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AN ACT
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relating to the administration and monitoring of health care |
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provided to foster children. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 107.002, Family Code, is amended by |
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adding Subsection (b-1) to read as follows: |
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(b-1) In addition to the duties required by Subsection (b), |
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a guardian ad litem appointed for a child in a proceeding under |
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Chapter 262 or 263 shall: |
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(1) review the medical care provided to the child; and |
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(2) in a developmentally appropriate manner, seek to |
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elicit the child's opinion on the medical care provided. |
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SECTION 2. Section 107.003, Family Code, is amended to read |
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as follows: |
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Sec. 107.003. POWERS AND DUTIES OF ATTORNEY AD LITEM FOR |
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CHILD AND AMICUS ATTORNEY. (a) An attorney ad litem appointed to |
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represent a child or an amicus attorney appointed to assist the |
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court: |
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(1) shall: |
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(A) subject to Rules 4.02, 4.03, and 4.04, Texas |
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Disciplinary Rules of Professional Conduct, and within a reasonable |
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time after the appointment, interview: |
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(i) the child in a developmentally |
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appropriate manner, if the child is four years of age or older; |
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(ii) each person who has significant |
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knowledge of the child's history and condition, including any |
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foster parent of the child; and |
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(iii) the parties to the suit; |
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(B) seek to elicit in a developmentally |
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appropriate manner the child's expressed objectives of |
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representation; |
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(C) consider the impact on the child in |
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formulating the attorney's presentation of the child's expressed |
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objectives of representation to the court; |
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(D) investigate the facts of the case to the |
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extent the attorney considers appropriate; |
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(E) obtain and review copies of relevant records |
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relating to the child as provided by Section 107.006; |
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(F) participate in the conduct of the litigation |
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to the same extent as an attorney for a party; |
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(G) take any action consistent with the child's |
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interests that the attorney considers necessary to expedite the |
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proceedings; |
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(H) encourage settlement and the use of |
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alternative forms of dispute resolution; and |
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(I) review and sign, or decline to sign, a |
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proposed or agreed order affecting the child; |
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(2) must be trained in child advocacy or have |
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experience determined by the court to be equivalent to that |
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training; and |
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(3) is entitled to: |
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(A) request clarification from the court if the |
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role of the attorney is ambiguous; |
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(B) request a hearing or trial on the merits; |
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(C) consent or refuse to consent to an interview |
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of the child by another attorney; |
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(D) receive a copy of each pleading or other |
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paper filed with the court; |
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(E) receive notice of each hearing in the suit; |
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(F) participate in any case staffing concerning |
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the child conducted by an authorized agency; and |
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(G) attend all legal proceedings in the suit. |
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(b) In addition to the duties required by Subsection (a), an |
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attorney ad litem appointed for a child in a proceeding under |
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Chapter 262 or 263 shall: |
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(1) review the medical care provided to the child; |
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(2) in a developmentally appropriate manner, seek to |
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elicit the child's opinion on the medical care provided; and |
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(3) for a child at least 16 years of age, advise the |
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child of the child's right to request the court to authorize the |
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child to consent to the child's own medical care under Section |
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266.010. |
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SECTION 3. Section 263.001, Family Code, is amended by |
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amending Subdivision (1) and adding Subdivisions (1-a) and (3-a) to |
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read as follows: |
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(1) "Advanced practice nurse" has the meaning assigned |
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by Section 157.051, Occupations Code. |
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(1-a) "Department" means the Department of Family and |
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Protective Services. |
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(3-a) "Physician assistant" has the meaning assigned |
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by Section 157.051, Occupations Code. |
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SECTION 4. Section 263.306(a), Family Code, is amended to |
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read as follows: |
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(a) At each permanency hearing the court shall: |
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(1) identify all persons or parties present at the |
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hearing or those given notice but failing to appear; |
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(2) review the efforts of the department or another |
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agency in: |
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(A) attempting to locate all necessary persons; |
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(B) requesting service of citation; and |
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(C) obtaining the assistance of a parent in |
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providing information necessary to locate an absent parent, alleged |
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father, or relative of the child; |
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(3) review the efforts of each custodial parent, |
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alleged father, or relative of the child before the court in |
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providing information necessary to locate another absent parent, |
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alleged father, or relative of the child; |
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(4) return the child to the parent or parents if the |
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child's parent or parents are willing and able to provide the child |
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with a safe environment and the return of the child is in the |
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child's best interest; |
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(5) place the child with a person or entity, other than |
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a parent, entitled to service under Chapter 102 if the person or |
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entity is willing and able to provide the child with a safe |
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environment and the placement of the child is in the child's best |
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interest; |
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(6) evaluate the department's efforts to identify |
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relatives who could provide the child with a safe environment, if |
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the child is not returned to a parent or another person or entity |
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entitled to service under Chapter 102; |
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(7) evaluate the parties' compliance with temporary |
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orders and the service plan; |
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(8) review the medical care provided to the child as |
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required by Section 266.007; |
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(9) ensure the child has been provided the |
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opportunity, in a developmentally appropriate manner, to express |
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the child's opinion on the medical care provided; |
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(10) for a child receiving psychotropic medication, |
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determine whether the child: |
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(A) has been provided appropriate psychosocial |
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therapies, behavior strategies, and other non-pharmacological |
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interventions; and |
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(B) has been seen by the prescribing physician, |
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physician assistant, or advanced practice nurse at least once every |
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90 days for purposes of the review required by Section 266.011; |
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(11) determine whether: |
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(A) the child continues to need substitute care; |
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(B) the child's current placement is appropriate |
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for meeting the child's needs, including with respect to a child who |
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has been placed outside of the state, whether that placement |
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continues to be in the best interest of the child; and |
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(C) other plans or services are needed to meet |
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the child's special needs or circumstances; |
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(12) [(9)] if the child is placed in institutional |
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care, determine whether efforts have been made to ensure placement |
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of the child in the least restrictive environment consistent with |
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the best interest and special needs of the child; |
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(13) [(10)] if the child is 16 years of age or older, |
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order services that are needed to assist the child in making the |
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transition from substitute care to independent living if the |
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services are available in the community; |
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(14) [(11)] determine plans, services, and further |
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temporary orders necessary to ensure that a final order is rendered |
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before the date for dismissal of the suit under this chapter; |
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(15) [(12)] if the child is committed to the Texas |
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Juvenile Justice Department [Youth Commission] or released under |
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supervision by the Texas Juvenile Justice Department [Youth
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Commission], determine whether the child's needs for treatment, |
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rehabilitation, and education are being met; and |
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(16) [(13)] determine the date for dismissal of the |
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suit under this chapter and give notice in open court to all parties |
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of: |
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(A) the dismissal date; |
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(B) the date of the next permanency hearing; and |
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(C) the date the suit is set for trial. |
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SECTION 5. Section 263.503(a), Family Code, is amended to |
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read as follows: |
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(a) At each placement review hearing, the court shall |
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determine whether: |
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(1) the child's current placement is necessary, safe, |
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and appropriate for meeting the child's needs, including with |
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respect to a child placed outside of the state, whether the |
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placement continues to be appropriate and in the best interest of |
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the child; |
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(2) efforts have been made to ensure placement of the |
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child in the least restrictive environment consistent with the best |
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interest and special needs of the child if the child is placed in |
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institutional care; |
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(3) the services that are needed to assist a child who |
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is at least 16 years of age in making the transition from substitute |
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care to independent living are available in the community; |
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(4) the child is receiving appropriate medical care; |
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(5) the child has been provided the opportunity, in a |
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developmentally appropriate manner, to express the child's opinion |
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on the medical care provided; |
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(6) a child who is receiving psychotropic medication: |
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(A) has been provided appropriate psychosocial |
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therapies, behavior strategies, and other non-pharmacological |
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interventions; and |
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(B) has been seen by the prescribing physician, |
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physician assistant, or advanced practice nurse at least once every |
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90 days for purposes of the review required by Section 266.011; |
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(7) other plans or services are needed to meet the |
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child's special needs or circumstances; |
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(8) [(5)] the department or authorized agency has |
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exercised due diligence in attempting to place the child for |
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adoption if parental rights to the child have been terminated and |
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the child is eligible for adoption; |
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(9) [(6)] for a child for whom the department has been |
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named managing conservator in a final order that does not include |
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termination of parental rights, a permanent placement, including |
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appointing a relative as permanent managing conservator or |
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returning the child to a parent, is appropriate for the child; |
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(10) [(7)] for a child whose permanency goal is |
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another planned, permanent living arrangement, the department has: |
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(A) documented a compelling reason why adoption, |
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permanent managing conservatorship with a relative or other |
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suitable individual, or returning the child to a parent is not in |
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the child's best interest; and |
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(B) identified a family or other caring adult who |
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has made a permanent commitment to the child; |
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(11) [(8)] the department or authorized agency has |
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made reasonable efforts to finalize the permanency plan that is in |
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effect for the child; and |
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(12) [(9)] if the child is committed to the Texas |
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Juvenile Justice Department [Youth Commission] or released under |
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supervision by the Texas Juvenile Justice Department [Youth
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Commission], the child's needs for treatment, rehabilitation, and |
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education are being met. |
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SECTION 6. Section 264.121, Family Code, is amended by |
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adding Subsection (g) to read as follows: |
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(g) For a youth taking prescription medication, the |
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department shall ensure that the youth's transition plan includes |
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provisions to assist the youth in managing the use of the medication |
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and in managing the child's long-term physical and mental health |
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needs after leaving foster care, including provisions that inform |
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the youth about: |
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(1) the use of the medication; |
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(2) the resources that are available to assist the |
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youth in managing the use of the medication; and |
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(3) informed consent and the provision of medical care |
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in accordance with Section 266.010(l). |
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SECTION 7. Section 266.001, Family Code, is amended by |
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amending Subdivision (1) and adding Subdivisions (1-a), (6), and |
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(7) to read as follows: |
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(1) "Advanced practice nurse" has the meaning assigned |
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by Section 157.051, Occupations Code. |
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(1-a) "Commission" means the Health and Human Services |
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Commission. |
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(6) "Physician assistant" has the meaning assigned by |
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Section 157.051, Occupations Code. |
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(7) "Psychotropic medication" means a medication that |
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is prescribed for the treatment of symptoms of psychosis or another |
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mental, emotional, or behavioral disorder and that is used to |
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exercise an effect on the central nervous system to influence and |
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modify behavior, cognition, or affective state. The term includes |
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the following categories when used as described by this |
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subdivision: |
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(A) psychomotor stimulants; |
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(B) antidepressants; |
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(C) antipsychotics or neuroleptics; |
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(D) agents for control of mania or depression; |
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(E) antianxiety agents; and |
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(F) sedatives, hypnotics, or other |
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sleep-promoting medications. |
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SECTION 8. Section 266.004, Family Code, is amended by |
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adding Subsections (h-1) and (h-2) to read as follows: |
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(h-1) The training required by Subsection (h) must include |
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training related to informed consent for the administration of |
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psychotropic medication and the appropriate use of psychosocial |
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therapies, behavior strategies, and other non-pharmacological |
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interventions that should be considered before or concurrently with |
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the administration of psychotropic medications. |
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(h-2) Each person required to complete a training program |
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under Subsection (h) must acknowledge in writing that the person: |
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(1) has received the training described by Subsection |
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(h-1); |
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(2) understands the principles of informed consent for |
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the administration of psychotropic medication; and |
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(3) understands that non-pharmacological |
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interventions should be considered and discussed with the |
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prescribing physician, physician assistant, or advanced practice |
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nurse before consenting to the use of a psychotropic medication. |
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SECTION 9. Chapter 266, Family Code, is amended by adding |
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Section 266.0042 to read as follows: |
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Sec. 266.0042. CONSENT FOR PSYCHOTROPIC MEDICATION. |
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Consent to the administration of a psychotropic medication is valid |
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only if: |
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(1) the consent is given voluntarily and without undue |
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influence; and |
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(2) the person authorized by law to consent for the |
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foster child receives verbally or in writing information that |
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describes: |
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(A) the specific condition to be treated; |
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(B) the beneficial effects on that condition |
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expected from the medication; |
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(C) the probable health and mental health |
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consequences of not consenting to the medication; |
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(D) the probable clinically significant side |
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effects and risks associated with the medication; and |
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(E) the generally accepted alternative |
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medications and non-pharmacological interventions to the |
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medication, if any, and the reasons for the proposed course of |
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treatment. |
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SECTION 10. The heading to Section 266.005, Family Code, is |
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amended to read as follows: |
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Sec. 266.005. PARENTAL NOTIFICATION OF CERTAIN |
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[SIGNIFICANT] MEDICAL CONDITIONS. |
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SECTION 11. Section 266.005, Family Code, is amended by |
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adding Subsection (b-1) and amending Subsection (c) to read as |
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follows: |
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(b-1) The department shall notify the child's parents of the |
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initial prescription of a psychotropic medication to a foster child |
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and of any change in dosage of the psychotropic medication at the |
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first scheduled meeting between the parents and the child's |
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caseworker after the date the psychotropic medication is prescribed |
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or the dosage is changed. |
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(c) The department is not required to provide notice under |
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Subsection (b) or (b-1) to a parent who: |
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(1) has failed to give the department current contact |
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information and cannot be located; |
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(2) has executed an affidavit of relinquishment of |
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parental rights; |
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(3) has had the parent's parental rights terminated; |
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or |
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(4) has had access to medical information otherwise |
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restricted by the court. |
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SECTION 12. Section 266.007(a), Family Code, is amended to |
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read as follows: |
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(a) At each hearing under Chapter 263, or more frequently if |
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ordered by the court, the court shall review a summary of the |
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medical care provided to the foster child since the last hearing. |
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The summary must include information regarding: |
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(1) the nature of any emergency medical care provided |
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to the child and the circumstances necessitating emergency medical |
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care, including any injury or acute illness suffered by the child; |
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(2) all medical and mental health treatment that the |
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child is receiving and the child's progress with the treatment; |
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(3) any medication prescribed for the child, [and] the |
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condition, diagnosis, and symptoms for which the medication was |
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prescribed, and the child's progress with the medication; |
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(4) for a child receiving a psychotropic medication: |
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(A) any psychosocial therapies, behavior |
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strategies, or other non-pharmacological interventions that have |
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been provided to the child; and |
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(B) the dates since the previous hearing of any |
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office visits the child had with the prescribing physician, |
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physician assistant, or advanced practice nurse as required by |
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Section 266.011; |
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(5) the degree to which the child or foster care |
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provider has complied or failed to comply with any plan of medical |
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treatment for the child; |
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(6) [(5)] any adverse reaction to or side effects of |
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any medical treatment provided to the child; |
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(7) [(6)] any specific medical condition of the child |
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that has been diagnosed or for which tests are being conducted to |
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make a diagnosis; |
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(8) [(7)] any activity that the child should avoid or |
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should engage in that might affect the effectiveness of the |
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treatment, including physical activities, other medications, and |
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diet; and |
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(9) [(8)] other information required by department |
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rule or by the court. |
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SECTION 13. Chapter 266, Family Code, is amended by adding |
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Section 266.011 to read as follows: |
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Sec. 266.011. MONITORING USE OF PSYCHOTROPIC DRUG. The |
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person authorized to consent to medical treatment for a foster |
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child prescribed a psychotropic medication shall ensure that the |
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child has been seen by the prescribing physician, physician |
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assistant, or advanced practice nurse at least once every 90 days to |
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allow the physician, physician assistant, or advanced practice |
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nurse to: |
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(1) appropriately monitor the side effects of the |
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medication; and |
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(2) determine whether: |
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(A) the medication is helping the child achieve |
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the treatment goals; and |
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(B) continued use of the medication is |
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appropriate. |
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SECTION 14. Section 533.0161(b), Government Code, is |
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amended to read as follows: |
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(b) The commission shall implement a system under which the |
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commission will use Medicaid prescription drug data to monitor the |
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prescribing of psychotropic drugs for [children who are]: |
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(1) children who are in the conservatorship of the |
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Department of Family and Protective Services[;] and |
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[(2)] enrolled in the STAR Health Medicaid managed care |
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program or eligible for both Medicaid and Medicare; and |
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(2) children who are under the supervision of the |
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Department of Family and Protective Services through an agreement |
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under the Interstate Compact on the Placement of Children under |
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Subchapter B, Chapter 162, Family Code. |
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SECTION 15. The heading to Subchapter A, Chapter 266, |
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Family Code, is repealed. |
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SECTION 16. The changes in law made by this Act apply to a |
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suit affecting the parent-child relationship pending in a trial |
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court on or filed on or after the effective date of this Act. |
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SECTION 17. This Act takes effect September 1, 2013. |
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______________________________ |
______________________________ |
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President of the Senate |
Speaker of the House |
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I certify that H.B. No. 915 was passed by the House on April |
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19, 2013, by the following vote: Yeas 138, Nays 0, 1 present, not |
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voting; and that the House concurred in Senate amendments to H.B. |
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No. 915 on May 16, 2013, by the following vote: Yeas 140, Nays 0, 2 |
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present, not voting. |
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______________________________ |
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Chief Clerk of the House |
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I certify that H.B. No. 915 was passed by the Senate, with |
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amendments, on May 15, 2013, by the following vote: Yeas 31, Nays |
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0. |
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______________________________ |
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Secretary of the Senate |
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APPROVED: __________________ |
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Date |
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__________________ |
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Governor |