Proposed Rules Title 40

TITLE 40. SOCIAL SERVICES AND ASSISTANCE

PART 19. DEPARTMENT OF FAMILY AND PROTECTIVE SERVICES

CHAPTER 700. CHILD PROTECTIVE SERVICES

The Department of Family and Protective Services (DFPS) proposes to amend rules in Title 40, Texas Administrative Code (TAC), Part 19, Chapter 700, Subchapters B, C, H, J, M, Q, & W, and add a new Subchapter E.

BACKGROUND AND PURPOSE

The new and amended rules aim to implement the provisions of the General Appropriations Act, Senate Bill 1 Regular Session 2021 (Article II, Special Provisions Related to All Health and Human Services Agencies, Section 26). The Department of Family and Protective Services (DFPS) with the assistance of HHSC, developed an alternative reimbursement methodology proposal for the 87th Legislature for foster care and Community-based Care (CBC) rates.

The purpose of the proposed rule amendments is to implement the alternative reimbursement methodology, which will transform the foster care system to better align and support the success of CBC by establishing clearly defined foster care models/service packages with new corresponding foster care rates.

SECTION-BY-SECTION SUMMARY

New §700.115 defines the Texas Child-Centered Care (T3C) system as defined service packages and add-on support services, whereby children, youth, and young adults will be matched through a uniform assessment tool. The rule also implements an agency rule waiver process, as long as the waiver does not conflict with state or federal law. Upon full implementation, T3C will replace the use of the Service Level System; however, during this process the Commissioner of the DFPS may waive a provision in any section in this chapter if the waiver is necessary to implement T3C.

The proposed amendment to §700.211 allows Court-Appointed Volunteer Advocates to receive information regarding the child's service package if they are placed under the T3C System in addition to the information they had already been receiving about the child's authorized service level.

The proposed amendment to §700.328 adds T3C, stating that foster care maintenance payments will be tied to the child's service level or T3C service package.

The proposed amendment to §700.332 adds T3C, stating DFPS may provide day care for authorized purposes to a foster parent if (among other things) the child's service level is basic or if placed in a T3C Basic Foster Family Home Service Package.

The proposed amendment to §700.334 adds T3C, allowing DFPS to provide special needs foster child day care services for authorized purposes to a foster parent if the child (among other things): has a billing service level of Basic or receives an approved waiver of the required basic service level through the regional day care coordinator or is placed in the T3C Basic Foster Family Home Service Package.

New §700.501 defines what a T3C Basic Foster Family Home Support Service Package is.

New §700.502 defines what a Substance Use Support Services Package is for a Foster Family Home.

New §700.503 defines what a Short-Term Assessment Support Services Package is for a Foster Family Home.

New §700.504 defines what a Mental & Behavioral Health Support Services Package is for a Foster Family Home.

New §700.505 defines what a Sexual Aggression/Sex Offender Support Services Package is for a Foster Family Home.

New §700.506 defines what a Complex Medical Needs or Medically Fragile Support Services Package is for a Foster Family Home.

New §700.507 defines what a Human Trafficking Victim/Survivor Support Service Package is for a Foster Family Home.

New §700.508 defines what an Intellectual or Developmental Disability (IDD)/Autism Spectrum Disorder Support Service Package is for a Foster Family Home

New §700.509 defines what a T3C Treatment Foster Family Care Support Service Package is for a Foster Family Home.

New §700.510 defines what a Transition Support Services for Youth and Young Adults Add-On is for a Foster Family Home.

New §700.511 defines what a Kinship Caregiver Support Services Add-On is for a Foster Family Home.

New §700.512 defines what a Pregnant & Parenting Youth or Young Adult Support Services Add-On is for a Foster Family Home.

New §700.513 explains that Division 2 will outline the parameters/requirements associated with the Tier I Service Packages under T3C for General Residential Operations (GRO).

New §700.514 defines what a Tier I: T3C Basic Child Care Operation Package is for a GRO.

New §700.515 defines what a Tier I: Services to Support Community Transition for Youth & Young Adults who are Pregnant or Parenting Package is for a GRO.

New §700.516 defines what a Tier I: Sexual Aggression/Sex Offender Treatment Services to Support Community Transition Package is for a GRO.

New §700.517 defines what a Tier I: Substance Use Treatment Services to Support Community Transition Package is for a GRO.

New §700.518 defines what a Tier I: Emergency Emotional Support & Assessment Center Package is for a GRO.

New §700.519 defines what a Tier I: Complex Medical Needs Treatment to Support Community Transition Package is for a GRO.

New §700.520 defines what a Tier I: Mental & Behavioral Health Treatment Services to Support Community Transition Package is for a GRO.

New §700.521 defines what a Tier I: Intellectual or Developmental Disability (IDD)/Autism Spectrum Disorder Treatment Services to Support Community Transition Package is for a GRO.

New §700.522 defines what a Tier I: Human Trafficking Victim/Survivor Treatment Services to Support Community Transition Package is for a GRO.

New §700.523 defines what a Tier II: Sexual Aggression/Sex Offender Services to Support Stabilization Package is for a GRO.

New §700.524 defines what a Tier II: Substance Use Services to Support stabilization Package is for a GRO.

New §700.525 defines what a Tier II: Aggression/Defiance Disorder Services to Support Stabilization Package is for a GRO.

New §700.526 defines what a Tier II: Complex Mental Health Services to Support Stabilization Package is for a GRO.

New §700.527 defines what a Tier II: Complex Medical Services to Support Stabilization Package is for a GRO.

New §700.528 defines what a Tier II: Human Trafficking Victim/Survivor Services to Support Stabilization Package is for a GRO.

The proposed amendment to §700.844 explains that under T3C, the maximum monthly payment for Adoption Assistance depends on the child's recommended service package at the beginning of the adoptive placement. The payment ceiling for a child who is placed in the T3C Basic Foster Family Support Services is $400 per month; the payment ceiling for a child placed in any other Service Package is $545 per month.

The proposed amendment to §700.1039 explains that under T3C, the maximum monthly payment for the Permanency Care Assistance Program depends on the child's recommended service package at the beginning of the adoptive placement. The payment ceiling for a child who is placed in the T3C Basic Foster Family Support Services is $400 per month; the payment ceiling for a child placed in any other Service Package is $545 per month.

The proposed amendment to §700.1733 states that for residential treatment services (in addition to other requirements) the client must have an initial service level determination of Specialized or Intense or if under the Texas Child-Centered Care (T3C) System, must be placed and receiving a T3C Service Package other than the T3C Basic Family Foster Family Home Service Package.FISCAL NOTE

Lea Ann Biggar, Chief Financial Officer of DFPS, has determined that for the first five years that the section(s) will be in effect, there will be a fiscal impact of $106.3 million in estimated administrative costs to support the transition and implementation of the Texas Child-Centered Care System. There will be no fiscal implications to local governments as a result of enforcing and administering the section(s) as proposed.

GOVERNMENT GROWTH IMPACT STATEMENT

DFPS has determined that during the first five years that the proposed rules will be in effect:

(1) the proposed rule amendments will not create or eliminate a government program;

(2) implementation of the proposed rule amendments will affect the number of employee positions;

(3) implementation of the proposed rule amendments will require an increase or decrease in future legislative appropriations to the agency;

(4) the proposed rule amendments will not affect fees paid to the agency;

(5) the proposed rule amendments will create a new regulation;

(6) the proposed rule amendments will limit an existing regulation;

(7) the proposed rule amendments will change the number of individuals subject to the rule; and

(8) the proposed rule amendments will not affect the state's economy.

SMALL BUSINESS, MICRO-BUSINESS, AND RURAL COMMUNITY IMPACT ANALYSIS

Ms. Biggar has also determined that there will be no adverse economic effect on small businesses, micro-businesses, or rural communities as the rule does not apply to small or micro-businesses, or rural communities.

ECONOMIC COSTS TO PERSONS AND IMPACT ON LOCAL EMPLOYMENT

There are no anticipated economic costs to persons who are required to comply with the section(s) as proposed.

There is no anticipated negative impact on local employment.

COSTS TO REGULATED PERSONS

Pursuant to subsection (c)(7) of Texas Government Code §2001.0045, the statute does not apply to a rule that is adopted by the Department of Family and Protective Services.

PUBLIC BENEFIT

Ms. Biggar has determined that for each year of the first five years the sections are in effect, the public will benefit from adoption of the section(s). The anticipated public benefit will be that the Texas Child-Centered Care System will transform the foster care system to better align and support the success of Community Based Care (CBC).

TAKINGS IMPACT ASSESSMENT

DFPS has determined that the proposal does not restrict or limit an owner's right to his or her property that would otherwise exist in the absence of government action and, therefore, does not constitute a taking under Government Code, §2007.043.

PUBLIC COMMENT

Comments and questions on this proposal must be submitted within 30 days of publication of the proposal in the Texas Register. Electronic comments and questions may be submitted to Katharine McLaughlin, Senior Policy Attorney, Katharine.McLaughlin@dfps.texas.gov or RULES@dfps.texas.gov . Hard copy comments may be submitted to the DFPS Rules Coordinator, Legal Services Sanjuanita Maltos, Department of Family and Protective Services E-611, P.O. Box 149030, Austin, Texas 78714-9030.

SUBCHAPTER A. ADMINISTRATION

40 TAC §700.115

STATUTORY AUTHORITY

The proposed new rule implements the General Appropriations Act, Senate Bill 1, Regular Session 2021 (Article II, Special Provisions Related to All Health and Human Services Agencies, Section 26).

The modification is proposed under Human Resources Code (HRC) §40.027, which provides that the Department of Family and Protective Services commissioner shall oversee the development of rules relating to the matters within the department's jurisdiction and notwithstanding any other law, shall adopt rules for the operation and provision of services by the department.

§700.115.Waiver Provision for Implementation of Texas Child-Centered Care.

(a) As used in this section, the term "Texas Child-Centered Care" (T3C) is defined as:

(1) Service Packages, that children, youth, and young adults will be matched to through a uniform assessment tool, as described in Subchapter E. Each Service Package has a corresponding rate methodology; and

(2) Add-on support services as described in §§700.510, 700.511, and 700.512 of this title (relating to What is the Transition Support Services for Youth and Young Adults Add-On? What is the Kinship Caregiver Support Services Add-On? What is the Pregnant & Parenting Youth or Young Adult Support Services Add-On?, respectively), for foster family homes.

(b) For purposes of T3C, a Child Placing Agency (CPA), General Residential Operation (GRO) or foster family home has to meet qualifications, as defined by Department of Family and Protective Services (DFPS), to become credentialed to offer a specific Service Package or Add-On Service as described by §§700.510, 700.511, and 700.512 of this title. DFPS will make the determination if a CPA or GRO is credentialed to offer services under T3C, while a credentialed CPA agency will make the determination if the individual foster family home meets the necessary requirements.

(c) Upon full implementation, as specified in the T3C Blue Print, T3C will replace the use of the Service Level System, described in Subchapter W. Effective January 1, 2025, the DFPS will pay for foster care and adoption assistance through either the service level or the T3C system.

(d) Notwithstanding any other provision in Chapter 700, to the extent necessary for the implementation of T3C, the DFPS may waive a provision in any section in this chapter as provided under subsection (e) of this section.

(e) The waiver of any rule provision contained in this chapter must be approved by the Commissioner of the DFPS, or that person's designee, after consultation with agency legal counsel to ensure that the waiver does not conflict with state or federal law.

(f) Nothing in this section shall be construed to authorize the Department of Family and Protective Services to waive a provision of any section in this chapter if such waiver violates state or federal law.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on September 23, 2024.

TRD-202404573

Quyona Gregg

Senior Policy Attorney

Department of Family and Protective Services

Earliest possible date of adoption: November 10, 2024

For further information, please call: (512) 929-6633

SUBCHAPTER B. CONFIDENTIALITY AND RELEASE OF RECORDS

40 TAC §700.211

STATUTORY AUTHORITY

The proposed amended rule implements the General Appropriations Act, Senate Bill 1, Regular Session 2021 (Article II, Special Provisions Related to All Health and Human Services Agencies, Section 26).

§700.211.Internet Application for Court-Appointed Volunteer Advocates.

(a) The Department of Family and Protective Services (DFPS) shall develop an Internet application that allows a court-appointed volunteer advocate representing a child in DFPS' managing conservatorship to:

(1) access the child's case file, as further specified in subsection (b) of this section and Memorandum of Understanding (MOU) entered into pursuant thereto; and

(2) add the volunteer advocate's findings and reports to the child's case file.

(b) DFPS shall enter into a MOU with the statewide organization representing court-appointed volunteer advocates in order to set forth the portions of a child's case file to which an appointed volunteer advocate shall have access. The MOU shall at a minimum:

(1) grant access to the following as it relates to the current conservatorship case of the child for whom the advocate has been appointed:

(A) demographic, locating, and contact information for principal and collateral participants;

(B) information regarding the child's current placement and any prior placements during the same conservatorship episode;

(C) information regarding the child's authorized service level or if placed under the Texas Child-Centered Care (T3C) System the child's Service Package, including supporting documentation in the current Common Application for Placement of Children in Residential Care;

(D) the case plan as that term is defined in §700.1319 of this title (relating to What is a case plan?), including the child service plan and any family service plan then in effect;

(E) information related to the child's permanency plan, including documentation related to permanency planning meetings held on the child's behalf;

(F) the temporary visitation schedule or visitation plan in effect for the case;

(G) list of all legal actions and statuses in the case;

(H) educational status information;

(I) information regarding the child's medical care, including the identity of the child's medical consenter, a listing of the child's medical and mental health assessments, and the child's medical and developmental history page; and

(J) a listing of the external documents associated with the case.

(2) provide that the types of information to which a volunteer advocate may gain access through the Internet application will be expanded upon the mutual agreement of the parties as technological enhancements are made to the Internet application and to DFPS' Information Management Protecting Adults and Children of Texas (IMPACT) case management system;

(3) set forth minimum security protocols CASA organizations and their volunteers must adhere to in order to minimize the unauthorized redisclosure of the information contained in the Internet application;

(4) detail the consequences for breaches of security or the unauthorized redisclosure of information accessed through the Internet application; and

(5) clarify the responsibilities of each party to the MOU, including any responsibilities for volunteer advocates in registering for the application and conditions of continued access to the system.

(c) Information available to court-appointed volunteer advocates through the Internet application remains confidential, and nothing in this rule shall be construed as a waiver of the confidentiality of the information transmitted by the application.

(d) For purposes of this rule, the term "volunteer advocate" includes any staff of the volunteer advocate organization with authority to access the records of a child in DFPS' managing conservatorship.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on September 23, 2024.

TRD-202404574

Quyona Gregg

Senior Policy Attorney

Department of Family and Protective Services

Earliest possible date of adoption: November 10, 2024

For further information, please call: (512) 929-6633

SUBCHAPTER C. ELIGIBILITY FOR CHILD PROTECTIVE SERVICES

40 TAC §§700.328, 700.332, 700.334

STATUTORY AUTHORITY

The proposed amended rules implement the General Appropriations Act, Senate Bill 1, Regular Session 2021 (Article II, Special Provisions Related to All Health and Human Services Agencies, Section 26).

§700.328.Foster Care Maintenance Payments.

(a) Other than in a catchment area in which the Department of Family and Protective Services (DFPS) contracts with a Single Source Continuum Contractor, all providers of 24-hour residential child care, including foster family homes verified by DFPS, general residential operations, residential treatment centers, independent foster family homes, independent foster group homes, Supervised Independent Living (SIL) providers, child-placing agencies, and any other entity that meets the definition of "child-care institution" under 42 U.S.C. §672 must complete a contract or agreement with DFPS in order to receive foster care maintenance payments.

(b) DFPS's foster care rates are approved by the Health and Human Services Commission in accordance with 1 TAC §355.7103 (relating to Rate-Setting Methodology for 24-Hour Residential Child-Care Reimbursements) and 1 TAC §355.7105 (relating to Reimbursement Methodology for Supervised Independent Living). Except as otherwise provided in those rules, the foster care payment rate is tied to the child's service level or under the Texas Child-Centered Care (T3C) System, the child's Service Package.

(c) Any entity that receives foster care maintenance payments in accordance with subsection (a) of this section must accept DFPS's Common Application for Placement of Children in Residential Child Care as the uniform assessment form and application for admission.

(d) General residential operations, residential treatment centers, independent foster family homes, independent foster group homes, SIL providers, Single Source Continuum Contractors, and child-placing agencies that receive payment from DFPS either directly or indirectly must submit cost reports in compliance with 1 TAC §355.7101 (relating to Cost Determination Process) and as specified in the entity's contract or agreement with DFPS. Failure to complete and submit a cost report is grounds for placing a hold on payments to the provider or for terminating the contract or agreement.

§700.332.Eligibility for Foster Care Day Care Services.

(a) In this subchapter, the following terms have the following meanings:

(1) "Day care" means the assessment, care, training, education, custody, treatment, or supervision of a foster child by a person other than the child's foster parent for less than 24 hours a day, but at least two hours a day, three or more days a week.

(2) "Emergency placement that is in the child's best interest" means that despite the exercise of reasonable diligence, compliance with the Department's verification process regarding the availability of community day care resources would interfere with a placement that is in the child's best interest.

(3) "School-aged child" means a child who has reached the age of 6 by September 1 of the current year or who enrolls in school and reaches the age of 6 during the school year.

(b) To the extent funds are available and in accordance with any priority system established under subsection (e) of this section, DFPS may provide day care for authorized purposes to a foster parent if:

(1) the child is 13 years or younger and either:

(A) placed in a foster family home or foster group home where each foster parent in the home works outside the home 40 hours per week or more; or

(B) the child of a parent who is a minor in foster care if the child:

(i) is not in the conservatorship of DFPS;

(ii) resides with the child's minor parent in a foster home where all caregivers are employed full-time;

(iii) receives primary care from the minor parent outside of school hours;

(iv) needs day care to allow the minor parent to remain in school and complete the minor parent's educational goals; and

(v) has a minor parent who is unable to access child care through a Texas Workforce Commission work or training program or through a school-based operation.

(2) the foster parent is a resident of Texas;

(3) the child's service level is basic or if placed in a T3C Basic Foster Family Home Service Package under the Texas Child-Centered (T3C) System;

(4) the child is in DFPS' managing conservatorship and not in an adoptive placement; and

(5) there is no other available type of day care provided by the community, and the foster parent verifies in writing that the foster parent has attempted to find appropriate day care services for the child through community services, including:

(A) Head Start programs;

(B) Prekindergarten classes;

(D) Any other available and appropriate resources in the foster parent's community.

(1) during the foster parents' work hours; or

(2) while the foster parents are attending judicial reviews, case conferences, or foster parent training.

(d) Day care for foster parents is not authorized for the following:

(1) full-time day care during school holidays;

(2) teacher in-service days;

(3) inclement-weather days;

(4) short breaks between semesters in a year-round school program;

(5) part-time care; or

(6) after-school care for school-aged children.

(e) To monitor the spending of funds, a priority system among foster parents will also be established in policy. The priority system will be based upon need, but at a minimum will require:

(1) a determination by DFPS that the provision of day care is critical to maintaining the placement of the child with the foster parent; and

(2) at least one child placed by DFPS:

(A) is under six years of age; or

(B) has a developmental delay (including physical, emotional, and cognitive or language) or physical disability.

(f) Notwithstanding any other provision of this section, if DFPS determines that requiring the written verification of a foster parent's attempts to find appropriate community day care services would prevent an emergency placement in the child's best interest, DFPS may waive the submission of the written verification of the foster parent's attempts. DFPS is authorized to require the submission of the written verification at any point following the initial authorization of day care services.

(g) The Associate Commissioner for Child Protective Services, the Associate Commissioner for Child Protective Investigations, or the Associate Commissioners' designees, may grant a good cause waiver of any of the requirements in subsection (b) or (d) of this section, if that person determines that:

(1) the placement cannot be sustained or is unlikely to be sustained if the foster parent cannot receive day care;

(2) there is no reasonable alternative to the provision of day care, such as a change in working hours; and

(3) day care services are only authorized in increments that are commensurate with the hours and days the foster parent and caregivers must be outside the home for employment.

(h) For a child who becomes ineligible during the term of a prior authorization, DFPS may in its discretion permit day care to continue through the end of the previously authorized period.

(i) DFPS pays for day care only in licensed child care centers and registered child care homes that are contracted through the local child care management service agency, unless care is self-arranged and DFPS gives prior approval to pay day care in the arrangement.

§700.334.Eligibility for Special Needs Foster Child Day Care Services.

(a) To the extent funds are available, DFPS may provide special needs foster child day care services for authorized purposes to a foster parent if the child:

(1) meets all eligibility requirements in §700.332 of this title (relating to Eligibility for Foster Care Day Care Services);

(2) is placed in a foster family or foster group home;

(3) has a billing service level of Basic or receives an approved waiver of the required basic service level through the regional day care coordinator or is placed in the T3C Basic Foster Family Home Service Package, under the Texas Child-Centered Care (T3C) System;

(4) is age 5 or younger;

(5) has been diagnosed by a professional as having a developmental delay, which is documented in the case record, in at least one of the following areas: physical, social, emotional, cognitive or language development; and

(6) has a service plan that specifies:

(A) the need for therapeutic or habilitative child day care; and

(B) how therapeutic child day care will meet specific needs related to the child's developmental delays that cannot be met by the foster parents.

(b) DFPS pays for special needs foster child day care only in licensed child-care centers and registered child-care homes that are contracted through the local child care management service agency, provide services beyond basic supervision, and are certified to provide care for children with special needs.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on September 23, 2024.

TRD-202404575

Quyona Gregg

Senior Policy Attorney

Department of Family and Protective Services

Earliest possible date of adoption: November 10, 2024

For further information, please call: (512) 929-6633

SUBCHAPTER E. TEXAS CHILD-CENTERED CARE SYSTEM SERVICE PACKAGES

DIVISION 1. BASIC FOSTER FAMILY HOME SUPPORT SERVICE PACKAGES

40 TAC §§700.501 - 700.512

STATUTORY AUTHORITY

The proposed new rules implement the General Appropriations Act, Senate Bill 1, Regular Session 2021 (Article II, Special Provisions Related to All Health and Human Services Agencies, Section 26).

§700.501.What is T3C Basic Foster Family Home Support Service Package?

(a) A trauma-informed foster family home that provides a child's basic living needs, including food, clothing, shelter, education, vocation, transportation, recreation, and extracurricular needs, which may vary based on age and developmental level.

(b) This Service Package is designed to offer community-based care for children, youth, and young adults based on their individual strengths and needs, and in accordance with their customized Service Plan and permanency goal.

(c) Child Placing Agencies and Foster Family Home Caregivers must be Credentialed to provide T3C Basic Foster Family Home Support Services in accordance with the guidelines and requirements as defined by the Department of Family and Protective Services pursuant to Chapter 40 of the Texas Human Resources Code.

§700.502.What is the Substance Use Support Services Package?

(a) A trauma-informed foster family home that in addition to providing a child's basic living needs, has enhanced training and skill in coordinating services and providing care for children, youth, and young adults that may present with a DSM diagnosis of substance-related disorder or with challenges with recurring substance use, and who require routine clinical intervention to support and manage day-to-day activities.

(b) This Service Package is designed to offer community-based care and treatment/recovery services for children, youth, and young adults based on their individual strengths and needs, and in accordance with their customized Service Plan and permanency goals.

(c) Child Placing Agencies and Foster Family Home Caregivers must be Credentialed to provide Substance Use Support Services in accordance with the guidelines and requirements as defined by the Department of Family and Protective Services pursuant to Chapter 40 of the Texas Human Resources Code.

§700.503.What is the Short-Term Assessment Support Services Package?

(a) A trauma-informed foster home that in addition to providing a child's basic living needs, provides short-term coordination of comprehensive assessments and evaluations for children, youth, and young adults who are in need of further assessment(s) and evaluation (s) to identify an appropriate Service Package and subsequent placement, who may present as:

(1) New to care, or transitioning from an unpaid placement, and where more information is needed to understand the child's custom service need(s); or

(2) Returning to foster care after an unauthorized absence or unauthorized placement; or

(3) Transitioning based on a recent, un-planned, disruption in placement..

(b) This Service Package is designed to offer community-based care, assessment, and treatment services for children, youth and young adults based on their individual strengths and needs, and in accordance with their customized Service Plan and permanency goal. This Service Package is not eligible for Add-On Services and is time-limited.

(c) Child Placing Agency and Foster Family Home Caregivers must be Credentialed to provide the Short-Term Assessment Support Services in accordance with the guidelines and requirements as defined by the Department of Family and Protective Services pursuant to Chapter 40 of the Texas Human Resources Code.

§700.504.What is the Mental & Behavioral Health Support Services Package?

(a) A trauma-informed foster home that in addition to providing a child's basic living needs, has enhanced training and skill in providing and coordinating services to children, youth, and young adults that may present with a DSM diagnosis for emotional, conduct, or behavioral disorder(s), and for whom routine clinical intervention (therapy, education, and/or medication) is needed to support and manage day-to-day activities.

(c) Child Placing Agencies and Foster Family Home Caregivers must be Credentialed to provide Mental & Behavioral Health Support Services in accordance with the guidelines and requirements as defined by the Department of Family and Protective Services pursuant to Chapter 40 of the Texas Human Resources Code.

§700.505.What is the Sexual Aggression/Sex Offender Support Services Package?

(a) A trauma-informed foster home that in addition to providing a child's basic living needs, has enhanced training and skill in providing and coordinating services to treat and support children, youth, and young adults who require routine clinical intervention and skilled caregiver support to manage day-to-day activities, who may present with one or more of the following:

(1) Ongoing, socially, and developmentally inappropriate displays of sexualized behavior; or

(2) Sexually aggressive behavior; or

(3) DSM diagnosis of a sexual behavior disorder; or

(4) Adjudication as a sexual offender.

(c) Child Placing Agencies and Foster Family Home Caregivers must be Credentialed to provide Sexual Aggression/Sex Offender Support Services in accordance with the guidelines and requirements as defined by the Department of Family and Protective Services pursuant to Chapter 40 of the Texas Human Resources Code.

§700.506.What is the Complex Medical Needs or Medically Fragile Support Services Package?

(a) A trauma-informed foster home that in addition to providing a child's basic living needs, has enhanced training and skill in providing and coordinating services to care for and support children, youth, and young adults who may present with a medical diagnosis that requires constant monitoring, access to skilled nursing and other care up to 24 hours a day/7 days a week (based on eligibility), or who may present with a complex medical need such as uncontrolled diabetes, and for whom the individual's well-being depends on the support, direction, or service of others.

(b) This Service Package is designed to offer community-based care, medical, and other therapy/rehabilitation services to support recovery (if applicable), well-being, and improve the quality of life for children, youth, and young adults, based on their individual strengths and needs, and in accordance with their customized Service Plan and permanency goal.

(c) Child Placing Agencies and Foster Family Home Caregivers must be Credentialed to provide Complex Medical Needs or Medically Fragile Support Services in accordance with the guidelines and requirements as defined by the Department of Family and Protective Services pursuant to Chapter 40 of the Texas Human Resources Code.

§700.507.What is Human Trafficking Victim/Survivor Support Service Package?

(a) A trauma-informed foster home that in addition to providing a child's basic living needs, has enhanced training and skill in providing and coordinating services to support children, youth, and young adults who present as suspected-unconfirmed or confirmed victims/survivors of sex and/or labor trafficking and who require routine clinical intervention to support and manage day-to-day activities.

(c) Child Placing Agencies and Foster Family Home Caregivers must be Credentialed to provide Human Trafficking Victim/Survivor Support Service in accordance with the guidelines and requirements as defined by the Department of Family and Protective Services pursuant to Chapter 40 of the Texas Human Resources Code.

§700.508.What is Intellectual or Developmental Disability (IDD)/Autism Spectrum Disorder Support Service Package?

(a) A trauma-informed foster home that in addition to providing a child's basic living needs, has enhanced training and skill in providing and coordinating services to care for and support children, youth, and young adults who may present with or who are pending a DSM diagnosis for Intellectual or Developmental Disability and/or Autism Spectrum Disorder, and who require routine clinical intervention and structure to support and manage day-to-day activities.

(b) This Service Package is designed to offer community-based care, therapy, and other rehabilitation services that promote development, independence, and improve life skills for children, youth, and young adults based on their individual strengths and needs, and in accordance with their customized Service Plan and permanency goal.

(c) Child Placing Agencies and Foster Family Home Caregivers must be Credentialed to provide Intellectual or Developmental Disability (IDD)/Autism Spectrum Disorder Support Services in accordance with the guidelines and requirements as defined by the Department of Family and Protective Services pursuant to Chapter 40 of the Texas Human Resources Code.

§700.509.What is T3C Treatment Foster Family Care Support Service Package?

(a) A trauma-informed, highly-structured foster home that in addition to providing a child's basic living needs, has highly-trained Foster Family Home Caregivers with skill in providing time-limited, strength-based therapeutic services to children, youth, and young adults who may present with a DSM diagnosis for an emotional, conduct, or behavioral disorder and for whom structured and frequent clinical intervention and complex case management is needed to support and manage day-to-day activities.

(b) In addition to the DSM diagnosis for an emotional disorder, the child may demonstrate two or more of the following:

(1) Major self-injurious actions, including a suicide attempt within the last 12 months;

(2) Difficulties that present a significant risk of harm to others, including frequent or unpredictable physical aggression; or

(3) An additional DSM diagnosis of substance-related and/or addictive disorder with severe impairment.

(c) The T3C Treatment Foster Family Care Support Services Package require the highest level of clinical intervention offered in a family setting to perform day-to-day activities.

(d) This Service Package is designed to offer community-based care and treatment/recovery services for children, youth, and young adults based on their individual strengths and needs, and in accordance with their customized Service Plan and permanency goal.

(e) Child Placing Agencies and Foster Family Home Caregivers must be Credentialed to provide T3C Treatment Foster Family Care Support Service in accordance with the guidelines and requirements as defined by the Department of Family and Protective Services pursuant to Chapter 40 of the Texas Human Resources Code.

§700.510.What is the Transition Support Services for Youth and Young Adults Add-On?

In addition to the youth or young adult's primary Service Package, this is a trauma-informed foster home with enhanced training and skill in caring for, coordinating services, assisting in completion of forms/referrals, and supporting experiential learning opportunities for youth and young adults ages 14-22 years old. The Transitional Support Services for Youth & Young Adults Add-On Service is intended to support the youth and young adult's transition to independence and adulthood.

§700.511.What is the Kinship Caregiver Support Services Add-On?

In addition to the child, youth, or young adult's primary Service Package, the Child Placing Agency provides enhanced support services to the Kinship Foster Family Home Caregivers. These support services should be customized to the needs of the Kinship Caregivers and the child, youth, or young adult living in the Kinship Foster Family Home. A portion of the funding to support this Add-On Service is intended to reimburse the Child Placing Agency for costs incurred to support the Kinship Caregivers through the foster home verification process.

§700.512.What is the Pregnant & Parenting Youth or Young Adult Support Services Add-On?

In addition to the youth or young adult's primary Service Package being offered through the Child Placing Agency, this Add-On Service is offered in a trauma-informed foster home that has enhanced training and skill in caring for, mentoring/coaching, and offering support services for youth who are pregnant or actively parenting their biological child(ren). Pregnant & Parenting Youth or Young Adult Support Services may be offered to the mother or the father, so long as the youth or young adult receiving the Add-On Service has their biological child placed with them and are residing in a Credentialed foster home.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on September 23, 2024.

TRD-202404576

Quyona Gregg

Senior Policy Attorney

Department of Family and Protective Services

Earliest possible date of adoption: November 10, 2024

For further information, please call: (512) 929-6633

DIVISION 2. GENERAL RESIDENITIAL OPERATION TIER I AND TIER II SUPPORT SERVICE PACKAGES

40 TAC §§700.513 - 700.528

STATUTORY AUTHORITY

The proposed new rules implement the General Appropriations Act, Senate Bill 1, Regular Session 2021 (Article II, Special Provisions Related to All Health and Human Services Agencies, Section 26).

§700.513.General Residential Operations - Tier T3C Treatment/Transition Service Packages.

Information contained in the rules in this Division 2, GENERAL RESIDENITIAL OPERATION TIER I AND TIER II SUPPORT SERVICE PACKAGES, outline the parameters/requirements associated with the Tier I Service Packages. The incorporation of these parameters and or requirements are consistent with or may exceed the state's Minimum Licensing Standards for a General Residential Operation and are not intended to change the existing character of the childcare operation. Providers may elect to become Credentialed to provide more than one T3C Service Package in a General Residential Operation Tier I or a Tier II setting.

§700.514.What is Tier I: T3C Basic Child Care Operation Package?

(a) A trauma-informed facility or cottage home that provides a child's basic living needs, including food, shelter, education, vocation, transportation, recreation, and extracurricular activities which may vary based on age and developmental level.

(b) This Service Package is designed to offer temporary facility-based, or cottage-home care for children, youth, and young adults based on their individual strengths and needs, and in accordance with their customized Service Plan and permanency goal.

(c) The Operation and Direct Care Staff must be Credentialed to provide Tier I: T3C Basic Child Care Operation Services in accordance with the guidelines and requirements as defined by the Department of Family and Protective Services pursuant to Chapter 40 of the Texas Human Resources Code.

§700.515.What is Tier I: Services to Support Community Transition for Youth & Young Adults who are Pregnant or Parenting Package?

(a) A trauma-informed facility, that in addition to providing for a youth, young adult, and their child's (if applicable) basic living needs, has enhanced training and expertise in caring for, mentoring/coaching, and providing/coordinating time-limited services to support the needs of youth and young adults who are pregnant or actively parenting their own biological child(ren). This Service Package may be offered to the mother and/or the father.

(b) This Service Package is designed to offer temporary, facility-based care, complex care coordination and case management, and therapeutic/skill-building services for youth and young adults based on their individual strengths and needs, and in accordance with their customized Service Plan and permanency goal.

(c) The Operation and Direct Care Staff must be Credentialed to provide Tier I: Services to Support Community Transition for Youth & Young Adults who are Pregnant or Parenting in accordance with the guidelines and requirements as defined by the Department of Family and Protective Services pursuant to Chapter 40 of the Texas Human Resources Code.

§700.516.What is Tier I: Sexual Aggression/Sex Offender Treatment Services to Support Community Transition Package?

(a) A trauma-informed facility, that in addition to providing a child's basic living needs, has a formal treatment program that specializes in providing and coordinating time-limited services to support the custom needs of children, youth, and young adults who requires structured and frequent on-site, clinical intervention by professionals with experience in serving this population, complex case management, and skilled and well-trained Caregivers to manage day-to-day activities, who present with one or more of the following:

(1) Ongoing, socially, and developmentally inappropriate displays of sexualized behavior; or

(2) Sexually aggressive behavior; or

(3) DSM diagnosis of a sexual behavior disorder; or

(4) Adjudication as a sex offender.

(b) In addition to the criteria listed above, children, youth, and young adults requiring Tier I: Sexual Aggression/Sex Offender Treatment Services to Support Community Transition Service Package, often present with a DSM diagnosis for an emotional disorder, and two or more of the following (which, if applicable, the General Residential Operation must be equipped to treat based on the custom needs of the child, youth, or young adult):

(1) Major self-injurious actions, including a suicide attempt within the last 12 months;

(2) Difficulties that present a significant risk of harm to others, including frequent or unpredictable physical aggression; or

(3) An additional DSM diagnosis of substance-related and/or addictive disorder with severe impairment.

(c) This Service Package is designed to offer temporary, facility-based care, complex care coordination and case management, and therapeutic/skill-building services for youth and young adults based on their individual strengths and needs, and in accordance with their customized Service Plan and permanency goal.

(d) The Operation and Direct Care Staff must be Credentialed to provide Tier I: Sexual Aggression/Sex Offender Treatment Services in accordance with the guidelines and requirements as defined by the Department of Family and Protective Services pursuant to Chapter 40 of the Texas Human Resources Code.

§700.517.What is Tier I: Substance Use Treatment Services to Support Community Transition Package?

(a) A trauma-informed facility, that in addition to providing a child's basic living needs, has a formal treatment program that specializes in providing and coordinating time-limited services to support the custom needs of children, youth, and young adults who may present with or who are pending a DSM diagnosis for a substance related and/or addictive disorder causing severe impairment, and who require structured and frequent, on-site, clinical intervention, and complex care coordination and case management to support and manage day-to-day activities.

(c) The Operation and Direct Care Staff must be Credentialed to provide Tier I: Substance Use Treatment Services in accordance with the guidelines and requirements as defined by the Department of Family and Protective Services pursuant to Chapter 40 of the Texas Human Resources Code.

§700.518.What is Tier I: Emergency Emotional Support & Assessment Center Package?

(a) A trauma-informed facility, that in addition to providing a child's basic living needs, has a formal emotional support and assessment program that specializes in providing time-limited services to support the custom needs of children, youth, and young adults who are in need of further assessment(s) and evaluation(s) to identify an appropriate Service Package and subsequent placement, who present as:

(1) New to care, or transitioning from an unpaid placement, with suspected but unconfirmed, or confirmed behavioral health need(s); or

(2) Transitioning after a stay in a psychiatric hospital; or

(3) Returning to foster care after an unauthorized absence, or unauthorized placement, with a suspected but unconfirmed, or confirmed behavioral health need(s); or

(4) Transitioning based on a recent, un-planned disruption in placement, where a suspected but unconfirmed, or confirmed behavioral health need(s) was a factor contributing to the disruption.

(c) The Operation and Direct Care Staff must be Credentialed to provide Tier I: Emergency Emotional Support & Assessment Center Services in accordance with the guidelines and requirements as defined by the Department of Family and Protective Services pursuant to Chapter 40 of the Texas Human Resources Code.

§700.519.What is Tier I: Complex Medical Needs Treatment to Support Community Transition Package?

(a) A trauma-informed facility, that in addition to providing a child's basic living needs, has a formal treatment/therapeutic program that specializes in providing a holistic, comprehensive array of medical and therapeutic supports, services, and enhanced care coordination, complex case management, and on-site access to care.

(b) This time-limited service is designed for children, youth, and young adults that present with complex medical conditions, which may include uncontrolled diabetes with a documented history of non-compliance with medication management, or who may present with a medical diagnosis and who may not be able to live without mechanical supports or the services of others because of life threatening conditions, including:

(1) The inability to maintain an open airway without assistance;

(2) The inability to be fed except through a feeding tube, gastric tube, or a parenteral route;

(3) The use of sterile techniques or specialized procedures to promote healing, prevent infection, prevent cross-infection or contamination, or prevent tissue breakdown; or

(4) Multiple physical disabilities including sensory impairments.

(c) This Service Package is designed to offer temporary, facility-based care, medical, and other therapy/rehabilitation services to support recovery (if applicable) and well-being and improve the quality of life for youth and young adults based on their individual strengths and needs, and in accordance with their customized Service Plan and permanency goal.

(d) The Operation and Direct Care Staff must be Credentialed to provide Tier I: Complex Medical Needs Treatment Services in accordance with the guidelines and requirements as defined by the Department of Family and Protective Services pursuant to Chapter 40 of the Texas Human Resources Code.

§700.520.What is Tier I: Mental & Behavioral Health Treatment Services to Support Community Transition Package?

(a) A trauma-informed facility, that in addition to providing a child's basic living needs, has a formal treatment program that specializes in providing and coordinating time-limited services to support the custom needs of children, youth, and young adults who may present with or who are pending a DSM diagnosis for an emotional, conduct, or behavioral disorder, and require structured and frequent, on-site, clinical intervention require structured and frequent, on-site therapy and clinical intervention, and complex care coordination and case management services to support and manage day-to-day activities.

(b) In addition to the DSM diagnosis, the child may demonstrate two or more of the following:

(1) Major self-injurious actions, including a suicide attempt within the last 12 months;

(2) Difficulties that present a significant risk of harm to others, including frequent or unpredictable physical aggression; or

(3) An additional DSM diagnosis of substance-related and/or addictive disorder with severe impairment.

(c) This Service Package is designed to offer temporary, facility-based care and treatment/recovery services for children, youth, and young adults based on their individual strengths and needs, and in accordance with their customized Service Plan and permanency goal.

(d) The Operation and Direct Care Staff must be Credentialed to provide Tier I: Mental & Behavioral Health Treatment Services in accordance with the guidelines and requirements as defined by the Department of Family and Protective Services pursuant to Chapter 40 of the Texas Human Resources Code.

§700.521.What is Tier I: Intellectual or Developmental Disability (IDD)/Autism Spectrum Disorder Treatment Services to Support Community Transition Package?

(a) Trauma-informed facility, that in addition to providing a child's basic living needs, has a formal treatment/therapeutic program that specializes in providing and coordinating time-limited services to support the custom needs of children, youth, and young adults who may present with or who are pending a DSM diagnosis of Intellectual or Developmental Disability (IDD) and/or Autism Spectrum Disorder, and who require structured and frequent, on-site therapy and clinical intervention, and complex care coordination and case management services to support and manage day-to-day activities.

(b) In addition, for children with a DSM diagnosis for Intellectual or Developmental Disability, and/or a DSM diagnosis for Autism Spectrum Disorder, the child's behavior may be characterized by prominent, severe deficits and pervasive impairment in one or more of the following areas:

(1) Conceptual, social, and practical adaptive skills to include daily living and self-care;

(2) Communication, cognition, or expressions of affect;

(3) Self-care activities or participation in social activities;

(4) Responding appropriately to an emergency; or

(5) Multiple physical disabilities, including sensory impairments.

(c) This Service Package is designed to offer temporary, facility-based care, therapy, and other services that promote development, independence, and improved life skills for children, youth, and young adults based on their individual strengths and needs, and in accordance with their customized Service Plan and permanency goal.

(d) The Operation and Direct Care Staff must be Credentialed to provide Tier I: Intellectual or Developmental Disability (IDD)/Autism Spectrum Disorder Treatment Services in accordance with the guidelines and requirements as defined by the Texas Department of Family and Protective Services pursuant to Chapter 40 of the Texas Human Resources Code.

§700.522.What is Tier I: Human Trafficking Victim/Survivor Treatment Services to Support Community Transition Package?

(a) A trauma-informed facility, that in addition to providing a child's basic living needs, has a formal treatment program that specializes in providing and coordinating time-limited services to support the custom needs of children, youth, and young adults who have been determined to be a victim/survivor of sex and/or labor trafficking, and require structured and frequent, on-site, clinical intervention require structured and frequent, on-site therapy and clinical intervention, and complex care coordination and case management services to support and manage day-to-day activities.

(b) Children, youth, and young adults qualifying for this service may be determined to be a victim/survivor of trafficking based on one or more of the following criteria:

(1) As a result of a criminal prosecution or who is currently alleged to be a victim/survivor of trafficking in a pending criminal investigation or prosecution.

(2) Identified by the parent or agency that placed the child, youth, or young adult in the operation as a victim/survivor of trafficking; or

(3) Determined by the operation to be a victim/survivor of trafficking based on reasonably reliable criteria, including one or more of the following:

(A) The child's own disclosure as a victim/survivor of trafficking;

(B) The assessment of a counselor or other professional; or

(C) Evidence that the child was recruited, harbored, transported, provided to another person, or obtained for the purpose of forced labor or commercial sexual activity.

(d) The Operation and Direct Care Staff must be Credentialed to provide Tier I: Human Trafficking Victim/Survivor Treatment Services in accordance with the guidelines and requirements as defined by the Department of Family and Protective Services pursuant to Chapter 40 of the Texas Human Resources Code.

§700.523.What is Tier II: Sexual Aggression/Sex Offender Services to Support Stabilization Package?

(a) A highly structured, trauma-informed facility that, in addition to providing a child's basic living needs, has an intensive treatment program that specializes in providing and coordinating time-limited services to support the emotional stability, well-being, and therapeutic needs of children, youth, and young adults, for whom other forms of specialized treatment have been tried and rendered unsuccessful, and/or treatment in a less-restrictive setting such as in a Foster Family Home or General Residential Operation- Tier I facility is not safe and appropriate based on individualized need(s) and absent the Tier II intervention, the child, youth, or young adult's well-being, or that of others they interact with, may be at risk and who are experiencing challenges with a lack of impulse control, and may present with one or more of the following:

(1) Ongoing, socially, and developmentally inappropriate displays of sexualized behavior; or

(2) Sexually aggressive behavior; or

(3) DSM diagnosis of a sexual behavior disorder; or

(4) Adjudication as a sex offender.

(b) In addition to the criteria listed above, children, youth, and young adults requiring Tier II: Sexual Aggression/Sexual Offender Services to Support Stabilization Service Package may present with a DSM-5 diagnosis for an emotional, conduct, or behavioral disorder, and two or more of the following (which, if applicable, the General Residential Operation offering this Service Package must be equipped to treat based on the custom needs of the child, youth, or young adult):

(1) Major self-injurious actions, including a suicide attempt within the last 12 months;

(2) Difficulties that present a significant risk of harm to others, including frequent or unpredictable physical aggression; or

(3) An additional DSM- diagnosis of substance-related and/or addictive disorder with severe impairment.

(c) This Service Package is designed to offer temporary, facility-based care, for children, youth, and young adults based on their individual strengths and needs, with the overall goal of achieving emotional and behavioral stability to the level that successful transition to a less restrictive placement offering treatment and recovery services can be achieved.

(d) The Operation and Direct Care Staff must be Credentialed to provide Tier II: Sexual Aggression/Sex Offender Services in accordance with the guidelines and requirements as defined by the Department of Family and Protective Services pursuant to Chapter 40 of the Texas Human Resources Code.

§700.524.What is Tier II: Substance Use Services to Support stabilization Package?

(a) A highly structured, trauma-informed facility that, in addition to providing a child's basic living needs, including food, clothing, shelter, education, vocation, transportation, recreation, and extracurricular needs, has an intensive treatment program that specializes in providing and coordinating time-limited services to support the emotional stability, well-being, and therapeutic needs of children, youth, and young adults, for whom other forms of specialized substance use and addictive disorder treatment have been tried and rendered unsuccessful, and/or treatment in a less-restrictive setting such as a Foster Family Home or General Residential Operation- Tier I facility is not safe and appropriate based on individualized needs and absent the Tier II intervention, the child, youth, or young adult's well-being, or that of others they interact with, may be at risk and who are experiencing challenges with a lack of impulse control, and have or are pending a DSM diagnosis for a substance related and/or addictive disorder with severe impairment.

(b) In addition to the DSM diagnoses for a substance related and/or addictive disorder with severe impairment, the child, youth, or young adult may demonstrate one of the following:

(1) Major self-injurious actions, including a suicide attempt within the last 12 months; or

(2) Difficulties that present a significant risk of harm to others, including frequent or unpredictable physical aggression.

(d) The Operation and Direct Care Staff must be Credentialed to provide Tier II: Substance Use Services in accordance with the guidelines and requirements as defined by the Department of Family and Protective Services pursuant to Chapter 40 of the Texas Human Resources Code.

§700.525.What is Tier II: Aggression/Defiance Disorder Services to Support Stabilization Package?

(a) A highly structured, trauma-informed facility that, in addition to providing a child's basic living needs, has an intensive treatment program that specializes in providing and coordinating time-limited services to support the emotional stability, well-being, and therapeutic needs of children, youth, and young adults, for whom other forms of specialized treatment have been tried and rendered unsuccessful, and/or treatment in a less-restrictive setting such as in a Foster Family Home or General Residential Operation- Tier I facility is not safe and appropriate based on individualized needs and absent the Tier II intervention, the child, youth, or young adult's well-being, or that of others they interact with, may be at risk, and who are experiencing challenges with a lack of impulse control, and may present with or are pending a DSM diagnosis of Oppositional Defiant Disorder or other Conduct Disorder, and may present with two or more of the following:

(1) Severe and chronic challenges in school, with peers, and/or in other social settings; or

(2) Severe and chronic challenges with authority and following rules (beyond what would be considered age-appropriate behavior); or

(3) Recurring delinquent behaviors which may have resulted in juvenile justice or law enforcement involvement; or

(4) Major self-injurious actions, including a suicide attempt within the last 12 months; or

(5) Difficulties that present a significant risk of harm to others, including frequent or unpredictable violence or physical aggression; or

(6) An additional DSM diagnosis of substance-related and/or addictive disorder with severe impairment.

(b) This Service Package is designed to offer temporary, facility-based care, for children, youth, and young adults based on their individual strengths and needs, with the overall goal of achieving emotional and behavioral stability to the level that successful transition to a less restrictive placement offering treatment and recovery services can be achieved.

(c) The Operation and Direct Care Staff must be Credentialed to provide Tier II: Aggression/Defiance Disorder Services in accordance with the guidelines and requirements as defined by the Texas Department of Family and Protective Services pursuant to Chapter 40 of the Texas Human Resources Code.

§700.526.What is Tier II: Complex Mental Health Services to Support Stabilization Package?

(a) A highly structured, trauma-informed facility that, in addition to providing a child's basic living needs, has an intensive treatment program that specializes in providing and coordinating time-limited services to support the emotional stability, well-being, and therapeutic needs of children, youth, and young adults, for whom other forms of specialized treatment have been tried and rendered unsuccessful, and/or treatment in a less-restrictive setting such as a Foster Family Home or General Residential Operation- Tier I facility is not safe and appropriate based on individualized needs and absent the Tier II intervention, the child, youth, or young adult's well-being, or that of others they interact with, may be at risk, and who are experiencing challenges with a lack of impulse control, and present with or are pending multiple, co-occurring DSM diagnoses for emotional, behavioral, neurological, and/or developmental disorder(s).

(b) In addition to the co-occurring DSM diagnoses, the child, youth, or young adult may demonstrate two or more of the following:

(1) Major self-injurious actions, including a suicide attempt within the last 12 months; or

(2) Difficulties that present a significant risk of harm to others, including frequent or unpredictable physical aggression; or

(3) An additional DSM diagnosis of substance-related and/or addictive disorder with severe impairment; and

(4) If one of the co-occurring DSM diagnoses is for Intellectual or Developmental Disability or Autism Spectrum Disorder, the child's behavior is characterized by prominent, severe deficits and pervasive impairment in one or more of the following areas (of development if diagnosis is Autism Spectrum Disorder):

(A) Conceptual, social, and practical adaptive skills to include daily living and self-care;

(B) Communication, cognition, or expressions of affect;

(D) Responding appropriately to an emergency; or

(E) Multiple physical disabilities, including sensory impairments.

(d) The Operation and Direct Care Staff must be Credentialed to provide Tier II: Complex Mental Health Services in accordance with the guidelines and requirements as defined by the Department of Family and Protective Services pursuant to Chapter 40 of the Texas Human Resources Code.

§700.527.What is Tier II: Complex Medical Services to Support Stabilization Package?

(a) A highly structured, trauma-informed facility that, in addition to providing a child's basic living needs, has an intensive treatment program that specializes in providing a holistic and comprehensive array of medical and behavioral health services and therapeutic supports for children, youth, and young adults that may present with a complex medical diagnosis that is defined as either one or more diagnoses that affect multiple organ systems, or one long-term health condition that results in functional limitations, high health care needs or utilization, and often the need for medical technology, and that may have a dual DSM diagnosis for an emotional, behavioral, neurological, and/or developmental disorder(s), that may include one or more of the following:

(1) Major self-injurious actions, including a suicide attempt within the last 12 months; or

(2) Difficulties that present a significant risk of harm to others, including frequent or unpredictable physical aggression; and

(3) If the one of the DSM diagnoses is for Intellectual or Developmental Disability or Autism Spectrum Disorder, the child's behavior is characterized by prominent, severe deficits and pervasive impairment in one or more of the following areas (of development if diagnosis is Autism Spectrum Disorder):

(A) Conceptual, social, and practical adaptive skills to include daily living and self-care;

(B) Communication, cognition, or expressions of affect;

(D) Responding appropriately to an emergency; or

(E) Multiple physical disabilities, including sensory impairments.

(b) In addition to the DSM diagnosis, children, youth, and young adults requiring the Tier II: Complex Medical Services to Support Stabilization may present with a medical diagnosis that requires the use of mechanical supports or services of others because of life threatening conditions, including:

(1) The inability to maintain an open airway without assistance;

(2) The inability to be fed except through a feeding tube, gastric tube, or a parenteral route;

(3) The use of sterile techniques or specialized procedures to promote healing, prevent infection, prevent cross-infection or contamination, or prevent tissue breakdown; or

(4) Multiple disabilities including sensory impairments.

(c) To qualify for Tier II: Complex Medical Services to Support Stabilization, the child must have a medical diagnosis as determined by a Physician, and have a qualifying DSM diagnosis, and present with needs that cannot be met in a less-restrictive setting such as a Foster Family Home or General Residential Operation- Tier I facility because it is not safe and appropriate based on individualized needs.

(d) This Service Package is designed to offer temporary, facility-based care, for children, youth, and young adults based on their individual strengths and needs, with the overall goal of achieving medical, emotional, and behavioral stability to the level that successful transition to a less restrictive placement offering treatment and recovery services can be achieved.

(e) The Operation and Direct Care Staff must be Credentialed to provide Tier II: Complex Medical Services in accordance with the guidelines and requirements as defined by the Department of Family and Protective Services pursuant to Chapter 40 of the Texas Human Resources Code.

§700.528.What is Tier II: Human Trafficking Victim/Survivor Services to Support Stabilization Package?

(b) Children, youth, and young adults qualifying for this service may be determined to be a victim/survivor of trafficking based on one or more of the following criteria:

(1) As a result of a criminal prosecution or who is currently alleged to be a victim/survivor of trafficking in a pending criminal investigation or prosecution;

(2) Identified by the parent or agency that placed the child, youth, or young adult in the operation as a victim/survivor of trafficking; or

(3) Determined by the operation to be a victim/survivor of trafficking based on reasonably reliable criteria, including one or more of the following:

(A) The child's own disclosure as a victim/survivor of trafficking;

(B) The assessment of a counselor or other professional; or

(C) Evidence that the child was recruited, harbored, transported, provided to another person, or obtained for the purpose of forced labor or commercial sexual activity.

(c) In addition to the determination of status as a victim/survivor of trafficking, and having a qualifying DSM diagnosis, the child, youth, or young adult, for whom other forms of specialized treatment have been tried and rendered unsuccessful, and/or treatment in a less-restrictive setting such as a Foster Family Home or General Residential Operation- Tier I facility is not safe and appropriate based on individualized needs and absent the Tier II intervention, the child, youth, or young adult's well-being, or that of others they interact with, may be at risk, and may demonstrate two or more of the following:

(1) Severe and chronic challenges in school, with peers, and/or in other social settings; or

(2) Severe and chronic challenges with authority and following rules (beyond what would be considered age-appropriate behavior); or

(3) Recurring delinquent behaviors which may have resulted in juvenile justice or law enforcement involvement; or

(4) Major self-injurious actions, including a suicide attempt within the last 12 months; or

(5) Difficulties that present a significant risk of harm to others, including frequent or unpredictable violence or physical aggression; or

(6) Substance-related issues or a pending diagnosis for an addictive disorder; or

(7) If DSM diagnosis is for an Intellectual or Developmental Disability or Autism Spectrum Disorder, the child's behavior is characterized by prominent, severe deficits and pervasive impairment in one or more of the following areas (of development if diagnosis is Autism Spectrum Disorder):

(A) Conceptual, social, and practical adaptive skills to include daily living and self-care;

(B) Communication, cognition, or expressions of affect;

(D) Responding appropriately to an emergency; or

(E) Multiple physical disabilities, including sensory impairments.

(d) This Service Package is designed to offer temporary, facility-based care, for children, youth, and young adults based on their individual strengths and needs, with the overall goal of achieving emotional and behavioral stability to the level that successful transition to a less restrictive placement offering treatment and recovery services can be achieved.

(e) The Operation and Direct Care Staff must be Credentialed to provide Tier II: Human Trafficking Victim/Survivor Services in accordance with the guidelines and requirements as defined by the Department of Family and Protective Services pursuant to Chapter 40 of the Texas Human Resources Code.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on September 23, 2024.

TRD-202404577

Quyona Gregg

Senior Policy Attorney

Department of Family and Protective Services

Earliest possible date of adoption: November 10, 2024

For further information, please call: (512) 929-6633

SUBCHAPTER H. ADOPTION ASSISTANCE PROGRAM

DIVISION 3. APPLICATION PROCESS, AGREEMENTS, AND BENEFITS

40 TAC §700.844

STATUTORY AUTHORITY

§700.844.How are monthly payment amounts determined?

(a) The following factors are considered and discussed in negotiating and determining benefits:

(1) We evaluate your child's present need for services in relation to your family's income, expenses, circumstances, and plans for the future.

(2) Benefits are intended only to assist in meeting your child's needs and your parental responsibilities.

(3) Any and all sources of income and support that are specifically designated for the child (such as Retirement, Survivors, Disability Insurance (RSDI) or Veterans Administration (VA) benefits) must be applied toward meeting the child's needs.

(4) We do not consider costs associated with your choice to meet the child's needs through private sources when those needs can be met through other publicly funded sources.

(5) If the child needs special services not covered by your private insurance or Texas Medicaid, we must determine the actual cost of services available to meet those needs. If actual costs are not available, we determine a reasonable estimate of projected costs.

(b) There is a limit to the amount of a monthly payment that you can negotiate. You are informed of the maximum monthly payment amount that you can negotiate at the time of your application for adoption assistance.

(1) an increase in your adoption assistance payment amount; or

(2) an appeal regarding the payment amount.

(d) The maximum monthly payment amount depends upon the child's authorized service level (or level of care) at the beginning of the adoptive placement. The payment ceiling for Basic care is $400 per month; the payment ceiling for Moderate, Specialized, and Intense care is $545 per month.

(e) Under the Texas Child-Centered Care (T3C) System, the maximum monthly payment depends on the child's recommended service package at the beginning of the adoptive placement. The payment ceiling for a child who is placed in the T3C Basic Foster Family Support Services is $400 per month; the payment ceiling for a child placed in any other Service Package is $545 per month.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on September 23, 2024.

TRD-202404578

Quyona Gregg

Senior Policy Attorney

Department of Family and Protective Services

Earliest possible date of adoption: November 10, 2024

For further information, please call: (512) 929-6633

SUBCHAPTER J. ASSISTANCE PROGRAMS FOR RELATIVES AND OTHER CAREGIVERS

DIVISION 2. PERMANENCY CARE ASSISTANCE PROGRAM

40 TAC §700.1039

STATUTORY AUTHORITY

§700.1039.What is the amount of monthly payments that a permanent kinship conservator may receive under a permanency care assistance agreement?

(a) The amount of monthly payments that will be paid to a permanent kinship conservator will be negotiated between DFPS and the prospective permanent kinship conservator prior to the signing of the permanency care assistance agreement, based on the criteria specified in subsection (b) of this section, subject to the maximum monthly payment amounts specified in subsection (c) of this section. These amounts may be periodically re-negotiated as circumstances change.

(b) The following factors are considered when negotiating the amount of monthly permanency care assistance payments to be made:

(1) the child's present need for services will be assessed in relation to the permanent kinship conservator's income, expenses, circumstances, and plans for the future;

(2) benefits are intended only to assist the permanent kinship conservator in meeting the child's needs and the permanent kinship conservator's responsibilities for meeting those needs;

(3) any and all sources of income and support that are specifically designated for the child (such as Retirement, Survivors, Disability Insurance (RSDI) or Veterans Administration (VA) benefits) must be applied toward meeting the child's needs;

(4) whether a publicly funded source may be used to meet the child's needs, even if the permanent kinship conservator does not choose to take advantage of the publicly funded source; and

(5) a determination of the actual or estimated costs of meeting the child's medical needs that cannot be met through private insurance or Texas Medicaid.

(c) The maximum monthly payment amount depends upon the child's authorized service level (ASL) at the time the permanency care assistance agreement is negotiated. The payment ceiling for a child whose ASL is Basic Care is $400 per month; the payment ceiling for a child whose ASL is Moderate, Specialized or Intense is $545 per month.

(d) Under the Texas Child-Centered Care (T3C) System, the maximum monthly payment depends on the child's recommended service package, at the time the permanency care assistance agreement is negotiated. The payment ceiling for a child who is placed in the T3C Basic Foster Family Support Services is $400 per month; the payment ceiling for a child placed in any other Service Package is $545 per month.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on September 23, 2024.

TRD-202404579

Quyona Gregg

Senior Policy Attorney

Department of Family and Protective Services

Earliest possible date of adoption: November 10, 2024

For further information, please call: (512) 929-6633

SUBCHAPTER Q. PURCHASED PROTECTIVE SERVCES

DIVISION 2. POST-PERMANENCY SERVICES

40 TAC §700.1733

STATUTORY AUTHORITY

§700.1733.Who is eligible for residential treatment services?

(a) Client eligibility. Only adopted children are eligible for residential treatment services through the post-permanency services program. To qualify, an adopted child:

(1) must be expected to return home and function in the adoptive family within 12 months;

(2) must not be eligible for treatment in a state hospital or state school; and

(3) must have an initial service level determination of Specialized or Intense or if under the Texas Child-Centered Care (T3C) System, must be placed and receiving a T3C Service Package other than the T3C Basic Family Foster Family Home Service Package.

(b) Family treatment and progress towards reunification.

(1) The child's adoptive family must participate in family treatment over the course of the child's stay in residential treatment.

(2) Every three-month review of the child's service plan must address the progress made towards reunifying the child with the adoptive family.

(3) The contractor must begin planning for a child's discharge from residential treatment services, and must carry out the discharge within 60 days, if either of the following conditions arises:

(A) the adoptive parents do not:

(i) maintain regular contact with the child;

(ii) participate in treatment; or

(iii) intend to let the child return home; or

(B) the child's functioning does not improve.

(1) If the service level of an adopted child in residential treatment services is reduced below the Specialized Service Level or the child no longer meets the criteria for the Service Package under which they were originally placed [~~at the end of a service level review~~], the contractor must immediately begin planning to:

(A) support the child's return to the adoptive home;

(B) refer the child and family to another facility that can meet the child's needs; or

(2) The child's eligibility for DFPS-paid residential treatment services ends 60 days after the effective date of the reduced service level.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on September 23, 2024.

TRD-202404580

Quyona Gregg

Senior Policy Attorney

Department of Family and Protective Services

Earliest possible date of adoption: November 10, 2024

For further information, please call: (512) 929-6633