Texas Administrative Code
Title 26 - HEALTH AND HUMAN SERVICES
Part 1 - HEALTH AND HUMAN SERVICES COMMISSION
Chapter 301 - LOCAL AUTHORITY RESPONSIBILITIES
Subchapter F - PROVIDER NETWORK DEVELOPMENT
Section 301.277 - Individual Selection of Providers

Universal Citation: 26 TX Admin Code ยง 301.277

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

(a) Individual choice. An LMHA shall give consumers the opportunity to choose from any available provider in the LMHA's provider network offering services for which the individual is authorized at the time of admission and at least annually thereafter.

(b) Changing providers. Individuals may request and change providers at any time.

(c) Provider information. An LMHA shall maintain a current list of providers and a provider profile for each provider in the network, including the LMHA, on its website. The LMHA's website must also provide instructions for requesting a change in providers as described in § 401.464 of Title 25 (relating to Notification and Appeals Processes).

(1) The provider list must include the following information about each provider:
(A) name;

(B) service locations and the services provided at each location; and

(C) contact information, including the provider's website address.

(2) The provider profile is a standardized form completed by the provider, may include information such as staffing patterns, special features of service delivery, and cultural and linguistic specialization. An LMHA shall use the provider profile template established by the department at the beginning of the planning cycle. The LMHA may add additional items to the provider profile based on input from the local PNAC.

(d) Provider selection process. The LMHA shall inform individuals, verbally and in writing, that they may choose to receive services from any available provider in the LMHA's network that offers the authorized services. The LMHA shall also provide individuals with a neutral presentation of available providers consistent with the plan to support consumer transition to the external network described in subsection (f) of this section. When an individual is given the opportunity to choose a provider, the LMHA shall:

(1) state that the individual may change providers at any time;

(2) give the individual the provider list, provider profiles, and a written copy of the procedures for requesting a change in providers;

(3) allow a reasonable period of time and make an area available for the individual to review the materials and make a decision; and

(4) maintain documentation of the individual's choice of provider.

(e) An LMHA shall not offer or schedule services before the individual selects a provider. If an individual is unable to select a provider or does not select a provider before leaving the first appointment, the LMHA shall provide the consumer with an appointment for ongoing services at an assigned provider. Except as provided in subsection (f) of this section, assignments shall rotate equally among all available external providers. In this situation, the LMHA shall also provide the individual with information about how to have the appointment rescheduled with a different provider.

(f) External network transition plan. The LMHA shall develop and implement a plan to promote consumer transition to the external network when a new provider joins the network.

(1) The plan shall be developed with input from the LMHA's PNAC, any local consumer-operated organization, and its external providers.

(2) LMHAs may emphasize benefits of receiving services from an external provider, but shall not favor one provider over another except to identify service sites that may be more convenient for a client.

(3) The plan may include reassigning consumers to external providers based on geographic proximity, but must give them the option of choosing a different provider instead.

(4) The plan may include directing new individuals to choose an external provider, but must give them the option of choosing an LMHA service site instead.

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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