SECTION 904.103. Accessing Alternative Living Arrangements for an Individual Residing in a State MR Facility Who Does Not Have the Ability to Give Legally Adequate Consent and Who Does Not Have a Legally Authorized Representative (LAR)

(a) If the IDT recommends an alternative living arrangement for an individual who does not have the ability to give legally adequate consent and who does not have an LAR, the IDT will:

(1) notify the individual's designated MRA and persons actively involved with the individual of the recommendation;

(2) identify issues which could prevent the individual from successfully adapting to an alternative living arrangement including:

(A) the individual's inability to provide legally adequate consent; and

(B) the lack of effective community services and supports to address behavioral or medical concerns;

(3) recommend possible solutions to address the issues; and

(4) document the identified issues and recommended solutions in the IDT report.

(b) If the IDT identifies the individual's inability to provide legally adequate consent as an issue that could prevent the individual from successfully adapting to an alternative living arrangement, the IDT will:

(1) explore options for addressing the issue; and

(2) document the options and the activities necessary for implementing the options in the community living/discharge plan.

(c) A representative from the designated MRA will meet with the individual, any persons actively involved with the individual, and the IDT to discuss the desired outcomes for the alternative living arrangement and preferences of geographic locations.

(1) During the meeting, state MR facility staff and the MRA representative will describe the different types of alternative living arrangements which are available and answer any questions asked by the individual and persons actively involved with the individual.

(2) The desired outcomes and preferences of the individual and persons actively involved with the individual will be documented in the written report of the IDT meeting.

(d) Once the desired outcomes and preferences of the individual and persons actively involved with the individual have been identified, the designated MRA is responsible for:

(1) contacting other involved MRAs and obtaining information about providers in their local service areas;

(2) coordinating communication between the individual, persons actively involved with the individual, the state MR facility, other involved MRAs and providers; and

(3) inviting a representative from each involved MRA to a meeting of the state MR facility's IDT to discuss the preferences and desires of the individual and persons actively involved with the individual regarding alternative living arrangements, as well as the service and support needs identified by the IDT, the individual, and persons actively involved with the individual.

(e) At the meeting described in subsection (d)(3) of this section or a later meeting of the IDT, state MR facility staff will begin the process of completing the community living profile as described in §412.278(c)(1) of this title (relating to Community Living/Discharge Plan for Alternative Living Arrangements).

(1) Copies of the completed profile will be sent to the individual, any actively involved persons, and the designated MRA within 14 calendar days of the IDT meeting at which it was initiated.

(2) If the preferred geographic location(s) of the individual is in the local service area of another MRA(s), the designated MRA will provide copies of the profile to the other involved MRA(s).

(f) The designated MRA will provide the individual, persons actively involved with the individual and the IDT with a list of the providers in the preferred geographic locations and current information prepared by the providers.

(g) The IDT will select providers to which the community living profile is to be sent. The providers selected must:

(1) consider any preferences and desires which may have been expressed by the individual or any persons actively involved with the individual;

(2) meet the needs of the individual, as determined by the IDT, including:

(A) medical and health;

(B) emotional and behavioral;

(C) transportation; and

(D) employment, vocational, and educational; and

(3) complement the individual's existing social relationships and support network.

(h) The IDT must ensure that the individual and persons actively involved with the individual have been informed that the community living profile will be shared with providers in accordance with §414.7(d) of this title (relating to When Consent for Disclosure is not Required: Clients Receiving MHMR Services).

(i) Within 14 calendar days of receiving the completed community living profile, the MRA will send the profile to the providers selected by the IDT. When more than one MRA is involved, the designated MRA will coordinate with the other involved MRAs to ensure that profiles are sent to all selected providers.

(j) The designated MRA must coordinate with the state MR facility and other involved MRAs, as appropriate, to assist the individual and persons actively involved with the individual, as appropriate, in making arrangements for visits to proposed providers. If an overnight visit is planned, the state MR facility will, prior to the visit, furnish the proposed provider with the following:

(1) identifying data including legal status and determined disability(ies);

(2) pertinent medical/medication information;

(3) behavioral data; and

(4) other pertinent treatment information.

(k) The state MR facility will send an adequate medication supply, clothing, personal items, and adaptive equipment with the individual at the time of the overnight visit.

(l) Following any visits to a proposed provider by the individual, the IDT will meet to select a provider and complete the community living/discharge plan.

(m) The IDT may request that the designated MRA facilitate the development of a specific alternative living arrangement if there is no arrangement in existence which meets the individual's service and support needs as described in the community living profile and the preferences and desires of the individual.

(n) If there is no consensus by the IDT concerning issues about the alternative living arrangement or other issues related to the individual's move as described in this section or in §412.277 of this title (relating to Arrangements for the Move to an Alternative Living Arrangement of an Individual Residing in a State MR Facility), the IDT will notify the head of the state MR facility within one working day of the date the IDT determines it cannot reach a consensus. The head of the state MR facility will name a review team, consistent with the state MR facility's written policies and procedures, to evaluate the situation and make a consensus recommendation to the head of the state MR facility within 21 calendar days.

(1) Within three working days of receiving the review team's recommendation, the head of the state MR facility will issue a written decision to:

(A) the staff members on the IDT;

(B) the individual; and

(C) any person(s) actively involved with the individual.

(2) The state MR facility will include with the written decision sent to the individual and each person who is actively involved with the individual a notice that the individual or actively involved person may request a review of the head of the facility's decision by the department's ombudsman in Central Office.

(A) The individual or actively involved person may request the review at any time prior to the individual moving from the state MR facility into an alternative living arrangement.

(B) The request for a review by the department's ombudsman may be made in writing to Consumer Services and Rights Protection, Ombudsman, Texas Department of Mental Health and Mental Retardation, P.O. Box 12668, Austin, Texas, 78711-2668, or by calling 1-800-252-8154.

(3) The ombudsman will decide whether the processes in this subchapter have been followed by reviewing relevant documentation from the IDT, the review team, the head of the facility, and the person who requested the review.

(A) The ombudsman will issue a written decision within 14 calendar days of the request to the person who requested the review and to the head of the state MR facility.

(B) If the ombudsman decides that the processes in this subchapter have been followed, then the head of the facility will take action to implement the decision referenced in paragraph (1) of this subsection.

(C) If the ombudsman decides that the processes in this subchapter have not been followed, then the head of the facility must take action to follow the processes in this subchapter.

Source Note: The provisions of this §904.103 adopted to be effective January 1, 2001, 25 TexReg 12746; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; transferred effective September 1, 2023, as published in the August 11, 2023, issue of the Texas Register, 48 TexReg 4397