Texas 2021 - 87th Regular

Texas House Bill HB1824 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	By: Price, et al. (Senate Sponsor - Nelson) H.B. No. 1824
2		-	(In the Senate - Received from the House May 10, 2021;
3		-	May 10, 2021, read first time and referred to Committee on Health &
4		-	Human Services; May 21, 2021, reported favorably by the following
5		-	vote: Yeas 9, Nays 0; May 21, 2021, sent to printer.)
6		-	Click here to see the committee vote
	1	+	87R20945 EAS-F
	2	+	By: Price, Smith, Coleman, Rose, Allison H.B. No. 1824
7	3
8	4
9	5		A BILL TO BE ENTITLED
10	6		AN ACT
11	7		relating to the continuity of services received by individuals
12	8		receiving services at state hospitals and state supported living
13	9		centers, the establishment of a pilot program to provide behavioral
14	10		health or psychiatric services to certain residential care facility
15	11		residents, and court orders for psychoactive medication for certain
16	12		patients.
17	13		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
18	14		SECTION 1. Section 574.102, Health and Safety Code, is
19	15		amended to read as follows:
20	16		Sec. 574.102. APPLICATION OF SUBCHAPTER. (a) This
21	17		subchapter applies to the application of medication to a patient:
22	18		(1) subject to a court order for mental health
23	19		services under this chapter or other law; or
24	20		(2) transferred from a residential care facility to an
25	21		inpatient mental health facility under Section 594.032.
26	22		(b) For purposes of this subchapter, a reference to a
27	23		patient includes a person described by Subsection (a).
28	24		SECTION 2. The heading to Section 574.103, Health and
29	25		Safety Code, is amended to read as follows:
30	26		Sec. 574.103. ADMINISTRATION OF MEDICATION TO PATIENT UNDER
31	27		COURT-ORDERED MENTAL HEALTH SERVICES OR TRANSFERRED FROM A
32	28		RESIDENTIAL CARE FACILITY TO AN INPATIENT MENTAL HEALTH FACILITY.
33	29		SECTION 3. Section 574.103(b), Health and Safety Code, is
34	30		amended to read as follows:
35	31		(b) A person may not administer a psychoactive medication to
36	32		a patient under court-ordered inpatient mental health services or
37	33		to a person transferred from a residential care facility to an
38	34		inpatient mental health facility under Section 594.032 who refuses
39	35		to take the medication voluntarily unless:
40	36		(1) the patient is having a medication-related
41	37		emergency;
42	38		(2) the patient is under an order issued under Section
43	39		574.106 or 592.156 authorizing the administration of the medication
44	40		regardless of the patient's refusal; or
45	41		(3) the patient is a ward who is 18 years of age or
46	42		older and the guardian of the person of the ward consents to the
47	43		administration of psychoactive medication regardless of the ward's
48	44		expressed preferences regarding treatment with psychoactive
49	45		medication.
50	46		SECTION 4. Sections 574.104(a) and (b), Health and Safety
51	47		Code, are amended to read as follows:
52	48		(a) A physician who is treating a patient in an inpatient
53	49		setting may, on behalf of the state, file an application in a
54	50		probate court or a court with probate jurisdiction for an order to
55	51		authorize the administration of a psychoactive medication
56	52		regardless of the patient's refusal if:
57	53		(1) the physician believes that the patient lacks the
58	54		capacity to make a decision regarding the administration of the
59	55		psychoactive medication;
60	56		(2) the physician determines that the medication is
61	57		the proper course of treatment for the patient;
62	58		(3) the patient is:
63	59		(A) under an order for inpatient mental health
64	60		services under this chapter or other law;
65	61		(B) transferred from a residential care facility
66	62		to an inpatient mental health facility under Section 594.032; or
67	63		(C) the subject of a filed [an] application for
68	64		court-ordered mental health services under Section 574.034 or [,
69	65		574.0345,] 574.035 [, or 574.0355 has been filed for the patient];
70	66		and
71	67		(4) the patient, verbally or by other indication,
72	68		refuses to take the medication voluntarily.
73	69		(b) An application filed under this section must state:
74	70		(1) that the physician believes that the patient lacks
75	71		the capacity to make a decision regarding administration of the
76	72		psychoactive medication and the reasons for that belief;
77	73		(2) each medication the physician wants the court to
78	74		compel the patient to take;
79	75		(3) whether an application for court-ordered mental
80	76		health services under Section 574.034, 574.0345, 574.035, or
81	77		574.0355 has been filed;
82	78		(4) whether a court order described by Subsection
83	79		(a)(3) for [inpatient mental health] services for the patient has
84	80		been issued and, if so, under what authority it was issued;
85	81		(5) the physician's diagnosis of the patient; and
86	82		(6) the proposed method for administering the
87	83		medication and, if the method is not customary, an explanation
88	84		justifying the departure from the customary methods.
89	85		SECTION 5. Sections 574.106(a) and (a-1), Health and Safety
90	86		Code, are amended to read as follows:
91	87		(a) The court may issue an order authorizing the
92	88		administration of one or more classes of psychoactive medication to
93	89		a patient who:
94	90		(1) is described by Section 574.102(a) [under a court
95	91		order to receive inpatient mental health services]; or
96	92		(2) is in custody awaiting trial in a criminal
97	93		proceeding and was ordered to receive inpatient mental health
98	94		services in the six months preceding a hearing under this section.
99	95		(a-1) The court may issue an order under this section only
100	96		if the court finds by clear and convincing evidence after the
101	97		hearing:
102	98		(1) that the patient lacks the capacity to make a
103	99		decision regarding the administration of the proposed medication
104	100		and treatment with the proposed medication is in the best interest
105	101		of the patient; or
106	102		(2) if the patient was ordered to receive inpatient
107	103		mental health services by a criminal court with jurisdiction over
108	104		the patient, that treatment with the proposed medication is in the
109	105		best interest of the patient and either:
110	106		(A) the patient presents a danger to the patient
111	107		or others in the inpatient mental health facility in which the
112	108		patient is being treated as a result of a mental illness [disorder
113	109		or mental defect] as determined under Section 574.1065; or
114	110		(B) the patient:
115	111		(i) has remained confined in a correctional
116	112		facility, as defined by Section 1.07, Penal Code, for a period
117	113		exceeding 72 hours while awaiting transfer for competency
118	114		restoration treatment; and
119	115		(ii) presents a danger to the patient or
120	116		others in the correctional facility as a result of a mental illness
121	117		[disorder or mental defect] as determined under Section 574.1065.
122	118		SECTION 6. Section 574.107, Health and Safety Code, is
123	119		amended by amending Subsection (a) and adding Subsection (c) to
124	120		read as follows:
125	121		(a) The costs for a hearing under this subchapter for a
126	122		patient committed under this chapter shall be paid in accordance
127	123		with Sections 571.017 and 571.018.
128	124		(c) The costs for a hearing under this subchapter for a
129	125		patient committed under Chapter 593 shall be paid by the county that
130	126		ordered the commitment under that chapter.
131	127		SECTION 7. Section 574.110, Health and Safety Code, is
132	128		amended by amending Subsection (a) and adding Subsection (a-1) to
133	129		read as follows:
134	130		(a) An [Except as provided by Subsection (b), an] order
135	131		issued under Section 574.106 for a patient that is committed under
136	132		this chapter, other than a patient to whom Subsection (a-1) or (b)
137	133		applies, expires on the expiration or termination date of the order
138	134		for temporary or extended mental health services in effect when the
139	135		order for psychoactive medication is issued.
140	136		(a-1) An order issued under Section 574.106 for a patient
141	137		that is committed under Chapter 593 expires as provided by Section
142	138		592.160.
143	139		SECTION 8. Section 576.025(a), Health and Safety Code, is
144	140		amended to read as follows:
145	141		(a) A person may not administer a psychoactive medication to
146	142		a patient receiving voluntary or involuntary mental health services
147	143		who refuses the administration unless:
148	144		(1) the patient is having a medication-related
149	145		emergency;
150	146		(2) the patient is younger than 16 years of age, or the
151	147		patient is younger than 18 years of age and is a patient admitted
152	148		for voluntary mental health services under Section 572.002(3)(B),
153	149		and the patient's parent, managing conservator, or guardian
154	150		consents to the administration on behalf of the patient;
155	151		(3) the refusing patient's representative authorized
156	152		by law to consent on behalf of the patient has consented to the
157	153		administration;
158	154		(4) the administration of the medication regardless of
159	155		the patient's refusal is authorized by an order issued under
160	156		Section 574.106 or 592.156; or
161	157		(5) the administration of the medication regardless of
162	158		the patient's refusal is authorized by an order issued under
163	159		Article 46B.086, Code of Criminal Procedure.
164	160		SECTION 9. Section 592.152(a), Health and Safety Code, is
165	161		amended to read as follows:
166	162		(a) A person may not administer a psychoactive medication to
167	163		a client receiving voluntary or involuntary residential care
168	164		services who refuses the administration unless:
169	165		(1) the client is having a medication-related
170	166		emergency;
171	167		(2) the refusing client's representative authorized by
172	168		law to consent on behalf of the client has consented to the
173	169		administration;
174	170		(3) the administration of the medication regardless of
175	171		the client's refusal is authorized by an order issued under Section
176	172		574.106 or 592.156; or
177	173		(4) the administration of the medication regardless of
178	174		the client's refusal is authorized by an order issued under Article
179	175		46B.086, Code of Criminal Procedure.
180	176		SECTION 10. Section 592.153(b), Health and Safety Code, is
181	177		amended to read as follows:
182	178		(b) A person may not administer a psychoactive medication to
183	179		a client who refuses to take the medication voluntarily unless:
184	180		(1) the client is having a medication-related
185	181		emergency;
186	182		(2) the client is under an order issued under Section
187	183		574.106 or 592.156 authorizing the administration of the medication
188	184		regardless of the client's refusal; or
189	185		(3) the client is a ward who is 18 years of age or older
190	186		and the guardian of the person of the ward consents to the
191	187		administration of psychoactive medication regardless of the ward's
192	188		expressed preferences regarding treatment with psychoactive
193	189		medication.
194	190		SECTION 11. Chapter 594, Health and Safety Code, is amended
195	191		by adding Subchapter D to read as follows:
196	192		SUBCHAPTER D. TEMPORARY TRANSFER BETWEEN RESIDENTIAL CARE
197	193		FACILITIES PILOT PROGRAM
198	194		Sec. 594.101. DEFINITIONS. In this subchapter:
199	195		(1) "Alternate residential care facility" means a
200	196		residential care facility other than the one in which a resident
201	197		resides prior to a temporary transfer.
202	198		(2) "Local intellectual and developmental disability
203	199		authority" has the meaning assigned by Section 531.002.
204	200		(3) "Originating residential care facility" means the
205	201		residential care facility at which the resident resides prior to a
206	202		temporary transfer.
207	203		(4) "State supported living center" has the meaning
208	204		assigned by Section 531.002.
209	205		(5) "Temporary transfer" means the transfer of a
210	206		resident from the originating residential care facility to an
211	207		alternate residential care facility to receive behavioral health or
212	208		psychiatric services for a limited time.
213	209		Sec. 594.102. TEMPORARY TRANSFERS BETWEEN RESIDENTIAL CARE
214	210		FACILITIES PILOT PROGRAM. (a) The commission may establish a pilot
215	211		program for the purpose of providing for temporary transfers of
216	212		residents from originating residential care facilities to
217	213		alternate residential care facilities to provide behavioral health
218	214		or psychiatric services for those residents. The pilot program
219	215		must include:
220	216		(1) one alternate residential care facility for
221	217		psychiatric services; and
222	218		(2) one or two alternate residential care facilities
223	219		for intensive behavioral health services.
224	220		(b) The executive commissioner, in consultation with the
225	221		work group described by Section 594.103, by rule shall specify the
226	222		types of information the commission must collect during the pilot
227	223		program to:
228	224		(1) evaluate the outcome of the pilot program;
229	225		(2) ensure the rights of persons in the pilot program
230	226		are commensurate with the rights of persons at the originating
231	227		facility, as appropriate; and
232	228		(3) ensure services provided under the pilot program
233	229		meet the applicable requirements under Section 594.108(c)(4) and
234	230		594.109(f)(4).
235	231		Sec. 594.103. WORK GROUP MEMBERS. If a pilot program is
236	232		established under this subchapter, the executive commissioner
237	233		shall establish a work group to consult in adopting the rules
238	234		described by Section 594.102(b). The work group is composed of:
239	235		(1) two representatives who are intellectual
240	236		disability advocates, one of whom is from Disability Rights Texas;
241	237		(2) one representative from a local intellectual and
242	238		developmental disability authority;
243	239		(3) a board certified behavioral analyst with
244	240		expertise working with individuals with intellectual disabilities;
245	241		(4) a psychiatrist with expertise working with
246	242		individuals with intellectual disabilities;
247	243		(5) a psychologist with expertise working with
248	244		individuals with intellectual disabilities;
249	245		(6) a current or former resident of a state supported
250	246		living center;
251	247		(7) a family member or guardian of a current or former
252	248		resident of a state supported living center; and
253	249		(8) any other individual the executive commissioner
254	250		considers appropriate to appoint to the work group.
255	251		Sec. 594.104. TEMPORARY TRANSFER LIMITATIONS. A temporary
256	252		transfer under a pilot program established under this subchapter
257	253		may not be considered a permanent transfer and is not a discharge
258	254		from the originating residential care facility.
259	255		Sec. 594.105. TEMPORARY TRANSFER OF VOLUNTARY RESIDENT. A
260	256		voluntary resident may not be temporarily transferred to an
261	257		alternate residential care facility under a pilot program under
262	258		this subchapter without legally adequate consent to the transfer.
263	259		Sec. 594.106. RETURN OF RESIDENT. A resident shall be
264	260		returned to the originating residential care facility after
265	261		participating in a pilot program under this subchapter. The
266	262		originating residential care facility shall maintain a vacancy for
267	263		the resident while the resident participates in the pilot program.
268	264		Sec. 594.107. TRANSFER OR DISCHARGE OF RESIDENT. A
269	265		resident who is transferred to an alternate residential care
270	266		facility under a pilot program under this subchapter who no longer
271	267		requires treatment at a residential care facility may be
272	268		transferred to an alternative placement or discharged directly from
273	269		the alternate residential care facility without returning to the
274	270		originating residential care facility.
275	271		Sec. 594.108. ALTERNATE RESIDENTIAL CARE FACILITY FOR
276	272		PSYCHIATRIC SERVICES. (a) Before the temporary transfer of a
277	273		resident to an alternate psychiatric residential care unit under a
278	274		pilot program under this subchapter, the resident must be examined
279	275		by a licensed psychiatrist who indicates that the resident is
280	276		presenting with symptoms of mental illness to the extent that care,
281	277		treatment, and rehabilitation cannot be provided in the originating
282	278		residential care facility.
283	279		(b) The commission may transfer a resident under a pilot
284	280		program under this subchapter for an initial period not to exceed 60
285	281		days for the purposes of receiving psychiatric services.
286	282		(c) The alternate residential care facility for psychiatric
287	283		services operated under a pilot program under this subchapter must:
288	284		(1) use an interdisciplinary treatment team to provide
289	285		clinical treatment that is:
290	286		(A) directed toward lessening the signs and
291	287		symptoms of mental illness; and
292	288		(B) similar to the clinical treatment provided at
293	289		a state psychiatric hospital;
294	290		(2) employ or contract for the services of at least one
295	291		psychiatrist who has expertise in diagnosing and treating persons
296	292		with intellectual disabilities;
297	293		(3) employ a board certified behavioral analyst who
298	294		has expertise in diagnosing and treating persons with intellectual
299	295		disabilities;
300	296		(4) assign staff members to residents participating in
301	297		the pilot program at an average ratio not to exceed:
302	298		(A) three residents to one direct support
303	299		professional during the day and evening; and
304	300		(B) six residents to one direct support
305	301		professional over night;
306	302		(5) provide additional training to direct support
307	303		professionals working on the alternate psychiatric care unit
308	304		regarding the service delivery system for residents served on that
309	305		unit; and
310	306		(6) ensure that each psychiatric unit complies with
311	307		the requirements for ICF-IID certification under the Medicaid
312	308		program, as appropriate.
313	309		Sec. 594.109. ALTERNATE RESIDENTIAL CARE FACILITY FOR
314	310		BEHAVIORAL HEALTH SERVICES. (a) Except as provided by Subsection
315	311		(c), before the temporary transfer of a resident to an intensive
316	312		behavioral health unit under a pilot program under this subchapter,
317	313		an interdisciplinary team must determine whether the resident is an
318	314		individual who, despite an interdisciplinary team having on two or
319	315		more occasions developed or revised an interdisciplinary team
320	316		action plan in response to the occurrence of a significant event
321	317		described by Subsection (b), and appropriate treatment and
322	318		implementation of the plan, including treatment targeted to the
323	319		individual's challenging behaviors, remains likely to cause
324	320		substantial bodily injury to others and requires an intensive
325	321		behavioral health environment to continue treatment and protect
326	322		other residents or the general public.
327	323		(b) For purposes of Subsection (a), a significant event
328	324		includes:
329	325		(1) the rate of the resident's challenging behavior
330	326		has remained consistently above baseline for at least four of six
331	327		months after implementation of the interdisciplinary team action
332	328		plan; and
333	329		(2) either:
334	330		(A) the intensity of the resident's behavior has
335	331		caused serious injury to others; or
336	332		(B) the resident's physical aggression towards
337	333		others has resulted in more than three crisis restraints in the last
338	334		30 days.
339	335		(c) The associate commissioner of the commission with
340	336		responsibility for state supported living centers may make an
341	337		exception to admission criteria to require a resident to
342	338		participate in a pilot program under this subchapter. The
343	339		exception must be based on a determination that the resident's
344	340		behavior poses an imminent threat to others.
345	341		(d) In making a determination under Subsection (a), the
346	342		interdisciplinary team shall document and collect evidence
347	343		regarding the reason the resident requires an intensive behavioral
348	344		health environment to continue treatment and protect other
349	345		residents or the general public.
350	346		(e) The interdisciplinary team shall provide the team's
351	347		findings, including any documentation and evidence regarding the
352	348		proposed resident, regarding whether the proposed resident should
353	349		participate in a pilot program under this subchapter to:
354	350		(1) the associate commissioner of the commission with
355	351		responsibility for state supported living centers;
356	352		(2) the director of the state supported living center;
357	353		(3) the independent ombudsman;
358	354		(4) the resident or the resident's parent, if the
359	355		resident is a minor; and
360	356		(5) the resident's legally authorized representative.
361	357		(f) An alternate residential care facility for behavioral
362	358		health services operated under a pilot program under this
363	359		subchapter must:
364	360		(1) use an interdisciplinary treatment team that is
365	361		specially trained to provide clinical treatment designed to serve
366	362		residents who meet criteria for the pilot program;
367	363		(2) employ board certified behavioral analysts with
368	364		expertise in diagnosing and treating persons with intellectual
369	365		disabilities to provide a ratio of one analyst serving each twelve
370	366		beds full-time in accordance with commission rules providing
371	367		appropriate procedures for maintaining that ratio;
372	368		(3) employ a professional qualified to provide
373	369		counseling consistent with evidence-based, trauma-informed
374	370		treatment;
375	371		(4) assign staff members to residents participating in
376	372		the program at an average ratio not to exceed:
377	373		(A) three residents to one direct support
378	374		professional during the day and evening; and
379	375		(B) six residents to one direct support
380	376		professional at night;
381	377		(5) provide additional training to direct support
382	378		professionals working at the alternate residential care facility
383	379		regarding the service delivery system for residents served at that
384	380		facility; and
385	381		(6) ensure that the intensive behavioral health units
386	382		comply with the requirements for ICF-IID certification under the
387	383		Medicaid program, as appropriate.
388	384		(g) Except as provided by Subsection (h), a resident
389	385		transfer to an alternate residential care facility for behavioral
390	386		health services under a pilot program under this subchapter may not
391	387		exceed six months.
392	388		(h) The initial period described by Subsection (g) may be
393	389		extended by an additional, one-time period of three months if:
394	390		(1) an interdisciplinary team determines:
395	391		(A) the resident meets the standard for admission
396	392		under this section; and
397	393		(B) an extension of the initial period will
398	394		likely enable the resident to no longer meet the criteria for the
399	395		pilot program within the period of the extension; and
400	396		(2) the extension is approved by the associate
401	397		commissioner of the commission with responsibility for state
402	398		supported living centers.
403	399		(i) Except as provided by Subsection (k), if at any time
404	400		during a resident's temporary transfer to a pilot program under
405	401		this subchapter, the interdisciplinary treatment team determines
406	402		that the resident no longer requires an intensive behavioral health
407	403		environment to continue treatment and protect public safety, the
408	404		resident shall be transferred back to the originating residential
409	405		care facility not later than the seventh day after the date the
410	406		interdisciplinary team makes that determination.
411	407		(j) Except as provided by Subsection (k), at the end of the
412	408		period described by Subsection (g) or (h), as applicable, the
413	409		resident shall be returned to the originating residential care
414	410		facility not later than the seventh day after the expiration of that
415	411		period.
416	412		(k) If the associate commissioner of the commission with
417	413		responsibility for state supported living centers determines that
418	414		there are extenuating circumstances preventing the transfer within
419	415		the period described by Subsection (i) or (j), as applicable, the
420	416		associate commissioner may extend the applicable period by an
421	417		additional three days and may extend each of those additional
422	418		three-day periods by an additional three days for as long as the
423	419		occurrence of those extenuating circumstances prevent the
424	420		resident's transfer. For purposes of this subsection, "extenuating
425	421		circumstances" include extremely hazardous weather conditions or
426	422		another disaster that prevents the timely transfer of a resident.
427	423		Sec. 594.110. ADMINISTRATIVE HEARINGS. (a) A resident is
428	424		entitled to an expedited administrative hearing under Section
429	425		594.015 to challenge the resident's required participation under
430	426		Section 594.109(c) in a pilot program under this subchapter. The
431	427		hearing must be held not later than seven days after the date the
432	428		associate commissioner determines that the resident should
433	429		participate in the pilot program.
434	430		(b) A resident who is subject to a transfer decision
435	431		described by Section 594.109 is entitled to an administrative
436	432		hearing under Section 594.015. The hearing shall be limited to
437	433		determining whether the transfer decision complies with Section
438	434		594.109. A resident may waive the right to a hearing, but if a
439	435		hearing is requested the resident may not be transferred until
440	436		after the administrative hearing.
441	437		(c) A resident is entitled to an administrative hearing with
442	438		the commission to contest an extension described by Section
443	439		594.109(h).
444	440		Sec. 594.111. RIGHT TO APPEAL. An individual may appeal a
445	441		decision made at a hearing described by Section 594.110 by filing
446	442		the appeal in a district court in Travis County not later than the
447	443		30th day after the date a final order is provided to the individual.
448	444		An appeal under this section is by trial de novo.
449	445		SECTION 12. Not later than November 1, 2022, the Health and
450	446		Human Services Commission shall consult with the work group
451	447		described by Section 594.103, Health and Safety Code, as added by
452	448		this Act, and adopt any necessary rules to implement Subchapter D,
453	449		Chapter 594, Health and Safety Code, as added by this Act.
454	450		SECTION 13. This Act takes effect immediately if it
455	451		receives a vote of two-thirds of all the members elected to each
456	452		house, as provided by Section 39, Article III, Texas Constitution.
457	453		If this Act does not receive the vote necessary for immediate
458	454		effect, this Act takes effect September 1, 2021.
459		-	* * * * *