Adopted Rules Title 26

TITLE 26. HEALTH AND HUMAN SERVICES

PART 1. HEALTH AND HUMAN SERVICES COMMISSION

CHAPTER 307. BEHAVIORAL HEALTH PROGRAMS

SUBCHAPTER G. BEHAVIORAL HEALTH GRANT AND FUNDING PROGRAMS

The Texas Health and Human Services Commission (HHSC) adopts §307.301, concerning Purpose, §307.305, concerning General Conditions of a Grant, §307.307, concerning Eligible Applicants, §307.309, concerning Eligible Projects, §307.311, concerning Grant Proposals and Selection Process, §307.313, concerning Contract Execution, and §307.315, concerning Project Review and Evaluation Report, in new Subchapter G, new Division 1, concerning Mental Health Grant Program for Justice-Involved Individuals, and new §307.351, concerning Purpose, §307.353, concerning Definitions, §307.355, concerning General Conditions of a Grant, §307.357, concerning Eligible Applicants, §307.359, concerning Eligible Projects, §307.361, concerning Grant Proposals and Selection Process, 307.363, concerning Selection Criteria, §307.365, concerning Contract Execution, and §307.367, concerning Project Review and Evaluation Report, in new Subchapter G, new Division 2, concerning Rural Initiatives Grant Program.

Sections 307.303, 307.309, 307.311, and 307.359 are adopted with changes to the proposed text as published in the February 9, 2024, issue of the Texas Register (49 TexReg 620). These rules will be republished.

Sections 307.301,307.305, 307.307, 307.313, 307.315, 307.351, 307.353, 307.355, 307.357, 307.361, 307.363, 307.365, and 307.367 are adopted without changes to the proposed text as published in the February 9, 2024, issue of the Texas Register (49 TexReg 620). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The purpose of the adopted rules is to comply with Senate Bill (S.B.) 1677, 88th Legislature, Regular Session, 2023, which requires HHSC to adopt rules to implement Texas Government Code §531.0993(d-1), and §531.09936.

The adopted rules in new Subchapter G, outline the general conditions of the grant, eligible applicants, selection process, contract execution, reporting requirements, and HHSC inspections of the operation and provision of mental health services under the Mental Health Grant for Justice-Involved Individuals (MHGJII) and the Rural Initiatives Grant Program.

The adopted rules in Division 1 establish the requirements of the MHGJII to provide grants to county-based community collaboratives for the purpose of reducing: (1) recidivism by, the frequency of arrests of, and incarceration of persons with mental illness; and (2) the total waiting time for forensic commitment of persons with mental illness to a state hospital. The adopted rules outline the assistance offered by HHSC to community collaboratives that include a county with a population of less than 250,000 in submitting a proposal for the MHGJII.

The adopted rules in Division 2 establish the requirements for the Rural Initiatives Grant Program, to provide grants to establish or expand behavioral health centers or jail diversion centers in a local service area of a local mental health authority (LMHA) or local behavioral health authority located primarily in rural areas to provide one or more of the following types of services: (1) additional forensic hospital beds and competency restoration services; (2) inpatient and outpatient mental health services to adults and children; or (3) services to reduce recidivism and the frequency of arrest, incarceration, and emergency detentions among persons with mental illness.

COMMENTS

The 31-day comment period ended Monday, March 11, 2024.

During this period, HHSC received comments regarding the proposed rules from four commenters, including Meadows Mental Health Policy Institute, Disability Rights of Texas, Texas Council on Developmental Disabilities, and Texas Jail Project. A summary of comments relating to the rules and HHSC's responses follows.

Meadows Mental Health Policy Institute's comment was focused on making sure that the rule language aligns with the intent of S.B. 292, 85th Legislature, Regular Session, 2017, concerning interdisciplinary rapid response teams. The joint comment received from Disability Rights of Texas, Texas Council on Developmental Disabilities, and Texas Jail Project focused on three recommendations related to enhancing the outcomes and safety of justice-involved individuals, and the provision of clear information to the public as to the regulations applicable to the grant.

Comment: A commenter suggested changing the definition of "rapid response team" so that it aligns with the intent of S.B. 292 to establish interdisciplinary rapid response teams to reduce law enforcement involvement with mental health emergencies. The suggested language included adding a law enforcement officer as part of this team, removing the reference to responding to individuals in a hospital or facility, and stating the goal of preventing an arrest.

Response: HHSC agrees with the comment and revised the definition in §307.303 of "rapid response team" by adding that the team may include a first responder such as law enforcement or emergency management services and adding the goal of preventing an arrest that leads to justice involvement, preventing harm to self or to others and death. HHSC also removed reference to a team responding to individuals in a hospital or facility.

Comment: A commenter recommends that the rule language specifically speak to allowing grant dollars to hire a liaison to work between the mental health authority and the jail. The liaison could be employed by and housed with either entity.

Response: HHSC disagrees with the comment and declines to make the suggested change, as the funds for this program allow for the creative development of program solutions for programs in jail settings that could include this type of workforce. The intent of the grant program is to allow the use of workforce and resources according to the needs in the communities and locations that the program will be implemented.

Comment: A commenter recommends HHSC add language to encourage the separation of individuals in jail awaiting competency restoration from the general inmate population to better ensure the safety of a vulnerable population, and that HHSC could assign extra points or increase consideration if this is included in the grant proposal.

Response: HHSC disagrees with the comment and declines to make the suggested recommendation as it is not applicable to all programs covered by this rule.

Comment: A commenter recommends that §307.313 and §307.365 delineate the state laws that are applicable to ensure the public and providers and regulatory staff have the same understanding.

Response: HHSC disagrees with the comment and declines the suggested change as the contract of the selected grantees will include the information of all applicable federal and state laws, and applicable regulations. Selected grantees will have the opportunity to ask questions about the terms of the contract before it is executed.

HHSC made changes in §307.303 to clarify the assertive community treatment (ACT) definition and §307.309 to clarify that grant proposals for ACT must be in addition to the ACT required in the LMHA/LBHA performance contract. HHSC made edits to §307.311(b) to clarify that an applicant must include in the proposal "how the applicant will meet" the objectives described in subsection (b)(1) and a minor edit in subsection (b)(1)(B). HHSC made edits to §307.359 to clarify the requirements for eligible projects.

DIVISION 1. MENTAL HEALTH GRANT PROGRAM FOR JUSTICE INVOLVED INDIVIDUALS

26 TAC §§307.301, 307.303, 307.305, 307.307, 307.309, 307.311, 307.313, 307.315

STATUTORY AUTHORITY

The new sections are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies; §531.0993 which requires HHSC to establish a program to provide grants to county-based community collaboratives for the purposes of reducing: (1) recidivism by, the frequency of arrests of, and incarceration of persons with mental illness; and (2) the total waiting time for forensic commitment of persons with mental illness to a state hospital; and §531.09936 which requires HHSC to establish or expand behavioral health centers or jail diversion centers in LMHA service areas to: (1) provide additional forensic hospital beds and competency restoration services; (2) provide inpatient and outpatient mental health services to adults and children; and (3) provide services to reduce recidivism and the frequency of arrest, incarceration, and emergency detentions among persons with mental illness in the service areas.

The new sections affect Texas Government Code §531.0055, §531.0993, and §531.09936.

§307.303.Definitions.

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

(1) ACT--Assertive community treatment. A 24-hour team-based service that provides treatment, rehabilitation, and support services in the community to individuals who have a history of multiple psychiatric hospitalizations (two or more in 180 days or four or more in two years) or at least one hospitalization of greater than 30 days duration in the last two years. The provision of ACT requires the following.

(A) Individuals identified as needing ACT services must be prioritized for supportive housing, supported employment, and co-occurring psychiatric and substance use disorder services as needed.

(B) The use of an integrated services approach merging clinical and rehabilitation staff expertise, such as psychiatric, substance use, vocational or employment, and supportive housing, within one mobile service delivery system.

(C) ACT Teams provide permanent supportive housing services, supported employment services, substance use services, psychotherapy services, and mental health rehabilitation services to individuals they serve with minimal external referrals for these services. Referrals are appropriate for specialized therapeutic modalities for complex trauma.

(D) Services are delivered on an individual basis with the exception of group activities to reduce social isolation or address substance use issues.

(E) The ACT Team has a maximum case ratio of 10 service recipients per staff person.

(F) The ACT Team implements ACT services according to the Substance Abuse and Mental Health Services Administration's evidence-based practices and the guidelines defined by Health and Human Services Commission.

(2) Applicant--An entity that submits a proposal to apply for a grant award that is part of a community collaborative.

(3) Community collaborative--A partnership that includes a county, a local mental health authority, or local behavioral health authority that operates in the county, and each hospital district, if any, located in the county. A community collaborative may include other local entities designated by the collaborative's members.

(4) Continuity of care--This term has the meaning set forth in §306.153 of this title (relating to Definitions).

(5) FACT--Forensic assertive community treatment. A service delivery model intended for individuals with serious mental illness who are involved with the criminal justice system. These individuals may have co-occurring substance use and physical health disorders. FACT addresses the likelihood that an individual will engage in future illegal behavior in the form of a new crime or failure to comply with conditions of probation or parole, and factors that increase an individual's likelihood of re-offense, such as lack of employment or livable wages, or the presence of a substance use disorder.

(6) Grantee--A recipient of a grant awarded under this division.

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

(8) Local behavioral health authority--An entity designated as the local behavioral health authority by HHSC in accordance with Texas Health and Safety Code §533.0356.

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

(10) Mental health jail diversion program--A program that serves individuals with behavioral health needs who are involved, or at risk of involvement, in the criminal justice system by diverting the individuals from jail and providing the individuals with, or connecting them to, community mental health and substance use services.

(11) Rapid response team--An interdisciplinary team that includes at least one behavioral health provider and may also include a first responder such as law enforcement or emergency management services. This team provides rapid assessment and deployment of resources for individuals who are experiencing acute clinical deterioration, or signs of imminent clinical deterioration, related to acute stress or a psychiatric condition that impairs or impedes their mental health in the community with the goal of preventing harm to self or to others, death, or an arrest that leads to justice involvement; preventing a higher intensive level of care, or hospitalization in the community; and connecting individuals to necessary behavioral health and intellectual disability services.

§307.309.Eligible Projects.

Grant proposals must meet the requirements and specifications set forth in the competitive request for proposal by HHSC. Projects eligible for grant funding include:

(1) continuation of a mental health jail diversion program;

(2) establishment or expansion of a mental health jail diversion program;

(3) establishment of alternatives to competency restoration in a state hospital, including outpatient competency restoration, inpatient competency restoration in a setting other than a state hospital, or jail-based competency restoration;

(4) provision of ACT in addition to the ACT required by the local mental health authority or local behavioral health authority performance contract or FACT with an outreach component;

(5) provision of intensive mental health services and substance use treatment not readily available in the county;

(6) provision of continuity of care services for an individual being released from a state hospital;

(7) establishment of interdisciplinary rapid response teams to reduce law enforcement's involvement with mental health emergencies; and

(8) provision of local community hospital, crisis, respite, or residential beds.

§307.311.Grant Proposals and Selection Process.

(a) Grant funds are made available to a local mental health authority or local behavioral health authority representing a community collaborative through a competitive request for proposal process.

(b) An applicant must include in the proposal how the applicant will meet:

(1) the objectives of reducing:

(A) recidivism by, the frequency of arrests of, and incarceration of persons with mental illness; and

(B) the total wait time for forensic commitment of persons with mental illness to a state hospital;

(2) a statement indicating the amount of matching funds the collaborative is able to provide; and

(3) a plan that:

(A) is endorsed by each of the collaborative's member entities;

(B) identifies a target population;

(D) includes outcome measures to evaluate the success of the plan; and

(E) describes how the success of the plan in accordance with the outcome measures would further the state's interest in the grant program's purposes.

(c) An applicant must submit a proposal for a grant directly to HHSC in the time and manner specified by HHSC. A proposal received after the deadline will not be considered. HHSC reviews and evaluates eligible, complete, and timely proposals in accordance with the evaluation methodology published in the request for proposal or other notice of potential grant award issued by HHSC.

(d) From money appropriated to HHSC for each state fiscal year to implement this grant, HHSC reserves at least 20 percent of that total for grants to community collaboratives that include a county with a population of less than 250,000.

(e) An applicant that includes a county with a population of less than 250,000 may request technical assistance or data from HHSC up to six months before the release of a funding opportunity.

(f) To the extent money appropriated to HHSC for a state fiscal year to implement this grant remains available to HHSC after grant recipients are selected for the fiscal year, HHSC makes grants available using the money remaining for the fiscal year through a competitive request for proposal process. Subsection (d) of this section does not apply to this process.

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 May 13, 2024.

TRD-202402139

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: June 2, 2024

Proposal publication date: February 9, 2024

For further information, please call: (512) 568-4605

DIVISION 2. RURAL INITIATIVES GRANT PROGRAM

26 TAC §§307.351, 307.353, 307.355, 307.357, 307.359, 307.361, 307.363, 307.365, 307.367

STATUTORY AUTHORITY

The new sections affect Texas Government Code §531.0055, §531.0993, and §531.09936.

§307.359.Eligible Projects.

Proposals must meet the requirements and specifications set forth in requests for proposals issued by HHSC. Proposals must be to expand or establish a behavioral health center or jail diversion center to provide one or more of the following types of services:

(1) forensic hospital beds and competency restoration services;

(2) inpatient and outpatient mental health services for adults and children, including counseling and psychiatric services; or

(3) services to reduce recidivism and the frequency of arrest, incarceration, and emergency detentions among persons with mental illness in the local service area.