Part 2.
TEXAS DEPARTMENT OF MENTAL HEALTH AND MENTAL RETARDATION
Chapter 412.
LOCAL AUTHORITY RESPONSIBILITIES
Subchapter G. MENTAL HEALTH COMMUNITY SERVICES STANDARDS
1.
GENERAL PROVISIONS
25 TAC §412.303
The Texas Department of Mental Health and Mental Retardation
(TDMHMR) proposes an amendment to §412.303, concerning definitions, of
Chapter 412, Subchapter G, governing Mental Health Community Services Standards.
The amendment to §412.303 would expand the definition of "crisis" to
include situations other than those in which the individual believes that
he or she presents an immediate danger to self or others or that his or her
mental or physical health is at risk of serious deterioration. In addition,
this amendment will make the definition of "crisis" synonymous with the definition
of "crisis" included in new Chapter 419, Subchapter L, governing Mental Health
Rehabilitative Services which is contemporaneously proposed in this issue
of the
Texas Register
.
Kevin Nolting, Acting Chief Financial Officer, has determined that for
each year of the first five year period that the proposed amendment is in
effect, enforcing or administering the proposed amendment does not have foreseeable
implications relating to costs or revenues of state or local governments.
It is not anticipated that the proposed amendment will have an adverse
economic effect on small businesses or micro-businesses.
It is not anticipated that the proposed amendment will affect a local economy.
Sam Shore, Acting Director of Community Mental Health Services, has determined
that for each year of the first five years the proposed amendment is in effect,
the public benefit will be the promulgation of clear requirements that better
ensure the safety and protection of individuals in psychiatric crisis. It
is not anticipated that there will be any additional economic cost to persons
required to comply with the proposed amendment.
Comments concerning the proposed amendment may be submitted in writing
to Linda Logan, Director, Policy Development, Texas Department of Mental Health
and Mental Retardation, P.O. Box 12668, Austin, Texas 78711-2668; by fax to
(512) 206-4750; or by e-mail to policy.co@mhmr.state.tx.us within 30 days
of publication.
The amendment is proposed under Texas Health and Safety Code
(THSC), §532.015(a), which provides the Texas Mental Health and Mental
Retardation Board with broad rulemaking authority; THSC, §571.006, which
provides the board with the authority to adopt rules as necessary for the
proper and efficient treatment of persons with mental illness; THSC, §534.052(a),
which provides the board with the authority to adopt rules and standards necessary
to ensure adequate provision of community-based mental health services through
the local mental health authority.
The proposed amendment would affect THSC, §§532.015, 534.052
and 571.006.
§412.303.Definitions.
The following words and terms, when used in this subchapter, have the
following meanings, unless the context clearly indicates otherwise:
(1) - (11)
(No change.)
(12)
Crisis--A situation in which
:
[
(A)
because of a mental health condition:
(i)
the individual presents an immediate danger to self or
others; or
(ii)
the individual's mental or physical health is at risk
of serious deterioration; or
(B)
an individual believes that he or she
presents an immediate danger to self or others or that his or her mental or
physical health is at risk of serious deterioration.
(13) - (45)
(No change.)
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of
the Secretary of State on May 14, 2004.
TRD-200403285
Rodolfo Arredondo
Chairman, Texas MHMR Board
Texas Department of Mental Health and Mental Retardation
Earliest possible date of adoption: June 27, 2004
For further information, please call: (512) 206-4581
25 TAC §§412.401 - 412.417
The Texas Department of Mental Health and Mental Retardation
(TDMHMR) proposes new §§412.401 - 412.417 of Chapter 412, Subchapter
I governing Mental Health Case Management Services. The repeals of existing §§412.451
- 412.466 of Chapter 412, Subchapter J, governing Service Coordination, are
contemporaneously proposed in this issue of the
Texas Register
.
The proposed subchapter describes the requirements for the provision of
mental health (MH) case management services. In addition, the proposed subchapter
addresses the requirement in Texas Health and Safety Code (THSC) §533.0354
that the provision of mental health services for adults with bipolar disorder,
schizophrenia, or clinically severe depression and for children with serious
emotional illnesses be accomplished using disease management practices.
The requirements for the provision of MH case management services described
in the proposed subchapter are based on TDMHMR's Resiliency and Disease Management
model. This model promotes the uniform provision of services that are based
on clinical evidence and recognized best practices. In addition, the model
promotes effective MH case management services by utilizing individual-specific
information that identifies an individual's mental health care needs, matches
those needs to a particular type(s) of case management service, and evaluates
the effectiveness of the service provided.
Proposed new §412.404 sets forth the general requirements for a provider
of MH case management services. Further, the proposed section details a provider's
responsibility to ensure that an individual with an assigned case manager
has an alternate case manager acting when the assigned case manager is not
available.
Proposed new §412.405 specifies eligibility requirements for an individual
to receive MH case management services, including that the individual must
qualify for a level-of-care.
Proposed new §412.406 requires a provider to obtain authorization
for a type, amount, and duration of MH case management services prior to the
delivery of such services. In addition, this proposed section describes the
circumstances under which reauthorization for services is required.
The proposed new subchapter describes the two types of MH case management
services in §412.407: routine and intensive. In addition, the proposed
section describes the responsibilities of a case manager for both types of
MH case management services.
For clarification, the proposed new §412.408 prohibits a case manager
from providing services to certain family members and describes activities
that do not constitute MH case management services.
The proposed new §412.409 describes the circumstances under which
a provider must notify the department because the individual may no longer
be available or eligible for MH case management services.
To ensure case managers are adequately prepared to understand the complexity
of medical and psychosocial interventions that are required to effectively
treat mental illness and emotional disturbance, the proposed new §412.410
sets forth the minimum qualifications for case managers and supervisors of
case managers.
Proposed new §412.411 describes the training required for staff members
providing MH case management services and the training for staff members supervising
the provision of MH case management services. This proposed section also sets
forth the requirements for the documentation and frequency of staff member
training.
The proposed new §412.412 sets forth the requirements for documentation
of MH case management services. The requirements vary depending on whether
the service provided was routine or intensive and whether it involved face-to-face
contact with the individual receiving MH case management services.
The proposed new §412.413 provides examples of activities that may
and may not be reimbursed as MH case management services.
The proposed new §412.414 reiterates an individual's right to request
a fair hearing based on federal law and regulations. In addition, this proposed
section requires the provider to give an individual notice of the right to
request a fair hearing in the form and manner prescribed by TDMHMR.
Proposed new §412.415 contains a list of exhibits referenced in the
proposed subchapter and how such exhibits may be obtained.
Proposed new §412.416 contains a list of laws and rules cited throughout
the proposed subchapter.
Kevin Nolting, Acting Chief Financial Officer, has determined that for
each year of the first five year period that the new sections are in effect,
enforcing or administering the program provider rules does not have foreseeable
implications relating to costs or revenues of state or local government.
It is not anticipated that the new sections will have an adverse economic
effect on small businesses or micro-businesses. It is not anticipated that
there will be any additional economic cost to persons required to comply with
the new sections.
Sam Shore, Acting Director, Community Mental Health Services, has determined
that, for each year of the first five years the proposed new sections are
in effect, the public benefit expected is the adoption of new rules that are
based on the department's Resiliency and Disease Management model, which promotes
the provision of high quality and effective community-based mental health
services by individual-specific information that identifies an individual's
mental health care needs, matches those needs to a particular type(s) of MH
case management services, and evaluates the effectiveness of the service provided.
It is not anticipated that the new sections will affect a local economy.
Comments concerning the proposed new sections may be submitted in writing
to Linda Logan, Director, Policy Development, Texas Department of Mental Health
and Mental Retardation, P.O. Box 12668, Austin, Texas 78711-2668; by fax to
(512) 206-4750; or by e-mail to policy.co@mhmr.state.tx.us within 30 days
of publication.
A hearing to accept oral and written testimony from members of the public
concerning this and other related proposals has been scheduled for 1:30 p.m.,
Monday, June 14, 2004, in the department's Central Office Auditorium in Building
2, 909 West 45th Street, Austin, Texas. Persons requiring an interpreter for
the deaf or hearing impaired should contact the department's Central Office
operator at least 72 hours prior to the hearing at TDD (512) 206-5330. Persons
requiring other accommodations for a disability should notify Martha Durham,
at least 72 hours prior to the hearing at (512) 206-4541 or at the TDY phone
number of Texas Relay, 1-800-735-2988.
The new sections are proposed under the Texas Health and Safety
Code, §532.015(a), which provides the Texas Board of Mental Health and
Mental Retardation with broad rulemaking authority; the Texas Health and Safety
Code, §533.0354, which requires the provision of mental health services
for adults with bipolar disorder, schizophrenia, or clinically severe depression
and for children with serious emotional illnesses be accomplished using disease
management practices; the Texas Government Code, §531.021(a), and the
Texas Human Resources Code, §32.021(a), which provide HHSC with the authority
to administer the federal medical assistance (Medicaid) program in Texas;
Acts 1995, 74th Legislature, Chapter 6, §1, (Senate Bill 509), which
clarifies the authority of HHSC to delegate the operation of all or part of
a Medicaid program to a health and human services agency; and the Human Resources
Code, §32.021(c), which provides an agency operating part of the Medicaid
program with the authority to adopt necessary rules for the proper and efficient
operation of the program. HHSC has delegated to TDMHMR the authority to operate
the Medicaid program for MH case management services.
The proposed new sections affect the THSC, §533.0354, the Texas Government
Code, §531.021(a), and the Texas Human Resources Code, §32.021.
§412.401.Purpose.
This subchapter describes requirements for the provision of mental
health case management services (MH case management services) funded by or
through the department.
§412.402.Application.
This subchapter applies to providers of MH case management services.
§412.403.Definitions.
The following words and terms, when used in this chapter, have the
following meanings, unless the context clearly indicates otherwise:
(1)
Adolescent--An individual who is at least 13 years of age,
but younger than 18 years of age.
(2)
Adult--An individual who is 18 years of age or older.
(3)
Business day--Any day except a Saturday, Sunday, or legal
holiday listed in the Texas Government Code, §662.021.
(4)
Case manager--A person who provides MH case management
services.
(5)
Case management plan--A written document developed by a
case manager, in collaboration with an individual and the individual's LAR
or primary caregiver, that identifies services needed by the individual and
sets forth a plan for how the individual may gain access to the identified
services.
(6)
Child--An individual who is at least three years of age,
but younger than 13 years of age.
(7)
Community-based--Provided in an individual's community.
(8)
CMHC or community mental health center--An entity established
in accordance with the Texas Health and Safety Code, §534.001, as a community
mental health center or a community mental health and mental retardation center.
(9)
CSSP or community services specialist--A staff member who,
as of August 31, 2004:
(A)
has received:
(i)
a high school diploma; or
(ii)
a high school equivalency certificate issued in accordance
with the law of the issuing state; and
(B)
had three continuous years of documented full time experience
in the provision of MH case management services.
(10)
Crisis--A situation in which:
(A)
because of a mental health condition:
(i)
the individual presents an immediate danger to self or
others: or
(ii)
the individual's mental or physical health is at risk
of serious deterioration; or
(B)
an individual believes that he or she presents an immediate
danger to self or others or that his or her mental or physical health is at
risk of serious deterioration.
(11)
Day--A calendar day, unless otherwise specified.
(12)
Department--The Texas Department of Mental Health and
Mental Retardation or its successor.
(13)
Employee--A staff member who receives a W2 Wage and Tax
Statement from a provider.
(14)
Individual--A person seeking or receiving MH case management
services.
(15)
IMD or institution for mental diseases--Based on 42 CFR §435.1009,
a hospital, nursing facility, or other institution of more than 16 beds that
is primarily engaged in providing psychiatric diagnosis, treatment, or care
of individuals with mental illness, including medical attention, nursing care,
and related services.
(16)
LAR or legally authorized representative--A person authorized
by law to act on behalf of a child or adolescent with regard to a matter described
in this subchapter, and who may be a parent, guardian, or managing conservator.
(17)
LOC or level of care--A designation given to the department's
standardized packages of mental health services, based on the uniform assessments
and the utilization management guidelines, which specify the type, amount,
and duration of MH case management services to be provided to an individual.
(18)
Life domains--Areas of life in which a child or adolescent
has unmet needs, including but are not limited to safety, health, emotional,
psychological, social, educational, cultural, and legal.
(19)
Mental health (MH) case management services--Services
to assist an individual in gaining and coordinating access to necessary care
and services appropriate to the individual's needs.
(20)
Primary caregiver--A person 18 years of age or older who
has actual care, control, and possession of a child or adolescent.
(21)
Provider--An entity that has an agreement with the department
to provide general revenue-funded MH case management services, Medicaid-funded
MH case management services, or both.
(22)
QMHP-CS or qualified mental health professional-community
services--A staff member who meets the definition of a QMHP-CS set forth in
Subchapter G of this chapter (relating to Mental Health Services Standards).
(23)
Site-based--Provided at a case manager's work site.
(24)
Staff member--Personnel of a provider including a full-time
and part-time employee, contractor, and intern, but excluding a volunteer.
(25)
Uniform assessments--Assessments promulgated by the department
that include the Adult Texas Recommended Authorization Guidelines, the Texas
Implementation of Medication Algorithms scales for adults, and the Children
and Adolescent Texas Recommended Authorization Guidelines.
(26)
Utilization management guidelines--Guidelines promulgated
by the department that establish the type, amount, and duration of MH case
management services for each LOC.
(27)
Wraparound planning--A strength-based, family-centered,
community-based planning process approved by the department through which
a case management plan is developed.
§412.404.Provider Requirements.
(a)
A provider must be a community mental health center (CMHC).
(b)
A provider must comply with Subchapter G of this chapter
(relating to Mental Health Community Services Standards).
(c)
A provider must assign a case manager to an individual
within two business days of receiving notification from the department or
its designee that the individual has been authorized to receive MH case management
services.
(d)
A provider must ensure that if an individual's assigned
case manager is not available, an alternate case manager will act as the individual's
assigned case manager.
(e)
A provider must maintain case manager-to-individual ratios
sufficient to perform the responsibilities of a case manager in accordance
with this subchapter.
(f)
A provider shall be responsible for a case manager's compliance
with this subchapter.
§412.405.Eligibility for MH Case Management Services.
(a)
An individual is eligible for general revenue-funded MH
case management services if the individual:
(1)
is a resident of the state of Texas;
(2)
is an adult with a severe and persistent mental illness,
or a child or adolescent with a serious emotional disturbance;
(3)
does not have a single diagnosis of mental retardation,
pervasive developmental disorder, or substance use disorder; and
(4)
qualifies for a LOC that, according to the utilization
management guideline, includes MH case management;
(b)
An individual is eligible for Medicaid-funded MH case management
services if, in addition to the criteria set forth in subsection (a) of this
section, the individual is:
(1)
eligible for Medicaid;
(2)
not an inmate of a public institution, as defined in 42
CFR §435.1009;
(3)
not a resident of an intermediate care facility for persons
with mental retardation as described in 42 CFR §440.150;
(4)
not a resident of an IMD, unless the individual is over
65 years or older and is expected to be discharged from an IMD to a non-institutional
setting within 180 days;
(5)
not a resident of a Medicaid-certified nursing facility,
unless the individual has been determined through a pre-admission screening
and annual resident review assessment to be eligible for the specialized service
of MH case management services;
(6)
not a recipient of case management services under another
Medicaid program, e.g. the Home and Community Services (HCS) waiver program
or Texas Health Steps; and
(7)
not a patient of a general medical hospital.
§412.406.Establishing Type, Amount, and Duration of MH Case Management Services.
(a)
The department or its designee will make the initial determination
of an individual's LOC using the uniform assessments which are referenced
as Exhibit A in §412.415 of this title (relating to Exhibits); and the
utilization management guidelines which are referenced as Exhibit B in §419.468
of this title (relating to Exhibits). If the LOC includes MH case management
services, the department or its designee will authorize the individual to
receive either routine or intensive MH case management services.
(b)
A provider must:
(1)
ensure that a QMHP-CS administers a uniform assessment
to the individual at intervals specified by the department or its designee
and applies the utilization management guidelines to obtain a recommended
LOC for the individual; and
(2)
clinically evaluate the needs of the individual to determine
if the amount of MH case management services associated with the recommended
LOC is sufficient to meet those needs.
(c)
If the provider determines that the amount of MH case management
services associated with the recommended LOC is sufficient to meet the individual's
needs, the provider must submit to the department or its designee a request
for service authorization in accordance with the recommended LOC.
(d)
If the provider determines that the amount of MH case management
services associated with the recommended LOC is not sufficient to meet the
individual's needs, the provider must submit to the department or its designee:
(1)
a request for an authorization of an LOC that is sufficient
to meet the individual's need or a request for authorization of additional
units of service; and
(2)
clinical justification for the request.
(e)
Upon receipt of a request submitted in accordance with
subsection (c) or (d) of this section, the department or its designee will:
(1)
review the documentation submitted by the provider;
(2)
based on the review of documentation and an evaluation
of available resources, authorize or deny an LOC for the individual; and
(3)
if applicable, authorize or deny a request for additional
units of service.
(f)
If the department authorizes an LOC that includes MH case
management services in accordance with subsection (e)(2) of this section,
the department will authorize the individual to receive either routine or
intensive MH case management services.
§412.407.MH Case Management Services.
(a)
MH case management services assist an individual in gaining
and coordinating access to necessary care and services appropriate to the
individual's needs. There are two types of MH case management services:
(1)
routine MH case management, for an adult, a child, or adolescent,
which is primarily site-based; and
(2)
intensive MH case management, for a child or adolescent,
which is primarily community-based.
(b)
A case manager assigned to an individual who is authorized
to receive routine MH case management services must:
(1)
meet face-to-face with the individual, and the individual's
LAR or primary caregiver if individual is a child or adolescent, within 14
days after the case manager is assigned to the individual in accordance with §412.404(c)
of this title (relating to Provider Requirements), or document why the meeting
did not occur;
(2)
meet face-to-face with the individual upon the request
of the individual, the LAR, or the primary caregiver at the case manager's
work site or document why the meeting did not occur;
(3)
identify the immediate need of the individual and assist
the individual in gaining access to a community resource that may address
that need;
(4)
document the identified need and the assistance given to
address the identified need; and
(5)
if notified that the individual is in crisis, coordinate
with the appropriate providers of emergency services to respond to the crisis,
as described in §412.314 of this title (relating to Crisis Services).
(c)
A case manager assigned to an individual who is authorized
to receive intensive MH case management services must:
(1)
meet face-to-face with the individual and the individual's
LAR or primary caregiver within seven days after the case manager was assigned
to the individual or within seven days after discharge from an inpatient psychiatric
setting, whichever is later or document the reasons the meeting did not occur;
(2)
meet face-to-face with the individual and the individual's
LAR or primary caregiver in accordance with the individual's case management
plan or document why the meeting did not occur;
(3)
meet face-to-face with the individual and the individual's
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;
(4)
meet face-to-face with the individual and the individual's
LAR or primary caregiver at the request of the individual, the LAR or primary
caregiver or document why the meeting did not occur;
(5)
gather information about the individual's strengths and
service needs across life domains from relevant sources, including:
(A)
the individual;
(B)
the individual's LAR or primary caregiver;
(C)
other agencies and organizations providing services to
the individual;
(D)
the individual's clinical record; and
(E)
other sources identified by the LAR or primary caregiver;
(6)
utilize wraparound planning to develop a case management
plan that addresses the individual's unmet needs across life domains and that
includes:
(A)
a prioritized list of the individual's unmet needs;
(B)
a description of the objective and measurable outcomes
for each of the unmet needs;
(C)
a description of the actions the individual, the case manager,
and other designated people will take to achieve those outcomes;
(D)
a list of the necessary services and service providers;
(E)
a description of the MH case management services to be
provided by the case manager; and
(F)
a statement of the maximum period of time between face-to-face
contacts with the individual, and the individual's LAR or primary caregiver,
determined in accordance with the utilization management guidelines;
(7)
assist the individual in gaining access to the needed services
and service providers including:
(A)
making referrals to potential service providers;
(B)
initiating contact with potential service providers;
(C)
arranging initial meetings and non-routine appointments;
(D)
arranging transportation to ensure the individual's attendance;
(E)
advocating with service providers; and
(F)
providing relevant information to service providers;
(8)
monitor the individual's progress toward the outcomes set
forth in the case management plan including;
(A)
gathering information from the individual, current service
providers, and other resources;
(B)
reviewing pertinent documentation, including the individual's
clinical records, and assessments;
(C)
ensuring the MH case management plan was implemented as
agreed upon;
(D)
ensuring needed services were provided;
(E)
determining if progress toward the desired outcomes was
made;
(F)
identifying barriers to accessing services or to obtain
maximum benefit from services;
(G)
advocating for the modification of services to address
the changes in the needs or status of the individual;
(H)
identifying emerging unmet service needs;
(I)
determining if the MH case management plan needs to be
modified to address the individual's unmet service needs more adequately;
and
(J)
revising the MH case management plan as necessary to address
the individual's unmet service needs.
(9)
upon notification that the individual is in crisis, coordinate
with the appropriate providers of emergency services to respond to the crisis,
as described in §412.314 of this title.
§412.408.Service Limitations.
(a)
A case manager may not provide MH case management services
to his or her child, parent, spouse, mother-in-law, father-in-law, son-in-law,
daughter-in-law, stepchild, stepparent, grandchild, or sibling.
(b)
The following activities do not constitute MH case management
services:
(1)
performing an activity that does not assist an individual
in gaining or coordinating access to needed services, such as:
(A)
merely accompanying an individual to:
(i)
a social or recreational event or other entertainment;
or
(ii)
locations to conduct the individual's personal affairs
(e.g. shopping, interviewing for a job, visiting friends or relatives, getting
a haircut, or finding housing);
(B)
merely helping the individual with domestic or financial
affairs, such as cleaning house or balancing a checkbook;
(2)
performing an activity that is an integral and inseparable
part of a service other than MH case management services, such as:
(A)
conducting skills training;
(B)
arranging a medical referral resulting from a physician's
appointment;
(C)
providing counseling or therapy;
(D)
providing crisis services described in the Mental Health
Community Services Standards §412.314 of this title (relating to Crisis
Services);
(E)
developing a treatment plan for services other than MH
case management; and
(F)
administering an assessment for a service other than MH
case management;
(3)
providing medical or nursing services, such as:
(A)
taking the temperature or vital signs of an individual;
(B)
consulting between medical professionals; and
(C)
refilling an individual's prescription;
(4)
performing pre-admission or intake activities;
(5)
providing services to the LAR or primary caregiver of the
individual, such as:
(A)
assisting the person to access services to address their
own needs;
(B)
teaching parenting skills; and
(C)
helping the person find employment;
(6)
transporting the individual, the individual's LAR or primary
caregiver;
(7)
monitoring the individual's general health status when
such information is not required to gain access or coordinate needed services
such as:
(A)
inquiring about the individual's general well-being;
(B)
monitoring the individual's self-administration of medications;
and
(C)
monitoring the physical safety of the individual;
(8)
performing outreach activities to inform the public of
MH case management services that are available or to locate individuals who
are potentially Medicaid eligible;
(9)
performing quality oversight of a service provider, such
as determining provider compliance with rules or regulation; and
(10)
conducting utilization review activities; and
(11)
authorizing services.
§412.409.Notification and Terminations.
(a)
The provider must notify the department or its designee
if the provider has reason to believe:
(1)
the individual no longer meets the eligibility criteria
for MH case management services as set forth in §412.405 of this title
(relating to Eligibility for MH Case Management Services);
(2)
the LAR of a child or adolescent has refused MH case management
services on behalf of the child or adolescent;
(3)
the adult has refused MH case management services;
(4)
the provider cannot locate the individual and the provider
has documented multiple attempts to locate the individual over a period of
two consecutive months;
(5)
the individual has died; or
(6)
the individual has established or intends to establish
residency outside of the provider's service area.
(b)
The department or its designee will terminate MH case management
services:
(1)
to an individual, if the department or its designee determines
that any one of the conditions described in subsection (a)(1) - (5) of this
section exists; or
(2)
to an individual who is not eligible for Medicaid, if the
department or its designee determines that there are insufficient resources
to provide MH case management services to the individual.
§412.410.Staff Qualifications.
(a)
A case manager for an adult must be:
(1)
a QMHP-CS or a CSSP;
(2)
an employee of the provider; and
(3)
trained in accordance with §412.411 of the title (relating
to Staff Training).
(b)
A case manager for a child or adolescent must be:
(1)
a QMHP-CS;
(2)
an employee of the provider; and
(3)
trained in accordance with §412.411 of the title.
(c)
The provider may require additional education and experience
for a case manager.
(d)
A staff member who supervises the provision of MH case
management services must:
(1)
meet the requirements set forth in subsection (b)(1) -
(3) of this section; and
(2)
have experience providing MH case management services.
§412.411.Staff Training.
(a)
A staff member who provides MH case management services
or supervises the provision of MH case management services must receive training
and demonstrate competency in the following areas:
(1)
the nature of mental illness and serious emotional disturbance;
(2)
the dignity and rights of an individual;
(3)
interacting with an individual who has a special physical
need such as a hearing or visual impairment;
(4)
responding to an individual's language and cultural needs
through knowledge of customs, beliefs, and values of various, racial, ethnic,
religious, and social groups;
(5)
identifying, preventing, and reporting abuse and neglect;
(6)
the requirements of this subchapter;
(7)
the uniform assessments;
(8)
the utilization management guidelines;
(9)
developing and implementing a case management plan;
(10)
identifying an individual in crisis;
(11)
appropriate actions to take in managing a crisis;
(12)
co-occurring psychiatric and substance use disorders,
as described in Chapter 411, Subchapter N of this title (relating to Standards
for Services to Persons with Co-Occurring Psychiatric and Substance Use Disorders);
(13)
the developmental needs of children, adolescents, and
adults;
(14)
the wraparound planning process approved by the department,
if the case manager is providing intensive MH case management services to
a child or adolescent;
(15)
health and human services available to children as described
in Texas Government Code §531.0244, if the case manager is providing
intensive MH case management to a child or adolescent;
(16)
the availability of resources within the local community;
and
(17)
strategies for advocating effectively for individuals.
(b)
The provider must document the training, competencies,
and experience in the personnel record of each person who received the training
described in this section.
§412.412.Documentation of MH Case Management Services.
(a)
A case manager must document the provision of MH case management
services as follows:
(1)
if the service involves face-to-face contact with the individual,
document:
(A)
the date of the contact;
(B)
start and stop time of the contact;
(C)
a description of the MH case management service provided;
(D)
the individual's response to the services being provided;
(E)
if the individual is receiving intensive MH case management
services, the progress or lack of progress in addressing the individual's
outcomes as identified in the case management plan; and
(F)
the case manager's signature and credentials including
the title "case manager;"
(2)
if the service does not involve face-to-face contact with
the individual, document:
(A)
the date(s) of the service;
(B)
a description of the MH case management service provided;
(C)
if the service involves face-to-face or telephone contact,
the person with whom the contact was made;
(D)
the outcome of the service; and
(E)
a case manager's signature and credentials including the
title "case manager."
(b)
The provider must retain documentation in compliance with
applicable federal and state laws, rules, and regulations.
§412.413.Medicaid Reimbursement.
(a)
A provider may file a claim for Medicaid MH case management
services, if a billable event occurs. A billable event is a face-to-face contact
between an individual who is eligible for Medicaid and a case manager who
provides an MH case management service:
(1)
during the contact; and
(2)
in accordance with §412.407 of this title (relating
to MH Case Management Services).
(b)
A unit of service for MH case management services is 15
continuous minutes.
(c)
The department will not reimburse a provider for Medicaid
MH case management services if:
(1)
the individual who was provided the service did not meet
the eligibility requirements set forth in §412.405 of this title (relating
to Recipient Eligibility for MH Case Management Services) at the time the
service was provided;
(2)
the service provided was an integral and inseparable part
of another service;
(3)
the service was provided by a person who was not qualified
in accordance with §412.410(a) of this title (related to Staff Qualifications);
(4)
the service provided was not the type, amount and duration
authorized by the department or its designee; or
(5)
the service was not provided or documented in accordance
with this subchapter.
(d)
The department will not reimburse a provider for Medicaid
MH case management services for coordination activities that are included
in the provision of:
(1)
rehabilitative crisis intervention services, as defined
in §419.457 of this title (relating to Crisis Intervention Services);
or
(2)
psychosocial rehabilitation services, as defined in §419.459
of this title (relating to Psychosocial Rehabilitation Services).
§412.414.Fair Hearings.
(a)
Any Medicaid eligible individual whose request for eligibility
for MH case management services is denied or is not acted upon with reasonable
promptness, or whose MH case management services have been terminated, suspended,
or reduced by the department is entitled to a fair hearing in accordance with
Texas Administrative Code, Title 1, Chapter 357 (relating to Medicaid Fair
Hearings).
(b)
A provider must, in the form and manner described by the
department, give a Medicaid eligible individual notice of the right to request
a fair hearing.
§412.415.Exhibits.
The following exhibits are referenced in this subchapter. For information
about obtaining copies of the exhibits contact Behavioral Health Services,
P.O. Box 12668, Austin, TX 78711-2668:
(1)
Exhibit A:
(A)
Adult Texas Recommended Authorization Guidelines;
(B)
Texas Implementation of Medication Algorithms Scales for
Adults; and
(C)
Child and Adolescent Texas Recommended Authorization Guidelines.
(2)
Exhibit B:
(A)
Adult Utilization Management Guidelines; and
(B)
Child and Adolescent Utilization Management Guidelines.
§412.416.References.
The following laws and rules are referenced in this subchapter:
(1)
Texas Administrative Code, Title 1, Chapter 357;
(2)
Texas Government Code §531.0244 and §662.021;
(3)
Texas Health and Safety Code, §534.001 and §591.003(13);
(4)
Chapter 411, Subchapter N of this title (relating to Standards
for Services to Persons with Co-Occurring Psychiatric and Substance Use Disorders);
(5)
Subchapter G of this chapter (relating to Mental Health
Community Services Standards);
(6)
Chapter 419, Subchapter L of this title (relating to Mental
Health Rehabilitative Services); and
(7)
42 CFR §435.1009 and §440.150.
§412.417.Distribution.
(a)
This subchapter shall be distributed to:
(1)
members of the Texas Department of Mental Health and Mental
Retardation Board or the applicable council;
(2)
executive, management, and program staff of the department;
(3)
executive directors of all community mental health centers;
and
(4)
advocates and advocacy organizations.
(b)
The executive director of each community mental health
center is responsible for disseminating copies of this subchapter to:
(1)
all appropriate staff; and
(2)
any individual, family member, employee, or other person
desiring a copy.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of
the Secretary of State on May 14, 2004.
TRD-200403283
Rodolfo Arredondo
Chairman, Texas MHMR Board
Texas Department of Mental Health and Mental Retardation
Earliest possible date of adoption: June 27, 2004
For further information, please call: (512) 206-4581
25 TAC §§412.451 - 412.466
(Editor's note: The text of the following sections proposed for
repeal will not be published. The sections may be examined in the offices
of the Texas Department of Mental Health and Mental Retardation or in the
Texas Register office, Room 245, James Earl Rudder Building, 1019 Brazos Street,
Austin.)
The Texas Department of Mental Health and Mental
Retardation (TDMHMR) proposes the repeal of §§412.451 - 412.466
of Chapter 412, Subchapter J, governing Service Coordination. New §§412.401
- 412.417 of Chapter 412, Subchapter I, governing Mental Health Case Management
Services, is contemporaneously proposed in this issue of the
Texas Register
.
The repeals would allow for the adoption of new rules governing the provision
of mental health case management services funded by or through the department.
Kevin Nolting, Acting Chief Financial Officer, has determined that for
each year of the first five-year period that the proposed repeal is in effect,
there will not be foreseeable implications relating to costs or revenues of
state or local government.
Sam Shore, Acting Director, Community Mental Health Services, has determined
that, for each year of the first five years the proposed repeal is in effect,
the public benefit expected is the adoption of new rules that are based on
the department's Resiliency and Disease Management model, which promotes the
provision of high quality and effective community-based mental health services
by individual-specific information that identifies an individual's mental
health care needs, matches those needs to a particular type(s) of mental health
case management services, and evaluates the effectiveness of the service provided.
It is not anticipated that there will be any additional economic cost to persons
required to comply with the proposed repeal.
It is not anticipated that the proposed repeal will affect a local economy.
It is not anticipated that the proposed repeal will have an adverse effect
on small businesses or micro-businesses because the proposed repeal does not
place requirements on small businesses or micro-businesses.
Written comments on the proposed repeal may be sent to Linda Logan, Director,
Policy Development, Texas Department of Mental Health and Mental Retardation,
P.O. Box 12668, Austin, Texas 78711-2668, within 30 days of publication.
The repeal is proposed under the Texas Health and Safety Code, §532.015,
which provides the Texas Mental Health and Mental Retardation Board (board)
with broad rulemaking authority; the Texas Health and Safety Code, §533.0354,
which requires the provision of mental health services for adults with bipolar
disorder, schizophrenia, or clinically severe depression and for children
with serious emotional illnesses be accomplished using disease management
practices; the Texas Government Code, §531.021(a), and the Texas Human
Resources Code, §32.021(a), which provide the Texas Health and Human
Services Commission (THHSC) with the authority to administer the federal medical
assistance (Medicaid) program in Texas; Acts 1995, 74th Legislature, Chapter
6, §1, (Senate Bill 509), which clarifies the authority of THHSC to delegate
the operation of all or part of a Medicaid program to a health and human services
agency; and the Human Resources Code, §32.021(c), which provides an agency
operating part of the Medicaid program with the authority to adopt necessary
rules for the proper and efficient operation of the program. THHSC has delegated
to the department the authority to operate the Medicaid program for mental
health case management.
The proposed repeal would affect the Texas Health and Safety Code, §533.0354;
the Texas Government Code, §531.021(a); and the Texas Human Resources
Code, §32.021.
§412.451.Purpose.
§412.452.Application.
§412.453.Definitions.
§412.454.Organizational Structure.
§412.455.Eligibility.
§412.456.Assessing the Need for Service Coordination.
§412.457.Local Authority Responsibilities.
§412.458.Caseloads.
§412.459.Quality Management.
§412.460.Termination of Service Coordination.
§412.461.Minimum Qualifications.
§412.462.Staff Training.
§412.463.Documentation of Service Coordination.
§412.464.Fair Hearings.
§412.465.References.
§412.466.Distribution.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of
the Secretary of State on May 14, 2004.
TRD-200403284
Rodolfo Arredondo
Chairman, Texas MHMR Board
Texas Department of Mental Health and Mental Retardation
Earliest possible date of adoption: June 27, 2004
For further information, please call: (512) 206-4581
25 TAC §§412.551 - 412.565
The Texas Department of Mental Health and Mental Retardation
(department) proposes new §§412.551 - 412.565 of new Chapter 412,
Subchapter L, governing service coordination for individuals with mental retardation.
The new rules describe the provision of service coordination to individuals
in the mental retardation priority population who live in the community. Currently,
Chapter 412, Subchapter J, addresses service coordination for individuals
living in the community in either the mental retardation priority population
or the mental health priority population. As a result of significant changes
being made to the mental health service array, the department has developed
separate rules to address service coordination for the two populations. New
Chapter 412, Subchapter I, governing mental health case management services,
is proposed contemporaneously in this issue of the
Texas Register
, and addresses the provision of case management services
(formerly referred to as service coordination) to individuals in the mental
health priority population.
The provision of service coordination, as described in the proposed new
rules, will not differ substantively from the manner in which service coordination
currently is provided to individuals in the mental retardation priority population
who are living in the community. Many of the requirements in the existing
sections that are not addressed in the new sections have been applicable only
to persons in the mental health priority population.
The provision in the existing subchapter that service coordination be provided
by an employee of the mental retardation authority (MRA) for the local service
area in which the individual resides is retained in new §412.559(a).
Minor changes have been made to the minimum qualifications for an MRA employee
who will be providing service coordination, including deletion of a provision
permitting certification as a licensed chemical dependency counselor or a
physician's assistant to be the sole qualification for providing service coordination.
In addition, new §412.559(b)(2) clarifies the qualifications of an MRA
employee who will provide service coordination if the employee has either
a high school diploma or equivalent, but does not have a college degree. In
addition, new §412.559(d) permits an MRA, at its discretion, to permit
an employee who was authorized by the MRA to provide service coordination
prior to April 1, 1999 (the original effective date of the current subchapter),
to continue to provide service coordination without meeting the minimum qualifications
described in subsection (b).
In a provision that is not described in the existing subchapter, new §412.462(b)
states that if an MRA decides to deny, involuntarily reduce, or terminate
service coordination for a non-Medicaid-eligible individual, then the MRA
must notify the individual or legally authorized representative (LAR) in writing
of the decision and provide an explanation of the procedure for the individual
or LAR to request a review by the MRA as required by §401.464 of this
title (relating to Notification and Appeals Process).
Kevin Nolting, Acting Chief Financial Officer, has determined that, for
each year of the first five year period that the proposed new sections are
in effect, there are no foreseeable fiscal implications relating to costs
or revenues of state or local government. The department does not anticipate
that the proposed new sections will have an adverse effect on small or micro-businesses.
The department does not anticipate that there will be any additional economic
cost to persons required to comply with the proposed new sections. The department
does not anticipate that the proposed new sections will affect a local economy.
Barry Waller, Acting Director, Community Mental Retardation Services, has
determined that, for each year of the first five-year period the proposed
new sections are in effect, the public benefit expected is the promulgation
of rules which clearly describe the provision of service coordination to individuals
in the department's mental retardation priority population who live in the
community.
Comments concerning the proposed new sections must be submitted in writing
to Linda Logan, Director, Policy Development, by mail to P.O. Box 12668, Austin,
Texas 78711, by fax to (512) 206-4744, or by e-mail to policy.co@mhmr.state.tx.us
within 30 days of publication of this notice.
The new sections are proposed under the Texas Health and Safety
Code, §532.015(a), which provides the Texas Board of Mental Health and
Mental Retardation with broad rulemaking authority; the Texas Government Code
(TGC), §531.021(a), and the Texas Human Resources Code (THRC), §32.021(a),
which provide the Texas Health and Human Services Commission (THHSC) with
the authority to administer the federal medical assistance (Medicaid) program
in Texas; Acts 1995, 74th Texas Legislature, Chapter 6, §1, (Senate Bill
509), which clarifies the authority of THHSC to delegate the operation of
all or part of a Medicaid program to a health and human services agency; and
THRC, §32.021(c), which provides an agency operating part of the Medicaid
program with the authority to adopt necessary rules for the proper and efficient
operation of the program. THHSC has delegated to the department the authority
to provide service coordination to Medicaid-eligible individuals in the mental
retardation priority population.
The proposed new sections affect TGC, §531.021(a); THSC, Title 7,
Subchapter D (Persons with Mental Retardation Act); and THRC, §32.021(a)
and (c).
§412.551.Purpose.
This subchapter describes requirements for service coordination delivered
by the mental retardation authority (MRA) to an individual in the mental retardation
priority population (MR priority population) who desires services.
§412.552.Application.
This subchapter applies to all mental retardation authorities (MRAs).
§412.553.Definitions.
The following words and terms, when used in this subchapter, have the
following meanings, unless the context clearly indicates otherwise:
(1)
Actively involved person--For an individual who lacks the
ability to provide legally adequate consent and who does not have a legally
authorized representative (LAR), a person whose significant and ongoing involvement
with the individual is determined by the individual's designated MRA to be
supportive of the individual based on the person's:
(A)
observed interactions with the individual;
(B)
knowledge of and sensitivity to the individual's preferences,
values, and beliefs;
(C)
availability to the individual for assistance or support;
and
(D)
advocacy for the individual's preferences, values, and
beliefs.
(2)
CARE--The department's Client Assignment and Registration
System, a database into which an MRA, state MR facility, or state MH facility
enters demographic and other data about an individual who has requested services
and supports (or on whose behalf services and supports have been requested)
or who is receiving services and supports.
(3)
Department--The Texas Department of Mental Health and Mental
Retardation or its successor.
(4)
Designated MRA--As indicated in CARE, the MRA responsible
for assisting an individual and LAR or actively involved person to access
mental retardation services and supports.
(5)
Duration--The specified period of time during which service
coordination is provided to an individual.
(6)
Frequency--The number of times during a specified period
that an individual is contacted by a person providing service coordination.
(7)
General revenue--Funds appropriated by the Texas Legislature
for use by the department.
(8)
HCS Program--A Medicaid waiver program operated by the
department.
(9)
ICF/MR--An intermediate care facility for persons with
mental retardation or a related condition.
(10)
ICF/MR Program--The Intermediate Care Facilities for Persons
with Mental Retardation Program, which provides Medicaid-funded residential
services to individuals with mental retardation or a related condition.
(11)
Institution for mental diseases (IMD)--As defined in §419.373
of this title (relating to Definitions), a hospital of more than 16 beds that
is primarily engaged in providing psychiatric diagnosis, treatment, and care
of individuals with mental diseases, including medical care, nursing care,
and related services.
(12)
Individual--A person who is or is believed to be a member
of the mental retardation priority population.
(13)
LAR (legally authorized representative)--A person authorized
by law to act on behalf of an individual with regard to a matter described
in this subchapter, and who may be a parent, guardian, or managing conservator
of a child, or the guardian of an adult.
(14)
Local service area--A geographic area composed of one
or more Texas counties.
(15)
Mental retardation--Consistent with Texas Health and Safety
Code (THSC), §591.003, significantly subaverage general intellectual
functioning existing concurrently with deficits in adaptive behavior and manifested
during the developmental period.
(16)
MRA (mental retardation authority)--As defined in THSC, §531.002,
an entity to which the Texas Mental Health and Mental Retardation Board delegates
its authority and responsibility within a specified region for planning, policy
development, coordination, and resource development and allocation, and for
supervising and ensuring the provision of mental retardation services to persons
in one or more local service areas.
(17)
Mental retardation priority population or MR priority
population--Those individuals who:
(A)
have mental retardation;
(B)
have a pervasive developmental disorder (PDD);
(C)
have a related condition and are eligible for services
in a Medicaid program operated by the department;
(D)
are nursing facility residents and eligible for specialized
services for mental retardation or a related condition pursuant to §1919(e)(7)
of the Social Security Act; or
(E)
are children eligible for early childhood intervention
(ECI) services provided in accordance with 40 TAC Chapter 108 (relating to
Early Childhood Intervention Services).
(18)
Parent Case Management Program--A program that utilizes
experienced, trained parents of individuals with disabilities to provide case
management for other families.
(19)
Partners in Policy Making--A leadership training program
administered by the Texas Planning Council for Developmental Disabilities
for self-advocates and parents.
(20)
Permanency planning--A philosophy and planning process
that focuses on the outcome of family support for an individual under 22 years
of age by facilitating a permanent living arrangement in which the primary
feature is an enduring and nurturing parental relationship.
(21)
Person-directed planning--A philosophy and planning process
that empowers an individual and, on the individual's behalf, an LAR or actively
involved person, to direct the development of a plan of services and supports.
(22)
PDD (pervasive developmental disorder)--As described in
the most current edition of the American Psychiatric Association's
Diagnostic and Statistical Manual of Mental Disorders
(DSM), a severe
and pervasive impairment in the developmental areas of reciprocal social interaction
skills or communication skills, or the presence of stereotyped behaviors,
interests, and activities manifested during the developmental period, usually
before 10 years of age.
(23)
Plan of services and supports--A written plan that:
(A)
describes the desired outcomes identified by the individual,
or LAR or actively involved person on behalf of the individual; and
(B)
describes the services and supports (including service
coordination services) to be provided to the individual, with specifics concerning
frequency and duration.
(24)
Related condition--As defined in the Code of Federal Regulations,
Title 42, §435.1009, a severe and chronic disability that:
(A)
is attributable to:
(i)
cerebral palsy or epilepsy; or
(ii)
any other condition, other than mental illness, found
to be closely related to mental retardation because the condition results
in impairment of general intellectual functioning or adaptive behavior similar
to that of persons with mental retardation, and requires treatment or services
similar to those required for those persons with mental retardation;
(B)
is manifested before the person reaches 22 years of age;
(C)
is likely to continue indefinitely; and
(D)
results in substantial functional limitation in three or
more of the following areas of major life activity:
(i)
self-care;
(ii)
understanding and use of language;
(iii)
learning;
(iv)
mobility;
(v)
self-direction; and
(vi)
capacity for independent living.
(25)
Service coordination--Assistance in accessing medical,
social, educational, and other appropriate services and supports that will
help an individual achieve a quality of life and community participation acceptable
to the individual (and LAR on the individual's behalf) as follows:
(A)
crisis prevention and management--linking and assisting
the individual and LAR or actively involved person to secure services and
supports that will enable them to prevent or manage a crisis;
(B)
monitoring--ensuring that the individual receives needed
services, evaluating the effectiveness and adequacy of services, and determining
if identified outcomes are meeting the individual's needs and desires as indicated
by the individual and LAR or actively involved person;
(C)
assessment--identifying the individual's needs and the
services and supports that address those needs as they relate to the nature
of the individual's presenting problem and disability; and
(D)
service planning and coordination--identifying, arranging,
advocating, collaborating with other agencies, and linking for the delivery
of outcome-focused services and supports that address the individual's needs
and desires as indicated by the individual and LAR or actively involved person.
(26)
Subaverage general intellectual functioning--Consistent
with THSC, §591.003, measured intelligence on standardized general intelligence
tests of two or more standard deviations (not including standard error of
measurement adjustments) below the age-group mean for the tests used.
(27)
State MH facility (state mental health facility)--A state
hospital or state center with an inpatient psychiatric component operated
by the department.
(28)
State MR facility (state mental retardation facility)--A
state school or a state center with a mental retardation residential component
operated by the department.
(29)
THSC--The Texas Health and Safety Code.
(30)
TxHmL Program or Texas Home Living Program--A Medicaid
waiver program operated by the department.
(31)
Waiver services--Home and community-based services provided
through a Medicaid waiver program approved by Centers for Medicare and Medicaid
Services (CMS) as described in §1915(c) of the Social Security Act.
§412.554.Eligibility.
(a)
To be eligible for service coordination, an individual
must be a member of the MR priority population and must meet at least one
of the following criteria:
(1)
have two or more documented needs that require services
and supports other than service coordination;
(2)
be in the process of enrolling in:
(A)
the HCS Program; or
(B)
the ICF/MR Program;
(3)
be in the process of enrolling in, or currently enrolled
in the TxHmL Program;
(4)
be seeking admission to a state MR facility;
(5)
be transitioning from an ICF/MR, including a state MR facility,
to community-based mental retardation services and supports other than another
ICF/MR or a nursing facility licensed in accordance with THSC, Chapter 242;
or
(6)
be transitioning from a state MH facility to community-based
mental retardation services and supports other than in an ICF/MR or a nursing
facility licensed in accordance with THSC, Chapter 242.
(b)
Service coordination may be funded by:
(1)
personal funds or third-party insurance other than Medicaid;
(2)
Medicaid targeted case management; or
(3)
general revenue.
(c)
Service coordination funded by Medicaid targeted case management:
(1)
may be provided only to an individual who is a Medicaid
recipient and:
(A)
who meets at least one of the criteria described in subsection
(a)(1), (2), (3), (4), or (5) of this section; or
(B)
who resides in a nursing facility licensed in accordance
with THSC, Chapter 242, and who has been determined through a preadmission
screening and annual resident review (PASARR) assessment to require specialized
services; and
(2)
may not be provided to an individual:
(A)
who is not a Medicaid recipient;
(B)
who resides in an institution for mental diseases (IMD);
or
(C)
who is receiving waiver services through any waiver program
except the TxHmL Program.
§412.555.Assessing an Individual's Need for Service Coordination.
(a)
If an individual is eligible for service coordination and
the individual or LAR or actively involved person desires service coordination,
then the designated MRA must use the Service Coordination Assessment--Mental
Retardation Services form to determine the individual's need for service coordination.
(b)
If the designated MRA determines an individual needs service
coordination, the MRA must develop a plan of services and supports as described
in §412.556(a) of this title (relating to MRA's Responsibilities).
(c)
A copy of the Service Coordination Assessment--Mental Retardation
Services form may be obtained by contacting the Office of Long Term Services
and Supports, Texas Department of Mental Health and Mental Retardation, P.O.
Box 12668, Austin, Texas 78711 or by accessing the department's website at
www.mhmr.state.tx.us.
§412.556.MRA's Responsibilities.
(a)
Developing a plan of services and supports.
(1)
If the MRA determines an individual needs service coordination,
the MRA must develop a plan of services and supports for the individual using
a person-directed planning process that is consistent with the department's
(2)
The plan of services and supports must include a component
that addresses the individual's service coordination needs, which:
(A)
is based on the results from the assessment performed in
accordance with §412.555(a) of this title (relating to Assessing an Individual's
Need for Service Coordination);
(B)
describes one or more of the elements of service coordination
(as defined) needed; and
(C)
identifies the frequency (which must be at least every
90 calendar days) and duration of service coordination to be provided.
(b)
Provision of service coordination.
(1)
The MRA must ensure that service coordination:
(A)
is provided to the individual in accordance with the individual's
plan of services and supports; and
(B)
is not provided by a staff person who is a member of the
individual's family.
(2)
The MRA may provide crisis prevention and management to
the individual without having first identified the need for such services
in the individual's plan of services and supports.
(c)
Reviewing the plan of services and supports. The MRA must
ensure that the plan of services and supports of each individual receiving
service coordination is reviewed quarterly to determine the appropriateness
and effectiveness of the services and supports provided by all community providers
and to ensure that the needs of the individual are being addressed.
(d)
Minimum contact. The MRA must ensure that the staff person
providing service coordination meets face-to-face with the individual at least
every 90 calendar days. This contact must involve at least one of the four
elements of service coordination (as defined).
(e)
Individuals enrolled in the TxHmL Program. In addition
to the requirements in this subchapter, the MRA must ensure service coordination
is provided to individuals enrolled in the TxHmL Program in accordance with
the requirements contained in Chapter 419, Subchapter N of this title (relating
to Texas Home Living (TxHmL) Program).
§412.557.Caseloads.
The MRA is responsible for determining the number of cases per staff
person who provides service coordination based on factors such as individuals'
needs, the frequency and duration of contacts, and travel time.
§412.558.Termination of Service Coordination.
The MRA must terminate service coordination for an individual if:
(1)
the individual no longer meets the eligibility criteria
for service coordination as set forth in §412.554 of this title (relating
to Eligibility); or
(2)
the individual or the LAR no longer desires service coordination.
§412.559.Minimum Qualifications.
(a)
Service coordination may be provided only by an employee
of the MRA.
(b)
Except as provided by subsection (d) of this section, a
staff person providing service coordination must have:
(1)
a bachelor's or advanced degree from an accredited college
or university with a major in a social, behavioral, or human service field
including, but not limited to, psychology, social work, medicine, nursing,
rehabilitation, counseling, sociology, human development, gerontology, educational
psychology, education, and criminal justice; or
(2)
a high school diploma or a certificate recognized by a
state as the equivalent of a high school diploma and:
(A)
two years of paid experience as a case manager in a state
or federally funded Parent Case Management Program or have graduated from
Partners in Policy Making; and
(B)
personal experience as an immediate family member of an
individual with mental retardation.
(c)
The MRA, at its discretion, may require additional education
and experience for staff who provide service coordination.
(d)
At the discretion of the MRA, a staff person who was authorized
by an MRA to provide service coordination prior to April 1, 1999, may provide
service coordination without meeting the minimum qualifications described
in subsection (b) of this section.
§412.560.Staff Training.
(a)
An MRA must ensure that the following staff receive training
as described in subsection (b) of this section within the first 90 days of
performing their service coordination duties:
(1)
staff who provide service coordination; and
(2)
staff who supervise or oversee the provision of service
coordination.
(b)
Training must address:
(1)
appropriate MRA policies, procedures, and standards;
(2)
the MRA's performance contract/memorandum requirements
regarding service coordination and case management;
(3)
plan of services and supports development and implementation;
(4)
person-directed planning consistent with the department's
(5)
permanency planning;
(6)
crisis prevention and management, monitoring, assessment,
and service planning and coordination;
(7)
community support services availability and management;
and
(8)
advocacy for individuals.
(c)
The MRA must document the training provided in accordance
with this section in the personnel record of each staff person providing,
supervising, or overseeing service coordination.
§412.561.Documentation of Service Coordination.
(a)
The MRA must document the required contacts described in
the individual's plan of services and supports, including:
(1)
the date of contact;
(2)
the description of the element(s) of service coordination
provided;
(3)
the progress or lack of progress in achieving goals or
outcomes;
(4)
the person with whom the contact occurred; and
(5)
the staff who provided the contact and his or her professional
discipline, if applicable.
(b)
The MRA must ensure that service coordination activities
are documented in the individual's record.
(c)
The MRA must identify the appropriate service code in CARE
for all individuals receiving service coordination.
(d)
The MRA must retain documentation in compliance with applicable
federal and state laws, rules, and regulations.
§412.562.Review Process.
(a)
Medicaid-eligible individuals. Any Medicaid-eligible individual
whose request for eligibility for service coordination is denied or is not
acted upon with reasonable promptness, or whose service coordination has been
terminated, suspended, or reduced by the department is entitled to a fair
hearing in accordance with 1 TAC Chapter 357 (relating to Medical Fair Hearings).
(b)
Non-Medicaid-eligible individuals. If an MRA decides to
deny, involuntarily reduce, or terminate service coordination for a non-Medicaid-eligible
individual, the MRA must notify the individual or LAR in writing of the decision
and provide an explanation of the procedure for the individual or LAR to request
a review by the MRA as required by §401.464 of this title (relating to
Notification and Appeals Process).
§412.563.Subchapter Supersedes Chapter 412, Subchapter J.
For individuals with mental retardation seeking or receiving service
coordination, this subchapter supersedes Chapter 412, Subchapter J (relating
to Service Coordination), upon the effective date of this subchapter.
§412.564.References.
References are made to the following state and federal statutes and
Texas Administrative Code:
(1)
Social Security Act, §1915(c) and §1919(e)(7);
(2)
Code of Federal Regulations (CFR), Title 42, §435.1009;
(3)
THSC, Chapter 242, §531.002, and §591.003;
(4)
1 TAC Chapter 357 (relating to Medical Fair Hearings);
(5)
40 TAC Chapter 108 (relating to Early Childhood Intervention
Services);
(6)
Chapter 412, Subchapter J of this title (relating to Service
Coordination);
(7)
§401.464 of the title (relating to Notification and
Appeals Process); and
(8)
Chapter 419, Subchapter N of this title (relating to Texas
Home Living (TxHmL) Program).
§412.565.Distribution.
(a)
This subchapter shall be distributed to:
(1)
members of the Texas MHMR Board;
(2)
executive, management, and program staff of Central Office;
(3)
executive directors of MRAs; and
(4)
advocates and advocacy organizations.
(b)
The executive director of each MRA must ensure that copies
of this subchapter are distributed to:
(1)
all appropriate staff; and
(2)
any individual, family member, employee, or other person
desiring a copy.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of
the Secretary of State on May 14, 2004.
TRD-200403277
Rodolfo Arredondo
Chairman, Texas MHMR Board
Texas Department of Mental Health and Mental Retardation
Earliest possible date of adoption: June 27, 2004
For further information, please call: (512) 206-4516
Subchapter D. HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM
25 TAC §419.155
The Texas Department of Mental Health and Mental Retardation
(department) proposes amendments to §419.155 (relating to Eligibility
Criteria) of Chapter 419, Subchapter D, governing Home and Community-Based
Services (HCS) Program.
Currently, the financial eligibility criteria in §419.155(b)(4) excludes
applicants and individuals under the age of 19 years receiving foster care
services from the Department of Family and Protective Services when the foster
care payment exceeds Level II. The proposed amendments would 1) remove the
payment restriction; 2) extend the age to under 20 years because young adults
may receive foster care services under certain conditions; and 3) clarify
that the residence in which the applicant or individual resides is a foster
family home or foster group home in which the primary caregiver is a foster
parent living in the home.
The proposed amendments would also add an eligibility requirement that
an applicant not be enrolled in the HCS Program and another Medicaid 1915(c)
waiver program simultaneously. The proposed language is consistent with the
language in the waiver approved by CMS. Additionally, the amendments would
change the reference to the Texas Department of Protective and Regulatory
Services (TDPRS) to Texas Department of Family and Protective Services (TDFPS).
Kevin Nolting, Acting Chief Financial Officer, has determined that, for
each year of the first five year period that the proposed amendments are in
effect, there are no foreseeable implications relating to costs or revenues
of state or local government. The department does not anticipate that the
proposed amendments will have an adverse effect on small or micro-businesses.
The department does not anticipate that there will be any additional economic
cost to persons required to comply with the proposed amendments. The department
does not anticipate that the proposed amendments will affect a local economy.
Barry Waller, Acting Director, Community Mental Retardation Services, has
determined that, for each year of the first five-year period the proposed
amendments are in effect, the public benefit expected is the promulgation
of Medicaid waiver program rules that extend program eligibility to children
who receive foster care services from TDFPS when the foster care payments
for their care exceed TDFPS payment Level II.
Comments concerning the proposed amendments must be submitted in writing
to Linda Logan, Director, Policy Development, by mail to P.O. Box 12668, Austin,
Texas 78711, by fax to (512) 206-4744, or by e-mail to policy.co@mhmr.state.tx.us
within 30 days of publication of this notice.
The amendments are proposed under the Texas Health and Safety
Code, §532.015(a), which provides the Texas Board of Mental Health and
Mental Retardation with broad rulemaking authority; the Texas Government Code, §531.021(a),
and the Texas Human Resources Code, §32.021(a), which provide the Texas
Health and Human Services Commission (THHSC) with the authority to administer
the federal medical assistance (Medicaid) program in Texas; Acts 1995, 74th
Texas Legislature, Chapter 6, §1, (Senate Bill 509), which clarifies
the authority of THHSC to delegate the operation of all or part of a Medicaid
program to a health and human services agency; and the Human Resources Code, §32.021(c),
which provides an agency operating part of the Medicaid program with the authority
to adopt necessary rules for the proper and efficient operation of the program.
THHSC has delegated to the department the authority to operate the HCS Program.
The proposed amendments affect Texas Government Code, §531.021(a),
and the Texas Human Resources Code, §32.021(a) and (c).
§419.155.Eligibility Criteria.
(a)
An applicant or individual is eligible for HCS program
services if he or she:
(1)
(No change.)
(2)
meets one of the following criteria:
(A) - (B)
(No change.)
(C)
qualifies for the ICF/MR LOC I as defined in §419.238
of this title (relating to Level of Care Criteria I) or ICF/MR VIII LOC as
defined in §419.239 of this title (relating to ICF/MR Level of Care VIII
Criteria) in ICF/MR Program rules at Chapter 419, Subchapter E, as determined
by the department according to §419.159 of this title (relating to Level
of Care Determination), and has been determined by the department or TDHS:
(i) - (ii)
(No change.)
(iii)
to be inappropriately placed in a Medicaid certified
nursing facility based on an annual resident review conducted in accordance
with the requirements of Texas Administrative Code, Title 40, §19.2500;
[
(3)
has an approved IPC for which the IPC cost does not exceed
125% of the annual ICF/MR reimbursement rate paid to a small ICF/MR, as defined
in 1 TAC §355.456 (relating to Rate Setting Methodology) for the individual's
level of need as it would be assigned under §419.240 of this title (relating
to Level of Need) or 125% of the estimated annualized per capita cost for
ICF/MR services, whichever is greater
; and
[
(4)
is not enrolled in another Medicaid 1915(c)
waiver program.
(b)
An applicant or individual is financially eligible for
the HCS Program if he or she:
(1) - (3)
(No change.)
(4)
is under 20 years of age and:
(A)
financially the responsibility of the Texas Department
of Family and Protective Services (TDFPS) in whole or in part; and
(B)
is being cared for in a foster home or group home:
(i)
that is licensed or certified and supervised by TDFPS or
a licensed public or private nonprofit child placing agency; and
(ii)
in which a foster parent is the primary caregiver residing
in the home;
[(4)
is under age 19 and financially the responsibility
of the Texas Department of Protective and Regulatory Services (TDPRS), in
whole or in part (not to exceed Level II foster care payment), and being cared
for in a family foster home licensed or certified and supervised by:]
[(A)
TDPRS; or]
[(B)
a licensed public or private nonprofit child placing agency;
or]
(5) - (6)
(No change.)
(c) - (d)
(No change.)
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of
the Secretary of State on May 14, 2004.
TRD-200403278
Rodolfo Arredondo
Chairman, Texas MHMR Board
Texas Department of Mental Health and Mental Retardation
Earliest possible date of adoption: June 27, 2004
For further information, please call: (512) 206-4516
25 TAC §§419.451 - 419.466
(Editor's note: The text of the following sections proposed for
repeal will not be published. The sections may be examined in the offices
of the Texas Department of Mental Health and Mental Retardation or in the
Texas Register office, Room 245, James Earl Rudder Building, 1019 Brazos Street,
Austin.)
The Texas Department of Mental Health and Mental
Retardation (department) proposes the repeal of §§419.451 - 419.466
of Chapter 419, Subchapter L, governing Medicaid rehabilitative services.
New §§419.451 - 419.470 of Chapter 419, Subchapter L, governing
mental health rehabilitative services, which would replace the repealed rules,
are contemporaneously proposed in this issue of the
Texas Register
.
The repeal would allow for the adoption of new rules governing mental health
rehabilitative services.
Kevin Nolting, Acting Chief Financial Officer, has determined that for
each year of the first five-year period that the proposed repeal is in effect,
there will not be foreseeable implications relating to costs or revenues of
state or local government.
Sam Shore, Acting Director, Community Mental Health Services, has determined
that, for each year of the first five years the proposed repeal is in effect,
the public benefit expected is the adoption of new rules that are based on
the department's Resiliency and Disease Management model, which promotes the
provision of high quality and effective community-based mental health services
by individual-specific information that identifies an individual's mental
health care needs, matches those needs to a particular type(s) of rehabilitative
services, and evaluates the effectiveness of the service provided. It is not
anticipated that there will be any additional economic cost to persons required
to comply with the proposed repeal.
It is not anticipated that the proposed repeal will affect a local economy.
It is not anticipated that the proposed repeal will have an adverse effect
on small businesses or micro-businesses because the proposed repeal does not
place requirements on small businesses or micro-businesses.
Written comments on the proposed repeal may be sent to Linda Logan, Director,
Policy Development, Texas Department of Mental Health and Mental Retardation,
P.O. Box 12668, Austin, Texas 78711-2668, within 30 days of publication.
The repeal is proposed for repeal under the Texas Health and
Safety Code, §532.015, which provides the Texas Mental Health and Mental
Retardation Board (board) with broad rulemaking authority; the Texas Health
and Safety Code, §533.0354, which requires the provision of mental health
services for adults with bipolar disorder, schizophrenia, or clinically severe
depression and for children with serious emotional illnesses be accomplished
using disease management practices; the Texas Government Code, §531.021(a),
and the Texas Human Resources Code, §32.021(a), which provide the Texas
Health and Human Services Commission (THHSC) with the authority to administer
the federal medical assistance (Medicaid) program in Texas; Acts 1995, 74th
Legislature, Chapter 6, §1, (Senate Bill 509), which clarifies the authority
of THHSC to delegate the operation of all or part of a Medicaid program to
a health and human services agency; and the Human Resources Code, §32.021(c),
which provides an agency operating part of the Medicaid program with the authority
to adopt necessary rules for the proper and efficient operation of the program.
THHSC has delegated to the department the authority to operate the Medicaid
program for mental health rehabilitative services.
The proposed repeal would affect the Texas Health and Safety Code, §533.0354;
the Texas Government Code, §531.021(a); and the Texas Human Resources
Code, §32.021.
§419.451.Purpose.
§419.452.Application.
§419.453.Definitions.
§419.454.Eligibility of Individuals for Rehabilitative Services Reimbursed by Medicaid.
§419.455.Rehabilitative Services: General Requirements.
§419.456.Community Support Services.
§419.457.Day Programs for Acute Needs.
§419.458.Day Programs for Skills Training.
§419.459.Day Programs for Skills Maintenance.
§419.460.Rehabilitative Treatment Plan Oversight.
§419.461.Documentation Requirements.
§419.462.Medicaid Reimbursement.
§419.463.Medicaid Provider Participation Requirements.
§419.464.Fair Hearings.
§419.465.References.
§419.466.Distribution.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of
the Secretary of State on May 14, 2004.
TRD-200403282
Rodolfo Arredondo
Chairman, Texas MHMR Board
Texas Department of Mental Health and Mental Retardation
Earliest possible date of adoption: June 27, 2004
For further information, please call: (512) 206-4581
an individual
believes that because of a mental health condition, he or she presents an
immediate danger to self or others or that his or her mental or physical health
is at risk of serious deterioration.
]
Subchapter I. MENTAL HEALTH CASE MANAGEMENT SERVICES
Subchapter J. SERVICE COORDINATION
Subchapter L. SERVICE COORDINATION FOR INDIVIDUALS WITH MENTAL RETARDATION
Chapter 419.
MEDICAID STATE OPERATING AGENCY RESPONSIBILITIES
and
]
.
]
Subchapter L. MEDICAID REHABILITATIVE SERVICES
Subchapter L. MENTAL HEALTH REHABILITATIVE SERVICES