SECTION 354.2711. Psychosocial Rehabilitative Services

(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.

(b) Independent living services assist an individual in acquiring the most immediate, fundamental functional skills needed to enable the individual to reside in the community and avoid more restrictive levels of treatment, or assist an individual in reducing behaviors or symptoms that prevent successful functioning in the individual's environment of choice. Such services include training in symptom management, personal hygiene, nutrition, food preparation, exercise, money management, and community integration activities.

(c) Coordination services are training activities that assist an individual in improving the ability to gain and coordinate access to necessary care and services appropriate to the individual's needs. Coordination services include instruction and guidance in such areas as:

(1) assessment--identifying strengths and areas of need across life domains;

(2) recovery/treatment planning--prioritizing needs, establishing life and treatment goals, selecting interventions, and developing and revising recovery/treatment plans that include wellness, relapse prevention, and crisis plans;

(3) access--identifying and initiating contact with potential service providers and support systems across all life domains, including advocacy groups;

(4) coordination--setting appointments, arranging transportation, and facilitating communication between providers; and

(5) advocacy--

(A) asserting treatment needs, requesting special accommodations, and evaluating provider effectiveness and compliance with the agreed upon recovery/treatment plan; and

(B) requesting improvements and modifications to ensure maximum benefit from the services and supports.

(d) Employment related services provide supports and skills training that are not job-specific and focus on developing skills to reduce or manage the symptoms of serious mental illness that interfere with an individual's ability to make vocational choices or obtain or retain employment. Such services consist of:

(1) instruction in dress, grooming, socially and culturally appropriate behaviors, and etiquette necessary to obtain and retain employment;

(2) training in task focus, maintaining concentration, task completion, and planning and managing activities to achieve outcomes;

(3) instruction in obtaining appropriate clothing, arranging transportation, utilizing public transportation, accessing and utilizing available resources related to obtaining employment, and accessing employment-related programs and benefits;

(4) interventions or supports provided on or off the job site to reduce behaviors or symptoms of serious mental illness that interfere with job performance or that interfere with the development of skills that would enable the individual to obtain or retain employment; and

(5) interventions designed to develop natural supports on or off the job site to compensate for skill deficits that interfere with job performance.

(e) Housing related services develop an individual's strengths and abilities to manage the symptoms of the individual's serious mental illness that interfere with the individual's capacity to obtain or maintain independent, integrated housing. Such services consist of:

(1) skills training related to:

(A) home maintenance and cleanliness;

(B) problem-solving with the individual's landlord and neighbors, mortgage lender, or homeowner's association; and

(C) maintaining appropriate interpersonal boundaries; and

(2) supportive contacts with the individual to reduce or manage the behaviors or symptoms related to the individual's serious mental illness that interfere with maintaining independent, integrated housing.

(f) Medication related services provide training regarding an individual's medication adherence. Such services consist of training in:

(1) the importance of the individual taking the medications as prescribed;

(2) the self-administration of the individual's medication;

(3) determining the effectiveness of the individual's medications;

(4) identifying side-effects of the individual's medications; and

(5) contraindications for medications prescribed.

(g) The requirements of this subsection apply for the delivery of psychosocial rehabilitative services.

(1) Psychosocial rehabilitative services:

(A) must be provided in accordance 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; and

(B) 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.

(2) Psychosocial rehabilitative services may be provided:

(A) only to adults who are not currently admitted to a CSU;

(B) individually or in a group; and

(C) only by a member of the individual's therapeutic team.

(3) The therapeutic team must be constituted and organized in a manner that ensures:

(A) the team includes a sufficient number of staff to adequately address the rehabilitative needs of individuals assigned to the team;

(B) team members are appropriately credentialed to provide the full array of component services;

(C) team members have regularly scheduled team meetings; and

(D) every member of the team is knowledgeable of the needs and services available to the specific individuals assigned to the team.

(4) Independent living services, coordination services, employment-related services, and housing-related services must be provided by a:

(A) QMHP-CS;

(B) CSSP; or

(C) peer provider.

(5) Only licensed medical personnel acting within the scope of their practice may provide medication-related services.

(6) Crisis-related services must be provided by a QMHP-CS.

(h) An individual receiving psychosocial rehabilitative services is not eligible to simultaneously receive either skills training and development or targeted case management services.

Source Note: The provisions of this §354.2711 adopted to be effective October 17, 2018, 43 TexReg 6819; amended to be effective January 23, 2023, 48 TexReg 209