TITLE 25.HEALTH SERVICES

Part 2. TEXAS DEPARTMENT OF MENTAL HEALTH AND MENTAL RETARDATION

Chapter 403. OTHER AGENCIES AND THE PUBLIC

Subchapter B. CHARGES FOR COMMUNITY-BASED SERVICES

25 TAC §§403.41 - 403.53

(Editor's note: The text of the following sections proposed for repeal will not be published. The sections may be examined in the offices of the Texas Department of Mental Health and Mental Retardation or in the Texas Register office, Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)

The Texas Department of Mental Health and Mental Retardation (TDMHMR) proposes the repeals of §§403.41 - 403.53 of Chapter 403, Subchapter B, concerning charges for community-based services. New §§412.101 - 412.114 of Chapter 412, Subchapter C, concerning charges for community services, which would replace the repealed sections, are contemporaneously proposed in this issue of the Texas Register .

The repeals would allow for the adoption of new and more current rules governing the same matters. The proposal would also fulfill the requirements of the Texas Government Code, §2001.039, concerning the periodic review of agency rules.

Gerry McKimmey, deputy commissioner for community programs, has determined that for each year of the first five years the proposed repeals are in effect, the proposed repeals do not have foreseeable implications relating to costs or revenues of the state or local governments.

Sam Shore, director, Behavioral Health Services, has determined that, for each year of the first five years the proposed repeals are in effect, the public benefit expected is the adoption of new and more current rules governing the same matters. It is anticipated that there would be no economic cost to persons required to comply with the proposed repeals.

It is not anticipated that the proposed repeals will affect a local economy.

It is not anticipated that the proposed repeals will have an adverse economic effect on small businesses or micro-businesses because the proposed repeals do not place requirements on small businesses or micro-businesses.

Written comments on the proposed repeals 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.

These sections are proposed for repeal under the Texas Health and Safety Code, §532.015, which provides the Texas Board of Mental Health and Mental Retardation (board) with broad rulemaking authority, and §534.067, which requires TDMHMR to establish a uniform fee collection policy for all local authorities that is equitable, provides for collections, and maximizes contributions to local revenue.

The proposed sections would affect the Texas Health and Safety Code, §534.067.

§403.41.Purpose.

§403.42.Application.

§403.43.Definitions.

§403.44.Principles.

§403.45.Financial Assessment.

§403.46.Determination of Ability to Pay.

§403.47.Rates.

§403.48.Billing Procedures.

§403.49.Monthly Ability-to-Pay Fee Schedule.

§403.50.Training.

§403.51.Information for Persons.

§403.52.References.

§403.53.Distribution.

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 February 12, 2001.

TRD-200100866

Andrew Hardin

Chairman, Texas MHMR Board

Texas Department of Mental Health and Mental Retardation

Earliest possible date of adoption: March 25, 2001

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


Chapter 412. LOCAL AUTHORITY RESPONSIBILITIES

Subchapter C. CHARGES FOR COMMUNITY SERVICES

25 TAC §§412.101 - 412.114

The Texas Department of Mental Health and Mental Retardation (TDMHMR) proposes new §§412.101 - 412.114 of new Chapter 412, Subchapter C, concerning charges for community services. The repeals of §§403.41 - 403.53 of Chapter 403, Subchapter B, concerning charges for community-based services, which the new sections would replace, are contemporaneously proposed in this issue of the Texas Register .

The proposed new sections describe TDMHMR's uniform fee collection policy for all local authorities that is equitable, provides for collections, and maximizes contributions to local revenue as required by the Texas Health and Safety Code, §534.067.

The proposed sections would fulfill the requirements of the Texas Government Code, §2001.039, concerning the periodic review of agency rules.

Gerry McKimmey, deputy commissioner for community programs, has determined that for each year of the first five years the proposed sections are in effect, enforcing or administering the sections does not have foreseeable implications relating to costs or revenues of the state or local governments.

Sam Shore, director, Behavioral Health Services, has determined that, for each year of the first five years the proposed sections are in effect, the public benefit expected is the implementation of a uniform fee collection policy for all local authorities that is equitable, provides for collections, and maximizes contributions to local revenue. It is anticipated that there would be no additional economic cost to persons required to comply with the proposed sections because the sections do not place additional requirements related to costs on such persons than those in the sections proposed for repeal.

It is not anticipated that the proposed sections will affect a local economy.

It is not anticipated that the proposed sections will have an adverse economic effect on small businesses or micro-businesses because the sections do not place additional requirements on small or micro-businesses than those in the sections proposed for repeal.

Written comments on the proposed sections 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.

These new sections are proposed under the Texas Health and Safety Code, §532.015, which provides the Texas Board of Mental Health and Mental Retardation (board) with broad rulemaking authority, and §534.067, which requires TDMHMR to establish a uniform fee collection policy for all local authorities that is equitable, provides for collections, and maximizes contributions to local revenue.

The proposed sections would affect the Texas Health and Safety Code, §534.067.

§412.101.Purpose.

(a)

The purpose of this subchapter is to comply with the Texas Health and Safety Code, §534.067, and the Health Care Financing Administration's interpretation of the Social Security Act, Section 1902(a)(17)(B) (which prohibits Medicaid payments for a free service), by establishing a uniform fee collection policy for local authorities for community services contracted for through the performance contract that are funded by TDMHMR and required local match and provided to members of the priority population that:

(1)

is equitable;

(2)

provides for collections; and

(3)

maximizes contributions to local revenue.

(b)

The provisions of this subchapter are not intended to preempt payment for community services by other funding sources (e.g., Texas Commission on Alcohol and Drug Abuse, Texas Department of Criminal Justice, third-party coverage).

§412.102.Application.

(a)

This subchapter applies to all local authorities for community services contracted for through the performance contract that are funded by TDMHMR and required local match and provided to members of the priority population.

(b)

This subchapter does not apply to:

(1)

programs and services that are prohibited by statute or regulation from charging fees to persons served (e.g., Early Childhood Intervention Program);

(2)

the TDMHMR In-Home and Family Support Program;

(3)

community-based residential services and inpatient services; and

(4)

specialized services mandated by the Omnibus Budget Reconciliation Act (OBRA) of 1987, as amended by OBRA 90, for preadmission screening and annual resident reviews (PASARR) provided to non-Medicaid eligible persons.

§412.103.Definitions.

The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise.

(1)

Ability to pay - A person has third-party coverage that will pay for needed services, the person's maximum monthly fee is greater than zero, or the person has identified payment for a needed service or services in an approved plan utilizing Social Security work incentive provisions (i.e., Plan to Achieve Self-Sufficiency; Impairment Related Work Expense ).

(2)

Community services or services - Mental health and mental retardation services required to be available in each local service area pursuant to the Texas Health and Safety Code, §534.053(a), for which TDMHMR contracts through the performance contract. A list of community services is available:

(A)

on the Internet at www.mhmr.state.tx.us and by searching "performance contract"; or

(B)

by contacting the local authority's administrative offices.

(3)

Family members -

(A)

Unmarried person under the age of 18 - The person, the person's parents, and the dependents of the parents, if residing in the same household;

(B)

Unmarried person age 18 or older - The person and his/her dependents;

(C)

Married person of any age - The person, his/her spouse, and their dependents.

(4)

Gross income - Revenue from all sources before taxes and other payroll deductions.

(5)

Inability to pay - A person's maximum monthly fee is zero and:

(A)

the person does not have third-party coverage;

(B)

the person has third-party coverage, but the person has exceeded the maximum benefit of the covered service(s) or the third-party coverage will not pay because the services needed by the person are not covered services; or

(C)

the person has not identified payment for a needed service or services in an approved plan utilizing Social Security work incentive provisions (i.e., Plan to Achieve Self-Sufficiency; Impairment Related Work Expense ).

(6)

Income-based public insurance - Government funded third-party coverage that bases eligibility and/or co-payments and deductibles on a person's (or parents') income (i.e., Medicaid and CHIP).

(7)

Local authority - An entity designated by the TDMHMR commissioner in accordance with the Texas Health and Safety Code, §533.035(a).

(8)

Local match - Funds or in-kind support from a local authority as required by the Texas Health and Safety Code, §534.066.

(9)

Performance contract - The contract between TDMHMR and a local authority in which TDMHMR agrees to pay the local authority a specified sum and in which the local authority agrees to provide local match, for, at a minimum, ensuring and/or monitoring the provision of specified mental health and mental retardation services in a local service area.

(10)

Person - A person in the priority population who is seeking or receiving services through a local authority.

(11)

Priority population - Those groups of persons with mental illness or mental retardation identified in TDMHMR's current strategic plan as being most in need of mental health and/or mental retardation services.

(12)

Rate - A fixed price for a service that represents the service's monetary value.

(13)

Third-party coverage - A public or private payor of community services that is not the person (e.g., Medicaid, Medicare, private insurance, CHIP, CHAMPUS).

§412.104.Principles.

TDMHMR supports the following principles:

(1)

Persons are charged for services based on their ability to pay.

(2)

Procedures for determining ability to pay are fair, equitable, and consistently implemented.

(3)

Paying for services in accordance with his/her ability to pay acknowledges the dignity of the person.

(4)

Paying for services in accordance with his/her ability to pay reinforces the role of the person as a customer, having the right and responsibility to influence the provision of those services.

(5)

Earned revenues are optimized.

§412.105.Accountability.

(a)

Prohibition from denying services. Local authorities are prohibited from denying services:

(1)

to a person because of the person's inability to pay for the services;

(2)

to a person in a crisis or emergency because a financial assessment has not been completed, financial responsibility has not been determined, or the person has a past-due account; or

(3)

pending resolution of an issue relating solely to payment for services, including failure of the person (or parent) to comply with any requirement in subsections (b)-(e) of this section.

(b)

Requirement to apply for Medicaid benefits. Parents whose children may be eligible for Medicaid and persons who may be eligible for Medicaid must apply for Medicaid or provide documentation that they have been denied Medicaid or that their Medicaid application is pending.

(c)

Requirement to enroll in CHIP. Parents of children who may be eligible for the Childrens Health Insurance Program (CHIP) must enroll in CHIP or provide documentation that they have been denied CHIP benefits or that their CHIP enrollment is pending.

(d)

Financial documentation. If requested by the local authority, persons (or parents) must provide the following financial documentation:

(1)

annual or monthly gross income/earnings, if any;

(2)

extraordinary expenses (i.e. major medical or health related expenses; major casualty losses; child care expenses for the previous year or projections for the next year);

(3)

number of family members; and

(4)

proof of any third-party coverage.

(e)

Permission to bill third-party coverage. Persons with third-party coverage must execute an assignment of benefits (i.e., give the local authority permission to bill the third-party coverage).

(f)

Failure to comply. A person's (or parent's) failure to comply with any requirement in subsections (b)-(e) of this section will result in the person (or parent) being charged the standard rate(s) for services, established in accordance with §412.107(a) of this title (relating to Rates), unless the person's interdisciplinary or multidisciplinary team makes a clinical determination that failure to comply is related to the person's mental illness or mental retardation or enforcement of the requirement would result in a reduction in functioning of the person or the person's refusal or rejection of the needed services. This determination requires clinical documentation and must be reassessed by the team at least every three months.

§412.106.Determination of Ability to Pay.

(a)

Financial assessment. A financial assessment must be completed and documented for each person within the first 30 days of services and updated at least annually, or whenever significant financial changes occur, as long as the person continues to receive services. The financial assessment is accomplished using the financial documentation listed in §412.105(d) of this title (relating to Accountability), which represents the finances of the:

(1)

person who is age 18 or older and the person's spouse; or

(2)

parents of the person who is under 18 years of age.

(b)

Maximum monthly fee. A person's maximum monthly fee is based on the financial assessment and calculated using the Monthly Ability-To-Pay Fee Schedule, referenced as Exhibit A in §412.112 of this title (relating to Exhibit). The calculation is based on the number of family members, annual gross income reduced by extraordinary expenses paid during the past 12 months or projected for the next 12 months. No other sliding scale is used.

(1)

A maximum monthly fee that is greater than zero is established for persons who are determined as having an ability to pay. If two or more members of the same family are receiving services, then the maximum monthly fee is for the family.

(2)

A maximum monthly fee of zero is established for persons who are determined as having an inability to pay.

(c)

Third-party coverage.

(1)

A person with third-party coverage that will pay for needed services is determined as having an ability to pay for those services.

(2)

If the person's third-party coverage will not pay for needed services because the local authority provider is not an approved provider, then the local authority will refer the person to his/her third-party coverage to identify a provider for which the third-party coverage will pay.

(3)

An exception to the provision described in paragraph (2) of this subsection is if the local authority is identified as being responsible for providing court-ordered outpatient services to the person.

(d)

Social Security work incentive provisions. A person has an ability to pay if the person identified payment for a needed service or services in his/her approved plan utilizing Social Security work incentive provisions (i.e., Plan to Achieve Self-Sufficiency; Impairment Related Work Expense ). Persons are not required to identify payment for any service for which they may be eligible as part of their approved plan for utilizing the Social Security work incentive provisions.

(e)

Notification. Written notification is provided to the person (or parents) that includes:

(1)

the determination of whether the person (or parent) has an ability or an inability to pay;

(2)

a copy of the financial assessment form that is signed by the person (or parent) and a copy of the Monthly Ability-to-Pay Fee Schedule, with the applicable areas indicated (i.e., annual gross income, number of household members, etc.);

(3)

the amount of the maximum monthly fee;

(4)

a statement that the person (or parent) may discuss with the interdisciplinary or multidisciplinary team any concerns the person (or parent) may have regarding the information contained in the written notification; and

(5)

a statement that the person (or parent) may voluntarily pay more than the maximum monthly fee.

§412.107.Standard Rates.

(a)

Each local authority must establish, at least annually, a reasonable standard rate for each community service.

(b)

The rate for a service provided to a Medicaid recipient that is reimbursed by Medicaid is the current approved Medicaid rate for the service. The rate for the same service provided to a person who is not a Medicaid recipient may not be less than the current approved Medicaid rate, but may be more if the current approved Medicaid rate does not cover the actual cost of the service.

§412.108.Billing Procedures.

(a)

Monthly services charge. All services provided during a month, and the standard rates for those services, are listed as the person's monthly services charge. Each service listed is identified as being covered by third-party coverage or as not being covered by third-party coverage. If a person has exceeded the maximum benefit of a particular covered service, then that service is identified as not being covered by third-party coverage.

(b)

Billing third-party coverage. The third-party coverage is billed the monthly services charge for covered services.

(1)

Third-party coverage that is not income-based public insurance.

(A)

If the local authority has a contract with the person's third-party coverage, then payment made by the third-party coverage for a covered service plus any applicable co-payment made by the person is full payment for that service.

(B)

If the local authority does not have a contract with the person's third-party coverage and if a balance remains after payment from the third-party coverage or if the third-party coverage will not pay for a covered service because the deductible hasn't been met, then the balance or deductible is applied toward the person's maximum monthly fee.

(2)

Income-based public insurance. Payment made by income-based public insurance for a covered service plus payment made by the person for any applicable co-payment and/or deductible is full payment for that service, (i.e.,:

(A)

for Medicaid recipients, Medicaid reimbursement is full payment; and

(B)

for CHIP recipients, CHIP reimbursement plus the recipient's co-payment and/or deductible payment is full payment).

(c)

Billing the person (or parents).

(1)

No third-party coverage. If the monthly services charge amount:

(A)

exceeds the person's maximum monthly fee, then the amount is reduced to equal the maximum monthly fee and the person (or parent) is billed the maximum monthly fee; or

(B)

is less than the person's maximum monthly fee, then the person (or parent) is billed the amount.

(2)

Third-party coverage that is not income-based public insurance.

(A)

If the local authority has a contract with the person's third-party coverage and:

(i)

the amount of all co-payments described in subsection (b)(1)(A) of this section exceeds the person's maximum monthly fee, then the amount is reduced to equal the maximum monthly fee and the person (or parent) is billed the maximum monthly fee. The person (or parent) is not billed for services not covered by third-party coverage, if any; or

(ii)

the amount of all co-payments described in subsection (b)(1)(A) of this section does not exceed the person's maximum monthly fee, then the monthly services charge amount for services not covered by third-party coverage is added to equal the total amount. If the total amount:

(I)

exceeds the person's maximum monthly fee, then the total amount is reduced to equal the maximum monthly fee and the person (or parent) is billed the maximum monthly fee; or

(II)

is less than the person's maximum monthly fee, then the person (or parent) is billed the total amount.

(B)

If the local authority does not have a contract with the person's third-party coverage, then the balance or deductible applied toward the person's maximum monthly fee as described in subsection (b)(1)(B) of this section is added to the monthly services charge amount for services not covered by third-party coverage to equal the total amount. If the total amount:

(i)

exceeds the person's maximum monthly fee, then the total amount is reduced to equal the maximum monthly fee and the person (or parent) is billed the maximum monthly fee; or

(ii)

is less than the person's maximum monthly fee, then the person (or parent) is billed the total amount.

(3)

Income-based public insurance.

(A)

If the amount of all co-payments and deductibles described in subsection (b)(2) of this section exceeds the person's maximum monthly fee, then the person (or parent) is billed the amount. The person (or parent) is not billed for services not covered by third-party coverage, if any.

(B)

If the amount of co-payments and deductibles described in subsection (b)(2) of this section does not exceed the person's maximum monthly fee, then the monthly services charge amount for services not covered by third-party coverage is added to equal the total amount. If the total amount:

(i)

exceeds the person's maximum monthly fee, then the total amount is reduced to equal the maximum monthly fee and the person (or parent) is billed the maximum monthly fee; or

(ii)

is less than the person's maximum monthly fee, then the person (or parent) is billed the total amount.

(4)

Social Security work incentive provisions. A person may be charged for specific services listed on the monthly services charge if the person identified payment for such services in his/her approved plan utilizing Social Security work incentive provisions (i.e., Plan to Achieve Self-Sufficiency; Impairment Related Work Expense ).

(d)

Statements.

(1)

Persons (and parents) 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 paid (or to be paid) by third-party coverage, if any;

(E)

the amount that is being reduced, if any; and

(F)

the amount to be paid.

(2)

Unless requested, 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)

Unless requested, statements are not be sent to persons who have been determined as having an inability to pay.

§412.109.Payment and Exemptions.

(a)

Payment.

(1)

Persons (and parents) are expected to promptly pay all charges owed.

(2)

If a person (or parent) claims, and provides documentation, that financial hardship prevents prompt payment of all charges owed, then the local authority may arrange for the person (or parent) to pay a lesser amount each month. Although the person (or parent) will pay a lesser amount each month because a portion of the charges will be deferred, the person (or parent) is still responsible for paying all charges owed.

(b)

Receipts. Receipts must be provided for all cash payments.

(c)

Waiver of charges. If a person's interdisciplinary or multidisciplinary team makes a clinical determination 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 by the team at least every three months.

(d)

Termination of services for cause. A person's services may be terminated in accordance with this subsection.

(1)

Irresponsible actions by a person that result in resources being wasted (e.g., missing multiple appointments without canceling, consistently losing medications) shall be referred to the person's interdisciplinary or multidisciplinary team. The team is responsible for making reasonable efforts to assist the person in stopping or reducing the irresponsible actions. (For example, if the team determines that the actions are related to the person's mental illness or mental retardation, then the team may modify the person's treatment. If the team determines that the actions are related to external circumstances, such as unreliable transportation, then the team may assist the person (or parent) in accessing reliable transportation.) If the team makes a clinical determination that the actions are not related to the person's mental illness or mental retardation and the team has been unsuccessful in assisting the person in stopping or reducing the actions, then the team may decide to terminate the person's services. The team may not terminate the person's services if termination is clinically contraindicated or if the local authority is identified as being responsible for providing court-ordered outpatient services to the person.

(2)

Past-due accounts of persons (or parents) who are not making payments are referred to the persons' interdisciplinary or multidisciplinary teams. The team is responsible for addressing the issue of non-payment with the person (or parent) and making reasonable efforts that will result in the person (or parent) making payments. (For example, if the team determines that non-payment is related to the person's mental illness or mental retardation, then the team may modify the person's treatment to address the non-payment. If the team determines that non-payment is related to financial hardship, then the team may assist the person (or parent) in making arrangements to pay a lesser amount each month in accordance with subsection (a) of this section.) If the team makes a clinical determination that non-payment is not related to the person's mental illness or mental retardation and, despite the team's efforts, the person (or parent) does not pay, then the team may decide to terminate the person's services. The team may not terminate the person's services if termination is clinically contraindicated or if the local authority is identified as being responsible for providing court-ordered outpatient services to the person.

(3)

If the team decides to terminate the person's services, then:

(A)

the team must provide clinical documentation that justifies its decision, including the basis for determining that termination is not clinically contraindicated; and

(B)

the person (or parent) shall be notified in writing of the decision and provided an opportunity to appeal the decision in accordance with §401.464 of this title (relating to Notification and Appeals Process). The notification shall prescribe the time frames and process for requesting an appeal and include a copy of this subchapter. If the person (or parent) requests an appeal within the prescribed time frame, then the person's services may not be terminated while the appeal is pending.

(4)

If a person (or parent) is dissatisfied with the decision of the appeal as described in paragraph (3)(B) of this subsection, then the person (or parent) may request a review by the Office of Consumer Services and Rights Protection - Ombudsman at TDMHMR Central Office.

(A)

The person (or parent) must request a review within 10 working days of receipt of notification of the appeal decision.

(B)

The person (or parent) may choose to have the staff conducting the review:

(i)

conduct the review by telephone conference with the person (or parent) and a representative from the local authority and make a decision based upon verbal testimony made during the telephone conference and any documents provided by the person (or parent) and the local authority; or

(ii)

conduct the review by making a decision based solely upon documents provided by the person (or parent) and the local authority without the presence of any of the parties involved.

(C)

The review:

(i)

will be conducted no sooner than 10 working days and no later than 30 working days of receipt of the request for a review unless an extension is granted by the director of the Office of Consumer Services and Rights Protection - Ombudsman;

(ii)

will include a review of the pertinent information concerning termination of the person's services and may include consultation with TDMHMR clinical staff and staff who oversee implementation of this subchapter;

(iii)

will result in a final decision which will either uphold, reverse, or modify the original decision to terminate the person's services; and

(iv)

is the final step of the appeal process for termination of services for cause.

(D)

Within five working days after the review, the staff who conducted the review will send written notification of the final decision to the person (or parent) and the local authority.

(e)

Prohibition of financial penalties. Financial penalties may not be imposed on a person (or parent).

(f)

Debt collection. Local 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 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 authorities will enforce the provisions contained in paragraph (1) of this subsection.

§412.110.Training.

All local authority staff who are involved in implementing or explaining the content of this subchapter must annually demonstrate competency in accordance with a prescribed training program developed by TDMHMR, in consultation with local authorities and consumer representatives.

§412.111.Information for Persons.

Persons and families must be provided TDMHMR-approved information on TDMHMR's policy of charges for community services contained in this subchapter prior to entry into services except in a crisis or emergency.

§412.112.Exhibit.

Exhibit A - The Monthly Ability-To-Pay Fee Schedule, is referenced in this subchapter. Copies of Exhibit A are available by contacting TDMHMR, Policy Development, P.O. Box 12668, Austin, TX 78711-2668.

§412.113.References.

Reference is made to the following statutes:

(1)

Texas Health and Safety Code, §534.067;

(2)

Social Security Act, Section 1902(a)(17)(B); and

(3)

Omnibus Budget Reconciliation Act (OBRA) of 1987, as amended by OBRA 90.

§412.114.Distribution.

This subchapter is distributed to:

(1)

all members of the Texas Board of Mental Health and Mental Retardation;

(2)

executive, management, and program staff of TDMHMR Central Office;

(3)

executive directors of all local authorities; and

(4)

advocacy organizations.

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 February 12, 2001.

TRD-200100865

Andrew Hardin

Chairman, Texas MHMR Board

Texas Department of Mental Health and Mental Retardation

Earliest possible date of adoption: March 25, 2001

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


Part 8. INTERAGENCY COUNCIL ON EARLY CHILDHOOD INTERVENTION

Chapter 621. EARLY CHILDHOOD INTERVENTION

Subchapter B. EARLY CHILDHOOD INTERVENTION SERVICE DELIVERY

25 TAC §621.24

The Interagency Council on Early Childhood Intervention (ECI) proposes an amendment to §621.24, concerning Program Administration for Comprehensive Services.

The purpose of the amendment is to add new subparagraphs (D) and (E) under subsection (b)(3). The statements in subparagraph (D) fold into rule ECI's deadline and requirement for standard use of the ECI logo and slogan. This information has been distributed to ECI providers in policy and is not a new requirement. The language in subparagraph (E) communicates that only ECI providers or at ECI's direction can the logo and slogan be used.

Donna Samuelson, Deputy Executive Director, ECI, has determined that for the first five-year period the proposed section will be in effect, there will be no fiscal implications for state or local government as a result of enforcing or administering the rule.

Ms. Samuelson also has determined that for each year of the first five years the proposed section is in effect, the public benefit anticipated as a result of enforcing the section will be the use of one logo and slogan used statewide so that it is easier for the public to find ECI services. There are no anticipated economic costs to persons who are required to comply with the rule as proposed. There will be no effect on small businesses.

Comments on the proposed amendment may be submitted to Denise Brady, Texas Interagency Council on Early Childhood Intervention, 4900 North Lamar, Austin, Texas 78751-2399, within 30 days of publication in the Texas Register .

The amendment is proposed under Chapter 73 of the Human Resources Code, which provides the agency with the authority to administer public programs for developmentally delayed children.

No other statutes, articles or codes are affected by the proposed amendment.

§621.24.Program Administration for Comprehensive Services.

(a)

Program eligibility for comprehensive services.

(1)

Funds for comprehensive services are available to public or private service organizations that may be current or potential providers of services for children with developmental delays.

(2)

Eligibility for continued funding shall be contingent upon the program's accomplishments, progress toward stated goals, compliance with state standards, implementation of program review findings, and availability of funds. The program provider shall submit an annual application for continuation funding.

(b)

Program requirements.

(1)

Child find. Each program must develop and implement a child find plan which includes:

(A)

ongoing contact and coordination with primary referral sources and other service providers, including, but not limited to:

(i)

child find programs located within the education service centers;

(ii)

local and regional health departments with Maternal and Child Health Programs under Title V of the Social Security Act;

(iii)

Medicaid's Early Periodic Screening, Diagnosis, and Treatment Program (EPSDT);

(iv)

head start programs;

(v)

hospitals;

(vi)

day care programs;

(vii)

school districts;

(viii)

social service agencies;

(ix)

primary health care providers;

(x)

Early Childhood Intervention (ECI) programs;

(xi)

child care management services (CCMS);

(xii)

any program funded under Development Disabilities Assistance and Bill of Rights Act; and

(xiii)

programs under Supplemental Security Income under Title XVI of the Social Security Act;

(B)

information regarding availability of other local services including other ECI programs;

(C)

accepting referrals for intervention services and evaluating each child for eligibility within 45 days of the referral.

(2)

Required services. Each comprehensive program must provide an evaluation and assessment, service coordination, and Individualized Family Service Plan (IFSP) and comprehensive services. Each program funded by the Interagency Council on Early Childhood Intervention must have the capacity to provide or arrange for all services described in §621.23(5)(C) of this title (relating to Service Delivery Requirements for Comprehensive Services). All services which the child or family receives, regardless of the funding sources, must be considered toward meeting the service needs of the child as defined in the child's IFSP. No ECI funding can be used to arrange, provide, or duplicate a service for which other funding sources, public or private, are available and could be used.

(3)

Public awareness. Each program must develop and implement a public awareness plan which includes:

(A)

information on child find, early identification, referral, and access to services of the Texas Early Childhood Intervention Program, locally and across the state;

(B)

a variety of continuous methods for reaching the general public; and

(C)

involvement and communication with public and private agencies; parent, professional, and advocacy groups; and other organizations or associations.

(D)

By September 1, 2001 programs must implement the use of the ECI logo and slogan and meet requirements listed in the ECI Graphic Standards Manual for all materials used for marketing, public awareness, child find, promotion, public education, and program correspondence. Programs must use "ECI" as part of their program name.

(E)

The ECI logo and slogan are for use by providers under contract with ECI or by entities not under contract when directed by the Interagency Council on Early Childhood Intervention. All use must be in accordance with the ECI Graphic Standards Manual.

(4)

Interagency coordination. Each program must develop and implement an interagency coordination plan which includes as a minimum procedures:

(A)

preventing duplication of assessments and services;

(B)

coordinating referrals to and from ECI programs;

(C)

participating in local and regional planning and coordination groups affecting services to young children; and

(D)

coordinating activities to make the most effective use of staff development and comprehensive service provision.

(5)

Staff composition and qualifications.

(A)

Programs must employ staff who meet the appropriate professional requirements and hold current professional credentials for their profession. Appropriate professional requirements are the entry level professional standards which:

(i)

are based on the state's highest requirements applicable to the profession or discipline in which a person is providing early intervention services; and

(ii)

establish suitable qualifications for personnel providing early intervention services to eligible children and their families, who are served by state, local, and private agencies.

(B)

ECI professional staff must abide by the licensure or certification requirements and the established rules of supervision and conduct for their professions.

(C)

For the occupational categories for which state authority has not established professional standards (such as service coordinator and early intervention specialist), programs must employ staff who are qualified in terms of education and experience for their assigned scopes of responsibilities and provide the required degree of supervision.

(D)

As of September 1, 1995, the following qualifications and responsibilities for EIS Professionals are effective.

(i)

Definitions of Early Intervention Specialist Professional levels. EIS Professional is an occupational title and occupational category specific to service providers employed by Early Childhood Intervention (ECI) programs. These service providers have demonstrated through their education and experience the knowledge and skills required in early intervention service delivery. There are two classes of EIS Professionals.

(I)

Entry level--Persons with bachelor's degrees which include a minimum of 18 hours of college credit related to the provision of early intervention services are eligible to apply for Entry Level status. An Entry Level EIS Professional will have a maximum of two years from the date of hiring to complete the requirements to be approved as a Fully Qualified EIS Professional. Failure to complete the required process within two years will result in the loss of professional status and privileges. Exceptions to this provision may be approved by the state ECI office on an individual basis for extreme circumstances. Requests for exceptions must be in writing.

(II)

Fully qualified--Persons meeting the conditions and requirements for Professional Recognition as Fully Qualified EIS Professionals.

(ii)

Scope of responsibilities. Early Intervention Specialist Professionals (Entry Level and Fully Qualified EIS Professionals) may represent the discipline of early intervention and may be one of the two required professionals on an Interdisciplinary Team (IDT). EIS Professionals may conduct family intake processes, participate in determining eligibility, conduct developmental screenings and assessments, participate in the development and implementation of Individualized Family Service Plans, and provide service coordination, special instruction, and family education services.

(iii)

Supervision. The Entry Level EIS Professionals must receive a minimum of one hour per week of direct supervision from a fully qualified professional until they have successfully completed the requirements to be Fully Qualified EIS Professionals. The supervising professionals may be from any of the disciplines related to early intervention and must meet the highest state standards for their profession.

(iv)

EIS Professionals and Provisional EIS Professionals who were hired before September 1, 1995, and are currently employed in ECI-funded programs, who failed to complete the required application process are not considered EIS Professionals. They will no longer be able to independently perform the scope of responsibilities of EIS Professionals as defined in clause (ii) of this subparagraph. To obtain status as Fully Qualified EIS Professionals, they must enter the system as Entry Level EIS Professionals and complete the conditions defined in clause (v) of this subparagraph.

(v)

Professional recognition for EIS Professionals hired after September 1, 1995. Persons hired as EIS Professionals after September 1, 1995, who are not Fully Qualified EIS Professionals are identified as Entry Level EIS Professionals and to be recognized as Fully Qualified EIS Professionals must:

(I)

meet the educational requirements of a bachelor's degree which includes a minimum of 18 hours of course credit relevant to early intervention service provision and submit a statement of intent to complete the required demonstrations of early intervention knowledge and skills and apply for full professional recognition;

(II)

within nine months of their hiring date, submit a progress report of the demonstration of early intervention knowledge and skills completed by their ECI program director and supervisor;

(III)

within two years of their hiring date, complete the required demonstrations of early intervention knowledge and skills and submit documentation to the state office; and

(IV)

complete the required processes or lose professional status and privileges. If the required processes are not completed as specified in subclauses (I)-(III) of this clause; they will no longer be able to independently perform the scope of responsibilities of EIS Professionals as defined in clause (ii) of this subparagraph.

(vi)

Continuing professional education requirements. EIS Professionals must meet annual continuing professional education requirements to maintain their status. Continuing professional education consists of the planned individual learning experiences as described in the EIS Professional's annual Individual Professional Development Plan (IPDP) which shall include completion of a minimum of ten contact hours of approved continuing professional development education experiences.

(vii)

EIS Professionals must submit annually the record of their continuing education on or before the anniversary of the certificate date.

(viii)

Registry. The Texas Interagency Council on Early Childhood Intervention shall issue certificates of recognition to and maintain a registry of individuals who successfully complete the requirements to be Fully Qualified EIS Professionals.

(ix)

Grievance process. Each local agency shall have a procedure for local resolution of personnel grievances. A party who has a disagreement with the local decision regarding his qualifications or status as an EIS Professional shall have an opportunity for dispute resolution at the local level. Agencies may use existing personnel grievance procedures to resolve disagreements and will inform their staff of their existence.

(x)

Complaints. Any individual or organization may file a complaint with the Council alleging that a requirement of the applicable federal and/or state regulations has been violated as provided in §621.43 of this title (relating to Confidentiality).

(E)

The director of the local ECI program must provide and document the amounts of appropriate supervision for all ECI contract staff and program staff to ensure the philosophy and intent of these regulations are met as adopted by the Interagency Council on Early Childhood Intervention.

(F)

Local programs must establish a procedure to ensure that employees have not been convicted of any felony or a misdemeanor related to child abuse or sexual abuse or any other offense against a person or family.

(6)

Inservice education. Each program shall annually assess and address the training needs of the early childhood intervention staff. Documentation of the development and implementation of each staff members individualized professional development plan (IPDP) shall be maintained by the program.

(7)

ECI child service standards.

(A)

Determination of staff-child ratios must take into account the degree of each child's developmental level of functioning, the setting in which the child will be served, and the nature of the comprehensive services to be provided.

(B)

Programs which provide child care as defined by the Texas Department of Human Services (TDHS) must meet licensing standards of TDHS.

(8)

Child health standards. Programs that receive ECI funds must have written policies and procedures which are implemented and evaluated in each of the following areas.

(A)

Medication policies. If staff is involved in the administration of medication, written policies must be maintained regarding such administration.

(B)

Infectious disease prevention and management.

(i)

All programs must adhere to the procedures of the universal precautions for the Texas Early Childhood Intervention Program, as issued by the council.

(ii)

All programs must comply with the Texas Communicable Disease Prevention and Control Act, Texas Civil Statutes, Article 4419b-1.

(iii)

In the event of an outbreak of a contagious disease, infants attending center-based activities must be excluded if they have not been immunized due to medical or religious contraindications.

(C)

Policies regarding serving children who are HIV positive. The following requirements must be enforced in serving children who are HIV positive.

(i)

Children with HIV infection must not be discriminated against on the basis of HIV infection. Reasonable accommodations will be made to serve them on the basis of individual need.

(ii)

Any information a parent may provide on the HIV status of a child or family member will be deemed confidential and released only to individuals designated by the parent.

(iii)

For identified children with HIV infection, with parental consent, the staff must communicate with the physician responsible for medical care and must involve the physician in programmatic decisions about treatment. Communication with the physician must occur prior to assessment and on an ongoing basis as needed.

(iv)

Programs cannot require HIV testing of children.

(9)

Safety regulations regarding emergencies for all buildings where ECI programs are housed. Programs that receive ECI funds must have written policies and procedures which are implemented and evaluated in the following areas.

(10)

Accessibility and safety. Programs that receive ECI funds must have written policies and procedures which are implemented and evaluated in the following areas.

(A)

All ECI services must be available in buildings that are physically accessible to persons with disabilities.

(B)

Buildings where the ECI program is housed (including offices) must be inspected annually by a local or state fire authority. A safety and sanitation inspection must be completed annually by an entity outside of the ECI program using an approved ECI checklist. If the fire or safety and sanitation inspection indicates that hazards exist, these hazards must be corrected.

(C)

Buildings must be clean, free of hazards, free of insect and rodent infestation, in good repair, with adequate light, ventilation, and temperature control.

(D)

An external emergency release mechanism must be provided for opening interior doors that can be locked from the inside. Locks may not be used to restrain a child within a room.

(E)

Buildings must be able to be safely evacuated in the event of an emergency.

(11)

Transportation safety. Programs that receive ECI funds must have written policies and procedures which are implemented and evaluated in the following areas.

(A)

The transportation system operated by the ECI program must meet local and state licensing, inspection, insurance, and capacity requirements.

(B)

Children must be transported in an appropriately installed, federally approved child passenger restraint seat, appropriate to the child's age and size.

(C)

Drivers of vehicles must have valid and appropriate drivers' licenses. Drivers must have current defensive driving certification.

(D)

Drivers and drivers' aides must have training in first aid, emergency care of seizures, and be certified in cardiopulmonary resuscitation for children and infants.

(12)

Reporting child abuse. The program must report suspected child abuse or neglect as required by the Texas Family Code, Chapter 261.

(13)

Staff health regulations. Programs that receive ECI funds must have written policies and procedures which are implemented and evaluated in the following areas.

(14)

Staff development for health and safety issues. Programs that receive ECI funds must have written policies and procedures which are implemented and evaluated in the following areas.

(A)

All staff who work directly with children must receive training in first aid and emergency care of seizures and be certified in cardiopulmonary resuscitation for children and infants.

(B)

All staff who work directly with children must receive training in the implementation of universal precautions for Texas ECI programs and in the recognition of common childhood illnesses.

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 February 9, 2001.

TRD-200100857

Donna Samuelson

Deputy Executive Director

Interagency Council on Early Childhood Intervention

Earliest possible date of adoption: March 25, 2001

For further information, please call: (512) 424-6750