(a) Protection of rights. A LIDDA must develop and
implement policies and procedures that protect the rights of individuals
and are consistent with Chapter 4, Subchapter C of this title (relating
to Rights of Individuals with an Intellectual Disability).
(b) Restrictions and limitations placed on an individual.
(1) A LIDDA:
(A) may implement behavioral support that involves
restrictions or limitations placed on an individual only in accordance
with paragraph (2) of this subsection and subsection (e) of this section;
(B) must comply with subsection (f) of this section
when using restraint, and for restraint used under subsection (f)(2)(A)
or (B) of this section, also comply with paragraph (2) of this subsection;
and
(C) may place another type of restriction or limitation
on an individual only if:
(i) the restriction or limitation protects the individual's
health or safety that is jeopardized by an identified behavior; and
(ii) the LIDDA complies with paragraphs (2) and (3)
of this subsection.
(2) A LIDDA must ensure that any restriction or limitation
placed on an individual, except for a restraint used under subsection
(f)(2)(C) of this section, is reviewed and approved by the rights
protection officer and, at the discretion of the LIDDA, other appropriate
staff members who are not on the individual's planning team, before
the restriction or limitation is implemented. If a restriction or
limitation is implemented in an emergency, including a behavioral
emergency, the LIDDA must notify the rights protection officer as
soon as possible after implementation.
(3) If a restriction or limitation not required to
be in a behavioral support plan is approved in accordance with paragraph
(2) of this subsection, the individual's plan of services and supports
must:
(A) include the restriction or limitation;
(B) identify the circumstances or criteria to be met
that will result in the removal of the restriction or limitation;
and
(C) require the planning team to review the restriction
or limitation, as necessary but at least annually, to determine appropriateness.
(c) Medication practices. A LIDDA's policies and procedures
relating to medication practices must:
(1) be consistent with accepted principles of practice
and applicable state laws and regulations to ensure medication is
administered safely and appropriately;
(2) be approved in writing by a physician or registered
nurse; and
(3) address:
(A) proper handling, storage, and disposal of medications;
(B) proper use of telephone orders if the LIDDA allows
for telephone orders;
(C) administration of medications by staff members
licensed or authorized to administer medications if the LIDDA allows
for administration of medications;
(D) supervision of self-administration of medication
by an individual; and
(E) documentation of follow-up and corrective action
when medication errors occur.
(d) Informed consent for psychoactive medication. Except
as provided by paragraph (2) of this subsection, a physician employed
or contracted by a LIDDA may prescribe psychoactive medication for
an individual only if the individual or LAR has given written informed
consent for the medication.
(1) In seeking informed consent for a psychoactive
medication, the prescribing physician must provide the individual
and LAR:
(A) an explanation of the medication and its purposes;
(B) the expected beneficial effects, side effects,
and risks of the medication;
(C) the probable consequences of not taking the medication;
(D) the existence and value of alternative forms of
treatment, if any, and why the physician does not recommend the alternative
treatment;
(E) instruction that the individual or LAR may withdraw
consent at any time without negative repercussions by a staff member
or prejudicing the future provision of services;
(F) an opportunity to ask questions concerning the
medication and its use; and
(G) the time period, not to exceed one year, for which
the individual's or LAR's consent will be effective.
(2) If an individual or LAR gives informed consent
for a psychoactive medication but is physically unable to document
the consent in writing, the prescribing physician must document in
the individual's record that informed consent was given and the reason
such consent was not documented by the individual or LAR.
(3) Prior to changing an individual's medication regimen
that would result in a change of medication class or in a significant
change in the benefits, side effects, or risks to the individual,
the physician must obtain written informed consent from the individual
or LAR in accordance with this subsection.
(e) Behavioral support.
(1) A LIDDA's policies and procedures related to behavioral
support must include:
(A) the accepted standards of professional practice
for the use of behavioral support, including the use of interventions
during a behavioral emergency; and
(B) a requirement that a provider of behavioral support:
(i) is licensed as a psychologist in accordance with
Texas Occupations Code, Chapter 501;
(ii) is licensed as a psychological associate in accordance
with Texas Occupations Code, Chapter 501;
(iii) has been issued a provisional license to practice
psychology in accordance with Texas Occupations Code, Chapter 501;
(iv) is a certified authorized provider as described
in §5.161 of this title (relating to Certified Authorized Provider);
(v) is licensed as a licensed clinical social worker
in accordance with Texas Occupations Code, Chapter 505;
(vi) is licensed as a licensed professional counselor
in accordance with Texas Occupations Code, Chapter 503; or
(vii) is certified as a behavior analyst by the Behavior
Analyst Certification Board, Inc.
(2) Except as provided by paragraph (4) of this subsection,
behavioral support interventions that involve restrictions or limitations
placed on an individual or the use of intrusive techniques may only
be provided in accordance with an approved written behavioral support
plan. The behavioral support plan must:
(A) be based on:
(i) a functional assessment of the individual's behavior
targeted by the plan; and
(ii) input from the individual's planning team and
other professionals, as appropriate;
(B) describe the interventions to be used that are
appropriate to the severity of the behavior targeted by the plan;
(C) be consistent with the outcomes identified in the
individual's plan of services and supports;
(D) be approved by the individual's planning team prior
to implementation;
(E) be accepted by the individual or LAR as evidenced
by the individual's or LAR's written informed consent;
(F) provide for the collection of behavioral data concerning
the targeted behavior; and
(G) require the professional who developed the plan
to:
(i) educate the individual and LAR and other persons
identified by the planning team (for example, family members and providers)
regarding the purpose, objectives, methods and documentation of the
behavioral support plan and subsequent revisions of the plan;
(ii) monitor and evaluate the success of the behavioral
support plan implementation as required by the plan;
(iii) review, with other members of the individual's
planning team, the behavioral support plan at least annually, or more
often as indicated, to determine the effectiveness of the plan; and
(iv) revise the plan as necessary, based on documented
outcomes of the plan's implementation.
(3) In obtaining informed consent as required by paragraph
(2)(E) of this subsection, the professional who developed that plan
must provide the individual or LAR:
(A) a description of the interventions to be used in
the behavioral support plan;
(B) the expected beneficial effects and risks of the
interventions;
(C) the probable consequences of not using the interventions;
(D) the existence and value of alternative interventions,
if any, and why the professional does not recommend the alternative
interventions;
(E) oral and written notification that the individual
or LAR may withdraw consent for the behavioral support plan at any
time without negative repercussions by a staff member or prejudicing
the future provision of services;
Cont'd... |