Proposed Rules Title 26

TITLE 26. HEALTH AND HUMAN SERVICES

PART 1. HEALTH AND HUMAN SERVICES COMMISSION

CHAPTER 303. PREADMISSION SCREENING AND RESIDENT REVIEW (PASRR)

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes in Texas Administrative Code (TAC), Title 26, Part 1, Chapter 303, concerning Preadmission Screening and Resident Review (PASRR), amendments to §§303.102, 303.201, 303.302, 303.303, 303.502, 303.503, 303.601, 303.602, 303.701, 303.703, 303.905, 303.907, 303.909, 303.910, and 303.912. HHSC also proposes new §303.901, §303.914 and new Subchapter J, concerning Disaster Rule Flexibilities, comprised of §303.1000; and the repeal of §303.901.

BACKGROUND AND PURPOSE

House Bill 4, 87th Legislature, Regular Session, 2021 added §531.02161 to the Texas Government Code which requires HHSC to ensure that Medicaid recipients have the option to receive services through telecommunications to the extent it is cost effective and clinically appropriate. A purpose of the proposed rules is to implement Texas Government Code §531.02161 as it applies to the preadmission screening and resident review (PASRR) process. Another purpose of the proposed rules is to define terms used in the revised PASRR rule for clarification. The proposed revisions to the training requirements for the habilitation coordinator, service coordinator, qualified mental health professional-community services (QMHP-CS), and staff involved in the PASRR process ensures training requirements are similar for all staff across all local intellectual and developmental disability authorities (LIDDAs), local mental health authorities (LMHAs), and local behavioral health authorities (LBHAs). The proposed revisions also address documentation requirements related to the PASRR process, including the new requirement to obtain written or oral consent for the use of audio-visual or audio-only communication methods. The proposed rules also require adjustments to the frequency of follow-up visits for residents with mental illness (MI), which mirrors the requirements of the habilitation coordinator related to the PASRR process. The proposed rules also require the MI specialized services team to agree the resident with MI no longer benefits from the MI specialized services when one or more specialized service is terminated.

The proposed rules provide that HHSC may allow LIDDAs, LMHAs, and LBHAs to use one or more of the exceptions specified in the rule while an executive order or proclamation declaring a state of disaster under Texas Government Code §418.014 is in effect. This provision is added to ensure that LIDDAs, LMHAs, LBHAs are able to operate and provide services effectively during a disaster.

The proposed rules repeal §303.901, Description of MI Specialized Services, and replace it with proposed new §303.901, Description of MI Specialized Services.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §303.102, Definitions, adds definitions for the following new terms: "audio-only," "audio-visual," "extenuating circumstances," "HHSC instructor-led training," and "in-person." The proposed amendment makes a minor change to the definition of "PCRP--Person-centered recovery plan" for clarity and references §303.302(a)(2) in the definitions of "PE--PASRR level II evaluation" and "Resident review" for clarity. The proposed amendment revises the definition of "SPT--Service planning team" to require that the person who develops a permanency plan using the HHSC Permanency Planning Instrument for Children Under 22 Years of Age form and performs other permanency planning activities for a designated resident under 22 years of age must be included on the SPT if the designated resident is at least 21 years of age but younger than 22 years of age. Further, the definition of "SPT" is amended to clarify that the following persons are required participants of an SPT: (1) a concerned person whose inclusion is requested by the designated resident or the LAR; and (2) at the discretion of the LIDDA, an individual who is directly involved in the delivery of services for people with ID or DD. The proposed amendment renumbers the definitions to account for the new definitions and changes made to existing definitions.

The proposed amendment to §303.201, Preadmission Process, clarifies that the LIDDA, LMHA, or LBHA, if provided a copy of a PL1 in accordance with subsection (a)(1)(B) of the section, must comply with §303.302(a)(1).

The proposed amendment to §303.302, LIDDA, LMHA, and LBHA Responsibilities Related to the PASRR Process allows a LIDDA, LMHA, or LBHA to meet with the individual or resident at the referring entity or nursing facility to gather information to complete a PASRR Level II evaluation (PE) resident review by audio-visual communication in extenuating circumstances if the LIDDA, LMHA, or LBHA obtains the written informed consent or oral consent of the individual, designated resident, or LAR and documents in the individual's or designated resident's record a description of the extenuating circumstances that prevented meeting in person with the individual or the designated resident. Further, the proposed amendment requires the LIDDA, LMHA, or LBHA to, if written or oral consent is not obtained to conduct this meeting, to instead meet with the LAR and NF staff most familiar with the individual or designated resident to review and gather all necessary information to complete the PE and enter the PE in the LTC online portal. The proposed amendment also allows a LIDDA, LMHA, or LBHA to complete the PE or resident review by meeting with the individual's LAR or resident's LAR in-person, via audio-visual communication, or via audio-only communication according to the LAR's preference. The proposed amendment requires a LIDDA, LMHA, or LBHA to ensure a habilitation coordinator or QMHP-CS or both, as applicable, participates in person, or via audio-visual communication in extenuating circumstances, in the resident's IDT meeting required by §303.302(c)(1). The proposed amendment replaces the term "face-to-face" with "in person" and makes minor changes for clarity.

The proposed amendment to §303.303, Qualifications and Requirements for Staff Person Conducting a PE or Resident Review, requires an LMHA or LBHA to ensure that before a staff person conducts a PE or resident review, the staff person receives "HHSC instructor-led" training, instead of "HHSC-developed training," about how to conduct a PE and resident review.

The proposed amendment to §303.502, Required Training for a Habilitation Coordinator, provides that a LIDDA must ensure a habilitation coordinator completes "HHSC approved computer-based person-centered planning and practices training" within the first 60 days of performing habilitation coordination duties; all "HHSC instructor-led," instead of "HHSC-developed" training, related to PASRR habilitation coordination within the first 60 days of performing habilitation coordination duties; and person-centered thinking training approved by HHSC within the first year of performing habilitation coordination duties. The proposed amendment makes minor changes for clarity.

The proposed amendment to §303.503, Documenting Habilitation Coordination Contacts, substitutes the phrase "in person, via audio-visual communication, or via audio-only communication" for "face-to-face or by telephone."

The proposed amendment to §303.601, Habilitation Coordination for a Designated Resident, requires a LIDDA to assign a habilitation coordinator to each designated resident within two days after a PE is completed, if the PE is positive for intellectual disability (ID) or development disability (DD). The proposed amendment clarifies that the habilitation coordinator must meet with the designated resident to provide habilitation coordination at least monthly if the designated resident is receiving a specialized service in addition to habilitation coordination and requires the habilitation coordinator to meet in person at least quarterly or more frequently as determined by the SPT using the findings of the HHSC Habilitative Assessment form and meet via audio-visual communication in a month when a meeting is not conducted in person if the designated resident or LAR consents orally or in writing to meeting via audio-visual communication. The proposed amendment also requires the habilitation coordinator to document the designated resident's or LAR's refusal in the designated resident's record if written or oral consent to meet via audio-visual communication is not obtained. The proposed amendment also makes minor edits and formatting changes for clarity.

The proposed amendment to §303.602, Service Planning Team Responsibilities Related to Specialized Services, substitutes the phrase "via audio-visual communication, or via audio-only communication," for "by phone." The proposed amendment also allows a habilitation coordinator to facilitate a quarterly SPT meeting via audio-visual communication in extenuating circumstances if the habilitation coordinator obtains written or oral consent to meet via audio-visual communication from the designated resident, or LAR and documents a description of the extenuating circumstances prior to convening the meeting. The proposed amendment also requires the habilitation coordinator to document the designated resident's or LAR's refusal in the designated resident's record if written or oral consent to meet via audio-visual communication is not obtained. In addition, the proposed amendment requires a SPT member who is a provider of a specialized service to participate, instead of "actively participate," in an SPT meeting, in person, via audio-visual communication, or via audio-only communication, unless the habilitation coordinator determines "participation," instead of "active participation" by the provider is not necessary. Further, the proposed amendment requires a habilitation coordinator to take certain action if the habilitation coordinator determines that "participation," instead of "active participation" by a provider is not necessary.

The proposed amendment to §303.701, Transition Planning for a Designated Resident, substitutes the phrase "via audio-visual communication, or via audio-only communication," for "by phone." The proposed amendment also allows a service coordinator to facilitate an SPT meeting convened by the service coordinator via audio-visual communication in extenuating circumstances if the service coordinator obtains written or oral consent to meet via audio-visual communication from the designated resident or LAR and documents a description of the extenuating circumstances prior to convening the meeting. The proposed amendment also requires the service coordinator to document the designated resident's or LAR's refusal in the designated resident's record if written or oral consent to meet via audio-visual communication is not obtained. In addition, the proposed amendment requires an SPT member who is a provider of a specialized service to participate, instead of "actively participate," in an SPT meeting, in person, via audio-visual communication, or via audio-only communication, unless the service coordinator determines that the provider's "participation," instead of "active participation" is not necessary. Further, the proposed amendment requires a service coordinator to take certain action if the service coordinator determines that the provider's "participation," instead of the provider's "active participation" is not necessary.

The proposed amendment to §303.703, Requirements for Service Coordinators Conducting Transition Planning, requires a service coordinator to complete "HHSC approved computer-based person-centered planning and practices" training instead of "person-center thinking" training. The proposed amendment substitutes the term "HHSC instructor-led" training for "HHSC-developed" training. A proposed amendment to add "person-centered thinking training approved by HHSC to be completed by the habilitation coordinator within the first year of performing habilitation coordination duties. The proposed amendment also corrects a rule reference and makes a minor change for clarity.

Proposed new §303.901, Description of MI Specialized Services, requires an LMHA or LBHA staff to conduct the uniform assessment to determine which level of care the resident with MI will receive and describes the specialized services available for a resident with MI. This new section reorders and reformats the content in repealed §303.901, Description of MI Specialized Services, to be consistent with the Texas Resiliency and Recovery (TRR) offered services, a service delivery system in Texas for community mental health services.

The proposed repeal of §303.901, Description of MI Specialized Services deletes the rule as no longer necessary, and replaces it with proposed new §303.901, Description of MI Specialized Services.

Proposed amendment to §303.905, Process for Service Initiation, requires an LMHA or LBHA to convene the meeting described in subsection (c)(3) in person or in extenuating circumstances via audio-visual communication. To conduct the meeting via audio-visual communication, a LMHA or LBHA must obtain written or oral consent to meet via audio-visual communication from the resident with MI or LAR and document a description of the extenuating circumstances prior to the meeting. The proposed amendment also requires the LMHA or LBHA to document the refusal of the resident with MI or LAR in the resident's record if written or oral consent to meet via audio-visual communication is not obtained. The proposed amendment also makes minor changes for clarity.

Proposed amendment to §303.907, Renewal and Revision of Person-Centered Recovery Plan, requires the QMHP-CS to convene an MI quarterly meeting in person, or in extenuating circumstances via audio-visual communication. To conduct the meeting via audio-visual communication, a QMHP-CS must obtain written or oral consent to meet via audio-visual communication from the resident with MI or LAR and document a description of the extenuating circumstances prior to the meeting. The proposed amendment also requires the QMHP-CS to document the refusal of the resident with MI or LAR in the resident's record if written or oral consent to meet via audio-visual communication is not obtained. The proposed amendment also makes minor changes for clarity.

Proposed amendment to §303.909, Refusal of the Uniform Assessment or MI Specialized Services, requires the LMHA or LBHA to inform the resident with MI who refuses to complete the uniform assessment or participate in MI specialized services that a follow-up visit will be conducted at the first MI quarterly meeting and removes the requirement for visits every 30 days for 90 days after the initial IDT meeting. The proposed amendment also requires the LMHA or LBHA to, if the resident with MI or the LAR refuses the uniform assessment or MI specialized services "at the first MI quarterly meeting," (instead of "after 90 days") inform the resident and the LAR that an annual IDT meeting is required and will be conducted, at which time the uniform assessment and MI specialized services will be offered again. The proposed amendment also makes minor changes for clarity.

Proposed amendment to §303.910, Suspension and Termination of MI Specialized Services, removes the requirement that an LMHA or LBHA suspend MI specialized services for a resident with MI if the resident or LAR requests that MI specialized services be suspended when transferring from one NF to another NF without an intervening hospital stay. The proposed amendment allows the LMHA or LBHA to terminate one or more MI specialized services if the MI specialized services team agrees that the resident with MI no longer benefits from the services. The proposed amendment also makes minor changes for clarity.

Proposed amendment to §303.912, Documentation, removes the reference to the required 30, 60, and 90 day follow-up meetings held after the initial IDT meeting for a resident with MI who refuses MI specialized services and makes minor changes for clarity.

Proposed new §303.914, Required Training for an LMHA or LBHA Staff Responsible for Coordinating MI Specialized Services, requires the LMHA and LBHA to ensure that an LMHA or LBHA staff responsible for coordinating MI specialized services completes specified training before coordinating MI specialized services and completes HHSC approved computer-based person-centered planning and practices training within the first 60 days of coordinating MI specialized services. The proposed new rule also requires that the LMHA or LBHA ensure that a supervisor, team lead, or quality monitoring staff person who has successfully completed the HHSC approved computer-based person-centered planning and practices training reviews and signs off on work completed by an LMHA or LBHA staff until such staff completes the training. The proposed new rule further requires the LMHA and LBHA to ensure that staff responsible for coordinating MI specialized services completes HHSC approved person-centered thinking training within the first year of coordinating MI specialized services and that staff responsible for coordinating MI specialized services demonstrate competency in the coordination of MI specialized services and maintain documentation of the training received by the staff.

Proposed new Subchapter J, Disaster Rule Flexibilities.

Proposed new §303.1000, Flexibilities to Certain Requirements During Declaration of Disaster, provides that HHSC may allow LIDDAs, LMHAs, and LBHAs to use one or more of the exceptions described in the rule while an executive order or proclamation declaring a state of disaster under Texas Government Code §418.014 is in effect. The rule provides that HHSC notifies LIDDAs, LMHAs, and LBHAs if it allows an exception to be used and the date an allowed exception must no longer be used.

FISCAL NOTE

Trey Wood, Chief Financial Officer, has determined that for each year of the first five years that the rules will be in effect, enforcing or administering the rules do not have foreseeable implications relating to costs or revenues of state or local governments.

GOVERNMENT GROWTH IMPACT STATEMENT

HHSC has determined that during the first five years that the rules will be in effect:

(1) the proposed rules will not create or eliminate a government program;

(2) implementation of the proposed rules will not affect the number of HHSC employee positions;

(3) implementation of the proposed rules will result in no assumed change in future legislative appropriations;

(4) the proposed rules will not affect fees paid to HHSC;

(5) the proposed rules will create new rules;

(6) the proposed rules will repeal and expand existing rules;

(7) the proposed rules will not change the number of individuals subject to the rules; and

(8) the proposed rules will not affect the state's economy.

SMALL BUSINESS, MICRO-BUSINESS, AND RURAL COMMUNITY IMPACT ANALYSIS

Trey Wood has also determined that there will be no adverse economic effect on small businesses, micro-businesses, or rural communities. The amendments do not require small businesses, micro-businesses, or rural communities to change current business practices.

LOCAL EMPLOYMENT IMPACT

The proposed rules will not affect a local economy.

COSTS TO REGULATED PERSONS

Texas Government Code §2001.0045 does not apply to these rules because the rules are necessary to protect the health, safety, and welfare of the residents of Texas and because the rules are necessary to implement legislation that does not specifically state that §2001.0045 applies to the rule.

PUBLIC BENEFIT AND COSTS

Haley Turner, Deputy Executive Commissioner for Community Services, has determined that for each year of the first five years the rules are in effect, the public benefit will be the improved facilitation of PASRR-related services because of more opportunities for interactions with Medicaid recipients to be conducted through telecommunications as required by state law. Another public benefit is the enhanced skills and knowledge of LMHA and LBHA staff who provide PASRR-related services because of additional training requirements Finally, a public benefit is the greater assurance that LIDDAs, LMHAs, LBHAs will be able to operate and provide PASRR-related services effectively during a disaster.

Trey Wood has also determined that for the first five years the rules are in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rules. The proposal does not impose new costs or fees on those required to comply.

TAKINGS IMPACT ASSESSMENT

HHSC has determined that the proposal does not restrict or limit an owner's right to his or her property that would otherwise exist in the absence of government action and, therefore, does not constitute a taking under Texas Government Code §2007.043.

PUBLIC COMMENT

Written comments on the proposal may be submitted to HHSC IDD Services, Lisa Habbit, Mail Code 354, P.O. Box 149030, Austin, Texas 78714-9030, or by email to IDDServicesPolicyandRules@hhs.texas.gov.

To be considered, comments must be submitted no later than 31 days after the date of this issue of the Texas Register. Comments must be: (1) postmarked or shipped before the last day of the comment period; (2) hand-delivered before 5:00 p.m. on the last working day of the comment period; or (3) emailed before midnight on the last day of the comment period. If the last day to submit comments falls on a holiday, comments must be postmarked, shipped, or emailed before midnight on the following business day to be accepted. When emailing comments, please indicate "Comments on Proposed Rule 22R121" in the subject line.

SUBCHAPTER A. GENERAL PROVISIONS

26 TAC §303.102

STATUTORY AUTHORITY

The amendment is authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, Texas Government Code §531.033, which provides the Executive Commissioner of HHSC with broad rulemaking authority; and Texas Human Resources Code §32.021, which provides that HHSC will adopt necessary rules for the proper and efficient administration of the Medicaid program.

The amendment implements Texas Government Code §531.02161.

§303.102.Definitions.

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

(1) Actively involved person--An individual who has significant, ongoing, and supportive involvement with a designated resident, as determined by the SPT based on the individual's:

(A) observed interactions with the designated resident;

(B) availability to the designated resident for assistance or support when needed; and

(2) Acute care hospital--A health care facility in which an individual receives short-term treatment for a severe physical injury or episode of physical illness, an urgent medical condition, or recovery from surgery and:

(A) may include a long-term acute care hospital, an emergency room within an acute care hospital, or an inpatient rehabilitation hospital; and

(B) does not include a stand-alone psychiatric hospital or a psychiatric hospital within an acute care hospital.

(3) Alternate placement assistance--Assistance provided to a resident to locate and secure services chosen by the resident or LAR that meets the resident's needs in a setting other than a NF. Alternate placement assistance includes transition planning, pre-move site review, and post-move monitoring.

(4) APRN--Advance practice registered nurse. An individual licensed to practice professional nursing as an advance practice registered nurse in accordance with Texas Occupations Code Chapter 301.

(5) Audio-only--An interactive, two-way audio communication that uses only sound and that meets the privacy requirements of the Health Insurance Portability and Accountability Act. Audio-only includes the use of telephonic communication. Audio-only does not include audio-visual or in-person communication.

(6) Audio-visual--An interactive, two-way audio and video communication that conforms to privacy requirements under the Health Insurance Portability and Accountability Act. Audio-visual does not include audio-only or in-person communication.

(7) [~~(5)~~] Behavioral support--An IHSS that:

(A) is assistance provided for a designated resident to increase adaptive behaviors and to replace or modify maladaptive behaviors that prevent or interfere with the designated resident's interpersonal relationships across all service and social settings;

(B) is delivered in the NF or in a community setting; and

(i) assessing the behaviors to be targeted in an appropriate behavior support plan and analyzing those assessment findings;

(ii) developing an individualized behavior support plan that reduces or eliminates the target behaviors, assisting the designated resident in achieving the outcomes identified in the HSP;

(iii) training and consulting with the LAR, family members, NF staff, other support providers, and the designated resident about the purpose, objectives, and methods of the behavior support plan;

(iv) implementing the behavior support plan or revisions to the behavior support plan and documenting service delivery in accordance with the IDD Habilitative Specialized Services Billing Guidelines;

(v) monitoring and evaluating the success of the behavior support plan implementation;

(vi) revising the behavior support plan as necessary; and

(vii) participating in SPT and IDT meetings.

(8) [~~(6)~~] CMWC--Customized manual wheelchair. In accordance with §554.2703(5) of this title (relating to Definitions) and consistent with the requirements of Texas Human Resources Code §32.0425, a wheelchair that consists of a manual mobility base and customized seating system and is adapted and fabricated to meet the individualized needs of a designated resident.

(9) [~~(7)~~] Collateral contact--A person who is knowledgeable about the individual seeking admission to a NF or the resident, such as family members, previous providers or caregivers, and who may support or corroborate information provided by the individual or resident.

(10) [~~(8)~~] Coma--A state of unconsciousness characterized by the inability to respond to sensory stimuli as documented by a physician.

(11) [~~(9)~~] Convalescent care--A type of care provided after an individual's release from an acute care hospital that is part of a medically prescribed period of recovery.

(12) [~~(10)~~] Day habilitation--An IHSS that:

(A) is assistance provided for a designated resident to acquire, retain, or improve self-help, socialization, and adaptive skills necessary to successfully and actively participate in all service and social settings;

(B) is delivered in a setting other than the designated resident's NF;

(D) includes expanded interactions, skills training activities, and programs of greater intensity or frequency beyond those a NF is required to provide by 42 Code of Federal Regulations (CFR) §483.24; and

(E) consists of:

(i) individualized activities consistent with achieving the outcomes identified in a designated resident's HSP to attain, learn, maintain, or improve skills;

(ii) activities necessary to reinforce therapeutic outcomes targeted by other support providers and other specialized services;

(iii) services in a group setting at a location other than a designated resident's NF for up to five days per week, six hours per day, on a regularly scheduled basis;

(iv) personal assistance for a designated resident who cannot manage personal care needs during the day habilitation activity;

(v) transportation between the NF and the day habilitation site, as well as during the day habilitation activity necessary for a designated resident's participation in day habilitation activities; and

(vi) participating in SPT and IDT meetings.

(13) [~~(11)~~] DD--Developmental disability. A disability that meets the criteria described in the definition of "persons with related conditions" in 42 CFR §435.1010.

(14) [~~(12)~~] Delirium--A serious disturbance in an individual's mental abilities that results in a decreased awareness of the individual's environment and confused thinking.

(15) [~~(13)~~] Designated resident--An individual:

(A) whose PE or resident review is positive for ID or DD;

(B) who is 21 years of age or older;

(D) who is a resident or has transitioned to the community from a NF within the previous 365 days.

(16) [~~(14)~~] DME--Durable medical equipment. The items described in §554.2703(10) of this title.

(17) [~~(15)~~] Emergency protective services--Services furnished by the Department of Family and Protective Services to an elderly or disabled individual who has been determined to be in a state of abuse, neglect, or exploitation.

(18) [~~(16)~~] Employment assistance--An IHSS that:

(A) is assistance provided for a designated resident who requires intensive help locating competitive employment in the community; and

(B) consists of:

(i) identifying a designated resident's employment preferences, job skills, and requirements for a work setting and work conditions;

(ii) locating prospective employers offering employment compatible with a designated resident's identified preferences, skills, and requirements;

(iii) contacting prospective employers on a designated resident's behalf and negotiating the designated resident's employment;

(iv) transporting a designated resident between the NF and the site where employment assistance services are provided and as necessary to help the designated resident locate competitive employment in the community; and

(v) participating in SPT and IDT meetings.

(19) [~~(17)~~] Essential supports--Those supports identified in a transition plan that are critical to a designated resident's health and safety and that are directly related to a designated resident's successful transition to living in the community from residing in a NF.

(20) [~~(18)~~] Exempted hospital discharge--A category of NF admission that occurs when a physician has certified that an individual who is being discharged from an acute care hospital is likely to require less than 30 days of NF services for the condition for which the individual was hospitalized.

(21) [~~(19)~~] Expedited admission--A category of NF admission that occurs when an individual meets the criteria for one of the following categories: convalescent care, terminal illness, severe physical illness, delirium, emergency protective services, respite, or coma.

(22) Extenuating circumstances--Circumstances beyond the LIDDA's, LMHA's or LBHA's control that preclude meeting in person. A disaster declared by the governor is excluded from this definition.

(23) [~~(20)~~] Habilitation coordination--Assistance for a designated resident residing in a NF to access appropriate specialized services necessary to achieve a quality of life and level of community participation acceptable to the designated resident and LAR on the designated resident's behalf.

(24) [~~(21)~~] Habilitation coordinator--An employee of a LIDDA who provides habilitation coordination.

(25) [~~(22)~~] HHSC--The Texas Health and Human Services Commission.

(26) HHSC instructor-led training--Training delivered by an HHSC employee.

(27) [~~(23)~~] HSP--Habilitation service plan. A plan developed by the SPT while a designated resident is residing in a NF that:

(A) is individualized and developed through a person-centered approach;

(B) identifies the designated resident's:

(i) strengths;

(ii) preferences;

(iii) desired outcomes; and

(iv) psychiatric, behavioral, nutritional management, and support needs as described in the NF comprehensive care plan or MDS assessment; and

(C) identifies the specialized services that will accomplish the desired outcomes of the designated resident, or the LAR's on behalf of the designated resident, including amount, frequency, and duration of each service.

(28) [~~(24)~~] ID--Intellectual disability, as defined in 42 CFR §483.102(b)(3)(i).

(29) [~~(25)~~] IDD--Intellectual and developmental disability.

(30) [~~(26)~~] IDT--Interdisciplinary team. A team consisting of:

(A) a resident with MI, ID, or DD;

(B) the resident's LAR, if any;

(D) a representative of:

(i) the LIDDA, if the resident has ID or DD;

(ii) the LMHA or LBHA, if the resident has MI; or

(iii) the LIDDA and the LMHA or LBHA, if the resident has MI and DD, or MI and ID; and

(E) others as follows:

(i) a concerned person whose inclusion is requested by the resident or LAR;

(ii) an individual specified by the resident, LAR, NF, LIDDA, LMHA, or LBHA, as applicable, who is professionally qualified, certified, or licensed with special training and experience in the diagnosis, management, needs, and treatment of people with MI, ID, or DD; and

(iii) a representative of the appropriate school district if the resident is school age and inclusion of the district representative is requested by the resident or LAR.

(31) [~~(27)~~] IHSS--IDD habilitative specialized services. IHSS are:

(A) behavioral support;

(B) day habilitation;

(D) independent living skills training; and

(E) supported employment.

(32) [~~(28)~~] ILST--Independent living skills training. An IHSS that:

(A) is assistance provided for a designated resident that is consistent with the designated resident's HSP;

(B) is provided in the designated resident's NF or in a community setting;

(C) includes expanded interactions, skills training activities, and programs of greater intensity or frequency beyond those a NF is required to provide by 42 CFR §483.24; and

(D) consists of:

(i) habilitation and support activities that foster improvement of or facilitate a designated resident's ability to attain, learn, maintain, or improve functional living skills and other daily living activities;

(ii) activities that help preserve the designated resident's bond with family members;

(iii) activities that foster inclusion in community activities generally attended by people without disabilities;

(iv) transportation to facilitate a designated resident's employment opportunities and participation in community activities, and between the designated resident's NF and a community setting; and

(v) participating in SPT and IDT meetings.

(33) [~~(29)~~] Implementation plan--A plan for each IHSS on the designated resident's plan of care that includes:

(A) a list of the designated resident's outcomes identified in the HSP that will be addressed using IHSS;

(B) specific objectives to address the outcomes required by subparagraph (A) of this paragraph that are:

(i) observable, measurable, and outcome-oriented; and

(ii) derived from assessments;

(D) the frequency, amount, and duration of IHSS needed to complete each objective; and

(E) the signature and date of the designated resident, LAR, and service provider agency.

(34) In-person (or in person)--Within the physical presence of another person. In-person or in person does not include audio-visual or audio-only communication.

(35) [~~(30)~~] LAR--Legally authorized representative. An individual authorized by law to act on behalf of an individual seeking admission to a NF or resident with regard to a matter described by this chapter, and who may be the parent of a minor child, the legal guardian, or the surrogate decision maker.

(36) [~~(31)~~] LBHA--Local behavioral health authority. An entity designated by the executive commissioner of HHSC, in accordance with Texas Health and Safety Code §533.0356.

(37) [~~(32)~~] LCSW--Licensed clinical social worker. An individual who is licensed as a licensed clinical social worker in accordance with Texas Occupations Code Chapter 505.

(38) [~~(33)~~] Licensed psychologist--An individual who is licensed as a psychologist in accordance with Texas Occupations Code Chapter 501.

(39) [~~(34)~~] LIDDA--Local intellectual and developmental disability authority. An entity designated by the executive commissioner of HHSC, in accordance with Texas Health and Safety Code §533A.035.

(40) [~~(35)~~] LMFT--Licensed marriage and family therapist. An individual who is licensed as a marriage and family therapist in accordance with Texas Occupations Code Chapter 502.

(41) [~~(36)~~] LMHA--Local mental health authority. An entity designated by the executive commissioner of HHSC, in accordance with Texas Health and Safety Code §533.035.

(42) [~~(37)~~] LPC--Licensed professional counselor. An individual who is licensed as a professional counselor in accordance with Texas Occupations Code Chapter 503.

(43) [~~(38)~~] LTC online portal--Long term care online portal. A web-based application used by Medicaid providers to submit forms, screenings, evaluations, and other information.

(44) [~~(39)~~] MCO service coordinator--Managed care organization service coordinator. The staff person assigned by a resident's Medicaid managed care organization to ensure access to and coordination of needed services.

(45) [~~(40)~~] MDS assessment--Minimum data set assessment. A standardized collection of demographic and clinical information that describes a resident's overall condition, which a licensed NF in Texas is required to submit for a resident admitted into the facility.

(46) [~~(41)~~] MI--Mental illness. Serious mental illness, as defined in 42 CFR §483.102(b)(1).

(47) [~~(42)~~] MI quarterly meeting--A quarterly meeting that is convened by the LMHA or LBHA for a resident with MI to develop, review, or revise the PCRP and the transition plan, if the resident is transitioning to the community.

(48) [~~(43)~~] MI specialized services--Specialized services for a resident with MI, if eligible, as described in the Texas Resilience and Recovery Utilization Management Guidelines, including:

(A) crisis intervention services;

(B) day programs for acute needs;

(D) psychiatric diagnostic interview examination;

(E) psychosocial rehabilitation services;

(F) routine case management; and

(G) skills training and development.

(49) [~~(44)~~] NF--Nursing facility. A Medicaid-certified facility that is licensed in accordance with the Texas Health and Safety Code Chapter 242.

(50) [~~(45)~~] NF comprehensive care plan--A comprehensive care plan, defined in §554.2703(3) of this title.

(51) [~~(46)~~] NF PASRR support activities--Actions a NF takes in coordination with a LIDDA, LMHA, or LBHA to facilitate the successful provision of an IHSS or MI specialized service, including:

(A) arranging transportation for a NF resident to participate in an IHSS or a MI specialized service outside the facility;

(B) sending a resident to a scheduled IHSS or MI specialized service with food and medications required by the resident; and

(C) stating in the NF comprehensive care plan an agreement to avoid, when possible, scheduling NF services at times that conflict with IHSS or MI specialized services.

(52) [~~(47)~~] NF specialized services--The following specialized services available to a resident with ID or DD:

(A) therapy services;

(B) CMWC; and

(53) [~~(48)~~] PA--Physician assistant. An individual who is licensed as a physician assistant in accordance with Texas Occupations Code Chapter 204.

(54) [~~(49)~~] PASRR--Preadmission screening and resident review. A federal requirement in 42 CFR Part 483, Subpart C that requires states to prescreen all individuals seeking admission to a Medicaid-certified NF for ID, DD, and MI.

(55) [~~(50)~~] PCRP--Person-centered recovery plan. For a resident with MI, the PCRP identifies the services and supports that are needed to:

(A) meet the needs of the resident with MI [~~MI's needs~~];

(B) achieve the desired outcomes; and

(C) maximize the [~~resident with MI's~~] ability for the resident with MI to live successfully in the most integrated setting possible.

(56) [~~(51)~~] PE--PASRR level II evaluation. An [~~A face-to-face~~] evaluation as described in §303.302(a)(2) of this chapter (relating to LIDDA, LMHA, and LBHA Responsibilities Related to the PASRR Process):

(A) of an individual seeking admission to a NF who is suspected of having MI, ID, or DD; and

(B) performed by a LIDDA, LMHA, or LBHA to determine if the individual has MI, ID, or DD and, if so, to:

(i) assess the individual's need for care in a NF;

(ii) assess the individual's need for specialized services; and

(iii) identify alternate placement options.

(57) [~~(52)~~] Physician--An individual who is licensed to practice medicine in accordance with Texas Occupations Code Chapter 155.

(58) [~~(53)~~] PL1--PASRR level I screening. The process of screening an individual seeking admission to a NF to identify whether the individual is suspected of having MI, ID, or DD.

(59) [~~(54)~~] Plan of care--A written plan that includes:

(A) the IHSS required by the NF baseline care plan or NF comprehensive care plan;

(B) the frequency, amount, and duration of each IHSS to be provided for the designated resident during a plan year; and

(60) [~~(55)~~] Preadmission process--A category of NF admission:

(A) from a community setting, such as a private home, an assisted living facility, a group home, a psychiatric hospital, or jail, but not an acute care hospital or another NF; and

(B) that is not an expedited admission or an exempted hospital discharge.

(61) [~~(56)~~] QIDP--Qualified intellectual disability professional. An individual who meets the qualifications described in 42 CFR §483.430(a).

(62) [~~(57)~~] QMHP-CS--Qualified mental health professional-community services. An individual who meets the qualifications of a QMHP-CS as defined in §301.303 of this title (relating to Definitions).

(63) [~~(58)~~] Referring entity--The entity that refers an individual to a NF, such as a hospital, attending physician, LAR or other personal representative selected by the individual, a family member of the individual, or a representative from an emergency placement source, such as law enforcement.

(64) [~~(59)~~] Relocation specialist--An employee or contractor of an MCO who provides outreach and relocation activities to individuals in NFs who express a desire to transition to the community.

(65) [~~(60)~~] Resident--An individual who resides in a NF.

(66) [~~(61)~~] Resident review--An [~~A face-to-face~~] evaluation of a resident performed by a LIDDA, LMHA, or LBHA as described in §303.302(a)(2) of this chapter (relating to LIDDA, LMHA, and LBHA Responsibilities Related to the PASRR Process):

(A) for a resident whose PE is positive for MI, ID, or DD who experienced a significant change in condition, to:

(i) assess the resident's need for continued care in a NF;

(ii) assess the resident's need for specialized services; and

(iii) identify alternate placement options; and

(B) for a resident suspected of having MI, ID, or DD, to determine whether the resident has MI, ID, or DD and, if so:

(i) assess the resident's need for continued care in a NF;

(ii) assess the resident's need for specialized services; and

(iii) identify alternate placement options.

(67) [~~(62)~~] Resident with MI--An individual:

(A) who is a resident of a NF;

(B) whose PE or resident review is positive for MI;

(D) who is a Medicaid recipient.

(68) [~~(63)~~] Respite--Services provided on a short-term basis to an individual because of the absence of or the need for relief by the individual's unpaid caregiver for a period not to exceed 14 days.

(69) [~~(64)~~] RN--Registered nurse. An individual licensed to practice professional nursing as a registered nurse in accordance with Texas Occupations Code Chapter 301.

(70) [~~(65)~~] Service coordination--Assistance in accessing medical, social, educational, and other appropriate services and supports, including alternate placement assistance, that will help an individual to achieve a quality of life and community participation acceptable to the individual and LAR on the individual's behalf.

(71) [~~(66)~~] Service coordinator--An employee of a LIDDA who provides service coordination.

(72) [~~(67)~~] Service provider agency--An entity that has a contract with HHSC to provide IHSS for a designated resident.

(73) [~~(68)~~] Severe physical illness--An illness resulting in ventilator dependence or a diagnosis, such as chronic obstructive pulmonary disease, Parkinson's disease, Huntington's disease, amyotrophic lateral sclerosis, or congestive heart failure, that results in a level of impairment so severe that the individual could not be expected to benefit from specialized services.

(74) [~~(69)~~] Significant change in condition--Consistent with §554.801(2)(C)(ii) of this title (relating to Resident Assessment), when a resident experiences a major decline or improvement in the resident's status that:

(A) will not normally resolve itself without further intervention by NF staff or by implementing standard disease-related clinical interventions;

(B) has an impact on more than one area of the resident's health status; and

(75) [~~(70)~~] Specialized services--The following support services, other than NF services, that are identified through the PE or resident review and may be provided to a resident who has a PE or resident review that is positive for MI, ID, or DD:

(A) NF specialized services;

(B) IHSS; and

(76) [~~(71)~~] SPT--Service planning team. A team convened by a LIDDA staff person that develops, reviews, and revises the HSP and the transition plan for a designated resident. The team must include:

~~[(A) The team must include:]~~

(A) [~~(i)~~] the designated resident;

(B) [~~(ii)~~] the designated resident's LAR, if any;

(C) [~~(iii)~~] the habilitation coordinator for discussions and service planning related to specialized services or the service coordinator for discussions related to transition planning if the designated resident is transitioning to the community;

(D) [~~(iv)~~] the MCO service coordinator, if the designated resident does not object;

(E) the person who develops a permanency plan using the HHSC Permanency Planning Instrument for Children Under 22 Years of Age form and performs other permanency planning activities for a designated resident under 22 years of age, if the designated resident is at least 21 years of age but younger than 22 years of age;

(F) [~~(v)~~] while the designated resident is in a NF:

(i) [~~(I)~~] a NF staff person familiar with the designated resident's needs; and

(ii) [~~(II)~~] an individual providing a specialized service for the designated resident or a representative of a provider agency that is providing specialized services for the designated resident;

(G) [~~(vi)~~] if the designated resident is transitioning to the community:

(i) [~~(I)~~] a representative from the community program provider, if one has been selected; and

(ii) [~~(II)~~] a relocation specialist; and

(H) [~~(vii)~~] a representative from the LMHA or LBHA, if the designated resident's PE is positive for MI.

~~[(B) Other participants on the SPT may include:]~~

(I) [~~(i)~~] a concerned person whose inclusion is requested by the designated resident or the LAR; and

(J) [~~(ii)~~] at the discretion of the LIDDA, an individual who is directly involved in the delivery of services for people with ID or DD.

(77) [~~(72)~~] Supported employment--An IHSS that:

(A) is assistance provided for a designated resident:

(i) who requires intensive, ongoing support to be self-employed, work from the designated resident's residence, or work in an integrated community setting at which people without disabilities are employed; and

(ii) to sustain competitive employment in an integrated community setting; and

(B) consists of:

(i) making employment adaptations, supervising, and providing training related to the designated resident's assessed needs;

(ii) transporting the designated resident between the NF and the site where the supported employment services are provided and as necessary to support the designated resident to be self-employed, work from the designated resident's residence, or work in an integrated community setting; and

(iii) participating in SPT and IDT meetings.

(78) [~~(73)~~] Surrogate decision maker--An actively involved family member of a resident who has been identified by an IDT in accordance with Texas Health and Safety Code §313.004 and who is available and willing to consent to medical treatment on behalf of the resident.

(79) [~~(74)~~] Terminal illness--A medical prognosis that an individual's life expectancy is six months or less if the illness runs its normal course and that is documented by a physician's certification in the individual's medical record maintained by a NF.

(80) [~~(75)~~] Therapy services--In accordance with §554.2703(46) of this title, assessment and treatment to help a designated resident learn, keep, or improve skills and functioning of daily living affected by a disabling condition. Therapy services are referred to as habilitative therapy services. Therapy services are limited to:

(A) physical therapy;

(B) occupational therapy; and

(81) [~~(76)~~] Transition plan--A plan developed by the SPT or MI quarterly meeting attendees that describes the activities, timetable, responsibilities, services, and essential supports involved in assisting a designated resident or resident with MI to transition from residing in a NF to living in the community.

(82) [~~(77)~~] Uniform assessment--The HHSC-approved uniform assessment tool for adult mental health services.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on October 2, 2023.

TRD-202303652

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: November 19, 2023

For further information, please call: (512) 438-5018

SUBCHAPTER B. PASRR SCREENING AND EVALUATION PROCESS

26 TAC §303.201

STATUTORY AUTHORITY

The amendment implements Texas Government Code §531.02161.

§303.201.Preadmission Process.

(a) A referring entity must complete a PL1 when an individual is seeking admission into a NF through the preadmission process, and:

(1) if the PL1 indicates the individual is suspected of having MI, ID, or DD:

(A) must notify the LIDDA, LMHA, or LBHA, as applicable; and

(B) must provide a copy of the PL1 to the LIDDA, LMHA, or LBHA, as applicable; and

(2) if the PL1 indicates the individual is not suspected of having MI, ID, or DD, must provide a copy of the completed PL1 to the NF.

(b) If a LIDDA, LMHA, or LBHA is provided a copy of a PL1 in accordance with subsection (a)(1)(B) of this section, the LIDDA, LMHA, or LBHA must:

(1) comply with §303.302(a)(1) of this chapter (relating to LIDDA, LMHA, and LBHA Responsibilities Related to the PASRR Process);

(2) [~~(1)~~] complete a PE in accordance with §303.302(a)(2) of this chapter [~~(relating to LIDDA, LMHA, and LBHA Responsibilities Related to the PASRR Process)~~];

(3) [~~(2)~~] comply with §303.302(b) and (c) of this chapter; and

(4) [~~(3)~~] make reasonable efforts to arrange for available community services and supports in the least restrictive setting to avoid NF admission, if the individual seeking admission to a NF, or the individual's LAR on the individual's behalf, wants to remain in the community.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on October 2, 2023.

TRD-202303653

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: November 19, 2023

For further information, please call: (512) 438-5018

SUBCHAPTER C. RESPONSIBILITIES

26 TAC §303.302, §303.303

STATUTORY AUTHORITY

The amendments are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, Texas Government Code §531.033, which provides the Executive Commissioner of HHSC with broad rulemaking authority; and Texas Human Resources Code §32.021, which provides that HHSC will adopt necessary rules for the proper and efficient administration of the Medicaid program.

The amendments implement Texas Government Code §531.02161.

§303.302.LIDDA, LMHA, and LBHA Responsibilities Related to the PASRR Process.

(a) A LIDDA, LMHA, or LBHA, as applicable, must:

(1) enter in the LTC online portal the data from a PL1 completed by a referring entity in accordance with §303.201(a)(1) of this chapter (relating to Preadmission Process) for an individual who is suspected of having MI, ID, or DD and who is seeking admission to a NF through the preadmission process;

(2) complete a PE or resident review as follows:

(A) within 72 hours after receiving a copy of the PL1 from the referring entity in accordance with §303.201(a)(1)(B) of this chapter or notification from the LTC online portal in accordance with §303.202 or §303.204(a) of this chapter (relating to Expedited Admission Process and Resident Review Process, respectively):

(i) call the referring entity or NF to schedule the PE or resident review; and

(ii) meet in person, or in extenuating circumstances meet via audio-visual communication, [~~face-to-face~~] with the individual or resident at the referring entity or NF to gather information to complete the PE or resident review; and

(B) within seven days after receiving a copy of the PL1 from the referring entity or notification from the LTC online portal:

(i) complete the PE or resident review by:

(I) reviewing the individual's or resident's:

(-a-) medical records;

(-b-) relevant service records, including those available in online databases, such as the Client Assignment and Registration (CARE) system, Clinical Management for Behavioral Health Services (CMBHS), and LTC online portal; and

(-c-) previous PEs, service plans, and assessments from other LIDDAs, LMHAs, or LBHAs;

(II) meeting [~~face-to-face~~] with the individual's LAR or resident's LAR in person, via audio-visual communication, or via audio-only communication according to the LAR's preference [~~or communicating with the LAR by telephone if the LAR is not able to meet face-to-face~~];

(III) communicating with a collateral contact as necessary;

(IV) providing information to the individual seeking admission or resident and the individual's LAR or resident's LAR, if any, about community services, supports, and programs for which the individual or resident may be eligible; and

(V) obtaining additional information as needed; and

(ii) enter the data from the PE or resident review in the LTC online portal; and

(3) within three business days after entering the data from the PE or resident review in the LTC online portal:

(A) if the PE or resident review is positive for MI, ID, or DD, provide the individual seeking admission or resident or the individual's LAR or resident's LAR with a summary of the results of the PE or resident review, using HHSC forms; or

(B) if the PE or resident review is negative for MI, ID, or DD, provide the individual seeking admission or resident or the individual's LAR or resident's LAR notice of the right to a fair hearing, using HHSC forms.

(b) If an individual seeking admission to a NF or a resident has a PE or resident review that is positive for ID, DD, or MI and a NF certifies in the LTC online portal that it cannot meet the needs of the individual or resident, then the LIDDA, LMHA, or LBHA, as applicable, must assist the individual, resident, or LAR in choosing another NF that will certify it can meet the needs of the individual or resident.

(c) If an individual seeking admission to a NF or a resident has a PE or resident review that is positive for ID, DD, or MI and a NF certifies in the LTC online portal that it can meet the needs of the resident or certifies in the LTC online portal that it can meet the needs of the individual and admits the individual, the LIDDA, LMHA or LBHA, as applicable, must:

(1) coordinate with the NF to schedule an IDT meeting to discuss specialized services;

(2) ensure a habilitation coordinator or QMHP-CS or both, as applicable, participates in person, or via audio-visual communication in extenuating circumstances, [~~participate~~] in the resident's IDT meeting as scheduled by the NF and collaborate [~~to, in collaboration~~] with the other members of the IDT to:

(A) identify which of the specialized services recommended for the resident that the resident, or LAR on the resident's behalf, wants to receive;

(B) identify the NF PASRR support activities for the resident; and

(3) within five business days after receiving notification from the LTC online portal that the NF entered information from the IDT meeting, confirm the LIDDA's, LMHA's, or LBHA's participation in the meeting and the specialized services recommended in the LTC online portal; and

(4) if Medicaid or other funding is available:

(A) initiate MI specialized services within 20 business days after the date of the IDT meeting; and

(B) provide the MI specialized services agreed upon in the IDT meeting to the resident.

(d) The LIDDA, LMHA, or LBHA must develop a written policy that describes the process the LIDDA, LMHA, or LBHA will follow to address challenges related to the participation in receiving IHSS or MI specialized services by the designated resident [~~resident's~~], resident with MI [~~MI's~~], or LAR [~~LAR's participation in receiving IHSS or MI specialized services~~].

(e) The LIDDA must ensure that a designated resident or LAR is informed orally and in writing of the processes for filing complaints as follows:

(1) the telephone number of the LIDDA to file a complaint;

(2) the telephone number of the IDD Ombudsman to file a complaint about the LIDDA;

(3) the telephone number of Complaint and Incident Intake to file a complaint about IHSS or the NF;

(4) the telephone number of DFPS Statewide Intake to report an allegation of abuse, neglect, or exploitation; and

(5) the telephone number of the Long-Term Care Ombudsman to file a complaint that relates to action, inaction, or a decision by any individual or entity who provides care or makes decisions related to a designated resident, that may adversely affect the health, safety, welfare, or rights of the designated resident.

(f) The LMHA or LBHA must ensure that a resident with MI or LAR is informed orally and in writing of the processes for filing complaints as follows:

(1) the telephone number of the LMHA or LBHA to file a complaint;

(2) the telephone number of the Ombudsman for Behavioral Health to file a complaint about MI specialized services or about an LMHA or LBHA;

(3) the telephone number of Complaint and Incident Intake to file a complaint about the NF;

(4) the telephone number of DFPS Statewide Intake to report an allegation of abuse, neglect, or exploitation; and

(5) the telephone number of the Long-Term Care Ombudsman to file a complaint that relates to action, inaction, or a decision by any individual or entity who provides care or makes decisions related to a resident with MI, that may adversely affect the health, safety, welfare, or rights of the resident with MI.

(g) If an individual seeking admission to a NF or a resident has a PE or resident review that is positive for MI and ID or MI and DD, the LIDDA is responsible for coordinating with the NF to schedule the IDT meeting to discuss specialized services.

(h) Before the LIDDA, LMHA, or LBHA staff conducts the meeting required in subsection (a)(2)(A)(ii) of this section via audio-visual communication, they must:

(1) do one of the following:

(A) obtain the written informed consent of the individual, designated resident, or LAR; or

(B) obtain the individual's, designated resident's, or LAR's oral consent and document the oral consent in the individual's or designated resident's record; and

(2) document in the individual's or designated resident's record a description of the extenuating circumstances that prevented meeting in person with the individual or the designated resident.

(i) If the LIDDA, LMHA, or LBHA does not obtain the written or oral consent required by subsection (h) of this section, the LIDDA, LMHA, or LBHA must conduct the meeting required in subsection (a)(2)(A)(ii) of this section by meeting with the LAR and NF staff most familiar with the individual or designated resident, to:

(1) review and gather all necessary information to complete the PE; and

(2) enter the PE in the LTC online portal.

§303.303.Qualifications and Requirements for Staff Person Conducting a PE or Resident Review.

(a) A LIDDA must ensure a PE or resident review is conducted by an individual who:

(1) is a QIDP; or

(2) has one of the following qualifications and at least one year of experience working directly with individuals with ID or DD:

(A) RN;

(B) LCSW;

(D) LMFT;

(E) Licensed Psychologist;

(F) APRN; or

(G) Physician.

(b) An LMHA or LBHA must ensure a PE or resident review is conducted by an individual who is a:

(1) QMHP-CS;

(2) RN;

(3) LCSW;

(4) LPC;

(5) LMFT;

(6) Licensed Psychologist;

(7) APRN;

(8) Physician; or

(9) PA.

(1) before a staff person conducts a PE or resident review, ensure the staff person:

(A) receives HHSC instructor-led [~~HHSC-developed~~ ] training about how to conduct a PE and resident review; and

(B) demonstrates competency in completing a PE and resident review; and

(2) maintain documentation of the training received by a staff person who conducts a PE or resident review.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on October 2, 2023.

TRD-202303654

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: November 19, 2023

For further information, please call: (512) 438-5018

SUBCHAPTER E. HABILITATION COORDINATION

26 TAC §303.502, §303.503

STATUTORY AUTHORITY

The amendments implement Texas Government Code §531.02161.

§303.502.Required Training for a Habilitation Coordinator.

(a) A LIDDA must ensure:

(1) a habilitation coordinator completes the following training before providing habilitation coordination:

(A) training that addresses:

(i) appropriate LIDDA policies, procedures, and standards;

(ii) this chapter, other HHSC rules relating to the provision of specialized services, and other HHSC rules affecting the LIDDA;

(iii) HHSC's IDD PASRR Handbook;

(iv) developing and implementing an HSP;

(v) conducting assessments, service planning, coordination, and monitoring;

(vi) providing crisis prevention and management;

(vii) community support services;

(viii) presenting community living options using HHSC-developed materials and forms, and offering educational opportunities and informational activities about community living options;

(ix) arranging visits to community providers;

(x) accessing specialized services for a designated resident;

(xi) the rights of an individual with an ID, including the right to live in the least restrictive setting appropriate to the person's individual needs and abilities and in a variety of living situations, as described in the Persons with an Intellectual Disability Act, Texas Health and Safety Code Chapter 592 and in an HHSC-developed rights handbook; and

(xii) advocacy for individuals with ID or DD;

(B) the HHSC computer-based training, "An Overview of the PASRR Process;" and

(2) a habilitation coordinator completes HHSC approved computer-based person-centered planning and practices [~~the following~~] training within the first 60 days of performing habilitation coordination duties;[:]

(3) [~~(A)~~] a habilitation coordinator completes all HHSC instructor-led [~~HHSC-developed~~ ] training related to PASRR habilitation coordination within the first 60 days of performing habilitation coordination duties; [~~and~~]

~~[(B) person-centered thinking training; and]~~

(4) [~~(3)~~] a supervisor, team lead, or quality monitoring staff person who has successfully completed the trainings in paragraphs [~~paragraph~~] (2) and (3) of this subsection reviews and signs off on work completed by a habilitation coordinator until the habilitation coordinator completes the trainings required in paragraphs [~~paragraph~~] (2) and (3) of this subsection; and[.]

(5) a habilitation coordinator completes person-centered thinking training approved by HHSC within the first year of performing habilitation coordination duties.

(b) A LIDDA must:

(1) ensure a habilitation coordinator demonstrates competency in providing habilitation coordination; and

(2) maintain documentation of the training received by habilitation coordinators.

§303.503.Documenting Habilitation Coordination Contacts.

(a) A LIDDA must ensure a habilitation coordinator documents all contacts, including:

(1) whether the contact was in person, via audio-visual communication, or via audio-only communication [~~face-to-face or by telephone~~];

(2) the date of contact;

(3) the description of the habilitation coordination activities provided;

(4) the name of the person with whom the contact occurred and the person's relationship to the designated resident; and

(5) the habilitation coordinator's name and title.

(b) A LIDDA must retain documentation in compliance with applicable federal and state laws, rules, and regulations unless instructed by HHSC to retain documentation for a longer period of time.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on October 2, 2023.

TRD-202303656

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: November 19, 2023

For further information, please call: (512) 438-5018

SUBCHAPTER F. HABILITATIVE SERVICE PLANNING FOR A DESIGNATED RESIDENT

26 TAC §303.601, §303.602

STATUTORY AUTHORITY

The amendments implement Texas Government Code §531.02161.

§303.601.Habilitation Coordination for a Designated Resident.

(a) A LIDDA must assign a habilitation coordinator to each designated resident within two days after a PE is completed if the PE is positive for ID or DD.

(1) The habilitation coordinator must [to] attend the initial IDT and provide habilitation coordination while the designated resident is residing in the NF.

(2) A designated resident may refuse habilitation coordination.

(b) Unless a designated resident has refused habilitation coordination, the assigned habilitation coordinator must:

(1) assess and reassess quarterly, and as needed, the designated resident's habilitative service needs by gathering information from the designated resident and other appropriate sources, such as the LAR, family members, social workers, and service providers, to determine the designated resident's habilitative needs and preferences and the specialized services that will address those needs and preferences;

(2) develop and revise, as needed, an individualized HSP in accordance with HHSC's rules and IDD PASRR Handbook, and using HHSC forms;

(3) assist the designated resident to access needed specialized services agreed upon in an IDT or SPT meeting, including:

(A) monitoring to determine if a specialized service agreed upon in an IDT or SPT meeting is requested within required timeframes in accordance with the IDD PASRR Handbook or documenting delays and the habilitation coordinator's follow-up activities; and

(B) ensuring the delivery of all specialized services agreed upon in an IDT or SPT meeting or documenting delays and the habilitation coordinator's follow-up activities;

(4) coordinate other habilitative programs and services that can address needs and achieve outcomes identified in the HSP;

(5) facilitate the coordination of the designated resident's HSP and NF comprehensive care plan, including ensuring the HSP is shared with members of the SPT within 10 calendar days after the HSP is updated or renewed;

(6) monitor and provide follow-up activities that consist of:

(A) monitoring the initiation and delivery of all specialized services agreed upon in an IDT or SPT meeting and following up when delays occur;

(B) monitoring the designated resident's and LAR's satisfaction with all specialized services; and

(C) determining the designated resident's progress or lack of progress toward achieving goals and outcomes identified in the HSP from the designated resident's and LAR's perspectives;

(7) [~~unless waived by HHSC,~~] meet [~~face-to-face~~ ] with the designated resident to provide habilitation coordination:

(A) at least monthly if the designated resident is receiving a specialized service in addition to habilitation coordination; and [~~or more frequently if needed; or~~]

(i) meet in person at least quarterly or more frequently as determined by the SPT using the findings of the HHSC Habilitative Assessment form; and

(ii) subject to subsection (d) of this section, meet via audio-visual communication in a month when a meeting is not conducted in person; or

(B) at least quarterly in person, if the [~~only specialized service the~~] designated resident is receiving only [is] habilitation coordination, unless the designated resident or the designated resident's LAR requests more frequent meetings;

(8) convene and facilitate an SPT meeting:

(A) at least quarterly; and

(B) between quarterly SPT meetings if:

(i) there is a change in the designated resident's service needs or medical condition; or

(ii) requested by the designated resident or LAR;

(9) coordinate with the NF in accessing medical, social, educational, and other appropriate services and supports that will help the designated resident achieve a quality of life acceptable to the designated resident and LAR on the resident's behalf;

(10) initially and annually thereafter:

(A) provide the designated resident and LAR an oral and written explanation of the designated resident's rights in accordance with the IDD PASRR Handbook; and

(B) inform the designated resident and LAR both orally and in writing of all the services available and requirements pertaining to the designated resident's participation;

(11) for a designated resident who has a guardian, determine at least annually if the letters of guardianship are current; and

(12) if appropriate, for a designated resident who does not have a guardian, ensure the SPT discusses whether the designated resident would benefit from a less restrictive alternative to guardianship or from guardianship and make appropriate referrals.

(c) Regardless of whether the designated resident is receiving or has refused habilitation coordination, the habilitation coordinator must:

(1) address community living options with the designated resident and LAR by:

(A) offering the educational opportunities and informational activities about community living options that are periodically scheduled by the LIDDA;

(B) providing information about the range of community living services, supports, and alternatives, identifying the services and supports the designated resident will need to live in the community, and identifying and addressing barriers to community living in accordance with HHSC's IDD PASRR Handbook and using HHSC materials at the following times:

(i) six months after the initial presentation of community living options during the PE described in §303.302(a)(2)(B)(i) of this Chapter (relating to LIDDA, LMHA, and LBHA Responsibilities Related to the PASRR Process) and at least every six months thereafter;

(ii) when requested by the designated resident or LAR;

(iii) when the habilitation coordinator is notified or becomes aware that the designated resident, or the LAR on the designated resident's behalf, is interested in speaking with someone about transitioning to the community; and

(iv) when notified by HHSC that the designated resident's response in Section Q of the MDS Assessment indicates the resident is interested in speaking with someone about transitioning to the community; and

(2) annually assess the designated resident's habilitative service needs by gathering information from the designated resident and other appropriate sources, such as the LAR, family members, social workers, and service providers, to determine the designated resident's habilitative needs and preferences.

(d) Before the habilitation coordinator conducts the meeting described in subsection (b)(7)(A)(ii) of this section via audio-visual communication, the habilitation coordinator must:

(1) obtain the written informed consent of the designated resident or LAR; or

(2) obtain the designated resident's or LAR's oral consent and document the oral consent in the designated resident's record.

(e) If the habilitation coordinator does not obtain the written or oral consent required by subsection (d) of this section, the habilitation coordinator must document the designated resident's or LAR's refusal in the designated resident's record.

§303.602.Service Planning Team Responsibilities Related to Specialized Services.

(a) The SPT for a designated resident must:

(1) meet at least quarterly, as convened by the habilitation coordinator;

(2) ensure that the designated resident, regardless of whether he or she has an LAR, participates in the SPT to the fullest extent possible and receives the support necessary to do so, including communication supports;

(3) develop an HSP for the designated resident;

(4) review and monitor identified risk factors, such as choking, falling, and skin breakdown, and report to the proper authority if they are not addressed;

(5) make timely referrals, service changes, and revisions to the HSP as needed;

(6) considering the designated resident's preferences, monitor to determine if the designated resident is provided opportunities for engaging in integrated activities:

(A) with residents who do not have ID or DD; and

(B) in community settings with people who do not have a disability; and

(7) develop the plan of care for a designated resident who receives IHSS.

(b) Each member of the SPT for a designated resident must:

(1) consistent with the SPT member's role, assist the habilitation coordinator in ensuring the designated resident's needs are being met; and

(2) participate in an SPT meeting in person, via audio-visual communication, or via audio-only communication [~~or by phone~~], except as described in subsection [~~subsections~~ ] (c)(3) or (e) of this section;

(1) submit to the habilitation coordinator a copy of all assessments of the designated resident that were completed by the provider or provider agency;

(2) submit a written report describing the designated resident's progress or lack of progress to the habilitation coordinator at least five days before a quarterly SPT meeting; and

(3) [~~actively~~] participate in an SPT meeting, in person, via audio-visual communication, or via audio-only communication [~~or by phone~~], unless the habilitation coordinator determines [~~active~~] participation by the provider is not necessary.

(d) If a habilitation coordinator determines [~~active~~] participation by a provider is not necessary as described in subsection (c)(3) of this section, the habilitation coordinator must:

(1) base the determination:

(A) on the information in the written report submitted in accordance with subsection (c)(2) of this section; and

(B) on the needs of the SPT; and

(2) document the reasons for exempting participation.

(e) A habilitation coordinator must facilitate a quarterly SPT meeting in person, or in extenuating circumstances via audio-visual communication.

(f) Before the habilitation coordinator conducts the meeting described in subsection (e) of this section via audio-visual communication, the habilitation coordinator must:

(1) do one of the following:

(A) obtain the written informed consent of the designated resident or LAR; or

(B) obtain the oral consent of the designated resident or LAR and document the oral consent in the designated resident's record; and

(2) document in the designated resident's record a description of the extenuating circumstances which required the use of audio-visual communication.

(g) If the habilitation coordinator does not obtain the written or oral consent required by subsection (f) of this section, the habilitation coordinator must document the designated resident's or LAR's refusal in the designated resident's record.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on October 2, 2023.

TRD-202303657

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: November 19, 2023

For further information, please call: (512) 438-5018

SUBCHAPTER G. TRANSITION PLANNING

26 TAC §303.701, §303.703

STATUTORY AUTHORITY

The amendments implement Texas Government Code §531.02161.

§303.701.Transition Planning for a Designated Resident.

(a) A LIDDA must assign a service coordinator for a designated resident if the designated resident, or the LAR on the designated resident's behalf, expresses an interest in moving to the community and has selected a community program.

(b) A service coordinator must facilitate the development, revisions, implementation, and monitoring of a transition plan in accordance with HHSC's IDD PASRR Handbook and using HHSC forms. A transition plan must identify the services and supports a designated resident needs to live in the community, including those essential supports that are critical to the designated resident's health and safety.

(1) meet as convened by the service coordinator;

(3) conduct transition planning activities and develop a transition plan for the designated resident.

(d) Consistent with an SPT member's role, each SPT member must:

(1) assist the service coordinator in developing, revising, implementing, and monitoring a designated resident's transition plan to ensure a successful transition to the community for the designated resident; and

(e) An SPT member who is a provider of a specialized service must [~~actively~~] participate in an SPT meeting, in person, via audio-visual communication, or via audio-only communication [~~or by phone~~], unless the service coordinator determines [~~active~~] participation by the provider is not necessary.

(f) If a service coordinator determines [~~active~~] participation by a provider is not necessary as described in subsection (e) of this section, the service coordinator must:

(1) base the determination on the needs of the SPT; and

(2) document the reasons for exempting participation.

(g) At an SPT meeting convened by a service coordinator, the service coordinator must facilitate the SPT meeting in person, or in extenuating circumstances via audio-visual communication.

(h) For a designated resident who is transitioning to the community, a service coordinator must, in accordance with HHSC's IDD PASRR Handbook and using HHSC forms, conduct and document a pre-move site review of the designated resident's proposed residence in the community to determine whether all essential supports in the designated resident's transition plan are in place before the designated resident's transition to the community.

(i) If the SPT makes a recommendation that a designated resident continue to reside in a NF, the SPT must:

(1) document the reasons for the recommendation; and

(2) include in the designated resident's transition plan:

(A) the barriers to moving to a more integrated setting; and

(B) the steps the SPT will take to address those barriers.

(j) Before the service coordinator conducts the meetings described in subsection (g) of this section via audio-visual communication, the service coordinator must:

(1) do one of the following:

(A) obtain the written informed consent of the designated resident or LAR; or

(B) obtain the oral consent of the designated resident or LAR and document the oral consent in the designated resident's record; and

(2) document in the designated resident's record a description of the extenuating circumstances which required the use of audio-visual communication.

(k) If the service coordinator does not obtain the written or oral consent required by subsection (j) of this section, the service coordinator must document the designated resident's or LAR's refusal in the designated resident's record.

§303.703.Requirements for Service Coordinators Conducting Transition Planning.

(a) A LIDDA must ensure that a service coordinator complies with [~~40 TAC~~] Chapter 331 of this title [~~2, Subchapter L~~] (relating to LIDDA Service Coordination [~~Service Coordination for Individuals with an Intellectual Disability~~]), including documenting in the transition plan the frequency and duration of service coordination while the designated resident is in the NF.

(b) A LIDDA must ensure:

(1) a service coordinator who conducts transition planning completes the following training before providing service coordination for a designated resident:

(A) training that addresses:

(i) this chapter;

(ii) HHSC's IDD PASRR Handbook;

(iii) the role of a relocation specialist and MCO service coordinator for a NF resident who wants to transition to the community;

(iv) services available through Texas Medicaid State Plan and all home and community-based services programs for individuals with ID or DD, such as [~~including but not limited to~~], access to nursing, durable medical equipment and supplies, and transition assistance supports;

(v) developing and implementing a transition plan for a designated resident;

(vi) an overview of community living options, educational opportunities, and informational activities about community living options; and

(vii) the rights of an individual with ID, including the right to live in the least restrictive setting appropriate to the person's individual needs and abilities and in a variety of living situations, as described in the Persons with an Intellectual Disability Act, Texas Health and Safety Code Chapter 592 and an HHSC-developed rights handbook;

(B) the HHSC computer-based training, "An Overview of the PASRR Process;" and

(2) a service coordinator who conducts transition planning completes HHSC approved computer-based person-centered planning and practices [~~the following~~] training within the first 60 days of performing service coordination duties;[:]

~~[(A) person-centered thinking training; and]~~

(3) [~~(B)~~] a service coordinator who conducts transition planning completes all HHSC instructor-led [~~HHSC-developed~~] training related to PASRR service coordination for transition planning within the first 60 days of performing transition planning duties; [~~and~~]

(4) [~~(3)~~] a supervisor, team lead, or quality monitoring staff person who has successfully completed the trainings in paragraphs [~~paragraph~~] (2) and (3) of this subsection reviews and signs off on work completed by a service coordinator until the service coordinator completes the trainings required in paragraphs [~~paragraph~~] (2) and (3) of this subsection; and[.]

(5) a service coordinator who conducts transition planning completes HHSC approved person-centered thinking training within the first year of performing transition planning duties.

(1) ensure a service coordinator who conducts transition planning demonstrates competency in conducting transition planning; and

(2) maintain documentation of the training received by service coordinators who conduct transition planning.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on October 2, 2023.

TRD-202303658

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: November 19, 2023

For further information, please call: (512) 438-5018

SUBCHAPTER I. MI SPECIALIZED SERVICES

26 TAC §303.901

STATUTORY AUTHORITY

The repeal is authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, Texas Government Code §531.033, which provides the Executive Commissioner of HHSC with broad rulemaking authority; and Texas Human Resources Code §32.021, which provides that HHSC will adopt necessary rules for the proper and efficient administration of the Medicaid program.

The repeal implements Texas Government Code §531.02161.

§303.901.Description of MI Specialized Services.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on October 2, 2023.

TRD-202303659

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: November 19, 2023

For further information, please call: (512) 438-5018

26 TAC §§303.901, 303.905, 303.907, 303.909, 303.910, 303.912, 303.914

STATUTORY AUTHORITY

The new sections and amendments are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, Texas Government Code §531.033, which provides the Executive Commissioner of HHSC with broad rulemaking authority; and Texas Human Resources Code §32.021, which provides that HHSC will adopt necessary rules for the proper and efficient administration of the Medicaid program.

The new sections and amendments implement Texas Government Code §531.02161.

§303.901.Description of MI Specialized Services.

(a) An LMHA or LBHA staff must conduct the uniform assessment to determine which level of care the resident with MI will receive.

(b) Specialized services for a resident with MI include the following.

(1) Skills training and development. Training provided to a resident with MI that:

(A) addresses the severe and persistent MI and symptom-related problems that interfere with the functioning of the resident with MI;

(B) provides opportunities for the resident with MI to acquire and improve skills needed to function as appropriately and independently as possible in the community; and

(C) facilitates community integration for the resident with MI and increases the length of community residency for the resident with MI.

(2) Medication training and support services. Education and guidance provided to a resident with MI and family members about the medications of the resident with MI and their possible side effects as described in §306.315 of this title (relating to Medication Training and Support Services).

(3) Psychosocial rehabilitation services. Social, educational, vocational, behavioral, and cognitive interventions provided by the therapeutic team members of a resident with MI that address deficits in their ability to develop and maintain social relationships, occupational or educational achievement, independent living skills, or housing. Psychosocial rehabilitative services include the following component services:

(A) coordination services;

(B) crisis related services;

(D) housing related services;

(E) independent living services; and

(F) medication related services.

(4) Case management. A primarily site-based service to assist a resident with MI or LAR in gaining and coordinating access to necessary care and services appropriate to the needs of the resident with MI.

(5) Psychiatric diagnostic interview examination. An assessment of a resident with MI that includes relevant past and current medical and psychiatric information and a documented diagnosis by a licensed professional practicing within the scope of his or her license.

§303.905.Process for Service Initiation.

(a) The LMHA or LBHA must comply with §303.302 of this chapter (relating to LIDDA, LMHA, and LBHA Responsibilities Related to the PASRR Process).

(b) At the initial IDT meeting, an [~~the~~] LMHA or LBHA staff [~~participating in the meeting, in conjunction with the IDT,~~] must:

(1) review the MI specialized services recommended on the PE;

(2) explain the uniform assessment;

(3) ensure the resident with MI, or LAR on behalf of the resident with MI [~~MI's behalf~~], understands the purpose of the uniform assessment; and

(4) have the resident with MI, or LAR on behalf of the resident with MI [~~MI's behalf~~], agree or decline to receive the uniform assessment and MI specialized services.

(1) complete the uniform assessment;

(2) develop the PCRP; and

(3) for a resident with MI only, convene a meeting in person, or in extenuating circumstances via audio-visual communication, to discuss the results of the uniform assessment and PCRP, and to determine the MI specialized services the resident with MI will receive.

(d) Attendees at the meeting convened in accordance with subsection (c)(3) of this section must include:

(1) the QMHP-CS who is familiar with the needs of the resident with MI [~~completed the uniform assessment and PCRP~~];

(2) the resident with MI;

(3) the LAR for the resident with MI [~~MI's LAR~~], if any; and

(4) a NF staff person familiar with the needs of the resident with MI [~~MI's needs~~].

(e) At the meeting convened in accordance with subsection (c)(3) of this section, the QMHP-CS must ensure the resident with MI, regardless of whether he or she has an LAR, participates in the meeting to the fullest extent possible and receives the support necessary to do so, including communication supports.

(f) The LMHA or LBHA must provide a copy of the completed uniform assessment and PCRP to the NF for inclusion in the NF comprehensive care plan for the resident with MI [~~MI's NF comprehensive care plan~~] within 10 calendar days after the meeting convened in accordance with subsection (c)(3) of this section.

(g) Before the LMHA or LBHA conducts the meeting described in subsection (c)(3) of this section via audio-visual communication, the LMHA or LBHA must:

(1) do one of the following:

(A) obtain the written informed consent of the resident with MI or LAR; or

(B) obtain oral consent from the resident with MI or LAR and document the oral consent in the record of the resident with MI; and

(2) document in the record of the resident with MI a description of the extenuating circumstances which required the use of audio-visual communication.

(h) If the LMHA or LBHA does not obtain the written or oral consent required by subsection (g) of this section, the LMHA or LBHA must document the resident with MI's or LAR's refusal in the record of the resident with MI.

§303.907.Renewal and Revision of Person-Centered Recovery Plan.

(a) At least quarterly, the QMHP-CS must convene an MI quarterly meeting, in person, or in extenuating circumstances via audio-visual communication, to:

(1) review the PCRP to determine whether the MI specialized services previously identified remain relevant; and

(2) determine whether the current uniform assessment accurately reflects the need for MI specialized services in the identified frequency for the resident with MI [~~MI's need for MI specialized services in the identified frequency~~], in the amount, and duration, or if an updated uniform assessment is required.

(b) The MI specialized services team initiates revisions to the PCRP in response to changes to the needs of the resident with MI.

(1) Any MI specialized services team member may ask the QMHP-CS to convene a meeting at any time to discuss whether the PCRP for the [a] resident with MI [~~MI's PCRP~~] needs to be revised to add a new MI specialized service or change the frequency, amount, or duration of an existing MI specialized service.

(2) The QMHP-CS must convene a meeting within seven calendar days after learning of the need to revise the PCRP for the resident with MI [~~MI's PCRP~~].

(c) If the MI specialized services team agrees to add a new MI specialized service to the PCRP or determines an updated uniform assessment is required, a QMHP-CS must, within seven calendar days after the meeting is held, update the uniform assessment and provide it to the MI specialized services team.

(d) The QMHP-CS must:

(1) document revisions on the PCRP within five calendar days after a team meeting; and

(2) retain the revised PCRP documentation in the LMHA or LBHA record for the resident with MI [~~MI's LMHA or LBHA record~~].

(e) Within ten calendar days after the PCRP is updated or renewed, the QMHP-CS must send each member of the MI specialized services team a copy of the revised PCRP.

(f) If the MI specialized services team determines a new MI specialized service is needed or determines a change in the frequency, amount, or duration of an existing service is needed, the PCRP must be revised before the LMHA or LBHA delivers a new or updated service.

(g) Before the QMHP-CS conducts the meeting described in subsection (a) of this section via audio-visual communication, the QMHP-CS must:

(1) do one of the following:

(A) obtain the written informed consent of the resident with MI or LAR; or

(B) obtain the oral consent from the resident with MI or LAR and document the oral consent in the record of the resident with MI; and

(2) document in the record of the resident with MI the extenuating circumstances which required the use of audio-visual communication.

(h) If the QMHP-CS does not obtain the written or oral consent required by subsection (g) of this section, the QMHP-CS must document the refusal of the resident with MI or LAR in the record of the resident with MI.

§303.909.Refusal of the Uniform Assessment or MI Specialized Services.

(a) When a resident with MI refuses the uniform assessment or MI specialized services, the LMHA or LBHA must:

(1) ask the resident with MI or the LAR to sign the Refusal of PASRR MI Specialized Services form and document on the form if the resident with MI or LAR refuses to sign;

(2) inform the resident with MI that a [~~of the need to conduct~~] follow-up visit will be conducted at the first MI quarterly meeting [~~visits every 30 days for 90 days after the initial IDT meeting~~]; and

(3) if the resident with MI or the LAR refuses [~~continues to refuse~~] the uniform assessment or MI specialized services at the first MI quarterly meeting [~~after 90 days,~~] inform the resident with MI and the LAR that an annual IDT meeting is required and will be conducted, at which time the uniform assessment and MI specialized services will be offered again.

(b) A resident with MI and their [or] LAR, if applicable, may agree to receive the uniform assessment or MI specialized services at any time.

§303.910.Suspension and Termination of MI Specialized Services.

(a) The LMHA or LBHA must suspend MI specialized services for a resident with [~~MI's~~] MI [~~specialized services~~] when:

(1) the resident with MI is admitted to an acute care hospital for fewer than 30 days and is returning to the same NF; or

(2) the resident with MI loses Medicaid eligibility.[~~; or~~]

~~[(3) the resident with MI or LAR requests that MI specialized services be suspended when transferring from one NF to another NF without an intervening hospital stay.]~~

(b) The LMHA or LBHA may terminate one or more MI specialized services of a resident with [~~MI's~~] MI [~~specialized services~~] if:

(1) the resident with MI loses Medicaid eligibility for more than 90 days; [or]

(2) the resident with MI or LAR requests the MI specialized services be terminated; or[.]

(3) the MI specialized services team, which includes the resident with MI and LAR, agrees the resident with MI no longer benefits from the MI specialized services.

§303.912.Documentation.

The [An] LMHA or LBHA must maintain the following documentation in the record of the resident with MI [~~MI's record~~]:

(1) all assessments used for service planning;

(2) documentation related to the initiation and delivery of MI specialized services, including reasons for delays and all follow-up activities;

(3) documentation related to monitoring MI specialized services, including:

(A) the satisfaction with MI specialized services by the resident with MI [~~MI's~~] or the LAR [~~LAR's satisfaction with MI specialized services~~]; and

(B) progress or lack of progress toward achieving goals and outcomes identified in the PCRP;

(4) documentation of all meetings required by this chapter[~~, including the required 30, 60, and 90 day follow-up meetings held after the initial IDT meeting for a resident with MI who refuses MI specialized services~~];

(5) guardianship paperwork and consents, if applicable; and

(6) documentation of the refusal of MI specialized services or uniform assessments or both by the [a] resident with MI [~~MI's refusal of MI specialized services or uniform assessments or both~~], if applicable.

§303.914.Required Training for an LMHA or LBHA Staff Responsible for Coordinating MI Specialized Services.

(a) The LMHA or LBHA must ensure:

(1) an LMHA or LBHA staff responsible for coordinating MI specialized services completes the following training before coordinating MI specialized services:

(A) training that addresses:

(i) appropriate LMHA or LBHA policies, procedures, and standards;

(ii) this chapter, other HHSC rules relating to the provision of specialized services, and other HHSC rules affecting the LMHA or LBHA; and

(iii) HHSC's PASRR MI Handbook;

(B) the HHSC computer-based PASRR training, "An Overview of the PASRR Process;" and

(C) additional trainings designated by HHSC through IDD-PASRR Handbook, PASRR MI Handbook, broadcasts, or other communications;

(2) an LMHA or LBHA staff completes HHSC approved computer-based person-centered planning and practices training within the first 60 days of coordinating MI specialized services;

(3) a supervisor, team lead, or quality monitoring staff person who has successfully completed the training in paragraph (2) of this subsection reviews and signs off on work completed by an LMHA or LBHA staff until an LMHA or LBHA staff completes the training required in paragraph (2) of this subsection; and

(4) an LMHA or LBHA staff responsible for coordinating MI specialized services completes HHSC approved person-centered thinking training within the first year of coordinating MI specialized services.

(b) The LMHA or LBHA must:

(1) ensure an LMHA or LBHA staff responsible for coordinating MI specialized services demonstrates competency in the coordination of MI specialized services; and

(2) maintain documentation of the training received by the LMHA or LBHA staff.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on October 2, 2023.

TRD-202303660

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: November 19, 2023

For further information, please call: (512) 438-5018

SUBCHAPTER J. DISASTER RULE FLEXIBILITIES

26 TAC §303.1000

STATUTORY AUTHORITY

The new section is authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, Texas Government Code §531.033, which provides the Executive Commissioner of HHSC with broad rulemaking authority; and Texas Human Resources Code §32.021, which provides that HHSC will adopt necessary rules for the proper and efficient administration of the Medicaid program.

The new section implements Texas Government Code §531.02161.

§303.1000.Flexibilities to Certain Requirements During Declaration of Disaster.

(a) HHSC may allow LIDDAs, LMHAs, and LBHAs to use one or more of the exceptions described in subsection (c) of this section while an executive order or proclamation declaring a state of disaster under Texas Government Code §418.014 is in effect. HHSC will notify LIDDAs, LMHAs, and LBHAs when an exception is permitted and the date the exception must no longer be used, which may be before the declaration of a state of disaster expires.

(b) Subject to the notification by HHSC, the following flexibilities may be available to LIDDAs, LMHAs, and LBHAs to the extent the flexibility is permitted by and does not conflict with other laws or obligations of the LIDDAs, LMHAs, and LBHAs and is allowed by federal and state law.

(c) LIDDAs, LMHAs, and LBHAs, for services normally provided in person, may use audio-visual communication or audio-only communication methods to engage with the individual or resident to carry out the requirements in:

(1) §303.302(a)(2)(A)(ii) of this chapter (relating to LIDDA, LMHA, and LBHA Responsibilities Related to the PASRR Process);

(2) §303.601(b)(7) of this chapter (relating to Habilitation Coordination for a Designated Resident);

(3) 303.602(e) of this chapter (relating to Service Planning Team Responsibilities Related to Specialized Services);

(4) 303.701(g) of this chapter (relating to Transition Planning for a Designated Resident);

(5) §303.905(c)(3) of this chapter (relating to Process for Service Initiation); and

(6) §303.907(a) of this chapter (relating to Renewal and Revision of Person-Centered Recovery Plan).

(d) LIDDAs, LMHAs, and LBHAs that use the flexibilities allowed under subsection (c) of this section, must comply with:

(1) all guidance on the application of the rules during the declaration of disaster that is published by HHSC on its website or in another communication format HHSC determines appropriate; and

(2) all policy guidance applicable to the rules identified in subsection (c) of this section issued by HHSC's Medicaid and CHIP Services.

(e) LIDDAs, LMHAs, and LBHAs must ensure any method of contact complies with all applicable requirements related to security and privacy of information.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on October 2, 2023.

TRD-202303661

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: November 19, 2023

For further information, please call: (512) 438-5018