Texas Administrative Code
Title 28 - INSURANCE
Part 1 - TEXAS DEPARTMENT OF INSURANCE
Chapter 11 - HEALTH MAINTENANCE ORGANIZATIONS
Subchapter Y - LIMITED SERVICE HMOS
Section 11.2405 - Minimum Standards - Mental Health and Chemical Dependency Services and Benefits
Current through Reg. 50, No. 13; March 28, 2025
Each limited service HMO evidence of coverage providing coverage for mental health and chemical dependency services and benefits must:
(1) cover, in compliance with the limited service HMO's standards of medical necessity, court-ordered mental health and chemical dependency treatment and may, if clearly disclosed, require the enrollee to have the treatment completed by a participating physician or provider in the HMO delivery network, as defined in Insurance Code § 843.002 (concerning Definitions), or as otherwise arranged by the limited service HMO;
(2) comply with Chapter 21, Subchapter P, of this title (relating to Mental Health Parity)
(3) provide primary mental health and chemical dependency services and benefits, including:
(4) demonstrate the capacity to provide, and may provide, secondary intensive rehabilitative, and community support services for mental illness and chemical dependency, including, but not limited to, case management, partial hospitalization, residential, acute day treatment, intensive outpatient service, Assertive Community Treatment teams, and habilitative or rehabilitative services for pervasive developmental disorders.