Rider 56:  Appropriate Care Settings for Individuals with Severe and Persistent Mental Illness and Co-Occurring Conditions Study 

HHSC Rider 56 (89th Texas Legislature):  According to HHSC, it’s in the beginning stages of implementation but plans to engage stakeholders in the process in early January as well as publish a communication about the Rider and related implementation plans.

Rider 56:  Appropriate Care Settings for Individuals with Severe and Persistent Mental Illness and Co-Occurring Conditions Study.   Out of funds appropriated in Strategy D.2.5, Community Behavioral Health Administration, the Health and Human Services Commission (HHSC) shall study and develop a proposal to implement a pilot program that provides residential intermediate care services for individuals with severe and persistent mental illness who may have co-occurring conditions, including traumatic brain injury, and intellectual or developmental disabilities, who, due to the acuity of their conditions, are inappropriate for community placement but no longer meet criteria for inpatient psychiatric care.

(a) For the purposes of developing the study and proposal:

(1) An individual must meet the following eligibility criteria to qualify for the pilot program:

(A) Have a diagnosis of severe and persistent mental illness and may have a cooccurring condition, such as a traumatic brain injury or intellectual and developmental disability; and

(B) Spent three or more of the past five years in a psychiatric hospital; or

(C) Have been incarcerated more than three times and experienced two psychiatric crises in the previous three years; and   or,

(D) Have been admitted to hospital emergency rooms more than three times with psychiatric crises.

(2) The proposed location of the pilot program shall not be classified as an Institution of Mental Disease under federal Medicaid regulations and shall be designed to ensure compliance with federal funding requirements.

(b) The study and proposal shall:

(1) Assess the existing unmet needs in the service continuum for the target population;

(2) Assess the need for nursing-level care and other specialized services for the target population;

(3) Identify opportunities to modify or expand eligibility criteria for existing programs and services;

(4) Scalable options for implementing the program at residential care facilities and nursing facilities;

(5) Evaluate whether vacated buildings on state hospital campuses or other state facilities could be rehabilitated and used to provide intensive residential services for the target population; and

(6) Evaluate statutory changes and funding needed to establish the pilot program to serve the target population, including the estimated cost to provide intensive residential services for the eligible population and the estimated cost to rehabilitate vacated buildings on state facility campuses to serve as the location of the pilot program.

No later than October 15, 2026, HHSC shall submit findings and recommendations from the study to the Senate Finance Committee, the House Appropriations Committee, the Legislative Budget Board, the Office of the Governor, and permanent standing committees in the House of Representatives and the Senate with jurisdiction over health and human services.