TITLE 25.HEALTH SERVICES

Part 2. TEXAS DEPARTMENT OF MENTAL HEALTH AND MENTAL RETARDATION

Chapter 401. SYSTEM ADMINISTRATION

Subchapter G. COMMUNITY MENTAL HEALTH AND MENTAL RETARDATION CENTERS

25 TAC §§401.441-401.456

The Texas Department of Mental Health and Mental Retardation (TDMHMR) adopts the repeals of §§401.441 - 401.456 of Chapter 401, Subchapter G, concerning community mental health and mental retardation centers, without changes as proposed in the February 25, 2000, issue of the Texas Register (25TexReg1514-1515). New §§411.301 - 411.316 of new Chapter 411, Subchapter G, concerning community MHMR centers, which replace the repealed sections, are contemporaneously adopted in this issue of the Texas Register .

The repeals allow for the adoption of new sections governing the same matters.

No comment on the proposed repeals was received.

These sections are repealed under the Texas Health and Safety Code, §532.015, which provides the Texas Mental Health and Mental Retardation Board (board) with broad rulemaking authority; §534.001(e), which requires the board to adopt rules specifying the elements that must be included in a community center's plan, and prescribing the procedure for submitting, approving, and modifying a center's plan; §534.006(a), which requires the board to adopt rules establishing an annual training program for members of boards of trustees; §534.021(a), which requires the board to adopt rules describing the approval and notification process relating to the acquisition of real property by a community center; §534.035(a), which requires the adoption of rules establishing review and audit procedures that provide reasonable assurance a community center has adequate and appropriate fiscal controls; and §534.038(d), which requires the board to adopt rules prescribing the process for a community center to appeal the commissioner's decision to appoint a manager or management team to manage and operate the center.

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 May 5, 2000.

TRD-200003168

Charles Cooper

Chairman, Texas MHMR Board

Texas Department of Mental Health and Mental Retardation

Effective date: May 25, 2000

Proposal publication date: February 25, 2000

For further information, please call: (512) 206-5216


Chapter 411. STATE AUTHORITY RESPONSIBILITIES

Subchapter G. COMMUNITY MHMR CENTERS

25 TAC §§411.301 - 401.316

The Texas Department of Mental Health and Mental Retardation (TDMHMR) adopts new §§411.301 - 411.316 of new Chapter 411, Subchapter G, concerning community MHMR centers. Sections 411.305 and 411.306 are adopted with changes to the proposed text as published in the February 25, 2000, issue of the Texas Register (25TexReg1515-1523). Sections 411.301 - 411.304 and 411.307 - 411.316 are adopted without changes. The repeals of §§401.441 - 401.456 of Chapter 401, Subchapter G, concerning community mental health and mental retardation centers, which the new sections replace, are contemporaneously repealed in this issue of the Texas Register .

The new rules are substantially the same as the rules they replace except in the following ways: The new rules establish review and audit procedures that provide reasonable assurance a community center has adequate and appropriate fiscal controls as required by the Texas Health and Safety Code, §534.035 (amended by the 76th Legislature, SB 452). The audit procedures include the current requirement for centers to submit copies of an annual audit of the center's accounts as well as an additional requirement for TDMHMR to conduct on-site audits of a center as it deems necessary. The review procedures include conducting a desk review of centers' annual audits and performing financial risk assessments based on centers' annual audit and/or any additional financial information that a center may be required to submit. Language is added to §411.310 requiring boards of trustees to assure TDMHMR unrestricted access to their centers' records, data, and other information to enable TDMHMR to audit, monitor, and review their centers' financial and programmatic activities and services as required by the rules' audit procedures and the Texas Health and Safety Code, §534.033 and §§534.035-.037. The new rules also replace language relating to appointment of a manager or management team with the statutory reference while continuing to include the process for a community center to appeal the commissioner's decision to appoint a manager or management team to manage and operate the center. Language is added to the "Charter To Be a Community Center" (Exhibit A) requiring centers to include in their plans their intention to create or operate a non-profit corporation as allowed by the Texas Health and Safety Code, Chapter 534, Subchapter C. The new rules also fulfill the requirements of the Texas Government Code, §2001.039, concerning the periodic review of agency rules.

Language in §411.305(c)(4) and §411.306(d) has been modified to be consistent with the statutory requirement contained in the Texas Health and Safety Code, §534.016.

Written comment on the proposal was received from the Parent Association for the Retarded of Texas (PART), Austin, and a parent of a state school resident, Garland.

Regarding the definition of "local authority" in §411.303(10), two commenters stated their belief that a local authority had to be non-profit and requested that the definition reflect such. The department responds that the definition is consistent with the definitions of "local mental health authority" and "local mental retardation authority" in §531.002 of the Texas Health and Safety Code, which do not include a requirement for non-profit status.

Regarding the principles of developing local services in §411.304(b)(1)-(3), two commenters recommended adding language that would equate persons receiving services with their legally authorized representatives (LARs) and narrow the influence of other stakeholders. The department responds that the principles described in the rule are general guidelines for developing publicly funded services at the local level and should be inclusive of all stakeholders. Additionally, it is unnecessary to add language equating LARs with persons receiving services because an LAR is legally responsible for acting in the person's best interest.

Regarding the provision of a comprehensive array of MHMR services in §411.305(a)(2)(C), two commenters requested that the phrase "including state schools" be added. The department declines to add the requested phrase because community centers are not responsible for providing state school services. The department notes that a local mental retardation authority, which could be a community center, must provide a person with mental retardation (or LAR) seeking residential services with a clear explanation of all of the programs and services for which the person is eligible, including state schools.

Regarding the ability of the commissioner to not accept the recommendation of the administrative law judge if it is not supported by substantial evidence in §411.305(c)(3)(B), §411.306(c)(2), and §411.309(b)(2), two commenters asked what would be the purpose having an administrative hearing if the commissioner could overrule the administrative law judge. The department responds that this is a model for administrative hearings that many regulatory agencies use. The administrative law judge hears and analyzes the evidence from all parties to the case, makes a proposal, and the commissioner has the discretion to make the final decision. This model makes sense to use when the decision is in a very specialized area and the agency wants to provide a forum for due process but keep the final decision-making authority with the head of the agency.

Regarding the phrase "provision of services to former consumers of a department facility" in §411.310(a)(3) and (b)(9)(C), two commenters requested changing the phrase to "provision of services to consumers entering or leaving a department facility" to be consistent with the language in §411.305(c)(4) and §411.306(d). The department responds that the language in §411.305(c)(4) and §411.306(d) has been modified because it did not accurately reflect the statutory requirement contained in the Texas Health and Safety Code, §534.016. The department declines to modify the language in §411.310(a)(3) and (b)(9)(C) because the requirements are consistent with the Texas Health and Safety Code, §534.016 and §534.033.

Regarding board of trustees training concerning the range of environments in which MHMR services are delivered in §411.310(c)(1)(C), two commenters requested that state schools be specifically mentioned as an environment. The department responds that there are numerous and varied environments in which MHMR services are delivered. To single out one environment could incorrectly imply its importance is greater than the others.

Regarding number 1 of Section II of the Exhibit A figure in §411.314(1), two commenters requested that the phrase "when appropriate and is the consumer's or LAR's choice" be added to the end of the second item. The commenters also requested that a third item be added stating, "providing services to persons entering or leaving state schools." The department responds that adding the commenters' suggested phrase would not make sense because the second item merely states that the purpose of a community center is to ensure the availability of a continuum of services, of which the center is a vital component, that "strives to develop services that are effective alternatives to large facilities." Developing and making available services that are effective alternatives to large facilities provide persons receiving services and their LARs with choices that they believe are appropriate. Regarding adding a third item, the department responds that the provision of services to persons entering or leaving state schools is part of the continuum of services that is addressed in the second item.

Regarding number 2 of Section II of the Exhibit A figure in §411.314(1), two commenters requested that "including state schools" be added after "comprehensive range of services." The department declines to add the requested phrase because community centers are responsible for providing a comprehensive range of services in the community . The department has the authority and responsibility for operating state schools.

Regarding the phrase "to assist in carrying out the policies of the state to assure treatment of persons in their own communities, when appropriate and feasible" in number 3 of Section II of the Exhibit A figure in §411.314(1), two commenters agreed with the statement and expressed appreciation that the rule acknowledges "the community" is not the only appropriate and feasible place for persons to receive services. The department appreciates the commenters' agreement.

These sections are adopted under the Texas Health and Safety Code, §532.015, which provides the Texas Mental Health and Mental Retardation Board (board) with broad rulemaking authority; §534.001(e), which requires the board to adopt rules specifying the elements that must be included in a community center's plan, and prescribing the procedure for submitting, approving, and modifying a center's plan; §534.006(a), which requires the board to adopt rules establishing an annual training program for members of boards of trustees; §534.021(a), which requires the board to adopt rules describing the approval and notification process relating to the acquisition of real property by a community center; §534.035(a), which requires the adoption of rules establishing review and audit procedures that provide reasonable assurance a community center has adequate and appropriate fiscal controls; and §534.038(d), which requires the board to adopt rules prescribing the process for a community center to appeal the commissioner's decision to appoint a manager or management team to manage and operate the center.

§411.305.Process to Establish a New Community Center.

(a)

Letter of intent. If a local agency decides to establish a new community center, then the local agency submits a letter of intent to the commissioner outlining the proposed new center's region, governing structure, and other information pertinent to the formation of the proposed new center.

(1)

If the local agency submitting the letter of intent is not a county or counties, the letter must be accompanied by a letter of endorsement from the appropriate county judge or judges.

(2)

The commissioner designates staff who are knowledgeable of community center operations to review the letter of intent using the following criteria:

(A)

the rationale clearly supports the benefits of establishing a new center over affiliation with an existing center and the establishment of a new center is consistent with the department's mission for the development of community services in Texas;

(B)

the population of the region of the proposed new center is at least 200,000 or large enough to support a center;

(C)

comprehensive array of mental health and mental retardation services will be provided;

(D)

the extent of the local contribution supports the intent; and

(E)

providing services efficiently is financially viable.

(3)

The commissioner's response to the local agency's letter of intent is based on the review described in paragraph (2) of this subsection and is sent to the local agency by certified mail, return receipt requested.

(A)

If the commissioner approves the letter of intent, the response includes notification of such approval.

(B)

If the commissioner does not approve the letter of intent, the response includes the reasons for disapproval.

(b)

Appointment of board of trustees. If the local agency receives approval of its letter of intent, then it prescribes the criteria and procedures for the appointment of members of a board of trustees as described in the Texas Health and Safety Code, §534.002 or §534.003, and §534.004, §534.005, and §534.0065. The local agency prescribes and makes available for public review the elements listed in the Texas Health and Safety Code, §534.004(a). If more than one agency is involved, the local agencies shall enter into a contract of interlocal agreement that stipulates the number of board members and the group from which the members are chosen, as provided in the Texas Health and Safety Code, §534.003(c). The local agencies may renegotiate or amend the contract of interlocal agreement as necessary to change the:

(1)

method of choosing the board of trustees members; or

(2)

membership of the board of trustees to more accurately reflect the ethnic and geographical diversity of the region's population.

(c)

Initial plan.

(1)

Submission. The board of trustees develops and submits to the commissioner an initial written plan to provide effective mental health and mental retardation services to the residents of the proposed region. The board of trustees shall appoint a mental health planning advisory council and a mental retardation planning advisory council, each with at least 50% representation of persons who have received or are receiving services or their family members, to assist in developing the initial plan. The board of trustees shall also seek input through a public process (e.g., public hearings, focus groups, town meetings) from the citizens in the proposed region regarding local needs and priorities. The initial plan must include the following elements:

(A)

a comprehensive service description, which includes:

(i)

a statement of the mission, vision, values, and principles which provide the foundation of the proposed community center's local service delivery system;

(ii)

a definition of all populations to be served;

(iii)

a description of relevant internal and external assessments and evaluations which may provide direction for the local strategic planning process;

(iv)

a statement of local service needs and priorities to be addressed through a combination of resource development, expansion, reduction, and termination with the local service delivery system with the rationales for these selections;

(v)

a summary of needs assessment data and processes used in the determination of local service needs and priorities;

(vi)

identified gaps in services and supports in the local service delivery system which may assist in the determination of local service needs and priorities;

(vii)

a description of existing local mental health and mental retardation resources and planned resource development activities;

(viii)

a statement regarding innovative services considered and how these affect the local strategic planning process;

(ix)

a statement of management needs and priorities to support an effective and efficient local service delivery system; and

(x)

plan objectives, strategies, and outcomes.

(B)

a charter in the format shown in "Charter To Be a Community MHMR Center," referenced as Exhibit A of §411.314 of this title (relating to Exhibits).

(C)

a prospectus, which describes:

(i)

any proposed transfer of funds, assets, liabilities, personnel, and consumer and administrative records/information from state-operated community services (SOCS) or other community centers and the time frames for transfer;

(ii)

any identified additional available funds;

(iii)

the arrangements for uninterrupted delivery of services; and

(iv)

the impact, and resolution if warranted, of current contractual obligations.

(2)

Review. The commissioner designates staff who are knowledgeable of community center operations to review the initial plan. The designated staff may verify the information contained in the initial plan. If additional information or changes are required for the commissioner to recommend approval, then the commissioner will notify in writing the board of trustees and specify requirements for resubmission, including time frames.

(3)

Notification of intended recommendation. The department notifies the board of trustees of the commissioner's intention to recommend approval or disapproval of the initial plan to the Texas MHMR Board. If the commissioner intends to recommend disapproval or partial disapproval, then:

(A)

the board of trustees may request an administrative hearing "proposal for decision" in accordance with §§411.153 - 411.158 of Chapter 411, Subchapter D of this title (relating to Administrative Hearings of the Department in Contested Cases). The hearing is not a hearing of a contested case under the Administrative Procedures Act and is limited to issues related to the initial plan. After all evidence has been heard, the administrative law judge closes the hearing. Within 30 days from the date the hearing closed, the administrative law judge submits a written proposal for decision to the commissioner;

(B)

the commissioner will accept the administrative law judge's recommendation in the proposal for decision unless the commissioner finds that the recommendation is not supported by substantial evidence; and

(C)

the department notifies the board of trustees of the commissioner's decision to recommend approval or disapproval of the initial plan to the Texas MHMR Board. If disapproval will be recommended, then no other appeal process is available.

(4)

Approval or disapproval. The commissioner recommends approval or disapproval of the initial plan to the Texas MHMR Board. The commissioner may recommend approval of portions of the initial plan and disapproval of other portions. The commissioner's recommendation shall include a written assessment of the initial plan by staff. A recommendation of approval requires that the assessment confirms that the initial plan properly fulfills the requirements of paragraph (1) of this subsection to provide a comprehensive array of mental health and mental retardation services, including screening and continuing care services in accordance with the Texas Health and Safety Code, §534.016.

(A)

If the Texas MHMR Board approves the initial plan in its entirety, then the department issues a certificate of recognition as a community center.

(B)

If the Texas MHMR Board approves portions of the initial plan and such approved portions properly fulfill the requirements of paragraph (1) of this subsection, then it instructs the official record to reflect such portions as the approved initial plan in its entirety and the department issues a certificate of recognition as a community center.

(C)

If the Texas MHMR Board does not approve the initial plan, then the department provides written notification to the board of trustees in a timely manner of the reasons for disapproval and the requirements for resubmission, including time frames.

(5)

Community center operations. A community center may perform and operate only for the purposes and functions defined in its current plan.

§411.306.Updating a Community Center's Current Plan.

(a)

Submission. On an assigned three-year cycle, or as requested by the Texas MHMR Board, or as necessary, the board of trustees of a community center shall submit to the commissioner an update of its current plan, which reflects the center's purposes and functions. The updated plan shall be in the format shown in "Charter To Be a Community MHMR Center," referenced as Exhibit A of §411.314 of this title (relating to Exhibits).

(b)

Review. The commissioner designates staff who are knowledgeable of community center operations to review the updated plan. The designated staff may verify the information contained in the updated plan. If additional information or changes are required for the commissioner to recommend approval, then the commissioner will notify in writing the board of trustees and specify requirements for resubmission, including time frames.

(c)

Notification of intended recommendation. The department notifies the board of trustees of the commissioner's intention to recommend approval or disapproval of the updated plan to the Texas MHMR Board. If the commissioner intends to recommend disapproval or partial disapproval, then:

(1)

the board of trustees may request an administrative hearing "proposal for decision" in accordance with §§411.153 - 411.158 of Chapter 411, Subchapter D of this title (relating to Administrative Hearings of the Department in Contested Cases). The hearing is not a hearing of a contested case under the Administrative Procedures Act and is limited to issues related to the updated plan. After all evidence has been heard, the administrative law judge closes the hearing. Within 30 days from the date the hearing closed, the administrative law judge submits a written proposal for decision to the commissioner;

(2)

the commissioner will accept the administrative law judge's recommendation in the proposal for decision unless the commissioner finds that the recommendation is not supported by substantial evidence; and

(3)

the department notifies the board of trustees of the commissioner's decision to recommend approval or disapproval of the updated plan to the Texas MHMR Board. If disapproval will be recommended, then no other appeal process is available.

(d)

Approval or disapproval. The commissioner recommends approval or disapproval of the updated plan to the Texas MHMR Board. The commissioner may recommend approval of portions of the updated plan and disapproval of other portions. The commissioner's recommendation shall include a written assessment of the updated plan by staff. A recommendation of approval requires that the assessment confirm that the updated plan properly fulfills the requirements contained in "Charter To Be a Community MHMR Center," referenced as Exhibit A of §411.314 of this title (relating to Exhibits), to provide a comprehensive array of mental health and mental retardation services, including screening and continuing care services in accordance with the Texas Health and Safety Code, §534.016.

(1)

If the Texas MHMR Board approves the updated plan in its entirety, then the department issues an updated a certificate of recognition as a community center.

(2)

If the Texas MHMR Board approves portions of the updated plan and such approved portions properly fulfill the requirements contained in "Charter To Be a Community MHMR Center," referenced as Exhibit A of §411.314 of this title (relating to Exhibits), then it instructs the official record to reflect such portions as the approved updated plan in its entirety and the department issues an updated certificate of recognition as a community center.

(3)

If the Texas MHMR Board does not approve the updated plan, then the department provides written notification to the board of trustees in a timely manner of the reasons for disapproval and the requirements for resubmission, if any, including time frames and the functions the community center may perform pending approval. If the Texas MHMR Board does not provide requirements for resubmission then the department no longer recognizes the entity as a community center.

(e)

Community center operations. A community center may perform and operate only for the purposes and functions defined in its current plan or as provided for in subsection (d)(3) of this section.

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 May 5, 2000.

TRD-200003167

Charles Cooper

Chairman, Texas MHMR Board

Texas Department of Mental Health and Mental Retardation

Effective date: May 25, 2000

Proposal publication date: February 25, 2000

For further information, please call: (512) 206-5216