Section 354.2701 - Eligible Individuals(a) Mental health rehabilitation services are available to a child or youth who: (1) is a resident of the State of Texas;(2) is a recipient of the Texas Medicaid Program; and(3) has a diagnosis or diagnoses of mental illness or serious emotional disturbance as defined in the latest edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, not including a single diagnosis of an intellectual or developmental disability or a substance use disorder and who: (A) has been determined via the uniform assessment process as described in § 354.2607 of this subchapter (relating to Assessment and Service Authorization) to have serious functional impairments and is in need of mental health rehabilitation services;(B) is at risk of disruption of a preferred living or child-care environment due to psychiatric symptoms; or(C) is enrolled in a school system's special education program because of serious emotional disturbance.(b) Mental health rehabilitation services are available to an adult who: (1) is a resident of the State of Texas;(2) is a recipient of the Texas Medicaid Program;(3) has a diagnosis or diagnoses of mental illness as defined in the latest edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, not including a single diagnosis of an intellectual or developmental disability, dementia, or a substance use disorder; and(4) who has been determined via an assessment process based on § 354.2607 of this subchapter to have serious functional impairments and is in need of mental health rehabilitation services.(c) An individual is not eligible for Medicaid-funded mental health rehabilitation services if the individual: (1) is an inmate of a public institution, as defined in RSA 435.1009;(2) is a resident of an intermediate care facility for individuals with an intellectual disability or related conditions as described in RSA 440.150;(3) is a resident of an IMD;(4) is a patient of a general medical hospital; or(5) is a resident of a nursing facility who has not been identified through the Preadmission Screening and Resident Review (PASSR) process as needing specialized mental health services.1 Tex. Admin. Code § 354.2701
Adopted by Texas Register, Volume 43, Number 41, October 12, 2018, TexReg 6824, eff. 10/17/2018