SECTION 72.204. Texas Department of Mental Health and Mental Retardation (TXMHMR)

(a) Mission. The mission of the Texas Department of Mental Health and Mental Retardation (TXMHMR) is to offer an array of services which respond to the needs of people with mental illness and mental retardation and which enable them to make choices that result in lives of dignity and increased independence. Our vision is that the TXMHMR service system will become one that is permeated with a commitment to continuous quality improvement (CQI) that is truly customer-driven. It embraces the belief that large public systems even with their inherent regulatory roles and resource limitations can become highly personalized, highly responsive, and highly innovative.

(b) Financial and service responsibilities to persons with disabilities. The Texas MHMR Act requires that TXMHMR identify its priority populations and the minimum array of services necessary to address the needs of persons within these priority populations. This legislation also requires that services be offered first to those most in need and that state dollars be used only for services provided to the priority population.

(1) Mental retardation services.

(A) Mental retardation priority population.

(i) The priority population for mental retardation services consists of the 70,840 persons considered to be the most in need. That is approximately 15% of the 480,000 Texans with mental retardation. TXMHMR estimates that there are approximately 26,000 persons with mental retardation in the priority population who currently require our agency's services and are not receiving them.

(ii) TXMHMR's priority population for mental retardation services includes those persons who request and need services and possess one or more of the following conditions:

(I) mental retardation, as defined by the Health and Safety Code, Title 7, §591.003(13);

(II) autism, as defined in the current edition of the Diagnostic and Statistical Manual (DSM);

(III) eligibility for Early Childhood Intervention services; or

(IV) eligibility for Omnibus Budget Reconciliation Act of 1987-mandated services for mental retardation or a related condition as per specific legislation.

(iii) The presence of mental retardation must be determined through a recognized diagnosis and evaluation process or through the use of assessments performed by qualified professionals as per interagency memoranda of understanding. Results of evaluations by appropriately credentialed professionals can be used to determine the presence of autism. For persons with mental retardation or autism, the priority population includes only those individuals whose needs for services can be most appropriately met through programs currently or potentially offered by TXMHMR rather than some other service system. Services are to be offered in coordination with efforts of other agencies to ensure that all services are provided by agencies as required by laws, rules, and regulations. The priority population does not include persons whose service needs may be most appropriately met through other means, as determined by TXMHMR.

(iv) Persons who are members of the priority population are eligible to receive services from TXMHMR. Since resources are insufficient to meet all the service needs of all the members of the priority population, services should be provided to meet the most intense needs first.

(v) Service participant groups include only members of the priority populations. The purpose of grouping service participants is to provide a structure for gathering data about members of the priority population who have specific characteristics which seem to influence the type and intensity of services required to meet their needs. These groups are mutually exclusive. If an individual has characteristics of more than one group, assignment should be made to the group that most accurately characterizes the person's most intense service needs. No one group has priority over any other group.

(vi) Service participant groups are comprised of members of the priority population who:

(I) have a challenging behavior (CB) (with or without a mental illness diagnosis) or which requires frequent intervention or regular monitoring. The severity of the behavior is such that it interferes significantly with daily living or learning activities;

(II) have a severely challenging behavior (SB) (with or without a mental illness diagnosis). The severity of the behavior is such that it seriously threatens the health and safety of this person or others. The management of the behavior is a primary consideration in planning the individual's activities;

(III) have a severe physical disability (PD) as evidenced by a need for an ongoing program designed and monitored by a professionally qualified habilitation therapist or specialist. Such programs are designed to alleviate the primary condition and decrease the effects of any secondary disability. These disabilities may include, but are not limited to, eating problems, ambulation problems, severe sensory (tactile, visual, or auditory) impairments, and other major physical disabilities;

(IV) have a health care (HC) need so severe that its treatment and monitoring are the foremost considerations in planning the individual's activities. Immediate 24-hour response from nursing staff, weekly physician intervention, and monitoring of a health care plan by a professional nurse is often needed;

(V) need either training or support (TS) to enable or maintain their community arrangements for living, working, or training;

(VI) are eligible to receive early childhood intervention (ECI) services according to the following criteria.

(-a-) A child is eligible for ECI services if the child is under three years of age, including those children authorized for services as visually or auditory impaired children under the Texas Education Code.

(-b-) A child is eligible for ECI services if the child is documented as developmentally delayed or has a medically diagnosed physical or mental condition that has a high probability of resulting in developmental delay.

(B) Community center services.

(i) TXMHMR 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 local service 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 placements. Short and long-term residential care and developmental programs may also be a part of services.

(ii) Eligible individuals receive care at 31 of the 35 community MHMR centers across the state. The four centers that provide care only to persons with mental illness are the Life Resource Center, Texas Panhandle Mental Health Authority, Navarro County MHMR Center, and Riceland Regional Mental Health Authority. Priority is given to clients who are most in need of treatment and support services from the TXMHMR system.

(C) 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, case management services, diagnosis and screening, 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. Four of the five state centers provide short and/or long-term residential care and nonresidential service in areas of the state not served by state schools or community MHMR centers. The range of services includes vocational, medical and dental services, and physical, occupational, and recreational therapy. Also included are support services such as maintenance, food services, and laundry. Individuals have the opportunity to participate in activities occurring in the local community. Persons with special needs are served by qualified professionals with consultation from specialists in the medical, dental, and habilitation fields. The five state centers delivering inpatient services are located in Amarillo, Beaumont, El Paso, Harlingen, and Laredo. All of these centers except Beaumont have facilities that are certified as intermediate care facilities for the mentally retarded (ICF/MR).

(D) State school services.

(i) Community services.

(I) Community services provided by state schools are designed to meet the needs of persons who have returned to the community from institutional placement and/or to prevent eligible persons 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 also offered include work adjustment training, pre-vocational services, sheltered workshops, support work, and independent employment. Services are both residential and nonresidential.

(II) TXMHMR provides these services directly through 13 state schools located throughout Texas. The 13 state schools are certified as intermediate care facilities for the mentally retarded (ICF-MR). Persons' needs are assessed by interdisciplinary teams, then the services are provided which best meet their individual needs.

(ii) Campus-based services.

(I) Campus-based services include residential services, therapeutic care and treatment, meals, education, medical care, and recreation for persons with mental retardation. Because many individuals have visual and hearing problems, muscular and/or skeletal anomalies or metabolic and nervous disorders, the facility also helps them cope with or correct their physical disabilities.

(II) Under 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 persons at a matching rate of approximately 36% state and 64% federal. The Texas State Legislature appropriates general revenue funds to TXMHMR to cover the costs of operating the schools. The reimbursement obtained from the federal government is returned to the state treasury and is not reflected in TXMHMR's budget.

(2) Mental health services.

(A) Mental health priority population.

(i) There are an estimated 2.6 million persons with mental illness in Texas. TXMHMR's priority population consists of approximately 15% of these persons. It is estimated that in 1993, 347,248 of those were persons with a major diagnosis of mental illness and functional impairment. TXMHMR's estimates suggest that there are approximately 90,000 persons in the priority population who currently need our agency's services but are not receiving them.

(ii) The department's priority population for mental health services consist of:

(I) children and adolescents under age 18 who have a diagnosis of mental illness, exhibit severe emotional or social disabilities which are life-threatening, or require prolonged intervention; and

(II) adults who have severe and persistent mental illnesses, such as schizophrenia, major depression, manic depressive disorders, or other severely disabling mental disorders which require crisis resolution or ongoing and long-term support and treatment.

(iii) In targeting services to the priority populations, the choice of and admission to services is determined jointly by the person seeking service and the provider. Factors used to make these determinations are the level of functioning of the individual, the need of the individual, and the availability of resources. TXMHMR funding is directed to provide the identified core services which are designed to meet the needs of these priority populations. Providers who wish to offer services to people other than those in the priority populations may do so using non-department funds.

(iv) The agency's strategic plan also identifies groups within the priority population with special needs. These include:

(I) children and adolescents;

(II) older adults;

(III) minorities; and

(IV) persons with mental illness in the criminal justice system.

(B) 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, two state centers, and one state center for youth. The average daily census in these state facilities is approximately 3,300. Nearly 18,000 persons receive residential services annually.

(ii) All state hospitals are accredited by the Joint Commission on Accreditation of Hospitals (JCAH). Certain units providing services for elderly patients are also certified to receive Medicare funds.

(C) Community services.

(i) Community mental health services are provided by 63 mental health authorities. Included in these authorities are 35 community mental health and mental retardation centers which provide mental health services under contract with TXMHMR. The remaining mental health authorities are state hospital or state center programs provided through community service centers which are located in the local service areas of the hospitals or state centers. These programs currently provide services to over 150,000 individuals annually.

(ii) 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.

(iii) Services provided by the local mental health authorities consist of individual support services; family support services; psychosocial rehabilitation services; service coordination; and residential services and housing, which may include supervised living arrangements. The crisis stabilization component of the residential services must be available to the residents of a mental health authority.

(D) Legislative mandates.

(i) The Texas State Legislature and TXMHMR require the provision of core services aimed at meeting individual needs and enhancing personal skills for optimum community living.

(ii) The Texas Mental Health and Mental Retardation Act specifies the core services as:

(I) 24-hour emergency screening and rapid crisis stabilization services;

(II) community-based crisis residential service or hospitalization;

(III) community-based assessments, including the development of interdisciplinary treatment plans and diagnosis and evaluation;

(IV) medication-related services, including medication clinics, laboratory monitoring, medication education, mental health maintenance education, and the provision of medication;

(V) family support services, including respite care;

(VI) psychosocial rehabilitation services, including social support activities, independent living skills, and vocational training; and

(VII) case management services.

(c) Service delivery data. The following data may be obtained by contacting the administrative head of the section or by contacting the director of planning and policy development, at [phone] or STS 824-4698.

(1) Public Information Office. This office produces the annual report and a directory of TXMHMR services. Telephone: [phone].

(2) Strategic planning. This office is responsible for demographic data and long-range planning. Telephone: [phone].

(3) Financial services. This area publishes the TXMHMR Annual Operating Budget and the Biennial Legislative Appropriations Request. Telephone: [phone].

(4) Information services. This office processes client data information from client assignment and registration system (CARE). Telephone: [phone].

(5) Mental health services. Questions regarding mental health services program and/or policy issues can be directed to this section. Telephone: adults [phone] and adolescents and children [phone].

(6) Mental retardation services. This section responds to inquiries about Mental Retardation Services Program and/or policy issues. Telephone: [phone].

(7) Consumer services and rights protection services. This area is responsible for information regarding issues or statistics regarding client rights. Telephone: [phone].

Source Note: The provisions of this §72.204 adopted to be effective September 1, 1993, 18 TexReg 5595.