Texas Register, Volume 49, Number 7, Pages 805-932, February 16, 2024 Page: 872
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Comment: Fourteen individuals provided substantially sim-
ilar comments and requested HHSC revise 448.801(h)(1),
448.803(b)(1), and 448.911(d)(2) to relax the requirement for
counselor interns to pass the chemical dependency counselor
licensing exam before providing telehealth services. These
commenters stated Level Ill counselor interns already oper-
ate under the supervision of a QCC to provide services in
person and have substantial training and experience, which
should allow them to provide services electronically. These
commenters also stated allowing counselor interns to provide
services through electronic means could enhance accessibility
to mental health care for individuals who may face barriers to
in-person appointments.
Response: HHSC declines to revise 448.801(h)(1), renum-
bered to 448.801(h)(1)(B); 448.803(b)(1), renumbered to
448.803(b)(1)(B); and 448.911(d)(2) because the chemical
dependency counselor licensing exam is necessary to demon-
strate the intern's skill set and proficiency in service delivery.
Comment: One individual requested clarification on whether
the 2,000 hours of supervised experience requirement, before
a counselor or counselor intern may provide services through
electronic means, would allow a licensed master social worker
(LMSW) or licensed professional counselor assistant (LPC-A)
to qualify under these paragraphs as being able to screen
individuals using electronic means once they achieve the 2,000
hours and are under a board-approved supervision plan.
Response: HHSC revises 448.801(h)(1) and 448.803(b)(1)
by dividing these paragraphs into two new subparagraphs
and relocating "prior to screening an individual through elec-
tronic means" to the beginning of these paragraphs. HHSC
revises 448.801(h)(1), renumbered to 448.801(h)(1)(A) and
448.803(b)(1), renumbered to 448.803(b)(1)(A), to clarify LM-
SWs or LPC-As, in addition to counselor interns, may conduct
screenings and assessments if they meet the requirements of
those subparagraphs.
HHSC also revises 448.801(h)(1), renumbered to
448.801(h)(1)(B), and 448.803(b)(1), renumbered to
448.803(b)(1)(B), to clarify that if the provider conducting the
screening or assessment is a counselor intern, the intern must
have passed the chemical dependency counselor licensing
exam because LMSWs and LPC-As may conduct screenings
and assessments without having to pass the chemical
dependency counselor licensing exam.
Comment: One individual stated 448.801(h)(3)(A), which only
allows CDTFs to screen individuals using audio-only technol-
ogy during a declared state of disaster, is too narrow and limit-
ing for both the prospective client and the organization complet-
ing the screening. The commenter stated this limitation dispro-portionately impacts indigent, low socio-economic-status, and
rural populations that may not have cell phone service, data,
or access to reliable broadband internet. The commenter also
stated this limitation makes maintaining an individual's privacy
during the screening process more difficult as the individual be-
ing screened may go to a place with public Wi-Fi, and in those
situations, the individual's ability to have privacy is greatly re-
duced. The commenter further stated clients who are incarcer-
ated often have limited options to complete screenings and being
able to be screened over the phone may be an incarcerated indi-
vidual's only means of being accepted into a treatment program.
The commenter recommended revising the rule to expand the
exceptions for using audio-only technology beyond a declaredstate of disaster and include the circumstances the commenter
noted in their comment.
Response: HHSC declines to revise 448.801(h)(3)(A) because
the language allowing the use of audio-only technology for
screening purposes only during declared states of disaster is
consistent with HHSC Medicaid Managed Care rules at 1 TAC
Chapter 353, Subchapter R, Telecommunications in Managed
Care Service Coordination and Assessments.
Comment: One individual recommended revising
448.801(h)(3)(B) to require the organization completing the
screening to document a justification for using audio-only
technology that clearly outlines the reason why they did not use
synchronous audiovisual technology to screen the individual.
Response: HHSC revises 448.801(h)(3)(B) and
448.803(b)(3)(B) to require the justification for using audio-only
technology to include the reason why the counselor or counselor
intern did not use synchronous audiovisual technology to
screen or assess the individual, in addition to requiring the
justification for their determination that using synchronous
audio-only technology is safe and clinically appropriate for the
individual being screened or assessed.
Comment: DRTx requested HHSC add language in the rules to
clarify that a counselor or counselor intern must obtain the in-
dividual's consent before using electronic means to screen or
treat the individual. DRTx further stated counselors or counselor
interns must discuss with the individual how the counselor or
counselor intern will conduct the screening or treatment, and if
the individual chooses to utilize electronic means, that individ-
ual's choice must be documented in the individual's client record,
as required by similar language in 448.803. DRTx noted their
recommended revisions are consistent with 1 TAC Chapter 353,
Subchapter R.
Response: HHSC revises 448.801(h)(4) and 448.803(b)(4)
to clarify that the requirement to conduct an in-person and
face-to-face screening or assessment with an individual when
the individual does not provide their verbal consent to partici-
pate in a screening or assessment through electronic means
is required by 448.911(u). HHSC notes 448.801(h) and
448.803(b) require a facility offering screenings and assess-
ments through electronic means to comply with the applicable
requirements under 448.911, including consent and consent
documentation requirements.
Comment: One individual expressed concern with 448.803(d)
requiring the assessment to result in a comprehensive diagnos-
tic impression and stated licensed chemical dependency coun-
selors (LCDCs) are not allowed to formulate comprehensive di-
agnostic impressions. The commenter further stated only a mas-ter's level professional licensed within the scope of their practice
may formulate comprehensive diagnostic impressions from as-
sessment results. The commenter recommended HHSC revise
the rules to require only a fully licensed diagnostic clinician to
properly review and approve a screening and assessment.
Response: HHSC revises 448.803(d) to clarify licensed interns
or other providers must operate within the scope of their license
when providing assessments. HHSC notes LCDCs are allowed
under 25 TAC 140.424(a)(1)(B), Standards for Private Practice,
to diagnose a patient based on an assessment.
Comment: TMA stated the "verbal consent" definition at
448.911(a)(5) could cause confusion because the definition
uses the terms "medical consenter" and "legally authorized49 TexReg 872 February 16, 2024 Texas Register
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Texas. Secretary of State. Texas Register, Volume 49, Number 7, Pages 805-932, February 16, 2024, periodical, February 16, 2024; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth1657764/m1/68/?rotate=270: accessed July 17, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.