Adopted Sections
An agency may take final action on a section 30 days after a proposal has been 
published in the Texas Register. The section becomes effective 20 days after the 
agency files the correct document with the Texas Register, unless a later date 
is specified or unless a federal statute or regulation requires implementation 
of the action on shorter notice.
If an agency adopts the section without any changes to the proposed text, only 
the preamble of the notice and statement of legal authority will be published. 
If an agency adopts the section with changes to the proposed text, the proposal 
will be republished with the changes.
TITLE 25. HEALTH SERVICES
Part I. Texas Department of Health
Chapter 133. Hospital Licensing
Standards
25 TAC sec.133.21
The Texas Department of Health (department) adopts an amendment to sec.133.21, 
concerning hospital licensing standards (standards) with changes to the proposed 
text as published in the January 7, 1992, issue of the Texas Register  (17 
TexReg 92). There are also changes to the text of the hospital licensing 
standards (standards) which the section adopts by reference. The amendment to 
the standards themselves adds a new Chapter 12 concerning special licensing 
standards governing the provision of mental health services in hospitals.
Chapter 12 has been added to address patient care and patient rights in the 
delivery of mental health services in general hospitals in response to direction 
from the Senate Interim Study Committee on Health and Human Services and the 
office of the lieutenant governor that resulted from the committee's study of 
abuses surrounding the operation of private psychiatric hospitals. The chapter 
is intended to coordinate with the rules recently adopted by the Texas Board of 
Mental Health and Mental Retardation (TXMHMR) in the February 14, 1992, issue of 
the Texas Register (17 TexReg 1290) and to provide standards and recommendations 
to prevent the occurrence in general hospitals of the recently identified abuses 
in the delivery of mental health services in private psychiatric hospitals. 
Because of the narrow scope of rulemaking authority granted to the Texas Board 
of Health in the Texas Hospital Licensing Law, Health and Safety Code, Chapter 
241, much of the chapter's content is, of necessity, couched in terms of 
recommendations.
Chapter 12 adopts by reference requirements in the "Medicare Conditions of 
Participation for Hospitals," as described in Title 42, Code of Federal 
Regulations, Chapter IV, Part 482, Subpart A, sec.482.2 and sec.482.57. The 
chapter also recommends that general hospitals comply with the following: Title 
42, Code of Federal Regulations, Chapter IV, Part 482, Subpart E, sec.482.61 and 
sec.482.62; the standards set out by the Joint Commission on Accreditation of 
Healthcare Organizations (JCAHO) in the most recent edition of the "Consolidated 
Standards Manual" for special treatment procedures and patient rights; and 25 
Texas Administrative Code, sec.404.81, the TXMHMR rules relating to patient 
abuse and neglect in private psychiatric hospital in 25 Texas Administrative 
Code, Chapter 401. The specific sections of Chapter 12 cover: purpose; 
application and scope; definitions; application for license or renewal license; 
notice to department; Medicare standards adopted and recommended; special 
treatment procedures; administration of medications; patient rights; patient 
complaint policy; compliance with reporting requirements of other state laws; 
protection against certain crimes and consumer abuses; compliance with 
applicable provisions of the Texas Mental Health Code, Title 7, Subtitle C; 
special standards covering investigations, notice, opportunity for correction, 
and enforcement actions.
The following comments were received concerning the proposed amendment. All 
references to "chapter" are to Chapter 12 and all references to "section" are to 
sections in Chapter 12.
COMMENT. Concerning the title of Chapter 12, a commenter said that use of the 
word "general" in the term "general hospital" was redundant because the 
definition of "hospital" includes a general hospital.
RESPONSE: The department agrees and has removed the modifier from the section 
title.
COMMENT: Concerning Chapter 12 generally, the numerous comments received by 
TXMHMR and discussed in the February 14, 1992, issue of the Texas Register by 
TXMHMR (17 TexReg 1290) are applicable to the department rules in Chapter 12 and 
should be considered.
RESPONSE: In an effort to comply with the findings and instructions from the 
Senate Interim Committee on Health and Human Services and to work with other 
agencies, the department has considered the comments received by TXMHMR and have 
included definitions and language as applicable to the department's final rules 
in Chapter 12.
COMMENT: Concerning Chapter 12 generally, a commenter requested that all 
references to recommendations in the proposed rules be revised in the final 
rules to require compliance, through the use of terms such as "shall" or "must."
RESPONSE: The department is aware of the enforcement problems posed by the use 
of "recommendations;" however, the department believes in the necessity of 
maintaining a parity with the TXMHMR rules addressing private psychiatric 
hospitals. Because of the narrow scope of rulemaking authority granted to the 
Texas Board of Health (board) in the Texas Hospital Licensing Law, the board is 
without the authority to adopt many of the TXMHMR provisions and thus is limited 
to "recommending" many of the provisions in the rules. The recommendations will 
not be used by the department in enforcement actions against affected hospitals; 
however, such hospitals should be aware that the "recommendations" may serve as 
standards of care in civil suits against violating hospitals. The department 
will refer cases involving risks to patient health and safety, including those 
arising under the "recommendations" to the attorney general for injunctive 
action.
COMMENT: Concerning Chapter 12 generally, the Hospital Licensing Advisory 
Council stipulated in its recommendation for approval of final rules to the 
board that the recommendation was based upon the premise that these rules should 
not be considered as a standard of care for hospitals who do not meet the 
definition of a hospital in these standards.
RESPONSE: The department recognizes the council's concern and has advised them 
that the rules apply only to those hospitals that meet the definition of 
hospital in Section 12-3.7. If a hospital voluntarily applies the provisions of 
Chapter 12 to all services within the hospital, the department has no authority 
to prevent that; however, it is the board's intent that Chapter 12 apply only to 
identifiable units of hospitals that provide mental health services as that term 
is defined in these rules, which include both chemical dependency units and 
psychiatric units.
COMMENT: Concerning Chapter 12 generally, a commenter questioned the necessity 
of requiring all hospitals licensed by the department to comply with Chapter 12. 
The commenter further objected to the "duplicative" inspection processes by the 
department, TXMHMR and the Texas Commission on Alcohol and Drug Abuse (TCADA).
RESPONSE: The department believes that both of the commenter's concerns are 
addressed in the multi-agency memorandum of understanding (MOU) among 14 
affected state agencies. This MOU sets out clearly the regulatory duties of the 
three facility licensing agencies, the department, TXMHMR and TCADA, and 
provides for the coordination of inspections and enforcement actions with the 
current facility licensing agency being the primary enforcement agency. One 
express purpose of the MOU is to prevent fragmented and duplicative inspections 
and enforcement actions. Chapter 12 applies only to the identifiable part of a 
general hospital (licensed by the department) which provides mental health 
services.
COMMENT: Concerning Chapter 12 generally, a commenter requested that the 
department be the sole agency responsible for regulating the separate and 
distinct units of medical-surgical hospitals which provide mental health 
services. The commenter objected to regulation by multiple state agencies, i.e., 
the department, TCADA, and TXMHMR.
RESPONSE: The commenter's concerns are not addressed in the final rules; 
however, they are addressed in the MOU presently being signed by the three state 
agencies referenced by the commenter. In the MOU, the participating agencies 
have agreed that the state agency with statutory authority to regulate a 
hospital will continue to have primary responsibility for the hospital. The 
primary agency may ask other signatory agencies to participate as consultants in 
inspections, surveys, and investigations.
COMMENT: Concerning Chapter 12 generally, because the treatment for mental 
illness is so different from that of chemical dependency treatment, one 
commenter questioned the feasibility of combining both types of treatment in one 
set of rules.
RESPONSE: The department recognizes the concern expressed by the commenter and 
has added a new definition for "chemical dependency" and incorporated in the 
definition of "mental health services" the provision of inpatient chemical 
dependency treatment. At this time, the department will proceed with the rules 
incorporating both types of treatment, but will consider, if necessary in the 
future, a separation of the treatments into individual sets of rules.
COMMENT: Concerning Chapter 12 generally, the Texas Hospital Association (THA) 
stated that the department should work with THA and be instructed by it in 
determining what requirements, if any, the department may impose on hospitals 
that are subject to Chapter 12 regarding allegations of abuse and neglect. The 
THA further objected to the use in the rules of the word "threat."
RESPONSE: In statutory and regulatory interpretation, words that are not defined 
or that are not words of art have their ordinary meanings. While the department 
does not think that "threat" is beyond the comprehension of ordinary readers, 
the department agrees to define the word "threat" and has done so in Section 12-
3.19. The department will consider bona fide comments from any organization or 
individual interested in improving the regulatory capability of the department. 
This would include THA and any other person with productive ideas. The 
department however, must reserve the final judgment in such matters to itself 
and to its policy-making body, the Texas Board of Health. In this particular 
instance, for the department to accept THA's comment in its entirety, would be 
to ignore the findings of the Senate Interim Committee on Health and Human 
Services in the area of private psychiatric hospitals and disregard the 
committee's instruction to the department to cooperate with the department's 
sister agencies in adopting rules to address the problems.
COMMENT: Concerning Section 12-2, as regards the application and scope of 
Chapter 12; and Section 12-4.2.2, as regards admitting and housing patients in 
an identifiable part of the hospital, a commenter requested clarification 
concerning which licensed hospitals are affected by Chapter 12.
RESPONSE: The department agrees that the application and scope of the chapter 
need clarification. Accordingly, the department has specifically added two 
additional subsections to address this issue. The first of these, Subsection 12-
2.2, clarifies that the chapter does not apply to the occasional provision of 
mental health services in a hospital without an organized mental health service 
and identifiable part of the hospital dedicated to the provision of those 
services. Of the hospitals that have an organized service and an identifiable 
part dedicated to the provision of mental health services, subsection 12.2.3 
specifies that the chapter applies only to the identifiable part of the hospital 
approved by the department for the admission and housing of patients receiving 
mental health services.
COMMENT: Concerning Section 12-3, as regards definitions, a commenter asked that 
the term "treatment team" be defined.
RESPONSE: The department disagrees, as the proposed rules are congruent with 
TXMHMR rules; in addition, each patient's treatment team will vary.
COMMENT: Concerning Section 12-3.7, as regards definition of "hospital," two 
commenters requested that the proposed definition be deleted, and the term 
"hospital" as used in Section 12.11.1, be modified to convey the meaning that 
each hospital licensed by the department that has a wing or a unit dedicated to 
the provision of mental health services must comply with the special standards 
recited in Chapter 12.
RESPONSE: The department agrees in part and has retained the definition of 
"hospital" by incorporating the suggested language in the definition.
COMMENT: Concerning Section 12-3.11, as regards the definition of "licensee," a 
commenter stated that the definition was not specific enough and in the context 
of the rules could be misconstrued to mean a "person."
RESPONSE: The department agrees and has revised the term "licensee" to mean "a 
person who has been granted a license to operate a hospital by the department."
COMMENT: Concerning Section 12-3, as regards definitions, a commenter suggested 
adding definitions in Subsections 12-3.14 and 12-3.17 for the words "patronage" 
and "polypharmacy" because they are necessary to parallel certain portions of 
the revised TXMHMR rules.
RESPONSE: The department agrees and has added definitions for those two words. 
The definition for "patronage" is taken directly from the current revised TXMHMR 
rules for private psychiatric hospitals. The definition for the word 
"polypharmacy" is based upon a definition of the word in certain TXMHMR rules 
that are now repealed and replaced by recently TXMHMR adopted rules on the 
administration of medication in TXMHMR hospitals. The department has broadened 
the former definition of the word by changing the word "neuroleptic" to 
"psychoactive." This broadens the definition enough for the purposes of Chapter 
12; however, it does not broaden it so much as it has been broadened by TXMHMR.
COMMENT: Concerning Section 12-4, as regards application for a hospital license 
or renewal license, a commenter questioned the intent of a supplemental 
application form to provide additional information relating to mental health 
services.
RESPONSE: The department will be expanding the current hospital license 
application form to include additional questions, if applicable, about the 
hospital's mental health services. If a hospital establishes mental health 
services, the hospital must submit drawings and inform the department of any 
changes to its mental health services throughout the licensing year.
COMMENT: Concerning Section 12-4.2, as regards pre-service notice to the 
department, during the comment period, the department should be was made aware 
of hospitals which may be providing mental health services in areas of the 
hospital which have not been approved for occupancy.
RESPONSE: The department has developed a new Section 12-4.2 which requires a 
hospital to notify the department of its intent to initiate the provision of 
mental health services and the requirement for approval of occupancy after 
completion of plan reviews and construction inspections. Commensurate with this 
change, the department has modified the title of section 12-4.
COMMENT: Concerning Section 12-5, as regards adoption and recommendation of 
Medicare standards, two commenters requested that the department delete the 
first sentence of proposed Section 12-5.1, relating to mandatory compliance with 
the Medicare conditions of participation for hospitals. Each commenter gives as 
his reason that the rule exceeds the board's statutory rulemaking authority.
RESPONSE: The department disagrees because the proposed language does not exceed 
statutory limits or the board's rulemaking authority under the Texas Hospital 
Licensing Law, Health and Safety Code, Chapter 241. The law permits the board to 
adopt the Medicare conditions of participation in 42 Code of Federal Regulation, 
sec.sec.482.2-482.57 as standards for hospital licensure.
COMMENT: Concerning Section 12-5, two commenters requested the deletion of the 
last sentence in the Section 12-5.1, relating to the two Medicare conditions of 
participation for private psychiatric hospitals. Again, each commenter gave as 
his reason that the board does not have the authority to adopt such provisions 
as rules.
RESPONSE: The department agrees in part and disagrees in part. Had the board 
adopted the two conditions as "rules" the commenters would be correct; however, 
as regards the use of the two conditions of participation for private 
psychiatric hospitals in 42 Code of Federal Regulation,  sec.482.61 and 
sec.482.62, the board again recommends that the hospitals also comply with these 
conditions relating to medical records and special staff requirements for 
psychiatric hospitals. The department believes that the provision of mental 
health services provided in hospitals licensed by the department should meet the 
same requirements as the mental health services provided in private psychiatric 
hospitals licensed by TXMHMR.
COMMENT: Concerning Section 12-6, as regards special treatment procedures, two 
commenters requested that Section 12-6 be deleted because the board does not 
have the statutory authority to adopt the rule.
RESPONSE: The department agrees that there is no basis for the board to adopt 
the provision as an enforcement standard; however, the department maintains that 
the board has again recommended that hospitals voluntarily comply with the 
provision in the interest of maintaining the same quality of service delivery in 
all hospitals providing mental health services, irrespective of the state agency 
licensing the hospital. The department has enumerated the definition of special 
treatment procedures as given in TXMHMR rules 25 Texas Administrative Code, 
sec.401.583.
COMMENT: Concerning Section 12-6, a commenter took exception to the requirement 
that the governing board and medical staff bylaws address specifics as to "how 
to" provide treatment procedures.
RESPONSE: The department agrees and has revised the language to require the 
governing body approve in the bylaws that policies and procedures be established 
and implemented for mental health service treatment procedures. The department 
also has changed the definition of "hospital administrator" to "hospital 
administration" and incorporated language throughout the chapter requiring 
hospital administration to enforce the bylaws and policies and procedures 
approved by the governing body for mental health services treatment and other 
provisions.
COMMENT: Concerning Section 12-7.1, as regards administration of medications, a 
commenter asked if the use of the term "direct supervision" by a registered 
nurse (RN) for all medication administration procedures included the RN's on-
site observation of the setup, delivery, and documentation of the administration 
of medication for a patient by any RN or licensed vocational nurse (LVN).
RESPONSE: The term "direct supervision" means the degree of supervision 
recognized in the rules of the Texas State Board of Nurse Examiners as 
appropriate for a registered nurse to exercise over a licensed nurse performing 
medication administration duties under the nursing plan of the hospital.
COMMENT: Concerning Section 12-7.2, as regards administration of medication, a 
commenter stated the term "licensed nurses" should state RN and LVN in this 
section if that is the department's intent.
RESPONSE: The department considers the term "licensed nurses" to include RNs and 
LVNs, as both disciplines must have a license to practice as a nurse in Texas.
COMMENT: Concerning Section 12-7.2, as regards administration of medication, a 
commenter requested the deletion of the language in Section 12-7. 2, relating to 
adoption of TXMHMR standards for state hospitals in the area of administration 
of medications. One commenter expressed concerns regarding proposed Section 12-
7.2, as it relates to medications. The commenter stated that requiring 
department licensed hospitals to use specific TXMHMR forms, as they relate to 
administration of medications, may lead to "presumptive deficiencies."
RESPONSE: The department disagrees with the request to delete the language 
requiring the adoption of TXMHMR standards governing medication administration 
for the previous mentioned reason that the need to have consistent rules 
governing the provision of all mental health services in hospitals throughout 
the state. The department, however, agrees with the second objection relating to 
TXMHMR forms and has modified the language to allow for use of TXMHMR forms or 
other forms which address the same items as contained in the TXMHMR forms.
COMMENT: Concerning Section 12-7.2, as regards administration of medications, a 
commenter recommended that Section 12-7.2 be revised to describe the 
circumstances in which polypharmacy could be used.
RESPONSE: The department agrees in part and has added language from the repealed 
TXMHMR rules in 25 TAC sec.405.826 as an illustration of how a physician, who 
meets the same qualifications as but is not the chief physician or chief 
physician designee, might be allowed to participate in the prescribing of 
polypharmacy. The department also has added a new definition for polypharmacy.
COMMENT: Concerning Section 12-8, as regards patient rights, a commenter 
recommended that the section be revised to require the enforcement of a patient 
rights policy based on the substantive provisions of the Health and Safety Code, 
Chapter 576, and the standards in the current edition of the Consolidated 
Standards Manual published by JCAHO. The commenter also requested that the 
substantive provisions themselves be described rather than referenced.
RESPONSE: The department disagrees for two reasons: first, the change to 
enforcement would exceed the board's capacity to adopt and the department's 
authority to enforce; and second, much of the substantive material is contained 
in the Recommended Patient's Bill of Rights, as described in Attachment A to 
Chapter 12.
COMMENT: Concerning Section 12-8, a commenter believes that the Senate Interim 
Study Committee on Health and Human Services directed the state agencies to 
inform and enforce patients' rights in hospitals which provide mental health 
services.
RESPONSE: The department has established recommendations in Section 12-8.2 for 
the education of hospital employees, governing body, hospital administration, 
medical staff, patient, and family and friends concerning the Recommended 
Patient's Bill of Rights. The recommendations allow for an ongoing review and 
explanation of the content of the Recommended Patient's Bill of Rights.
COMMENT: Concerning Sections 12-8.2 and 12-8.2.2, as regards display of rights, 
a commenter noted that the rule recommends that the hospital widely display the 
Recommended Patient's Bill of Rights and distribute the document to everyone but 
the hospital employees. The commenter requested that the document also be 
distributed to hospital employees.
RESPONSE: The department has revised the rule to remedy this omission and to 
include hospital employees. The revised rule also includes a requirement that 
the content of the document be reviewed with hospital employees at periodic 
staff training sessions.
COMMENT: Concerning Sections 12-8.2 and 12-8.2.2, a commenter recommended that 
Section 12-8.2 be revised to include language providing that "Each patient shall 
have the rights as delineated in the Patient's Bill of Rights," and to phrase 
the display provision in mandatory terms.
RESPONSE: The department disagrees, as the proposed language is beyond the 
authority of the board to adopt and the department to enforce and must remain a 
recommendation (see Health and Safety Code, sec.241.026).
COMMENT: Concerning Section 12-8.2.2, as regards posting of the Recommended 
Patient's Bill of Rights, a commenter considered as unnecessary and unattractive 
the requirement that the posting be in all areas.
RESPONSE: The department disagrees, as the proposed language parallels the 
TXMHMR final rules.
COMMENT: Concerning Section 12-8.3, as regards education of a patient's family 
and friends, a commenter suggested that the section be revised to include 
language mandating patient signature, witnesses and filing of the Recommended 
Patient's Bill of Rights.
RESPONSE: The department disagrees, as the proposed language is beyond the 
authority of the board to adopt and the department to enforce and must remain a 
recommendation (see Health and Safety Code, sec.241.026).
COMMENT: Concerning Section 12-9, as regards patient complaint policy, a 
commenter believes that the Senate Interim Study Committee on Health and Human 
Services directed the state agencies to inform and enforce the patient complaint 
policy in hospitals which provide mental health services.
RESPONSE: The department has established recommendations in Section 12-9 for the 
education of hospital employees, governing body, hospital administration, 
medical staff, patient and family and friends of the patient concerning the 
complaint policy. The recommendations allow for an ongoing review and 
explanation of the content of the patient complaint policy. The department has 
changed the terminology of the "complaint hot line" to "patient information and 
complaint line" so as not to construe the purpose of the phone as a crisis 
intervention line.
COMMENT: Concerning Section 12-9, a commenter stated that the section should be 
deleted in its entirety. The commenter's reason is that the posting of the 
"Recommended Patient's Bill of Rights" should suffice to apprise patients and 
families of their rights.
RESPONSE: The department disagrees and considers the proposed language requiring 
a hospital patient complaint policy, patient information provided regarding the 
policy, and the posting of the policy to be necessary to assure that patient 
complaints are addressed.
COMMENT: Concerning Section 12-9, a commenter objected to the provisions in the 
section relating to the hospital patient complaint policy.
RESPONSE: The department disagrees with the commenter's objection, as the 
proposed rule is applicable for all licensed hospitals to assure that patient 
complaints are addressed.
COMMENT: Concerning Section 12-9, a commenter objected to the posting of the 
hospital's complaint procedures throughout the hospital as unsightly and untidy.
RESPONSE: The department disagrees because it regards notice to patients, 
families and friends of the existence of the policy to be of an importance equal 
to, if not greater than the aesthetics of mental health units.
COMMENT: Concerning Section 12-10, as regards compliance with other state law, a 
commenter recommended that the section be deleted because the board does not 
have the authority to adopt rules suggesting compliance with the rules of 
another agency.
RESPONSE: The department disagrees for the previously mentioned reason that the 
board has again made a recommendation and has included language to encourage the 
hospital to educate all governing body members and appropriate staff about civil 
and criminal laws that could govern conduct occurring in the provision of mental 
health services. The department believes that every person providing care of any 
type should be required to review these enumerated laws as part of a medical 
jurisprudence in-service training. The department has added language from 
TXMHMR's current rules on private psychiatric hospitals and recommends a 
hospital policy forbidding violation of TXMHMR rules, specifically to emphasize 
the need for instruction in this area.
COMMENT: Concerning Section 12-10.1, as regards reporting requirements, a 
commenter recommended that the section be deleted in its entirety, and suggested 
the department prepare and distribute to hospital personnel a brochure regarding 
incidents that are reportable by law; and concerning Section 12-10.2, as regards 
protection against certain crimes and consumer abuses, a commenter recommended 
that this section be deleted in its entirety and, in lieu of its adoption, the 
department develop and distribute a brochure containing a list of the offenses 
and references on whom to contact to file a complaint.
RESPONSE: The department disagrees for the previously mentioned reason that the 
board has made a recommendation and has included language to assure all 
governing body members and appropriate staff are educated about civil and 
criminal laws that may govern conduct occurring in the provision of mental 
health services. The department believes that every person providing care of any 
type should be required to review these enumerated laws as part of a medical 
jurisprudence in-service training. The department agrees that the brochure has 
merit and may at some time in the future prepare such a brochure. The department 
has corrected Subsection 12-10.1.1 to delete an erroneous statement that child 
abuse also had to be reported to the department as the licensing agent, if abuse 
took place in a hospital. The provision now recommends that it be reported to 
the department if it took place in a hospital licensed by the department.
COMMENT: Concerning Section 12-10.3, as regards compliance with certain 
provisions of the Texas Mental Health Code, a commenter recommended that the 
section be deleted because it is unnecessary.
RESPONSE: The department disagrees because in many areas of patient care it 
would be impossible for the hospitals licensed by the department to maintain the 
same standards as those licensed by TXMHMR if the provisions were deleted.
COMMENT: Concerning Section 12-10.3, two commenters recommended that the rules 
be revised to allow psychologists to perform admission intake assessments. One 
commenter opposed any rule change that would allow psychologists to perform 
admission intake assessments.
RESPONSE: The department has investigated the question of who is qualified by 
training and supported by law to admit patients to private psychiatric 
hospitals, what elements of the admission process are integral to adequate 
patient care, and how to ensure that those elements are present without regard 
to who technically admits the patient to services. In this regard, it is the 
department's position, as is TXMHMR, that a medical examination by a physician 
is necessary to identify any underlying conditions that may be present as 
psychiatric symptoms, and to identify any underlying conditions that may require 
immediate treatment, or affect the treatment of psychiatric illness. Treatment 
that is based on a psychiatric assessment without benefit of a medical 
examination poses a significant risk to the patient, and constitutes a 
significant risk management issue to health care providers and mental health 
professionals. The department, as does TXMHMR, supports and encourages a 
multidisciplinary approach to patient intake and admission.
COMMENT: Concerning Section 12-10.3.1.1, as regards voluntary inpatient mental 
health services, a commenter recommended for the sake of consistency in the 
rules, that throughout the rules all assessments or examinations be done on a 
"face-to-face" basis with the patient.
RESPONSE: The department agrees and has incorporated this requirement throughout 
the final rules.
COMMENT: Concerning Section 12-10.3.1, four commenters expressed concern that 
the proposed rules did not allow for emergency situations in which a physician 
is not readily available.
RESPONSE: The department disagrees but has revised the language to clarify 
voluntary admission of patients. The licensing standards require a physician be 
present or available within 30 minutes to evaluate the patient for an emergency 
medical condition.
COMMENT: Concerning Section 12-10.3.1.3, as regards oral requests for release, a 
commenter recommended that the provision be changed to require a patient or 
responsible party's signature.
RESPONSE: The department disagrees, as the proposed and final rules parallel the 
TXMHMR final rules; however, the department has added clarifying language 
regarding the documentation of a request for release.
COMMENT: Concerning Sections 12-10.3.1.5 and 12-10.3.1.5.2, as regards voluntary 
inpatient mental health services, the department and TXMHMR both received 
numerous comments about the provisions in their rules regarding voluntary 
admissions and emergency detention.
RESPONSE: The department has included language adopted by TXMHMR in the 
department rules. The department's language deviates from TXMHMR only in use of 
the terminology for emergency detention.
COMMENT: Concerning Section 12-10.4, as regards emergency detention, a commenter 
stated the proposed language addresses emergency detention, but not emergency 
admission.
RESPONSE: The department considers the proposed language to be acceptable. An 
emergency detention is a special type of statutory procedure, and by its nature, 
if carried out as prescribed by the Health and Safety Code, Chapter 573, is a 
type of emergency entry into a hospital.
COMMENT: Concerning Section 12-10.4.1, as regards emergency detention, a 
commenter asked that the section be revised to require that a person temporarily 
admitted for emergency detention must be examined by a physician as soon as 
possible within 24 hours after apprehension.
RESPONSE: The department disagrees. The language must be a recommendation 
because of the narrow range of rulemaking granted to the board in the licensing 
law.
COMMENT: Concerning Section 12-10.4.2, as regards emergency detention, a 
commenter suggested that the section be revised to require the verbatim 
inclusion in the rule of the statutory criteria for emergency admission found in 
the Health and Safety Code, sec.573.022.
RESPONSE: The department disagrees. Inclusion by reference is a legitimate 
device. It provides both economy and accuracy; when the referenced statutory 
provision changes, the rule does not necessarily have to be amended.
COMMENT: Concerning Section 12-10.4.2, as regards emergency admission, a 
commenter stated there are no provisions in the proposed rules to allow for 
emergency treatment of patients with emergency medical needs, while they may be 
waiting for a physician evaluation.
RESPONSE: The department believes that any hospital staff physician can attend 
to a medical emergency without having such a provision in the rules.
COMMENT: Concerning Section 12-11, as regards enforcement of special standards, 
a commenter believes that the Senate Interim Committee for Health and Human 
Services directed the state agencies to regulate hospitals providing mental 
health services so as to protect all patients admitted and treated.
RESPONSE: Due to the narrow scope of rulemaking authority under the Texas 
Hospital Licensing Law, Health and Safety Code, Chapter 241, the language in the 
section stipulates that hospitals licensed by the department should comply with 
the recommendations of Chapter 12. The department will cite failure or refusal 
to follow the recommendations and counsel the hospital.
The following comments were received on the "Recommended Patient's Bill Of 
Rights" (RPBOR) in Attachment A to Chapter 12.
COMMENT: Concerning RPBOR generally, a commenter requested that the department's 
rules and the TXMHMR rules be identical.
RESPONSE: The board has followed the form and text of the TXMHMR RPBOR to the 
greatest extent possible. The board has no authority to adopt the exact text of 
the TXMHMR rule and the board does not have the authority to adopt rules which 
make continued licensure contingent on the use of the TXMHMR rule. In this area, 
the board can only make recommendations.
COMMENT: Concerning the introduction to RPBOR, as regards its background, a 
commenter suggested that the introduction be revised to read, "It is the 
responsibility of the hospital to make sure the patient has been informed of his 
rights, and the hospital's responsibility to respect and provide for those 
rights to maintain licensure."
RESPONSE: The department disagrees. RPBOR is recommended by the board and, as 
such, may not be used by the department to deny licensure. Also, many of its 
precepts are not necessary to maintain licensure. However, for these reasons, 
the department has deleted the language in paragraph #2 of RPBOR.
COMMENT: Concerning Section A(1), as regards the right to have a copy of RPBOR, 
a commenter requested that this paragraph be expanded to provide that a copy of 
RPBOR may be provided to the patient's guardian or other person(s) accompanying 
the patient at the time of admission.
RESPONSE: The department believes that the new language in the final Section 12-
8.3 of Chapter 12 and RPBOR adequately addresses the commenter's concern.
COMMENT: Concerning Section A(2), as regards explanation of rights to patients, 
two commenters recommended that this provision should be revised to recognize 
that a patient may not be able to understand the explanation early in the 
patient's hospitalization.
RESPONSE: The department agrees and has revised the rule to clarify a number of 
procedural steps in the rights communication process. Language has been added 
explaining the procedure to be followed in the event the patient refuses to sign 
RPBOR. Language also has been added clarifying that these rights should be 
explained to each patient within 24 hours of being admitted to the hospital to 
receive services. In addition, language has been added recommending staff to 
later discuss rights with patients who, at the earliest stages of admission, 
appear incapable of fully comprehending their rights. The changes parallel 
revisions in the language of the TXMHMR final rules concerning Patient's Bill of 
Rights.
COMMENT: Concerning Section A(2), a commenter stated that a patient's competence 
must be determined at the time of admission. The commenter concluded that when 
patients are not competent, or when there are no competent relatives available 
or identifiable, an alternative procedure should be outlined.
RESPONSE: Although the department disagrees with the commenter's assumptions 
about the patient's competency and the competency of the patient's family, etc., 
the department agrees with the commenter that an alternate procedure should be 
provided for patients who do not, or can not, understand the explanation of 
patient rights within the recommended time frame. While only a court can find a 
person incompetent, the possibility that a person may be too ill to participate 
in the explanation of rights early in his or her hospitalization is very real. 
For this reason, the department has revised this provision to recognize that all 
patients may not be able to understand this information during the early days of 
hospitalization and to recommend to the hospitals that they periodically attempt 
to provide the rights explanation until the patient understands or until the 
patient is discharged or transferred, whichever is earlier.
COMMENT: Concerning Section B(3), as regards patient complaints, the final draft 
of the Memorandum of Understanding signed by the multi-state agencies has 
resulted in a need to change portions of Chapter 12, including RPBOR.
RESPONSE: Due to the provisions of the Memorandum of Understanding requiring 
TXMHMR as the primary agency for receiving complaints, the department has 
deleted the department information and complaint line telephone number from 
RPBOR.
COMMENT: Concerning Section C, as regards recommended basic rights for all 
patients, a commenter noted that the word "Recommended" be deleted from the 
heading of this section in order to prevent misunderstanding regarding 
compliance with the basic rights requirement.
RESPONSE: The department maintains that the hospital licensing standards cannot 
exceed Medicare requirements, therefore the language has been adopted as 
proposed, including the word "Recommended."
COMMENT: Concerning Section C(3), as regards the right to a clean and humane 
environment, a commenter recommended that this provision be revised to read, 
"You have the right to a humane treatment environment that provides reasonable 
protection from harm, and appropriate privacy for personal needs, and to be 
treated with respect and dignity."
RESPONSE: The department likes the commenter's suggested language because it 
parallels the language in TXMHMR's final rules; accordingly the final wording 
reflects the suggestion.
COMMENT: Concerning Section C(4), as regards the right to appropriate treatment, 
a commenter suggested that this paragraph be revised to read, "You have the 
right to appropriate treatment in the least restrictive appropriate setting 
available."
RESPONSE: The department agrees and has modified the language to reflect better 
the language found in the Health and Safety Code and the TXMHMR final rules.
COMMENT: Concerning Section C(6), as regards charges for services, a commenter 
recommended that this paragraph be revised. The commenter's concern centered on 
the inability of a hospital to provide a patient with a full and accurate 
account for the "cost of services" at the time of admission.
RESPONSE: The department agrees and has revised the paragraph to recommend the 
provision of information regarding estimated charges to patients and to identify 
additional information to which the patient should have access. The revised 
language parallels the TXMHMR final rules.
COMMENT: Concerning Section C(7), as regards fair compensation for labor 
performed, a commenter took exception to the requirement to allow the right to 
fair compensation for labor performed for the hospital in accordance with the 
Fair Labor and Standards Act. The commenter stated that the work provided by 
patients is part of their treatment regimen, not labor for the hospital.
RESPONSE: Even though the provision is a recommendation, the department believes 
that the existing language of the provision correctly states the federal law 
and, regardless of the department's position, the hospital is bound under the 
Fair Labor and Standards Act to provide compensation to any patient who performs 
work for the hospital beyond caring for his or her own immediate surroundings.
COMMENT: Concerning Section C(8), as regards the right to be informed about the 
hospital's rules and regulations, a commenter noted that not all patients are 
capable of understanding all hospital rules and regulations concerning conduct 
and course of treatment prior to admission.
RESPONSE: The department agrees and, diverging from the TXMHMR final rules, has 
revised the language in Section 12-8.3.2 in Chapter 12 to recognize that all 
patients may not be able to understand this information prior to admission or at 
admission and to recommend to hospitals that they periodically attempt to 
provide the information until the patient understands, until the patient is 
discharged, or until the patient is transferred, whichever is earlier.
COMMENT: Concerning Section C(9), as regards the right to maintain personal 
communications, a commenter suggested this provision be modified to provide the 
patient with the right to have visitors and to communicate with persons outside 
the facility within the general rules provided by the facility.
RESPONSE: The department agrees and has revised the provision to further 
articulate the prohibition of the use of subtle barriers to communication. The 
revised language parallels the TXMHMR final rules.
COMMENT: Concerning Section C(9), a commenter took exception to the proposed 
language in the last sentence of this provision as regards the right of a 
patient to have his or her attorney contact the patient. The objection was based 
upon the strict federal confidentiality requirements imposed upon chemical 
dependency treatment programs in return for the receipt of federal funding.
RESPONSE: Although the provision is a recommendation, in the interests of 
accuracy, to avoid confusion, and to achieve parity with the rules adopted by 
TXMHMR, the department has not revised the provision.
COMMENT: Concerning Section C(14), as regards the right to refuse certain 
treatment procedures, a commenter recommended replacement of the term "unusual 
medications" with the term "unnecessary or excessive medications." The commenter 
also recommended the deletion of the term "hazardous assessment procedures." The 
commenter found the terms to be imprecise.
RESPONSE: The department disagrees because it believes that the existing 
definition in the TXMHMR final rules regarding "unusual medications" is 
appropriate.
COMMENT: Concerning Section C(17), as regards disclosure of risks and benefits 
of care, procedures and treatment (informed consent), a commenter recommended 
that the term "unusual" in reference to medications and treatment be deleted.
RESPONSE: The department disagrees. The terms "unusual medications" and "special 
treatment procedures" are defined in Section 12-3 of Chapter 12 and adequately 
address unusual treatment.
COMMENT: Concerning Section C(19), as regards physical restraints, a commenter 
recommended this provision be revised to include the statutory language 
regarding restraints.
RESPONSE: The department agrees and has revised the language in the provision. 
This revision parallels the TXMHMR final rules.
COMMENT: Concerning Section C(20), as regards the right to meet with staff 
responsible for care, a commenter suggested that this provision be revised to 
limit the patient's right to know about proposed changes in the professional 
staff responsible for the patient's care.
RESPONSE: The department disagrees and has not revised the language of this 
provision because it parallels the TXMHMR final rules.
COMMENT: Concerning Section C(20), a commenter stated that the need for the 
hospital staff to be identifiable to the patients (i.e., hospital staff wearing 
name tags) was not addressed in this section.
RESPONSE: The department declines to add language recommending staff 
identification because the department believes that it is the prerogative of the 
respective hospitals to set this policy.
COMMENT: Concerning Section D(1), as regards a voluntary patient's request for 
release from hospital, a commenter requested the language in this provision be 
changed to require the patient to sign a request for release.
RESPONSE: The department disagrees because it concurs with the TXMHMR final 
rules which allow for oral request to be treated as effective without a 
signature.
COMMENT: Concerning Section D(1), a commenter noted that the age of consent for 
a minor to voluntarily self-admit to a hospital under the Health and Safety 
Code, sec.572.001, is 16 years of age, not 18 years as stated in the section.
RESPONSE: The department agrees and has revised RPBOR to reflect 16 years, the 
correct age for a minor to be able to self admit under the statutory provision 
cited in the comment.
COMMENT: Concerning Section E(2), concerning the right to call a lawyer or have 
a lawyer called, a commenter recommended that this provision be revised to 
narrow the hospital's responsibilities regarding the for persons under the 
Health and Safety Code, Chapter 573, relating to emergency detention. The 
requested revision should state that the facility is required to provide a 
telephone for the person to communicate with a lawyer, and the statute does not 
require the hospital to assist the person in obtaining a lawyer.
RESPONSE: The department agrees and has revised the provision by deleting the 
reference to the patient's right to have the language regarding the availability 
of a telephone to the patient, or the responsibility placed on the hospital 
staff to assist the patient if asked to contact a lawyer remains in effect.
COMMENT: Concerning Section E(4), as regards the return of a person discharged 
from emergency detention to be returned to a suitable place, a commenter 
questioned the appropriateness and cost to the hospital of making arrangements 
to transport patients discharged from emergency detention back to where they 
were picked up, or to their home in Texas, or to another suitable place.
RESPONSE: The requirement for the hospital to make arrangements is found in the 
Health and Safety Code, sec.573.024. The statute also requires the county in 
which the patient was apprehended to pay for the transportation.
In addition, the department made minor editorial changes to Chapter 12 and the 
Recommended Bill of Rights for clarification.
The commenters generally were for the adoption; however, they had questions, 
recommendations, and concerns regarding specific provisions in the amendment.
Comments were received from the following: Texas Hospital Association; Texas 
Society of Psychiatric Physicians; Board of Vocational Nurse Examiners; Texas 
Psychological Association; Shannon Medical Center; Capital Area Psychological 
Association; Palo Duro Hospital; Memorial Medical Center of East Texas; Hospital 
Licensing Advisory Council; and department staff.
The amendment is adopted under the Health and Safety Code, sec.241.026, which 
provides authorization for the Texas Board of Health to adopt and enforce rules 
and minimum standards for hospitals relating to staffing by physicians and 
nurses; hospital services relating to patient care; and fire prevention, safety, 
and sanitary provisions of hospitals; and sec.12.001 which provides the Texas 
Board of Health, with the authority to adopt rules for the performance of every 
duty imposed by law on the Texas Board of Health, the Texas Department of 
Health, and the commissioner of health.
sec.133.21. Adoption by Reference.
(a) The Texas Department of Health adopts by reference the rules contained in 
the department publication effective September 1, l985, entitled, "Hospital 
Licensing Standards," as amended through June 1992.
(b) (No change.)
This agency hereby certifies that the rule as adopted has been reviewed by legal 
counsel and found to be a valid exercise of the agency's legal authority.
Issued in Austin, Texas, on May 19, 1992.
TRD-9206860
Robert A. MacLean, M.D.
Deputy Commissioner
Texas Department of Health
Effective date: June 9, 1992
Proposal publication date: January 7, 1992
For further information, please call: (512) 458-7500
       
TITLE 34. PUBLIC FINANCE
Part I. Comptroller of Public Accounts
Chapter 3. Tax Administration
Subchapter A. General Rules
34 TAC sec.3.7
The Comptroller of Public Accounts adopts new sec.3.7, concerning successor 
liability, with changes to the proposed text as published in the March 3, 1992, 
issue of the Texas Register  (17 TexReg 1597).
During the 70th Legislature, 1987, Second Called Session, sec.111.020 was added 
to the Tax Code. This provision made the purchaser of a business or stock of 
goods liable for tax, penalty, and interest or any other amounts owed the state 
by the seller of the business or stock of goods under the Tax Code, Title 2. 
Before this section was added to the Tax Code, the successor's liability 
provisions were found only in Chapter 151. Section 111.020 has an effective date 
of July 21, 1987.
Changes were made to subsections (b) and (e) ((f) in the proposed section). 
Subsection (e) was deleted and the remaining subsections were relettered.
Changes to subsections (b) and (e) ((f) in the proposed section) were to show 
that the certificate of no tax due or a statement concerning the amount owed by 
the seller of the business will be issued to the seller. While the purchaser of 
a business may request that a certificate be issued, the certificate itself or a 
statement concerning any amounts due will be sent to the seller. This change was 
made to protect audit confidentiality. The other change to subsection (e) was to 
put the public on notice regarding the fees required to be collected for the 
issuance of certificates effective January 1, 1992.
A comment on the section was received from an attorney in Austin. The commenter 
felt that assessing an amount on a purchaser who purchased an identifiable 
segment of a business on a proportional amount owed by a seller overall was 
unfair. It was the commenter's feeling that if the liability of the identifiable 
segment could not be clearly established from the seller's books and records, 
then successor's liability should not be assessed. The comptroller concurs with 
the individual's comments by deleting subsection (e).
The commenter also felt that subsection (d)(4), "all the inventory of a 
business," should be treated separately per the statutory provision. Since the 
comptroller has consistently treated "inventory" and "stock of goods" 
interchangeably, the comptroller did not feel this change was necessary. If a 
purchaser buys either "all the inventory" or the "stock of goods," successor 
liability may apply.
The words "successor's liability" which appear in the title were changed to 
"successor liability."
The new section is adopted under the Tax Code, sec.111.002, which provides the 
comptroller with the authority to prescribe, adopt, and enforce rules relating 
to the administration and enforcement of the provisions of the Tax Code, Title 
2.
sec.3.7. Successor Liability: Liability Incurred by Purchase of a Business.
(a) A purchaser of any business or stock of goods is liable for payment of any 
amount owed the state by the seller under the Tax Code, Title 2. The purchaser 
must, at the time of purchase, withhold a sufficient amount from the purchase 
price to pay any amounts due. The amount withheld must equal all tax, penalty, 
and interest or any other amounts assessed or to be assessed against the seller. 
The purchaser shall not be liable for an amount greater than the purchase price 
of the business or stock of goods.
(b) A purchaser's duty to withhold the amount owed by the seller will continue 
until the seller presents to the purchaser a certificate from the comptroller 
stating that no tax is due. Failure of the purchaser to withhold and remit to 
the comptroller the required amount makes the purchaser liable for such amount 
to the extent of the purchase price.
(c) The purchase price shall include, but not be limited to, monetary 
consideration, assumption of debt, transfer of property, forgiveness of debt, or 
issuance of debt instruments.
(d) When determining if a "business" has been or will be sold, the comptroller 
will examine the transaction to determine what the parties to the transaction 
intended to buy and sell. The answer in each situation will depend on the type 
of business involved. A seller may have sold a "business" even when few assets 
were transferred. Depending on the type of business involved, a "business" may 
be sold if an owner sells:
(1) a building, land, furniture, fixtures, inventory, and the right to use the 
seller's trade name; or
(2) all the capital assets of a business; or
(3) the name and goodwill of a business; or
(4) all the inventory of a business; or
(5) fixed assets and realty necessary to operate a similar business as the 
seller at the same location.
(e) A certificate stating the amount due or that no tax is due may be obtained 
in the following manner. The seller, the seller's assignee, or purchaser must 
make a written request for the certificate before the sale of the business is 
completed. The comptroller must issue a certificate to the seller within 60 days 
after the records are made available by the seller for audit or within 60 days 
after receiving the written request for the certificate, whichever period 
expires later, but in any event not later than 90 days after receiving the 
written request. If any amount is found to be due, it must be paid before the 
certificate will be issued. Failure of the comptroller to timely issue the 
certificate to the seller will release the purchaser from any further obligation 
to withhold an amount from the purchase price. Effective January 1, 1992, the 
Government Code, sec.403.301, requires the comptroller to collect a fee for each 
certificate issued.
(f) The seller must inform the comptroller in writing of the name and address of 
the purchaser and must file a final report immediately after the sale of the 
business.
(g) The collection, refund, and penalty provisions of the Tax Code, Title 2, 
Subtitle B, apply to payments required under successor's liability. Failure of a 
purchaser to pay the assessment of successor's liability in a timely fashion or 
to request a hearing thereon will result in a penalty of 10% as provided by the 
Tax Code, Title 2, Subtitle B, in addition to any amounts of penalty previously 
assessed against the seller. Successors cannot challenge the validity of the 
underlying liability of the predecessor.
(h) The sale of a business or stock of goods by a bankruptcy trustee or by the 
administrator, executor, or guardian in an estate or probate proceeding is not a 
sale by a vendor or former owner for purposes of this section and the purchaser 
will not incur liability hereunder.
This agency hereby certifies that the rule as adopted has been reviewed by legal 
counsel and found to be a valid exercise of the agency's legal authority.
Issued in Austin, Texas on May 19, 1992.
TRD-9206888
Martin Cherry
Chief, General Law Section
Comptroller of Public Accounts
Effective date: June 9, 1992
Proposal publication date: March 3, 1992
For further information, please call: (512) 463-4028
       
TITLE 37. PUBLIC SAFETY AND CORRECTIONS
Part III. Texas Youth Commission
Chapter 81. Administrative Provisions
General
37 TAC sec.81.13
The Texas Youth Commission (TYC) adopts an amendment to  sec.81.13, concerning 
the selection process of an architect/engineer, without changes to the proposed 
text as published in the April 17, 1992, issue of the Texas Register  (17 TexReg 
2748).
The amendment to the section is merely the correction of an error in reference 
to a previous paragraph.
The change will bring about a more efficient selection process of an architect 
or engineer.
No comments were received regarding adoption of the amendment.
The amendment is adopted under the Human Resources Code,  sec.61.048, which 
provides the Texas Youth Commission with the authority to promulgate rules 
relating to award of contracts for construction.
This agency hereby certifies that the rule as adopted has been reviewed by legal 
counsel and found to be a valid exercise of the agency's legal authority.
Issued in Austin, Texas, on May 18, 1992.
TRD-9206910
Ron Jackson
Executive Director
Texas Youth Commission
Effective date: June 10, 1992
Proposal publication date: April 17, 1992
For further information, please call: (512) 483-5244
       
Placement Planning
37 TAC sec.85.33
The Texas Youth Commission (TYC) adopts an amendment to  sec.85.33, with changes 
to the proposed text as published in the April 17, 1992, issue of the Texas 
Register  (17 TexReg 2748).
The amendment to the section will bring about a more efficient parole release 
process for youth whose parents live in Mexico. The changes merely serve to 
clarify the meaning of paragraph (1)(A) as well as to specify the name of the 
form referred to in the subparagraph.
When these youth are returned home on parole, the TYC staff responsible for 
contacting the Mexican Consulate is no longer centralized placement, but rather 
the Statewide Reception Center (SRC) transportation and the institutional 
placement coordinator (IPC).
No comments were received regarding adoption of the amendment.
The amendment is adopted under the Human Resources Code,  sec.61.034, which 
provides the Texas Youth Commission with the authority to make rules appropriate 
to the proper accomplishment of its functions.
sec.85.33. Parole of Youth Whose Parents Live in Mexico.
(a) Policy. The Texas Youth Commission (TYC) works with the Mexican Consulate 
and the United States Immigration and Naturalization Service for parole release 
of the youth whose parents or closest adult relative live in Mexico. Such youth 
are released and returned to their homes on parole status and without parole 
supervision. Procedures herein apply to all programs releasing TYC youth whose 
parents live in Mexico.
(b) Rules.
(1) When completion of program criteria has been met, the releasing program 
information the institutional placement coordinator (IPC) of the pending 
release. The Statewide Reception Center (SRC) is responsible for notification of 
appropriate persons within specified time limits.
(A) Thirty days before parole release, the TYC staff of the releasing program:
(i) notifies the appropriate Mexican Consulate of the expected release date so 
that arrangements can be made for returning the youth home;
(ii) sends notification of parole release to the appropriate authorities, CCF-
181, Notification to Juvenile Court;
(iii) completes the parole release packet;
(iv) notifies the assigned parole officer of release arrangements;
(v) sends the family notification of parole release (in both English and 
Spanish); and
(vi) sends written notice to the Immigration and Naturalization Service in the 
region.
(B) At least two days before the release, SRC transportation confirms the 
release date, time, and place with the consulate and the parole office.
(2) On the day of parole release, SRC transportation transports the youth to a 
place designated by the Mexican Consulate office. The assigned parole officer is 
present at the designated location.
(3) The youth is left in the care of the consulate and a written receipt for the 
youth signed by the Mexican Consul General or designee is obtained.
(4) If the release of a youth is canceled for any reason, the releasing program 
immediately notifies IPC who notifies the Mexican Consulate, Immigration and 
Naturalization Service, parole officer, and other affected parties.
This agency hereby certifies that the rule as adopted has been reviewed by legal 
counsel and found to be a valid exercise of the agency's legal authority.
Issued in Austin, Texas, on May 18, 1992.
TRD-9206911
Ron Jackson
Executive Director
Texas Youth Commission
Effective date: June 10, 1992
Proposal publication date: April 17, 1992
For further information, please call: (512) 483-5244
       
TITLE 40. SOCIAL SERVICES AND ASSISTANCE
Part I. Texas Department of Human Services
Chapter 48. Community Care for Aged and Disabled
In-Home and Family Support Program
40 TAC sec.48.2707
The Texas Department of Human Services (DHS) adopts an amendment to sec.48. 
2707, concerning program restrictions, in its Community Care for the Aged and 
Disabled chapter, without changes to the proposed text as published in the April 
17, 1992, issue of the Texas Register (17 TexReg 2751).
The justification for the amendment is to make DHS's rules more consistent with 
those of the Texas Department of Mental Health and Mental Retardation and with 
legislative intent.
The amendment will function by eliminating United States citizenship as a 
requirement for In-Home and Family Support Program eligibility.
No comments were received regarding adoption of the amendment.
The amendment is adopted under the Human Resources Code, Title 2, Chapters 22 
and 32 wich authorizes the department to administer public and medical 
assistance programs.
This agency hereby certifies that the rule as adopted has been reviewed by legal 
counsel and found to be a valid exercise of the agency's legal authority.
Issued in Austin, Texas, on May 20, 1992.
TRD-9206904
Nancy Murphy
Agency liaison, Policy and Document Support
Texas Department of Human Services
Effective date: June 30, 1992
Proposal publication date: April 17, 1992
For further information, please call: (512) 450-3765