Current through Reg. 49, No. 38; September 20, 2024
(a)
Assessment.
(1) A QMHP-CS with appropriate
supervision and training must perform an assessment of an individual in
accordance with the requirements of the Texas Medicaid Provider Procedures
Manual (TMPPM), including all updates and revisions, and all the handbooks,
standards, and guidelines as determined by HHSC or a managed care organization
(MCO) with which they contract.
(2)
An assessment of an individual may be performed as a telemedicine medical
service or a telehealth service, including via an audio-only platform, in
accordance with the requirements and limitations of Subchapter A, Division 33
of this chapter (relating to Advanced Telecommunications Services).
(b) Documentation. The assessment
must be documented and must include:
(1) the
individual's identifying information;
(2) completion of the appropriate uniform
assessment(s) and assessment guideline calculations;
(3) the individual's present status and
relevant history, including education, employment, housing, legal, military,
developmental, and current available social and support systems;
(4) the individual's co-occurring substance
use, intellectual or developmental disability, or physical health condition, if
any;
(5) the individual's relevant
past and current medical and psychiatric information, which may include trauma
history;
(6) information from the
individual and LAR, if applicable, regarding the individual's strengths, needs,
natural supports, community participation, responsiveness to previous
treatment, as well as preferences for and objections to specific
treatments;
(7) the need or desire
of the individual for family member involvement or other identified natural
supports in treatment and mental health community services, if the individual
is an adult without an LAR;
(8) the
identification of the LAR's or family members' need for education and support
services related to the individual's mental illness or emotional disturbance
and the plan to facilitate the LAR's or family members' receipt of the needed
education and support services;
(9)
recommendations and conclusions regarding treatment needs;
(10) the mode of delivery; and
(11) date, signature, and credentials of the
staff member completing the assessment.
(c) Diagnostics. The diagnosis of a mental
illness must be:
(1) rendered by an LPHA,
acting within the scope of his license, who has interviewed the
individual;
(2) based on diagnostic
criteria from the latest edition of the American Psychiatric Association's
Diagnostic and Statistical Manual of Mental Disorders;
(3) documented in writing, including the
date, signature, and credentials of the person making the diagnosis;
and
(4) supported by and included
in the uniform assessment.
(d) Provision of services. The comprehensive
provider agency and staff members must provide services in accordance with the
requirements of the TMPPM, including all updates and revisions, and all
handbooks, standards, and guidelines as determined by HHSC or an MCO with which
they contract.
(e) A service
described in this subsection may be delivered as a telemedicine medical service
or a telehealth service, including via an audio-only platform, in accordance
with the requirements and limitations of Subchapter A, Division 33 of this
chapter. The comprehensive provider agency and staff members must implement
procedures to ensure that each individual is provided mental health services
based on:
(1) the assessment conducted under
subsection (a) of this section;
(2)
medical necessity as determined by an LPHA; and
(3) when available, physical health care
needs as determined by a physician, physician assistant, or advanced practice
registered nurse.
(f)
Prerequisites to provision of services. Except for crisis intervention services
provided under §
354.2707 of this subchapter
(relating to Crisis Intervention Services), before providing services to an
individual under this subchapter a comprehensive provider agency must:
(1) if required by the managed care
organization, submit authorization requests to the MCO with which the
individual is enrolled for the type(s), amount, and duration of services to be
provided to the individual in accordance with the uniform assessment and the
utilization management guidelines; and
(2) in collaboration with the individual and
his LAR, if applicable, develop a recovery/treatment plan for the individual
that complies with the requirements of this subchapter.
