| (a) Assessment.
(1) A QMHP-CS with appropriate supervision and training
must perform an assessment of an individual in accordance with the
requirements of the Texas Medicaid Provider Procedures Manual (TMPPM),
including all updates and revisions, and all the handbooks, standards,
and guidelines as determined by HHSC or a managed care organization
(MCO) with which they contract.
(2) An assessment of an individual may be performed
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).
(b) Documentation. The assessment must be documented
and must include:
(1) the individual's identifying information;
(2) completion of the appropriate uniform assessment(s)
and assessment guideline calculations;
(3) the individual's present status and relevant history,
including education, employment, housing, legal, military, developmental,
and current available social and support systems;
(4) the individual's co-occurring substance use, intellectual
or developmental disability, or physical health condition, if any;
(5) the individual's relevant past and current medical
and psychiatric information, which may include trauma history;
(6) information from the individual and LAR, if applicable,
regarding the individual's strengths, needs, natural supports, community
participation, responsiveness to previous treatment, as well as preferences
for and objections to specific treatments;
(7) the need or desire of the individual for family
member involvement or other identified natural supports in treatment
and mental health community services, if the individual is an adult
without an LAR;
(8) the identification of the LAR's or family members'
need for education and support services related to the individual's
mental illness or emotional disturbance and the plan to facilitate
the LAR's or family members' receipt of the needed education and support
services;
(9) recommendations and conclusions regarding treatment
needs;
(10) the mode of delivery; and
(11) date, signature, and credentials of the staff
member completing the assessment.
(c) Diagnostics. The diagnosis of a mental illness
must be:
(1) rendered by an LPHA, acting within the scope of
his license, who has interviewed the individual;
(2) based on diagnostic criteria from the latest edition
of the American Psychiatric Association's Diagnostic and Statistical
Manual of Mental Disorders;
(3) documented in writing, including the date, signature,
and credentials of the person making the diagnosis; and
(4) supported by and included in the uniform assessment.
(d) Provision of services. The comprehensive provider
agency and staff members must provide services in accordance with
the requirements of the TMPPM, including all updates and revisions,
and all handbooks, standards, and guidelines as determined by HHSC
or an MCO with which they contract.
(e) A service described in this subsection 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. The comprehensive
provider agency and staff members must implement procedures to ensure
that each individual is provided mental health services based on:
(1) the assessment conducted under subsection (a) of
this section;
(2) medical necessity as determined by an LPHA; and
(3) when available, physical health care needs as determined
by a physician, physician assistant, or advanced practice registered
nurse.
(f) Prerequisites to provision of services. Except
for crisis intervention services provided under §354.2707 of
this subchapter (relating to Crisis Intervention Services), before
providing services to an individual under this subchapter a comprehensive
provider agency must:
(1) if required by the managed care organization, submit
authorization requests to the MCO with which the individual is enrolled
for the type(s), amount, and duration of services to be provided to
the individual in accordance with the uniform assessment and the utilization
management guidelines; and
(2) in collaboration with the individual and his LAR,
if applicable, develop a recovery/treatment plan for the individual
that complies with the requirements of this subchapter.
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