| (a) A QMHP-CS or LPHA must begin discharge planning
for an individual at the time of the individual's admission.
(1) Discharge planning must involve the individual,
the IDT, the individual's LAR or adult caregiver, as applicable, and
any other person authorized by the individual and the individual's
adult caregiver or LAR if applicable, unless clinically contraindicated.
(2) Discharge planning must be provided in accordance
with §510.41(m)(3) of this title (relating to Facility Functions
and Services) and include:
(A) the IDT recommendations for services and supports,
including placement needs, that should be provided after discharge;
(B) the IDT arrangements for the recommended services
and supports;
(C) a PASRR screening, as required by paragraph (3)
of this subsection; and
(D) the IDT post-discharge care information provided
in a language and format easily understandable to the individual,
and the individual's LAR or adult caregiver, if applicable.
(3) An individual considered for discharge from the
CSU to a Medicaid-certified nursing facility must have a PASRR Level
I screening completed, in accordance with the Code of Federal Regulations,
Title 42, Part 483, Subpart B (relating to Requirements for Long-Term
Care Facilities) before discharge; and
(4) if the screening indicates that the individual
has a mental illness, ID, or DD, the CSU staff member coordinating
the individual's transfer must contact and arrange for the designated
LMHA, LBHA, or LIDDA to conduct a PASRR Level II evaluation of the
individual before CSU discharge, in accordance with Chapter 303 of
this title (relating to Preadmission Screening and Resident Review
(PASRR)).
(b) The individual's treating physician must prepare
a written discharge summary that includes:
(1) a description of the individual's treatment at
the CSU and the response to that treatment;
(2) a description of the individual's condition at
discharge;
(3) a description of the individual's placement after
discharge;
(4) a description of the services and supports the
individual will receive after discharge;
(5) a final diagnosis based on the current edition
of the Diagnostic and Statistical Manual
of Mental Disorders;
(6) a description, including dosage instructions, of
the prescribed medications the individual will need until the individual
is evaluated by a physician, or provider with prescriptive authority;
and
(7) the name of the person or entity responsible for
providing and paying for the medication referenced in paragraph (6)
of this subsection, which is not required to be the CSU.
(c) The CSU staff member coordinating the individual's
discharge must provide a copy of the discharge summary as authorized
by state and federal law, to LMHA, LBHA, LIDDA, or other community
providers and consult with them to ensure continuity of care for the
individual upon discharge from the CSU.
(d) The CSU staff member coordinating the individual's
discharge must contact and coordinate with the individual's existing
service providers and in accordance with the Health Insurance Portability
and Accountability Act or other law prior to the individual's discharge.
(e) If the individual, or the individual's LAR, adult
caregiver, or others authorized by the individual, refuse to participate
in the discharge planning, the CSU staff member coordinating the individual's
discharge must document the circumstances of the refusal in the individual's
medical record.
(f) If extremely hazardous weather conditions exist
or a disaster occurs, the physician may request the presiding judge
or magistrate of a court that has jurisdiction over proceedings brought
in accordance with Texas Health and Safety Code Chapter 574 to extend
the period during which the individual may be detained in accordance
with Texas Health and Safety Code §572.004(e).
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