40 Tex. Admin. Code § 700.527 - What is Tier II: Complex Medical Services to Support Stabilization Package?

(a) A highly structured, trauma-informed facility that, in addition to providing a child's basic living needs, has an intensive treatment program that specializes in providing a holistic and comprehensive array of medical and behavioral health services and therapeutic supports for children, youth, and young adults that may present with a complex medical diagnosis that is defined as either one or more diagnoses that affect multiple organ systems, or one long-term health condition that results in functional limitations, high health care needs or utilization, and often the need for medical technology, and that may have a dual DSM diagnosis for an emotional, behavioral, neurological, and/or developmental disorder(s), that may include one or more of the following:

(1) Major self-injurious actions, including a suicide attempt within the last 12 months; or

(2) Difficulties that present a significant risk of harm to others, including frequent or unpredictable physical aggression; and

(3) If the one of the DSM diagnoses is for Intellectual or Developmental Disability or Autism Spectrum Disorder, the child's behavior is characterized by prominent, severe deficits and pervasive impairment in one or more of the following areas (of development if diagnosis is Autism Spectrum Disorder):

(A) Conceptual, social, and practical adaptive skills to include daily living and self-care;

(B) Communication, cognition, or expressions of affect;

(C) Self-care activities or participation in social activities;

(D) Responding appropriately to an emergency; or

(E) Multiple physical disabilities, including sensory impairments.

(b) In addition to the DSM diagnosis, children, youth, and young adults requiring the Tier II: Complex Medical Services to Support Stabilization may present with a medical diagnosis that requires the use of mechanical supports or services of others because of life threatening conditions, including:

(1) The inability to maintain an open airway without assistance;

(2) The inability to be fed except through a feeding tube, gastric tube, or a parenteral route;

(3) The use of sterile techniques or specialized procedures to promote healing, prevent infection, prevent cross-infection or contamination, or prevent tissue breakdown; or

(4) Multiple disabilities including sensory impairments.

(c) To qualify for Tier II: Complex Medical Services to Support Stabilization, the child must have a medical diagnosis as determined by a Physician, and have a qualifying DSM diagnosis, and present with needs that cannot be met in a less-restrictive setting such as a Foster Family Home or General Residential Operation- Tier I facility because it is not safe and appropriate based on individualized needs.

(d) This Service Package is designed to offer temporary, facility-based care, for children, youth, and young adults based on their individual strengths and needs, with the overall goal of achieving medical, emotional, and behavioral stability to the level that successful transition to a less restrictive placement offering treatment and recovery services can be achieved.

(e) The Operation and Direct Care Staff must be Credentialed to provide Tier II: Complex Medical Services in accordance with the guidelines and requirements as defined by the Department of Family and Protective Services pursuant to Chapter 40 of the Texas Human Resources Code.

Notes

40 Tex. Admin. Code § 700.527

Adopted by Texas Register, Volume 49, Number 51, December 20, 2024, TexReg 10391, eff. 12/22/2024