26 Tex. Admin. Code § 261.227 - Discharge From a Facility
(a) When a
discharge occurs, a program provider must comply with
42 CFR §
483.440(b)(4) and (5) and
this section.
(b) The effective
date of a discharge is the first full day the individual is absent from the
facility.
(c) Prior to the
effective date of a discharge, a program provider must take the following
action or document why such action is not feasible:
(1) notify the individual, LAR, and the
individual's MRA of the proposed discharge in writing at least 30 days before
the effective date of the proposed discharge;
(2) document the reason for the proposed
discharge and, if the reason is that the facility can no longer meet the
individual's needs, explain why;
(3) counsel the individual or LAR about the
proposed discharge, including the potential outcomes of the proposed discharge;
and
(4) develop a final summary and
post-discharge plan in accordance with
42 CFR §
483.440(b)(5) and provide a
copy of both documents to the individual, LAR, and the individual's
MRA.
(d) If any actions
required by subsection (c) of this section are not feasible prior to the
effective date of a discharge, a program provider must, within 7 days after the
effective date of the discharge, complete the required actions.
(e) Within 3 days after the effective date of
a discharge, a program provider must:
(1)
electronically submit a completed Client Movement Form to the department;
and
(2) submit a paper copy of the
completed Client Movement Form to the appropriate TDHS Medicaid eligibility
worker.
(f) Except when
an individual requires immediate admission to a psychiatric facility for
inpatient services as provided in subsection (i) of this section, if a program
provider proposes a discharge due to the individual's maladaptive behavior, the
discharge must be approved in writing by the department prior to the effective
date of the discharge. To request approval, the program provider must submit
the following documentation to the department's Office of Medicaid
Administration:
(1) a description of the
maladaptive behavior(s);
(2) a
summary of all behavioral interventions attempted, ranging from the most
positive to the most restrictive, with the individual's response to these
interventions, and reasons the interventions were ineffective in decreasing or
eliminating the behavior(s);
(3)
chronological psychoactive medication history, including start and stop dates
of medications, dose changes to medications, and reasons for discontinuance or
changes to dosages (e.g., adverse reactions, allergies, or increase in target
symptoms);
(4) evidence of
participation by a psychologist in the IDT meeting discussing the proposed
discharge;
(5) evidence of approval
of the proposed discharge by the facility's specially constituted
committee;
(6) a description of the
proposed living arrangement for the individual after the effective date of the
discharge; and
(7) a written
agreement from a representative of the proposed living arrangement to accept
the individual on or after the effective date of the discharge.
(g) The department will review the
documentation submitted in accordance with subsection (f) of this section and,
within 14 days after receiving the documentation, provide written notice to the
program provider of its approval or denial of the discharge.
(h) If a proposed discharge is approved by
the department in accordance with subsection (g) of this section, a
psychologist must participate in the development of the post-discharge plan
described in subsection (c)(4) of this section.
(i) If the reason for a discharge is that the
individual requires immediate admission to a psychiatric facility for inpatient
services, a program provider other than a state school or state center must,
within three days after the effective date of the discharge, notify the Office
of Medicaid Administration and the individual's MRA of:
(1) the individual's admission to the
psychiatric facility; and
(2)
whether the program provider intends to re-admit the individual to the facility
and, if not, why the individual will not be re-admitted.
(j) During a discharge, a program provider
may accept payment from the individual or other person to hold the individual's
residential placement in the facility if a written contract, signed and dated
by the program provider and the individual or the other person, is executed
prior to each discharge that specifies:
(1)
the amount, not to exceed the department's rate of reimbursement for the
individual's LON on the effective date of discharge, that the individual or
other person agrees to pay the program provider to hold the individual's
residential placement;
(2) the
period of time for which the individual's residential placement in the facility
will be held by the program provider;
(3) that the program provider is not
obligated to hold the individual's residential placement after the period of
time described in paragraph (2) of this subsection; and
(4) agreement by the program provider that
the individual or other person may terminate the contract immediately upon
written notice to the program provider.
Notes
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