PART 1. HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 748. MINIMUM STANDARDS FOR GENERAL RESIDENTIAL OPERATIONS
The Texas Health and Human Services Commission (HHSC) adopts amendments to §§748.103, 748.1205, 748.1219, 748.1271, and 748.1337; new §§748.124 - 748.126; and the repeal of §748.125.
New §748.125 is adopted with changes to the proposed text as published in the May 13, 2022, issue of the Texas Register (47 TexReg 2829). This rule will be republished.
Amendments to §§748.103, 748.1205, 748.1219, 748.1271, and 748.1337; new §748.124 and §748.126; and the repeal of §748.125 are adopted without changes to the proposed text as published in the May 13, 2022, issue of the Texas Register (47 TexReg 2829). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The amendments, new sections, and repeal are necessary to comply with SECTION 20 of Senate Bill 1896, 87th Legislature, Regular Session, 2021, that added §42.0433 to Texas Human Resources Code (HRC). New HRC §42.0433 requires HHSC to adopt a model suicide prevention, intervention, and postvention policy for use by residential child-care facilities. This section also requires each residential child-care facility to adopt either the model policy or another suicide prevention, intervention, and postvention policy that has been approved by the Executive Commissioner of HHSC. The adopted rules implement these changes for general residential operations (GROs).
COMMENTS
The 31-day comment period ended June 13, 2022. During this period, HHSC received 13 comments regarding the proposed rules from two commenters, the Texas Alliance of Child and Family Services and Disability Rights Texas. A summary of comments relating to the rules and HHSC's responses follows.
Comment: Regarding §748.124(a)(2)(C) and §748.125(c)(1), the commenter said that the annual suicide prevention training required by the model suicide prevention, intervention, and postvention policy or another suicide prevention, intervention, and postvention policy approved by the Executive Commissioner of HHSC should be competency based.
Response: HHSC disagrees with the comment and declines to revise the rules to require competency-based training for either policy. HRC §42.0433 does not require that the training be competency based. In addition, requiring the trainings to be competency-based would likely result in additional costs and administrative and regulatory burdens to providers. While HHSC will not make further changes to these rules in response to this comment, HHSC may consider the recommendation during future revisions to Chapter 748.
Comment: Regarding §748.125(b)(3), the commenter expressed concern over the breadth of risk factors of suicide listed and said that every child in foster care will have at least one or more of these factors. The commenter encouraged technical assistance, state-approved training, or both to help clarify the distinctions between risk factors and warning signs and to prevent a child from being given treatment that is not indicated based on a response to the identification of risk factors.
Response: HHSC agrees that technical assistance and training will be beneficial. No rule changes are required since the request is for technical assistance and training. The curriculum for the training in subsection §748.125(c)(1)(A) requires a discussion of the risk factors, protective factors, and warning signs of suicide. HHSC will develop a technical assistance document that discusses the distinctions between these factors and warning signs. HHSC will also explore the options of training providers and developing a training curriculum that may be used by providers.
Comment: Regarding §748.125(b)(7), the commenter voiced appreciation for the clarity and helpfulness of the list of warning signs.
Response: HHSC appreciates the comment. No rule changes are required.
Regarding §748.125(c)(1), HHSC received two comments.
Comment 1: The commenter stated that HHSC went beyond the requirements of the statute by requiring one hour of training for caregivers that are not employees. The statute only requires one hour of training for employees.
Response 1: HHSC disagrees with the comment and declines to revise the rule. While HRC §42.0433 does not require training for non-employees, it also does not restrict HHSC from expanding the requirement to non-employees. Moreover, HRC §42.042(e)(1) gives HHSC the authority to promulgate minimum standards that promote the health, safety, and welfare of children in regulated facilities. As the commenter stated, the prevention of suicide is a "critically important issue"; as reflected in this comment, the topic of suicide prevention is linked to the health, safety, and welfare of children in care. It is critical that all caregivers in GROs, whether the caregiver is an employee or a volunteer, be trained to know the risk factors, protective factors, and warning signs of suicide; understand safety planning and how to implement a safety plan; and understand suicide screenings.
Comment 2: The commenter stated that the statute requires HHSC to "provide to a residential child-care facility any technical assistance necessary to adopt or implement a suicide prevention, intervention, or postvention policy." A component of that policy is training, and the commenter recommended that HHSC provide helpful information to include specific criteria for training and any known trainings that would meet HHSC's requirements.
Response 2: HHSC agrees with the comment, but no rule changes are required. The basic curriculum for the training is provided in the rules. HHSC will explore the options of training providers and developing a training curriculum that may be used by providers. HHSC will also include a non-exhaustive list of training that meet this requirement in a Helpful Information box in the courtesy minimum standards publication.
Regarding §748.125(d), HHSC received two comments.
Comment 1: The commenter stated that the requirements to conduct a screening every 30 days for a residential treatment center and every 90 days for all other types of residential care are at odds with normalcy and may exacerbate contagion. The commenter recommended a more nuanced balance: at admission for children over 10, with a history or risk of suicide, or a request by the parent; and at the required frequency and duration recommended by the treating professional if a prior screening has placed the child at potential risk of suicide, or immediately if the child begins to demonstrate warning signs of suicide.
Response 1: HHSC disagrees with the comment and declines to revise the rule. Peer-reviewed, published research studies have not found that asking a child about suicidal thoughts results in a statistically significant increase in suicidal thoughts. Rather, multiple studies indicate that acknowledging and talking about suicide reduces suicidal thoughts and may lead to improvements in mental health in those receiving treatment. In fact, not asking a child about suicidal thoughts may lead to a lack of appropriate and timely intervention. This also supports requiring screenings to be routine (i.e., every 30 days or 90 days) and not just when recommended by a treating professional or as warning signs appear. The requirement for routine screenings will reduce the possibility of missing a child's risk of suicide.
Comment 2: The commenter asked if there were any screening tools that would not require asking a child questions each time that the child is screened.
Response 2: HHSC is not aware of any screening tool or accepted practice that would not require involving the child in answering screening tool questions each time the child is screened; however, different screening tools have varying methods that may be appropriate in obtaining information from a child.
Comment: Regarding §748.125(d)(2), the commenter recommended that HHSC, as part of technical assistance, list the screening tools that meet the criteria in the rules, especially those "supported by evidence-based research demonstrating the tool performs reliably regardless of who administers the tool or performs the scoring or rating."
Response: HHSC agrees with the comment and will include a non-exhaustive list of screening tools that meet this requirement in a Helpful Information box in the courtesy minimum standards publication. No rule change is required.
Comment: Regarding §748.125(d)(4)(B)(i), the commenter stated that the requirement to administer a screening to a child based on a history of suicide attempts or thoughts should be more specific.
Response: HHSC agrees with the comment and has revised the rule to clarify that a GRO would have to receive information at the time of the admission indicating that a child younger than 10 has a history of suicide attempts or suicidal thoughts.
Comment: Regarding §748.125(f)(1), the commenter expressed concerns with the challenge of coordinating a meeting with two members of the service planning team when a child returns from hospitalization and recommended any meeting and follow up steps be in accordance with the child's discharge plan from the treating facility.
Response: HHSC partially agrees with the comment. HHSC agrees that requiring two service planning team members to participate in a meeting could cause coordination issues and changed the rule to only require a professional level service provider to meet with the child. However, HHSC disagrees that follow-up with a child should be in accordance with a child's discharge plan from the treating facility following a hospitalization for a mental health crisis and declines to revise the requirement for the meeting with the child. HRC §42.0433 requires the model policy to support children who return to an operation following hospitalization for a mental health condition. The statutory requirement is not limited to a hospitalization for suicide related factors. In addition, peer-reviewed, published research shows that individuals are at high risk of suicide following discharge from hospitalization regardless of the reason for admission. The requirement to meet with the child within 24 hours of the child's return to the operation ensures children who are at an increased risk of suicide are safe.
Comment: Regarding §748.125(f)(2)(A), the commenter expressed concern with the language requiring suicide monitoring for a child who was not admitted for suicide related factors and recommended that the ongoing risk screenings for suicide be in accordance with the child's discharge plan rather than weekly.
Response: HHSC disagrees with the comment and declines to revise the rule. HRC §42.0433 requires the model policy to support children who return to an operation following a hospitalization for a mental health condition. The requirement is not limited to a hospitalization for suicide related factors. Peer-reviewed, published research shows that individuals are at high risk of suicide following discharge from hospitalization regardless of the reason for admission. The purpose of these additional steps is to ensure children who are at an increased risk of suicide are safe.
Comment: Regarding §748.1337(a), the commenter noted that the proposed rules list trauma as a risk factor for suicide and that existing rules for service planning require the operation to integrate trauma informed care in the care, treatment, and management of each child based on the needs identified in the admission assessment; however, the commenter noted existing rules do not specify when and operation must complete a trauma assessment. As such, the commenter recommended clarifying that a trauma assessment must be performed at the time of admission.
Response: HHSC disagrees with the comment and declines to revise the rule. Section 748.1337 requires a child's initial service plan to include information about the child's trauma history and triggers. In turn, §748.125(b)(3)(D) includes such history as a risk factor for suicide. It would be beyond the scope of this rule project to add an additional general requirement for a trauma assessment at the time of admission. Moreover, any such change would require specific notice and an opportunity for the public to comment on it. While HHSC will not make further changes to §748.1337(a) in response to this comment, HHSC may consider the recommendation during future revisions to Chapter 748.
HHSC noticed during the publication of the proposed rules that the title of Chapter 748, Subchapter C, Division 1 was not consistent with the title of Chapter 749, Subchapter C, Division 1. HHSC is updating the division titles to make them consistent. In addition, HHSC made a minor editorial change to correct a citation in §748.125(g)(2)(D)(i).
SUBCHAPTER C. ORGANIZATION AND ADMINISTRATION
DIVISION 1. REQUIRED PLANS AND POLICIES, INCLUDING DURING THE APPLICATION PROCESS
26 TAC §§748.103, 748.124 - 748.126
STATUTORY AUTHORITY
The amendments and new section are adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and Texas Government Code §531.02011, which transferred the regulatory functions of the Texas Department of Family and Protective Services to HHSC. In addition, HRC §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of HRC.
§748.125.What is the model suicide prevention, intervention, and postvention policy?
(a) Purpose. The purpose of the model suicide prevention, intervention, and postvention policy is to:
(1) Protect the health and well-being of children in the care of general residential operations by implementing procedures to prevent suicide, including screening and assessment procedures for risk of suicide;
(2) Require intervention when a child attempts or dies by suicide; and
(3) Address the needs of children in care and staff after a child attempts or dies by suicide.
(b) Definitions.
(1) Postvention--Activities that promote healing and reduce the risk of suicide by a person affected by the suicide of another.
(2) Protective factors of suicide--Characteristics that make it less likely that a child will consider, attempt, or die by suicide, including:
(A) Effective behavioral health care;
(B) Connectedness to individuals, family, community, and social institutions;
(C) Supportive relationships with caregivers;
(D) Problem-solving skills, coping skills, and ability to adapt to change;
(E) Self-esteem or sense of purpose; and
(F) Cultural or personal beliefs that discourage suicide.
(3) Risk factors of suicide--Characteristics or conditions that increase the chance that a child may consider, attempt, or die by suicide, including:
(A) A prior suicide attempt;
(B) Knowing someone who died by suicide, particularly a family member, friend, peer, or hero;
(C) Access to lethal means;
(D) History of childhood trauma, including neglect, physical abuse, or sexual abuse or assault;
(E) A history of being bullied;
(F) A mental health diagnosis, particularly depressive disorders and other mood disorders;
(G) Abuse of alcohol or drugs;
(H) Social isolation;
(I) Severe or prolonged stress;
(J) Chronic physical pain or illness;
(K) Loss of a family member; or
(L) The ending of a relationship.
(4) Suicide contagion--Exposure to suicide or suicidal behaviors within a family, or from friends or media reports, that can result in an increase in suicide or suicidal behaviors.
(5) Suicide risk assessment--A comprehensive evaluation of a child by a medical health professional to confirm suspected suicide risk, estimate the immediate danger to the child, and decide on a course of treatment and a plan for intervention to ensure the child's safety.
(6) Suicide risk screening--A procedure in which a standardized instrument is used to identify children who may be at risk of suicide. The screening may be done orally (with the screener asking questions), with pencil and paper, or using a computer.
(7) Warning signs of suicide--Indicators that a child may be in danger of suicide and need help, including:
(A) Talking about wanting to die or to hurt or kill oneself;
(B) Looking for a way to kill oneself;
(C) Being preoccupied with death in conversation, writing, or drawing;
(D) Talking about feeling hopeless or having no reason to live;
(E) A change in personality;
(F) Giving away belongings;
(G) Withdrawing from friends and family;
(H) Having aggressive or hostile behavior;
(I) Neglecting personal appearance;
(J) Running away from home or a residential placement; or
(K) Risk-taking behavior, such as reckless driving or being sexually promiscuous.
(c) Prevention--Training.
(1) All caregivers and employees must complete at least one hour of annual suicide prevention training that meets the instructor and documentation requirements of Subchapter F, Division 6 of this chapter (relating to Annual Training) with a curriculum that includes:
(A) The risk factors, protective factors, and warning signs of suicide;
(B) Understanding safety planning, including:
(i) How safety plans are created;
(ii) How safety plans are shared with employees and caregivers;
(iii) How safety plans are expected to be implemented by employees and caregivers; and
(iv) Each employee's or caregiver's role in the prevention of suicide, including never leaving a child alone if the suicide risk screening finds that the child is a high risk for suicide, until a mental health professional conducts a suicide risk assessment; and
(C) Understanding suicide screening, including clarifying:
(i) Each person's role in the screening process;
(ii) When an employee or caregiver should initiate a suicide risk screening for a child; and
(iii) What actions an employee or caregiver must take to initiate a suicide risk screening for a child.
(2) The operation must promote suicide prevention training for non-employees, as appropriate.
(d) Prevention--Suicide Risk Screening.
(1) The policy must describe the suicide risk screening tool that you will use and the process for implementing the screenings.
(2) The suicide risk screening tool must be supported by evidence-based research demonstrating the tool performs reliably regardless of who administers the tool or performs the scoring or rating.
(3) Any person who meets the conditions and training requirements of the screening tool manual or instructions may administer the suicide risk screening to a child. You must document that any person conducting a screening meets the conditions and training requirements.
(4) At a minimum, the screening tool must be administered:
(A) At admission for each child 10 years of age or older;
(B) At admission for each child younger than 10 years of age if:
(i) The information provided to the operation at the time of admission indicates that the child has a history of suicide attempts or suicidal thoughts; or
(ii) The parent who admits the child or operation requests a screening to be administered because of the child's risk factors or warning signs of suicide;
(C) Every 30 days after admission for each child 10 years of age or older in a residential treatment center;
(D) Every 90 days after admission for each child 10 years of age or older in a general residential operation that is not a residential treatment center; and
(E) Immediately for a child of any age whenever the child exhibits warning signs of suicide that necessitate a suicide screening be conducted.
(5) Any screening must be performed in a manner that protects the child's privacy.
(6) Each screening must be documented.
(e) Intervention--Based on the Results of a Suicide Risk Screening.
(1) If the suicide risk screening finds the child to be a high risk for suicide, the operation must:
(A) Immediately refer the child to a mental health professional for a suicide risk assessment;
(B) Not leave the child alone until a mental health professional assesses the child;
(C) Remove any harmful objects, chemicals, or substances that a child could use to carry out a suicide attempt;
(D) Alert each person responsible for the child's care or supervision of the high risk for suicide and any new or updated safety plan; and
(E) Upon conclusion of the risk assessment, follow through on recommendations by the mental health professional and update the child's safety plan and service plan accordingly.
(2) If the suicide risk screening finds the child to have a potential for risk of suicide, the operation must:
(A) Refer the child to a mental health professional for a suicide risk assessment within 24 hours;
(B) Closely monitor the child to ensure the child's safety until a mental health professional assesses the child;
(C) Remove any harmful objects, chemicals, or substances that a child could use to carry out a suicide attempt;
(D) Alert each person responsible for the child's care or supervision of the potential risk of suicide and any new or updated safety plan; and
(E) Upon conclusion of the risk assessment, follow through on recommendations by the mental health professional and update the child's safety plan and service plan accordingly.
(f) Intervention--Returning Post Hospitalization. To ensure a child's readiness to return to the care of your operation following a mental health crisis (for example, from a suicide attempt or psychiatric hospitalization):
(1) A professional level service provider must meet with the child within 24 hours of the child's return to an operation to discuss protocols that would help to ease the child's transition back into the operation, ensure the child's safety, and reduce any risk of suicide.
(2) The protocols must include:
(A) Weekly suicide risk screenings for the first 30 days or until the child is no longer reporting suicidal thoughts, whichever is longer;
(B) Creating or reviewing and updating the child's safety plan; and
(C) Removal of any harmful objects, chemicals, or substances that a child could use to carry out a suicide attempt or self-harm for a period to be determined by the treatment team, but not less than 30 days.
(3) The operation must alert any persons responsible for the child's care or supervision of the new protocols and new or updated safety plan.
(g) Postvention.
(1) Addressing Suicide Deaths.
(A) Create a Postvention Team and Written Action Plan and Protocols. To prevent suicide contagion and support the children and staff at the operation, you must create a postvention team. This team is responsible for developing a written action plan with protocols in the event of a death by suicide. The postvention team should consider how a death would affect other children and staff at the operation and consider how to provide psychological first aid, crisis intervention, and other support to children and staff at your operation.
(B) While the action plan needs to be flexible for varying situations, the written action plan must include:
(i) A communication strategy that:
(I) Does not inadvertently glamorize or romanticize the child or the death;
(II) Occurs in small group settings, allowing the postvention team to monitor responses of individuals in the group;
(III) Strives to treat all deaths at the operation in the same way (for example, having one approach for honoring a child who dies from cancer, a car accident, or suicide);
(IV) Emphasizes the importance of seeking help for anyone with an underlying mental health diagnosis, such as a mood disorder;
(V) Emphasizes the importance of staff and other children recognizing the signs of suicide; and
(VI) Decreases the stigma associated with seeking help for mental health concerns;
(ii) Mental health resources for children and staff who have a difficult time coping, including:
(I) Opportunities to debrief to process thoughts and feelings related to the suicide death; and
(II) Referrals to grief counseling and suicide survivor support groups to the extent possible; and
(iii) A review of lessons learned from the child's death by suicide. All communications regarding lessons learned should be approached in a way that ensures a blame-free environment.
(2) Addressing Suicide Attempts. In the event of a suicide attempt according to §748.305 of this chapter (relating to What constitutes a suicide attempt by a child?), you must:
(A) As needed, immediately call emergency services and render first aid until professional medical treatment can be provided;
(B) Not leave the child alone until a mental health professional assesses the child;
(C) Move all other children out of the immediate area as soon as possible;
(D) Report and document the suicide attempt as a serious incident as required by:
(i) §748.303(a)(12) of this chapter (relating to When must I report and document a serious incident?);
(ii) §748.311 of this chapter (relating to How must I document a serious incident?); and
(iii) §748.313(1) of this chapter (relating to What additional documentation must I include with a written serious incident report?); and
(E) Offer mental health resources for children and staff who have a difficult time coping, including:
(i) Opportunities to debrief to process thoughts and feelings related to the suicide attempt; and
(ii) Referrals to grief counseling and suicide survivor support groups to the extent possible; and
(F) Conduct a review of lessons learned from the child's suicide attempt. All communications regarding lessons learned should be approached in a way that ensures a blame-free environment.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August 26, 2022.
TRD-202203264
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: September 19, 2022
Proposal publication date: May 13, 2022
For further information, please call: (512) 438-3269
STATUTORY AUTHORITY
The repeal is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and Texas Government Code §531.02011, which transferred the regulatory functions of the Texas Department of Family and Protective Services to HHSC. In addition, HRC §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of HRC.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August 26, 2022.
TRD-202203265
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: September 19, 2022
Proposal publication date: May 13, 2022
For further information, please call: (512) 438-3269
DIVISION 1. ADMISSION
STATUTORY AUTHORITY
The amendments are adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and Texas Government Code §531.02011, which transferred the regulatory functions of the Texas Department of Family and Protective Services to HHSC. In addition, HRC §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of HRC.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August 26, 2022.
TRD-202203266
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: September 19, 2022
Proposal publication date: May 13, 2022
For further information, please call: (512) 438-3269
STATUTORY AUTHORITY
The amendment is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and Texas Government Code §531.02011, which transferred the regulatory functions of the Texas Department of Family and Protective Services to HHSC. In addition, HRC §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of HRC.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August 26, 2022.
TRD-202203267
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: September 19, 2022
Proposal publication date: May 13, 2022
For further information, please call: (512) 438-3269
STATUTORY AUTHORITY
The amendment is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and Texas Government Code §531.02011, which transferred the regulatory functions of the Texas Department of Family and Protective Services to HHSC. In addition, HRC §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of HRC.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August 26, 2022.
TRD-202203268
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: September 19, 2022
Proposal publication date: May 13, 2022
For further information, please call: (512) 438-3269
The Texas Health and Human Services Commission (HHSC) adopts amendments to §§749.103, 749.1107, 749.1135, 749.1189, 749.1309, 749.3391, 749.3395, and 749.3423; new §§749.136 - 749.138; and the repeal of §749.137.
New §749.136 and §749.137 are adopted with changes to the proposed text as published in the May 13, 2022, issue of the Texas Register (47 TexReg 2836). These rules will be republished.
Amendments to §§749.103, 749.1107, 749.1135, 749.1189, 749.1309, 749.3391, 749.3395, and 749.3423; new §749.138; and the repeal of §749.137 are adopted without changes to the proposed text as published in the May 13, 2022, issue of the Texas Register (47 TexReg 2836). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The amendments, new sections, and repeal are necessary to comply with SECTION 20 of Senate Bill 1896, 87th Legislature, Regular Session, 2021, that added §42.0433 to Texas Human Resources Code (HRC). New HRC §42.0433 requires HHSC Child Care Regulation (CCR) to adopt a model suicide prevention, intervention, and postvention policy for use by residential child-care facilities. This section also requires each residential child-care facility to adopt either the CCR model policy or another suicide prevention, intervention, and postvention policy that has been approved by the Executive Commissioner of HHSC. The adopted rules implement these changes for child-placing agencies (CPAs).
COMMENTS
The 31-day comment period ended June 13, 2022. During this period, HHSC received 10 comments regarding the proposed rules from one commenter, the Texas Alliance of Child and Family Services. A summary of comments relating to the rules and HHSC's responses follows.
Comment: Regarding §749.137(b)(3), the commenter expressed concern over the breadth of risk factors of suicide listed and said that every child in foster care will have at least one or more of these factors. The commenter encouraged technical assistance, state-approved training, or both to help clarify the distinctions between risk factors and warning signs and to prevent a child from being given treatment that is not indicated based on a response to the identification of risk factors.
Response: HHSC agrees with the comment. No rule changes are required since the request is for technical assistance and training. The curriculum for the training in subsection §749.137(c)(2)(A) requires a discussion of the risk factors, protective factors, and warning signs of suicide. HHSC will develop a technical assistance document that discusses the distinctions between these factors and warning signs. HHSC will also explore the options of training providers and developing a training curriculum that may be used by providers.
Comment: Regarding §749.137(b)(7), the commenter voiced appreciation for the clarity and helpfulness of the list of warning signs.
Response: HHSC appreciates the comment. No rule changes are required.
Regarding §749.137(c)(1), HHSC received two comments.
Comment 1: Regarding §749.137(c)(1), the commenter stated that HHSC went beyond the requirements of the statute by requiring one hour of training annually for foster parents because they are not employees and requiring it every year is repetitive. The commenter noted that, while the proposed rule doesn't add to the number of trainings required by a foster family, it limits a child placing agency's flexibility to determine the home's needed curriculum. In addition, the commenter stated it also would not be helpful in all homes, such as a home only caring for children with primary medical needs who are also immobile. The commenter recommended possible options: (1) only require the training for foster parents through the child's service plan if a child is displaying warning signs of suicide; (2) list suicide prevention training as a possible curriculum topic for annual training; (3) require the training as a pre-service training without requiring that it be repeated each year; or (4) require the training be completed within the first year of being licensed without requiring annual repetition.
Response 1: HHSC agrees in part and disagrees in part with the comment. While HRC §42.0433 does not require training for non-employees, it also does not restrict HHSC from expanding the requirement to non-employees. HRC §42.042(e)(1) gives HHSC the authority to promulgate minimum standards that promote the health, safety, and welfare of children in regulated facilities, including foster homes. As the commenter stated, the prevention of suicide is a "critically important issue"; reflected in this comment, the topic of suicide prevention is linked to the health, safety, and welfare of children in care. It is critical that foster parents be trained to know the risk factors, protective factors, and warning signs of suicide, understand safety planning and how to implement a safety plan, and understand suicide screenings. Non-ambulatory children with primary medical needs have thoughts and feelings and may have risk factors or exhibit warning signs of suicide; therefore, HHSC declines to revise the rule to exempt this population of children from the same protections as other children in care. However, HHSC agrees that foster parents are volunteer families that are expected to complete several training requirements that reduce the flexibility of the CPA to train the foster parents on other topics. Therefore, HHSC agrees to revise the rule to limit suicide prevention training in foster homes to foster parents verified to care for children five years of age and older and to require this training (1) within a year of verification, and (2) every two years thereafter. This change was also made at §749.136(a)(2)(C) and (D).
Comment 2: The commenter stated that the statute requires HHSC to "provide to a residential child-care facility any technical assistance necessary to adopt or implement a suicide prevention, intervention, or postvention policy." A component of that policy is training, and the commenter recommended that HHSC provide helpful information to include specific criteria for training and any known trainings that would meet HHSC's requirements.
Response 2: HHSC agrees with the comment, but no rule changes are required. The basic curriculum for the training is provided in the rules. HHSC will explore the options of training providers and developing a training curriculum that may be used by providers. HHSC will also include a non-exhaustive list of trainings that meet this requirement in a Helpful Information box in the courtesy minimum standards publication.
Regarding §749.137(d), HHSC received two comments.
Comment 1: The commenter stated that the requirements to conduct a screening every 30 days for a residential treatment center and every 90 days for all other types of residential care are at odds with normalcy and may exacerbate contagion. The commenter recommended a more nuanced balance: at admission for children over 10, with a history or risk of suicide, or a request by the parent; and at the required frequency and duration recommended by the treating professional if a prior screening has placed the child at potential risk of suicide, or immediately if the child begins to demonstrate warning signs of suicide.
Response 1: HHSC disagrees with the comment and declines to revise the rule. Peer-reviewed, published research studies have not found that asking a child about suicidal thoughts results in a statistically significant increase in suicidal thoughts. Rather, multiple studies indicate that acknowledging and talking about suicide reduce suicidal thoughts and may lead to improvements in mental health in those receiving treatment. In fact, not asking a child about suicidal thoughts may lead to a lack of appropriate and timely intervention. This also supports requiring screenings to be routine (i.e., every 30 days or 90 days) and not just recommended by a treating professional or as warning signs appear. The requirement for routine screenings will reduce the possibility of missing a child's risk of suicide. Finally, the proposed requirement for screenings was a compromise between experts in suicide prevention that preferred a suicide screening at admission for every child over five and every 30 days thereafter and providers that preferred a longer time frame for the frequency of subsequent screenings.
Comment 2: The commenter asked if there were any screening tools that would not require asking a child questions each time that the child is screened.
Response 2: HHSC is not aware of any screening tool or accepted practice that would not require involving the child in answering screening tool questions each time the child is screened; however, different screening tools have varying methods that may be appropriate in obtaining information from a child.
Comment: Regarding §749.137(d)(2), the commenter recommended that HHSC, as part of technical assistance, list the screening tools that meet the criteria in the rules, especially those "supported by evidence-based research demonstrating the tool performs reliably regardless of who administers the tool or performs the scoring or rating."
Response: HHSC agrees with the comment and will include a non-exhaustive list of screening tools that meet this requirement in a Helpful Information box in the courtesy minimum standards publication. No rule change is required.
Comment: Regarding §749.137(d)(4)(B)(i), the commenter stated that the requirement to administer a screening to a child based on a history of suicide attempts or thoughts should be more specific.
Response: HHSC agrees with the comment and has revised the rule to clarify that a CPA would have to receive information at the time of admission indicating that a child younger than 10 has a history of suicide attempts or suicidal thoughts.
Comment: Regarding §749.137(f)(1), the commenter expressed concerns with the challenge of coordinating a meeting with two members of the service planning team when a child returns from hospitalization and recommended any meeting and follow up steps be in accordance with the child's discharge plan from the treating facility.
Response: HHSC partially agrees with the comment. HHSC agrees that requiring two service planning team members to participate in a meeting could cause coordination issues and changed the rule to only require child placement management staff to meet with the child. However, HHSC disagrees that follow-up with a child should be in accordance with a child's discharge plan from the treating facility following a hospitalization for a mental health crisis and declines to revise the requirement for the meeting with the child. HRC §42.0433 requires the model policy to support children who return to an operation following hospitalization for a mental health condition. The requirement is not limited to a hospitalization for suicide related factors. In addition, peer-reviewed, published research shows that individuals are at high risk of suicide following discharge from hospitalization regardless of the reason for admission. The requirement to meet with the child within 24 hours of the child's return to the operation ensures children who are at an increased risk of suicide are safe.
Comment: Regarding §749.137(f)(2)(A), the commenter expressed concern with the language requiring suicide monitoring for a child who was not admitted for suicide related factors and recommended that the ongoing risk screenings for suicide be in accordance with the child's discharge plan rather than weekly.
Response: HHSC disagrees with the comment and declines to revise the rule. HRC §42.0433 the model policy to support children who return to an operation following a hospitalization for a mental health condition. The requirement is not limited to a hospitalization for suicide related factors. Peer-reviewed, published research shows that individuals are at high risk of suicide following discharge from hospitalization regardless of the reason for admission. The purpose of these additional steps is to ensure children who are at an increased risk of suicide are safe.
HHSC noticed during the publication of the proposed rules that the title of Chapter 748, Subchapter C, Division 1 was not consistent with the title of Chapter 749, Subchapter C, Division 1. HHSC is updating the division titles to make them consistent. In addition, HHSC made a minor editorial change to correct a citation in §749.137(g)(2)(D)(i).
SUBCHAPTER C. ORGANIZATION AND ADMINISTRATION
DIVISION 1. PLANS AND POLICIES REQUIRED DURING THE APPLICATION PROCESS
26 TAC §§749.103, 749.136 - 749.138
STATUTORY AUTHORITY
The amendments and new sections are adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and Texas Government Code §531.02011, which transferred the regulatory functions of the Texas Department of Family and Protective Services to HHSC. In addition, HRC §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of HRC.
§749.136.What suicide prevention, intervention, and postvention policy must I have?
(a) A child-placing agency that is licensed or certified to provide only foster care services or to provide both foster care services and adoption services must adopt either:
(1) The model suicide prevention, intervention, and postvention policy in §749.137 of this division (relating to What is the model suicide prevention, intervention, and postvention policy?); or
(2) Another suicide prevention, intervention, and postvention policy that is approved by the Executive Commissioner of the Texas Health and Human Services Commission or designee and:
(A) Addresses suicide prevention, intervention, and prevention for children in the care of your agency;
(B) Is based on current and best evidence-based practices;
(C) Requires employees to receive annual suicide prevention training that includes understanding of safety planning and screening for risk;
(D) Requires foster parents in homes verified to care for children five years of age or older to complete at least one hour of suicide prevention training:
(i) Within a year of being verified; and
(ii) every two years thereafter;
(E) Promotes suicide prevention training for non-employees, as appropriate; and
(F) Includes plans and procedures to support children who return to your agency's care following hospitalization for a mental health condition.
(b) The suicide prevention, intervention, and postvention policy adopted under subsection (a) of this section may be part of a broader mental health crisis plan if the components of the plan include suicide prevention, intervention, and postvention.
§749.137.What is the model suicide prevention, intervention, and postvention policy?
(a) Purpose. The purpose of the model suicide prevention, intervention, and postvention policy is to:
(1) Protect the health and well-being of children in an agency's care by implementing procedures to prevent suicide, including screening and assessment procedures for risk of suicide;
(2) Require intervention when a child attempts or dies by suicide; and
(3) Address the needs of children in an agency's care, employees, caregivers, and adoptive parents after a child attempts or dies by suicide.
(b) Definitions.
(1) Postvention--Activities that promote healing and reduce the risk of suicide by a person affected by the suicide of another.
(2) Protective factors of suicide--Characteristics that make it less likely that a child will consider, attempt, or die by suicide, including:
(A) Effective behavioral health care;
(B) Connectedness to individuals, family, community, and social institutions;
(C) Supportive relationships with caregivers;
(D) Problem-solving skills, coping skills, and ability to adapt to change;
(E) Self-esteem or sense of purpose; and
(F) Cultural or personal beliefs that discourage suicide.
(3) Risk factors of suicide--Characteristics or conditions that increase the chance that a child may consider, attempt, or die by suicide, including:
(A) A prior suicide attempt;
(B) Knowing someone who died by suicide, particularly a family member, friend, peer, or hero;
(C) Access to lethal means;
(D) History of childhood trauma, including neglect, physical abuse, or sexual abuse or assault;
(E) A history of being bullied;
(F) A mental health diagnosis, particularly depressive disorders and other mood disorders;
(G) Abuse of alcohol or drugs;
(H) Social isolation;
(I) Severe or prolonged stress;
(J) Chronic physical pain or illness;
(K) Loss of a family member; or
(L) The ending of a relationship.
(4) Suicide contagion--Exposure to suicide or suicidal behaviors within a family, or from friends or media reports, that can result in an increase in suicide or suicidal behaviors.
(5) Suicide risk assessment--A comprehensive evaluation of a child by a medical health professional to confirm suspected suicide risk, estimate the immediate danger to the child, and decide on a course of treatment and a plan for intervention to ensure the child's safety.
(6) Suicide risk screening--A procedure in which a standardized instrument is used to identify children who may be at risk of suicide. The screening may be done orally (with the screener asking questions), with pencil and paper, or using a computer.
(7) Warning signs of suicide--Indicators that a child may be in danger of suicide and need help, including:
(A) Talking about wanting to die or to hurt or kill oneself;
(B) Looking for a way to kill oneself;
(C) Being preoccupied with death in conversation, writing, or drawing;
(D) Talking about feeling hopeless or having no reason to live;
(E) A change in personality;
(F) Giving away belongings;
(G) Withdrawing from friends and family;
(H) Having aggressive or hostile behavior;
(I) Neglecting personal appearance;
(J) Running away from home or a residential placement; or
(K) Risk-taking behavior, such as reckless driving or being sexually promiscuous.
(c) Prevention--Training.
(1) Employees and foster parents must complete at least one hour of suicide prevention training as follows:
(A) Employees must complete the training annually;
(B) Foster parents verified to care for children five years of age or older must complete the training:
(i) Within a year of verification; and
(ii) every two years thereafter; and
(C) The suicide prevention training must meet the instructor and documentation requirements of Subchapter F, Division 7 of this chapter (relating to Annual Training).
(2) The curriculum for the suicide prevention training in paragraph (1) of this subsection must include:
(A) The risk factors, protective factors, and warning signs of suicide;
(B) Understanding safety planning, including:
(i) How safety plans are created;
(ii) How safety plans are shared with employees and caregivers;
(iii) How safety plans are expected to be implemented by employees and caregivers; and
(iv) Each employee's or caregiver's role in the prevention of suicide, including never leaving a child alone if the suicide risk screening finds that the child is a high risk for suicide, until a mental health professional conducts a suicide risk assessment; and
(C) Understanding suicide screening, including clarifying:
(i) Each person's role in the screening process;
(ii) When an employee or caregiver should initiate a suicide risk screening for a child; and
(iii) What actions an employee or caregiver must take to initiate a suicide risk screening for a child.
(3) The agency must promote suicide prevention training for non-employees, as appropriate.
(d) Prevention--Suicide Risk Screening.
(1) The policy must describe the suicide risk screening tool that you will use and the process for implementing the screenings.
(2) The suicide risk screening tool must be supported by evidence-based research demonstrating the tool performs reliably regardless of who administers the tool or performs the scoring or rating.
(3) Any person who meets the conditions and training requirements of the screening tool manual or instructions may administer the suicide risk screening to a child. You must document that any person conducting a screening meets the conditions and training requirements.
(4) For children receiving foster care services, the screening tool must be administered:
(A) At admission for each child 10 years of age or older;
(B) At admission for each child younger than 10 years of age if:
(i) The information provided to the operation at the time of admission indicates that the child has a history of suicide attempts or suicidal thoughts; or
(ii) The parent who admits the child, a foster parent, or child-placing agency requests a screening to be administered because of the child's risk factors or warning signs of suicide;
(C) Every 90 days after admission for all children 10 years of age or older; and
(D) Immediately for a child of any age whenever the child exhibits warning signs of suicide that necessitate a suicide screening be conducted, including when requested by a foster parent.
(5) For children receiving adoption services, the screening tool must be administered immediately for a child of any age whenever the child exhibits warning signs of suicide that necessitate a suicide screening be conducted, including when requested by an adoptive parent.
(6) Any screening must be performed in a manner that protects the child's privacy.
(7) Each screening must be documented in the child's record.
(e) Intervention--Based on the Results of a Suicide Risk Screening.
(1) If the suicide risk screening finds the child to be a high risk for suicide, the agency, caregiver, or adoptive parent must:
(A) Immediately refer the child to a mental health professional for a suicide risk assessment;
(B) Not leave the child alone until a mental health professional assesses the child;
(C) Remove any harmful objects, chemicals, or substances that a child could use to carry out a suicide attempt;
(D) Alert each person responsible for the child's care or supervision of the high risk for suicide and any new or updated safety plan; and
(E) Upon conclusion of the risk assessment, follow through on recommendations by the mental health professional and update the child's safety plan and service plan accordingly.
(2) If the suicide risk screening finds the child to have a potential for risk of suicide, the agency, caregiver, or adoptive parent must:
(A) Refer the child to a mental health professional for a suicide risk assessment within 24 hours;
(B) Closely monitor the child to ensure the child's safety until a mental health professional assesses the child;
(C) Remove any harmful objects, chemicals, or substances that a child could use to carry out a suicide attempt;
(D) Alert each person responsible for the child's care or supervision of the potential risk of suicide and any new or updated safety plan; and
(E) Upon conclusion of the risk assessment, follow through on recommendations by the mental health professional and update the child's safety plan and service plan accordingly.
(f) Intervention--Returning Post Hospitalization. To ensure a child's readiness to return to care under the same child-placing agency following a mental health crisis (for example, from a suicide attempt or psychiatric hospitalization):
(1) Child placement management staff must meet with the child within 24 hours of the child's arrival to a home to discuss protocols that would help to ease the child's transition into the home post hospitalization, ensure the child's safety, and reduce any risk of suicide.
(2) The protocols must include:
(A) Weekly suicide risk screenings for the first 30 days or until the child is no longer reporting suicidal thoughts, whichever is longer;
(B) Creating or reviewing and updating the child's safety plan; and
(C) Removal of any harmful objects, chemicals, or substances that a child could use to carry out a suicide attempt or self-harm for a period to be determined by the treatment team, but not less than 30 days.
(3) The agency must alert any persons responsible for the child's care or supervision of the new protocols and new or updated safety plan.
(g) Postvention.
(1) Addressing Suicide Deaths.
(A) Create a Postvention Team and Written Action Plan and Protocols. To prevent suicide contagion and support employees, children, caregivers, and adoptive parents, you must create a postvention team. This team is responsible for developing a written action plan with protocols in the event of a death by suicide. The postvention team should consider:
(i) How a death would affect employees, caregivers, adoptive parents, and other children receiving services in the home where the death occurred; and
(ii) How to provide psychological first-aid, crisis intervention, and other support to the employees, caregivers, adoptive parents, and other children receiving services in the home where the death occurred.
(B) While the action plan needs to be flexible for varying situations, the written action plan must include:
(i) A communication strategy that:
(I) Does not inadvertently glamorize or romanticize the child or the death;
(II) Occurs in settings that allow the postvention team to monitor responses of individuals in the home;
(III) Strives to treat all deaths in the same way (for example, having one approach for honoring a child who dies from cancer, a car accident, or suicide);
(IV) Emphasizes the importance of seeking help for anyone with an underlying mental health diagnosis, such as a mood disorder;
(V) Emphasizes the importance of employees, caregivers, adoptive parents, and children recognizing the signs of suicide; and
(VI) Decreases the stigma associated with seeking help for mental health concerns;
(ii) Mental health resources for employees, caregivers, adoptive parents, and children who have a difficult time coping, including:
(I) Opportunities to debrief to process thoughts and feelings related to the suicide death; and
(II) Referrals to grief counseling and suicide survivor support groups to the extent possible; and
(iii) A review of lessons learned from the child's death by suicide. All communications regarding lessons learned should be approached in a way that ensures a blame-free environment.
(2) Addressing Suicide Attempts. In the event of a suicide attempt according to §749.505 of this chapter (relating to What constitutes a suicide attempt by a child?):
(A) The caregiver must, as needed, immediately call emergency services and render first aid until professional medical treatment can be provided;
(B) The caregiver must not leave the child alone until a mental health professional assesses the child;
(C) The caregiver must move all other children out of the immediate area as soon as possible;
(D) The agency must report and document the suicide attempt as a serious incident as required by:
(i) §749.503(a)(12) of this chapter (relating to When must I report and document a serious incident?);
(ii) §749.511 of this chapter (relating to How must I document a serious incident?); and
(iii) §749.513(1) of this chapter (relating to What additional documentation must I include with a written serious incident report?);
(E) The agency must offer mental health resources for employees, caregivers, and children who have a difficult time coping, including:
(i) Opportunities to debrief to process thoughts and feelings related to the suicide attempt; and
(ii) Referrals to community services and other resources when a child has attempted suicide; and
(F) The agency must conduct a review of lessons learned from the child's suicide attempt. All communications regarding lessons learned should be approached in a way that ensures a blame-free environment.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August 26, 2022.
TRD-202203269
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: September 19, 2022
Proposal publication date: May 13, 2022
For further information, please call: (512) 438-3269
STATUTORY AUTHORITY
The repeal is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and Texas Government Code §531.02011, which transferred the regulatory functions of the Texas Department of Family and Protective Services to HHSC. In addition, HRC §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of HRC.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August 26, 2022.
TRD-202203271
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: September 19, 2022
Proposal publication date: May 13, 2022
For further information, please call: (512) 438-3269
DIVISION 1. ADMISSIONS
STATUTORY AUTHORITY
The amendment is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and Texas Government Code §531.02011, which transferred the regulatory functions of the Texas Department of Family and Protective Services to HHSC. In addition, HRC §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of HRC.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August 26, 2022.
TRD-202203272
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: September 19, 2022
Proposal publication date: May 13, 2022
For further information, please call: (512) 438-3269
STATUTORY AUTHORITY
The amendment is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and Texas Government Code §531.02011, which transferred the regulatory functions of the Texas Department of Family and Protective Services to HHSC. In addition, HRC §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of HRC.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August 26, 2022.
TRD-202203275
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: September 19, 2022
Proposal publication date: May 13, 2022
For further information, please call: (512) 438-3269
STATUTORY AUTHORITY
The amendment is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and Texas Government Code §531.02011, which transferred the regulatory functions of the Texas Department of Family and Protective Services to HHSC. In addition, HRC §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of HRC.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August 26, 2022.
TRD-202203279
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: September 19, 2022
Proposal publication date: May 13, 2022
For further information, please call: (512) 438-3269
DIVISION 1. SERVICE PLANS
STATUTORY AUTHORITY
The amendment is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and Texas Government Code §531.02011, which transferred the regulatory functions of the Texas Department of Family and Protective Services to HHSC. In addition, HRC §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of HRC.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August 26, 2022.
TRD-202203280
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: September 19, 2022
Proposal publication date: May 13, 2022
For further information, please call: (512) 438-3269
DIVISION 5. REQUIRED INFORMATION
STATUTORY AUTHORITY
The amendments are adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and Texas Government Code §531.02011, which transferred the regulatory functions of the Texas Department of Family and Protective Services to HHSC. In addition, HRC §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of HRC.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August 26, 2022.
TRD-202203281
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: September 19, 2022
Proposal publication date: May 13, 2022
For further information, please call: (512) 438-3269
STATUTORY AUTHORITY
The amendment is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and Texas Government Code §531.02011, which transferred the regulatory functions of the Texas Department of Family and Protective Services to HHSC. In addition, HRC §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of HRC.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on August 26, 2022.
TRD-202203282
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: September 19, 2022
Proposal publication date: May 13, 2022
For further information, please call: (512) 438-3269