|(a) Adequate provider network. The LMHA and MCO must
maintain a provider network that is adequate and qualified to provide
all mental health community services that the LMHA and MCO are required
to provide under a contract with the department.
(b) Crisis screening and response system. The LMHA
and MCO must have a crisis screening and response system in operation
24 hours a day, every day of the year, that is available to individuals
throughout its contracted service delivery area. The telephone system
to access the crisis screening and response system must include a
toll-free crisis hotline number and be easily accessible and well
publicized. Calls to the crisis hotline must be answered by a hotline
staff member who is trained in compliance with this subchapter. The
hotline must have teletypewriter (TTY) capabilities or other assistive
technology that is available and effective.
(c) Telephone access. In addition to the crisis screening
and response system described in subsection (b) of this section, the
LMHA and MCO must ensure the availability of a telephone system and
call center that allows individuals to contact the LMHA or MCO through
a toll-free number that must:
(1) operate without using telephone answering equipment
at least on business days during normal business hours, except on
national holidays, due to uncontrollable interruption of service,
or with prior approval of the department;
(2) have sufficient staff to operate efficiently;
(3) collect, document, and store detailed information,
including special needs information, on all telephone inquiries and
(4) during times other than those described in paragraph
(1) of this subsection provide electronic call answering methods that
include an outgoing message providing the crisis hotline telephone
number, in languages relevant to the service area, for callers to
leave a message; and
(5) return routine calls before the end of the next
business day for all messages left after hours.
(d) Timely services based on need. The LMHA and MCO
must arrange mental health services for an individual within the following
(1) Crisis services.
(A) Hotline calls. For all calls to the toll-free crisis
(i) the call must be answered by a staff member within
30 seconds, on average, at least 95 percent of the time; and
(ii) if the call is identified as a potential crisis,
a QMHP-CS must begin a telephone screening immediately but no later
than one minute after the call is so identified.
(B) Emergency care services. If during a screening
it is determined that an individual is experiencing a crisis that
may require emergency care services, the QMHP-CS must:
(i) take immediate action to address the emergency
situation to ensure the safety of all parties involved;
(ii) activate the immediate screening and assessment
processes as described in §412.321 of this title (relating to
Crisis Services); and
(iii) provide or obtain mental health community services
or other necessary interventions to stabilize the crisis.
(C) Urgent care services. If the screening indicates
that an individual needs urgent care services, a QMHP-CS must within
eight hours of the initial incoming hotline call or notification of
a potential crisis situation:
(i) perform a face-to-face assessment; and
(ii) provide or obtain mental health community services
or other necessary interventions to stabilize the crisis.
(2) Routine care services. If the screening indicates
that an individual needs routine care services, a QMHP-CS must perform
a uniform assessment within 14 days after the screening. If the assessment
indicates an LOC for routine care services, the individual must begin
receiving services immediately. When the provision of the service
package is not possible because services are at capacity, the individual
must be referred to an available practitioner appropriate to meet
the individual's needs or be placed on a waiting list for services,
subject to the following exceptions:
(A) individuals eligible for Medicaid who are determined
to be in need of Mental Health Case Management, under Chapter 412,
Subchapter I of this title, or Mental Health Rehabilitative Services,
under Chapter 419, Subchapter L of this title, cannot be placed on
a waiting list and must be served.
(B) individuals eligible for Medicaid who are determined
to need services other than Mental Health Case Management, under Chapter
412, Subchapter I of this title, and Mental Health Rehabilitative
Services, under Chapter 419, Subchapter L of this title, must be referred
to appropriate, available practitioners of that service. Only if an
appropriate Medicaid practitioner is not available may the individual
be placed on a waiting list. All efforts undertaken to refer Medicaid
individuals must be documented.
(e) Communication with individuals. The LMHA, MCO,
and provider must ensure effective communication with the individual
and LAR (if applicable) in an understandable format as appropriate
to meet the needs of individuals, which may require using:
(1) interpretative services;
(2) translated materials; or
(3) a staff member who can effectively respond to the
cultural (e.g., customs, beliefs, actions, and values) and language
needs of the individual and LAR (if applicable).
(f) Service information. The LMHA and MCO must proactively
disseminate to individuals and their LAR (if applicable) information
about mental illness and the LMHA's or MCO's mental health community
services in a format and language that is easily understood and based
on the demographics for any group comprising more than 10 percent
of the population in the local service area. Information about mental
illness and the LMHA's or MCO's community services must be in a format
and language that is easily understood by individuals with a disability
(e.g., deafness, hard of hearing, and blindness).
(g) Access to emergency medical and crisis services.
The LMHA and MCO must develop procedures for its providers' use in
accessing emergency medical and crisis services for individuals.
(h) Continuity of services. The LMHA and MCO must ensure
(1) are provided continuity of services as defined
by the department; and
(2) are informed of whom to contact regarding continuity
and coordination of their services, in accordance with Chapter 412,
Subchapter D of this title (relating to Mental Health Services--Admission,
Continuity, and Discharge).
(i) Referral for physical health services. If a nursing
or medical assessment indicates physical health needs outside the
scope of the provider's competency, credentialing, or capacity to
treat, the LMHA and MCO must make and document appropriate referrals
to other healthcare providers and provide adequate follow up at subsequent
visits to confirm access to the referrals.