| (a) Pre-admission screening and assessment.
(1) Before admission to a CSU, an individual must meet
clinical criteria for admission, as determined by pre-admission screening
and assessment.
(2) An individual who voluntarily presents to the CSU
may leave the CSU at any time during the pre-admission screening and
assessment process before the individual's admission.
(3) Pre-admission screening and assessment of an individual
must:
(A) occur either in the CSU or in the community at
any location where mental health crisis services are provided; and
(B) be provided by a QMHP-CS or LPHA trained in accordance
with HHSC screening and assessment requirements policy and displaying
competency in all domains of crisis screening and assessment in accordance
with §301.331(b) of this title (relating to Competency and Credentialing).
(b) CSU screening and assessment policy. CSU screening
and assessment policy must include a process for:
(1) accessing an individual's community-based screening
and assessment; and
(2) conducting CSU screenings that address the criteria
for immediate:
(A) assessment of risk of deterioration and danger
to self and others;
(B) medical screening and assessment; and
(C) psychiatric examination;
(3) ensuring an individual who is waiting for a physician
examination remains in a location that is determined to be clinically
appropriate and available; and
(4) ensuring that an individual who presents to a CSU
for pre-admission screening and assessment is afforded the protections
in §306.87 of this subchapter (relating to Protection of an Individual
receiving Crisis Stabilization Unit Services).
(c) Screening. Pre-admission screening identifies the
acuity of the individual's crisis episode and determines the need
for further assessments, including assessments to determine risk of
deterioration and immediate danger to self and others, in accordance
with Texas Health and Safety Code §572.0025(f) and §573.021.
The initial screening of an individual must lead to:
(1) immediate and appropriate referrals; and
(2) documentation that incorporates the following domains:
(A) suicide risk screening;
(B) homicide risk screening; and
(C) risk of deterioration.
(d) Assessment. If a pre-admission screening indicates
an individual requires immediate assessment to determine risk of deterioration
and immediate danger to self and others, the assessment must be conducted
with the individual, either in person or through the use of telemedicine
medical services or telehealth services in accordance with 22 TAC §174.9(2)
(relating to Provision of Mental Health Services), and must include:
(1) a suicide assessment that documents current and
past suicide risks regarding suicidal ideation, plans, and past suicide
attempts;
(2) a psychosocial assessment that includes historical
and current information including identification of social, psychological,
environmental, and cultural factors that may be contributing to the
emergency; and
(3) a mental health assessment, documenting symptomology,
functionality, historical and current diagnosis, and treatment for
mental illnesses or serious emotional disturbances and, when available:
(A) a review of records of past treatment;
(B) a review of history from collateral sources as
permitted by Health Insurance Portability and Accountability Act;
(C) a consult with current healthcare providers;
(D) a review of history of previous treatment and the
response to that treatment, including a record of dose, response,
side effects and adherence to past psychiatric medications; and
(E) an up-to-date record of all medications currently
prescribed, and the name of the physician or provider with prescriptive
authority.
(e) Physician examination. If a pre-admission assessment
indicates an individual requires immediate physician examination to
determine clinical need for CSU admission, the examination may not
be delegated to a non-physician, in accordance with Texas Health and
Safety Code §572.0025(f), and:
(1) must be conducted with the individual, either in
person or through telemedicine medical services, in accordance with
Texas Health and Safety Code §572.0025(f) and §573.021;
and
(2) must include:
(A) a physical examination consisting of an assessment
for medical stability; and
(B) a psychiatric examination.
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