Current through Reg. 49, No. 38; September 20, 2024
(a)
Pre-admission screening and assessment.
(1)
Before admission to a CSU, an individual must meet clinical criteria for
admission, as determined by pre-admission screening and assessment.
(2) An individual who voluntarily presents to
the CSU may leave the CSU at any time during the pre-admission screening and
assessment process before the individual's admission.
(3) Pre-admission screening and assessment of
an individual must:
(A) occur either in the
CSU or in the community at any location where mental health crisis services are
provided; and
(B) be provided by a
QMHP-CS or LPHA trained in accordance with HHSC screening and assessment
requirements policy and displaying competency in all domains of crisis
screening and assessment in accordance with § 301.331(b) of this title
(relating to Competency and Credentialing).
(b) CSU screening and assessment policy. CSU
screening and assessment policy must include a process for:
(1) accessing an individual's community-based
screening and assessment; and
(2)
conducting CSU screenings that address the criteria for immediate:
(A) assessment of risk of deterioration and
danger to self and others;
(B)
medical screening and assessment; and
(C) psychiatric examination;
(3) ensuring an individual who is
waiting for a physician examination remains in a location that is determined to
be clinically appropriate and available; and
(4) ensuring that an individual who presents
to a CSU for pre-admission screening and assessment is afforded the protections
in § 306.87 of this subchapter (relating to Protection of an Individual
receiving Crisis Stabilization Unit Services).
(c) Screening. Pre-admission screening
identifies the acuity of the individual's crisis episode and determines the
need for further assessments, including assessments to determine risk of
deterioration and immediate danger to self and others, in accordance with Texas
Health and Safety Code §
572.0025(f)
and §
573.021.
The initial screening of an individual must lead to:
(1) immediate and appropriate referrals;
and
(2) documentation that
incorporates the following domains:
(A)
suicide risk screening;
(B)
homicide risk screening; and
(C)
risk of deterioration.
(d) Assessment. If a pre-admission screening
indicates an individual requires immediate assessment to determine risk of
deterioration and immediate danger to self and others, the assessment must be
conducted with the individual, either in person or through the use of
telemedicine medical services or telehealth services in accordance with 22 TAC
§
174.9(2)
(relating to Provision of Mental Health Services), and must include:
(1) a suicide assessment that documents
current and past suicide risks regarding suicidal ideation, plans, and past
suicide attempts;
(2) a
psychosocial assessment that includes historical and current information
including identification of social, psychological, environmental, and cultural
factors that may be contributing to the emergency; and
(3) a mental health assessment, documenting
symptomology, functionality, historical and current diagnosis, and treatment
for mental illnesses or serious emotional disturbances and, when available:
(A) a review of records of past
treatment;
(B) a review of history
from collateral sources as permitted by Health Insurance Portability and
Accountability Act;
(C) a consult
with current healthcare providers;
(D) a review of history of previous treatment
and the response to that treatment, including a record of dose, response, side
effects and adherence to past psychiatric medications; and
(E) an up-to-date record of all medications
currently prescribed, and the name of the physician or provider with
prescriptive authority.
(e) Physician examination. If a pre-admission
assessment indicates an individual requires immediate physician examination to
determine clinical need for CSU admission, the examination may not be delegated
to a non-physician, in accordance with Texas Health and Safety Code §
572.0025(f),
and:
(1) must be conducted with the
individual, either in person or through telemedicine medical services, in
accordance with Texas Health and Safety Code §
572.0025(f)
and §
573.021;
and
(2) must include:
(A) a physical examination consisting of an
assessment for medical stability; and
(B) a psychiatric examination.
