SECTION 565.35. Enclosed Beds

(a) The program provider may allow the use of an enclosed bed in a residence if the enclosed bed is purchased, obtained, and complies with the requirements in subsection (c) of this section prior to June 19, 2023.

(b) An enclosed bed is prohibited in a residence if it is purchased or obtained on or after June 19, 2023, even if it complies with subsection (c) of this section.

(c) If the program provider allows the use of an enclosed bed in a residence, the program provider must:

(1) visually inspect the enclosed bed to ensure it meets the criteria of an enclosed bed as defined in §565.3 of this chapter(related to Definitions);

(2) ensure that a physician, occupational therapist, or physical therapist:

(A) conducts an annual assessment to determine:

(i) if the individual has a medical need for the enclosed bed;

(ii) the circumstances under which the enclosed bed may be used;

(iii) that less restrictive methods would be ineffective in protecting the individual and the reasons for that determination;

(iv) how to use the enclosed bed and any contraindications specific to the individual;

(v) how and when to document the use of the enclosed bed; and

(vi) how to monitor the use of the enclosed bed to ensure it is being used in accordance with the assessment; and

(B) follows up after any significant change to determine if the individual still has a medical need for the enclosed bed;

(3) obtain and retain the following documentation:

(A) a letter of medical necessity from the prescribing physician or professional therapist; and

(B) a receipt from a durable medical equipment company for the enclosed bed;

(4) develop and implement policies and procedures that require:

(A) routine checks of the enclosure bed to ensure it is in good repair and safe for the individual;

(B) a documented quarterly review by a registered nurse (RN) or professional therapist to ensure the enclosed bed is still safe and necessary given the individual's current needs and other less restrictive options available; and

(C) an order for the enclosed bed updated annually, or sooner if the RN has determined there is a significant change to the individual's condition.

(d) To prevent misuse or overuse of the enclosed bed, the program provider must:

(1) develop and implement a usage plan that details when the enclosed bed will be used that is consistent with the assessment and order;

(2) require any staff member who provides services to an individual with an enclosed bed to read and document understanding of the usage plan before providing services; and

(3) make the usage plan readily available to staff members providing services.

(e) All enclosed beds are prohibited after June 19, 2028.

Source Note: The provisions of this §565.35 adopted to be effective June 21, 2023, 48 TexReg 3246