25 TAC §§411.501-411.506
The Texas Department of Mental Health and Mental Retardation
(TDMHMR) proposes new Subchapter K, §§411.501-411.506, concerning
Model Program Standards for Mental Retardation Services, of Chapter 411, governing
State Authority Responsibilities. The new subchapter is promulgated pursuant
to the Texas Health and Safety Code, §533.0345, which requires TDMHMR
to develop model program standards in rule form for use by each state agency
that provides or pays for mental retardation services.
The model program standards are needed to improve the consistency of mental
retardation services provided or paid for by state agencies in Texas. In recent
years, the delivery of services and supports to individuals with developmental
disabilities has significantly changed in focus, with self-determination by
consumers becoming a driving force. In response to a multiplicity of factors,
service delivery environments have rapidly evolved. Changes in service environments
have been a positive response to social, political, and economic factors.
Individuals with developmental disabilities now have a central role in designing
services and supports that are responsive, flexible, and successful in meeting
their needs and desires.
To further this approach to service provision, the Texas Department of
Mental Health and Mental Retardation utilizes The Council on Quality and Leadership
in Supports of Person with Disabilities' Personal Outcome Measures as the
basis for services delivered to individuals with mental retardation through
its local authorities. These outcome measures also serve as the basis for
the proposed model program standards.
The model program standards are needed because, although some rules and
regulations may vary depending upon funding sources, all interactions with
individuals should be consistent with universal principles. Individuals with
developmental disabilities should be seen as people first. Planning for support
services should be person-directed and evaluation of service quality should
be based upon outcome measures that are defined and prioritized by each person
who is receiving services. Each person who is receiving services should select
personal goals and should be provided support to work toward achievement of
identified goals. The strengths, capabilities, preferences, and desires of
each individual should be the focus of services, supports, and planning efforts,
rather than placing an emphasis on needs and deficits. Individuals should
be offered options for services and supports, and their preferences and desires
should be respected. Each individual should be supported to develop and maintain
personal relationships with others, to include extended family members, friends,
and significant others.
Individuals' physical presence in the community that will provide them
with opportunities that can lead to greater social interaction should be supported.
It is expected that supports and services will be directed at increasing individuals'
participation and involvement in all aspects of community life.
Basic protections in the areas of safety, health, rights, and abuse/neglect
should be in place for each person who is receiving services. Individuals
should live and work in environments that are safe. Individuals should be
free from all forms of abuse, neglect, and exploitation. Each individual should
be free to exercise his/her rights, and supports should encourage full expression
of rights. Due process must be provided when rights are limited. Positive
approaches should be employed when providing services and supports. Procedures
used to change behavior or limit freedom should be implemented only as a part
of an individualized and time-limited plan that is subjected to careful professional
review. Individuals should be supported to access health care that is coordinated
and comprehensive to enable them to enjoy the best possible health. Additionally,
individuals should be assisted to learn about and participate in making healthcare
decisions. Accepted principles of practice should be followed to ensure that
all medications are administered safely and appropriately.
To meet the ever-changing needs and desires of individuals, implementation
of ongoing processes designed to obtain information from people is essential.
Individualized supports should facilitate the presence of outcomes for each
person. Evaluation of the extent to which organizations processes contribute
to the outcomes should be ongoing. Individuals who are receiving services
should be involved in the evaluation of services as well as efforts to facilitate
improvements in services.
The proposed standards of care would capture this philosophy of service
provision succinctly and in a way that can be individualized by programs statewide,
regardless of funding source.
William Campbell, deputy commissioner for finance and administration, has
determined that for each year of the first five years the proposed new sections
are in effect, enforcing or administering the sections may have significant
implications relating to cost or revenue of the state or local governments.
The existence or extent of implications depend on the extent to which governments
provide or pay for services that are already in compliance with the proposed
standards.
Barry Waller, director, Long Term Services and Supports, has determined
that for each year of the first five years the proposed new sections are in
effect, the public benefit expected is the promulgation of standards designed
to improve the consistency of mental retardation services provided by or through
a state agency. It is anticipated that there would be no additional economic
cost to persons required to comply with the proposed rules.
It is anticipated that the proposed new section will not affect a local
economy.
It is anticipated that the proposed new sections may have an adverse economic
effect on small businesses or micro-businesses because they require state
agencies that provide or pay for mental retardation services to meet standards
that may be new. The extent of adverse economic effect cannot be determined
at this time.
Written comments on the proposal may be sent to Linda Logan, director,
Policy Development, Texas Department of Mental Health and Mental Retardation,
P.O. Box 12668, Austin, Texas 78711-2668, within 30 days of publication.
The sections are proposed under the Texas Health and Safety Code, §532.015,
which provides the Texas Mental Health and Mental Retardation Board with broad
rulemaking authority; and Texas Health and Safety Code, §533.0345, which
requires TDMHMR to promulgate model program standards for use by other state
agencies that provide or pay for mental retardation services.
The sections would affect the Texas Health and Safety Code, §533.0345.
§411.501.Purpose.
The purpose of this subchapter is to provide model program standards
for mental retardation services provided or paid for by state agencies.
§411.502.Application.
This subchapter applies to the following state agencies:
(1)
Texas Commission for the Blind;
(2)
Texas Department of Health;
(3)
Texas Health and Human Services Commission;
(4)
Texas Department of Human Services;
(5)
Texas Juvenile Probation Commission;
(6)
Texas Department of Protective and Regulatory Services;
(7)
Texas Rehabilitation Commission; and
(8)
any other state agency that may now or later provide or
purchase mental retardation services as identified by the Texas Health and
Human Services Commission.
§411.503.Definitions.
The following words and terms, when used in this subchapter, have the
following meanings:
(1)
Legally authorized representative--The parent or managing
conservator of a person with mental retardation who is a minor or the guardian
of the person of person with mental retardation who is an adult.
(2)
Mental retardation--Significantly subaverage general intellectual
functioning, which is measured intelligence on standardized general intelligence
tests of two or more standard deviations below the age-group mean for the
tests used, existing concurrently with:
(A)
deficits in adaptive behavior, which is the effectiveness
or degree to which an individual meets the standards of personal independence
and social responsibility expected of the individual's age and cultural group;
and
(B)
initial manifestation during the developmental period (birth
to 18 years of age).
(3)
Mental retardation services--Programs and assistance provided
or paid for by a state agency for individuals with mental retardation.
§411.504.Model Program Standards for Mental Retardation Services.
(a)
Program standards for mental retardation services for an
individual with mental retardation must address:
(1)
basic protections for safety, health, rights, and freedom
from abuse, neglect, and exploitation;
(2)
due process if a person's rights are to be limited;
(3)
acceptable principles of practice to ensure that all medications
are administered safely and appropriately;
(4)
support to access health care and to participate in making
health care decisions;
(5)
provision of individualized supports for the person with
mental retardation as chosen by the person or the person's legally authorized
representative that promote the presence of the following personal outcomes
to the extent possible:
(A)
The individual chooses services.
(B)
The individual chooses where to work.
(C)
The individual lives in integrated environments.
(D)
The individual interacts with other members of the community.
(E)
The individual is satisfied with personal life situations.
(F)
The individual is respected.
(G)
The individual participates in the life of the community.
(H)
The individual has and keeps personal possessions.
(I)
The individual realizes personal goals.
(J)
The individual chooses daily routine.
(K)
The individual has time, space, and opportunity for privacy.
(L)
The individual has friends.
(b)
Biennially the department shall review the model standards
developed under subsection (a) of this section and determine whether each
standard contributes effectively to the consistency of service delivery by
state agencies
§411.505.References.
The following provisions of law are referenced in this subchapter:
Texas Health and Safety Code, §533.0345.
§411.506.Distribution.
This subchapter is distributed to the following persons:
(1)
executive, management, and program in TDMHMR Central Office;
(2)
superintendents/directors and executive directors of TDMHMR
state schools, state centers, and local mental retardation authorities;
(3)
the chief executive officers of following state agencies:
(A)
Texas Commission for the Blind;
(B)
Texas Department of Health;
(C)
Texas Health and Human Services Commission;
(D)
Texas Department of Human Services;
(E)
Texas Juvenile Probation Commission;
(F)
Texas Department of Protective and Regulatory Services;
(G)
Texas Rehabilitation Commission; and
(H)
any other state agency that may now or later provide or
purchase mental retardation services;
(4)
the chief executive officers of advocacy and consumer organizations
for persons with mental retardation; and
(5)
any interested person.
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 July 17, 2000.
TRD-200004922
Charles Cooper
Chairman, Texas MHMR Board
Texas Department of Mental Health and Mental Retardation
Earliest possible date of adoption: August 27, 2000
For further information, please call: (512) 206-4516