TITLE 25.HEALTH SERVICES

Part 1. TEXAS DEPARTMENT OF HEALTH

Chapter 97. COMMUNICABLE DISEASES

Subchapter F. SEXUALLY TRANSMITTED DISEASES INCLUDING ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) AND HUMAN IMMUNODEFICIENCY VIRUS (HIV)

25 TAC §§97.131, 97.134, 97.137, 97.140, 97.142, 97.144

The Texas Department of Health (department) adopts amendments to §§97.131, 97.134, 97.137, 97.140, 97.142, and 97.144 concerning sexually transmitted diseases including acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) without changes to the proposed text as published in the March 9, 2001, issue of the Texas Register (26 TexReg 1977), and therefore the sections will not be republished.

Government Code §2001.039 requires that each state agency review and consider for readoption each rule adopted by that agency pursuant to Government Code, Chapter 2001 (Administrative Procedure Act). Sections 97.131 - 97.146 have been reviewed and the department has determined that reasons for adopting the sections continue to exist; specific amendments covering definitions; how to report sexually transmitted disease; exposure of health-care personnel to AIDS, HIV infection; counseling and testing for state employees exposed to HIV infection on the job; model health education program/resource guide for HIV/AIDS education of school-age children; and model policies for handling, care, and treatment of HIV/AIDS-infected persons in the custody of or under the supervision of correctional facilities, law enforcement agencies, fire departments, emergency medical services providers, and district probation departments are necessary and described in this preamble.

The department published a Notice of Intention to Review §§97.131 - 97.146 as required by Government Code §2001.039 in the Texas Register on January 14, 2000 (25 TexReg 275). No comments were received due to this publication.

The adopted amendment to §97.131 deletes a reference to the United States Public Health Service and retains the definition of AIDS and HIV infection as defined by the Centers for Disease Control and Prevention. The amendment adds the four-digit expanded code "-3199" to the department's zip code.

The adopted amendment to §97.134 pluralizes the word disease in the title of the section, and adds the four-digit expanded code "-3199" to the department's zip code.

The adopted amendment to §97.137 deletes the specific name of the publication to which health-care personnel should refer to prevent job-related exposures to HIV infection, and re-directs them to follow the most current guidance provided by the Centers for Disease Control and Prevention. This adopted amendment is necessary to prevent incorrect reference to federal guidance which may be subject to title change, and refers stakeholders to contact the department for publications related to the prevention of HIV or AIDS.

The adopted amendment to §97.140 deletes the specific name of the publication which provides guidelines for counseling state employees who are exposed to HIV on the job, and re-directs them to follow the most current guidelines developed by the department. This adopted amendment is necessary to prevent incorrect reference to department guidance which may be subject to title change. The adopted amendment also reflects a change of name and address for the State Office of Risk Management.

The adopted amendment to §97.142 deletes the specific name of the publication which provides information on the model education program and also serves as a resource guide for health educators in accordance with the Health and Safety Code, Chapter 85, §§85.004 - 85.005 and §85.007, and Chapter 163, §§163.001 - 163.002. This adopted amendment is necessary to prevent incorrect reference to department guidance which may be subject to title change. The adopted amendment also removes language that reflected a charge would be imposed for copies of the publication. Adopted amended language makes copies available upon request.

The adopted amendment to §97.144 deletes the specific name of the publication which serves as model policies concerning persons in custody as required by the Health and Safety Code, Chapter 85, §85.141. This adopted amendment is necessary to prevent incorrect reference to department guidance which may be subject to title change. The adopted amendment also reflects a change of name in the program from which copies may be obtained.

Minor editorial changes were made in the proposed rules to clarify intent and improve the accuracy of the sections.

No comments were received on the proposal during the comment period.

The amendments are adopted under the Health and Safety Code, §81.004, which provides the board authority to adopt rules necessary for the effective administration and implementation of Chapter 81, Communicable Diseases; §85.016, which provides the board with authority to adopt rules necessary to implement Subchapters A through F of Chapter 85, Acquired Immune Deficiency Syndrome and Human Immunodeficiency Virus Infection; and the Health and Safety Code, §12.001, which provides the board with the authority to adopt rules for its procedure and for the performance of each duty imposed by law on the board, the department, or the commissioner of health.

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 July 16, 2001.

TRD-200104102

Susan Steeg

General Counsel

Texas Department of Health

Effective date: August 5, 2001

Proposal publication date: March 9, 2001

For further information, please call: (512) 458-7236


Part 2. TEXAS DEPARTMENT OF MENTAL HEALTH AND MENTAL RETARDATION

Chapter 406. ICF/MR PROGRAMS

Subchapter C. VENDOR PAYMENTS

25 TAC §§406.101, 406.103 - 406.107

The Texas Department of Mental Health and Mental Retardation (department) adopts the repeal of Chapter 406, Subchapter C, governing vendor payments, without changes to the text as proposed in the March 30, 2001, issue of the Texas Register (26 TexReg 2479).

Except for §406.106, the subject matter of the subchapter is addressed in new sections of Chapter 419, Subchapter E, governing ICF/MR Programs. The department does not believe that the subject matter of §406.106 should be required.

The repeal is part of a comprehensive reorganization of chapters and subchapters within the department's portion of the Texas Administrative Code in conjunction with the sunset review of agency rules required by Texas Government Code, §2001.039 (as added by Senate Bill 178, Section 1.11, 76th Legislature).

No written comments were received concerning the proposed repeal.

The repeals are adopted under the Texas Health and Safety Code, §532.015(a), which provides the Texas Board of Mental Health and Mental Retardation with broad rulemaking authority; the Texas Government Code, §531.021(a), and the Texas Human Resources Code, §32.021(a), which provide the Texas Health and Human Services Commission (HHSC) with the authority to administer the federal medical assistance (Medicaid) program in Texas; Acts 1995, 74th Texas Legislature, Chapter 6, §1, (Senate Bill 509), which clarifies the authority of HHSC to delegate the operation of all or part of a Medicaid program to a health and human services agency; and the Human Resources Code, §32.021(c), which provides an agency operating part of the Medicaid program with the authority to adopt necessary rules for the proper and efficient operation of the program. HHSC has delegated to the department the authority to operate the ICF/MR Program.

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 July 18, 2001.

TRD-200104171

Andrew Hardin

Chair, Texas MHMR Board

Texas Department of Mental Health and Mental Retardation

Effective date: September 1, 2001

Proposal publication date: March 30, 2001

For further information, please call: (512) 206-5232


Subchapter E. ELIGIBILITY AND REVIEW

25 TAC §§406.201 - 406.217

The Texas Department of Mental Health and Mental Retardation (department) adopts the repeal of Chapter 406, Subchapter E, governing eligibility and review, without changes to the text as proposed in the May 18, 2001, issue of the Texas Register (26 TexReg 3599).

Except for §406.216, the subject matter of the subchapter is addressed in new sections of Chapter 419, Subchapter E, governing ICF/MR Programs. The department does not believe that the subject matter of §206.216 should be required.

The repeal is part of a comprehensive reorganization of chapters and subchapters within the department's portion of the Texas Administrative Code in conjunction with the sunset review of agency rules required by Texas Government Code, §2001.039 (as added by Senate Bill 178, §1.11, 76th Legislature).

No written comments were received concerning the proposed repeal.

The repeal is adopted under the Texas Health and Safety Code, §532.015(a), which provides the Texas Board of Mental Health and Mental Retardation with broad rulemaking authority; the Texas Government Code, §531.021(a), and the Texas Human Resources Code, §32.021(a), which provide the Texas Health and Human Services Commission (HHSC) with the authority to administer the federal medical assistance (Medicaid) program in Texas; Acts 1995, 74th Texas Legislature, Chapter 6, §1, (Senate Bill 509), which clarifies the authority of HHSC to delegate the operation of all or part of a Medicaid program to a health and human services agency; and the Human Resources Code, §32.021(c), which provides an agency operating part of the Medicaid program with the authority to adopt necessary rules for the proper and efficient operation of the program. HHSC has delegated to the department the authority to operate the ICF/MR Program.

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 July 18, 2001.

TRD-200104172

Andrew Hardin

Chair, Texas MHMR Board

Texas Department of Mental Health and Mental Retardation

Effective date: September 1, 2001

Proposal publication date: May 18, 2001

For further information, please call: (512) 206-5232


Subchapter G. ADDITIONAL FACILITY RESPONSIBILITIES

25 TAC §§406.302 - 406.309, 406.311

The Texas Department of Mental Health and Mental Retardation (department) adopts the repeals of §§406.302-406.309 and §406.311 of Chapter 406, Subchapter G, governing additional facility responsibilities, without changes to the text as proposed in the March 30, 2001, issue of the Texas Register (26 TexReg 2479).

The subject matter of the following sections that are being repealed is addressed in new sections of Chapter 419, Subchapter E, governing ICF/MR Program: §406.303, governing facility capacity; §406.304, governing release from the facility; §406.308, record retention and other related record requirements; §406.309, governing abuse and neglect reporting requirements; and §406.311, governing living options. The subject matter of the following sections that are being repealed is not addressed in the new sections because those topics already are addressed in either federal regulations or Texas Department of Health rules: §406.302, governing day services; §406.305, governing health and hygiene services; §406.306, governing requirements for self-administration of medication; and §406.307, governing medical transportation.

The repeals are part of a comprehensive reorganization of chapters and subchapters within the department's portion of the Texas Administrative Code in conjunction with the sunset review of agency rules required by Texas Government Code, §2001.039 (as added by Senate Bill 178, Section 1.11, 76th Legislature).

No written comments were received concerning the proposed repeal.

The repeals are adopted under the Texas Health and Safety Code, §532.015(a), which provides the Texas Board of Mental Health and Mental Retardation with broad rulemaking authority; the Texas Government Code, §531.021(a), and the Texas Human Resources Code, §32.021(a), which provide the Texas Health and Human Services Commission (HHSC) with the authority to administer the federal medical assistance (Medicaid) program in Texas; Acts 1995, 74th Texas Legislature, Chapter 6, §1, (Senate Bill 509), which clarifies the authority of HHSC to delegate the operation of all or part of a Medicaid program to a health and human services agency; and the Human Resources Code, §32.021(c), which provides an agency operating part of the Medicaid program with the authority to adopt necessary rules for the proper and efficient operation of the program. HHSC has delegated to the department the authority to operate the ICF/MR Program.

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 July 18, 2001.

TRD-200104173

Andrew Hardin

Chair, Texas MHMR Board

Texas Department of Mental Health and Mental Retardation

Effective date: September 1, 2001

Proposal publication date: March 30, 2001

For further information, please call: (512) 206-5232


Chapter 409. MEDICAID PROGRAMS

Subchapter L. MENTAL RETARDATION LOCAL AUTHORITY (MRLA) PROGRAM

25 TAC §§409.505, 409.523, 409.525

The Texas Department of Mental Health and Mental Retardation (department) adopts amendments to §409.505, concerning eligibility criteria, §409.523 concerning maintenance of MRLA program waiting list, and §409.525, concerning process for referral and enrollment of individuals, of Chapter 409, Subchapter L, concerning mental retardation local authority (MRLA) program, without changes to the text as proposed in the June 1, 2001, issue of the Texas Register (26 TexReg 3914).

The amendments to §409.505, concerning eligibility criteria, correspond to recently approved revisions in Intermediate Care Facilities for Persons with Mental Retardation (ICF/MR) Program rules that combine the criteria for level-of-care (LOC) I, V, and VI under a single LOC designation, LOC I, while retaining the current LOC VIII designation. The amendments also update references to new sections of Chapter 419, Subchapter E, concerning ICF/MR Program rules, which were approved for adoption in June by the Texas Mental Health and Mental Retardation Board. A reference to the new ICF/MR Program rules also is updated by an amendment to §409.525, concerning process for referral and enrollment of individuals.

The amendments to §409.523, concerning maintenance of MRLA program waiting list, changes the length of time an applicant or the applicant's legally authorized representative (LAR) has to respond to an MRA's notification that a program opening is available to the applicant. The current rule permits 60 calendar days; the amendments shorten the time to 20 working days. In addition, the amendments allow the MRA to remove an applicant's name from the waiting list if the applicant or the LAR does not respond to the MRA's attempts to contact the applicant or LAR during the MRA's annual update of its waiting list. The amendments also add provisions allowing an applicant's name to be re-instated to the MRA's waiting list based on the department's review of the circumstances under which the name was removed.

A hearing to accept public comment concerning the proposed amendments was held on June 13, 2001, in Austin. No testimony was presented. Written comments were received from the parent/guardian of a state MR facility resident, Garland; and the Parent Association for the Retarded of Texas, Austin.

Concerning the amendments to §§409.505 and 409.523, two commenters questioned why the criteria for level-of-care (LOC) I, V, and VI have been combined under a single LOC designation, LOC I, while retaining the current LOC VIII designation. The department responds that because the assignments of LOCs for the waiver programs are based upon criteria used in the ICF/MR Program, these rules were revised to be consistent with changes in the ICF/MR program to be effective September 1, 2001. The revision of the ICF/MR Program rules combined three levels of care for a diagnosis of mental retardation to one level of care. Upon implementation of the revision there will be one level of care for the diagnosis of mental retardation and one level of care for the diagnosis of a related condition.

Concerning the amendments to §419.165, two commenters asked what method an MRA uses to contact applicants and LARs and how the attempts are documented. The commenters asked if the contact is by registered letter, which requires a proof of receipt, and whether more than one attempt is made to contact the applicant or LAR. The department responds that the contract between the department and an MRA requires MRA staff to attempt to contact the individual or LAR. If attempts to contact the individual or LAR are unsuccessful, the MRA must contact the individual by certified mail, telephone, or face-to-face to determine continued interest in having the individual's name remain on the waiting list. The MRA must document these efforts in the Client Assignment and Registration System (CARE).

The amendments are adopted under the Texas Health and Safety Code, §532.015(a), which provides the Texas Board of Mental Health and Mental Retardation with broad rulemaking authority; the Texas Government Code, §531.021(a), and the Texas Human Resources Code, §32.021(a), which provide the Texas Health and Human Services Commission (THHSC) with the authority to administer the federal medical assistance (Medicaid) program in Texas; Acts 1995, 74th Texas Legislature, Chapter 6, §1, (Senate Bill 509), which clarifies the authority of THHSC to delegate the operation of all or part of a Medicaid program to a health and human services agency; and the Human Resources Code, §32.021(c), which provides an agency operating part of the Medicaid program with the authority to adopt necessary rules for the proper and efficient operation of the program. THHSC has delegated to the department the authority to operate the MRLA Program.

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 July 18, 2001.

TRD-200104170

Andrew Hardin

Chair, Texas MHMR Board

Texas Department of Mental Health and Mental Retardation

Effective date: September 1, 2001

Proposal publication date: June 1, 2001

For further information, please call: (512) 206-5232


Chapter 419. MEDICAID STATE OPERATING AGENCY RESPONSIBILITIES

Subchapter D. HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM

25 TAC §§419.155, 419.159, 419.164, 419.165

The Texas Department of Mental Health and Mental Retardation (department) adopts amendments to §419.155, concerning eligibility criteria, §419.159, concerning level of care (LOC) determination, and §419.165, concerning maintenance of HCS Program waiting list, of Chapter 419, Subchapter D, concerning home and community-based services (HCS) program, without changes to the text as proposed for public comment in the June 1, 2001, issue of the Texas Register (26 TexReg 3915). Section 419.164, concerning process for enrollment of applicants, is adopted with changes.

The amendments to §419.155, concerning eligibility criteria, correspond to recently approved revisions in Intermediate Care Facilities for Persons with Mental Retardation (ICF/MR) Program rules that combine the criteria for level-of-care (LOC) I, V, and VI under a single LOC designation, LOC I, while retaining the current LOC VIII designation. The revisions also update references to the new sections of Chapter 419, Subchapter E, concerning ICF/MR Program rules, which were approved for adoption in June by the Texas Mental Health and Mental Retardation Board. References to the recently adopted ICF/MR Program rules also are updated by amendments to §419.159, concerning level of care (LOC) determination, and §419.164, concerning process for enrollment of applicants. In addition, §419.164 is amended to update a reference to a recently adopted department rule, Chapter 415, Subchapter D, concerning diagnostic eligibility for services and supports -- mental retardation priority population and related conditions.

The amendments to §419.165, concerning maintenance of HCS Program waiting list, change the length of time an applicant or the applicant's legally authorized representative (LAR) has to respond to an mental retardation authority's (MRA) notification that a program opening is available to the applicant. The current rule permits 60 calendar days; the amendments shorten the time to 20 working days. In addition, the amendments allow the MRA to remove an applicant's name from the waiting list if the applicant or the LAR does not respond to the MRA's attempts to contact the applicant or LAR during the MRA's annual update of the its waiting list. The amendments also add provisions allowing an applicant's name to be re-instated to an MRA's waiting list based on the department's review of the circumstances under which the name was removed.

Clauses (a)(4)(B)(i) and (ii) of §419.164, concerning process for enrollment of applicants, are restructured to more clearly delineate the actions an MRA must take to enroll an applicant, and clause (iii) is relettered as new clause (ii).

A hearing to accept public comment concerning the proposed amendments was held on June 13, 2001, in Austin. No testimony was presented. Written comments were received from the parent/guardian of a state MR facility resident, Garland; and the Parent Association for the Retarded of Texas, Austin.

Concerning the amendments to §419.155, two commenters questioned why the criteria for level-of-care (LOC) I, V, and VI have been combined under a single LOC designation, LOC I, while retaining the current LOC VIII designation. The department responds that because the assignments of LOCs for the waiver programs are based upon criteria used in the ICF/MR Program, these rules were revised to be consistent with changes in the ICF/MR program to be effective September 1, 2001. The revision of the ICF/MR Program rules combined three levels of care for a diagnosis of mental retardation to one level of care. Upon implementation of the revision there will be one level of care for the diagnosis of mental retardation and one level of care for the diagnosis of a related condition.

Concerning the amendments to §419.165, two commenters asked what method an MRA uses to contact applicants and LARs and how the attempts are documented. The commenters asked if the contact is by registered letter, which requires a proof of receipt, and whether more than one attempt is made to contact the applicant or LAR. The department responds that the contract between the department and an MRA requires MRA staff to attempt to contact the individual or LAR. If attempts to contact the individual or LAR are unsuccessful, the MRA must contact the individual by certified mail, telephone, or face-to-face to determine continued interest in having the individual's name remain on the waiting list. The MRA must document these efforts in the Client Assignment and Registration System (CARE).

The amendments are adopted under the Texas Health and Safety Code, §532.015(a), which provides the Texas Board of Mental Health and Mental Retardation with broad rulemaking authority; the Texas Government Code, §531.021(a), and the Texas Human Resources Code, §32.021(a), which provide the Texas Health and Human Services Commission (THHSC) with the authority to administer the federal medical assistance (Medicaid) program in Texas; Acts 1995, 74th Texas Legislature, Chapter 6, §1, (Senate Bill 509), which clarifies the authority of THHSC to delegate the operation of all or part of a Medicaid program to a health and human services agency; and the Human Resources Code, §32.021(c), which provides an agency operating part of the Medicaid program with the authority to adopt necessary rules for the proper and efficient operation of the program. THHSC has delegated to the department the authority to operate the HCS Program.

§419.164.Process for Enrollment of Applicants.

(a) An applicant or the applicant's LAR on behalf of the applicant must submit a written request for HCS Program services to the MRA serving the area where the applicant wishes to receive services.

(1) The MRA must register the applicant on the MRA's waiting list as specified in §419.165 of this title (relating to Maintenance of HCS Program Waiting List).

(2) Upon written notification by the department of a program vacancy in the MRA's local service area, the MRA notifies the first applicant on the waiting list of the vacancy and begins the enrollment process by informing the applicant or the LAR of the applicant's right to choose between participation in the ICF/MR Program in a state school setting or a community-based setting, the HCS Program, or other services. The MRA must document the applicant's choice of programs or the LAR's choice on behalf of the applicant on the HCS Verification of Choice form. Copies of the HCS Verification of Choice form are available by contacting the Texas Department of Mental Health and Mental Retardation, Office of Medicaid Administration, P.O. Box 12668, Austin, Texas 78711-2668.

(3) If the applicant or the LAR chooses participation in the HCS Program, the MRA will assign a service coordinator who develops a person-directed plan (PDP) in conjunction with the service planning team. The service planning team must include the applicant and the LAR acting on the applicant's behalf and may include other persons chosen by the applicant and the LAR. At minimum, the PDP must include the following:

(A) a description of the applicant's current services and supports, identifying those that will be available if the applicant is enrolled in the HCS Program;

(B) a description of outcomes to be achieved for the applicant through the HCS Program, including determinations of further service needs through assessments to be accomplished after enrollment, and justification for each service component to be included in the IPC;

(C) documentation that the type and amount of each service component included in the individual's IPC:

(i) are necessary for the individual to live in the community, to ensure the individual's health and welfare in the community, and to prevent the need for institutional services;

(ii) do not replace existing natural supports or other non-program sources for the service components; and

(iii) when the proposed IPC includes residential support, the reasons that the team concluded that supervision and assistance from awake service providers during normal sleeping hours are required to assure the individual's health and welfare including but not limited to the individual's demonstrated needs for staff intervention to respond to:

(I) the individual's medical condition;

(II) a behavior displayed by the individual that poses a danger to the individual or to others; or

(III) the individual's need for assistance with activities of daily living during normal sleeping hours;

(D) a description of all determinations needed to establish the applicant's eligibility for SSI or Medicaid benefits and for a LOC; and

(E) a description of actions and methods to be used to reach identified service outcomes, projected completion dates, and person(s) responsible for completion.

(4) The MRA compiles and maintains information necessary to process the applicant's request, or LAR's request on behalf of the applicant, for enrollment in the HCS Program.

(A) If the applicant's financial eligibility for the HCS Program must be established, the MRA initiates, monitors, and supports the processes necessary to obtain a financial eligibility determination.

(B) The MRA must complete an MR/RC Assessment if a LOC determination is necessary, in accordance with §419.159 and §419.161 of this title (relating to Level of Care (LOC) Determination and Level of Need Assignment, respectively).

(i) The MRA must:

(I) perform or endorse a determination that the applicant has mental retardation in accordance with Chapter 415, Subchapter D of this title (relating to Diagnostic Eligibility for Services and Supports -- Mental Retardation Priority Population and Related Conditions); or

(II) verify that the applicant has been diagnosed by a licensed physician as having a related condition as defined in §419.203 of this title (relating to Definitions).

(ii) The MRA must administer the ICAP and recommend a LON assignment to the department in accordance with §§419.161 and 419.162 of this title (relating Level of Need Assignment and Department Review of Level of Need (LON), respectively).

(C) The MRA must develop a proposed IPC with the applicant or the LAR based on the PDP and in accordance with this subchapter.

(5) The service coordinator must inform the applicant or the LAR of all available HCS program providers in the local service area. The service coordinator must:

(A) provide information to the applicant or the LAR regarding program providers in the MRA's local service area;

(B) review the proposed IPC with potential program providers as requested by the applicant or the LAR;

(C) arrange for meetings/visits with potential program providers as desired by the applicant or the LAR;

(D) assure that the applicant's or LAR's choice of a program provider is documented, signed by the applicant or the LAR, and retained by the MRA in the applicant's record; and

(E) negotiate/finalize the proposed IPC and the date services will begin with the selected program provider. If the service coordinator and the selected program provider are unable to agree on the proposed IPC, the service coordinator and program provider will consult jointly with the department to achieve resolution.

(b) When the proposed IPC is finalized and the selected program provider has agreed to deliver the services delineated on the IPC, the MRA will submit the enrollment information to the department. When appropriate, the MRA will also submit supporting documentation as required in §419.158(b) of this title (relating to Department Review of Individual Plan of Care (IPC)) and §419.162(b) of this title (relating to Department Review of Level of Need (LON)).

(c) The department will notify the applicant or the LAR, the selected program provider, and the MRA of its approval or denial of the applicant's enrollment. When enrollment is approved, the department must authorize the applicant's enrollment in the HCS Program through the automated enrollment and billing system and issue an enrollment letter that includes the effective date of the applicant's enrollment in the HCS Program.

(d) Upon notification of an applicant's enrollment approval, the MRA must provide the selected program provider copies of all enrollment documentation, and associated supporting documentation including relevant assessment results and recommendations and the applicant's PDP.

(e) The selected program provider must not initiate services until notified of the department's approval of the individual's enrollment.

(f) The selected program provider must develop an initial ISP in accordance with §419.174 of this title (relating to Certification Principles: Service Delivery) based on the PDP and IPC as developed by the service planning team.

(g) When the department assigns a program vacancy to an applicant who is a member of a specific target group identified in the approved waiver, the MRA must assist the applicant with the enrollment process in accordance with 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 July 18, 2001.

TRD-200104168

Andrew Hardin

Chair, Texas MHMR Board

Texas Department of Mental Health and Mental Retardation

Effective date: September 1, 2001

Proposal publication date: June 1, 2001

For further information, please call: (512) 206-5232


Subchapter P. HOME AND COMMUNITY-BASED SERVICES - OBRA (HCS-O) PROGRAM

25 TAC §419.655, §419.659

The Texas Department of Mental Health and Mental Retardation (department) adopts amendments to §419.655, concerning eligibility criteria, and §419.659, concerning level of care (LOC) determination, of Chapter 419, Subchapter P, concerning home and community-based services -- OBRA (HCS-O) program, without changes to the text as proposed in the July 2, 2001, issue of the Texas Register (26 TexReg 3917).

The amendments to §419.655, concerning eligibility criteria, correspond to revisions in Intermediate Care Facilities for Persons with Mental Retardation (ICF/MR) Program rules that combine the criteria for level-of-care (LOC) I, V, and VI under a single LOC designation, LOC I, while retaining the current LOC VIII designation. The amendments to §419.659, concerning level of care (LOC) determination, update references to the new sections of Chapter 419, Subchapter E, concerning ICF/MR Program rules, which were approved for adoption in June by the Texas Mental Health and Mental Retardation Board.

A hearing to accept public comment concerning the proposed amendments was held on June 13, 2001, in Austin. No testimony was presented. Written comments were received from the parent/guardian of a state MR facility resident, Garland; and the Parent Association for the Retarded of Texas, Austin.

Concerning the amendments to §419.655, two commenters questioned why the criteria for level-of-care (LOC) I, V, and VI have been combined under a single LOC designation, LOC I, while retaining the current LOC VIII designation. The department responds that because the assignments of LOCs for the waiver programs are based upon criteria used in the ICF/MR Program, these rules were revised to be consistent with changes in the ICF/MR program to be effective September 1, 2001. The revision of the ICF/MR Program rules combined three levels of care for a diagnosis of mental retardation to one level of care. Upon implementation of the revision there will be one level of care for the diagnosis of mental retardation and one level of care for the diagnosis of a related condition.

The amendments are adopted under the Texas Health and Safety Code, §532.015(a), which provides the Texas Board of Mental Health and Mental Retardation with broad rulemaking authority; the Texas Government Code, §531.021(a), and the Texas Human Resources Code, §32.021(a), which provide the Texas Health and Human Services Commission (THHSC) with the authority to administer the federal medical assistance (Medicaid) program in Texas; Acts 1995, 74th Texas Legislature, Chapter 6, §1, (Senate Bill 509), which clarifies the authority of THHSC to delegate the operation of all or part of a Medicaid program to a health and human services agency; and the Human Resources Code, §32.021(c), which provides an agency operating part of the Medicaid program with the authority to adopt necessary rules for the proper and efficient operation of the program. THHSC has delegated to the department the authority to operate the HCS-O Program.

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 July 18, 2001.

TRD-200104169

Andrew Hardin

Chair, Texas MHMR Board

Texas Department of Mental Health and Mental Retardation

Effective date: September 1, 2001

Proposal publication date: June 1, 2001

For further information, please call: (512) 206-5232