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TITLE 26HEALTH AND HUMAN SERVICES
PART 1HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 306BEHAVIORAL HEALTH DELIVERY SYSTEM
SUBCHAPTER DMENTAL HEALTH SERVICES--ADMISSION, CONTINUITY, AND DISCHARGE
DIVISION 3ADMISSION TO A STATE MENTAL HEALTH FACILITY OR A FACILITY WITH A CONTRACTED PSYCHIATRIC BED--PROVIDER RESPONSIBILITIES
RULE §306.175Voluntary Admission Criteria for a Facility with a Contracted Psychiatric Bed Authorized by an LMHA or LBHA or for a State Mental Health Facility

(a) Request for voluntary admission.

  (1) In accordance with Texas Health and Safety Code §572.001, a request for voluntary admission of an individual with a mental illness may only be made by:

    (A) the individual, if the individual is at least 16 years of age or older;

    (B) the LAR if:

      (i) the individual is younger than 18 years of age; and

      (ii) the LAR is described by §306.153(36)(A)(i) or (iii) of this subchapter (relating to Definitions); or

    (C) the LAR, if the LAR is described by §306.153(36)(A)(ii), and admission is sought pursuant to the provisions of Texas Health and Safety Code §572.001(c-1) - (c-4).

  (2) In accordance with Texas Health and Safety Code §572.001(b) and (e), a request for admission must:

    (A) be in writing and signed by the LAR or individual making the request; and

    (B) include a statement that the LAR or individual making the request:

      (i) agrees that the individual remains in the SMHF or facility with a CPB until the individual's discharge; and

      (ii) consents to diagnosis, observation, care, and treatment of the individual until:

        (I) the discharge of the individual; or

        (II) the individual is entitled to leave the SMHF or facility with a CPB, in accordance with Texas Health and Safety Code §572.004, after a request for discharge is made.

  (3) The consent given under paragraph (2)(B)(ii) of this subsection does not waive an individual's rights described in:

    (A) 25 TAC Chapter 404, Subchapter E (relating to Rights of Persons Receiving Mental Health Services);

    (B) 25 TAC Chapter 405, Subchapter E (relating to Electroconvulsive Therapy (ECT));

    (C) 25 TAC Chapter 414, Subchapter I (relating to Consent to Treatment with Psychoactive Medication--Mental Health Services); and

    (D) 25 TAC Chapter 415, Subchapter F (relating to Interventions in Mental Health Services).

(b) Failure to meet admission criteria. If the physician of an SMHF or facility with a CPB determines that an individual does not meet admission criteria and that community resources may appropriately serve the individual, the facility contacts the LMHA or LBHA to discuss the availability and appropriateness of community-based services for the individual to receive. The LMHA or LBHA must contact the individual, the individual's family or any other person providing support as authorized by the individual, and LAR, if any, no later than 24 hours after the LMHA or LBHA is notified of the failure to meet the admission criteria.

(c) Examination.

  (1) A physician must conduct an examination on each individual requesting voluntary admission in accordance with this subsection.

  (2) In accordance with Texas Health and Safety Code §572.0025(f)(1)(A), a physician conducts a physical and psychiatric examination, either in person or through the use of audiovisual or other telecommunications technology within 72 hours before voluntary admission or 24 hours after voluntary admission for the following:

    (A) an assessment for medical stability; and

    (B) a psychiatric examination, and, if indicated, a substance use assessment.

  (3) In accordance with Texas Health and Safety Code §572.0025(f)(1); the physician may not delegate the examination to a non-physician.

(d) Meets admission criteria. If, after examination, the physician determines that the individual meets admission criteria of the SMHF or facility with a CPB, the SMHF or facility with a CPB admits the individual.

(e) Does not meet admission criteria. If, after the examination, the physician determines that the individual does not meet the admission criteria of the SMHF or facility with a CPB, the SMHF or the facility with a CPB contacts the designated LMHA or LBHA to coordinate alternate outpatient community services as clinically indicated.

(f) Capacity to consent.

  (1) If a physician determines that an individual whose consent is necessary for a voluntary admission does not have the capacity to consent to diagnosis, observation, care, and treatment, the SMHF or the facility with a CPB may not voluntarily admit the individual.

  (2) When appropriate, the SMHF or the facility with a CPB initiates an emergency detention proceeding in accordance with Texas Health and Safety Code, Chapter 573, or files an application for court-ordered inpatient mental health services in accordance with Texas Health and Safety Code Chapter 574.

(g) Intake assessment. In accordance with Texas Health and Safety Code §572.0025(b), an assessment professional for an SMHF or facility with a CPB, before voluntary admission of an individual, conducts an intake assessment for:

  (1) obtaining relevant information about the individual, including:

    (A) psychiatric and medical history;

    (B) social history;

    (C) symptomology;

    (D) support systems;

    (E) finances;

    (F) third-party coverage or insurance benefits; and

    (G) advance directives;

  (2) explaining, orally and in writing, the individual's rights described in 25 TAC Chapter 404, Subchapter E;

  (3) explaining, orally and in writing, the SMHF's or facility with a CPB's services and treatment as they relate to the individual;

  (4) explaining, orally and in writing, the existence, purpose, telephone number, and address of the protection and advocacy system established in Texas, pursuant to Texas Health and Safety Code §576.008; and

  (5) explaining, orally and in writing, the individual trust fund account, charges for services, and the financial responsibility form.

(h) Requirements for voluntary admission. An SMHF or facility with a CPB may voluntarily admit an individual only if:

  (1) a request for admission is made in accordance with subsection (a) of this section;

  (2) a physician has:

    (A) in accordance with Texas Health and Safety Code §572.0025(f)(1):

      (i) conducted an examination in accordance with subsection (c) of this section within 72 hours before the admission or 24 hours after the admission; or

      (ii) has consulted with a physician who has conducted an examination in accordance with subsection (c) of this section within 72 hours before the admission or 24 hours after the admission;

    (B) determined that the individual meets the admission criteria of the SMHF or facility with a CPB and that admission is clinically justified; and

    (C) issued an order admitting the individual; and

  (3) in accordance with Texas Health and Safety Code §572.0025(f)(2), the administrator or designee of the SMHF or facility with a CPB has signed a written statement agreeing to admit the individual.

(i) Documentation of admission order. In accordance with Texas Health and Safety Code §572.0025(f)(1), the order described in subsection (h)(2)(C) of this section is issued:

  (1) in writing and signed by the issuing physician; or

  (2) orally or electronically if, within 24 hours after its issuance, the SMHF or facility with a CPB has a written order signed by the issuing physician.

(j) Periodic evaluation. To determine the need for continued inpatient treatment, a physician or physician's designee must evaluate and document justification for continued stay for an individual voluntarily receiving acute inpatient treatment as often as clinically indicated, but no less than once a week.


Source Note: The provisions of this §306.175 adopted to be effective May 20, 2020, 45 TexReg 3301

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