reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter M - MENTAL HEALTH TARGETED CASE MANAGEMENT AND MENTAL HEALTH REHABILITATION › Division 1 - GENERAL PROVISIONS › Section 354.2607 - Assessment and Service Authorization

Current through Reg. 49, No. 28; July 12, 2024
(a)
					 Assessment.
(1) A QMHP-CS with appropriate
					 supervision and training must perform an assessment of an individual in
					 accordance with the requirements of the Texas Medicaid Provider Procedures
					 Manual (TMPPM), including all updates and revisions, and all the handbooks,
					 standards, and guidelines as determined by HHSC or a managed care organization
					 (MCO) with which they contract.
(2)
					 An assessment of an individual may be performed 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).
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter M - MENTAL HEALTH TARGETED CASE MANAGEMENT AND MENTAL HEALTH REHABILITATION › Division 1 - GENERAL PROVISIONS › Section 354.2609 - Recovery/Treatment Planning, Recovery/Treatment Plan Review, and Discharge Summary

Current through Reg. 49, No. 28; July 12, 2024
(a) Timeframe for recovery/treatment plan.
(1) A comprehensive provider agency must
					 comply 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.
(2) Recovery,
					 treatment planning, treatment plan review, and discharge summaries, 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).
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter M - MENTAL HEALTH TARGETED CASE MANAGEMENT AND MENTAL HEALTH REHABILITATION › Division 1 - GENERAL PROVISIONS › Section 354.2611 - Pharmacological Management, Psychiatric Diagnostic Evaluations, and Psychotherapy

Current through Reg. 49, No. 28; July 12, 2024
(a) Service
					 Array. A comprehensive provider agency must have the capability to deliver
					 pharmacological management, psychiatric diagnostic evaluation, and
					 psychotherapy, either directly or through subcontract(s).
(b) Pharmacological management.
					 Pharmacological management is the in-depth management of psychopharmacological
					 agents to treat a client's mental health symptoms. Pharmacological management
					 is a physician service and cannot be provided by a non-physician or "incident
					 to" a physician service, with the exception of advanced practice registered
					 nurses and physician assistants whose scope of license in Texas permits them to
					 prescribe under delegation of prescriptive authority. Supporting documentation
					 for pharmacological management must include:
(1) complete diagnosis using diagnostic
					 criteria from the latest edition of the American Psychiatric Association's
					 Diagnostic and Statistical Manual of Mental Disorders;
(2) current list of medications;
(3) current psychiatric symptoms and
					 problems, to include presenting mental status;
(4) problems, reactions, and side effects, if
					 any, to medications;
(5) any
					 medication modifications made during the visit and the reasons for medication
					 adjustments, including the discontinuation of a medication;
(6) desired therapeutic drug levels, if
					 applicable, for medications requiring blood level monitoring;
(7) current laboratory values, if applicable,
					 for medications requiring monitoring for potential side effects; and
(8) the individual's related treatment
					 goals.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter M - MENTAL HEALTH TARGETED CASE MANAGEMENT AND MENTAL HEALTH REHABILITATION › Division 1 - GENERAL PROVISIONS › Section 354.2613 - Criminal History Background Checks

Current through Reg. 49, No. 28; July 12, 2024
A comprehensive provider agency must obtain a criminal
						history background check on each staff member and applicant to whom an offer of
						employment is made if the responsibilities of the position include personal
						contact with an individual receiving services, in order to ensure that
						individuals do not come in contact with and are not provided services by a
						staff member 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 comprehensive provider agency has determined to be a contraindication to
						employment.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter M - MENTAL HEALTH TARGETED CASE MANAGEMENT AND MENTAL HEALTH REHABILITATION › Division 2 - MENTAL HEALTH TARGETED CASE MANAGEMENT › Section 354.2651 - Eligible Individuals

Current through Reg. 49, No. 28; July 12, 2024
(a) Mental health
					 targeted case management is 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 targeted case management
					 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.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter M - MENTAL HEALTH TARGETED CASE MANAGEMENT AND MENTAL HEALTH REHABILITATION › Division 2 - MENTAL HEALTH TARGETED CASE MANAGEMENT › Section 354.2653 - Continued Eligibility

Current through Reg. 49, No. 28; July 12, 2024
Continued eligibility for mental health targeted case
						management services is based on:
(1)
					 the eligibility criteria described in §354.2651 of this division (relating
					 to Eligible Individuals);
(2) a
					 reassessment by the comprehensive provider agency every:
(A) 90 days for children and youth;
					 or
(B) 180 days for adults;
					 and
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter M - MENTAL HEALTH TARGETED CASE MANAGEMENT AND MENTAL HEALTH REHABILITATION › Division 2 - MENTAL HEALTH TARGETED CASE MANAGEMENT › Section 354.2655 - Mental Health Targeted Case Management Services

Current through Reg. 49, No. 28; July 12, 2024
(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.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter M - MENTAL HEALTH TARGETED CASE MANAGEMENT AND MENTAL HEALTH REHABILITATION › Division 2 - MENTAL HEALTH TARGETED CASE MANAGEMENT › Section 354.2657 - Documentation Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) Mental health
					 targeted case management documentation. Mental health targeted case management
					 services must be documented in the individual's medical record. Case managers
					 are required to maintain a record of every individual receiving mental health
					 targeted case management, including:
(1) the
					 name of the individual;
(2) the
					 name of the comprehensive provider agency and the name of the assigned case
					 manager;
(3) the date, nature,
					 content, and units of each service received and whether goals specified in the
					 recovery/treatment plan have been achieved;
(4) whether the individual has declined
					 services in the recovery/treatment plan;
(5) the need for, and occurrences of,
					 coordination with other staff members;
(6) a timeline for obtaining needed services;
					 and
(7) a timeline for reevaluation
					 of the recovery/treatment plan.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter M - MENTAL HEALTH TARGETED CASE MANAGEMENT AND MENTAL HEALTH REHABILITATION › Division 2 - MENTAL HEALTH TARGETED CASE MANAGEMENT › Section 354.2659 - Exclusions

Current through Reg. 49, No. 28; July 12, 2024
(a) The following services are not covered as
					 mental health targeted case management:
(1)
					 case management activities that are an integral component of another covered
					 Medicaid service;
(2) the provision
					 of a medical, educational, social/behavioral, or another service to which an
					 individual has been referred, including foster care services;
(3) performing an activity that does not
					 directly assist an individual in gaining or coordinating access to needed
					 services;
(4) providing medical or
					 nursing services;
(5) performing
					 pre-admission or intake activities;
(6) providing services to the LAR or primary
					 caregiver of the individual outside of the services allowable under this
					 subchapter;
(7) transporting the
					 individual, LAR, or primary caregiver outside of what is allowable under this
					 subchapter;
(8) monitoring the
					 individual's general health status;
(9) performing outreach activities;
(10) performing quality oversight of a
					 service provider;
(11) conducting
					 utilization review or utilization management activities;
(12) conducting quality assurance activities;
					 and
(13) authorizing services or
					 authorizing the provision of services.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter M - MENTAL HEALTH TARGETED CASE MANAGEMENT AND MENTAL HEALTH REHABILITATION › Division 3 - MENTAL HEALTH REHABILITATION › Section 354.2701 - Eligible Individuals

Current through Reg. 49, No. 28; July 12, 2024
(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.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter M - MENTAL HEALTH TARGETED CASE MANAGEMENT AND MENTAL HEALTH REHABILITATION › Division 3 - MENTAL HEALTH REHABILITATION › Section 354.2703 - Continued Eligibility

Current through Reg. 49, No. 28; July 12, 2024
(a) A QMHP-CS
					 conducts an assessment, as described in § 354.2607 of this subchapter
					 (relating to Assessment and Service Authorization), to determine the
					 individual's continued eligibility for mental health rehabilitative services,
					 based on the eligibility requirements described in §354.2701 of this
					 division (relating to Eligible Individuals).
(b) An adult is automatically eligible for
					 continued services, regardless of whether his or her level of functioning has
					 improved and regardless of requirements described in this section, if the
					 individual has a diagnosis of:
(1)
					 schizophrenia;
(2) bipolar
					 disorder; or
(3) major depressive
					 disorder with a level of functioning that qualified the individual
					 initially.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter M - MENTAL HEALTH TARGETED CASE MANAGEMENT AND MENTAL HEALTH REHABILITATION › Division 3 - MENTAL HEALTH REHABILITATION › Section 354.2705 - Mental Health Rehabilitative Services

Current through Reg. 49, No. 28; July 12, 2024
Mental health rehabilitative services are interventions
						that provide assistance to individuals in maintaining functioning and achieving
						rehabilitation goals as defined in the individual's recovery/treatment plan.
						Mental health rehabilitative services include:
(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.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter M - MENTAL HEALTH TARGETED CASE MANAGEMENT AND MENTAL HEALTH REHABILITATION › Division 3 - MENTAL HEALTH REHABILITATION › Section 354.2707 - Crisis Intervention Services

Current through Reg. 49, No. 28; July 12, 2024
(a) Crisis
					 intervention services are intensive, community-based, one-to-one services
					 provided to an individual who requires services to control acute symptoms that
					 place the individual at immediate risk of hospitalization, incarceration, or
					 placement in a more restrictive treatment setting. The intervention:
(1) is in response to a crisis;
(2) seeks to reduce or manage symptoms of
					 serious mental illness or serious emotional disturbance; and
(3) seeks to prevent admission of the
					 individual to a more restrictive environment.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter M - MENTAL HEALTH TARGETED CASE MANAGEMENT AND MENTAL HEALTH REHABILITATION › Division 3 - MENTAL HEALTH REHABILITATION › Section 354.2709 - Medication Training and Support Services

Current through Reg. 49, No. 28; July 12, 2024
(a) Medication training and support services
					 must assist an individual in:
(1)
					 understanding the nature of the individualTs serious mental illness or serious
					 emotional disturbance;
(2)
					 understanding the concepts of recovery and resilience within the context of the
					 serious mental illness or serious emotional disturbance;
(3) understanding the role of the
					 individualTs prescribed medications in reducing symptoms and increasing or
					 maintaining his/her functioning;
(4) identifying and managing the individualTs
					 symptoms and potential side effects of his/her medication;
(5) learning the contraindications of the
					 individualTs medication;
(6)
					 understanding the overdose precautions of the individualTs medication;
					 and
(7) learning
					 self-administration of the individual's medication.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter M - MENTAL HEALTH TARGETED CASE MANAGEMENT AND MENTAL HEALTH REHABILITATION › Division 3 - MENTAL HEALTH REHABILITATION › Section 354.2711 - Psychosocial Rehabilitative Services

Current through Reg. 49, No. 28; July 12, 2024
(a)
					 Psychosocial rehabilitative services must include the following services, as
					 determined necessary for every individual:
(1)
					 independent living;
(2)
					 coordination;
(3) employment
					 related;
(4) housing related;
					 and
(5) medication
					 related.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter M - MENTAL HEALTH TARGETED CASE MANAGEMENT AND MENTAL HEALTH REHABILITATION › Division 3 - MENTAL HEALTH REHABILITATION › Section 354.2713 - Skills Training and Development Services

Current through Reg. 49, No. 28; July 12, 2024
(a)
					 Skills training and development is training provided to an individual or the
					 LAR or primary caregiver of an individual. The training:
(1) addresses serious mental illness or
					 serious emotional disturbance and symptom-related problems that interfere with
					 the individual's functioning;
(2)
					 provides opportunities for the individual to acquire and improve skills needed
					 to function in the community as appropriately and independently as possible;
					 and
(3) facilitates the
					 individual's community integration.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter M - MENTAL HEALTH TARGETED CASE MANAGEMENT AND MENTAL HEALTH REHABILITATION › Division 3 - MENTAL HEALTH REHABILITATION › Section 354.2715 - Day Programs for Acute Needs

Current through Reg. 49, No. 28; July 12, 2024
(a)
					 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) include 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; and
(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.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter M - MENTAL HEALTH TARGETED CASE MANAGEMENT AND MENTAL HEALTH REHABILITATION › Division 3 - MENTAL HEALTH REHABILITATION › Section 354.2717 - Exclusions

Current through Reg. 49, No. 28; July 12, 2024
(a) Mental health rehabilitative services do
					 not include:
(1) job task-specific vocational
					 services;
(2) educational
					 services;
(3) room and board
					 residential costs;
(4) services
					 that are an integral and inseparable part of another Medicaid-reimbursable
					 service, including targeted case management services, residential
					 rehabilitative behavioral health services, institutional, and waiver
					 services;
(5) services that are
					 covered elsewhere in the state Medicaid plan;
(6) respite services; or
(7) family support services.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter N - PEER SPECIALIST SERVICES › Division 1 - GENERAL PROVISIONS › Section 354.3001 - Purpose and Applicability

Current through Reg. 49, No. 28; July 12, 2024
(a) Peer
					 specialists providing services under this subchapter support recipients with a
					 mental health condition and/or substance use disorder to actively plan and work
					 toward long-term recovery.
(b) This
					 subchapter establishes requirements for providing peer specialist services
					 through Medicaid and applies only to peer specialist services that are Medicaid
					 reimbursable under this subchapter and other applicable rule or law.
(c) This subchapter implements §
											RSA
					 531.0999 of the Texas Government Code and
					 §
											RSA
					 32.024(kk) of the Texas
					 Human Resources Code, which requires HHSC to include peer specialists as
					 Medicaid providers.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter N - PEER SPECIALIST SERVICES › Division 1 - GENERAL PROVISIONS › Section 354.3003 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this
						subchapter, have the following meanings unless the context clearly indicates
						otherwise.
(1) Adult--A person who is
					 21 years or older.
(2)
					 Certification entity--An organization approved by HHSC to certify:
(A) peer specialists;
(B) peer specialist supervisors;
					 and
(C) peer specialist training
					 entities.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter N - PEER SPECIALIST SERVICES › Division 2 - MENTAL HEALTH TARGETED CASE MANAGEMENT › Section 354.3011 - Eligibility to Receive Services

Current through Reg. 49, No. 28; July 12, 2024
A recipient must:
(1) be an adult;
(2) be a Medicaid recipient;
(3) have a mental health condition or
					 substance use disorder, or both; and
(4) have peer specialist services included in
					 the recipient's person-centered recovery plan.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter N - PEER SPECIALIST SERVICES › Division 2 - MENTAL HEALTH TARGETED CASE MANAGEMENT › Section 354.3013 - Services Provided

Current through Reg. 49, No. 28; July 12, 2024
(a) All peer
					 specialist services must be recovery-oriented, person-centered,
					 relationship-focused, and trauma-informed.
(b) Peer specialist services may include:
(1) recovery and wellness support, which
					 includes providing information on and support with planning for
					 recovery;
(2) mentoring, which
					 includes serving as a role model and providing assistance in finding needed
					 community resources and services; and
(3) advocacy, which includes providing
					 support in stressful or urgent situations, and helping to ensure that the
					 recipient's rights are respected.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter N - PEER SPECIALIST SERVICES › Division 2 - MENTAL HEALTH TARGETED CASE MANAGEMENT › Section 354.3015 - Medicaid Reimbursement

Current through Reg. 49, No. 28; July 12, 2024
(a) Peer
					 specialist services must be documented in a recipient's person-centered
					 recovery plan.
(b) Medicaid mental
					 health rehabilitation services are billed separately from the peer specialist
					 services described in this chapter.
(c) The amount, duration, and scope of peer
					 specialist services available through the Texas Medicaid Program are
					 established according to applicable federal regulations, the Texas state plan
					 for medical assistance under Title XIX of the Social Security Act, state law,
					 and HHSC rules. Information regarding benefits and limitations is available to
					 providers of these services through the Texas Medicaid Provider Procedures
					 Manual.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter N - PEER SPECIALIST SERVICES › Division 3 - MENTAL HEALTH REHABILITATION › Section 354.3051 - Minimum Qualifications

Current through Reg. 49, No. 28; July 12, 2024
(a) A peer
					 specialist must:
(1) be at least 18 years of
					 age;
(2) have lived
					 experience;
(3) have a high school
					 diploma or General Equivalency Diploma (GED);
(4) be willing to appropriately share his own
					 recovery story with recipients;
(5)
					 be able to demonstrate current self-directed recovery; and
(6) pass criminal history and registry checks
					 as described in § 354.3201 of this subchapter (relating to Criminal
					 History and Registry Checks).
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter N - PEER SPECIALIST SERVICES › Division 3 - MENTAL HEALTH REHABILITATION › Section 354.3053 - Scope of Work

Current through Reg. 49, No. 28; July 12, 2024
(a) A peer
					 specialist provides peer specialist services as described in § 354.3013 of
					 this subchapter (relating to Services Provided).
(b) A peer specialist may also provide mental
					 health rehabilitative services that are within the peer specialist's knowledge
					 and abilities.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter N - PEER SPECIALIST SERVICES › Division 3 - MENTAL HEALTH REHABILITATION › Section 354.3055 - Ethical Responsibilities

Current through Reg. 49, No. 28; July 12, 2024
(a) A peer
					 specialist may not:
(1) practice
					 psychotherapy, make clinical or diagnostic assessments, or dispense expert
					 opinions;
(2) engage in any service
					 that requires a license;
(3)
					 falsify any documentation related to application, training, testing,
					 certification, or services provided under this subchapter;
(4) retaliate against any person who, in good
					 faith, makes a complaint or files a grievance against the peer specialist
					 regarding services provided under this subchapter;
(5) engage in conduct that is prohibited by
					 state, federal, or local law, including those laws prohibiting the use,
					 possession, or distribution of drugs or alcohol;
(6) participate in, condone, or promote
					 discrimination on the basis of race, creed, color, national origin, gender,
					 sexual orientation, religion, age, physical disability, or economic status in
					 the performance of peer specialist services or training;
(7) delay or fail to report suspicion of
					 abuse or neglect to the proper authority;
(8) violate law, rule, or policy related to a
					 recipient's privacy and confidentiality;
(9) violate professional and personal
					 boundaries, including having sexual contact with a recipient; or
(10) have a dual relationship with a
					 recipient.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter N - PEER SPECIALIST SERVICES › Division 4 - ORGANIZATIONS IN WHICH PEER SPECIALISTS DELIVER SERVICES › Section 354.3101 - Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) An organization in which peer specialists
					 deliver services must provide supervision for peer specialists as described in
					 §354.3103 of this division (relating to Supervision of Peer
					 Specialists).
(b) In order to be
					 reimbursed by Medicaid for peer specialist services under this subchapter, an
					 organization must:
(1) be a Medicaid-enrolled
					 provider in Texas;
(2) comply with
					 all applicable federal, state, and local laws and regulations;
(3) bill for covered peer specialist services
					 in a manner and format prescribed by HHSC; and
(4) maintain documentation as specified in
					 the Texas Medicaid Provider Procedures Manual.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter N - PEER SPECIALIST SERVICES › Division 4 - ORGANIZATIONS IN WHICH PEER SPECIALISTS DELIVER SERVICES › Section 354.3103 - Supervision of Peer Specialists

Current through Reg. 49, No. 28; July 12, 2024
(a) Peer
					 specialist supervision must focus on a peer specialist's provision of services,
					 including review of cases and activities, skill building, problem resolution,
					 and professional growth. Supervision may also include aspects specific to the
					 organization, such as following organizational policy or other administrative
					 matters.
(b) Peer specialist
					 supervision must occur:
(1) at least once
					 weekly for a peer specialist with an initial certification;
(2) at least once monthly for a peer
					 specialist with a two-year certification; or
(3) more frequently at the request of the
					 peer specialist.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter N - PEER SPECIALIST SERVICES › Division 4 - ORGANIZATIONS IN WHICH PEER SPECIALISTS DELIVER SERVICES › Section 354.3105 - Peer Specialist Supervisor Minimum Qualifications

Current through Reg. 49, No. 28; July 12, 2024
(a) A peer specialist supervisor must:
(1) be at least 18 years of age;
(2) be a:
(A) QCC;
(B) LPHA;
(C) QMHP-CS, with a QCC or LPHA supervising
					 the QMHP-CS; or
(D) QPS, with a QCC
					 or LPHA supervising the QPS;
(3) pass criminal history and registry checks
					 as described in § 354.3201 of this subchapter (relating to Criminal
					 History and Registry Checks);
(4)
					 meet the training requirements in § 354.3163 of this subchapter (relating
					 to Supervisor Training) and § 354.3165 of this subchapter (relating to
					 Peer Specialist Supervisor Certification Renewal Training); and
(5) be a certified peer specialist supervisor
					 under this subchapter.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter N - PEER SPECIALIST SERVICES › Division 5 - MENTAL HEALTH REHABILITATION › Section 354.3151 - Training Entity Minimum Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) A training entity must have:
(1) a physical location in Texas;
(2) experience in training or sponsoring
					 training for paraprofessionals;
(3)
					 experience in training or sponsoring training that uses adult learning
					 principles;
(4) experience in
					 training or sponsoring training related to elements of peer specialist
					 services;
(5) a plan to provide
					 training for at least one of the following:
(A) peer specialists, including:
(i) core training; and
(ii) at least one type of supplemental
					 training; or
(B) peer
					 specialist supervisors under §354.3163 of this division (relating to
					 Supervisor Training);
(6) if the training entity is an
					 organization, rather than a single individual, a plan to approve each
					 instructor who will provide training under the organization, per
					 §354.3153(a)(2) of this division (relating to Instructor
					 Requirements);
(7) a plan to
					 provide training on a regularly scheduled basis, including primary training
					 location(s), training schedule, and procedures related to
					 registration/enrollment, training methodology, course completion/graduation
					 requirements, and evaluation of training;
(8) a documented application process for peer
					 specialists and/or peer specialist supervisors, including:
(A) use of HHSC-approved scoring rubric(s);
					 and
(B) availability of application
					 materials in prevalent languages, professionally translated;
(9) if the training entity is an
					 organization, rather than a single individual, a documented internal review
					 process designed to ensure consistency and equity in application scoring;
					 and
(10) a documented fee
					 policy.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter N - PEER SPECIALIST SERVICES › Division 5 - MENTAL HEALTH REHABILITATION › Section 354.3153 - Instructor Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) An instructor
					 must:
(1) be a certified peer specialist in
					 good standing, and must have the certification endorsement related to any
					 supplemental training before providing that training;
(2) if part of an organization certified to
					 provide training under this subchapter, rather than certified as an individual,
					 be approved by the organization to provide each type of training described in
					 this subchapter before facilitating that training; and
(3) use training curricula pre-approved by
					 HHSC, including the knowledge assessment(s) required by §354.3159(e)
					 (relating to Core and Supplemental Training) and §354.3163(b) (relating to
					 Supervisor Training) of this division.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter N - PEER SPECIALIST SERVICES › Division 5 - MENTAL HEALTH REHABILITATION › Section 354.3155 - Orientation and Self-Assessment

Current through Reg. 49, No. 28; July 12, 2024
(a) A peer
					 specialist must complete required orientation before applying to participate in
					 core training.
(b) The orientation
					 items are posted on the HHSC website and training entity websites.
(c) The orientation items are completed
					 through online modules, self-study, and a readiness assessment.
(d) Orientation includes:
(1) a self-assessment tool;
(2) a description of peer specialist
					 services;
(3) a description of a
					 peer specialist's typical workday;
(4) employment demographics for peer
					 specialists;
(5) review of the
					 background check requirements and other minimum qualifications to be certified
					 under this chapter;
(6) information
					 about peer specialist careers;
(7)
					 information about the concept of recovery; and
(8) the evidence base for peer
					 support.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter N - PEER SPECIALIST SERVICES › Division 5 - MENTAL HEALTH REHABILITATION › Section 354.3157 - Application for Training

Current through Reg. 49, No. 28; July 12, 2024
(a) A person who
					 has completed the orientation and self-assessment required in §354.3155 of
					 this division (relating to Orientation and Self-Assessment) may apply for
					 training by submitting to a training entity, in a format specified by the
					 training entity:
(1) a complete
					 application;
(2) proof that the
					 person completed the required orientation and self-assessment; and
(3) any other documentation required by the
					 training entity.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter N - PEER SPECIALIST SERVICES › Division 5 - MENTAL HEALTH REHABILITATION › Section 354.3159 - Core and Supplemental Training

Current through Reg. 49, No. 28; July 12, 2024
(a) Core training and supplemental training
					 must be delivered in a classroom setting. If provided through
					 telecommunication, participants must be able to ask questions in real time and
					 interact with the instructor and other classmates.
(b) Core training must be consistent with
					 subsection § 354.3013(a) of this subchapter (relating to Services
					 Provided).
(c) Upon successful
					 completion of core training, a person is eligible for the supplemental training
					 consistent with the person's lived experience:
(1) Mental Health Peer Specialist, for a
					 person with lived experience in recovery from a mental health condition;
					 or
(2) Recovery Support Peer
					 Specialist, for a person with lived experience in recovery from a substance use
					 disorder.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter N - PEER SPECIALIST SERVICES › Division 5 - MENTAL HEALTH REHABILITATION › Section 354.3161 - Peer Specialist Certification Renewal Training

Current through Reg. 49, No. 28; July 12, 2024
(a) In order to qualify for renewal under
					 § 354.3207 of this subchapter (relating to Peer Specialist Certification
					 Renewal), a peer specialist must obtain at least 20 hours of training each
					 certification period, of which three hours must be related to the ethical
					 responsibilities of a peer specialist.
(b) Renewal training must be relevant to the
					 skills required of, or services provided by, a peer specialist under this
					 subchapter.
(c) Renewal training
					 may include classroom training, webinars, online training, and
					 conferences.
(d) Renewal training
					 may be obtained through:
(1) a certified
					 training entity under this subchapter;
(2) training pre-approved by a certification
					 entity under this subchapter; or
(3) training approved for continuing
					 education for a mental health or substance use disorder professional, if the
					 training also complies with subsection (b) of this section.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter N - PEER SPECIALIST SERVICES › Division 5 - MENTAL HEALTH REHABILITATION › Section 354.3163 - Supervisor Training

Current through Reg. 49, No. 28; July 12, 2024
(a) A peer
					 specialist supervisor must successfully complete training on peer specialist
					 services and the recovery model from a certified training entity before being
					 certified to supervise a peer specialist under this subchapter.
(b) Successful completion of supervisor
					 training must be documented through a knowledge assessment completed by each
					 participant at the end of each training.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter N - PEER SPECIALIST SERVICES › Division 5 - MENTAL HEALTH REHABILITATION › Section 354.3165 - Peer Specialist Supervisor Certification Renewal Training

Current through Reg. 49, No. 28; July 12, 2024
(a) In order to qualify for renewal under
					 Division 6 of this subchapter (relating to Peer Specialist and Peer Specialist
					 Supervisor Certification), a peer specialist supervisor must obtain at least
					 six hours of training each certification period related to peer specialist
					 supervision and leadership.
(b)
					 Renewal training may be obtained through:
(1)
					 a training entity under this subchapter;
(2) training pre-approved by a certification
					 entity under this subchapter; or
(3) training pre-approved for continuing
					 education for a mental health or substance use disorder professional, if the
					 training relates to peer specialist supervision and leadership.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter N - PEER SPECIALIST SERVICES › Division 6 - PEER SPECIALIST AND PEER SPECIALIST SUPERVISOR CERTIFICATION › Section 354.3201 - Criminal History and Registry Checks

Current through Reg. 49, No. 28; July 12, 2024
(a) A certified peer specialist, certified
					 peer specialist supervisor, or applicant for either certification must disclose
					 and provide to a certification entity complete information about all:
(1) misdemeanor and felony charges;
(2) indictments;
(3) deferred adjudications;
(4) episodes of community supervision or
					 probation; and
(5)
					 convictions.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter N - PEER SPECIALIST SERVICES › Division 6 - PEER SPECIALIST AND PEER SPECIALIST SUPERVISOR CERTIFICATION › Section 354.3203 - Procedures for Peer Specialist Certification

Current through Reg. 49, No. 28; July 12, 2024
(a) An applicant must submit all required
					 information and documentation to a certification entity electronically or in
					 hard copy, as specified by the certification entity, including:
(1) application form;
(2) proof of core training and supplemental
					 training;
(3) state-issued
					 identification; and
(4) signed
					 ethics statement.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter N - PEER SPECIALIST SERVICES › Division 6 - PEER SPECIALIST AND PEER SPECIALIST SUPERVISOR CERTIFICATION › Section 354.3205 - Initial Peer Specialist Certification

Current through Reg. 49, No. 28; July 12, 2024
(a) Initial peer specialist certification is
					 valid for six months.
(b) During
					 the initial certification period, a peer specialist must document at least 250
					 hours of supervised work experience as a peer specialist under this subchapter.
(1) Independent study, such as reading or
					 watching instructional videos, does not count toward the required
					 hours.
(2) Time spent receiving
					 supervision, other than observation of the peer specialist providing services,
					 does not count toward the required hours.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter N - PEER SPECIALIST SERVICES › Division 6 - PEER SPECIALIST AND PEER SPECIALIST SUPERVISOR CERTIFICATION › Section 354.3207 - Peer Specialist Certification Renewal

Current through Reg. 49, No. 28; July 12, 2024
(a) After the initial certification under
					 §354.3205 of this division (relating to Initial Peer Specialist
					 Certification), peer specialist certification must be renewed every two
					 years.
(b) Each peer specialist
					 certification renewal under this section must include the following
					 documentation:
(1) any application or other
					 form required by the certification entity;
(2) documentation of the peer specialist's
					 renewal training hours; and
(3)
					 results of the certification entity's criminal history and registry background
					 checks conducted on the peer specialist:
(A)
					 immediately before renewing the certification; and
(B) per the requirements found in
					 §354.3201 of this division (relating to Criminal History and Registry
					 Checks).
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter N - PEER SPECIALIST SERVICES › Division 6 - PEER SPECIALIST AND PEER SPECIALIST SUPERVISOR CERTIFICATION › Section 354.3209 - Procedures for Peer Specialist Supervisor Certification

Current through Reg. 49, No. 28; July 12, 2024
(a) An applicant must submit all required
					 information and documentation to a certification entity electronically or in
					 hard copy, as specified by the certification entity, including:
(1) application form;
(2) proof of peer specialist supervisor
					 training;
(3) state-issued
					 identification; and
(4) signed
					 ethics statement.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter N - PEER SPECIALIST SERVICES › Division 6 - PEER SPECIALIST AND PEER SPECIALIST SUPERVISOR CERTIFICATION › Section 354.3211 - Peer Specialist Supervisor Certification Renewal

Current through Reg. 49, No. 28; July 12, 2024
(a) A peer specialist supervisor
					 certification must be renewed every two years.
(b) Each peer specialist supervisor
					 certification renewal under this section must include the following
					 documentation:
(1) any application or other
					 form required by the certification entity;
(2) documentation of the peer specialist
					 supervisor's re-certification training hours; and
(3) results of the certification entity's
					 criminal history and registry background checks conducted on the peer
					 specialist supervisor:
(A) immediately before
					 renewing the certification; and
(B)
					 per the requirements found in §354.3201 of this division (relating to
					 Criminal History and Registry Checks).