TITLE health-services

Part II. Texas Department of Mental Health and Mental Retardation

Chapter 401. System Administration

Subchapter I. Certification of Community Residential Programs

(Editor's note: The text of the following sections proposed for repeal will not be published.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

The Texas Department of Mental Health and Mental Retardation (department) proposes the repeal of §§401.551-401.565, concerning certification of community residential programs, as part of a comprehensive reorganization of chapters and subchapters within the department's portion of the Texas Administrative Code.

Key provisions of the sections are incorporated into new Chapter 412, Subchapter H, concerning standards for mental retardation community services and supports, as part of a comprehensive reorganization of chapters and subchapters within the department's portion of the Texas Administrative Code. The new subchapter is published contemporaneously for public comment in this issue of the Texas Register , as are other related subchapters being proposed for repeal.

Donald C. Green, chief financial officer, has determined that for each year of the first five-year period the repeals are in effect there will be no fiscal impact on state or local governments of as a result of enforcing the repeals.

Leon Evans, director, community services, has determined that for each year of the first five years the repeals are in effect the public benefit will be the existence of a concise and relevant body of policy documents as a result of repealing unnecessary rules. There is no anticipated economic impact on small businesses expected to be affected by the repeal. No local economic impact is anticipated as a result of adopting the repeal as proposed.

A hearing to accept oral and written testimony from the public concerning this and other related rules has been scheduled for 1:30 p.m, Friday, February 13, 1998, in Room 240 of department's Central Office auditorium in Building 2, 909 West 45th Street in Austin. If accommodations are required for persons who are hearing impaired, please notify the Office of Policy Development at least 72 hours in advance by calling 512/206-4516.

Written comments on the proposal may be sent to Linda Logan, director, Policy Development, Texas Department of Mental Health and Mental Retardation, P.O. Box 12668, Austin, Texas 78711-2668, within 30 days of publication.

The repeals are proposed under the Texas Health and Safety Code, §532.015, which provides the Texas Mental Health and Mental Retardation Board with broad rulemaking authority.

Texas Health and Safety Code, §534.052 and §534.058 are affected by these proposed repeals.

§401.551.Purpose.

§401.552.Application.

§401.553.Definitions.

§401.554.General Provisions Governing Certification of Community Residential Programs.

§401.555.Requirements for Certification.

§401.556.Initial Application Process and Provisional Certification.

§401.557.Certification Decision and Notification.

§401.558.Alternative Certification Status.

§401.559.Certification Renewal.

§401.560.Change in Certification.

§401.561.Denial, Suspension, and Revocation of Certification.

§401.562.Inspection Authority and Reporting Responsibilities.

§401.563.Exhibits.

§401.564.References.

§401.565.Distribution.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State, on January 12, 1998.

TRD-9800421

Ann Utley

Chair, Texas MHMR Board

Texas Department of Mental Health and Mental Retardation

Earliest possible date of adoption: February 23, 1998

For further information, please call: (512) 206-4516

Chapter 408. Standards and Quality Assurance

Subchapter A. Standards of the Texas Department of Mental Health and Mental Retardation

25 TAC §§408.1-408.10

The Texas Department of Mental Health and Mental Retardation (department) proposes the repeal of §§408.1-408.10, concerning standards of the Texas Department of Mental Health and Mental Retardation -- quality assurance, as part of a comprehensive reorganization of chapters and subchapters within the department's portion of the Texas Administrative Code.

The subchapter adopts by reference a number of national quality assurance standards as well as the department's mental health and mental retardation standards for services and supports delivered by local authorities in the community. The mental health standards have been incorporated into Chapter 408, Subchapter B, concerning mental health community services standards. Key provisions of the 1988 TDMHMR Community Standards for Individuals with Mental Retardation have been incorporated into new Chapter 412, Subchapter H concerning standards and quality assurance for mental retardation community services and supports, which is published contemporaneously for public comment in this issue of the Texas Register .

Leon Evans, director, community services, has determined that for each year of the first five years the repeals are in effect, the public benefit will be the existence of a concise and relevant body of policy documents as a result of repealing unnecessary rules. There is no anticipated economic impact on small businesses expected to be affected by the repeals. No local economic impact is anticipated as a result of adopting the repeals as proposed.

The repeals are proposed under the Texas Health and Safety Code, §532.015, which provides the Texas Mental Health and Mental Retardation Board with broad rulemaking authority.

Texas Health and Safety Code, §534.052 and §534.058 are affected by these proposed repeals.

§408.1.Purpose.

§408.2.Application.

§408.3.Definition.

§408.4.Scope.

§408.5.Standards of Care.

§408.6.Governing Body.

§408.7.Director of Standards and Quality Assurance.

§408.8.Program Reviews.

§408.9.References.

§408.10.Distribution.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State, on January 12, 1998.

TRD-9800422

Ann Utley

Chair, Texas MHMR Board

Texas Department of Mental Health and Mental Retardation

Earliest possible date of adoption: February 23, 1998

For further information, please call: (512) 206-4516

Subchapter C. Quality Assurance and Improvement System (Oais) for Mental Retardation Services and Supports

25 TAC §§408.51-408.63

The Texas Department of Mental Health and Mental Retardation (department) proposes the repeal of §§408.51-408.63, concerning quality assurance and improvement system (QAIS) for mental retardation services and supports, as part of a comprehensive reorganization of chapters and subchapters within the department's portion of the Texas Administrative Code.

Leon Evans, director, community services, has determined that for each year of the first five years the repeals are in effect the public benefit will be the existence of a concise and relevant body of policy documents as a result of repealing unnecessary rules. There is no anticipated economic impact on small businesses expected to be affected by the repeals. No local economic impact is anticipated as a result of adopting the repeals as proposed.

The repeals are proposed under the Texas Health and Safety Code, §532.015, which provides the Texas Mental Health and Mental Retardation Board with broad rulemaking authority.

Texas Health and Safety Code, §534.052 and §534.058 are affected by these proposed repeals.

§408.51.Purpose.

§408.52.Application.

§408.53.Definitions.

§408.54.Responsibilities of Local Authorities and Designated Providers.

§408.55.Self-assessment by Local Authorities and Designated Providers.

§408.56.Outcome Measures for People.

§408.57.Outcome Measures for Organizations.

§408.58.Plan of Improvement.

§408.59.External Validation.

§408.60.Exhibits.

§408.61.Training.

§408.62.References.

§408.63.Distribution.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State, on January 12, 1998.

TRD-9800423

Ann Utley

Chair, Texas MHMR Board

Texas Department of Mental Health and Mental Retardation

Earliest possible date of adoption: February 23, 1998

For further information, please call: (512) 206-4516

Subchapter E. Health, Safety, and Rights in Community-based Mental Retardation Programs

25 TAC §§408.151-408.164

The Texas Department of Mental Health and Mental Retardation (department) proposes the repeal of §§408.151-408.164, concerning health, safety, and rights in community-based mental retardation programs.

Key provisions of the sections are incorporated into new Chapter 412, Subchapter H, concerning standards and quality assurance for mental retardation community services and supports, as part of a comprehensive reorganization of chapters and subchapters within the department's portion of the Texas Administrative Code. The new subchapter is published contemporaneously for public comment in this issue of the Texas Register , as are other related subchapters proposed for repeal.

Leon Evans, director, community services, has determined that for each year of the first five years the repeals are in effect the public benefit will be the existence of a concise and relevant body of policy documents as a result of repealing unnecessary rules. There is no anticipated economic impact on small businesses expected to be affected by the repeals. No local economic impact is anticipated as a result of adopting the repeals as proposed.

The repeals are proposed under the Texas Health and Safety Code, §532.015, which provides the Texas Mental Health and Mental Retardation Board with broad rulemaking authority.

Texas Health and Safety Code, §534.052 and §534.058 are affected by these proposed repeals.

§408.151.Purpose.

§408.152.Application.

§408.153.Definitions.

§408.154.Encouraging Full Expression of Individual Rights.

§408.155.Human Resources.

§408.156.Medication Practice and Health Related Services.

§408.157.Infection Control.

§408.158.Behavior Management.

§408.159.Psychoactive Medications.

§408.160.Consumer Records.

§408.161.Environmental Requirements.

§408.162.Additional Requirements.

§408.163.References.

§408.164.Distribution.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State, on January 12, 1998.

TRD-9800424

Ann Utley

Chair, Texas MHMR Board

Texas Department of Mental Health and Mental Retardation

Earliest possible date of adoption: February 23, 1998

For further information, please call: (512) 206-4516

Chapter 409. Medicaid Programs

Subchapter D. Home and Community-based Services

25 TAC §409.100

The Texas Department of Mental Health and Mental Retardation (TDMHMR) proposes an amendment to §409.100, concerning Home and Community-Based Services (HCS).

In accordance with the Federal Balanced Budget Act of 1997, the proposed amendments would remove the requirement for an HCS consumer to have a history of institutionalization in an Intermediate Care Facility for Persons with Mental Retardation or Related Conditions or nursing facility in order to receive Medicaid-reimbursed for supported employment services. The proposed amendments would allow Medicaid matched funding for supported employment services for all eligible HCS consumers.

Don Green, chief financial officer, has determined that for each year of the first five-year period the rule, as proposed, would be in effect there would be for FY 1998 a net fiscal impact of $0, of which $68,861 is federal and ($68,861) is state, for FY 1999 the net fiscal impact would be $0, of which $70,376 is federal and ($70,376) is state, for FY 2000 the net fiscal impact would be $0, of which $71,924 is federal and ($71,924) is state, for FY 2001 the net fiscal impact would be $0, of which $73,506 is federal and ($73,506) is state, for FY 2002 the net fiscal impact would be $0, of which $75,124 is federal and ($75,124) is state.

Ernest McKenney, director, Medicaid Administration, has determined that for each year of the first five years the amendment would be in effect the public benefit anticipated would be a savings in state expenditures for supported employment services provided to HCS consumers. There is no anticipated economic cost to persons who are required to comply with the proposed amendment. There would be no effect on small business.

A public hearing will be held at 8:30 a.m., February 19, 1998, in Room 240 of the main TDMHMR Central Office building (Building 2) at TDMHMR Central Office, 909 West 45th Street, Austin, Texas, to accept oral and written testimony concerning the proposal. Persons requiring an interpreter for the deaf or hearing impaired should notify Sheila Wilkins, Office of Policy Development, at least 72 hours prior to the hearing by calling (512) 206-4516.

Questions about the content of the proposal may be directed to Mr. McKenney. Comments on the proposed sections should be submitted to Linda Logan, director, Policy Development, Texas Department Mental Health and Mental Retardation, P.O. Box 12668, Austin, TX 78711-2668, within 30 days of publication.

The amendment is proposed under the Texas Health and Safety Code, §532.015(a), which provides TDMHMR with broad rulemaking authority; Human Resource Code, Chapter 32, §32.021, and Government Code, Chapter 531, §531.021, which provide the Texas Health and Human Services Commission (THHSC) with the authority to administer federal medical assistance funds and administer the state's medical assistance program. Senate Bill 509 of the 74th Texas Legislature clarifies THHSC's authority to delegate the operation of all or part of a Medicaid program to a health and human service agency.

The amendment affects Human Resources Code, Chapter 32, and Government Code, Chapter 531, §531.021.

§409.100.Service Components of Home and Community-based Services (HCS) Program.

(a)

HCS service components are selected for inclusion in an applicant's or program participant's Individual Plan of Care (IPC) to supplement rather than replace that individual's natural community supports. HCS service components are selected based on assessments which identify specific services and supports necessary for the individual to continue living in the community and prevent the individual's admission to institutional based services. The following service components are available to all individuals enrolled in the HCS Program unless indicated otherwise:

(1)-(6)

(No change.)

(7)

Supported employment is provided in conjunction with day habilitation and may be provided up to an annual maximum of $3,000 per individual. Supported employment reimbursement is available only if documentation verifies that supported employment services have been denied or are otherwise unavailable to the individual through either the Texas Rehabilitation Commission or the public school system. [ Medicaid-reimbursed supported employment may be provided only if the participant has a documented previous history of institutionalization in a nursing facility or an intermediate care facility for persons with mental retardation or a related condition. Supported employment may be provided as a state-funded, non-Medicaid reimbursed HCS service component for individuals without a prior history of institutionalization subject to the availability of state funding. ] Any person receiving supported employment must have an identified need and desire for employment.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State, on January 12, 1998.

TRD-9800426

Ann Utley

Chair, Texas MHMR Board

Texas Department of Mental Health and Mental Retardation

Earliest possible date of adoption: February 23, 1998

For further information, please call: (512) 206-4516

Subchapter J. Reimbursement for Services in Institutions for Mental Diseases (IMD)

25 TAC §§409.373-409.375

The Texas Department of Mental Health and Mental Retardation (TDMHMR) proposes amendments to §409.373-409.375, concerning governing Reimbursement for Services in Institutions for Mental Diseases (IMD).

In accordance with the Federal Balanced Budget Act of 1997, the proposed amendments would remove the requirement for an inspection of care (IOC) in IMDs. Additionally, two minor revisions are made regarding the definitions of terms and the deletion of an unnecessary reference to an initial time period which was pertinent when the rule was initially promulgated.

Don Green, chief financial officer, has determined that for each year of the first five-year period the amendments would be in effect there would be no fiscal implications for state or local government or small businesses.

Ernest McKenney, director, Medicaid Administration, has determined that for each year of the first five years the amendments would be in effect the public benefit anticipated would be the elimination of duplicative consumer quality of care reviews. There is no anticipated economic cost to persons who are required to comply with the proposed amendments. There would be no effect on small business.

The amendments are proposed under the Texas Health and Safety Code, §532.015(a), which provides TDMHMR with broad rulemaking authority; Human Resource Code, Chapter 32, §32.021, and Government Code, Chapter 531, §531.021, which provide the Texas Health and Human Services Commission (THHSC) with the authority to administer federal medical assistance funds and administer the state's medical assistance program. Senate Bill 509 of the 74th Texas Legislature clarifies THHSC's authority to delegate the operation of all or part of a Medicaid program to a health and human service agency.

The amendments affect Human Resources Code, Chapter 32, and Government Code, Chapter 531, §531.021.

§409.373.Definitions.

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

[ ~~Medical review team~~

- A team designated by TDMHMR Office of Medicaid Administration, that includes at least one physician, as prescribed by 42 Code of Federal Regulations §456.602, who is familiar with the care of mentally ill individuals. No team member may be employed by or have a significant financial interest in the facility under review.]

Qualified mental health professional

- A person acting within the scope of his or her training and licensure or certification, who is a:

(A)

[ ~~certified or~~ ] licensed social worker as defined by the Human Resources Code, §50.001;

(B)-(E)

(No change.)

§409.374.Eligible Population.

Reimbursement for IMD services is limited to individuals:

(1)-(7)

(No change.)

(8)

for whom the department has authorized IMD services based on medical necessity. Effective June 1, 1996, request for initial authorization must be submitted to the department's Office of Medicaid Administration within seven calendar days of the first day for which Medicaid reimbursement for the provision of IMD services will be requested. Request for authorization of continued stay must be submitted no later than seven calendar days prior to the end date of the initial and all subsequent authorizations. Initial and continued stay authorizations are valid for up to 31 calendar days. [ For persons receiving IMD services, prior to June 1, 1996, authorization will be granted until July 1, 1996. Requests for authorization of continued stay for these persons must also be submitted no later than seven calendar days prior to the end date of the initial authorization. Authorizations will be determined by a registered nurse or a licensed physician. ]

§409.375.Provider Eligibility for Reimbursement.

(a)-(b)

(No change.)

(c)

Evidence of compliance with subsection (a) of this section will be validated through [ ~~onsite inspections~~ ] reviews by [ ~~a medical review team designated by~~ ] the TDMHMR Office of Medicaid Administration. Reviews [ ~~Inspections~~ ] will occur at an interval decided upon by the department [ ~~and the team but no less than annually~~ ]. No facility may be notified more than 48 hours before the scheduled [ ~~arrival of the team~~ ] review . For each Medicaid patient, [ ~~the team~~ ] TDMHMR will additionally review:

(1)-(3)

(No change.)

(d)

If the provider fails to provide evidence of compliance with subsection (c)(1)-(3) of this section, then the provider must take corrective action, as needed, based on the findings [ ~~in the medical review team's~~ ] contained in TDMHMR's report.

(1)-(2)

(No change.)

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State, on January 12, 1998.

TRD-9800428

Ann Utley

Chair, Texas MHMR Board

Texas Department of Mental Health and Mental Retardation

Earliest possible date of adoption: February 23, 1998

For further information, please call: (512) 206-4516

Chapter 412. Local Authority Responsibilities

Subchapter H. Standards and Quality Assurance for Mental Retardation Community Services and Supports

25 TAC §§412.351-412.373

The Texas Department of Mental Health and Mental Retardation (department) proposes new §§412.351-412.373, concerning standards and quality assurance for mental retardation community services. The new subchapter is part of a comprehensive reorganization of chapters and subchapters within the department's portion of the Texas Administrative Code.

The new subchapter incorporates selected provisions of the following subchapters of this title which are proposed contemporaneously for repeal in this issue of the Texas Register : Chapter 401, Subchapter I, concerning certification of community residential programs; Chapter 408, Subchapter A, concerning standards of the Texas Department of Mental Health and Mental Retardation -- quality assurance (which adopts by reference the 1988 TDMHMR Community Standards for Individuals with Mental Retardation); Chapter 408, Subchapter C, concerning quality assurance and improvement system (QAIS) for mental retardation services and supports; and Chapter 408, Subchapter E, concerning health, safety, and rights in community-based mental retardation programs.

The new subchapter describes the quality assurance and improvement system (QAIS) by which local mental retardation authorities and designated providers assess their performance in the provision of community-based supports and services to individuals with mental retardation; minimum standards for health, safety, and rights which are necessary to ensure the protection of individuals receiving mental retardation supports and services in community-based programs; and how QAIS will be extended to cover community residential programs for individuals with mental retardation which receive funding directly from or through contracts for service with the department in its role as the state mental retardation authority. The community residential programs have been certified in the past by the department based on the 1988 TDMHMR Community Standards for Individuals with Mental Retardation.

The minimum standards described in this subchapter replace the more prescriptive 1988 TDMHMR Community Standards for Individuals with Mental Retardation and are an integral part of the QAIS process. Local authorities and designated providers collect data as part of their self-assessment based on these standards.

The subchapter also includes a section concerning respite services as required by the Texas Health and Safety Code, §534.057.

Donald C. Green, chief financial officer, has determined that for each year of the first five-year period the new sections are in effect there will be a fiscal impact on state or local governments as a result of enforcing the new sections.

Leon Evans, director, community services, has determined that for each year of the first five years the new sections are in effect the public benefit will be the efficient and effective execution of the department's state authority oversight of community-based mental retardation programs, and the existence of a concise and relevant body of policy documents as a result of incorporating select provisions of five existing subchapters into a single new subchapter. There is no anticipated economic impact on small businesses expected to be affected by the new sections. No local economic impact is anticipated as a result of adopting the new sections as proposed.

A hearing to accept oral and written testimony from the public concerning the proposed new subchapter has been scheduled for 1:30 p.m, Friday, February 13, 1998, in Room 240 of department's Central Office auditorium in Building 2, 909 West 45th Street in Austin. If accommodations are required for persons who are hearing impaired, please notify the Office of Policy Development at least 72 hours in advance by calling 512/206-4516.

The new sections are proposed under the Texas Health and Safety Code, §532.015, which provides the Texas Mental Health and Mental Retardation Board with broad rulemaking authority; §534.052, which requires the board to adopt rules to ensure the adequate provision of community-based mental retardation services through a local authorities; §534.058, which requires the department to develop standards of care for services provided by local authorities and their subcontractors to ensure that the quality of those services is consistent with the quality of care available in department facilities; and §534.057 which requires the department to adopt rules concerning respite services.

Texas Health and Safety Code, §§534.052, 534.057, and 534.058 are affected by these proposed new sections.

§412.351.Purpose.

This subchapter describes the:

(1)

quality assurance and improvement system (QAIS) for community-based mental retardation services and supports funded by the Texas Department of Mental Health and Mental Retardation, including community-based residential programs for individuals with mental retardation which receive funding directly from or through contracts for service with the department in its role as the state mental retardation authority and which formerly were certified by the department under the repealed 1988 TDMHMR Community Standards for Individuals with Mental Retardation.

(2)

minimum standards, as required by the Texas Health and Safety Code (THSC), §534.052, for ensuring:

(A)

the health, safety, and rights of individuals receiving community-based mental retardation services and supports; and

(B)

that the quality of those services and supports are consistent with those provided by department facilities, as required by the Texas Health and Safety Code, §534.058; and

(3)

minimum standards, as required by Texas Health and Safety Code, §534.057.

§412.352.Application.

(a)

The provisions of this subchapter apply to community-based mental retardation services and supports funded by the department and delivered by:

(1)

local mental retardation authorities and the providers with which they contract; and

(2)

designated providers.

(b)

The provisions of this subchapter apply to community-based residential programs which formerly were certified by the department under the repealed 1988 TDMHMR Community Standards for Individuals with Mental Retardation.

§412.353.Definitions.

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

Actively involved

-- Involvement with the individual which the individual's planning team deems to be of a quality nature based on the following:

(A)

observed interactions of the person with the individual;

(B)

advocacy for the best interests of the individual;

(C)

knowledge of and sensitivity to the individual's preferences, values, and beliefs;

(D)

ability to communicate with the individual; and

(E)

availability to the individual for assistance or support when needed.

AIDS

-- Acquired immune deficiency syndrome as defined by the National Centers for Disease Control and Prevention of the U.S. Public Health Service.

Behavior management

-- All efforts to increase socially adaptive behavior and to modify maladaptive or problem behaviors and replace them with behaviors and skills that are adaptive and socially productive. This broad category includes behavior interventions, emergency procedures used to protect an individual or other persons due to the actions of that individual, and both formal and informal planned interactions intended to increase socially adaptive behavior and/or to modify maladaptive or problem behaviors.

CARE

- The department's Client Assignment and Registration System, an on-line data entry system developed to provide demographic and other data about individuals served by the department.

Community center

-- A community mental health and mental retardation center established under the Texas Health and Safety Code, Title 7, Chapter 534.

Department

-- The Texas Department of Mental Health and Mental Retardation.

Designated provider

-- As defined in the Texas Health and Safety Code, §534.054, a service provider with whom the department contracts for the delivery of a specific community-based mental retardation service in a specified local service area of the state if the MRA for that local service area is unable or unwilling to provide that service. The term does not include a local authority.

Emergency care

-- Procedures and intervention designed to respond to medical emergencies.

Hepatitis B

-- An infection of the liver caused by the hepatitis B virus (HBV).

Hepatitis B immunization

-- Vaccination of persons at risk of infection from HBV.

Hepatitis B testing

-- Blood test for detection of hepatitis B surface antigens and antibodies.

HIV

-- Human immunodeficiency virus.

HIV testing

-- Blood test for detection of human immunodeficiency virus infection.

HRC (human rights committee)

-- A committee appointed by the MRA comprising an independent group of representatives with the delegated authority to ensure that the civil and legal rights of individuals receiving services are acknowledged, respected, and protected through the review of organizational practices and approaches. The HRC is a mechanism for ensuring due process. Members of the human rights committee include, but are not limited to, individuals served by the MRA or designated provider, their legally authorized representatives, local advocates, and persons from the community who are not affiliated with the MRA or designated provider.

(A)

Minimally, one committee member should be experienced in issues and decisions regarding human rights.

(B)

At least one committee member should be knowledgeable of current behavior management strategies At least one third of the members should not be affiliated with the MRA or designated provider.

(C)

Any member directly involved in the development, review, or approval of a proposal before the committee will not take part in deliberations relative to that proposal.

(D)

Members should receive appropriate training to maximize the benefit of their participation on the committee.

Informed consent (legally adequate consent)

-- A term consistent with provisions of the Texas Health and Safety Code, §591.006, concerning consent obtained from an individual with mental retardation which is legally adequate when each of the following conditions has been met:

(A)

legal status: The individual giving the consent is of the minimum legal age and currently does not have a guardian appointed to manage personal affairs by an appropriate court of law;

(B)

comprehension of information: The individual giving the consent has been informed of and comprehends the nature, purpose, consequences, risks, and benefits of and alternatives to the procedure, and the fact that withholding or withdrawal of consent shall not prejudice the future provision of care and services to the individual with mental retardation; and

(C)

voluntariness: The consent has been given voluntarily and free from coercion and undue influence.

Legally authorized representative

-- The parent of an individual who is a minor, the guardian of an individual who has been determined by a court to lack capacity, or the managing conservator of an individual.

Local authority

-- As defined in the Texas Health and Safety Code, §531.002, an entity to which the Texas Mental Health and Mental Retardation Board delegates its authority and responsibility within a specified region for planning, policy development, coordination, and resource development and allocation and for supervising and ensuring the provision of mental retardation services to individuals with mental retardation in one or more local service areas.

Medication administration

-- The direct application of a drug by injection, inhalation, ingestion, topical application or any other means to the body of a person in accord with the Texas Medical Practice Act.

Outcome Based Performance Measures

-- The Council's copyrighted system of quality improvement and measurement that emphasizes responsiveness on the part of service organizations to the individual needs of that organization's consumers rather than traditional compliance with established standards. The system:

(A)

focuses on outcomes for consumers rather than the organizational processes that contribute to those outcomes but also looks at outcome measures for organizations;

(B)

is concise, focusing on those priority outcomes that people with disabilities indicate are most important to them; and

(C)

can be used with all services and programs -- residential, vocational, social, or residential -- and for consumers with different disabilities.

Planning team

-- The individual with the ability to provide legally adequate consent, the legally authorized representative (LAR), if any, and those persons chosen by the individual and LAR, if any, who assess the individual's treatment, training, and service/support plan needs and make recommendations to the MRA or designated provider for services which will enable the individual to meet desired personal outcomes. Team members typically could include:

(A)

family members or other persons who are actively involved in the life of the individual;

(B)

persons who are professionally qualified, certified, or both, in various professions with special training and experience in the diagnosis, management, needs, and treatment of individuals with mental retardation;

(C)

persons who are directly involved in the delivery of mental retardation services to the individual; and

(D)

member(s) of the local authority's public responsibility committee (PRC), if requested by the individual with the ability to provide legally adequate consent or the LAR, if any, or the PRC in instances when the individual does not have either the ability to provide legally adequate consent or an LAR.

Polypharmacy

-- Simultaneous use of more than one psychoactive medication from the same medication class to treat an individual. The period of overlapping use of more than one psychoactive medication when a physician changes an individual from one drug to another shall not be considered polypharmacy.

Provider

(A)

Any organization or entity, associated by a contract in a working alliance with a local authority or the department to provide community-based services and supports, including its employees or agents; or

(B)

that part of a local authority directly providing services and supports to individuals with mental retardation, including employees or agents.

Psychoactive medication

-- Any medication which is prescribed for the primary intent of improving cognition, affective state, and/or behavior.

Quality Assurance and Improvement System (QAIS)

-- The framework by which local authorities and designated providers measure the quality, efficiency, and effectiveness of their organizations and the services and supports they provide to consumers either directly or by contracting with providers. It is an outcome-oriented system that concentrates on measuring desired results and the processes used to obtain those results, as defined by the consumer. The system is based on The Council's Outcome Based Performance Measures and involves three stages:

(A)

self-assessment;

(B)

quality improvement plan; and

(C)

external validation.

Respite services

-- Services which assist both individuals with mental retardation and their families during times of crisis or other specific events. Designed to be of short duration, the services may vary from one day to a maximum of 30 consecutive calendar days per episode. Respite services may be provided either in the family home or in a residence operated or contracted by the local authority.

Restraint

-- Refers to the use of personal restraint methods or mechanical devices that are intended to restrict the movement or normal functioning of a portion of an individual's body.

State operated community-based MHMR services division

-- Those entities which provide community-based mental health and/or mental retardation services and which are operated by the department. Formerly known as community-based service divisions of state facilities.

Tardive dyskinesia

-- A possible side effect of neuroleptic medication characterized by involuntary and abnormal movements which are purposeless and stereotypical.

The Council

-- The Council on Quality and Leadership in Supports for People with Disabilities, formerly The Accreditation Council, is a diversified quality enhancement organization with an international focus in the field of human services which: develops standards of quality; develops and disseminates materials; provides training, consultation, and technical assistance; and operates an accreditation program for organizations which serve people with disabilities.

Tuberculosis

-- A disease spread through airborne particles containing tubercle bacilli which become established in the lungs and may spread throughout the body.

§412.354.Responsibilities of Local Authorities and Designated Providers.

(a)

Through its contract with the department, the local authority or designated provider shall assure its compliance with the provisions of this subchapter.

(b)

Through its contract with other providers, the local authority shall require compliance with the provisions of this subchapter as it applies to services and supports provided by the provider which are funded through the department.

(c)

Programs under the purview of the Texas Interagency Council on Early Childhood Intervention are not required to be surveyed as a part of QAIS.

(d)

Nothing in this subchapter is intended to diminish or negate any contractual requirement on the organization, including a contractual requirement to comply with applicable department rules.

§412.355.Self-assessment by Local Authorities and Designated Providers.

(a)

Self-assessment and the subsequent development of a quality improvement plan as described in §412.358 of this title (relating to Quality Improvement Plan) occurs annually and is completed by the fourth calendar quarter following completion of the previous self assessment. The self-assessment is based on The Council 's Outcome Based Performance Measures which are adopted by reference as Exhibit A in §412.370 of this title (relating to Exhibits) and is designed to evaluate two aspects of quality, which are:

(1)

outcomes of services that contribute to the quality of life (outcome measures for people); and

(2)

the organizational structure and processes that support quality services and supports (outcome measures for organizations).

(b)

The self-assessment is conducted by a team comprising at least four people, including the team coordinator.

(1)

The chief executive officer (CEO) or designee of the local authority or designated provider names a staff member as team coordinator.

(2)

The team coordinator selects other members of the team with consideration given to both the communication needs and the diverse cultural, ethnic, and religious backgrounds of the consumers who receive services and supports from that local authority or designated provider. Recommended team members include:

(A)

at least one consumer and/or family member;

(B)

one direct care staff person;

(C)

one person from the local community who has no affiliation with the organization; and

(D)

one administrative staff person.

(c)

The local authority or designated provider also may choose to include on the team persons from other local authorities or designated providers of similar size. Having a team member from outside the organization may prove beneficial when reviewing the outcome measures for organizations.

(d)

Team members will receive training in the self-assessment process in addition to an orientation which includes an overview of the consumers being reviewed, the importance of confidentiality, scheduling, and team assignments.

(1)

The training is based on model curriculum provided by the department, as described in §412.371 of this title (relating to Training.)

(2)

Each team member will sign a statement agreeing to respect the confidential nature of the information concerning the consumers being reviewed.

(e)

The self assessment will be performed using guidelines provided by the department, applicable department rules, and the organization's contract with the department.

(f)

The self-assessment process should take no longer than 15 working days with a formal feedback session immediately following the completion of the self-assessment. This timeframe permits the organization to gain a "snapshot" of itself and maintain the continuity and validity of the self-assessment. The self-assessment is divided into the following key components:

(1)

visits to settings where services and supports are provided for:

(A)

discussion and interaction with consumers, staff, service coordinators, and other significant people;

(B)

observation of the environment; and

(C)

review of documentation, when necessary;

(2)

the completion of all individual consumer interviews;

(3)

the team synthesis and consensus process including;

(A)

compilation of interview or rating sheets; and

(B)

a consensus to generate a summary report of findings; and

(4)

feedback session for the CEO and invited staff.

§412.356.Outcome Measures for People.

(a)

The outcome measures for people survey is designed to measure the impact of services and supports on the lives of consumers

(b)

A stratified, random sample for the survey is developed as described in the QAIS Implementation Manual. Technical assistance in developing the sample is available from the department's Office of Research and Evaluation.

(c)

The program coordinator/case manager for each consumer included in the survey will be contacted by the team coordinator or another team member to explain the assessment process and to obtain the written consent of the consumer or the consumer's legally authorized representative as described in Chapter 403, Subchapter K of this title (relating to Client-Identifying Information).

(d)

The presence of each outcome is determined by the consumer or the consumer's legally authorized representative. It is evidenced through the interview process with the consumer and, when appropriate, with the consumer's legally authorized representative and the other significant people in the consumer's life. An outcome also can be met if it is absent but the consumer or legal representative has determined that it is unimportant to the consumer. There should be evidence that the consumer or legally authorized representative has an experiential context for making such a choice.

(e)

The interview is supplemented by observations of the consumer's environment and, when necessary, by reviewing documentation to resolve perceived conflicts in information.

(f)

Each outcome measure will be addressed with every consumer chosen for the interview process.

(g)

The Outcome Measures for People Results Worksheet is adopted by reference as Exhibit B and the Outcomes for People Scoring Grid is adopted by reference as Exhibit C in §412.370 of this title (relating to Exhibits).

§412.357.Outcome Measures for Organizations.

(a)

The outcome measures for the organization support the findings of the outcome measures for people. The issues of health, safety, and rights are reviewed through assessment of the supports and services provided by the organization.

(b)

The organization's written documentation, together with interviews of designated staff and other stakeholders and the observations of team members, form the basis for reviewing the outcomes for organizations. Documentation of a utilization management process, policies and procedures, and strategic planning will be in evidence.

(c)

An organization profile will be generated by the team which identifies the extent to which processes contribute to outcomes, strengths in meeting outcomes, and areas needing improvement.

(d)

The Outcomes for Organizations Results Worksheet is adopted by reference as Exhibit D in §412.370 of this title (relating to Exhibits).

§412.358.Quality Improvement Plan.

(a)

The quality improvement is intended to be a dynamic document that guides the organization in assuring that improvements are made which support consumers in realizing their desired outcomes. Consistent with the quality improvement plan, the organization will implement changes which facilitate its achievement of the 18 outcomes for organizations described in Exhibit A in §412.370 of this title (relating to Exhibits).

(b)

A team selected by the organization's CEO to coordinate the quality improvement plan activities should include at least one representative from the self-assessment team to ensure the continuity of the process.

(c)

The quality improvement plan is developed within 30 calendar days of the feedback session described in §412.355(f)(4) of this title (relating to Self-assessment by Local Authorities and Designated Providers) and will be reviewed, amended, and acted upon as determined necessary by a quarterly sampling of the relevant outcomes.

(d)

In developing the quality improvement plan, the team analyzes the self-assessment data and other relevant information such as the organization's strategic plan or reports of other regulatory entities, reviews the organization's monitoring of critical issues data analysis, develops a concise profile of the strengths and weaknesses evident in critical areas, determines areas for improvement, and arranges these in priorities based upon the organization's mission and its contract with the department.

(1)

As part of the analysis, strategies that address high priority issues and barriers to opportunities for improvement are identified and described.

(2)

Ultimately, the team consolidates the results of these efforts into a written quality improvement plan consistent with any additional strategy or planning done by the organization.

(e)

The following should be reflected in the quality improvement plan:

(1)

the organization's mission statement;

(2)

goals essential for the fulfillment of the mission;

(3)

action steps which will lead to the accomplishment of goals and which are specific enough to articulate responsibilities across the organization;

(4)

a quarterly evaluation process which will document progress towards goals, illuminate areas for further quality enhancement endeavors, and include a sampling of relevant outcomes; and

(5)

an evaluation process which describes and assesses leadership and its involvement in setting direction, and developing and maintaining a leadership system that supports the mission.

§412.359.External Validation.

(a)

The local authority or designated provider will submit its annual self-assessment results and quality improvement plan along with the quarterly updates to the department's Office of Quality Management for the external validation portion of the QAIS. The external validation is intended to:

(1)

reassure the public that public funds are being expended prudently for the purpose intended; and

(2)

affirm to the administrators of the local authority or designated provider and to the trustees of the local authority that QAIS is being implemented as intended and that data are representative of the organization's performance.

(b)

The external validation process consists of three phases:

(1)

pre-visit activities including:

(A)

desk review of requested documentation;

(B)

determination of external validation team composition;

(C)

selection of an independent, stratified/random sample of individuals from the CARE system, separate from the sample used by the organization in the self-assessment as described in §412.356 of this title (relating to Outcome Measures for People);

(D)

scheduling of on-site external validation process activities: and

(E)

coordination of external validation process with organization;

(2)

on-site activities intended to confirm the findings and products of the organization's self-assessment and quality improvement plan are:

(A)

examination of the products of the internal self-assessment through validation of the organization's implementation of the self-assessment instrument and quality improvement plan;

(B)

feedback regarding the consumers' responses concerning all outcomes and confirmation of the findings on the health, safety, and rights outcome measures through interviews with the consumers selected in the random sample described in paragraph (1)(C) of this subsection; and

(C)

establishment of the organization's overall inter-rater reliability; and

(3)

followup reporting activities including:

(A)

an optional closed exit conference with key staff, at the discretion of the organization chief executive officer;

(B)

an open exit conference for staff, consumers, advocates, parents, and other interested parties; and

(C)

provision of information to the department's Community Services Division.

(c)

The external validation team leader will:

(1)

provide information to the department's Community Services Division regarding the organization's performance as reflected in the self assessment and the status of the quality improvement plan; and

(2)

notify the organization's CEO and department's Community Services Division of problems in the outcome areas of health, safety, and rights which require immediate action.

(d)

The membership of the external validation team is composed as described in the QAIS Implementation Manual.

(e)

During every fiscal year, each local authority and designated provider will conduct a self-assessment and develop a quality improvement plan. A desk review will be conducted by the department's Office of Quality Management of the annual self-assessment and quality improvement plan submitted by each local authority and designated provider. The on-site visit portion of the external validation component will take place in one, two, or three year cycles, depending on the organization's accomplishment as reflected in the following elements which are described in detail in the QAIS Implementation Manual:

(1)

a valid self assessment;

(2)

addressing of high impact issues in the quality improvement plan;

(3)

completion and implementation of a quality improvement plan; and

(4)

presence of outcomes and processes in the self assessment.

(f)

The 18 outcomes for organizations described in Exhibit A assess whether an organization has the necessary and appropriate processes in place to support the 30 outcomes for people.

(g)

Information obtained during the external validation of every organization's self-assessment and quality improvement plan will be used by the department's Community Services Division for contract enforcement and negotiations and in compiling statewide data related to outcomes for people and organizations.

(h)

Deemed status will be granted by the department to those organizations accredited by The Council based on evidence presented to the department's Office of Quality Management of continuing accreditation. These organizations will be exempt from the on-site external validation process, but will be required to submit an annual self-assessment and quality improvement plan to the department's Office of Quality Management for data compilation and further contract negotiation. Deemed status for accreditation by other nationally recognized accreditation associations which meet the requirements of QAIS will be considered by the department's Office of Quality Management upon request by a local authority or designated provider.

§412.360.Encouraging Full Expression of Individual Rights.

(a)

The MRA or designated provider will encourage the full expression of legal and civil rights by each individual receiving services and will provide supports, as necessary, to assist individuals and their legally authorized representatives in the exercise of their rights. The MRA or designated provider will fully inform individuals and their legally authorized representatives of their rights as guaranteed under the Persons with Mental Retardation Act (Texas Health and Safety Code, Title 7, Subtitle D). In doing so, the MRA or designated provider will refer to Chapter 405, Subchapter Y of this title (relating to Client Rights -- Mental Retardation Services) and use the handbook prescribed in the subchapter.

(b)

The MRA or designated provider shall ensure that due process is provided when an individual's rights must be limited. As applicable, see Chapter 405, Subchapter J of this title (relating to Surrogate Decision-Making for Community-Based ICF/MR and ICF/MR/RC Facilities). Due process includes:

(1)

obtaining informed consent in writing for a period not to exceed one year from the individual or the legally authorized representative; and

(2)

review by the individual's planning team and, if appropriate, the human rights committee of the proposed limitation of the individual's rights.

(c)

When an individual's rights must be limited, the individual's planning team will consider what, if any, training or modifications to the individual's service plan might enable the limitations to be removed.

(d)

The MRA or designated provider shall develop and implement written policies and procedures for reporting and investigating allegations of rights violations and allegations of abuse, neglect, and exploitation, and taking appropriate action in confirmed cases. See Chapter 405, Subchapter Y of this title (relating to Client Rights Mental Retardation Services) and Chapter 404, Subchapter B of this title (relating to Abuse, Neglect, and Exploitation of People Served by Providers of Local Authorities), and Chapter 404, Subchapter A of this title (relating to Abuse, Neglect, and Exploitation in TDMHMR Facilities.)

(e)

Procedures for appeal of decisions shall be delineated and publicized, and shall include a mechanism for external review or mediation if agreement can not be reached. For MRAs, these procedures will include those set forth in §401.464 of this title (relating to Notification and Appeals Process). See Chapter 401, Subchapter G of this title (relating to Community Mental Health and Mental Retardation Centers.)

§412.361.Human Resources.

The MRA or designated provider ensures that:

(1)

all staff possess the work experience and education/credentials required by the job description or contract;

(2)

professional personnel are licensed, certified, or registered, if required by law;

(3)

verification of credentials and verification of the renewal of credentials is maintained in the human resource file for all certified or licensed professionals;

(4)

there is a mechanism in place for maintaining and ensuring standards of professional and ethical practice;

(5)

staff have the necessary training and demonstrate the necessary skills to ensure that the health, safety, and support needs of individuals are met ; and

(6)

documentation is maintained of the type and content of training and attendance records.

§412.362.Medication Practice and Health Related Services.

(a)

The MRA or designated provider operates in accordance with accepted principles of practice and applicable federal and state laws and regulations to ensure medication is administered safely and appropriately. The written policies and procedures of the MRA or designated provider shall address:

(1)

proper handling, storage, and disposal of medications;

(2)

proper use of telephone orders;

(3)

administration of medications by staff licensed or authorized to administer medications;

(4)

supervision of self-administration;

(5)

administration of medications without errors; and

(6)

documentation of follow up and corrective action when medication errors do occur.

(b)

Each individual receives preventive and timely health care services based on health needs and condition.

(c)

The MRA or designated provider ensures the availability of physician, dental, nursing, pharmacy, and laboratory services by qualified personnel, in compliance with laws and regulations, based on each individual's needs, and provides for emergency care during hours of program operation.

(d)

The MRA or designated provider has written policies and procedures which address the use of physical restraints and psychoactive medication when necessary during a medical or dental procedure or to promote healing following a medical procedure or an injury. The policies and procedures shall address appropriate documentation including:

(1)

medical necessity;

(2)

the behavior to be controlled;

(3)

a physician's or dentist's written order;

(4)

renewals, if necessary, every 12 hours; and

(5)

provision of appropriate medical treatment and observation.

§412.363.Infection Control.

(a)

In accordance with recommendations of The Centers For Disease Control and Prevention and the Occupational Safety and Health Administration, the MRA or designated provider shall ensure that an infection control plan is in place to decrease the risk for infection and/or transmission of diseases.

(b)

The plan addresses the following:

(1)

orientation training and updates;

(2)

prevention and management of infections for staff/providers and individuals (to include, but not be limited to, HIV, hepatitis B, and tuberculosis);

(3)

postexposure treatment for consumers and staff;

(4)

procedures for reporting of reportable diseases to the Texas Department of Health (TDH);

(5)

personnel policies in compliance with state and federal law;

(6)

criteria for determining when a consumer should be tested for HIV and hepatitis B;

(7)

hepatitis B immunization; and

(8)

special waste disposal as required by TDH as described in 25 TAC §§1.131-1.137 (relating to Definition, Treatment, and Disposition of Special Waste from Health Care).

(c)

Documentation shall be included in the MRA's records that the plan has been implemented.

§412.364.Behavior Management.

(a)

The MRA or designated provider has written policies and procedures addressing behavior management which:

(1)

specify all approved interventions including aversive procedures and techniques;

(2)

designate a hierarchy of intervention from most positive and least intrusive to most restrictive and intrusive; and

(3)

specify accepted standards of professional practice for the use of these interventions.

(b)

Restrictive and/or intrusive interventions (i.e., physical restraint, time-out, or psychoactive medications) are used only when warranted by the severity of the behavior, based on a functional analysis and team input, and result in desired behavioral outcomes.

(c)

The emergency use of restrictive interventions occurs when the behavior is not predictable and presents the clear threat of injury to self or others. If emergency interventions are needed more than twice during two consecutive months a functional analysis is undertaken to develop a program to reduce the frequency and severity of the identified behaviors.

(d)

Restrictive and/or intrusive interventions may be used as part of an individualized plan that is intended to lead to less restrictive means of managing and eliminating the behavior or controlling the symptoms of mental illness.

(e)

Monitoring of the individual during all restrictive interventions is at the appropriate level for the type of intervention being used and assures that individual rights are protected.

(f)

All restrictive interventions addressing the management of targeted behavior are justified by the functional assessment, the current level of behavior, and are reviewed by the treatment team at least annually to determine the ongoing need and to assess for the possible decrease in the use of the intervention, based on current clinical evidence. When possible, the acquisition of adaptive replacement behaviors are also measured.

(g)

Non-contingent interventions (i.e. environmental engineering, counseling, etc.) are similarly evaluated for their effectiveness through the use of individualized and quantified measures.

(h)

Except in an emergency, written informed consent for a period not to exceed one year is obtained when restrictive and/or intrusive interventions are included as part of a behavior management program.

(1)

The Human Rights Committee should review the situation carefully as a matter of due process. When the failure to obtain written informed consent is based on the individual's assessed inability to provide legally adequate consent, the need for obtaining a guardian should be considered. When applicable, surrogate decision making will be considered as described in Chapter 405, Subchapter J of this title (relating to Surrogate Decision-Making for Community-Based ICF/MR and ICF/MR/RC Facilities.)

(2)

The individual or guardian have the right to withdraw consent to treatment at any time without regard to any time limit specified in the consent form.

(3)

People do not have the right to cause injury to self or others, but the individual does have a right to be free of unnecessary drugs and other restrictive interventions and to receive appropriate treatment. This can best be ascertained when planned interventions are evaluated and determined to be effective.

§412.365.Psychoactive Medications.

In accordance with accepted principles of practice, the MRA or designated provider shall ensure that:

(1)

psychoactive medications are used judiciously as part of an individualized plan in which the following are carefully considered:

(A)

rationale including current DSM diagnosis;

(B)

benefits of treatment in light of potential risks of the targeted behavior;

(C)

overall impact on the individual's quality of life;

(D)

adjunctive procedures;

(E)

monitoring of side effects; and

(F)

monitoring for efficacy;

(2)

when tardive dyskinesia is suspected, the physician:

(A)

informs the individual and/or legal guardian;

(B)

discusses treatment options; and

(C)

documents in the record that the individual and/or legal guardian has been informed of the suspected condition, possible treatment options, and the rationale for the treatment chosen;

(3)

the physician obtains a second opinion to review and determine the safety of any usage of polypharmacy or over the maximum dosage levels when clinically indicated prior to the individual receiving such medications;

(4)

informed consent in writing for a period not to exceed one year from the individual or legally authorized representative including a surrogate decision-making committee, if applicable, as described in Chapter 405, Subchapter J of this title (relating to Surrogate Decision-Making for Community-Based ICF/MR and ICF/MR/RC Facilities) is obtained prior to initiation of the medication unless the use is necessitated by an emergency as described in §412.364 of this title (relating to Behavior Management.). Informed consent must include:

(A)

an explanation of the medication and its purposes;

(B)

expected beneficial effects, side effects and risks;

(C)

probable consequences of not taking medication;

(D)

the existence and value of alternative less restrictive forms of treatment, if any, and why the physician rejects the alternative therapy;

(E)

instruction that the individual with the ability to provide legally adequate consent or the LAR may withdraw consent at any time without negative actions on the part of staff;

(F)

an offer to answer any questions concerning the medication and its use; and

(G)

a specification of the time period to be covered by the consent document;

(5)

informed consent will be obtained on at least an annual basis or any time the medication regimen is altered in a way which would result in a change of medication class or result in a significant change in the risks or benefits to the individual; and

(6)

if the individual with the ability to provide legally adequate consent or the LAR consents to the administration of psychoactive medication but is physically unable to provide written consent, the physician will document the verbal consent in the individual's record.

§412.366.Consumer Records.

(a)

In accordance with accepted principals of practice, each MRA or designated provider must insure that a separate confidential record is established and maintained for each individual receiving services. This record must provide accurate documentation of the organization's efforts to provide health care, habilitation and support services, social information, and the protection of rights. The record should provide a readily accessible means of communication among all service providers.

(b)

The MRA or designated provider will ensure that record entries:

are properly corrected when errors in documentation occur;

(6)

are timely;

(7)

are properly signed and dated;

(8)

do not reference other consumers;

(9)

use only accepted abbreviations and symbols;

(10)

provide comprehensible documentation of services provided; and

(11)

are consistent with written policies and procedures.

(c)

Falsification of records is prohibited and the MRA or designated provider will ensure that falsification of records is not supported, encouraged, or condoned under any circumstances.

(d)

The MRA or designated provider must provide and maintain accurate and complete consumer data as required by the state authority through the performance contract or performance memorandum and this subchapter.

(e)

The MRA or designated provider shall make all records, reports, and other program information available for review on a timely basis when requested by the state authority.

§412.367.Environmental Requirements.

The MRA or designated provider ensures that:

(1)

each individual's environment promotes human rights and dignity;

(2)

each individual is served by a sufficient number and type of staff to provide services needed and to insure the safety and health of each individual;

(3)

all sites meet the appropriate chapter of the most recent edition of the Life Safety Code (LSC);

(4)

all sites have emergency plans which address relevant emergencies appropriate for the type of service, geographic location, and the individuals receiving services;

(5)

all staff are knowledgeable of the emergency plans and that staff and individuals follow the plans during both drills and real procedures; and

(6)

the local sanitation codes and licensure requirements are met.

§412.368.Respite Services.

The MRA has written policies and procedures addressing the provision of respite services which shall:

(1)

encourage the use of existing local providers;

(2)

ensure participation by the individual, family, and other actively involved persons in the choice of a qualified provider;

(3)

describe how in-home providers are selected and trained;

(4)

describe how emergency backup for in-home respite care providers is provided;

(5)

address admission procedures; and

(6)

require development of a respite plan which includes addressing the unique medical and support needs of the individual.

§412.369.Additional Requirements.

(a)

The MRA or designated provider assists individuals to enter the service delivery system whether or not they are admitted to direct services operated/contracted by the MRA.

(b)

The MRA or designated provider ensures that information and education materials are available which are adapted to the cultural, economic and educational characteristics and translated into the languages appropriate to the major population subgroups of the local service area.

(c)

The MRA or designated provider ensures that when services which are provided by two or more agencies that services are coordinated/integrated and consistent with the needs of the individual consumer.

(d)

The MRA or designated provider ensures that:

(1)

each individual receiving services and the legally authorized representative are encouraged to participate in the individual's planning team;

(2)

each individual's planning team designs an individually tailored plan of services and supports (formal and informal) which describe what the individual needs to acquire the needed and desired skills and goals and details how the authority will assist and support;

(3)

individual plans are modified or changed in response to the individual's specific accomplishments, need or desire for new programs, or difficulties in acquiring or maintaining skills; and

(4)

each individual has a staff person who is accountable for supporting and assisting the individual in planning, coordinating, and monitoring supports and services.

(e)

The MRA or designated provider ensures that:

(1)

prior to admission to services a determination of mental retardation is made as described in Chapter 405, Subchapter D of this title (relating to Determination of Mental Retardation and Eligibility for Admission to Services.)

(2)

assessments appropriate to the needs of the individual and in response to requests by the individual or legally authorized representative are obtained in order to direct and guide the service provision;

(3)

within 21 days of initial contact the individual is:

(A)

admitted into existing services;

(B)

placed on a waiting list for existing services; or

(C)

determined to be ineligible for services and referred to an agency that can address the service request; and

(4)

when available services have been refused by the individual or legally authorized representative, the refusal is documented and appropriate alternatives are considered.

§412.370.Exhibits.

(a)

Documents adopted by reference in this subchapter include:

(1)

Exhibit A -- The Council's Outcome Based Performance Measures - 1993;

(2)

Exhibit B -- Outcomes for People Results Worksheet;

(3)

Exhibit C -- Outcomes for People Scoring Grid; and

(4)

Exhibit D -- Outcomes for Organizations Worksheet.

(b)

Copies of the Outcome Based Performance Measures listed in subsection (a)(1) of this section may be obtained by contacting The Council, 100 West Road, Suite 406, Towson, Maryland 21204. All other documents listed in subsection (a) of this section may be obtained by contacting the Office of Policy Development, Texas Department of Mental Health and Mental Retardation, P.O. Box, 12668, Austin, Texas 78711-2668.

§412.371.Training.

(a)

Training and other learning opportunities for all stakeholders of the local authority or designated provider and for the members of the external validation teams are based on The Council's Outcome Based Performance Measures and other service quality improvement concepts. Start-up training is provided for all stakeholders, including:

(1)

board members (of local authorities);

(2)

managers and supervisors;

(3)

staff providing services and supports;

(4)

other professional and para-professional staff, including external service providers; and

(5)

consumers, family members, and advocates.

(b)

Training is consistent with guidelines and materials provided by the department and must be tailored to the needs and interests of the stakeholder groups.

(c)

Specific training packages for the QAIS self-assessment review team and the quality improvement plan team include information on interviewing techniques, confidentiality, decision-making, and the processes for implementing the self assessment and the quality improvement plan.

§412.372.References.

Statutes and department rules referenced in this subchapter include:

(1)

Texas Health and Safety Code, §§531.002, 534.052, 534.054; and

(2)

Texas Health and Safety Code, §534.052;

(3)

Texas Health and Safety Code, §534.054(c);

(4)

Texas Health and Safety Code, §534.058;

(5)

Texas Health and Safety Code, §591.006;

(6)

Persons with Mental Retardation Act (Texas Health and Safety Code, Title 7, Subtitle D);

(7)

Texas Medical Practice Act;

(8)

Chapter 401, Subchapter G of this title (relating to Community Mental Health and Mental Retardation Centers.

(9)

Chapter 403, Subchapter K of this title (relating to Client-Identifying Information.)

(10)

Chapter 404, Subchapter A of this title (relating to Abuse, Neglect, and Exploition in TDMHMR Facilities;

(11)

Chapter 404, Subchapter B of this title (relating to Abuse, Neglect, and Exploitation of People served by Providers of Local Authorities);

(12)

Chapter 405, Subchapter Y of this title (relating to Client Rights -- Mental Retardation Services; and

(13)

Life Safety Code.

§412.373.Distribution.

(a)

Copies of this subchapter shall be distributed to:

(1)

members of the Texas Mental Health and Mental Retardation Board;

(2)

executive, management, and program staff of the department's Central Office;

(3)

chairs of boards of trustees of local authorities;

(4)

CEOs of local authorities and designated providers; and

(5)

interested advocates and advocacy organizations.

(b)

The CEOs of local authorities and designated providers are responsible for distributing copies of this subchapter to:

any individual receiving services and supports who requests a copy;

(5)

family members and advocates of individuals receiving services and supports who requests a copy; and

(6)

any employee who requests a copy; and

(7)

any other person who requests a copy.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State, on January 12, 1998.

TRD-9800420

Ann Utley

Chair, Texas MHMR Board

Texas Department of Mental Health and Mental Retardation

Earliest possible date of adoption: February 23, 1998

For further information, please call: (512) 206-4516