Section 2.152 - Special Considerations(a) Persons admitted to a SMHF three times in 180 days. Persons who are admitted to a SMHF three times in 180 days are considered to be at risk for future admission to inpatient services. Pursuant to the Texas Government Code, § 531.0244(b)(4), to prevent the unnecessary placement in an institution, the SMHF and designated LMHA shall: (1) during discharge planning, review the patient's previous continuing care plans to determine the effectiveness of the clinical and non-clinical services and supports identified, and recommend in the patient's current continuing care plan those services and supports that have been effective and as well as those designed to prevent unnecessary admission to the SMHF;(2) determine the availability and appropriateness of clinical and non-clinical services and supports in the intensity needed by the patient (i.e., type, amount, scope, and duration) which will prevent unnecessary admission to the SMHF; and(3) consider appropriateness of the patient's continued stay in the SMHF.(b) Nursing facilities. (1) Information regarding alternate services and supports. Prior to a person being admitted to a nursing facility on absence for trial placement (ATP) or directly after discharge, the designated LMHA shall provide the person, the person's LAR, and, unless the LAR is a family member, at least one family member of the person, if possible, with information about alternative services and supports for which the person may be eligible.(2) Preadmission screening. Prior to a person being admitted to a nursing facility on ATP or directly after discharge, the SMHF shall contact the Texas Department of Human Services to conduct a preadmission screening as required by 40 TAC §19.2500(relating to Preadmission Screening and Resident Review (PASARR)).(3) ATP. If a patient is admitted to a nursing facility on ATP, then the designated LMHA shall conduct and document, including justification for its recommendations, the activities described in this paragraph. (A) The designated LMHA shall make at least one face-to-face contact with the patient at the nursing facility. The contact shall include: (i) a review of the patient's medical record at the nursing facility; and(ii) discussions with the patient and LAR, if any, the nursing facility staff, and other staff who provide care to the patient regarding: (I) the needs of the patient and the care he/she is receiving;(II) the ability of the nursing facility to provide the appropriate care;(III) the provision of mental health services, if needed by the patient; and(IV) the patient's adjustment to the nursing facility.(B) Before the end of the initial ATP period as described in §412.206(b)(2) of this title (relating to Absence for Trial Placement (ATP)), the designated LMHA shall recommend to the SMHF one of the following: (i) discharging the patient if the LMHA determines that: (I) the nursing facility is capable of providing, and willing to provide, appropriate care to the patient after discharge;(II) any mental health services needed by the patient are being provided to the patient while he/she is residing in the nursing facility; and(III) the patient and LAR, if any, agrees to the nursing facility placement;(ii) extending the patient's ATP period in accordance with §412.206(b)(3) of this title;(iii) returning the patient to the SMHF in accordance with §412.205(b)(2) of this title (relating to Absences From a SMHF); or(iv) initiating involuntary admission to the SMHF in accordance with §412.205(a)(2) of this title.(4) Discharge. If a person is admitted to a nursing facility directly upon discharge, then the designated LMHA shall conduct and document the activities described in this paragraph. (A) The designated LMHA shall make face-to-face contact with the person at the nursing facility within seven days after discharge to determine if the nursing facility is providing adequate and appropriate care to the person. The contact shall include: (i) a review of the person's medical record at the nursing facility; and(ii) discussions with the person, or the person's LAR, if any, the nursing facility staff, and other staff who provide care to the person regarding: (I) the needs of the person and the care he/she is receiving;(II) the ability of the nursing facility to provide the appropriate care;(III) the delivery of mental health services, if needed by the person; and(IV) the person's adjustment to the nursing facility.(B) If the designated LMHA determines from its contact that the nursing facility is not providing adequate and appropriate care to the person, then the LMHA shall make a reasonable effort to encourage the nursing facility to provide adequate and appropriate care.(C) If the designated LMHA's efforts to encourage the nursing facility to provide adequate and appropriate care are unsuccessful and the LMHA determines that the nursing facility is unable or unwilling to provide adequate and appropriate care, then the LMHA shall: (i) make recommendations to the person and the person's LAR, if any, regarding alternate residential placement; and(ii) provide assistance in accessing alternate placement, if requested by the person or LAR to do so.(D) If the designated LMHA identifies or suspects any instance of mistreatment, abuse or neglect, or injuries of unknown origin at the nursing facility, then the LMHA shall make a report to the Texas Department of Human Services (TDHS) via its complaint hotline (1-800-458-9858).(c) Assisted living. (1) A SMHF or LMHA may not refer a person to an assisted living facility that is not licensed under the Texas Health and Safety Code, Chapter 247.(2) As required by the Texas Health and Safety Code, § 247.063(b), if a SMHF or LMHA gains knowledge of an assisted living facility that is not operated or licensed by TDHS, an LMHA, or TDMHMR, and that has four or more residents who are unrelated to the proprietor of the facility, then the SMHF or LMHA shall report the name, address, and telephone number of the facility to TDHS.(d) Minors. (1) To the extent permitted by medical privacy laws, the SMHF and designated LMHA shall make a reasonable effort to involve a minor's LAR or the LAR's designee.(2) A minor committed to or placed in a SMHF under the Texas Family Code, Chapter 55, Subchapter C or D, shall be discharged in accordance with the Texas Family Code, Chapter 55, Subchapter C or D, as appropriate.(e) Patients suspected of having mental retardation. If the SMHF suspects a patient has mental retardation, then the SMHF shall notify the designated LMHA liaison staff and the designated MRA. The designated MRA shall assign an MRA liaison staff to the patient to ensure compliance with Chapter 415, Subchapter D of this title (concerning Diagnostic Eligibility for Services and Supports--Mental Retardation Priority Population and Related Conditions).(f) Criminal Code. (1) Texas Code of Criminal Procedure (TCCP), Article 46.02 or Chapter 46B: Incompetency to stand trial. (A) Discharge of a patient committed under TCCP, Article 46.02, §6 (Civil commitment--charges pending) or Article 46B.102 (Commitment Hearing: Mental Illness), shall be in accordance with the TCCP, Article 46.02, §8 (General) or Article 46B.107 (Release of Defendant After Commitment).(B) Discharge of a patient committed under TCCP, Article 46.02, §5 (Criminal commitment) or Article 46B.073 (Commitment For Restoration to Competency), shall be in accordance with TCCP, Article 46.02, §5 (Criminal commitment) or Article 46B.083 (Report By Facility Head).(C) For a patient committed under TCCP, Article 46.02 or Chapter 46B, who is discharged and returned to the committing court, the SMHF shall, within 24 hours after discharge, notify the following of the discharge: (i) the patient's designated LMHA; and(ii) the Texas Correctional Office on Offenders with Medical or Mental Impairments.(2) TCCP, Article 46.03: Insanity defense. A person acquitted by reason of insanity and committed to a SMHF under TCCP, Article 46.03, may be discharged only upon order of the committing court in accordance with TCCP, Article 46.03, §4(d)(5) (Disposition following acquittal by reason of insanity) (Judicial release).(g) Special needs offenders. (1) Pre-admission assessment after release from county or city jail. If a county or city jail refers a special needs offender (SNO) in the priority population to an LMHA and notifies the LMHA of the referral at least 24 hours prior to the SNO's release from a county or city jail, then the LMHA shall arrange for a face-to-face contact between the SNO and a QMHP-CS to occur within seven days after the SNO's release. (A) If the SNO is currently receiving LMHA services from the LMHA that is notified of the referral, then at the face-to-face contact the QMHP-CS shall re-assess the SNO and arrange for appropriate services.(B) If the SNO is not currently receiving LMHA services from the LMHA that is notified of the referral, then at the face-to-face contact the QMHP-CS shall conduct a pre-admission assessment in accordance with §412.315(a) of this title (relating to Assessment and Treatment Planning) and comply with §412.161(b)(2)(A) or (B) of this title (relating to Screening and Assessment), as appropriate).(C) If the LMHA does not have a face-to-face contact with a SNO, then the LMHA shall document the reasons for not doing so.(2) Pre-admission assessment after release from state prison or state jail. If an LMHA is notified of the anticipated release from prison or a state jail of a SNO in the priority population who is currently taking psychoactive medication(s) for a mental illness and who will be released with a 10-day supply of the psychoactive medication(s), then the LMHA shall arrange for a face-to-face contact between the SNO and QMHP-CS to occur within seven days after the SNO's release. (A) At the face-to-face contact, the QMHP-CS shall conduct a pre-admission assessment in accordance with §412.315(a) of this title and comply with §412.161(b)(2)(A) or (B) of this title (as appropriate). If the LMHA determines that the SNO should receive services immediately, then the LMHA must arrange for the SNO to meet with a prescriber of medication before the SNO's entire supply of psychoactive medication has been administered.(B) If the LMHA does not have a face-to-face contact with the SNO, then the LMHA shall document the reasons for not doing so.40 Tex. Admin. Code § 2.152
The provisions of this §2.152 adopted to be effective November 1, 2003, 28 TexReg 9251; Transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841