| (a) Mental health rehabilitation services are available
to a child or youth who:
(1) is a resident of the State of Texas;
(2) is a recipient of the Texas Medicaid Program; and
(3) has a diagnosis or diagnoses of mental illness
or serious emotional disturbance as defined in the latest edition
of the American Psychiatric Association's Diagnostic and Statistical
Manual of Mental Disorders, not including a single diagnosis of an
intellectual or developmental disability or a substance use disorder
and who:
(A) has been determined via the uniform assessment
process as described in §354.2607 of this subchapter (relating
to Assessment and Service Authorization) to have serious functional
impairments and is in need of mental health rehabilitation services;
(B) is at risk of disruption of a preferred living
or child-care environment due to psychiatric symptoms; or
(C) is enrolled in a school system's special education
program because of serious emotional disturbance.
(b) Mental health rehabilitation services are available
to an adult who:
(1) is a resident of the State of Texas;
(2) is a recipient of the Texas Medicaid Program;
(3) has a diagnosis or diagnoses of mental illness
as defined in the latest edition of the American Psychiatric Association's
Diagnostic and Statistical Manual of Mental Disorders, not including
a single diagnosis of an intellectual or developmental disability,
dementia, or a substance use disorder; and
(4) who has been determined via an assessment process
based on §354.2607 of this subchapter to have serious functional
impairments and is in need of mental health rehabilitation services.
(c) An individual is not eligible for Medicaid-funded
mental health rehabilitation services if the individual:
(1) is an inmate of a public institution, as defined
in 42 CFR §435.1009;
(2) is a resident of an intermediate care facility
for individuals with an intellectual disability or related conditions
as described in 42 CFR §440.150;
(3) is a resident of an IMD;
(4) is a patient of a general medical hospital; or
(5) is a resident of a nursing facility who has not
been identified through the Preadmission Screening and Resident Review
(PASSR) process as needing specialized mental health services.
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