| (a) Service Array. A comprehensive provider agency
must have the capability to deliver pharmacological management, psychiatric
diagnostic evaluation, and psychotherapy, either directly or through
subcontract(s).
(b) Pharmacological management. Pharmacological management
is the in-depth management of psychopharmacological agents to treat
a client's mental health symptoms. Pharmacological management is a
physician service and cannot be provided by a non-physician or "incident
to" a physician service, with the exception of advanced practice registered
nurses and physician assistants whose scope of license in Texas permits
them to prescribe under delegation of prescriptive authority. Supporting
documentation for pharmacological management must include:
(1) complete diagnosis using diagnostic criteria from
the latest edition of the American Psychiatric Association's Diagnostic
and Statistical Manual of Mental Disorders;
(2) current list of medications;
(3) current psychiatric symptoms and problems, to include
presenting mental status;
(4) problems, reactions, and side effects, if any,
to medications;
(5) any medication modifications made during the visit
and the reasons for medication adjustments, including the discontinuation
of a medication;
(6) desired therapeutic drug levels, if applicable,
for medications requiring blood level monitoring;
(7) current laboratory values, if applicable, for medications
requiring monitoring for potential side effects; and
(8) the individual's related treatment goals.
(c) Psychiatric diagnostic evaluation.
(1) Psychiatric diagnostic evaluations must be conducted
by:
(A) a physician;
(B) a psychologist;
(C) an advanced practice registered nurse;
(D) a physician assistant;
(E) a licensed clinical social worker;
(F) a licensed professional counselor; or
(G) a licensed marriage and family therapist.
(2) Documentation for a psychiatric diagnostic evaluation
must include:
(A) the individual's presenting problem(s);
(B) the individual's prior diagnoses and any prior
treatment;
(C) other pertinent medical, social, and family history;
(D) clinical observations and results of a mental status
examination;
(E) complete diagnosis using diagnostic criteria from
the latest edition of the American Psychiatric Association's Diagnostic
and Statistical Manual of Mental Disorders;
(F) expected long-term and short-term goals; and
(G) recommendations.
(d) Psychotherapy. Psychotherapy services may include
individual psychotherapy, group psychotherapy, or family psychotherapy.
A comprehensive provider agency is required to use evidence-based
psychotherapy modalities in accordance with the utilization management
guidelines.
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