| (a) Purpose. This rule establishes basic criteria,
standards, and guidelines for delivering health care services to youth
assigned to residential facilities operated by the Texas Juvenile
Justice Department (TJJD) and to certain identified contract-care
programs.
(b) Definitions. See §380.9175 of this title for
definitions of certain terms in this rule.
(c) Criteria for Medical Care.
(1) Medical providers provide primary medical care
according to the following criteria:
(A) lifesaving treatment;
(B) limb-saving treatment;
(C) reasonable care to relieve pain;
(D) reasonable care for a degenerative condition;
(E) preventive services, including age-appropriate
immunizations; and
(F) treatment for medical conditions that, if left
untreated, could result in serious bodily harm.
(2) Procedures outside these criteria for medical care
must be approved by the TJJD medical director in consultation with
TJJD's executive director or designee.
(d) Criteria for Dental Care.
(1) The dentist ensures equitable access to basic preventive
services and essential treatment procedures when disease, significant
malfunction, or injury occurs. Treatment priorities, in order, are:
(A) emergency/urgent--treatment for conditions that
will worsen or become life-threatening or acute without immediate
intervention;
(B) interceptive--intermediate treatment for asymptomatic
advanced hard- or soft-tissue disease or loss of masticatory function;
(C) rehabilitative--definitive treatment for chronic
hard- or soft-tissue disease or loss of masticatory function; and
(D) elective or special needs.
(2) The attending dentist may deviate from this prioritization
if necessary to protect a youth's overall health.
(3) TJJD provides neither orthodontic braces nor maintenance
of orthodontic braces for youth. However, if a youth has orthodontic
braces when admitted to TJJD, TJJD provides necessary care to prevent
injury to the mouth.
(A) The youth's parent/guardian is responsible for
the maintenance and adjustment of orthodontic braces after notification
of TJJD policy.
(B) TJJD staff may assist youth and parents/guardians
in making orthodontic appointments, if needed. Appointments are usually
made with the treating orthodontist, although a local orthodontist
who agrees to examine and treat the youth may be used.
(C) TJJD staff may provide transportation for orthodontic
care if the staff can accommodate traveling the distance required
to return a youth to the treating orthodontist.
(e) Services.
(1) TJJD administers at least the following services,
either directly or through contractual arrangements:
(A) physical examinations and treatment;
(B) dental examinations and treatment;
(C) treatment of injuries;
(D) mental health evaluations;
(E) immunizations;
(F) laboratory and diagnostic tests;
(G) administration of prescription or non-prescription
medication for an illness or condition;
(H) substance use disorder evaluations; and
(I) examination following use of physical force and/or
following decontamination resulting from using oleoresin capsicum
spray (pepper spray).
(2) Each TJJD institution and certain identified contract-care
programs have a health services administrator designated to act as
the local health authority. The local health authority provides coordination
and/or supervision of medical services for youth.
(3) Contract health care professionals provide health
care services in the infirmary at each TJJD institution for youth
who need increased observation or medical care, but who do not need
hospitalization.
(4) At TJJD institutions:
(A) nurses are available seven days a week to triage
youth health concerns and respond to on-site emergencies;
(B) nurses conduct a regularly scheduled sick call
five days a week to address non-urgent sick-call requests;
(C) medical and psychiatric providers deliver services
on-site or via telemedicine or telepsychiatry at least once weekly;
and
(D) dental staff provide services on-site on a routine
basis.
(5) At TJJD halfway houses:
(A) nurses provide case management; and
(B) medical, psychiatric, and dental services are completed
by providers in the community. Fees for services are covered through
Medicaid funding or by TJJD.
(6) When admitted to TJJD, all youth receive a:
(A) health screening;
(B) physical examination, unless a physical examination
was performed and documented within the past 90 days;
(C) mental health screening and evaluation;
(D) dental screening and examination, unless a dental
screening and examination were performed and documented within the
past 180 days; and
(E) vision and hearing screening.
(7) If the vision screening indicates the youth needs
a new prescription for eyewear, state-issued prescription eyewear
is provided. Youth placed in high-restriction facilities are prohibited
from wearing contact lenses, except when medically necessary and when
glasses are ineffective for correcting vision.
(8) If the youth fails the hearing screening, the youth
is referred to an audiologist for evaluation and treatment as needed.
(9) If the dentist determines a dental cleaning is
necessary, the procedure is scheduled, performed by a dental hygienist,
and documented in the electronic health record.
(10) Youth receive physical and dental examinations
annually and treatment as needed, in accordance with (c) and (d) above.
(11) In facilities housing females, obstetrical and
gynecological services are available on-site or by referral.
(12) Family planning services are available by referral
for youth who request information.
(f) Limitation of Services.
(1) TJJD is not responsible for medical costs incurred
by a youth:
(A) on furlough or conditional placement status with
a parent, relative, or guardian;
(B) on parole status, unless the youth's placement
is in a TJJD-operated/contract residential program;
(C) on escape or abscond status; or
(D) in a detention center or a county facility.
(2) Pharmaceutical, cosmetic, and medical experiments
are prohibited. This policy does not preclude individual treatment
of a youth who needs a specific medical procedure that is not generally
available.
(g) Health Care Requirements.
(1) Facilities housing more than 25 youth must have
a central medical room with medical examination facilities.
(2) When youth are in the infirmary, they are supervised
by a TJJD staff member at all times.
(3) The physician or dentist at each facility is the
decision authority for clinical decisions under their respective areas
of responsibility.
(4) The medical provider develops the youth's medical
plan of care.
(5) At TJJD institutions, a medical provider is available
once each week to provide health care services to youth and to respond
to youths' health concerns.
(6) Youth complaints about services they did or did
not receive are processed through the youth grievance system in accordance
with §380.9331 of this title.
(7) At each TJJD institution, the superintendent, health
services administrator, medical provider, and dentist must have regularly
scheduled meetings to review health care services at the facility,
including any concerns, problems, or barriers related to providing
health care. If concerns are identified, a corrective action plan
is developed, implemented, and monitored to ensure that issues are
adequately addressed.
(8) A youth who, by history or examination, has a serious
or life-threatening medical condition may be placed on medical alert
status by a medical provider. A nurse may temporarily place a youth
on medical alert status until a medical provider can be notified.
(9) The facility administrator may authorize medical
and pharmacological intervention when required in a life-threatening
situation, consistent with §380.9181 of this title. When intervention
requires psychotropic medication, the authorization must meet criteria
in §380.9192 of this title.
Cont'd... |
