Current through Reg. 49, No. 38; September 20, 2024
(a) The
TXMHMR service system is dedicated to providing mental health and mental
retardation services/supports which are viewed as satisfactory by persons
receiving those services/supports and their legally authorized representatives.
Therefore, local authorities and their contractors shall take steps to assure
that these persons:
(1) have a method to
express their concerns or dissatisfaction;
(2) are assisted to do so in a constructive
way; and
(3) have their concerns or
dissatisfaction addressed through a review process.
(b) A request to review decisions described
in this section may be made by the person requesting or receiving
services/supports, the person's legal representative, or any other individual
with the person's consent.
(c) At
the time of admission into services and on an annual basis thereafter, the
local authority and its contractors shall provide to persons who receive
services/supports and their legally authorized representatives written
notification in a language and/or method understood by the individual of the
local authority or its contractor's policy for addressing concerns or
dissatisfaction with services/supports. The notification shall explain:
(1) an easily understood process for persons
and legally authorized representatives to request a review of their concerns or
dissatisfaction by the local authority or its contractor, whichever is
appropriate;
(2) how the person may
receive assistance in requesting the review;
(3) the timeframes for the review;
and
(4) the method by which the
person is informed of the outcome of that review.
(d) Local authorities and their contractors
shall notify persons and legally authorized representatives in writing in a
language and/or method understood by the individual of the following decisions
and of the process to appeal by requesting a review of those decisions:
(1) a decision to deny the person
services/supports at the conclusion of a local authority's procedure which
determines whether the person meets the criteria for the priority population;
and
(2) a decision to terminate
services/supports and follow-along from the local authority or its contractor,
if appropriate.
(e) The
written notification referred to in subsection (d) of this section must:
(1) be given or mailed to the person and the
legally authorized representative within ten working days of the date the
decision was made;
(2) state the
reason for the decision;
(3)
explain that the person and legally authorized representative may contact
either the local authority or its contractor, whichever is appropriate, within
30 days of receipt of notification if dissatisfied with the decision and
request that the decision be reviewed in accordance with subsection (g) of this
section; and
(4) include name(s),
phone number(s) and address(es) of one or more accessible staff to contact
during office hours.
(f)
If a person or legally authorized representative believes that the local
authority or its contractor has made a decision to involuntarily reduce
services by changing the amount, duration, or scope of services/supports
provided and is dissatisfied with that decision, then the person may request in
writing that the decision be reviewed in accordance with subsection (g) of this
section.
(g) The review by the
local authority or its contractor shall:
(1)
begin within ten working days of receipt of the request for a review and be
completed within ten working days of the time it begins unless an extension is
granted by the CEO of the local authority or its contractor, whichever is
appropriate;
(2) begin immediately
upon receipt of the request and be completed within five working days if the
decision is related to a crisis service;
(3) be conducted by an individual(s) who was
not involved in the initial decision;
(4) include a review of the original decision
which led to the person's dissatisfaction;
(5) result in a decision to uphold, reverse,
or modify the original decision; and
(6) provide the person an opportunity to
express his or her concerns in person or by telephone to the individual
reviewing the decision. The review shall also allow the person to:
(A) have a representative talk with the
reviewer; or
(B) submit his or her
concerns in writing, on tape, or in some other fashion.
(h) Following a review, either the
local authority or its contractor, whichever is appropriate, shall explain to
the person and legally authorized representative in writing and also in person
or by telephone, if requested, the action it will take or, if no action will be
taken, why it will not change the decision or believes such action would not be
in the person's best interest. This is the final step in the review
process.
(i) The notification and
review process described in this section:
(1)
is applicable only to services/supports funded by TXMHMR and provided or
contracted for by its local authorities;
(2) does not preclude a person or legally
authorized representative's right to reviews, appeals, or other actions that
accompany other funds administered through a local authority or its
contractors, or to other appeals processes provided for by other state and
federal laws, e.g., Texas Health and Safety Code, Title 7, Chapter 593 (Persons
with Mental Retardation Act);
42 USC
§1396 (Medicaid statute); and Texas
Human Resources Code, Chapter 73 (Chapter 621 of this title (relating to Early
Childhood Intervention)), Early Childhood Intervention programs as funded by
the Texas Interagency Council for Early Childhood Intervention.
