87R20945 EAS-F
 
  By: Price, Smith, Coleman, Rose, Allison H.B. No. 1824
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the continuity of services received by individuals
  receiving services at state hospitals and state supported living
  centers, the establishment of a pilot program to provide behavioral
  health or psychiatric services to certain residential care facility
  residents, and court orders for psychoactive medication for certain
  patients.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 574.102, Health and Safety Code, is
  amended to read as follows:
         Sec. 574.102.  APPLICATION OF SUBCHAPTER. (a)  This
  subchapter applies to the application of medication to a patient:
               (1)  subject to a court order for mental health
  services under this chapter or other law; or 
               (2)  transferred from a residential care facility to an
  inpatient mental health facility under Section 594.032.
         (b)  For purposes of this subchapter, a reference to a
  patient includes a person described by Subsection (a). 
         SECTION 2.  The heading to Section 574.103, Health and
  Safety Code, is amended to read as follows:
         Sec. 574.103.  ADMINISTRATION OF MEDICATION TO PATIENT UNDER
  COURT-ORDERED MENTAL HEALTH SERVICES OR TRANSFERRED FROM A
  RESIDENTIAL CARE FACILITY TO AN INPATIENT MENTAL HEALTH FACILITY.
         SECTION 3.  Section 574.103(b), Health and Safety Code, is
  amended to read as follows:
         (b)  A person may not administer a psychoactive medication to
  a patient under court-ordered inpatient mental health services or
  to a person transferred from a residential care facility to an
  inpatient mental health facility under Section 594.032 who refuses
  to take the medication voluntarily unless:
               (1)  the patient is having a medication-related
  emergency;
               (2)  the patient is under an order issued under Section
  574.106 or 592.156 authorizing the administration of the medication
  regardless of the patient's refusal; or
               (3)  the patient is a ward who is 18 years of age or
  older and the guardian of the person of the ward consents to the
  administration of psychoactive medication regardless of the ward's
  expressed preferences regarding treatment with psychoactive
  medication.
         SECTION 4.  Sections 574.104(a) and (b), Health and Safety
  Code, are amended to read as follows:
         (a)  A physician who is treating a patient in an inpatient
  setting may, on behalf of the state, file an application in a
  probate court or a court with probate jurisdiction for an order to
  authorize the administration of a psychoactive medication
  regardless of the patient's refusal if:
               (1)  the physician believes that the patient lacks the
  capacity to make a decision regarding the administration of the
  psychoactive medication;
               (2)  the physician determines that the medication is
  the proper course of treatment for the patient;
               (3)  the patient is:
                     (A)  under an order for inpatient mental health
  services under this chapter or other law; 
                     (B)  transferred from a residential care facility
  to an inpatient mental health facility under Section 594.032; or
                     (C)  the subject of a filed [an] application for
  court-ordered mental health services under Section 574.034 or [,
  574.0345,] 574.035 [, or 574.0355 has been filed for the patient];
  and
               (4)  the patient, verbally or by other indication,
  refuses to take the medication voluntarily.
         (b)  An application filed under this section must state:
               (1)  that the physician believes that the patient lacks
  the capacity to make a decision regarding administration of the
  psychoactive medication and the reasons for that belief;
               (2)  each medication the physician wants the court to
  compel the patient to take;
               (3)  whether an application for court-ordered mental
  health services under Section 574.034, 574.0345, 574.035, or
  574.0355 has been filed;
               (4)  whether a court order described by Subsection
  (a)(3) for [inpatient mental health] services for the patient has
  been issued and, if so, under what authority it was issued;
               (5)  the physician's diagnosis of the patient; and
               (6)  the proposed method for administering the
  medication and, if the method is not customary, an explanation
  justifying the departure from the customary methods.
         SECTION 5.  Sections 574.106(a) and (a-1), Health and Safety
  Code, are amended to read as follows:
         (a)  The court may issue an order authorizing the
  administration of one or more classes of psychoactive medication to
  a patient who:
               (1)  is described by Section 574.102(a) [under a court
  order to receive inpatient mental health services]; or
               (2)  is in custody awaiting trial in a criminal
  proceeding and was ordered to receive inpatient mental health
  services in the six months preceding a hearing under this section.
         (a-1)  The court may issue an order under this section only
  if the court finds by clear and convincing evidence after the
  hearing:
               (1)  that the patient lacks the capacity to make a
  decision regarding the administration of the proposed medication
  and treatment with the proposed medication is in the best interest
  of the patient; or
               (2)  if the patient was ordered to receive inpatient
  mental health services by a criminal court with jurisdiction over
  the patient, that treatment with the proposed medication is in the
  best interest of the patient and either:
                     (A)  the patient presents a danger to the patient
  or others in the inpatient mental health facility in which the
  patient is being treated as a result of a mental illness [disorder
  or mental defect] as determined under Section 574.1065; or
                     (B)  the patient:
                           (i)  has remained confined in a correctional
  facility, as defined by Section 1.07, Penal Code, for a period
  exceeding 72 hours while awaiting transfer for competency
  restoration treatment; and
                           (ii)  presents a danger to the patient or
  others in the correctional facility as a result of a mental illness 
  [disorder or mental defect] as determined under Section 574.1065.
         SECTION 6.  Section 574.107, Health and Safety Code, is
  amended by amending Subsection (a) and adding Subsection (c) to
  read as follows:
         (a)  The costs for a hearing under this subchapter for a
  patient committed under this chapter shall be paid in accordance
  with Sections 571.017 and 571.018.
         (c)  The costs for a hearing under this subchapter for a
  patient committed under Chapter 593 shall be paid by the county that
  ordered the commitment under that chapter.
         SECTION 7.  Section 574.110, Health and Safety Code, is
  amended by amending Subsection (a) and adding Subsection (a-1) to
  read as follows:
         (a)  An [Except as provided by Subsection (b), an] order
  issued under Section 574.106 for a patient that is committed under
  this chapter, other than a patient to whom Subsection (a-1) or (b)
  applies, expires on the expiration or termination date of the order
  for temporary or extended mental health services in effect when the
  order for psychoactive medication is issued.
         (a-1)  An order issued under Section 574.106 for a patient
  that is committed under Chapter 593 expires as provided by Section
  592.160.
         SECTION 8.  Section 576.025(a), Health and Safety Code, is
  amended to read as follows:
         (a)  A person may not administer a psychoactive medication to
  a patient receiving voluntary or involuntary mental health services
  who refuses the administration unless:
               (1)  the patient is having a medication-related
  emergency;
               (2)  the patient is younger than 16 years of age, or the
  patient is younger than 18 years of age and is a patient admitted
  for voluntary mental health services under Section 572.002(3)(B),
  and the patient's parent, managing conservator, or guardian
  consents to the administration on behalf of the patient;
               (3)  the refusing patient's representative authorized
  by law to consent on behalf of the patient has consented to the
  administration;
               (4)  the administration of the medication regardless of
  the patient's refusal is authorized by an order issued under
  Section 574.106 or 592.156; or
               (5)  the administration of the medication regardless of
  the patient's refusal is authorized by an order issued under
  Article 46B.086, Code of Criminal Procedure.
         SECTION 9.  Section 592.152(a), Health and Safety Code, is
  amended to read as follows:
         (a)  A person may not administer a psychoactive medication to
  a client receiving voluntary or involuntary residential care
  services who refuses the administration unless:
               (1)  the client is having a medication-related
  emergency;
               (2)  the refusing client's representative authorized by
  law to consent on behalf of the client has consented to the
  administration;
               (3)  the administration of the medication regardless of
  the client's refusal is authorized by an order issued under Section
  574.106 or 592.156; or
               (4)  the administration of the medication regardless of
  the client's refusal is authorized by an order issued under Article
  46B.086, Code of Criminal Procedure.
         SECTION 10.  Section 592.153(b), Health and Safety Code, is
  amended to read as follows:
         (b)  A person may not administer a psychoactive medication to
  a client who refuses to take the medication voluntarily unless:
               (1)  the client is having a medication-related
  emergency;
               (2)  the client is under an order issued under Section
  574.106 or 592.156 authorizing the administration of the medication
  regardless of the client's refusal; or
               (3)  the client is a ward who is 18 years of age or older
  and the guardian of the person of the ward consents to the
  administration of psychoactive medication regardless of the ward's
  expressed preferences regarding treatment with psychoactive
  medication.
         SECTION 11.  Chapter 594, Health and Safety Code, is amended
  by adding Subchapter D to read as follows:
  SUBCHAPTER D. TEMPORARY TRANSFER BETWEEN RESIDENTIAL CARE
  FACILITIES PILOT PROGRAM
         Sec. 594.101.  DEFINITIONS. In this subchapter:
               (1)  "Alternate residential care facility" means a
  residential care facility other than the one in which a resident
  resides prior to a temporary transfer.
               (2)  "Local intellectual and developmental disability
  authority" has the meaning assigned by Section 531.002.
               (3)  "Originating residential care facility" means the
  residential care facility at which the resident resides prior to a
  temporary transfer.
               (4)  "State supported living center" has the meaning
  assigned by Section 531.002.
               (5)  "Temporary transfer" means the transfer of a
  resident from the originating residential care facility to an
  alternate residential care facility to receive behavioral health or
  psychiatric services for a limited time.
         Sec. 594.102.  TEMPORARY TRANSFERS BETWEEN RESIDENTIAL CARE
  FACILITIES PILOT PROGRAM. (a) The commission may establish a pilot
  program for the purpose of providing for temporary transfers of
  residents from originating residential care facilities to
  alternate residential care facilities to provide behavioral health
  or psychiatric services for those residents. The pilot program
  must include:
               (1)  one alternate residential care facility for
  psychiatric services; and
               (2)  one or two alternate residential care facilities
  for intensive behavioral health services.
         (b)  The executive commissioner, in consultation with the
  work group described by Section 594.103, by rule shall specify the
  types of information the commission must collect during the pilot
  program to:
               (1)  evaluate the outcome of the pilot program;
               (2)  ensure the rights of persons in the pilot program
  are commensurate with the rights of persons at the originating
  facility, as appropriate; and
               (3)  ensure services provided under the pilot program
  meet the applicable requirements under Section 594.108(c)(4) and
  594.109(f)(4).
         Sec. 594.103.  WORK GROUP MEMBERS. If a pilot program is
  established under this subchapter, the executive commissioner
  shall establish a work group to consult in adopting the rules
  described by Section 594.102(b). The work group is composed of:
               (1)  two representatives who are intellectual
  disability advocates, one of whom is from Disability Rights Texas;
               (2)  one representative from a local intellectual and
  developmental disability authority;
               (3)  a board certified behavioral analyst with
  expertise working with individuals with intellectual disabilities;
               (4)  a psychiatrist with expertise working with
  individuals with intellectual disabilities;
               (5)  a psychologist with expertise working with
  individuals with intellectual disabilities;
               (6)  a current or former resident of a state supported
  living center;
               (7)  a family member or guardian of a current or former
  resident of a state supported living center; and
               (8)  any other individual the executive commissioner
  considers appropriate to appoint to the work group.
         Sec. 594.104.  TEMPORARY TRANSFER LIMITATIONS. A temporary
  transfer under a pilot program established under this subchapter
  may not be considered a permanent transfer and is not a discharge
  from the originating residential care facility.
         Sec. 594.105.  TEMPORARY TRANSFER OF VOLUNTARY RESIDENT. A
  voluntary resident may not be temporarily transferred to an
  alternate residential care facility under a pilot program under
  this subchapter without legally adequate consent to the transfer.
         Sec. 594.106.  RETURN OF RESIDENT. A resident shall be
  returned to the originating residential care facility after
  participating in a pilot program under this subchapter.  The
  originating residential care facility shall maintain a vacancy for
  the resident while the resident participates in the pilot program.
         Sec. 594.107.  TRANSFER OR DISCHARGE OF RESIDENT. A
  resident who is transferred to an alternate residential care
  facility under a pilot program under this subchapter who no longer
  requires treatment at a residential care facility may be
  transferred to an alternative placement or discharged directly from
  the alternate residential care facility without returning to the
  originating residential care facility.
         Sec. 594.108.  ALTERNATE RESIDENTIAL CARE FACILITY FOR
  PSYCHIATRIC SERVICES. (a) Before the temporary transfer of a
  resident to an alternate psychiatric residential care unit under a
  pilot program under this subchapter, the resident must be examined
  by a licensed psychiatrist who indicates that the resident is
  presenting with symptoms of mental illness to the extent that care,
  treatment, and rehabilitation cannot be provided in the originating
  residential care facility.
         (b)  The commission may transfer a resident under a pilot
  program under this subchapter for an initial period not to exceed 60
  days for the purposes of receiving psychiatric services.
         (c)  The alternate residential care facility for psychiatric
  services operated under a pilot program under this subchapter must:
               (1)  use an interdisciplinary treatment team to provide
  clinical treatment that is:
                     (A)  directed toward lessening the signs and
  symptoms of mental illness; and
                     (B)  similar to the clinical treatment provided at
  a state psychiatric hospital;
               (2)  employ or contract for the services of at least one
  psychiatrist who has expertise in diagnosing and treating persons
  with intellectual disabilities;
               (3)  employ a board certified behavioral analyst who
  has expertise in diagnosing and treating persons with intellectual
  disabilities;
               (4)  assign staff members to residents participating in
  the pilot program at an average ratio not to exceed:
                     (A)  three residents to one direct support
  professional during the day and evening; and
                     (B)  six residents to one direct support
  professional over night;
               (5)  provide additional training to direct support
  professionals working on the alternate psychiatric care unit
  regarding the service delivery system for residents served on that
  unit; and
               (6)  ensure that each psychiatric unit complies with
  the requirements for ICF-IID certification under the Medicaid
  program, as appropriate.
         Sec. 594.109.  ALTERNATE RESIDENTIAL CARE FACILITY FOR
  BEHAVIORAL HEALTH SERVICES. (a) Except as provided by Subsection
  (c), before the temporary transfer of a resident to an intensive
  behavioral health unit under a pilot program under this subchapter,
  an interdisciplinary team must determine whether the resident is an
  individual who, despite an interdisciplinary team having on two or
  more occasions developed or revised an interdisciplinary team
  action plan in response to the occurrence of a significant event
  described by Subsection (b), and appropriate treatment and
  implementation of the plan, including treatment targeted to the
  individual's challenging behaviors, remains likely to cause
  substantial bodily injury to others and requires an intensive
  behavioral health environment to continue treatment and protect
  other residents or the general public.
         (b)  For purposes of Subsection (a), a significant event
  includes:
               (1)  the rate of the resident's challenging behavior
  has remained consistently above baseline for at least four of six
  months after implementation of the interdisciplinary team action
  plan; and
               (2)  either:
                     (A)  the intensity of the resident's behavior has
  caused serious injury to others; or
                     (B)  the resident's physical aggression towards
  others has resulted in more than three crisis restraints in the last
  30 days.
         (c)  The associate commissioner of the commission with
  responsibility for state supported living centers may make an
  exception to admission criteria to require a resident to
  participate in a pilot program under this subchapter. The
  exception must be based on a determination that the resident's
  behavior poses an imminent threat to others.
         (d)  In making a determination under Subsection (a), the
  interdisciplinary team shall document and collect evidence
  regarding the reason the resident requires an intensive behavioral
  health environment to continue treatment and protect other
  residents or the general public.
         (e)  The interdisciplinary team shall provide the team's
  findings, including any documentation and evidence regarding the
  proposed resident, regarding whether the proposed resident should
  participate in a pilot program under this subchapter to:
               (1)  the associate commissioner of the commission with
  responsibility for state supported living centers;
               (2)  the director of the state supported living center;
               (3)  the independent ombudsman;
               (4)  the resident or the resident's parent, if the
  resident is a minor; and
               (5)  the resident's legally authorized representative.
         (f)  An alternate residential care facility for behavioral
  health services operated under a pilot program under this
  subchapter must:
               (1)  use an interdisciplinary treatment team that is
  specially trained to provide clinical treatment designed to serve
  residents who meet criteria for the pilot program;
               (2)  employ board certified behavioral analysts with
  expertise in diagnosing and treating persons with intellectual
  disabilities to provide a ratio of one analyst serving each twelve
  beds full-time in accordance with commission rules providing
  appropriate procedures for maintaining that ratio;
               (3)  employ a professional qualified to provide
  counseling consistent with evidence-based, trauma-informed
  treatment;
               (4)  assign staff members to residents participating in
  the program at an average ratio not to exceed:
                     (A)  three residents to one direct support
  professional during the day and evening; and
                     (B)  six residents to one direct support
  professional at night;
               (5)  provide additional training to direct support
  professionals working at the alternate residential care facility
  regarding the service delivery system for residents served at that
  facility; and
               (6)  ensure that the intensive behavioral health units
  comply with the requirements for ICF-IID certification under the
  Medicaid program, as appropriate.
         (g)  Except as provided by Subsection (h), a resident
  transfer to an alternate residential care facility for behavioral
  health services under a pilot program under this subchapter may not
  exceed six months.
         (h)  The initial period described by Subsection (g) may be
  extended by an additional, one-time period of three months if: 
               (1)  an interdisciplinary team determines:
                     (A)  the resident meets the standard for admission
  under this section; and
                     (B)  an extension of the initial period will
  likely enable the resident to no longer meet the criteria for the
  pilot program within the period of the extension; and
               (2)  the extension is approved by the associate
  commissioner of the commission with responsibility for state
  supported living centers.
         (i)  Except as provided by Subsection (k), if at any time
  during a resident's temporary transfer to a pilot program under
  this subchapter, the interdisciplinary treatment team determines
  that the resident no longer requires an intensive behavioral health
  environment to continue treatment and protect public safety, the
  resident shall be transferred back to the originating residential
  care facility not later than the seventh day after the date the
  interdisciplinary team makes that determination.
         (j)  Except as provided by Subsection (k), at the end of the
  period described by Subsection (g) or (h), as applicable, the
  resident shall be returned to the originating residential care
  facility not later than the seventh day after the expiration of that
  period.
         (k)  If the associate commissioner of the commission with
  responsibility for state supported living centers determines that
  there are extenuating circumstances preventing the transfer within
  the period described by Subsection (i) or (j), as applicable, the
  associate commissioner may extend the applicable period by an
  additional three days and may extend each of those additional
  three-day periods by an additional three days for as long as the
  occurrence of those extenuating circumstances prevent the
  resident's transfer. For purposes of this subsection, "extenuating
  circumstances" include extremely hazardous weather conditions or
  another disaster that prevents the timely transfer of a resident.
         Sec. 594.110.  ADMINISTRATIVE HEARINGS. (a) A resident is
  entitled to an expedited administrative hearing under Section
  594.015 to challenge the resident's required participation under
  Section 594.109(c) in a pilot program under this subchapter. The
  hearing must be held not later than seven days after the date the
  associate commissioner determines that the resident should
  participate in the pilot program.
         (b)  A resident who is subject to a transfer decision
  described by Section 594.109 is entitled to an administrative
  hearing under Section 594.015. The hearing shall be limited to
  determining whether the transfer decision complies with Section
  594.109. A resident may waive the right to a hearing, but if a
  hearing is requested the resident may not be transferred until
  after the administrative hearing.
         (c)  A resident is entitled to an administrative hearing with
  the commission to contest an extension described by Section
  594.109(h).
         Sec. 594.111.  RIGHT TO APPEAL. An individual may appeal a
  decision made at a hearing described by Section 594.110 by filing
  the appeal in a district court in Travis County not later than the
  30th day after the date a final order is provided to the individual.
  An appeal under this section is by trial de novo.
         SECTION 12.  Not later than November 1, 2022, the Health and
  Human Services Commission shall consult with the work group
  described by Section 594.103, Health and Safety Code, as added by
  this Act, and adopt any necessary rules to implement Subchapter D,
  Chapter 594, Health and Safety Code, as added by this Act.
         SECTION 13.  This Act takes effect immediately if it
  receives a vote of two-thirds of all the members elected to each
  house, as provided by Section 39, Article III, Texas Constitution.  
  If this Act does not receive the vote necessary for immediate
  effect, this Act takes effect September 1, 2021.