Current through Reg. 49, No. 38; September 20, 2024
(a) Mental health targeted case management
services are provided to eligible individuals to assist them in gaining access
to needed medical, social/behavioral, educational, and other services and
supports that are appropriate to the individual's needs.
(b) Mental health targeted case management
includes:
(1) development and periodic
revision of a specific recovery/treatment plan, per §
354.2609 of this subchapter
(relating to Recovery/Treatment Planning, Recovery/Treatment Plan Review, and
Discharge Summary);
(2) making
referrals and performing other related activities to help an individual obtain
needed services and supports, including activities that help link an individual
with:
(A) medical, social/behavioral, and
educational providers; and
(B)
other providers that provide needed services to address identified needs and
achieve goals in the recovery/treatment plan;
(3) monitoring and follow up activities of
service effectiveness, with the individual, family members, providers, or other
entities or individuals, that occur regularly or at least annually to ensure
the recovery/treatment plan is implemented and adequately addresses the
individual's needs; and
(4)
coordination with, and not duplication of, activities provided as part of
institutional services and discharge planning activities that take place at
inpatient facilities.
(c)
Mental health targeted case management services must be provided, at minimum,
by an individual credentialed as a QMHP-CS and in accordance with the
requirements of the Texas Medicaid Provider Procedures Manual (TMPPM),
including all updates and revisions and all handbooks, standards, and
guidelines as determined by HHSC or a managed care organization (MCO) with
which they contract.
(d) Mental
health targeted case management, as described in this section, 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 (relating to Advanced
Telecommunications Services.)
(e) A
mental health targeted case manager must be assigned to an individual within
two business days after receiving notification that the individual has been
authorized to receive mental health targeted case management
services.
(f) The assigned mental
health targeted case manager must:
(1) meet
with the individual and the individual's LAR or primary caregiver within seven
calendar days after the case manager is assigned;
(2) assist the individual in identifying the
individual's immediate needs and in determining access to community resources
that may address those needs;
(3)
identify the individual's strengths, service needs, and assistance required to
address identified needs;
(4)
identify the goals and actions required to meet the individual's identified
needs;
(5) take the steps necessary
to accomplish the goals required to meet the individual's identified needs by
using referral, linking, advocacy, and monitoring;
(6) meet with the individual at the
individual's, the LAR's, or the primary caregiver's request, or document why
the meeting did not occur;
(7) meet
with the LAR, with or without the individual present, to provide a service that
assists the individual in gaining and coordinating access to necessary care and
services;
(8) meet with the
individual and the LAR or primary caregiver upon notification of a clinically
significant change in the individual's functioning, life status, or service
needs, or document why the meeting did not occur; and
(9) if notified that the individual is in
crisis, coordinate with the appropriate providers of emergency services to
respond to the crisis.
(g) Intensive case management services,
available only to children and youth, incorporate wraparound process planning
in the approach to recovery/treatment planning and recovery/treatment plan
implementation. The assigned mental health targeted case manager must:
(1) incorporate wraparound process planning
in developing a recovery/treatment plan that addresses the child's or youth's
unmet needs across life domains and includes, in addition to the required
elements listed in §
354.2609 of this subchapter:
(A) a list of the child's or youth's natural
strengths and supports;
(B) a
crisis plan developed in collaboration with the LAR, caregiver, and
family;
(C) a prioritized list of
the child's or youth's unmet needs that includes a discussion of the priorities
and needs expressed by the child or youth and the LAR or primary
caregiver;
(D) a description of the
objective and measurable outcomes for each of the unmet needs as well as a
projected time frame for each outcome;
(E) a description of the actions the child or
youth, the case manager, and other designated people must take to achieve those
outcomes;
(F) a list of the
necessary services, service providers and the availability of the services;
and
(G) a statement of the maximum
period between contacts with the child or youth, and the LAR or primary
caregiver, determined in accordance with the utilization management
guidelines;
(2) develop
and document an intensive case management plan based on the child's or youth's
needs that may include information across life domains from relevant sources
such as the child or youth, the LAR or primary caregiver, other agencies and
organizations providing services to the child or youth, the child's or youth's
medical record, and other sources identified by the child or youth, LAR, or
primary caregiver;
(3) ensure
services are delivered in clinically appropriate, client-centered,
community-based settings;
(4) meet
with the child or youth and the LAR or primary caregiver:
(A) within seven calendar days after the case
manager is assigned to the child or youth or document the reasons the meeting
did not occur;
(B) within seven
calendar days after discharge from an inpatient psychiatric setting or document
the reasons the meeting did not occur; and
(C) according to the child's or youth's
recovery/treatment plan or document the reasons the meeting did not
occur;
(5) take necessary
steps to assist the child or youth in gaining access to needed services and
service providers, and document these activities, including:
(A) making referrals to potential service
providers;
(B) initiating contact
with potential service providers;
(C) arranging, facilitating linkages, and
accompanying the child or youth to initial meetings and non-routine
appointments;
(D) arranging
transportation to ensure the child's or youth's attendance at appointments with
services providers;
(E) advocating
with service providers; and
(F)
providing relevant information to service providers; and
(6) monitor the child's or youth's progress
toward the outcomes set forth in the recovery/treatment plan, including:
(A) gathering information from the child or
youth, current service providers, LAR, primary caregiver, and other
resources;
(B) reviewing pertinent
documentation, including the child's or youth's clinical records and
assessments;
(C) ensuring that the
recovery/treatment plan was implemented as agreed upon;
(D) ensuring that needed services were
provided;
(E) determining whether
progress toward the desired outcomes was made;
(F) identifying barriers to accessing
services or to obtaining maximum benefit from services;
(G) advocating for the modification of
services to address changes in the needs or status of the child or
youth;
(H) identifying emerging
unmet service needs;
(I)
determining whether the recovery/treatment plan needs to be modified to address
the child's or youth's unmet service needs more adequately; and
(J) revising the recovery/treatment plan as
necessary to address the child's or youth's unmet service needs.
