Current through Reg. 50, No. 13; March 28, 2025
(a) Adequate provider network. The LMHA and
MCO must maintain a provider network that is adequate and qualified to provide
all mental health community services that the LMHA and MCO are required to
provide under a contract with the department.
(b) Crisis screening and response system. The
LMHA and MCO must have a crisis screening and response system in operation 24
hours a day, every day of the year, that is available to individuals throughout
its contracted service delivery area. The telephone system to access the crisis
screening and response system must include a toll-free crisis hotline number
and be easily accessible and well publicized. Calls to the crisis hotline must
be answered by a hotline staff member who is trained in compliance with this
subchapter. The hotline must have teletypewriter (TTY) capabilities or other
assistive technology that is available and effective.
(c) Telephone access. In addition to the
crisis screening and response system described in subsection (b) of this
section, the LMHA and MCO must ensure the availability of a telephone system
and call center that allows individuals to contact the LMHA or MCO through a
toll-free number that must:
(1) operate
without using telephone answering equipment at least on business days during
normal business hours, except on national holidays, due to uncontrollable
interruption of service, or with prior approval of the department;
(2) have sufficient staff to operate
efficiently;
(3) collect, document,
and store detailed information, including special needs information, on all
telephone inquiries and calls;
(4)
during times other than those described in paragraph (1) of this subsection
provide electronic call answering methods that include an outgoing message
providing the crisis hotline telephone number, in languages relevant to the
service area, for callers to leave a message; and
(5) return routine calls before the end of
the next business day for all messages left after hours.
(d) Timely services based on need. The LMHA
or local behavioral health authority (LBHA), as defined at Texas Health and
Safety Code §
533.0356 must
arrange mental health services for an individual within the following time
frames.
(1) Crisis services.
(A) Hotline calls. For all calls to the
toll-free crisis hotline:
(i) a staff member
must answer each call within 30 seconds, on average, at least 95 percent of the
time;
(ii) the LMHA, LBHA, or their
subcontractors must train a staff member in crisis screening to conduct a
crisis hotline screening as provided in the LMHAs' and LBHAs' contract with the
Texas Health and Human Services Commission; and
(iii) if the staff member determines the call
is a potential crisis, a staff member trained in crisis screening, in
accordance with clause (ii) of this subparagraph, must begin a telephone
screening no later than one minute after the determination is made.
(B) Emergency care services. If a
staff member determines during a screening that an individual is experiencing a
crisis that may require emergency care services, the staff member trained in
crisis screening, in accordance with subparagraph (A)(ii) of this paragraph,
must:
(i) take immediate action to address
the emergency situation to ensure the safety of all parties involved;
(ii) activate the immediate screening and
assessment processes as described in §
301.351 of this subchapter
(relating to Crisis Services); and
(iii) provide or obtain mental health
community services or other necessary interventions to stabilize the
crisis.
(C) Urgent care
services. If the screening indicates that an individual needs urgent care
services, a QMHP-CS must within eight hours of the initial incoming hotline
call or notification of a potential crisis situation:
(i) perform a face-to-face assessment;
and
(ii) provide or obtain mental
health community services or other necessary interventions to stabilize the
crisis.
(2)
Routine care services. If the screening indicates that an individual needs
routine care services, a QMHP-CS must perform a uniform assessment within 14
days after the screening. If the assessment indicates an LOC for routine care
services, the individual must begin receiving services immediately. When the
provision of the service package is not possible because services are at
capacity, the individual must be referred to an available practitioner
appropriate to meet the individual's needs or be placed on a waiting list for
services, subject to the following exceptions:
(A) individuals eligible for Medicaid who are
determined to be in need of Mental Health Case Management, under Chapter 306,
Subchapter E of this title, or Mental Health Rehabilitative Services, under
Chapter 306, Subchapter F of this title, cannot be placed on a waiting list and
must be served.
(B) individuals
eligible for Medicaid who are determined to need services other than Mental
Health Case Management, under Chapter 306, Subchapter E of this title, and
Mental Health Rehabilitative Services, under Chapter 306, Subchapter F of this
title, must be referred to appropriate, available practitioners of that
service. Only if an appropriate Medicaid practitioner is not available may the
individual be placed on a waiting list. All efforts undertaken to refer
Medicaid individuals must be documented.
(e) Communication with individuals. The LMHA,
MCO, and provider must ensure effective communication with the individual and
LAR (if applicable) in an understandable format as appropriate to meet the
needs of individuals, which may require using:
(1) interpretative services;
(2) translated materials; or
(3) a staff member who can effectively
respond to the cultural (e.g., customs, beliefs, actions, and values) and
language needs of the individual and LAR (if applicable).
(f) Service information. The LMHA and MCO
must proactively disseminate to individuals and their LAR (if applicable)
information about mental illness and the LMHA's or MCO's mental health
community services in a format and language that is easily understood and based
on the demographics for any group comprising more than 10 percent of the
population in the local service area. Information about mental illness and the
LMHA's or MCO's community services must be in a format and language that is
easily understood by individuals with a disability (e.g., deafness, hard of
hearing, and blindness).
(g) Access
to emergency medical and crisis services. The LMHA and MCO must develop
procedures for its providers' use in accessing emergency medical and crisis
services for individuals.
(h)
Continuity of services. The LMHA and MCO must ensure that individuals:
(1) are provided continuity of services as
defined by the department; and
(2)
are informed of whom to contact regarding continuity and coordination of their
services, in accordance with Chapter 412, Subchapter D of Title 25 (relating to
Mental Health Services--Admission, Continuity, and Discharge).
(i) Referral for physical health
services. If a nursing or medical assessment indicates physical health needs
outside the scope of the provider's competency, credentialing, or capacity to
treat, the LMHA and MCO must make and document appropriate referrals to other
healthcare providers and provide adequate follow up at subsequent visits to
confirm access to the referrals.
