Bill Text: TX HB1824 | 2021-2022 | 87th Legislature | Comm Sub
Bill Title: 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.
Spectrum: Slight Partisan Bill (Republican 4-2)
Status: (Engrossed - Dead) 2021-05-26 - Removed from local & uncontested calendar [HB1824 Detail]
Download: Texas-2021-HB1824-Comm_Sub.html
By: Price, et al. (Senate Sponsor - Nelson) | H.B. No. 1824 | |
(In the Senate - Received from the House May 10, 2021; | ||
May 10, 2021, read first time and referred to Committee on Health & | ||
Human Services; May 21, 2021, reported favorably by the following | ||
vote: Yeas 9, Nays 0; May 21, 2021, sent to printer.) | ||
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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 [ |
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court-ordered mental health services under Section 574.034 or [ |
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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 [ |
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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) [ |
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(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 [ |
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(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 | ||
[ |
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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 [ |
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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. | ||
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