Part 1.
TEXAS DEPARTMENT OF HEALTH
Chapter 37.
MATERNAL AND INFANT HEALTH SERVICES
Subchapter H. SUDDEN INFANT DEATH SYNDROME
25 TAC §§37.171 - 37.173
The Texas Department of Health (department) adopts new §§37.171
- 37.173 concerning sudden infant death syndrome (SIDS) and reimbursement
to counties for autopsies performed upon children younger than 12 months of
age for whom SIDS is the primary cause of death. Sections 37.171 and 37.172
are adopted with changes to the proposed text as published in the December
3, 1999, issue of the
Texas Register
(24 TexReg
10714). Section 37.173 is adopted without change, and therefore will not be
republished.
Family Code, Chapter 264, requires that the medical examiner or justice
of the peace of a county in which a child younger than six years of age dies
must hold an inquest to determine whether the death was unexpected or the
result of abuse or neglect. The investigation must include an autopsy. Health
and Safety Code, §673.002, as amended by the 76th Legislature, requires
the department to define SIDS and to reimburse counties $500 for the cost
of autopsies performed upon children younger than 12 months of age, if the
primary cause of death is SIDS. Reimbursement by the department is subject
to the availability of funds.
The following comments were received concerning the proposed sections.
Following each comment is the department's response and any resulting change(s).
Comment: Concerning the subchapter as a whole, one commentor stated that
the use of undefined elements of medical history and death scene investigation
provides a financial disincentive to find a cause of death other than SIDS,
such as a vaccine reaction, because no payment is available for any diagnosis
other than SIDS.
Response: The department disagrees that the law or proposed rules provide
an incentive to determine that SIDS is the cause of death. The department
makes a $500 payment directly to the county which is responsible for conducting
the autopsy, not to the physician who performs the autopsy and makes a diagnosis
based on the criteria stated in the definition. The physician who conducts
the autopsy remains professionally and legally responsible for the diagnosis
whether or not the county is reimbursed by the department. No change was made
as a result of this comment.
Comment: Concerning the subchapter as a whole, one commentor stated that
SIDS is not really a diagnosis, but is often used when insufficient effort
or and testing results in failure to isolate a cause of death.
Response: SIDS is a recognized diagnosis of exclusion. Although research
continues, the cause of death for some infants simply cannot be established.
The county may be reimbursed for the cost of an autopsy only if the primary
cause of death is SIDS, and all other known causes of death have been ruled
out through the medical history, death scene investigation, and a complete
autopsy. The physician must determine whether a particular event or condition
was the primary cause of death or was merely coincidental with the death,
utilizing all three sources of information. No change made as a result of
this comment.
Comment: Concerning the subchapter as a whole, one commentor stated "those
who make the reports have no clear directives or incentive to implicate a
vaccine as a contributing factor."
Response: The department does not believe the legislature intended to provide
an incentive for declaring SIDS, vaccines, or any other factor to be the primary
cause of an infant's death. A physician's determination that SIDS is the primary
cause of death of a child younger than 12 months of age should be based on
the recognized criteria, and all relevant information should be considered
when making any diagnosis. No change was made as a result of this comment.
Comment: Concerning §37.171, one commentor stated that the phrase
"children 12 months old or younger" in the proposed rules would include children
who are 12 months and 29 days old. Since children over one year of age would
not be considered infants, the commentor recommends that the age criterion
be changed to "children younger than 12 months of age".
Response: The department agrees and has amended the section accordingly.
Comment: Concerning §37.172, one commentor stated that the lack of
definitions for the terms "death scene investigation" and "medical history"
could financially reward those who fail to determine the actual cause of a
child's death due to lack of effort.
Response: The department has no authority to review the professional competence
of physicians or the activities of law enforcement officials when they seek
to determine the cause of death of children under 12 months of age. Health
and Safety Code §673.002 establishes only a reimbursement mechanism for
autopsies, if the primary cause of death is found to be SIDS. Although the
physician responsible for the diagnosis should be familiar with the information
concerning death scene investigation contained in "Morbidity and Mortality
Weekly Report" (Volume 45, No. RR-10, June 21, 1996) published by the Centers
for Disease Control and Prevention, the law does not require the department
to adopt rules which mandate the elements of a death scene investigation.
The department will continue to work with all county judges and with medical
examiners and other pathologists to provide educational material concerning
information which should be obtained from a medical history and during a death
scene investigation. No change was made as a result of this comment.
Comment: Concerning §37.172(1), one commentor stated that the procedures
used by different physicians for a "complete autopsy" may vary. The commentor
suggested that "autopsy" should be defined as "a post mortem examination of
the body a of a person, including X-ray and an examination of the internal
organs and structures after dissection, including gross and histologic examination
and other laboratory studies as indicated, to determine the cause of death
or the nature of any pathological changes that may have contributed to the
death."
Response: The proposed definition of "autopsy" is the same as that in the
Code of Criminal Procedure, Article 49.01(1), and certainly would not preclude
any physician from obtaining some or all the additional evidence specified
by the commentor as the basis for a determination of the cause of death of
a child younger than 12 months of age. No change was made as a result of this
comment.
Comment: Concerning §37.172(4), one commentor stated that the child's
social history, including but not limited to the Child Protective Services
family history, is vitally important to the final determination of the cause
of death. The commentor suggested that SIDS be defined as "death of an infant
which remains unexplained after all known caused have been ruled out through
a complete autopsy, death scene investigation and medical and social history
including but not limited to Child Protective Services family history of the
infant."
Response: The department acknowledges the importance of a complete and
accurate history in determining the cause of an infant's death. The department
agrees with the commentor's suggestion and has amended the section accordingly.
The comments on the proposed rules received by the department were submitted
by the Texas Child Fatality Review Team State Committee and by Parents Requesting
Open Vaccine Education. The comments were neither for nor against the rules
in their entirety; however, they raised questions, offered comments for clarification
purposes, and suggested clarifying language concerning specific provisions
in the rules.
The new sections are adopted under the Health and Safety Code, §673.002,
which requires the department to adopt rules defining SIDS and establishing
a method for obtaining reimbursement for the cost of autopsies for children
younger than 12 months of age whose primary cause of death is SIDS; and §12.001,
which provides the Texas Board of Health with the authority to adopt rules
for the performance of every duty imposed by law on the board, the department,
and the commissioner of health.
§37.171.Purpose.
The purpose of these sections is to define sudden infant death syndrome
(SIDS) and to establish a payment mechanism for autopsies for children younger
than 12 months of age who die unexpectedly and whose primary cause of death
is SIDS.
§37.172.Definitions.
The following words and terms pertain explicitly to this subchapter
and shall have the following meanings, unless the context clearly indicates
otherwise.
(1)
Autopsy - A post mortem examination of the body of a person,
including X-rays and an examination of the internal organs and structures
after dissection, to determine the cause of death or the nature of any pathological
changes that may have contributed to the death.
(2)
Infant - A child who is younger than 12 months of
age.
(3)
Parent - A natural parent, step parent, adoptive parent,
legal guardian, or other legal custodian of a child.
(4)
Sudden infant death syndrome (SIDS) - Death of an
infant which remains unexplained after all known causes have been ruled out
through a complete autopsy, death scene investigation, and medical and social
history including, but not limited to, Child Protective Services family history
of the infant.
This agency hereby certifies that the adoption has been
reviewed by legal counsel and found to be a valid exercise of the agency's
legal authority.
Filed with the Office of
the Secretary of State on April 3, 2000.
TRD-200002397
Susan K. Steeg
General Counsel
Texas Department of Health
Effective date: April 23, 2000
Proposal publication date: December 3, 1999
For further information, please call: 458-7236
The Texas Department of Health (department) adopts the repeal of §§229.401
- 229.412 and new §§229.401 - 229.412 concerning the licensing of
tattoo and certain body piercing studios. New §§229.403, 229.407
and 229.408 are adopted with changes to the proposed text as published in
the December 3, 1999, issue of the
Texas Register
(24 TexReg 10736). The repeal of §§229.401 - 229.412 and
new §§229.401 - 229.402, 229.404 - 229.406, and 229.409 - 229.412
are adopted without changes and therefore those sections will not be republished.
Specifically, the new sections cover general provisions; definitions; licensing
fees, procedures, and exemptions; physical facilities; personnel responsibilities;
client qualifications, disclosure, and records; sterilization; care of the
new tattoo and body piercing; tattooing and body piercing instruments and
jewelry; report of infection or allergic reactions; disposal of infectious
waste; and refusal, revocation, or suspension of license and enforcement provisions.
The new sections contain new language and incorporate language that were
previously located in §§229.401 - 229.412, which have been repealed.
Sections 229.401 - 229.412 have been repealed for the purpose of reorganization
and implementing Senate Bills (SB) 61 and 932 which were enacted during the
76th Texas Legislature, Regular Session, 1999. The new sections clarify existing
requirements for tattoo studios and includes new language for certain body
piercing studios. The new sections establish new licensure fees for certain
body piercing studios and clarify existing licensure requirements for tattoo
studios. The new sections provide for standards of sterilization, sanitation,
record keeping, and aseptic technique. In addition, the new sections address
requirements for those persons under the age of 18 wishing to receive a tattoo
or body piercing. Finally, the new sections clarify the department's inspection
authority and enforcement options available under Health and Safety Code,
Chapter 146, (Tattoo and Certain Body Piercing Studios), and Chapter 431,
(Texas Food, Drug, and Cosmetic Act).
The following comments were received by the department concerning the proposed
sections. Following each comment is the department's response and any resulting
change(s).
Comment: Concerning §229.408(c)(1), one commenter stated that antibacterial
or antimicrobial soaps can both be used to cleanse the area.
Response: The department agrees that this was the intent of the regulation
and has added "or antimirobial" to §229.408(c)(1) to clarify that intent.
Comment: Concerning §§229.401 - 229.412, one commenter commended
the department on comprehensive rules which will protect the public health.
Response: The department agrees with the commenter. No change was made
as a result of this comment.
Comment: Concerning §229.405(c), two commenters stated that body piercing
artists should wear sterile surgical gloves rather than single-service examination
gloves.
Response: The department disagrees with the two commenters because the
use of single- service medical examination gloves is used universally throughout
the medical and tattoo industry for these types of procedures or operations.
No change was made as a result of this comment.
Comment: Concerning §229.405(i), one commenter stated that the department
should require each artist performing body piercing procedures to receive
mandatory, certified training in the prevention of the transmission in blood
borne pathogens as well as having a four-year degree in a medical field.
Response: The department disagrees with the commenter. The language in
this section does require that an artist performing tattoo or body piercing
procedures to have the education, training, and experience to practice aseptic
technique and to prevent the transmission of blood borne pathogens; however,
the law provides no authority for the department to require a four-year degree
or certification for this training. No change was made as a result of this
comment.
Comment: Concerning §229.402, one commenter stated that the state
should require that the jewelry used for piercing be made of surgical implant
grade, such as 316L or M series.
Response: The department agrees with the commenter. Jewelry as defined
in §229.402(22) states the following: "Any personal ornament inserted
into a pierced area, which must be made of surgical implant grade stainless
steel (minimum of 316L or 316LVM), solid 14k or 18k gold, niobium, titanium
(minimum of 6A14V), or platinum, which is free of nicks, scratches, or irregular
surfaces and has been properly sterilized prior to use." No change was made
as a result of this comment.
Comment: Concerning §229.403(a), three commenters stated that a license
should be required for each body piercer.
Response: The department disagrees with the commenter. The law requires
that we license the studio not the individual artist who is employed at the
studio. No change was made as a result of this comment.
Comment: Concerning §229.403(f), one commenter stated that ear piercing
should fall under these regulations.
Response: The department disagrees with the commenter. The law exempts
from licensing, those body piercers who only pierce an individual's earlobe.
No change was made as a result of this comment.
Comment: Concerning §§229.401 - 229.412, one commenter requested
that the rules for body piercing be separated from the rules for tattooing.
Response: The department disagrees with the commenter. SB 61 amended Health
and Safety Code, Chapter 146, to include regulations concerning certain body
piercing studios. Sections 229.401 - 229.412 are being repealed for the purpose
of reorganization and implementing SB 61 and 932. The law does not allow for
body piercing and tattoo regulations to be separate. No change was made as
a result of this comment.
Comment: Concerning §229.403(f), one commenter stated that all ear
piercing should be exempt from the licensing requirements.
Response: The department disagrees with the commenter. The law only allows
for the exemption of licensing for those piercing the earlobe. No change was
made as a result of this comment.
The commenters were: Body Rights of Austin, DR Powers Tattoo Studio, Association
of Professional Piercers, Kenneth Magness, Ear Piercing Manufacturers of the
United States, and one department staff member.
The department is making the following changes due to staff comments to
clarify the intent and improve the accuracy of the section; and as a correction
to the proposed text as printed in the
Texas Register
.
Change: Concerning §229.403(a), the department determined that two
licensing applications for tattoo and body piercing studios were needed for
accounting purposes. Clarifying language has been deleted/added to stipulate
fee requirements in §229.403(a). Additionally, language has been added
to §229.403(c) to clarify that two separate applications are required
to be submitted.
Change: Concerning §229.407(a), one of the "section" symbols was removed
to read §229.409(a)-(c).
Subchapter V. MINIMUM STANDARDS FOR LICENSURE OF TATTOO STUDIOS
25 TAC §§229.401 - 229.412
The repeals are adopted under the Health and Safety Code, §146.010(a)
and §146.015(a), which provides the department with the authority to
adopt necessary regulations pursuant to the enforcement of this Chapter; and §12.001,
which provides the Texas Board of Health (board) with the authority to adopt
rules for the performance of every duty imposed by law on the board, the department
and the commissioner of health; Health and Safety Code, Chapter 146, Tattoo
and Certain Body Piercing Act, and the Health and Safety Code, Chapter 12.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of
the Secretary of State on April 3, 2000.
TRD-200002398
Susan K. Steeg
General Counsel
Texas Department of Health
Effective date: April 23, 2000
Proposal publication date: December 3, 1999
For further information, please call: 458-7236
25 TAC §§229.401 - 229.412
The new sections are adopted under the Health and Safety Code, §146.010(a)
and §146.015(a), which provides the department with the authority to
adopt necessary regulations pursuant to the enforcement of this Chapter; and §12.001,
which provides the Texas Board of Health (board) with the authority to adopt
rules for the performance of every duty imposed by law on the board, the department
and the commissioner of health; Health and Safety Code, Chapter 146, Tattoo
and Certain Body Piercing Act, and the Health and Safety Code, Chapter 12.
§229.403.Licensing Fees. Procedures, and Exemptions.
(a)
License fees. All tattoo and body piercing studios shall
obtain a license annually except as indicated below from the Texas Department
of Health (department) and shall pay an annual, non-refundable license fee
for each place of business operated as follows:
(1)
$450 per tattoo only studio or temporary location license
for a specified length of time not to exceed seven days;
(2)
$600 for a tattoo and body piercing studio or temporary
location license for a specified length of time not to exceed seven days -
the fee to be paid as follows: $450 for the tattoo portion; and $150 for the
body piercing portion; and
(3)
$200 per body piercing only studio or temporary location
license for a specified length of time not to exceed seven days.
(b)
License forms. License forms may be obtained from the Drugs
and Medical Devices Division, Texas Department of Health, 1100 West 49th Street,
Austin, Texas, 78756-3182.
(c)
License application. An application shall be submitted
for each tattoo studio and a separate application shall be submitted for each
body piercing studio. The initial license application for each studio or temporary
location shall be signed and verified, shall be made on the license application
furnished by the department, and shall contain the following information:
(1)
the full or legal name under which the studio or temporary
location is conducted;
(2)
the address of the studio or temporary location that
is to be licensed. Sufficient descriptive information must be included if
the studio or temporary location is located in a portion of the building with
other license holders;
(3)
if a proprietorship, the name and residence address
of the proprietor; if a partnership, the names and residence addresses of
all partners; if a corporation, the date and place of incorporation and name
and address of its registered agent in the state; or if any other type of
association, then the names of the principals of such association;
(4)
for each studio or temporary location, the name(s)
and residence address(es) of the responsible individual(s) thereof;
(5)
the name(s) of the studio's or temporary location's
artist(s);
(6)
the usual days and hours of operation of each studio
or temporary location; and
(7)
a description of all services to be provided at the
studio or temporary location.
(d)
Issuance of license. The department may issue a license
to the owner of a studio or temporary location after determining that the
studio or temporary location is in compliance with applicable statutes, rules,
and zoning codes.
(1)
The initial studio license shall be valid for one year
from the date of issuance which becomes the anniversary date. The temporary
location license is valid for a specified period not to exceed seven days.
(2)
The renewal studio license shall be valid for one
year from the anniversary date.
(3)
The license shall be displayed in a prominent place
in the studio or temporary location.
(e)
Renewal of license - applicable to studios only.
(1)
Each year, the license holder shall renew its license in
accordance with the requirements of this section.
(2)
The license holder shall renew the license by filing
an application for renewal on the form prescribed by the department accompanied
by the required licensure fee. A licensee must file for renewal before the
expiration date of the current license. A person who files a renewal application
after the expiration date must pay an additional $100 as a delinquency fee.
(3)
Failure to submit the renewal application annually
shall subject the studio to the enforcement provisions of the Tattoo and Certain
Body Piercing Studio Act and also to the provision of §229.412 of this
title (relating to Refusal, Revocation or Suspension of License and Enforcement
Provisions).
(A)
Amendment of license. A license must be amended when the
name, ownership, or location of the licensed studio is changed. Such changes
require submission of the fees as outlined in subsection (a) of this section.
(B)
Notification of change of location of studio.
(i)
Not fewer than 30 days in advance of the change, the licensee
shall notify the commissioner or the commissioner's designee in writing of
the licensee's intent to change the location of a licensed studio. The notice
shall include the address of the new location, and the name and residence
address of the individual in charge of the studio at the new location.
(ii)
Notice will be deemed adequate if the licensee provides
the intent and verification notices to the commissioner or the commissioner's
designee within the established time frames of clause (i) of this subparagraph
by certified mail, return receipt requested, mailed to the Drugs and Medical
Devices Division, Texas Department of Health, 1100 West 49th Street, Austin,
Texas, 78756.
(iii)
Not later than the tenth day after the change of location
is complete, the license holder shall notify the department in writing and
shall verify the information submitted under clause (i) of this subparagraph.
(f)
Exemption from licensure. Persons who engage only in the
following are exempt from the licensing requirements of this section:
(1)
a studio or temporary location located within a medical
facility which is licensed under other law, or an office or clinic of a person
licensed by the Texas State Board of Medical Examiners;
(2)
a person who performs only ear piercing; or
(3)
a facility in which only ear piercing is performed.
§229.407.Sterilization.
(a)
A studio or temporary location is required to utilize instruments
that have been prepared as described in §229.409(a)-(c) of this title
(relating to Tattooing and Body Piercing Instruments and Jewelry). The studio
or temporary location shall use sterilization equipment that is approved by
the United States Food and Drug Administration for the purpose of sterilization,
and adequate in size to accommodate necessary utensils and instruments. A
copy of the manufacturer's recommended procedures for operation of the sterilization
unit(s) must be available for inspection by an authorized agent.
(b)
Each person responsible for the sterilization of instruments
shall be able to demonstrate to the department's authorized agent the correct
sterilization procedures and the proper operation of autoclave and/or dry
heat sterilization equipment.
(c)
After each use, the reusable instruments shall be cleansed
to remove blood and tissue residue before sterilization as described in §229.409(n)
of this title.
(d)
Instruments requiring sterilization shall be packed in
packages approved for the sterilization unit. Instruments shall be packed
individually, or as a set provided such set is intended to be used for a single
procedure. Each package shall be labeled with the date of sterilization and
the initials of the person sterilizing the instruments. Packaged sterilized
instruments shall be kept in a sterile condition and stored in a clean dust-tight
container when not in use.
(e)
Each package of instruments sterilized shall be monitored
for sterilization by the use of chemical/heat sensitive indicators.
(f)
Each studio or temporary location shall maintain sterilization
records. The information shall be permanently recorded and made available
for examination by an authorized agent in the studio for at least two years
from the date of the last entry. These permanent records shall be maintained
at the studio and shall include the following:
(1)
date of sterilization;
(2)
quantity and type of instruments to be sterilized;
and
(3)
name or initials of the individual sterilizing the
instruments.
(g)
Sterilized instruments stored in an approved manner and
not used within 30 days after sterilization shall no longer be considered
sterile and shall be resterilized before use, unless the studio or temporary
location utilizes presterilized instruments sterilized by the manufacturer.
If presterilized instruments are used, the artist shall obtain documentation
from the manufacturer that describes the method of sterilization utilized
by the manufacturer and the manufacturer's recommendations for storage and
maintenance of sterility. This documentation shall be available for inspection
by an authorized agent. The artist shall follow the manufacturer's instructions
for storage and maintenance of sterility.
(h)
One of the following methods of sterilization shall be
used.
(1)
Autoclave - steam under pressure:
(A)
121 degrees Celsius (250 degrees Fahrenheit) and a pressure
of at least 15 pounds per square inch for not less than 30 minutes after the
chamber of the autoclave has reached the required temperature and pressure;
or
(B)
as specified in the manufacturer's operator's manual.
(2)
Dry heat sterilization:
(A)
160 degrees Celsius (320 degrees Fahrenheit) for not less
than one hour under atmospheric pressure after the sterilizer has reached
the required temperature; or
(B)
as specified in the manufacturer's operator's manual.
§229.408.Care of the New Tattoo and/or Body Piercing.
(a)
Each time tattooing or body piercing is performed the client
(and if applicable, the parent, managing conservator, or guardian) shall receive
oral and written instructions on the care of the area tattooed or pierced.
The client shall sign a written statement in the permanent client record acknowledging
that the client has received a copy of the written care instructions, and
that the client has read and understands the instructions.
(b)
The written care instructions for tattooing shall contain
at least the following items:
(1)
for at least two weeks, the need to minimize exposure to
the sun, and to discourage swimming in fresh, salt, or chlorinated water;
(2)
the need to properly cleanse the tattooed area;
(3)
the need to apply antibiotic ointment or cream;
(4)
the need to use sterile bandage(s) or other sterile
dressing(s) when necessary;
(5)
the name of the artist, and the name, address, and
telephone number of the studio or temporary location; and
(6)
the instructions for the client to consult a health
care practitioner at the first sign of infection or an allergic reaction,
and to report any diagnosed infection, allergic reaction, or adverse reaction
resulting from the application of the tattoo to the artist and to the Texas
Department of Health, Drugs and Medical Devices Division, at 1-888-839-6676.
(c)
The written care instructions for body piercing shall contain
at least the following items:
(1)
the need to properly cleanse the pierced area by using
antibacterial or antimicrobial soap for the external skin and or an antiseptic
or carbamide peroxide mouthwash for the oral cavity;
(2)
for at least the first two to six weeks, the need
to minimize exposure to the sun, and to discourage swimming in fresh, salt,
or chlorinated water;
(3)
the need to use sterile bandage(s) or other sterile
dressing(s) when necessary;
(4)
the name of the artist, and the name, address, and
telephone number of the studio or temporary location; and
(5)
the instructions for the client to consult a health
care practitioner at the first sign of infection or an allergic reaction,
and to report any diagnosed infection, allergic reaction, or adverse reaction
resulting from the body piercing to the artist and to the Texas Department
of Health, Drugs and Medical Devices Division, at 1-888-839-6676.
This agency hereby certifies that the adoption has been
reviewed by legal counsel and found to be a valid exercise of the agency's
legal authority.
Filed
with the Office of the Secretary of State on April 3, 2000.
TRD-200002399
Susan K. Steeg
General Counsel
Texas Department of Health
Effective date: April 23, 2000
Proposal publication date: December 3, 1999
For further information, please call: (512) 458-7236
Chapter 401.
SYSTEM ADMINISTRATION
Subchapter D. CONTRACTS MANAGEMENT FOR COMMUNITY-BASED SERVICES
25 TAC §401.351
The Texas Department of Mental Health and Mental Retardation
(TDMHMR) adopts amendments to §401.351 (relating to Methods of Procurement)
of Chapter 401, Subchapter D, concerning contracts management for community-based
services, with changes to the proposed text as published in the January 28,
2000, issue of the
Texas Register
(25 TexReg
527).
The amendments allow local authorities of TDMHMR to procure qualified contractors
of any community service through open enrollment in order to establish and
maintain a provider network.
Language was added to (3)(D)(ii) clarifying that the contractor or its
designated staff complete (rather than participate in) orientation conducted
or approved by the local authority.
Written public comment on the proposal was received from the Burke Center
in Lufkin.
Regarding the requirement to approve for inclusion in its provider network
all applicants whose applications are complete and who meet all requirements
specified in the request for applications in (3)(C)(ii), the commenter expressed
concern that the local authority would not have discretion to turn down an
applicant. The commenter stated that "the only means by which a local authority
could create some wiggle-room for themselves (sic) would be in how they (sic)
write the RFA (request for applications) criteria." The commenter suggested
allowing the local authority to determine the criteria for approving applicants.
The department responds that the local authority has the ability to determine
award criteria by describing the eligibility requirements in the RFA. Since
open enrollment is not a competitive procurement method, all applicants who
fulfill the eligibility requirements must be awarded a contract. If the local
authority wants to choose providers on a competitive basis, then it should
use the request for proposal method of procurement.
Regarding (3)(B)(ii), the commenter expressed concern about the absence
of language relating to conflicts of interest. The commenter asked if the
department intended for such requirement to be included in the criteria for
approval in (3)(B)(ii)(VII). The department responds that §401.344(b)
and (f) contain the subchapter's provisions relating to conflict of interest
and standards of conduct.
Regarding (1), (3), and (3)(A), the commenter stated that the rule did
not provide adequate direction in determining which method of procurement
to use. Additionally, the commenter stated that the rule seemed to provide
two contradictory ways to determine if a local authority should use open enrollment.
The commenter related that the term "may" in paragraph (3) implied use of
open enrollment was permissive, while language in subparagraph (3)(A) stated
that open enrollment "is used" to procure qualified contractors for inclusion
in the provider network. The commenter requested that language be added or
modified "to guide local authorities as to how to make the procurement method
choice and when it is mandatory that a particular method be used" or at least
state "that it is solely at the local authority's discretion as to which method
to use." The department responds that the local authority has the sole discretion
to determine which method provides the best value to the authority. Additionally,
the needs of the community identified in the authority's local plan should
guide the authority in its determination of procurement method. For example:
An authority's local plan indicates a need for improved access to and choice
of psychiatrists. The authority may determine that open enrollment provides
best value in procuring multiple psychiatrists who are located in all parts
of the authority's service area. Or the authority may determine that a request
for proposals provides best value because there are several psychiatrist groups
in the service area who will compete for the contract which will allow the
authority to possibly negotiate a lower rate in exchange for exclusivity.
The indicators that could be used to determine best value are so varied it
would be impossible to articulate specific criteria to determine use of either
procurement method.
This section is adopted under the Texas Health and Safety Code, §532.015(a),
which provides the Texas Board of Mental Health and Mental Retardation (board)
with broad rulemaking authority, and §534.052(a), which requires the
board to adopt rules it considers necessary and appropriate to ensure the
adequate provision of community-based mental health and mental retardation
services through a local mental health or mental retardation authority.
§401.351. Methods of Procurement.
The state authority shall procure community-based services to be provided
by another organization through either the method described in paragraph (1)
or paragraph (2) of this section. All local authorities shall procure community-based
services to be provided by another organization through one of the methods
described in this section.
(1)
Request for proposal (RFP). A contract may be procured
using the request for proposal method in accordance with this subsection.
(A)
Determination of method. A contract must be procured through
the RFP method unless a determination is made that the sole source method
is permissible under this section or that open enrollment will be used. The
RFP method is typically applicable to those situations where funds of greater
than $1,000 are available to the contracting entity for the provision of a
service without reference to a particular person with a mental disability.
(B)
Solicitation.
(i)
The contracting entity must make a reasonable effort to
give notice of the intent to contract for services to each potential provider
in the authority's local service area. An RFP must be published in a local
newspaper or professional association newsletter, or solicited through announcements
by direct mail to all known providers by the contracting entity at least 10
days, but not more than 60 days, prior to the due date of submission of proposals.
An RFP must contain, but is not limited to, the following information:
(I)
the community-based service to be purchased;
(II)
the approximate number of persons with a mental disability
to be served pursuant to the contract;
(III)
the geographic area to be served pursuant to the contract;
(IV)
applicable funding limitations;
(V)
method of payment;
(VI)
the contract term;
(VII)
any limitations on who may submit a proposal and any
limitations in the services;
(VIII)
the procedure for requesting a procurement package;
and
(IX)
the date by which proposals must be submitted.
(ii)
A contracting entity must provide a procurement package
to each entity that requests one. No requirement that restricts competition
by unreasonably eliminating or limiting participation in the procurement process
may be included in the procurement package. A procurement package must contain:
(I)
a detailed description of the community-based services
to be purchased, including all information included in the RFP;
(II)
a detailed description of information to be included
in a proposal;
(III)
instructions for the submission of questions concerning
the procurement by potential offerors;
(IV)
instructions for the submission of proposals;
(V)
requirements that a potential offeror must fulfill to
participate in the procurement process, including assurances that:
(-a-)
the offeror has made no attempt nor will make any attempt
to induce any person or firm to submit or not submit a proposal;
(-b-)
the offeror has arrived at the proposal independently
without consultation, communication, or agreement for the purposes of restricting
competition;
(-c-)
the offeror and its officers or employees have
no relationship now or will have no relationship during the contract period
that interferes with fair competition or that is a financial or other conflict
of interest, real or apparent; and
(-d-)
no member of the offeror's staff or governing authority
has participated in the development of specific criteria for award of the
contract, nor will participate in the selection of the proposal to be awarded
the contract.
(VI)
the criteria for evaluation of proposals.
(iii)
A proposal must include, but is not limited to, the
following information:
(I)
the offeror's name, address, telephone number, and type
of legal entity;
(II)
the offeror's credentials for providing the community-based
service, including applicable certifications, licenses, and/or evidence of
compliance with applicable TDMHMR community standards;
(III)
information concerning the factors set forth in subparagraph
(C)(iii) of this paragraph.
(iv)
Changes to a procurement package may be made by the contracting
entity prior to the date designated for submission of proposals, provided
all offerors that have obtained a procurement package are notified of the
change and are provided fair opportunity to respond.
(v)
Except as provided in the Texas Open Records Act, Texas
Government Code, Chapter 552, all information submitted in a proposal is confidential
until a contract has been awarded.
(vi)
Any amendments to a proposal must be made by the offeror
in writing and must be received prior to the submission date for proposals.
(vii)
The contracting entity must document all transactions
concerning contracts.
(viii)
The contracting entity may validate any information
in a proposal by using outside sources or materials.
(C)
Award.
(i)
For a proposal to be considered for award, the offeror
must follow all instructions and meet all requirements specified in the procurement
package.
(ii)
Clarification or confirmation of information submitted
in a proposal may be obtained if such information is necessary to complete
the award process; however, no offeror may be given information which would
give that offeror an unfair competitive advantage.
(iii)
The award of a contract is made by determining the lowest
and best proposal. The determination shall include consideration of any relevant
information included in the RFP, including:
(I)
price;
(II)
the ability of the offeror to perform the contract and
to provide the required services;
(III)
whether the offeror can perform the contract or provide
the services within the period required, without delay or interference;
(IV)
the offeror's history of compliance with the laws relating
to its business operations and the affected services and whether it is currently
in compliance;
(V)
whether the offeror's financial resources are sufficient
to perform the contract and to provide the services;
(VI)
whether necessary or desirable support and ancillary
services are available to the offeror;
(VII)
the character, responsibility, integrity, reputation,
and experience of the offeror;
(VIII)
the quality of the facilities and equipment available
to or proposed by the offeror;
(IX)
the ability of the offeror to provide continuity of services;
and
(X)
the ability of the offeror to meet all applicable written
policies, principles, and regulations.
(iv)
Negotiation may be conducted either to complete the procurement
process or to complete an evaluation of an acceptable proposal. When only
one proposal has a reasonable chance of being awarded, contract staff and
the potential contractor/subcontractor will negotiate the contract requirements
as necessary to complete the procurement process. When more than one acceptable
proposal is received, negotiation is used to further evaluate competitive
proposals and to select one or more for award. In this situation, no potential
contractor/subcontractor is given information that will give the contractor/subcontractor
a competitive advantage over the other potential contractors/subcontractors.
(v)
An RFP may be canceled without award for any reason or
for no reason.
(vi)
Each offeror who submits an acceptable proposal but is
not awarded a contract is entitled to timely notification in writing that
the proposal is no longer being considered.
(vii)
Upon written request, an unsuccessful offeror is entitled
to receive information concerning why its proposal was not accepted.
(2)
Sole source. A contract may be procured
using the sole source method in accordance with this section.
(A)
Determination of method. The sole source method is typically
applicable in those situations where funds are available for the provision
of services and certain conditions exist which indicate that the RFP method
is not appropriate.
(i)
A contract may be procured using the sole source method,
only if:
(I)
it is documented that only one source can or will provide
the needed services;
(II)
the contract is with another governmental entity;
(III)
there exists an emergency situation in which a delay
may result in harm to person(s) with a mental disability who is to receive
the community-based service;
(IV)
the contract is for less than $1,000 for a one-year period;
or
(V)
no acceptable proposal was received through a substantially
similar RFP within the previous 12 months.
(ii)
A contract procured using the sole source method pursuant
to clause (i)(III) of this subparagraph, may be for a term of only six months
or for the balance of the fiscal year, whichever is greater.
(iii)
A contract procured using the sole source method pursuant
to clause (i)(IV) of this subparagraph may not be divided in order to qualify
for the sole source method.
(iv)
The contracting entity must justify and document awarding
a sole source contract. Documentation must accurately and concisely substantiate
the necessity for a sole source contract on the basis of one or more of the
reasons listed in clause (i) of this subparagraph.
(B)
Award. The procedure for awarding contracts using the
sole source method is established by the contracting entity.
(3)
Open enrollment. A local authority may use open
enrollment to establish and maintain a provider network in accordance with
this subsection.
(A)
Determination of method. Open enrollment is used by a
local authority to procure qualified contractors for inclusion in the local
authority's provider network.
(B)
Solicitation.
(i)
At least once every two years the local authority must
publish in a local newspaper or professional association newsletter a request
for applications notice to procure qualified contractors for inclusion in
the local authority's provider network. In addition, the local authority must
continuously and prominently display such request for applications notice
at the local authority's administrative office(s). The request for applications
notice must include:
(I)
the types of community services, including brief descriptions,
for which the local authority intends to contract;
(II)
the geographic area to be served under the contracts;
(III)
the procedure for obtaining the request for applications
for inclusion in the local authority's provider network; and
(IV)
the date and time by which applications must be submitted,
if any.
(ii)
A local authority must provide the request for applications
to each entity that requests one. A request for applications must include:
(I)
a detailed description of each type of community service
for which the local authority intends to contract, including all information
included in the request for applications notice;
(II)
the amount of payment for each type of community service
for which the local authority intends to contract and the method used to determine
that amount;
(III)
a detailed description of the information to be included
in an application;
(IV)
instructions for the submission of applications;
(V)
eligibility requirements an applicant must fulfill to
be included in the local authority's provider network (e.g., credentials for
providing the community service(s), such as applicable certifications, licenses;
evidence of compliance with relevant TDMHMR rules; evidence of accessibility;
evidence of providing quality services; evidence of financial solvency; and
evidence of liability insurance);
(VI)
assurances that:
(-a-)
the applicant is not currently held in abeyance or barred
from the award of a federal or state contract;
(-b-)
the applicant is not currently delinquent in its
payments of any franchise tax owed to the state of Texas; and
(VII)
the criteria for approval.
(iii)
An application must include the following information:
(I)
the applicant's name, address, telephone number, and type
of legal entity;
(II)
the type(s) of community service(s) that the applicant
intends to provide;
(III)
assurances that the applicant meets the requirements
described in subparagraph (B)(ii)(VI) of this paragraph;
(IV)
evidence that the applicant fulfills the eligibility
requirements described in subparagraph (B)(ii)(V) of this paragraph; and
(V)
a statement that the applicant agrees to provide the specified
community service(s) at the amount of payment described in the request for
applications.
(C)
Approval process for inclusion on a local authority's
provider network.
(i)
The local authority may obtain clarification or confirmation
of information submitted in an application.
(ii)
The local authority must approve for inclusion on its
provider network all applicants whose applications are complete and who meet
all requirements specified in the request for applications.
(D)
Provider network contracts. All contracts for a specific
type of community service provided through a provider network must contain
the same contract conditions, provisions, and requirements, including:
(i)
the requirement that the contractor immediately notify
the local authority of any change, or potential change, in its status that
could affect its inclusion on the network;
(ii)
the requirement that, before services can be delivered
to consumers, the contractor or its designated staff complete orientation
conducted or approved by the local authority relating to the local authority's
policies and procedures;
(iii)
the statement that the contractor is prohibited from:
(I)
offering any gift with a value in excess of $10 to potential
consumers; and
(II)
soliciting potential consumers through direct-mail or
by telephone.
(iv)
the requirement that the local authority maintain and
make available to consumers and potential consumers, current information about
each contractor of community services participating in its network that:
(I)
represents all participating contractors fairly;
(II)
is organized and relevant to consumers and potential
consumers; and
(III)
includes results from consumer satisfaction surveys;
and
(v)
the requirement that the local authority allow consumers
to choose freely any participating contractor of a specific type of community
service within its network, without influence by any local authority staff
or representative.
This agency hereby certifies that the adoption
has been reviewed by legal counsel and found to be a valid exercise of the
agency's legal authority.
Filed with the Office of
the Secretary of State on April 3, 2000.
TRD-200002352
Charles Cooper
Chairman, Texas MHMR Board
Texas Department of Mental Health and Mental Retardation
Effective date: April 23, 2000
Proposal publication date: January 28, 2000
For further information, please call: (512) 206-5216
Subchapter B. CHARGES FOR COMMUNITY-BASED SERVICES
25 TAC §403.46, §403.48
The Texas Department of Mental Health and Mental Retardation
(TDMHMR) adopts amendments to §403.46 and §403.48 of Chapter 403,
Subchapter B, concerning charges for community-based services. Section 403.48
is adopted with changes to the proposed text as published in the December
31, 1999, issue of the
Texas Register
(24
TexReg 11895). Section 403.46 is adopted without changes and will not be republished.
Language in §403.48(c)(2) has been modified to state: "If the local
MHMR authority has a contract with the person's insurance carrier, then the
local MHMR authority shall charge the person in accordance with such contract.
For services not covered by the person's insurance carrier, the local MHMR
authority shall charge the person his or her maximum monthly fee in accordance
with this subchapter. Payments collected from a person pursuant to a contract
between the person's insurance carrier and the local MHMR authority are separate
from, and may not be included as part of, the person's maximum monthly fee
for services that are not covered by the person's insurance carrier." Proposed
language in new subsection (h) of §403.48 concerning the Children's Health
Insurance Plan (CHIP) has been deleted because modified language in §403.48(c)
addresses charges for services when a person has third party coverage.
Written comment on the proposal was received from the Texas Council of
Community MHMR Centers, Austin; MHMR of Tarrant County, Fort Worth; Denton
County MHMR Center, Denton; and Texas Interagency Council on Early Childhood
Intervention, Austin.
Regarding §403.48(c)(2), one commenter asked why TDMHMR would want
to promulgate a rule giving a local MHMR authority permission to comply with
requirements of a contract it has with an insurance carrier and over which
TDMHMR has no jurisdiction. The department acknowledges that it does not have
jurisdiction regarding the provisions of a contract between a local MHMR authority
and an insurance carrier. However, pursuant to the Texas Health and Safety
Code, §534.067, the department does have jurisdiction regarding the establishment
of a uniform fee collection policy for all local MHMR authorities. The department
has been made aware of inconsistent implementation of the policy due to the
lack of clear direction. The clarifying language ensures uniformity in situations
in which the authority has a contract with the person's insurance carrier.
In other words, the policy recognizes such contracts as a method of maximizing
contributions.
Regarding §403.48(h), the same commenter stated that CHIP is not a
TDMHMR-administered program and, for community MHMR centers/local MHMR authorities,
the program will become one more payor source alternative to TDMHMR, such
as Medicaid, Medicaid managed care, and private insurance, which centers/authorities
bill for services as long as the centers/authorities are enrolled by the payor
as a provider. The commenter also stated that collection of any co-payments
and deductibles will be subject to the provisions in the provider agreement
between the center/authority and the payor. The commenter suggested deleting
provisions relating to CHIP in (h)(1) and (h)(2) since the responsibility
for the action described falls to the CHIP contractor based on the requirements
of the Health and Human Services Commission (HHSC). The department agrees
with the commenter and responds that language specific to CHIP has been deleted.
Regarding §403.48(h)(3), the commenter asked that TDMHMR investigate
the intent of §1.06 (cost-sharing) of HHSC's draft CHIP contract, which
states "...the co-payments and deductibles outlined in this section are the
only amounts that a provider may collect from a CHIP-eligible family." The
commenter expressed concern that the statement does not make clear whether
it applies only to CHIP-reimbursed services or to any service the CHIP provider
delivers that is not reimbursable by CHIP. Regarding the same section of the
draft contract, which states "Federal law prohibits charging co-payments or
deductibles to members of Native American Tribes," the commenter asked if
such requirement is specific to CHIP or to other federally funded services
as well. The department responds that the draft contract language that states,
"... the only amounts that a provider may collect from a CHIP eligible family,"
references only those services that are reimbursable by CHIP. If a local MHMR
authority that is a provider of CHIP services delivers non-CHIP-reimbursable
services, then the authority charges the family a maximum monthly fee in accordance
with the subchapter. Regarding members of Native American Tribes, the department
responds that the contract provision is specific to CHIP.
Regarding §403.48(h)(4), the commenter suggested adding "and/or deductibles"
after co-payment. The commenter also stated that the department may consider
adding the provision to §403.48(c) relating to third party coverage.
The department responds that language addressing the commenter's concerns
has been added to §403.48(c)(2). The department notes that provisions
specific to CHIP have been deleted.
Regarding §403.48(h), the commenter suggested adding the sentence
"Local MHMR authorities may not expend local authority funds to meet co-payment
and deductible requirements of CHIP-enrolled persons." The commenter also
stated that the department may consider adding the provision to §403.48(c)
relating to third party coverage. The department responds that promulgating
such a policy would be the responsibility of HHSC.
Regarding §403.48(h), the commenter suggested adding language to the
rule which describes HHSC's currently undefined policy regarding an agency's
ability to serve or deny services to persons eligible for CHIP enrollment,
but who refuse to enroll or pay deductibles or co-payments. The commenter
requested that the department actively work to ensure that persons requiring
crisis services can obtain them from the local authority regardless of CHIP
enrollment or any other payor enrollment status. The department responds that
promulgating such a policy would be the responsibility of HHSC. Concerning
the provision of crisis services without regard to payor status, the department
notes that local mental health authorities must comply with the department's
rules governing mental health community services standards (Chapter 412, Subchapter
G), which do not allow for the provision of crisis services to be contingent
on a person's payor status.
The same commenter stated that in the few years since the department's
fee collection policy was originally promulgated many more members of the
priority population have payor sources alternative to the department and Medicaid.
The commenter suggested that the policy be modified to reflect the new environment
for community MHMR services. The department agrees with the commenter and
responds that it is in the process of revising the fee collection policy to
reflect the new reimbursement environment for community MHMR services.
Regarding §403.48(c), one commenter asked if it was permissible to
charge the person his or her maximum monthly fee (MMF) based upon the
Regarding extraordinary expenses in §403.46(a), the commenter requested
a more specific definition and examples. The department responds that extraordinary
expenses are described in §403.45(b)(2) to include major medical or health-related
expenses; major casualty losses due to fire, theft, flood, etc.; and child
care expenses for the previous year or projections for the next year. Additionally,
the training program developed by the department (as required in §403.50)
addresses extraordinary expenses. Within the Implementation Manual, on the
top of page 3 of the
How to Perform Financial Assessment
and Determine Fees for Members of the Priority Population in Non-Emergencies
, Version 2, dated August 13, 1996, states: "Ask the person to name
extraordinary expenses (§403.45): - (1) major medical or health related
expenses (2) major casualty losses due to fire, fire, theft, flood, etc. (3)
child care expenses for the previous year or projections for the next year.
Note: These are the only allowable extraordinary expenses."
Regarding §403.48(c)(2), the commenter requested clarification and
asked if the provision meant that it is permissible to collect co-payments
even if they amount to more than the person's MMF. The department responds
that if the local MHMR authority has a contract with the person's insurance
carrier that allows the authority to collect co-payments, then it is permissible
for the authority to collect co-payments even if they amount to more than
the person's MMF.
Regarding §403.48(h), the commenter requested confirmation that a
local MHMR authority can only collect the CHIP co-payment for CHIP reimbursable
services; can only collect MMFs for non-reimbursable CHIP services; and, if
there is a balance left after collecting the CHIP co-payment and the CHIP
payment, cannot collect a MMF to offset the balance. The department responds
by confirming the commenter's statements. The department notes that the cost
of a CHIP-reimbursed service should equal the family's co-payment and the
payment from CHIP.
Regarding §403.48(h), another commenter stated that the provisions
in proposed subsection (h) "assumes that the children with MH will receive
services only from a local MHMR community center. In some if not a lot of
cases, the parents will want to and/or will utilize several local non-MHMR
MH services. The local community center will not have the ability to access
(the information as to) whether the annual maximum co-pay has been paid if
payments are made to multiple providers. Further, it is unclear whether MHMR
should deny services to any child if the co-pay is not recovered prior to
the child receiving services. That would be the only way to ensure state GR
(general revenue) is not used to cover actual costs of providing CHIP services."
The department responds that the organization administering CHIP is responsible
for ensuring CHIP providers have current information regarding when a person
has paid his or her maximum out-of-pocket expense. Regarding denying services
if the co-pay is not collected, the department responds that developing such
a policy would be the responsibility of HHSC.
Regarding §403.48(c)(2), one commenter stated that collecting co-payment
should not be permissive, but should be mandatory as stated in subsection
(h) for CHIP co-payments. The commenter also requested that language be added
to (c)(2) which requires, in cases in which the person's insurance carrier
refuses to pay out-of-network, that the person utilize a provider within the
network of his or her insurance carrier or pay the full standard rate for
the service. The department responds that language in (c)(2) has been modified
to require the local MHMR authority to charge a person in accordance with
the contract it has with the person's insurance carrier. Regarding cases in
which the person's insurance carrier refuses to pay out-of-network, the department
responds that such situations will be addressed in the policy's next revision.
One commenter expressed concern that local MHMR authorities would implement
the proposed amendments by collecting co-payments or deductibles from CHIP
families for the provision of Early Childhood Intervention services. The commenter
stated that state and federal regulations do not permit families to share
the cost of Early Childhood Intervention services; therefore, providers of
Early Childhood Intervention services, which include most or all local MHMR
authorities, are prohibited from collecting co-payments or deductibles. The
department responds that §403.42 describes the subchapter's application.
Specifically, §403.42(b)(1) states that the "subchapter does not apply
to programs and services that are prohibited by statute or regulation from
charging fees to persons served (e.g., Early Childhood Intervention Program)..."
These sections are adopted under the Texas Health and Safety
Code, §532.015(a), which provides the Texas Mental Health and Mental
Retardation Board (board) with broad rulemaking authority; the Texas Health
and Safety Code, §534.052(a), which requires the board to adopt rules
it considers necessary and appropriate to ensure the adequate provision of
community-based mental health and mental retardation services through a local
mental health or mental retardation authority under Chapter 534, Subchapter
B; and the Texas Health and Safety Code, §534.067, which requires TDMHMR
to establish a uniform fee collection policy for all local mental health and
mental retardation authorities.
§403.48. Billing Procedures.
(a)
Monthly services charge. All services provided during
a month, and the rates for those services, are listed on the person's monthly
services charge. If the total charges:
(1)
exceed the person's maximum monthly fee, then the charges
are discounted to equal the maximum monthly fee and the person is billed the
maximum monthly fee;
(2)
are less than the person's maximum monthly fee, then
the person is billed for the charges listed on the monthly services charge.
(b)
Medicaid recipients.
(1)
For Medicaid recipients, the Medicaid program is billed
for Medicaid-covered services rendered according to federal and state regulations
and procedures. Medicaid reimbursement is considered full payment.
(2)
Medicaid recipients receiving non-Medicaid-covered
services are charged a maximum monthly fee in accordance with this subchapter.
(c)
Third-party coverage.
(1)
If a person has third-party coverage and executes an assignment
of benefits, then the local MHMR authority will bill the third-party payor.
The local MHMR authority will subtract the third-party payment from the person's
monthly service charge, and the remaining balance, if any, is what the person
will pay up to the person's maximum monthly fee.
(2)
If the local MHMR authority has a contract with the
person's insurance carrier, then the local MHMR authority shall charge the
person in accordance with such contract. For services not covered by the person's
insurance carrier, the local MHMR authority shall charge the person a maximum
monthly fee in accordance with this subchapter. Payments collected from a
person pursuant to a contract between the person's insurance carrier and the
local MHMR authority are separate from, and may not be included as part of,
the person's maximum monthly fee for services that are not covered by the
person's insurance carrier.
(d)
Statements.
(1)
Persons who have been determined as having the ability
to pay are sent monthly or quarterly statements that include:
(A)
an itemized list, at least by date and by type, of all
services received;
(B)
the standard rate for each service;
(C)
the total charge for the period;
(D)
the amount that is being discounted, if any; and
(E)
the amount to be paid.
(2)
Unless requested by the person, statements are
not sent to persons with an ability to pay if they maintain a zero balance
(i.e., the person does not currently owe any money).
(3)
Statements may not be sent to persons who have been
determined as having an inability to pay.
(4)
When the person's interdisciplinary or multidisciplinary
team has determined that being charged for services and receiving statements
will result in a reduction in the functioning level of the person or the person's
refusal or rejection of the needed services, then charges will cease and statements
will no longer be sent. This determination requires clinical documentation
and must be reassessed at least annually by the team.
(e)
Receipts. Receipts must be provided for all cash payments.
(f)
Punitive action. Financial penalties may not be imposed
on a person nor may a person be denied services as punitive action. Actions
such as missed appointments without canceling or consistently losing medications
by a person should be addressed by the person's interdisciplinary or multidisciplinary
team.
(g)
Debt collection. Local MHMR authorities must make reasonable
efforts to collect debts before an account is referred to a debt collection
agency. Local authorities must document their efforts at debt collection.
(1)
Local MHMR authorities must incorporate into a written
agreement or contract for debt collection provisions that state that both
parties shall:
(A)
maintain the confidentiality of the information and not
disclose the identity of the person or any other identifying information;
and
(B)
not harass, threaten, or intimidate persons and their
families.
(2)
Local MHMR authorities will enforce the provisions
contained in paragraph (1) of this subsection.
This agency hereby certifies that the adoption has been
reviewed by legal counsel and found to be a valid exercise of the agency's
legal authority.
Filed with the Office of
the Secretary of State on April 3, 2000.
TRD-200002353
Charles Cooper
Chairman, Texas MHMR Board
Texas Department of Mental Health and Mental Retardation
Effective date: April 23, 2000
Proposal publication date: December 31, 1999
For further information, please call: (512) 206-5216
Subchapter A. CLIENT-IDENTIFYING INFORMATION
Chapter 229.
FOOD AND DRUG
Subchapter V. MINIMUM STANDARDS FOR LICENSURE OF TATTOO AND CERTAIN BODY PIERCING STUDIOS
Part 2.
TEXAS DEPARTMENT OF MENTAL HEALTH AND MENTAL RETARDATION
Chapter 403.
OTHER AGENCIES AND THE PUBLIC
Chapter 414.
PROTECTION OF CONSUMERS AND CONSUMER RIGHTS