(a) Description. Day programs for acute needs provide short term, intensive treatment to an individual who requires multidisciplinary treatment in order to stabilize acute psychiatric symptoms or prevent admission to a more restrictive setting. Day programs for acute needs:
  (1) are provided in a highly structured and safe environment with constant supervision;
  (2) ensure an opportunity for frequent interaction between an individual and staff members;
  (3) are services that are goal oriented and focus on:
    (A) reality orientation;
    (B) symptom reduction and management;
    (C) appropriate social behavior;
    (D) improving peer interactions;
    (E) improving stress tolerance;
    (F) the development of coping skills; and
  (4) consist of the following component services:
    (A) psychiatric nursing services;
    (B) pharmacological instruction;
    (C) symptom management training; and
    (D) functional skills training.
(b) Conditions.
  (1) Day programs for acute needs:
    (A) may only be provided to eligible adults;
    (B) may be provided in a setting with any number of individuals; and
    (C) may be provided:
      (i) on site; or
      (ii) in a short-term, crisis-resolution oriented residential treatment setting that is not:
        (I) a general medical hospital;
        (II) a psychiatric hospital; or
        (III) an IMD.
  (2) Except as provided by paragraphs (4) and (5) of this subsection, day programs for acute needs must be provided by:
    (A) a QMHP-CS;
    (B) a CSSP; or
    (C) a peer provider.
  (3) Day programs for acute needs must, at all times:
    (A) have a sufficient number of staff members to ensure safety and program adequacy; and
    (B) at a minimum include:
      (i) one RN for every 16 individuals at the day program's location;
      (ii) one physician to be available by phone, with a response time not to exceed 15 minutes;
      (iii) two staff members who are QMHP-CSs, CSSPs, or peer providers at the day program's location;
      (iv) one additional QMHP-CS who is not assigned full-time to another day program to be physically available, with a response time not to exceed 30 minutes; and
      (v) additional QMHP-CSs, CSSPs, or peer providers at the day program's location sufficient to maintain a ratio of one staff member to every four individuals.
  (4) Psychiatric nursing services, as described in subsection (c)(1) of this section, must be provided by an RN at the day program's location.
  (5) Pharmacological instruction, as described in subsection (c)(2) of this section, must be provided by a licensed medical personnel.
(c) Components of day programs for acute needs.
  (1) Psychiatric nursing services consist of:
    (A) a nursing assessment;
    (B) the coordination of medical activities (e.g., referrals to specialists and scheduling medical laboratory tests);
    (C) the administration of medication;
    (D) laboratory specimen collections and screenings (e.g., the Abnormal Involuntary Movement Scale);
    (E) emergency medical interventions as ordered by a physician; and
    (F) other nursing services.
  (2) Pharmacological instruction is training to an individual that addresses medication issues related to the crisis precipitating the provision of day programs for acute needs. Such medication issues consist of:
    (A) the role of the individual's medications in stabilizing acute psychiatric symptoms or preventing admission to a more restrictive setting;
    (B) the identification of substances that reduce the effectiveness of the individual's medications;
    (C) appropriate interventions to reduce side effects of the medications; and
    (D) the self-administration of the individual's medication.
  (3) Symptom management training assists an individual in recognizing and reducing her or his symptoms and includes training the individual on:
    (A) the identification of thoughts, feelings, or behaviors that indicate the onset of acute psychiatric symptoms;
    (B) developing coping strategies to address the symptoms;
    (C) ways to avoid symptomatic episodes;
    (D) identification of external circumstances that trigger the onset of the acute psychiatric symptoms; and
    (E) relapse prevention strategies.
  (4) Functional skills training assists an individual in acquiring the skills needed to enable the individual to continue to reside in the community and avoid more restrictive levels of treatment and includes training the individual on:
    (A) personal hygiene;
    (B) nutrition;
    (C) food preparation;
    (D) money management;
    (E) socially and culturally appropriate behavior; and
    (F) accessing and participating in community activities.
(d) Frequency and duration. The provision of day programs for acute needs must be in accordance with the amount and duration for which the provider has obtained authorization in accordance with §416.6 of this title (relating to Service Authorization and Recovery Plan).

Source Note: The provisions of this §306.321 adopted to be effective January 22, 2014, 39 TexReg 299; transferred effective March 15, 2020, as published in the February 21, 2020 issue of the Texas Register, 45 TexReg 1239