(a) The TXMHMR service system is dedicated to providing
mental health and mental retardation services/supports which are viewed
as satisfactory by persons receiving those services/supports and their
legally authorized representatives. Therefore, local authorities and
their contractors shall take steps to assure that these persons:
(1) have a method to express their concerns or dissatisfaction;
(2) are assisted to do so in a constructive way; and
(3) have their concerns or dissatisfaction addressed
through a review process.
(b) A request to review decisions described in this
section may be made by the person requesting or receiving services/supports,
the person's legal representative, or any other individual with
the person's consent.
(c) At the time of admission into services and on an
annual basis thereafter, the local authority and its contractors shall
provide to persons who receive services/supports and their legally
authorized representatives written notification in a language and/or
method understood by the individual of the local authority or its
contractor's policy for addressing concerns or dissatisfaction with
services/supports. The notification shall explain:
(1) an easily understood process for persons and legally
authorized representatives to request a review of their concerns or
dissatisfaction by the local authority or its contractor, whichever
is appropriate;
(2) how the person may receive assistance in requesting
the review;
(3) the timeframes for the review; and
(4) the method by which the person is informed of the
outcome of that review.
(d) Local authorities and their contractors shall notify
persons and legally authorized representatives in writing in a language
and/or method understood by the individual of the following decisions
and of the process to appeal by requesting a review of those decisions:
(1) a decision to deny the person services/supports
at the conclusion of a local authority's procedure which determines
whether the person meets the criteria for the priority population;
and
(2) a decision to terminate services/supports and
follow-along from the local authority or its contractor, if appropriate.
(e) The written notification referred to in subsection
(d) of this section must:
(1) be given or mailed to the person and the legally
authorized representative within ten working days of the date the
decision was made;
(2) state the reason for the decision;
(3) explain that the person and legally authorized
representative may contact either the local authority or its contractor,
whichever is appropriate, within 30 days of receipt of notification
if dissatisfied with the decision and request that the decision be
reviewed in accordance with subsection (g) of this section; and
(4) include name(s), phone number(s) and address(es)
of one or more accessible staff to contact during office hours.
(f) If a person or legally authorized representative
believes that the local authority or its contractor has made a decision
to involuntarily reduce services by changing the amount, duration,
or scope of services/supports provided and is dissatisfied with that
decision, then the person may request in writing that the decision
be reviewed in accordance with subsection (g) of this section.
(g) The review by the local authority or its contractor
shall:
(1) begin within ten working days of receipt of the
request for a review and be completed within ten working days of the
time it begins unless an extension is granted by the CEO of the
local authority or its contractor, whichever is appropriate;
(2) begin immediately upon receipt of the request and
be completed within five working days if the decision is related to
a crisis service;
(3) be conducted by an individual(s) who was not involved
in the initial decision;
(4) include a review of the original decision which
led to the person's dissatisfaction;
(5) result in a decision to uphold, reverse, or modify
the original decision; and
(6) provide the person an opportunity to express his
or her concerns in person or by telephone to the individual reviewing
the decision. The review shall also allow the person to:
(A) have a representative talk with the reviewer; or
(B) submit his or her concerns in writing, on tape,
or in some other fashion.
(h) Following a review, either the local authority
or its contractor, whichever is appropriate, shall explain to the
person and legally authorized representative in writing and also in
person or by telephone, if requested, the action it will take or,
if no action will be taken, why it will not change the decision or
believes such action would not be in the person's best interest. This
is the final step in the review process.
(i) The notification and review process described in
this section:
(1) is applicable only to services/supports funded
by TXMHMR and provided or contracted for by its local authorities;
(2) does not preclude a person or legally authorized
representative's right to reviews, appeals, or other actions that
accompany other funds administered through a local authority or its
contractors, or to other appeals processes provided for by other state
and federal laws, e.g., Texas Health and Safety Code, Title 7, Chapter
593 (Persons with Mental Retardation Act); 42 USC §1396 (Medicaid
statute); and Texas Human Resources Code, Chapter 73 (Chapter 621
of this title (relating to Early Childhood Intervention)), Early Childhood
Intervention programs as funded by the Texas Interagency Council for
Early Childhood Intervention.
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Source Note: The provisions of this §301.155 adopted to be effective February 11, 1994, 19 TexReg 591; amended to be effective January 3, 1997, 21 TexReg 12402; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; transferred effective January 1, 2024, as published in the Texas Register December 1, 2023, 48 TexReg 7081 |