40 Tex. Admin. Code § 2.152 - Special Considerations
(a)
Persons admitted to a SMHF three times in 180 days. Persons who are admitted to
a SMHF three times in 180 days are considered to be at risk for future
admission to inpatient services. Pursuant to the Texas Government Code, §
531.0244(b)(4),
to prevent the unnecessary placement in an institution, the SMHF and designated
LMHA shall:
(1) during discharge planning,
review the patient's previous continuing care plans to determine the
effectiveness of the clinical and non-clinical services and supports
identified, and recommend in the patient's current continuing care plan those
services and supports that have been effective and as well as those designed to
prevent unnecessary admission to the SMHF;
(2) determine the availability and
appropriateness of clinical and non-clinical services and supports in the
intensity needed by the patient (i.e., type, amount, scope, and duration) which
will prevent unnecessary admission to the SMHF; and
(3) consider appropriateness of the patient's
continued stay in the SMHF.
(b) Nursing facilities.
(1) Information regarding alternate services
and supports. Prior to a person being admitted to a nursing facility on absence
for trial placement (ATP) or directly after discharge, the designated LMHA
shall provide the person, the person's LAR, and, unless the LAR is a family
member, at least one family member of the person, if possible, with information
about alternative services and supports for which the person may be
eligible.
(2) Preadmission
screening. Prior to a person being admitted to a nursing facility on ATP or
directly after discharge, the SMHF shall contact the Texas Department of Human
Services to conduct a preadmission screening as required by 40 TAC
§19.2500(relating to Preadmission Screening and Resident Review
(PASARR)).
(3) ATP. If a patient is
admitted to a nursing facility on ATP, then the designated LMHA shall conduct
and document, including justification for its recommendations, the activities
described in this paragraph.
(A) The
designated LMHA shall make at least one face-to-face contact with the patient
at the nursing facility. The contact shall include:
(i) a review of the patient's medical record
at the nursing facility; and
(ii)
discussions with the patient and LAR, if any, the nursing facility staff, and
other staff who provide care to the patient regarding:
(I) the needs of the patient and the care
he/she is receiving;
(II) the
ability of the nursing facility to provide the appropriate care;
(III) the provision of mental health
services, if needed by the patient; and
(IV) the patient's adjustment to the nursing
facility.
(B)
Before the end of the initial ATP period as described in §412.206(b)(2) of
this title (relating to Absence for Trial Placement (ATP)), the designated LMHA
shall recommend to the SMHF one of the following:
(i) discharging the patient if the LMHA
determines that:
(I) the nursing facility is
capable of providing, and willing to provide, appropriate care to the patient
after discharge;
(II) any mental
health services needed by the patient are being provided to the patient while
he/she is residing in the nursing facility; and
(III) the patient and LAR, if any, agrees to
the nursing facility placement;
(ii) extending the patient's ATP period in
accordance with §412.206(b)(3) of this title;
(iii) returning the patient to the SMHF in
accordance with §412.205(b)(2) of this title (relating to Absences From a
SMHF); or
(iv) initiating
involuntary admission to the SMHF in accordance with §412.205(a)(2) of
this title.
(4) Discharge. If a person is admitted to a
nursing facility directly upon discharge, then the designated LMHA shall
conduct and document the activities described in this paragraph.
(A) The designated LMHA shall make
face-to-face contact with the person at the nursing facility within seven days
after discharge to determine if the nursing facility is providing adequate and
appropriate care to the person. The contact shall include:
(i) a review of the person's medical record
at the nursing facility; and
(ii)
discussions with the person, or the person's LAR, if any, the nursing facility
staff, and other staff who provide care to the person regarding:
(I) the needs of the person and the care
he/she is receiving;
(II) the
ability of the nursing facility to provide the appropriate care;
(III) the delivery of mental health services,
if needed by the person; and
(IV)
the person's adjustment to the nursing facility.
(B) If the designated LMHA
determines from its contact that the nursing facility is not providing adequate
and appropriate care to the person, then the LMHA shall make a reasonable
effort to encourage the nursing facility to provide adequate and appropriate
care.
(C) If the designated LMHA's
efforts to encourage the nursing facility to provide adequate and appropriate
care are unsuccessful and the LMHA determines that the nursing facility is
unable or unwilling to provide adequate and appropriate care, then the LMHA
shall:
(i) make recommendations to the person
and the person's LAR, if any, regarding alternate residential placement;
and
(ii) provide assistance in
accessing alternate placement, if requested by the person or LAR to do
so.
(D) If the
designated LMHA identifies or suspects any instance of mistreatment, abuse or
neglect, or injuries of unknown origin at the nursing facility, then the LMHA
shall make a report to the Texas Department of Human Services (TDHS) via its
complaint hotline (1-800-458-9858).
(c) Assisted living.
(1) A SMHF or LMHA may not refer a person to
an assisted living facility that is not licensed under the Texas Health and
Safety Code, Chapter 247.
(2) As
required by the Texas Health and Safety Code, §
247.063(b),
if a SMHF or LMHA gains knowledge of an assisted living facility that is not
operated or licensed by TDHS, an LMHA, or TDMHMR, and that has four or more
residents who are unrelated to the proprietor of the facility, then the SMHF or
LMHA shall report the name, address, and telephone number of the facility to
TDHS.
(d) Minors.
(1) To the extent permitted by medical
privacy laws, the SMHF and designated LMHA shall make a reasonable effort to
involve a minor's LAR or the LAR's designee.
(2) A minor committed to or placed in a SMHF
under the Texas Family Code, Chapter 55, Subchapter C or D, shall be discharged
in accordance with the Texas Family Code, Chapter 55, Subchapter C or D, as
appropriate.
(e)
Patients suspected of having mental retardation. If the SMHF suspects a patient
has mental retardation, then the SMHF shall notify the designated LMHA liaison
staff and the designated MRA. The designated MRA shall assign an MRA liaison
staff to the patient to ensure compliance with Chapter 415, Subchapter D of
this title (concerning Diagnostic Eligibility for Services and Supports--Mental
Retardation Priority Population and Related Conditions).
(f) Criminal Code.
(1) Texas Code of Criminal Procedure (TCCP),
Article 46.02 or Chapter 46B: Incompetency to stand trial.
(A) Discharge of a patient committed under
TCCP, Article 46.02, §6 (Civil commitment--charges pending) or Article
46B.102 (Commitment Hearing: Mental Illness), shall be in accordance with the
TCCP, Article 46.02, §8 (General) or Article 46B.107 (Release of Defendant
After Commitment).
(B) Discharge of
a patient committed under TCCP, Article 46.02, §5 (Criminal commitment) or
Article 46B.073 (Commitment For Restoration to Competency), shall be in
accordance with TCCP, Article 46.02, §5 (Criminal commitment) or Article
46B.083 (Report By Facility Head).
(C) For a patient committed under TCCP,
Article 46.02 or Chapter 46B, who is discharged and returned to the committing
court, the SMHF shall, within 24 hours after discharge, notify the following of
the discharge:
(i) the patient's designated
LMHA; and
(ii) the Texas
Correctional Office on Offenders with Medical or Mental Impairments.
(2) TCCP, Article
46.03: Insanity defense. A person acquitted by reason of insanity and committed
to a SMHF under TCCP, Article 46.03, may be discharged only upon order of the
committing court in accordance with TCCP, Article 46.03, §4(d)(5)
(Disposition following acquittal by reason of insanity) (Judicial
release).
(g) Special
needs offenders.
(1) Pre-admission assessment
after release from county or city jail. If a county or city jail refers a
special needs offender (SNO) in the priority population to an LMHA and notifies
the LMHA of the referral at least 24 hours prior to the SNO's release from a
county or city jail, then the LMHA shall arrange for a face-to-face contact
between the SNO and a QMHP-CS to occur within seven days after the SNO's
release.
(A) If the SNO is currently
receiving LMHA services from the LMHA that is notified of the referral, then at
the face-to-face contact the QMHP-CS shall re-assess the SNO and arrange for
appropriate services.
(B) If the
SNO is not currently receiving LMHA services from the LMHA that is notified of
the referral, then at the face-to-face contact the QMHP-CS shall conduct a
pre-admission assessment in accordance with §412.315(a) of this title
(relating to Assessment and Treatment Planning) and comply with
§412.161(b)(2)(A) or (B) of this title (relating to Screening and
Assessment), as appropriate).
(C)
If the LMHA does not have a face-to-face contact with a SNO, then the LMHA
shall document the reasons for not doing so.
(2) Pre-admission assessment after release
from state prison or state jail. If an LMHA is notified of the anticipated
release from prison or a state jail of a SNO in the priority population who is
currently taking psychoactive medication(s) for a mental illness and who will
be released with a 10-day supply of the psychoactive medication(s), then the
LMHA shall arrange for a face-to-face contact between the SNO and QMHP-CS to
occur within seven days after the SNO's release.
(A) At the face-to-face contact, the QMHP-CS
shall conduct a pre-admission assessment in accordance with §412.315(a) of
this title and comply with §412.161(b)(2)(A) or (B) of this title (as
appropriate). If the LMHA determines that the SNO should receive services
immediately, then the LMHA must arrange for the SNO to meet with a prescriber
of medication before the SNO's entire supply of psychoactive medication has
been administered.
(B) If the LMHA
does not have a face-to-face contact with the SNO, then the LMHA shall document
the reasons for not doing so.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.