(a) Pre-admission screening and assessment.
  (1) Before admission to a CSU, an individual must meet clinical criteria for admission, as determined by pre-admission screening and assessment.
  (2) An individual who voluntarily presents to the CSU may leave the CSU at any time during the pre-admission screening and assessment process before the individual's admission.
  (3) Pre-admission screening and assessment of an individual must:
    (A) occur either in the CSU or in the community at any location where mental health crisis services are provided; and
    (B) be provided by a QMHP-CS or LPHA trained in accordance with HHSC screening and assessment requirements policy and displaying competency in all domains of crisis screening and assessment in accordance with §301.331(b) of this title (relating to Competency and Credentialing).
(b) CSU screening and assessment policy. CSU screening and assessment policy must include a process for:
  (1) accessing an individual's community-based screening and assessment; and
  (2) conducting CSU screenings that address the criteria for immediate:
    (A) assessment of risk of deterioration and danger to self and others;
    (B) medical screening and assessment; and
    (C) psychiatric examination;
  (3) ensuring an individual who is waiting for a physician examination remains in a location that is determined to be clinically appropriate and available; and
  (4) ensuring that an individual who presents to a CSU for pre-admission screening and assessment is afforded the protections in §306.87 of this subchapter (relating to Protection of an Individual receiving Crisis Stabilization Unit Services).
(c) Screening. Pre-admission screening identifies the acuity of the individual's crisis episode and determines the need for further assessments, including assessments to determine risk of deterioration and immediate danger to self and others, in accordance with Texas Health and Safety Code §572.0025(f) and §573.021. The initial screening of an individual must lead to:
  (1) immediate and appropriate referrals; and
  (2) documentation that incorporates the following domains:
    (A) suicide risk screening;
    (B) homicide risk screening; and
    (C) risk of deterioration.
(d) Assessment. If a pre-admission screening indicates an individual requires immediate assessment to determine risk of deterioration and immediate danger to self and others, the assessment must be conducted with the individual, either in person or through the use of telemedicine medical services or telehealth services in accordance with 22 TAC §174.9(2) (relating to Provision of Mental Health Services), and must include:
  (1) a suicide assessment that documents current and past suicide risks regarding suicidal ideation, plans, and past suicide attempts;
  (2) a psychosocial assessment that includes historical and current information including identification of social, psychological, environmental, and cultural factors that may be contributing to the emergency; and
  (3) a mental health assessment, documenting symptomology, functionality, historical and current diagnosis, and treatment for mental illnesses or serious emotional disturbances and, when available:
    (A) a review of records of past treatment;
    (B) a review of history from collateral sources as permitted by Health Insurance Portability and Accountability Act;
    (C) a consult with current healthcare providers;
    (D) a review of history of previous treatment and the response to that treatment, including a record of dose, response, side effects and adherence to past psychiatric medications; and
    (E) an up-to-date record of all medications currently prescribed, and the name of the physician or provider with prescriptive authority.
(e) Physician examination. If a pre-admission assessment indicates an individual requires immediate physician examination to determine clinical need for CSU admission, the examination may not be delegated to a non-physician, in accordance with Texas Health and Safety Code §572.0025(f), and:
  (1) must be conducted with the individual, either in person or through telemedicine medical services, in accordance with Texas Health and Safety Code §572.0025(f) and §573.021; and
  (2) must include:
    (A) a physical examination consisting of an assessment for medical stability; and
    (B) a psychiatric examination.

Source Note: The provisions of this §306.53 adopted to be effective May 27, 2021, 46 TexReg 3257