(a) Mission. The mission of the Texas Department of Mental Health and Mental Retardation (TXMHMR) is to offer an array of services which respond to the needs of people with mental illness and mental retardation and which enable them to make choices that result in lives of dignity and increased independence. Our vision is that the TXMHMR service system will become one that is permeated with a commitment to continuous quality improvement (CQI) that is truly customer-driven. It embraces the belief that large public systems even with their inherent regulatory roles and resource limitations can become highly personalized, highly responsive, and highly innovative.
(b) Financial and service responsibilities to persons with disabilities. The Texas MHMR Act requires that TXMHMR identify its priority populations and the minimum array of services necessary to address the needs of persons within these priority populations. This legislation also requires that services be offered first to those most in need and that state dollars be used only for services provided to the priority population.
  (1) Mental retardation services.
    (A) Mental retardation priority population.
      (i) The priority population for mental retardation services consists of the 70,840 persons considered to be the most in need. That is approximately 15% of the 480,000 Texans with mental retardation. TXMHMR estimates that there are approximately 26,000 persons with mental retardation in the priority population who currently require our agency's services and are not receiving them.
      (ii) TXMHMR's priority population for mental retardation services includes those persons who request and need services and possess one or more of the following conditions:
        (I) mental retardation, as defined by the Health and Safety Code, Title 7, §591.003(13);
        (II) autism, as defined in the current edition of the Diagnostic and Statistical Manual (DSM);
        (III) eligibility for Early Childhood Intervention services; or
        (IV) eligibility for Omnibus Budget Reconciliation Act of 1987-mandated services for mental retardation or a related condition as per specific legislation.
      (iii) The presence of mental retardation must be determined through a recognized diagnosis and evaluation process or through the use of assessments performed by qualified professionals as per interagency memoranda of understanding. Results of evaluations by appropriately credentialed professionals can be used to determine the presence of autism. For persons with mental retardation or autism, the priority population includes only those individuals whose needs for services can be most appropriately met through programs currently or potentially offered by TXMHMR rather than some other service system. Services are to be offered in coordination with efforts of other agencies to ensure that all services are provided by agencies as required by laws, rules, and regulations. The priority population does not include persons whose service needs may be most appropriately met through other means, as determined by TXMHMR.
      (iv) Persons who are members of the priority population are eligible to receive services from TXMHMR. Since resources are insufficient to meet all the service needs of all the members of the priority population, services should be provided to meet the most intense needs first.
      (v) Service participant groups include only members of the priority populations. The purpose of grouping service participants is to provide a structure for gathering data about members of the priority population who have specific characteristics which seem to influence the type and intensity of services required to meet their needs. These groups are mutually exclusive. If an individual has characteristics of more than one group, assignment should be made to the group that most accurately characterizes the person's most intense service needs. No one group has priority over any other group.
      (vi) Service participant groups are comprised of members of the priority population who:
        (I) have a challenging behavior (CB) (with or without a mental illness diagnosis) or which requires frequent intervention or regular monitoring. The severity of the behavior is such that it interferes significantly with daily living or learning activities;
        (II) have a severely challenging behavior (SB) (with or without a mental illness diagnosis). The severity of the behavior is such that it seriously threatens the health and safety of this person or others. The management of the behavior is a primary consideration in planning the individual's activities;
        (III) have a severe physical disability (PD) as evidenced by a need for an ongoing program designed and monitored by a professionally qualified habilitation therapist or specialist. Such programs are designed to alleviate the primary condition and decrease the effects of any secondary disability. These disabilities may include, but are not limited to, eating problems, ambulation problems, severe sensory (tactile, visual, or auditory) impairments, and other major physical disabilities;
        (IV) have a health care (HC) need so severe that its treatment and monitoring are the foremost considerations in planning the individual's activities. Immediate 24-hour response from nursing staff, weekly physician intervention, and monitoring of a health care plan by a professional nurse is often needed;
        (V) need either training or support (TS) to enable or maintain their community arrangements for living, working, or training;
        (VI) are eligible to receive early childhood intervention (ECI) services according to the following criteria.
          (-a-) A child is eligible for ECI services if the child is under three years of age, including those children authorized for services as visually or auditory impaired children under the Texas Education Code.
          (-b-) A child is eligible for ECI services if the child is documented as developmentally delayed or has a medically diagnosed physical or mental condition that has a high probability of resulting in developmental delay.
    (B) Community center services.
      (i) TXMHMR contracts with community MHMR centers to provide mental retardation services. Community MHMR centers are locally staffed and governed by a local board of trustees. The centers are usually designated as the mental retardation authority (MRA) for their local service area and are responsible for the provision of a wide range of services as a condition for receiving state funds. These services include case management, emergency services, medical treatment, and respite care. Other services that may be provided are work-related activities including vocational training, vocational assessments, sheltered workshops, supported work programs, and job placements. Short and long-term residential care and developmental programs may also be a part of services.
      (ii) Eligible individuals receive care at 31 of the 35 community MHMR centers across the state. The four centers that provide care only to persons with mental illness are the Life Resource Center, Texas Panhandle Mental Health Authority, Navarro County MHMR Center, and Riceland Regional Mental Health Authority. Priority is given to clients who are most in need of treatment and support services from the TXMHMR system.
    (C) State center services.
      (i) Community services. State centers provide community-based services to persons with mental retardation in areas of the state not served by state schools or community MHMR centers. Services include in-home support services, respite services, family support, case management services, diagnosis and screening, and training and treatment to enhance the individual's ability to function as independently as possible. Individuals may request services by contacting state centers located in Amarillo, Beaumont, El Paso, Harlingen, and Laredo.
      (ii) Campus-based services. Four of the five state centers provide short and/or long-term residential care and nonresidential service in areas of the state not served by state schools or community MHMR centers. The range of services includes vocational, medical and dental services, and physical, occupational, and recreational therapy. Also included are support services such as maintenance, food services, and laundry. Individuals have the opportunity to participate in activities occurring in the local community. Persons with special needs are served by qualified professionals with consultation from specialists in the medical, dental, and habilitation fields. The five state centers delivering inpatient services are located in Amarillo, Beaumont, El Paso, Harlingen, and Laredo. All of these centers except Beaumont have facilities that are certified as intermediate care facilities for the mentally retarded (ICF/MR).
    (D) State school services.
      (i) Community services.
        (I) Community services provided by state schools are designed to meet the needs of persons who have returned to the community from institutional placement and/or to prevent eligible persons from requiring institutionalization. These services include in-home support services, respite services, family support services, case management services, and diagnostic and evaluation services designed to help the individual live independently. Vocational programs also offered include work adjustment training, Cont'd...