Part III.
Texas Commission on Alcohol and Drug Abuse
Chapter 142.
Investigations and Hearings
40 TAC §142.22, §142.31
The Texas Commission on Alcohol and Drug Abuse adopts amendments
to §142.22 and §142.31 concerning Investigations and Hearings without
changes to the proposed text as published in the June 25, 1999 issue of the
These sections contain the procedures concerning investigations of abuse
or neglect of children, the elderly, or the disabled by chemical dependency
counselors or facilities funded or licensed by the commission and describe
the procedures for facility and chemical dependency counselor disciplinary
hearings.
These amendments are adopted to update organizational references and provide
consistency with the Government Code regarding minimum amount of notice that
must be given regarding the date, time and place of administrative hearings.
No comments were received regarding adoption of the amendments.
These amendments are adopted under the Texas Health and Safety
Code, Chapter 464, which provides the Texas Commission on Alcohol and Drug
Abuse with the authority to adopt rules and standards for the licensure of
chemical dependency treatment facilities and under Texas Occupations Code,
Chapter 504, which provides the commission with the authority to establish
procedures for the licensure of chemical dependency counselors.
The codes affected by the adopted amendments are the Texas Health and Safety
Code, Chapter 464 and Texas Occupations Code, Chapter 504.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August
11, 1999.
TRD-9905024
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 1999
Proposal publication date: June 25, 1999
For further information, please call: (512) 349-6733
Subchapter B. Contract Administration
40 TAC §144.101
The Texas Commission on Alcohol and Drug Abuse adopts amendments
to §144.101 concerning Contract Administration. This section is adopted
with changes to the proposed text as published in the June 25, 1999 issue
of the
Texas Register
(24 TexReg 4760).
This section contains information regarding contract acceptance and legal
precedence.
These amendments are adopted to require that providers carry a fidelity
bond or insurance coverage equal to the amount of funding provided under the
commission contract or $100,000, whichever is less; to mandate that this fidelity
bond or insurance must provide for indemnification of losses due to fraudulent
or dishonest acts committed by any of the provider's employees or volunteers
who have access to funds; and to state the required order of legal precedence
that must be followed by providers. Some revisions have been made in response
to comments and, in some instances, wording has been changed for clarity of
content or grammatical correctness.
Comments were received from individuals.
Comment: The proposed rule requires a fidelity bond or insurance coverage
equal to the amount of funding under the commission contract or $100,000,
whichever is less. Previous rules only required bonding for the executive
director and chief financial officer. This will result in greater cost for
providers. The level of coverage required is excessive, as it is highly unlikely
that a fraudulent act would result in the loss of the entire amount of the
grant. It seems overkill to provide a bond for all employees and volunteers
when they have no access to funds.
Response: The commission acknowledges that the cost may be somewhat higher
in some instances, but believes the expanded coverage is necessary to protect
the provider and the commission against general malfeasance and acts of fraud
that may be committed by other staff in the organization. The rule has been
revised to only mandate coverage for individuals with access to funds.
These amendments are adopted under the Texas Health and Safety
Code, §461.012(a)(15) which provides the Texas Commission on Alcohol
and Drug Abuse with the authority to adopt rules governing the functions of
the commission, including rules that prescribe the policies and procedures
followed by the commission in administering any commission programs.
The code affected by these amendments is the Texas Health and Safety Code,
Chapter 461.
§144.101.Contract Acceptance and Legal Precedence.
(a)
To execute a contract, the provider shall submit an original
acceptance notice signed by an official authorized to enter into such agreements
on behalf of the governing body within 14 calendar days of the contract's
postmark date. If board approval is required and cannot be obtained within
14 days, the provider must submit a written extension request before the deadline
which includes the date of the scheduled board meeting.
(b)
Changes in state or federal laws and regulations may affect
contract provisions. Any modifications resulting from such changes are automatically
made part of the contract and go into effect on the date set by the law or
regulation.
(c)
The provider shall have insurance or other provisions to
ensure that assets purchased with commission funds will be replaced if lost,
destroyed, damaged, or stolen.
(d)
The provider shall carry a fidelity bond or insurance coverage
equal to the amount of funding provided under the commission contract(s) or
$100,000, whichever is less. The fidelity bond or insurance must provide for
indemnification of losses due to fraudulent or dishonest acts committed by
any of the provider's employees or volunteers who have access to funds, either
individually or in concert with others.
(e)
Providers shall follow this order of legal precedence:
(1)
federal and state laws (including, but not limited to the
federal block grant found at United States Code, Title 42, §300x);
(2)
rules adopted by the commission and applicable federal
regulations;
(3)
terms and conditions of the contract;
(4)
requirements stated in the request for proposals;
and
(5)
the application as amended or adjusted by the commission.
This agency hereby certifies that the adoption has been
reviewed by legal counsel and found to be a valid exercise of the agency's
legal authority.
Filed with the Office of the Secretary of State on August
11, 1999.
TRD-9905028
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 1999
Proposal publication date: June 25, 1999
For further information, please call: (512) 349-6733
40 TAC §§144.105, 144.122, 144.125
The Texas Commission on Alcohol and Drug Abuse adopts the
repeal of §§144.105, 144.122 and 144.125 concerning Contract Administration
without changes to the proposed text as published in the June 25, 1998, issue
of the
Texas Register
(24 TexReg 4763).
These sections contain the requirements for legal precedence, double billings,
and Medicaid.
These sections are repealed because the requirements in these sections
have been incorporated into other sections.
No comments were received regarding the adoption of the repeals.
The repeals are adopted under the Texas Health and Safety Code,
§461.012(a)(15) which provides the Texas Commission on Alcohol and Drug
Abuse with the authority to adopt rules governing the functions of the commission,
including rules that prescribe the policies and procedures followed by the
commission in administering any commission programs.
The code affected by the repeals is the Texas Health and Safety Code, Chapter
461.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August
11, 1999.
TRD-9905030
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 1999
Proposal publication date: June 25, 1999
For further information, please call: (512) 349-6733
40 TAC §§144.201, 144.203, 144.204, 144.211-144.216
The Texas Commission on Alcohol and Drug Abuse adopts amendments
to §§144.201 and 144.211-144.216 and adopts new §144.203 and
§144.204 concerning Program Oversight. Section 144.201 is adopted with
changes to the proposed text as published in the June 25, 1999 issue of the
These sections contain information regarding commission oversight, on-site
contract reviews, on-site compliance reviews, independent audit report, auditor
qualifications, independent audit report requirements, independent audit report
submission, corrective action plan, and audit report desk reviews.
These amendments and new sections are adopted to clarify how the commission
may provide oversight to funded providers; to describe the purpose of and
process for on-site contract reviews and inform providers of their responsibilities
for responding to identified issues; to outline the on-site compliance review
process including provider response and corrective action; to clarify the
rules regarding required single audits and program audits; to specify that
auditors must be licensed in the state in which the audit is performed at
the time the audit is performed; to clarify what requirements must be included
in the audit report; to specify that the rules regarding audit submission
refer to independent audit reports; to clarify that the corrective action
plan relates to the independent financial audit report and management letter;
and to more accurately name and describe the audit report desk review process.
Comments were received from the Association of Substance Abuse Programs
and individuals.
Comment received regarding §144.201: We strongly oppose this addition
because it appears to allow TCADA to remove original documents from facility
premises to make copies. This is unacceptable, the loss of these original
documents would make it impossible for the facility to defend themselves in
the event that legal or audit issues arose.
Response: This is not a change from current rules. The commission does
not, under normal circumstances, remove any records from the provider's site.
This provision is included for those very rare occasions when removing a document
might be necessary to remove a document for a short period of time to protect
its integrity during an investigation.
Comment regarding §144.203 and §144.204: These appear to be new
terms and have caused confusion. What is the difference between the two? If
they are replacing old terms such as monitoring visits, please clarify and
highlight in the Provider Bulletin or Handbook. I am also concerned about
the statement that the results of the on-site contract review will be used
by the commission in future funding decisions.
Response: The on-site contract review is what has been called a monitoring
visit. This function is conducted by staff in the commission's program branch.
On-site compliance reviews are also referred to as compliance visits, or audits.
They are conducted by staff in the commission's quality assurance branch.
The commission believes it is necessary to consider past provider performance
in funding decisions, and the on-site contract review is one indicator of
performance.
These amendments and new sections are adopted under the Texas
Health and Safety Code, §461.012(a)(15) which provides the Texas Commission
on Alcohol and Drug Abuse with the authority to adopt rules governing the
functions of the commission, including rules that prescribe the policies and
procedures followed by the commission in administering any commission programs.
The code affected by these amendments and new sections is the Texas Health
and Safety Code, Chapter 461.
§144.201.Commission Oversight.
(a)
All commission-funded providers, regardless of the level
of funding, are subject to periodic reviews by the commission for adherence
with applicable federal, state and commission statutes and regulations and
contract requirements. These include contract desk reviews, on-site contract
reviews, and compliance reviews.
(b)
The commission shall determine the extent of the review.
(c)
The commission may conduct a scheduled or unannounced on-site
reviews or request the provider to submit materials for desk review.
(d)
The applicant shall allow commission staff to access the
facility's grounds, buildings, and records and to interview members of the
governing body, staff, and clients.
(e)
The provider shall allow commission staff to examine all
property and examine or copy all books, recordings, client records, and documents
related to the contract or a commission requirement on or off the premises.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August
11, 1999.
TRD-9905031
Mark Smock
Deputy Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 1999
Proposal publication date: June 25, 1999
For further information, please call: (512) 349-6733
40 TAC §144.202
The Texas Commission on Alcohol and Drug Abuse adopts the
repeal of §144.202 concerning Program Oversight without changes to the
proposed text as published in the June 25, 1999, issue of the
Texas Register
(24 TexReg 4766).
This section contains the requirements for organization response.
The section is repealed because the requirements in this section have been
incorporated into other sections.
No comments were received regarding the adoption of the repeal.
The repeal is adopted under the Texas Health and Safety Code,
§461.012(a)(15) which provides the Texas Commission on Alcohol and Drug
Abuse with the authority to adopt rules governing the functions of the commission,
including rules that prescribe the policies and procedures followed by the
commission in administering any commission programs.
The code affected by the repeal is the Texas Health and Safety Code, Chapter
461.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August
11, 1999.
TRD-9905032
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 1999
Proposal publication date: June 25, 1999
For further information, please call: (512) 349-6733
40 TAC §§144.312, 144.313, 144.321, 144.322, 144.324, 144.325, 144.327
The Texas Commission on Alcohol and Drug Abuse adopts amendments
to §§144.312, 144.313, 144.322, 144.324, and 144.325 and adopts
new §144.321 and §144.327 concerning organizational requirements.
Section 144.313 and §144.322 are adopted with changes to the proposed
text as published in the June 25, 1999 issue of the
Texas Register
(24 TexReg 4766). Sections 144.312, 144.321, 144.324,
144.325, 144.327 are adopted without changes and will not be republished.
These sections contain information regarding organizational structure,
governing body and chief executive officer, policies and procedures, records,
limiting barriers, complaints and reports, and standards of conduct.
These amendments and new sections are adopted to expand these rules to
make them comparable to facility licensure standards (which apply only to
treatment providers) so that prevention providers are held to the same organization
standards as treatment providers; to replace the term executive director with
chief executive officer; to require providers to maintain documentation signed
by each employee that policies and procedures have been read and understood;
to replace the term governing authority with governing body; to ensure that
members of the governing body are aware of their responsibilities and liabilities
as well as the program's target populations and their particular cultural
needs; to specify the minimum requirements for and responsibilities of a chief
executive officer; to establish requirements for policies and procedures;
to clarify that providers must maintain current personnel documentation on
each employee and to list the minimum items that must be included; to clarify
the retention requirements for contract related records; to require a written
policy prohibiting discrimination; to mandate that providers retain documentation
of formal agreements and contracts to address identified problems with program
service access by people with disabilities; to expand the requirements for
handling complaints to include complaints from clients, participants and their
families; to state that reports of abuse, neglect or exploitation must be
made verbally to the commission's investigation department; and to establish
standards of conduct for the program and its personnel.
Comments on 144.321 were received from the Association of Substance Abuse
Programs and individuals.
Comment: This rule references TCADA Workplace and Education Guidelines
for HIV and Other Communicable Diseases. Is this different from what is currently
required and should programs already have a copy of this? Why is this being
changed?
Response: The current rule references workplace guidelines published by
the Texas Department of Health. TCADA developed its own workplace guidelines
because the TDH guidelines did not focus on communicable diseases (hepatitis
and tuberculosis) encountered by TCADA providers and the populations they
serve. The TDH guidelines also lack the Center for Disease Control's standard
precautions for infection control. The new TCADA guidelines will be mailed
to all funded providers with the revised rules.
These amendments and new sections are adopted under the Texas
Health and Safety Code, §461.012(a)(15) which provides the Texas Commission
on Alcohol and Drug Abuse with the authority to adopt rules governing the
functions of the commission, including rules that prescribe the policies and
procedures followed by the commission in administering any commission programs.
The code affected by these amendments and new sections is the Texas Health
and Safety Code, Chapter 461.
§144.313.Governing Body and Chief Executive Officer.
(a)
All entities shall have a governing body that is legally
responsible for the integrity of the fiscal and programmatic management of
the organization.
(b)
The governing body shall be a separate business entity
with legal authority to operate in the State of Texas.
(c)
Staff members, including the chief executive officer, of
a public or nonprofit entity shall not serve on their employer's governing
board.
(d)
The governing body shall appoint a chief executive officer
to manage the day-to-day operations of the organization and ensure that the
organization has the programmatic, managerial, and financial capability to
ensure proper planning, management, and delivery of funded services.
(e)
The governing body shall meet at least quarterly and maintain
minutes that include:
(1)
date, time, and place of the meeting;
(2)
names of members present and absent; and
(3)
summary of discussion and action taken.
(f)
The governing body shall provide all members with information
about the responsibilities and liabilities of the governing body and its individual
members.
(g)
The governing body shall ensure that all of its members
are familiar with the program's target population and sensitive to the needs
of the different cultures represented.
(h)
The chief executive officer shall:
(1)
have documented education and/or experience in financial,
administrative, and personnel management, and other areas needed to manage
the facility effectively;
(2)
ensure compliance with applicable laws and rules;
(3)
ensure that all staff are competent and trained;
(4)
establish mechanisms to ensure quality of services;
and
(5)
maintain adequate financial records according to generally
accepted accounting principles.
§144.322.Records.
(a)
The provider shall maintain current personnel documentation
on each employee. Training records may be stored separately from the main
personnel file, but shall be easily accessible upon request. Required documentation
includes, as applicable:
(1)
a copy of the current job description signed by the employee;
(2)
application or resume with documentation of required
qualifications;
(3)
documentation that required credentials were verified
directly with the credentialing body;
(4)
annual performance evaluations;
(5)
personnel data that includes date hired, rate of pay,
and documentation of all pay increases and bonuses;
(6)
documentation of appropriate screening and/or background
checks;
(7)
signed documentation of initial and other required
training; and
(8)
records of any disciplinary actions.
(b)
The provider shall maintain all records relating to the
contract for at least three years from the date the independent financial
audit is due (when required) or would have been due (when not required) as
stated in §144.214 of this title (relating to Independent Audit Report
Submission). If any litigation, audit, or other action is in process at the
end of three years, the records must be kept until the action is resolved.
If a provider closes business operations, it shall ensure that records relating
to the contract are securely stored and accessible for at least three years.
The provider shall provide the commission with the name and address of the
responsible party.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August
11, 1999.
TRD-9905033
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 1999
Proposal publication date: June 25, 1999
For further information, please call: (512) 349-6733
40 TAC §144.321
The Texas Commission on Alcohol and Drug Abuse adopts the
repeal of §144.321 concerning organizational responsibilities without
changes to the proposed text as published in the June 25, 1999, issue of the
This section contains the requirements for HIV policies.
The section is repealed because the requirements in this section have
been incorporated into a new section that addresses all required policies.
No comments were received regarding the adoption of the repeal.
The repeal is adopted under the Texas Health and Safety Code,
§461.012(a)(15) which provides the Texas Commission on Alcohol and Drug
Abuse with the authority to adopt rules governing the functions of the commission,
including rules that prescribe the policies and procedures followed by the
commission in administering any commission programs.
The code affected by the repeal is the Texas Health and Safety Code, Chapter
461.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August
11, 1999.
TRD-9905035
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 1999
Proposal publication date: June 25, 1999
For further information, please call: (512) 349-6733
40 TAC §144.326
The Texas Commission on Alcohol and Drug Abuse adopts new
§144.326 concerning organizational requirements. This section is adopted
with changes to the proposed text as published in the June 25, 1999 issue
of the
Texas Register
(24 TexReg 4769).
This section contains information regarding staffing.
This new section is adopted to establish minimum requirements related to
staffing. This entire subchapter is being expanded to make these rules comparable
to the facility licensure standards (which apply only to treatment providers).
This expansion ensures that prevention providers are held to the same organization
standards as treatment providers. Thus, this new section will ensure that
prevention providers are held to the same staffing standards as treatment
providers. There is one new requirement included in this new section which
is that providers must obtain the results of a criminal background check for
each staff person who has contact with adolescents and/or children.
Comments were received from individuals.
Comment: The language in this section can be very open to interpretation.
For example "suitability of staff members" - how do we define "suitability"?
We would like to have more objectivity for monitoring purposes.
Response: Given the immense diversity in programs, it is not feasible to
provide concrete and specific standards for staffing. Furthermore, we believe
programs should have the responsibility and authority to determine the details
of their program design and staffing. As far as contract reviews ("monitoring")
are concerned, the provider is expected to provide clear justification for
its staffing decisions.
Comment: We oppose this standard as written, because the initial orientation
requirements in Chapter 144 should be consistent with §148.113(b).
Response: The rule was written to parallel the licensure requirements.
Although the wording is slightly different, the only content difference is
the exclusion of emergency and evacuation procedures. This topic was not included
because chapter 144 does not require providers to adopt emergency and evacuation
procedures. The rule has been revised to make the wording as similar as possible.
This new section is adopted under the Texas Health and Safety
Code, §461.012(a)(15) which provides the Texas Commission on Alcohol
and Drug Abuse with the authority to adopt rules governing the functions of
the commission, including rules that prescribe the policies and procedures
followed by the commission in administering any commission programs.
The code affected by this section is the Texas Health and Safety Code,
Chapter 461.
§144.326.Staffing.
(a)
The provider shall have an adequate number of qualified
staff to comply with commission rules, provide the services described in the
program description, and protect the health, safety, and welfare of clients/participants.
(b)
The program shall hire applicants who meet the minimum
qualifications listed in the job description.
(c)
The application or resume shall document required education,
training, and related work experience.
(d)
The facility shall develop and implement procedures for
reviewing the background and suitability of any employee with access to clients/participants.
The review shall be appropriate for each person's level of access and shall
adequately protect clients/participants.
(e)
The program shall obtain the results of a statewide criminal
background check from the Department of Public Safety on all staff with access
to adolescents or children.
(f)
The facility shall ensure that staff are adequately trained
and competent to perform job duties.
(g)
Each employee shall complete initial training during the
first seven calendar days of employment. The initial training shall include,
as applicable:
(1)
client/participant rights;
(2)
client/participant complaint procedures;
(3)
confidentiality of client/participant-identifying
information;
(4)
client/participant abuse, neglect, and exploitation;
(5)
requirements for reporting abuse, neglect, and exploitation;
(6)
standards of conduct; and
(7)
the individual's specific job duties.
(h)
The program shall establish an annual staff training plan
for employees based on the program design and identified staff needs. The
plan must include annual cultural competency training for all employees.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August
11, 1999.
TRD-9905034
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 1999
Proposal publication date: June 25, 1999
For further information, please call: (512) 349-6733
40 TAC §§144.411-144.416, 144.441-144.447, 144.451-144.455, 144.457–144.460, 144.462
The Texas Commission on Alcohol and Drug Abuse adopts amendments
to §§144.411-144.416 and 144.441-144.447 and adopts new §§144.451-144.455,
144.457-144.460 and 144.462 concerning Prevention and Intervention. Sections
144.411, 144.412, 144.416, and 144.441 are adopted with changes to the proposed
text as published in the June 25, 1999 issue of the
Texas Register
(24 TexReg 4770). Sections 144.413-144.415, 144.447,
144.451-144.455, 144.457-144.460 and 144.462 are adopted without changes to
the proposed text and will not be republished.
These sections contain information regarding program design and implementation,
program self-evaluation, performance and activity measures, performance measure
review, participant rights, smoking policies, information dissemination, prevention
education and skills training, alternatives, problem identification and referral,
community-based process, environmental and social policy, intervention services,
youth prevention programs, youth intervention programs, community coalitions,
prevention training services, prevention resource centers, pregnant postpartum
prevention programs, pregnant postpartum intervention programs, other special
prevention programs, HIV early intervention services, and HIV outreach services.
These amendments and new sections are adopted to reorganize the rules to
present them in more logical order; to clarify the process and requirements
for program design and implementation; to describe the requirements for self-evaluation
of programs; to specify that performance and activity measures may be defined
for both the primary and secondary target populations; to refine the performance
measure review process; to clarify that participant rights apply to participants
in both prevention and intervention programs; to outline the additional rights
of participants in intervention programs; to require programs to have written
smoking policies and to prohibit all adults from using tobacco products in
the presence of adolescent program participants on site; to clarify the requirements
related to information dissemination; to refine the requirements related to
prevention education and skills training; to more fully describe the strategy
of alternatives; to include identification of risk factors for HIV and sexually
transmitted diseases during the screening process; to expand the requirements
related to follow-up in the problem identification and referral strategy;
to present the community-based process in a more organized and detailed manner;
to more fully describe intervention services and present the requirements
related to these services in a logical and organized format; to add requirements
for each program type that may be funded as a prevention or intervention program;
and to make grammatical changes to improve readability and understanding.
Some revisions have been made in response to comments and, in some instances,
wording has been changed for clarity of content or grammatical correctness.
Comments were received from the Association of Substance Abuse Programs
and individuals.
The following comments were received regarding §144.411.
Comment: This sections talks about long-range goals. What is the time frame?
Response: No specific time frame is implied. The goals should describe
what the program is trying to accomplish.
Comment: The examples of universal, selective and indicated populations
do not exactly reflect the Institute of Medicine (IOM) definitions where the
indicated target population includes groups with identified risk factors,
beyond experimentation and problem behaviors, such as prenatally substance-exposed
young children, developmentally delayed youth, pregnant adolescents, victims
of domestic violence, etc.
Response: The commission disagrees. Selective prevention programs target
specific subgroups that are believed to be at greater risk than the general
population. Risk groups may be identified on the basis of biological, psychological,
social, or environmental risk factors. Pregnant adolescents would be part
of an indicated population because of their high-risk behaviors, but the others
listed are at risk because of their physical or environmental risk factors.
Comment received regarding §144.412: The rule says that prevention
programs need to do self-evaluation unless exempted through an executive order.
What is an executive order? How do you get one?
Response: To avoid confusion, the commission will specifically list programs
required to perform self-evaluation and delete the reference to an executive
order.
The following are comments received in regard to §144.416.
Comment: The rule states that staff and "other adults" can't use tobacco
products in the presence of participants. This needs further definition. Does
it include our clients, participants in a 12 step program that use our facility
but aren't in our program, etc.?
Response: "Other adults" includes all other adults: volunteers, clients,
and visitors. The rule has been revised to clarify this.
Comment: We oppose this standard as written. We do not want to support
or promote the use of tobacco products, however, this rule is problematic
and unrealistic. The way this rule is written when a program transports clients
to a 12-step meetings and/or recovery support group recreational activities
(both of which are structured program activities), then the staff would be
inappropriately required to police this issue. An on premises prohibition
is sufficient.
Response: The commission agrees. The text has been revised to clarify that
the rule only applies on the program site.
Comment: We have an adult-only facility. Does this mean that none of our
clients or 12-step groups can smoke outside the building in the view of other
clients?
Response: This rule only applies to prevention programs. Smoking regulations
for treatment facilities are located in the licensure rules. The rule has
been revised to clarify that it refers to adolescent participants.
Comment received regarding §144.442: The rule requires curricula to
be based on proven, effective principles. Who decides what are proven effective
principles? Who says the activities are OK? Would suggest the old language,
...
or an outline approved by the commission
remain. This allows for flexibility and provides non-NIDA identified research
based programs (an assumption the language
proven,
effective principles
implies) the opportunity to be approved.
Response: The provider is responsible for researching literature discussing
current research and best practices and using that information to adopt, modify,
or develop an appropriate curriculum. The language was carefully chosen to
allow providers to choose or develop their own curricula (rather than adopting
a NIDA-identified model), provided it incorporates principles and practices
supported by research. The provider is also responsible for designing appropriate
activities to implement the curricula. The overall program, including curricula
and activities, is approved by the commission through the funding process.
Comment regarding §144.445: The proposed rule requires working agreements
to be redone annually. This is a hardship for agencies with lots of working
agreements. We have over 70 working agreements. Since we tailor the agreement
to each agency, it would be a full-time job to negotiate these every year.
This is cost prohibitive and does not measure whether people are really working
together. We would like there to be something that an agency could do by itself
that says this is still what we want to do and not have to get with all the
other agencies to renew yearly. Another alternative would be to include language
in the agreement that it is on-going unless there is a significant change
in agency operations.
Response: Working agreements need to be reviewed regularly to see if revisions
are needed and to reaffirm mutual commitment to the agreement. Annual review
can be particularly helpful in renewing a relationship that has been disrupted
by staff turnover. It gives both agencies the opportunity to remind staff
of appropriate procedures and obligations under the agreement. While a written
document does not guarantee effective implementation and coordination, it
is an important foundation for long-term organizational collaboration. To
streamline the paperwork, agreements can be printed with multiple signature/date
lines, so that the original copy can simply be resigned if it is still appropriate.
We have also revised the rule to allow the agreements to be renewed through
other documented contacts. For example, the providers could review the agreement
by phone and document the results.
Comment regarding §144.447: We run an intervention program. Intervention
services are beginning to look more like treatment services with the types
of documentation that are being required. One way of possibly pulling intervention
services out is to actually separate intervention services from prevention
services because as it is, it is confusing.
Response: The distinction between prevention, intervention and treatment
is the target population. Treatment programs serve individuals who meet the
DSM-IV criteria for substance abuse or dependence. Intervention programs serve
individuals (indicated) who do not meet DSM-IV criteria but are showing early
warning sign such as failing grades, dropping out of school, and/or use of
alcohol and other gateway drugs. The basic units of documentation are similar
for intervention and treatment, but the documentation requirements are much
more comprehensive and detailed for treatment programs. We are using the term
"intervention" to help distinguish this kind of program from other prevention
programs, who serve the general population (universal) or at-risk groups (selective).
Comment regarding §144.452: Is this different from a Youth Prevention
Intervention program (YPI)?
Response: No.
Comment regarding §144.455: One of the required services is "prevention
needs assessment and resource identification." Is this an annual needs assessment
or something else?
Response: The assessment process should be ongoing. Formal components of
the needs assessment might be conducted annually or more often as needed.
The following comments were received in regard to §144.456.
Comment: The rule says that within one hour, the client is to be given
the opportunity to talk with a trained counselor or trained volunteer. What
does the volunteer need to be trained in?
Response: Volunteers should be trained in crisis intervention and have
knowledge of available community resources. Training in chemical dependency
would also be helpful. The rule has been revised to provide clarification.
Comment: For a small council, with a very small staff and virtually no
volunteers, this is a very difficult requirement. Those councils that serve
a number of counties with a small staff and very limited resources may not
be able to meet this requirement.
Response: The commission acknowledges that this requirement will be more
difficult for small councils. However, we believe the service is essential,
and that it can be provided even when there are few staff to share on-call
responsibilities. Councils can also meet this requirement by pooling resources
with other health and human service providers, forwarding calls to an existing
hotline, or similar arrangements.
Comment: The rule requires crisis intervention services. How do you define
intervention in terms of crisis? How do you get clients to where they need
to go when you can't by law disclose information to another agency without
the client signing a release form, which means you have to see him or her
in person?
Response: Crisis intervention is defined in §144.21. When referrals
are given over the phone, it is not necessary to contact the program to which
the client is referred. However, contact between the two programs can be beneficial,
particularly if the council will be involved in providing aftercare. It also
allows referring agencies to track the follow-through rate on referrals. One
way to accomplish this is for the receiving agency to ask applicants where
they were referred from, and then to obtain consent to release information
back to the referring agency.
The following comments were received in regards to §144.457 and §144.458.
Comment: I am concerned about doing away with Infant Primary Prevention
Intervention program category. Though in the old rules there never was a real
good match between the brief descriptive statements and the title, at least
the title better described our primary target population (infants).
Response: This is a change in terminology and does not exclude programs
focused on infants.
Comment: What will the quarterly report contain that our measures don't
cover already? Why must there be multiple reporting processes and forms?
Response: Narrative reports, which are generally required only in specialized
programs, provide a vehicle to collect information needed to monitor program
implementation. They complement performance and activities measures to provide
a more comprehensive view of program performance.
These amendments and new sections are adopted under the Texas
Health and Safety Code, §461.012(a)(15) which provides the Texas Commission
on Alcohol and Drug Abuse with the authority to adopt rules governing the
functions of the commission, including rules that prescribe the policies and
procedures followed by the commission in administering any commission programs.
The code affected by these amendments and new sections is the Texas Health
and Safety Code, Chapter 461.
§144.411.Program Design and Implementation.
(a)
The provider shall determine what population(s) the program
is designed to serve: universal, selective or indicated.
(1)
Universal programs reach the general population (such as
all students in a school).
(2)
Selective programs target a subset of the general
population which is at high risk for substance abuse (such as children of
drug users).
(3)
Indicated programs are designed for those who may
already be experimenting with drugs or who exhibit other problem-related behaviors.
(b)
The program shall identify and describe the primary and
secondary target populations including specific information about:
(1)
age, gender, and ethnicity;
(2)
risk and protective factors;
(3)
patterns of substance use;
(4)
social and cultural characteristics;
(5)
knowledge, beliefs, values, and attitudes; and
(6)
needs.
(c)
The program shall identify long-range goals which:
(1)
address identified risks, needs and/or problems of the
primary and secondary target populations;
(2)
are designed to enhance protective factors;
(3)
clearly describe behavioral and/or societal changes
to be achieved; and
(4)
are realistic in relation to available resources.
(d)
The program shall establish objectives for each contract
period that are linked to the goals. Objectives must:
(1)
be realistic, outcome oriented, measurable, and time-specific;
(2)
include performance and activity measures required
in the contract; and
(3)
address specific family strategies, as applicable
(e)
The program design shall be based on a logical, conceptually
sound framework to connect the prevention or intervention effort with the
intended result of preventing alcohol, tobacco, and other drug problems. The
program shall gather and use reliable evidence of effectiveness from comparable
programs to select and guide the program design. The program shall use results
that come from sound studies to assess potential effectiveness of the program
design relative to the needs of the target population.
(f)
In order to carry out the program design, the program shall
incorporate a combination of some or all of CSAP's six prevention strategies
(information dissemination, prevention education and skills training, alternative
activities, problem identification and referral, community-based process,
and environmental and social policy). All Youth Prevention Programs (YPP)
and Youth Prevention Intervention (YPI) Programs must at a minimum conduct
prevention education and skills training as a core strategy. Each strategy
and activity must:
(1)
relate directly to program goals and objectives; and
(2)
address identified needs.
(g)
The program shall be designed to build on and support related
prevention and intervention efforts in the community. The program shall secure
and maintain the support of key decision makers and leaders, and shall establish
formal linkages and coordinate with other community resources.
(h)
The program shall be appropriately structured to implement
the program design. The prevention effort shall be consistent with the availability
of personnel, resources, and realistic opportunities for implementation.
(i)
The program design, content, communications, and materials
shall:
(1)
be available in the primary language of the target population;
(2)
be appropriate to the literacy level, gender, race,
ethnicity, sexual orientation, age, and developmental level of the target
population; and
(3)
recognize the cultural identification (context) of
the family unit.
(j)
The program design shall be delivered at an appropriate
time with sufficient intensity and applied over an appropriate duration so
that results can be sustained.
§144.412.Program Self-Evaluation.
(a)
The program shall perform self-evaluation to verify, document,
and quantify program activities and effectiveness. Programs required to complete
the self-evaluation include Youth Prevention Programs, Youth Intervention
Programs, Community Coalitions, Core Council Services, Pregnant-Post Partum
Prevention Programs, Pregnant-Post Partum Intervention Programs, Adult Primary
Prevention, HIV Early Intervention Services, HIV Outreach Services, and Compulsive
Gambling.
(b)
Programs shall conduct evaluation activities using the
Prevention Plus III format unless the commission has approved an alternative
model.
(c)
For programs in the first year of funding from the commission,
the evaluation process must include:
(1)
identification of goals and objectives (PP III Step 1);
(2)
assessment of the service delivery process (PP III
Step 2); and
(3)
a plan for assessment of the program outcomes (plan
for PP III Step 3).
(d)
In subsequent funding years, the evaluation must include:
(1)
identification of goals and objectives (PP III Step 1);
(2)
assessment of the service delivery process (PP III
Step 2); and
(3)
implementation of the assessment of the program outcomes
(PP III Step 3).
(e)
The program shall submit a written evaluation report using
the format specified by the commission. The provider must submit the report
at the end of each contract period, no later than September 30th unless otherwise
stipulated in the contract.
(f)
The program shall use information gained from the annual
self-evaluation to make appropriate changes to the program and the staff training
plan. Any change requiring commission approval must be made through a contract
amendment as described in §144.103 of this title(relating to Amendments).
§144.416.Smoking Policies.
(a)
The program shall prohibit smoking inside program buildings.
(b)
The program shall not allow vending machines that dispense
tobacco products on site.
(c)
Staff shall not provide, distribute, or facilitate participant
access to tobacco products.
(d)
Staff and other adults (volunteers, clients, and visitors)
shall not use tobacco products in the presence of adolescent participants
on the program site.
(e)
The program shall prohibit adolescents from using tobacco
products on the program site or during structured program activities.
(f)
The program shall have a written smoking policy that complies
with this section.
§144.441.Information Dissemination.
(a)
Each program that provides activities within this strategy
shall disseminate information about these topics as appropriate for the target
population:
(1)
the nature and extent of alcohol, tobacco, and other drug
use, abuse, and addiction;
(2)
HIV infection, tuberculosis, hepatitis, and sexually
transmitted diseases; and/or
(3)
information about available services and resources.
(b)
The information shall be accurate and current.
(c)
The information shall be accessible and understandable
to the target population in terms of:
(1)
content; and
(2)
mode, time, and location of delivery.
(d)
The program shall document the number of persons receiving
written information/literature.
(e)
For presentations, documentation shall include, as applicable:
(1)
date, time, and duration of activity;
(2)
location of activity;
(3)
staff/volunteers conducting activity;
(4)
purpose and goal of activity; and
(5)
number of participants.
This agency hereby certifies that the adoption has been
reviewed by legal counsel and found to be a valid exercise of the agency's
legal authority.
Filed with the Office of the Secretary of State on August
11, 1999.
TRD-9905036
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 1999
Proposal publication date: June 25, 1999
For further information, please call: (512) 349-6733
40 TAC §144.417
The Texas Commission on Alcohol and Drug Abuse adopts new
§144.417, concerning Prevention and Intervention. This new section is
adopted without changes to the proposed text as published in the June 25,
1999, issue of the
Texas Register
(24 TexReg
4777) and will not be republished.
This section contains information regarding staff training.
This new section is adopted to establish requirements for training the
staff of prevention and intervention programs, including training during the
first six months after hire and annually thereafter.
A comment on this section was received from an individual.
Comment: The staff training requirement of eight hours in subsequent years
seems excessive, particularly if restricted in content to the area of prevention
training. In the cases of well-implemented and stable intervention programs
with demonstrable positive outcomes, this rule will necessitate time be taken
from direct services to fulfill an arbitrary hourly requirement. We would
recommend that the staff training plan, both in content and time (number of
hours) and for both initial and subsequent training efforts, be individually
determined based on program design and be submitted to TCADA for approval
annually. Response: Well trained staff are essential. We do not believe eight
hours of training over the course of a year is excessive, particularly because
many individuals have no background or training when they are hired. Initial
training may be waived for individuals with documentation of equivalent training.
We also believe the guidelines are broad enough to allow programs to design
individualized training plans. After the initial training, the only requirement
is that the content be related to the program design.
This new section is adopted under the Texas Health and Safety
Code, §461.012(a)(15) which provides the Texas Commission on Alcohol
and Drug Abuse with the authority to adopt rules governing the functions of
the commission, including rules that prescribe the policies and procedures
followed by the commission in administering any commission programs.
The code affected by this section is the Texas Health and Safety Code,
Chapter 461.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August
11, 1999.
TRD-9905037
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 1999
Proposal publication date: June 25, 1999
For further information, please call: (512) 349-6733
40 TAC §§144.431-144.435
The Texas Commission on Alcohol and Drug Abuse adopts the
repeal of §§144.431-144.435, concerning Prevention and Intervention
without changes to the proposed text as published in the June 25, 1998, issue
of the
Texas Register
(24 TexReg 4777).
These sections contain the requirements for HIV early intervention services,
HIV outreach services, prevention resources centers, infant primary prevention
and intervention programs, and core council services.
The sections are repealed because this entire subchapter has been reorganized
to present the rules in a more logical order. The requirements of these sections
are incorporated into new sections that are being adopted concurrently.
No comments were received regarding the adoption of the repeals.
The repeals are adopted the Texas Health and Safety Code, §461.012(a)(15)
which provides the Texas Commission on Alcohol and Drug Abuse with the authority
to adopt rules governing the functions of the commission, including rules
that prescribe the policies and procedures followed by the commission in administering
any commission programs.
The code affected by the repeals is the Texas Health and Safety Code, Chapter
461.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August
11, 1999.
TRD-9905039
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 1999
Proposal publication date: June 25, 1999
For further information, please call: (512) 349-6733
40 TAC §144.456
The Texas Commission on Alcohol and Drug Abuse adopts new
§144.456, concerning Prevention and Intervention. The amendment is adopted
with changes to the proposed text as published in the June 25, 1999, issue
of the
Texas Register
(24 TexReg 4778).
This section contains information regarding core council services.
This section is adopted because this section was reorganized to present
the information in a more logical order and to require that Core Council service
providers render crisis intervention services.
Comments on this section were received from individuals.
Comment: The rule says that within one hour, the client is to be given
the opportunity to talk with a trained counselor or trained volunteer. What
does the volunteer need to be trained in?
Response: Volunteers should be trained in crisis intervention and have
knowledge of available community resources. Training in chemical dependency
would also be helpful. The rule has been revised to provide clarification.
Comment: For a small council, with a very small staff and virtually no
volunteers, this is a very difficult requirement. Those councils that serve
a number of counties with a small staff and very limited resources may not
be able to meet this requirement.
Response: The commission acknowledges that this requirement will be more
difficult for small councils. However, we believe the service is essential,
and that it can be provided even when there are few staff to share on-call
responsibilities. Councils can also meet this requirement by pooling resources
with other health and human service providers, forwarding calls to an existing
hotline, or similar arrangements.
Comment: The rule requires crisis intervention services. How do you define
intervention in terms of crisis? How do you get clients to where they need
to go when you can't by law disclose information to another agency without
the client signing a release form, which means you have to see him or her
in person?
Response: Crisis intervention is defined in §144.21. When referrals
are given over the phone, it is not necessary to contact the program to which
the client is referred. However, contact between the two programs can be beneficial,
particularly if the council will be involved in providing aftercare. It also
allows referring agencies to track the follow-through rate on referrals. One
way to accomplish this is for the receiving agency to ask applicants where
they were referred from, and then to obtain consent to release information
back to the referring agency.
This new section is adopted under the Texas Health and Safety
Code, §461.012(a)(15) which provides the Texas Commission on Alcohol
and Drug Abuse with the authority to adopt rules governing the functions of
the commission, including rules that prescribe the policies and procedures
followed by the commission in administering any commission programs.
The code affected by this new section is the Texas Health and Safety Code,
Chapter 461.
§144.456.Core Council Services
(a)
Core council service providers are community-based organizations
that provide alcohol, tobacco and other drug prevention and intervention services
to the community at large in their identified catchment area. Core council
service providers conduct a variety of services aimed to reduce use and abuse
of ATOD in the targeted community(ies) including information, referral and
placement services.
(b)
Core council services programs shall offer universal, selective
and indicated strategies to individuals, families, and communities within
the service area defined in the contract.
(c)
Minimum core council services shall include the following:
(1)
Information dissemination shall be provided for the purposes
of awareness and case finding in the community.
(2)
Problem identification and referral shall be provided
for the purpose of the identification of appropriate treatment needs through
screening, referral, placement and follow-up.
(3)
Crisis intervention services shall be provided for
the purpose of providing immediate response to individuals and/or families
in crisis who may call or present themselves in need of core council services.
(A)
Core council service programs shall establish an avenue
for a person in crisis to speak with a trained counselor or trained volunteer
within one hour of the initial call received during and after normal business
hours. Training must include crisis intervention techniques and available
community resources.
(B)
Core council service programs shall develop written policies
and procedures for crisis intervention services during and after normal business
hours.
(C)
Core council service programs shall provide training annually
on crisis telephone call policies and procedures for all employees who answer
(or may answer) the telephone during or after normal business hours.
(4)
Minors and tobacco activities shall be provided
for the purpose of reducing minors' access to tobacco products throughout
the catchment area served.
(5)
Community-based process shall be provided for the
purpose of enhancing the ability of the community to more effectively provide
substance abuse services.
(d)
Core council services may include assessment for treatment
as described in §144.448 of this title (relating to Assessment for Treatment).
Core council service programs conducting assessments for treatment shall maintain
written agreements with referral sources/treatment providers to a. identify
assessment roles in order to minimize duplicate efforts in conducting treatment
assessments.
(e)
Core council service providers shall not provide intervention
counseling.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August
11, 1999.
TRD-9905038
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 1999
Proposal publication date: June 25, 1999
For further information, please call: (512) 349-6733
40 TAC §§144.511, 144.512, 144.521-144.526, 144.531, 144.541, 144.543, 144.545, 144.551-144.554
The Texas Commission on Alcohol and Drug Abuse adopts amendments
to §§144.511, 144.512, 144.521-144.525, 144.531, 144.541, 144.543,
144.545, and 144.551-144.554 and adopts new §144.526 concerning Treatment.
Sections 144.522, 144.541, 144.543, and 144.545 are adopted with changes to
the proposed text as published in the June 25, 1999 issue of the
Texas Register
(24 TexReg 4779). Sections 144.511, 144.512, 144.521,
144.523-144.526, 144.531, and 144.551-144.554 are adopted without changes
to the proposed text and will not be republished.
These sections contain information regarding program design and implementation,
self evaluation, client eligibility, priority populations, capacity management,
facility capacity system, interim services for priority populations, length
of stay guidelines, admission, specialized treatment services for females,
pharmacotherapy services, family services, performance measure review, select
performance measure definitions, client billings and client data systems (CDS)
forms.
These amendments and new section are adopted to provide more guidance about
the use of data, research and studies in program design; to describe the self
evaluation process and how to use the resulting information; to clarify how
to determine an adolescent's ability to pay; to add veterans to the list of
priority populations (required by new legislation); to require providers to
implement an outreach plan that specifically targets members of the commission's
designated priority populations who fall within the program's target population;
to add requirements regarding capacity management, particularly for certain
populations; to specify that programs must use the state's facility capacity
management system to facilitate prompt, appropriate placements; to clarify
the procedures to be used by treatment programs to report available capacity
and waiting list information; to describe required interim services; to incorporate
length of stay guidelines in the rules; to fully describe the admission process
and to ensure that admission criteria will not automatically exclude certain
individuals; to clarify what is required of programs that serve pregnant adult
or adolescent females and adult or adolescent females with dependent children;
to expand the requirements of pharmacotherapy programs; to fully describe
family services, including purpose, potential recipients, reimbursable services,
acceptable providers, and required documentation; to update the performance
measure review process; to clarify performance measure definitions; to specify
which clients are to be reflected on the monthly client billings; to revise
the description of the billing system; to update references; and to make grammatical
changes that enhance readability and understanding. Some revisions have been
made in response to comments and, in some instances, wording has been changed
for clarity of content or grammatical correctness.
Comments were received from the Association of Substance Abuse Programs
and individuals.
The following are comments received regarding §144.522.
Comment: We serve a culturally distinct target population. The rule talks
about marketing to the priority populations. If we must market to the priority
populations whether or not they fit within our target population, then we
have lost our identity and cultural competency. The concept of target populations
seems to have been restricted to prevention and intervention and removed from
treatment. We continue to need that option under treatment.
Response: The commission's rules regarding target population are virtually
identical for prevention, intervention, and treatment programs. Every program
is required to identify a specific target population, and that population
may be a culturally distinct subset of the general population. The intent
is for programs to market to members of the target population who fall within
the priority population categories. The rule has been revised to clarify this
issue. However, if a member of the priority population who does not fall within
the program's target population requests treatment, the provider should accommodate
the client (if appropriate) or provide referral to a more suitable program.
Comment: Only those programs that are not meeting their required priority
population targets should be a mandated to establish outreach plans.
Response: The commission believes this is an important standard. The commission
has not established priority population targets, so the rule will apply to
all programs. Providers who maintain high capacity utilization and have large
numbers of priority population members will simply need to document existing
outreach strategies.
Comment regarding §144.525: We strongly oppose this rule as written.
The requirement of counseling and education as a function of interim services
is an unacceptable unfunded mandate.
Response: This definition of interim services is mandated in the substance
abuse block grant. The program is not required to provide these services directly.
Counseling and education about HIV and TB are usually available free of charge
through the local health department.
The following are comments received regarding §144.526.
Comment: We would advocate that the commission not state that any revisions
adopted by the Texas Department of Insurance supersede the recommended lengths
of stay listed in this section. TCADA and its funded programs are not directly
regulated by TDI. Therefore automatically adopting rules designed for insurance
products might not be in the best interest of TCADA, its funded programs and
indigent clientele.
Response: The commission acknowledges that the statute is not absolutely
clear in terms of applicability. The intent, however, is clearly for the two
agencies to collaborate in establishing a single set of standards for chemical
dependency treatment services in Texas. Although TDI publishes the standards,
the law requires collaboration with the commission, and both agencies work
together to determine the content.
Comment: I am very concerned about the length of stay for adolescent treatment
programs. 70% of my clients are intravenous heroin users, and 60 days of treatment
will not be effective.
Response: The length of stay guidelines are just that-guidelines. If an
individual needs additional time in a specific level of treatment, the provider
can continue services provided justification is documented in the client record.
However, providers are expected to transfer clients to less intensive levels
of service as treatment progresses. When multiple levels of treatment are
used, the recommended length of stay for a treatment episode increases significantly.
In fact, an adolescent who goes through four levels of treatment (Level II
and III Residential, Level III and IV Outpatient) could be in treatment up
to 15 months without exceeding the length of stay guidelines. Providers with
a limited range of services should consider restructuring and/or collaborating
to provide a full continuum of care.
Comment: In 60 days, you are just beginning to reach an adolescent who
needs service at this level. The minimum length of stay should be between
120 and 180 days. The proposed regulation would add more paperwork in utilization
and extension justifications. It would be easier to justify discharging a
client earlier than planned if they make acceptable progress.
Response: This does not require additional paperwork. Providers are already
required to document regular treatment plan reviews, which must include an
assessment of the continued appropriateness of the current treatment level.
The following comments were received regarding §144.531.
Comment: Commission rules say that every client admitted to a Level II,
III, or IV treatment program must meet the DSM-IV criteria for abuse or dependence.
Our Amarillo network is using the Texas Department of Insurance (TDI) criteria,
which say that clients must be chemically dependent to be admitted to a residential
program. Which should we follow?
Response: All providers must comply with commission rules. However, a provider
may choose to adopt the more restrictive diagnostic criteria published by
TDI.
Comment: The rule says that admission criteria cannot automatically exclude
individuals based on past or present prescription medication. Does that include
methadone? At the current time, some detoxification programs reject methadone
clients because they have a total abstinence-based philosophy.
Response: Yes, methadone is included.
Comment: The rule states that all treatment programs must implement procedures
to identify clients exhibiting conditions or behavior that may suggest unmet
mental health needs. This calls for expertise beyond the licensed ability
of an LCDC. It will require hiring of an LPC, LMSW, Ph.D., or other higher
credentialed person. At the least it will call for a contractual arrangement
with a mental heath facility. Otherwise you are leaving the LCDC professional
and the contractor open to legal action when a client disagrees. This will
add significantly to service costs and will require a higher unit cost.
Response: The rule calls for a simple screening process, not a professional
mental health assessment. It is comparable to the process a school counselor
might use in identifying students who need to be assessed for chemical dependency.
To help LCDCs perform this function more effectively, licensure rules will
require related information to be included in the eight hours of annual training
that is mandated by statute.
Comment: This mentions that the program will assess each applicant face-to
face. So often, clients are referred from another city and we have to conduct
telephone screenings and assessments as to the appropriateness of a client.
No more telephone screenings? This will greatly delay admission time, and
create more time and expense, especially for clients and outside agencies
who will need to transport the clients and work with them in the interim.
Response: Telephone screening is acceptable. The commission has never allowed
a chemical dependency assessment to be conducted over the phone.
Comment: We strongly oppose this rule as written. In certain instances
it is appropriate to deny admission based on prior treatment. Clients who
leave treatment against staff advise or who are discharge at staff request,
prior to successful completion, should not be rewarded with immediate readmission.
We suggest the following alternative:
(g) The program
shall not automatically deny admission to a previous client based on prior
treatment UNLESS the individual left against staff advice, was discharged
at staff request prior to successful completion, or has been admitted to the
facility three or more times in the past 12 months.
Response: The rule simply says the facility cannot automatically deny admission
based on prior treatment. The factors mentioned can be considered when deciding
whether to readmit the individual. However, the provider must also consider
that chemical dependency is a chronic, relapsing disease and many clients
are successful in subsequent episodes of treatment despite initial failures.
The following are comments received regarding §144.541.
Comment: The rule requires a coordinated marketing/outreach plan - Advertising?
Or what? We cannot use TCADA funds for advertising/marketing. How do we show
this on time sheets or in job descriptions so it will not be denied by TCADA
and our outside auditors? It is direct opposition to the OMB Circulars. We
already work with CPS and TANF and all local hospitals and social service
agencies. To require a completely written and documented plan will require
an additional staff time and increase costs. It also requires us to work with
agencies who may not want to work with us in the way TCADA requires. Other
agencies have restrictions on their staff time. Why does TCADA always assume
they will work with us in the way, and in the time frame TCADA requires its
providers? Unit cost amounts need to be increased as either direct program
costs or indirect costs will have to be increased.
Response: OMB Circulars allow promotional activities and materials designed
to educate the community and target population about available services. Networking
and collaboration is another valuable outreach/marketing strategy, and your
agency appears to be actively engaged with key organizations in your area.
After evaluating your current efforts in relation to capacity utilization,
it may be that you simply need to document what you are already doing. If
your program is not consistently full, you should look for additional ways
to bring clients into your program. This rule does not dictate how you work
with local agencies, and it does not assume that they will respond to your
overtures. The rule has been revised to delete the word "marketing" to avoid
redundant language.
Comment: The rules require program to provide written referral and service
coordination procedures with qualified providers to provide Early Childhood
Intervention assessments and counseling. Will the referrals on the screening
suffice or is this an ongoing process? We refer children for ECI and therapy
as part of their treatment - is this what you are talking about?
Response: Yes.
The following are comments received regarding §144.543.
Comment: The new methadone rules state that if a client remains in a commission-funded
slot for more than 18 months, the provider must review the treatment plan
and justify the need for continued commission-funded treatment. This requirement
seems to represent a change in philosophy that is contrary to best practices,
which stress long-term retention. It seems that in order to contain costs,
the commission is forcing providers to discharge clients before they are ready
to move on. The commission states the intent of this rule is to encourage
movement out of commission-funded slots and into private treatment programs
so that more clients can be served. However, 80% of my population falls into
the working poor, medically indigent population. These people cannot afford
private pay treatment. Providers were not involved in determining the appropriate
length of stay. We recommend the commission remove this provision and establish
a workgroup to make recommendations on this issue.
Response: The proposed rule in no way implies that providers should discharge
clients who are not ready; it simply requires periodic justification for continued
treatment. However, the commission recognizes that in the current environment
this might be interpreted as a move away from nationally recognized standards
of pharmacotherapy for opiate addiction. We also realize that many working,
low-income clients cannot afford private treatment. In light of the widespread
concerns, the commission has taken this provision out of the rules, and will
establish a workgroup of methadone providers to examine the underlying issues
and make recommendations. Commission staff will continue to work with providers
to identify clients who can be appropriately transferred to private programs
so that new clients can be admitted.
Comment: The proposed rule states that providers may bill for methadone
clients with an excused/planned absence for up to two consecutive days, provided
approved absences do not exceed eight days in a single month. I am concerned
because methadone programs are governed by two agencies and the amount of
days allowed for absences before discharging a client are different. TDH recommends
that clients be discharged after 14 consecutive days of absence, especially
if unapproved. I would like to see the agencies reach consensus about the
time allowed.
Response: The proposed rule does not relate to client discharges; programs
should follow TDH guidance on that issue. The commission is simply allowing
providers to receive reimbursement for a limited number of excused client
absences per month. If the client was absent for six consecutive days, the
provider could only bill TCADA for two of those days (and only if the absence
was excused). The client could, however, remain in the program. The language
of the rules has been revised to clarify the intent.
The following comments were received regarding §144.545.
Comment: We would recommend that Family Support Groups be added to the
list of reimbursable family services. Many prevention-oriented agencies offer
this type of program and it should be a reimbursable activity for treatment
providers.
Response: Prevention programs are paid on a cost reimbursement basis to
provide a range of services. In treatment programs, the provider is reimbursed
for providing specific units of treatment. Peer support groups are an adjunct
to treatment, not an element of treatment. They have never been a reimbursable,
and do not count towards the required hours of service under licensure rules.
The commission agrees that support groups can be a valuable experience for
families and help them establish a continuing support system in the community.
Treatment programs may choose to make such groups available to clients and
their families.
Comment: The rule lists things that can be done for family services, but
does not require that the services be age and developmentally appropriate.
Response: The rule has been revised to require services to be age and developmentally
appropriate.
Comment: Will treatment programs now be providing prevention services?
This seems inappropriate if there are existing prevention providers with the
needed services and expertise.
Response: Language has been added encouraging collaboration with existing
prevention programs.
Comment: Without additional funding the new family service requirements
can only be implemented by serving fewer clients.
Response: Family services are reimbursable. Providers can bill for each
unit of individual or group family services provided.
Comment: The listed services are poorly defined and open to interpretation.
They need to be more specific.
Response: The services are described using standard terminology. Commission
staff will be providing extensive guidance and technical assistance to help
providers implement family services.
These amendments and new section are adopted under the Texas
Health and Safety Code, §461.012(a)(15) which provides the Texas Commission
on Alcohol and Drug Abuse with the authority to adopt rules governing the
functions of the commission, including rules that prescribe the policies and
procedures followed by the commission in administering any commission programs.
The code affected by the adopted amendments and new section is the Texas
Health and Safety Code, Chapter 461.
§144.522.Priority Populations.
(a)
The commission has established six priority populations.
Preference shall be given in the following priority order:
(1)
pregnant injecting drug users;
(2)
pregnant substance abusers;
(3)
injecting drug users;
(4)
former Supplemental Security Income recipients previously
disabled from substance abuse;
(5)
parents with children in foster care; and
(6)
veterans with honorable discharges.
(b)
The program shall implement an outreach plan that specifically
targets members of these priority populations who fall within the program's
target population.
(c)
The program shall establish screening procedures to identify
members of priority populations and admit them before all others, in priority
order.
§144.541.Specialized Treatment Services for Females.
(a)
Specialized female programs shall serve pregnant adult
or adolescent females and adult or adolescent females with dependent children.
Females with dependent children include females in treatment who are attempting
to regain custody of their children.
(b)
These programs shall treat the female and her dependent
children as a unit and therefore admit both females and their children into
treatment, when appropriate and possible.
(c)
All programs offering specialized female services shall
provide a comprehensive treatment program. The following services shall be
provided directly or through collaborative agreements and case management
arrangements with other service providers:
(1)
primary medical care for females receiving treatment, including
age-appropriate and specific reproductive health care and prenatal care;
(2)
gender-specific substance abuse treatment and other
therapeutic interventions for females that address issues of relationships,
sexual and physical abuse and parenting;
(3)
childcare while the females are receiving services;
(4)
primary pediatric care for the clients' children,
including immunizations;
(5)
therapeutic interventions for the children; and
(6)
documented sufficient case management and transportation
services to ensure that female clients and their children have access to the
services provided by paragraphs (1) through (5) of this subsection.
(d)
Programs shall implement a coordinated outreach plan that
targets services and organizations that regularly serve adult or adolescent
females with or without dependent children, including Child Protective Services
and the Temporary Aid for Needy Families (TANF) program.
(e)
Treatment programs serving women with dependent children
shall report monthly measures for the women's children when the children receive
prevention and/or intervention services.
(f)
Programs serving adult or adolescent females shall, to
the extent possible, provide an array of services including Levels II, III,
and IV treatment and structured aftercare, either directly or through case
management and service agreements. Level, intensity, and duration of services
shall be clinically appropriate.
(g)
Programs shall have written referral and service coordination
procedures with qualified providers to provide:
(1)
assessments for children for Early Childhood Intervention
services; and
(2)
counseling or therapy to address the children's identified
developmental, emotional, or psychosocial needs.
§144.543.Pharmacotherapy Services.
(a)
All programs providing pharmacotherapy services shall maintain
compliance with applicable statutes and regulations adopted by the:
(1)
Texas Department of Health;
(2)
Food and Drug Administration; and
(3)
Drug Enforcement Agency.
(b)
Programs shall establish a phase/level system which is
consistent with guidelines from the Substance Abuse and Mental Health Services
Administration (SAMHSA) and includes the following phases:
(1)
Phase I: During the first 45 days of treatment, the client
shall receive four individual counseling sessions. If not, justification shall
be documented in the client record.
(2)
Phase II: After 45 days of continuous treatment, the
client shall receive two individualized counseling sessions monthly. Justification
shall be documented in the client record each month this standard is not met.
(c)
All Pharmacotherapy programs must conduct the Methadone
Annual Survey as directed by the Commission.
(d)
All Pharmacotherapy programs shall adopt policies and procedures
that conform with §144.523 of this title (relating to Capacity Management),
§144.524 of this title (relating to Facility Capacity System), and §144.535
of this title (relating to Interim Services).
(e)
A Pharmacotherapy program can bill for a client receiving
methadone who has an excused or planned absence for up to two consecutive
days. The frequency of approved absences shall be reasonable and appropriate.
The provider shall not bill for more than eight days of excused/planned absences
for a single client in a 30-day period.
(f)
All Pharmacotherapy programs shall complete a client fee
assessment on each commission-funded client every six months.
(g)
All direct care employees 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.
§144.545.Family Services
(a)
Providing services to the family of the primary client
is required of all commission funded programs. Family centered services are
a crucial ingredient in providing comprehensive, community-based services
to children, adolescents and adults. The family service program should not
duplicate existing community prevention or intervention program that offer
appropriate services. Treatment, intervention, and prevention programs are
expected to collaborate to establish a coordinated array of substance abuse
services for families.
(b)
Family services shall be designed to identify family risk
factors associated with the client's chemical dependency, improve the health
and functioning of the family unit and/or to assist individual family members
to support the client in achieving and maintaining a healthy, drug-free life
style. All services provided to family members shall be age and developmentally
appropriate.
(c)
Family services are provided to the entire family, including
older adults, individual family members, and/or a subset of family members.
Reimbursable family services include:
(1)
family psychosocial assessment;
(2)
individual counseling or therapy;
(3)
group counseling or therapy;
(4)
family counseling or therapy;
(5)
family case management;
(6)
family in-home support; and
(7)
structured, curriculum-based education and/or skills
training accompanied by group process.
(d)
Family services must be provided by qualified staff including
LCDCs who have the documented education, training and experience needed to
perform the specific family services being provided. Qualifications shall
be based on industry standards and applicable licensure requirements. LCDCs
may provide family education, assessment, and counseling services for issues
that are directly related to substance abuse treatment and prevention within
the family (including the development of healthy family behavior patterns),
commensurate with the individual's training and experience. However, clients
and/or family members in need of therapy on issues outside the LCDC's scope
of professional practice must be referred to a qualified mental health professional
such as an LMSW (Licensed Master Social Worker), LMFT (Licensed Marriage and
Family Therapist), LPC (Licensed Professional Counselor) or LPA (Licensed
Psychological Associate).
(e)
Family services must be documented in the client record.
The record must include the elements listed.
(1)
Family psychosocial assessment. The assessment must be
conducted by a licensed and qualified professional based upon education and
training.
(2)
Family service plan. The counselor, client and family
shall develop the plan and update it as goals are accomplished or needs change.
This plan must include:
(A)
abilities, strengths, preferences, problems and needs identified
from the client and family assessment;
(B)
goals that are realistic, outcome-oriented, measurable,
time limited and stated in behavior terms that are understandable to the client
and family;
(C)
specific services to be provided that enable the family
to achieve the agreed upon goals; and.
(D)
aftercare services to be provided upon discharge, including
necessary community supports.
(3)
Progress notes. Progress notes must document
the services provided and the family's response. The provider shall document
each service contact in a signed progress note that includes:
(A)
date, nature, and duration of the contact;
(B)
individuals involved;
(C)
content and goals addressed;
(D)
progress or lack of progress toward the goals; and
(E)
other relevant information.
(4)
Discharge plan. Discharge planning shall begin
at the time of the initial treatment plan and shall address ongoing family
needs and support activities. The family shall receive a copy of the discharge
plan, including:
(A)
family goals or activities to sustain progress;
(B)
referrals for other needed support services;
(C)
aftercare services; and
(D)
follow-up.
This agency hereby certifies that the adoption
has been reviewed by legal counsel and found to be a valid exercise of the
agency's legal authority.
Filed with the Office of the Secretary of State on August
11, 1999.
TRD-9905040
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 1999
Proposal publication date: June 25, 1999
For further information, please call: (512) 349-6733
40 TAC §144.532
The Texas Commission on Alcohol and Drug Abuse adopts amendments
to §144.532 concerning Treatment. This sections is adopted with changes
to the proposed text as published in the June 25, 1999 issue of the
This section contains information regarding core program requirements.
These amendments are adopted to update the name of the section; to delineate
the exact responsibilities of all commission-funded programs; to make grammatical
changes to enhance readability and understanding; to require all programs
to provide family education and counseling and group aftercare; to mandate
formal letters of agreement that must be renewed annually; to require that
programs operating at low capacity implement structured outreach plans; to
mandate that programs must document active participation in collaborations
to support community resource development; to increase the number of hours
of additional structured activities during evenings and weekends; and to specify
that all counseling sessions and other activities counted toward the required
hours of service must be of at least 30 minutes duration. Some revisions have
been made in response to comments and, in some instances, wording has been
changed for clarity of content or grammatical correctness.
Comments were received from the Association of Substance Abuse Programs
and individuals.
Comment: Although many programs offer an aftercare component, this is a
new requirement and it has an associated cost. It affects counselor caseloads,
scheduling and administration of records. Until such time as a program is
able to re-negotiate a rate that takes into consideration this new requirement,
a program should have the opportunity to present a case and apply for a waiver.
Response: The commission recognizes that this requirement will impact the
workload of counselors or require additional cost to providers who are not
currently offering aftercare. However, aftercare is a vital component of treatment
and accepted industry standard, and we believe the benefits of aftercare merit
the additional cost. Research shows that the most important factor in successful
recovery is the length of time a client is engaged in the treatment delivery
system. The length of stay guidelines proposed in these rules will shift service
delivery toward multi-level treatment for individual clients, and aftercare
is an important part of the individual's continuum. To minimize the burden
placed on providers, the commission has provided two methods for a provider
to receive reimbursement for aftercare. First, we have added language to this
rule clarifying that Level IV treatment can meet the requirement for aftercare
if it is provided as a transitional level of care for a client transferring
from a Level II or Level III program. Second, under the new family services
initiative, providers can bill for family services provided after the client's
discharge, which is also aftercare. The commission's rules regarding waivers
are found in §144.11 (Variances).
Comment: We consider our Level IV treatment program to be aftercare. So
what is aftercare for aftercare? Aftercare is not defined.
Response: Aftercare is defined in §144.21 (Definitions). Although
Level IV is part of the treatment continuum, the commission will consider
transitional Level IV services as meeting the requirement in this rule. However,
Level IV providers are strongly encouraged to provide less intensive aftercare
services as described above retain clients in the treatment delivery system
for as long as possible.
Comment: We oppose requiring providers to "provide" referrals for family
members and family education and counseling. Using the word "offer" would
continue to require programs to make the services available, but would not
hold us accountable for making sure every family participated.
Response: The wording has been revised for clarification.
Comment: Please define what specific case management activities are required.
The definition does not indicate how extensive a service we are required to
provide. We have extensive, intensive case management for HIV clients and
Dual Diagnosis client but are unable to provide the full complement of those
services to all clients without specific funding. Will those services be billable
if done as a session with the client?
Response: The proposed rule does not require the intense level of case
management you provide for HIV and dual diagnosis clients. Case management
is defined in §144.21. Programs are expected to link clients with needed
services, help clients develop skills to use basic community resources more
effectively, and monitor and coordinate those services. In most situations,
these activities can be conducted through telephone contacts and regularly
scheduled client sessions. The only case management activity that is billable
is monitoring client follow-through during counseling. Telephone calls and
other collateral contacts are not billable and cannot be made during a counseling
session.
Comment: The rules require residential treatment programs to provide 10
hours of planned, structured activities during evenings and weekends in addition
to the hours required by licensure rules. What kinds of groups and activities
can be included? The clause either needs to be explicitly and extensively
defined or simply have a phrase such as "as clinically defined by the program".
Response: Many treatment programs schedule virtually all of their services
and activities during business hours. This rule is designed to help clients
learn to structure their leisure time in constructive ways, including drug-free
leisure activities. Examples of such activities include game nights, movie
nights, AA meetings, shopping trips, meditation or relaxation sessions, supervised
study sessions, dances, field trips, cooking lessons, etc. The commission
has intentionally left the rule flexible so that providers can determine what
is clinically appropriate for their programs.
Comment: The requirement for additional structured activities is very difficult,
because you need to give the clients time to do their laundry, wash their
baby's bottles, etc. You want them to learn time management and you need to
allow them some time to live. How can you include these extra structured hours
and still allow time for these types of activities?
Response: The commission believes the number of hours required is reasonable.
Clients have 112 awake hours in a week. In Level II programs, 20 hours of
treatment are required. The additional hours raise the scheduled activities
to 30 hours. That is less than a regular work week and leaves 82 hours for
clients to relax and attend to personal needs.
Comment: Making sure everyone goes to the additional structured activities
is a problem. Some clients work, and others (such as HIV positive clients)
may be physically unable to participate in all the extra activities.
Response: The provider is not required to ensure that every client attends
every activity. The activities must be scheduled and provided, and staff should
establish an expectation that all clients attend when they are able to do
so. However, there is flexibility for clients who work or have other scheduled
activities (family visits, educational classes, etc.) or are physically unable
to participate.
Comment: Many comments related to the proposed rule reducing the maximum
number of clients allowed in group counseling sessions from 16 to 12. They
cited a number of cost concerns and said the proposed change would be a significant
challenge to cost effective staffing patterns. Many also mentioned that the
commission has not changed its reimbursement rates for many years, but has
gradually increased standards. In addition, providers noted that proposals
and bid rates were submitted to the commission based on the current rule,
and in some situations the rule could have an impact on the staffing pattern
and cost.
Response: Group size is a key factor in the efficacy of group therapy,
and the current maximum is considerably higher than accepted industry standards.
However, the commission does recognize the cost and workload implications
of the proposed rule. While some programs already meet this standard and others
could make relatively minor changes to come into compliance, the impact would
be significant in many programs. Rates have remained static despite increasing
standards, and providers have relied on the current rule in developing their
programs. Therefore, the commission will withdraw this proposed rule change.
However, the commission will be examining its rate structure during FY2000,
and will consider this factor during its analysis.
Comment: Can we see more than 12 clients in a group if we have two counselors?
Response: The current maximum of 16 clients will remain in place. Groups
cannot have more than 16 clients even with additional counselors present.
The maximum group size is established to address group dynamics.
Comment: The proposed rule requires providers to document active participation
in collaborations to support community resource development. This goes beyond
the scope of what TCADA should require of a provider who is funded to perform
a particular service. Requiring a funded provider to develop community resources
for gaps in publicly funded services is beyond their scope. For many programs,
their non-profit missions often precipitate active participation in community
and community efforts to develop services, but this should not be a governmental
requirement unless the program they are funded to provide has elements of
advocacy and community organization involved.
Response: Collaboration has always been a vital aspect of service delivery
and is required under current rules for all providers. Furthermore, the commission's
recent requests for proposals have emphasized collaboration and coordination
with the goal of establishing a continuum of treatment, prevention, and intervention
services supported by a range of ancillary services. Effective collaboration
includes identifying and addressing gaps in available services. This activity
is particularly important in the transition to networks, when groups of providers
will be required to ensure the availability of a service continuum. The commission
does not believe the proposed rule is unreasonable or excessive. This is an
expectation for all providers, so the language of the rule has been revised
to delete "where gaps in the service delivery system exist".
These amendments are adopted under the Texas Health and Safety
Code, §461.012(a)(15) which provides the Texas Commission on Alcohol
and Drug Abuse with the authority to adopt rules governing the functions of
the commission, including rules that prescribe the policies and procedures
followed by the commission in administering any commission programs.
The code affected by the adopted amendments is the Texas Health and Safety
Code, Chapter 461.
§144.532.Core Program Requirements.
(a)
All treatment programs shall comply with applicable chemical
dependency treatment facility licensure requirements for the specified level
of service established in Chapter 148 of this title (relating to Facility
Licensure).
(b)
All programs funded by the commission shall:
(1)
implement a systematic process to identify and offer appropriate
referrals for family members of clients;
(2)
inform clients and involved family members of family
services offered directly and through other community resources; and
(3)
document family participation and attempts to engage
family members in services.
(c)
Levels II, III, and IV treatment programs funded by the
commission shall provide:
(1)
family education and counseling related to the client's
substance abuse (to the extent possible and appropriate);
(2)
life skills training;
(3)
case management;
(4)
relapse prevention services;
(5)
support group opportunities for adolescents and adults,
including older adults; and
(6)
individual and/or family aftercare. Level IV treatment
can be used to satisfy this requirement if it is provided as a transitional
level of care for a client transferring from a Level II or Level III treatment
program.
(d)
The program shall have written description of all educational
and didactic sessions, including curricula, outlines, and activities.
(e)
Group size shall be limited to a number that allows effective
interaction between the group and facilitator and between group members.
(1)
Group counseling sessions are limited to a maximum of 16
clients.
(2)
Group education sessions, didactic sessions, and other
groups are limited to a maximum of 32 clients. This limitation does not apply
to seminars, outside speakers, or other events designed for a large audience.
(f)
The program shall establish formal letters of agreement
with available substance abuse and other mental health, health care, and social
services to meet the needs of clients and family members. Agreements to coordinate
services must be established in writing and renewed annually (through signature
or other documented contact), and shall include:
(1)
names of the organizations entering into the agreement;
(2)
services or activities each organization will provide;
(3)
signatures of authorized representatives; and
(4)
dates of action and expiration.
(g)
The program shall develop and implement a written plan
of operation explaining outreach efforts, including specific strategies to
reach members of the priority populations listed in §144.522 of this
title (relating to Priority Populations). The commission may waive this requirement
if the program demonstrates high capacity utilization and adequate engagement
of priority populations.
(h)
The program shall document active participation in collaborations
to support community resource development.
(i)
Levels II, III, and IV residential programs shall schedule
planned, structured activities during evenings and weekends. These hours are
in addition to those required by licensure rules. The minimum number of additional
hours for Levels II, III, and IV are 10 hours for adults and 15 hours for
adolescents. The program shall maintain documentation that the activities
were provided, including sign-in sheets. Client participation does not need
to be individually recorded in client records.
(j)
All counseling sessions and other activities counted toward
the required hours of service must last at least 30 minutes.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August
11, 1999.
TRD-9905041
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 1999
Proposal publication date: June 25, 1999
For further information, please call: (512) 349-6733
40 TAC §§144.533, 144.542, 144.544
The Texas Commission on Alcohol and Drug Abuse adopts the
repeal of §§144.533, 144.542 and 144.544 concerning Treatment without
changes to the proposed text as published in the June 25, 1998, issue of the
These sections contain information on service enhancements, court commitment
services and dual diagnosis programs.
The sections are repealed due to reorganization of the rules and deletion
of outdated requirements. Requirements related to service enhancements have
been incorporated into appropriate sections in this chapter which are being
concurrently adopted. Requirements related to court commitment services have
been consolidated into §148.238 of this title (related to Court Commitment
Services) so that they will all be contained in one section, which is also
concurrently adopted. Requirements related to dual diagnosis programs have
been deleted.
No comments were received regarding the adoption of the repeals.
The repeals are adopted the Texas Health and Safety Code, §461.012(a)(15)
which provides the Texas Commission on Alcohol and Drug Abuse with the authority
to adopt rules governing the functions of the commission, including rules
that prescribe the policies and procedures followed by the commission in administering
any commission programs.
The code affected by the repeals is the Texas Health and Safety Code, Chapter
461.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August
11, 1999.
TRD-9905042
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 1999
Proposal publication date: June 25, 1999
For further information, please call: (512) 349-6733
40 TAC §§144.611-144.616
The Texas Commission on Alcohol and Drug Abuse adopts new
§§144.611-144.616 concerning Network Management Organizations (NMOs).
Sections 144.611, 144.612, and 144.614-144.616 are adopted without changes
to the proposed text as published in the June 25, 1999 issue of the
These sections contain information regarding service structure; outreach;
screening, assessment and referral; care coordination; monitoring service
utilization; and service delivery planing and implementation.
These new sections are adopted to establish standards for network management
organizations. These rules will apply to networks established under the fiscal
year 2000 request for proposals.
A comment on these sections was received from an individual.
Comment: Though the NMOs as described in the proposed revisions to Chapter
144 refer to management of treatment services, in looking ahead to the possible
provision of prevention and intervention services through networks, some general
concerns exist. The proposed rules require procedures that minimize duplication
between the NMO and the service providers in the network. In what manner will
the TCADA rules allow for prevention and intervention service networks composed
of, administered by, owned by and/or established by the providers of the network
services?
Response: In the FY2000 RFP for networks, the commission allowed an organization
to serve as the NMO and provide prevention or intervention services.
These new sections are adopted under the Texas Health and Safety
Code, §461.012(a)(15) which provides the Texas Commission on Alcohol
and Drug Abuse with the authority to adopt rules governing the functions of
the commission, including rules that prescribe the policies and procedures
followed by the commission in administering any commission programs.
The code affected by these new sections is the Texas Health and Safety
Code, Chapter 461.
§144.613.Screening, Assessment, and Referral.
(a)
The NMO shall ensure that all persons in the network service
area have 24-hour access seven days a week to a toll-free telephone information
line for substance abuse prevention, intervention, and treatment services.
(b)
The NMO shall provide screening and referral services to
ensure access to the appropriate level and type of services needed by applicants
and their families.
(1)
Screening. The screening process shall be designed to identify
warning signs for alcohol, tobacco, and/or other drug abuse. The screening
shall also identify STD/HIV risk factors as appropriate. If a potential substance
abuse problem is identified, the NMO shall arrange for a substance abuse assessment.
(2)
Referral. The NMO shall also identify needs that cannot
be met by the network and help the applicant and family members access appropriate
support systems and community resources. The program shall maintain a list
of referral resources.
(3)
Follow-up. The NMO shall conduct and document follow-up
on referrals whenever possible.
(4)
Documentation. The NMO shall maintain documentation
which includes:
(A)
date of the screening;
(B)
name of the individual screened;
(C)
demographics of the individual screened;
(D)
referrals made; and
(E)
any follow-up contacts.
(c)
Assessments for treatment may be provided directly or through
referral to a network treatment provider.
(1)
Assessment tools shall be appropriate for the target population.
(2)
Assessment shall be provided through a confidential,
face-to-face interview.
(3)
The assessment shall include a criteria-based evaluation
to determine the appropriate level of treatment.
(4)
All assessments shall be conducted by qualified credentialed
counselors or counselor interns working under appropriate supervision.
(5)
Documentation shall include a written summary of the
applicant's needs, treatment recommendations, and referrals.
(d)
The NMO may also conduct financial assessments for treatment
applicants as described in §144.521 of this title (relating to Client
Eligibility).
(e)
The NMO shall have written procedures that describe screening,
assessment, and referral activities.
(f)
The procedures shall minimize duplication between the NMO
and treatment providers, especially in the area of assessments. Any activity
completed by the NMO does not need to be repeated or duplicated by the treatment
program.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August
11, 1999.
TRD-9905043
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 1999
Proposal publication date: June 25, 1999
For further information, please call: (512) 349-6733
Subchapter A. Licensure Information
40 TAC §§148.3, 148.4, 148.21, 148.23-148.27, 148.41, 148.61
The Texas Commission on Alcohol and Drug Abuse adopts amendments
to §§148.3, 148.4, 148.21, 148.23-148.27, 148.41 and 148.61 concerning
Licensure Information. Sections 148.41 and 148.61 are adopted with changes
to the proposed text as published in the June 25, 1999 issue of the
These sections describe sites and services, variances, new license application
process, changes in status, change in ownership, licensure fees, inactive
status and closure, licensure review, sanctions, and definitions of terms
used in this chapter.
These amendments are adopted to clarify which chemical dependency treatment
programs are required to have a license issued by the commission; to explain
what sites may offer what services; to clarify that a provider must be approved
as a clinical training institution before designating interns to perform duties;
to clarify the variance process; to describe what happens if an applicant
fails to provide evidence of compliance within six months; to specify which
department within the commission must receive advance notice of proposed changes
relevant to a facility's license, invalid licenses, and notices of closure;
to clarify that advance written approval is required before a facility moves
to a new location; to more fully describe the processes related to inactive
status; to require that the licensure certificate must be displayed at each
approved site; to clarify that practicing at an unapproved site is subject
to the same penalty as practicing without a license; and to number, expand
and refine the definitions of terms used and to remove definitions of terms
no longer used in this chapter. Some revisions have been made in response
to comments and, in some instances, wording has been changed for clarity of
content or grammatical correctness.
Comments were received from a number of individuals.
Comment received on §148.41: It appears that there has been an attempt
to remove the wording of "licensed" sites, yet this one rule refers to "unlicensed"
sites and thus continues the confusion over whether sites are licensed.
Response: The word "unlicensed" has been replaced with "unapproved" to
be consistent with changes in other sections.
A number of comments were received on §148.61. Definitions:
Comment: The definition of abuse states that abuse may be perpetrated by
staff or other clients/participants. Client abuse of other clients is serious
and needs attention. However, there is a concern about a client who curses
another client and if this needs to be reported as an abuse incident. As the
definition reads, every time a client is observed cursing another client an
abuse report would be indicated. This could set up a huge reporting overload
that may overstress the process.
Response: The commission concurs. This language has been removed from the
definition.
Comment: We strongly oppose the expansion of the definition of aftercare.
This change mandates TCADA facility licensure if two or more hours of service
are provided. This has the potential to dramatically negatively impact successful
outcomes by decreasing duration and scope of aftercare services. TCADA funded
programs may in many cases be able to bill for outpatient services, however,
unfunded programs may not. Our concern is that, rather than incurring the
additional cost of TCADA licensure, some facilities may simply decrease or
stop providing aftercare services.
Response: The commission disagrees. If the program is providing two or
more hours of treatment services per week, it is providing treatment and should
be licensed. The wording has been revised to indicate that this does not apply
to non-treatment activities.
Comment: I am concerned that the proposed definition of direct supervision
does not address the practicum student.
Response: The definition has been revised to include practicum students.
Comment: The definition of direct supervision is incomplete. There is no
provision to document supervision of a CI with over 4,000 hours who has not
tested.
Response: Individuals who have completed their 4,000 hours are not interns,
they are graduates. Direct supervision is not required for graduates.
Comment: The tiered approach to clinical supervision outlined in this proposed
definition/rule is a positive change and we are in favor of the change. However,
it would seem more appropriate to address this is in the body of the rules
rather than in the definitions.
Response: The term is used often enough that the requirements would have
to be repeated in various sections of the rules. When the rules are published,
defined terms will be bolded to alert readers that there is a specific definition.
Comment: There are separate and mutually exclusive criteria for substance
abuse and substance dependence in the DSM-IV, yet the commission's definition
of chemical dependency includes both. It would be advisable to separate your
definitions to be in sync with the DSM-IV criteria.
Response: For clinical purposes, the commission distinguishes between substance
abuse and substance dependence in accordance with the DSM-IV criteria. However,
state statute dictates the definition of chemical dependency when used in
the legal context (such as identifying a "chemical dependency treatment facility").
Comment: A common use of "dually diagnosed" in the behavioral sciences
can refer to persons with diagnoses of mental illness, substance abuse/substance
dependence, and/or mental retardation. Commonly used also is the term "multiply
diagnosed".
Response: The commission has defined dually diagnosed based on its usage
in the rules.
Comment: The definitions of aftercare and residential site are confusing.
Aftercare is provided after discharge from a treatment facility, but the residential
site definitions suggest that aftercare is an element of treatment.
Response: The definition of residential site has been revised to include
aftercare.
Comment: The definition of family should be expanded to include family
members of adolescents who do not live in the home but are in the treatment
area.
Response: All family members are included in this definition, regardless
of location. The phrase "who perform the roles and functions of family members
in the lives of client's participants" relates only to "significant others".
Language has been clarified.
Comment: The definition of neglect does not have a proposed change. However,
clarification is needed on the issue of providing prescription medication
for a client who becomes ill. We cannot use TCADA funds to pay for medication.
If we don't provide it are we in a neglect situation and liable? If we cannot
access an outside source are you requiring us to commit neglect? Remember
most treatment centers are non-profit agencies with limited other resources.
Give us some leeway for exceptional or emergency situations. Some social service
agencies are actually not open at night or on weekends to get assistance from
when needed.
Response: If a client becomes ill, the provider should take (and document)
all reasonable and necessary steps to obtain appropriate care. Commission
funds can be used to purchase medication if other resources are not available.
The provider is not guilty of neglect if all reasonable and necessary steps
were taken to obtain appropriate care for the client, even if the efforts
are unsuccessful.
These amendments are adopted under the Texas Health and Safety
Code, Chapter 464, which provides the Texas Commission on Alcohol and Drug
Abuse with the authority to adopt rules licensing chemical dependency treatment
facilities.
The code affected by the proposed amendments is the Texas Health and Safety
Code, Chapter 464.
§148.41.Sanctions.
(a)
The commission shall deny, suspend, revoke, or refuse to
renew a license, or place on probation a facility whose license has been suspended,
or reprimand a facility if an applicant, licensee, owner, member of the governing
body, administrator, or clinical staff member of the facility:
(1)
has a documented history of client abuse or neglect; or
(2)
violates any provision of the Act or other applicable
statute, or a commission rule.
(b)
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.
(c)
The commission may impose an administrative penalty against
a facility regulated under the Act who violates authorizing statutes, or a
rule or order adopted under the statutes.
(d)
A facility practicing without a license or practicing at
an unapproved site is subject to a civil penalty of not more than $25,000
for each violation of the Act or these rules. Each day a violation continues
or occurs is a separate violation.
(e)
Surrender or expiration of a license does not interrupt
an investigation or sanctions process. The facility is not eligible to regain
the license until all outstanding investigations, disciplinary proceedings,
or hearings are resolved.
(f)
A facility whose license has been revoked is not eligible
to apply for licensure until two years have passed since that date of revocation.
§148.61.Definitions.
The following words and terms, when used in this chapter, shall have
the following meanings unless the context clearly indicates otherwise.
(1)
Abuse - Any act or failure to act which is done knowingly,
recklessly or intentionally, including incitement to act, which caused or
may have caused injury to a client. Injury may include, but is not limited
to: physical injury, mental disorientation, or emotional harm, whether it
is caused by physical action or verbal statement. Client abuse includes:
(A)
any sexual activity between facility personnel and a client;
(B)
corporal punishment;
(C)
nutritional or sleep deprivation;
(D)
efforts to cause fear;
(E)
the use of any form of communication to threaten, curse,
shame, or degrade a client;
(F)
restraint that does not conform with these rules;
(G)
coercive or restrictive actions taken in response to the
patient's request for discharge or refusal of medication or treatment that
are illegal or not justified by the patient's condition; and
(H)
any other act or omission classified as abuse by the Texas
Family Code, §261.001.
(2)
Act - Texas Health and Safety Code, Chapter 464.
(3)
Admission - Formal documented acceptance of a prospective
client to a treatment facility, based on specifically defined criteria.
(4)
Adolescent - An individual 13 through 17 years of
age whose disabilities of minority have not been removed by marriage or judicial
decree.
(5)
Adult - An individual 18 years of age or older, or
an individual under the age of 18 whose disabilities of minority have been
removed by marriage or judicial decree.
(6)
Advanced practice nurse - A registered nurse currently
licensed in Texas who is prepared for advanced practice and approved by the
Texas State Board of Nurse Examiners.
(7)
Aftercare - Structured services provided after discharge
from a treatment facility which are designed to strengthen and support the
client's recovery and prevent relapse. Aftercare may be provided by the facility
directly or through a letter of agreement with another provider. If the program
provides two or more hours of chemical dependency counseling, chemical dependency
education, and/or life skills training per week, it must be licensed as an
outpatient program.
(8)
Applicant (licensure) - A person who has submitted
a complete application to the commission for licensure, relicensure, or change
in status, and paid the application fee.
(9)
Approval - Written authorization.
(10)
Assessment (treatment) - The process used to interpret
information from the psychosocial history to identify the participant's strengths,
problems, and needs in order to develop an appropriate plan for treatment.
(11)
Case management - A systematic process to ensure
clients receive all substance abuse, physical health, mental health, social,
and other services needed to resolve identified problems and needs. Case management
activities are provided by an accountable staff person and include:
(A)
linking a client with needed services;
(B)
helping a client develop skills to use basic community
resources and services; and
(C)
monitoring and coordinating the services received by a
client.
(12)
Chemical dependency - Substance abuse and substance
dependence as defined in the current edition of the Diagnostic and Statistical
Manual of Mental Disorders, published by the American Psychiatric Association.
(13)
Chemical dependency counseling - Face-to-face interactions
in which a counselor helps an individual, family or group identify, understand,
and resolve issues and problems related to chemical dependency.
(14)
Chemical dependency counselor - A qualified credentialed
counselor or counselor intern.
(15)
Chemical dependency education - A planned, structured
presentation of information training, provided by qualified staff (not clients),
which is related to chemical dependency. It includes but is not limited to:
physiological and psychological effects, emotional and social deterioration,
rehabilitation and relapse, and risk of acquiring Human Immunodeficiency Virus.
(16)
Chemical dependency treatment - A planned, structured,
and organized program designed to initiate and promote a person's chemical-free
status or to maintain the person free of illegal drugs. It includes, but is
not limited to, the application of planned procedures to identify and change
patterns of behavior related to or resulting from chemical dependency that
are maladaptive, destructive, or injurious to health, or to restore appropriate
levels of physical, psychological, or social functioning lost due to chemical
dependency.
(17)
Chief executive officer - The individual authorized
by the governing body to act on its behalf in the overall administration of
the facility.
(18)
Child - An individual under the age of 13.
(19)
Child abuse and neglect - Any act or omission that
constitutes abuse or neglect of a child by a person responsible for a child's
care, custody, or welfare as defined in the Texas Family Code §261.001.
(20)
Client - An individual who has been admitted to a
chemical dependency treatment facility licensed by the commission and is currently
receiving services.
(21)
Clinical training institution - An individual or
legal entity approved by the commission to provide a counselor training program
in which counselor interns obtain supervised work experience.
(22)
Commission - The Texas Commission on Alcohol and
Drug Abuse.
(23)
Confidentiality laws - Federal law (42 United States
Code, §290 dd-2) and state law (Texas Health and Safety Code, Chapter
611) and regulations adopted pursuant to these statutes.
(24)
Consenter - The individual legally responsible for
giving informed consent for a client. This may be the client, parent, guardian,
or conservator. Unless otherwise provided by law, a legally competent adult
is his or her own consenter. Consenters include adult clients, clients 16
or 17 years of age, and clients under 16 years of age admitting themselves
for chemical dependency counseling under the provisions of the Texas Family
Code, §32.004.
(25)
Consultant - An individual who is not an employee
who provides professional advice or services to the facility for compensation.
(26)
Counselor - See chemical dependency counselor.
(27)
Counselor intern (CI) - A person pursuing a course
of training in chemical dependency counseling at a regionally accredited institution
of higher education or an approved clinical training institution who has been
designated as a counselor intern by the institution. The activities of a counselor
intern shall be performed under the direct supervision of a qualified credentialed
counselor.
(28)
Direct care staff - Staff responsible for providing
treatment, care, supervision, or other client services that involve a significant
amount of face-to-face contact.
(29)
Direct supervision - Oversight and direction of a
counselor intern provided by a qualified credentialed counselor (QCC). If
the intern has less than 2,000 hours of supervised work experience, the supervisor
must be on site when the intern is providing services. If the intern has at
least 2,000 hours of documented supervised work experience, the supervisor
may be on site or immediately accessible by telephone. The qualified credentialed
counselor shall:
(A)
assume responsibility for the actions of the intern within
the scope of the intern's clinical training;
(B)
be available for assistance;
(C)
conduct and document a complete review of the intern's
current written work at least weekly during the practicum and the first 1000
hours of supervised work experience, monthly during the second 1000 hours,
and quarterly during the final 2000 hours;
(D)
complete and document a session to observe the intern providing
services to chemical dependency clients at least weekly during the practicum,
every two weeks during the first 1000 hours of supervised work experience,
monthly during the second 1000 hours, and as deemed necessary during the final
2000 hours; and
(E)
meet with the intern (in a group or individual session)
at least one hour each week to provide written and verbal feedback and direction;
and
(F)
sign off on all clinical assessments, treatment plans,
and discharge summaries completed by the intern.
(30)
Discharge - Formal, documented termination from
a treatment facility. Discharge occurs when a client successfully completes
treatment goals, leaves against professional advice, or is terminated for
other reasons.
(31)
DSM-IV - The Diagnostic and Statistical Manual of
Mental Disorders, Fourth Edition-Revised, published by the American Psychiatric
Association. Any reference to DSM-IV is understood to mean the most recent
edition of the Diagnostic and Statistical Manual of Mental Disorders.
(32)
Dually diagnosed - Diagnosed with co-occurring psychiatric
and substance abuse disorders.
(33)
Education - See chemical dependency education.
(34)
Employee - An individual hired directly by the facility
to provide services in exchange for money or other compensation, as determined
under the usual common law rules. An employee is subject to the will and control
of the employer not only as to what shall be done but as to how it shall be
done.
(35)
Ensure - Take all reasonable and necessary steps
to achieve results.
(36)
Experience - Direct participation in a similar job
activity supervised by a qualified individual.
(37)
Exploitation - An act or process to use, either directly
or indirectly, the labor or resources of a client for monetary or personal
benefit, profit or gain of another individual or organization.
(38)
Extension services - Services provided by a licensed
facility at a registered site that is not owned, leased, or operated by the
licensed facility.
(39)
Family - The children, parents, brothers, sisters,
other relatives, foster parents, or guardians of clients, or significant others
who perform the roles and functions of family members in the lives of clients/participants.
(40)
FTE - Full Time Equivalent staff position requiring
40 hours per week.
(41)
Facility - A legal entity with a single governing
body, a single administration, and a single staff that provides chemical dependency
treatment.
(42)
Governing body - The individual or individuals legally
established to operate a facility. The governing body has ultimate legal authority
and responsibility for the facility's finances, services and operations.
(43)
HIV - Human Immunodeficiency Virus infection.
(44)
Immediate supervision - Being physically present
while a task is being performed.
(45)
Individual service day - A day on which a specific
client receives services.
(46)
Intake - The administrative process for gathering
information about a prospective client and giving a prospective client information
about the treatment facility and the facility's treatment and services.
(47)
Intervention and assessment service - A service that
offers assessment, counseling, evaluation, treatment intervention, or referral
services or makes treatment recommendations to an individual with respect
to chemical dependency.
(48)
License - A grant of authority to a facility to provide
chemical dependency treatment in the State of Texas, which is issued by the
commission under the Act.
(49)
Licensed chemical dependency counselor (LCDC) - A
counselor licensed by the Texas Commission on Alcohol and Drug Abuse.
(50)
Licensed dietitian - An individual who is currently
licensed or provisionally licensed by the Texas State Board of Examiners of
Dietitians.
(51)
Licensed health professional - A physician, physician
assistant, advance practice nurse, registered nurse, or licensed vocational
nurse as defined in these rules.
(52)
Licensed marriage and family therapist (LMFT) - An
individual who is currently licensed as a marriage and family therapist by
the Texas State Board of Examiners of Marriage and Family Therapists.
(53)
Licensed master social worker (LMSW) - An individual
who is licensed as a master social worker by the Texas State Board of Social
Work Examiners.
(54)
Licensed professional counselor (LPC) - An individual
licensed as a professional counselor by the Texas State Board of Examiners
of Professional Counselors.
(55)
Licensed psychological associate - A person licensed
as a psychological associate by the Texas State Board of Examiners of Psychologists.
(56)
Licensed vocational nurse (LVN) - A nurse licensed
by the Texas State Board of Vocational Nurse Examiners.
(57)
Life skills training- A formalized program of training
provided by qualified staff (not clients), based upon a written curriculum,
to help clients manage daily responsibilities effectively and become gainfully
employed. It may include instruction in communication and social interaction,
stress management, problem solving, daily living, and decision making.
(58)
Mechanical restraint - Use of a physical device to
control or restrict a person's physical movement or actions.
(59)
Medical emergency - A medical condition with acute
symptoms of sufficient severity that a prudent layperson could reasonably
expect the absence of immediate medical attention to result in death or serious
harm.
(60)
Medication error - Medication not given according
to the written order by the prescribing professional or as recommended on
the medication label. Includes duplicate doses, missed doses, and doses of
the wrong amount or drug.
(61)
Mental health referral service - See Qualified Mental
Health Referral Service.
(62)
Neglect - Actions resulting from inattention, disregard,
carelessness, ignoring or omission of reasonable consideration that caused,
or might have caused, physical or emotional injury to a client. Examples of
neglect include, but are not limited to:
(A)
failure to provide adequate nutrition, clothing, or health
care;
(B)
failure to provide a safe environment free from abuse;
(C)
failure to maintain adequate numbers of appropriately trained
staff;
(D)
failure to establish or carry out an appropriate individualized
treatment plan; and
(E)
any other act or omission classified as neglect by the
Texas Family Code, §261.001.
(63)
Offer - To make available.
(64)
On call - Immediately available for telephone consultation.
(65)
On duty - Scheduled and present at the site to perform
job duties.
(66)
Orders (written, verbal, or telephone) - Direct communication
between a physician and licensed program staff in which the physician directs
specific treatments.
(67)
Person - An individual, firm, partnership, corporation,
association, or other business or professional entity.
(68)
Personal restraint - Physical contact to control
or restrict a person's physical movement or actions.
(69)
Personnel - Members of the governing body, employees,
contract providers, consultants, agents, representatives, volunteers, and
other individuals working on behalf of the facility through a formal or informal
agreement.
(70)
Physician - A physician licensed by the Texas State
Board of Medical Examiners, or a physician employed by any agency of the United
States who has a license in any other state of the United States.
(71)
Physician assistant - An individual registered as
a physician assistant by the Texas State Board of Medical Examiners.
(72)
Policy - A statement of direction or guiding principle
issued by the governing body.
(73)
Practicum - A 300 hour course of structured clinical
training in the 12 core functions required for chemical dependency counselor
licensure.
(74)
Private practice - Unless otherwise defined by a
licensing board, an individual's professional counseling practice in which
the individual:
(A)
provides all treatment services personally;
(B)
does not report to a supervisor or utilize subordinate
counseling staff;
(C)
is a licensed chemical dependency counselor or exempt from
licensure.
(75)
Procedure - A step-by-step set of instructions.
(76)
Program - A specific level of chemical dependency
treatment delivered to a defined client population.
(77)
Program director - The individual who manages a chemical
dependency treatment program.
(78)
Provide - To perform or deliver.
(79)
Psychiatric emergency - Symptoms requiring immediate
psychiatric attention.
(80)
Psychologist - An individual licensed as a psychologist
by the Texas State Board of Examiners of Psychologists.
(81)
Qualified credentialed counselor (QCC) - A licensed
chemical dependency counselor or one of the professionals listed below:
(A)
licensed professional counselor (LPC);
(B)
licensed master social worker (LMSW);
(C)
licensed marriage and family therapist (LMFT);
(D)
licensed psychologist;
(E)
licensed physician;
(F)
certified addictions registered nurse (CARN);
(G)
licensed psychological associate; and
(H)
advance practice nurse recognized by the Board of Nurse
Examiners as a clinical nurse specialist or nurse practitioner with a specialty
in psyche-mental health (APN-P/MH).
(82)
Qualified mental health referral service - A
service that does not provide treatment directly but instead refers clients
in need of chemical dependency treatment to qualified providers. A mental
health referral service shall meet the statutory requirements of Texas Health
and Safety Code, §164.007.
(83)
Refer - Identify appropriate services and provide
information and assistance needed to access them.
(84)
Registered nurse (RN) - A professional nurse licensed
by the Texas State Board of Nurse Examiners.
(85)
Religious organization - A church, synagogue, mosque,
or other religious institution:
(A)
the purpose of which is the propagation of religious beliefs;
and
(B)
that is exempt from federal income tax by being listed
as an exempt organization under the Internal Revenue Code (26 United States
Code), Section 501(a).
(86)
Residential site - A site owned, leased, or
operated by the facility where clients who are receiving chemical dependency
treatment stay in a structured, supervised, 24-hour living environment, including
aftercare.
(87)
Retaliate - Adverse actions taken to punish or discourage
a person who reports a violation or cooperates with an investigation, inspection,
or proceeding. Such actions include but are not limited to suspension or termination
of employment, demotion, discharge, transfer, discipline, restriction of privileges,
harassment, and discrimination.
(88)
Seclusion - The placement of a client alone in a
room from which exit is prevented.
(89)
Service day - A day during which the program provides
scheduled services to any client.
(90)
Sexual exploitation - A pattern, practice, or scheme
of conduct that can reasonably be construed as being for the purposes of sexual
arousal or gratification or sexual abuse of any person. It may include sexual
contact, a request for sexual contact, or a representation that sexual contact
or exploitation is consistent with or part of treatment.
(91)
Site - A single identifiable location owned, leased,
or controlled by a facility where any element of chemical dependency treatment
is offered or provided, including aftercare.
(92)
Small family living environment - A single apartment
unit, house, or similar residence designed for an average size family, with
no more than four bedrooms.
(93)
Solicit - To contact a person for the purpose of
inducing the person, directly or indirectly, to enter treatment or make a
referral.
(94)
Special treatment procedures - Personal restraint,
mechanical restraint, and seclusion.
(95)
Staff - Individuals employed by the facility to provide
services for the facility in exchange for money or other compensation.
(96)
Support services - Services designed to provide individuals
with a stable living environment, such as meals, shelter, and access to peer
support groups.
(97)
Treatment - See chemical dependency treatment.
(98)
Treatment intervention - A meeting designed to persuade
a chemically dependent individual to enter treatment.
(99)
Treatment level - The intensity of treatment provided
by a program.
(100)
Treatment protocol - Instructions for the delivery
of treatment services to groups of clients by non-licensed and licensed staff.
(101)
Unethical conduct - Conduct prohibited by the ethical
standards adopted by state or national professional organizations or by rules
established by a profession's state licensing agency.
(102)
Unprofessional conduct - An act or omission that
violates commonly accepted standards of behavior for individuals or organizations.
(103)
Volunteer - An individual who provides services
for the facility without compensation. Unpaid students are volunteers.
This agency hereby certifies that the adoption has been
reviewed by legal counsel and found to be a valid exercise of the agency's
legal authority.
Filed with the Office of the Secretary of State on August
11, 1999.
TRD-9905044
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 1999
Proposal publication date: June 25, 1999
For further information, please call: (512) 349-6733
40 TAC §§148.71-148.74, 148.113, 148.116, 148.117, 148.119
The Texas Commission on Alcohol and Drug Abuse adopts amendments
to §§148.71-148.74, 148.113, 148.116, 148.117 and 148.119 concerning
Facility Management. Sections 148.74, 148.116 and 148.119 are adopted with
changes to the proposed text as published in the June 25, 1999 issue of the
These sections contain information on: the governing body; chief executive
officer; policies, procedures and licensure rules; standards of conduct; initial
training; personnel files and training records; basic staffing requirements;
and clinical training institutions.
These amendments are adopted to change the term executive director to chief
executive officer; to require timely correction of identified deficiencies;
to specify the requirements for and duties of a chief executive officer; to
clarify the requirements related to policies, procedures and licensure rules;
to make it clear that client abuse, neglect and exploitation are considered
an unprofessional and unethical act; to add to the standards of conduct the
requirement that facility personnel shall not have an intentional personal
or business relationship with a client until at least two years after the
client's discharge; to require facilities to have written policies that comply
with the commission's rules on standards of conduct; to require that initial
training must be completed within seven days of hire; to specify under what
circumstances video, manual or computer-based training are acceptable; to
specify requirements for documentation of initial staff training; to clarify
the requirements for personnel files and training records; to clarify basic
staffing requirements for various duties; to add to the section on basic staffing
requirements the rule that former clients shall not be hired until at least
two years after discharge from active treatment; to clarify that counselor
interns may only be used in facilities registered as clinical training institutions;
and to update references. Some revisions have been made in response to comments
and, in some instances, wording has been changed for clarity of content or
grammatical correctness.
Comments were received from the Association of Substance Abuse Programs
and individuals.
Comment received on §148.73: The inconsistent and frequent nature
of the TCADA rule changes makes it very difficult to ensure compliance with
Commission rules. This is primarily due to the difficulty in determining which
set of TCADA rules is the most current. We suggest that TCADA needs to establish
a standard time frame for review and/or revision of their rules. Perhaps no
more often than every two to three years, unless there is a new statutory
mandate which needs to be addressed.
Response: The commission reviews rules on an annual basis. On occasion
it has been necessary to make minor revisions during the year to accommodate
a pressing need.
Two comments were received regarding §148.74:
Comment: A provision has been added to the standards of conduct prohibiting
facility personnel from entering into a personal or business relationship
with a client until at least two years after the client's discharge. What
guided the decision for a timeframe of two years? What is the impetus behind
applying the prohibition to all facility personnel? Counselors are guided
by their own licensure rules and ethics on these matters. This rule is very
broad and thus problematic in its potential interpretation and application.
In many situations staff will not know that someone they enter into a relationship
with was once a client. Another area of concern is what constitutes a business
relationship. If a person is employed by a treatment center and also has an
interest in a local retail shop, can the person sell merchandise to a former
client? We would encourage the timeframe be reduced and more clarity be added
to the range of activities that would be considered a violation.
Response: Ethical codes for counseling professionals prohibit inappropriate
relationships, but do not define them. The commission's experience with complaints
and investigations indicates that inappropriate relationships with clients
are widespread in the chemical dependency field, indicating a need for clearer
guidance. The two-year time frame was based on the industry standard that
extends the counselor-client relationship for two years after discharge. The
standard is being applied to all facility personnel because experience shows
potentially harmful relationships often involve non-credentialed staff, including
interns and administrators. The commission acknowledges that the proposed
rule is broadly worded and subject to interpretation, but such language is
often necessary to accomplish the purpose of a rule. We have revised the text
to add "intentional" to address the fact that staff may not know they are
in a relationship with a former client. This rule does not preclude general
business transactions that do not involve establishing a relationship with
client, such as the one described.
Comment: Can providers hire clients to help around the facility (i.e. cleaning
administrative offices)? If it is a total prohibition just say so.
Response: No. The rule has been revised to make this clear.
Comment regarding §148.116: Elimination of supervisory documentation
of competency lessens an important standard of quality control in a facility
setting.
Response: The commission will retain this requirement.
The following two comments were received regarding §148.117.
Comment: This section should state that former clients cannot be hired
until two years after leaving any of the facility's programs, including aftercare.
Response: Language has been added to parallel §148.163, which states
that former clients are not eligible for employment until at least two years
after documented discharge from active treatment. The commission believes
two years is an adequate time of separation, even if it includes a period
of aftercare. Furthermore, the rules do not require documentation for aftercare,
so the expanded prohibition suggested could not be implemented feasibly.
Comment: Paragraph (c) states that chemical dependency education shall
be taught by chemical dependency counselors or people who have the specialized
education, expertise, and/or experience needed to teach the material. Paragraph
(f) says that counselors shall not provide counseling on trauma, abuse, or
sexual issues unless they are licensed and have specialized education/training
and supervised experience in the subject. These statements are way too vague.
Provide us with a consultant-approved outline of what you want in the way
of course content. Better yet develop a course and provide it to us for use.
This would seem like a given function of a state agency to provide contractors.
If you want a high degree of specialized training as a part of the contract
you should at least assist us in obtaining the materials.
Response: These sections are worded to allow providers to determine what
is appropriate in their own programs. The commission does not dictate the
content of client education and therefore cannot dictate specific qualifications
for the instructors. Paragraph (f) specifically states that the provider can
define (in writing) what training is appropriate. This provision should not
be interpreted to say that the commission requires programs to provide counseling
focused on trauma, abuse, or sexual issues. These topics are extremely sensitive
and require considerable expertise that most LCDCs do not have. If the program
decides to provide such counseling, it must take responsibility for determining
whether the person doing the counseling has sufficient knowledge and skills.
These amendments are adopted under the Texas Health and Safety
Code, Chapter 464, which provides the Texas Commission on Alcohol and Drug
Abuse with the authority to adopt rules licensing chemical dependency treatment
facilities.
The code affected by the adopted rules is the Texas Health and Safety Code,
Chapter 464.
§148.74.Standards of Conduct.
(a)
The facility and all of its personnel shall:
(1)
protect the health, safety, rights, and welfare of clients;
(2)
provide adequate services as described in the program
description;
(3)
comply with all applicable laws, regulations, policies,
and procedures;
(4)
maintain required licenses, permits, and credentials;
and
(5)
comply with professional and ethical codes of conduct.
(b)
Neither the facility nor any of its personnel shall:
(1)
commit an illegal, unprofessional or unethical act (including
client abuse, neglect, or exploitation);
(2)
assist or knowingly allow another person to commit
an illegal, unprofessional, or unethical act;
(3)
knowingly provide false or misleading information;
(4)
omit significant information from required reports
and records or interfere with their preservation;
(5)
retaliate against anyone who reports a violation or
cooperates during a review, inspection, investigation, hearing, or other related
activity; or
(6)
interfere with commission reviews, inspections, investigations,
hearings, or related activities. This includes taking action to discourage
or prevent someone else from cooperating with the activity.
(c)
Facility personnel shall report violations of laws, rules,
and professional and ethical codes of conduct to the commission.
(d)
The facility and its personnel shall not enter into an
intentional personal or business relationship with a person who receives services
from the facility until at least two years after the service recipient's discharge.
(e)
The facility shall have written policies on staff conduct
and reporting procedures that comply with this section.
§148.116.Personnel Files and Training Records.
(a)
The facility shall ensure that staff are qualified, trained,
and supervised to perform assigned duties.
(b)
The facility shall maintain current personnel documentation
on each employee. Training records and supervision records may be stored separately
from the main personnel file, but shall be easily accessible upon request.
Required documentation includes, if applicable:
(1)
job description;
(2)
application or resume;
(3)
documentation that the facility has direct verification
from the credentialing authority (by telephone or letter) that required credentials
are current at the time of employment and maintained throughout employment;
(4)
documentation of appropriate screening and required
background checks;
(5)
signed documentation of required training (initial
and annual);
(6)
documentation of other training the employee has completed;
(7)
written supervisory approval to provide treatment
services independently;
(8)
records of direct supervision for all counselor interns;
(9)
annual performance evaluations; and
(10)
records of any disciplinary actions.
(c)
Documentation of external training for individual staff
members shall include:
(1)
date;
(2)
number of hours;
(3)
topic;
(4)
instructor's name; and
(5)
signature of the instructor (or equivalent verification).
(d)
The facility shall maintain documentation of all internal
training.
(1)
For each topic, the file shall include an outline of the
contents and the name, credentials, and relevant qualifications of the person
providing the training.
(2)
For each group training session, the facility shall
maintain on file a dated participant sign-in sheet.
(3)
When internal training is delivered to only one or
two individuals at a time, the individual's dated certificate of completion
may substitute for the participant sign-in sheet.
(e)
Personnel files shall be kept for at least two years after
the individual stops working at the facility. Documentation of training required
in §148.118 of this title (relating to Training Requirements Relating
to Abuse, Neglect, Professional or Unethical Conduct) must be kept for at
least five years.
§148.119.Clinical Training Institutions.
A facility shall not use a counselor intern for performing counseling,
assessments, or treatment interventions unless the facility is registered
with the commission as a clinical training institution as required in Chapter
150 of this title (relating to Counselor Licensure).
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August
11, 1999.
TRD-9905045
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 1999
Proposal publication date: June 25, 1999
For further information, please call: (512) 349-6733
40 TAC §148.112
The Texas Commission on Alcohol and Drug Abuse adopts an
amendment to §148.112 concerning Facility Management. The amendment is
adopted without changes to the proposed text as published in the June 25,
1999 issue of the
Texas Register
(24 TexReg
4796) and will not be republished.
This section contains information on hiring practices.
The amendment is adopted to direct that the facility must obtain the results
of a statewide criminal background check done on all staff who have access
to adolescents or children.
No comments were received regarding adoption of this amendment.
This amendment is adopted under the Texas Health and Safety Code,
Chapter 464, which provides the Texas Commission on Alcohol and Drug Abuse
with the authority to adopt rules licensing chemical dependency treatment
facilities.
The code affected by this amendment is the Texas Health and Safety Code,
Chapter 464.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August
11, 1999.
TRD-9905046
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 1999
Proposal publication date: June 25, 1999
For further information, please call: (512) 349-6733
40 TAC §148.114
The Texas Commission on Alcohol and Drug Abuse adopts an
amendment to §148.114 concerning Facility Management. The amendment is
adopted with changes to the proposed text as published in the June 25, 1999
issue of the
Texas Register
(24 TexReg 4796).
This section contains information on special training requirements.
This amendment is adopted to allow a facility to accept documented training
from another organization during the year prior to employment if it meets
commission requirements; to require a minimum number of hours of face-to-face
training in issues related to abuse, neglect, exploitation, illegal, unprofessional
and unethical conduct for all staff who have any client contact; to set standards
for required, face-to-face training related to tuberculosis, HIV, Hepatitis
C and other sexually transmitted diseases for all direct care staff; to require
that direct care employees have their current certification in CPR within
90 days of hire and to specify that staff in programs that serve women with
their dependent children must have certification in both adult and child/infant
CPR; to specify the requirements for nonviolent crisis intervention training,
training in special treatment procedures, training for staff who conduct intakes
or assess applicants for admission, detoxification training, training of staff
who supervise self-administration of medication, and staff training requirements
in adolescent programs; and to state the conditions under which video, manual
or computer-based training are acceptable. Some revisions have been made in
response to comments and, in some instances, wording has been changed for
clarity of content or grammatical correctness.
Comments were received from a number of individuals.
Comment: We strongly support allowing the use of video/computer based training.
This provides flexibility and should make it easier to stay in compliance.
Comment: The rule states that training for intake staff must include information
to help staff recognize possible unmet mental health needs. This puts providers
in position for liability if they are not able to recognize such an unmet
need and a client then kills himself.
Response: The commission disagrees with this comment. A provider is always
at some risk for liability in the case of a client death. The risk increases
if the provider cannot show that reasonable and necessary steps were taken
to recognize and respond to warning signs. Providers are required to assess
clients prior to admission to determine whether or not they meet admission
criteria and are appropriate for admission. Training admission staff how to
recognize unmet mental health needs shows the provider made some effort to
avoid such an incident. The intent of this rule, however, is broader than
screening for risk to self and/or others. It is also designed to facilitate
appropriate referrals for clients with other mental health needs: depression,
anxiety, thought disorders, etc.
Comment: What is the distinction between "training" and "in-service training".
Response: These terms have been replaced with the terms "external training"
and "internal training" to clarify the difference.
Comment: For non-violent crisis intervention training, the rule states
that the instructor must be certified or have equivalent experience. What
is considered equivalent experience? Can one of our employees with extensive
inpatient psychiatric experience be qualified to provide the training? We
have been unable to find a certified instructor who will do just two hours
of training for us. There is a shortage of qualified instructors to do just
the basic training. Since the four hour training costs $50 per employee, a
two-hour refresher course could cost $25 per employee.
Response: The provider is responsible for determining equivalent experience.
Factors to consider might include years of experience in high-risk settings,
past training, and special research on the topic. An individual with extensive
inpatient psychiatric experience who had received regular crisis intervention
training would probably be qualified to conduct the training, particularly
with additional research. We have also modified the new requirement to state
that refresher courses may be taught by individuals with recognized knowledge
and experience in crisis intervention. This should allow many providers to
meet this requirement through in-internal training.
Comment: In the past, the rule required annual training for staff in adolescent
programs. That has been changed to eight hours. The intent must be balanced
with the cost. Eight hours often requires more than one session, which is
more difficult to monitor to ensure that everybody gets the required hours.
Response: This is a critical population that is very challenging to serve.
We believe the importance of this issue merits the proposed hours. To help
relieve the burden on facilities, we have also proposed revisions to allow
use of alternate training modalities such as videos and manual-based instruction.
Comment: This whole section needs to be reviewed. Except for large multi-provider
agencies that can draw on a large cross section of trainers these requirements
are becoming increasingly expensive. At some point TCADA needs to use its
in house or contractual consultants to recommend programs we can purchase,
or actually provide to us training programs we can present that meet these
requirements. Otherwise TCADA needs to expand the training provided through
the HIV Connection or the Leadership program to provide the training in all
areas in a manner to meet the TCADA time requirements.
Response: The commission acknowledges that training requires a significant
investment of time and money. However, we believe all of the required training
is necessary. To ease the burden, new provisions have been added which allow
providers to use video, manual, or computer based training for many courses.
Also, the eight hours of required adolescent training will be provided through
the regional leadership trainings. We will also try to identify other resources
to help providers meet these requirements.
Comment: The requirement for eight hours of training annually for staff
who conduct intakes or assess applicants for admission is arbitrary, excessive
and professionally indefensible. We hire an LCDC or other QCC for their credentials
and professional experience. The facility should determine the length of time
and the Clinical or Executive Director certifies the staff person is properly
licensed and knows agency procedures.
Response: Eight hours of training annually is required by law.
Comment: Clarification is needed on how often during the eight-hour training
should the instructor be present for discussion; i.e., every hour, or after
each module of training. Must they stay for videotapes?
Response: This is a general provision that applies to all trainings. The
language allows the instructor to determine when the face-to-face session(s)
is appropriate. The instructor does not need to be present for videotapes.
Comment: Adolescent training should include normal adolescent development,
dual diagnoses specific to adolescent population, how to engage the adolescent
client in treatment, and how to avoid power struggles with the adolescent
client.
Response: The commission agrees. We believe these issues are encompassed
in the more general topics listed.
Comment: Please clarify the number of hours for abuse training in outpatient
programs. The information is contradictory.
Response: Additional language has been added to clarify this issue.
This amendment is adopted under the Texas Health and Safety Code,
Chapter 464, which provides the Texas Commission on Alcohol and Drug Abuse
with the authority to adopt rules licensing chemical dependency treatment
facilities.
The code affected by this amendment is the Texas Health and Safety Code,
Chapter 464.
§148.114.Special Training Requirements.
(a)
The facility shall ensure that staff are adequately trained
and competent to perform job duties.
(b)
The facility may accept documented training from another
organization completed during the year prior to employment if it meets commission
requirements.
(c)
The facility shall provide face-to-face training in issues
relating to abuse, neglect, exploitation, illegal, unprofessional, and unethical
conduct to all staff who have any client contact.
(1)
This training shall comply with the interagency memorandum
of understanding on abuse training (see §148.118 of this title relating
to Training Requirements Relating to Abuse, Neglect, and Unprofessional or
Unethical Conduct).
(2)
Crisis intervention training and other training related
to improving client care may be included in the required hours.
(3)
Full time staff in residential programs must receive
at least eight hours every year, and full time staff in outpatient programs
must receive at least two hours every year. (The hours for staff of outpatient
programs is less because the interagency memorandum of understanding on abuse
training does not apply to outpatient programs.) Hours of training for part
time staff may be determined by the facility based on the number of hours
worked and the amount of direct client contact.
(d)
All direct care staff shall complete two hours of face-to-face
training related to tuberculosis, HIV, Hepatitis C, and other sexually transmitted
diseases during the first 90 days of employment.
(1)
The training must be based on the Texas Commission on Alcohol
and Drug Abuse Workplace and Education Guidelines for HIV and Other Communicable
Diseases.
(2)
Staff shall receive an update with current information
every two years.
(e)
All direct care employees in residential programs shall
have current certification in CPR within 90 days of hire.
(1)
Personnel in licensed medical facilities are exempt if
emergency resuscitation equipment and trained response teams are available
24 hours a day.
(2)
Licensed medical physicians, registered nurses, licensed
vocational nurses, physician assistants, and advanced practice nurses are
also exempt.
(3)
Staff working in programs that serve women with their
dependent children must have certification in adult and child/infant CPR.
(f)
All direct care employees shall have at least four hours
of face-to-face training in nonviolent crisis intervention during the first
90 days of employment.
(1)
The instructor shall have successfully completed a course
for crisis intervention instructors or have equivalent training and experience.
(2)
The training shall teach employees how to use verbal
and other non-physical methods for prevention, early intervention, and crisis
management.
(3)
Staff must receive an additional two hours of nonviolent
crisis intervention in every subsequent year. These hours may be taught by
an individual with knowledge and experience in crisis intervention.
(g)
All direct care employees working in programs that use
special treatment procedures shall have face-to-face training and competency
in the safe methods of the specific procedures used within 90 days of hire.
This includes all direct care staff working in adolescent programs, detoxification
programs, or programs that accept emergency detentions. The training must
last approximately four hours and must include hands-on practice under the
supervision of a qualified instructor. It is required one time only.
(h)
Each employee who conducts intakes or assesses applicants
for admission shall complete eight hours of training in the program's intake
and admission determination procedures annually.
(1)
The first eight hours must be completed during the first
90 days of employment, and an employee shall not conduct intakes or assess
applicants for admission unless training is complete and current.
(2)
The training shall cover the DSM-IV diagnostic criteria
for substance-related disorders, and shall also include information to help
staff recognize possible unmet mental health needs and provide appropriate
referrals for further mental health assessment and follow-up.
(i)
All direct care employees working in detoxification programs
shall complete detoxification training during the first 90 days of employment.
The training is required one time only and shall:
(1)
be provided by a physician, physician assistant, advanced
practice nurse, or registered nurse with at least one year of documented experience
in detoxification;
(2)
include:
(A)
signs of withdrawal;
(B)
pregnancy-related complications (if the program admits
females of child-bearing age);
(C)
observation and monitoring procedures;
(D)
appropriate intervention;
(E)
complications requiring transfer; and
(F)
frequently-used medications, including purpose and precautions.
(j)
All programs that admit females of child-bearing age shall
have at least one staff person with documented knowledge of pregnant substance-abusing
females and their care. When a pregnant female is admitted, all members of
the treatment team shall receive information needed to provide appropriate
care.
(k)
All employees responsible for supervising clients in self-administration
of medication who are not credentialed to administer medication shall complete
at least two hours of documented training from a physician, pharmacist, physician
assistant, or registered nurse before performing this task. The training is
required one time and must be completed during the first 90 days of employment.
It shall include:
(1)
prescription labels;
(2)
medical abbreviations;
(3)
routes of administration;
(4)
use of drug reference materials;
(5)
storage, maintenance, handling, and destruction of
medication;
(6)
documentation requirements; and
(7)
procedures for medication errors, adverse reactions,
and side effects.
(l)
All supervisory and direct care staff working in adolescent
programs shall receive at least eight hours of specialized education or training
in adolescent health and development each year. The training shall include:
(1)
psychosocial stages of adolescent development;
(2)
physical growth and development;
(3)
adolescent culture;
(4)
communicable diseases;
(5)
mental health;
(6)
substance abuse and dependency in adolescents; and
(7)
family systems.
(m)
Unless otherwise specified, video, manual, or computer-based
training is acceptable if the supervisor discusses the material with the employee
in a face-to-face session to highlight key issues and answer questions.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August
11, 1999.
TRD-9905047
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 1999
Proposal publication date: June 25, 1999
For further information, please call: (512) 349-6733
40 TAC §§148.141, 148.143, 148.161-148.164, 148.171-148.173, 148.181, 148.183, 148.185
The Texas Commission on Alcohol and Drug Abuse adopts amendments
to §§148.141, 148.143, 148.161-148.163, 148.171-148.173, 148.181,
148.183, 148.185 and adopts new §148.164 concerning Client Management.
Sections 148.163 and 148.164 are adopted with changes to the proposed text
as published in the June 25, 1999 issue of the
Texas
Register
(24 TexReg 4798). Sections 148.141, 148.143, 148.161, 148.162,
148.171-148.173, 148.181, 148.183 and 148.185 are adopted without changes
to the proposed text and will not be republished.
These sections contain information on: required postings; voluntary clients
- additional rights; client abuse, neglect, and exploitation; behavior management;
client labor; searches; client record security; general documentation requirements;
release of confidential information; significant incident reports; special
treatment procedures; and adolescents absent without permission.
These amendments and new section are adopted to clarify that it is the
commission's current poster on reporting complaints and violations that must
be posted; to specify that required postings must be at each approved site;
to clarify the process regarding requests for discharge from voluntary clients
under 16 years of age; to replace the term executive director with chief executive
officer; to fully describe the process for reporting allegations of client
abuse, neglect or exploitation; to specify that the client government process
cannot substitute for the client grievance procedure; to mandate that written
information about required housekeeping activities and responsibilities be
given to the client at the time of admission; to specify that two years must
elapse between discharge of a former client and (1) the employment of the
former client by the facility, (2) any intentional business relationship between
the former client and a facility staff member, and/or (3) the giving of personal
gifts to the former client by a staff member; to require a policy on searches
and to set parameters for the search process in facilities that choose to
allow searches; to add requirements regarding client and applicant record
security including location of records, protection of applicant information,
and a record of destroyed client records; to clarify the requirement for signatures
on documentation; to include applicant information and specific legal citations
in the section on release of confidential information; to clarify the requirements
regarding significant incident reports; to require all adolescent programs,
detoxification programs and programs that accept emergency detentions to authorize
the use of personal restraint; to reduce the maximum amount of time personal
restraint may be used on a client; and to clarify what programs must have
written procedures for use when an adolescent leaves the program without permission.
Some revisions have been made in response to comments and, in some instances,
wording has been changed for clarity of content or grammatical correctness.
Comments were received from the Association of Substance Abuse Programs
and individuals.
The following comments are regarding §148.163.
Comment: The proposed rule prohibits a facility from hiring a former client
for two years after discharge. What is the rationale behind this requirement
and what guided the decision to designate a two-year timeframe? Historically,
former clients have often been afforded opportunities to work at the treatment
facility, which has allowed them to establish employment histories. Many times
these are in maintenance, housekeeping/kitchen, and other supportive type
of positions. Given the drug and alcohol histories many clients have, this
opportunity has been important to their community transition. Additionally,
it seems there could be some discrimination liability on the part of providers
if the person is qualified for the job and is turned down because of being
a former client.
Response: The rationale for this rule has several components. First, failure
to maintain adequate boundaries between staff and clients is harmful to clients
and can jeopardize recovery. When a client becomes a coworker, we believe
such boundary violations are almost inevitable. The commission's experience
with complaints and investigations indicate that inappropriate relationships
with clients are widespread in the chemical dependency field, indicating a
need for clearer guidance. Second, the former clients frequently become intimately
involved in the recovery issues of new clients, often preventing full resolution
of their own issues. This is true even when the former client is employed
in a support position, although to a far lesser extent. Conversely, the former
client's unresolved personal issues can have a negative impact on active clients.
Third, an important step in recovery is establishing an independent support
system in the community. Clients who work in the treatment program frequently
become dependent on the treatment environment to provide support for their
recovery. The commission acknowledges that discharged clients face barriers
to employment, and establishing a work history can be very helpful in obtaining
future jobs. However, we feel that this benefit is outweighed by the problems
described above. The two-year time frame was based on the industry standard
that extends the counselor-client relationship for two years after discharge.
The liability issue could be addressed by having clients sign a form at the
time of admission documenting that they understand that recovery is a long-term
process that requires development of an independent support system outside
of the treatment environment, and therefore they will not be eligible for
employment at the facility for two years after discharge.
The following are comments received regarding §148.164.
Comment: This new section tells providers what kind of search they can
make in their privately owned facilities for protection of their own clients.
That is micro-management. If you must go into those areas, don't mandate.
Look at it from a liability point of view.
Response: The commission has specifically avoided mandating provider policy
relating to client searches. The proposed rules consist solely of standards
necessary to protect the rights of clients who are subjected to searches.
State statute specifically requires the commission to adopt rules protecting
the rights of individuals receiving services from a treatment facility. From
a liability perspective, these rules could help a provider avoid suits charging
violation of client rights. If a person filed charges alleging that the provider
should have conducted a more intrusive search to avoid contraband, the rules
would provide a defense.
Comment: In an adolescent program, contraband is a big issue, especially
in an outpatient program. Local law enforcement officers will not transport
a juvenile on a request or on a suspicion. You are requiring us to fail if
a local authority over which we have no jurisdiction will not cooperate. Each
facility should have a policy on strip searches and the right to enforce it.
At the least under this policy TCADA is requiring the provider to deny services
to the client (with all the possible legal ramifications) or you are requiring
the provider to subject the other clients to a possible abuse and neglect
situation.
Response: The commission believes that providers can conduct thorough searches
that will detect most contraband without stripping the client. Close supervision
will also help maintain a safe environment, particularly in an outpatient
program. The language related to strip searches and law enforcement personnel
has been removed. However, language requiring the client to be fully clothed
during a search has been retained.
Comment: This is a brand new section dealing with client searches. We are
generally in support of these rules. However, the documentation requirements
are excessive. We recommend that TCADA keep the base of these rules, but ease
off on the documentation requirements.
Response: The commission does not believe that documenting the reason for
the search and its results is excessive. We have substituted "reason" for
the originally proposed wording, "circumstances prompting".
The following are comments received regarding §148.183.
Comment: The rule states that all adolescent programs, detoxification programs,
and programs accepting emergency detentions shall authorize use of personal
restraint. Does that mean all adolescent programs? The wording is too vague.
Response: It does mean all adolescent programs.
Comment: The rule essentially mandates the use of specialized treatment
procedures in certain settings. This should not be mandated; it should be
up to the provider to make this decision. Some providers are philosophically
opposed to using physical restraint with clients.
Response: This rule is designed to protect the safety of staff and clients.
The commission prohibits the use of physical restraint except when a client
is endangering self or others. Clients in adolescent programs, detoxification
programs, and programs accepting emergency detention are much more likely
to exhibit violent behavior that presents danger to self or others than clients
in other settings. In such situations, it is inevitable that staff will physically
intervene. If they are not properly trained, the intervention is likely to
be ineffective, use unnecessary force, and/or cause injury or pain.
Comment: Is the personal restraint training for adolescent programs to
be done once or annually?
Response: The rule refers back to §148.114, which states that the
training is required one time only.
These amendments and new section are adopted under the Texas
Health and Safety Code, Chapter 464, which provides the Texas Commission on
Alcohol and Drug Abuse with the authority to adopt rules licensing chemical
dependency treatment facilities.
The code affected by these amendments and new section is the Texas Health
and Safety Code, Chapter 464.
§148.163.Client Labor.
(a)
Clients can be required to maintain their own living quarters
and client activity areas if they are physically able to do so. These housekeeping
activities and individual/group responsibilities shall be clearly defined
in writing and presented to the client at the time of admission.
(b)
The facility shall not hire clients to fill staff positions.
Former clients are not eligible for employment at the facility until at least
two years after documented discharge from active treatment.
(c)
Except for activities permitted in subsection (a) of this
section, clients shall be required or allowed to work only when the following
conditions are met.
(1)
Work responsibilities (and compensation, if applicable)
are defined in writing.
(2)
Staff explain the work requirements before admission.
(3)
The client gives voluntary written consent.
(4)
Work does not interfere or conflict with treatment.
(5)
Work does not endanger client safety or well-being.
(6)
Work does not involve access to client records.
(7)
Work arrangements do not violate client confidentiality.
(8)
The facility provides appropriate equipment, supplies,
instruction, and assistance.
(d)
The facility shall not allow clients to solicit donations
or raise funds for the facility. This does not prevent clients from participating
in small fund-raising activities when the following conditions are met:
(1)
the activity is completely voluntary;
(2)
the activity is conducted in compliance with confidentiality
regulations;
(3)
clients have direct control of the funds; and
(4)
all proceeds are used for the direct benefit of the
clients.
(e)
The facility and its staff members shall not enter into
an intentional business relationship with any client or give personal gifts
to clients until at least two years after documented discharge.
§148.164.Searches.
(a)
The facility shall adopt a policy on searches. If searches
are allowed, the facility shall adopt a search procedure that ensures the
protection of client rights.
(b)
Searches may only be conducted to protect the health, safety,
and welfare of clients, including detection of drugs and weapons.
(c)
Searches must be conducted in a professional manner that
maintains respect and dignity for the client. All searches must comply with
the following standards.
(1)
Staff members performing a personal search must be the
same gender as the client.
(2)
The client must be allowed to remain fully clothed
during a personal search. The client may be required to remove jackets, coats,
and extra garments. Staff may use their hands to pat down the client's body
to feel for illicit items.
(3)
The client must be present when a search is conducted
of belongings such as back packs, purses, and luggage.
(4)
When searching bedrooms, all clothes, furniture, and
personal items must be returned to their original state.
(5)
All searches must be witnessed by a second staff person
or another individual who is not directly involved in the search.
(6)
All searches must be documented in the client record,
including the reason for the search, the result of the search, and the signature
of the individuals conducting and witnessing the search.
This agency hereby certifies that the adoption has been
reviewed by legal counsel and found to be a valid exercise of the agency's
legal authority.
Filed with the Office of the Secretary of State on August
11, 1999.
TRD-9905048
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 1999
Proposal publication date: June 25, 1999
For further information, please call: (512) 349-6733
40 TAC §§148.201-148.203, 148.211, 148.231-148.233, 148.236-148.238, 148.252, 148.261-148.268
The Texas Commission on Alcohol and Drug Abuse adopts amendments
to §§148.201, 148.202, 148.211, 148.231-148.233, 148.236, 148.252,
148.261-148.268 and adopts new §§148.203, 148.237, and 148.238 concerning
Program Services. Sections 148.202, 148.203, 148.211 and 148.231 are adopted
with changes to the proposed text as published in the June 25, 1999 issue
of the
Texas Register
(24 TexReg 4801). Sections
148.201, 148.232, 148.233, 148.236-148.238, 148.252, and 148.261-268 are adopted
without changes to the proposed text and will not be republished.
These sections contain information on: general information; services required
in all programs; client transportation; Level I treatment (outpatient or residential
detoxification); adolescents; parents and their dependent children; structured
therapeutic children's services; extension services; small family living environments;
court commitment services; meals in residential programs; general provisions
for medication; medication storage; medication inventory; disposing of medication;
staff qualifications and training; authorizations for medication; administration
of medication; and self-administration of medication.
These amendments and new sections are adopted to add and/or update appropriate
references; to ensure that residential programs have procedures that provide
for clients to continue prescribed medication after admission; to require
that chemical dependency education is based on a course curriculum and that
all sessions include opportunities for client participation and discussion;
to require programs to provide education about specific communicable diseases;
to require clients be referred for other services they need; to mandate that
facilities have a written policy regarding the use of facility vehicles and/or
staff to transport clients and to set parameters for facilities that choose
to use their resources to provide transportation for clients; to clarify and/or
add requirements for Level I treatment programs including periodic checks
while clients are sleeping, some additional experience and/or training requirements
for certain staff, and at least one counseling session to encourage clients
to seek appropriate treatment after detoxification; to strengthen the requirements
for adolescent treatment programs including family involvement, prohibition
of tobacco use by adolescents, and prohibition of tobacco use in the presence
of adolescents by staff and other adults; to clarify the requirements for
programs for parents and their dependent children and for structured therapeutic
children's services provided in connection with their parents' treatment;
to specify that extension sites must be registered and approved prior to service
provision at the site; to add requirements for small family living environments
to this subchapter and to clarify that small family living environments are
only for outpatient clients who need temporary living arrangements in order
to access services; to consolidate the rules on court commitment services
in one place; to specify that residential programs are responsible for the
meals of clients who are scheduled to be away from the facility at meal time;
and to clarify the requirements regarding medication policies and procedures
including inventory, disposal, storage, administration and self-administration
as well as training for staff who administer medication. Some revisions have
been made in response to comments and, in some instances, wording has been
changed for clarity of content or grammatical correctness.
Comments were received from the Association of Substance Abuse Programs
and a number of individuals.
The following are comments received in response to §148.202.
Comment: We are opposed to requiring licensed (but non-funded) facilities
to provide case management services. To require referrals to ancillary services
is reasonable, so we recommend that TCADA go back to the original wording
of this standard. Response: The commission accepts this comment. The original
wording will remain unchanged.
Comment: We are opposed to the new requirement that all programs provide
gender-specific services. This requirement in TCADA funded gender specific
programs makes sense. We are opposed to this level of micro-management in
non-funded programs.
Response: Traditionally, substance abuse treatment programs have been designed
to meet the needs of a predominately male population. Studies have shown that
these programs do not meet the needs of many women. Gender-specific programs
were created in response, but the long-range goal is for all programs to meet
the needs of both genders. This standard can be met by simply offering a separate
women's group.
The following are the comments received regarding §148.203.
Comments: This is a brand new section dealing with client transportation.
We are generally in support of these rules. The commission should not, however,
establish the number of moving violations that would preclude someone from
providing client transportation. It should be sufficient for a person to have
a license if the facility is willing to accept the risk and pay the liability
insurance.
Response: The commission concurs and has removed this provision from the
rules.
Comment: Drivers under 21 years of age should be allowed if the facility
carries the proper insurance.
Response: The commission accepts this comment. The rule has been revised
accordingly.
Comment regarding §148.211: Requiring night staff to conduct hourly
checks is excessive. This goes beyond what even the federal government requires
for prisoners in a community based setting. Requiring three documented checks
per night seems reasonable enough and, depending on the configuration of the
facility, even this could be redundant. This is micromanagment. It should
be up to the facility to determine the time period we need. Also, what does
TCADA consider an appropriate "check" on a sleeping client?
Response: The commission believes periodic checks are necessary for security
and clinical purposes. Staff should walk through the entire building and look
into each bedroom to see that clients are sleeping and/or resting comfortably.
Night can be a difficult time for many clients, especially new ones, and it
is often necessary for the staff person to spend some time with an upset or
anxious client. The rule has been revised to require checks three times per
night.
Comment regarding §148.232: Who is to assess the parent-child interaction?
Childcare, counselor, or family therapist?
Response: The facility should determine who is most appropriate. When multiple
staff are involved with the client, a team staffing might provide the best
alternative.
Comment regarding §148.238: The rules for court commitment programs
say the program needs to be able to provide an appropriate level of services,
but it doesn't mention Level IV services. We are not funded by TCADA to provide
Level III, but we are funded to provide Level IV. We are located in a rural
area, and judges are often willing to commit clients to our program.
Response: An individual cannot be court committed to treatment unless he
or she is a danger to self or others, or is suffering abnormal distress and
deteriorating in ability to function independently and is unable to make a
rational and informed choice regarding treatment. The commission does not
believe such an individual can be safely or effectively treated in an outpatient
program that provides only two hours of services per week.
Two comments were received regarding §148.233.
Comment: We need an exact definition of the 90 contact hours of education
and training required for the supervisor/consultant. If this is the college
courses, such as offered by Lamar University, it is a one or two year program
that will cost us $2,000 per staff.
Response: The rule has been written to allow a variety of educational and
training experiences to be considered. The only requirement is that the content
must address child development and/or early childhood education. College courses
are acceptable but not required. A three-hour college course is generally
equivalent to 45 contact (or clock) hours of education.
Comment: Is there a specific program we need to access for our childcare
workers?
Response: No. The rule simply requires 8 hours of training that addresses
the six topics listed.
Comment regarding §148.262: Reference to non-prescription medications
has been deleted. If a client has Tylenol, cough syrup, aspirin, creams, etc.
that could be a danger to small children. Non-prescription drugs need to be
kept where children cannot get to them. This section goes on to say that non-prescription
drugs may be kept by the client with written permission from a licensed professional
or the Program Director. I personally do not want that responsibility.
Response: The content of the rule has not changed. The term "non-prescription"
has been replaced with "over-the-counter", a term more familiar to the general
population. The provision about client's maintaining personal possession of
over-the-counter medication was added to give providers greater discretion.
The language permits authorization for clients to keep their own over-the-counter
medication, but does not require it.
Comment regarding §148.267: It would be useful to include a definition
of medication error.
Response: Medication errors are defined in §148.61. When the commission
publishes the rules for distribution to providers, defined terms are printed
in bold to alert readers that the word has a specific definition.
These amendments and new sections are adopted under the Texas
Health and Safety Code, Chapter 464, which provides the Texas Commission on
Alcohol and Drug Abuse with the authority to adopt rules licensing chemical
dependency treatment facilities.
The code affected by these amendments and new sections is the Texas Health
and Safety Code, Chapter 464.
§148.202.Services Required In All Programs.
(a)
All services shall be delivered according to the written
program description referenced in §148.73 of this title (relating to
Policies, Procedures, and Licensure Rules). The program shall maintain a service
schedule listing services provided and timeframes in which they are provided.
(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 of efforts and activities.
(d)
Every residential program shall adopt medication procedures
so that clients can continue taking prescribed medication after admission.
(e)
Chemical dependency education shall follow a course curriculum
that identifies lecture topics and major points to be discussed. All educational
sessions shall include opportunities for client participation and discussion.
(f)
The program shall provide education about the health risks
of tobacco products and nicotine addiction.
(g)
The program shall provide education about tuberculosis,
HIV, Hepatitis C, and other sexually transmitted diseases based on the
(h)
The provider shall:
(1)
provide access to pre-test and post-test counseling and
anonymous or confidential HIV testing; and
(2)
ensure that testing for the etiologic agent for AIDS
is not carried out unless it is accompanied by written consent and counseling
that conforms to the model protocol developed by the Texas Department of Health;
and
(3)
refer HIV positive clients to a provider of HIV early
intervention services (when available).
(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 refer clients to physical health, mental
health, and ancillary services necessary to meet treatment goals and conduct
follow-up. Residential programs shall ensure clients have access to appropriate
physical and mental health services.
(k)
Programs that admit females of child-bearing age shall
ensure that at least one staff person has training and/or experience in providing
specialized care for substance-abusing pregnant females. In addition, the
program shall:
(1)
adopt procedures for the care of pregnant clients that
is approved by a licensed health care professional;
(2)
implement the procedures whenever a pregnant female
is admitted;
(3)
refer pregnant clients who are not receiving prenatal
care to an appropriate health care provider and monitor follow-through; and
(4)
provide gender specific services.
(l)
Clients in residential programs shall have an opportunity
for eight continuous hours of sleep each night.
§148.203.Client Transportation.
(a)
The facility shall have a written policy on the use of
facility vehicles and/or staff to transport clients.
(b)
If the facility allows the use of facility vehicles and/or
staff to transport clients, it must adopt transportation procedures which
include the following elements:
(1)
Any vehicle used to transport a client must have appropriate
insurance coverage for business use with a current safety inspection sticker
and license.
(2)
All vehicles used to transport clients must be maintained
in safe driving condition.
(3)
Drivers must have a valid driver's license.
(4)
Drivers and passengers must wear seatbelts at all
times the vehicle is in operation.
(5)
A vehicle shall not be used to transport more passengers
than designated by the manufacturer.
(6)
Drivers shall not use cellular phones while driving.
(7)
Use of tobacco products shall not be allowed in the
vehicle.
(8)
Every vehicle used for client transportation shall
have a fully stocked first aid kit and A:B:C fire extinguisher that are easily
accessible.
§148.211.Level I Treatment (Outpatient or Residential Detoxification).
(a)
Every client shall have a medical history and physical
as required in §148.291 of this title (relating to Detoxification History
and Assessment).
(b)
The program shall provide continuous supervision for clients.
(1)
In residential programs, direct care staff shall be awake
and on duty where the clients are located 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. Night staff shall conduct and document at least three checks
while clients are sleeping.
(2)
In outpatient programs, direct care staff shall
be awake and on site whenever a client is on site. Clients shall have access
to an on-call health care professional with detoxification experience 24 hours
a day.
(c)
If the program accepts clients with acute withdrawal symptoms
or a history of acute withdrawal symptoms, the program shall have:
(1)
a licensed vocational nurse or registered nurse with detoxification
experience on duty during all hours of operation; and
(2)
a physician on call 24 hours a day.
(d)
Level of observation shall be based on medical recommendations
and program design.
(e)
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)
the form used for the admission and medical history
and physical;
(3)
treatment protocol or standing orders for each major
drug category; and
(4)
emergency procedures.
(f)
The clinical supervisor shall be a physician, physician
assistant, advanced practice nurse, or registered nurse.
(g)
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)
conduct at least one counseling session to encourage
clients to seek appropriate treatment after detoxification.
(h)
Direct care staff shall complete training in detoxification
and special treatment procedures as described in §148.114 of this title
(relating to Special Training Requirements).
(i)
Staff shall help each client develop an individualized
post-detoxification plan that includes appropriate referrals.
§148.231.Adolescents.
(a)
The facility shall address the special needs of adolescents
and protect their rights.
(b)
Residential facilities shall have separate sleeping areas,
bedrooms, and bathrooms for adults and adolescents and for males and females.
The facility shall have adequate barriers to divide the populations.
(c)
Adults and adolescents may be mixed for specific groups
or activities when there are therapeutic benefits for both populations. The
program shall also provide separate groups and activities for adults and adolescents.
(d)
The facility shall obtain consent for admission and authorization
to obtain medical treatment at the time of admission for all clients under
16 years of age.
(e)
The program shall involve the adolescent's family or an
alternate support system in the treatment process or document why this is
not happening.
(f)
Residential and day-treatment programs shall provide access
to education approved by the Texas Education Agency within three school days
of admission 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 and shall not arbitrarily restrict
any communications without clear, written. individualized clinical justification
documented in the client record.
(i)
The facility shall ensure that staff who plan, supervise,
or provide chemical dependency education or counseling to adolescents have
specialized education or training as required in §148.114 of this title
(relating to Special Training Requirements).
(j)
All direct-care employees 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
and family relationships.
(o)
The program shall prohibit adolescent clients from using
tobacco products on the program site or during structured program activities.
(p)
Staff shall not provide, distribute, or facilitate access
to tobacco products.
(q)
Staff and other adults (volunteers, clients, and visitors)
shall not use tobacco products in the presence of adolescent clients on site.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August
11, 1999.
TRD-9905049
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 1999
Proposal publication date: June 25, 1999
For further information, please call: (512) 349-6733
40 TAC §§148.212-148.214
The Texas Commission on Alcohol and Drug Abuse adopts amendments
to §§148.212-148.214 concerning Program Services. These sections
are adopted with changes to the proposed text as published in the June 25,
1999 issue of the
Texas Register
(24 TexReg
4808).
These sections contain information on Level II treatment (day treatment
or intensive residential); Level III treatment (residential or intensive out
patient); and Level IV treatment (transitional outpatient or transitional
residential).
These amendments are adopted to clarify and/or add requirements for Level
II, III and IV treatment programs including setting minimum requirements for
those admitted to each program, implementing new staff to client ratios during
sleeping hours, ensuring that every residential client has a medical history
and physical examination, conducting periodic checks while clients are sleeping,
and requiring individual counseling at least once a month in Level IV treatment
programs. Some revisions have been made in response to comments and, in some
instances, wording has been changed for clarity of content or grammatical
correctness.
Comments were received from the Association of Substance Abuse Programs
and individuals.
The following are comments received regarding §§148.212, 148.213,
and 148.214.
Comment: Requiring night staff to conduct hourly checks is excessive. This
goes beyond what even the federal government requires for prisoners in a community
based setting. Requiring three documented checks per night seems reasonable
enough and, depending on the configuration of the facility, even this could
be redundant. This is micromanagment. It should be up to the facility to determine
the time period we need. Also, what does TCADA consider an appropriate "check"
on a sleeping client?
Response: The commission believes periodic checks are necessary for security
and clinical purposes. Staff should walk through the entire building and look
into each bedroom to see that clients are sleeping and/or resting comfortably.
Night can be a difficult time for many clients, especially new ones, and it
is often necessary for the staff person to spend some time with an upset or
anxious client. The rule has been revised to require checks three times per
night.
Comment: The rules attempt to define medically stable and able to participate.
The same definition is used for all three levels of care. The definitions
are not flexible enough to accommodate various programs. Some programs have
greater medical supports or can handle different types of patients than others.
Response: The commission disagrees that the definitions do not accommodate
different types of programs. The level of staffing and support provided by
the program will in part determine what kind of physical or mental impairments
prevent the client from participating in treatment at that program.
Comment: We oppose changing the time frames for completion of assessments
and treatment plans.
Response: The change is reasonable and establishes a uniform standard across
all levels of care.
Comment: We strongly oppose mandating a 1:32 ratio when clients are sleeping.
This will have a significant financial impact, especially in programs with
ratios just slightly above the 1:32 ratio. TCADA has not proposed increasing
its reimbursement rates so TCADA funded programs are being ask to absorb yet
another unfunded mandate.
Response: The commission believes the current rule (which simply requires
one staff person regardless of the number of clients) is not sufficient to
protect the health and safety of clients. We proposed the 1:32 ratio with
full awareness that it could have significant cost impact on some providers,
depending on current staffing levels and physical plant configuration. This
is the only comment we received on this rule, which leads us to believe the
impact will not be onerous for large numbers of providers. Facilities that
have a bed capacity slightly over 32 have the option of requesting a variance.
The following comments regarding §148.214 were received.
Comment: The rules for Level IV mandates an average of two hours of treatment
per week. I would like to recommend that this be changed to be a little more
flexible. More often than not, this is a transitional setting. Giving clients
the opportunity to come back less frequently for shorter periods of time may
assist with outcome. Requiring two hours per week can also become a barrier
to them remaining in treatment. The client may only need to be there 30 minutes
every other week for a one-on-one or an hour every week for a group. I know
the argument is that this is an average, but then you have to front load the
program. That is not in agreement with the concept of individual, client-driven,
need-based treatment. This requirement seems out of context with the direction
TCADA is going everywhere else.
Response: The commission agrees with many of the points raised above. It
is essential to keep the client engaged in the treatment system for an extended
period of time, and treatment should be designed to provide a gradual transition
to self-supported recovery. This means treatment contacts will become shorter
and/or less frequent over time. The point of difference is whether the final
contacts are treatment or aftercare. Level IV was designed as a transitional
level of care. The two hour minimum was recommended by a group of providers
from across the state who spent two days examining the clinical aspects of
the commission's licensure standards. The commission agrees with their conclusion
that anything less than two hours per week is not treatment, but intervention
(if delivered before treatment) or aftercare (if delivered after treatment).
The commission strongly encourages providers to provide extended aftercare
and, under other proposed rules, requires some level of aftercare in all funded
programs. We recognize that aftercare is not presently a reimbursable service,
but this is at least partially balanced by the fact that aftercare services
do not fall under the rules governing treatment (such as maximum group size).
Lowering the threshold for "treatment" would increase the cost of providing
those less intensive transitional services. Finally, we believe a multi-level
system of care based on averages gives providers considerable flexibility
in creating an individualized episode of care for each client. We have found
that difficulties occur when treatment is rigidly structured into programs
where all clients receive the same array of services (often for the same period
of time), regardless of need. These programs are generally designed to meet
the minimum hours of service for a given level of care, leaving no flexibility
for decreasing attendance requirements in response to individual need. An
alternate strategy would be to offer an array of services, and select from
that array to create an individualized treatment program for each client,
which could be revised as often as needed. Under this system, the level of
care would be determined by the content of the individualized treatment plan.
Comment: Level IV programs are now required to provide individual counseling
at least once per month. In the Northstar pilot project, the contract with
Value Options reimburses program providers $35 per day for Supportive Outpatient
which would be for two hours of service. This economically prohibits individual
counseling unless it can be billed in addition to the per day rate once a
month.
Response: One of the basic precepts of effective treatment is that it must
be delivered in accordance with an individualized treatment plan. A provider
cannot develop, review, and revise a client's treatment plan without some
individual sessions.
These amendments are adopted under the Texas Health and Safety
Code, Chapter 464, which provides the Texas Commission on Alcohol and Drug
Abuse with the authority to adopt rules licensing chemical dependency treatment
facilities.
The code affected by these amendments is the Texas Health and Safety Code,
Chapter 464.
§148.212.Level II Treatment (Day Treatment or Intensive Residential).
(a)
All clients admitted to Level II shall not have:
(1)
a documented, reported, or observed medical condition that
requires immediate medical treatment or continuous medical supervision (as
determined by a prudent lay person); or
(2)
an observable physical or mental impairment that prevents
the client from participating in treatment.
(b)
The program shall have enough staff to provide close supervision
and individualized treatment, even if this requires more staff than indicated
by the minimum staff-to-client ratios listed in this section.
(c)
Counselor caseloads shall not exceed ten clients for each
counselor.
(d)
Direct care staff shall be awake and on site during all
hours of program operation.
(1)
In outpatient programs, the direct care staff-to-client
ratio shall be at least 1:16 during all hours of operation.
(2)
In residential programs, the direct care staff-to-client
ratio shall be at least 1:16 during the hours clients are awake and 1:32 when
clients are asleep.
(3)
Night staff shall conduct and document at least three
checks while clients are sleeping.
(e)
Counselors shall complete a comprehensive client assessment
and initial treatment recommendations within three individual service days
of admission for all clients transferred from Level I or admitted directly
to a Level II program.
(f)
An individualized treatment plan shall be completed for
all clients 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)
three hours of chemical dependency counseling (including
at least one hour of individual counseling);
(2)
14 hours of additional counseling, chemical dependency
education, or life skills training; and
(3)
three hours of structured social and/or recreational
activities.
(h)
Every residential client shall have a medical history and
physical examination as required by §148.301 of this title (relating
to Client History and Assessment).
(i)
Program staff shall offer related services to identified
significant others.
§148.213.Level III Treatment (Residential or Intensive Outpatient).
(a)
All clients admitted to Level III shall be able to function
with limited supervision and support and shall not have:
(1)
a documented, reported, or observed medical condition that
requires immediate medical treatment or continuous medical supervision (as
determined by a prudent lay person); or
(2)
an observable physical or mental impairment that prevents
the client from participating in treatment.
(b)
The program shall have enough staff to meet treatment needs
within the context of the program description, even if this requires more
staff than indicated by the minimum staff-to-client ratios listed in this
section.
(c)
Counselor caseloads shall not exceed 16 clients per counselor.
(d)
Direct care staff shall be awake and on site during all
hours of program operation.
(1)
In outpatient programs, the direct care staff-to-client
ratio shall be at least 1:16 during all hours of operation.
(2)
In residential programs, the direct care staff-to-client
ratio shall be at least 1:16 during the hours clients are awake and 1:32 when
clients are asleep.
(3)
Night staff shall conduct and document at least three
checks while clients are sleeping.
(e)
For clients transferred from Level I or admitted directly
to this level of treatment, counselors shall complete a comprehensive client
assessment and initial treatment recommendations within three individual service
days of admission.
(f)
All clients shall have an individualized treatment plan
within five 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 two hours of chemical
dependency counseling (with at least one hour of individual counseling every
two weeks) and eight hours of additional counseling, chemical dependency education,
or life skills training.
(h)
Every residential client shall have a medical history and
physical examination completed and filed in the client record within 96 hours
of admission, as required by §148.301 of this title (relating to Client
History and Assessment).
§148.214.Level IV Treatment (Transitional Outpatient or Transitional Residential).
(a)
All clients admitted to Level IV programs shall be able
to function with minimal supervision and support and shall not have:
(1)
a documented, reported, or observed medical condition that
requires immediate medical treatment or continuous medical supervision (as
determined by a prudent lay person); or
(2)
an observable physical or mental impairment that prevents
the client from participating in treatment.
(b)
A Level IV program shall not admit a client transferred
directly from Level I without written justification in the client record.
(c)
The program shall have enough staff to provide clients
with adequate support and guidance, even if this requires more staff than
indicated by the minimum staff-to-client ratios listed in this section.
(d)
Counselor caseloads shall not exceed 20 clients per counselor
in residential programs. Outpatient programs shall set limits on counselor
caseload size that ensure effective, individualized treatment and rehabilitation.
Criteria used to set the caseload size shall be documented.
(e)
The program shall be adequately staffed during hours of
operation to ensure effective service delivery.
(f)
In residential programs, the awake direct care staff-to-client
ratio shall be at least 1:20 during the hours clients are awake and at least
1:32 when clients are sleeping. Night staff shall conduct at least three checks
while clients are sleeping.
(g)
For clients transferred from Level I or admitted directly
to this level of treatment, counselors shall complete a comprehensive client
assessment and initial treatment recommendations within three individual service
days of admission. In outpatient programs, this period shall not exceed 45
calendar days.
(h)
All clients shall have an individualized treatment plan
within five individual service days of admission. In outpatient programs,
this period shall not exceed 45 calendar days.
(i)
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 counseling and one hour of additional counseling, life skills training,
or chemical dependency education. Individual counseling shall be provided
at least once a month.
(j)
Every residential client shall have a medical history and
physical examination as required by §148.301 of this title (relating
to Client History and Assessment).
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August
11, 1999.
TRD-9905050
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 1999
Proposal publication date: June 25, 1999
For further information, please call: (512) 349-6733
40 TAC §148.235
The Texas Commission on Alcohol and Drug Abuse adopts the
repeal of §148.235 concerning Program Services without changes to the
proposed text as published in the June 25, 1998, issue of the
Texas Register
(24 TexReg 4810).
This section contains the requirements for pharmocotherapy programs.
The section is repealed because the commission is no longer required to
license methadone programs. These programs are now under the sole regulatory
jurisdiction of the Texas Department of Health.
No comments were received regarding the adoption of the repeal.
The repeal is adopted under the Texas Health and Safety Code,
Chapter 464, which provides the Texas Commission on Alcohol and Drug Abuse
with the authority to adopt rules licensing chemical dependency treatment
facilities.
The code affected by the repeal is the Texas Health and Safety Code, Chapter
464.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August
11, 1999.
TRD-9905051
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 1999
Proposal publication date: June 25, 1999
For further information, please call: (512) 349-6733
40 TAC §§148.281, 148.282, 148.284, 148.291-148.293, 148.301-148.304, 148.322–148.324
The Texas Commission on Alcohol and Drug Abuse adopts amendments
to §§148.281, 148.282, 148.284, 148.291-148.293, 148.301-148.304,
and 148.322-148.324 concerning Treatment Process. These amendments are adopted
without changes to the proposed text as published in the June 25, 1999, issue
of the
Texas Register
(24 TexReg 4810) and
will not be republished.
These sections contain information on: admission criteria; admission determination;
client orientation; detoxification history and assessment; detoxification
plan; detoxification notes; client history and assessment; treatment plan;
progress notes; treatment plan reviews; discharge plan; discharge summary;
and discharge follow-up.
These amendments are adopted to clarify the typical age range served by
adolescent and adult programs, when exceptions may be warranted and how they
must be approved; to describe the admission determination process; to require
that information about searches the program may use be included in client
orientation; to expand the requirements related to detoxification history
and assessment including reducing the time allowed to complete the detoxification
history to 24 hours; to require that goals be established as part of the detoxification
plan and that progress or lack of progress toward those goals be addressed
in detoxification notes; to specify the process for and requirements of the
client history and assessment; to describe the treatment plan process and
document; to clarify what is to be included in progress notes; to specify
that programs must define in writing the intervals at which treatment plans
will be reviewed; to mandate that the treatment plan must be revised when
the client enters a new level of service; to require that family members who
were initially involved in the initial treatment planning participate in reviews
or that the counselor must document why this does not occur; to specify that
discharge planning begins at the time of admission and must be completed before
the client's scheduled discharge; to state what must be addressed in the discharge
plan; and to institute a time limit of 90 days after discharge for follow-up
to occur.
Comments on the proposed amendments were received from individuals.
Comment regarding §§148.291, 148.292, and 148.293: These sections
seem to apply only to detoxification programs but there is no heading that
denotes this. Are physical examinations, detox plans, and detox notes required
for every level of care?
Response: No. When the rules are printed for distribution to providers,
headings are included.
Comment regarding §148.303: We need to allow a copy of the program
schedule and group sheets to help document the client's level of participation.
The requirement as written will create additional paperwork for the counselors,
increase costs and decrease client contact.
Response: The proposed change may increase documentation time for some
providers who are not funded by the commission. It is, however, consistent
with industry standards. The change will have no impact on funded providers,
who are already held to these requirements. Comment regarding §148.304:
This section basically demands family involvement. Our clients come from homeless
and totally dysfunctional family environments. Many times the family's initial
cooperation is self-serving to get the client away from them or out of their
house. Many times for therapeutic reasons the client does not need family
involvement in the short time we have to treat him/her in residential services.
The number of chemical dependency and personal issues the client has may be
extensive. The staff time to maintain contact with or even try to track down
members for reviews based on changes in the treatment plan (remember it is
individualized and a very fluid document) would be extensive, expensive and
destroy time lines. Response: The commission recognizes that family involvement
is not always appropriate and/or feasible. The rules simply asks for the provider
to document why the family is not participating. Even this is not necessary
if family members did not participate in developing the original treatment
plan.
These amendments are adopted under the Texas Health and Safety
Code, Chapter 464, which provides the Texas Commission on Alcohol and Drug
Abuse with the authority to adopt rules licensing chemical dependency treatment
facilities.
The code affected by these amendments is the Texas Health and Safety Code,
Chapter 464.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August
11, 1999.
TRD-9905052
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 1999
Proposal publication date: June 25, 1999
For further information, please call: (512) 349-6733
40 TAC §§148.331, 148.341, 148.353, 148.355, 148.372, 148.373
The Texas Commission on Alcohol and Drug Abuse adopts amendments
to §§148.331, 148.341, 148.353, 148.355 and adopts new §148.372
and §148.373 concerning Physical Plant. Section 148.331 is adopted with
changes to the proposed text as published in the June 25, 1999, issue of the
These sections contain information on: general environment; general physical
plant provisions; exits; furniture and supplies; physical plant requirements
for children; and physical plant requirements for small family living environments.
These amendments and new sections are adopted to require that any needed
corrective action plan to ensure compliance with the Americans with Disabilities
Act is implemented within a reasonable time frame; to clarify the requirements
for private space for confidential interactions; to expand the prohibitions
on smoking, firearms and other weapons; to require prohibitions on alcohol,
illegal drugs, illegal activities and violence on site; to prohibit the use
of recreational vehicles and campers as client sleeping areas; to clarify
under what circumstances windows may be smaller than the size stated in the
rules; to specify the required ratio of washers and dryers to clients; to
specify the physical plant requirements that are specific to programs that
provide children's services or childcare on site; and to specify the physical
requirements for small family living environments. Some revisions have been
made in response to comments and, in some instances, wording has been changed
for clarity of content or grammatical correctness.
The following comments on §148.331 were received from individuals.
Comment: The rule requires the program to prohibit firearms. What specific
actions are expected of the provider? Is it necessary to post a sign to this
effect?
Response: At a minimum, the prohibition must be stated in the program's
policies and the statement of client rules and responsibilities. Providers
are not required to post a sign.
Comment: The rule says that staff shall not provide, distribute, or facilitate
access to tobacco products. Does this mean that if a client is allowed to
go to a store on free time and buys cigarettes we are in the wrong? Must we
require clients who work to work for a smoke free company?
Response: No. In these examples, the staff person is not taking action
to make it easier for clients to get cigarettes. An example of facilitating
access would be buying cigarettes for clients or driving them to the store
for the specific purpose of buying cigarettes. On the other hand, the facility
could take clients to a store to buy various personal items. If clients choose
to purchase cigarettes on such a trip, the facility would not be "facilitating"
access. The term "distribute" has been removed from the rule to clarify that
a facility may collect and store cigarettes for clients (e.g., in a detoxification
program), and distribute or provide access to the client's own cigarettes.
The distinction here is that the client came to the facility with the cigarettes
already in his or her possession. Only adult clients may possess or use tobacco
products.
Comment: The proposed rule says that staff shall not use tobacco products
in the presence of adult clients. You are really putting a harsh requirement
in place. "In the presence" is not clear. To outlaw smoking during counseling
is okay. But does it mean where clients can see? This is micromanaging.
Response: The commission has withdrawn this proposed requirement for adults.
It will remain in place for adolescents, which is not a change from the rule
currently in effect.
These amendments and new sections are adopted under the Texas
Health and Safety Code, Chapter 464, which provides the Texas Commission on
Alcohol and Drug Abuse with the authority to adopt rules licensing chemical
dependency treatment facilities.
The code affected by these amendments and new sections is the Texas Health
and Safety Code, Chapter 464.
§148.331. General Environment.
(a)
The facility shall provide a safe, secure, and well-maintained
environment.
(b)
The facility shall comply with the Americans with Disabilities
Act (ADA). The facility shall maintain documentation that it has conducted
a self-inspection to evaluate compliance and implemented a corrective action
plan within reasonable time frames to address identified deficiencies.
(c)
The environment shall enhance client dignity and confidentiality.
(d)
The facility shall have adequate space, furniture, and
supplies for the services described in the program description.
(e)
The facility shall have private space for counseling,
assessments, and other confidential interactions. Staff shall not office in
space needed for other activities, and partitions are not acceptable for creating
private space.
(f)
The facility shall prohibit smoking inside facility buildings
and during structured program activities.
(g)
The facility shall not permit vending machines that dispense
tobacco products on the program site.
(h)
Staff shall not provide or facilitate client access to
tobacco products.
(i)
The facility shall prohibit firearms and other weapons
on the site.
(j)
The facility shall prohibit alcohol, illegal drugs, illegal
activities, and violence on the site.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August
11, 1999.
TRD-9905053
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 1999
Proposal publication date: June 25, 1999
For further information, please call: (512) 349-6733
40 TAC §§148.371
The Texas Commission on Alcohol and Drug Abuse adopts the
repeal of §148.371 concerning Physical Plant without changes as published
in the June 25, 1999, issue of the
Texas Register
(24 TexReg 4815).
This section contains the requirements for small family living environments.
This section is repealed because these requirements are revised and have
been moved to other portions of the rules.
No comments were received regarding the adoption of the repeal.
The repeal is adopted under the Texas Health and Safety Code,
Chapter 464, which provides the Texas Commission on Alcohol and Drug Abuse
with the authority to adopt rules licensing chemical dependency treatment
facilities.
The code affected by the repeal is the Texas Health and Safety Code, Chapter
464.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August
11, 1999.
TRD-9905054
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 1999
Proposal publication date: June 25, 1999
For further information, please call: (512) 349-6733
Subchapter A. Civil Court Commitments
40 TAC §§149.1, 149.11-149.16
The Texas Commission on Alcohol and Drug Abuse adopts the
repeal of §§149.1 and 149.11-149.16 concerning Court Commitments
without changes as published in the June 25, 1999, issue of the
Texas Register
(24 TexReg 4816).
These sections describe the definitions of terms used, authority of the
commission regarding court commitments, approval needed by facilities, licensure
requirements, staff training requirements, general procedures, and the documentation
required for court commitments.
These sections are repealed because these rules have been incorporated
into the rules for all licensed facilities.
No comments were received regarding the adoption of the repeals.
The repeals are adopted under the Texas Health and Safety Code,
§461.012(a)(15) and §462 which provide the Texas Commission on Alcohol
and Drug Abuse with the authority to adopt rules and standards for approval
of chemical dependency treatment facilities to accept court commitments.
The code affected by the repeals is the Texas Health Safety Code, §461.012(a)(15)
and §462.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August
11, 1999.
TRD-9905055
Mark Smock
Deputy for Finance and Administration
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 1999
Proposal publication date: June 25, 1999
For further information, please call: (512) 349-6733
Chapter 159.
Administrative Rules and Procedures
The Texas Commission for the Blind adopts the repeal of §§159.1-159.16,
159.22, 159.24, and 159.31-159.35 and simultaneously adopts new §§159.1-159.3;
159.20-159.23; and 159.40-159.45 without changes to the proposed text as published
in the June 4, 1999, issue of the
Texas Register
(24 TexReg 4213). The adopted text will not be republished.
The repeals are adopted in order to adopt rewritten and reorganized rules.
New Subchapter A contains various general rules required by state law.
Human Resources Code §91.018 requires the Commission to promulgate rules
establishing methods by which consumers or service recipients can be notified
of the name, mailing address, and telephone number of the Commission for the
purpose of directing complaints. Section 159.1 contains these methods. The
Business Corporation Act requires state agencies to require Texas corporations
contracting with agencies to certify in writing that its corporate franchise
taxes are current; §159.2 contains this requirement and other related
rules. Government Code §2001.103 requires state agencies to have rules
for the reimbursement of witnesses. These rules are contained in §159.3.
New Subchapter B contains procedural rules of the Commission's board. Section
159.20 speaks to the frequency of board meetings. Section 159.21 contains
the rules required by Government Code §2001.021 regarding how a person
may petition for adoption of rules. § 159.22 contains the board's procedures
for hearing public comments and requesting to appear before the board. §
159.23 contains the procedures for public hearings that are required by Government
Code §2001.029.
New Subchapter C contains rules required by Government Code §552.262
regarding access to public information maintained by the Commission. Section
159.40 contains the method for requesting public information. Section 159.41
contains information about available copy formats. Section 159.42 contains
the agency's charges for providing copies. Section 159.43 contains procedures
pertaining to estimates, deposits, and waivers of charges. Section 159.44
contains procedures for processing public complaints of overcharges. Section
159.45 contains rules on gaining access to public information when copies
are not requested.
The Commission received no comments regarding the proposal.
Subchapter A. Procedures of the Commission
40 TAC §§159.1-159.16
The repeals are adopted under the authority of Human Resources
Code, Title 5, Chapter 91, §91.011(g), which authorizes the commission
to adopt rules prescribing the policies and procedures followed by the commission
in the administration of its programs.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August
13, 1999.
TRD-9905118
Terrell I. Murphy
Executive Director
Texas Commission for the Blind
Effective date: September 2, 1999
Proposal publication date: June 4, 1999
For further information, please call: (512) 459-2611
40 TAC §§159.1-159.3
The new rules are adopted under the Human Resources Code,
Title 5, Chapter 91, §91.011, which authorizes the Commission to adopt
rules prescribing the policies and procedures followed by the Commission in
the administration of its programs and §91.018, which requires the Commission
to promulgate rules establishing methods by which consumers or service recipients
can be notified of the name, mailing address, and telephone number of the
commission for the purpose of directing complaints to the commission.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August
13, 1999.
TRD-9905104
Terrell I. Murphy
Executive Director
Texas Commission for the Blind
Effective date: September 2, 1999
Proposal publication date: June 4, 1999
For further information, please call: (512) 459-2611
40 TAC §§159.20-159.23
The new rules are adopted under the Human Resources Code,
Title 5, §91.011, which authorizes the Commission to adopt rules prescribing
the policies and procedures followed by the Commission in the administration
of its programs and requires the Commission to develop and implement policies
that provide the public with a reasonable opportunity to appear before it.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August
13, 1999.
TRD-9905105
Terrell I. Murphy
Executive Director
Texas Commission for the Blind
Effective date: September 2, 1999
Proposal publication date: June 4, 1999
For further information, please call: (512) 459-2611
40 TAC §159.22, §159.24
The repeals are adopted under Human Resources Code, Title
5, §91.011, which authorizes the Commission to adopt rules prescribing
the policies and procedures followed by the Commission in the administration
of its programs.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August
13, 1999.
TRD-9905107
Terrell I. Murphy
Executive Director
Texas Commission for the Blind
Effective date: September 2, 1999
Proposal publication date: June 4, 1999
For further information, please call: (512) 459-2611
40 TAC §§159.31-159.35
The repeals are adopted under Human Resources Code, Title
5, §94.012, which authorizes the Commission to promulgate rules in the
administration of the Business Enterprises Program.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August
13, 1999.
TRD-9905108
Terrell I. Murphy
Executive Director
Texas Commission for the Blind
Effective date: September 2, 1999
Proposal publication date: June 4, 1999
For further information, please call: (512) 459-2611
40 TAC §§159.40-159.45
The new rules are adopted under the Human Resources Code,
Title 5, §91.011, which authorizes the Commission to adopt rules prescribing
the policies and procedures followed by the Commission in the administration
of its programs.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August
13, 1999.
TRD-9905106
Terrell I. Murphy
Executive Director
Texas Commission for the Blind
Effective date: September 2, 1999
Proposal publication date: June 4, 1999
For further information, please call: (512) 459-2611
Subchapter A. Vocational Rehabilitation Program
The Texas Commission for the Blind adopts the amendment of §161.13,
the repeal of §§161.43-161.44, and new §§161.43-161.45
without changes to the proposed text as published in the June 11, 1999, issue
of the
Texas Register
(24 TexReg 4353). The
adopted text will not be republished.
To receive the full benefits of federal funds, the agency is required to
administer the Vocational Rehabilitation Program according to the provisions
in the federal Rehabilitation Act of 1973. The Act has been amended, and the
agency has updated its rules accordingly.
The repeal of §161.43 and §161.44, pertaining to action by the
executive director after hearings, is adopted because the authority of the
executive director to review decisions of hearing officers was removed in
the federal amendments.
The Act requires the addition of mediation to the choices for resolving
disputes. Notice that the appellant has the right to request mediation is
included in §161.13, pertaining to filing a request for review. New §161.45
contains conforming mediation procedures.
New §161.43 and §161.44 contain the Act's requirements pertaining
to implementation of decisions and the rights of parties aggrieved by final
decisions to bring a civil action for review of the decision.
The Commission received no comments regarding the proposal.
40 TAC §161.13
The amendment is adopted under Human Resources Code, Title
5, §91.011, which authorizes the Commission to adopt rules prescribing
the policies and procedures followed by the Commission in the administration
of its programs.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August
13, 1999.
TRD-9905111
Terrell I. Murphy
Executive Director
Texas Commission for the Blind
Effective date: September 2, 1999
Proposal publication date: June 11, 1999
For further information, please call: (512) 459-2611
40 TAC §161.43, §161.44
The repeals are adopted under Human Resources Code, Title
5, §91.011, which authorizes the Commission to adopt rules prescribing
the policies and procedures followed by the Commission in the administration
of its programs.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August
13, 1999.
TRD-9905109
Terrell I. Murphy
Executive Director
Texas Commission for the Blind
Effective date: September 2, 1999
Proposal publication date: June 11, 1999
For further information, please call: (512) 459-2611
40 TAC §§161.43-161.45
The new rules are adopted under Human Resources Code, Title
5, §91.011, which authorizes the Commission to adopt rules prescribing
the policies and procedures followed by the Commission in the administration
of its programs.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August
13, 1999.
TRD-9905110
Terrell I. Murphy
Executive Director
Texas Commission for the Blind
Effective date: September 2, 1999
Proposal publication date: June 11, 1999
For further information, please call: (512) 459-2611
40 TAC §§171.1-171.4
The Texas Commission for the Blind adopts the repeal of Chapter
171, §§171.1-171.4, pertaining to Cooperative Activities, without
changes to the proposed text as published in the June 4, 1999, issue of the
The repeal is adopted in order to simultaneously adopt a new chapter. During
the review of this chapter pursuant to the agency's rule review plan, the
agency decided to rename the chapter and make improvements. §§171.1,
171.2, and 171.4 were deleted because they duplicate rules in other chapters.
The agency's memoranda of understanding are contained in the new chapter.
The agency deleted obsolete memoranda and revised the rule citations in those
memoranda of understandings where necessary to reflect the current TAC location
of the lead agency's rules where the full text of the memorandum is published.
The Commission received no comments in response to the proposal.
The repeals are adopted under Human Resources Code, Title 5,
§91.011, which authorizes the Commission to adopt rules prescribing the
policies and procedures followed by the Commission in the administration of
its programs.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August
13, 1999.
TRD-9905112
Terrell I. Murphy
Executive Director
Texas Commission for the Blind
Effective date: September 2, 1999
Proposal publication date: June 4, 1999
For further information, please call: (512) 459-2611
The Texas Commission for the Blind adopts
new Chapter 171, §§171.1-171.4, pertaining to Memoranda of Understanding,
without changes to the proposed text as published in the June 4, 1999, issue
of the
Texas Register
(24 TexReg 4220). The
adopted text will not be republished.
The purpose of each rule is to define the individual responsibilities of
signatory agencies to various memoranda of agreement when certain populations
can benefit from services from multiple state agencies. Section 171.1 contains
the memorandum of agreement required by Human Resources Code 22.011. Section
171.2 is required by Family Code §264.003. Section 171.3 is required
by Texas Education Code §29.011. Section 171.4 is required by Health
and Safety Code §614.015.
The Commission received no comments regarding the proposal.
The new rules are adopted under the Human Resources Code, Title
5, §91.011, which authorizes the Commission to adopt rules prescribing
the policies and procedures followed by the Commission in the administration
of its programs and §91.021, which requires the Commission to negotiate
interagency agreements with other state agencies to extend and improve the
regular services provided by the agencies.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August
13, 1999.
TRD-9905119
Terrell I. Murphy
Executive Director
Texas Commission for the Blind
Effective date: September 2, 1999
Proposal publication date: June 4, 1999
For further information, please call: (512) 459-2611
Chapter 701.
Communities in School
40 TAC Chapter 701
(Editor's note: In order to comply with Senate
Bill 330 (Attachment 1), 76th Legislature, Regular Session, which transfers
all functions, obligations, rights, contracts, records, and rules of the Texas
Workforce Commission relating to the Communities in Schools program to the
Texas Department of Protective and Regulatory Services, the Texas Workforce
Commission is requesting the Administrative transfer of the rules, listed
in Attachment 2, from the Texas Workforce Commission to the Texas Department
of Protective and Regulatory Services, effective September 1, 1999.
The Texas Register is administratively transferring the following rules
listed in the conversion chart published in this issue under the Tables and
graphics section. The table lists the old rule numbers and the new rule numbers
that corresponds to them.)
Figure: 40 TAC Chapter 701
Chapter 827.
Communities in School
40 TAC Chapter 827
(Editor's note: In order to comply with Senate
Bill 330 (Attachment 1), 76th Legislature, Regular Session, which transfers
all functions, obligations, rights, contracts, records, and rules of the Texas
Workforce Commission relating to the Communities in Schools program to the
Texas Department of Protective and Regulatory Services, the Texas Workforce
Commission is requesting the Administrative transfer of the rules, listed
in Attachment 2, from the Texas Workforce Commission to the Texas Department
of Protective and Regulatory Services, effective September 1, 1999.
The Texas Register is administratively transferring the following rules
listed in the conversion chart published in this issue under the Tables and
graphics section. The table lists the old rule numbers and the new rule numbers
that corresponds to them.)
Figure: 40 TAC Chapter 701
Subchapter C. Training Provider Certification
Chapter 144.
Contract Requirements
Subchapter C. Program Oversight
Subchapter D. Organizational
Subchapter E. Prevention and Intervention
Subchapter F. Treatment
Subchapter G. Network Management Organizations (NMOs)
Chapter 148.
Facility Licensure
Subchapter B. Facility Management
Subchapter C. Client Management
Subchapter D. Program Services
Subchapter E. Treatment Process
Subchapter F. Physical Plant
Chapter 149.
Court Commitments
Part IV.
Texas Commission for the Blind
Subchapter A. General Rules
Subchapter B. Commission Board Procedures
Subchapter B. Fair Hearing Procedures for Resolution of Client Dissatisfaction
Subchapter C. Full and Evidentiary Hearings for Business Enterprises Operators
Subchapter C. Access to Public Information
Chapter 161.
Appeals and Hearing Procedures
Chapter 171.
Cooperative Activities
Part XIX.
Texas Department of Protective and Regulatory Services
Part XX.
Texas Workforce Commission
Chapter 841.
Workforce Investment Act