| (33) LOC or level of care--A designation given to the
department's standardized packages of mental health community services,
based on the uniform assessment and the utilization management guidelines,
which recommend the type, amount, and duration of mental health community
services to be provided to an individual.
(34) LPC or licensed professional counselor--A staff
member who is licensed as a licensed professional counselor by the
Texas State Board of Examiners of Professional Counselors in accordance
with Texas Occupations Code, Chapter 503.
(35) LPHA or licensed practitioner of the healing arts--A
staff member who is:
(A) a physician;
(B) a licensed professional counselor (LPC);
(C) a licensed clinical social worker (LCSW);
(D) a psychologist;
(E) an advanced practice registered nurse (APRN);
(F) a physician assistant (PA); or
(G) a licensed marriage and family therapist (LMFT).
(36) LVN or licensed vocational nurse--A staff member
who is licensed as a licensed vocational nurse by the Texas Board
of Nursing in accordance with Texas Occupations Code, Chapter 301.
(37) Management information system--An information
system designed to supply an LMHA or MCO with information needed to
plan, organize, staff, direct, and control their operations and clinical
decision-making.
(38) MCO or managed care organization--An entity that
has a current Texas Department of Insurance certificate of authority
to operate as a Health Maintenance Organization (HMO) in the Texas
Insurance Code, Chapter 843, or as an approved nonprofit health corporation
in the Texas Insurance Code, Chapter 844, and that provides mental
health community services pursuant to a contract with the department.
(39) Medical necessity--The need for a service that:
(A) is reasonable and necessary for the diagnosis or
treatment of a mental health disorder or a co-occurring psychiatric
and substance use disorder (COPSD) in order to improve or maintain
an individual's level of functioning;
(B) is provided in accordance with professionally accepted
clinical guidelines and standards of practice in behavioral health
care;
(C) is furnished in the most clinically appropriate,
available setting in which the service can be safely provided;
(D) is provided at a level that is safe and appropriate
for the individual's needs and facilitates the individual's recovery;
and
(E) could not be omitted without adversely affecting
the individual's mental or physical health or the quality of care
rendered.
(40) Medical record--The systematic, organized account,
compiled by health care providers, of information relevant to the
services provided to an individual. This includes an individual's
history, present illness, findings on examination, treatment and discharge
plans, details of direct and indirect care and services, and notes
on progress.
(41) Mental health community services--All services
medically necessary to treat, care for, supervise, and rehabilitate
individuals who have a mental illness or emotional disorder or a COPSD.
These services include services for the prevention of and recovery
from such disorders, but do not include inpatient services provided
in a state facility.
(42) Mental illness--An illness, disease, or condition
(other than a sole diagnosis of epilepsy, dementia, substance use
disorder, mental retardation, or pervasive developmental disorder)
that:
(A) substantially impairs an individual's thought,
perception of reality, emotional process, development, or judgment;
or
(B) grossly impairs an individual's behavior as demonstrated
by recent disturbed behavior.
(43) Peer provider--A staff member who:
(A) has received:
(i) a high school diploma; or
(ii) a high school equivalency certificate issued in
accordance with the law of the issuing state;
(B) has at least one cumulative year of receiving mental
health community services; and
(C) is under the direct clinical supervision of an
LPHA.
(44) Physician--A staff member who is:
(A) licensed as a physician by the Texas Medical Board
in accordance with Texas Occupations Code, Chapter 155; or
(B) authorized to perform medical acts under an institutional
permit at a Texas postgraduate training program approved by the Accreditation
Council for Graduate Medical Education, the American Osteopathic Association,
or the Texas Medical Board.
(45) Physician assistant--A staff member who has specialized
psychiatric/mental health training and who is licensed as a physician
assistant by the Texas State Board of Physician Assistant Examiners
in accordance with Texas Occupations Code, Chapter 204.
(46) Provider--Any person or legal entity that contracts
with the department, an LMHA, or an MCO to provide mental health community
services to individuals, including that part of an LMHA or MCO directly
providing mental health community services to individuals. The term
includes providers of mental health case management services and providers
of mental health rehabilitative services.
(47) Psychologist--A staff member who is licensed as
a psychologist by the Texas State Board of Examiners of Psychologists
in accordance with Texas Occupations Code, Chapter 501.
(48) QMHP-CS or qualified mental health professional-community
services--A staff member who is credentialed as a QMHP-CS who has
demonstrated and documented competency in the work to be performed
and:
(A) has a bachelor's degree from an accredited college
or university with a minimum number of hours that is equivalent to
a major (as determined by the LMHA or MCO in accordance with §412.316(d)
of this title (relating to Competency and Credentialing)) in psychology,
social work, medicine, nursing, rehabilitation, counseling, sociology,
human growth and development, physician assistant, gerontology, special
education, educational psychology, early childhood education, or early
childhood intervention;
(B) is a registered nurse (RN); or
(C) completes an alternative credentialing process
as determined by the LMHA or MCO in accordance with §412.316(c)
and (d) of this title relating to (Competency and Credentialing).
(49) Recovery--The process by which a person becomes
able or regains the ability to live, work, learn, and participate
fully in his or her community.
(50) Referral--The process of identifying appropriate
services and providing the information and assistance needed to access
them.
(51) RN or registered nurse--A staff member who is
licensed as a registered nurse by the Texas Board of Nursing in accordance
with Texas Occupations Code, Chapter 301.
(52) Restraint--The same meaning as defined in Chapter
415, Subchapter F of this title (relating to Interventions in Mental
Health Programs).
(53) Routine care services--Mental health community
services provided to an individual who is not in crisis.
(54) Safety monitoring--Ongoing observation of an individual
to ensure the individual's safety. An appropriate staff person must
be continuously present in the individual's immediate vicinity, provide
ongoing monitoring of the individual's mental and physical status,
and ensure rapid response to indications of a need for assistance
or intervention. Safety monitoring includes maintaining continuous
visual contact with frequent face-to-face contacts as needed.
(55) Screening Activities performed by a Qualified
Mental Health Professional--Community Services (QMHP-CS) to gather
triage information to determine the need for in-depth assessment.
The QMHP-CS collects this information through face-to-face or telephone
interviews with the individual or collateral. This service includes
screenings to determine if the individual's need is emergent, urgent,
or routine (which is conducted prior to the face-to-face assessment
to determine the need for emergency services).
(56) Seclusion--The same meaning as defined in Chapter
415, Subchapter F of this title.
(57) Staff member--Anyone who works or provides services
for an LMHA, MCO, or provider as an employee, contractor, intern,
or volunteer.
(58) Support services--Mental health community services
delivered to an individual, LAR, or family member(s) to assist the
individual in functioning in the individual's chosen living, learning,
working, and socializing environments.
Cont'd... |
