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 37. PUBLIC SAFETY AND CORRECTIONS Part III. Texas Youth Commission Chapter 87. Treatment Health Care Services 37 TAC sec.sec.87.91, 87.93, 87.95, 87.99, 87.101, 87.103, 87.105, 87.111 The Texas Youth Commission (TYC) adopts amendments to sec. sec.87.91, 87.93, 87.95, 87.99, 87.101, 87.103, 87.105, and 87.111, concerning medical consent, medical care, medical expenditures, suicide alert, medical alert, psychopharmacotherapy, pharmaceuticals, and acquired immune deficiency syndrome (AIDS). Section 87.99 is adopted with changes to the proposed text as published in the May 22, 1992, issue of the Texas Register (17 TexReg 3770). Sections 87.91, 87.93, 87.95, 87.101, 87.103, 87.105, and 87.111 are adopted without changes and will not be republished. The amendments to the sections will bring about a more efficient use of the commission's medical resources. The amendments add procedures for medical consent by committed youth who are age 18 or older and allow consideration of discharge after appropriate referral, for youth who are low risk and have serious medical and mental health problems. To the section regarding AIDS, rules regarding housing and treatment are being added. Changes to the proposed version of sec.87.111 clarify the agency procedure for assessing TYC youth who are at risk for suicide. The changes to the proposed section further specify mental health professionals who are assigned specific job functions in the procedure. The section provides TYC staff procedures for assessing, treating and removing from alert status a youth believed to be at risk of suicide. One commenter, regarding section 87.93 concerning medical care, suggested that psychologists be included in the health professionals listed as delivering medical/dental services. The commission understands that the point here is to include the psychologists as a part of the health team and concur with that in philosophy; however, the policy referenced specifically addresses responsibilities of health care staff as in medical or dental complaints. The commenter is probably also suggesting that psychologists be included here because psychiatrists are. However, the psychiatrists are included in this particular policy only because of their prescriptive authority. Therefore the policy was not changed. A commenter objected to language which limited performance of mental health assessments to licensed psychiatrists and Ph.D. psychologists clarifying that other professionals are also qualified to perform such an assessment. Another commenter agreed with proposed changes and provided the agency with information regarding licensure information regarding psychologists. Additional comments were received during a public hearing following the 30 day review period. Speakers and letters read into the record stressed that mental health professionals other than psychiatrists and Ph.D. psychologists are qualified to perform mental health assessments. TYC agrees with the comments regarding mental health professionals' qualifications regarding assessments for suicide risk youth. TYC staff considered all input and adopts the sections with changes. Changes assign specific staff responsibilities and clarify which mental health professionals may also be assigned related tasks. Commenting against the amendments were the Texas Psychological Association and the National Association of Social Workers. Commenting in favor of the amendments was the Texas Psychological Association. The amendments are adopted under the Human Resources Code, sec.61.076, which provides the Texas Youth Commission with the authority to provide medical and psychiatric treatment as necessary. sec.87.99. Suicide Alert. (a) Policy. A designated, qualified mental health professional conducts a mental health assessment of youth who are at risk of suicide. Program staff are made aware of youth placed on suicide alert status. All direct care staff receive suicide prevention training. A mental health assessment is completed when a youth expresses suicidal intent through words or actions, exhibits significant depression, or when the record indicates prior suicidal attempts or ideations. This policy does not apply when a youth is home on parole except where specifically stated. (b) Rules. (1) All staff, including parole officers, are responsible for reporting a youth believed to be at risk for suicide to a designated, qualified mental health professional. (2) Mental health professionals qualified to conduct suicide risk assessment include psychiatrists, psychologists and social workers with advanced clinical practitioner certification (MSW-ACP). In institutions or reception center, the mental health professional designated with primary responsibility and accountability for evaluation and monitoring of all youth referred for suicide risk are the psychiatrist and/or doctoral level psychologist. (3) The Suicide Probability Scale will be administered by a designated mental health professional to youth at risk in agency residential facilities as part of a mental health assessment. (A) The doctoral psychologist/psychiatrist may designate other qualified mental health professionals to administer the Suicide Probability Scale or to serve as the youth's principal counselor while on alert status, but retains ultimate responsibility for the suicide evaluation process and supervision of treatment for all youth on alert status. (B) Youth whose T-score is above 74 on the Suicide Probability Scale are always referred to a psychiatrist/doctoral psychologist for further evaluation. (4) Youth may be placed on "suicide alert pending" by nurses, or treatment or administrative staff until the evaluation by the designated mental health professional. (5) Youth placed on alert will be seen by the psychiatrist/doctoral psychologist or their designee once per week for a minimum of two weeks. (6) The frequency of continued counseling for youth on alert status is determined by the designated mental health professional at all settings, including parole. (7) Youth are removed from alert status by the designated mental health professional initiating the status when the youth has stabilized. (8) Youth on suicide alert status may not be moved to another placement unless that placement is a TYC institution, residential treatment center, or other placement having on-site psychiatric/doctoral psychological staff. (9) Youth who have been on suicide alert within the past six months are reevaluated by a designated, qualified mental health professional following a placement change. (10) The file of a youth on alert status is color coded red. (11) When a youth is placed on or removed from suicide alert status, the HLS- 210 Suicide Alert form is filled out and placed in the medical subfile and a copy in casework subfile and relevant data is entered in the automated medical records system. 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 September 18, 1992. TRD-9212856 Ron Jackson Executive Director Texas Youth Commission Effective date: October 13, 1992 Proposal publication date: May 22, 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 Home and Community-Based Services 40 TAC sec.sec.48.2209-48.2215 The Texas Department of Human Services (DHS) adopts new sec.sec.48.2209- 48. 2215, concerning home and community-based services, without changes to the proposed text as published in the August 14, 1992, issue of the Texas Register (17 TexReg 5673). The justification for the new sections is to add the guidelines that the Texas Department of Mental Health and Mental Retardation (TXMHMR) may use to determine provider sanctions and onsite follow-up review visits. The new sections will function by increasing compliance with the provider survey and certification standards as a result of notifying providers of the specific guidelines that TXMHMR will use. No comments were received regarding adoption of the sections. The new sections are adopted under the Human Resources Code, Title 2, Chapters 22 and 32, which provides the department with the authority 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 September 22, 1992. TRD-9212925 Nancy Murphy Agency Liaison, Policy and Document Support Texas Department of Human Services Effective date: October 15, 1992 Proposal publication date: August 14, 1992 For further information, please call: (512) 450-3765 Part III. Texas Commission on Alcohol and Drug Abuse Chapter 154. DWI Repeat Offender Program Standards and Procedures General Provisions 40 TAC sec.sec.154.1-154.7 Texas Commission on Alcohol and Drug Abuse adopts new sec. sec.154.1-154.7 concerning DWI repeat offender program standards and procedures, without changes to the proposed text as published in August 7, 1992, issue of the Texas Register (17 TexReg 5518). The new sections are adopted to define terms commonly used to establish minimum standards and criteria for the operation of approved DWI repeat offender programs for persons who are convicted of the offense of DWI more than once, and a court has required the offender to attend a DWI repeat offender educational program approved by the Texas Commission on Alcohol and Drug Abuse. The sections are adopted in order to define what programs must do to become a DWI repeat offender program approved by the Texas Commission on Alcohol and Drug Abuse. The sections will establish quality programming in DWI repeat offender education programs approved by the commission. No comments were received regarding adoption of the new sections. The new sections are adopted under the Texas Code of Criminal Procedure, Article 42.12, sec.13(j), which provides the Texas Commission on Alcohol and Drug Abuse with the authority to promulgate written rules and regulations setting forth minimum standards for the operation of approved DWI Repeat Offender Programs for persons who are convicted of the offense of DWI more than once, and a court has required that person to attend a DWI repeat offender educational program. 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 September 22, 1992. TRD-9212928 Bob Dickson Executive Director Texas Commission on Alcohol and Drug Abuse Effective date: November 1, 1992 Proposal publication date: August 7, 1992 For further information, please call: (512) 867-8720 DWI Repeat Offender Program Standards 40 TAC sec.sec.154.20-154.32 The Texas Commission on Alcohol and Drug Abuse adopts new sec.sec.154.20-154. 32 concerning DWI repeat offender program standards and procedures. Section 154.28 is adopted with changes to the proposed text as published in the August 7, 1992, issue of the Texas Register (17 TexReg 5520). Sections 154. 20-154.27 and sec. sec.154.29-154.32 are adopted without changes and will not be republished. The new sections are adopted to define terms commonly used to establish minimum standards and criteria for the operation of approved DWI repeat offender programs for person who are convicted of the offense of DWI more than once, and a court has required the offender to attend a DWI repeat offender educational program approved by the Texas Commission on Alcohol and Drug Abuse. The new sections are adopted in order to define what programs must do to become a DWI repeat offender program approved by the Texas Commission on Alcohol and Drug Abuse. In sec.154.28, the program instructor qualifications were changed by deleting two of the credentials/education choices listed. The new sections will establish uniformity and quality programming in DWI repeat offender education programs approved by the commission. One comment was received regarding program instructor qualifications per sec.154.28. The respondent felt that the two-year chemical dependency counseling experience for instructors, limited on otherwise qualified person from instructing the course. Names of groups and associations making comments for and against the section. Do not list individuals commenting against sec.154.28 was the Austin Driving School. To provide optimum service to the DWI repeat offender, it was determined that program instructors need to have a minimum of two-years of chemical dependency experience in order to effectively handle situations which could arise during the DWI Repeat Offender Program. The new sections are adopted under the Texas Code of Criminal Procedure, Article 42.12, sec.13(j), which provides the Texas Commission on Alcohol and Drug Abuse with the authority to promulgate written rules and regulations setting forth minimum standards for the operation of approved DWI Repeat Offender Programs for person who are convicted of the offense of DWI more than once, and a court has required that person to attend a DWI repeat offender educational program. sec.154.28. Program Instructors. Program instructors must: (1) be a licensed counselor intern, licensed chemical dependency counselor, certified social worker, licensed professional counselor, or psychologist, or possess a bachelor's degree in the field of sociology, psychology, rehabilitation counseling, or a closely related field approved by the commission; (2) have a minimum of two years of chemical dependency counseling experience; (3) serve as resource manager by referring participants to a full range of community services as needed; (4) be knowledgeable about the curriculum entitled the Texas DWI Intervention Program, and utilize that curriculum in instruction of participants; (5) work in coordination with probation personnel and abide by all program policies and procedures and standards as approved by the courts, probation personnel, Criminal Justice Assistance Division and the commission; (6) have completed training in the administration of the approved screening instrument utilized by the program. 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 September 22, 1992. TRD-9212927 Bob Dickson Executive Director Texas Commission on Alcohol and Drug Abuse Effective date: November 1, 1992 Proposal publication date: August 7, 1992 For further information, please call: (512) 867-8720 Texas Department of Insurance Exempt Filing Notification Pursuant to the Insurance Code, Chapter 5, Subchapter L (Editor's Note: As required by the Insurance Code, Article 5.96 and 5. 97, the Texas Register publishes notices of actions taken by the State Board of Insurance pursuant to Chapter 5, Subchapter L, of the Code. Board action taken under these articles is not subject to the Administrative Procedure and Texas Register Act. These actions become effective 15 days after the date of publication or on a later specified date.