(a) A managed care organization (MCO) must ensure that
each contracted comprehensive provider agency meets the requirements
established in this subchapter.
(b) An MCO must develop policies, procedures, and contract
requirements to ensure that contracted comprehensive provider agencies
adhere to the requirements in this subchapter.
(c) An MCO must not approve or contract with a comprehensive
provider agency as a provider of mental health targeted case management
and mental health rehabilitative services unless the comprehensive
provider agency:
(1) is enrolled as a Texas Medicaid provider in accordance
with §352.7 of this title (related to Applying for Enrollment);
(2) attests in the credentialing application to the
MCO and agrees in the contract to comply with applicable state and
federal regulations, rules, policies, and procedures relating to mental
health targeted case management and mental health rehabilitative services;
(3) agrees to comply with applicable state and federal
laws governing participation of providers in the Medicaid program;
(4) agrees to submit accurate and complete cost reports
in accordance with applicable HHSC requirements;
(5) is not listed on the HHSC Inspector General's Excluded
Individuals/Entities Listing;
(6) provides or subcontracts for the full array of
mental health targeted case management and mental health rehabilitative
services listed in Chapter 354, Subchapter M, of this title (relating
to Mental Health Targeted Case Management and Mental Health Rehabilitation),
with the exception of §354.2715 of this title (relating to Day
Programs for Acute Needs (DPAN)); and
(7) has staff that are credentialed in accordance with §353.1415
of this subchapter (relating to Staff Member Credentialing).
(d) If an MCO contracts with a comprehensive provider
agency to provide mental health targeted case management and mental
health rehabilitative services specific to children who are at risk
of juvenile justice involvement, expulsion from school, displacement
from the home, hospitalization, residential treatment, or serious
injury to self, others, or animals, the MCO must ensure the comprehensive
provider agency has a referral arrangement with a Texas Medicaid enrolled
provider within the MCO network that has the ability to otherwise
meet the needs of the child and that can provide the services to the
child without interruption in services and without otherwise affecting
the child's access to care.
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