Texas Register
(21 TexReg 7935-7938). Sections 406.201,
406.203, and 406.217 are adopted without changes.
The adopted amendments incorporate methodology which identifies the level
of service needed by an individual as determined by the Inventory for Client
and Agency Planning (ICAP) assessment instrument (available for inspection
by contacting the Medicaid section of TDMHMR Central Office); establish payment
classifications that are consistent with the Home and Community-based Services
(HCS) program; incorporate several new definitions; and improve the organization
and readability of the text.
Language in §406.202 was modified to add several new definitions and
revise two definitions. The proposed language of §406.204(a)(2) and
§406.204(b)(3) was deleted. Language in §406.204(b)(4)(B)(i), regarding
persons with challenging behavior, was modified to include classifications
for serious behavior. Language in §406.204(b)(4)(B)(ii), regarding the
definition of persons eligible for the pervasive plus category, was modified
to specifically state that the 1:1 coverage must be available all hours that
the individual is awake. Language in §406.204 (b)(4)(B)(iii), regarding
the eligibility for a level of need for persons with serious medical problems,
was modified to specify the amount of nursing time an individual requires,
rather than having a study done by the utilization review team. This specificity
will ensure greater reliability by measuring staff time to provide care to
the person rather than judging by the individual's medical condition. Language
in §406.214, regarding utilization review, was modified to add new §406.214(e)
and new §406.214(f) to accommodate comments by delineating provider's
appeal rights in the assignment of the level of need.
Oral testimony was received at the public hearing, held on September 9,
1996. Written comments were received from six respondents regarding adoption
of the rule, with several commenters offering recommendations for revision.
Those respondents offering comment on the rule include: Educare Community
Living Corporation, Austin; New Adventures of Hope, El Paso; Concho Residential
Services, Inc., San Angelo; Concept Six, Austin; State-operated Mental Retardation
Facilities; and, Parent Association for the Retarded of Texas, Inc., Austin.
Concerning proposed §406.204(b)(5)(B)(ii), one commenter stated that
Items 70 and 72 cannot be scored "7", since "7" applies to aggressive behavior
only.
The department responds that the commenter is mistaken. The scoring described
by the commenter is not used in the new instructions.
Concerning proposed §406.204(a)(3), one commenter asked why the level-of-care
system is still needed, given that the new level-of-need system is in place.
The department responds that the level-of-care criteria are used to determine
eligibility for programs outside the scope of TDMHMR. The department will
retain the level-of-care system for eligibility purposes only.
Concerning proposed §406.204(a)(3), one commenter asked if the level-of-care
system remains in place, will providers' licenses still be limited to a certain
level (e.g., a Level V home), rather than allowing for various levels of
care in the same home.
The department responds that the license category will not restrict providers
from mixing levels of care after January 1, 1997.
Concerning proposed §406.204(b)(4)(B)(iii), one commenter asked what
type of study will be conducted to determine appropriate alterations to the
payment for the individual in need of extensive medical services, and who
will conduct it.
The department responds that the text has been modified to eliminate the
need for a study.
Concerning proposed §406.204(b)(4)(B), one commenter stated that the
department must address the issue of individuals with extensive medical needs
very clearly. The commenter stated that although an individual with substantial
nursing needs will generally fall into a higher need category simply because
of the pervasiveness of his/her disabilities, there are exceptions.
The department responds that it will continue to closely follow this issue.
Concerning proposed Chapter 406, Subchapter E, in general, one commenter
stated that the current proposal does not include §406.211 of this title,
which was proposed earlier in the year. The commenter stated that the"piece-meal"
revision of this subchapter makes it very difficult to review or understand
this policy and provide comments.
The department responds that §406.211 was adopted at the October 1996
meeting of the Texas MHMR Board, to ensure that the modifications to the
therapeutic leave and extended therapeutic leave requirements were in place
for the holiday season.
Concerning proposed referenced information in general, one commenter stated
that several referenced forms and documents were not included in the distribution
of the proposal, which required the commenter to obtain copies of these references
elsewhere in order to review and comment on the proposed amendments.
The department responds that referenced forms and documents which are not
germane to the proposed amendments are not routinely included in field distribution
versions of proposed rules. Interested parties may obtain copies of all such
forms and documents by contacting the department's Medicaid office.
Concerning proposed §406.202, one commenter asked that the department
replace language regarding an individual's "legally authorized representative"
with language such as "someone legally empowered to act on his behalf."
The department responds that the language is consistent with the language
used in other department rules.
Concerning proposed §406.203(a), one commenter requested that the
department delete the phrase "the developmental disability of." The commenter
stated that the proposed rule is for the ICF/MR program, not ICF/DD program.
The department responds that the term "mental retardation' refers to a
subcategory of the more broadly utilized term "developmental disabilities."
Other subcategories of developmental disabilities are included in the ICF/MR
program under the term "related conditions" (RC).
Concerning §406.203(a)(1), one commenter asks why the intelligence
quotient (IQ) for related conditions is fixed at an IQ of 75 and the IQ for
mental retardation is set at 69.
The department responds the IQ criteria for mental retardation is set in
state law. A higher limit has been established for the wide range of developmental
disabilities contained in the RC program.
Concerning §406.204, this section does not show what ICF/MR/RC Level
VIII is based on.
The department responds that the definition of "person with related conditions"
in §406.202 describes Level VIII.
Concerning the proposal in general, one commenter stated that §§406.205-406.208
were not included in the proposal.
The department responds that §§406.205-406.208 were not amended.
Concerning §406.216, one commenter stated that definitions for "Interdisciplinary
team" (IDT) and "Qualified mental retardation professional" (QMRP) need to
be added.
The department responds by adding the definitions to §406.202.
Concerning the proposed role of mental retardation authorities, one commenter
stated that mental retardation authorities should not be given the role of
performing utilization reviews or continued-stay reviews of level-of-care
or level-of-need assignments at ICF/MR facilities. The commenter stated that
a state agency should perform these functions.
The department responds that the role of a mental retardation authority
is not addressed in the sections.
One commenter stated that the proposed four levels of need will replace
the four levels of mental retardation. The commenter noted that the proposed
levels of need are a more subjective system of assessment than the current
system and will likely result in significantly more individuals becoming
eligible for services.
The department responds that the basic eligibility criteria for ICF/MR
program levels of care have not been changed.
Concerning the Inventory for Client and Agency Planning (ICAP), one commenter
requested information concerning the validity and reliability of the instrument.
The department responds that the instrument is a nationally tested psychometric
assessment instrument. Validity and reliability data are published in the
examiner's manual for the ICAP.
Concerning §406.204, one commenter asked if there were differences
between level-of-care and level-of-need determinations.
The department responds that there is a difference between level-of-care
and level-of-need. Level-of-care relates to eligibility and is determined
by adaptive behavior level (ABL) and intellectual functioning. Level-of-need
is a payment category. The level-of-care criteria have not been changed.
Concerning proposed §406.204(b)(B)(i), one commenter stated that the
scores mentioned pertain to frequency counts of problem behavior, with no
attention to severity or intensity. The commenter noted that many of the
individuals served have low frequency but high intensity problem behaviors.
The department responds that the ICAP measures both frequency and intensity.
Further, the Texas Department Human Services (TDHS) Form 3650 measures additional
staffing needs associated with challenging behaviors.
Concerning §406.216(a), one commenter asked if the ICAP has to be
administered every six months.
The department responds that the ICAP service levels must be administered
annually. However, a change which involves an increase in the level-of-need
score must have prior approval by TDMHMR.
Concerning §406.216(a), one commenter asked why the ICAP has to be
administered annually.
The department responds that it agreed with an advisory panel recommendation
that the appropriate interval for such a review is annually.
One commenter asked if six hours of active treatment are required for individuals
who exhibit continuous aggression.
The department responds that "active treatment" is a federal term. There
has been no interpretation of a required number of hours. Active treatment
must be delivered whenever the consumer requires it. A definition for "active
treatment" has been added.
Concerning proposed §406.204(a)(6)(B), one commenter asked why an
individual who does not respond to his environment, but needs continuous
care for medical reasons, is not eligible for the ICF/MR Program.
The department responds the eligibility criteria reflects the federal requirement
that persons who cannot benefit from active treatment are not eligible for
ICF/MR funding.
Concerning §406.204(b), one commenter inquired about appeal procedures
regarding the level-of-need assignment. The commenter expressed concern that
only the individual or someone legally empowered to represent the individual
could appeal the level-of-need assignment.
The department responds that level-of-need appeal procedures will be addressed
in modifications to §406.214, regarding Utilization Review, which will
be proposed in the near future.
Concerning proposed §406.204(b)(5)(B)(ii), one commenter asked whether
a different level of supervision can be instituted after the level-of-need
has been initially established.
The department responds when the person no longer needs a continuous one-on-one
staffing level, a new level-of-need should be submitted to TDMHMR by the
facility.
Concerning the level-of-need assessment, one commenter asked how the level-of-need
assessment information will be documented.
The department responds that the level-of-need will be documented on TDHS
Form 3650, in Item #10 (recommended by the provider) and Item #85 (assigned
by TDHS or TDMHMR).
One commenter asked who will be responsible for administering the ICAP.
The department responds that each provider is responsible for having trained
staff assess individuals for whom it provides services. The department has
provided training to facility staff regarding the administration of the ICAP
Concerning the ICAP, one commenter asked whether the pervasive category
equates to the TDMHMR facility funding formula.
The department responds that the level-of-need is not the same as TDMHMR
facility funding formulas. State schools and state-operated ICFs/MR have
their own reimbursement methodology.
One commenter stated that the cost of the ICAP would be prohibitively expensive
for the commenter's facility.
The department responds that the $103.00 cost for a single test kit includes
the examiner's manual and 25 response booklets. The cost of the Compuscore
disk is $185. Additional sets of 25 booklets can be obtained for $30.40 each.
Small providers may choose to share costs with other small providers to keep
costs low.
Concerning the ICAP, one commenter stated there was not sufficient time
to train staff for implementation by January 1, 1997.
The department responds that although the time frame is limited, there
has been an adequate period for preparation. There is no mechanism for reimbursement
for persons living in non-state operated ICFs/MR who do not have a level-of-need
score after January 1, 1997.
Concerning §406.216(d), one commenter stated the time line of 10 working
days for the completion of the level-of-care assessment form is less realistic
than the current 20 calendar day time line.
The department responds that the time line has been modified to reflect
20 working days.
Concerning the rule in general, one commenter asked whether there is a
duplication of the information currently reported to CARE and therefore a
duplication of resources.
The department responds that CARE reporting is not used for Medicaid funding.
One commenter asked who will administer the ICAP and what type of training
will be offered.
The department responds that each provider is responsible for having trained
staff assess individuals for whom it provides services. Six training sessions
have been offered and related training tapes are available for purchase from
the publisher of the ICAP.
The amendents are adopted under the Texas Health and Safety Code,
§532.015, which provides the Texas Mental Health and Mental Retardation
Board with broad rulemaking authority, and under the provisions of Texas
Government Code, §531.021, which provides the Texas Health and Human
Services Commission with the authority to administer federal medical assistance
funds.
The sections affects Texas Human Resources Code, §§32.001-32.040,
and Texas Government Code, Chapter 531, §531.021.
§406.202.Definitions for Level-of-care and Level-of-need Criteria.
The following words and terms, when used in this chapter, shall have
the following meanings, unless the context clearly indicates otherwise:
Active treatment
-Continuous aggressive, consistent implementation
of a program of habilitation, specialized and generic training, treatment,
health services, and related services. The program must be directed toward:
(A)
the acquisition or maintenance of the behaviors
necessary for the individual to function with as much self-determination
and independence as possible, and
(B)
the prevention or deceleration of regression or loss
of current optimal functional status. Active treatment does not include services
to maintain generally independent individuals who are able to function with
little supervision or in the absence of a continuous active treatment program.
Adaptive behavior level (ABL)
-The effectiveness or degree
to which the individual meets the standards of personal independence and
social responsibility expected of the person's age and cultural group. The
assessment should be conducted with a standardized assessment instrument.
Cerebral palsy
-A group of disabling conditions that results
from nonprogressive damage to the central nervous system which usually occurs
before, during, or shortly after birth. The disability is characterized by
an inability to fully control motor functions.
Continued-stay review
-The individual review conducted by the
Texas Department of Human Services (TDHS) no later than six months following
the individual's admission to an ICF/MR facility and at least every six months
thereafter. The purpose of each review is to determine if the individual
continues to need the care and services provided by the ICF/MR Program and
if the level-of-care determination and level-of-need assignment are appropriate.
The Texas Department of Human Services may determine that the individual
no longer needs the care and services provided by the ICF/MR Program or that
the level-of-care determination and level-of-need assignment is not appropriate.
In this case, TDHS staff members make a new level-of-care determination and
level-of-need assignment.
Epilepsy
-A paroxysmal transient disturbance of brain function
that may be manifested as episodic impairment or loss of consciousness, abnormal
motor phenomena, psychic or sensory disturbances, and perturbation of the
autonomic nervous system. Symptoms are the result of paroxysmal disturbance
of the electrical activity of the brain.
ICAP service level
-The ICAP service level identifies the level
of services needed by an individual as determined by the Inventory for Client
and Agency Planning (ICAP) assessment instrument.
Interdisciplinary team (IDT)
-Those individuals (professionals,
paraprofessionals and non-professionals) who possess the knowledge, skills
and expertise necessary to accurately identify the comprehensive array of
an individual's needs and design a program which is responsive to those needs.
LON
-Level-of-need is the state classification system that
incorporates either the actual or adjusted ICAP service level and selected
items on the TDHS 3650 form.
Medical care plan
-A plan developed by a physician, in cooperation
with licensed nursing personnel, for an individual who requires 24-hour supervision
by licensed nurses.
Mental retardation
-Significantly subaverage general intellectual
functioning existing concurrently with deficits in adaptive behavior and
originating during the developmental period.
Persons with related conditions
-Individuals who have a severe,
chronic disability that:
(A)
is attributed to:
(i)
cerebral palsy or epilepsy;
or
(ii)
any other condition, other
than mental illness, found to be closely related to mental retardation because
the condition results in impairment of general intellectual functioning or
adaptive behavior similar to that of persons with mental retardation, and
requires treatment or services similar to those required for mentally retarded
persons;
(B)
is manifested before the person reaches age 22;
(C)
is likely to continue indefinitely; and
(D)
results in substantial functional limitations in at
least three of the following areas of major life activity;
(i)
self-care;
(ii)
understanding and use
of language;
(iii)
learning;
(iv)
mobility;
(v)
self-direction;
(vi)
capacity for independent
living.
TDHS
-The Texas Department of Human Services.
TDMHMR
-The Texas Department of Mental Health and Mental Retardation.
Qualified mental retardation professional
-A person who has
at least one year of experience working directly with individuals with mental
retardation or other developmental disabilities and who integrates, coordinates
and monitors each individual's active treatment program; and is:
(A)
a doctor of medicine or osteopathy;
(B)
a registered nurses; or
(C)
an individual who holds at least a bachelor's degree
in one of the following professional categories:
(i)
occupational therapist
or occupational therapist assistant;
(ii)
physical therapist or
physical therapist assistant;
(iii)
psychologist, with at
least a masters degree;
(iv)
social worker;
(v)
speech-language pathologist;
(vi)
professional recreation
staff;
(vii)
dietitian; or
(viii)
human services professional.
§406.204.Level-of-Care Determination and Level-of-Need Assignment.
(a)
Level-of-Care Determination.
(1)
The level-of-care determination is performed by the Texas
Department of Human Services according to the level-of-care criteria in this
subchapter. Information submitted to the Texas Department of Human Services
must be based on current data obtained from standardized evaluations and
formal assessments which include physical, emotional, social, and cognitive
factors.
(2)
The ICF/MR Program has four levels of care: ICF/MR
I, ICF/MR V, ICF/MR VI, and ICF-MR/RC VIII. Level-of-care determinations
for the ICF/MR I, ICF/MR V, and ICF/MR VI levels of care are based on the
individual's intellectual functioning. Level-of-care VIII determinations
are based on the following variables regarding the developmental needs of
each individual:
(A)
adaptive behavior and
(B)
health status.
(3)
A single, specific deficit or developmental need
does not necessarily indicate a need for active treatment.
(4)
If an I.Q. score cannot be obtained for a person with
severe or profound deficits in intellectual functioning, a social composite
score (S.C.) obtained on the Vineland Adaptive Behavior Scale or other professionally
accepted scale must be submitted. Documentation must be available that an
assessment of intelligence with a standardized instrument was attempted.
(5)
An individual is not eligible for the ICF/MR Program
if he:
(A)
Has been medically diagnosed as having "brain death," which
includes no evidence of sensory receptivity or sensory responsiveness on
a permanent basis; or
(B)
Does not respond in any way to his environment, but needs
continuous care for medical reasons.
(6)
Some individuals may have special health care
needs that necessitate placement in a facility which meets provisions of
the National Fire Protection Association's Life Safety Code, 1985 edition,
for accommodating special health care needs. When this occurs, placement
in a facility that meets appropriate Life Safety Code requirements takes
precedence over placement in a facility that matches the individual's level-of-care.
Regardless of his level-of care determination, an individual who requires
a 24 hour medical care plan is eligible for residence only in a facility
that meets the provisions of either chapter 12 or chapter 13 of the 1985
Life Safety Code.
(7)
If the Texas Department of Human Services determines
that information submitted for a level-of-care was not correct, the level-of-care
determination is reevaluated. If information originally submitted has changed,
the level-of-care determination is also re-evaluated.
(8)
If an individual's I.Q., adaptive behavior level,
and/or health status are such that he does not meet all the criteria for
any one level-of-care, TDHS conducts a special review of his application
for a level-of-care. TDHS may ask him to submit current psychological, social,
medical, and/or other evaluations.
(9)
The criteria for each level-of-care include a profile
of typical developmental needs for that level-of-care. Based on I.Q., adaptive
behavior level, and health status, an individual may meet the criteria for
two levels of care. In this situation, application is made for the level-of-care
that best meets the individual's developmental needs. This determination
is based on the profile that most closely describes the individual. A single
deficit in any of the categories of skills noted in a profile does not necessarily
make the individual ineligible for that level-of-care.
(b)
Level-of-Need Assignment.
(1)
A level-of-need(LON) assignment is required for the ICF/MR
and HCS programs.
(2)
The LON assignment is performed by the Texas Department
of Human Services according to the LON criteria in this subchapter. Information
submitted to the Texas Department of Human Services must be based on the
initial data obtained from the Inventory for Client and Agency Planning(ICAP)
and selected items on the TDHS Form 3650.
(3)
The ICF/MR Program has five levels of need: Intermittent,
Limited, Extensive, and Pervasive.
(4)
LON assignments are based on the following variables
regarding the developmental needs of each individual:
(A)
The ICAP service level score are categorized as levels
of need when the score range is as follows:
(i)
A score is considered to be an Intermittent LON (1) if
the ICAP Service Level equals 7, 8, or 9;
(ii)
A score is considered to be a Limited LON (5) if the ICAP
Service Level equals 4, 5, or 6;
(iii)
A score is considered to be an Extensive LON (8) if the
ICAP Service Level equals 2 or 3;
(iv)
A score is considered to be a Pervasive LON (6) if the
ICAP Service Level equals 1.
(v)
A score is considered to be a Pervasive LON (9) if TDHS
Form 3650 is scored with a least one Item 70 -73 = 2.
(B)
The Level-of-need can be modified to take into account
extraordinary service needs that result from unusual behavioral or medical
challenges. The level-of-need for these individuals combines ICAP Service
Level Scores and needs identified on selected items on the TDHS Form 3650.
A LON that does not directly correspond to the ICAP service level will be
subject to utilization review by TDHS and TDMHMR.
(i)
Persons who have challenging behaviors that require a behavior
program that requires constant preventive actions by additional staff will
be classified to the next level-of-need from the original level. Normal staffing
ratios are exceeded, although additional staff may assist in the supervision
of other individuals. If an individual is already in the pervasive category
due to an ICAP score, the person will retain the pervasive level-of-need.
Very serious problems have the following classification:
(I)
The behavior(s) presents a danger to self or others.
(II)
The behavior(s) warrants individualized objectives and
includes written procedures.
(III)
The frequency of the behavior(s) is reduced only with
constant staffing and a highly structured environment.
(IV)
The behavior(s) is difficult or impossible for a single
staff person to control when it occurs.
(V)
The behavior(s) precludes some activities/environments
that cannot be structured. The interventions used to control the behavior
will require regular documentation, monitoring, and revisions as needed to
meet the needs of the individual. Form 3650 is scored with at least one of
Items 70-73 = 1. The ICAP service level is moved to the next higher level-of-need.
(ii)
Persons who are at risk of hurting themselves or others
and require a constant daily ratio of 1:1, consisting of an average of 16
hours a day that the individual is awake, will be categorized under a special
service level-of-need for constant 1:1 surveillance. The behavior(s) is considered
extremely serious, or a critical problem whenever:
(I)
The behavior(s) may be life-threatening;
(II)
The behavior(s) warrant the highest priority of individualized
objectives and include a written record of every occurrence of the behavior;
(III)
The frequency of the behavior(s) is difficult to reduce;
or
(IV)
The consequences of the behavior(s) are difficult to minimize.
Form 3650 is scored with at least one of Items 70-73 = 2. The LON is Pervasive
+ (LON = 9) moved to the highest level-of-need.
(iii)
Persons who have extensive medical needs that require
frequent nursing intervention will be classified at the next higher level-of-need
(e.g., extensive will be classified as pervasive). If an individual is already
in the pervasive category due to an ICAP score, the person will retain the
pervasive level of service: Form 3650 is scored with Item #39 = 6 (frequency
code) and 15 or 16 (service code).
(5)
If the Texas Department of Human Services
determines that information submitted for a LON was not correct, the LON
assignment is reevaluated. If information originally submitted has changed,
the LON assignment may also be re-evaluated.
§406.214.Utilization Review.
(a)
Utilization review (UR) plans and procedures must conform
with policies of the Department of Health and Human Services, as required
by 42 Code of Federal Regulations §456.401. The Texas State Plan for
Title XIX requires a UR process for ICF/MR facilities participating in the
Texas Medical Assistance Program.
(b)
ICF/MR Program teams of the TDMHMR, or its designee perform
the UR functions for Title XIX clients in the facility.
(c)
The Texas Department of Mental Health and Mental Retardation
(TDMHMR) is responsible for developing and maintaining level-of-care and
level-of-need criteria to evaluate the necessity for each individual's continued
stay. These level-of-care and level-of-need criteria are specified in §§406.205-406.208
of this title.
(d)
UR-plan objectives are to:
(1)
promote quality care and to promote training that meets
individual needs;
(2)
determine whether needed services are available and
are provided on a continuing basis;
(3)
determine that the individual's are classified in
the correct payment category;
(4)
ensure that the services provided are necessary; and
(5)
review the individual program plan.
(e)
The provider may request a reconsideration of the assignment
of level-of-need made by TDMHMR or its designee by completing the Reconsideration
Notice and sending it to the Utilization Review Section of Medicaid Administration
at TDMHMR by certified mail within ten days of the date notification of the
level-of-need assignment. Additional clinical and supporting documents must
be sent by the provider. The Utilization Review Department will review all
reconsiderations and notify the provider verbally within five working days
of the receipt of the reconsideration form as to the decision of the department.
Written confirmation will follow within five working days of the verbal notification.
Prior approval is not a guarantee of payment.
(f)
The utilization review section of the TDMHMR office of
Medicaid Administration, or its designee, will conduct periodic retrospective
reviews. Based on such reviews, TDMHMR may recoup or deny payments to a provider.
§406.216. Preadmission and Admission Process.
(a)
The Texas Department of Human Services (TDHS) reviews Preadmission
and admission level-of-care and level-of-need assessments when a contracted
facility has requested vendor assistance for care for a Medicaid applicant
or consumer. ICF/MR I, ICF/MR V, and ICF/MR VI Preadmission level-of-care
and level-of-need assessments are valid for 30 days or until the individual
assessed is admitted to an ICF/MR facility, whichever is sooner. ICF/MR/RC
VIII Preadmission level-of-care and level-of-need assessments are valid for
90 days or until the individual assessed is admitted to an ICF/MR/RC facility,
whichever is sooner. Admission level-of-care and level-of-need assessments
are valid for 180 days after the date of admission or TDHS stamp-in date.
(b)
Before an individual's admission, an interdisciplinary
team of health care professionals, including a QMRP, must conduct a comprehensive
medical, nutritional, social, and psychological review of the individual's
status and need for ICF/MR care. If the evaluation indicates that the individual's
needs could be met by alternative services, facility staff must enter this
fact in the individual's record and document attempts to locate the services.
(c)
A physician must certify that each applicant or Medicaid
client needs ICF/MR services at the time of admission to the Medicaid program
and every six months thereafter. This certification is documented on the
level-of-care assessment form for each individual. TDHS processes only those
level-of-care assessment forms that include physicians' signatures. This
physician certification is part of each individual's record and is reviewed
annually as part of the inspection-of-care process. Facility staff must ensure
that the recertification states: "I hereby certify that this individual continues
to require ICF/MR care."
(d)
The facility must submit the person's level-of-care and
level-of-need (as described in §406.204 of this subchapter) to TDHS
ICF/MR/RC Regional Office within 20 working days of admission to the facility.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Issued in Austin, Texas, on January 17, 1997.
TRD-9700220
Ann K. Utley
Chairman, Texas MHMR Board
Texas Mental Health and Mental Retardation
Effective date: January 28, 1997
Proposal publication date: August 23, 1996
For further information, please call: (512) 206-4516