Part 1.
TEXAS DEPARTMENT OF HUMAN SERVICES
Chapter 97.
HOME AND COMMUNITY SUPPORT SERVICES AGENCIES
Subchapter D. ENFORCEMENT
40 TAC §97.52
The Texas Department of Human Services (DHS) adopts an amendment
to §97.52 without changes to the proposed text pub-lished in the July
7, 2000, issue of the
Texas Register
(25 TexReg
6479).
Justification for the adoption is to correct a technical error in transmitting
the final adopted version of 40 TAC §97.52. The Severity Level 1 Violations
chart was inadvertently omitted from §97.52(b)(3)(C)(iii) when it was
transmitted to the
Texas Register
as the adopted
rule and published in the June 16, 2000, issue (25 TexReg 5941). DHS filed
a public notice in the "In Addition" section of the July 7, 2000, issue of
the
Texas Register
(25 TexReg 6479).
The department received no comments regarding the adoption.
The amendment is adopted under the Health and Safety Code, Chapter
142, which provides the department with the authority to adopt rules for the
licensing and regulation of home and community support services agencies.
The amendment implements the Health and Safety Code, Chapter 142.001-142.030.
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 10, 2000.
TRD-200005579
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Effective date: September 1, 2000
Proposal publication date: July 7, 2000
For further information, please call: (512) 438-3108
Chapter 144.
CONTRACT REQUIREMENTS
Subchapter A. GENERAL PROVISIONS
40 TAC §§144.1, 144.11, 144.21
The Texas Commission on Alcohol and Drug Abuse adopts amendments
to §§144.1, 144.11, and 144.21 concerning General Provisions without
changes to the proposed text as published in the June 9, 2000, issue of the
These sections contain information regarding applicability, waivers and
definitions.
These amendments are adopted to more clearly state that statutes governing
state agencies apply if there is a conflict between such statutes and these
rules; to change the term variance to waiver; to establish a time limit for
waivers; to clarify several definitions; to add new definitions for graduate,
unethical conduct and unprofessional conduct; to add the term cost reimbursement
and eliminate the term financial assistance to more precisely describe this
type of payment mechanism; to replace the term unit cost with the term unit
rate; and to make grammatical changes to improve readability and understanding.
Comments on the rules were received from the Association of Substance Abuse
Programs and an individual.
The following comments were received regarding §144.21.
Comment: The definition of financial assistance is being eliminated. Is
it being replaced with cost reimbursement? This is an important shift in basic
terminology , and we recommend the Commission provide more information about
how this term will be referenced and used. Response: The term "financial assistance"
is being replaced with "cost reimbursement". Financial assistance contracts
were defined as those based on a line-item budget rather than a unit cost
rate. Those contracts have always been cost reimbursement contracts. More
information about this and other changes will be published in the Provider
Bulletin. Comment: You define which professionals are QCCs. Some period of
work experience should be stated for many of these professionals. An LMSW
or LPC may have no working knowledge of substance abuse. Response: The professionals
defined as Qualified Credentialed Counselors (QCCs) are authorized by law
to provide chemical dependency counseling. The commission agrees that specific
knowledge and experience with substance abuse is important, but a competent
counselor can acquire these assets on the job. In light of continued reports
of counselor shortages, it is important to keep the pool of potential applicants
as large as possible. Individual facilities may establish more stringent hiring
criteria than those listed in the rules. Comment: The rules contain a definition
for unit rate. We are pleased to see TCADA defining and utilizing this type
of contract/payment system.
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 rules 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 9, 2000.
TRD-200005534
Karen Pettigrew
General Counsel
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 2000
Proposal publication date: June 9, 2000
For further information, please call: (512) 349-6733
40 TAC §144.101
The Texas Commission on Alcohol and Drug Abuse adopts amendments
to §144.101 concerning Contract Administration with changes to the proposed
text as published in the June 9, 2000, issue of the
Texas Register
(25 TexReg 5561).
This section contains information regarding general contract provisions.
The amendments are adopted to more fully outline the steps required before
a contract is considered fully executed; to raise the cap on the required
fidelity bond or insurance; to specify that providers will be held to performance
standards stated in the contract; and to make other changes to improve readability
and understanding.
Comments on the rules were received from the Association of Substance Abuse
Programs.
The following comments were received.
Comment: The proposed rule requires signed contracts to be returned to
the commission within 14 calendar days of the postmark date. Documents postmarked
by TCADA are sometimes not actually received at the provider's office until
as much as 10 days after the postmark. We believe 21 days is more reasonable
considering the mail service factor. Or, delivery by certified mail with a
14 day deadline from the date of receipt.
Response: It is extremely important for all contracts to be signed and
returned to the commission before the contract period begins. Negotiations
are conducted in advance, so the content of the contract has been reviewed
and agreed upon before it is mailed to the provider. Providers are expected
to make advance arrangements if necessary so the document can be signed in
a timely manner. The rule has been revised to require contracts to be returned
before the start of the contract period.
Comment: This rule references §144.413 and §144.552. Neither
one of these sections are included in the published rules.
Response: No changes are proposed for these sections, so the text was not
published in the
Texas Register
. The current
language in these sections remain in effect.
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 rule is the Texas Health and Safety Code,
Chapter 461.
§144.101.General Contract Provisions.
(a)
A contract is not fully executed until it has been signed
by the commission and the provider. The commission's policy is to have all
contracts executed before the start date of the contract.
(1)
The commission shall send the provider two original contracts
signed by the commission. Both copies of the contract must be signed by an
official authorized to enter into such agreements on behalf of the governing
body. One shall be submitted to the commission before the start of the contract
period and the other shall be maintained by the organization.
(2)
If the provider makes any modifications to the original
contract, both signed copies must be mailed to the commission for review.
The commission may approve the counter-offer by co-signing the revised contracts
and returning one copy to the provider or continue negotiations.
(3)
No payment or advance of funds will be made until the contract
is fully executed.
(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 approved
in writing by the commission 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.
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.
(1)
If the provider's contract with the commission is $100,000
or less, coverage shall be equal to the contract amount.
(2)
If the provider's contract is over $100,000, coverage shall
be equal to $100,000 or 10% of the contract amount, whichever is greater,
but in no event shall coverage exceed $500,000.
(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)
applicable federal regulations;
(3)
rules adopted by the commission ; and
(4)
the contract.
(f)
All providers shall be held to performance standards stated
in the contract.
(1)
Performance standards for prevention and intervention programs
include the performance and activity measures described in §144.413 of
this title (relating to Performance and Activity Measures).
(2)
Performance standards for treatment programs include the
performance measures defined in §144.552 of this title (relating to Select
Performance Measure Definitions).
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 9, 2000.
TRD-200005535
Karen Pettigrew
General Counsel
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 2000
Proposal publication date: June 9, 2000
For further information, please call: (512) 349-6733
40 TAC §144.102
The Texas Commission on Alcohol and Drug Abuse adopts the
repeal of §144.102 concerning Contract Administration without changes
to the proposal as published in the June 9, 2000, issue of the
Texas Register
(25 TexReg 5562).
This section contains the requirements for amendments.
The repeal is adopted because requirements for contract amendments will
be included in individual contracts.
The following comments were received from the Association of Substance
Abuse Programs and an individual regarding the adoption of the repeal: Why
are you deleting this section? Does it imply no contract amendments will ever
be permitted? This seems very unrealistic for both TCADA and providers because
circumstances do come up where it is reasonable and warranted to make a contract
amendment(s). We recommend keeping this section or revising it to specify
how amendments to the terms and conditions can be made in the current environment.
Response: Amendments will be permitted in FY 2001. Information about amending
contracts will be found in the contract itself instead of in the rules.
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 9, 2000.
TRD-200005537
Karen Pettigrew
General Counsel
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 2000
Proposal publication date: June 9, 2000
For further information, please call: (512) 349-6733
40 TAC §§144.103 - 144.109, 144.121, 144.124, 144.131- 144.134, 144.141, 144.142, 144.145
The Texas Commission on Alcohol and Drug Abuse adopts amendments
to §§144.103-144.108, 144.121, 144.124, 144.131-144.133, 144.141,
144.142 and adopts new §§144.109, 144.134, and 144.145 concerning
Contract Administration. Sections 144.104 - 144.106, 144.109, 144.121, 144.131,
144.132, 144.134, 144.141, 144.142 and 144.145 are adopted with changes to
the proposed text as published in the June 9, 2000, issue of the
Texas Register
(25 TexReg 5562). Sections 144.103, 144.107, 144.108,
144.24 and 144.133 are adopted without changes to the proposed text and will
not be republished. These sections contain information regarding organizational
and personnel changes, matching awards, financial eligibility and third party
payment, payment requirements, reporting, cost reimbursement for treatment
services, billing for treatment services, application of federal and state
requirements, indirect costs, equipment and supplies, travel, minor remodeling,
procurement of goods and services, subcontracting, and contract closeout.
These amendments and new sections are adopted to require all funded providers
to contribute at least 5% match; to stipulate that rules regarding third party
payments apply to all programs that are subject to financial eligibility requirements;
to specify that providers cannot bill the commission for any services delivered
to an individual who has access to another public or private funding source;
to provide more direction on becoming a Medicaid provider; to require providers
serving individuals under 18 years of age to become a Children's Health Insurance
Program provider; to strictly prohibit double billing for any service; to
require providers to collect client fees according to a sliding fee scale;
to limit advance payments; to stipulate reporting requirements for various
types of programs; to limit the use of cost reimbursement as a payment mechanism
to 12 months unless the commission's executive director grants a waiver; to
specify restrictions on billing including limitations on the types and hours
of services that providers can charge to the commission; to clarify the application
of federal and state regulations; to allow the commission to require that
administrative expenses be charged as direct costs; to provide clearer guidance
about the process by which a provider requests that administrative costs be
charged as indirect costs; to limit the requirement for prior approval for
certain expenditures only to providers on cost reimbursement; to require prior
approval for transfers among program budget line items when cumulative transfers
exceed 10% of the total program budget; to define and require a physical inventory
of controlled items; to specify limits on costs for mileage and out-of-state
travel; to fully describe the process required to expend Commission funds
for minor remodeling; to provide more details regarding the procurement of
goods and services by providers; to prohibit the use of subcontractors that
are not in good standing with legal, regulatory, and funding agencies, including
the commission; to specify what information a provider must submit to the
commission regarding proposed subcontractors; to establish a time limit of
90 days after the end of a contract for claims for reimbursement for subcontractors
to be submitted; to stipulate that subcontractors are subject to commission
oversight; to establish a process for the closeout of contracts; and to make
other changes to improve readability and understanding.
Comments on these sections were received from the Association of Substance
Abuse Programs and individuals.
Comment received regarding §144.103. Organizational and Personnel
Changes: Thank you for deleting (G) "any other individuals identified as key
personnel in the application." With all of the personnel changes, that was
difficult to keep up with.
The following are comments received regarding §144.104 Matching Awards.
Comment: This rule now requires all contracts, including treatment contracts
where a waiver has historically been applied, to provide matching funds. For
many treatment providers this equates to a 5% rate reduction. Many providers,
including prevention programs have used or are using available "other" dollars
to help offset the recent funding restrictions in order to maintain continuity
and reduce disruption to services. If you are a large service provider, (i.e.
$1 million) a 5% match equates to $50,000 which is a substantial sum of unrestricted
funds to come up with for drug and alcohol non-profit agencies. Although in-kind
contributions can be applied toward match, $50,000 of in-kind contributions
can also be difficult to accrue. To assist providers in maintaining levels
of service in light of budget reductions and to allow for stability and continuity,
we recommend removing the proposed rules and utilizing TCADA's option to waive
match for both prevention and treatment service providers. At a minimum, revise
the wording in the proposed rule to clearly indicate individual requests for
match waivers will be reviewed and granted by TCADA.
Response: Under state statute, the commission cannot waive the match requirement
unless it determines that the requirement will jeopardize the provision of
needed services. The commission does not agree that a blanket waiver meets
the intent of the statute; such a determination can only be made on a case-by-case
basis. Providers can request a waiver through existing provisions in the rules.
Comment: As the primary provider of substance abuse services to medically
indigent clients, we have extremely limited opportunity to access additional
funding eligible to be used for matching purposes. Few of our clients have
private insurance, and most billings are denied. Client fees are minimal,
and local city and county funds are already limited and spread thin to meet
diverse needs. Other sources of income include federal and state criminal
justice contracts. Clarification is needed as to the eligibility of these
funds to be used as match. The 5% match requirement is unrealistic given our
limited opportunities to generate additional income given the population we
are charged to serve.
Response: In general, other federal and state funds may not be used to
match federal block grant dollars. Organizations should refer to the grant
or contract and laws and rules that govern the other state or federal funds
to determine whether or not they can be used as match. The rule has been revised
to clarify that in-kind contributions and program income may be used to meet
the match requirement.
Comment: The initiation of a 5% match for treatment services, which includes
significant match restrictions, imposes a large hurdle for an existing program
and an even larger obstacle for a start-up program. Unlike prevention or intervention
services that can typically be managed from a leased office, treatment services
are cost-efficiently and program-effectively provided from program-owned facilities.
Even in the best circumstances, a large cash investment is a huge risk for
the short-term contracts offered by TCADA. To mitigate this risk and encourage
programs that provide much-needed treatment capacity, the matching fund requirements
should be greatly expanded. Specifically, we encourage TCADA to consider as
match: a. Building and remodeling costs not funded by grants b. Food stamp
payment to residents paid over to programs c. Federal program income sources
such as breakfast/lunch programs d. Federal education entitlements such as
Eisenhower, Title I, and SDFSC leveraged to strengthen our education services
for clients
Response: The commission can accept match only to the extent permitted
by applicable regulations. Cash and in-kind match must meet the same requirements
as contract expenditures. In general, federal and state funds cannot be used
as match. Providers should review their federal and state grants and related
regulations to see if permission is given to use the dollars as match. The
federal block grant prohibits building and remodeling costs except for minor
remodeling. Food stamps cannot be used as match because the source is federal
funds.
The following are comments received regarding §144.105 Financial Eligibility
and Third Party Payment.
Comment: The rule requires any provider offering services eligible for
Medicaid reimbursement to take all necessary steps to obtain a Medicaid provider
number and become an approved Medicaid provider. The services funded by the
Medicaid state plan should be listed and referenced.
Response: The commission does not agree that this information should be
included as part of the commission's rules because it is governed by the state
Medicaid plan. Detailed information regarding eligible services is provided
through the Provider Bulletin and other publications.
Comment: Programs providing outpatient treatment services to children and
adolescents are required to enroll in the Texas Medicaid Program. A question
has arisen about programs providing counseling in adolescent intervention
programs and substance abuse assessments. Do these programs need a Medicaid
number or only licensed treatment programs?
Response: This rule does not apply to adolescent intervention programs.
The services provided by such programs are not eligible for Medicaid reimbursement.
Comment: The rules states that any provider in a STAR or STAR+ service
area must take all necessary steps to enroll with those program health plans
to be reimbursed for services delivered to those clients. If the client is
on Medicaid and the provider does not receive authorization from a STAR or
STAR+ program can they discharge the client based on inability to pay?
Response: A commission-funded provider cannot deny services to a client
based solely on inability to pay. If the provider has exhausted all appeals,
the costs of treating the client can be charged to the commission.
Comment: Providers serving individuals under 18 years of age are required
to take all necessary steps to become an approved Children's Health Insurance
Program (CHIP) provider. The CHIP portion is confusing because assessment
and intervention activities are included in the benefit package which are
services often performed by councils under OSAR and prevention providers and
not typically viewed as "insured services". It would be helpful here to list
covered CHIP services under (d)(2) and providers that must apply.
Response: At this time, the rules do not require prevention and intervention
providers (including OSARs) to enroll as CHIP providers. Detailed information
about CHIP is provided through the Provider Bulletin and other publications.
The commission will also provide a training session on CHIP.
Comment: Will TCADA be providing information or references as to where
providers can find both Medicaid and CHIP eligibility standards?
Response: This information will be provided through the Provider Bulletin
and other publications.
Comment: This entire section poses a documentation nightmare. In addition,
it seems that substance abuse providers are being asked to perform the duties
of Medicaid and CHIP program staff. These are activities which in many hospitals
or similar settings require several staff members to perform. Perhaps they
have the money to hire those people; we do not.
Response: The commission recognizes that billing multiple funding sources
increases administrative procedures and documentation. However, the commission
does not agree that the burden outweighs the benefit of leveraging all available
funding sources to extend the limited dollars allocated to the commission
for substance abuse programs. As of August,1999, less than 20% of the need
for treatment was being met in Texas. Every unit of service billed to Medicaid
or CHIP leverages federal dollars and increases the total quantity of substance
abuse services available for poor Texans. Furthermore, ability to access multiple
funding streams enhances the financial stability of providers in a rapidly
changing environment.
Comments received regarding §144.106 Payment Requirements follow.
Comment: This section does not address prevention/intervention programs
which receive cash advances. I suggest that some mention be added to make
it more clear.
Response: Under the new rules, no commission-funded program will receive
monthly cash advances.
Comment: We recommend that TCADA continue to give providers the option
to choose method of payment rather than allow an advance on an exception basis
only. We believe a failsafe system is already in place for advance payments
through the FSR or quarterly financial reports. To improve accountability,
TCADA can increase internal controls of the existing safeguards and only require
reimbursements for providers who don't comply with procedures. At a minimum,
allow providers to choose advance payments for personnel costs. Providers
do not necessarily have adequate reserve or access to a line of credit to
function on a reimbursement basis. Although we do appreciate that the rule
allows working capital advances on an exception basis, we are unclear about
what constitutes an exception.
Response: The amount of surplus cash that remains in the contracting system
at closeout and the commission's previous inability to predict carryforward
from year to year indicates that the current system does not have adequate
operational safeguards. Furthermore, cost reimbursement is the standard method
of payment in most comparable state and federal programs. Providers may request
a working capital advance based on their organization's cash flow. The commission
would expect to see supporting information such as: all sources of funding
for the agency, timing of other funding, restricted versus unrestricted sources
of revenue, timing of liquidation of liabilities, whether or not the agency
has a relationship with a bank for a loan or line of credit, and sources of
match and program income and flexibility associated with those resources.
The following are comments received regarding §144.107 Reporting.
Comment: Why has the commission changed the deadline for submitting reports
from 30 to 20 days? Unless TCADA is then able to significantly reduce the
time it takes to turn around reports back to providers as a result of this
10 day reduction, we believe providers should be given the 30 day period currently
in effect.
Response: The timeframe has been shortened to enhance the commission's
ability to manage cash flow. This is also consistent with the practices of
other health and human service agencies which require reports to be submitted
as early as three days after the close of a reporting period. It is unclear
what turnaround the commenter is referring to in the last sentence.
Comment: The 20-day deadline is unrealistic, particularly for providers
in a network setting. Because the last half of the month payroll and expenses
are run on the 15th of the following month it would be very difficult to accurately
report all expenses if the FSR is due 20 days after the end of the reporting
period. We are in a network, and the network management organization (NMO)
requires the FSR to be submitted in 20 days so they can meet the current 30-day
deadline. We have had to continually request an extension to ensure accurate
reporting. If the NMO deadline will be 20 days, participating providers will
have an even shorter deadline.
Response: Deadlines within the network are an issue for negotiation between
the subcontractor and the NMO.
Comment: Programs that treat individuals for intravenous substance abuse
shall notify the commission through the facility capacity management system
when the program's capacity for treating intravenous substance abusers reaches
90%. What does this mean? We report all available beds on a daily basis. Is
this sufficient?
Response: There is a separate question on the reporting form for this item.
It is in addition to reporting the number of beds.
The following comment was received regarding §144.121. Application
of State and Federal Regulations: It would be helpful if TCADA would cite
the appropriate UGMS sections we must comply with much as it does the other
federal circulars.
Response: Providers are required to comply with all of UGMS, as is true
of the federal circulars.
One comment was received regarding §144.124. Indirect Cost: A new
rule states that the commission reserves the right to require administrative
expenses to be charged as direct costs. Since the RFP process upon which an
award is based clearly distinguishes between program, administrative, and
indirect costs, an award should not be subject to a "reserves the right" clause.
This implies an after-the-fact change to the RFP process. Since the chosen
provider is obligated to perform under the terms and conditions of the RFP,
TCADA should also be bound to abide by the characterization of costs as presented
in the RFP.
Response: The budget instructions for the Comprehensive Services Request
for Proposal for FY 2001 states (on page 173) that the commission reserves
the right to mandate direct charging.
The following are comments received regarding §144.142 Subcontracting.
Comment: Requiring a provider to perform an annual documented subcontractor
monitoring visit appears to be a significant new requirement and is a big
area of TCADA audit vulnerability for providers. We recommend more specific
instruction be provided in the rule about the scope of sub-contractor monitoring
and what it needs to entail, how it should be documented and generally what
TCADA expects from a provider in order to successfully comply with this provision.
Response: The proposed rule simply states that the provider shall monitor
subcontractor compliance; it does not specifically mandate an annual on-site
visit. The commission will provide additional guidance in the Provider Bulletin.
Comment: Providers are told to require all subcontractors to permit access
to TCADA staff. Does this apply in situations such as NorthSTAR?
Response: The rules in this chapter do not apply to NorthSTAR. However,
the NorthSTAR contract contains similar provisions.
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 the adopted rules is the Texas Health and Safety Code,
Chapter 461.
§144.103.Organizational and Personnel Changes.
The provider shall notify the commission in writing within ten business
days of:
(1)
changes in the provider's legal name, address, telephone
number, or legal status; and
(2)
changes in the following personnel:
(A)
certifying representative;
(B)
board chair;
(C)
chief executive officer;
(D)
chief financial officer;
(E)
project director; or
(F)
contact person.
§144.104.Matching Awards.
(a)
Unless waived in writing by the commission, all providers
shall contribute at least 5.0% of the total commission-funded program expenditures
in cash or in-kind match from sources eligible to be used for matching purposes.
(b)
Match shall comply with requirements found in the applicable
Office of Management and Budget (OMB) circulars as stated in §144.121
of this title (relating to Application of State and Federal Regulations).
§144.105.Financial Eligibility and Third Party Payment.
(a)
The rules in this section apply to all programs subject
to financial eligibility requirements, including all treatment programs. If
applicable to a prevention or intervention program, the requirement for financial
eligibility determination shall be stipulated in the contract.
(b)
The Commission is the payor of last resort for substance
abuse services. A provider shall not bill the commission for services provided
to a client if:
(1)
the individual does not meet the commission's eligibility
criteria as described in §144.521 of this title (relating to Client Eligibility);
or
(2)
the individual has access to another public or private
funding source that pays for substance abuse services addressing the individual's
diagnosis or condition.
(c)
Any provider offering services eligible for Medicaid reimbursement
shall take all necessary steps to obtain a Medicaid provider number and become
an approved Medicaid provider. The process must be initiated no later than
30 days after the beginning date of a contract with the commission.
(1)
All programs providing outpatient treatment services to
children and adolescents must contact the National Heritage Insurance Company
(NHIC) to initiate enrollment as a Chemical Dependency Treatment Facility
(CDTF) in the Texas Medicaid Program.
(2)
Any provider delivering services in the STAR, STAR+, and/or
NorthStar service areas must take all necessary steps to enroll with those
Program Health Plans to be reimbursed for services delivered to those clients.
(3)
The provider must screen all clients for Medicaid eligibility.
If a client appears eligible but has not yet applied, the provider shall direct
the client to apply for Medicaid benefits and provide assistance as needed
to facilitate the enrollment process.
(4)
The provider must bill Medicaid for all covered services
delivered to eligible clients.
(d)
Providers serving individuals under 18 years of age shall
take all necessary steps to become an approved Children's Health Insurance
Program (CHIP) provider by contacting the contracted Health Maintenance Organization
(HMO), Behavioral Health Organization (BHO), or Exclusive Provider Organization
(EPO) in the region. The process must be initiated no later than 30 days after
the beginning date of a contract with the commission.
(1)
The provider must screen all clients under the age of 18
for CHIP eligibility. If a client appears eligible but has not yet applied,
the provider shall direct the client's consentor to apply for CHIP benefits
and provide assistance as needed to facilitate the enrollment process.
(2)
The provider must bill CHIP for all covered services delivered
to eligible clients.
(e)
The provider shall not bill the commission for any part
of any unit of service that has been billed to another entity or that is eligible
for reimbursement by another entity. If the third party payor denies payment
and all appeals have been exhausted, the provider may bill the commission
for that unit of service.
(f)
The provider shall make a reasonable effort to collect
fees generated from clients paying according to a sliding fee scale, but the
provider may waive collection if the administrative cost of collection will
exceed the fee to be collected. The provider shall not bill the commission
for any uncollected client fees.
§144.106.Payment Requirements.
(a)
Payments shall be made only when the contract has been
fully executed.
(b)
To be eligible for payments, the provider must comply with
provisions of the contract, rules, policies, and procedures of the commission,
and other applicable state and federal laws and regulations.
(c)
The commission may delay or deny payment if the provider
is not in compliance with commission requirements, which include:
(1)
rules adopted by the commission;
(2)
the contract; and
(3)
other applicable statutes and regulations.
(d)
Providers paid through cost reimbursement may request a
working capital advance.
(1)
A working capital advance may be granted if the provider
submits documentation justifying the need for working capital. Advances shall
be granted on an exception basis only.
(2)
A provider receiving a cash advance shall minimize the
time between disbursement of funds by the commission and expenditure of funds
by the program. The commission may reduce or reject payment if the program
has excess cash on hand.
(e)
All providers must submit requests for payment promptly
and regularly.
(1)
Payment requests must be submitted at least monthly.
(2)
Failure to submit payment requests in a timely manner may
result in nonpayment.
(f)
Payment requests shall be complete, accurate, submitted
in the format required by the commission, and certified by the provider's
authorized representative (specified in the contract).
(g)
Treatment programs funded through the unit rate payment
mechanism shall use the client billing forms to request reimbursement. A billing
form must be submitted for each client served in the program who is supported
with commission funds. Treatment programs funded through cost reimbursement
shall also submit client billing forms, but payments will be based on satisfactory
submission of a request for reimbursement.
(h)
The provider shall maintain documentation necessary to
support all payment requests.
§144.107.Reporting.
(a)
The provider shall submit all reports as required by commission
rules, the contract, and applicable instruction manuals. Reports shall be
submitted in the specified form, manner, and timeframe. Unless otherwise specified,
reports are due 20 days after the end of the reporting period.
(b)
The provider shall submit all performance reports, financial
reports, and requests for payment through the designated web-based computer
system. The provider's authorized official or designee specified in the Electronic
Forms Signature Agreement is responsible for the completeness and accuracy
of the data.
(c)
Treatment programs shall report available capacity and
waiting list information daily through the commission's facility capacity
management system and comply with procedures specified by the commission.
(d)
A provider that treats individuals for intravenous substance
abuse shall notify the commission through the facility capacity management
system when the program's capacity for treating intravenous substance abusers
reaches 90%.
(e)
All treatment programs shall submit Client Data System
(CDS) forms to the commission through the commission's web-based computer
system for all clients receiving commission-funded substance abuse treatment
services.
(f)
The provider shall acquire and maintain the equipment and
software needed for the web-based computer system.
(g)
The provider shall establish adequate internal controls,
security, and oversight for the approval and transfer of complete and accurate
information.
(h)
When equipment problems prevent electronic submission of
required reports, the provider shall fax or mail paper copies to the commission.
(i)
Providers shall reconcile internal accounting records with
documentation submitted to the commission and maintain supporting documentation
on site.
(j)
Adjustments to the final FSR will not be made more than
90 days after the end of the contract period unless the provider's independent
audit report demonstrates that the FSR is incorrect.
§144.108.Cost Reimbursement for Treatment Services.
(a)
The commission's standard payment mechanism for treatment
services is the unit rate payment mechanism.
(b)
The commission may place a treatment program on cost reimbursement
if the provider does not have the resources to provide needed treatment services
without start-up funding and meets at least one of the following criteria:
(1)
has never before provided treatment or prevention services
funded by the commission;
(2)
will provide commission-funded services in a specific geographic
area or to a specific population for the first time;
(3)
will provide services at the commission's request to meet
identified needs; or
(4)
demonstrates other extenuating circumstances.
(c)
Cost reimbursement is granted for a single 12-month period
unless the commission's executive director grants a waiver based on extenuating
circumstances.
§144.109.Billing for Treatment Services.
(a)
Treatment programs shall not bill the commission for services
provided:
(1)
at an unlicensed site if the site is required to have a
license; or
(2)
by a staff person who does not meet the commission's minimum
requirements.
(b)
Programs may bill for only one level and service type (outpatient
or residential) per client per day.
(c)
An outpatient program shall not bill the commission for
more than:
(1)
nine hours of service per week for Level IV;
(2)
19 hours of service per week for Level III; and
(3)
29 hours of service per week for Level II.
(d)
Outpatient programs shall only request payment for substance
abuse education, life skills training, and counseling (individual, group,
or family). The following activities are not reimbursable: peer support groups,
case management, academic courses, and recreation.
(e)
A residential program may hold an empty bed and bill for
a client who is on a planned, approved absence for up to two consecutive days.
The frequency of approved absences shall be reasonable and appropriate and
shall not exceed four days in a 30-day period, except as provided below.
(1)
Providers shall include planned absences for delivery in
treatment plans for each pregnant female, and shall ensure that a bed is available
for the female upon her return.
(2)
Absences for medical treatment (including delivery), court
appearances, or other emergencies may exceed 48 hours, but commission approval
is required if the absence exceeds 96 hours.
(f)
The provider shall maintain complete documentation for
all services paid for by commission funds as described in §144.553 of
this title (related to Treatment Documentation).
§144.121.Application of Federal and State Regulations.
(a)
All providers shall comply with the provisions of the Uniform
Grant Management Standards (UGMS). Expenditures of commission funds, including
required cash match, shall be reasonable, necessary, and allowable, and must
receive required prior approval as stated in UGMS. All providers shall also
comply with federal cost principles and administrative requirements as appropriate
for the organization. When there is a conflict between UGMS and the federal
regulations, the most restrictive shall apply. The federal cost principles
and administrative requirements are applicable as follows:
(1)
state and local governments or Indian Tribal governments
shall comply with cost principles found in the Office of Management and Budget
(OMB) Circular A-87 and administrative requirements found in the OMB Circular
A-102;
(2)
not-for-profit providers shall comply with cost principles
found in the OMB Circular A-122 and administrative requirements found in the
OMB Circular A-110 (with changes incorporated as the Code of Federal Regulations,
Title 45, Part 74);
(3)
educational organizations shall comply with cost principles
found in OMB Circular A-21 and administrative requirements found in OMB Circular
A-110; (with changes incorporated as the Code of Federal Regulations, Title
45, Part 74);
(4)
commercial organizations shall comply with cost principles
found in Code of Federal Regulations, Title 48, Part 31, and administrative
requirements found in OMB Circular A-110 (with changes incorporated as the
Code of Federal Regulations, Title 45, Part 74); and
(5)
hospitals shall comply with cost principles found in the
Code of Federal Regulations, Title 45, Part 74, and administrative requirements
found in OMB Circular A-110.
(b)
All references in the circulars to "Federal" or "Federally'
shall be expanded to read "Federal or State" or "Federally or State", as applicable.
References to "recipient" shall be expanded to read "recipient, contractor,
subcontractor, subrecipient, or provider".
(c)
The provider shall also comply with requirements and restrictions
found in the Substance Abuse Prevention and Treatment federal block grant,
found at United States Code, Title 42, §300x.
§144.124.Indirect Cost.
(a)
The commission reserves the right to require administrative
expenses to be charged as direct costs.
(b)
A provider may request approval to charge administrative
expenses as indirect costs. Three mechanisms are available for charging shared
administrative costs. The provider may:
(1)
submit documentation of an indirect cost rate approved
by the provider's cognizant agency;
(2)
request a negotiated rate with the commission based on
a cost allocation plan; or
(3)
use an indirect cost rate not to exceed 10% as provided
in the Uniform Grant Management Standards (UGMS). If requesting this option,
the provider must provide supporting documentation to show the direct salary
and wage costs of providing the service (excluding overtime, shift premiums,
and fringe benefits).
(c)
All providers receiving funds from other sources must maintain
a cost allocation plan showing how administrative costs are distributed among
funding sources.
§144.131.Expenditures Requiring Prior Approval.
For providers on a cost reimbursement payment mechanism, prior written
approval is required for certain costs charged to the commission contract
or reported as program income or match. Costs that are allowable only with
prior written approval from the commission include:
(1)
Equipment. Items used solely for the delivery of funded
substance abuse services that have a unit cost of $1,000 or more and a useful
life of more than one year.
(2)
Minor remodeling. Work described in §144.134 of this
title (relating to Minor Remodeling) costing $1,000 or more in the aggregate.
(3)
Contractual services. Contracting out, subgranting, or
otherwise obtaining the services of a third party to perform activities which:
(A)
are central to the purposes of the contract; or
(B)
cost $5,000 or more.
(4)
Transfers. Any transfer among program budget line items
for direct costs when cumulative transfers exceed or are expected to exceed
10% of the total approved program budget.
(5)
Other. Items requiring prior approval in accordance with
the Uniform Grant Management Standards or the appropriate Office of Management
and Budget (OMB) circular.
§144.132.Equipment and Supplies.
(a)
Equipment includes all tangible personal property that
costs $1,000 or more per unit and has a useful life of more than one year.
A set of components designed to function together shall be treated as a single
unit.
(b)
Supplies include all materials and other expendable property
needed to carry out a contract with a unit cost of less than $1,000.
(c)
The provider shall conduct an annual physical inventory
of all equipment and controlled items purchased with commission funds no later
than 60 days after the close of the provider's fiscal year.
(1)
Controlled items are those that have a unit cost of $500
- $999 and/or a high risk of theft. Examples include televisions, fax machines,
video recorder/players, printers, software, and mobile telephones.
(2)
The inventory shall conform with standards found in the
Uniform Grant Management Standards or the applicable Office of Management
and Budget (OMB) circular.
(3)
Inventory records shall be current, maintained at the program
site, and reported as part of the annual contract closeout.
§144.133.Travel.
(a)
Expenses for transportation, lodging, meals, and related
items are allowable when they are incurred by an employee or volunteer on
official business which is directly attributable to the contract or required
for administration of the provider.
(b)
Costs for lodging, meals, and related items may not exceed
the State of Texas per diem rates and costs for mileage may not exceed the
State of Texas rate for mileage reimbursement. When applicable, the provider
may use the state's schedule of per diem rates for out-of-state travel. If
the provider's policies and procedures establish a lower per diem rate, the
lower rate shall apply.
(c)
Alcoholic beverages and tobacco products are not allowable
costs.
§144.134.Minor Remodeling.
(a)
Minor remodeling is work which is required to change the
interior arrangements or other physical characteristics of an existing building,
or to install equipment so that the building may be used more effectively.
It does not include work which substantially increases the value of the building.
(b)
The provider shall have written approval from the commission
before starting any minor remodeling project.
(c)
Any remodeling project must meet the following conditions:
(1)
The building's useful life shall be consistent with the
funded program purposes;
(2)
The remodeling shall be essential to the commission-funded
program;
(3)
The remodeled space shall be occupied by the program; and
(4)
The building shall be owned by the provider; or if the
facility is leased, there shall be at least three years remaining in the lease
period.
(d)
If the program is funded only in part by the commission,
only a pro-rata share of the total minor remodeling costs may be charged to
the commission.
(e)
Costs for minor remodeling shall not exceed an aggregate
of $5,000 per provider per year.
(f)
The following expenses are examples of unallowable costs:
(1)
relocation of exterior walls, roof, and floors in order
to increase the amount of space to be used;
(2)
development or repair of parking lots; and
(3)
completion of unfinished shell space to make it suitable
for human occupancy.
(g)
A written request for remodeling must include a narrative
description of the proposed functional utilization of the space and the final
cost estimate. The following documents must accompany the request, as applicable:
(1)
a single line drawing of the existing space and proposed
alterations;
(2)
equipment requirements prepared by the persons who will
use and be responsible for the working space;
(3)
final working drawings and specifications; and
(4)
the design analysis report describing the heating, ventilation,
air conditioning, plumbing, and electrical systems.
§144.141.Procurement of Goods and Services.
(a)
The provider may use small purchase procurement procedures
to obtain services, supplies, or other property if the total cost of all purchases
does not exceed $25,000 for the contract period. These rules do not apply
to obtaining the services of a professional as defined in Texas Government
Code, Chapter 2254.
(1)
For any purchase under $2,000, price or rate quotations
are not required.
(2)
The provider shall obtain three verbal or written price
or rate quotations for any purchase between $2,000 and $10,000. Telephone
and other verbal quotations must be documented and available for inspection.
(3)
The provider shall obtain three written price or rate quotations
for any purchase of over $10,000. Facsimiles or printed copies of electronic
transmissions are acceptable.
(b)
The provider shall select the vendor providing the best
value for the goods or services desired and document the rationale for selection.
(c)
A single purchase may include more than one item. Large
purchases shall not be divided into small lots in order to avoid bid requirements,
especially when bought from the same vendor in the same fiscal year.
(d)
If purchases for the contract period are expected to exceed
$25,000, the provider shall comply with requirements found in the Uniform
Grant Management Standards or the applicable Office of Management and Budget
(OMB) circular.
§144.142.Subcontracting.
(a)
The provisions in this section apply when a provider subcontracts,
assigns, or transfers any activity central to the purposes of the contract
to a third party.
(1)
The subcontractor shall be a corporation, partnership,
sole proprietor, or other entity with legal authority to operate in the State
of Texas.
(2)
The subcontractor shall be in good standing with all applicable
legal, regulatory and funding agencies. If the subcontractor has been funded
by the commission, the organization shall not be suspended or delinquent on
a repayment agreement, and shall not have had a contract terminated by the
commission for cause within the past three years. The provider shall require
any potential subcontractor to disclose all legal, regulatory, or contractual
actions initiated against it in the past three years, including pending actions
and/or investigations.
(3)
The provider shall submit the following information about
each subcontractor within five business days after entering a contract:
(A)
the name, address, and telephone number of the subcontractor;
(B)
the names, addresses, and telephone numbers of the chief
executive officer, chief financial officer, clinical director, and members
of the governing authority; and
(C)
the name of any person employed by or associated with the
subcontractor who has been sanctioned by the commission within the past three
years, and a description of the person's relationship and responsibilities
with the subcontractor.
(b)
The provider shall, in writing, require any subcontractor
to comply with applicable laws and regulations and with the provisions and
stipulations of the provider's contract with the commission.
(c)
The relationship between the provider and the subcontractor
shall be formalized in a written agreement that is signed by the governing
body or legally responsible party of both the provider and the subcontractor.
(d)
The provider shall retain sufficient rights and controls
to fulfill its contract responsibilities to the commission. Subcontracting
does not relieve the funded provider of any responsibility to the commission
under the contract.
(e)
The provider shall monitor subcontractor compliance with
provisions of the contract and applicable laws and regulations, and shall
take appropriate steps to ensure corrective action when issues of non-compliance
are identified. The monitoring activity must be documented and will be subject
to review by the commission.
(f)
The provider is responsible for paying subcontractors.
When a contract ends, the provider and each subcontractor shall settle all
claims promptly, including those from employees, vendors, and other subcontractors.
Claims for reimbursement to pay subcontractors will not be considered more
than 90 days after the end date of the contract.
(g)
When a subcontractor becomes insolvent or otherwise incapacitated,
abandons the contract, or is discharged by the funded provider, the funded
provider shall notify the commission in writing within three working days.
(h)
Subcontractors must also comply with all applicable state
and federal laws and regulations and commission requirements contained in
the commission's rules. These specifically include the audit requirements
of Office of Management and Budget (OMB) Circular A-133 if applicable, and
all other federal and state regulations required in §144.121 of this
title (relating to Application of Federal and State Regulations).
(i)
Subcontractors are subject to commission oversight. The
provider shall, in writing, require the subcontractor to permit access as
described in §144.201 (relating to Commission Oversight).
§144.145.Contract Closeout.
(a)
Submission of Documents. Providers shall submit all financial,
performance, and other closeout reports required under the contract within
60 days after the contract end date. The commission is not liable for any
claims that are not resolved with the commission within 90 days after the
contract end date.
(b)
Equipment. Providers shall submit an inventory of commission
owned property at closeout and request disposition instructions for commission
owned property that is no longer needed.
(c)
Payment of Refunds. Any funds paid to the provider in excess
of the amount to which the provider is finally determined to be entitled under
the terms of the contract constitute a debt to the commission and will result
in a refund due. The provider shall pay any refundable amount within the time
period established by the commission.
(d)
Disallowances and Adjustments. The closeout of the contract
does not affect:
(1)
The commission's right to disallow costs and recover funds
on the basis of a later audit or other review.
(2)
The provider's obligation to return any funds due as a
result of later refunds, corrections, or other transactions.
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 9, 2000.
TRD-200005536
Karen Pettigrew
General Counsel
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 2000
Proposal publication date: June 9, 2000
For further information, please call: (512) 349-6733
40 TAC §§144.201, 144.204, 144.211, 144.214 - 144.216
The Texas Commission on Alcohol and Drug Abuse adopts amendments
to §§144.201, 144.204, 144.211, 144.214, 144.215 and 144.216 concerning
Program Oversight. Sections 144.201 and 144.214 are adopted with changes to
the proposed text as published in the June 9, 2000, issue of the
Texas Register
(25 TexReg 5569). Sections 144.204, 144.211, 144.215
and 144.216 are adopted without changes to the proposed text and will not
be republished.
These sections contain information regarding commission oversight, on-site
reviews, independent audit report, independent audit report submission, corrective
action plan, and audit report desk reviews.
These amendments are adopted to reserve for the Commission the right to
require an audit for a program with expenditures of less than $300,000; to
require that providers submit documentation of their board's approval or disapproval
of audit reports; to specify that the commission will approve corrective action
plans and may require modifications to the plan before approval; to stipulate
that if a desk review identifies excess revenue, the provider must refund
the money within the specified time frame; and to make grammatical changes
to improve readability and understanding.
Comments on these sections were received from the Association of Substance
Abuse Programs and individuals
The following comments were received regarding §144.204. On-site Reviews.
Comment: I suggest TCADA include time frames for its response to agencies
much as it has for service providers.
Response: The purpose of rules is to define standards with which providers
must comply. Procedures and timeframes for commission staff are located in
the commission's internal administrative procedures manual.
Comment: Providers are required to respond to inspection reports within
14 days of the postmark date. Again, the issue of mail time experience from
postmark. We recommend 21 days or 14 days from the date it is received through
a vehicle such as certified mail.
Response: Issues described in the inspection report are shared with the
provider during the exit conference. Commission staff also fax a copy of the
report to the provider at the time of mailing. This gives the provider a full
14 days to prepare a response. The following comments were received regarding §144.214.
Independent Audit Report Submission.
Comment: The amended paragraph replacing the Audit Report Submission Checklist
with Board approval imposes an undue burden to some providers in the timing
and method of assurance that information contained in the Single Audit report
is accurate. The complexity of an audit for a large, multi-state corporation
requires the entire nine-month period allowed in the regulations. The addition
of board approval to submit the report would require the external audit to
be completed several weeks earlier. The report would need to be approved by
the national board and then sent to the Texas board for its approval of the
grant information relevant to Texas programs. The Audit Report Submission
Checklist requires assurance by the individual CPA or firm that the required
disclosures are included in the audit report. Since the audit report is addressed
to and presented to board at the next scheduled board meeting, it is an undue
burden to require board approval of the report as a prerequisite to timely
filing. The required assurances are provided by the required CPA opinions
and not by a Board action on those assurances.
Response: The purpose for requiring board approval is to ensure that the
board has reviewed the audit report and is aware of any findings in the report
and that the report submitted to TCADA is a final report and not a draft version.
To avoid placing an undue burden on providers, the commission has revised
the rule to require board approval prior to the commission's final acceptance
of the report rather than prior to submission.
Comment: I'm glad to see you changed the rule to require that all audits
be submitted nine months after the close of the provider's fiscal year. Thirteen
months seemed to be a very long time which could have posed problems for TCADA
and the agency.
Response: This rule was revised to correspond to a change in federal and
state guidance.
One comment was received regarding §144.215 Audit Report Desk Reviews:
Providers are required to respond to inspection reports within 14 days of
the postmark date. Again, the issue of mail time experience from postmark.
We recommend 21 days or 14 days from the date it is received through a vehicle
such as certified mail.
Response: This section refers to corrective action plans for the independent
audit report, not commission audit reports. The time frame for responses to
inspection reports is addressed under §144.204. The rule regarding resolution
of desk audits provides an additional 14 day period to submit a satisfactory
response.
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 rules 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 desk reviews and on-site reviews.
(b)
The commission shall determine the extent of the review.
(c)
The commission may conduct a scheduled or unannounced on-site
review.
(d)
Under certain circumstances, the provider must also submit
a single audit or a program-specific audit as described in §144.211 of
this title (relating to Independent Audit Report).
(e)
The applicant shall allow commission staff to access the
facility's grounds, buildings, and records and to interview members of the
governing body, staff, participants, and clients.
(f)
The provider shall allow commission staff to examine all
property and examine or copy all books, recordings, client records, and documents
related to or potentially related to the contract or a commission requirement.
§144.214.Independent Audit Report Submission.
(a)
The provider shall submit four copies of all required audit
documentation to the commission, including:
(1)
the audit report;
(2)
any separately issued management letters;
(3)
management responses as required in §144.215 of this
title (relating to Corrective Action Plan); and
(4)
documentation of board approval or disapproval of the audit
report.
(b)
Audits shall be completed and submitted no later than nine
months after the provider's fiscal year end. Documentation of board approval
may be submitted separately if the board is unable to review the audit report
before the due date, but this documentation must be provided before the commission's
final acceptance of the audit.
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 9, 2000.
TRD-2000005538
Karen Pettigrew
General Counsel
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 2000
Proposal publication date: June 9, 2000
For further information, please call: (512) 349-6733
40 TAC §144.203
The Texas Commission on Alcohol and Drug Abuse adopts the
repeal of §144.203 concerning Program Oversight without changes to the
proposal as published in the June 9, 2000, issue of the
Texas Register
(25 TexReg 5570).
This section contains the requirements for on-site contract reviews.
The repeal is adopted because the requirements contained in this section
have been incorporated into other sections.
No comments were received regarding the repeal of this section.
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 9, 2000.
TRD-200005539
Karen Pettigrew
General Counsel
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 2000
Proposal publication date: June 9, 2000
For further information, please call: (512) 349-6733
40 TAC §§144.311, 144.313, 144.321 - 144.323, 144.325
The Texas Commission on Alcohol and Drug Abuse adopts amendments
to §§144.311, 144.313, 144.321-144.323, and 144.325 concerning organizational
requirements. Section 144.311 is adopted with changes to the proposed text
as published in the June 9, 2000, issue of the
Texas
Register
(25 TexReg 5571). Sections 144.313, 144.321-144.323, and 144.325
are adopted without changes to the proposed text and will not be republished.
These sections contain information regarding general requirements, management
and organization, policies and procedures, documentation and records, commission
logo and slogan, and complaints and reports.
These amendments are adopted to reorganize a portion of these rules; to
expand the policies and procedures section to include a listing of all the
policies and procedures that must be contained in the organization's policy
and procedures manual; to specify that documentation must be complete, current,
factual, accurate, permanent and legible; to add requirements for authentication
and error correction; to expand the rule regarding use of the commission's
logo to include electronic media; to require that all providers report serious
incidents to the commission within 24 hours of discovery; and to make other
changes to improve readability and understanding. The change made to §144.311
is to correct a spelling error.
The following comments were received from the Association of Substance
Abuse Programs and individuals regarding §144.321 Policies and Procedures.
Comment: We appreciate the listing of required polices and procedures for
the policy and procedure manual.
Comment: This seems redundant and somewhat confusing. We all know we have
to maintain a policy and procedure manual which addresses all requirements
in the chapter. However, (b) seems to imply as stated that those items (1)
through (19) are all that are required to be in the manual. I know that is
not the case but if all of these items are enumerated elsewhere in the rules
why restate them here?
Response: The proposed rules do not require that the policy and procedure
manual address all requirements in the chapter. This is a comprehensive listing
of procedures required by Chapter 144. The inclusion of other policies and
procedures is left to the discretion of the provider based on internal management
needs.
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 rules is the Texas Health and Safety Code,
Chapter 461.
§144.311.General Requirements.
Funded providers shall establish and maintain effective internal programmatic
and financial controls to ensure:
(1)
commission-funded programs are operated efficiently and
effectively;
(2)
the provider maintains compliance with other funding and
regulatory agencies;
(3)
appropriate controls are in place to safeguard assets;
(4)
commission funds are properly spent;
(5)
commission funds are properly accounted for;
(6)
client/participants receive appropriate services; and
(7)
client services are adequately documented.
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 9, 2000.
TRD-200005540
Karen Pettigrew
General Counsel
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 2000
Proposal publication date: June 9, 2000
For further information, please call: (512) 349-6733
40 TAC §144.312
The Texas Commission on Alcohol and Drug Abuse adopts the
repeal of §144.312 concerning organizational requirements without changes
to the proposal as published in the June 9, 2000, issue of the
Texas Register
(25 TexReg 5573).
This section contains the requirements for organizational structure.
The repeal is adopted because requirements for organizational structure
have been incorporated into other sections.
No comments were received regarding the repeal of this section.
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 9, 2000.
TRD-200005542
Karen Pettigrew
General Counsel
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 2000
Proposal publication date: June 9, 2000
For further information, please call: (512) 349-6733
40 TAC §144.326
The Texas Commission on Alcohol and Drug Abuse adopts amendments
to § 144.326 concerning organizational requirements without changes to
the proposed text as published in the June 9, 2000, issue of the
Texas Register
(25 TexReg 5574).
This section contains information regarding staffing.
The amendments are adopted to establish minimum qualifications for clinical
program directors; to stipulate that annual training must include both cultural
competency and standards of conduct; and to make grammatical changes to improve
readability and understanding.
The following comments were received from the Association of Substance
Abuse Programs and individuals.
Comment: The rule states that every program shall have an employee designated
to serve as director and that the individual must have appropriate education
and training and at least two years of experience providing related services.
Does these mean each program has to have an individual program director, or
can one person serve as director over several programs. Does this imply the
title has to be Director or does a job description describing managerial responsibility
suffice?
Response: One person may serve as program director for multiple programs.
The job title is not important, but the job description must document that
the person is clinically responsible for the program.
Comment: While we support and agree that experience is desirable and necessary
for program directors, there are instances when a person can possess a track
record of needed program management/clinical skills but not meet two years
in direct substance abuse services. Provisions for flexibility need to be
incorporated into this rule to allow providers to manage their own programs.
Two years should be a benchmark not a requirement. We recommend wording that
allows an exception when the candidate's background and experience clearly
demonstrate strong ability to perform the job functions.
Response: The commission believes that two years of related experience
is a minimal standard for a person who has clinical responsibility for program
design and implementation. Exceptions may be addressed by requesting a waiver.
Comment: The proposed rule requires providers to obtain the results of
a statewide criminal background check on all staff and to use criteria listed
in the Texas Occupations Code 53.022 and 53.023 to evaluate criminal history
reports and make related employment decisions. The time and cost (I believe
the cost is $17.00 per check plus duplication) and time involved in getting
checks has been and remains a concern regarding this rule. Although in and
of itself not an exorbitant fee, when added together with the many administrative
costs of implementing the new rules it does become an issue. We agree safety
is a foremost concern and that background checks for staff working with children
and youth is necessary as is counseling staff, but all staff seems over burdensome.
The rule clearly states the program shall develop and implement written procedures
for reviewing the background and suitability of any employee with access to
the program's clients, participants or funds. This rule requires that processes
be in place to protect clients and TCADA funds, and along with a program's
required liability insurance, should provide needed assurances without requiring
background checks on all employees. We recommend keeping the previous wording
related to children and youth or expanding to include counseling staff, but
removing the proposed language for all staff.
Response: The commission recognizes that criminal background checks add
to the provider's administrative cost. However, the commission disagrees that
the general language provides sufficient protection and that the requirement
should apply only to counseling staff. The commission has a responsibility
to protect the health and safety of service recipients and to see that state
funds are managed responsibly. Because many crimes are committed by repeat
offenders, we believe it is a basic precaution to obtain a criminal background
check for all staff with access to service recipients and/or funds.
Comment: I was unable to locate the Texas Occupations Code over the Internet
to check the criteria are that providers will use to evaluate. Without knowing
what the criteria are, a general caution is that in the substance abuse field
many people in recovery are hired who may likely have a criminal background.
We hope TCADA has reviewed the criteria and considered this carefully when
they elected to adopt these guidelines. Finally, I hope TCADA will make a
copy of this available to providers.
Response: The Texas Occupations Code is not yet available on the Internet.
The referenced criteria are currently used by the commission in reviewing
the criminal histories of licensed counselors and applicants for licensure.
They provide a framework for evaluating the history but do not impose rigid
mandates. Providers will be given a copy of the guidelines.
Comment: The new rules require prospective employees to pass a pre-employment
drug test that meets criteria established by the commission. Drug and alcohol
prevention and treatment programs take drug and alcohol use among their employees
very seriously. They recognize signs quickly and take action with regard to
possible use. Many do test not only at pre-employment but intermittently.
We believe pre-employment drug tests should be the choice of a provider organization.
Response: The commission recognizes that many providers have adequate procedures
but does not agree that leaving this to the discretion of individual providers
is sufficient. It is the commission's intention to contract only with providers
who can support that they maintain a drug-free workplace, and requiring employees
to pass a drug screen is an essential element of a drug-free workplace.
Comment: The specific criteria for the required employee drug test should
be clearly defined in the rule. Providers should have the opportunity to comment
on the criteria when it is develop by TCADA staff.
Response: The commission disagrees that the specific parameters of the
drug screen must be included in the text of the rule. Providers are welcome
to comment on the criteria when they are published.
Comment: I do not like the addition of the required criminal background
checks or drug screens. We seem to be getting more and more intrusive in the
lives of our employees and prospective employees. Neither one of these checks,
criminal background or drug, will prevent someone from doing drugs or stealing
funds after they have become employees and its adds more costs to program
services. These are unfunded mandates.
Response: The commission agrees that these measures cannot guarantee that
an employee will not steal funds or use drugs. They do, however, minimize
the risk by identifying individuals with a history of similar behavior. The
commission believes the added protection for clients and state funds justifies
the additional cost to providers.
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 rules 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 9, 2000.
TRD-200005541
Karen Pettigrew
General Counsel
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 2000
Proposal publication date: June 9, 2000
For further information, please call: (512) 349-6733
40 TAC §§144.411, 144.412, 144.414, 144.415, 144.416, 144.418, 144.446, 144.447, 144.451 - 144.453, 144.455, 144.458, 144.460, 144.462
The Texas Commission on Alcohol and Drug Abuse adopts amendments
to §§144.411, 144.412, 144.414, 144.415, 144.416, 144.446, 144.447,
144.451-144.453, 144.455, 144.458, 144.460, 144.462 and adopts new §144.418
concerning Prevention and Intervention without changes to the proposed text
as published in the June 9, 2000, issue of the
Texas
Register
(25 TexReg 5575).
These sections contain information regarding program design and implementation,
program self-evaluation, performance measure review, participant rights, tobacco
products, transportation, environmental and social policy, intervention services,
youth prevention programs, youth intervention programs, community coalitions,
prevention resource centers, pregnant postpartum intervention programs, HIV
early intervention services, and HIV outreach services.
These amendments and new section are adopted to change a program name to
Youth Intervention Program; to state that programs must perform self-evaluations
unless the contract waives this requirement; to delete obsolete references;
to clarify actions the commission may take after receiving a corrective action
plan, which now include imposing contract restrictions or sanctions or terminating
the contract; to require that providers maintain documentation that participants
receiving individualized services in an intervention program have received
required information and agreed to participate in the program; to clarify
requirements regarding tobacco products and related prohibitions; to add requirements
regarding transportation of participants; to specify the elements required
for documentation of minors and tobacco presentations; to update the requirements
for the intervention assessment; to add documentation requirements for intervention
services; to expand requirements for Youth Intervention Programs; to stipulate
that community coalitions are to implement community-based processes and environmental
and social policy strategies; to change the reporting requirement for prevention
resource centers from a monthly report to a quarterly report; to enhance the
services and outreach efforts of pregnant postpartum intervention programs;
to clarify the responsibility of both HIV early intervention services and
HIV outreach services to provide interim services; to clarify that these two
programs are to link with Texas Department of Health sponsored community or
regional planning groups; to stipulate that both of these types of programs
are to market their services; to identify the target population for HIV outreach
services; and to make grammatical changes to improve readability and understanding.
Comments on these sections were received from the Association of Substance
Abuse Programs and individuals.
The following comment was received regarding §144.414 Performance
Measure Review: Does the elimination of the statement-a revision of the performance
goals and/or interim goals, with appropriate timelines established to measure
progress-imply that there will no longer be an action available to TCADA and
providers to negotiate new performance goals? Or, is that assumed to be an
option within the corrective action plan? There are situations where revising
performance measures/goals is reasonable, indicated and warranted. We recommend
that the option to negotiate revised performance goals be continued and should
be stated in rule.
Response: The commission expects providers to establish realistic goals
and will hold providers accountable for performance in relation to those goals.
Occasionally, circumstances beyond the provider's control do justify revised
measures, and such revisions can be part of a corrective action plan. The
commission does not agree that this option should be explicitly stated in
the rule.
The following comment was received regarding §144.447 Intervention
Services: The provider is required to collect information about family history
of ATOD use. For school-based programs, there is a problem in some school
districts with asking family members these types of questions. A parent survey
was sent out in one school district that caused a major controversy and the
school district now will not permit these questions. We recommend excluding
this item, at least for school-based intervention programs.
Response: This section does not apply to school-based universal or selected
programs that typically involve large groups of adolescents. It applies only
to indicated programs when they provide individualized counseling for youth
who are showing early warning signs of substance use or abuse and/or exhibiting
other high risk problem behaviors. When an adolescent enters intervention
counseling services, a thorough assessment is necessary to identify his or
her needs and develop an appropriate service plan. The family history of substance
use and abuse is a critical element of such an assessment. The rules specify
that the assessment shall be conducted in a culturally appropriate face-to-face
session. Whenever possible, parents and other family members participate in
the assessment interview and subsequent services and can provide the information
directly. When it is not possible to engage parents, providers can request
such information from the adolescent. It is neither necessary nor appropriate
to gather this data through a survey. If the school has policies that prohibit
this information from being discussed within the context of a private counseling
session, the program can request a waiver.
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 rules 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 9, 2000.
TRD-200005543
Karen Pettigrew
General Counsel
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 2000
Proposal publication date: June 9, 2000
For further information, please call: (512) 349-6733
40 TAC §144.417
The Texas Commission on Alcohol and Drug Abuse adopts amendments
to § 144.417 concerning Prevention and Intervention without changes to
the proposed text as published in the June 9, 2000, issue of the
Texas Register
(25 TexReg 5579).
This section contains information staff training.
These amendments are adopted to increase the basic training required for
direct service prevention and intervention staff from eight to 16 hours; to
add one required topic; and to make other changes to improve readability and
understanding.
No comments were received regarding adoption of the amendments.
The 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 rule 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 9, 2000.
TRD-200005544
Karen Pettigrew
General Counsel
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 2000
Proposal publication date: June 9, 2000
For further information, please call: (512) 349-6733
40 TAC §§144.448, 144.456, 144.457, 144.459
The Texas Commission on Alcohol and Drug Abuse adopts the
repeal of §§144.448, 144.456, 144.457, and 144.459 concerning Prevention
and Intervention without changes to the proposal as published in the June
9, 2000, issue of the
Texas Register
(25 TexReg
5579).
These sections contain the requirements for assessment for treatment, core
council services, pregnant postpartum prevention programs, and other special
prevention programs.
The repeals are adopted because some of these requirements are deleted
and others are incorporated into amended or new sections that are concurrently
proposed.
No comments were received regarding the repeal of these sections.
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 9, 2000.
TRD-200005546
Karen Pettigrew
General Counsel
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 2000
Proposal publication date: June 9, 2000
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 with changes to the proposed text as
published in the June 9, 2000, issue of the
Texas
Register
(25 TexReg 5580).
This section contains information regarding outreach, screening, assessment,
and referral services.
This new section is adopted to establish requirements for outreach, screening,
assessment and referral services (OSARs), which were previously referred to
as core council services; to require that crisis intervention services be
handled by a Qualified Credentialed Counselor or counselor intern; and to
permit OSARs to provide brief intervention counseling to motivate and prepare
an individual for treatment or self-directed change. The change that was made
to the proposed text was to delete a phrase that was inadvertently inserted
in paragraph (m).
The following comments on this section were received from the Association
of Substance Abuse Programs and individuals.
Comment: The proposed rule allows funded OSAR providers to provide treatment
services as well as assessment services. We support the rule revision because
it increases the flexibility in rural or underserved areas to provide needed
services.
Comment: OSAR providers are required to do Minors and Tobacco activities.
This is a service more directly involved in Youth Prevention than in OSAR.
This is especially true now that information dissemination for OSARs is limited
to increasing the knowledge of how to access services. Furthermore, OSAR staff
are already performing multiple functions and do not have sufficient time
for the Minors and Tobacco activities.
Response: The commission disagrees that the Minors and Tobacco activities
should be performed by Youth Prevention Programs. OSARs are the only providers
who are assigned catchment areas that ensure coverage for the entire state.
Although the subject matter is different, the activity is not incompatible
with other OSAR functions. The Minors and Tobacco activities are an information
dissemination function which is one of the OSAR's required services. Providers
are expected to budget sufficient staff to provide all required services.
Comment: OSAR Counselors are doing screenings, assessments, and referrals
for clients. These are very important but very time consuming functions. It
is very difficult for a counselor to stop in midstream to go out of the office
in order to carry out the required Outreach component of the OSAR function
(and the Minors and Tobacco function). Also, when outreach is being conducted
more clients are accessing the needed service thus creating more business.
Increased funding is needed in order for the OSARs to carry out all of their
functions.
Response: The commission believes that outreach is a critical function,
particularly because priority populations are less likely to access services
on their own. Outreach encompasses a variety activities, and many of them
do not require face-to-face contact. OSARs are not expected to implement outreach
models that rely primarily on street outreach and other intensive casefinding
activities. Instead, OSAR providers should design a multi-faceted outreach
plan that uses resources as efficiently as possible. Such a plan usually focuses
on gatekeepers who already interact with members of the commission's priority
population. The commission acknowledges that limited time is always a factor.
Assessment, usually the most time-consuming activity, is not required for
every person who accesses OSAR services and should only be conducted when
necessary. Moreover, OSARs are expected to work with local treatment providers
to eliminate duplicative assessments. Because treatment providers need to
conduct an in-depth assessment in order to develop a treatment plan, it is
possible that some of the assessments currently conducted by your organization
could be eliminated by expanding the screening process to elicit information
needed to make a referral to an appropriate treatment provider.
Comment: Under the new requirements, how much flexibility will we have
within our network regarding the assessment requirements?
Response: The rules provide the fundamental framework for all commission-funded
services, including those provided through networks. The commission's contract
with the network management organization may include further provisions specific
to the network. The specific division of responsibilities within a network
is determined through negotiation between the management organization and
its subcontractors.
Comment: Wouldn't it be a conflict of interest to allow OSARs to make referrals
to themselves-which is what will happen if OSARs are also treatment providers?
Response: Many OSARs have been treatment providers for many years with
no apparent problems with conflict of interest. In rural areas, OSARs may
be the only accessible treatment provider or the only provider offering the
level of services needed by an applicant. Prohibiting self-referral would
severely limit access to services. Furthermore, current treatment capacity
meets less than 20% of the need. With effective outreach, the capacity of
all providers should be fully utilized.
Comment: Programs are required to establish an avenue for a person in crisis
to speak with a trained counselor within one hour of the initial call. "Trained
counselor" should be clearly defined. Can a person who has received training
in crisis intervention provide this service or must it be a QCC? It is also
important to note that there is a financial aspect to implementing this rule,
as overtime pay may be required of staff responding to crisis calls after
normal business hours.
Response: As defined in the rules, a counselor is a QCC, a counselor intern
working under direct supervision, or a graduate. Under this rule, the counselor
must be trained in crisis intervention. The requirement for after-hours coverage
is not new. The change is that coverage must be provided by a trained counselor.
This is necessary because crisis calls sometimes involve severely disturbed
individuals. The commission considered the financial impact of this rule when
it was proposed.
Comment: The OSAR in our area cannot possibly do all of the things outlined
in (a) unless TCADA provides additional funding to hire more staff. At present,
they are inundated with client screenings. We operate in a managed care network.
I recommend that OSARs conduct the client assessments, crisis intervention
and other related duties for the network and the Councils on Alcohol and Drug
Abuse be given back the responsibility for (and funding associated with) information
dissemination, community based process and other community information and
education duties.
Response: The commission expects applicants who are competing for funds
to budget sufficient staff to provide all required services. The Councils
on Alcohol and Drug Abuse are no longer associated with specific programs.
Like other community-based organizations, they request funding for a variety
of services. Traditionally, these providers have competed for SIC contracts
to provide screening, referral, and related services. In FY 2001, SIC contracts
are being converted to OSARs. The services required in these contracts have
not changed, except that all OSARs are expected to offer treatment assessments
(in FY 2000 it was optional for an SIC to have the capacity to conduct assessments).
The OSAR provides an integrated package of services that provides essential
infrastructure. The commission does not agree that it would be equally effective
to divide these activities among different providers. Within a network, the
configuration of services and the level of subcontractor funding are determined
by negotiations between the managed care organization and the subcontractors.
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 the adopted rule is the Texas Health and Safety Code,
Chapter 461.
§144.456.Outreach, Screening, Assessment, and Referral Services
(a)
Outreach, Screening, Assessment, and Referral (OSAR) 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. OSAR service providers conduct a variety
of services aimed to reduce use and abuse of ATOD in the targeted community.
(b)
OSAR services programs shall offer universal, selective
and indicated strategies to individuals, families, and communities within
the service area defined in the contract.
(c)
Information dissemination shall be provided for the purposes
of education and awareness in the community. Information dissemination shall
be focused on increasing access to services for the community, including the
commission's priority populations described in §144.522 of this title
(relating to Priority Populations).
(d)
Problem identification and referral shall be provided for
the purpose of the identification of appropriate service needs through screening,
referral, placement and follow-up.
(e)
Crisis intervention services shall be provided for the
purpose of responding to individuals and/or families in need of immediate
services.
(1)
Crisis intervention may be a single contact or a short
series of contacts.
(2)
The program shall develop written policies and procedures
for crisis intervention services during and after normal business hours.
(3)
Crisis intervention must be provided by a QCC or a counselor
intern working under direct supervision.
(4)
The program shall establish an avenue for a person in crisis
to speak with a trained counselor within one hour of the initial call received
during and after normal business hours.
(5)
The program 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. Training must include
crisis intervention techniques and available community resources.
(f)
The program shall provide treatment assessments and placements.
(1)
All assessments shall be conducted in a confidential, face-to-face
interview.
(2)
All assessments shall be conducted by qualified credentialed
counselors (QCCs) or counselor interns working under direct supervision.
(3)
The program shall use an assessment tool that is approved
by the commission and appropriate for the target population.
(4)
If an individual meets the DSM-IV criteria for substance
abuse or dependence, the program shall refer the individual for appropriate
treatment services. With written consent, the program shall forward a copy
of the assessment to the treatment provider.
(5)
The OSAR shall maintain written agreements with referral
sources/treatment providers to identify assessment roles in order to minimize
duplicate efforts in conducting treatment assessments.
(6)
Documentation shall include:
(A)
date of assessment;
(B)
zipcode of the individual assessed;
(C)
demographics of the individual assessed
(D)
the written assessment, including a diagnostic impression
based on DSM-IV criteria;
(E)
referrals and placements made; and
(F)
any follow-up contacts.
(g)
The program may provide brief motivational counseling to
motivate and prepare an individual for treatment or self-directed change in
behavior if treatment is not indicated.
(h)
Minors and tobacco activities shall be provided for the
purpose of reducing minors' access to tobacco products throughout the catchment
area served. The OSAR shall submit a quarterly narrative report on minors
and tobacco activities, including:
(1)
tobacco retailer education;
(2)
tobacco information and education;
(3)
media awareness; and
(4)
tobacco coalition and community involvement.
(i)
Community-based process shall be provided for the purpose
of enhancing the ability of the community to more effectively provide substance
abuse services.
(j)
The program shall maintain a resource manual or file that
contains current information about local referral resources, including location
and contact information, services offered, and eligibility criteria. At a
minimum, the resource manual or file shall include information about all prevention,
intervention, and treatment programs in the OSAR's catchment area.
(k)
The program shall develop and implement written procedures
to identify and provide appropriate referrals for individuals exhibiting conditions
or behavior that may suggest unmet mental health needs. The program shall
also provide annual training on mental health issues to all staff members
who interact with service recipients.
(l)
OSAR programs shall work with other organizations in the
area to coordinate substance abuse and other services for the individual and/or
family.
(m)
OSAR providers may operate separate prevention, intervention,
and/or treatment programs to meet the needs of the community. These services
may not, however, be provided with resources allocated to the OSAR function.
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 9, 2000.
TRD-200005545
Karen Pettigrew
General Counsel
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 2000
Proposal publication date: June 9, 2000
For further information, please call: (512) 349-6733
40 TAC §§144.511, 144.521 - 144.523, 144.525, 144.526, 144.532, 144.541, 144.543, 144.545, 144.551, 144.553
The Texas Commission on Alcohol and Drug Abuse adopts amendments
to §§144.511, 144.522, 144.523, 144.526, 144.532, 144.541, 144.543,
144.545, 144.551 and adopts new §§144.521, 144.525, and 144.553
concerning Treatment. Sections 144.511, 144.525, 144.526, 144.532, 144.545,
144.551 and 144.553 are adopted with changes to the proposed text as published
in the June 9, 2000, issue of the
Texas Register
(25 TexReg 5581). Sections 144.521-144.523, 144.541, 144.543 are adopted
without changes to the proposed text and will not be republished.
These sections contain information regarding program plan and implementation,
client eligibility, priority populations, waiting list and interim services,
admission determination and placement, length of stay guidelines, core program
requirements, specialized treatment services for females, pharmacotherapy
services, family services, performance measure review, and client record documentation.
These amendments and new sections are adopted to more fully describe the
requirements for a written program plan; to require programs to develop admission
criteria that addresses their specific target population; to require a quality
improvement system for all treatment programs and to specify the requirements
for this system; to revise the rules regarding client eligibility to require
the use of financial eligibility criteria and procedures developed by the
commission; to delete former Supplemental Security Income recipients previously
disabled from substance abuse as a priority population; to stipulate that
providers are to accept applicants from the whole state when space is available;
to combine requirements for capacity management and interim services into
one section; to prohibit providers from holding empty beds or slots for anticipated
clients for more than 48 hours; to implement the Texas Department of Insurance
admission criteria to place clients in the most appropriate level of care
available; to describe the utilization review process that must be used with
the length of stay guidelines; to clarify that pregnant women and women with
dependent children may remain in residential treatment for three months; to
require that programs offering specialized treatment services for females
have documented, regular contact with certain programs and organizations that
serve the target population; to prohibit these programs from admitting females
who are not in their priority population unless they can document that all
community outreach contacts have been contacted and no potential priority
clients can be identified for admission; to require that pharmacotherapy programs
develop and implement a plan to achieve accreditation as required by federal
regulations; to stipulate that the consent of the adult client is required
before family services are provided; to delete family case management from
the list of reimbursable family services; to revise the steps the commission
may take after receiving a program's corrective action plan to include imposing
contract restrictions or sanctions or terminating the contract; to outline
requirements for client record documentation; and to make grammatical changes
to improve readability and understanding.
Comments on these sections were received from the Association of Substance
Abuse Programs and individuals.
One comment was received regarding §144.511 Program Plan and Implementation:
We support continuous quality improvement programs and many of our members
operate a system similar to the one outlined in this rule. We believe a system
should be in place, but are concerned about specificity of program design
and content outlined in the rule(s) related to this function. We believe the
direction to establish a quality improvement program can be accomplished in
j (1) by adding review of TCADA performance measures. The rest of the subject
specific rules-- j(2), (k) (1-6) can be removed. This will allow for more
flexibility and still provide a provision for quality improvement programs.
If need be, documentation guidelines can be included in a rule handbook.
Response: The rule has been revised as suggested.
The following are comments received regarding §144.521 Client Eligibility.
Comment: The rule requires programs to use financial eligibility criteria,
forms and assessment procedures established by the commission. To date, there
does not seem to be any clear and specific TCADA criteria, forms and assessment
procedures established. We recommend these be developed, with provider input,
and distributed prior to the rule being placed into effect.
Response: Providers will receive this information with their FY 2001 contracts.
The commission will also provide training on how to implement these instruments.
The short timeframe did not allow for a period of provider comment prior to
implementation, but the commission will consider all suggestions for revisions.
Comment: Sliding fee scales should be the purview of the provider. Can
this not be an area of local option? One board may have the funds to not wish
to charge in excess of TCADA's payment rate while others may know that the
patient will never pay the required match and either choose to waive it entirely
or reject the client because the amount owed would work a detriment on the
provider's finances. If there is to be a provision for a sliding fee scale,
it is important that the provider set it in keeping with their local needs
and area financial restraints.
Response: The commission does not agree that the sliding fee scale should
be a local option. Financial eligibility is one of the most basic and most
important standards relating to publicly funded services. The commission is
obligated to establish standards that direct public funds to people who do
not have the means to pay for services. The commission recognizes that some
people above the income threshold for free services can afford to pay a portion
but not the full cost of treatment. Without a sliding fee scale, these clients
would not have access to services. The rules require providers to make a reasonable
effort to collect client fees, but does not expect that 100% of those fees
will be collected. Providers do, however, have the option not to charge client
fees and not to bill TCADA.
Comments received regarding §144.522. Priority Populations follow.
Comment: I object to the priority populations. All of us are here to serve
those who abuse alcohol and other drugs. Can't we just serve those who need
services?
Response: These priority populations are established in the federal Substance
Abuse Prevention and Treatment block grant and/or state law.
Comment: I think local funding sources will object when they learn we are
required to serve applicants from every region in the state when we do not
have sufficient treatment capabilities to serve "our own". I realize that
we can give preference to local applicants but will you change this in the
future?
Response: These rules apply only to commission-funded services. Although
local funding sources may contribute match, most of the cost is borne by the
state. The proposed rule requires providers to accept clients from other regions
only when capacity is available. An applicant from any part of the state who
is part of the commission's priority populations must be given preference
over a non-priority applicant. The commission has no plans to change its policy
on allowing providers to give preference to local applicants of equal or greater
priority status than applicants from other parts of the state.
The following are comments received regarding §144.523. Waiting List
and Interim Services.
Comment: The rule states that when a program does not have the capacity
to admit an injecting drug user or pregnant female, the program shall place
the individual in another treatment facility or provide reasonable access
to interim services. We have always complied with a best effort approach to
finding help for applicants for service. But no provider has the ability or
resources to arrange for services at some other facility. How shall any provider
"place" the individual in another treatment facility. "Refer" would be a more
appropriate word.
Response: The commission recognizes that a treatment provider cannot ensure
that the client will be admitted when a referral is made. In this case, however,
if the client is not admitted, interim services must be provided. The term
"place" is used to communicate that the provider's responsibility for providing
interim services is not absolved by making a referral that does not result
in admission.
Comment: There are far too many interim services to arrange in a rural
service area. It would be very difficult in an urban area. For us, it is impossible.
Response: Interim services are required by the federal Substance Abuse
Prevention and Treatment block grant. The commission does not have the discretion
to waive the requirement. Most of the required interim services (counseling
and education about HIV and TB and referrals for HIV and TB treatment) can
be obtained through the local health department. The additional services required
for pregnant women (counseling on the effects of alcohol and drugs on the
fetus and referrals for prenatal care) are generally available through local
health clinics.
Comments received regarding §144.525 Admission Determination and Placement
follow.
Comment: Under the new rules, providers implement TDI admission criteria
to determine the appropriate level of service. To comply providers need access
to training on administering the criteria and guidelines for documenting administration
of TDI admission criteria in a fashion acceptable to TCADA. Rather than immediate
implementation of this rule on September 1, we suggest it go into effect following
receipt of appropriate TCADA training.
Response: The commission disagrees that training should be a prerequisite
to implementation of the rule. Training will be provided, but the rule and
the admission criteria are sufficiently detailed to permit immediate implementation.
Comment: The rules state that if an appropriate provider is not accessible
to the client, the provider shall arrange for treatment in a program with
the most appropriate level of care accessible to the client. If a provider
does not offer a program or if a provider is not accessible to the client,
a reasonable effort at referral should suffice. The wording in "shall arrange
for" suggests a case management function that the treatment provider is not
funded to provide.
Response: The rule has been revised to clarify the intent.
Comment: The word applicant should be used and not used interchangeably
with client. A distinction needs to be made between someone who has not been
accepted because they do not meet TDI criteria for the program, and client
who is currently being served but no longer meets criteria.
Response: The commission agrees with the comment and has revised the rule
accordingly.
Comment: While we are already involved in a strong QCC program here we
object to the rules providing such a strong encroachment into local management
prerogatives with all the detail that is provided here. Make it shorter and
more permissive.
Response: It is not clear which section the commenter is referencing, but
the commission assumes it is the language in paragraph (b). The TDI criteria
are designed for a delivery system where clients have access to all levels
of service. However, public funds are insufficient to provide all levels of
service throughout the state. This detail is provided so that providers know
how to apply the placement criteria when a full continuum of services is not
available.
Comment: This is very confusing. We are going to utilize the DSM-IV diagnostic
criteria then we are going to further evaluate the admission according to
TDI admission criteria to determine appropriate level of care? Then, to assess
HIV, we are going to use NIDA's reference. You are making this more difficult
than it has to be.
Response: The commission disagrees that these requirements are unnecessarily
complex. To ensure appropriate use of available treatment dollars, the commission
must establish standards to ensure that clients admitted to commission-funded
programs need treatment and that they receive the most appropriate treatment
available. Furthermore, the federal Substance Abuse Prevention and Treatment
block grant requires the commission to improve the process for referring individuals
to treatment facilities that can provide the treatment modality that is most
appropriate for their individual needs. Structured criteria provide a consistent
and reliable way to achieve those goals. The DSM-IV is the single national
standard used to establish chemical abuse and dependency, and the TDI admission
criteria are the state's uniform standard for chemical dependency treatment
placement. HIV is a major health problem in this country, and substance abusers
are at high risk. The block grant places great emphasis on HIV issues, and
the commission believes that HIV screening and referral is a critical need
for this population. The NIDA criteria provide a scientifically sound method
for substance abuse professionals to assess an individual's HIV risk.
Comments received regarding §144.526 Length of Stay Guidelines follow.
Comment: The length of stay for women with children Level II Residential
Treatment was substantially reduced in FY 00. While we continue to meet all
contract performance measures, comparison of FY 99 and FY 00 data shows there
has been a 17% decrease in the number of women abstinent at the time of follow-up.
It is our experience that all the issues involved in treating women and their
children and preparing them for independent living cannot be addressed adequately
within this shortened length of stay.
Response: In the proposed rule, TCADA interpreted the TDI length of stay
guidelines to address the special needs of this population by adjusting the
guideline for residential treatment from 35 days (applicable to other adults)
to three months. The intent was to permit three months in a Level II Residential
program, and the rule will be clarified to reflect that. An individual client
may stay in residential treatment longer than three months if clinical justification
is documented in the client record. The guidelines allow an additional 70
days in a Level III Residential program. Providers should also consider whether
other levels of care might be sufficient to meet the woman's needs for a portion
of her treatment.
Comment: The rule states that women with children and pregnant women with
a substance abuse or dependence diagnosis are eligible for three months of
residential treatment at a specialized female service provider. Depending
at what point in her pregnancy a female arrives in treatment as well as her
progress and life situation, a 3 month stay may not take her through delivery
or allow time for her to be in a safe environment after treatment to delivery.
We recommend a rule be added that outlines extended stay criteria for pregnant
females up to delivery and through initial post partum periods.
Response: When the lengths of stay for Level II and Level III are combined,
a pregnant woman could stay in residential treatment for more than six months
without exceeding the guidelines. Furthermore, the rules already allow extended
lengths of stay if clear clinical justification is documented in the client
record.
The following are comments received regarding §144.532 Core Program
Requirements.
Comment: The rules require programs to implement a written plan of operation
explaining outreach efforts, including specific strategies to reach members
of the priority populations. There is no funding for treatment centers to
provide outreach services to find priority population clients. They are funded
to provide treatment services for TCADA's priority and eligible populations.
Outreach strategies and activities are often full programs in and of themselves.
Unless these outreach "efforts" are meant to be simple and focused on maximizing
bed capacity, we believe this rule should removed. And, if this rule is being
implemented in an effort to ensure beds are fully utilized, then the phrase
that was deleted-the commission may waive this requirement if the program
demonstrates high capacity utilization and adequate engagement of the priority
population-- should remain.
Response: The outreach efforts are meant to be simple and focused on maximizing
utilization by the priority populations. The commission accepts the comment
and has revised the rule as requested.
Comment: Levels II, III, and IV treatment programs funded by the commission
shall provide family education and counseling related to the client's substance
abuse. If you aren't funding this why do you now require it?
Response: Research clearly indicates that family involvement is a critical
factor in achieving positive treatment outcomes. The commission believes that
these services must be an integral part of every treatment program. The costs
associated with these services should be included when calculating the cost
of a unit of treatment.
One comment was received regarding §144.551 Performance Measure Review:
Does the elimination of the statement-a revision of the performance goals
and/or interim goals, with appropriate timelines established to measure progress-imply
that there will no longer be an action available to TCADA and providers to
negotiate new performance goals? Or, is that assumed to be an option within
the corrective action plan. There are situations where revising performance
measures/goals is reasonable, indicated and warranted. We recommend that the
option to negotiate revised performance goals be continued and should be stated
in rule.
Response: The commission expects providers to establish realistic goals
and will hold providers accountable for performance in relation to those goals.
Occasionally, circumstances beyond the provider's control do justify revised
measures, and such revisions can be part of a corrective action plan. The
commission does not agree that this option should be explicitly stated in
the rule. A comment was received regarding §144.553. Client Record Documentation:
Sections (b) and (c) seem to be contradictory. Are you requesting each session
attended by the client to be documented or do you want one weekly progress
note which addresses all sessions? If counselors try to remember what went
on in each session during a once weekly progress note, that might pose some
auditing problems. I believe you should state either one weekly progress note
or progress note written after each session.
Response: The commission concurs and has revised the rule to require a
brief note for each session and a summary note each week addressing the client's
progress toward treatment goals.
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 the adopted rules is the Texas Health and Safety Code,
Chapter 461.
§144.511.Program Plan and Implementation.
(a)
The program shall develop a written plan to guide the delivery
of services for the contract period. The plan must be approved through the
application process and any changes to the plan must be approved through a
contract amendment.
(b)
The program shall revise the plan each year on the basis
of needs data and results of self-evaluation, and these changes must be approved
through the contract renewal or amendment process.
(c)
The written plan shall include a description of the program
design, target population, goals and objectives, admission criteria, and services
and activities.
(d)
The program design must be based on a logical, conceptually
sound framework with the intended result of reducing 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 related to the needs of the target population.
(e)
The program shall identify and describe the target population,
including specific information about:
(1)
age, gender, and ethnicity;
(2)
patterns of substance use;
(3)
social and cultural characteristics;
(4)
knowledge, beliefs, values, and attitudes; and
(5)
needs.
(f)
The program shall identify long-range goals which:
(1)
address identified needs and/or problems; and
(2)
clearly describe behavioral and/or societal changes to
be achieved.
(g)
The program shall establish objectives for each contract
period that are linked to the long range goals. Objectives must:
(1)
be realistic, outcome-oriented, measurable, and time-specific;
and
(2)
address effectiveness, efficiency, and client satisfaction;
and
(3)
include performance measures required in the contract.
(h)
The program shall develop admission criteria that identify
members of the target population and ensure that the needs of persons admitted
are appropriate to the program's design and services.
(i)
The written plan shall include key services and activities
used to achieve program goals and objectives. Each service and activity must:
(1)
relate directly to the goals and objectives;
(2)
address identified needs; and
(3)
be appropriate for the target population. The program design,
content, communications, and materials shall be:
(A)
available in the primary language of the target population;
and
(B)
appropriate to the literacy level, gender, race, ethnicity,
sexual orientation, age, and developmental level of the target population.
(j)
The program shall develop and implement a quality improvement
system that uses data to monitor and evaluate program implementation and performance.
This system shall include a quality improvement team that meets on a regular
basis (at least quarterly) to review commission performance measures and other
relevant program data, identify issues, and implement appropriate action to
improve service delivery.
(k)
The program shall maintain documentation of its quality
improvement activities, including minutes of each quality improvement meeting.
(l)
The program shall conduct and document an annual self assessment
of program implementation and performance that covers all components of the
written program plan.
(m)
The program shall use information gained from the annual
self assessment and other quality improvement activities to make appropriate
changes to the program plan and the staff training plan. Any change requiring
commission approval must be made through the contract renewal or amendment
process.
§144.525.Admission Determination and Placement.
(a)
All admissions must be authorized or denied by a QCC.
(1)
For every applicant admitted to treatment, the client record
must include documentation signed by a QCC that the individual met all applicable
admission criteria, including the DSM-IV diagnostic criteria.
(2)
When an applicant is denied admission, the program shall
maintain documentation signed by a QCC which explains why the admission was
denied.
(b)
The admission determination shall include an evaluation
based on Texas Department of Insurance (TDI) admission criteria (as interpreted
in subsection (c) of this section) to determine the appropriate level of service.
The provider shall match individual applicant needs with appropriate treatment
intensity and setting.
(1)
If the provider does not offer a program appropriate for
the applicant as determined by the TDI criteria, the provider shall refer
the applicant to a provider that does offer the needed service.
(2)
If an appropriate provider is not accessible to the applicant,
the provider shall arrange for treatment (through admission or referral) in
a program with the most appropriate level of care accessible to the applicant.
(3)
If the applicant is placed on a waiting list, the provider
may admit the client to a less intensive program on an interim basis.
(4)
The client record shall contain documentation demonstrating
that the client met the TDI admission criteria or justifying the reason for
admission if the criteria were not met.
(c)
The commission has interpreted the TDI admission criteria
to apply them to the commission's priority populations. Any revisions adopted
by the Texas Department of Insurance supercede the admission criteria listed
in this section. For pregnant women and/or women with children under their
care, a DSM-IV diagnosis of Substance Dependence or Substance Abuse shall
suffice for admission to a residential treatment program.
(d)
As part of the assessment, the program shall assess each
applicant's risk for HIV infection, tuberculosis, and other sexually transmitted
diseases. Risk assessments shall follow guidelines as set by the National
Institute on Drug Abuse's "Preventing HIV Among Substance Abusers: Risk Assessment/Risk
Reduction."
(e)
The program's admission criteria shall not exclude members
of the commission's priority populations defined in §144.522 of this
title (relating to Priority Populations).
(f)
The program's admission criteria shall not automatically
exclude individuals based on:
(1)
physical or mental health history;
(2)
current physical or mental health diagnoses or services;
(3)
past or present prescription medications;
(4)
assumptions of ability to benefit from treatment without
documented current behavioral evidence;
(5)
drugs being abused;
(6)
ability to read and write; or
(7)
pregnancy.
(g)
The program shall not automatically deny admission to a
previous client based on prior treatment. If the applicant has been admitted
to the facility three or more times in the past 12 months, the provider may
consider this information (including circumstances of prior discharges) in
determining whether to admit the applicant. The program shall not deny admission
based on prior treatment if the applicant has only one or two prior admissions
or if the applicant is in need of detoxification.
(h)
The program shall not automatically deny admission based
on a perceived threat of harm to self or others. The program shall have a
policy and procedures for assessment of potential harm to self or others.
If the program determines that an individual is a current risk to self or
others, the program may require an evaluation from a qualified mental health
provider prior to admission.
(i)
The program shall not require a period of abstinence prior
to admission or require treatment clients to complete detoxification unless
the client meets TDI admission criteria for detoxification services.
(j)
All treatment programs shall develop and implement written
procedures to identify clients exhibiting conditions or behavior that may
suggest unmet mental health needs. The program shall collaborate with and
provide referrals to available resources (including qualified and credentialed
mental health professionals) to address the client's mental health needs.
(k)
The program shall provide appropriate referrals for all
persons who are denied treatment. Documentation shall include:
(1)
date(s) of application and denial;
(2)
identifying information;
(3)
the reason the person was denied admission; and
(4)
organizations to which the client was referred.
§144.526.Length of Stay Guidelines.
(a)
Length of stay in treatment shall be determined by the
needs of the individual client. Whenever possible, multiple levels of care
shall be used to provide a continuum of care for each individual client.
(b)
The commission has adopted Texas Department of Insurance
length of stay guidelines to provide a tool for monitoring service utilization.
Clients may remain in a specific level of treatment for a longer or shorter
period of time based on individual need.
(c)
When the client is admitted, the projected length of stay
(LOS) shall be documented in the client record. The initial projected length
of stay shall not exceed Texas Department of Insurance (TDI) Guidelines.
(d)
All facilities shall implement procedures to monitor length
of stay according to TDI guidelines.
(1)
The program shall conduct the first treatment plan review
no later than midway through the client's projected length of stay. The review
shall include a comparison of the client's status with the TDI continuing
stay criteria.
(2)
If the client meets the continuing stay criteria, the program
shall revise the treatment plan and the estimated length of stay (not to exceed
the TDI guidelines).
(3)
If the client does not meet the continuing stay criteria,
the program shall confirm that the client meets the discharge criteria. Based
on client need, the program shall transfer the client to a lower level of
care (if available) or discharge the client.
(4)
The program shall conduct a treatment plan review shortly
before the estimated date of discharge (or earlier, if appropriate).
(5)
If the client has reached the maximum recommended length
of stay but is not ready for transfer or discharge, justification for extending
treatment shall be documented in the client record. The client's status shall
be reviewed regularly, and the client shall be moved to a less restrictive
level of care as quickly as clinically appropriate.
(e)
The commission has interpreted the Texas Department of
Insurance Guidelines to apply them to the commission's defined levels of service.
Any revisions adopted by the Texas Department of Insurance supercede the recommended
lengths of stay listed in this section.
(1)
Residential Level I (Detoxification): 1-14 days for adults
and adolescents.
(2)
Outpatient Level I (Detoxification) 3-9 days for adults,
not applicable for adolescents.
(3)
Residential Level II (Intensive Residential): 14-35 days
for adults and 14-60 days for adolescents.
(4)
Outpatient Level II (Day Treatment): 14-35 days for adults
and 14-60 days for adolescents.
(5)
Residential Level III (Residential): 28-70 days for adults
and 28-120 days for adolescents.
(6)
Outpatient Level III (Intensive Outpatient): 30-84 days
for adults and 30-84 days for adolescents.
(7)
Outpatient Level IV (Outpatient): Up to 180 days for adults
and adolescents.
(f)
The commission has interpreted the TDI guidelines to apply
them to the commission's priority populations and specialized services. Regardless
of the length of stay guidelines listed in subsection (e) of this section,
women with dependent children and pregnant women with substance abuse or dependence
diagnosis are eligible for three months of Level II residential treatment
at a specialized female service provider.
§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;
(2)
life skills training;
(3)
case management;
(4)
disease management;
(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 I, II or III treatment
program.
(d)
The program shall have written descriptions 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
non-therapeutic 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 and demonstrate active use
of cooperative agreements 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 the priority population.
(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.
§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 programs 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. Family services shall be initiated only with knowledge and consent
of an adult client, and the timing of all family services shall be clinically
appropriate for the individual client.
(c)
Family services may be provided to the entire family, including
older adults, individual family members, and/or a subset of family members.
(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.
If the client and/or family refuses family services or if the services are
clinically contraindicated, supporting documentation must be included in the
client record. When family services are provided, 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 behavioral 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.
§144.551.Performance Measure Review.
(a)
The treatment program will be held to specific performance
measures as stated in the contract.
(b)
The commission shall review actual performance and notify
the program in writing if the program failed to achieve the expected level
of performance.
(c)
If the program fails to achieve the expected level of performance,
the program shall respond within 30 days from the postmark date of the commission's
written notification. The program must submit a written corrective action
plan to the commission. The corrective action plan must include the program's
method and timeframes for correcting or resolving the noted deficiencies.
(d)
After receiving the response, the commission shall take
at least one of the following actions.
(1)
Notify the program in writing that the corrective action
plan has been approved and should be implemented as outlined.
(2)
Specify additional corrective actions or conditions.
(3)
Impose contract restrictions or sanctions or terminate
the contract.
§144.553.Client Record Documentation.
(a)
The provider shall maintain complete documentation for
all services paid for by commission funds. Documentation shall comply with
licensure rules and with the standards in this section.
(b)
The progress notes shall contain a record of all sessions
attended by the client. The following information shall be included for each
session:
(1)
the date of the session and beginning and end times;
(2)
the topic and/or goal of the session; and
(3)
the level of the client's participation.
(c)
In addition, a summary progress note shall be written at
least weekly. The weekly progress note shall include a summary of observations
made over the course of the week, including specific information about the
client's progress toward or away from each treatment plan goal. Other significant
information relating to the client's status shall also be recorded.
(d)
Progress notes shall also include:
(1)
documentation of the purpose, duration, justification,
and approval of any approved absence from a residential program;
(2)
a record of all case management, referral, linkage, and
follow-up activities; and
(3)
a progress note documenting the information gathered in
the 60-day follow-up contact, including:
(A)
the date and time of successful follow-up contact;
(B)
the name of the person contacted and relationship to the
client;
(C)
the telephone number of the person contacted;
(D)
documentation of any unsuccessful attempts at follow-up;
and
(E)
the signature of the person who conducted and documented
the follow-up interview.
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 9, 2000.
TRD-200005547
Karen Pettigrew
General Counsel
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 2000
Proposal publication date: June 9, 2000
For further information, please call: (512) 349-6733
40 TAC §§144.512, 144.521, 144.524, 144.525, 144.531, 144.533, 144.554
The Texas Commission on Alcohol and Drug Abuse adopts the
repeal of §§144.512, 144.521, 144.524, 144.525, 144.531, 144.533,
and 144.554 concerning Treatment without changes to the proposal as published
in the June 9, 2000, issue of the
Texas Register
(25 TexReg 5587).
These sections contain the requirements for self-evaluation, client eligibility,
facility capacity management, interim services, admission, client billings,
and client data systems (CDS) forms.
The repeals are proposed because some of these requirements are deleted
and others are incorporated into amended or new sections.
No comments were received regarding the repeal of these sections.
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 9, 2000.
TRD-200005548
Karen Pettigrew
General Counsel
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 2000
Proposal publication date: June 9, 2000
For further information, please call:
40 TAC §§144.611 - 144.616
The Texas Commission on Alcohol and Drug Abuse adopts the
repeal of §§144.611-144.616 concerning Network Management Organizations
(NMOs) without changes to the proposal as published in the June 9, 2000, issue
of the
Texas Register
(25 TexReg 5588).
These sections contain the requirements for service structure; outreach;
screening, assessment, and referral; care coordination; monitoring service
utilization; and service delivery planning and implementation.
The repeals are adopted because provisions specific to individual network
management organizations will be included in their contracts.
The following comments were received from the Association of Substance
Abuse Programs and an individual regarding the adoption of the repeal: All
items pertaining to NMOs have been eliminated from the rules, so where do
networks stand in the scope of things? What happens when contract stipulations
conflict with the rules? Which takes precedent?
Response: Should a conflict exist, the rules take precedence over contract
stipulations.
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 9, 2000.
TRD-200005549
Karen Pettigrew
General Counsel
Texas Commission on Alcohol and Drug Abuse
Effective date: September 1, 2000
Proposal publication date: June 9, 2000
For further information, please call: (512) 349-6733
Chapter 159.
ADMINISTRATIVE RULES AND PROCEDURES
Subchapter A. GENERAL INFORMATION
40 TAC §159.1
The Texas Commission for the Blind adopts the amendment
of §159.1 in its administrative rules and procedures pertaining to complaints
without changes to the text proposed in the June 2, 2000, issue of the
No comments were made in response to the proposal.
The amendment is adopted under the authority of Human Resources
Code, Title 5, Chapter 91, §91.018, which authorizes the Commission to
promulgate rules establishing methods for directing complaints to the agency.
The adoption affects Subtitle C, Title 10, Government Code, Chapter 2113.
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, 2000.
TRD-200005624
Terrell I. Murphy
Executive Director
Texas Commission for the Blind
Effective date: August 31, 2000
Proposal publication date: June 2, 2000
For further information, please call: (512) 377-0611
40 TAC §159.5
The Texas Commission for the Blind adopts new §159.5
concerning conducting criminal history checks on applicants for employment
without changes to the text proposed in the June 2, 2000, issue of the
No comments were received on the proposal.
The rule is adopted under the authority of Human Resources Code,
Title 5, Chapter 91, §91.0165, which states that the Commission by rule
shall establish criteria for denying a person's employment application based
on the results of a criminal history check.
The adoption affects no other statutes.
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, 2000.
TRD-200005611
Terrell I. Murphy
Executive Director
Texas Commission for the Blind
Effective date: August 31, 2000
Proposal publication date: June 2, 2000
For further information, please call: (512) 377-0611
40 TAC §159.6
The Texas Commission for the Blind adopts §159.6 concerning
payment rates for medical services provided to consumers without changes to
the text published in the June 2, 2000, issue of the
Texas Register
(25 TexReg 5294). The rule is adopted to define how
rates for medical treatment and procedures are set to ensure that the State
is getting the best value for services while at the same time ensuring that
consumers have adequate access to assessment and treatment services. The rules
also establish a method for waiving rates in cases where a particular rate
would deny a person access to services and establishes the Board's schedule
for periodic review of all rates.
No comments were received on the proposal.
The rule is adopted under the authority of Human Resources Code,
Title 5, Chapter 91, § 91.029, which authorizes the Commission to adopt
rules and standards governing the determination of rates the Commission will
pay for medical services.
The adoption affects no other statutes.
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, 2000.
TRD-200005625
Terrell I. Murphy
Executive Director
Texas Commission for the Blind
Effective date: August 31, 2000
Proposal publication date: June 2, 2000
For further information, please call: (512) 377-0611
Subchapter A. GENERAL INFORMATION
40 TAC §163.6
The Texas Commission for the Blind adopts new §163.6
concerning service delivery without changes to the text proposed in the June
2, 2000, issue of the
Texas Register
(25 TexReg
5294). The rule is adopted to comply with statutory requirements that the
agency establish standards for the delivery of services. The section addresses
oversight and monitoring of service delivery, guidelines to service delivery
staff, reasonable time frames for service delivery, and sharing of financial
information for planning purposes.
No comments were received on the proposal.
The rule is adopted under the authority of Human Resources Code,
Title 5, Chapter 91, §91.022, which authorizes the agency to establish
and maintain, by rule guidelines for the delivery of services by the Commission
consistent with state and federal law
The adoption affects no other statutes.
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, 2000.
TRD-200005622
Terrell I. Murphy
Executive Director
Texas Commission for the Blind
Effective date: August 31, 2000
Proposal publication date: June 2, 2000
For further information, please call: (512) 377-0611
Subchapter A. GENERAL INFORMATION
40 TAC §164.5
The Texas Commission for the Blind adopts new §164.5
concerning service delivery without changes to the text proposed in the June
2, 2000, issue of the
Texas Register
(25 TexReg
5295). The rule is adopted to comply with statutory requirements that the
agency establish standards for the delivery of services. The section addresses
oversight and monitoring of service delivery, guidelines to service delivery
staff, reasonable time frames for service delivery, and sharing of financial
information for planning purposes.
No comments were received on the proposal.
The rule is adopted under the authority of Human Resources Code,
Title 5, Chapter 91, §91.022, which authorizes the agency to establish
and maintain, by rule guidelines for the delivery of services by the Commission
consistent with state and federal law
The adoption affects no other statutes.
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, 2000.
TRD-200005620
Terrell I. Murphy
Executive Director
Texas Commission for the Blind
Effective date: August 31, 2000
Proposal publication date: June 2, 2000
For further information, please call: (512) 377-0611
Subchapter A. GENERAL INFORMATION
40 TAC §169.7
The Texas Commission for the Blind adopts §169.7 concerning
service delivery without changes to the text proposed in the June 2, 2000,
issue of the
Texas Register
(25 TexReg 5296).
The rule is adopted to comply with statutory requirements that the agency
establish standards for the delivery of services. The section addresses oversight
and monitoring of service delivery, guidelines to service delivery staff,
reasonable time frames for service delivery, and sharing of financial information
for planning purposes.
No comments were received on the proposal.
The rule is adopted under the authority of Human Resources Code,
Title 5, Chapter 91, §91.022, which authorizes the agency to establish
and maintain, by rule guidelines for the delivery of services by the Commission
consistent with state and federal law
The adoption affects no other statutes.
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, 2000.
TRD-200005619
Terrell I. Murphy
Executive Director
Texas Commission for the Blind
Effective date: August 31, 2000
Proposal publication date: June 2, 2000
For further information, please call: (512) 377-0611
Chapter 260.
AREA AGENCY ON AGING ADMINISTRATIVE REQUIREMENTS
The Texas Department on Aging adopts the repeal of §260.3 relating
to Access and Assistance Program, §260.5 relating to Information and
Assistance Services, §260.7 relating to Case Management Services, §260.9
relating to Legal Awareness/Legal Assistance Services and §260.13 relating
to Implementation of the Options for Independent Living Program and adopts
new §260.3 relating to System of Access and Assistance. The repeals of §§260.3,
260.5, 260.7, 260.9 and 260.13 are adopted without changes to the proposed
text as published in the June 9, 2000, issue of the
Texas Register
(25 TexReg 5588) and will not be republished. New §260.3
is adopted with changes to the proposed text and will be republished.
New §260.3 consolidates the current rules relating to Access and Assistance
and creates a single comprehensive rule. In addition, the new rule provides
Area Agencies on Aging with the necessary information and direction needed
to provide information and coordinate services for older persons in accordance
with the Older Americans Act.
New §260.3 outlines the general requirements of the Area Agency on
Aging System of Access and Assistance and outlines the specific requirements
for each component making up the system of access and assistance. The new
rule includes sections relating to system and client outcomes, professional
staffing, system integration, client eligibility, client intake, prohibited
service activities, confidentiality of client records, release of client information,
client contributions, conflicts of interest, reporting, Information, Referral
and Assistance, Care Coordination and Benefits Counseling.
The following comments were received regarding §260.3:
Comment #1, §260.3(b)(1)(D)
North Texas Area Agency on Aging
Comment: The rule does not identify what services are to be included.
Department Response: The Department concurs. Language has been added to
clarify. The text of the rule has been modified to read: (D) Access and assistance
services are accessible, flexible, coordinated and designed to support an
individual's highest level of functioning in the least restrictive environment.
Comment #2, §260.3(b)(1)(E)
North Texas Area Agency on Aging
Comment: The rule does not identify what services are to be included.
Department Response: The Department concurs. Language has been added to
clarify. The text of the rule has been modified to read: (E) Access and assistance
services are available to persons age 60 years and older regardless of income
or location within the service area.
Comment #3, §260.3(e)(1)
Health and Human Services Commission
Comment: We would like to suggest the following change to the rule as currently
drafted. In subsection (e), paragraph (1), add the phrase "information about
community services" following the word "services" and before the word "maximizes."
Department Response: The Department concurs. Language has been added to
include "information about services." The text of the rule has been modified
to read: (1) The system of access and assistance shall strive to develop cooperative
working relationships with local service providers to build an integrated
service delivery system which ensures broad access to and information about
community services, maximizes the utilization of existing resources, avoids
duplication of effort and gaps in services and facilitates the ability of
people who need services to easily find the most appropriate provider.
Comment #4, §260.3(n)
North Texas Area Agency on Aging
Comment: The rule identifies possible activities under Information, Referral
and Assistance. The rule should state "...consists of activities such as"
instead of "consists of..."
Department Response: The Department concurs. The text of the rule has been
modified to read: (n) Information, Referral and Assistance. The information,
referral and assistance process consists of activities such as assessing the
needs of the inquirer, evaluating appropriate resources, assessing appropriate
response modes, indicating organizations capable of meeting those needs, providing
enough information about each organization to help inquirers make an informed
choice, helping inquirers for whom services are unavailable by locating alternative
resources, when necessary, actively participating in linking the inquirer
to needed services and following up on referrals to ensure the service was
received or provided.
Comment #5, §260.3(n)(5)(A)
Health and Human Services Commission
Comment: We would like to suggest the following change to the rule as currently
drafted. In subsection (n), paragraph (5), subparagraph (A), you make reference
to developing criteria for inclusion or exclusion of agencies and programs
in the resource database. Such criteria have already been developed for use
by the I&R Network and should be referenced as available in the rule.
Department Response: The Department generally concurs. The Department believes
multiple criteria sources may exist in the network. Language has been added
to clarify. The text of the rule has been modified to read: (A) Access and
assistance staff shall develop criteria for the inclusion or exclusion of
agencies and programs in the resource database or use criteria developed by
other information, referral and assistance entities. These criteria shall
be uniformly applied and published so that staff and the public will be aware
of the scope and limitations of the database.
Comment #6, §260.3(n)(5)(B)
North Texas Area Agency on Aging
Comment: The statement is unclear. Please clarify.
Department Response: The Department concurs. The text of the rule has been
modified to read: (B) A standardized profile shall be developed for each organization
that is part of the community service delivery system.
Comment #7, §260.3(n)(5)(D)
Health and Human Services Commission
Comment: Similarly, in subparagraph (D) of the same paragraph, you reference
using a standard service classification system; we would suggest explicitly
referencing the AIRS/Infoline Taxonomy.
Department Response: The Department concurs AIRS/Infoline Taxonomy is the
standard service classification system. Language has been added to clarify.
The text of the rule has been modified to read: (D) Access and assistance
staff shall use the AIRS/Infoline Taxonomy to facilitate retrieval of community
resource information and to promote the reliability and consistency of information
across the service region and across the state.
Comment #8, §260.3(n)(6)(C)
North Texas Area Agency on Aging
Comment: Please identify what is meant by "this" information. Language
is unclear.
Department Response: The Department concurs. Language has been added to
clarify. The text of the rule has been modified to read: (C) The area agency
on aging shall use recorded information to identify service gaps and overlaps,
assist with needs assessments, support the development of products, identify
issues for staff training, facilitate the development of the resource information
system.
Comment #9, §260.3(n)(7)
Office of the Attorney General
Comment: Spell out acronym (I&R).
Department Response: The suggested change has been made. The text of the
rule has been modified to read: (7) Cooperation with Local Information and
Referral (I&R) Providers.
Comment #10, §260.3(n)(7)(A)
Health and Human Services Commission
Comment: Finally, in paragraph (7), subparagraph (A), you discuss working
with local I&R systems; we would suggest using a little stronger language
that explicitly references working with the Area Information Center.
Department Response: The Department concurs. Language has been added to
clarify. The text of the rule has been modified to read: (A) In communities
with comprehensive and/or specialized I&R providers, including Area Information
Centers, when applicable, the area agency on aging shall develop cooperative
working relationships to build an integrated system of information, referral
and assistance which ensures broad access to services, maximizes the utilization
of existing resources, avoids duplication of effort and encourages seamless
access to community resource information.
Comment #11, 260.3(n)(8)(A)
Office of the Attorney General
Comment: Insert "which are adopted by reference" after "Systems."
Department Response: The suggested change has been made. The text of the
rule has been modified to read: (A) Access and assistance staff providing
information, referral and assistance services shall adhere to the standards
of conduct set forth by the Alliance of Information and Referral Systems which
are adopted by reference.
Comment #12, §260.3(n)(8)(B)
Capital Area Agency on Aging
Comment: While I agree philosophically with having an Information, Referral
and Assistance program that performs in a professional manner and follows
the standards set out by the Alliance of Information and Referral Systems
(AIRS), I strongly disagree with the requirement that we seek AIRS accreditation.
In the current form, the accreditation process is onerous for small agencies
with little administrative staff to oversee the process, which consists of
two steps: consultation and on-site review. This process can take well over
a year to complete.
The initial accreditation application fee is $1,000, which is non-refundable.
Additional expenses incurred during the On-Site Review process, all expenses
related to travel (hotel, food, incidentals), are also the responsibility
of the applying agency. These are funds that would be taken away from providing
services to our clients.
I would strongly urge reconsideration of inclusion of this rule or modification
of the language that would encourage area agencies to seek AIRS accreditation
but not require it.
Department Response: The Department concurs. Language has been added to
clarify. The text of the rule has been modified to read: (B) Area agencies
on aging are encouraged to seek agency accreditation with the Alliance of
Information and Referral Systems.
Comment #13, §260.3(o)(1)(B)
Office of the Attorney General
Comment: Insert "defined as by the program entitled" after "management,"
and "as required by" after "Living."
Department Response: The suggested change has been made. The text of the
rule has been modified to read: (B) Care Management, which includes the model
of care management as defined by the program entitled, Options for Independent
Living, as required by in Human Resource Code Chapter 101, Subchapter C.
Comment #14, §260.3(o)(2), (o)(2)(A), (o)(2)(A)(i), (o)(2)(A)(ii),
(o)(2)(A)(iii)
Office of the Attorney General
Comment: Language is unclear and should include "without an assessment"
after authorization wherever listed.
Department Response: The suggested change has been made. The text of the
rule has been modified to read: (2) Service Authorization. A process which
identifies a need for a service(s) and uses the direct purchase of service
procedures to obtain and initiate one or more services. There are two types
of service authorization. They include service authorization without an assessment
and service authorization requiring an assessment.
(A) Service Authorization Without an Assessment.
(i) Service authorization without an assessment may be used to procure
all services except home delivered meals, homemaker, personal assistance and
residential repair.
(ii) Service authorization without an assessment may be performed by any
area agency on aging- approved access and assistance staff member either by
phone or in person.
(iii) Service authorization without an assessment must be based on a client
intake completed by area agency on aging access and assistance staff or by
a qualified source.
Comment #15, §260.3(o)(2)(C)(i)
Office of the Attorney General
Comment: In this section you should identify the additional criteria identified
in Human Resource Code, Chapter 101, Subchapter C, relating to Options for
Independent Living for a total of five criteria. In addition, insert "only"
after provided.
Department Response: The suggested change has been made. The text of the
rule has been modified to read: (i) Care management services may be provided
only to persons age 60 years and older, with priority given to those:
(I) who have recently suffered a major illness or health care crisis or
have recently been hospitalized and need additional attention during the recuperation
period in accordance with Human Resource Code, Chapter 101, Subchapter C,
relating to Options for Independent Living;
(II) who live in a rural area;
(III) who are moderately to severely impaired in activities of daily living
and instrumental activities of daily living;
(IV) have insufficient caregiver support; and
(V) who are in great economic or social need, particularly low-income,
minority older persons.
Comment #16, §260.3(o)(2)(C)(ii)(II)
Office of the Attorney General
Comment: Insert "Care managers shall develop" before "a written plan."
Department Response: The suggested change has been made. The text of the
rule has been modified to read: (II) Care Plan. Care Managers shall develop
a written plan that is based upon the client's preferences, as supported by
identified priority needs and within available public/private resources. The
care plan must specify the amount, frequency and duration of each service
to be provided and identify the outcomes to be achieved.
Comment #17, §260.3(o)
North Texas Area Agency on Aging
Comment: Omit "for" after arrange.
Department Response: The suggested change has been made. The text of the
rule has been modified to read: (o) Care Coordination. The purpose of care
coordination is to assess the needs of a client and effectively plan, arrange,
coordinate and follow-up on services which most appropriately meet the identified
needs as mutually defined by access and assistance staff, the client, and
where appropriate, a family member(s) or other caregiver.
Comment #18, §260.3(o)(2)(C)(ii)(III)
North Texas Area Agency on Aging
Comment: The rule identifies possible activities under Care Coordination.
The rule should state "...with the capacity of the provider and may include
but is not limited to:"
Department Response: The Department concurs. Language has been added to
clarify. The text of the rule has been modified to read: (III) Service Arrangement.
Care managers shall arrange for services identified in the care plan to begin
at the earliest possible date, consistent with the capacity of the provider
and may include, but is not limited to:
Comment #19, §260.3(o)(2)(C)(ii)(IV)
Office of the Attorney General
Comment: Insert "Care managers shall conduct monitoring and follow-up activities
which include" before "verifying."
Department Response: The suggested change has been made. The text of the
rule has been modified to read: (IV) Monitoring/Follow-up Activities. Care
managers shall conduct monitoring and follow-up activities which include verifying
service delivery, determining the extent to which services meet the needs
and expectations of the client, and where necessary, advocating for improvements
in service delivery. Monitoring shall include at least monthly contacts with
the client and a home visit not less than every six months.
Comment #20, §260.3(o)(2)(C)(ii)(V)
North Texas Area Agency on Aging
Comment: Change "upon" to "on."
Department Response: The suggested change has been made. The text of the
rule has been modified to read: (V) Reassessments shall be conducted and the
care plan shall be amended as needed based on changes in client status and
provider effectiveness and may be conducted by phone or in person.
Comment #21, §260.3(o)(2)(C)(ii)(VI)(-a-)
North Texas Area Agency on Aging
Comment: Language is unclear. Please clarify.
Department Response: The Department concurs. Language has been added to
clarify. The text of the rule has been modified to read: (-a-) the client
needs assessment, including initial referral date and date of completion of
assessment; re-assessment(s), if applicable;
Comment #22, §260.3(o)(2)(C)(ii)(VIII)
Office of the Attorney General
Comment: Insert "and adopted by reference" after "Managers."
Department Response: The suggested change has been made. The text of the
rule has been modified to read: (VIII) Professional Conduct. Care managers
must adhere to the pledge of ethics and the standards of practice for professional
geriatric care managers as set forth by the National Association of Professional
Geriatric Care Managers and adopted by reference.
Comment #23, §260.3(p)(3)(E)
Office of the Attorney General
Comment: Should this say "dispute resolution?"
Department Response: The Department concurs. Language has been added to
clarify. The text of the rule has been modified to read: (E) Individual Rights.
Age discrimination, disability discrimination, abuse, neglect, exploitation
and dispute resolution.
Comment #24, §260.3(p)(4)(D)
North Texas Area Agency on Aging
Comment: This statement is very awkward. System integration is addressed
under subsection (e).
Department Response: Department concurs. Subsection (p)(4)(D) has been
deleted from rule.
40 TAC §§260.3, 260.5, 260.7, 260.9, 260.13
The repeals are adopted under Texas Human Resources Code §101.021,
which provides the Texas Department on Aging with the authority to promulgate
rules governing the operation of the Department.
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 14, 2000.
TRD-200005674
Gary Jessee
Program Specialist
Texas Department on Aging
Effective date: September 3, 2000
Proposal publication date: June 9, 2000
For further information, please call: (512) 424-6857
40 TAC §260.3
The new section is adopted under Texas Human Resources Code §101.021,
which provides the Texas Department on Aging with the authority to promulgate
rules governing the operation of the Department.
§260.3.System of Access and Assistance.
(a)
Purpose and Goals. This rule establishes the requirements
for implementation by area agencies on aging of the system of access and assistance.
Each area agency on aging shall establish and/or maintain a system of access
and assistance. The program shall incorporate necessary strategies and activities
to meet the following goals:
(1)
to provide persons age 60 years and older efficient access
to needed services;
(2)
to conduct effective screening and assessment of individual
needs and preferences;
(3)
to efficiently and effectively target resources so that
persons most in need receive assistance; and
(4)
to establish a strong local role and clear identity of
the area agency on aging as a source of access and assistance for eligible
persons and/or their family members or other caregivers.
(b)
Outcomes.
(1)
The area agency on aging shall achieve the following system
outcomes.
(A)
The area agency on aging will conduct outreach and/or marketing
to inform eligible persons and/or their family members or other caregivers
of available services.
(B)
The area agency on aging shall serve as a source of connection
to comprehensive information on services, benefits and opportunities.
(C)
The area agency on aging system of access and assistance
shall meet specific local needs and take advantage of specific local strengths
and resources including volunteers.
(D)
Access and assistance services are accessible, flexible,
coordinated and designed to support an individual's highest level of functioning
in the least restrictive environment.
(E)
Access and assistance services are available to persons
age 60 years and older regardless of income or location within the service
area.
(F)
The area agency on aging system of access and assistance
shall have the capability to respond to racially, culturally and ethnically
diverse groups.
(2)
The area agency on aging shall achieve the following client
outcomes.
(A)
Eligible persons and/or their family members or other caregivers
served are provided sufficient information to make informed decisions about
services.
(B)
People in need are connected with existing benefits and
services.
(C)
Clients are provided an opportunity to express their level
of satisfaction with access and assistance services received.
(D)
Services are provided so that clients maintain hope, dignity,
respect and independence.
(c)
The area agency on aging system of access and assistance
shall include:
(1)
Information, Referral and Assistance;
(2)
Benefits Counseling;
(3)
Care Coordination; and
(4)
Ombudsman Services.
(d)
Professional Staffing. The area agency on aging shall strive
to maintain an adequate level of professional access and assistance staff
who possess necessary general and specialized knowledge. Where applicable,
access and assistance staff must complete the training and certification requirements
set forth by the Department.
(e)
System Integration.
(1)
The system of access and assistance shall strive to develop
cooperative working relationships with local service providers to build an
integrated service delivery system which ensures broad access to and information
about community services, maximizes the utilization of existing resources,
avoids duplication of effort and gaps in services and facilitates the ability
of people who need services to easily find the most appropriate provider.
(2)
Coordination with the Texas Department of Human Services.
Area agency on aging access and assistance staff shall work with the local
Texas Department of Human Services (TDHS) staff to ensure any person who may
be eligible for TDHS services will be referred to that agency. The area agency
on aging may provide services to persons who are eligible for TDHS services
in the following instances:
(A)
the person is on a interest list for TDHS services;
(B)
the person is in need of immediate service provision and
awaiting determination of eligibility for TDHS services; or
(C)
the person is in need of immediate service provision and
awaiting location and placement of a TDHS family care or primary home care
service provider.
(f)
Client Eligibility. Eligible clients include any person
age 60 years and older.
(g)
Client Intake. The intake process varies with the type
of service indicated. For all clients, access and assistance staff will determine
client needs and preferences. If clients have multiple or complex needs, access
and assistance staff will gather identifying information to determine eligibility
for services funded by the area agency on aging or other agencies.
(h)
Prohibited Service Activities. Access and assistance staff
will not perform or participate in any of the following activities:
(1)
accepting gifts from a client;
(2)
lending or borrowing money or articles to or from a client;
(3)
transporting a client in an access and assistance staff
person's automobile unless appropriate liability insurance is in force; and
(4)
driving or riding in a client's automobile.
(i)
Confidentiality of Client Records. Area agency on aging
access and assistance staff shall comply with the requirements described in
40 TAC §270.1(d), regarding confidentiality of client records.
(j)
Release of Client Information. When referrals are made,
access and assistance staff must obtain and clearly document the consent of
the client for release of confidential information to other service provider
agency(ies). This consent may be obtained from the client verbally or in writing.
(k)
Client Contributions.
(1)
Area agency on aging access and assistance staff must comply
with the requirements described in 40 TAC §270.1(j), regarding client
contributions.
(2)
Care management clients who meet the criteria identified
in Human Resource Code 101, Subchapter C relating to Options for Independent
Living shall be encouraged to contribute towards the cost of their care through
a suggested co-payment schedule.
(l)
Conflicts of Interest. The area agency on aging shall ensure
that any conflicts of interest between the function of access and assistance
and the provision of direct client services are disclosed to the Department.
The intent is to separate the function of access and assistance from the provision
of other client services.
(m)
Reporting. The area agency on aging must comply with the
reporting requirements identified in §260.1(c)(2) of this title (relating
to programmatic reports).
(n)
Information, Referral and Assistance. The information,
referral and assistance process consists of activities such as assessing the
needs of the inquirer, evaluating appropriate resources, assessing appropriate
response modes, indicating organizations capable of meeting those needs, providing
enough information about each organization to help inquirers make an informed
choice, helping inquirers for whom services are unavailable by locating alternative
resources, when necessary, actively participating in linking the inquirer
to needed services and following up on referrals to ensure the service was
received or provided.
(1)
Target Population.
(A)
Information, referral and assistance services shall be
provided to any person age 60 years and older and/or his/her family member
or other caregiver.
(B)
Information, referral and assistance services shall be
provided to Medicare and Medicaid beneficiaries of any age under the provisions
of funds received from the Health Care Financing Administration.
(2)
Access and assistance staff shall provide telephone, electronic
or walk-in information, referral and assistance services in which the inquirer
has one-to-one contact with an information, referral and assistance specialist.
(3)
Service providers shall coordinate with emergency response
organizations, such as local law enforcement agencies or other existing agencies/activities
as appropriate to provide the necessary coverage.
(4)
The area agency on aging telephone messaging system will
provide callers with appropriate emergency phone numbers when calls are received
after hours.
(5)
Resource Information.
(A)
Access and assistance staff shall develop criteria for
the inclusion or exclusion of agencies and programs in the resource database
or use criteria developed by other information, referral and assistance entities.
These criteria shall be uniformly applied and published so that staff and
the public will be aware of the scope and limitations of the database.
(B)
A standardized profile shall be developed for each organization
that is part of the community service delivery system.
(C)
Information in the resource database shall be indexed and
accessible in ways that support the information, referral and assistance process.
(D)
Access and assistance staff shall use the AIRS/Infoline
Taxonomy to facilitate retrieval of community resource information and to
promote the reliability and consistency of information across the service
region and across the state.
(E)
The resource database shall be updated through continuous
revision or at intervals sufficiently frequent to ensure accuracy of information
and comprehensiveness of its content.
(6)
Information, Referral and Assistance Log.
(A)
Access and assistance staff shall maintain a system for
collecting and organizing inquirer information that facilitates appropriate
referrals and provides a basis for describing requests.
(B)
A unit of service is a client's initial request for information
or assistance. The area agency on aging shall have a system for recording
both initial inquiries and follow-up contacts made by either the client or
the agency.
(C)
The area agency on aging shall use recorded information
to identify service gaps and overlaps, assist with needs assessments, support
the development of products, identify issues for staff training, facilitate
the development of the resource information system.
(7)
Cooperation with Local Information and Referral (I&R)
Providers.
(A)
In communities with comprehensive and/or specialized information
and referral (I&R) providers, including Area Information Centers, when
applicable, the area agency on aging shall develop cooperative working relationships
to build an integrated system of information, referral and assistance which
ensures broad access to services, maximizes the utilization of existing resources,
avoids duplication of effort and encourages seamless access to community resource
information.
(B)
If the area agency on aging is designated by the Texas
Information and Referral Network as an Area Information Center, the area agency
on aging must meet the expectations of the designation.
(8)
Professional Conduct.
(A)
Access and assistance staff providing information, referral
and assistance services shall adhere to the standards of conduct set forth
by the Alliance of Information and Referral Systems which are adopted by reference.
(B)
Area agencies on aging are encouraged to seek agency accreditation
with the Alliance of Information and Referral Systems.
(o)
Care Coordination. The purpose of care coordination is
to assess the needs of a client and effectively plan, arrange, coordinate
and follow-up on services which most appropriately meet the identified needs
as mutually defined by access and assistance staff, the client, and where
appropriate, a family member(s) or other caregiver.
(1)
Program Design. The operational design of care coordination
is dictated by the needs of the area agency on aging service area and includes
a combination of levels of care. These levels of care coordination include:
(A)
Service Authorization; and
(B)
Care Management, which includes the model of care management
as defined by the program entitled, Options for Independent Living, as required
by in Human Resource Code Chapter 101, Subchapter C.
(2)
Service Authorization. A process which identifies a need
for a service(s) and uses the direct purchase of service procedures to obtain
and initiate one or more services. There are two types of service authorization.
They include service authorization without an assessment and service authorization
requiring an assessment.
(A)
Service Authorization Without an Assessment.
(i)
Service authorization without an assessment may be used
to procure all services except home delivered meals, homemaker, personal assistance
and residential repair.
(ii)
Service authorization without an assessment may be performed
by any area agency on aging- approved access and assistance staff member either
by phone or in person.
(iii)
Service authorization without an assessment must be based
on a client intake completed by area agency on aging access and assistance
staff or by a qualified source.
(B)
Service Authorization Requiring an Assessment.
(i)
Service authorization requiring an assessment may be used
to procure home delivered meals, homemaker, personal assistance and residential
repair.
(ii)
Service authorization requiring an assessment may be performed
by any area agency on aging-approved access and assistance staff member either
by phone or in person.
(iii)
In addition to completing the client intake, a modified
assessment must be conducted which may include:
(I)
TDHS Form 2060;
(II)
Nutritional Risk Assessment; or
(III)
Service appropriate assessment.
(iv)
Area agency on aging access and assistance staff may conduct
the assessment, procure it or accept it from a qualified source.
(C)
Care Management. Care management is a process that assists
clients with multiple needs by developing and implementing comprehensive plans
of care.
(i)
Care management services may be provided only to persons
age 60 years and older, with priority given to those:
(I)
who have recently suffered a major illness or health care
crisis or have recently been hospitalized and need additional attention during
the recuperation period in accordance with Human Resource Code, Chapter 101,
Subchapter C, relating to Options for Independent Living;
(II)
who live in a rural area;
(III)
who are moderately to severely impaired in activities
of daily living and instrumental activities of daily living;
(IV)
have insufficient caregiver support; and
(V)
who are in great economic or social need, particularly
low-income, minority older persons.
(ii)
Care management must include the following:
(I)
Comprehensive Client Assessment: A needs assessment may
be provided, procured or accepted from a qualified source and must include
the following components:
(-a-)
cognitive status (if applicable);
(-b-)
emotional status (if applicable);
(-c-)
physical environment (requires on-site evaluation);
(-d-)
social environment, including informal or family support;
(-e-)
physical status;
(-f-)
economic status;
(-g-)
self-care capacity; and
(-h-)
services presently received.
(II)
Care Plan. Care Managers shall develop a written plan
that is based upon the client's preferences, as supported by identified priority
needs and within available public/private resources. The care plan must specify
the amount, frequency and duration of each service to be provided and identify
the outcomes to be achieved.
(III)
Service Arrangement. Care managers shall arrange for
services identified in the care plan to begin at the earliest possible date,
consistent with the capacity of the provider and may include, but is not limited
to:
(-a-)
exploring the availability and quality of services, eligibility
criteria and accessibility of a service to the client;
(-b-)
making and documenting referrals to community service
agencies;
(-c-)
working with volunteers to provide services;
(-d-)
working with family and friends of the client to help
achieve specific service goals; and
(-e-)
authorizing services deemed appropriate by the area agency
on aging using direct purchase of service procedures.
(IV)
Monitoring/Follow-up Activities. Care managers shall conduct
monitoring and follow-up activities which include verifying service delivery,
determining the extent to which services meet the needs and expectations of
the client, and where necessary, advocating for improvements in service delivery.
Monitoring shall include at least monthly contacts with the client and a home
visit not less than every six months.
(V)
Reassessment. Reassessments shall be conducted and the
care plan shall be amended as needed based on changes in client status and
provider effectiveness and may be conducted by phone or in person.
(VI)
Client Case Records. A confidential client case record
shall be maintained on each client served and shall be protected from damage,
theft and unauthorized inspection and shall contain at least:
(-a-)
the client needs assessment, including initial referral
date and date of completion of assessment; re-assessment(s), if applicable;
(-b-)
the care plan including amount, frequency and duration
of each service to be provided;
(-c-)
names of service providers and informal caregivers who
render services to the client;
(-d-)
a notation explaining any lapse in service;
(-e-)
notation of hospital admission and/or discharge, with
dates;
(-f-)
date and signature for each notation;
(-g-)
record of all care manager contacts and visits;
(-h-)
record of any client complaints and action taken;
(-i-)
record of termination or closure; and
(-j-)
list of names and phone numbers for notification in event
of an emergency.
(VII)
Care management may not be provided by any entity with
a vested interest in the delivery of services purchased by the area agency
on aging without an approved waiver from the Department.
(VIII)
Professional Conduct. Care managers must adhere to the
pledge of ethics and the standards of practice for professional geriatric
care managers as set forth by the National Association of Professional Geriatric
Care Managers and adopted by reference.
(p)
Other key components of the area agency on aging system
of access and assistance include Benefits Counseling and Ombudsman Services.
The requirements for the Ombudsman Program are identified in §260.11
of this title (relating to Ombudsman Services).
(1)
Benefits Counseling. Benefits counseling includes both
legal assistance and legal awareness services.
(A)
Legal Assistance. Legal assistance includes the provision
of client-specific advice, counseling and/or representation on matters involving
insurance issues, public/private benefits, consumer problems and other legal
issues.
(B)
Legal Awareness. Legal awareness includes general education
and outreach on matters involving insurance issues, public/private benefits,
consumer problems and other legal issues.
(2)
Targeting.
(A)
Benefits counseling services shall be provided to persons
age 60 years and older and/or their family members or other caregivers.
(B)
Benefits counseling services shall be provided to Medicare
and Medicaid beneficiaries of any age under the provisions of funds received
from the Health Care Financing Administration.
(3)
The area agency on aging shall focus its benefits counseling
services on the following priority issue areas:
(A)
Income Maintenance/Public Benefit. Food Stamps, Social
Security, Social Security Disability, Supplemental Security Income, veterans
benefits, pensions, railroad retirement, child support, unemployment compensation,
general assistance and other income benefits.
(B)
Medical Entitlements. Medicare, Medicaid, QMB/SLMB, Veterans
Administration Medical, indigent health and other medical entitlements.
(C)
Insurance. Medicare Supplement, HMO, long-term care policies,
individual health policies, group health policies/COBRA and non-health insurance.
(D)
Surrogate Decision Making. Advanced directives, durable/general
powers of attorney, money management, guardianship, custody and other probate
matters.
(E)
Individual Rights. Age discrimination, disability discrimination,
abuse, neglect, exploitation and dispute resolution.
(F)
Housing. Landlord/tenant issues, repair/modification, utilities,
rent subsidy, alternative housing, home equity lending/reverse mortgage, homestead
tax credit, weatherization, property tax, housing relocation and general property.
(G)
Institutional Care. Acute care, nursing facility care,
assisted living facility care and mental health care.
(H)
Consumer Issues. Bankruptcy, collections, financial counseling,
bill reductions, solicitation and unfair sales practices/fraud.
(4)
Benefits counseling services shall be provided according
to the following:
(A)
If a request for assistance involving any of the priority
issue areas identified in Paragraph (3) of this subsection requires intervention
by an attorney or paralegal, the client shall be referred to an appropriate
provider in the area.
(B)
For the purpose of handling requests or referrals which
originate from sources other than the area agency on aging, the benefits counselor,
in consultation with the local legal provider(s), shall develop an appropriate
and timely referral process.
(C)
Regardless of the referral source, it shall first be determined
whether or not the client may be assisted with other resources, such as the
Legal Hotline for Older Texans, pro-bono or reduced-fee providers or through
services funded by the Legal Services Corporation.
(5)
Relationship with Providers. The area agency on aging shall
establish the following procedures when working with providers of benefits
counseling and related legal services:
(A)
To accomplish Paragraph (4), Subparagraph (A) of this Subsection,
the area agency on aging shall coordinate with the Legal Hotline for Older
Texans, Texas Young Lawyers Association, the private bar and local legal programs
(such as law clinics or student law programs), Legal Services Corporation
grantees, the Ombudsman Program or other programs.
(B)
The area agency on aging shall utilize the Legal Hotline
for Older Texans to provide legal consultation and back-up to access and assistance
staff, as needed.
(C)
If consultation/back-up is needed for access and assistance
staff in addition to Paragraph (5), Subparagraph (B) of this Subsection, such
assistance may be obtained through agreements with programs such as pro-bono
or reduced-fee attorneys, law school students, local legal programs or Legal
Services Corporation grantees.
(6)
Education and Outreach.
(A)
Education and outreach activities include the dissemination
of accurate, timely and relevant information regarding any issue identified
under the priority areas in paragraph (3) of this Subsection to persons identified
under Paragraph (2) of this Subsection.
(B)
Education and outreach may be provided to individuals or
through a group setting such as forums, workshops, seminars and training sessions
and other public venues, and shall be reported as legal awareness.
(7)
Classification of Activities.
(A)
The provision of activities described in Paragraph (6)
of this Subsection to eligible persons in a one-on-one setting or by telephone
where detailed information is provided but no client intake is necessary shall
be reported as legal awareness.
(B)
The provision of advice, counseling and/or representation
on matters involving insurance issues, public/private benefits, consumer problems
and other legal issues shall be reported as legal assistance if a client intake
is completed.
(C)
If a client has a simple request for information on any
topic including those identified under Paragraph (3) of this Subsection, it
shall be reported as information, referral and assistance.
(D)
While education and outreach initiatives that include the
dissemination of information through mass media may be budgeted as associated
costs under legal awareness, the activities may not be reported as units of
service.
(E)
Presentations or other activities that describe the services
of the area agency on aging in general including the benefits counseling program
may not be reported as units of service.
(8)
The area agency on aging shall collaborate and/or partner
with local, state and federal entities to provide education and outreach.
Such entities may include but are not limited to the Texas Department of Insurance,
Texas Legal Services Center, Texas Medical Foundation, Health Care Financing
Administration and the Social Security Administration.
(9)
Benefits counselors shall complete the training and certification
requirements as set forth in the benefits counseling certification manual
issued by the Department.
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 14, 2000.
TRD-200005675
Gary Jessee
Program Specialist
Texas Department on Aging
Effective date: September 3, 2000
Proposal publication date: June 9, 2000
For further information, please call: (512) 424-6857
The Texas Department on Aging adopts the repeal of §270.5 and
adopts new §270.5 relating to Nutrition Service Requirements. The repeal
is adopted without changes to the proposed text as published in the June 9,
2000, issue of the
Texas Register
(25 TexReg
5594) and will not be republished. New §270.5 is adopted with changes
and will be republished.
New §270.5 provides Area Agencies on Aging and contracted meal providers
with the information necessary to ensure the provision of congregate and home
delivered meals meets the requirements of the Older Americans Act as well
as state and local regulations. In addition, this rule is the result of a
coordinated rule making process between the Texas Department on Aging and
the Texas Department of Human Services.
The new rule as adopted includes sections relating to compliance with laws
and regulations, compliance with USDA, match requirements, program income,
facilities, record keeping, service days, meal requirements, menus, standard
recipes, modified diets, meal packaging, holding times, delivery windows,
training, nutrition outreach, nutrition education, monitoring, complaint handling,
subcontracting and customer satisfaction surveys.
The following comments were received regarding §270.5:
Comment #1, §270.5(c), (d), (q)(3)
North Texas Area Agency on Aging
Comment: There are several places in the rule where "vendor" as well as
"contract agency" should be identified.
Department Response: The Department concurs. Language has been added to
clarify. The text of the rule has been modified to read: (c) Compliance with
Laws and Regulations. The contract agency/vendor shall follow procedures and
maintain facilities that are in compliance with all applicable federal, state
and local fire, health, sanitation and safety laws and regulations. All food
preparation, handling, and service activities shall comply with Texas Department
of Health Division of Food and Drug, "Rules on Food Service Sanitation." The
contractor must provide a copy of all required inspection results to the area
agency on aging within five calendar days of receipt of the results.
(d) USDA Compliance. Contract agencies/vendors must comply with the Older
Americans Act, §311, concerning surplus commodities and United States
Department of Agriculture Food Distribution Regulations, 7 Code of Federal
Regulations, Part 350; must ensure that only eligible meals served by Older
Americans Act funded projects are reported for USDA cash/commodity reimbursement;
and must ensure that cash will only be used to purchase food grown in the
United States.
(3) Contract agencies/vendors may be reimbursed for up to two consecutive
deliveries per month per client when a meal is delivered and the participant
is not home to accept it. However, contract agencies must have written procedures
in place to ensure a follow-up with participants when they are not home to
receive meals.
Comment #2, §270.5(b)(2)
Texoma Area Agency on Aging
Tri-County Senior Nutrition Project, Inc.
Comment: Does TDoA currently dictate a minimum score requirement? We feel
that this would be contradictory to the OAA, as we currently use their definitions
for an eligible home delivered meal client, not a score from the 2060.
Department Response: The Department does not concur. The Older Americans
Act defines general eligibility for home delivered meal clients. However,
the Department in coordination with the Texas Department Human Services (TDHS)
has established requirements which will target services to those persons most
in need.
Comment #3, §270.5(b)(1), (b)(2)
Texoma Area Agency on Aging
Tri-County Senior Nutrition Project, Inc.
Comment: Subsection (b)(1) seems to contradict subsection (b)(2).
Department Response: The Department concurs. Language has been added to
clarify. The text of the rule has been modified to read: (1) Eligibility criteria
shall meet the provisions stated in the Older Americans Act, §307 (a)(13)(A)
and (I) relating to eligibility.
Comment #4, §270.5(b)(4)
Texoma Area Agency on Aging
Tri-County Senior Nutrition Project, Inc.
Comment: Do you mean the nutritional risk assessment? If so, perhaps the
proper wording should be used here.
Department Response: The Department concurs. Language has been added to
clarify. The text of the rule has been modified to read: (4) All meal participants
must complete a Nutritional Risk Assessment not less than once per year.
Comment #5, §270.5(c)
Texoma Area Agency on Aging
Tri-County Senior Nutrition Project, Inc.
Comment: It usually takes our nutrition provider up to 10 days to collect
the information from all 20 sites. Can this be modified?
Department Response: The Department does not concur. The rule requires
contract agency provider sites to provide a copy of all required inspection
results to the area agency on aging within five calendar days of receipt of
the results. It does not require the contract agency wait until all provider
sites have their inspections completed. They should be submitted as they are
completed. Five days seems reasonable for provider sites to submit the information.
Comment #6, §270.5(e)(1), (e)(2)
Combined Community Action, Inc.
Hill County Community Action Association, Inc.
Meals on Wheels Nutrition and Fellowship Project
Texas Association of Aging Programs
Comment: We strongly oppose the 10% cash match requirement in the proposed
new rule. The 10% match currently required by the Older Americans Act is not
a required cash match.
Department Response: The Department concurs. A workgroup was held to discuss
the match requirement. Language has been added to clarify. The text of the
rule has been modified to read: (e) Match. Contract agencies will provide
a minimum of 10% cash or in-kind match.
Because a cash match is no longer required, the need for a waiver has become
obsolete. Subsection (e)(2) has been deleted from rule.
Comment #7, §270.5(k)(1)
Office of the Attorney General
Comment: Include "meal included on the" after "each."
Department Response: The suggested change has been made. The text of the
rule has been modified to read: (1) Each meal included on the menu and a list
of allowable substitutions must be approved by a dietician consultant as meeting
1/3 of the recommended dietary allowance (RDA) for older adults and the Dietary
Guidelines for Americans. The approval must occur and be documented prior
to the date the meal is served. The dietary consultant must be a registered
dietician who is:
Comment #8, §270.5(q)(3)
Texoma Area Agency on Aging
Tri-County Senior Nutrition Project, Inc.
Comment: Can the same protocols established by TDHS for Title XX meals
be referenced here so providers will not have to use two different procedures?
Department Response: The Department does not concur. These rules were written
in coordination with the TDHS. In the near future, TDHS nutrition standards
will be modified to include the same language in subsection (q)(3).
Comment #9, §270.5(q)(4)
Office of the Attorney General
Comment: Modify "changes" to "change."
Department Response: The suggested change has been made. The text of the
rule has been modified to read: (4) Contract agencies must have written procedures
in place to ensure significant change in the meal participant's physical or
mental condition or environment is reported, investigated and appropriate
action is implemented within one business day following notification of the
change.
Comment #10, §270.5(r)(2)
Office of the Attorney General
Comment: End the sentence after duties and insert "Training" before "must
include."
Department Response: The suggested change has been made. The text of the
rule has been modified to read: (2) The contract agency must provide all staff,
including volunteers who come in contact with clients in a capacity other
than just serving or delivering meals, with at least two hours of training
before assuming duties. Training must include:
Comment #11, §270.5(r)(4)
Office of the Attorney General
Comment: Include "to be completed no later than" after training, remove
"within" and include "after" before "assumption."
Department Response: The suggested changes have been made. The text of
the rule has been modified to read: (4) The contract agency must provide the
food service supervisor with at least six hours of training to be completed
no later than 30 days after assumption of duties in the following food preparation
areas:
Comment #12 & #13, §270.5(r)(5)
Coastal Bend Area Agency on Aging
Comment: We pulled the current state standards and compared the proposed
requirement. We recommend this be changed as follows: Texas Food Protection
Management certification requires 14 hours of food safety education by the
state accredited FPM program and passing an examination. Recertification is
required every 3 years after initial certification and entails 6 hours of
education by a state accredited FPM program and passing an examination. Students
passing the examinations are issued a state FPM certification card entitling
them to reciprocity for FPM certification throughout all jurisdiction of the
state.
Texoma Area Agency on Aging
Tri-County Senior Nutrition Project, Inc.
Comment: We do not believe the requirements in the Texas Food Establishment
Rules published by the Texas Department of Health give the food service supervisor
the option of being certified within one year.
Department Response: The Department generally concurs. Language has been
added to clarify the requirements for the food service supervisor. The text
of the rule has been modified to read: (5) The food service supervisor must
comply with the Texas Department of Health rules regarding the knowledge and
demonstration of a food protection manager.
By clarifying (r)(5), (r)(6) is unnecessary. Subsection (r)(6) has been
deleted from rule. Subsection (r)(7) has been renumbered (r)(6).
Comment #14, §270.5(t)
Office of the Attorney General
Comment: Remove "includes" after which and insert "identifies." After "source"
insert "of information presented."
Department Response: The suggested changes have been made. The text of
the rule has been modified to read: (t) Nutrition Education. Nutrition Education
must be provided on a monthly basis to congregate and home delivered meal
clients. An annual written plan for nutrition education must be developed
which identifies subject matter, presenter, materials used and source of information
presented. This plan must be maintained for monitoring purposes.
Comment #15, §270.5(u)(1)
North Texas Area Agency on Aging
Comment: I believe this section should make reference to the monitoring
requirements for vendors.
Department Response: The Department concurs. Language has been added to
clarify. The text of the rule has been modified to read: (1) The contract
agency will be monitored by the area agency on aging in accordance with 40
TAC 260.1 (d) relating to provider reviews or, for a vendor, 40 TAC 260.19
(f) relating to quality assurance.
Comment #16, §270.5(w)(1)
Office of the Attorney General
Comment: Include "by the contract agency" after maintained.
Department Response: The suggested change has been made. The text of the
rule has been modified to read: (1) The contract agency must inform clients
in writing of complaint procedures on or before initiation of service. Documentation
of receipt of the complaint procedure by the meal participant must be maintained
by the contract agency for monitoring purposes.
Part 3.
TEXAS COMMISSION ON ALCOHOL AND DRUG ABUSE
Subchapter B. CONTRACT ADMINISTRATION
Subchapter C. PROGRAM OVERSIGHT
Subchapter D. ORGANIZATIONAL
Subchapter E. PREVENTION AND INTERVENTION
Subchapter F. TREATMENT
Subchapter G. NETWORK MANAGEMENT ORGANIZATIONS (NMOS)
Part 4.
TEXAS COMMISSION FOR THE BLIND
Chapter 163.
VOCATIONAL REHABILITATION PROGRAM
Chapter 164.
INDEPENDENT LIVING PROGRAM
Chapter 169.
BLIND AND VISUALLY IMPAIRED CHILDREN'S PROGRAM
Part 9.
TEXAS DEPARTMENT ON AGING
Chapter 270.
GENERAL SERVICE REQUIREMENTS