| (a) A LIDDA, LMHA, or LBHA, as applicable, must:
(1) enter in the LTC online portal the data from a
PL1 completed by a referring entity in accordance with §303.201(a)(1)
of this chapter (relating to Preadmission Process) for an individual
who is suspected of having MI, ID, or DD and who is seeking admission
to a NF through the preadmission process;
(2) complete a PE or resident review as follows:
(A) within 72 hours after receiving a copy of the PL1
from the referring entity in accordance with §303.201(a)(1)(B)
of this chapter or notification from the LTC online portal in accordance
with §303.202 or §303.204(a) of this chapter (relating to
Expedited Admission Process and Resident Review Process, respectively):
(i) call the referring entity or NF to schedule the
PE or resident review; and
(ii) meet in person, or in extenuating circumstances
meet via audio-visual communication, with the individual or resident
at the referring entity or NF to gather information to complete the
PE or resident review; and
(B) within seven days after receiving a copy of the
PL1 from the referring entity or notification from the LTC online
portal:
(i) complete the PE or resident review by:
(I) reviewing the individual's or resident's:
(-a-) medical records;
(-b-) relevant service records, including those available
in online databases, such as the Client Assignment and Registration
(CARE) system, Clinical Management for Behavioral Health Services
(CMBHS), and LTC online portal; and
(-c-) previous PEs, service plans, and assessments
from other LIDDAs, LMHAs, or LBHAs;
(II) meeting with the individual's LAR or resident's
LAR in person, via audio-visual communication, or via audio-only communication
according to the LAR's preference;
(III) communicating with a collateral contact as necessary;
(IV) providing information to the individual seeking
admission or resident and the individual's LAR or resident's LAR,
if any, about community services, supports, and programs for which
the individual or resident may be eligible; and
(V) obtaining additional information as needed; and
(ii) enter the data from the PE or resident review
in the LTC online portal; and
(3) within three business days after entering the data
from the PE or resident review in the LTC online portal:
(A) if the PE or resident review is positive for MI,
ID, or DD, provide the individual seeking admission or resident or
the individual's LAR or resident's LAR with a summary of the results
of the PE or resident review, using HHSC forms; or
(B) if the PE or resident review is negative for MI,
ID, or DD, provide the individual seeking admission or resident or
the individual's LAR or resident's LAR notice of the right to a fair
hearing, using HHSC forms.
(b) If an individual seeking admission to a NF or a
resident has a PE or resident review that is positive for ID, DD,
or MI and a NF certifies in the LTC online portal that it cannot meet
the needs of the individual or resident, then the LIDDA, LMHA, or
LBHA, as applicable, must assist the individual, resident, or LAR
in choosing another NF that will certify it can meet the needs of
the individual or resident.
(c) If an individual seeking admission to a NF or a
resident has a PE or resident review that is positive for ID, DD,
or MI and a NF certifies in the LTC online portal that it can meet
the needs of the resident or certifies in the LTC online portal that
it can meet the needs of the individual and admits the individual,
the LIDDA, LMHA or LBHA, as applicable, must:
(1) coordinate with the NF to schedule an IDT meeting
to discuss specialized services;
(2) ensure a habilitation coordinator or QMHP-CS or
both, as applicable, participates in person, or via audio-visual communication
in extenuating circumstances, in the resident's IDT meeting as scheduled
by the NF and collaborate with the other members of the IDT to:
(A) identify which of the specialized services recommended
for the resident that the resident, or LAR on the resident's behalf,
wants to receive;
(B) identify the NF PASRR support activities for the
resident; and
(C) determine whether the resident is best served in
a facility or community setting;
(3) within five business days after receiving notification
from the LTC online portal that the NF entered information from the
IDT meeting, confirm the LIDDA's, LMHA's, or LBHA's participation
in the meeting and the specialized services recommended in the LTC
online portal; and
(4) if Medicaid or other funding is available:
(A) initiate MI specialized services within 20 business
days after the date of the IDT meeting; and
(B) provide the MI specialized services agreed upon
in the IDT meeting to the resident.
(d) The LIDDA, LMHA, or LBHA must develop a written
policy that describes the process the LIDDA, LMHA, or LBHA will follow
to address challenges related to the participation in receiving IHSS
or MI specialized services by the designated resident, resident with
MI, or LAR.
(e) The LIDDA must ensure that a designated resident
or LAR is informed orally and in writing of the processes for filing
complaints as follows:
(1) the telephone number of the LIDDA to file a complaint;
(2) the telephone number of the IDD Ombudsman to file
a complaint about the LIDDA;
(3) the telephone number of Complaint and Incident
Intake to file a complaint about IHSS or the NF;
(4) the telephone number of DFPS Statewide Intake to
report an allegation of abuse, neglect, or exploitation; and
(5) the telephone number of the Long-Term Care Ombudsman
to file a complaint that relates to action, inaction, or a decision
by any individual or entity who provides care or makes decisions related
to a designated resident, that may adversely affect the health, safety,
welfare, or rights of the designated resident.
(f) The LMHA or LBHA must ensure that a resident with
MI or LAR is informed orally and in writing of the processes for filing
complaints as follows:
(1) the telephone number of the LMHA or LBHA to file
a complaint;
(2) the telephone number of the Ombudsman for Behavioral
Health to file a complaint about MI specialized services or about
an LMHA or LBHA;
(3) the telephone number of Complaint and Incident
Intake to file a complaint about the NF;
(4) the telephone number of DFPS Statewide Intake to
report an allegation of abuse, neglect, or exploitation; and
(5) the telephone number of the Long-Term Care Ombudsman
to file a complaint that relates to action, inaction, or a decision
by any individual or entity who provides care or makes decisions related
to a resident with MI, that may adversely affect the health, safety,
welfare, or rights of the resident with MI.
(g) If an individual seeking admission to a NF or a
resident has a PE or resident review that is positive for MI and ID
or MI and DD, the LIDDA is responsible for coordinating with the NF
to schedule the IDT meeting to discuss specialized services.
(h) Before the LIDDA, LMHA, or LBHA staff conducts
the meeting required in subsection (a)(2)(A)(ii) of this section via
audio-visual communication, they must:
(1) do one of the following:
(A) obtain the written informed consent of the individual,
designated resident, or LAR; or
(B) obtain the individual's, designated resident's,
or LAR's oral consent and document the oral consent in the individual's
or designated resident's record; and
(2) document in the individual's or designated resident's
record a description of the extenuating circumstances that prevented
meeting in person with the individual or the designated resident.
(i) If the LIDDA, LMHA, or LBHA does not obtain the
written or oral consent required by subsection (h) of this section,
the LIDDA, LMHA, or LBHA must conduct the meeting required in subsection
(a)(2)(A)(ii) of this section by meeting with the LAR and NF staff
most familiar with the individual or designated resident, to:
(1) review and gather all necessary information to
complete the PE; and
(2) enter the PE in the LTC online portal.
|
