Adopted Rules Title 26

TITLE 26. HEALTH AND HUMAN SERVICES

PART 1. HEALTH AND HUMAN SERVICES COMMISSION

CHAPTER 303. PREADMISSION SCREENING AND RESIDENT REVIEW (PASRR)

The Texas Health and Human Services Commission (HHSC) adopts amendments to §303.102, concerning Definitions; §303.201, concerning Preadmission Process; §303.302, concerning LIDDA, LMHA, and LBHA Responsibilities Related to the PASRR Process; §303.303, concerning Qualifications and Requirements for Staff Person Conducting a PE or Resident Review; §303.502, concerning Required Training for a Habilitation Coordinator; §303.503, concerning Documenting Habilitation Coordination Contacts; §303.601, concerning Habilitation Coordination for a Designated Resident; §303.602, concerning Service Planning Team Responsibilities Related to Specialized Services; §303.701, concerning Transition Planning for a Designated Resident; §303.703, concerning Requirements for Service Coordinators Conducting Transition Planning; §303.905, concerning Process for Service Initiation, §303.907, concerning Renewal and Revision of Person-Centered Recovery Plan, §303.909, concerning Refusal of the Uniform Assessment or MI Specialized Services; §303.910, concerning Suspension and Termination of MI Specialized Services; and §303.912, concerning Documentation.

HHSC adopts new §303.901, concerning Description of MI Specialized Services and §303.914, concerning Required Training for an LMHA or LBHA Staff Responsible for Coordinating MI Specialized Services and new Subchapter J, concerning Disaster Rule Flexibilities, comprised of §303.1000, concerning Flexibilities to Certain Requirements During Declaration of Disaster.

HHSC also adopts the repeal of §303.901, Description of MI Specialized Services.

Sections 303.102, 303.601, 303.602, 303.701, 303.901, 303.905, 303.907, 303.909, and 303.1000 are adopted with changes to the proposed text as published in the October 20, 2023, issue of the Texas Register (48 TexReg 6174). These rules will be republished.

Sections 303.201, 303.302, 303.303, 303.502, 303.503, 303.703, 303.910, 303.912, 303.914, and the repeal of §303.901 are adopted without changes to the proposed text as published in the October 20, 2023, issue of theTexas Register (48 TexReg 6174). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

House Bill 4, 87th Legislature, Regular Session, 2021 added §531.02161 to the Texas Government Code which requires HHSC to ensure that Medicaid recipients have the option to receive services through telecommunications to the extent it is cost effective and clinically appropriate. A purpose of the adopted rules is to implement Texas Government Code §531.02161 as it applies to the preadmission screening and resident review (PASRR) process. Another purpose of the adopted rules is to define terms used in the revised PASRR rule for clarification. The adopted rules ensure training requirements are similar for staff involved in the PASRR process across all local intellectual and developmental disability authorities (LIDDAs), local mental health authorities (LMHAs), and local behavioral health authorities (LBHAs). The adopted rules address documentation requirements related to the PASRR process, including the new requirement to obtain written or oral consent for the use of audio-visual or audio-only communication methods. The adopted rules require adjustments to the frequency of follow-up visits for residents with mental illness (MI), which mirrors the requirements of the habilitation coordinator related to the PASRR process. The adopted rules also require the MI specialized services team to agree the resident with MI no longer benefits from the MI specialized services when one or more specialized service is terminated.

The adopted rules provide that HHSC may allow LIDDAs, LMHAs, and LBHAs to use one or more of the exceptions specified in the rules while an executive order or proclamation declaring a state of disaster under Texas Government Code §418.014 is in effect. This provision ensures that LIDDAs, LMHAs, LBHAs are able to operate and provide services effectively during a disaster.

The adopted rules repeal §303.901, Description of MI Specialized Services, and replace it with new §303.901, Description of MI Specialized Services.

COMMENTS

The 31-day comment period ended November 20, 2023.

During this period, HHSC received comments regarding the proposed rules from five commenters: Cross Healthcare Management; Tri-County Behavioral Healthcare; Texas Medical Association; Disability Rights Texas; and Texas Council of Community Centers. A summary of comments relating to the rules and HHSC's responses follows.

Comment: A commenter noted they are in support of the rule changes as long as there are not additional burdens imposed on the nursing facility, such as having to make separate arrangements to coordinate audio-only or audio-visual meetings.

Response: HHSC did not make changes to the rules in response to this comment. The rule changes do not impose additional burdens on nursing facilities.

Comment: Regarding the definition of Service Planning Team (SPT), a commenter asked for clarification regarding the inclusion of the person who develops a permanency plan in the service planning team definition.

Response: HHSC did not make changes to the rules in response to this comment. The commenter did not specify the clarification requested and the definition of "service planning team" describes this member of the team as "the person who develops a permanency plan using the HHSC Permanency Planning Instrument for Children Under 22 Years of Age form and performs other permanency planning activities for a designated resident under 22 years of age, if the designated resident is at least 21 years of age but younger than 22 years of age."

Comment: Regarding the definition of SPT, the same commenter asked if the person completing the permanency plan must participate in all service planning team meetings or only when the permanency plan is due.

Comment: A commenter asked whether the service planning team member who is the permanency planner must participate in all service planning team meetings and whether this member must provide the permanency planning instrument to the service planning team.

Response: HHSC did not make changes to the rules in response to this comment. The proposed rules do not allow for the exclusion of the person who develops the permanency plan from a service planning team meeting. Responsibilities of persons who develop the permanency plan are not addressed in Chapter 303 but a person who develops the permanency plan would likely assist with providing the permanency planning instrument to the service planning team.

Comment: A commenter recommended deleting §303.302(d), because there are other PASRR requirements already in place to address barriers and challenges. The LIDDA, LMHA, or LBHA must develop a written policy that describes the process the LIDDA, LMHA, or LBHA will follow to address challenges related to the participation in receiving IDD habilitative specialized services (IHSS) or MI specialized services by the designated resident, resident with MI, or legally authorized representative (LAR).

Response: HHSC declines to remove this rule as suggested. Section 303.302(d) requires a process to address challenges related to a resident's participation in receiving IHSS or MI specialized services. Other PASRR requirements address barriers to community living and transitions into the community.

Comment: Regarding §303.502(a)(2) - (3), commenters recommended allowing habilitation coordinators to complete HHSC approved computer-based person-centered planning and practices training and all HHSC instructor-led training related to PASRR habilitation coordination within the first 90 days of performing habilitation coordination duties, rather than 60 days, due to difficulties at times in enrolling staff in instructor-led courses.

Response: HHSC declines to make changes in response to this comment. The HHSC approved person-centered planning and practices training is computer-based and can be taken at any time to easily accommodate habilitation coordinators' schedules. In addition, HHSC will be offering the instructor-led training more frequently to address the demand for this training.

Comment: In reference to §303.601(a), commenters suggested clarification is needed as to whether the rule should indicate "business days" or "calendar days."

Response: HHSC agrees with the requested change and revised §303.601(a) to specify that a LIDDA must assign a habilitation coordinator to each designated resident within "two business days" (instead of "two days") after a PASRR level II evaluation (PE) is completed if the PE is positive for intellectual disability or developmental disability. Additionally, HHSC revised §303.102 by adding definitions for "business day" and "calendar day" for clarity.

Comment: Regarding §303.601(b)(7)(A), a commenter suggested that the "more frequently if needed more than monthly" language be retained, because some individuals may require visits that are more frequent than monthly.

Response: HHSC declines to make changes in response to this comment. The requirement in the rule that a habilitation coordinator must meet with a designated resident "at least monthly" is a minimum requirement and, therefore, allows for more frequent meetings if necessary.

Comment: Regarding §303.703(b)(2) - (3), commenters recommended allowing the service coordinators to complete HHSC approved computer-based person-centered planning and practices training and all HHSC instructor-led training related to PASRR service coordination for transition planning within the first 90 days of performing transition planning duties, rather than 60 days, due to difficulties at times enrolling staff in instructor-led courses.

Response: HHSC declines to make changes in response to this comment. The HHSC approved person-centered planning and practices training is computer-based and can be taken at any time to easily accommodate service coordinators' schedules. In addition, HHSC will be offering the instructor-led training more frequently to address the demand for this training.

Comment: A commenter noted that "crisis intervention services" and "day programs for acute needs" are included in current §303.901 but not in proposed §303.901(b), though such services are offered under the Texas Resiliency and Recovery (TRR) program. The commenter also noted that proposed §303.901(b) does not reference the TRR Utilization Management Guidelines (TRR Guidelines) in its description of services for a resident with MI. As a result, the commenter noted concerns that it is not clear what services, if any, are available outside of the services listed in proposed §303.901(b)(1) through (5). The commenter recommended that proposed §303.901(b) be amended to clarify the availability of other services offered under the TRR program, such as day programs for acute needs.

Response: The definition of "MI specialized services" in §303.102(50) includes a non-exclusive list of MI specialized services available and provides that the services are described in the Texas Resilience and Recovery Utilization Management Guidelines. Descriptions of some MI specialized services are included in §303.901(b) because those services are the MI specialized services most commonly used. HHSC revised §303.901(b) to clarify that the subsection describes some of the MI specialized services.

Comment: A commenter noted that in the proposed rules, a meeting via audio-visual communication is permitted in extenuating circumstances if consent is obtained from the resident or their LAR to meet via audio-visual communication and a description of the extenuating circumstances is documented in the resident's record. The rules as proposed state that, if consent is not obtained, the resident or LAR's refusal must be documented in the resident's record. The commenter recommended that proposed §§303.302, 303.602, 303.701, 303.905, and 303.907 be clarified to account for situations where the resident or LAR has refused to or neglected to provide consent to meet via audio-visual communication despite extenuating circumstances that preclude an in-person meeting.

Response: HHSC agrees with the requested change as to §§303.602, 303.701, 303.905, and 303.907. Accordingly, HHSC revised §303.602(g) to, if consent to meet via audio-visual communication is not obtained because of extenuating circumstances, require a habilitation coordinator to convene an SPT meeting in person as soon as possible after the extenuating circumstances no longer exist. HHSC made a similar change in §§303.701(k), 303.905(h) and 303.907(h) regarding meetings conducted by a service coordinator, LMHA, LBHA, and a qualified mental health professional - community services (QMHP-CS). HHSC declines to make the requested change to §303.302 because §303.302(i) describes the action a LIDDA, LMHA, or LBHA must take if consent to meet via audio-visual communication is not obtained because of extenuating circumstances. Also, the definition for "extenuating circumstances" in §303.102 was modified for clarity.

Comment: A commenter disagreed with the proposed change in §303.909(a)(2) and stated a concern that waiting for 90 days for a follow-up visit may be too long. Conversely, another commenter agreed with the proposed change.

Response: HHSC agrees with the requested change and revised §303.909(a)(2) to require the LMHA or LBHA to inform the resident that a follow-up visit will be conducted every 30 days for 90 days after the initial interdisciplinary team (IDT) meeting, consistent with the current rule. HHSC also revised §303.909(a) to clarify that the LMHA and LBHA are required to conduct a follow-up visit every 30 days for 90 days after the initial IDT meeting and make the 90th day follow-up visit the first MI quarterly meeting.

Comment: Regarding §303.914(a)(2), commenters suggested a revision to the timeframe in which an LMHA or LBHA staff must complete the HHSC approved computer-based person-centered planning and practices training within the first 90 days of coordinating MI specialized services instead of the proposed 60-day timeframe.

Response: HHSC declines to revise the rule as suggested. The commenter did not provide a reason for changing the time frame for completing the HHSC approved person-centered planning and practices training. Because the training can be taken at any time to easily accommodate staff schedules, the proposed 60-day timeframe should provide staff with sufficient time to complete the training.

Comment: A commenter noted they would like to see HHSC courses that align more closely with TRR services instead of those designed for the IDD population.

Response: HHSC did not make changes in response to this comment because it is outside the scope of this project.

Comment: Regarding §303.905(c), a commenter asked for clarification regarding the timeline for completing the uniform assessment, developing the person-centered recovery plan, and providing copies of these documents to the nursing facility.

Response: HHSC did not make changes in response to this comment. Section 303.905(c) and (f) include the timeframes for completing the uniform assessment and the person-centered recovery plan and providing copies of these documents to the nursing facility. Additional guidance about these activities is provided in the Preadmission Screening and Resident Review Mental Illness Handbook. Further, definitions for "business day" and "calendar day" were added to §303.102 for clarity.

In addition to the changes made to the rules in response to comments, HHSC made the changes below.

In §303.907(a), HHSC added, "with the MI specialized services team" to clarify that the QMHP-CS must include the team in the quarterly meeting.

In §303.901(b), HHSC changed "specialized services" to "MI specialized services" because "MI specialized services" is the defined term and used throughout the chapter.

HHSC revised §303.102(78)(G) and (H) to correct formatting, revised §303.1000(c)(3) and (4) to add section symbols to the section numbers, and added a comma to newly formatted §303.909(a)(4) for clarity.

SUBCHAPTER A. GENERAL PROVISIONS

26 TAC §303.102

STATUTORY AUTHORITY

The amendment is authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, Texas Government Code §531.033, which provides the Executive Commissioner of HHSC with broad rulemaking authority; and Texas Human Resources Code §32.021, which provides that HHSC will adopt necessary rules for the proper and efficient administration of the Medicaid program.

§303.102.Definitions.

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

(1) Actively involved person--An individual who has significant, ongoing, and supportive involvement with a designated resident, as determined by the SPT based on the individual's:

(A) observed interactions with the designated resident;

(B) availability to the designated resident for assistance or support when needed; and

(2) Acute care hospital--A health care facility in which an individual receives short-term treatment for a severe physical injury or episode of physical illness, an urgent medical condition, or recovery from surgery and:

(A) may include a long-term acute care hospital, an emergency room within an acute care hospital, or an inpatient rehabilitation hospital; and

(B) does not include a stand-alone psychiatric hospital or a psychiatric hospital within an acute care hospital.

(3) Alternate placement assistance--Assistance provided to a resident to locate and secure services chosen by the resident or LAR that meets the resident's needs in a setting other than a NF. Alternate placement assistance includes transition planning, pre-move site review, and post-move monitoring.

(4) APRN--Advance practice registered nurse. An individual licensed to practice professional nursing as an advance practice registered nurse in accordance with Texas Occupations Code Chapter 301.

(5) Audio-only--An interactive, two-way audio communication that uses only sound and that meets the privacy requirements of the Health Insurance Portability and Accountability Act. Audio-only includes the use of telephonic communication. Audio-only does not include audio-visual or in-person communication.

(6) Audio-visual--An interactive, two-way audio and video communication that conforms to privacy requirements under the Health Insurance Portability and Accountability Act. Audio-visual does not include audio-only or in-person communication.

(7) Behavioral support--An IHSS that:

(A) is assistance provided for a designated resident to increase adaptive behaviors and to replace or modify maladaptive behaviors that prevent or interfere with the designated resident's interpersonal relationships across all service and social settings;

(B) is delivered in the NF or in a community setting; and

(i) assessing the behaviors to be targeted in an appropriate behavior support plan and analyzing those assessment findings;

(ii) developing an individualized behavior support plan that reduces or eliminates the target behaviors, assisting the designated resident in achieving the outcomes identified in the HSP;

(iii) training and consulting with the LAR, family members, NF staff, other support providers, and the designated resident about the purpose, objectives, and methods of the behavior support plan;

(iv) implementing the behavior support plan or revisions to the behavior support plan and documenting service delivery in accordance with the IDD Habilitative Specialized Services Billing Guidelines;

(v) monitoring and evaluating the success of the behavior support plan implementation;

(vi) revising the behavior support plan as necessary; and

(vii) participating in SPT and IDT meetings.

(8) Business day--Any day except Saturday, Sunday, or a national or state holiday listed in Texas Government Code §662.003(a) or (b).

(9) Calendar day--Any day, including weekends and holidays.

(10) CMWC--Customized manual wheelchair. In accordance with §554.2703(5) of this title (relating to Definitions) and consistent with the requirements of Texas Human Resources Code §32.0425, a wheelchair that consists of a manual mobility base and customized seating system and is adapted and fabricated to meet the individualized needs of a designated resident.

(11) Collateral contact--A person who is knowledgeable about the individual seeking admission to a NF or the resident, such as family members, previous providers or caregivers, and who may support or corroborate information provided by the individual or resident.

(12) Coma--A state of unconsciousness characterized by the inability to respond to sensory stimuli as documented by a physician.

(13) Convalescent care--A type of care provided after an individual's release from an acute care hospital that is part of a medically prescribed period of recovery.

(14) Day habilitation--An IHSS that:

(A) is assistance provided for a designated resident to acquire, retain, or improve self-help, socialization, and adaptive skills necessary to successfully and actively participate in all service and social settings;

(B) is delivered in a setting other than the designated resident's NF;

(D) includes expanded interactions, skills training activities, and programs of greater intensity or frequency beyond those a NF is required to provide by 42 Code of Federal Regulations (CFR) §483.24; and

(E) consists of:

(i) individualized activities consistent with achieving the outcomes identified in a designated resident's HSP to attain, learn, maintain, or improve skills;

(ii) activities necessary to reinforce therapeutic outcomes targeted by other support providers and other specialized services;

(iii) services in a group setting at a location other than a designated resident's NF for up to five days per week, six hours per day, on a regularly scheduled basis;

(iv) personal assistance for a designated resident who cannot manage personal care needs during the day habilitation activity;

(v) transportation between the NF and the day habilitation site, as well as during the day habilitation activity necessary for a designated resident's participation in day habilitation activities; and

(vi) participating in SPT and IDT meetings.

(15) DD--Developmental disability. A disability that meets the criteria described in the definition of "persons with related conditions" in 42 CFR §435.1010.

(16) Delirium--A serious disturbance in an individual's mental abilities that results in a decreased awareness of the individual's environment and confused thinking.

(17) Designated resident--An individual:

(A) whose PE or resident review is positive for ID or DD;

(B) who is 21 years of age or older;

(D) who is a resident or has transitioned to the community from a NF within the previous 365 days.

(18) DME--Durable medical equipment. The items described in §554.2703(10) of this title.

(19) Emergency protective services--Services furnished by the Department of Family and Protective Services to an elderly or disabled individual who has been determined to be in a state of abuse, neglect, or exploitation.

(20) Employment assistance--An IHSS that:

(A) is assistance provided for a designated resident who requires intensive help locating competitive employment in the community; and

(B) consists of:

(i) identifying a designated resident's employment preferences, job skills, and requirements for a work setting and work conditions;

(ii) locating prospective employers offering employment compatible with a designated resident's identified preferences, skills, and requirements;

(iii) contacting prospective employers on a designated resident's behalf and negotiating the designated resident's employment;

(iv) transporting a designated resident between the NF and the site where employment assistance services are provided and as necessary to help the designated resident locate competitive employment in the community; and

(v) participating in SPT and IDT meetings.

(21) Essential supports--Those supports identified in a transition plan that are critical to a designated resident's health and safety and that are directly related to a designated resident's successful transition to living in the community from residing in a NF.

(22) Exempted hospital discharge--A category of NF admission that occurs when a physician has certified that an individual who is being discharged from an acute care hospital is likely to require less than 30 days of NF services for the condition for which the individual was hospitalized.

(23) Expedited admission--A category of NF admission that occurs when an individual meets the criteria for one of the following categories: convalescent care, terminal illness, severe physical illness, delirium, emergency protective services, respite, or coma.

(24) Extenuating circumstances--Circumstances beyond the LIDDA's, LMHA's or LBHA's control that prevents meeting in person. A disaster declared by the governor is excluded from this definition.

(25) Habilitation coordination--Assistance for a designated resident residing in a NF to access appropriate specialized services necessary to achieve a quality of life and level of community participation acceptable to the designated resident and LAR on the designated resident's behalf.

(26) Habilitation coordinator--An employee of a LIDDA who provides habilitation coordination.

(27) HHSC--The Texas Health and Human Services Commission.

(28) HHSC instructor-led training--Training delivered by an HHSC employee.

(29) HSP--Habilitation service plan. A plan developed by the SPT while a designated resident is residing in a NF that:

(A) is individualized and developed through a person-centered approach;

(B) identifies the designated resident's:

(i) strengths;

(ii) preferences;

(iii) desired outcomes; and

(iv) psychiatric, behavioral, nutritional management, and support needs as described in the NF comprehensive care plan or MDS assessment; and

(C) identifies the specialized services that will accomplish the desired outcomes of the designated resident, or the LAR's on behalf of the designated resident, including amount, frequency, and duration of each service.

(30) ID--Intellectual disability, as defined in 42 CFR §483.102(b)(3)(i).

(31) IDD--Intellectual and developmental disability.

(32) IDT--Interdisciplinary team. A team consisting of:

(A) a resident with MI, ID, or DD;

(B) the resident's LAR, if any;

(D) a representative of:

(i) the LIDDA, if the resident has ID or DD;

(ii) the LMHA or LBHA, if the resident has MI; or

(iii) the LIDDA and the LMHA or LBHA, if the resident has MI and DD, or MI and ID; and

(E) others as follows:

(i) a concerned person whose inclusion is requested by the resident or LAR;

(ii) an individual specified by the resident, LAR, NF, LIDDA, LMHA, or LBHA, as applicable, who is professionally qualified, certified, or licensed with special training and experience in the diagnosis, management, needs, and treatment of people with MI, ID, or DD; and

(iii) a representative of the appropriate school district if the resident is school age and inclusion of the district representative is requested by the resident or LAR.

(33) IHSS--IDD habilitative specialized services. IHSS are:

(A) behavioral support;

(B) day habilitation;

(D) independent living skills training; and

(E) supported employment.

(34) ILST--Independent living skills training. An IHSS that:

(A) is assistance provided for a designated resident that is consistent with the designated resident's HSP;

(B) is provided in the designated resident's NF or in a community setting;

(C) includes expanded interactions, skills training activities, and programs of greater intensity or frequency beyond those a NF is required to provide by 42 CFR §483.24; and

(D) consists of:

(i) habilitation and support activities that foster improvement of or facilitate a designated resident's ability to attain, learn, maintain, or improve functional living skills and other daily living activities;

(ii) activities that help preserve the designated resident's bond with family members;

(iii) activities that foster inclusion in community activities generally attended by people without disabilities;

(iv) transportation to facilitate a designated resident's employment opportunities and participation in community activities, and between the designated resident's NF and a community setting; and

(v) participating in SPT and IDT meetings.

(35) Implementation plan--A plan for each IHSS on the designated resident's plan of care that includes:

(A) a list of the designated resident's outcomes identified in the HSP that will be addressed using IHSS;

(B) specific objectives to address the outcomes required by subparagraph (A) of this paragraph that are:

(i) observable, measurable, and outcome-oriented; and

(ii) derived from assessments;

(D) the frequency, amount, and duration of IHSS needed to complete each objective; and

(E) the signature and date of the designated resident, LAR, and service provider agency.

(36) In-person (or in person)--Within the physical presence of another person. In-person or in person does not include audio-visual or audio-only communication.

(37) LAR--Legally authorized representative. An individual authorized by law to act on behalf of an individual seeking admission to a NF or resident with regard to a matter described by this chapter, and who may be the parent of a minor child, the legal guardian, or the surrogate decision maker.

(38) LBHA--Local behavioral health authority. An entity designated by the executive commissioner of HHSC, in accordance with Texas Health and Safety Code §533.0356.

(39) LCSW--Licensed clinical social worker. An individual who is licensed as a licensed clinical social worker in accordance with Texas Occupations Code Chapter 505.

(40) Licensed psychologist--An individual who is licensed as a psychologist in accordance with Texas Occupations Code Chapter 501.

(41) LIDDA--Local intellectual and developmental disability authority. An entity designated by the executive commissioner of HHSC, in accordance with Texas Health and Safety Code §533A.035.

(42) LMFT--Licensed marriage and family therapist. An individual who is licensed as a marriage and family therapist in accordance with Texas Occupations Code Chapter 502.

(43) LMHA--Local mental health authority. An entity designated by the executive commissioner of HHSC, in accordance with Texas Health and Safety Code §533.035.

(44) LPC--Licensed professional counselor. An individual who is licensed as a professional counselor in accordance with Texas Occupations Code Chapter 503.

(45) LTC online portal--Long term care online portal. A web-based application used by Medicaid providers to submit forms, screenings, evaluations, and other information.

(46) MCO service coordinator--Managed care organization service coordinator. The staff person assigned by a resident's Medicaid managed care organization to ensure access to and coordination of needed services.

(47) MDS assessment--Minimum data set assessment. A standardized collection of demographic and clinical information that describes a resident's overall condition, which a licensed NF in Texas is required to submit for a resident admitted into the facility.

(48) MI--Mental illness. Serious mental illness, as defined in 42 CFR §483.102(b)(1).

(49) MI quarterly meeting--A quarterly meeting that is convened by the LMHA or LBHA for a resident with MI to develop, review, or revise the PCRP and the transition plan, if the resident is transitioning to the community.

(50) MI specialized services--Specialized services for a resident with MI, if eligible, as described in the Texas Resilience and Recovery Utilization Management Guidelines, including:

(A) crisis intervention services;

(B) day programs for acute needs;

(D) psychiatric diagnostic interview examination;

(E) psychosocial rehabilitation services;

(F) routine case management; and

(G) skills training and development.

(51) NF--Nursing facility. A Medicaid-certified facility that is licensed in accordance with the Texas Health and Safety Code Chapter 242.

(52) NF comprehensive care plan--A comprehensive care plan, defined in §554.2703(3) of this title.

(53) NF PASRR support activities--Actions a NF takes in coordination with a LIDDA, LMHA, or LBHA to facilitate the successful provision of an IHSS or MI specialized service, including:

(A) arranging transportation for a NF resident to participate in an IHSS or a MI specialized service outside the facility;

(B) sending a resident to a scheduled IHSS or MI specialized service with food and medications required by the resident; and

(C) stating in the NF comprehensive care plan an agreement to avoid, when possible, scheduling NF services at times that conflict with IHSS or MI specialized services.

(54) NF specialized services--The following specialized services available to a resident with ID or DD:

(A) therapy services;

(B) CMWC; and

(55) PA--Physician assistant. An individual who is licensed as a physician assistant in accordance with Texas Occupations Code Chapter 204.

(56) PASRR--Preadmission screening and resident review. A federal requirement in 42 CFR Part 483, Subpart C that requires states to prescreen all individuals seeking admission to a Medicaid-certified NF for ID, DD, and MI.

(57) PCRP--Person-centered recovery plan. For a resident with MI, the PCRP identifies the services and supports that are needed to:

(A) meet the needs of the resident with MI;

(B) achieve the desired outcomes; and

(58) PE--PASRR level II evaluation. An evaluation as described in §303.302(a)(2) of this chapter (relating to LIDDA, LMHA, and LBHA Responsibilities Related to the PASRR Process):

(A) of an individual seeking admission to a NF who is suspected of having MI, ID, or DD; and

(B) performed by a LIDDA, LMHA, or LBHA to determine if the individual has MI, ID, or DD and, if so, to:

(i) assess the individual's need for care in a NF;

(ii) assess the individual's need for specialized services; and

(iii) identify alternate placement options.

(59) Physician--An individual who is licensed to practice medicine in accordance with Texas Occupations Code Chapter 155.

(60) PL1--PASRR level I screening. The process of screening an individual seeking admission to a NF to identify whether the individual is suspected of having MI, ID, or DD.

(61) Plan of care--A written plan that includes:

(A) the IHSS required by the NF baseline care plan or NF comprehensive care plan;

(B) the frequency, amount, and duration of each IHSS to be provided for the designated resident during a plan year; and

(62) Preadmission process--A category of NF admission:

(A) from a community setting, such as a private home, an assisted living facility, a group home, a psychiatric hospital, or jail, but not an acute care hospital or another NF; and

(B) that is not an expedited admission or an exempted hospital discharge.

(63) QIDP--Qualified intellectual disability professional. An individual who meets the qualifications described in 42 CFR §483.430(a).

(64) QMHP-CS--Qualified mental health professional-community services. An individual who meets the qualifications of a QMHP-CS as defined in §301.303 of this title (relating to Definitions).

(65) Referring entity--The entity that refers an individual to a NF, such as a hospital, attending physician, LAR or other personal representative selected by the individual, a family member of the individual, or a representative from an emergency placement source, such as law enforcement.

(66) Relocation specialist--An employee or contractor of an MCO who provides outreach and relocation activities to individuals in NFs who express a desire to transition to the community.

(67) Resident--An individual who resides in a NF.

(68) Resident review--An evaluation of a resident performed by a LIDDA, LMHA, or LBHA as described in §303.302(a)(2) of this chapter (relating to LIDDA, LMHA, and LBHA Responsibilities Related to the PASRR Process):

(A) for a resident whose PE is positive for MI, ID, or DD who experienced a significant change in condition, to:

(i) assess the resident's need for continued care in a NF;

(ii) assess the resident's need for specialized services; and

(iii) identify alternate placement options; and

(B) for a resident suspected of having MI, ID, or DD, to determine whether the resident has MI, ID, or DD and, if so:

(i) assess the resident's need for continued care in a NF;

(ii) assess the resident's need for specialized services; and

(iii) identify alternate placement options.

(69) Resident with MI--An individual:

(A) who is a resident of a NF;

(B) whose PE or resident review is positive for MI;

(D) who is a Medicaid recipient.

(70) Respite--Services provided on a short-term basis to an individual because of the absence of or the need for relief by the individual's unpaid caregiver for a period not to exceed 14 days.

(71) RN--Registered nurse. An individual licensed to practice professional nursing as a registered nurse in accordance with Texas Occupations Code Chapter 301.

(72) Service coordination--Assistance in accessing medical, social, educational, and other appropriate services and supports, including alternate placement assistance, that will help an individual to achieve a quality of life and community participation acceptable to the individual and LAR on the individual's behalf.

(73) Service coordinator--An employee of a LIDDA who provides service coordination.

(74) Service provider agency--An entity that has a contract with HHSC to provide IHSS for a designated resident.

(75) Severe physical illness--An illness resulting in ventilator dependence or a diagnosis, such as chronic obstructive pulmonary disease, Parkinson's disease, Huntington's disease, amyotrophic lateral sclerosis, or congestive heart failure, that results in a level of impairment so severe that the individual could not be expected to benefit from specialized services.

(76) Significant change in condition--Consistent with §554.801(2)(C)(ii) of this title (relating to Resident Assessment), when a resident experiences a major decline or improvement in the resident's status that:

(A) will not normally resolve itself without further intervention by NF staff or by implementing standard disease-related clinical interventions;

(B) has an impact on more than one area of the resident's health status; and

(77) Specialized services--The following support services, other than NF services, that are identified through the PE or resident review and may be provided to a resident who has a PE or resident review that is positive for MI, ID, or DD:

(A) NF specialized services;

(B) IHSS; and

(78) SPT--Service planning team. A team convened by a LIDDA staff person that develops, reviews, and revises the HSP and the transition plan for a designated resident. The team must include:

(A) the designated resident;

(B) the designated resident's LAR, if any;

(C) the habilitation coordinator for discussions and service planning related to specialized services or the service coordinator for discussions related to transition planning if the designated resident is transitioning to the community;

(D) the MCO service coordinator, if the designated resident does not object;

(E) the person who develops a permanency plan using the HHSC Permanency Planning Instrument for Children Under 22 Years of Age form and performs other permanency planning activities for a designated resident under 22 years of age, if the designated resident is at least 21 years of age but younger than 22 years of age;

(F) while the designated resident is in a NF:

(i) a NF staff person familiar with the designated resident's needs; and

(ii) an individual providing a specialized service for the designated resident or a representative of a provider agency that is providing specialized services for the designated resident;

(G) if the designated resident is transitioning to the community:

(i) a representative from the community program provider, if one has been selected; and

(ii) a relocation specialist;

(H) a representative from the LMHA or LBHA, if the designated resident's PE is positive for MI;

(I) a concerned person whose inclusion is requested by the designated resident or the LAR; and

(J) at the discretion of the LIDDA, an individual who is directly involved in the delivery of services for people with ID or DD.

(79) Supported employment--An IHSS that:

(A) is assistance provided for a designated resident:

(i) who requires intensive, ongoing support to be self-employed, work from the designated resident's residence, or work in an integrated community setting at which people without disabilities are employed; and

(ii) to sustain competitive employment in an integrated community setting; and

(B) consists of:

(i) making employment adaptations, supervising, and providing training related to the designated resident's assessed needs;

(ii) transporting the designated resident between the NF and the site where the supported employment services are provided and as necessary to support the designated resident to be self-employed, work from the designated resident's residence, or work in an integrated community setting; and

(iii) participating in SPT and IDT meetings.

(80) Surrogate decision maker--An actively involved family member of a resident who has been identified by an IDT in accordance with Texas Health and Safety Code §313.004 and who is available and willing to consent to medical treatment on behalf of the resident.

(81) Terminal illness--A medical prognosis that an individual's life expectancy is six months or less if the illness runs its normal course and that is documented by a physician's certification in the individual's medical record maintained by a NF.

(82) Therapy services--In accordance with §554.2703(46) of this title, assessment and treatment to help a designated resident learn, keep, or improve skills and functioning of daily living affected by a disabling condition. Therapy services are referred to as habilitative therapy services. Therapy services are limited to:

(A) physical therapy;

(B) occupational therapy; and

(83) Transition plan--A plan developed by the SPT or MI quarterly meeting attendees that describes the activities, timetable, responsibilities, services, and essential supports involved in assisting a designated resident or resident with MI to transition from residing in a NF to living in the community.

(84) Uniform assessment--The HHSC-approved uniform assessment tool for adult mental health services.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on March 26, 2024.

TRD-202401266

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: April 15, 2024

Proposal publication date: October 20, 2023

For further information, please call: (512) 438-5018

SUBCHAPTER B. PASRR SCREENING AND EVALUATION PROCESS

26 TAC §303.201

STATUTORY AUTHORITY

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on March 26, 2024.

TRD-202401267

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: April 15, 2024

Proposal publication date: October 20, 2023

For further information, please call: (512) 438-5018

SUBCHAPTER C. RESPONSIBILITIES

26 TAC §303.302, §303.303

STATUTORY AUTHORITY

The amendments are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, Texas Government Code §531.033, which provides the Executive Commissioner of HHSC with broad rulemaking authority; and Texas Human Resources Code §32.021, which provides that HHSC will adopt necessary rules for the proper and efficient administration of the Medicaid program.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on March 26, 2024.

TRD-202401268

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: April 15, 2024

Proposal publication date: October 20, 2023

For further information, please call: (512) 438-5018

SUBCHAPTER E. HABILITATION COORDINATION

26 TAC §303.502, §303.503

STATUTORY AUTHORITY

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on March 26, 2024.

TRD-202401269

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: April 15, 2024

Proposal publication date: October 20, 2023

For further information, please call: (512) 438-5018

SUBCHAPTER F. HABILITATIVE SERVICE PLANNING FOR A DESIGNATED RESIDENT

26 TAC §303.601, §303.602

STATUTORY AUTHORITY

§303.601.Habilitation Coordination for a Designated Resident.

(a) A LIDDA must assign a habilitation coordinator to each designated resident within two business days after a PE is completed if the PE is positive for ID or DD.

(1) The habilitation coordinator must attend the initial IDT and provide habilitation coordination while the designated resident is residing in the NF.

(2) A designated resident may refuse habilitation coordination.

(b) Unless a designated resident has refused habilitation coordination, the assigned habilitation coordinator must:

(1) assess and reassess quarterly, and as needed, the designated resident's habilitative service needs by gathering information from the designated resident and other appropriate sources, such as the LAR, family members, social workers, and service providers, to determine the designated resident's habilitative needs and preferences and the specialized services that will address those needs and preferences;

(2) develop and revise, as needed, an individualized HSP in accordance with HHSC's rules and IDD PASRR Handbook, and using HHSC forms;

(3) assist the designated resident to access needed specialized services agreed upon in an IDT or SPT meeting, including:

(A) monitoring to determine if a specialized service agreed upon in an IDT or SPT meeting is requested within required timeframes in accordance with the IDD PASRR Handbook or documenting delays and the habilitation coordinator's follow-up activities; and

(B) ensuring the delivery of all specialized services agreed upon in an IDT or SPT meeting or documenting delays and the habilitation coordinator's follow-up activities;

(4) coordinate other habilitative programs and services that can address needs and achieve outcomes identified in the HSP;

(5) facilitate the coordination of the designated resident's HSP and NF comprehensive care plan, including ensuring the HSP is shared with members of the SPT within 10 calendar days after the HSP is updated or renewed;

(6) monitor and provide follow-up activities that consist of:

(A) monitoring the initiation and delivery of all specialized services agreed upon in an IDT or SPT meeting and following up when delays occur;

(B) monitoring the designated resident's and LAR's satisfaction with all specialized services; and

(C) determining the designated resident's progress or lack of progress toward achieving goals and outcomes identified in the HSP from the designated resident's and LAR's perspectives;

(7) meet with the designated resident to provide habilitation coordination:

(A) at least monthly if the designated resident is receiving a specialized service in addition to habilitation coordination; and

(i) meet in person at least quarterly or more frequently as determined by the SPT using the findings of the HHSC Habilitative Assessment form; and

(ii) subject to subsection (d) of this section, meet via audio-visual communication in a month when a meeting is not conducted in person; or

(B) at least quarterly in person, if the designated resident is receiving only habilitation coordination, unless the designated resident or the designated resident's LAR requests more frequent meetings;

(8) convene and facilitate an SPT meeting:

(A) at least quarterly; and

(B) between quarterly SPT meetings if:

(i) there is a change in the designated resident's service needs or medical condition; or

(ii) requested by the designated resident or LAR;

(9) coordinate with the NF in accessing medical, social, educational, and other appropriate services and supports that will help the designated resident achieve a quality of life acceptable to the designated resident and LAR on the resident's behalf;

(10) initially and annually thereafter:

(A) provide the designated resident and LAR an oral and written explanation of the designated resident's rights in accordance with the IDD PASRR Handbook; and

(B) inform the designated resident and LAR both orally and in writing of all the services available and requirements pertaining to the designated resident's participation;

(11) for a designated resident who has a guardian, determine at least annually if the letters of guardianship are current; and

(12) if appropriate, for a designated resident who does not have a guardian, ensure the SPT discusses whether the designated resident would benefit from a less restrictive alternative to guardianship or from guardianship and make appropriate referrals.

(c) Regardless of whether the designated resident is receiving or has refused habilitation coordination, the habilitation coordinator must:

(1) address community living options with the designated resident and LAR by:

(A) offering the educational opportunities and informational activities about community living options that are periodically scheduled by the LIDDA;

(B) providing information about the range of community living services, supports, and alternatives, identifying the services and supports the designated resident will need to live in the community, and identifying and addressing barriers to community living in accordance with HHSC's IDD PASRR Handbook and using HHSC materials at the following times:

(i) six months after the initial presentation of community living options during the PE described in §303.302(a)(2)(B)(i) of this Chapter (relating to LIDDA, LMHA, and LBHA Responsibilities Related to the PASRR Process) and at least every six months thereafter;

(ii) when requested by the designated resident or LAR;

(iii) when the habilitation coordinator is notified or becomes aware that the designated resident, or the LAR on the designated resident's behalf, is interested in speaking with someone about transitioning to the community; and

(iv) when notified by HHSC that the designated resident's response in Section Q of the MDS Assessment indicates the resident is interested in speaking with someone about transitioning to the community; and

(2) annually assess the designated resident's habilitative service needs by gathering information from the designated resident and other appropriate sources, such as the LAR, family members, social workers, and service providers, to determine the designated resident's habilitative needs and preferences.

(d) Before the habilitation coordinator conducts the meeting described in subsection (b)(7)(A)(ii) of this section via audio-visual communication, the habilitation coordinator must:

(1) obtain the written informed consent of the designated resident or LAR; or

(2) obtain the designated resident's or LAR's oral consent and document the oral consent in the designated resident's record.

(e) If the habilitation coordinator does not obtain the written or oral consent required by subsection (d) of this section, the habilitation coordinator must document the designated resident's or LAR's refusal in the designated resident's record.

§303.602.Service Planning Team Responsibilities Related to Specialized Services.

(a) The SPT for a designated resident must:

(1) meet at least quarterly, as convened by the habilitation coordinator;

(2) ensure that the designated resident, regardless of whether he or she has an LAR, participates in the SPT to the fullest extent possible and receives the support necessary to do so, including communication supports;

(3) develop an HSP for the designated resident;

(4) review and monitor identified risk factors, such as choking, falling, and skin breakdown, and report to the proper authority if they are not addressed;

(5) make timely referrals, service changes, and revisions to the HSP as needed;

(6) considering the designated resident's preferences, monitor to determine if the designated resident is provided opportunities for engaging in integrated activities:

(A) with residents who do not have ID or DD; and

(B) in community settings with people who do not have a disability; and

(7) develop the plan of care for a designated resident who receives IHSS.

(b) Each member of the SPT for a designated resident must:

(1) consistent with the SPT member's role, assist the habilitation coordinator in ensuring the designated resident's needs are being met; and

(2) participate in an SPT meeting in person, via audio-visual communication, or via audio-only communication, except as described in subsection (c)(3) or (e) of this section;

(1) submit to the habilitation coordinator a copy of all assessments of the designated resident that were completed by the provider or provider agency;

(2) submit a written report describing the designated resident's progress or lack of progress to the habilitation coordinator at least five days before a quarterly SPT meeting; and

(3) participate in an SPT meeting, in person, via audio-visual communication, or via audio-only communication, unless the habilitation coordinator determines participation by the provider is not necessary.

(d) If a habilitation coordinator determines participation by a provider is not necessary as described in subsection (c)(3) of this section, the habilitation coordinator must:

(1) base the determination:

(A) on the information in the written report submitted in accordance with subsection (c)(2) of this section; and

(B) on the needs of the SPT; and

(2) document the reasons for exempting participation.

(e) A habilitation coordinator must facilitate a quarterly SPT meeting in person, or in extenuating circumstances via audio-visual communication.

(f) Before the habilitation coordinator conducts the meeting described in subsection (e) of this section via audio-visual communication, the habilitation coordinator must:

(1) do one of the following:

(A) obtain the written informed consent of the designated resident or LAR; or

(B) obtain the oral consent of the designated resident or LAR and document the oral consent in the designated resident's record; and

(2) document in the designated resident's record a description of the extenuating circumstances which required the use of audio-visual communication.

(g) If the habilitation coordinator does not obtain the written or oral consent required by subsection (f) of this section, the habilitation coordinator must:

(1) document the designated resident's or LAR's refusal in the designated resident's record; and

(2) convene an SPT meeting in person as soon as possible after the extenuating circumstances no longer exist.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on March 26, 2024.

TRD-202401270

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: April 15, 2024

Proposal publication date: October 20, 2023

For further information, please call: (512) 438-5018

SUBCHAPTER G. TRANSITION PLANNING

26 TAC §303.701, §303.703

STATUTORY AUTHORITY

§303.701.Transition Planning for a Designated Resident.

(a) A LIDDA must assign a service coordinator for a designated resident if the designated resident, or the LAR on the designated resident's behalf, expresses an interest in moving to the community and has selected a community program.

(b) A service coordinator must facilitate the development, revisions, implementation, and monitoring of a transition plan in accordance with HHSC's IDD PASRR Handbook and using HHSC forms. A transition plan must identify the services and supports a designated resident needs to live in the community, including those essential supports that are critical to the designated resident's health and safety.

(1) meet as convened by the service coordinator;

(3) conduct transition planning activities and develop a transition plan for the designated resident.

(d) Consistent with an SPT member's role, each SPT member must:

(1) assist the service coordinator in developing, revising, implementing, and monitoring a designated resident's transition plan to ensure a successful transition to the community for the designated resident; and

(2) participate in an SPT meeting in person, via audio-visual communication, or via audio-only communication, except as described in subsection (e) or (g) of this section.

(e) An SPT member who is a provider of a specialized service must participate in an SPT meeting, in person, via audio-visual communication, or via audio-only communication, unless the service coordinator determines participation by the provider is not necessary.

(f) If a service coordinator determines participation by a provider is not necessary as described in subsection (e) of this section, the service coordinator must:

(1) base the determination on the needs of the SPT; and

(2) document the reasons for exempting participation.

(g) At an SPT meeting convened by a service coordinator, the service coordinator must facilitate the SPT meeting in person, or in extenuating circumstances via audio-visual communication.

(h) For a designated resident who is transitioning to the community, a service coordinator must, in accordance with HHSC's IDD PASRR Handbook and using HHSC forms, conduct and document a pre-move site review of the designated resident's proposed residence in the community to determine whether all essential supports in the designated resident's transition plan are in place before the designated resident's transition to the community.

(i) If the SPT makes a recommendation that a designated resident continue to reside in a NF, the SPT must:

(1) document the reasons for the recommendation; and

(2) include in the designated resident's transition plan:

(A) the barriers to moving to a more integrated setting; and

(B) the steps the SPT will take to address those barriers.

(j) Before the service coordinator conducts the meetings described in subsection (g) of this section via audio-visual communication, the service coordinator must:

(1) do one of the following:

(A) obtain the written informed consent of the designated resident or LAR; or

(B) obtain the oral consent of the designated resident or LAR and document the oral consent in the designated resident's record; and

(2) document in the designated resident's record a description of the extenuating circumstances which required the use of audio-visual communication.

(k) If the service coordinator does not obtain the written or oral consent required by subsection (j) of this section, the service coordinator must:

(1) document the designated resident's or LAR's refusal in the designated resident's record; and

(2) convene an SPT meeting in person as soon as possible after the extenuating circumstances no longer exist.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on March 26, 2024.

TRD-202401271

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: April 15, 2024

Proposal publication date: October 20, 2023

For further information, please call: (512) 438-5018

SUBCHAPTER I. MI SPECIALIZED SERVICES

26 TAC §303.901

STATUTORY AUTHORITY

The repeal is authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, Texas Government Code §531.033, which provides the Executive Commissioner of HHSC with broad rulemaking authority; and Texas Human Resources Code §32.021, which provides that HHSC will adopt necessary rules for the proper and efficient administration of the Medicaid program.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on March 26, 2024.

TRD-202401272

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: April 15, 2024

Proposal publication date: October 20, 2023

For further information, please call: (512) 438-5018

26 TAC §§303.901, 303.905, 303.907, 303.909, 303.910, 303.912, 303.914

STATUTORY AUTHORITY

§303.901.Description of MI Specialized Services.

(a) An LMHA or LBHA staff must conduct the uniform assessment to determine which level of care the resident with MI will receive.

(b) Some of the MI specialized services for a resident with MI are described in more detail in this subsection.

(1) Skills training and development. Training provided to a resident with MI that:

(A) addresses the severe and persistent MI and symptom-related problems that interfere with the functioning of the resident with MI;

(B) provides opportunities for the resident with MI to acquire and improve skills needed to function as appropriately and independently as possible in the community; and

(C) facilitates community integration for the resident with MI and increases the length of community residency for the resident with MI.

(2) Medication training and support services. Education and guidance provided to a resident with MI and family members about the medications of the resident with MI and their possible side effects as described in §306.315 of this title (relating to Medication Training and Support Services).

(3) Psychosocial rehabilitation services. Social, educational, vocational, behavioral, and cognitive interventions provided by the therapeutic team members of a resident with MI that address deficits in their ability to develop and maintain social relationships, occupational or educational achievement, independent living skills, or housing. Psychosocial rehabilitative services include the following component services:

(A) coordination services;

(B) crisis related services;

(D) housing related services;

(E) independent living services; and

(F) medication related services.

(4) Case management. A primarily site-based service to assist a resident with MI or LAR in gaining and coordinating access to necessary care and services appropriate to the needs of the resident with MI.

(5) Psychiatric diagnostic interview examination. An assessment of a resident with MI that includes relevant past and current medical and psychiatric information and a documented diagnosis by a licensed professional practicing within the scope of his or her license.

§303.905.Process for Service Initiation.

(a) The LMHA or LBHA must comply with §303.302 of this chapter (relating to LIDDA, LMHA, and LBHA Responsibilities Related to the PASRR Process).

(b) At the initial IDT meeting, an LMHA or LBHA staff must:

(1) review the MI specialized services recommended on the PE;

(2) explain the uniform assessment;

(3) ensure the resident with MI, or LAR on behalf of the resident with MI, understands the purpose of the uniform assessment; and

(4) have the resident with MI, or LAR on behalf of the resident with MI, agree or decline to receive the uniform assessment and MI specialized services.

(1) complete the uniform assessment;

(2) develop the PCRP; and

(3) for a resident with MI only, convene a meeting in person, or in extenuating circumstances via audio-visual communication, to discuss the results of the uniform assessment and PCRP, and to determine the MI specialized services the resident with MI will receive.

(d) Attendees at the meeting convened in accordance with subsection (c)(3) of this section must include:

(1) the QMHP-CS who is familiar with the needs of the resident with MI;

(2) the resident with MI;

(3) the LAR for the resident with MI, if any; and

(4) a NF staff person familiar with the needs of the resident with MI.

(e) At the meeting convened in accordance with subsection (c)(3) of this section, the QMHP-CS must ensure the resident with MI, regardless of whether he or she has an LAR, participates in the meeting to the fullest extent possible and receives the support necessary to do so, including communication supports.

(f) The LMHA or LBHA must provide a copy of the completed uniform assessment and PCRP to the NF for inclusion in the NF comprehensive care plan for the resident with MI within 10 calendar days after the meeting convened in accordance with subsection (c)(3) of this section.

(g) Before the LMHA or LBHA conducts the meeting described in subsection (c)(3) of this section via audio-visual communication, the LMHA or LBHA must:

(1) do one of the following:

(A) obtain the written informed consent of the resident with MI or LAR; or

(B) obtain oral consent from the resident with MI or LAR and document the oral consent in the record of the resident with MI; and

(2) document in the record of the resident with MI a description of the extenuating circumstances which required the use of audio-visual communication.

(h) If the LMHA or LBHA does not obtain the written or oral consent required by subsection (g) of this section, the LMHA or LBHA must:

(1) document the resident with MI's or LAR's refusal in the record of the resident with MI; and

(2) convene a meeting in person as soon as possible after the extenuating circumstances no longer exist.

§303.907.Renewal and Revision of Person-Centered Recovery Plan.

(a) At least quarterly, the QMHP-CS must convene an MI quarterly meeting with the MI specialized services team, in person, or in extenuating circumstances via audio-visual communication, to:

(1) review the PCRP to determine whether the MI specialized services previously identified remain relevant; and

(2) determine whether the current uniform assessment accurately reflects the need for MI specialized services in the identified frequency for the resident with MI, in the amount, and duration, or if an updated uniform assessment is required.

(b) The MI specialized services team initiates revisions to the PCRP in response to changes to the needs of the resident with MI.

(1) Any MI specialized services team member may ask the QMHP-CS to convene a meeting at any time to discuss whether the PCRP for the resident with MI needs to be revised to add a new MI specialized service or change the frequency, amount, or duration of an existing MI specialized service.

(2) The QMHP-CS must convene a meeting within seven calendar days after learning of the need to revise the PCRP for the resident with MI.

(c) If the MI specialized services team agrees to add a new MI specialized service to the PCRP or determines an updated uniform assessment is required, a QMHP-CS must, within seven calendar days after the meeting is held, update the uniform assessment and provide it to the MI specialized services team.

(d) The QMHP-CS must:

(1) document revisions on the PCRP within five calendar days after a team meeting; and

(2) retain the revised PCRP documentation in the LMHA or LBHA record for the resident with MI.

(e) Within ten calendar days after the PCRP is updated or renewed, the QMHP-CS must send each member of the MI specialized services team a copy of the revised PCRP.

(f) If the MI specialized services team determines a new MI specialized service is needed or determines a change in the frequency, amount, or duration of an existing service is needed, the PCRP must be revised before the LMHA or LBHA delivers a new or updated service.

(g) Before the QMHP-CS conducts the meeting described in subsection (a) of this section via audio-visual communication, the QMHP-CS must:

(1) do one of the following:

(A) obtain the written informed consent of the resident with MI or LAR; or

(B) obtain the oral consent from the resident with MI or LAR and document the oral consent in the record of the resident with MI; and

(2) document in the record of the resident with MI the extenuating circumstances which required the use of audio-visual communication.

(h) If the QMHP-CS does not obtain the written or oral consent required by subsection (g) of this section, the QMHP-CS must:

(1) document the refusal of the resident with MI or LAR in the record of the resident with MI; and

(2) convene an MI specialized services team meeting in person as soon as possible after the extenuating circumstances no longer exist.

§303.909.Refusal of the Uniform Assessment or MI Specialized Services.

(a) When a resident with MI refuses the uniform assessment or MI specialized services, the LMHA or LBHA must:

(1) ask the resident with MI or the LAR to sign the Refusal of PASRR MI Specialized Services form and document on the form if the resident with MI or LAR refuses to sign;

(2) inform the resident with MI that a follow-up visit will be conducted every 30 days for 90 days after the initial IDT meeting;

(3) conduct a follow-up visit every 30 days for 90 days after the initial IDT meeting and make the 90th day follow-up visit the first MI quarterly meeting; and

(4) if the resident with MI or the LAR refuses the uniform assessment or MI specialized services at the first MI quarterly meeting, inform the resident with MI and the LAR that an annual IDT meeting is required and will be conducted, at which time the uniform assessment and MI specialized services will be offered again.

(b) A resident with MI and their LAR, if applicable, may agree to receive the uniform assessment or MI specialized services at any time.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on March 26, 2024.

TRD-202401273

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: April 15, 2024

Proposal publication date: October 20, 2023

For further information, please call: (512) 438-5018

SUBCHAPTER J. DISASTER RULE FLEXIBILITIES

26 TAC §303.1000

STATUTORY AUTHORITY

§303.1000.Flexibilities to Certain Requirements During Declaration of Disaster.

(a) HHSC may allow LIDDAs, LMHAs, and LBHAs to use one or more of the exceptions described in subsection (c) of this section while an executive order or proclamation declaring a state of disaster under Texas Government Code §418.014 is in effect. HHSC will notify LIDDAs, LMHAs, and LBHAs when an exception is permitted and the date the exception must no longer be used, which may be before the declaration of a state of disaster expires.

(b) Subject to the notification by HHSC, the following flexibilities may be available to LIDDAs, LMHAs, and LBHAs to the extent the flexibility is permitted by and does not conflict with other laws or obligations of the LIDDAs, LMHAs, and LBHAs and is allowed by federal and state law.

(c) LIDDAs, LMHAs, and LBHAs, for services normally provided in person, may use audio-visual communication or audio-only communication methods to engage with the individual or resident to carry out the requirements in:

(1) §303.302(a)(2)(A)(ii) of this chapter (relating to LIDDA, LMHA, and LBHA Responsibilities Related to the PASRR Process);

(2) §303.601(b)(7) of this chapter (relating to Habilitation Coordination for a Designated Resident);

(3) §303.602(e) of this chapter (relating to Service Planning Team Responsibilities Related to Specialized Services);

(4) §303.701(g) of this chapter (relating to Transition Planning for a Designated Resident);

(5) §303.905(c)(3) of this chapter (relating to Process for Service Initiation); and

(6) §303.907(a) of this chapter (relating to Renewal and Revision of Person-Centered Recovery Plan).

(d) LIDDAs, LMHAs, and LBHAs that use the flexibilities allowed under subsection (c) of this section, must comply with:

(1) all guidance on the application of the rules during the declaration of disaster that is published by HHSC on its website or in another communication format HHSC determines appropriate; and

(2) all policy guidance applicable to the rules identified in subsection (c) of this section issued by HHSC's Medicaid and CHIP Services.

(e) LIDDAs, LMHAs, and LBHAs must ensure any method of contact complies with all applicable requirements related to security and privacy of information.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on March 26, 2024.

TRD-202401274

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: April 15, 2024

Proposal publication date: October 20, 2023

For further information, please call: (512) 438-5018