PART 1. HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 745. LICENSING
The Texas Health and Human Services Commission (HHSC) adopts amendments to §745.31 and §745.37; and new §§745.9051, 745.9053, 745.9055, 745.9057, 745.9059, 745.9061, 745.9063, 745.9065, 745.9067, 745.9069, 745.9071, 745.9073, 745.9075, 745.9077, 745.9085, 745.9087, 745.9089, 745.9091, 745.9093, 745.9095, and 745.9097.
Amended §745.31 and §745.37; and new §§745.9053, 745.9055, 745.9057, 745.9059, 745.9061, 745.9063, 745.9065, 745.9067, 745.9069, 745.9071, 745.9073, 745.9075, 745.9087, and 745.9089 are adopted with changes to the proposed text as published in the in the April 26, 2024, issue of the Texas Register (49 TexReg 2641). These rules will be republished.
New §§745.9051, 745.9077, 745.9085, 745.9091, 745.9093, 745.9095, and 745.9097 are adopted without changes to the proposed text as published in the April 26, 2024, issue of the Texas Register (49 TexReg 2641). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The amendments and new sections are necessary to comply with House Bill (H.B.) 3121, 87th Legislature, Regular Session, 2021, which created Texas Health and Safety Code Chapter 577A, Psychiatric Residential Youth Treatment Facilities. Chapter 577A mandates HHSC Child Care Regulation (CCR) to create a voluntary process whereby a general residential operation (GRO) may be certified as a psychiatric residential youth treatment facility (PRYTF) to provide treatments and services to individuals 21 years of age or younger with a severe emotional disturbance. Section 577A.004 requires HHSC to adopt rules to implement the chapter. Accordingly, CCR is adopting amended rules in Chapter 745, Subchapter B to (1) clarify that CCR will also regulate PRYTFs that will care for young adults 18 to 21 years of age in addition to child care; and (2) update rules to meet current practice and to improve readability and understanding. In addition, CCR is adopting new rules in Chapter 745, Subchapter O to (1) define terms; (2) create an application process, including requiring accreditation and a current GRO license; (3) create a renewal process every two years; (4) establish application and renewal fees; (5) clarify how inspections, investigations, and confidentiality will apply to PRYTFs; and (6) establish the enforcement actions that HHSC may take against a PRYTF.
COMMENTS
The 31-day comment period ended May 28, 2024. During this period, HHSC received a comment regarding the proposed rules from one commenter representing Texas Alliance of Child and Family Services (the comment was developed from a committee of residential child-care operations, including child-placing agencies, GROs, and residential treatment centers). A summary of the comment relating to the rules and responses from HHSC follows.
Comment: Regarding §745.9053(a)(1), one commenter stated that because out-of-state providers would need to undergo a lengthy process of initial and then full licensure as a GRO, to attract out-of-state providers there should be recognition in standards for qualified providers from out-of-state that can demonstrate they meet comparable requirements in their state.
Response: HHSC disagrees with the comment and declines to revise §745.9053(a)(1). Texas Health and Safety Code §577A.054(a) states that for HHSC may only issue a PRYTF certificate to a GRO that is licensed under Chapter 42, Texas Human Resources Code. Out-of-state providers do not meet this requirement.
CCR updated §§745.9055(a)(2), 745.9057(a), 745.9063(1), and 745.9065 to clarify the GROs responsibility to continue to meet the Texas Human Resources Code §42.0461, regarding public notice and hearing requirements, and §42.252, regarding operational plan requirements.
In addition, HHSC made minor editorial changes to update the term "Licensing" by modifying the rule title at §745.31 and §745.37 without changing the meaning of the rule titles, and by changing "Licensing" to "Child Care Regulation" at §§745.9053(a)(2) and (3)(D), 745.9059, 745.9061, 745.9063, 745.9065, 745.9071 (in the title and at (b)(3)(B)), and 745.9087(2); modify the language to exclude usage of first- and second-person pronouns in §§745.31, 745.37, 745.9055, 745.9057, 745.9059, 745.9061, 745.9063, 745.9065, 745.9067, 745.9069, 745.9071, 745.9073, 745.9075, 745.9087, and 745.9089, but without changing the meaning of the rules; add an "and" at §745.9053(b)(1)(B); and corrected two punctuation errors at §745.9089. HHSC also updated the title of Subchapter B, changing "Child Care and Other Operations That We Regulate" to "Child Care and other Operations That Are Subject to Regulation," and titles in Subchapter O, changing Division 1 from "Definitions for Licensing" to "Licensing" and Division 3 from "Renewals" to "Certificate Renewals."
SUBCHAPTER B. CHILD CARE AND OTHER OPERATIONS THAT ARE SUBJECT TO REGULATION
STATUTORY AUTHORITY
The amendments are adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, as well as Texas Government Code §531.033, which requires the Executive Commissioner to adopt rules necessary to carry out the duties of HHSC under Chapter 531 of the Texas Government Code. In addition, Texas Health and Safety Code §577A.004 requires HHSC to adopt rules necessary to implement Chapter 577A. Finally, amendments to current rules adopted under Texas Human Resources Code §42.042 are authorized under that section.
§745.31.What operations are subject to regulation under this chapter and corresponding minimum standards?
(a) Child day care and residential child care are subject to regulation under this chapter and corresponding minimum standards, unless Child Care Regulation (CCR) determines the operation is exempt from regulation.
(b) Residential child-care operations include:
(1) Child-placing agencies that verify foster homes and approve adoptive homes; and
(2) General residential operations, which CCR may also certify as a psychiatric residential youth treatment facility (PRYTF) as defined at §745.9051 of this chapter (relating to What do the following words and terms mean when used in this subchapter?).
(c) For a PRYTF, CCR regulates the operation's care of young adults 18 to 21 years of age in addition to child care.
§745.37.What specific types of operations are subject to regulation under this chapter and corresponding minimum standards?
The charts in paragraphs (1) and (2) of this section list the types of operations for child day care and residential child care that are subject to regulation under this chapter and corresponding minimum standards.
(1) Types of Child Day-Care Operations:
Figure: 26 TAC §745.37(1) (.pdf)
(2) Types of Residential Child-Care Operations:
Figure: 26 TAC §745.37(2) (.pdf)
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 September 18, 2024.
TRD-202404488
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: October 15, 2024
Proposal publication date: April 26, 2024
For further information, please call: (512) 438-3269
DIVISION 1. LICENSING
STATUTORY AUTHORITY
The new section is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, as well as Texas Government Code §531.033, which requires the Executive Commissioner to adopt rules necessary to carry out the duties of HHSC under Chapter 531 of the Texas Government Code. In addition, Texas Health and Safety Code §577A.004 requires HHSC to adopt rules necessary to implement Chapter 577A. Finally, amendments to current rules adopted under Texas Human Resources Code §42.042 are authorized under that section.
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 September 18, 2024.
TRD-202404489
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: October 15, 2024
Proposal publication date: April 26, 2024
For further information, please call: (512) 438-3269
26 TAC §§745.9053, 745.9055, 745.9057, 745.9059, 745.9061, 745.9063, 745.9065
STATUTORY AUTHORITY
The new sections are adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, as well as Texas Government Code §531.033, which requires the Executive Commissioner to adopt rules necessary to carry out the duties of HHSC under Chapter 531 of the Texas Government Code. In addition, Texas Health and Safety Code §577A.004 requires HHSC to adopt rules necessary to implement Chapter 577A. Finally, amendments to current rules adopted under Texas Human Resources Code §42.042 are authorized under that section.
§745.9053.What requirements must a general residential operation meet before applying for a psychiatric residential youth treatment facility (PRYTF) certificate?
(a) Before applying for a PRYTF certificate a general residential operation must:
(1) Have a current initial or full license as a general residential operation;
(2) Have Child Care Regulation's approval to provide treatment services to children with an emotional disorder, as provided in §748.63 of this title (relating to Can I provide each type of service that Licensing regulates?); and
(3) Be accredited by:
(A) The Joint Commission;
(B) The Commission on Accreditation of Rehabilitation Facilities;
(C) The Council on Accreditation; or
(D) Another accreditation organization whose standards relate to the care of children and young adults receiving mental health services in a residential setting and is approved by Child Care Regulation.
(b) To meet the accreditation requirement under subsection (a)(3) of this section, a general residential operation:
(1) May obtain accreditation for:
(A) The entire general residential operation, including the PRYTF; or
(B) Only the part of the general residential operation where the PRYTF will operate; and
(2) May have an initial, provisional, full, or other type of accreditation that is appropriate to the accreditation organization.
§745.9055.What does a completed application for a psychiatric residential youth treatment facility (PRYTF) certificate include?
(a) A general residential operation (GRO) must submit:
(1) A PRYTF certificate application (Form 2973, Psychiatric Residential Youth Treatment Facility Application);
(2) A General Residential Operations - Additional Operation Plan (Form 2960, Application for a License to Operate a Residential Child Care Facility, Attachment C) that describes and includes the capacity of the children to be served by the GRO, including any children and young adults that the PRYTF will serve and as required by Texas Human Resources Code §42.252;
(3) An updated floor plan of the building and surrounding space the entire operation will use, including dimensions of the indoor space and the specific areas to be used by the PRYTF;
(4) Additional written policies required in §748.4821 of this title (relating to What additional policies must a general residential operation (GRO) submit as part of the application process for a psychiatric residential youth treatment facility (PRYTF) certificate?); and
(5) The PRYTF certificate application fee.
(b) The GRO may submit an updated General Residential Operations - Additional Operation Plan (Form 2960, Attachment C) if the GRO is already licensed to provide treatment services to children with emotional disorders.
§745.9057.How do the public notice and hearing requirements apply to an application for a psychiatric residential youth treatment facility (PRYTF) certificate?
(a) A general residential operation (GRO) that is applying for a PRYTF certificate must comply with the rules in Subchapter D, Division 4 of this chapter (relating to Public Notice and Hearing Requirements for Residential Child-Care Operations) if the addition of the PRYTF causes the GRO to meet one of the exceptions in §745.273(b) of this chapter (relating to Which residential child care operations must meet the public notice and hearing requirements?).
(b) The initial public notice and hearing, or a subsequent public notice and hearing, of the GRO must describe and include the capacity of the children and young adults the PRYTF will serve.
(c) If the GRO does not comply with the public notice and hearing requirements, Child Care Regulation may deny the operation a PRYTF certificate.
§745.9059.How long does Child Care Regulation (CCR) have to review an application for a psychiatric residential youth treatment facility (PRYTF) certificate?
(a) CCR has 21 calendar days after receiving a general residential operation's (GRO's) application for a PRYTF certificate to review the paperwork, unless there is good cause to exceed this timeframe.
(b) After CCR reviews the GRO's application, CCR will notify the GRO in writing that:
(1) There is good cause to delay the timeframe for making a determination on the application, consistent with §745.327 of this chapter (relating to When does Licensing have good cause for exceeding its timeframes for processing my application?);
(2) The GRO is ineligible to receive a PRYTF certificate because it does not meet one or more of the requirements under §745.9053(a) of this division (relating to What requirements must a general residential operation meet before applying for a psychiatric residential youth treatment facility (PRYTF) certificate?);
(3) The GRO's application is complete and accepted for processing; or
(4) The GRO's application is incomplete. The notification letter will:
(A) Identify any application materials submitted that do not show compliance with relevant statutes, rules, or minimum standards; and
(B) Explain what the GRO must do to complete the application.
(c) If the GRO's application is not complete by the first anniversary of the date the GRO submitted its application for a PRYTF certificate, CCR will close the application and the GRO must submit a new application, materials, and a PRYTF certificate application fee.
§745.9061.How long does Child Care Regulation (CCR) have to determine whether to issue a psychiatric residential youth treatment facility (PRYTF) certificate after accepting the application?
(a) CCR determines whether to issue a PRYTF certificate no later than two months after CCR accepts the application, unless there is good cause to exceed this timeframe consistent with §745.327 of this chapter (relating to When does Licensing have good cause for exceeding its timeframes for processing my application?).
(b) The general residential operation may file a complaint regarding timeframes according to §745.325 of this chapter (relating to How do I file a complaint regarding timeframes for processing my application?).
§745.9063.What factors will Child Care Regulation (CCR) consider when evaluating an application for a psychiatric residential youth treatment facility (PRYTF) certificate?
CCR determines whether to issue a PRYTF certificate by considering:
(1) The application and any information submitted with the application, including any information noted in Texas Human Resources Code §42.252(f);
(2) The on-site inspection to determine compliance with relevant statutes, rules, and minimum standards;
(3) Any information that CCR gathers through the application process, including any written comments and written information submitted to CCR during the process that CCR considers to be relevant to the decision to issue the PRYTF certificate; and
(4) If a public hearing is required by the GRO under §745.273(b) of this chapter (relating to Which residential child-care operations must meet the public notice and hearing requirements?) any requirements under Texas Human Resources Code §42.0461, including the Verbatim Record and summary Report of Public Comment from the Community, as required in §745.275 of this chapter (relating to What are the specific requirements for a public notice and hearing?).
§745.9065.For what reason may Child Care Regulation (CCR) deny a psychiatric residential youth treatment facility (PRYTF) certificate based on the results of a required public hearing?
If a public hearing is required in §745.273 of this chapter (relating to Which residential child-care operations must meet the public notice and hearing requirements?), CCR may deny the general residential operation's request for a PRYTF certificate for a reason described in Texas Human Resources Code §42.0461(e).
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 September 18, 2024.
TRD-202404490
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: October 15, 2024
Proposal publication date: April 26, 2024
For further information, please call: (512) 438-3269
26 TAC §§745.9067, 745.9069, 745.9071, 745.9073
STATUTORY AUTHORITY
The new sections are adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, as well as Texas Government Code §531.033, which requires the Executive Commissioner to adopt rules necessary to carry out the duties of HHSC under Chapter 531 of the Texas Government Code. In addition, Texas Health and Safety Code §577A.004 requires HHSC to adopt rules necessary to implement Chapter 577A. Finally, amendments to current rules adopted under Texas Human Resources Code §42.042 are authorized under that section.
§745.9067.When does a psychiatric residential youth treatment facility (PRYTF) need to apply to renew the PRYTF certificate?
(a) A PRYTF must apply to renew the PRYTF certificate every two years after the date Child Care Regulation (CCR) issues the certificate.
(b) A PRYTF must timely apply to renew the PRYTF certificate, even if:
(1) There is a pending civil or administrative penalty against the PRYTF; or
(2) The general residential operation or PRYTF is under an enforcement action.
(c) During the year that the PRYTF renews the PRYTF certificate, the renewal period:
(1) Begins 60 calendar days before the anniversary of when CCR issued the PRYTF certificate; and
(2) Ends on the date of the anniversary.
(d) If the PRYTF is late in applying for renewal of the PRYTF certificate, the PRYTF has 30 additional calendar days after the renewal period to apply for renewal.
§745.9069.What does a completed renewal application for a psychiatric residential youth treatment facility (PRYTF) certificate include?
A PRYTF must submit a completed PRYTF renewal application, which includes:
(1) Timely submitting the renewal application as required by §745.9067 of this division (relating to When does a psychiatric residential youth treatment facility (PRYTF) need to apply to renew the PRYTF certificate?);
(2) Verification that the following information is current and accurate:
(A) The list of controlling persons at the operation; and
(B) The list of governing body's members, such as officers and owners, if applicable;
(3) A statement as to whether the operation continues to need any existing waivers and variances that the PRYTF will also want to apply to the care of children and young adults receiving psychiatric health treatments and services;
(4) Validation on the provider website the list of persons who require a background check because of their association with the operation;
(5) Verification of the ongoing accreditation of the PRYTF; and
(6) A PRYTF certificate renewal fee.
§745.9071.What happens after Child Care Regulation (CCR) receives a psychiatric residential youth treatment facility (PRYTF)renewal application?
(a) After receiving a PRYTF renewal application, CCR evaluates whether:
(1) The PRYTF completed the renewal application as required by §745.9069 of this division (relating to What does a completed renewal application for a psychiatric residential youth treatment facility (PRYTF) certificate include?);
(2) The general residential operation license is current and approved to provide treatment services to children with emotional disorders;
(3) The PRYTF has paid each administrative penalty that the PRYTF owes after waiving or exhausting any due process provided under Texas Health and Safety Code §571.025; and
(4) The PRYTF meets the statutory, rule, and minimum standard requirements after CCR inspects the PRYTF.
(b) Within 30 calendar days of receiving the renewal application, CCR will send written notice that:
(1) CCR has renewed the PRYTF certificate;
(2) The PRYTF renewal application is incomplete because it did not meet one or more of the renewal application requirements in subsection (a) of this section; or
(3) CCR refuses to renew the PRYTF certificate because:
(A) The PRYTF did not submit a completed PRYTF renewal application;
(B) The PRYTF is no longer accredited as required by §748.4823(a) of this title (relating to When must a psychiatric residential youth treatment facility (PRYTF) notify Child Care Regulation (CCR) about accreditation changes regarding the PRYTF?);
(C) The general residential operation does not have a license;
(D) The general residential operation is not approved to provide treatment services to children with emotional disorders;
(E) The PRYTF did not pay the PRYTF certificate renewal fee;
(F) The PRYTF did not pay an administrative penalty that the PRYTF owes after waiving or exhausting any due process provided under Texas Health and Safety Code §571.025; or
(G) After inspecting the PRYTF, CCR determined that it does not meet the statute, rule, and minimum standard requirements.
(c) If the PRYTF renewal application is incomplete, the written notice will include:
(1) CCR's determination that the PRYTF did not meet one or more of the renewal application requirements in subsection (a) of this section; and
(2) A list of the requirements that the PRYTF must complete before CCR can renew the PRYTF certificate.
(d) If the PRYTF submitted an incomplete renewal application during the renewal period, the PRYTF may attempt to submit the missing information until the PRYTF certificate expires.
(e) If the PRYTF submitted an incomplete renewal application during the late renewal period, the PRYTF has 15 calendar days to submit a completed application from the date CCR determined that the renewal application was incomplete.
§745.9073.When does a psychiatric residential youth treatment facility (PRYTF) certificate expire?
(a) A PRYTF certificate expires if:
(1) The PRYTF does not submit a renewal application during the renewal period or late renewal period;
(2) The PRYTF submits a renewal application during the renewal period, the PRYTF was notified that the application was incomplete, and the PRYTF did not submit a completed renewal application before the end of the late renewal period; or
(3) The PRYTF submits a renewal application during the late renewal period, the PRYTF was notified that the application was incomplete, and the PRYTF did not submit a completed renewal application within 15 calendar days after notification.
(b) If the PRYTF certificate expires:
(1) Within 24 hours, the general residential operation (GRO) must inform the following persons that the PRYTF certificate has expired;
(A) All parents of children receiving psychiatric health treatments and services; and
(B) Young adults and any guardians of the young adults receiving psychiatric health treatments and services;
(2) The GRO must immediately:
(A) Discharge and stop providing care to the young adults 18 to 21 years of age receiving psychiatric health treatments and services unless the young adult meets the requirements of §748.1931 of this title (relating to After a child in my care turns 18 years old, may the person remain in my care?);
(B) For children receiving psychiatric health treatments and services:
(i) Enroll the child into the general residential operation, if appropriate; or
(ii) Discharge the child to the child's parents.
(3) Before the GRO that had the PRYTF certificate can operate again as a PRYTF, the PRYTF must submit a new PRYTF application, materials, and PRYTF certificate application fee.
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 September 18, 2024.
TRD-202404491
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: October 15, 2024
Proposal publication date: April 26, 2024
For further information, please call: (512) 438-3269
STATUTORY AUTHORITY
The new section is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, as well as Texas Government Code §531.033, which requires the Executive Commissioner to adopt rules necessary to carry out the duties of HHSC under Chapter 531 of the Texas Government Code. In addition, Texas Health and Safety Code §577A.004 requires HHSC to adopt rules necessary to implement Chapter 577A. Finally, amendments to current rules adopted under Texas Human Resources Code §42.042 are authorized under that section.
§745.9075.What fees must a general residential operation (GRO) pay to apply for and maintain its psychiatric residential youth treatment facility (PRYTF) certificate?
In addition to the fees required by §745.509 of this chapter (relating to What fees must I pay to apply for and maintain a license for an operation?), the following chart contains non-refundable fees applicable to a PRYTF, when the fees are due, and the consequences for failure to pay on time:
Figure: 26 TAC §745.9075 (.pdf)
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 September 18, 2024.
TRD-202404492
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: October 15, 2024
Proposal publication date: April 26, 2024
For further information, please call: (512) 438-3269
STATUTORY AUTHORITY
The new section is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, as well as Texas Government Code §531.033, which requires the Executive Commissioner to adopt rules necessary to carry out the duties of HHSC under Chapter 531 of the Texas Government Code. In addition, Texas Health and Safety Code §577A.004 requires HHSC to adopt rules necessary to implement Chapter 577A. Finally, amendments to current rules adopted under Texas Human Resources Code §42.042 are authorized under that section.
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 September 18, 2024.
TRD-202404493
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: October 15, 2024
Proposal publication date: April 26, 2024
For further information, please call: (512) 438-3269
26 TAC §§745.9085, 745.9087, 745.9089, 745.9091, 745.9093, 745.9095, 745.9097
STATUTORY AUTHORITY
The new sections are adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, as well as Texas Government Code §531.033, which requires the Executive Commissioner to adopt rules necessary to carry out the duties of HHSC under Chapter 531 of the Texas Government Code. In addition, Texas Health and Safety Code §577A.004 requires HHSC to adopt rules necessary to implement Chapter 577A. Finally, amendments to current rules adopted under Texas Human Resources Code §42.042 are authorized under that section.
§745.9087.Denial of certificate.
The Texas Health and Human Services Commission (HHSC) may deny a psychiatric residential youth treatment facility (PRYTF) certificate if HHSC determines ineligibility based on:
(1) A provision in Texas Health and Safety Code Chapter 577A; or
(2) HHSC's evaluation of the application under the criteria described in §745.9063 of this subchapter (relating to What factors will Child Care Regulation (CCR) consider when evaluating an application for a psychiatric residential youth treatment facility (PRYTF) certificate?).
§745.9089.Refusal To Renew.
The Texas Health and Human Services Commission (HHSC) may refuse to renew a psychiatric residential youth treatment facility (PRYTF) certificate for a reason listed in §745.8605 of this chapter (relating to When can Licensing recommend or impose an enforcement action against my operation?) or if:
(1) The PRYTF did not submit a complete renewal application, timely or otherwise, according to §745.9069 of this subchapter (relating to What does a completed renewal application for a psychiatric residential youth treatment facility (PRYTF) certificate include?);
(2) The PRYTF was not accredited at the time of the renewal;
(3) The general residential operation (GRO) does not have a current license to operate at the time of the renewal, including if:
(A) HHSC revokes the GRO's license;
(B) HHSC refuses to renew the GRO's license;
(C) The GRO voluntarily closes;
(D) HHSC suspends the GRO's license; or
(E) The GRO voluntarily suspends their license;
(4) The GRO is not approved to provide treatment services to children with an emotional disorder at the time of renewal;
(5) The PRYTF has not paid an administrative penalty after waiving or exhausting any due process provided under Texas Health and Safety Code §571.025;
(6) The PRYTF has not timely submitted the renewal fee to HHSC; or
(7) The PRYTF does not meet:
(A) A provision in Texas Health and Safety Code Chapter 577A;
(B) A rule in this subchapter; or
(C) A minimum standard in Chapter 748, Subchapter W of this title (relating to Additional Requirements for Operations that Provide Psychiatric Health Treatments and Services).
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on September 18, 2024.
TRD-202404494
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: October 15, 2024
Proposal publication date: April 26, 2024
For further information, please call: (512) 438-3269
The Texas Health and Human Services Commission (HHSC) adopts an amendment to §748.61; and new §§748.4801, 748.4803, 748.4805, 748.4807, 748.4809, 748.4821, 748.4823, 748.4825, 748.4831, 748.4833, 748.4841, 748.4843, 748.4845, 748.4847, 748.4851, 748.4861, 748.4863, 748.4865, 748.4867, 748.4869, and 748.4881.
Amended §748.61 and new §§748.4803, 748.4807, 748.4821, 748.4823, 748.4825, 748.4841, 748.4843, 748.4845, 748.4847, 748.4861, 748.4863, 748.4865, 748.4867, 748.4869, and 748.4881 are adopted with changes to the proposed text as published in the in the April 26, 2024, issue of the Texas Register (49 TexReg 2671). These rules will be republished.
New §§748.4801, 748.4805, 748.4809, 748.4831, 748.4833, and 748.4851 are adopted without changes to the proposed text as published in the April 26, 2024, issue of the Texas Register (49 TexReg 2671). These ruleswill not be republished.
BACKGROUND AND JUSTIFICATION
The amendment and new sections are necessary to comply with House Bill (H.B.) 3121, 87th Legislature, Regular Session, 2021, which created Texas Health and Safety Code Chapter 577A, Psychiatric Residential Youth Treatment Facilities. Chapter 577A mandates HHSC Child Care Regulation (CCR) to create a voluntary process whereby a general residential operation (GRO) may be certified as a psychiatric residential youth treatment facility (PRYTF) to provide treatments and services to individuals 21 years of age or younger with a severe emotional disturbance. Section 577A.004 requires HHSC to adopt rules to implement Chapter 577A; and Section 577A.101 requires HHSC to adopt minimum standards for a certified PRYTF. Accordingly, CCR is adopting an amended rule in Chapter 748, Subchapter B to update the types of services CCR regulates to include treatment services for individuals who are 21 of age or younger with a severe emotional disturbance that are admitted to a certified PRYTF. In addition, CCR is adopting new rules in Chapter 748, Subchapter W to (1) define terms and explain the scope of the rules; (2) add requirements for policies, notifications and postings, including requiring ongoing accreditation; (3) require a treatment director; (4) update the training requirements for a caregiver and certain employees; (5) update the child to caregiver ratio during night-sleeping hours; and (6) add admission criteria and specific requirements for plans of care.
COMMENTS
The 31-day comment period ended May 28, 2024. During this period, HHSC received comments regarding the proposed rules from five commenters: Disability Rights Texas, Texas Medical Association, Texas Association of Health Plans, Texas Alliance of Child and Family Services (the comments were developed from a committee of residential child-care operations, including child-placing agencies, GROs, and Residential Treatment Centers), and an individual. A summary of the comments relating to the rules and responses from HHSC' follows.
Comment: Regarding §748.4821 and §748.4863, one commenter was concerned with mixing older residents with younger residents who may be easily manipulated or at risk of potentially more sophisticated and predatory residents. While the language of §748.4863 addresses separating the populations during therapeutic services and in living quarters, §748.4821 leaves up to the facility the development of a policy to protect the separation of the populations in relation to use of restrooms and indoor/outdoor activities. The commenter strongly recommended that HHSC provide more guidance to providers in terms of what the goal of the policy is and the expectation that staff will ensure the separation of the populations. As it relates to restrooms, the policy should address ensuring the restrooms are locked and unlocked by staff who monitor the use. In the activity areas, the policy should stipulate sufficient staff to supervise all the activity areas while in use to ensure the continued separation of the populations.
Response: HHSC agrees in part and disagrees in part with the comment. HHSC agrees that the standards can provide more guidance to support a stronger policy but does not agree that the policy must mandate locked restrooms and absolute separation of the populations in all instances. Accordingly, HHSC is enhancing the policy requirement at §748.4821(2) regarding the supervision of PRYTF young adults and children when sharing restrooms or indoor or outdoor activity areas. Although the PRYTF population and general population can mix for short periods of time, the enhanced policy now requires a schedule for PRYTF young adults and children to use restrooms and for indoor and outdoor activity times, and an outline for the specific staffing schedule caregivers will use and how caregivers will maintain supervision, based on the supervision needs in the young adults' and children's service plans. After the PRYTF submits the policy, CCR staff are required to review it to determine if the policy is consistent with minimum standards considering the operation's program and number of children in care and then provide feedback as needed.
Comment: Regarding §748.4833, one commenter recommended that non-physician health care professionals be removed as an option for being a treatment director because only physicians would be able to provide or oversee the level of care specified by the underlying Texas statue or other state or federal standards for psychiatric facilities, including federal psychiatric hospitals and psychiatric residential treatment facilities for individuals under the age of 21. The commenter stated that since a facility is required to admit or provide treatment services only when the individual "requires residential psychiatric treatment under the direction of a licensed physician to improve the individual's condition," the underlying statute contemplates those treatments be provided under the direction of a physician.
Response: HHSC disagrees and declines to revise the rule in response to the comment. A treatment director is not responsible for the direct treatment of an individual but, as noted in current §748.603, is responsible for the overall treatment program, including clinical responsibility for the management of therapeutic interventions, providing directions and overall management of the treatment program, and overseeing the treatment of all children receiving treatment services. Chapter 748 does not contemplate a treatment director making medical decisions that cannot be legally made. Instead, the service planning team is responsible for developing the service plan and new §748.4869(c) requires a psychiatrist or physician to be on the service planning team to develop an individual's service plan (which is another name for a treatment plan). These plans are also based on an individual's admission assessment; identification of medical needs and therapeutic needs, including a plan for a psychiatric evaluation; follow-up treatment; testing; and the use of psychotropic medications. A service plan also requires a list of emotional, physical, and social needs that require specific professional expertise, and plans to obtain the appropriate professional consultation and treatment for those needs. Also, the federal statutes do not apply to PRYTFs, and Texas Health and Safety Code §577A.002 explicitly exempts a PRYTF from state licensure requirements for a mental hospital, private mental hospital, or other mental health facility licensed under Texas Health and Safety Code Chapter 577.
Comment: Regarding §§748.4843, 748.4845, and 748.4847 related to training, one commenter strongly recommended that mandated training be competency-based. The training should include testing to provide evidence that the person heard, understood, and can apply the training to the work situation. Most training programs, including on line, require testing to demonstrate the individual's competence when the training is completed.
Response: HHSC agrees with the comment. The intent of the additional training is that it meets the current training requirements related to instructor requirements, being competency-based, curriculum requirements, timely completion of the training, appropriate types of training, and documentation. As such, the three training rules have been revised accordingly.
Comment: Regarding §748.4867 and additional specific services an initial service plan must include, one commenter recommended adding language that the services must be included "unless consultation with professionals, documented in the youth's treatment records, indicates that such services are inappropriate for the initial service plan" or similar language to account for the need for clinical judgement in identifying services.
Response: HHSC disagrees and declines to revise the rule in response to the comment. The added services are specifically required by Texas Health and Safety Code §577A.101.
Comment: Regarding §748.4869(a) and (b), one commenter had concerns whether the requirement that a licensed psychiatrist or physician be included in the care team when providing psychiatric health treatments and services extends to the service planning team as contemplated under Texas Health and Safety Code Chapter 577A. The commenter also had concerns that treatment services regarding medical needs would be outside the scope of practice of non-physician behavioral health professionals listed in proposed subsection (b) and recommended a psychiatrist or physician be included on the service planning team for children with primary medical needs.
Response: HHSC disagrees with the comment and declines to revise subsection (a) of the rule or make the suggested change to subsection (b) of the rule at this time. CCR specifically added the requirement that a licensed psychiatrist or physician be included in the service planning team to develop an initial service plan for an individual that will be receiving psychiatric health treatments and services in subsection (c) in response to Texas Health and Safety Code Chapter 577A. Regarding children with primary medical needs, §748.4869 replaces §748.1339 for PRYTFs, but subsection (b) has not changed from what is in current §748.1339. Any change to §748.4869(b) would only impact PRYTFs and would not impact all GROs. HHSC will review the comment requiring a psychiatrist or a physician to be on the service planning team for a child with primary medical needs in the next comprehensive rule review, which will also ensure the public can comment on any more broadly proposed change.
Comment: Regarding §748.4869(c), one commenter recommended deleting a licensed or registered occupational therapist from the list of professionals that could be on the initial service planning team for an individual receiving psychiatric health treatments and services because the occupational therapist may not have the relevant skill set. The commenter did recommend keeping subparagraph (c)(6) for allowance of other disciplines and professions.
Response: HHSC agrees with the comment and has revised the rule as recommended.
There were also several general comments regarding the rules.
General Comment 1: Two commenters had three comments related to funding.
General Comment 1A: One commenter recognized the need for high quality settings to serve children with higher needs, but there doesn't seem to be a clear funding mechanism. The commenter encouraged the state to continue to search for options that are sufficiently funded, like Qualified Residential Treatment Programs (QRTPs), the Residential Treatment Center (RTC) Division Project, and the state's transition to the Texas Child-Centered Care (T3C) structure for rates and delivery of residential care.
General Comment 1B: One commenter stated that there is no rate structure to support the specialized PRYTF setting, so it is unlikely to attract qualified providers.
General Comment 1C: One commenter stated that there is a gap in Medicaid coverage for residential treatment for youth experiencing mental health challenges, especially after short-term crisis stabilization in a psychiatric hospital. The commenter recommended aligning the PRYTF standards with the federal Medicaid Psychiatric Residential Treatment Facilities (PRTFs) standards to create a pathway for Medicaid coverage for children with severe mental health needs.
Response to General Comments 1A, 1B, and 1C: The comments are outside the scope of this rule project. H.B. 3121 did not provide a funding mechanism or otherwise address funding for care in a PRYTF. Moreover, the alignment of PRYTF standards with PRTF standards would not make these individuals Medicaid eligible. Medicaid PRTF funding is not currently in the Texas Medicaid state plan, so funding would not be available even if the standards were aligned at this time. However, if Medicaid PRTF funding is made available later, HHSC can look at the option of aligning these standards. Finally, the comment to encourage the continued search for options that are sufficiently funded, like QRTPs, the RTC Division Project, and the state's transition to T3C structure for rates and delivery of residential care, will be forwarded to the appropriate persons associated with these options in HHSC and the Department of Family and Protective Services.
General Comment 2: One commenter found the PRYTF title confusing with Medicaid Psychiatric Residential Treatment Facilities (PRTFs) and preferred a different nomenclature, maybe Youth Treatment Facility.
Response: HHSC disagrees and declines to revise any rule in response to the comment. HHSC understands the nomenclature problem for this type of facility; however, HHSC does not find any alternative title for a PRYTF, including Youth Treatment Facility, any less confusing and the PRYTF title is specifically used in Texas Health and Safety Code Chapter 577A.
General Comment 3: One commenter expressed concern with mixing the PRYTF population with the general GRO population.
Response: HHSC disagrees and declines to revise any rule in response to the comment. There are already regulations in place that support the general GRO population of children in care. This includes training requirements, supervision requirements, and specific supervision requirements noted on each child's service plan that must be followed. In addition, a GRO is already required to be approved to provide treatment services to children with emotional disorders, so a GRO should be very aware of this population. If a GRO cannot ensure the safety of a child in a mixed population setting, then the GRO would have to find a different solution to protect the safety of the child. Finally, a GRO that does not want to mix the PRYTF population with the general GRO population is not required to.
General Comment 4: One commenter expressed concern with HHSC assuming jurisdiction over the adult PRYTF population as this may be a slippery slope into taking authority over the extended foster care population, which could lead to negative outcomes for those young adults if they are investigated and treated as perpetrators rather than young adults in care.
Response: HHSC disagrees and declines to revise any rule in response to the comment. While the Texas Health and Safety Code Chapter 577A gives HHSC jurisdiction over PRYTFs, including their care of young adults, HHSC has no authority to assume jurisdiction under the Texas Human Resources Code Chapter 42 for the extended foster care population.
General Comment 5: One commenter expressed strong support for the PRYTF rules to expand the current limited capacity for children and young adults seeking quality local mental health services.
Response: HHSC appreciates the support of Alec's Law and the PRYTF rules.
In addition, HHSC made several minor editorial changes to delete the term "Licensing" by modifying the rule title at §748.61 without changing the rule title meaning, and by replacing "Licensing" with "Child Care Regulation" at §748.4823; modify the language to exclude usage of first- and second-person pronouns in §§748.61, 748.4803, 748.4807, 748.4821, 748.4823, 748.4825, 748.4841, 748.4843, 748.4861, 748.4863, 748.4865, 748.4867, 748.4869, and 748.4881, but without changing the meaning of the rules; update a citation at §748.61(3)(E); correct punctuation and add an "and" at §748.4821(1); correct the term "psychiatric health treatments and services" in several places at §748.4843(b)(1) and (2) and §748.4847(b)(2)(A) and (B) and (d)(1) and (2); and correct the spelling of "may" at §748.4863(c).
SUBCHAPTER B. DEFINITIONS AND SERVICES
DIVISION 2. SERVICES
STATUTORY AUTHORITY
The amendment is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, as well as Texas Government Code §531.033, which requires the Executive Commissioner to adopt rules necessary to carry out the duties of HHSC' under Chapter 531 of Texas Government Code. In addition, Texas Health and Safety §577A.004 requires HHSC to adopt rules necessary to implement Chapter 577A and §577A.101 requires HHSC to adopt minimum standards for a certified PRYTF. Finally, amendments to current rules adopted under Texas Human Resources Code §42.042 are authorized under that section.
§748.61.What types of services are subject to regulation under this chapter?
The following types of services are subject to regulation under this chapter:
(1) Child-Care Services--Services that meet a child's basic need for shelter, nutrition, clothing, nurture, socialization and interpersonal skills, care for personal health and hygiene, supervision, education, and service planning;
(2) Treatment Services--In addition to child-care services, a specialized type of child-care services designed to treat and support children:
(A) With an Emotional Disorder who have a:
(i) Current Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) diagnosis, such as mood disorders, psychotic disorders, or dissociative disorders, and demonstrate two or more of the following:
(I) Major self-injurious actions, including a suicide attempt within the last 12 months;
(II) Difficulties that present a significant risk of harm to others, including frequent or unpredictable physical aggression; or
(III) An additional DSM-5 diagnosis of substance-related or addictive disorder with severe impairment; or
(ii) Severe emotional disturbance as defined by §748.4801 of this chapter (relating to What do the following terms mean when used in this subchapter?) who are admitted to a certified psychiatric residential youth treatment facility also defined at §748.4801 of this chapter, in addition to young adults 18 to 21 years of age who also qualify for these services;
(B) With a DSM-5 diagnosis of Intellectual Disability that is characterized by prominent, severe deficits and pervasive impairment in one or more of the following areas:
(i) Conceptual, social, and practical adaptive skills to include daily living and self-care;
(ii) Communication, cognition, or expressions of affect;
(iii) Self-care activities or participation in social activities;
(iv) Responding appropriately to an emergency; or
(v) Multiple physical disabilities, including sensory impairments;
(C) With a DSM-5 diagnosis of Autism Spectrum Disorder that is characterized by prominent, severe deficits and pervasive impairment in one or more of the following areas of development:
(i) Conceptual, social, and practical adaptive skills to include daily living and self-care;
(ii) Communication, cognition, or expressions of affect;
(iii) Self-care activities or participation in social activities;
(iv) Responding appropriately to an emergency; or
(v) Multiple physical disabilities, including sensory impairments;
(D) With Primary Medical Needs, who cannot live without mechanical supports or the services of others because of life-threatening conditions, including:
(i) The inability to maintain an open airway without assistance, which does not include the use of inhalers for asthma;
(ii) The inability to be fed except through a feeding tube, gastric tube, or a parenteral route;
(iii) The use of sterile techniques or specialized procedures to promote healing, prevent infection, prevent cross-infection or contamination, or prevent tissue breakdown; or
(iv) Multiple physical disabilities including sensory impairments; and
(E) Determined to be a trafficking victim, including a child:
(i) Determined to be a trafficking victim as the result of a criminal prosecution or who is currently alleged to be a trafficking victim in a pending criminal investigation or prosecution;
(ii) Identified by the parent or agency that placed the child in the operation as a trafficking victim; or
(iii) Determined by the operation to be a trafficking victim based on reasonably reliable criteria, including one or more of the following:
(I) The child's own disclosure as a trafficking victim;
(II) The assessment of a counselor or other professional; or
(III) Evidence that the child was recruited, harbored, transported, provided to another person, or obtained for the purpose of forced labor or commercial sexual activity; and
(3) Additional Programmatic Services, which include:
(A) Emergency Care Services--A specialized type of child-care services designed and offered to provide short-term child care to children who, upon admission, are in an emergency constituting an immediate danger to the physical health or safety of the child or the child's offspring;
(B) Transitional Living Program--A residential services program designed to serve children 14 years old or older for whom the service or treatment goal is basic life skills development toward independent living, which includes basic life skills training and the opportunity for children to practice those skills and is not an independent living program;
(C) Assessment Services Program--Services to provide an initial evaluation of the appropriate placement for a child to ensure that appropriate information is obtained to facilitate service planning;
(D) Therapeutic Camp Services--A camping program to augment an operation's treatment services with an experiential curriculum exclusively for a child with an emotional disorder who has difficulty functioning in his home, school, or community and is only available to children 13 years old and older; and
(E) Respite Child-Care Services--See §748.73 of this chapter (relating to What are respite child-care services?).
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on September 18, 2024.
TRD-202404495
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: October 15, 2024
Proposal publication date: April 26, 2024
For further information, please call: (512) 438-3269
DIVISION 1. DEFINITIONS AND SCOPE
26 TAC §§748.4801, 748.4803, 748.4805, 748.4807, 748.4809
STATUTORY AUTHORITY
The new sections are adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, as well as Texas Government Code §531.033, which requires the Executive Commissioner to adopt rules necessary to carry out the duties of HHSC' under Chapter 531 of Texas Government Code. In addition, Texas Health and Safety §577A.004 requires HHSC to adopt rules necessary to implement Chapter 577A and §577A.101 requires HHSC to adopt minimum standards for a certified PRYTF. Finally, amendments to current rules adopted under Texas Human Resources Code §42.042 are authorized under that section.
§748.4803.When is a general residential operation (GRO) required to meet the additional rules of this subchapter?
A GRO that is a certified psychiatric residential youth treatment facility must meet the additional rules in this subchapter when providing psychiatric health treatments and services to an individual.
§748.4807.How do the rules in this subchapter apply to the care of a young adult 18 to 21 years of age at a psychiatric residential treatment facility (PRYTF)?
The rules in this chapter that apply to a PRYTF as noted in §748.4805 of this division (relating to In addition to the rules in this subchapter, what other rules in this chapter apply to a psychiatric residential youth treatment facility (PRYTF)?) also apply to the care of a young adult 18 to 21 years of age whom the PRYTF has admitted for psychiatric health treatments and services.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on September 18, 2024.
TRD-202404497
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: October 15, 2024
Proposal publication date: April 26, 2024
For further information, please call: (512) 438-3269
26 TAC §§748.4821, 748.4823, 748.4825
STATUTORY AUTHORITY
The new sections are adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, as well as Texas Government Code §531.033, which requires the Executive Commissioner to adopt rules necessary to carry out the duties of HHSC' under Chapter 531 of Texas Government Code. In addition, Texas Health and Safety §577A.004 requires HHSC to adopt rules necessary to implement Chapter 577A and §577A.101 requires HHSC to adopt minimum standards for a certified PRYTF. Finally, amendments to current rules adopted under Texas Human Resources Code §42.042 are authorized under that section.
§748.4821.What additional policies must a general residential operation (GRO) submit as part of the application process for a psychiatric residential youth treatment facility (PRYTF) certificate?
A GRO must develop written policies that address:
(1) How the PRYTF will provide 24-hour medical and emergency services, including 24-hour nursing services; and
(2) How caregivers will supervise young adults 18 to 21 years of age receiving psychiatric health treatments and services and children in the GRO, including the PRYTF, when sharing restrooms or indoor or outdoor activity areas. The policy must:
(A) Include a schedule for the young adults and children to use restrooms, for indoor activity time, including cafeteria usage, and outdoor activity time; and
(B) Outline the specific staffing schedule caregivers will use and how the caregivers will maintain supervision, based on the supervision needs in the young adults' and children's service plans.
§748.4823.When must a psychiatric residential youth treatment facility (PRYTF) notify Child Care Regulation (CCR) about accreditation changes regarding the PRYTF?
(a) A PRYTF must always meet the accreditation requirement of §745.9053 of this title (relating to What requirements must a general residential operation meet before applying for a psychiatric residential youth treatment facility (PRYTF) certificate?).
(b) A PRYTF must notify CCR within two days if the accreditation organization informs the PRYTF that it has taken or will take an action that will result in the PRYTF no longer meeting the accreditation requirement of §745.9053 of this title for any period. Such an action includes revoking, suspending, or refusing to renew the PRYTF's accreditation.
§748.4825.Where must a psychiatric residential youth treatment facility (PRYTF) post the PRYTF certificate?
The PRYTF must post the PRYTF certificate in a prominent and publicly accessible place where employees, children, young adults, parents, and others will be able to view it easily.
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 September 18, 2024.
TRD-202404498
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: October 15, 2024
Proposal publication date: April 26, 2024
For further information, please call: (512) 438-3269
STATUTORY AUTHORITY
The new sections are adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, as well as Texas Government Code §531.033, which requires the Executive Commissioner to adopt rules necessary to carry out the duties of HHSC' under Chapter 531 of Texas Government Code. In addition, Texas Health and Safety §577A.004 requires HHSC to adopt rules necessary to implement Chapter 577A and §577A.101 requires HHSC to adopt minimum standards for a certified PRYTF. Finally, amendments to current rules adopted under Texas Human Resources Code §42.042 are authorized under that section.
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 September 18, 2024.
TRD-202404499
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: October 15, 2024
Proposal publication date: April 26, 2024
For further information, please call: (512) 438-3269
26 TAC §§748.4841, 748.4843, 748.4845, 748.4847
STATUTORY AUTHORITY
The new sections are adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, as well as Texas Government Code §531.033, which requires the Executive Commissioner to adopt rules necessary to carry out the duties of HHSC' under Chapter 531 of Texas Government Code. In addition, Texas Health and Safety §577A.004 requires HHSC to adopt rules necessary to implement Chapter 577A and §577A.101 requires HHSC to adopt minimum standards for a certified PRYTF. Finally, amendments to current rules adopted under Texas Human Resources Code §42.042 are authorized under that section.
§748.4841.What are the pre-service experience requirements for a caregiver providing psychiatric health treatments and services?
(a) A caregiver responsible for an individual receiving psychiatric health treatments and services must have a minimum of 40 hours of supervised caregiver experience in:
(1) The current general residential operation providing treatment services to children with an emotional disorder;
(2) Another general residential operation providing treatment services to children with an emotional disorder;
(3) A psychiatric residential youth treatment facility providing psychiatric health treatments and services to children or young adults; or
(4) A residential or hospital setting providing direct care, supervision, guidance, and protection of children or young adults with a severe emotional disturbance.
(b) Until a caregiver has the minimum amount of supervised child-care experience as specified in subsection (a) of this section, the caregiver:
(1) May not be assigned as the only caregiver responsible for a group of individuals if any individual in the group is receiving psychiatric health treatments and services;
(2) Must be always supervised by another caregiver who has already satisfied the 40-hour experience requirement; and
(3) Must have their supervised child-care experience documented in the appropriate personnel record.
§748.4843.What additional pre-service training requirements apply to a caregiver or an employee at a psychiatric residential youth treatment facility (PRYTF)?
(a) In addition to the types of pre-service training and hours at §748.863(a) of this chapter (relating to What are the pre-service training requirements for a caregiver?), a caregiver must complete four hours of suicide prevention training before the caregiver may be counted in the child to caregiver ratio if any individual in the group is receiving psychiatric health treatments and services.
(b) In addition to the types of pre-service training and hours at §748.864(a) of this chapter (relating to What are the pre-service training requirements for an employee?), a child-care administrator, professional level service provider, treatment director, and case manager must complete four hours of suicide prevention training within 90 days of beginning job duties that include:
(1) Providing services to or planning services for individuals receiving psychiatric health treatments and services; or
(2) Managing or overseeing employees that provide services to or plans services for individuals receiving psychiatric health treatments and services.
(c) To meet the pre-service training requirements, the suicide prevention training must meet:
(1) The instructor requirements at §748.869(a) and (b) of this chapter (relating to How must pre-service training be conducted?); and
(2) The curriculum requirements at §748.125(c)(1) of this chapter (relating to What is the model suicide prevention, intervention, and postvention policy?).
(d) A caregiver or employee (child-care administrator, professional level service provider, treatment director, and case manager) does not have to complete the four hours of suicide prevention training if the caregiver or employee has documentation that it was completed during the last 12 months.
(e) The PRYTF must document the exemption factor in the appropriate personnel record.
§748.4845.Who must have first-aid and CPR training in a psychiatric residential youth treatment facility?
(a) Caregivers providing psychiatric health treatments and services to individuals must have a current certificate of training with an expiration or renewal date in:
(1) First-aid with rescue breathing and choking, which may be through instructor-led training or self-instructional training; and
(2) Pediatric and adult cardiopulmonary resuscitation (CPR).
(b) Each caregiver must be certified in first aid and CPR within 90 days of employment.
(c) At least one person counted in the child to caregiver ratio must be certified in first aid and CPR at all times.
(d) To meet the first-aid and CPR training requirements, the training must meet:
(1) The CPR training requirements at §748.913 of this chapter (relating to What are the requirements for CPR training?); and
(2) The documentation requirements at §748.915 of this chapter (relating to What documentation must I maintain for the first aid and CPR certifications?).
§748.4847.What additional annual training requirements apply to a caregiver or an employee at a psychiatric residential youth treatment facility (PRYTF)?
(a) A caregiver providing psychiatric health treatments and services to an individual in a PRYTF must complete 50 annual training hours.
(b) In addition to the one hour of annual suicide prevention training required in §748.125(c) of this chapter (relating to What is the model suicide prevention, intervention, and postvention policy?):
(1) A caregiver must complete four additional hours of annual suicide prevention training for a total of five hours of annual suicide prevention training if the caregiver provides care to an individual receiving psychiatric health treatments and services; and
(2) A child-care administrator, professional level service provider, treatment director, and case manager must complete four additional hours of annual suicide prevention training for a total of five hours of annual suicide prevention training if the employee is or will be:
(A) Providing services to or planning services for individuals receiving psychiatric health treatments and services; or
(B) Managing or overseeing other employees that provide services to or plans services for individuals receiving psychiatric health treatments and services.
(c) In addition to the specific types of annual training and hours required in §748.930(b) of this chapter (relating to What are the annual training requirements for a caregiver?), a caregiver providing psychiatric health treatments and services to an individual must complete two hours of annual training on administering psychotropic medication.
(d) In addition to the specific types of annual training and hours required in §748.931(b) and (c) of this chapter (relating to What are the annual training requirements for an employee), a child-care administrator, professional level service provider, treatment director, and case manager must complete two hours of annual training on administering psychotropic medication if the employee is or will be:
(1) Providing services to or planning services for individuals receiving psychiatric health treatments and services; or
(2) Managing or overseeing other employees that provide services to or plans services for individuals receiving psychiatric health treatments and services.
(e) To meet the annual training requirements, the annual training must meet the requirements in:
(1) §748.935 of this chapter (relating to When must an employee or caregiver complete the annual training?);
(2) §748.937 of this chapter (relating to What types of hours or instruction can be used to complete the annual training requirements?);
(3) §748.941 of this chapter (relating to How must annual training be conducted?);
(4) §748.945 of this chapter (relating to What curriculum components must be included in the annual training for administering psychotropic medication?);
(5) §748.125(c)(1) of this chapter (relating to What is the model suicide prevention, intervention, and postvention policy?), relating to the curriculum components for suicide prevention training; and
(6) §748.949 of this chapter (relating to What documentation must I maintain for annual training?).
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 September 18, 2024.
TRD-202404500
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: October 15, 2024
Proposal publication date: April 26, 2024
For further information, please call: (512) 438-3269
STATUTORY AUTHORITY
The new section is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, as well as Texas Government Code §531.033, which requires the Executive Commissioner to adopt rules necessary to carry out the duties of HHSC' under Chapter 531 of Texas Government Code. In addition, Texas Health and Safety §577A.004 requires HHSC to adopt rules necessary to implement Chapter 577A and §577A.101 requires HHSC to adopt minimum standards for a certified PRYTF. Finally, amendments to current rules adopted under Texas Human Resources Code §42.042 are authorized under that section.
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 September 18, 2024.
TRD-202404501
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: October 15, 2024
Proposal publication date: April 26, 2024
For further information, please call: (512) 438-3269
26 TAC §§748.4861, 748.4863, 748.4865, 748.4867, 748.4869
STATUTORY AUTHORITY
The new sections are adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, as well as Texas Government Code §531.033, which requires the Executive Commissioner to adopt rules necessary to carry out the duties of HHSC' under Chapter 531 of Texas Government Code. In addition, Texas Health and Safety §577A.004 requires HHSC to adopt rules necessary to implement Chapter 577A and §577A.101 requires HHSC to adopt minimum standards for a certified PRYTF. Finally, amendments to current rules adopted under Texas Human Resources Code §42.042 are authorized under that section.
§748.4861.Whom may a psychiatric residential youth treatment facility (PRYTF) admit for psychiatric health treatments and services?
A PRYTF may only admit an individual for psychiatric health treatments and services who:
(1) Is 21 years of age or younger;
(2) Has been diagnosed with a severe emotional disturbance by a licensed mental health professional;
(3) Requires residential psychiatric treatment under the direction of a licensed physician to improve the individual's condition; and
(4) Was referred for treatment or services in a PRYTF by a licensed mental health professional.
§748.4863.May individuals receiving different types of service live in the same living quarters?
(a) Except as provided by subsections (c) and (d) of this section, children receiving different types of service may reside in the same living quarters as long as:
(1) A professional level service provider completes an evaluation of the living quarters for each child that the psychiatric residential youth treatment facility (PRYTF) places in the living quarters; and
(2) In each evaluation, the professional level service provider ensures that:
(A) There is no conflict of care with the best interests of any of the children placed in the living quarters;
(B) Placing the child with different service or treatment needs in the living quarters will not adversely impact the other children in the living quarters;
(C) The number of children in the living quarters is appropriate at all times based on the needs of all children in the living quarters;
(D) Caregivers can appropriately supervise all children in the living quarters at all times; and
(E) The PRYTF can meet the needs of all children in the living quarters.
(b) If the treatment or service needs of any child in the living quarters changes, the professional level service provider must evaluate the needs of each child in the living quarters to ensure there is no conflict of care.
(c) Children admitted for emergency care services must receive any therapeutic services (such as group therapy or art therapy) separately from children admitted for non-emergency care and must have separate living quarters, such as a separate wing of an operation, or a separate cottage. The PRYTF may combine children admitted for emergency care services with children in non-emergency care for meals, recreation, and transportation.
(d) Young adults 18 to 21 years of age receiving psychiatric health treatments and services that are not in the care of the Texas Department of Family and Protective Services and did not come immediately from another residential child-care operation:
(1) Must receive therapeutic services (such as group therapy or art therapy) separately from children admitted to the operation, including the PRYTF;
(2) Must have separate living quarters, such as a separate wing of an operation, or a separate cottage; and
(3) Must not use an area of the general residential operation's building or grounds at the same time with children admitted to the operation, including the PRYTF, except restrooms and indoor and outdoor activity areas may be shared under a policy required by §748.4821 of this subchapter (relating to What additional policies must a general residential operation (GRO) submit as part of the application process for a psychiatric residential youth treatment facility (PRYTF) certificate?).
§748.4865.Are there additional requirements for a preliminary service plan when a psychiatric residential youth treatment facility (PRYTF) admits an individual for psychiatric health treatments and services?
When a PRYTF admits an individual for psychiatric health treatments and services, in addition to the requirements listed in §748.1331 of this chapter (relating to What are the requirements for a preliminary service plan?), the preliminary service plan for an individual receiving psychiatric health treatments and services must include:
(1) Therapeutic needs, including plans for psychiatric evaluation, the use of psychotropic medications, and one-to-one therapy;
(2) Family engagement activities;
(3) Plans to consult with qualified professionals, including case managers, primary care professionals, community-based mental health providers, school staff, and other support planners; and
(4) Nursing care.
§748.4867.Are there additional requirements for an initial service plan when a psychiatric residential youth treatment facility (PRYTF) admits an individual for psychiatric health treatments and services?
(a) In addition to the requirements listed in (b)(2) in Figure: 26 TAC §748.1337(b) of this chapter (relating to What must a child's initial service plan include?), the initial service plan for an individual receiving psychiatric health treatments and services must include:
(1) One-to-one therapy;
(2) Family engagement activities;
(3) Consultation services with qualified professionals, including case managers, primary care professionals, community-based mental health providers, school staff, and other support planners;
(4) 24-hour nursing services, though services do not need to be onsite; and
(5) Direct care and supervision services, supportive services for daily living and safety, and positive behavior management services.
(b) A PRYTF must document all professional consultations, examinations, recommendations, and treatment in the individual's record.
§748.4869.Who must be involved in developing an initial service plan?
(a) A service planning team must develop the service plan. The team must consist of:
(1) At least one of the individual's current caregivers;
(2) For a child, a person designated to make decisions regarding a child's participation in childhood activities; and
(3) At least one professional level service provider who provides direct services to the individual.
(b) Except as provided by subsection (c) of this section, if a general residential operation is providing treatment services to a child, the team must also include two of the following professions:
(1) A licensed professional counselor;
(2) A psychologist;
(3) A psychiatrist or physician;
(4) A licensed registered nurse;
(5) A licensed masters level social worker;
(6) A licensed or registered occupational therapist; or
(7) Any other person in a related discipline or profession that is licensed or regulated in accordance with state law.
(c) If a psychiatric residential youth treatment facility is providing psychiatric health treatments and services to an individual, the team must also include a licensed psychiatrist or physician and one of the following professionals:
(1) A licensed professional counselor;
(2) A psychologist;
(3) A licensed registered nurse;
(4) A licensed masters level social worker; or
(5) Any other person in a related discipline or profession that is licensed or regulated in accordance with state law.
(d) The individual and parents or guardian must be invited to a service planning meeting, so that they may participate and provide input into the development of the service plan.
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 September 18, 2024.
TRD-202404502
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: October 15, 2024
Proposal publication date: April 26, 2024
For further information, please call: (512) 438-3269
STATUTORY AUTHORITY
The new sections are adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, as well as Texas Government Code §531.033, which requires the Executive Commissioner to adopt rules necessary to carry out the duties of HHSC' under Chapter 531 of Texas Government Code. In addition, Texas Health and Safety §577A.004 requires HHSC to adopt rules necessary to implement Chapter 577A and §577A.101 requires HHSC to adopt minimum standards for a certified PRYTF. Finally, amendments to current rules adopted under Texas Human Resources Code §42.042 are authorized under that section.
§748.4881.After a child in the care of a psychiatric residential youth treatment facility (PRYTF) turns 18 years old, may the young adult remain in care?
A child who turns 18 years old in the care of a PRYTF may remain in care until the young adult's 22nd birthday.
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 September 18, 2024.
TRD-202404503
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: October 15, 2024
Proposal publication date: April 26, 2024
For further information, please call: (512) 438-3269