Adopted Rules Title 26

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 February 7, 2025.

TRD-202500452

Effective date: February 27, 2025

Proposal publication date: November 1, 2024

For further information, please call: (512) 438-2910

CHAPTER 306. BEHAVIORAL HEALTH DELIVERY SYSTEM

The Texas Health and Human Services Commission (HHSC) adopts amendments to §306.151, relating to Purpose; §306.152, relating to Application and Responsibility for Compliance; §306.153, relating to Definitions; §306.154, relating to Notification and Appeals Process for Local Mental Health Authority or Local Behavioral Health Authority Services; §306.161, relating to Screening and Assessment; §306.162, relating to Determining County of Residence; §306.163, relating to Most Appropriate and Available Treatment Options; §306.171, relating to General Admission Criteria for a State Hospital or a Facility with a Contracted Psychiatric Bed; §306.172, relating to Admission Criteria for Maximum-Security Units; §306.173, relating to Admission Criteria for an Adolescent Forensic Unit; §306.174, relating to Admission Criteria for Waco Center for Youth; §306.175, relating to Voluntary Admission Criteria for a State Hospital or a Facility with a Contracted Psychiatric Bed; §306.176, relating to Admission Criteria for a State Hospital or a Facility with a Contracted Psychiatric Bed for Emergency Detention; §306.177, relating to Admission Criteria Under Order of Protective Custody or Court-ordered Inpatient Mental Health Services; §306.178, relating to Voluntary Treatment Following Involuntary Admission; §306.191, relating to Transfers Between State Hospitals; §306.192, relating to Transfers Between a State Hospital and a State Supported Living Center; §306.193, relating to Transfers Between a State Hospital and an Out-of-State Facility; §306.194, relating to Transfers Between a State Hospital and Another Facility in Texas; §306.195, relating to Changing Local Mental Health Authorities or Local Behavioral Health Authorities; §306.201, relating to Discharge Planning; §306.202, relating to Special Considerations for Discharge Planning; §306.203, relating to Discharge of an Individual Voluntarily Receiving Inpatient Treatment; §306.204, relating to Discharge of an Individual Involuntarily Receiving Treatment; §306.205, relating to Pass or Furlough from a State Hospital or a Facility with a Contracted Psychiatric Bed; §306.207, relating to Post Discharge or Furlough: Contact and Implementation of the Recovery or Treatment Plan; and §306.221, relating to Screening and Intake Assessment Training Requirements at a State Hospital and a Facility with a Contracted Psychiatric Bed.

HHSC adopts new §306.155, relating to Local Mental Health Authority, Local Behavioral Health Authority, and Continuity of Care Liaison Responsibilities; §306.361, relating to Purpose; §306.363, relating to Application; §306.365, relating to Definitions; §306.367, relating to General Provisions; and §306.369, relating to Documentation Requirements.

HHSC adopts the repeal of §306.206, relating to Absence for Trial Placement.

Sections 306.151, 306.153 - 306.155, 306.162, 306.163, 306.171, 306.175 - 306.177, 306.191, 306.194, 306.195, 306.201 - 306.205, 306.207, 306.221, 306.361, 306.363, 306.365, 306.367, and 306.369 are adopted with changes to the proposed text as published in the September 13, 2024, issue of the Texas Register (49 TexReg 7192). These rules will be republished.

Sections 306.152, 306.161, 306.172 - 306.174, 306.178, 306.192, 306.193 and 306.206 are adopted without changes to the proposed text as published in the September 13, 2024, issue of the Texas Register (49 TexReg 7192). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The Texas Health and Human Services Commission (HHSC) adopts amendments and the repeal of a rule in the Texas Administrative Code (TAC), Title 26 Chapter 306, Subchapter D relating to Mental Health Services--Admission, Continuity, and Discharge, and adopts new rules in 26 TAC Chapter 306, Subchapter H relating to Behavioral Health Services--Telecommunications. The adopted rules are necessary to implement Senate Bill (S.B.) 26, 88th Legislature, Regular Session, 2023 and House Bill (H.B.) 4, 87th Legislature, Regular Session, 2021.

S.B. 26 requires HHSC to adopt or amend existing rules to address a local mental health authority's (LMHA's) responsibility for ensuring the successful transition of patients determined ready for discharge from an HHSC mental health facility. This adoption also includes application to a local behavioral health authority (LBHA). To implement S.B. 26, the adopted rules:

Require state hospitals to participate in joint discharge planning with an LMHA or LBHA;

Require coordination between the LMHAs or LBHAs and the state hospital to determine appropriate community services for a patient;

Require an LMHA or LBHA to arrange for the provision of services upon discharge;

Require the LMHA's or LBHA's transition support services to complement joint discharge planning efforts;

Require each state hospital to designate at least one employee to provide transition support services for patients determined medically appropriate for discharge;

Require each state hospital to concentrate transition support services on patients admitted and discharged multiple times within 30 days, or patients who had a long-term stay (more than 365 consecutive days); and

Allow voluntary admission to an inpatient mental health facility, including a state hospital, only if space is available.

To implement H.B. 4, the adopted rules ensure that individuals receiving HHSC-funded behavioral health services have the option to receive services as telemedicine or telehealth services, including using an audio-only platform, to the extent it is clinically effective and cost-effective.

Additionally, the adopted rules clarify statutory requirements; add, remove, and update definitions; delete references to managed care organizations (MCOs); update Medicaid-related information; update and add cross-references; and make grammatical and editorial changes for understanding, accuracy, and uniformity.

COMMENTS

The 31-day comment period ended on October 14, 2024.

During this period, HHSC received comments regarding the proposed rules from one commenter, the Texas Council of Community Centers. A summary of comments relating to the rules and HHSC's responses follows.

Comment: A commenter recommended fully aligning the continuity of care (CoC) liaison responsibilities in §306.155 with the responsibilities outlined in the Performance Contract Notebook.

Response: HHSC agrees with the commenter that the proposed rule should align with the responsibilities outlined in the Performance Contract Notebook. HHSC will use the CoC liaison responsibilities listed in §306.155 to inform updates to the Performance Contract Notebook.

Comment: A commenter recommended amending §306.155(16) to allow uniform assessments completed within 10 days before a planned discharge to still apply in circumstances in which a planned discharge has been delayed.

Response: HHSC declines to revise the rule in response to the comment. Due to the potential for changes in mental health status, particularly in cases of delayed discharge, a uniform assessment must be conducted within ten business days before discharge. This rule reinforces the importance of using the most current clinical assessment and supports HHSC policy that an Adults Needs and Strengths Assessment or Child and Adolescent Needs and Strength be valid for only 10 days.

Comment: A commenter recommended HHSC consider discussing an increase of the seven-day timeframe detailed in §306.204(c)(3)(B), regarding a state hospital or facility with an HHSC-funded contracted psychiatric bed's responsibility to provide or pay for no more than a seven-day supply of an individual's medications.

Response: HHSC declines to revise the rule in response to the comment. Texas Health and Safety Code §574.081(c-2) currently provides that "[t]he executive commissioner may not adopt rules requiring a mental health facility to provide or pay for psychoactive medication for more than seven days after furlough or discharge."

HHSC revised §306.151 to spell out acronyms the first time used in the section to improve understanding.

HHSC revised §306.153(16), (66), and (75); §306.171(e); §306.175(a)(2)(A) and (B) and (b)(1); §306.175(e)(2), (g), and (h)(1); §306.176(d)(3) and (e); §306.177(c); §306.191(a), (b)(4), and (c); §306.194(a); §306.195(a)(1)(C), (a)(2)(B), (a)(3), (a)(4), and (b); §306.201(b), (c)(2), (c)(3)(A) and (B), (c)(4) - (6), (d)(1)(B), (d)(2) and (3), (e) and (e)(1), (g)(1), (h)(1)(B)(v) and (vii), and (k)(5); §306.202(c)(5)(B) and (c)(6)(A)(iii); §306.203(b)(2) and (d)(2)(C)(i)(II); §306.203(d)(2)(C)(i)(II); §306.205(d)(2)(B) and (C); §306.367(d)(4); and §306.369(b)(1) by making editorial changes to clarify the meaning of these rules referring to the "LAR."

HHSC revised §306.153(21) to update the Texas Government Code citation from §531.055 to Chapter 522, Subchapter D; §306.153(68) to update the Texas Government Code citation from §531.251 to §547.0051; and §306.361 to update the Texas Government Code citation from §531.02161 to §548.0002. The updates implement H.B. 4611, 88th Legislature, Regular Session, 2023, which makes non-substantive revisions to the Texas Government Code that make the statute more accessible, understandable, and usable.

HHSC revised §306.153(39) and §306.365(7) to add "or in-person" so that when the term "in-person" is used in a rule it has the same meaning as "in person."

HHSC revised §306.153(60), §306.155(5), §306.194(a), §306.201(c)(2), §306.201(d)(1)(C), §306.201(h)(3)(B)(ii) and (iii) to make punctuation changes to correct grammar and improve clarity.

HHSC revised §306.153(62) to change "Level" to "level" to use the spelling of "PASRR level I screening" used in 26 TAC §303.102 where the term in §306.153(62) is defined.

HHSC revised §306.154(c) to change the reference to 25 TAC §401.464 to 26 TAC §301.155 to align with the administrative transfer of the referenced rule.

HHSC revised §306.154(d) to clarify that an individual may obtain additional information and resources both on the HHSC website and by calling the Ombudsman.

HHSC revised §306.155(16) - (19) to clarify the requirement for a CoC liaison to schedule appointments in advance for needed programs and services in a new paragraph (17). HHSC then renumbered paragraphs (17) - (19) as paragraphs (18) - (20), which required revising §306.195(a)(1)(B) to change the reference to §306.155(19) to §306.155(20).

HHSC revised §306.162(b)(3) to clarify that the transferring LMHA or LBHA will hold a transfer meeting with the receiving LMHA or LBHA and the minor's LAR. This change improves the readability of this rule and clarifies the role of the transferring LMHA or LBHA.

HHSC revised §306.163(f)(2) to change the reference to 25 TAC §412.106(c)(2) to 26 TAC §301.111(c)(2) to align with the administrative transfer of the referenced rule.

HHSC revised §306.175(a)(3)(A) - (D) to change references to 25 TAC Chapter 404, Subchapter E, 25 TAC Chapter 405, Subchapter E, 25 TAC Chapter 414, Subchapter I, and 25 TAC Chapter 415, Subchapter F to 26 TAC Chapter 320, Subchapter A, 26 TAC Chapter 307, Subchapter I, 26 TAC Chapter 320, Subchapter B, and 26 TAC Chapter 320, Subchapter C, respectively.

HHSC revised §306.175(c)(1) by replacing "each individual" with "an individual" to correct the grammar and improve clarity.

HHSC revised §306.175(g)(2) to change the reference to 25 TAC Chapter 404, Subchapter E, to 26 TAC Chapter 320, Subchapter A to align with the administrative transfer of the referenced rules.

HHSC revised §306.176(a)(1) to clarify the rule that an individual of any age is transported to the state hospital or CPB by a peace officer or "by" emergency medical services personnel.

HHSC revised §306.176(e)(2) - (5) to list all of the written and oral explanations that must be provided to the individual or LAR in new subparagraphs (A) - (D) under subsection (e)(2). Included in these revisions, HHSC changed the reference to 25 TAC Chapter 404, Subchapter E, to 26 TAC Chapter 320, Subchapter A to align with the administrative transfer of the referenced rules.

HHSC revised §306.177(c) to clarify that it is the intake assessment that must include what is listed in paragraphs (1) and (2) of the rule. HHSC revised §306.177(c)(2) to clarify that a written and oral explanation is "provided to the individual or LAR." HHSC also changed proposed §306.177(c)(2) - (4) to (c)(2)(A) - (C) to move the list of all the written and oral explanations that must be provided under (c)(2). In new subparagraph (A), under (c)(2), HHSC changed the reference to 25 TAC Chapter 404, Subchapter E, to 26 TAC Chapter 320, Subchapter A to align with the administrative transfer of the referenced rules.

HHSC revised §306.191(c) to add a parenthetical needed after the word "Bed" in the title of §306.175(a)(1).

HHSC revised §306.201(c)(4) to change "services and supports recommended" to "recommended services and supports." This change is needed to improve the readability of this rule.

HHSC revised §306.201(h)(2) to add "or LAR" in the rule after "An individual" to clarify that an individual or LAR may request additional records.

HHSC revised §306.201(k)(5) to change "refuse" to "refuses" and §306.202(g)(1)(C) to add "who is" in front of "discharged." These grammatical changes are needed to improve the readability of these rules.

HHSC revised §306.202(a) by removing "the" after "To prevent," and §306.202(g)(1)(C) to add "who is," in front of "discharged, to correct the grammar and clarify the rules.

HHSC revised §306.203(b) to reorganize the rule text to use active voice. The change is made to conform with the HHSC rule drafting guidelines.

HHSC revised §306.203(c)(2)(B) and (d)(1)(A), and §306.204(b)(2) and (3), to remove "time" in front of "period" to correct the grammar and clarify the rules.

HHSC revised §306.205(a)(1) to change "notifies" to "must notify" to clarify the rule imposes a requirement for the state hospital or contracted psychiatric bed (CPB) to notify the committing court of the individual's absence.

HHSC revised §306.205(a)(3)(B) to add a period at the end of the rule to correct the rule's formatting.

HHSC revised §306.207(c) to change "must identify" to "identifies" because the sentence is describing a certain situation as a precondition to the requirements for the designated LMHA or LBHA.

HHSC revised §306.221(a)(1)(B) to change the reference to 25 TAC Chapter 404, Subchapter E, to 26 TAC Chapter 320, Subchapter A. HHSC also revised §306.221(a)(2)(B) to change the reference to 25 TAC §404.165 to 26 TAC §320.29 to align with the administrative transfer of the referenced rule.

HHSC revised §306.361 to spell out "HHSC" to identify what the acronym means when used in §306.361 and §306.363.

HHSC revised §306.363 to spell out the acronyms "LMHA" and "LBHA" the first time used to identify what the acronyms mean when used in the rule. HHSC revised §306.363(3), (4), and (5) to add "HHSC-funded" in front of the references to a "substance use intervention provider" and a "substance use treatment provider." HHSC also revised §306.363 to make minor edits to change plural nouns to singular nouns per HHSC's rulemaking guidelines.

HHSC revised §306.365(11) to add "an HHSC-funded substance use intervention provider" as another type of "provider" in a new subparagraph (D), renumbered proposed (11)(D) to (11)(E), and added "an HHSC-funded" in front of the reference to a substance use treatment provider.

HHSC revised §306.367(b) and §306.369(c) to change "providers" to "provider" to use singular instead of plural per HHSC's rulemaking guidelines.

HHSC revised §306.367(d)(2) to use "in-person" instead of "in person" because "in-person" in this rule is used as a term to describe the type of service delivery.

HHSC revised §306.369(b) to replace "Prior to" with "Before" to clarify the meaning of the rule by using plain language.

SUBCHAPTER D. MENTAL HEALTH SERVICES--ADMISSION, DISCHARGE, AND CONTINUITY OF CARE

DIVISION 1. GENERAL PROVISIONS

26 TAC §§306.151 - 306.155

The amendments and new sections are adopted under 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, §531.008, which requires the Executive Commissioner of HHSC to establish a division for administering state facilities, including state hospitals and state supported living centers, and §531.02161, which requires the Executive Commissioner of HHSC to, by rule, develop and implement a system that ensures behavioral health services may be provided using an audio-only platform to the extent permitted by state and federal law and to the extent it is cost-effective and clinically effective; Health and Safety Code §533.014 which requires the Executive Commissioner of HHSC to adopt rules relating to LMHA treatment responsibilities, §533.0356 which allows the Executive Commissioner to adopt rules governing LBHAs, §533A.0355 which requires the Executive Commissioner of HHSC to adopt rules establishing the roles and responsibilities of local intellectual and developmental disability authorities, §534.052 which requires the Executive Commissioner of HHSC to adopt rules necessary and appropriate to ensure the adequate provision of community-based services through LMHAs, §534.0535 which requires the Executive Commissioner of HHSC to adopt rules that require continuity of services and planning for patient care between HHSC facilities and LMHAs, and §552.001 which provides HHSC with authority to operate the state hospitals.

§306.151.Purpose.

(a) The purpose of this subchapter is to:

(1) provide requirements on admission, discharge, and continuity of care; and

(2) address the interrelated roles and responsibilities of state hospitals, facilities with contracted psychiatric beds (CPBs), local mental health authorities (LMHAs), local behavioral health authorities (LBHAs), and local intellectual and developmental disability authorities (LIDDAs) in the delivery of mental health and co-occurring substance use disorder (SUD) services to individuals.

(b) This subchapter establishes criteria for individuals receiving mental health services and SUD services and provides guidelines related to:

(1) clinically appropriate placement in an inpatient, residential, or community setting based on screening and assessment of the individual;

(2) timely access to evaluation and mental health, SUD, and other services in the least restrictive and most appropriate setting; and

(3) transitioning care between service types and providers for individuals receiving mental health or SUD services at state hospitals, CPBs, LMHAs, LBHAs, and LIDDAS, effectively and without interruption. §306.153.Definitions.

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

(1) Absence--When an individual, previously admitted to a state hospital or CPB, and not discharged from the admitting facility, is physically away from the facility for any reason, including hospitalization, home visit, special activity, or unauthorized departure.

(2) Admission--Includes:

(A) an individual's acceptance to a state hospital or CPB for voluntary or involuntary inpatient or residential treatment services; or

(B) the acceptance of an individual in the mental health priority population into LMHA or LBHA services.

(3) Adolescent--An individual who is 13 years of age, but younger than 18 years of age.

(4) Adult--An individual who is at least 18 years of age or older.

(5) Advance directive--As used in this subchapter, includes:

(A) an instruction made under Texas Health and Safety Code Chapter 166; or

(B) a declaration for mental health treatment made in accordance with Civil Practice and Remedies Code Chapter 137.

(6) Alternate provider--An entity that provides mental health services or SUD services in the community but does not provide these services under contract with an LMHA or LBHA.

(7) APRN--Advanced practice registered nurse. A registered nurse licensed by the Texas Board of Nursing to practice as an advanced practice registered nurse as provided by Texas Occupations Code §301.152.

(8) Assessment--The administrative process a state hospital or CPB uses to gather information from an individual, including a medical history and the concerns for which the individual is seeking treatment, to determine whether the individual should be examined by a physician to determine if admission is clinically justified, as defined by Texas Health and Safety Code §572.0025(h)(2).

(9) Assessment professional--In accordance with Texas Health and Safety Code §572.0025(c) - (d), a staff member of a state hospital or CPB, whose responsibilities include conducting the intake assessment described in §306.175(g) of this subchapter (relating to Voluntary Admission Criteria for a State Hospital or a Facility with a Contracted Psychiatric Bed) and §306.176(e) of this subchapter (relating to Admission Criteria for a State Hospital or a Facility with a Contracted Psychiatric Bed for Emergency Detention), and who is:

(A) a physician licensed to practice medicine under Texas Occupations Code Chapter 155;

(B) a physician assistant licensed under Texas Occupations Code Chapter 204;

(D) a registered nurse licensed under Texas Occupations Code Chapter 301;

(E) a psychologist licensed under Texas Occupations Code Chapter 501;

(F) a psychological associate licensed under Texas Occupations Code Chapter 501;

(G) a licensed professional counselor licensed under Texas Occupations Code Chapter 503;

(H) a licensed social worker licensed under Texas Occupations Code Chapter 505; or

(I) a licensed marriage and family therapist licensed under Texas Occupations Code Chapter 502.

(10) Audio-only technology--A synchronous interactive, two-way audio communication that uses only sound and that conforms to privacy requirements of the Health Insurance Portability and Accountability Act. Audio-only includes the use of telephonic communication. Audio-only does not include audiovisual or in-person communication.

(11) Audiovisual technology--A synchronous interactive, two-way audio and video communication that conforms to privacy requirements under the Health Insurance Portability and Accountability Act. Audiovisual does not include audio-only or in-person communication.

(12) Business day--Any day except a Saturday, Sunday, or legal holiday listed in Texas Government Code §662.021.

(13) Capacity--An individual's ability to understand and appreciate the nature and consequences of a decision regarding the individual's medical treatment, and the ability of the individual to reach an informed decision in the matter.

(14) Child--An individual who is at least three years of age, but younger than 13 years of age.

(15) CoC liaison--Continuity of care liaison. A dedicated full-time staff member who is a QMHP-CS or LPHA that facilitates continuity of care.

(16) Continuity of care--Activities designed to ensure an individual is provided uninterrupted services during a transition between inpatient and outpatient services and that assist the individual and LAR, if applicable, in identifying, accessing, and coordinating LMHA or LBHA services and other appropriate services and supports in the community needed by the individual, including:

(A) assisting with admissions and discharges;

(B) facilitating access to appropriate services and supports in the community, including identifying and connecting the individual with community resources, and coordinating the provision of services;

(D) promoting implementation of the individual's recovery or treatment plan; and

(E) coordinating notification of continuity of care services between the individual and the individual's family and any other person providing support as authorized by the individual and LAR, if applicable.

(17) Continuity of care worker--A LIDDA staff member responsible for providing continuity of care services.

(18) COPSD--Co-occurring psychiatric and substance use disorder.

(19) COPSD model--An application of evidence-based practices for an individual diagnosed with co-occurring conditions of psychiatric and substance use disorder.

(20) CPB--Contracted psychiatric bed. A facility with an HHSC-contracted psychiatric bed that:

(A) includes a community mental health hospital and a private psychiatric bed that:

(i) is authorized by an LMHA or LBHA; and

(ii) is used for inpatient care in the community; and

(B) does not include a crisis respite unit, crisis residential unit, an extended observation unit, or a crisis stabilization unit.

(21) CRCG--Community Resource Coordination Group. A local interagency group comprised of public and private providers who collaborate to develop individualized service plans for individuals whose needs may be met through interagency coordination and cooperation. CRCGs are established and operate in accordance with a Memorandum of Understanding on Services for Persons Needing Multiagency Services, as required by Texas Government Code Chapter 522, Subchapter D.

(22) Crisis--A situation in which:

(A) an individual presents an immediate danger to self or others;

(B) an individual's mental or physical health is at risk of serious deterioration; or

(C) an individual believes the individual presents an immediate danger to self or others, or the individual's mental or physical health is at risk of serious deterioration.

(23) Crisis treatment alternatives--Community-based facilities or units and services providing short-term, residential crisis treatment to ameliorate a behavioral health crisis in the least restrictive and most appropriate environment, including crisis stabilization units, extended observation units, crisis residential units, and crisis respite units. The intensity and scope of services varies by facility type and is available in a local service area based upon the local needs and characteristics of the community.

(24) Day--A calendar day, unless otherwise specified.

(25) DD--Developmental disability. A disability that meets the criteria described in Texas Health and Safety Code §531.002(15).

(26) Designated LMHA or LBHA--The LMHA or LBHA:

(A) that serves the individual's county of residence, which is determined in accordance with §306.162 of this subchapter (relating to Determining County of Residence); or

(B) that does not serve the individual's county of residence but has taken responsibility for ensuring the individual's services.

(27) DFPS--Texas Department of Family and Protective Services or its designee.

(28) Discharge--Means:

(A) the release of an individual from the custody and care of a provider of inpatient services; or

(B) the termination of LMHA or LBHA services delivered to an individual by the individual's LMHA or LBHA.

(29) Discharge planning specialist--A designated state hospital staff member responsible for coordinating continuity of care services with a specific focus on an individual's community transition in accordance with Texas Health and Safety Code §534.0535. This term is synonymous with a "transition support specialist."

(30) Discharged unexpectedly--A discharge from the custody and care of a provider of inpatient services:

(A) due to an individual's unauthorized departure;

(B) at the individual's request;

(D) due to the death of the individual; or

(E) due to the execution of an arrest warrant for the individual.

(31) DSM--Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association.

(32) Emergency medical condition--This term has the meaning assigned by the Emergency Medical Treatment and Active Labor Act (42 U.S.C. §1395dd), regarding Examination and treatment for emergency medical conditions and women in labor.

(33) Family partner--An experienced, trained primary caregiver, such as the parent of an individual with a mental illness or serious emotional disturbance, who provides peer mentoring, education, and support to the caregivers of a child who is receiving mental health community services in accordance with Chapter 301, Subchapter G of this title (relating to Mental Health Community Services Standards).

(34) Furlough--The authorization for an individual to leave from a state hospital or CPB for longer than a 72-hour period in accordance with Texas Health and Safety Code Chapter 574, Subchapter F.

(35) HHSC--Texas Health and Human Services Commission or its designee.

(36) ID--Intellectual disability. A disability that meets the criteria in Texas Health and Safety Code §591.003.

(37) Individual--A person seeking or receiving services under this subchapter.

(38) Inpatient services--Residential psychiatric treatment provided to an individual in:

(A) a state hospital;

(B) a CPB;

(D) a crisis stabilization unit licensed under Chapter 510 of this title (relating to Private Psychiatric Hospitals and Crisis Stabilization Units); or

(E) any other type of mental health hospital.

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

(40) Intake assessment--The administrative process conducted by an assessment professional for:

(A) gathering information about an individual, including the psychiatric and medical history, social history, symptomology, and support system; and

(B) giving the individual information about the facility and the facility's treatment and services.

(41) Involuntary admission--An individual receiving inpatient services based on an admission to a state hospital or CPB in accordance with:

(A) §306.176 of this subchapter (relating to Admission Criteria for a State Hospital or a Facility with a Contracted Psychiatric Bed for Emergency Detention);

(B) §306.177 of this subchapter (relating to Admission Criteria Under Order of Protective Custody or Court-ordered Inpatient Mental Health Services);

(C) an order for temporary inpatient mental health services issued in accordance with Texas Health and Safety Code §574.034 or Texas Family Code Chapter 55;

(D) an order for extended inpatient mental health services issued in accordance with Texas Health and Safety Code §574.035 or Texas Family Code Chapter 55;

(E) an order for commitment issued as described in Texas Code of Criminal Procedure Chapter 46B; or

(F) an order for commitment issued as described in Texas Code of Criminal Procedure Chapter 46C.

(42) LAR--Legally authorized representative. A person authorized by state law to act on behalf of an individual.

(43) LBHA--Local behavioral health authority. An entity designated as an LBHA by HHSC in accordance with Texas Health and Safety Code §533.0356(a).

(44) LIDDA--Local intellectual and developmental disability authority. An entity designated by HHSC in accordance with Texas Health and Safety Code §533A.035(a).

(45) LMHA--Local mental health authority. An entity designated as an LMHA by HHSC in accordance with Texas Health and Safety Code §533.035(a).

(46) LMHA or LBHA network provider--An entity that provides mental health and SUD services in the community pursuant to a contract or memorandum of understanding with an LMHA or LBHA, including that part of an LMHA or LBHA directly providing mental health services.

(47) LMHA or LBHA services--Inpatient mental health and outpatient mental health and SUD services provided by an LMHA or LBHA network provider to an individual in the individual's home community.

(48) Local service area--A geographic area composed of one or more Texas counties defining the population that may receive services from an LMHA, LBHA, or LIDDA.

(49) LPHA--Licensed practitioner of the healing arts. This term has the meaning as defined in §301.303 of this title (relating to Definitions).

(50) Mental illness--This term has the meaning as assigned by Texas Health and Safety Code §571.003.

(51) MH priority population--Mental health priority population. As identified in state performance contracts with LMHAs or LBHAs, those groups of children and adolescents with SED, or adults with severe and persistent mental illness, assessed as in need of mental health services.

(52) Minor--An individual younger than 18 years of age who has not been emancipated under Texas Family Code Chapter 31.

(53) Nursing facility--A Medicaid-certified facility licensed in accordance with Texas Health and Safety Code Chapter 242.

(54) Offender with special needs--An individual who has a terminal or serious medical condition, a mental illness, an ID, a DD, or a physical disability, and is served by the Texas Correctional Office on Offenders with Medical or Mental Impairments as provided in Texas Health and Safety Code Chapter 614.

(55) Ombudsman--The Ombudsman for Behavioral Health Access to Care established by HHSC in accordance with Texas Government Code §531.9933.

(56) Outpatient management plan--The prescribed regimen of medical, psychiatric, or psychological care or treatment as defined in Texas Code of Criminal Procedure Article 46C.263(c).

(57) PASRR--Preadmission screening and resident review as defined in §303.102 of this title (relating to Definitions).

(58) Pass--The authorization for an individual to leave from a state hospital or CPB for not more than a 72-hour period in accordance with Texas Health and Safety Code Chapter 574, Subchapter F.

(59) PE--PASRR level II evaluation. This term has the meaning as defined in §303.102 of this title.

(60) Peer specialist--A person who uses lived experience, in addition to skills learned in formal training, to deliver strengths-based, person-centered services to promote an individual's recovery and resiliency in accordance with 1 TAC Chapter 354, Subchapter N (relating to Peer Specialist Services).

(61) Permanent residence--The physical location in the community where an individual lives, or if a minor, where the minor's parents or legal guardian lives. A post office box is not considered a permanent residence.

(62) PL1--PASRR level I screening. This term has the meaning as defined in §303.102 of this title.

(63) Preliminary examination--An assessment for medical stability and a psychiatric examination in accordance with Texas Health and Safety Code §573.022(a)(2).

(64) QMHP-CS--Qualified mental health professional-community services. An LMHA or LBHA staff member who meets the qualifications and performs the functions described in Chapter 301, Subchapter G of this title (relating to Mental Health Community Services Standards).

(65) Recovery--A process of change through which an individual improves the individual's health and wellness, lives a self-directed life, and strives to reach the individual's full potential.

(66) Recovery or treatment plan--A written plan:

(A) developed in collaboration with an individual or LAR and a QMHP-CS or LPHA as defined in §301.303 of this title;

(B) amended at any time based on an individual's needs or requests;

(D) completed in conjunction with the uniform assessment;

(E) that identifies the individual's changing strengths, capacities, goals, preferences, needs, and desired outcomes; and

(F) that includes recommended services and supports or reasons for the exclusion of services and supports.

(67) Screening--Activities to:

(A) collect triage information through interviews with an individual or collateral contact;

(B) determine if the individual's need is emergent, urgent, or routine, and conducted before the assessment to determine the need for emergency services; and

(68) SED--Serious emotional disturbance. A disorder that meets the criteria described in Texas Government Code §547.0051.

(69) SSLC--State supported living center. Consistent with Texas Health and Safety Code §531.002, a residential facility operated by HHSC to provide an individual with an ID a variety of services, including medical treatment, specialized therapy, and training in the acquisition of personal, social, and vocational skills.

(70) State hospital--Consistent with Texas Health and Safety Code §552.002, a mental health facility operated by HHSC, including Waco Center for Youth.

(71) SUD--Substance use disorder. The use of one or more drugs, including alcohol, which significantly and negatively impacts one or more major areas of life functioning and which meets the criteria for SUD as described in the version of the DSM currently recognized by HHSC.

(72) TAC--Texas Administrative Code.

(73) TCOOMMI--Texas Correctional Office on Offenders with Medical or Mental Impairments or its designee.

(74) Treating physician--A physician who coordinates and oversees an individual's treatment.

(75) Treatment team--A group of treatment providers, working with an individual, the LAR, if applicable, and the LMHA, LBHA, or LIDDA in a coordinated manner to provide comprehensive mental health, SUD, and ID services to the individual.

(76) Uniform assessment--An assessment tool adopted by HHSC under §301.353 of this title (relating to Provider Responsibilities for Treatment Planning and Service Authorization) used for recommending an individual's level of care.

(77) Voluntary admission--An individual receiving inpatient services based on an admission made in accordance with:

(A) §306.175 of this subchapter;

(B) §306.178 of this subchapter (relating to Voluntary Treatment Following Involuntary Admission);

(D) Texas Health and Safety Code §572.0025. §306.154.Notification and Appeals Process for Local Mental Health Authority or Local Behavioral Health Authority Services.

(a) Any individual who is eligible for Medicaid and whose request for eligibility to receive LMHA or LBHA Medicaid services is denied or is not acted upon with reasonable promptness is entitled to a fair hearing in accordance with 1 TAC Chapter 357, Subchapter A (relating to Uniform Fair Hearings Rules).

(b) Any individual who is eligible for Medicaid and whose services have been terminated, suspended, or reduced by HHSC is entitled to a fair hearing in accordance with 1 TAC Chapter 357, Subchapter A.

(c) Any individual who has not applied for or is not eligible for Medicaid, whose request for eligibility to receive LMHA or LBHA services is denied or is not acted upon with reasonable promptness, or whose services have been terminated, suspended, or reduced by a provider, is entitled to notification and right of appeal in accordance with §301.155 of this title (relating to Notification and Appeals Process).

(d) At any time, an individual may obtain additional information and resources on the HHSC website and from the Ombudsman by calling toll-free 1-800-252-8154. §306.155.Local Mental Health Authority, Local Behavioral Health Authority, and Continuity of Care Liaison Responsibilities.

LMHAs and LBHAs must develop policies and procedures that require:

(1) the LMHA or LBHA to employ at least one dedicated full-time staff member who is a QMHP-CS or LPHA to act as the CoC liaison to support continuity of care activities;

(2) a CoC liaison to delegate continuity of care responsibilities to other continuity of care staff, if necessary;

(3) a CoC liaison not to have assigned duties outside of activities supporting continuity of care and related functions;

(4) an alternate staff member to act as the CoC liaison in the absence of the person identified as the primary CoC liaison;

(5) communication and facilitation of services between the continuity of care team and parties involved in the individual's care, including:

(A) a mental health peer specialist or a recovery support peer specialist as described in 1 TAC §354.3159 (relating to Core and Supplemental Training); or

(B) a family partner;

(6) coordination with other state agencies responsible for the care of a child such as DFPS, the Texas Department of Criminal Justice, or the Texas Juvenile Justice Department;

(7) initiation of contact with the parties involved in the individual's care at a state hospital or CPB within three business days after admission;

(8) coordination of post-discharge activities with local community parties involved in the individual's care, including other LMHAs, LBHAs, and LIDDAs;

(9) a CoC liaison to conduct continuity of care activities, including responding to communications from a facility within three business days after the facility sent the communication;

(10) the LMHA or LBHA to provide notification of the CoC liaison's contact information, including if there is a CoC liaison personnel change, and the CoC liaison's designated alternate staff member's contact information within three business days to each facility that has an individual admitted in the LMHA's or LBHA's care;

(11) a QMHP-CS or LPHA acting as the CoC liaison to maintain the QMHP-CS' certification as a QMHP-CS or the LPHA's licensure as an LPHA;

(12) identification of a process for obtaining services and resources for an individual, as needed;

(13) LMHA or LBHA representation by an assigned CoC liaison in treatment team meetings at a state hospital or CPB as requested by the facility;

(14) the availability of a CoC liaison to communicate with providers from 8:00 a.m. to 5:00 p.m. on business days, coordinate coverage to respond to continuity of care service needs 24 hours a day, and follow up as necessary to ensure continuity of care needs are met;

(15) monitoring of the number of individuals who are currently admitted to state hospitals or CPBs and the number of individuals who are discharged from these facilities;

(16) a CoC liaison to conduct a uniform assessment, either in person or by audiovisual technology, to ensure a level of care determination is made within ten business days before discharge;

(17) a CoC liaison ensures all LMHA, LBHA, or LIDDA appointments are scheduled in advance for needed programs and services to minimize any disruption in services or support at the time of discharge and community integration;

(18) LMHA or LBHA staff to participate in all applicable court proceedings;

(19) LMHA or LBHA staff to participate in the development of an outpatient management plan for an individual who is on a Texas Code of Criminal Procedure Chapter 46C commitment and whom a state hospital identifies as suitable for outpatient placement; and

(20) a CoC liaison to initiate transition planning with the receiving LMHA or LBHA when the individual is changing LMHAs or LBHAs.

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 February 3, 2025.

TRD-202500355

For further information, please call: (737) 704-9063

DIVISION 2. SCREENING AND ASSESSMENT FOR CRISIS SERVICES AND ADMISSION INTO LOCAL MENTAL HEALTH AUTHORITY OR LOCAL BEHAVIORAL HEALTH AUTHORITY SERVICES

26 TAC §§306.161 - 306.163

§306.162.Determining County of Residence.

(a) County of Residence for Adults.

(1) An adult's county of residence is the county of the adult's permanent residence or, if applicable, the county of the LAR's permanent residence, unless there is a preponderance of evidence to the contrary. If the adult is not a Texas resident or indicates no permanent address, the adult's county of residence is the county in which the evidence indicates the adult resides.

(2) If an adult is unable to communicate the location of the adult's permanent residence, there is no evidence indicating the location of an adult's permanent residence, or if an adult is not a Texas resident, the adult's county of residence is the county in which the adult is physically present when the adult requests or requires services.

(3) The county in which the paying LMHA or LBHA is located is the adult's county of residence if the individual receives services:

(A) delivered in the local service area of another LMHA or LBHA for an adult's community mental health services; or

(B) for an adult's living arrangement located outside the paying LMHA's or LBHA's local service area.

(b) County of Residence for Minors.

(1) Except as provided in paragraph (2) of this subsection, a minor's county of residence is the county in which the minor's LAR's permanent residence is located.

(2) A minor's county of residence is the county in which the minor currently resides if:

(A) it cannot be determined in which county the minor's LAR's permanent residence is located;

(B) a state agency is the minor's LAR;

(D) the minor is at least 16 years of age and self-enrolling into services.

(3) A minor in DFPS conservatorship may continue receiving services from the LMHA or LBHA where the minor was last enrolled in services until another appropriate placement is established. Once placement is established, the transferring LMHA or LBHA will hold a transfer meeting with the receiving LMHA or LBHA and the minor's LAR.

(1) The LMHA or LBHA must initiate or continue providing clinically necessary services, including discharge planning, until a disagreement regarding county of residence is resolved.

(2) If an LMHA or LBHA initiates a disagreement regarding county of residence that the executive directors of the affected LMHAs or LBHAs cannot resolve, the HHSC performance contract manager of the affected LMHAs or LBHAs resolves the disagreement.

(d) Disagreements regarding county of residence initiated by an individual or another person or entity on behalf of the individual. The Ombudsman may consult with the HHSC performance contract manager of the affected LMHAs or LBHAs and help resolve a disagreement initiated by an individual or by another person or entity on behalf of the individual.

(e) Changing county of residence status. If an individual currently receiving LMHA or LBHA services moves the individual's permanent residence to a county within the local service area of another LMHA or LBHA, the LMHAs or LBHAs affected by the change must comply with §306.195 of this subchapter (relating to Changing Local Mental Health Authorities or Local Behavioral Health Authorities). §306.163.Most Appropriate and Available Treatment Options.

(a) Recommendation for treatment. The designated LMHA or LBHA is responsible for recommending the most appropriate and available treatment alternative for an individual in need of mental health or SUD services.

(b) Inpatient services.

(1) Before an LMHA or LBHA refers an individual for inpatient services, the LMHA or LBHA must screen and assess the individual to determine if the individual requires inpatient services.

(2) If the screening and assessment indicates the individual requires inpatient services and inpatient services are the least restrictive and most appropriate setting available, the LMHA or LBHA must refer the individual:

(A) to a state hospital or CPB, if the LMHA or LBHA determines that the individual meets the criteria for admission; or

(B) to an LMHA or LBHA network provider of inpatient services.

(3) If the individual is identified in the applicable HHSC automation system as having an ID or a DD, the LMHA or LBHA must inform the designated LIDDA that the individual has been referred for inpatient services.

(4) If the LMHA, LBHA, or LMHA or LBHA-network provider refers the individual for inpatient services, the LMHA or LBHA must communicate necessary information to the contracted inpatient provider before or at the time of admission, including the individual's:

(A) identifying information, including address;

(B) legal status, for example regarding guardianship, charges pending, or custody, as applicable;

(D) behavioral information, including information regarding COPSD;

(E) other pertinent treatment information;

(F) finances, third-party coverage, and other benefits, if known; and

(G) advance directive.

(5) If an LMHA or LBHA, other than the individual's designated LMHA or LBHA, refers the individual for inpatient services, the state hospital or CPB must notify the individual's designated LMHA or LBHA of the referral for inpatient services by the end of the next business day.

(6) The designated LMHA or LBHA must assign a CoC liaison to an individual admitted to a state hospital, a CPB, or an LMHA or LBHA inpatient services network provider.

(7) If the individual has an ID or a DD, the designated LIDDA must assign a continuity of care worker to the individual.

(8) The LMHA or LBHA CoC liaison, and LIDDA continuity of care worker as applicable, are responsible for the facilitation of the individual's continuity of services.

(9) The LMHA or LBHA is responsible for continuity of care and must plan to the greatest extent possible for the successful transition of individuals who are determined by a state hospital or CPB to be clinically appropriate for discharge from these facilities to a community setting in accordance with Texas Health and Safety Code §534.0535.

(1) An LMHA or LBHA must ensure the provision of crisis services to an individual experiencing a crisis while the individual is in its local service area.

(2) An individual in need of a higher level of care, but not requiring inpatient services, has the option, as available, for admission to other services such as a diversion center, crisis respite unit, crisis residential unit, extended observation unit, or crisis stabilization unit.

(d) LMHA or LBHA Services.

(1) If an LMHA or LBHA admits an individual to LMHA or LBHA services, the LMHA or LBHA must ensure the provision of services in the least restrictive and most appropriate setting available.

(2) The LMHA or LBHA must assign, to an individual receiving services, a staff member who is responsible for coordinating the individual's services.

(e) Court Ordered Treatment. The LMHA or LBHA must provide services to an individual ordered by a court to participate in outpatient mental health services or competency restoration services, if available, when the court identifies the LMHA or LBHA as being responsible for those services.

(f) Referral to alternate provider.

(1) If an individual requests a referral to an alternate provider, and there is not a court order to receive services from the LMHA or LBHA, the LMHA or LBHA must make a referral to an alternate provider in accordance with the individual's request.

(2) If an individual has third-party coverage, but the coverage will not pay for needed services because the designated LMHA or LBHA does not have a provider in its network that is approved by the third-party coverage, the designated LMHA or LBHA must comply with §301.111(c)(2) of this title (relating to Determination of Ability to Pay).

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 February 3, 2025.

TRD-202500356

For further information, please call: (737) 704-9063

DIVISION 3. ADMISSION TO A STATE HOSPITAL OR A FACILITY WITH A CONTRACTED PSYCHIATRIC BED--PROVIDER RESPONSIBILITIES

26 TAC §§306.171 - 306.178

§306.171.General Admission Criteria for a State Hospital or a Facility with a Contracted Psychiatric Bed.

(a) With the exceptions of Waco Center for Youth, a maximum-security unit, and an adolescent forensic unit, a state hospital or CPB may admit an individual who has been assessed by an LMHA or LBHA and recommended for inpatient admission only if the individual has a mental illness and because of the mental illness:

(1) presents a substantial risk of serious harm to self or others; or

(2) evidences a substantial risk of mental or physical deterioration.

(b) An individual's admission to a state hospital or CPB may not occur if the individual:

(1) has a condition that requires medical care that is not available at the state hospital or CPB; or

(2) has a physical medical condition that is unstable and could reasonably require inpatient medical treatment for the condition.

(c) If an individual arrives at a state hospital or CPB for mental health services, and the designated LMHA or LBHA did not screen or refer the individual as described in §306.163 of this subchapter (relating to Most Appropriate and Available Treatment Options):

(1) the state hospital or CPB must notify the designated LMHA or LBHA that the individual has presented for services at the state hospital or CPB within three business days of the individual's presentation for services; and

(2) the state hospital or CPB physician must determine if the individual has an emergency medical condition and decide whether the facility has the capability to treat the emergency medical condition.

(A) If the state hospital or CPB has the capability to treat the emergency medical condition, the facility must admit the individual in accordance with the Emergency Medical Treatment and Active Labor Act (EMTALA) as described in 42 U.S.C. §1395dd.

(B) If the state hospital or CPB does not have the capability to treat the emergency medical condition, the facility must provide evaluation and treatment within its capability to stabilize the individual and arrange for the individual to be transferred to a hospital that has the capability to treat the emergency medical condition in accordance with EMTALA and, as applicable, Medicare and Medicaid regulations.

(d) If an LMHA or LBHA authorized an individual's admission to a state hospital or CPB, and the facility determines that the individual does not meet inpatient criteria for admission, the facility must contact the designated LMHA or LBHA to coordinate alternate outpatient community services at the time of the admission denial.

(e) The designated LMHA or LBHA must contact the individual or LAR within 24 hours after being notified that the individual does not meet inpatient admission criteria and notify the individual or LAR that the LMHA or LBHA will provide referrals and referral follow-up for ongoing services as clinically indicated to address the individual's mental health or other needs. §306.175.Voluntary Admission Criteria for a State Hospital or a Facility with a Contracted Psychiatric Bed.

(a) Request for voluntary admission.

(1) In accordance with Texas Health and Safety Code §572.001, a request for voluntary admission of an individual with a mental illness may only be made by:

(A) the individual, if the individual is at least 16 years of age or older;

(B) an LAR who meets the criteria described in paragraph (4)(A)(i) or (iii) of this subsection, if the individual is younger than 18 years of age; or

(C) an LAR who meets the criteria described in paragraph (4)(A)(ii) of this subsection, if the admission is sought pursuant to the provisions of Texas Health and Safety Code §572.001(c-1) - (c-4).

(2) In accordance with Texas Health and Safety Code §572.001(b) and (e), a request for admission must:

(A) be in writing and signed by the individual or LAR making the request; and

(B) include a statement that the individual or LAR making the request:

(i) agrees that the individual will remain in the state hospital or CPB until the individual's discharge; and

(ii) consents to diagnosis, observation, care, and treatment of the individual until:

(I) the discharge of the individual; or

(II) the individual is entitled to leave the state hospital or CPB, in accordance with Texas Health and Safety Code §572.004, after a request for discharge is made.

(3) The consent given under paragraph (2)(B)(ii) of this subsection does not waive an individual's rights described in:

(A) Chapter 320, Subchapter A of this title (relating to Rights of Individuals Receiving Mental Health Services);

(B) Chapter 307, Subchapter I of this title (relating to Electroconvulsive Therapy (ECT));

(C) Chapter 320, Subchapter B of this title (relating to Consent to Treatment with Psychoactive Medication--Mental Health Services); and

(D) Chapter 320, Subchapter C of this title (relating to Interventions in Mental Health Services).

(4) An LAR is a person authorized by state law to act on behalf of an individual for the purposes of:

(A) admission, transfer, or discharge that includes:

(i) a parent, non-DFPS managing conservator, or guardian;

(ii) a representative of DFPS for a minor under DFPS conservatorship pursuant to Texas Health and Safety Code §572.001 (c-2) - (c-4); or

(iii) a person authorized by a district court under Texas Family Code Chapter 35A to consent for the temporary admission of a minor; or

(B) consent on behalf of an individual regarding a matter described in this subchapter other than admission, transfer, or discharge that includes:

(i) persons described in subparagraph (A) of this paragraph;

(ii) a person eligible to consent to treatment for a minor under Texas Family Code §32.001(a); and

(iii) an agent acting under a Medical Power of Attorney under Texas Health and Safety Code Chapter 166 or a Declaration for Mental Health Treatment under Texas Civil Practice and Remedies Code Chapter 137.

(b) Failure to meet admission criteria. If a physician of a state hospital or CPB determines that an individual does not meet admission criteria and that community resources may appropriately serve the individual, the facility must contact the LMHA, LBHA, or LIDDA to discuss the availability and appropriateness of community-based services for the individual. The LMHA, LBHA, or LIDDA must:

(1) contact the individual and LAR, if applicable, no later than 24 hours after the LMHA, LBHA, or LIDDA is notified of the failure to meet the admission criteria; and

(2) provide referrals and referral follow-up for ongoing services as clinically indicated to address the individual's mental health needs and SUD needs.

(1) A physician must conduct an examination on an individual requesting voluntary admission in accordance with this subsection.

(2) In accordance with Texas Health and Safety Code §572.0025(f)(1)(A), a physician must conduct a physical and psychiatric examination, either in person or through audiovisual or other telecommunications technology within 72 hours before voluntary admission or 24 hours after voluntary admission, that includes:

(A) an assessment for medical stability;

(B) a psychiatric examination; and

(3) In accordance with Texas Health and Safety Code §572.0025(f)(1); the physician may not delegate the examination to a non-physician.

(d) Meets admission criteria. If, after examination, a physician determines that an individual meets the admission criteria of a state hospital or CPB, the state hospital or CPB must admit the individual.

(e) To meet the needs of an individual who does not meet admission criteria to a state hospital or CPB, an LMHA or LBHA, as applicable, must:

(1) provide community mental health services and supportive services to the individual; or

(2) refer the individual or LAR to community mental health services and supportive services.

(f) Capacity to consent.

(1) If a physician determines that an individual whose consent is necessary for a voluntary admission does not have the capacity to consent to diagnosis, observation, care, and treatment, the state hospital or CPB may not voluntarily admit the individual.

(2) When appropriate, the state hospital or CPB may initiate an emergency detention proceeding in accordance with Texas Health and Safety Code Chapter 573 or file an application for court-ordered inpatient mental health services in accordance with Texas Health and Safety Code Chapter 574.

(g) Intake assessment. Before voluntary admission of an individual, in accordance with Texas Health and Safety Code §572.0025(b), an assessment professional for a state hospital or CPB, must conduct an intake assessment with the individual and LAR, if applicable, to:

(1) obtain relevant information about the individual, including:

(A) psychiatric and medical history;

(B) social history;

(D) support systems;

(E) finances;

(F) third-party coverage or insurance benefits; and

(G) advance directives;

(2) explain, orally and in writing, the individual's rights described in Chapter 320, Subchapter A of this title;

(3) explain, orally and in writing, the state hospital's or CPB's services and treatment as the services and treatment relate to the individual;

(4) explain, orally and in writing, the existence, purpose, telephone number, and address of the protection and advocacy system established in Texas, pursuant to Texas Health and Safety Code §576.008; and

(5) explain, orally and in writing, the individual trust fund account, charges for services, and the financial responsibility form.

(h) Requirements for voluntary admission.

(1) An individual or LAR must make a request for admission in accordance with subsection (a) of this section;

(2) a physician must:

(A) in accordance with Texas Health and Safety Code §572.0025(f)(1):

(i) conduct an examination in accordance with subsection (c) of this section within 72 hours before the admission or 24 hours after the admission; or

(ii) consult with a physician who has conducted an examination in accordance with subsection (c) of this section within 72 hours before the admission or 24 hours after the admission;

(B) determine that the individual meets the admission criteria of the state hospital or CPB and that admission is clinically justified; and

(3) in accordance with Texas Health and Safety Code §572.0025(f)(2), the administrator or designee of the state hospital or CPB must sign a written statement agreeing to admit the individual; and

(4) in accordance with Texas Health and Safety Code §572.0026, the state hospital or CPB must have available space for the individual.

(i) Documentation of admission order. In accordance with Texas Health and Safety Code §572.0025(f)(1), the order described in subsection (h)(2)(C) of this section is issued:

(1) in writing and signed by the issuing physician; or

(2) orally or electronically if, within 24 hours after its issuance, the state hospital or CPB has a written order signed by the issuing physician.

(j) Periodic evaluation. To determine the need for continued inpatient treatment, a physician or physician's designee must evaluate and document justification for continued stay for an individual voluntarily receiving acute inpatient treatment as often as clinically indicated, but no less than once a week. §306.176.Admission Criteria for a State Hospital or a Facility with a Contracted Psychiatric Bed for Emergency Detention.

(a) Acceptance for preliminary examination. In accordance with Texas Health and Safety Code §573.021 and §573.022, a state hospital or CPB must accept for a preliminary examination:

(1) an individual, of any age, who has been apprehended and transported to the state hospital or CPB by a peace officer or by emergency medical services personnel in accordance with Texas Health and Safety Code §573.001 or §573.012; or

(2) an adult who has been transported to the state hospital or CPB by the adult's guardian in accordance with Texas Health and Safety Code §573.003.

(b) Preliminary examination.

(1) A physician must conduct a preliminary examination of an individual as soon as possible but not more than 12 hours after the individual is transported to the state hospital or CPB for emergency detention.

(2) The preliminary examination must consist of:

(A) an assessment for medical stability; and

(B) a psychiatric examination, including a substance use assessment if indicated, to determine if the individual meets the criteria described in subsection (c)(1) of this section.

(1) in accordance with Texas Health and Safety Code §573.022(a)(2), a physician determines from the preliminary examination that:

(A) the individual has a mental illness;

(B) the individual evidences a substantial risk of serious harm to himself or others;

(D) emergency detention is the least restrictive means by which the necessary detention may be accomplished;

(2) in accordance with Texas Health and Safety Code §573.022(a)(3), a physician must make a written statement documenting the determination described in paragraph (1) of this subsection and describing:

(A) the nature of the individual's mental illness;

(B) the risk of harm the individual evidences, demonstrated either by the individual's behavior or by evidence of severe emotional distress and deterioration in the individual's mental condition to the extent that the individual cannot remain at liberty; and

(3) the physician issues and signs a written order admitting the individual for emergency detention; and

(4) the individual meets the admission criteria of the state hospital or CPB.

(d) Release.

(1) The state hospital or CPB must release the individual accepted for a preliminary examination if:

(A) a preliminary examination of the individual has not been conducted within 12 hours after the individual is apprehended and transported to the facility by the peace officer or transported for emergency detention; or

(B) in accordance with Texas Health and Safety Code §573.023(a), the individual is not admitted for emergency detention on completion of the preliminary examination.

(2) If the state hospital or CPB does not admit the individual on an emergency detention in accordance with Texas Health and Safety Code Chapter 573, the facility must contact the designated LMHA or LBHA to provide referrals and referral follow-up for ongoing services as clinically indicated to address the individual's mental health needs.

(A) The LMHA or LBHA in the individual's county of residence must contact the individual within 24 hours of being notified that the individual does not meet emergency detention criteria.

(B) The LMHA or LBHA must provide referrals and referral follow-up for ongoing services as clinically indicated to address the individual's mental health needs, as applicable, when the individual does not meet admission criteria to a state hospital or CPB.

(3) In accordance with Texas Health and Safety Code §576.007(a), if an individual who is an adult is not admitted on emergency detention, the state hospital or CPB must make a reasonable effort to notify the individual's family, or any other person providing support as authorized by the individual and LAR, if applicable, before the individual is released.

(e) Intake assessment. An assessment professional for a state hospital or CPB must conduct an intake assessment as soon as possible, but not later than 24 hours after an individual is admitted for emergency detention. All documents related to the intake assessment must be provided to the individual or LAR and include:

(1) a request for relevant information about the individual, such as:

(A) psychiatric and medical history;

(B) social history;

(D) support systems;

(E) finances;

(F) third-party coverage or insurance benefits; and

(G) advance directives; and

(2) a written and oral explanation of:

(A) the individual's rights described in Chapter 320, Subchapter A of this title(relating to Rights of Individuals Receiving Mental Health Services);

(B) the state hospital's or CPB's services and treatment as the services and treatment relate to the individual;

(C) the existence, purpose, telephone number, and address of the protection and advocacy system established in Texas, pursuant to Texas Health and Safety Code §576.008; and

(D) the individual's trust fund account, charges for services, and the financial responsibility form. §306.177.Admission Criteria Under Order of Protective Custody or Court-ordered Inpatient Mental Health Services.

(a) A state hospital or CPB may admit an individual after receiving:

(1) an order of protective custody only if a court has issued a protective custody order in accordance with Texas Health and Safety Code §574.022 and the facility has received it; or

(2) for court-ordered inpatient mental health services only if a court has issued:

(A) an order for temporary inpatient mental health services issued in accordance with Texas Health and Safety Code §574.034, or Texas Family Code Chapter 55;

(B) an order for extended inpatient mental health services issued in accordance with Texas Health and Safety Code §574.035, or Texas Family Code Chapter 55;

(D) an order for commitment issued in accordance with the Texas Code of Criminal Procedure Chapter 46C.

(b) If a state hospital or CPB admits an individual in accordance with subsection (a) of this section, a physician, PA, or APRN must issue and sign a written order admitting the individual.

(c) A state hospital or CPB must conduct an intake assessment with the individual, and LAR, if applicable, as soon as possible, but not later than 24 hours after the individual is admitted under a protective custody order or court-ordered inpatient mental health services. The intake assessment must include:

(1) a request for relevant information about the individual, including:

(A) psychiatric and medical history;

(B) social history;

(D) support systems;

(E) finances;

(F) third-party coverage or insurance benefits; and

(G) advance directives; and

(2) a written and oral explanation provided to the individual or LAR of:

(A) the individual's rights described in Chapter 320, Subchapter A of this title(relating to Rights of Individuals Receiving Mental Health Services);

(B) the state hospital's or CPB's services and treatment as the services and treatment relate to the individual; and

(C) the existence, purpose, telephone number, and address of the protection and advocacy system established in Texas, pursuant to Texas Health and Safety Code §576.008.

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 February 3, 2025.

TRD-202500357

For further information, please call: (737) 704-9063

DIVISION 4. TRANSFERS AND CHANGING LOCAL MENTAL HEALTH AUTHORITIES OR LOCAL BEHAVIORAL HEALTH AUTHORITIES

26 TAC §§306.191 - 306.195

§306.191.Transfers Between State Hospitals.

(a) The individual, LAR, if applicable, any other person authorized by the individual, state hospital staff, or the designated LMHA or LBHA, may initiate a request to transfer an individual from one state hospital to another state hospital.

(b) A transfer between state hospitals may occur when deemed advisable by the administrator of the transferring state hospital with the agreement of the administrator of the receiving state hospital based on:

(1) the condition and desires of the individual;

(2) geographic residence of the individual;

(3) program and bed availability; and

(4) geographical proximity to the individual's family and any other person authorized by the individual and LAR, if applicable.

(c) An individual voluntarily receiving treatment may not be transferred without the consent of the individual or LAR who made the request for voluntary admission in accordance with §306.175(a)(1) of this subchapter (relating to Voluntary Admission Criteria for a State Hospital or a Facility with a Contracted Psychiatric Bed).

(d) In accordance with Texas Health and Safety Code §575.011 and §575.017, if a state hospital transfers an individual receiving court-ordered inpatient mental health services from one state hospital to another state hospital, the transferring state hospital must notify the committing court and the designated LMHA, LBHA, or LIDDA of the transfer.

(e) If a prosecuting attorney has notified the state hospital administrator that an individual has criminal charges pending, the administrator must notify the judge of the court before which charges are pending if the individual transfers to another state hospital.

(f) For an individual transferring between a state hospital and a maximum-security unit or adolescent forensic unit, 25 TAC Chapter 415, Subchapter G (relating to Determination of Manifest Dangerousness) governs the transfer. §306.194.Transfers Between a State Hospital and Another Facility in Texas.

(a) In accordance with Texas Health and Safety Code §575.011, §575.014, and §575.017, an individual may transfer between a state hospital and a psychiatric hospital not operated by HHSC. The state hospital must notify the designated LMHA or LBHA of the transfer. A state hospital must not transfer an individual voluntarily receiving treatment without the consent of the individual or LAR who made the request for voluntary admission in accordance with §306.175(a)(1) of this subchapter (relating to Voluntary Admission Criteria for a State Hospital or a Facility with a Contracted Psychiatric Bed).

(b) In accordance with Texas Health and Safety Code §575.015, an individual may transfer from a state hospital to a federal agency. The transferring state hospital must notify the designated LMHA or LBHA of the transfer.

(c) In accordance with Texas Health and Safety Code §575.016 and §575.017, an individual may transfer from a facility of the institutional division of the Texas Department of Criminal Justice to a state hospital. §306.195.Changing Local Mental Health Authorities or Local Behavioral Health Authorities.

(a) If an individual currently receiving LMHA or LBHA services intends to move the individual's permanent residence to a county within the local service area of another LMHA or LBHA and seek services from the new LMHA or LBHA the following requirements apply.

(1) The originating LMHA or LBHA must:

(A) ensure the CoC liaison submits requested information to the new LMHA or LBHA, including treatment information pertinent to the individual's continuity of care within seven days after the request, and coordinate an intake appointment at the receiving LMHA or LBHA;

(B) ensure the CoC liaison initiates transition planning with the receiving LMHA or LBHA in accordance with §306.155(20) of this subchapter (relating to Local Mental Health Authority, Local Behavioral Health Authority, and Continuity of Care Liaison Responsibilities);

(C) educate the individual or LAR on the provisions of this subchapter regarding the individual's transfer, consisting of:

(i) information regarding walk-in intake services, if applicable, where no appointment is scheduled for the individual's initial intake to determine eligibility;

(ii) the rights of an individual eligible for services;

(iii) notification for the receiving LMHA or LBHA of the individual's intent to move the individual's permanent residence;

(iv) the point of contact at the receiving LMHA or LBHA;

(v) the 988 Suicide and Crisis Lifeline; and

(vi) the receiving LMHA's or LBHA's crisis hotline;

(D) assist in facilitating and scheduling the intake appointment at the new LMHA or LBHA once the relocation has been confirmed;

(E) ensure the individual has sufficient medication for up to 90 days or to last until the medication management appointment date at the receiving LMHA or LBHA; and

(F) maintain the individual's case in open status in the applicable HHSC automation system for 90 days or until notified that the individual has been admitted to services at the receiving LMHA or LBHA, whichever occurs first.

(2) The receiving LMHA or LBHA must:

(A) initiate transition planning with the originating LMHA or LBHA;

(B) promptly request records pertinent to the individual's treatment, with the individual's consent or the consent of the LAR;

(C) conduct an intake assessment in accordance with §301.353(a) of this title (relating to Provider Responsibilities for Treatment Planning and Service Authorization) and determine whether the individual should receive services immediately or be placed on a waiting list for services;

(D) if the individual is eligible and is not on the waitlist, authorize an initial 180 days of services for an adult and 90 days for a child or an adolescent for transitioning and ongoing care, including the provision of medications;

(E) authorize the individual in the same level of care at the initial assessment in accordance with §301.327 of this title (relating to Access to Mental Health Community Services) and pursuant to Medicaid regulations and policies;

(F) provide the appropriate services based on the clinical needs of the individual;

(G) if there are resource limitations for the receiving LMHA or LBHA, follow the process outlined in §301.327 of this title; and

(H) initiate contact with individual within 14 days.

(3) If the individual or LAR seeks services from the new LMHA or LBHA without prior knowledge of the originating LMHA or LBHA:

(A) the receiving LMHA or LBHA must:

(i) initiate transition planning with the originating LMHA or LBHA;

(ii) promptly request records pertinent to the individual's treatment, with the individual's consent, if applicable;

(iii) conduct an intake assessment in accordance with §301.353(a) of this title and determine whether the individual should receive services immediately or be placed on a waiting list for services; and

(iv) if the individual is eligible and is not on the waitlist, authorize an initial 180 days of services for an adult and 90 days for a child or an adolescent for transitioning and ongoing care, including the provision of medications; and

(B) the originating LMHA or LBHA must:

(i) submit requested information to the new LMHA or LBHA within seven days after the request; and

(ii) maintain the individual's case in open status in the applicable HHSC automation system for 90 days or until notified that the individual has been admitted to services at the new LMHA or LBHA, whichever occurs first.

(4) If the new LMHA or LBHA denies services to the individual during the transition period, or reduces or terminates services at the conclusion of the authorized period, the new LMHA or LBHA must notify the individual or LAR in writing within ten business days of the proposed action and the right to appeal the proposed action in accordance with §306.154 of this subchapter (relating to Notification and Appeals Process for Local Mental Health Authority or Local Behavioral Health Authority Services).

(b) Requirements related to an individual receiving inpatient services at a state hospital or CPB. If an individual at a state hospital or CPB or LAR informs the state hospital or CPB that the individual intends to move the individual's permanent residence to a county within the local service area of another LMHA or LBHA and seek services from the new LMHA or LBHA:

(1) the state hospital or CPB must notify the following of the individual's intent to move the individual's permanent residence upon discharge:

(A) the originating LMHA or LBHA, if the individual was receiving LMHA or LBHA services from the originating LMHA or LBHA before admission to the state hospital or CPB; and

(B) the new LMHA or LBHA;

(2) the following must participate in the individual's discharge planning in accordance with §306.201 of this subchapter (relating to Discharge Planning):

(A) the state hospital or CPB;

(B) the new LMHA or LBHA; and

(C) the originating LMHA or LBHA, if the individual was receiving LMHA or LBHA services from the originating LMHA or LBHA before admission to the state hospital or CPB; and

(3) if the individual was receiving LMHA or LBHA services from the originating LMHA or LBHA before admission to the state hospital or CPB, the originating LMHA or LBHA must maintain the individual's case in open status in the applicable HHSC automation system for 90 days or until notified that the individual is admitted to services at the new LMHA or LBHA, whichever occurs first.

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 February 3, 2025.

TRD-202500358

For further information, please call: (737) 704-9063

DIVISION 5. DISCHARGE AND ABSENCES FROM A STATE HOSPITAL OR A FACILITY WITH A CONTRACTED PSYCHIATRIC BED

26 TAC §§306.201 - 306.205, 306.207

§306.201.Discharge Planning.

(a) At the time of an individual's admission to a state hospital or CPB, the designated LMHA or LBHA, if applicable, and the state hospital or CPB must begin discharge planning for the individual. The state hospital or CPB must send an electronic admission initial notification within three business days to the appropriate LMHA, LBHA, and LIDDA to initiate discharge planning.

(b) The designated LMHA or LBHA CoC liaison or other designated staff; the designated LIDDA continuity of care worker, if applicable; the individual; the LAR, if applicable; and any other person authorized by the individual, such as guardian ad litem or attorney ad litem, must participate in discharge planning with the state hospital or CPB. The state hospital or CPB must initiate coordination of discharge planning.

(1) Except for the state hospital or CPB treatment team and the individual, involvement in discharge planning may be through teleconference or video-conference calls.

(2) The state hospital or CPB must invite the LMHA, LBHA, or LIDDA, as applicable, to routine recovery or treatment plan meetings as well as any additional meetings that arise specific to discharge planning. The state hospital or CPB must notify meeting participants a minimum of 24 hours before each scheduled meeting regarding recovery or treatment planning and any additional meetings specific to discharge planning.

(3) The state hospital or CPB must ensure the development and completion of the discharge plan as listed in subsection (c) of this section and coordinate with the LMHA, LBHA, or LIDDA, if applicable, before the individual's discharge.

(4) The LMHA or LBHA must facilitate the transition of individuals who are determined by the state hospital or CPB to be medically appropriate for discharge in accordance with Texas Health and Safety Code §534.0535 from a facility to a community setting by connecting the individuals to resources available in the individuals' county of residence or choice.

(1) Considering all pertinent information about the individual's clinical needs, the state hospital or CPB must identify and recommend specific clinical services and supports needed by the individual after discharge or while on pass or furlough.

(2) The state hospital or CPB and the LMHA, LBHA, or LIDDA, if applicable, must jointly identify, recommend, and help coordinate access to services for the individual and LAR, if applicable, regarding specific non-clinical services and supports needed by the individual after discharge, including the individual's need for housing, supported employment, education resources, and food assistance, clothing resources, and other supplemental supports or governmental benefits as applicable.

(3) If an individual needs a living arrangement, the LMHA or LBHA CoC liaison or LIDDA continuity of care worker must:

(A) identify a living arrangement consistent with the individual's clinical needs and preference that is available and has accessible services and supports as agreed upon by the individual or LAR; or

(B) ensure the individual or LAR is referred to housing services and support the individual through the process of obtaining and applying for housing services during the discharge planning process if a living arrangement is unavailable.

(4) The LMHA or LBHA CoC liaison or LIDDA continuity of care worker in collaboration with the individual and LAR, if applicable, must identify potential providers and resources for the recommended services and supports and arrange for provision of services upon discharge in accordance with Texas Health and Safety Code §534.0535.

(5) The state hospital or CPB must attempt to educate the individual and LAR, if applicable, to prepare the individual for care after discharge or while on pass or furlough.

(6) The state hospital or CPB must provide the individual and LAR, if applicable, with written notification of the existence, purpose, telephone number, and address of the protection and advocacy system established in Texas, pursuant to Texas Health and Safety Code §576.008.

(7) The LMHA, LBHA, or LIDDA must comply with the PASRR processes as described in Chapter 303 of this title (relating to Preadmission Screening and Resident Review (PASRR)) for an individual referred to a nursing facility.

(d) Before an individual's discharge or approval for a pass or furlough:

(1) the individual's treatment team must ensure the development of a plan to include the individual's stated goals. The plan must consist of:

(A) a description of the individual's living arrangement after discharge, or while on pass or furlough, that reflects the individual's preferences, choices, and available community resources;

(B) arrangements and referrals for the available and accessible services and supports agreed upon by the individual or LAR recommended in the individual's discharge plan;

(C) a written description of recommended clinical and non-clinical services and supports the individual receives after discharge or while on pass or furlough;

(D) documentation of arrangements and referrals for the services and supports recommended upon discharge or while on pass or furlough.

(E) a description of behavioral health symptoms identified at discharge or before a pass or furlough, including any symptoms that may disrupt the individual's stability in the community;

(F) the individual's goals, strengths, interventions, and objectives as stated in the individual's discharge plan in the state hospital or CPB;

(G) comments or additional information;

(H) a final diagnosis based on the version of the DSM currently recognized by HHSC;

(I) the names, contact information, and addresses of providers to whom the individual will be referred for any services or supports after discharge or while on pass or furlough; and

(J) a description of:

(i) the types and amount of medication the individual needs after discharge or while on pass or furlough until the individual is evaluated by a physician; or

(ii) for 90 days after discharge, the person or entity responsible for providing and paying for the medication.

(2) The state hospital or CPB must request that the individual or LAR sign the discharge plan and document in the discharge plan whether the individual or LAR agree or disagree with the plan.

(3) If the individual or LAR refuses to sign the discharge plan described in paragraph (2) of this subsection, the state hospital or CPB must document in the individual's record whether the individual or LAR agrees to the plan or not, reasons stated, and any other circumstances of the refusal.

(4) If applicable, the individual's treating physician must document in the individual's record reasons why the individual does not require continuing care or a discharge plan.

(5) If the LMHA or LBHA disagrees with the state hospital or CPB treatment team's decision concerning discharge:

(A) the treating physician of the state hospital or CPB must consult with the LMHA or LBHA physician or designee to resolve the disagreement within 24 hours; and

(B) if the disagreement continues unresolved, the medical director or designee of the state hospital or CPB must refer the issue to the Texas State Hospitals Chief Medical Officer to render a final determination.

(e) Discharge notice to family or LAR.

(1) In accordance with Texas Health and Safety Code §576.007, before discharging an adult, the state hospital or CPB must make a reasonable effort to notify the individual's family or any identified person providing support to the individual. Discharge notification requires authorization by the individual or LAR.

(2) Before discharging an individual who is at least 16 years of age, but younger than 18 years of age, who voluntarily consented for the individual's own admission, the state hospital or CPB must make a reasonable effort to notify the individual's LAR, if applicable, of the discharge within 72 hours before the date of discharge.

(3) Before discharging a minor for whom a parent, managing conservator, or guardian provided consent for admission, the state hospital or CPB must notify the minor's LAR of the discharge.

(f) Release of minors. Upon discharge, the state hospital or CPB may release a minor only to the minor's LAR or the LAR's designee.

(1) If the LAR or the LAR's designee is unwilling to retrieve the minor from the state hospital or CPB and the LAR is not a state agency:

(A) the state hospital or CPB must:

(i) notify DFPS, so DFPS can take custody of the minor from the state hospital or CPB;

(ii) refer the matter to the LMHA or LBHA to schedule a meeting with representatives from the required agencies described in subsection (f)(2)(A) of this section, the LAR, and minor to explore resources and make recommendations;

(iii) document the LMHA or LBHA referral in the discharge plan;

(iv) refer the matter to the local CRCG to schedule a meeting with representation from the required agencies described in subsection (f)(2)(A) of this section, the LAR, and the minor to explore resources and make recommendations; and

(v) document the CRCG referral in the discharge plan; and

(B) the medical directors or the medical directors' designees of the state hospital or CPB; designated LMHA, LBHA, or LIDDA; and DFPS must meet to develop and finalize the discharge recommendations.

(2) If the LAR is a state agency unwilling to assume physical custody of the minor from the state hospital or CPB, the state hospital or CPB must:

(A) refer the matter to the local CRCG office, or state CRCG office if applicable, to schedule a meeting with representatives from the member agencies, in accordance with 40 TAC, Part 19, Chapter 702, Subchapter E (relating to Memorandum of Understanding with Other State Agencies), the LAR, and minor to explore resources and make recommendations; and

(B) document the CRCG referral in the discharge plan.

(g) Notice to the designated LMHA, LBHA, or LIDDA. At least 24 hours before an individual's planned discharge, pass, or furlough, and no later than 24 hours after an unexpected discharge, a state hospital or CPB must notify the designated LMHA, LBHA, or LIDDA of the anticipated or unexpected discharge and convey the following information about the individual:

(1) identifying information, including address and contact information of the individual or LAR;

(2) legal status, for example, regarding guardianship, charges pending, or custody if the individual is a minor;

(3) the day and time the individual will be discharged or participating in a pass or furlough;

(4) the individual's destination address after discharge, or while on pass or furlough;

(5) medical information;

(6) current medications;

(7) clinical documentation, including information regarding a COPSD, an ID, or a DD; and

(8) other pertinent treatment information, including the discharge plan.

(h) Discharge packet.

(1) At a minimum, a discharge packet must include:

(A) the discharge plan;

(B) referral instructions, including:

(i) state hospital or CPB contact person;

(ii) name of the designated LMHA or LBHA CoC liaison or LIDDA continuity of care worker;

(iii) names of community resources and providers to whom the individual is referred, including contacts, appointment dates and times, addresses, and phone numbers;

(iv) a description of to whom or where the individual is released upon discharge, including the individual's intended residence, address, and phone number;

(v) instructions for the individual or LAR;

(vi) medication regimen and prescriptions, as applicable; and

(vii) dated signature of the individual or LAR and a member of the state hospital or CPB treatment team;

(D) the treating physician's orders.

(2) At discharge, or while on pass or furlough, the state hospital or CPB provides a copy of the discharge packet or pass or furlough plan to the individual and LAR, if applicable. An individual or LAR may request additional records.

(3) Within 24 hours after discharge, or while on pass or furlough, the state hospital or CPB must send a copy of the discharge packet or pass or furlough plan to:

(A) the designated LMHA, LBHA, or LIDDA; and

(B) the providers to whom the individual is referred, including:

(i) an LMHA or LBHA network provider, if the LMHA or LBHA is responsible for ensuring the individual's services after discharge or while on pass or furlough;

(ii) an alternate provider if the individual requested referral to an alternate provider; and

(iii) a county jail if the individual will be transported to the county jail upon discharge.

(i) Unexpected Discharge.

(1) The state hospital or CPB and the designated LMHA, LBHA, or LIDDA must make reasonable efforts to provide discharge planning for an individual discharged unexpectedly.

(2) If there is an unexpected discharge, the state hospital or CPB social worker or a designee must document the reason for not completing discharge planning activities in the individual's record.

(j) Transportation. A state hospital or CPB must:

(1) initiate and secure transportation in collaboration with an LMHA, an LBHA, or a LIDDA pursuant to an individual's discharge or pass or furlough plan; and

(2) inform a designated LMHA, LBHA, or LIDDA of an individual's transportation needs after discharge or while on pass or furlough.

(k) Discharge summary.

(1) Within ten days after an individual's discharge, the individual's physician of the state hospital or CPB must complete a written discharge summary for the individual.

(2) Within 21 days after an individual's discharge from an LMHA or LBHA, the LMHA or LBHA must complete a written discharge summary for the individual.

(3) The written discharge summary must include:

(A) a description of the individual's treatment and the individual's response to that treatment;

(B) a description of the level of care for services received;

(D) a description of the individual's living arrangement after discharge;

(E) a description of the community services and supports the individual will receive after discharge;

(F) a final diagnosis based on the version of the DSM currently recognized by HHSC; and

(G) a description of the amount of medication available to the individual, if applicable.

(4) The discharge summary must be sent to the individual's:

(A) designated LMHA, LBHA, or LIDDA, as applicable; and

(B) providers to whom the individual was referred.

(5) Documentation of refusal. If the individual or LAR refuses to participate in the discharge planning, the circumstances of the refusal must be documented in the individual's record.

(l) An LMHA or LBHA must provide continuity of care services designed to support joint discharge planning efforts in accordance with Texas Health and Safety Code §534.0535. §306.202.Special Considerations for Discharge Planning.

(a) Three Admissions Within 180 Days. An individual admitted to a state hospital or CPB three times within 180 days is considered at risk for future admission to inpatient services. To prevent potentially unnecessary admissions to an inpatient facility, the designated LMHA or LBHA must:

(1) during discharge planning, review the individual's previous recovery or treatment plans to determine the effectiveness of the clinical services received;

(2) include in the recovery or treatment plan:

(A) non-clinical supports, such as those provided by a mental health peer specialist or recovery support peer specialist, identified to support the individual's ongoing recovery; and

(B) recommendations for services and interventions from the individual's current or previous care plan that support the individual's strengths and goals and prevent unnecessary admission to a state hospital or CPB;

(3) determine the availability and level of care, including type, amount, scope, and duration of clinical and non-clinical supports, such as those provided by a mental health peer specialist or recovery support peer specialist, that promote ongoing recovery and prevent unnecessary admission to a state hospital or CPB; and

(4) consider appropriateness of the individual's continued stay in the state hospital or CPB.

(b) Discharge Planning Specialists. Pursuant to Texas Health and Safety Code §534.053, each state hospital must designate at least one employee to deliver continuity of care services for individuals who are determined medically appropriate for discharge from the facility. The state hospital must concentrate the provision of continuity of care services for individuals who have been:

(1) admitted to and discharged from a state hospital three or more times during a 30-day period; or

(2) in the state hospital for longer than 365 consecutive days.

(1) In accordance with 42 CFR Part 483, Subpart C, and as described in Chapter 554, Subchapter BB of this title (relating to Nursing Facility Responsibilities Related to Preadmission Screening and Resident Review (PASRR)), a nursing facility must coordinate with the referring entity to ensure the referring entity screens the individual for admission to the nursing facility before the nursing facility admits the individual.

(2) As the referring entity, the state hospital or CPB must complete a PL1 Screening and forward the completed form in accordance with §303.301 of this title (relating to Referring Entity Responsibilities Related to the PASRR Process).

(3) The LMHA, LBHA, or LIDDA must conduct a PE in accordance with Chapter 303 of this title (relating to Preadmission Screening and Resident Review (PASRR)).

(4) If a nursing facility admits an individual while on pass or furlough, the designated LMHA or LBHA must conduct and document, including justification for its recommendations, the activities described in paragraphs (5) and (6) of this subsection.

(5) The designated LMHA or LBHA must make at least one in-person contact with the individual at the nursing facility while on pass or furlough. The contact must consist of:

(A) a review of the individual's record at the nursing facility; and

(B) discussions with the individual, the LAR, if applicable, the nursing facility staff, and other staff who provide care to the individual regarding:

(i) the individual's needs and the care the individual 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 individual; and

(iv) the individual's adjustment to the nursing facility.

(6) Before the end of the initial pass or furlough period described in §306.205(a) of this subchapter (relating to Pass or Furlough from a State Hospital or Facility with a Contracted Psychiatric Bed, the designated LMHA or LBHA must recommend to the state hospital or CPB one of the following:

(A) discharging the individual if the LMHA or LBHA determines that:

(i) the nursing facility is capable and willing to provide appropriate care to the individual after discharge;

(ii) any mental health services needed by the individual are being provided to the individual while residing in the nursing facility; and

(iii) the individual and LAR, if applicable, agrees to the nursing facility admission;

(B) extending the individual's pass or furlough period in accordance with §306.205(a)(2) of this subchapter;

(C) returning the individual to the state hospital or CPB in accordance with §306.205 of this subchapter (relating to Pass or Furlough from a State Hospital or a Facility with a Contracted Psychiatric Bed); or

(D) initiating involuntary admission to the state hospital or CPB in accordance with §306.176 (relating to Admission Criteria for a State Hospital or a Facility with a Contracted Psychiatric Bed for Emergency Detention) and §306.177 (relating to Admission Criteria Under Order of Protective Custody or Court-ordered Inpatient Mental Health Services) of this subchapter.

(d) Assisted Living.

(1) A state hospital, a CPB, an LMHA, or an LBHA may only refer an individual to an assisted living facility that is licensed under Texas Health and Safety Code Chapter 247.

(2) As required by Texas Health and Safety Code §247.063(b), if a state hospital, a CPB, an LMHA, or an LBHA gains knowledge of an assisted living facility not operated or licensed by the state, the state hospital, CPB, LMHA, or LBHA must report the name, address, and telephone number of the facility to HHSC Complaint and Incident Intake at 1-800-458-9858.

(e) Minors.

(1) To the extent permitted by medical privacy laws, the state hospital or CPB and designated LMHA or LBHA must make a reasonable effort to involve a minor's LAR or the LAR's designee in the treatment and discharge planning process.

(2) A minor committed to or placed in a state hospital or CPB under 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 applicable.

(f) An individual suspected of having an ID. If a state hospital or CPB suspects an individual has an ID, the state hospital or CPB must notify the designated LMHA or LBHA CoC liaison and the designated LIDDA to:

(1) assign a LIDDA continuity of care worker to the individual; and

(2) conduct an assessment in accordance with Chapter 304 of this title (relating to Diagnostic Assessment).

(g) Criminal Code.

(1) Texas Code of Criminal Procedure Chapter 46B.

(A) An individual committed to a state hospital or CPB under Texas Code of Criminal Procedure Article 46B.102 may only be discharged by order of the committing court under Texas Code of Criminal Procedure, Article 46B.107.

(B) An individual committed to a state hospital or CPB under Texas Code of Criminal Procedure Article 46B.073 must be discharged and transferred, in accordance with Texas Code of Criminal Procedure Article 46B.081 through Article 46B.083.

(C) For an individual committed under Texas Code of Criminal Procedure Chapter 46B, who is discharged and returned to the committing court, the state hospital or CPB, within 24 hours after discharge, must notify the following of the discharge:

(i) the individual's designated LMHA or LBHA; and

(ii) the TCOOMMI.

(2) Texas Code of Criminal Procedure Chapter 46C: Insanity defense. An individual committed to a state hospital or CPB under Texas Code of Criminal Procedure Chapter 46C may only be discharged by order of the committing court in accordance with Texas Code of Criminal Procedure Article 46C.253 or Article 46C.268.

(h) Offenders with special needs following discharge from a state hospital or CPB. The LMHA or LBHA must comply with the requirements as defined by the LMHA's and LBHA's TCOOMMI contract for offenders with special needs.

(1) An LMHA or LBHA that receives a referral for an offender with special needs in the MH priority population from a county or city jail at least 24 hours before the individual's release must complete one of the following actions:

(A) if the offender with special needs is currently receiving LMHA or LBHA services, the LMHA or LBHA must:

(i) notify the offender with special needs of the referral from a county or city jail;

(ii) arrange an in-person contact between the offender with special needs and a QMHP-CS to occur within 15 days after the individual's release; and

(iii) ensure that the QMHP-CS, at the in-person contact, reassesses the individual and arranges for appropriate services, including transportation needs at the time of release;

(B) if the individual is not currently receiving LMHA or LBHA services from the LMHA or LBHA that is notified of the referral, the LMHA or LBHA must:

(i) ensure that at the in-person contact required in subparagraph (A) of this paragraph, the QMHP-CS conducts a pre-admission assessment in accordance with §301.353(a) of this title (relating to Provider Responsibilities for Treatment Planning and Service Authorization); and

(ii) comply with §306.161(b) of this subchapter (relating to Screening and Assessment), as applicable; or

(C) if the LMHA or LBHA is unable to conduct an in-person contact with the individual required in paragraph (1)(A) of this subsection, the LMHA or LMHA must document the reasons for not doing so in the individual's record.

(2) If an LMHA or LBHA is notified of the anticipated release from prison or a state jail of an offender with special needs in the MH priority population who is currently taking psychoactive medications for a mental illness and who will be released with a 30-day supply of the psychoactive medications, the LMHA or LBHA must arrange an in-person contact required in paragraph (1)(A) of this subsection between the individual and QMHP-CS within 15 days after the individual's release.

(A) If the offender with special needs is released from state prison or state jail after hours or the LMHA or LBHA is otherwise unable to schedule the in-person contact required in paragraph (2) of this subsection before the individual's release, the LMHA or LBHA must make a good faith effort to locate and contact the individual. If the designated LMHA or LBHA is unable to have an in-person contact with the individual within 15 days after being released, the LMHA or LBHA must document the reasons for not doing so in the individual's record.

(B) At the in-person contact required in paragraph (2) of this subsection:

(i) the QMHP-CS with appropriate supervision and training must perform an assessment in accordance with §301.353(a) of this title and comply with §306.161(b) and (c) of this subchapter, as applicable; and

(ii) if the LMHA or LBHA determines that the offender with special needs should receive services immediately, the LMHA or LBHA must arrange for the individual to meet with a physician or designee authorized by state law to prescribe medication before the individual requires a refill of the prescription.

(C) If the LMHA or LBHA is unable to conduct an in-person contact with the offender with special needs required in paragraph (2) of this subsection, the LMHA or LBHA must document the reasons for being unable to do so in the individual's record.

(3) If the offender with special needs is on parole or probation, the state hospital or CPB must notify a representative of TCOOMMI before the discharge of the individual known to be on parole or probation. §306.203.Discharge of an Individual Voluntarily Receiving Inpatient Treatment.

(a) A state hospital or CPB must discharge an individual voluntarily receiving treatment if the administrator or designee of the state hospital or CPB concludes that the individual can no longer benefit from inpatient services based on the physician's determination, as delineated in Division 5 of this subchapter (relating to Discharge and Absences from a State Hospital or a Facility with a Contracted Psychiatric Bed).

(b) If an individual voluntarily receiving treatment or LAR makes a written request for discharge:

(1) the state hospital or CPB must discharge the individual in accordance with Texas Health and Safety Code §572.004; and

(2) the individual or LAR must sign, date, and document the time on the discharge request.

(c) In accordance with Texas Health and Safety Code §572.004, if an individual informs a staff member of a state hospital or CPB of the individual's desire to leave the state hospital or CPB, the state hospital or CPB must:

(1) as soon as possible, assist the individual in documenting the written request and obtaining the necessary signature; and

(2) within four hours after a written request is made known to the state hospital or CPB, notify:

(A) the treating physician; or

(B) another physician who is a state hospital or CPB staff member, if the treating physician is not available during that period.

(d) Results of physician notification required by subsection (c)(2) of this section.

(1) In accordance with Texas Health and Safety Code §572.004(c) and (d):

(A) a state hospital or CPB, based on a physician's determination, must discharge an individual within the four-hour period described in subsection (c)(2) of this section; or

(B) if the physician who is notified in accordance with subsection (c)(2) of this section has reasonable cause to believe that the individual may meet the criteria for court-ordered inpatient mental health services or emergency detention, the physician must examine the individual as soon as possible, but no later than 24 hours, after the request for discharge is made known to the state hospital or CPB.

(2) Reasonable cause to believe that the individual may meet the criteria for court-ordered inpatient mental health services or emergency detention.

(A) If a physician does not examine an individual who may meet the criteria for court-ordered inpatient mental health services or emergency detention within 24 hours after the request for discharge is made known to the state hospital or CPB, the facility must discharge the individual.

(B) If a physician, in accordance with Texas Health and Safety Code §572.004(d), examines the individual as described in paragraph (1)(B) of this subsection and determines that the individual does not meet the criteria for court-ordered inpatient mental health services or emergency detention, the state hospital or CPB must discharge the individual upon completion of the examination.

(C) If a physician, in accordance with Texas Health and Safety Code §572.004(d), examines the individual as described in paragraph (1)(B) of this subsection and determines that the individual meets the criteria for court-ordered inpatient mental health services or emergency detention, the state hospital or CPB, by 4:00 p.m. on the next business day, must:

(i) if the state hospital or CPB intends to detain the individual, require the physician or designee, in accordance with Texas Health and Safety Code §572.004(d), to:

(I) file an application for court-ordered inpatient mental health services or emergency detention and obtains a court order for further detention of the individual;

(II) notify the individual and LAR, if applicable, of such intention; and

(III) document in the individual's record the reasons for the decision to detain the individual; or

(ii) discharge the individual.

(e) In accordance with Texas Health and Safety Code §572.004(i), after a written request from a minor individual admitted under §306.175(a)(1)(B) of this subchapter (relating to Voluntary Admission Criteria for a State Hospital or a Facility with a Contracted Psychiatric Bed, the state hospital or CPB must:

(1) notify the minor's parent, managing conservator, or guardian of the request and:

(A) if the minor's parent, managing conservator, or guardian objects to the discharge, the minor continues receiving voluntary treatment; or

(B) if the minor's parent, managing conservator, or guardian does not object to the discharge, the minor individual is discharged and released to the minor's LAR; and

(2) document the request in the minor's record.

(f) In accordance with Texas Health and Safety Code §572.004(f)(1), a state hospital or CPB is not required to complete the requirements described in this section if the individual documents and signs a written statement withdrawing the request for discharge. §306.204.Discharge of an Individual Involuntarily Receiving Treatment.

(a) Discharge from emergency detention.

(1) Except as provided by §306.178 of this subchapter (relating to Voluntary Treatment Following Involuntary Admission) and in accordance with Texas Health and Safety Code §573.021(b) and §573.023(b), a state hospital or CPB must immediately discharge an individual under emergency detention if:

(A) the state hospital administrator, administrator of the CPB, or designee concludes, based on a physician's determination, the individual no longer meets the criteria in §306.176(c)(1) of this subchapter (relating to Admission Criteria for a State Hospital or a Facility with a Contracted Psychiatric Bed for Emergency Detention); or

(B) except as provided in paragraph (2) of this subsection:

(i) 48 hours has elapsed from the time the individual was presented to the state hospital or CPB; and

(ii) the state hospital or CPB has not obtained a court order for further detention of the individual.

(2) In accordance with Texas Health and Safety Code §573.021(b), if the 48-hour period described in paragraph (1)(B)(i) of this subsection ends on a Saturday, Sunday, or legal holiday, or before 4:00 p.m. on the next business day after the individual was presented to the state hospital or CPB, the state hospital or CPB may detain the individual until 4:00 p.m. on such business day.

(b) Discharge under order of protective custody. Except as provided by §306.178 of this subchapter and in accordance with Texas Health and Safety Code §574.028, a state hospital or CPB must immediately discharge an individual under an order of protective custody if:

(1) the state hospital administrator, administrator of the CPB, or designee determines that, based on a physician's determination, the individual no longer meets the criteria described in Texas Health and Safety Code §574.022(a);

(2) the state hospital administrator, administrator of the CPB, or designee does not receive notice that the individual's continued detention is authorized after a probable cause hearing held within the period prescribed by Texas Health and Safety Code §574.025(b);

(3) a final order for court-ordered inpatient mental health services has not been entered within the period prescribed by Texas Health and Safety Code §574.005; or

(4) an order to release the individual is issued in accordance with Texas Health and Safety Code §574.028(a).

(1) Except as provided by §306.178 of this subchapter and in accordance with Texas Health and Safety Code §574.085 and §574.086(a), a state hospital or CPB must immediately discharge an individual under a temporary or extended order for inpatient mental health services if:

(A) the order for inpatient mental health services expires; or

(B) the state hospital administrator, administrator of the CPB, or designee concludes that, based on a physician's determination, the individual no longer meets the criteria for court-ordered inpatient mental health services.

(2) In accordance with Texas Health and Safety Code §574.086(b), before discharging an individual in accordance with paragraph (1) of this subsection, the state hospital administrator, administrator of the CPB, or designee must consider whether the individual should receive court-ordered outpatient mental health services in accordance with a modified order described in Texas Health and Safety Code §574.061.

(3) In accordance with Texas Health and Safety Code §574.081, at the time an individual receiving court-ordered inpatient mental health services is furloughed or discharged from a state hospital or CPB, the state hospital or CPB must provide and pay for psychoactive medication and any other medication prescribed to counteract adverse side effects of psychoactive medication. This requirement also applies for a patient on a pass.

(A) A state hospital or CPB is only required to provide or pay for these medications if funding to cover the cost of the medications is available to be paid to the facility for this purpose from HHSC.

(B) The state hospital or CPB must provide or pay for the medications in an amount sufficient to last until the individual can see a physician, or provider with prescriptive authority, but the state hospital or CPB is not required to provide or pay for more than a seven-day supply.

(C) The state hospital or CPB must inform an individual if funding is not available to provide or pay for the medications upon pass, furlough, or discharge, and if funding is not available, the individual's designated LMHA or LBHA is responsible for providing psychoactive medications as provided in §306.207(2)(A) of this division (relating to Post Discharge or Furlough: Contact and Implementation of the Recovery or Treatment Plan), if applicable.

(4) An individual committed under Texas Code of Criminal Procedure Chapter 46B or 46C may only be discharged as provided by §306.202(f) of this division (relating to Special Considerations for Discharge Planning).

(d) Discharge packet. A state hospital administrator, administrator of a CPB, or designee must forward a discharge packet, as provided in §306.201(h) of this division (relating to Discharge Planning), of any individual committed under the Texas Code of Criminal Procedure to the jail and the LMHA or LBHA in accordance with state and federal privacy laws. §306.205.Pass or Furlough from a State Hospital or a Facility with a Contracted Psychiatric Bed.

(a) An individual who is under consideration for discharge as described in §306.203 of this division (relating to Discharge of an Individual Voluntarily Receiving Treatment) or §306.204(c) of this division (relating to Discharge of an Individual Involuntarily Receiving Treatment) may leave the state hospital or CPB while on pass or furlough if the state hospital or CPB and the designated LMHA or LBHA agree that a pass or furlough will be beneficial in implementing the individual's recovery or treatment plan. The designated LMHA or LBHA is responsible for monitoring the individual while the individual is on pass or furlough.

(1) If an individual on an involuntary commitment under Texas Health and Safety Code Chapter 574 is authorized for a pass or furlough, the state hospital or CPB must notify the committing court of the individual's absence.

(2) The state hospital or CPB may extend an initial pass or furlough if:

(A) requested by the designated LMHA or LBHA; and

(B) the extension is clinically justified.

(3) A furlough that exceeds 60 days must be approved by:

(A) the state hospital administrator or designee, or the administrator of the CPB or designee; and

(B) the designated LMHA or LBHA executive director or designee.

(4) The state hospital or CPB must not authorize a pass or furlough that exceeds the expiration date of the individual's order for inpatient mental health services.

(b) The administrator of a state hospital or CPB may contact a peace officer as described under Texas Health and Safety Code §574.083 if:

(1) an individual is absent without authority from a state hospital or CPB;

(2) the individual has violated the conditions of a pass or furlough; or

(3) the individual's condition has deteriorated to the extent that the individual's continued absence under pass or furlough is not appropriate.

(c) If the individual is detained in a nonmedical facility by a peace officer, the LMHA or LBHA must ensure the individual receives proper care and medical attention in accordance with Texas Health and Safety Code §574.083.

(d) In accordance with Texas Health and Safety Code §574.084, an individual's furlough may be revoked only after an administrative hearing held in accordance with this subsection.

(1) The state hospital or CPB must conduct a hearing by a hearing officer who is a mental health professional not directly involved in treating the individual.

(2) The state hospital or CPB must:

(A) hold an informal hearing within 72 hours after the individual returns to the facility;

(B) provide the individual or LAR and facility staff members an opportunity to present information supporting the state hospital's or CPB's position; and

(C) provide the individual or LAR the option to select another person or staff member to serve as the individual's advocate.

(3) Within 24 hours after the conclusion of the hearing, the hearing officer must determine if:

(A) revocation of the furlough is justified because:

(i) the individual was absent without authority from the facility;

(ii) the individual violated the conditions of the furlough; or

(iii) the individual's condition deteriorated to the extent the individual's continued furlough was inappropriate; or

(B) the furlough was justified.

(4) The hearing office must render the final decision in writing, including the basis for the hearing officer's decision, and place the decision in the individual's file.

(5) If the hearing officer's decision does not revoke the furlough, the individual may leave the state hospital or CPB pursuant to the conditions of the furlough.

(6) The state hospital or CPB must ensure the individual's record includes a copy of the hearing officer's report.

(e) Only the committing criminal court may grant a pass or furlough from a state hospital or CPB for individuals committed under Texas Code of Criminal Procedure Chapter 46B or 46C. §306.207.Post Discharge or Furlough: Contact and Implementation of the Recovery or Treatment Plan.

(a) The designated LMHA or LBHA must:

(1) contact an individual following discharge or furlough from a state hospital or CPB;

(2) implement the individual's recovery or treatment plan within seven days after discharge in accordance with this section; and

(3) ensure the successful transition of the individual determined by the state hospital or CPB to be medically appropriate for discharge in accordance with Texas Health and Safety Code §534.0535.

(b) LMHA or LBHA contact after discharge or furlough.

(1) The designated LMHA or LBHA must contact an individual in person or using audiovisual technology within seven days after discharge or furlough of an individual who is:

(A) discharged or on furlough from a state hospital or CPB and referred to the LMHA or LBHA for services or supports as indicated in the recovery or treatment plan;

(B) discharged from an LMHA or LBHA-network provider of inpatient services and referred to the LMHA or LBHA for services or supports as indicated in the recovery or treatment plan;

(C) discharged from an alternate provider of inpatient services and receiving LMHA or LBHA services from the designated LMHA or LBHA at the time of admission and who, upon discharge, is referred to the LMHA or LBHA for services or supports as indicated in the recovery or treatment plan;

(D) discharged from the LMHA's or LBHA's crisis stabilization unit or any overnight crisis facility and referred to the LMHA or LBHA for services or supports as indicated in the discharge plan; or

(E) an offender with special needs discharged from a state hospital or CPB returning to jail.

(2) During the contact required by paragraph (1)(A) of this paragraph, the designated LMHA or LBHA must:

(A) reassess the individual;

(B) ensure the provision of the services and supports specified in the individual's recovery or treatment plan by making the services and supports available and accessible as determined by the individual's level of care; and

(C) assist the individual in accessing the services and supports specified in the individual's recovery or treatment plan.

(3) The designated LMHA or LBHA must develop or review an individual's recovery or treatment plan in accordance with §301.353(e) of this title (relating to Provider Responsibilities for Treatment Planning and Service Authorization) and consider treatment recommendations in the state hospital's or CPB's discharge plan within ten business days after the contact required by paragraph (1)(A) of this paragraph.

(4) The designated LMHA or LBHA must make a good faith effort to contact an individual as required by paragraph (1)(A) of this paragraph. If the designated LMHA or LBHA does not have the required contact with the individual, the LMHA or LBHA must document the attempts made and reasons the contact did not occur in the individual's record.

(c) For an individual whose recovery or treatment plan identifies the designated LMHA or LBHA as responsible for providing or paying for the individual's psychoactive medications, the designated LMHA or LBHA must ensure:

(1) the provision of psychoactive medications for the individual; and

(2) the individual has an appointment with a physician or designee authorized by state law to prescribe medication before the earlier of the following events:

(A) the individual's supply of psychoactive medication from the state hospital or CPB has been depleted; or

(B) the 15th day after the individual is on furlough or discharged from the state hospital or CPB.

(d) The designated LMHA or LBHA must document in an individual's record the LMHA's or LBHA's activities described in this section, and the individual's responses to those activities.

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 February 3, 2025.

TRD-202500359

For further information, please call: (737) 704-9063

26 TAC §306.206

STATUTORY AUTHORITY

The repeal is adopted under 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, §531.008, which requires the Executive Commissioner of HHSC to establish a division for administering state facilities, including state hospitals and state supported living centers, and §531.02161, which requires the Executive Commissioner of HHSC to, by rule, develop and implement a system that ensures behavioral health services may be provided using an audio-only platform to the extent permitted by state and federal law and to the extent it is cost-effective and clinically effective; Health and Safety Code §533.014 which requires the Executive Commissioner of HHSC to adopt rules relating to LMHA treatment responsibilities, §533.0356 which allows the Executive Commissioner to adopt rules governing LBHAs, §533A.0355 which requires the Executive Commissioner of HHSC to adopt rules establishing the roles and responsibilities of local intellectual and developmental disability authorities, §534.052 which requires the Executive Commissioner of HHSC to adopt rules necessary and appropriate to ensure the adequate provision of community-based services through LMHAs, §534.0535 which requires the Executive Commissioner of HHSC to adopt rules that require continuity of services and planning for patient care between HHSC facilities and LMHAs, and §552.001 which provides HHSC with authority to operate the state hospitals.

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 February 3, 2025.

TRD-202500360

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: February 23, 2025

Proposal publication date: September 13, 2024

For further information, please call: (737) 704-9063

DIVISION 6. TRAINING

26 TAC §306.221