EMERGENCY 
 RULES 
 
 An agency may adopt a new or amended section or repeal an existing section on 
an emergency basis if it determines that such action is necessary for the public 
health, safety, or welfare of this state. The section may become effective 
immediately upon filing with the  Texas Register, or on a stated date less than 
20 days after filing and remaining in effect no more than 120 days. The 
emergency action is renewable once for no more than 60 additional days. 
  Symbology in amended emergency sections. New language added to an existing 
section is indicated by the use of  bold text. [Brackets] indicate deletion of 
existing material within a section. 
 
   
  TITLE 40. SOCIAL SERVICES AND ASSISTANCE 
 Part III. Texas Commission on Alcohol and Drug Abuse 
  Chapter 148. Facility Licensure 
  
  Subchapter C. Client Management 
 
  40 TAC sec.sec.148.141-148.147, 148.161-148.163, 148.171-148.173, 148.181-
148.185 
 
  The Texas Commission on Alcohol and Drug Abuse adopts on an emergency basis 
new sec.sec.148.141-148.147, 148.161-148.163, 148.171-148.173, and 148. 181-
148.185 concerning client management in licensed chemical dependency facilities. 
The new sections are being adopted to establish minimum criteria regarding 
client rights and grievances; abuse, neglect, and exploitation; client 
information security and confidentiality; and crisis management, including 
special treatment procedures. 
 The new sections are adopted on an emergency basis because the agency has been 
placed under conservatorship and is mandated to make immediate changes to its 
rules and operations. 
 The new sections are adopted under the Texas Health and Safety Code, Title 6, 
Chapter 464, which provides the Texas Commission on Alcohol and Drug Abuse with 
the authority to adopt rules and standards for licensure of chemical dependency 
treatment facilities. 
 
 
  sec.148.141. Required Postings. 
 
  (a) The facility shall post a legible copy of the following documents in a 
prominent public location that is readily available to clients, visitors, and 
employees: 
 
  (1) the Client Bill of Rights; 
   
  (2) the commission's poster on reporting complaints and violations; and 
   
  (3) the client grievance procedure. 
     
  (b)  The Bill of Rights and the commission's poster shall be displayed in 
English and in a second language at each licensed site. 
 
     
  sec.148.142. Client Bill of Rights. The facility shall respect and protect 
clients rights. The Bill of Rights shall include: 
 
  (1) You have the right to a humane environment that provides reasonable 
protection from harm and appropriate privacy for your personal needs. 
   
  (2) You have the right to be free from abuse, neglect, and exploitation. 
   
  (3)  You have the right to be treated with dignity and respect. 
   
  (4)  You have the right to appropriate treatment in the least restrictive 
setting available that meets your needs. 
   
  (5) You have the right to be told about the program's rules and regulations 
before you are admitted. 
   
  (6) You have the right to be told before admission: 
 
  (A) the condition to be treated; 
   
  (B) the proposed treatment; 
   
  (C) the risks, benefits, and side effects of all proposed treatment and 
medication; and 
   
  (D) the probable health and mental health consequences of refusing treatment; 
and 
   
  (E) other treatments that are available and which ones, if any, might be 
appropriate for you. 
     
  (7) You have the right to accept or refuse treatment after receiving this 
explanation. 
   
  (8)  If you agree to treatment or medication, you have the right to change 
your mind at any time (unless specifically restricted by law). 
   
  (9) You have the right to a treatment plan designed to meet your needs, and 
you have the right to take part in developing that plan. 
   
  (10) You have the right to meet with staff to review and update the plan on a 
regular basis. 
   
  (11) You have the right to refuse to take part in research without affecting 
your regular care. 
   
  (12) You have the right not to receive unnecessary or excessive medication. 
   
  (13) You have the right not to be restrained or placed in a locked room by 
yourself unless you are a danger to yourself or others. 
   
  (14) You have the right to have information about you kept private and to be 
told about the times when the information can be released without your 
permission. 
   
  (15) You have the right to communicate with people outside the facility. This 
includes the right to have visitors, to make telephone calls, and to send and 
receive sealed mail. This right may be restricted on an individual basis by your 
doctor or the person in charge of the program if it is necessary for your 
treatment or for security, but even then you may contact an attorney or the 
commission at any reasonable time. 
   
  (16) You have the right to be told in advance of all estimated charges and any 
limitations on the length of services that the facility is aware of. 
   
  (17) You have the right to receive an explanation of your treatment or your 
rights if you have questions while you are in treatment. 
   
  (18) If you consented to treatment, you have the right to leave the facility 
within four hours of requesting release unless a physician determines that you 
pose a threat of harm to yourself and others. 
   
  (19) You have the right to make a complaint and receive a fair response from 
the facility within a reasonable amount of time. 
   
  (20) You have the right to complain directly to the Texas Commission on 
Alcohol and Drug Abuse at any reasonable time. 
   
  (21) You have the right to get a copy of these rights before you are admitted, 
including the commission's address and phone number. 
   
  (22) You have the right to have your rights explained to you in simple terms, 
in a way you can understand, within 24 hours of being admitted. 
 
     
  sec.148.143. Voluntary Clients-Additional Rights. In addition to the rights 
described in sec.148.142 of this title (relating to Client Bill of Rights), 
voluntary clients must be advised as to the following rights with regard to 
requests for discharge: 
 
  (1) You have the right to leave the treatment facility within 24 hours after 
you tell a staff person you want to leave. If you want to leave, you need to say 
so in writing or tell a staff person. If you tell a staff person you want to 
leave, the staff person must write it down for you to ensure that it is 
documented. There are only three reasons why you would not be allowed to leave: 
 
  (A) First, if you change your mind and want to stay at the facility, you can 
sign a document that states that you do not wish to leave; or you can tell a 
staff member that you do want to stay, and the staff member has to write it down 
for you. 
   
  (B) Second, if your doctor thinks you need to stay longer and an "application 
for court-ordered services or emergency detention" is filed with a judge, you 
may not be able to leave. This application must be filed within four days of 
your request to be discharged. The judge would be asked to decide if you should 
stay at the facility or if you should be allowed to leave. You can only be made 
to stay if the judge decides that either: 
 
  (i)  you are likely to cause serious harm to yourself; 
   
  (ii)  you are likely to cause serious harm to others; or 
   
  (iii)  your condition will continue to deteriorate and you are unable to make 
an informed decision as to whether or not to stay for treatment. 
     
  (C)  Third, if you are under 16 years old, and the person who admitted you 
(your parents, guardian, or conservator) doesn't want you to leave, you may not 
be able to leave. If you request release, staff must explain to you whether or 
not you can sign yourself out and why. The facility must notify the person who 
does have the authority to sign you out and tell that person that you want to 
leave. That person must talk to your doctor, and your doctor must document the 
date, time and outcome of the conversation in your medical record. 
     
  (2) Within 24 hours of telling staff you want to leave, you have the right to 
be examined face-to-face and assessed for discharge readiness by your doctor, 
with input from your treatment team. The doctor must note in your medical record 
and tell you about any plans to file an application for court-ordered treatment 
or for detaining you for other clinical reasons. If the doctor finds that you 
are ready to be discharged, you should be discharged without further delay. 
   
  (3) Nobody can ask a judge to commit you for services while you are a 
voluntary client unless you leave the facility without permission or you refuse 
or are unable to consent to appropriate and necessary treatment. Even if you 
leave the facility without permission or refuse or are unable to consent to 
appropriate and necessary treatment nobody can ask a judge to commit you unless: 
 
  (A) you are likely to cause serious harm to yourself or others; or 
   
  (B) your condition will continue to deteriorate and you are unable to make an 
informed decision as to whether or not to stay for treatment. If an order of 
protective custody is sought, the doctor must show that as a result of your 
deteriorating condition, you are very likely to present a risk of serious harm 
to yourself or others. 
 
       
  sec.148.144. Rights of Persons Apprehended for Emergency Detention. 
 
  (a) The rights of each person apprehended for emergency detention for 
inpatient chemical dependency services at a treatment facility are granted under 
the relevant sections of the Texas Health and Safety Code, Title 6, Subtitle B, 
Chapter 462. The client must be advised immediately of these rights orally, in 
writing, and in simple non-technical terms. Each person apprehended or detained, 
but not yet admitted, for emergency detention must be advised of the following 
rights: 
 
  (1) You have the right to be told: 
 
  (A) where you are; 
   
  (B) why you are being kept at the facility; and 
   
  (C) that your detention may result in a longer period of involuntary care. 
     
  (2) You have the right to be told that anything you do or say may be used to 
determine whether you should be allowed to leave and whether you need court-
ordered treatment. It may also be used in court. 
   
  (3) You have the right to call an attorney at any reasonable time. The 
facility must help you call an attorney if you ask. 
   
  (4) You have the right to have a preliminary examination by a physician 
conducted immediately upon arrival at the treatment facility, following 
apprehension, to determine whether your condition meets the criteria for 
admission under emergency detention. 
   
  (5) You have the right to be seen by a doctor. You will not be allowed to 
leave if the doctor believes that: 
 
  (A) you may seriously harm yourself or others; 
   
  (B) the risk of this happening is likely unless you are restrained; and 
   
  (C) emergency detention is the least restrictive means of restraint. 
     
  (6) If the doctor decides you do not meet all of these criteria, you must be 
allowed to leave. A decision concerning whether you must stay must be made 
within 24 hours, except weekends and legal holidays, the decision may be delayed 
until 4:00 p.m. on the first regular work day. The decision may also be delayed 
in the event of an extreme weather emergency. If the court is asked to order you 
to stay longer, you must be told that you have a right to a hearing within 72 
hours. 
   
  (7) If the physician finds you do not need to be here, you have the right to 
be released and will be taken back to where you were picked up or to another 
suitable place. 
     
  (b) If the person is accepted for treatment on an emergency detention, the 
personnel of the treatment facility shall immediately advise the person of the 
following rights. 
 
  (1) You have the right not to be detained for more than 24 hours after the 
hour of initial detention unless an order for further detention is obtained, 
except that if the 24-hour period ends on a Saturday, Sunday or legal holiday or 
before 4:00 p.m. on the first business day succeeding the Saturday, Sunday or 
legal holiday, the period of detention shall end no later than 4:00 p.m. of the 
first succeeding business day. 
   
  (2) You have the right to be released if the head of the facility determines 
that the criteria for emergency detention, as outlined in the Texas Health and 
Safety Code, Title 6, Subtitle B, sec.462.043(b), no longer applies. 
   
  (3) You have the right to be transferred back to the location of apprehension, 
or other suitable place, if released form emergency detention, unless you are 
arrested or object to the return. 
   
  (4) You have the right to be informed that no later than the 24th hour after 
the hour of initial detention, the head of the treatment may file a petition for 
court-ordered treatment. 
   
  (5) You have the right to be informed that if a petition for court-ordered 
treatment is filed, you are entitled to a judicial probable cause hearing no 
later than the 72nd hour on which detention begins under an order of protective 
custody to determine whether you should remain in the treatment facility. 
   
  (6) You have the right to have an attorney appointed if you do not have an 
attorney, when application for court-ordered services is filed. 
   
  (7) You have the right to communicate with your attorney at any reasonable 
time and to have assistance in contacting the attorney. 
   
  (8) You have the right to be informed that anything you say to the personnel 
of the treatment facility may be used in making a determination relating to 
detention, may result in the filing of a petition for court-ordered treatment, 
and may be used at a court hearing. 
   
  (9) You have the right to present evidence and to cross-examine witnesses who 
testify on behalf of the petitioner at a hearing. 
   
  (10)  You have the right to refuse medication unless there is an imminent 
likelihood of serious physical injury to you or others if the medication is 
refused. 
   
  (11) You have the right to be informed that beginning on the 24th hour before 
a hearing for court-ordered treatment, you may refuse to take medication unless 
the medication is necessary to save your life. 
   
  (12)  You have the right to request that a hearing be held in the county of 
which you are a resident, if within the state. 
 
       
  sec.148.145. Order of Protective Custody-Special Rights.  Clients apprehended, 
detained, admitted or held under an order of protective custody must be advised 
of the following rights. 
 
  (1) You have the right to call a lawyer or to have a lawyer appointed to 
represent you in a hearing to determine whether you must remain in custody until 
a hearing on court-ordered chemical dependency treatment is held. 
   
  (2) Before a probable cause hearing is held, you have the right to be told in 
writing: 
 
  (A) that you have been placed under an order of protective custody; 
   
  (B) why the order was issued; and 
   
  (C) the time and place of a hearing to determine whether you must remain in 
custody until a hearing on court-ordered chemical dependency treatment. This 
notice must also be given to your attorney. 
     
  (3) You have the right to a hearing within 72 hours of your detention, except 
that on weekends or legal holidays, the hearing may be delayed until 4:00 p.m. 
on the first regular workday, or in the event of an extreme weather emergency. 
   
  (4) You have the right to be released from custody if: 
 
  (A) 72 hours has passed and a hearing has not taken place (except weather 
emergencies and extensions for weekends and legal holidays); 
   
  (B) an order for court-ordered chemical dependency treatment has not been 
issued within 14 days of the filing of an application (30 days if a delay was 
granted); or 
   
  (C) your doctor finds that you no longer need court-ordered chemical 
dependency treatment. 
 
       
  sec.148.146. Client Grievance Procedure. 
 
  (a) The facility shall have a written grievance procedure for clients. 
   
  (b) Staff shall give each client a copy of the grievance procedure during 
orientation and explain it in clear, simple terms that the client understands. 
   
  (c)  The grievance procedure shall tell clients that they can: 
 
  (1)  file a grievance about any violation of client rights or commission 
rules; 
   
  (2) file a grievance with any staff member; 
   
  (3) submit a grievance in writing and get help writing it if they are unable 
to read or write; 
   
  (4) submit a grievance directly to the Texas Commission on Alcohol and Drug 
Abuse at any time; and 
   
  (5) request pens, paper, envelopes, postage, and access to a telephone for the 
purpose of filing a grievance. 
     
  (d) The procedure shall also include: 
 
  (1) a reasonable, specific deadline for completing the process; and 
   
  (2) the address and toll-free telephone number of the Texas Commission on 
Alcohol and Drug Abuse. 
 
       
  sec.148.147. Responding to Client Grievances. 
 
  (a) The facility shall: 
 
  (1) acknowledge the grievance in writing within 24 hours (72 hours on 
weekends); 
   
  (2) evaluate the grievance thoroughly and objectively, obtaining additional 
information as needed; 
   
  (3)  inform the client of the findings and recommendations within seven 
calendar days; 
   
  (4) take action to resolve all grievances promptly and fairly; 
   
  (5) forward all grievances that cannot be resolved to the Texas Commission on 
Alcohol and Drug Abuse; 
   
  (6) document all grievances, including the final disposition, and keep the 
documentation in a central file; 
     
  (b) The facility shall not: 
 
  (1) discourage, intimidate, harass, or seek retribution against clients who 
try to exercise their rights or file a grievance; or 
   
  (2) restrict, discourage, or interfere with client communication with an 
attorney or with the commission for the purposes of filing a grievance. 
     
  (c) The facility shall have a written policy on client grievances and a 
written procedure for staff. 
 
     
  sec.148.161. Client Abuse, Neglect, and Exploitation.  The facility shall 
protect clients from abuse, neglect, and exploitation. 
 
  (1)  Any person who receives an allegation or has reason to suspect that a 
client has been, is, or will be abused, neglected, or exploited shall 
immediately inform the facility director or designee. 
   
  (2) If the allegation involves sexual exploitation, the facility director 
shall also comply with reporting requirements listed in the Civil Practice and 
Remedies Code, sec.81.006. 
   
  (3) The facility director shall take immediate action to prevent or stop the 
abuse, neglect, or exploitation and provide appropriate care and treatment. 
   
  (4) The facility director or designee shall make a verbal report to the Texas 
Commission on Alcohol and Drug Abuse within 24 hours. This is in addition to the 
reports specified in the Texas Human Resources Code, sec.48.36 and the Texas 
Family Code, sec.34.01. 
   
  (5)  The person who reported the incident shall submit a written incident 
report to the facility director within 24 hours. 
   
  (6) The facility director shall send a written report to the Texas Commission 
on Alcohol and Drug Abuse within two working days after receiving notification 
of the incident. This report shall include: 
 
  (A) the name of the client and the person the allegations are against; 
   
  (B) the information required in the incident report or a copy of the incident 
report; 
   
  (C) other individuals, organizations, and law enforcement notified. 
     
  (7) The facility director shall also notify the legal consenter. If the client 
is the legal consenter, family members and significant others may be notified 
only if the client gives written consent. 
   
  (8) The facility shall not investigate the complaint or take action unless 
directed to do so by the commission. 
   
  (9) The governing authority or its designee shall take action needed to 
prevent any confirmed incident from recurring. 
   
  (10)  The facility shall: 
 
  (A) document all investigations and resulting actions and keep the 
documentation in a central file; 
   
  (B) have a written policy that clearly prohibits the abuse, neglect, and 
exploitation of clients and a written procedure that defines the steps that will 
be taken to investigate and resolve any alleged incident; 
   
  (C) enforce the policy and procedure and provide appropriate sanctions for 
confirmed violations. 
 
       
  sec.148.162. Behavior Management. <ol> Facility staff shall use appropriate 
behavior management to enforce program rules and protect the health, safety, 
welfare, and rights of all clients. 
 
  (1) The governing body shall adopt a written policy on behavior management. 
The policy shall ensure that behavior management is reasonable. It shall also 
clearly prohibit: 
 
  (A) physical discipline; 
   
  (B) measures involving the use of food, water, sleep, or bathroom privileges; 
   
  (C) consequences that are harsh, cruel, or excessive; 
   
  (D) consequences that are used for the convenience of staff; or 
   
  (E) behavior management that is authorized, supervised, or carried out by 
clients. 
     
  (2) The facility director or designee shall monitor compliance and enforce the 
policy. Violations will be considered client abuse. 
   
  (3) The program shall have a written procedure describing what action will be 
taken when a client violates program rules. 
   
  (4) The procedure shall clearly identify grounds for client discharge. 
   
  (5) When staff impose behavioral consequences, they shall explain the reasons 
and describe appropriate behavior. 
   
  (6) Staff shall use behavior management fairly and objectively. 
   
  (7) The facility director shall approve any system used by the program to 
modify client behavior by granting or restricting privileges. 
 
  (A) Written criteria shall be: 
 
  (i) designed to support treatment goals; 
   
  (ii) stated in behavioral terms when possible; and 
   
  (iii)  applied consistently to all clients. 
     
  (B) Client progress through the system shall be documented in the client 
record. 
     
  (8) The program may have a system of client government if staff monitor the 
group and approve its decisions. 
 
     
  sec.148.163. Client Labor. 
 
  (a) All clients should be encouraged to maintain their own living quarters and 
client activity areas. These housekeeping activities and individual/group 
responsibilities shall be clearly defined in writing. 
   
  (b) The facility shall not depend on client labor or require clients to work 
unless: 
 
  (1) work responsibilities are defined in writing; 
   
  (2) staff explain the work requirements before admission; and 
   
  (3) the client gives voluntary written consent. 
     
  (c) The facility shall not allow clients to work for the facility if the job 
interferes or conflicts with the client's treatment. 
   
  (d) The facility shall compensate clients fairly for work unless the activity 
is clinically designed and justified in the written program description or the 
client's treatment plan. 
   
  (e) Work shall not endanger client safety or well-being. 
   
  (f) The facility shall provide appropriate equipment, supplies, and assistance 
for all housekeeping duties and required work. 
   
  (g) The facility shall not allow clients to solicit donations or raise funds 
for the facility. 
   
  (h) Clients may participate in small-scale, time-limited activities to earn 
money for special activities if: 
 
  (1) the activity is not part of scheduled services or individual treatment 
plans; 
   
  (2) all benefits go directly to the clients; 
   
  (3) participation is completely voluntary; and 
   
  (4)  the program ensures full compliance with confidentiality statutes. 
 
       
  sec.148.171. Client Record Security. 
 
  (a) The facility shall protect client records and other client-identifying 
information from loss, tampering, and unauthorized access or disclosure. 
   
  (b) The facility shall limit access to the records to staff with job duties 
requiring their use. 
   
  (c) Staff shall keep records locked at all times unless an authorized person 
is continuously present in the immediate area. 
   
  (d)  The program shall have an effective tracking system, and an assigned 
staff person shall account for each record at the end of each day or shift. 
   
  (e)  If client records are computerized, the facility shall: 
 
  (1)  protect the files from unauthorized or accidental access; and 
   
  (2)  have a backup system. 
     
  (f) Client records shall be kept for at least five years. Records of 
adolescent clients shall be kept for at least five years after the client turns 
18. 
   
  (g) If client records are microfilmed or destroyed, the facility shall take 
steps to protect confidentiality. 
   
  (h) Programs that do not provide services at a program site shall implement 
procedures to ensure the security and confidentiality of client information. 
 
     
  sec.148.172. General Documentation Requirements. The facility shall keep 
complete, current documentation. 
 
  (1) All required documents shall be factual and accurate. 
   
  (2) All documents and entries shall be signed and dated. If the document 
relates to past activity, the date of the activity shall also be recorded. 
   
  (3) Documentation shall be permanent and legible. 
   
  (4) When it is necessary to correct a client record, incident report, or other 
legal document, the error shall be marked through with a single line, dated, and 
initialed by the writer. 
   
  (5) The facility shall create a record for each client at the time of 
admission. All documents related to active clients shall be filed and readily 
available. 
   
  (6) All records shall conform to the facility's procedures for content and 
organization. 
   
  (7) The facility shall have an organized file system so that records can be 
found quickly. 
 
     
  sec.148.173. Release of Confidential Information. 
 
  (a) The facility shall implement written procedures for protecting and 
releasing client information that conform to federal and state confidentiality 
laws. 
   
  (b) Staff shall follow written procedures for responding to verbal and written 
requests for client-identifying information. 
   
  (c) Facility personnel shall not acknowledge the presence of a client or 
disclose any client-identifying information unless: 
 
  (1) the client gives full written consent; 
   
  (2) the disclosure is authorized by an appropriate court order as defined in 
the federal regulations; 
   
  (3) the disclosure is made to medical personnel in a medical emergency or to 
qualified personnel for research, audit, or program evaluation; or 
   
  (4) the disclosure is otherwise permitted by law. 
     
  (d) The client's written consent to release information shall include: 
 
  (1) the name of the person or program releasing the information; 
   
  (2) the name of the individual or organization receiving the information; 
   
  (3) the name of the client; 
   
  (4) the specific purpose of disclosure; 
   
  (5) how much and what kind of information will be released; 
   
  (6) the signature of the legal consenter; 
   
  (7) the date of signature; 
   
  (8) a statement that the consenter may revoke the consent at any time (unless 
otherwise restricted by law), but the revocation will not affect information 
already released under the consent; and 
   
  (9) the date, event, or condition upon which the consent will expire. 
     
  (e) The facility shall not deny clients access to the content of their records 
except as provided by the Texas Health and Safety Code, Title 7, Subtitle E, 
sec.611.0045. 
 
     
  sec.148.181. Significant Incident Reports. 
 
  (a) Staff shall complete an incident report for all significant client 
incidents, including: 
 
  (1) incidents of actual or suspected abuse, neglect, exploitation, or other 
violation of client rights; 
   
  (2) accidents and injuries; 
   
  (3) medical emergencies; 
   
  (4) behavioral and psychiatric emergencies; 
   
  (5) medication errors; 
   
  (6) illegal or violent behavior; 
   
  (7) loss of a client record; 
   
  (8) personal or mechanical restraint or seclusion; 
   
  (9) release of confidential information without client consent; 
   
  (10) fire or significant disruption of program operation; 
   
  (11) death of an active client (on or off the program site); and 
   
  (12) clients absent without permission. 
     
  (b) The incident report shall be completed within 24 hours. 
   
  (c)  A procedure or form shall require staff to document: 
 
  (1) what happened (details of the incident); 
   
  (2) how it happened (sequence of events); 
   
  (3) when it happened (exact or approximate date and time); 
   
  (4) where it happened (exact or approximate location); 
   
  (5)  who was involved; 
   
  (6) what action was taken; and 
   
  (7)  what happened to the client(s). 
     
  (d) The person writing the report shall sign it and record the date and time 
it was completed. 
   
  (e) The program director shall verify appropriate follow-up and then sign the 
report. 
   
  (f) The facility shall store incident reports in a central file. 
   
  (g) Once a year, the facility director or designee shall review all incident 
reports to: 
 
  (1) identify patterns; 
   
  (2) evaluate the effectiveness of staff response; and 
   
  (3) take any corrective or preventive action needed. 
     
  (h) The facility shall have a procedure to ensure compliance with this 
section. 
 
     
  sec.148.182. Responding to Emergencies. 
 
  (a) The facility shall ensure that staff have the training and resources 
necessary to protect the health and safety of clients and other individuals 
during medical and psychiatric emergencies. 
   
  (b) The facility shall have written procedures for responding to medical 
emergencies which include: 
 
  (1)  using CPR and first aid techniques; 
   
  (2) getting medical advice and instructions if needed; 
   
  (3) getting outside assistance and arranging for transportation to an 
appropriate facility if needed. 
     
  (c)  If a program accepts pregnant women, the procedures shall include 
specific instructions for pregnancy-related medical emergencies. 
   
  (d) The facility shall have written procedures for responding to psychiatric 
crises which include: 
 
  (1) using crisis intervention techniques; 
   
  (2)  starting special treatment procedures, if applicable; and 
   
  (3)  getting outside assistance and arranging for transportation to an 
appropriate facility if needed. 
     
  (e) The facility shall post a list of emergency providers and telephone 
numbers near each telephone. 
 
     
  sec.148.183. Special Treatment Procedures. Staff shall use special treatment 
procedures appropriately to protect the health, safety, and rights of clients 
and other individuals. 
 
  (1) The governing body shall adopt a policy to authorize or prohibit the use 
of personal restraint, mechanical restraint, and seclusion. 
   
  (2) In programs authorized to use special treatment procedures, direct care 
staff shall be trained as described in sec.148.114 of this title (relating to 
Special Training Requirements). 
   
  (3) Staff shall not use special treatment procedures unless: 
 
  (A) a client's behavior endangers the client or others; and 
   
  (B) less restrictive methods have been tried and failed. 
     
  (4)  Staff shall not use special treatment procedures as discipline, for the 
convenience of staff, or as a substitute for less restrictive methods of 
intervention. 
   
  (5) Staff shall not use more force than is reasonable and necessary to prevent 
imminent harm during special treatment procedures. The use of unnecessary force 
is client abuse. 
   
  (6) Staff shall obtain authorization from the supervising qualified 
credentialed counselor before starting restraint or seclusion or as soon as 
possible. 
 
  (A)  Authorization may be obtained in person or by phone. 
   
  (B) The facility shall not use standing authorizations for special treatment 
procedures. 
   
  (C) Each authorization shall include a maximum time frame. 
     
  (7) When staff restrain or seclude a client, they shall immediately (or as 
soon as possible) tell the client what behavior is required for release. 
   
  (8) Staff shall release the client as soon as the client's behavior is no 
longer a danger to self or others. 
   
  (9) If a potentially dangerous situation arises (such as choking, seizures, or 
fire), the client shall be released immediately. 
   
  (10) During special treatment procedures, staff shall provide attention for 
personal needs, including: 
 
  (A) regular meals and fluids; 
   
  (B) regularly prescribed medications; and 
   
  (C) use of a toilet. 
     
  (11) Clinical staff shall evaluate the incident during the next treatment plan 
evaluation and develop other strategies for managing the client's behavior and 
preventing similar incidents. 
   
  (12) The facility director or designee shall: 
 
  (A) review all incident reports involving special treatment procedures; 
   
  (B) investigate unusual or possibly unjustified use of the procedures; and 
   
  (C) take appropriate action to address any identified problems. 
     
  (13) Facilities using personal restraint shall comply with the following. 
 
  (A) Staff shall not personally restrain a client for longer than one hour. At 
the end of one hour, staff shall implement the facility's psychiatric emergency 
procedures. 
   
  (B) The supervising staff member shall observe the client throughout the 
incident. 
     
  (14)  Facilities using seclusion shall comply with the following. 
 
  (A)  Seclusion rooms shall be set up to prevent clients from harming 
themselves and shall allow staff to observe clients easily in all parts of the 
room. 
   
  (B) Staff shall not hold a client in seclusion more than 12 hours. At the end 
of 12 hours, staff shall implement the facility's psychiatric emergency 
procedures. 
   
  (C) Staff shall conduct a visual check every 15 minutes and give the client 
attention for personal needs. 
     
  (15)  Facilities using mechanical restraint shall comply with the following. 
 
  (A) Staff shall obtain authorization for mechanical restraint from a 
physician. 
   
  (B) A client may not be held in mechanical restraint more than 12 hours. At 
the end of 12 hours, staff shall implement the facility's psychiatric emergency 
procedures. 
   
  (C) A staff member shall be watching the client throughout the period of 
restraint. 
   
  (D) Staff shall check the client's circulation every 15 minutes and adjust the 
restraint as needed. 
   
  (E) The program shall not use devices that are not designed for the 
therapeutic restraint of humans. 
     
  (16) The facility shall have a written procedure for staff that ensures 
compliance with this section. 
 
     
  sec.148.184. Documenting Special Treatment Procedures. Staff shall record the 
following information in the client record within 24 hours: 
 
  (1) the circumstances leading to the client's loss of control; 
   
  (2) the specific behavior that made special treatment necessary; 
   
  (3) less restrictive interventions that were tried before restraint or 
seclusion began; 
   
  (4) the signed authorization of the supervising qualified credentialed 
counselor or physician; 
   
  (5) the names of the staff members who implemented the procedure; 
   
  (6) the date and time the procedure began and ended; 
   
  (7) the specific type of hold or device used during restraint; 
   
  (8) the behavior required for release; 
   
  (9) the client's response; 
   
  (10) observations made, including the 15 minute checks; and 
   
  (11) the attention given for personal needs. 
 
     
  sec.148.185. Adolescents Absent Without Permission. The facility shall have 
written procedures that staff use when an adolescent leaves the facility without 
permission. The procedure shall include: 
 
  (1)  time frames that determine when a client is absent without permission; 
   
  (2) time frames and persons responsible for notifying the legal consenter(s); 
   
  (3) actions to be taken by staff; and 
   
  (4)  incident report documentation. 
       
  Issued in Austin, Texas, on August 17, 1995. 
 TRD-9510421 
  Thomas Mann, Jr. 
 General Counsel 
 Texas Commission on Alcohol and Drug Abuse 
    Effective date: August 21, 1995 
 Expiration date: December 19, 1995 
 For further information, please call: (512) 867-8720 
         
       
  Subchapter D. Program Services 
 
  40 TAC sec.sec.148.201, 148.202, 148.211-148.214, 148.231-148.235, 148.251-
148.254, 148.261-148.268 
 
  The Texas Commission on Alcohol and Drug Abuse adopts on an emergency basis 
new sec.sec.148.201, 148.202, 148.211-148.214, 148.231-148.235, 148.251-148. 
254, and 148.261-148.268, concerning program services in licensed chemical 
dependency facilities. The new sections are being adopted to establish minimum 
standards for programs services, including the four treatment levels; special 
provisions for special populations; food and nutrition; and medication. 
 The new sections are adopted on an emergency basis because the agency has been 
placed under conservatorship and is mandated to make immediate changes to its 
rules and operations. 
 The new sections are adopted under the Texas Health and Safety Code, Title 6, 
Chapter 464, which provides the Texas Commission on Alcohol and Drug Abuse with 
the authority to adopt rules and standards for licensure of chemical dependency 
treatment facilities. 
 
 
  sec.148.201. General Information. 
 
  (a) Every program shall comply with the rules in sec.148.202 of this title 
(relating to Services Required in All Programs). 
   
  (b) Every program shall also comply with the rules in all applicable Treatment 
Level sections: 
 
  (1) sec.148.211 of this title (relating to Level I Treatment); 
   
  (2) sec.148.212 of this title (relating to Level II Treatment); 
   
  (3) sec.148.213 of this title (relating to Level III Treatment); or 
   
  (4) sec.148.214 of this title (relating to Level IV Treatment); 
     
  (c) Additional rules and exemptions for specific populations and programs are 
found under Special Provisions. 
 
     
  sec.148.202. Services Required In All Programs. 
 
  (a) All services shall be delivered according to a written plan. 
   
  (b) The program shall be culturally appropriate for the population served. 
   
  (c)  Members of the client's treatment team shall demonstrate effective 
communication and coordination. 
   
  (d) Every residential client shall have a medical history and physical 
examination. 
   
  (e) Chemical dependency education shall follow a course outline that 
identifies lecture topics and major points to be discussed. 
   
  (f) The program shall provide education about the health risks of tobacco 
products and nicotine addiction. The facility shall also offer treatment for 
nicotine addiction (directly or through referral) and inform the client that 
this treatment is available. 
   
  (g) The program shall provide HIV education based on the Model Workplace 
Guidelines for Direct Service Providers developed by the Texas Department of 
Health. 
   
  (h) Clients shall have access to HIV counseling and testing services directly 
or through referral. 
 
  (1) Services shall be voluntary, anonymous, and not limited by ability to pay. 
   
  (2)  Counseling shall be based on the model protocol developed by the Texas 
Department of Health. 
     
  (i) The program shall make testing for tuberculosis and sexually transmitted 
diseases available to all clients unless the program has access to test results 
obtained during the past year. 
 
  (1)  Services may be made available directly or through referral. 
   
  (2)  If a client tests positive, the program shall refer the client to an 
appropriate health care provider and take appropriate steps to protect clients 
and staff. 
     
  (j) The program shall: 
 
  (1) provide access to appropriate medical care and mental health services 
directly or through referral; 
   
  (2) refer pregnant clients who are not receiving prenatal care to an 
appropriate health care provider and monitor follow-through; and 
   
  (3) refer clients to ancillary services necessary to meet treatment goals. 
 
       
  sec.148.211. Level I Treatment. 
 
  (a) All clients admitted to stabilization programs shall be in need of 
detoxification or crisis stabilization. 
   
  (b) Every client shall have a medical history and physical. 
 
  (1) Residential clients shall have the medical history and physical within 24 
hours of admission. If the facility cannot meet this deadline because of 
exceptional circumstances, the circumstances shall be documented in the client 
record. Until a client's medical history and physical is complete, staff shall 
observe the client closely and monitor vital signs. 
   
  (2) Outpatient clients shall have the medical history and physical before 
admission. 
     
  (c) The program shall provide continuous supervision for clients. 
 
  (1) In residential programs, direct care staff shall be awake and on site 24 
hours a day. 
 
  (A) During day and evening hours, at least two awake staff shall be on duty 
for the first 12 clients, with one more person on duty for each additional one 
to 16 clients. 
   
  (B) At night, at least one awake staff member shall be on duty for the first 
12 clients, with one more person on duty for each additional one to 16 clients. 
     
  (2) In outpatient programs, direct care staff shall be awake and on site 
whenever a client is on site. Clients shall have access to on-call staff 24 
hours a day. 
     
  (d) If the program accepts clients with acute detoxification symptoms or a 
history of acute detoxification symptoms, the program shall have: 
 
  (1) a licensed vocational nurse or registered nurse on duty during all hours 
of operation; and 
   
  (2) a physician on call 24 hours a day. 
     
  (e) Level of observation shall be based on medical recommendations and program 
design. 
   
  (f) A physician shall approve all medical policies, procedures, guidelines, 
tools, and forms, which shall include: 
 
  (1) screening instruments (including a medical risk assessment) and 
procedures; 
   
  (2) treatment protocol or standing orders for each chemical the program is 
prepared to detoxify; and 
   
  (3)  emergency procedures. 
     
  (g) The medical supervisor shall be a physician, physician assistant, advanced 
nurse practitioner, or registered nurse. 
   
  (h) The program shall: 
 
  (1) ensure continuous access to emergency medical care; 
   
  (2) provide clients access to mental health evaluation and linkage with mental 
health services when indicated; and 
   
  (3) use written procedures to encourage clients to seek appropriate treatment 
after stabilization. 
     
  (i) Direct care staff shall complete training as described in sec.148.114 of 
this title (relating to Special Training Requirements). 
   
  (j) Staff shall help each client develop an individualized post-stabilization 
plan that includes appropriate referrals. 
 
     
  sec.148.212. Level II Treatment. 
 
  (a) All clients admitted to Level II shall be: 
 
  (1) medically stable; and 
   
  (2) able to participate in treatment. 
     
  (b) The program shall have enough staff to provide close supervision and 
individualized treatment. 
   
  (c) Counselor caseloads shall not exceed 1:10. 
   
  (d) Direct care shall be awake and on site during all hours of program 
operation. The ratio for direct-care staff to clients shall be at least 1:16: 
 
  (1) during the hours clients are awake in residential programs; and 
   
  (2) during all hours of operation in outpatient programs. 
     
  (e) Counselors shall complete a comprehensive client assessment within three 
individual service days of admission. 
   
  (f)  An individualized treatment plan shall be completed within five 
individual service days of admission. 
   
  (g) The facility shall deliver an average of 20 hours of structured activities 
per week for each client, including: 
 
  (1) ten hours of chemical dependency education and/or counseling; 
   
  (2) four hours of additional education, counseling, or rehabilitation 
activities; and 
   
  (3) three hours of structured social and/or recreational activities. 
     
  (h) Each client shall have an opportunity to participate in physical 
recreation at least weekly. 
   
  (i) Program staff offer chemical dependency services to identified significant 
others. 
   
  (j)  The program shall provide each client with opportunities to apply 
knowledge and practice skills in a structured, supportive environment. 
 
     
  sec.148.213. Level III Treatment. 
 
  (a) All clients admitted to Level III shall be: 
 
  (1) medically stable; and 
   
  (2) able to function with limited supervision and support. 
     
  (b) The program shall have enough staff to meet treatment needs within the 
context of the program description. 
   
  (c) Counselor caseloads shall not exceed 1:16. 
   
  (d)  Direct care shall be awake and on site during all hours of program 
operation. The ratio for direct-care staff to clients shall be at least 1:16: 
 
  (1) during the hours clients are awake in residential programs; and 
   
  (2) during all hours of operation in outpatient programs. 
     
  (e)  For clients admitted directly to this level of treatment, counselors 
shall complete a comprehensive client assessment within five individual service 
days of admission. 
   
  (f) All clients shall have an individualized treatment plan within seven 
individual service days of admission. 
   
  (g) The facility shall deliver an average of ten hours of structured 
activities per week for each client, including at least five hours of chemical 
dependency education and/or counseling. 
   
  (h) The program design and application shall include increasing levels of 
responsibility for clients and frequent opportunities for clients to apply 
knowledge and practice skills in structured and non-structured settings. 
 
     
  sec.148.214. Level IV Treatment. 
 
  (a) All clients admitted to intermediate programs shall be: 
 
  (1) medically stable; and 
   
  (2)  able to function with minimal structure and support. 
     
  (b) The program shall have enough staff to provide clients with adequate 
support and guidance. 
   
  (c) The program shall set limits on counselor caseload size that ensure 
effective, individualized treatment and rehabilitation. Criteria used to set the 
caseload size shall be documented. 
   
  (d) The program shall be adequately staffed during hours of operation to 
ensure effective service delivery. 
   
  (e) In residential programs, the ratio for awake direct-care staff to clients 
shall be at least 1:16 during the hours clients are awake. 
   
  (f) For clients admitted directly to this level of treatment, counselors shall 
complete a comprehensive client assessment within: 
 
  (1) five individual service days of admission in residential programs; and 
   
  (2) 45 calendar days of admission in outpatient programs. 
     
  (g) All clients shall have an individualized treatment plan within: 
 
  (1) seven individual service days of admission in residential programs; and 
   
  (2) 45 calendar days of admission in outpatient programs. 
     
  (h) The facility shall deliver an average of two hours of structured 
activities per week for each client, including at least one hour of chemical 
dependency education or counseling. These activities shall be designed to help 
clients establish a healthy, independent lifestyle. 
   
  (i) The program shall offer chemical dependency counseling services. 
   
  (j) The program design and application shall include increasing levels of 
responsibility for clients and frequent opportunities for clients to 
independently apply knowledge and practice skills in non-structured settings. 
 
     
  sec.148.231. Adolescents. 
 
  (a) The facility shall address the special needs of adolescents and protect 
their rights. 
   
  (b)  Residential facilities shall separate bedrooms and bathrooms for adults 
and adolescents and for males and females. 
   
  (c) Adults and adolescents may be mixed for specific groups or activities when 
no conflict exists. 
   
  (d) The facility shall obtain authorization to obtain medical treatment from 
the consenter when the client is admitted. 
   
  (e)  Providers shall observe legal or other statutory laws which define the 
adult population to be served when it is different from the commission's 
definition. 
   
  (f) Residential and day-treatment shall provide access to education approved 
by the Texas Education Agency when treatment is expected to last more than 14 
days. 
   
  (g) The program's treatment services, lectures, and written materials shall be 
age-appropriate and easily understood by clients. 
   
  (h) The facility shall allow regular communication between an adolescent 
client and the client's family. 
   
  (i) The facility shall ensure that staff who plan, supervise, or provide 
education or counseling to adolescents have specialized education or training in 
the emotional, mental health, and chemical dependency problems of adolescents 
and appropriate treatment for them. 
 
  (1) Individuals who plan or supervise such services shall be qualified 
credentialed counselors. 
   
  (2) Direct care staff shall have training in human adolescent development, 
family systems, adolescent psycho-pathology and mental health, chemical 
dependency and addiction in adolescents, and adolescent socialization issues. 
     
  (j)  All direct-care staff shall be trained and competent to use personal 
restraint. 
   
  (k) In residential programs, the direct care staff-to-client ratio shall be at 
least 1:8 during waking hours (including program-sponsored activities away from 
the facility) and 1:16 during sleeping hours. 
   
  (l) Clients shall be under direct supervision at all times. 
 
  (1) At the program site, staff shall be within eyesight or hearing distance 
and readily available at all times. If clients are not within eyesight, staff 
shall conduct visual checks at least once every hour, including bed checks. 
   
  (2) In public places, clients shall be within eyesight at all times. 
     
  (m) Admission criteria shall limit admission to adolescents 13 through 17 
years of age. 
 
  (1) Children who are 10 through 12 years of age and young adults 18 through 20 
years of age may be admitted only when the assessment indicates that the 
individual's needs, experiences, and behavior are similar to those of adolescent 
clients. 
   
  (2)  Each exception shall be approved in writing by the program director. 
     
  (n) The treatment plan shall address adolescent needs and issues. 
   
  (o) The program shall involve the adolescent's family or an alternate support 
system in the treatment process or document why this is not happening. 
   
  (p) Staff shall not provide, distribute, or facilitate access to tobacco 
products. 
   
  (q) Staff shall not use tobacco products in the presence of adolescent 
clients. 
   
  (r) The program shall prohibit adolescent clients from using tobacco products 
on the program site or during structured program activities. 
   
  (s) Residential programs shall define the level of care provided according to 
the statewide level of care system. 
 
     
  sec.148.232. Parents and Their Dependent Children. 
 
  (a) The program shall address the specialized needs of the parent and include 
services for children. 
   
  (b) Education, counseling, and rehabilitation services shall address: 
 
  (1) the effects of chemical dependency on a women's health and pregnancy; 
   
  (2) parenting skills; and 
   
  (3) health and nutrition. 
     
  (c) The program shall have a procedure to regularly assess parent-child 
interactions. Any identified needs shall be addressed in treatment. 
   
  (d) Program staff shall provide access to family planning services. 
   
  (e) The program shall provide or arrange for childcare with a qualified 
provider while the mother participates in treatment activities. Before 
supervising children independently, the provider shall have infant CPR 
certification and at least eight hours of training in the following areas: 
 
  (1) chemical dependency and its impact on the family; 
   
  (2)  child development and age-appropriate activities; 
   
  (3) child health and safety; 
   
  (4) universal precautions; 
   
  (5)  appropriate child supervision techniques; and 
   
  (6) signs of child abuse. 
     
  (f) Staff shall not allow anyone except the legal guardian or a person 
authorized by the legal guardian to take a child away from the facility. If an 
individual shows documentation of legal custody, staff shall record the person's 
identification before releasing the child. 
   
  (g)  The program shall have a procedure to use if a parent abuses or neglects 
a child. 
   
  (h) Residential programs shall not accept dependents over the age of 12. 
   
  (i) Children over the age of six shall not share a bedroom with a member of 
the opposite sex who is not in the immediate family. 
 
     
  sec.148.233. Children's Services. 
 
  (a) General Requirements. 
 
  (1) The program shall ensure that children are directly supervised by parents 
or qualified providers at all times. 
   
  (2) The program shall have a written policy and a current schedule showing who 
is responsible for the children at all times. 
   
  (3) The daily activity schedule shall include a variety of structured and 
unstructured age-appropriate activities. 
   
  (4) The program shall provide a variety of age-appropriate equipment, toys, 
and learning materials. 
   
  (5) School age children shall have access to school. 
   
  (6) Standards protecting the health, safety, and welfare of clients apply to 
their children. 
   
  (7) Behavior management shall be fair, reasonable, consistent, and related to 
the child's behavior. Physical discipline is prohibited. 
     
  (b) Staffing. 
 
  (1) Every children's program shall have a supervisor or consultant with at 
least: 
 
  (A) 90 clock hours of education and training in child development and/or early 
childhood education; and 
   
  (B) one year of documented experience providing services to children. 
     
  (2) Before supervising children independently, direct care staff shall have 
infant CPR certification and at least eight hours of training in: 
 
  (A) chemical dependency and its impact on the family; 
   
  (B) child development and age-appropriate activities; 
   
  (C) child health and safety; 
   
  (D) universal precautions; 
   
  (E) appropriate child supervision techniques; and 
   
  (F) signs of child abuse. 
     
  (3) All direct care staff shall have current certification in CPR for infants 
and children. A staff person with such certification shall be on duty at all 
times. 
   
  (4) When staff are responsible for children, the staff-to-child ratio shall 
not exceed 1:4 for infants (18 months and younger) and 1:10 for toddlers and 
children. 
   
  (5) When clients are responsible for children, the parent-to-child ratio shall 
not exceed 1:2 for infants (18 months and younger) and 1:4 for toddlers and 
children. Clients shall not supervise another parent's children without written 
consent from the legal guardian and staff approval. 
     
  (c)  Safety Practices. 
 
  (1) The evacuation procedures shall include provisions for children approved 
by the fire marshal. 
   
  (2) The program shall not allow children to use: 
 
  (A) climbing equipment or swings on or near concrete or asphalt; 
   
  (B) toys that explode or shoot things; and 
   
  (C) other sharp or dangerous items. 
     
  (3) The program shall have safeguards to prevent children from using toys that 
are dangerous because they are not age-appropriate. 
   
  (4) The program site shall meet the additional physical plant requirements 
listed in sec.148.372 of this title (relating to Additional Physical Plant 
Requirements for Children). 
     
  (d)  Health Practices. 
 
  (1) The program shall have procedures for isolating parents and children who 
have communicable diseases and providing them with appropriate care and 
supervision. 
   
  (2) The program shall keep current immunization records for each child at the 
program site as required by the Texas Department of Health. 
   
  (3) The program shall obtain a consent to obtain emergency medical care for 
each child at admission. 
   
  (4) Each child shall have a medical assessment from a medical doctor, 
physician assistant, advanced nurse practitioner, or registered nurse within 96 
hours of admission. Copies of an assessment performed up to seven days before 
admission may be used. 
   
  (5) The program shall provide potty chairs for small children and sanitize 
them after each use. 
   
  (6) The program shall provide age appropriate bathing facilities. Infants 
shall not be bathed in sinks. 
   
  (7) Staff, volunteers, and parents shall use universal precautions when caring 
for children other than their own. 
   
  (8)  The program shall ensure that children are clean and appropriately 
dressed. 
   
  (9) Staff shall check all diapers frequently, change without delay, and 
dispose of the diapers in a sealed container. 
   
  (10) The program shall provide an adequate diet for childhood growth and 
development, including two snacks per day. 
   
  (11) Children's medication shall be given by the parent or a licensed medical 
professional according to the label and documented by a trained staff member. 
 
       
  sec.148.234. Correctional Facilities. 
 
  (a) Correctional facilities participating in the state's Criminal Justice 
Initiative shall implement modified policies and procedures as needed to meet 
the goals of the Texas Commission on Alcohol and Drug Abuse and the criminal 
justice system when approved by the commission. 
   
  (b) Programs in state and local correctional facilities shall not be required 
to meet rules in areas under the control of the correctional system as approved 
by the commission. 
 
  (1)  In-Prison Therapeutic Communities (ITC's) and Substance Abuse Felony 
Punishment Facilities (SAFPF's) shall comply with the rules of the Texas 
Department of Criminal Justice (TDCJ). 
   
  (2) County jails shall comply with applicable regulations. 
     
  (c) When Texas Department of Criminal Justice rules conflict with Texas 
Commission on Alcohol and Drug Abuse rules, Texas Department of Criminal Justice 
rules shall prevail. 
   
  (d)  Programs operating in correctional facilities are exempt from the 
following rules: 
 
  (1) Sections 148.351-148.359 of this title (relating to Residential Physical 
Plant Requirements); 
   
  (2) Sections 148.251-148. 254 of this title (relating to Food and Nutrition); 
and 
   
  (3) Sections 148.261-148.268 of this title (relating to Medication). 
   
  (4) Rules requiring residential facilities to obtain medical history and 
physical examinations and provide medical care for clients. 
 
       
  sec.148.235. Pharmacotherapy Programs. 
 
  (a) Synthetic narcotic programs shall provide appropriate chemical dependency 
treatment based on the medical model. 
   
  (b) Synthetic narcotic programs shall comply with applicable rules established 
by the Texas Department of Health (40 TAC  ssec.229. 141-229.152) and the Food 
and Drug Administration (Code of Federal Regulations, Title 21, Chapter 1, Part 
291). 
   
  (c) The commission's rules for medication do not apply to methadone and other 
synthetic narcotics regulated by the Texas Department of Health. 
   
  (d) Admission screening shall be performed by a licensed medical professional 
or a chemical dependency counselor with at least one year of pharmacotherapy 
experience. 
   
  (e)  Admission shall be authorized by a physician. 
   
  (f) Each client shall have a medical history and physical examination filed in 
the client record. 
   
  (g) Treatment shall be consistent with recognized standards of current 
pharmacotherapy practice. 
   
  (h) Counseling and medical services shall be based on the assessment and 
recommendations of the treatment team and ordered by a physician. 
 
  (1) The program shall provide at least four individual counseling sessions 
during the first 45 days of treatment. 
   
  (2) After the first 45 days, the frequency of counseling shall be based on the 
individualized assessment. 
   
  (3) The client record shall contain documentation to support the frequency of 
counseling ordered. 
     
  (i) The program shall provide case management services. 
 
  (1) A case manager shall be assigned to each client. 
   
  (2) The case manager shall be a chemical dependency counselor or a licensed 
medical professional. 
   
  (3) When the client is participating in regular counseling, the primary 
counselor shall be the case manager. 
     
  (j) The client record shall contain regular documentation of the client's 
status, including: 
 
  (1) adequacy of dose; 
   
  (2) results of recent drug urine screens; 
   
  (3) physical status and use of prescription medication; 
   
  (4) employment/vocational needs; 
   
  (5) legal and social status; 
   
  (6) overall client stability; and 
   
  (7) other relevant information. 
     
  (k) All direct care staff shall demonstrate knowledge or receive training that 
includes: 
 
  (1) symptoms of opiate withdrawal; 
   
  (2) drug urine screens; 
   
  (3) current standards of pharmacotherapy; and 
   
  (4) poly-drug addiction. 
 
       
  sec.148.251. Meals in Outpatient Programs. 
 
  (a) Programs shall provide a meal break after five consecutive hours of 
scheduled activities. 
   
  (b) If the facility prepares meals in a centralized kitchen on site, it shall 
pass an annual kitchen health inspection as required by the Texas Food, Drug, 
and Cosmetics Act. 
 
     
  sec.148.252. Meals in Residential Programs. 
 
  (a) The program shall provide wholesome, well-balanced meals. 
   
  (b) The program shall provide modified diets to residents who medically 
require them as determined by a licensed medical professional. Special diets 
shall be prepared in consultation with a licensed dietitian. 
   
  (c) All food shall be selected, stored, prepared, and served in a safe, 
healthy manner. 
   
  (d)  The program shall provide at least three meals daily, with no more than 
14 hours between any two meals. 
   
  (e) A licensed dietitian shall approve menus and written guidelines for 
substitutions in advance; or 
 
  (1)  approve a meal planning manual with sample menus and guidelines for 
substitutions; 
   
  (2) approve menus prepared by new staff before they plan meals independently; 
   
  (3) review a sample of menus served at least annually; and 
   
  (4) provide staff training as needed. 
 
       
  sec.148.253. Meals Prepared by Clients. 
 
  (a) Staff shall provide training and supervision needed to ensure compliance 
with the rules in sec.148.252 of this title (relating to Meals in Residential 
Programs). 
   
  (b)  The program shall define duties in writing and have written instructions 
posted or easily accessible to clients. 
   
  (c) If menu planning and independent meal preparation is part of the clients' 
treatment program, a licensed dietitian shall: 
 
  (1) approve the client training curriculum; and 
   
  (2) provide training or approve a training program for staff who instruct and 
supervise clients in meal preparation. 
 
       
  sec.148.254. Meals Provided by a Food Service.  When meals are provided by a 
food service, a written contract shall require the food service to: 
 
  (1) comply with the rules in sec.148.252 of this title (relating to Meals in 
Residential Programs); and 
   
  (2) pass an annual kitchen health inspection as required by the Texas Food, 
Drug, and Cosmetics Act. 
 
     
  sec.148.261. General Provisions for Medication. 
 
  (a) The facility shall adopt a written policy and procedures describing the 
handling and use of medication. 
   
  (b) If the facility has a licensed pharmacy on site, procedures approved by 
the licensed pharmacist may be substituted for those specified by these rules. 
   
  (c) Medication shall be used only for therapeutic and medical purposes and 
shall not be administered in excessive doses. 
 
     
  sec.148.262. Medication Storage. 
 
  (a) Medications, syringes, and needles shall be accessible only to staff who 
are authorized to provide medication. 
   
  (b) The program shall keep all prescription and non-prescription medications, 
syringes, and needles in locked storage. Used needles and syringes shall be 
placed in rigid, puncture-proof containers. 
   
  (c) The program shall store all medications, syringes, and needles in their 
original containers in a neat and orderly fashion. 
   
  (d) The program shall store all medication under appropriate conditions. Drugs 
requiring refrigeration shall be stored in a locked compartment separate from 
food items. 
   
  (e) Clients may not keep prescription or non-prescription medication in their 
personal possession on site without a physician's specific authorization. Staff 
shall ensure that authorized clients keep medication on their persons or safely 
stored. 
   
  (f) The facility shall ensure that stock prescription medications are stored 
in a licensed pharmacy or physician's office and dispensed by a pharmacist or 
physician as required by the Texas Pharmacy Act. 
 
     
  sec.148.263. Medication Inventory. 
 
  (a) The program shall use an effective system to track and account for all 
prescription medication. 
   
  (b) Staff shall inventory and inspect all stored medication at least monthly. 
   
  (c) The inventory system shall include centralized documentation of the 
following information about each container of prescription medication: 
 
  (1) date the medication entered the facility; 
   
  (2) initial amount of medication; 
   
  (3) amount administered to the client as recorded on the client administration 
record; 
   
  (4)  amount present at each inventory; 
   
  (5) amount present at disposition; and 
   
  (6) monthly reconciliation between the administration record and the 
inventory. 
     
  (d) The staff member conducting the inventory shall sign and date the 
inventory sheet. 
 
     
  sec.148.264. Disposing of Medication. 
 
  (a) Staff shall separate the following medication immediately and dispose of 
it within 30 days: 
 
  (1) medication past the expiration date; 
   
  (2) medication remaining after the prescribed length of therapy; and 
   
  (3) medication prescribed for clients who have left the program. 
     
  (b) The facility shall dispose of medication safely. 
   
  (c) Two staff members shall witness and document disposal. 
 
     
  sec.148.265. Staff Qualifications and Training. The facility shall ensure that 
staff who handle or administer medication are properly credentialed and trained. 
 
  (1) Single doses of prescription medication shall be prepared and packaged by 
a licensed pharmacist or physician. 
   
  (2)  Prescription medication shall be administered by staff who are legally 
credentialed to administer medication. 
   
  (3) The program shall have a comprehensive drug reference manual easily 
accessible to staff. 
   
  (4)  Staff who supervise self-administration shall be trained as described in 
sec.148.114 of this title (relating to Special Training Requirements). 
 
     
  sec.148.266. Authorization for Medication. 
 
  (a) Staff shall not give prescription medication to a client without a 
physician's order or prescription. 
   
  (b) Each written order for medication shall include: 
 
  (1) the date prescribed; 
   
  (2) the name and dose of the medication; 
   
  (3) the frequency and route of administration; and 
   
  (4) the physician's signature. 
 
       
  sec.148.267. Administration of Prescription Medication. 
 
  (a)  Staff shall administer and discontinue medication exactly as ordered. 
   
  (b) Staff shall document each dose administered in the client's record. 
   
  (c) The medication administration record shall include: 
 
  (1)  the client's name; 
   
  (2) drug allergies (or the absence of known allergies); 
   
  (3) the name and dose of each medication; 
   
  (4)  the frequency and route of each medication; 
   
  (5) the date and time of each dose administered; and 
   
  (6) the signature of the staff person who administered or supervised each 
dose. 
     
  (d) When a client is absent for scheduled doses, staff shall take action to 
ensure that the client receives the medication as prescribed. 
   
  (e) When a medication error is identified or a client appears to have an 
adverse reaction to medication, staff shall: 
 
  (1) notify a physician; 
   
  (2) complete an incident report; and 
   
  (3) document the facts and the physician contact in the client record. 
 
       
  sec.148.268. Self-Administration of Medication. 
 
  (a) Clients may self-administer medication under the supervision of staff who 
are trained as described in sec.148.114 of this title (relating to Staff 
Training). 
   
  (b) Supervision is limited to: 
 
  (1) removing the container from storage; 
   
  (2) handing the container to the client; 
   
  (3)  observing the client take the medication; 
   
  (4) immediately reporting to a medical professional any unusual signs, 
symptoms, or actions; and 
   
  (5) returning the container to storage. 
         
  Issued in Austin, Texas, on August 17, 1995. 
 TRD-9510423 
  Thomas Mann, Jr. 
 General Counsel 
 Texas Commission on Alcohol and Drug Abuse 
    Effective date: August 21, 1995 
 Expiration date: December 19, 1995 
 For further information, please call: (512) 867-8720 
         
       
  Subchapter E. Treatment Process 
 
  40 TAC sec.sec.148.281-148.284, 148.291-148.293, 148.301-148.304, 148.321-
148.325 
 
  The Texas Commission on Alcohol and Drug Abuse adopts on an emergency basis 
new sec.sec.148.281-148.284, 148.291-148.293, 148.301-148.304, and 148. 321-
148.325, concerning the treatment process in licensed chemical dependency 
facilities. The new sections are being adopted to establish minimum criteria for 
the delivery of chemical dependency treatment. 
 The new sections are adopted on an emergency basis because the agency has been 
placed under conservatorship and is mandated to make immediate changes to its 
rules and operations. 
 The new sections are adopted under the Texas Health and Safety Code, Title 6, 
Chapter 464, which provides the Texas Commission on Alcohol and Drug Abuse with 
the authority to adopt rules and standards for licensure of chemical dependency 
treatment facilities. 
 
 
  sec.148.281. Admission. 
 
  (a) Each program shall have written admission criteria describing the 
observable and measurable symptoms, behavior, and conditions that qualify a 
person for admission. 
   
  (b) The criteria shall describe a client population appropriate for the 
program and specify the age group to be served. 
   
  (c) Every person admitted shall be chemically dependent or in need of 
detoxification. 
   
  (d) Individuals in need of detoxification shall be treated in a Level I 
program. 
 
     
  sec.148.282. Screening. 
 
  (a) Every client admitted to the program shall meet the admission criteria. 
 
  (1) In programs providing Level II, III, or IV treatment, screening shall be 
done by a chemical dependency counselor. Counselor interns shall consult with a 
qualified credentialed counselor who authorizes admission. 
   
  (2) In Level I programs, screening shall be done by a licensed medical 
professional. Non-physicians shall have at least one year of detoxification 
treatment experience. 
 
  (A) A chemical dependency counselor with one year of detoxification experience 
may do the screening with consultation from a licensed medical professional who 
authorizes the admission. 
   
  (B) In outpatient and supported living detoxification programs, a physician 
shall examine the client face-to-face and authorize the admission. 
     
  (3)  Clients shall be treated in the environment that best meets their needs. 
     
  (b) Justification for admission (based on the admission criteria) shall be 
signed by the individual authorizing admission and filed in the client record at 
admission. 
   
  (c) If an individual is not admitted, the program shall document the reason 
and refer the applicant to appropriate services. 
 
     
  sec.148.283. Intake and Consent to Treatment. 
 
  (a) Before admission, a trained staff member shall document: 
 
  (1) the reason for admission; and 
   
  (2) relevant information about the prospective client's financial resources 
and insurance benefits. 
     
  (b) The facility shall obtain written authorization from the consenter before 
providing any treatment or medication. Before admission, a trained staff member 
shall explain the following information to the prospective client and consenter 
in simple, non-technical terms: 
 
  (1) the specific condition to be treated; 
   
  (2) the program's services and treatment process; 
   
  (3) the expected benefits of the treatment; 
   
  (4) the probable health and mental health consequences of not consenting; 
   
  (5) the side effects and risks associated with the treatment; 
   
  (6) any generally accepted alternatives and whether an alternative might be 
appropriate; 
   
  (7) the estimated average daily charge, including an explanation of any 
services that may be billed separately; 
   
  (8) the qualifications of the staff who will provide the treatment; 
   
  (9) the name of the primary counselor; 
   
  (10) expectations for client participation; and 
   
  (11) the Client Bill of Rights as specified in sec.148.142 of this title 
(relating to Client Bill of Rights). 
     
  (c) All information shall be provided verbally and in writing. 
   
  (d) If possible, all information shall be provided in the consenter's primary 
language. 
   
  (e) The consent form shall be dated and signed by: 
 
  (1) the client; 
   
  (2) the consenter; and 
   
  (3) the staff person providing the information. 
     
  (f) The facility shall not use coercive or undue influence to obtain consent. 
   
  (g) The facility shall not knowingly misrepresent the amount of insurance 
coverage available or the amount and percentage of a charge for which the 
prospective client will be responsible. 
   
  (h) The consenter may revoke consent at any time and for any reason. 
   
  (i) The consenter has the right to refuse treatment or medication unless a 
physician treating the patient orders medication to prevent imminent serious 
physical harm to the client or to another individual. 
 
     
  sec.148.284. Client Orientation. 
 
  (a) The facility shall provide a complete orientation for clients and 
consenters within 24 hours. When appropriate the orientation should include 
family members and significant others identified by the client. 
   
  (b) The facility shall explain the information aloud in a way the client and 
consenter can understand. 
   
  (c)  The orientation shall include: 
 
  (1) Client Bill of Rights; 
   
  (2) client grievance procedure; 
   
  (3) program rules; 
   
  (4)  violations and other behavior that can lead to disciplinary action or 
discharge; 
   
  (5) any behavior management procedures used to enforce program rules; 
   
  (6) the program's philosophy and treatment objectives; 
   
  (7) opportunities for family or significant others involvement in the 
treatment program; and 
   
  (8) rules about visits, telephone calls, mail, and gifts, as applicable. 
     
  (d) If an emergency or the client's physical or mental condition prevents 
orientation within 24 hours, staff shall explain the circumstances in the client 
record and present the information as soon as possible. 
   
  (e) The client record shall contain documentation, signed and dated by the 
client, showing that the client understands and has received a copy of the 
Client Bill of Rights, the client grievance procedure, and the program rules. 
 
     
  sec.148.291. Stabilization History. 
 
  (a) The program shall obtain enough medical and psychosocial information about 
the client to provide a clear understanding of the client's present status. 
   
  (b) A chemical dependency counselor or licensed medical professional shall 
collect and document the following information: 
 
  (1) alcohol and other drug use, past and present; 
   
  (2) past psychiatric and chemical dependency treatment; 
   
  (3) significant medical history and current health status; 
   
  (4) current living situation; 
   
  (5) current employment situation; and 
   
  (6) current emotional state and behavioral functioning. 
     
  (c) The stabilization history shall be initiated within 24 hours of admission, 
and completed and filed in the client record within 72 hours. If an emergency or 
the client's physical condition prevents documentation within 24 hours, staff 
shall explain the circumstances in the client record and obtain the information 
as soon as possible. 
   
  (d) A complete medical history and physical examination shall be filed in the 
client record within 24 hours of admission. A medical history and physical 
examination completed during the 24 hours preceding admission may be substituted 
if it is approved by the program's physician, physician assistant, or advanced 
nurse practitioner. 
 
     
  sec.148.292. Stabilization Plan. 
 
  (a) A clinical staff person authorized by the program shall identify the 
client's short term needs (based on the stabilization history, the medical 
history, and the physical examination) and develop an appropriate stabilization 
plan. 
   
  (b) The stabilization plan shall be reviewed and signed by a physician or 
another licensed medical professional. Non-physicians shall have at least one 
year of stabilization experience. 
   
  (c) The client shall also sign the stabilization plan. 
   
  (d) The completed and signed stabilization plan shall be filed in the client 
record within 24 hours of admission. 
   
  (e)  The program shall revise the stabilization plan whenever the client's 
needs change significantly. 
 
     
  sec.148.293. Stabilization Notes. <ol> The program shall implement the 
stabilization plan and document the client's response. 
 
  (1)  Program staff shall document services provided to the client. This may be 
done by filing a copy of the program schedule in the client record and 
documenting the client's level of participation. 
   
  (2) Staff shall record timed and dated stabilization observation notes during 
each shift. These notes shall include: 
 
  (A) the client's physical condition, including vital signs; 
   
  (B) the client's mood and behavior; 
   
  (C)   client statements about the client's condition and needs; and 
   
  (D)  information about the client's progress or lack of progress in relation 
to treatment goals. 
     
  (3) Additional notes shall be documented as needed. 
 
     
  sec.148.301. Psychosocial History. 
 
  (a) A counselor shall document a psychosocial history that provides a thorough 
understanding of the client's history and present status, including: 
 
  (1) circumstances leading to admission; 
   
  (2) alcohol and other drug use, past and present; 
   
  (3) past psychiatric and chemical dependency treatment; 
   
  (4) significant medical history and current health status; 
   
  (5)  family and social history; 
   
  (6) current living situation; 
   
  (7)  relationships with family of origin, nuclear family, and significant 
others; 
   
  (8) education and vocational training; 
   
  (9)  employment history (including military) and current status; 
   
  (10)  legal history and current legal status; 
   
  (11) emotional state and behavioral functioning, past and present; and 
   
  (12) strengths, weaknesses, and needs. 
     
  (b) The program may use a client questionnaire to gather some of the 
information needed for the psychosocial evaluation, but a counselor shall review 
and discuss the questionnaire with the client and document the discussion, 
including additional information needed to provide a clear and comprehensive 
psychosocial history. 
   
  (c) Programs may use a psychosocial history from an outside source if: 
 
  (1) it meets the commission's criteria; 
   
  (2) it was completed during the six months preceding admission; and 
   
  (3) a counselor reviews the information with the client and documents an 
update. 
     
  (d) A qualified credentialed counselor shall review and sign the psychosocial 
history and/or any updates. 
   
  (e) For residential clients, a completed medical history and physical 
examination shall be filed in the client record within 96 hours of admission. 
 
  (1) The facility may use a medical history and physical examination completed 
up to 30 days before admission or received from the referring facility if a 
physician, physician assistant, advanced nurse practitioner, or registered nurse 
reviews the information with the client and documents an update within 96 hours 
of admission. 
   
  (2) When the update reflects a significant change in the client's status, the 
client shall receive further evaluation from a physician. 
 
       
  sec.148.302. Treatment Plan. 
 
  (a) A counselor shall develop a written list of the client's problems and 
needs based on the psychosocial history. 
   
  (b) The counselor and client shall work together to develop a written 
treatment plan that addresses identified problems and needs. When possible and 
appropriate, family members and significant others should also participate. 
   
  (c) The program shall involve the client's family or an alternate support 
system in the treatment process or document why this is not happening. 
   
  (d) Goals shall clearly state in behavioral terms what the client is expected 
to achieve during treatment. 
   
  (e) The treatment plan shall list the services and other strategies the 
program will provide to help the client achieve the goals. 
   
  (f) The treatment plan shall identify the client's primary counselor, and 
shall be dated and signed by the client and the counselor. 
   
  (g) A qualified credentialed counselor shall review and sign the treatment 
plan. 
 
     
  sec.148.303. Progress Notes. 
 
  (a) The program shall implement the treatment plan. 
   
  (b) Program staff shall document services provided to the client. This may be 
done by filing a copy of the program schedule in the client record and 
documenting the client's level of participation in the progress notes. 
   
  (c) Counselors shall write a progress note at least weekly when services are 
provided. 
   
  (d) Weekly notes shall describe the client's progress toward stated treatment 
plan goals and other significant information. 
 
     
  sec.148.304. Treatment Plan Reviews. 
 
  (a) The primary counselor shall meet with the client to review the treatment 
plan at appropriate intervals. 
   
  (b) The treatment plan review shall include: 
 
  (1) an evaluation of the client's progress toward each goal; 
   
  (2)  revision of the goals as needed; and 
   
  (3) an assessment of the continued appropriateness of the current treatment 
level. 
     
  (c) All reviews and revised treatment plans shall be dated and signed by the 
client and the counselor. If the counselor is a counselor intern, the document 
shall be reviewed and signed by a qualified credentialed counselor. 
 
     
  sec.148.321. Discharge Criteria. <ol> Each program shall develop and follow 
appropriate, written criteria to decide when clients will be discharged or 
transferred to another level within the facility. The criteria shall describe: 
 
  (1) indicators used to determine satisfactory completion of the level; 
   
  (2) circumstances under which clients may be referred or transferred to 
another level or facility; and 
   
  (3) circumstances under which clients may be discharged before completing the 
program. 
 
     
  sec.148.322. Discharge Plan. 
 
  (a) The program shall plan all discharges with clients and consenters to 
provide reasonable protection and continuity of services to the client. 
   
  (b) The program shall involve the client's family or an alternate support 
system in the discharge planning process or document why this is not happening. 
   
  (c) Discharge planning shall occur before the client's scheduled discharge. 
   
  (d) A written discharge plan shall be developed to address ongoing client 
needs, including: 
 
  (1) individual goals or activities to sustain recovery; 
   
  (2)  referrals; and 
   
  (3) aftercare services, if applicable. 
     
  (e)  The client and consenter shall sign the discharge plan. 
   
  (f) The program shall give the client and consenter a copy of the plan, and 
then file the signed plan in the client record. 
 
     
  sec.148.323. Discharge Summary. 
 
  (a) The program shall complete a discharge summary for each client, including: 
 
  (1) needs and problems identified at the time of admission; 
   
  (2) services provided; 
   
  (3) assessment of the client's progress towards goals; and 
   
  (4) circumstances of discharge. 
     
  (b) Staff shall complete the discharge summary within 30 days of discharge. 
 
     
  sec.148.324. Discharge Follow-Up. <ol> The facility shall contact each client 
after discharge and then document the individual's current status or the reason 
the contact was unsuccessful. 
 
   
  sec.148.325. Request for Discharge. 
 
  (a) The facility shall not hold a voluntary client against the consenter's 
will. 
   
  (b) The facility shall have written procedures for handling discharges and 
discharge requests that comply with applicable statutes. 
   
  (c) The facility shall comply with the provisions of Texas Health and Safety 
Code, Title 2, Subtitle H, Chapter 164 and shall not try to keep a client in 
treatment by coercion, intimidation, or misrepresentation. 
   
  (d) The facility shall not say or do anything to influence the client's 
decision that is not justified by the client's condition. 
   
  (e) When a client or consenter requests discharge, the facility shall release 
the client within 96 hours, unless: 
 
  (1)  The client or consenter files a written withdrawal of the request; 
   
  (2) An application for court-ordered treatment or emergency detention is filed 
and the patient is detained; or 
   
  (3) The client is a minor admitted with the consent of a parent, guardian, or 
conservator and that person, after consulting with facility personnel, objects 
in writing to the release of the client. 
         
  Issued in Austin, Texas, on August 17, 1995. 
 TRD-9510425 
  Thomas Mann, Jr. 
 General Counsel 
 Texas Commission on Alcohol and Drug Abuse 
    Effective date: August 21, 1995 
 Expiration date: December 19, 1995 
 For further information, please call: (817) 867-8720 
         
         Chapter 150. Counselor Licensure 
  
  40 TAC sec.sec.150.1-150.10, 150.31-150.38, 150.51-150.54, 150.61 
 
  The Texas Commission on Alcohol and Drug Abuse adopts on an emergency basis 
new sec.sec.150.1-10, 150.31-150.38, 150.51-150.54, and 150.61, concerning 
licensure requirements for chemical dependency counselors. The new sections are 
being adopted to establish definitions; set requirements and exemptions for 
licensure; describe procedures for licensure application; set licensure fees; 
establish minimum requirements for licensure, including background 
investigations, interns, criminal justice peer interns, examination, renewal, 
and reciprocity; describe sanctions for violations; and set standards for 
counselor ethics. 
 The new sections are adopted on an emergency basis because the agency has been 
placed under conservatorship and is mandated to make immediate changes to its 
rules and operations. 
 The new sections are adopted under the Texas Civil Statutes, Article 4512o, 
which provides the Texas Commission on Alcohol and Drug Abuse with the authority 
to establish a procedure for the licensure of chemical dependency counselors. 
 
 
  sec.150.1. Authority.  The commission is given authority under Texas Civil 
Statutes, Article 4512o, to adopt and enforce rules for the licensure of 
chemical dependency counselors. 
 
   
  sec.150.2. Application of the Rules. 
 
  (a) The commission's interpretation of these rules shall be binding on all 
applicants, counselor interns (CIs), criminal justice peer interns (CJPIs), and 
licensed chemical dependency counselors (LCDCs). 
   
  (b) Information, opinions, and advice provided by commission staff shall not 
be considered binding on the commissioners if the matter requires action by the 
commissioners. 
   
  (c)  Commission activity does not set precedent. Every situation will be 
considered on its own merit. 
 
     
  sec.150.3. Definitions.  The following words and terms, when used in this 
chapter, shall have the following meanings, unless the context clearly indicates 
otherwise. 
   
   Applicant-A person who has submitted an application for licensure and paid 
the application fee. 
   
   Approved practicum providers-An individual or legal entity approved by the 
commission to supervise practicums. 
   
   Chemical dependency counseling-Assisting an individual or group to develop an 
understanding of chemical dependency problems, define goals, and plan action 
reflecting the individual's or group's interest, abilities, and needs as 
affected by claimed or indicated chemical dependency problems. 
   
   Commission (TCADA) -The Texas Commission on Alcohol and Drug Abuse. 
   
   Client-A person who receives counseling or treatment services from a licensed 
chemical dependency counselor or intern, or from an organization where the 
counselor or intern is working on a paid or voluntary basis. A client's status 
continues for two years after services end. 
   
   Continuing education hour-At least 50 minutes of participation in an 
organized, systematic learning experience which deals with and is designed for 
the acquisition of knowledge, skills, and information. Continuing education 
shall be related or specific to chemical dependency counseling. 
   
   Continuum of care-All activities beginning with entry into a Substance Abuse 
Felony Punishment Facility (SAFPF) or In-prison Therapeutic Community (ITC), and 
continuing after release to Phase, I, II, and III transition treatment. 
   
   Counselor intern (CI)-A person pursuing a course of study in chemical 
dependency counseling and authorized by the commission to provide chemical 
dependency counseling under clinical supervision of a qualified credentialed 
counselor (QCC). 
   
   Criminal justice peer intern (CJPI)-A person who has graduated from a 
treatment program based on the therapeutic community model, is pursuing a course 
of study in chemical dependency counseling, and is working in the Texas Criminal 
Justice Chemical Dependency Treatment Initiative. 
   
   Direct supervision -Oversight and direction provided by a qualified 
credentialed counselor who is either employed by the same entity as the intern, 
or who has a written agreement with the intern to provide supervision. The 
qualified credentialed counselor shall: 
 
  (A) assume responsibility for the actions of the counselor intern within the 
scope of internship counseling duties; 
   
  (B) be on site for assistance; 
   
  (C)  conduct a complete review of the counselor intern's written work product 
at least weekly; 
   
  (D) observe the intern in a counseling (group/individual) setting at least 
weekly; and 
   
  (E) meet with the intern at least weekly to provide written and verbal 
feedback and direction. 
     
   Intern-A counselor intern or criminal justice peer intern approved by the 
commission. 
   
   Licensed chemical dependency counselor (LCDC)-A person who: 
 
  (A) renders, for compensation, chemical dependency counseling or chemical 
dependency counseling-related services to an individual, group, organization, 
corporation, institution, or the general public; 
   
  (B)  implies that the person is licensed, trained, or experienced in chemical 
dependency counseling; and 
   
  (C) holds a license under this chapter to offer or provide chemical dependency 
counseling. 
     
   Licensee-An individual who has been granted a license to practice chemical 
dependency counseling by the Texas Commission on Alcohol and Drug Abuse and 
whose license is active and not under suspension. 
   
   Phase III supervised recovery-The period following Phase II non-residential 
transitional treatment, during which the offender discontinues formal contact 
with the transition team and accepts increasing responsibility for recovery. An 
intensive supervision probation officer or a parole officer provides supervision 
of the therapeutic community graduate in Phase III until the terms of probation 
or parole are completed. 
   
   Probation-A period of time during which an intern or licensed chemical 
dependency counselor shall abide by special conditions established by the 
commission. 
   
   Qualified credentialed counselor (QCC)-An individual who is licensed by the 
state as a chemical dependency counselor (LCDC), professional counselor (LPC), 
master social worker (LMSW), marriage and family therapist (LMFT), psychologist, 
or physician, or who is a certified addictions registered nurse (CARN). LPCs, 
LMSWs, LMFTs, CARNs, psychologists, and physicians shall have proof available 
upon request of two years of chemical dependency counseling experience. 
   
   Related education hours-Coursework in psychology, upper division sociology, 
counseling, mental health, behavioral science, psychiatric nursing, 
pharmacology, ethics, and rehabilitation counseling. 
   
   Sexual exploitation -A pattern, practice, or scheme of conduct by a person 
regulated under this Act that may include sexual contact, that can reasonably be 
construed as being for the purpose of sexual arousal or gratification or sexual 
abuse of any person. It is not a defense to sexual exploitation of a client or 
former client if it occurs: 
 
  (A) with consent of the client or former client; 
   
  (B) outside of therapy or treatment; 
   
  (C) off the premises used for therapy or treatment; and 
   
  (D) within a two-year period following termination of treatment. 
     
   Specific education hours to alcohol and drug (A&D) -Courses that deal 
directly with substances that alter the mind and/or moods, or counseling to deal 
with dependency or addiction to any of these substances. 
   
   Supervised work experience-Documented, verifiable, work experience performed 
within the 12 core functions of chemical dependency counseling under the direct 
supervision of a qualified credentialed counselor. Supervised work experience 
may be paid or voluntary. 
   
   Therapeutic community -A treatment model in which the client population 
functions as a separate community that is highly structured and ritualized, and 
designed to habilitate or rehabilitate its residents based on predetermined 
goals. 
   
   12 core functions -Screening, intake, orientation, assessment, treatment 
planning, counseling (individual, group, and significant others), case 
management, crisis intervention, client education, referral, report and record 
keeping, and consultation. 
 
   
  sec.150.4. Exemptions. 
 
  (a) This chapter does not apply to the following people when they are acting 
within the scope of their authorized duties: 
 
  (1) counselors employed by federal institutions; 
   
  (2)  licensed health care professionals; 
   
  (3) individuals certified by the Texas Department of Criminal justice; 
   
  (4) school counselors certified by the Texas Education Agency; 
   
  (5) licensed psychologists, licensed professional counselors, licensed master 
social workers; 
   
  (6)  religious leaders of congregations; and 
   
  (7) counselor interns who are designated by the commission and working under 
the supervision of a qualified credentialed counselor. 
     
  (b) Residents of other states are exempt if: 
 
  (1) they are legally authorized to provide chemical dependency counseling in 
those states; and 
   
  (2) they do not offer or provide chemical dependency counseling in Texas for 
more than 30 days in any 12-month period. 
     
  (c) A person who qualifies for an exemption but chooses to get a license from 
the commission is subject to the same rules and sanctions as other licensees. 
 
     
  sec.150.5. License Required. <ol> An individual identified to the public as a 
chemical dependency counselor must be licensed or exempt under this chapter. 
Individuals who are not licensed chemical dependency counselors shall not: 
 
  (1) offer or provide chemical dependency counseling; 
   
  (2) perform chemical dependency assessments or interventions; 
   
  (3)  represent themselves as chemical dependency counselors; or 
   
  (4)  use any name, title or designation that implies licensure under this 
chapter. 
 
     
  sec.150.6. Scope of Practice. A licensed chemical dependency counselor is 
licensed to provide chemical dependency services involving the application of 
the principles, methods, and procedures of the chemical dependency profession as 
defined by the profession's ethical standards and the twelve core functions. The 
license does not qualify an individual to provide services outside this scope of 
practice. 
 
   
  sec.150.7. Discrimination Prohibited. 
 
  (a) The commission shall not discriminate against any person because of sex, 
race, religion, age, national origin, or disability. 
   
  (b) A disabled applicant may request special accommodations by completing a 
form supplied by the commission. The commission will make every effort to 
accommodate special needs without violating its laws and rules. 
 
     
  sec.150.8. Consumer Information. 
 
  (a) Upon request, the commission will provide information describing its 
regulatory function and procedures used for filing and resolving complaints. 
   
  (b) Licensed chemical dependency counselors shall keep a public notice 
prominently displayed in their place of business which includes: 
 
  (1) the name, mailing address, and telephone number of the commission; and 
   
  (2) a statement telling consumers that a complaint against a licensed chemical 
dependency counselor may be filed with the commission. 
 
       
  sec.150.9. Official Roster. 
 
  (a) A person's name and address will not appear in any roster produced by the 
commission unless the person is in good standing when the list is compiled. 
   
  (b) Licensed chemical dependency counselors and counselor interns shall notify 
the commission in writing within 14 days of a change in address. 
 
     
  sec.150.10. Fees. 
 
  (a) Through December 31, 1995, the schedule for licensure fees is: 
 
  (1) initial application fee-$25; 
   
  (2)  initial licensure fee-$50; 
   
  (3) licensure examination fee-$175; 
   
  (4) renewal fee: 
 
  (A) renewal application fee-$25; 
   
  (B) license renewal fee-$50; 
     
  (5) late renewal penalty: 
 
  (A) when renewed 1-90 days after expiration-$87; 
   
  (B) when renewed more than 90 days but less than two years after expiration-
$175; 
     
  (6) inactive status fee-$75; 
   
  (7) certificate replacement fee-$10. 
     
  (b) Effective January 1, 1996, the schedule for licensure fees shall be: 
 
  (1) initial application fee-$25; 
   
  (2)  initial licensure fee-$50; 
   
  (3) licensure examination fee-$275; 
   
  (4) renewal fee: 
 
  (A) renewal application fee-$25; 
   
  (B) license renewal fee-$75; 
     
  (5) late renewal penalty: 
 
  (A) when renewed 1-90 days after expiration-$138; 
   
  (B) when renewed more than 90 days but less than two years after expiration-
$275; 
     
  (6) inactive status fee-$75; 
   
  (7) certificate replacement fee-$25. 
     
  (c) The commission shall charge a fee for any documentation request: 
 
  (1) list of licensed counselors (or mailing labels), the greater of: 
 
  (A) $25 per order plus $5.00 handling fee; or 
   
  (B) $.01 per name plus $5.00 handling fee. 
     
  (2) standard size paper copy (documents over 50 pages), per page-$.10; 
   
  (3) local fax, per page-$.10; 
   
  (4) long distance fax (same area code), per page-$.50; 
   
  (5) long distance fax (different area code), per page -$1.00. 
     
  (d) Licensure fees are not refundable. 
   
  (e)  Fees shall be paid in full with cashier's checks or money orders. 
 
     
  sec.150.31. Licensure Application. 
 
  (a) A person who wants to be licensed shall submit the application fee and a 
complete licensure application. The application shall: 
 
  (1) be submitted on the form currently provided by the commission; 
   
  (2) include a recent full face wallet size photograph of the applicant; and 
   
  (3) be signed, dated, and notarized. 
     
  (b) An applicant shall: 
 
  (1) disclose and provide complete information on all misdemeanor and felony 
convictions; 
   
  (2) read the Texas Civil Statutes, Article 4512o, and commission rules (40 
TAC, Chapter 150); 
   
  (3) follow all laws and rules, including the ethical standards; and 
   
  (4) allow the commission to seek any additional information or references it 
finds necessary. 
 
       
  sec.150.32. Requirements for Licensure. To be eligible for a license under 
this chapter, a person shall: 
 
  (1) be at least 18 years of age; 
   
  (2) have a high school diploma or its equivalent; 
   
  (3)  successfully complete 270 classroom hours of approved curricula; 
 
  (A)  at least 135 hours shall be chemical dependency specific education. 
   
  (B) the remaining hours shall be related education; 
     
  (4)  complete 4,000 hours of approved supervised experience working with 
chemically dependent persons; 
   
  (5) complete 300 hours of approved supervised field work practicum, which 
shall be documented on a form provided by the commission; 
   
  (6) submit two letters of reference from licensed chemical dependency 
counselors; 
   
  (7) submit a written case presentation to the commission; 
   
  (8) pass an oral chemical dependency counselor examination approved by the 
commission; 
   
  (9) pass the written chemical dependency counselor examination approved by the 
commission; 
   
  (10) be worthy of the public trust and confidence, as determined by the 
commission; 
   
  (11) sign a written agreement to abide by the standards of ethics contained in 
sec.150.61 of this title (relating to Ethical Standards). 
 
     
  sec.150.33. Background Investigation. 
 
  (a) The commission will conduct a background investigation on every applicant 
for internship and licensure. Checks are conducted when: 
 
  (1) an individual submits the initial application for internship or licensure; 
   
  (2) a counselor intern becomes eligible for licensure; 
   
  (3) a licensed chemical dependency counselor applies for license renewal; and 
   
  (4) any time the commission deems it necessary. 
     
  (b) The commission will obtain a criminal history report from the Department 
of Public Safety (DPS). If authorized by statute, the commission will also 
obtain a criminal history report from the Federal Bureau of Investigations. 
   
  (c) The individual shall disclose and provide complete information regarding 
all misdemeanor and felony convictions. Failure to make full and accurate 
disclosure will be grounds for immediate denial of the application, disciplinary 
action, or revocation of the license or intern designation. 
   
  (d) The commission shall evaluate the present fitness of any individual who 
has a record of misdemeanor or felony convictions to provide chemical dependency 
counseling. 
   
  (e) Factors considered by the commission in determining the present fitness of 
a person who has been convicted of a crime include: 
 
  (1)  the number and nature of criminal conviction(s); 
   
  (2) the age at the time each crime was committed; 
   
  (3) the amount of time since last conviction; 
   
  (4) the conduct and work history of the person before and after the criminal 
conviction(s); 
   
  (5) evidence of the person's rehabilitation efforts and outcome; 
   
  (6) two letters of recommendation from qualified credentialed counselors; and 
   
  (7) other evidence of fitness that may be relevant. 
     
  (f) Members of the commission's governing board, or a subcommittee established 
by the board, shall review cases involving one or more of the following 
convictions: 
 
  (1) murder, including but not limited to attempted murder, vehicular 
manslaughter, involuntary manslaughter, and homicide; 
   
  (2) sexual assault, including but not limited to attempted sexual assault, 
rape, sodomy, indecency with a child, molestation, sexual assault of a child, 
and indecent exposure; 
   
  (3)  kidnapping, attempted kidnapping, or a related conviction. 
     
  (g)  All other cases will be processed by the Counselor Licensure Department 
according to the following criteria. An individual's category shall be 
determined by the most serious offense as defined by law. 
 
  (1)  Category I: Felonies or misdemeanors that may result in harm to others. 
An individual with a Category I conviction shall have at least ten years from 
the date of the last felony or misdemeanor conviction in order to be eligible 
for licensure. 
   
  (2) Category II: Felonies which do not result in harm to others. An individual 
with a Category II conviction shall have at least seven years from the date of 
the last felony or misdemeanor conviction in order to be eligible for licensure. 
   
  (3) Category III: Misdemeanors which do not result in harm to others. An 
individual with a Category III conviction shall have at least five years from 
the date of the last felony or misdemeanor conviction in order to be eligible 
for licensure. 
     
  (h) If an individual with a history of criminal convictions has met the 
eligibility criteria specified in subsection (g) of this section, the commission 
may: 
 
  (1) deny an application (initial or renewal); 
   
  (2) place conditions on a counselor intern or licensed chemical dependency 
counselor (if all other requirements are met); or 
   
  (3) grant unconditional approval for counselor intern or licensed chemical 
dependency counselor (if all other requirements are met). 
     
  (i) The commission will continue an individual's probation unless: 
 
  (1) the individual has met all conditions of probation and submitted all 
required documents during the month they were due; 
   
  (2) the individual committed no legal violations while on probation; 
   
  (3) there are no pending complaints or investigative finding; and 
   
  (4) the individual meets the screening criteria listed in subsection (g) of 
this section. 
     
  (j) An individual who does not accept the commission's decision may request a 
hearing under the procedures established in the 40 TAC, Chapter 142. 
 
     
  sec.150.34. Counselor Intern. 
 
  (a) A person preparing for licensure shall be designated as a counselor intern 
by the commission. 
   
  (b) To be approved as a counselor intern, an applicant shall: 
 
  (1)  complete the 270 hours of approved curricula, including at least 135 
classroom hours specific to chemical dependency counseling and up to 135 hours 
of related classroom hours; 
   
  (2) apply for internship or licensure and pay the application fee; 
   
  (3) pass the background investigation; and 
   
  (4) submit two letters of reference from qualified credentialed counselors. If 
these letters are not written by licensed chemical dependency counselors, the 
intern shall submit two additional letters of reference from licensed chemical 
dependency counselors before taking the licensure examination. 
     
  (c) A counselor intern performs chemical dependency counseling activities and 
services as part of a supervised course of study, and shall work under the 
direct supervision of a qualified credentialed counselor. 
 
  (1) One qualified credentialed counselor shall not supervise more than five 
interns. 
   
  (2) Qualified credentialed counselors shall provide adequate and appropriate 
direct supervision. 
     
  (d)  A counselor intern has four years to satisfy the requirements to be 
licensed. After four years, the individual shall repeat the practicum and accrue 
a full 4,000 hours of supervised work experience; hours accumulated during the 
initial four-year internship are lost. An intern who gives up intern status 
before the four year period expires shall also start over on the practicum and 
work experience. 
   
  (e) An applicant shall be designated as a counselor intern before 
participating in a practicum to meet licensure requirements, with one exception. 
Students enrolled in an accredited university, college, junior college, or 
community college may complete the practicum before being designated as a 
counselor intern if the practicum is: 
 
  (1) part of the assigned curriculum; and 
   
  (2) performed under the auspices of the educational institution. 
     
  (f) All practicums shall be performed under the supervision of an approved, 
current, practicum provider designated by the commission. 
   
  (g) The commission will not accept a practicum without documentation from the 
practicum provider that shows the student successfully completed all 300 hours. 
   
  (h) A counselor intern shall not advertise or represent the designation to the 
public. 
 
     
  sec.150.35. Criminal Justice Peer Intern. 
 
  (a) To be designated as a criminal justice peer intern (CJPI), an individual 
shall: 
 
  (1) complete a chemical dependency treatment program that uses the therapeutic 
community model; 
   
  (2) complete treatment requirements of the continuum of care; 
   
  (3) transfer successfully to Phase III supervised recovery; 
   
  (4) maintain 12 months of continued abstinence from mind altering substances; 
   
  (5) complete 135 approved classroom hours specific to chemical dependency; and 
   
  (6) submit an application to the commission; 
   
  (7) pay the application fee; and 
   
  (8)  submit two letters of reference from licensed chemical dependency 
counselors. 
     
  (b) A criminal justice peer intern shall complete a course of study which 
leads to counselor intern status within two years. The criminal justice peer 
intern approval and the related exemption expire after two years if the criminal 
justice peer intern has not achieved counselor intern status. 
   
  (c) The criminal justice peer intern shall not practice outside of the Texas 
Criminal Justice Chemical Dependency Treatment Initiative. 
   
  (d) All criminal justice peer interns shall work under the direct supervision 
of a licensed chemical dependency counselor. A licensed chemical dependency 
counselor may not supervise more than five criminal justice peer interns. 
   
  (e) The commission will immediately revoke the criminal justice peer intern 
designation when the individual stops working in the state criminal justice 
system. 
   
  (f) Voluntary work experience will be counted toward the 4,000 hours of work 
experience required for licensure, but paid work will not. 
   
  (g) A criminal justice peer intern will not automatically transition to 
counselor intern status after two years. A criminal justice peer intern shall: 
 
  (1) submit an application for counselor intern; and 
   
  (2) satisfy background investigation requirements; 
   
  (3) complete the 270 hours of education; and 
   
  (4)  submit the required reference letters. 
 
       
  sec.150.36. Examination. 
 
  (a) The written and oral chemical dependency counselor examination will be 
offered twice a year. 
   
  (b) To be eligible for the examination, a counselor intern shall: 
 
  (1)  complete the approved 300 hour practicum; 
   
  (2) complete the 4,000 hours of supervised work experience; 
   
  (3) have two letters of reference from licensed chemical dependency counselors 
on file; 
   
  (4)  submit a written case study to the commission; 
   
  (5) send the commission a letter of intent to test before the deadline; and 
   
  (6)  pay the examination fee before the deadline. 
     
  (c) The commission shall send examinees their test results within 30 days of 
the examination date. 
   
  (d) If requested by someone who fails the oral examination, the commission 
will provide a written analysis of the person's performance on the oral 
examination. 
   
  (e) An applicant shall not take the examination more than three times. 
 
     
  sec.150.37. Issuing Licenses. 
 
  (a) After passing the examination, an applicant shall pay the licensure fee 
and pass a background investigation. 
   
  (b) If the applicant has met all requirements for licensure, the commission 
will issue the license. 
   
  (c) The licensee shall return the license if it is suspended or revoked. 
   
  (d) Licenses may not be duplicated to provide a counselor with a second copy 
of the license. 
   
  (e) The commission will replace a lost or damaged certificate if the licensee 
provides: 
 
  (1) the remnants of the original license (if damaged); 
   
  (2) the original license and copy of legal documents for a name change; 
   
  (3) the original license (for printing error); or 
   
  (4) a notarized statement if the license has been lost, stolen, or totally 
destroyed. 
     
  (f) A license replaced because of a printing error or mail damage will be 
replaced without cost, but all other license replacements require a fee, as 
specified in sec.150.10 of this title (relating to Fees). The fee shall be paid 
in advance with a money order or cashier's check. 
 
     
  sec.150.38. License Expiration and Renewal. 
 
  (a) A license issued under this chapter is valid for two years, or until the 
expiration date printed on the license. 
   
  (b) To renew a license, the counselor shall: 
 
  (1) send a renewal application to the commission; 
   
  (2) pay the renewal application and license fees; and 
   
  (3) complete at least 60 hours of continuing education approved by the 
commission during the two-year licensure period. This shall include 45 hours of 
education related to chemical dependency and at least three hours in each of the 
following areas: 
 
  (A)  ethics; 
   
  (B) HIV education; 
   
  (C) cultural awareness and sensitivity; 
   
  (D) compulsive gambling; and 
   
  (E) sexual abuse. 
     
  (4) demonstrate to the commission that the applicant is worthy of the public 
trust and confidence. 
     
  (c) Until the commission prepares or approves continuing education programs 
for licensed chemical dependency counselors, the commission will approve all 
continuing education hours on a case-by-case basis. 
   
  (d) Renewal fees are due on or before the expiration date. A licensee who 
submits a late renewal application shall pay a penalty fee in addition to the 
renewal application and licensure fees. 
 
  (1) If the license is renewed within 90 days of the expiration date, the 
penalty fee is equal to one-half the current examination fee. 
   
  (2)  If the license is renewed after 90 days, but within two years from the 
expiration date, the penalty fee is equal to the current examination fee. 
     
  (e) A license cannot be renewed after two years. To obtain a new license, the 
person shall comply with all requirements and procedures for obtaining an 
initial license. This includes obtaining an additional 4,000 hours of supervised 
work experience. 
   
  (f) A license ceases to be valid on the expiration date, unless the person has 
met all requirements before that date and is waiting to receive a renewal 
license. When the licensee receives the renewal license, the previous license is 
no longer valid. 
 
     
  sec.150.51. Civil Penalty Enforcement. 
 
  (a) A person who violates the Texas Civil Statutes, Article 4512o, or a rule 
in this chapter is subject to a civil penalty of not less than $50 nor more than 
$500 for each day of violation. 
   
  (b) If a person has violated, is violating, or is threatening to violate the 
Texas Civil Statutes, Article 4512o, or these rules, the commission may bring a 
civil action in a district court for injunctive relief to restrain the 
violation. 
 
     
  sec.150.52. Reciprocity. 
 
  (a) The commission may issue a license based on reciprocity if the individual: 
 
  (1) submits an application and pays the application and licensure fees; 
   
  (2) is at least 18 years of age; 
   
  (3) passes the background investigation; and 
   
  (4) is currently licensed or certified by another state as a chemical 
dependency counselor (or its equivalent). 
     
  (b) The commission will not issue a license based on reciprocity unless it 
finds that the licensing or certification standards of the state of origin are 
at least substantially equivalent to the requirements of this chapter, including 
practices and requirements in: 
 
  (1) scope of practice; 
   
  (2) education and experience; 
   
  (3) examination; 
   
  (4) continuing education; 
   
  (5) ethics; and 
   
  (6) enforcement. 
 
       
  sec.150.53. Sanctions. 
 
  (a) The commission may impose sanctions on a licensee or intern for: 
 
  (1) violating or assisting another to violate the Texas Civil Statutes, 
Article 4512o, or these rules; 
   
  (2) circumventing or attempting to circumvent the Texas Civil Statutes, 
Article 4512o, or these rules; 
   
  (3) participating, directly or indirectly, in a plan to evade the Texas Civil 
Statutes, Article 4512o, or these rules; 
   
  (4) engaging in false, misleading, or deceptive conduct as defined by Business 
and Commerce Code, sec.17.46; 
   
  (5) engaging in conduct that discredits or tends to discredit the profession 
of chemical dependency counseling; 
   
  (6) revealing or causing to be revealed, directly or indirectly, a 
confidential communication made to the licensed chemical dependency counselor by 
a client or recipient of services, except as required by law; 
   
  (7) having a license to practice chemical dependency counseling in another 
jurisdiction refused, suspended, or revoked for a reason that the commission 
finds would constitute a violation of this chapter; 
   
  (8) refusing to perform an act or service for which the person is licensed to 
perform under this chapter on the basis of the client's or recipient's sex, 
race, religion, age, national origin, or handicaps; or 
   
  (9) committing an act of sexual exploitation in violation of Penal Code, 
sec.12.14, or for which liability exists under Civil Practice and Remedies Code, 
Chapter 81. 
     
  (b) Sanctions may include: 
 
  (1)  refusal to issue an initial license, a renewal license, or an intern 
designation; 
   
  (2) reprimand; 
   
  (3) probation; or 
   
  (4)  suspension or revocation of a license or intern designation. 
     
  (c)  The commission will determine the length of the probation or suspension. 
The commission may hold a hearing at any time and revoke the probation or 
suspension. 
   
  (d) If the commission investigates a complaint against an intern and finds 
that the supervising licensed chemical dependency counselor failed to provide 
adequate and appropriate supervision within the twelve core functions, the 
commission shall initiate disciplinary action against the supervising licensed 
chemical dependency counselor. The supervisor shall: 
 
  (1) receive notice of the hearing; 
   
  (2) receive notice of the actions or omissions alleged; 
   
  (3) have a chance to offer evidence to disprove the allegations; and 
   
  (4) have all appeal rights provided for in these rules. 
     
  (e) If the commission intends to impose sanctions, the commission's executive 
director or designee will notify the applicant in writing. 
   
  (f) The individual has the right to appeal the action and will receive due 
process as described in Chapter 142 of this title (relating to Investigations 
and Hearings) 
   
  (g) Surrender or expiration of a license does not interrupt the investigation 
or sanctions process. Unless the licensed chemical dependency counselor or 
intern is cleared through the investigation or hearings process, the commission 
shall impose the proposed sanctions and withdraw the person's license in 
negative status. The individual is not eligible to regain the license until all 
outstanding investigations, disciplinary proceedings, or hearings are resolved. 
 
     
  sec.150.54. Suspension for Failure to Pay Child Support. 
 
  (a)  The Office of the Attorney General may obtain an order suspending the 
license of an licensed chemical dependency counselor or the designation of an 
intern who: 
 
  (1) is a non-custodial parent; 
   
  (2) owes more than 90 days of past due child support; and 
   
  (3) is not in compliance with an existing repayment plan. 
     
  (b) On receiving a final order for suspension from the Office of the Attorney 
General, the commission shall: 
 
  (1) record the suspension in the person's file; 
   
  (2) report the suspension as appropriate; and 
   
  (3) demand surrender of the suspended license or designation. 
     
  (c) The commission shall implement the terms of the final order for suspension 
without additional review or hearing. 
   
  (d) The licensee or intern is not entitled to a refund for any fees paid. 
   
  (e) A licensee or intern who provides chemical dependency counseling during 
the period of suspension is subject to civil penalties, as provided in 
sec.150.51 of this title (relating to Civil Penalties) . 
   
  (f) An order suspending a license under this section does not affect the 
commission's power to grant, deny, suspend, revoke, terminate, or renew a 
license. 
 
     
  sec.150.61. Ethical Standards. 
 
  (a) Mandate. All applicants, counselor interns, criminal justice peer interns, 
and licensed chemical dependency counselors shall comply with these ethical 
standards. 
   
  (b)  Discrimination not allowed. The licensed chemical dependency counselor or 
intern shall not discriminate against any client or other person on the basis of 
sex, race, religion, age, national origin, or handicap. 
   
  (c)  Responsibility. The licensed chemical dependency counselor or intern 
shall maintain objectivity, integrity, and the highest standards in providing 
services to the client. 
   
  (d) Competence. The licensed chemical dependency counselor or intern shall: 
 
  (1) try to prevent the practice of chemical dependency counseling by 
unqualified or unauthorized persons; 
   
  (2) report violations of Texas Civil Statutes, Article 4512o, or rules adopted 
thereto, including violations of this section, to the commission; 
   
  (3) recognize the limitations of his or her ability and shall not offer 
services or use techniques that exceed his or her professional competence; 
   
  (4) not engage in the practice of chemical dependency counseling if impaired 
by, intoxicated by, or under the influence of chemicals, including, alcohol; and 
   
  (5) support peer assistance programs. 
     
  (e) Legal Standards and professional conduct. The licensed chemical dependency 
counselor or intern shall uphold the law and refrain from unprofessional 
conduct. In so doing, the licensed chemical dependency counselor or intern 
shall: 
 
  (1) not make any claim, directly or by implication, that the counselor 
possesses professional qualifications or affiliations that the counselor does 
not possess; 
   
  (2) not mislead or deceive the public or any person; 
   
  (3) not promote, develop, market, profit from, or associate himself or herself 
with any commercial product, unless the counselor has determined that the 
product does not tend to mislead the public, is factually accurate, and is 
consistent with the ethical standards of the profession as set forth in this 
section; 
   
  (4) not commit any crime of moral turpitude, or any act which might tend to 
discredit the profession; 
     
  (f) Public statements. The licensed chemical dependency counselor or intern 
shall: 
 
  (1)  report information fairly and accurately to clients, other professionals, 
and the general public, and shall not make inappropriate, unprofessional, or 
inaccurate representations; 
   
  (2) acknowledge the work of others, including but not limited to, practicum or 
work experience; 
   
  (3)  document materials and techniques used in the performance of the 
counselor's professional services; and 
   
  (4) advise all persons the counselor instructs or trains, in the skills or 
techniques of chemical dependency counseling, of the training or qualifications 
required to properly perform those skills or techniques. 
     
  (g) Publication credit or acknowledgment. The licensed chemical dependency 
counselor or intern shall give credit to, or expressly acknowledge all persons 
or works which have contributed to or directly influenced any publication of the 
counselor. 
   
  (h) Client welfare. The licensed chemical dependency counselor or intern shall 
respect a client's dignity, and shall not engage in any action that may injure 
the welfare of any client or person to whom the counselor is providing services. 
The licensed chemical dependency counselor or intern shall: 
 
  (1) remain loyal and professionally responsible to the client at all times, 
and shall inform the client of the counselor's loyalties and responsibilities; 
   
  (2) not engage in any activity which could be considered a professional 
conflict, and shall immediately remove himself or herself from such a conflict 
if one occurs; 
   
  (3) terminate any professional relationship or counseling service which is not 
beneficial, or is in any way detrimental to the client; 
   
  (4) always act in the best interest of the client; 
   
  (5) never require a client to divulge confidential information obtained from 
another professional, without obtaining the express informed consent of the 
professional and the client; and 
   
  (6)  not offer or provide chemical dependency counseling or related services 
in settings or locations which are inappropriate, harmful to the client or 
others, or would tend to discredit the profession of chemical dependency 
counseling. 
     
  (i) Confidentiality. The licensed chemical dependency counselor or intern 
shall protect the privacy of all clients and shall not disclose confidential 
information without express written consent, unless required by law. The 
licensed chemical dependency counselor or intern shall remain knowledgeable of 
and obey all state and federal laws and regulations relating to confidentiality 
of chemical dependency treatment records, and shall: 
 
  (1) inform the client, and obtain the client's consent, before tape-recording 
the client, allowing another person to observe or monitor the client, or using 
client records for any purpose other than the provision of chemical dependency 
treatment of that client; 
   
  (2) ensure the maintenance of confidentiality of client records; 
   
  (3) not discuss or divulge information obtained in clinical or consulting 
relationships except in appropriate settings and for professional purposes which 
clearly relate to the case; 
   
  (4) make every effort to avoid invasion of the privacy of the client; and 
   
  (5) not reveal client identifying information, except as required by law, 
without the express written consent of the client. 
     
  (j)  Client relationships. The licensed chemical dependency counselor or 
intern shall inform the client about all relevant and important aspects of the 
professional relationship between the client and the counselor, and shall: 
 
  (1) in the case of clients who are not their own consenters, inform the 
client's parent(s) or legal guardian(s) of circumstances which might influence 
the professional relationship; 
   
  (2) not enter into a professional relationship with members of the client's 
family, close friends or associates, or others whose welfare might be 
jeopardized in any way by such relationship; and 
   
  (3) not engage in any type or form of sexual activity with a client. 
     
  (k) Relationships with other professionals. The licensed chemical dependency 
counselor or intern shall treat other professionals with respect, courtesy, and 
fairness, and shall: 
 
  (1)  not provide or offer to provide professional services to a client who is 
receiving chemical dependency treatment from another professional, except with 
the knowledge of the other professional and the consent of the client, until 
treatment with the other professional ends; and 
   
  (2) cooperate with the commission, professional peer review groups or 
programs, and professional ethics committees or associations, and promptly 
supply all requested or relevant information unless prohibited by law. 
     
  (l) Remuneration. The licensed chemical dependency counselor or intern shall, 
in advance of treatment, establish financial arrangements with a client, which 
shall be in accordance with professional standards in the relevant community, 
including, without limitation, informing the client of the counselor's fee 
schedule for all treatment services to be provided to the client, and shall not: 
 
  (1)  charge exorbitant or unreasonable fees for any treatment service; 
   
  (2)  pay or receive any commission, consideration, or benefit of any kind 
related to the referral of a client for treatment; 
   
  (3) engage in fee splitting with other professionals, without the written 
consent of the client; 
   
  (4) use the client relationship for the purpose of personal gain, or profit, 
except for the normal, usual charge for treatment provided; and 
   
  (5) provide treatment to a client, or accept a professional fee or any gift or 
gratuity from a client if the client is entitled to chemical dependency 
treatment free of charge, or at minimal cost to the client, through an agency or 
other institution, unless the client consents in writing. 
     
  (m) Professional obligations. The licensed chemical dependency counselor or 
intern shall support changes in public policy and legislation which advocate the 
provision of chemical dependency treatment for individuals impaired by chemical 
dependency of any kind, and shall inform the public through active participation 
in community affairs of the effects of chemical dependency, and shall: 
 
  (1) make every effort to provide access to treatment, including advising 
clients about resources and services, taking into account the financial 
constraints of the client; and 
   
  (2) in all activities of the profession, act to promote the welfare of all 
human beings. 
         
  Issued in Austin, Texas, on August 17, 1995. 
 TRD-9510427 
  Thomas Mann, Jr. 
 General Counsel 
 Texas Commission on Alcohol and Drug Abuse 
    Effective date: August 21, 1995 
 Expiration date: December 19, 1995 
 For further information, please call: (512) 867-8720