Current through Reg. 50, No. 13; March 28, 2025
(a) Coordinating
provision of crisis services. The LMHA and MCO must develop and implement
policies and procedures governing the provision of crisis services that:
(1) identify providers' roles and
responsibilities in responding to a crisis;
(2) describe the coordination of crisis
services to be required among providers of crisis services, law enforcement,
the judicial system, and other community entities; and
(3) comply with Chapter 419, Subchapter L of
Title 25 (relating to Mental Health Rehabilitative Services).
(b) Immediate screening and
assessment.
(1) Screening and assessment. All
providers of crisis services must be available 24 hours a day, every day of the
year, to perform immediate screenings and assessments of individuals in crisis,
including assessments to determine risk of deterioration and immediate danger
to self or others. Crisis assessments cannot be delegated to law enforcement
officials.
(2) QMHP-CS assessment.
Individuals experiencing a crisis, as determined by a QMHP-CS screening, must
be assessed face-to-face or via telemedicine by someone who is at least
credentialed as a QMHP-CS within one hour after the individual presents to the
provider in a crisis, either via the crisis hotline or a face-to-face encounter
(e.g., walk-in). The QMHP-CS must provide ongoing crisis services until the
crisis is resolved or the individual is placed in a clinically appropriate
environment.
(c) LPHA
consultation. An LPHA must always be available for consultation with the
QMHP-CS.
(d) Physician assessment.
If the individual requires emergency care services, as determined by the
QMHP-CS's assessment of risk of deterioration and danger as described in
subsection (b) of this section, then the provider of crisis services must have
a physician, preferably a psychiatrist, perform a face-to-face or telemedicine
assessment of the individual as soon as possible, but not later than 12 hours
after the QMHP-CS's assessment to determine the need for emergency
services.
(e) Documenting crisis
services. The provider of crisis services must maintain documentation of the
crisis services, including:
(1) the date the
service was provided;
(2) the
beginning and end time of the crisis contact;
(3) the name and any other identifying
information of the individual to whom the service was provided (if
given);
(4) the location where the
service was provided;
(5) the
behavioral description of the presenting problem;
(6) lethality (e.g., suicide,
violence);
(7) substance use or
abuse;
(8) trauma, abuse, or
neglect;
(9) the outcome of the
crisis (e.g., individual in hospital, individual with friend and scheduled to
see doctor at 9:00 a.m. the following day);
(10) the names and titles of staff members
involved;
(11) all actions
(including rehabilitative interventions and referrals to other agencies) used
by the provider to address the problems presented;
(12) the response of the individual, and if
appropriate, the response of the LAR and family members;
(13) the signature of the staff member
providing the service and a notation as to whether the staff member is an LPHA
or a QMHP-CS;
(14) any pertinent
event or behavior relating to the individual's treatment which occurs during
the provision of the service; and
(15) follow up activities, which may include
referral to another provider.
(f) Communication of crisis contacts. If an
individual who is currently receiving mental health services has experienced a
crisis and has been assessed in accordance with subsection (b) of this section,
the provider of crisis services must communicate in writing (e.g., e-mail or
fax) the details of the crisis contact to the provider of ongoing mental health
services to ensure that the individual receives continuity of care and
treatment and include such communication in the medical record. This crisis
contact communication:
(1) may not disclose
any substance abuse-related information unless disclosed in compliance with
federal law as described in 42 CFR Part 2;
(2) must take place no later than the next
business day after conclusion of the crisis contact; and
(3) may disclose mental health information
for the purpose of continuity of care and treatment without the individual's
consent if disclosure is made in accordance with:
(A) Texas Health and Safety Code, §
533.009
(relating to Exchange of Patient and Client Records), when the provider of
ongoing services is part of the department's service delivery system;
or
(B) in accordance with Texas
Health and Safety Code, §
611.004(a)(7)
(relating to the Authorized Disclosure of Confidential Information other than
in Judicial or Administrative Proceeding), when the provider of ongoing
services is not part of the department's service delivery system.
