SECTION 354.2609. Recovery/Treatment Planning, Recovery/Treatment Plan Review, and Discharge Summary

(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).

(b) A comprehensive provider agency must develop a written recovery/treatment plan:

(1) before the provision of mental health targeted case management or mental health rehabilitative services; and

(2) within 10 business days after the date the individual is eligible and has been authorized for routine care services.

(c) Credentials for completing recovery/treatment plan. A staff member credentialed as a QMHP-CS, at a minimum, is responsible for completing and signing the plan.

(d) Content of recovery/treatment plan (plan).

(1) The plan must reflect input from the individual and each of the disciplines of treatment to be provided to the individual based on the assessment. The plan must include:

(A) a description of the individual's presenting problem(s);

(B) a description of the individual's strengths;

(C) a description of the individual's needs arising from the mental illness or serious emotional disturbance;

(D) a description of the individual's co-occurring substance use disorder, intellectual or developmental disability, or physical health condition(s), if any;

(E) a description of the recovery goals and objectives based on the assessment, and expected outcomes of the treatment in accordance with paragraph (2) of this subsection;

(F) the expected date by which the recovery/treatment goals will be achieved; and

(G) a list of the type(s) of intervention(s) within each form of treatment that will be provided to the individual (e.g., psychosocial rehabilitation, medication services, supported employment), and for each type of service listed:

(i) a description of the strategies to be implemented by staff members in providing the service and achieving goals;

(ii) the frequency, number of units (e.g., 10 counseling sessions, two skills training sessions), and duration of each service to be provided (e.g., .5 hour, 1.5 hours); and

(iii) the credentials of the staff member responsible for providing the service.

(2) The goals and objectives with expected outcomes required by paragraph (1)(E) of this subsection must:

(A) specifically address the individual's unique needs, preferences, experiences, and cultural background;

(B) specifically address the individual's co-occurring substance use or physical health disorder, if any;

(C) be expressed in terms of overt, observable actions of the individual;

(D) be objective and measurable using quantifiable criteria; and

(E) reflect the individual's self-direction, autonomy, and desired outcomes.

(3) The plan must be developed in consultation with the individual, and LAR if applicable.

(4) The individual, and LAR if applicable, must be provided, in an understandable format as appropriate, to meet the needs of every individual, a copy of the plan and each subsequent reviewed and revised plan.

(e) Review of recovery/treatment plan.

(1) A comprehensive provider agency must:

(A) review an individual's continued eligibility for services as specified in §354.2703 of this subchapter (relating to Continued Eligibility); and

(B) review an individual's plan prior to requesting an authorization for the continuation of services, including:

(i) reviewing the individual's plan in its entirety, considering input from the individual, the individual's LAR, as applicable, and each member of the therapeutic team;

(ii) determining if the plan adequately addresses the needs of the individual;

(iii) documenting progress on all goals and objectives; and

(iv) documenting any recommendation for continuing services, any change from current services, and any discontinuation of services.

(2) In addition to the required review under paragraph (1)(B) of this subsection, a comprehensive provider agency must review an individual's recovery/treatment plan:

(A) if clinically indicated; and

(B) at the request of the individual, the LAR, or the primary caregiver of a child or youth.

(3) Any time an individual's recovery/treatment plan is reviewed, the comprehensive provider agency must:

(A) meet with the individual to solicit and consider input from the individual regarding a self-assessment of progress toward the recovery goals;

(B) solicit and consider the input from each member of the therapeutic team in assessing the individual's progress toward the recovery goals and objectives with expected outcomes;

(C) solicit and consider input from the LAR or primary caregiver, as applicable, regarding the level of satisfaction with the services provided; and

(D) document all the input described in subparagraphs (A) - (C) of this paragraph.

(f) Revisions to the recovery/treatment plan. If, after any review of the recovery/treatment plan, the individual or comprehensive provider agency determines that the plan does not adequately address the needs of the individual, the comprehensive provider agency, with input from the individual, must appropriately revise the content of the plan.

(g) Discharge Summary. Not later than 21 calendar days after an individual's discharge from services, whether planned or unplanned, a comprehensive provider agency must document in the individual's medical record:

(1) a summary, based on input from each member of the therapeutic team, of all the services provided, the individual's response to treatment, and any other relevant information;

(2) recommendations made to the individual, LAR, or primary caregiver for follow up services, if any; and

(3) the individual's most current diagnosis, based on diagnostic criteria from the latest edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders.

Source Note: The provisions of this §354.2609 adopted to be effective October 17, 2018, 43 TexReg 6819; amended to be effective January 23, 2023, 48 TexReg 209