| |
| |
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A BILL TO BE ENTITLED
|
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AN ACT
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|
relating to the continuity of services received by individuals |
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|
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. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 574.102, Health and Safety Code, is |
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|
amended to read as follows: |
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|
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 |
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|
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. |
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Sec. 594.110. ADMINISTRATIVE HEARINGS. (a) A resident is |
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entitled to an expedited administrative hearing under Section |
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594.015 to challenge the resident's required participation under |
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Section 594.109(c) in a pilot program under this subchapter. The |
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hearing must be held not later than seven days after the date the |
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associate commissioner determines that the resident should |
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participate in the pilot program. |
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(b) A resident who is subject to a transfer decision |
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described by Section 594.109 is entitled to an administrative |
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hearing under Section 594.015. The hearing shall be limited to |
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determining whether the transfer decision complies with Section |
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594.109. A resident may waive the right to a hearing, but if a |
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hearing is requested the resident may not be transferred until |
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after the administrative hearing. |
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(c) A resident is entitled to an administrative hearing with |
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the commission to contest an extension described by Section |
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594.109(h). |
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Sec. 594.111. RIGHT TO APPEAL. An individual may appeal a |
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decision made at a hearing described by Section 594.110 by filing |
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the appeal in a district court in Travis County not later than the |
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30th day after the date a final order is provided to the individual. |
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An appeal under this section is by trial de novo. |
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SECTION 12. Not later than November 1, 2022, the Health and |
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Human Services Commission shall consult with the work group |
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described by Section 594.103, Health and Safety Code, as added by |
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this Act, and adopt any necessary rules to implement Subchapter D, |
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Chapter 594, Health and Safety Code, as added by this Act. |
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SECTION 13. This Act takes effect immediately if it |
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receives a vote of two-thirds of all the members elected to each |
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house, as provided by Section 39, Article III, Texas Constitution. |
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If this Act does not receive the vote necessary for immediate |
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effect, this Act takes effect September 1, 2021. |