21000, Admissions and Discharges from State Supported Living Centers

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Revision 24-1; Effective March 1, 2024

21100 Definitions

Revision 24-1; Effective March 1, 2024

In this section, the terms below have the following meanings:

Community Resource Coordination Group (CRCG) – County-based groups of local partners and community members. They work with parents, caregivers, youth and adults to identify and coordinate services and supports for people with complex needs. These needs include behavioral health, basic needs and caregiver support. CRCGs work with local partners to coordinate services through many agencies for people with needs that cannot be met by a single agency.

Contracted local intellectual and developmental disability authority (LIDDA) – One of 13 LIDDAs with a state supported living center (SSLC) in its local service area. Texas Health and Human Services Commission (HHSC) contracts with the LIDDA to deliver the community living options information process (CLOIP) for residents of the LIDDAs without an SSLC in their local service area.

Crisis – A situation where:

the person presents an immediate danger to self or others;
the person’s mental or physical health is at risk of serious deterioration;
the person believes they present an immediate danger to self or others; or
the person believes that their mental or physical health is at risk of serious deterioration.

Crisis Intervention Specialist (CIS) – Provides information about intellectual and developmental disability (IDD) programs and services. They collaborate with LIDDA staff and Transition Support Team (TST) members to identify people with IDD in the LIDDA’s local service area who are at risk of requiring crisis services.

Crisis Respite – Short-term, up to 14 calendar days, respite for a person with a diagnosis of IDD. Provided in an out-of-home or in-home setting when the crisis can be stabilized within 72 hours. Service helps the person stabilize in the community.

Designated LIDDA – The LIDDA identified in the Client Assignment and Registration (CARE) System is assigned based on the adult person’s county of residence.

Interdisciplinary Team (IDT) – IDD professionals, paraprofessionals and concerned people, as appropriate, who assess a person’s treatment, training and habilitation needs and recommend services. Also determine if the person is best served in a facility or in a community setting.

Team membership always includes:
- the person;
- the person’s legally authorized representative (LAR), if any; and
- people a LIDDA or SSLC specifies, as appropriate, who are professionally qualified, certified or licensed with special training and experience in the diagnosis, management, needs and treatment of people with IDD.
Other participants in IDT meetings may include:
- people the person or the LAR request;
- people, at the discretion of the LIDDA or SSLC, who are directly involved in the delivery of IDD services to the person; and,
- representatives of the appropriate school district if the person is eligible for public school education.

Legally Authorized Representative (LAR) – A person authorized by law to act on behalf of a person about a matter described in this subchapter. May include a parent, guardian managing conservator of a minor, or the guardian of an adult.

Permanency Planning – For people younger than 22 who are moving from a family-based setting into an intermediate care facility for individuals with an intellectual disability or related condition (ICF/IID), including an SSLC, a Home and Community-based Services (HCS) residential setting, or a nursing facility (NF). The process targets goal development and pathways to provide continuity of support for the youth temporarily living in an institutional setting. The plan includes specific supports for the youth to remain connected to their parents or other family and for them to return to their family home or another family-based alternative.

State Supported Living Center (SSLC) – Facilities providing campus-based services and supports to people with intellectual disabilities who are medically fragile or have significant behavioral health needs. Texas has 13 SSLCs in the state. The ICF/IID Medicaid program funds residential placement in SSLCs for qualified residents.

Transition Support Team (TST) – Team of professionals, regionally constituted, to provide educational activities, technical assistance and de-identified case-specific peer review support to LIDDAs and IDD service providers in a region.

21200 State Supported Living Center Services

Revision 24-1; Effective March 1, 2024

State Supported Living Center (SSLC) residents receive 24-hour services that provide comprehensive behavioral treatment and health care. Each resident receives an individualized plan of services and supports that authorizes services and supports to meet identified needs. Services may include:

medical;
psychiatry;
nursing;
dental services;
skills training;
behavior supports;
occupational therapy;
physical therapy;
speech therapy;
adaptive aids;
day habilitation;
vocational programs;
employment services;
community activities; and
services to maintain connections between residents and their families.

21300 Admission to an SSLC

Revision 24-1; Effective March 1, 2024

For SSLC admissions, the local intellectual and developmental disability authority (LIDDA):

serves as the point of entry for a person seeking admission or commitment to State Supported Living Center (SSLC);
assesses eligibility for admission to an SSLC;
provides information on community-based and residential services to the person or a legally authorized representative (LAR); and
follows the guidelines outlined in 16000, Guidelines for Determining Less Restrictive Setting to determine if a person can be adequately and appropriately habilitated in an available, less restrictive setting when admission to an SSLC is requested.

Information about LIDDA responsibilities related to PIDA commitments without an Interdisciplinary Team (IDT) recommendation will be added to this subsection as rules are developed. If a LIDDA is requested to help access an SSLC admission under this commitment type, contact the SSLC Admissions and Placement Coordinator for their LIDDA catchment area.

Note: The LIDDA is not the point of entry for courts seeking restoration commitments related to competency to stand trial or fitness to proceed with charges.

21400 SSLC Admission Criteria

Revision 24-1 Effective March 1, 2024

26 TAC, Section 904.25

The Texas Health and Safety Code (THSC) establishes four mandatory State Supported Living Center (SSLC) admission criteria:

the person has a diagnosis of intellectual disability (ID);
evidence shows that because of the ID, the person:
- represents a substantial risk of physical impairment or injury to self or others; or
- is unable to provide for and is not providing for their most basic personal physical needs;
The person cannot adequately and appropriately habilitate in an available, less restrictive setting; and
The SSLC provides habilitation services, care, training and treatment appropriate to the person’s needs.

The Texas Health and Human Services Commission (HHSC) follows two standards to assess eligibility. The person must have:

an Intelligence Quotient (IQ) four or more standard deviations below the mean, such as in the severe or profound range of an ID; and
an Inventory for Client and Agency Planning (ICAP) service level of 1-4 or an ICAP service level of 5 or 6 with extraordinary medical needs that:
- require at least 180 minutes per week of direct nursing treatment if the adult caregiver were not providing such treatment; or
- would require intensive staff intervention and resources to prevent incidents of dangerous behavior and serious physical injury to the adult or others if the adult’s caregiver were not managing such incidents.

If the person is determined eligible and the person or legally authorized representative (LAR) chooses to pursue admission, the local intellectual and developmental disability authority (LIDDA) will submit an application packet to the SSLC that serves the person’s county of residence.

21500 Types of Admission to an SSLC

Revision 24-1 Effective March 1, 2024

State supported living center (SSLC) admission types fall into two categories:

voluntary, without court commitment; and
involuntary, with court commitment.

21510 Voluntary Admissions to an SSLC

Revision 24-1 Effective March 1, 2024

Types of voluntary admissions include:

emergency;
respite; and
regular.

21520 Emergency Admission of an Adult or a Minor to an SSLC

Revision 24-1 Effective March 1, 2024

26 TAC, Section 904.37

Emergency voluntary admission is a time-limited admission for a person with an urgent need for services for a period not to exceed 12 months. An emergency admission requires consent of the adult with the capacity to give legally adequate consent, the guardian of a person or the parent of a minor.

Note: Because of the permanency planning statute, an emergency admission for a person under 22 is limited to six months.

An emergency admission may occur if:

persuasive evidence shows the person has a diagnosis of an intellectual disability (ID);
the person has an urgent need for services;
appropriate space is available at the State Supported Living Center (SSLC); and
the SSLC can provide relief sufficient to address the emergency care need within a year after the date of admission for an adult, or within six months for a person under 22.

If a person with the capacity to give legally adequate consent or legally authorized representative (LAR) requests an emergency admission to an SSLC, the local intellectual and developmental disability authority (LIDDA) staff must submit Form 8654, State Supported Living Center (SSLC) Admission Application, to the Texas Health and Human Services Commission (HHSC) SSLC Continuity of Services (COS) coordinator to determine if conditions for this admission type have been met. If it is agreed all conditions listed above have been met , the SSLC COS coordinator provides the LIDDA with Form 8656, Emergency Admission/Discharge Agreement. The LIDDA completes the designated sections of the form and submits it, complete with signatures of LIDDA and the person or LAR, to the HHSC SSLC COS coordinator. The SSLC COS coordinator requests approval and signatures of the other parties. Form 8656 contains the agreements between the person or their LAR, the LIDDA and the SSLC.

The Emergency Admission/Discharge Agreement describes the:

reason for admission, including the circumstances precipitating the need for admission and expected outcomes and must include permanency planning for minors;
responsibilities of the person or legally authorized representative (LAR), LIDDA and SSLC about the care, treatment and the person’s discharge, including how the terms of the agreement will be monitored; and
length of time of the emergency admission and anticipated date of discharge.

The HHSC commissioner or their designee must approve the Emergency Admission/Discharge Agreement before the person is admitted to an SSLC.

The Emergency Admission/Discharge Agreement, including the date of discharge, must not be changed unless the LIDDA gets approval from the commissioner or designee. The SSLC discharges the resident by the date specified in the Emergency Admission/Discharge Agreement.

If the resident or LAR, with input from the interdisciplinary team (IDT), agree the resident benefits from extending their stay beyond the emergency admission’s time limits, a civil commitment under the Persons with Intellectual Disabilities Act (PIDA) must be requested and in place before the emergency admission agreement expires.

21530 Respite Admission

Revision 24-1 Effective March 1, 2024

26 TAC, Section 904.55

Respite voluntary admission is a time-limited service to address the person or the person’s family’s need for assistance or relief. Respite admission can be requested by the person requesting the service or their legally authorized representative (LAR).

A respite admission may occur if:

persuasive evidence shows the person has a diagnosis of an intellectual disability (ID);
the state supported living center (SSLC) has appropriate space available;
the SSLC provides services that meet the needs of the person; and
the person or the person’s family urgently needs help or relief provided within a period not more than 30 calendar days after the date of admission.

Note: One 30-day extension may be allowed if the relief sought has not been satisfied during the initial 30 days.

Process for respite admission to an SSLC is:

The local intellectual and developmental disability authority (LIDDA) must complete Form 8654, State Supported Living Center (SSLC) Admission Application, and submit it to the SSLC serving their area.
The SSLC identifies if there is space for the person’s respite stay.
The SSLC notifies the LIDDA of the available space for the person’s respite stay and requests the LIDDA contact the person or their LAR to determine if they still need respite care.
If respite admission is needed, the LIDDA completes and submits the Respite Admission/Discharge Agreement provided by the SSLC, which contains the agreements by the person or their LAR, the LIDDA and the SSLC. The person’s SSLC Admission Application also should be updated if there have been changes in medication, diagnoses or other issues.
The person’s LIDDA service plan documents how the respite stay will be used to assist the person achieve the purpose identified in the Respite Admission/Discharge Agreement.
If it is determined an extension of the respite stay is needed, this request must be submitted at least three business days before the original Respite Admission/Discharge Agreement expires.
The head of the SSLC must agree the space continues to be available and all parties must consent.

Note: Home and Community-based Services (HCS) rules prohibit the provider from providing respite to an HCS program recipient in an institution, such as an ICF/IID, nursing facility or hospital.

21540 Regular Voluntary Admission

Revision 24-1 Effective March 1, 2024

26 TAC, Section 904.25

Regular voluntary admission is placement for a person who requires habilitative services, care, treatment and training. State supported living centers (SSLCs) do not permit the regular voluntary admission of a minor, as noted in 26 TAC section 904.35.

Only an adult with the capacity to give legally adequate consent may request a regular voluntary admission to an SSLC for habilitative services, care, treatment and training. A court-appointed guardian may not request a regular voluntary admission on behalf of the ward.

For a person who does not have the legal capacity to consent to an admission, a voluntary admission is not available. If admission is determined necessary, the person must meet criteria for a civil commitment under the Persons with Intellectual Disability Act (PIDA).

The criteria for a regular voluntary admission are identified in 21400, SSLC Admission Criteria, with two additional criteria.

For a regular voluntary admission the:

Texas Health and Human Services Commission (HHSC) must make sure space is available in an SSLC; and
SSLC’s facility director must determine if the SSLC provides services that meet the person’s needs.

Local intellectual and developmental disability authority (LIDDA) staff must consult with HHSC SSLC Continuity of Services (COS) coordinator for guidance if a person requests a regular voluntary admission to an SSLC.

If the person requests voluntary admission to an SSLC and the LIDDA agrees the person meets criteria for voluntary admission, the LIDDA completes an SSLC Admission Application, Form 8654 for the person and submits it to the SSLC.

Note: The criteria for an involuntary commitment under the PIDA are the same as for the regular voluntary admission criteria, except for the civil commitment process. Review 21610, Civil Commitment of a Person under the PIDA for more information.

21600 Involuntary Admissions

Revision 24-1 Effective March 1, 2024

A court orders an involuntary admission for a person who has demonstrated a need for an institutional setting. These admissions occur because of one of the following court orders:

civil commitments under the Persons with Intellectual Disability Act (PIDA);
civil commitment under the PIDA without an interdisciplinary team (IDT) recommendation;
forensic commitment under the Code of Criminal Procedure; and
forensic commitment under the Family Code.

21610 Civil Commitment of a Person under the Persons with Intellectual Disability Act

Revision 24-1 Effective March 1, 2024

26 TAC, Sections 904.25 and 904.29

If the local intellectual and developmental disability authority (LIDDA) determines a person meets admission criteria and needs long-term habilitative services, care, treatment and training in a state supported living center (SSLC), the LIDDA coordinates completion of an:

Form 8654, SSLC Admission Application packet; and
an application to the court for a civil commitment under the Persons with Intellectual Disability Act (PIDA).

Note: Form 8515, Guidelines for Determining Less Restrictive Setting must be part of the SSLC application packet. Review 16000, Guidelines for Determining Less Restrictive Setting for more information.

A person may be committed to an SSLC for residential services if an interdisciplinary team (IDT) recommendation includes the following findings:

the person is determined to have intellectual disability (ID) per Texas Administrative Code, Title 26, Chapter 304 relating to Diagnostic Assessment;
the person, because of an ID:
- represents a substantial risk of physical impairment or injury to self or others; or
- is unable to provide for and is not providing for their most basic personal physical needs;
the person cannot be adequately and appropriately habilitated in an available, less restrictive setting; and
the SSLC provides habilitative services, care, training and treatment appropriate to the adult's needs.

An IDT recommendation must be completed during the six months before the date of the commitment hearing per 26 Texas Administrative Code (TAC), Section 904.25.

A person represents a substantial risk of physical impairment or injury to self or others or is unable to provide for and is not providing for the person's most basic personal physical needs if:

the person's intellectual quotient (IQ) is four or more standard deviations below the mean, such as in the severe or profound range of ID;
the person's Inventory for Client and Agency Planning (ICAP) service level equals:
- 1, 2, 3 or 4; or
- 5 or 6 and the person:
  - has extraordinary medical needs that would require at least 180 minutes of direct nursing services if the person’s caregiver were not providing such treatment; or
  - exhibits incidents of dangerous behavior that would require intensive staff intervention and resources to prevent serious physical injury to the person or others if the person's caregiver were not managing such incidents; or
- the person meets other objective measures as determined by the department.

A minor may not be admitted to an SSLC on a civil commitment unless the following has been completed before admission:

Community Resource Coordination Group (CRCG) completes a consultation for the minor and provides information to the minor’s family about available community supports that might serve as an alternative to an SSLC; or
if the minor lives in a county not served by a CRCG, the LIDDA must inform the parent or guardian of all community-based services and any other service and support options the minor may be eligible for and complete the permanency planning process described in 26 TAC, Section 904.171;
available community supports that might serve as an alternative to admitting the minor to an SSLC were attempted; and
if there are indications the minor may have a serious emotional disturbance, a children’s mental health professional assessed the minor to determine if a serious emotional disturbance exists and services to address the serious emotional disturbance were attempted.

Further details about information supporting the application packet are available in 21700, LIDDA Responsibilities in Admissions to an SSLC.

Note: Civil commitments under the PIDA are not time limited. This does not, prevent an IDT from making a referral to the community following admission.

21620 Civil Commitment of a Person under the PIDA without an IDT recommendation

Revision 24-1 Effective March 1, 2024

Information will be added to this subsection as rules are developed. If a LIDDA is requested to help access an SSLC admission under this commitment type, contact the SSLC Admissions and Placement Coordinator for their LIDDA catchment area.

21630 Commitment of an Adult under the Texas Code of Criminal Procedure

Revision 24-1 Effective March 1, 2024

40 TAC, Section 2.256; Texas Code of Criminal Procedure, Chapter 16, Articles 46.02, Section 6B and 46C

An adult may be committed to a state supported living center (SSLC) if all charges pending against the adult have not been dismissed and one of the following criteria are met:

the adult is found incompetent to stand trial and no substantial probability has been found that the adult will become competent in the near future; or
the adult previously was committed to a maximum-security unit of a facility in connection with the same offense.

Note: The adult being committed to an SSLC must also meet admission criteria, per 21400, SSLC Admission Criteria.

The SSLC may request a civil commitment for an adult who has reached their maximum time served under a 46B commitment if the person is not determined to be appropriate to refer to the community.

The local intellectual and developmental disability authority (LIDDA) facilitates the application for the civil commitment. This process involves completing all steps in 21610, Civil Commitment of a Person under the PIDA.

21640 Forensic Commitments Under the Family Code

Revision 24-1 Effective March 1, 2024

26 TAC, Sections 904.31, 904.33 and 904.51; Texas Family Code, Sections 55.41 and 55.60

A minor in the juvenile justice system may be committed to a state supported living center (SSLC) if:

the minor is found to be unfit to proceed or to lack responsibility for the minor’s actions pursuant to juvenile charges;
the minor is determined to have a diagnosis of intellectual disability (ID) and because of this the minor is unfit to proceed or that the minor lacks responsibility for their actions; and
the minor meets all other criteria outlined in 21400, SSLC Admission Criteria.

When a juvenile court notifies the Texas Health and Human Services Commission (HHSC) that a placement order for a minor has been issued under Texas Family Code, HHSC notifies the appropriate local intellectual and developmental disability authority (LIDDA) of the placement order.

Before the minor’s admission under a placement order, the LIDDA must submit or obtain the following documents to share with the state supported living center (SSLC). This could require collaborating with the court, justice center, probation office, the legally authorized representative (LAR) and the independent school district (ISD) serving the youth:

the original court order;
an offense record;
a determination of intellectual disability (DID), if available;
a current medical assessment;
a physician’s medication orders;
a social history;
a psychological history;
an immunization record;
a copy of social security card;
a certified copy of birth certificate;
the Admission, Review, and Dismissal (ARD) Committee report, Individual Education Plan (IEP) and Full Individual and Initial Evaluation (FIE);
a copy of the Medicaid card, if applicable;
any legal document dealing with custody of the minor;
current letters of guardianship, order appointing a guardian and related orders, if the minor has a guardian;
any documents concerning the minor’s immigration status;
a completed Inventory for Client and Agency Planning (ICAP) booklet and intellectual disability/related condition (ID/RC) assessment form, if available; and
any other available evaluation.

The SSLC coordinates admission arrangements with the juvenile probation department serving the LIDDA’s service area upon receipt of the required documents.

21650 Involuntary Admissions for Restoration

Revision 24-1 Effective March 1, 2024

The local intellectual and developmental disability authority (LIDDA) is not the point of entry for courts seeking restoration commitments related to competency to stand trial or fitness to proceed with charges. However, the state supported living center (SSLC) notifies the LIDDA when a person admits under a restoration commitment for service planning and coordination. An application is not required for restoration commitments, but the LIDDA may be asked to help gather information and coordinate services.

Code of Criminal Procedure Restoration: Admission of an adult for up to 60 days for misdemeanors and 120 days for felonies. The court may grant a one-time 60-day extension.

The SSLC’s interdisciplinary team (IDT) submits a report to the court that describes:
- the treatment provided to the adult;
- the IDT’s opinion of if the adult is competent or not competent to stand trial; and
- if the adult meets commitment criteria.

Family Code Restoration: Admission of a minor for up to 90 days.

The SSLC’s IDT submits a report to the court that describes:
- the treatment provided to the minor;
- the IDT’s opinion of if the minor is fit or unfit to proceed with charges; and
- if the minor meets commitment criteria.

The court may assign a LIDDA or the SSLC Director may request a LIDDA to facilitate a civil commitment following the person’s completion of their sentence or requirements of the criminal court. In this case, the LIDDA will follow the guidelines for civil commitment in 21610, Civil Commitment of a Person under the Persons with Intellectual Disability Act (PIDA).

21700 LIDDA Responsibilities in Admissions to an SSLC

Revision 24-1 Effective March 1, 2024

26 TAC, Chapter 904, Continuity of Services—State Facilities

The local intellectual and developmental disability authority (LIDDA) is responsible for referring an eligible person to a state supported living center (SSLC). That process includes the following preliminary steps to makes sure the person and their legally authorized representative (LAR) are provided with the following information:

a verbal and written explanation of residential services and supports for which the person may be eligible, including:
- SSLC;
- community intermediate care facilities for individuals with an intellectual disability (ID) or related conditions (ICFs/IID);
- waiver services under Section1915(c) of the Social Security Act (SSA);
- other community-based services and supports;
information relating to if appropriate residential services are available in each program that the person may be eligible, including SSLCs, community ICFs/IID, waiver services, or other services located nearest to the person’s residence; and
if a person is under 22, provide the LAR an explanation of permanency planning.

The LIDDA’s interdisciplinary team (IDT) should determine the least restrictive setting for the person being considered for admission to an SSLC.

During this process, the LIDDA engages with the following entities as appropriate to the person’s needs:

regional Transition Support Team (TST) to obtain guidance and referrals to help the LIDDA consider other services, supports or approaches that could be attempted in a less restrictive setting;
Crisis Intervention Specialist (CIS) and Crisis Respite (CR) to help address unmet needs of the person or the person’s support system or provider; and
for those under 22, their Community Resource Coordination Group (CRCG) on the discussion of options to assure all avenues for addressing unmet needs in the community have been explored.

Documentation of these efforts should be included in the SSLC packet and documented on Form 8515, Guidelines for Determining Less Restrictive Settings.

Information will be added to this subsection about LIDDA responsibilities related to PIDA commitments completed without an IDT recommendation as rules are developed. If a LIDDA is requested to help access an SSLC admission under this commitment type, contact the SSLC Admissions and Placement Coordinator for their LIDDA catchment area.

21710 Interdisciplinary Team Review of Appropriateness of Referral

Revision 24-1 Effective March 1, 2024

26 TAC, Chapter 904, Continuity of Services—State Facilities

When a person or their legally authorized representative (LAR) requests the person be admitted to a state supported living center (SSLC) and the local intellectual and developmental disability authority (LIDDA) has documented the sharing of information and the review of less restrictive options to meet the needs of the person, the LIDDA submits an SSLC application packet for the LIDDA’s Interdisciplinary Team (IDT) to review. The LIDDA’s IDT reviews the packet prepared to determine the appropriateness of the application.

A complete SSLC Admission Application packet, Form 8654, must include an IDT recommendation. This can also be used in court commitments to satisfy the need for an IDT recommendation as described in 26 Texas Administrative Code (TAC) Chapter 904, Continuity of Services—State Facilities.

Note: The SSLC Admission Application provides a list of additional items needed for each type of admission. Those documents are required to complete the application.

If the LIDDA’s IDT determines an applicant meets the criteria for admission to an SSLC, the LIDDA:

notifies the person or LAR in writing;
contacts the SSLC serving the area where the applicant lives or, if the applicant requests an interstate transfer, the area where the person's LAR or family lives or intends to live;
contacts the interstate compact coordinator at Texas Health and Human Services Commission (HHSC) if the applicant requests an interstate transfer for more information on transfer requirements;
makes sure all information required for the admission packet is included with the completed SSLC Admission Application, Form 8654 and submits it to the SSLC assigned to their service area; and
opens an assignment in Client Assignment and Registration (CARE) indicating the person is waiting for services in an SSLC.

If the LIDDA's IDT determines the applicant does not meet the criteria for commitment or voluntary admission to an SSLC, the LIDDA:

notifies the applicant or LAR in writing of the determination and explains the procedure for the applicant or LAR to request a review of the IDT's determination by the LIDDA; or
if the applicant requested interstate transfer, notifies the interstate compact coordinator in writing of the LIDDA’s determination.

If the applicant or their LAR requests a review of the IDT's determination by the LIDDA, the LIDDA completes a review of all information used to make this determination. The LIDDA provides the result of the review to the applicant or LAR in writing.

If a review by the LIDDA of the IDT’s determination results in the determination being upheld, the LIDDA notifies the applicant or LAR in writing that they may contact the IDD Ombudsman to request a review by:

writing to IDD Ombudsman, Mail Code H-700, P.O. Box 13247, Austin, Texas 78714-3247;
emailing ombudsmanidd@hhs.texas.gov; or
calling the IDD Ombudsman at 800-252-8154.

If the applicant or LAR makes this request, the IDD Ombudsman reviews relevant documentation provided by the applicant and LAR, the IDT and the LIDDA and determines if the LIDDA followed the processes described in this subchapter.

If the ombudsman decides the processes in this subchapter were followed, the ombudsman helps the applicant gain access to an appropriate program that the applicant is eligible for or places the applicant on the waiting list of an appropriate program that the applicant is eligible.
If the ombudsman decides the processes in this subchapter were not followed, then the LIDDA must take action to follow the processes in this subchapter.
The ombudsman issues a written decision to the applicant, the applicant's LAR, and the LIDDA within 14 calendar days of the request.

Information will be added to this subsection about PIDA commitments completed without an IDT recommendation as rules are developed. If a LIDDA is requested to help access an SSLC admission under this commitment type, contact the SSLC Admissions and Placement Coordinator for their LIDDA catchment area.

21720 Process for Admission of an Adult or Minor Committed to an SSLC under the PIDA

Revision 24-1 Effective March 1, 2024

When it is determined that a person is in need of an involuntary commitment under the Persons with Intellectual Disability Act (PIDA), the local intellectual and developmental disability authority (LIDDA) must file an application for commitment if the person or their legally authorized representative (LAR) do not.

The LIDDA must file the application with the county court where the person lives or last maintained residence. If the person is not enrolled in home and community-based services (HCS), their residence may be considered where their parent, conservator or LAR lives.

Note: Psychiatric hospitals, residential treatment centers, and jails or detention facilities are not considered “residences.”

The application for a person’s commitment to a residential care facility, previously referred to as a state supported living center, under the PIDA must:

be notarized by the county clerk and include:
- the name, birth date, sex, and address of the proposed resident;
- the name and address of the proposed resident’s parent or guardian, if applicable;
- a short statement of facts that show commitment to a facility is necessary and appropriate; and
- a short statement that explains why admission to less restrictive services is inappropriate.

The LIDDA must file an interdisciplinary team (IDT) recommendation with the county court as a separate document from the application for commitment. The LIDDA may use the IDT recommendation in the SSLC admission application. The recommendation must be a distinct document in this filing. If a person, their LAR or another concerned member of the community files the application for commitment, the LIDDA receives an order from the court for an IDT recommendation.

The IDT recommendation needs to include evidence gathered supporting the need for commitment, such as:

SSLC Admission Application, Form 8654;
legal, hospital, psychiatric treatment records;
transition support team (TST) meeting minutes;
Community Resource Coordination Group (CRCG) minutes or letter for people under 22;
determination of intellectual disability (DID) report;
Inventory for Client and Agency Planning (ICAP);
Behavior Support Plan; and
any other document supporting the person’s needs for services and supports.

The LIDDA needs to help the person complete an application for representation of an indigent person with the court officer. This is not needed if the person or their LAR has funds to pay court fees and attorneys associated with the hearing.

The LIDDA receives notice of the commitment hearing and the LIDDA representative who filed the application is expected to attend. If the LIDDA representative does not receive a subpoena, the LIDDA needs to obtain consent to participate in the hearing from the person or their LAR before the hearing.

The LIDDA representative needs to be prepared to answer questions from the attorneys and the judge about how it was decided the person needs to be committed to an institution. Questioners may ask about the less restrictive alternatives tried and why they inadequately addressed the person’s need for services and supports.

The court may subpoena the examiner who completed the person’s Determination of Intellectual Disability (DID) to answer questions about this report. If the DID examiner does not receive a subpoena, the LIDDA representative at the hearing needs to be prepared to verify the DID report is part of the person’s medical record at the LIDDA.

The person’s LAR will receive a notice compelling them to participate in the hearing. The person will participate unless their attorney chooses to request the court waive their appearance before the court.

If a court orders a person to be committed to an SSLC at the hearing, the LIDDA forwards a copy of the commitment order to the SSLC admission coordinator to add to the SSLC admission packet.

The Texas Health and Human Services Commission (HHSC) determines when a vacancy exists in an SSLC. HHSC decides which people are appropriate to fill the vacancy based on information provided in the application packets. HHSC notifies the LIDDA when a vacancy becomes available to meet the person’s needs.

Note: The LIDDA needs to anticipate alternate services and supports will be needed while the person waits for admission to an SSLC. It is recommended the LIDDA submit a complete admission packet to their designated SSLC while waiting on a commitment hearing. This gives HHSC more time to find an appropriate bed to meet the person’s needs.

When the LIDDA is notified a vacancy exists in an SSLC for the person, LIDDA staff will:

contact the person and their LAR or family to determine if the person is still seeking admission to an SSLC under the commitment;
explain the arrangement that has been identified and ask the person or their LAR if they will accept the proposed admission to the SSLC; and
update the information in the person's application packet, such as making sure the assessments reflect the person's current level of functioning.

If the LIDDA finds, after speaking with the person and their LAR, they no longer wish to pursue admission to an SSLC under the commitment order, the LIDDA notifies the court in writing and informs the SSLC so the vacancy may be used by another applicant.

When notifying the court in writing, the following guidance is provided:

use agency letterhead and memorandum format;
in the subject line, include the following information as listed on the PIDA commitment order:
- name of the court;
- cause number; and
- name of the person;
provide the reason the person or their LAR declined the vacancy, including information about the resources the person is using to meet their needs in lieu of SSLC services; and
provide contact information for the person or LAR and the LIDDA representative should the court need additional information.

The SSLC will offer admission to the person under the commitment order if the LIDDA finds the person or their LAR on their behalf, will accept the admission. In this case, the LIDDA:

Requests the applicant be enrolled in the intermediate care facility for individuals with intellectual disability and related conditions (ICF/IID) program and prepares Form 8578, Intellectual Disability/Related Conditions (ID/RC). A community physician must sign Form 8578 and it must be submitted to the SSLC within 15 days of admission.
- Note: The person’s community physician must sign the pre-admission (purpose code 2) ID/RC. It is best to do this before admission in the event the physician wants to visit the person before signing the form.
Coordinates the following with the SSLC admission staff:
- transportation arrangements for the person on the day of admission appropriate to the need;
- arrangements for the person’s LAR, family member or staff familiar with the person if a LAR does not exist to be present at the admission; and
- the exchange of essential information about the person, including any necessary training, to advise the SSLC staff of the person’s needs.

Information will be added to this subsection about any LIDDA responsibilities relevant to PIDA commitments completed without an IDT recommendation as rules are developed. If a LIDDA is requested to help access an SSLC admission under this commitment type, contact the SSLC Admissions and Placement Coordinator for their LIDDA catchment area.

21730 Responsibilities of LIDDAs for People Admitted to an SSLC

Revision 24-1 Effective March 1, 2024

Review 10000, Community Living Options Information Process, of this handbook for this information.

21800 Community Placement from an SSLC

Revision 24-1 Effective March 1, 2024

This section outlines local intellectual and developmental disability authority (LIDDA) responsibilities relevant to the community placement of a resident from a state supported living center (SSLC).

21810 Community Living Discharge Plan for Alternative Living Arrangements

Revision 24-1 Effective March 1, 2024

26 TAC, Section 904.107

Should a resident’s interdisciplinary team (IDT) determine community living would better help the resident achieve quality-of-life outcomes, a community living discharge plan (CLDP) for alternative living arrangements will be developed.

The state supported living center (SSLC) staff prepares the CLDP. The plan incorporates information provided by the resident, their legally authorized representative (LAR), the local intellectual and developmental disability authority (LIDDA), other facility staff and the resident’s anticipated provider.

The plan is customized to the abilities and needs of the resident and must specify:

timelines and intervals for monitoring activities after the resident moves into the community;
the designated LIDDA’s and proposed LIDDA’s responsibilities if the residential location is out of the designated LIDDA’s service area,
the provider’s responsibilities; and
the criteria for discharge from the SSLC related to involuntary commitment.

The plan outlines the resident’s outcomes for community living that are the basis for his or her person directed plan and service coordination plan.

The resident, their LAR, the SSLC IDT, the designated and proposed LIDDAs when both exist, and the provider representatives must approve the plan before the resident leaves the SSLC.

21820 Community Living

Revision 24-1 Effective March 1, 2024

Review 9000, Enhanced Community Coordination Responsibilities for SSLC and ICF/IID Diversions and Transitions of this handbook for LIDDA responsibilities for pre-move and post-move monitoring of a person who has transitioned from a state supported living center (SSLC) into a community placement.

21900 Discharge from an SSLC of a Person who Moves to an Alternative Living Arrangement

Revision 24-1 Effective March 1, 2024

26 TAC, Section 904.125

A person who has transitioned from a state supported living center (SSLC) into an alternate living arrangement, such as a community placement with intellectual and developmental disability (IDD) services, which include home and community-based services (HCS) and intermediate care facility for individuals with intellectual disabilities and related conditions (ICF/IID), may be discharged from their civil commitment to the SSLC if the SSLC documents in the person’s community living discharge plans (CLDP) record that:

the person’s needs are better served in a setting other than an SSLC; and
the person is being successfully treated and habilitated in the current community living arrangement.

The local intellectual and developmental disability authority (LIDDA)must report the person’s progress to the SSLC after:

the person transitions to a community placement; and
when they meet the established criteria for discharge in the CLDP.

When the LIDDA submits a recommendation for discharge from the commitment to the SSLC, the SSLC notes receipt in the person’s record. The LIDDA sends a notice of the intent to discharge to the person, the court that originally committed the person under the Persons with Intellectual Disability Act (PIDA) if such a commitment exists, and the person’s legally authorized representative (LAR) or actively involved family member.

If the person or LAR does not agree with the plan to discharge the person from commitment, an administrative hearing is arranged. If the person or their LAR agree to the discharge plan, the LIDDA initiates the discharge entry into the Client Assignment and Registration (CARE) System and notifies the person, LAR and actively involved family member or friend of the completed discharge. The LIDDA also notifies the committing court. The SSLC sends a written notice to the LIDDA and the provider when the discharge is finalized.

When notifying the court in writing, the following guidance is provided:

use agency letterhead and memorandum format;
in the subject line, clearly list the following information as listed on the PIDA commitment order:
- name of the court;
- cause number;
- name of the person; and
- the reason for the communication, which is “Discharge of Commitment”.
provide justification for the court to discharge the commitment, including:
- a description of the person’s successful community placement, including the names of any IDD program services the person is accessing;
- a progress report on needs identified in the application for commitment of the person, particularly addressing any health and safety risks and how they are resolved or being addressed in the community;
- a statement that the person has met the objectives of their community living discharge plan at the SSLC;
- a request that the person be discharged from the court’s commitment by saying, for example, “We respectfully request”; and
- contact information for the LIDDA representative.