Section 306.202 - Special Considerations for Discharge Planning(a) Three Admissions Within 180 Days. An individual admitted to an SMHF or a facility with a CPB three times within 180 days is considered at risk for future admission to inpatient services. To prevent the unnecessary admissions to an inpatient facility, the designated LMHA or LBHA must:(1) during discharge planning, review the individual's previous recovery or treatment plans to determine the effectiveness of the clinical services received;(2) include in the recovery or treatment plan:(A) non-clinical supports, such as those provided by a peer specialist or recovery coach, identified to support the individual's ongoing recovery; and(B) recommendations for services and interventions from the individual's current or previous care plan(s) that support the individual's strengths and goals and prevent unnecessary admission to an SMHF or facility with a CPB;(3) determine the availability and level of care "type, amount, scope and duration" of clinical and non-clinical supports, such as those provided by a peer specialist or recovery coach, that promote ongoing recovery and prevent unnecessary admission to an SMHF or facility with a CPB; and(4) consider appropriateness of the individual's continued stay in the SMHF or facility with a CPB.(b) Nursing Facility Referral or Admission. (1) In accordance with 42 CFR Part 483, Subpart C, and as described in 40 TAC Chapter 19, Subchapter BB (relating to Nursing Facility Responsibilities Related to Preadmission Screening and Resident Review (PASRR)), a nursing facility must coordinate with the referring entity to ensure the referring entity screens the individual for admission to the nursing facility before the nursing facility admits the individual.(2) As the referring entity, the SMHF or facility with a CPB must complete a PASRR Level I Screening and forward the completed form in accordance with § 303.301 of this title (relating to Referring Entity Responsibilities Related to the PASRR Process).(3) The LMHA or LBHA must conduct a PASRR Level II Evaluation in accordance with Chapter 303 of this title.(4) If a nursing facility admits an individual on an ATP, the designated LMHA or LBHA must conduct and document, including justification for its recommendations, the activities described in paragraphs (5) and (6) of this subsection.(5) The designated LMHA or LBHA must make at least one face-to-face contact with the individual at the nursing facility on an ATP. The contact must consist of:(A) a review of the individual's record at the nursing facility; and(B) discussions with the individual and LAR, if any, the nursing facility staff, and other staff who provide care to the individual regarding: (i) the individual's needs and the care the individual is receiving;(ii) the ability of the nursing facility to provide the appropriate care;(iii) the provision of mental health services, if needed by the individual; and(iv) the individual's adjustment to the nursing facility.(6) Before the end of the initial ATP period described in § 306.206(b)(2) of this subchapter (relating to Absence for Trial Placement), the designated LMHA or LBHA must recommend to the SMHF or facility with a CPB one of the following:(A) discharging the individual if the LMHA or LBHA determines that: (i) the nursing facility is capable and willing to provide appropriate care to the individual after discharge;(ii) any mental health services needed by the individual are being provided to the individual while residing in the nursing facility; and(iii) the individual and LAR, if any, agrees to the nursing facility admission;(B) extending the individual's ATP period in accordance with § 306.206(b)(3) of this subchapter;(C) returning the individual to the SMHF or facility with a CPB in accordance with § 306.205 of this subchapter (relating to Pass or Furlough from a State Mental Health Facility or a Facility with a Contracted Psychiatric Bed); or(D) initiating involuntary admission to the SMHF or facility with a CPB in accordance with § 306.176 (relating to Admission Criteria for a Facility with a Contracted Psychiatric Bed Authorized by an LMHA or LBHA or for a State Mental Health Facility for Emergency Detention) and § 306.177(relating to Admission Criteria Under Order of Protective Custody or Court-ordered Inpatient Mental Health Services) of this subchapter.(c) Assisted Living. (1) An SMHF, facility with a CPB, LMHA, or LBHA may not refer an individual to an assisted living facility that is not licensed under the Texas Health and Safety Code, Chapter 247.(2) As required by Texas Health and Safety Code § 247.063(b), if an SMHF, facility with a CPB, LMHA, or LBHA gains knowledge of an assisted living facility not operated or licensed by the state, the SMHF, facility with a CPB, LMHA, or LBHA reports the name, address, and telephone number of the facility to HHSC Complaint and Incident Intake at 1-800-458-9858.(d) Minors. (1) To the extent permitted by medical privacy laws, the SMHF or facility with a CPB and designated LMHA or LBHA must make a reasonable effort to involve a minor's LAR or the LAR's designee in the treatment and discharge planning process.(2) A minor committed to or placed in an SMHF or facility with a CPB under Texas Family Code, Chapter 55, Subchapter C or D, shall be discharged in accordance with the Texas Family Code, Chapter 55, Subchapter C or D as applicable.(e) An individual suspected of having an ID. If an SMHF or facility with a CPB suspects an individual has an ID, the SMHF or facility with a CPB must notify the designated LMHA or LBHA continuity of care worker and the designated LIDDA to:(1) assign a LIDDA continuity of care worker to the individual; and(2) conduct an assessment in accordance with 40 TAC Chapter 5, Subchapter D (relating to Diagnostic Assessment).(f) Criminal Code. (1) Texas Code of Criminal Procedure, Chapter 46B: Incompetency to stand trial. (A) The SMHF or facility with a CPB must discharge an individual committed under Texas Code of Criminal Procedure, Article 46B.102 (relating to Civil Commitment Hearing: Mental Illness), in accordance with Texas Code of Criminal Procedure, Article 46B.107 (relating to Release of Defendant after Civil Commitment).(B) The SMHF or facility with a CPB must discharge an individual committed under Texas Code of Criminal Procedure, Article 46B.073 (relating to Commitment for Restoration to Competency), in accordance with Texas Code of Criminal Procedure, Article 46B.083 (relating to Supporting Commitment Information Provided by Facility or Program).(C) For an individual committed under Texas Code of Criminal Procedure, Chapter 46B, discharged and returned to the committing court, the SMHF or facility with a CPB, within 24 hours after discharge, must notify the following of the discharge: (i) the individual's designated LMHA or LBHA; and(2) Texas Code of Criminal Procedure, Chapter 46C: Insanity defense. An SMHF or facility with a CPB must discharge an individual acquitted by reason of insanity and committed to an SMHF or facility with a CPB under Texas Code of Criminal Procedure, Chapter 46C, only upon order of the committing court in accordance with Texas Code of Criminal Procedure, Article 46C.268.(g) Offenders with special needs following discharge from an SMHF or facility with a CPB. The LMHA or LBHA must comply with the requirements as defined by the LMHA's and LBHA's TCOOMMI contract for offenders with special needs. (1) An LMHA or LBHA that receives a referral for an offender with special needs in the MH priority population from a county or city jail at least 24 hours before the individual's release must complete one of the following actions: (A) if the offender with special needs is currently receiving LMHA or LBHA services, the LMHA or LMHA: (i) notifies the offender with special needs of the county or city jail's referral;(ii) arranges a face-to-face contact between the offender with special needs and a QMHP-CS to occur within 15 days after the individual's release; and(iii) ensures that the QMHP-CS, at the face-to-face contact, re-assesses the individual and arranges for appropriate services, including transportation needs at the time of release.(B) if the individual is not currently receiving LMHA or LBHA services from the LMHA or LBHA that is notified of the referral, the LMHA or LMHA: (i) ensures that at the face-to-face contact required in subparagraph (A) of this paragraph, the QMHP-CS conducts a pre-admission assessment in accordance with § 301.353(a) of this title (relating to Provider Responsibilities for Treatment Planning and Service Authorization); and(ii) complies with § 306.161(b) of this subchapter (relating to Screening and Assessment), as appropriate; or(C) if the LMHA or LBHA does not conduct a face-to-face contact with the individual, the LMHA or LMHA must document the reasons for not doing so in the individual's record.(2) If an LMHA or LBHA is notified of the anticipated release from prison or a state jail of an offender with special needs in the MH priority population who is currently taking psychoactive medication(s) for a mental illness and who will be released with a 30-day supply of the psychoactive medication(s), the LMHA or LBHA must arrange a face-to-face contact between the individual and QMHP-CS within 15 days after the individual's release. (A) If the offender with special needs is released from state prison or state jail after hours or the LMHA or LBHA is otherwise unable to schedule the face-to-face contact before the individual's release, the LMHA or LBHA makes a good faith effort to locate and contact the individual. If the designated LMHA or LBHA does not have a face-to-face contact with the individual within 15 days, the LMHA or LBHA must document the reasons for not doing so in the individual's record.(B) At the face-to-face contact: (i) the QMHP-CS with appropriate supervision and training must perform an assessment in accordance with § 301.353(a) of this title and comply with § 306.161(b) and (c) of this subchapter, as appropriate; and(ii) if the LMHA or LBHA determines that the offender with special needs should receive services immediately, the LMHA or LBHA must arrange for the individual to meet with a physician or designee authorized by state law to prescribe medication before the individual requires a refill of the prescription.(C) If the LMHA or LBHA does not conduct a face-to-face contact with the offender with special needs, the LMHA or LBHA must document the reasons for not doing so in the individual's record.(3) If the offender with special needs is on parole or probation, the SMHF or facility with a CPB must notify a representative of TCOOMMI before the discharge of the individual known to be on parole or probation.26 Tex. Admin. Code § 306.202
Adopted by Texas Register, Volume 45, Number 20, May 15, 2020, TexReg 3316, eff. 5/20/2020