The repeal is authorized by Health and Safety Code, §12.0111, which requires the department to charge fees for issuing or renewing a license; §773.050(e) which authorizes the department to adopt minimum standards of first responder organizations; §773.050(b) and §773.0495 which authorize the department to adopt minimum standards for certified and licensed EMS personnel; and Government Code, §531.0055, and Health and Safety Code, §1001.075, which authorize the Executive Commissioner of the Health and Human Services Commission to adopt rules and policies necessary for the operation and provision of health and human services by the department and for the administration of Health and Safety Code, Chapter 1001.

The repeal affects the Health and Safety Code, §773. The review of the section implements Government Code, §2001.039.

§157.14.Requirements for First Responder Organization Registration.

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 March 31, 2006.

TRD-200601951

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

25 TAC §157.14

The new section is authorized by Health and Safety Code, §12.0111, which requires the department to charge fees for issuing or renewing a license; §773.050(e) which authorizes the department to adopt minimum standards of first responder organizations; §773.050(b) and §773.0495 which authorize the department to adopt minimum standards for certified and licensed EMS personnel; and Government Code, §531.0055, and Health and Safety Code, §1001.075, which authorize the Executive Commissioner of the Health and Human Services Commission to adopt rules and policies necessary for the operation and provision of health and human services by the department and for the administration of Health and Safety Code, Chapter 1001.

The new section affects the Health and Safety Code, §773. The review of the section implements Government Code, §2001.039.

§157.14.Requirements for a First Responder Organization License.

(a) A First Responder Organization (FRO) is a group or association of certified emergency medical services personnel that works in cooperation with a licensed emergency medical services provider to:

(1) routinely respond to medical emergency situations;

(2) utilize personnel who are emergency medical services (EMS) certified by the Texas Department of State Health Services (department); and

(3) provide on-scene patient care to the ill and injured and does not transport patients.

(b) Individuals or organizations meeting the description in subsection (a) of this section must comply with the requirements outlined in this section including submission of an application for a license.

(1) A Basic Life Support (BLS) or Advanced Life Support (ALS) First Responder Organization affiliated with a Texas licensed EMS Provider must apply for an FRO license by submitting a completed application to the department. A complete application consists of the following:

(A) provider license application form;

(B) personnel list including social security number or EMS personnel identification (ID) number and certification/licensure level;

(D) staffing plan including days of the week and hours of the day the FRO will be available for response;

(E) written affiliation agreement with the primary licensed EMS provider in the service area. The primary licensed EMS provider must provide a letter attesting that the following items have been reviewed and approved by the director and medical director of the EMS provider:

(i) level(s) of certification/licensure of FRO personnel providing care;

(ii) response, dispatch and treatment protocols including an equipment and supply list approved by the medical director of the licensed EMS provider;

(iii) description of how the FRO receives notification of calls;

(iv) patient care reporting procedures;

(v) process for the assessment of care provided by the FRO personnel;

(vi) response code policies for FRO personnel;

(vii) on-scene chain-of-command policies;

(viii) policies regarding FRO personnel canceling en route EMS units;

(ix) policies regarding FRO personnel accompanying patients in EMS providers vehicles including when FRO personnel hold the highest certification or licensure on the scene; and

(x) patient confidentiality.

(F) It is not necessary to submit the individual items in subparagraph (E)(i) - (x) of this subsection with the application, if each is referenced in the affiliation agreement. All items listed in paragraph (1) of this subsection must be immediately available for review by department personnel upon request during unannounced site visits or complaint investigations.

(2) Any FRO which is, or has a contract with, an entity such as a business, corporation or department and whose first responder employees or members are compensated by that entity for providing first responder service shall pay a nonrefundable $60 application fee. If the license is issued for less than 12 months, the nonrefundable fee shall be $30. The FRO personnel described in this paragraph are not exempt from the payment of certification or license application fees.

(3) Applicants who meet all the requirements shall be issued an FRO license. The license may be valid for up to 2 years, but may be issued for less than 2 years for administrative purposes.

(4) Although not required, the FRO license application may be submitted with the license application of the affiliated EMS provider. The FRO is responsible for submitting fees, if applicable.

(5) An affiliation agreement between a licensed EMS provider and a licensed FRO does not automatically imply any legal liability beyond the agreements listed in paragraph (1)(E) of this subsection.

(6) A violation of statute or rule by an FRO will not implicate the affiliated EMS provider unless both organizations are involved in the violation. Likewise, a violation of statute or rule by an affiliated EMS provider does not implicate the FRO unless both organizations are involved in the violation.

(d) Application requirements for an FRO not affiliated with a licensed EMS provider.

(1) A BLS first responder organization not affiliated with a licensed EMS provider may apply for an FRO License by submitting a completed application to the department. A complete application consists of the following:

(A) application form;

(B) personnel list including social security number or personnel ID number and certification/licensure level;

(D) staffing plan including days of the week and hours of the day the FRO will be available for response;

(E) response, dispatch and treatment protocols including an equipment and supply list approved by the FRO medical director;

(F) letter of recognition from the primary licensed 911 EMS Provider or from the highest elected city/county official in the service area and a written explanation why the EMS provider will not enter into an agreement with the FRO;

(G) description of how the FRO receives notification of calls; and

(H) process for the assessment of care provided by the FRO personnel.

(I) The application for a FRO license will be considered incomplete if any items listed in subparagraphs (A) - (H) of this paragraph are not enclosed with the application.

(J) All items listed in subparagraphs (A) - (H) of this paragraph must be immediately available for review by department personnel if requested during unannounced site visits or complaint investigations.

(2) An ALS first responder organization not affiliated with a licensed EMS provider may apply for an FRO License by submitting a completed application to the department. A complete application consists of the following:

(A) application form;

(B) personnel list including social security number or personnel ID number and certification/licensure level;

(D) staffing plan including days of the week and hours of the day the FRO will be available for response.

(E) The FRO shall have an agreement with all licensed EMS providers and their medical directors who routinely transport patients treated by the FRO's personnel. Each agreement shall be approved by the person responsible for the FRO, director and medical director of each licensed EMS provider. At a minimum, the agreements shall address:

(i) the level(s) of certification/licensure of FRO personnel providing care;

(ii) the response, dispatch and treatment protocols including an equipment and supply list approved by the FRO medical director and a letter of approval from the medical director(s) of the licensed transporting providers with whom the FRO has agreements;

(iii) a description of how the FRO receives notification of calls;

(iv) patient care reporting procedures;

(v) a process for the assessment of care provided by FRO personnel;

(vi) response code policies for FRO personnel;

(vii) on-scene chain-of-command policies;

(viii) policies regarding FRO personnel canceling en route EMS units;

(ix) policies regarding FRO personnel accompanying patients in provider's vehicles including when FRO personnel hold the highest certification or licensure on the scene; and

(x) patient confidentiality.

(F) The application for a FRO license is incomplete if any items listed in paragraph (2) of this subsection are not enclosed with the application.

(G) All items listed in paragraph (2) of this subsection must be immediately available for review by department personnel if requested during unannounced site visits or complaint investigations.

(3) Any FRO which is, or has a contract with, an entity such as a business, corporation or department and whose first responder employees or members are compensated by that entity for providing first responder services shall pay a nonrefundable $60 application fee. If the license is issued for less than 12 months, the nonrefundable fee shall be $30. The FRO personnel described in this paragraph are not exempt from the payment of certification and license application fees.

(4) Applicants who meet all the requirements for a license shall be issued an FRO license. The license is issued for 2 years. For administrative purposes, it may be issued for less than 2 years.

(e) Responsibilities of the FRO. During the license period the FRO's responsibilities shall include:

(1) assuring ongoing compliance with the terms of all EMS provider agreement(s);

(2) assuring the existence of and adherence to a quality assurance plan which shall, at a minimum, include:

(A) the standard of patient care and the medical director's protocols;

(B) pharmaceutical storage;

(D) preventive maintenance of medical equipment and vehicles owned by the FRO;

(E) policies and procedures;

(F) complaint management; and

(G) patient care reporting and documentation.

(3) ensuring that all medical personnel are currently certified or licensed by the department;

(4) assuring that all personnel on the scene of an emergency are prominently identified by, at least, the last name and the first initial of the first name, the certification or license level and the FRO name. An FRO may utilize an alternative identification system in incident specific situations that pose a potential for danger if the individuals are identified by name;

(5) assuring that all vehicles utilized by FRO personnel carry proof of first responder registration or have the name of the FRO prominently displayed and visible from the outside of the vehicle while on the scene of an emergency;

(6) assuring the confidentiality of all patient information in compliance with all federal and state laws;

(7) developing and adhering to an agreement between the primary transport provider and first responder organization concerning the use of patient refusal forms and documentation for incidents when an informed treatment refusal form cannot be obtained;

(8) developing and adhering to an agreement between the primary transport provider and first responder organization concerning the maintenance of FRO records;

(9) assuring that patient care reports are completed accurately for all patients:

(A) the report shall be accurate, complete and clearly written.

(B) the report shall document, at a minimum, the patient's name, condition upon arrival at the scene; the prehospital care provided; the dispatch time; scene arrival time; and the identification of the EMS staff.

(10) assuring that all relevant patient care information is supplied in writing to the licensed EMS provider at the time the patient is transferred to the provider;

(11) assuring that a full written report is provided, upon request, within 1 business day to the transport provider and/or hospital facility where the patient was delivered;

(12) assuring that all requested patient records are made promptly available to the first responder organization's medical director;

(13) assuring that current protocols are available to all certified or licensed personnel;

(14) monitoring and enforcing compliance with all policies;

(15) assuring provisions for the appropriate disposal of medical and/or biohazardous waste materials;

(16) assuring that all documents, reports or information provided to the department are current, accurate and complete;

(17) assuring compliance with all federal and state laws and regulations and all local ordinances, policies and codes at all times;

(18) assuring that the department is notified within 5 business days whenever there is a change:

(A) in the level of service;

(B) in the declared service area;

(D) in the physical location of the first responder organization;

(E) in the physical location of patient report file storage, to assure that the department has access to these records at all times;

(F) of the administrator;

(G) of e-mail address; or

(H) of EMS providers associated with the FRO.

(19) assuring that the department is notified within 1 business day when a change of the medical director has occurred;

(20) assuring the FRO has written operating policies, procedures and medical protocols and provides all medical personnel a copy initially and whenever such policies, procedures and/or medical protocols are changed. A copy of the written operating policies, procedures and medical protocols shall be made available to the department upon request. At a minimum, policies shall adequately address:

(A) personal protective equipment;

(B) immunizations available to personnel;

(D) communicable disease exposure;

(E) credentialing of new response personnel before being assigned to respond to emergencies. The credentialing process shall include, at minimum:

(i) a comprehensive orientation session of the FRO's policies and procedures, safety precautions, and quality management process; and

(ii) an internship period in which all new personnel practice under the supervision of, and are evaluated by, another more experienced person, if operationally feasible.

(F) appropriate documentation of patient care;

(21) assuring that all documents, reports or information provided to the department are current, truthful and correct;

(22) assuring that the department is notified within 1 business day of a collision involving an FRO vehicle responding to a scene or while at the scene of an emergency and resulting in personal injury or death of any person;

(23) maintaining motor vehicle liability insurance as required by the Texas Transportation Code under Subchapter D, §601.071 and §601.072, for all vehicles owned or operated by the FRO;

(24) providing continuous coverage for the service area as defined in the staffing plan; and

(25) responding to requests for assistance from the highest elected official of a political subdivision or from the department during a declared emergency or mass casualty situation.

(f) License renewal.

(1) The department may notify the FRO at least 90 days before the expiration date of the current license at the address shown in the current records of the department. If a notice of expiration is not received, it is the responsibility of the FRO to notify the department and request license renewal application information.

(2) FROs shall submit a completed application and nonrefundable fee, if applicable, and must verify compliance with the requirements of the license.

(g) License denial. A license may be denied for, but not limited to, the following reasons:

(1) failure to meet requirements for an FRO license in accordance with this section;

(2) previous failure to meet the responsibilities of an FRO as described in this section;

(3) falsifying any information, record or document required for an FRO license;

(4) misrepresenting any requirements for an FRO license or renewal of an FRO license;

(5) history of criminal activity while licensed as an FRO;

(6) history of disciplinary action relating to the FRO license; and/or

(7) issuing a check for application for an FRO license which is subsequently returned to the department unpaid.

(h) License revocation criteria. An FRO license may be revoked or suspended for failure to meet the responsibilities of a licensed FRO as described in this section.

(i) For all applications and renewal applications, the department is authorized to collect subscription and convenience fees, in amounts determined by the Texas Online Authority to recover costs associated with application and renewal application processing through Texas Online.

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 March 31, 2006.

TRD-200601950

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

Subchapter C. EMERGENCY MEDICAL SERVICES TRAINING AND COURSE APPROVAL

25 TAC §§157.33, 157.34, 157.40

(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 Department of State Health Services or in the Texas Register office, Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)

The repeals are authorized by Health and Safety Code, §12.0111, which requires the department to charge fees for issuing or renewing a license; §773.050(e) which authorizes the department to adopt minimum standards of first responder organizations; §773.050(b) and §773.0495 which authorize the department to adopt minimum standards for certified and licensed EMS personnel; and Government Code, §531.0055, and Health and Safety Code, §1001.075, which authorize the Executive Commissioner of the Health and Human Services Commission to adopt rules and policies necessary for the operation and provision of health and human services by the department and for the administration of Health and Safety Code, Chapter 1001.

The repeals affect the Health and Safety Code, §773. The review of the sections implements Government Code, §2001.039.

§157.33.Certification.

§157.34.Recertification.

§157.40.Paramedic Licensure.

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 March 31, 2006.

TRD-200601953

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

25 TAC §§157.33, 157.34, 157.40

The new sections are authorized by Health and Safety Code, §12.0111, which requires the department to charge fees for issuing or renewing a license; §773.050(e) which authorizes the department to adopt minimum standards of first responder organizations; §773.050(b) and §773.0495 which authorize the department to adopt minimum standards for certified and licensed EMS personnel; and Government Code, §531.0055, and Health and Safety Code, §1001.075, which authorize the Executive Commissioner of the Health and Human Services Commission to adopt rules and policies necessary for the operation and provision of health and human services by the department and for the administration of Health and Safety Code, Chapter 1001.

The new sections affect the Health and Safety Code, §773. The review of the sections implements Government Code, §2001.039.

§157.33.Certification.

(a) Certification requirements. A candidate for emergency medical services (EMS) certification shall:

(1) be at least 18 years of age;

(2) have a high school diploma or GED certificate:

(A) the high school diploma must be from a school accredited by the Texas Education Agency (TEA) or a corresponding agency from another state. Candidates who received a high school education in another country must have their transcript evaluated by a foreign credentials evaluation service that attests to its equivalency. A home school diploma is acceptable if it is accompanied by a letter of acceptance into a regionally accredited college;

(B) an emergency care attendant (ECA) who provides emergency medical care exclusively as a volunteer for a licensed provider or registered FRO is exempt from paragraph (2) of this subsection.

(3) have successfully completed a Department of State Health Services (department)-approved course; and

(4) submit an application, meeting the requirements in §157.3 of this title (relating to Processing EMS Provider Licenses and Applications for EMS Personnel Certification and Licensing), and the following nonrefundable fees as applicable:

(A) $60 for emergency care attendant (ECA) or emergency medical technician (EMT);

(B) $90 for EMT-intermediate (EMT-I) or EMT-paramedic (EMT-P); and

(C) EMS volunteer--no fee. However, if such an individual receives compensation during the certification period, the exemption ceases and the individual shall pay a prorated fee to the department based on the number of years remaining in the certification period when employment begins. The nonrefundable fee for ECA or EMT certification shall be $15 per each year remaining in the certification. The nonrefundable fee for EMT-I or EMT-P shall be $22.50 per each year remaining in the certification. Any portion of a year will count as a full year; and

(5) provide evidence of current active or inactive National Registry certification at the appropriate level. National Registry First Responder certification is considered the appropriate corresponding certification level for an ECA.

(b) Length of certification. A candidate who meets the requirements of subsection (a) of this section shall be certified for four years beginning on the date of issuance of a certificate and wallet-size certificate. A candidate must verify current certification before staffing an EMS vehicle. Certification may be verified by the applicant's receipt of the official department identification card, by using the department's certification website, or by contacting the department directly.

(1) The department has final authority for scheduling all certification examination sessions.

(2) Examinations shall be administered at regularly scheduled times in various locations across the state.

(3) The candidate shall be responsible for making appropriate arrangements for the examination.

(4) The department is not required to set special examination schedules for a single candidate or for a specific group of candidates.

(d) Time limits for completing requirements.

(1) An initial candidate for certification shall complete all requirements for certification no later than two years after the candidate's course completion date. The application will expire two years from the date the mailed application is postmarked, or the date a faxed, online submission or hand-delivered application is received at the department.

(A) The National Registry certification described in subsection (a)(5) of this section must remain current until the final requirement for state certification is met.

(B) The applicant shall update the application if any changes occur between the time of original submission and the time the final requirement for certification is met.

(2) A candidate who does not complete all requirements for certification within two years of the candidate's initial course completion date must meet the requirements of subsection (a) of this section, including the completion of another initial course to achieve certification.

(e) Non-transferability of certificate. A certificate is not transferable. A duplicate certificate may be issued if requested with a nonrefundable fee of $10.

(f) A candidate may apply for a lower level than the level of National Registry certification held.

(g) Voluntary downgrades.

(1) An individual who holds a current Texas EMS certification or paramedic license may be certified at a lower level voluntarily for the remainder of the certification period by submitting an application for the lower level certification and the applicable nonrefundable fee as required in subsection (a)(4) of this section.

(2) On the date the downgrade is final, the previous higher level of certification/license shall be surrendered. To regain the original higher level of certification, the candidate shall follow late recertification procedures according to §157.34(d) of this title (relating to Recertification), within one year after the surrender date.

(h) Inactive certification. A certified EMT, EMT-I, or EMT-P may make application to the department for inactive certification at any time during the certification period or within one year after the certificate expiration date.

(1) The request for inactive certification shall be accompanied by a nonrefundable fee of $30 in addition to the regular nonrefundable fee in subsection (a)(4)(A) and (B) of this section. If the final requirement is completed during the one-year period after expiration, the application fees listed in §157.34(d) of this title will be required. Volunteers are not exempt from inactive fees.

(2) Period of inactive certification.

(A) The inactive certification period shall begin upon date of issuance of the notice of inactive certification and remain in effect until the end of the original active certification period for those candidates who are currently certified. The candidate's active certification is surrendered upon issuance of the notice of inactive certification.

(B) If the candidate is within the final year of active certification and chooses to renew with inactive certification, the inactive certification begins on the first day after the expiration of the current active certificate and shall remain in effect for four years.

(C) If the candidate applies during and/or completes the final requirement for inactive certification within one year after the expiration of active certification, the inactive certification period shall remain in effect for four years from the date of issuance of the notice of inactive certification.

(3) While on inactive certification, a person shall not practice other than to act as a bystander rendering first aid or cardiopulmonary resuscitation (CPR) or the use of an Automated External Defibrillator in the capacity of a layperson. Practicing in any other capacity for compensation or as a volunteer shall be cause for denial of reentry and decertification.

(4) An individual shall not simultaneously hold inactive and active certification.

(i) Reciprocity.

(1) A person who is currently certified by the National Registry but did not complete a department-approved course may apply for the equal or lower level Texas certification by submitting a reciprocity application and a nonrefundable fee of $120.

(A) Applicants holding National Registry EMT-intermediate certification must submit written verification of proficiency of EMT-intermediate skills from an approved education program.

(B) National Registry first responder certification is not eligible for reciprocity at the ECA level.

(C) A candidate will not be eligible for reciprocity if the National Registry certification expires prior to the completion of all requirements for certification as listed in this section.

(D) A candidate who meets the requirements of this section shall be certified for four years beginning on the date of issuance of a certificate and wallet-size certificate.

(2) A person currently certified by another state may apply for equal or lower level Texas certification by submitting a reciprocity application and a nonrefundable fee of $120.

(A) The candidate must pass the National Registry assessment exam.

(B) Applicants holding EMT-intermediate out-of-state certification must submit written proof of proficiency on all of the EMT-Intermediate skills signed by a Texas certified EMS coordinator or instructor.

(D) A candidate will not be eligible for reciprocity if the out-of-state certification expires prior to the completion of all requirements for certification as listed in this section.

(E) A candidate who meets the requirements of this section shall be certified for four years beginning on the date of issuance of a certificate and wallet-size certificate.

(3) Personnel receiving department issued certification through reciprocity must recertify prior to the expiration of the certificate by following the requirements in §157.34 of this title.

(j) Equivalency.

(1) Candidates meeting the following criteria may apply for certification only through the equivalency process as described in this subsection:

(A) an individual who completed EMS training outside the United States or its possessions;

(B) an individual who is certified or licensed in another healthcare discipline;

(D) an individual who has held department issued inactive certification for more than four years.

(2) A candidate applying for certification by equivalency shall:

(A) submit a copy of the curriculum and work history completed by the candidate to a regionally accredited post secondary institution approved by the department to sponsor an EMS education program for its review;

(B) obtain a course completion document that verifies that the program is satisfied that all curriculum requirements have been met. Evaluations of curricula conducted by post secondary educational institutions under this subsection shall be consistent with the institution's established policies and procedures for awarding credit by transfer or advanced placement; and

(C) the candidate may then apply for initial certification with the department as described in subsection (a) of this section.

(k) For all applications and renewal applications, the department is authorized to collect subscription and convenience fees, in amounts determined by the Texas Online Authority, to recover costs associated with application and renewal application processing through Texas Online.

§157.34.Recertification.

(a) Recertification requirements.

(1) Not later than the 30th day before the date a person's certificate is scheduled to expire, the Department of State Health Services (department) may send to the person a notice of expiration at the address shown in the current records of the department.

(2) If a certificant has not received a notice of expiration from the department 30 days prior to the expiration, it is the duty of the certificant to notify the department and to request an application for recertification or download an application from the Internet.

(3) To maintain certification status without a lapse, an applicant shall submit a completed application for recertification and shall meet all requirements for renewal of the current certification prior to the expiration date of the current certificate, but no earlier than one year prior to the expiration date.

(4) The certificant shall submit the following non-refundable fees as applicable:

(A) $60 for Emergency Care Attendant (ECA) or Emergency Medical Technician (EMT);

(B) $90 for EMT-Intermediate (EMT-I) or EMT-Paramedic (EMT-P); and

(C) EMS volunteer--no fee. However, if such an individual receives compensation during the certification period, the exemption ceases and the individual shall pay a prorated fee to the department based on the number of years remaining in the certification period when employment begins. The non-refundable fee for ECA or EMT certification shall be $15 per each year remaining in the certification. The non-refundable fee for EMT-I or EMT-P shall be $22.50 per each year remaining in the certification. Any portion of a year will count as a full year.

(5) Recertification by voluntary downgrade. An individual who holds a Texas EMS certification or paramedic license may renew at a lower level by meeting the requirements of this subsection. The applicant must meet the requirements for the lower level of certification requested as described in subsection (b) or (f) of this section. On the date the downgrade is final, the previous higher level of certification becomes invalid. To regain the original higher level of certification, the candidate shall meet the late recertification requirements outlined in subsection (f) of this section, within one year after the expiration date.

(6) A certificate is not transferable.

(7) Military personnel. A person certified by the department who is deployed in support of military, security, or other action by the United Nations Security Council, a national emergency declared by the president of the United States, or a declaration of war by the United States Congress is eligible for recertification under timely recertification requirements from the person's date of demobilization until one calendar year after the date of demobilization but will not be certified during that period.

(A) In addition to requirements described in this subsection, the candidate shall submit a copy of deployment and demobilization orders.

(B) The four-year certification will commence on issue date of the certificate.

(C) If all requirements are not completed within one year after date of demobilization, the candidate must meet the requirements of late recertification within one additional year, as described in subsection (f) of this section.

(b) Recertification options. Upon submission of a completed application for recertification, the applicant shall commit to, and recertify through one of the options described in paragraphs (1) - (5) of this subsection.

(1) Option 1--Written Examination Recertification Process.

(A) The applicant shall pass the National Registry assessment exam. An overall score of 70 is considered to be passing.

(B) If the applicant fails the examination for recertification, the applicant may attempt two retests of the examination after:

(i) submitting a retest application for each attempt at any eligible level; and

(ii) submitting a non-refundable retest fee of $30 for each attempt.

(C) For each subsequent retest attempt, an applicant may apply for and retest at a lower level by complying with paragraph (1)(B) of this subsection, if applicable.

(D) An applicant who selects option 1 and attempts the exam but does not pass the National Registry assessment examination may not gain recertification by any other option and shall not qualify for inactive certification addressed in §157.33(h) of this title (relating to Certification) or subsection (e) or (f) of this section.

(E) An applicant who does not pass the third attempt at the National Registry assessment examination:

(i) shall successfully complete a Formal Recertification Course as described in paragraph (4) of this subsection; and

(ii) shall submit a course completion certificate of the Formal recertification course, reflecting that the course was completed after the 2nd retest failure; and

(iii) shall pass the National Registry assessment examination in accordance with the provisions in subparagraphs (A) - (D) of this paragraph.

(iv) shall not qualify for more than a total of six attempts at the exam, in any combination of levels attempted.

(F) The certification status of an applicant who does not successfully complete the examination recertification process as described in paragraph (1)(A) - (E) of this subsection shall expire on the date of the current certificate.

(i) The applicant will have until 90 days after expiration date of the current certificate to submit the application, pay the renewal fee of 1-1/2 times the amount described in subsection (a)(4) of this section and successfully complete the examination recertification process. If the applicant has already submitted an application and fee prior to the expiration of the certificate, another application will not be required, but an additional one-half fee shall be necessary. If applicable, the retest process, including appropriate retest applications and fees, may continue during the 90-day period.

(ii) If applicant does not apply for and successfully complete the Option 1 recertification process within 90 days following expiration, applicant shall meet requirements of late recertification described in subsection (d)(3) of this section. Another application and a non-refundable renewal fee that is equal to two times the amount designated in subsection (a)(4) of this section shall be required. Successful completion of the late recertification process must be accomplished within one year of expiration.

(iii) A candidate whose certificate has been expired for one year or more may not renew the certificate. The candidate may become certified by complying with the requirements of §157.33(a) or (j) of this title.

(2) Option 2--Continuing Education Recertification Process. The certificant shall attest to accrual of department approved EMS continuing education as specified in §157.38 of this title (relating to Continuing Education).

(3) Option 3--National Registry Recertification Process. The applicant shall attest to and hold current National Registry certification at the time of applying for recertification.

(4) Option 4--Formal Course Recertification Process. The applicant shall attest to successful completion of a department approved recertification course.

(A) The recertification course, as prescribed by the Education and Training Manual, shall be a formal structured interactive training course as approved by the department and conducted within the four-year certification period.

(B) The minimum contact hours required for recertification courses are:

Figure: 25 TAC §157.34(b)(4)(B)

(5) Option 5--CCMP Recertification Process. An applicant affiliated with an EMS provider that has a department-approved Comprehensive Clinical Management Program (CCMP) may be recertified if:

(A) the applicant is currently credentialed in the provider's CCMP;

(B) the applicant has been enrolled in the provider's CCMP for at least six continuous months; and

(C) the applicant submits to the department a signed written statement by the CCMP's medical director, attesting to the applicant's successful participation in and completion of the provider's CCMP.

(6) If a candidate wishes to change options (other than option 1), another application form must be submitted. An additional fee is not required if the candidate completes all requirements within the same time period of the original submission.

(c) After verification by the department of the information submitted by the applicant, that the information is true, correct and complete with regard to the applicant meeting recertification requirements by the certification expiration date, the department shall recertify the applicant for four years, commencing on the day following the expiration date of the most recent certificate. A candidate must verify current certification before staffing an EMS vehicle. Certification may be verified by the applicant's receipt of the official department identification card, by using the department's certification website, or by contacting the department directly.

(d) Late recertification.

(1) The candidate whose certification has expired shall be considered late, non-certified and shall not function in the capacity of an EMS certificant or represent that he is EMS certified until recertification is issued.

(2) A candidate whose certificate has been expired for 90 days or less may renew the certificate by submitting an application accompanied by a non-refundable renewal fee that is equal to 1-1/2 times the normally required application renewal fee for that level as listed in subsection (a)(4) of this section. Applicant shall meet one of the recertification options described in subsection (b)(1) - (5) of this section and submit verification of skills proficiency from an approved education program. If the applicant has already submitted an application and fee, but has not met all of the requirements prior to expiration, another application will not be required, but a total of 1-1/2 times the normally required application renewal fee shall be necessary. The applicant shall be recertified for a period of four years beginning on the date of issuance.

(3) A candidate whose certificate has been expired for more than 90 days but less than one year may renew the certificate by submitting an application accompanied by a non-refundable renewal fee that is equal to two times the normally required application renewal fee as listed in subsection (a)(4) of this section. Applicant shall meet one of the recertification options described in subsection (b)(2) - (6) of this section and submit verification of skills proficiency from an approved education program. If the applicant has already submitted an application and fee, but has not met all of the requirements prior to the 90th day after expiration, another application will not be required, but a total of two times fee shall be necessary.

(4) The applicant shall be recertified for a period of four years beginning on the date of issuance.

(5) A candidate whose certificate has been expired for one year or more may not renew the certificate. The candidate may become certified by complying with the requirements of §157.33(a) or (j) of this title.

(6) A candidate who was certified in this state, moved to another state, and is currently certified or licensed and has been in practice in the other state for two years preceding the date of application may become certified without reexamination. The candidate may gain recertification by:

(A) submitting to the department a non-refundable fee that is equal to two times the normally required renewal fee for certification as listed in subsection (a)(4) of this section; and

(B) attesting to regular practice of emergency medical care in the other state for the two years preceding the date of application.

(e) Renewal of inactive certification.

(1) To renew inactive certification, an applicant holding inactive certification shall submit an application and the non-refundable fee as described in §157.33(a)(4) of this title. The $30 inactive fee is not required for renewal when renewing inactive certification. A candidate who meets requirements for inactive renewal shall be awarded inactive certification for a period of four years beginning on the first day after the expiration of the previous inactive certification.

(2) A candidate whose inactive certification has been expired for 90 days or less may renew the inactive certification during the 90 day period after expiration of the certification upon submitting a fee of 1-1/2 times the normally required renewal fee as described in subsection (a)(4) of this section. If the applicant has already submitted an application and fee, but has not met all of the requirements prior to expiration, another application will not be required, but a total of 1-1/2 fee shall be necessary. The applicant shall be recertified for a period of four years beginning on the date of issuance.

(3) A candidate whose inactive certification has been expired more than 90 days but less than one year may renew the inactive certification upon submitting a fee of two times the normally required renewal fee as described in subsection (a)(4) of this section. If the applicant has already submitted an application and fee, but has not met all of the requirements prior to the 90th day after expiration, another application will not be required, but a total of two times fee shall be necessary. The applicant shall be recertified for a period of four years beginning on the date of issuance.

(4) A candidate whose inactive certificate has been expired more than one year must regain active certification before reapplying for inactive certification as described in subsection (f) of this section.

(f) Inactive to active certification.

(1) An inactive certificant prior to the expiration of the first four-year inactive certification period may obtain active certification by submitting an application and the non-refundable fee to the department, as described in subsection (a)(4) of this section and by completing one of the following options:

(A) Option 1--meet the normal 4 year continuing education requirement for certification renewal as listed in subsection (b)(2) of this section, submit verification of skills proficiency from an approved education program, and pass the national registry assessment exam.

(B) Option 2--complete a department approved recertification course, and pass the national registry assessment exam.

(2) A certificant who has held inactive certification for more than four years may return to active certification only by completing requirements described in §157.33(a) or (j) of this title.

(g) For all applications and renewal applications, the department is authorized to collect subscription and convenience fees, in amounts determined by the Texas Online Authority, to recover costs associated with application and renewal application processing through Texas Online.

§157.40.Paramedic Licensure.

(a) Requirements for paramedic licensure.

(1) A currently certified paramedic may apply for a paramedic license if the candidate has at least one of the following degrees from an institution of post secondary education which has been accredited by an agency recognized by the U.S. Department of Education as an approved accrediting authority:

(A) an associate degree in emergency medical services (EMS);

(B) a baccalaureate degree; or

(2) Initial paramedic license. A candidate for initial paramedic licensure under this section shall:

(A) be at least 18 years of age;

(B) submit an application and a nonrefundable fee, if applicable, of $120; EMS volunteer--no fee; however, if the applicant later receives compensation during the renewed licensure period, the exemption ceases and the individual shall pay a prorated fee to the Department of State Health Services (department) based on the number of years remaining in the licensure period when employment begins. The non-refundable fee shall be $30 per each year remaining in the licensure. Any portion of a year that the licensed paramedic receives compensation for his paramedic service will count as a full year.

(D) have met the appropriate requirements in paragraph (1) of this subsection;

(E) submit an official transcript from an accredited institution of post secondary education showing successful completion of at least one of the academic degrees referenced in paragraph (1) of this subsection;

(F) An initial candidate not currently holding a current EMT-paramedic certification shall complete all requirements for licensure no later than two years after the candidate's course completion date. A candidate holding a current EMT-paramedic certification may apply at any time.

(G) The application will expire two years from the date the mailed application is postmarked, or the date a faxed, online submission or hand-delivered application is received at the department.

(i) The National Registry certification described in subparagraph (C) of this paragraph must remain current until the final requirement for paramedic licensure is met.

(ii) The applicant shall update the application if any changes occur between the time of original submission until the final requirement for licensure is met.

(3) Verification of information. After verification by the department of the information submitted by the candidate, a candidate who meets the requirements will be issued a paramedic license valid for a period of four years from the date of issuance of the license. A candidate must verify current licensure before staffing an EMS vehicle. Licensure may be verified by the applicant's receipt of the official department identification card, by using the department's certification website, or by contacting the department directly.

(4) The license is not transferable.

(5) Duplicate copies of the paramedic license may be issued, by the department to replace lost credentials for a fee of $10.

(6) A licensed paramedic may not hold another department EMS certification except for that of EMS course coordinator or EMS instructor.

(b) Renewal of paramedic license.

(1) Prior to the expiration of a license, the department may send a notice of expiration by United States mail or electronic mail to the licensee at the address shown in current records of the department. It is the responsibility of the licensed paramedic to notify the bureau of any change of address.

(2) If a licensed paramedic has not received notice of expiration from the department at least 30 days prior to the expiration of the license, it is the duty of the license holder to notify the department and request an application for renewal of the license. Failure to apply timely for renewal of the license shall result in expiration of the license.

(3) To maintain licensure status without a lapse, an applicant shall submit an application and fee (if applicable) for renewal of a license and shall complete all requirements for renewal of the license prior to the expiration date, but no earlier than one year prior to the expiration date.

(A) The licensee shall submit a non-refundable fee of $120 with the application.

(B) EMS volunteer--no fee. However, if the applicant later receives compensation during the renewed licensure period, the exemption ceases and the individual shall pay a prorated fee to the department based on the number of years remaining in the licensure period when employment begins. The non-refundable fee shall be $30 per each year remaining in the licensure. Any portion of a year that the licensed paramedic receives compensation for his paramedic service will count as a full year.

(C) Applicants holding a paramedic license may renew by completing any of the recertification options listed in §157.34(b) of this title (relating to Recertification). A licensee selecting Option 2, as defined in §157.34(b)(2) of this title, and in accordance with §157.38 of this title (relating to Continuing Education) may substitute up to 12 contact hours in the "Preparatory" content area and up to 48 contact hours of continuing education in the "Additional Approved Categories" area with any course of non-clinical professional development study approved by the licensee's medical director.

(4) After verification by the department of the information submitted, the paramedic license will be renewed for four years beginning on the day following the expiration date of the license. A new wallet-size card will be issued by the department.

(5) A license is not transferable.

(6) Military personnel. A licensed paramedic who is deployed in support of military, security, or other action by the United Nations Security Council, a national emergency declared by the President of the United States, or a declaration of war by the United States Congress, is eligible for relicensure under timely relicensure requirements from the person's date of demobilization until one calendar year after the date of demobilization, but will not be licensed during that period.

(A) In addition to requirements described in this subsection, the candidate shall submit a copy of deployment and demobilization orders.

(B) If all requirements are not completed within one year after date of demobilization, the candidate must meet the requirements of late paramedic relicensure within one additional year, as described in subsection (c) of this section.

(1) Following the expiration date of the paramedic license, a candidate shall not be considered licensed and may not function in the capacity of an EMS licensee or certificant or represent that he is licensed or certified until relicensure is issued.

(2) A candidate whose paramedic license has been expired for 90 days or less may renew the license by submitting an application accompanied by a non-refundable renewal fee that is equal to 1-1/2 times the normally required application renewal fee for that level as listed in subsection (a)(2)(B) of this section. The applicant shall meet one of the recertification options described in subsection §157.34(b) of this title and submit verification of skills proficiency from an approved education program. If the applicant has already submitted an application and fee, but has not met all of the requirements prior to expiration, another application will not be required, but a total of one and one-half of the fee shall be necessary. The applicant shall be recertified for a period of four years beginning on the date of issuance.

(3) A candidate whose paramedic license has been expired for more than 90 days but less than one year may renew the license by submitting an application accompanied by a non-refundable renewal fee that is equal to two times the normally required application renewal fee as listed in subsection (a)(2)(B) of this section. Applicant shall meet one of the recertification options described in §157.34(b) of this title and submit verification of skills proficiency from an approved education program. If the applicant has already submitted an application and fee, but has not met all of the requirements prior to the 90th day after expiration, another application will not be required, but a total of two times fee shall be necessary.

(4) The applicant shall be licensed for a period of four years beginning on the date of issuance.

(5) A candidate whose license has been expired for one year or more may not renew the license. The candidate may become licensed by complying with the requirements of paragraph (2) of this subsection and §157.33(j) of this title (relating to Certification).

(d) Voluntary downgrades refer to §157.33(g) of this title.

(e) Renewal by voluntary downgrade refer to §157.34(a)(5) of this title.

(f) Inactive paramedic licensure. A licensed paramedic may make application to the department for inactive licensure at any time during the license period or within one year after the license expiration date.

(1) The request for inactive licensure shall be accompanied by a nonrefundable fee of $30 in addition to the regular nonrefundable application fee in subsection (a)(2)(B) of this section. If the final requirement is completed during the three month period after expiration, the application is considered late and the total fee required will be 1-1/2 times the amount in subsection (a)(2)(B) of this section. Volunteers are not exempt from inactive fees.

(2) Period of inactive paramedic licensure.

(A) The inactive license period shall begin upon date of issuance of the notice of inactive license and remain in effect until the end of the original active license period for those candidates who are currently licensed. The candidate's active license is surrendered upon issuance of the notice of inactive certification.

(B) If the candidate is within the final year of active licensure and chooses to renew with inactive licensure, the inactive licensure begins on the first day after the expiration of the current active license and shall remain in effect for four years.

(C) If the candidate applies during and/or completes the final requirement for inactive licensure within one year after the expiration of active license, the inactive license period shall remain in effect for four years from the date of issuance of the notice of inactive licensure.

(3) While holding an inactive licensure, a person shall not practice other than to act as a bystander rendering first aid or cardiopulmonary resuscitation (CPR) or the use of an Automated External Defibrillator in the capacity of a layperson. Practicing in any other capacity for compensation or as a volunteer shall be cause for denial of reentry and decertification.

(4) An individual shall not simultaneously hold inactive and active EMS personnel certification and/or licensure.

(5) Renewal of inactive licensure.

(A) To renew an inactive license, the applicant shall submit an application and the non-refundable fee, as described in subsection (a)(2)(B) of this section before expiration of the inactive license period. A candidate who meets requirements for inactive renewal shall be awarded an inactive license for a period of four years beginning on the first day after the expiration of the previous inactive license.

(B) A candidate whose inactive license has been expired for 90 days or less may renew the inactive license during the 90 day period after expiration of the license upon submitting a fee of 1-1/2 times the normally required renewal fee as described in subsection (a)(2)(B) of this section. If the applicant has already submitted an application and fee, but has not met all of the requirements prior to expiration, another application will not be required, but a total of 1-1/2 times the normally required renewal fee shall be necessary. The applicant shall be relicensed for a period of four years beginning on the date of issuance.

(C) A candidate whose inactive license has been expired more than 90 days but less than one year may renew the inactive license upon submitting a fee of two times the normally required renewal fee as described in subsection (a)(2)(B) of this section. If the applicant has already submitted an application and fee, but has not met all of the requirements prior to the 90th day after expiration, another application will not be required, but a total of two times the normally required renewal fee shall be necessary. The applicant shall be relicensed for a period of four years beginning on the date of issuance.

(D) A candidate whose inactive license has been expired more than one year must regain active licensure before reapplying for an inactive license as described in §157.33(j) of this title.

(g) Inactive to active licensure.

(1) An inactive licensed paramedic prior to the expiration of the first four-year inactive licensure period may obtain active licensure by submitting an application and the non-refundable fee to the department, as described in subsection (a)(2)(B) of this section and by completing one of the following options:

(A) Option 1--meet the normal 4 year CE requirement for paramedic license renewal as listed in §157.34(b)(2) of this title, submit verification of skills proficiency from an approved education program, and pass the national registry assessment exam.

(B) Option 2--complete a department approved recertification course, and pass the national registry assessment exam.

(2) A licensee who has held an inactive paramedic license more than four years may return to active licensure only by completing requirements described in subsection (a)(2) of this section or §157.33(j) of this title.

(h) Reciprocity. A person currently certified by the National Registry and/or certified or licensed as a paramedic in another state, who meets all the requirements of subsection (a)(1), (2)(B), (D), (E) and (G) of this section may apply for paramedic licensure by submitting an application along with a nonrefundable fee of $120 and meeting the requirements set forth in §157.33(i) of this title.

(1) After the department evaluates the application and verifies that the requirements for reciprocity have been met, the candidate will be licensed in Texas for four years from the issuance date of the paramedic license.

(2) Prior to the expiration of the reciprocity license, the certificant shall reapply and renew the license according to the requirements of subsection (b) of this section.

(i) Equivalency. Candidates meeting the following criteria may apply for a paramedic license upon successful completion of the equivalency process as described in subsection (a)(1), (2)(B), (D), (E) and (G) of this section and §157.33(j) of this title:

(1) an individual who completed EMS training outside the United States or its possessions;

(2) an individual who is certified or licensed in another healthcare discipline;

(3) an individual whose department issued EMS certification or license has been expired for more than one year; or

(4) an individual who has held department issued inactive certification or license for more than four years.

(j) Conversion from inactive paramedic certification to inactive paramedic licensure. A certified paramedic currently holding inactive certification who meets all other criteria as defined in subsection (a)(1) of this section may apply for inactive licensure.

(1) The inactive certificant shall:

(A) submit an application for inactive licensure to the department along with a nonrefundable fee of $120; and

(B) submit evidence of the issuance of a degree from an accredited college or university as defined in subsection (a)(1) of this section.

(2) After verification by the department of the information submitted, an inactive paramedic license will be issued for four years beginning on the day of issuance.

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 March 31, 2006.

TRD-200601952

Cathy Campbell

General Counsel

Department of State Health Services

Earliest possible date of adoption: May 14, 2006

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

Chapter 412. LOCAL MENTAL HEALTH AUTHORITY RESPONSIBILITIES

Subchapter I. MENTAL HEALTH CASE MANAGEMENT SERVICES

25 TAC §§412.403, 412.405 - 412.408, 412.410 - 412.413, 412.415 - 412.417

The Executive Commissioner of the Health and Human Services Commission, on behalf of the Department of State Health Services (department), proposes amendments to §§412.403, 412.405 - 412.408, 412.410 - 412.413, and 412.415 - 412.417, concerning mental health case management services.

BACKGROUND AND PURPOSE

This subchapter describes requirements for the provision of mental health case management services (MH case management services) funded by or through the department. The proposed amendments include the addition of language that either better explains terms already included in the definitions, or adds newly defined terms, providing clarification for providers and others who are impacted by these rules.

Several new requirements are added to §412.411, relating to Staff Training. These additional requirements are intended to highlight and emphasize that case managers and case manager supervisors must not only comply with the provisions in this subsection, but also with standards and requirements found in other rules of the department. Such other rules include the requirements of Chapter 412, Subchapter G, of this title (relating to Mental Health Community Services Standards), Chapter 404, Subchapter E, of this title (relating to Rights of Persons Receiving Mental Health Services), and Chapter 414, Subchapter L, of this title (relating to Abuse, Neglect, and Exploitation in Local Authorities and Community Centers).

Certain language is moved from §412.405, relating to Eligibility for MH Case Management Services, to §412.413, relating to Medicaid Reimbursement. These changes are proposed to more accurately reflect that, although an individual may meet the basic eligibility criteria for MH case management services, circumstances sometimes exist in which those services are not reimbursable under Medicaid. Moving the language to the section concerning Medicaid reimbursement is intended to assist readers in understanding this distinction.

The proposed amendments also remove all references to the Texas Department of Mental Health and Mental Retardation and replace them with the new agency name, the Department of State Health Services.

Additionally, Government Code, §2001.039, requires that each state agency review and consider for re-adoption each rule adopted by that agency pursuant to the Government Code, Chapter 2001 (Administrative Procedure Act). Sections 412.401 - 412.417 have been reviewed and the department has determined that reasons for adopting the sections continue to exist because rules on this subject are needed. Sections 412.401, 412.402, 412.404, 412.409, and 412.414 are open for comment without proposed amendments.

SECTION-BY-SECTION SUMMARY

In addition to certain grammatical and formatting changes, as well as changing the references to the Texas Department of Mental Health and Mental Retardation to the Department of State Health Services in §412.403 and §412.417, the following amendments are proposed.

Proposed amendments to §412.403 add language to the definition of "CSSP or community services specialist" to require the CSSP staff to possess demonstrated competency in the provision and documentation of case management services in accordance with the subchapter and with the case management billing guidelines. Also proposed is the addition of the following new definitions: "family partner," "intensive case management," "routine case management," and "strengths-based." Amendments were also made to the definitions of "department," staff member," "uniform assessment," "utilization management guideline," and "wraparound planning," for clarification and a better understanding of these terms as they are used in this subchapter. The definitions are renumbered to accommodate the additions.

Section 412.405, relating to Eligibility for MH Case Management Services, is proposed to be amended by deleting subsection (b) and moving it to §412.413 of this title (relating to Medicaid Reimbursement), as it more accurately refers to the availability of Medicaid reimbursement than to eligibility for the services.

Section 412.406, relating to Establishing Type, Amount, and Duration of MH Case Management Services, is amended to require the department or its designee to notify the individual seeking services or the individual's legally authorized representative, not later than seven days after a determination has been made, whether a request for MH case management services has been authorized or denied. This section and §412.408, relating to Service Limitations, are both amended by deleting references to the section title, "Exhibits," and replacing it with "Guidelines."

Section 412.407, relating to MH Case Management Services, is amended to clarify that an assessment of unmet needs involves discussing what those needs are with the individual, establishing time frames for meeting outcomes, explaining the availability of services and providing case management offsite if it is necessary to facilitate linkage to a needed service.

Proposed amendments to §412.410 include grammatical changes only.

Section 412.411, relating to Staff Training, is amended by the addition of language requiring case managers and supervisors of case managers to receive training and demonstrate competency in the requirements of this subchapter, as well as the requirements of Chapter 412, Subchapter G of this title (relating to Mental Health Community Services Standards), Chapter 404, Subchapter E, of this title (relating to Rights of Persons Receiving Mental Health Services), and Chapter 414, Subchapter L, of this title (relating to Abuse, Neglect, and Exploitation in Local Authorities and Community Centers). The section is also amended to provide that case managers and case manager supervisors must receive training and demonstrate competency in developing and implementing a case management plan when providing intensive case management services to a child or adolescent.

Section 412.412, relating to Documentation of MH Case Management Services, is amended to reflect the expectation that not only are service provision events to be documented, but attempts to provide the service are expected to be documented as well by the case manager. Additionally, the section is amended to require the case manager to document referrals and the disposition of those referrals made.

Section 412.413, relating to Medicaid Reimbursement, is amended by the addition of language indicating that the department will not reimburse a provider for Medicaid MH case management services provided in excess of eight hours. The section is also amended by the addition of a new subsection (f), the text of which is proposed for deletion from §412.405(b) of this title, relating to Eligibility for MH Case Management Services. This change is intended to clarify that the language more accurately refers to the availability of Medicaid reimbursement than to eligibility for the services, and to assist readers in better understanding the distinction between an individual's eligibility for services and a provider's ability to be reimbursed, under Medicaid, for providing those services.

Section 412.415 is renamed as "Guidelines." In addition, the text of the rule is amended by changing references to "exhibits" to "guidelines," and by correcting the department's address for purposes of obtaining copies of any of the guidelines.

Section 412.416 is amended by the addition of several rules that are referenced in the subchapter.

FISCAL NOTE

Machelle Pharr, Chief Financial Officer, has determined that, for each year of the first five years that the sections will be in effect, there will be no fiscal implications to state or local governments as a result of enforcing and administering the sections as proposed.

SMALL AND MICRO-BUSINESS IMPACT ANALYSIS

Ms. Pharr has also determined that there will be no effect on small businesses or micro-businesses required to comply with the sections as proposed. This was determined by interpretation of the rules that small businesses and micro-businesses will not be required to alter their business practices in order to comply with the sections. There are no anticipated economic costs to persons who are required to comply with the sections as proposed. There is no anticipated negative impact on local employment.

PUBLIC BENEFIT

In addition, Dave Wanser, Deputy Commissioner, has determined that, for each year of the first five years the sections are in effect, the public will benefit from adoption of the sections. The public benefit anticipated as a result of enforcing or administering the sections is to ensure the availability of mental health case management services, that such services will be provided by qualified and trained staff, and that correctly provided and documented services will be appropriately reimbursed by the department.

REGULATORY ANALYSIS

The department has determined that this proposal is not a "major environmental rule" as defined by Government Code, §2001.0225. "Major environmental rule" is defined to mean a rule the specific intent of which is to protect the environment or reduce risk to human health from environmental exposure and that may adversely affect, in a material way, the economy, a sector of the economy, productivity, competition, jobs, the environment or the public health and safety of a state or a sector of the state. This proposal is not specially intended to protect the environment or reduce risks to human health from environmental exposure.

TAKINGS IMPACT ASSESSMENT

PUBLIC COMMENT

Comments on the proposal may be submitted to Chris DeWitt, Department of State Health Services, Mental Health and Substance Abuse Program Services Unit, 909 West 45th Street - Mail Code 2018, Austin, Texas 78751, or by email to Chris.Dewitt@dshs.state.tx.us. Comments will be accepted for 30 days following publication of the proposal in the Texas Register .

LEGAL CERTIFICATION

The amendments are authorized by Health and Safety Code, §534.052, which requires the adoption of rules necessary and appropriate to ensure the adequate provision of community based mental health services through a local mental health authority; Health and Safety Code, §534.053, which requires the department to ensure that case management services are available in each local mental health authority service area; and Government Code, §531.0055, and Health and Safety Code, §1001.075, which authorize the Executive Commissioner of the Health and Human Services Commission to adopt rules and policies necessary for the operation and provision of health and human services by the department and for the administration of Health and Safety Code, Chapter 1001.

The amendments affect Government Code, Chapter 531; and Health and Safety Code, Chapters 534 and 1001.

§412.403.Definitions.

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

(1) - (7) (No change.)

(8) CSSP or community services specialist--A staff member who, as of August 31, 2004:

(A) (No change.)

(B) has had three continuous years of documented full time experience in the provision of MH case management services ; and [ . ]

(C) has demonstrated competency in the provision and documentation of MH case management services in accordance with this subchapter and the MH Case Management Billing Guidelines.

(9) - (10) (No change.)

(11) Department-- Department of State Health Services [ ~~The Texas Department of Mental Health and Mental Retardation or its successor~~ ].

(12) (No change.)

(13) Family partner--Experienced parent (i.e. parent of an individual with a serious emotional disturbance) who provides peer mentoring, education, and support to the caregivers of a child who is receiving mental health community services.

(14) [ ~~(13)~~ ] Individual--A person seeking or receiving MH case management services.

(15) [ ~~(14)~~ ] IMD or institution for mental diseases--Based on 42 CFR §435.1009, a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing psychiatric diagnosis, treatment, or care of individuals with mental illness, including medical attention, nursing care, and related services.

(16) Intensive case management--In conjunction with wraparound process planning, this is a focused intervention of coordinating community-based services that assist a child or adolescent in gaining access to necessary care and services appropriate to the individual's needs. It also includes monitoring service effectiveness and proactive crisis planning and management.

(17) [ ~~(15)~~ ] LAR or legally authorized representative--A person authorized by law to act on behalf of a child or adolescent with regard to a matter described in this subchapter, and who may be a parent, guardian, or managing conservator.

(18) [ ~~(16)~~ ] LOC or level of care--A designation given to the department's standardized packages of mental health services, based on the uniform assessment and the utilization management guidelines, which specify the type, amount, and duration of MH case management services to be provided to an individual.

(19) [ ~~(17)~~ ] Life domains--Areas of life in which a child or adolescent has unmet needs, including but are not limited to safety, health, emotional, psychological, social, educational, cultural, and legal.

(20) [ ~~(18)~~ ] MH case management plan--A written document developed by a case manager, in collaboration with the individual and the individual's LAR or primary caregiver, that identifies services needed by the individual and sets forth a plan for how the individual may gain access to the identified services.

(21) [ ~~(19)~~ ] Mental health (MH) case management services--Services to assist an individual in gaining and coordinating access to necessary care and services appropriate to the individual's needs.

(22) [ ~~(20)~~ ] Primary caregiver--A person 18 years of age or older who has actual care, control, and possession of a child or adolescent.

(23) [ ~~(21)~~ ] Provider--An entity that has an agreement with the department to provide general revenue-funded MH case management services, Medicaid-funded MH case management services, or both.

(24) [ ~~(22)~~ ] QMHP-CS or qualified mental health professional-community services--A staff member who meets the definition of a QMHP-CS set forth in Subchapter G of this chapter (relating to Mental Health Services Standards).

(25) Routine case management--Primarily site-based services that assist an adult, child or adolescent in gaining and coordinating access to necessary care and services appropriate to the individual's needs.

(26) [ ~~(23)~~ ] Site-based--Provided at a case manager's work site.

(27) [ ~~(24)~~ ] Staff member--Personnel of a provider including a full-time and part-time employee, contractor, [ ~~and~~ ] intern, and [ ~~but excluding~~ ] a volunteer.

(28) Strengths-based--Concept used in wraparound planning that identifies, builds on and enhances the capabilities, knowledge, skills and assets of the child and family, their community, and other team members. The focus is on increasing functional strengths and assets rather than on the elimination of deficits.

(29) [ ~~(25)~~ ] Uniform assessment--An assessment tool adopted [ ~~promulgated~~ ] by the department that includes the Adult Texas Recommended Assessment [ ~~Authorization~~ ] Guidelines, the Texas Implementation of Medication Algorithms scales for adults, and the Children and Adolescent Texas Recommended Assessment [ ~~Authorization~~ ] Guidelines.

(30) [ ~~(26)~~ ]Utilization management guidelines--Guidelines [ ~~promulgated~~ ] by the department that establish the type, amount, and duration of MH case management services for each LOC.

(31) [ ~~(27)~~ ] Wraparound process planning-- A philosophy of care that includes a definable planning process involving the child and family that results in a unique set of community services and natural supports individualized for that child and family to achieve a positive set of outcomes. Wraparound process planning is for a child or adolescent: [ ~~A strength-based, family-centered, community-based planning process approved by the department through which a MH case management plan is developed.~~ ]

(A) with serious emotional disturbance;

(B) who has multiple, complex needs;

(D) who is authorized for a LOC inclusive of intensive case management.

§412.405.Eligibility for MH Case Management Services.

[ ~~(a)~~ ] An individual is eligible for general revenue-funded MH case management services if the individual:

(1) is a resident of the State [ ~~state~~ ] of Texas;

(2) is an adult with a severe and persistent mental illness, or a child or adolescent with a serious emotional disturbance;

(3) does not have a single diagnosis of mental retardation, pervasive developmental disorder, or substance use disorder; and

(4) qualifies for an LOC that includes MH case management services . [ ; ]

~~[ ~~(b)~~ An individual is eligible for Medicaid-funded MH case management services if, in addition to the criteria set forth in subsection (a) of this section, the individual is:]~~

~~[ ~~(1)~~ eligible for Medicaid;]~~

~~[ ~~(2)~~ not an inmate of a public institution, as defined in 42 CFR §435.1009;]~~

~~[ ~~(3)~~ not a resident of an intermediate care facility for persons with mental retardation as described in 42 CFR §440.150;]~~

~~[ ~~(4)~~ not a resident of an IMD;]~~

[ ~~(5)~~ not a resident of a Medicaid-certified nursing facility, unless the individual has been determined through a pre-admission screening and resident review assessment to be eligible for the specialized service of MH case management services or the individual is expected to be discharged to a non-institutional setting within 180 days;]

~~[ ~~(6)~~ not a recipient of case management services under another Medicaid program, e.g. the Home and Community Services (HCS) waiver program or Texas Health Steps; and]~~

~~[ ~~(7)~~ not a patient of a general medical hospital.]~~

§412.406.Establishing Type, Amount, and Duration of MH Case Management Services.

(a) The department or its designee will make the initial determination of an individual's LOC using the uniform assessment which is referenced as Exhibit A in §412.415 of this title (relating to Guidelines [ ~~Exhibits~~ ]); and the utilization management guidelines which are referenced [ ~~as Exhibit B~~ ] in §412.415 of this title. If the LOC includes MH case management services, the department or its designee will authorize the individual to receive either routine or intensive MH case management services.

(b) - (d) (No change.)

(e) Upon receipt of a request submitted in accordance with subsection (c) or (d) of this section, the department or its designee will:

(1) (No change.)

(2) based on the review of documentation and an evaluation of available resources, authorize or deny an LOC for the individual, and if authorized, it will authorize the individual to receive either routine or intensive MH case management services; [ ~~and~~ ]

(3) if applicable, authorize or deny a request for additional units of service ; and [ . ]

(4) communicate to the individual or LAR, no longer than 7 days after the determination has been made, whether the service has been authorized or denied.

§412.407.MH Case Management Services.

(a) - (b) (No change.)

(1) meet face-to-face with the individual and the individual's LAR or primary caregiver within seven days after the case manager is [ ~~was~~ ] assigned to the individual or within seven days after discharge from an inpatient psychiatric setting, whichever is later , or document the reasons the meeting did not occur;

(2) - (4) (No change.)

(5) gather information about the individual's strengths and service needs across life domains from relevant sources, including:

(A) - (D) (No change.)

(E) other sources identified by the individual or LAR or primary caregiver;

(6) utilize wraparound planning to develop an MH case management plan that addresses the individual's unmet needs across life domains and that includes:

(A) a prioritized list of the individual's unmet needs which includes a discussion of the priorities and needs expressed by the individual and the individual's LAR ;

(B) a description of the objective and measurable outcomes for each of the unmet needs as well as a projected time frame for each outcome ;

(D) a list of the necessary services and service providers and the availability of the services ;

(E) - (F) (No change.)

(7) assist the individual in gaining access to the needed services and service providers including:

(A) - (B) (No change.)

(C) arranging , and if necessary to facilitate linkage, accompanying the individual to initial meetings and non-routine appointments;

(D) - (F) (No change.)

(8) monitor the individual's progress toward the outcomes set forth in the MH case management plan including;

(A) - (E) (No change.)

(F) identifying barriers to accessing services or to obtaining [ ~~obtain~~ ] maximum benefit from services;

(G) - (J) (No change.)

(9) upon notification that the individual is in crisis, coordinate with the appropriate providers of emergency services to respond to the crisis, as described in §412.314 of this title; and

(10) (No change.)

(d) A case manager must notify an individual in writing of the process for making a complaint to the client rights officers of the provider and the department if the individual expresses dissatisfaction with:

(1) scheduling meetings with the case manager ; [ , ] or

(2) (No change.)

§412.408.Service Limitations.

(a) (No change.)

(b) Activities that do not constitute MH case management services are identified in the department's MH Case Management Services Billing Guidelines, referenced [ ~~as Exhibit C~~ ] in §412.415 of this title (relating to Guidelines [ ~~Exhibits~~ ]).

§412.410.Staff Qualifications.

(a) - (b) (No change.)

(1) - (2) (No change.)

(3) be trained in accordance with §412.411 of this [ ~~the~~ ] title; and

(4) (No change.)

§412.411.Staff Training.

(a) A case manager and a supervisor of a case manager must receive training and demonstrate competency in the following areas:

(1) the requirements of this subchapter and of Chapter 412, Subchapter G, of this title (relating to Mental Health Community Services Standards);

(2) [ ~~(1)~~ ] the nature of mental illness and serious emotional disturbance;

(3) [ ~~(2)~~ ] the dignity and rights of an individual in accordance with Chapter 404, Subchapter E, of this title (relating to Rights of Persons Receiving Mental Health Services) ;

(4) [ ~~(3)~~ ] awareness and sensitivity in communicating and coordinating services with an individual who has a special physical need such as a hearing or visual impairment [ ~~interacting with an individual who has a special physical need such as a hearing or visual impairment~~ ];

(5) [ ~~(4)~~ ] responding to an individual's language and cultural needs through knowledge of customs, beliefs, and values of various, racial, ethnic, religious, and social groups;

(6) [ ~~(5)~~ ] identifying, preventing, and reporting abuse , [ ~~and~~ ] neglect and exploitation in accordance with Chapter 414, Subchapter L, of this title (relating to Abuse, Neglect, and Exploitation in Local Authorities and Community Centers) ;

~~[ ~~(6)~~ the requirements of this subchapter;]~~

(7) - (8) (No change.)

(9) developing and implementing an MH case management plan if the case manager is providing intensive MH case management services to a child or adolescent ;

(10) - (11) (No change.)

(12) co-occurring psychiatric and substance use disorders, as described in Chapter 411, Subchapter N of this title (relating to Standards for Services to Individuals [ ~~Persons~~ ] with Co-Occurring Psychiatric and Substance Use Disorders (COPSD) );

(13) - (17) (No change.)

(b) (No change.)

§412.412.Documentation of MH Case Management Services.

(a) A case manager must document the provision of MH case management services , as well as attempts to provide MH case management services, as follows:

(1) (No change.)

(2) if the service does not involve face-to-face contact with the individual, document:

(A) - (B) (No change.)

(D) (No change.)

(E) the case manager's signature and credentials of QMHP-CS or CSSP ; and [ . ]

(3) A case manager must document referrals made and the disposition of each referral.

(b) (No change.)

§412.413.Medicaid Reimbursement.

(a) - (b) (No change.)

(1) - (3) (No change.)

(4) the service provided was not the type, amount, and duration authorized by the department or its designee; [ or ]

(5) the service was not provided or documented in accordance with this subchapter ; or [ . ]

(6) the service provided is in excess of 8 hours per individual per day.

(d) - (e) (No change.)

(f) An individual is eligible for Medicaid-funded MH case management services if, in addition to the criteria set forth in §412.405 of this title (relating to Eligibility for MH Case Management Services), the individual is:

(1) eligible for Medicaid;

(2) not an inmate of a public institution, as defined in 42 CFR §435.1009;

(3) not a resident of an intermediate care facility for persons with mental retardation as described in 42 CFR §440.150;

(4) not a resident of an IMD;

(5) not a resident of a Medicaid-certified nursing facility, unless the individual has been determined through a pre-admission screening and resident review assessment to be eligible for the specialized service of MH case management services or the individual is expected to be discharged to a non-institutional setting within 180 days;

(6) not a recipient of case management services under another Medicaid program, e.g., the Home and Community Services (HCS) waiver program or Texas Health Steps; and

(7) not a patient of a general medical hospital.

§412.415. Guidelines [ ~~Exhibits~~ ].

The following guidelines [ ~~exhibits~~ ] are referenced in this subchapter. For information about obtaining copies of the guidelines [ ~~exhibits~~ ] contact the Department of State Health Services, Community Mental Health and Substance Abuse Program Services, Mail Code 2018 [ ~~TDMHMR, Behavioral Health Services~~ ], P.O. Box 12668, Austin, TX 78711-2668 . [ : ]

(1) Uniform [ ~~Exhibit A: uniform~~ ] assessment guidelines , which include [ ~~includes~~ ]:

(A) Adult Texas Recommended Assessment [ ~~Authorization~~ ] Guidelines;

(B) - (C) (No change.)

(2) Utilization [ ~~Exhibit B: utilization~~ ] management guidelines, which include:

(A) - (B) (No change.)

(3) [ ~~Exhibit C:~~ ] MH Case Management Services Billing Guidelines.

§412.416.References.

The following laws and rules are referenced in this subchapter:

(1) - (3) (No change.)

(4) Chapter 404, Subchapter E, of this title (relating to Rights of Persons Receiving Mental Health Services);

(5) [ ~~(4)~~ ] Chapter 411, Subchapter N of this title (relating to Standards for Services to Individuals [ ~~Persons~~ ] with Co-Occurring Psychiatric and Substance Use Disorders (COPSD) );

(6) [ ~~(5)~~ ] Subchapter G of this chapter (relating to Mental Health Community Services Standards);

(7) §412.314 of this title (relating to Crisis Services);

(8) Chapter 414, Subchapter L, of this title (relating to Abuse, Neglect, and Exploitation in Local Authorities and Community Centers);

(9) [ ~~(6)~~ ] §419.457 of this title (relating to Crisis Intervention Services);

(10) [ ~~(7)~~ ] §419.459 of this title (relating to Psychosocial Rehabilitative [ ~~Rehabilitation~~ ] Services); and

(11) [ ~~(8)~~ ] 42 CFR §435.1009 and §440.150.

§412.417.Distribution.

(a) This subchapter shall be distributed to:

(1) members of the Department of State Health Services [ ~~Texas Department of Mental Health and Mental Retardation Board~~ ] or the applicable council;

(2) - (4) (No change.)

(b) (No change.)

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 April 3, 2006.

TRD-200601977

For further information, please call: (512) 458-7111 x6972

Chapter 419. MENTAL HEALTH SERVICES--MEDICAID STATE OPERATING AGENCY RESPONSIBILITIES

The Executive Commissioner of the Health and Human Services Commission (HHSC), on behalf of the Department of State Health Services (department), proposes amendments to §§419.451 - 419.459, 419.461 - 419.470, and the repeal of §419.460, concerning mental health rehabilitative services.

BACKGROUND AND PURPOSE

This subchapter describes requirements for the provision of mental health rehabilitative services. During the 79th Texas legislative session, the legislature appropriated funds to restore the general counseling benefit to all Medicaid recipients, resulting in an amendment to the Medicaid State Plan. Due to the restoration of the general counseling benefit to all Medicaid recipients, the proposed amendments and repeal include the repeal of §419.460 of this title (relating to Rehabilitative Counseling and Psychotherapy), thus removing the rehabilitative counseling and psychotherapy benefit from the array of rehabilitative services. This change will avoid any duplication of the service that could result in double billing by providers.

Proposed amendments include removal of the word "Medicaid" from the title of the subchapter and from various provisions throughout the affected sections, to reflect that the subchapter applies to all MH rehabilitative services, not just Medicaid rehabilitative services. In addition, throughout the rules, all references to the department are changed from the Texas Department of Mental Health and Mental Retardation to the Department of State Health Services.

Another proposed change is the addition of skills training and development in a group modality (as opposed to one-to-one), to reflect the current understanding, described in recent published scientific literature, that providing this service in a group modality is effective in treating children and adolescents.

Certain language is moved from §419.455, relating to Eligibility, to §419.465, relating to Medicaid Reimbursement. These changes are proposed to more accurately reflect that, although an individual may meet the basic eligibility criteria for MH case management services, circumstances sometimes exist in which those services are not reimbursable under Medicaid. Moving the language to the section concerning Medicaid reimbursement is intended to assist readers in understanding this distinction.

The proposed amendments require that psychosocial rehabilitative services must be provided by members of a clearly defined therapeutic team, and the role and function of that team is described. New language is also proposed to better define and clarify the components of "coordination services" as that term is used in this subchapter.

Additionally, Government Code, §2001.039, requires that each state agency review and consider for re-adoption each rule adopted by that agency pursuant to the Government Code, Chapter 2001 (Administrative Procedure Act). Sections 419.451-419.470 have been reviewed and the department has determined that reasons for adopting the sections continue to exist because rules on this subject are needed.

SECTION-BY-SECTION SUMMARY

Certain grammatical and formatting changes are proposed throughout the rules, as well as removal of the word, "Medicaid," from §§419.451-419.456, 419.458, 419.459, 419.461-419.467, and 419.470. References in §419.453 to the Texas Department of Mental Health and Mental Retardation (TDMHMR), and in §419.468 and the division of Behavioral Health Services, are changed to the Department of State Health Services. A reference in §419.470 to TDMHMR or the applicable council is changed to the State Health Services Council. In addition to these changes, the following amendments are proposed.

Section 419.453, relating to Definitions, is amended by revising the definition of the term, "Medicaid provider." A separate definition of the term, "provider," is added as a newly defined term. Also, within the definition of "MH rehabilitative services," the term, "psychosocial rehabilitation services," is changed to "psychosocial rehabilitative services." In addition, the definition of "MH rehabilitative services" is amended by deleting rehabilitative counseling and psychotherapy from the list of enumerated services that are within the array of available rehabilitative services as a result of the restoration of the general counseling benefit to all Medicaid recipients.

Also in §419.453, the definition of "peer provider" is amended by changing the requirement that a peer provider has at least one cumulative year of receiving mental health services "from or through the department" to a requirement that the person has at least one cumulative year of receiving mental health services "for a disorder that is treated in the target population for Texas." This change recognizes that a person may qualify to serve as a peer provider as a result of receiving mental health services outside of Texas, as long as they were treated for a disorder that fall within the target population for Texas. The definition of "peer provider" is also amended by removing the requirement that the person "has demonstrated competency in the provision and documentation of Medicaid MH rehabilitative services in accordance with this subchapter and the Medicaid MH Rehabilitative Services Billing Guidelines." Deletion of this requirement is proposed because it would not be realistic to expect that an individual who is otherwise qualified to serve as a peer provider would be in a position to demonstrate such competence without having first served as a peer provider or in some other capacity as a provider of MH rehabilitative services. To enforce such a requirement would in most, if not all, instances prevent an individual from ever qualifying to serve as a peer provider.

Proposed amendments to §419.455, relating to Eligibility, include the renumbering of paragraph (1) of this section and the deletion of text which is proposed to be moved to §419.465 of this title (relating to Medicaid Reimbursement) to more accurately refer to the availability of Medicaid reimbursement rather than to eligibility for the service.

Proposed amendments to §419.456, relating to Service Authorization and Treatment Plan, include the addition of language in subsection (b)(1)(B) of that section, to require that the medical necessity of crisis intervention services be documented. Also, subsection (d)(2) is amended by adding language to require that, at the time a treatment plan is reviewed, the provider must solicit input from the individual, or from the LAR or primary caregiver of a child or adolescent, regarding the services received to date and whether the services received have led to improvement and/or if there are other services to address unmet needs. This proposed new language replaces language currently in the rule, which is less specific and requires only that input be solicited regarding satisfaction with the services provided. The proposed new language recognizes that while there may be satisfaction with a particular service, it does not mean that the individual or the individual's LAR or primary caregiver believe that the individual's needs have been fully met.

Section 419.457, relating to Crisis Intervention Services, is proposed to be amended by deleting subsection (a)(6) because the rehabilitative counseling and psychotherapy benefit has been removed from the array of rehabilitative services, and the language in this sub-section could be confused with rehabilitative counseling.

Section 419.458, relating to Medication Training and Support, is amended by the addition of language clarifying that medication training and support services consists of instruction and guidance based on curricula promulgated by the department, including the patient/family education program guidelines referenced in §412.468(3) of this title (relating to Guidelines).

Proposed amendments to §419.459 include changing the name of the title to Psychosocial Rehabilitative Services, and changing all references to psychosocial rehabilitation services to psychosocial rehabilitative services. In addition, subsection (b)(1) is amended to require that psychosocial rehabilitative services must be provided by members of a clearly defined therapeutic team, and the role and function of that team is described. Subsection (b)(3) is also amended, to require that the therapeutic team be constituted and organized in a manner that ensures that "every member of the team is knowledgeable of the needs and of the services available to the specific individuals assigned to the team." Finally, amendments are proposed to subsection (c)(2), to more fully describe and clarify the components of "coordination services," as that term is used in this subchapter.

Section 419.460, relating to Rehabilitative Counseling and Psychotherapy is repealed because the general rehabilitative counseling and psychotherapy service is being restored as a benefit to Medicaid recipients, effective December 1, 2005.

Proposed amendments to §419.461, relating to Skills Training and Development Services, include the deletion of subsection (b)(3) and (4) of this section, which will allow providers to provide skills training and development to a child or adolescent in a group setting. The section is also amended by the addition of language indicating that skills training and development services may be provided to an adult, child, adolescent, LAR, or primary caregiver of a child or adolescent. The section is also amended by the deletion of subsection (b)(9) of this section, which requires that skills training and development services provided to an LAR or primary caregiver of a child or adolescent must be provided by either a QMHP-CS or a CSSP.

Proposed amendments to §419.462, relating to Day Programs for Acute Needs, include the addition of two new components of symptom management training, which involves providing assistance and training to individuals in recognizing and reducing their symptoms. The proposed additional components involve training in ways to avoid symptomatic episodes.

Proposed amendments to §419.464, relating to Staff Member Training, include the addition of language to subsection (a)(2)(B) of this section, clarifying that staff must be trained on skills training curricula that has been reviewed and approved by the department.

Section 419.465, relating to Medicaid Reimbursement, clarifies that a provider may only bill for medically necessary services to Medicaid-eligible individuals. It further clarifies that with the exception of crisis intervention services and psychosocial rehabilitative services that are being provided in a crisis situation, the department will not reimburse a Medicaid provider for any combination of MH rehabilitative services delivered in excess of 8 hours per individual per day. The amended rule clarifies that crisis services shall be provided to the individual until the crisis is resolved. The section is also amended by the addition of language that is proposed for deletion from §419.455 of this title (relating to Eligibility), as it more accurately refers to the availability of Medicaid reimbursement than to eligibility for the services.

Section 419.468 is renamed as "Guidelines." In addition, the text of the rule is amended by changing references to "exhibits" are changed to "guidelines," and by correcting the department's address for purposes of obtaining copies of any of the guidelines.

Section 419.469, relating to References, is amended by the addition of several rules that are referenced in the subchapter.

Section 419.470, relating to Distribution, includes the addition of language requiring distribution of this subchapter to the members of the State Health Services Council, and also to be made available by the chief executive officer of each provider to all staff members who deliver MH rehabilitative services.

FISCAL NOTE

Michael D. Maples, Manager, Program Services Unit for the Community Mental Health and Substance Abuse Section, has determined that, for each year of the first five years that the sections will be in effect, there will be fiscal implications to state and local governments as a result of enforcing and administering the sections as proposed. Because the federal Medicaid program is a cost reimbursement program, however, the proposed sections will not result in any significant increase or decrease in costs or revenues to either the state or the LMHAs, as more fully explained below.

The department allocates general revenue to the local mental health authorities (LMHAs) to be used for a variety of mental health community services (the LMHAs are community centers or other entities established by local governments and are, therefore, local governments). In addition, the LMHAs are reimbursed through the federal Medicaid program for providing certain mental health services. Mr. Maples estimates that there will be a decrease in federal funds (and thus, revenues) to the department and to the LMHAs as a result of the discontinuation of the rehabilitative counseling and psychotherapy benefit. The decreased revenues are estimated to be $304,438 for each of fiscal years 2007 - 2011. However, the decreased revenues to the state will be offset by the restoration of the Medicaid general counseling benefit by HHSC.

Mr. Maples also estimates that there will be an increase in federal funds (and, thus, revenues) to the department and to the LMHAs as a result of the new Medicaid benefit of group skills training for children and adolescents. The increased revenues are estimated at $95,839 for each of fiscal years 2007 - 2011. While these increased revenues are less than the decreased revenues resulting from the discontinuation of the rehabilitative counseling and psychotherapy benefit, they represent less than one-half of one percent of the federal funding attributable to the delivery of community mental health services in Texas.

Because the federal Medicaid program is a cost reimbursement program, any increase in costs to state or local governments are anticipated to be equal to the estimated increase in federal revenues for both state and local governments. Therefore, for each year of the first five years that the sections will be in effect, Mr. Maples has determined that there is no foreseeable increase or decrease in costs to state or local governments as a result of enforcing or administering the proposed sections.

SMALL AND MICRO-BUSINESS IMPACT ANALYSIS

Mr. Maples has also determined that there will be no effect on small businesses or micro-businesses required to comply with the sections as proposed. This was determined by interpretation of the rules that small businesses and micro-businesses will not be required to alter their business practices in order to comply with the sections. There are no anticipated economic costs to persons who are required to comply with the sections as proposed. There is no anticipated negative impact on local employment.

PUBLIC BENEFIT

In addition, Dave Wanser, Deputy Commissioner, has determined that, for each year of the first five years that the sections will be in effect, the public will benefit from adoption of the sections. The public benefit anticipated as a result of enforcing or administering the sections is to ensure the availability of mental health rehabilitative services, that the need for such services is appropriately assessed and authorized, that the uniqueness of services is clearly delineated between adult and child, that such services will be provided by qualified and trained staff, that correctly provided and documented services will be appropriately reimbursed by the department and that a fair hearings process is available.

REGULATORY ANALYSIS

The department has determined that this proposal is not a "major environmental rule" as defined by Government Code, §2001.0225. "Major environmental rule" is defined to mean a rule the specific intent of which is to protect the environment or reduce risk to human health from environmental exposure and that may adversely affect, in a material way, the economy, a sector of the economy, productivity, competition, jobs, the environment or the public health and safety of a state or a sector of the state. This proposal is not specially intended to protect the environment or reduce risks to human health from environmental exposure.

TAKINGS IMPACT ASSESSMENT

The department has determined that the proposal does not restrict or limit an owner's right to his or her property that would otherwise exist in the absence of government action and, therefore, do not constitute a taking under Government Code, §2007.043.

PUBLIC COMMENT

Comments on the proposal may be submitted to Chris Dewitt, Department of State Health Services, Mental Health and Substance Abuse Program Services Unit, 909 West 45th Street, Mail Code 2018, Austin, Texas 78751, or by email to chris.dewitt@dshs.state.tx.us. Comments will be accepted for 30 days following publication of the proposal in the Texas Register .

LEGAL CERTIFICATION

Subchapter L. MENTAL HEALTH REHABILITATIVE SERVICES

25 TAC §§419.451 - 419.459, 419.461 - 419.470