26 TAC Ch. 306

Behavioral Health Delivery System

This subchapter establishes standards for local mental health authorities (LMHAs), managed care organizations (MCOs), state mental health facilities (SMHFs), and certain Medicaid providers to ensure effective, coordinated services for individuals with co-occurring psychiatric and substance use disorders (COPSD). Covered entities must provide integrated assessments, develop individualized treatment plans, ensure staff meet defined specialty competencies, and implement quality management systems. Access to services may not be denied based on diagnosis history, medications, or prior treatment outcomes. The rule governs service delivery standards and organizational responsibilities rather than licensing a specific facility type.

§306.1 Purpose
The purpose of this subchapter is to improve existing mental health services provided by the entities defined in §411.653 of this title (relating to Definitions) by establishing standards to ensure the effective and coordinated provision of services to individuals who require specialized support or treatment due to co-occurring psychiatric and substance use disorders (COPSD).
Source Note: The provisions of this §306.1 adopted to be effective September 7, 2003, 28 TexReg 7396; amended to be effective November 17, 2011, 36 TexReg 7669; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 467.

§306.3 Application
(a) The provisions of this subchapter apply to entities defined in §411.653 of this title (relating to Definitions).

(b) The provisions of this subchapter are in addition to requirements contained in other DSHS rules. This subchapter does not supercede other DSHS rules that may also apply to the provision of services to individuals as defined in §411.653 of this title.
Source Note: The provisions of this §306.3 adopted to be effective September 7, 2003, 28 TexReg 7396; amended to be effective November 17, 2011, 36 TexReg 7669; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 467.

§306.5 Definitions
The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise.

(1) Access--An individual's ability to obtain the psychiatric and substance use disorder services needed.

(2) Adolescent--A person who is 13 through 17 years of age.

(3) Adult--A person who is 18 years of age or older.

(4) Child--A person who is 3 through 12 years of age.

(5) Contract--A legally enforceable written agreement for the purchase of services.

(6) Co-occurring psychiatric and substance use disorders (COPSD)--The co-occurring diagnoses of psychiatric disorders and substance use disorders.

(7) Diagnostic and Statistical Manual of Mental Disorders (DSM)--The most recent edition of the American Psychiatric Association's official classification of mental disorders.

(8) Entity or entities--The terms used to refer to the following:

(A) local mental health authorities (LMHAs);

(B) Managed care organizations (MCOs);

(C) state mental health facilities (SMHF); and

(D) Medicaid providers who are required to comply with Chapter 419, Subchapter L of this title, governing Mental Health Rehabilitative Services, or Chapter 412, Subchapter I of this title, governing Mental Health Case Management Services.

(9) Family member--Anyone an individual identifies as being involved in the individual's life (e.g., the individual's parent, spouse, child, sibling, significant other, or friend).

(10) Individual--

(A) For an LMHA--An adult with COPSD, adolescent with COPSD, or child with COPSD seeking or receiving services from or through the LMHA or its provider.

(B) For an MCO--An enrolled adult with COPSD, adolescent with COPSD, or child with COPSD seeking or receiving services from or through the MCO or its provider.

(C) For an SMHF--An adult with COPSD, adolescent with COPSD, or child with COPSD seeking or receiving services from or through the SMHF or its provider.

(D) For a provider of rehabilitative services or a provider of mental health case management services reimbursed by Medicaid--An adult with COPSD, adolescent with COPSD, or child with COPSD seeking or receiving rehabilitative services or mental health case management services reimbursed by Medicaid.

(11) Integrated assessment--An assessment of an individual to gather both substance use and psychiatric information.

(12) Legally authorized representative (LAR)--A person authorized by law to act on behalf of an individual with regard to a matter (e.g., a parent, guardian, or managing conservator of a child or adolescent, a guardian of an adult, or a personal representative of a deceased individual).

(13) Local mental health authority (LMHA)--An entity designated as the local mental health authority by the DSHS in accordance with the Health and Safety Code, §533.035(a).

(14) Managed care organization (MCO)--An entity that has a current Department of Insurance certificate of authority to operate as a health maintenance organization (HMO) under Insurance Code, Subchapter C of Chapter 843, or as an approved nonprofit health corporation under Insurance Code, Chapter 884.

(15) Psychiatric disorder--An emotional disturbance in a child or adolescent or a psychiatric disorder in an adult who is a member of the mental health priority population as defined in the Health and Human Services System Strategic Plan 2011 - 2015.

(16) Readiness to change--An individual's emotional and cognitive awareness of the need to change, coupled with a commitment to change.

(17) Services--Services provided to treat a psychiatric or substance use disorder.

(18) Staff--Full- or part-time employees, contractors, and interns of an entity.

(19) Substance use disorder--The use of one or more drugs, including alcohol, which significantly and negatively impacts one or more major areas of life functioning and which meets criteria described in the current Diagnostic and Statistical Manual of Mental Disorders for substance abuse or substance dependence.

(20) Support services--Services delivered to an individual, legally authorized representative (LAR) or family member(s) to assist the individual in functioning in the living, learning, working, and socializing environments.

(21) Treatment plan--A written document developed by the provider, in consultation with the individual (and LAR on the individual's behalf), that is based on assessments of the individual and which addresses the individual's strengths, needs, goals, and preferences regarding service delivery as referenced in §412.322 of this title (relating to Provider Responsibilities for Treatment Planning and Service Authorization) of Chapter 412, Subchapter G of this title, governing Mental Health Community Services Standards.
Source Note: The provisions of this §306.5 adopted to be effective September 7, 2003, 28 TexReg 7396; amended to be effective November 17, 2011, 36 TexReg 7669; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 467.

§306.7 Services to Individuals with COPSD
(a) Entities, entities' contracted providers, and each of their respective staff providing service to an individual with COPSD shall ensure that services are provided in compliance with applicable licensure, scope of practice and other law and:

(1) address both psychiatric and substance use disorders;

(2) are provided within established practice guidelines for this population; and

(3) facilitate individuals or LARs in accessing available services they need and choose, including self-help groups.

(b) The services provided to an individual with COPSD shall comply with applicable licensure, scope of practice and other law and be provided:

(1) by staff who are competent in the areas identified in §411.658 of this title (relating to Specialty Competencies of Staff Providing Services to Individuals with COPSD);

(2) in an individual or small group setting;

(3) in an age, gender, and culturally appropriate manner; and

(4) in accordance with the individual's treatment plan.
Source Note: The provisions of this §306.7 adopted to be effective September 7, 2003, 28 TexReg 7396; amended to be effective November 17, 2011, 36 TexReg 7669; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 467.

§306.9 Responsibility for Compliance
(a) Entities must comply with this subchapter.

(b) Entities that are LMHAs, MCOs, or SMHFs must require providers, by contract, to comply with §411.654 of this title (relating to Services to Individuals with COPSD), §411.657 of this title (relating to Access to Services), §411.658 of this title (relating to Specialty Competencies of Staff Providing Services to Individuals with COPSD), and §411.660 of this title (relating to Screening, Assessment, and Treatment Planning).

(c) Entities must monitor staff and contract providers who provide services to an individual with COPSD for compliance with the applicable provisions of §§411.657 - 411.660 of this title.

(d) An entity that is an MCO must comply and must require staff to comply with Chapter 404, Subchapter E of this title, governing Rights of Persons Receiving Mental Health Services.
Source Note: The provisions of this §306.9 adopted to be effective September 7, 2003, 28 TexReg 7396; amended to be effective November 17, 2011, 36 TexReg 7669; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 467.

§306.11 DSHS Responsibilities
(a) DSHS must make available training resources for the competencies identified in §411.658 of this title (relating to Specialty Competencies of Staff Providing Services to Individuals with COPSD).

(b) DSHS must require LMHAs and SMHFs to develop quality management systems that ensure an appropriate integrated assessment for each individual and the appropriate delivery of services.
Source Note: The provisions of this §306.11 adopted to be effective September 7, 2003, 28 TexReg 7396; amended to be effective November 17, 2011, 36 TexReg 7669; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 467.

§306.13 Access to Services
(a) In determining an individual's initial and ongoing eligibility for any service, an entity may not exclude an individual based on the following factors:

(1) the individual's past or present mental illness or substance use diagnosis or services;

(2) medications prescribed to the individual in the past or present;

(3) the presumption of the individual's inability to benefit from treatment;

(4) the specific substance used by the individual;

(5) the individual's continued substance use; or

(6) the individual's level of success in prior treatment episodes.

(b) Entities must ensure that an individual's refusal of a particular service does not preclude the individual from accessing other needed mental health or substance abuse services.

(c) The LMHAs, MCOs, and SMHFs must ensure that individuals have access to staff who meet specialty competencies described in §411.658 of this title (relating to Specialty Competencies of Staff Providing Services to Individuals with COPSD).

(d) Entities must establish and implement procedures to ensure the continuity of screening, assessment, and treatment services provided to individuals.
Source Note: The provisions of this §306.13 adopted to be effective September 7, 2003, 28 TexReg 7396; amended to be effective November 17, 2011, 36 TexReg 7669; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 467.

§306.15 Specialty Competencies of Staff Providing Services to Individuals with COPSD
(a) Entities must ensure that services to individuals are age and culturally appropriate and are provided by staff within their scope of practice who have the following minimum knowledge, technical, and interpersonal competencies prior to providing services.

(1) Knowledge competencies:

(A) knowledge of the fact that psychiatric and substance use disorders are potentially recurrent relapsing disorders, and that although abstinence is the goal, relapses can be opportunities for learning and growth;

(B) knowledge of the impact of substance use disorders on developmental, social, and physical growth and development of children and adolescents;

(C) knowledge of interpersonal and family dynamics and their impact on individuals;

(D) knowledge of the current Diagnostic and Statistical Manual of Mental Disorders diagnostic criteria for psychiatric disorders and substance use disorders and the relationship between psychiatric disorders and substance use disorders;

(E) knowledge regarding the increased risks of self-harm, suicide, and violence in individuals;

(F) knowledge of the elements of an integrated treatment plan and community support plan for individuals;

(G) basic knowledge of pharmacology as it relates to individuals;

(H) basic understanding of the neurophysiology of addiction;

(I) basic knowledge of withdrawal symptoms and their potential risk factors to clients;

(J) knowledge of the phases of recovery for individuals;

(K) knowledge of the relationship between COPSD and Axis III disorders; and

(L) basic knowledge of self-help in recovery.

(2) Technical competencies:

(A) ability to perform age-appropriate assessments of individuals; and

(B) ability to formulate an individualized treatment plan and community support plan for individuals.

(3) Interpersonal competencies:

(A) ability to tailor interventions to the process of recovery for individuals;

(B) ability to tailor interventions with readiness to change; and

(C) ability to support individuals who choose to participate in 12-step recovery programs.

(b) Within 90 days of the effective date of this subchapter, entities must ensure that staff who provide services to individuals with COPSD, and who have not previously done so, have demonstrated the competencies described in subsection (a) of this section. These competencies may be evidenced by compliance with current licensure requirements of the governing or supervisory boards for the respective disciplines involved in serving individuals with COPSD or by documentation regarding the attainment of the competencies described in subsection (a) of this section. For unlicensed staff delivering these services, these competencies are evidenced by documentation regarding their attainment as required in subsection (a) of this section.
Source Note: The provisions of this §306.15 adopted to be effective September 7, 2003, 28 TexReg 7396; amended to be effective November 17, 2011, 36 TexReg 7669; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 467.

§306.17 Quality Management
(a) The LMHAs and MCOs must develop and implement a plan for quality management of services to individuals with COPSD as required in §412.317 (relating to Quality Management) of Chapter 412, Subchapter G of this title, governing Mental Health Community Services Standards.

(b) The SMHFs must develop and implement a plan for quality management of services to individuals. The plan must be incorporated into the Improving Organizational Performance System (IOPS) and must identify clinical measures. The plan must describe the following:

(1) activities for measuring, assessing, and improving processes for delivering services in accordance with this subchapter; and

(2) methods for evaluating and improving outcomes for individuals receiving services.
Source Note: The provisions of this §306.17 adopted to be effective September 7, 2003, 28 TexReg 7396; amended to be effective November 17, 2011, 36 TexReg 7669; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 467.

§306.19 Screening, Assessment, and Treatment Planning
(a) Screening and assessment. When a screening determines an assessment is necessary, an integrated assessment must be conducted to consider relevant past and current medical, psychiatric, and substance use information, including:

(1) information from the individual (and LAR on the individual's behalf) regarding the individual's strengths, needs, natural supports, responsiveness to previous treatment, as well as preferences for and objections to specific treatments;

(2) the needs and desire of the individual for family member involvement in treatment and services if the individual is an adult without an LAR; and

(3) recommendations and conclusions regarding treatment needs and eligibility for services for individuals.

(b) Treatment plan development.

(1) The individual (and LAR on the individual's behalf, if applicable) must be involved in all aspects of planning the individual's treatment. If the individual has requested the involvement of a family member, then the provider must attempt to involve the family member in all aspects of planning the individual's treatment.

(2) The treatment plan must identify services to be provided and must include measurable outcomes that address COPSD.

(3) The treatment plan must identify the LAR's or family members' need for education and support services related to the individual's mental illness and substance abuse and a method to facilitate the LAR's or family members' receipt of the needed education and support services.

(4) The individual, LAR, and, if requested, family member, must be given a copy of the treatment plan.

(c) Treatment plan review. Each individual's treatment plan must be reviewed in accordance with DSHS-defined timeframes and the review must be documented.

(d) Progress notes. The medical record notes must contain a description of the individual's progress towards goals identified in the treatment plan, as well as other clinically significant activities or events.

(e) Episode of care summary. Upon discharge or transfer of an individual from one entity to another, the individual's medical record must identify the services provided according to this subchapter and the items referenced in §412.322 (relating to Provider Responsibilities for Treatment Planning and Service Authorization) of Chapter 412, Subchapter G of this title, governing Mental Health Community Services Standards.
Source Note: The provisions of this §306.19 adopted to be effective September 7, 2003, 28 TexReg 7396; amended to be effective November 17, 2011, 36 TexReg 7669; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 467.

§306.101 Purpose
This subchapter explains the process and requirements for an applicant to be certified as a Texas Certified Community Behavioral Health Clinic by the Texas Health and Human Services Commission.
Source Note: The provisions of this §306.101 adopted to be effective September 29, 2022, 47 TexReg 6198; amended to be effective April 16, 2026, 51 TexReg 2396.

§306.103 Application
This subchapter applies to an applicant and a Texas Certified Community Behavioral Health Clinic as these terms are defined in §306.105 of this subchapter (relating to Definitions).
Source Note: The provisions of this §306.103 adopted to be effective September 29, 2022, 47 TexReg 6198; amended to be effective April 16, 2026, 51 TexReg 2396.

§306.105 Definitions
The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise.

(1) Applicant--An entity applying or reapplying for certification as a Texas Certified Community Behavioral Health Clinic (T-CCBHC).

(2) Application--A form that an applicant submits to the Texas Health and Human Services Commission to apply for or renew the applicant's certification as a T-CCBHC.

(3) Community needs assessment--A method to identify the needs of the community and to describe how the applicant can meet those needs. This assessment is objective and includes feedback from people receiving services, program staff, and other key community members.

(4) Crisis stabilization--Services to address a mental health or substance use crisis.

(5) Family-centered--A way to plan, deliver, and evaluate services that involves participation between families, caregivers, and professionals.

(6) Governmental entity--A state agency or a political subdivision of Texas, such as a city, county, hospital district, hospital authority, or state entity.

(7) HHSC--The Texas Health and Human Services Commission or its designee.

(8) LBHA--Local behavioral health authority. An entity designated by HHSC under Texas Health and Safety Code §533.0356(a) as the local behavioral health authority.

(9) LMHA--Local mental health authority. An entity designated by HHSC under Texas Health and Safety Code §533.035(a) as the local mental health authority.

(10) Outpatient mental health treatment services--Mental health services a T-CCBHC directly provides to adults and youth consisting of:

(A) pharmacological management;

(B) individual counseling or psychotherapy;

(C) group counseling or psychotherapy; and

(D) family counseling or psychotherapy.

(11) Outpatient substance use treatment services--Substance use treatment services a T-CCBHC directly provides to adults and youth consisting of:

(A) individual substance use counseling;

(B) group substance use counseling; and

(C) substance use education services.

(12) Person--An individual receiving services under this subchapter.

(13) Person-centered--Approaches that focus on a person's strengths and personal goals giving the person the chance to improve their quality of life, make choices, and have control. This method helps a person explore the person's preferences, needs, and wants while addressing medical and non-medical needs to support the person in reaching the person's full potential.

(14) T-CCBHC--Texas Certified Community Behavioral Health Clinic. An entity HHSC certifies under this subchapter.
Source Note: The provisions of this §306.105 adopted to be effective September 29, 2022, 47 TexReg 6198; amended to be effective April 16, 2026, 51 TexReg 2396.

§306.107 Certification Eligibility
An applicant must meet the criteria in this section for certification.

(1) Staffing requirements.

(A) Staffing plans must reflect the findings of the applicant's community needs assessment.

(B) The applicant's staff members must have and be current with all necessary licenses and accreditations required by the state to provide the required services.

(C) Staff members must be trained to serve the needs of the clinic's patients as identified through the community needs assessment and in compliance with Section 223(a)(2)(A) of the Protecting Access to Medicare Act of 2014.

(D) Staff must be trained in a person-centered and family-centered approach.

(2) Availability and accessibility of services.

(A) An applicant may not refuse or limit services if a person cannot pay for the services.

(B) An applicant may not refuse or limit services to any person in the local service area based on where the person lives, the person's housing situation, or if the person does not have a permanent address. An applicant may coordinate care and transfer services to an appropriate provider for a person who lives outside the applicant's local service area.

(3) Care coordination.

(A) An applicant must coordinate care across settings and providers to make sure that transitions are seamless for a person receiving health services.

(B) A T-CCBHC must have:

(i) a health information technology system that includes an electronic health record; and

(ii) a plan focusing on ways to improve care coordination using health information technology.

(4) Scope of services.

(A) An applicant must directly provide the following services:

(i) crisis services, including:

(I) 24-hour mobile crisis outreach services, except as required under subparagraph (C) of this paragraph;

(II) crisis intervention services; and

(III) crisis stabilization services;

(ii) mental health and substance use screening, assessment, and diagnosis, including risk assessment for possible harm to self or others;

(iii) person-centered treatment planning, and family-centered treatment planning, when appropriate; and

(iv) outpatient mental health treatment services and outpatient substance use treatment services.

(B) An applicant must provide the following services either directly or by agreement with another entity:

(i) outpatient primary care screening and monitoring of health indicators and health risks;

(ii) mental health targeted case management as defined in 1 TAC §353.1403 (relating to Definitions);

(iii) mental health rehabilitative services as defined in 1 TAC §353.1403;

(iv) peer specialist services, as defined in 1 TAC §354.3013 (relating to Services Provided), and family partner supports; and

(v) community-based mental health and substance use care for members of the armed forces and veterans.

(C) A T-CCBHC that is not an LMHA or LBHA must make an agreement with an LMHA or LBHA in the applicant's local service area to provide mobile crisis outreach services. This agreement must include shared protocols for coordination. HHSC may grant permission for a T-CCBHC to provide mobile crisis outreach services directly if the T-CCBHC has a dedicated, long-term funding source that is not time limited, and a government entity oversees the mobile crisis outreach services.

(5) Quality and other reporting.

(A) A T-CCBHC must report encounter data, clinical outcomes data, quality data, and other data that HHSC may request.

(B) A T-CCBHC must have health information technology systems that allow reporting on data and quality measures.

(6) Organizational authority.

(A) An applicant must be:

(i) a non-profit or governmental entity;

(ii) an entity operated under the authority of the Indian Health Service, an Indian tribe, or tribal organization, pursuant to a contract, grant, cooperative agreement, or compact with the Indian Health Service pursuant to the Indian Self-Determination Act and Education Act (25 U.S.C 5301, et seq.); or

(iii) an urban Indian organization pursuant to a grant or contract with the Indian Health Service under title V of the Indian Health Care Improvement Act (25 U.S.C 1601, et seq.).

(B) An applicant must operate as an entity listed under subparagraph (A) of this paragraph for at least two years in Texas before applying for T-CCBHC certification.

(C) An applicant's T-CCBHC must have a governing board.

(i) The governing board must:

(I) have at least 51 percent of its members be people with lived experience of a mental health or substance use need or family members of people receiving behavioral health services; or

(II) create an advisory committee that meets the requirements of subclause (I) of this clause that gives feedback to the governing board about the T-CCBHC's:

(-a-) community needs;

(-b-) goals and objectives;

(-c-) service development;

(-d-) quality improvement and activities;

(-e-) fiscal and budgetary priorities; and

(-f-) governance.

(ii) The governing board must consider feedback provided by an advisory committee described in clause (i)(II) of this subparagraph in its decision-making processes.

(D) An applicant must:

(i) be enrolled as a Medicaid provider;

(ii) be credentialed and contracted with at least one managed care organization; and

(iii) have a Chemical Dependency Treatment Facility license under Chapter 564 of this title (relating to Chemical Dependency Treatment Facilities) to deliver adult and youth outpatient substance use treatment.
Source Note: The provisions of this §306.107 adopted to be effective September 29, 2022, 47 TexReg 6198; amended to be effective April 16, 2026, 51 TexReg 2396.

§306.109 Application Process
To be considered for certification or recertification, an applicant must fill out and submit a complete application by using the application and instructions on the HHSC website.

(1) HHSC reviews an application based on the certification eligibility requirements in §306.107 of this subchapter (relating to Certification Eligibility) and may deny an application for certification for good cause, including if:

(A) the application is missing any required information;

(B) the applicant did not submit the application following HHSC's application instructions or published notice;

(C) the application has false information;

(D) HHSC, any other agency in Texas or in another state, or federal agency has terminated the applicant's contract, license, or certification for cause within the four years before the date the applicant submitted the application;

(E) the applicant is excluded or debarred from contracting with the State of Texas or the federal government;

(F) the applicant has an outstanding Medicaid program audit exception or other unresolved financial liability owed to the State of Texas; or

(G) the applicant terminated a provider agreement in a "federal health care program," as defined in 42 U.S.C §1320a-7b(f), while an adverse action or sanction was in effect.

(2) HHSC gives priority to reviewing and approving applications from LMHAs and LBHAs when appropriate.

(3) If an applicant does not meet all eligibility requirements listed on the application, HHSC considers the applicant ineligible and denies the application. The applicant can apply again by submitting a new application to HHSC after the date HHSC denies the application.

(4) If an applicant meets all eligibility requirements listed on the application, the applicant must submit supporting documentation and participate in interviews, as requested by HHSC, to confirm the applicant meets each certification criterion in §306.107 of this subchapter.

(5) The applicant must submit the information to HHSC within a timeframe agreed on by the applicant and HHSC. The timeframe agreed on may not be more than 60 calendar days after the date HHSC requests the information.
Source Note: The provisions of this §306.109 adopted to be effective September 29, 2022, 47 TexReg 6198; amended to be effective April 16, 2026, 51 TexReg 2396.

§306.111 Certification Standards
(a) To keep certification, a T-CCBHC must work with other T-CCBHCs in the same geographic service area to make sure they do not duplicate services for people who receive services from more than one T-CCBHC.

(b) A T-CCBHC must keep all required licenses during the certification period. If any required licenses are revoked and a T-CCBHC is unable to operate in Texas, the certification will be void.

(c) T-CCBHC certification is approved for four years, subject to the limits outlined in §306.109(1) of this subchapter (relating to Application Process).

(d) A T-CCBHC may reapply for certification if eligible as outlined in §306.109 of this subchapter.

(e) To prevent a gap in certification, a T-CCBHC must submit an application, as defined in §306.105(2) of this subchapter (relating to Definitions), to be considered for recertification. A T-CCBHC must submit an application between 180 calendar days and 60 calendar days before the date the current certification expires.
Source Note: The provisions of this §306.111 adopted to be effective September 29, 2022, 47 TexReg 6198; amended to be effective April 16, 2026, 51 TexReg 2396.

§306.251 Purpose
The subchapter describes requirements for providing mental health case management services (MH case management services) funded by or through the department.
Source Note: The provisions of this §306.251 adopted to be effective February 14, 2013, 38 TexReg 647; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 469.

§306.253 Application
The subchapter applies to providers of MH case management services.
Source Note: The provisions of this §306.253 adopted to be effective February 14, 2013, 38 TexReg 647; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 469.

§306.255 Definitions
The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:

(1) Adolescent--An individual who is at least 13 years of age, but younger than 18 years of age.

(2) Adult--An individual who is 18 years of age or older.

(3) Assessment or reassessment--A systematic process for determining an individual's need for any clinically necessary medical, educational, social, or other services (e.g., taking client history, gathering information from other sources, identifying the needs of the individual, and completing related documentation).

(4) Business day--Any day except a Saturday, Sunday, or legal holiday listed in the Texas Government Code, §662.021.

(5) Case manager--An employee who provides MH case management services.

(6) Child--An individual who is at least three years of age, but younger than 13 years of age.

(7) CFR--Code of Federal Regulations.

(8) Community based--A description of the location where routine or intensive case management services are provided (i.e., in an individual's community).

(9) Community mental health center or CMHC--An entity established in accordance with the Texas Health and Safety Code, §534.001, as a community mental health center or a community mental health and mental retardation center.

(10) Community resources--People or entities providing services that address the identified needs of individuals receiving MH case management services (e.g., providers of medical care, food, clothing, child care, employment, or housing).

(11) Community services specialist or CSSP--A staff member who, as of August 31, 2004:

(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; and

(B) has had three continuous years of documented full-time experience in the provision of MH case management services; and

(C) has demonstrated competency in the provision and documentation of MH case management services in accordance with this subchapter and the MH Case Management Billing Guidelines.

(12) Crisis--A situation in which:

(A) the individual presents an immediate danger to self or others;

(B) the individual's mental or physical health is at risk of serious deterioration; or

(C) an individual believes that he or she presents an immediate danger to self or others or that his or her mental or physical health is at risk of serious deterioration.

(13) Day--A calendar day, unless otherwise specified.

(14) Department--Department of State Health Services (DSHS).

(15) Designee--A person or entity named by the department to act on its behalf.

(16) Dual relationship--A situation that occurs if a case manager interacts with an individual in more than one capacity, whether it be before, during, or after the professional, social, or business relationship. Dual relationships can occur simultaneously or consecutively.

(17) Employee--A person who receives a W2 Wage and Tax Statement from a provider.

(18) Individual--A person seeking or receiving MH case management services.

(19) Institution for mental diseases or IMD--Based on 42 CFR §435.1009, a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing psychiatric diagnosis, treatment, or care of individuals with mental illness, including medical attention, nursing care, and related services.

(20) Intensive case management--A focused effort to coordinate community resources that assist a child or adolescent in gaining access to necessary care and services appropriate to the child's or adolescent's needs. The standards for providing intensive case management services are set forth in §412.407 of this title (relating to MH Case Management Services Standards).

(21) Intensive case management plan or plan--A written document that is part of the medical record and is developed by a case manager, in collaboration with the individual and the individual's LAR or primary caregiver, that identifies services needed by the individual and sets forth a plan for how the individual may gain access to the identified services.

(22) Legally authorized representative or LAR--A person authorized by law to act on behalf of an individual with regard to a matter described in this subchapter, including, but not limited to, a parent, guardian, or managing conservator.

(23) Level of care or LOC--A designation given to the department's standardized packages of mental health services, based on the uniform assessment and the utilization management guidelines, which specify the type, amount, and duration of MH case management services to be provided to an individual.

(24) Life domains--Areas of life in which a child or adolescent has unmet needs, including, but not limited to safety, health, emotional, psychological, social, educational, cultural, and legal needs.

(25) Local Behavioral Health Authority (LBHA)--An entity designated as the local behavioral health authority in accordance with Texas Health and Safety Code, §533.0356.

(26) Medically necessary--A clinical determination made by an LPHA that services:

(A) are reasonable and necessary for the treatment of a mental health disorder or to improve, maintain, or prevent deterioration of functioning resulting from such a disorder;

(B) are provided in accordance with accepted standards of practice in behavioral health care;

(C) are furnished in the most appropriate and least restrictive setting in which services can be safely provided;

(D) are at the most appropriate level or amount of service that can be safely provided; and

(E) could not have been omitted without adversely affecting the individual's mental and/or physical health or the quality of care rendered.

(27) Mental health (MH) case management services--Activities that assist an individual in gaining and coordinating access to necessary care and services appropriate to the individual's needs. Case management activities include assessment, recovery planning, referral and linkage, and monitoring and follow up. Activities may be provided as routine case management or intensive case management.

(28) Monitoring and follow-up--Activities and contacts that are necessary to ensure that referrals and linkages are effectively implemented and adequately addressing the needs of the individual. The activities and contacts may be with the individual, LAR, primary caregiver, family members, providers, or other people and entities to determine whether services are being furnished, the adequacy of those services, and changes in the needs or status of the individual.

(29) Primary caregiver--A person 18 years of age or older who:

(A) has actual care, control, and possession of a child or adolescent; or

(B) has assumed responsibility for providing shelter and care for an adult.

(30) Provider--An entity that is:

(A) a community mental health center that has a contract with the department to provide general revenue-funded MH case management services, Medicaid-funded MH case management services, or both;

(B) a Local Behavioral Health Authority (LBHA) that has a contract with the department to provide general revenue-funded MH case management services, or a subcontractor of a LBHA.

(31) Qualified mental health professional-community services or QMHP-CS--A staff member who meets the definition of a QMHP-CS set forth in Subchapter G of this chapter (relating to Mental Health Community Services Standards).

(32) Recovery--A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.

(33) Recovery plan or treatment plan--A written plan developed with the individual and, as required, the LAR and a QMHP-CS that specifies the individual's recovery goals, objectives, and strategies/interventions in conjunction with the uniform assessment that guides the recovery process and fosters resiliency as further described in §412.322(e) of this title (relating to Provider Responsibilities for Treatment Planning and Service Authorization) concerning content and timeframe of treatment plan.

(34) Recovery planning--A systematic process for ensuring the individual's active participation and allowing the LAR, and the primary caregiver and others to develop goals and identify a course of action to respond to the clinically assessed needs. The assessed needs may address medical, social, educational, and other services needed by the individual.

(35) Referral and linkage--Activities that help link an individual with medical, social, and educational providers, and with other programs and services that are capable of providing needed services (e.g., referrals to providers for needed services and scheduling appointments).

(36) Routine case management--Services that assist an individual in gaining and coordinating access to necessary care and services appropriate to the individual's needs. The standards for providing routine case management services are set forth in §412.407 of this title.

(37) Site based--The location where routine case management services are usually provided (i.e., the case manager's place of business).

(38) Staff member--Provider personnel, including a full-time and part-time employee, contractor, or intern, but excluding a volunteer.

(39) Strengths based--The concept used in service delivery that identifies, builds on, and enhances the capabilities, knowledge, skills, and assets of the child, adolescent, LAR, or primary caregiver, and family, their community, and other team members. The focus is on increasing functional strengths and assets rather than on the elimination of deficits.

(40) TAC--Texas Administrative Code.

(41) Uniform assessment--An assessment adopted by the department that is used for recommending an appropriate level of care (LOC).

(42) Utilization management guidelines--Guidelines developed by the department that establish the type, amount, and duration of MH case management services for each LOC.

(43) Wraparound process planning or other department-approved model--A strengths-based course of action involving a child or an adolescent and family, including any additional people identified by the child or adolescent, LAR, primary caregiver, and family, that results in a unique set of community services and natural supports that are individualized for the child or adolescent to achieve a positive set of identified outcomes.
Source Note: The provisions of this §306.255 adopted to be effective February 14, 2013, 38 TexReg 647; amended to be effective March 27, 2017, 42 TexReg 1458; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 469.

§306.257 Provider Requirements
(a) The provider must comply with Subchapter G of this chapter (relating to Mental Health Community Services Standards).

(b) The provider must assign a case manager to an individual within two business days after receiving notification from the department or its designee that the individual has been authorized to receive MH case management services.

(c) The provider must ensure that an alternate case manager acts as the individual's assigned case manager if an individual's assigned case manager is not available.

(d) The provider must maintain case manager-to-individual ratios sufficient to perform the responsibilities of a case manager in accordance with this subchapter.

(e) The provider is responsible for a case manager's compliance with this subchapter.
Source Note: The provisions of this §306.257 adopted to be effective February 14, 2013, 38 TexReg 647; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 469.

§306.259 Eligibility for MH Case Management Services
For an individual to be eligible for MH case management services, the individual must:

(1) be a resident of the State of Texas;

(2) be an adult with a severe and persistent mental illness, or a child or adolescent with a serious emotional disturbance who may have a diagnosis described in paragraph (3) of this section;

(3) not have a single diagnosis of an intellectual or developmental disability or a substance use disorder; and

(4) qualify for an LOC that includes MH case management services.
Source Note: The provisions of this §306.259 adopted to be effective February 14, 2013, 38 TexReg 647; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 469.

§306.261 Authorization for MH Case Management Services
(a) A provider must:

(1) ensure that a QMHP-CS administers the uniform assessment to the individual at intervals specified by the department and obtain a recommended LOC for the individual;

(2) evaluate the clinical needs of the individual to determine if the amount of MH case management services associated with the recommended LOC described in the utilization management guidelines is sufficient to meet those needs; and

(3) ensure that an LPHA reviews the recommended LOC and verifies whether the services are medically necessary.

(b) If the provider determines that the type of MH case management services associated with the recommended LOC is sufficient to meet the individual's needs, the provider must submit to the department or its designee a request for service authorization according to the recommended LOC.

(c) If the provider determines that the type of MH case management services associated with the recommended LOC is not sufficient to meet the individual's needs, the provider must submit to the department or its designee:

(1) a request for an authorization of an LOC that is sufficient to meet the individual's need or a request for authorization of additional units of service; and

(2) the clinical justification for the request.

(d) The department or its designee makes the initial determination of an individual's LOC using the uniform assessment which is referenced in §412.416 of this title (relating to Guidelines) and the utilization management guidelines, which are referenced in §412.416 of this title. If the LOC includes MH case management services, the department or its designee will authorize the individual to receive either routine or intensive case management services.

(e) Upon receipt of a request submitted according to subsection (c) or (d) of this section, the department or its designee will:

(1) review the documentation submitted by the provider;

(2) based on the review of documentation and an evaluation of available resources, authorize or deny an LOC for the individual, and if authorized, it authorizes the individual to receive either routine or intensive MH case management services; and

(3) communicate to the individual or LAR, no longer than seven business days after the determination has been made, whether the service has been authorized or denied.
Source Note: The provisions of this §306.261 adopted to be effective February 14, 2013, 38 TexReg 647; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 469.

§306.263 MH Case Management Services Standards
(a) Assessment. An individual is assessed according to §412.406 of this title (relating to Authorization for MH Case Management Services) to determine the LOC necessary to address the individual's needs. If the individual needs either routine or intensive case management the provider must assign a case manager according to §412.404(b) of this title (relating to Provider Requirements). MH case management services, as well as attempts to provide case management, must be documented according to §412.413 of this title (relating to Documenting MH Case Management Services).

(1) MH case management services must:

(A) be delivered according to the department's utilization management guidelines, which are described in §412.415 of this title (relating to Fair Hearings and Appeal Processes); and

(B) include regular, but at least annual, monitoring of service effectiveness and proactive crisis planning and management.

(2) Case managers must recognize that:

(A) an LAR as authorized by law may act on behalf of an individual in matters such as accepting or declining services; and

(B) a primary caregiver who is not the individual's LAR is included in recovery planning and discussions that relate to the individual if written permission is obtained from the individual or LAR.

(b) Routine case management. Routine case management is provided to eligible adults, children, or adolescents and is primarily a site-based service. A case manager assigned to an individual who is authorized to receive routine case management services must:

(1) meet face-to-face with the individual and the individual's LAR or primary caregiver within 14 days after the case manager is assigned to the individual or document why the meeting did not occur;

(2) assist the individual in identifying the individual's immediate needs and in determining access to community resources that may address those needs;

(3) identify the strengths, service needs, and assistance required to address the identified needs;

(4) identify the goals and actions required to meet the individual's identified needs;

(5) specify the goals and actions to be accomplished;

(6) develop a timeline for obtaining the needed services;

(7) take the steps that are necessary to accomplish the goals required to meet the individual's identified needs by using referral, linking, advocacy, and monitoring;

(8) meet face-to-face with the individual upon the individual's, the LAR's, or the primary caregiver's request, or document why the meeting did not occur;

(9) reassess the individual's needs at least annually or as changes occur;

(10) meet face-to-face with the LAR, with or without the child or adolescent being present, to provide a service that assists the child or adolescent in gaining and coordinating access to necessary care and services;

(11) meet face-to-face with the individual and the LAR or primary caregiver upon notification of a clinically significant change in the individual's functioning, life status, or service needs, or document why the meeting did not occur;

(12) if notified that the individual is in crisis, coordinate with the appropriate providers of emergency services to respond to the crisis, as described in Chapter 412, Subchapter G, specifically §412.321 of this title (relating to Crisis Services); and

(13) develop a timeline for reevaluating the individual's needs.

(c) Intensive case management. Intensive case management is provided to eligible children and adolescents and is primarily community-based. A case manager assigned to a child or adolescent who is authorized to receive intensive case management services must:

(1) develop an intensive case management plan (plan) based on the child's or adolescent's needs that may include information across life domains from relevant sources, including:

(A) the child or adolescent;

(B) the LAR or primary caregiver;

(C) other agencies and organizations providing services to the child or adolescent;

(D) the individual's medical record; and

(E) other sources identified by the individual, LAR, or primary caregiver;

(2) meet face-to-face with the child or adolescent and the LAR or primary caregiver:

(A) within seven days after the case manager is assigned to the child or adolescent;

(B) within seven days after discharge from an inpatient psychiatric setting, whichever is later; or

(C) document the reasons the meeting did not occur;

(3) meet face-to-face with the child or adolescent and the LAR or primary caregiver according to the child's or adolescent's plan or document why the meeting did not occur;

(4) identify the child or adolescent's strengths, service needs, and assistance that will be required to address the identified needs in the plan;

(5) comply with subsection (b)(4) - (13) of this section;

(6) incorporate wraparound process planning or other department-approved model in developing a plan that addresses the child's or adolescent's unmet needs across life domains, in accordance with the department's utilization management guidelines and subsection (d) of this section;

(7) take steps that are necessary to assist the child or adolescent in gaining access to the needed services and service providers, including:

(A) making referrals to potential service providers;

(B) initiating contact with potential service providers;

(C) arranging, and if necessary to facilitate linkage, accompanying the child or adolescent to initial meetings and non-routine appointments;

(D) arranging transportation to ensure the child's or adolescent's attendance;

(E) advocating with service providers; and

(F) providing relevant information to service providers;

(8) monitor the child's or adolescent's progress toward the outcomes set forth in the plan, including:

(A) gathering information from the child or adolescent, current service providers, LAR, primary caregiver, and other resources;

(B) reviewing pertinent documentation, including the child's or adolescent's clinical records, and assessments;

(C) ensuring that the plan was implemented as agreed upon;

(D) ensuring that needed services were provided;

(E) determining whether progress toward the desired outcomes was made;

(F) identifying barriers to accessing services or to obtaining maximum benefit from services;

(G) advocating for the modification of services to address changes in the needs or status of the child or adolescent;

(H) identifying emerging unmet service needs;

(I) determining whether the plan needs to be modified to address the child's or adolescent's unmet service needs more adequately;

(J) revising the plan as necessary to address the child's or adolescent's unmet service needs;

(K) a description of the intensive case management services to be provided by the case manager; and

(L) a statement of the maximum period of time between face-to-face contacts with the child or adolescent, and the LAR or primary caregiver, determined in accordance with the utilization management guidelines.

(d) Wraparound process planning. Wraparound process planning or other department-approved model may include, but is not limited to:

(1) a list of identified natural strengths and supports;

(2) a crisis plan developed in collaboration with the LAR, caregiver, and family that identifies circumstances to determine a crisis that would jeopardize the child's or adolescent's tenure in the community and the actions necessary to avert such loss of tenure;

(3) a prioritized list of the child's or adolescent's unmet needs that includes a discussion of the priorities and needs expressed by the child or adolescent and the LAR or primary caregiver;

(4) a description of the objective and measurable outcomes for each of the unmet needs as well as a projected time frame for each outcome;

(5) a description of the actions the child or adolescent, the case manager, and other designated people take to achieve those outcomes; and

(6) a list of the necessary services and service providers and the availability of the services.
Source Note: The provisions of this §306.263 adopted to be effective February 14, 2013, 38 TexReg 647; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 469.

§306.265 Making a Complaint
A provider must, in accordance with Chapter 404, Subchapter E of this title (relating to Rights of Persons Receiving Mental Health Services), notify the individual or LAR and, if the individual is a child or adolescent, the primary caregiver in writing of the process for making a complaint to the provider's client rights officer.
Source Note: The provisions of this §306.265 adopted to be effective February 14, 2013, 38 TexReg 647; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 469.

§306.267 Service Limitations
(a) A case manager must not provide MH case management services to an individual if a dual relationship exists.

(b) Activities that do not constitute MH case management services are identified in the department's MH Case Management Billing Guidelines as referenced in §412.416 of this title (relating to Guidelines).

(c) The provider must ensure that a conflict of interest does not exist if the same case manager is providing other, non-case management services.

(d) The provider must ensure that providers of case management services cannot authorize services.

(e) The receipt of MH case management services cannot be conditioned upon receipt of other services.
Source Note: The provisions of this §306.267 adopted to be effective February 14, 2013, 38 TexReg 647; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 469.

§306.269 Notification and Terminations
(a) Notification. The provider must notify the department or its designee if the provider has reason to believe that:

(1) the individual no longer meets the eligibility criteria for MH case management services as set forth in §412.405 of this title (relating to Eligibility for MH Case Management Services);

(2) the LAR of an individual has refused MH case management services on behalf of the individual;

(3) the adult or LAR has refused MH case management services;

(4) the provider cannot locate the individual and the provider has documented multiple attempts to locate the individual over a period of two consecutive months;

(5) the individual has died;

(6) the individual has established or intends to establish residency outside of the provider's service area; or

(7) if MH case management services are terminated for any reason described in paragraphs (1) - (6) of this subsection, the provider shall document the reason for terminating MH case management services.

(b) Termination. The department or designee shall terminate MH case management services provided to an individual if:

(1) the department or designee is notified of any of the circumstances described in subsection (a) of this section;

(2) it is determined that the individual no longer meets the eligibility criteria for MH case management services as set forth in §412.405 of this title; or

(3) the individual is not eligible for Medicaid and the department or its designee determines that there are insufficient resources to continue to provide MH case management services to the individual.
Source Note: The provisions of this §306.269 adopted to be effective February 14, 2013, 38 TexReg 647; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 469.

§306.271 MH Case Management Employee Qualifications
(a) A case manager must be:

(1) a QMHP-CS or a CSSP;

(2) an employee of the provider; and

(3) competent according to §412.412 of this title (relating to MH Case Management Employee Competencies).

(b) The provider may require additional education and experience for a case manager.

(c) An employee who supervises a case manager must be an employee of the provider and either:

(1) be a QMHP-CS;

(2) be competent according to §412.412 of this title and have experience in providing MH case management services; or

(3) hold a master's degree in a related field;

(4) demonstrate competency according to §412.412 of this title;

(5) demonstrate competency in knowledge of community resources; and

(6) demonstrate competency in MH case management evidenced-based practices.
Source Note: The provisions of this §306.271 adopted to be effective February 14, 2013, 38 TexReg 647; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 469.

§306.273 MH Case Management Employee Competencies
(a) The provider must implement a process to ensure the competency of a case manager and a case manager supervisor that, at a minimum, ensures:

(1) an accurate knowledge of the requirements of this subchapter and the following subchapters of this title:

(A) Chapter 412, Subchapter G of this title (relating to Mental Health Community Services Standards);

(B) Chapter 404, Subchapter E of this title (relating to Rights of Persons Receiving Mental Health Services);

(C) Chapter 414, Subchapter L of this title (relating to Abuse, Neglect, and Exploitation in Local Authorities and Community Centers); and

(D) Chapter 411, Subchapter N of this title (relating to Standards for Services to Individuals with Co-Occurring Psychiatric and Substance Use Disorders (COPSD));

(2) an accurate understanding of the nature of mental illness and serious emotional disturbance;

(3) an awareness and sensitivity in communicating and coordinating services with an individual who has a special physical need such as a hearing or visual impairment;

(4) the ability to respond to an individual's language and cultural needs through knowledge of customs, beliefs, and values of various, racial, ethnic, religious, and social groups;

(5) the ability to complete the uniform assessment;

(6) the ability to understand and apply the utilization management guidelines;

(7) the ability to develop and implement a plan if the case manager is providing intensive case management services to a child or adolescent;

(8) the ability to identify an individual in crisis;

(9) knowledge of appropriate actions to take in managing a crisis;

(10) an understanding of the developmental needs of an adult, a child, or an adolescent;

(11) an understanding of the wraparound planning process or other department-approved model, if the case manager is providing intensive case management services to a child or adolescent;

(12) knowledge of health and human services available to a child or adolescent as described in Texas Government Code §546.0052, if the case manager is providing intensive case management services to a child or adolescent;

(13) knowledge of available resources within the local community;

(14) knowledge of strategies for advocating effectively on behalf of individuals; and

(15) the ability to document the MH case management services described in §412.413 of this title (relating to Documenting MH Case Management Services).

(b) The provider shall require each case manager and case manager supervisor, prior to providing MH case management services, to:

(1) demonstrate the competencies described in subsection (a) of this section; and

(2) ensure that documentation verifying competencies is maintained in the personnel record of each case manager and case manager supervisor.
Source Note: The provisions of this §306.273 adopted to be effective February 14, 2013, 38 TexReg 647; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 469; amended to be effective April 1, 2025, 50 TexReg 2207.

§306.275 Documenting MH Case Management Services
(a) Location of documentation. MH case management services, as well as attempts to provide MH case management services, as described in this section, must be documented in the individual's medical record.

(1) For routine case management, the case manager must document the information required by §412.407(b)(3) - (6) of this title (relating to MH Case Management Services Standards), as well as the steps taken to meet the individual's goals and needs as required by §412.407(b)(7) of this title, in the individual's medical record.

(2) For intensive case management:

(A) the assigned case manager must include the intensive case management plan required by §412.407(c)(1) of this title in the individual's medical record; and

(B) the assigned case manager must document steps taken to meet the individual's goals and needs as required by §412.407(c)(7) of this title in the individual's progress notes.

(b) Assessment and reassessment. As a result of the face-to-face meetings, assessments, and reassessments required in §412.407 of this title, the case manager must document the individual's:

(1) identified strengths, service needs, and assistance given to address the identified need; and

(2) specific goals and actions to be accomplished.

(c) Service documentation. The case manager must document the following for all services provided:

(1) the event or behavior that occurs while providing the MH case management service or the reason for this specific encounter;

(2) the person, persons, or entity, including other case managers, with whom the encounter or contact occurred;

(3) the recovery plan goal(s) that was the focus of the MH case management service, including the progress or lack of progress in achieving recovery plan goal(s);

(4) the timeline for obtaining the needed services;

(5) the specific intervention that is being provided;

(6) the plan to proceed based upon the facts presented in this encounter or the resolution, if any;

(7) the date the MH case management service was provided;

(8) the begin and end time of the MH case management service;

(9) the location where the MH case management service was provided and whether it was a face-to-face or telephone contact;

(10) the signature of the employee providing the MH case management service and their credentials; and

(11) the timeline for reevaluating the needed services.

(d) Crisis service documentation. In addition to the requirements described in subsection (a) of this section, a provider must document the following for crisis intervention services:

(1) the documentation required by Chapter 412, Subchapter G, specifically §412.321(e) of this title (relating to Crisis Services); and

(2) the outcome of the individual's crisis.

(e) Refusing MH case management services. If the individual refuses MH case management services, the case manager must:

(1) document the reason for the refusal in the progress notes of the individual's medical record; and

(2) request that the individual sign a waiver of MH case management services that is filed in the individual's medical record.

(f) Documentation retention. The provider must retain documentation in compliance with applicable records retention requirements in federal and state laws, rules, and regulations.
Source Note: The provisions of this §306.275 adopted to be effective February 14, 2013, 38 TexReg 647; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 469.

§306.277 Medicaid Reimbursement
(a) In accordance with §412.407 of this title (relating to MH Case Management Services Standards), a billable event is a face-to-face contact during which the case manager provides an MH case management service to an:

(1) individual who is Medicaid eligible; or

(2) LAR on behalf of a child or adolescent who is Medicaid eligible.

(b) A unit of service for MH case management services is 15 continuous minutes.

(c) The department shall not reimburse a provider for Medicaid MH case management services if:

(1) the individual who was provided the service did not meet the eligibility requirements set forth in §412.405 of this title (relating to Eligibility for MH Case Management Services) at the time the service was provided;

(2) the service provided was an integral and inseparable part of another service;

(3) the service was provided by a person who was not qualified in accordance with §412.411(a) of this title (relating to MH Case Management Employee Qualifications);

(4) the service provided was not the type, amount, and duration authorized by the department or its designee;

(5) the service was not provided or documented in accordance with this subchapter;

(6) the service provided is in excess of eight hours per individual per day; or

(7) the services provided do not conform to the requirements set forth in the department's MH Case Management Billing Guidelines.

(d) The department shall not reimburse a provider for Medicaid MH case management services for coordination activities that are included in the provision of:

(1) rehabilitative crisis intervention services, as described in Chapter 419, Subchapter L, specifically §419.457 of this title (relating to Crisis Intervention Services); or

(2) psychosocial rehabilitative services, as described in Chapter 419, Subchapter L, specifically §419.459 of this title (relating to Psychosocial Rehabilitative Services).

(e) If Medicaid-funded MH case management services are continued prior to a fair hearing, as required by 1 TAC §357.11 (relating to Notice and Continued Benefits), the provider may file a claim for such services.

(f) An individual is eligible for Medicaid-funded MH case management services if, in addition to the criteria set forth in §412.405 of this title, the individual is:

(1) eligible for Medicaid;

(2) not an inmate of a public institution, as defined in 42 CFR §435.1009;

(3) not a resident of an intermediate care facility for persons with mental retardation as described in 42 CFR §440.150;

(4) not a resident of an IMD;

(5) not a resident of a Medicaid-certified nursing facility, unless the individual has been determined through a pre-admission screening and resident review assessment to be eligible for the specialized service of MH case management services or the individual is expected to be discharged to a non-institutional setting within 180 days;

(6) not a recipient of MH case management services under another Medicaid program (e.g., the Home and Community Services waiver program or Texas Health Steps); and

(7) not a patient of a general medical hospital.
Source Note: The provisions of this §306.277 adopted to be effective February 14, 2013, 38 TexReg 647; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 469.

§306.279 Fair Hearings and Appeal Processes
(a) Right of Medicaid-eligible individual to request a fair hearing. Any Medicaid eligible individual whose request for eligibility for MH case management services is denied or is not acted upon with reasonable promptness, or whose MH case management services have been terminated, suspended, or reduced by the department, is entitled to a fair hearing in accordance with 1 TAC Chapter 357, Subchapter A (relating to Uniform Fair Hearing Rules).

(b) Right of non-Medicaid eligible individual to request an appeal. Any individual who has not applied for or is not eligible for Medicaid whose request for eligibility for MH case management services is denied or is not acted upon with reasonable promptness, or whose MH case management services have been terminated, suspended, or reduced by a local mental health authority or its contractor, is entitled to notification and right of appeal in accordance with the department's rules concerning such matters for non-Medicaid-eligible individuals.
Source Note: The provisions of this §306.279 adopted to be effective February 14, 2013, 38 TexReg 647; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 469.

§306.281 Guidelines
The following guidelines, as revised, are referenced in this subchapter. For information about obtaining copies of the guidelines contact the Department of State Health Services, Mental Health Program Services, P.O. Box 149347, Mail Code 2018, Austin, TX 78714-9347, (512) 467-5427 or access them electronically.

(1) Uniform assessment guidelines are available online at: http://www.dshs.state.tx.us/mhprograms/RDMAssess.shtm.

(2) Utilization management guidelines for adults and children are available online at: http://www.dshs.state.tx.us/mhprograms/RDMClinGuide.shtm.

(3) MH Case Management Billing Guidelines are available at: http://www.dshs.state.tx.us/Layouts/ContentPage.aspx?PageID=35712&id=8589961742&terms=billing+guidelines.
Source Note: The provisions of this §306.281 adopted to be effective February 14, 2013, 38 TexReg 647; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 469.

§306.301 Purpose
The purpose of this subchapter is to describe the requirements for providing mental health (MH) rehabilitative services that includes the following:

(1) crisis intervention services;

(2) medication training and support services;

(3) psychosocial rehabilitative services;

(4) skills training and development services; and

(5) day programs for acute needs.
Source Note: The provisions of this §306.301 adopted to be effective January 22, 2014, 39 TexReg 299; transferred effective March 15, 2020, as published in the February 21, 2020 issue of the Texas Register, 45 TexReg 1239.

§306.303 Application
This subchapter applies to providers of MH rehabilitative services funded through Medicaid, or a general revenue contract with the department.
Source Note: The provisions of this §306.303 adopted to be effective January 22, 2014, 39 TexReg 299; transferred effective March 15, 2020, as published in the February 21, 2020 issue of the Texas Register, 45 TexReg 1239.

§306.305 Definitions
The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise.

(1) Adolescent--An individual who is at least 13 years of age, but younger than 18 years of age.

(2) Adult--An individual who is 18 years of age or older.

(3) APRN or Advanced practice registered nurse--A staff member who is a registered nurse approved by the Texas Board of Nursing as a clinical nurse specialist in psychiatric/mental health or nurse practitioner in psychiatric/mental health, in accordance with Texas Occupations Code, Chapter 301. The term is synonymous with "advanced nurse practitioner."

(4) Authorization period--The duration for which the provider has obtained authorization in accordance with §416.6(a) of this title (relating to Service Authorization and Recovery Plan).

(5) Business day--Any day except a Saturday, Sunday, or legal holiday listed in Texas Government Code, §662.021.

(6) CFP or Certified family partner--A person who:

(A) is 18 years of age or older;

(B) has received:

(i) a high school diploma; or

(ii) a high school equivalency certificate issued in accordance with the laws applicable to the issuing agency;

(C) has at least one year of lived experience raising a child or adolescent with an emotional or mental health issues as a parent or LAR;

(D) has at least one year of experience navigating a child-service system (e.g., mental health, juvenile justice, social security, or special education) as a parent or LAR; and

(E) has successfully completed the certified family partner (CFP) training and passed the certification examination recognized by the department.

(7) CFR--The Code of Federal Regulations.

(8) Child--An individual who is at least three years of age, but younger than 13 years of age.

(9) Crisis--A situation in which:

(A) an individual presents an immediate danger to self or others;

(B) an individual's mental or physical health is at risk of serious deterioration; or

(C) an individual believes that he or she presents an immediate danger to self or others or that his or her mental or physical health is at risk of serious deterioration.

(10) CSSP or community services specialist--A staff member who, as of August 30, 2004:

(A) 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 had three continuous years of documented full-time experience in the provision of MH rehabilitative services; and

(C) has demonstrated competency in the provision and documentation of MH rehabilitative services in accordance with this subchapter and the MH Rehabilitative Services Billing Guidelines.

(11) CSU or crisis stabilization unit--A crisis stabilization unit licensed under the Texas Health and Safety Code, Chapter 577; and Chapter 134 of this title (relating to Private Psychiatric Hospitals and Crisis Stabilization Units).

(12) Day--Calendar day, unless otherwise specified.

(13) Department--The Department of State Health Services.

(14) Direct clinical supervision--An LPHA's or QMHP's interaction with a staff member who delivers MH rehabilitative services to ensure that MH rehabilitative services are clinically appropriate and in compliance with this subchapter by:

(A) conducting a documented meeting with the staff member at regularly scheduled intervals; and

(B) conducting documented observations of the staff member providing MH rehabilitative services at a frequency determined by the supervisor based on the staff member's skill level.

(15) Face-to-face--A contact with an individual that occurs when the individual is in the physical presence of the staff member who is delivering the service. Face-to-face does not include contacts made through the use of electronic media.

(16) Group--A face-to-face service delivery modality involving at least one staff member and:

(A) two to eight adults; or

(B) two to six children or adolescents and may include their LARs or primary caregivers, which do not count toward the group size limit.

(17) Health risk factors--Circumstances that contribute to the premature death and disabling chronic diseases such as heart disease, diabetes and cancers. They include, but are not limited to, substance abuse or addiction, high blood pressure, tobacco use, high blood glucose, use of and side effects of some neuroleptic medications, physical inactivity, overweight and obesity, and unsafe sex.

(18) IMD or institution for mental diseases--Based on 42 CFR §435.1009, a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment, or care of individuals with serious mental illness, including medical attention, nursing care, and related services.

(19) Individual--A person seeking or receiving MH rehabilitative services.

(20) In vivo--The individual's natural environment (e.g., the individual's residence, work place, or school).

(21) LAR or legally authorized representative--A person authorized by law to act on behalf of an adult, child, or adolescent with regard to a matter described in this subchapter, including, but not limited to, a parent, guardian, or managing conservator.

(22) LMFT or Licensed marriage and family therapist--An individual who is licensed as a licensed marriage and family therapist by the Texas State Board of Examiners of Marriage and Family Therapists in accordance with Texas Occupations Code, Chapter 502.

(23) Licensed medical staff member--A staff member who is:

(A) a physician (MD) or (DO);

(B) a physician assistant (PA);

(C) an APRN;

(D) a registered nurse (RN);

(E) an LVN; or

(F) a pharmacist.

(24) LPC or Licensed professional counselor--A person 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.

(25) LOC or level of care--A designation given to the department's standard sets of mental health services, based on the uniform assessment and utilization management guidelines referenced in §416.17 of this title (relating to Guidelines), which specify the type, amount, and duration of MH rehabilitative services to be provided to an individual.

(26) LPHA or licensed practitioner of the healing arts--This term shall have the meaning set forth in the §412.303 of this title (relating to Definitions).

(27) LVN or licensed vocational nurse--A staff member who is licensed as a vocational nurse by the Texas Board of Nursing in accordance with Texas Occupations Code, Chapter 301.

(28) Mental health (MH) rehabilitative services--Services that:

(A) are individualized, age-appropriate training and instructional guidance that restore an individual's functional deficits due to serious mental illness or SED;

(B) are designed to improve or maintain the individual's ability to remain in the community as a fully integrated and functioning member of that community; and

(C) consist of the following services:

(i) crisis intervention services;

(ii) medication training and support services;

(iii) psychosocial rehabilitative services;

(iv) skills training and development services; and

(v) day programs for acute needs.

(29) Medicaid provider--A Medicaid-enrolled provider with which the department has a Medicaid provider agreement to provide MH rehabilitative services under the State's Medicaid Program.

(30) Medical necessity or medically necessary--A clinical determination made by an LPHA that services:

(A) are reasonable and necessary for the treatment of a serious mental illness; or to improve, maintain, or prevent deterioration of functioning resulting from such a disorder;

(B) are provided in accordance with accepted standards of practice in behavioral health care;

(C) are furnished in the most appropriate and least restrictive setting in which services can be safely provided;

(D) are at the most appropriate level or amount of service that can be safely provided; and

(E) could not have been omitted without adversely affecting the individual's mental and/or physical health or the quality of care rendered.

(31) Mental health disorder--Health conditions involving changes in thinking, mood, and/or behaviors that are associated with distress or impaired functioning. When mental health disorders are more severe, they are called serious mental illnesses, which includes anxiety disorder, attention-deficit/hyperactivity disorder, depressive and other mood disorders, eating disorders, schizophrenia, and others.

(32) Nursing services--Services provided or delegated by an RN acting within the scope of his or her practice, as described in Texas Occupations Code, Chapter 301.

(33) On site--At a location operated by a provider or a person or entity under arrangement with the provider.

(34) PA or Physician assistant--A staff member who is licensed as a physician assistant by the Texas State Board of Physician Assistant Examiners in accordance with Texas Occupations Code, Chapter 204.

(35) 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; and

(B) has at least one cumulative year of receiving mental health services for a disorder that is treated in the target population for Texas.

(36) Pharmacist--A staff member who is licensed as a pharmacist by the Texas State Board of Pharmacy in accordance with Texas Occupations Code, Chapter 558.

(37) Physician--A staff member who is:

(A) licensed as a physician by the Texas Medical Boards in accordance with Texas Occupations Code, Chapter 155 (Medical Doctor or Doctor of Osteopathy); or

(B) authorized to perform medical acts under an institutional permit at a Texas postgraduate training program approved by the Accreditation Council on Graduate Medical Education, the American Osteopathic Association, or the Texas Medical Board.

(38) Primary caregiver--A person 18 years of age or older who has actual care, control, and possession of a child or adolescent.

(39) Problem-solving--The use of specific steps and strategies to analyze and evaluate a problematic situation in order to determine a course of action to resolve the problematic situation.

(40) Provider--An entity with which the department has a contractual agreement to provide MH Rehabilitative Services, including a Medicaid provider.

(41) 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.

(42) QMHP-CS or qualified mental health professional-community services--A staff member who meets the definition of a QMHP-CS set forth in §412.303 of this title (relating to Definitions).

(43) Recovery--A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.

(44) Recovery plan or treatment plan--A written plan developed with the individual and, as required, the LAR and a QMHP-CS that specifies the individual's recovery goals, objectives, and strategies/interventions in conjunction with the uniform assessment that guides the recovery process and fosters resiliency as further described in §412.322(e) of this title (relating to Provider Responsibilities for Treatment Planning and Service Authorization).

(45) Resilience--The ability to cope with and recover from adversity and stress.

(46) 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.

(47) SED or Serious emotional disturbance--A diagnosed mental health disorder that substantially disrupts a child's or adolescent's ability to function socially, academically, and emotionally.

(48) Serious mental illness--An illness, disease, disorder, or condition (other than a sole diagnosis of epilepsy, dementia, substance use disorder, or intellectual or developmental disability) 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.

(49) Staff member--Personnel of a provider including a full-time or part-time employee, contractor, intern, or volunteer.

(50) Therapeutic team--A group of staff members who work together in a coordinated manner for the purpose of providing comprehensive mental health services to an individual.

(51) Uniform assessment--An assessment adopted by the department that is used for recommending an approved level of care (LOC).

(52) Utilization management guidelines--Guidelines developed by the department that suggest the type, amount, and duration of mental health services for each LOC.
Source Note: The provisions of this §306.305 adopted to be effective January 22, 2014, 39 TexReg 299; transferred effective March 15, 2020, as published in the February 21, 2020 issue of the Texas Register, 45 TexReg 1239.

§306.307 General Requirements for Providers of MH Rehabilitative Services
(a) Compliance with MH community standards. In addition to complying with this subchapter, a provider must also comply with Chapter 412, Subchapter G of this title (relating to Mental Health Community Services Standards) in the provision of MH rehabilitative services, as described in §412.304(a)(4) and (b) of this title (relating to Responsibility for Compliance).

(b) Staff supervision and oversight. A provider must develop policies and procedures in accordance with this subchapter for the supervision and oversight of staff members who provide MH rehabilitative services. Staff members who provide supervision must have experience in providing rehabilitative services and training in supervising rehabilitative services. The MH rehabilitative services provided by a:

(1) CFP must be directly supervised by a staff member who is credentialed as a QMHP-CS at minimum and who must have at least one year experience in the department-approved recovery and resilience protocol;

(2) peer provider must be under the direct clinical supervision of an LPHA;

(3) CSSP must be clinically supervised by a QMHP-CS;

(4) QMHP-CS must be clinically supervised by at least another QMHP-CS; and

(5) QMHP-CS supervisor of another QMHP-CS must be clinically supervised by an LPHA.

(c) Subcontract for providing services.

(1) A provider may choose to have any MH rehabilitative service provided by a person or entity through a subcontract.

(2) A provider must ensure that, if MH rehabilitative services are provided through a subcontract, then the subcontractor complies with all applicable federal and state laws, rules, and regulations, and any provider manuals and policy clarification letters promulgated by the department.

(d) Prohibitions against discrimination and retaliation.

(1) A provider may not discriminate against or deny services to an individual based on race, color, national origin, religion, sex, sexual orientation, age, disability, co-occurring disorder, or political affiliation.

(2) A provider must ensure that an individual's refusal of any service offered by the provider does not preclude the individual from accessing a needed MH rehabilitative service.
Source Note: The provisions of this §306.307 adopted to be effective January 22, 2014, 39 TexReg 299; transferred effective March 15, 2020, as published in the February 21, 2020 issue of the Texas Register, 45 TexReg 1239.

§306.309 Eligibility
An individual is eligible for MH rehabilitative services if:

(1) the individual:

(A) is a resident of the State of Texas;

(B) is an adult with a serious mental illness or a child or adolescent with a serious emotional disturbance (SED); and

(C) qualifies for an LOC; and

(2) a determination that such services are medically necessary has been made by an LPHA who is:

(A) an employee of the department;

(B) an employee of an entity designated to make such determinations on behalf of the department; or

(C) a contractor of an entity designated to make such determinations on behalf of the department, if the LPHA is not otherwise employed by or contracting with an entity providing MH rehabilitative services through a subcontract.
Source Note: The provisions of this §306.309 adopted to be effective January 22, 2014, 39 TexReg 299; transferred effective March 15, 2020, as published in the February 21, 2020 issue of the Texas Register, 45 TexReg 1239.

§306.311 Service Authorization and Recovery Plan
(a) Prerequisites to providing services. With the exception of crisis intervention services:

(1) the provider must obtain prior authorization from the department or its designee for the MH rehabilitative services to be provided in accordance with the uniform assessment, which is referenced in §416.17 of this title (relating to Guidelines); and the utilization management guidelines, which are referenced in §416.17 of this title; and

(2) an LPHA must determine whether the need for MH rehabilitative services meets the definition of medical necessity.

(b) Recovery planning.

(1) In collaboration with the individual or LAR, develop a recovery plan in accordance with §412.322(e) of this title (relating to Provider Responsibilities for Treatment Planning and Service Authorization) that also includes a list of the type(s) of MH rehabilitative services authorized in accordance with subsection (a)(1) of this section.

(2) A provider must develop the recovery plan required by paragraph (1) of this subsection within 10 days after the authorization date.

(c) Documenting medical necessity for crisis intervention services.

(1) An LPHA must, within two business days after crisis intervention services are provided:

(A) determine whether the crisis intervention services met the definition of medical necessity; and

(B) if the crisis intervention services were determined to meet medical necessity, document the medical necessity for such services.

(2) A provider is not required to develop a recovery plan for providing crisis intervention services.

(d) Reauthorization of MH rehabilitative services.

(1) Prior to the expiration of the authorization period or depleting the amount of services authorized:

(A) the provider must make a determination of whether the individual continues to need MH rehabilitative services; and

(B) an LPHA must determine whether the continuing need for MH rehabilitative services meets the definition of medical necessity.

(2) If the determination is that the individual continues to need MH rehabilitative services and that such services are medically necessary, the provider must:

(A) request another authorization from the department or its designee for the same type and amount of MH rehabilitative service previously authorized; or

(B) submit a request to the department or its designee, with documented clinical reasons for such request, to change the type or amount of MH rehabilitative services previously authorized if:

(i) the provider determines that the type or amount of MH rehabilitative services previously authorized is inappropriate to address the individual's needs; and

(ii) the criteria described in the utilization management guidelines for changing the type or amount of MH rehabilitative services has been met.

(e) Recovery plan review.

(1) In collaboration with the individual or LAR or primary caregiver, the provider must, review the recovery plan to determine if the plan adequately assists the individual in achieving recovery through the identified goals, objectives, and needs:

(A) at intervals set forth in the utilization management guidelines;

(B) as clinically indicated; and

(C) at the request of the individual, LAR, or primary caregiver.

(2) At the time the recovery plan is reviewed, the provider must:

(A) solicit active participation of the individual and LAR or primary caregiver of a child or adolescent regarding the services received to date and whether the services received have led to improvement and/or if there are other services to address unmet needs; and

(B) document such input.

(f) Revisions to the recovery plan. If, after review of the recovery plan, the provider in collaboration with the individual or LAR determines that the recovery plan does not adequately address the needs of the individual, the provider must, as appropriate:

(1) revise the content of the recovery plan; or

(2) must document medical necessity if there is a change in an LOC; and

(3) request authorization for a change in the type or amount of the MH rehabilitative services authorized consistent with subsection (d)(2) of this section.
Source Note: The provisions of this §306.311 adopted to be effective January 22, 2014, 39 TexReg 299; transferred effective March 15, 2020, as published in the February 21, 2020 issue of the Texas Register, 45 TexReg 1239.

§306.313 Crisis Intervention Services
(a) Description. Crisis intervention services are interventions provided in response to a crisis in order to reduce or manage symptoms of serious mental illness or SED and to prevent admission of an individual to a more restrictive environment. Crisis intervention services consist of the following interventions:

(1) an assessment of dangerousness of the individual to self or others;

(2) the coordination of emergency care services in accordance with §412.314 of this title (relating to Access to Mental Health Community Services);

(3) behavior skills training to assist the individual in reducing distress and managing symptoms;

(4) problem-solving;

(5) reality orientation to help the individual identify and manage his or symptoms of serious mental illness or SED; and

(6) providing instruction, structure, and emotional support to the individual in adapting to and coping with immediate stressors.

(b) Conditions.

(1) Crisis intervention services may be provided to:

(A) an adult; or

(B) a child or adolescent.

(2) Crisis intervention services must be provided one-to-one.

(3) Crisis intervention services may be provided:

(A) on site; or

(B) in vivo.

(4) Crisis intervention services must be provided by a QMHP-CS at a minimum.

(5) Crisis intervention services may not be provided to an individual who is currently admitted to a CSU.

(6) Crisis intervention services may be provided to an individual without first obtaining authorization from the department, or its designee, in accordance with §416.6 of this title (relating to Service Authorization and Recovery Plan).

(7) Crisis intervention services may be provided without a recovery plan described in §416.6 of this title.
Source Note: The provisions of this §306.313 adopted to be effective January 22, 2014, 39 TexReg 299; transferred effective March 15, 2020, as published in the February 21, 2020 issue of the Texas Register, 45 TexReg 1239.

§306.315 Medication Training and Support Services
(a) Description. Medication training and support services consist of education and guidance about medications and their possible side effects. The department has reviewed and approved the use of the materials that are available on the department's internet site at: http://www.dshs.state.tx.us/mhsa/patient-family-ed/ and other materials which have been formally reviewed and approved by the department, to assist an individual in:

(1) understanding the nature of an adult's serious mental illness or a child's or adolescent's SED;

(2) understanding the concepts of recovery and resilience within the context of the serious mental illness;

(3) understanding the role of the individual's prescribed medications in reducing symptoms and increasing or maintaining the individual's functioning;

(4) identifying and managing the individual's symptoms and potential side effects of the individual's medication;

(5) learning the contraindications of the individual's medication;

(6) understanding the overdose precautions of the individual's medication; and

(7) learning self-administration of the individual's medication.

(b) Conditions.

(1) Medication training and support services may be provided to:

(A) an eligible adult;

(B) an eligible child or adolescent; or

(C) the LAR or primary caregiver of an eligible adult, child, or adolescent.

(2) Medication training and support services provided to an adult may be provided:

(A) individually; or

(B) in a group.

(3) Medication training and support services provided to a child or adolescent may be provided:

(A) individually; or

(B) in a group.

(4) Medication training and support services provided to an LAR or primary caregiver may be provided:

(A) individually; or

(B) in a group, except that the adult, child or adolescent may also be present.

(5) Medication training and support services may be provided:

(A) on site; or

(B) in vivo.

(6) Medication training and support services provided to an adult or LAR must be provided by:

(A) a QMHP-CS;

(B) a CSSP;

(C) a peer provider; or

(D) a licensed medical staff member.

(7) Medication training and support services provided to a child, adolescent, LAR, or primary caregiver must be provided by:

(A) a QMHP-CS;

(B) a CSSP;

(C) a CFP; or

(D) a licensed medical staff member.

(8) Medication training and support services may not be provided to an individual who is currently admitted to a CSU.

(c) Frequency and duration. The provision of medication training and support services must be in accordance with the amount and duration for which the provider has obtained authorization in accordance with §416.6 of this title (relating to Service Authorization and Recovery Plan).
Source Note: The provisions of this §306.315 adopted to be effective January 22, 2014, 39 TexReg 299; transferred effective March 15, 2020, as published in the February 21, 2020 issue of the Texas Register, 45 TexReg 1239.

§306.317 Psychosocial Rehabilitative Services
(a) Description. Psychosocial rehabilitative services are social, behavioral, and cognitive interventions provided by members of an individual's therapeutic team that build on strengths and focus on restoring the individual's ability to develop and maintain social relationships, occupational or educational achievement, and other independent living skills that are affected by or the result of a serious mental illness in adults. Psychosocial rehabilitative services may also address the impact of co-occurring disorders upon the individual's ability to reduce symptomology and increase daily functioning. Psychosocial rehabilitative services that include, but are not limited to, the following component services:

(1) independent living services;

(2) coordination services;

(3) employment related services;

(4) housing related services;

(5) medication related services; and

(6) crisis related services.

(b) Conditions.

(1) Psychosocial rehabilitative services:

(A) may only be provided to an eligible adult;

(B) may be provided individually or in a group;

(C) may be provided on site or in vivo;

(D) must be provided by a member of the individual's therapeutic team; and

(E) may not be provided to an individual who is currently admitted to a CSU.

(2) The therapeutic team must be constituted and organized in a manner that ensures that:

(A) the team includes a sufficient number of staff to adequately address the rehabilitative needs of individuals assigned to the team;

(B) team members are appropriately credentialed to provide the full array of component services;

(C) team members have regularly scheduled team meetings either in person or by teleconference; and

(D) every member of the team is knowledgeable of the needs and of the services available to the specific individuals assigned to the team.

(3) Independent living services, coordination services, employment related services, and housing related services, as described in subsection (c)(1) - (4) of this section, must be provided by:

(A) a QMHP-CS;

(B) a CSSP; or

(C) a peer provider.

(4) Medication related services, as described in subsection (c)(5) of this section, must be provided by licensed medical personnel.

(5) Crisis related services, as described in subsection (c)(6) of this section, must be provided by a QMHP-CS.

(6) As part of providing the coordination services described in subsection (c)(2) of this section, a QMHP-CS must conduct the uniform assessment at intervals specified by the department to determine the type, amount, and duration of MH rehabilitative services.

(c) Components of psychosocial rehabilitative services. Psychosocial rehabilitative services include, but are not limited to, the following.

(1) Independent living services assist an individual in acquiring the most immediate, fundamental functional skills needed to enable the individual to reside in the community and avoid more restrictive levels of treatment or reducing behaviors or symptoms that prevent successful functioning in the individual's environment of choice. Such services include training in symptom management, personal hygiene, nutrition, food preparation, exercise, money management and community integration activities.

(2) Coordination services are training activities that assist an individual in improving his or her ability to gain and coordinate access to necessary care and services appropriate to the needs of the individual. Coordination services include, but are not limited to, instruction and guidance in such areas as:

(A) assessment--identifying strengths and areas of need across life domains;

(B) recovery planning--prioritizing needs and establishing life and treatment goals, selecting interventions, developing and revising recovery plans that include wellness, relapse prevention, and crisis plans;

(C) access--identifying potential service providers and support systems across all life domains (e.g., medical, social, educational, substance use), initiating contact with providers and support systems including advocacy groups;

(D) coordination--setting appointments, arranging transportation, facilitating communication between providers; and

(E) advocacy--

(i) asserting treatment needs, requesting special accommodations, evaluating provider effectiveness and compliance with the agreed upon recovery plan; and

(ii) requesting improvements and modifications to ensure maximum benefit from the services and supports.

(3) Employment related services provide supports and skills training that are not job-specific and focus on developing skills to reduce or manage the symptoms of serious mental illness that interfere with an individual's ability to make vocational choices or obtain or retain employment. Such services consist of:

(A) instruction in dress, grooming, socially and culturally appropriate behaviors, and etiquette necessary to obtain and retain employment;

(B) training in task focus, maintaining concentration, task completion, and planning and managing activities to achieve outcomes;

(C) instruction in obtaining appropriate clothing, arranging transportation, utilizing public transportation, accessing and utilizing available resources related to obtaining employment, and accessing employment-related programs and benefits (e.g., unemployment, workers' compensation, and Social Security);

(D) interventions or supports provided on or off the job site to reduce behaviors or symptoms of serious mental illness that interfere with job performance or that interfere with the development of skills that would enable the individual to obtain or retain employment; and

(E) interventions designed to develop natural supports on or off the job site to compensate for skill deficits that interfere with job performance.

(4) Housing related services develop an individual's strengths and abilities to manage the symptoms of the individual's serious mental illness that interfere with the individual's capacity to obtain or maintain tenure in independent integrated housing. Such services consist of:

(A) skills training related to:

(i) home maintenance and cleanliness;

(ii) problem-solving with the individual's landlord and neighbors, mortgage lender, or homeowners association; and

(iii) maintaining appropriate interpersonal boundaries; and

(B) supportive contacts with the individual to reduce or manage the behaviors or symptoms related to the individual's serious mental illness that interfere with maintaining independent integrated housing.

(5) Medication related services provide training regarding an individual's medication adherence. Such services consist of training in:

(A) the importance of the individual taking the medications as prescribed;

(B) the self-administration of the individual's medication;

(C) determining the effectiveness of the individual's medications;

(D) identifying side-effects of the individual's medications; and

(E) contraindications for medications prescribed.

(6) Crisis related services respond to an individual in crisis in order to reduce symptoms of serious mental illness or SED and to prevent admission of the individual to a more restrictive environment.

(d) Frequency and duration. The provision of psychosocial rehabilitative services must be in accordance with the amount and duration for which the provider has obtained authorization in accordance with §416.6 of this title (relating to Service Authorization and Recovery Plan).
Source Note: The provisions of this §306.317 adopted to be effective January 22, 2014, 39 TexReg 299; transferred effective March 15, 2020, as published in the February 21, 2020 issue of the Texas Register, 45 TexReg 1239.

§306.319 Skills Training and Development Services
(a) Description.

(1) Skills training and development services is training provided to an eligible individual or the LAR or primary caregiver of an eligible adult, child, or adolescent. Such training:

(A) addresses serious mental illness or SED and symptom-related problems that interfere with the individual's functioning and living, working, and learning environment;

(B) provides opportunities for the individual to acquire and improve skills needed to function as appropriately and independently as possible in the community; and

(C) facilitates the individual's community integration and increases his or her community tenure.

(2) Skills training and development services consist of teaching an individual the following skills:

(A) skills for managing daily responsibilities (e.g., paying bills, attending school, and performing chores);

(B) communication skills (e.g., effective communication and recognizing or change problematic communication styles);

(C) pro-social skills (e.g., replacing problematic behaviors with behaviors that are socially and culturally appropriate or developing interpersonal relationship skills necessary to function effectively with family, peer, teachers, or other people in the community);

(D) problem-solving skills;

(E) assertiveness skills (e.g., resisting peer pressure, replacing aggressive behaviors with assertive behaviors, and expressing one's own opinion in a manner that is socially appropriate);

(F) social skills and expanding the individual social support network, (e.g., selection of appropriate friends and healthy activities);

(G) stress reduction techniques (e.g., progressive muscle relaxation, deep breathing exercises, guided imagery, and selected visualization);

(H) anger management skills (e.g., identification of antecedents to anger, calming down, stopping and thinking before acting, handling criticism, avoiding and disengaging from explosive situations);

(I) skills to manage the symptoms of serious mental illness or SED and to recognize and modify unreasonable beliefs, thoughts and expectations;

(J) skills to identify and utilize community resources and informal supports;

(K) skills to identify and utilize acceptable leisure time activities (e.g., identifying pleasurable leisure time activities that will foster acceptable behavior); and

(L) independent living skills (e.g., money management, accessing and using transportation, grocery shopping, maintaining housing, maintaining a job, and decision making).

(3) Skills training and development services consist of:

(A) assisting the child or adolescent in learning the skills described in paragraph (2) of this subsection; and

(B) increasing the LAR's or primary caregiver's understanding of and ability to respond to the individual's needs identified in the uniform assessment or documented in the recovery plan.

(b) Conditions.

(1) Skills training and development services may be provided to:

(A) an eligible adult;

(B) an eligible child or adolescent; or

(C) the LAR or primary caregiver of an individual.

(2) Skills training and development services provided to an individual, LAR, or primary caregiver of a child or adolescent may be provided:

(A) individually; or

(B) in a group.

(3) Skills training and development services may be provided:

(A) on site; or

(B) in vivo.

(4) Skills training and development services provided to an individual must be provided according to curricula approved by the department.

(5) Skills training and development services provided to an adult or LAR must be provided by:

(A) a QMHP-CS;

(B) a CSSP; or

(C) a peer provider.

(6) Skills training and development services provided to a child or adolescent, LAR, or primary caregiver must be provided by:

(A) a QMHP-CS;

(B) a CSSP; or

(C) a CFP.

(7) Skills training and development services may not be provided to an individual who is currently admitted to a CSU.

(c) Frequency and Duration. The provision of skills training and development services must be in accordance with the amount and duration for which the provider has obtained authorization in accordance with §416.6 of this title (relating to Service Authorization and Recovery Plan).
Source Note: The provisions of this §306.319 adopted to be effective January 22, 2014, 39 TexReg 299; transferred effective March 15, 2020, as published in the February 21, 2020 issue of the Texas Register, 45 TexReg 1239.

§306.321 Day Programs for Acute Needs
(a) Description. Day programs for acute needs provide short term, intensive treatment to an individual who requires multidisciplinary treatment in order to stabilize acute psychiatric symptoms or prevent admission to a more restrictive setting. Day programs for acute needs:

(1) are provided in a highly structured and safe environment with constant supervision;

(2) ensure an opportunity for frequent interaction between an individual and staff members;

(3) are services that are goal oriented and focus on:

(A) reality orientation;

(B) symptom reduction and management;

(C) appropriate social behavior;

(D) improving peer interactions;

(E) improving stress tolerance;

(F) the development of coping skills; and

(4) consist of the following component services:

(A) psychiatric nursing services;

(B) pharmacological instruction;

(C) symptom management training; and

(D) functional skills training.

(b) Conditions.

(1) Day programs for acute needs:

(A) may only be provided to eligible adults;

(B) may be provided in a setting with any number of individuals; and

(C) may be provided:

(i) on site; or

(ii) in a short-term, crisis-resolution oriented residential treatment setting that is not:

(I) a general medical hospital;

(II) a psychiatric hospital; or

(III) an IMD.

(2) Except as provided by paragraphs (4) and (5) of this subsection, day programs for acute needs must be provided by:

(A) a QMHP-CS;

(B) a CSSP; or

(C) a peer provider.

(3) Day programs for acute needs must, at all times:

(A) have a sufficient number of staff members to ensure safety and program adequacy; and

(B) at a minimum include:

(i) one RN for every 16 individuals at the day program's location;

(ii) one physician to be available by phone, with a response time not to exceed 15 minutes;

(iii) two staff members who are QMHP-CSs, CSSPs, or peer providers at the day program's location;

(iv) one additional QMHP-CS who is not assigned full-time to another day program to be physically available, with a response time not to exceed 30 minutes; and

(v) additional QMHP-CSs, CSSPs, or peer providers at the day program's location sufficient to maintain a ratio of one staff member to every four individuals.

(4) Psychiatric nursing services, as described in subsection (c)(1) of this section, must be provided by an RN at the day program's location.

(5) Pharmacological instruction, as described in subsection (c)(2) of this section, must be provided by a licensed medical personnel.

(c) Components of day programs for acute needs.

(1) Psychiatric nursing services consist of:

(A) a nursing assessment;

(B) the coordination of medical activities (e.g., referrals to specialists and scheduling medical laboratory tests);

(C) the administration of medication;

(D) laboratory specimen collections and screenings (e.g., the Abnormal Involuntary Movement Scale);

(E) emergency medical interventions as ordered by a physician; and

(F) other nursing services.

(2) Pharmacological instruction is training to an individual that addresses medication issues related to the crisis precipitating the provision of day programs for acute needs. Such medication issues consist of:

(A) the role of the individual's medications in stabilizing acute psychiatric symptoms or preventing admission to a more restrictive setting;

(B) the identification of substances that reduce the effectiveness of the individual's medications;

(C) appropriate interventions to reduce side effects of the medications; and

(D) the self-administration of the individual's medication.

(3) Symptom management training assists an individual in recognizing and reducing her or his symptoms and includes training the individual on:

(A) the identification of thoughts, feelings, or behaviors that indicate the onset of acute psychiatric symptoms;

(B) developing coping strategies to address the symptoms;

(C) ways to avoid symptomatic episodes;

(D) identification of external circumstances that trigger the onset of the acute psychiatric symptoms; and

(E) relapse prevention strategies.

(4) Functional skills training assists an individual in acquiring the skills needed to enable the individual to continue to reside in the community and avoid more restrictive levels of treatment and includes training the individual on:

(A) personal hygiene;

(B) nutrition;

(C) food preparation;

(D) money management;

(E) socially and culturally appropriate behavior; and

(F) accessing and participating in community activities.

(d) Frequency and duration. The provision of day programs for acute needs must be in accordance with the amount and duration for which the provider has obtained authorization in accordance with §416.6 of this title (relating to Service Authorization and Recovery Plan).
Source Note: The provisions of this §306.321 adopted to be effective January 22, 2014, 39 TexReg 299; transferred effective March 15, 2020, as published in the February 21, 2020 issue of the Texas Register, 45 TexReg 1239.

§306.323 Documentation Requirements
(a) MH rehabilitative services documentation. A rehabilitative services provider must document the following for all MH rehabilitative services:

(1) the name of the individual to whom the service was provided;

(2) the type of service provided;

(3) the specific goal or objective addressed, modality, and method used to provide the service;

(4) the date the service was provided;

(5) the begin and end time of the service;

(6) the location where the service was provided;

(7) the signature of the staff member providing the service and a notation of their credential (e.g., a QMHP-CS, a pharmacist, a CSSP, a CFP, or a peer provider);

(8) any pertinent event or behavior relating to the individual's treatment which occurs during the provision of the service;

(9) any pertinent information required to be documented by the curricula, protocol, or practice approved by the department; and

(10) the outcome or response, as applicable:

(A) for crisis intervention service, the outcome of the crisis;

(B) for psychosocial coordination services, the outcome of the services;

(C) for day programs for acute needs, the progress or lack of progress in stabilizing the individual's acute psychiatric symptoms; or

(D) for all other services, the individual's response, including the progress or lack of progress in achieving recovery plan goals and objectives.

(b) Crisis services documentation. In addition to the requirements described in subsection (a) of this section, when providing crisis services, a provider must document the information required by §412.321(e) of this title (relating to Crisis Services).

(c) Medical necessity documentation. An LPHA must document that MH rehabilitative services are medically necessary when the services are authorized and reauthorized.

(d) Frequency of documentation.

(1) Day programs for acute needs. For day programs for acute needs, the documentation required by subsection (a)(1) - (9) and (10)(C) of this section must be made daily.

(2) Programs other than day programs for acute needs. For MH rehabilitative services other than day programs for acute needs, the documentation required by subsection (a)(1) - (9) and (10)(A), (B), and (D) of this section must be made after each face-to-face contact that occurs to provide the MH rehabilitative service.

(3) Medical necessity. An LPHA must document medical necessity in accordance with §416.6 of this title (relating to Service Authorization and Recovery Plan).

(4) Retention. A provider must retain documentation in compliance with applicable federal and state laws, rules, and regulations.
Source Note: The provisions of this §306.323 adopted to be effective January 22, 2014, 39 TexReg 299; transferred effective March 15, 2020, as published in the February 21, 2020 issue of the Texas Register, 45 TexReg 1239.

§306.325 Staff Member Competency and Training
(a) General competency of staff members. In accordance with §412.316 of this title (relating to Competency and Credentialing), a provider must ensure the competency of staff members prior to providing services.

(b) MH rehabilitative services training and competency of staff members. A provider must ensure that staff members providing MH rehabilitative services receive initial training and ensure the competency of a staff member who provides or supervises the provision MH rehabilitative services in the following areas:

(1) the nature of serious mental illness and SED;

(2) the concepts of recovery and resilience;

(3) the department-approved curricula, protocol, or practice;

(4) the rehabilitative practice techniques found in curricula, program practices, and protocols; and

(5) the prevalence of health risk factors.

(c) Additional training related to children and adolescents. A staff member who routinely provides or supervises the provision of MH rehabilitative services to a child or adolescent must receive training and demonstrate competency as required by subsection (b) of this section and in the following areas:

(1) the aspects of a child's or adolescent's growth and development (including physical, emotional, cognitive, educational and social) and the treatment needs of a child and adolescent; and

(2) the department's approved skills training curricula, protocol, or practice guidelines.

(d) Except for the direct clinical supervision of a peer provider, which must be provided by an LPHA, the clinical supervision of the provision of MH rehabilitative services must be provided by a staff member who is, at minimum, a QMHP-CS.

(e) Approved curricula. If a staff member provides MH rehabilitative services through a department-approved curricula, protocol, or practice guideline, the staff member must be trained in the implementation of the curriculum, protocol, or practice guideline.

(f) Follow-up training. In addition to the training required in subsection (a) of this section, staff members may be required to receive additional training as determined by the department.

(g) Training documentation. A provider must document that a staff member has successfully completed the training and has demonstrated competencies in the areas described in subsection (a) of this section.
Source Note: The provisions of this §306.325 adopted to be effective January 22, 2014, 39 TexReg 299; transferred effective March 15, 2020, as published in the February 21, 2020 issue of the Texas Register, 45 TexReg 1239.

§306.327 Medicaid Reimbursement
(a) Billable and non-billable activities.

(1) A Medicaid provider may only bill for medically necessary MH rehabilitative services that are provided face-to-face to:

(A) a Medicaid-eligible individual;

(B) the LAR of a Medicaid-eligible adult (on behalf of the adult); or

(C) the LAR or primary caregiver of a Medicaid-eligible child or adolescent (on behalf of the child or adolescent).

(2) The cost of the following activities are included in the Medicaid MH rehabilitative services reimbursement rate(s) and may not be directly billed by the Medicaid provider:

(A) developing and revising the recovery plan and interventions that are appropriate to an individual's needs;

(B) staffing and team meetings to discuss the provision of MH rehabilitative services to a specific individual;

(C) monitoring and evaluating outcomes of interventions, including contacts with a person other than the individual;

(D) documenting the provision of MH rehabilitative services;

(E) a staff member traveling to and from a location to provide MH rehabilitative services;

(F) all services provided within a day program for acute needs that are delivered by a staff member, including services delivered in response to a crisis or an episode of acute psychiatric symptoms; and

(G) administering the uniform assessment to individuals who are receiving psychosocial rehabilitative services.

(b) Non-reimbursable activities.

(1) The department will not reimburse a Medicaid provider for any MH rehabilitative services provided to an individual who is:

(A) a resident of an intermediate care facility for persons with an intellectual or developmental disability as described in 42 CFR §440.150;

(B) a resident in an IMD;

(C) an inmate of a public institution as defined in 42 CFR §435.1009;

(D) a resident in a Medicaid-certified nursing facility unless the individual has been determined through a pre-admission screening and annual resident review assessment to be eligible for the specialized service of MH rehabilitative services;

(E) a patient in a general medical hospital; or

(F) not Medicaid-eligible.

(2) With the exception of crisis intervention services and psychosocial rehabilitative services that are being provided to resolve a crisis situation, the department will not reimburse a Medicaid provider for any combination of MH rehabilitative services delivered in excess of eight hours per individual per day. In addition, the department will not reimburse a Medicaid provider for more than:

(A) two hours per individual per day of medication training and support services;

(B) four hours per individual per day of psychosocial rehabilitative services when the psychosocial rehabilitative services are being provided in non-crisis situations;

(C) four hours per individual per day of skills training and development services; and

(D) six hours per individual per day of day programs for acute needs.

(3) The department will not reimburse a Medicaid provider for:

(A) an MH rehabilitative service that is not included in the individual's recovery plan (except for crisis intervention services documented in accordance with §416.6(b) of this title (relating to Service Authorization and Recovery Plan)) and psychosocial rehabilitative services provided in a crisis situation;

(B) an MH rehabilitative service that is not authorized in accordance with §416.6 of this title (except for crisis intervention services documented in accordance with §416.6(b) of this title);

(C) an MH rehabilitative service provided in excess of the amount authorized in accordance with §416.6(a)(1) of this title;

(D) an MH rehabilitative service provided outside of the duration authorized in accordance with §416.6(b) of this title;

(E) a psychosocial rehabilitative service provided to an individual receiving MH case management services in accordance with Chapter 412, Subchapter I of this title (relating to MH Case Management);

(F) an MH rehabilitative service that is not documented in accordance with §416.12 of this title (relating to Documentation Requirements);

(G) an MH rehabilitative service provided to an individual who does not meet the eligibility criteria as described in §416.5 of this title (relating to Eligibility);

(H) an MH rehabilitative service provided to an individual who does not have a current uniform assessment (except for crisis intervention services documented in accordance with §416.6(b) of this title);

(I) an MH rehabilitative service provided to an individual who is not present, awake, and participating during such service;

(J) an MH rehabilitative service that is provided via electronic media;

(K) a crisis service provided to an individual who does not have a serious mental illness; and

(L) any other activity or service identified as non-reimbursable in the department's MH Rehabilitative Services Billing Guidelines, referenced in §416.17 of this title (relating to Guidelines).

(c) Services provided same time and same day.

(1) If a Medicaid provider provides more than one MH rehabilitative service to an individual at the same time and on the same day, the Medicaid provider may bill for only one of the services provided.

(2) A Medicaid provider may bill for a MH rehabilitative service provided to a child or adolescent's LAR or primary caregiver at the same time and on the same day the child or adolescent is receiving another MH rehabilitative service only if the staff member providing the service to the LAR or primary caregiver is different from the staff member providing the service to the child or adolescent.

(d) Services provided before a fair hearing. If the provision of a MH rehabilitative service is continued prior to a fair hearing decision being rendered, as required by 1 TAC §357.7 (relating to Agency and Designee Responsibilities), the Medicaid provider may bill for such service.
Source Note: The provisions of this §307.327 adopted to be effective January 22, 2014, 39 TexReg 299; transferred effective March 15, 2020, as published in the February 21, 2020 issue of the Texas Register, 45 TexReg 1239.

§306.329 Medicaid Provider Participation Requirements
(a) Qualifications. To become a Medicaid provider of MH rehabilitative services, an entity must:

(1) be established as a community mental health center in accordance with Texas Health and Safety Code, §534.001, that:

(A) provides services comparable to MH rehabilitative services and the services described in the Texas Health and Safety Code, §534.053(a)(1) - (7);

(B) is in compliance with Chapter 412, Subchapter G of this title (relating to Mental Health Community Services Standards);

(C) conducts criminal history clearances on all contractors delivering MH rehabilitative services and all employees and applicants of the Medicaid provider to whom an offer of employment is made and ensures that individuals do not come in contact with and are not provided services by an employee or contractor of the Medicaid provider (or employee or contractor of contractors delivering MH rehabilitative services under a contract with the Medicaid provider) who has a conviction for any of the criminal offenses listed in Texas Health and Safety Code, §250.006, or for any criminal offense that the Medicaid provider has determined to be a contraindication to employment; and

(D) has a Medicaid provider agreement with the department to provide MH rehabilitative services; or

(2) be a corporation incorporated or registered to do business in the State of Texas that:

(A) has completed an application evidencing that it:

(i) provides services comparable to MH rehabilitative services and the services described in the Texas Health and Safety Code, §534.053(a)(1) - (7);

(ii) is in compliance with Chapter 412, Subchapter G, of this title;

(iii) has demonstrated a history of providing, as well as the capacity to continue to provide, services to individuals required to submit to mental health treatment:

(I) under the Texas Code of Criminal Procedure, Article 17.032 (relating to Release on Personal Bond of Certain Mentally Ill Defendants), or Article 42.12 §11(d) (relating to Community Supervision); and

(II) under the Texas Health and Safety Code, Chapter 573 (relating to Emergency Detention) and Chapter 574 (relating to Court-Ordered Mental Health Services); and

(iv) conducts criminal history clearances on all contractors delivering MH rehabilitative services and all employees and applicants of the corporation to whom an offer of employment is made and ensures that individuals do not come in contact with and are not provided services by an employee or contractor of the corporation (or employee or contractor of contractors delivering MH rehabilitative services under a contract with the corporation) who has a conviction for any of the criminal offenses listed in Texas Health and Safety Code, §250.006, or for any criminal offense that the corporation has determined to be a contraindication to employment;

(B) has had its application information confirmed by an on-site visit by the department;

(C) has had its application approved by the department; and

(D) has signed a Medicaid provider agreement with the department to provide MH rehabilitative services.

(b) Compliance. A Medicaid provider must:

(1) comply with all applicable federal and state laws, rules, and regulations, and any Medicaid provider manuals and policy clarification letters promulgated by the department;

(2) document and bill for reimbursement of MH rehabilitative services in the manner and format prescribed by the department;

(3) allow the department access to all individuals and individuals' records;

(4) maintain capacity to provide those services that are described in Texas Health and Safety Code, §534.053(a)(1) - (7); and

(5) maintain capacity to provide services to individuals required to submit to mental health treatment:

(A) under the Texas Code of Criminal Procedure, Article 17.032 (relating to Release on Personal Bond of Certain Mentally Ill Defendants), or Article 42.12 §11(d) (relating to Community Supervision); and

(B) under the Texas Health and Safety Code, Chapter 573 (relating to Emergency Detention) and Chapter 574 (relating to Court-Ordered Mental Health Services).
Source Note: The provisions of this §306.329 adopted to be effective January 22, 2014, 39 TexReg 299; transferred effective March 15, 2020, as published in the February 21, 2020 issue of the Texas Register, 45 TexReg 1239.

§306.331 Fair Hearings and Reviews
(a) Right of Medicaid-eligible individual to request a fair hearing. Any Medicaid-eligible individual whose request for eligibility for MH rehabilitative services is denied or is not acted upon with reasonable promptness, or whose MH rehabilitative services have been terminated, suspended, or reduced by the department is entitled to a fair hearing in accordance with 1 TAC Chapter 357, Subchapter A (relating to Uniform Fair Hearing Rules).

(b) Notice. The Medicaid provider must notify the department or its designee if the provider has reason to believe that an individual's MH rehabilitative services should be denied, reduced or terminated.

(c) Right of non-Medicaid eligible individual to request a review. Any individual who has not applied for or is not eligible for Medicaid whose request for eligibility for MH rehabilitative services is not acted upon with reasonable promptness, or whose MH rehabilitative services have been terminated, suspended, or reduced by a local mental health authority or its contractor is entitled to the right of review and notification in accordance with the department's rules concerning such matters for non-Medicaid-eligible individuals.
Source Note: The provisions of this §306.331 adopted to be effective January 22, 2014, 39 TexReg 299; transferred effective March 15, 2020, as published in the February 21, 2020 issue of the Texas Register, 45 TexReg 1239.

§306.333 Guidelines
The following guidelines are referenced in this subchapter. For information about obtaining copies of the guidelines contact the Department of State Health Services, Mental Health Program Services Section, Mail Code 2018, P.O. Box 149347, Austin, Texas 78714-9347, (512) 467-5427 or access them electronically.

(1) The uniform assessment guidelines are available at: http://www.dshs.state.tx.us/mhprograms/RDMAssess.shtm.

(2) The utilization management guidelines for adults and children are available at: http://www.dshs.state.tx.us/mhprograms/RDMClinGuide.

(3) Patient and family education resources are available at http://www.dshs.state.tx.us/mhsa/patient-family-ed/.

(4) Medicaid MH Rehabilitative Services Billing Guidelines are available at: http://www.dshs.state.tx.us/mhsa/rdm/billing/.
Source Note: The provisions of this §306.333 adopted to be effective January 22, 2014, 39 TexReg 299; transferred effective March 15, 2020, as published in the February 21, 2020 issue of the Texas Register, 45 TexReg 1239.

§306.351 Purpose
The purpose of this subchapter is to require the use and maintenance of the Texas Health and Human Services Commission (HHSC) Psychiatric Drug Formulary.
Source Note: The provisions of this §306.351 adopted to be effective February 24, 2021, 46 TexReg 1246.

§306.352 Application
(a) This subchapter applies to HHSC facilities, HHSC-funded community behavioral health centers (including substance use treatment providers), local authorities, and their respective contractors for medications and medication-related services funded by HHSC. The HHSC Psychiatric Drug Formulary in its entirety applies to all HHSC facilities in all circumstances except when HHSC transfers an individual to a general hospital to receive non-mental health acute care services.

(b) HHSC facilities and local authorities are responsible for drafting contracts with their contractors that provide HHSC-funded medications and medication-related services to ensure that contractors comply with this subchapter.
Source Note: The provisions of this §306.352 adopted to be effective February 24, 2021, 46 TexReg 1246.

§306.353 Definitions
The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise.

(1) Adverse drug reaction--Any response to a drug that is noxious and unintended and occurs at doses normally used in humans.

(2) Contractor--An entity that provides HHSC-funded mental health services pursuant to a contract with a service system component or HHSC.

(3) Drug entity--A specific chemical compound and all its pharmaceutically equivalent salt forms that are used in the diagnosis, cure, mitigation, treatment or prevention of disease.

(4) Emergency--A situation in which it is immediately necessary to administer medication to an individual to prevent:

(A) imminent probable death or substantial bodily harm to the individual because the individual:

(i) overtly or continually is threatening or attempting to commit suicide or serious bodily harm; or

(ii) is behaving in a manner that indicates that the individual is unable to satisfy the individual's need for nourishment, essential medical care, or self-protection; or

(B) imminent serious physical or emotional harm to others as indicated by threats, attempts, or other acts the individual overtly or continually makes or commits.

(5) HHSC--Texas Health and Human Services Commission.

(6) HHSC facility--A facility operated by HHSC, including state hospitals and state supported living centers.

(7) HHSC Psychiatric Drug Formulary--A listing by nonproprietary name of all drugs approved for use by service system components and their contractors that is updated annually, at a minimum.

(8) Individual--Any person receiving services from a service system component or contractor.

(9) Interim Formulary Update--An update to the HHSC Psychiatric Drug Formulary, which is incorporated into the HHSC Psychiatric Drug Formulary.

(10) Local authority--A local mental health authority designated in accordance with Texas Health and Safety Code, §533.035(a), a local behavioral health authority designated in accordance with Texas Health and Safety Code, §533.0356, and a local intellectual and developmental disability authority designated in accordance with Texas Health and Safety Code §533A.035(a).

(11) Mental health services--Any services concerned with the diagnosis, treatment, and care of individuals for a mental illness (known as serious emotional disturbance in reference to children and adolescents), which may be accompanied by a co-occurring diagnosis.

(12) PEFC--Psychiatric Executive Formulary Committee. A committee composed of representatives from the state hospitals, state supported living centers, community behavioral health entities, and others as selected by the state hospitals associate commissioner in consultation with the state supported living center associate commissioner, the behavioral health services associate commissioner, and the intellectual and developmental services associate commissioner. The committee is responsible for the formulation of broad professional policies regarding the evaluation, selection, handling, use, administration, and all other matters relating to the use of drugs and devices in an HHSC facility, local authority, and their respective contractors for medications and medication-related services funded by HHSC.

(13) Pharmacy and Therapeutics Committee--An HHSC facility committee composed of physicians, pharmacists, registered nurses, and others as selected by the facility head, or their designee, that assists in the formulation of broad professional policies regarding the evaluation, selection, distribution, handling, use, administration, and all other matters relating to the use of drugs and devices in the facility.

(14) Practitioner--A person who acts within the scope of a professional license to prescribe, distribute, administer, or dispense a prescription drug or device, (e.g. a physician, registered nurse, advanced practice registered nurse, physician assistant, licensed vocational nurse, pharmacist, or dentist).

(15) Reserve drug--A formulary drug with specific guidelines for use as described in the HHSC Psychiatric Drug Formulary.

(16) Service system component--HHSC, an HHSC facility, and a local authority.
Source Note: The provisions of this §306.353 adopted to be effective February 24, 2021, 46 TexReg 1246.

§306.354 General Requirements
(a) HHSC maintains a closed formulary (HHSC Psychiatric Drug Formulary) that lists drugs approved by the PEFC for use by service system components and their contractors.

(b) A drug is not available for general use by service system components or their contractors unless it is approved by the PEFC. Drugs not listed in the HHSC Psychiatric Drug Formulary or Interim Formulary Update may not be used except under the limited circumstances described in §306.359 of this subchapter (relating to Prescribing Non-formulary Drugs).

(c) The use of formulary drugs in unusual clinical situations or the use of unusual drug combinations must be accompanied by written justification in the individual's medical record. Additional clinical consultation in these situations should occur as deemed necessary by the prescribing practitioner.

(d) Reserve drugs may be prescribed for use outside the guidelines described in the formulary if the prescription is justified in the individual's medical record and reviewed in audits of reserve drug use conducted by the service system component as clinically indicated.

(e) Drug research conducted at an HHSC facility is governed by 25 TAC Chapter 414, Subchapter P (relating to Research in TDMHMR Facilities). Local authorities conducting drug research must comply with all applicable state and federal laws, rules, and regulations, including 45 CFR Part 46, as required by §301.325 of this title (relating to Rights and Protection).
Source Note: The provisions of this §306.354 adopted to be effective February 24, 2021, 46 TexReg 1246.

§306.355 Organization of HHSC Psychiatric Drug Formulary
(a) Drugs are listed in the HHSC Psychiatric Drug Formulary by their nonproprietary names. The list is based on a modified format of the American Hospital Formulary Service Drug Information and includes an alphabetical index. The use of proprietary names, which may follow in parentheses, is for information purposes only and is not meant to be an endorsement. Cost comparisons and prescribing information are provided as determined necessary by the PEFC. The HHSC Psychiatric Drug Formulary provides tables summarizing the recommended dosage ranges for the psychotropic drugs for clinician reference. These tables are intended as guidelines and are not intended to replace other references or the clinician's clinical judgment. Clinicians should consult the approved Food and Drug Administration product labeling or other clinical resources on the appropriate prescribing of psychoactive medications. The HHSC Psychiatric Drug Formulary notes limitations recommended by the PEFC regarding the use of a drug, including specific limitations or guidelines for the use of a reserve drug.

(b) The Interim Formulary Update conforms to the same format as the HHSC Psychiatric Drug Formulary and shall be incorporated into the annual HHSC Psychiatric Drug Formulary.
Source Note: The provisions of this §306.355 adopted to be effective February 24, 2021, 46 TexReg 1246.

§306.356 Responsibilities of the Psychiatric Executive Formulary Committee
(a) The PEFC maintains and updates the HHSC Psychiatric Drug Formulary by:

(1) recommending standards of drug use that discourage unnecessary duplication of therapeutic alternatives and encourage the highest standards of medical and pharmacy practice;

(2) periodically reviewing the drugs listed in the formulary to ensure consistency with need, effectiveness, risk, and cost;

(3) consulting with experts in clinical pharmacy, pharmacology, and other medical specialties as necessary to objectively assess drugs under consideration; and

(4) considering the applications submitted in accordance with §306.357 of this subchapter (relating to Adding a Drug to the HHSC Psychiatric Drug Formulary) or as:

(A) presented by committee members; or

(B) submitted by other qualified persons at the invitation of the PEFC chairperson.

(b) The PEFC may make other recommendations concerning drug use and policy.

(c) Approval of a drug entity for inclusion in the HHSC Psychiatric Drug Formulary does not imply approval of all formulations for that drug. The PEFC designates the formulations that are allowed for general use by service system components and their contractors.

(d) Approval of a drug formulation constitutes approval of all brands of the product that have been proven to be bioequivalent as listed in the then-current Approved Drug Products with Therapeutic Equivalence Evaluations, published by the United States Food and Drug Administration.

(e) For a drug entity that has known bioequivalency problems, the PEFC may limit its use to a specific brand based on objective clinical pharmacokinetic data.
Source Note: The provisions of this §306.356 adopted to be effective February 24, 2021, 46 TexReg 1246.

§306.357 Adding a Drug to the HHSC Psychiatric Drug Formulary
(a) Applying to have a drug added to the HHSC Psychiatric Drug Formulary.

(1) Any member of the PEFC, any service system component practitioner, or any contract practitioner may apply to have a drug added to the HHSC Psychiatric Drug Formulary by completing the New Drug Application form found in the HHSC Psychiatric Drug Formulary on the HHSC Psychiatric Formulary website.

(2) Include the following with the New Drug Application form:

(A) published articles in biomedical literature that substantiate the efficacy and safety of the proposed drug;

(B) information on the advantages of the proposed drug compared with similar formulary drugs;

(C) a list of formulary drugs that the proposed drug would replace or supplement; and

(D) cost effectiveness data.

(b) Submitting the application.

(1) An HHSC facility practitioner or HHSC facility contract practitioner shall submit the application to the facility's pharmacy and therapeutics committee for approval. If the committee approves the application, the committee forwards the application to the PEFC.

(2) A non-facility service system component practitioner or non-facility service system component contract practitioner shall submit the application to the component's clinical/medical director or designee who determines if the application is appropriate and complete, and if so, shall forward the application to the PEFC.

(3) A member of the PEFC shall submit the application directly to the PEFC.

(c) Considering the application. The PEFC considers the drug application and shall:

(1) approve the proposed drug's inclusion and, if appropriate, approve audit criteria and recommend dosage guidelines;

(2) approve the proposed drug on a trial basis for a specified period of time;

(3) approve the proposed drug as a reserve drug, with guidelines;

(4) postpone the decision until a later meeting; or

(5) deny the proposed drug's inclusion.
Source Note: The provisions of this §306.357 adopted to be effective February 24, 2021, 46 TexReg 1246.

§306.358 Changing the HHSC Psychiatric Drug Formulary
(a) Changes to the HHSC Psychiatric Drug Formulary are based on need, effectiveness, risk, and cost as contained in current and unbiased biomedical literature.

(b) The HHSC Psychiatric Drug Formulary is updated and published once a year, at a minimum. Quarterly updates to the HHSC Psychiatric Drug Formulary, if any, will be listed in an Interim Formulary Update.
Source Note: The provisions of this §306.358 adopted to be effective February 24, 2021, 46 TexReg 1246.

§306.359 Prescribing Non-formulary Drugs
(a) Non-formulary drugs may be prescribed:

(1) if no formulary drug exists that is as safe or effective in the specified situation;

(2) if a limited trial of the drug is safer or more effective than any drug listed in the formulary, based on available medical evidence and the prescribing practitioner's clinical judgment;

(3) if the course of therapy established prior to the individual's admission to the facility where he or she is being treated would be interrupted; or

(4) in an emergency.

(b) Each local authority shall develop and enforce written policies and procedures for monitoring and approving the prescribing of non-formulary drugs by its practitioners and contract practitioners.

(c) HHSC shall develop and enforce written policies and procedures for monitoring and approving the prescribing of non-formulary drugs by HHSC facility practitioners and facility contract practitioners.
Source Note: The provisions of this §306.359 adopted to be effective February 24, 2021, 46 TexReg 1246.

§306.360 Adverse Drug Reactions
(a) Each local authority shall develop written policies and procedures for reporting adverse drug reactions to the Food and Drug Administration.

(b) HHSC shall develop written policies and procedures for HHSC facilities for reporting adverse drug reactions to the Food and Drug Administration.
Source Note: The provisions of this §306.360 adopted to be effective February 24, 2021, 46 TexReg 1246.

§306.361 Purpose
The purpose of this subchapter is to establish methods and parameters of service delivery for individuals receiving general revenue-funded behavioral health services that the Texas Health and Human Services Commission (HHSC) determines are clinically effective and cost-effective in accordance with Texas Government Code §548.0002.
Source Note: The provisions of this §306.361 adopted to be effective February 23, 2025, 50 TexReg 997

§306.363 Application
This subchapter applies to:

(1) a local mental health authority (LMHA);

(2) a local behavioral health authority (LBHA);

(3) an HHSC-funded substance use intervention provider;

(4) an HHSC-funded substance use treatment provider; and

(5) a subcontracted provider of an LMHA, LBHA, HHSC-funded substance use intervention provider, and HHSC-funded substance use treatment provider.
Source Note: The provisions of this §306.363 adopted to be effective February 23, 2025, 50 TexReg 997

§306.365 Definitions
The following words and terms, when used in this subchapter, have the following meanings unless the context clearly indicates otherwise.

(1) Audio-only technology--A synchronous interactive, two-way audio communication that uses only sound and that conforms to privacy requirements of the Health Insurance Portability and Accountability Act. Audio-only includes the use of telephonic communication. Audio-only does not include audiovisual or in-person communication.

(2) Audiovisual technology--A synchronous interactive, two-way audio and video communication that conforms to privacy requirements under the Health Insurance Portability and Accountability Act. Audiovisual does not include audio-only or in-person communication.

(3) CFR--Code of Federal Regulations.

(4) HHSC--Texas Health and Human Services Commission or its designee.

(5) HIPAA--The Health Insurance Portability and Accountability Act, 42 U.S.C. §1320d et seq.

(6) Individual--A person seeking or receiving services under this subchapter.

(7) In person or in-person--Within the physical presence of another person. In person or in-person does not include interacting with an individual through audiovisual or audio-only communication.

(8) LAR--Legally authorized representative. A person authorized by state law to act on behalf of an individual.

(9) LBHA--Local behavioral health authority. An entity designated as the local behavioral health authority by HHSC in accordance with Texas Health and Safety Code §533.0356.

(10) LMHA--Local mental health authority. An entity designated as the local mental health authority by HHSC in accordance with Texas Health and Safety Code §533.035(a).

(11) Provider--A person or entity that contracts to deliver services under this subchapter with:

(A) HHSC;

(B) an LMHA;

(C) an LBHA;

(D) an HHSC-funded substance use intervention provider; or

(E) an HHSC-funded substance use treatment provider.
Source Note: The provisions of this §306.365 adopted to be effective February 23, 2025, 50 TexReg 997

§306.367 General Provisions
(a) A provider may deliver services as permitted under this subchapter, if such delivery is permitted under the provider's state license, permit, or other legal authorization.

(b) If a behavioral health service has a procedure code that is billable in Medicaid, but the service is funded through general revenue, a provider must adhere to:

(1) the Texas Medicaid Provider Procedures Manual and the Behavioral Health and Case Management Services Handbook posted on the Texas Medicaid and Healthcare Partnership website;

(2) the Texas Medicaid Provider Procedures Manual and Telecommunications Services Handbook posted on the Texas Medicaid and Healthcare Partnership website; and

(3) other Medicaid guidance concerning delivery of behavioral health services by audiovisual technology and audio-only technology.

(c) A provider may deliver behavioral health services that do not have a procedure code billable in Medicaid either in person, by audiovisual technology, or by audio-only technology.

(d) A provider delivering behavioral health services by audiovisual technology or audio-only technology as permitted under this subchapter must:

(1) deliver behavioral health services in person or use audiovisual technology rather than audio-only technology, whenever possible;

(2) offer the option of in-person service delivery and not require an individual to receive services through audiovisual technology or audio-only technology;

(3) defer to the needs of the individual receiving services, allowing the method of service delivery to be accessible, person-centered and family-centered, and driven primarily by the individual's choice rather than provider convenience;

(4) only deliver the service by audiovisual technology and audio-only technology if agreed to by the individual or LAR;

(5) determine that providing the service by audiovisual technology or audio-only technology is clinically appropriate and safe;

(6) deliver services in compliance with state standards set forth in Texas Health and Safety Code §533.035(d) and §533.0356(h), Texas Health and Safety Code Chapter 464, and in accordance with applicable HHSC rules; and

(7) maintain the confidentiality of protected health information as required by 42 CFR Part 2, 45 CFR Parts 160 and 164, Texas Occupations Code Chapter 159, Texas Health and Safety Code Chapter 611, and other applicable federal and state law.

(e) A provider must ensure any software or technology used complies with all applicable state and federal requirements, including HIPAA confidentiality and data encryption requirements, and with the United States Department of Health and Human Services rules implementing HIPAA confidentiality and data encryption requirements.
Source Note: The provisions of this §306.367 adopted to be effective February 23, 2025, 50 TexReg 997

§306.369 Documentation Requirements
(a) A provider must accurately document the services rendered and identify the method of service delivery. Documentation requirements for behavioral health services delivered by audiovisual technology or audio-only technology are the same as for service delivery in person.

(b) Before delivering a behavioral health service by audio-only technology, a provider must:

(1) obtain informed consent from the individual or LAR except when doing so is not feasible or could result in death or injury to the individual;

(2) if applicable, document in the individual's medical record that informed consent was obtained verbally; and

(3) document the reason why the provider delivered services by audio-only technology.

(c) A provider must adhere to documentation requirements in accordance with publications and conditions described in §306.367(b) of this subchapter (relating to General Provisions) if the general revenue-funded behavioral health service has a procedure code that is billable in Medicaid.
Source Note: The provisions of this §306.369 adopted to be effective February 23, 2025, 50 TexReg 997

§306.1251 Disaster Flexibilities
(a) In the event of a state of disaster declared pursuant to Texas Government Code §418.014 for statewide disasters or limited areas subject to the declaration, the flexibilities listed under subsection (c) of this section will be available until the state of disaster is terminated.

(b) Telehealth and telemedicine have the same meaning as the terms telehealth services and telemedicine medical services defined in §111.001 of the Texas Occupations Code (relating to Definitions).

(c) The following flexibilities are available to community behavioral health providers to the extent such providers are providing services under Title 25, Part 1 or Title 26, Part 1 of the Texas Administrative Code (TAC) and to the extent the flexibilities do not conflict with federal or state laws, regulations, rules, or orders.

(1) For rules under Title 25, Part 1 and Title 26, Part 1 of the TAC that require a community behavioral health provider to deliver certain services:

(A) through face-to-face or in-person contact, such as the following rules, the provider may use telehealth, telemedicine, video-conferencing, or telephonic methods to engage with the individual to provide these services, to the extent such use is permitted within the scope of the provider's state license, permit, or other legal authorization:

(i) §301.327 of this title (relating to Access to Mental Health Community Services);

(ii) §301.351 of this title (relating to Crisis Services);

(iii) §301.353 of this title (relating to Provider Responsibilities for Treatment Planning and Service Authorization);

(iv) §301.357 of this title (relating to Additional Standards of Care Specific to Mental Health Community Services for Children and Adolescents);

(v) §301.359 of this title (relating to Telemedicine Services);

(vi) §306.207 of this chapter (relating to Post Discharge or Absence for Trial Placement: Contact and Implementation of the Recovery or Treatment Plan);

(vii) §306.263 of this chapter (relating to MH Case Management Services Standards);

(viii) §306.275 of this chapter (relating to Documenting MH Case Management Services);

(ix) §306.277 of this chapter (relating to Medicaid Reimbursement);

(x) §306.305 of this chapter (relating to Definitions);

(xi) §306.323 of this chapter (relating to Documentation Requirements);

(xii) §306.327 of this chapter (relating to Medicaid Reimbursement);

(xiii) §307.53 of this title (relating to Eligibility Criteria and HCBS-AMH Assessment);

(xiv) 25 TAC §415.10 (relating to Medication Monitoring); and

(xv) 25 TAC §415.261 (relating to Time Limitation on an Order for Restraint or Seclusion Initiated in Response to a Behavioral Emergency); or

(B) in a specific physical space or on site, such as 25 TAC §414.554 (relating to Responsibilities of Local Authorities, Community Centers, and Contractors), the provider may deliver the service using virtual platforms, such as telephone or videoconferencing.

(2) Section 307.5 of this title (relating to Eligibility Criteria) that require a child or adolescent participating in the Youth Empowerment Services (YES) Waiver Program to reside with their legally authorized representative to receive services may reside with another responsible adult. Providers must ensure the alternate residency complies with any applicable requirements related to participation in the YES Waiver Program. The flexibility allowed under this subsection IS NOT IN EFFECT unless and until the Centers for Medicare & Medicaid Services approves HHSC's request for activation of Appendix-K.

(3) For rules under Title 25, Part 1 and Title 26, Part 1 of the TAC that require staff training through face-to-face or in-person contact or in a specific physical space or on site, staff training may be done on virtual platforms.

(4) For rules under Title 25, Part 1 and Title 26, Part 1 of the TAC where HHSC may issue guidance to extend timeframe flexibilities:

(A) the extended timeframe may not be longer than 120 days for compliance with staff training requirements based on training availability and feasibility during, or resulting from, a declared disaster; and

(B) an individual's or staff member's health or safety shall not be compromised by the flexibilities for training requirements provided in:

(i) §306.83 of this chapter (relating to Staff Training); and

(ii) §301.331 of this title (relating to Competency and Credentialing).

(d) Providers that avail themselves of the flexibilities allowed under subsection (c) of this section, must comply with:

(1) all guidance on the application of the rules during the declaration of disaster that is published by HHSC on its website or in another communication format HHSC determines appropriate; and

(2) all policy guidance applicable to the rules identified in subsection (c) of this section issued by the Texas Health and Human Service Commission Medicaid Services Department.

(e) Providers must ensure any method of contact complies with all applicable requirements related to security and privacy of information.
Source Note: The provisions of this §306.1251 adopted to be effective November 15, 2021, 46 TexReg 7639.