| (a) Recommendation for treatment. The designated LMHA
or LBHA is responsible for recommending the most appropriate and available
treatment alternative for an individual in need of mental health services.
(b) Inpatient services.
(1) Before an LMHA or LBHA refers an individual for
inpatient services, the LMHA or LBHA must screen and assess the individual
to determine if the individual requires inpatient services.
(2) If the screening and assessment indicates the individual
requires inpatient services and inpatient services are the least restrictive
setting available, the LMHA or LBHA refers the individual:
(A) to an SMHF or facility with a CPB, if the LMHA
or LBHA determines that the individual meets the criteria for admission;
or
(B) to an LMHA or LBHA network provider of inpatient
services.
(3) If the individual is identified in the applicable
HHSC automation system as having an ID, the LMHA or LBHA informs the
designated LIDDA that the individual has been referred for inpatient
services.
(4) If the LMHA, LBHA, or LMHA or LBHA-network provider
refers the individual for inpatient services, the LMHA or LBHA must
communicate necessary information to the contracted inpatient provider
before or at the time of admission, including the individual's:
(A) identifying information, including address;
(B) legal status (e.g., regarding guardianship, charges
pending, custody as applicable;
(C) pertinent medical and medication information, including
known disabilities;
(D) behavioral information, including information regarding
COPSD;
(E) other pertinent treatment information;
(F) finances, third-party coverage, and other benefits,
if known; and
(G) advance directive.
(5) If an LMHA or LBHA, other than the individual's
designated LMHA or LBHA, refers the individual for inpatient services,
the SMHF or facility with a CPB notifies the individual's designated
LMHA or LBHA of the referral for inpatient services by the end of
the next business day.
(6) The designated LMHA or LBHA assigns a continuity
of care worker to an individual admitted to an SMHF, a facility with
a CPB, or an LMHA or LBHA inpatient services network provider.
(7) If the individual has an ID or DD, the designated
LIDDA assigns a continuity of care worker to the individual.
(8) The LMHA or LBHA continuity of care worker, and
LIDDA continuity of care worker as applicable, are responsible for
the facilitation of the individual's continuity of services.
(c) Community-based crisis treatment options.
(1) An LMHA or LBHA must ensure the provision of crisis
services to an individual experiencing a crisis while the individual
is in its local service area.
(2) Individuals in need of a higher level of care,
but not requiring inpatient services, have the option, as available,
for admission to other services such as crisis respite, crisis residential,
extended observation, or crisis stabilization unit.
(d) LMHA or LBHA Services.
(1) If an LMHA or LBHA admits an individual to LMHA
or LBHA services, the LMHA or LBHA ensures the provision of services
in the most integrated setting available.
(2) The LMHA or LBHA assigns, to an individual receiving
services, a staff member who is responsible for coordinating the individual's
services.
(e) Court Ordered Treatment. The LMHA or LBHA must
provide services to an individual ordered by a court to participate
in outpatient mental health services or competency restoration services,
if available, when the court identifies the LMHA or LBHA as being
responsible for those services.
(f) Referral to alternate provider.
(1) If an individual requests a referral to an alternate
provider, and it is not court ordered to receive services from the
LMHA or LBHA, the LMHA or LBHA makes a referral to an alternate provider
in accordance with the request.
(2) If an individual has third-party coverage, but
the coverage will not pay for needed services because the designated
LMHA or LBHA does not have a provider in its network that is approved
by the third-party coverage, the designated LMHA or LBHA acts in accordance
with 25 TAC §412.106(c)(2) (relating to Determination of Ability
to Pay).
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