Section 354.2655 - Mental Health Targeted Case Management Services(a) Mental health targeted case management services are provided to eligible individuals to assist them in gaining access to needed medical, social/behavioral, educational, and other services and supports that are appropriate to the individual's needs.(b) Mental health targeted case management includes:(1) development and periodic revision of a specific recovery/treatment plan, per § 354.2609 of this subchapter (relating to Recovery/Treatment Planning, Recovery/Treatment Plan Review, and Discharge Summary);(2) making referrals and performing other related activities to help an individual obtain needed services and supports, including activities that help link an individual with:(A) medical, social/behavioral, and educational providers; and(B) other providers that provide needed services to address identified needs and achieve goals in the recovery/treatment plan;(3) monitoring and follow up activities of service effectiveness, with the individual, family members, providers, or other entities or individuals, that occur regularly or at least annually to ensure the recovery/treatment plan is implemented and adequately addresses the individual's needs; and(4) coordination with, and not duplication of, activities provided as part of institutional services and discharge planning activities that take place at inpatient facilities.(c) Mental health targeted case management services must be provided, at minimum, by an individual credentialed as a QMHP-CS and in accordance with the requirements of the Texas Medicaid Provider Procedures Manual (TMPPM), including all updates and revisions and all handbooks, standards, and guidelines as determined by HHSC or a managed care organization (MCO) with which they contract.(d) Mental health targeted case management, as described in this section, may be delivered as a telemedicine medical service or a telehealth service, including via an audio-only platform, in accordance with the requirements and limitations of Subchapter A, Division 33 of this chapter (relating to Advanced Telecommunications Services.)(e) A mental health targeted case manager must be assigned to an individual within two business days after receiving notification that the individual has been authorized to receive mental health targeted case management services.(f) The assigned mental health targeted case manager must:(1) meet with the individual and the individual's LAR or primary caregiver within seven calendar days after the case manager is assigned;(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 individual's strengths, service needs, and assistance required to address identified needs;(4) identify the goals and actions required to meet the individual's identified needs;(5) take the steps necessary to accomplish the goals required to meet the individual's identified needs by using referral, linking, advocacy, and monitoring;(6) meet with the individual at the individual's, the LAR's, or the primary caregiver's request, or document why the meeting did not occur;(7) meet with the LAR, with or without the individual present, to provide a service that assists the individual in gaining and coordinating access to necessary care and services;(8) meet 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; and(9) if notified that the individual is in crisis, coordinate with the appropriate providers of emergency services to respond to the crisis.(g) Intensive case management services, available only to children and youth, incorporate wraparound process planning in the approach to recovery/treatment planning and recovery/treatment plan implementation. The assigned mental health targeted case manager must: (1) incorporate wraparound process planning in developing a recovery/treatment plan that addresses the child's or youth's unmet needs across life domains and includes, in addition to the required elements listed in § 354.2609 of this subchapter: (A) a list of the child's or youth's natural strengths and supports;(B) a crisis plan developed in collaboration with the LAR, caregiver, and family;(C) a prioritized list of the child's or youth's unmet needs that includes a discussion of the priorities and needs expressed by the child or youth and the LAR or primary caregiver;(D) a description of the objective and measurable outcomes for each of the unmet needs as well as a projected time frame for each outcome;(E) a description of the actions the child or youth, the case manager, and other designated people must take to achieve those outcomes;(F) a list of the necessary services, service providers and the availability of the services; and(G) a statement of the maximum period between contacts with the child or youth, and the LAR or primary caregiver, determined in accordance with the utilization management guidelines;(2) develop and document an intensive case management plan based on the child's or youth's needs that may include information across life domains from relevant sources such as the child or youth, the LAR or primary caregiver, other agencies and organizations providing services to the child or youth, the child's or youth's medical record, and other sources identified by the child or youth, LAR, or primary caregiver;(3) ensure services are delivered in clinically appropriate, client-centered, community-based settings;(4) meet with the child or youth and the LAR or primary caregiver: (A) within seven calendar days after the case manager is assigned to the child or youth or document the reasons the meeting did not occur;(B) within seven calendar days after discharge from an inpatient psychiatric setting or document the reasons the meeting did not occur; and(C) according to the child's or youth's recovery/treatment plan or document the reasons the meeting did not occur;(5) take necessary steps to assist the child or youth in gaining access to needed services and service providers, and document these activities, including: (A) making referrals to potential service providers;(B) initiating contact with potential service providers;(C) arranging, facilitating linkages, and accompanying the child or youth to initial meetings and non-routine appointments;(D) arranging transportation to ensure the child's or youth's attendance at appointments with services providers;(E) advocating with service providers; and(F) providing relevant information to service providers; and(6) monitor the child's or youth's progress toward the outcomes set forth in the recovery/treatment plan, including: (A) gathering information from the child or youth, current service providers, LAR, primary caregiver, and other resources;(B) reviewing pertinent documentation, including the child's or youth's clinical records and assessments;(C) ensuring that the recovery/treatment 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 youth;(H) identifying emerging unmet service needs;(I) determining whether the recovery/treatment plan needs to be modified to address the child's or youth's unmet service needs more adequately; and(J) revising the recovery/treatment plan as necessary to address the child's or youth's unmet service needs.1 Tex. Admin. Code § 354.2655
Adopted by Texas Register, Volume 43, Number 41, October 12, 2018, TexReg 6823, eff. 10/17/2018; Amended by Texas Register, Volume 48, Number 03, January 20, 2023, TexReg 0211, eff. 1/23/2023