SECTION 301.327. Access to Mental Health Community Services

(a) Adequate provider network. The LMHA and MCO must maintain a provider network that is adequate and qualified to provide all mental health community services that the LMHA and MCO are required to provide under a contract with the department.

(b) Crisis screening and response system. The LMHA and MCO must have a crisis screening and response system in operation 24 hours a day, every day of the year, that is available to individuals throughout its contracted service delivery area. The telephone system to access the crisis screening and response system must include a toll-free crisis hotline number and be easily accessible and well publicized. Calls to the crisis hotline must be answered by a hotline staff member who is trained in compliance with this subchapter. The hotline must have teletypewriter (TTY) capabilities or other assistive technology that is available and effective.

(c) Telephone access. In addition to the crisis screening and response system described in subsection (b) of this section, the LMHA and MCO must ensure the availability of a telephone system and call center that allows individuals to contact the LMHA or MCO through a toll-free number that must:

(1) operate without using telephone answering equipment at least on business days during normal business hours, except on national holidays, due to uncontrollable interruption of service, or with prior approval of the department;

(2) have sufficient staff to operate efficiently;

(3) collect, document, and store detailed information, including special needs information, on all telephone inquiries and calls;

(4) during times other than those described in paragraph (1) of this subsection provide electronic call answering methods that include an outgoing message providing the crisis hotline telephone number, in languages relevant to the service area, for callers to leave a message; and

(5) return routine calls before the end of the next business day for all messages left after hours.

(d) Timely services based on need. The LMHA or local behavioral health authority (LBHA), as defined at Texas Health and Safety Code §533.0356 must arrange mental health services for an individual within the following time frames.

(1) Crisis services.

(A) Hotline calls. For all calls to the toll-free crisis hotline:

(i) a staff member must answer each call within 30 seconds, on average, at least 95 percent of the time;

(ii) the LMHA, LBHA, or their subcontractors must train a staff member in crisis screening to conduct a crisis hotline screening as provided in the LMHAs' and LBHAs' contract with the Texas Health and Human Services Commission; and

(iii) if the staff member determines the call is a potential crisis, a staff member trained in crisis screening, in accordance with clause (ii) of this subparagraph, must begin a telephone screening no later than one minute after the determination is made.

(B) Emergency care services. If a staff member determines during a screening that an individual is experiencing a crisis that may require emergency care services, the staff member trained in crisis screening, in accordance with subparagraph (A)(ii) of this paragraph, must:

(i) take immediate action to address the emergency situation to ensure the safety of all parties involved;

(ii) activate the immediate screening and assessment processes as described in §301.351 of this subchapter (relating to Crisis Services); and

(iii) provide or obtain mental health community services or other necessary interventions to stabilize the crisis.

(C) Urgent care services. If the screening indicates that an individual needs urgent care services, a QMHP-CS must within eight hours of the initial incoming hotline call or notification of a potential crisis situation:

(i) perform a face-to-face assessment; and

(ii) provide or obtain mental health community services or other necessary interventions to stabilize the crisis.

(2) Routine care services. If the screening indicates that an individual needs routine care services, a QMHP-CS must perform a uniform assessment within 14 days after the screening. If the assessment indicates an LOC for routine care services, the individual must begin receiving services immediately. When the provision of the service package is not possible because services are at capacity, the individual must be referred to an available practitioner appropriate to meet the individual's needs or be placed on a waiting list for services, subject to the following exceptions:

(A) individuals eligible for Medicaid who are determined to be in need of Mental Health Case Management, under Chapter 306, Subchapter E of this title, or Mental Health Rehabilitative Services, under Chapter 306, Subchapter F of this title, cannot be placed on a waiting list and must be served.

(B) individuals eligible for Medicaid who are determined to need services other than Mental Health Case Management, under Chapter 306, Subchapter E of this title, and Mental Health Rehabilitative Services, under Chapter 306, Subchapter F of this title, must be referred to appropriate, available practitioners of that service. Only if an appropriate Medicaid practitioner is not available may the individual be placed on a waiting list. All efforts undertaken to refer Medicaid individuals must be documented.

(e) Communication with individuals. The LMHA, MCO, and provider must ensure effective communication with the individual and LAR (if applicable) in an understandable format as appropriate to meet the needs of individuals, which may require using:

(1) interpretative services;

(2) translated materials; or

(3) a staff member who can effectively respond to the cultural (e.g., customs, beliefs, actions, and values) and language needs of the individual and LAR (if applicable).

(f) Service information. The LMHA and MCO must proactively disseminate to individuals and their LAR (if applicable) information about mental illness and the LMHA's or MCO's mental health community services in a format and language that is easily understood and based on the demographics for any group comprising more than 10 percent of the population in the local service area. Information about mental illness and the LMHA's or MCO's community services must be in a format and language that is easily understood by individuals with a disability (e.g., deafness, hard of hearing, and blindness).

(g) Access to emergency medical and crisis services. The LMHA and MCO must develop procedures for its providers' use in accessing emergency medical and crisis services for individuals.

(h) Continuity of services. The LMHA and MCO must ensure that individuals:

(1) are provided continuity of services as defined by the department; and

(2) are informed of whom to contact regarding continuity and coordination of their services, in accordance with Chapter 412, Subchapter D of this title (relating to Mental Health Services--Admission, Continuity, and Discharge).

(i) Referral for physical health services. If a nursing or medical assessment indicates physical health needs outside the scope of the provider's competency, credentialing, or capacity to treat, the LMHA and MCO must make and document appropriate referrals to other healthcare providers and provide adequate follow up at subsequent visits to confirm access to the referrals.

Source Note: The provisions of this §301.327 adopted to be effective April 29, 2009, 34 TexReg 2603; transferred effective March 15, 2020, as published in the February 21, 2020 issue of the Texas Register, 45 TexReg 1237; amended to be effective July 3, 2023, 48 TexReg 3505