SECTION 353.1405. Managed Care Organization Responsibilities

(a) A managed care organization (MCO) must ensure that each contracted comprehensive provider agency meets the requirements established in this subchapter.

(b) An MCO must develop policies, procedures, and contract requirements to ensure that contracted comprehensive provider agencies adhere to the requirements in this subchapter.

(c) An MCO must not approve or contract with a comprehensive provider agency as a provider of mental health targeted case management and mental health rehabilitative services unless the comprehensive provider agency:

(1) is enrolled as a Texas Medicaid provider in accordance with §352.7 of this title (related to Applying for Enrollment);

(2) attests in the credentialing application to the MCO and agrees in the contract to comply with applicable state and federal regulations, rules, policies, and procedures relating to mental health targeted case management and mental health rehabilitative services;

(3) agrees to comply with applicable state and federal laws governing participation of providers in the Medicaid program;

(4) agrees to submit accurate and complete cost reports in accordance with applicable HHSC requirements;

(5) is not listed on the HHSC Inspector General's Excluded Individuals/Entities Listing;

(6) provides or subcontracts for the full array of mental health targeted case management and mental health rehabilitative services listed in Chapter 354, Subchapter M, of this title (relating to Mental Health Targeted Case Management and Mental Health Rehabilitation), with the exception of §354.2715 of this title (relating to Day Programs for Acute Needs (DPAN)); and

(7) has staff that are credentialed in accordance with §353.1415 of this subchapter (relating to Staff Member Credentialing).

(d) If an MCO contracts with a comprehensive provider agency to provide mental health targeted case management and mental health rehabilitative services specific to children who are at risk of juvenile justice involvement, expulsion from school, displacement from the home, hospitalization, residential treatment, or serious injury to self, others, or animals, the MCO must ensure the comprehensive provider agency has a referral arrangement with a Texas Medicaid enrolled provider within the MCO network that has the ability to otherwise meet the needs of the child and that can provide the services to the child without interruption in services and without otherwise affecting the child's access to care.

Source Note: The provisions of this §353.1405 adopted to be effective October 17, 2018, 43 TexReg 6816