| (a) Three Admissions Within 180 Days. An individual
admitted to an SMHF or a facility with a CPB three times within 180
days is considered at risk for future admission to inpatient services.
To prevent the unnecessary admissions to an inpatient facility, the
designated LMHA or LBHA must:
(1) during discharge planning, review the individual's
previous recovery or treatment plans to determine the effectiveness
of the clinical services received;
(2) include in the recovery or treatment plan:
(A) non-clinical supports, such as those provided by
a peer specialist or recovery coach, identified to support the individual's
ongoing recovery; and
(B) recommendations for services and interventions
from the individual's current or previous care plan(s) that support
the individual's strengths and goals and prevent unnecessary admission
to an SMHF or facility with a CPB;
(3) determine the availability and level of care "type,
amount, scope and duration" of clinical and non-clinical supports,
such as those provided by a peer specialist or recovery coach, that
promote ongoing recovery and prevent unnecessary admission to an SMHF
or facility with a CPB; and
(4) consider appropriateness of the individual's continued
stay in the SMHF or facility with a CPB.
(b) Nursing Facility Referral or Admission.
(1) In accordance with 42 CFR Part 483, Subpart C,
and as described in 40 TAC Chapter 19, Subchapter BB (relating to
Nursing Facility Responsibilities Related to Preadmission Screening
and Resident Review (PASRR)), a nursing facility must coordinate with
the referring entity to ensure the referring entity screens the individual
for admission to the nursing facility before the nursing facility
admits the individual.
(2) As the referring entity, the SMHF or facility with
a CPB must complete a PASRR Level I Screening and forward the completed
form in accordance with §303.301 of this title (relating to Referring
Entity Responsibilities Related to the PASRR Process).
(3) The LMHA or LBHA must conduct a PASRR Level II
Evaluation in accordance with Chapter 303 of this title.
(4) If a nursing facility admits an individual on an
ATP, the designated LMHA or LBHA must conduct and document, including
justification for its recommendations, the activities described in
paragraphs (5) and (6) of this subsection.
(5) The designated LMHA or LBHA must make at least
one face-to-face contact with the individual at the nursing facility
on an ATP. The contact must consist of:
(A) a review of the individual's record at the nursing
facility; and
(B) discussions with the individual and LAR, if any,
the nursing facility staff, and other staff who provide care to the
individual regarding:
(i) the individual's needs and the care the individual
is receiving;
(ii) the ability of the nursing facility to provide
the appropriate care;
(iii) the provision of mental health services, if needed
by the individual; and
(iv) the individual's adjustment to the nursing facility.
(6) Before the end of the initial ATP period described
in §306.206(b)(2) of this subchapter (relating to Absence for
Trial Placement), the designated LMHA or LBHA must recommend to the
SMHF or facility with a CPB one of the following:
(A) discharging the individual if the LMHA or LBHA
determines that:
(i) the nursing facility is capable and willing to
provide appropriate care to the individual after discharge;
(ii) any mental health services needed by the individual
are being provided to the individual while residing in the nursing
facility; and
(iii) the individual and LAR, if any, agrees to the
nursing facility admission;
(B) extending the individual's ATP period in accordance
with §306.206(b)(3) of this subchapter;
(C) returning the individual to the SMHF or facility
with a CPB in accordance with §306.205 of this subchapter (relating
to Pass or Furlough from a State Mental Health Facility or a Facility
with a Contracted Psychiatric Bed); or
(D) initiating involuntary admission to the SMHF or
facility with a CPB in accordance with §306.176 (relating to
Admission Criteria for a Facility with a Contracted Psychiatric Bed
Authorized by an LMHA or LBHA or for a State Mental Health Facility
for Emergency Detention) and §306.177 (relating to Admission
Criteria Under Order of Protective Custody or Court-ordered Inpatient
Mental Health Services) of this subchapter.
(c) Assisted Living.
(1) An SMHF, facility with a CPB, LMHA, or LBHA may
not refer an individual to an assisted living facility that is not
licensed under the Texas Health and Safety Code, Chapter 247.
(2) As required by Texas Health and Safety Code §247.063(b),
if an SMHF, facility with a CPB, LMHA, or LBHA gains knowledge of
an assisted living facility not operated or licensed by the state,
the SMHF, facility with a CPB, LMHA, or LBHA reports the name, address,
and telephone number of the facility to HHSC Complaint and Incident
Intake at 1-800-458-9858.
(d) Minors.
(1) To the extent permitted by medical privacy laws,
the SMHF or facility with a CPB and designated LMHA or LBHA must make
a reasonable effort to involve a minor's LAR or the LAR's designee
in the treatment and discharge planning process.
(2) A minor committed to or placed in an SMHF or facility
with a CPB under Texas Family Code, Chapter 55, Subchapter C or D,
shall be discharged in accordance with the Texas Family Code, Chapter
55, Subchapter C or D as applicable.
(e) An individual suspected of having an ID. If an
SMHF or facility with a CPB suspects an individual has an ID, the
SMHF or facility with a CPB must notify the designated LMHA or LBHA
continuity of care worker and the designated LIDDA to:
(1) assign a LIDDA continuity of care worker to the
individual; and
(2) conduct an assessment in accordance with 40 TAC
Chapter 5, Subchapter D (relating to Diagnostic Assessment).
(f) Criminal Code.
(1) Texas Code of Criminal Procedure, Chapter 46B:
Incompetency to stand trial.
(A) The SMHF or facility with a CPB must discharge
an individual committed under Texas Code of Criminal Procedure, Article
46B.102 (relating to Civil Commitment Hearing: Mental Illness), in
accordance with Texas Code of Criminal Procedure, Article 46B.107
(relating to Release of Defendant after Civil Commitment).
(B) The SMHF or facility with a CPB must discharge
an individual committed under Texas Code of Criminal Procedure, Article
46B.073 (relating to Commitment for Restoration to Competency), in
accordance with Texas Code of Criminal Procedure, Article 46B.083
(relating to Supporting Commitment Information Provided by Facility
or Program).
(C) For an individual committed under Texas Code of
Criminal Procedure, Chapter 46B, discharged and returned to the committing
court, the SMHF or facility with a CPB, within 24 hours after discharge,
must notify the following of the discharge:
(i) the individual's designated LMHA or LBHA; and
(ii) the TCOOMMI.
(2) Texas Code of Criminal Procedure, Chapter 46C:
Insanity defense. An SMHF or facility with a CPB must discharge an
individual acquitted by reason of insanity and committed to an SMHF
or facility with a CPB under Texas Code of Criminal Procedure, Chapter
46C, only upon order of the committing court in accordance with Texas
Code of Criminal Procedure, Article 46C.268.
(g) Offenders with special needs following discharge
from an SMHF or facility with a CPB. The LMHA or LBHA must comply
with the requirements as defined by the LMHA's and LBHA's TCOOMMI
contract for offenders with special needs.
(1) An LMHA or LBHA that receives a referral for an
offender with special needs in the MH priority population from a county
or city jail at least 24 hours before the individual's release must
complete one of the following actions:
(A) if the offender with special needs is currently
receiving LMHA or LBHA services, the LMHA or LMHA:
(i) notifies the offender with special needs of the
county or city jail's referral;
(ii) arranges a face-to-face contact between the offender
with special needs and a QMHP-CS to occur within 15 days after the
individual's release; and
(iii) ensures that the QMHP-CS, at the face-to-face
contact, re-assesses the individual and arranges for appropriate services,
including transportation needs at the time of release.
(B) if the individual is not currently receiving LMHA
or LBHA services from the LMHA or LBHA that is notified of the referral,
the LMHA or LMHA:
(i) ensures that at the face-to-face contact required
in subparagraph (A) of this paragraph, the QMHP-CS conducts a pre-admission
assessment in accordance with §301.353(a) of this title (relating
to Provider Responsibilities for Treatment Planning and Service Authorization);
and
(ii) complies with §306.161(b) of this subchapter
(relating to Screening and Assessment), as appropriate; or
(C) if the LMHA or LBHA does not conduct a face-to-face
contact with the individual, the LMHA or LMHA must document the reasons
for not doing so in the individual's record.
(2) If an LMHA or LBHA is notified of the anticipated
release from prison or a state jail of an offender with special needs
in the MH priority population who is currently taking psychoactive
medication(s) for a mental illness and who will be released with a
30-day supply of the psychoactive medication(s), the LMHA or LBHA
must arrange a face-to-face contact between the individual and QMHP-CS
within 15 days after the individual's release.
(A) If the offender with special needs is released
from state prison or state jail after hours or the LMHA or LBHA is
otherwise unable to schedule the face-to-face contact before the individual's
release, the LMHA or LBHA makes a good faith effort to locate and
contact the individual. If the designated LMHA or LBHA does not have
a face-to-face contact with the individual within 15 days, the LMHA
or LBHA must document the reasons for not doing so in the individual's
record.
(B) At the face-to-face contact:
(i) the QMHP-CS with appropriate supervision and training
must perform an assessment in accordance with §301.353(a) of
this title and comply with §306.161(b) and (c) of this subchapter,
as appropriate; and
(ii) if the LMHA or LBHA determines that the offender
with special needs should receive services immediately, the LMHA or
LBHA must arrange for the individual to meet with a physician or designee
authorized by state law to prescribe medication before the individual
requires a refill of the prescription.
(C) If the LMHA or LBHA does not conduct a face-to-face
contact with the offender with special needs, the LMHA or LBHA must
document the reasons for not doing so in the individual's record.
(3) If the offender with special needs is on parole
or probation, the SMHF or facility with a CPB must notify a representative
of TCOOMMI before the discharge of the individual known to be on parole
or probation.
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