An LMHA may only provide services if one or more of the following
conditions is present.
(1) The LMHA determines that interested, qualified
providers are not available to provide services in the LMHA's service
area or that no providers meet procurement specifications.
(2) The network of external providers does not provide
the minimum level of individual choice. A minimal level of individual
choice is present if individuals and their legally authorized representatives
can choose from two or more qualified providers.
(3) The network of external providers does not provide
individuals with access to services that is equal to or better than
the level of access in the local network, including services provided
by the LMHA, as of a date determined by the department. An LMHA relying
on this condition must submit the information necessary for the department
to verify the level of access.
(4) The combined volume of services delivered by external
providers is not sufficient to meet 100 percent of the LMHA's service
capacity for each level of care identified in the LMHA's plan.
(5) Existing agreements restrict the LMHA's ability
to contract with external providers for specific services during the
two-year period covered by the LMHA's plan. If the LMHA relies on
this condition, the department shall require the LMHA to submit copies
of relevant agreements.
(6) The LMHA documents that it is necessary for the
LMHA to provide specified services during the two-year period covered
by the LMHA's plan to preserve critical infrastructure needed to ensure
continuous provision of services. An LMHA relying on this condition
must:
(A) document that it has evaluated a range of other
measures to ensure continuous delivery of services, including but
not limited to those identified by the LANAC and the department at
the beginning of each planning cycle;
(B) document implementation of appropriate other measures;
(C) identify a timeframe for transitioning to an external
provider network, during which the LMHA shall procure an increasing
proportion of the service capacity from external provider in successive
procurement cycles; and
(D) give up its role as a service provider at the end
of the transition period if the network has multiple external providers
and the LMHA determines that external providers are willing and able
to provide sufficient added service volume within a reasonable period
of time to compensate for service volume lost should any one of the
external provider contracts be terminated.
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| Source Note: The provisions of this §301.259 adopted to be effective January 1, 2015, 39 TexReg 10478; transferred effective March 15, 2020, as published in the February 21, 2020 issue of the Texas Register, 45 TexReg 1237 |
