(a) When a discharge occurs, a program provider must comply with 42 CFR §483.440(b)(4) and (5) and this section.
(b) The effective date of a discharge is the first full day the individual is absent from the facility.
(c) Prior to the effective date of a discharge, a program provider must take the following action or document why such action is not feasible:
  (1) notify the individual, LAR, and the individual's MRA of the proposed discharge in writing at least 30 days before the effective date of the proposed discharge;
  (2) document the reason for the proposed discharge and, if the reason is that the facility can no longer meet the individual's needs, explain why;
  (3) counsel the individual or LAR about the proposed discharge, including the potential outcomes of the proposed discharge; and
  (4) develop a final summary and post-discharge plan in accordance with 42 CFR §483.440(b)(5) and provide a copy of both documents to the individual, LAR, and the individual's MRA.
(d) If any actions required by subsection (c) of this section are not feasible prior to the effective date of a discharge, a program provider must, within 7 days after the effective date of the discharge, complete the required actions.
(e) Within 3 days after the effective date of a discharge, a program provider must:
  (1) electronically submit a completed Client Movement Form to the department; and
  (2) submit a paper copy of the completed Client Movement Form to the appropriate TDHS Medicaid eligibility worker.
(f) Except when an individual requires immediate admission to a psychiatric facility for inpatient services as provided in subsection (i) of this section, if a program provider proposes a discharge due to the individual's maladaptive behavior, the discharge must be approved in writing by the department prior to the effective date of the discharge. To request approval, the program provider must submit the following documentation to the department's Office of Medicaid Administration:
  (1) a description of the maladaptive behavior(s);
  (2) a summary of all behavioral interventions attempted, ranging from the most positive to the most restrictive, with the individual's response to these interventions, and reasons the interventions were ineffective in decreasing or eliminating the behavior(s);
  (3) chronological psychoactive medication history, including start and stop dates of medications, dose changes to medications, and reasons for discontinuance or changes to dosages (e.g., adverse reactions, allergies, or increase in target symptoms);
  (4) evidence of participation by a psychologist in the IDT meeting discussing the proposed discharge;
  (5) evidence of approval of the proposed discharge by the facility's specially constituted committee;
  (6) a description of the proposed living arrangement for the individual after the effective date of the discharge; and
  (7) a written agreement from a representative of the proposed living arrangement to accept the individual on or after the effective date of the discharge.
(g) The department will review the documentation submitted in accordance with subsection (f) of this section and, within 14 days after receiving the documentation, provide written notice to the program provider of its approval or denial of the discharge.
(h) If a proposed discharge is approved by the department in accordance with subsection (g) of this section, a psychologist must participate in the development of the post-discharge plan described in subsection (c)(4) of this section.
(i) If the reason for a discharge is that the individual requires immediate admission to a psychiatric facility for inpatient services, a program provider other than a state school or state center must, within three days after the effective date of the discharge, notify the Office of Medicaid Administration and the individual's MRA of:
  (1) the individual's admission to the psychiatric facility; and
  (2) whether the program provider intends to re-admit the individual to the facility and, if not, why the individual will not be re-admitted.
(j) During a discharge, a program provider may accept payment from the individual or other person to hold the individual's residential placement in the facility if a written contract, signed and dated by the program provider and the individual or the other person, is executed prior to each discharge that specifies:
  (1) the amount, not to exceed the department's rate of reimbursement for the individual's LON on the effective date of discharge, that the individual or other person agrees to pay the program provider to hold the individual's residential placement;
  (2) the period of time for which the individual's residential placement in the facility will be held by the program provider;
  (3) that the program provider is not obligated to hold the individual's residential placement after the period of time described in paragraph (2) of this subsection; and
  (4) agreement by the program provider that the individual or other person may terminate the contract immediately upon written notice to the program provider.

Source Note: The provisions of this §261.227 adopted to be effective September 1, 2001, 26 TexReg 5384; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; transferred effective October 1, 2020, as published in the Texas Register August 28, 2020, 45 TexReg 6127