Part 1. TEXAS DEPARTMENT OF HUMAN SERVICES

Chapter 20. COST DETERMINATION PROCESS

40 TAC §20.101

The Texas Department of Human Services (DHS) proposes an amendment to §20.101, concerning introduction, in its Cost Determination Process chapter. The purpose of the amendment is to establish payment rates for two years coincident with the state biennium. It will allow payment rates to be determined at the same time that the state legislature is establishing funding for these programs for the state's biennium. The proposal requires that payment rates for the Primary Home Care, Day Activity and Health Services, Emergency Response Services, and Residential Care programs be determined on a state fiscal year basis for a period of two years.

The Health and Human Services Commission proposes similar policy for Medicaid-funded services, codified at 1 TAC §355.101, in this issue of the Texas Register .

Eric M. Bost, commissioner, has determined that for the first five- year period the section is in effect there will be no fiscal implications for state or local government as a result of enforcing or administering the sections.

Mr. Bost also has determined that for each year of the first five years the section is in effect the public benefit anticipated as a result of enforcing the section will be that payment rates for the programs will be determined at the same time that the state legislature is establishing funding for these programs for the state's biennium. This will provide an opportunity for a better understanding of the relationship between the rates and funding, and rates will be known for a two-year period. There will be no effect on large, small, or micro businesses. While the rates will be set once every two years, the rates for both years need not be the same. Factors such as inflation will be taken into account when setting the rates for each of the two years of the biennium. Other rules allow the department to adjust rates in response to emergencies. No changes in practice are required of any business. There is no anticipated economic cost to persons who are required to comply with the proposed section.

Questions about the content of this proposal may be directed to Carolyn Pratt at (512) 438-4057 in DHS's Rate Analysis Department. Written comments on the proposal may be submitted to Supervisor, Rules and Handbooks Unit-215, Texas Department of Human Services E-205, P.O. Box 149030, Austin, Texas 78714-9030, within 30 days of publication in the Texas Register .

For further information, contact local offices of the Texas Department of Human Services.

Under §2007.003(b) of the Texas Government Code, the department has determined that Chapter 2007 of the Government Code does not apply to these rules. Accordingly, the department is not required to complete a takings impact assessment regarding these rules.

The amendment is proposed under the Human Resources Code, Title 2, Chapters 22 and 32, which authorizes the department to administer public and medical assistance programs; and under Texas Government Code §531.021, which provides the Health and Human Services Commission with the authority to administer federal medical assistance funds.

The amendment implements the Human Resources Code, §§22.001- 22.030 and §§32.001-32.042.

§20.101.Introduction.

(a)-(b)

(No change.)

(c)

The Texas Department of Human Services (DHS) reimburses providers for contracted client services through reimbursement amounts determined as described in this chapter and in reimbursement methodologies for each program. Non-Medicaid, statewide, uniform reimbursements and reimbursement ceilings are approved by the Texas Department of Human Services. Medicaid, statewide, uniform reimbursements, and reimbursement ceilings are approved by the Texas Health and Human Services Commission (HHSC). In Medicaid programs where reimbursements are contractor-specific, the HHSC approves the reimbursement parameter dollar amounts, e.g., ceilings, floors, or program reimbursement formula limits. In approving reimbursement amounts DHS or the HHSC takes into consideration staff recommendations based on the application of formulas and procedures described in this chapter and in reimbursement methodologies for each program. However, DHS or the HHSC may adjust staff recommendations when DHS or the HHSC deems such adjustments are warranted by particular circumstances likely to affect achievement of program objectives, including economic conditions and budgetary considerations. Medicaid reimbursement methodology rules are developed and recommended for approval to the HHSC. The HHSC has oversight authority with respect to the state's Medicaid rules.

(1)

Reimbursement amounts will be determined coincident with the state's biennium.

(2)

[ (1) ] Objective of cost determination process. The objective of the cost determination process is to define direct and indirect costs which are allowable and, therefore, may be considered for use in the overall reimbursement determination process. The cost determination process seeks to collect accurate financial and other statistical data which constitute the foundation upon which reimbursements are determined.

(A)

Cost-reporting. In order to ensure adequate financial and statistical information upon which to base reimbursement, DHS requires that each contracted provider submit a periodic cost report or supplemental report. It is the responsibility of the provider to submit accurate and complete information, in accordance with all pertinent DHS cost reporting rules and cost report instructions, on the cost report and any supplemental reports required by DHS.

(B)

Pro forma costing. When historical costs are unavailable, such as in the case of a new program, reimbursement may be based on a pro forma approach. This approach involves using historical costs of delivering similar services, where appropriate data are available, and estimating the basic types and costs of products and services necessary to deliver services meeting federal and state requirements.

(3)

[ (2) ] Relationship between cost determination and reimbursement determination processes. The cost determination process seeks to evaluate individual cost items of providers to determine their allowability and to determine whether individual cost reports are of reasonable accuracy for potential use in reimbursement determination. The reimbursement determination process takes the evaluation of allowable costs one step further by comparing allowable costs across providers to identify those levels of cost, either for individual cost items or groups of cost items, which must be incurred by efficient and economic providers of services meeting all state and federal standards. Thus, all costs allowed in the cost determination process may not necessarily be used in the reimbursement determination process. The basic objective of the reimbursement methodologies employed by DHS is to facilitate and balance the broader objectives of the programs administered by the agency by:

(A)

promoting reasonable access for eligible clients to services that meet federal and state quality standards via contracting with an adequate number of qualified providers; and

(B)

expending taxpayer dollars in a reasonable and prudent manner such that eligible clients are served at the lowest cost to taxpayers consistent with state and federal laws, standards and regulations, and with program objectives.

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

Filed with the Office of the Secretary of State, on May 23, 2000.

TRD-200003643

Paul Leche

General Counsel, Legal Services

Texas Department of Human Services

Earliest possible date of adoption: July 9, 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 proposes amendments to §§144.1, 144.11, and 144.21 concerning General Provisions. These sections contain information regarding applicability, waivers and definitions.

These amendments are proposed 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.

Jay Kimbrough, Executive Director, has determined that for the first five-year period the rules are in effect there will be no fiscal implications for state or local government as a result of enforcing the rules.

Mr. Kimbrough has also determined that for each year of the first five years the rules are in effect the anticipated public benefit will be more clarity about the applicability of the rules, the waiver process and the terms used within the rules. There is no additional effect on small businesses. There is no anticipated economic cost to persons required to comply with the proposed amendments.

Comments on the proposal may be submitted to Tamara Allen, Rules Manager, Texas Commission on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas 78708-0529. Comments must be received no later than 30 days from the date this proposal is published in the Texas Register .

These amendments are proposed 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 proposed amendments is the Texas Health and Safety Code, Chapter 461.

§144.1.Applicability.

(a)

This chapter applies to all prevention, intervention, and treatment programs funded by the commission.

(b)

When a statute that governs state agencies is in conflict with commission rules, the statute shall apply. [ Where other laws apply, however, state agencies funded by the commission shall not be required to comply with comparable commission rules. ]

Waivers [ Variances ].

The commission's executive director may grant a temporary waiver [ variance ] from a requirement in this chapter to a provider or a group of providers. A waiver shall not extend beyond the contract period during which it is granted. To be eligible for a waiver [ variance ], the provider must show that an alternative method is used to meet the intent of the rule and the services are not significantly affected. All waivers [ variances ] must be requested and approved in writing prior to initiation of the waiver .

§144.21.Definitions.

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

(1)-(13)

(No change.)

(14)

Case management - A systematic process to ensure clients receive all substance abuse, physical health, mental health, social, and other services needed to resolve identified problems and needs. Case management activities are provided by an accountable staff person and include:

(A)

linking a client with needed services;

(B)

helping a client develop skills to use basic community resources and services; and

(C)

communicating, monitoring and coordinating [ the ] services for [ received by ] a client.

(15)-(19)

(No change.)

(20)

Cognizant agency - The federal or state agency responsible for reviewing, negotiating, and approving an organization's [ cost allocation plans or ] indirect cost rate [ proposals ]. TCADA has not been designated as a cognizant agency.

(21)-(25)

(No change.)

(26)

Cost Reimbursement - A payment mechanism that provides reimbursement, at actual cost, to the contractor for performing at a certain level of effort regardless of the level of output achieved.

(27)

[ (26) ] Counseling - Face-to-face interactions in which a counselor helps an individual, family or group identify, understand, and resolve issues and problems.

(28)

[ (27) ] Counselor - A qualified credentialed counselor , [ or a ] counselor intern , or graduate .

(29)

[ (28) ] Counselor intern (CI) - A person pursuing a course of training in chemical dependency counseling at a regionally accredited institution of higher education , an approved practicum provider, or an approved clinical training institution who has been designated as a counselor intern by the institution. The activities of a counselor intern shall be performed under the direct supervision of a qualified credentialed counselor (QCC).

(30)

[ (29) ] Crisis intervention - Services designed to intervene in situations which may or may not involve alcohol and drug abuse, and which may escalate and result in a crisis if immediate attention is not provided. Services include face-to-face individual, family, or group interviews/interactions and/or telephone contacts to identify needs.

(31)

[ (30) ] CSAP's six prevention strategies - The six strategies identified by the Center for Substance Abuse Prevention that are delivered in prevention and intervention programs. The six strategies are: prevention education and skills training, alternatives, problem identification and referral, information dissemination, community-based process, and environmental and social policy.

(32)

[ (31) ] Cultural competency training - Training to improve an individual's ability to understand and interact with persons of [ a ] different cultures [ culture ]. Culture defines the lifestyle of a distinct population and includes values, behavioral norms, and patterns of interpersonal relationships. It may be based on race, ethnicity, religion, age, gender, sexual orientation, or disability.

(33)

[ (32) ] Discharge - Formal, documented termination from a treatment facility. Discharge occurs when a client successfully completes treatment goals, leaves against professional advice, or is terminated for other reasons.

(34)

[ (33) ] Documentation - A written and/or electronic record that includes a date and a written or digital signature and provides authenticated evidence to substantiate compliance with standards, such as minutes of meetings, memoranda, schedules, notices, logs, records, policies, procedures, and announcements.

(35)

[ (34) ] DSM-IV - The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Revised, published by the American Psychiatric Association. Any reference to DSM-IV is understood to mean the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders.

(36)

[ (35) ] Ensure - To take all reasonable and necessary steps to achieve results.

(37)

[ (36) ] Environmental and social policy - A strategy designed to establish or change written and unwritten community standards, codes, and attitudes, thereby influencing incidence and prevalence of substance abuse in the general population. It includes activities that center on legal and regulatory initiatives and those that relate to the service and action-oriented initiatives.

(38)

[ (37) ] Evaluation (program) - A formal process for collecting, analyzing, and interpreting information about a program's implementation and effectiveness.

(39)

[ (38) ] Exit summary - Documentation of all referral and follow-up activities provided to individuals or family members receiving intervention counseling services.

(40)

[ (39) ] Exploitation - An act or process to use, either directly or indirectly, the labor or resources of a client/participant for monetary or personal benefit, profit, or gain of another individual or organization.

(41)

[ (40) ] Facility - A legal entity that provides one or more chemical dependency treatment programs.

(42)

[ (41) ] Family - The children, parents, brothers, sisters, other relatives, foster parents, guardians, or significant others who perform the roles and functions of family members in the lives of clients/participants.

[ (42)

Financial assistance - A payment mechanism where payment is based on an approved line item budget. ]

(43)

Graduate - An individual who has successfully completed the 270 hours of education, 300 hour practicum, and 4,000 hours of supervised work experience but has neither received a license nor failed the examination four times.

(44)

[ (43) ] HIV - Human Immunodeficiency Virus, the virus that causes AIDS. Infection is determined through a testing and counseling process overseen by the Texas Department of Health. Being infected with HIV is not necessarily equated with having a diagnosis of AIDS.

(45)

[ (44) ] HIV Antibody Counseling and Testing - A structured counseling session performed by Prevention Counseling and Partner Elicitation (PCPE) counselors registered with the Texas Department of Health (TDH). It promotes risk reduction behavior for those at risk of infection with HIV and other sexually transmitted diseases and offers testing for HIV infection.

(46)

[ (45) ] Indicated program - An intervention program designed to prevent the onset of substance abuse in individuals who do not meet DSM-IV criteria for abuse or dependence, but are showing early warning signs such as failing grades, dropping out of school, and/or use of alcohol and other gateway drugs.

(47)

[ (46) ] Information dissemination - A strategy that provides awareness and knowledge of ATOD problems and/or HIV infection and their harmful effects on individuals, families, and communities. It also gives the general population information about available programs and services. Information dissemination is characterized by one-way communication from the source to the audience, with limited contact between the two. Information is disseminated through written communications and/or in-person community presentations.

(48)

[ (47) ] Intervention - A process that utilizes multiple strategies designed to prevent or interrupt the [ illegal ] use of alcohol, tobacco and other drugs by youth who are showing early warning signs of substance use or abuse and/or exhibiting other high risk problem behaviors, and to break the cycle of harmful use of legal substances and all use of illegal substances by adults in order to halt the progression and escalation of use, abuse, and related problems. Intervention strategies target indicated populations.

(49)

[ (48) ] Intervention counseling - Face-to-face interactions to assist individuals, families, and groups to identify, understand, and resolve issues and problems related to ATOD use within a specific number of sessions or within a certain time frame. It is intended to intervene in problem situations and high risk behaviors which, if not addressed, may escalate to substance abuse or cause communicable disease.

(50)

[ (49) ] Key performance measures - Measures that reflect the services that are critical to the program design and intended outcomes of the program. Key performance measures are specified for all commission funded programs.

(51)

[ (50) ] Life skills training (treatment) - A structured program of training, based upon a written curriculum, to help clients manage daily responsibilities effectively and become gainfully employed. It may include instruction in communication and social interaction, stress management, problem solving, daily living, and decision making.

[ (51)

Minor Remodeling - Work required to change the interior arrangements or other physical characteristics of an existing facility, or to install equipment in order to meet program requirements and needs. It does not include relocation of exterior walls, roof, and floors in order to increase the amount of space to be used, development or repair of parking lots, and completion of unfinished shell space to make it suitable for occupancy. ]

(52)

Neglect - Actions resulting from inattention, disregard, carelessness, ignoring, or omission of reasonable consideration that caused, or might have caused, physical or emotional injury to a client/participant. Examples of neglect include, but are not limited to, failure to provide adequate nutrition, clothing, or health care; failure to provide a safe environment free from abuse; failure to maintain adequate numbers of appropriately trained staff; failure to establish or carry out an appropriate individualized treatment plan; and any other act or omission classified as neglect by the Texas Family Code, §261.001.

(53)

Offer - To make available.

(54)

Older adult - A person aged 55 or older.

(55)

OMB - United States Office of Management and Budget.

(56)

Outcome - The impact on the system or client/participant served.

(57)

Outreach - Activities directed toward finding individuals who might not use services due to lack of awareness or active avoidance, and who would otherwise be ignored or underserved.

(58)

Participant - An individual who is receiving prevention or intervention services.

(59)

Policy - A statement of direction or guiding principle issued by a [ the ] governing body.

(60)

Prevention - A process that utilizes multiple strategies designed to preclude the onset of the [ illegal ] use of alcohol, tobacco and other drugs by youth. Prevention principles and strategies foster the development of social and physical environments that facilitate healthy, drug-free lifestyles. Prevention strategies target universal and selective [ selected ] populations.

(61)

Prevention education and skills training - A curriculum-based strategy designed to develop decision-making, problem solving, and other life skills. It also provides accurate information about the harmful effects of ATOD use, abuse and addiction pertinent to the needs of the target population. The basis of activities under this strategy is interaction between the educator/facilitator and the participants. These activities are aimed to increase protective factors, foster resiliency, decrease risk factors and affect critical life and social skills relative to substance abuse and/or HIV risk of the participant and/or family members.

(62)

Primary population - The individuals directly targeted to participate in and benefit from the program.

(63)

Problem identification and referral - A strategy that provides services designed to ensure access to appropriate levels and types of services needed by youth or adult participants. It includes identification of those individuals who have used or are at risk of using alcohol, tobacco, and other drugs. This strategy does not include assessments [ any activity ] designed to determine if a person is in need of treatment.

(64)

Procedure - A step-by-step set of instructions.

(65)

Program - A specific type of service delivered to a specific population [ as identified in the proposal ].

(66)-(84)

(No change.)

(85)

Unethical conduct - Conduct prohibited by the ethical standards adopted by state or national professional organizations or by rules established by a profession's state licensing agency.

(86)

Unprofessional conduct - An act of omission that violates commonly accepted standards of behavior for individuals or organizations.

(87)

[ (85) ] Unit rate [ cost ] - A payment mechanism in which a specified rate of payment is made in exchange for a specified unit of services.

(88)

[ (86) ] Universal program - A prevention program designed to address an entire population with messages and programs aimed at preventing or delaying the use and abuse of alcohol, tobacco, and other drugs. Universal prevention programs are delivered to large groups without any prior screening for substance abuse risk.

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

Filed with the Office of the Secretary of State, on May 24, 2000.

TRD-200003688

Karen Pettigrew

General Counsel

Texas Commission on Alcohol and Drug Abuse

Earliest possible date of adoption: July 9, 2000

For further information, please call: (512) 349-6733

40 TAC §144.101

The Texas Commission on Alcohol and Drug Abuse proposes amendments to §144.101 concerning Contract Administration. This sections contains information regarding general contract provisions.

The amendments are proposed 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 $100,000 or 10% of the contract, whichever is greater; to specify that providers will be held to performance standards stated in the contract; and to make other changes to improve readability and understanding.

Jay Kimbrough, Executive Director, has determined that for the first five-year period the rules are in effect there will be no fiscal implications for state or local government as a result of enforcing the rules.

Mr. Kimbrough has also determined that for each year of the first five years the rules are in effect the anticipated public benefit will be a better understanding of the contract process and better protection of the public funds. There is no additional effect on small businesses. There is an anticipated economic cost to some of the persons required to comply with the proposed amendments. The amendment requires a higher level of indemnity insurance for large providers (those receiving more than $1 million from TCADA). At the present time, 42 providers fall into this category; only 12 of those have contracts over $2 million. Cost impact will depend on the provider's current coverage size of the facility, and other factors, but it is estimated that premiums could increase by 25% per year for an additional $200,000 in coverage or 35% for an additional $400,000 in coverage.

Comments on the proposal may be submitted to Tamara Allen, Rules Manager, Texas Commission on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas 78708-0529. Comments must be received no later than 30 days from the date this proposal is published in the Texas Register .

These amendments are proposed 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 proposed amendments is the Texas Health and Safety Code, Chapter 461.

General Contract Provisions [ Acceptance and Legal Precendence ]. (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 within 14 calendar days of the contract's postmark date and the other shall be maintained by the organization.

(2)

If board approval is required and cannot be obtained within 14 days, the provider must submit a written extension request before the deadline which includes the date of the scheduled board meeting.

(3)

If the provider makes any modifications to the original contract, both signed copies must 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.

(4)

No payment or advance of funds will be made until the contract is fully executed.

[ (a)

To execute a contract, the provider shall submit an original acceptance notice signed by an official authorized to enter into such agreements on behalf of the governing body. If board approval is required and cannot be obtained within 14 days, the provider must submit a written extension request before the deadline which includes the date of the scheduled board meeting. ]

(b)

Changes in state or federal laws and regulations may affect contract provisions. Any modifications resulting from such changes are automatically made part of the contract and go into effect on the date set by the law or regulation.

(c)

The provider shall have insurance or other provisions to ensure that assets purchased with commission funds will be replaced if lost, destroyed, damaged, or stolen.

(d)

The provider shall carry a fidelity bond or insurance coverage [ equal to the amount of funding provided under the commission contract(s) or $100,000, whichever is less ]. The fidelity bond or insurance must provide for indemnification of losses due to fraudulent or dishonest acts committed by any of the provider's employees or volunteers who have access to funds, either individually or in concert with others.

(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.

(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)

[ (2) ] rules adopted by the commission [ and applicable federal regulations ]; and

(4)

[ (3) terms and conditions of ] the contract . [ ; ]

[ (4)

requirements stated in the request for proposals; and ]

[ (5)

the application as amended or adjusted by the commission. ]

(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 proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State, on May 24, 2000.

TRD-200003689

Karen Pettigrew

General Counsel

Texas Commission on Alcohol and Drug Abuse

Earliest possible date of adoption: July 9, 2000

For further information, please call: (512) 349-6733

40 TAC §144.102

(Editor's note: The text of the following section proposed for repeal will not be published. The section may be examined in the offices of the Texas Commission on Alcohol and Drug Abuse or in the Texas Register office, Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)

The Texas Commission on Alcohol and Drug Abuse proposes the repeal of §144.102 concerning Contract Administration. This section contains the requirements for amendments. The repeal is proposed because requirements for contract amendments will be included in individual contracts.

Jay Kimbrough, Executive Director, has determined that for the first five-year period the repeal is in effect there will be no fiscal implications for state or local government as a result of the proposed repeals.

Mr. Kimbrough has also determined that for each year of the first five years the repeal is in effect the anticipated public benefit will be a more logical placement of information about the process to amend a contract. There will be no effect on small businesses. There is no anticipated economic cost to current providers.

Comments on the proposal may be submitted to Tamara Allen, Rules Manager, Texas Commission on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas 78708-0529. Comments must be received no later than 30 days from the date the proposal is published in the Texas Register .

The repeal is proposed 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 proposed repeals is the Texas Health and Safety Code, Chapter 461.

§144.102.Amendments.

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

Filed with the Office of the Secretary of State, on May 24, 2000.

TRD-200003691

Karen Pettigrew

General Counsel

Texas Commission on Alcohol and Drug Abuse

Earliest possible date of adoption: July 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 proposes amendments to §§144.103-144.108, 144.121, 144.124, 144.131-144.133, 144.141, 144.142 and proposes new §§144.109, 144.134, and 144.145. concerning Contract Administration. 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 proposed to require all funded providers to contribute 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.

Jay Kimbrough, Executive Director, has determined that for the first five-year period the rules are in effect there will be no fiscal implications for state or local government as a result of enforcing the rules.

Mr. Kimbrough has also determined that for each year of the first five years the rules are in effect the anticipated public benefit will be a more effective contract administration process for commission funded providers. There is no additional effect on small businesses. There is no anticipated economic cost to persons required to comply with the proposed amendments and new sections.

Comments on the proposal may be submitted to Tamara Allen, Rules Manager, Texas Commission on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas 78708-0529. Comments must be received no later than 30 days from the date this proposal is published in the Texas Register .

These amendments and new sections are proposed 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 proposed amendments and new sections 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 . [ ; and ]

[ (G)

any other individuals identified as key personnel in the application. ]

§144.104.Matching [ Prevention ] Awards.

(a)

Unless waived in writing by the commission, all providers [ funded to provide prevention or intervention services ] shall contribute 5.0% of the total commission-funded program expenditures in matching funds from funding 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).

Financial Eligibility and Third Party Payment [ Billing ]. (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)

[ (a) ] The Commission is the payor of last resort for substance abuse services [ chemical dependency treatment ]. 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 [ client is not financially eligible ] as described in §144.521 of this title (relating to Client Eligibility); or

(2)

the individual [ client ] has access to another public or private funding source that pays for substance abuse services addressing the individual's diagnosis or condition [ of payment for appropriate treatment ].

(c)

[ (b) ] Any provider offering services eligible [ which are that ] 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 execution 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)

[ (1) ] The provider must screen all clients for Medicaid eligibility. If a client appears [ is ] eligible but has not yet applied [ enrolled ], the provider shall direct the client to apply for Medicaid benefits and provide assistance as needed to facilitate the enrollment process.

(4)

[ (2) ] 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 execution 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)

[ (c) ] The provider shall not bill the commission for any part of any [ a ] unit of service that has been billed to another entity or that is eligible for reimbursement by another entity. [ Medicaid or another third party payor who requires the provider to accept reimbursement as payment in full. ] If the third party payor denies payment and all appeals have been exhausted, [ or fails to respond or reimburse the provider for more than 60 days after the date the claim was billed, ] the provider may bill the commission for that unit of service. [ During the last month of the contract period, the provider may bill the commission for all outstanding third party reimbursement if the provider has reason to believe the payment request will be denied If the provider charges the commission for a unit of service and then receives payment from another entity for the same unit of service, the revenue shall be treated as program income in accordance with §144.123 of this title (relating to Program Income). ]

(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.

[ (d)

A provider shall not bill and receive payment in excess of actual costs from more than one entity for the same service at the same time for the same client. The total amount paid to a provider shall not exceed the actual costs of providing the services, either by client or in the aggregate. If double billing generates revenue that exceeds actual costs, the revenue shall be treated as program income in accordance with §144.123 of this title (relating to Program Income).]

[ (e)

The provider may accept funds from other funding sources that provide general support for the program.]

[ (f)

All requests for payment must be submitted no more than 30 days after the end of the contract period. The commission will not reimburse requests received after the 30-day period.]

[ (g)

Payment requests shall be accurate, and submitted in the format required by the commission, and certified by the provider's authorized representative (specified in the contract).]

§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 [ withhold ] payment if the provider is not in compliance with commission requirements, which include:

(1)

rules adopted by the commission;

(2)

terms and conditions in 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.

[ (d)

The commission shall not reimburse treatment services provided at an unlicensed site if the site is required to have a license.]

[ (e)

Providers paid through the financial assistance payment mechanism who want to receive cash advances must submit the completed method of payment selection form to the commission].

[ (f)

Payment may only be requested one month in advance.]

[ (g)

If a request for advance payment exceeds the limit established by the commission, the provider must submit documentation that justifies the need for additional funds.]

[ (h)

The 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 Financial Status Report or other documentation shows the program has commission funds on hand.]

§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 [ 30 ] 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. [ When equipment problems prevent electronic submission, the provider shall fax or mail paper copies to the commission. ] 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)

[ (c) ] The provider shall acquire and maintain the equipment and software needed for the web-based computer system.

(g)

[ (d) ] 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.

[ (e)

The provider shall submit financial reports on an accrual basis. ]

[ (f)

The provider shall reconcile the general ledger with the Financial Status Report (FSR) each quarter and maintain supporting documentation on site. ]

Cost Reimbursement [ Financial Assistance ] for Treatment Services.

(a)

The commission's standard payment mechanism for treatment services is the unit rate [ cost ] payment mechanism.

(b)

The commission may place a treatment program on cost reimbursement [ financial assistance ] 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 a specific type of commission-funded services for the first time; ]

(2)

[ (3) ] will provide commission-funded services in a specific geographic area or to a specific population for the first time; or

(3)

[ (4) ] will provide [ expand ] 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.

[ (c)

Every treatment provider on financial assistance shall submit a plan for moving from financial assistance to a unit cost basis for reimbursement. The plan must include specific actions to be taken and target dates for completion.]

[ (d)

A treatment provider on financial assistance will be transferred to unit cost payment as soon as the provider meets financial and service stability criteria or at the end of 12 months, whichever is less.]

[ (e)

To meet financial and service stability criteria, the treatment program must:]

[ (1)

reach 80% of its client capacity as specified in the contract;]

[ (2)

implement written financial policies and procedures;]

[ (3)

achieve at least 80% of the state minimum performance measures targets in completion, follow-up and abstinence; and]

[ (4)

have a computed unit cost rate under 125% of the maximum rate for services provided.]

[ (f)

If a treatment provider does not meet the financial and service stability criteria after 12 months, the commission may place the provider on a more intensive schedule of review and technical assistance and extend financial assistance for up to four three-month periods. ]

[ (g)

No treatment provider can remain on financial assistance for more than 24 months 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)

Residential programs may bill separately for family services if:

(1)

the program has allocated dollars for family services in the program budget; and

(2)

the family service units billed are in addition to the minimum hours of services required for the client's designated level of care.

(e)

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, and recreation.

(f)

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.

(g)

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 UGMS is silent, or when there is a conflict between UGMS and the federal regulations, the federal regulations shall apply. The federal cost principles and administrative requirements are applicable as follows: [ Expenditures and administration of commission and match funds shall follow guidelines for reasonableness, allowability, and administration according to the cost principles and administrative requirements for the appropriate organizational structure as specified below: ]

(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 [ Uniform Grant Management Standards (UGMS) ];

(2)

not-for-profit providers shall comply with [ UGMS as applicable, ] cost principles found in the OMB [ Office of Management and Budget (OMB) ] Circular A-122 and administrative requirements found in the OMB Circular [ Office of Management and Budget (OMB) Circulars ] 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 [ UGMS as applicable, ] 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 [ UGMS as applicable, ] 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, [ or ] 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.

[ (d)

In those instances in which UGMS is more restrictive than OMB Circulars A-110 and A-122, the provisions of UGMS shall apply. Circulars A-110 and A-122 shall apply only to the extent that no counterpart provisions exist in UGMS. ]

§144.124.Indirect Cost.

(a)

The commission reserves the right to require administrative expenses to be charged as direct costs.

(b)

[ (a) ] A provider may request approval to charge administrative expenses as indirect costs. Three mechanisms are available for charging shared administrative costs. The provider may [ In order to charge indirect costs, a provider must submit ]:

(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)

[ notice that the provider will ] use an indirect cost rate not to exceed [ of ] 10% as provided in the Uniform Grant Management Standards (UGMS). If requesting this option, the provider must provide [ The notice must include ] supporting documentation to show the direct salary and wage costs of providing the service (excluding overtime, shift premiums, and fringe benefits). [ This option shall be available only if included in UGMS. ]

(c)

All providers receiving funds from other sources must maintain a cost allocation plan showing how administrative costs are distributed among funding sources.

[ (b)

If the provider uses a cost allocation plan, the plan shall be submitted with the budget plan for advance approval. ]

[ (1)

The plan shall include a detailed explanation and itemization of which costs are included as direct and which costs are allocated as indirect. ]

[ (2)

The plan shall set forth the formula or basis for distributing shared (indirect) costs to a cost center. ]

[ (3)

Supporting documentation for the plan shall include: ]

[ (A)

the basis upon which costs are allocated; ]

[ (B)

the rational for the basis selected; and ]

[ (C)

the relevance to the commission-funded program. ]

§144.131.Expenditures Requiring Prior Approval.

For providers on a cost reimbursement payment mechanism, prior written [ Prior ] 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 [ which ] have a unit cost [ price ] 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 $5,000 or more in the aggregate [ which is required to change the interior arrangements or other physical characteristics of an existing facility, or to install equipment so that the facility may be used more effectively. Minor remodeling shall not exceed $10,000 ].

(3)

Contractual services. Contracting out, subgranting, or otherwise obtaining the services of a third party to perform activities which relate directly to service delivery or fiduciary requirements set forth in the contract. [ : ]

[ (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 [ cost categories ] when cumulative [ year-to-date ] 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 [ includes property ] needed to carry out a contract with a unit cost of [ that costs ] less than $1,000.

(c)

The provider shall conduct an annual physical inventory of all equipment and controlled items purchased with commission funds. [ The inventory shall conform with standards found in the applicable Office of Management and Budget (OMB) circular. ]

(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 [ or the federal per diem guidelines, as applicable ]. 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 [ travel ] 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 $10,000 per provider per year.

(f)

The following expenses are unallowable:

(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 [ costing no more than $25,000 in total ]. 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.

(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)

[ (c) ] If purchases for the contract period are expected to exceed $25,000, the provider [ Purchases over $25,000 ] 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 [ Providers shall not subcontract, assign, or transfer ] any activity central to the purposes of the contract to a third party [ without prior written approval from the commission ].

(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:

(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;

(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 [ approved ] subcontractor to comply with [ all provisions of the commission's contract and 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. [ The provider is responsible for paying subcontractors and shall monitor activities to assure compliance with applicable requirements. ]

(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 [ if the situation will affect the delivery of needed services. ]

(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 [ OMB Circulars ] required in [ the ] §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. All providers shall submit all financial, performance, and other closeout reports required under the contract within 60 days after the contract end date. The commission shall not be liable for any costs incurred by the provider in the performance of the contract which have not been filed with the commission within 90 days following the close of the contract period.

(b)

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 closeout time period established by the commission.

(c)

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

Filed with the Office of the Secretary of State, on May 24, 2000.

TRD-200003690

Karen Pettigrew

General Counsel

Texas Commission on Alcohol and Drug Abuse

Earliest possible date of adoption: July 9, 2000

For further information, please call: (512) 349-6733

40 TAC §§144.201, 144.204, 144.211, 144.214, 144.215, 144.216

The Texas Commission on Alcohol and Drug Abuse proposes amendments to §§144.201, 144.204, 144.211, 144.214, 144.215, and 144.216 concerning Program Oversight. 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 proposed 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 along with the audit report; 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.

Jay Kimbrough, Executive Director, has determined that for the first five-year period the rules are in effect there will be no fiscal implications for state or local government as a result of enforcing the rules.

Mr. Kimbrough has also determined that for each year of the first five years the rules are in effect the anticipated public benefit will be a more effective accountability process, including corrective action. There is no additional effect on small businesses. There is no anticipated economic cost to persons required to comply with the proposed amendments.

Comments on the proposal may be submitted to Tamara Allen, Rules Manager, Texas Commission on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas 78708-0529. Comments must be received no later than 30 days from the date this proposal is published in the Texas Register .

These amendments are proposed 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 proposed amendments 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 [ compliance reviews, monitoring visits, and contract monitoring reviews ].

(b)

The commission shall determine the extent of the review.

(c)

The commission may conduct a scheduled or unannounced on-site review [ reviews or request the provider to submit materials for desk 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)

[ (d) ] The applicant shall allow commission staff to access the facility's grounds, buildings, and records and to interview members of the governing body, staff, participants, and clients.

(f)

[ (e) ] The provider shall allow commission staff to examine all property and examine or copy all books, recordings, client records, and documents related to the contract or a commission requirement [ on or off the premises ].

§144.204.On-Site [ Compliance ] Reviews.

(a)

On-site [ compliance ] reviews will be conducted to examine compliance with the contract and with applicable federal, state, and commission regulations.

(b)

After an on-site [ compliance ] review, the provider will be notified in writing of any noncompliance with federal, state, and commission regulations [ regulation ] identified by the commission in the form of a draft report.

(c)

The provider shall respond to the draft report and the deficiencies (if any) and submit a plan of corrective action (if necessary) to the commission within 14 calendar days of the postmark date of the draft report .

(d)

The corrective action plan shall include:

(1)

the title(s) of the person(s) responsible for the corrective action;

(2)

the corrective action planned; and

(3)

the anticipated completion date.

(e)

If the provider believes corrective action is not required for a noted deficiency, the response shall include an explanation and specific reasons.

(f)

The commission shall approve the corrective action plan and may require modifications prior to approval. The provider's replies and the approved corrective action plan (if any) shall become part of the final report.

(g)

The provider shall correct deficiencies identified in the final report within the time frame specified in the approved corrective action plan [ a reasonable period of time ].

§144.211.Independent Audit Report.

(a)

Providers that expend a total amount of federal awards (from the commission and other funding sources) of at least $300,000 during their fiscal year must have a single audit or program-specific audit in accordance with Office of Management and Budget Circular A-133, the requirements of the Single Audit Act Amendments of 1996, and other governance guiding the program.

(1)

If the funds are expended under more than one federal program, the provider shall have a Single Audit.

(2)

If the funds are expended under only one federal program and the provider is not subject to laws, regulations, or federal contracts that require a financial statement audit, the provider may elect to have a program-specific audit.

(3)

The provider shall comply with the single audit requirements of Office of Management and Budget (OMB) Circular A-133.

(b)

Providers expending a total amount of state funds of at least $300,000 during their fiscal year must have either a single audit or a program-specific audit as described in the Uniform Grant Management Standards. If the provider is already required to have a single audit because of federal funding, an additional [ program ] audit is not required.

(c)

Providers that expend less than $300,000 in federal funds from all sources and less than $300,000 in state funds from all sources during their fiscal year are not required to have an audit. However, these providers shall submit a signed statement to the commission after their fiscal year end documenting that they did not expend $300,000 or more in state or federal funds during the fiscal year.

(d)

When a provider expends both state and federal funds and is required to submit a single audit report, the state and federal expenditures may be combined in one financial statement in the report. However, the source and total amount of funds expended (state vs. federal) must be clearly stated.

(e)

The commission reserves the right to require an audit for a program with expenditures less than $300,000.

§144.214.Independent Audit Report Submission.

(a)

The provider shall submit four [ two ] 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 [ the commission's Audit Report Submission Checklist ].

(b)

Audits [ for fiscal years beginning on or after July 1, 1998 ] shall be completed and submitted no later than nine months after the provider's fiscal year end. [ Audits for fiscal years beginning on or before June 30, 1998 must be completed and submitted no later than 13 months after the provider's fiscal year end. ]

§144.215.Corrective Action Plan.

(a)-(d)

(No change.)

(e)

The commission shall approve the corrective action plan and may require modifications prior to approval.

§144.216.Audit Report Desk Reviews [ Commission Review of Audit Report ].

(a)

After reviewing the audit, the commission will send the provider a resolution letter requesting a response to any administrative findings or deficiencies.

(1)

[ (b) ] The provider shall respond to the commission within 14 calendar days of the postmark date.

(2)

If the response is not satisfactory, an additional 14 days will be given to provide a satisfactory response. If the issue is not resolved after that time period, the provider will be referred for sanctions.

[ (c)

If further action is required, additional resolution letters will request specific actions or responses. The provider must respond to these requests within the given timeframes. ]

(b)

[ (d) ] When the review process indicates that no further action is needed, the commission will mail an acceptance letter to the provider.

(c)

If excess revenue is identified during the desk review process, the provider must refund the money within the specified time frame.

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

Filed with the Office of the Secretary of State, on May 24, 2000.

TRD-200003692

Karen Pettigrew

General Counsel

Texas Commission on Alcohol and Drug Abuse

Earliest possible date of adoption: July 9, 2000

For further information, please call: (512) 349-6733

40 TAC §144.203

(Editor's note: The text of the following section proposed for repeal will not be published. The section may be examined in the offices of the Texas Commission on Alcohol and Drug Abuse or in the Texas Register office, Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)

The Texas Commission on Alcohol and Drug Abuse proposes the repeal of §144.203 concerning Program Oversight. This section contains the requirements for on-site contract reviews. The repeal is proposed because the requirements contained in this section have been incorporated into other sections.

Jay Kimbrough, Executive Director, has determined that for the first five-year period the repeal is in effect there will be no fiscal implications for state or local government as a result of the proposed repeals.

Mr. Kimbrough has also determined that for each year of the first five years the repeal is in effect the anticipated public benefit will be elimination of redundant rules. There will be no effect on small businesses. There is no anticipated economic cost to current providers.

Comments on the proposal may be submitted to Tamara Allen, Rules Manager, Texas Commission on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas 78708-0529. Comments must be received no later than 30 days from the date the proposal is published in the Texas Register.

The repeal is proposed 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 proposed repeals is the Texas Health and Safety Code, Chapter 461.

§144.203.On-site Contract Reviews.

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

Filed with the Office of the Secretary of State, on May 24, 2000.

TRD-200003693

Karen Pettigrew

General Counsel

Texas Commission on Alcohol and Drug Abuse

Earliest possible date of adoption: July 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 proposes amendments to §§144.311, 144.313, 144.321-144.323, and 144.325 concerning organizational requirements. 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 proposed 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.

Jay Kimbrough, Executive Director, has determined that for the first five-year period the rules are in effect there will be no fiscal implications for state or local government as a result of enforcing the rules.

Mr. Kimbrough has also determined that for each year of the first five years the rules are in effect the anticipated public benefit will be a better understanding of the organizational requirements for providers. There is no additional effect on small businesses. There is no anticipated economic cost to persons required to comply with the proposed amendments.

Comments on the proposal may be submitted to Tamara Allen, Rules Manager, Texas Commission on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas 78708-0529. Comments must be received no later than 30 days from the date the proposal is published in the Texas Register .

These amendments are proposed 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 proposed amendments 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)

commision-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; [ and ]

(6)

client/participants receive appropriate services; and

(7)

client services are adequately documented.

Management and Organization [ Governing Body and Chief Executive Officer ].

(a)

All entities shall have a governing body that is legally responsible for the integrity of the fiscal and programmatic management of the organization.

(b)

The governing body shall be a distinct [ separate ] business entity with legal authority to operate in the State of Texas.

(c)

Staff members, including the chief executive officer, of a public or nonprofit entity shall not serve on their employer's governing board.

(d)

The governing body shall appoint a chief executive officer to manage the day-to-day operations of the organization and ensure that the organization has the programmatic, managerial, and financial capability to ensure proper planning, management, and delivery of funded services.

(e)

The governing body shall meet at least quarterly and maintain minutes that include:

(1)

date, time, and place of the meeting;

(2)

names of members present and absent; and

(3)

summary of discussion and action taken.

(f)

The governing body shall provide all members with information about the responsibilities and liabilities of the governing body and its individual members.

(g)

The governing body shall ensure that all of its members are familiar with the provider's target population(s) [ program's target population ] and sensitive to the needs of the different cultures represented.

(h)

The chief executive officer shall:

(1)

have documented education and/or experience in financial, administrative, and personnel management, and other areas needed to manage the organization [ facility ] effectively;

(2)

ensure compliance with applicable laws and rules;

(3)

ensure that all staff are competent and trained;

(4)

establish mechanisms to ensure quality of services; and

(5)

maintain adequate financial records according to generally accepted accounting principles.

(i)

The provider shall maintain a chart of the organization's structure and documentation of its staffing pattern.

(1)

Documentation shall be sufficient to identify all staff positions, the individuals filling those positions, and current vacancies.

(2)

The provider shall review and update the information (if necessary) at least annually.

§144.321.Policies and Procedures.

(a)

The provider shall maintain a current manual that includes all policies and procedures required by the commission.

(1)

Policies shall be approved by the board, reviewed annually, and revised as needed.

(2)

Procedures shall be approved by the chief executive officer, reviewed annually, and revised as needed.

(3)

The provider shall require each employee to read the policies and procedures applicable to the position and maintain documentation signed by the employee that the policies and procedures have been read and understood.

(b)

The policy and procedure manual must include the following policies and procedures, as applicable.

(1)

All providers shall adopt and implement TCADA Workplace and Education Guidelines for HIV and Other Communicable Diseases in order to meet requirements as specified by the Americans with Disabilities Act, the Texas Health and Safety Code, Chapter 85, and standard precautions for infection control as outlined by The Centers for Disease Control and Prevention.

(2)

All providers shall implement written policies and procedures to protect client/participant records and client/participant-identifying information from unauthorized disclosure in accordance with the federal regulations governing Confidentiality of Alcohol and Drug Abuse Patient Records, Code of Federal Regulations, Title 42, Part 2.

(3)

All providers shall implement a written policy prohibiting discrimination, as required in §144.324 of this title (relating to Limiting Barriers).

(4)

All providers shall implement a written policy and procedures for handling complaints as required in §144.325 of this title (relating to Complaints and Reports).

(5)

All providers shall implement procedures for reviewing employee backgrounds as required in §144.326 of this title (relating to Staffing).

(6)

All providers shall implement a policy on standards of conduct as required in §144.327 of this title (relating to Standards of Conduct).

(7)

All programs shall implement a policy and procedures to protect client and participant rights, as required in §144.415 of this title (relating to Participant Rights) and §148.142 of this title (relating to Client Bill of Rights).

(8)

All programs shall implement a policy and, if applicable, procedures on the use of facility vehicles and/or staff to transport participants or clients, as required in §144.418 of this title (relating to Transportation) and §148.203 of this title (relating to Client Transportation).

(9)

All prevention and intervention programs shall implement a tobacco policy as required in §144.416 of this title (relating to Tobacco Products). Treatment providers shall also have a tobacco policy to implement the provisions found in §148.331 of this title (relating to General Environment) and §148.231 of this title (relating to Adolescents).

(10)

All OSAR programs and treatment programs shall implement procedures for mental health referrals as required in §144.456 of this title (relating to OSAR Services) and §144.525 of this title (relating to Admission Determination and Placement).

(11)

All OSAR programs shall implement policies and procedures for crisis intervention as required in §144.456 of this title (relating to OSAR Services).

(12)

All Pregnant Postpartum Intervention Programs and Specialized Female Programs shall implement service coordination procedures for providing children's services as required in §144.458 of this title (relating to Pregnant Postpartum Intervention Programs) and §144.541 of this title (relating to Specialized Treatment Services for Females).

(13)

All HIV Outreach programs shall implement procedures to protect the confidentiality of identified individuals as required in §144.462 of this title (relating to HIV Outreach Services).

(14)

All treatment programs shall implement financial eligibility assessment procedures as required in §144.521 of this title (relating to Client Eligibility).

(15)

All treatment programs shall implement screening and admission procedures as required in §144.522 of this title (relating to Priority Populations).

(16)

All treatment programs shall implement waiting list procedures as required in §144.523 of this title (relating to Waiting List and Interim Services).

(17)

All treatment programs shall implement a policy and procedures for assessment of potential harm to self or others as required in §144.525 of this title (relating to Admission Determination and Placement).

(18)

All treatment programs shall implement procedures for monitoring length of stay as required in §144.526 of this title (Length of Stay Guidelines).

(19)

All pharmacotherapy programs shall adopt policies and procedures for capacity management as required in §144.543 of this title (relating to Pharmacotherapy Services).

[ (a)

The provider shall operate according to policies and procedures that comply with all applicable commission rules. ]

[ (b)

The governing body shall establish policies that comply with commission rules, and the chief executive officer shall use the policies to develop and implement all needed procedures.]

(c)

The policy and procedures manual shall be current, consistent [ in compliance ] with current commission rules, individualized to the program, well organized, and easily accessible to all staff at all times.

(d)

Within 10 days of a policy or procedure change, the provider shall inform staff about any changes to the policy and procedure manual that are relevant to their job duties and document the notification. If training is needed, it shall be provided and documented within 60 days.

[ (e)

The provider shall adopt and implement TCADA Workplace and Education Guidelines for HIV and Other Communicable Diseases in order to meet requirements as specified by the Americans with Disabilities Act, the Texas Health and Safety Code, Chapter 85, and standard precautions for infection control as outlined by The Centers for Disease Control and Prevention]

[ (f)

The provider shall implement written policies and procedures to protect client/participant records and client/participant-identifying information from unauthorized disclosure in accordance with the federal regulations governing Confidentiality of Alcohol and Drug Abuse Patient Records, Code of Federal Regulations, Title 42, Part 2.]

Documentation and Records. (a)

The provider shall keep complete, current documentation.

(1)

All required documents shall be factual and accurate.

(2)

Authentication shall include signature, credentials when applicable, and date. If the document relates to past activity, the date of the activity shall also be recorded.

(3)

Documentation shall be permanent and legible.

(4)

When it is necessary to correct a required document, the error shall be marked through with a single line, dated, and initialed by the writer.

(b)

[ (a) ] The provider shall maintain current personnel documentation on each employee. Training records may be stored separately from the main personnel file, but shall be easily accessible upon request. Required documentation includes, as applicable:

(1)

a copy of the current job description signed by the employee;

(2)

application or resume with documentation of required qualifications;

(3)

documentation that required credentials were verified directly with the credentialing body;

(4)

annual performance evaluations;

(5)

personnel data that includes date hired, rate of pay, and documentation of all pay increases and bonuses;

(6)

documentation of appropriate screening and/or background checks;

(7)

signed documentation of initial and other required training; and

(8)

records of any disciplinary actions.

(c)

[ (b) ] The provider shall maintain all records relating to the contract for at least three years from the date the independent financial audit is accepted [ due ] (when required) or would have been due (when not required) as stated in §144.214 of this title (relating to Independent Audit Report Submission). If any litigation, audit, or other action is in process at the end of three years, the records must be kept until the action is resolved. If a provider closes business operations, it shall ensure that records relating to the contract are securely stored and accessible for at least three years. The provider shall provide the commission with the name and address of the responsible party.

§144.323.Commission Logo and Slogan.

The provider may not use the commission's logo and slogan in [ on ] publications, electronic media, or video material unless the commission has given written permission [ approval ].

§144.325.Complaints and Reports.

(a)

Providers shall have written policy and procedures for handling complaints from clients, participants, and their families.

(b)

The provider shall display a sign informing the public of the policy and procedures on complaints. The sign shall be prominently displayed at all times and shall provide notice of the commission's compliance division and its mailing address and toll-free phone number.

(c)

The provider shall verbally report all allegations of participant or client abuse, neglect, and exploitation to the commission's investigation department at (800) 832-9623 within 24 hours, and submit documentation within two working days. The provider shall investigate the allegation, take appropriate action, and maintain documentation of the investigation and resulting actions.

(d)

The chief executive officer or designee shall report the following incidents to the commission's investigation department at (800) 832-9623 within 24 hours of discovery:

(1)

fires and natural disasters;

(2)

substantial disruption of program operation;

(3)

death of an active client/participant (on or off the program site);

(4)

violations of laws, rules, and professional and ethical codes of conduct; and

(5)

legal, regulatory, or contractual action taken against the program.

(e)

[ (d) ] The provider shall not retaliate against anyone who reports a violation or cooperates during an investigation or related activity.

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

Filed with the Office of the Secretary of State, on May 24, 2000.

TRD-200003694

Karen Pettigrew

General Counsel

Texas Commission on Alcohol and Drug Abuse

Earliest possible date of adoption: July 9, 2000

For further information, please call: (512) 349-6733

40 TAC §144.312

(Editor's note: The text of the following section proposed for repeal will not be published. The section may be examined in the offices of the Texas Commission on Alcohol and Drug Abuse or in the Texas Register office, Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)

The Texas Commission on Alcohol and Drug Abuse proposes the repeal of §144.312 concerning organizational requirements. This section contains the requirements for organizational structure. The repeal is proposed because requirements for organizational structure have been incorporated into other sections.

Jay Kimbrough, Executive Director, has determined that for the first five-year period the repeal is in effect there will be no fiscal implications for state or local government as a result of the proposed repeals.

Mr. Kimbrough has also determined that for each year of the first five years the repeal is in effect the anticipated public benefit will be the elimination of redundant rules. There will be no effect on small businesses. There is no anticipated economic cost to current providers.

Comments on the proposal may be submitted to Tamara Allen, Rules Manager, Texas Commission on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas 78708-0529. Comments must be received no later than 30 days from the date the proposal is published in the Texas Register.

The repeal is proposed 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 proposed repeals is the Texas Health and Safety Code, Chapter 461.

§144.312.Organizational Structure.

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

Filed with the Office of the Secretary of State, on May 24, 2000.

TRD-200003696

Karen Pettigrew

General Counsel

Texas Commission on Alcohol and Drug Abuse

Earliest possible date of adoption: July 9, 2000

For further information, please call: (512) 349-6733

40 TAC §144.326

The Texas Commission on Alcohol and Drug Abuse proposes amendments to §144.326 concerning organizational requirements. This section contains information regarding staffing.

The amendments are proposed 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.

Jay Kimbrough, Executive Director, has determined that for the first five-year period the rules are in effect there will be no fiscal implications for state or local government as a result of enforcing the rules.

Mr. Kimbrough has also determined that for each year of the first five years the rules are in effect the anticipated public benefit will be assurance that program directors are well qualified, that programs offer a safe and drug-free environment, and that staff are appropriately trained on standards of conduct. There is no additional effect on small businesses. There is an anticipated economic cost to some persons required to comply with the proposed amendments. Some programs will have a cost because the amendments establish minimum standards for individuals who direct the program's services. The commission anticipates that most program directors currently meet these standards, but some programs may need to find a more experienced director. For these programs, salary for the program director might increase $5,000 per year. Some programs will have an economic cost because they will be required to obtain criminal background checks on all employees, not just those with access to children or adolescents. The cost associated with this requirement will vary based on the method used to obtain the background check and will be between $3-$15 per staff person. The final change that will result in an economic cost is the requirement that prospective employees must pass a pre-employment drug test. This will cost between $20-$40 per staff person.

Comments on the proposal may be submitted to Tamara Allen, Rules Manager, Texas Commission on Alcohol and Drug Abuse, P. O. Box 80529, Austin, Texas 78708-0529. Comments must be received no later than 30 days from the date the proposal is published in the Texas Register .

These amendments are proposed 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 proposed amendments is the Texas Health and Safety Code, Chapter 461.

§144.326.Staffing.

(a)

The provider shall have an adequate number of qualified staff to comply with commission rules, provide the services described in the program description, and protect the health, safety, and welfare of clients/participants.

(b)

Every program shall have an employee designated to serve as director. The individual must have appropriate education and training and at least two years of experience providing related services.

(1)

The director of a prevention program must have at least two years of experience in substance abuse prevention, and the director of an intervention program must have at least two years experience in intervention. At least one year of experience must be specific to the program's target population.

(2)

The director of a treatment program must be a QCC with at least two years of post-licensure experience providing treatment, with at least one year of experience providing services to the program's target population (adult, adolescent, or specialized female).

(3)

The program director shall spend and document sufficient time at the program site to provide appropriate oversight and supervision.

(c)

[ (b) ] The program shall hire applicants who meet the minimum qualifications listed in the job description.

[ (c) ]

The application or resume shall document required education, training, and related work experience.

(d)

The program [ facility ] 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 . The review shall be appropriate for each person's level of access and shall adequately protect the program's clients/participants and financial resources .

(e)

The program shall obtain the results of a statewide criminal background check from the Department of Public Safety on all staff [ with access to adolescents or children ]. The program shall use the criteria listed in §§53.022 and 53.023 of the Texas Occupations Code to evaluate criminal history reports and make related employment decisions.

(f)

The program shall require all prospective employees to pass a pre-employment drug test that meets criteria established by the commission.

(g)

[ (f) ] The facility shall ensure that staff are adequately trained and competent to perform job duties.

(h)

[ (g) ] Each employee shall complete initial training during the first seven calendar days of employment. The initial training shall include, as applicable:

(1)

client/participant rights;

(2)

client/participant complaint procedures;

(3)

confidentiality of client/participant-identifying information;

(4)

client/participant abuse, neglect, and exploitation;

(5)

requirements for reporting abuse, neglect, and exploitation;

(6)

standards of conduct; and

(7)

the individual's specific job duties.

(i)

[ (h) ] The program shall establish an annual staff training plan for employees based on the program design and identified staff needs. The plan must include annual [ cultural competency ] training for all employees on: [ . ]

(1)

cultural competency; and

(2)

standards of conduct.

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

Filed with the Office of the Secretary of State, on May 24, 2000.

TRD-200003695

Karen Pettigrew

General Counsel

Texas Commission on Alcohol and Drug Abuse

Earliest possible date of adoption: July 9, 2000

For further information, please call: (512) 349-6733

40 TAC §§144.411, 144.412, 144.414, 144.415, 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 proposes amendments to §§144.411, 144.412, 144.414, 144.415, 144.446, 144.447, 144.451-144.453, 144.455, 144.458, 144.460, 144.462 and proposes new §144.418 concerning Prevention and Intervention. 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 are proposed 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.

Jay Kimbrough, Executive Director, has determined that for the first five-year period the rules are in effect there will be no fiscal implications for state or local government as a result of enforcing the rules.

Mr. Kimbrough has also determined that for each year of the first five years the rules are in effect the anticipated public benefit will be more clarity regarding requirements for prevention and intervention programs. There is no additional effect on small businesses. There is no anticipated economic cost to persons required to comply with the proposed amendments and new section.

Comments on the proposal may be submitted to Tamara Allen, Rules Manager, Texas Commission on Alcohol and Drug Abuse, P.O. Box 80529, Austin, Texas, 78708-0529. Comments must be received no later than 30 days from the date the proposal is published in the Texas Register .

The amendments and new section are proposed 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 proposed amendments and new section is the Texas Health and Safety Code, Chapter 461.

§144.411.Program Design and Implementation.

(a)-(e)

(No change.)

(f)

In order to carry out the program design, the program shall incorporate a combination of some or all of CSAP's six prevention strategies (information dissemination, prevention education and skills training, alternative activities, problem identification and referral, community-based process, and environmental and social policy). All Youth Prevention Programs (YPP) and Youth [ Prevention ] Intervention Programs (YPI) [ Programs ] must at a minimum conduct prevention education and skills training as a core strategy. Each strategy and activity must:

(1)-(2)

(No change.)

(g)-(j)

(No change.)

§144.412.Program Self-Evaluation.

(a)

The program shall perform self-evaluation to verify, document, and quantify program activities and effectiveness unless the contract waives this requirement . [ Programs required to complete the self-evaluation include Youth Prevention Programs, Youth Intervention Programs, Community Coalitions, Core Council Services, Pregnant-Post Partum Prevention Programs, Pregnant-Post Partum Intervention Programs, Adult Primary Prevention, HIV Early Intervention Services, HIV Outreach Services, and Compulsive Gambling. ]

(b)-(e)

(No change.)

(f)

The program shall use information gained from the annual self-evaluation to make appropriate changes to the program and the staff training plan. Any change requiring commission approval must be made through a contract amendment [ as described in §144.103 of this title (relating to Amendments) ].

§144.414.Performance Measure Review.

(a)-(c)

(No change.)

(d)

After receiving the response, the commission shall take at least one of the following actions.

(1)

(No change.)

(2)

Specify [ Negotiate ] additional corrective actions or conditions [ , a revision of the performance goals and/or interim goals, with appropriate timelines established to measure progress ].

(3)

Impose contract restrictions or sanctions or terminate the contract.

§144.415.Participant Rights.

(a)-(c)

(No change.)

(d)

The provider shall maintain documentation that participants receiving individualized services in an intervention program have received the required information and agreed to participate in the program.

(e)

[ (d) ] Programs that provide services to identified individuals shall maintain the confidentiality of participant-identifying information as required by the federal regulations governing Confidentiality of Alcohol and Drug Abuse Patient Records, Code of Federal Regulations, Title 42, Part 2.

Tobacco Products [ Smoking Policies ].

(a)

The program shall prohibit use of tobacco products [ smoking ] inside program buildings.

(b)-(c)

(No change.)

(d)

Staff and other adults (volunteers, clients, and visitors) shall not use tobacco products in the presence of children or adolescent participants on the program site.

(e)

The program shall prohibit children and adolescents from using tobacco products on the program site or during structured program activities.

(f)

The program shall have a written [ smoking ] policy that complies with this section.

§144.418.Transportation.

(a)

The program shall have a written policy on the use of facility vehicles and/or staff to transport participants.

(b)

If the program allows the use of program vehicles and/or staff to transport participants, it must adopt transportation procedures which include the following elements:

(1)

Any vehicle used to transport a participant must have appropriate insurance coverage for business use with a current safety inspection sticker and license.

(2)

All vehicles used to transport participants must be maintained in safe driving condition.

(3)

Drivers must have a valid driver's license.

(4)

Drivers and passengers must wear seatbelts at all times the vehicle is in operation.

(5)

A vehicle shall not be used to transport more passengers than designated by the manufacturer.

(6)

Drivers shall not use cellular phones while driving.

(7)

Use of tobacco products shall not be allowed in the vehicle.

(8)

Every vehicle used for client transportation shall have a fully stocked first aid kit and A:B:C fire extinguisher that are easily accessible.

§144.446.Environmental and Social Policy.

(a)-(d)

(No change.)

(e)

Documentation of minors and tobacco presentations shall include the elements required in §144.441 of this title (relating to Information Dissemination).

§144.447.Intervention Services.

(a)

Each [ A ] program that provides activities within this strategy shall provide intervention services to [ may offer intervention services to meet the needs of ] individual participants who [ do not meet DSM-IV criteria for abuse or dependence, but ] are showing early warning signs of substance use or abuse and/or [ and ] exhibiting other high risk problem behaviors [ associated with substance abuse ]. Family members may also be involved in intervention services.

(b)

The program shall determine the needs of the participant (and family members) in a culturally appropriate, face-to-face assessment. The intervention assessment shall gather information to identify the participant's risk and protective factors in five domains: individual, family, school, peer relationships, and community.

(1)

(No change.)

(2)

Information about the family shall include:

(A)

structure; [ and ]

(B)

functioning ; and [ . ]

(C)

family history of ATOD use.

(3)

School information shall include:

(A)

(No change.)

(B)

academic performance; and

[(C)

social functioning; and]

(C)

[ (D) ] behavioral functioning issues.

(4)

Information about peer relationships shall include:

(A)

(No change.)

(B)

gang or club involvement; [ and ]

(C)

legal issues ; and [ . ]

(D)

social functioning.

(5)

Information about the community shall include:

(A)

(No change.)

(B)

general environment; [ and ]

(C)

criminal activity ; and [ . ]

(D)

availability of ATOD.

(c)

The staff person [ counselor ] and the participant (and family members, if appropriate) shall develop a service plan to address identified needs. The service plan shall include:

(1)-(3)

(No change.)

(d)

Intervention counseling shall be conducted through confidential face-to-face contacts with participants and/or family members. [ All intervention counseling sessions shall be documented in the participant's service record, including a summary of the session and progress toward or away from identified goals. ]

(e)

Intervention services shall be documented in an individual service record which includes:

(1)

the intervention assessment;

(2)

the intervention service plan;

(3)

documentation of each intervention counseling session, including a summary of the session and progress toward or away from identified goals;

(4)

referrals and follow-ups; and

(5)

an exit summary which includes a description of the results achieved and participant status at closure.

[(e)

The program shall provide information, referrals, and follow-up for participant and/or family needs that cannot be met by the program. These referrals must be documented in the service record.]

[(f)

The program may also provide crisis intervention, family case management, and support group opportunities.]

[(g)

When intervention services are completed, the counselor shall file an exit summary in the service record which includes a description of the results achieved and participant status at closure.]

§144.451.Youth Prevention Programs.

(a)

The goal of youth prevention programs shall be to preclude the onset of the [ illegal ] use of alcohol, tobacco and other drugs by youth and to foster the development of social and physical environments that facilitate healthy, drug-free lifestyles.

(b)

(No change.)

§144.452.Youth Intervention Programs.

(a)

The goal of youth intervention programs shall be to prevent or interrupt the [ illegal ] use of alcohol, tobacco and other drugs by youth who are showing early warning signs of substance use or abuse and/or exhibiting other high-risk problem behaviors [ and to break the cycle of harmful use of legal substances and all use of illegal substances by adults ] in order to halt the progression and escalation of use, abuse, and related problems.

(b)

Youth intervention programs shall offer indicated prevention strategies to youth and their families , including intervention services as described in §144.447 of this title (relating to Intervention Services) .

(c)

The program shall provide information, referrals, and follow-up for participant and/or family needs that cannot be met by the program. These referrals must be documented.

(d)

If a participant shows signs of established substance abuse or dependency and appears to be in need of more intensive services, the program shall refer the client for treatment assessment and placement. The program may continue to provide intervention services on an interim basis to a participant who has been referred to treatment.

(e)

The program may also provide crisis intervention services to participants and their families to intervene in situations which may or may not involve alcohol and drug use, and which may escalate and result in crisis if immediate attention is not provided.

(1)

Crisis intervention may be offered through telephone contacts and/or face-to-face individual, family, and group interventions.

(2)

Crisis intervention services must be documented.

(3)

Crisis intervention services in the context of a youth intervention program may be provided by non-licensed staff who are qualified to perform these functions.

§144.453.Community Coalitions.

(a)

Community coalitions shall implement strategies designed to accomplish the following goals:

(1)

to prevent and reduce substance use and abuse among youth in each community served;

(2)-(3)

(No change.)

(b)-(c)

(No change.)

(d)

Community coalitions shall implement community-based processes and environmental and social policy strategies in the community.

(e)

[ (d) ] Community coalitions shall not provide or subcontract for the provision of individual direct services , including [ -- ] prevention education and skills training, alternative activities or problem identification and referral [ --as described in §144.442 of this title (relating to Prevention Education and Skills Training) ].

§144.455.Prevention Resource Centers.

(a)-(b)

(No change.)

(c)

Identified target groups shall include at a minimum: prevention professionals and volunteers; community leaders; teachers; school counselors and educational administrators; children and adolescents [ youth ]; parents and families; communities at large; local news media within the region served; and other persons in need of training in the area of alcohol, tobacco and other drugs.

(d)

(No change.)

(e)

Each program shall submit a quarterly narrative [ monthly ] report detailing the past quarter's [ month's ] efforts in the required Prevention Resource Center services categories.

§144.458.Pregnant Postpartum Intervention Programs.

(a)

(No change.)

(b)

Pregnant postpartum intervention programs shall provide [ indicated ] intervention strategies to pregnant and postpartum substance using or abusing women and their children .

(c)

The following services shall be provided directly or through collaborative agreements and case management arrangements with other service providers:

(1)

primary medical care including age-appropriate reproductive health care, prenatal care, and perinatal care;

(2)

counseling services that address gender-specific issues including relationships, parenting, and sexual and physical abuse;

(3)

primary pediatric care including immunizations;

(4)

assessments for Early Childhood Intervention services;

(5)

counseling and other supportive interventions to address the children's identified developmental, emotional, or psychocial needs; and

(6)

transportation services to ensure that participants and their children have access to services.

(d)

Programs shall implement a coordinated outreach plan targeting services and organizations that regularly serve adult or adolescent females with or without dependent children, including but not limited to Child Protective Services, the Temporary Aid for Needy Families (TANF) program, and STD, perinatal, and pediatric clinics.

(e)

Programs shall refer participants for treatment assessment and placement and/or peer support groups when indicated.

(f)

[ (c) ] Each program shall submit a quarterly narrative report.

§144.460.HIV Early Intervention Services (HEI).

(a)

Programs receiving HIV early intervention funds shall provide comprehensive HIV services to HIV infected persons with substance abuse problems and/or persons at risk of being infected as a result of substance abuse related activity and their families and/or significant others. HIV early intervention services shall include the following components.

(1)-(2)

(No change.)

(3)

Case management to identify and access appropriate medical and social services for HIV infected clients and their families and/or significant others.

(A)

Medical services for HIV [ HI- ] infected clients include laboratory analyses to monitor HIV status and ensure access to prescribed medication and/or alternative treatments used to slow down or prevent HIV disease progression. Services may also include clinical supervision as needed to carry out medical service functions.

(B)

(No change.)

(b)-(c)

(No change.)

(d)

HIV early intervention programs share responsibility for providing interim services required in §144.523 of this title (relating to Waiting List and Interim Services) with TCADA-funded HIV outreach programs as a referral resource for all treatment programs in the region where HIV Outreach and HEI programming is available.

(1)

Service agreements between these two program types will specifically outline each program's responsibilities for HIV antibody test counseling and testing, TB screening, and education about the relationship between substance abuse and communicable disease.

(2)

Each service agreement shall be renewed at the beginning of each fiscal year through signature or other documented contact.

(e)

[ (d) ] Programs shall establish linkages with a comprehensive community resource network of related health, social service providers, and Texas Department of Health (TDH)-sponsored community or regional planning groups.

(1)

Networks shall be documented by written service agreements that are specific as to activities performed by the referral agency and those performed by the commission-funded provider. Service agreements shall be signed by responsible parties of both agencies.

(2)

Letters from TDH HIV Prevention and Services planning bodies which describe the commission-funded provider as being an active member or participant is sufficient documentation for the requirement to have an agreement with TDH-sponsored community or regional planning groups. [ Service agreements shall be signed by responsible parties of both agencies. Letters from planning councils/consortia/groups chairs or co-chairs which describe the commission-funded provider as being an active member or participant is sufficient documentation for this requirement. ]

(3)

Each service agreement or planning group letter shall be renewed at the beginning of each fiscal year through signature or other documented contact .

(f)

Programs shall implement case identification strategies that develop relationships with and market HEI services to the target populations, HIV outreach programs, other HIV service organizations, substance abuse treatment programs, and related health organizations.

(g)

[ (e) ] Each HEI program shall submit annual goals relating to anticipated numbers of persons to be served during the course of the contract period. Goals shall address the following key performance measures:

(1)

Referral/follow-up: The percentage of client referrals made by the HIV Early Intervention program which resulted in an initial contact of service provider by the client within 1 to 14 days during the report period.

(2)

Clients receiving substance abuse services: The percentage of clients who receive substance abuse services while enrolled as a client of HIV early intervention services.

(h)

[ (f) ] Each HEI program shall submit annual and quarterly reports.

§144.462.HIV Outreach Services.

(a)

HIV outreach programs identify [ target ] substance abusers who may or may not be seeking treatment and provide them with information, activities, referrals, and education directed toward informing drug users about the relationship between drug use (especially injecting drug activity) and communicable diseases. The target population includes:

(1)

injecting drug users at risk of HIV infection;

(2)

women, adolescents, and ethnic minority drug users at risk of infection from HIV and other communicable diseases through drug use or unprotected sexual activities; and

(3)

other drug users at risk of HIV and other communicable diseases.

(b)-(c)

(No change.)

(d)

HIV Outreach Programs share responsibility for providing interim services required in §144.523 of this title (relating to Waiting List and Interim Services) with TCADA-funded HEI programs as a referral resource for all treatment programs in the region where HIV Outreach and HEI programming is available.

(1)

Service agreements between these two program types will specifically outline each program's responsibilities for HIV antibody test counseling and testing, TB screening, and education about the relationship between substance abuse and communicable disease.

(2)

Each service agreement shall be renewed at the beginning of each fiscal year through signature or other documented contact.

(e)

[ (d) ] HIV outreach programs shall establish linkages with a comprehensive community resource network of related health, social service providers and Texas Department of Health (TDH)-sponsored community or regional planning groups.

(1)

Service agreements shall outline services and activities performed by each agency, and include signatures from responsible parties of each program. [ Letters from planning council/consortia chairs or co-chairs which describe the commission funded provider as an active member or participant is sufficient documentation for this requirement. ]

(2)

Letters from TDH HIV Prevention and Services planning bodies which describe the commission-funded provider as being an active member or participant is sufficient documentation for the requirement to have an agreement with TDH-sponsored community or regional planning groups.

(3)

[ (2) ] Each service agreement or planning group letter shall be renewed at the beginning of each fiscal year through signature or other documented contact .

(f)

HIV outreach programs shall implement case identification strategies that develop relationships with and market HIV outreach services to target populations, HIV Early Intervention programs, other HIV service organizations, substance abuse treatment programs, and related health organizations.

(g)

[ (e) ] HIV outreach programs shall report to the commission monthly, quarterly and annually.

(1)

Monthly reports shall be submitted electronically through the commission's web-based computer system and will include data on key performance measures and demographics.

(2)

Quarterly documents will report street activities that include a narrative describing observations or current trends in drug activity, barriers and/or successful strategies used when providing outreach services to the target population.

(3)

Program self-evaluation is required and shall consist of a report generated annually by ongoing program work using the Prevention Plus III process.

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

Filed with the Office of the Secretary of State, on May 24, 2000.

TRD-200003697

Karen Pettigrew

General Counsel

Texas Commission on Alcohol and Drug Abuse

Earliest possible date of adoption: July 9, 2000

For further information, please call: (512) 349-6733

40 TAC §144.417

The Texas Commission on Alcohol and Drug Abuse proposes an amendment to §144.417 concerning Prevention and Intervention. This section contains information regarding staff training.

The amendment is proposed 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.

Jay Kimbrough, Executive Director, has determined that for the first five-year period the rule is in effect there will be no fiscal implications for state or local government as a result of enforcing the rule.

Mr. Kimbrough has also determined that for each year of the first five years the rule is in effect the anticipated public benefit will better trained prevention and intervention staff. There is no additional effect on small businesses. There is an anticipated economic cost to persons required to comply with the proposed amendment. The amendment requires an additional eight hours of training for prevention and intervention staff. In addition to lost productivity, some providers may need to secure outside resources for this training. The commission estimates the cost for eight hours of outside training would be approximately $350-$750.

Comments on the proposal may be submitted to Tamara Allen, Rules Manager, Texas Commission on Alcohol and Drug Abuse, P.O. Box 80529, Austin, Texas, 78708-0529. Comments must be received no later than 30 days from the date the proposal is published in the Texas Register .

The amendment is proposed 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 proposed amendment is the Texas Health and Safety Code, Chapter 461.

§144.417.Staff Training.

(a)

During the first six months of employment, all direct service prevention and intervention staff shall receive a total of 16 [ eight ] hours of training (or document 16 [ eight ] hours of equivalent training) , with a minimum of three hours in each of the following areas:

(1)

(No change.)

(2)

risk and protective factors/ building resiliency; [ and ]

(3)

child development and/or adolescent development, as appropriate ; and [ . ]

(4)

strategies for strengthening families.

(b)

Staff shall have specific [ Specific ] training in the curriculum implemented for Prevention Education/Skills Training before facilitating the curriculum independently.

(c)

In subsequent years, all direct services prevention staff shall receive eight hours of prevention training related to the program design.

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

Filed with the Office of the Secretary of State, on May 24, 2000.

TRD-200003698

Karen Pettigrew

General Counsel

Texas Commission on Alcohol and Drug Abuse

Earliest possible date of adoption: July 9, 2000

For further information, please call: (512) 349-6733

40 TAC §§144.448, 144.456, 144.457, 144.459

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

The Texas Commission on Alcohol and Drug Abuse proposes the repeal of §§144.448, 144.456, 144.457, and 144.459 concerning Prevention and Intervention. These sections contain the requirements for assessment for treatment, core council services, pregnant postpartum prevention programs, and other special prevention programs. The repeals are proposed because some of these requirements are deleted and others are incorporated into amended or new sections that are concurrently proposed.

Jay Kimbrough, Executive Director, has determined that for the first five-year period the repeal is in effect there will be no fiscal implications for state or local government as a result of the proposed repeals.

Mr. Kimbrough has also determined that for each year of the first five years the repeals are in effect the anticipated public benefit will be the elimination of unnecessary rules. There will be no effect on small businesses. There is no anticipated economic cost to current providers.

Comments on the proposal may be submitted to Tamara Allen, Rules Manager, Texas Commission on Alcohol and Drug Abuse, P.O. Box 80529, Austin, Texas, 78708-0529. Comments must be received no later than 30 days from the date the proposal is published in the Texas Register .

The repeals are proposed 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 proposed repeals is the Texas Health and Safety Code, Chapter 461.

§144.448.Assessment for Treatment.

§144.456.Core Council Services.

§144.457.Pregnant Postpartum Prevention Programs.

§144.459.Other Special Prevention Programs.

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

Filed with the Office of the Secretary of State, on May 24, 2000.

TRD-200003700

Karen Pettigrew

General Counsel

Texas Commission on Alcohol and Drug Abuse

Earliest possible date of adoption: July 9, 2000

For further information, please call: (512) 349-6733

40 TAC §144.456

The Texas Commission on Alcohol and Drug Abuse proposes new §144.456, concerning Prevention and Intervention. This section contains information regarding outreach, screening, assessment, and referral services.

This new section is proposed 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.

Jay Kimbrough, Executive Director, has determined that for the first five-year period the rule is in effect there will be no fiscal implications for state or local government as a result of enforcing the rule.

Mr. Kimbrough has also determined that for each year of the first five years the rule is in effect the anticipated public benefit will more effective outreach, screening, assessment and referral services. There is no additional effect on small businesses. There is an anticipated economic cost to persons required to comply with the new section. While this new section basically maintains the existing requirements for these programs, a new requirement is that crisis intervention must be provided by counselors (licensed individuals or interns working under appropriate supervision). Providers who currently rely on non-counseling staff will need to recruit qualified individuals. The commission estimates the salary difference will be approximately $5,000-$10,000 per position per year.

Comments on the proposal may be submitted to Tamara Allen, Rules Manager, Texas Commission on Alcohol and Drug Abuse, P.O. Box 80529, Austin, Texas, 78708-0529. Comments must be received no later than 30 days from the date the proposal is published in the Texas Register .

The new section is proposed 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 new section 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. ability of the community to more effectively provide substance abuse services.

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

Filed with the Office of the Secretary of State, on May 24, 2000.

TRD-200003699

Karen Pettigrew

General Counsel

Texas Commission on Alcohol and Drug Abuse

Earliest possible date of adoption: July 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 proposes amendments to §§144.511, 144.522, 144.523, 144.526, 144.532, 144.541, 144.543, 144.545, 144.551 and proposes new §§144.521, 144.525, and 144.553 concerning Treatment. 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 are proposed 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.

Jay Kimbrough, Executive Director, has determined that for the first five-year period the rules are in effect there will be no fiscal implications for state or local government as a result of enforcing the rules.

Mr. Kimbrough has also determined that for each year of the first five years the rules are in effect the anticipated public benefit will be better understanding of treatment requirements, greater accountability, and more efficient use of state funds. There is no additional effect on small businesses. There is no anticipated economic cost to persons required to comply with the proposed amendments and new sections.

Comments on the proposal may be submitted to Tamara Allen, Rules Manager, Texas Commission on Alcohol and Drug Abuse, P.O. Box 80529, Austin, Texas, 78708-0529. Comments must be received no later than 30 days from the date the proposal is published in the Texas Register .

The amendments and new sections are proposed 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 proposed amendments and new sections is the Texas Health and Safety Code, Chapter 461.

§144.511.Program Plan [ Design ] 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)

[ (a) ] 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.

[(b)

The program shall develop a written plan for the contract period. The plan shall initially be developed as part of the application process and revised annually on the basis of needs data and results of self-evaluation. ]

(e)

[ (c) ] 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)

[ (d) ] 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)

[ (e) ] 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)

[ (2) ] 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)

[ (f) ] The written plan [ program design ] shall include key services [ strategies ] and activities used to achieve program goals and objectives. Each service [ strategy ] 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.

(1)

This system shall include a quality improvement team that meets on a regular basis (at least quarterly) to review relevant program data, identify issues, and implement appropriate action to improve service delivery.

(2)

Each year, the quality improvement team shall select critical objectives (including the core set of performance measures established by the commission and critical issues identified in the previous annual evaluation).

(k)

The program shall maintain documentation of its quality improvement activities, including minutes of each quality improvement meeting. The minutes shall document:

(1)

date and members present;

(2)

issues discussed, including key conclusions and decisions;

(3)

selection of critical objectives (including the core set of performance measures established by the commission and critical issues identified in the previous annual evaluation);

(4)

regular review of performance data for each selected critical objective;

(5)

implementation of appropriate program adjustments; and

(6)

follow-up to determine effectiveness of actions taken.

(l)

The program shall conduct and document an annual self assessment of program implementation and performance. At a minimum, the self assessment shall cover the critical objectives targeted for quality improvement and all other 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.

§144.521.Client Eligibility.

(a)

The program shall complete and document a clinical evaluation of each individual presenting for treatment.

(1)

Every client admitted to a Level I treatment program shall meet the DSM-IV criteria for substance dependence and substance intoxication or withdrawal or be in need of crisis stabilization. Crisis stabilization is appropriate for persons who are cognitively and/or emotionally impaired to such an extent that they are unable to participate in assessment and treatment activities. Persons in need of crisis stabilization may be admitted to Level I treatment for no more than 72 hours.

(2)

Every client admitted to a Level II, III, or IV treatment program shall meet the DSM-IV criteria for substance abuse or dependence.

(3)

The provider shall match individual client needs with appropriate treatment intensity and setting as described in §144.525 of this title (relating to Admission Determination and Placement).

(b)

The program shall complete and document a financial assessment of each applicant before admission.

(1)

The program shall use financial eligibility criteria, forms, and assessment procedures established by the commission unless it has received written approval from the commission to use alternative instruments.

(2)

A person who has access to another public or private funding source that pays for substance abuse services for the individual's diagnosis is not eligible for commission-funded services.

(3)

A person whose adjusted income is at or below 200% of the federal poverty guidelines is eligible for free services.

(4)

A person whose adjusted income is above 200% of the federal poverty guidelines shall be charged for services according to the commission's sliding fee scale.

(c)

For adolescents, ability to pay shall be determined by parental or family income unless:

(1)

the adolescent applies for treatment without parental knowledge; and

(2)

the adolescent refuses to consent to parental notification.

(d)

If an adolescent program determines that both conditions in subsection (c) of this section are met, the adolescent's income may be used to determine financial eligibility.

(e)

If the client is physically unable to respond to the request for financial and other eligibility information due to intoxication or other behavioral health issue, the financial assessment may be delayed, but it must be completed within five days of admission.

(f)

The program shall provide appropriate referrals for all persons who are found to be ineligible. 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.

§144.522.Priority Populations.

(a)

The commission has established five [ six ] priority populations. Preference shall be given in the following priority order:

(1)-(3)

(No change.)

[(4)

former Supplemental Security Income recipients previously disabled from substance abuse;]

(4)

[ (5) ] parents with children in foster care; and

(5)

[ (6) ] veterans with honorable discharges.

(b)-(c)

(No change.)

(d)

Providers shall accept applicants from every region in the state when space is available. If two applicants are of equal priority status, preference may be given to an applicant living in the provider's region.

Waiting List and Interim Services [ Capacity Management ].

(a)

The program shall maintain a waiting list or other organized and documented system to track eligible individuals who have been screened but cannot be treated immediately because of insufficient capacity. Eligible individuals who cannot enter treatment due to other circumstances may be placed on the waiting list, but the provider shall not hold empty beds or slots for anticipated clients for more than 48 hours .

(b)-(d)

(No change.)

(e)

The program shall implement written procedures [ a mechanism ] to maintain contact with individuals [ pregnant women and intravenous drug users ] waiting for admission.

(f)

When a program does not have 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 (when another treatment facility is not available).

(1)

Interim services shall be offered within 48 hours.

(2)

Interim services shall include counseling and education about HIV and tuberculosis (TB), including the risks of needle-sharing, the risks of transmission to sexual partners and infants, and steps that can be taken to prevent transmission. Referrals for HIV or tuberculosis treatment shall be provided if necessary. For pregnant females, interim services shall also include counseling about the effects of alcohol and drug use on the fetus and referrals for prenatal care.

(3)

The program shall maintain documentation of interim services provided.

[(f)

If a pregnant women is placed on the waiting list, the program must make interim services available to her within 48 hours as described in §144.525 of this title (relating to Interim Services for Priority Populations).]

(g)

The program shall ensure that each individual who requests and is in need of treatment for intravenous drug abuse is admitted to an appropriate program not later than 120 days after making the request. Interim services must be provided within 48 hours as described in subsection (f) of this section. [ : ]

[(1)

14 days after making the request; or]

[(2)

120 days after making the request when interim services are provided to the individual within 48 hours as described in subsection (f) of this section §144.525 of this title (relating to Interim Services for Priority Populations).]

(h)

(No change.)

§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 client needs with appropriate treatment intensity and setting.

(1)

If the provider does not offer a program appropriate for the client as determined by the TDI criteria, the provider shall refer the client to a provider that does offer the needed service.

(2)

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.

(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)

(No change.)

(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. [ When a client's length of stay in a level of treatment exceeds the guidelines, the provider shall clearly document the needs and conditions justifying the variance in the client record. ]

(d)

All facilities shall implement procedures to monitor length of stay according to TDI [ these ] 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)

(No change.)

(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 residential treatment at a specialized female service provider.

§144.532.Core Program Requirements.

(a)-(b)

(No change.)

(c)

Levels II, III, and IV treatment programs funded by the commission shall provide:

(1)

family education and counseling related to the client's substance abuse [ (to the extent possible and appropriate) ];

(2)-(3)

(No change.)

(4)

disease management [ relapse prevention services ];

(5)

(No change.)

(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 [ Level ] III treatment program.

(d)

The program shall have written descriptions [ description ] of all educational and didactic sessions, including curricula, outlines, and activities.

(e)

Group size shall be limited to a number that allows effective interaction between the group and facilitator and between group members.

(1)

(No change.)

(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 [ formal letters of agreement ] with available substance abuse and other mental health, health care, and social services to meet the needs of clients and family members. Agreements to coordinate services must be established in writing and renewed annually (through signature or other documented contact), and shall include:

(1)-(4)

(No change.)

(g)

The program shall develop and implement a written plan of operation explaining outreach efforts, including specific strategies to reach members of the priority populations listed in §144.522 of this title (relating to Priority Populations). [ The commission may waive this requirement if the program demonstrates high capacity utilization and adequate engagement of priority populations. ]

(h)-(j)

(No change.)

§144.541.Specialized Treatment Services for Females.

(a)

Specialized female residential and outpatient programs shall serve the following priority populations:

(1)

Adolescent or adult women who are pregnant;

(2)

Adolescent or adult women with custodial, dependent children under the age of 18 when the woman is not bringing the child(ren) into treatment with her;

(3)

Adolescent or adult women with dependent children under the custodianship of the Texas Department of Protective and Regulatory Services;

(4)

Adolescent or adult women whose children participate in the mother's outpatient program.

(b)

The priority population for women and children residential programs is adolescent or adult women with dependent children. Newborns and children aged 12 years or less may accompany the mother into a residential program for women and children.

[(a)

Specialized female programs shall serve pregnant adult or adolescent females and adult or adolescent females with dependent children. Females with dependent children include females in treatment who are attempting to regain custody of their children.]

(c)

[ (b) ] These programs shall treat the female and her dependent children as a unit and therefore admit both females and their children into treatment, when appropriate and possible.

(d)

[ (c) ] All programs offering specialized female services shall provide a comprehensive treatment program. The following services shall be provided directly or through collaborative agreements and case management arrangements with other service providers:

(1)

primary medical care for females receiving treatment, including age-appropriate and specific reproductive health care and prenatal care;

(2)

gender-specific substance abuse treatment and other therapeutic interventions for females that address issues of relationships, sexual and physical abuse and parenting;

(3)

childcare while the females are receiving services;

(4)

primary pediatric care for the clients' children, including immunizations;

(5)

therapeutic and other structured interventions for the children; and

(6)

documented sufficient case management and transportation services to ensure that female clients and their children have access to the services provided by paragraphs (1) through (5) of this subsection.

(e)

[ (d) ] Programs shall implement a coordinated outreach plan that targets services and organizations that regularly serve adult or adolescent females with or without dependent children[ , including Child Protective Services and the Temporary Aid for Needy Families (TANF) program ]. Outreach to engage the target population shall include regular, documented contacts with:

(1)

Temporary Aid for Needy Families (TANF) and Welfare to Work offices;

(2)

Child Protective Services;

(3)

Early Childhood Intervention programs;

(4)

Health clinics that serve low-income women, infants, and children;

(5)

Domestic violence programs;

(6)

STD clinics and HIV programs; and

(7)

Criminal Justice and Texas Youth Commission personnel.

(f)

[ (e) ] Treatment programs serving women with dependent children shall report monthly measures for the women's children when the children receive prevention and/or intervention services.

(g)

[ (f) ] Programs serving adult or adolescent females shall, to the extent possible, provide an array of services including Levels II, III, and IV treatment and structured aftercare, either directly or through case management and service agreements. Level, intensity, and duration of services shall be clinically appropriate.

(h)

[ (g) ] Programs shall have written referral and service coordination procedures with qualified providers to provide:

(1)

assessments for children for Early Childhood Intervention services; and

(2)

counseling or therapy to address the children's identified developmental, emotional, or psychosocial needs.

(i)

Specialized female programs and residential programs for women and children shall not admit females who are not in the priority population unless they have documented contact with all community outreach contacts showing that no potential priority clients can be identified and admitted.

§144.543.Pharmacotherapy Services.

(a)

(No change.)

(b)

Programs shall establish a phase/level system which is consistent with guidelines from the Substance Abuse and Mental Health Services Administration (SAMHSA) and includes the following phases:

(1)-(2)

(No change.)

(3)

Phase III: After two years of continuous treatment, the client shall receive at least one counseling session per month.

(c)

(No change.)

(d)

All Pharmacotherapy programs shall adopt policies and procedures that conform with §144.523 of this title (relating to Waiting List and Interim Services [ Capacity Management ]) and §144.107 of this title (related to Reporting) [ , §144.524 of this title (relating to Facility Capacity System), and §144.535 of this title (relating to Interim Services) ].

(e)-(g)

(No change.)

(h)

All pharmacotherapy programs shall develop and implement a plan to achieve accreditation as required by federal regulations.

§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 [ program ] that offer appropriate services. Treatment, intervention, and prevention programs are expected to collaborate to establish a coordinated array of substance abuse services for families.

(b)

Family services shall be designed to identify family risk factors associated with the client's chemical dependency, improve the health and functioning of the family unit and/or to assist individual family members to support the client in achieving and maintaining a healthy, drug-free life style. All services provided to family members shall be age and developmentally appropriate. 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 [ are ] provided to the entire family, including older adults, individual family members, and/or a subset of family members. Reimbursable family services include:

(1)-(4)

(No change.)

[(5)

family case management;]

(5)

[ (6) ] family in-home support; and

(6)

[ (7) ] structured, curriculum-based education and/or skills training accompanied by group process.

(d)

(No change.)

(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 [ The ] record must include the elements listed.

(1)

(No change.)

(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)

(No change.)

(B)

goals that are realistic, outcome-oriented, measurable, time limited and stated in behavioral [ behavior ] terms that are understandable to the client and family;

(C)-(D)

(No change.)

(3)-(4)

(No change.)

§144.551.Performance Measure Review.

(a)-(c)

(No change.)

(d)

After receiving the response, the commission shall take at least one of the following actions.

(1)

(No change.)

(2)

Specify [ Negotiate ] additional corrective actions or conditions , a revision of the performance targets and/or interim targets, with appropriate timelines established to measure progress.

(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)

Progress notes 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 proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State, on May 24, 2000.

TRD-200003701

Karen Pettigrew

General Counsel

Texas Commission on Alcohol and Drug Abuse

Earliest possible date of adoption: July 9, 2000

For further information, please call: (512) 349-6733

40 TAC §§144.512, 144.521, 144.524, 144525, 144.531, 144.553, 144.554

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

The Texas Commission on Alcohol and Drug Abuse proposes the repeal of §§144.512, 144.521, 144.524, 144.525, 144.531, 144.553, and 144.554 concerning Treatment. These sections contain the requirements for self-evaluation, client eligibility, facility capacity management, interim services for priority populations, 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 that are concurrently proposed.

Jay Kimbrough, Executive Director, has determined that for the first five-year period the repeal is in effect there will be no fiscal implications for state or local government as a result of the proposed repeals.

Mr. Kimbrough has also determined that for each year of the first five years the repeals are in effect the anticipated public benefit will be the elimination of unnecessary rules. There will be no effect on small businesses. There is no anticipated economic cost to current providers.

Comments on the proposal may be submitted to Tamara Allen, Rules Manager, Texas Commission on Alcohol and Drug Abuse, P.O. Box 80529, Austin, Texas, 78708-0529. Comments must be received no later than 30 days from the date the proposal is published in the Texas Register .

The repeals are proposed 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 proposed repeals is the Texas Health and Safety Code, Chapter 461.

§144.512.Self-Evaluation.

§144.521.Client Eligibility.

§144.524.Facility Capacity System.

§144.525.Interim Services for Priority Populations.

§144.531.Admission.

§144.553.Client Billings.

§144.554.Client Data Systems (CDS) Forms.

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

Filed with the Office of the Secretary of State, on May 24, 2000.

TRD-200003702

Karen Pettigrew

General Counsel

Texas Commission on Alcohol and Drug Abuse

Earliest possible date of adoption: July 9, 2000

For further information, please call: (512) 349-6733

40 TAC §§144.611-144.616

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

The Texas Commission on Alcohol and Drug Abuse proposes the repeal of §§144.611-144.616 concerning Network Management Organizations (NMOs). 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 proposed because provisions specific to individual network management organizations will be included in their contracts.

Jay Kimbrough, Executive Director, has determined that for the first five-year period the repeal is in effect there will be no fiscal implications for state or local government as a result of the proposed repeals.

Mr. Kimbrough has also determined that for each year of the first five years the repeals are in effect the anticipated public benefit will be individualized requirements for each network management organization. There will be no effect on small businesses. There is no anticipated economic cost to current providers.

Comments on the proposal may be submitted to Tamara Allen, Rules Manager, Texas Commission on Alcohol and Drug Abuse, P.O. Box 80529, Austin, Texas, 78708-0529. Comments must be received no later than 30 days from the date the proposal is published in the Texas Register .

The repeals are proposed 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 proposed repeals is the Texas Health and Safety Code, Chapter 461.

§144.611.Service Structure.

§144.612.Outreach.

§144.613.Screening, Assessment, and Referral.

§144.614.Care Coordination.

§144.615.Monitoring Service Utilization.

§144.616.Service Delivery Planning and Implementation.

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

Filed with the Office of the Secretary of State, on May 24, 2000.

TRD-200003703

Karen Pettigrew

General Counsel

Texas Commission on Alcohol and Drug Abuse

Earliest possible date of adoption: July 9, 2000

For further information, please call: (512) 349-6733

Chapter 260. AREA AGENCY ON AGING ADMINISTRATIVE REQUIREMENTS

The Texas Department on Aging proposes the repeal of the existing §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 proposes a new §260.3 relating to System of Access and Assistance. The proposed new rule consolidates the current rules relating to Access and Assistance and creates a single comprehensive rule. In addition, the proposed 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.

The proposed new section 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 as proposed 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 Texas Department on Aging staff will recommend to the Board on Aging the current service, Information and Assistance be renamed Information, Referral and Assistance, the current service Case Management be renamed Care Coordination and the current service Legal Assistance/Legal Awareness be renamed Benefits Counseling. Comments regarding the proposed renaming should be made during this review period.

Frank Pennington, Director of Program and Fiscal Accountability, has determined that for the first five-year period the repeal and new section are in effect there will be no fiscal implications for state government as a result of enforcing or administering the repeal or the new section. The cost of implementing will be managed within current agency fiscal operations. There will be no effect on small business.

Mr. Pennington also has determined that for each year of the first five years the rule is in effect the public benefit anticipated will be a system of access and assistance for older persons that is administered in the most effective manner possible. Parts of this rule will ensure improved visibility of Area Agencies on Aging to foster access to services and benefits. Additionally, the Area Agencies on Aging will have a clearer understanding of their program responsibilities and authorities for the benefit of all older persons in Texas.

Comments on the repeal and the new rule may be submitted to Frank Pennington, Director of Program and Fiscal Accountability, Texas Department on Aging, P. O. Box 12786, Austin, Texas 78711. All comments must be written and delivered via mail, in person, or facsimile. E-mail and verbal comments cannot be accepted. All comments must be received within 30 calendar days following the date of publication of this proposed repeal and new rule in the Texas Register .

40 TAC §§260.3, 260.5, 260.7, 260.9, 260.13

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

The repeals are proposed 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.

Texas Human Resources Code, Chapter 101, Subchapter B, §§101.021 to 101.031, relating to Powers and Duties of the Board are affected and implemented by this proposed action.

§260.3.Access and Assistance Program.

§260.5.Information and Assistance Service.

§260.7.Case Management Service.

§260.9.Legal Awareness/Legal Assistance Services.

§260.13.Implementation of the Options for Independent Living Program.

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

Filed with the Office of the Secretary of State, on May 26, 2000.

TRD-200003735

Gary Jessee

Program Specialist

Texas Department on Aging

Earliest possible date of adoption: July 9, 2000

For further information, please call: (512) 424-6857

40 TAC §260.3

The new section is proposed 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.

Texas Human Resources Code, Chapter 101, Subchapter B, §§101.021 to 101.031, relating to Powers and Duties of the Board is affected and implemented by this proposed action.

§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)

Services are accessible, flexible, coordinated and designed to support an individual's highest level of functioning in the least restrictive environment.

(E)

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 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 an 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, Subsection (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 §270.1(j) of this title, 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 regarding programmatic reports.

(n)

Information, Referral and Assistance. The information, referral and assistance process consists of 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. 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 local community service delivery system or other geographic area covered by the area agency on aging.

(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 a standard service classification system 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 this 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 I&R Providers.

(A)

In communities which have multiple comprehensive and specialized information and referral (I&R) providers, 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.

(B)

Area agencies on aging shall 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 for, 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 defined as Options for Independent Living 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 only and service authorization requiring an assessment.

(A)

Service Authorization Only.

(i)

Service authorization only may be used to procure all services except home delivered meals, homemaker, personal assistance and residential repair.

(ii)

Service authorization only may be performed by any area agency on aging- approved access and assistance staff member either by phone or in person.

(iii)

Service authorization only 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)