Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 354 - MEDICAID HEALTH SERVICES
Subchapter M - MENTAL HEALTH TARGETED CASE MANAGEMENT AND MENTAL HEALTH REHABILITATION
Division 1 - GENERAL PROVISIONS
Section 354.2611 - Pharmacological Management, Psychiatric Diagnostic Evaluations, and Psychotherapy

Universal Citation: 1 TX Admin Code ยง 354.2611

Current through Reg. 49, No. 38; September 20, 2024

(a) Service Array. A comprehensive provider agency must have the capability to deliver pharmacological management, psychiatric diagnostic evaluation, and psychotherapy, either directly or through subcontract(s).

(b) Pharmacological management. Pharmacological management is the in-depth management of psychopharmacological agents to treat a client's mental health symptoms. Pharmacological management is a physician service and cannot be provided by a non-physician or "incident to" a physician service, with the exception of advanced practice registered nurses and physician assistants whose scope of license in Texas permits them to prescribe under delegation of prescriptive authority. Supporting documentation for pharmacological management must include:

(1) complete diagnosis using diagnostic criteria from the latest edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders;

(2) current list of medications;

(3) current psychiatric symptoms and problems, to include presenting mental status;

(4) problems, reactions, and side effects, if any, to medications;

(5) any medication modifications made during the visit and the reasons for medication adjustments, including the discontinuation of a medication;

(6) desired therapeutic drug levels, if applicable, for medications requiring blood level monitoring;

(7) current laboratory values, if applicable, for medications requiring monitoring for potential side effects; and

(8) the individual's related treatment goals.

(c) Psychiatric diagnostic evaluation.

(1) Psychiatric diagnostic evaluations must be conducted by:
(A) a physician;

(B) a psychologist;

(C) an advanced practice registered nurse;

(D) a physician assistant;

(E) a licensed clinical social worker;

(F) a licensed professional counselor; or

(G) a licensed marriage and family therapist.

(2) Documentation for a psychiatric diagnostic evaluation must include:
(A) the individual's presenting problem(s);

(B) the individual's prior diagnoses and any prior treatment;

(C) other pertinent medical, social, and family history;

(D) clinical observations and results of a mental status examination;

(E) complete diagnosis using diagnostic criteria from the latest edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders;

(F) expected long-term and short-term goals; and

(G) recommendations.

(d) Psychotherapy. Psychotherapy services may include individual psychotherapy, group psychotherapy, or family psychotherapy. A comprehensive provider agency is required to use evidence-based psychotherapy modalities in accordance with the utilization management guidelines.

Disclaimer: These regulations may not be the most recent version. Texas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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