 and the total amount was not divided to qualify for a non-competitive procurement; or

(6) a competitive procurement was attempted and either no qualified response or only one qualified response was received.

(b) Award. The award of a contract procured non-competitively must be made in accordance with §412.55(c) of this title (relating to Contract Procurement).

Comments

Source Note: The provisions of this §2.59 adopted to be effective April 22, 2001, 26 TexReg 2845; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§2.60: Open Enrollment

(a) Determination. The local authority may issue a Request for Applications (RFA) to procure community services through open enrollment in accordance with this section.

(b) Solicitation.

(1) The local authority must publish in a local newspaper or professional association newsletter an RFA Notice to providers of all community services the local authority intends to procure through open enrollment. In addition, the local authority must continuously and prominently display such RFA Notice at the local authority's administrative office(s). At least once every two years the local authority must publish in a local newspaper or professional association newsletter an RFA Notice to providers of all community services currently procured through open enrollment. The RFA Notice must include:

(A) a brief description of the types of community services the local authority intends to procure through open enrollment;

(B) the geographic area to be served;

(C) the procedure for obtaining an application; and

(D) the date and time by which applications must be submitted, if any.

(2) A local authority must provide an application to each business entity that requests one. An RFA must include:

(A) a detailed description of each type of community service the local authority intends to procure through open enrollment, the consumer eligibility criteria, and all other information included in the RFA Notice;

(B) the rate of payment for each type of community service and the method used to determine that rate;

(C) a detailed description of the information to be included in an application;

(D) instructions for the submission of applications;

(E) respondents eligibility requirements for contract award (e.g., credentials for providing the community service(s), such as applicable certifications, licenses; evidence of compliance or ability to comply with relevant TDMHMR rules; evidence of accessibility; evidence of providing quality services; evidence of financial solvency; and evidence of liability insurance); and

(F) assurances that:

(i) the respondent is not currently held in abeyance or barred from the award of a federal or state contract; and

(ii) the respondent is currently in good standing for state tax, pursuant to the Texas Business Corporation Act, Texas Civil Statutes, Article 2.45.

(3) An application must include the following information:

(A) the respondent's name, address, telephone number, and type of business entity;

(B) all information required in paragraph (2)(C), (E), and (F) of this subsection; and

(C) a statement that the respondent agrees to provide the specified community service(s) at the rate of payment described in the RFA.

(c) Award.

(1) The local authority may obtain clarification or confirmation of information submitted in an application.

(2) The local authority must award a contract to all respondents whose applications are complete and who meet all requirements specified in the RFA.

(3) All contracts for each type of community service provided through open enrollment must contain the same contract term, conditions, provisions, and requirements, including a statement that the contractor is prohibited from:

(A) offering any gift with a value in excess of $10 to potential consumers; and

(B) soliciting potential consumers through direct-mail or by telephone.

Comments

Source Note: The provisions of this §2.60 adopted to be effective April 22, 2001, 26 TexReg 2845; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§2.61: Consumer Access to Participating Community Services Contractors in Provider Network

(a) The local authority must maintain, and make available to consumers, current information about each community services contractor participating in its provider network. The information must represent all participating contractors fairly and must be organized and relevant to consumers.

(b) The local authority must allow consumers to choose freely, without influence by any local authority staff or representative, any contractor participating in the provider network that provides the type of community service which the local authority has authorized for the consumer.

Comments

Source Note: The provisions of this §2.61 adopted to be effective April 22, 2001, 26 TexReg 2845; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§2.62: Monitoring and Enforcing Community Services Contracts

(a) Monitoring. The local authority must maintain a contracts management system that ensures each community services contractor performs in accordance with the provisions of the contract. The local authority shall monitor each community services contractor's compliance with the contract and evaluate the contractor's provision of services, including:

(1) competency of the contractor to provide care;

(2) consumers' access to services;

(3) safety of the environment in which services are provided;

(4) continuity of care;

(5) compliance with the performance expectations (referenced in §412.57(b)(13) of this title (relating to Provisions for Community Services Contracts));

(6) satisfaction of consumers and family members with services provided; and

(7) utilization of resources.

(b) Enforcing. The local authority shall enforce each community services contract. The local authority shall develop policies and procedures regarding contract enforcement that address the use of at least the following enforcement actions:

(1) training;

(2) technical assistance for contractors;

(3) a plan of correction; and

(4) sanctions, which may include:

(A) withholding or recouping funds;

(B) imposing financial penalties;

(C) requiring service delivery at no additional cost to the local authority;

(D) suspending participation in the provider network;

(E) contract amendment; and

(F) contract termination.

Comments

Source Note: The provisions of this §2.62 adopted to be effective April 22, 2001, 26 TexReg 2845; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§2.63: References

The following laws and rules are referenced in this subchapter:

(1) Texas Health and Safety Code, Chapter 250, §533.007, §533.017, §533.035, §534.052. §534.055, §534.061, §534.065, and §534.066;

(2) Tax Code, Chapter 171;

(3) Texas Civil Statutes, Article 2.45;

(4) Texas Government Code, Chapter 783, and §411.115;

(5) Title VI of the Civil Rights Act of 1964;

(6) Section 504 of the Rehabilitation Act of 1973;

(7) the Americans with Disabilities Act of 1990 (ADA);

(8) the Age Discrimination in Employment Act of 1967;

(9) 1 TAC, Part 1, Chapter 5, Subchapter A, Division 4;

(10) Chapter 414, Subchapter A of this title (relating to Client-Identifying Information); and

(11) Chapter 414, Subchapter K of this title (relating to Criminal History Clearances).

Comments

Source Note: The provisions of this §2.63 adopted to be effective April 22, 2001, 26 TexReg 2845; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§2.64: Distribution

This subchapter shall be distributed to:

(1) members of the Texas MHMR Board;

(2) executive, management, and program staff of Central Office;

(3) chairpersons, board of trustees or governing body, and executive directors, all local authorities; and

(4) advocacy organizations.

Comments

Source Note: The provisions of this §2.64 adopted to be effective April 22, 2001, 26 TexReg 2845; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

Subchapter C

§2.101: Purpose

The purpose of this subchapter is to comply with Texas Health and Safety Code, §534.067, by establishing a uniform fee collection policy for an MRA that:

(1) is equitable;

(2) provides for collections; and

(3) maximizes contributions to local revenue.

Comments

Source Note: The provisions of this §2.101 adopted to be effective September 1, 2002, 27 TexReg 2041; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective November 1, 2007, 32 TexReg 7494

§2.102: Application

(a) This subchapter applies to an MRA for community services contracted for through the performance contract that the MRA provides directly or through a subcontractor to a member of the MR priority population. This subchapter also applies to an adult person in the MR priority population and a parent of a person under age 18 years in the MR priority population.

(b) This subchapter does not apply to:

(1) a program or service that is prohibited by statute or regulation from charging a fee to a person served;

(2) the DADS In-Home and Family Support Program--Mental Retardation;

(3) residential services as described in the performance contract; and

(4) specialized services mandated by the Omnibus Budget Reconciliation Act (OBRA) of 1987, as amended by OBRA 90, for a preadmission screening and resident review (PASARR) provided to a non-Medicaid eligible person.

Comments

Source Note: The provisions of this §2.102 adopted to be effective September 1, 2002, 27 TexReg 2041; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective November 1, 2007, 32 TexReg 7494

§2.103: Definitions

The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise.

(1) Ability to pay--The person has third-party coverage that will pay for needed services, the person's maximum monthly fee is greater than zero, or the person has identified payment for a needed service or services in an approved plan utilizing Social Security work incentive provisions (i.e., Plan to Achieve Self-Sufficiency; Impairment Related Work Expense).

(2) Community services or services--Except for residential services, eligibility determination, and screening, the required and optional mental retardation services described in the performance contract.

(3) DADS--The Department of Aging and Disability Services.

(4) Extraordinary expenses--Major medical or health related expenses, major casualty losses, and child care expenses for the previous year or projections for the next year.

(5) Family members--

(A) For an unmarried person under age 18 years--The person, the person's parents, and the dependents of the parents, if residing in the same household;

(B) For an unmarried person age 18 years or older--The person and the person's dependents; or

(C) For a married person of any age--The person, the person's spouse, and their dependents.

(6) Gross income--Revenue from all sources before taxes and other payroll deductions. The term does not include child support received.

(7) Inability to pay--The person's maximum monthly fee is zero and the person:

(A) does not have third-party coverage;

(B) has third-party coverage, but has exceeded the maximum benefit of the covered service(s) or the third-party coverage will not pay because the services needed by the person are not covered services; or

(C) has not identified payment for a needed service or services in an approved plan utilizing Social Security work incentive provisions (i.e., Plan to Achieve Self-Sufficiency; Impairment Related Work Expense).

(8) Income-based public insurance--Government funded third-party coverage that bases eligibility on income (i.e., CHIP and Medicaid).

(9) MMF--Maximum monthly fee. A fee that is calculated in accordance with §2.106(b) of this chapter (relating to Determination of Ability to Pay).

(10) MRA--Mental retardation authority. An entity to which the Health and Human Services Commission's authority and responsibility described in Texas Health and Safety Code, §531.002(11) have been delegated.

(11) MR priority population--Groups of persons identified in the Health and Human Services Commission's current strategic plan as being most in need of mental retardation services.

(12) Parent--A biological or adoptive parent of a person under age 18 years.

(13) Performance contract--A written agreement between DADS and an MRA for the provision of one or more functions as described in Texas Health and Safety Code, §533.035(a).

(14) Person--A person in the MR priority population who is seeking or receiving services through an MRA.

(15) Significant financial change--Any change in the person's (or parent's) financial status as shown in the financial documentation, as described in §2.105(d) of this subchapter (relating to Accountability), that affects the person's (or parent's) ability to pay. Examples of a significant financial change are:

(A) a reduction in income due to the loss of a job or due to a reduction in hours worked on a job;

(B) an increase in income because of an inheritance or a salary increase;

(C) an increase or decrease in the number of family members;

(D) the gain or loss of third-party coverage; and

(E) an increase or decrease in extraordinary expenses.

(16) Standard charge--A fixed price for a community service or unit of service.

(17) Team--A person's service planning team.

(18) Third-party coverage--A public or private payer of community services (e.g., Medicaid, Medicare, private insurance, CHIP, TRICARE).

Comments

Source Note: The provisions of this §2.103 adopted to be effective September 1, 2002, 27 TexReg 2041; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective November 1, 2007, 32 TexReg 7494

§2.105: Accountability

(a) Prohibition from denying services. An MRA is prohibited from denying services:

(1) to a person because of the person's inability to pay for the services;

(2) to a person in crisis, and the denial is because:

(A) a financial assessment has not been completed;

(B) financial responsibility has not been determined;

(C) the person has a past-due account; or

(D) the person had services involuntarily reduced or terminated for non-payment under §2.109(d) of this subchapter (relating to Payments, Collections, and Non-payment); or

(3) to a person pending resolution of an issue relating solely to payment for services, including failure of the person (or parent) to comply with any requirement in subsection (c), (d), (e), or (g) of this section.

(b) Identifying funding sources. An MRA must identify and access available funding sources other than DADS, and assist a person (or parent) in identifying and accessing available funding sources other than DADS, to pay for services. Available funding sources may include third-party coverage, state and/or local governmental agency funds (e.g., crime victims fund), Qualified Medicare Beneficiary (QMB) Program, or a trust that provides for the person's need for community services.

(c) Requirement for a parent to enroll a child in income-based public insurance. A parent of a child who may be eligible for Medicaid or the Children's Health Insurance Program (CHIP) must enroll the child in Medicaid or CHIP or provide documentation that the child has been denied Medicaid or CHIP benefits or that the child's Medicaid or CHIP enrollment is pending. An MRA must provide assistance as needed to facilitate the enrollment process.

(d) Financial documentation. A person (or parent) must provide the following financial documentation:

(1) annual or monthly gross income/earnings, if any;

(2) extraordinary expenses (as defined) paid during the past 12 months or projected for the next 12 months;

(3) number of family members (as defined); and

(4) proof of any third-party coverage.

(e) Authorizing third-party coverage payment to the MRA. A person (or parent) with third-party coverage must execute an assignment of benefits authorizing third-party coverage payment to the MRA.

(f) Failure to comply.

(1) Except as provided by paragraph (2) of this subsection, if the person (or parent) fails to comply with any requirement in subsection (c), (d), (e), or (g) of this section, then the MRA must charge the person (or parent) the standard charge(s) for services. If, within 30 days after the person (or parent) initially failed to comply, the person (or parent) complies with the requirements, then the MRA must adjust the person's account to retroactively reflect compliance.

(2) The MRA may not charge the person the standard charge(s) for services if the MRA makes a decision, which is documented and includes input from the person's team, that the person's failure to comply is related to the person's functioning limitations. The decision must be reassessed at least annually. If the MRA decides that a person's failure to comply is related to the person's functioning limitations, then the MRA must develop and implement a plan to reduce or eliminate the barriers related to the person's failure to comply.

(g) Requirement for an adult person to apply for Supplemental Security Income (SSI) to become eligible for Medicaid. An adult person who may be eligible for Medicaid must apply for SSI or provide documentation that the person has been denied SSI or that the person's SSI application is pending. The MRA must provide assistance as needed to facilitate all aspects of the application process.

Comments

Source Note: The provisions of this §2.105 adopted to be effective September 1, 2002, 27 TexReg 2041; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective November 1, 2007, 32 TexReg 7494

§2.106: Determination of Ability to Pay

(a) Financial assessment.

(1) An MRA must conduct and document a financial assessment for a person within 30 days after the person begins to receive services.

(2) Except for a Medicaid recipient who is receiving Supplemental Security Income (SSI) benefits but not receiving employment income, the MRA must update a person's financial assessment at least annually while the person is receiving services. The MRA must monitor the continuing availability of benefits for a person with income-based public insurance.

(3) The MRA must update a person's financial assessment if the person experiences a significant financial change.

(4) The financial assessment must be conducted using the financial documentation listed in §2.105(d) of this subchapter (relating to Accountability) that represents the finances of:

(A) the person who is age 18 years or older and the person's spouse; or

(B) the parents of the person who is under age 18 years.

(b) MMF. A person's MMF is based on the financial assessment and calculated using the Monthly Ability-To-Pay Fee Schedule, as referenced in §2.110 of this subchapter (relating to Monthly Ability-To-Pay Fee Schedule). The calculation is based on the number of family members and annual gross income, reduced by extraordinary expenses paid during the past 12 months or projected for the next 12 months. No other sliding scale is used.

(1) An MMF that is greater than zero is established for a person who is determined as having an ability to pay. If two or more members of the same family are receiving services, then the MMF is for the family.

(2) An MMF of zero is established for a person who is determined as having an inability to pay.

(c) Third-party coverage.

(1) Third-party coverage that will pay. A person with third-party coverage that will pay for needed services is determined as having an ability to pay for those services.

(2) Third-party coverage that will not pay.

(A) If the person's third-party coverage will not pay for needed services because the MRA does not have an approved provider on its network, then the MRA must propose to refer the person to the person's third-party coverage to identify a provider for which the third-party coverage will pay unless:

(i) the MRA is identified as being responsible for providing court-ordered services to the person;

(ii) the MRA is able to negotiate adequate payment for services with the person's third-party coverage; or

(iii) the person (or parent) voluntarily agrees to pay the standard charge(s) for the needed service(s).

(B) If the MRA proposes to refer the person to the person's third-party coverage as described in paragraph (2)(A) of this subsection, then the MRA must provide written notification to the person (or parent) in accordance with §2.109(e)(1) of this subchapter (relating to Payments, Collections, and Non-payment), which provides an opportunity to appeal. The MRA must also comply with §2.109(e)(2) - (3) of this subchapter as initiated by the person (or parent).

(C) If the MRA refers the person to third-party coverage, then the MRA must assist the person (or parent) in identifying a provider for which the third-party coverage will pay.

(D) If a person who has been referred to third-party coverage is unable to identify or access needed services from an approved provider or if access will be unduly delayed, then the MRA must:

(i) assist the person (or parent) in resolving the matter with the third-party coverage (e.g., contacting customer service at the third-party coverage, filing a complaint with the third-party coverage or the Texas Department of Insurance); and

(ii) if indicated, ensure the provision of the needed services to the person pending resolution.

(E) The MRA must maintain documentation of:

(i) all referrals as described in paragraph (2)(C) of this subsection;

(ii) all assistance as described in paragraph (2)(D)(i) of this subsection; and

(iii) whether the person received services pending resolution as described in paragraph (2)(D)(ii) of this subsection.

(d) Social Security work incentive provisions. A person who identified payment for specific needed services in the person's approved plan utilizing Social Security work incentive provisions (i.e., Plan to Achieve Self-Sufficiency; Impairment Related Work Expense) is determined as having an ability to pay for the specific services. A person is not required to identify payment for any service for which the person may be eligible as part of the person's approved plan for utilizing the Social Security work incentive provisions.

(e) Notification. After a financial assessment is conducted, the MRA must provide written notification to the person (or parent) that includes:

(1) the determination of whether the person (or parent) has an ability or an inability to pay;

(2) a copy of the financial assessment form and a copy of the Monthly Ability-to-Pay Fee Schedule, with the applicable areas indicated (i.e., annual gross income, number of family members);

(3) the amount of the MMF;

(4) the name and phone number of at least one MRA staff who the person (or parent) may contact during office hours to discuss the information contained in the written notification; and

(5) a statement that the person (or parent) may voluntarily pay more than the maximum monthly fee.

Comments

Source Note: The provisions of this §2.106 adopted to be effective September 1, 2002, 27 TexReg 2041; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective November 1, 2007, 32 TexReg 7494

§2.107: Standard Charges

An MRA must establish, at least annually, a reasonable standard charge for a community service as indicated in the performance contract. The standard charge must cover, at a minimum, the MRA's cost of ensuring the provision of the service.

Comments

Source Note: The provisions of this §2.107 adopted to be effective September 1, 2002, 27 TexReg 2041; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective November 1, 2007, 32 TexReg 7494

§2.108: Billing Procedures

(a) Monthly account.

(1) The MRA must maintain a monthly account for a person that lists all services provided to the person during the month and the standard charges for the services. Each service listed must indicate whether the service is:

(A) covered by Medicare third-party coverage;

(B) covered by non-Medicare third-party coverage;

(C) not covered by third-party coverage; or

(D) identified for payment in the person's approved plan utilizing Social Security work incentive provisions.

(2) If a person has exceeded the maximum third-party coverage benefit of a particular covered service, then that service is indicated as not covered by third-party coverage.

(b) Accessing funding sources. The MRA must access all available funding sources before using DADS funds to pay for a person's services. Funding sources may include third-party coverage, state and/or local governmental agency funds (e.g., crime victims fund), Qualified Medicare Beneficiary (QMB) Program, or a trust that provides for the person's need for community services.

(c) Billing third-party coverage. The MRA bills the person's third-party coverage the monthly account amount for covered services. If the MRA has negotiated a reimbursement amount with the third-party coverage that is different from the monthly account amount, then the MRA may bill the third-party coverage the negotiated reimbursement amount for covered services.

(d) Billing the person (or parent).

(1) No third-party coverage. If the monthly account amount for services not covered by third-party coverage:

(A) exceeds the person's MMF, then the amount is reduced to equal the MMF and the MRA bills the person (or parent) the MMF; or

(B) is less than the person's MMF, then the MRA bills the person (or parent) the monthly account amount for services not covered by third-party coverage.

(2) Medicare third-party coverage. Nothing in this paragraph is intended to conflict with any applicable law, rule, or regulation with which an MRA must comply.

(A) The following amounts are added to equal the total amount applied toward the person's MMF:

(i) the amount of all applicable co-payments and co-insurance for services listed in the monthly account as covered by Medicare third-party coverage;

(ii) the amount Medicare third-party coverage was billed but did not pay because the deductible hasn't been met; and

(B) If the total amount applied toward the person's MMF as described in paragraph (2)(A) of this subsection:

(i) exceeds the person's MMF, then the amount is reduced to equal the MMF and the MRA bills the person (or parent) the MMF; or

(ii) is less than the person's MMF, then the MRA bills the person (or parent) the total amount applied toward the MMF.

(3) Non-Medicare third-party coverage.

(A) Cost-sharing exceeds MMF. If the amount of all applicable co-payments, co-insurance, and deductibles for services listed in the monthly account as covered by non-Medicare third-party coverage exceeds the person's MMF, then the MRA bills the person (or parent) all applicable co-payments, co-insurance, and deductibles.

(B) Cost-sharing does not exceed MMF.

(i) If the amount of all applicable co-payments, co-insurance, and deductibles for services listed in the monthly account as covered by non-Medicare third-party coverage does not exceed the person's MMF, then the following amounts are added to equal the total amount applied toward the person's MMF:

(I) the amount of all applicable co-payments, co-insurance, and deductibles; and

(II) the monthly account amount for services not covered by third-party coverage.

(ii) If the total amount applied toward the person's MMF as described in paragraph (3)(B)(i) of this subsection:

(I) exceeds the person's MMF, then the amount is reduced to equal the MMF and the MRA bills person (or parent) the MMF; or

(II) is less than the person's MMF, then the MRA bills the person (or parent) the total amount applied toward the MMF.

(C) Annual cost-sharing limit. If the person (or parent) has reached the person's annual cost-sharing limit (i.e., maximum out-of-pocket expense) as verified by the non-Medicare third-party coverage, then the MRA must not bill the person (or parent) any co-payments, co-insurance, or deductibles, as applicable to the annual cost-sharing limit, for services covered by the non-Medicare third-party coverage for the remainder of the policy-year.

(4) Social Security work incentive provisions.

(A) If the person identified a payment amount for specific services in the person's approved plan utilizing Social Security work incentive provisions (i.e., Plan to Achieve Self-Sufficiency; Impairment Related Work Expense), then the MRA bills the person the monthly account amount for the specific services up to the identified payment amount. If the monthly account amount for the specific services is greater than the identified payment amount, then the remaining balance is applied toward the person's MMF.

(B) The following amounts are added to equal the total amount applied toward the person's MMF:

(i) any remaining balance as described in paragraph (4)(A) of this subsection; and

(ii) the monthly account amount for services not covered by third-party coverage.

(C) If the total amount applied toward the person's MMF as described in paragraph (4)(B) of this subsection:

(i) exceeds the person's MMF, then the amount is reduced to equal the MMF and the MRA bills person (or parent) the MMF; or

(ii) is less than the person's MMF, then the MRA bills the person (or parent) the total amount applied toward the MMF.

(e) Statements.

(1) The MRA must send to a person (or parent) who has been determined as having the ability to pay monthly or quarterly statements that include:

(A) an itemized list, at least by date and by type, of all services provided during the period;

(B) the standard charge for each service;

(C) the total charge for the period;

(D) the amount paid (or to be paid) by each funding source; and

(E) the amount to be paid by the person (or parent).

(2) Unless requested otherwise, the MRA may not send a statement to a person (or parent) who has an ability to pay if the person (or parent) maintains a zero balance (i.e., the person (or parent) does not currently owe any money).

(3) Unless requested otherwise, the MRA may not send a statement to a person (or parent) who has an inability to pay.

Comments

Source Note: The provisions of this §2.108 adopted to be effective September 1, 2002, 27 TexReg 2041; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective November 1, 2007, 32 TexReg 7494

§2.109: Payments, Collections, and Non-payment

(a) Payment and collection.

(1) A person (or parent) must promptly pay all charges owed to the MRA.

(2) An MRA must make reasonable efforts to collect payments from all available funding sources before accessing DADS funds to pay for a person's services.

(b) Financial hardship. If a person (or parent) claims financial hardship as provided in this subsection, then the MRA must determine whether a significant financial change (as defined) has occurred. If a significant financial change has occurred, then the MRA must immediately update the person's (or parent's) financial assessment as required in §2.106(a) of this subchapter (relating to Determination of Ability to Pay).

(1) If a person (or parent) claims, and provides documentation, that financial hardship prevents prompt payment of all charges owed, then the MRA may arrange for the person (or parent) to pay a lesser amount each month.

(2) If a person (or parent) claims that financial hardship prevents prompt payment of all charges owed, then the MRA must arrange for the person (or parent) to pay a lesser amount each month only if the person has third-party coverage that is neither income-based public insurance nor Medicare and the person's cost-sharing exceeds the person's MMF. The lesser amount:

(A) will be no more than the person's MMF, if the person's MMF is greater than zero; or

(B) will be no more than $5.00, if the person's MMF is zero.

(3) Although the person (or parent) may pay a lesser amount each month because a portion of the charges will be deferred, the person (or parent) is still responsible for paying all charges owed.

(c) Discontinuing charges to a person (or parent) for services. If the MRA makes a decision, which is documented and includes input from the person's team, that being charged for services and receiving statements will result in a significant reduction in the functioning of the person or the person's (or parent's) refusal or rejection of the needed services, then the MRA must stop charging the person (or parent) for services and stop sending statements. The decision must be reassessed at least annually. If the MRA decides to discontinue charging the person (or parent) for services, then the MRA must develop and implement a plan to address the issues related to the person's functioning limitations or the person's (or parent's) refusal or rejection of the needed services.

(d) Involuntary reduction or termination of services for non-payment by person (or parent).

(1) The MRA must address the past-due account of a person (or parent) who is not making payments to ensure reasonable efforts to secure payments are initiated with the person (or parent). For example, if the MRA determines that non-payment is related to financial hardship, then the MRA may assist the person (or parent) in making arrangements to pay a lesser amount each month in accordance with subsection (a)(2) of this section or if the MRA makes a decision, which is documented and includes input from the person's team, that non-payment is related to the person's functioning limitations, then the person's service plan may be modified to address the non-payment.

(2) If the MRA makes a decision, which is documented and includes input from the person's team, that non-payment is not related to the person's functioning limitations and, despite reasonable efforts to secure payment, the person (or parent) does not pay, then the MRA may propose to involuntarily reduce or terminate the person's services. The MRA may not propose to involuntarily reduce or terminate the person's services if:

(A) the proposed action would result in a significant reduction in the person's functioning;

(B) the proposed action would put at risk the person's health, safety, or support system; or

(C) the MRA is identified as being responsible for providing court-ordered services to the person.

(3) If the MRA proposes to involuntarily reduce or terminate the person's services, then the MRA must:

(A) maintain documentation that the proposed action would not result in a significant reduction in the person's functioning or put at risk the person's health, safety, or support system; and

(B) provide written notification to the person (or parent) in accordance with subsection (e)(1) of this section and comply with subsection (e)(2) - (3) as initiated by the person (or parent).

(e) Notification, Appeal, and Review.

(1) Notification. The MRA must notify the person (or parent) in writing of the proposed action (i.e., to involuntarily reduce or terminate the person's services or refer the person to third-party coverage) and the right to appeal the proposed action in accordance with §2.46 of this chapter (relating to Notification and Appeals Process). The notification must describe the time frames and process for requesting an appeal and include a copy of this subchapter. If the person (or parent) requests an appeal within the prescribed time frame, then the MRA must not take the proposed action while the appeal is pending. The MRA may take the proposed action if the person (or parent) does not request a review within the prescribed time frame.

(2) Appeal and appeal decision. The MRA must conduct the appeal in accordance with §2.46(g) of this chapter. The MRA must notify the person (or parent) in writing of the appeal decision in accordance with §2.46(h) of this chapter and the right to have the appeal decision reviewed by the Office of Consumer Rights and Services at DADS if the person (or parent) is dissatisfied with the appeal decision. The notification must describe the time frames and process for requesting a review.

(3) Review of appeal decision. If the person (or parent) is dissatisfied with the appeal decision, then the person (or parent) may request a review by the Office of Consumer Rights and Services at DADS. A request for review must be submitted to the Office of Consumer Rights and Services, Department of Aging and Disability Services, P.O. Box 149030, MC E-249, Austin, TX 78714-9030, within 10 working days after receipt of the appeal decision. If the person (or parent) requests a review within the prescribed time frame, then the MRA must not take the proposed action while the review is pending. The MRA may take the proposed action if the person (or parent) does not request a review within the prescribed time frame and the appeal decision upholds the decision to take the proposed action.

(A) A person (or parent) who requests a review may choose to have the reviewer conduct the review:

(i) by telephone conference with the person (or parent) and a representative from the MRA and make a decision based upon verbal testimony made during the telephone conference and any documents provided by the person (or parent) and the MRA; or

(ii) by making a decision based solely upon documents provided by the person (or parent) and the MRA without the presence of any of the parties involved.

(B) The review:

(i) is conducted no sooner than 10 working days and no later than 30 working days after receipt of the request for review unless an extension is granted by the director of the Office of Consumer Rights and Services;

(ii) includes an examination of the pertinent information concerning the proposed action and may include consultation with DADS staff who are responsible for the policy contained in this subchapter;

(iii) results in a final decision which will uphold, reverse, or modify the original decision to take the proposed action; and

(iv) is the final step of the appeal process for involuntarily reducing or terminating the person's services for non-payment and for referring the person to third-party coverage.

(C) Within five working days after the review, the reviewer sends written notification of the final decision to the person (or parent) and the MRA.

(D) The MRA must take appropriate action consistent with the final decision.

(f) Prohibition of financial penalties. The MRA must not impose financial penalties on a person (or parent).

(g) Debt collection. The MRA must make reasonable efforts to collect debts before an account is referred to a debt collection agency. The MRA must document its efforts at debt collection.

(1) The MRA must incorporate into a written agreement or contract for debt collection provisions that state that both parties must:

(A) maintain the confidentiality of the information and not disclose the identity of the person or any other identifying information; and

(B) not harass, threaten, or intimidate a person or the person's family.

(2) The MRA must enforce the provisions contained in paragraph (1) of this subsection.

Comments

Source Note: The provisions of this §2.109 adopted to be effective September 1, 2002, 27 TexReg 2041; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective November 1, 2007, 32 TexReg 7494

§2.110: Monthly Ability-to-Pay Fee Schedule

The Monthly Ability-To-Pay Fee Schedule, which can be found at www.dads.state.tx.us, is based on 150% of the Federal Poverty Guidelines. DADS may revise the Monthly Ability-To-Pay Fee Schedule, based on any changes in the Federal Poverty Guidelines.

Comments

Source Note: The provisions of this §2.110 adopted to be effective September 1, 2002, 27 TexReg 2041; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective November 1, 2007, 32 TexReg 7494

§2.111: Training

MRA staff who are involved in implementing or explaining the content of this subchapter must receive initial training and demonstrate competency prior to performing tasks related to charging for community services. Such staff must demonstrate competency annually thereafter.

Comments

Source Note: The provisions of this §2.111 adopted to be effective September 1, 2002, 27 TexReg 2041; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective November 1, 2007, 32 TexReg 7494

§2.112: Brochure for a Person (or Parent)

(a) DADS makes available on its website a brochure that contains the policies for charging for community services that are contained in this subchapter, including:

(1) a general reference to the statutory trust exemption; and

(2) information related to claiming financial hardship.

(b) An MRA must provide a person (or parent) a copy of the brochure prior to the person's entry into services, except in a crisis.

Comments

Source Note: The provisions of this §2.112 adopted to be effective September 1, 2002, 27 TexReg 2041; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective November 1, 2007, 32 TexReg 7494

Subchapter D

§2.151: Most Appropriate and Available Treatment Alternative

The designated LMHA is responsible for recommending the most appropriate and available treatment alternative for persons in need of mental health services in accordance with this section.

(1) Inpatient services.

(A) Before an LMHA refers a person for inpatient services, the LMHA shall screen and assess the person to determine if the person requires inpatient services.

(B) If the screening and assessment indicates the person requires inpatient services and inpatient services represents the least restrictive setting available, then the LMHA shall refer the person:

(i) to a SMHF, if the LMHA determines that the person meets the criteria for admission to the SMHF;

(ii) to an LMHA-network provider of inpatient services; or

(iii) to an alternate provider of inpatient services, if appropriate.

(C) If the person is identified in CARE as having mental retardation, then the LMHA shall inform the designated MRA that the person has been referred for inpatient services.

(D) If the LMHA refers the person for inpatient services, then the LMHA is responsible for communicating necessary information to the SMHF or other provider of inpatient services prior to or at the time of admission, to include:

(i) identifying data, including address;

(ii) legal status (e.g., regarding guardianship, charges pending, custody, if person is a minor);

(iii) pertinent medical and medication information, including known disabilities;

(iv) behavioral data including information regarding COPSD;

(v) other pertinent treatment information; and

(vi) finances, third-party coverage, and other benefits, if known.

(E) If the LMHA that refers the person for inpatient services is not the person's designated LMHA, then the LMHA shall notify the designated LMHA of the referral by the end of the next business day.

(F) The designated LMHA shall assign an LMHA liaison staff to a person admitted to a SMHF. If the person has mental retardation, then the designated MRA shall assign an MRA liaison staff to the person as well. If the LMHA refers a person to a mental health facility, as described in subparagraph (B)(ii) or (iii) of this paragraph, and the person is admitted, the designated LMHA shall assign an LMHA liaison staff. The LMHA liaison staff, and MRA liaison staff if any, are responsible for the person's continuity of services.

(2) Crisis services. An LMHA is responsible for ensuring the provision of crisis services to any person found in its local service area who is in crisis.

(3) LMHA Services.

(A) If an LMHA admits a person to LMHA services, then the LMHA shall ensure the provision of services in the most integrated setting available.

(B) The LMHA shall ensure the provision of LMHA services to a person ordered by a court to participate in outpatient mental health services if the court identifies the LMHA as being responsible for those services in accordance with the Texas Health and Safety Code, §574.037, or the Texas Code of Criminal Procedure, Article 46.03, §4(d)(4) or (d)(6).

(C) The LMHA shall assign to a person receiving LMHA services a staff person who is responsible for the person's continuity of services.

(4) Referral to alternate provider.

(A) If a person requests to be referred to an alternate provider, then the LMHA shall make a referral to an alternate provider in accordance with the request.

(B) If a person has third-party coverage, but the coverage will not pay for needed services because the designated LMHA does not have a provider on its network that is approved by the third-party coverage, then the designated LMHA shall take action in accordance with §412.106(c)(2) of this title (relating to Determination of Ability to Pay) of Subchapter C of this chapter (concerning Charges for Community Services).

Comments

Source Note: The provisions of this §2.151 adopted to be effective November 1, 2003, 28 TexReg 9251; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§2.152: Special Considerations

(a) Persons admitted to a SMHF three times in 180 days. Persons who are admitted to a SMHF three times in 180 days are considered to be at risk for future admission to inpatient services. Pursuant to the Texas Government Code, §531.0244(b)(4), to prevent the unnecessary placement in an institution, the SMHF and designated LMHA shall:

(1) during discharge planning, review the patient's previous continuing care plans to determine the effectiveness of the clinical and non-clinical services and supports identified, and recommend in the patient's current continuing care plan those services and supports that have been effective and as well as those designed to prevent unnecessary admission to the SMHF;

(2) determine the availability and appropriateness of clinical and non-clinical services and supports in the intensity needed by the patient (i.e., type, amount, scope, and duration) which will prevent unnecessary admission to the SMHF; and

(3) consider appropriateness of the patient's continued stay in the SMHF.

(b) Nursing facilities.

(1) Information regarding alternate services and supports. Prior to a person being admitted to a nursing facility on absence for trial placement (ATP) or directly after discharge, the designated LMHA shall provide the person, the person's LAR, and, unless the LAR is a family member, at least one family member of the person, if possible, with information about alternative services and supports for which the person may be eligible.

(2) Preadmission screening. Prior to a person being admitted to a nursing facility on ATP or directly after discharge, the SMHF shall contact the Texas Department of Human Services to conduct a preadmission screening as required by 40 TAC §19.2500 (relating to Preadmission Screening and Resident Review (PASARR)).

(3) ATP. If a patient is admitted to a nursing facility on ATP, then the designated LMHA shall conduct and document, including justification for its recommendations, the activities described in this paragraph.

(A) The designated LMHA shall make at least one face-to-face contact with the patient at the nursing facility. The contact shall include:

(i) a review of the patient's medical record at the nursing facility; and

(ii) discussions with the patient and LAR, if any, the nursing facility staff, and other staff who provide care to the patient regarding:

(I) the needs of the patient and the care he/she is receiving;

(II) the ability of the nursing facility to provide the appropriate care;

(III) the provision of mental health services, if needed by the patient; and

(IV) the patient's adjustment to the nursing facility.

(B) Before the end of the initial ATP period as described in §412.206(b)(2) of this title (relating to Absence for Trial Placement (ATP)), the designated LMHA shall recommend to the SMHF one of the following:

(i) discharging the patient if the LMHA determines that:

(I) the nursing facility is capable of providing, and willing to provide, appropriate care to the patient after discharge;

(II) any mental health services needed by the patient are being provided to the patient while he/she is residing in the nursing facility; and

(III) the patient and LAR, if any, agrees to the nursing facility placement;

(ii) extending the patient's ATP period in accordance with §412.206(b)(3) of this title;

(iii) returning the patient to the SMHF in accordance with §412.205(b)(2) of this title (relating to Absences From a SMHF); or

(iv) initiating involuntary admission to the SMHF in accordance with §412.205(a)(2) of this title.

(4) Discharge. If a person is admitted to a nursing facility directly upon discharge, then the designated LMHA shall conduct and document the activities described in this paragraph.

(A) The designated LMHA shall make face-to-face contact with the person at the nursing facility within seven days after discharge to determine if the nursing facility is providing adequate and appropriate care to the person. The contact shall include:

(i) a review of the person's medical record at the nursing facility; and

(ii) discussions with the person, or the person's LAR, if any, the nursing facility staff, and other staff who provide care to the person regarding:

(I) the needs of the person and the care he/she is receiving;

(II) the ability of the nursing facility to provide the appropriate care;

(III) the delivery of mental health services, if needed by the person; and

(IV) the person's adjustment to the nursing facility.

(B) If the designated LMHA determines from its contact that the nursing facility is not providing adequate and appropriate care to the person, then the LMHA shall make a reasonable effort to encourage the nursing facility to provide adequate and appropriate care.

(C) If the designated LMHA's efforts to encourage the nursing facility to provide adequate and appropriate care are unsuccessful and the LMHA determines that the nursing facility is unable or unwilling to provide adequate and appropriate care, then the LMHA shall:

(i) make recommendations to the person and the person's LAR, if any, regarding alternate residential placement; and

(ii) provide assistance in accessing alternate placement, if requested by the person or LAR to do so.

(D) If the designated LMHA identifies or suspects any instance of mistreatment, abuse or neglect, or injuries of unknown origin at the nursing facility, then the LMHA shall make a report to the Texas Department of Human Services (TDHS) via its complaint hotline (1-800-458-9858).

(c) Assisted living.

(1) A SMHF or LMHA may not refer a person to an assisted living facility that is not licensed under the Texas Health and Safety Code, Chapter 247.

(2) As required by the Texas Health and Safety Code, §247.063(b), if a SMHF or LMHA gains knowledge of an assisted living facility that is not operated or licensed by TDHS, an LMHA, or TDMHMR, and that has four or more residents who are unrelated to the proprietor of the facility, then the SMHF or LMHA shall report the name, address, and telephone number of the facility to TDHS.

(d) Minors.

(1) To the extent permitted by medical privacy laws, the SMHF and designated LMHA shall make a reasonable effort to involve a minor's LAR or the LAR's designee.

(2) A minor committed to or placed in a SMHF under the Texas Family Code, Chapter 55, Subchapter C or D, shall be discharged in accordance with the Texas Family Code, Chapter 55, Subchapter C or D, as appropriate.

(e) Patients suspected of having mental retardation. If the SMHF suspects a patient has mental retardation, then the SMHF shall notify the designated LMHA liaison staff and the designated MRA. The designated MRA shall assign an MRA liaison staff to the patient to ensure compliance with Chapter 415, Subchapter D of this title (concerning Diagnostic Eligibility for Services and Supports--Mental Retardation Priority Population and Related Conditions).

(f) Criminal Code.

(1) Texas Code of Criminal Procedure (TCCP), Article 46.02 or Chapter 46B: Incompetency to stand trial.

(A) Discharge of a patient committed under TCCP, Article 46.02, §6 (Civil commitment--charges pending) or Article 46B.102 (Commitment Hearing: Mental Illness), shall be in accordance with the TCCP, Article 46.02, §8 (General) or Article 46B.107 (Release of Defendant After Commitment).

(B) Discharge of a patient committed under TCCP, Article 46.02, §5 (Criminal commitment) or Article 46B.073 (Commitment For Restoration to Competency), shall be in accordance with TCCP, Article 46.02, §5 (Criminal commitment) or Article 46B.083 (Report By Facility Head).

(C) For a patient committed under TCCP, Article 46.02 or Chapter 46B, who is discharged and returned to the committing court, the SMHF shall, within 24 hours after discharge, notify the following of the discharge:

(i) the patient's designated LMHA; and

(ii) the Texas Correctional Office on Offenders with Medical or Mental Impairments.

(2) TCCP, Article 46.03: Insanity defense. A person acquitted by reason of insanity and committed to a SMHF under TCCP, Article 46.03, may be discharged only upon order of the committing court in accordance with TCCP, Article 46.03, §4(d)(5) (Disposition following acquittal by reason of insanity) (Judicial release).

(g) Special needs offenders.

(1) Pre-admission assessment after release from county or city jail. If a county or city jail refers a special needs offender (SNO) in the priority population to an LMHA and notifies the LMHA of the referral at least 24 hours prior to the SNO's release from a county or city jail, then the LMHA shall arrange for a face-to-face contact between the SNO and a QMHP-CS to occur within seven days after the SNO's release.

(A) If the SNO is currently receiving LMHA services from the LMHA that is notified of the referral, then at the face-to-face contact the QMHP-CS shall re-assess the SNO and arrange for appropriate services.

(B) If the SNO is not currently receiving LMHA services from the LMHA that is notified of the referral, then at the face-to-face contact the QMHP-CS shall conduct a pre-admission assessment in accordance with §412.315(a) of this title (relating to Assessment and Treatment Planning) and comply with §412.161(b)(2)(A) or (B) of this title (relating to Screening and Assessment), as appropriate).

(C) If the LMHA does not have a face-to-face contact with a SNO, then the LMHA shall document the reasons for not doing so.

(2) Pre-admission assessment after release from state prison or state jail. If an LMHA is notified of the anticipated release from prison or a state jail of a SNO in the priority population who is currently taking psychoactive medication(s) for a mental illness and who will be released with a 10-day supply of the psychoactive medication(s), then the LMHA shall arrange for a face-to-face contact between the SNO and QMHP-CS to occur within seven days after the SNO's release.

(A) At the face-to-face contact, the QMHP-CS shall conduct a pre-admission assessment in accordance with §412.315(a) of this title and comply with §412.161(b)(2)(A) or (B) of this title (as appropriate). If the LMHA determines that the SNO should receive services immediately, then the LMHA must arrange for the SNO to meet with a prescriber of medication before the SNO's entire supply of psychoactive medication has been administered.

(B) If the LMHA does not have a face-to-face contact with the SNO, then the LMHA shall document the reasons for not doing so.

Comments

Source Note: The provisions of this §2.152 adopted to be effective November 1, 2003, 28 TexReg 9251; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

Subchapter F

Division 1

§2.251: Purpose

The purpose of this subchapter is to:

(1) establish criteria and procedures for:

(A) the admission, placement, or commitment of an individual to a state mental retardation facility in accordance with:

(i) the Persons with Mental Retardation Act (PMRA);

(ii) the Texas Family Code, Chapter 55; and

(iii) the Texas Code of Criminal Procedure, §46.02 and §46.03;

(B) the transfer of an individual from:

(i) one state MR facility to another;

(ii) a state MR facility to a state MH facility; and

(iii) a state MH facility to a state MR facility;

(C) an individual's move to an alternative living arrangement from a state MR facility; and

(D) the discharge of an individual from a state MR facility;

(2) describe the responsibilities of the mental retardation authority (MRA) for:

(A) the admission, placement, or commitment of an individual to a state MR facility;

(B) an individual's move to an alternative living arrangement from a state MR facility; and

(C) the review of an individual who moved from a state MR facility prior to September 1, 1997, and has an assignment of community placement in CARE; and

(3) describe the responsibilities of the ombudsman in the department's Central Office.

Comments

Source Note: The provisions of this §2.251 adopted to be effective January 1, 2001, 25 TexReg 12746; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§2.252: Application

This subchapter applies to:

(1) state mental retardation facilities (state MR facilities);

(2) mental retardation authorities (MRAs);

(3) providers; and

(4) the department's Central Office.

Comments

Source Note: The provisions of this §2.252 adopted to be effective January 1, 2001, 25 TexReg 12746; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§2.253: Definitions

The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:

(1) Actively involved--Significant and ongoing involvement with the individual who does not have the ability to provide legally adequate consent and who does not have an LAR which the individual's planning team deems to be supportive based on the following:

(A) observed interactions of the person with the individual;

(B) advocacy for the individual;

(C) knowledge of and sensitivity to the individual's preferences, values and beliefs; and

(D) availability to the individual for assistance or support when needed.

(2) Applicant--An individual seeking residential services in a state MR facility.

(3) CARE--DADS' Client Assignment and Registration System, a database with demographic and other data about an individual who is receiving services and supports or on whose behalf services and supports have been requested.

(4) CLOIP--Community living options information process. The activities described in §2.274(a)(2) of this subchapter (relating to Consideration of Living Options for Individuals Residing in State MR Facilities) performed by a contract MRA to provide information and education about community living options to an individual who is 22 years of age or older residing in a state MR facility or to the individual's LAR.

(5) Commissioner--The commissioner of DADS.

(6) Consensus--A negotiated agreement that all parties can and will support in implementation. The negotiation process involves the open discussion of ideas with all parties encouraged to express opinions.

(7) Contract MRA--An MRA that has a contract with DADS to conduct the CLOIP.

(8) CRCG (Community Resource Coordination Group)--A local interagency group composed of public and private agencies that develops service plans for individuals whose needs can be met only through interagency coordination and cooperation. The group's role and responsibilities are described in the Memorandum of Understanding on Coordinated Services to Persons Needing Services from More Than One Agency, available on the Health and Human Services Commission website at www.hhsc.state.tx.us/crcg/crcg.htm.

(9) DADS--The Department of Aging and Disability Services.

(10) Dangerous behavior--Behavior exhibited by an individual who is physically aggressive, self-injurious, sexually aggressive, or seriously disruptive and requires a written behavioral intervention plan to prevent or reduce serious physical injury to the individual or others.

(11) Department--Department of Aging and Disability Services.

(12) Designated MRA--The MRA assigned to an individual in CARE.

(13) Discharge--The release by DADS of an individual voluntarily admitted or committed by court order for residential mental retardation services from the custody and care of a state MR facility and termination of the individual's assignment to the state MR facility in CARE.

(14) Emergency admission/discharge agreement--A written agreement between the state MR facility, the individual or LAR, and the designated MRA, sample copies of which are available from the Department of Aging and Disability Services, Provider Services Division, State Mental Retardation Facilities Section, P.O. Box 149030, Mail Code W-511, Austin, Texas 78714-9030, that describes:

(A) the purpose of the emergency admission, including the circumstances that precipitated the need for the admission and the expected outcomes from the admission;

(B) the responsibilities of each party regarding the care, treatment, and discharge of the individual, including how the terms of the agreement will be monitored;

(C) the length of time of the emergency admission, which is that amount of time necessary to accomplish the purpose of the admission; and

(D) the anticipated date of discharge.

(15) Facility of record--The facility that serves the local service area(s) assigned to the individual's designated MRA.

(16) Family-based alternative--A family setting in which the family provider or providers are specially trained to provide support and in-home care for children with disabilities or children who are medically fragile.

(17) Head of the facility--The superintendent or director of a state MR facility.

(18) ICAP (Inventory for Client and Agency Planning)--A validated, standardized assessment that measures the level of supervision an individual requires and, thus, the amount and intensity of services and supports the individual needs.

(19) ICAP service level--A designation that identifies the level of services needed by an individual as determined by the ICAP.

(20) IDT (Interdisciplinary team)--Mental retardation professionals and paraprofessionals and other concerned persons, as appropriate, who assess an individual's treatment, training, and habilitation needs and make recommendations for services, including recommendations of whether the individual is best served in a facility or in a community setting.

(A) Team membership always includes:

(i) the individual;

(ii) the individual's LAR, if any; and

(iii) persons specified by an MRA or a state MR facility, as appropriate, who are professionally qualified and/or certified or licensed with special training and experience in the diagnosis, management, needs, and treatment of individuals with mental retardation.

(B) Other participants in IDT meetings may include:

(i) other concerned persons whose inclusion is requested by the individual or the LAR;

(ii) at the discretion of the MRA or state MR facility, persons who are directly involved in the delivery of mental retardation services to the individual; and

(iii) if the individual is school eligible, representatives of the appropriate school district.

(21) Individual--A person who has or is believed to have mental retardation.

(22) Interstate transfer--The admission of an individual to a state MR facility directly from a similar facility in another state.

(23) IQ (intelligence quotient)--A score reflecting the level of an individual's intelligence as determined by the administration of a standardized intelligence test.

(24) LAR (legally authorized representative)--A person authorized by law to act on behalf of an individual with regard to a matter described in this subchapter, and may include a parent, guardian, or managing conservator of a minor, or the guardian of an adult.

(25) Legally adequate consent--Consent given by a person when each of the following conditions has been met:

(A) legal status: The individual giving the consent:

(i) is 18 years of age or older, or younger than 18 years of age and is or has been married or had his or her disabilities removed for general purposes by court order as described in the Texas Family Code, Chapter 31; and

(ii) has not been determined by a court to lack capacity to make decisions with regard to the matter for which consent is being sought;

(B) comprehension of information: The individual giving the consent has been informed of and comprehends the nature, purpose, consequences, risks, and benefits of and alternatives to the procedure, and the fact that withholding or withdrawal of consent shall not prejudice the future provision of care and services to the individual with mental retardation; and

(C) voluntariness: The consent has been given voluntarily and free from coercion and undue influence.

(26) Less restrictive setting--A setting which allows the greatest opportunity for the individual to be integrated into the community.

(27) Local service area--A geographic area composed of one or more Texas counties delimiting the population which may receive services from a local MRA.

(28) Mental retardation--Consistent with THSC, §591.003, significantly subaverage general intellectual functioning existing concurrently with deficits in adaptive behavior and manifested during the developmental period.

(29) Minor--An individual under the age of 18.

(30) MRA (mental retardation authority)--An entity to which the Health and Human Services Commission's authority and responsibility described in THSC, §531.002(11) has been delegated.

(31) Natural support network--Those persons, including family members, church members, neighbors, and friends, who assist and sustain an individual with supports that occur naturally within the individual's environment and that are not reimbursed or purposely developed by a person or system.

(32) Ombudsman--Consistent with THSC, §533.039, an employee of DADS who is responsible for assisting an individual or LAR if the individual is denied a service by DADS, a DADS program or facility, or an MRA. The ombudsman must explain and provide information on DADS and MRA services, facilities, and programs, and the rules, procedures, and guidelines applicable to the individual denied services, and assist the individual in gaining access to an appropriate program or in placing the individual on an appropriate waiting list.

(33) Permanency planning--A philosophy and planning process that focuses on the outcome of family support for an individual under 22 years of age by facilitating a permanent living arrangement in which the primary feature is an enduring and nurturing parental relationship.

(34) Planning team--A group organized by the MRA and composed of:

(A) the individual;

(B) the individual's legally authorized representative (LAR), if any;

(C) actively-involved family members or friends of the individual who has neither the ability to provide legally adequate consent nor an LAR;

(D) other concerned persons whose inclusion is requested by the individual with the ability to provide legally adequate consent or the LAR;

(E) a representative from the designated MRA; and

(F) a representative from the individual's provider.

(35) PMRA--Persons with Mental Retardation Act, Texas Health and Safety Code, Title 7, Subtitle D.

(36) Provider--A public or private entity that delivers community-based residential services and supports for individuals, including, but not limited to, an intermediate care facility for individuals with mental retardation (ICF/MR) or a nursing facility. The term also includes a public or private entity that provides waiver services.

(37) Related services--Services for school eligible individuals as described in 19 TAC §89.1060 (relating to Definitions of Certain Related Services).

(38) Respite admission/discharge agreement--A written agreement between the state MR facility, the individual or LAR, and MRA, sample copies of which are available from the Department of Aging and Disability Services, Provider Services Division, State Mental Retardation Facilities Section, P.O. Box 149030, Mail Code W-511, Austin, Texas 78714-9030, that describes:

(A) the purpose of the respite admission including the circumstances that precipitated the need for the admission and the expected outcomes from the admission;

(B) the length of time the individual will receive respite services from the state MR facility; and

(C) the responsibilities of each party regarding the care, treatment, and discharge of the individual.

(39) School eligible--A term describing those individuals between the ages of three and 22 who are eligible for public education services.

(40) Service delivery system--All facility and community-based services and supports operated or contracted for by DADS.

(41) Services and supports--Programs and assistance for persons with mental retardation that may include a determination of mental retardation, interdisciplinary team recommendations, education, special training, supervision, care, treatment, rehabilitation, residential care, and counseling, but does not include those services or programs that have been explicitly delegated by law to other state agencies.

(42) Significantly subaverage general intellectual functioning--Consistent with THSC, §591.003, measured intelligence on standardized general intelligence tests of two or more standard deviations (not including standard error of measurement adjustments) below the age-group mean for the tests used.

(43) State MH facility (state mental health facility)--A state hospital.

(44) State MR facility (state mental retardation facility)--A state school or a state center with a mental retardation residential component.

(45) State MR facility living options instrument--A written document used to guide the discussion of living options during a planning meeting that results in a recommendation by the IDT of whether the individual should remain in the current living arrangement at the state MR facility or move to an alternative living arrangement.

(46) THSC--Texas Health and Safety Code.

(47) Waiver services--Home and community-based services provided through a Medicaid waiver program approved by Centers for Medicare and Medicaid Services (CMS) as described in §1915(c) of the Social Security Act.

Comments

Source Note: The provisions of this §2.253 adopted to be effective January 1, 2001, 25 TexReg 12746; amended to be effective March 31, 2002, 27 TexReg 2445; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective September 1, 2006, 31 TexReg 6783; amended to be effective April 2, 2009, 34 TexReg 2154

§2.254: Department's Philosophy Concerning Continuum of Care

(a) The department will maintain a balanced and effective service delivery system that affords a full range of services and supports to individuals and their families.

(1) The continuum of care within the department's service delivery system encompasses residential services in state mental retardation (MR) facilities and community-based ICF/MR programs, waiver services, and those services and supports provided or contracted by a mental retardation authority (MRA).

(2) Residential services in a state MR facility are intended to serve individuals with severe or profound mental retardation and those individuals with mental retardation who are medically fragile or who have behavioral problems.

(b) If an individual or LAR chooses services in a state MR facility, the MRA serving the local service area where the individual lives will assist the individual or LAR in accessing those services if the individual is eligible, i.e., meets the criteria described in this subchapter for admission or commitment to a state MR facility.

(c) It is the policy of the State of Texas to strive to ensure that the basic needs for safety, security, and stability are met for each individual under 22 years of age with a developmental disability. A successful family is the most efficient and effective way to meet those needs. The state and local communities must work together to provide encouragement and support for well-functioning families and ensure that each individual receives the benefits of being a part of a successful permanent family as soon as possible.

(d) For an individual residing in a state MR facility, the MRA designated in CARE for that individual is responsible for:

(1) maintaining a link between the individual and the individual's home community;

(2) ensuring that the individual, LAR, and state MR facility are provided with information concerning alternative living arrangements that may be appropriate for the individual;

(3) assisting the individual or LAR who decides to seek an alternative living arrangement in accessing the alternative living arrangement, including working with other MRAs if the alternative living arrangement being sought is outside the designated MRA's local service area; and

(4) providing the state MR facility with current, provider-furnished information about services and supports in the MRA's local service area.

(e) The MRA and state MR facility will provide the supports and encouragement necessary to ensure that each individual or LAR is able to exercise choice and decision-making authority in all issues related to services and supports.

(1) Whether an individual lives in the community or is a resident of a state MR facility, if the individual does not have an LAR and cannot communicate a preference concerning services and supports, the MRA or state MR facility will involve those persons who are actively involved with the individual in discussions regarding services and supports.

(2) For the individual residing in a state MR facility, the state MR facility must have procedures in place to ensure that an individual residing in the state MR facility or the individual's LAR is supported in making decisions concerning living options.

(3) The following principles support choice and decision-making by the individual or LAR. Each MRA and state MR facility must follow these principles when addressing issues of services and supports.

(A) The choices, preferences, expectations, likes, and dislikes of the individual and LAR are the dominant force in discussions about service planning.

(B) When considering Medicaid services, the individual with the ability to provide legally adequate consent or LAR is entitled to choose a provider from:

(i) a list of ICF/MR Program providers qualified and willing to provide services and supports to that individual; or

(ii) a list of waiver program providers serving the area in which the individual or LAR is interested.

(C) The individual will be provided with opportunities for appropriate training, counseling, and other learning experiences that may facilitate the exercise of choice and decision-making. If the individual has an LAR, these opportunities will be provided only with the consent of the LAR.

(D) Whenever possible, the individual and the LAR will be encouraged to visit a residential setting prior to the individual's admission. If the individual does not have an LAR, persons who are actively involved with the individual will be encouraged to visit a residential setting prior to the individual's admission, unless the individual objects.

Comments

Source Note: The provisions of this §2.254 adopted to be effective January 1, 2001, 25 TexReg 12746; amended to be effective March 31, 2002, 27 TexReg 2445; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

Division 2

§2.255: Criteria for Commitment and Regular Voluntary Admission of an Adult to a State Mr Facility Under the Pmra

(a) In accordance with THSC, §§593.003, 593.052, and 593.041, an adult may be committed to a state MR facility for residential services only if:

(1) the adult is determined to have mental retardation in accordance with §415.155 of this title (relating to Determination of Mental Retardation (DMR));

(2) the adult, because of mental retardation:

(A) represents a substantial risk of physical impairment or injury to self or others; or

(B) is unable to provide for and is not providing for the adult's most basic personal physical needs;

(3) the adult cannot be adequately and appropriately habilitated in an available, less restrictive setting;

(4) the state MR facility provides habilitative services, care, training, and treatment appropriate to the adult's needs; and

(5) a report by an IDT recommending the placement has been completed in accordance with §412.264 of this title (relating to IDT Recommendation Concerning the Commitment of an Adult or a Minor or the Regular Voluntary Admission of an Adult to a State MR Facility Under the PMRA) during the six months preceding the date of the commitment hearing.

(b) An adult with the capacity to give legally adequate consent may be admitted to a state MR facility under a regular voluntary admission for residential services only if:

(1) in accordance with THSC, §§593.003, 593.013, and 593.026:

(A) the adult has been determined to have mental retardation in accordance with §415.155 of this title (relating to Determination of Mental Retardation (DMR));

(B) a report by an MRA's IDT recommending the placement has been completed in accordance with §412.264 of this title (relating to IDT Recommendation Concerning the Commitment of an Adult or a Minor or the Regular Voluntary Admission of an Adult to a State MR Facility Under the PMRA) during the six months preceding the request for admission;

(C) the department determines space is available in a state MR facility; and

(D) the facility superintendent determines that the state MR facility provides services that meet the needs of the adult; and

(2) the IDT report referenced in paragraph (1)(B) of this subsection includes the following findings:

(A) because of mental retardation, the adult:

(i) represents a substantial risk of physical impairment or injury to self or others; or

(ii) is unable to provide for and is not providing for the adult's most basic personal physical needs;

(B) the adult cannot be adequately and appropriately habilitated in an available, less restrictive setting; and

(C) the state MR facility provides habilitative services, care training and treatment appropriate to the adult's needs.

(c) An adult represents a substantial risk of physical impairment or injury to self or others or is unable to provide for and is not providing for the adult's most basic personal physical needs, as referenced in subsection (a)(2) and (b)(2)(A) of this section, if:

(1) the adult's IQ is four or more standard deviations below the mean, (i.e., in the severe or profound range of mental retardation);

(2) the adult's ICAP service level equals:

(A) 1, 2, 3, or 4; or

(B) 5 or 6 and the adult:

(i) has extraordinary medical needs that would require direct nursing treatment for at least 180 minutes per week if the adult's caregiver were not providing such treatment; or

(ii) exhibits incidents of dangerous behavior that would require intensive staff intervention and resources to prevent serious physical injury to the adult or others if the adult's caregiver were not managing such incidents; or

(3) the adult meets other objective measures as determined by the department.

Comments

Source Note: The provisions of this §2.255 adopted to be effective January 1, 2001, 25 TexReg 12746; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§2.256: Criteria for Commitment of an Adult under the Texas Code of Criminal Procedure

(a) In accordance with Texas Code of Criminal Procedure (TCCP), Article 46.02, §5, an adult must be committed to the maximum security unit of a facility designated by the department for residential services for a period not to exceed 18 months if:

(1) the adult is found incompetent to stand trial for any felony or misdemeanor because of mental retardation; and

(2) the court did not make a determination that there is no substantial probability that the adult will become competent in the foreseeable future.

(b) In accordance with TCCP, Article 46.02, §6, an adult must be committed to a state MR facility for residential services if:

(1) the following criteria are met:

(A) the adult is found incompetent to stand trial and there is found no substantial probability that the adult will become competent in the foreseeable future; or

(B) the adult has been previously committed to a maximum security unit of a facility under TCCP, Article 46.02, §5, in connection with the same offense; and

(2) all charges pending against the adult have not been dismissed; and

(3) in accordance with THSC, §§593.003, 593.052, and 593.041:

(A) the adult is determined to have mental retardation in accordance with §415.155 of this title (relating to Determination of Mental Retardation (DMR));

(B) the adult, because of mental retardation:

(i) represents a substantial risk of physical impairment or injury to self or others; or

(ii) is unable to provide for and is not providing for the adult's most basic personal physical needs;

(C) the adult cannot be adequately and appropriately habilitated in an available, less restrictive setting;

(D) the state MR facility provides habilitative services, care, training and treatment appropriate to the adult's needs; and

(E) a report by an IDT recommending the placement has been completed in accordance with §412.264 of this title (relating to IDT Recommendation Concerning the Commitment of an Adult or a Minor or the Regular Voluntary Admission of an Adult to a State MR Facility Under the PMRA) during the six months preceding the date of the commitment hearing.

(c) In accordance with TCCP, Article 46.02, §7, an adult must be committed to a state MR facility for residential services if:

(1) the following criteria are met:

(A) the adult is found incompetent to stand trial and there is found no substantial probability that the adult will become competent in the foreseeable future; or

(B) the adult has been previously committed to a facility under TCCP, Article 46.02, §5, in connection with the same offense; and

(2) all charges pending against the adult have been dismissed; and

(3) in accordance with THSC, §§593.003, 593.052, and 593.041:

(A) the adult is determined to have mental retardation in accordance with §415.155 of this title (relating to Determination of Mental Retardation (DMR));

(B) the adult, because of mental retardation:

(i) represents a substantial risk of physical impairment or injury to self or others; or

(ii) is unable to provide for and is not providing for the adult's most basic personal physical needs;

(C) the adult cannot be adequately and appropriately habilitated in an available, less restrictive setting;

(D) the state MR facility provides habilitative services, care, training and treatment appropriate to the adult's needs; and

(E) a report by an IDT recommending the placement has been completed in accordance with §412.264 of this title (relating to IDT Recommendation Concerning the Commitment of an Adult or a Minor or the Regular Voluntary Admission of an Adult to a State MR Facility Under the PMRA) during the six months preceding the date of the commitment hearing.

(d) In accordance with TCCP, Article 46.02, §8, an adult committed to a state MR facility in accordance with TCCP, Article 46.02, §6, who has felony charges pending or an adult committed to a state MR facility in accordance with TCCP, Article 46.02, §7, who has had felony charges dismissed must be:

(1) committed to the maximum security unit of the facility designated by the department; and

(2) within 60 calendar days of arrival on the maximum security unit, be transferred to a nonsecurity unit or to a community program designated by the department, unless the adult is determined to be manifestly dangerous by a review board of the department.

(e) In accordance with TCCP, Article 46.03, §4(a), an adult may be committed to a state MR facility for residential services if:

(1) the adult is found not guilty of criminal conduct by reason of insanity;

(2) the conduct did not involve an act, attempt, or threat of serious bodily injury to another person; and

(3) in accordance with THSC, §§593.003, 593.052, and 593.041:

(A) the adult is determined to have mental retardation in accordance with §415.155 of this title (relating to Determination of Mental Retardation (DMR));

(B) the adult, because of mental retardation:

(i) represents a substantial risk of physical impairment or injury to self or others; or

(ii) is unable to provide for and is not providing for the adult's most basic personal physical needs;

(C) the adult cannot be adequately and appropriately habilitated in an available, less restrictive setting;

(D) the state MR facility provides habilitative services, care, training and treatment appropriate to the adult's needs; and

(E) a report by an IDT recommending the placement has been completed in accordance with §412.264 of this title (relating to IDT Recommendation Concerning the Commitment of an Adult or a Minor or the Regular Voluntary Admission of an Adult to a State MR Facility Under the PMRA) during the six months preceding the date of the commitment hearing.

(f) In accordance with TCCP, Article 46.03, §4(b) and (d), an adult must be committed to the maximum security unit of a facility designated by the department for residential services if:

(1) the adult is found not guilty of criminal conduct by reason of insanity;

(2) the conduct involved an act, attempt, or threat of serious bodily injury to another person; and

(3) in accordance with THSC, §§593.003, 593.052, and 593.041:

(A) the adult is determined to have mental retardation in accordance with §415.155 of this title (relating to Determination of Mental Retardation (DMR));

(B) the adult, because of mental retardation:

(i) represents a substantial risk of physical impairment or injury to self or others; or

(ii) is unable to provide for and is not providing for the adult's most basic personal physical needs;

(C) the adult cannot be adequately and appropriately habilitated in an available, less restrictive setting;

(D) the state MR facility provides habilitative services, care, training and treatment appropriate to the adult's needs; and

(E) a report by an IDT recommending the placement has been completed in accordance with §412.264 of this title (relating to IDT Recommendation Concerning the Commitment of an Adult or a Minor or the Regular Voluntary Admission of an Adult to a State MR Facility Under the PMRA) during the six months preceding the date of the commitment hearing.

(g) In accordance with TCCP, Article 46.03, §4(b), an adult committed to the maximum security unit of a facility designated by the department as described in subsection (g) of this section, must, within 60 calendar days of arrival on the maximum security unit, be transferred to a nonsecurity unit designated by the department, unless the adult is determined to be manifestly dangerous by a review board of the department.

(h) An adult represents a substantial risk of physical impairment or injury to self or others or is unable to provide for and is not providing for the adult's most basic personal physical needs, as referenced in subsections (b)(3)(B), (c)(3)(B), (e)(3)(B), and (f)(3)(B) of this section, if:

(1) the adult's IQ is four or more standard deviations below the mean, (i.e., in the severe or profound range of mental retardation);

(2) the adult's ICAP service level equals:

(A) 1, 2, 3, or 4; or

(B) 5 or 6 and the adult:

(i) has extraordinary medical needs that would require direct nursing treatment for at least 180 minutes per week if the adult's caregiver were not providing such treatment; or

(ii) exhibits incidents of dangerous behavior that would require intensive staff intervention and resources to prevent serious physical injury to the adult or others if the adult's caregiver were not managing such incidents; or

(3) the adult meets other objective measures as determined by the department.

Comments

Source Note: The provisions of this §2.256 adopted to be effective January 1, 2001, 25 TexReg 12746; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§2.257: Criteria for Commitment of a Minor to a State Mr Facility Under the Pmra

(a) In accordance with THSC, §§593.003, 593.052, and 593.041, a minor may be committed to a state MR facility for residential services only if:

(1) the minor is determined to have mental retardation in accordance with §415.155 of this title (relating to Determination of Mental Retardation (DMR));

(2) the minor, because of mental retardation:

(A) represents a substantial risk of physical impairment or injury to self or others; or

(B) is unable to provide for and is not providing for the minor's most basic personal physical needs;

(3) the minor cannot be adequately and appropriately habilitated in an available, less restrictive setting;

(4) the state MR facility provides habilitative services, care, training, and treatment appropriate to the minor's needs; and

(5) a report by an MRA's IDT recommending the placement has been completed in accordance with §412.264 of this title (relating to IDT Recommendation Concerning the Commitment of an Adult or a Minor or the Regular Voluntary Admission of an Adult to a State MR Facility Under the PMRA) during the six months preceding the date of the commitment hearing.

(b) A minor represents a substantial risk of physical impairment or injury to self or others or is unable to provide for and is not providing for the minor's most basic personal physical needs, as referenced in subsection (a)(2) of this section, if:

(1) the minor's IQ is four or more standard deviations below the mean, (i.e., in the severe or profound range of mental retardation);

(2) the minor's ICAP service level equals:

(A) 1, 2, 3, or 4; or

(B) 5 or 6 and the minor:

(i) has extraordinary medical needs that would require direct nursing treatment for at least 180 minutes per week if the minor's caregiver were not providing such treatment; or

(ii) exhibits incidents of dangerous behavior that would require intensive staff intervention and resources to prevent serious physical injury to the minor or others if the minor's caregiver were not managing such incidents; or

(3) the minor meets other objective measures as determined by the department.

(c) A determination that a minor cannot be adequately and appropriately habilitated in an available, less restrictive setting, as referenced in subsection (a)(3) of this section, may not be made unless:

(1) a CRCG held a staffing concerning the minor and provided information to the minor's family about available community supports that could serve as an alternative to admission of the minor to a state MR facility;

(2) available community supports that could serve as an alternative to admission of the minor to a state MR facility were attempted; and

(3) if there are indications that the minor may have a serious emotional disturbance, the minor was assessed by a children's mental health professional to determine if a serious emotional disturbance exists and services to address the serious emotional disturbance were attempted.

Comments

Source Note: The provisions of this §2.257 adopted to be effective January 1, 2001, 25 TexReg 12746; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§2.258: Criteria for Placement of a Minor in a State Mr Facility for Assessment Under the Texas Family Code

(a) In accordance with Texas Family Code, §55.33, a minor in the juvenile justice system may be placed in a state MR facility for not more than 90 calendar days if:

(1) the minor is found to be unfit to proceed; and

(2) the juvenile court determines that the minor meets the commitment criteria described in §412.257 of this title (relating to Criteria for Commitment of a Minor to a State MR Facility Under the PMRA).

(b) In accordance with Texas Family Code, §55.52, a minor in the juvenile justice system may be placed in a state MR facility for not more than 90 calendar days if:

(1) the minor is found to lack responsibility for the minor's actions; and

(2) the juvenile court determines that the minor meets the commitment criteria described in §412.257 of this title (relating to Criteria for Commitment of a Minor to a State MR Facility Under the PMRA).

Comments

Source Note: The provisions of this §2.258 adopted to be effective January 1, 2001, 25 TexReg 12746; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§2.259: Criteria for Commitment of a Minor to a State Mr Facility Under the Texas Family Code

(a) In accordance with Texas Family Code, §55.41 and §55.60, a minor in the juvenile justice system may be committed to a state MR facility only if:

(1) the minor is found to be unfit to proceed or to lack responsibility for the minor's actions pursuant to juvenile charges;

(2) the minor is determined to have mental retardation and the mental retardation is the reason that the minor is unfit to proceed or that the minor lacks responsibility for his actions;

(3) because of mental retardation, the minor:

(A) represents a substantial risk of physical impairment or injury to self or others; or

(B) is unable to provide for and is not providing for the minor's most basic personal physical needs;

(4) the minor cannot be adequately and appropriately habilitated in an available, less restrictive setting; and

(5) the state MR facility provides habilitative services, care, training and treatment appropriate to the minor's needs.

(b) A minor represents a substantial risk of physical impairment or injury to self or others or is unable to provide for and is not providing for the minor's most basic personal physical needs, as referenced in subsection (a)(3) of this section, if:

(1) the minor's IQ is four or more standard deviations below the mean, (i.e., in the severe or profound range of mental retardation);

(2) the minor's ICAP service level equals:

(A) 1, 2, 3, or 4; or

(B) 5 or 6 and the minor:

(i) has extraordinary medical needs that would require direct nursing treatment for at least 180 minutes per week if the minor's caregiver were not providing such treatment; or

(ii) exhibits incidents of dangerous behavior that would require intensive staff intervention and resources to prevent serious physical injury to the minor or others if the minor's caregiver were not managing such incidents; or

(3) the minor meets other objective measures as determined by the department.

Comments

Source Note: The provisions of this §2.259 adopted to be effective January 1, 2001, 25 TexReg 12746; amended to be effective March 31, 2002, 27 TexReg 2445; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§2.260: Criteria for Regular Voluntary Admission of a Minor to a State Mr Facility under the Pmra

A state MR facility will not permit the regular voluntary admission of a minor under the PMRA.

Comments

Source Note: The provisions of this §2.260 adopted to be effective January 1, 2001, 25 TexReg 12746; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§2.261: Criteria for Emergency Admission of an Adult or a Minor to a State Mr Facility Under the Pmra

(a) In accordance with THSC, §593.027, an individual may be admitted under an emergency admission to a state MR facility for residential services without:

(1) the individual having been determined to have mental retardation in accordance with §415.155 of this title (relating to Determination of Mental Retardation (DMR); or

(2) a report by an IDT recommending the placement having been completed in accordance with §412.264 of this title (relating to IDT Recommendation Concerning the Commitment of an Adult or a Minor or the Regular Voluntary Admission of an Adult to a State MR Facility Under the PMRA) during the six months preceding the request for admission.

(b) An admission under subsection (a) of this section may occur if:

(1) there is persuasive evidence that the individual has mental retardation;

(2) the individual has an urgent need for the services;

(3) the state MR facility has appropriate space available; and

(4) the state MR facility can provide relief within a year after the date of admission.

Comments

Source Note: The provisions of this §2.261 adopted to be effective January 1, 2001, 25 TexReg 12746; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§2.262: Criteria for Admission of an Adult or a Minor to a State Mr Facility for Respite Care Under the Pmra

(a) In accordance with THSC, §593.028, an individual may be admitted to a state MR facility for respite care without:

(1) the individual having been determined to have mental retardation in accordance with §415.155 of this title (relating to Determination of Mental Retardation (DMR); or

(2) a report by an IDT recommending the placement having been completed in accordance with subsection §412.264 of this title (relating to IDT Recommendation Concerning the Commitment of an Adult or a Minor or the Regular Voluntary Admission of an Adult to a State MR Facility Under the PMRA) during the six months preceding the request for admission.

(b) An admission under subsection (a) of this section may occur if:

(1) there is persuasive evidence that the individual has mental retardation;

(2) the state MR facility has appropriate space available;

(3) the state MR facility provides services that meet the needs of the individual; and

(4) the individual or the individual's family urgently requires assistance or relief that can be provided within a period not to exceed 30 calendar days after the date of admission.

Comments

Source Note: The provisions of this §2.262 adopted to be effective January 1, 2001, 25 TexReg 12746; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§2.263: Criteria for an Order of Protective Custody

(a) In accordance with THSC, §593.044, an individual for whom an application for commitment is filed may be taken into protective custody only if the court determines from certificates filed with the court that the individual is:

(1) believed to be a person with mental retardation; and

(2) likely to cause injury to self or others if not immediately restrained.

(b) An individual under an order of protective custody may be detained for not more than 20 calendar days after the date on which the custody begins pending an order of the court.

(c) The state MR facility in which an individual is held in protective custody must discharge the individual not later than the 20th day after the date on which custody begins if the court that issued the order of protective custody has not issued a court commitment or further detention orders.

Comments

Source Note: The provisions of this §2.263 adopted to be effective January 1, 2001, 25 TexReg 12746; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§2.264: Mra Idt Recommendation Concerning the Commitment of an Adult or a Minor or the Regular Voluntary Admission of an Adult to a State Mr Facility Under the Pmra

The IDT at an MRA must do the following in making a report of its findings and recommendations as described in §2.255(a)(5) and (b)(1)(B) of this subchapter (relating to Criteria for Commitment and Regular Voluntary Admission of an Adult to a State MR Facility Under the PMRA), §2.256(b)(3)(E), (c)(3)(E), (e)(3)(E), and (f)(3)(E) of this subchapter (relating to Criteria for Commitment of an Adult under the Texas Code of Criminal Procedure), and §2.257(a)(5) of this subchapter (relating to Criteria for Commitment of a Minor to a State MR Facility Under the PMRA)

(1) in accordance with THSC, §593.013:

(A) interview the individual or the individual's LAR;

(B) review the individual's:

(i) social and medical history;

(ii) medical assessment, which must include an audiological, neurological, and vision screening;

(iii) psychological and social assessment, including the ICAP; and

(iv) determination of adaptive behavior level;

(C) determine the individual's need for additional assessments, including educational and vocational assessments;

(D) obtain any additional assessment(s) necessary to plan services;

(E) identify the individual's or LAR's habilitation and service preferences and the individual's needs;

(F) recommend services to address the individual's needs that consider the individual's or LAR's interests, choices, and goals and, for an individual under 22 years of age, the individual's permanency planning goal;

(G) encourage the individual and the individual's LAR to participate in IDT meetings;

(H) if desired, use a previous assessment, social history, or other relevant record from a school district, public or private agency, or appropriate professional if the IDT determines that the assessment, social history or record is valid;

(I) prepare a written report of its findings and recommendations that is signed by each IDT member and send a copy of the report within 10 working days to the individual or LAR, as appropriate; and

(J) if the individual is being considered for commitment to the state MR facility, submit the IDT report promptly to the court, as ordered, and to the individual or LAR, as appropriate; and

(2) determine whether:

(A) the individual, because of mental retardation:

(i) represents a substantial risk of physical impairment or injury to self or others; or

(ii) is unable to provide for and is not providing for the individual's most basic personal physical needs;

(B) the individual cannot be adequately and appropriately habilitated in an available, less restrictive setting; and

(C) the state MR facility provides habilitative services, care, training and treatment appropriate to the individual's needs.

Comments

Source Note: The provisions of this §2.264 adopted to be effective January 1, 2001, 25 TexReg 12746; amended to be effective March 31, 2002, 27 TexReg 2445; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective September 1, 2006, 31 TexReg 6783

§2.265: Mra Referral of an Applicant to a State Mr Facility

(a) If an individual or LAR requests residential services in a state MR facility, the designated MRA must provide an oral and written explanation as described in §5.159(c) of this title (relating to Assessment of Individual's Need for Services and Supports).

(b) If the MRA's IDT determines that an applicant meets the criteria described in §2.255 of this subchapter (relating to Criteria for Commitment and Regular Voluntary Admission of an Adult to a State MR Facility Under the PMRA) or §2.257 of this subchapter (relating to Criteria for Commitment of a Minor to a State MR Facility Under the PMRA), the MRA will:

(1) notify the applicant or LAR in writing;

(2) contact the state MR facility serving the area in which the applicant lives or, if the applicant is requesting an interstate transfer, the area in which the individual's LAR or family lives or intends to live;

(3) contact the interstate compact coordinator at the Health and Human Services Commission, if the applicant is requesting an interstate transfer;

(4) compile and submit all information required to complete an application packet, as described in subsection (g) of this section;

(5) open an assignment in CARE indicating the applicant is waiting for services in a state MR facility.

(c) If the MRA's IDT determines that the applicant does not meet the criteria for commitment or regular voluntary admission to a state MR facility as described in this subchapter, the MRA will:

(1) notify the applicant or LAR in writing of the determination and explain the procedure for the applicant or LAR to request a review of the IDT's determination by the MRA in accordance with §2.46 of this chapter (relating to Notification and Appeals Process); or

(2) if the applicant was requesting an interstate transfer, notify the interstate compact coordinator in writing of the determination.

(d) If a review by the MRA of the IDT's determination results in the determination being upheld, the MRA will inform the applicant or LAR in writing that a request for a review by DADS' ombudsman may be made in writing to the Department of Aging and Disability Services, Consumer Rights and Services Division, P.O. Box 149030, Mail Code E-249, Austin, Texas 78714-9030, or by calling 1-800-458-9858.

(e) If the applicant or LAR requests a review, DADS' ombudsman will review relevant documentation provided by the applicant and LAR, the IDT, and the MRA, and determine whether the processes described in this subchapter were followed.

(1) The ombudsman will issue a written decision to the applicant, the applicant's LAR, and the MRA within 14 calendar days of the request.

(2) If the ombudsman decides that the processes in this subchapter were followed, the ombudsman will assist the applicant in gaining access to an appropriate program for which the applicant is eligible or in placing the applicant on the waiting list of an appropriate program for which the applicant is eligible.

(3) If the ombudsman decides that the processes in this subchapter were not followed, then the MRA must take action to follow the processes in this subchapter.

(f) If the MRA determines that an applicant meets the criteria described in §2.261 of this subchapter (relating to Criteria for Emergency Admission of an Adult or a Minor to a State MR Facility Under the PMRA) or §2.262 of this subchapter (relating to Criteria for Admission of an Adult or a Minor to a State MR Facility for Respite Care Under the PMRA), the MRA will:

(1) contact the state MR facility serving the area in which the applicant lives;

(2) compile all of the information required to complete an application packet as described in subsection (h) or (i) of this section, as appropriate; and

(3) request the applicant's enrollment in the ICF/MR Program as described in §9.244(e) of this title (relating to Applicant Enrollment in the ICF/MR Program), if appropriate.

(g) A complete application packet, as referenced in subsection (b)(4) of this section, must include:

(1) the original order of commitment, if applicable;

(2) a completed Application for Admission including signature of the applicant or the applicant's LAR (copies of the Application for Admission are available by contacting the Department of Aging and Disability Services, Provider Services Division, State Mental Retardation Facilities Section, P.O. Box 149030, Mail Code W-511, Austin, Texas 78714-9030);

(3) a DMR report with statement that the applicant has mental retardation, as described in §5.155(g) of this title (relating to Determination of Mental Retardation (DMR));

(4) a completed ICAP (Inventory for Client and Agency Planning) booklet and MR/RC Assessment form;

(5) an IDT report completed as described in §2.264 of this subchapter (relating to MRA IDT Recommendation Concerning the Commitment of an Adult or a Minor or the Regular Voluntary Admission of an Adult to a State MR Facility Under the PMRA) recommending the commitment or regular voluntary admission of the applicant to a state MR facility;

(6) copies of available psychological, medical, and social histories for the applicant;

(7) a copy of any divorce decree pertaining to the applicant;

(8) any legal document dealing with the custody of a minor;

(9) current letters of guardianship, order appointing a guardian, and related orders, if the applicant has a guardian;

(10) a copy of any will naming the applicant as a devisee;

(11) a certified copy of the applicant's birth certificate;

(12) a copy of the applicant's immunization record;

(13) a copy of the applicant's social security card;

(14) a copy of the applicant's Medicare and Medicaid card (if applicable);

(15) any record regarding care and treatment of the individual in a state mental health facility or a psychiatric hospital;

(16) for the applicant who is school eligible, the Admission, Review and Dismissal (ARD) Committee report, Individual Education Plan (IEP), and Comprehensive Assessment;

(17) for the applicant who is a minor, results of the CRCG staffing held as described in §2.257(c) of this subchapter;

(18) for the applicant under 22 years of age, results of the MRA's permanency planning process as described in §2.283(a) of this subchapter (relating to MRA and State MR Facility Responsibilities); and

(19) any documents concerning the applicant's immigration status.

(h) A complete application packet for emergency admission of an individual, as referenced in subsection (f)(2) of this section, must include:

(1) a completed Application for Admission including signature of the applicant or the applicant's LAR (copies of the Application for Admission are available by contacting the Department of Aging and Disability Services, Provider Services Division, State Mental Retardation Facilities Section, P.O. Box 149030, Mail Code W-511, Austin, Texas 78714-9030);

(2) a written request from the MRA for the emergency admission of the applicant;

(3) documentation:

(A) describing the persuasive evidence that the individual has mental retardation;

(B) of the reasons supporting the individual's urgent need for the emergency admission, including the circumstances precipitating the need for the emergency admission;

(C) of the expected outcomes from the emergency admission; and

(D) that the requested relief can be provided by the state MR facility within a year after the individual is admitted;

(4) a copy of any divorce decree pertaining to the individual;

(5) any legal document dealing with the custody of a minor;

(6) current letters of guardianship, order appointing a guardian and related orders, if the individual has a guardian;

(7) a certified copy of the applicant's birth certificate;

(8) a copy of the applicant's immunization record;

(9) a copy of the applicant's social security card;

(10) a copy of the applicant's Medicare and Medicaid card (if applicable);

(11) for the applicant who is school eligible, the Admission, Review and Dismissal (ARD) Committee report, Individual Education Plan (IEP), and Comprehensive Assessment;

(12) for the applicant who is a minor, the results of the CRCG staffing held as described in §2.257(c) of this subchapter;

(13) for the applicant under 22 years of age, results of the MRA's permanency planning process as described in §2.283(a) of this subchapter;

(14) any record regarding care and treatment of the individual in a state mental health facility or a psychiatric hospital;

(15) any documents concerning the applicant's immigration status; and

(16) if requested by DADS:

(A) a DMR report with a statement that the applicant has mental retardation, as described in §5.155(g) of this title, if requested by DADS; and

(B) a completed ICAP (Inventory for Client and Agency Planning) booklet and MR/RC Assessment form.

(i) A complete application packet for admission of an indivisueal for respite care, as referenced in susection (f)(2) of this section, must include:

(1) a completed Application for Admission including signature of the applicant or the applicant's LAR (copies of the Application for Admission are available by contacting the Department of Aging and Disability Services, Provider Services Division, State Mental Retardation Facilities Section, P.O. Box 149030, Mail Code W-511, Austin, Texas 78714-9030);

(2) a written request from the MRA for the admission of the applicant for respite care;

(3) documentation:

(A) describing the persuasive evidence that the individual has mental retardation;

(B) of the reasons why the individual or the individual's family urgently requires respite care; and

(C) that the requested assistance or relief can be provided by the state MR facility within a period not to exceed 30 calendar days after the date of admission;

(4) a copy of any divorce decree pertaining to the individual;

(5) any legal document dealing with the custody of a minor;

(6) current letters of guardianship, order appointing a guardian and related orders, if the individual has a guardian;

(7) a certified copy of the applicant's birth certificate;

(8) a copy of the applicant's immunization record;

(9) a copy of the applicant's social security card;

(10) a copy of the applicant's Medicare and Medicaid card (if applicable);

(11) for the applicant who is school eligible, the Admission, Review and Dismissal (ARD) Committee report, Individual Education Plan (IEP), and Comprehensive Assessment;

(12) any documents concerning the applicant's immigration status; and

(13) if requested by DADS:

(A) a DMR report with a statement that the applicant has mental retardation, as described in §5.155(g) of this title, if requested by DADS; and

(B) a completed ICAP (Inventory for Client and Agency Planning) booklet and MR/RC Assessment form.

Comments

Source Note: The provisions of this §2.265 adopted to be effective January 1, 2001, 25 TexReg 12746; amended to be effective March 31, 2002, 27 TexReg 2445; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective September 1, 2006, 31 TexReg 6783

§2.266: Process for Admission of an Adult or a Minor Who Has Been Committed to a State Mr Facility Under the Pmra

(a) If a court orders an individual committed to a state MR facility, the MRA will coordinate the compilation of an application packet for submission to the state MR facility serving the individual's county of residence.

(b) The MRA must retain a copy of the application packet, as described in §2.265(g) of this subchapter (relating to MRA Referral of an Applicant to a State MR Facility) and send the original application packet to the admission coordinator of the state MR facility.

(c) DADS will determine when a vacancy exists in a state MR facility and which individuals are appropriate to fill the vacancy, based on the information in the application packets.

(d) Upon notification from DADS that an appropriate vacancy in a state MR facility is available, the MRA will contact the LAR or family of each individual identified by DADS as appropriate to fill the vacancy and will:

(1) determine whether the LAR or family of the individual is still seeking admission of the individual to a state MR facility under the commitment;

(2) determine whether the individual would accept the proposed admission to the state MR facility; and

(3) update the information in the individual's application packet, including ensuring that the assessments reflect the individual's current level of functioning.

(e) The state MR facility will offer admission under the commitment order to one of those individuals identified by DADS as appropriate to fill the vacancy and who the MRA has determined would accept the proposed admission to the state MR facility.

(f) If the applicant or the applicant's LAR accepts the proposed admission, the MRA must request enrollment of the applicant in the ICF/MR Program as described in §9.244 of this title (relating to Applicant Enrollment in the ICF/MR Program), if appropriate.

(g) If the applicant or LAR has accepted the proposed admission, and the MRA has filed for commitment, but the commitment order has not been completed, the MRA may petition the court for an order of protective custody.

(h) The MRA shall coordinate the following with the state MR facility's admission coordinator:

(1) transportation arrangements for the individual on the day of the admission;

(2) arrangements for the individual's LAR to be present at the state MR facility when the individual is admitted, or if the individual does not have an LAR, for the individual's family members or other actively involved persons to be present; and

(3) the exchange of essential information training necessary to familiarize staff at the state MR facility with the needs of the individual.

(i) If the LAR or family of the individual no longer wishes to pursue admission of the individual to a state MR facility under the commitment order, the MRA will notify the court in writing.

Comments

Source Note: The provisions of this §2.266 adopted to be effective January 1, 2001, 25 TexReg 12746; amended to be effective March 31, 2002, 27 TexReg 2445; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective September 1, 2006, 31 TexReg 6783

§2.267: Process for the Regular Voluntary Admission of an Adult to a State Mr Facility Under the Pmra

(a) In accordance with THSC, §593.021, only the adult seeking admission may apply for a regular voluntary admission to a state MR facility for residential services.

(b) If the MRA IDT recommends that the applicant be admitted to a state MR facility for regular voluntary services, the MRA must retain a copy of the application packet, as described in §2.265(g) of this subchapter (relating to MRA referral of an Applicant to a State MR Facility) and send the original application packet to the admission coordinator of the state MR facility.

(c) DADS will determine when a vacancy exists in a state MR facility and which individuals are appropriate to fill the vacancy, based on the information in the application packets.

(d) Upon notification from DADS that an appropriate vacancy in a state MR facility is available, the MRA will contact each individual identified by DADS as appropriate to fill the vacancy and will:

(1) determine whether the individual is still seeking admission to a state MR facility;

(2) update the information in the individual's application packet, including ensuring that the assessments reflect the individual's current level of functioning; and

(3) determine if the individual would accept the proposed admission to the state MR facility.

(e) The state MR facility will offer admission to one of those individuals identified by DADS as appropriate to fill the vacancy and who the MRA has determined would accept the proposed admission to the state MR facility.

(f) If the applicant or the applicant's LAR accepts the proposed admission, the MRA must request enrollment of the applicant in the ICF/MR Program as described in §9.244 of this title (relating to Applicant Enrollment in the ICF/MR Program), if appropriate.

(g) The MRA will coordinate the individual's pre-admission visit, if such visit is appropriate and desired by the individual.

Comments

Source Note: The provisions of this §2.267 adopted to be effective January 1, 2001, 25 TexReg 12746; amended to be effective March 31, 2002, 27 TexReg 2445; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective September 1, 2006, 31 TexReg 6783

§2.268: Process for Placement of a Minor under the Texas Family Code in a State Mr Facility

(a) If DADS is notified by a juvenile court that a placement order for a minor has been issued under Texas Family Code, §55.33 or §55.52, DADS will notify the appropriate MRA of the placement order.

(b) Prior to the minor's admission under a placement order, the MRA must submit the following documents to the state MR facility:

(1) the original court order;

(2) an offense record;

(3) a DMR, if available;

(4) a current medical assessment;

(5) a physician's medication orders;

(6) a social history;

(7) a psychological history;

(8) an immunization record;

(9) a copy of social security card;

(10) a certified copy of birth certificate;

(11) the Admission, Review and Dismissal (ARD) Committee report, Individual Education Plan (IEP), and Comprehensive Assessment;

(12) a copy of the Medicaid card, if applicable;

(13) any legal document dealing with custody of the minor;

(14) current letters of guardianship, order appointing a guardian, and related orders, if the minor has a guardian;

(15) any documents concerning the minor's immigration status;

(16) a completed ICAP (Inventory for Client and Agency Planning) booklet and MR/RC assessment form, if available; and

(17) other available evaluations.

(c) Upon receipt of the required documents, the state MR facility will coordinate admission arrangements with the juvenile probation department or the MRA.

(d) Within 30 calendar days after the minor is admitted to the state MR facility, the state MR facility will schedule an IDT meeting to develop an individual program plan (IPP) for the minor.

(e) Not later than the 75th calendar day after the date the court issues a placement order under Texas Family Code, §55.33, the state MR facility will submit to the court a report that:

(1) describes the treatment of the minor provided by the state MR facility;

(2) states whether the state MR facility believes the minor is fit or unfit to proceed; and

(3) if the state MR facility believes the minor is unfit to proceed, states whether the minor meets the commitment criteria described in §2.257 of this subchapter (relating to Criteria for Commitment of a Minor to a State MR Facility Under the PMRA).

(f) If the state MR facility believes that the minor is unfit to proceed and meets the commitment criteria described in §2.257 of this subchapter, the state MR facility will submit an affidavit to the court stating the conclusions reached as a result of the diagnosis.

(g) Not later than the 75th calendar day after the date the court issues a placement order under Texas Family Code, §55.52, the state MR facility will submit to the court a report that:

(1) describes the treatment of the minor provided by the state MR facility;

(2) states whether the state MR facility believes the minor has mental retardation; and

(3) if the state MR facility believes the minor has mental retardation, states whether the minor meets the commitment criteria described in §2.257 of this subchapter.

(h) If the state MR facility believes that the minor has mental retardation and meets the commitment criteria described in §2.257 of this subchapter, the state MR facility will submit an affidavit to the court stating the conclusions reached as a result of the diagnosis.

Comments

Source Note: The provisions of this §2.268 adopted to be effective January 1, 2001, 25 TexReg 12746; amended to be effective March 31, 2002, 27 TexReg 2445; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective September 1, 2006, 31 TexReg 6783

§2.269: Process for the Emergency Admission of an Adult or a Minor to a State Mr Facility Under the Pmra

(a) In accordance with THSC, §593.021, only the following persons may apply for admission to a state MR facility for emergency services:

(1) the individual seeking admission; or

(2) the LAR of an individual.

(b) If the MRA determines that an individual meets the criteria for emergency admission under §2.261 of this subchapter (relating to Criteria for Emergency Admission of an Adult or a Minor to a State MR Facility Under the PMRA), the MRA must retain a copy of the application packet, as described in §2.265(h) of this subchapter (relating to MRA Referral of an Applicant to a State MR Facility) and send the original application packet to the admission coordinator of the state MR facility.

(c) DADS will determine when a vacancy exists in a state MR facility and which individuals are appropriate to fill the vacancy, based on the information in the application packets.

(d) Upon notification from DADS that an appropriate vacancy in a state MR facility is available, the MRA will contact each individual identified by DADS as appropriate to fill the vacancy and will:

(1) determine whether the individual is still seeking emergency admission to a state MR facility;

(2) update the information in the individual's application packet, including ensuring that the assessments reflect the individual's current level of functioning; and

(3) determine whether the individual would accept the proposed emergency admission to the state MR facility.

(e) The state MR facility will offer emergency admission to one of those individuals identified by DADS as appropriate to fill the vacancy and who the MRA has determined would accept the proposed emergency admission to the state MR facility.

(f) Prior to admission of the individual, the MRA must:

(1) negotiate the terms of the Emergency Admission/Discharge Agreement with the parties and prepare the agreement;

(2) send a copy of the completed Emergency Admission/Discharge Agreement to the individual or LAR, the state MR facility, and the Department of Aging and Disability Services, Provider Services Division, State Mental Retardation Facilities Section, P.O. Box 149030, Mail Code W-511, Austin, Texas 78714-9030; and

(3) develop a service coordination plan to accomplish the expected outcomes identified in the Emergency Admission/Discharge Agreement.

(g) If the individual is under 22 years of age, the Emergency Admission/Discharge Agreement must incorporate elements of the individual's permanency plan, as appropriate, and specify that the individual is to be admitted for no longer than six months to receive emergency services in the state MR facility.

(h) The Emergency Admission/Discharge Agreement must be approved by the commissioner or designee prior to the admission of the individual by the state MR facility.

(i) If the Emergency Admission/Discharge Agreement is approved by the commissioner or designee and the individual is admitted, the state MR facility will, at the time of admission:

(1) complete a physical examination of the individual and issue orders addressing the applicant's medication, treatment, and diet needs; and

(2) develop a plan of services and supports to be provided while the individual is a resident.

(j) Within 30 calendar days after the individual is admitted, the state MR facility will arrange for:

(1) a DMR to be conducted in accordance with §5.155 of this title (relating to Determination of Mental Retardation (DMR)); and

(2) an IDT at the state MR facility to make findings and recommendations in accordance with the process described for an MRA IDT in §2.264 of this subchapter (relating to MRA IDT Recommendation Concerning the Commitment of an Adult or a Minor or the Regular Voluntary Admission of an Adult to a State MR Facility Under the PMRA).

(k) The terms of the Emergency Admission/Discharge Agreement, including the date of discharge, may not be amended unless the MRA obtains approval from the commissioner or designee.

(l) The individual will be discharged by the state MR facility under the terms of the Emergency Admission/Discharge Agreement.

(m) If DADS determines that the terms of the Emergency Admission/Discharge Agreement cannot be met, the MRA may initiate commitment proceedings under the PMRA.

Comments

Source Note: The provisions of this §2.269 adopted to be effective January 1, 2001, 25 TexReg 12746; amended to be effective March 31, 2002, 27 TexReg 2445; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective September 1, 2006, 31 TexReg 6783

§2.270: Process for Admission of an Adult or a Minor to a State Mr Facility for Respite Care Under the Pmra

(a) In accordance with THSC, §593.021, only the following persons may apply for admission to a state MR facility for respite care:

(1) the individual seeking admission; or

(2) the LAR of an individual.

(b) If the MRA determines that an applicant meets the criteria for respite care under §412.262 of this title (relating to Criteria for Admission of an Adult or a Minor to a State MR Facility for Respite Care Under the PMRA), the MRA must retain a copy of the application packet, as described in §412.265(i) of this title (relating to MRA Referral of an Applicant to a State MR Facility) and send the original application packet to the admission coordinator of the state MR facility.

(c) The department will determine when a vacancy exists in a state MR facility and which individuals for whom the state MR facility can meet their needs and are appropriate to fill the vacancy, based on the information in the application packets.

(d) Upon notification from the department that an appropriate vacancy in a state MR facility is available, the MRA will contact each individual identified by the department as appropriate to fill the vacancy and will:

(1) determine whether the individual is still seeking respite care in a state MR facility;

(2) update the information in the individual's application packet, including ensuring that the assessments reflect the individual's current level of functioning; and

(3) determine whether the individual would accept the proposed admission for respite care to the state MR facility.

(e) The state MR facility will offer admission for respite care to one of those individuals identified by the department as appropriate to fill the vacancy and who the MRA has determined would accept the proposed admission to the state MR facility.

(f) At the time of admission:

(1) the MRA must:

(A) negotiate the terms of the Respite Admission/Discharge Agreement with the parties and prepare the agreement; and

(B) develop a service coordination plan to accomplish the purpose of the admission described in the Respite Admission/Discharge Agreement; and

(2) the state MR facility will:

(A) complete a physical examination of the individual and issue orders addressing the applicant's medication, treatment, and diet needs; and

(B) develop a plan of services and supports to be provided while the individual is a resident.

(g) The individual will be discharged by the state MR facility under the terms of the Respite Admission/Discharge Agreement.

(h) One extension of no more than 30 calendar days to the individual's agreed length of stay may be granted by the head of the state MR facility if:

(1) the relief sought by the individual or the individual's family has not been provided within 30 calendar days of the date of admission;

(2) the MRA submits an amended Respite Admission/Discharge Agreement to the state MR facility at least three working days prior to the expiration of the original Respite Admission/Discharge Agreement;

(3) the head of the state MR facility determines that the requested assistance or relief can be provided during the requested extension period including that space is available at the state MR facility; and

(4) the parties to the original Respite Admission/Discharge Agreement consent to the extension.

Comments

Source Note: The provisions of this §2.270 adopted to be effective January 1, 2001, 25 TexReg 12746; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

Division 3

§2.271: Transfer of an Individual Between State Mr Facilities

(a) The transfer of an individual from one state MR facility to another may be proposed by:

(1) the individual who is able to provide legally adequate consent;

(2) the individual's LAR; or

(3) the state MR facility in which the individual resides.

(b) The transfer of an individual from one state MR facility to another may be made if the state MR facility in which the individual resides determines that:

(1) the state MR facility is no longer appropriate to the individual's needs;

(2) the individual can be treated and habilitated better in another state MR facility; or

(3) the individual can be treated and habilitated in a state MR facility located geographically closer to the individual's family.

(c) If a state MR facility proposes that the individual be transferred to another state MR facility, the state MR facility will notify the individual or LAR, in writing, at least 31 calendar days before the date of the proposed transfer, of the proposed transfer and the right to request an administrative hearing to contest the proposed transfer, in accordance with §414.155 of this title (relating to Notice of Hearing).

(d) If the individual or LAR, or another person as the representative of the individual or LAR, requests an administrative hearing, the individual will not be transferred pending the hearing.

(e) If the state MR facility denies a request from the individual or LAR for a transfer, the state MR facility will notify the individual or LAR, in writing, of the right to request an administrative hearing to contest the denial, in accordance with §414.155 of this title (relating to Notice).

(f) If a transfer proposed by the individual or LAR is approved by the state MR facility or a transfer proposed by the state MR facility is not contested by the individual or LAR, the state MR facility will send necessary documents regarding the individual to the receiving state MR facility. In addition, the state MR facility in which the individual resides will notify the individual's designated MRA of the proposed transfer.

(g) The receiving state MR facility will review the documentation and initiate any necessary action, including arranging for a pre-transfer visit, to determine whether the receiving state MR facility can provide appropriate services to the individual.

(h) At the conclusion of its review and necessary action, the receiving state MR facility will notify the state MR facility in which the individual resides, in writing, of its determination of whether it can provide appropriate services to the individual and, if it can provide appropriate services, the projected date of an available vacancy.

(i) The state MR facility in which the individual resides will notify the individual or LAR and the individual's designated MRA of the determination made by the receiving state MR facility and the projected date of an available vacancy, if applicable.

(j) Pending the vacancy becoming available, the state MR facility in which the individual resides will provide periodic updates to the individual or LAR about the status of the transfer.

(k) When the vacancy at the receiving state MR facility becomes available, the state MR facility in which the individual resides will notify the individual or LAR about such availability and coordinate arrangements with the receiving state MR facility for the individual to be transferred.

Comments

Source Note: The provisions of this §2.271 adopted to be effective January 1, 2001, 25 TexReg 12746; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§2.272: Transfer of an Individual from a State Mr Facility to a State Mh Facility

(a) An individual committed to a state MR facility for residential services may be transferred to a state MH facility for mental health care if a licensed physician of the state MR facility determines after an examination that care, treatment, control and rehabilitation in a state MH facility is in the best interest of the individual.

(b) The individual will be returned to the state MR facility within 30 calendar days unless a court order transferring the individual is obtained by the state MH facility as described in subsection (c) of this section.

(c) If the state MH facility determines that hospitalization of the individual is necessary for longer than 30 calendar days, the state MH facility will request from the committing court an order transferring the individual to the state MH facility. In support of the request, the state MH facility will submit two certificates of medical examination for mental illness to the court, as described in THSC, §574.011, stating that the individual:

(1) is a person with mental illness; and

(2) requires observation or treatment in the state MH facility.

(d) If the state MH facility determines that an individual who has been transferred to a state MH facility under a court order no longer requires hospitalization, the state MH facility will request that the committing court approve the return of the individual to the state MR facility, in accordance with THSC, §594.045.

(e) An individual admitted to a state MR facility under a regular voluntary admission for residential services may be transferred to a state MH facility only if the individual consents to the transfer.

Comments

Source Note: The provisions of this §2.272 adopted to be effective January 1, 2001, 25 TexReg 12746; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§2.273: Transfer of an Individual from a State Mh Facility to a State Mr Facility

An individual receiving inpatient services in a state MH facility, other than an individual transferred under §412.272 of this title (relating to Transfer of an Individual from a State MR Facility to a State MH Facility), who has been determined by the MRA to require residential services in a state MR facility, may be admitted to the state MR facility only in accordance with the criteria and process set forth in Division 2 of this subchapter (relating to Admission and Commitment).

Comments

Source Note: The provisions of this §2.273 adopted to be effective January 1, 2001, 25 TexReg 12746; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

Division 4

§2.274: Consideration of Living Options for Individuals Residing in State Mr Facilities

(a) Individuals 22 years of age or older.

(1) A contract MRA must conduct the CLOIP for an individual 22 years of age or older residing in a state MR facility:

(A) before the individual's annual planning meeting as referenced in subsection (c)(2) of this section; and

(B) upon request of the individual or LAR to learn about living options other than the state MR facility.

(2) In conducting the CLOIP, the contract MRA must:

(A) provide standardized educational materials approved by DADS describing living options and supports in the community;

(B) offer the individual or LAR the opportunity to visit examples of living options available in the community and to visit with peers utilizing these options; and

(C) document the results of the CLOIP in a format approved by DADS.

(3) A state MR facility must notify the contract MRA, in accordance with DADS procedures, of a request by an individual or LAR for information regarding living options other than the state MR facility.

(4) After the contract MRA receives the notification required by paragraph (3) of this subsection, the contract MRA must contact the individual or LAR and conduct the CLOIP in accordance with paragraph (2) of this subsection.

(5) The contract MRA must:

(A) submit results of the CLOIP to the state MR facility in accordance with DADS procedures to assist the IDT in making a recommendation described in subsection (g)(4)(D) of this section; and

(B) participate in person or by telephone in a planning meeting for which the contract MRA is notified in accordance with subsection (d)(3) of this section, unless the individual or LAR requests otherwise.

(b) Individuals under 22 years of age. The designated MRA must discuss community living options with an individual under 22 years of age residing in a state MR facility or LAR in accordance with the permanency planning process described in §9.244(f) - (i) of this title (relating to Applicant Enrollment in the ICF/MR Program).

(c) Types of planning meetings in which living options are discussed for an individual residing in a state MR facility.

(1) Within 30 days after admission of an individual to a state MR facility, the state MR facility must conduct an initial planning meeting in which living options are discussed.

(2) Annually, the state MR facility must conduct a planning meeting in which living options are discussed (annual planning meeting).

(3) The state MR facility must conduct a planning meeting if, at any time, the individual or LAR requests a discussion about living options including a request for information about living options other than the state MR facility or requests to move to a specific setting or area of the state.

(d) Notification of planning meetings. In accordance with DADS procedures, the state MR facility must notify:

(1) the individual and LAR of a planning meeting described in subsection (c) of this section;

(2) the designated MRA of a planning meeting described in subsection (c) of this section and, if appropriate, request from the designated MRA information about alternative living arrangements and community services and supports in the area in which the individual is interested in living that the IDT will need before making a recommendation as described in subsection (g)(4)(D) of this section; and

(3) the contract MRA:

(A) of an annual planning meeting described in subsection (c)(2) of this section for an individual 22 years of age or older; and

(B) a planning meeting described in subsection (c)(3) of this section for which a CLOIP must be conducted by the contract MRA in accordance with subsection (a)(1)(B) of this section.

(e) Additional planning meeting participants as determined by individual or LAR. The individual with the ability to provide legally adequate consent or the LAR of an individual who does not have the ability to provide legally adequate consent may choose to:

(1) invite other family members, friends, or other interested persons to a planning meeting; or

(2) exclude any and all family members, friends, or other interested persons from attending a planning meeting.

(f) Facilitation of a planning meeting. The state MR facility must:

(1) encourage the attendance and participation in a planning meeting by those persons invited by the individual or LAR;

(2) make a reasonable attempt to schedule the planning meeting at a time that is convenient for the individual's LAR and those family members, friends, or other persons invited by the individual or LAR; and

(3) use communication devices and techniques (including the use of sign language), as appropriate, to facilitate the involvement of the individual and LAR during a planning meeting.

(g) Conducting the planning meeting.

(1) At a planning meeting described in subsection (c)(1) of this section, the IDT must review the individual's or LAR's awareness of living options explained by the designated MRA during the admission process, as required by §5.159(c) of this title (relating to Assessment of Individual's Need for Services and Supports).

(2) At a planning meeting described in subsection (c)(2) or (3) of this section, the IDT must review, as appropriate to the individual's age:

(A) the results of the CLOIP submitted to the state MR facility in accordance with subsection (a)(5)(A) of this section; or

(B) the results of the permanency planning process submitted to the state MR facility in accordance with §9.244(f)(7)(C) of this title.

(3) In conducting a planning meeting described in subsection (c) of this section, the IDT must use the State MR Facility Living Options Instrument which may be obtained from the Department of Aging and Disability Services, Provider Services Division, State Mental Retardation Facilities Section, P.O. Box 149030, Mail Code W-511, Austin, Texas 78714-9030 or at www.dads.state.tx.us.

(4) At the conclusion of a planning meeting described in subsection (c) of this section, the IDT must document:

(A) the decision of an individual who has the ability to provide legally adequate consent or an LAR to consider potential living options;

(B) the choice of living option preferred by the individual or the individual's LAR;

(C) the IDT's conclusions as to whether or not the state MR facility is the most appropriate living arrangement for the individual;

(D) the recommendation by the IDT of whether the individual should remain in the current living arrangement at the state MR facility or move to an alternative living arrangement; and

(E) for an individual under 22 years of age, the IDT's conclusions as to whether or not the permanency planning goal has been accomplished.

(h) Choice for individual to remain in state MR facility. An individual with the ability to provide legally adequate consent or the LAR may choose for the individual to remain a resident of a state MR facility if the individual has been determined to have mental retardation in accordance with §5.155 of this title (relating to Determination of Mental Retardation).

Comments

Source Note: The provisions of this §2.274 adopted to be effective April 2, 2009, 34 TexReg 2154

§2.275: Accessing Alternative Living Arrangements for an Individual Residing in a State Mr Facility Who Has the Ability to Provide Legally Adequate Consent or Has a Legally Authorized Representative (LAR)

(a) If an individual with the ability to provide legally adequate consent or an LAR agrees with and accepts an IDT recommendation to seek an alternative living arrangement, the IDT will inform the individual's designated MRA to schedule a planning meeting as appropriate.

(b) If the individual is a minor, the IDT's goal in identifying potential alternative living arrangements is to ensure that the alternative living arrangement will provide a consistent, nurturing environment and an enduring, positive adult relationship with a specific person who will be an advocate for that minor.

(1) If it is not possible for the minor to live with the natural family, the feasibility of other family living arrangements should be explored as possible support options.

(2) The IDT will determine the frequency, timing, and scope of IDT meetings to ensure that a minor residing in a state MR facility is reviewed by the IDT as often as necessary based on the changing needs of the minor and the family. The IDT will designate a state MR facility contact person with whom the designated MRA must communicate at least quarterly to discuss existing and planned alternative living arrangements which may be appropriate for the minor. This information will be communicated to the minor's LAR in a manner and frequency preferred by the LAR.

(c) When the individual is school eligible, at least 30 calendar days notice of IDT meetings will be given to the individual, the LAR, and the representative from the appropriate school district. The school district representative will be invited to IDT meetings at which movement by the school eligible individual to the community will be discussed.

(d) During an IDT meeting, state MR facility staff and staff from the designated MRA will describe the different types of alternative living arrangements and answer any questions the individual or LAR may have. The individual or LAR will be asked to identify the desired outcomes for the alternative living arrangement, and preferences of geographic location(s) within the state where the individual wants to live or the LAR wants the individual to live.

(e) Once the desired outcomes and preferences of the individual or the LAR have been identified, the designated MRA is responsible for:

(1) contacting other involved MRAs and obtaining information about providers in their local service areas;

(2) coordinating communication between the individual or LAR, the state MR facility, other involved MRAs and providers; and

(3) inviting a representative from each involved MRA to a meeting of the state MR facility's IDT to discuss the preferences and desires of the individual or LAR regarding alternative living arrangements, as well as the service and support needs identified by the IDT, the individual, and the LAR.

(f) At the meeting described in subsection (e)(3) of this section or a later meeting of the IDT, state MR facility staff will begin the process of completing the community living profile as described in §412.278(c)(1) of this title (relating to Community Living/Discharge Plan for Alternative Living Arrangements).

(1) Copies of the completed profile will be sent to the individual or LAR and the designated MRA within 14 calendar days of the IDT meeting at which it was initiated.

(2) If the preferred geographic location(s) of the individual or LAR is in the local service area of another MRA(s), the designated MRA will provide copies of the profile to the other involved MRA(s).

(g) The designated MRA will provide the individual, the LAR, and the IDT with a list of the providers in the preferred geographic locations and current information prepared by the providers.

(1) The individual or LAR will select providers to which the community living profile is to be sent.

(2) The state MR facility's IDT will ensure that the individual or the LAR have been informed that the community living profile will be shared with providers in accordance with §414.7(d) of this title (relating to When Consent for Disclosure is not Required: Clients Receiving MHMR Services).

(h) Within 14 calendar days of receiving the completed community living profile, the MRA will send the profile to the providers selected by the individual or the LAR. When more than one MRA is involved, the designated MRA will coordinate with the other involved MRAs to ensure that profiles are sent to all selected providers.

(i) The designated MRA must coordinate with the state MR facility and other involved MRAs, as appropriate, to assist the individual or LAR in making arrangements for visits to proposed providers. If an overnight visit is planned, the state MR facility will, prior to the visit, furnish the proposed provider with the following:

(1) identifying data including legal status and determined disability(ies);

(2) pertinent medical/medication information;

(3) behavioral data; and

(4) other pertinent treatment information.

(j) The state MR facility will send an adequate medication supply, clothing, personal items, and adaptive equipment with the individual at the time of the overnight visit.

(k) The individual or LAR will inform a designated state MR facility staff person when a provider has been selected. The individual or LAR may choose a provider with an immediate opening or, if there is no immediate opening, may ask to be placed on a waiting list for the desired services.

(l) After the individual or LAR has selected provider, the IDT will meet to complete the community living/discharge plan as described in §412.278 of this title (relating to Community Living/Discharge Plan for Alternative Living Arrangements).

(m) The individual or LAR may request that the designated MRA facilitate the development of a specific community living arrangement if there is no arrangement in existence which meets the individual's service and support needs as described in the community living profile and the preferences and desired outcomes of the individual or LAR.

Comments

Source Note: The provisions of this §2.275 adopted to be effective January 1, 2001, 25 TexReg 12746; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§2.276: Accessing Alternative Living Arrangements for an Individual Residing in a State Mr Facility Who Does Not Have the Ability to Give Legally Adequate Consent and Who Does Not Have a Legally Authorized Representative (LAR)

(a) If the IDT recommends an alternative living arrangement for an individual who does not have the ability to give legally adequate consent and who does not have an LAR, the IDT will:

(1) notify the individual's designated MRA and persons actively involved with the individual of the recommendation;

(2) identify issues which could prevent the individual from successfully adapting to an alternative living arrangement including:

(A) the individual's inability to provide legally adequate consent; and

(B) the lack of effective community services and supports to address behavioral or medical concerns;

(3) recommend possible solutions to address the issues; and

(4) document the identified issues and recommended solutions in the IDT report.

(b) If the IDT identifies the individual's inability to provide legally adequate consent as an issue that could prevent the individual from successfully adapting to an alternative living arrangement, the IDT will:

(1) explore options for addressing the issue; and

(2) document the options and the activities necessary for implementing the options in the community living/discharge plan.

(c) A representative from the designated MRA will meet with the individual, any persons actively involved with the individual, and the IDT to discuss the desired outcomes for the alternative living arrangement and preferences of geographic locations.

(1) During the meeting, state MR facility staff and the MRA representative will describe the different types of alternative living arrangements which are available and answer any questions asked by the individual and persons actively involved with the individual.

(2) The desired outcomes and preferences of the individual and persons actively involved with the individual will be documented in the written report of the IDT meeting.

(d) Once the desired outcomes and preferences of the individual and persons actively involved with the individual have been identified, the designated MRA is responsible for:

(1) contacting other involved MRAs and obtaining information about providers in their local service areas;

(2) coordinating communication between the individual, persons actively involved with the individual, the state MR facility, other involved MRAs and providers; and

(3) inviting a representative from each involved MRA to a meeting of the state MR facility's IDT to discuss the preferences and desires of the individual and persons actively involved with the individual regarding alternative living arrangements, as well as the service and support needs identified by the IDT, the individual, and persons actively involved with the individual.

(e) At the meeting described in subsection (d)(3) of this section or a later meeting of the IDT, state MR facility staff will begin the process of completing the community living profile as described in §412.278(c)(1) of this title (relating to Community Living/Discharge Plan for Alternative Living Arrangements).

(1) Copies of the completed profile will be sent to the individual, any actively involved persons, and the designated MRA within 14 calendar days of the IDT meeting at which it was initiated.

(2) If the preferred geographic location(s) of the individual is in the local service area of another MRA(s), the designated MRA will provide copies of the profile to the other involved MRA(s).

(f) The designated MRA will provide the individual, persons actively involved with the individual and the IDT with a list of the providers in the preferred geographic locations and current information prepared by the providers.

(g) The IDT will select providers to which the community living profile is to be sent. The providers selected must:

(1) consider any preferences and desires which may have been expressed by the individual or any persons actively involved with the individual;

(2) meet the needs of the individual, as determined by the IDT, including:

(A) medical and health;

(B) emotional and behavioral;

(C) transportation; and

(D) employment, vocational, and educational; and

(3) complement the individual's existing social relationships and support network.

(h) The IDT must ensure that the individual and persons actively involved with the individual have been informed that the community living profile will be shared with providers in accordance with §414.7(d) of this title (relating to When Consent for Disclosure is not Required: Clients Receiving MHMR Services).

(i) Within 14 calendar days of receiving the completed community living profile, the MRA will send the profile to the providers selected by the IDT. When more than one MRA is involved, the designated MRA will coordinate with the other involved MRAs to ensure that profiles are sent to all selected providers.

(j) The designated MRA must coordinate with the state MR facility and other involved MRAs, as appropriate, to assist the individual and persons actively involved with the individual, as appropriate, in making arrangements for visits to proposed providers. If an overnight visit is planned, the state MR facility will, prior to the visit, furnish the proposed provider with the following:

(1) identifying data including legal status and determined disability(ies);

(2) pertinent medical/medication information;

(3) behavioral data; and

(4) other pertinent treatment information.

(k) The state MR facility will send an adequate medication supply, clothing, personal items, and adaptive equipment with the individual at the time of the overnight visit.

(l) Following any visits to a proposed provider by the individual, the IDT will meet to select a provider and complete the community living/discharge plan.

(m) The IDT may request that the designated MRA facilitate the development of a specific alternative living arrangement if there is no arrangement in existence which meets the individual's service and support needs as described in the community living profile and the preferences and desires of the individual.

(n) If there is no consensus by the IDT concerning issues about the alternative living arrangement or other issues related to the individual's move as described in this section or in §412.277 of this title (relating to Arrangements for the Move to an Alternative Living Arrangement of an Individual Residing in a State MR Facility), the IDT will notify the head of the state MR facility within one working day of the date the IDT determines it cannot reach a consensus. The head of the state MR facility will name a review team, consistent with the state MR facility's written policies and procedures, to evaluate the situation and make a consensus recommendation to the head of the state MR facility within 21 calendar days.

(1) Within three working days of receiving the review team's recommendation, the head of the state MR facility will issue a written decision to:

(A) the staff members on the IDT;

(B) the individual; and

(C) any person(s) actively involved with the individual.

(2) The state MR facility will include with the written decision sent to the individual and each person who is actively involved with the individual a notice that the individual or actively involved person may request a review of the head of the facility's decision by the department's ombudsman in Central Office.

(A) The individual or actively involved person may request the review at any time prior to the individual moving from the state MR facility into an alternative living arrangement.

(B) The request for a review by the department's ombudsman may be made in writing to Consumer Services and Rights Protection, Ombudsman, Texas Department of Mental Health and Mental Retardation, P.O. Box 12668, Austin, Texas, 78711-2668, or by calling 1-800-252-8154.

(3) The ombudsman will decide whether the processes in this subchapter have been followed by reviewing relevant documentation from the IDT, the review team, the head of the facility, and the person who requested the review.

(A) The ombudsman will issue a written decision within 14 calendar days of the request to the person who requested the review and to the head of the state MR facility.

(B) If the ombudsman decides that the processes in this subchapter have been followed, then the head of the facility will take action to implement the decision referenced in paragraph (1) of this subsection.

(C) If the ombudsman decides that the processes in this subchapter have not been followed, then the head of the facility must take action to follow the processes in this subchapter.

Comments

Source Note: The provisions of this §2.276 adopted to be effective January 1, 2001, 25 TexReg 12746; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§2.277: Arrangements for the Move to an Alternative Living Arrangement of an Individual Residing in a State Mr Facility

(a) Within 14 calendar days of the IDT meeting at which a provider is selected the state MR facility will forward the following to the designated MRA, any other involved MRA, the provider, and the individual with the ability to provide legally adequate consent or the LAR, as appropriate:

(1) a copy of the draft community living/discharge plan;

(2) the planned date for the individual's move, if available;

(3) the report from the last annual planning meeting of the IDT;

(4) the most recent psychological, social, medical, and vocational/educational assessments; and

(5) reports from any interim meetings of the IDT which addressed living options issues not addressed at the annual planning meeting.

(b) The MRA will review the material and visit the provider setting as needed, to determine whether the provider setting:

(1) complies with applicable Life Safety Code requirements;

(2) presents environmental concerns that impact the individual's needs;

(3) effectively addresses the outcomes important to the individual or LAR and the services and supports necessary assist the individual in achieving those outcomes; and

(4) ensures the individual's health, safety, and welfare.

(c) Within 14 calendar days of making its determination in subsection (b) of this section, the MRA must notify the IDT in writing that:

(1) the provider setting meets the criteria in subsection (b) of this section and that the MRA recommends that the IDT approve the provider setting; or

(2) the provider setting does not meet the criteria in subsection (b) of this section and that the MRA recommends that the IDT not approve the provider setting.

(d) If the MRA recommends that the IDT not approve the provider setting, the MRA must include in the notice described in subsection (c)(2) of this section:

(1) the criteria described in subsection (b) of this section that the provider setting did not meet; and

(2) the reasons why the MRA determined the criteria was not met.

(e) If the IDT accepts an MRA recommendation to approve the provider setting, the community living/discharge plan will be completed for distribution to all parties, and final arrangements will be initiated for the individual's move to the community.

(f) If the MRA has recommended that the provider setting not be approved, the IDT will make written recommendations for specific remedies to address the problems and send the recommendations to the provider and the individual or LAR.

(1) The individual with the ability to provide legally adequate consent or the LAR has the option of:

(A) continuing with the move after the IDT determines that the recommendations have been or are in the process of being implemented by the provider;

(B) continuing with the move without the IDT determining that the recommendations have been or are in the process of being implemented by the provider; or

(C) selecting another provider.

(2) If the individual does not have the ability to provide legally adequate consent and does not have an LAR, then the individual will remain in the state MR facility until:

(A) the IDT determines that the recommendations have been or are in the process of being implemented by the provider; or

(B) another provider is identified by the by the IDT.

(g) When the individual moves, the state MR facility shall ensure the following:

(1) a 30-day supply of prescribed medications has been provided;

(2) the individual's personal belongings accompany the individual;

(3) all necessary financial arrangements and agreements are addressed;

(4) appropriate special instructions for the individual or others are furnished in writing and orally prior to or at the time of departure;

(5) the records described in subsection (i) of this section accompany the individual; and

(6) the appropriate Social Security office has been notified of the individual's impending move.

(h) Responsibilities for transporting the individual to the alternative living arrangement will be detailed in the community living/discharge plan. If deemed necessary by the IDT, these responsibilities could include having state MR facility and/or MRA staff accompany the individual and remaining there for a period of time deemed necessary for satisfactory transition. The MRA must assign a service coordinator who will meet with the individual and LAR before or on the day of the move.

(i) The following records, as applicable, will be provided by the state MR facility to the provider before the move or will accompany the individual, with copies also offered to the individual or LAR, before or at the time of the move:

(1) a copy of the birth certificate;

(2) copies of any current legal documents;

(3) a copy of the individual's Social Security card;

(4) a current photograph;

(5) a copy of the immunization record;

(6) a copy of the height and weight record;

(7) a copy of the seizure record;

(8) a copy of the most recent physician's orders, to include treatment and diet orders;

(9) a copy of the most recent medical and dental examination;

(10) copies of the most recent laboratory test results to include any one of a kind laboratory test results;

(11) copies of any additional significant reports including the most recent chest X-ray, electrocardiogram (EKG), or electroencephalogram (EEG);

(12) a copy of the social history and the most recent psychological examination;

(13) Medicaid, Medicare, or third-party insurance cards, if available;

(14) a copy of current nursing care plan;

(15) a summary of the individual's medical history to include all major surgeries, significant acute illnesses, and injuries requiring hospitalization or a long recovery period;

(16) a summary of the individual's medication history to include start and stop dates, dose ranges and effectiveness of all long-term medications, and history of antibiotic use to include dates, effectiveness, sensitivities, and allergies;

(17) a summary of dental history including all oral surgeries, extractions, restorations, appliances, and types of anesthesia required for dental work; and

(18) any other data requested by the community program or by the individual or LAR.

(j) Prior to or at the time of movement, the state MR facility physician shall prepare a letter summarizing the highly relevant medical information to be given to the new physician or health care entity that will be providing services to the individual in the community. The letter will be copied to the designated MRA and other involved MRA and the provider. When appropriate, the state MR facility physician shall communicate directly with the new physician or health care entity.

(k) If a school eligible individual will be enrolled in public school, the state MR facility and MRA must provide the following to the school district prior to the move or within 14 working days after the move:

(1) the birth certificate or other document as proof of identity;

(2) the medical history and medical records, including current immunization records;

(3) the social history;

(4) the vision and hearing screening and/or evaluation;

(5) reports of psychological, educational, related services, and vocational assessments;

(6) the habilitation plan, including plan for reintegration;

(7) the Admission, Review and Dismissal (ARD) Committee report, Individual Education Plan (IEP), and Comprehensive Assessment, and, for school eligible individuals over the age of 13, the most recent Individual Transition Plan; and

(8) if the individual was committed to the state MR facility, a copy of the court order.

(l) A provider required to comply with §411.63 of this title (relating to Interagency Coordination of Special Education Services to Students with Disabilities in Residential Care Facilities) must notify, in writing, the school district where the provider is located of the admission of a school eligible individual. The notification will occur no later than three working days after the admission.

Comments

Source Note: The provisions of this §2.277 adopted to be effective January 1, 2001, 25 TexReg 12746; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§2.278: Community Living/Discharge Plan for Alternative Living Arrangements

(a) Designated state MR facility staff will prepare the community living/discharge plan as described in §412.277 of this title (relating to Arrangements for the Move to an Alternative Living Arrangement of an Individual Residing in a State MR Facility) and this section. The plan incorporates information provided by the individual, LAR, MRA, other state MR facility staff, and the provider. The plan:

(1) is customized based on the abilities and needs of the individual to specify the:

(A) timelines and intervals for monitoring activities;

(B) form those monitoring activities will take (e.g. on-site visitations, phone contacts, record reviews, and written reports);

(C) responsibilities of the designated MRA and other MRAs if the proposed move is outside the designated MRA's local services area;

(D) responsibilities of the provider; and

(E) criteria for a recommendation for discharge from the state MR facility;

(2) identifies the individual's or LAR's desired outcomes for an alternative living arrangement that serve as the basis for the person directed plan and service coordination plan to be developed by the designated MRA or the MRA for the local service area where the individual will live; and

(3) is approved by the individual, LAR, MRA, state MR facility, and provider before the individual moves from the state MR facility.

(b) The plan can be in any format acceptable to all parties (individual, LAR, MRA, state MR facility, and provider), but must contain the elements described in this section. A sample format provided by the department may be used as is or modified as deemed appropriate. Copies are available by contacting the Office of State Mental Retardation Facilities, Texas Department of Mental Health and Mental Retardation, P.O. Box 12268, Austin, Texas 78711-2668, 512/206-4516.

(c) The community living/discharge plan will be completed as follows:

(1) The community living profile (section I of the sample format), completed by the IDT when a recommendation for an alternative living arrangement has been made and accepted, describes:

(A) essential information identifying the individual;

(B) the preferences and desired outcomes of the individual or LAR;

(C) health and safety issues;

(D) the date of the determination of mental retardation conducted as described in §415.155 of this title (relating to Determination of Mental Retardation (DMR)); and

(E) name and telephone number of state MR facility contact person.

(2) The community living data (section II of the sample format), completed by the state MR facility upon selection of a provider, with information from the provider and MRA, describes:

(A) the name, address, and telephone number(s) of the physician or health care entity that will become the individual's primary health care provider;

(B) the name(s), address(es), and telephone numbers of contacts at the designated MRA, and others, as appropriate;

(C) the name, address, telephone number, and type (e.g. HCS or ICF/MR) of provider, and contact person (address and telephone number, if different);

(D) the name, address, telephone number for school, job, or day program and contact person (address and telephone number, if different);

(E) the name, address, and telephone number of individual program coordinator; and

(F) the identification of the MRA service coordinator assigned to provide continuity of services.

(3) The findings and observations (section III of the sample format) are described by the state MR facility and include:

(A) thorough medical and behavioral information, which will be communicated to the physician who will be providing care in the community;

(B) all current physician orders and treatments, including rationale for all medications prescribed and dispensed by the state MR facility, and amount dispensed which will be continued after the move; and

(C) a brief summary of findings, events, and progress during the period the individual resided in the state MR facility;

(4) The community living information (section IV of the sample format) is compiled based on information supplied by the individual, LAR, state MR facility and MRA staff, and the provider and includes:

(A) the individual's personal likes, dislikes, and preferences (including friends and important relationships);

(B) the specific steps and activities necessary to accomplish a successful transition;

(C) the outcomes important to the individual and related personal goals; and

(D) the services and supports necessary to support the individual in achieving the personal outcomes important in the individual's life (e.g. residential, vocational, social, leisure, religion, health, safety, financial, and transportation);

(5) The community living monitoring activities (section V of the sample format) include:

(A) the responsibilities of the MRA(s), as the agent of the department, for determining whether the outcomes and criteria established for successful transition have been met with a description of how the determination is to be accomplished (e.g. on-site visitation, phone contacts, record reviews, and written reports) and specific timelines for the completion of monitoring activities;

(B) the specific actions to be taken by the MRA(s) and state MR facility in the event that the outcomes and criteria are not being met;

(C) the criteria by which the MRA(s) will make a recommendation to the head of the state MR facility that the individual be discharged from the state MR facility;

(D) a list of the persons, which must include the individual or LAR, to be notified of the recommendation that the individual be discharged from the state MR facility and how such notice will be accomplished;

(E) the timeframe for changing the county of residence in CARE if the move is outside the local service area of the designated MRA; and

(F) the expected date of discharge from the state MR facility.

(6) The agreements portion (section VI of the sample format) is reviewed and signed by the individual, if appropriate, LAR, and an authorized representative of the state MR facility, MRA(s), and provider, and contains the typed names and titles of the signatories, and the date the plan is approved and signed. This portion includes, at a minimum, the following terms:

(A) the provider agrees that the community physician, assigned direct care staff, provider consultants, and other service providers have been informed of all the information contained in the community living/discharge plan;

(B) the provider agrees that the MRA(s), as the agent of the department, shall have access to the individual, the living setting, and necessary records;

(C) the provider agrees to notify the MRA(s) and the individual's LAR of any conditions which may indicate the living arrangement is in jeopardy and to give the MRA(s) and LAR written notice of intent to discharge the individual at least 30 calendar days before the planned day of discharge;

(D) the MRA(s) agrees that the provider and a designated state MR facility staff person will receive accurate and timely written reports, including a list of specific findings for any significant monitoring activity described in paragraph (5) of this subsection;

(E) the state MR facility and MRA(s) agree that the individual and LAR have had an opportunity to participate in the development of the community living/discharge plan; and

(F) the individual, LAR, state MR facility, MRA(s), and provider agree to make a good faith effort to resolve issues that may be identified by any of these parties until the community living/discharge plan culminates in the individual's discharge from the state MR facility.

(7) The discharge plans/activities (section VI of the sample format) are summarized by the state MR facility upon completion of the terms and conditions specified in the community living monitoring activities portion of the plan and will include:

(A) a summary of the outcomes and status of the alternative living arrangement;

(B) a resolution of any issues that occurred during the transition process; and

(C) date of discharge from the state MR facility.

(d) If the provider does not actively participate in the development of the community living/discharge plan before the individual is moved from the state MR facility to the alternative living arrangement, the IDT will inform the individual or LAR of the circumstances.

(1) The individual with the ability to provide legally adequate consent or the LAR has the option of:

(A) continuing with the move after resolution of the problems;

(B) continuing with the move without resolution of the problems with the understanding that the individual will be discharged from the state MR facility 30 calendar days after the move; or

(C) selecting another provider.

(2) If the individual does not have the ability to provide legally adequate consent and does not have an LAR, then the individual will remain in the state MR facility until:

(A) the problems are resolved (in a reasonable period of time as determined by the IDT) and community living/discharge plan is completed satisfactorily; or

(B) another provider is selected by the IDT because the problems cannot be resolved.

(e) In the event that issues cannot be resolved during the development or implementation of the community living/discharge plan, the issue may be forwarded to the commissioner or designee for review and recommended action.

(f) If, following the individual's move to the community, the provider doesn't comply with the provisions of the community living/discharge plan and the MRA(s) has exhausted all options to resolve the conflict, the IDT at the state MR facility will be reconvened.

(1) If the IDT determines that the individual with the ability to provide legally adequate consent or the LAR wants to continue with the alternative living arrangement the IDT will recommend to the head of the state MR facility that the individual be discharged from the state MR facility within 30 calendar days of the IDT meeting and that monitoring activities required by the community living/discharge plan be discontinued.

(2) If the IDT determines that the individual with the ability to provide legally adequate consent or the LAR is not satisfied with the alternative living arrangement and the issues are not resolved, the individual or LAR may request that the IDT reconvene to address the issues causing the dissatisfaction and to assist the individual or LAR to find another alternative living arrangement.

(3) If the individual does not have the ability to provide legally adequate consent and does not have an LAR, the IDT will research the situation and will refer the issue to the commissioner or designee for review and recommended action. If it is determined that the individual should be removed from the provider's services, the IDT and MRA(s) will work cooperatively to find alternative services.

(g) If during the term of this plan representatives of the department and staff of the MRA have evidence to believe that an individual is in an unsafe environment or that the individual's needs are not being met, they will immediately notify:

(1) the appropriate licensing or regulatory agency;

(2) the LAR; and

(3) the state MR facility from which the individual moved.

(h) If the necessity for an out-of-state transfer is indicated, the state MR facility will contact the department's Interstate Compact coordinator in Central Office.

Comments

Source Note: The provisions of this §2.278 adopted to be effective January 1, 2001, 25 TexReg 12746; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

Division 5

§2.279: Discharge from a State Mr Facility of an Individual Who Moves to an Alternative Living Arrangement

(a) An individual who moves from a state MR facility into an alternative living arrangement may be discharged from the state MR facility of record pursuant to THSC, Chapter 594, if the state MR facility determines and documents in the individual's Community Living/Discharge plan or other record that:

(1) the individual's needs are better served in a setting other than a state MR facility; and

(2) the individual is being successfully treated and habilitated in the current community living arrangement.

(b) Upon receipt of a recommendation from an MRA as referenced in §412.278(c)(5)(C) of this title (relating to Community Living/Discharge Plan for Alternative Living Arrangements), the state MR facility may determine that the criteria described in subsection (a) of this section have been met and, if so, will:

(1) document in the individual's record the receipt of the notification; and

(2) send notice of the intent to discharge in accordance with §414.155 of this title (relating to Notice).

(c) If the individual was committed under the PMRA, the committing court will be notified of the discharge from the state MR facility as required in THSC, §594.018.

(d) As a courtesy, the facility sends written notice of the intent to discharge to the actively involved family member or friend of the individual who does not have an LAR, unless the individual has requested that those persons not be notified of information regarding the individual.

(e) If the individual or the LAR, or another person as the representative for the individual or LAR, requests an administrative hearing before the proposed date of the discharge, the facility of record will arrange for the hearing following the procedures described in Chapter 414, Subchapter D of this title (relating to Administrative Hearings Under the PMRA).

(f) If the individual or LAR does not request an administrative hearing to contest the proposed discharge within the time period allowed by §414.156 of this title (relating to Request for an Administrative Hearing), the state MR facility:

(1) initiates the discharge entry into CARE;

(2) notifies the individual, LAR, if any, or actively involved family member or friend in writing that discharge has been completed;

(3) notifies the committing court, as required by THSC, §594.018, of the discharge if the individual was committed under THSC, Chapter 593; and

(4) sends written notification to the designated MRA and provider that discharge has been completed.

Comments

Source Note: The provisions of this §2.279 adopted to be effective January 1, 2001, 25 TexReg 12746; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§2.280: Administrative Discharges Initiated by a State Mr Facility

(a) A state MR facility may discharge an individual who has been admitted or committed to a state MR facility if:

(1) the individual is determined as a result of a DMR conducted in accordance with §415.155 of this title (relating to Determination of Mental Retardation (DMR)) to not have mental retardation;

(2) the individual has been listed as an unauthorized departure for at least 30 calendar days and attempts to locate the individual have been unsuccessful; or

(3) the individual with the ability to provide legally adequate consent or with an LAR moves from the state MR facility against staff advice.

(b) The state MR facility will notify the individual or LAR of a proposed discharge at least 31 calendar days prior to the date of the proposed discharge.

(1) If the proposed discharge is because the individual is determined not to have mental retardation, as described in subsection (a)(1) of this section, the notice will specify that the individual or LAR has the right to request an administrative hearing to contest the findings of the DMR in accordance with §414.155 of this title (relating to Notice ).

(2) If the proposed discharge is because the individual has been listed as an unauthorized departure as described in subsection (a)(2) of this section or individual is leaving the state MR Facility against staff advice as described in (a)(3) of this section, the notice will specify that the individual or LAR has the right to request an administrative hearing to contest the proposed discharge in accordance with §414.155 of this title (relating to Notice).

Comments

Source Note: The provisions of this §2.280 adopted to be effective January 1, 2001, 25 TexReg 12746; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§2.281: Administrative Discharges from a Voluntary Admission Initiated by an Individual or Lar

A state MR facility must discharge an individual who has been voluntarily admitted to a state MR facility no later than 96 hours after the time the individual or LAR requests discharge of the individual unless:

(1) the head of the MR facility determines that the individual's condition or other circumstances are such that the individual cannot be discharged without endangering the safety of the individual or the general public;

(2) the head of the facility files an application for judicial commitment under THSC, §593.041; and

(3) a court issues an order of protective custody under THSC, §593.044 pending a final determination on the application for judicial commitment.

Comments

Source Note: The provisions of this §2.281 adopted to be effective January 1, 2001, 25 TexReg 12746; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

Division 6

§2.282: Review by Local Mra of Individual in a Community Living Arrangement

(a) Upon written notification to MRAs from the department identifying individuals who moved from a state MR facility into an alternative living arrangement prior to September 1, 1997, a planning team organized by the designated MRA must review each identified individual's:

(1) treatment and habilitation in the alternative living arrangement; and

(2) need, if any, for monitoring.

(b) The designated MRA must notify the individual with the ability to provide legally adequate consent or LAR, if any, in writing of the intent to conduct the review and request suggestions of convenient times and locations. If the individual does not have the ability to provide legally adequate consent and does not have an LAR, notice of the intent to conduct the review with a request for convenient times and locations must be sent to an actively involved family member or friend.

(1) The notice must explain the purpose of the review and state that the review may result in the discharge of the individual from the state MR facility designated in CARE for that individual.

(2) Copies of the notice must be sent to the individual's provider and the state MR facility with a request for suggestions of convenient times and locations for the review.

(c) The review must be scheduled at a time and location mutually agreeable to all members of the planning team and conducted using the Guidelines for Determining Level of Monitoring by Designated MRA, copies of which are available from the Office of State Mental Retardation Facilities, TDMHMR. P.O. Box 12668, Austin, Texas 78711-2668. The review must address:

(1) the level of satisfaction in the alternative living arrangement on the part of the individual, LAR, or actively involved family member or friend;

(2) behavioral issues;

(3) employment/vocation issues;

(4) medical issues;

(5) provider issues; and

(6) any other issues which are of concern to any member of the planning team.

(d) If a need for monitoring activities is identified by the planning team during the review, the designated MRA must send a letter to all members of the planning team that describes:

(1) the type of monitoring activities recommended by the planning team;

(2) the persons responsible for conducting the monitoring activities;

(3) a timeline for accomplishing the monitoring activities; and

(4) a tentative date for the planning team to reconvene and review whether the individual is being successfully treated and habilitated in that alternative living arrangement and the individual's need, if any, for continued monitoring.

(e) If the planning team determines that monitoring activities for the individual are not needed, the designated MRA must notify the state MR facility, in writing, with copies to all members of the planning team.

(f) An individual may be discharged from the state MR facility designated in CARE pursuant to THSC, Chapter 594, if the state MR facility determines that:

(1) the individual's needs are better served in a setting other than a state MR facility; and

(2) the individual is being successfully treated and habilitated in the current alternative living arrangement.

(g) Upon receipt of a notification from an MRA as described in subsection (e) of this section, the state MR facility may conclude that the criteria described in subsection (f) of this section have been met and, if so, will:

(1) document the receipt of the notification and the findings of the planning team;

(2) send notice of the intent to discharge in accordance with §414.155 of this title (relating to Notice); and

(3) if the individual was committed under the THSC, Chapter 593, Subchapter C, notify the committing court of the discharge from the state MR facility as required in THSC, §594.018.

(h) As a courtesy, the state MR facility will send written notice of the intent to discharge to the actively involved family member or friend of the individual who does not have an LAR, unless the individual has requested that those persons not be notified of information regarding the individual.

(i) If the individual or LAR, or another person as the representative for the individual or LAR, requests an administrative hearing before the proposed date of the discharge, the state MR facility will arrange for the hearing following the policies and procedures described in Chapter 414, Subchapter D of this title (relating to Administrative Hearings Under the PMRA ).

(j) If the individual or LAR does not request an administrative hearing to contest the proposed discharge within the time period allowed by §414.156 of this title (relating to Request for an Administrative Hearing) the state MR facility will:

(1) initiate the discharge entry into CARE;

(2) notify the individual, LAR, if any, or actively involved family member or friend in writing that discharge has been completed;

(3) notify the committing court, as required by THSC, §594.018, of the discharge if the individual was committed under THSC, Chapter 593; and

(4) send written notification to the designated MRA and provider that discharge has been completed.

Comments

Source Note: The provisions of this §2.282 adopted to be effective January 1, 2001, 25 TexReg 12746; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

Division 7

§2.283: Mra and State Mr Facility Responsibilities

(a) MRA responsibilities.

(1) Except for a request for admission for respite care, when admission to a state MR facility is requested for an individual under 22 years of age, the designated MRA must:

(A) before the individual is admitted to the facility, inform the LAR:

(i) of the benefits of living in a family or community setting;

(ii) that the individual's stay in the facility is considered temporary; and

(iii) that an ongoing permanency planning process is required;

(B) take or ensure that the actions described in §9.244(f) of this title (relating to Applicant Enrollment in the ICF/MR Program) are taken to conduct permanency planning; and

(C) take the actions described in §9.244(g)-(i) of this title regarding a volunteer advocate.

(2) An MRA does not have to comply with paragraph (1)(A) of this subsection if the individual has been committed to a state MR facility under Chapter 46B, Code of Criminal Procedure, or Chapter 55, Family Code.

(3) For an individual under 22 years of age who resides in a state MR facility, the designated MRA must conduct a permanency planning review in accordance with §9.250 of this title (relating to Permanency Planning Reviews).

(b) State MR facility responsibilities.

(1) Upon the admission of an individual under 22 years of age to a state MR facility, a state MR facility:

(A) requests from and encourages the LAR to provide the information described in §9.222(e) of this title (relating to Permanency Planning and LAR Participation for Individuals Under 22 Years of Age);

(B) makes notifications as described in §9.222(c) and (d) of this title; and

(C) incorporates permanency planning as an integral part of the individual's initial individual program plan (IPP) and identifies information in the IPP as described in §9.222(a) of this title.

(2) For an individual under 22 years of age who resides in a state MR facility, a state MR facility:

(A) incorporates permanency planning as an integral part of the individual's IPP and identifies information in the IPP as described in §9.222(a) of this title;

(B) takes the actions described in §9.222(b) of this title to assist the individual's designated MRA in conducting permanency planning;

(C) requests from and encourages the LAR to provide the information described in §9.222(e) of this title;

(D) provides notice to the individual and LAR of a meeting to conduct the annual review of the individual's IPP as described in §9.222(g) of this title;

(E) attempts to notify the LAR of an emergency situation as described in §9.222(h) of this title;

(F) attempts to locate the LAR as described in §9.222(i) of this title, if the LAR does not respond to a notification by the state MR facility; and

(G) notifies DADS as described in §9.222(j) of this title if the LAR cannot be located.

(3) A state MR facility makes reasonable accommodations to promote the participation of the LAR as described in §9.222(f) of this title.

(4) A state MR facility documents compliance with the requirements of this subsection in the individual's record.

(c) DADS referral. If, within one year of the date DADS receives the notification described in subsection (b)(2)(G) of this section, DADS is unable to locate the LAR, DADS refers the case to:

(1) the Child Protective Services Division of the Department of Family and Protective Services if the individual is under 18 years of age; or

(2) the Adult Protective Services Division of the Department of Family and Protective Services if the individual is 18-22 years of age.

Comments

Source Note: The provisions of this §2.283 adopted to be effective September 1, 2006, 31 TexReg 6783

Subchapter G

§2.301: Purpose

The purpose of this subchapter is to describe the role and responsibilities of an MRA, including those responsibilities described in THSC, §533.0355(b).

Comments

Source Note: The provisions of this §2.301 adopted to be effective December 1, 2008, 33 TexReg 9512

§2.302: Application

This subchapter applies to an MRA.

Comments

Source Note: The provisions of this §2.302 adopted to be effective December 1, 2008, 33 TexReg 9512

§2.303: Definitions

The following terms and phrases, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:

(1) Actively involved--Significant, ongoing, and supportive involvement with an individual by a person, as determined by the MRA, based on the person's:

(A) interactions with the individual;

(B) availability to the individual for assistance or support when needed; and

(C) knowledge of, sensitivity to, and advocacy for the individual's needs, preferences, values, and beliefs.

(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) Behavioral emergency--A situation in which severely aggressive, destructive, violent, or self-injurious behavior exhibited by an individual:

(A) poses a substantial risk of imminent probable death of, or substantial bodily harm to, the individual or others;

(B) has not abated in response to attempted preventive de-escalatory or redirection techniques;

(C) is not addressed in a written behavioral support plan; and

(D) does not occur during a medical or dental procedure.

(4) Behavioral support--Specialized interventions that assist an individual with increasing adaptive behaviors to replace or modify maladaptive or socially unacceptable behaviors that prevent or interfere with the individual's inclusion in home and family life or community life.

(5) Capacity--A person's ability to:

(A) understand the information provided to the person regarding a proposed psychoactive medication or behavioral support plan as described in §2.313(d)(1) or (e)(3) of this subchapter (relating to Health, Safety, and Rights); and

(B) make a decision whether to take the proposed medication or accept the behavioral support plan.

(6) CARE--The Client Assignment and Registration System database.

(7) CRCG--Community resource coordination group. A local interagency group composed of public and private agencies, organizations, and families that develops a coordinated plan of services and supports for an individual with complex needs. The group's role and responsibilities are described in the Memorandum of Understanding on Coordinated Services to Persons Needing Services from More than One Agency, available at www.dads.state.tx.us.

(8) DADS--The Department of Aging and Disability Services.

(9) Designated MRA--The MRA assigned to an individual in CARE.

(10) Developmental period--Birth through 17 years of age.

(11) General revenue services--Non-residential mental retardation services funded by general revenue through the performance contract, including:

(A) eligibility determinations;

(B) service coordination not funded by Medicaid Targeted Case Management; and

(C) respite.

(12) HCS Program--The Home and Community-based Services Program. A program operated by DADS and approved by the Centers for Medicare and Medicaid Services in accordance with §1915(c) of the Social Security Act that provides community-based services and supports to eligible individuals who live in their own homes or family homes or other residences permitted under DADS rules related to the HCS Program.

(13) ICF/MR Program--The Intermediate Care Facility for Persons with Mental Retardation Program. A program operated by DADS in accordance with the Social Security Act that provides Medicaid-funded residential services to individuals with mental retardation or a related condition.

(14) Individual--A person seeking or receiving services and supports from an MRA.

(15) Informed consent--Consent given by an individual or the individual's LAR if the person giving the consent:

(A) is:

(i) 18 years of age or older; or

(ii) younger than 18 years of age and is or has been married or had the disabilities of minority removed for general purposes by court order as described in the Texas Family Code, Chapter 31;

(B) has not been determined by a court to lack capacity to make decisions with regard to the matter for which consent is being sought;

(C) has been provided the information described in §2.313(d)(1) or (e)(3) of this subchapter;

(D) has the capacity to give consent, as determined by the prescribing physician or the professional who develops the behavioral support plan, as applicable; and

(E) gives the consent voluntarily, free from coercion or undue influence.

(16) LAR--legally authorized representative. A person authorized by law to act on behalf of an individual with regard to a matter described in this subchapter, and who may be a parent, guardian, or managing conservator of a minor, or the guardian of an adult.

(17) Local planning--A broad-based community participatory process that identifies community values, service needs, and service priorities for individuals in the mental retardation priority population within a local service area and which guides resource development and allocation and results in a local plan that identifies goals and establishes strategies for accomplishment.

(18) Local service area--A geographic area composed of one or more Texas counties as identified in the performance contract to be served by an MRA.

(19) Medication class--A group of medications with similar actions and indications for use.

(20) Mental retardation--Consistent with THSC, §591.003, significantly subaverage general intellectual functioning existing concurrently with deficits in adaptive behavior and manifested during the developmental period.

(21) MRA--mental retardation authority. As defined in THSC, §531.002, an entity designated in accordance with the THSC, §533.035(a), to which the Health and Human Services Commission executive commissioner delegates the state's authority and responsibility within a specified region for planning, policy development, coordination, including coordination with criminal justice entities, and resource development and allocation and for supervising and ensuring the provision of mental retardation services to persons with mental retardation in the most appropriate and available setting to meet individual needs in one or more local service areas.

(22) Mental retardation priority population--Those persons who meet one or more of the following descriptions:

(A) have mental retardation;

(B) have a pervasive developmental disorder;

(C) have a related condition, are eligible for, and are enrolling in the ICF/MR Program, the HCS Program, or the TxHmL Program;

(D) are nursing facility residents who are eligible for specialized services for mental retardation or a related condition pursuant to §1919(e)(7) of the Social Security Act; or

(E) are children eligible for early childhood intervention services provided in accordance with Chapter 108 of this title (relating to Division for Early Childhood Intervention Services).

(23) Performance contract--A written agreement between DADS and an MRA as required by THSC, §534.054, for the provision of one or more functions as described in THSC, §533.035(a), and for the provision of general revenue services. The performance contract allocates general revenue funds for the MRA to fulfill its role and responsibilities as an MRA.

(24) Permanency planning--A philosophy and planning process that focuses on the outcome of family support for an individual under 22 years of age by facilitating a permanent living arrangement in which the primary feature is an enduring and nurturing parental relationship.

(25) Person-directed planning--A process that empowers the individual (and the LAR on the individual's behalf) to direct the development of a plan for services and supports that meet the individual's outcomes. The process:

(A) identifies existing services and supports necessary to achieve the individual's outcomes;

(B) identifies natural supports available to the individual and negotiates needed service system supports;

(C) occurs with the support of a group of people chosen by the individual (and the LAR on the individual's behalf); and

(D) accommodates the individual's style of interaction and preferences regarding time and setting.

(26) Planning team--Persons convened by an individual's MRA to develop a plan of services and supports for an individual. The team includes:

(A) the individual;

(B) if applicable, the LAR or actively involved person:

(C) the staff member assigned to the individual by the MRA; and

(D) other persons chosen by the individual, LAR, or actively involved person.

(27) Psychoactive medication--A medication for which the primary intended therapeutic effect is to treat or ameliorate the signs or symptoms of mental disorder, or to modify mood, affect, perception, or behavior.

(28) Restraint--A manual method, except for physical guidance or prompting of brief duration, or a mechanical device to restrict:

(A) the free movement or normal functioning of all or a portion of an individual's body; or

(B) normal access by an individual to a portion of the individual's body.

(29) Rights protection officer--As referenced in §4.113 of this title (relating to Rights Protection Officer at a State MR Facility or MRA), the staff member of an MRA whose primary duty is to advocate for the rights of individuals served by that MRA and to assist LARs in advocating for the rights of individuals.

(30) Safety net functions--As referenced in THSC, §533.0355(a)(6), functions performed by an MRA with available resources to respond to an individual in the mental retardation priority population who has an intensive need or who is in crisis to protect the individual's health and safety.

(31) Service coordination--A service provided by an MRA as defined in §2.553 of this chapter (relating to Definitions) contained in Subchapter L (relating to Service Coordination for Individuals with Mental Retardation).

(32) Service coordinator--An MRA employee who:

(A) meets the qualifications and has received training set forth in §2.559 of this chapter (relating to Minimum Qualifications) and §2.560 of this chapter (relating to Staff Training) contained in Subchapter L (relating to Service Coordination for Individuals with Mental Retardation); and

(B) performs service coordination activities.

(33) Services and supports--General revenue services and other publicly funded mental retardation services.

(34) Staff member--Personnel of an MRA including a full-time and part-time employee and a contractor.

(35) State MR facility--A state school or a state center with a mental retardation residential component that is operated by DADS.

(36) Subaverage general intellectual functioning--Consistent with THSC, §591.003, measured intelligence on standardized general intelligence tests of two or more standard deviations (not including standard error of measurement adjustments) below the age-group mean for the tests used.

(37) THSC--The Texas Health and Safety Code.

(38) TxHmL Program--The Texas Home Living Program. A program operated by DADS and approved by the Centers for Medicare and Medicaid Services in accordance with §1915(c) of the Social Security Act, that provides community-based services and supports to eligible individuals who live in their own homes or in their family homes.

Comments

Source Note: The provisions of this §2.303 adopted to be effective December 1, 2008, 33 TexReg 9512

§2.305: Mra's Role and Responsibilities

(a) An MRA's role is to serve as the single point of access to services and supports for the residents within the MRA's local service area.

(b) As the single point of access, an MRA's responsibilities include:

(1) providing information about services and supports to an individual and LAR or actively involved person;

(2) ensuring an individual's access into services and supports by:

(A) conducting intake and eligibility activities for an individual seeking services and supports; and

(B) enrolling or admitting an eligible individual into services and supports;

(3) performing safety net functions;

(4) ensuring the provision and oversight of general revenue services by:

(A) developing and managing a network of general revenue services providers; and

(B) establishing processes to monitor the performance of general revenue services providers;

(5) conducting service coordination;

(6) conducting utilization management;

(7) conducting planning for the local service area, including ensuring involvement by a local advisory committee and other stakeholders;

(8) conducting permanency planning for certain individuals under 22 years of age; and

(9) protecting the rights of an individual.

(c) This subchapter elaborates on the responsibilities listed in subsection (b) of this section and describes other responsibilities of an MRA.

Comments

Source Note: The provisions of this §2.305 adopted to be effective December 1, 2008, 33 TexReg 9512

§2.307: Access, Screening, Intake, Service Coordination, Enrollment, State Mr Facility Admission, and Safety Net Functions

(a) Access. An MRA must have a place of business reasonably accessible to the residents of the local service area where an individual can learn about all services and supports for which the individual may be eligible. The MRA must assist an individual for whom it is the designated MRA with accessing such services and supports.

(b) Screening. An MRA must develop policies and procedures related to screening an individual seeking services and supports that address:

(1) providing an explanation of services and supports to the individual and LAR or actively involved person and family member using DADS-approved documents;

(2) gathering and documenting information to determine a need for services and supports;

(3) triaging immediate needs to be responsive to a crisis situation;

(4) determining whether a request can be met with resources at the MRA or whether the individual will be directed to alternate resources in the community;

(5) if the individual is under 22 years of age and the LAR is requesting residential services, providing to the LAR an explanation of permanency planning;

(6) assisting the individual or LAR in identifying services and supports preferences and documenting those preferences; and

(7) registering the individual's name on the appropriate interest lists.

(c) Intake. An MRA must develop policies and procedures related to intake that address:

(1) determining if an individual seeking services and supports is a member of the mental retardation priority population in accordance with Chapter 5, Subchapter D, of this title (relating to Diagnostic Eligibility for Services and Supports--Mental Retardation Priority Population and Related Conditions), and eligible for general revenue services;

(2) determining an individual's eligibility for service coordination in accordance with §2.554 of this chapter (relating to Eligibility) and §2.555 of this chapter (relating to Assessing an Individual's Need for Service Coordination) contained in Subchapter L (relating to Service Coordination for Individuals with Mental Retardation), and documenting a description of the individual's preferences and needs using a person-directed planning process that is consistent with DADS' Person Directed Planning and Family Directed Planning Guidelines for Individuals with Mental Retardation;

(3) conducting the financial assessment as required by Subchapter C of this chapter (relating to Charges for Community Services) and assisting an individual with applying for Medicaid benefits, Supplemental Security Income, or Social Security Disability Income, if appropriate;

(4) providing an explanation of rights of individuals with mental retardation in accordance with Chapter 4, Subchapter C of this title (relating to Rights and Protection of Individuals Receiving Mental Retardation Services); and

(5) providing information to the individual and LAR about the MRA's complaint, notification, and appeal processes in accordance with Subchapter A of this chapter (relating to Mental Retardation Authority Notification and Appeal).

(d) Service coordination.

(1) An MRA must offer an individual service coordination if the individual:

(A) is eligible for Medicaid and service coordination; or

(B) is not eligible for Medicaid, but is eligible for service coordination and will be enrolled in general revenue services other than service coordination.

(2) An MRA must designate a staff member to authorize and monitor an individual's service need in accordance with the performance contract if the individual:

(A) is not eligible for service coordination; and

(B) will be enrolled in a general revenue service other than service coordination.

(e) Enrollment into general revenue services.

(1) An MRA must develop policies and procedures related to enrollment into general revenue services that address:

(A) the development of a written plan of services and supports based on the individual's preferences and needs that includes:

(i) current services and supports, including existing natural supports;

(ii) outcomes to be achieved by the individual and the general revenue services to be provided to the individual;

(iii) any assessment to be conducted after enrollment;

(iv) the reason for each general revenue service to be provided; and

(v) the amount and duration of each general revenue service to be provided; and

(B) the authorization for the provision of the general revenue services identified in the plan.

(2) Except for the provision of respite in an emergency, the MRA may not provide general revenue services unless authorized in accordance with the policies and procedures required by paragraph (1) of this subsection.

(f) Enrollment in the ICF/MR, HCS, and TxHmL programs.

(1) An MRA must enroll an individual in the ICF/MR, HCS, or TxHmL programs, in accordance with the performance contract and DADS rules relating to those programs.

(2) An MRA must conduct permanency planning for an individual under 22 years of age who is enrolling in an HCS Program residential setting or an ICF/MR in accordance with the performance contract and DADS rules relating to those programs.

(g) Commitment or admission to a state MR facility.

(1) An MRA must perform its responsibilities related to an individual's commitment or admission to a state MR facility in accordance with Subchapter F of this chapter (relating to Continuity of Services--State Mental Retardation Facilities).

(2) An MRA must conduct permanency planning for an individual under 22 years of age who is committed to a state MR facility in accordance with §2.283 of this chapter (relating to MRA and State MR Facility Responsibilities) contained in Subchapter F (relating to Continuity of Services--State Mental Retardation Facilities), and the performance contract.

(h) Safety net functions. An MRA must develop policies and procedures related to safety net functions that reflect the priorities of its local planning efforts and are responsive to the needs of its local service area.

Comments

Source Note: The provisions of this §2.307 adopted to be effective December 1, 2008, 33 TexReg 9512

§2.309: Mra Responsibilities for Institutional Residents

(a) Community living options information process at state MR facilities. An MRA must implement the community living options information process for residents 22 years of age and older at state MR facilities as required by the performance contract and DADS rules.

(b) Continuity of services. An MRA must comply with Subchapter F (relating to Continuity of Services--State Mental Retardation Services), Division 4 of this chapter (relating to Moving From a State MR Facility to an Alternative Living Arrangement), when a state MR facility interdisciplinary team recommends an alternative living arrangement for an individual residing in the facility.

(c) Permanency planning.

(1) An MRA must conduct permanency planning for an individual under 22 years of age who is:

(A) residing in a nursing facility;

(B) enrolled in the ICF/MR Program, including a state MR facility; or

(C) receiving residential support or supervised living from the HCS Program.

(2) An MRA must conduct permanency planning in accordance with the performance contract and the following rules:

(A) Section 2.283 of this chapter (relating to MRA and State MR Facility Responsibilities) contained in Subchapter F (relating to Continuity of Services--State Mental Retardation Facilities);

(B) Section 9.167 of this title (relating to Permanency Planning Reviews) contained in Chapter 9, Subchapter D (relating to Home and Community-based Services (HCS) Program); and

(C) Section 9.250 of this title (relating to Permanency Planning Reviews) contained in Chapter 9, Subchapter E (relating to ICF/MR Programs--Contracting).

Comments

Source Note: The provisions of this §2.309 adopted to be effective December 1, 2008, 33 TexReg 9512

§2.311: Provision and Oversight of General Revenue Services

(a) An MRA is responsible for ensuring the provision of and overseeing an array of general revenue services described in the performance contract that is responsive to the needs of its local service area.

(b) An MRA must have policies and procedures that ensure on-going assessments are conducted for an individual, and general revenue services in the individual's plan of services and supports are coordinated and monitored in accordance with §2.556 of this chapter (relating to MRA's Responsibilities) and §2.561 of this chapter (relating to Documentation of Service Coordination) contained in Subchapter L (relating to Service Coordination for Individuals with Mental Retardation).

(c) An MRA must have policies and procedures related to respite (in-home, facility-based, or both) funded by general revenue that:

(1) encourage the use of existing local providers of respite;

(2) encourage participation by the individual and LAR or actively involved person in the choice of a qualified provider of in-home respite;

(3) describe how in-home respite providers are selected and trained;

(4) describe how emergency backup for in-home respite providers is provided;

(5) address admission procedures; and

(6) require development of a respite plan prior to the delivery of respite except in an emergency.

Comments

Source Note: The provisions of this §2.311 adopted to be effective December 1, 2008, 33 TexReg 9512

§2.313: Health, Safety, and Rights

(a) Protection of rights. An MRA must develop policies and procedures that protect the rights of individuals and are consistent with Chapter 4, Subchapter C of this title (relating to Rights of Individuals with Mental Retardation).

(b) Restrictions and limitations placed on an individual.

(1) An MRA:

(A) may implement behavioral support that involves restrictions or limitations placed on an individual only in accordance with paragraph (2) of this subsection and subsection (e) of this section;

(B) must comply with subsection (f) of this section when using restraint, and for restraint used under subsection (f)(2)(A) or (B) of this section, also comply with paragraph (2) of this subsection; and

(C) may place another type of restriction or limitation on an individual only if:

(i) the restriction or limitation protects the individual's health or safety that is jeopardized by an identified behavior; and

(ii) the MRA complies with paragraphs (2) and (3) of this subsection.

(2) An MRA must ensure that any restriction or limitation placed on an individual, except for a restraint used under subsection (f)(2)(C) of this section, is reviewed and approved by the rights protection officer and, at the discretion of the MRA, other appropriate staff members who are not on the individual's planning team, before the restriction or limitation is implemented. If a restriction or limitation is implemented in an emergency, including a behavioral emergency, the MRA must notify the rights protection officer as soon as possible after implementation.

(3) If a restriction or limitation not required to be in a behavioral support plan is approved in accordance with paragraph (2) of this subsection, the individual's plan of services and supports must:

(A) include the restriction or limitation;

(B) identify the circumstances or criteria to be met that will result in the removal of the restriction or limitation; and

(C) require the planning team to review the restriction or limitation, as necessary but at least annually, to determine appropriateness.

(c) Medication practices. An MRA's policies and procedures relating to medication practices must:

(1) be consistent with accepted principles of practice and applicable state laws and regulations to ensure medication is administered safely and appropriately;

(2) be approved in writing by a physician or registered nurse; and

(3) address:

(A) proper handling, storage, and disposal of medications;

(B) proper use of telephone orders if the MRA allows for telephone orders;

(C) administration of medications by staff members licensed or authorized to administer medications if the MRA allows for administration of medications;

(D) supervision of self-administration of medication by an individual; and

(E) documentation of follow-up and corrective action when medication errors occur.

(d) Informed consent for psychoactive medication. Except as provided by paragraph (2) of this subsection, a physician employed or contracted by an MRA may prescribe psychoactive medication for an individual only if the individual or LAR has given written informed consent for the medication.

(1) In seeking informed consent for a psychoactive medication, the prescribing physician must provide the individual and LAR:

(A) an explanation of the medication and its purposes;

(B) the expected beneficial effects, side effects, and risks of the medication;

(C) the probable consequences of not taking the medication;

(D) the existence and value of alternative forms of treatment, if any, and why the physician does not recommend the alternative treatment;

(E) instruction that the individual or LAR may withdraw consent at any time without negative repercussions by a staff member or prejudicing the future provision of services;

(F) an opportunity to ask questions concerning the medication and its use; and

(G) the time period, not to exceed one year, for which the individual's or LAR's consent will be effective.

(2) If an individual or LAR gives informed consent for a psychoactive medication but is physically unable to document the consent in writing, the prescribing physician must document in the individual's record that informed consent was given and the reason such consent was not documented by the individual or LAR.

(3) Prior to changing an individual's medication regimen that would result in a change of medication class or in a significant change in the benefits, side effects, or risks to the individual, the physician must obtain written informed consent from the individual or LAR in accordance with this subsection.

(e) Behavioral support.

(1) An MRA's policies and procedures related to behavioral support must include:

(A) the accepted standards of professional practice for the use of behavioral support, including the use of interventions during a behavioral emergency; and

(B) a requirement that only the following professionals may develop a behavioral support plan:

(i) a licensed psychologist licensed by the Texas State Board of Examiners of Psychologists or a qualified person under the supervision of a licensed psychologist;

(ii) a psychological associate licensed by the Texas State Board of Examiners of Psychologists or a qualified person under the supervision of a licensed psychological associate;

(iii) a behavior analyst certified by the Behavior Analyst Certification Board, Inc. or a qualified person under the supervision of a certified behavior analyst; or

(iv) a DADS-certified psychologist certified in accordance with §5.161 of this title (relating to TDMHMR-Certified Psychologist).

(2) Except as provided by paragraph (4) of this subsection, behavioral support interventions that involve restrictions or limitations placed on an individual or the use of intrusive techniques may only be provided in accordance with an approved written behavioral support plan. The behavioral support plan must:

(A) be based on:

(i) a functional assessment of the individual's behavior targeted by the plan; and

(ii) input from the individual's planning team and other professionals, as appropriate;

(B) describe the interventions to be used that are appropriate to the severity of the behavior targeted by the plan;

(C) be consistent with the outcomes identified in the individual's plan of services and supports;

(D) be approved by the individual's planning team prior to implementation;

(E) be accepted by the individual or LAR as evidenced by the individual's or LAR's written informed consent;

(F) provide for the collection of behavioral data concerning the targeted behavior; and

(G) require the professional who developed the plan to:

(i) educate the individual and LAR and other persons identified by the planning team (for example, family members and providers) regarding the purpose, objectives, methods and documentation of the behavioral support plan and subsequent revisions of the plan;

(ii) monitor and evaluate the success of the behavioral support plan implementation as required by the plan;

(iii) review, with other members of the individual's planning team, the behavioral support plan at least annually, or more often as indicated, to determine the effectiveness of the plan; and

(iv) revise the plan as necessary, based on documented outcomes of the plan's implementation.

(3) In obtaining informed consent as required by paragraph (2)(E) of this subsection, the professional who developed that plan must provide the individual or LAR:

(A) a description of the interventions to be used in the behavioral support plan;

(B) the expected beneficial effects and risks of the interventions;

(C) the probable consequences of not using the interventions;

(D) the existence and value of alternative interventions, if any, and why the professional does not recommend the alternative interventions;

(E) oral and written notification that the individual or LAR may withdraw consent for the behavioral support plan at any time without negative repercussions by a staff member or prejudicing the future provision of services;

(F) an opportunity to ask questions concerning the behavioral support plan; and

(G) the time period, not to exceed one year, for which the individual's or LAR's consent will be effective.

(4) An MRA may implement behavioral support that involves restrictions or limitations placed on an individual or the use of intrusive techniques without a behavioral support plan if the support is in response to a behavioral emergency. If such behavioral support is implemented more than twice during two consecutive months, the MRA must conduct a functional assessment to determine if a behavioral support plan is needed to reduce the frequency and severity of the behaviors exhibited during the behavioral emergency.

(f) Restraint.

(1) An MRA must have and implement a curriculum that ensures staff members are trained in the prevention and management of aggressive behavior. The curriculum must be consistent with the requirements of this subsection.

(2) A staff member may use restraint only under the following circumstances:

(A) in a behavioral emergency;

(B) as part of a behavioral support plan that addresses inappropriate behavior exhibited voluntarily by an individual; or

(C) in accordance with an order for the restraint from a physician, dentist, occupational therapist, or physical therapist.

(3) A staff member is prohibited from using restraint:

(A) in a manner that:

(i) obstructs the individual's airway, including the placement of anything in, on, or over the individual's mouth or nose;

(ii) impairs the individual's breathing by putting pressure on the individual's torso; or

(iii) places the individual in a prone or supine position;

(B) for disciplinary purposes (that is, for retaliation or retribution);

(C) for the convenience of a staff member or other individuals; or

(D) as a substitute for effective treatment or habilitation.

(4) If restraint will be used as part of a behavioral support plan, the planning team must:

(A) with the involvement of a physician or registered nurse, identify and document:

(i) the individual's known physical or medical conditions that might constitute a risk to the individual during the use of restraint;

(ii) the individual's ability to communicate; and

(iii) other factors, such as the individual's:

(I) cognitive functioning level;

(II) height;

(III) weight;

(IV) emotional condition, including whether the individual has a history of having been physically or sexually abused; and

(V) age; and

(B) review and update with a physician or registered nurse, at least annually or when a condition or factor documented in accordance with paragraph (4)(A) of this subsection changes significantly.

(5) If restraint is used in a behavioral emergency more than twice during two consecutive months, the planning team must ensure a functional assessment of the individual is conducted to determine if a behavioral support plan is needed to reduce the frequency and severity of the behaviors exhibited during the behavioral emergency.

(6) If a staff member restrains an individual in accordance with paragraph (2) of this subsection, the staff member must:

(A) use the minimal amount of force or pressure that is reasonable and necessary to ensure the safety of the individual and others;

(B) safeguard the individual's dignity, privacy, and well-being; and

(C) not secure the individual to a stationary object while the individual is in a standing position.

(7) If a staff member restrains an individual in accordance with paragraph (2)(A) or (B) of this subsection, the staff member may only use a restraint hold in which the individual's limbs are held close to the body to limit or prevent movement and that is in compliance with paragraph (3)(A) of this subsection.

(8) A staff member must release an individual from restraint:

(A) as soon as the individual no longer poses a risk of imminent physical harm to the individual or others; or

(B) as soon as possible if the individual in restraint experiences a medical emergency, as indicated by the medical emergency.

(9) After restraining an individual in a behavioral emergency, a staff member must:

(A) as soon as possible but no later than one hour after the use of restraint, notify a registered nurse, licensed vocational nurse, or a professional identified in subsection (e)(1)(B) of this section of the restraint;

(B) ensure that medical services are obtained for the individual as necessary; and

(C) discuss the circumstances of the restraint with a professional identified in subsection (e)(1)(B) of this section.

Comments

Source Note: The provisions of this §2.313 adopted to be effective December 1, 2008, 33 TexReg 9512

§2.315: Mra Administrative Functions

(a) In-Home and Family Support Program--Mental Retardation. An MRA must administer the In-Home and Family Support Program--Mental Retardation in accordance with Chapter 1, Subchapter I of this title (relating to TDMHMR In-Home and Family Support Program) and the performance contract.

(b) Local planning.

(1) An MRA must conduct local planning in accordance with THSC, §533.0352, and ensure involvement of the local advisory committee and other stakeholders.

(2) An MRA must participate in the local CRCG when an individual has complex needs and requires multiagency services.

(3) An MRA must coordinate with local agencies to build an integrated service delivery system which ensures broad access to and information about community services, identifies the MRA's safety net functions, and maximizes the utilization of existing resources while avoiding duplication of effort and gaps in services.

(c) Quality management. An MRA must develop a quality management program to monitor the performance of general revenue services providers and the MRA's compliance with the performance contract.

(d) Utilization management. An MRA must have:

(1) procedures describing how it authorizes general revenue services; and

(2) methods for evaluating the effectiveness of the authorization procedures.

(e) Information systems. An MRA must have information systems that:

(1) capture valid and reliable data; and

(2) accurately report required data to funding sources (for example, the Medicaid administration contractor, DADS, and other state and local agencies).

(f) Network management. An MRA must develop and manage a network of qualified providers that offer the array of general revenue services described in the performance contract.

(1) If the MRA is a provider of general revenue services, the MRA must have written procedures describing the qualifications and expectations of staff members.

(2) If a provider of general revenue services is a contractor of the MRA, the MRA must:

(A) ensure the contract is procured and complies with the requirements of Subchapter B of this chapter (relating to Contracts Management for Local Authorities);

(B) have a process for resolving complaints from contract providers; and

(C) provide appropriate technical assistance and training to ensure contract providers understand their contractual obligations (for example, documentation and billing).

(g) Consideration of public input, ultimate cost-benefit, and client care issues. In accordance with THSC, §533.035(c) an MRA must consider public input, ultimate cost-benefit, and client care issues to ensure individual choice and the best use of public money in:

(1) assembling a network of general revenue services providers;

(2) making recommendations relating to the most appropriate and available treatment alternatives for individuals in the need of services and supports; and

(3) procuring services for a local service area, including a request or proposal or open-enrollment procurement method.

(h) Interest list management.

(1) An MRA must contact individuals on the HCS Program interest list annually as required by and in accordance with the performance contract.

(2) An MRA must have policies and procedures for registering individuals on the MRA's interest list for general revenue services and annually contacting them in accordance with the performance contract.

(i) Qualifications and availability of staff members.

(1) Criminal history and registry clearances. An MRA must conduct criminal history and registry clearances for job and volunteer applicants in accordance with Chapter 4, Subchapter K of this title (relating to Criminal History and Registry Clearances).

(2) Availability of staff members. An MRA must ensure the continuous availability of trained and qualified staff members to ensure the provision of service coordination and general revenue services.

(3) Qualifications of a staff member who is a service coordinator. An MRA must ensure a staff member who is a service coordinator meets the qualifications set forth in §2.559 of this chapter (relating to Minimum Qualifications) contained in Subchapter L (relating to Service Coordination for Individuals with Mental Retardation).

(4) Qualifications of a staff member other than a service coordinator.

(A) An MRA must ensure that a staff member who is not a service coordinator and who directly provides general revenue services is at least 18 years of age and:

(i) has a high school diploma or a certificate recognized by a state as the equivalent of a high school diploma; or

(ii) has documentation of a proficiency evaluation of experience and competence to perform the job tasks that includes:

(I) written competency-based assessment of the ability to document service delivery and observations of an individual; and

(II) at least three personal references from persons not related by blood or marriage that indicate the ability to provide a safe, healthy environment for an individual.

(B) An MRA must:

(i) document the required education and work experience for a staff member who is not a service coordinator and who directly provides general revenue services and the supervisor of such staff member by position classification, by position category, or by individual position; and

(ii) ensure that a supervisor of a staff member who is not a service coordinator and who directly provides general revenue services has a minimum of one year experience working directly with people with mental retardation or other developmental disabilities (for example, work experience, volunteer experience, or personal experience as a family member).

(C) An MRA must ensure that a staff member who is not a service coordinator and who directly provides general revenue services and the supervisor of such staff member have required state certification or licensure.

(5) Required competencies and skills relating to health, safety, and support needs of individuals.

(A) An MRA must identify in writing the required competencies and skills for a staff member by position classification, position category, or individual position that meet the health, safety, and support needs of individuals and include:

(i) timeframes and frequency for the staff member to demonstrate competency; and

(ii) a method for measuring the competency and skills of the staff member.

(B) An MRA must maintain documentation that a staff member has demonstrated competencies and skills required by subparagraph (A) of this paragraph.

Comments

Source Note: The provisions of this §2.315 adopted to be effective December 1, 2008, 33 TexReg 9512

Subchapter L

§2.551: Purpose

This subchapter describes requirements for service coordination delivered by the mental retardation authority (MRA) to an individual in the mental retardation priority population (MR priority population) who desires services.

Comments

Source Note: The provisions of this §2.551 adopted to be effective August 31, 2004, 29 TexReg 8313; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§2.552: Application

This subchapter applies to all mental retardation authorities (MRAs).

Comments

Source Note: The provisions of this §2.552 adopted to be effective August 31, 2004, 29 TexReg 8313; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§2.553: Definitions

The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:

(1) Actively involved person--For an individual who lacks the ability to provide legally adequate consent and who does not have a legally authorized representative (LAR), a person whose significant and ongoing involvement with the individual is determined by the individual's designated MRA to be supportive of the individual based on the person's:

(A) observed interactions with the individual;

(B) knowledge of and sensitivity to the individual's preferences, values, and beliefs;

(C) availability to the individual for assistance or support; and

(D) advocacy for the individual's preferences, values, and beliefs.

(2) CARE--The department's Client Assignment and Registration System, a database into which an MRA, state MR facility, or state MH facility enters demographic and other data about an individual who has requested services and supports (or on whose behalf services and supports have been requested) or who is receiving services and supports.

(3) Department--The Department of Aging and Disability Services (DADS).

(4) Designated MRA--As indicated in CARE, the MRA responsible for assisting an individual and LAR or actively involved person to access mental retardation services and supports.

(5) Duration--The specified period of time during which service coordination is provided to an individual.

(6) Frequency--The minimum number of times during a specified period that an individual is to be contacted by a person providing service coordination based on the individual's need for contacts as determined by person-directed planning.

(7) General revenue--Funds appropriated by the Texas Legislature for use by the department.

(8) HCS Program--A Medicaid waiver program operated by the department.

(9) ICF/MR--An intermediate care facility for persons with mental retardation or a related condition.

(10) ICF/MR Program--The Intermediate Care Facilities for Persons with Mental Retardation Program, which provides Medicaid-funded residential services to individuals with mental retardation or a related condition.

(11) Institution for mental diseases (IMD)--As defined in 25 TAC §419.373, 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.

(12) Individual--A person who is or is believed to be a member of the mental retardation priority population.

(13) LAR (legally authorized representative)--A person authorized by law to act on behalf of an individual with regard to a matter described in this subchapter, and who may be a parent, guardian, or managing conservator of a child, or the guardian of an adult.

(14) Local service area--A geographic area composed of one or more Texas counties.

(15) Mental retardation--Consistent with Texas Health and Safety Code (THSC), §591.003, significantly subaverage general intellectual functioning existing concurrently with deficits in adaptive behavior and manifested during the developmental period.

(16) MRA (mental retardation authority)--An entity to which the Texas Health and Human Services Commission's authority and responsibility described in THSC, §531.002(11) has been delegated.

(17) Mental retardation priority population or MR priority population--Those individuals who:

(A) have mental retardation;

(B) have a pervasive developmental disorder (PDD);

(C) have a related condition and are eligible for, and enrolling in services in the ICF/MR Program, HCS Program, or TxHmL Program;

(D) are nursing facility residents and eligible for specialized services for mental retardation or a related condition pursuant to §1919(e)(7) of the Social Security Act; or

(E) are children eligible for early childhood intervention (ECI) services provided in accordance with Chapter 108 of this title (relating to Early Childhood Intervention Services).

(18) Parent Case Management Program--A program that utilizes experienced, trained parents of individuals with disabilities to provide case management for other families.

(19) Partners in Policy Making--A leadership training program administered by the Texas Planning Council for Developmental Disabilities for self-advocates and parents.

(20) Permanency planning--A philosophy and planning process that focuses on the outcome of family support for an individual under 22 years of age by facilitating a permanent living arrangement in which the primary feature is an enduring and nurturing parental relationship.

(21) Person-directed planning--A philosophy and planning process that empowers an individual and, on the individual's behalf, an LAR or actively involved person, to direct the development of a plan of services and supports.

(22) PDD (pervasive developmental disorder)--As described in the most current edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), a severe and pervasive impairment in the developmental areas of reciprocal social interaction skills or communication skills, or the presence of stereotyped behaviors, interests, and activities manifested during the developmental period, usually before 10 years of age.

(23) Plan of services and supports--A written plan that:

(A) describes the desired outcomes identified by the individual, or LAR or actively involved person on behalf of the individual;

(B) describes the services and supports to be provided to the individual, including service coordination; and

(C) identifies the frequency (which must be at least every 90 calendar days) and duration of service coordination to be provided to the individual.

(24) Related condition--As defined in the Code of Federal Regulations, Title 42, §435.1009, a severe and chronic disability that:

(A) is attributable to:

(i) cerebral palsy or epilepsy; or

(ii) any other condition, other than mental illness, found to be closely related to mental retardation because the condition results in impairment of general intellectual functioning or adaptive behavior similar to that of persons with mental retardation, and requires treatment or services similar to those required for those persons with mental retardation;

(B) is manifested before the person reaches 22 years of age;

(C) is likely to continue indefinitely; and

(D) results in substantial functional limitation in three or more of the following areas of major life activity:

(i) self-care;

(ii) understanding and use of language;

(iii) learning;

(iv) mobility;

(v) self-direction; and

(vi) capacity for independent living.

(25) Relative--A person related to the individual within the fourth degree of consanguinity or within the second degree of affinity.

(26) Service coordination--Assistance in accessing medical, social, educational, and other appropriate services and supports that will help an individual achieve a quality of life and community participation acceptable to the individual (and LAR on the individual's behalf) as follows:

(A) crisis prevention and management--linking and assisting the individual and LAR or actively involved person to secure services and supports that will enable them to prevent or manage a crisis;

(B) monitoring--ensuring that the individual receives needed services, evaluating the effectiveness and adequacy of services, and determining if identified outcomes are meeting the individual's needs and desires as indicated by the individual and LAR or actively involved person;

(C) assessment--identifying the individual's needs and the services and supports that address those needs as they relate to the nature of the individual's presenting problem and disability; and

(D) service planning and coordination--identifying, arranging, advocating, collaborating with other agencies, and linking for the delivery of outcome-focused services and supports that address the individual's needs and desires as indicated by the individual and LAR or actively involved person.

(27) Subaverage general intellectual functioning--Consistent with THSC, §591.003, measured intelligence on standardized general intelligence tests of two or more standard deviations (not including standard error of measurement adjustments) below the age-group mean for the tests used.

(28) State MH facility (state mental health facility)--A state hospital or state center with an inpatient psychiatric component operated by the Department of State Health Services.

(29) State supported living center--A state-supported and structured residential facility operated by the department to provide persons with mental retardation a variety of services, including medical treatment, specialized therapy, and training in the acquisition of personal, social, and vocational skills, but does not include a community-based facility owned by the department.

(30) THSC--The Texas Health and Safety Code.

(31) TxHmL Program or Texas Home Living Program--A Medicaid waiver program operated by the department.

(32) Waiver services--Home and community-based services provided through a Medicaid waiver program approved by Centers for Medicare and Medicaid Services (CMS) as described in §1915(c) of the Social Security Act.

Comments

Source Note: The provisions of this §2.553 adopted to be effective August 31, 2004, 29 TexReg 8313; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective August 1, 2005, 30 TexReg 4334; amended to be effective June 1, 2010, 35 TexReg 4439

§2.554: Eligibility

(a) To be eligible for service coordination, an individual must be a member of the MR priority population and must meet at least one of the following criteria:

(1) have two or more documented needs that require services and supports other than service coordination as evidenced by a Service Coordination Assessment--Mental Retardation Services conducted by the designated MRA within 30 calendar days before being determined eligible for service coordination;

(2) be in the process of enrolling in the ICF/MR, HCS, or TxHml Program;

(3) be currently enrolled in the HCS or TxHmL Program;

(4) be seeking admission to a state supported living center;

(5) be transitioning from an ICF/MR, including a state supported living center, to community-based mental retardation services and supports other than another ICF/MR or a nursing facility licensed in accordance with THSC, Chapter 242; or

(6) be transitioning from a state MH facility to community-based mental retardation services and supports other than in an ICF/MR or a nursing facility licensed in accordance with THSC, Chapter 242.

(b) A copy of the Service Coordination Assessment--Mental Retardation Services form may be obtained by contacting Access and Intake, Office of Mental Retardation Authorities, Department of Aging and Disability Services W-354, P.O. Box 149030, Austin, Texas 78714-9030, or by accessing the DADS website at www.dads.state.tx.us.

Comments

Source Note: The provisions of this §2.554 adopted to be effective August 31, 2004, 29 TexReg 8313; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective August 1, 2005, 30 TexReg 4334; amended to be effective June 1, 2010, 35 TexReg 4439

§2.555: Funding Service Coordination

(a) Service coordination may be funded by:

(1) personal funds or third-party insurance other than Medicaid;

(2) Medicaid targeted case management; or

(3) general revenue.

(b) Service coordination funded by Medicaid targeted case management:

(1) may be provided only to an individual who is a Medicaid recipient and:

(A) who meets at least one of the criteria described in §2.554(a)(1), (2), (3), (4), or (5) of this subchapter (relating to Eligibility); or

(B) who resides in a nursing facility licensed in accordance with THSC, Chapter 242, and who has been determined through a preadmission screening and resident review (PASARR) assessment to require specialized services; and

(2) may not be provided to an individual:

(A) who is not a Medicaid recipient;

(B) who resides in an institution for mental diseases; or

(C) who is receiving waiver services through any waiver program except the HCS or TxHmL Program.

Comments

Source Note: The provisions of this §2.555 adopted to be effective June 1, 2010, 35 TexReg 4439

§2.556: Mra's Responsibilities

(a) Developing a plan of services and supports. If the designated MRA determines an individual is eligible for and desires service coordination, the MRA must develop a plan of services and supports for the individual using person-directed planning that is consistent with the department's Person Directed Planning Guidelines. For the HCS and TxHmL Programs, the person-directed plan (PDP), as defined in §9.153 and §9.553 of this title (relating to Definitions), qualifies as a plan of services and supports.

(b) Provision of service coordination.

(1) The MRA must ensure that service coordination:

(A) is provided to the individual in accordance with the individual's plan of services and supports; and

(B) is not provided by a staff person who is a relative of the individual or who has the same residence as the individual.

(2) The MRA may provide crisis prevention and management to the individual without having first identified the need for such services in the individual's plan of services and supports.

(3) If, as a result of monitoring, the staff person providing service coordination identifies a concern with implementation of the plan of services and supports, the MRA must ensure the concern is communicated to the entity providing the services and supports and attempts are made to resolve the concern.

(c) Revising the plan of services and supports.

(1) The MRA must ensure that the staff person providing service coordination to the individual revises the individual's plan of services and supports if:

(A) the individual's needs change; or

(B) the individual, LAR or actively involved person, service provider, or other person provides relevant information indicating revision of the plan is appropriate.

(2) The MRA must ensure that the staff person revises the plan using person-directed planning that is consistent with the department's Person Directed Planning Guidelines.

(d) Minimum contact. The MRA must ensure that the staff person providing service coordination meets face-to-face with the individual at least every 90 calendar days. This contact must involve at least one of the four elements of service coordination.

(e) Individuals enrolled in the TxHmL Program. In addition to the requirements in this subchapter, the MRA must ensure service coordination is provided to individuals enrolled in the TxHmL Program in accordance with the requirements contained in Chapter 9, Subchapter N of this title (relating to Texas Home Living (TxHmL) Program).

(f) Individuals enrolled in the HCS Program. In addition to the requirements in this subchapter, the MRA must ensure service coordination is provided to individuals enrolled in the HCS Program in accordance with Chapter 9, Subchapter D, of this title (relating to Home and Community-based Services (HCS) Program).

Comments

Source Note: The provisions of this §2.556 adopted to be effective August 31, 2004, 29 TexReg 8313; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective August 1, 2005, 30 TexReg 4334; amended to be effective June 1, 2010, 35 TexReg 4439

§2.557: Caseloads

The MRA is responsible for determining the number of cases per staff person who provides service coordination based on factors such as individuals' needs, the frequency and duration of contacts, and travel time.

Comments

Source Note: The provisions of this §2.557 adopted to be effective August 31, 2004, 29 TexReg 8313; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§2.558: Termination of Service Coordination

The MRA must terminate service coordination for an individual if:

(1) the individual no longer meets the eligibility criteria for service coordination as set forth in §2.554 of this title (relating to Eligibility); or

(2) the individual or the LAR no longer desires service coordination.

Comments

Source Note: The provisions of this §2.558 adopted to be effective August 31, 2004, 29 TexReg 8313; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective August 1, 2005, 30 TexReg 4334

§2.559: Minimum Qualifications

(a) Service coordination may be provided only by an employee of the MRA.

(b) Except as provided by subsections (d), (e), and (f) of this section, a staff person providing service coordination must have:

(1) a bachelor's or advanced degree from an accredited college or university with a major in a social, behavioral, or human service field including, but not limited to, psychology, social work, medicine, nursing, rehabilitation, counseling, sociology, human development, gerontology, educational psychology, education, and criminal justice; or

(2) a high school diploma or a certificate recognized by a state as the equivalent of a high school diploma and:

(A) two years of paid experience as a case manager in a state or federally funded Parent Case Management Program or have graduated from Partners in Policy Making; and

(B) personal experience as an immediate family member of an individual with mental retardation.

(c) The MRA, at its discretion, may require additional education and experience for staff who provide service coordination.

(d) At the discretion of the MRA, a staff person who was authorized by an MRA to provide service coordination prior to April 1, 1999, may provide service coordination without meeting the minimum qualifications described in subsection (b) of this section.

(e) Until December 31, 2011, an MRA may hire a person to provide service coordination who was employed as a case manager for an HCS Program provider for any period of time prior to June 1, 2010, even if the person does not meet the minimum qualifications described in subsection (b) of this section.

(f) Beginning January 1, 2012, an MRA may hire a person to provide service coordination who was hired by another MRA in accordance with subsection (e) of this section.

Comments

Source Note: The provisions of this §2.559 adopted to be effective August 31, 2004, 29 TexReg 8313; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective June 1, 2010, 35 TexReg 4439

§2.560: Staff Training

(a) An MRA must ensure that the following staff receive training as described in subsection (b) of this section within the first 90 days of performing their service coordination duties:

(1) staff who provide service coordination; and

(2) staff who supervise or oversee the provision of service coordination.

(b) Training must address:

(1) appropriate MRA policies, procedures, and standards;

(2) the MRA's performance contract/memorandum requirements regarding service coordination and case management;

(3) plan of services and supports development and implementation;

(4) person-directed planning consistent with the department's Person Directed Planning and Family Directed Planning Guidelines for Individuals with Mental Retardation;

(5) permanency planning;

(6) crisis prevention and management, monitoring, assessment, and service planning and coordination;

(7) community support services availability and management; and

(8) advocacy for individuals.

(c) The MRA must document the training provided in accordance with this section in the personnel record of each staff person providing, supervising, or overseeing service coordination.

Comments

Source Note: The provisions of this §2.560 adopted to be effective August 31, 2004, 29 TexReg 8313; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§2.561: Documentation of Service Coordination

(a) The MRA must document the required contacts described in the individual's plan of services and supports, including:

(1) the date of contact;

(2) the description of the element(s) of service coordination provided;

(3) the progress or lack of progress in achieving goals or outcomes;

(4) the person with whom the contact occurred; and

(5) the staff who provided the contact and his or her professional discipline, if applicable.

(b) The MRA must ensure that service coordination activities are documented in the individual's record.

(c) The MRA must identify the appropriate service code in CARE for all individuals receiving service coordination.

(d) The MRA must retain documentation in compliance with applicable federal and state laws, rules, and regulations.

Comments

Source Note: The provisions of this §2.561 adopted to be effective August 31, 2004, 29 TexReg 8313; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§2.562: Review Process

(a) Medicaid-eligible individuals. Any Medicaid-eligible individual whose request for eligibility for service coordination is denied or is not acted upon with reasonable promptness, or whose service coordination has been terminated, suspended, or reduced by the department is entitled to a fair hearing in accordance with 1 TAC Chapter 357, Subchapter A (relating to Uniform Fair Hearing Rules).

(b) Non-Medicaid-eligible individuals. If an MRA decides to deny, involuntarily reduce, or terminate service coordination for a non-Medicaid-eligible individual, the MRA must notify the individual or LAR in writing of the decision and provide an explanation of the procedure for the individual or LAR to request a review by the MRA as required by §2.46 of this chapter (relating to Notification and Appeals Process).

Comments

Source Note: The provisions of this §2.562 adopted to be effective August 31, 2004, 29 TexReg 8313; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective August 1, 2005, 30 TexReg 4334; amended to be effective June 1, 2010, 35 TexReg 4439

Chapter 4

Subchapter A

§4.1: Purpose

The purpose of this subchapter is to require facilities, local authorities, community centers, their respective contract providers, and TDMHMR Central Office to comply with all applicable privacy laws, rules, and regulations.

Comments

Source Note: The provisions of this §4.1 adopted to be effective April 23, 2003, 28 TexReg 3340; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.2: Application

This subchapter applies to:

(1) all facilities of the Texas Department of Mental Health and Mental Retardation (TDMHMR);

(2) TDMHMR Central Office;

(3) all local authorities; and

(4) all community centers.

Comments

Source Note: The provisions of this §4.2 adopted to be effective April 23, 2003, 28 TexReg 3340; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.3: Definitions

The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:

(1) Community center--A center established under the Texas Health and Safety Code, Title 7, Chapter 534, Subchapter A.

(2) Contract provider--A person, entity, or organization that contracts with a facility, local authority, or community center to provide mental health or mental retardation services, or alcohol or drug abuse treatment.

(3) Facility--A state mental health facility or a state mental retardation facility.

(4) Individual--A person who, voluntarily or involuntarily, is seeking or receiving, or has sought or received mental health or mental retardation services, or alcohol or drug abuse treatment from or through a facility, a local authority, a community center, or its respective contract providers, or TDMHMR Central Office.

(5) Local authority--An entity designated by the TDMHMR commissioner in accordance with the Texas Health and Safety Code, §533.035(a).

(6) More stringent--In accordance with 45 CFR 160.202, a state law that meets one or more of the following criteria:

(A) with respect to a use or disclosure, the law prohibits or restricts a use or disclosure where the use or disclosure would be permitted under the federal regulation, except if the disclosure is to the U.S. Department of Health and Human Services or to the individual;

(B) with respect to the rights of an individual regarding access to or amendment of protected health information, the law permits greater rights of access or amendment;

(C) with respect to information to be provided to an individual about a use, a disclosure, rights, and remedies, the law provides a greater amount of information;

(D) with respect to consent or authorization for use or disclosure of protected health information, the law narrows the scope or duration of the consent or authorization, increases privacy protections, or reduces the coercive effect of obtaining the consent or authorization; or

(E) with respect to recordkeeping or accounting of disclosures, the law provides for the retention or reporting of more detailed information or for a longer duration.

(7) Notice of Privacy Practices--Pursuant to 45 CFR §164.501, a written notice developed and distributed by a covered entity, as defined in 45 CFR §160.103, that describes:

(A) the uses and disclosures of protected health information that may be made by the entity; and

(B) individuals' rights and the entity's legal duties with respect to protected health information.

(8) Protected health information or PHI--

(A) Any information that identifies or could be used to identify an individual, whether oral or recorded in any form, that relates to:

(i) the past, present, or future physical or mental health or condition of the individual;

(ii) the provision of health care to the individual; or

(iii) the payment for the provision of health care to the individual.

(B) The term includes, but is not limited to:

(i) an individual's name, address, date of birth, or Social Security number;

(ii) an individual's medical record or case number

(iii) a photograph or recording of an individual;

(iv) statements made by an individual, either orally or in writing, while seeking or receiving services from or through a facility, a local authority, a community center, or its respective contract providers, or TDMHMR Central Office;

(v) any acknowledgment that an individual is seeking or receiving or has sought or received services from or through a facility, a local authority, a community center, or its respective contract providers, or TDMHMR Central Office;

(vi) direct identifiers of relatives, employers, or household members of an individual; and

(vii) any information by which the identity of an individual can be determined either directly or by reference to other publicly available information.

(C) The term does not include:

(i) health information that has been de-identified in accordance with 45 CFR §164.514(b); and

(ii) employment records held by an entity as an employer.

(9) State mental health facility--A state hospital or a state center with an inpatient component that is operated by TDMHMR.

(10) State mental retardation facility--A state school or a state center with a mental retardation residential component that is operated by TDMHMR.

Comments

Source Note: The provisions of this §4.3 adopted to be effective April 23, 2003, 28 TexReg 3340; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.4: Requirements

(a) TDMHMR Central Office and each facility, local authority, and community center shall comply with all applicable federal and state statutes, rules and regulations pertaining to privacy of protected health information (PHI) including, but not limited to, the federal and state statutes, rules and regulations described in §414.5 of this title (relating to Regulations and Statutes Governing Confidentiality of Protected Health Information).

(1) As set forth in 45 CFR Part 160 Subpart B, where a provision of 45 CFR Part 160 or 164 is contrary to a provision of state law, the federal regulation preempts the state law unless the provision of state law:

(A) is more stringent (as defined) than the provision of the federal regulation;

(B) provides for the reporting of disease or injury, child abuse, birth, or death, or for the conduct of public health surveillance, investigation, or intervention; or

(C) requires a health plan to report, or to provide access to, information for the purpose of management audits, financial audits, program monitoring and evaluation, or the licensure or certification of providers or persons.

(2) TDMHMR's "Interpretive Guidance on Laws Pertaining to Privacy of Mental Health and Mental Retardation Records for the TDMHMR Service Delivery System," referenced as Exhibit A in §414.6 of this title (relating to Exhibits), provides an interpretation of the applicable federal and state statutes, rules and regulations described in §414.5 of this title, applying the preemption provisions described in paragraph (1) of this subsection. TDMHMR Central Office and all facilities must comply with the "Interpretive Guidance on Laws Pertaining to Privacy of Mental Health and Mental Retardation Records for the TDMHMR Service Delivery System."

(b) Information to be included in Notice of Privacy Practice.

(1) Each facility, local authority, and community center shall include in its Notice of Privacy Practice a statement that disclosures may be made between facilities, local authorities, community centers, their respective contract providers, and TDMHMR Central Office for the purpose of treatment, payment, or health care operations without the individual's consent as permitted by Texas Health and Safety Code, §533.009.

(2) TDMHMR Central Office and each facility, local authority, and community center shall include in its Notice of Privacy Practice a statement:

(A) that identifies it as a part of the TDMHMR service delivery system; and

(B) that individuals may file a complaint with TDMHMR Consumer Services and Rights Protection/Ombudsman Office by calling 1-800-252-8154 or writing to P.O. Box 12668, Austin, TX 78711.

(c) Each facility, local authority, and community center is responsible for ensuring that contracts with its contract providers require compliance with subsection (a) of this section.

Comments

Source Note: The provisions of this §4.4 adopted to be effective April 23, 2003, 28 TexReg 3340; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.5: Regulations and Statutes Governing Confidentiality of Protected Health Information

(a) Federal regulations. The following federal regulations pertain to privacy of protected health information (PHI):

(1) Code of Federal Regulations, Title 45, Parts 160 and 164, Federal Standards for Privacy of Individually Identifiable Health Information (i.e., Federal Privacy Rule), promulgated by the Secretary of the United States Department of Health and Human Services;

(2) Code of Federal Regulations, Title 42, Part 2, Confidentiality of Alcohol and Drug Abuse Patient Records, promulgated by the Secretary of the United States Department of Health and Human Services;

(3) Code of Federal Regulations, Title 34, Part 99, governing the disclosure of educational records of school-age children, promulgated by the Secretary of the United States Department of Education; and

(4) Code of Federal Regulations, Title 42, Part 51, Subpart D, and Code of Federal Regulations, Title 45, §1386.22, governing access to PHI by advocates for individuals with mental illness and mental retardation, promulgated by the Secretary of the United States Department of Health and Human Services.

(b) Federal statutes.

(1) The Health Insurance Portability and Accountability Act (HIPAA), 42 USC §1320d et seq., provides the statutory authority for the United States Department of Health and Human Services to promulgate the Federal Privacy Rule.

(2) 42 USC §10805(a)(4) (Protection and Advocacy for Mentally Ill Individuals) and 42 USC §15043(a)(2)(I) (Protection and Advocacy of Individual Rights) provide the authority for access of PHI by Advocacy, Inc.

(3) 42 USC §290dd-2 provides the statutory authority to promulgate the federal regulations on confidentiality of alcohol and drug abuse patient records, referenced in subsection (a)(2) of this section.

(c) State statutes.

(1) Texas Health and Safety Code, Chapter 181, pertains to privacy of medical records.

(2) Texas Open Records Act, Texas Government Code, Chapter 552, provides that all information collected, assembled, or maintained in any form by governmental bodies, and agencies operating in part or whole with state funds, in connection with the transaction of official business is public information; however, the act does set out certain exceptions. One such exception is information deemed confidential by law, such as PHI.

(3) Texas Health and Safety Code, §576.005, §576.0055, and Chapter 611, pertain to the confidentiality of PHI that relates to MHMR services.

(4) Texas Health and Safety Code, Chapter 81, Subchapter F, governs the confidentiality of information related to HIV/AIDS test results.

(5) The provisions for disclosure of PHI that relates to mental retardation services are contained in the Persons with Mental Retardation Act, Texas Health and Safety Code, Chapter 595. The provisions described in §576.005, §576.0055, and Chapters 595 and 611 of Texas Health and Safety Code should be interpreted together in reaching a determination regarding the use or disclosure of PHI that relates to mental retardation services.

(6) Texas Human Resources Code, Chapter 48, establishes authority for the Texas Department of Protective and Regulatory Services (TDPRS) to have access to PHI necessary to conduct investigations into allegations of abuse, neglect, and exploitation of individuals.

(7) Texas Medical Practice Act, Texas Occupations Code, Chapter 159, governs physician-patient communication.

(8) Texas Health and Safety Code, §533.009, governs the exchange of PHI between facilities, local authorities, community centers, and their respective contract providers.

(9) Texas Health and Safety Code, §595.005(c), governs the disclosure of educational records of individuals receiving mental retardation services.

(10) Texas Government Code, Chapter 559, provides that persons have a right to be informed about information that a state governmental body collects about them, and to have incorrect information that is possessed about them by a state governmental body corrected.

(11) Texas Family Code, Chapter 32, governs consent to treatment of a child by a non-parent or the child.

(12) Texas Health and Safety Code, Chapter 241, Subchapter G, governs the disclosure of PHI in hospitals licensed under the chapter.

(13) Texas Health and Safety Code, §614.017, governs the exchange of information relating to a special needs offender.

(14) Texas Government Code, §531.042, requires information regarding care and support options be given to at least one family member of a patient or client, if possible.

(15) Texas Health and Safety Code, §572.004(i), requires notification of a minor individual's parent, managing conservator, or guardian when the minor, who has been voluntarily admitted to a state mental health facility by the parent, managing conservator, or guardian, files a written request for discharge.

(16) Texas Health and Safety Code, §576.007(a), requires a state mental health facility to make a reasonable effort to notify an adult individual's family before the adult is discharged or released from the facility if the adult grants permission for the notification.

Comments

Source Note: The provisions of this §4.5 adopted to be effective April 23, 2003, 28 TexReg 3340; amended to be effective January 1, 2004, 28 TexReg 11336; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.6: Exhibit

This subchapter references Exhibit A--"Interpretive Guidance on Laws Pertaining to Privacy of Mental Health and Mental Retardation Records for the TDMHMR Service Delivery System," copies of which are available by contacting TDMHMR, Policy Development, P.O. Box 12668, Austin, TX 78711-2668, or by calling toll free at 1-888-404-1511, extension 4516. The exhibit is also accessible via the Internet at www.mhmr.state.tx.us/hipaa.html.

Comments

Source Note: The provisions of this §4.6 adopted to be effective April 23, 2003, 28 TexReg 3340; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.7: References

Reference is made to the following state and federal statutes, rules, and regulations:

(1) 45 CFR Parts 160 and 164, and §1386.22;

(2) 42 CFR Part 2 and Part 51, Subpart D;

(3) 34 CFR Part 99;

(4) 42 USC §290dd-2, §1320d et seq., §10805(a)(4), and §15043(a)(2)(I);

(5) Texas Health and Safety Code:

(A) Chapter 81, Subchapter F;

(B) Chapter 241, Subchapter G;

(C) Chapter 534, Subchapter A;

(D) Chapters 181; 595; and 611; and

(E) §§533.009, 533.035(a), 572.004, 576.005, 576.0055, 576.007, 595.005(c), and 614.017;

(6) Texas Government Code, Chapters 552 and 559, and §531.042;

(7) Texas Human Resources Code, Chapter 48;

(8) Texas Occupations Code, Chapter 159; and

(9) Texas Family Code, Chapter 32.

Comments

Source Note: The provisions of this §4.7 adopted to be effective April 23, 2003, 28 TexReg 3340; amended to be effective January 1, 2004, 28 TexReg 11336; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.8: Distribution

(a) This subchapter shall be distributed to:

(1) members of the Texas Mental Health and Mental Retardation Board;

(2) executive, management, and program staff of TDMHMR Central Office;

(3) CEOs of all facilities, local authorities, and community centers; and

(4) advocacy organizations.

(b) The CEO of each facility, local authority, and community center shall disseminate the information contained in this subchapter to all appropriate staff members and contract providers.

Comments

Source Note: The provisions of this §4.8 adopted to be effective April 23, 2003, 28 TexReg 3340; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

Subchapter C

§4.101: Purpose

This subchapter describes:

(1) the rights of an individual with mental retardation and of an LAR; and

(2) procedures of DADS for informing and protecting the rights of:

(A) an individual residing in a state MR facility or receiving services and supports from an MRA; and

(B) an LAR.

Comments

Source Note: The provisions of this §4.101 adopted to be effective January 1, 2007, 31 TexReg 10349

§4.103: Application

This subchapter applies to:

(1) a state MR facility; and

(2) an MRA.

Comments

Source Note: The provisions of this §4.103 adopted to be effective January 1, 2007, 31 TexReg 10349

§4.105: Definitions

The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:

(1) Actively involved person--A person with significant and ongoing involvement with an individual who lacks the ability to provide legally adequate consent and who does not have an LAR. The MRA providing services and supports to the individual or the state MR facility in which the individual resides determines if the person is actively involved based on the person's:

(A) observed interactions with the individual;

(B) knowledge of and sensitivity to the individual's preferences, values, and beliefs;

(C) availability to the individual for assistance or support; and

(D) advocacy for the individual's preferences, values, and beliefs.

(2) DADS--The Department of Aging and Disability Services.

(3) Individual--A person who has mental retardation.

(4) LAR (legally authorized representative)--A person authorized by law to act on behalf of an individual with regard to a matter described in this subchapter, which may be a parent, guardian, or managing conservator of a minor individual, or the guardian of an adult individual.

(5) Local service area--A geographic area composed of one or more Texas counties that determines the MRA from which an individual may receive services.

(6) Mental retardation--Consistent with THSC, §591.003, significantly subaverage general intellectual functioning existing concurrently with deficits in adaptive behavior and originating during the developmental period.

(7) MRA (mental retardation authority)--An entity to which the Texas Health and Human Services Commission's authority and responsibility described in THSC, §531.002(11) has been delegated.

(8) PMRA (Persons with Mental Retardation Act)--Texas statutes relating to persons with mental retardation codified in THSC, Chapters 591 - 597.

(9) Services and supports--Assistance to an individual through an MRA or a state MR facility, which may include:

(A) eligibility determination;

(B) service coordination;

(C) community services; and

(D) residential assistance.

(10) State MR facility (state mental retardation facility)--A state school or a state center operated by DADS.

(11) Subaverage general intellectual functioning--Consistent with THSC, §591.003, measured intelligence on standardized general intelligence tests of two or more standard deviations (not including standard error of measurement adjustments) below the age-group mean for the tests used.

(12) THSC (Texas Health and Safety Code)--A codification of Texas statutes relating to health and safety.

Comments

Source Note: The provisions of this §4.105 adopted to be effective January 1, 2007, 31 TexReg 10349

§4.107: Rights of an Individual

The PMRA provides that an individual in Texas has the rights, benefits, and privileges guaranteed by the constitutions and laws of the United States and Texas, unless those rights, benefits, and privileges are lawfully restricted. The following specific rights listed in the PMRA are not exclusive and do not limit the rights otherwise guaranteed by the constitutions and laws of the United States and Texas:

(1) the right to protection from exploitation and abuse, as described in THSC, §592.012;

(2) the right to live in the least restrictive setting appropriate to the individual's needs and abilities and in a variety of living situations, as described in THSC, §592.013;

(3) the right to receive publicly supported educational services, as described in THSC, §592.014;

(4) the right to equal opportunities in employment, as described in THSC, §592.015;

(5) the right to purchase, rent, or lease real property, as described in THSC, §592.016;

(6) the right to adequate treatment and habilitative services, as described in THSC, §592.017;

(7) the right to promptly receive a determination of mental retardation using diagnostic techniques that are adapted to that individual's cultural background, language, and ethnic origin to determine if the individual is in need of mental retardation services, as described in THSC, §592.018;

(8) the right to request and promptly receive an administrative hearing to contest the findings of the determination of mental retardation, as described in THSC, §592.019;

(9) the right to an additional, independent determination of mental retardation performed at the individual's expense if the individual questions the validity or results of the determination of mental retardation, as described in THSC, §592.020; and

(10) the right to the presumption of competency, due process in guardianship proceedings, and fair compensation for the individual's labor for the economic benefit of another, regardless of any direct or incidental therapeutic value to the individual, as described in THSC, §592.021.

Comments

Source Note: The provisions of this §4.107 adopted to be effective January 1, 2007, 31 TexReg 10349

§4.109: Rights of an Individual Receiving Services and Supports and an Lar

(a) An LAR has the authority to make certain decisions on an individual's behalf.

(b) An individual receiving services and supports and an LAR have the following rights:

(1) the right to participate in the development and periodic review of an individualized treatment plan and to receive the individual's progress in writing at reasonable intervals, as described in THSC, §§592.033 - 592.035;

(2) the right to choose from several appropriate services, if possible, as described in THSC, §592.035(b);

(3) the right to withdraw the individual from services and supports, as described in THSC, §592.036;

(4) the right to not receive unnecessary or excessive medications, as described in THSC, §592.038;

(5) the right to initiate a complaint on behalf of the individual, as described in THSC, §592.039;

(6) the right to be given written notice of the rights guaranteed by the PMRA in plain and simple language when the individual begins to receive services and supports, as described in THSC, §592.040;

(7) the right to have access to information contained in the individual's record, as described in THSC, §595.004; and

(8) the right to request an administrative hearing to contest a proposed transfer or discharge of the individual from a state MR facility, the denial of a requested discharge or transfer of the individual from a state MR facility, or the results of a determination of mental retardation of the individual, as described in Subchapter D of this chapter (relating to Administrative Hearings Under the PMRA).

(c) An individual residing in a state MR facility has the following additional rights, as described in THSC, §592.051 and §592.052:

(1) the right to a normal residential environment;

(2) the right to a humane physical environment;

(3) the right to communication and visits;

(4) the right to possess personal property; and

(5) the right to prompt, adequate, and necessary medical and dental care and treatment for physical and mental ailments and to prevent an illness or disability.

Comments

Source Note: The provisions of this §4.109 adopted to be effective January 1, 2007, 31 TexReg 10349

§4.111: Penalties for a Violation of Rights of an Individual

THSC, Chapter 591, Subchapter C, Penalties and Remedies, describes the penalties and remedies available for a violation of the rights of an individual guaranteed by the PMRA.

Comments

Source Note: The provisions of this §4.111 adopted to be effective January 1, 2007, 31 TexReg 10349

§4.113: Rights Protection Officer at a State Mr Facility or Mra

(a) A state MR facility and an MRA must employ a rights protection officer whose primary duty is to advocate for the rights of individuals served by that state MR facility or MRA and to assist LARs in advocating for the rights of individuals.

(b) The superintendent of a state MR facility and the chief executive officer of an MRA must specify the duties of the rights protection officer, which must include:

(1) receiving a complaint regarding the violation of an individual's or LAR's rights or the quality of services and supports;

(2) investigating a complaint or forwarding the complaint to the appropriate investigatory entity;

(3) advocating for the resolution of a complaint;

(4) reporting the results of an investigation to the complainant, consistent with confidentiality rights;

(5) reviewing policies, procedures, and practices of the state MR facility or MRA that affect the rights of an individual and LAR to ensure that the individual's and LAR's rights are protected;

(6) serving as or coordinating with the liaison between the state MR facility or MRA and the Department of Family and Protective Services regarding allegations of abuse or neglect;

(7) acting as the liaison between the state MR facility or MRA and advocacy organizations; and

(8) acting as the liaison between the state MR facility or MRA and DADS Consumer Rights and Services.

(c) The superintendent of a state MR facility and the chief executive officer of an MRA must ensure that the duties of the rights protection officer do not include any supervision of or responsibility for the delivery of services and supports that would represent a conflict of interest with the rights protection officer's primary duty of advocacy on an individual's and LAR's behalf.

(d) A state MR facility and an MRA must ensure that in every program and residential area of the state MR facility and MRA:

(1) the name, telephone number, e-mail address, and mailing address of the rights protection officer are posted conspicuously; and

(2) a telephone is accessible for an individual to contact the rights protection officer.

Comments

Source Note: The provisions of this §4.113 adopted to be effective January 1, 2007, 31 TexReg 10349

§4.115: Dads Consumer Rights and Services

(a) A state MR facility and an MRA must post DADS' Consumer Rights and Services toll-free number (1-800-458-9858) conspicuously in every program and residential area of the state MR facility or the MRA.

(b) A consumer rights representative in DADS Consumer Rights and Services assists an individual or an LAR upon request if DADS or an MRA denies services to the individual, including admission to a state MR facility.

(c) The consumer rights representative:

(1) explains and provides information about services and supports and the rules, procedures, and guidelines applicable to the individual who has been denied services; and

(2) assists the individual and the LAR in gaining access to appropriate services and supports or in placing the individual's name on an appropriate interest list.

Comments

Source Note: The provisions of this §4.115 adopted to be effective January 1, 2007, 31 TexReg 10349

§4.117: Rights Handbooks

(a) DADS publishes handbooks describing the rights of an individual in simple, non-technical language and makes these handbooks available in English and in Spanish.

(b) A state MR facility must give a copy of Your Rights in a State School or Center to an individual and LAR or actively involved person when the state MR facility admits the individual and annually thereafter.

(c) An MRA must give a copy of Your Rights in Mental Retardation Community Programs to an individual and LAR or actively involved person when the individual applies to the MRA for services and supports and annually thereafter.

(d) DADS provides copies of Your Rights in Mental Retardation Community Programs to an MRA upon request in any language used by a significant percentage of the population in the MRA's local service area.

(e) A state MR facility and an MRA must conspicuously and at all times display the appropriate rights handbook in areas frequented by an individual, an individual's family member, or an LAR. The state MR facility and MRA must write in the handbook the name, telephone number, e-mail address, and mailing address of the rights protection officer at that state MR facility or MRA.

(f) A state MR facility and an MRA must provide the appropriate rights handbook to a person who requests a copy.

(g) The rights handbooks specified in subsections (b) and (c) of this section may be obtained:

(1) through DADS' website at http://www.dads.state.tx.us/news_info/publications/brochures/index.html#consumer;

(2) by writing the Department of Aging and Disability Services, Consumer Rights and Services, P.O. Box 149030, Mail Code E-249, Austin, Texas 78714-9030; or

(3) by calling the toll-free number at 1-800-458-9858.

(h) The following rights handbooks may be obtained by accessing the website or by writing or calling, as described in subsection (g)(1) - (3) of this section:

(1) Your Rights in the Home and Community-based Services (HCS) Program;

(2) Your Rights in the Texas Home Living Program; and

(3) Your Rights in an ICF-MR Facility.

(i) A state MR facility and an MRA may photocopy a rights handbook.

Comments

Source Note: The provisions of this §4.117 adopted to be effective January 1, 2007, 31 TexReg 10349

§4.119: Communication of Rights to an Individual Receiving Services and Supports and to an Lar

(a) When a state MR facility or MRA gives a copy of the rights handbook in accordance with §4.117 of this subchapter (relating to Rights Handbooks), the state MR facility or MRA must explain the rights described in the rights handbook to the individual and LAR or actively involved person in plain and simple language and in a manner that the individual and LAR or actively involved person can easily understand. The explanation must address:

(1) circumstances under which the individual's rights may be limited;

(2) procedures that must be followed by the state MR facility or MRA to limit the individual's rights; and

(3) how and with whom a complaint about a violation of a right may be filed.

(b) The language and manner used to provide the explanation must be designed for effective communication, tailored to meet the individual's ability to comprehend, and be responsive to any visual or hearing impairment.

(c) If the individual is unable to comprehend the explanation of rights described in subsection (a) of this section, the explanation provided to the LAR or actively involved person meets the requirements of this section.

(d) The state MR facility or MRA must document that the explanation of rights occurred. The documentation must state the name of the individual and the date that the explanation of rights occurred, and must include the dated signatures of the individual, LAR or actively involved person, and the staff member who explained the rights to the individual. The state MR facility or MRA must maintain the documentation in the individual's record.

Comments

Source Note: The provisions of this §4.119 adopted to be effective January 1, 2007, 31 TexReg 10349

§4.121: Staff Training in Rights

A state MR facility and an MRA must ensure that:

(1) an employee of the state MR facility or MRA who will provide direct services and supports to an individual or will routinely perform job duties in proximity to an individual, and the supervisor of such an employee, receive instruction on the contents of this subchapter before starting job duties and annually thereafter; and

(2) an employee of the state MR facility or MRA who will not provide direct services and supports to an individual and will not routinely perform job duties in proximity to an individual, and the supervisor of such an employee, receive instruction on the contents of this subchapter within two months after starting job duties and every two years thereafter.

Comments

Source Note: The provisions of this §4.121 adopted to be effective January 1, 2007, 31 TexReg 10349

Subchapter D

§4.151: Purpose

The purpose of this subchapter is to describe fair and equitable process and procedures for conducting administrative hearings requested under the Persons with Mental Retardation Act, Texas Health and Safety Code, Title 7, Subtitle D, to contest:

(1) the conclusion of a determination of mental retardation conducted by a state MR facility or mental retardation authority;

(2) the denial of an individual's or LAR's request to transfer or discharge the individual; and

(3) a state MR facility's proposed transfer or discharge of an individual.

Comments

Source Note: The provisions of this §4.151 adopted to be effective December 27, 2000, 25 TexReg 12785; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.152: Application

The provisions of this subchapter apply to:

(1) state MR facilities;

(2) mental retardation authorities; and

(3) TDMHMR Central Office.

Comments

Source Note: The provisions of this §4.152 adopted to be effective December 27, 2000, 25 TexReg 12785; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.153: Definitions

The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise.

(1) CEO or chief executive officer--The superintendent of a state MR facility or the executive director of a mental retardation authority.

(2) Discharge--The release by TDMHMR of an individual committed or voluntarily admitted for residential mental retardation services from the custody and care of a state MR facility and the termination of the individual's assignment to the state MR facility in the Client Assignment and Registration System (CARE).

(3) Hearing officer--An attorney designated to conduct and preside over an administrative hearing held under this subchapter.

(4) Individual--A person who is seeking or receiving residential mental retardation services from a state MR facility or mental retardation services from a mental retardation authority.

(5) LAR or legally authorized representative--A person authorized by law to act on behalf of an individual with regard to a matter in this subchapter, and who may include a parent, guardian, or managing conservator of a minor individual; a guardian of an adult.

(6) Mental retardation authority--An entity designated by the commissioner to which the Texas Mental Health and Mental Retardation Board delegates its authority and responsibility for planning, policy development, coordination, and resource allocation, and resource development for and oversight of mental retardation services and supports in one or more local service areas.

(7) Party--Each person and the state MR facility or mental retardation authority named or admitted as a party in an administrative hearing held under this subchapter.

(8) Preponderance of evidence--Evidence which is of greater weight or more convincing than the evidence which is offered in opposition to it.

(9) State MR facility--A facility operated by TDMHMR that provides residential mental retardation services to individuals with mental retardation.

(10) Transfer--The reassignment of an individual from one state MR facility to another state MR facility.

(11) Trial de novo--A new trial, which is held as if no administrative hearing had been held.

Comments

Source Note: The provisions of this §4.153 adopted to be effective December 27, 2000, 25 TexReg 12785; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.154: General Principles

(a) An individual or LAR is entitled to request an administrative hearing to contest:

(1) the conclusion of a determination of mental retardation conducted by a state MR facility or mental retardation authority, as provided by the Texas Health and Safety Code, §592.019;

(2) the denial of an individual's or LAR's request to transfer or discharge the individual, as provided by the Texas Health and Safety Code, §594.012; or

(3) a state MR facility's proposed transfer or discharge of an individual, as provided by the Texas Health and Safety Code, §594.014.

(b) An administrative hearing held under this subchapter is not a "contested case" under the Administrative Procedures Act, Texas Government Code, Chapter 2001.

(c) If the last day of a time period referenced in this subchapter is a Saturday, Sunday, or day on which TDMHMR's Central Office is closed, then the period extends through the end of the next day which is not a Saturday, Sunday, or day on which TDMHMR's Central Office is closed.

Comments

Source Note: The provisions of this §4.154 adopted to be effective December 27, 2000, 25 TexReg 12785; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.155: Notice

(a) Written notice to the individual or LAR of the right to request an administrative hearing must be provided by:

(1) the state MR facility or mental retardation authority, as applicable, at the time the report, as referenced in §415.755(h) of this title (relating to Determination of Mental Retardation (DMR)), is provided to the individual or LAR who requested the determination of mental retardation;

(2) a state MR facility, upon its denial of a request by the individual or LAR for a transfer or discharge; or

(3) a state MR facility, at least 31 calendar days before the date of the state MR facility's proposed transfer or discharge of the individual.

(b) The notice must contain:

(1) the conclusion of the determination of mental retardation as to whether or not the individual has mental retardation, for the notice referenced in subsection (a)(1) of this section;

(2) the decision to deny a requested transfer or discharge and the reasons for such decision, for the notice referenced in subsection (a)(2) of this section;

(3) the decision to propose a transfer or discharge, the reasons for such proposal, and the date of the proposed transfer or discharge, for the notice referenced in subsection (a)(3) of this section;

(4) an explanation of the individual's or LAR's right to request an administrative hearing and the procedure for requesting such;

(5) the timeframe for requesting a hearing;

(6) a statement that the individual or LAR may represent himself or herself or use another person as a representative; and

(7) the name, address, and phone number of the person designated by the state MR facility or mental retardation authority to receive the request for an administrative hearing.

Comments

Source Note: The provisions of this §4.155 adopted to be effective December 27, 2000, 25 TexReg 12785; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.156: Request for an Administrative Hearing

(a) A request for an administrative hearing must be received by the state MR facility or mental retardation authority within 30 calendar days after the individual's or LAR's receipt of notice referenced in §414.155(a) of this title (relating to Notice).

(b) The request for administrative hearing must be submitted in accordance with the instructions provided in the notice referenced in §414.155(a) of this title (relating to Notice).

(c) The request for an administrative hearing may be oral or in writing.

(d) The state MR facility or mental retardation authority, as appropriate, must document in writing an oral request for an administrative hearing.

(e) The state MR facility or mental retardation authority, as appropriate, must forward the request for an administrative hearing to the TDMHMR's Office of Legal Services within one working day after receipt of the request.

(f) A party may not take action to transfer or discharge an individual if an administrative hearing is requested under subsection (a)(2) or (a)(3) of §414.154 of this title (relating to General Principles).

Comments

Source Note: The provisions of this §4.156 adopted to be effective December 27, 2000, 25 TexReg 12785; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.157: Preliminary Matters

(a) The hearing officer must contact the person who requested a hearing within five working days after the receipt of the request by the Office of Legal Services.

(b) The hearing officer must set a date, time, and location convenient for the parties for the administrative hearing. The hearing officer may conduct the hearing by telephone for appropriate reasons, including the location of the person who requested the hearing and other persons who will be participating in the hearing

(c) The administrative hearing must be held no later than 30 calendar days after the date the hearing was requested, unless a continuance beyond 30 calendar days is agreed to by the person who requested the hearing.

(d) The hearing officer must, at least 20 calendar days prior to the date of the hearing, send a written notice of the hearing to the person who requested the hearing and the CEO.

(e) The notice must contain:

(1) the time, date, and location of the hearing;

(2) the issue being contested at the hearing;

(3) a statement that the individual or LAR may represent himself or herself or choose another person as a representative;

(4) a statement that each party must, upon request, provide the other parties with the opportunity to examine and copy any records concerning the individual and relevant to the contested issue at least 14 calendar days prior to the hearing;

(5) a statement that requests for reasonable accommodations or for interpreters at the hearing must be made to the hearing officer, in writing, at least five calendar days prior to the hearing; and

(6) a copy of this subchapter.

Comments

Source Note: The provisions of this §4.157 adopted to be effective December 27, 2000, 25 TexReg 12785; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.158: Burden of Proof

(a) For hearings held under the Texas Health and Safety Code, §593.008, the state MR facility or mental retardation authority, as appropriate, has the burden of proof by a preponderance of the evidence to demonstrate that the conclusion of the determination of mental retardation as to whether or not the individual has mental retardation is accurate.

(b) For hearings held for actions described under the Texas Health and Safety Code, §594.012, the state MR facility has the burden of proof by a preponderance of the evidence to demonstrate that the criteria for transfer or discharge have not been met, as set forth in:

(1) the Texas Health and Safety Code, §594.011;

(2) §412.271(b) of this title (relating to Transfer of an Individual Between State MR Facilities);

(3) §412.279 of this title (relating to Discharge from a State MR Facility of an Individual Who Moves to an Alternate Living Arrangement); or

(4) §412.282 of this title (relating to Review by Local MRA of Individual in a Community Living Arrangement).

(c) For hearings held for actions described under the Texas Health and Safety Code, §594.014, the state MR facility has the burden of proof by a preponderance of the evidence to demonstrate that the criteria for transfer or discharge have been met, as set forth in:

(1) the Texas Health and Safety Code, §594.011;

(2) §412.271(b) of this title (relating to Transfer of an Individual Between State MR Facilities);

(3) §412.279 of this title (relating to Discharge from a State MR Facility of an Individual Who Moves to an Alternate Living Arrangement);

(4) §412.280 of this title (relating to Administrative Discharges Initiated by a State MR Facility); or

(5) §412.282 of this title (relating to Review by Local MRA of Individual in a Community Living Arrangement).

Comments

Source Note: The provisions of this §4.158 adopted to be effective December 27, 2000, 25 TexReg 12785; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.159: The Administrative Hearing

(a) The person requesting the hearing has the option of having the hearing open or closed to the public.

(b) The individual, LAR, and CEO have the right to:

(1) be present at the hearing and represent themselves or have another person represent them;

(2) examine witnesses;

(3) present oral and written testimony and evidence;

(c) Any interested person may appear at the hearing and give oral or written testimony.

(d) In a hearing held under the Texas Health and Safety Code, §593.008, the individual, LAR, or representative may introduce the results of an independent determination of mental retardation.

(e) The hearing shall be tape recorded and the state MR facility or mental retardation authority, as appropriate, shall provide the equipment for such recording.

(f) The hearing officer must notify the parties, in writing, of any requests or orders made by the hearing officer, including that for submission of documents. If the hearing officer requests the submission of documents, then the notification must include a statement that each party must provide a copy of all documents submitted to the hearing officer to the other parties within a time period specified by the hearing officer.

(g) The hearing officer may not orally announce the decision of the hearing on the date of the hearing unless the hearing officer intends to issue a written decision on that day.

Comments

Source Note: The provisions of this §4.159 adopted to be effective December 27, 2000, 25 TexReg 12785; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.160: Hearing Officer's Decision

(a) Within 10 working days after the hearing, the hearing officer must send a written decision to all parties that includes:

(1) findings of fact, the reasons for those findings, and conclusions of law;

(2) a statement that to appeal the decision, a party must file an appeal with the county court of Travis County or county in which the individual resides within 30 calendar days of the date of the written decision; and

(3) a statement that the decision is final on the 31st calendar day after the date of the written decision, unless an appeal is timely filed.

(b) A party may appeal the hearing officer's decision without filing a motion for rehearing with the hearing officer.

(c) An appeal is by trial de novo.

(d) A party may not take action on the hearing officer's decision if an appeal is filed.

Comments

Source Note: The provisions of this §4.160 adopted to be effective December 27, 2000, 25 TexReg 12785; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.161: References

Reference is made to the following statutes and TDMHMR rules:

(1) Texas Health and Safety Code, Title 7, Subtitle D; Title 7, Chapter 534, Subchapter A; §592.019; §593.005; §593.008; §594.011; §594.012; and §594.014;

(2) Texas Government Code, Chapter 2001;

(3) §415.755(h) of this title (relating to Determination of Mental Retardation (DMR);

(4) §412.271(b) of this title (relating to Transfer of an Individual Between State MR Facilities);

(5) §412.279 of this title (relating to Discharge from a State MR Facility of an Individual Who Moves to an Alternate Living Arrangement);

(6) §412.280 of this title (relating to Administrative Discharges Initiated by a State MR Facility); and

(7) §412.282 of this title (relating to Review by Local MRA of Individual in a Community Living Arrangement).

Comments

Source Note: The provisions of this §4.161 adopted to be effective December 27, 2000, 25 TexReg 12785; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.162: Distribution

This subchapter shall be distributed to:

(1) members of the Texas MHMR Board;

(2) executive, management, and program staff at Central Office;

(3) superintendents/directors of all state MR facilities;

(4) executive directors of all mental retardation authorities; and

(5) advocacy organizations.

Comments

Source Note: The provisions of this §4.162 adopted to be effective December 27, 2000, 25 TexReg 12785; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

Subchapter K

§4.501: Purpose

The purpose of this subchapter is to protect consumers at a facility, local authority, community center, or contract provider of residential services, and the property of those consumers. To do so, this subchapter:

(1) describes the process by which criminal history clearances are conducted for applicants for employment or volunteer status with facilities, local authorities, community centers, and contract providers of residential services;

(2) requires facilities, local authorities, community centers, and contract providers of residential services to have an effective self-reporting procedure for employees and volunteers; and

(3) describes the process by which registry clearances are conducted for applicants for employment or volunteer status with facilities, local authorities, community centers, and contract providers of residential services.

Comments

Source Note: The provisions of this §4.501 adopted to be effective February 6, 2002, 27 TexReg 749; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.502: Application

(a) This subchapter applies to:

(1) facilities (which include TDMHMR Central Office);

(2) local authorities; and

(3) community centers.

(b) Facilities, local authorities, and community centers must require their contract providers of residential services, including residences certified by the intermediate care facilities for the mentally retarded or persons with a related condition (ICF/MR or ICF/MR/RC) program that are owned and operated by a local authority or community center, to comply with the applicable provisions of this subchapter.

(c) This subchapter does not apply to residences certified by the ICF/MR or ICF/MR/RC program that are owned by a local authority or community center but operated under contract by a private provider, or that are privately owned and operated. Criminal history and registry clearances are conducted for such residences in accordance with rules of the Texas Department of Human Services (TDHS) in 40 TAC §§76.101- 76.106.

Comments

Source Note: The provisions of this §4.502 adopted to be effective February 6, 2002, 27 TexReg 749; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.503: Definitions

The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:

(1) Applicant--At the employer's discretion, either a person who is one of a select number of final candidates for a position as an employee or volunteer or a person to whom the employer intends to offer a position as an employee or volunteer. The term "applicant" does not include a member of the Texas MHMR Board, a member of a local authority's or community center's board of trustees, or a member of a facility's, local authority's, or community center's advisory committee that is not a public responsibility committee (PRC).

(2) Community center--A community mental health and mental retardation center established under the Texas Health and Safety Code, Title 7, Chapter 534, Subchapter A.

(3) Consumer--An individual receiving services from a facility, local authority, community center, or contract provider of residential services.

(4) Conviction--The adjudication of guilt, plea of guilty or nolo contendere, or the assessment of probation or community supervision for a violation of the Penal Code.

(5) Facility--Any state hospital, state school, or state center operated by TDMHMR, or TDMHMR Central Office.

(6) Local authority--An entity designated by the TDMHMR commissioner in accordance with the Texas Health and Safety Code, §533.035(a).

(7) Provider--Any entity or person who contracts with a facility, local authority, or community center to deliver residential services to individuals with mental illness or mental retardation who have been furloughed or discharged from a facility or community center as described in the Texas Government Code, §411.115(b). This does not include private ICF/MR or ICF/MR/RC providers.

(8) Professional clinical intern--A person who is enrolled in a formal clinical rotation at a university/college in a professional training program accredited by the appropriate licensing authority or board of examiners, or is engaged in a recognized graduate level, clinical professional degree program. Professional degree programs include, but are not limited to, clinical psychology, dentistry, medicine, nursing, occupational therapy, pharmacy, physical therapy, psychiatry, and social work.

(9) Registry--

(A) The Nurse Aide Registry maintained by the Texas Department of Human Services in accordance with §94.11 of Title 40 (relating to Registry, Findings, Inquiries); and

(B) the Employee Misconduct Registry maintained by the Texas Department of Human Services in accordance with the Texas Health and Safety Code, Chapter 253.

(10) Visiting group--A group of varying individuals associated with an organization (e.g., civic, fraternal, corporate, religious, social, service, or education), which is not affiliated with a facility, local authority, community center, or provider, that visits a facility, local authority, community center, or provider (e.g., tours) or participates in a special event and has constant and adequate staff supervision.

(11) Volunteer--An individual who is not part of a visiting group and who provides time or services to consumers, a facility, local authority, community center, volunteer services council, or provider without compensation from the facility, local authority, community center, volunteer services council, or provider other than reimbursement for actual expenses. The term does not include a professional clinical intern.

(12) Volunteer services council--A 501(c)(3) organization that is formed for the purpose of generating resources on behalf of a facility, local authority, or community center.

Comments

Source Note: The provisions of this §4.503 adopted to be effective February 6, 2002, 27 TexReg 749; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.504: Pre-employment and Pre-assignment Clearance

(a) Each facility, local authority, community center, and provider must conduct:

(1) a pre-employment criminal history and registry clearance of all applicants (as defined) for employment; and

(2) a pre-assignment criminal history and registry clearance of all applicants for volunteer status.

(b) A provider that is required to conduct criminal history and registry clearances in accordance with the Texas Health and Safety Code, Chapter 250, must provide evidence of compliance with that law to the facility, local authority, or community center with which it contracts.

(c) For professional clinical interns, a written agreement must exist between the facility, local authority, or community center and the university/college. The written agreement must include:

(1) a statement that responsibility for the care of consumers is retained by the facility, local authority, or community center;

(2) a statement that background checks of professional clinical interns must ensure compliance with subsection (d) of this section; and

(3) a description of how background checks of professional clinical interns will be conducted and funded.

(d) The following individuals may not be employed by, assigned volunteer status at, or serve as a professional clinical intern at, a facility, local authority, community center, or provider:

(1) an individual who has been convicted of any of the criminal offenses listed in subsection (g) of this section;

(2) an individual who has been convicted of a criminal offense that the facility, local authority, community center, or provider has determined to be a contraindication to employment or volunteer status at that entity;

(3) an individual who is listed as revoked in the Nurse Aide Registry; or

(4) an individual who is listed as unemployable in the Employee Misconduct Registry.

(e) The facility, local authority, community center, or provider must inform applicants in writing at the time that application is made of the following:

(1) that a pre-employment/pre-assignment criminal history and registry clearance will be conducted;

(2) the types of criminal offenses for which a conviction would bar employment or volunteer status as required by law;

(3) that conviction of other types of criminal offenses may be considered a contraindication to employment or volunteer status at that entity; and

(4) that being listed as revoked in the Nurse Aide Registry or being listed as unemployable in the Employee Misconduct Registry would bar employment or volunteer status.

(f) An applicant who is not listed as revoked in the Nurse Aide Registry and who is not listed as unemployable in the Employee Misconduct Registry may be employed on a temporary or interim basis pending a criminal history clearance if an emergency exists in which there is a risk to the health and safety of consumers as a result of unfilled positions or in which the operations of the organization are severely impaired as determined by the chief executive officer of the facility, local authority, community center, or provider.

(1) The applicant must furnish the employer with an affidavit stating that the applicant has not been convicted of any of the criminal offenses listed in subsection (g) of this section or any criminal offense that the employer has determined is a contraindication to employment. The affidavit will be kept in the applicant's file. A sample affidavit may be obtained by contacting Human Resource Services, TDMHMR, P.O. Box 12668, Austin, Texas 78711-2668.

(2) Within 72 hours of the time the person is employed on a temporary or interim basis, the facility, local authority, community center, or provider must initiate a criminal history clearance of that person as described in §414.505 of this title (relating to Obtaining or Requesting Criminal History Record Information and Checking Registry).

(3) If the criminal history record information reveals a conviction for any of the criminal offenses listed in subsection (g) of this section or for any criminal offense that the employer has determined is a contraindication to employment, then the facility, local authority, community center, or provider must immediately discharge the person as unemployable.

(4) An applicant may not receive volunteer assignment on a temporary or interim basis pending a criminal history clearance.

(g) Consistent with the Texas Health and Safety Code, §250.006, convictions of criminal offenses which constitute an absolute bar to employment are:

(1) criminal homicide (Penal Code, Chapter 19);

(2) kidnapping and unlawful restraint (Penal Code, Chapter 20);

(3) indecency with a child (Penal Code, §21.11);

(4) sexual assault (Penal Code, §22.011);

(5) aggravated assault (Penal Code, §22.02);

(6) injury to a child, elderly individual, or disabled individual (Penal Code, §22.04);

(7) abandoning or endangering a child (Penal Code, §22.041);

(8) aiding suicide (Penal Code, §22.08);

(9) agreement to abduct from custody (Penal Code, §25.031);

(10) sale or purchase of a child (Penal Code, §25.08);

(11) arson (Penal Code, §28.02);

(12) robbery (Penal Code, §29.02);

(13) aggravated robbery (Penal Code, §29.03);

(14) a conviction under the laws of another state, federal law, or the Uniform Code of Military Justice for an offense containing elements that are substantially similar to the elements of an offense listed under paragraphs (1) - (13) of this subsection; and

(15) a conviction which occurred within the previous five years for:

(A) assault that is punishable as a Class A misdemeanor or as a felony (Penal Code, §22.01);

(B) burglary (Penal Code, §30.02);

(C) theft that is punishable as a felony (Penal Code, Chapter 31);

(D) misapplicateion of fiduciary property or property of a financial institution that is punishable as a Class A misdemeanor or felony (Penal Code, §32.45); or

(E) securing execution of a document by deception that is punishable as a Class A misdemeanor or a felony (Penal Code, §32.46).

Comments

Source Note: The provisions of this §4.504 adopted to be effective February 6, 2002, 27 TexReg 749; amended to be effective September 1, 2003, 28 TexReg 6885; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.505: Obtaining or Requesting Criminal History Record Information and Checking Registry

(a) Facilities must obtain criminal history record information directly from the Texas Department of Public Safety (TDPS) by contacting Crime Records Services, TDPS, P.O. Box 4143, Austin, TX 78765-4143.

(b) Local authorities and community centers may:

(1) pay a private agency to obtain criminal history record information directly from TDPS; or

(2) obtain criminal history record information directly from the Texas Department of Public Safety (TDPS) by contacting Crime Records Services, TDPS, P.O. Box 4143, Austin, TX 78765-4143.

(c) In addition to obtaining criminal history record information from TDPS, facilities, local authorities, community centers, and providers must obtain criminal history information for applicants who have lived outside the State of Texas at any time during the two years preceding the application for employment/volunteer status through the FBI using a complete set of fingerprints on the official FBI card. The FBI charges for this information. The official FBI card may be obtained from Human Resource Services, TDMHMR, P.O. Box 12668, Austin, TX 78711-2668.

(d) A provider that is not required to conduct criminal history clearances in accordance with the Texas Health and Safety Code, Chapter 250, must obtain criminal history record information through the facility, local authority, or community center with which it contracts.

(e) Facilities, local authorities, community centers, and providers must check the Employee Misconduct Registry and the Nurse Aide Registry by calling 1-800-452-3934.

Comments

Source Note: The provisions of this §4.505 adopted to be effective February 6, 2002, 27 TexReg 749; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.506: Criminal History Record Information and Registry Information

(a) Facilities, local authorities, community centers, and providers will have written policies and procedures consistent with this subchapter that describe how information obtained through a criminal history and registry clearance will be processed and later destroyed. The policies and procedures must include:

(1) processes that protect the confidentiality of criminal history record information pursuant to the Texas Health and Safety Code, §250.007;

(2) the process for notifying an applicant if:

(A) the applicant's criminal history record information identifies a conviction barring, or a contraindication to, employment or volunteer status; or

(B) the applicant is listed as revoked in the Nurse Aide Registry or is listed as unemployable in the Employee Misconduct Registry;

(3) information on how an applicant can address inaccuracies in criminal history record information (i.e., the opportunity to be heard by Texas Department of Public Safety (TDPS), pursuant to Texas Health and Safety Code, §250.005(b)) if the applicant believes he/she has been unjustly denied employment or volunteer status as a result of inaccurate criminal history record information; and

(4) procedures for destroying all criminal history record information obtained in accordance with this subchapter after an employment/volunteer decision has been made or personal action has been taken, as required by the Texas Government Code, §411.115(e).

(b) If an applicant's criminal history record information identifies a conviction barring employment or volunteer status or if the applicant is listed as revoked in the Nurse Aide Registry or is listed as unemployable in the Employee Misconduct Registry, then the applicant must be notified in writing of the following:

(1) the existence of the TDPS or FBI record of the conviction or the registry listing;

(2) the applicant's ineligibility for employment or volunteer status because of the conviction or registry listing; and

(3) how to address possible inaccuracies in criminal history record information (i.e., the opportunity to be heard by Texas Department of Public Safety (TDPS), pursuant to Texas Health and Safety Code, §250.005(b)) or how to address a possibly inaccurate registry listing (i.e., by calling TDHS registry administrators at 1-800-458-9858).

Comments

Source Note: The provisions of this §4.506 adopted to be effective February 6, 2002, 27 TexReg 749; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.507: Self-Reporting and Subsequent Criminal History and Registry Checks

(a) Upon the effective date of this subchapter, each facility, local authority, community center, and provider must initiate a registry check of all current employees and volunteers. If an employee/volunteer is listed as revoked in the Nurse Aide Registry or listed as unemployable in the Employee Misconduct Registry, then the employer must immediately discharge the employee or volunteer.

(b) Following employment with or assignment of volunteer status at a facility, local authority, community center, or provider, all employees and volunteers must report to a person designated by that facility, local authority, community center, or provider:

(1) any subsequent convictions or offenses for which they are charged; and

(2) a subsequent listing as revoked in the Nurse Aide Registry or listing as unemployable in the Employee Misconduct Registry.

(c) A facility, local authority, community center, or provider may conduct subsequent criminal history and registry checks on any employee or volunteer at any time it deems appropriate.

(d) Each facility, local authority, community center, and provider must develop written policies and procedures consistent with this subchapter describing how it will respond to information obtained through self-reporting and subsequent criminal history and registry checks.

(1) Pursuant to the Texas Health and Safety Code, §533.007(b), adverse personnel action may not be taken if the information received pertains to arrest warrants or wanted persons' notices. However, the employer may reassign the employee/volunteer to a non-direct care area until resolution of the matters relating to the arrest warrant or wanted persons' notice.

(2) If the information reflects a conviction for an offense listed in §414.504(g) of this title (relating to Pre-employment and Pre-assignment Clearance), then consideration may be given to any contention by the employee/volunteer concerning errors of fact or identity in the criminal history record information. While the employee/volunteer is attempting to rectify the accuracy of the information, the employer must remove the employee/volunteer from direct contact with consumers. If the employee or volunteer fails to rectify the accuracy of the information, as provided by Texas Health and Safety Code, §250.005(b), then the employer must immediately discharge the employee or volunteer.

(3) If the information reflects a conviction for an offense determined to be a contraindication to employment or volunteer status, then consideration may be given to any contention by the employee/volunteer concerning errors of fact or identity in the criminal history record information. While the employee/ volunteer is attempting to rectify the accuracy of the information, the employer may remove the employee/volunteer from direct contact with consumers. If the employee or volunteer fails to rectify the accuracy of the information, as provided by Texas Health and Safety Code, §250.005(b), then the employer must immediately discharge the employee or volunteer.

(4) If the information indicates the employee/volunteer is listed as revoked in the Nurse Aide Registry or listed as unemployable in the Employee Misconduct Registry, then the employer must immediately discharge the employee or volunteer.

Comments

Source Note: The provisions of this §4.507 adopted to be effective February 6, 2002, 27 TexReg 749; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.508: References

The following documents were referenced in this subchapter:

(1) 40 TAC §§76.101-76.106 and §94.11;

(2) Texas Health and Safety Code, Chapters 250, 253, and 534, and §533.007 and §533.035;

(3) Texas Government Code, §411.115; and

(4) Penal Code, Chapters 19-22, 25, 28-29, and 31.

Comments

Source Note: The provisions of this §4.508 adopted to be effective February 6, 2002, 27 TexReg 749; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.509: Distribution

(a) This subchapter will be distributed to:

(1) members of the Texas MHMR Board;

(2) executive, management, and program staff at TDMHMR Central Office;

(3) chief executive officers of all facilities, local authorities, and community centers; and

(4) advocacy organizations.

(b) A copy of this subchapter will be made available upon request to:

(1) any person who applies for employment or volunteer status with TDMHMR, a local authority, community center, or provider;

(2) any employee or volunteer of TDMHMR, a local authority, community center, or provider;

(3) the counsel of record of an applicant, employee, or volunteer; and

(4) any interested person.

Comments

Source Note: The provisions of this §4.509 adopted to be effective February 6, 2002, 27 TexReg 749; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

Subchapter L

§4.551: Purpose

The purpose of this subchapter is to implement §48.255(c) of the Human Resources Code, which requires TDMHMR to develop joint rules with the Texas Department of Protective and Regulatory Services (TDPRS) to facilitate investigations in local authorities and community centers and to describe the requirements for:

(1) reporting allegations of abuse, neglect, and exploitation of persons served;

(2) ensuring the safety and protections of persons served involved in allegations;

(3) facilitating investigations; and

(4) ensuring proper disciplinary or other action is taken when abuse, neglect, or exploitation is confirmed.

Comments

Source Note: The provisions of this §4.551 adopted to be effective July 1, 2001, 26 TexReg 4708; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.552: Application

(a) This subchapter applies to local authorities and community centers. However, local authorities and community centers that are Medicaid providers of a home and community-based services waiver program must comply with TDMHMR rules governing the home and community-based services waiver program when addressing abuse, neglect, and exploitation in the home and community-based services waiver program.

(b) Local authorities and community centers are responsible for amending their contracts to ensure contractors' compliance with this subchapter.

Comments

Source Note: The provisions of this §4.552 adopted to be effective July 1, 2001, 26 TexReg 4708; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.553: Definitions

The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:

(1) Abuse--For purposes of reporting allegations, the term is defined by the investigatory agency. For purposes of classifying allegations as part of the TDMHMR Client Abuse and Neglect Reporting System (CANRS), the term is defined in CANRS Definitions, which is referenced as Exhibit A of §414.562 of this title (relating to Exhibits).

(2) Administrator--The individual in charge of a local authority or community center, or designee.

(3) Agent--Any individual not employed by a local authority, community center, or contractor, but working under the auspices of the local authority, community center, or contractor (e.g., student, volunteer).

(4) Allegation--A report by an individual suspecting or having knowledge that a person served has been or is in a state of abuse, neglect, or exploitation as defined by the investigatory agency or in CANRS Definitions, which is referenced as Exhibit A in §414.562 of this title.

(5) Clinical practice--Relates to the demonstration of professional competence by a licensed professional.

(6) Community center--A community mental health center, community mental retardation center, or community mental health and mental retardation center, established under the Texas Health and Safety Code, Title 7, Chapter 534, Subchapter A.

(7) Confirmed--The finding of an investigation if there is a preponderance of credible evidence to support that abuse, neglect, or exploitation occurred.

(8) Contractor--Any organization, entity, or individual who contracts with a local authority or community center to provide mental health or mental retardation services to a person served. The term includes a local independent school district with which a local authority or community centers has a memorandum of understanding (MOU) for educational services.

(9) Contractor CEO--The individual in charge of a contractor that has one or more employees excluding the CEO.

(10) Exploitation--For purposes of reporting allegations, the term is defined by the investigatory agency. For purposes of classifying allegations as part of the TDMHMR CANRS, the term is defined in CANRS Definitions, which is referenced as Exhibit A in §414.562 of this title.

(11) Investigatory agency--An agency with statutory authority to investigate abuse, neglect, and exploitation of a person served by a local authority, community center, or contractor. For example, the Texas Department of Protective and Regulatory Services investigates allegations in local authorities and community centers (including intermediate care facilities for the mentally retarded or persons with a related condition (ICF/MR or ICF/MR/RC) operated by a local authority or community center) and all contractors of local authorities and community centers except psychiatric hospitals; the Texas Department of Health (TDH) investigates allegations in psychiatric hospitals; and the Texas Commission on Alcohol and Drug Abuse (TCADA) investigates allegations in TCADA-funded programs operated by a local authority or community center pursuant to a contract with TCADA.

(12) Local authority--An entity designated by the TDMHMR commissioner in accordance with the Texas Health and Safety Code, §533.035(a).

(13) Neglect--For purposes of reporting allegations, the term is defined by the investigatory agency. For purposes of classifying allegations as part of the TDMHMR CANRS, the term is defined in CANRS Definitions, which is referenced as Exhibit A in §414.562 of this title.

(14) Perpetrator--An individual who has committed an act of abuse, neglect, or exploitation.

(15) Person served--

(A) Any person with mental illness or mental retardation receiving services from a local authority or community center or through a contract with a local authority or community center who is registered or assigned in the Client Assignment and Registration (CARE) system; or

(B) any child or disabled person as defined in the Human Resources Code, Chapter 48, who is otherwise receiving services from a local authority or community center or through a contract with a local authority or community center.

(16) Professional review--A review of clinical and/or professional practice(s) by peer professionals.

(17) Retaliatory action--Any action intended to inflict emotional or physical harm or inconvenience on an employee, agent, or person served that is taken because he or she has reported abuse, neglect, or exploitation. Retaliatory action includes, but is not limited to, harassment, disciplinary measures, discrimination, reprimand, threat, and criticism.

Comments

Source Note: The provisions of this §4.553 adopted to be effective July 1, 2001, 26 TexReg 4708; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.554: Responsibilities of Local Authorities, Community Centers, and Contractors

(a) Promulgate and implement policies and procedures. Each local authority and community center shall promulgate and implement policies and procedures that meet the requirements of this section.

(b) Prohibition of abuse, neglect, and exploitation. Each local authority, community center, and contractor shall ensure that its employees and agents are informed of the prohibition of abuse, neglect, and exploitation of persons served.

(c) Identifying programs and investigatory agencies.

(1) Each local authority, community center, and contractor shall ensure that the name and phone number of the investigatory agency are clearly identified and displayed for its employees and agents at each of its program and service delivery sites.

(2) Each local authority and community center shall provide to each investigatory agency a list of the names and addresses of its contracted and non-contracted program and service delivery sites in the investigatory agency's purview, including the name of the staff who will serve as contact for investigators, as required in subsection (g)(1) of this section.

(d) Reporting abuse, neglect, and exploitation and securing evidence.

(1) Each local authority, community center, and contractor shall require its employees and agents who suspect or have knowledge of abuse, neglect, or exploitation of a person served to:

(A) make a verbal report to the investigatory agency immediately, but in no case more than one hour after suspicion or knowledge of the abuse, neglect, or exploitation, in compliance with existing state laws, rules, memorandums of understanding, and this subchapter;

(B) as needed, assist any individual in making a report when the individual alleging abuse, neglect, or exploitation is not an employee or agent, (e.g., a person served, a guest); and

(C) secure evidence related to the allegation in accordance with "Guidelines for Securing Evidence" referenced as Exhibit B in §414.562 of this title (relating to Exhibits).

(2) Failure to make reports of abuse, neglect, or exploitation immediately without sufficient justification is considered a violation of this section and makes the employee or agent subject to disciplinary or other appropriate action and possible criminal prosecution.

(3) In addition to the reporting requirement described in paragraph (1)(A) of this subsection, reports regarding alleged sexual exploitation committed by a mental health services provider are made to the prosecuting attorney in the county in which the alleged sexual exploitation occurred and any state licensing board that has responsibility for the mental health services provider's licensing in accordance with the Texas Civil Practice and Remedies Code, §81.006. A copy of the Texas Civil Practice and Remedies Code, §81.006, and §81.001, which includes the definitions of "sexual exploitation" and "mental health services provider," is referenced as Exhibit C in §414.562 of this title (relating to Exhibits).

(e) Notifying contractor CEO. If the administrator is notified of an allegation involving a contractor, then the administrator must immediately notify the contractor CEO of the allegation unless the contractor CEO is the alleged perpetrator. If the contractor CEO is the alleged perpetrator, then the administrator shall ensure the activities described in subsections (f), (h), and (i) are accomplished.

(f) Safeguarding the alleged victim. Immediately upon notification of an allegation by the investigatory agency the administrator or contractor CEO shall ensure necessary measures are taken to secure the safety of the alleged victim(s) involved in the allegation, including:

(1) ensuring immediate and on-going medical and psychological attention is provided to the alleged victim(s), as necessary; and

(2) separating the alleged victim(s) from the alleged perpetrator(s) until an investigation has been completed.

(g) Prohibiting retaliatory action. Any employee or agent, or any individual affiliated with an employee or agent is prohibited from engaging in retaliatory action against an employee, agent, or person served who in good faith reports an allegation. Any employee or agent found to have engaged in retaliatory action is subject to disciplinary or other appropriate action.

(1) Any employee or agent who believes he or she is being subjected to retaliatory action upon making a report of abuse, neglect, or exploitation, or who believes an allegation has been ignored without cause, should immediately contact the administrator or contractor CEO and may also contact the Office of Consumer Services and Rights Protection - Ombudsman at TDMHMR's Central Office, at the toll free number 1-800-252-8154.

(2) Retaliatory action against a person served which might be considered abuse, neglect, or exploitation must be reported in accordance with this section.

(h) Facilitating investigations.

(1) Administrators and contractor CEOs shall ensure the designation of a contact staff at each program and service delivery site who will be responsible for coordinating with the investigator to ensure the availability of and access to private interview space, private telephones, and employees, agents, and persons served.

(2) Administrators and contractor CEOs shall require employees and agents to cooperate with investigators so that investigators are afforded immediate access to persons served, employees, agents, records of persons served, and other documents requested by the investigator.

(3) Falsification of fact during an investigation is considered a violation of this section and makes the employee or agent subject to disciplinary or other appropriate action and possible criminal prosecution.

(i) Referring allegations involving clinical practice. If the investigator refers to the administrator or contractor CEO an allegation involving the clinical practice of a licensed professional, then the administrator or contractor CEO shall refer the allegation for professional review or, if the local authority, community center, or contractor does not have a professional review process, the administrator or contractor CEO shall refer the allegation to the appropriate licensing authority. The administrator or contractor CEO shall ensure relevant conclusions of a professional review are submitted to the appropriate licensing authority.

(j) Facilitating resolution of other issues.

(1) Administrators and contractor CEOs shall ensure that general complaints and administrative issues that are referred to them by an investigator are reviewed and resolved in a timely manner.

(2) Local authorities, community centers, and contractors shall afford TDMHMR immediate access to persons served, employees, agents, records of persons served, and other documents when TDMHMR responds to a complaint that the health, welfare, or safety of a person served may be jeopardized.

Comments

Source Note: The provisions of this §4.554 adopted to be effective July 1, 2001, 26 TexReg 4708; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.555: Information to Be Provided to Victim or Alleged Victim and Others

(a) Each local authority and community center shall promulgate and implement policies and procedures that meet the requirements of this section.

(b) As soon as possible, but no later than 24 hours following notification of an allegation by the investigatory agency, the administrator or contractor CEO shall notify the alleged victim and the alleged victim's guardian or parent (if the alleged victim is a minor) of the allegation.

(c) The administrator or contractor CEO shall ensure that the victim or alleged victim, guardian, or parent (if the victim or alleged victim is a minor) is notified of:

(1) the finding and any decisions made after review and/or appeal of the finding;

(2) the method to appeal the finding, if any;

(3) how to receive a copy of the investigative report; and

(4) if the allegation is confirmed, the disciplinary or other action taken against the perpetrator.

Comments

Source Note: The provisions of this §4.555 adopted to be effective July 1, 2001, 26 TexReg 4708; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.556: Investigations Conducted by the Texas Department of Protective and Regulatory Services (TDPRS)

(a) TDPRS submits a copy of the investigative report to the administrator or contractor CEO or both in accordance with Chapter 711 of Title 40 (relating to Investigations in TDMHMR Facilities and Related Programs).

(b) The administrator or contractor CEO may not change a confirmed finding made by a TDPRS investigator. The administrator or contractor CEO may request a review of the finding or the methodology used to conduct the investigation in accordance with Chapter 711 of Title 40 (relating to Investigations in TDMHMR Facilities and Related Programs).

Comments

Source Note: The provisions of this §4.556 adopted to be effective July 1, 2001, 26 TexReg 4708; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.557: Disciplinary and Other Action

(a) Each local authority and community center shall promulgate and implement policies and procedures that meet the requirements of this section.

(b) Administrators and contractor CEOs must take appropriate disciplinary or other action in confirmed cases of abuse, neglect, and exploitation involving employees and agents.

(1) If the investigatory agency has a process by which the administrator or contractor CEO can request a review of the finding and a review is requested, then the outcome of the review is final and forms the basis for disciplinary action.

(2) If the investigatory agency does not have a process by which the administrator or contractor CEO can request a review of the finding, the investigatory agency's finding is final and forms the basis for disciplinary action.

(c) Nothing in this subchapter precludes an administrator or contractor CEO from taking disciplinary or other appropriate action pending investigation, including termination of employment. If disciplinary or other action is taken before the investigation is complete, then the executive director or CEO shall notify the investigator of such action and the investigation continues.

(d) Administrators and contractor CEOs shall ensure that disciplinary or other appropriate action, including seeking criminal prosecution as appropriate, is taken when an employee or agent fails to make reports immediately without sufficient justification or an employee or agent is found to have made a false statement of fact during an investigation.

Comments

Source Note: The provisions of this §4.557 adopted to be effective July 1, 2001, 26 TexReg 4708; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.558: Data Reporting Responsibilities

If the perpetrator or alleged perpetrator is an employee or agent of a local authority, community center, or contractor, or the perpetrator is unknown, then the administrator shall ensure that a Client Abuse and Neglect Reporting form (AN-1-A) is completed within 14 calendar days of the receipt of the investigative report or decision made after review or appeal using the CANRS Definitions and the CANRS Classifications. (The Client Abuse and Neglect Reporting form (AN-1-A), the CANRS Definitions, and the CANRS Classifications are referenced as Exhibits E, A, and D, respectively, in §414.562 of this title (relating to Exhibits).) Within one working day after completion of the AN-1-A form, the administrator shall ensure that:

(1) the information contained in the completed AN-1-A is entered into the Client Abuse and Neglect Reporting System (CANRS); or

(2) if access to CANRS is unavailable, a copy of the completed AN-1-A is forwarded for data entry to the Office of Consumer Services and Rights Protection - Ombudsman, TDMHMR, P.O. Box 12668, Austin, TX 78711-2668.

Comments

Source Note: The provisions of this §4.558 adopted to be effective July 1, 2001, 26 TexReg 4708; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.559: Confidentiality of Investigative Process and Report

(a) The reports, records, and working papers used by or developed in the investigative process by an investigatory agency, and the investigatory agency's resulting investigative report, are confidential and may be disclosed only as allowed by law or rule.

(b) Upon request, the administrator or contractor CEO will provide a copy of the investigative report to the victim or alleged victim or guardian with the identities of other persons served and any information determined confidential by law concealed. The administrator or contractor CEO may charge a reasonable fee for providing a copy of the investigative report.

(c) Advocacy, Inc. is entitled to access the records of persons served in accordance with 42 USC §10805 and §10806 or §6042(a)(2)(I) (Protection and Advocacy of Individuals with Mental Illness and Protection and Advocacy of Individuals with Developmental Disabilities). A copy of 42 USC §10805, §10806, and §6042(a)(2)(I) are referenced as Exhibit F in §414.562 of this title (relating to Exhibits).

Comments

Source Note: The provisions of this §4.559 adopted to be effective July 1, 2001, 26 TexReg 4708; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.560: Competency of Employees and Agents

(a) Each local authority, community center, and contractor shall ensure that all employees and agents demonstrate a thorough understanding of the relevant elements of reporting, investigating, and preventing abuse, neglect, and exploitation, before contact with persons served and annually thereafter. The relevant elements of reporting, investigating, and preventing abuse, neglect, and exploitation include:

(1) the acts and signs of possible abuse, neglect, and exploitation;

(2) the prohibition of abuse, neglect, and exploitation of persons served;

(3) the disciplinary consequences for:

(A) committing abuse, neglect, and exploitation;

(B) failing to report abuse, neglect, or exploitation; and

(C) failing to cooperate with an investigation;

(4) the procedures for reporting allegations of abuse, neglect, and exploitation;

(5) the prohibition of retaliatory action and the consequences for engaging in retaliatory action;

(6) the methods for preventing abuse, neglect, and exploitation; and

(7) memoranda of understanding and rules of investigatory agencies.

(b) Each local authority, community center, and contractor shall ensure that employees and agents who will routinely perform any job duty in proximity to persons served demonstrate competency in the safe management of verbally and physically aggressive behavior before contact with persons served and annually thereafter.

(c) Each local authority, community center, and contractor shall ensure that documentation of the competencies of its employees and agents is maintained.

Comments

Source Note: The provisions of this §4.560 adopted to be effective July 1, 2001, 26 TexReg 4708; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.561: Tdmhmr Oversight Responsibilities

The Office of Consumer Services and Rights Protection - Ombudsman in TDMHMR's Central Office is responsible for the maintenance of systems that provide statistical trends in abuse, neglect, and exploitation in local authorities and community centers.

Comments

Source Note: The provisions of this §4.561 adopted to be effective July 1, 2001, 26 TexReg 4708; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.562: Exhibits

The following exhibits are referenced in this subchapter:

(1) Exhibit A--CANRS Definitions;

(2) Exhibit B--"Guidelines for Securing Evidence";

(3) Exhibit C--a copy of the Texas Civil Practice and Remedies Code, §81.001 and §81.006;

(4) Exhibit D--CANRS Classifications;

(5) Exhibit E--Client Abuse and Neglect Report form (AN-1-A); and

(6) Exhibit F--a copy of 42 USC §10805, §10806, and §6042(a)(2)(I).

Comments

Source Note: The provisions of this §4.562 adopted to be effective July 1, 2001, 26 TexReg 4708; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.563: References

Reference is made to the following statutes and rules:

(1) Texas Health and Safety Code, Chapter 534, Subchapter A, and §533.035(a);

(2) Texas Civil Practices and Remedies Code, Chapter 81;

(3) Human Resources Code, §48.255(c);

(4) 42 USC §10805, §10806, and §6042(a)(2)(I); and

(5) Texas Administrative Code, Title 40, Chapter 711 (relating to Investigations in TDMHMR Facilities and Related Programs).

Comments

Source Note: The provisions of this §4.563 adopted to be effective July 1, 2001, 26 TexReg 4708; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.564: Distribution

(a) This subchapter shall be distributed to:

(1) members of the Texas MHMR Board;

(2) investigatory agencies;

(3) executive, management, and program staff of Central Office;

(4) administrators of all local authorities and community centers; and

(5) advocacy organizations.

(b) Each administrator is responsible for disseminating copies of this subchapter to:

(1) employees and agents;

(2) contractors; and

(3) any person served or other individual desiring a copy.

(c) Each contractor CEO is responsible for disseminating copies of this subchapter to all employees and agents.

Comments

Source Note: The provisions of this §4.564 adopted to be effective July 1, 2001, 26 TexReg 4708; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

Subchapter P

§4.751: Purpose

The purpose of this subchapter is to establish uniform guidelines for the review, approval, conduct, and oversight of research in facilities that:

(1) ensure the protection of the rights, privacy, and welfare of human subjects involved in research;

(2) provide for the creation and utilization of a designated Institutional Review Board (IRB) for each facility electing to be involved in the conduct of research;

(3) provide for the investigation of allegations of misconduct in science related to research conducted at a facility; and

(4) conform with the requirements of Title 45, Code of Federal Regulations, Part 46 (Protection of Human Subjects), Subparts A, B, and D.

Comments

Source Note: The provisions of this §4.751 adopted to be effective July 5, 2004, 29 TexReg 6093; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.752: Application

This subchapter applies to all research involving:

(1) individuals receiving services from a facility; or

(2) facility resources (e.g., employees, property, and non-public information).

Comments

Source Note: The provisions of this §4.752 adopted to be effective July 5, 2004, 29 TexReg 6093; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.753: Definitions

The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:

(1) Assent--Affirmative agreement of a prospective human subject to participate in research, which is obtained when the subject does not have capacity or legal authority to consent.

(2) Authorization--The written permission given by an individual who is participating in a research study or the individual's LAR to use or disclose certain protected health information related to the research study.

(3) Central Office--TDMHMR's administrative offices in Austin.

(4) Designated institutional review board (IRB)--The IRB, chosen by the facility and approved by the Office of Research Administration in accordance with this subchapter, that will review, approve, and monitor all research to be conducted at the facility.

(5) Facility--A state mental health facility, a state mental retardation facility, or Central Office.

(6) Human subject--Consistent with 45 CFR §46.102(f), referenced as Exhibit A in §414.763 of this title (relating to Exhibits), a living individual about whom a key researcher conducting research obtains:

(A) data through intervention or interaction with the individual; or

(B) identifiable private information.

(7) Individual--A person who has received or is receiving mental health or mental retardation services from a facility.

(8) Informed consent--The knowing approval of an individual or an individual's legally authorized representative (LAR) to participate in a research study, given under the individual's or LAR's ability to exercise free power of choice without undue inducement or any element of force, fraud, deceit, duress, or other form of constraint or coercion.

(9) Institutional review board (IRB)--A board whose membership meets the requirements of §414.755(d) of this title (relating to Designated Institutional Review Board (IRB)), and whose purpose is to review and approve proposed research as well as oversee the conduct of approved research.

(10) Investigation (of misconduct in science)--The formal examination and evaluation of all relevant facts to determine if misconduct in science has occurred.

(11) Investigational medication or device--Any drug, biological product, or medical device under investigation for human use that is not currently approved by the Food and Drug Administration for the indication being studied.

(12) Key researcher--A principal investigator, a co-investigator, or a person who has direct and ongoing contact with human subjects participating in a research study or with prospective human subjects.

(13) Legally authorized representative (LAR)--A person or entity authorized under applicable law to consent on behalf of a prospective human subject to the subject's participation in a research study and to authorize the use or disclosure of protected health information.

(14) Limited data set--Protected health information that excludes the following direct identifiers of an individual or of relatives, employers, or household members of an individual:

(A) names;

(B) postal address information, other than town or city, state, and zip code;

(C) telephone numbers;

(D) fax numbers;

(E) electronic mail addresses;

(F) social security numbers;

(G) medical record numbers;

(H) health plan beneficiary numbers;

(I) account numbers;

(J) certificate/license numbers;

(K) vehicle identifiers and serial numbers;

(L) device identifiers and serial numbers;

(M) Web Universal Resource Locators (URLs);

(N) Internet Protocol (IP) address numbers;

(O) biometric identifiers, including finger and voice prints; and

(P) full face photographic images and comparable images.

(15) Mental health priority population--Persons with mental illness, including severe emotional disturbance, identified in TDMHMR's current strategic plan as being most in need of mental health services.

(16) Mental retardation priority population--Persons with mental retardation identified in TDMHMR's current strategic plan as being most in need of mental retardation services.

(17) Minimal risk--The probability and magnitude of harm or discomfort anticipated in the research are not greater in and of themselves than those ordinarily encountered in daily life or during the performance of routine psychical or psychological examination or tests.

(18) Misconduct in science--The fabrication, falsification, plagiarism, or other practices that seriously deviate from those that are commonly accepted within the scientific community for proposing, conducting, or reporting research. It does not include honest error or honest differences in interpretations or judgments of data.

(19) Notice of Privacy Practices--A written notice describing:

(A) the uses and disclosures of protected health information that may be made by a facility; and

(B) individuals' rights and the facility's legal duties with respect to protected health information.

(20) Office of Research Administration (ORA)--The Central Office department that is responsible for the duties described in §414.762 of this title (relating to Responsibilities of the Office of Research Administration (ORA)).

(21) Principal investigator--The person identified as responsible for conducting a research study.

(22) Privacy coordinator--A member of the workforce of a facility who is responsible for working with the TDMHMR Central Office Privacy Official in developing and implementing the facility's policies and procedures relating to state and federal medical privacy laws.

(23) Protected health information (PHI)--

(A) Any information that identifies or could be used to identify an individual, whether oral or recorded in any form, that relates to:

(i) the past, present, or future physical or mental health or condition of the individual;

(ii) the provision of health care to the individual; or

(iii) the payment for the provision of health care to the individual.

(B) The term includes, but is not limited to:

(i) an individual's name, address, date of birth, or Social Security number;

(ii) an individual's medical record or case number;

(iii) a photograph or recording of an individual;

(iv) statements made by an individual, either orally or in writing, while seeking or receiving services from or through a facility;

(v) any acknowledgment that an individual is seeking or receiving or has sought or received services from or through a facility;

(vi) direct identifiers of relatives, employers, or household members of the individual; and

(vii) any information by which the identity of an individual can be determined either directly or by reference to other publicly available information.

(C) The term does not include:

(i) health information that has been de-identified in accordance with 45 CFR §164.514(b); and

(ii) employment records held by a facility as an employer.

(24) Research--A systematic investigation, including research development, testing and evaluation, designed to develop or contribute to generalizable knowledge. Activities that meet this definition constitute research for purposes of this subchapter whether or not they are conducted or supported under a program which is considered research for other purposes. For example, certain demonstration and service programs may include research activities.

(25) Rights officer--An employee appointed by a facility CEO to protect and advocate for the rights of persons receiving services from the facility.

(26) State mental health facility--A state hospital or a state center with an inpatient component that is operated by TDMHMR.

(27) State mental retardation facility--A state school or a state center with a mental retardation residential component that is operated by TDMHMR.

(28) TDMHMR--The Texas Department of Mental Health and Mental Retardation.

Comments

Source Note: The provisions of this §4.753 adopted to be effective July 5, 2004, 29 TexReg 6093; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.754: General Principles

(a) Participation in research that can advance scientific knowledge of mental disorders and conditions is integral to the mission of TDMHMR.

(b) TDMHMR's guiding principle for all research involving human subjects at its facilities is the protection of the personal rights, safety, well-being, privacy, and dignity of the subjects.

(1) To ensure the protection of human subjects involved in research at its facilities, TDMHMR promulgates this subchapter and adopts by reference Title 45, Code of Federal Regulations, Part 46 (Protection of Human Subjects), Subparts A, B, and D, referenced as Exhibit A in §414.763 of this title (relating to Exhibits).

(2) To ensure ethical principles are maintained when research involving human subjects is conducted at its facilities, TDMHMR adopts by reference "The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research, Report of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research" (April 18, 1979), referenced as Exhibit B in §414.763 of this title.

(3) To ensure all research undertaken at its facilities is conducted with a fundamental commitment to high ethical standards regarding the conduct of scientific research, TDMHMR adopts by reference 42 CFR Part 50, Subpart A, (Responsibility of PHS Awardee and Applicant Institutions for Dealing With and Reporting Possible Misconduct in Science), referenced as Exhibit C in §414.763 of this title.

(4) To protect the privacy of human subjects involved in research at its facilities, TDMHMR adopts by reference the Federal Standards for Privacy of Individually Identifiable Health Information, Title 45, Code of Federal Regulations, Part 160 and Part 164, Subparts A and E, promulgated by the U.S. Department of Health and Human Services pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

(c) TDMHMR is committed to research conducted in a manner that is consistent with the best interests and protection of personal rights and welfare of human subjects involved in the research.

(1) An individual may not be approached to participate in a research study if the research conflicts with the individual's treatment goals.

(2) No research involving human subjects may be conducted unless the risks to human subjects are minimized and are reasonable in relation to the anticipated benefits.

(3) No undue inducement or coercion may be used to influence human subjects to participate in a research study.

(4) Unless scientifically justified, individuals may not be excluded from participating in research on the basis of personal characteristics, such as race, color, ethnicity, national origin, religion, sex, age, disability, sexual orientation, or political affiliation.

(5) Human subject participation in research studies must be equitable with measures taken to ensure the research sample is adequately representative of the population of interest. Within the population of interest subject selection procedures must offer equitable opportunity for access to participation in research and access to potential benefits of participation.

(6) Individuals receiving mental health services under an order of protective custody pursuant to the Texas Health and Safety Code, Chapter 574, may not be approached about participation in a research study involving an investigational medication or device prior to the entry of an order for temporary or extended mental health services.

(7) Research may not be conducted with human subjects who are involuntarily committed if the research involves:

(A) placebos as the primary medication therapy;

(B) medication or doses of medication as the primary medication therapy which are known to be ineffective for the targeted disorder or condition; or

(C) an investigational medication or device that is proposed to be undertaken when previous research on the medication or device with 100 human subjects or fewer has provided minimal or no documentation of the efficacy and safety of the medication or device for the population with the targeted disorder or condition.

(8) Research may not be conducted at a facility if the protocol:

(A) extends the use of a placebo or washout period unreasonably;

(B) deprives the human subject of reasonable relief; or

(C) extends a human subject's use of placebos as the primary medication therapy after the subject is discharged from the facility.

(9) Unless otherwise provided for in this subchapter, research involving human subjects may not be conducted at a facility unless:

(A) the research has been reviewed and approved by the facility's designated IRB in accordance with §414.757 of this title (relating to Review and Approval of Proposed Research);

(B) the facility CEO has agreed to have the research conducted at the facility; and

(C) if required, the necessary assurance and certification has been submitted to the appropriate federal agency, (e.g., Health and Human Services, Food and Drug Administration) and the agency has indicated its approval.

(10) Research conducted at a facility may not hinder the facility's ability to accomplish its primary purpose.

(d) Right to file a complaint.

(1) A human subject involved in research or his/her LAR is entitled to file a complaint about alleged mistreatment or other concerns relating to the research with the facility's rights officer or with any other applicable complaint mechanism in place.

(2) An individual or his/her LAR is entitled to file a complaint about violations of the Federal Standards for Privacy of Individually Identifiable Health Information (45 CFR Part 160 and Part 164, Subparts A and E) with the facility's privacy coordinator, the TDMHMR Consumer Services and Rights Protection/Ombudsman Office, or the Office for Civil Rights at the U.S. Department of Health and Human Services, as set forth in the Notice of Privacy Practices.

Comments

Source Note: The provisions of this §4.754 adopted to be effective July 5, 2004, 29 TexReg 6093; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.755: Designated Institutional Review Board (IRB)

(a) Each facility electing to participate in research must have a designated IRB. The designated IRB is responsible for reviewing, approving, and monitoring all research conducted at that facility, with the exception of research involving multiple facilities as provided by subsection (c) of this section.

(b) A facility may choose one of the following options for its designated IRB, which must be approved by the ORA as outlined in subsection (f) of this section.

(1) Facility IRB. An IRB, established and operated by a facility, whose membership meets the requirements described in subsection (d) of this section.

(2) Another facility's IRB. A facility IRB as described in paragraph (1) of this subsection.

(3) University IRB. An IRB, established and operated by a university, whose membership meets the requirements described in subsection (d) of this section.

(4) Central Office IRB. An IRB, established and operated by Central Office, whose membership meets the requirements described in subsection (d) of this section.

(c) A facility's CEO may request that the Central Office IRB act as the facility's designated IRB for a research study that involves multiple facilities.

(d) The membership of the IRB must comply with the requirements in 45 CFR §46.107, referenced as Exhibit A in §414.763 of this title (relating to Exhibits) and this subsection.

(1) Facility IRB. Membership of a facility IRB must include at least three members who are familiar with the mental disorders or conditions and concerns of the population(s) served by the facility or facilities.

(A) At least one of the three members described in this paragraph must be a professional in the field of mental health or mental retardation, as appropriate to the facility or facilities.

(B) At least two of the three members described in this paragraph must be:

(i) a person who is or has been in the mental health priority population or mental retardation priority population, as appropriate to the facility or facilities;

(ii) a family member of a person who is or has been in the mental health priority population or mental retardation priority population, as appropriate to the facility or facilities; or

(iii) an advocate for persons who are or have been in the mental health priority population or mental retardation priority population, as appropriate to the facility or facilities.

(2) University IRB. Membership of a university IRB must include at least three members or ad hoc members who are familiar with the mental disorders or conditions and concerns of the population(s) served by the facility or facilities.

(A) At least one of the three members described in this paragraph must be a professional in the field of mental health or mental retardation, as appropriate to the facility or facilities.

(B) At least two of the three members described in this paragraph must be:

(i) a person who is or has been in the mental health priority population or mental retardation priority population, as appropriate to the facility or facilities;

(ii) a family member of a person who is or has been in the mental health priority population or mental retardation priority population, as appropriate to the facility or facilities; or

(iii) an advocate for persons who are or have been in the mental health priority population or mental retardation priority population, as appropriate to the facility or facilities.

(3) Central Office IRB. Membership of the Central Office IRB must include local representation from various regions of the state and at least three members who are familiar with the mental disorders or conditions and concerns of the population(s) served by TDMHMR.

(A) At least one of the three members described in this paragraph must be a professional in the field of mental health and mental retardation.

(B) At least two of the three members described in this paragraph must be:

(i) a person who is or has been in the mental health priority population, a family member of a person who is or has been in the mental health priority population, or an advocate for persons who are or have been in the mental health priority population; and

(ii) a person who is or has been in the mental retardation priority population, a family member of a person who is or has been in the mental retardation priority population, or an advocate for persons who are or have been in the mental retardation priority population.

(e) Each IRB must have written policies and procedures that are consistent with this subchapter and TDMHMR's rules governing the care and protection of individuals as described in §414.764(5) of this title (relating to References) and that address:

(1) the functions and operations of the IRB as required by 45 CFR §46.103(b)(4) and (5);

(2) the review or screening process to determine whether proposed research is exempt from the requirements of federal regulations made in accordance with 45 CFR §46.101(b), including required documentation, and any necessary approvals;

(3) the process for ensuring that each IRB member and key researcher involved in an approved research study receives documented training in applicable ethics, laws, and regulations governing research involving human subjects; and

(4) the process for disclosing and considering potential conflicts of interest, financial or otherwise, by IRB members and key researchers.

(f) ORA approval of a designated IRB.

(1) A facility seeking approval for its own facility IRB, another facility's IRB, or a university IRB as its designated IRB, as described in subsection (b)(1), (2), or (3) of this section, must submit the following to the ORA:

(A) IRB membership information in sufficient detail to determine compliance with subsection (d) of this section and which describes each member's chief anticipated contribution to IRB deliberations, and any employment or other relationship between each member and the facility, university, or Central Office, as appropriate;

(B) the written policies and procedures described in subsection (e) of this section;

(C) the written policy for the communication of IRB deliberations, recommendations, and decisions to the facility CEO and the ORA; and

(D) if approval is for a university IRB or another facility's IRB, a copy of the written agreement in which the university IRB or other facility IRB accepts responsibility for reviewing, approving, and monitoring all research to be conducted at the facility seeking approval; and

(E) if approval is for a university IRB, a detailed description of how the facility will collaborate with the university IRB to ensure compliance with any requirement in this subchapter that is unique to TDMHMR (i.e., the duties, activities, and responsibilities of both the facility and the university IRB).

(2) A facility seeking approval for the Central Office IRB as its designated IRB, as described in subsection (b)(4) of this section, must submit a written request from the facility CEO to the ORA.

(g) The ORA shall review the information submitted by the facility and will approve, disapprove, or enter into negotiations to attain approval for the IRB as the facility's designated IRB. The ORA will provide written notice of approval or disapproval to the requesting facility.

(h) Any change in a designated IRB's membership, policies, or procedures must be reported to and approved by the ORA.

(i) The ORA may require that a designated IRB comply with additional requirements related to documentation and approval if the ORA determines that such requirements are necessary to ensure the protection of human subjects.

(j) The ORA may revoke approval of a designated IRB at any time the ORA determines the IRB fails to maintain standards in accordance with federal regulations and this subchapter.

Comments

Source Note: The provisions of this §4.755 adopted to be effective July 5, 2004, 29 TexReg 6093; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.756: Irb Functions and Operations

(a) Each designated IRB shall:

(1) follow its written policies and procedures as described in §414.755(e) of this title (relating to Designated Institutional Review Board (IRB));

(2) function in accordance with 45 CFR §46.108, referenced as Exhibit A in §414.763 of this title (relating to Exhibits);

(3) ensure proposed research is reviewed and approved in accordance with §414.757 of this title (relating to Review and Approval of Proposed Research);

(4) except when an expedited review is used as described in 45 CFR §46.108(b), ensure proposed research is reviewed and approved only at meetings in which at least one of each of the following members are present, participating, and voting:

(A) a member who satisfies the requirements of §414.755(d)(1)(A), (2)(A), or (3)(A) of this title, as appropriate to the IRB; and

(B) a member who satisfies the requirements of §414.755(d)(1)(B), (2)(B), or (3)(B) of this title, as appropriate to the IRB, and in the case of the Central Office IRB, as appropriate to the facility or facilities for which the research is proposed.

(5) exercise appropriate oversight to ensure that:

(A) its policies and procedures designed for protecting the rights, privacy, and welfare of human subjects are being effectively applied; and

(B) research is being conducted at the facility or facilities in accordance with the approved protocol;

(6) maintain records of its operations in accordance with 45 CFR §46.115;

(7) submit to the ORA documentation of its continuing review of all approved and active research protocols; and

(8) immediately notify the ORA of any unanticipated serious problems or events involving risks to the human subjects or others.

(b) Each designated IRB has the authority to suspend or terminate research that is not being conducted in accordance with the IRB's requirements or that has been associated with significant unexpected harm to human subjects. If an IRB suspends or terminates research, then the IRB must promptly notify the following in writing of the suspension or termination and include a statement of the reasons for the IRB's action:

(1) the principal investigator;

(2) appropriate facility or facilities officials; and

(3) the ORA.

Comments

Source Note: The provisions of this §4.756 adopted to be effective July 5, 2004, 29 TexReg 6093; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.757: Review and Approval of Proposed Research

(a) Proposed research must be submitted to the facility's designated IRB and contain adequate written information for the IRB to determine whether the requirements described in 45 CFR §46.111, referenced as Exhibit A in §414.763 of this title (relating to Exhibits), are satisfied, including the following:

(1) A complete description of how the research protocol will be implemented at the facility or facilities, including:

(A) the process for recruiting, screening, and selecting human subjects;

(B) procedures for obtaining and documenting informed consent;

(C) how many subjects are required at the facility or facilities;

(D) the process for and level of clinical monitoring of human subjects throughout the research period;

(E) procedures for obtaining and documenting authorization to use or disclose protected health information (PHI) or a request for a waiver or alteration of authorization with justification; and

(F) appropriate and sufficient information to enable the facility to provide an accounting of disclosures as required in 45 CFR §164.528(b), if the proposed research includes a request for a waiver or alteration of authorization to use or disclose PHI or the proposed research involves using or disclosing decedents' protected health information without an authorization.

(2) A thorough justification of the research protocol and proposed analyses, including;

(A) a description of the procedures designed to minimize risks to subjects; and

(B) the scientific rationale for targeting the proposed population(s) as human subjects.

(3) If the proposed research would extend a human subject's use of an investigational medication or device as the primary treatment after the subject is discharged from the facility, then the research proposal must also contain a memorandum of agreement between the principal investigator and the local authority responsible for the subject's continuity of care which states that, before the conclusion of the subject's participation in the research study, the local authority agrees:

(A) to make face-to-face contact with the subject to determine whether the subject will need medication services when the subject's participation in the research study has ended; and

(B) to arrange for the provision of needed medication services for the subject when the subject's participation in the research study has ended.

(b) Each designated IRB shall review all proposed research at the facility in accordance with 45 CFR §46.109, concerning IRB review of research.

(c) Each designated IRB has the authority to approve, require modifications to, or disapprove any proposed research. Approval of proposed research shall be based on:

(1) consideration of the information described in subsection (a)(1) - (3) of this section;

(2) the IRB's verification that the requirements in 45 CFR §46.111, concerning criteria for IRB approval of research, §414.754 of this title (relating to General Principles), and §414.758 of this title (relating to Informed Consent) are met; and

(3) the IRB's verification that procedures for obtaining and documenting authorization to use or disclose PHI meet the requirements in 45 CFR §164.508, unless:

(A) the IRB approves a waiver or alternation of the authorization requirement as permitted in §414.760(b) of this title (relating to Using and Disclosing Protected Health Information in Research); or

(B) the IRB determines and documents that:

(i) the data needed for the research is contained in a limited data set and the researcher will comply with the requirements in 45 CFR §164.514(e), including the execution of a data use agreement; or

(ii) the data needed for the research is limited to decedents' protected health information and documentation submitted by the researcher meets the requirements in 45 CFR §164.512(i)(1)(iii).

(d) The designated IRB may take into consideration deliberations and reviews from another IRB that has approved the protocol for a specific research proposal, but the designated IRB is ultimately responsible for approval of the proposed research.

(e) Research review and documentation process.

(1) Facility IRB as the designated IRB. The research review and documentation process for a facility IRB, as described in §414.755(b)(1) and (2) of this title (relating to Designated Institutional Review Board (IRB)), is generally as follows.

(A) The research proposal is reviewed by the facility IRB and, if approved, forwarded to the CEO of the facility where the research is to be conducted.

(B) The facility CEO is informed of the facility IRB's approval or disapproval and recommendations, if any.

(C) If the research proposal is approved by the facility IRB, the facility CEO considers the facility IRB's recommendations, if any, and either approves or disapproves the research proposal for implementation at the facility.

(D) If the research proposal is approved, the ORA is notified in writing of the CEO's and IRB's approval including copies of the IRB's meeting minutes concerning the review of the proposal, the proposal itself, and the CEO's and IRB's documentation of approval.

(2) University IRB as the designated IRB. The research review and documentation process for a facility using a university IRB is generally as follows.

(A) The research proposal is screened by the facility CEO and, if determined appropriate for implementation at the facility, forwarded to the university IRB for review.

(B) The research proposal is reviewed by the university IRB.

(C) The facility CEO is informed of the university IRB's approval or disapproval and recommendations, if any.

(D) If the research proposal is approved by the university IRB, the facility CEO considers the university IRB's recommendations, if any, and either approves or disapproves the research proposal for implementation at the facility.

(E) If the research proposal is approved, the ORA is notified in writing of the CEO's and IRB's approval including copies of the IRB's meeting minutes concerning the review of the proposal, the proposal itself, and the CEO's and IRB's documentation of approval.

(3) Central Office IRB as the designated IRB. The research review and documentation process for a facility using the Central Office IRB is generally as follows.

(A) The research proposal is screened by the facility CEO and, if determined appropriate for implementation at the facility, forwarded to the Central Office IRB.

(B) The research proposal is reviewed by the Central Office IRB.

(C) The facility CEO is informed of the Central Office IRB's approval or disapproval and recommendations, if any.

(D) If the research proposal is approved by the Central Office IRB, the facility CEO considers the Central Office IRB's recommendations, if any, and either approves or disapproves the research proposal for implementation at the facility.

(E) If the research proposal is approved, the ORA is notified in writing of the CEO's and IRB's approval including copies of the IRB's meeting minutes concerning the review of the proposal, the proposal itself, and the CEO's and IRB's documentation of approval.

(4) Central Office IRB as a facility's designated IRB for research studies involving multiple facilities. When a facility's CEO requests that the Central Office IRB act as its designated IRB for a research study involving multiple facilities, pursuant to §414.755(c) of this title, then the research review and documentation process is generally as follows.

(A) The research proposal is reviewed and approved by:

(i) each facility CEO;

(ii) the Central Office IRB; and

(iii) the appropriate Central Office director(s), (i.e., director of state mental health facilities or director of state mental retardation facilities).

(B) If the research proposal is approved by the facility CEOs, the Central Office IRB, and the appropriate Central Office director(s), the ORA is notified in writing of the approval, including copies of the IRB's meeting minutes concerning the review of the proposal, the proposal itself, and documentation of approval of the CEOs and the Central Office IRB.

(f) In addition to approval by the designated IRB and facility CEO, review and approval by the TDMHMR medical director is required for any research proposal involving:

(1) a placebo as the primary medication therapy;

(2) medication or doses of medication as the primary medication therapy which are known to be ineffective for the targeted disorder or condition; or

(3) an investigational medication or device.

(g) The review process for proposed research may require additional steps as necessary, (e.g., in the event a proposal is initially rejected).

(h) The facility CEO or designee is responsible for ensuring that all key researchers are qualified to perform any clinical duties assigned to them and are knowledgeable of TDMHMR's rules governing the care and protection of individuals as described in §414.764(5) of this title (relating to References).

Comments

Source Note: The provisions of this §4.757 adopted to be effective July 5, 2004, 29 TexReg 6093; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.758: Informed Consent

Requirements for approval of proposed research.

(1) The procedures for obtaining and documenting informed consent meet the requirements in 45 CFR §46.116 and §46.117, referenced as Exhibit A in §414.763 of this title (relating to Exhibits), and adequately address:

(A) any extension of the subject's length of stay at the facility as a result of participation in the research;

(B) if the research involves an investigational medication or device, the subject's ability to receive the medication or device after the research has concluded;

(C) whether the research involves the use of a placebo and the likelihood of assignment to the placebo condition;

(D) whether the research involves medication or doses of medication which are known to be ineffective for the targeted disorder or condition and the likelihood of assignment to such medication or doses of medication; and

(E) any risk of deterioration in the subject's condition and the potential consequences of such deterioration (e.g., an extension in the length of stay, the use of interventions such as restraint, seclusion, or emergency medications).

(2) For research protocols that present greater than minimal risk, there are procedures to ensure prospective human subjects are adequately assessed for capacity to consent and:

(A) provide for a qualified professional, who is independent of the research study, to assess prospective human subjects for capacity to consent;

(B) describe who will conduct the assessments; and

(C) describe the nature of the assessment and justification if less formal procedures to assess capacity will be used.

(3) If minors are the proposed human subjects, the requirements in 45 CFR §46.408 (concerning Requirements for Permission by Parents or Guardians and for Assent by Children) have been met.

(4) There are procedures to ensure that:

(A) before obtaining consent, each prospective human subject or the subject's LAR understands the information provided; and

(B) if consent is obtained from the subject's LAR, attempts are made, to the extent possible given the prospective subject's capacity, to obtain the subject's assent to participation.

(5) There are adequate safeguards to minimize the possibility of coercion or undue influence. For example, the possible advantages of the subject's participation in the research may not be so valuable as to impair the subject's ability to weigh the risks of the research against those advantages. Possible advantages within the limited choice environment of a facility may include enhancement of general living conditions, medical care, quality of food, or amenities; opportunity for earnings; or change in commitment status.

(6) There are procedures to ensure that a prospective human subject's objection to enrollment in research or a human subject's objection to continued participation in a research protocol is heeded in all circumstances, regardless of whether the subject or the subject's LAR has given consent. Objection may be conveyed verbally, in writing, behaviorally, or by other indications or means. The procedures may, however, provide for a key researcher, with approval of the LAR (if appropriate) and acting with a level of sensitivity to avoid the possibility or the appearance of coercion, to approach an individual who has previously objected to ascertain whether the individual has changed his/her mind or to approach an individual who has not given consent to ascertain whether the individual wants to enroll in the research protocol.

(7) Because informed consent is an ongoing process, there are procedures to ensure that, throughout the course of the research study, human subjects' comprehension and capacity are assessed and enhanced.

Comments

Source Note: The provisions of this §4.758 adopted to be effective July 5, 2004, 29 TexReg 6093; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.759: Research Involving Offenders as Human Subjects

(a) Definition of offender. "Offender" means any individual involuntarily confined or detained in a penal institution, including:

(1) individuals sentenced to a penal institution under criminal or civil statute;

(2) individuals detained in other facilities by virtue of statutes or commitment procedures that provide alternatives to criminal prosecution or incarceration in a penal institution; and

(3) individuals detained pending arraignment, trial, or sentencing.

(b) IRB membership. In addition to the requirements in §414.755(d) of this title (relating to Designated Institutional Review Board (IRB)), membership of an IRB that will review proposed research involving offenders or alleged offenders as human subjects must include at least one member who is an offender advocate or representative with appropriate background and experience to serve in that capacity.

(c) Permitted research. Research at a facility may involve offenders or alleged offenders as human subjects only if, in the judgment of the designated IRB, the proposed research involves solely the following:

(1) study of the possible causes, effects, and processes of criminal commitment or criminal confinement, or of criminal behavior, provided that the study presents no more than minimal risk and no more than inconvenience to the subjects;

(2) study of facilities as institutional structures or of individuals criminally committed to a facility, provided that the study presents no more than minimal risk and no more than inconvenience to the subjects;

(3) research on conditions particularly affecting individuals criminally committed to a facility as a class; or

(4) research on treatments or practices, both innovative and accepted, which have the intent and reasonable probability of improving the health or well-being of the subjects.

Comments

Source Note: The provisions of this §4.759 adopted to be effective July 5, 2004, 29 TexReg 6093; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.760: Using and Disclosing Protected Health Information (PHI) in Research

(a) Except as provided by this section, in order to use or disclose protected health information (PHI), an authorization is required that:

(1) conforms with the requirements of 45 CFR §164.508; and

(2) if the research includes treatment, includes a statement that the subject's right to access his or her PHI created or obtained during the course of research may be temporarily suspended for as long as the research is in progress, and will be reinstated upon completion of the research.

(b) During the review of proposed research, the designated IRB has the authority to approve a waiver or alteration of the authorization requirement in accordance with 45 CFR §164.512(i).

(c) The designated IRB has the authority to approve the use or disclosure of PHI for purposes preparatory to research if the IRB obtains from the researcher adequate representations as required by 45 CFR §164.512(i)(1)(ii).

(d) For a research study approved prior to April 14, 2003, the PHI of a human subject participating in the study may be used or disclosed for the research study if one of the following was obtained prior to April 14, 2003:

(1) an authorization or other express legal permission from the subject or the subject's LAR to use or disclose PHI for the research study;

(2) informed consent of the subject to participate in the research study or informed consent from the subject's LAR for the subject to participate in the research study; or

(3) a waiver of informed consent by the designated IRB for the research study.

Comments

Source Note: The provisions of this §4.760 adopted to be effective July 5, 2004, 29 TexReg 6093; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.761: Investigation of Allegations of Misconduct in Science

(a) All research undertaken at facilities shall be conducted with a fundamental commitment to high ethical standards regarding the conduct of scientific research.

(b) Reports of alleged misconduct in science are made to the ORA, who shall ensure that:

(1) each allegation is reviewed and investigated by an appropriate entity in accordance with 42 CFR 50, Subpart A, referenced as Exhibit C in §414.763 of this title (relating to Exhibits);

(2) the investigating entity submits to the ORA information documenting the disposition of each allegation; and

(3) the following are notified of confirmed incidents of misconduct in science:

(A) the IRB that approved the research protocol; and

(B) the agency funding the research.

Comments

Source Note: The provisions of this §4.761 adopted to be effective July 5, 2004, 29 TexReg 6093; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.762: Responsibilities of the Office of Research Administration (ORA)

The ORA is responsible for:

(1) approving the establishment or utilization of an IRB by a facility as the facility's designated IRB;

(2) providing staff support to the Central Office IRB;

(3) reviewing and developing TDMHMR rules and policies governing the conduct of research at facilities;

(4) maintaining all documentation regarding a designated IRB's review of research for a facility;

(5) receiving reports of misconduct in science, ensuring each allegation of misconduct in science is reviewed and investigated, and maintaining and reporting information regarding misconduct in science as required by the Office of Research Integrity in accordance with 42 CFR 50, Subpart A, referenced as Exhibit C in §414.762 of this title (relating to Exhibits); and

(6) providing technical assistance and interpretation of policies, procedures, TDMHMR rules, and regulations concerning the conduct of research involving human subjects at facilities.

Comments

Source Note: The provisions of this §4.762 adopted to be effective July 5, 2004, 29 TexReg 6093; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.763: Exhibits

The following exhibits are referenced in this subchapter, copies of which are available by contacting TDMHMR, Office of Policy Development, P.O. Box 12668, Austin, TX 78711-2668:

(1) Exhibit A--Title 45, Code of Federal Regulations, Part 46 (Protection of Human Subjects), Subparts A, B, and D;

(2) Exhibit B--"The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research, Report of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research" (April 18, 1979); and

(3) Exhibit C--Title 42, Code of Federal Regulations, Part 50, Subpart A (Responsibility of PHS Awardee and Applicant Institutions for Dealing With and Reporting Possible Misconduct in Science).

Comments

Source Note: The provisions of this §4.763 adopted to be effective July 5, 2004, 29 TexReg 6093; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.764: References

The following statutes and TDMHMR rules are referenced in this subchapter:

(1) Title 45, Code of Federal Regulations, Part 46 (2002) (Protection of Human Subjects), Subparts A, B, and D;

(2) Title 42, Code of Federal Regulations, Part 50, Subpart A (2002) (Responsibility of PHS Awardee and Applicant Institutions for Dealing With and Reporting Possible Misconduct in Science);

(3) Title 45, Code of Federal Regulations, Part 160 and Part 164, Subparts A and E (2002) (Standards for Privacy of Individually Identifiable Health Information);

(4) Texas Health and Safety Code, Chapter 574 and §533.035; and

(5) TDMHMR rules governing the care and protection of individuals, which address:

(A) rights and protection of persons receiving services in TDMHMR facilities;

(B) consent to treatment with psychoactive or psychotropic medication;

(C) interventions involving persons receiving services in TDMHMR facilities; and

(D) abuse, neglect, and exploitation of persons receiving services in TDMHMR facilities.

Comments

Source Note: The provisions of this §4.764 adopted to be effective July 5, 2004, 29 TexReg 6093; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§4.765: Distribution

This subchapter is distributed to:

(1) all members of the Texas Mental Health and Mental Retardation Board;

(2) executive, management, and program staff of Central Office;

(3) CEOs of all facilities; and

(4) advocacy organizations.

Comments

Source Note: The provisions of this §4.765 adopted to be effective July 5, 2004, 29 TexReg 6093; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

Chapter 5

Subchapter A

§5.1: Purpose

(a) The purpose of this subchapter is to establish standards for prescribing psychoactive medication to patients served by the state mental health and mental retardation system in Texas.

(b) This subchapter is not a clinical guide to prescribing psychoactive medication and is not the only source of information concerning related issues of appropriate practice.

(c) Accepted guidelines, as defined in §415.3 of this title (relating to Definitions) supplement the use of this subchapter.

Comments

Source Note: The provisions of this §5.1 adopted to be effective August 31, 2004, 29 TexReg 8325; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§5.2: Application

(a) The provisions of this subchapter apply to the employees and contractors of:

(1) the facilities of the Texas Department of Mental Health and Mental Retardation (TDMHMR); and

(2) TDMHMR local authorities.

(b) The provisions of this subchapter may not apply to prescribing practice in research projects that have been approved in accordance with TDMHMR's policies and procedures concerning the review and approval of research involving human subjects.

Comments

Source Note: The provisions of this §5.2 adopted to be effective August 31, 2004, 29 TexReg 8325; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§5.3: Definitions

The following words and terms, when used in this subchapter, have the following meanings:

(1) Accepted guidelines--The Texas Implementation of Medication Algorithms (TIMA) or an alternative guideline formally approved in writing by the TDMHMR medical director. In cases in which none are formally approved, current professionally recognized clinical guidelines or accepted standards of care are considered the accepted guidelines.

(2) Child psychiatrist--A physician who is certified by the American Board of Psychiatry and Neurology and holds a subspecialty certificate in child and adolescent psychiatry, or who is board eligible, i.e., has an active approved application on file in the board office, or who is currently in training in an approved residency and is supervised by a board eligible or board-certified child and adolescent psychiatrist.

(3) DSM--The current edition of The Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Press.

(4) Legally authorized representative (LAR)--A person authorized by law to act on behalf of an individual with regard to a matter described in this subchapter, who may be a parent, guardian, or managing conservator of a minor, or the guardian of an adult.

(5) Local authority (LA)--The entity designated by TDMHMR to plan, facilitate, coordinate, and ensure the provision of services to individuals with mental illness or mental retardation.

(6) Medication error--Any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional.

(7) Physician--A doctor of medicine or osteopathy who holds a current license or institutional permit to practice medicine in Texas.

(8) Plan of care--The written document specifying how comprehensive care of the person with mental illness or mental retardation is to be carried out (sometimes called the "multidisciplinary treatment plan" or "interdisciplinary plan of care").

(9) Polypharmacy--Concurrent use of more than one psychoactive medication having identical or very similar mechanisms of action.

(10) Prescribing professional--A physician or other health care professional who, as authorized by statute, may prescribe under the supervision of a physician.

(11) PRN--As needed (pro re nata).

(12) Psychiatric emergency--A situation in which, in the opinion of the physician, it is immediately necessary to administer medication to a patient to ameliorate the signs and symptoms of that patient's mental illness and to prevent:

(A) imminent probable death or substantial bodily harm to the patient because the patient:

(i) overtly or continually is threatening or attempting to commit suicide or serious bodily harm; or

(ii) is behaving in a manner that indicates that the patient is unable to satisfy the patient's need for nourishment, essential medical care, or self-protection; or

(B) imminent physical or emotional harm to others, because of threats, attempts, or other acts the patient makes or commits.

(13) Psychiatrist--A physician who is certified by the American Board of Psychiatry and Neurology or who is board eligible, i.e., has an active approved application on file in the board office, or a physician who is currently in training in such a program and is supervised by a board eligible or board certified psychiatrist.

(14) Psychoactive medication--Medication whose primary intended therapeutic effect is to treat or ameliorate the signs or symptoms of mental disorder or to modify mood, affect, perception, or behavior, consistent with THSC, Chapter 574, Subchapter G, §574.101.

(15) Service setting--A state mental health facility, state mental retardation facility, a local authority (LA) site, or a service site contracted to one of these entities.

(16) Team--The patient, patient's LAR, and with the patient's consent, the patient's family members, and the group of professionals and direct care workers responsible for the care of the patient, sometimes called the "multidisciplinary team" or "interdisciplinary team."

Comments

Source Note: The provisions of this §5.3 adopted to be effective August 31, 2004, 29 TexReg 8325; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§5.4: Philosophy

The standard of care for psychoactive medication use in patients should not vary according to service setting. The variations in treatment should be individualized according to patient needs.

Comments

Source Note: The provisions of this §5.4 adopted to be effective August 31, 2004, 29 TexReg 8325; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§5.5: General Principles

(a) All state facilities and LAs will establish and implement written policies and procedures as approved by their medical staff in accordance with this subchapter.

(b) The prescribing professional will practice within the scope of his or her license with supervision as appropriate to that license.

(c) The prescribing of psychoactive medication will be in accordance with accepted guidelines. Use of psychoactive medication that falls outside accepted guidelines may be permissible if the clinical rationale is documented in the patient record.

(d) In no case will psychoactive medication be used for punishment, for convenience of staff, as a substitute for appropriate psychosocial treatments, or in amounts that interfere with a patient's quality of life or plan of care.

(e) The patient's plan of care will reflect any use of psychoactive medication as part of an integrated treatment approach aimed at increasing the patient's functioning and quality of life.

(f) The prescribing professional will document the rationale for initiating, continuing, or discontinuing psychoactive medication in the clinical record.

(g) Medications traditionally considered psychoactive may be prescribed for nonpsychiatric indications if such use is supported by accepted guidelines and the provisions of this subchapter would not apply.

(h) If a service setting must meet other standards (external or otherwise), the more stringent standards will prevail.

(i) The service setting will have policies and procedures governing the scope of practice regarding prescription of psychoactive medications when the prescribing professional is not a psychiatrist. These policies and procedures must require involvement of a psychiatrist and describe the nature, extent, and time frame of this involvement regarding the following:

(1) initiation of any psychoactive medication;

(2) significant changes in the medication regimen other than simple titration or substitution of equivalent medications;

(3) institution of polypharmacy under §415.7(e)(4) of this title (relating to Prescribing Parameters); and

(4) prescription of any regimen that falls outside accepted guidelines, including dosing guidelines.

(j) Each service setting must ensure psychiatric consultation is available at all times.

Comments

Source Note: The provisions of this §5.5 adopted to be effective August 31, 2004, 29 TexReg 8325; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§5.6: Evaluation and Diagnosis

(a) Prior to initiating psychoactive medication according to accepted guidelines, the prescribing professional will:

(1) assess and document the medical history including the chief complaint, psychiatric history, substance use history, and medication history along with medication allergies of the patient;

(2) conduct and document a mental status examination of the patient according to accepted guidelines;

(3) assess and document the current physical status and general health of the patient in detail sufficient for safe prescription of the medication contemplated and may include a reference to a physical examination conducted within the past 12 months, a physical examination by the physician, or a referral of the patient for a more thorough examination as appropriate to health status and service setting;

(4) assess and document the need for laboratory screening and other procedures to gather relevant clinical information; and

(5) make and document the psychiatric diagnosis in accordance with the DSM and within the scope of the professional's license.

(b) The prescribing professional will solicit input and discuss with the team the the proposed treatment with psychoactive medication.

(c) If psychoactive medication known to cause movement disorders is contemplated, an appropriately trained and competent staff will screen the patient for abnormal involuntary movements using a standardized procedure such as the Abnormal Involuntary Movement Scale (AIMS) or Dyskensia Identification System Condensed User Scale (DISCUS), as appropriate, and document the result of the examination prior to initiation of the medication.

(d) In a psychiatric emergency, the assessments and documentation required by this section will take place as soon as is feasible after the emergency. If the patient has already received such assessments during this treatment episode, then the prescribing professional will document only those assessments and decisions that directly relate to the emergency.

Comments

Source Note: The provisions of this §5.6 adopted to be effective August 31, 2004, 29 TexReg 8325; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§5.7: Prescribing Parameters

(a) Target signs and symptoms. The prescribing professional will identify and document the target signs and symptoms along with their initial frequency and severity for each medication prescribed prior to its initial use.

(b) Choice of psychoactive medication. The prescribing professional will choose the psychoactive medication in accordance with accepted guidelines.

(c) Laboratory and screenings. The prescribing professional will identify, order, and follow up any laboratory tests, screenings, or other procedures indicated by the proposed psychoactive medication and the physical condition of the patient in accordance with accepted guidelines.

(d) Dose and route of administration. The prescribing professional will choose doses at or below the maximum doses indicated in the TDMHMR Formulary. Higher doses or unusual routes of administration may be used with documentation in the patient record of appropriate supporting clinical rationale. The use of nasogastric intubation requires consultation with a second physician with documentation of the consultation in the supporting clinical rationale.

(e) Polypharmacy. The prescribing professional will not prescribe polypharmacy as a mechanism to avoid single drug dosage recommendations, adequate monotherapy drug trials, or adequate psychosocial treatment or programming. Polypharmacy is acceptable practice when:

(1) overlapping medications are used as part of a change from one medication to another;

(2) currently prescribed medication is not available in the route most appropriate to a psychiatric emergency situation;

(3) documentation exists of inadequate patient response after simpler and safer regimens have been attempted following accepted guidelines; or

(4) accepted guidelines provide no guidance and appropriate single drug trials have failed, provided the rationale for determining the choice to prescribe polypharmacy is documented to support the situation, and:

(A) the prescribing professional is privileged through the medical staff privileging process to prescribe psychoactive medication; and

(B) the prescribing professional is a psychiatrist, or in the case of a child patient, a child psychiatrist, or consults with a psychiatrist or a child psychiatrist as appropriate prior to initiating polypharmacy.

(f) Orders not written in person. The service setting will have policies and procedures which govern orders not written in person (such as verbal, telephone, fax, or electronic orders) by the prescribing professional. These will address who may give orders, who may accept them, and how orders will be documented in the patient record. Orders will be authenticated by the prescribing professional within a time frame appropriate to the service setting as set forth in that setting's approved policies and procedures.

(g) PRN orders. The prescribing professional may write PRN orders in accordance with accepted guidelines and Chapter 414, Subchapter I of this title (relating to Consent to Treatment with Psychoactive Medication-Mental Health Services). The service setting will have policies and procedures for PRN orders that address:

(1) indications;

(2) appropriate medication classes and dosing, including maximum dose in 24 hours; and

(3) time frames for:

(A) medication administration;

(B) order duration;

(C) assessment of effectiveness;

(D) continued PRN use; and

(E) documentation standards that apply to the order itself and the assessments.

(h) Psychiatric emergency orders. The physician may order a single, immediate administration of a psychoactive medication(s) for a psychiatric emergency. The service setting will have policies and procedures for emergency use of psychoactive medications in accordance with accepted guidelines and Chapter 414, Subchapter I of this title, governing Consent to Treatment with Psychoactive Medication-Mental Health Services, and Chapter 412, Subchapter H, governing Standards and Quality Assurance for Mental Retardation Community Services and Supports as appropriate that address:

(1) indications;

(2) appropriate medication classes and dosing, including maximum dose in 24 hours;

(3) assessment of effectiveness;

(4) patient education;

(5) review with consideration of changing the current plan of care if a pattern of use of psychiatric emergency orders emerges; and

(6) documentation time frames and standards that address the incident, the use of medications, and the outcome.

Comments

Source Note: The provisions of this §5.7 adopted to be effective August 31, 2004, 29 TexReg 8325; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§5.8: Emergency Use of Psychoactive Medication

(a) Emergency psychoactive medications are used to treat the signs and symptoms of mental illness in a psychiatric emergency when other interventions are ineffective or inappropriate.

(b) The selection of the medication should take into account the patient's current medication regimen. Using a medication that the patient is currently prescribed is preferable, if clinically indicated.

(c) All required documentation will be entered into the patient's record as soon as the emergency abates.

Comments

Source Note: The provisions of this §5.8 adopted to be effective August 31, 2004, 29 TexReg 8325; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§5.9: Consent and Patient Education

(a) Informed consent for treatment with a psychoactive medication will be obtained in accordance with the provisions of Chapter 414, Subchapter I of this title (relating to Consent to Treatment with Psychoactive Medication - Mental Health Facilities) or Chapter 405, Subchapter I of this title (relating to Consent to Treatment with Psychotropic Medication - Mental Retardation Facilities), as appropriate.

(b) The use of PRN medication requires an appropriate consent process in accordance with the provisions referred to in subsection (a) of this section.

(c) The service setting will provide individual and group medication education when appropriate to patients, their families, and LARs according to accepted guidelines (e.g., TIMA patient and family education guidelines). If accepted guidelines do not exist, the education will discuss characteristics of the medication, including expected benefits, potential adverse or side effects, dosage, standard alternative treatments, legal rights, and any questions the patient, family, or LAR may have. Education is also provided to address significant changes in the patient's medication regimen.

(d) The service setting will have policies and procedures to address medication education and documentation standards.

Comments

Source Note: The provisions of this §5.9 adopted to be effective August 31, 2004, 29 TexReg 8325; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§5.10: Medication Monitoring

(a) All patients receiving psychoactive medication will receive timely ongoing face-to-face evaluation and documentation by the prescribing professional of:

(1) data collected since the last follow-up, including data about the frequency, severity, and timing of target signs and symptoms;

(2) effectiveness of the medication in treating target signs and symptoms; and

(3) assessment for side effects and adverse effects.

(b) Using the assessment data and with input from the team, the prescribing professional will continue or alter the medication regimen to maximize the benefit to the patient.

(c) At initiation of a new medication or significant change in medication regimen, medication monitoring will occur as often as medically necessary and for the period of time needed to stabilize the clinical response. Such monitoring will occur at least weekly for one month in hospitals and crisis stabilization units (unless discharged in the interim) and at least monthly in outpatient and residential settings. Rationale for less frequent monitoring will be documented.

(d) Further minimum frequencies of medication monitoring in patients are:

(1) state mental health facility settings--monthly as described in subsections (a) and (b) of this section. Also, every 90 days, the medication monitoring includes review of consent issues and long-term consequences of psychoactive medication;

(2) state mental retardation facility settings--monthly review of data with appropriate members of the team and every third month (quarterly) face-to-face evaluation of the patient. Rationale for less frequent monitoring will be documented;

(3) LA programs--medication monitoring appointments will be scheduled quarterly as described in subsections (a) and (b) of this section. Rationale for less frequent monitoring will be documented.

(e) For medications known to cause movement disorders, appropriately trained and competent staff will screen the patient quarterly for abnormal involuntary movements using a standardized procedure such as AIMS, document the results, and arrange for any appropriate follow-up with a psychiatrist or neurologist, if indicated.

(f) Clinically significant adverse effects or side effects will be evaluated by a physician, managed according to accepted guidelines, and addressed in the plan of care.

(g) Laboratory testing or other procedures needed for the continued safe and effective use of medication will be ordered according to accepted guidelines.

(h) In any service setting that operates a pharmacy, the pharmacist will evaluate medication orders and patient medication records in accordance with the rules of the Texas State Board of Pharmacy (Texas Administrative Code, Title 22, Part 15) and will include a review for dosage range according to the TDMHMR Formulary, polypharmacy, and PRN use. The service setting will have policies and procedures in place for doing this review and the documentation and outcome of any questions arising out of this review.

Comments

Source Note: The provisions of this §5.10 adopted to be effective August 31, 2004, 29 TexReg 8325; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§5.11: Special Populations

Special populations will be managed according to accepted guidelines as appropriate to their special needs.

(1) Patients with dyskinesias, including tardive dyskinesia.

(A) A diagnosis of a dyskinesia will be verified by a psychiatrist or neurologist and documented in the patient record along with suspected or known duration and severity.

(B) The patient and, as appropriate, family and LAR will receive relevant education about the diagnosis and its implications for psychoactive medication use.

(C) Risks and benefits of continued psychoactive medication use will be assessed and communicated to the patient and, as appropriate, family or LAR. If continued use is recommended, a new consent for medication will be obtained.

(D) If continued use of psychoactive medication is contemplated, then the prescribing professional, if not a psychiatrist or neurologist, must obtain and document consultation from a psychiatrist or neurologist.

(2) Children.

(A) Except in an emergency, if the prescribing professional is not a child psychiatrist, then prescribing psychoactive medication which falls outside accepted guidelines requires consultation from a child psychiatrist in addition to any other requirements.

(B) If the prescribing professional is a child psychiatrist, then use of polypharmacy is governed as indicated in §415.7 of this title (relating to Prescribing Parameters).

(3) Patients with mental retardation.

(A) A specific psychiatric diagnosis will be made in accordance with the DSM prior to initiating psychoactive medication. If it is not possible to make a specific diagnosis in accordance with the DSM, clinical justification for initiating psychoactive medication will be documented.

(B) Except in an emergency or acute psychiatric hospitalization, psychoactive medications are prescribed only after behavioral and clinical baselines have been established.

(C) Specific target behaviors or clinical signs and quality of life outcomes must be objectively defined, quantified, and tracked using recognized empirical measurement methods appropriate to the service setting in order to monitor psychoactive medication efficacy.

(4) Patients with substance use disorders.

(A) Service settings will assess the occurrence of co-occurring psychiatric and substance use disorders during evaluations for medication, initiation of medication, and medication monitoring, and will have policies and procedures which address the assessment .

(B) Provision of medication services to this population will be in accordance with accepted guidelines for patients with these comorbid conditions and will be in collaboration and coordination with other treatments that the patient may be receiving for substance use.

(5) Pregnant or nursing patients.

(A) Informed consent for use of psychoactive medication in this population must specifically document that the risk and benefits of that use on the fetus or infant have been discussed with the patient and, as appropriate, LAR and family.

(B) Prior to prescribing psychoactive medication, the prescribing professional will seek to collaborate with the physician or clinic providing prenatal, postnatal, or pediatric care to include providing, with consent, appropriate documentation of diagnoses and plan of care to that service provider.

(6) Geriatric patients. Service settings will have policies and procedures for prescribing psychoactive medication which are responsive to the special needs of geriatric patients..

(7) Other special populations. Prescribing professionals will be aware that other populations exist that may have particular clinical or special risk factors associated with their treatment with psychoactive medications. Consultation with an appropriate specialist or expert will be considered when treating these populations.

Comments

Source Note: The provisions of this §5.11 adopted to be effective August 31, 2004, 29 TexReg 8325; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§5.12: Quality Improvement

(a) Each service setting will have in place policies and procedures that address standards monitoring and related procedures for quality management of provision of psychoactive medication related services.

(b) At a minimum, psychoactive medication utilization in each service setting must be reviewed and evaluated at least semiannually and strategies for improvement identified using accepted guidelines.

(c) Required areas of review include:

(1) appropriateness of prescribing (including choice of medication, dose, and route);

(2) documentation;

(3) polypharmacy;

(4) emergency use of psychoactive medication;

(5) PRN use;

(6) medication errors;

(7) adverse drug reactions; and

(8) frequency of medication monitoring.

(d) Medication utilization will be reviewed by the medical staff and necessary strategies for improvement approved by the medical staff for implementation.

Comments

Source Note: The provisions of this §5.12 adopted to be effective August 31, 2004, 29 TexReg 8325; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§5.13: References

The following statutes and TDMHMR rules are referenced in this subchapter:

(1) Texas Administrative Code, Title 25, Part II, Chapter 414, Subchapter I, relating to Consent to Treatment with Psychoactive Medications - Mental Health Services; and

(2) Texas Administrative Code Title 25, Part II, Chapter 405, Subchapter I, relating to Consent to Treatment with Psychotropic Medication.

Comments

Source Note: The provisions of this §5.13 adopted to be effective August 31, 2004, 29 TexReg 8325; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§5.14: Distribution

This subchapter is distributed to:

(1) all members of the Texas Mental Health and Mental Retardation Board;

(2) executive, management, and program staff of Central Office;

(3) CEOs and medical directors of all facilities and LAs;

(4) advocacy organizations; and

(5) any person on request.

Comments

Source Note: The provisions of this §5.14 adopted to be effective August 31, 2004, 29 TexReg 8325; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

Subchapter C

§5.101: Purpose

The purpose of this subchapter is to provide policies and procedures governing the use and maintenance of the TDMHMR Drug Formulary.

Comments

Source Note: The provisions of this §5.101 adopted to be effective February 6, 2002, 27 TexReg 755; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§5.102: Application

(a) This subchapter applies to TDMHMR facilities, Central Office, local authorities, and their respective contractors for medications and medication-related services funded by the Texas Department of Mental Health and Mental Retardation (TDMHMR). (The TDMHMR Drug Formulary in its entirety applies to all TDMHMR facilities in all circumstances except when an individual receives acute care services of limited duration in a general hospital.)

(b) TDMHMR facilities, Central Office, and local authorities are responsible for amending the contracts of their contractors that provide TDMHMR-funded medications and medication-related services to ensure their compliance with this subchapter.

Comments

Source Note: The provisions of this §5.102 adopted to be effective February 6, 2002, 27 TexReg 755; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§5.103: Definitions

The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:

(1) Adverse drug reaction--Any adverse symptom or sign that is an unexpected reaction to medication and that is noxious, unintended, and occurs at doses normally used in humans for the prophylaxis, diagnosis, or therapy of disease, or for the modification of physiological function.

(2) Contractor--An entity that provides TDMHMR-funded mental health or mental retardation services pursuant to a contract with a service system component or TDMHMR.

(3) Drug entity--A specific chemical compound and all of its pharmaceutically equivalent salt forms which are used in the treatment or mitigation of disease.

(4) Emergency--A situation in which it is immediately necessary to administer medication to an individual to prevent:

(A) imminent probable death or substantial bodily harm to the individual because the individual:

(i) overtly or continually is threatening or attempting to commit suicide or serious bodily harm; or

(ii) is behaving in a manner that indicates that the individual is unable to satisfy the individual's need for nourishment, essential medical care, or self-protection; or

(B) imminent physical or emotional harm to others because of threat, attempts, or other acts the individual overtly or continually makes or commits.

(5) Individual--Any person receiving services from a service system component or contractor.

(6) Local authority--An entity designated by the TDMHMR commissioner in accordance with the Texas Health and Safety Code, §533.035(a).

(7) Practitioner--A person who acts within the scope of a professional license to prescribe, distribute, administer, or dispense a prescription drug or device, (e.g., a physician, nurse, nurse practitioner, pharmacist, dentist).

(8) Pharmacy and therapeutics committee--A TDMHMR facility committee composed of physicians, pharmacists, registered nurses, and others as appointed by the facility CEO that recommends drug-related policy to the facility's clinical/medical director and CEO.

(9) Reserve drug--A formulary drug with specific guidelines for use as described in the formulary.

(10) Service system component--A TDMHMR facility or local authority.

(11) State mental health facility--A state hospital or a state center with an inpatient component that is operated by TDMHMR.

(12) State mental retardation facility--A state school or a state center with a mental retardation residential component that is operated by TDMHMR.

(13) TDMHMR--The Texas Department of Mental Health and Mental Retardation.

(14) TDMHMR Drug Formulary or formulary--A continually revised printed listing by nonproprietary name of all drugs approved for use by service system components and their contractors.

(15) TDMHMR facility--A state mental health facility or a state mental retardation facility.

Comments

Source Note: The provisions of this §5.103 adopted to be effective February 6, 2002, 27 TexReg 755; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§5.104: General Requirements

(a) The Texas Department of Mental Health and Mental Retardation maintains a closed formulary (TDMHMR Drug Formulary) that lists drugs approved by the Executive Formulary Committee for use by service system components and their contractors.

(b) A drug is not available for general use by service system components or their contractors unless it is approved by the Executive Formulary Committee. Drugs not listed in the TDMHMR Drug Formulary or the Interim Formulary Update may not be used except under the limited circumstances described in §415.110 of this title (relating to Prescribing Non-formulary Drugs).

(c) The use of formulary drugs in unusual clinical situations or the use of unusual drug combinations must be accompanied by written justification in the individual's medical record. Additional clinical consultation in these situations should occur as deemed necessary by the prescribing physician.

(d) Reserve drugs, as defined in §415.103 of this title (relating to Definitions), may be prescribed for use outside the guidelines described in the formulary if the prescription is justified in the individual's medical record and reviewed in routine audits of reserve drug use conducted by the service system component.

(e) Drug research conducted at a TDMHMR facility is governed by Chapter 414, Subchapter P of this title (concerning Research at TDMHMR Facilities). Local authorities conducting drug research must comply with all applicable state and federal laws, rules, and regulations, including Title 45, Code of Federal Regulations, Part 46 (Protection of Human Subjects), as required by §412.309(f) of this title (relating to Rights and Responsibilities) of Chapter 412, Subchapter G of this title (concerning Mental Health Community Services Standards).

Comments

Source Note: The provisions of this §5.104 adopted to be effective February 6, 2002, 27 TexReg 755; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

§5.105: Organization of Tdmhmr Drug Formulary

Drugs are listed in the TDMHMR Drug Formulary by nonproprietary name. The list is based on a modified format of the American Hospital Formulary Service Drug Information and includes an alphabetical index. Proprietary names may follow in parentheses for information only; the listing of proprietary names is not an endorsement. Cost comparisons and prescribing information are provided a