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RULE §2.151Most Appropriate and Available Treatment Alternative

The designated LMHA is responsible for recommending the most appropriate and available treatment alternative for persons in need of mental health services in accordance with this section.

  (1) Inpatient services.

    (A) Before an LMHA refers a person for inpatient services, the LMHA shall screen and assess the person to determine if the person requires inpatient services.

    (B) If the screening and assessment indicates the person requires inpatient services and inpatient services represents the least restrictive setting available, then the LMHA shall refer the person:

      (i) to a SMHF, if the LMHA determines that the person meets the criteria for admission to the SMHF;

      (ii) to an LMHA-network provider of inpatient services; or

      (iii) to an alternate provider of inpatient services, if appropriate.

    (C) If the person is identified in CARE as having mental retardation, then the LMHA shall inform the designated MRA that the person has been referred for inpatient services.

    (D) If the LMHA refers the person for inpatient services, then the LMHA is responsible for communicating necessary information to the SMHF or other provider of inpatient services prior to or at the time of admission, to include:

      (i) identifying data, including address;

      (ii) legal status (e.g., regarding guardianship, charges pending, custody, if person is a minor);

      (iii) pertinent medical and medication information, including known disabilities;

      (iv) behavioral data including information regarding COPSD;

      (v) other pertinent treatment information; and

      (vi) finances, third-party coverage, and other benefits, if known.

    (E) If the LMHA that refers the person for inpatient services is not the person's designated LMHA, then the LMHA shall notify the designated LMHA of the referral by the end of the next business day.

    (F) The designated LMHA shall assign an LMHA liaison staff to a person admitted to a SMHF. If the person has mental retardation, then the designated MRA shall assign an MRA liaison staff to the person as well. If the LMHA refers a person to a mental health facility, as described in subparagraph (B)(ii) or (iii) of this paragraph, and the person is admitted, the designated LMHA shall assign an LMHA liaison staff. The LMHA liaison staff, and MRA liaison staff if any, are responsible for the person's continuity of services.

  (2) Crisis services. An LMHA is responsible for ensuring the provision of crisis services to any person found in its local service area who is in crisis.

  (3) LMHA Services.

    (A) If an LMHA admits a person to LMHA services, then the LMHA shall ensure the provision of services in the most integrated setting available.

    (B) The LMHA shall ensure the provision of LMHA services to a person ordered by a court to participate in outpatient mental health services if the court identifies the LMHA as being responsible for those services in accordance with the Texas Health and Safety Code, §574.037, or the Texas Code of Criminal Procedure, Article 46.03, §4(d)(4) or (d)(6).

    (C) The LMHA shall assign to a person receiving LMHA services a staff person who is responsible for the person's continuity of services.

  (4) Referral to alternate provider.

    (A) If a person requests to be referred to an alternate provider, then the LMHA shall make a referral to an alternate provider in accordance with the request.

    (B) If a person has third-party coverage, but the coverage will not pay for needed services because the designated LMHA does not have a provider on its network that is approved by the third-party coverage, then the designated LMHA shall take action in accordance with §412.106(c)(2) of this title (relating to Determination of Ability to Pay) of Subchapter C of this chapter (concerning Charges for Community Services).

Source Note: The provisions of this §2.151 adopted to be effective November 1, 2003, 28 TexReg 9251; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841

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