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 42 CFR §435.1009;

(2) is a resident of an intermediate care facility for individuals with an intellectual disability or related conditions as described in 42 CFR §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.

Source Note: The provisions of this §354.2701 adopted to be effective October 17, 2018, 43 TexReg 6819