26 TAC Ch. 307

Behavioral Health Program

This chapter governs three distinct Texas behavioral health programs administered by HHSC and local mental health/behavioral health authorities: (1) the YES Waiver, a §1915(c) Medicaid home- and community-based pilot providing intensive community services to children and adolescents with severe emotional disturbance as an alternative to inpatient psychiatric placement; (2) the HCBS-Adult Mental Health program, providing Medicaid home- and community-based services to adults with serious mental illness who have high utilization of inpatient, correctional, or emergency services; and (3) Jail-Based Competency Restoration (JBCR), setting standards for LMHAs, LBHAs, and their subcontractors delivering competency restoration services (mental health, SUD, and IDD) to individuals found incompetent to stand trial in county jails. Operators and providers under each program must meet eligibility, care planning, staffing, training, and fair-hearing requirements as specified.

§307.1 Purpose and Application
(a) Purpose. The purpose of this subchapter is to implement a pilot program, under the waiver provisions of the federal Social Security Act, §1915(c), that prevents or reduces institutionalization of children and adolescents with severe emotional disturbance (SED), enables more flexibility in providing intensive community-based services for children and adolescents with SED, and provides support for their families by improving access to services.

(b) Application. The subchapter applies to:

(1) persons and entities that have a Medicaid provider agreement to provide the waiver program services, as described in this subchapter;

(2) local mental health authorities (LMHAs), which have administrative responsibilities under the waiver program; and

(3) children and adolescents who are applicants for or recipients of services under the waiver program.
Source Note: The provisions of this §307.1 adopted to be effective November 19, 2009, 34 TexReg 8038; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 471.

§307.3 Definitions
The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise.

(1) Adolescent--An individual who is at least 13 years of age, but younger than 19 years of age.

(2) Assessment--A set of standardized assessment measures used by the department to determine level of need as set forth in the approved waiver.

(3) Child--An individual who is at least three years of age, but younger than 13 years of age.

(4) Department--Department of State Health Services.

(5) LAR or legally authorized representative--A person authorized by law to act on behalf of a child or adolescent with regard to a matter described in this subchapter, including, but not limited to, a parent, guardian, or managing conservator.

(6) LMHA or local mental health authority--An entity designated as the local mental authority by the department in accordance with the Health and Safety Code, §533.035(a).

(7) LPHA or licensed practitioner of the healing arts--A person who is:

(A) a physician;

(B) a licensed professional counselor;

(C) a licensed clinical social worker;

(D) a licensed psychologist;

(E) an advanced practice nurse; or

(F) a licensed marriage and family therapist.

(8) Provider--Any person or legal entity that has an agreement with the department and the single state Medicaid agency to provide the waiver program services, as described in the approved waiver.

(9) SED or severe emotional disturbance--A child or adolescent with a serious functional impairment or acute severe psychiatric symptomatology as identified by the assessment.

(10) Waiver program--A Medicaid program that provides waiver program services to a limited number of eligible children or adolescents, in accordance with the provisions of the waiver approved under the federal Social Security Act, §1915(c).

(11) Waiver program services--Medicaid community-based services provided under the approved waiver program.
Source Note: The provisions of this §307.3 adopted to be effective November 19, 2009, 34 TexReg 8038; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 471.

§307.5 Eligibility Criteria
(a) To participate in the waiver program, the child or adolescent must meet the following eligibility criteria:

(1) be eligible for Medicaid, under a Medicaid Eligibility Group included in the approved waiver;

(2) live in a county included in the waiver program;

(3) be reasonably expected to qualify for inpatient care under the Texas Medicaid inpatient psychiatric admission guidelines, as defined in the approved waiver, in the absence of waiver services;

(4) reside:

(A) in a non-institutional setting with the child's or adolescent's LAR; or

(B) in the child's or adolescent's own home or apartment, if legally emancipated; and

(5) choose, or have the LAR choose, the waiver program services as an alternative to care in an inpatient psychiatric facility, in accordance with the provisions of the approved waiver.

(b) The participating child or adolescent must be determined to meet the eligibility criteria in subsection (a) of this section on an annual basis to continue in the waiver program.

(c) The department reserves the right to limit, in each county, the number of eligible children or adolescents that may participate in the waiver program, in accordance with the provisions of the approved waiver.
Source Note: The provisions of this §307.5 adopted to be effective November 19, 2009, 34 TexReg 8038; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 471.

§307.7 Co-payments
The receipt of certain waiver program services may be dependent upon the child's or adolescent's and/or LAR's ability to make a co-payment.
Source Note: The provisions of this §307.7 adopted to be effective November 19, 2009, 34 TexReg 8038; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 471.

§307.9 Individual Plan of Care (IPC)
(a) Each child and adolescent determined eligible to participate in the waiver program is assigned a mental health case manager, subject to the rules in Chapter 412, Subchapter I, of this title (relating to Mental Health Case Management Services). The mental health case manager must coordinate with the child or adolescent, LAR, waiver service providers and LMHA to develop an IPC that is based upon the assessment.

(b) The initial IPC must be reviewed by an LPHA at the LMHA that serves the geographic area of the participant's residence before forwarding to the department for approval. The IPC must be approved by the department before a provider can begin delivering waiver program services. To be approved, the IPC must:

(1) promote the child's or adolescent's inclusion into the community;

(2) protect the child's or adolescent's health and welfare in the community;

(3) supplement, rather than replace, the child's or adolescent's natural and other non-waiver program support systems and resources;

(4) be designed to prevent or reduce the likelihood of the child's or adolescent's admission to an inpatient psychiatric facility; and

(5) be the most appropriate type and amount of services to meet the child's or adolescent's needs.

(c) The IPC must be reviewed by an LPHA at the LMHA and submitted to the department for approval as part of the annual eligibility determination required under §419.3 of this title (relating to Eligibility Criteria). Any recommended changes to the IPC outside the annual review process must be approved by the department.

(d) To demonstrate that the waiver program services specified in the IPC meet the requirements described in subsection (b) of this section, the LMHA must submit the following to the department:

(1) an assessment of the child or adolescent that identifies and supports the waiver program services included in the IPC; and

(2) documentation that natural and other non-waiver program support systems and resources are unavailable or are insufficient to meet the goals specified in the IPC.

(e) The department may conduct utilization review of an IPC and supporting documentation at any time to determine if the services specified in the IPC meet the requirements described in subsection (b) of this section. If the department determines that one or more of the services specified in the IPC do not meet the requirements described in subsection (b) of this section, the department may deny, reduce, or terminate the service, modify the IPC, and send written notification to the child or adolescent, LAR, and the provider.

(f) In addition to the utilization review conducted in accordance with subsection (e) of this section, the department may conduct utilization review of the provider and the provision of waiver program services at any time.

(g) The cost of implementing the IPC must be within the cost ceiling identified by the department and the single state Medicaid agency. For children and adolescents with service needs that exceed the cost ceiling, the department has a process to ensure that their needs are met, which includes examining third-party resources or possible transition to other waiver programs or inpatient services.
Source Note: The provisions of this §307.9 adopted to be effective November 19, 2009, 34 TexReg 8038; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 471.

§307.11 Transition Planning
(a) The LMHA is required to develop a transition plan for an adolescent who will become 19 years of age while receiving services under the waiver program. The transition plan must be developed at least six months prior to the month the adolescent becomes 19 years of age to ensure that the adolescent is appropriately transitioned to adult services.

(b) The transition plan, required under subsection (a) of this section, must be developed in consultation with the adolescent and, if appropriate, the LAR, as well as future providers, allowing adequate time for a smooth transition of the adolescent into adult services. The transition plan must include:

(1) a summary of the mental health community services and treatment received while in the waiver program;

(2) the adolescent's current assessment, e.g., diagnosis, medications, level of functioning, and unmet needs;

(3) information from the adolescent and the LAR, if appropriate, regarding the adolescent's strengths, preferences for mental health community services, and responsiveness to past interventions; and

(4) an IPC that:

(A) indicates the mental health and other community services the adolescent will receive at the point of becoming 19 years of age; and

(B) ensures the adolescent will be provided a smooth transition to adult services.
Source Note: The provisions of this §307.11 adopted to be effective November 19, 2009, 34 TexReg 8038; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 471.

§307.13 Inquiry List
(a) Inquiry List. A list, maintained by each LMHA, of children and adolescents as defined by §419.2 of this title (relating to Definitions) who are interested in receiving YES Waiver program services and who reside in the LMHA's service area.

(1) Only a child or adolescent or the child's or adolescent's LAR may place a child's or adolescent's name on the inquiry list.

(2) The LMHA must assign the child or adolescent a registration date on the inquiry list that is based on the chronological date and time the phone call or voice message requesting YES Waiver program services was received.

(b) Maintenance of Inquiry List. The LMHA must maintain an up-to-date inquiry list.

(1) The LMHA must remove a child's or adolescent's name from the inquiry list if it is documented that:

(A) the child or adolescent or LAR has requested verbally or in writing that the child or adolescent's name be removed from the inquiry list;

(B) the child or adolescent or LAR has declined verbally or in writing YES Waiver program services;

(C) the child or adolescent or LAR has not responded to the LMHA's notification of a waiver vacancy within 30 calendar days of the LMHA's notification of the vacancy;

(D) the child or adolescent has moved out of Texas; or

(E) the child or adolescent is deceased.

(2) If a child's or adolescent's name is removed from an inquiry list in accordance with paragraph (1) of this subsection, and if the child or adolescent, LAR, or LMHA requests that the child's or adolescent's name be reinstated on the inquiry list, the child or adolescent, LAR, or LMHA may request that the department review the circumstances under which the child's or adolescent's name was removed from the LMHA's inquiry list. At its discretion the department may:

(A) reinstate the child's or adolescent's name on the inquiry list according to the original date the child or adolescent or LAR requested the child's or adolescent's name be added in accordance with subsection (a) of this section; or

(B) add the child's or adolescent's name to the inquiry list according to the date the child or adolescent or LAR requested that the department review the circumstances under which the child or adolescent's name was removed.

(c) Denial of enrollment. The department shall remove a child's or adolescent's name from an LMHA's inquiry list if the department has denied the child's or adolescent's enrollment in the YES Waiver program and the child or adolescent or LAR has had an opportunity to exercise the child or adolescent's right to appeal the decision in accordance with §419.8 of this title (relating to Right to Fair Hearing) and did not appeal the decision, or appealed the decision and did not prevail.

(d) Reserve capacity. There are a percentage of vacancies in the YES Waiver program that are reserved for children or adolescents who are at imminent risk of being relinquished to state custody.

(1) If a child or adolescent whose name has been added to the LMHA's inquiry list must wait to be enrolled, then the LMHA must screen the child or adolescent for imminent risk of relinquishment.

(2) If the LMHA determines that the child or adolescent may be at imminent risk of relinquishment, the LMHA must complete the YES Waiver Reserve Capacity Screening Form and submit to the department for review.

(3) If the department determines that the child or adolescent is at imminent risk of relinquishment, the department must authorize the LMHA to complete the enrollment process within three business days.

(4) If a child or adolescent is denied reserve capacity, then the LMHA must assign the child or adolescent a registration date on the inquiry list that is based on the chronological date and time the phone call or voice message requesting YES Waiver program services was received in accordance with subsection (a)(2) of this section.
Source Note: The provisions of this §307.13 adopted to be effective October 16, 2016, 41 TexReg 8069; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 471.

§307.15 Right to Fair Hearing
The LMHA or the department must notify the child or adolescent, and LAR, of the right to a fair hearing, conducted in accordance with the rules in 1 Texas Administrative Code, Chapter 357, Subchapter A (relating to Uniform Fair Hearing Rules), under the following circumstances:

(1) a child or adolescent is denied participation in the waiver program, unless the reason for the denial is the program participation limit referred to in §419.3(c) of this title (relating to Eligibility Criteria);

(2) a child or adolescent is denied continued participation in the waiver program; or

(3) waiver program services for a child or adolescent are denied, reduced, suspended, or terminated.
Source Note: The provisions of this §307.15 adopted to be effective November 19, 2009, 34 TexReg 8038; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 471.

§307.51 Purpose and Application
(a) The purpose of this subchapter is to implement the Home and Community-Based Services--Adult Mental Health (HCBS-AMH) program, providing home and community-based services to individuals with a serious mental illness who are eligible for or currently receiving Medicaid in accordance with the Medicaid state plan and applicable state legislative direction.

(b) The subchapter applies to:

(1) a person or entity contracting with HHSC to provide HCBS-AMH services, as described in this subchapter;

(2) an entity having administrative responsibilities under this program; and

(3) an individual applying for or enrolled in the HCBS-AMH program.
Source Note: The provisions of this §307.51 adopted to be effective July 23, 2019, 44 TexReg 3637.

§307.52 Definitions
The following words and terms, when used in this subchapter, have the following meanings unless the context clearly indicates otherwise.

(1) Activities of daily living--Routine daily activities. These activities include:

(A) performing personal hygiene activities;

(B) dressing;

(C) meal planning and preparation;

(D) managing finances;

(E) shopping for food, clothing, and other essential items;

(F) performing essential household chores;

(G) communicating by phone or other media;

(H) navigating public transportation;

(I) participating in the community; and

(J) other activities as defined by HHSC.

(2) Adult--An individual 18 years of age or older.

(3) Assessor--A qualified mental health professional-community services as defined in 25 TAC Chapter 412, Subchapter G (relating to Mental Health Community Services Standards) who conducts the HCBS-AMH assessment evaluating an individual's need for HCBS-AMH.

(4) Designee--A person or entity named by HHSC to act on its behalf.

(5) HCBS--Home and community-based services.

(6) HCBS-AMH--Home and community-based services-adult mental health.

(7) HCBS-AMH assessment--A set of HHSC-defined standardized assessment measures used by HHSC to determine an individual's level of need based on an individual's strengths and needs. The HCBS-AMH assessment serves as the basis for the IRP.

(8) HHSC--Texas Health and Human Services Commission, or its designee.

(9) Individual--A person seeking or receiving services under this subchapter.

(10) IRP--Individual recovery plan. A written, individualized plan, developed in accordance with 25 TAC Chapter 412, Subchapter D (relating to Mental Health Services--Admission, Continuity, and Discharge) and 25 TAC §412.322 (relating to Provider Responsibilities for Treatment Planning and Service Authorization) in consultation with the individual and LAR, if applicable, identifying necessary HCBS-AMH services the provider will deliver to the individual and which serves as the treatment plan or recovery plan.

(11) LAR--Legally authorized representative. A person authorized by law to act on behalf of an individual as defined in Texas Health and Safety Code §241.151.

(12) Ombudsman--The Ombudsman for Behavioral Health Access to Care established by Texas Government Code §531.02251, which serves as a neutral party to help consumers, including consumers who are uninsured or have public or private health benefit coverage, and behavioral health care providers navigate and resolve issues related to consumer access to behavioral health care, including care for mental health conditions and substance use disorders.

(13) Provider--A person or entity that contracts with HHSC to provide services under this subchapter.

(14) Serious mental illness--An illness, disease, or condition (other than a sole diagnosis of epilepsy, neurocognitive disorders, substance use disorder, or intellectual disability) that:

(A) substantially impairs thought, perception of reality, emotional process, development, or judgment; or

(B) grossly impairs an individual's behavior as demonstrated by recent disturbed behavior.
Source Note: The provisions of this §307.52 adopted to be effective July 23, 2019, 44 TexReg 3637.

§307.53 Eligibility Criteria and HCBS-AMH Assessment
(a) To participate in the HCBS-AMH program, an assessor must conduct an HCBS-AMH assessment on each individual for HHSC to determine that the individual meets the needs-based eligibility criteria for HCBS-AMH.

(1) The assessor must consult with the individual, the individual's LAR, if applicable, treatment team, providers, and other persons according to the needs and desire of the individual to conduct the HCBS-AMH assessment.

(2) The HCBS-AMH assessment must:

(A) be conducted face-to-face as permitted under Medicaid guidelines;

(B) take into account the ability of the individual to perform two or more activities of daily living; and

(C) assess the individual's need for HCBS-AMH.

(b) For HHSC to determine an individual eligible to participate in HCBS-AMH, the individual must meet criteria in accordance with applicable state legislative direction and eligibility requirements as set forth in the Medicaid state plan, including:

(1) having three years or more of consecutive or cumulative inpatient psychiatric hospitalizations during the five years before initial enrollment in the HCBS-AMH program;

(2) having two or more psychiatric crises and four or more discharges from correctional facilities during the three years before initial enrollment in HCBS-AMH; or

(3) having two or more psychiatric crises and fifteen or more total emergency department documented contacts in which services are delivered during the three years before initial enrollment in HCBS-AMH.

(c) The HCBS-AMH assessment must be repeated at least annually for each individual, and when circumstances necessitate a re-assessment, using the same requirements outlined in subsections (a) and (b) of this section.

(d) HHSC approves each HCBS-AMH initial eligibility assessment, annual assessment, and assessment conducted based on a change in circumstances.
Source Note: The provisions of this §307.53 adopted to be effective July 23, 2019, 44 TexReg 3637.

§307.54 Individual Recovery Plan
(a) An IRP must:

(1) prepare for the individual's effective transition to the community;

(2) promote the individual's inclusion into the community;

(3) protect the individual's health and welfare in the community;

(4) supplement, rather than replace, the individual's natural support systems and resources;

(5) be designed to prevent or reduce the individual's likelihood of:

(A) an inpatient psychiatric facility admission;

(B) a correctional facility admission; and

(C) an emergency department visit in which services are delivered;

(6) include the most appropriate type and amount of services to meet the individual's needs;

(7) prevent the provision of unnecessary or inappropriate care;

(8) be based on the individual's preferences, needs, and goals; and

(9) be developed with the individual, LAR, individual's treatment team and providers, and other persons according to the needs and desire of the individual.

(b) An HHSC-approved designee must review the IRP and submit it to HHSC for its approval.

(c) An HHSC-approved designee must submit to HHSC, with the IRP:

(1) an HCBS-AMH assessment of the individual identifying the individual's needs and supporting the HCBS-AMH included in the IRP; and

(2) documentation that non-HCBS-AMH support systems and resources are unavailable or are insufficient to meet the goals specified in the IRP.

(d) A provider must obtain HHSC's approval of the IRP before the provider may deliver HCBS-AMH program services.

(e) HHSC may conduct a utilization review of an IRP and supporting documentation at any time to determine if the services specified in the IRP meet the requirements described in subsection (a) of this section.

(f) If HHSC determines one or more of the services specified in the IRP do not meet the requirements described in subsection (a) of this section, HHSC may:

(1) deny, reduce, or terminate the service; or modify the IRP; and

(2) send written notification to the individual, LAR, and the provider according to §307.57 of this subchapter (relating to Fair Hearings Process).

(g) The cost of the IRP must be reasonable as determined by HHSC.
Source Note: The provisions of this §307.54 adopted to be effective July 23, 2019, 44 TexReg 3637.

§307.55 Co-payments
A co-payment for HCBS-AMH services may be assessed as described in 25 TAC Chapter 412, Subchapter C (relating to Charges for Community Services).
Source Note: The provisions of this §307.55 adopted to be effective July 23, 2019, 44 TexReg 3637.

§307.56 Provider Qualifications and Contracting
(a) A prospective provider may request and submit an application to HHSC to provide HCBS-AMH at any time. The application sets forth the qualifications to be a provider.

(b) HHSC must approve the provider and enter into a contract with the provider before the provider serves any individual.

(c) HCBS providers must comply with any applicable federal or state law or rule.
Source Note: The provisions of this §307.56 adopted to be effective July 23, 2019, 44 TexReg 3637.

§307.57 Fair Hearings Process
(a) Right of an individual to request a fair hearing. Any individual whose request for eligibility to receive HCBS-AMH is denied or is not acted upon with reasonable promptness, or whose services have been terminated, suspended, or reduced by HHSC, is entitled to a fair hearing in accordance with 1 TAC Chapter 357, Subchapter A (relating to Uniform Fair Hearing Rules).

(b) At any time, an individual may contact the Ombudsman for additional information and resources by calling toll-free (1-800-252-8154) or online at hhs.texas.gov/ombudsman.
Source Note: The provisions of this §307.57 adopted to be effective July 23, 2019, 44 TexReg 3637.

§307.101 Purpose
The purpose of this subchapter is to provide standards for jail-based competency restoration as required by Texas Code of Criminal Procedure Chapter 46B, relating to Incompetency to Stand Trial. Jail-based competency restoration includes:

(1) mental health services;

(2) intellectual disability services;

(3) co-occurring psychiatric and substance use disorder treatment services;

(4) competency restoration education in the county jail for an individual found incompetent to stand trial;

(5) discharge planning services; and

(6) continuity of care services.
Source Note: The provisions of this §307.101 adopted to be effective August 6, 2018, 43 TexReg 5091; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 470; amended to be effective February 23, 2025, 50 TexReg 1022.

§307.103 Application
This subchapter applies to a local mental health authority, local behavioral health authority, or a subcontractor of a local mental health authority or local behavioral health authority delivering jail-based competency restoration authorized by Texas Code of Criminal Procedure Chapter 46B, regardless of the funding source for the jail-based competency restoration program.
Source Note: The provisions of this §307.103 adopted to be effective August 6, 2018, 43 TexReg 5091; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 470; amended to be effective February 23, 2025, 50 TexReg 1022.

§307.105 Definitions
The following words and terms, when used in this subchapter, have the following meanings unless the context clearly indicates otherwise.

(1) Business day--Any day except a Saturday, Sunday, or legal holiday listed in Texas Government Code §662.021.

(2) CFR--Code of Federal Regulations.

(3) Competency restoration--The treatment or education process for restoring an individual's ability to consult with the individual's attorney with a reasonable degree of rational understanding, including a rational and factual understanding of the court proceedings and charges against the individual as defined in Texas Code of Criminal Procedure Article 46B.001.

(4) Competency restoration training module--An HHSC-approved training module used by program staff members to provide legal education to an individual receiving competency restoration services.

(5) COPSD--Co-occurring psychiatric and substance use disorder.

(6) Court--A court of law presided over by a judge, judges, or a magistrate in civil and criminal cases.

(7) Day--A calendar day, unless otherwise specified.

(8) Extension--As described in Texas Code of Criminal Procedure Article 46B.080(d), an extension begins on the later of:

(A) the date the court enters the order under Article 46B.080(a); or

(B) the date competency restoration services begin pursuant to the order entered under Article 46B.080(a).

(9) Good standing--Entities eligible to contract with HHSC pursuant to HHSC procurement and contract rules and guidelines.

(10) HHSC--Texas Health and Human Services Commission or its designee.

(11) ID--Intellectual disability. Consistent with Texas Health and Safety Code §591.003, significantly sub-average general intellectual functioning existing concurrently with deficits in adaptive behavior as defined in §304.102 of this title (relating to Definitions) and originating before age 18.

(12) Individual--A person receiving services under this subchapter.

(13) Inpatient mental health facility--The term has the meaning assigned in Texas Health and Safety Code §571.003.

(14) IST--Incompetent to stand trial. The term has the meaning described in Texas Code of Criminal Procedure Article 46B.003.

(15) JBCR--Jail-based competency restoration. Competency restoration services in a county jail setting provided in a designated space separate from the space used for the general population of the county jail.

(16) JBCR program--A jail-based competency restoration program developed and implemented by a county or counties in accordance with the Texas Code of Criminal Procedure Article 46B.091.

(17) LBHA--Local behavioral health authority. An entity designated as the local behavioral health authority by HHSC in accordance with Texas Health and Safety Code §533.0356.

(18) Legally authorized representative--A person authorized by state law to act on behalf of an individual with regard to a matter described in this subchapter.

(19) LIDDA--Local intellectual and developmental disability authority. An entity designated as the local intellectual and developmental disability authority by HHSC in accordance with Texas Health and Safety Code §533A.035(a).

(20) LMHA--Local mental health authority. An entity designated as the local mental health authority by HHSC in accordance with Texas Health and Safety Code §533.035(a).

(21) LPHA--Licensed practitioner of the healing arts. A person who is:

(A) a physician;

(B) a physician assistant;

(C) an advanced practice registered nurse;

(D) a licensed psychologist;

(E) a licensed professional counselor;

(F) a licensed clinical social worker; or

(G) a licensed marriage and family therapist.

(22) Mental illness--An illness, disease, or condition as defined by Texas Health and Safety Code §571.003.

(23) Non-clinical services--Services that support an individual's care but do not provide direct diagnosis, treatment, or care for the individual.

(24) OCR--Outpatient competency restoration. As defined in Chapter 307, Subchapter D of this title (relating to Outpatient Competency Restoration), a community-based program with the specific objective of attaining restoration to competency pursuant to Texas Code of Criminal Procedure Chapter 46B.

(25) Program staff member--An employee or person with whom the program contracts or subcontracts for the provision of JBCR. A program staff member includes specially trained security officers, all licensed and credentialed staff, and other people directly contracted or subcontracted to provide JBCR to an individual.

(26) QIDP--Qualified intellectual disability professional as defined in 42 CFR §483.430(a).

(27) QMHP-CS--Qualified mental health professional-community services as defined in Chapter 301, Subchapter G of this title (relating to Mental Health Community Services Standards).

(28) Residential care facility--A state supported living center or the Intermediate Care Facilities for Individuals with an Intellectual Disability (ICF-IID) component of the Rio Grande State Center.

(29) Safety plan--An individualized written plan to prevent or manage crises.

(30) Serious injury--An injury determined by a physician to require medical treatment by a licensed medical professional (e.g., physician, dentist, physician's assistant, or advance practice nurse) or requires medical treatment in an emergency department or licensed hospital.

(31) Significantly sub-average general intellectual functioning--Consistent with Texas Health and Safety Code §591.003, measured intelligence on standardized general intelligence tests of two or more standard deviations (not including standard error of measurement adjustments) below the age-group mean for the test used.

(32) SUD--Substance use disorder. The use of one or more substances, including alcohol, which significantly and negatively impacts one or more major areas of life functioning, and which meets the criteria for substance use disorder as described in the HHSC-recognized edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association.

(33) TAC--Texas Administrative Code.

(34) Treatment team--A group of treatment providers, including a psychiatrist and LPHA; the individual; and the individual's legally authorized representative, if any, who work together in a coordinated manner to provide competency restoration services to the individual.
Source Note: The provisions of this §307.105 adopted to be effective August 6, 2018, 43 TexReg 5091; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 470; amended to be effective February 23, 2025, 50 TexReg 1022.

§307.107 JBCR Program Eligibility Requirements
(a) A JBCR program must meet the standards set forth in Texas Code of Criminal Procedure Article 46B.091.

(b) A JBCR program must:

(1) be an LMHA or LBHA in good standing with HHSC; or

(2) a subcontractor of an LMHA or LBHA in good standing with HHSC.

(c) An LMHA or LBHA must contract with the county to provide JBCR.

(d) An LMHA or LBHA that provides JBCR must comply with Chapter 301, Subchapter A of this title (relating to Contracts Management for Local Authorities) and the contract management and oversight requirements of the Texas Comptroller of Public Accounts.
Source Note: The provisions of this §307.107 adopted to be effective August 6, 2018, 43 TexReg 5091; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 470; amended to be effective February 23, 2025, 50 TexReg 1022.

§307.109 Service Standards
A JBCR program must:

(1) use a multidisciplinary treatment team focused on the objective of restoring the individual to competency to stand trial;

(2) employ or contract for the services of at least one psychiatrist;

(3) provide JBCR through licensed professionals, QMHP-CSs, or QIDPs as permitted by their professional license or credentials;

(4) provide weekly competency restoration hours commensurate to the treatment hours provided as part of a competency restoration program at an inpatient mental health facility;

(5) provide JBCR in a designated space in the jail, separate from the space used for the general population of the jail;

(6) ensure coordination of general health care;

(7) provide mental health treatment, SUD treatment, and referral to ID services to individuals, as clinically indicated, for competency restoration;

(8) supply clinically appropriate psychoactive medications for purposes of administering court-ordered medication to individuals as applicable and in accordance with Texas Code of Criminal Procedure Article 46B.086 or Texas Health and Safety Code §574.106; and

(9) assess individuals for suicidality and homicidality and develop a safety plan based on the needs of the individual.
Source Note: The provisions of this §307.109 adopted to be effective August 6, 2018, 43 TexReg 5091; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 470; amended to be effective February 23, 2025, 50 TexReg 1022.

§307.111 JBCR Program Staff Member Training
(a) A JBCR program must recruit, train, and maintain qualified program staff members with documented competency in accordance with Chapter 301, Subchapter G, Division 2 of this title (relating to Organizational Standards), specifically:

(1) §301.327(e) of this title (relating to Access to Mental Health Community Services);

(2) §301.329 of this title (relating to Medical Records System); and

(3) §301.331 of this title (relating to Competency and Credentialing).

(b) Before providing services, a JBCR program must train each program staff member and ensure demonstrated competence in:

(1) the rights of an individual receiving mental health services as described in Chapter 320, Subchapter A of this title (relating to Rights of Individuals Receiving Mental Health Services);

(2) the rights of an individual with an intellectual disability and a legally authorized representative as described in Chapter 334 of this title (relating to Rights of Individuals with an Intellectual Disability);

(3) identifying, preventing, and reporting abuse, neglect, and exploitation in accordance with the Texas Commission on Jail Standards or HHSC as set forth in applicable state laws and rules; and

(4) using a protocol for preventing and managing aggressive behavior, including preventative de-escalation intervention strategies.
Source Note: The provisions of this §307.111 adopted to be effective August 6, 2018, 43 TexReg 5091; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 470; amended to be effective February 23, 2025, 50 TexReg 1022.

§307.113 Policies and Procedures
A JBCR program must develop and implement written policies and procedures for:

(1) maintaining a list of each program staff member providing JBCR, including:

(A) position and credentials;

(B) reporting structure; and

(C) responsibilities;

(2) maintaining program staff member training records;

(3) describing JBCR eligibility as determined by the JBCR program, intake and assessment, and treatment planning as described in §307.121 of this subchapter (relating to Treatment Planning), and transition and discharge processes to include coordination and continuity of care planning with an LMHA, LBHA, or LIDDA, or an LMHA, LBHA, or LIDDA subcontractor;

(4) describing how an individual is assessed for:

(A) suicidality and homicidality;

(B) the degree of suicidality and homicidality;

(C) the development of a safety plan;

(5) developing a safety plan that must document:

(A) warning signs, including thoughts, images, changes in mood and behavior, or situations that may prompt a crisis;

(B) internal coping strategies that distract from crisis thoughts and urges;

(C) a process for communicating safety concerns and recommended precautions to the jail relating to an individual participating in JBCR;

(D) the process for identifying and addressing suicidal and homicidal means;

(6) outlining a JBCR program's process to assess, evaluate, and report to the court an individual's restoration to competency status and readiness for return to court as specified in Texas Code of Criminal Procedure Articles 46B.077(b) and 46B.079;

(7) addressing how a program staff member collaborates with the jail medical provider to address continuity of care, treatment, and overall therapeutic environment during evenings and weekends, including responding to behavioral health crisis or physical health crisis consistent with §301.351(a) and (e) of this title (relating to Crisis Services);

(8) educating an individual about the individual's rights while participating in JBCR;

(9) coordinating with the court concerning the JBCR program's ability to provide services to a new participant within 72 hours after admission in accordance with §307.117 of this title and Texas Code of Criminal Procedure Article 46B.073(d); and

(10) accommodating individual needs through adaptive materials and approaches as needed, including accommodations for language barriers and disabilities.
Source Note: The provisions of this §307.113 adopted to be effective August 6, 2018, 43 TexReg 5091; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 470; amended to be effective February 23, 2025, 50 TexReg 1022.

§307.115 Individual Eligibility
(a) If there is an OCR program available to serve the individual, a JBCR program must collaborate with the OCR program to screen the individual for OCR services. The individual must be deemed ineligible for OCR in accordance with Chapter 307, Subchapter D of this title (relating to Recommendation Regarding Outpatient Competency Restoration Program Admission) before a JBCR program makes a recommendation to the court regarding the individual's eligibility for JBCR.

(b) If there is not an OCR program available to serve the individual, a JBCR program must screen the individual to determine if JBCR is appropriate and make a recommendation to the court regarding the individual's eligibility for JBCR.
Source Note: The provisions of this §307.115 adopted to be effective August 6, 2018, 43 TexReg 5091; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 470; amended to be effective February 23, 2025, 50 TexReg 1022.

§307.117 Admission
(a) A JBCR program may only admit an individual to JBCR upon receipt of a court order requiring the individual to participate in JBCR under Texas Code of Criminal Procedure Chapter 46B, Subchapter D.

(b) In accordance with Texas Code of Criminal Procedure Article 46B.0735, the initial competency restoration period begins on the later of:

(1) the date the individual is:

(A) ordered to participate in OCR services; or

(B) committed to a mental health facility, residential care facility, or JBCR; or

(2) the date competency services begin.

(c) When a JBCR program determines an individual is eligible for JBCR, the program must ensure the individual will receive competency restoration services no later than 72 hours after admission to the JBCR program.

(d) A JBCR program must, when necessary, seek a court order for psychoactive medications in accordance with Texas Health and Safety Code §574.106 or Texas Code of Criminal Procedure Article 46B.086.
Source Note: The provisions of this §307.117 adopted to be effective August 6, 2018, 43 TexReg 5091; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 470; amended to be effective February 23, 2025, 50 TexReg 1022.

§307.119 Rights of Individuals Receiving JBCR
A JBCR program must:

(1) inform the individual receiving JBCR of the individual's rights in accordance with Chapter 320, Subchapter A of this title (relating to Rights of Individuals Receiving Mental Health Services) or Chapter 334 of this title (relating to Rights of Individuals with an Intellectual Disability), as applicable;

(2) provide the individual with a copy of the rights handbook published for an individual receiving mental health services or an individual with an ID; and

(3) explain to the individual receiving JBCR how to initiate a complaint and how to contact:

(A) the HHS Office of the Ombudsman for complaints against the JBCR program;

(B) the Texas Commission on Jail Standards for complaints against the county jail; and

(C) the Texas protection and advocacy system.
Source Note: The provisions of this §307.119 adopted to be effective August 6, 2018, 43 TexReg 5091; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 470; amended to be effective February 23, 2025, 50 TexReg 1022.

§307.121 Treatment Planning
Within five days after admission to JBCR, based on an individual's competency evaluation and JBCR program assessment, the JBCR program must develop the individual's treatment plan in accordance with Chapter 320, Subchapter A of this title (relating to Rights of Individuals Receiving Mental Health Services) and Chapter 301, Subchapter G of this title (relating to Mental Health Community Services Standards) to include the individual's:

(1) strengths, to assist the individual in:

(A) overcoming barriers to achieving a factual and rational understanding of legal proceedings; and

(B) consulting with the individual's lawyer with a reasonable degree of rational understanding;

(2) trauma history;

(3) physical health concerns or issues;

(4) medication and medication management;

(5) level of family and community support;

(6) mental health concerns or issues;

(7) ID concerns or issues;

(8) SUD or COPSD concerns or issues; and

(9) specific non-clinical services and supports needed by the individual after discharge, including:

(A) housing assistance;

(B) food assistance;

(C) governmental benefits;

(D) clothing resources; and

(E) other supplemental supports.
Source Note: The provisions of this §307.121 adopted to be effective August 6, 2018, 43 TexReg 5091; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 470; amended to be effective February 23, 2025, 50 TexReg 1022.

§307.123 Competency Restoration Education
(a) A JBCR program must submit the competency restoration training module for HHSC review and approval before providing services and annually thereafter.

(b) A JBCR program must educate individuals using multiple learning formats, which may include:

(1) discussion;

(2) written text;

(3) video; and

(4) experiential methods, such as role-playing or mock trial.

(c) A JBCR program must ensure an individual with accommodation needs receives adapted materials and approaches as needed, including accommodations for language barriers and disabilities.
Source Note: The provisions of this §307.123 adopted to be effective August 6, 2018, 43 TexReg 5091; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 470; amended to be effective February 23, 2025, 50 TexReg 1022.

§307.125 Procedures for Determining Competency Status in a JBCR Program
(a) A JBCR program psychiatrist or psychologist who has the qualifications described by Texas Code of Criminal Procedure Article 46B.022 must evaluate the individual's competency and report to the court as required by Article 46B.079.

(b) A JBCR program psychiatrist or psychologist must promptly send a report to the court, if at any time during an individual's commitment for JBCR, the JBCR psychiatrist or psychologist determines the individual is:

(1) restored to competency; or

(2) unlikely to be restored to competency in the foreseeable future.

(c) If the JBCR program psychiatrist or psychologist determines that the individual has not restored to competency by the end of the 60th calendar day after the date the individual began receiving JBCR, the JBCR program must continue to provide competency restoration services to the individual for the period authorized under Texas Code of Criminal Procedure Chapter 46B, Subchapter D, including any extension ordered under Article 46B.080, unless the JBCR program is notified that space at a mental health facility or residential care facility or an OCR program appropriate for the individual is available and:

(1) for an individual charged with a felony, not less than 45 calendar days are remaining in the initial restoration period; or

(2) for an individual charged with a felony or misdemeanor, an extension has been ordered under Article 46B.080 and not less than 45 calendar days are remaining under the extension order.

(d) After receipt of a notice under subsection (c) of this section, the JBCR program must collaborate with the court and the county jail to support the transfer of the individual without unnecessary delay to the appropriate mental health facility, residential care facility, or OCR program for the remainder of the period permitted by Texas Code of Criminal Procedure Article 46B.073(b), including any extension that may be ordered under Article 46B.080 if an extension has not previously been ordered under that article.

(e) If the individual is not transferred, as referenced in subsection (d) of this section, and if the JBCR program psychiatrist or psychologist determines that the individual has not been restored to competency by the end of the period authorized under Texas Code of Criminal Procedure Chapter 46B, Subchapter D, the individual must be returned to the court for further proceedings.
Source Note: The provisions of this §307.125 adopted to be effective August 6, 2018, 43 TexReg 5091; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 470; amended to be effective February 23, 2025, 50 TexReg 1022.

§307.127 Preparation for Discharge from a JBCR Program
(a) At any time an individual is restored to competency, the treatment team must collaborate with appropriate entities to facilitate:

(1) continuity of care, including specific non-clinical services and supports needed by the individual after discharge, such as:

(A) housing assistance;

(B) food assistance;

(C) governmental benefits;

(D) clothing resources; and

(E) other supplemental supports; and

(2) the individual's discharge from the JBCR program to the individual's discharge setting, including:

(A) the county jail;

(B) the LMHA;

(C) the LBHA;

(D) the LIDDA;

(E) other community mental health provider; or

(F) the care of a responsible person.

(b) If the individual is determined to be unlikely to restore to competency in the foreseeable future or is not restored after completing the JBCR program, the treatment team must collaborate with appropriate entities to facilitate:

(1) continuity of care, including specific non-clinical services and supports needed by the individual after discharge, such as:

(A) housing assistance;

(B) food assistance;

(C) governmental benefits;

(D) clothing resources; and

(E) other supplemental supports; and

(2) the individual's discharge from the JBCR program to the individual's discharge setting, including:

(A) a mental health facility;

(B) a residential care facility;

(C) the LMHA;

(D) the LBHA;

(E) the LIDDA;

(F) other community mental health provider; or

(G) the care of a responsible person.

(c) If an individual is not restored to competency by the 60th day and is being transferred to a facility or OCR program, the JBCR treatment team must collaborate with appropriate entities to facilitate:

(1) continuity of care, including specific non-clinical services and supports needed by the individual after discharge, such as:

(A) housing assistance;

(B) food assistance;

(C) governmental benefits;

(D) clothing resources; and

(E) other supplemental supports; and

(2) the individual's discharge from the JBCR program to:

(A) a mental health facility;

(B) a residential care facility; or

(C) an OCR program.
Source Note: The provisions of this §307.127 adopted to be effective August 6, 2018, 43 TexReg 5091; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 470; amended to be effective February 23, 2025, 50 TexReg 1022.

§307.129 Outcome Measures
(a) For the purposes of this section, "competency as determined by the JBCR psychiatrist or psychologist" refers to the clinical opinion of the psychiatrist or psychologist provided under Texas Code of Criminal Procedure Articles 46B.079(b) and 46B.091, as applicable.

(b) A JBCR program must collect and report the following data for an individual admitted to a JBCR program, using HHSC's designated automation system:

(1) individual outcomes:

(A) the number of individuals on felony charges;

(B) the number of individuals on misdemeanor charges;

(C) date individual was ordered to JBCR;

(D) date of first JBCR service provided;

(E) whether the court granted an extension;

(F) the average number of calendar days for an individual charged with a felony to be restored to competency, as determined by the JBCR psychiatrist or psychologist;

(G) the average number of calendar days for an individual charged with a misdemeanor to be restored to competency, as determined by the JBCR psychiatrist or psychologist;

(H) the number of individuals charged with a misdemeanor and not restored to competency, as determined by the JBCR psychiatrist or psychologist;

(I) the number of individuals charged with a felony and not restored to competency, as determined by the JBCR psychiatrist or psychologist;

(J) the number of individuals charged with a misdemeanor and restored to competency, as determined by the JBCR psychiatrist or psychologist;

(K) the number of individuals charged with a felony and restored to competency, as determined by the JBCR psychiatrist or psychologist;

(L) the average length of time between determination of non-restorability by the JBCR psychiatrist or psychologist and transfer to an inpatient mental health facility, residential care facility, or OCR program pursuant to Texas Code of Criminal Procedures Article 46B.091(j-1);

(M) the number of individuals restored to competency as determined by the JBCR psychiatrist or psychologist in 60 calendar days or less;

(N) the number of individuals found IST who were found ineligible for JBCR based on the JBCR program screening and the reason why;

(O) the number of individuals not restored to competency and who were transferred to an inpatient mental health facility or residential care facility; and

(P) the number of individuals whose charges were dismissed before completion of JBCR; and

(2) administrative outcomes, in a format specified by HHSC, for the JBCR program, including:

(A) the costs associated with operating the JBCR program; and

(B) the number of:

(i) reported and confirmed cases of abuse, neglect, and exploitation;

(ii) reported and confirmed cases of rights violations;

(iii) restraints and seclusions used;

(iv) emergency medications used;

(v) serious injuries; and

(vi) deaths, in accordance with §320.143 of this title (relating to Documenting, Reporting, and Analyzing Restraint or Seclusion) or Chapter 301, Subchapter H of this title (relating to Deaths of Individuals Served by Community Mental Health Centers), as applicable.
Source Note: The provisions of this §307.129 adopted to be effective August 6, 2018, 43 TexReg 5091; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 470; amended to be effective February 23, 2025, 50 TexReg 1022.

§307.131 Compliance with Statutes, Rules, and Other Documents
(a) In addition to any applicable federal or state law or rule, a JBCR program must comply with:

(1) Texas Health and Safety Code Chapter 574 (relating to Court-Ordered Mental Health Services);

(2) Texas Human Resources Code Chapter 48 (relating to Investigations and Protective Services for Elderly Persons and Persons with Disabilities);

(3) 26 TAC:

(A) Chapter 301, Subchapter G of this title (relating to Mental Health Community Services Standards);

(B) Chapter 301, Subchapter H of this title (relating to Deaths of Individuals Served by Community Mental Health Centers);

(C) Chapter 306, Subchapter A of this title (relating to Standards for Services to Individuals with Co-occurring Psychiatric and Substance Use Disorders (COPSD));

(D) Chapter 320, Subchapter A of this title (relating to Rights of Individuals Receiving Mental Health Services);

(E) Chapter 320, Subchapter C of this title (relating to Interventions in Mental Health Services);

(F) Chapter 320, Subchapter D of this title (relating to Prescribing of Psychoactive Medication); and

(G) Chapter 334 of this title (relating to Rights of Individuals with an Intellectual Disability).

(b) Concerning confidentiality, a JBCR program must comply with the Health Insurance Portability and Accountability Act, 42 U.S.C. §1320d et seq and other applicable federal and state laws, including:

(1) 42 CFR Part 2 and Part 51, Subpart D;

(2) 45 CFR Parts 160 and 164, and Part 1326, Subpart C;

(3) Texas Health and Safety Code Chapter 81, Subchapter F;

(4) Texas Health and Safety Code Chapters 181, 595, and 611;

(5) Texas Health and Safety Code §§533.009, 576.005, 576.007, and 614.017;

(6) Texas Government Code Chapters 552 and 559;

(7) Texas Occupations Code Chapter 159; and

(8) Texas Business and Commerce Code §521.053.
Source Note: The provisions of this §307.131 adopted to be effective August 6, 2018, 43 TexReg 5091; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 470; amended to be effective February 23, 2025, 50 TexReg 1022.

§307.151 Purpose
The purpose of this subchapter is to provide standards for outpatient competency restoration (OCR) services provided to individuals ordered to participate in an OCR program pursuant to the Texas Code of Criminal Procedure Chapter 46B.
Source Note: The provisions of this §307.151 adopted to be effective February 9, 2021, 46 TexReg 918.

§307.153 Application
This subchapter applies to:

(1) local mental health authorities (LMHAs), local behavioral health authorities (LBHAs), and LMHA or LBHA subcontractors that administer OCR programs; and

(2) other providers under contract with the Texas Health and Human Services Commission to administer an OCR program.
Source Note: The provisions of this §307.153 adopted to be effective February 9, 2021, 46 TexReg 918.

§307.155 Definitions
The following words and terms, when used in this subchapter, have the following meanings.

(1) Adaptive behavior--The effectiveness with which, or degree to which, an individual meets the standards of personal independence and social responsibility expected of the individual's age and cultural group.

(2) Competency restoration--The treatment or education process for restoring an individual's ability to consult with the individual's attorney with a reasonable degree of rational understanding, including a rational and factual understanding of the court proceedings and charges against the individual.

(3) Court--A court of law presided over by a judge, judges, or a magistrate in civil and criminal cases.

(4) Extension--The term has the meaning described in Texas Code of Criminal Procedure, Article 46B.080(d). An extension begins on the later of:

(A) the date the court enters the order under Article 46B.080(a); or

(B) the date competency restoration services begin pursuant to the order entered under Article 46B.080(a).

(5) HHSC--Texas Health and Human Services Commission or its designee.

(6) Individual--A person receiving services under this subchapter.

(7) IST--Incompetent to stand trial. The term has the meaning described in Texas Code of Criminal Procedure, Article 46B.003.

(8) LBHA--Local behavioral health authority. An entity designated as an LBHA by HHSC in accordance with Texas Health and Safety Code §533.0356.

(9) LIDDA--Local intellectual and developmental disability authority. An entity designated as a LIDDA by HHSC in accordance with Texas Health and Safety Code §533A.035(a).

(10) LMHA--Local mental health authority. An entity designated as an LMHA by HHSC in accordance with Texas Health and Safety Code §533.035.

(11) Medical record--An organized account of information relevant to the medical services provided to an individual, including an individual's history, present illness, findings on examination, treatment and discharge plans, details of direct and indirect care and services, and notes on progress.

(12) OCR--Outpatient competency restoration. A community-based program with the specific objective of attaining restoration to competency pursuant to Texas Code of Criminal Procedure Chapter 46B.

(13) OCR provider--An entity identified in §307.153 of this subchapter (relating to Application) that provides OCR services.

(14) Ombudsman--The Ombudsman for Behavioral Health Access to Care established by Texas Government Code §531.02251, including care for mental health conditions and substance use disorders.

(15) Subcontractor--A person or entity that contracts with an OCR provider to provide OCR services.

(16) TAC--Texas Administrative Code.
Source Note: The provisions of this §307.155 adopted to be effective February 9, 2021, 46 TexReg 918; amended to be effective February 9, 2023, 48 TexReg 519.

§307.157 Recommendation Regarding Outpatient Competency Restoration Program Admission
(a) The OCR provider must assess the individual to determine if OCR services are appropriate by ensuring the following assessments are conducted by a person qualified to conduct the assessments pursuant to their state license, permit, or other legal authorization:

(1) a clinical assessment, including substance use history; and

(2) a violence risk assessment utilizing a validated risk assessment tool.

(b) If an OCR provider determines that OCR services are appropriate for an individual, the provider must:

(1) inform the court, in writing, that the individual is being recommended for admission into the OCR program; and

(2) develop and submit a comprehensive treatment plan to the court in accordance with Texas Code of Criminal Procedure, Article 46B.0711(c)(1) or 46B.072(c)(1) as applicable, identifying the persons responsible for providing treatment to the individual and listing services the individual will be provided, including:

(A) competency restoration education;

(B) access to housing resources;

(C) access to transportation resources; and

(D) a regimen of medical, psychiatric, or psychological care or treatment.

(c) If an OCR provider determines that OCR services are inappropriate for an individual, the provider must:

(1) inform the court, in writing, of the individual's ineligibility for admission into the OCR program; and

(2) document reasons for ineligibility in the individual's medical record.
Source Note: The provisions of this §307.157 adopted to be effective February 9, 2023, 48 TexReg 519.

§307.159 Admission to an Outpatient Competency Restoration Program
(a) An OCR provider must admit an individual to an OCR program upon receipt of a court order requiring the individual to participate in OCR services under Texas Code of Criminal Procedure Chapter 46B, Subchapter D.

(b) In accordance with Texas Code of Criminal Procedure, Article 46B.0735, the initial competency restoration period begins on the later of:

(1) the date the individual is ordered to participate in OCR services; or

(2) the date the individual is committed to a mental health facility, residential care facility, or jail-based competency restoration program; or

(3) the date competency restoration services begin.
Source Note: The provisions of this §307.159 adopted to be effective February 9, 2023, 48 TexReg 519.

§307.161 General Service Requirements
An OCR provider:

(1) must make competency restoration education interactive and available in multiple learning formats to the individual receiving competency restoration education, which may include:

(A) discussion;

(B) written text and discussion;

(C) recorded video and discussion; and

(D) experiential learning, such as role-playing or mock trial, and discussion;

(2) must ensure an individual who requires accommodations receives adapted materials and approaches as needed, including accommodations for language barriers and disabilities;

(3) must make available an appropriate prescribed regimen of medical, psychiatric, or psychological care or treatment, including administration of psychoactive medication in accordance with 25 TAC Chapter 414, Subchapter I (relating to Consent to Treatment with Psychoactive Medication--Mental Health Services);

(4) may use telecommunications or information technology to provide competency restoration services that are compliant with the Health Insurance Portability and Accountability Act; and

(5) must identify each person's role and responsibility in court proceedings in the OCR program's training module for individuals in the OCR program.
Source Note: The provisions of this §307.161 adopted to be effective February 9, 2021, 46 TexReg 918.

§307.163 Assessment, Reassessment, Court Reporting, and Extension
(a) An OCR provider must:

(1) regularly evaluate the individual's progress towards attainment of competency to stand trial and likeliness to restore to competency in the foreseeable future;

(2) report the individual's progress toward achieving competency to the court in accordance with Texas Code of Criminal Procedure, Article 46B.077:

(A) no later than the 14th day after the date competency restoration services begin; and

(B) at least once each 30-day period following the date of the first report to the court after competency restoration services begin;

(3) promptly report to the court the individual's attainment of competency or whether the individual is not likely to restore to competency in the foreseeable future in accordance with Texas Code of Criminal Procedure, Article 46B.079; and

(4) notify the court no later than 15 days before the date on which the initial restoration period is to expire that the period is about to expire in accordance with Texas Code of Criminal Procedure, Article 46B.079.

(b) The notice provided under subsection (a)(4) of this section may include a request for a 60-day extension of the initial restoration period for OCR services, and include an explanation for the request in accordance with Texas Code of Criminal Procedure, Article 46B.079(d).
Source Note: The provisions of this §307.163 adopted to be effective February 9, 2021, 46 TexReg 918; amended to be effective February 9, 2023, 48 TexReg 519.

§307.165 Discharge Requirements
(a) When an OCR provider discharges an individual from OCR services upon completion of court-ordered participation in the OCR program, the OCR provider must provide continuity of care services. Discharge planning begins upon admission into the OCR program and includes:

(1) a plan for maintaining housing and utilities for three months or more after discharge;

(2) coordination of ongoing services through the LMHA or LBHA in the individual's county of residence or the individual's designated LIDDA as provided in section 5000 of the LIDDA handbook available on HHSC's website;

(3) the provision of medication and documentation of a scheduled psychiatric follow-up appointment after discharge;

(4) completion of all appropriate benefits applications on behalf of any individual, including signing up for long-term subsidized housing;

(5) confirmation that an assisted living facility to which an individual is referred is licensed under Texas Health and Safety Code Chapter 247 and Chapter 553 of this title (relating to Licensing Standards for Assisted Living Facilities) by contacting the HHSC Assisted Living Facility Licensing and Certification Unit, if applicable;

(6) coordination of appropriate transfer to an inpatient treatment facility, if applicable; and

(7) coordination of appropriate transfer if returned to custody.

(b) For an unplanned discharge, an OCR provider must:

(1) notify the court of the unplanned discharge;

(2) make efforts to assist in facilitating service coordination with the LMHA or LBHA in the individual's county of residence or the individual's designated LIDDA to ensure the individual's continuity of care; and

(3) document continuity of care efforts in the individual's medical record.

(c) An OCR provider must document the reasons for the individual's failure to complete the OCR program in the individual's record, if applicable.

(d) Before an individual is discharged from an OCR program, an OCR provider must collaborate with courts to encourage timely resolution of legal issues.
Source Note: The provisions of this §307.165 adopted to be effective February 9, 2021, 46 TexReg 918; amended to be effective February 9, 2023, 48 TexReg 519.

§307.167 Data
(a) An OCR provider must collect and report the following data into HHSC's designated automation system for each individual admitted to or discharged from an OCR program, including:

(1) whether the individual has been charged with a felony;

(2) whether the individual has been charged with a misdemeanor;

(3) whether the individual withdrew from the OCR program without the court's authorization;

(4) whether the individual received an additional charge of a Class B misdemeanor or a higher category of offense while ordered to the OCR program;

(5) whether the individual has been restored to competency within the timeframe allotted by statute;

(6) the number of days from the day the court orders OCR to the day the individual begins participation in the OCR program;

(7) the number of days an individual charged with a felony received treatment and services in the OCR program;

(8) the number of days an individual charged with a misdemeanor received treatment and services in the OCR program;

(9) whether an extension of services was sought for an individual charged with a felony;

(10) whether an extension of services was sought for an individual charged with a misdemeanor;

(11) whether an individual has not restored to competency at the conclusion of court-ordered services as determined by the court; and

(12) types of services provided to the individual other than psychiatric services and competency restoration education.

(b) In a format specified by HHSC, an OCR provider must submit costs associated with operating the OCR program to HHSC quarterly.

(c) In a format specified by HHSC, an OCR provider must submit administrative outcomes on the OCR program regarding:

(1) reported and confirmed cases of abuse, neglect, and exploitation;

(2) reported and confirmed cases of rights violations;

(3) restraints and seclusions used;

(4) emergency medications used;

(5) serious injuries; and

(6) deaths.
Source Note: The provisions of this §307.167 adopted to be effective February 9, 2021, 46 TexReg 918; amended to be effective February 9, 2023, 48 TexReg 519.

§307.169 Written Policies and Procedures
An OCR provider must develop and implement written policies and procedures that outline processes for:

(1) maintaining a list of each staff member providing OCR services, including the staff members':

(A) position and credentials;

(B) reporting structure; and

(C) responsibilities;

(2) maintaining staff member training records;

(3) describing an individual's eligibility and ineligibility criteria for OCR services;

(4) screening an individual's appropriateness for OCR services;

(5) admitting an individual within the OCR program provider's catchment area;

(6) developing a treatment plan and discharge plan;

(7) delivering all required components of competency restoration services;

(8) admitting an individual:

(A) who is referred by another LMHA, LBHA, or LIDDA that is outside of the OCR program's catchment area but is within close physical proximity to the OCR program;

(B) who is without an OCR program in the individual's service area; and

(C) where OCR services are potentially appropriate;

(9) documenting the types of services provided in the OCR program other than competency restoration services in accordance with §307.161 of this subchapter (relating to General Service Requirements);

(10) regularly monitoring, evaluating, and documenting the individual's progress towards attainment of competency to stand trial and likeliness to restore to competency in the foreseeable future in accordance with §307.163 of this subchapter (relating to Assessment, Reassessment, Court Reporting, and Extension);

(11) notifying the court:

(A) that the initial restoration period will expire and when it will expire;

(B) if the individual has attained competency to stand trial or is not likely to attain competency in the foreseeable future;

(C) of a request for an extension of continued restoration services as specified in the Texas Code of Criminal Procedure, Articles 46B.079(d) and 46B.080; and

(D) the individual's readiness to return to court;

(12) complying with reporting procedures specified in Texas Code of Criminal Procedure, Article 46B.079;

(13) preparing for an individual's planned or unplanned discharge from the OCR program and ensuring continuity of care in accordance with §307.165 of this subchapter (relating to Discharge Requirements), as appropriate; and

(14) educating an individual about the individual's rights and participation in the OCR program.
Source Note: The provisions of this §307.169 adopted to be effective February 9, 2021, 46 TexReg 918; amended to be effective February 9, 2023, 48 TexReg 519.

§307.171 Staff Member Training
An OCR provider must ensure staff members complete training and document evidence of training in the following:

(1) trauma informed care;

(2) cultural competency;

(3) rights of persons receiving OCR services in accordance with §307.173 of this subchapter (relating to Rights);

(4) identifying, preventing, and reporting abuse, neglect, and exploitation in accordance with 25 TAC Chapter 414, Subchapter L (relating to Abuse, Neglect, and Exploitation in Local Authorities and Community Centers) to the Texas Department of Family and Protective Services at 1-800-252-5400 or online at www.txabusehotline.org in accordance with applicable state laws and rules; and

(5) using a protocol for preventing and managing aggressive behavior, including de-escalation intervention techniques in accordance with 25 TAC Chapter 415, Subchapter F (relating to Interventions in Mental Health Services).
Source Note: The provisions of this §307.171 adopted to be effective February 9, 2021, 46 TexReg 918.

§307.173 Rights
(a) An OCR provider must:

(1) inform the individual receiving OCR services of the individual's rights in accordance with 25 TAC Chapter 404, Subchapter E (relating to Rights of Persons Receiving Mental Health Services) or 40 TAC Chapter 4, Subchapter C (relating to Rights of Individuals with an Intellectual Disability), as applicable;

(2) provide the individual with a copy of the rights handbook published for an individual receiving mental health services or an individual with an ID; and

(3) explain to the individual receiving OCR services how to initiate a complaint and how to contact:

(A) the Ombudsman for complaints against the OCR provider; and

(B) the Texas protection and advocacy agency.

(b) The individual may contact the Ombudsman for additional information and resources, at any time, by calling toll-free at 1-800-252-8154 or online at hhs.texas.gov/ombudsman.
Source Note: The provisions of this §307.173 adopted to be effective February 9, 2021, 46 TexReg 918.

§307.175 Compliance with Statutes and Rules
In addition to any applicable federal or state law or rule, an OCR provider must comply with:

(1) Texas Health and Safety Code Chapter 574;

(2) Texas Code of Criminal Procedure Chapter 46B;

(3) Other applicable federal and state laws, including:

(A) Health Insurance Portability and Accountability Act of 1996;

(B) 42 CFR Part 2 and Part 51, Subpart D;

(C) 45 CFR Parts 160 and 164;

(D) Texas Health and Safety Code Chapters 181, 595, and 611;

(E) Texas Health and Safety Code §533.009, §576.005, §576.007, and §614.017;

(F) Texas Occupations Code Chapter 159; and

(G) Texas Business and Commerce Code §521.053;

(4) 25 TAC Chapter 405, Subchapter K (relating to Deaths of Persons Served by TXMHMR Facilities or Community Mental Health and Mental Retardation Centers) as it relates to community-based services and community centers;

(5) Chapter 306, Subchapter A of this title (relating to Standards for Services to Individuals with Co-occurring Psychiatric and Substance Use Disorders (COPSD));

(6) 25 TAC Chapter 414, Subchapter L (relating to Abuse, Neglect, and Exploitation in Local Authorities and Community Centers); and

(7) 25 TAC Chapter 415, Subchapter F (relating to Interventions in Mental Health Services).
Source Note: The provisions of this §307.175 adopted to be effective February 9, 2021, 46 TexReg 918; amended to be effective February 9, 2023, 48 TexReg 519.

§307.201 Purpose
The purpose of this subchapter is to implement the relinquishment avoidance program in accordance with Texas Family Code Chapter 262, Subchapter E, which provides beds in residential treatment center operations to prevent the relinquishment of parental conservatorship to the Texas Department of Family and Protective Services solely to obtain mental health services for a child with a serious emotional disturbance. For this subchapter, the relinquishment avoidance program is called the Residential Treatment Center (RTC) Project.
Source Note: The provisions of this §307.201 adopted to be effective April 10, 2023, 48 TexReg 1829.

§307.203 Application
This subchapter applies to:

(1) residential treatment center (RTC) providers that contract with the Texas Health and Human Services Commission to provide RTC Project services;

(2) local mental health authorities and local behavioral health authorities, with RTC Project administrative responsibilities; and

(3) a child, and their legally authorized representative, who:

(A) meet eligibility criteria as provided in §307.207 of this subchapter (relating to Eligibility Criteria to Participate in the RTC Project); and

(B) are applicants or recipients of services from the RTC Project.
Source Note: The provisions of this §307.203 adopted to be effective April 10, 2023, 48 TexReg 1829.

§307.205 Definitions
The following words and terms, when used in this subchapter, have the following meanings:

(1) Business day--Any day except a Saturday, Sunday, or legal holiday listed in Texas Government Code §662.021.

(2) Case manager--An employee of the local mental health authority (LMHA) or local behavioral health authority (LBHA) who provides mental health case management services.

(3) Child--A person under 18 years of age as defined under Texas Human Resources Code §42.002 and not emancipated under state law.

(4) DFPS--The Texas Department of Family and Protective Services.

(5) Eligibility assessment--The process an LMHA or an LBHA uses to gather information from a child and the child's legally authorized representative to determine if the child meets eligibility criteria for receiving services through the Residential Treatment Center (RTC) Project.

(6) HHSC--The Texas Health and Human Services Commission, or its designee.

(7) LAR--Legally authorized representative. A person authorized by law to act on behalf of a child regarding a matter described in this subchapter, and may include a parent, legal guardian, or managing conservator of a child.

(8) LBHA--Local behavioral health authority. An entity designated as the local behavioral health authority by HHSC in accordance with Texas Health and Safety Code §533.0356.

(9) LMHA--Local mental health authority. An entity designated as the local mental health authority by HHSC in accordance with Texas Health and Safety Code §533.035(a).

(10) LPHA--Licensed practitioner of the healing arts. A person who is:

(A) a physician;

(B) a physician assistant;

(C) an advanced practice registered nurse;

(D) a licensed psychologist;

(E) a licensed professional counselor;

(F) a licensed clinical social worker; or

(G) a licensed marriage and family therapist.

(11) Ombudsman--The Ombudsman for Behavioral Health Access to Care established by Texas Government Code §531.02251 serves as a neutral party to help individuals, including individuals who are uninsured or have public or private health benefit coverage, and behavioral health care providers navigate and resolve issues related to the individual's access to behavioral health care, including care for mental health conditions and substance use disorders.

(12) RTC--Residential treatment center. A general residential operation regulated under Texas Human Resources Code Chapter 42 and Chapter 748 of this title (relating to Minimum Standards for General Residential Operations) for seven or more children that exclusively provides treatment services for children with emotional disorders.

(13) RTC Project--The HHSC relinquishment avoidance program that provides residential mental health services to a child with a serious emotional disturbance without the child entering the managing conservatorship of DFPS, in accordance with Texas Family Code Chapter 262, Subchapter E.

(14) RTC project team--The HHSC team that provides oversight of the RTC Project.

(15) RTC contractor--A residential treatment center that contracts with HHSC to provide services under this subchapter.

(16) SED--Serious emotional disturbance. A mental, behavioral, or emotional disorder of sufficient duration to result in functional impairment that substantially interferes with or limits a person's role or ability to function in family, school, or community activities in accordance with Texas Government Code §531.251.

(17) Service planning team--A team that must develop, review, and revise the service plan and discharge plan. The team must consist of:

(A) an RTC contractor;

(B) in addition to the requirements outlined in Chapter 748, Subchapter I of this title (relating to Admission, Service Planning, and Discharge), the service planning team includes:

(i) the child;

(ii) the child's LAR;

(iii) a representative from the LMHA or LBHA assigned to work with the child and family; and

(iv) the child's individual and family therapist; and

(C) other participants on the service planning team may include other individuals as requested by the child, the child's LAR, the LMHA or LBHA, or the RTC and agreed upon by the child's LAR.
Source Note: The provisions of this §307.205 adopted to be effective April 10, 2023, 48 TexReg 1829.

§307.207 Eligibility Criteria to Participate in the RTC Project
(a) The child must:

(1) be a resident of the State of Texas;

(2) be younger than 18 years of age;

(3) have an SED as determined by a professional authorized to make the determination within the scope of their Texas state license, permit, or other certification;

(4) require residential treatment services, as outlined in §307.213 of this subchapter (relating to Assessing Eligibility); and

(5) not be in DFPS managing conservatorship by written court order issued under Texas Family Code Chapter 153.

(b) The child's parent or managing conservator must be at risk of relinquishing parental conservatorship of the child if there are no community-based mental health or financial resources available to adequately protect the safety and well-being of the child or others, including household members, because of the child's SED.

(c) The child's LAR must attest to the appropriate referral source as described in §307.209(a) of this subchapter (relating to Referral Process) that the family is at risk of relinquishing the child for the sole purpose of accessing mental health services.

(d) The RTC Project limits the number of children for participation in the RTC Project based on funding and placement availability.
Source Note: The provisions of this §307.207 adopted to be effective April 10, 2023, 48 TexReg 1829.

§307.209 Referral Process
(a) A referral may occur in one of two ways:

(1) An LAR, or an individual supporting the family with the LAR's consent, interested in the RTC Project requests a referral for treatment services through the child's designated LMHA or LBHA which then submits a referral to the RTC Project team; or

(2) DFPS may submit a referral to the RTC Project team when DFPS receives an intake for which a referral may be appropriate.

(b) Upon receipt of a referral from the RTC Project, the LMHA or LBHA schedules the child's eligibility assessment with the child's LAR.

(c) The LMHA or LBHA must notify the child's LAR of the child's eligibility assessment results within two business days after eligibility is determined and send a complete application packet within two business days after its completion to the RTC Project team as outlined in §307.217 of this subchapter (relating to Application Packet).

(d) If the child is eligible for RTC Project services, the RTC Project team places the child on the RTC Project interest list.

(e) If the child's eligibility for the RTC Project is not approved at the time of the referral, the RTC Project notifies the LMHA or LBHA within seven business days. The LMHA or LBHA notifies the child's LAR, in writing, within seven business days after notification. The child's LAR may request a review of this decision as outlined in §307.215 of this subchapter (relating to Notification and Appeal Process).
Source Note: The provisions of this §307.209 adopted to be effective April 10, 2023, 48 TexReg 1829.

§307.211 Interest List Management
(a) The child remains on the RTC Project interest list until the child is admitted to an RTC or removed from the interest list pursuant to §307.211(b) of this section.

(b) The RTC Project team removes a child's name from the interest list if:

(1) the RTC Project team determines the child is ineligible in accordance with §307.207 of this subchapter (relating to Eligibility Criteria to Participate in the RTC Project);

(2) the child's LAR submits a request to remove the child's name from the RTC Project interest list verbally or in writing;

(3) the child's LAR declines RTC Project services verbally or in writing;

(4) the child's LAR declines LMHA or LBHA services verbally or in writing;

(5) the child is placed in DFPS managing conservatorship by written court order issued under Texas Family Code Chapter 153;

(6) the child is no longer a resident of Texas;

(7) the child is committed to the Texas Juvenile Justice Department or the Texas Department of Criminal Justice;

(8) the child is deceased;

(9) The child is no longer in need of RTC Project services and has been on the interest list for over 30 calendar days as described in subsection (c) of this section;

(10) the LMHA, LBHA, or RTC Project team has been unable to contact the child's LAR to complete the activities or documents required for the application packet;

(11) the child is admitted for treatment through the RTC Project; or

(12) the child has exhausted all placement options or has been denied admission into all eligible RTC operations participating in the RTC Project more than once, as outlined in the HHSC RTC Project policy manual.

(c) If the child is no longer in need of RTC Project services, the child's LAR may request that the child remain on the RTC Project interest list for 30 calendar days in case such services are needed in the future. While the child is on the interest list, the LMHA or LBHA must monitor the child's need for RTC Project services and offer, provide, or secure services for the child at the appropriate level of care indicated by the child's eligibility assessment.
Source Note: The provisions of this §307.211 adopted to be effective April 10, 2023, 48 TexReg 1829.

§307.213 Assessing Eligibility
(a) The LMHA or LBHA must designate a staff person who is a qualified mental health professional-community services, as defined in §301.303 of this title (relating to Definitions), or LPHA, to assess the child for eligibility within two business days after a request for referral is received from the LAR or the RTC Project team. The LMHA or LBHA must determine:

(1) the most appropriate and available treatment options in accordance with §306.163 of this title (relating to Most Appropriate and Available Treatment Options); and

(2) there are no other mental health services available to support the child in their community.

(b) If the child's LAR informs the LMHA or LBHA that the child is at immediate risk of relinquishment to DFPS conservatorship, the LMHA or LBHA must assess the child within 24 hours for emergency eligibility. The children's mental health director or designee must evaluate if the child is at immediate risk of relinquishment to DFPS and if so, follow the procedures outlined under §307.217 of this subchapter (relating to Application Packet) and in the RTC Project policy manual posted on the HHSC website.
Source Note: The provisions of this §307.213 adopted to be effective April 10, 2023, 48 TexReg 1829.

§307.215 Notification and Appeal Process
(a) The LMHA or LBHA must inform the child's LAR, in writing, within seven business days of the child's removal from the interest list for RTC Project services for the applicable reasons provided in §307.211(b) of this subchapter (relating to Interest List Management).

(b) If the child's name is removed from the interest list, the written notification to the child's LAR includes:

(1) the reasons for the removal of the child's name from the interest list and the process for appealing the decision in accordance with this section;

(2) the availability of information and assistance from the HHSC Ombudsman by contacting the Ombudsman at 1-800-252-8154 or online at hhs.texas.gov/ombudsman;

(3) the telephone number and address of the protection and advocacy system established in Texas; and

(4) information developed by DFPS regarding the process for initiating an intake with DFPS for possible investigation and filing of a Suit Affecting the Parent Child Relationship pursuant to Texas Family Code Title 5, Chapter 262.

(c) An LAR whose child is determined ineligible for RTC Project services may appeal the decision by:

(1) submitting a written request for review of the decision to the RTC Project team, as provided in the written notification, within 30 calendar days after the date of the RTC Project team's written denial;

(2) including an explanation why the child's LAR disagrees with the denial; and

(3) submitting any relevant supporting documentation for RTC Project eligibility.

(d) The RTC Project team reviews and responds to the child's LAR's appeal within ten business days after receiving the appeal and informs the child's LAR, in writing, of the appeal's outcome unless there are extenuating circumstances necessitating an extension. The extension will be communicated with the child's LAR.
Source Note: The provisions of this §307.215 adopted to be effective April 10, 2023, 48 TexReg 1829.

§307.217 Application Packet
(a) The LMHA or LBHA must ensure an application packet is completed for every child on the interest list who meets eligibility criteria for the RTC Project.

(1) The LMHA or LBHA assists the child's LAR to complete the application packet and submits the completed application packet on behalf of the child's LAR to the RTC Project team.

(2) The RTC Project team looks for RTC treatment for the child after eligibility is determined and the application packet is complete.

(b) After the RTC Project team submits the child's application packet to the RTC contractor, the RTC contractor must:

(1) review the application packet to determine eligibility for RTC contractor admission in accordance with Chapter 748, Subchapter I of this title (relating to Admission, Service Planning, and Discharge); and

(2) notify the RTC Project team, in writing, of the child's eligibility for admission within two business days after the RTC contractor's determination is made.

(c) If the RTC contractor determines they can admit and treat the child, the RTC Project team notifies the appropriate LMHA or LBHA within two business days, and the LMHA or LBHA notifies the child's LAR of the admission options within two business days after notification.

(1) If there are multiple RTC treatment options, the RTC Project team notifies the appropriate LMHA or LBHA, and the LMHA or LBHA notifies the child's LAR within two business days after notification.

(2) The child's LAR consults with the LMHA or LBHA and makes a final determination to accept or decline the RTC options.

(3) The LMHA or LBHA notifies the RTC Project Team about the child's LAR's decision within two business days.

(4) the RTC Project team authorizes the child's LAR's choice of available RTC options within two business days after notification.

(d) If the RTC contractor determines they are unable to meet the treatment needs of the child at the RTC, the RTC contractor must notify the RTC Project team within two business days after making the determination and describe the reasons why the child cannot be admitted.

(e) If all RTC contractors associated with the RTC Project deny the child's admission, the RTC Project team will notify the LMHA or LBHA that the child is denied by all RTC contractors within seven business days after the last contractor denial. The LMHA or LBHA must notify the child's LAR, in writing, within seven business days after notification.
Source Note: The provisions of this §307.217 adopted to be effective April 10, 2023, 48 TexReg 1829.

§307.219 Local Mental Health Authority and Local Behavioral Health Authority Requirements
(a) The LMHA or LBHA must not require an LAR to contact DFPS to initiate a referral to the RTC Project in accordance with Texas Family Code §262.353.

(b) The LMHA or LBHA must designate a staff person as an RTC Project liaison responsible for receiving and submitting referrals to the RTC Project.

(c) The LMHA or LBHA must assign a case manager after the child is determined eligible for the RTC Project. The LMHA or LBHA case manager must:

(1) offer the child services at the appropriate level of care indicated by the eligibility assessment, including referrals to community resources as appropriate;

(2) offer the child's LAR Certified Family Partner services, as defined in §306.305 of this title (relating to Definitions);

(3) assist the child's LAR in applying for Medicaid or Medicaid Buy-In;

(4) assist the child's LAR with completing the application packet after determined eligible for the RTC Project;

(5) as part of the application packet, assist the child's LAR with obtaining either a psychiatric evaluation, psychosocial assessment, or psychological evaluation of the child that includes a mental health diagnosis, if one has not been completed within the past year or if it is not available. The mental health diagnosis must be determined by a professional authorized to make the determination within the scope of their Texas state license, permit, or other certification;

(6) enroll the child in an RTC level of care, provided in the Utilization Management Guidelines and Manual posted on the HHSC website after the child's admission to the RTC;

(7) attend service planning team meetings conducted by the RTC contractor;

(8) submit monthly progress reports to the RTC Project team;

(9) attend the child's discharge planning meeting conducted by the RTC contractor;

(10) schedule a discharge follow-up appointment with the child and family after the child's discharge from the RTC; and

(11) schedule a child's appointment with a physician, or designee authorized by Texas state law, to prescribe medications after the child's discharge from the RTC.
Source Note: The provisions of this §307.219 adopted to be effective April 10, 2023, 48 TexReg 1829.

§307.221 Residential Treatment Center Contractor Requirements
(a) RTC contractors must be licensed by HHSC Child Care Regulation and have a contract with HHSC to provide RTC Project services.

(b) The RTC contractor must provide comprehensive residential treatment services as outlined in this subchapter, in the HHSC contract, and as described in the HHSC child-care minimum standards for general residential operations. The RTC must:

(1) provide psychotherapy services that include individual and family therapy;

(2) psychopharmacological therapy for the treatment of psychiatric illness with psychotropic medication on an ongoing basis if indicated based on psychiatric evaluation;

(3) integrate a trauma-informed care approach into the care, treatment, and supervision of each child. Trauma-informed care is care that is child and family-centered and takes into consideration:

(A) the unique culture, experiences, and beliefs of the child and family;

(B) the impact traumatic experiences have on the life of the child;

(C) the symptoms of childhood trauma;

(D) an understanding of the child's personal trauma history;

(E) the recognition of the child's trauma triggers;

(F) methods of responding that improve the child's ability to trust, to feel safe, and to adapt to changes in the child's environment; and

(G) the impact traumatic experiences have on the child's family;

(4) include habilitation activities, such as vocational services, as appropriate; and

(5) provide services in accordance with the HHSC provider contract.

(c) The RTC contractor must assign an LPHA for each child. The LPHA or treatment director must:

(1) ensure the delivery of therapeutic services to the child;

(2) provide recommendations for the child's service plan, in consultation with the service planning team; and

(3) provide recommendations for the child's discharge plan in consultation with the service planning team.

(d) The RTC contractor must notify all members of the service planning team in writing at least two weeks in advance of the child's service plan meetings.

(e) If the child's service planning team determines the child needs continued residential treatment beyond six months, and the RTC contractor does not have an agreement for an extended treatment curriculum with HHSC, the RTC must:

(1) submit a request to the RTC Project team for the child's ongoing treatment before the sixth month of treatment in accordance with the RTC Project policy manual posted on the HHSC website; and

(2) document in the child's service plan the need for an anticipated length of stay beyond the six-month timeframe, and why a less intensive level of care is not appropriate.

(f) The service plan must:

(1) be approved by the service planning team and must meet the requirements outlined in Chapter 748, Subchapter I of this title (relating to Admission, Service Planning, and Discharge); and

(2) be reviewed monthly, and updated at least every 90 calendar days, in accordance with Chapter 748, Subchapter I of this title. If the child's needs change, the service plan must be updated to address the changes.

(g) The child's LAR must be included by the RTC contractor in developing the child's service plan, and in meetings to the greatest extent possible, as provided in the Residential Treatment Center Project Family Agreement. If the child's LAR, or other parties responsible for the child's care are unable to participate, the RTC contractor must review the service plan to ensure that the child's service plan goals and level of care adequately address the child's treatment needs.
Source Note: The provisions of this §307.221 adopted to be effective April 10, 2023, 48 TexReg 1829.

§307.223 Discharge Plan
(a) The child may be discharged from the RTC Project:

(1) when the service planning team determines that the child completed treatment and no longer requires a residential level of care;

(2) when the child's LAR requests discharge from the operation; or

(3) in accordance with Chapter 748, Subchapter I of this title (relating to Admission, Service Planning, and Discharge).

(b) If the RTC contractor determines at any point throughout treatment that the child is not appropriate for continued treatment at the RTC and must be discharged in less than 14 calendar days:

(1) the RTC contractor must notify the child's LAR and the LMHA or LBHA within 24 hours after the determination and before discharge;

(2) the RTC contractor must notify the RTC Project team, in writing, within 24 hours, but no later than one business day, after the determination; and

(3) the RTC contractor must conduct an emergency staffing with the child's service planning team for continuity of care services.

(c) If the RTC contractor determines at any point throughout treatment that the child requires an emergency discharge, the RTC contractor must follow emergency discharge and transfer requirements in accordance with Chapter 748, Subchapter I of this title, and:

(1) notify the child's LAR and LMHA or LBHA immediately after determining the child is not appropriate for continued treatment at the RTC and before the child's discharge;

(2) notify the RTC Project team, in writing, within one business day after the determination is made; and

(3) conduct an emergency staffing with the child's service planning team for continuity of care services.

(d) The RTC contractor must develop the discharge plan in consultation with the service planning team.

(1) The discharge plan must be approved by the treating psychiatrist and must meet the requirements outlined in Chapter 748, Subchapter I of this title; and

(2) The RTC contractor must submit a copy of the child's:

(A) final discharge plan to the child's LAR, LMHA or LBHA, and RTC Project team 30 calendar days before discharge;

(B) recommendations regarding the child's educational needs to the child's LAR at the time of discharge; and

(C) discharge summary to the child's LAR, LMHA or LBHA, and the RTC Project within seven calendar days after the child's discharge.
Source Note: The provisions of this §307.223 adopted to be effective April 10, 2023, 48 TexReg 1829.

§307.251 Purpose
The purpose of this subchapter is to implement the Behavioral Health Partnership Program. This program delivers mental health and substance use resources to school districts served by a regional education service center and in which the local mental health authority (LMHA) or local behavioral health authority (LBHA) also delivers services. The program allows LMHAs and LBHAs to request a waiver to employ a professional who fulfills the duties outlined in Texas Education Code §8.152.
Source Note: The provisions of this §307.251 adopted to be effective June 11, 2024, 49 TexReg 4056.

§307.253 Application
The subchapter applies to local mental health authorities and local behavioral health authorities.
Source Note: The provisions of this §307.253 adopted to be effective June 11, 2024, 49 TexReg 4056.

§307.255 Definitions
The following words and terms, when used in this subchapter, have the following meanings unless the context clearly indicates otherwise.

(1) BHPP liaison--Behavioral Health Partnership Program liaison. For purposes of this subchapter, a "non-physician mental health professional" as referenced under Texas Education Code §8.152 is included in the term "behavioral health partnership program liaison."

(2) Business day--Any day except a Saturday, Sunday, or legal holiday listed in Texas Government Code §662.021.

(3) Child--An individual under 18 years of age as defined under Texas Human Resources Code §42.002 and not emancipated as described in Texas Family Code Chapter 31.

(4) ESC--Regional education service center. An entity designated as the educational service center by the Texas Education Agency in accordance with Texas Education Code, Subtitle B, Chapter 8, Subchapter A.

(5) HHSC--Texas Health and Human Services Commission or its designee.

(6) LBHA--Local behavioral health authority. An entity designated as the local behavioral health authority by HHSC in accordance with Texas Health and Safety Code §533.0356.

(7) LMHA--Local mental health authority. An entity designated as the local mental health authority by HHSC in accordance with Texas Health and Safety Code §533.035(a).

(8) LMSW--Licensed master social worker. A person who holds a master social worker license in accordance with Texas Occupations Code Chapter 505.

(9) LPC associate--Licensed professional counselor associate. A person who holds a professional counselor associate license in accordance with 22 TAC §681.2 (relating to Definitions).

(10) NPMHP--Non-Physician Mental Health Professional.

(11) TAC--Texas Administrative Code.
Source Note: The provisions of this §307.255 adopted to be effective June 11, 2024, 49 TexReg 4056.

§307.257 Behavioral Health Partnership Program Liaison Qualifications
A BHPP liaison must meet the qualifications as an NPMHP under Texas Health and Safety Code §571.003 or serve under a waiver approved by HHSC in accordance with §307.267 of this subchapter (relating to Texas Health and Human Services Commission Notification).
Source Note: The provisions of this §307.257 adopted to be effective June 11, 2024, 49 TexReg 4056.

§307.259 Local Mental Health Authority or Local Behavioral Health Authority Responsibilities
(a) The LMHA or LBHA must:

(1) enter into a memorandum of understanding with the ESC to collaborate regarding the administration of this subchapter;

(2) employ a BHPP liaison to serve as a mental health and substance use resource for school districts located in the region served by an ESC and in which the LMHA or LBHA delivers services;

(3) pay the ESC a reasonable and negotiated cost-recovery fee, not to exceed $15,000 per year unless the LMHA or LBHA and the ESC agree to a higher amount, for providing the space and administrative support necessary for the BHPP liaison to carry out the professional duties outlined in Texas Education Code §8.155;

(4) supervise the BHPP liaison;

(5) consult with any other LMHA or LBHA in the region and the regional ESC for input on supervising the BHPP liaison and coordinating services provided by the BHPP liaison;

(6) submit a written quarterly activity and evaluation report to the HHSC contract manager regarding the outcomes for school districts and students resulting from services delivered by a BHPP liaison in accordance with §307.263 of this subchapter (relating to Responsibilities of a Behavioral Health Partnership Program Liaison);

(7) submit a written annual activity and evaluation report to the HHSC contract manager regarding the outcomes for school districts and students resulting from services delivered by a BHPP liaison in accordance with Texas Education Code§8.155;

(8) submit a written waiver request to BHPP@hhs.texas.gov if required under Texas Education Code §8.152(c);

(9) ensure an LMSW or an LPC associate is eligible for an HHSC waiver request as outlined in this subchapter and the LMSW or LPC associate has the ability to fulfill the duties outlined in this subchapter if a waiver is requested;

(10) retain documentation in accordance with the LMHA's and LBHA's policies and procedures on efforts made to hire an NPMHP before submitting a waiver request; and

(11) submit a new waiver request, as needed, if the HHSC BHPP liaison vacates the position.

(b) If a BHPP liaison vacates the position within one year of approval of the waiver under subsection (a)(11) of this section, a new waiver request is not required.

(c) If a BHPP liaison vacates the position more than a year after approval of the waiver under subsection (a)(11) of this section, the LMHA or LBHA must attempt to hire a professional pursuant to Texas Education Code §8.152 before requesting a waiver under subsection (a)(11) of this section.
Source Note: The provisions of this §307.259 adopted to be effective June 11, 2024, 49 TexReg 4056.

§307.261 Determining which Local Mental Health Authority or Local Behavioral Health Authority Employs a Behavioral Health Partnership Program Liaison
If two or more LMHAs or LBHAs provide services in a region served by a regional ESC, the LMHA or LBHA that primarily operates in the county in which the center is located shall:

(1) in making a hiring decision about a BHPP liaison, consult with the other LMHAs or LBHAs providing services in that region;

(2) consult with the ESC before making the final hiring decision; and

(3) employ the BHPP liaison.
Source Note: The provisions of this §307.261 adopted to be effective June 11, 2024, 49 TexReg 4056.

§307.263 Responsibilities of a Behavioral Health Partnership Program Liaison
(a) A BHPP liaison must:

(1) serve as a mental health and substance use resource for school districts located in the region served by a regional ESC in which the LMHA or LBHA provides services; and

(2) operate within the scope of their professional state license.

(b) A BHPP liaison is responsible for carrying out the following functions and duties required of an NPMHP in accordance with Texas Education Code §8.155, including:

(1) helping school district personnel gain awareness and a better understanding of mental health and co-occurring mental health and substance use disorders;

(2) assisting school district personnel to implement initiatives related to mental health or substance use under state law or agency rules, interagency memorandums of understanding, and related programs; and

(3) ensuring school district personnel are aware of:

(A) the list of recommended best practice-based programs and research-based practices developed under Texas Education Code §38.351;

(B) other public and private mental health and substance use prevention, treatment, and recovery programs available in the school district, including evidence-based programs delivered by an LMHA or LBHA and other public and private mental health resources, such as the Texas School Mental Health Resources database as required by Texas Education Code §38.253; and

(C) other available public and private mental health and substance use prevention, treatment, and recovery program resources administered by the LMHA or LBHA or HHSC to support school districts, students, and families;

(4) on a monthly basis, facilitating mental health first aid training;

(5) on a monthly basis, facilitating training on the effects of grief and trauma and providing support to children with intellectual or developmental disabilities who suffer from grief or trauma; and

(6) on a monthly basis, facilitating training on prevention and intervention programs that have been shown to be effective in helping students cope with pressures to:

(A) use alcohol, cigarettes, or illegal drugs; or

(B) misuse prescription drugs.

(c) A BHPP liaison employed under this subchapter must not treat or provide counseling to a student or provide advice to school district personnel regarding a specific student.
Source Note: The provisions of this §307.263 adopted to be effective June 11, 2024, 49 TexReg 4056.

§307.265 Texas Health and Human Services Commission Waiver Process
(a) If an LMHA or LBHA is unable to employ a person who qualifies as an NPMHP for the BHPP liaison position in its designated ESC, the LMHA or LBHA may request a waiver from the HHSC Executive Commissioner, or designee, to employ an LMSW or LPC associate to serve as the BHPP liaison, pursuant to Texas Education Code §8.152(c).

(b) To apply for a waiver, the LMHA or LBHA must complete and submit the written HHSC Local Mental and Behavioral Health Authority Waiver Request Form to BHPP@hhs.texas.gov addressing the following information:

(1) the name of the LMHA or LBHA requesting the waiver;

(2) the LMHA or LBHA's staff member's name and contact information;

(3) the LMHA or LBHA's recruitment efforts to hire an NPMHP;

(4) the duration of time the LMHA or LBHA was unable to hire for this position before requesting a waiver; and

(5) that the BHPP liaison waiver candidate is licensed as an LMSW or LPC associate.
Source Note: The provisions of this §307.265 adopted to be effective June 11, 2024, 49 TexReg 4056.

§307.267 Texas Health and Human Services Commission Notification
The HHSC Executive Commissioner or designee will deliver written notification to the LMHA or LBHA within ten business days after receipt of the submission regarding:

(1) whether the waiver request is approved; or

(2) the opportunity to remedy and resubmit the waiver request if the waiver request is denied.
Source Note: The provisions of this §307.267 adopted to be effective June 11, 2024, 49 TexReg 4056.

§307.401 Purpose.
This subchapter explains what the Texas Health and Human Services Commission (HHSC) requires to be a Coordinated Specialty Care for First Episode Psychosis (CSC-FEP) provider. It sets requirements for provider staff. It also explains policies and procedures for the CSC-FEP program.
Source Note: The provisions of this §307.401 adopted to be effective July 19, 2026, 51 TexReg 4567.

§307.403 Application
The subchapter applies to an HHSC contracted provider of the CSC-FEP program services.
Source Note: The provisions of this §307.403 adopted to be effective July 19, 2026, 51 TexReg 4567.

§307.405 Definitions
The following words and terms when used in this subchapter, have the following meanings unless the context clearly indicates otherwise.

(1) Certified peer specialist--A person who uses lived experience and formal training to help others recover using standards defined in 1 TAC Chapter 354, Subchapter N (relating to Peer Specialist Services).

(2) CFP--Certified family partner. A person who cares for an enrolled individual using standards defined in 1 TAC §353.1415 (relating to Staff Member Credentialing).

(3) Community center--An entity established as a community mental health center under Texas Health and Safety Code §534.001.

(4) CSC-FEP program--Coordinated Specialty Care for First Episode Psychosis program. A program that provides comprehensive, evidence-based treatment and support for individuals experiencing first episode of psychosis.

(5) DSM--The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders.

(6) FTE--Full-time equivalent. In this subchapter, an FTE is not a headcount but a way of measuring the workload of any combination of staff members whose work hours total 40 hours a week.

(7) HHSC--The Texas Health and Human Services Commission or its designee.

(8) Individual--A person receiving services under this subchapter.

(9) LAR--Legally authorized representative. A person authorized by law to act on an individual's behalf about a matter described in this subchapter, including a parent, guardian, the managing conservator of a minor, or the guardian of an adult.

(10) LBHA--Local behavioral health authority. An entity designated as the local behavioral health authority by HHSC under Texas Health and Safety Code §533.0356.

(11) Licensed therapist--A staff member who is licensed as:

(A) a psychologist by the Texas State Board of Examiners of Psychologists under Texas Occupations Code Chapter 501;

(B) a psychological associate by the Texas State Board of Examiners of Psychologists under Texas Occupations Code Chapter 501;

(C) a professional counselor by the Texas State Board of Examiners of Professional Counselors under Texas Occupations Code Chapter 503;

(D) a clinical social worker or master social worker by the Texas State Board of Social Worker Examiners under Texas Occupations Code Chapter 505; or

(E) a marriage and family therapist by the Texas State Board of Examiners of Marriage and Family Therapists under Texas Occupations Code Chapter 502.

(12) LMHA--Local mental health authority. An entity designated as the local mental health authority by HHSC under Texas Health and Safety Code §533.035(a).

(13) Physician--A staff member who is licensed to practice medicine under Texas Occupations Code Chapter 155.

(14) Provider--A person or entity that contracts with HHSC, an LMHA, an LBHA, or a community center to provide CSC-FEP program services.

(15) Recovery plan--A written plan a CSC-FEP provider must use, according to §301.353 of this title (relating to Provider Responsibilities for Treatment Planning and Service Authorization).

(16) SEES--Supported employment and education specialist. A staff member who helps an individual receiving services look for jobs and education opportunities.

(17) Staff member--A person who works full-time or part-time. This includes a contractor or intern, but not a volunteer.

(18) TAC--Texas Administrative Code.

(19) Treatment team--Staff members who provide CSC-FEP program services.

(20) Uniform assessment--An age-appropriate tool described in §301.353 of this title and used for recommending an individual's level of care.
Source Note: The provisions of this §307.405 adopted to be effective July 19, 2026, 51 TexReg 4567.

§307.407 Eligibility Requirements
An individual eligible for the CSC-FEP program must:

(1) be at least 15 years old and up to 30 years old, regardless of when the individual first experienced psychosis; and

(2) meet the criteria for a psychotic disorder from the version of the DSM recognized by HHSC.
Source Note: The provisions of this §307.407 adopted to be effective July 19, 2026, 51 TexReg 4567.

§307.409 Program Requirements
(a) The provider must implement a CSC-FEP program that includes the following services:

(1) psychotherapy;

(2) family education and support;

(3) peer support for recovery from mental illness;

(4) medication prescribed to treat mental illness, when clinically appropriate; and

(5) support for education and job-related goals.

(b) The provider must:

(1) ensure the service period of up to 36 months starts on the date the provider enrolls the individual in the CSC-FEP program;

(2) establish and maintain an individual's medical record according to:

(A) state and federal laws and regulations; and

(B) the provider's admission standards and procedures;

(3) complete the uniform assessment at the individual's intake within 10 calendar days of the referral date; and

(4) conduct, review, and revise the uniform assessment according to §301.353 of this title (relating to Provider Responsibilities for Treatment Planning and Service Authorization).

(c) The provider must ensure each treatment team:

(1) maintains a census of at least 20 individuals;

(2) makes and documents five attempts to meet in person each month for the first 12 months the individual is enrolled in the CSC-FEP program. The team must document the reason why any in-person meetings did not happen; and

(3) meets at least one time a week and includes the following staff members:

(A) a team lead;

(B) a case manager or skills trainer;

(C) a certified peer specialist;

(D) a CFP; and

(E) a SEES.
Source Note: The provisions of this §307.409 adopted to be effective July 19, 2026, 51 TexReg 4567.

§307.411 Staffing Requirements
(a) A treatment team must include the following roles:

(1) a team lead;

(2) a SEES;

(3) a licensed therapist, if the team lead does not provide counseling;

(4) a case manager or skills trainer;

(5) a certified peer specialist who may meet with all individuals in the CSC-FEP program;

(6) a CFP, who may meet with all families of the individuals in the CSC-FEP program; and

(7) a physician.

(b) A provider may include additional staff members to address an individual's program needs.

(c) A treatment team member may not hold both the CFP and certified peer specialist roles at the same time.

(d) The provider must employ at least three FTE staff members per treatment team. The three FTE staff members do not include the physician.
Source Note: The provisions of this §307.411 adopted to be effective July 19, 2026, 51 TexReg 4567.

§307.413 Training Requirements
(a) A provider must use a training organization listed on the HHSC website to provide an initial onboarding training to all treatment team members.

(b) The provider must ensure that a licensed therapist providing counseling services in the CSC-FEP program completes required training.

(c) The provider must maintain written training records for the treatment team members.

(d) The treatment team members must maintain the applicable licenses required by law to provide CSC-FEP program services.

(e) The provider must ensure all treatment team members only provide services within the scope of the member's license or credentialing.
Source Note: The provisions of this §307.413 adopted to be effective July 19, 2026, 51 TexReg 4567.

§307.415 Outreach Plan
A provider must maintain an outreach plan. The plan must have written policies and procedures to maintain a census as described in §307.409(c)(1) of this subchapter (relating to Program Requirements).
Source Note: The provisions of this §307.415 adopted to be effective July 19, 2026, 51 TexReg 4567.

§307.417 Service Provision
(a) A provider must develop a recovery plan when an individual is admitted to the program. This process is found in §301.353 of this title (relating to Provider Responsibilities for Treatment Planning and Service Authorization).

(b) The provider must:

(1) educate an individual enrolled in the CSC-FEP program on medication options and best practices for medication treatment as clinically appropriate; and

(2) document the following for an individual:

(A) the individual's name;

(B) CSC-FEP program admission date; and

(C) information about the individual's primary medical care, if any, including the individual's:

(i) medical history;

(ii) primary care referral date;

(iii) date of first appointment with the primary care provider; and

(iv) subsequent medical care appointments.

(c) The provider must ensure an individual in the CSC-FEP program can get the services listed in §307.409(a) of this subchapter (relating to Program Requirements) that match the individual's treatment goals.

(d) The provider must document efforts to support the individual's needs by:

(1) directing the individual to resources in the community;

(2) helping the individual access available community resources;

(3) helping the individual with housing and job needs; and

(4) documenting in the recovery plan if community support resources are not available.

(e) To identify a crisis or safety planning needs, the provider must:

(1) give the provider's support service crisis hotline information to the individual and the individual's LAR, if applicable, to use if a crisis happens;

(2) deliver crisis services to the individual according to §301.327 of this title (relating to Access to Mental Health Community Services);

(3) assess the individual during intake for safety risk;

(4) proactively monitor safety risk throughout treatment and identify safety concerns;

(5) develop and implement a safety plan within 24 hours for the individual whom the treatment team identifies as a safety risk; and

(6) maintain the individual's safety plan.

(f) The provider must ensure the service period in the CSC-FEP program for the individual does not go over 36 months except as described in §307.419 of this subchapter (relating to Waiver Request).

(g) The provider must transition the individual from the CSC-FEP program to the most appropriate level of care, according to standards set in §301.353 of this title, when the individual:

(1) is no longer eligible for the program; or

(2) chooses to leave the CSC-FEP program.
Source Note: The provisions of this §307.417 adopted to be effective July 19, 2026, 51 TexReg 4567.

§307.419 Waiver Request
A provider must submit a written waiver request for HHSC to process the following exceptions to the CSC-FEP program requirements:

(1) hiring a licensed therapist intern when the provider is unable to recruit a licensed therapist;

(2) admission of an individual who is outside the age eligibility; and

(3) extending the service period past three years.
Source Note: The provisions of this §307.419 adopted to be effective July 19, 2026, 51 TexReg 4567.

§307.501 Purpose
The purpose of this subchapter is:

(1) to establish uniform procedures for informed consent to ECT;

(2) to establish statewide reporting requirements for the use of ECT and other procedures;

(3) to establish statewide registration requirements for ECT equipment;

(4) to prohibit the use of ECT in persons under 16 years of age;

(5) to prohibit the administration of ECT by any person not licensed to practice medicine in Texas; and

(6) to provide explicit safeguards for patients in all facilities of the Texas Department of Mental Health and Mental Retardation, community mental health and mental retardation centers, private inpatient psychiatric hospitals licensed by the Texas Department of Health under the Texas Health and Safety Code, Chapter 577, and psychiatric units of hospitals licensed by the Texas Department of Health under the Texas Health and Safety Code, Chapter 241, by:

(A) establishing appropriate limits for the therapeutic utilization of electroconvulsive therapy;

(B) establishing current guidelines of the American Psychiatric Association and the Food and Drug Administration as the references of choice in questions of practice related to ECT, except to the extent that they conflict with the provisions of the Health and Safety Code, Title 7, Subtitle C, Chapter 578; and

(C) prohibiting the use of chemical or gaseous agents for convulsive therapy except as a research procedure conducted in accordance with Subchapter Q of this chapter (relating to Departmental Procedures for the Protection of Human Subjects Involved in Research).
Source Note: The provisions of this §307.501 adopted to be effective January 1, 1992, 16 TexReg 7528; amended to be effective December 10, 1993, 18 TexReg 8790; transferred effective December 27, 2024, as published in the November 29, 2024, issue of the Texas Register, 49 TexReg 9771

§307.503 Application
(a) The provisions of this subchapter apply to all organizations and individuals providing electroconvulsive therapy on an inpatient or outpatient basis, in or on a contractual basis with:

(1) all facilities of the Texas Department of Mental Health and Mental Retardation;

(2) community mental health and mental retardation centers;

(3) psychiatric hospitals licensed by the Texas Department of Health under the Health and Safety Code, Chapter 577; and

(4) psychiatric units of hospitals licensed by the Texas Department of Health under the Health and Safety Code, Chapter 241.

(b) Pursuant to the Health and Safety Code, Title 7, Subtitle C, Chapter 578, the following provisions of this subchapter apply to all organizations and individuals administering ECT in Texas:

(1) §405.104 of this title (relating to General Requirements);

(2) §405.108 of this title (relating to Informed Consent to ECT);

(3) §405.112(b) of this title (relating to Report of Electroconvulsive Therapy);

(4) §405.114 of this title (relating to Registration of ECT Stimulus Apparatus); and

(5) §405.115 of this title (relating to Enforcement and Penalties).
Source Note: The provisions of this §307.503 adopted to be effective January 1, 1992, 16 TexReg 7528; amended to be effective December 10, 1993, 18 TexReg 8790; transferred effective December 27, 2024, as published in the November 29, 2024, issue of the Texas Register, 49 TexReg 9771

§307.505 Definitions
The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise.

(1) Chemical or gaseous agents--Those substances which may be capable of inducing a seizure and including, but not limited to, pentylenetetrazol (Metrazol) and flurothyl (Indoklon).

(2) Chief executive officer--The superintendent or director of a state hospital, state school, or state center; the executive director of a community mental health and mental retardation center; or the person responsible for management and operation of a hospital or other health care facility or entity providing ECT.

(3) Commissioner--The commissioner of the Texas Department of Mental Health and Mental Retardation.

(4) Community mental health and mental retardation center--A community mental health and/or mental retardation center established by the Texas Health and Safety Code, Chapter 534.

(5) Department--The Texas Department of Mental Health and Mental Retardation.

(6) ECT--Electroconvulsive therapy.

(7) Electroconvulsive therapy (ECT)--A treatment in which controlled, medically applied electrical current results in a therapeutic seizure, usually attenuated by anesthesia and muscle relaxants.

(8) Fully qualified psychiatrist--A physician, licensed to practice medicine in Texas, who has completed approved residency training in psychiatry.

(9) Informed consent--The knowing consent of a patient or the guardian of the person of the patient in keeping with the provisions of §405.108 of this title (relating to Informed Consent to ECT), so situated as to be able to exercise free power of choice without undue inducement or any element of force, fraud, deceit, duress, or other form of constraint or coercion. If consent is given by the guardian of the person of a patient who has been adjudicated incompetent to manage his or her own personal affairs, then the decision must be based on knowledge of what the patient would desire, if known.

(10) Insulin coma treatment--The production of a coma for therapeutic purposes through the administration of insulin.

(11) Maintenance therapy--Treatment with electroconvulsive therapy on an individually determined intermittent schedule for purposes of preventing relapse.

(12) Multiple-monitored ECT--The induction of more than one adequate seizure during one episode of anesthesia.

(13) Nurse anesthetist--A nurse credentialed by the Board of Nurse Examiners as a nurse anesthetist.

(14) Prefrontal sonic sound treatment--A treatment, not described or defined in biomedical literature, which is defined in California statutes governing ECT and other treatments as "The direct stimulation and/or destruction of brain cells or brain tissue by ultrasound for therapeutic purposes."

(15) Psychosurgery--Surgical intervention to sever fibers connecting one part of the brain with another or to remove or to destroy brain tissue with the intent of modifying or altering severe disturbances of behavior, thought content, or mood. For purposes of this subchapter, the term does not include such surgery for the relief of intractable physical pain or the treatment of neurological disease or abnormality.

(16) Regressive or depatterning ECT--The prolonged use of daily or more frequent treatments.

(17) Reportable therapies--Electroconvulsive therapy, insulin coma treatment, "prefrontal sonic sound treatment," psychosurgery, multiple-monitored ECT, "regressive" or "depatterning" ECT, or any other convulsive or coma-producing therapy to treat mental illness.

(18) Series of treatments--Usually six-15 treatments.

(19) TXMHMR medical director--The department's medical director.

(20) Treatment--The administration of electroconvulsive therapy, unilaterally or bilaterally, with anesthesia, under appropriate clinical conditions for monitoring, safety, and efficacy.
Source Note: The provisions of this §307.505 adopted to be effective January 1, 1992, 16 TexReg 7528; amended to be effective December 10, 1993, 18 TexReg 8790; transferred effective December 27, 2024, as published in the November 29, 2024, issue of the Texas Register, 49 TexReg 9771

§307.507 General Requirements
(a) Only a physician licensed to practice medicine in Texas may administer ECT and a physician may not delegate the act of administering the therapy. A nonphysician who administers ECT is considered to be practicing medicine in violation of the Medical Practice Act, Texas Civil Statutes, Article 4495b.

(b) No person under the age of 16 shall receive ECT.

(c) Prior to receiving ECT, every patient, voluntary or involuntary, competent or incompetent, shall be given full explanation of ECT consistent with the definition of ECT in §405.103 of this title (relating to Definitions) and meeting the requirements of §405.108 of this title (relating to Informed Consent to ECT).

(d) If any patient, without regard to competency, objects to ECT and there is an alternative method of treatment (that is not contraindicated and which has a reasonable potential for success) to which the patient does not object, the alternative method shall be considered and, if mutually acceptable to the patient or the guardian of the person of the patient and the treating physician, shall be used. It is not to be inferred, however, that ECT should be held as a treatment of "last resort." Full documentation of the factors considered in arriving at the decision to use ECT, the consent process, the treatment procedures, and patient response to treatment shall be entered into the patient's permanent medical record.

(e) The use of ECT for punishment, solely for control of behavior, for convenience of staff, in order to make patients more compliant, and the use of ECT in a discriminatory or abusive manner are explicitly prohibited.
Source Note: The provisions of this §307.507 adopted to be effective January 1, 1992, 16 TexReg 7528; amended to be effective December 10, 1993, 18 TexReg 8790; transferred effective December 27, 2024, as published in the November 29, 2024, issue of the Texas Register, 49 TexReg 9771

§307.509 Indications and Contraindications for the Use of Electroconvulsive Therapy (ECT)
(a) The major indications for the therapeutic use of ECT are major mood disorders. ECT may be considered for some other disorders, with appropriate consideration of the risk/benefit ratio.

(b) The major contraindications to the therapeutic use of ECT are as follows:

(1) absolute space-occupying intracranial pathology;

(2) relative, requiring clinical consideration:

(A) cardiovascular disease, including arrhythmias, myocardial disease, or coronary artery disease;

(B) diseases which render a patient likely to suffer hemorrhage, including peptic ulcer, subdural hematoma, and aortic aneurysm;

(C) degenerative diseases of the central nervous system;

(D) glaucoma although it is recognized that intraocular pressure is not increased by ECT, and is, in fact, reduced during the seizure period, medications used adjunctively to the treatment may result in increased intraocular pressure. For patients with glaucoma, consideration should be given to pretreatment with physostigmine;

(E) severe orthopedic disability.
Source Note: The provisions of this §307.509 adopted to be effective January 1, 1992, 16 TexReg 7528; transferred effective December 27, 2024, as published in the November 29, 2024, issue of the Texas Register, 49 TexReg 9771

§307.511 Medical Evaluation Required Prior to a Course of Electroconvulsive Therapy (ECT)
(a) A thorough evaluation of the patient's psychiatric and physical status with review of pertinent laboratory findings shall be done within 30 days prior to the initiation of a course of ECT and shall be recorded in the patient's permanent medical record. Physical evaluation shall include a neurological examination. Other determinations shall include, but not be limited to, the following:

(1) laboratory as appropriate to medical history and/or conditions, such as:

(A) complete blood count;

(B) electrolytes; and

(C) serum pseudocholinesterase if there is no documentation of successful use of muscle relaxant medication with general anesthesia, and if there is no record of previous testing;

(2) x-rays as appropriate to medical history and/or conditions;

(3) electrocardiogram.

(b) Abnormalities reported or found in the neurological or cardiac evaluation shall be evaluated by a medical specialist in the appropriate field, such evaluation to be incorporated in writing into the patient's permanent record prior to initiation of ECT.
Source Note: The provisions of this §307.511 adopted to be effective January 1, 1992, 16 TexReg 7528; transferred effective December 27, 2024, as published in the November 29, 2024, issue of the Texas Register, 49 TexReg 9771

§307.513 Consultation Required
(a) Before initiating a course of ECT, it shall be the responsibility of the attending physician who is not a fully qualified psychiatrist to obtain consultation from a fully qualified psychiatrist, licensed to practice medicine in Texas.

(b) The consultant shall render a written report regarding the appropriateness and probable benefits to be obtained by administration of ECT. That report will be incorporated into the patient's permanent medical record.
Source Note: The provisions of this §307.513 adopted to be effective January 1, 1992, 16 TexReg 7528; amended to be effective December 10, 1993, 18 TexReg 8790; transferred effective December 27, 2024, as published in the November 29, 2024, issue of the Texas Register, 49 TexReg 9771

§307.515 Informed Consent to ECT
(a) Consent under this section is not valid unless the person giving consent understands the information presented and consents voluntarily and without coercion or undue influence.

(b) A person who gives consent may revoke consent for any reason at any time, with revocation effective immediately.

(c) Prior to each individual ECT treatment, consent to electroconvulsive therapy must be obtained. Unless the person consents in accordance with this subchapter, ECT may not be administered to:

(1) a patient who is 16 years or older and voluntarily receiving services;

(2) an involuntary patient who is 16 years or older and who has not been adjudicated incompetent to manage his or her own personal affairs;

(3) an involuntary patient who is 16 years or older and who has been adjudicated incompetent to manage his or her own personal affairs, unless:

(A) the patient has an appointed guardian of the person of the patient;

(B) the guardian of the person consents to treatment in accordance with this section; and

(C) the consent of the guardian is based on knowledge of what the patient would desire, if known.

(d) Consent shall be documented by the signature of the person giving consent on the form entitled "Disclosure and Consent for Electroconvulsive Therapy" which is referenced as Exhibit A of §405.117 of this title (relating to Exhibits), and which shall include a supplemental statement about the individual patient containing the information in the form entitled "Supplemental Statement" which is referenced as Exhibit B of §405.117 of this title (relating to Exhibits), including:

(1) indications for therapy for the patient;

(2) medical evaluation results;

(3) contraindications to therapy;

(4) results of psychiatric and other medical consultation(s) relevant to ECT; and

(5) for a patient 65 years of age or older:

(A) known current medical conditions that may increase the possibility of injury or death as a result of ECT; and

(B) statement by two physicians that the treatment is medically necessary.

(e) The consent form shall be fully completed to explicitly state the following information:

(1) the nature and seriousness of the mental condition requiring ECT;

(2) the nature of the procedures to be followed, including anesthesia, and their purposes, including the identification of any procedures which are experimental;

(3) the nature, degree, duration, and probability of significant risks and/or side effects and/or adverse effects resulting from ECT commonly known by the medical profession, including:

(A) memory changes of events prior to, during, and immediately following the treatment;

(B) fractures and dislocations of bones;

(C) the probability of significant temporary post-treatment confusion requiring special care; and

(D) the possibility of permanent memory dysfunction, especially noting the possible degree and duration of memory loss, the possibility of permanent, irrevocable memory loss, the remote possibility of seizures, and the possibility of death;

(4) that there is a division of opinion as to the efficacy of the procedure;

(5) the benefits reasonably to be expected;

(6) the probable degree or duration of improvement or remission expected with or without the procedure;

(7) a disclosure of any appropriate alternative procedures that might be advantageous for the patient;

(8) an offer to answer any inquiries concerning the procedures;

(9) an instruction that the consenting party is free to withdraw consent and to discontinue an individual treatment or a series of treatments at any time without prejudice to the care of the individual;

(10) an instruction that consent is for one individual treatment, and that additional treatments shall require renewed written informed consent; and

(11) the side effects of anesthesia shall also be explained.

(f) Before a patient receives ECT, the hospital, facility, or physician administering the therapy shall ensure that:

(1) the patient and the patient's guardian of the person, if any, receive a copy of the completed consent form, a written supplement containing related information concerning the individual patient, in the patient's primary language, if possible;

(2) the consent form and supplement are orally explained to the patient and the patient's guardian of the person, if any, in simple, nontechnical terms in the patient's primary language, if possible, or by means reasonably calculated to communicate with a hearing-impaired or visually-impaired person, if applicable;

(3) the patient or the patient's guardian of the person, as appropriate, signs the consent form, which states that the person has read and understood the consent form and written supplement; and

(4) the signed consent form is made a part of the patient's permanent medical record.

(g) In cases in which the individual giving consent is the guardian of the person, the requirements of the consent process may be fulfilled through a phone conversation that includes all of the elements that would be discussed in person, witnessed by one individual who is not the physician who will be administering ECT. A copy of the consent form and written supplement must be mailed or faxed to the individual giving consent prior to obtaining the initial informed consent. The consent must be obtained for each individual treatment.

(h) For a patient 65 years of age or older, before each treatment series begins the hospital, facility, or physician administering the procedure shall:

(1) ensure two physicians sign the appropriate section of the supplemental statement described in subsection (d)(5) of this section stating that the treatment is medically necessary; and

(2) inform the patient and the patient's guardian of the person, if any, orally and in the supplemental statement described in subsection (d)(5) of this section, of any known current medical condition the patient has that may increase the possibility of injury or death as a result of the treatment.
Source Note: The provisions of this §307.515 adopted to be effective December 10, 1993, 18 TexReg 8790; amended to be effective February 11, 1998, 23 TexReg 1089; transferred effective December 27, 2024, as published in the November 29, 2024, issue of the Texas Register, 49 TexReg 9771

§307.517 Limitations on Use: Number per Year and Number per Series of Treatments
(a) No more than 24 electroconvulsive therapy treatments may be administered to a given patient in any 12-month period, dated from the date of the first treatment except as provided in this subsection.

(1) Exceptions to this limitation require, prior to the additional treatments:

(A) for state facilities, the written approval of the department's medical director, who shall consider the recommendations of an independent, fully qualified psychiatrist who is not affiliated with the department except in a consultative capacity; or

(B) for all other providers, the written concurrence of a fully qualified psychiatrist not involved in the patient's care.

(2) All reports of such consultations shall become a part of the patient's permanent medical record.

(b) The number of ECTs to be given in eight consecutive weeks shall ordinarily be limited to 15. In those cases in which it is considered clinically advantageous to exceed these numbers of treatments in any given series, the attending physician shall obtain a second consultative opinion from a fully qualified psychiatrist who is not directly associated with the patient's care.
Source Note: The provisions of this §307.517 adopted to be effective January 1, 1992, 16 TexReg 7528; amended to be effective December 10, 1993, 18 TexReg 8790; transferred effective December 27, 2024, as published in the November 29, 2024, issue of the Texas Register, 49 TexReg 9771

§307.519 Personnel and Equipment Procedures
(a) Personnel. ECT may be administered only by a licensed physician credentialed by the facility providing the treatment to use ECT, or by a licensed physician in training in an approved residency program under the direct supervision of a fully qualified psychiatrist so trained and credentialed. In specific circumstances a licensed physician who is not a fully qualified psychiatrist but who has demonstrated training and experience in the administration of ECT may administer ECT providing authorization has been provided in writing to the chief executive officer by the hospital or facility medical director. Assistants shall include a recovery nurse and an ECT treatment nurse or assistant trained in ECT procedures.

(b) Equipment. Equipment available in the ECT room shall receive a general inspection on a regular basis. Equipment shall include, but not be limited to, the following:

(1) an ECT machine of contemporary model which shall be calibrated at least semiannually;

(2) a respiratory support system including oxygen, endotracheal intubation tray, suction apparatus, and equipment for tracheotomy;

(3) a cardiac arrest tray with appropriate drugs;

(4) a cardiac monitor and defibrillator.

(c) Recovery area. A recovery area containing emergency equipment and supplies shall be used, the patients to be therein until adequately recovered and all vital signs are stable. The recovery room will be equipped and staffed to meet commonly accepted standards for postanesthesia units.

(d) Anesthesia. Anesthesia practice shall meet commonly accepted standards for patient evaluation for anesthesia, informed consent, induction, maintenance, monitoring, and documentation of anesthesia.

(1) General anesthesia shall be administered to all patients as a standard procedure during ECT. In the rare event that general anesthesia is contraindicated, the administering physician shall obtain consultation and written concurrence by two physicians, at least one of whom is a fully qualified psychiatrist.

(2) Anesthesia shall be administered only by persons credentialed by the medical staff to do so, and who are:

(A) licensed anesthesiologists;

(B) licensed physicians credentialed and privileged in anesthesiology for ECT; or

(C) nurse anesthetists (CRNA).

(3) At least one person in attendance must be certified in advanced cardiorespiratory life support (ACLS).
Source Note: The provisions of this §307.519 adopted to be effective January 1, 1992, 16 TexReg 7528; amended to be effective December 10, 1993, 18 TexReg 8790; transferred effective December 27, 2024, as published in the November 29, 2024, issue of the Texas Register, 49 TexReg 9771

§307.521 Prohibition of Induction of Seizure by Chemical or Gaseous Agent
No chemical or gaseous agent may be used as a means to induce a seizure for therapeutic purposes, in lieu of or as a substitute for electroconvulsive therapy, unless such procedure is conducted as a research investigation and meets all the requirements of Subchapter Q of this chapter (relating to Departmental Procedures for the Protection of Human Subjects Involved in Research).
Source Note: The provisions of this §307.521 adopted to be effective January 1, 1992, 16 TexReg 7528; transferred effective December 27, 2024, as published in the November 29, 2024, issue of the Texas Register, 49 TexReg 9771

§307.523 Report of ECT
(a) Reporting requirements for state facilities and community centers.

(1) A report of each individual ECT administered to a patient shall be entered into the patient's medical record and shall include, but not be limited to, the following:

(A) diagnosis for which ECT given;

(B) date of treatment;

(C) type of ECT machine used;

(D) duration and strength of electrical stimulation;

(E) all medications administered; and

(F) any complications or adverse effects.

(2) A report of all ECT treatments will be provided at the end of each month to the chief executive officer. The report shall include the following:

(A) name, age, gender, and identification number of patient;

(B) diagnosis for which ECT given;

(C) dates and number of treatments given; and

(D) any complications or adverse effects.

(b) Reporting requirements for all providers.

(1) On a quarterly basis, the chief executive officer of a mental hospital or other facility that administers ECT, psychosurgery, "prefrontal sonic treatment," or any other convulsive or coma-producing therapy to treat mental illness and any physician who administers ECT on an outpatient basis shall make a written report to the TXMHMR medical director containing the information requested on the form entitled "Report of ECT/Other Therapies" which is referenced as Exhibit C of §405.117 of this title (relating to Exhibits). The reporting format requires clinical data from before, after, and 30 days after treatment.

(A) The facility and/or its medical staff shall require that the treating physician(s) provide complete, accurate, and timely information to the CEO for this purpose.

(B) Reports must submitted to be received by the TXMHMR medical director not later than 30 days following the end of each state fiscal year quarter. For treatments administered in September, October, and November, the deadline is December 31; for December, January, and February, the deadline is March 31; for March, April, and May, the deadline is June 30; and for June, July, and August, the deadline is September 30.

(2) The report will include, but may not be limited to, the following information for the quarter:

(A) the number of persons who received the therapy, including:

(i) the number of persons receiving voluntary mental health services who consented to the therapy;

(ii) the number of involuntary patients who consented to the therapy; and

(iii) the number of involuntary patients for whom a guardian of the person consented to the therapy;

(B) the age, gender, and race of the persons receiving therapy;

(C) the general source of the treatment payment;

(D) the number of non-electroconvulsive treatments listed in paragraph (1) of this subsection;

(E) the number of electroconvulsive treatments administered for each complete series of treatments, excluding maintenance treatments;

(F) the number of maintenance electroconvulsive treatments administered;

(G) the number of fractures, reported memory losses, incidents of apnea, and cardiac arrests without death;

(H) autopsy findings if death followed within 14 days after the date of the administration of the therapy; and

(I) other information that may be required by the department.

(c) Reporting requirements for the department.

(1) Annually the department shall compile the information reported under subsection (b) of this section by mental hospital, other facility, and private physician administering ECT on an outpatient basis. Private physicians and individual patients shall not be named or otherwise identified.

(2) A copy of the report shall be filed with the governor and presiding officer of each house of the legislature.

(3) The department shall use this information to analyze, audit, and monitor the use of ECT and other reportable procedures.
Source Note: The provisions of this §307.523 adopted to be effective January 1, 1992, 16 TexReg 7528; amended to be effective December 10, 1993, 18 TexReg 8790; amended to be effective February 11, 1998, 23 TexReg 1089; transferred effective December 27, 2024, as published in the November 29, 2024, issue of the Texas Register, 49 TexReg 9771

§307.525 ECT on Outpatient Basis
If ECT is to be given to patients on an outpatient basis, all the provisions of this subchapter apply.
Source Note: The provisions of this §307.525 adopted to be effective January 1, 1992, 16 TexReg 7528; amended to be effective December 10, 1993, 18 TexReg 8790; transferred effective December 27, 2024, as published in the November 29, 2024, issue of the Texas Register, 49 TexReg 9771

§307.527 Registration of ECT Stimulus Apparatus
(a) A person may not administer ECT unless the equipment used to administer the therapy is registered annually with the department. All ECT stimulus apparatus must be registered with the department by the mental hospital or other facility or by the private physician administering ECT on an outpatient basis.

(1) The department shall use the information to analyze, audit, and monitor the use of ECT.

(2) The department shall file annually a report summarizing the information with the governor and the presiding officers of the legislature. The report shall not name or otherwise identify individual physicians or patients.

(b) Within 30 days of the effective date of this subchapter, the applicant must complete and submit the form adopted by reference as Exhibit D, including a nonrefundable application fee of $50.00, for all items of ECT stimulus apparatus which are housed or used at a specific location.

(c) Upon receipt of the application and fee, the department may conduct an investigation if it believes the stimulus apparatus in question may be dangerous or faulty. For purposes of investigation, any duly authorized agent of the department may at any time enter upon the premises of any facility in which ECT is administered to inspect the ECT stimulus apparatus or to take other action the department deems necessary to ascertain and assure compliance with state law and this section. Any such duly authorized agent may have access for the purposes of examination and transcription to such records and documents as the department deems relevant to the investigation.

(d) The department may deny, suspend, or revoke a registration if it determines that the stimulus apparatus is dangerous or faulty. Such action is the subject of a contested case under the Administrative Procedure and Texas Register Act. Hearings will be conducted in accordance with Chapter 403, Subchapter O of this title (relating to Practice and Procedure with Respect to Administrative Hearings of the Department in Contested Cases).
Source Note: The provisions of this §307.527 adopted to be effective December 10, 1993, 18 TexReg 8790; transferred effective December 27, 2024, as published in the November 29, 2024, issue of the Texas Register, 49 TexReg 9771

§307.529 Enforcement and Penalties
(a) For private psychiatric hospitals and psychiatric units of general hospitals, the Texas Department of Health shall enforce the applicable rules and standards adopted by the department to the same extent as it enforces rules adopted by the Texas Board of Health. A violation of this subchapter is subject to the same consequences as a violation of a rule adopted by the Texas Board of Health.

(b) A person who violates a provision of this subchapter may be subject to injunction, civil penalties, and related costs pursuant to the provisions of the Health and Safety Code, Chapter 571, §§571.022-.024, and Chapter 241, §241.055.

(c) A person licensed by the Texas Department of Health or regulated by the department who violates a provision of this subchapter may be subject to administrative penalties and related costs pursuant to the Health and Safety Code, Chapter 571, §§571.025-.026, and Chapter 241, §241.058 and §241.0585.

(d) A treatment facility or mental health facility that violates a provision of this subchapter is liable to a person receiving care or treatment from the facility who is harmed as a result of the violation, consistent with the provisions of the Health and Safety Code, Chapter 321, Subsections 321.003-.004.
Source Note: The provisions of this §307.529 adopted to be effective December 10, 1993, 18 TexReg 8790; transferred effective December 27, 2024, as published in the November 29, 2024, issue of the Texas Register, 49 TexReg 9771

§307.531 Exhibits
The following exhibits referenced in this subchapter are available by contacting TDMHMR, Policy Development, P.O. Box 12668, Austin, Texas 78711-2668:

(1) Exhibit A--"Disclosure and Consent for Electroconvulsive Therapy":

Attached Graphic

(2) Exhibit B--"Supplemental Statement"; and

Attached Graphic

(3) Exhibit C--"Report of ECT/Other Therapies."

Attached Graphic
Source Note: The provisions of this §307.531 adopted to be effective February 11, 1998, 23 TexReg 1089; transferred effective December 27, 2024, as published in the November 29, 2024, issue of the Texas Register, 49 TexReg 9771