SECTION 301.331. Competency and Credentialing

(a) Competency of staff members, including volunteers. The LMHA, MCO, and provider must implement a process to ensure the competency of staff members prior to providing services that, at a minimum:

(1) ensures services are provided by staff members who are operating within the scope of their license, job description, or contract specification;

(2) ensures that the mental health community services provided by peer providers are limited to mental health rehabilitative, supported employment, supported housing, parent support group, and family partner services; and

(3) defines competency-based expectations for each position as follows:

(A) required competencies must be included for all staff members, including adequate, accurate knowledge of:

(i) the nature of severe and persistent mental illness and serious emotional disturbances;

(ii) the recovery and resiliency model of mental illness and serious emotional disturbance;

(iii) the dignity and rights of an individual, as described in Chapter 404, Subchapter E of this title (relating to Rights of Persons Receiving Mental Health Services);

(iv) identifying, preventing, and reporting abuse, neglect, and exploitation, in accordance with Chapter 414, Subchapter L of this title (relating to Abuse, Neglect, and Exploitation in Local Authorities and Community Centers);

(v) individual confidentiality, as described in Chapter 414, Subchapter A of this title (relating to Protected Health Information) and other relevant state and federal laws affecting confidentiality of medical records, including Title 42 CFR Part 2;

(vi) interacting with an individual who has a physical disability such as a hearing or visual impairment;

(vii) responding to an individual's language and cultural needs through knowledge of customs, beliefs, and values of various, racial, ethnic, religious, and social groups;

(viii) exposure control of blood borne pathogens;

(ix) identification of an individual as being in a crisis and accessing emergency or urgent care services;

(x) proper documentation of services provided; and

(xi) planning and training for responding to severe weather, disasters, and bioterrorism;

(B) critical competencies must be included for positions in which a staff member's primary job duties are related to individual service contacts and interactions and include, but are not limited to, adequate and accurate knowledge of:

(i) cardio pulmonary resuscitation (CPR);

(ii) first aid;

(iii) safe management of verbally and physically aggressive behavior;

(iv) utilization of assistive technology such as communication devices with individuals who are deaf or hard of hearing; and

(v) seizure response and assessment;

(C) specialty competencies must be included for positions in which a staff member performs specialized services and tasks and include adequate and accurate knowledge of specialized services and tasks, such as:

(i) the requirements of this subchapter;

(ii) age appropriate clinical assessment including the uniform assessment;

(iii) age appropriate engagement techniques (e.g., motivational interviewing);

(iv) use of telemedicine equipment;

(v) the utilization management guidelines;

(vi) developing and implementing an individualized treatment plan;

(vii) appropriate actions to take in a crisis (e.g., screening, intervention, management and if applicable, suicide/homicide precautions);

(viii) services for co-occurring psychiatric and substance use disorders described in Chapter 411, Subchapter N of this title (relating to Standards for Services to Individuals with Co-Occurring Psychiatric and Substance Use Disorders (COPSD));

(ix) accessing resources within the local community;

(x) strategies for effective advocacy and referral for an individual;

(xi) infection control;

(xii) recognition, reporting, and recording of side effects, contraindications, and drug interactions of psychoactive medication;

(xiii) age appropriate rehabilitative approaches;

(xiv) proficiency in specimen collection;

(xv) the peer-provider or consumer-operated service model;

(xvi) assessment and intervention with children, adolescents, and families; and

(xvii) clinical specialties directly related to the services to be performed.

(D) crisis hotline competencies must be included for positions in which a staff member routinely answers the crisis hotline and include adequate and accurate knowledge of:

(i) the nature of severe and persistent mental illness and serious emotional disturbances and COPSD;

(ii) behavioral health crisis situations;

(iii) operating a telephone system to access behavioral health crisis screening and response;

(iv) age appropriate crisis intervention and response;

(v) utilization of assistive technology such as communication devices with individuals who are deaf or hard of hearing;

(vi) advocacy for treatment in the most clinically appropriate, available environment; and

(vii) applicable privacy laws, rules, and regulations including those described in Chapter 414, Subchapter A of this title (relating to Protected Health Information) and in Title 42 CFR Part 2.

(E) telemedicine competencies must be included for positions in which a staff member's job duties are related to assisting with telemedicine services and include adequate and accurate knowledge of:

(i) operation of the telemedicine equipment; and

(ii) how to use the equipment to adequately present the individual.

(4) requires staff members to demonstrate competencies in the following manner:

(A) all staff members must demonstrate required competencies before contact with individuals, confidential information, or protected health information and periodically throughout the staff member's tenure of employment or association with the LMHA, MCO, or provider;

(B) all staff members in positions that require critical competencies must demonstrate the critical competencies before contact with individuals and periodically throughout the staff member's or volunteer's tenure of employment or association with the LMHA, MCO, or provider;

(C) all staff members in positions that require specialty competencies must demonstrate the specialty competencies before providing the specialized service(s) or performing the specialized task(s) and periodically throughout the staff member's or volunteer's tenure of employment or association with the LMHA, MCO, or provider; and

(D) all staff members in positions that require crisis hotline competencies must demonstrate those competencies before providing crisis hotline services and at least annually throughout the staff member's or volunteer's tenure of employment or association with the LMHA, MCO, or provider.

(b) Competency of crisis services providers. The LMHA and MCO must develop and implement policies and procedures governing the provision of crisis services to ensure that providers with which they contract or employ for the provision of crisis services are trained in:

(1) crisis access and age appropriate assessment and intervention services;

(2) advocacy for the most clinically appropriate, available environment; and

(3) community referral resources.

(c) Credentialing and appeals. Before providing services, the LMHA and MCO must:

(1) implement a timely credentialing and re-credentialing process for all its licensed staff members, peer providers, family partners, and every QMHP-CS and CSSP;

(2) ensure that documentation verifying a staff member's credentialing and re-credentialing is maintained in the staff member's personnel records;

(3) have a process for staff members to appeal credentialing and re-credentialing decisions; and

(4) require providers to:

(A) use the LMHA's or MCO's credentialing and re-credentialing and appeals processes for all of the provider's licensed staff, QMHP-CSs, CSSPs, peer providers, family partners, and utilization management job functions; or

(B) implement a credentialing and re-credentialing process for all of the provider's licensed staff, QMHP-CSs, CSSPs, peer providers, family partners, and utilization management job functions that meets the LMHA's or MCO's credentialing and re-credentialing criteria and have a process for those staff members to appeal credentialing and re-credentialing decisions.

(d) Additional requirements for credentialing a QMHP-CS. For credentialing as a QMHP-CS who is not a registered nurse, the credentialing and re-credentialing process described in subsection (c) of this section must include:

(1) determining the minimum number of coursework hours that is equivalent to a major and whether a combination of coursework hours in the specified areas is acceptable;

(2) reviewing the individual's coursework; and

(3) justifying and documenting the credentialing decisions; or

(4) completing an alternative credentialing process identified by the department.

(e) Additional requirements for credentialing as a CSSP. For credentialing as a CSSP, the credentialing and re-credentialing process described in subsection (c) of this section must include:

(1) verifying a high school diploma or high school equivalent certificate issued in accordance with the law of the issuing state;

(2) verifying three continuous years of documented full-time experience in the provision of mental health case management or rehabilitative services prior to August 31, 2004;

(3) reviewing the staff member's provision and documentation of mental health case management or rehabilitative services; and

(4) certifying, justifying, and documenting the credentialing decisions.

(f) Additional requirements for credentialing as a peer provider. For credentialing as a peer provider, the credentialing and re-credentialing process described in subsection (c) of this section or the alternative credentialing by an organization recognized by the department must, at minimum, include:

(1) verifying a high school diploma or high school equivalent certificate issued in accordance with the law of the issuing state;

(2) verifying at least one cumulative year of receiving mental health community services for a disorder that is treated in the target population for Texas;

(3) demonstration of competency in the provision and documentation of mental health rehabilitative services, supported employment, or supported housing; and

(4) justifying and documenting the credentialing decisions.

(g) Additional requirements for utilization management job functions. For credentialing as a staff member who performs utilization management job functions, the credentialing and re-credentialing process described in subsection (c) of this section must include:

(1) the staff member's job description indicating the performance of utilization management functions;

(2) if the staff member is not the utilization management physician, the staff member's job description indicating they neither provide services nor supervise service providers;

(3) documenting licenses;

(4) documenting training and supervision received; and

(5) justifying and documenting credentialing decisions.

(h) Maintaining documented personnel information. The LMHA, MCO, and provider must maintain personnel files for each staff member that include:

(1) a current, signed job description for each staff member;

(2) documented, periodic performance reviews;

(3) copies of current credentials and training; and

(4) criminal background checks.

Source Note: The provisions of this §301.331 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