Current through Reg. 49, No. 38; September 20, 2024
(a) Recommendation for treatment. The
designated LMHA or LBHA is responsible for recommending the most appropriate
and available treatment alternative for an individual in need of mental health
services.
(b) Inpatient services.
(1) Before an LMHA or LBHA refers an
individual for inpatient services, the LMHA or LBHA must screen and assess the
individual to determine if the individual requires inpatient
services.
(2) If the screening and
assessment indicates the individual requires inpatient services and inpatient
services are the least restrictive setting available, the LMHA or LBHA refers
the individual:
(A) to an SMHF or facility
with a CPB, if the LMHA or LBHA determines that the individual meets the
criteria for admission; or
(B) to
an LMHA or LBHA network provider of inpatient services.
(3) If the individual is identified in the
applicable HHSC automation system as having an ID, the LMHA or LBHA informs the
designated LIDDA that the individual has been referred for inpatient
services.
(4) If the LMHA, LBHA, or
LMHA or LBHA-network provider refers the individual for inpatient services, the
LMHA or LBHA must communicate necessary information to the contracted inpatient
provider before or at the time of admission, including the individual's:
(A) identifying information, including
address;
(B) legal status (e.g.,
regarding guardianship, charges pending, custody as applicable;
(C) pertinent medical and medication
information, including known disabilities;
(D) behavioral information, including
information regarding COPSD;
(E)
other pertinent treatment information;
(F) finances, third-party coverage, and other
benefits, if known; and
(G) advance
directive.
(5) If an LMHA
or LBHA, other than the individual's designated LMHA or LBHA, refers the
individual for inpatient services, the SMHF or facility with a CPB notifies the
individual's designated LMHA or LBHA of the referral for inpatient services by
the end of the next business day.
(6) The designated LMHA or LBHA assigns a
continuity of care worker to an individual admitted to an SMHF, a facility with
a CPB, or an LMHA or LBHA inpatient services network provider.
(7) If the individual has an ID or DD, the
designated LIDDA assigns a continuity of care worker to the
individual.
(8) The LMHA or LBHA
continuity of care worker, and LIDDA continuity of care worker as applicable,
are responsible for the facilitation of the individual's continuity of
services.
(c)
Community-based crisis treatment options.
(1)
An LMHA or LBHA must ensure the provision of crisis services to an individual
experiencing a crisis while the individual is in its local service
area.
(2) Individuals in need of a
higher level of care, but not requiring inpatient services, have the option, as
available, for admission to other services such as crisis respite, crisis
residential, extended observation, or crisis stabilization unit.
(d) LMHA or LBHA Services.
(1) If an LMHA or LBHA admits an individual
to LMHA or LBHA services, the LMHA or LBHA ensures the provision of services in
the most integrated setting available.
(2) The LMHA or LBHA assigns, to an
individual receiving services, a staff member who is responsible for
coordinating the individual's services.
(e) Court Ordered Treatment. The LMHA or LBHA
must provide services to an individual ordered by a court to participate in
outpatient mental health services or competency restoration services, if
available, when the court identifies the LMHA or LBHA as being responsible for
those services.
(f) Referral to
alternate provider.
(1) If an individual
requests a referral to an alternate provider, and it is not court ordered to
receive services from the LMHA or LBHA, the LMHA or LBHA makes a referral to an
alternate provider in accordance with the request.
(2) If an individual has third-party
coverage, but the coverage will not pay for needed services because the
designated LMHA or LBHA does not have a provider in its network that is
approved by the third-party coverage, the designated LMHA or LBHA acts in
accordance with 25 TAC §
412.106(c)(2)
(relating to Determination of Ability to Pay).