(a) Mental health targeted case management services
are provided to eligible individuals to assist them in gaining access
to needed medical, social/behavioral, educational, and other services
and supports that are appropriate to the individual's needs.
(b) Mental health targeted case management includes:
(1) development and periodic revision of a specific
recovery/treatment plan, per §354.2609 of this subchapter (relating
to Recovery/Treatment Planning, Recovery/Treatment Plan Review, and
Discharge Summary);
(2) making referrals and performing other related activities
to help an individual obtain needed services and supports, including
activities that help link an individual with:
(A) medical, social/behavioral, and educational providers;
and
(B) other providers that provide needed services to
address identified needs and achieve goals in the recovery/treatment
plan;
(3) monitoring and follow up activities of service
effectiveness, with the individual, family members, providers, or
other entities or individuals, that occur regularly or at least annually
to ensure the recovery/treatment plan is implemented and adequately
addresses the individual's needs; and
(4) coordination with, and not duplication of, activities
provided as part of institutional services and discharge planning
activities that take place at inpatient facilities.
(c) Mental health targeted case management services
must be provided, at minimum, by an individual credentialed as a QMHP-CS
and in accordance with the requirements of the Texas Medicaid Provider
Procedures Manual (TMPPM), including all updates and revisions and
all handbooks, standards, and guidelines as determined by HHSC or
a managed care organization (MCO) with which they contract.
(d) Mental health targeted case management, as described
in this section, may be delivered as a telemedicine medical service
or a telehealth service, including via an audio-only platform, in
accordance with the requirements and limitations of Subchapter A,
Division 33 of this chapter (relating to Advanced Telecommunications
Services.)
(e) A mental health targeted case manager must be assigned
to an individual within two business days after receiving notification
that the individual has been authorized to receive mental health targeted
case management services.
(f) The assigned mental health targeted case manager
must:
(1) meet with the individual and the individual's LAR
or primary caregiver within seven calendar days after the case manager
is assigned;
(2) assist the individual in identifying the individual's
immediate needs and in determining access to community resources that
may address those needs;
(3) identify the individual's strengths, service needs,
and assistance required to address identified needs;
(4) identify the goals and actions required to meet
the individual's identified needs;
(5) take the steps necessary to accomplish the goals
required to meet the individual's identified needs by using referral,
linking, advocacy, and monitoring;
(6) meet with the individual at the individual's, the
LAR's, or the primary caregiver's request, or document why the meeting
did not occur;
(7) meet with the LAR, with or without the individual
present, to provide a service that assists the individual in gaining
and coordinating access to necessary care and services;
(8) meet with the individual and the 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; and
(9) if notified that the individual is in crisis, coordinate
with the appropriate providers of emergency services to respond to
the crisis.
(g) Intensive case management services, available only
to children and youth, incorporate wraparound process planning in
the approach to recovery/treatment planning and recovery/treatment
plan implementation. The assigned mental health targeted case manager
must:
(1) incorporate wraparound process planning in developing
a recovery/treatment plan that addresses the child's or youth's unmet
needs across life domains and includes, in addition to the required
elements listed in §354.2609 of this subchapter:
(A) a list of the child's or youth's natural strengths
and supports;
(B) a crisis plan developed in collaboration with the
LAR, caregiver, and family;
(C) a prioritized list of the child's or youth's unmet
needs that includes a discussion of the priorities and needs expressed
by the child or youth and the LAR or primary caregiver;
(D) a description of the objective and measurable outcomes
for each of the unmet needs as well as a projected time frame for
each outcome;
(E) a description of the actions the child or youth,
the case manager, and other designated people must take to achieve
those outcomes;
(F) a list of the necessary services, service providers
and the availability of the services; and
(G) a statement of the maximum period between contacts
with the child or youth, and the LAR or primary caregiver, determined
in accordance with the utilization management guidelines;
(2) develop and document an intensive case management
plan based on the child's or youth's needs that may include information
across life domains from relevant sources such as the child or youth,
the LAR or primary caregiver, other agencies and organizations providing
services to the child or youth, the child's or youth's medical record,
and other sources identified by the child or youth, LAR, or primary
caregiver;
(3) ensure services are delivered in clinically appropriate,
client-centered, community-based settings;
(4) meet with the child or youth and the LAR or primary
caregiver:
(A) within seven calendar days after the case manager
is assigned to the child or youth or document the reasons the meeting
did not occur;
(B) within seven calendar days after discharge from
an inpatient psychiatric setting or document the reasons the meeting
did not occur; and
(C) according to the child's or youth's recovery/treatment
plan or document the reasons the meeting did not occur;
(5) take necessary steps to assist the child or youth
in gaining access to needed services and service providers, and document
these activities, including:
(A) making referrals to potential service providers;
(B) initiating contact with potential service providers;
(C) arranging, facilitating linkages, and accompanying
the child or youth to initial meetings and non-routine appointments;
(D) arranging transportation to ensure the child's
or youth's attendance at appointments with services providers;
(E) advocating with service providers; and
(F) providing relevant information to service providers;
and
(6) monitor the child's or youth's progress toward
the outcomes set forth in the recovery/treatment plan, including:
(A) gathering information from the child or youth,
current service providers, LAR, primary caregiver, and other resources;
(B) reviewing pertinent documentation, including the
child's or youth's clinical records and assessments;
(C) ensuring that the recovery/treatment plan was implemented
as agreed upon;
(D) ensuring that needed services were provided;
(E) determining whether progress toward the desired
outcomes was made;
(F) identifying barriers to accessing services or to
obtaining maximum benefit from services;
(G) advocating for the modification of services to
address changes in the needs or status of the child or youth;
(H) identifying emerging unmet service needs;
(I) determining whether the recovery/treatment plan
needs to be modified to address the child's or youth's unmet service
needs more adequately; and
(J) revising the recovery/treatment plan as necessary
to address the child's or youth's unmet service needs.
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