Current through Reg. 50, No. 13; March 28, 2025
(a) A LIDDA, LMHA, or LBHA, as applicable,
must:
(1) enter in the LTC online portal the
data from a PL1 completed by a referring entity in accordance with §
303.201(a)(1) of
this chapter (relating to Preadmission Process) for an individual who is
suspected of having MI, ID, or DD and who is seeking admission to a NF through
the preadmission process;
(2)
complete a PE or resident review as follows:
(A) within 72 hours after receiving a copy of
the PL1 from the referring entity in accordance with §
303.201(a)(1)(B)
of this chapter or notification from the LTC online portal in accordance with
§
303.202 or §
303.204(a) of
this chapter (relating to Expedited Admission Process and Resident Review
Process, respectively):
(i) call the referring
entity or NF to schedule the PE or resident review; and
(ii) meet in person, or in extenuating
circumstances meet via audio-visual communication, with the individual or
resident at the referring entity or NF to gather information to complete the PE
or resident review; and
(B) within seven days after receiving a copy
of the PL1 from the referring entity or notification from the LTC online
portal:
(i) complete the PE or resident review
by:
(I) reviewing the individual's or
resident's:
(-b-) relevant service records, including
those available in online databases, such as the Client Assignment and
Registration (CARE) system, Clinical Management for Behavioral Health Services
(CMBHS), and LTC online portal; and
(-c-) previous PEs, service plans, and
assessments from other LIDDAs, LMHAs, or LBHAs;
(II) meeting with the individual's LAR or
resident's LAR in person, via audio-visual communication, or via audio-only
communication according to the LAR's preference;
(III) communicating with a collateral contact
as necessary;
(IV) providing
information to the individual seeking admission or resident and the
individual's LAR or resident's LAR, if any, about community services, supports,
and programs for which the individual or resident may be eligible;
and
(V) obtaining additional
information as needed; and
(ii) enter the data from the PE or resident
review in the LTC online portal; and
(3) within three business days after entering
the data from the PE or resident review in the LTC online portal:
(A) if the PE or resident review is positive
for MI, ID, or DD, provide the individual seeking admission or resident or the
individual's LAR or resident's LAR with a summary of the results of the PE or
resident review, using HHSC forms; or
(B) if the PE or resident review is negative
for MI, ID, or DD, provide the individual seeking admission or resident or the
individual's LAR or resident's LAR notice of the right to a fair hearing, using
HHSC forms.
(b)
If an individual seeking admission to a NF or a resident has a PE or resident
review that is positive for ID, DD, or MI and a NF certifies in the LTC online
portal that it cannot meet the needs of the individual or resident, then the
LIDDA, LMHA, or LBHA, as applicable, must assist the individual, resident, or
LAR in choosing another NF that will certify it can meet the needs of the
individual or resident.
(c) If an
individual seeking admission to a NF or a resident has a PE or resident review
that is positive for ID, DD, or MI and a NF certifies in the LTC online portal
that it can meet the needs of the resident or certifies in the LTC online
portal that it can meet the needs of the individual and admits the individual,
the LIDDA, LMHA or LBHA, as applicable, must:
(1) coordinate with the NF to schedule an IDT
meeting to discuss specialized services;
(2) ensure a habilitation coordinator or
QMHP-CS or both, as applicable, participates in person, or via audio-visual
communication in extenuating circumstances, in the resident's IDT meeting as
scheduled by the NF and collaborate with the other members of the IDT to:
(A) identify which of the specialized
services recommended for the resident that the resident, or LAR on the
resident's behalf, wants to receive;
(B) identify the NF PASRR support activities
for the resident; and
(C) determine
whether the resident is best served in a facility or community
setting;
(3) within five
business days after receiving notification from the LTC online portal that the
NF entered information from the IDT meeting, confirm the LIDDA's, LMHA's, or
LBHA's participation in the meeting and the specialized services recommended in
the LTC online portal; and
(4) if
Medicaid or other funding is available:
(A)
initiate MI specialized services within 20 business days after the date of the
IDT meeting; and
(B) provide the MI
specialized services agreed upon in the IDT meeting to the resident.
(d) The LIDDA, LMHA, or
LBHA must develop a written policy that describes the process the LIDDA, LMHA,
or LBHA will follow to address challenges related to the participation in
receiving IHSS or MI specialized services by the designated resident, resident
with MI, or LAR.
(e) The LIDDA must
ensure that a designated resident or LAR is informed orally and in writing of
the processes for filing complaints as follows:
(1) the telephone number of the LIDDA to file
a complaint;
(2) the telephone
number of the IDD Ombudsman to file a complaint about the LIDDA;
(3) the telephone number of Complaint and
Incident Intake to file a complaint about IHSS or the NF;
(4) the telephone number of DFPS Statewide
Intake to report an allegation of abuse, neglect, or exploitation;
and
(5) the telephone number of the
Long-Term Care Ombudsman to file a complaint that relates to action, inaction,
or a decision by any individual or entity who provides care or makes decisions
related to a designated resident, that may adversely affect the health, safety,
welfare, or rights of the designated resident.
(f) The LMHA or LBHA must ensure that a
resident with MI or LAR is informed orally and in writing of the processes for
filing complaints as follows:
(1) the
telephone number of the LMHA or LBHA to file a complaint;
(2) the telephone number of the Ombudsman for
Behavioral Health to file a complaint about MI specialized services or about an
LMHA or LBHA;
(3) the telephone
number of Complaint and Incident Intake to file a complaint about the
NF;
(4) the telephone number of
DFPS Statewide Intake to report an allegation of abuse, neglect, or
exploitation; and
(5) the telephone
number of the Long-Term Care Ombudsman to file a complaint that relates to
action, inaction, or a decision by any individual or entity who provides care
or makes decisions related to a resident with MI, that may adversely affect the
health, safety, welfare, or rights of the resident with MI.
(g) If an individual seeking
admission to a NF or a resident has a PE or resident review that is positive
for MI and ID or MI and DD, the LIDDA is responsible for coordinating with the
NF to schedule the IDT meeting to discuss specialized services.
(h) Before the LIDDA, LMHA, or LBHA staff
conducts the meeting required in subsection (a)(2)(A)(ii) of this section via
audio-visual communication, they must:
(1) do
one of the following:
(A) obtain the written
informed consent of the individual, designated resident, or LAR; or
(B) obtain the individual's, designated
resident's, or LAR's oral consent and document the oral consent in the
individual's or designated resident's record; and
(2) document in the individual's or
designated resident's record a description of the extenuating circumstances
that prevented meeting in person with the individual or the designated
resident.
(i) If the
LIDDA, LMHA, or LBHA does not obtain the written or oral consent required by
subsection (h) of this section, the LIDDA, LMHA, or LBHA must conduct the
meeting required in subsection (a)(2)(A)(ii) of this section by meeting with
the LAR and NF staff most familiar with the individual or designated resident,
to:
(1) review and gather all necessary
information to complete the PE; and
(2) enter the PE in the LTC online
portal.
