Header:
TEXAS ADMINISTRATIVE CODE
TITLE 40. SOCIAL SERVICES AND ASSISTANCE
PART 2. DEPARTMENT OF ASSISTIVE AND REHABILITATIVE SERVICES
CHAPTER 107. DIVISION FOR REHABILITATION SERVICES
SUBCHAPTER N. MEMORANDA OF UNDERSTANDING WITH OTHER STATE AGENCIES
Date:
08/31/2009
Document:
40 TAC § 107.1605 (2011)
§ 107.1605. Memorandum of Understanding Concerning Coordination of Services to Disabled Persons
(a) Basis. The Texas Department of Human Services (TDHS), the Texas Department of Health (TDH), the Texas Department of Mental Health and Mental Retardation (TDMHMR), the Texas Rehabilitation Commission (TRC), the Texas Commission for the Blind (TCB), the Texas Commission for the Deaf (TCD), and the Texas Education Agency (TEA) are required under the provisions of the Human Resource Code, § 22.011, to adopt a joint memorandum of understanding to facilitate the coordination of services to disabled persons.
(b) Texas Department of Human Services.
(1) Financial and service responsibilities to disabled persons.
(A) Health care services.
(i) TDHS is the state agency responsible for administration of the Medicaid program, a federally assisted program under the Social Security Act, Title XIX. One of the most important Medicaid benefits provided to low-income individuals is comprehensive health care services. In Texas, Medicaid services are funded by a combination of 40% state funds and 60% federal funds. The federal matching rate is based on the state's average per capita income.
(ii) Medicaid eligibility is linked by federal law to eligibility for Supplemental Security Income (SSI), the financial assistance program for low-income aged, blind, and disabled individuals and Aid to Families with Dependent Children (AFDC), the financial assistance program for low-income, single-parent families. Eligibility for SSI benefits is determined by the Social Security Administration (SSA) based on income and resource requirements and a determination of disability. The SSA contracts with the Texas Rehabilitation Commission (TRC) to perform the disability determinations. Of the three million Texans living in poverty, the Texas Medicaid program covers about 790,000 individuals. Of that number, more than 128,000 are disabled individuals under age 65.
(iii) Federal regulations specify which Medicaid services states must provide as well as a range of optional services states may elect to cover.
(I) Mandatory Medicaid services. Physician services; inpatient and outpatient hospital; laboratory and x-ray; home health care; ambulance; rural health clinic; nurse midwife; early, periodic screening, diagnosis, and treatment (EPSDT) services for children up to age 21; and long-term institutional care services in skilled nursing facilities (SNF).
(II) Optional Medicaid services. Eyeglasses; optometric; podiatric and chiropractic services; ambulatory surgical centers; hearing aid services; limited oral surgery; postsurgical lenses; vendor drug services; medical transportation; family planning; primary home care; day activity and health services; and long-term institutional care services in intermediate care facilities (ICF), intermediate care facilities for the mentally retarded (ICF-MR), and skilled nursing facilities (SNF) for children under age 21.
(III) Medicaid waiver services. Under the provisions of the Social Security Act, 1915(c), states have the option to provide certain home and community-based services to individuals who would otherwise require long-term institutional care. Pending approval of the waiver requests by the Health Care Financing Administration (HCFA), states may define the home and community-based services and make them available to a limited number of individuals on less than a statewide basis. The cost of these additional home and community-based services must be not greater than the cost of Medicaid services without a waiver. Texas currently has two 1915(c) waiver programs which serve disabled individuals.
(-a-) The waiver program for medically dependent children provides Medicaid benefits and in-home skilled nursing services to children under age 18 who would otherwise require nursing home care in an ICF or a SNF. This waiver program will be expanded to serve 120 children statewide. Eligible children are served on a first-come, first-served basis.
(-b-) the 1915(c) waiver program for mentally retarded individuals is designed to provide 11 different home and community-based services to individuals living in their own homes or with family members as alternatives to institutional care in an ICF-MR. Eligible clients use their SSI to pay room and board costs. Home and community-based services are delivered based on an individual plan of care. This waiver program is in its third year of operation and can serve a maximum of 450 clients located in 15 geographic catchment areas. This waiver program is administered through an interagency contract between TDHS and TDMHMR. The state matching funds are provided by TDMHMR.
(B) Protective services for children and adults.
(i) Child protective services.
(I) Child protective services (CPS) is the branch of DHS that provides services to abused or neglected children. These services include intake/investigation of abuse/neglect referrals, in-home services, removal services, substitute care, reunification, and adoption. All these services are provided to children on the basis of abuse/neglect.
(II) Child protective services are provided without regard to income. If a child is removed from his home and placed into the conservatorship of the state, foster care maintenance payments are made to the provider. The child may be eligible for AFDC (Title IV-E) foster care or state paid foster care (SPFC). Both of these carry with them Medicaid coverage. A third type medical assistance only (MAO) is available for some children who are not eligible for AFDC-FC or SPFC.
(ii) Adult protective services.
(I) The adult protective services (APS) program of TDHS investigates reports of abuse, neglect, or exploitation of disabled adults and, when a report is validated, provides or arranges for services to remedy the situation in the least restrictive manner possible.
(II) TDHS also has oversight responsibility for investigations of abuse, neglect, or exploitation conducted by other state agencies who operate, license, certify, or register facilities for the disabled. TDHS receives and reviews complaints about these investigations.
(III) Of the 18,896 clients served in fiscal year 1988, 29% (5,480) were disabled non-elderly persons. TDHS expects to provide APS services to approximately 6,300 disabled persons in fiscal year 1989.
(C) Community care services for aged and disabled persons. Community care services are provided to low-income elderly and disabled people with chronic health conditions to help them remain at home or in community settings. These services also provide a support system to families caring for their elderly or disabled members. Eligibility for community care services is based on age, income, financial resources, the degree of functional impairment, and, in some cases, medical need. The income eligibility ceiling for community care services is $ 678.65 per month and the resource limit is $ 5,000.
(i) In-home community care services.
(I) Primary home care (PHC) provides medically necessary personal care or supportive care supervised by a registered nurse and provided in the client's home. TDHS contracts with licensed home health agencies to provide these services to individuals for up to 30 hours per week.
(II) Family care (FC) provides personal care, housekeeping, escort service, and meal preparation in the client's own home. These services are provided through contracts with home health agencies up to 20 hours per week.
(III) Congregate and home-delivered meals provides nutritious meals in a central location or a client's home through community-based provider agencies. All menus are approved by a registered dietician or nutritionist.
(IV) Emergency response services (ERS) is a 24-hour electronic monitoring service that permits quick response to emergencies utilizing a network of volunteers and remote telephone-calling capability to a base station. Services are available to functionally impaired elderly or disabled adults who live alone or who are physically isolated from the community.
(ii) Out-of-home community care services.
(I) Adult foster care (AFC) provides suspension and assistance with daily living to eligible adults in 24-hour living arrangements provided in certified foster homes for up to three clients and licensed group homes for four to eight clients. Clients pay their own room and board costs and TDHS pays the care-giver for personal care and supervision.
(II) Day activity and health services (DAHS) provide personal care, nursing services, physical rehabilitation, and nutrition and supportive services in adult day-care facilities licensed by TDH and certified by DHS. These services are available at least 10 hours per week day and can provide respite for families.
(III) Special services for the handicapped provide counseling, personal care, help with independent living skills, and transportation.
(IV) Residential care services are provided to eligible adults who require access to personal care services on a 24-hour basis, but not daily nursing intervention. Services may include board, protective supervision, personal care, social and recreational services, housekeeping, laundry, and transportation.
(iii) Demonstration project. The shared attendant care project is targeted to the needs of younger physically disabled people who need personal care services to maintain living situations in the community. It allows clients to hire and supervise their own attendants and schedule care according to their daily routines. This project serves approximately 240 clients in three sites, San Antonio, South Texas, and the Orange-Beaumont area. The fiscal year 1987 expenditures were $ 1,128,000.
(D) Other TDHS services. All TDHS services are available to low-income disabled individuals based on the eligibility criteria associated with the various funding sources. TDHS offices are accessible to mobility-impaired individuals. Interpreter services are provided to deaf individuals to assist in the application process.
(2) Service delivery data. TDHS has a variety of data identifying the type of services, the number of clients receiving services, and expenditure data for all programs. The following most comprehensive TDHS documents contain service delivery and expenditure data.
(A) Legislative appropriations request (LAR). The LAR is a document prepared and submitted to the Legislative Budget Board and the Governor's Budget Office prior to each legislative session. It contains the department's request for appropriations for the next biennium based on four levels of funding for each program and activity. It also provides a summary of the department's request. Specifically, it provides the objective and a description of each program and activity as well as data for need indicators, performance measures, object of expense, and method of finance for a five-year period. This period includes two years of the appropriations request and the three previous years.
(B) Fiscal year operating plan. The fiscal year operating plan is the budget for the department based on appropriations received. It contains a breakdown of budgeted dollars by program area and activity at the state level. For each program, the document states the need, the description of program activities, the budget allocation for each activity, the performance measures or units of service, and the method of finance. The allocation covers a three-year period: the current fiscal year and two previous years.
(C) Annual report.
(i) The annual report is a fiscal year description of TDHS services, a review of the services, and an accounting of department expenditures. The report contains a section of statistics that depicts estimated expenditures by method of finance, benefit expenditures by region, a summary of agency information by county, aged and disabled benefits by county, families and children benefits by county, and data concerning the regulation of child care facilities.
(ii) In addition to client-related data, TDHS has demographic data from the 1985 special Texas census and population estimates and projections from the Texas Department of Health.
(iii) The 1985 special Texas census was a mailout survey to the general population of Texas. It was a data collection effort comprising a sample of 22,000 Texas households to identify human service needs in support of the TDHS budget and planning process. With a response rate of over 64% of the valid sample, data was collected for more than 12,300 households or over 33,000 individuals. The data collected for each person concentrated on money income; demographics (age, sex, race/ethnicity, marital status, language, and education); employment status; medical insurance coverage; medical utilization; disability; functional impairment; help available for the disabled; day care for children; child support payments; and knowledge about runaways, child abuse and/or neglect, and family violence shelters. Based on the response rate and the selection of data variables, data may provide adequate representation for the state and for TDHS regions.
(iv) TDHS service delivery and demographic data may be requested from the office of the associate commissioner for budget, planning, and economic analysis.
(c) Texas Department of Health.
(1) Financial and service responsibilities to disabled persons.
(A) Chronically Ill and Disabled Children's Services Bureau.
(i) The Chronically Ill and Disabled Children's Services Bureau provides diagnosis and evaluation, restorative and corrective medical treatment; speech, occupational, and physical therapy; transportation; meals and lodging; and case management through purchased services for children below the age of 21 who meet medical, financial, and residency requirements. Persons with the diagnosis of cystic fibrosis are eligible regardless of age.
(ii) The Chronically Ill and Disabled Children's Services Bureau also administers:
(I) the Hemophilia Assistance Program, which provides assistance to adult (over age 21) hemophilia patients for the purchase of blood products;
(II) the Epilepsy Assistance Program, which provides diagnosis, treatment, and support services for persons with epilepsy, through contracts with private organizations; and
(III) the Children's Outreach Heart Program, which provides prediagnostic and follow-up evaluation services for cardiovascular disorders for children in South Texas who meet financial eligibility requirements, through a contract with the Children's Heart Institute of Texas.
(iii) The Chronically Ill and Disabled Children's Services Bureau also administers the SSI Disabled Children's Services Program.
(iv) For program information, contact the manager of field and provider relations, Chronically Ill and Disabled Children's Services Bureau, (512) 465-2666.
(v) The Chronically Ill and Disabled Children's Services Bureau has written agreements with TCB, TRC, TEA, the Texas Youth Council (TYC), and TDHS. All of these concern coordination of services for persons eligible for both programs party to each agreement.
(B) Supplemental Security Income Disabled Children's Program (SSI-DCP).
(i) The SSI-DCP provides case management services for all disabled children (below the age of 16) receiving SSI benefits. Services provided directly include diagnosis, counseling, and referral; interagency liaison; follow-up through care management provided by medical social workers; and the purchase of services and adaptive equipment if not available through any other resource.
(ii) For program information, contact the manager of field and provider relations, Chronically Ill and Disabled Children's Services Bureau, (512) 465-2666.
(iii) As the SSI-DCP program is administered by the Chronically Ill and Disabled Children's Services Bureau, interagency agreements between SSI-DCP are described above in paragraph (1)(E) of this subsection.
(C) Kidney Health Program.
(i) Provides assistance to Texas residents with end-stage renal disease (ESRD), as certified by a licensed nephrologist, with assistance in paying for drugs, hospitalization, medical services and supplies, and transportation. Clients are reimbursed directly for drugs and travel; reimbursement is made directly to the provider for medical services and supplies. The Kidney Health Program does not pay for services covered by Medicare, Medicaid, or private insurance.
(ii) For program information, contact the director of the Kidney Health Program, (512) 465-2654.
(D) Vision, hearing, and speech services (VHSS).
(i) VHSS holds legal authority to establish standards and regulate screening for special senses and communication disorders, primarily vision and hearing problems, and to assure standardized performance of audiometric testing devices statewide. VHSS legislation permits it to provide services to identified individuals in need when services are not otherwise available. The VHSS provides hearing aids and attendant services to medically indigent children, birth-20 years of age.
(ii) For program information, contact the director of vision hearing and speech services, Division of Maternal and Child Health, (512) 458-7420.
(iii) VHSS and TDHS have entered into a contract for reimbursement of hearing aid services to Medicaid clients aged 0-20. VHSS acts as a custodial for a telecommunications device for the deaf (TDD) supplied to TDH by TCD. The TDD promotes better communications regarding services TDH provides for all Texans.
(E) Early childhood intervention (ECI).
(i) The Early Childhood Intervention (ECI) Program was established by the Texas Legislature to serve children who are developmentally delayed or at risk of developmental delay. ECI contracts with 68 programs across the state. These programs are affiliated with local school districts, educational service centers, state centers, state schools, TDMHMR community centers, private rehabilitation centers, and universities. Children who are age six or younger, are not eligible for public school enrollment, and who are developmentally delayed or at risk of developmental delay are eligible for services provided through an ECI funded program.
(ii) For program information, contact Early Childhood Intervention, (512) 465-2671.
(iii) The ECI program represents an interagency effort of TDH, TDMHMR, TDHS, and TEA. ECI is governed by an interagency council with a representative from each of the departments, plus an appointee from the governor's office. Program staff are also distributed among the four agencies.
(F) Bureau of long-term care.
(i) The purpose of the statewide Long-Term Care Program of TDH is to assure that quality care is provided to persons in long-term care and related facilities and that these facilities are properly utilized. TDH inspects and licenses nursing homes, custodial care homes, personal care homes, certain facilities for the mentally retarded, maternity homes, and certain adult day-care and adult health care facilities. TDH surveys and certifies nursing homes and facilities for the mentally retarded that participate in Medicaid and surveys and recommends certification of nursing homes participating in Medicare. TDH performs inspection of care visits relating to care and services provided to each Medicaid recipient in nursing homes and facilities for the mentally retarded and determines the appropriate level of care needed for each recipient.
(ii) For program information, contact the bureau chief; Bureau of Long-Term Care, (512) 458-7706.
(iii) The Bureau of Long-Term Care has entered into the following memoranda of understanding:
(I) with TDHS regarding quality assurance, inspection of care, and level of care determination related to Medicaid;
(II) with TDHS regarding survey and certification of nursing homes and facilities for the mentally retarded that participate in Medicaid;
(III) with the Texas Department on Aging (TDoA) regarding that agency's ombudsman program and the responsibilities of both agencies in complaint investigations; and
(IV) with the Texas Board of Licensure for Nursing Home Administrators for training of nursing home administrators (being developed at this time).
(G) The bureau has entered into the following interagency contracts:
(i) with TDoA to provide inspection and survey information under public disclosure;
(ii) with TDoA to train ombudsmen and TDoA representatives on nursing home standards and complaint investigation procedures; and
(iii) with TDC to microfiche old records.
(2) Service delivery data.
(A) TDH produces several documents and reports on a department-wide basis either annually or biannually. These are:
(i) legislative appropriations request (LAR). The LAR is published biennially and includes program need indicators for each TDH program, program objectives, descriptions of program performance measures, the TDH budget and expenditures, and activity profiles;
(ii) Texas hospital data inventory, published annually;
(iii) Bureau of Health Data and Policy Analysis, population projection to 2,000, published annually;
(iv) Bureau of Epidemiology; reported mortality and morbidity in Texas, published annually;
(v) Texas vital statistics, published annually.
(B) To examine these documents, contact at the TDH Library, (512) 458-7559.
(C) In addition, bureaus and programs of the Texas Department of Health generate annual reports for their programs specifically tailored to their program needs. Additional information may be requested by contacting the Special Assistant, Office of the Commissioner, Texas Department of Health, 1100 West 49th Street, Austin, Texas 78756, (512) 458-7375.
(d) Texas Department of Mental Health and Mental Retardation.
(1) Mission. The mission of TDMHMR is to afford Texas citizens with mental illness and mental retardation the opportunity to live as useful and productive lives as possible and to develop their respective mental capacities to the fullest practicable extent. The department establishes that its first priority and primary obligation is to assist and serve those children and adults who are the most severely disabled, especially those who reside in, or are at significant risk of placement in, a state facility. The department shall assure that these mentally ill and mentally retarded individuals who are the first priority of the department are afforded treatment in their own home communities whenever appropriate and feasible. Toward this end, the department shall emphasize those services for mentally ill and mentally retarded persons which are effective alternatives to treatment in large residential facilities.
(2) Financial and services responsibilities to disabled persons.
(A) Mental retardation services.
(i) Mental retardation priority population.
(I) The priority population is that group of individuals with mental retardation who, according to specified criteria, are most in need of treatment and support from the TDMHMR service delivery system. Service group priority is assigned according to the condition which interfaces with community participation. Mental retardation diagnosis alone is not sufficient.
(II) Assignment of persons to service group categories must be performed by a professional person with mental retardation experience. In assigning priority population service groups, the client is evaluated according to the highest need of the individual. Priority service groups I-V are eligible for receipt of services funded with any funds received from TDMHMR or its state facilities and the required local match. The priority following population service groups are listed in the order of priority for use with state funds.
(-a-) Priority I. Mental retardation with severe health care needs and/or severe physical disabilities.
(-b-) Priority II. Mental retardation with severe behavior problems and/or mental illness diagnosis (dual diagnosis).
(-c-) Priority III. Profound or severe level of mental retardation with needs for basic care; self help skills; prevocational, vocational, and/or independent living skills training.
(-d-) Priority IV. Moderate or mild mental retardation with need for prevocational, vocational, and/or independent living skills training, and/or criminal offender.
(-e-) Priority V. An individual within the certified client population as specified within the prospective payment program who does not meet the priority population definitions of service groups I, II, III, or IV or who has a need for early childhood intervention services.
(ii) Community center services.
(I) TDMHMR contracts with community MHMR centers to provide mental retardation services. Community MHMR centers are locally staffed and governed by a local board of trustees. The centers are usually designated as the mental retardation authority (MRA) for their area and are responsible for the provision of a wide range of services as a condition for receiving state funds. These services include case management, emergency services, medical treatment, and respite care. Other services that may be provided are work-related activities including vocational training, vocational assessments, sheltered workshops, supported work programs, and job placement. Short-term and long-term residential care and developmental programs may also be a part of services.
(II) Eligible individuals receive care at 31 of the 34 community MHMR centers across the state. Three centers provide care only to mentally ill persons (MHMR of Southeast Texas, Navarro County MHMR Center, and Texas Panhandle MRA). Priority is given to clients who are most in need of treatment and support services from the MHMR system.
(iii) State center services.
(I) Community services. State centers provide community-based services to persons with mental retardation in areas of the state not served by state schools or community MHMR centers. Services include in-home support services, respite services, family support, and training and treatment to enhance the individual's ability to function as independently as possible. Individuals may request services by contacting state centers located in Amarillo, Beaumont, El Paso, Harlingen, and Laredo.
(II) Campus-based services. State centers provide short-term and/or long-term residential care and non-residential services in areas of the state not served by state schools or community MHMR centers. The range of services include vocational, medical and dental services, physical, occupational, and recreational therapy. Also included are support services such as maintenance, food service, and laundry. Clients have the opportunity to participate in activities occurring in the local community. Clients with special needs are reserved by qualified professionals with consultation from specialists in the medical, dental, and rehabilitation fields. The five state centers are located in Amarillo, Beaumont, El Paso, Harlingen, and Laredo.
(iv) State school services.
(I) Community services.
(-a-) Community services provided by state schools are designed to meet the needs of clients who have returned to the community from institutional placement and/or to prevent eligible clients from requiring institutionalization. These services include in-home support services, respite services, family support services, case management services, and diagnostic and evaluation services designed to help the individual live independently. Vocational programs including work adjustment training, prevocational services, sheltered workshops, supported work, and independent employment are also offered. Services are both residential and nonresidential in nature.
(-b-) TDMHMR provides these services directly through 13 state schools located throughout the state. Clients' needs are assessed by interdisciplinary teams and then the services are provided which best meet their individual needs.
(II) Campus-based services.
(-a-) Campus-based services include residential, therapeutic care, and treatment, meals, education, physical care; and recreation for persons with mental retardation. Because many clients have visual and hearing problems, muscular and/or skeletal anomalies, or metabolic and nervous disorders, the facility also helps them to cope with or correct their physical handicaps. TDMHMR provides these services directly in 13 campuses located throughout the state.
(-b-) TDMHMR classifies clients according to the severity of their mental retardation and other factors such as physical problems in order to provide appropriate services.
(-c-) All of the 13 state schools are certified as ICF-MRs. Under Title XIX of the Social Security Act (Medicaid), the federal government reimburses the state for a significant portion of the costs of providing ICF-MR services to eligible clients at a matching rate of approximately 46% state and 54% federal. The Texas Legislature appropriate general revenue to TDMHMR to cover the costs of operating the schools. The reimbursement obtained from the federal government is returned to the state treasury and thus is not reflected in TDMHMR's budget.
(B) Mental health services.
(i) Mental health priority population.
(I) The priority population is that group of children and adults who, according to specified criteria, are most in need of treatment and support from the TDMHMR services delivery system. The determination of need is based upon a mix of characteristics which render the mentally dysfunctional individual to be currently or potentially dangerous and/or dependent upon external community resources and therefore at risk of institutionalization.
(II) Assignment of persons to service group categories must be performed by a qualified mental health professional.
(III) Priority Service Groups I, II, III, IV, and V are eligible for the receipt of services funded with any funds received from the department or its state facilities and the required local match. The priority population service groups are listed in order of priority for use of state funds. It is not anticipated that sufficient state funding will be available to meet the needs of all persons within these service groups; therefore, clients in higher priority service groups would be given preference for programs and services. Non-priority Service Group VI members are eligible to be served with center resources funded by nondepartmental sources (local non-match, contributions, grants).
(ii) Priority population service groups.
(I) Service Group I. Chronically dysfunctional mental disorder with present dangerousness and/or dependency.
(II) Service Group II. Historically dysfunctional mental disorder, with present dangerousness and/or dependency.
(III) Service Group III. Primary commitment: A person with present dangerousness and/or dependency who has a current, first-time commitment (including emergency detention and orders of protective custody) to psychiatric services.
(IV) Service Group IV. Chronically dysfunctional mental disorder, with threat of deterioration to dangerousness and/or dependency.
(V) Service Group V. Dysfunctional mental disorder, with threat of deterioration to dangerousness and/or dependency.
(iii) Campus-based services.
(I) Campus-based services include residential, therapeutic care and treatment, meals, medical care, and recreation for persons with mental illness. These services are provided at eight state hospitals, one state center for youth, and three state centers. The average daily census in these state facilities is currently approximately 4,000 and nearly 20,000 persons will receive residential services this year.
(II) All state hospitals are accredited by the Joint Commission on Accreditation of Hospitals (JCAH). Certain units providing services for the elderly patients are also certified to receive Medicare funds.
(iv) Community services.
(I) Community mental health services are provided by 63 mental health authorities. Included in these authorities are 34 community mental health and mental retardation centers which provide mental health services under contract with TDMHMR. The remaining mental health authorities are state hospital or state center programs provided through outreach centers, which are located in the service areas of the hospitals or state centers. These programs currently provide services to over 150,000 individuals annually.
(II) Services provided by the local mental health authorities consist of an array of residential services which may include supervised living arrangements, halfway houses, foster care, personal care, boarding homes, and fairweather lodges. The crisis stabilization component of the residential service array must be available to the residents of a mental health authority.
(III) Other programs include 24-hour emergency screening and assessment, community and state hospital liaison, family support programs, medication related services, psychosocial rehabilitation programs, day treatment, and case management services.
(v) Legislative mandates.
(I) The Texas Legislature has mandated an array of core services that must be available to each mental health authority in the state. The core services to be available to each mental health authority are:
(-a-) a crisis stabilization unit or contracted inpatient crisis beds;
(-b-) 24-hour emergency screening and assessment which includes:
(-1-) multi-disciplinary assessment;
(-2-) crisis intervention team; and
(-3-) crisis hot line;
(-c-) family support services;
(-d-) medication related services;
(-e-) case management; and
(-f-) psychosocial rehabilitation services which include:
(-1-) independent living skills;
(-2-) social support; and
(-3-) vocational training.
(II) The legislature also directed the Texas Board of Mental Health and Mental Retardation to appoint a citizens' planning advisory committee to advise the department on all stages of the development and implementation of the long-range strategic plan. This committee has had an active role in the development of the department's strategic plan.
(III) The department has also reached agreements with the Texas Department of Corrections (TDC) to provide services for people released from TDC; with TEC to provide services after people have left their services; with TRC to provide vocational services; and with TDHS to provide children's services.
(3) Service delivery data. The following data may be obtained by contacting the administrative head of the section or by contacting the assistant deputy commissioner for management and support, Management Analysis and Reporting Unit, (512) 465-4693 or STS 824-4693.
(A) Public information office. This office produces the annual report and a directory of TDMHMR services. (512) 465-4540.
(B) Strategic planning. This office is responsible for demographic data and long-range planning (512) 465-4620.
(C) Budget and fiscal services. This area publishes the TDMHMR annual operating budget and the biennial legislative appropriation request (512) 465-4550.
(D) Information services. This office processes client data information from CARE (client assignment and registration system). (512) 465-4570.
(E) Mental health services. Questions regarding mental health services program and/or policy issues can be directed to this section. (512) 465-4511.
(F) Mental retardation services. This section will be able to respond to inquiries about mental retardation services program and/or policy issues. (512) 465-4511.
(G) Client services and rights protection. This area is responsible for information regarding issues relating to an individual client or statistics regarding client abuse and neglect. (512) 465-4578.
(e) Texas Rehabilitation Commission.
(1) Financial and service responsibilities to disabled persons.
(A) Vocational Rehabilitation Program.
(i) Services provided to improve employability include evaluations to determine vocational, educational, medical, and psychological status and needs; limited vocationally necessary medical treatment; training in trade schools, business colleges, rehabilitation centers, halfway houses, colleges, and universities; interpreter services for the deaf; job placement and assistance to employers in modifying jobs for disabled individuals; and devices such as wheelchairs, artificial limbs, or braces to improve functioning on the job.
(ii) Individuals served must have a physical or mental disability that results in a substantial handicap to employment, and there must be a reasonable expectation that services will improve employability.
(B) Extended Rehabilitation Services Program (ERS).
(i) This program provides long-term sheltered employment and, in some cases, residential living services. Through sheltered employment opportunities and supervised living programs, the ERS program provides an alternative to institutional living for its clients. Other rehabilitation services such as assistive devices, transportation, and job readiness evaluations may also be provided.
(ii) To be eligible, the individual must have a physical or mental disability that results in substantial handicap to employment. There must be a reasonable expectation that services will improve employability, and the handicap must be severe enough to render the person incapable of entering the competitive labor market. The individual must be able to produce enough to earn at least 15% of minimum wage during a six-hour day.
(C) Independent living centers.
(i) These are non-residential services centers which help persons with disabilities determine what services are available and how to obtain them. Clients may receive assistance in obtaining attendant care, housing, and transportation; referral to community resources; advocacy; counseling; training in independent living skills; individual and group social and recreational activities; coordination of interpreter services; and peer counseling.
(ii) The individual must believe that the disability is interfering with his ability to live independently.
(iii) Independent living centers are located in Austin, Dallas, El Paso, Houston, San Antonio, Amarillo, and Crockett.
(D) Independent living services.
(i) Services include adaptive equipment such as wheelchairs, and environmental control systems, communication aids, modification of vehicles, and sponsorship of medical rehabilitation services.
(ii) To be eligible, the individual must have a severe physical or mental disability which interferes with his ability to function independently, and there must be a reasonable expectation that services will substantially improve the person's ability to function independently. Also, the individual must have an economic need and cannot be eligible for either the vocational rehabilitation or extended rehabilitation services programs of the agency. This program is available in the same cities as independent living centers.
(E) Comprehensive medical rehabilitation services.
(i) This program provides inpatient medical rehabilitation services, specifically for persons with spinal cord or brain injuries, to enable them to obtain greater levels of independence and self-care.
(ii) Individuals who have recently sustained a traumatic spinal cord or brain injury, are not eligible for services through other resources, have an economic need, and for whom there is reasonable expectation that services will improve independent functioning, may be served.
(F) Deaf-blind multihandicapped services.
(i) Services include an outdoor training program (a one-week summer camp), parent counseling, and residential and day services including vocational and daily living skills training. The day program may also be used to provide respite care.
(ii) Individuals who have both visual and hearing impairments which substantially impede their ability to live independently may be eligible. Residential services are for adults; there are no age requirements for the one-week summer camp and two-week 24-hour respite services provided on the campus of the Texas School for the Blind.
(2) Service delivery data.
(A) TRC has information available on the demographic characteristics of clients served and of services provided.
(B) Budget and planning data is available upon request by contacting the commission's budget and planning office at (512) 445-8280. Programmatic information is available through the commission's program section at (512) 445-8281.
(C) Information and data sharing.
(i) TRC's annual report. A general, illustrated narrative description of TRC programs with numbers and descriptions of people served.
(ii) The TRC program reference guide. A pocket-size prospective document consisting of a current description of each commission program, benefit statements including cost/benefit data, and listings by county of numbers of clients served, numbers of successful rehabilitants, and their average weekly earnings.
(f) Texas Commission for the Blind.
(1) Financial and service responsibilities to disabled persons.
(A) TCB has the primary responsibility for providing services to visually handicapped persons except welfare services and services for children provided by regularly established educational agencies and state authorities (Human Resources Code, Title V, § 91.021(a)).
(B) The commission offers a continuum of services for blind and visually impaired individuals of all ages. These services programs include:
(i) Visually Handicapped Children's Program. State funding is used to provide service which will prevent blindness, restore vision, reduce dependency for those who have permanent visual problems, and prepare the child for enhanced vocational success. Services include counseling and guidance for the child and family; diagnostic and evaluative information; skills development services; adaptive aids; educational support services; resource development and utilization; prevocational information; and information and referral services. Target population: blind, blind multihandicapped, deaf-blind, severely visually impaired, ages 0-16. Clients ages 16-22 may receive transition services from either the Visually Handicapped Children's Program or vocational rehabilitation services.
(ii) Vocational rehabilitation services. This program is funded by both the state and federal government. All services are provided with the ultimate goal of employment for the blind or visually impaired individual. Services include vocational counseling, vocational training, rehabilitation teacher services, orientation and mobility, physical restoration, employment assistance in sheltered, supported, or competitive employment, personal/social adjustment training and rehabilitation engineering. Eligibility criteria are the presence of a physical or mental disability (including a visual condition which is a substantial handicap to employment) and a reasonable expectation that vocational rehabilitation services will benefit the individual in terms of employment. The target populations are blind, blind multihandicapped, deaf-blind, or severely visually impaired individuals desiring employment.
(iii) Independent living rehabilitation. This program is designed to help blind and visually impaired individuals live as independently as possible. Services include counseling, evaluation and skills training, referral, advocacy, and assistance with eye medical problems. These services are for individuals for whom employment is not plausible. While most clients are elderly, there are no age restrictions. Funding comes from federal Title VII, A, B, and C funds and state funds for serving older blind clients.
(iv) Deaf-blind services.
(I) Services are provided to deaf-blind clients statewide who are eligible for service through the Visually Handicapped Children's Program, the Vocational Rehabilitation Program, and the Independent Living Rehabilitation/Older Blind Programs.
(II) Specific services include rehabilitation center training, adaptive skills training, career guidance, job readiness counseling, and employment assistance. Funding is provided federally through a three-year grant for serving deaf-blind and the Vocational Rehabilitation Act.
(2) Service delivery data.
(A) Biennial report. The commission's biennial report for fiscal years 1985-1986 contains a brief description of each program offered and services provided. The report also summarizes who was served and how funds were expended in general.
(B) Legislative appropriations request (LAR). Requests are submitted every two years to the governor's budget office and the legislative budget office. The last request was filed for fiscal years 1988 and 1989. The 1990 and 1991 request should be submitted by October of 1989. The LAR details by programs and activities their objectives and descriptions. It lists specific budget details and need indicators.
(C) The commission has detailed and general information regarding the types of services provided to all clients of the commission in its Burroughs 1955 computer data base. General information on clients served is currently available. Special computer runs may be provided for more specific information on a special request basis.
(D) Additional information may be requested by contacting Client Services Division, Texas Commission for the Blind, P.O. Box 12866, Austin, Texas 78711, (512) 459-2602 or 1-800-252-5204.
(g) Texas Commission for the Deaf.
(1) Financial and service responsibilities to disabled persons.
(A) TCD is authorized to provide direct delivery services to persons who are deaf or hearing-impaired. These services are rendered through biennial contracts with nonprofit, community-based organizations, called councils for the deaf. When TCD has a contract with such an organization, the organization is referred to as a council for the deaf by TCD although the official name of the organization may not include this phrase. TCD currently has 16 such contracted councils located in 15 cities: Amarillo, Lubbock, Big Spring, El Paso, Corpus Christi, San Antonio, Abilene, Fort Worth, Austin, Houston (two), Sherman, Waco, Dallas, Tyler, and Beaumont.
(B) The number of staff, types of direct services and number of clients vary considerably from council to council. Many of the councils provide direct services in addition to those authorized and subsidized by the state through TCD. The range of TCD-contracted services include the following.
(i) Interpreter services. Interpreters are provided for deaf clients to assist them in obtaining educational, medical, legal, governmental, and economic services. Interpreters are also available through the councils for state agencies, courts, and businesses; however, these entities must reimburse the councils. Payment for interpreters is reimbursed monthly by TCD on an hourly basis for services provided. The rate of payment is determined by the fee schedule recommended for interpreters by TCD.
(ii) Information and referral services. Councils provide information regarding general and specialized community services to persons who are deaf or hearing-impaired, as well as information about deafness to the general public.
(iii) Services to the elderly deaf. Clients who are 60 years or older and deaf or hearing-impaired are assisted in obtaining information and/or services from agencies such as TDoA, local agencies on aging, Social Security offices, and local parks and recreation departments. Services provided may include case management, transportation assistance, nutrition, social interaction, and communication. This program reduces the need for long-term care; provides information to concerned individuals; and provides training to other personnel serving the elderly. These programs are referred to as services to older hearing-impaired Texans (SOHIT).
(iv) Message relay services. Councils provide message relay services to persons who are deaf or hearing-impaired who otherwise have no alternative means to access telephone communication with persons, agencies, and organizations. Persons who are deaf use telecommunication devices for the deaf (TDDs) to call the councils who then relay the messages via regular telephone communication. Councils are reimbursed according to TCD established rate schedules.
(v) Other services. In addition to these services, TCD has the following service and financial responsibilities:
(I) establish a Board of Evaluation of Interpreters to conduct interpreter exams and to develop with TRC a communication competency evaluation for vocational rehabilitation counselors who work at TRC with clients who are deaf;
(II) issue certificates to interpreters and renew certificates at varying skill levels. TCD is required to charge fees for these services;
(III) establish a system to approve courses and workshops for the instruction and continuing education of interpreters;
(IV) establish a schedule of fees recommended by TCD for the payment of interpreters required by law to be provided in proceedings of state agencies, courts, and political subdivisions and adopt a schedule of recommended reasonable fees for interpreters at varying skill levels;
(V) adopt a sliding fee scale for persons who are deaf or hearing-impaired who receive interpreter services in nongovernmental settings and that are reimbursed by TCD. The fee scale is based on the requestor's financial ability to pay; however, a client may not be denied this service because of his/her inability to pay;
(VI) design and provide a decal to be attached to motor vehicles regularly operated by persons who are hearing-impaired with a cost of not more than $ 2.00 per decal. This is a volunteer program;
(VII) monitor TDDs which have been placed by TCD in local emergency response centers, state agencies. The TDDs are maintained by TCD; however, TCD has the authority to require entities to pay for needed repairs;
(VIII) offer a one-week summer camp session for deaf and hearing-impaired children and youth to participate in barrier free recreation and instructional activities. TCD annually contracts with a private facility for this program. Eligibility requirements are that students must be deaf or hearing-impaired, ages 8-17, and selected by TCD by referrals from the regional day schools for the deaf, the Texas School for the Deaf, and local school districts;
(IX) publish an annual directory of services to deaf in Texas, Registry of Interpreters, SOHIT directory, and agency newsletter "Guidepost." Fees for all publications (with the exception of "Guidepost") may be waived for a client who is deaf or hearing-impaired if he is unable to pay.
(vi) Contracts. Currently, TCD has interagency contracts primarily concerning interpreter services with these agencies: the Texas Employment Commission (TEC), the Texas Alcohol and Drug Abuse Commission, and TDC.
(vii) Memoranda of understanding. House Bill 550, passed by the 70th Legislature, requires TCD to write memoranda of understanding to coordinate the delivery of services to deaf persons and to reduce duplication of services with each of the following agencies: TDHS, TDMHMR, TEC, TDH, the Texas College and University Coordinating Board, the Central Education Agency, TDoA, the Texas School for the Deaf, TRC, and TDC. TCD will also participate in a multiagency memorandum of understanding coordinated by TRC.
(2) Service delivery data.
(A) Contact person. Program specialist, Texas Commission for the Deaf, (512) 469-9891 Voice/TDD.
(i) Information regarding councils for the deaf.
(I) TCD-contracted services directory. Provides names of councils, locations, phone numbers, and names of staff;
(II) TCD-contracted service listing. Briefly lists services provided by each council, including interpreter services for state agencies; and
(III) descriptions of services for TCD-contracted services. Describes services provided by councils.
(ii) Directory of services for the deaf. Provides community, church-sponsored, education, postsecondary educational, rehabilitation, speech, and hearing services.
(iii) Registry of interpreters. Provides names, locations, phone numbers, and interpreting skill levels of interpreters who are certified by TCD, the National Registry of Interpreters for the Deaf, or the Texas Society of Interpreters for the Deaf and who pays a listing fee.
(iv) Directory of services for the elderly deaf (SOHIT). Provides a survey of state agency services for which persons who are elderly and hearing-impaired or deaf eligible.
(v) TCD "Guidepost." Agency newsletter.
(vi) Legislative appropriations request. Request for biennium funding for the agency prepared and submitted to the legislative budget office and the governor's budget office. These documents provide summaries of program activities, goals, and objectives.
(B) TCD has placed approximately 600 TDDs with state agencies, emergency dispatch centers in local government, public service entities, and private entities which have TCD contracts (councils for the deaf).
(h) Texas Education Agency.
(1) Financial and service responsibilities to disabled persons.
(A) Description of the handicapped population of children and youth the agency is authorized to serve.
(i) Handicapped by age inclusive.
(I) Three-21 years:
(-a-) orthopedically handicapped;
(-b-) other health impaired;
(-c-) mentally retarded;
(-d-) emotionally disturbed;
(-e-) learning disabled;
(-f-) speech handicapped;
(-g-) autistic;
(-h-) multiple handicapped; and
(-i-) pregnant students.
(II) Birth-21 years:
(-a-) auditorially handicapped;
(-b-) visually handicapped; and
(-c-) deaf-blind.
(ii) Other student populations:
(I) bilingual students (limited English proficient);
(II) educationally and economically disadvantaged students;
(III) children of migrant workers;
(IV) gifted and talented students;
(V) pre-kindergarten (four-year-old limited English proficient and economically disadvantaged);
(VI) refugee children needing transition services;
(VII) delinquent, neglected, and those in correctional facilities;
(VIII) adults (educationally disadvantaged and limited English speaking); and
(IX) dropouts and students at risk of dropping out.
(B) Services administered by the agency relating to the needs of children and youth.
(i) Special education for handicapped students.
(I) Comprehensive individualized student assessment including identification and referral and determination of physical, mental, emotional, general educational, and vocational education needs.
(II) Individualized instruction provided by the district in a variety of classroom arrangements within the school and also in-home, hospital, and residential facility-based arrangements.
(III) Related services when needed to enable a handicapped student to benefit from the specialized instruction:
(-a-) art therapy;
(-b-) adaptive equipment;
(-c-) audiological services;
(-d-) corrective therapy;
(-e-) counseling services;
(-f-) medical diagnostic services;
(-g-) music therapy;
(-h-) occupational therapy;
(-i-) orientation and mobility training;
(-j-) psychological services;
(-k-) recreation therapy;
(-l-) school health services;
(-m-) social work services;
(-n-) transportation; and
(-o-) vision training.
(IV) Other support services, including special instructional equipment and materials, consultative services, and staff development services.
(ii) Vocational education program.
(I) Vocational training and job placement programs at high school and college levels. Includes special provisions for handicapped and educationally disadvantaged children.
(II) The Job Training and Partnership Act (JTPA) Program operated by school districts provide job-specific training, counseling, remedial education, and vocational exploration opportunities.
(2) Sources of funds.
(A) Foundation of school program funds.
(i) Service description. State funds generated by handicapped students may be used to employ or contract with special education personnel to provide special education instruction and related services as stipulated by each handicapped student's individual education plan. A maximum of 15% of state special education program's share of general administrative costs, including administrative and clerical personnel. These funds are also used to purchase instructional supplies, materials, and specialized equipment.
(ii) Delivery method.
(I) State special education funds are distributed on the basis of full-time equivalents of handicapped students served during the school district's best four of eight weeks of overall average daily attendance (ADA). For the purposes of special education funding, the term "full-time equivalent student" means 30 hours of contact a week between a special education student and special education program personnel.
(II) School districts do count ADA and receive credit for contact hours for serving eligible handicapped students residing at intermediate care facilities for the mentally retarded (ICF-MRs) and also in care and treatment facilities approved by the TDHS and TDMHMR if these facilities are located within the districts' boundaries. However, no local taxes are generated for these particular students since their parents/guardians reside in school districts other than the ones where the facilities are located. Children in the conservatorship of the state also do not generate local taxes.
(iii) Eligibility requirements. Students who have turned three years of age on September 1 and who have not had their 22nd birthday and who meet the eligibility criteria for the handicapping conditions stated in 19 TAC § 89.211 concerning handicapped students.
(iv) Delivery method. Handicapped students receive special education instruction and related services in their local schools based upon the recommendations of the Admission, Review, and Dismissal (ARD) Committee for placement in the least restrictive environment.
(B) Education of the Handicapped Act-Part B, Texas Education Agency.
(i) Service description.
(I) Funds are used to pay for salary costs of special education personnel, special materials and equipment, related services, consultant services, student evaluation services, staff travel, and related services and residential care costs for residential placements of severely handicapped students in non-public schools approved by TEA.
(II) These funds supplement state and local funds in the provision of special education instruction and related services for all handicapped students; special services for three, four, and five-year-olds; and special education teacher training.
(III) Public Law 99-457 amended this Act to provide for interagency coordination, to allow split-funding, and to prevent duplication of services.
(ii) Delivery method. TEA allocates federal funds primarily through local school districts and special education cooperatives supplemented by services from the regional education service centers. Funding is allocated on a per-child basis through a count of students taken each year on December 1.
(iii) Eligibility requirements. Students served are handicapped students from age three-21 who meet the criteria established in 19 TAC § 89.211 concerning handicapped students.
(C) Education of the Handicapped Act-Part C, Deaf-blind.
(i) Service description. Services include technical assistance in transition services from education program to future living and work setting, sheltered living experiences, vocational training, and related services; consultative/counseling services for families of service providers; in-service training for staff working with deaf-blind persons, and coordination of activities with other agencies.
(ii) Delivery method. Children receive this aid in their local schools. TEA provides technical assistance in local schools or residential facilities on an as needed basis.
(iii) Eligibility criteria. Deaf-blind children, ages 0-21.
(D) Regional services for the deaf.
(i) Service description. Eligible deaf students receive a basic instructional program suitable to their educational needs and are provided with the opportunity for achievement more equal to their peers with normal hearing. Funding provides supplemental instructional services; parent counseling and training; special diagnostics; special media, materials, and equipment; and staff development.
(ii) Delivery method. Local school districts make applications to TEA for funds to meet identified priorities of the local programs, based on standards established by TEA. Applications are then negotiated and become contracts.
(iii) Eligibility requirements. Students are deaf or hearing-impaired and meet other specific criteria outlined in 19 TAC § 89.211(c) concerning handicapped students.
(E) Visually handicapped services.
(i) Service description. Services include:
(I) the review of applications for state funding by school districts and regional education service centers to provide education services adapted for visually handicapped students;
(II) the evaluation of special education services for the individually handicapped;
(III) the maintenance of a system of registration of visually handicapped students;
(IV) the development of standards and guidelines for special education services for the visually handicapped;
(V) the provision of consultation and technical assistance to programs serving the visually handicapped; and
(VI) the maintenance of effective liaison with other agencies and service providers involved with services to visually handicapped students.
(ii) Delivery method.
(I) Students receive these special services in their local schools. TEA staff work directly with school districts in evaluating programs, developing standards and guidelines, providing technical assistance, and keeping a registry of visually handicapped students. Funding is based on the needs of the districts' programs.
(II) A section of the division of special education funding (services for the visually impaired) is primarily responsible for the ongoing development and administration of comprehensive statewide services for the education of visually handicapped students, as assigned by law.
(iii) Eligibility requirements. Students must be legally blind and age 0-21.
(F) Visually handicapped services--education service centers.
(i) Services description.
(I) Funding supports:
(-a-) existing programs, to expand direct and supportive services for visually handicapped students which are not available through use of other funds;
(-b-) development of special cooperative formed specifically to meet the educational and related service needs of visually handicapped students;
(-c-) programs for visually handicapped infants; and
(-d-) minimum components of services for the visually handicapped in each education service center to provide direct services and technical assistance as needed.
(II) Specific types of activities include:
(-a-) supplemental instructional services;
(-b-) orientation and mobility training;
(-c-) parent counseling and training;
(-d-) special diagnostics;
(-e-) other special related services;
(-f-) special media, materials, and equipment; and
(-g-) staff development and other supplemental services.
(ii) Delivery method. Students receive services in their local schools. Local school districts and regional education service centers may apply for state supplemental funding aid for special services to visually handicapped students. Funding does not supplant existing other funds or programs and is allocated by TEA.
(iii) Eligibility requirements. Students served must be visually handicapped students from 0-21, and meet eligibility criteria for the visually handicapped as outlined in 19 TAC § 89.211(d) concerning handicapped students. Funding to districts is on a need/application basis rather than formula allocation.
(3) Service delivery data.
(A) Types of data collected on children and youth.
(i) Number of handicapped students by district, age, handicapping condition, and services provided including residential contract care.
(ii) Number of different student populations residing in each district apart from parent or guardian.
(iii) Number of economically disadvantaged students by district.
(iv) Number of special student populations by district, migrant, bilingual, limited English proficient, refugees, and legal and undocumented immigrants.
(v) Number of handicapped and non-handicapped students in correctional facilities, and other state-operated residential facilities.
(B) Contact person. Director of interagency coordination for the handicapped, (512) 463-9283.
(i) Agreement. TDHS, TDH, TDMHMR, TRC, TCB, TCD, and TEA agree:
(1) to share all pertinent client information at the local level that is deemed appropriate to any agency involved in service planning or service delivery. Client information shared between agencies involved in service delivery is not open to public inspection and will not be disclosed in any manner that will identify an individual unless ordered by the court. Any transfer of information will be made according to the rules and regulations of the transferring agency and will be made only for the purposes of providing treatment or services;
(2) to share the service delivery data identified in this memorandum of understanding upon request through the designated contact person for each state agency;
(3) to review and, if necessary, update this memorandum of understanding prior to the end of each state fiscal year;
(4) to adopt this memorandum of understanding and all revisions to this memorandum by rule; and
(5) to consult with and solicit input from advocacy and consumer groups in the formulation of this memorandum of understanding through the public comment process for proposed rule publication; and
(6) to adhere to all applicable and state requirements of program accessibility for disabled individuals.
(j) Effective date. This agreement is effective March 14, 1989.
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