Part I.
Texas Department of Human Services
Chapter 1.
Presumptive Medicaid Eligibility for Pregnant Women
Subchapter A. Eligibility Requirements
40 TAC §1.1
The Texas Department of Human Services (DHS) proposes an
amendment to §1.1, concerning client eligibility requirements, in its
Presumptive Medicaid Eligibility for Pregnant Women chapter. The purpose of
the amendment is to comply with the Personal Responsibility and Work Opportunity
Act of 1996, under which Medicaid Type Program 32 coverage expired in January
1999.
Eric M. Bost, commissioner, has determined that for the first five- year
period the proposed section will be in effect there will be no fiscal implications
for state or local government as a result of enforcing or administering the
section.
Mr. Bost also has determined that for each year of the first five years
the section is in effect the public benefit anticipated as a result of enforcing
the section will be that the reference to a discontinued program is deleted
from the rule. There will be no effect on small businesses because the program
was discontinued January 1, 1997. There is no anticipated economic cost to
persons who are required to comply with the proposed section.
Questions about the content of the proposal may be directed to Mary Haifley
at (512) 438-2599 in DHS's Texas Works Department. Written comments on the
proposal may be submitted to Supervisor, Rules and Handbooks Unit-208, Texas
Department of Human Services E-205, P.O. Box 149030, Austin, Texas 78714-9030,
within 30 days of publication in the
Texas Register
.
Under §2007.003(b) of the Texas Government Code, the department has
determined that chapter 2007 of the Government Code does not apply to this
rule. Accordingly, the department is not required to complete a takings impact
assessment regarding this rule.
The amendment is proposed under the Human Resources Code, Title
2, Chapters 22 and 32, which provides the department with the authority to
administer public and medical assistance programs and under Texas Government
Code §531.021, which provides the Health and Human Services Commission
with the authority to administer federal medical assistance funds.
The amendment implements §§22.001-22.030 and 32.001-32.042 of
the Human Resources Code.
§1.1. Client Eligibility Requirements.
(a)-(b)
(No change.)
(c)
Requirements for Application. To be eligible for presumptive
Medicaid eligibility, pregnant women must meet the following requirements.
(1)
Citizenship. Citizenship requirements are the same as
those requirements specified for
Temporary Assistance for Needy Families
(TANF)
[
(2)-(3)
(No change.)
(d)-(e)
(No change.)
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on
June 10, 1999.
TRD-9903440
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: July 25, 1999
For further information, please call:
Subchapter A. Medicaid Benefits for Temporarily Legalized Aliens
40 TAC §5.1002, §5.1004
(Editor's note: The text of the following sections proposed for
repeal will not be published. The sections may be examined in the offices
of the Texas Department of Human Services or in the Texas Register office,
Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)
The Texas Department of Human Services (DHS) proposes
the repeal of §§5.1002 and §5.1004, concerning Legal Basis
and Eligibility Requirements, in its Medicaid Programs for Aliens chapter.
The purpose of the repeals is to comply with the Personal Responsibility and
Work Opportunity Act of 1996, under which Medicaid Type Program 32 coverage
expired in January 1999.
Eric M. Bost, commissioner, has determined that for the first five- year
period the proposed sections will be in effect there will be no fiscal implications
for state or local government as a result of enforcing or administering the
sections.
Mr. Bost also has determined that for each year of the first five years
the sections are in effect the public benefit anticipated as a result of enforcing
the sections will be that rules for a discontinued program are deleted from
the rules. There will be no effect on small businesses because the program
was discontinued January 1, 1997. There is no anticipated economic cost to
persons who are required to comply with the proposed sections.
Questions about the content of the proposal may be directed to Mary Haifley
at (512) 438-2599 in DHS's Texas Works Department. Written comments on the
proposal may be submitted to Supervisor, Rules and Handbooks Unit-208, Texas
Department of Human Services E-205, P.O. Box 149030, Austin, Texas 78714-9030,
within 30 days of publication in the
Texas Register
.
Under §2007.003(b) of the Texas Government Code, the department has
determined that chapter 2007 of the Government Code does not apply to these
rules. Accordingly, the department is not required to complete a takings impact
assessment regarding these rules.
The repeals are proposed under the Human Resources Code, Title
2, Chapters 22 and 32, which provides the department with the authority to
administer public and medical assistance programs and under Texas Government
Code §531.021, which provides the Health and Human Services Commission
with the authority to administer federal medical assistance funds.
The repeals implement §§22.001-22.030 and 32.001-32.042 of the
Human Resources Code.
§5.1002. Legal Basis.
§5.1004. Eligibility Requirements.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of the Secretary of State, on
June 10, 1999.
TRD-9903441
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: July 25, 1999
For further information, please call:
The Texas Department of Human Services (DHS) proposes to amend §§15.100,
concerning definitions; 15.105, concerning description of eligible clients;
15.210, concerning time frames for buy-in enrollment; 15.305, concerning eligibility
requirements for the aged, blind, or disabled; 15.410, concerning deeming
of resources; 15.455, concerning unearned income; 15.460, concerning income
exemptions; and 15.475, concerning deeming of income; in its Medicaid Eligibility
chapter. The purpose of the amendments is to update references to the Aid
to Families with Dependent Children (AFDC) program to the current program
name, Temporary Assistance for Needy Families (TANF). There are no policy
changes.
Eric M. Bost, commissioner, has determined that for the first five-year
period the proposed amendments will be in effect there will be no fiscal implications
for state or local governments as a result of enforcing or administering the
amendments.
Mr. Bost also has determined that for each year of the first five years
the amendments are in effect the public benefit anticipated as a result of
enforcing the amendments will be that DHS's rules will not contain references
to an obsolete program. The rules will reflect the correct program name. The
amendments will not have an adverse economic effect on small or large businesses
because they contain no policy changes. They only update references from AFDC
to TANF.
Questions about the content of this proposal may be directed to Judy Coker
at (512) 438-3227 in DHS's Long-Term Care section. Written comments on the
proposal may be submitted to Supervisor, Rules and Handbooks Unit-191, Texas
Department of Human Services E-205, P.O. Box 149030, Austin, Texas 78714-9030,
within 30 days of publication in the
Texas Register
.
Subchapter A. General Information
40 TAC §15.100, §15.105
Under §2007.003(b) of the Texas Government Code, the
department has determined that Chapter 2007 of the Government Code does not
apply to these rules. Accordingly, the department is not required to complete
a takings impact assessment regarding these rules. The department has determined
that the proposed rule will not affect any private real property interests.
Accordingly, no takings impact assessment regarding this rule is required
under §2007.043 of the Texas Government Code and §2.19 of the Private
Real Property Rights Preservation Act Guidelines adopted by the Attorney General
and published on January 12, 1996, in the
Texas Register
(21 TexReg 387).
The amendments are proposed under the Human Resources Code, Title 2, Chapters
22 and 32, which authorizes the department to administer public and medical
assistance programs and under Texas Government Code §531.021, which provides
the Health and Human Services Commission with the authority to administer
federal medical assistance funds.
The amendments implement §§22.001-22.030 and 32.001-32.042 of
the Human Resources Code.
§15.100.Definitions.
The following words and terms, when used in this chapter, have the
following meanings unless the context clearly indicates otherwise:
(1) - (2)
(No change.)
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(A)
The insured is the individual upon whose life a whole life
or straight life policy is effected.
(B)
The beneficiary is the individual (or entity) named in
the con- tract to receive the proceeds of the policy upon the death of the
insured.
(C)
The owner is the individual paying the premiums on the
policy, with the right to change it as he may see fit. The owner is the only
individual who can receive the cash surrender amount of the policy.
(D)
The insurer-assurer is the company that contracts with
the owner.
(E)
The face value amount is the basic death benefit or maturity
amount, which is specified on the policy's face. The face value does not include
dividends, additional amounts payable because of accidental death, or other
special provisions.
(F)
The cash surrender value is the amount that the insurer
pays if the policy is cancelled before death or before it has matured. The
cash surrender value usually increases with the age of the policy.
(G)
A participating life insurance policy is one in which dividends
are distributed to the policy holder.
(H)
A nonparticipating life insurance policy means that dividends
are not distributed to the policy holders.
(I)
Default is the failure to pay the insurance premiums. There
may be conditions in the policy relating to default.
(J)
Ordinary life insurance (also known as whole life or straight
life) is a contract for which the owner pays premiums and the insurer pays
the face amount of the policy to the beneficiary upon the death of the insured.
(K)
An individual policy is a policy that is paid for entirely
by the owner.
(L)
A group policy is usually issued through an employer or
organization. The premiums may include some contribution from the employer.
(M)
Dividends are shares of surplus funds allocated to the
policy holders of participating insurance policies. They generally represent
a previous overpayment of premiums. Dividends may be received as cash payments;
used to reduce future premium payments; applied to the existing insurance
to increase coverage; or left as a separate accumulation of funds that draw
interest.
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(A)
The owner engages in periodic advice and consultation with
the tenant, inspection of the production activities, and furnishing of machinery,
equipment, livestock, and production expenses.
(B)
The owner makes management decisions that affect the success
of the enterprise.
(C)
The owner performs a specified amount of physical labor
to produce the commodities raised.
(D)
The owner does not meet the full requirements above but
his involvement in crop production is nevertheless significant.
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(123)
Temporary Assistance for Needy Families
(TANF) - Financial assistance to low-income families under Title IV of the
Social Security Act. TANF clients are also eligible for Medicaid.
(124) - (138)
(No change.)
§15.105.Description of Eligible Clients.
The Texas Medical Assistance Program provides, under Title XIX (Medicaid)
of the Social Security Act, certain benefits to all individuals who meet the
department's definition of eligible recipients. Eligible recipients are:
(1)
individuals who are
:
[
(A)
Temporary Assistance for Needy Families
(TANF) recipients whose eligibility criteria are outlined in Chapter 3 of
this title (relating to Income Assistance Services);
(B)
Pregnant women and children whose eligibility
criteria are outlined in Chapter 4 of this title (relating to Medicaid Programs
- Children and Pregnant Women); or
(C)
Medically needy recipients whose eligibility
criteria are outlined in Chapter 2 of this title (relating to Medically Needy
Program).
(2) - (17)
(No change.)
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of the Secretary of State, on
June 10, 1999.
TRD-9903442
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: July 25, 1999
For further information, please call: (512) 438-3765
40 TAC §15.210
Under §2007.003(b) of the Texas Government Code, the
department has determined that Chapter 2007 of the Government Code does not
apply to these rules. Accordingly, the department is not required to complete
a takings impact assessment regarding these rules. The department has determined
that the proposed rule will not affect any private real property interests.
Accordingly, no takings impact assessment regarding this rule is required
under §2007.043 of the Texas Government Code and §2.19 of the Private
Real Property Rights Preservation Act Guidelines adopted by the Attorney General
and published on January 12, 1996, in the
Texas Register
(21 TexReg 387).
The amendment is proposed under the Human Resources Code, Title 2, Chapters
22 and 32, which authorizes the department to administer public and medical
assistance programs and under Texas Government Code §531.021, which provides
the Health and Human Services Commission with the authority to administer
federal medical assistance funds.
The amendment implements §§22.001-22.030 and 32.001-32.042 of
the Human Resources Code.
§15.210.Time Frames for Buy-in Enrollment.
(a)
Clients who have Medicare Part B coverage at the time they
are certified for Medicaid are enrolled as follows:
(1)
Supplemental Security Income (SSI)
[
(2) - (5)
(No change.)
(b) - (c)
(No change.)
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on
June 10, 1999.
TRD-9903443
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: July 25, 1999
For further information, please call: (512) 438-3765
40 TAC §15.305
Under §2007.003(b) of the Texas Government Code, the
department has determined that Chapter 2007 of the Government Code does not
apply to these rules. Accordingly, the department is not required to complete
a takings impact assessment regarding these rules. The department has determined
that the proposed rule will not affect any private real property interests.
Accordingly, no takings impact assessment regarding this rule is required
under §2007.043 of the Texas Government Code and §2.19 of the Private
Real Property Rights Preservation Act Guidelines adopted by the Attorney General
and published on January 12, 1996, in the
Texas Register
(21 TexReg 387).
The amendment is proposed under the Human Resources Code, Title 2, Chapters
22 and 32, which authorizes the department to administer public and medical
assistance programs and under Texas Government Code §531.021, which provides
the Health and Human Services Commission with the authority to administer
federal medical assistance funds.
The amendment implements §§22.001-22.030 and 32.001-32.042 of
the Human Resources Code.
§15.305.Eligibility Requirements for the Aged, Blind, or Disabled.
(a) - (d)
(No change.)
(e)
To be eligible, a client must file:
(1)
for all other benefits to which he may be entitled.
(A)
(No change.)
(B)
These benefits do not include:
(i)
federal, state, local, or private programs based on need,
such as
Temporary Assistance for Needy Families
[
(ii)
(No change.)
(2) - (3)
(No change.)
(f) - (k)
(No change.)
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on
June 10, 1999.
TRD-9903444
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: July 25, 1999
For further information, please call: (512) 438-3765
40 TAC §15.410
Under §2007.003(b) of the Texas Government Code, the
department has determined that Chapter 2007 of the Government Code does not
apply to these rules. Accordingly, the department is not required to complete
a takings impact assessment regarding these rules. The department has determined
that the proposed rule will not affect any private real property interests.
Accordingly, no takings impact assessment regarding this rule is required
under §2007.043 of the Texas Government Code and §2.19 of the Private
Real Property Rights Preservation Act Guidelines adopted by the Attorney General
and published on January 12, 1996, in the
Texas Register
(21 TexReg 387).
The amendment is proposed under the Human Resources Code, Title 2, Chapters
22 and 32, which authorizes the department to administer public and medical
assistance programs and under Texas Government Code §531.021, which provides
the Health and Human Services Commission with the authority to administer
federal medical assistance funds.
The amendment implements §§22.001-22.030 and 32.001-32.042 of
the Human Resources Code.
§15.410.Deeming of Resources.
(a)
Deeming of spouse's resources. The department deems spouse's
resources as follows:
(1)
spouses living together. If a married client lives in the
same household with an ineligible spouse, the department counts both the ineligible
spouse's and the client's resources and applies the couple resource limit
to the combined countable resources. The spouse's resources are counted even
if they are not available to the client. Pension funds owned by an ineligible
spouse or parent are excluded from resources for deeming purposes. If the
ineligible spouse is
a Temporary Assistance for Needy Families (TANF)
[
(2) - (3)
(No change.)
(b)
Deeming for children. The department's requirements regarding
deeming for children are as follows:
(1)
If a disabled child under 18 lives with his parents in
the same household, the department must deem to the child certain resources
of the parents. If a parent is
a TANF
[
(2)- (3)
(No change.)
(c)
(No change.)
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on
June 10, 1999.
TRD-9903445
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: July 25, 1999
For further information, please call: (512) 438-3765
40 TAC §§15.455, 15.460, 15.475
Under §2007.003(b) of the Texas Government Code, the
department has determined that Chapter 2007 of the Government Code does not
apply to these rules. Accordingly, the department is not required to complete
a takings impact assessment regarding these rules. The department has determined
that the proposed rule will not affect any private real property interests.
Accordingly, no takings impact assessment regarding this rule is required
under §2007.043 of the Texas Government Code and §2.19 of the Private
Real Property Rights Preservation Act Guidelines adopted by the Attorney General
and published on January 12, 1996, in the
Texas Register
(21 TexReg 387).
The amendments are proposed under the Human Resources Code, Title 2, Chapters
22 and 32, which authorizes the department to administer public and medical
assistance programs and under Texas Government Code §531.021, which provides
the Health and Human Services Commission with the authority to administer
federal medical assistance funds.
The amendments implement §§22.001-22.030 and 32.001-32.042 of
the Human Resources Code.
§15.455.Unearned Income.
(a)
(No change.)
(b)
Support and maintenance (S/M). The following requirements
apply to support and maintenance.
(1)
Support and maintenance not counted as income. Support
and maintenance are not counted as income if:
(A) - (G)
(No change.)
(H)
the client lives in a public assistance household, defined
as one in which each member receives cash or vendor payments from one of the
following:
Temporary Assistance for Needy Families (TANF)
[
(I)
(No change.)
(2) - (9)
(No change.)
(c) - (d)
(No change.)
(e)
Other unearned income. Other sources of unearned income
include:
(1)
(No change.)
(2)
interest payments on joint bank accounts. In this
context, the term "spouse" includes a spouse whose income is considered in
the applied income determination process. Interest payments on joint bank
accounts are considered as follows:
(A)
if the coholders of the account are not eligible for SSI,
TANF
[
(B)
if one or more coholders are eligible for
TANF
[
(C)
(No change.)
(3) - (11)
(No change.)
§15.460.Income Exemptions.
(a)
(No change.)
(b)
The Texas Department of Human Services exempts income that
a client receives from any of the following sources:
(1) - (5)
(No change.)
(6)
the amount of income of a dependent who is receiving
Supplemental Security Income (SSI) or
Temporary Assistance for Needy
Families (TANF)
[
(7) - (38)
(No change.)
§15.475.Deeming of Income.
(a)
The following requirements apply:
(1) - (3)
(No change.)
(4)
The Texas Department of Human Services (DHS) exempts
certain types of income that may be received by a client's ineligible spouse,
ineligible parent, a parent's ineligible spouse, or any ineligible children
living in the household. The following types of income are not deemed to the
client:
(A) - (E)
(No change.)
(F)
amount of income of a dependent who is receiving
Supplemental Security Income (SSI)
[
(G) - (II)
(No change.)
(b)
The following exceptions apply to deeming of income:
(1)
If the client's spouse, parent, or parent's spouse is a
member of
a TANF
[
(2) - (10)
(No change.)
(c) - (d)
(No change.)
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on
June 10, 1999.
TRD-9903446
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: July 25, 1999
For further information, please call: (512) 438-3765
40 TAC §20.101, §20.105
The Texas Department of Human Services (DHS) proposes amendments
to §20.101, concerning Introduction, and §20.105, concerning General
Reporting and Documentation Requirements, Methods, and Procedures, in its
Cost Determination Process chapter. This proposal is submitted simultaneously
with a proposal by the Texas Health and Human Services Commission (HHSC) to
amend corresponding provisions of Title 1, Chapter 355, TAC.
The purpose of the amendments is to comply with changes in state and federal
laws. One proposed amendment reflects a change in the Medicaid program rate
approval process. The proposed amendment reflects the current process in which
the Texas Board of Human Services no longer recommends rates to HHSC, because
HHSC was assigned responsibility for Medicaid rate determination by a change
in state law in House Bill 2913, 75th Legislature (1997). Since rates for
most non-Medicaid payment rates have a Medicaid counterpart, approval of the
Medicaid rates by HHSC effectively determines the non-Medicaid counterpart
rates. Thus, a proposed amendment provides that non- Medicaid payment rates
will be set to coincide with the counterpart Medicaid rates. A proposed amendment
also removes references to the federal Boren Amendment, which formerly applied
to the nursing facility program, because it is no longer in effect as a result
of a change in federal law.
Eric M. Bost, commissioner, has determined that for the first five-year
period the sections are in effect there will be no fiscal implications for
state or local government as a result of enforcing or administering the sections.
Mr. Bost also has determined that for each year of the first five years
the sections are in effect the public benefit anticipated as a result of enforcing
the sections will be that the rules will reflect the changes in federal and
state law and that providers will have defined for them the payment rate approval
process. There will be no effect on small businesses, because the amendments
reflect HHSC and DHS current Medicaid rate approval processes, based on changes
in state law; and establish consistency in non-medicaid rate approval processes.
The amendments also delete references to the federal Boren Amendment, which
is no longer in effect as a result of a change in federal law. No changes
in practice are required of any businesses, large or small. There is no anticipated
economic cost to persons who are required to comply with the proposed sections.
Under §2007.003(b) of the Texas Government Code, the department has
determined that chapter 2007 of the Government Code does not apply to these
rules. Accordingly, the department is not required to complete a takings impact
assessment regarding these rules.
Questions about the content of this proposal may be directed to Kathy Hall
at (512) 438-3702 in DHS's Rate Analysis Department. Written comments on the
proposal may be submitted to Supervisor, Rules and Handbooks Unit-200, Texas
Department of Human Services E-205, P.O. Box 149030, Austin, Texas 78714-9030,
within 30 days of publication in the
Texas Register
.
The amendments are proposed under the Human Resources Code, Title
2, Chapters 22 and 32, which authorizes the department to administer public
and medical assistance programs; and under Texas Government Code §531.021,
which provides the Health and Human Services Commission with the authority
to administer federal medical assistance funds.
The amendments implement the Human Resources Code, §§22.001-
22.030 and §§32.001-32.042.
§20.101. Introduction.
(a)-(b)
(No change.)
(c)
The Texas Department of Human Services (DHS) reimburses
providers for contracted client services through reimbursement amounts determined
as described in this chapter and in reimbursement methodologies for each program.
Non-Medicaid, statewide, uniform reimbursements and reimbursement ceilings
are approved by the Texas
Department
(1)-(2)
(No change.)
§20.105. General Reporting and Documentation Requirements, Methods, and Procedures.
(a)-(c)
(No change.)
(d)
Amended cost report due dates. DHS accepts submittal of
provider- initiated or DHS-requested amended cost reports as follows.
(1)
Provider-initiated amended cost reports must be received
no later than the date in subparagraph (A) or (B) of this paragraph, whichever
occurs first. Amended cost reports received after the required date have no
effect on the reimbursement determination. Amended cost report information
that cannot be verified will not be used in reimbursement determinations.
Provider-initiated amended cost reports must be received no later than the
earlier of:
(A)
(No change.)
(B)
for Medicaid programs, 30 days prior to the public hearing
on proposed reimbursement or reimbursement parameter amounts; and for non-Medicaid
programs
30 days prior to the administrative closing of the cost report
database for reimbursement determination
[
(2)
(No change.)
(e)-(f)
(No change.)
(g)
Public hearings.
(1)
Uniform reimbursements. For Medicaid programs where reimbursements
are uniform by class of service and/or provider type, DHS
and the HHSC
will hold a public hearing on proposed reimbursements before the
HHSC
[
(2)
Contractor-specific reimbursements.
For Medicaid
programs in which
[
(h)
(No change.)
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on
June 9, 1999.
TRD-9903398
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Proposed date of adoption: September 1, 1999
For further information, please call: (512) 438-3765
Chapter 142.
Investigations and Hearings
40 TAC §142.22, §142.31
The Texas Commission on Alcohol and Drug Abuse proposes amendments
to §142.22 and §142.31 concerning Investigations and Hearings. These
sections contain the procedures concerning investigations of abuse or neglect
of children, the elderly, or the disabled by chemical dependency counselors
or facilities funded or licensed by the commission and describe the procedures
for facility and chemical dependency counselor disciplinary hearings.
These amendments are proposed to update organizational references and provide
consistency with the Government Code regarding minimum amount of notice that
must be given regarding the date, time and place of administrative hearings.
Terry Faye Bleier, Executive Director, has determined that for the first
five-year period the rules are in effect there will be no fiscal implications
for state or local government as a result of enforcing the rules.
Ms. Bleier has also determined that for each year of the first five years
the rules are in effect the anticipated public benefit will be clarity about
the procedures concerning investigations of abuse or neglect of children,
the elderly, or the disabled by chemical dependency counselors or facilities
funded or licensed by the commission and consistency regarding the minimum
notice given to respondents in administrative hearings. There is no additional
effect on small businesses. There is no anticipated economic cost to persons
required to comply with the proposed amendments.
Comments on the proposal may be submitted to Tamara Allen, Quality Assurance,
Texas Commission on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas
78708-0529. Comments must be received no later than 30 days from the date
the proposal is published in the
Texas Register
.
These amendments are proposed under the Texas Health and Safety
Code, Chapter 464, which provides the Texas Commission on Alcohol and Drug
Abuse with the authority to adopt rules and standards for the licensure of
chemical dependency treatment facilities and under Texas Civil Statutes, Article
4512o, which provides the commission with the authority to establish procedures
for the licensure of chemical dependency counselors.
The codes affected by the proposed amendments are the Texas Health and
Safety Code, Chapter 464 and Texas Civil Statutes, Article 4512o.
§142.22. Investigations of Abuse or Neglect of Children, the Elderly, or the Disabled.
(a)-(d)
(No change.)
(e)
Reports. In abuse or neglect cases, the investigator submits
a written report to the [
(f)-(g)
(No change.)
§142.31. Procedure for Facility and Chemical Dependency Counselor Disciplinary Hearings.
(a)-(d)
(No change.)
(e)
The respondent is entitled to at least
ten
[
(f)-(l)
(No change.)
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on
June 14, 1999.
TRD-9903487
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Earliest possible date of adoption: July 25 ,1999
For further information, please call: (512) 349-6733
40 TAC §142.32
The Texas Commission on Alcohol and Drug Abuse proposes an
amendment to §142.32 concerning Investigations and Hearings. This section
describes the procedures regarding administrative penalties for facilities
and chemical dependency counselors.
The amendment is proposed to: clarify commission's authority to classify
offenses not already included in the guidelines; complete the list of disciplinary
actions available to the commission; establish commission's role in judging
compliance; allow the commission to choose an administrative penalty or an
alternate action when the total dollar value of a facility's assessed penalty
is over $5,000; limit the number of facility waivers and require compliance
as a precondition when appropriate; eliminate waiver of administrative penalties
for counselors; clarify board and executive director responsibilities in approving
administrative penalties; provide licensees an option to surrender the license
in lieu of paying administrative penalties; and eliminate an outdated transition
clause. In addition, amendments to the graphics that are included in this
section are made to revise the method of assigning points for history of disciplinary
action and to clarify that only full compliance is sufficient to receive credit
for efforts to correct violations when assigning points.
Terry Faye Bleier, Executive Director, has determined that for the first
five-year period the rule is in effect there will be minimal fiscal implications
for the commission as facilities and counselors are assessed fees and pay
those fees to the commission. There will be no fiscal impact for other state
agencies or local government as a result of the proposed amendment.
Ms. Bleier has also determined that for each year of the first five years
the rule is in effect the public benefit anticipated will be consistent, orderly
and fair sanctions for persons and entities regulated by the commission. There
is no additional effect on small businesses. There is no additional anticipated
economic cost to persons required to comply with the amended rule as proposed;
however, specific persons and entities will pay penalties to the commission.
Comments on the proposal may be submitted to Tamara Allen, Quality Assurance,
Texas Commission on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas
78708-0529. Comments must be received no later than 30 days from the date
the proposal is published in the
Texas Register
.
The amendment is proposed under the Texas Health and Safety Code,
Chapter 464, which provides the Texas Commission on Alcohol and Drug Abuse
with the authority to adopt rules and standards for the licensure of chemical
dependency treatment facilities and under Texas Civil Statutes, Article 4512o,
which provides the commission with the authority to establish procedures for
the licensure of chemical dependency counselors.
The codes affected by the proposed amendment is the Texas Health and Safety
Code, Chapter 464 and Texas Civil Statutes, Article 4512o.
§142.32. Administrative Penalties.
(a)
Violations are categorized according to the seriousness
of the violation and the actual or potential harm to the health, safety, and
welfare of the public. The commission has established specific guidelines
for assigning categories.
These guidelines show how various offenses
are categorized, but do not limit the commission's authority to categorize
any particular offense that is not already included in the guidelines or to
modify those offenses already categorized.
These guidelines are available
for review at the commission's administrative offices at 9001 North IH 35,
Suite 105, Austin, Texas, 78753.
(b)
Administrative penalties are not assessed for the most
serious violations, which are assigned to Category A. Instead, the commission
will seek to
deny, refuse to renew,
revoke or suspend the license.
(c)
Administrative penalties are not an option if the licensee
has failed to pay administrative penalties assessed in the past.
(d)
Self-reported facility violations are not subject to administrative
penalties provided:
(1)
the facility is required to report the violation;
(2)
the facility achieves
full
compliance
(as determined by the commission)
by the established deadline; and
(3)
the commission does not initiate a field investigation.
(e)
Administrative penalties for facilities are assessed using
the following point system.
(1)
Points are assigned to each violation using the matrix
shown in Figure 1.
Figure 1: 40 TAC §142.32(e)
(2)
The point value of all violations is added and the
total is multiplied by $10 per point.
(3)
If the total dollar value is over $5,000, the commission
may
[
(4)
The commission will waive collection of the administrative
penalties if:
(A)
all violations fall into Category C or Category D; [
(B)
the total assessed dollar value is less than $1,000;
(C)
administrative penalties have
not been waived two times in the past; and
(D)
compliance, where appropriate,
has been achieved or the facility has entered into an agreement with the commission
which ensures future compliance.
(f)
Administrative penalties for counselors are assessed using
the following point system.
(1)
Points are assigned to each violation using the matrix
shown in Figure 2.
Figure 2: 40 TAC §142.32(f)
(2)
The point value of all violations is added and the
total is multiplied by $12 per point.
(3)
If the total dollar value is over $2,000, the commission
may
[
[
The commission will
waive collection of the administrative penalties if:]
[
all violations fall into Category C or Category
D; and]
[
the total assessed dollar value is less than
$500.]
(g)-(h)
(No change.)
(i)
The licensee shall accept the determination and recommended
penalty or request an administrative hearing in writing within 20 days of
the mailing of the notice. If the licensee accepts the determination and recommended
penalty, the board
(in cases involving facilities) or the executive director
(in cases involving counselors)
shall issue an order approving both.
(j)-(l)
(No change.)
(m)
A licensee may surrender the license in lieu of paying
administrative penalties. The licensee may reapply for licensure if administrative
penalties are paid within one year from the date of license surrender.
[
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on
June 14, 1999.
TRD-9903488
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Earliest possible date of adoption: July 25 ,1999
For further information, please call: (512) 349-6733
40 TAC §§143.3, 143.17, 143.21, 143.25
The Texas Commission on Alcohol and Drug Abuse proposes amendments
to §143.17 and §143.21 and proposes new §143.3 and §143.25
concerning Funding. These sections describe the service procurement plan,
the process for funding decisions, the quarterly funding process and the developmental
funding process.
These amendments and new sections are proposed to establish a service procurement
plan, state that the commission may choose an alternative funding process
when no fundable application is received, rename the developmental funding
process to quarterly funding process to more accurately name this process,
refine the quarterly funding process, and establish a new developmental funding
process.
Terry Faye Bleier, Executive Director, has determined that for the first
five-year period the rules are in effect there will be no fiscal implications
for state or local government as a result of enforcing the rules.
Ms. Bleier has also determined that for each year of the first five years
the rules are in effect the anticipated public benefit will be a more fully
developed funding process, which will provide better options for ensuring
service needs are met. There is no additional effect on small businesses.
There is no anticipated economic cost to persons required to comply with the
proposed amendments and new rules.
Comments on the proposal may be submitted to Tamara Allen, Quality Assurance,
Texas Commission on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas
78708-0529. Comments must be received no later than 30 days from the date
the proposal is published in the
Texas Register
.
These amendments and new rules are proposed under the Texas Health
and Safety Code, Chapter 461.012(15), which provides the Texas Commission
on Alcohol and Drug Abuse with the authority to adopt rules governing the
functions of the commission, including rules that prescribe the policies and
procedures followed by the commission in administering any commission programs.
The code affected by the proposed amendments and new rules is the Texas
Health and Safety Code, Chapter 461.
§143.3. Service Procurement Plan.
(a)
The commission develops an annual service procurement
plan to implement the Statewide Service Delivery Plan. The plan includes funding
goals for the state overall and for each region.
(b)
The service procurement plan identifies what services
are needed, where the services are needed, and the priority order of the services
to be purchased. It may also specify the desired level of funding for each
service.
§143.17. Funding Decisions.
(a)
(No change.)
(b)
The panel's recommendations are reviewed [
(c)-(g)
(No change.)
(h)
If the commission does not
receive a fundable application for a desired service, it may choose an alternative
process to procure the service, including:
(1)
the quarterly funding process described in
§143.21 of this title (relating to Quarterly Funding);
(2)
the developmental funding process described
in §143.25 of this title (relating to Developmental Funding); or
(3)
noncompetitive renewal described in §143.24
of this title (relating to Noncompetitive Renewal).
§143.21. Quarterly [
(a)
The commission
may use
[
(1)
purchase additional services if service needs and funds
remain after a competitive request for proposals;
(2)
distribute funds that become available and must be
awarded during a contract period; and
(3)
consider funding for unsolicited applications.
(b)
Funds available for one-time procurements and funds available
for recurring services are
competed
[
(c)
(No change.)
(d)
The commission identifies the goals and services/products
to be purchased based on its
service procurement plan
[
(e)
Selection criteria are designed to select applications
that provide the best overall value to the state.
(1)
(No change.)
(2)
A minimum score is established for
quarterly
[
(3)
Selection criteria for
quarterly
[
(f)
Once per quarter, if funds are available, notice
[
(1)
the services to be purchased;
(2)
the geographic area to be served;
(3)
funding limitations;
(4)
method of payment;
(5)
contract period;
(6)
requirements for submitting an application; and
(7)
the procedure the commission will use to award the
contract.
(g)
The commission accepts applications on an ongoing basis,
and may also consider previously submitted proposals. Applications eliminated
during
prior
competition may be revised and resubmitted for
quarterly
[
(h)
During the quarterly process, the commission will
not consider applications received more than six months before the quarterly
application due date unless the applicant has submitted a letter requesting
consideration of a prior application during that six-month period.
[
(i)
All applications are subject to the same requirements
and deadlines.
[
(1)
To be considered for funding, an applicant must meet the
application criteria listed in §143.15
of this title
(relating
to Application Criteria).
(2)
Applicants who are not already funded by the commission
must submit additional documentation regarding the organization's legal and
financial status.
(3)
If required, applicants shall comply with the Texas
Review and Comment System (TRACS).
(j)
Each application is evaluated in relation to the
services to be purchased and the selection criteria.
Commission staff
evaluate and score proposals that were not scored during the competitive RFP.
RAC members may also serve as reviewers outside their own regions.
(k)
(No change.)
(l)
The panel's recommendations are reviewed [
(m)
Quarterly
[
§143.25. Developmental Funding.
(a)
The commission may initiate the developmental funding
process when a competitive process has failed to elicit an acceptable offer
for a service identified in the annual services procurement plan.
(b)
The commission will establish funding criteria for each
developmental project to identify the minimum standards that must be met by
an applicant in order to receive funds. The funding criteria will be approved
by the commission's executive director.
(c)
A notice that funds are available for the service will
be published on the commission's website, on the state's electronic business
daily, and in the
Texas Register
for at least
21 days.
(d)
Commission staff will meet with the Regional Advisory
Consortium, local providers, and other community groups and stakeholders to
provide information about the identified need and identify potential providers.
Staff will facilitate development of consensus on an organization or coalition
to apply for the developmental funding.
(e)
If more than one provider is interested in the project,
the commission will terminate the developmental process and initiate a competitive
process.
(f)
When only one prospective applicant is identified, commission
staff may provide consultation and technical assistance during the development
of an application for developmental funding.
(g)
After the application is submitted, an internal selection
panel will review the proposal to determine whether it meets the minimum criteria
established for the project and conduct a cost analysis or budget review.
(h)
If the internal selection panel determines that the application
meets the minimum criteria, it will recommend a level of funding and an implementation
plan that includes:
(1)
roles and responsibilities of the provider and commission
staff;
(2)
completion dates for key milestones; and
(3)
conditions for payments related to achievement of
key milestones.
(i)
The panel's recommendations will be reviewed by the commission's
executive management team and approved by the executive director.
(j)
An organization funded through the developmental process
must meet the application criteria stated in §143.15 of this title (relating
to Application Criteria) when the contract is signed, except that a treatment
applicant does not need to be licensed to provide the requested services to
the proposed population until service delivery begins.
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on
June 14, 1999.
TRD-9903489
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Earliest possible date of adoption: July 25 ,1999
For further information, please call: (512) 349-6733
Subchapter A. General Provisions
40 TAC §144.1, §144.21
The Texas Commission on Alcohol and Drug Abuse proposes amendments
to §144.1 and §144.21 concerning General Provisions. These sections
describe the applicability of this chapter and the definitions of terms used
in this chapter.
These amendments are proposed to clarify that this chapter applies to intervention
programs as well as prevention and treatment programs funded by the commission
and to add and/or clarify the definitions of terms used in this chapter.
Terry Faye Bleier, Executive Director, has determined that for the first
five-year period the rules are in effect there will be no fiscal implications
for state or local government as a result of enforcing the rules.
Ms. Bleier has also determined that for each year of the first five years
the rules are in effect the anticipated public benefit will be a better understanding
of the rules contained in this chapter and the programs to which these rules
pertain. There is no additional effect on small businesses. There is no anticipated
economic cost to persons required to comply with the proposed amendments.
Comments on the proposal may be submitted to Tamara Allen, Quality Assurance,
Texas Commission on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas
78708-0529. Comments must be received no later than 30 days from the date
the proposal is published in the
Texas Register
.
In addition, there will be a hearing to receive public comments on these proposed
rules at 4:30 p.m., Monday July 12, 1999, at the Austin Convention Center,
5000 East Cesar Chavez, Austin, Texas. If you have questions about the hearing,
you may contact Albert Ruiz, Community Network Coordinator, Texas Commission
on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas 78708-0529; phone
1-800-832-9623, extension 6607; or via email albert_ruiz@tcada.state.tx.us.
These amendments are proposed under the Texas Health and Safety
Code, §461.012(a)(15) which provides the Texas Commission on Alcohol
and Drug Abuse with the authority to adopt rules governing the functions of
the commission, including rules that prescribe the policies and procedures
followed by the commission in administering any commission programs.
The code affected by the proposed amendments is the Texas Health and Safety
Code, Chapter 461.
§144.1. Applicability.
(a)
This chapter applies to all prevention
, intervention,
and treatment programs funded by the commission.
(b)
(No change.)
§144.21. Definitions.
The following words and terms, when used in this chapter, shall have
the following meanings, unless the context clearly indicates otherwise.
(1)
Abuse - Any act or failure to act which is done knowingly,
recklessly or intentionally, including incitement to act, which caused or
may have caused injury to a client
or participant
. Injury may include,
but is not limited to: physical injury, mental disorientation, or emotional
harm, whether it is caused by physical action or verbal statement. Client
/participant
abuse
may be perpetrated by staff or other clients/particpants
and
includes: [
(A)
any sexual activity between
facility personnel and a client/participant;
(B)
corporal punishment;
(C)
nutritional or sleep deprivation,
(D)
efforts to cause fear;
(E)
the use of any form of communication
to threaten, curse, shame, or degrade a client/participant;
(F)
restraint that does not conform
with chapter 148 of this title (relating to Facility Licensure);
(G)
coercive or restrictive actions
taken in response to the client's/participant's request for discharge or refusal
of medication or treatment that are illegal or not justified by the client's/participant's
condition; and
(H)
any other act or omission
classified as abuse by the Texas Family Code, §261.001.
(2)
Admission - Formal
documented acceptance of a prospective client to a treatment facility, based
on specifically defined criteria.
(3)
Access - Ability to obtain
or make use of.
(4)
[
(5)
[
(6)
Aftercare - Structured
services provided after discharge from a treatment facility which are designed
to strengthen and support the client's recovery and prevent relapse.
(7)
AIDS - Acquired Immune
Deficiency Syndrome, the end stage of HIV infection. AIDS can only be diagnosed
by a physician using criteria established by the National Centers for Disease
Control and Prevention.
(8)
Alternatives- A strategy
that gives participants and their families the opportunity to take part in
educational, cultural, recreational, and work-oriented substance-free activities.
Activities under this strategy are designed to encourage and foster bonding
with peers, family and community.
(9)
[
(10)
[
(11)
Assets (individual)
- A set of essential building blocks that help young people grow up healthy,
caring, and responsible. External assets include support, empowerment, boundaries
and expectations, and constructive use of time. Internal assets include commitment
to learning, positive values, social competencies, and positive identity.
(12)
ATOD - Alcohol, tobacco
and other drugs.
(13)
Care coordination -
Processes used to ensure an individual receives all needed substance abuse
services through a seamless, organized delivery system.
(14)
[
(A)
linking a client with needed services;
(B)
helping a client develop skills to use basic community
resources and services; and
(C)
monitoring and coordinating the services received by a
client.
(15)
[
(16)
Chemical dependency
screening - A brief interview conducted in person or by phone determine if
there is a potential substance abuse problem. Screening may be performed by
a non-QCC. If a potential problem is identified, the individual should be
referred for a treatment assessment.
(17)
[
(18)
[
(19)
Client Data Systems
(CDS) Forms - CDS forms include the Admission Report, Discharge Report, Follow-up
Report, and CDS Facility Summary.
[
CODAP - Client-Oriented
Data Acquisition Process.]
(20) Cognizant agency - The federal or state
agency responsible for reviewing, negotiating, and approving an organization's
cost allocation plans or indirect cost proposals.
(21)
Combination program
- A comprehensive prevention and/or intervention program which serves a combination
of target populations (universal, selective, or indicated) by providing a
range of prevention and/or intervention services to meet different levels
of need for a particular setting.
(22)
[
(23)
Community-based process
- A strategy designed to enhance the ability of the community to provide effective
prevention, intervention, and treatment services for ATOD problems and HIV
infection through community mobilization and empowerment. Activities include
multi-agency coordination and collaboration, networking, and development of
written agreements among community organizations.
(24)
Community coalition
- A diverse group of community organizations and individuals organized to
reduce ATOD problems in the community.
(25)
[
(26)
Continuum of services
- A planned, coordinated service system which includes prevention, intervention,
outreach, screening, referral, treatment and aftercare. Continuity of care
has two dimensions and goals: (1) cross-sectional, so that the services provided
to an individual at any given time are comprehensive and coordinated; and
(2) longitudinal, so that the system provides comprehensive, integrated services
over time and is responsive to changes in the person's needs.
(27)
[
[
Counseling session
- A scheduled meeting of 30 minutes or longer duration where group, individual,
or family counseling is provided.]
(28)
[
(29)
[
(30)
[
(31)
CSAP's six prevention
strategies - The six strategies identified by the Center for Substance Abuse
Prevention that are delivered in prevention and intervention programs. The
six strategies are: prevention education and skills training, alternatives,
problem identification and referral, information dissemination, community-based
process, and environmental and social policy.
(32)
[
(33)
Discharge - Formal,
documented termination from a treatment facility. Discharge occurs when a
client successfully completes treatment goals, leaves against professional
advice, or is terminated for other reasons.
(34)
[
(35)
[
(36)
[
(37)
Environmental and social
policy - A strategy designed to establish or change written and unwritten
community standards, codes, and attitudes, thereby influencing incidence and
prevalence of substance abuse in the general population. It includes activities
that center on legal and regulatory initiatives and those that relate to the
service and action-oriented initiatives.
(38)
Evaluation (program)
- A formal process for collecting, analyzing, and interpreting information
about a program's implementation and effectiveness.
[
Evaluation program
- Written assessment activities, performed internally or externally, of a
program or a service and its staff, activities, and planning process to determine
whether program or service goals are met, staff and activities are efficient
and effective, and whether or not a program or service has any effect on the
problem which it was created to address and/or on the population which it
was created to serve.]
(39)
Exit summary - Documentation
of all referral and follow-up activities provided to individuals or family
members receiving intervention counseling services.
(40)
[
(41)
Facility - A legal entity
that provides one or more chemical dependency treatment programs.
(42)
[
(43)
[
(44)
[
(45)
HIV Antibody Counseling
and Testing - A structured counseling session performed by Prevention Counseling
and Partner Elicitation (PCPE) counselors registered with the Texas Department
of Health (TDH). It promotes risk reduction behavior for those at risk of
infection with HIV and other sexually transmitted diseases and offers testing
for HIV infection.
(46)
Indicated program -
An intervention program designed to prevent the onset of substance abuse in
individuals who do not meet DSM-IV criteria for abuse or dependence, but are
showing early warning signs such as failing grades, dropping out of school,
and use of alcohol and other gateway drugs.
(47)
Information dissemination
- A strategy that provides awareness and knowledge of ATOD problems and/or
HIV infection and their harmful effects on individuals, families, and communities.
It also gives the general population information about available programs
and services. Information dissemination is characterized by one-way communication
from the source to the audience, with limited contact between the two. Information
is disseminated through written communications and/or in-person community
presentations.
(48)
[
(49)
[
(50)
Key performance measures
- Measures that reflect the services that are critical to the program design
and intended outcomes of the program. Key performance measures are specified
for all commission funded programs.
(51)
[
(52)
Minor Remodeling - Work
required to change the interior arrangements or other physical characteristics
of an existing facility, or to install equipment in order to meet program
requirements and needs. It does not include relocation of exterior walls,
roof, and floors in order to increase the amount of space to be used, development
or repair of parking lots, and completion of unfinished shall space to make
it suitable for occupancy.
(53)
[
(54)
[
(55)
Older adult - A person
aged 55 or older.
(56)
[
(57)
[
(58)
Outreach - Activities
directed toward finding individuals who might not use services due to lack
of awareness or active avoidance, and who would otherwise be ignored or underserved.
(59)
Participant - An individual
who is receiving prevention or intervention services.
(60)
Policy - A statement
of direction or guiding principle issued by the governing body.
(61)
[
(62)
Prevention education
and skills training - A curriculum-based strategy designed to develop decision-making,
problem solving, and other life skills. It also provides accurate information
about the harmful effects of ATOD use, abuse and addiction pertinent to the
needs of the target population. The basis of activities under this strategy
is interaction between the educator/facilitator and the participants. These
activities are aimed to increase protective factors, foster resiliency, decrease
risk factors and affect critical life and social skills relative to substance
abuse and/or HIV risk of the participant and/or family members.
(63)
Primary population -
The individuals directly targeted to participate in and benefit from the program.
(64)
Problem identification
and referral - A strategy that provides services designed to ensure access
to appropriate levels and types of services needed by youth or adult participants.
It includes identification of those individuals who have used or are at risk
of using alcohol, tobacco, and other drugs. This strategy does not include
any activity designed to determine if a person is in need of treatment.
(65)
Procedure - A step-by-step
set of instructions.
(66)
[
(67)
[
(68)
[
(69)
[
(70)
[
(A)
licensed professional counselor (LPC);
(B)
licensed master social worker (LMSW);
(C)
licensed marriage and family therapist (LMFT);
(D)
licensed psychologist;
(E)
licensed physician;
(F)
certified addictions registered nurse (CARN);
(G)
licensed psychological associate; and
(H)
advance practice nurse recognized by the Board of Nurse
Examiners as a clinical nurse specialist or nurse practitioner with a specialty
in psyche-mental health (APN-P/MH).
(71)
Referral - The
process of identifying appropriate services and providing the information
and assistance needed to access them. (72) Retaliate - Take adverse action
to punish or discourage a person who reports a violation or cooperates with
an investigation, inspection, or proceeding. Such actions include but are
not limited to suspension or termination of employment, demotion, discharge,
transfer, discipline, restriction of privileges, harassment, and discrimination.
(73)
Risk factor - A characteristic
or attribute of an individual, group, or environment associated with an increased
probability of certain disorders, addictive diseases, or behaviors.
(74)
Screening - See chemical
dependency screening.
(75)
Secondary population
- Family members and other individuals targeted to receive ancillary services
because of their relationship to the participant/client.
(76)
Selective program -
A prevention program designed to target subsets of the total population that
are deemed to be at higher risk for substance abuse by virtue of membership
in a particular population segment. Risk groups may be identified on the basis
of biological, psychological, social or environmental risk factors, and targeted
groups may be defined by age, gender, family history, place of residence,
or victimization by physical and/or sexual abuse. Selective prevention programs
target the entire subgroup regardless of the degree of individual risk.
(77)
Service record - The
required documentation for all participants receiving intervention counseling
services.
(78)
[
(79)
Standard Precautions--Infection
control guidelines written by the National Centers for Disease Control and
Prevention which are designed to prevent transmission of communicable diseases
such as HIV, hepatitis, sexually transmitted diseases and TB within the healthcare
setting. The commission's interpretation of those guidelines are found in
TCADA Workplace and Education Guidelines for HIV and Other Communicable Diseases.
(80)
[
(81)
Strategy - A prevention
approach implemented to support the overall design and goals of a program.
(82)
[
[
TAC - Texas Administrative
Code.]
(83)
TCADA - Texas Commission
on Alcohol and Drug Abuse.
(84)
[
(85)
Treatment assessment
- An assessment to determine if an individual meets the DSM-IV criteria for
substance abuse or dependence and is need of treatment. The assessment also
determines the level of treatment most appropriate for the individual.
(86)
[
(87)
Universal program -
A prevention program designed to address an entire population with messages
and programs aimed at preventing or delaying the use and abuse of alcohol,
tobacco, and other drugs. Universal prevention programs are delivered to large
groups without any prior screening for substance abuse risk.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of the Secretary of State, on
June 14, 1999.
TRD-9903490
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Earliest possible date of adoption: July 25 ,1999
For further information, please call: (512) 349-6733
40 TAC §144.101
The Texas Commission on Alcohol and Drug Abuse proposes an
amendment to §144.101 concerning Contract Administration. This section
contains information regarding contract acceptance and legal precedence.
These amendment is proposed to require that providers carry a fidelity
bond or insurance coverage equal to the amount of funding provided under the
commission contract or $100,000, whichever is less; to mandate that this fidelity
bond or insurance must provide for indemnification of losses due to fraudulent
or dishonest acts committed by any of the provider's employees or volunteers;
and to state the required order of legal precedence that must be followed
by providers.
Terry Faye Bleier, Executive Director, has determined that for the first
five-year period the rule is in effect there will be no fiscal implications
for state or local government as a result of enforcing the rule.
Ms. Bleier has also determined that for each year of the first five years
the rule is in effect the anticipated public benefit will be better protection
of public funds and more clarity about which rules and regulations govern
commission funded programs. There is no additional effect on small businesses.
The anticipated economic cost to persons required to comply with the proposed
amendment will vary depending upon the provider's current insurance plan.
It is estimated that the cost could be approximately $200 per year.
Comments on the proposal may be submitted to Tamara Allen, Quality Assurance,
Texas Commission on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas
78708-0529. Comments must be received no later than 30 days from the date
the proposal is published in the
Texas Register
.
In addition, there will be a hearing to receive public comments on these proposed
rules at 4:30 p.m., Monday July 12, 1999, at the Austin Convention Center,
5000 East Cesar Chavez, Austin, Texas. If you have questions about the hearing,
you may contact Albert Ruiz, Community Network Coordinator, Texas Commission
on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas 78708-0529; phone
1-800-832-9623, extension 6607; or via email albert_ruiz@tcada.state.tx.us.
The amendment is proposed under the Texas Health and Safety Code,
§461.012(a)(15) which provides the Texas Commission on Alcohol and Drug
Abuse with the authority to adopt rules governing the functions of the commission,
including rules that prescribe the policies and procedures followed by the
commission in administering any commission programs.
The code affected by the proposed amendment is the Texas Health and Safety
Code, Chapter 461.
§144.101. Contract Acceptance and Legal Precedence .
(a)-(c)
(No change.)
(d)
The provider shall carry a fidelity bond or insurance
coverage equal to the amount of funding provided under the commission contract
or $100,000, whichever is less. The fidelity bond or insurance must provide
for indemnification of losses due to fraudulent or dishonest acts committed
by any of the provider's employees or volunteers either individually or in
concert with others.
[
(e)
Providers shall follow this
order of legal precedence:
(1)
federal and state laws (including, but not
limited to the federal block grant found at United States Code, Title 42,
§300x);
(2)
rules adopted by the commission and applicable
federal regulations;
(3)
terms and conditions of the contract;
(4)
requirements stated in the request for
proposals; and
(5)
the application as amended or adjusted
by the commission.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of the Secretary of State, on
June 14, 1999.
TRD-9903491
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Earliest possible date of adoption: July 25 ,1999
For further information, please call: (512) 349-6733
40 TAC §§144.102-144.108, 144.123, 144.131, 144.133, 144.141, 144.142
The Texas Commission on Alcohol and Drug Abuse proposes amendments
to §§144.102-144.104, 144.106, 144.107, 144.123, 144.131, 144.133,
144.141, 144.142 and proposes new §144.105 and §144.108. concerning
Contract Administration. These sections contain information regarding amendments,
organizational and personnel changes, matching prevention awards, billing,
payment, reporting, financial assistance for treatment services, program income,
expenditures requiring prior approval, travel, procurement, and subcontracting.
These amendments are proposed to require that all requests for contract
amendments must be received at least 60 days before the end of the contract
period unless the commission's executive director grants a waiver; to replace
the term executive director with chief executive officer; to clarify that
required matching funds are calculated based on the total program expenditures;
to consolidate all provisions related to billing into a single section; to
state that the commission is the payor of last resort; to expand the requirement
for eligible providers to bill Medicaid for covered services to include the
Children's Health Insurance Program and other public reimbursement; to describe
the payment process; to establish that reports are due 30 days after the end
of the reporting period; to replace the term electronic interface system with
the web-based computer system; to describe the financial assistance payment
mechanism for new treatment service providers, including limiting the amount
of time a treatment provider can remain on financial assistance and setting
criteria that must be met before the transfer is made to unit cost reimbursement;
to clarify that commission funded providers must not use inability to pay
as a reason to refuse any commission funded service, not just treatment, to
an otherwise eligible applicant; to set a maximum of $10,000 for work considered
to be minor remodeling; to specify that tobacco products are not allowable
travel costs; to increase the monetary maximums that determine what type of
price or rate quotation is required for small purchases; and to add language
which will allow providers to subcontract with individuals.
Terry Faye Bleier, Executive Director, has determined that for the first
five-year period the rules are in effect there will be no fiscal implications
for state or local government as a result of enforcing the rules.
Ms. Bleier has also determined that for each year of the first five years
the rules are in effect the anticipated public benefit will be a more effective
contract administration process for commission funded providers. There is
no additional effect on small businesses. There is no anticipated economic
cost to persons required to comply with the proposed amendments and new sections.
Comments on the proposal may be submitted to Tamara Allen, Quality Assurance,
Texas Commission on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas
78708-0529. Comments must be received no later than 30 days from the date
the proposal is published in the
Texas Register
.
In addition, there will be a hearing to receive public comments on these proposed
rules at 4:30 p.m., Monday July 12, 1999, at the Austin Convention Center,
5000 East Cesar Chavez, Austin, Texas. If you have questions about the hearing,
you may contact Albert Ruiz, Community Network Coordinator, Texas Commission
on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas 78708-0529; phone
1-800-832-9623, extension 6607; or via email albert_ruiz@tcada.state.tx.us.
These amendments and new sections are proposed under the Texas
Health and Safety Code, §461.012(a)(15) which provides the Texas Commission
on Alcohol and Drug Abuse with the authority to adopt rules governing the
functions of the commission, including rules that prescribe the policies and
procedures followed by the commission in administering any commission programs.
The code affected by the proposed amendments is the Texas Health and Safety
Code, Chapter 461.
§144.102. Amendments.
(a)-(c)
(No change.)
(d)
All requests for contract
amendments must be received at the commission at least 60 days before the
end of the contract period. Under extenuating circumstances, however, the
commission's executive director may waive this requirement.
§144.103. Organizational and Personnel Changes.
The provider shall notify the commission in writing within ten business
days of:
(1)
(No change.)
(2)
changes in the following personnel:
(A)-(B)
(No change.)
(C)
chief
executive
officer
[
(D)-(G)
(no change.)
§144.104. Matching Prevention Awards.
(a)
Unless waived in writing by the commission, all providers
funded to provide prevention or intervention services shall contribute 5.0%
of the
total program expenditures
[
(b)
(No change.)
§144.105. Billing.
(a)
The Commission is the payor of last resort for chemical
dependency treatment. A provider shall not bill the commission for services
provided to a client if:
(1)
the client is not financially eligible as described in
§144.521 of this title (relating to Client Eligibility); or
(2)
the client has access to another public or private
source of payment for appropriate treatment.
(b)
Any provider offering services which are eligible for
Medicaid, Children's Health Insurance Program (CHIP), or other public reimbursement
shall become an approved provider.
(1)
The provider must screen all clients for Medicaid and
CHIP eligibility. If a client is eligible but has not yet enrolled, the provider
shall direct the client to apply for Medicaid or CHIP benefits and provide
assistance as needed to facilitate the enrollment process.
(2)
The provider must bill Medicaid and CHIP for all
covered services delivered to eligible clients.
(c)
The provider shall not bill the commission for a unit
of service that has been billed to Medicaid or another third party payor who
requires the provider to accept reimbursement as payment in full. If the third
party payor denies payment or fails to respond or reimburse the provider for
more than 60 days after the date the claim was billed, the provider may bill
the commission for that unit of service. During the last month of the contract
period, the provider may bill the commission for all outstanding third party
reimbursement if the provider has reason to believe the payment request will
be denied. If the provider charges the commission for a unit of service and
then receives payment from another entity for the same unit of service, the
revenue shall be treated as program income in accordance with §144.123
of this title (relating to Program Income).
(d)
A provider shall not bill and receive payment in excess
of actual costs from more than one entity for the same service at the same
time for the same client. The total amount paid to a provider shall not exceed
the actual costs of providing the services, either by client or in the aggregate.
If double billing generates revenue that exceeds actual costs, the revenue
shall be treated as program income in accordance with §144.123 of this
title (relating to Program Income).
(e)
The provider may accept funds from other funding sources
that provide general support for the program.
(f)
All requests for payment must be submitted no more than
30 days after the end of the contract period. The commission will not reimburse
requests received after the 30-day period.
(g)
Payment requests shall be accurate and submitted in the
format required by the commission, and certified by the provider's authorized
representative (specified in the contract).
§144.106. Payment [
(a)-(b)
(No change.)
(c)
The commission may withhold payment if the provider is
not in compliance with commission requirements, which include:
(1)
rules adopted by the commission; [
(2)
terms and conditions in the contract
; and
(3)
other applicable statutes
and regulations.
(d)
(No change.)
(e)
Providers paid through the financial assistance payment
mechanism who want to receive [
(f)-(h)
(No change.)
[
Reimbursements must be requested
at least quarterly. Final payment must be requested within 90 days after the
end of the budget period.]
[
Payment requests shall be
accurate and submitted in the format required by the commission, and certified
by the provider's authorized representative (specified in the contract).]
§144.107. Reporting.
(a)
The provider shall submit all reports as required by commission
rules, the contract, and applicable instruction manuals. Reports shall be
submitted in the specified form, manner, and timeframe.
Unless otherwise
specified, reports are due 30 days after the end of the reporting period.
(b)
The provider shall submit all performance reports, financial
reports, and requests for payment through the designated
web-based computer
[
(c)
The provider shall acquire and maintain the equipment
and software needed for the
web-based computer
[
(d)-(e)
(No change.)
(f)
The provider shall reconcile
the general ledger with the Financial Status Report (FSR) each quarter and
maintain supporting documentation on site.
§144.108. Financial Assistance for Treatment Services.
(a)
The commission's standard payment mechanism for treatment
services is the unit cost payment mechanism.
(b)
The commission may place a treatment program on financial
assistance if the provider does not have the resources to provide needed treatment
services without start-up funding and:
(1)
has never before provided treatment or prevention services;
(2)
will provide a specific type of commission-funded
services for the first time;
(3)
will provide commission-funded services in a specific
geographic area or to a specific population for the first time; or
(4)
will expand services at the commission's request
to meet identified needs.
(c)
Every treatment provider on financial assistance shall
submit a plan for moving from financial assistance to a unit cost basis for
reimbursement. The plan must include specific actions to be taken and target
dates for completion.
(d)
A treatment provider on financial assistance will be transferred
to unit cost payment as soon as the provider meets financial and service stability
criteria or at the end of 12 months, whichever is less.
(e)
To meet financial and service stability criteria, the
treatment program must:
(1)
reach 80% of its client capacity as specified in the contract;
(2)
implement written financial policies and procedures;
(3)
achieve at least 80% of the state minimum performance
measures targets in completion, follow-up and abstinence; and
(4)
have a computed unit cost rate under 125% of the
maximum rate for services provided.
(f)
If a treatment provider does not meet the financial and
service stability criteria after 12 months, the commission may place the provider
on probation and extend financial assistance for up to four three-month periods.
(g)
No treatment provider can remain on financial assistance
for more than 24 months unless the commission's executive director grants
a waiver based on extenuating circumstances.
§144.123. Program Income.
(a)
(No change.)
(b)
The program may charge reasonable fees for commission-funded
services or activities provided:
(1)
(No change.)
(2)
an otherwise eligible applicant is not refused commission-funded
services
[
§144.131. Expenditures Requiring Prior Approval.
Prior approval is required for certain costs charged to the commission
contract or reported as program income or match. Costs that are allowable
only with prior approval from the commission include:
(1)
(No change.)
(2)
Minor remodeling
[
(3)-(5)
(No change.)
§144.133. Travel.
(a)-(b)
(No change.)
(c)
Alcoholic beverages
and tobacco products
are
not allowable travel costs.
§144.141. Procurement.
(a)
The provider may use small purchase procurement procedures
to obtain services, supplies, or other property costing no more than $25,000
in total. These rules do not apply to obtaining the services of a professional
as defined in Texas Government Code, Chapter 2254.
(1)
For any purchase under
$2,000
[
(2)
The provider shall obtain three verbal or written
price or rate quotations for any purchase between
$2,000 and $10,000
[
(3)
The provider shall obtain three written price or
rate quotations for any purchase over
$10,000
[
(b)
The provider shall select the vendor providing the best
value and document the
rationale
[
(c)
(No change.)
§144.142. Subcontracting.
(a)
Providers shall not subcontract, assign, or transfer any
activity central to the purposes of the contract without prior written approval
from the commission.
The subcontractor shall be a corporation, partnership,
sole proprietor, or another entity with legal authority to operate in the
State of Texas.
(b)-(h)
(No change.)
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on
June 14, 1999.
TRD-9903492
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Earliest possible date of adoption: July 25, 1999
For further information, please call: (512) 349-6733
40 TAC §§144.105, 144.122, 144.125
(Editor's note: The text of the following sections proposed for
repeal will not be published. The sections may be examined in the offices
of the Texas Commission on Alcohol and Drug Abuse or in the Texas Register
office, Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)
The Texas Commission on Alcohol and Drug Abuse proposes
the repeal of §§144.105, 144.122 and 144.125 concerning Contract
Administration. These sections contain the requirements for legal precedence,
double billings, and Medicaid. The repeals are proposed because the requirements
in these sections have been incorporated into other sections.
Terry Bleier, Executive Director, has determined that for the first five-year
period the repeals are in effect there will be no fiscal implications for
state or local government as a result of the proposed repeals.
Ms. Bleier has also determined that for each year of the first five years
the repeals are in effect the anticipated public benefit will less confusion
about these regulations and how they relate to other requirements. There will
be no effect on small businesses. There is no anticipated economic cost to
current providers.
Comments on the proposal may be submitted to Tamara Allen, Quality Assurance,
Texas Commission on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas
78708-0529. Comments must be received no later than 30 days from the date
the proposal is published in the
Texas Register
.
In addition, there will be a hearing to receive public comments on these proposed
rules at 4:30 p.m., Monday July 12, 1999, at the Austin Convention Center,
5000 East Cesar Chavez, Austin, Texas. If you have questions about the hearing,
you may contact Albert Ruiz, Community Network Coordinator, Texas Commission
on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas 78708-0529; phone
1-800-832-9623, extension 6607; or via email albert_ruiz@tcada.state.tx.us.
The repeals are proposed under the Texas Health and Safety Code,
§461.012(a)(15) which provides the Texas Commission on Alcohol and Drug
Abuse with the authority to adopt rules governing the functions of the commission,
including rules that prescribe the policies and procedures followed by the
commission in administering any commission programs.
The code affected by the proposed repeals is the Texas Health and Safety
Code, Chapter 461.
§144.105. Legal Precedence.
§144.122. Double Billings.
§144.125. Medicaid.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of the Secretary of State, on
June 14, 1999.
TRD-9903493
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Earliest possible date of adoption: July 25, 1999
For further information, please call: (512) 349-6733
40 TAC §§144.201, 144.203, 144.204, 144.211-144.216
The Texas Commission on Alcohol and Drug Abuse proposes amendments
to §§144.201,144.211-144.216 and proposes new §144.203 and
§144.204 concerning Program Oversight. These sections contain information
regarding commission oversight, on-site contract reviews, on-site compliance
reviews, independent audit report, auditor qualifications, independent audit
report requirements, independent audit report submission, corrective action
plan, and audit report desk reviews.
These amendments and new sections are proposed to clarify how the commission
may provide oversight to funded providers; to describe the purpose of and
process for on-site contract reviews and inform providers of their responsibilities
for responding to identified issues; to outline the on-site compliance review
process including provider response and corrective action; to clarify the
rules regarding required single audits and program audits; to specify that
auditors must be licensed in the state in which the audit is performed at
the time the audit is performed; to clarify what requirements must be included
in the audit report; to specify that the rules regarding audit submission
refer to independent audit reports; to clarify that the corrective action
plan relates to the independent financial audit report and management letter;
and to more accurately name and describe the audit report desk review process.
Terry Faye Bleier, Executive Director, has determined that for the first
five-year period the rules are in effect there will be no fiscal implications
for state or local government as a result of enforcing the rules.
Ms. Bleier has also determined that for each year of the first five years
the rules are in effect the anticipated public benefit will be better program
oversight by the commission and a clearer understanding of the audit process
and related requirements on the part of commission-funded providers. There
is no additional effect on small businesses. There is no anticipated economic
cost to persons required to comply with the proposed amendments and new sections.
Comments on the proposal may be submitted to Tamara Allen, Quality Assurance,
Texas Commission on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas
78708-0529. Comments must be received no later than 30 days from the date
the proposal is published in the
Texas Register
.
In addition, there will be a hearing to receive public comments on these proposed
rules at 4:30 p.m., Monday July 12, 1999, at the Austin Convention Center,
5000 East Cesar Chavez, Austin, Texas. If you have questions about the hearing,
you may contact Albert Ruiz, Community Network Coordinator, Texas Commission
on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas 78708-0529; phone
1-800-832-9623, extension 6607; or via email albert_ruiz@tcada.state.tx.us.
These amendments and new sections are proposed under the Texas
Health and Safety Code, §461.012(a)(15) which provides the Texas Commission
on Alcohol and Drug Abuse with the authority to adopt rules governing the
functions of the commission, including rules that prescribe the policies and
procedures followed by the commission in administering any commission programs.
The code affected by the proposed amendments and new sections is the Texas
Health and Safety Code, Chapter 461.
§144.201. Commission Oversight [
(a)
All commission-funded providers, regardless of the level
of funding, are subject to periodic reviews by the commission for
adherence
[
(b)
The commission shall determine the extent of the review
[
(c)
The commission may conduct a scheduled or unannounced
on-site
reviews
[
(d)-(e)
(No change.)
§144.203. On-site Contract Reviews.
(a)
On-site contract reviews shall be conducted to determine
if the provider has the financial and programmatic systems in place to meet
contract requirements and deliver services.
(b)
After an on-site contract review, the provider will receive
a written summary of the review. The report will include a summary checklist
of the major areas reviewed and the provider's performance related to these
areas.
(c)
The provider shall respond to the report by the specified
deadline.
(d)
The provider shall address the issues noted in the report
within the allotted time frames or request an extension.
(e)
The results of on-site contract review will be used by
the commission in future funding decisions.
(f)
Results of on-site contract reviews will be shared with
other departments in the commission. The commission may decide to conduct
additional reviews of the provider, based on the results of the on-site contract
review.
§144.204. On-Site Compliance Reviews.
(a)
On-site compliance reviews will be conducted to examine
compliance with applicable federal, state, and commission regulations.
(b)
After an on-site compliance review, the provider will
be notified in writing of any noncompliance with federal, state, and commission
regulation identified by the commission in the form of a draft report.
(c)
The provider shall respond to the draft report and the
deficiencies (if any) and submit a plan of corrective action (if necessary)
to the commission within 14 calendar days of the postmark date.
(d)
The corrective action plan shall include:
(1)
the title(s) of the person(s) responsible for the corrective
action;
(2)
the corrective action planned; and
(3)
the anticipated completion date.
(e)
If the provider believes corrective action is not required
for a noted deficiency, the response shall include an explanation and specific
reasons.
(f)
The provider's replies and corrective action plan (if
any) shall become part of the final report.
(g)
The provider shall correct deficiencies identified in
the final report within a reasonable period of time.
§144.211. Independent [
(a)
Providers [
(1)
If the funds are expended under more than one federal
program the provider shall have a Single Audit.
(2)
If the funds are expended under only one federal
program and the provider is not subject to laws, regulations, or federal contracts
that require a financial statement audit, the provider may elect to have a
program-specific audit.
(3)
The provider shall comply with the single audit requirements
of Office of Management and Budget (OMB) Circular A-133.
(b)
Providers expending a total amount of state funds
of at least $300,000 during their fiscal year must have either a single audit
or a program-specific audit as described in the Uniform Grant Management Standards.
If the provider is already required to have a single audit because of federal
funding, an additional program audit is not required.
[
(c)
Providers that expend less than $300,000 in federal
funds from all sources and less than $300,000 in state funds from all sources
during their fiscal year are not required to have an audit. However, these
providers shall submit a signed statement to the commission after their fiscal
year end documenting that they did not expend $300,000 or more in state or
federal funds during the fiscal year.
[
(d)
When a provider expends both state and federal funds
and is required to submit a single audit report, the state and federal expenditures
may be combined in one financial statement in the report. However, the source
and amount of funds expended (state vs. federal) must be clearly stated.
[
§144.212. Auditor Qualifications.
(a)
(No change.)
(b)
The selected auditor must meet the requirements of the
Government Auditing Standards (GAS) and be licensed in the state in which
the audit is performed
at the time the audit is performed.
(c)
(No change.)
§144.213. Independent Audit Report Requirements .
(a)
The audit report shall include the requirements found
in:
(1)
(No change.)
(2)
Government Auditing Standards (GAS); [
(3)
Uniform Grants Management Standards
[
(4)
the commission's contract(s),
including any stipulations and amendments.
(b)
In addition, the audit shall meet requirements of the
following publications (issued by the American Institute of Certified Public
Accountants), as applicable:
(1)
Audits of Not-for-Profit Organizations
[
(2)
Audits of State and Local Governmental Units
[
(3)
Audits of Colleges and Universities
[
(4)
Audits of Providers of Health Care Services
[
(5)
Audits of Certain Not-for-Profit Organizations;
or
[
(6)
Audits of Voluntary Health
Care and Welfare Organizations.
§144.214. Independent Audit Report Submission.
(a)
The provider shall submit two copies of all required audit
documentation to the commission, including:
(1)
the audit report;
(2)
any separately issued management letters;
(3)
management responses as required in §144.215
of this title (relating to Corrective Action Plan); and
(4)
the commission's Audit Report Submission Checklist.
(b)
Audits for fiscal years beginning on or after July 1,
1998 shall be completed and submitted no later than nine months after the
provider's fiscal year end. Audits for fiscal years beginning on or before
June 30, 1998 must be completed and submitted no later than 13 months after
the provider's fiscal year end.
§144.215. Corrective Action Plan.
(a)
The provider shall prepare a response that includes a
corrective action plan for each deficiency noted in the independent
financial
audit report and management letter.
(b)-(d)
(No change.)
§144.216. Audit Report Desk Reviews Commission Review of Audit Report.
(a)
After reviewing the audit, the commission will send the
provider
a
[
(b)-(d)
(No change.)
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on
June 14, 1999.
TRD-9903496
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Earliest possible date of adoption: July 25 ,1999
For further information, please call: (512) 349-6733
40 TAC §144.202
(Editor's note: The text of the following section proposed for
repeal will not be published. The section may be examined in the offices of
the Texas Commission on Alcohol and Drug Abuse or in the Texas Register office,
Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)
The Texas Commission on Alcohol and Drug Abuse proposes
the repeal of §144.202 concerning Program Oversight. This section contains
the requirements for organization response. The repeal is proposed because
the requirements in this section will be incorporated into other sections.
Terry Bleier, Executive Director, has determined that for the first five-year
period the repeal is in effect there will be no fiscal implications for state
or local government as a result of the proposed repeals.
Ms. Bleier has also determined that for each year of the first five years
the repeal is in effect the anticipated public benefit will more clarity for
providers about what they must do in response to the various program oversight
activities conducted or required by the commission. There will be no effect
on small businesses. There is no anticipated economic cost to current providers.
Comments on the proposal may be submitted to Tamara Allen, Quality Assurance,
Texas Commission on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas
78708-0529. Comments must be received no later than 30 days from the date
the proposal is published in the
Texas Register
.
In addition, there will be a hearing to receive public comments on these proposed
rules at 4:30 p.m., Monday July 12, 1999, at the Austin Convention Center,
5000 East Cesar Chavez, Austin, Texas. If you have questions about the hearing,
you may contact Albert Ruiz, Community Network Coordinator, Texas Commission
on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas 78708-0529; phone
1-800-832-9623, extension 6607; or via email albert_ruiz@tcada.state.tx.us.
The repeal is proposed under the Texas Health and Safety Code,
§461.012(a)(15) which provides the Texas Commission on Alcohol and Drug
Abuse with the authority to adopt rules governing the functions of the commission,
including rules that prescribe the policies and procedures followed by the
commission in administering any commission programs.
The code affected by the proposed repeals is the Texas Health and Safety
Code, Chapter 461.
§144.202. Organization Response.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of the Secretary of State, on
June 14, 1999.
TRD-9903494
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Earliest possible date of adoption: July 25 ,1999
For further information, please call: (512) 349-6733
40 TAC §§144.312, 144.313, 144.321, 144.322, 144.324, 144.325, 144.327
The Texas Commission on Alcohol and Drug Abuse proposes amendments
to §§144.312, 144.313, 144.322, 144.324, and 144.325 and proposes
new §144.321 and §144.327 concerning organizational requirements.
These sections contain information regarding organizational structure, governing
body and chief executive officer, policies and procedures, records, limiting
barriers, complaints and reports, and standards of conduct.
These amendments and new sections are proposed to expand these rules to
make them comparable to facility licensure standards (which apply only to
treatment providers) so that prevention providers are held to the same organization
standards as treatment providers; to replace the term executive director with
chief executive officer; to require providers to maintain documentation signed
by each employee that policies and procedures have been read and understood;
to replace the term governing authority with governing body; to ensure that
members of the governing body are aware of their responsibilities and liabilities
as well as the program's target populations and their particular cultural
needs; to specify the minimum requirements for and responsibilities of a chief
executive officer; to establish requirements for policies and procedures;
to clarify that providers must maintain current personnel documentation on
each employee and to list the minimum items that must be included; to clarify
the retention requirements for contract related records; to require a written
policy prohibiting discrimination; to mandate that providers retain documentation
of formal agreements and contracts to address identified problems with program
service access by people with disabilities; to expand the requirements for
handling complaints to include complaints from clients, participants and their
families; to state that reports of abuse, neglect or exploitation must be
made verbally to the commission's investigation department; and to establish
standards of conduct for the program and its personnel.
Terry Faye Bleier, Executive Director, has determined that for the first
five-year period the rules are in effect there will be no fiscal implications
for state or local government as a result of enforcing the rules.
Ms. Bleier has also determined that for each year of the first five years
the rules are in effect the anticipated public benefit will be that prevention
providers will be held to the same standards as treatment providers, which
will result in better administration of prevention programs. There is no additional
effect on small businesses. There is no anticipated economic cost to persons
required to comply with the proposed amendments and new sections.
Comments on the proposal may be submitted to Tamara Allen, Quality Assurance,
Texas Commission on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas
78708-0529. Comments must be received no later than 30 days from the date
the proposal is published in the
Texas Register
.
In addition, there will be a hearing to receive public comments on these proposed
rules at 4:30 p.m., Monday July 12, 1999, at the Austin Convention Center,
5000 East Cesar Chavez, Austin, Texas. If you have questions about the hearing,
you may contact Albert Ruiz, Community Network Coordinator, Texas Commission
on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas 78708-0529; phone
1-800-832-9623, extension 6607; or via email albert_ruiz@tcada.state.tx.us.
These amendments and new sections are proposed under the Texas
Health and Safety Code, §461.012(a)(15) which provides the Texas Commission
on Alcohol and Drug Abuse with the authority to adopt rules governing the
functions of the commission, including rules that prescribe the policies and
procedures followed by the commission in administering any commission programs.
The code affected by the proposed amendments and new sections is the Texas
Health and Safety Code, Chapter 461.
§144.312. Organizational Structure.
(a)
(No change.)
(b)
The provider shall maintain a current manual that includes
all policies and procedures required by the commission.
(1)
(No change.)
(2)
Procedures shall be approved by the
chief
executive
officer
[
(3)
The provider shall require each employee to read
the policies and procedures applicable to the position
and maintain documentation
signed by the employee that the policies and procedures have been read and
understood
.
(4)
(No change.)
§144.313. Governing Body and Chief Executive Officer [
(a)
All entities shall have a governing
body
[
(b)
The governing
body
[
(c)
Staff members, including the
chief
executive
officer
[
(d)
The governing
body
[
(e)
The governing
body
[
(1)
date, time, and place of the meeting;
(2)
names of members present and absent; and
(3)
summary of discussion and action taken.
(f)
The governing body shall provide all members with
information about the responsibilities and liabilities of the governing body
and its individual members.
[
(g)
The governing body shall ensure
that all of its members are familiar with the program's target population
and sensitive to the needs of the different cultures represented.
(h)
The chief executive officer
director shall:
(1)
have documented education and/or experience
in financial, administrative, and personnel management, and other areas needed
to manage the facility effectively;
(2)
ensure compliance with applicable laws
and rules:
(3)
ensure that all staff are competent and
trained;
(4)
establish mechanisms to ensure quality
of services; and
(5)
maintain adequate financial records according
to generally accepted accounting principles.
§144.321. Policies and Procedures.
(a)
The provider shall operate according to policies and procedures
that comply with all applicable commission rules.
(b)
The governing body shall establish policies that comply
with commission rules, and the chief executive officer shall use the policies
to develop and implement all needed procedures.
(c)
The policy and procedures manual shall be current, in
compliance with current commission rules, individualized to the program, well
organized, and easily accessible to all staff at all times.
(d)
Within ten days of a policy or procedure change, the provider
shall inform staff about any changes to the policy and procedure manual that
are relevant to their job duties and document the notification. If training
is needed, it shall be provided and documented within 60 days.
(e)
The provider shall adopt and implement
TCADA Workplace and Education Guidelines for HIV and Other Communicable Diseases
in order to meet requirements as specified by the Americans with Disabilities
Act, the Texas Health and Safety Code, Chapter 85, and standard precautions
for infection control as outlined by The Centers for Disease Control and Prevention.
(f)
The provider shall implement written policies and procedures
to protect client/participant records and client/participant-identifying information
from unauthorized disclosure in accordance with the federal regulations governing
Confidentiality of Alcohol and Drug Abuse Patient Records, Code of Federal
Regulations, Title 42, Part 2.
§144.322. Records.
[
The provider shall protect
client/participant records and client/participant-identifying information
from unauthorized disclosure in accordance with the federal regulations governing
Confidentiality of Alcohol and Drug Abuse Patient Records, Code of Federal
Regulations, Title 42, Part 2. ]
(a)
[
(1)
a copy of the current job description signed by the employee;
(2)
application or resume with documentation of required
qualifications;
(3)
documentation that required credentials were verified
directly
with the credentialing body;
(4)
annual performance evaluations;
(5)
personnel data that includes date hired, rate of
pay, and documentation of all pay increases and bonuses:
(6)
documentation of appropriate
screening and/or background checks;
(7)
signed documentation
of initial and other required training; and
(8)
records of any disciplinary
actions.
(b)
[
§144.324. Limiting Barriers.
(a)
The provider shall
implement and enforce a written
policy prohibiting discrimination
[
(b)
(No change.)
(c)
The provider shall maintain
documentation of formal agreements and contracts to address identified deficiencies
in access to program services for people with disabilities.
§144.325. Complaints and Reports.
(a)
Providers shall have written policy and procedures for
handling complaints from
clients,
participants
, and their
families
[
(b)
(No change.)
(c)
The provider shall
verbally
report all allegations
of abuse, neglect, and exploitation to the
commission's investigation
department
[
(d)
The provider shall not retaliate against anyone who reports
a violation or cooperates during an investigation or related activity.
§144.327. Standards of Conduct.
(a)
The program and all of its personnel shall:
(1)
protect the health, safety, rights, and welfare of clients/participants;
(2)
provide adequate services as described in the program
description;
(3)
comply with all applicable laws, regulations, policies,
and procedures;
(4)
maintain required licenses, permits, and credentials;
and
(5)
comply with professional and ethical codes of conduct.
(b)
Neither the program nor any of its personnel shall:
(1)
abuse, neglect, or exploit clients/participants;
(2)
commit an illegal, unprofessional or unethical act;
(3)
assist or knowingly allow another person to commit
an illegal, unprofessional, or unethical act;
(4)
knowingly provide false or misleading information;
(5)
omit significant information from required reports
and records or interfere with their preservation;
(6)
retaliate against anyone who reports a violation
or cooperates during a review, audit, inspection, investigation, hearing,
or other related activity; or
(7)
interfere with commission reviews, inspections, investigations,
hearings, or related activities. This includes taking action to discourage
or prevent someone else from cooperating with the activity.
(c)
The program shall have a written policy on staff conduct
that complies with this section.
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on
June 14, 1999.
TRD-9903495
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Earliest possible date of adoption: July 25 ,1999
For further information, please call: (512) 349-6733
40 TAC §144.321
(Editor's note: The text of the following section proposed for
repeal will not be published. The section may be examined in the offices of
the Texas Commission on Alcohol and Drug Abuse or in the Texas Register office,
Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)
The Texas Commission on Alcohol and Drug Abuse proposes
the repeal of §144.321 concerning organizational responsibilities. This
section contains the requirements for HIV policies. The repeal is proposed
because the requirements in this section will be incorporated into a new section
that addresses all required policies.
Terry Bleier, Executive Director, has determined that for the first five-year
period the repeal is in effect there will be no fiscal implications for state
or local government as a result of the proposed repeals.
Ms. Bleier has also determined that for each year of the first five years
the repeal is in effect the anticipated public benefit will clear guidance
about all required policies as they will be consolidated into one section.
There will be no effect on small businesses. There is no anticipated economic
cost to current providers.
Comments on the proposal may be submitted to Tamara Allen, Quality Assurance,
Texas Commission on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas
78708-0529. Comments must be received no later than 30 days from the date
the proposal is published in the
Texas Register
.
In addition, there will be a hearing to receive public comments on these proposed
rules at 4:30 p.m., Monday July 12, 1999, at the Austin Convention Center,
5000 East Cesar Chavez, Austin, Texas. If you have questions about the hearing,
you may contact Albert Ruiz, Community Network Coordinator, Texas Commission
on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas 78708-0529; phone
1-800-832-9623, extension 6607; or via email albert_ruiz@tcada.state.tx.us.
The repeal is proposed the Texas Health and Safety Code, §461.012(a)(15)
which provides the Texas Commission on Alcohol and Drug Abuse with the authority
to adopt rules governing the functions of the commission, including rules
that prescribe the policies and procedures followed by the commission in administering
any commission programs.
The code affected by the proposed repeal is the Texas Health and Safety
Code, Chapter 461.
§144.321. HIV Policies.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of the Secretary of State, on
June 14, 1999.
TRD-9903498
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Earliest possible date of adoption: July 25 ,1999
For further information, please call: (512) 349-6733
40 TAC §144.326
The Texas Commission on Alcohol and Drug Abuse proposes new
§144.326 concerning organizational requirements. This section contains
information regarding staffing.
This new section is proposed to establish minimum requirements related
to staffing. This entire subchapter is being expanded to make these rules
comparable to the facility licensure standards (which apply only to treatment
providers). This expansion ensures that prevention providers are held to the
same organization standards as treatment providers. Thus, this new section
will ensure that prevention providers are held to the same staffing standards
as treatment providers. There is one new requirement included in this new
section which is that providers must obtain the results of a criminal background
check for each staff person who has contact with adolescents and/or children.
Terry Faye Bleier, Executive Director, has determined that for the first
five-year period the rule is in effect there will be no fiscal implications
for state or local government as a result of enforcing the rules.
Ms. Bleier has also determined that for each year of the first five years
the rule is in effect the anticipated public benefit will be that prevention
providers will be held to the same standards regarding staffing as treatment
providers, which will result in more effective and better staffed prevention
programs. There is no additional effect on small businesses. The only anticipated
economic cost to comply with the new section is the cost of criminal background
checks, which is estimated at $15.00 per staff person for programs that serve
adolescents and/or children.
Comments on the proposal may be submitted to Tamara Allen, Quality Assurance,
Texas Commission on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas
78708-0529. Comments must be received no later than 30 days from the date
the proposal is published in the
Texas Register
.
In addition, there will be a hearing to receive public comments on these proposed
rules at 4:30 p.m., Monday July 12, 1999, at the Austin Convention Center,
5000 East Cesar Chavez, Austin, Texas. If you have questions about the hearing,
you may contact Albert Ruiz, Community Network Coordinator, Texas Commission
on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas 78708-0529; phone
1-800-832-9623, extension 6607; or via email albert_ruiz@tcada.state.tx.us.
This new section is proposed under the Texas Health and Safety
Code, §461.012(a)(15) which provides the Texas Commission on Alcohol
and Drug Abuse with the authority to adopt rules governing the functions of
the commission, including rules that prescribe the policies and procedures
followed by the commission in administering any commission programs.
The code affected by the proposed new section is the Texas Health and Safety
Code, Chapter 461.
§144.326. Staffing
(a)
The provider shall have an adequate number of qualified
staff to comply with commission rules, provide the services described in the
program description, and protect the health, safety, and welfare of clients/participants.
(b)
The program shall hire applicants who meet the minimum
qualifications listed in the job description.
(c)
The application or resume shall document required education,
training, and related work experience.
(d)
The facility shall develop and implement procedures for
reviewing the background and suitability of any employee with access to clients/participants.
The review shall be appropriate for each person's level of access and shall
adequately protect clients/participants.
(e)
The program shall obtain the results of a statewide criminal
background check from the Department of Public Safety on all staff with access
to adolescents or children.
(f)
The facility shall ensure that staff are adequately trained
and competent to perform job duties.
(g)
Each employee shall complete initial training during the
first seven calendar days of employment. The initial training shall include,
as applicable:
(1)
client/participant rights and complaint procedures;
(2)
confidentiality of client/participant-identifying
information;
(3)
abuse, neglect, and exploitation (including reporting
requirements);
(4)
standards of conduct; and
(5)
the individual's specific job duties.
(h)
The program shall establish an annual staff training plan
for employees based on the program design and identified staff needs. The
plan must include annual cultural competency training for all employees.
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on
June 14, 1999.
TRD-9903497
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Earliest possible date of adoption: July 25 ,1999
For further information, please call: (512) 349-6733
40 TAC §§144.411-144.416, 144.441-144.447, 144.451-144.455, 144.457–144.460, 144.462
The Texas Commission on Alcohol and Drug Abuse proposes amendments
to §§144.411-144.416 and 144.441-144.447 and proposes new §§144.451-144.455,
144.457-144.460 and 144.462 concerning Prevention and Intervention. These
sections contain information regarding program design and implementation,
program self-evaluation, performance and activity measures, performance measure
review, participant rights, smoking policies, information dissemination, prevention
education and skills training, alternatives, problem identification and referral,
community-based process, environmental and social policy, intervention services,
youth prevention programs, youth intervention programs, community coalitions,
prevention training services, prevention resource centers, pregnant postpartum
prevention programs, pregnant postpartum intervention programs, other special
prevention programs, HIV early intervention services, and HIV outreach services.
These amendments and new sections are proposed to reorganize the rules
to present them in more logical order; to clarify the process and requirements
for program design and implementation; to describe the requirements for self-evaluation
of programs; to specify that performance and activity measures must be defined
for both the primary and secondary target populations; to refine the performance
measure review process; to clarify that participant rights apply to participants
in both prevention and intervention programs; to outline the additional rights
of participants in intervention programs; to require programs to have written
smoking policies and to prohibit all adults from using tobacco products in
the presence of program participants; to clarify the requirements related
to information dissemination; to refine the requirements related to prevention
education and skills training; to more fully describe the strategy of alternatives;
to include identification of risk factors for HIV and sexually transmitted
diseases during the screening process; to expand the requirements related
to follow-up in the problem identification and referral strategy; to present
the community-based process in a more organized and detailed manner; to more
fully describe intervention services and present the requirements related
to these services in a logical and organized format; to add requirements for
each program type that may be funded as a prevention or intervention program;
and to make grammatical changes to improve readability and understanding.
Terry Faye Bleier, Executive Director, has determined that for the first
five-year period the rules are in effect there will be no fiscal implications
for state or local government as a result of enforcing the rules.
Ms. Bleier has also determined that for each year of the first five years
the rules are in effect the anticipated public benefit will be a better understanding
of the requirements for prevention and intervention programs and more clarity
of the various types of strategies and programs that may be implemented. There
is no additional effect on small businesses. There is no anticipated economic
cost to persons required to comply with the proposed amendments and new sections.
Comments on the proposal may be submitted to Tamara Allen, Quality Assurance,
Texas Commission on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas
78708-0529. Comments must be received no later than 30 days from the date
the proposal is published in the
Texas Register
.
In addition, there will be a hearing to receive public comments on these proposed
rules at 4:30 p.m., Monday July 12, 1999, at the Austin Convention Center,
5000 East Cesar Chavez, Austin, Texas. If you have questions about the hearing,
you may contact Albert Ruiz, Community Network Coordinator, Texas Commission
on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas 78708-0529; phone
1-800-832-9623, extension 6607; or via email albert_ruiz@tcada.state.tx.us.
These amendments and new sections are proposed under the Texas
Health and Safety Code, §461.012(a)(15) which provides the Texas Commission
on Alcohol and Drug Abuse with the authority to adopt rules governing the
functions of the commission, including rules that prescribe the policies and
procedures followed by the commission in administering any commission programs.
The code affected by the proposed amendments and new sections is the Texas
Health and Safety Code, Chapter 461.
§144.411. Program Design and Implementation.
(a)
The provider shall determine what population the
program is designed to serve: universal, selective, indicated, or a combination.
[
(1)
Universal programs reach the
general population (such as all students in a school).
(2)
Selective programs target
a subset of the general population which is at high risk for substance abuse
(such as children of drug users).
(3)
Indicated programs are
designed for those who may already be experimenting with drugs or who exhibit
other problem-related behaviors.
(4)
Combination programs
provide a range of services for a specific community service setting.
(b)
The program shall identify and describe the primary
and secondary target populations including specific information about:
[
(1)
age, gender, and ethnicity;
(2)
risk and protective factors;
(3)
patterns of substance
use;
(4)
social and cultural characteristics;
(5)
knowledge, beliefs, values,
and attitudes; and
(6)
needs.
(c)
The program shall identify long-range goals which:
[
(1)
address identified risks, needs and/or problems of
the primary and secondary target populations;
[
(2)
are designed to enhance protective factors;
[
(3)
clearly describe behavioral and/or societal
changes to be achieved; and
[
(4)
are realistic in relation
to available resources.
(d)
The program shall establish objectives for each contract
period that are linked to the goals. Objectives must:
[
(1)
be realistic, outcome oriented, measurable, and time-specific;
[
(2)
include performance and activity measures required
in the contract; and
[
(3)
address specific family strategies, as applicable.
[
[
social and cultural
characteristics;]
[
knowledge, beliefs,
values, and attitudes; and]
[
needs.]
(e)
The program design shall be based on a logical,
conceptually sound framework to connect the prevention or intervention effort
with the intended result of preventing alcohol, tobacco, and other drug problems.
The program shall gather and use reliable evidence of effectiveness from comparable
programs to select and guide the program design. The program shall use results
that come from sound studies to assess potential effectiveness of the program
design relative to the needs of the target population.
[
[
address identified risks,
needs and/or problems;]
[
are designed to enhance
protective factors;]
[
clearly describe behavioral
and/or societal changes to be achieved; and]
[
ensure adequate availability
of resources to accomplish identified goals.]
(f)
In order to carry out the program design, the program
shall incorporate a combination of some or all CSAP's six prevention strategies
(information dissemination, prevention education and skills training, alternative
activities, problem identification and referral, community-based process,
and environmental and social policy). All Youth Prevention Programs (YPP)
and Youth Prevention Intervention (YPI) Programs must at a minimum conduct
prevention education and skills training as a core strategy. Each strategy
and activity must:
[
(1)
relate directly to program goals and objectives;
and
[
(2)
address identified needs.
[
(g)
The program shall be designed to build on and support
related prevention and intervention efforts in the community. The program
shall secure and maintain the support of key decision makers and leaders,
and shall establish formal linkages and coordinate with other community resources.
[
[
relate directly to program
goals and objectives;]
[
address identified needs;]
[
be of sufficient time,
intensity, and duration to produce intended results; and]
[
be appropriate for the
target population. The program design, content, communications, and materials
shall be:]
[
available in the primary language of the target
population; and ]
[
appropriate to the literacy level, gender,
race, ethnicity, sexual orientation, age, and developmental level of the target
population.]
(h)
The program shall be appropriately structured to
implement the program design. The prevention effort shall be consistent with
the availability of personnel, resources, and realistic opportunities for
implementation.
[
(i)
The program design, content, communications,
and materials shall:
[
(1)
be available in the primary
language of the target population;
(2)
be appropriate to the
literacy level, gender, race, ethnicity, sexual orientation, age, and developmental
level of the target population; and
(3)
recognize the cultural
identification (context) of the family unit.
(j)
The program design shall be
delivered at an appropriate time with sufficient intensity and applied over
an appropriate duration so that results can be sustained.
§144.412. Program Self-Evaluation.
(a)
The program shall perform self-evaluation to verify, document,
and quantify program activities and effectiveness
unless exempted through
an executive order
.
(b)
Programs shall conduct evaluation activities using
the Prevention Plus III format unless the commission has approved an alternative
model.
[
(c)
For programs in the first year of funding from the
commission, the evaluation process must include:
[
(1)
identification of goals and
objectives (PP III Step 1);
(2)
assessment of the service
delivery process (PP III Step 2); and
(3)
a plan for assessment
of the program outcomes (plan for PP III Step 3).
(d)
In subsequent funding years, the evaluation must
include:
[
(1)
identification of goals and objectives (PP III Step 1);
(2)
assessment of the service delivery process (PP III
Step 2); and
(3)
implementation of the assessment of the program
outcomes (PP III Step 3)
. [
(e)
The program shall submit a written evaluation report
using the format specified by the commission. The provider must submit the
report at the end of each contract period, no later than September 30th unless
otherwise stipulated in the contract.
[
[
identification of goals and
objectives (PP III Step 1);]
[
assessment of the service
delivery process (PP III Step 2); and]
[
implementation of the
assessment of the program outcomes (PP III Step 3).]
(f)
The program shall use information gained from the
annual self-evaluation to make appropriate changes to the program and the
staff training plan. Any change requiring commission approval must be made
through a contract amendment as described in §144.103 of this title (relating
to Amendments).
[
[
The program shall use information
gained from the annual self-evaluation to revise the program plan and staff
training plan. ]
§144.413. Performance and Activity Measures.
(a)
(No change.)
(b)
The program shall track and appropriately document the
performance and activity measures defined for the
primary and secondary
target
populations
[
(c)
(No change.)
§144.414. Performance Measure Review.
(a)
(No change.)
(b)
The commission shall review actual performance on key
measures [
(c)-(d)
(No change.)
[
If the program fails to satisfactorily
resolve any performance measure deficiencies as noted in the commission's
review, the commission will implement further corrective action and may impose
one or more of the following sanctions:]
[
designation as a high-risk provider;]
[
suspension of payments;]
[
one-time decrease in the contract amount
for the fiscal year;]
[
permanent decrease in the contract amount;
or]
[
termination of the contract.]
§144.415. Participant Rights.
(a)
Each provider shall develop and implement a policy and
age-appropriate procedures to protect the rights of children, families, and
adults participating in a prevention
or intervention
program.
(b)
(No change.)
(c)
Participants receiving individualized services in
an intervention program also have the right to refuse or accept services after
being informed of services and responsibilities, including:
[
(1)
program goals and objectives;
[
(2)
rules and regulations; and
[
(3)
participant rights.
[
(d)
Programs that provide services to identified individuals
shall maintain the confidentiality of participant-identifying information
as required by the federal regulations governing Confidentiality of Alcohol
and Drug Abuse Patient Records, Code of Federal Regulations, Title 42, Part
2.
[
[
program goals and objectives;]
[
rules and regulations;
and]
[
participant rights.
]
[
Programs that provide services
to identified individuals shall maintain the confidentiality of participant-identifying
information as required by the federal regulations governing Confidentiality
of Alcohol and Drug Abuse Patient Records, Code of Federal Regulations, Title
42, Part 2. ]
§144.416. Smoking Policies
(a)-(c)
(No change.)
(d)
Staff
and other adults
shall not use tobacco
products in the presence of participants.
(e)
(No change.)
(f)
The program shall have a written
smoking policy that complies with this section.
§144.441. Information Dissemination.
(a)
Each program that provides
activities within
this strategy [
(1)
the nature and extent of alcohol, tobacco, and other drug
use, abuse, and addiction;
(2)
HIV infection, tuberculosis, hepatitis, and sexually
transmitted diseases;
and/or
[
(3)
information about available services and resources.
(b)-(c)
(No change.)
(d)
The program shall document the number of persons
receiving written information/literature. For presentations, documentation
[
(1)
date, time, and duration of activity;
(2)
location of activity;
(3)
staff/volunteers conducting activity;
(4)
purpose and goal of activity;
and
(5)
number of participants
.
[
[
pieces of literature/written
information distributed.]
§144.442. Prevention Education and Skills Training.
(a)
(No change.)
(b)
The activities must include extensive interaction [
(c)
Activities shall be
conducted according to
[
(d)
Each program that provides
activities within
this strategy must help participants gain knowledge and/or skills needed to
access assistance or help with a problem.
(e)
(No change.)
§144.443. Alternatives [
(a)
Each program that provides
activities within
this strategy shall provide alternative activities designed to
assist
participants in
:
(1)
mastering
[
(2)
developing/maintaining relationships;
[
(3)
bonding with peers, family,
school , and community;
(4)
building cultural understanding,
and honoring diversity; and
(5)
identifying activities
which offset the attraction to fill needs met by alcohol, tobacco and other
drug use.
(b)
Alternative activities should be planned and conducted
to complement the exisiting program design and proposed outcomes
[
(c)
(No change.)
§144.444. Problem Identification and Referral.
(a)
General requirements. Each program that provides
activities within
this strategy shall provide problem identification
and referral services to ensure access to the appropriate level and type of
services needed by participants and their families. Required components include
screening, referral, and follow-up.
(b)
Screening. The screening process shall be designed to
identify warning signs for alcohol, tobacco, and/or other drug abuse [
(c)
Referral. The program shall identify needs that cannot
be met by the program and help the participant access appropriate support
systems and community resources. The program shall maintain a
current
list of referral resources
, including other services provided
by the organization
.
(d)
Follow-up. The program shall conduct and document follow-up
on referrals whenever possible.
Unsuccessful attempts at follow-up shall
also be documented.
(e)
Documentation. The program shall maintain documentation
of each screening
which includes:
(1)
date of the screening;
(2)
zipcode
[
(3)
demographics of the individual screened
[
(4)
referrals made
[
(5)
any follow-up contacts.
§144.445. Community-Based Process.
(a)
Each program that provides activities
within this strategy shall work with other service providers, organizations,
individuals, and families to promote substance abuse services and improve
the community's ability to prevent substance abuse and related problems.
[
[
The program must work with
other service providers, organizations, and individuals to promote substance
abuse services and improve the community's ability to prevent substance abuse
and related problems.]
[
The program must use
existing community services and resources effectively to enhance the prevention
program.]
[
The program must establish
linkages with other service providers to build a continuum of substance abuse
services in the community.]
[
To the extent possible
and appropriate, the program must involve family members in the prevention
program and coordinate appropriate services for them.]
[
When the program coordinates
services with another provider, there must be a written letter of agreement
that includes:]
[
names of the providers entering
into the agreement;]
[
services or activities each
provider will provide;]
[
signatures of authorized
representatives; and]
[
dates of action and expiration.]
[
Documentation of
community process activities shall include, as applicable:]
[
date, time, and duration
of activity;]
[
key contact persons/providers
involved;]
[
purpose and goal of activity;]
[
further action steps needed;
and]
[
action or change achieved.]
(b)
The program must use existing
community services and resources effectively to enhance the prevention program.
(c)
The program must establish
formal linkages with other service providers to build a continuum of substance
abuse services in the community. Where gaps exist, the program shall document
active participation in collaborations to support community resource development.
(d)
When the program coordinates
services with another provider, there must be a written letter of agreement
that is renewed annually and includes:
(1)
names of the providers entering into the agreement;
(2)
services or activities each provider will
provide;
(3)
signatures of authorized representatives;
and
(4)
dates of action and expiration.
(e)
Documentation of community
process activities shall include, as applicable:
(1)
date, time, and duration of activity;
(2)
key contact persons/providers involved;
(3)
purpose and goal of activity;
(4)
further action steps needed; and
(5)
action or change achieved.
§144.446. Environmental and Social Policy.
(a)
Each program that provides
activities within
this strategy shall take steps to influence the incidence and prevalence of
substance abuse through:
(1)
legal and regulatory strategies; or
(2)
service and action-oriented activities.
(b)-(d)
(No change.)
§144.447. Intervention [
(a)
A program may offer
intervention
[
[
Intervention counseling shall
be conducted through confidential face-to-face contacts with participants
and/or family members.]
[
The program shall assess
the individual's or family's needs and develop a service plan to address the
identified needs and the services to be provided.]
[
The program shall document
participation and follow-through, including any changes in the participant's
or family's status.]
[
The program shall provide
information and referrals for participant and/or family needs that cannot
be met by the program.]
(b)
The program shall determine
the needs of the participant (and family members) in a culturally appropriate,
face-to-face assessment. The assessment shall gather information to identify
the participant's risk and protective factors in five domains: individual,
family, school, peer relationships, and community.
(1)
Information about the individual shall include:
(A)
age, gender, culture and ethnicity;
(B)
individual assets;
(C)
ATOD use; and
(D)
legal issues.
(2)
Information about the family shall
include:
(A)
structure; and
(B)
functioning.
(3)
School information shall include:
(A)
literacy level;
(B)
academic performance;
(C)
social functioning; and
(D)
behavioral functioning issues.
(4)
Information about peer relationships
shall include:
(A)
ATOD use;
(B)
gang or club involvement; and
(C)
legal issues.
(5)
Information about the community shall
include:
(A)
economic status;
(B)
general environment; and
(C)
criminal activity.
(c)
The counselor and the participant
(and family members, if appropriate) shall develop a service plan to address
identified needs. The service plan shall include:
(1)
behavioral goals;
(2)
timelines for completion; and
(3)
recommended services/interventions.
(d)
Intervention counseling shall
be conducted through confidential face-to-face contacts with participants
and/or family members. All intervention counseling sessions shall be documented
in the participant's service record, including a summary of the session and
progress toward or away from identified goals.
(e)
The program shall provide
information, referrals, and follow-up for participant and/or family needs
that cannot be met by the program. These referrals must be documented in the
service record.
(f)
The program may also provide
crisis intervention, family case management, and support group opportunities.
(g)
When intervention services
are completed, the counselor shall file an exit summary in the service record
which includes a description of the results achieved and participant status
at closure.
§144.451. Youth Prevention Programs
(a)
The goal of youth prevention programs shall be to preclude
the onset of the illegal use of alcohol, tobacco and other drugs by youth
and to foster the development of social and physical environments that facilitate
healthy, drug-free lifestyles.
(b)
Youth prevention programs shall offer universal and/or
selective prevention strategies to youth and their families.
§144.452. Youth Intervention Programs
(a)
The goal of youth intervention programs shall be to interrupt
the illegal use of alcohol, tobacco and other drugs by youth and to break
the cycle of harmful use of legal substances and all use of illegal substances
by adults in order to halt the progression and escalation of use, abuse, and
related problems.
(b)
Youth intervention programs shall offer indicated prevention
strategies to youth and their families.
§144.453. Community Coalitions.
(a)
Community coalitions shall implement strategies designed
to accomplish the following goals:
(1)
to reduce substance use and abuse among youth in each
community served;
(2)
to strengthen collaboration in communities and support
the existing community-based prevention, intervention, and treatment infrastructure;
and
(3)
to increase citizen participation and greater commitment
among all sectors of the community toward reducing substance use and abuse.
(b)
Community coalitions shall include (or document attempts
to recruit) one or more representatives from each of these areas:
(1)
youth;
(2)
parents;
(3)
businesses;
(4)
media;
(5)
schools;
(6)
community organizations serving youth;
(7)
faith-based groups;
(8)
civic and/or volunteer groups;
(9)
health care professionals;
(10)
state, local, or tribal governmental agencies with
expertise in substance abuse; and
(11)
other organizations involved in reducing substance
abuse.
(c)
Each program shall submit a quarterly report that includes
a current list of all members in the coalition and a summary of the past quarter's
activities.
(d)
Community coalitions shall not provide or subcontract
for the provision of individual direct services - prevention education and
skills training, alternative activities or problem identification and referral
- as described in §144.442 of this title (relating to Prevention Education
and Skills Training.
§144.454. Prevention Training Services
(a)
Prevention training services are designed to strengthen
and expand a prevention infrastructure through the provision of statewide
training and technical assistance. The program shall provide these services
by dissemination of information on the latest prevention technology, research
and best practice approaches to encourage and support implementation of research-based
prevention programs.
(b)
The program shall submit a quarterly program narrative
report. The report shall address the following:
(1)
trainings;
(2)
program administration and staffing;
(3)
marketing efforts and collaboration;
(4)
follow-up/technical assistance; and
(5)
training schedule.
§144.455. Prevention Resource Centers.
(a)
The goal of each Prevention Resource Center shall be to
increase the effectiveness and visibility of prevention of alcohol, tobacco
and other drug use and abuse within the region it is funded to serve through
information dissemination, community education, and identification of training
resources and best practices in prevention.
(b)
Each Prevention Resource Center shall provide universal
prevention strategies to the region it serves.
(c)
Identified target groups shall include at a minimum: prevention
professionals and volunteers; community leaders; teachers; school counselors
and educational administrators; children and youth; parents and families;
communities at large; local news media within the region served; and other
persons in need of training in the area of alcohol, tobacco and other drugs.
(d)
The following services are required of all funded Prevention
Resource Centers:
(1)
prevention needs assessment and resource identification;
(2)
prevention information marketing efforts;
(3)
prevention training and referral to resources;
(4)
prevention materials clearinghouse;
(5)
regional coordination/networking; and
(6)
regional prevention resource center web site and
toll-free number.
(e)
Each program shall submit a monthly report detailing the
past month's efforts in the required Prevention Resource Center services categories.
§144.457. Pregnant Postpartum Prevention Programs.
(a)
The goal of pregnant postpartum prevention programs shall
be to preclude the onset of the use of alcohol, tobacco, and other drugs by
pregnant and postpartum women and to foster the development of social and
physical environments that facilitate healthy, drug-free lifestyles for the
women and their children.
(b)
Pregnant postpartum prevention programs shall offer universal
and/or selective prevention strategies to address the comprehensive service
needs and issues of non-using pregnant and postpartum women who are at risk
for substance abuse and their families.
(c)
Each program shall submit a quarterly narrative report.
§144.458. Pregnant Postpartum Intervention Programs
(a)
The goal of pregnant postpartum intervention programs
shall be to intervene on the substance use or abuse of pregnant and postpartum
women and to reduce the incidence of drug exposure of their unborn, newborn,
and/or young children .
(b)
Pregnant postpartum intervention programs shall provide
indicated intervention strategies to pregnant and postpartum substance using
or abusing women.
(c)
Each program shall submit a quarterly narrative report.
§144.459. Other Special Prevention Programs.
(a)
Special prevention programs are designed to meet the needs
of specific target populations.
(b)
Each program shall establish key performance measures
required and negotiated by the commission according to the specific program
design.
§144.460. HIV Early Intervention Services (HEI).
(a)
Programs receiving HIV early intervention funds shall
provide comprehensive HIV services to HIV infected persons with substance
abuse problems and/or persons at risk of being infected as a result of substance
abuse related activity and their families and/or significant others. HIV early
intervention services shall include the following components.
(1)
Access to HIV antibody counseling and testing. HEI staff
who perform HIV antibody counseling and testing must be currently registered
as a Prevention Counseling and Partner Elicitation (PCPE) counselor with the
Texas Department of Health.
(2)
Access to screening for tuberculosis and sexually
transmitted diseases.
(3)
Case management to identify and access appropriate
medical and social services for HIV infected clients and their families and/or
significant others.
(A)
Medical services for HI- infected clients include laboratory
analyses to monitor HIV status and ensure access to prescribed medication
and/or alternative treatments used to slow down or prevent HIV disease progression.
Services may also include clinical supervision as needed to carry out medical
service functions.
(B)
Social services for HIV infected clients and their families
and/or their significant others may include but are not limited to: legal
counseling, mental health counseling, child care, child welfare and family
services, social services advocacy, transportation to treatment programs or
HIV-related appointments, housing referrals, support groups, health and wellness
education (including education and counseling about medication scheduling
and adherence), and nutrition counseling.
(b)
Case management must be documented by the use of individualized
service plans which address and prioritize client needs identified through
assessment.
(1)
Service plans shall be completed within two weeks of a
client's entrance into HEI services.
(2)
Client and case manager participation in the service
plan process is required and is documented by signature of both parties on
the plan.
(3)
Objectives and strategies stated in the service plan
shall be specific and measurable.
(4)
Progress on service plan goals and objectives shall
be documented in client progress notes.
(5)
Service plans shall be updated based upon information
from the progress notes.
(c)
HIV early intervention services shall be provided only
if the client voluntarily gives informed consent. Receiving these services
shall not be required as a condition of receiving substance abuse treatment
or other services.
(d)
Programs shall establish linkages with a comprehensive
community resource network of related health, social service providers, and
community or regional planning groups.
(1)
Networks shall be documented by written service agreements
that are specific as to activities performed by the referral agency and those
performed by the commission-funded provider.
(2)
Service agreements shall be signed by responsible
parties of both agencies. Letters from planning councils/consortia/groups
chairs or co-chairs which describe the commission-funded provider as being
an active member or participant is sufficient documentation for this requirement.
(3)
Each service agreement or planning group letter shall
be renewed at the beginning of each fiscal year.
(e)
Each HEI program shall submit annual goals relating to
anticipated numbers of persons to be served during the course of the contract
period. Goals shall address the following key performance measures:
(1)
Referral/follow-up: The percentage of client referrals
made by the HIV Early Intervention program which resulted in an initial contact
of service provider by the client within 1 to 14 days during the report period.
(2)
Clients receiving substance abuse services: The percentage
of clients who receive substance abuse services while enrolled as a client
of HIV early intervention services.
(f)
Each HEI program shall submit annual and quarterly reports.
§144.462. HIV Outreach Services.
(a)
HIV outreach programs target substance abusers who may
or may not be seeking treatment and provide them with information, activities,
referrals, and education directed toward informing drug users about the relationship
between drug use (especially injecting drug activity) and communicable diseases.
(b)
HIV outreach service programs shall use outreach models
that are scientifically sound. Unless the commission approves another model
in writing, programs shall use one or more of the following models:
(1)
The NIDA Standard Intervention
Model for Injection Drug Users: Intervention Manual,
National AIDS
Demonstration Research (NADR) Program, National Institute on Drug Abuse, February,
1992;
(2)
AIDS Intervention Program
for Injecting Drug Users: Intervention Manual,
Rhodes, R., Humfleet,
G.L., et al., February, 1992; and
(3)
The Indigenous Leader Model:
Intervention Manual,
Wiebel, W. and Levin, L.B., February 1992.
(c)
HIV outreach services shall be delivered at times and
locations that meet the needs of the target population.
(1)
Outreach workers who perform HIV antibody test counseling
must be currently registered as Prevention Counseling and Partner Elicitation
(PCPE) counselors with the Texas Department of Health. PCPE counseling must
be performed as a one-to-one activity in a safe and confidentially secure
environment.
(2)
Commission-funded HIV outreach programs shall refer
all persons found to be HIV-infected to commission-funded HIV Early Intervention
programs.
(3)
Written procedures shall effectively secure confidentiality
of individuals who are identified through outreach activities as HIV infected
or at risk for HIV.
(d)
HIV outreach programs shall establish linkages with a
comprehensive community resource network of related health, social service
providers and community or regional planning groups.
(1)
Service agreements shall outline services and activities
performed by each agency, and include signatures from responsible parties
of each program. Letters from planning council/consortia chairs or co-chairs
which describe the commission funded provider as an active member or participant
is sufficient documentation for this requirement.
(2)
Each service agreement or planning group letter shall
be renewed at the beginning of each fiscal year.
(e)
HIV outreach programs shall report to the commission monthly,
quarterly and annually.
(1)
Monthly reports shall be submitted electronically through
the commission's web-based computer system and will include data on key performance
measures and demographics.
(2)
Quarterly documents will report street activities
that include a narrative describing observations or current trends in drug
activity, barriers and/or successful strategies used when providing outreach
services to the target population.
(3)
Program self-evaluation is required and shall consist
of a report generated annually by ongoing program work using the Prevention
Plus III process.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of the Secretary of State, on
June 14, 1999.
TRD-9903499
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Earliest possible date of adoption: July 25,1999
For further information, please call: (512) 349-6733
40 TAC §144.417
The Texas Commission on Alcohol and Drug Abuse proposes new
§144.417 concerning Prevention and Intervention. This section contains
information regarding staff training.
This new section is proposed to establish requirements for training the
staff of prevention and intervention programs, including training during the
first six months of hire and annually thereafter.
Terry Faye Bleier, Executive Director, has determined that for the first
five-year period the rule is in effect there will be no fiscal implications
for state or local government as a result of enforcing the rule.
Ms. Bleier has also determined that for each year of the first five years
the rule is in effect the anticipated public benefit will be better and more
consistently trained prevention and intervention program staff. There is no
additional effect on small businesses. The anticipated economic cost to persons
required to comply with the proposed new section will vary for each provider.
It will depend upon their present training practices and the methods used
to implement these new requirements. It is estimated that the cost could be
up to $800 per year for each provider.
Comments on the proposal may be submitted to Tamara Allen, Quality Assurance,
Texas Commission on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas
78708-0529. Comments must be received no later than 30 days from the date
the proposal is published in the
Texas Register
.
In addition, there will be a hearing to receive public comments on these proposed
rules at 4:30 p.m., Monday July 12, 1999, at the Austin Convention Center,
5000 East Cesar Chavez, Austin, Texas. If you have questions about the hearing,
you may contact Albert Ruiz, Community Network Coordinator, Texas Commission
on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas 78708-0529; phone
1-800-832-9623, extension 6607; or via email albert_ruiz@tcada.state.tx.us.
This new section is proposed under the Texas Health and Safety
Code, §461.012(a)(15) which provides the Texas Commission on Alcohol
and Drug Abuse with the authority to adopt rules governing the functions of
the commission, including rules that prescribe the policies and procedures
followed by the commission in administering any commission programs.
The code affected by the proposed new section is the Texas Health and Safety
Code, Chapter 461.
§144.417. Staff Training
(a)
During the first six months of employment, all direct
service prevention staff shall receive a total of eight hours of training
(or document eight hours of equivalent training) in the following areas:
(1)
cultural competency;
(2)
risk and protective factors/ building resiliency;
and
(3)
child development and/or adolescent development,
as appropriate.
(b)
Specific training in the curriculum implemented for Prevention
Education/Skills Training before facilitating the curriculum independently.
(c)
In subsequent years, all direct services prevention staff
shall receive eight hours prevention training related to the program design.
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on
June 14, 1999.
TRD-9903500
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Earliest possible date of adoption: July 25, 1999
For further information, please call: (512) 349-6733
40 TAC §§144.431-144.435
(Editor's note: The text of the following sections proposed for
repeal will not be published. The sections may be examined in the offices
of the Texas Commission on Alcohol and Drug Abuse or in the Texas Register
office, Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)
The Texas Commission on Alcohol and Drug Abuse proposes
the repeal of §§144.431-144.435 concerning Prevention and Intervention.
These sections contain the requirements for HIV early intervention services,
HIV outreach services, prevention resources centers, infant primary prevention
and intervention programs, and core council services. The repeals are proposed
because this entire subchapter has been reorganized to present the rules in
a more logical order. The requirements of these sections are incorporated
into new sections that are being proposed concurrently.
Terry Bleier, Executive Director, has determined that for the first five-year
period the repeals are in effect there will be no fiscal implications for
state or local government as a result of the proposed repeals.
Ms. Bleier has also determined that for each year of the first five years
the repeals are in effect the anticipated public benefit will that the rules
will be easier to find as they are presented in more logical order. There
will be no effect on small businesses. There is no anticipated economic cost
to current providers.
Comments on the proposal may be submitted to Tamara Allen, Quality Assurance,
Texas Commission on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas
78708-0529. Comments must be received no later than 30 days from the date
the proposal is published in the
Texas Register
.
In addition, there will be a hearing to receive public comments on these proposed
rules at 4:30 p.m., Monday July 12, 1999, at the Austin Convention Center,
5000 East Cesar Chavez, Austin, Texas. If you have questions about the hearing,
you may contact Albert Ruiz, Community Network Coordinator, Texas Commission
on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas 78708-0529; phone
1-800-832-9623, extension 6607; or via email albert_ruiz@tcada.state.tx.us.
The repeals are proposed the Texas Health and Safety Code, §461.012(a)(15)
which provides the Texas Commission on Alcohol and Drug Abuse with the authority
to adopt rules governing the functions of the commission, including rules
that prescribe the policies and procedures followed by the commission in administering
any commission programs.
The code affected by the proposed repeals is the Texas Health and Safety
Code, Chapter 461.
§144.431. HIV Early Intervention Services.
§144.432. HIV Outreach Services.
§144.433. Prevention Resource Centers.
§144.434. Infant Primary Prevention and Intervention Programs.
§144.435. Core Council Services.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of the Secretary of State, on
June 14, 1999.
TRD-9903502
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Earliest possible date of adoption: July 25, 1999
For further information, please call: (512) 349-6733
40 TAC §144.456
The Texas Commission on Alcohol and Drug Abuse proposes new
§144.456 concerning Prevention and Intervention. This section contains
information regarding core council services.
This new section is proposed because this section was reorganized to present
the information in a more logical order and to implement a new requirement
that Core Council service providers must render crisis intervention services.
Terry Faye Bleier, Executive Director, has determined that for the first
five-year period the rule is in effect there will be no fiscal implications
for state or local government as a result of enforcing the rules.
Ms. Bleier has also determined that for each year of the first five years
the rule is in effect the anticipated public benefit will be more clarity
about core council services and their role in prevention and intervention
as well as the provision of crisis intervention services to the public. There
is no additional effect on small businesses. The anticipated economic cost
to persons required to comply with the proposed new section will vary depending
on current service and equipment. It is estimated that it could cost up to
$1,000 per year.
Comments on the proposal may be submitted to Tamara Allen, Quality Assurance,
Texas Commission on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas
78708-0529. Comments must be received no later than 30 days from the date
the proposal is published in the
Texas Register
.
In addition, there will be a hearing to receive public comments on these proposed
rules at 4:30 p.m., Monday July 12, 1999, at the Austin Convention Center,
5000 East Cesar Chavez, Austin, Texas. If you have questions about the hearing,
you may contact Albert Ruiz, Community Network Coordinator, Texas Commission
on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas 78708-0529; phone
1-800-832-9623, extension 6607; or via email albert_ruiz@tcada.state.tx.us.
This new section is proposed under the Texas Health and Safety
Code, §461.012(a)(15) which provides the Texas Commission on Alcohol
and Drug Abuse with the authority to adopt rules governing the functions of
the commission, including rules that prescribe the policies and procedures
followed by the commission in administering any commission programs.
The code affected by the proposed new section is the Texas Health and Safety
Code, Chapter 461.
§144.456. Core Council Services
(a)
Core council service providers are community-based organizations
that provide alcohol, tobacco and other drug prevention and intervention services
to the community at large in their identified catchment area. Core council
service providers conduct a variety of services aimed to reduce use and abuse
of ATOD in the targeted community(ies) including information, referral and
placement services.
(b)
Core council services programs shall offer universal,
selective and indicated strategies to individuals, families, and communities
within the service area defined in the contract.
(c)
Minimum core council services shall include the following:
(1)
Information dissemination shall be provided for the purposes
of awareness and case finding in the community.
(2)
Problem identification and referral shall be provided
for the purpose of the identification of appropriate treatment needs through
screening, referral, placement and follow-up.
(3)
Crisis intervention services shall be provided for
the purpose of providing immediate response to individuals and/or families
in crisis who may call or present themselves in need of core council services.
(A)
Core council service programs shall establish an avenue
for a person in crisis to speak with a trained counselor or trained volunteer
within one hour of the initial call received during and after normal business
hours.
(B)
Core council service programs shall develop written policies
and procedures for crisis intervention services during and after normal business
hours.
(C)
Core council service programs shall provide training annually
on crisis telephone call policies and procedures for all employees who answer
(or may answer) the telephone during or after normal business hours.
(4)
Minors and tobacco activities shall be provided
for the purpose of reducing minors' access to tobacco products throughout
the catchment area served.
(5)
Community-based process shall be provided for the
purpose of enhancing the ability of the community to more effectively provide
substance abuse services.
(d)
Core council services may include assessment for treatment
as described in §144.448 of this title (relating to Assessment for Treatment).
Core council service programs conducting assessments for treatment shall maintain
written agreements with referral sources/treatment providers to a. identify
assessment roles in order to minimize duplicate efforts in conducting treatment
assessments.
(e)
Core council service providers shall not provide intervention
counseling.
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on
June 14, 1999.
TRD-9903501
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Earliest possible date of adoption: July 25, 1999
For further information, please call: (512) 349-6733
40 TAC §§144.511, 144.512, 144.521-144.526, 144.531, 144.541, 144.543, 144.545, 144.551-144.554
The Texas Commission on Alcohol and Drug Abuse proposes amendments
to §§144.511, 144.512, 144.521-144.525, 144.531, 144.541, 144.543,
144.545, and 144.551-144.554 and proposes new §144.526 concerning Treatment.
These sections contain information regarding program design and implementation,
self evaluation, client eligibility, priority populations, capacity management,
facility capacity system, interim services for priority populations, length
of stay guidelines, admission, specialized treatment services for females,
pharmacotherapy services, family services, performance measure review, select
performance measure definitions, client billings and client data systems (CDS)
forms.
These amendments and new section are proposed to provide more guidance
about the use of data, research and studies in program design; to describe
the self evaluation process and how to use the resulting information; to clarify
how to determine an adolescent's ability to pay; to add veterans to the list
of priority populations (required by new legislation); to require providers
to implement a marketing/outreach plan that specifically targets priority
populations; to add requirements regarding capacity management, particularly
for certain populations; to specify that programs must use the state's facility
capacity management system to facilitate prompt, appropriate placements; to
clarify the procedures to be used by treatment programs to report available
capacity and waiting list information; to describe required interim services;
to incorporate length of stay guidelines in the rules; to fully describe the
admission process and to ensure that admission criteria will not automatically
exclude certain individuals; to clarify what is required of programs that
serve pregnant adult or adolescent females and adult or adolescent females
with dependent children; to expand the requirements of pharmacotherapy programs;
to fully describe family services, including purpose, potential recipients,
reimbursable services, acceptable providers, and required documentation; to
update the performance measure review process; to clarify performance measure
definitions; to specify which clients are to be reflected on the monthly client
billings; to revise the description of the billing system; to update references;
and to make grammatical changes that enhance readability and understanding.
Terry Faye Bleier, Executive Director, has determined that for the first
five-year period the rules are in effect there will be no fiscal implications
for state or local government as a result of enforcing the rules.
Ms. Bleier has also determined that for each year of the first five years
the rules are in effect the anticipated public benefit will be a better understanding
of these requirements and, as a result, more effective and efficient treatment
programs for those who are chemically dependent. There is no additional effect
on small businesses. There is no anticipated economic cost to persons required
to comply with the proposed amendments and new section.
Comments on the proposal may be submitted to Tamara Allen, Quality Assurance,
Texas Commission on Alcohol and Drug Abuse, P.O. Box 80529, Austin, Texas,
78708-0529. Comments must be received no later than 30 days from the date
the proposal is published in the
Texas Register
.
In addition, there will be a hearing to receive public comments on these proposed
rules at 4:30 p.m., Monday July 12, 1999, at the Austin Convention Center,
5000 East Cesar Chavez, Austin, Texas. If you have questions about the hearing,
you may contact Albert Ruiz, Community Network Coordinator, Texas Commission
on Alcohol and Drug Abuse, P.O. Box 80529, Austin, Texas, 78708-0529; phone
1-800-832-9623, extension 6607; or via email albert_ruiz@tcada.state.tx.us.
These amendments and new section are proposed under the Texas
Health and Safety Code, §461.012(a)(15) which provides the Texas Commission
on Alcohol and Drug Abuse with the authority to adopt rules governing the
functions of the commission, including rules that prescribe the policies and
procedures followed by the commission in administering any commission programs.
The code affected by the proposed amendments and new section is the Texas
Health and Safety Code, Chapter 461.
§144.511.Program Design and Implementation.
(a)
The program design must be based on a logical, conceptually
sound framework with the intended result of reducing alcohol, tobacco, and
other drug problems.
The program shall gather and use reliable evidence
of effectiveness from comparable programs to select and guide the program
design. The program shall use results that come from sound studies to assess
potential effectiveness of the program design related to the needs of the
target population.
[
(b)-(d)
(No change.)
(e)
The program shall establish objectives for each contract
period that are linked to the long range goals. Objectives must:
(1)
be realistic,
outcome-oriented
, measurable,
and time-specific; and
(2)
(No change.)
(f)
(No change.)
[(g)
The program must also develop and implement
an annual plan to provide employees with training and continuing education
in the program's services. The plan must include cultural awareness and sensitivity
training for all employees.]
§144.512.Self Evaluation.
(a)
Each program shall develop and implement a system
that makes use of data
to monitor and evaluate the quality, efficiency,
and effectiveness of its program(s) [
(b)
The system shall identify
program strengths and
problem areas,
develop necessary program adjustments, and ensure the
implementation of these adjustments.
[
(c)
(No change.)
(d)
The program shall also document:
(1)
identified
program strengths and
problem areas;
(2)
resulting program adjustment to be made
[
(3)
the implementation of these adjustments
[
(4)
the results of
the self-evaluation system
corrective actions taken.
[(e)
The program shall use information gained
from the annual self-evaluation to revise the program plan and staff training
plan.]
§144.521.Client Eligibility.
(a)-(c)
(No change.)
(d)
For adolescents, ability to pay shall be determined
by parental or family income unless:
[
(1)
the adolescent applies for treatment without
parental knowledge; and
(2)
the adolescent refuses to consent
to parental notification.
§144.522.Priority Populations.
(a)
[
(1)
pregnant injecting drug users;
(2)
pregnant substance abusers;
(3)
injecting drug users;
(4)
former Supplemental Security Income recipients previously
disabled from substance abuse;
(5)
parents with children in foster care; and
(6)
veterans with honorable discharges
[
(b)
The program shall implement a marketing/outreach
plan that specifically targets these priority populations.
(c)
The program shall establish screening
procedures to identify members of priority populations and admit them before
all others, in priority order.
§144.523.Capacity Management.
(a)
The program shall maintain a waiting list
or other
organized and documented system to track
[
(b)-(c)
(No change.)
(d)
The program shall consult the state's
facility capacity management system to facilitate prompt placement in an appropriate
treatment program within a reasonable geographic area.
(e)
The program shall implement a mechanism
to maintain contact with pregnant women and intravenous drug users waiting
for admission.
(f)
If a pregnant women is placed on the waiting
list, the program must make interim services available to her within 48 hours
as described in §144.525 of this title (relating to Interim Services
for Priority Populations).
(g)
The program shall ensure that each individual
who requests and is in need of treatment for intravenous drug abuse is admitted
to an appropriate program not later than:
(1)
14 days after making the request; or
(2)
120 days after making the request when interim services
are provided to the individual within 48 hours as described in §144.525
of this title (relating to Interim Services for Priority Populations).
(h)
[
§144.524.Facility Capacity System.
(a)
Treatment programs shall report available capacity and
waiting list information through the commission's facility capacity management
system and comply with procedures
specified by the commission
[
(b)-(c)
(No change.)
§144.525.Interim Services for Priority Populations .
(a)
When a program does not have capacity to admit an injecting
drug user or pregnant female, the program shall [
(b)
Interim services shall
be offered within 48 hours.
[
[(1)
be offered within 48 hours; ]
[(2)
continue until the individual is
admitted into treatment; and]
[(3)
include strategies to reduce the
adverse health effect of intravenous drug use and to reduce the risk of transmission
of disease.]
(c)
Interim services shall include counseling and education
about HIV and tuberculosis (TB), including the risks of needle-sharing, the
risks of transmission to sexual partners and infants, and steps that can be
taken to prevent transmission. Referrals for HIV or tuberculosis treatment
shall be provided if necessary.
For pregnant females, interim services
shall also
include counseling
[
(d)
The program shall maintain documentation of interim services
provided.
[(e)
Even when interim services are provided,
an individual requesting treatment for intravenous drug use shall be admitted
to an appropriate program within 120 days.]
§144.526.Length of Stay Guidelines.
(a)
Length of stay in treatment shall be determined by the
needs of the individual client. Whenever possible, multiple levels of care
shall be used to provide a continuum of care for each individual client.
(b)
The commission has adopted Texas Department of Insurance
guidelines to provide a tool for monitoring service utilization. Clients may
remain in a specific level of treatment for a longer or shorter period of
time based on individual need.
(c)
When a client's length of stay in a level of treatment
exceeds the guidelines, the provider shall clearly document the needs and
conditions justifying the variance in the client record.
(d)
All facilities shall implement procedures to monitor length
of stay according to these guidelines.
(e)
The commission has interpreted the Texas Department of
Insurance Guidelines to apply them to the commission's defined levels of service.
Any revisions adopted by the Texas Department of Insurance supercede the recommended
lengths of stay listed in this section.
(1)
Residential Level I (Detoxification): 1-14 days for adults
and adolescents.
(2)
Outpatient Level I (Detoxification): 3-9 days for
adults, not applicable for adolescents.
(3)
Residential Level II (Intensive Residential): 14-35
days for adults and 14-60 days for adolescents.
(4)
Outpatient Level II (Day Treatment): 14-35 days for
adults and 14-60 days for adolescents.
(5)
Residential Level III (Residential): 28-70 days for
adults and 28-120 days for adolescents.
(6)
Outpatient Level III (Intensive Outpatient): 30-84
days for adults and 30-84 days for adolescents.
(7)
Outpatient Level IV (Outpatient): Up to 180 days for
adults and adolescents.
Admission
[
(a)
The program shall assess each applicant face-to-face
to determine if the person is appropriate for admission.
[
(1)
Every client admitted to a Level I treatment
program shall meet the DSM-IV criteria for substance intoxication or withdrawal.
Persons in need of crisis stabilization who meet the criteria for substance
dependence may be admitted to Level I treatment for up to 72 hours.
(2)
Every client admission to a Level
II, III, or IV treatment program shall meet the DSM-IV criteria for substance
abuse or dependence.
(b)
All admissions must be authorized or denied by a QCC.
[
(1)
For every applicant admitted to treatment,
the client record must include documentation signed by a QCC that the individual
met all applicable admission criteria, including the DSM-IV diagnostic criteria.
(2)
When an applicant is denied admission,
the program shall maintain documentation signed by a QCC which explains why
the admission was denied.
(c)
The assessment shall include a criteria-based evaluation
to determine the appropriate level of service
[
(d)
As part of the assessment, the
[
[(1)
Education shall adhere to TCADA Workplace
Guidelines for HIV and AIDS.]
[(2)
Risk assessments and risk reduction
counseling shall follow guidelines as set by the National Institute on Drug
Abuse's "Preventing HIV Among Substance Abusers: Risk Assessment/Risk Reduction."]
(e)
The program's admission criteria shall
not exclude members of the commission's priority populations defined in §144.522
of this title (relating to Priority Populations).
(f)
The program's admission criteria shall
not automatically exclude individuals based on:
(1)
physical or mental health history;
(2)
current physical or mental health diagnoses or services;
(3)
past or present prescription medications;
(4)
assumptions of ability to benefit from treatment without
documented current behavioral evidence; or
(5)
drugs being abused.
(g)
The program shall not automatically deny
admission to a previous client based on prior treatment unless the individual
has been admitted to the facility three or more times in the past 12 months.
(h)
The program shall not automatically deny
admission based on a perceived threat of harm to self or others. The program
shall have a policy and procedures for assessment of potential harm to self
or others. If the program determines that an individual is a current risk
to self or others, the program may require an evaluation from a qualified
mental health provider prior to admission.
(i)
All treatment programs shall develop and
implement written procedures to identify clients exhibiting conditions or
behavior that may suggest unmet mental health needs. The program shall collaborate
with and provide referrals to available resources (including qualified and
credentialed mental health professionals) to address the client's mental health
needs.
§144.541.Specialized Treatment Services for Females.
(a)
Specialized female programs shall serve pregnant
adult or adolescent
females and
adult or adolescent
females
with dependent children. Females with dependent children include females in
treatment who are attempting to regain custody of their children.
(b)
These programs shall treat the
female and her dependent
children
[
(c)
All programs offering specialized female services shall
provide a comprehensive treatment program. The following services shall be
provided directly or through
collaborative agreements and case management
arrangements with other service providers:
(1)
primary medical care for females receiving treatment, including
age-appropriate and specific reproductive health care and
prenatal care;
(2)
gender-specific substance abuse treatment and other
therapeutic interventions for females that [
(3)
childcare while the females are receiving services;
(4)
primary pediatric care for the clients' children,
including immunizations;
(5)
therapeutic interventions for the children[
(6)
documented
sufficient case management and
transportation services to ensure that female clients and their children have
access to the services provided by paragraphs (1)-(5) of this subsection.
(d)
Programs shall
implement a coordinated marketing/outreach
plan that targets services and organizations that regularly serve adult or
adolescent females with or without dependent children, including Child Protective
Services and the Temporary Aid for Needy Families (TANF) program
[
(e)
Treatment programs serving women with dependent children
shall report monthly measures [
(f)
Programs serving adult or adolescent females
shall provide an array of services including Levels II, III, and IV treatment
and structured aftercare, either directly or through case management and service
agreements. Level, intensity, and duration of services shall be clinically
appropriate.
(g)
Programs shall have written referral and
service coordination procedures with qualified providers to provide:
(1)
assessments for children for Early Childhood Intervention
services; and
(2)
counseling or therapy to address the children's identified
developmental, emotional, or psychosocial needs.
§144.543.Pharmacotherapy Services.
(a)
(No change.)
(b)
Programs shall establish a phase/level system which is
consistent with guidelines from the
Substance Abuse and Mental Health
Services Administration (SAMHSA)
[
(1)
Phase I: During the first 45 days of treatment, the client
shall receive [
(2)
Phase II: After 45 days of continuous treatment, the
client shall receive [
[(3)
Phase III: After two years of continuous
treatment, the client shall receive at least one individual counseling session
per month.]
(c)
(No change.)
(d)
All Pharmacotherapy programs shall adopt
policies and procedures that conform with §144.523 of this title (relating
to Capacity Management), §144.524 of this title (relating to Facility
Capacity System), and §144.535 of this title (relating to Interim Services).
(e)
A Pharmacotherapy program can bill for
a client receiving methadone who has an excused or planned absence for up
to two consecutive days. The frequency of approved absences shall be reasonable
and appropriate and shall not exceed eight days in a 30-day period.
(f)
All Pharmacotherapy programs shall complete
a client fee assessment on each commission-funded client every six months.
If a client remains in a commission-funded slot for more than 18 months, the
provider must review the treatment plan and justify the need for continued
commission-funded treatment in the client's record.
(g)
All direct care employees shall demonstrate
knowledge or receive training that includes:
(1)
symptoms of opiate withdrawal;
(2)
drug urine screens;
(3)
current standards of pharmacotherapy; and
(4)
poly-drug addiction.
§144.545.Family Services.
(a)
Providing services to the family of the primary client
is required of all commission funded programs. Family centered services are
a crucial ingredient in providing comprehensive, community-based services
to children, adolescents and adults.
[
(b)
Family services shall be designed to identify family
risk factors
[
(c)
Family services
are
[
(1)
family psychosocial
assessment
[
(2)
individual
counseling or
therapy;
(3)
group
counseling or
therapy; [
(4)
family counseling or therapy;
(5)
family case management;
(6)
family in-home support; and
(7)
[
(d)
Family services must be provided by qualified staff
including LCDCs
who have the
documented education,
training
and experience needed to perform the specific
family services being provided
[
(e)
Family services must be documented in [
(1)
Family psychosocial
assessment
[
(2)
Family service plan. The counselor
, client
and family shall develop the plan
and update it as goals are accomplished
or needs change. This plan
[
(A)
abilities, strengths, preferences,
problems
and needs identified
from the client and family assessment
[
(B)
goals
that are realistic, outcome-oriented, measurable,
time limited and stated in behavior terms that are understandable to the client
and family
[
(C)
specific
services to be provided
that enable
[
(D)
aftercare services to be provided upon
discharge, including necessary community supports.
(3)
Progress notes. Progress notes must document
the services provided
and the family's response
[
(A)
date, nature, and duration of the contact;
(B)
individuals involved;
(C)
content and goals addressed;
(D)
progress
or lack of progress
toward the goals;
and
(E)
other relevant information.
(4)
Discharge plan.
Discharge planning shall
begin at the time of the initial treatment plan. And
[
(A)
family goals or activities to sustain progress;
(B)
referrals for other needed
support
services;
[
(C)
aftercare services
; and
[
(D)
follow-up.
§144.551.Performance Measure Review.
(a)
(No change.)
(b)
The commission shall review actual performance [
(c)-(d)
(No change.)
[(e)
If the program fails to satisfactorily
resolve any performance measure deficiencies as noted in the commission's
review, the commission will implement further corrective action and may impose
one or more of the following sanctions:]
[(1)
designation as a high-risk provider;]
[(2)
suspension of payments;]
[(3)
one-time decrease in the contract amount for the
fiscal year;]
[(4)
permanent decrease in the contract amount; or]
[(5)
termination of the contract.]
§144.552.Select Performance Measure Definitions.
(a)
Completion of Treatment. This measure applies to Levels
II, III, and IV, except for pharmacotherapy programs. For a client to have
completed
a level of
treatment, the client record must indicate
that all of the following criteria have been met.
(1)
A client must substantially complete
his or her
[
(A)
The percentage of the
individual's,
planned
duration of stay
(as documented in the most recent treatment plan)
that was completed by the client. [
(B)
The percentage of the behavioral objectives identified
in the original treatment plan and subsequent revisions that have been achieved
by the client.
(2)
A discharge plan or transfer note must have been
completed in accordance with the requirements noted in §148.322 of this
title (relating to Discharge Plan) or §148.304 of this title (relating
to Treatment Plan Reviews).
(3)
The discharge summary or transfer note shall indicate
whether the client has successfully completed treatment according to the above
criteria, and must be signed by a qualified credentialed counselor. The client
record must also contain supporting documentation for completion.
(b)
Abstinence. This measure applies to Levels II, III, and
IV programs, except for pharmacotherapy programs.
Abstinence is the percent
of clients who report no use of alcohol or drugs within the past 30 days when
contacted 60 days after discharge from the treatment program. For those clients
who are transferred to another commission-funded level of service within the
same program (therefore no follow-up is required), abstinence is the percent
of transferred clients who report no use of alcohol or drugs during the 30
days prior to discharge or the duration of treatment, whichever is less.
[(1)
For youth, abstinence is the percent
of youth who report no use of alcohol or drugs within the past 30 days when
contacted 60 days after discharge from the treatment program. For those youth
who are transferred to another commission-funded level of service within the
same program (therefore no follow-up is required), abstinence is the percent
of transferred youth who report no use of alcohol or drugs during the 30 days
prior to discharge or the duration of treatment, whichever is less.]
[(2)
For adults, abstinence is the percent
of adults who report no use of alcohol or drugs within the past 30 days when
contacted 60 days after discharge from the treatment program. For those adults
who are transferred to another commission-funded level of service within the
same program (therefore no follow-up is required), abstinence is the percent
of transferred adults who report no use of alcohol or drugs during the 30
days prior to discharge or the duration of treatment, whichever is less.]
(c)
(No change.)
(d)
One-Year Retention Rate. This measure applies to Level
IV Pharmacotherapy programs. The One-Year Retention Rate is the percentage
of clients admitted within the previous fiscal year who have remained continuously
active in the program for at least one year
as documented by CDS forms
.
(e)
Abstinence Rate. This measure applies to Level IV Pharmacotherapy
programs. The Abstinence Rate is based on the percentage of clients with no
positive urinalysis for illicit opiates, amphetamines, cocaine, and barbiturates
in the 90 days prior to the Methadone Annual Survey.
The client record
shall contain copies of all urinalysis test results.
This calculation
excludes recent admissions.
(f)
Employment Rate. This measure applies to Level IV Pharmacotherapy
programs. The Employment Rate is based on the percentage of all active clients
employed at the time of the Methadone Annual Survey
, as documented in
the client record
. This calculation excludes recent admissions.
§144.553.Client Billings.
(a)
Treatment programs shall submit monthly client billings
for each client served in the program who is supported [
(b)-(d)
(No change.)
[(e)
Billings with incomplete or invalid information
may generate an error report. When a billing error report is received, the
program shall promptly correct the errors or resubmit new client billings
as needed. Errors must be corrected before the next billing cycle.]
(e)
[
(f)
[
(g)
[
(1)
weekly summary progress notes which provide a summary of
all scheduled groups attended by the client, including the dates covered,
the topics, the number of hours, and the client's level of participation;
(2)
documentation of the purpose, duration, and justification
of any approved absence from a residential program;
(3)
a record of all case management, referral, linkage,
and follow-up activities; and
(4)
a progress note documenting the information gathered
in the 60-day follow-up contact, including:
(A)
the date and time of successful follow-up contact;
(B)
the name of the person contacted and relationship to the
client;
(C)
the telephone number of the person contacted;
(D)
documentation of any unsuccessful attempts at follow-up;
and
(E)
the signature of the person who conducted and documented
the follow-up interview.
Client Data Systems (CDS) Forms
[
(a)
All treatment programs shall submit
CDS forms
[
(b)
Programs shall comply with reporting procedures detailed
in the
CDS
[
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on
June 14, 1999.
TRD-9903503
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Earliest possible date of adoption: July 25, 1999
For further information, please call: (512) 349-6733
§144.554.40 TAC §144.532
The Texas Commission on Alcohol and Drug Abuse proposes amendments
to §144.532 concerning Treatment. This section contains information regarding
core program requirements.
These amendments are proposed to update the name of the section; to delineate
the exact responsibilities of all commission-funded programs; to make grammatical
changes to enhance readability and understanding; to require all programs
to provide family education and counseling and group aftercare; to reduce
the maximum number of clients allowed in a group counseling session from 16
to 12; to mandate formal letters of agreement that must be renewed annually;
to require that programs operating at low capacity implement structured outreach
plans; to mandate that where gaps in service delivery exist, programs must
document active participation in collaborations to support community resource
development; to increase the number of hours of additional structured activities
during evenings and weekends; and to specify that all counseling sessions
and other activities counted toward the required hours of service must be
of at least 30 minutes duration.
Terry Faye Bleier, Executive Director, has determined that for the first
five-year period the rules are in effect there will be no fiscal implications
for state or local government as a result of enforcing the rules.
Ms. Bleier has also determined that for each year of the first five years
the rules are in effect the anticipated public benefit will be better and
more consistent provision of core services in all commission funded treatment
programs and improved quality of care. There is no additional effect on small
businesses. There is an anticipated economic cost to persons required to comply
with the proposed amendments. There is no impact for implementing the requirements
for family services since the commission will reimburse these costs. The cost
to implement aftercare will depend upon current program design and staffing
pattern. It is estimated that the cost for aftercare could be up to $600 per
year.
Comments on the proposal may be submitted to Tamara Allen, Quality Assurance,
Texas Commission on Alcohol and Drug Abuse, P.O. Box 80529, Austin, Texas,
78708-0529. Comments must be received no later than 30 days from the date
the proposal is published in the
Texas Register
.
In addition, there will be a hearing to receive public comments on these proposed
rules at 4:30 p.m., Monday July 12, 1999, at the Austin Convention Center,
5000 East Cesar Chavez, Austin, Texas. If you have questions about the hearing,
you may contact Albert Ruiz, Community Network Coordinator, Texas Commission
on Alcohol and Drug Abuse, P.O. Box 80529, Austin, Texas, 78708-0529; phone
1-800-832-9623, extension 6607; or via email albert_ruiz@tcada.state.tx.us.
These amendments are proposed under the Texas Health and Safety
Code, §461.012(a)(15) which provides the Texas Commission on Alcohol
and Drug Abuse with the authority to adopt rules governing the functions of
the commission, including rules that prescribe the policies and procedures
followed by the commission in administering any commission programs.
The code affected by the proposed amendments is the Texas Health and Safety
Code, Chapter 461.
Core Program Requirements
[
(a)
All treatment programs shall comply with applicable chemical
dependency treatment facility licensure requirements for the specified level
of service established in Chapter 148 of this title (relating to Facility
Licensure).
(b)
All programs funded by the commission shall
[
(1)
implement a systematic process to identify
and provide
appropriate referrals for family members
of clients
;
(2)
inform clients and involved family members of family
services offered directly and through other community resources; and
(3)
document family participation and attempts to engage
family members in services.
(c)
Levels II, III, and IV treatment programs funded by the
commission shall provide:
(1)
[
(2)
life
[
(3)
case management;
(4)
relapse prevention services; [
(5)
support group opportunities for adolescents and adults
, including older adults; and
(6)
aftercare, including group counseling.
(d)
The program shall have written description of all educational
and didactic sessions, including curricula, outlines, and activities.
(e)
Group size shall be limited to a number that allows effective
interaction between the group and facilitator and between group members.
(1)
Group counseling sessions are limited to a maximum of
12
[
(2)
Group education sessions, didactic sessions, [
(f)
The program shall establish
formal letters of agreement
[
(1)
names of the organizations entering into the agreement;
(2)
services or activities each organization will provide;
(3)
signatures of authorized representatives; and
(4)
dates of action and expiration.
(g)
The program shall develop and implement
a written plan of operation explaining outreach efforts, including specific
strategies to reach members of the priority populations listed in §144.522
of this title (relating to Priority Populations). The commission may waive
this requirement if the program demonstrates high capacity utilization and
adequate engagement of priority populations.
(h)
Where gaps in the service delivery system
exist, the program shall document active participation in collaborations to
support community resource development.
(i)
Levels II, III, and IV residential programs
shall schedule planned, structured activities during evenings and weekends.
These hours are in addition to those required by licensure rules. The minimum
number of additional hours for Levels II, III, and IV are 10 hours for adults
and 15 hours for adolescents. The program shall maintain documentation that
the activities were provided, including sign-in sheets. Client participation
does not need to be individually recorded in client records.
(j)
All counseling sessions and other activities
counted toward the required hours of service must last at least 30 minutes.
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on
June 14, 1999.
TRD-9903504
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Earliest possible date of adoption: July 25, 1999
For further information, please call: (512) 349-6733
§144.532.40 TAC §§144.533, 144.542, 144.544
(Editor's note: The text of the following sections proposed for
repeal will not be published. The sections may be examined in the offices
of the Texas Commission on Alcohol and Drug Abuse or in the Texas Register
office, Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)
The Texas Commission on Alcohol and Drug Abuse proposes
the repeal of §§144.533, 144.542 and 144.544 concerning Treatment.
These sections contain information on service enhancements, court commitment
services and dual diagnosis programs. The repeals are proposed due to reorganization
of the rules and deletion of outdated requirements. Requirements related to
service enhancements have been incorporated into appropriate sections in this
chapter which are being concurrently proposed. Requirements related to court
commitment services have been consolidated into §148.238 of this title
(related to Court Commitment Services) so that they will all be contained
in one section, which is also concurrently proposed. Requirements related
to dual diagnosis programs have been deleted.
Terry Bleier, Executive Director, has determined that for the first five-year
period the repeals are in effect there will be no fiscal implications for
state or local government as a result of the proposed repeals.
Ms. Bleier has also determined that for each year of the first five years
the repeals are in effect the anticipated public benefit will be that the
continuing requirements from these rules will be presented in a manner that
makes them easier to find and understand. This will result in better services
from treatment programs. There will be no effect on small businesses. There
is no anticipated economic cost to current providers.
Comments on the proposal may be submitted to Tamara Allen, Quality Assurance,
Texas Commission on Alcohol and Drug Abuse, P.O. Box 80529, Austin, Texas,
78708-0529. Comments must be received no later than 30 days from the date
the proposal is published in the
Texas Register
.
In addition, there will be a hearing to receive public comments on these proposed
rules at 4:30 p.m., Monday July 12, 1999, at the Austin Convention Center,
5000 East Cesar Chavez, Austin, Texas. If you have questions about the hearing,
you may contact Albert Ruiz, Community Network Coordinator, Texas Commission
on Alcohol and Drug Abuse, P.O. Box 80529, Austin, Texas, 78708-0529; phone
1-800-832-9623, extension 6607; or via email albert_ruiz@tcada.state.tx.us.
The repeals are proposed under the Texas Health and Safety Code,
§461.012(a)(15) which provides the Texas Commission on Alcohol and Drug
Abuse with the authority to adopt rules governing the functions of the commission,
including rules that prescribe the policies and procedures followed by the
commission in administering any commission programs.
The code affected by the proposed repeals is the Texas Health and Safety
Code, Chapter 461.
§144.533.Service Enhancements.
§144.542.Court Commitment Services.
§144.544.Dual Diagnosis Programs.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of the Secretary of State, on
June 14, 1999.
TRD-9903505
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Earliest possible date of adoption: July 25, 1999
For further information, please call: (512) 349-6733
40 TAC §§144.611-144.616
The Texas Commission on Alcohol and Drug Abuse proposes new
§§144.611-144.616 concerning Network Management Organizations (NMOs).
These sections contain information regarding service structure; outreach;
screening, assessment and referral; care coordination; monitoring service
utilization; and service delivery planing and implementation.
These new sections are proposed to establish standards for network management
organizations. These rules will apply to networks established under the fiscal
year 2000 request for proposals.
Terry Faye Bleier, Executive Director, has determined that for the first
five-year period the rules are in effect there will be no fiscal implications
for state or local government as a result of enforcing the rules.
Ms. Bleier has also determined that for each year of the first five years
the rules are in effect the anticipated public benefit will be clarity about
the roles and responsibilities of network management organizations. There
is no additional effect on small businesses. There is no anticipated economic
cost to persons required to comply with the proposed new rules.
Comments on the proposal may be submitted to Tamara Allen, Quality Assurance,
Texas Commission on Alcohol and Drug Abuse, P.O. Box 80529, Austin, Texas,
78708-0529. Comments must be received no later than 30 days from the date
the proposal is published in the
Texas Register
.
In addition, there will be a hearing to receive public comments on these proposed
rules at 4:30 p.m., Monday July 12, 1999, at the Austin Convention Center,
5000 East Cesar Chavez, Austin, Texas. If you have questions about the hearing,
you may contact Albert Ruiz, Community Network Coordinator, Texas Commission
on Alcohol and Drug Abuse, P.O. Box 80529, Austin, Texas, 78708-0529; phone
1-800-832-9623, extension 6607; or via email albert_ruiz@tcada.state.tx.us.
These new sections are proposed under the Texas Health and Safety
Code, §461.012(a)(15) which provides the Texas Commission on Alcohol
and Drug Abuse with the authority to adopt rules governing the functions of
the commission, including rules that prescribe the policies and procedures
followed by the commission in administering any commission programs.
The code affected by the proposed new sections is the Texas Health and
Safety Code, Chapter 461.
§144.611.Service Structure.
(a)
The network management organization (NMO) shall maintain
a chart of the network's organization that identifies all organizations in
the network and indicates their function(s) and relationship to the NMO.
(b)
The NMO shall maintain a network that includes the following
services:
(1)
outreach, screening, assessment, and referral (OSAR);
(2)
adult treatment (Levels I, II, III and IV);
(3)
youth treatment (Levels II, III, and IV); and
(4)
specialized female services (Levels II, III, and IV).
(c)
The following services must also be included in the network
if they were funded in the service area during the state's fiscal year 1999:
(1)
pharmacotherapy;
(2)
pregnant/postpartum intervention; and
(3)
HIV outreach.
(d)
The network shall be organized to provide each client with
a continuum of services based on individual need.
(e)
The network shall also provide minors and tobacco activities
to reduce minors' access to tobacco products throughout the service area.
(f)
OSAR and minors and tobacco activities may be provided
directly by the NMO or through a separate organization that does not provide
treatment services in the network.
§144.612.Outreach.
(a)
The NMO shall coordinate outreach efforts throughout the
provider network.
(b)
The NMO shall develop and implement an annual outreach
plan to:
(1)
increase target populations' knowledge of available services;
(2)
improve access to services; and
(3)
promote appropriate service utilization.
(c)
The outreach plan shall:
(1)
describe continuing and new outreach efforts;
(2)
include specific strategies to reach and engage the
commission's priority populations as described in §144.522 of this title
(relating to Priority Populations).
(3)
be responsive to system evaluation findings; and
(4)
demonstrate coordination of outreach efforts to avoid
gaps or duplication of effort.
(d)
The NMO shall submit copies of the outreach plan to the
following individuals no later than 60 days after signing the commission's
contract:
(1)
members of the NMO's governing body;
(2)
members of the service area's Regional Advisory Consortium(s);
(3)
the CEO of each provider in the service network; and
(4)
the commission's regional administrator assigned to
the service area.
(e)
The NMO shall ensure that outreach efforts encompass the
entire service area and reach culturally diverse populations.
§144.613.Screening, Assessment, and Referral.
(a)
The NMO shall ensure that all persons in the network service
area have 24-hour access seven days a week to a toll-free telephone information
line for substance abuse prevention, intervention, and treatment services.
(b)
The NMO shall provide screening and referral services to
ensure access to the appropriate level and type of services needed by applicants
and their families.
(1)
Screening. The screening process shall be designed to identify
warning signs for alcohol, tobacco, and/or other drug abuse The screening
shall also identify STD/HIV risk factors as appropriate. If a potential substance
abuse problem is identified, the NMO shall arrange for a substance abuse assessment.
(2)
Referral. The NMO shall also identify needs that cannot
be met by the network and help the applicant and family members access appropriate
support systems and community resources. The program shall maintain a list
of referral resources.
(3)
Follow-up. The NMO shall conduct and document follow-up
on referrals whenever possible.
(4)
Documentation. The NMO shall maintain documentation
which includes:
(A)
date of the screening;
(B)
name of the individual screened;
(C)
demographics of the individual screened
(D)
referrals made; and
(E)
any follow-up contacts.
(c)
Assessments for treatment may be provided directly or through
referral to a network treatment provider.
(1)
Assessment tools shall be appropriate for the target population.
(2)
Assessment shall be provided through a confidential,
face-to-face interview.
(3)
The assessment shall include a criteria-based evaluation
to determine the appropriate level of treatment.
(4)
All assessments shall be conducted by qualified credentialed
counselors or counselor interns working under appropriate supervision.
(5)
Documentation shall include a written summary of the
applicant's needs, treatment recommendations, and referrals.
(d)
The NMO may also conduct financial assessments for treatment
applicants as described in §144.521 of this title (relating to Client
Eligibility).
(e)
The NMO shall have written procedures that describe screening,
assessment, and referral activities.
(f)
The procedures shall minimize duplication between the NMO
and treatment providers, especially in the area of assessments. Any activity
completed by the NMO does not need to be repeated or duplicated by the treatment
program.
§144.614.Care Coordination.
The NMO shall establish a care coordination system to maximize the
efficiency and effectiveness of the service delivery system. The care coordination
system shall include but is not limited to the components described in §144.522
of this title (relating to Priority Populations), §144.523 of this title
(relating to Capacity Management), and §144.525 of this title (relating
to Interim Services). Through written policies and procedures, the NMO shall:
(1)
maintain a centralized waiting list for all network services;
(2)
make use of any slot that can benefit a client until
a more appropriate service is available before placing any prospective client
on the waiting list;
(3)
coordinate admission, transfer, transportation, and
discharge of clients throughout the network;
(4)
provide appropriate screening, referral, and care
coordination for clients with co-occurring psychiatric and substance abuse
disorders; and
(5)
use providers outside the service network when needs
cannot be met by network providers.
§144.615.Monitoring Service Utilization.
(a)
The NMO shall verify the provider has justification for
any client whose length of stay at a level of service exceeds the guidelines
listed in §144.526 of this title (relating to Length of Stay Guidelines).
Documentation for the justification may be a progress note in the client's
record or an updated treatment plan indicating problems needing resolution.
(b)
The NMO shall develop procedures to maximize use of available
capacity.
(1)
Admission and length of stay data shall be reviewed for
the network as a whole, for individual providers, and for specific programs
and services.
(2)
The NMO shall develop and implement a written plan
to address any problems identified.
(3)
The NMO shall evaluate the results of actions taken
and amend the plan as needed.
(c)
The NMO shall not offer incentives related to determinations
regarding length of stay.
§144.616.Service Delivery Planning and Implementation.
(a)
The NMO shall develop a process to track and respond to
changing needs of the community. There shall be written policies and procedures
describing:
(1)
What sources of information will be used to determine areas
of greatest need, including input from the Regional Advisory Consortia (RAC)
and from providers;
(2)
How information about community needs and resources
will be obtained from the RAC, providers, and other community stakeholders;
(3)
How needs will be prioritized; and
(4)
How funds are distributed to areas of greatest need,
including criteria for determining from where funds would be freed.
(b)
The NMO shall establish a written agreement with the regional
RAC that includes:
(1)
How information about the network (including service demand
and utilization) will be shared with the RAC;
(2)
How information about community needs and resources
will be obtained from the RAC.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of the Secretary of State, on
June 14, 1999.
TRD-9903506
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Earliest possible date of adoption: July 25, 1999
For further information, please call: (512) 349-6733
Subchapter A. Licensure Information
40 TAC §§148.3, 148.4, 148.21, 148.23-148.27, 148.41, 148.61
The Texas Commission on Alcohol and Drug Abuse proposes amendments
to §§148.3, 148.4, 148.21, 148.23-148.27, 148.41 and 148.61 concerning
Licensure Information. These sections describe sites and services, variances,
new license application process, changes in status, change in ownership, licensure
fees, inactive status and closure, licensure review, sanctions, and definitions
of terms used in this chapter.
These amendments are proposed to clarify which chemical dependency treatment
programs are required to have a license issued by the commission; to explain
what sites may offer what services; to clarify that a provider must be approved
as a clinical training institution before designating interns to perform duties;
to clarify the variance process; to describe what happens if an applicant
fails to provide evidence of compliance within six months; to specify which
department within the commission must receive advance notice of proposed changes
relevant to a facility's license, invalid licenses, and notices of closure;
to clarify that advance written approval is required before a facility moves
to a new location; to more fully describe the processes related to inactive
status; to require that the licensure certificate must be displayed at each
approved site; to clarify that practicing at an unlicensed site is subject
to the same penalty as practicing without a license; and to number, expand
and refine the definitions of terms used and to remove definitions of terms
no longer used in this chapter.
Terry Faye Bleier, Executive Director, has determined that for the first
five-year period the rules are in effect there will be no fiscal implications
for state or local government as a result of enforcing the rules.
Ms. Bleier has also determined that for each year of the first five years
the rules are in effect the anticipated public benefit will be a clearer and
more effective licensure process for facilities providing chemical dependency
treatment services. There is no additional effect on small businesses. There
is no anticipated economic cost to persons required to comply with the proposed
amendments.
Comments on the proposal may be submitted to Tamara Allen, Quality Assurance,
Texas Commission on Alcohol and Drug Abuse, P.O. Box 80529, Austin, Texas,
78708-0529. Comments must be received no later than 30 days from the date
the proposal is published in the
Texas Register
.
In addition, there will be a hearing to receive public comments on these proposed
rules at 4:30 p.m., Monday July 12, 1999, at the Austin Convention Center,
5000 East Cesar Chavez, Austin, Texas. If you have questions about the hearing,
you may contact Albert Ruiz, Community Network Coordinator, Texas Commission
on Alcohol and Drug Abuse, P.O. Box 80529, Austin, Texas, 78708-0529; phone
1-800-832-9623, extension 6607; or via email albert_ruiz@tcada.state.tx.us.
These amendments are proposed under the Texas Health and Safety
Code, Chapter 464, which provides the Texas Commission on Alcohol and Drug
Abuse with the authority to adopt rules licensing chemical dependency treatment
facilities.
The code affected by the proposed amendments is the Texas Health and Safety
Code, Chapter 464.
§148.3.Sites and Services.
(a)
(No change.)
(b)
Facilities providing chemical dependency treatment
for dually diagnosed clients must be licensed by the commission unless exempt
under §148.2 of this title (relating to License Required).
[
(c)
A facility that has received commission approval to provide
a specific level of service [
(d)
The provider shall have written approval from the commission
as a clinical training institution before designating [
(e)
(No change.)
§148.4.Variances.
(a)
The commission's executive director
or designee
may grant a temporary variance to a facility or group of facilities.
(b)-(c)
(No change.)
(d)
A variance cannot be granted for a statutory
requirement.
§148.21.New Licensure Application.
(a)-(c)
(No change.)
(d)
If an applicant fails to provide evidence of compliance
within six months, the application will be
denied
[
§148.23.Changes in Status.
(a)
A facility shall give the
commission's licensure department
[
(b)
The facility shall receive written approval from the commission
before:
(1)
(No change.)
(2)
adding a new site
or moving to a new location
;
(3)-(4)
(No change.)
(c)
The provider must also notify the
commission's licensure
department
[
§148.24.Change in Ownership.
(a)
(No change.)
(b)
The facility shall notify the
commission's licensure
department
[
(c)
(No change.)
(d)
The invalid licensure certificate shall be returned to
the
commission's licensure department
[
§148.25.Licensure Fees.
(a)-(b)
(No change.)
(c)
A facility shall pay the full licensure fee for any licensure
period during which it provides chemical dependency treatment. Failure to
notify the
commission's licensure department
[
(d)-(f)
(No change.)
§148.26.Inactive Status and Closure.
(a)
Inactive Status.
The commission will automatically
retire the license of any
[
(1)
If granted, inactive status is limited to six months. The
licensee is responsible for all licensure fees and for proper maintenance
of client records while on inactive status.
(2)
To return to active status, the facility shall submit
a written request to reactivate the license.
(3)
If the license is not reactivated, it
will be
automatically
retired
[
(b)
Closure. The facility shall notify the
commission's
licensure department
[
(1)
A license becomes invalid when a program closes and the
licensure certificate shall be returned to the
commission's licensure
department
[
(2)
When a facility closes, the provider is responsible
for properly maintaining client records in compliance with confidentiality
regulations.
§148.27.Licensure Review.
(a)-(d)
(No change.)
(e)
The facility shall display the licensure certificate prominently
at each
approved
[
§148.41.Sanctions.
(a)-(c)
(No change.)
(d)
A facility practicing without a license
or practicing
at an unlicensed site
is subject to a civil penalty of not more than
$25,000 for each violation of the Act or these rules. Each day a violation
continues or occurs is a separate violation.
(e)-(f)
(No change.)
§148.61.Definitions.
The following words and terms, when used in this chapter, shall have
the following meanings unless the context clearly indicates otherwise.
(1)
Abuse--Any act or failure to act which is done
knowingly, recklessly or intentionally, including incitement to act, which
caused or may have caused injury to a client. Injury may include, but is not
limited to: physical injury, mental disorientation, or emotional harm, whether
it is caused by physical action or verbal statement. Client abuse
may
be perpetrated by staff or other clients and
includes:
(A)
any sexual activity between facility personnel and a client;
(B)
corporal punishment;
(C)
nutritional or sleep deprivation,
(D)
efforts to cause fear;
(E)
the use of any form of communication to threaten, curse,
shame, or degrade a client;
(F)
restraint that does not conform with these rules;
(G)
coercive or restrictive actions taken in response to the
patient's request for discharge or refusal of medication or treatment that
are illegal or not justified by the patient's condition; and
(H)
any other act or omission classified as abuse by the Texas
Family Code, §261.001.
(2)
Act--Texas Health and Safety Code,
Chapter 464.
[Acute withdrawal--
Withdrawal symptoms
that threaten the physical safety of the client, including but not limited
to: seizures, hypertensive crisis, deliriums tremens, and severe dehydration
with metabolic imbalances.]
(3)
Admission--Formal
documented
acceptance of a prospective client to a treatment facility
, based on
specifically defined criteria
.
(4)
Adolescent--An individual 13 through 17
years of age whose disabilities of minority have not been removed by marriage
or judicial decree.
(5)
Adult--An individual 18 years of age or
older, or an individual under the age of 18 whose disabilities of minority
have been removed by marriage or judicial decree.
(6)
Advanced practice nurse--A registered nurse
currently licensed in Texas who is prepared for advanced practice and approved
by the Texas State Board of Nurse Examiners.
(7)
Aftercare [
(8)
Applicant
(licensure)
--A person
who has submitted a complete application to the commission for licensure,
relicensure, or change in status, and paid the application fee.
(9)
Approval--Written authorization.
(10)
Assessment (treatment)--The process used
to
interpret information from the psychosocial history to identify
[
(11)
Case management--A systematic
process to ensure clients receive all substance abuse, physical health, mental
health, social, and other services needed to resolve identified problems and
needs. Case management activities are provided by an accountable staff person
and include:
(A)
linking a client with needed services;
(B)
helping a client develop skills to use basic
community resources and services; and
(C)
monitoring and coordinating the services received
by a client.
(12)
Chemical dependency--
Substance
abuse and substance dependence as defined in the current edition of the Diagnostic
and Statistical Manual of Mental Disorders, published by the American Psychiatric
Association.
[
(13)
Chemical dependency counseling--Face-to-face
interactions
in which a counselor helps an individual, family or group
[
(14)
Chemical dependency counselor--A qualified
credentialed counselor or counselor intern [
(15)
Chemical dependency education--A planned,
structured presentation of information training, provided by qualified staff
(not clients), which is related to chemical dependency. It includes but is
not limited to: physiological and psychological effects, emotional and social
deterioration, rehabilitation and relapse, and risk of acquiring Human Immunodeficiency
Virus.
(16)
Chemical dependency treatment--A planned,
structured, and organized program designed to initiate and promote a person's
chemical-free status or to maintain the person free of illegal drugs. It includes,
but is not limited to, the application of planned procedures to identify and
change patterns of behavior related to or resulting from chemical dependency
that are maladaptive, destructive, or injurious to health, or to restore appropriate
levels of physical, psychological, or social functioning lost due to chemical
dependency.
(17)
Chief executive officer--The individual
authorized by the governing body to act on its behalf in the overall administration
of the facility.
(18)
Child--An individual under the age of
13.
(19)
Child abuse and neglect--Any act
or omission that constitutes abuse or neglect of a child by a person responsible
for a child's care, custody, or welfare as defined in the Texas Family Code
§261.001.
(20)
Client--An individual who has been admitted
to a chemical dependency treatment facility licensed by the commission and
is currently receiving services.
(21)
Clinical training institution--An individual
or legal entity approved by the commission to
provide a counselor training
program in which counselor interns obtain supervised work experience.
[
(22)
Commission--The Texas Commission on Alcohol
and Drug Abuse.
[Commissioners--
Members of the commission's
governing body.]
(23)
Confidentiality laws--Federal law (42
United States Code, §290 dd-2) and state law (Texas Health and Safety
Code, Chapter 611) and regulations adopted pursuant to these statutes.
(24)
Consenter--The individual legally responsible
for giving informed consent for a client. This may be the client, parent,
guardian, or conservator. Unless otherwise provided by law, a legally competent
adult is his or her own consenter. Consenters include adult clients, clients
16 or 17 years of age, and clients
under
[
(25)
Consultant--An individual who is not an
employee who provides professional advice or services to the facility for
compensation.
(26)
Counselor--See chemical dependency counselor.
(27)
Counselor intern (CI)--A person pursuing
a course of training in chemical dependency counseling at a regionally accredited
institution of higher education or
an approved
[
[Day treatment--
An outpatient program
where the client spends more than five consecutive hours at the program site.]
[Detoxification services--
Chemical dependency
treatment designed to systematically reduce the amount of alcohol and other
toxic chemicals in a client's body, manage withdrawal symptoms, and encourage
the client to seek ongoing treatment for chemical dependency.]
(28)
Direct care staff--Staff responsible for
providing treatment, care, supervision, or other client services that involve
a significant amount of face-to-face contact.
(29)
Direct supervision--Oversight and direction
of a counselor intern provided by a qualified credentialed counselor (QCC).
If the intern has less than 2,000 hours of supervised work experience, the
supervisor must be on site when the intern is providing services. If the intern
has at least 2,000 hours of documented supervised work experience, the supervisor
may be on site or immediately accessible by telephone. The qualified credentialed
counselor shall:
(A)
assume responsibility for the actions of the intern within
the scope of the intern's clinical training;
(B)
be available for assistance;
(C)
conduct and document a complete review of the intern's
current
written work [
(D)
complete and document a session to observe the intern providing
services to chemical dependency clients at least weekly
during the first
1000 hours, monthly during the second 1000 hours, and as deemed necessary
during the final 2000 hours
[
(E)
meet with the intern
(in a group or individual session)
at least
one hour each week
[
(30)
Discharge--
Formal, documented
termination from a treatment facility. Discharge occurs when a client successfully
completes treatment goals, leaves against professional advice, or is terminated
for other reasons.
[
(31)
DSM-IV--The Diagnostic and Statistical
Manual of Mental Disorders, Fourth Edition-Revised, published by the American
Psychiatric Association. Any reference to DSM-IV is understood to mean the
most recent edition of the Diagnostic and Statistical Manual of Mental Disorders.
(32)
Dually diagnosed--Diagnosed with
co-occurring psychiatric and substance abuse disorders.
(33)
Education--See chemical dependency education.
(34)
Employee--An individual hired directly
by the facility to provide services in exchange for money or other compensation,
as determined under the usual common law rules. An employee is subject to
the will and control of the employer not only as to what shall be done but
as to how it shall be done.
(35)
Ensure--Take all reasonable and necessary
steps to achieve results.
[Executive director--
The individual
authorized by the governing body to act on its behalf in the overall administration
of the facility.]
(36)
Experience--Direct participation in a
similar job activity supervised by a qualified individual.
(37)
Exploitation--An act or process to use,
either directly or indirectly, the labor or resources of a client for monetary
or personal benefit, profit or gain of another individual or organization.
(38)
Extension services--Services provided
by a licensed facility at a registered site that is not owned, leased, or
operated by the licensed facility.
(39)
Family--The children, parents, brothers,
sisters, other relatives, foster parents, guardians, or significant others
who perform the roles and functions of family members in the lives of clients/participants.
(40)
FTE--Full Time Equivalent staff position
requiring 40 hours per week.
(41)
Facility--A legal entity with a single
governing body, a single administration, and a single staff that provides
chemical dependency treatment.
(42)
Governing body--The individual or individuals
legally established to operate a facility. The governing body has ultimate
legal authority and responsibility for the facility's finances, services and
operations.
(43)
HIV--Human Immunodeficiency Virus infection.
(44)
Immediate supervision--Being physically
present while a task is being performed.
(45)
Individual service day--A day on which
a specific client receives services.
(46)
Intake--The administrative process for
gathering information about a prospective client and giving a prospective
client information about the treatment facility and the facility's treatment
and services.
(47)
Intervention and assessment service--A
service that offers assessment, counseling, evaluation, treatment intervention,
or referral services or makes treatment recommendations to an individual with
respect to chemical dependency.
(48)
License--A grant of authority to a facility
to provide chemical dependency treatment in the State of Texas, which is issued
by the commission under the Act.
(49)
Licensed chemical dependency counselor
(LCDC)--A counselor licensed by the Texas Commission on Alcohol and Drug Abuse.
(50)
Licensed dietitian--An individual who
is currently licensed or provisionally licensed by the Texas State Board of
Examiners of Dietitians.
(51)
Licensed health professional--A physician,
physician assistant, advance practice nurse, registered nurse, or licensed
vocational nurse as defined in these rules.
(52)
Licensed marriage and family therapist
(LMFT)--An individual who is currently licensed as a marriage and family therapist
by the Texas State Board of Examiners of Marriage and Family Therapists.
(53)
Licensed master social worker (LMSW)--An
individual who is licensed as a master social worker by the Texas State Board
of Social Work Examiners.
(54)
Licensed professional counselor (LPC)--An
individual licensed as a professional counselor by the Texas State Board of
Examiners of Professional Counselors.
(55)
Licensed psychological associate--A person
licensed as a psychological associate by the Texas State Board of Examiners
of Psychologists.
(56)
Licensed vocational nurse (LVN)--A nurse
licensed by the Texas State Board of Vocational Nurse Examiners.
(57)
Life
skills training
[
(58)
Mechanical restraint--Use of a physical
device to control or restrict a person's physical movement or actions.
(59)
Medical emergency--
A medical condition
with acute symptoms of sufficient severity that a prudent layperson could
reasonably expect the absence of immediate medical attention to result in
[
[Medication--
Any drug used to treat
a condition or relieve symptoms, including prescription drugs and over-the-counter
drugs.]
(60)
Medication error--Medication not given
according to the written order
by the prescribing professional or as recommended
on the medication label
. Includes duplicate doses, missed doses, and
doses of the wrong amount or drug.
(61)
Mental health referral service--See Qualified
Mental Health Referral Service.
(62)
Neglect--Actions resulting from inattention,
disregard, carelessness, ignoring or omission of reasonable consideration
that caused, or might have caused, physical or emotional injury to a client.
Examples of neglect include, but are not limited to:
(A)
failure to provide adequate nutrition, clothing, or health
care;
(B)
failure to provide a safe environment free from abuse;
(C)
failure to maintain adequate numbers of appropriately trained
staff;
(D)
failure to establish or carry out an appropriate individualized
treatment plan; and
(E)
any other act or omission classified as neglect by the
Texas Family Code, §261.001.
(63)
Offer--To make available.
(64)
On call--Immediately available for telephone
consultation.
(65)
On duty--Scheduled and present at the
site to perform job duties.
(66)
Orders (written, verbal, or telephone)--Direct
communication between a physician and licensed program staff in which the
physician directs specific treatments.
(67)
Person--An individual, firm, partnership,
corporation, association, or other business or professional entity.
(68)
Personal restraint--Physical contact to
control or restrict a person's physical movement or actions.
(69)
Personnel--Members of the governing body,
employees, contract providers, consultants, agents, representatives, volunteers,
and other individuals working on behalf of the facility through a formal or
informal agreement.
(70)
Physician--A physician licensed by the
Texas State Board of Medical Examiners, or a physician employed by any agency
of the United States who has a license in any other state of the United States.
(71)
Physician assistant--An individual registered
as a physician assistant by the Texas State Board of Medical Examiners.
(72)
Policy--A statement of direction
or guiding principle issued by the governing body.
(73)
Practicum--A 300 hour course of structured
clinical training in the 12 core functions required for chemical dependency
counselor licensure.
(74)
Private practice--Unless otherwise defined
by a licensing board, an individual's professional counseling practice in
which the individual:
(A)
provides all treatment services personally;
(B)
does not report to a supervisor or utilize subordinate
counseling staff;
(C)
is a licensed chemical dependency counselor or exempt from
licensure.
(75)
Procedure--A step-by-step set
of instructions.
[Process counseling--
Counseling designed
to help clients identify and explore the feelings and emotions they encounter
and resolve areas of conflict that led to their problems associated with chemical
dependency. It does not include cognitively oriented or psychoeducational
groups.]
(76)
Program--A specific level of chemical
dependency treatment delivered to a defined client population.
(77)
Program director--The individual who manages
a chemical dependency treatment program.
(78)
Provide--To perform or deliver.
(79)
Psychiatric emergency--Symptoms requiring
immediate psychiatric attention.
(80)
Psychologist--An individual licensed as
a psychologist by the Texas State Board of Examiners of Psychologists.
(81)
Qualified credentialed counselor (QCC)--A
licensed chemical dependency counselor or one of the professionals listed
below:
(A)
licensed professional counselor (LPC);
(B)
licensed master social worker (LMSW);
(C)
licensed marriage and family therapist (LMFT);
(D)
licensed psychologist;
(E)
licensed physician
(F)
certified addictions registered nurse (CARN);
(G)
licensed psychological associate; and
(H)
advance practice nurse recognized by the Board of Nurse
Examiners as a clinical nurse specialist or nurse practitioner with a specialty
in psyche-mental health (APN-P/MH).
(82)
Qualified mental health referral
service--A service that does not provide treatment directly but instead refers
clients in need of chemical dependency treatment to qualified providers. A
mental health referral service shall meet the statutory requirements of Texas
Health and Safety Code, §164.007.
(83)
Refer--Identify appropriate services and
provide information
and assistance
needed to access them.
(84)
Registered nurse (RN)--A professional
nurse licensed by the Texas State Board of Nurse Examiners.
(85)
Religious organization--A church, synagogue,
mosque, or other religious institution:
(A)
the purpose of which is the propagation of religious beliefs;
and
(B)
that is exempt from federal income tax by being listed
as an exempt organization under the Internal Revenue Code (26 United States
Code), Section 501(a).
(86)
Residential site--A site owned, leased,
or operated by the facility where clients
who are receiving chemical
dependency treatment stay in a structured, supervised, 24-hour living environment
[
(87)
Retaliate--Adverse actions taken to punish
or discourage a person who reports a violation or cooperates with an investigation,
inspection, or proceeding. Such actions include but are not limited to suspension
or termination of employment, demotion, discharge, transfer, discipline, restriction
of privileges, harassment, and discrimination.
[Screening--
Determining whether a client
meets the program's admission criteria, based on the person's reason for admission,
medical and chemical use history, and other needed information.]
(88)
Seclusion--The placement of a client alone
in a room from which exit is prevented.
(89)
Service day--A day during which the program
provides scheduled services to any client.
(90)
Sexual exploitation--A pattern, practice,
or scheme of conduct that can reasonably be construed as being for the purposes
of sexual arousal or gratification or sexual abuse of any person. It may include
sexual contact, a request for sexual contact, or a representation that sexual
contact or exploitation is consistent with or part of treatment.
(91)
Site--A single identifiable location owned,
leased, or controlled by a facility where any element of chemical dependency
treatment is offered or provided
, including aftercare
.
(92)
Small family living environment--A single
apartment unit, house, or similar residence designed for an average size family,
with no more than four bedrooms.
(93)
Solicit--To contact a person for the purpose
of inducing the person, directly or indirectly, to enter treatment or make
a referral.
(94)
Special treatment procedures--Personal
restraint, mechanical restraint, and seclusion.
(95)
Staff--Individuals employed by the facility
to provide services for the facility in exchange for money or other compensation.
[STDs--
Sexually transmitted diseases.]
(96)
Support services--Services designed to
provide individuals with a stable living environment, such as meals, shelter,
and access to peer support groups.
(97)
Treatment--See chemical dependency treatment.
(98)
Treatment intervention--A meeting designed
to persuade a chemically dependent individual to enter treatment.
(99)
Treatment level--The intensity of treatment
provided by a program.
(100)
Treatment protocol--Instructions for
the delivery of treatment services to groups of clients by non-licensed and
licensed staff.
(101)
Unethical conduct--Conduct prohibited
by the ethical standards adopted by state or national professional organizations
or by rules established by a profession's state licensing agency.
(102)
Unprofessional conduct--An act or omission
that violates commonly accepted standards of behavior for individuals or organizations.
(103)
Volunteer--An individual who provides
services for the facility without compensation. Unpaid students are volunteers.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of the Secretary of State, on
June 14, 1999.
TRD-9903507
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Earliest possible date of adoption: July 25, 1999
For further information, please call: (512) 349-6733
40 TAC §§148.71-148.74, 148.113, 148.116, 148.117, 148.119
The Texas Commission on Alcohol and Drug Abuse proposes amendments
to §§148.71-148.74, 148.113, 148.116, 148.117 and 148.119 concerning
Facility Management. These sections contain information on: the governing
body; chief executive officer; policies, procedures and licensure rules; standards
of conduct; initial training; personnel files and training records; basic
staffing requirements; and clinical training institutions.
These amendments are proposed to change the term executive director to
chief executive officer; to require timely correction of identified deficiencies;
to specify the requirements for and duties of a chief executive officer; to
clarify the requirements related to policies, procedures and licensure rules;
to make it clear that client abuse, neglect and exploitation are considered
an unprofessional and unethical act; to add to the standards of conduct the
requirement that facility personnel shall not have a personal or business
relationship with a client until at least two years after the client's discharge;
to require facilities to have written policies that comply with the commission's
rules on standards of conduct; to require that initial training must be completed
within seven days of hire; to specify under what circumstances video, manual
or computer-based training are acceptable; to specify requirements for documentation
of initial staff training; to clarify the requirements for personnel files
and training records; to clarify basic staffing requirements for various duties;
to add to the section on basic staffing requirements the rule that former
clients shall not be hired until at least two years after discharge from active
treatment; and to clarify that counselor interns may only be used in facilities
registered as clinical training institutions.
Terry Faye Bleier, Executive Director, has determined that for the first
five-year period the rules are in effect there will be no fiscal implications
for state or local government as a result of enforcing the rules.
Ms. Bleier has also determined that for each year of the first five years
the rules are in effect the anticipated public benefit will be better management
in facilities providing chemical dependency treatment services. There is no
additional effect on small businesses. There is no anticipated economic cost
to persons required to comply with the proposed amendments.
Comments on the proposal may be submitted to Tamara Allen, Quality Assurance,
Texas Commission on Alcohol and Drug Abuse, P.O. Box 80529, Austin, Texas,
78708-0529. Comments must be received no later than 30 days from the date
the proposal is published in the
Texas Register
.
In addition, there will be a hearing to receive public comments on these proposed
rules at 4:30 p.m., Monday July 12, 1999, at the Austin Convention Center,
5000 East Cesar Chavez, Austin, Texas. If you have questions about the hearing,
you may contact Albert Ruiz, Community Network Coordinator, Texas Commission
on Alcohol and Drug Abuse, P.O. Box 80529, Austin, Texas, 78708-0529; phone
1-800-832-9623, extension 6607; or via email albert_ruiz@tcada.state.tx.us.
These amendments are proposed under the Texas Health and Safety
Code, Chapter 464, which provides the Texas Commission on Alcohol and Drug
Abuse with the authority to adopt rules licensing chemical dependency treatment
facilities.
The code affected by the proposed amendments is the Texas Health and Safety
Code, Chapter 464.
§148.71.Governing Body.
(a)
The facility's governing body is legally responsible for
the management, services, and operations of the program. The governing body
shall:
(1)
(No change.)
(2)
designate
a chief
[
(3)-(8)
(No change.)
(9)
ensure
timely
correction of identified
organizational, fiscal, and program deficiencies.
(b)
(No change.)
Chief
Executive
Officer
[
The
chief
executive
officer
[
(1)
have documented education and/or experience
[
(2)
ensure compliance with applicable laws and rules;
(3)
ensure that all staff are competent and trained; [
(4)
establish mechanisms to ensure quality
of treatment services; and
(5)
[
(A)
an annual budget;
(B)
records of income and expenditures; and
(C)
a written fee policy.
§148.73.Policies, Procedures, and Licensure Rules.
(a)
The facility shall operate according to a written program
description and policies and procedures that comply with
all applicable
licensure rules.
(b)
(No change.)
(c)
The governing body shall establish policies that comply
with licensure rules, and the
chief
executive
officer
[
(d)
The policy and procedures manual shall be current,
in compliance with current licensure standards, individualized to the program,
well organized, and easily accessible to all staff at all times.
(e)
Within 10 days of a policy or procedure change, the
[
§148.74.Standards of Conduct.
(a)
(No change.)
(b)
Neither the facility nor any of its personnel shall:
(1)
commit an illegal, unprofessional or unethical act
(including client abuse, neglect, or exploitation)
;
(2)-(6)
(No change.)
(c)
(No change.)
(d)
Facility personnel shall not enter into
a personal or business relationship with a person who receives services from
the facility until at least two years after the service recipient's discharge.
(e)
[
§148.113.Initial Training.
(a)
Each employee shall complete initial training
during
the first seven calendar days of employment
[
(b)-(c)
(No change.)
(d)
Video, manual, or computer-based training
is acceptable if the supervisor discusses the material with the employee in
a face-to-face session to highlight key issues and answer questions.
(e)
Documentation of the initial training
shall be signed by the supervisor and the employee and maintained in the employee's
personnel file.
§148.116.Personnel Files and Training Records.
(a)
(No change.)
(b)
The facility shall maintain current personnel documentation
on each employee
. Training records and supervision records may be stored
separately from the main personnel file, but shall be easily accessible upon
request. Required documentation
[
(1)
job description;
(2)
application or resume;
(3)
documentation that the facility has direct verification
from the credentialing authority (by telephone or letter) that required credentials
are current at the time of employment and maintained throughout employment
[
(4)
documentation of appropriate screening
and required
background checks
;
(5)
signed documentation of required training
(initial
and annual)
;
(6)
documentation of other training the employee
has completed
[
(7)
records of direct supervision for all counselor [
(8)
annual performance evaluations; and
(9)
records of any disciplinary actions.
(c)
Documentation
of training for individual staff members
[
(1)
date;
(2)
number of hours;
(3)
topic
[
(4)
instructor's name [
(5)
signature of the instructor (or equivalent verification)
[
[(6)
signature of the person completing
the training].
(d)
The facility shall maintain documentation
of all in-service training.
(1)
For each topic, the file shall include an outline of the
contents and the name, credentials, and relevant qualifications of the person
providing the training.
(2)
For each group training session, the facility shall
maintain on file a dated participant sign-in sheet.
(3)
When in-service training is delivered to only one
or two individuals at a time, the individual's dated certificate of completion
may substitute for the participant sign-in sheet.
(e)
[
§148.117.Basic Staffing Requirements.
(a)-(b)
(No change.)
(c)
Chemical dependency education shall be taught by chemical
dependency counselors or people who have the
specialized
education
, expertise,
and
/or
experience needed to teach the material,
including knowledge of chemical dependency and its relationship to the topic.
(d)
(No change.)
(e)
All chemical dependency counselor [
(1)
The QCC may not supervise more than five trainees.
(2)
The facility shall adjust the supervisor's direct
treatment responsibilities to allow adequate time for supervision.
(f)
Counselors
shall not provide
[
(g)
New employees who have not completed crisis intervention
and/or CPR training shall not be on site alone.
One or more direct care
staff trained in non-violent crisis intervention shall be on duty
and
on site
at all times that the program is in operation. In residential
programs, one or more direct care staff certified in CPR must also be on duty
and on site
at all times that the program is in operation.
(h)
Direct care staff
[
(i)
The facility shall not allow its clients to serve as staff.
Former clients shall not be hired until at least two years after discharge
from active treatment.
(j)
The facility shall ensure that personnel do not endanger
the health, safety or well-being of clients and do not use mood-altering substances
which interfere with their job performance.
§148.119.Clinical Training Institutions.
A facility shall not
use
[
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on
June 14, 1999.
TRD-9903508
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Earliest possible date of adoption: July 25, 1999
For further information, please call: (512) 349-6733
40 TAC §148.112
The Texas Commission on Alcohol and Drug Abuse proposes amendments
to §148.112 concerning Facility Management. This section contains information
on hiring practices.
These amendments are proposed to direct that the facility must obtain the
results of a statewide criminal background check done on all staff who have
access to adolescents or children.
Terry Faye Bleier, Executive Director, has determined that for the first
five-year period the rules are in effect there will be no fiscal implications
for state or local government as a result of enforcing the rules.
Ms. Bleier has also determined that for each year of the first five years
the rules are in effect the anticipated public benefit will be better protection
of adolescents and children who are served by chemical dependency programs.
There is no additional effect on small businesses. The anticipated economic
cost to persons required to comply with the proposed amendments is $15 per
staff person for those programs that serve adolescents and children.
Comments on the proposal may be submitted to Tamara Allen, Quality Assurance,
Texas Commission on Alcohol and Drug Abuse, P.O. Box 80529, Austin, Texas,
78708-0529. Comments must be received no later than 30 days from the date
the proposal is published in the
Texas Register
.
In addition, there will be a hearing to receive public comments on these proposed
rules at 4:30 p.m., Monday July 12, 1999, at the Austin Convention Center,
5000 East Cesar Chavez, Austin, Texas. If you have questions about the hearing,
you may contact Albert Ruiz, Community Network Coordinator, Texas Commission
on Alcohol and Drug Abuse, P.O. Box 80529, Austin, Texas, 78708-0529; phone
1-800-832-9623, extension 6607; or via email albert_ruiz@tcada.state.tx.us.
These amendments are proposed under the Texas Health and Safety
Code, Chapter 464, which provides the Texas Commission on Alcohol and Drug
Abuse with the authority to adopt rules licensing chemical dependency treatment
facilities.
The code affected by the proposed amendments is the Texas Health and Safety
Code, Chapter 464.
§148.112.Hiring Practices.
(a)-(e)
(No change.)
(f)
The facility shall obtain the results
of a statewide criminal background check from the Department of Public Safety
on all staff with access to adolescents or children.
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on
June 14, 1999.
TRD-9903509
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Earliest possible date of adoption: July 25, 1999
For further information, please call: (512) 349-6733
40 TAC §148.114
The Texas Commission on Alcohol and Drug Abuse proposes amendments
to §148.114 concerning Facility Management. This section contains information
on special training requirements.
This amendment is proposed to allow a facility to accept documented training
from another organization during the year prior to employment if it meets
commission requirements; to require a minimum number of hours of face-to-face
training in issues related to abuse, neglect, exploitation, illegal, unprofessional
and unethical conduct for all staff who have any client contact; to set standards
for required, face-to-face training related to tuberculosis, HIV, Hepatitis
C and other sexually transmitted diseases for all direct care staff; to require
that direct care employees have their current certification in CPR within
90 days of hire and to specify that staff in programs that serve women with
their dependent children must have certification in both adult and child/infant
CPR; to specify the requirements for nonviolent crisis intervention training,
training in special treatment procedures, training for staff who conduct intakes
or assess applicants for admission, detoxification training, training of staff
who supervise self-administration of medication, and staff training requirements
in adolescent programs; and to state the conditions under which video, manual
or computer-based training are acceptable
Terry Faye Bleier, Executive Director, has determined that for the first
five-year period the rules are in effect there will be no fiscal implications
for state or local government as a result of enforcing the rules.
Ms. Bleier has also determined that for each year of the first five years
the rules are in effect the anticipated public benefit will be better management
in facilities providing chemical dependency treatment services. There is no
additional effect on small businesses. The anticipated economic cost to persons
required to comply with the proposed new rules will depend upon the type of
program and the current training practices. The proposed amendments could
result in a slight increase or decrease in training costs.
Comments on the proposal may be submitted to Tamara Allen, Quality Assurance,
Texas Commission on Alcohol and Drug Abuse, P.O. Box 80529, Austin, Texas,
78708-0529. Comments must be received no later than 30 days from the date
the proposal is published in the
Texas Register
.
In addition, there will be a hearing to receive public comments on these proposed
rules at 4:30 p.m., Monday July 12, 1999, at the Austin Convention Center,
5000 East Cesar Chavez, Austin, Texas. If you have questions about the hearing,
you may contact Albert Ruiz, Community Network Coordinator, Texas Commission
on Alcohol and Drug Abuse, P.O. Box 80529, Austin, Texas, 78708-0529; phone
1-800-832-9623, extension 6607; or via email albert_ruiz@tcada.state.tx.us.
These amendments are proposed under the Texas Health and Safety
Code, Chapter 464, which provides the Texas Commission on Alcohol and Drug
Abuse with the authority to adopt rules licensing chemical dependency treatment
facilities.
The code affected by the proposed amendments is the Texas Health and Safety
Code, Chapter 464.
§148.114.Special Training Requirements.
(a)
(No change.)
(b)
The facility may accept documented training from another
organization completed during the year prior to employment if it meets commission
requirements.
[
(c)
The facility shall [
(1)
This training shall comply with the interagency
memorandum of understanding on abuse training (see §148.118 of this title
(relating to Training Requirements Relating to Abuse, Neglect, and Unprofessional
or Unethical Conduct)).
(2)
Crisis intervention training and
other training related to improving client care may be included in the required
hours.
(3)
Full time staff in residential programs
must receive at least eight hours every year, and full time staff in outpatient
programs must receive at least two hours every year. Hours of training for
part time staff may be determined by the facility based on the number of hours
worked and the amount of direct client contact.
(d)
All direct care staff shall complete
two hours of
face-to-face
[
(1)
The training must be based on the Texas
Commission on Alcohol and Drug Abuse Workplace and Education Guidelines for
HIV and Other Communicable Diseases.
(2)
Staff shall receive an update with
current information every two years.
[(e)
All employees shall receive information
on tuberculosis and STDs that includes:]
[(1)
high-risk populations,]
[(2)
symptoms;]
[(3)
containment;]
[(4)
standard testing and treatment procedures; ]
[(5)
available resources; and]
[(6)
appropriate referral.]
(e)
[
(1)
Personnel in licensed medical facilities are exempt if
emergency resuscitation equipment and trained response teams are available
24 hours a day.
(2)
Licensed medical physicians, registered nurses, licensed
vocational nurses, physician assistants, and advanced practice nurses are
also exempt.
(3)
Staff working in programs that serve
women with their dependent children must have certification in adult and child/infant
CPR.
(f)
[
(1)
The instructor shall have successfully completed a course
for crisis intervention instructors or have equivalent training and experience.
(2)
The training shall teach employees how to use verbal
and other non-physical methods for prevention, early intervention, and crisis
management.
(g)
[
[(i)
Supervisors shall observe and document
that counselors demonstrate competency in the facility's treatment modalities
before working without immediate supervision.]
(h)
[
(1)
The first eight hours must be completed
during the first 90 days of employment, and an employee shall not conduct
intakes or assess applicants for admission unless training is complete and
current.
(2)
The training shall cover the DSM-IV
diagnostic criteria for substance abuse disorders, and shall also include
information to help staff recognize possible unmet mental health needs and
provide appropriate referrals for further mental health assessment and follow-up.
(i)
[
(1)
be provided by a physician, physician assistant, advanced
practice nurse, or registered nurse with at least one year of documented experience
in detoxification;
(2)
include:
(A)
signs of withdrawal;
(B)
pregnancy-related complications (if the program admits
females of child-bearing age);
(C)
observation and monitoring procedures;
(D)
appropriate intervention; [
(E)
complications requiring transfer
; and
(F)
frequently-used medications, including
purpose and precautions.
(j)
[
(k)
[
(1)
prescription labels;
(2)
medical abbreviations;
(3)
routes of administration;
(4)
use of drug reference materials;
(5)
storage, maintenance, handling, and destruction of
medication;
(6)
documentation requirements; and
(7)
procedures for medication errors, adverse reactions,
and side effects.
(l)
All supervisory and direct care staff
working in adolescent programs shall receive at least eight hours of specialized
education or training in adolescent health and development each year. The
training shall include:
(1)
psychosocial stages of adolescent development;
(2)
physical growth and development;
(3)
adolescent culture;
(4)
communicable diseases;
(5)
mental health;
(6)
substance abuse and dependency in adolescents; and
(7)
family systems.
(m)
Unless otherwise specified, video, manual,
or computer-based training is acceptable if the supervisor discusses the material
with the employee in a face-to-face session to highlight key issues and answer
questions.
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on
June 14, 1999.
TRD-9903510
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Earliest possible date of adoption: July 25, 1999
For further information, please call: (512) 349-6733
40 TAC §§148.141, 148.143, 148.161-148.164, 148.171-148.173, 148.181, 148.183, 148.185
The Texas Commission on Alcohol and Drug Abuse proposes amendments
to §§148.141, 148.143, 148.161-148.163, 148.171-148.173, 148.181,
148.183, 148.185 and proposes new §148.164 concerning Client Management.
These sections contain information on: required postings; voluntary clients--additional
rights; client abuse, neglect, and exploitation; behavior management; client
labor; searches; client record security; general documentation requirements;
release of confidential information; significant incident reports; special
treatment procedures; and adolescents absent without permission.
These amendments and new section are proposed to clarify that it is the
commission's current poster on reporting complaints and violations that must
be posted; to specify that required postings must be at each approved site;
to clarify the process regarding requests for discharge from voluntary clients
under 16 years of age; to replace the term executive director with chief executive
officer; to fully describe the process for reporting allegations of client
abuse, neglect or exploitation; to specify that the client government process
cannot substitute for the client grievance procedure; to mandate that written
information about required housekeeping activities and responsibilities be
given to the client at the time of admission; to specify that two years must
elapse between discharge of a former client and (1) the employment of the
former client by the facility, (2) any business relationship between the former
client and a facility staff member, and/or (3) the giving of personal gifts
to the former client by a staff member; to require a policy on searches and
to set parameters for the search process in facilities that choose to allow
searches; to add requirements regarding client and applicant record security
including location of records, protection of applicant information, and a
record of destroyed client records; to clarify the requirement for signatures
on documentation; to include applicant information and specific legal citations
in the section on release of confidential information; to clarify the requirements
regarding significant incident reports; to require all adolescent programs,
detoxification programs and programs that accept emergency detentions to authorize
the use of personal restraint; to reduce the maximum amount of time personal
restraint may be used on a client; and to clarify what programs must have
written procedures used when an adolescent leaves the program without permission.
Terry Faye Bleier, Executive Director, has determined that for the first
five-year period the rules are in effect there will be no fiscal implications
for state or local government as a result of enforcing the rules.
Ms. Bleier has also determined that for each year of the first five years
the rules are in effect the anticipated public benefit will be better protection
of clients in facilities providing chemical dependency treatment services.
There is no additional effect on small businesses. There is no anticipated
economic cost to persons required to comply with the proposed amendments and
new section.
Comments on the proposal may be submitted to Tamara Allen, Quality Assurance,
Texas Commission on Alcohol and Drug Abuse, P.O. Box 80529, Austin, Texas,
78708-0529. Comments must be received no later than 30 days from the date
the proposal is published in the
Texas Register
.
In addition, there will be a hearing to receive public comments on these proposed
rules at 4:30 p.m., Monday July 12, 1999, at the Austin Convention Center,
5000 East Cesar Chavez, Austin, Texas. If you have questions about the hearing,
you may contact Albert Ruiz, Community Network Coordinator, Texas Commission
on Alcohol and Drug Abuse, P.O. Box 80529, Austin, Texas, 78708-0529; phone
1-800-832-9623, extension 6607; or via email albert_ruiz@tcada.state.tx.us.
These amendments and new section are proposed under the Texas
Health and Safety Code, Chapter 464, which provides the Texas Commission on
Alcohol and Drug Abuse with the authority to adopt rules licensing chemical
dependency treatment facilities.
The code affected by the proposed amendments and new section is the Texas
Health and Safety Code, Chapter 464.
§148.141.Required Postings.
(a)
The facility shall post a legible copy of the following
documents in a prominent public location that is readily available to clients,
visitors, and employees:
(1)
(No change.)
(2)
the commission's
current
poster on reporting
complaints and violations; and
(3)
(No change.)
(b)
The Bill of Rights and the commission's poster shall be
displayed in English and in a second language at each
approved
[
§148.143.Voluntary Clients-Additional Rights.
In addition to the rights described in §148.142 of this title
(relating to Client Bill of Rights), voluntary clients in residential programs
shall be advised as to the following rights with regard to requests for discharge:
(1)
You have the right to leave the treatment facility within
four hours after you tell a staff person you want to leave. If you want to
leave, you need to say so in writing or tell a staff person. If you tell a
staff person you want to leave, the staff person must write it down for you
to ensure that it is documented. There are only three reasons why you would
not be allowed to leave:
(A)-(B)
(No change.)
(C)
Third, if you are under 16 years old, and the person who
admitted you (your parents, guardian, or conservator) doesn't want you to
leave, you may not be able to leave. If you request release, staff must explain
to you whether or not you can sign yourself out and why. The facility must
notify the person who does have the authority to sign you out and tell that
person that you want to leave. That person must talk
with the program
director
[
(2)-(3)
(No change.)
§148.161.Client Abuse, Neglect, and Exploitation.
(a)
(No change.)
(b)
Any person who receives an allegation or has reason to
suspect that a client has been, is, or will be abused, neglected, or exploited
shall immediately inform the
chief
executive
officer
[
(c)
If the allegation involves sexual exploitation, the
chief
executive
officer
[
(d)
The
chief
executive
officer
[
(e)
The
chief
executive
officer
[
(f)
The person who reported the incident shall submit a written
incident report to the
chief
executive
officer
[
(g)
The
chief
executive
officer
[
(1)
the name of the client and the person the allegations are
against;
(2)
the information required in the incident report or
a copy of the incident report;
(3)
other individuals, organizations, and law enforcement
notified.
(h)
The
chief
executive
officer
[
(i)
The facility shall investigate the complaint and take appropriate
action unless otherwise directed by the
commission's investigations department
[
(j)
The governing
body
[
(k)
(No change.)
§148.162.Behavior Management.
Facility staff shall use appropriate behavior management to enforce
program rules and protect the health, safety, welfare, and rights of all clients.
(1)-(7)
(No change.)
(8)
The program may have a system of client government
if staff monitor the clients' governing group and approve its decisions.
The client government process cannot be used in place of the client grievance
procedure.
§148.163.Client Labor.
(a)
Clients can be required to maintain their own living quarters
and client activity areas if they are physically able to do so. These housekeeping
activities and individual/group responsibilities shall be clearly defined
in writing
and presented to the client at the time of admission
.
(b)
The facility shall not hire clients to fill staff positions.
Former clients are not eligible for employment at the facility until at least
two years after documented discharge from active treatment.
(c)-(d)
(No change.)
(e)
Staff members shall not enter into a business
relationship with any client or give personal gifts to clients until at least
two years after documented discharge.
§148.164.Searches.
(a)
The facility shall adopt a policy on searches. If searches
are allowed, the facility shall adopt a search procedure that ensures the
protection of client rights.
(b)
Searches may only be conducted to protect the health, safety,
and welfare of clients, including detection of drugs and weapons.
(c)
Searches must be conducted in a professional manner that
maintains respect and dignity for the client. All searches must comply with
the following standards.
(1)
Staff members performing a body search must be the same
gender as the client.
(2)
The client must be allowed to remain fully clothed
during a body search. The client may be required to remove jackets, coats,
and extra garments. Staff may use their hands to pat down the client's body
to feel for illicit items.
(3)
The client must be present when a search is conducted
of belongings such as back packs, purses, and luggage.
(4)
When searching bedrooms, all clothes, furniture, and
personal items must be returned to their original state.
(5)
All searches must be witnessed by a second staff person
or another individual who is not directly involved in the search.
(6)
All searches must be documented in the client record,
including the circumstances prompting the search, the result of the search,
and the signature of the individuals conducting and witnessing the search.
(d)
Strip searches are not allowed. If the provider believes
a strip search is necessary, the provider must contact local law enforcement
and request that the client be transferred to the criminal justice system.
The circumstances and justification for the request and transfer must be documented
in the client record.
§148.171.Client Record Security.
(a)
The facility shall implement a written policy and procedures
to protect
all
client records and other client-identifying information
from loss, tampering, and unauthorized access or disclosure.
(1)
All active client records must be stored
at the facility, and inactive records in off-site storage must be fully protected.
(2)
Information that identifies applicants
must be protected to the same degree as information that identifies clients.
(b)-(d)
(No change.)
(e)
The program shall have an effective tracking system, and
an assigned staff person shall ensure that each record is returned to the
locked
file at the end of each day or shift.
(f)-(g)
(No change.)
(h)
If client records are microfilmed, scanned, or destroyed,
the facility shall take steps to protect confidentiality.
The facility
shall maintain a record of all client records destroyed on or after September
1, 1999, including the client's name, record number, birthdate, and dates
of admission and discharge.
§148.172.General Documentation Requirements.
The facility shall keep complete, current documentation.
(1)
(No change.)
(2)
All documents and entries shall
have full original
signature, credentials, and date
[
(3)-(4)
(No change.)
(5)
The facility shall create a record for each client
at the time of admission. All documents related to active clients shall be
filed and readily available
on site
.
(6)-(7)
(No change.)
§148.173.Release of Confidential Information.
(a)
The facility shall implement written procedures for protecting
and releasing client
and applicant
information that conform to
federal and state confidentiality laws
and regulations, including 42
CFR Part 2 (the federal regulations on the Confidentiality of Alcohol and
Drug Abuse Patient Records).
(b)-(e)
(No change.)
§148.181.Significant Incident Reports.
(a)
Staff shall complete an incident report for all significant
client incidents, including:
(1)-(9)
(No change.)
(10)
fire or significant disruption of program operation
(including disruption due to insufficient staffing)
;
(11)
death of an active
outpatient or residential
client (on or off the program site); and
(12)
clients absent without permission from a residential
[
(b)-(e)
(No change.)
(f)
The
chief
executive
officer
[
(1)
fires and natural disasters;
(2)
substantial disruption of program operation;
(3)
death of an active client (on or off the program site);
and
(4)
violations of laws, rules, and professional and ethical
codes of conduct.
(g)
The
chief
executive
officer
[
(h)
(No change.)
(i)
Once a year, the
chief
executive
officer
[
(1)
identify patterns;
(2)
evaluate the effectiveness of staff response; and
(3)
take any corrective or preventive action needed.
(j)
(No change.)
§148.183.Special Treatment Procedures.
Staff shall use special treatment procedures appropriately to protect
the health, safety, and rights of clients and other individuals.
(1)
The governing body shall adopt a policy to either authorize
or prohibit the use of personal restraint, mechanical restraint, and seclusion.
All adolescent programs, detoxification programs, and programs accepting emergency
detentions shall authorize use of personal restraint.
(2)-(11)
(No change.)
(12)
The
chief
executive
officer
[
(A)
review all incident reports involving special treatment
procedures;
(B)
investigate unusual or possibly unjustified use of the
procedures; and
(C)
take appropriate action to address any identified problems.
(13)
Facilities using personal restraint shall comply
with the following.
(A)
Staff shall not personally restrain a client for longer
than
twenty minutes
[
(B)
(No change.)
(14)-(16)
(No change.)
§148.185.Adolescents Absent Without Permission.
The facility shall have written procedures that staff use when an adolescent
leaves a [
(1)
time frames that determine when a client is absent without
permission;
(2)
time frames and persons responsible for notifying
the legal consenter(s);
(3)
actions to be taken by staff; and
(4)
incident report documentation.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of the Secretary of State, on
June 14, 1999.
TRD-9903511
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Earliest possible date of adoption: July 25, 1999
For further information, please call: (512) 349-6733
40 TAC §§148.201-148.203, 148.211, 148.231-148.233, 148.236-148.238, 148.252, 148.261-148.268
The Texas Commission on Alcohol and Drug Abuse proposes amendments
to §§148.201, 148.202, 148.211, 148.231-148.233, 148.236, 148.252,
148.261-148.268 and proposes new §§148.203, 148.237, and 148.238
concerning Program Services. These sections contain information on: general
information; services required in all programs; client transportation; Level
I treatment (outpatient or residential detoxification); adolescents; parents
and their dependent children; structured therapeutic children's services;
extension services; small family living environments; court commitment services;
meals in residential programs; general provisions for medication; medication
storage; medication inventory; disposing of medication; staff qualifications
and training; authorizations for medication; administration of medication;
and self-administration of medication.
These amendments and new sections are proposed to add and/or update appropriate
references; to ensure that residential programs have procedures that provide
for clients to continue prescribed medication after admission; to require
that chemical dependency education is based on a course curriculum and that
all sessions include opportunities for client participation and discussion;
to require programs to provide education about specific communicable diseases;
to require case management for other services needed by clients; to mandate
that facilities have a written policy regarding the use of facility vehicles
and/or staff to transport clients and to set parameters for facilities that
choose to use their resources to provide transportation for clients; to clarify
and/or add requirements for Level I treatment programs including hourly checks
while clients are sleeping, some additional experience and/or training requirements
for certain staff, and at least one counseling session to encourage clients
to seek appropriate treatment after detoxification; to strengthen the requirements
for adolescent treatment programs including family involvement and prohibition
of tobacco use by adolescents, staff and other adults; to clarify the requirements
for programs for parents and their dependent children and for structured therapeutic
children's services provided in connection with their parents' treatment;
to specify that extension sites must be registered and approved prior to service
provision at the site; to add requirements for small family living environments
to this subchapter and to clarify that small family living environments are
only for outpatient clients who need temporary living arrangements in order
to access services; to consolidate the rules on court commitment services
in one place; to specify that residential programs are responsible for the
meals of clients who are scheduled to be away from the facility at meal time;
and to clarify the requirements regarding medication policies and procedures
including inventory, disposal, storage, administration and self-administration
as well as training for staff who administer medication.
Terry Faye Bleier, Executive Director, has determined that for the first
five-year period the rules are in effect there will be no fiscal implications
for state or local government as a result of enforcing the rules.
Ms. Bleier has also determined that for each year of the first five years
the rules are in effect the anticipated public benefit will be improved programs
and services for all clients from facilities providing chemical dependency
treatment services. There is no additional effect on small businesses. There
is no anticipated economic cost to persons required to comply with the proposed
amendments and new sections.
Comments on the proposal may be submitted to Tamara Allen, Quality Assurance,
Texas Commission on Alcohol and Drug Abuse, P.O. Box 80529, Austin, Texas,
78708-0529. Comments must be received no later than 30 days from the date
the proposal is published in the
Texas Register
.
In addition, there will be a hearing to receive public comments on these proposed
rules at 4:30 p.m., Monday July 12, 1999, at the Austin Convention Center,
5000 East Cesar Chavez, Austin, Texas. If you have questions about the hearing,
you may contact Albert Ruiz, Community Network Coordinator, Texas Commission
on Alcohol and Drug Abuse, P.O. Box 80529, Austin, Texas, 78708-0529; phone
1-800-832-9623, extension 6607; or via email albert_ruiz@tcada.state.tx.us.
These amendments and new sections are proposed under the Texas
Health and Safety Code, Chapter 464, which provides the Texas Commission on
Alcohol and Drug Abuse with the authority to adopt rules licensing chemical
dependency treatment facilities.
The code affected by the proposed amendments is the Texas Health and Safety
Code, Chapter 464.
§148.201.General Information.
(a)
Every program shall comply with the rules in §148.202
of this title (relating to Services Required in All Programs)
and §148.203
of this title (relating to Client Transportation)
.
(b)-(c)
(No change.)
§148.202.Services Required In All Programs.
(a)
All services shall be delivered according to
the
[
(b)-(c)
(No change.)
(d)
Every residential program shall adopt medication procedures
so that clients can continue taking prescribed medication after admission.
[
(e)
Chemical dependency education shall follow a course
curriculum
[
(f)
(No change.)
(g)
The program shall provide [
(h)-(i)
(No change.)
(j)
The program shall
provide case management for clients
with regard
[
(k)
Programs that admit females of child-bearing age shall
ensure that at least one staff person has training and/or experience in providing
specialized care for substance-abusing pregnant females. In addition, the
program shall:
(1)
(No change.)
(2)
implement the procedures whenever a pregnant female
is admitted; [
(3)
refer pregnant clients who are not receiving prenatal
care to an appropriate health care provider and monitor follow-through
; and
(4)
provide gender specific services.
(l)
(No change.)
§148.203.Client Transportation.
(a)
The facility shall have a written policy on the use of
facility vehicles and/or staff to transport clients.
(b)
If the facility allows the use of facility vehicles and/or
staff to transport clients, it must adopt transportation procedures which
include the following elements:
(1)
Any vehicle used to transport a client must have appropriate
insurance coverage for business use with a current safety inspection sticker
and license.
(2)
All vehicles used to transport clients must be maintained
in safe driving condition.
(3)
Drivers must be at least 21 years of age and have
a valid driver's license.
(4)
An individual with more than two moving violations
during the previous five years shall not be allowed to transport clients.
(5)
Drivers and passengers must wear seatbelts at all
times the vehicle is in operation.
(6)
A vehicle shall not be used to transport more passengers
than designated by the manufacturer.
(7)
Drivers shall not use cellular phones while driving.
(8)
Use of tobacco products shall not be allowed in the
vehicle.
(9)
Every vehicle used for client transportation shall
have a fully stocked first aid kit and A:B:C fire extinguisher that are easily
accessible.
§148.211.Level I Treatment (Outpatient or Residential Detoxification) .
(a)
Every client shall have a medical history and physical
as required in §148.291 of this title (relating to Detoxification History
and Assessment)
.
[
Residential clients shall
have the medical history and physical completed and filed within 24 hours
of admission. If the facility cannot meet this deadline because of exceptional
circumstances, the circumstances shall be documented in the client record.
Until a client's medical history and physical is complete, staff shall observe
the client closely and monitor vital signs.]
[
Outpatient clients shall
have the medical history and physical completed and available for review by
program staff before admission.]
(b)
The program shall provide continuous supervision for clients.
(1)
In residential programs, direct care staff shall be awake
and
on duty where the clients are located
[
(A)
During day and evening hours, at least two awake staff
shall be on duty for the first 12 clients, with one more person on duty for
each additional one to 16 clients.
(B)
At night, at least one awake staff member shall be on duty
for the first 12 clients, with one more person on duty for each additional
one to 16 clients.
Night staff shall conduct and document hourly checks
while clients are sleeping.
(2)
In outpatient programs, direct care staff shall
be awake and on site whenever a client is on site. Clients shall have access
to
an
on-call
health care professional with detoxification
experience
[
(c)
If the program accepts clients with acute withdrawal symptoms
or a history of acute withdrawal symptoms, the program shall have:
(1)
a licensed vocational nurse or registered nurse
with
detoxification experience
on duty during all hours of operation; and
(2)
a physician on call 24 hours a day.
(d)
Level of observation shall be based on medical recommendations
and program design.
(e)
A physician shall approve all medical policies, procedures,
guidelines, tools, and forms, which shall include:
(1)
screening instruments (including a medical risk assessment)
and procedures;
(2)
the form used for the admission and
medical history and physical;
(3)
[
(4)
[
(f)
The clinical supervisor shall be a physician, physician
assistant, advanced practice nurse, or registered nurse.
(g)
The program shall:
(1)
ensure continuous access to emergency medical care;
(2)
provide clients access to mental health evaluation
and linkage with mental health services when indicated; and
(3)
conduct at least one counseling session
[
(h)
Direct care staff shall complete training
in detoxification
and special treatment procedures
as described in §148.114 of this
title (relating to Special Training Requirements).
(i)
Staff shall help each client develop an individualized
post-detoxification plan that includes appropriate referrals.
§148.231.Adolescents.
(a)
(No change.)
(b)
Residential facilities shall have separate
sleeping
areas, bedrooms,
[
(c)-(d)
(No change.)
(e)
The program shall involve the adolescent's family
or an alternate support system in the treatment process or document why this
is not happening.
[
(f)-(h)
(No change.)
(i)
The facility shall ensure that staff who plan, supervise,
or provide chemical dependency education or counseling to adolescents have
specialized education or training
as required in §148.114 of this
title (relating to Special Training Requirements)
[
[(1)
Individuals who plan or supervise such
services shall be qualified credentialed counselors.]
[(2)
Direct care employees shall have
training in human adolescent development, family systems, adolescent psycho-pathology
and mental health, chemical dependency and addiction in adolescents, and adolescent
socialization issues.]
(j)-(m)
(No change.)
(n)
The treatment plan shall address adolescent needs and issues
and family relationships
.
(o)
The program shall prohibit adolescent clients from
using tobacco products on the program site or during structured program activities.
[
(p)
(No change.)
(q)
Staff
and other adults
shall not use tobacco
products in the presence of adolescent clients.
[(r)
The program shall prohibit adolescent
clients from using tobacco products on the program site or during structured
program activities.]
§148.232.Parents and Their Dependent Children.
(a)
(No change.)
(b)
Education, counseling, and rehabilitation services shall
address:
(1)
(No change.)
(2)
parenting
education,
skills
development
and support
; [
(3)
health and nutrition
, including health care of
children; and
(4)
child development.
(c)
The program shall have a procedure to regularly assess
parent-child interactions. Any identified needs shall be
documented and
addressed in treatment.
(1)
The assessment shall include documented
examples of incidents and behaviors.
(2)
Identified issues and problems will
be addressed in individual counseling or parenting sessions.
(d)
(No change.)
(e)
The program shall provide or arrange for childcare with
a qualified provider while the parent participates in treatment activities.
Before supervising children independently, the provider shall have infant
/child
CPR certification and at least eight hours of training in the
following areas:
(1)
chemical dependency and its impact on the family;
(2)
child development and age-appropriate activities;
(3)
child health and safety;
(4)
standard
[
(5)
appropriate child supervision techniques; and
(6)
signs of child abuse.
(f)-(h)
(No change.)
(i)
If the program provides childcare on site, it must provide
a safe and sanitary environment appropriate for children.
The physical
plant shall meet the requirements listed in §148.372 of this title (relating
to Physical Plant Requirements for Children).
[(1)
Heating equipment shall be cool enough
to touch safely.]
[(2)
Heavy furniture and equipment shall
be securely installed to prevent tipping or collapsing.]
[(3)
Electrical outlets accessible to
children shall have child-proof covers or safety devices.]
[(4)
Air conditioners, fans, and heating
units shall be mounted out of children's reach or have safety guards.]
[(5)
Grounds shall be kept free of standing
water and sharp objects.]
[(6)
Tap water shall be no hotter than
110 degrees Fahrenheit.]
[(7)
Items potentially dangerous for
children shall be stored safely.]
[(8)
Areas that are more than two feet
above ground level (such as stairs, porches, and platforms) shall have railings
low enough for children to reach.]
[(9)
Tanks, ditches, sewer pipes, dangerous
machinery, and other hazards shall be fenced.]
[(10)
Outdoor play areas shall be enclosed
by a fence at least four feet high if:]
[(A)
the play area is located close to a road, pool, deep ditch,
or other hazard; or]
[(B)
there are more than six children in the group.]
[(11)
Outdoor play equipment shall
be in a safe location and securely anchored (unless portable by design).]
[(12)
Buildings, furniture, and equipment
shall not have openings or angles that could trap or injure a child's head.]
[(13)
Swing seats shall be durable, lightweight,
and relatively pliable.]
§148.233.Structured Therapeutic Children's Services.
(a)
General requirements
for programs that provide structured
services for dependent children as part of the parent's treatment
.
(1)
The program shall ensure that children are directly supervised
by parents or qualified childcare providers at all times. The program is always
responsible for providing oversight and guidance to ensure children receive
appropriate care when they are supervised by clients.
(2)
The program shall have a written policy and a current
schedule showing who is responsible for the children at all times.
(3)
The program shall provide a variety of age-appropriate
equipment, toys, and learning materials.
(4)
Standards protecting the health, safety, and welfare
of clients apply to their children.
(5)
Behavior management shall be fair, reasonable, consistent,
and related to the child's behavior. Physical discipline is prohibited.
(b)
Staffing.
(1)
Every program that provides structured therapeutic children's
services shall have a supervisor or consultant with at least:
(A)
(No change.)
(B)
one year of documented
, supervised
experience
providing services to children.
(2)
Before supervising children independently, direct
care employees shall have
infant/child
[
(A)
chemical dependency and its impact on the family;
(B)
child development and age-appropriate activities;
(C)
child health and safety;
(D)
standard
[
(E)
appropriate child supervision techniques; and
(F)
signs of child abuse.
(3)-(5)
(No change.)
(c)
Safety practices.
(1)
The emergency evacuation procedures shall include provisions
for children [
(2)-(3)
(No change.)
(4)
The program site shall meet the additional physical
plant requirements listed in
§148.272 of this title (Relating to
Physical Plant Requirements for Children)
[
(d)
Health practices.
(1)
(No change.)
(2)
Staff, volunteers, and parents shall use
standard
[
(3)-(4)
(No change.)
(e)
Residential Programs shall also comply with the following
requirements.
(1)
Childcare programs shall include pre-school, after
school, and homework support.
The daily activity schedule shall include
a variety of structured and unstructured age-appropriate activities.
(2)-(4)
(No change.)
(5)
Each child shall have a medical assessment from a
medical doctor, physician assistant, advanced practice nurse, or registered
nurse within 96 hours of admission. Copies of an assessment performed up to
seven days before admission may be used.
Children shall also have access
to primary pediatric care, including immunizations.
(6)-(8)
(No change.)
(9)
The program shall provide an adequate diet for childhood
growth and development, including two snacks per day.
Menus for children
shall be approved as described in §148.252 of this title (relating to
Meals in Residential Programs).
[(10)
Rooms and buildings shall have
at least 30 usable square feet of indoor activity space per child when occupied
by children.]
[(11)
Where children share sleeping space
with parents, bedrooms shall have at least 30 usable square feet per infant
(in cribs) and 40 usable square feet per child.]
[(12)
Nurseries shall have 35 usable
square feet per crib.]
[(13)
The program site shall have adequate
outdoor play space with a safe route of access.]
§148.236.Extension Services.
(a)
Programs that provide services at a site that is not owned,
leased, operated, or controlled by the facility shall develop procedures to
protect the confidentiality of client-identifying information.
(1)
Client records shall be accounted for and secured in permanent
storage
at an approved site
at the end of each work day.
(2)
(No change.)
(b)
(No change.)
(c)
The facility shall not provide services at an extension
site until the site has been registered and approved by the commission's licensure
department.
[
§148.237.Small Family Living Environments.
(a)
A small family living environment is a single apartment
unit, house, or similar residence (housing no more than six people) which
is available to adult clients participating in an outpatient program.
(b)
Small family living environments shall be permitted only
under these circumstances:
(1)
housing arrangements are offered as an option to outpatient
clients needing temporary living arrangements in order to access services;
(2)
clients using the housing are adults;
(3)
use of the housing is completely voluntary; it is
neither required nor implied as a condition of participation;
(4)
clients using the housing are not discriminated against
or given preference over other clients, either in admissions or services;
and
(5)
housing is used by no more than 25% of the clients
in a program.
(c)
A small family living environment is not an acceptable
option for clients who need residential treatment. A client may be admitted
to a small family living environment only when all of the following conditions
are met.
(1)
The client is participating in a Level III or Level IV
outpatient treatment program.
(2)
A QCC determines that the client can reasonably be
expected to remain abstinent without 24-hour supervision.
(3)
The client demonstrates sufficient stability and life
skills to function adequately without staff supervision.
(d)
Each client who lives in a small family living environment
shall sign a consent before admission that includes the following provisions:
(1)
housing is offered as an option and is not required as
a condition for participation in the program;
(2)
use of the housing is completely voluntary;
(3)
clients using the housing are not discriminated against
or given preference over other program participants, either in admissions
or services;
(4)
the housing units are not licensed facilities and
do not meet the health and safety standards required in residential facilities;
(5)
the facility is responsible for the selection, inspection,
approval, and monitoring of these units regarding building safety, maintenance,
repair, fire safety, and sanitation, including all required inspections and
approvals; and
(6)
clients may leave the housing at any time without
affecting their treatment services.
(e)
If the unit is owned or operated by another entity, the
facility shall have a written agreement that defines responsibilities and
addresses:
(1)
finances;
(2)
maintenance; and
(3)
client confidentiality.
§148.238.Court Commitment Services.
(a)
Facilities accepting court commitments shall be licensed
to provide the appropriate level of service:
(1)
emergency detention: Level I or Level II residential services;
(2)
adult inpatient involuntary civil or criminal commitments:
Level II or Level III residential services for adults;
(3)
adult outpatient involuntary civil or criminal commitments:
Level II or Level III outpatient services;
(4)
juvenile inpatient commitments: Level II residential
services for adolescents;
(5)
juvenile outpatient commitments: Level II or Level
III outpatient services for adolescents.
(b)
The facility's court commitment program shall implement
procedures for compliance with Texas Health and Safety Code, Chapter 462.
(c)
The facility shall have a procedure for reporting unauthorized
departures to the referring courts. Verbal report shall be made immediately,
with written confirmation within 24 hours.
(d)
The facility shall ensure that the designated staff members
working with the court commitment program develop a working relationship with
the judiciary. Staff members shall provide the judiciary with sufficient information
in writing on the program design, treatment methods, and admission processes
to assist the judiciary in committing appropriate clients to the facility.
(e)
The facility shall also develop and implement written referral
procedures that incorporate other available resources to assist in the referral
and placement of clients that are inappropriate for admission.
(f)
The program shall provide the judiciary with sufficient
written information about its program design, treatment methods, admission
processes, lengths of stay and continuum of care to assist the judiciary in
committing appropriate clients to the facility.
(g)
The program shall accept all chemical dependency clients
brought to the facility under an emergency detention warrant, order of protective
custody, or civil court order for treatment. A general pre-screening and assessment
of the individual seeking a civil court commitment for chemical dependency
may be used to determine whether the client may be appropriate for chemical
dependency treatment. A formal screening and assessment is not required before
admission. For reporting purposes, only clients brought to the facility pursuant
to an emergency detention or civil court order or originally referred from
such an order, will be counted as court commitment clients.
(h)
The program's admission criteria shall not exclude individuals
who meet the criteria for emergency detention or civil court ordered chemical
dependency treatment, including individuals who are likely to cause serious
harm to themselves or others.
(i)
The program shall have policies and procedures for crisis
stabilization and medically-supervised detoxification. A Level I program shall
provide these services directly. All programs providing other levels of service
shall either provide these services directly or have access to them as documented
in written agreements.
(j)
The program shall adopt protocols for the stabilization
and management of clients who are a danger to themselves or others as required
by §462.062 of the Texas Health and Safety Code.
(k)
A program that accepts emergency detentions shall adopt
a policy authorizing use of special treatment procedures and implement procedures
that conform with §148.183 of this title (relating to Special Treatment
Procedures) and §148.184 of this title (relating to Documenting Special
Treatment Procedures).
(l)
The client record shall contain documentation of the conditions
and/or behaviors that caused the client's entry into the civil court commitment
process.
(m)
The client record shall also contain copies of the following
documents:
(1)
order for emergency detention (if applicable);
(2)
application for court-ordered treatment services;
(3)
two physician's certificates of medical examination
for chemical dependency;
(4)
order of protective custody for chemical dependency;
(5)
notice of hearing of application for court-ordered
chemical dependency treatment;
(6)
waiver of attendance at hearing (if applicable);
(7)
finding of probable cause hearing;
(8)
order of commitment or writ of commitment;
(9)
transfer order (if applicable) and
(10)
modification order of the initial petition for court
ordered treatment (if applicable).
(n)
The facility's court commitment program shall provide training
for at least two designated staff to ensure they understand and comply with
court commitment statutes, regulations, and procedures.
§148.252.Meals in Residential Programs.
(a)-(c)
(No change.)
(d)
The program shall provide at least three meals daily, with
no more than 14 hours between any two meals.
The program shall provide
package meals or make other arrangements for clients who are scheduled to
be away from the facility during meal time.
(e)
(No change.)
§148.261.General Provisions for Medication.
(a)
The facility shall
implement
[
(b)
(No change.)
(c)
Prescription medication
[
§148.262.Medication Storage.
(a)
Prescription and over-the-counter medications
[
(b)
The program shall keep all prescription and
over-the-counter
[
(c)
(No change.)
(d)
The program shall store all medication under appropriate
conditions.
(1)
Drugs requiring refrigeration shall be stored
in a locked compartment separate from food items.
(2)
Topical medications shall be separated
from oral and injectable medications in a labeled box, drawer, compartment,
or shelf.
(e)
Clients may not keep prescription [
(f)
(No change.)
(g)
The facility must ensure that
prescription
medication
is in a [
(1)
If the medication is a sample, the medication
must have an attached, signed label from the prescribing professional that
includes the name of the client, name of medication, dosage, route and frequency
of the prescribed medication, prescribed date, medication expiration date,
and initial dosage amount in the container. A copy of this information must
be filed in the client record.
(2)
If clients are required to take medication
with them off site, the medication must be in a container labeled by the pharmacy
or prescribing professional.
§148.263.Medication Inventory.
(a)
(No change.)
(b)
Staff shall inventory and inspect all stored
prescription
medication at least
daily
[
(c)
The inventory system shall include
a
centralized
medication inventory form with
[
(1)
date the medication entered the facility;
(2)
initial amount of medication;
(3)
amount administered to the client as recorded on the
client administration record;
(4)
amount present at each inventory;
(5)
amount present at disposition; and
(6)
daily
[
(d)
The staff member conducting the inventory shall sign and
date the inventory sheet.
When a discrepancy exists between the administration
record and the inventory count form, a note explaining the reason for the
discrepancy or action taken to reconcile/correct the discrepancy shall be
signed by the staff member conducting the inventory and kept with the medication
inventory forms.
§148.264.Disposing of Medication.
(a)
Staff shall separate the following medication immediately
and dispose of it within 30 days:
(1)
(No change.)
(2)
prescription
medication remaining after
the prescribed length of therapy; [
(3)
medication prescribed for clients who have left the
program
; and
(4)
medication that has spoiled or been
refused by the client.
(b)
(No change.)
(c)
Two staff members shall witness and document disposal
, including amount of medication disposed and method used
.
§148.265.Staff Qualifications and Training.
The facility shall ensure that staff who handle or administer medication
are properly credentialed and trained.
(1)-(3)
(No change.)
(4)
Staff who supervise self-administration
of prescription
or over-the-counter medications
shall be trained as described in §148.114
of this title (relating to Special Training Requirements).
§148.266.Authorization for Medication.
(a)
Staff shall not give prescription medication to a client
without a prescription or order from a physician
or from a licensed dentist,
podiatrist,
[
(b)
Each written order for medication shall include:
(1)-(3)
(No change.)
(4)
the signature of the
prescribing professional
[
§148.267.Administration of [
(a)
Staff shall provide
[
(b)
Each dose of prescription and over-the-counter medication
taken by the client shall be documented
[
(c)
The medication [
(1)
the client's name;
(2)
drug allergies (or the absence of known allergies);
(3)
the name and dose of each medication;
(4)
the frequency and route of each medication;
(5)
the date and time of each dose [
(6)
the signature of the staff person who administered
or supervised
each dose.
(d)
When a client is absent for scheduled doses
of prescription
medication
, staff shall take action to ensure that the client receives
the medication as prescribed.
(e)
When [
(1)
notify
the prescribing professional or another
[
(2)
complete an incident report; and
(3)
document the facts[
(f)
When a medication error is identified,
a staff member shall:
(1)
contact a licensed health professional or a pharmacist
to clarify what action should or should not be taken;
(2)
complete an incident report; and
(3)
document the facts in the client record, including
the date, time, name and telephone number of the person contacted, the recommendation,
and any other related action taken.
§148.268.Self-Administration of Medication.
(a)-(b)
(No change.)
(c)
Staff shall document each dose supervised in the client's
record
as required in §148.267 of this title (relating to Administration
of Medication)
.
[(d)
The medication record shall include:]
[(1)
the client's name;]
[(2)
drug allergies (or the absence of known allergies);]
[(3)
the name and dose of each medication;]
[(4)
the frequency and route of each medication;]
[(5)
the date and time of each dose supervised; and]
[(6)
the signature of the staff person who supervised
each dose.]
[(e)
When a client is absent for scheduled
doses, staff shall take action to ensure that the client receives the medication
as prescribed.]
[(f)
When a medication error is identified
or a client appears to have an adverse reaction to medication, staff shall:]
[(1)
notify a physician or an authorized physician assistant
or advanced practice nurse;]
[(2)
complete an incident report; and]
[(3)
document the facts and the physician (or physician
assistant or advanced practice nurse) contact in the client record.]
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of the Secretary of State, on
June 14, 1999.
TRD-9903512
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Earliest possible date of adoption: July 25, 1999
For further information, please call: (512) 349-6733
40 TAC §§148.212-148.214
The Texas Commission on Alcohol and Drug Abuse proposes amendments
to §§148.212-148.214 concerning Program Services. These sections
contain information on Level II treatment (day treatment or intensive residential);
Level III treatment (residential or intensive out patient); and Level IV treatment
(transitional outpatient or transitional residential).
These amendments are proposed to clarify and/or add requirements for Level
II, III and IV treatment programs including setting minimum requirements for
those admitted to each program, implementing new staff to client ratios during
sleeping hours, ensuring that every residential client has a medical history
and physical examination, conducting hourly checks while clients are sleeping
in Level II and III treatment programs, and requiring individual counseling
at least once a month in Level IV treatment programs.
Terry Faye Bleier, Executive Director, has determined that for the first
five-year period the rules are in effect there will be no fiscal implications
for state or local government as a result of enforcing the rules.
Ms. Bleier has also determined that for each year of the first five years
the rules are in effect the anticipated public benefit will be improved services
for clients from facilities providing Level II, Level III and/or Level IV
chemical dependency treatment services. There is no additional effect on small
businesses. The anticipated economic cost to persons required to comply with
the proposed amendments varies. The cost is related to implementing the 1:32
staff-to-client ratio during sleeping hours. There will be no additional cost
for programs with less than 33 beds. The additional cost for larger programs
will depend on current staffing patterns. It is estimated that it could cost
as much as $30,000 per year for every additional 32 beds.
Comments on the proposal may be submitted to Tamara Allen, Quality Assurance,
Texas Commission on Alcohol and Drug Abuse, P.O. Box 80529, Austin, Texas,
78708-0529. Comments must be received no later than 30 days from the date
the proposal is published in the
Texas Register
.
In addition, there will be a hearing to receive public comments on these proposed
rules at 4:30 p.m., Monday July 12, 1999, at the Austin Convention Center,
5000 East Cesar Chavez, Austin, Texas. If you have questions about the hearing,
you may contact Albert Ruiz, Community Network Coordinator, Texas Commission
on Alcohol and Drug Abuse, P.O. Box 80529, Austin, Texas, 78708-0529; phone
1-800-832-9623, extension 6607; or via email albert_ruiz@tcada.state.tx.us.
These amendments are proposed under the Texas Health and Safety
Code, Chapter 464, which provides the Texas Commission on Alcohol and Drug
Abuse with the authority to adopt rules licensing chemical dependency treatment
facilities.
The code affected by the proposed amendments is the Texas Health and Safety
Code, Chapter 464.
§148.212.Level II Treatment (Day Treatment or Intensive Residential) .
(a)
All clients admitted to Level II shall
not have
[
(1)
a documented, reported, or observed medical condition
that requires immediate medical treatment or continuous medical supervision
(as determined by a prudent lay person); or
[
(2)
an observable physical or mental impairment that
prevents the client from participating
[
(b)
The program shall have enough staff to provide close supervision
and individualized treatment
, even if this requires more staff than indicated
by the minimum staff-to-client ratios listed in this section
.
(c)
Counselor caseloads shall not exceed ten clients for each
counselor.
(d)
Direct care staff shall be awake and on site during all
hours of program operation. [
(1)
In outpatient programs, the direct care staff-to-client
ratio shall be at least 1:16 during all hours of operation.
[
(2)
In residential programs, the direct care staff-to-client
ratio shall be at least 1:16 during the hours clients are awake and 1:32 when
clients are asleep.
[
(3)
Night staff shall conduct and document
hourly checks while clients are sleeping.
(e)
Counselors shall complete a comprehensive client assessment
and initial treatment recommendations
within three individual service
days of admission for all clients transferred from Level I or admitted directly
to a Level II program.
(f)
An individualized treatment plan shall be completed for
all clients within five individual service days of admission.
(g)
The facility shall deliver an average of 20 hours of structured
activities per week for each client, including:
(1)
three hours of chemical dependency counseling (including
at least one hour of individual counseling);
(2)
14 hours of additional counseling, chemical dependency
education, or life skills training; and
(3)
three hours of structured social and/or recreational
activities.
(h)
Every residential client shall have a medical history
and physical examination as required by §148.301 of this title (relating
to Client History and Assessment).
[
(i)
Program staff shall offer related services to identified
significant others.
§148.213.Level III Treatment (Residential or Intensive Outpatient) .
(a)
All clients admitted to Level III shall be
able to
function with limited supervision and support and shall not have
:
(1)
a documented, reported, or observed medical condition
that requires immediate medical treatment or continuous medical supervision
(as determined by a prudent lay person); or
[
(2)
an observable physical or mental impairment that
prevents the client from participating in treatment
[
(b)
The program shall have enough staff to meet treatment needs
within the context of the program description
, even if this requires
more staff than indicated by the minimum staff-to-client ratios listed in
this section
.
(c)
Counselor caseloads shall not exceed 16 clients per counselor.
(d)
Direct care staff shall be awake and on site during all
hours of program operation. [
(1)
In outpatient programs, the direct care staff-to-client
ratio shall be at least 1:16 during all hours of operation.
[
(2)
In residential programs, the direct care staff-to-client
ratio shall be at least 1:16 during the hours clients are awake and 1:32 when
clients are asleep
[
(3)
Night staff shall conduct and document
hourly checks while clients are sleeping.
(e)
For clients transferred from Level I or admitted directly
to this level of treatment, counselors shall complete a comprehensive client
assessment
and initial treatment recommendations
within
three
[
(f)
All clients shall have an individualized treatment plan
within
five
[
(g)
The facility shall deliver an average of ten hours of structured
activities per week for each client, including at least two hours of chemical
dependency counseling (with at least one hour of individual counseling every
two weeks) and eight hours of additional counseling, chemical dependency education,
or life skills training.
(h)
Every residential client shall have a
medical history and physical examination completed and filed in the client
record within 96 hours of admission, as required by §148.301 of this
title (relating to Client History and Assessment).
§148.214.Level IV Treatment (Transitional Outpatient or Transitional Residential) .
(a)
All clients admitted to Level IV programs shall be
able to function with minimal supervision and support and shall not have
:
(1)
a documented, reported, or observed medical condition
that requires immediate medical treatment or continuous medical supervision
(as determined by a prudent lay person); or
[
(2)
an observable physical or mental impairment that
prevents the client from participating in treatment
[
(b)
A Level IV program shall not admit a client transferred
directly from Level I without written justification in the client record.
(c)
The program shall have enough staff to provide clients
with adequate support and guidance,
even if this requires more staff
than indicated by the minimum staff-to-client ratios listed in this section
.
(d)
Counselor caseloads shall not exceed 20 clients per counselor
in residential programs. Outpatient programs shall set limits on counselor
caseload size that ensure effective, individualized treatment and rehabilitation.
Criteria used to set the caseload size shall be documented.
(e)
The program shall be adequately staffed during hours of
operation to ensure effective service delivery.
(f)
In residential programs, the awake direct care staff-to-client
ratio shall be at least
1:20
[
(g)
For clients transferred from Level I or admitted directly
to this level of treatment, counselors shall complete a comprehensive client
assessment
and initial treatment recommendations within three individual
service days of admission. In outpatient programs, this period shall not exceed
45 calendar days.
[
[(1)
five individual service days of admission
in residential programs; and]
[(2)
45 calendar days of admission in
outpatient programs.]
(h)
All clients shall have an individualized treatment plan
within
five individual service days of admission. In outpatient programs,
this period shall not exceed 45 calendar days.
[
[(1)
seven individual service days of admission
in residential programs; and]
[(2)
45 calendar days of admission in
outpatient programs.]
(i)
The facility shall deliver an average of two hours of structured
activities per week for each client, including at least one hour of chemical
dependency counseling and one hour of additional counseling, life skills training,
or chemical dependency education.
Individual counseling shall be provided
at least once a month.
(j)
Every residential client shall have a
medical history and physical examination as required by §148.301 of this
title (relating to Client History and Assessment).
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on
June 14, 1999.
TRD-9903513
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Earliest possible date of adoption: July 25, 1999
For further information, please call: (512) 349-6733
40 TAC §148.235
(Editor's note: The text of the following section proposed for
repeal will not be published. The section may be examined in the offices of
the Texas Commission on Alcohol and Drug Abuse or in the Texas Register office,
Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)
The Texas Commission on Alcohol and Drug Abuse proposes
the repeal of §148.235 concerning Program Services. This section contains
the requirements for pharmocotherapy programs. The repeal is proposed because
the commission is no longer required to license methadone programs. These
programs are now under the sole regulatory jurisdiction of the Texas Department
of Health.
Terry Bleier, Executive Director, has determined that for the first five-year
period the repeal is in effect there will be no fiscal implications for state
or local government as a result of the proposed repeal.
Ms. Bleier has also determined that for each year of the first five years
the repeal is in effect the anticipated public benefit will be clarity about
the regulatory jurisdiction of pharmocotherapy programs. There will be no
effect on small businesses. There is no anticipated economic cost to current
providers.
Comments on the proposal may be submitted to Tamara Allen, Quality Assurance,
Texas Commission on Alcohol and Drug Abuse, P.O. Box 80529, Austin, Texas,
78708-0529. Comments must be received no later than 30 days from the date
the proposal is published in the
Texas Register
.
In addition, there will be a hearing to receive public comments on these proposed
rules at 4:30 p.m., Monday July 12, 1999, at the Austin Convention Center,
5000 East Cesar Chavez, Austin, Texas. If you have questions about the hearing,
you may contact Albert Ruiz, Community Network Coordinator, Texas Commission
on Alcohol and Drug Abuse, P.O. Box 80529, Austin, Texas, 78708-0529; phone
1-800-832-9623, extension 6607; or via email albert_ruiz@tcada.state.tx.us.
The repeal is proposed under the Texas Health and Safety Code,
Chapter 464, which provides the Texas Commission on Alcohol and Drug Abuse
with the authority to adopt rules licensing chemical dependency treatment
facilities.
The code affected by the proposed repeal is the Texas Health and Safety
Code, Chapter 464.
§148.235.Pharmocotherapy Programs.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of the Secretary of State, on
June 14, 1999.
TRD-9903514
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Earliest possible date of adoption: July 25, 1999
For further information, please call: (512) 349-6733
40 TAC §§148.281, 148.282, 148.284, 148.291-148.293, 148.301-148.304, 148.322-148.324
The Texas Commission on Alcohol and Drug Abuse proposes amendments
to §§148.281, 148.282, 148.284, 148.291-148.293, 148.301-148.304,
and 148.322-148.324 concerning Treatment Process. These sections contain information
on: admission criteria; admission determination; client orientation; detoxification
history and assessment; detoxification plan; detoxification notes; client
history and assessment; treatment plan; progress notes; treatment plan reviews;
discharge plan; discharge summary; and discharge follow-up.
These amendments are proposed to clarify the typical age range served by
adolescent and adult programs, when exceptions may be warranted and how they
must be approved; to describe the admission determination process; to require
that information about searches the program may use be included in client
orientation; to expand the requirements related to detoxification history
and assessment including reducing the time allowed to complete the detoxification
history to 24 hours; to require that goals be established as part of the detoxification
plan and that progress or lack of progress toward those goals be addressed
in detoxification notes; to specify the process for and requirements of the
client history and assessment; to describe the treatment plan process and
document; to clarify what is to be included in progress notes; to specify
that programs must define in writing the intervals at which treatment plans
will be reviewed; to mandate that the treatment plan must be revised when
the client enters a new level of service; to require that either family members
who were initially involved in the initial treatment planning participate
in reviews or that the counselor must document why this does not occur; to
specify that discharge planning begins at the time of admission and must be
completed before the client's scheduled discharge; to state what must be addressed
in the discharge plan; and to institute a time limit of 90 days after discharge
for follow-up to occur.
Terry Faye Bleier, Executive Director, has determined that for the first
five-year period the rules are in effect there will be no fiscal implications
for state or local government as a result of enforcing the rules.
Ms. Bleier has also determined that for each year of the first five years
the rules are in effect the anticipated public benefit will be improved chemical
dependency treatment programs for all clients receiving services from licensed
facilities. There is no additional effect on small businesses. There is no
anticipated economic cost to persons required to comply with the proposed
amendments.
Comments on the proposal may be submitted to Tamara Allen, Quality Assurance,
Texas Commission on Alcohol and Drug Abuse, P.O. Box 80529, Austin, Texas,
78708-0529. Comments must be received no later than 30 days from the date
the proposal is published in the
Texas Register
.
In addition, there will be a hearing to receive public comments on these proposed
rules at 4:30 p.m., Monday July 12, 1999, at the Austin Convention Center,
5000 East Cesar Chavez, Austin, Texas. If you have questions about the hearing,
you may contact Albert Ruiz, Community Network Coordinator, Texas Commission
on Alcohol and Drug Abuse, P.O. Box 80529, Austin, Texas, 78708-0529; phone
1-800-832-9623, extension 6607; or via email albert_ruiz@tcada.state.tx.us.
These amendments are proposed under the Texas Health and Safety
Code, Chapter 464, which provides the Texas Commission on Alcohol and Drug
Abuse with the authority to adopt rules licensing chemical dependency treatment
facilities.
The code affected by the proposed amendments is the Texas Health and Safety
Code, Chapter 464.
§148.281.Admission Criteria .
(a)
(No change.)
(b)
The criteria shall describe a client population appropriate
for the program and specify the age group to be served.
(1)
Adolescent programs serve youth 13 to
17 years of age. However, children who are 10 through 12 years of age and
young adults 18 through 20 years of age may be admitted to an adolescent program
only when the assessment indicates that the individual's needs, experiences,
and behavior are similar to those of adolescent clients.
(2)
Adult programs serve individuals
18 years of age or older. However, adolescents who are 17 years of age may
be admitted to an adult program when they are referred by the criminal justice
system or when the individual's needs, experiences, and behavior indicate
that treatment in an adult program is clinically appropriate.
(3)
Each exception shall be approved
in writing by the program director.
(c)-(d)
(No change.)
Admission Determination
[
(a)
Every client admitted to the program shall meet the
diagnostic
admission criteria.
(1)
In programs providing Level II, III, or IV treatment,
a QCC shall assess the applicant to determine if the applicant meets the diagnostic
and other admission criteria and recommend an appropriate level of treatment
[
(2)
In Level I programs,
applicants shall be assessed
[
(A)
A chemical dependency counselor with one year of detoxification
experience may
assess the applicant
[
(B)
In outpatient [
(3)
Clients shall be treated in the least restrictive
environment available that best meets their needs.
(b)
Justification for admission (based on the
diagnostic
and other
admission criteria) shall be signed by the individual authorizing
admission and filed in the client record at admission.
(c)
If an individual is not admitted, the program shall refer
and assist
the applicant to
obtain
appropriate services.
(d)
The provider shall maintain a written log that lists all
applicants
[
§148.284.Client Orientation.
(a)-(b)
(No change.)
(c)
The orientation shall include:
(1)-(4)
(No change.)
(5)
any behavior management procedures
or searches
used to enforce program rules;
(6)-(8)
(No change.)
(d)-(e)
(No change.)
§148.291.Detoxification History and Assessment .
(a)
A chemical dependency counselor or licensed health professional
shall collect and document the following information:
(1)
alcohol and other drug use, past and present;
(2)
past psychiatric and chemical dependency treatment;
(3)
significant medical history
, including personal
and family medical history, allergies, medications,
and current health
status;
(4)
current living situation;
(5)
current employment situation; and
(6)
current emotional state and behavioral functioning.
(b)
The program shall obtain enough medical and psychosocial
information about the client to provide a clear understanding of the client's
present status.
(c)
The detoxification history shall be [
(d)
Each client shall have a
[
(1)
Residential clients shall have the medical
history and physical completed and filed within 24 hours of admission. If
the facility cannot meet this deadline because of exceptional circumstances,
the circumstances shall be documented in the client record. Until a client's
medical history and physical is complete, staff shall observe the client closely
and monitor vital signs.
(2)
A medical history and physical examination
completed during the 24 hours preceding admission may be substituted if it
is approved by the program's physician, physician assistant, or advanced practice
nurse.
(3)
Outpatient clients shall have the
medical history and physical completed and available for review by program
staff before admission.
Detoxification
[
(a)
A clinical staff person authorized by the program shall
identify the client's short term needs
and establish appropriate goals
(based on the detoxification history, the medical history, and the
physical examination) and develop an appropriate detoxification plan.
(b)
The detoxification plan shall be reviewed and signed by
a physician or another licensed health professional. Non-physicians shall
have at least one year of detoxification experience.
(c)
The client shall also sign the detoxification plan.
(d)
The completed and signed detoxification plan shall be filed
in the client record within 24 hours of admission.
(e)
The program shall revise the detoxification plan whenever
the client's needs change significantly.
§148.293.Detoxification Notes.
The program shall implement the detoxification plan and document the
client's response.
(1)
Program staff shall document services provided to the client
and progress or lack of progress toward detoxification goals
. [
(2)-(3)
(No change.)
§148.301.Client History and Assessment.
(a)
A counselor shall document a psychosocial history
and assessment
that provides a thorough understanding of the client's
history and present status
. The psychosocial history shall include
[
(1)
circumstances leading to admission;
(2)
alcohol and other drug use, past and present;
(3)
past psychiatric and chemical dependency treatment;
(4)
significant medical history and current health status;
(5)
family
structure
[
(6)
current living situation
, including family involvement
with Child Protective Services as applicable
;
(7)
relationships with family of origin, nuclear family,
and significant others;
(8)
social history including club or
gang involvement if applicable;
(9)
[
(10)
[
(11)
[
(12)
[
(13)
[
(b)
The program may use a client questionnaire to gather some
of the information needed for the psychosocial
history
[
(c)
(No change.)
(d)
A counselor shall complete an assessment of the client
based on the psychosocial history.
A qualified credentialed counselor
shall review and sign the psychosocial history
and assessment
and/or
any updates.
(e)
For residential clients, a medical history and physical
examination shall be completed and filed in the client record within 96 hours
of admission.
(1)
The medical history and physical shall be completed
and signed by a physician, physician assistant, advanced nurse practitioner,
or RN with a bachelor's degree and at least four years of experience in conducting
medical histories and physicals.
[
(2)
The facility may use a medical history and physical
examination completed up to 30 days before admission or received from the
referring facility.
[
§148.302.Treatment Plan.
(a)
A counselor shall develop a written list of the client's
problems and needs based on the psychosocial history
and assessment
.
(b)
The counselor and client shall work together to develop
an individualized,
[
(c)
Issues identified in the treatment plan which exceed
the expertise of staff shall be identified, and the client shall be referred
to a qualified provider as appropriate. All referrals shall be documented
in the client record.
[
(d)
Goals shall
be individualized, realistic, measurable,
time specific, appropriate to the level of treatment, and
clearly
stated
[
(e)-(g)
(No change.)
§148.303.Progress Notes.
(a)
(No change.)
(b)
Program staff shall document
all
services provided
to the client. [
(c)
(No change.)
(d)
Counselors shall write a progress note at least weekly
when services are provided. Weekly notes shall describe the client's progress
or lack of progress
toward stated treatment plan goals and other significant
information.
(e)
(No change.)
§148.304.Treatment Plan Reviews.
(a)
The primary counselor shall meet with the client to review
the treatment plan at appropriate intervals
defined in writing by the
program
.
(b)
(No change.)
(c)
When a client is transferred to a different level of service,
the counselor shall document a transfer note in the client record.
The
treatment plan must be revised when the client enters a new level of service.
(d)
(No change.)
(e)
Family members who participated in the
initial treatment planning shall participate in the treatment plan reviews,
or the counselor shall document why they are not participating.
§148.322.Discharge Plan.
(a)-(b)
(No change.)
(c)
Discharge planning shall
begin at the time of admission
and be completed
[
(d)-(f)
(No change.)
§148.323.Discharge Summary.
(a)
The program shall complete a discharge summary for each
client, including:.
(1)
needs and problems identified at the time of admission
, during treatment, and at discharge
;
(2)
(No change.)
(3)
assessment of the client's progress towards goals;
[
(4)
circumstances of discharge
; and
(5)
arrangements for aftercare.
(b)-(c)
(No change.)
§148.324.Discharge Follow-Up.
The facility shall contact each client
no later than 90 days
after discharge
from the facility
and then document the individual's
current status or the reason the contact was unsuccessful.
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on
June 14, 1999.
TRD-9903515
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Earliest possible date of adoption: July 25, 1999
For further information, please call: (512) 349-6733
40 TAC §§148.331, 148.341, 148.353, 148.355, 148.372, 148.373
The Texas Commission on Alcohol and Drug Abuse proposes amendments
to §§148.331, 148.341, 148.353, 148.355 and proposes new §148.372,
and §148.373 concerning Physical Plant. These sections contain information
on: general environment; general physical plant provisions; exits; furniture
and supplies; physical plant requirements for children; and physical plant
requirements for small family living environments.
These amendments and new sections are proposed to require that any needed
corrective action plan to ensure compliance with the Americans with Disabilities
Act is implemented within a reasonable time frame; to clarify the requirements
for private space for confidential interactions; to expand the prohibitions
on smoking, firearms and other weapons; to require prohibitions on alcohol,
illegal drugs, illegal activities and violence on site; to prohibit the use
of recreational vehicles and campers as client sleeping areas; to clarify
under what circumstances windows may be smaller than the size stated in the
rules; to specify the required ratio of washers and dryers to clients; to
specify the physical plant requirements that are specific to programs that
provide children's services or childcare on site; and to specify the physical
requirements for small family living environments.
Terry Faye Bleier, Executive Director, has determined that for the first
five-year period the rules are in effect there will be no fiscal implications
for state or local government as a result of enforcing the rules.
Ms. Bleier has also determined that for each year of the first five years
the rules are in effect the anticipated public benefit will be safer and more
adequate physical plants in licensed facilities providing chemical dependency
treatment services. There is no additional effect on small businesses. There
is no anticipated economic cost to persons required to comply with the proposed
amendments and new sections.
Comments on the proposal may be submitted to Tamara Allen, Quality Assurance,
Texas Commission on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas
78708-0529. Comments must be received no later than 30 days from the date
the proposal is published in the
Texas Register
.
In addition, there will be a hearing to receive public comments on these proposed
rules at 4:30 p.m., Monday July 12, 1999, at the Austin Convention Center,
5000 East Cesar Chavez, Austin, Texas. If you have questions about the hearing,
you may contact Albert Ruiz, Community Network Coordinator, Texas Commission
on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas 78708-0529; phone
1-800-832-9623, extension 6607; or via email albert_ruiz@tcada.state.tx.us.
These amendments and new sections are proposed under the Texas
Health and Safety Code, Chapter 464, which provides the Texas Commission on
Alcohol and Drug Abuse with the authority to adopt rules licensing chemical
dependency treatment facilities.
The code affected by the proposed amendments is the Texas Health and Safety
Code, Chapter 464.
§148.331.General Environment.
(a)
(No change.)
(b)
The facility shall comply with the Americans with Disabilities
Act (ADA). The facility shall maintain documentation that it has conducted
a self-inspection to evaluate compliance and implemented a corrective action
plan
within reasonable time frames
to address identified deficiencies.
(c)-(d)
(No change.)
(e)
The facility shall have private [
(f)
The facility shall prohibit smoking inside facility buildings
and during structured program activities
.
(g)
(No change.)
(h)
Staff shall not provide, distribute, or facilitate
access to tobacco products.
[
(i)
Staff shall not use tobacco products in
the presence of clients.
(j)
The facility shall prohibit firearms and
other weapons on the site.
(k)
The facility shall prohibit alcohol, illegal
drugs, illegal activities, and violence on the site.
§148.341.General Physical Plant Provisions.
(a)
All programs shall comply with the following rules.
(1)-(2)
(No change.)
(3)
Mobile homes
, recreational vehicles, and campers
shall not be used for client sleeping areas.
(b)-(c)
(No change.)
§148.353.Exits.
(a)-(d)
(No change.)
(e)
Windows shall provide a secondary means of escape. Windows
shall not be less than 20 inches in width and 24 inches in height, unless
the facility is protected throughout by an approved, operational automatic
sprinkler system.
[
[(1)
the sleeping room has a door leading
directly to the outside of the building; or]
[(2)
the facility is protected throughout
by an approved automatic sprinkler system.]
(f)-(i)
(No change.)
§148.355.Furniture and Supplies.
(a)-(d)
(No change.)
(e)
All clients shall have access to laundry services or properly
maintained laundry facilities
equivalent to one washer and dryer per
25 clients
.
(f)
(No change.)
§148.372.Physical Plant Requirements for Children.
(a)
All programs that provide children's services or childcare
on site shall provide a safe and sanitary environment appropriate for children.
(1)
Heating equipment shall be cool enough to touch safely.
(2)
Heavy furniture and equipment shall be securely installed
to prevent tipping or collapsing.
(3)
Electrical outlets accessible to children shall have
child-proof covers or safety devices.
(4)
Air conditioners, fans, and heating units shall be
mounted out of children's reach or have safety guards.
(5)
Grounds shall be kept free of standing water and sharp
objects.
(6)
Tap water shall be no hotter than 110 degrees Fahrenheit.
(7)
Items potentially dangerous for children shall be
stored safely.
(8)
Areas that are more than two feet above ground level
(such as stairs, porches, and platforms) shall have railings low enough for
children to reach.
(9)
Tanks, ditches, sewer pipes, dangerous machinery,
and other hazards shall be fenced.
(10)
Outdoor play areas shall be enclosed by a fence at
least four feet high if:
(A)
the play area is located close to a road, pool, deep ditch,
or other hazard; or
(B)
there are more than six children in the group.
(11)
Outdoor play equipment shall be in a safe location
and securely anchored (unless portable by design).
(12)
Buildings, furniture, and equipment shall not have
openings or angles that could trap or injure a child's head.
(13)
Swing seats shall be durable, lightweight, and relatively
pliable.
(b)
Residential programs shall meet the following requirements:
(1)
Rooms and buildings shall have at least 30 usable square
feet of indoor activity space per child when occupied by children.
(2)
Bedrooms shall have at least 40 usable square feet
per child. This applies whether the child is sleeping with the parent or with
other children.
(3)
When infant share the parent's bedroom, the room shall
contain at least 30 usable square feet per infant.
(4)
Nurseries shall have 35 usable square feet per crib.
(5)
The program site shall have adequate outdoor play
space with a safe route of access.
§148.373.Physical Plant Requirements for Small Family Living Environments.
(a)
A small family living environment is a single apartment
unit, house, or similar residence (housing no more than six people) which
is available to adult clients participating in an outpatient program as described
in §148.237 of this title (relating to Small Family Living Environments).
(b)
A facility shall meet all residential physical plant rules
in §§148.351-148.359 of this title (relating to Required Inspections,
Space Requirements, Exits, Fire Systems, Furniture and Supplies, Lighting,
Plumbing, Sanitation, and Ventilation) if:
(1)
clients are required to live in the housing as a condition
of receiving treatment services, or
(2)
more than 25% of the clients in an outpatient program
live in the optional housing.
(c)
A small family living environment must meet the requirements
in §148.341 of this title (relating to General Physical Plant Provisions).
(d)
Each unit shall meet applicable state laws and local codes
and ordinances.
(e)
Buildings shall be inspected and approved annually by the
fire marshal as required.
(f)
Each unit shall have at least one working, portable A:B:C
fire extinguisher for the living area and one B:C fire extinguisher for the
kitchen. Fire extinguishers shall be approved by the Underwriter Laboratories
or the fire marshal.
(g)
Each unit shall have at least one working smoke detector
approved by the Underwriter Laboratories or the fire marshal.
(h)
Doors shall not require a key for exit from the inside.
(i)
Buildings and grounds shall be structurally sound, in good
repair, and clean.
(j)
The residence shall be maintained in a sanitary condition.
(k)
All plumbing, equipment, and appliances shall be maintained
in good working condition.
(l)
Clients shall be able to keep the temperature between 65
degrees and 85 degrees Fahrenheit.
(m)
There shall be at least 40 square feet per client in multiple-occupant
bedrooms and at least 80 square feet per client in single-occupant bedrooms.
(n)
In multiple-occupant residences, bedrooms shall have doors
for privacy.
(o)
The residence shall have a bathroom with a sink, a toilet,
and a tub or shower with an adequate supply of hot water.
(p)
The residence shall have cooking facilities that include
a sink with hot water, a stove, and a refrigerator.
(q)
Lighting shall be sufficient to meet the needs of clients.
(r)
The residence shall be appropriately furnished and have
an atmosphere that preserves client dignity and confidentiality.
(s)
Each client shall have a separate bed with a solid frame
and mattress.
(t)
The residence shall have adequate closet and drawer space
for each client to store clothes and personal property.
(u)
Clients shall have access to private or public laundry
facilities.
(v)
The facility shall inspect the residence at least quarterly
to monitor compliance with these rules and correct identified problems.
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on
June 14, 1999.
TRD-9903516
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Earliest possible date of adoption: July 25, 1999
For further information, please call: (512) 349-6733
40 TAC §148.371
(Editor's note: The text of the following section proposed for
repeal will not be published. The section may be examined in the offices of
the Texas Commission on Alcohol and Drug Abuse or in the Texas Register office,
Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)
The Texas Commission on Alcohol and Drug Abuse proposes
the repeal of §148.371 concerning Physical Plant. This section contains
the requirements for small family living environments. This repeal is proposed
because these requirements are being revised. The portion of the requirements
that address program services will be moved to that subchapter and the portion
that addresses physical plant requirements will be moved to a new section
within this subchapter. Both of those actions are concurrently proposed for
adoption.
Terry Bleier, Executive Director, has determined that for the first five-year
period the repeal is in effect there will be no fiscal implications for state
or local government as a result of the proposed repeal.
Ms. Bleier has also determined that for each year of the first five years
the repeal is in effect the anticipated public benefit will be clarity about
the purpose of and requirements for small family living environments. There
will be no effect on small businesses. There is no anticipated economic cost
to current providers.
Comments on the proposal may be submitted to Tamara Allen, Quality Assurance,
Texas Commission on Alcohol and Drug Abuse, P.O. Box 80529, Austin, Texas,
78708-0529. Comments must be received no later than 30 days from the date
the proposal is published in the
Texas Register
.
In addition, there will be a hearing to receive public comments on these proposed
rules at 4:30 p.m., Monday July 12, 1999, at the Austin Convention Center,
5000 East Cesar Chavez, Austin, Texas. If you have questions about the hearing,
you may contact Albert Ruiz, Community Network Coordinator, Texas Commission
on Alcohol and Drug Abuse, P.O. Box 80529, Austin, Texas, 78708-0529; phone
1-800-832-9623, extension 6607; or via email albert_ruiz@tcada.state.tx.us.
The repeal is proposed under the Texas Health and Safety Code,
Chapter 464, which provides the Texas Commission on Alcohol and Drug Abuse
with the authority to adopt rules licensing chemical dependency treatment
facilities.
The code affected by the proposed repeal is the Texas Health and Safety
Code, Chapter 464.
§148.371.Small Family Living Environments.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of the Secretary of State, on
June 14, 1999.
TRD-9903517
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Earliest possible date of adoption: July 25, 1999
For further information, please call: (512) 349-6733
Subchapter A. Civil Court Commitments
AFDC
] applicants in 45 Code of Federal Regulations
§233.50. [
Citizenship requirements for aliens applying for Medicaid
are as specified in §5.1002 of this title (relating to Legal Basis).
]
Chapter 5.
Medicaid Programs for Aliens
Chapter 15.
Medicaid Eligibility
(3)
Aid to Families with Dependent Children
(AFDC) - Financial assistance to low income families under Title IV-A of the
Social Security Act. AFDC clients are also eligible for Medicaid.
]
(4)
] Alimony - Allowance made
by a court to one spouse from funds of the other spouse, either pending decision
on a suit for separation or divorce or after a decision in the suit.
(5)
] Alternate care - A service
provided in a client's home or community as an alternative to institutional
care.
(6)
] Annuity - An amount payable
yearly or at other regular intervals.
(7)
] Appeal - A client's request
for a fair hearing concerning a department action.
(8)
] Applicant - An individual
with a pending application for medical assistance.
(9)
] Application - A completed,
signed, and dated application for assistance (aged and disabled).
(10)
] Applied income - The
amount of personal income a client in a long-term care facility must pay,
to the facility, toward his cost of care.
(11)
] Assets - All items
that have monetary value and are owned by an individual.
(12)
] Audit reconciliation
- The process by which a facility with audit exceptions takes corrective action
to clear the exceptions.
(13)
] Award - Something of
value conferred or bestowed on an individual as a result of merit or need.
(14)
] BENDEX (Beneficiary
Data Exchange) - Computer tape from the Social Security Administration (SSA)
giving Retirement, Survivors, and Disability Insurance (RSDI) and Medicare
information about the department's clients.
(15)
] Blind - An individual
is considered blind under Supplemental Security Income (SSI) requirements
if the visual acuity in his better eye is 20/200 or less with corrective lenses,
or if he has tunnel vision that limits his field of vision to 20 degrees or
less.
(16)
] Bond - A written obligation
to pay a sum of money at a future date.
(17)
] Budgeting - The process
of determining a client's eligibility and applied income.
(18)
] Burial space - A burial
plot, grave site, crypt, mausoleum, urn, casket, niche, or other repository
customarily and traditionally used for the deceased's bodily remains. The
term also includes necessary and reasonable improvements or additions to these
spaces, including, but not limited to, vaults, headstones, markers, or plaques;
burial containers; arrangements for opening and closing of grave site; and
contracts for care and maintenance of the grave site. Contracts for care and
maintenance are sometimes referred to as endowment or perpetual care.
(19)
] Buy-in - The payment
of Medicare Part B premiums by the department and for eligible Medicaid clients.
(20)
] Client - Either an
applicant for or a recipient of medical assistance.
(21)
] Common law marriage
- A relationship in which the parties live together and represent themselves
to the public as husband and wife.
(22)
] Community Care for
Aged and Disabled (CCAD) - A group of alternate care services, either home-based
or community based, for eligible aged and disabled Texans.
(23)
] Community care service
- A service provided in a client's home or community, as opposed to services
provided in an institution. The terms community care and alternate care are
synonymous.
(24)
] Compensation - Any
money, real or personal property, food, shelter, or services received by a
client that are not usually provided by a family member.
(25)
] Countable income -
The amount of a client's income after all exemptions and exclusions.
(26)
] Countable resource
- Any resource that the department would have counted, in whole or in part,
toward the re- source limitation.
(27)
] Current market value
- Current value of a re- source at the time of sale or transfer. See the definition
of fair market value in this section.
(28)
] Deeming - Counting
all or part of the income or resources of another person (parent or spouse)
as income or resources available to the client.
(29)
] Deemor - A person (spouse
or parent of a client) whose income or resources are available to the client.
(30)
] Disabled - An individual
who is unable to engage in any substantial, gainful activity because of any
medically determinable physical or mental impairment that can be expected
to result in death or has lasted or can be expected to last for a continuous
period of at least 12 months.
(31)
] Discounting - The advancement
of money on a negotiable note or agreement and the deduction of interest or
a premium in advance.
(32)
] Early and periodic
screening, diagnosis, and treatment (EPSDT) - Services offered under Medicaid
for eligible children.
(33)
] Earned income - Income
a client receives for services performed as an employee or as a result of
self-employment.
(34)
] Earned income credits
(EIC) - Payments from the Internal Revenue Service (IRS) to persons who have
tax dependents and gross monthly earnings at or below levels established by
IRS.
(35)
] Earned income tax credit
(EITC) - A special tax credit that reduces the federal tax liability of certain
low-income working taxpayers.
(36)
] Equity - The fair market
value of a resource minus all money owed on it.
(37)
] Excluded income - Income
that is not counted when determining eligibility but that is counted to determine
applied income.
(38)
] Excluded resource -
Any resource that the department does not count toward the resource limitation.
(39)
] Exempt income - Income
that is not counted in eligibility nor applied income determination.
(40)
] Extended care facility
(ECF) - A nursing home that is participating in Medicare as a skilled nursing
facility.
(41)
] Fair hearing - A meeting
conducted by a regional hearing officer with a client or his representative
who disagrees with and wishes to appeal some action taken on the client's
case.
(42)
] Fair market value -
Amount of money an item would bring if sold in the current local market.
(43)
] Federal benefit rate
(FBR) - Standard payment amount in the SSI program.
(44)
] Fiduciary agent - An
individual who has authority to manage another person's funds.
(45)
] Financial duress -
Having insufficient funds to meet living expenses because of debts incurred
for medical expenses for the institutionalized spouse, community-based spouse,
or dependent, or because of replacement of a resource lost through theft or
acts of God.
(46)
] Financial management
- The way a client manages his income, pays expenses, and maintains any remaining
funds.
(47)
] Fraud - Deliberate
misrepresentation or willful withholding of information for the purpose of
obtaining public assistance; either for self or another individual.
(48)
] Health insurance claim
(HIC) - Medicare claim number, which is the same as Social Security claim
number or Railroad Retirement claim number (number with an alpha suffix.)
(49)
] Home - A structure
in which a client lives (including mobile homes, houseboats, and motor homes),
other buildings, and all adjacent land.
(50)
] Housebound Veterans
Administration benefits (HB) - Veteran's Administration benefits for persons
living in the community who need regular aid-and-attendance from another person.
(51)
] Hospital insurance
benefits (HIB) - Part A of Medicare.
(52)
] Income - Receipt of
any property or service a client can apply, either directly or by sale or
conversion, to meet basic needs for food, clothing, and shelter. Countable
income is the amount of a client's income after all exemptions and exclusions.
(53)
] Income Eligibility
Verification System (IEVS) - Computer tape matches required by federal law.
(54)
] Ineligible child -
for deeming purposes, the natural or adopted child of the client, of the client's
spouse, or of the parent or parent's spouse, who lives with the client, is
not eligible for SSI or Medical Assistance Only, and who is under age 18,
or under age 21 and a student regularly attending a school, college, university,
or course of vocational training in preparation for gainful employment.
(55)
] Infrequent payment
- A payment that is received no more than once per calendar quarter.
(56)
] Inheritance - Cash,
other liquid resources, noncash items, or any right in real or personal property
received at the death of another. An individual may not have access to his
inheritance pending legal action. An inheritance is income in the month of
receipt unless the inherited item would be an excluded resource. Effective
August 11, 1993, waiving an inheritance may result in a transfer of assets
penalty.
(57)
] In-kind support and
maintenance - Food, clothing, or shelter that is provided to the client or
that is purchased by someone else. Any cash payments given directly to the
client for food, clothing, or shelter are cash income and not in-kind support
and maintenance.
(58)
] Institution - An establishment
that makes avail- able some treatment or services, besides food and shelter,
to four or more persons who are not related to the proprietor. Also see definition
of public institution in this section.
(59)
] Institutional care
- Long-term nursing care in a nursing home, ICF-MR facility, or state institution.
(60)
] Institutional cases
- Medical assistance only cases in state institutions.
(61)
] Insurance - The following
terms apply to the definition of insurance:
(62)
] Intermediate Care
Facility (ICF) - Medium level of nursing home care. Formerly ICF III. Effective
October 1, 1990, an ICF is officially designated as nursing facility (NF).
(63)
] Intermediate Care Facility
for Mentally Retarded (ICF-MR) - Public or private facilities that provide
client care in 24-hour specialized residential settings for the mentally retarded.
(64)
] Intermediate Care II
(ICF II) - Level of care in a nursing home for persons who need minimal nursing
care. Effective October 1, 1990, an ICF is officially designated as nursing
facility (NF).
(65)
] Irregular payment -
A payment made without an agreement or understanding and without any reasonable
expectation that payment will occur again.
(66)
] Level of care (LOC)
- Type of care a client is eligible to receive in an ICF/MR facility.
(67)
] Level of care determination
(LCD) - Determination made by a Texas Department of Health MR program regarding
the type of care a client requires.
(68)
] Life estate - A contract
transferring certain rights in property to a person for his life time. The
person usually has the right to possess, use, receive profits, and sell his
estate interest.
(69)
] Liquid resources -
Cash or financial instrument that can be converted to cash within 20 workdays.
Liquid resources include cash, savings accounts, checking accounts, stocks,
bonds, and time deposits. Liquid resources may also include promissory notes,
loans, and mortgages.
(70)
] Loan - A transaction
whereby one party advances money to another party who promises to repay the
debt in full, with or without interest.
(71)
] Long Term Care Unit
(LTCU) of Texas Department of Health (TDH) - A team of TDH health-care professionals
responsible for quality assurance, licensure, and certification functions
in the Title XIX facilities.
(72)
] Materially Participating
- A business owner is determined to be materially participating if he meets
any one of the following criteria:
(73)
] Medicaid - A program
of medical care authorized by Title XIX of the Social Security Act and the
Human Resources Code. It is a federal/state program that is state administered,
utilizing a combination of state and federal dollars to purchase medical care
for categorically needy and medically indigent people.
(74)
] Medicaid-qualifying
trusts (MQT) - A Medicaid- qualifying trust is one that the client, his spouse,
guardian, or anyone holding his power of attorney establishes using the client's
money. The client is the beneficiary of a Medicaid-qualifying trust. A Medicaid-qualifying
trust is one that was established between June 1, 1986, and August 10, 1993.
Trusts which meet the MQT definition and were established prior to June 1,
1986, are treated as standard inter vivos trusts.
(75)
] Medical Assistance
Only (MAO) - Programs providing Medicaid coverage only, with no cash assistance.
(76)
] Medical care facility
- A nursing facility (Title XIX, Title XX, or private), hospital, ICF-MR,
or an institution for mental diseases (IMD).
(77)
] Medical care identification
card - A monthly computer-issued notice to Medicaid clients, verifying Medicaid
cover- age. Also referred to as Medicaid card.
(78)
] Medical effective date
(MED) - Date Medicaid coverage begins.
(79)
] Medical necessity (MN) - The
determination that a client requires the services of registered nurses or
licensed nurses in an institutional setting.
(80)
] Medical services -
Those services which are directed toward diagnostic, preventive, therapeutic,
or palliative treatment of a medical condition and which are performed, directed,
or supervised by a state-licensed health professional.
(81)
] Medically necessary
- The need for medical services in an amount and frequency sufficient, according
to accepted standards of medical practice, to preserve health and life and
to prevent future impairment. For dental services, prosthetic devices, and
walking aids/shoes, the client must provide a statement of medical necessity
from his physician, or a nurse practitioner, clinical nurse specialist, or
physician's assistant who is working in collaboration with his physician.
(82)
] Medicare - Medical
coverage available to persons 65 years old or older and to certain disabled
persons under Title XVIII of the Social Security Act.
(83)
] Mineral rights - Ownership
interests in the oil, gas, or minerals beneath the surface of a piece of property.
Also see surface rights.
(84)
] National Heritage Insurance
Company (NHIC) - Company contracted with the department to serve as the insuring
agent in providing health benefits to Medicaid clients.
(85)
] Nursing facility (NF)
- Formerly ICF or SNF.
(86)
] Old Age, Survivors,
and Disability Insurance (OASDI) - Title II of the Social Security Act. Also
referred to as RSDI.
(87)
] Parent - A child's
natural or adoptive parent or the spouse of the natural or adoptive parent.
(88)
] Pension funds - Monies
held in a retirement fund under a plan administered by an employer or union,
or an individual retirement account (IRA) or Keogh account as described in
the Internal Revenue Code.
(89)
] Preadmission screening
and annual resident review (PASARR) - Federally mandated screening for mental
illnesses, mental retardation, and related conditions before admission to
a nursing facility to determine if placement is appropriate.
(90)
] Prepaid burial contract
- An agreement in which a client prepays his burial expenses and the seller
agrees to furnish the burial.
(91)
] Prize - Something of
value won in a contest, lottery, or game of chance.
(92)
] Promissory notes -
A written or oral, unconditional agreement by the purchaser to pay the seller
a specific sum of money at a specified time or on demand.
(93)
] Property agreement
- A pledge or security of a particular property or properties for the payment
of a debt or the performance of some other obligation within a specified time.
Property agreements on real estate (land and buildings) are generally referred
to as mortgages but may also be called land contracts, contracts for deed,
or deeds of trust.
(94)
] Provider - A person,
group, or agency providing a service to a client for a fee that is paid by
the department. Providers are sometimes called vendors.
(95)
] Public institution
- An establishment that is operated or controlled by a federal or state government
unit, or a political subdivision, such as the city or county.
(96)
] Purchased health services
- The department's state office division that monitors the NHIC contract.
(97)
] Quality control (QC)
- Review of a random sample of cases to determine correctness of assistance
provided.
(98)
] Railroad retirement
benefits (RR) - Retirement, disability annuity, and survivorship benefits
available to railroad employees and their families.
(99)
] Real property - Land
and houses or immovable objects attached to the land.
(100)
] Redetermination -
The decision concerning a client's continued eligibility for Medicaid benefits.
(101)
] Refund value - The
amount that a client would receive upon revocation or liquidation of his burial
contract. The refund value is considered an available resource.
(102)
] Relative - Son, daughter,
grandson, grand- daughter, stepson, stepdaughter, half sister, half brother,
grandmother, grandfather, in-laws, mother, father, stepmother, stepfather,
aunt, uncle, sister, brother, stepsister, stepbrother, nephew, niece. A dependant
relative is one who was living in the client's home before the client's absence
and who is unable to support himself outside of the client's home due to medical,
social, or other reasons.
(103)
] Rent - payment, either
as cash or in-kind, which an individual receives for the use of real or personal
property, such as land, housing, or machinery. Rental income is considered
unearned income unless it is derived from self-employment, that is, someone
is in the business of renting properties.
(104)
] Resources - Cash,
other liquid assets, or any real or personal property or other nonliquid assets
owned by a client, his spouse, or parent, that could be converted to cash.
(105)
] Restitution - Securing
payment from a client when fraud is not indicated or pursued and when the
client has been undercharged applied income because of previously unreported
or under-reported monthly income or resources that do not involve income averaging.
(106)
] Retirement, survivors,
and disability insurance benefits (RSDI) - Title II of the Social Security
Act. Also referred to as OASDI.
(107)
] Review - The process
of redetermining a client's continued eligibility for Medicaid.
(108)
] Rider 49 status -
Medicaid clients in nursing facilities in March 1980, who qualify for ICF
II levels of care. Entitled to continue ICF II and to retain Medicaid after
leaving facility, if eligible.
(109)
] Royalty - A payment
to an individual for permitting another to use or market his property (such
as mineral rights, patents, or copyrights).
(110)
] Skilled nursing facility
- A type of nursing home under Medicaid and Medicare. Also referred to as
extended care facility, under Medicare. Effective October 1, 1990, refers
only to Medicare facilities.
(111)
] Social Security (SS)-
A federal system of old-age, unemployment, or disability insurance for various
categories of employed and dependent persons, financed by a fund maintained
jointly by employees, employers, and the government.
(112)
] Social Security Administration
(SSA) - An organization of the Department of Health and Human Services (HHS).
SSA processes SSI/SDX transactions for the states and is involved extensively
in the Medicare program.
(113)
] Social Security claim
number (SSCN) - Usually same as Medicare claim number.
(114)
] Social Security number
(SSN) - A reference number used by the SSA to identify individual contributors
to the Social Security fund.
(115)
] Social service -
Any service, other than medical, which is intended to assist a person with
a physical disability or social disadvantage to function in society on a level
comparable to that of a person who does not have such a disability or disadvantage.
No in-kind items are expressly identified as social services.
(116)
] State data exchange
(SDX) - Computer tape from the SSA giving SSI information about the department's
clients. SDX information can be used as a source of verification and is available
to workers through the department's computer terminals.
(117)
] Stocks - Shares of
ownership in a corporation.
(118)
] Supplementary medical
insurance benefits (SMIB) - Part B of Medicare.
(119)
] Supplemental security
income (SSI) - A needs-tested program, administered by the SSA, that provides
monthly income to aged, blind, and disabled individuals.
(120)
] Support - Contributions
in cash or in kind that provide some or all of a client's usual needs.
(121)
] Support and maintenance
- The value of both food and shelter that a client receives.
(122)
] Support or maintenance
- The value of either food or shelter that a client receives, but not both.
(123)
] Surface rights -
Ownership interests in the exterior or upper boundary of land.
eligible for Aid
to Families with Dependent Children (AFDC) or who would be except for age
and school-attendance requirements. Also covered are the caretaker, second
parent, and certified children; except when there is an only child who is
18 through 20 years old and therefore eligible for medical assistance only.
In these cases, caretakers and second parents are eligible. To be eligible
for Medicaid benefits, a family must meet the eligibility criteria outlined
in Chapter 3, Income Assistance, of the department's rules.
]
Subchapter B. Medicaid and Third-party Resources
SSI
] and
Temporary Assistance for Needy Families (TANF)
[
AFDC
] clients are enrolled for buy-in effective the first month they
receive a cash payment.
Subchapter C. Basic Program Requirements
Aid to Families
with Dependent Children
], or
Subchapter D. Resources
an AFDC
] caretaker, his resources are not counted.
an AFDC
] caretaker
or a client, his resources are not counted.
Subchapter E. Income
Aid to Families with Dependent Children (AFDC)
], Supplemental Security
Income (SSI), Refugee Assistance Act of 1980, a Bureau of Indian Affairs (BIA)
general assistance program, payments based on need provided by a state/local
government income maintenance program, Veterans Administration (VA) pension
for veterans or widows, VA dependency and indemnity compensation (DIC) for
parents, or payments under the Disaster Relief Act of 1974;
AFDC
], nor MAO, nor do they have spouses or parents
whose incomes are deemed to the client, all interest payments and deposits
made by the ineligible coholders are considered as income of the client;
AFDC
], SSI, or MAO; or are spouses or parents whose incomes are
deemed to the client, a deposit by the coholder, spouse, or parent is not
considered to be income to the client;
aid to families with dependent children (AFDC)
]. This income has already been considered in determining the dependent's
need for SSI or
TANF
[
AFDC
].
SSI
] or
Temporary
Assistance for Needy Families (TANF)
[
AFDC
]. This income
has already been considered in determining the dependent's need for SSI or
TANF
[
AFDC
];
an AFDC
] group, that person's income
is not deemed to the client.
Chapter 20.
Cost Determination Process
[Board
] of Human
Services [
(board)
].
Medicaid, statewide, uniform reimbursements,
and reimbursement ceilings are approved by
[
The board recommends
for approval to
] the Texas Health and Human Services Commission (HHSC)
[
medical assistance or Medicaid reimbursements that are uniform by class
]. In Medicaid programs where reimbursements are contractor-specific,
[
the board recommends for approval to
] the HHSC
approves
the reimbursement parameter dollar amounts, e.g., ceilings, floors,
or program reimbursement formula limits. In approving reimbursement amounts
DHS or the HHSC
[
the board
] takes into consideration staff
recommendations based on the application of formulas and procedures described
in this chapter and in reimbursement methodologies for each program. However,
DHS or the HHSC
[
the board
] may adjust staff recommendations
when
DHS or the HHSC
[
the board
] deems such adjustments
are warranted by particular circumstances likely to affect achievement of
program objectives, including economic conditions and budgetary considerations.
[
For the nursing facility program subject to the federal Boren Amendment,
any downward reimbursement adjustments may not exceed the amount of any mark-up
or margin over projected costs. For the nursing facility program, this limitation
ensures that downward reimbursement adjustments do not reduce reimbursement
below the costs which must be incurred by efficient and economic providers
meeting federal and state standards.
] Medicaid reimbursement methodology
rules are developed and recommended for approval [
by the board
]
to the HHSC. The HHSC has oversight authority with respect to the state's
Medicaid rules.
45 days, prior to the
DHS board meeting to approve reimbursement or reimbursement parameter amounts
].
Texas Board of Human Services (board)
] approves reimbursements.
The purpose of the hearing is to give interested parties an opportunity to
comment on
the
[
DHS's
] proposed reimbursements. Notice
of the hearing will be provided to the public. The notice of the public hearing
will identify the name, address, and telephone number to contact for the materials
pertinent to the proposed reimbursements. At least ten working days before
the public hearing takes place, material pertinent to the proposed statewide
uniform Medicaid reimbursements will be made available to the public. This
material will include the proposed reimbursements, the inflation adjustments
used to determine them, and the impact on reimbursements of the major cost
limits. This material will be furnished to anyone who requests it. After the
public hearing, if negative comments are received, a [
written
]
summary of the comments made during the public hearing will be presented to
the
HHSC
[
board
].
In programs where
] reimbursements are
contractor-specific, DHS
and the HHSC
will hold a public hearing
on the reimbursement determination parameter dollar amounts (e.g., ceilings,
floors, or program reimbursement formula limits) before the
HHSC
[
board
] approves parameter dollar amounts. The purpose of the hearing
is to give interested parties an opportunity to comment on
the
[
DHS's
] proposed reimbursement parameter dollar amounts. Notice
of the hearing will be provided to the public. The notice of the public hearing
will identify the name, address, and telephone number to contact for the materials
pertinent to the proposed reimbursement parameter dollar amounts. At least
ten working days before the public hearing takes place, material pertinent
to the proposed reimbursement parameter dollar amounts will be made available
to the public. This material will include the proposed reimbursement parameter
dollar amounts, the inflation adjustments used to determine them, and the
impact on the reimbursement parameter dollar amounts of the major cost limits.
This material will be furnished to anyone who requests it. After the public
hearing, if negative comments are received, a [
written
] summary
of the comments made during the public hearing will be presented to
HHSC
[
the board
].
Part III.
Texas Commission on Alcohol and Drug Abuse
assistant
] deputy for
quality assurance
[
program compliance
] within five days of initiating the
investigation. The commission notifies all relevant parties of the investigative
findings in writing.
15
] days notice of the date, time, and place of the administrative
hearing. The administrative hearing shall be conducted by an administrative
law judge employed by the State Office of Administrative Hearings. Administrative
hearings shall comply with the requirements of Texas Government Code, Chapter
2001, Subchapter C and the State Office of Administrative Hearings' Rules
of Procedure, 1 Texas Administrative Code, Chapter 155.
will
] seek to revoke or suspend the facility's license
instead of imposing an administrative penalty.
and
]
will
] seek to revoke or suspend the counselor's license
instead of imposing an administrative penalty.
(4)
(A)
(B)
Facilities shall not be required to pay administrative penalties under
these rules until January 1, 1999.
]
Chapter 143.
Funding
and approved
] by the commission's executive management team
and approved by
the executive director
.
Developmental ] Funding.
uses
] the
quarterly
[
developmental
] funding process to:
handled
] separately
under the quarterly funding process
.
statewide
service delivery plan, RAC recommendations,
] and results of the previous
Request for Proposals (RFP), as applicable.
developmental
] funding. The minimum score may be less than
the score established for a competitive RFP if the commission has the resources
necessary to provide appropriate technical assistance.
developmental
] funds are approved by the commission's executive director.
Notice
] of available funds is published [
quarterly
] in the
Texas Register
and [
monthly
] on the commission's website and the state's electronic business daily.
The notice includes:
developmental
] funding.
Unsolicited applications are considered in the same way as other applications
during this process. Each application is evaluated in relation to the services
to be purchased and the selection criteria.
]
Once per quarter, if funds are available for development,
the commission reviews the applications.
]
and approved
] by the commission's executive management team
and approved by
the executive director
.
Developmental
] funding
will not be available for services that will be included in a competitive
RFP beginning six months prior to the scheduled RFP.
Under extenuating
circumstances, however, the commission's executive director may waive this
provision.
Chapter 144.
Contract Requirements.
any sexual activity between facility personnel and
a client; corporal punishment; nutritional or sleep deprivation; efforts to
cause fear; the use of any form of communication to threaten, curse, shame,
or degrade a client; restraint that does not conform with these standards;
coercive or restrictive actions taken in response to the client's request
for discharge or refusal of medication or treatment that are illegal or not
justified by the client's condition; and any other act or omission classified
as abuse by the Texas Family Code, §261.001.
]
(2)
] Adolescent - An individual
13 through 17 years of age whose disabilities of minority have not been removed
by marriage or judicial decree.
(3)
] Adult - An individual
18 years of age or older, or an individual under the age of 18 whose disabilities
of minority have been removed by marriage or judicial decree.
(4)
] Approve - Authorize in
writing.
(5)
] Assessment - A process
which identifies problems, needs, strengths, and resources as they pertain
to ATOD use or abuse and related behaviors or activities. Assessments are
used to initiate, maintain, or update individualized plans to address the
identified needs and problems. See also Treatment Assessment.
(6)
] Case management -
A systematic process to ensure clients receive all substance abuse, physical
health, mental health, social, and other services needed to resolve identified
problems and needs. Case management activities are
[
Services
]
provided by an accountable staff person
and
[
which
]
include:
(7)
] Chemical dependency
-
Substance dependence or substance abuse as defined in the current edition
of the Diagnostic and Statistical Manual of Mental Disorders.
[
The abuse of, psychological or physical dependence on, or addiction to alcohol,
a toxic inhalant, or any substance designated as a controlled substance in
the Texas Controlled Substances Act.
]
(8)
] Child - An individual
under the age of 13.
(9)
] Client - An individual
who has been admitted to a
chemical dependency
[
substance
abuse
] treatment facility licensed or funded by the commission and is
currently receiving services. [
A licensed chemical dependency counselor
providing chemical dependency services at a facility shall not have a non-professional
relationship with any client receiving chemical dependency or related services
from the facility for two years after the client is discharged.
]
(10)
(11)
] Commission - The Texas
Commission on Alcohol and Drug Abuse.
(12)
] Consenter - The individual
legally responsible for giving informed consent for a client. This may be
the client, parent, guardian, or conservator. Unless otherwise provided by
law, a legally competent adult is his or her own consenter. Consenters include
adult clients, clients 16 or 17 years of age, and clients under 16 years of
age admitting themselves for
chemical dependency
[
substance
abuse
] counseling under the provisions of the
Texas
Family
Code, §32.004.
(13)
] Counseling -
Face-to-face interactions in which a counselor helps an individual, family
or group identify, understand, and resolve issues and problems.
[
Assisting an individual or group to develop an understanding of problems,
define goals, and plan action reflecting the individual's or group's interest,
abilities, and needs as affected by chemical dependency problems.
]
(14)
(15)
] Counselor - A qualified
credentialed counselor or a counselor intern [
working under direct supervision
].
(16)
] Counselor intern (CI)
- A person pursuing a course of training in chemical dependency counseling
at a regionally accredited institution of higher education or an approved
clinical training institution who has been designated as a counselor intern
by the institution. The activities of a counselor intern shall be performed
under the direct supervision of a qualified credentialed counselor (QCC).
(17)
] Crisis intervention
- Services designed to intervene in situations which may or may not involve
alcohol and drug abuse, and which may
escalate and
result in a
crisis if immediate attention is not provided. Services include face-to-face
individual, family, or group interviews
/interactions
and/or telephone
contacts to identify [
the participant's family's
] needs.
(18)
] Cultural
competency
[
awareness and sensitivity
] training - Training to improve
an individual's ability to understand and interact with persons of a different
culture. Culture defines the lifestyle of a distinct population and includes
values, behavioral norms, and patterns of interpersonal relationships. It
may be based on race, ethnicity, religion, age, gender, sexual orientation,
or disability.
(19)
] Documentation - A written
and/or electronic
record that includes a date and signature and provides
authenticated evidence to substantiate compliance with standards, such as
minutes of meetings, memoranda, schedules, notices, logs, records, policies,
procedures, and announcements.
(20)
] DSM-IV - The Diagnostic
and Statistical Manual of Mental Disorders, Fourth Edition-Revised, published
by the American Psychiatric Association.
Any reference to DSM-IV is understood
to mean the most recent edition of the Diagnostic and Statistical Manual of
Mental Disorders.
(21)
] Ensure - To take all
reasonable and necessary steps to achieve results.
(22)
(23)
] Exploitation - An act
or process to use, either directly or indirectly, the labor or resources of
a client
/participant
for monetary or personal benefit, profit,
or gain of another individual or organization.
(24)
] Family - The
children,
parents, brothers, sisters, other relatives, foster parents,
guardians, or significant others who perform the roles and functions of family
members in the lives of clients/participants.
(25)
] Financial assistance
- A payment mechanism where payment is based on an approved line item budget.
(26)
] HIV - Human Immunodeficiency
Virus
, the virus that causes AIDS. Infection is determined through a
testing and counseling process overseen by the Texas Department of Health.
Being infected with HIV is not necessarily equated with having a diagnosis
of AIDS
.
(27)
] Intervention - A process
that utilizes multiple strategies designed interrupt the illegal use of alcohol,
tobacco and other drugs by youth and to break the cycle of harmful use of
legal substances and all use of illegal substances by adults in order to halt
the progression and escalation of use, abuse, and related problems. Intervention
strategies target indicated populations.
(28)
] Intervention counseling
-
Face-to-face interactions to assist
[
The process of assisting
] individuals, families, and groups to identify, understand, and resolve
issues and problems related to
ATOD use
[
substance abuse
]
within a specific number of sessions or within a certain time frame. It is
intended
[
in order
] to intervene in problem situations and
high risk behaviors [
associated with substance abuse
] which, if
not addressed, may escalate to substance abuse
or cause communicable
disease
[
severe impairment
].
(29)
] Life skills training
(treatment)
- A
structured
[
formalized
] program
of training, based upon a written
curriculum
[
program description
], to
help clients
[
assist the client in acquiring personal
habits, attitudes, values, and social interaction skills that will enable
the client to
]
manage daily responsibilities
[
function
] effectively and [
/or
] become gainfully employed. It
may include
[
includes
] instruction in communication
and social interaction
, stress management, problem solving, daily living,
and decision making.
(30)
] Neglect - Actions resulting
from inattention, disregard, carelessness, ignoring, or omission of reasonable
consideration that caused, or might have caused, physical or emotional injury
to a client
/participant
. Examples of neglect include, but are not
limited to, failure to provide adequate nutrition, clothing, or health care;
failure to provide a safe environment free from abuse; failure to maintain
adequate numbers of appropriately trained staff; failure to establish or carry
out an appropriate individualized treatment plan; and any other act or omission
classified as neglect by the Texas Family Code, §261.001.
(31)
] Offer - To make available.
(32)
] OMB - Office of Management
and Budget.
(33)
] Outcome - The impact
on the system or client/participant served.
(34)
] Prevention - A process
that utilizes multiple strategies designed to preclude the onset of the illegal
use of alcohol, tobacco and other drugs by youth. Prevention principles and
strategies foster the development of social and physical environments that
facilitate healthy, drug-free lifestyles. Prevention strategies target universal
and selected populations.
(35)
] Program - A [
system of service delivery consisting of a
] specific type of service
delivered to a specific population as identified in the proposal.
(36)
] Protective factors
-
Characteristics within individuals and social systems which may inoculate
or protect persons against risk factors and strengthen their determination
to reject or avoid substance abuse.
[
Those characteristics within
social systems, such as family, schools, peer groups, that foster resiliency
and include high expectations, caring and support, and the opportunity to
be involved.
]
(37)
] Provide - To perform
or deliver.
(38)
] Provider - A distinct
legal entity with an administrative and functional structure organized to
deliver substance abuse services.
(39)
] Qualified credentialed
counselor (QCC) - A licensed chemical dependency counselor or one of the professionals
listed below:
(40)
] Staff - Individuals
employed
[
hired directly
] by a provider to provide services
[
for the provider
] in exchange for money or other compensation.
(41)
] STDs - Sexually transmitted
diseases.
(42)
] Substance abuse - The
use of one or more drugs, including alcohol, which significantly and negatively
impacts one or more major areas of life functioning.
(43)
(44)
] Treatment (chemical
dependency) - A planned, structured, and organized program designed to initiate
and promote a person's chemical-free status or to maintain the person free
of illegal drugs.
It includes, but is not limited to, the application
of planned procedures to identify and change patterns of behavior related
to or resulting from chemical dependency that are maladaptive, destructive,
or injurious to health, or to restore appropriate levels of physical, psychological,
or social functioning lost due to chemical dependency.
(45)
] Unit cost - A payment
mechanism in which a specified rate of payment is made in exchange for a specified
unit of services.
Subchapter B. Contract Administration
The provider shall maintain employee bonding
for the executive director and the chief financial officer.
]
director
];
award amount expended
]
in matching funds.
Request ].
and
]
monthly
] cash advances must submit
the completed method of payment selection form to the commission.
(i)
(j)
electronic interface
] system. When equipment problems prevent
electronic submission, the provider shall fax or mail paper copies to the
commission. The provider's authorized official or designee specified in the
Electronic Forms Signature Agreement is responsible for the completeness and
accuracy of the data.
electronic
interface
] system.
treatment
] for inability to pay.
Remodeling
].
Work costing $5,000 or more which is required to change the interior arrangements
or other physical characteristics of an existing facility, or to install equipment
so that the facility may be used more effectively.
Minor remodeling shall
not exceed $10,000.
$1,000
], price or rate quotations are not required.
$1,000 and $5,000
]. Telephone and other verbal quotations
must be documented.
$5,000
].
rational
] for selection.
Subchapter C. Program Oversight Compliance Review ].
compliance
] with applicable federal, state and commission
statutes and regulations and contract requirements.
These include compliance
reviews, monitoring visits, and contract monitoring reviews.
,which shall be limited to services funded by the commission
].
inspection
] or request
the provider
to submit
materials for
desk
review.
Financial ] Audit Report .
(except for-profit entities)
] that
expend a total amount of federal awards (from the commission and other funding
sources) of at least $300,000 during their fiscal year must have a single
audit or program-specific audit in accordance with the requirements of the
Single Audit Act Amendments of 1996 and other governance guiding the program.
Providers
shall inform the commission in the contract if they expect to spend $300,000
or more in total federal awards from all funding sources.
]
Providers (including for-profit
entities) expending a total amount of state funds from the commission of at
least $300,000 during their fiscal year must have a program-specific audit
that meets the standards in OMB Circular A-133. If the provider is already
required to have a single audit because of federal funding, an additional
program audit is not required.
]
Providers that expend less than $300,000 in federal funds from all sources
and less than $300,000 in state funds during their fiscal year are not required
to have an audit.
]
and
]
the commission's contract(s), including any stipulations and amendments
]
; and
Audits of State and Local Governmental Units
];
Audits of Certain Not-for-Profit Organizations
];
Audits of Providers of Health Care Services
];
Audits of Voluntary Health Care and Welfare Organizations
];
[
or
]
Audits of Colleges and Universities.
]
an initial
] resolution letter requesting
a response to any administrative findings or deficiencies.
Subchapter D. Organizational
director
], reviewed annually, and
revised as needed.
Authority ].
authority
] that is legally responsible for the integrity of the fiscal
and programmatic management of the organization.
authority
] shall
be a separate business entity with legal authority to operate in the State
of Texas [
and shall not be a sole proprietor or partnership
].
director
], of a public or nonprofit entity shall
not serve on their employer's governing board.
authority
] shall
appoint a
chief executive officer
[
person
] to manage
the day-to-day operations of the organization and ensure that the organization
has the programmatic, managerial, and financial capability to ensure proper
planning, management, and delivery of funded services.
authority
] shall
meet at least quarterly and maintain minutes that include:
Members of the governing authority
shall receive training on cultural sensitivity and awareness.
]
(a)
(b)
]
The provider shall maintain
current personnel documentation on each employee. Training records may be
stored separately from the main personnel file, but shall be easily accessible
upon request. Required documentation includes, as applicable
[
Personnel files shall contain
]:
(c)
] The provider shall maintain
all records relating to the contract for at least three years from the date
the
independent financial
[
final
] audit [
report
] is due
(when required) or would have been due (when not required)
as stated in §144.214 of this title (relating to Independent Audit Report
Submission)
. If any litigation, audit, or other action is in process
at the end of three years, the records must be kept until the action is resolved.
If a provider closes business operations, it shall ensure that records relating
to the contract are securely stored and accessible for at least three years.
The provider shall provide the commission with the name and address of the
responsible party.
not discriminate
] against
an individual or group based on race, religion, ethnicity, country of origin,
age, disability (including mental illness), sexual orientation, or gender.
The provider shall also ensure that no person or group of persons is restricted
from receiving the same services or the same quality of services available
to others.
of funded programs
].
commission in writing
] within 24 hours, and submit
documentation within two working days. The provider shall investigate the
allegation, take appropriate action, and maintain documentation of the investigation
and resulting actions.
Subchapter E. Prevention and Intervention
The program design shall be based on a logical, conceptually
sound framework with the intended result of preventing alcohol, tobacco, and
other drug problems. The design should take into consideration current research
and evaluation data and effectiveness of comparable programs relative to the
needs of the target population.
]
The program shall develop a written plan for the contract period. The
plan shall initially be developed as part of the application process and revised
annually on the basis of needs data and results of self-evaluation.
]
The provider shall determine what population the program is designed
to serve: universal, selective, indicated, or a combination.
]
Universal programs
reach the general population (such as all students in a school).
]
Selective programs target a subset of the general population
which is at high risk for substance abuse (such as children of drug users).
]
Indicated programs are designed for
those who may already be experimenting with drugs or who exhibit other problem-related
behaviors.
]
The program
shall identify and describe the target population including specific information
about:
]
age, gender, and ethnicity;
]
risk and protective factors;
]
patterns of substance use;
]
(4)
(5)
(6)
The program
shall identify long-range goals which:
]
(1)
(2)
(3)
(4)
The program shall establish objectives for
each contract period that are linked to the goals. Objectives must:
]
be realistic, measurable, and time-specific; and
]
include
performance and activity measures required in the contract.
]
The program design shall include key strategies and activities
used to achieve program goals and objectives. Each strategy and activity must:
]
(1)
(2)
(3)
(4)
(A)
(B)
The program shall be designed to build on and
support related prevention and intervention efforts in the community. The
program shall establish linkages and coordinate with other community resources.
]
The program shall establish an annual staff
training plan for employees based on the program design and identified staff
needs. The plan must include cultural awareness and sensitivity training for
all employees.
]
Programs required to complete the self-evaluation include
Prevention, Intervention, Core Council Services, HIV Outreach Services, Infant
Primary Prevention and Intervention Programs, and Compulsive Gambling.
]
Programs shall
conduct evaluation activities using the Prevention Plus III format unless
the commission has approved an alternative model.
]
For programs in the first year of funding from the commission,
the evaluation process must include:
]
a plan for assessment of the program
outcomes (plan for PP III Step 3).
]
In subsequent funding years,
the evaluation must include:
]
(1)
(2)
(3)
The program shall submit a written evaluation
report using the format specified by the commission. The provider must submit
the report at the end of each contract period, no later than September 30th
unless otherwise stipulated in the contract.
]
(g)
population
] and the services
provided. The program must maintain adequate documentation to substantiate
the reported numbers.
at least twice each fiscal year
] and notify the program
in writing if the program failed to achieve the expected level of performance.
(e)
(1)
(2)
(3)
(4)
(5)
Participants
in an intervention program also have the right to:
]
a humane
environment that provides reasonable protection from harm
];
be informed
of the program rules and regulations before participation; and
]
accept or refuse
services after being informed of services and responsibilities.
]
When participants receive individualized services in an intervention
program, the provider shall inform participants and consenters (if applicable)
about:
]
(1)
(2)
(3)
(e)
to individuals over the age of nine
] shall disseminate
information about
these topics as appropriate for the target population
:
and
]
Documentation
] shall include, as applicable:
; and
]
(6)
where information is exchanged
] between the leader and the participants.
based on
] a written, time-specific curriculum
which is based
on proven, effective principles
[
or outline approved by the commission
].
Alternative Activities ].
help participants master
]
new skills [
and develop relationships
] ; [
and
]
offset attraction to and fill needs met by alcohol, tobacco, and other
drug use.
]
Activities must be selected to meet the identified needs of the participants
].
and HIV risk factors, as deemed appropriate
].
The screening shall
also identify STD/HIV risk factors as appropriate.
name and address
]
of the individual screened;
referrals made; and
]
any follow-up contacts
]
; and
Prevention programs implementing community-based process shall meet
the following standards.
]
(1)
(2)
(3)
(4)
(5)
(A)
(B)
(C)
(D)
(6)
(A)
(B)
(C)
(D)
(E)
Additional ] Services.
additional
] services to meet the needs of individual participants
who do not meet DSM-IV criteria for abuse or dependence, but are showing early
warning signs of substance abuse and other problem behaviors associated with
substance abuse. Family members may also be involved in intervention services
[
and their families, such as intervention counseling, crisis intervention,
family case management, and support group opportunities.
]
(1)
(2)
(3)
(4)
Subchapter F. Treatment
The design should take into consideration current
research and evaluation data and effectiveness of comparable programs relative
to the needs of the target population.
]
, and then use the data and results
to make appropriate program adjustments
].
The program shall use
this system to revise the program plan and make appropriate program adjustments.
Any change requiring commission approval must be made through a contract amendment
as described in §144.103 of this title (relating to Amendments).
evaluate progress, develop
and take corrective actions, and monitor and evaluate the results of corrective
actions taken.
]
evaluated progress
];
corrective actions taken
]; and
Commission funds may be used
to provide treatment for any adolescent client, regardless of ability to pay.
]
The program shall implement procedures
to identify members of priority populations and admit them before all others.
] The commission has established
six priority populations. Preference
shall be given in
the following priority order:
all other substance abusers
].
for
] eligible individuals
who have been screened but cannot be treated immediately.
(d)
] Capacity management may be
handled through a centralized intake system.
described in the applicable manual
].
make every effort to
] place the individual in another treatment facility or provide
reasonable
access to interim services.
:
]
provide information and education
] about the effects of alcohol and drug use on the fetus and referrals
for prenatal care.
Screening
and Assessment
].
Clients
receiving treatment services shall have a presenting problem which meets the
appropriate DSM-IV criteria as specified in Chapter 148 of this title (relating
to Facility Licensure).
]
The screening shall include a criteria-based evaluation to determine
the appropriate level of service.
]
The psychosocial
history and assessment for an adolescent shall take developmental issues into
account and shall address child welfare involvement, peer relationships, and
gang involvement
].
The
]
program shall [
provide education and shall
] assess each
applicant's
[
client's
] risk for HIV infection, tuberculosis, and
other
sexually transmitted diseases.
Risk assessments shall follow
guidelines as set by the National Institute on Drug Abuse's "Preventing HIV
Among Substance Abusers: Risk Assessment/Risk Reduction."
family
] as a unit and therefore admit both females
and their children into treatment, when appropriate and possible.
may
] address issues
of relationships, sexual and physical abuse and parenting;
,
which may address their developmental needs, their potential for substance
abuse, and their issues of sexual and physical abuse and neglect
]; and
inform relevant entities in their communities that the specialized female
program is available
].
and annual goals
] for the women's
children when the children receive prevention and/or intervention services.
Food and Drug Administration
] and includes the following phases:
at least
] four individual counseling sessions.
If not, justification shall be documented in the client record.
at least
] two individualized counseling sessions
monthly.
Justification shall be documented in the client record each
month this standard is not met.
Family services supplement
an existing treatment program by providing services to the family of the primary
client. Commission funds shall not be used to provide services available through
other sources.
]
problems
] associated with the client's chemical
dependency, improve the health and functioning of the family unit and/or to
assist individual family members to
support the client in achieving and
maintaining a
achieve healthy, drug-free life
style
[
styles
].
may be
] provided
to the entire family,
including older adults,
individual family
members,
and/
or a subset of family members.
Reimbursable family
[
Family
] services include:
evaluations
];
and
]
(4)
] structured, curriculum-based
education and/or skills training accompanied by group process.
function
]. Qualifications shall be based on industry standards
and applicable licensure requirements. LCDCs may provide family education,
assessment, and counseling services for issues that are directly related to
substance abuse
treatment and prevention
within the family (including
the development of healthy
family
behavior patterns), commensurate
with the individual's training and experience. However, clients and/or family
members in need of
therapy
[
counseling
] on issues outside
the LCDC's scope of professional practice must be referred to a qualified
mental health professional such as an
LMSW (Licensed Master Social Worker),
LMFT (Licensed Marriage and Family Therapist), LPC (Licensed Professional
Counselor) or LPA (Licensed Psychological Associate)
[
LPC, LMFT,
or LMSW
].
a separate
section of
] the client record. The
record
[
file
]
must include the elements listed.
evaluation
]. The
assessment
[
evaluation
] must be conducted
by a
licensed and qualified
[
properly credentialed
]
professional
based upon education and training
.
which
] must include:
during the evaluation
];
that address identified needs and state in behavioral
terms what the family is expected to achieve during the treatment period
];
to help
] the family
to
achieve
the agreed
upon
[
identified
] goals
; and
[
.
]
and describe
the family's progress towards stated goals
]. The
provider
[
family therapist
] shall document each service contact in a signed
progress note that includes:
The discharge
plan
] shall address ongoing family needs
and support activities.
The family shall receive a copy of the discharge plan
, including:
and
]
, if applicable.
]
with
targets at least twice each fiscal year
] and notify the program in writing
if the program failed to achieve the expected level of performance.
the
] planned duration of
stay
[
the program
]
and
individualized
treatment plan objectives. This means that the
average of subparagraphs (A) and (B) of this paragraph must equal or exceed
75%.
In programs with a variable length
of stay, the planned duration of stay documented in the most recent treatment
plan is used as a basis for calculation.
]
fully or partially
] with commission funds.
(f)
] Forms submitted to the commission
must contain complete and valid information.
(g)
] The commission will not accept
or process payment requests until corresponding
Client Data System
[
Client Oriented Data Acquisition Process (CODAP)
] Admission forms
have been submitted [
and all errors identified through the electronic
interface system's edit checks have been corrected
].
(h)
] The provider shall maintain
complete documentation for all services paid for by commission funds. In addition
to the items required by licensure rules, the client record shall include
the following information:
CODAP Reports
].
Client Oriented Data Acquisition Process (CODAP) reports
] to the
commission
through the commission's web-based computer system for
[
on
] all clients receiving commission-funded substance abuse treatment
services.
CDS forms include Adult and Youth Admission Reports (AARs/YARs),
Adult and Youth Discharge Reports (ADRs/YDRs), Adult and Youth Follow-up Reports
(AFRs/YFRs), Detox Brief Follow-up Report (DBFR), and a CDS Facility Summary
(CFS).
CODAP
] Reference and Instruction Manual.
Any changes to instructions that are mailed to treatment programs from the
commission prior to revising the
CDS Reference and Instruction Manual
[
CODAP manual
] will supersede the instructions in the current
CDS Reference and Instruction Manual
[
CODAP manual
].
General Treatment Services
].
The program shall, to the extent possible and appropriate
]:
education about dysfunctional relationships within
the
] family
education and counseling related to the client's substance
abuse
;
coping
] skills training;
and
]
16
] clients.
multifamily groups,
] and other groups are limited to a maximum of 32
clients. This limitation does not apply to seminars, outside speakers, or
other events designed for a large audience.
links
] with available substance abuse and other mental
health, health care, and social services to meet the needs of clients and
family members. Agreements to coordinate services must be established in writing
and renewed annually,
and shall include:
Subchapter G. Network Management Organizations (NMOs)
Chapter 148.
Facility Licensure
A facility shall have written approval from the commission before accepting
court commitments.
]
(or category of court commitment approval)
] may provide that service at any of its
approved
[
licensed
] sites or through registered extension
sites
[
services
].
and compensating
] interns to perform counseling, assessments, or treatment interventions.
deactivated
].
After a six-month waiting period, the
[
The
]
applicant may
reapply by submitting a new application and application
fee
[
reactivate the application by informing the commission in
writing, but the application will be treated as a new application
].
commission
] advance notice of any proposed change in a
program's licensure status and submit the appropriate application and fees.
Notice of less than 60 days may delay approval.
commission
] in writing within 30 days after a
change in the organization's name or the client gender(s) being served.
commission
] at least 60 days before a change
in ownership takes effect.
commission
] within
ten days of the change in ownership.
commission
]
of closure does not excuse a licensee from paying fees.
Any
] facility in which services
are suspended for more than 30 days
unless the facility sends a written
request for inactive status
[
shall notify the commission with a
letter
] justifying why the commission should not retire the license.
To be eligible for inactive status, the facility must be in good standing
with no pending sanctions or investigations.
expires
] at the end of
the six month period.
commission
] in writing within 30 days
when it closes a chemical dependency treatment program.
commission
] within 30 days.
licensed
] site.
services
]--
Structured services provided after discharge from a treatment facility which
are designed to strengthen and support the client's recovery and prevent relapse.
[
Services provided by a facility to a client who has been discharged
and is no longer receiving services from any of that facility's treatment
programs.
] Aftercare may be provided by the facility directly or through
a letter of agreement with another provider.
If the program provides
two or more hours of services per week, it must be licensed as an outpatient
program.
gain sufficient information to identify, among other things,
]
the participant's strengths, problems, and needs
in order to develop
an appropriate plan for treatment
[
as they relate to the use/abuse
of alcohol and/or other drugs and the risk of contracting or transmitting
infectious diseases/sexually transmitted diseases
].
The abuse of, psychological or physical dependence
on, or addiction to alcohol, a toxic inhalant, or any substance designated
as a controlled substance in the Texas Controlled Substances Act.
]
between clients and counselors to help clients
] identify,
understand, and resolve issues and problems related to chemical dependency.
working under direct supervision
].
supervise a counselor intern who performs counseling, assessments, or
interventions.
]
13-
]16 years
of age admitting themselves for chemical dependency counseling under the provisions
of the
Texas
Family Code, §32.004.
a registered
] clinical training institution who has been designated as a counselor
intern by the institution. The activities of a counselor intern shall be performed
under the direct supervision of a qualified credentialed counselor.
product
] at least weekly
during
the first 1000 hours, monthly during the second 1000 hours, and quarterly
during the final 2000 hours
;
and document the observation
];
and
weekly
] to provide
written and verbal feedback and direction.
The time when a client leaves a facility and
will no longer be receiving chemical dependency treatment from that facility.
]
Skills Training
]--A formalized program of training provided by qualified
staff (not clients), based upon a written
curriculum
[
program
description
], to
help clients
[
assist the client in
acquiring personal habits, attitudes, values, and social interaction skills
that will enable the client to
]
manage daily responsibilities
[
function
] effectively and[
/or
] become gainfully employed.
It
may include
[
includes
] instruction in communication
and social interaction
, stress management, problem solving, daily living,
and decision making.
Physical symptoms requiring immediate medical attention to prevent
]death or
serious
[
imminent
] harm.
sleep overnight
].
Subchapter B. Facility Management
an
] executive
officer
[
director
];
Director
].
director
]
is responsible for the day-to-day operations of the facility and is accountable
to the facility's governing body. The
chief
executive
officer
[
director
] shall:
demonstrate competence
] in financial
, administrative,
and personnel management, and other areas needed to manage the facility effectively;
and
]
(4)
] maintain adequate financial
records according to generally accepted accounting principles. Financial records
shall include:
director
] shall use the policies to develop and implement all
needed procedures.
The
] facility shall inform staff about any changes to the
policy and procedure manual that are relevant to their job duties
and
[
,
] document the notification[
, and provide training
as needed
].
If training is needed, it shall be provided and documented
within 60 days.
(d)
] The facility shall have written
policies on staff conduct and reporting procedures that comply with this section.
before working without
immediate supervision.
]
that
] includes,
if
[
as
] applicable:
verification of current credentials
];
written supervisory approval to provide treatment
services independently
];
trainees and
] interns;
for in-service training
] shall include:
content
];
and qualifications
];
and
; and
]
(d)
] Personnel files shall be kept
for at least two years after the individual stops working at the facility.
Documentation of training required in §148.118 of this title (relating
to Training Requirements Relating to Abuse, Neglect, and Unprofessional or
Unethical Conduct) must be kept for at least five years.
trainees and
]
interns shall work under the direct supervision of a qualified credential
counselor
as required in Chapter 150 of this title (relating to Counselor
Licensure)
.
providing
] group or individual counseling focused on trauma, abuse, or sexual
issues
unless they are licensed and
[
shall
] have specialized
education
/training
and
supervised experience in the subject.
Required
training
must be
[
which is
] defined in
writing by the program
and documented in the individual's personnel file
.
Staff
] included
in staff-to-client ratios shall not have job duties that
prevent ongoing
and consistent
[
interfere with effective
] client supervision.
compensate
] a counselor
intern for performing counseling, assessments, or treatment interventions
unless the facility is registered with the commission as a clinical training
institution as required in §150.72 of this title (relating to Clinical
Training Institutions).
Staff shall have all required training before performing
job duties independently. Training must be completed within 90 days from the
date of hire. Unless otherwise specified, training in the following topics
is required only once.
]
annually
] provide
face-to-face
[
staff who have any client contact with at least eight
hours of approved
] training in issues relating to abuse, neglect, exploitation,
illegal, unprofessional, and unethical conduct
to all staff who have
any client contact
.
HIV
] training
related to tuberculosis,
HIV, Hepatitis C, and other sexually transmitted diseases during the first
90 days of employment
[
based on the commission's AIDS/HIV Model
Workplace Guidelines
].
(f)
] All direct care employees
in residential programs shall have current certification in CPR
within
90 days of hire
.
(g)
] All direct care employees
shall have
at least four hours of face-to-face
training [
and competency
] in nonviolent crisis intervention
during the first
90 days of employment, with two additional hours every subsequent year.
(h)
] All direct care employees
working in programs that use special treatment procedures shall have
face-to-face
training and competency in the safe methods of the specific
procedures used
within 90 days of hire. This includes all direct care
staff working in adolescent programs, detoxification programs, or programs
that accept emergency detentions. The training must last approximately four
hours and must include hands-on practice under the supervision of a qualified
instructor. It is required one time only.
(j)
] Each employee who conducts
intakes or
assesses applicants for admission
[
screenings
]
shall complete eight hours of training in the program's intake and
admission
determination
[
screening
] procedures annually. [
An employee
shall not conduct screening or intake unless training is complete and current.
]
(k)
] All direct care employees
working in detoxification programs shall complete detoxification training
during the first 90 days of employment. The training is required one time
only and
[
which
] shall:
and
]
(l)
] All programs that admit females
of child-bearing age shall have at least one staff person with documented
knowledge of pregnant substance-abusing females and their care. When a pregnant
female is admitted, all members of the treatment team shall receive information
needed to provide appropriate care.
(m)
] All employees responsible
for supervising clients in self-administration of medication who are not credentialed
to administer medication shall complete
at least two hours of
documented
training from a physician, pharmacist, physician assistant, or registered
nurse before performing this task. The training
is required one time
and must be completed during the first 90 days of employment. It
shall
include:
Subchapter C. Client Management
licensed
] site.
to your doctor
], and
the program director
[
your doctor
] must document the date, time and outcome of
the conversation in your
client
[
medical
] record.
If the person who admitted you to the facility does not want you to leave
the facility and says so in writing, you must remain in treatment.
director
] or designee.
If the allegation involves the chief
executive officer, it shall be reported directly to the facility's governing
body or the commission's investigations department.
director
] shall also
comply with reporting requirements listed in the Civil Practice and Remedies
Code, §81.006.
director
] shall take immediate action to prevent or stop the abuse,
neglect, or exploitation and provide appropriate care and treatment.
director
] or designee shall make a verbal report to the
commission's
investigations department
[
commission
]
immediately but
no later than
[
within
] 24 hours. This is in addition to the
reports specified in the Texas Human Resources Code, §48.082 and the
Texas Family Code, §261.001.
director
] within 24 hours.
director
] shall send a written report to the
commission's investigations
department
[
commission
] within two working days after receiving
notification of the incident. This report shall include:
director
] or designee shall also notify the legal consenter. If the
client is the legal consenter, family members and significant others may be
notified only if the client gives written consent.
commission
].
authority
] or
its designee shall take action needed to prevent any confirmed incident from
recurring.
be signed and dated
]. If
the document relates to past activity, the date of the activity shall also
be recorded.
Signature stamps are not acceptable.
or day treatment
] program.
director
] shall report these incidents to the
commission's investigations
department
[
commission in writing
] within 72 hours of discovery:
director
] shall report all incidents of alleged client abuse, neglect,
and exploitation to the
commission's investigations department
[
commission
] as described in §148.161 of this title (relating
to Client Abuse, Neglect, and Exploitation).
director
] or designee shall review all incident reports
to:
director
] or designee shall:
one hour
]. At the end of
twenty minutes
[
one hour
], staff shall implement the facility's
psychiatric emergency procedures.
residential or day treatment
] program without permission.
The procedure shall include:
Subchapter D. Program Services
a
] written
program description referenced in §148.73
of this title (relating to Policies, Procedures, and Licensure Rules). The
program shall maintain
plan [
which includes
] a service schedule
listing services provided and timeframes in which they are provided.
Every residential client shall have a medical history and physical
examination that is signed by a physician, physician assistant, or advanced
nurse practitioner.
]
outline
] that identifies lecture topics and major
points to be discussed.
All educational sessions shall include opportunities
for client participation and discussion.
HIV
] education
about tuberculosis, HIV, Hepatitis C, and other sexually transmitted diseases
based on the
Texas Commission on Alcohol
and Drug Abuse Workplace and Education Guidelines for HIV and Other Communicable
Diseases
[
Model Workplace Guidelines developed by the Texas
Department of Health
].
refer clients
] to
physical
health,
mental health, and ancillary services necessary to meet treatment goals and
conduct follow-up. Residential programs shall ensure clients have access to
appropriate
physical
[
health care
] and mental health
services.
and
]
(1)
(2)
on site
]
24 hours a day.
staff
] 24 hours a day.
(2)
] treatment protocol or
standing orders for each
major drug category
[
chemical the
program is prepared to detoxify
]; and
(3)
] emergency procedures.
use written procedures
] to encourage clients to seek appropriate
treatment after detoxification.
bedroom areas
] and bathrooms for adults
and adolescents and for males and females. The facility shall have adequate
barriers to divide the populations.
Providers shall observe legal or other statutory
laws which define the adult population to be served when it is different from
the commission's definition.
]
in the emotional,
mental health, and chemical dependency problems of adolescents and appropriate
treatment for them
].
The program shall involve the adolescent's family or an alternate
support system in the treatment process or document why this is not happening.
]
and
]
universal
] precautions;
infant
] CPR
certification and at least eight hours of training in:
universal
] precautions;
approved by the fire marshal
].
§148.232 of this
title (relating to Parents and Their Dependent Children).
]
universal
] precautions when caring for children other than
their own.
The provider shall not provide treatment at a school
or other site which is prohibited by law.
]
adopt
]
written procedures describing the handling, administration,
documentation,
disposal, inventory, and use of medication. This includes procedures
for handling medication errors and adverse reactions.
Medication
]
shall be used only for therapeutic and medical purposes and shall [
not
] be administered [
except
] as prescribed
by the appropriately
licensed professional
[
or directed
].
Medications
], syringes, and needles shall be accessible only to
staff who are authorized to provide medication.
This does not include
vitamins and mineral supplements.
non-prescription
] medications, syringes, and needles in
locked storage unless a client is authorized to keep the medication in his
or her possession. Used needles and syringes shall be placed in rigid, puncture-proof
containers.
or non-prescription
] medication in their personal possession on site without specific
written
authorization
filed in the client record
from a physician
or from a licensed dentist, podiatrist,
[
or a properly authorized
] physician assistant or advanced practice nurse
practicing within
licensure requirements. Clients may not keep over-the-counter medication in
their personal possession on site without specific written authorization filed
in the client record from the supervising health care professional or program
director.
Staff shall ensure that authorized clients keep medication
on their persons or safely stored and inaccessible to other clients.
properly labeled
] container
labeled by the pharmacy
. [
If clients are required to take medication with them off site,
the medication must be in an appropriate container with an appropriate label.
]
monthly
].
documentation of
] the following
information about each container of prescription medication:
monthly
] reconciliation
between the administration record and the inventory.
and
]
or an authorized
] physician assistant or advanced
practice nurse
(prescribing within licensure limitations)
.
physician, physician assistant, or advanced practice nurse
].
Prescription ] Medication.
Licensed health professionals
shall administer
] and discontinue medication exactly as ordered.
Licensed health professionals
shall document each dose administered
] in the client's
medication
record.
administration
] record shall
include:
administered
]; and
a medication error is identified or
] a
client appears to have an adverse reaction to medication, a licensed health
professional or other staff member shall:
a
] physician
, dentist, podiatrist,
[
or an authorized
] physician assistant or advanced practice nurse
(preferably the
prescribing professional) within a reasonable amount of time based on the
medication and client status
;
and the physician (or physician
assistant or advanced practice nurse) contact
] in the client record
, including the date and time of notification and any other related action
taken
.
be
]:
medically stable;
and
]
able to participate
]
in treatment.
The direct care staff-to-client ratio shall
be at least 1:16 during:
]
the
hours clients are awake in residential programs; and
]
all hours of operation in outpatient programs.
]
Each residential client shall
have an opportunity to participate in physical recreation at least weekly.
]
medically stable;
and
]
able to function
with limited supervision and support
].
The direct care staff-to-client ratio shall
be at least 1:16 during:
]
the
hours clients are awake in residential programs; and
]
all hours of operation in outpatient programs
].
five
] individual service days of admission.
seven
] individual service days of admission.
medically stable;
and
]
able to function
with minimal supervision and support
].
1:16
] during the hours
clients are awake
and at least 1:32 when clients are sleeping. Night
staff shall conduct hourly checks while clients are sleeping.
[
At least one staff person shall be on site and accessible to clients during
sleeping hours.
]
within:
]
:
]
Subchapter E. Treatment Process
Screening
].
screening shall be conducted by a chemical dependency counselor
]. If a counselor intern
assesses the applicant
[
conducts
the screening
], the intern shall consult with a qualified credentialed
counselor who authorizes
the
admission
and signs the admission
form
.
screening shall be done
] by a licensed health professional.
Non-physicians shall have at least one year of detoxification treatment experience.
do the screening
]
with consultation from a licensed health professional who authorizes the admission
and signs the admission form.
and supported living
] detoxification
programs, a physician, physician assistant, or advanced practice nurse shall
examine the
applicant
[
client
] face-to-face, authorize
the admission, and sign the admission form.
clients
] found to be ineligible or inappropriate
for admission. The documentation shall include the reason the individual was
not admitted and where the individual was referred.
initiated within
24 hours of admission, and
] completed and filed in the client record
within
24
[
72
] hours of admission. If an emergency or
the client's physical condition prevents documentation within 24 hours, staff
shall explain the circumstances in the client record and obtain the information
as soon as possible.
A
] medical
history and physical examination
signed by a physician, physician assistant,
or advanced nurse practitioner.
[
shall be completed and filed in
the client record within 24 hours of admission. A medical history and physical
examination completed during the 24 hours preceding admission may be substituted
if it is approved by the program's physician, physician assistant, or advanced
practice nurse.
]
Stabilization
] Plan.
This may be done by filing a copy of the program schedule in the client record
and documenting the client's level of participation.
]
, including
]:
and social history
];
(8)
] education
(including
school functioning and peer relationships)
and vocational training;
(9)
] employment history (including
military) and current status;
(10)
] legal history and current
legal status;
(11)
] emotional state and
behavioral functioning, past and present; and
(12)
] strengths, weaknesses,
and needs.
evaluation
], but a counselor shall review and discuss the questionnaire with the
client and document the discussion[
, including additional information
needed to provide a clear and comprehensive psychosocial history
].
The client questionnaire shall not take the place of the psychosocial history
and assessment.
The facility may use a medical
history and physical examination completed up to 30 days before admission
or received from the referring facility. If the examination was completed
more than 96 hours before admission, a licensed health professional must review
the information with the client and documents an update within 96 hours of
admission.
]
When the update reflects a significant change
in the client's status, the client shall receive further evaluation from a
physician, physician assistant, or advanced practice nurse.
]
a
] written treatment plan that addresses
identified problems and needs.
Family members shall participate in the
treatment planning process, or the counselor shall document why they did not
participate.
[
When possible and appropriate, family members and
significant others should also participate.
]
The program shall involve the client's family
or an alternate support system in the treatment process or document why this
is not happening.
]
state
] in behavioral terms what the client is expected
to achieve during treatment.
This may be done by filing a copy of the program schedule
in the client record and documenting the client's level of participation in
the progress notes.
] The record shall include individual documentation
of all group services [
if the schedule of services is not followed
].
occur
] before the client's scheduled discharge.
and
]
Subchapter F. Physical Plant
counseling
]
space
for counseling, assessments, and other confidential interactions
. Staff shall not office in space needed for other activities
,
and partitions are not acceptable for creating private space
.
The facility shall prohibit firearms
and double-edged, fixed-blade knives on the site.
]
:
]
Chapter 149.
Court Commitments