(a) The department will maintain a balanced and effective service delivery system that affords a full range of services and supports to individuals and their families.
  (1) The continuum of care within the department's service delivery system encompasses residential services in state mental retardation (MR) facilities and community-based ICF/MR programs, waiver services, and those services and supports provided or contracted by a mental retardation authority (MRA).
  (2) Residential services in a state MR facility are intended to serve individuals with severe or profound mental retardation and those individuals with mental retardation who are medically fragile or who have behavioral problems.
(b) If an individual or LAR chooses services in a state MR facility, the MRA serving the local service area where the individual lives will assist the individual or LAR in accessing those services if the individual is eligible, i.e., meets the criteria described in this subchapter for admission or commitment to a state MR facility.
(c) It is the policy of the State of Texas to strive to ensure that the basic needs for safety, security, and stability are met for each individual under 22 years of age with a developmental disability. A successful family is the most efficient and effective way to meet those needs. The state and local communities must work together to provide encouragement and support for well-functioning families and ensure that each individual receives the benefits of being a part of a successful permanent family as soon as possible.
(d) For an individual residing in a state MR facility, the MRA designated in CARE for that individual is responsible for:
  (1) maintaining a link between the individual and the individual's home community;
  (2) ensuring that the individual, LAR, and state MR facility are provided with information concerning alternative living arrangements that may be appropriate for the individual;
  (3) assisting the individual or LAR who decides to seek an alternative living arrangement in accessing the alternative living arrangement, including working with other MRAs if the alternative living arrangement being sought is outside the designated MRA's local service area; and
  (4) providing the state MR facility with current, provider-furnished information about services and supports in the MRA's local service area.
(e) The MRA and state MR facility will provide the supports and encouragement necessary to ensure that each individual or LAR is able to exercise choice and decision-making authority in all issues related to services and supports.
  (1) Whether an individual lives in the community or is a resident of a state MR facility, if the individual does not have an LAR and cannot communicate a preference concerning services and supports, the MRA or state MR facility will involve those persons who are actively involved with the individual in discussions regarding services and supports.
  (2) For the individual residing in a state MR facility, the state MR facility must have procedures in place to ensure that an individual residing in the state MR facility or the individual's LAR is supported in making decisions concerning living options.
  (3) The following principles support choice and decision-making by the individual or LAR. Each MRA and state MR facility must follow these principles when addressing issues of services and supports.
    (A) The choices, preferences, expectations, likes, and dislikes of the individual and LAR are the dominant force in discussions about service planning.
    (B) When considering Medicaid services, the individual with the ability to provide legally adequate consent or LAR is entitled to choose a provider from:
      (i) a list of ICF/MR Program providers qualified and willing to provide services and supports to that individual; or
      (ii) a list of waiver program providers serving the area in which the individual or LAR is interested.
    (C) The individual will be provided with opportunities for appropriate training, counseling, and other learning experiences that may facilitate the exercise of choice and decision-making. If the individual has an LAR, these opportunities will be provided only with the consent of the LAR.
    (D) Whenever possible, the individual and the LAR will be encouraged to visit a residential setting prior to the individual's admission. If the individual does not have an LAR, persons who are actively involved with the individual will be encouraged to visit a residential setting prior to the individual's admission, unless the individual objects.

Source Note: The provisions of this §904.7 adopted to be effective January 1, 2001, 25 TexReg 12746; amended to be effective March 31, 2002, 27 TexReg 2445; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; transferred effective September 1, 2023, as published in the August 11, 2023, issue of the Texas Register, 48 TexReg 4397