25 TAC §§412.453, 412.455-412.457, 412.462, 412.463, 412.465
The Texas Department of Mental Health and Mental Retardation
(TDMHMR) proposes new §412.456 and §412.463 and amendments to §412.453,
§412.455, §412.457, §412,462, and §419.465, of Chapter
412, Subchapter J, governing Service Coordination. The repeals of §412.456
and §412.463 are published contemporaneously for public comment in this
issue of the
Texas Register
.
Language would be added in §412.453(6), relating to family-directed
planning, to clarify that the terms "family-directed planning" and "wraparound
approach" are synonymous for the purposes of this rule. In §412.453(6)(D),
the term "family" would be added to clarify that the definition of family-directed
planning is supportive of the self-determination of the family and child.
Language in §412.453(10) would be added to clarify that the term "LAR"
also includes the managing conservator. The definition for "plan of care"
in §412.453 would be revised to clarify that the plan of care is not
limited only to service coordination, but is a comprehensive written plan
for delivering services and supports and may include a clinical treatment
plan, a nursing plan of care, a behavior plan, an education plan, or the strategies
portion of the person-directed plan, etc. In §412.453, a new definition
for "reasonable efforts" would be added to describe the activities that must
occur to meet the criteria for some of the exceptions to the requirement for
conducting the face-to-face contacts with the LAR and child. The subsequent
definitions would be renumbered as a result of the new definition. In §412.455(1),
language would be added to require that an individual be determined to need
service coordination as part of the eligibility criteria and clarify that
the legal definition for the term "a person with a related condition" is attached.
Language would be added in §412.455 (1)(A) to clarify that service coordination
does not count as a service when determining multiple services needed by an
individual. In §412.455(1)(C), language would be added to provide consistency
with existing terminology. In the same paragraph, the time period for individuals
to be transitioning from an institution to the community would be deleted
because they may need service coordination for as long as they reside in the
community. Additionally, the 30-day time frame prior to discharge or furlough
would be more appropriately addressed in 1 TAC, Chapter 355, Subchapter F,
§355.743, concerning Reimbursement Methodology for Service Coordination.
New §412.456 would clarify that as part of the evaluation for service
coordination, the local authority must determine the specific services and
supports needed from community providers and whether the individual needs
service coordination; if service coordination is needed, the local authority
must determine the frequency, duration, and intensity of service coordination.
The language in §412.457(f) would be changed to clarify that the face-to-face
contacts with the child and the child's legally authorized representative
(LAR) must occur within 30 calendar days of each other rather than within
the same month. New language would be added to clarify that, if the parent
is not the guardian or managing conservator, the face-to-face contact must
occur with the guardian or managing conservator. Clarifying language in §412.457(f)(1)-(4)
would be added to establish the exceptions to the requirement for a face-to-face
contact with the child and child's LAR, including documentation requirements.
New language would be added in §412.462(b)(4)-(6) to clarify that
training for person-directed planning is required only for persons providing
service coordination to adults with mental retardation; that training for
family-directed planning or the wraparound approach is required only for persons
providing service coordination to children; and that training for permanency
planning is required only for persons providing service coordination to children
with mental retardation. The subsection §412.462(c) would be deleted
because it is not relevant to providing service coordination. As a result,
the subsequent subsection would be renumbered. New §412.463(a) would
clarify that required contacts described in the plan of care must be documented.
New §412.463(b), would be added to require that contacts made in addition
to the required contacts made with the individual may be documented in the
plan of care are summarized in the progress notes. As a result of adding the
new subsection, the subsequent subsections would be renumbered. New §412.463(c),
would be added to clarify that the local authority need only retain documentation
according to applicable federal and state laws, rules, and regulations. The
citation of Texas Family Code, §§32.003 or 32.004, would be added
to §419.465, relating to references, as part of the exceptions to conducting
a face-to-face contact with the LAR.
William R. Campbell, chief financial officer, has determined that for each
of the first five years the proposed new sections and amendments are in effect,
enforcing or administering the sections would not have implications relating
to costs or revenues for state or local government.
Dave Wanser, director, Behavioral Health Services, has determined that
for each year of the first five years the proposed new sections and amendments
are in effect, the public benefit expected as a result of adopting the proposed
amendments is more effective and efficient policies and procedures to guide
the provision of service coordination. There is no probable economic cost
to persons required to comply with these sections. It is not anticipated that
these sections would have an adverse economic effect on small businesses because
they do not participate in the service coordination program. It is not anticipated
that the amendments to the rule will affect a local economy.
A public hearing will be held at 10:30 p.m. on June 22, 1999, in the auditorium
of the main TDMHMR Central Office building (Building 2), 909 West 45th Street,
Austin, Texas, to accept oral and written testimony concerning the proposal.
Persons needing an accommodation to attend the hearing and persons with special
needs requiring assistance should contact Sheila Wilkins, Office of Policy
Development, at least 72 hours prior to the hearing by calling (512) 206-4516.
Persons with hearing impairments may also call
TTY-Message
- Texas Relay
toll-free at (800) 735-2988.
Comments on the proposal may be submitted to Linda Logan, director, Policy
Development, Texas Department Mental Health and Mental Retardation, P.O. Box
12668, Austin, TX 78711-2668, within 30 days of publication of this notice.
The new sections are proposed under the Texas Health and Safety
Code, §532.015(a), which provides TDMHMR with broad rulemaking authority;
the Texas Government Code, §531.021(a), and the Texas Human Resources
Code §32.021(a), which provide the Texas Health and Human Services Commission
(THHSC) with the authority to administer the federal medical assistance (Medicaid)
program in Texas; Acts 1995, 74th Texas Legislature, Chapter 6, §1, (Senate
Bill 509), which clarifies the authority of THHSC to delegate the operation
of all or part of a Medicaid program to a health and human services agency;
and the Human Resources Code, §32.021(c), which provides an agency operating
part of the Medicaid program with the authority to adopt necessary rules for
the proper and efficient operation of the program. THHSC has designated TDMHMR
as the operating agency for the Medicaid service coordination program.
The sections affect the Health and Safety Code, §532.015, Human Resources
Code, §32.021, and Government Code, §531.021.
§412.453. Definitions.
The following words and terms, when used in this chapter, have the
following meanings, unless the context clearly indicates otherwise:
(1)
Adult mental health priority population - Those individuals
18 years of age and older who have severe and persistent mental illnesses,
such as schizophrenia, major depression, manic depressive disorder, or other
severely disabling mental disorders which require crisis resolution or ongoing
and long-term support and treatment.
(2)
Client Assignment Registration System (CARE) - TDMHMR's
centralized, confidential database, which registers and tracks individuals
receiving services funded by or through TDMHMR throughout the service delivery
system. CARE uses unique, statewide identification numbers to collect, maintain
and report descriptive information for each individual served.
(3)
Child mental health priority population - Those individuals
under the age of 18 years with a diagnosis of mental illness who exhibit serious
emotional, behavioral, or mental disorders and who:
(A)
have a serious functional impairment;
(B)
are at risk of disruption of a preferred living or child
care environment; or
(C)
are enrolled in a school system's special education program
because of a serious emotional disturbance.
(4)
Community support services - Services provided
in the community that enhance and improve an individual's health, safety,
well-being, and quality of life. These services may include clinical services,
such as medical, psychological, social, and rehabilitative or other community-based
services which are legal, financial, or educational in nature.
(5)
Duration - The length of time the contact should
last and the length of time service coordination is provided.
(6)
Family-directed planning
or wraparound approach
- A process that empowers the family of a minor with to direct the
development of a plan of supports and services which meet the child and family's
personal outcomes. The process:
(A)
identifies existing supports and services necessary to
achieve the child and family's outcomes;
(B)
identifies natural supports available to the child and
family and negotiates needed service system supports;
(C)
occurs with the support of a group of people chosen by
the child and family;
(D)
is supportive of the self-determination of the
family
and
child; and
(E)
mirrors the way in which families without children with
disabilities make plans.
(7)
Frequency - The number of times during a specified
period that an individual is contacted by a person providing service coordination.
(8)
Individual - A person in the adult mental health,
child mental health, or mental retardation priority populations who is seeking
or receiving mental health or mental retardation services from a local authority.
(9)
Intensity - The type of service coordination contact,
i.e., by telephone or in person.
(10)
LAR (legally authorized representative) - The parent
, guardian, or managing conservator
[
or guardian
] of an individual
who is a minor or the guardian of the person of an individual who is an adult.
(11)
Local authority - An entity to which the Texas MHMR
Board delegates its authority and responsibility within a specified region
for planning, policy development, coordination, and resource development and
allocation and for supervising and ensuring the provision of mental health
services to people with mental illness and/or mental retardation services
to people with mental retardation in one or more local service areas.
(12)
Mental retardation priority population - Those individuals
who:
(A)
have mental retardation, as defined in the Texas Health
and Safety Code, §591.003(13);
(B)
have autism or any other pervasive developmental disorder,
as defined in the current edition of the
Diagnostic
and Statistical Manual
(DSM); or
(C)
are eligible for OBRA '87 mandated services for mental
retardation or a related condition as per specific legislation.
(13)
Parent Case Management Program - A program
that utilizes experienced, trained parents of individuals with disabilities
to provide case management for other families.
(14)
Partners in Policy Making - A leadership training
program administered by the Texas Planning Council for Developmental Disabilities
for self-advocates and parents.
(15)
Permanency planning - A philosophy and planning
process that focuses on the outcome of family support by facilitating a permanent
living arrangement with the primary feature of an enduring and nurturing parental
relationship.
(16)
Person-directed planning - A process that empowers
the individual (and the LAR on the individual's behalf) to direct the development
of a plan of supports and services that meet the individual's personal outcomes.
The process:
(A)
identifies existing supports and services necessary to
achieve the individual's outcomes;
(B)
identifies natural supports available to the individual
and negotiates needed services system supports;
(C)
occurs with the support of a group of people chosen by
the individual (and the LAR on the individual's behalf); and
(D)
mirrors the way in which people without disabilities make
plans.
(17)
Plan of care -
A comprehensive written
plan for providing services and supports that meets the individual's needs
and reflects the individual's choices and outcomes (and the LAR on the individual's
behalf). To be comprehensive, the plan of care may include the clinical treatment
plan, nursing plan of care, behavior plan, education plan, or the strategies
portion of the person-directed plan.
[
A format for documenting
an individual's services and supports that reflect the individual's choices
and outcomes (and those of the LAR on the individual's behalf).
]
(18)
Reasonable efforts -
More than one attempt to contact the LAR, including but not limited to, a
visit to the LAR, correspondence mailed to and telephone calls made to the
LAR, contact with a third party or the use of special services to locate the
LAR, or other appropriate attempts to contact the LAR as determined by the
circumstances.
[
(18)
Service coordination
-Assistance in accessing medical, social, educational, and other appropriate
services that will help an individual achieve a quality of life and community
participation acceptable to the individual (and LAR on the individual's behalf)
as follows:]
[
(A)
crisis prevention and management
- locating and coordinating services and supports to prevent or manage a crisis;]
[
(B)
monitoring - ensuring that
the individual receives needed services, evaluating the effectiveness and
adequacy of services, and determining if identified outcomes are meeting the
individual's needs and desires as indicated by the individual (and the LAR
on the individual's behalf);]
[
(C)
assessment -identifying the
nature of the presenting problem and the service and support needs of the
individual; and]
[
(D)
service planning and coordination
- identifying, arranging, advocating, collaborating with other agencies, and
linking for the delivery of outcome-focused services and supports that address
the individual's needs and desires as indicated by the individual (and the
LAR on the individual's behalf).]
(19)
Service coordination
- Assistance in accessing medical, social, educational, and other appropriate
services and supports that will help an individual achieve a quality of life
and community participation acceptable to the individual (and LAR on the individual's
behalf) as follows:
(A)
crisis prevention and management - locating
and coordinating services and supports to prevent or manage a crisis;
(B)
monitoring - ensuring that the individual receives
needed services, evaluating the effectiveness and adequacy of services, and
determining if identified outcomes are meeting the individual's needs and
desires as indicated by the individual (and the LAR on the individual's behalf);
(C)
assessment - identifying the service and support
needs for the individual as they relate to the nature of the individual's
presenting problem and disability; and
(D)
service planning and coordination - identifying,
arranging, advocating, collaborating with other agencies, and linking for
the delivery of outcome-focused services and supports that address the individual's
needs and desires as indicated by the individual (and the LAR on the individual's
behalf).
§412.455. Eligibility.
To be eligible for service coordination, an individual must be:
(1)
in the adult mental health, child mental health, or mental
retardation priority populations or be a person with a related condition,
as defined in 42 CFR §435.1009
(Attachment A) and determined to
need service coordination as described in §412.456 of this title (relating
to Evaluation for Service Coordination)
, and:
(A)
require multiple services and supports from community
providers
, excluding service coordination
;
(B)
be transitioning between community providers or placements;
or
(C)
be
[
if
] transitioning from an institutional
to a
community
[
noninstitutional
] provider [
, be
within 30 days prior to discharge or furlough
]; or
(2)
a resident in a Medicaid certified nursing facility
and be eligible for OBRA '87 mandated services for mental illness, mental
retardation, or a related condition.
§412.456. Evaluation for Service Coordination.
(a)
The local authority must evaluate each individual to determine
the specific services and supports needed from community providers and whether
service coordination is needed. If service coordination is needed, the local
authority determines frequency, duration, and intensity of the service coordination
that the individual will receive.
(b)
The local authority must evaluate:
(1)
adults in the mental health priority population by completing
the uniform assessment for the adult mental health population.
(2)
children in the mental health priority population
by completing the uniform assessment for the child mental health population.
(3)
individuals in the mental retardation priority population
and individuals with a related condition, as defined in 42 CFR §435.1009
by completing the Service Coordination Evaluation, Mental Retardation Services.
§412.457. Plan of Care.
(a)
The local authority must document in the individual's
plan of care the results from the evaluation performed in accordance with
§412.456 of this title (relating to Evaluation for Service Coordination),
including:
(1)
the individual's choices and outcomes (and those of the
LAR on the individual's behalf);
(2)
the specific services and supports to be provided
by community providers; and
(3)
the frequency, duration, and intensity of service
coordination.
(b)
Service coordination must be provided in accordance with
the individual's plan of care.
(c)
If an individual's needs change, the local authority must
revise the individual's plan of care, as appropriate, and/or adjust the frequency,
duration, and intensity of service coordination in consultation with the individual
(and the LAR on the individual's behalf). The local authority must perform
a new evaluation in accordance with §412.456 of this title (relating
to Evaluation for Service Coordination), if necessary.
(d)
The local authority may provide crisis prevention and
management prior to documenting the service in the individual's plan of care.
(e)
The local authority must provide a minimum of one face-to-face
contact every 90 days to each individual receiving service coordination.
[
(1)
For children, the face-to-face
contact must be with both the child and the LAR.]
[
(2)
The face-to-face contact
with the child and the LAR does not have to occur during the same service
coordination contact, but must occur within the same month.]
[
(3)
If a child's LAR lives
outside the local authority's service area, a telephone contact may replace
the face-to-face contact provided the local authority documents in the record
its justification for replacing the face-to-face contact with a telephone
contact.]
[
(4)
If a child resides with
a primary care giver who is not a service provider or the child's LAR, the
face-to-face contact may occur with the primary care giver provided the LAR
has given written permission for such to occur.]
(f)
Except as provided in paragraphs
(1)-(4) of this subsection, for children, the local authority must conduct
a face-to face contact with both the child and the LAR. The face-to-face contact
with the child and the LAR may occur separately, but the contacts must occur
within 30 calendar days of each other. If the parent is not the guardian or
managing conservator, the local authority must conduct the face-to-face contact
with the guardian or managing conservator.
(1)
LARs residing inside the service area.
(A)
If the LAR resides inside the local authority's
service area, then the local authority must make reasonable efforts to conduct
the face-to-face contact with the LAR. If the face-to-face contact is unsuccessful,
then the local authority must make reasonable efforts to replace it with a
telephone contact. The local authority must document in the child's record
the reasonable efforts made to conduct the face-to-face contact and the result
of the efforts.
(B)
If the local authority makes reasonable efforts
to conduct a telephone contact with the LAR and is unsuccessful, then the
local authority must document in the child's record the efforts made to conduct
the telephone contact and the result of the efforts.
(2)
LARs residing outside the local service
area. If the LAR resides outside the local authority's service area, then
the local authority has the option of either conducting a face-to-face contact
with the LAR or a telephone contact with the LAR. If the local authority makes
reasonable efforts to conduct a telephone contact with the LAR and is unsuccessful,
then the local authority must document in the child's record the efforts made
to conduct the telephone contact and the result of the efforts.
(3)
Contacting the primary care giver. If
the child resides with a primary care giver who is not the service provider
or the LAR, then the face-to-face contact may occur with the primary care
giver.
(A)
If the local authority makes reasonable efforts
to conduct the face-to-face contact with the primary care giver instead of
the LAR and is unsuccessful, then the local authority may replace the face-to-face
contact with a telephone contact. The local authority must document in the
child's record the reasonable efforts made to conduct the face-to-face contact
and the result of the efforts.
(B)
If the local authority makes reasonable efforts
to conduct a telephone contact with the primary care giver and is unsuccessful,
then the local authority must document in the child's record the efforts made
to conduct the telephone contact and the result of the efforts.
(4)
Contact is not required.
(A)
The local authority is not required to contact
the LAR:
(i)
if a court has removed the disabilities of
minority of the child in accordance with the Texas Family Code, Chapter 31;
(ii)
if the child is or has been married;
(iii)
if the child requests treatment without parental
consent as described in the Texas Family Code, §§32.003 or 32.004;
or
(iv)
if the child lives independently and is self-supporting.
(B)
The local authority must document such justification
once in the child's record.
§412.462. Staff Training.
(a)
The following persons must receive training as described
in subsection (b) of this section within the first 90 days of performing their
service coordination-related duties:
(1)
persons who provide service coordination; and
(2)
persons who supervise and oversee the provision of
service coordination.
(b)
Training must include:
(1)
appropriate policies, procedures, and standards;
(2)
the local authority's performance contract/memorandum
requirements regarding service coordination and case management;
(3)
plan of care development and implementation;
(4)
person-directed planning
for persons providing
service coordination to adults with mental retardation
;
(5)
family-directed planning
or wraparound approach
for persons providing service coordination to children
;
(6)
permanency planning
for persons providing service
coordination to children with mental retardation
;
(7)
crisis prevention and management, monitoring, assessment,
and service planning and coordination;
(8)
community support services availability and management;
and
(9)
advocacy for individuals.
(c)
The local authority must document
the training provided in accordance with this section in the personnel record
of each person providing, supervising, or overseeing service coordination.
[
(c)
Prior to the local authority
submitting a claim for Medicaid reimbursement for service coordination, the
local authority must ensure that the person who provided the service coordination
has successfully completed competency-based training on:]
[
(1)
the requirements regarding the provision of
case management as set forth in the
Medicaid Targeted
Case Management Services State Plan
;]
[
(2)
the
Case Management
Services Medicaid Reimbursement Provider Manual
; and]
[
(3)
the
Medicaid
Targeted Case Management Services - Billing and Payment Review Protocol
].
[
(d)
The local authority must
document the training provided in accordance with this section in the personnel
record of each person providing, supervising, or overseeing service coordination.]
§412.463. Documentation of Service Coordination.
(a)
The local authority must document the required contacts
described in the individual's plan of care, including:
(1)
the date of contact;
(2)
the description of the service coordination provided;
(3)
the progress or lack of progress in achieving goals
or outcomes;
(4)
the person with whom the contact occurred; and
(5)
the person who provided the contact and that person's
professional discipline.
(b)
The local authority's authorities documentation of service
coordination provided, in addition to the required contacts with the individual,
may be summarized in the progress notes.
(c)
The local authority must identify the appropriate service
code in CARE for all individuals receiving service coordination.
(d)
The local authority must retain documentation in compliance
with applicable federal and state laws, rules, and regulations.
§412.465. References.
References are made to the following state and federal statutes and
Texas Administrative Code:
(1)
Texas Health and Safety Code, §591.003(13);
(2)
25 TAC, Chapter 408, Subchapter B, governing Mental
Health Community Services Standards;
(3)
25 TAC, Chapter 412, Subchapter H, governing Standards
and Quality Assurance for Mental Retardation Community Services and Supports;
[
and
]
(4)
42 CFR §435.1009
; and
[
.
]
(5)
Texas Family Code, §§32.003
and 32.004.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of the Secretary of State, on
May 24, 1999.
TRD-9903046
Charles Cooper
Chairman
Texas Department of Mental Health and Mental Retardation
Earliest possible date of adoption: July 11, 1999
For further information, please call: (512) 206-4516
25 TAC §412.456, §412.463
(Editor's note: The text of the following sections proposed for
repeal will not be published. The sections may be examined in the offices
of the Texas Department of Mental Health and Mental Retardation or in the
Texas Register office, Room 245, James Earl Rudder Building, 1019 Brazos Street,
Austin.)
The Texas Department of Mental Health and Mental
Retardation (TDMHMR) proposes the repeals of §412.456 and §412.463
of Chapter 412, Subchapter J, governing Service Coordination.
These sections are being proposed for repeal in order to adopt new §412.456
and §412.463 of Chapter 412, Subchapter J, governing Service Coordination,
which address substantially the same issues. New §412.456 and §412.463
are contemporaneously proposed for public comment in this issue of the Texas Register.
William R. Campbell, chief financial officer, has determined that for each
of the first five years the proposed repeals are in effect, the proposed repeals
would not have foreseeable implications relating to costs or revenues of state
or local governments.
Dave Wanser, director, Behavioral Health Services, has determined that
for each year of the first five years the proposed repeals are in effect,
the public benefit expected is the ability of TDMHMR to adopt new rules that
provide more effective and efficient policies and procedures to guide the
provision of service coordination. There is no probable economic cost to persons
required to comply with the new rules. It is not anticipated that the proposed
repeals would have an adverse economic effect on small businesses because
they do not participate in the service coordination program. It is not anticipated
that the proposed repeals will affect a local economy.
A public hearing will be held at 10:30 p.m. on June 22, 1999, in auditorium
of the main TDMHMR Central Office building (Building 2), 909 West 45th Street,
Austin, Texas, to accept oral and written testimony concerning the proposal.
Persons needing an accommodation to attend the hearing and persons with special
needs requiring assistance should contact Sheila Wilkins, Office of Policy
Development, at least 72 hours prior to the hearing by calling (512) 206-4516.
Persons with hearing impairments may also call
TTY-Message
- Texas Relay
toll-free at (800) 735-2988.
Comments on the proposal may be submitted to Linda Logan, director, Policy
Development, Texas Department Mental Health and Mental Retardation, P.O. Box
12668, Austin, TX 78711-2668, within 30 days of publication of this notice.
The rules are proposed for repeal under the Texas Health and
Safety Code, §532.015(a), which provides TDMHMR with broad rulemaking
authority; the Texas Government Code, §531.021(a), and the Texas Human
Resources Code §32.021(a), which provide the Texas Health and Human Services
Commission (THHSC) with the authority to administer the federal medical assistance
(Medicaid) program in Texas; Acts 1995, 74th Texas Legislature, Chapter 6,
§1, (Senate Bill 509), which clarifies the authority of THHSC to delegate
the operation of all or part of a Medicaid program to a health and human services
agency; and the Human Resources Code, §32.021(c), which provides an agency
operating part of the Medicaid program with the authority to adopt necessary
rules for the proper and efficient operation of the program. THHSC has designated
TDMHMR as the operating agency for the Medicaid service coordination program.
The sections affect the Health and Safety Code, §532.015, Human Resources
Code, §32.021, and Government Code, §531.021.
§412.456. Evaluation for Service Coordination.
§412.463. Documentation of Service Coordination.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of the Secretary of State, on
May 24, 1999.
TRD-9903047
Charles Cooper
Chairman
Texas Department of Mental Health and Mental Retardation
Earliest possible date of adoption: July 11, 1999
For further information, please call: (512) 206-4516