Common use of Local Mental Health Authority Clause in Contracts

Local Mental Health Authority. (LMHA) 1. Describe the Behavioral Health Services indicated in detail in the Provider Procedures Manual and in the Texas Medicaid Bulletin, include the amount, duration, and scope of basic and Value-added Services, and the HMO’s responsibility to provide these services; 2. Describe criteria, protocols, procedures and instrumentation for referral of Medicaid Members from and to the HMO and the LMHA; 3. Describe processes and procedures for referring Members with SPMI or SED to the LMHA for assessment and determination of eligibility for rehabilitation or targeted case management services; 4. Describe how the LMHA and the HMO will coordinate providing Behavioral Health Services to Members with SPMI or SED; 5. Establish clinical consultation procedures between the HMO and LMHA including consultation to effect referrals and on-going consultation regarding the Member’s progress; 6. Establish procedures to authorize release and exchange of clinical treatment records; 7. Establish procedures for coordination of assessment, intake/triage, utilization review/utilization management and care for persons with SPMI or SED; 8. Establish procedures for coordination of inpatient psychiatric services (including Court- ordered Commitment of Members under 21) in state psychiatric facilities within the LMHA’s catchment area; 9. Establish procedures for coordination of emergency and urgent services to Members; 10. Establish procedures for coordination of care and transition of care for new Members who are receiving treatment through the LMHA; and 11. Establish that when Members are receiving Behavioral Health Services from the Local Mental Health Authority that the HMO is using the same UM guidelines as those prescribed for use by local mental health authorities by DSHS which are published at: xxxx://xxx.xxxx.xxxxx.xx.xx/centraloffice/behavioralhealthservices/RDMClinGuide.html. The HMO must offer licensed practitioners of the healing arts (defined in 25 T.A.C., Part 2, Chapter 419, Subchapter L), who are part of the Member’s treatment team for rehabilitation services, the opportunity to participate in the HMO’s Network. The practitioner must agree to accept the HMO’s Provider reimbursement rate, meet the credentialing requirements, and comply with all the terms and conditions of the HMO’s standard Provider contract. HMOs must allow Members receiving rehabilitation services to choose the licensed practitioners of the healing arts who are currently a part of the Member’s treatment team for rehabilitation services to provide Covered Services. If the Member chooses to receive these services from licensed practitioners of the healing arts who are part of the Member’s rehabilitation services treatment team but are not part of the HMO’s Network, the HMO must reimburse the Local Mental Health Authority through Out-of-Network reimbursement arrangements. Nothing in this section diminishes the potential for the Local Mental Health Authority to seek best value for rehabilitative services by providing these services under arrangement, where possible, as specified is 25 T.A.C. §419.455.

Local Mental Health Authority. (LMHA) 1. Describe describe the Behavioral Health Services indicated in detail in the Provider Procedures Manual and in the Texas Medicaid Bulletin, include the amount, duration, and scope of basic and Value-added Services, and the HMO’s MCO's responsibility to provide these services; 2. Describe describe criteria, protocols, procedures and instrumentation for referral of Medicaid Members from and to the HMO MCO and the LMHA; 3. Describe describe processes and procedures for referring Members with SPMI or SED to the LMHA for assessment and determination of eligibility for rehabilitation or targeted case management servicesTargeted Case Management Services; 4. Describe describe how the LMHA and the HMO MCO will coordinate providing Behavioral Health Services to Members with SPMI or SED; 5. Establish establish clinical consultation procedures between the HMO MCO and LMHA including consultation to effect referrals and on-going ongoing consultation regarding the Member’s 's progress; 6. Establish establish procedures to authorize release and exchange of clinical treatment records; 7. Establish establish procedures for coordination of assessment, intake/triage, utilization review/utilization management and care for persons with SPMI or SED; 8. Establish establish procedures for coordination of inpatient psychiatric services (including Court- ordered Commitment of Members under 21birth through age 20) in state psychiatric facilities within the LMHA’s 's catchment area; 9. Establish establish procedures for coordination of emergency and urgent services to Members; 10. Establish establish procedures for coordination of care and transition of care for new Members who are receiving treatment through the LMHA; and 11. Establish that establish that, when Members are receiving Behavioral Health Services from the Local Mental Health Authority that Authority, the HMO MCO is using the same UM guidelines as those prescribed for use by local mental health authorities Local Mental Health Authorities by DSHS which are DSHS, published at: xxxx://xxx.xxxx.xxxxx.xx.xx/centraloffice/behavioralhealthservices/RDMClinGuide.html. xxxx://xxx.xxxx.xxxxx.xx.xx/mhsa/umguidelines/. The HMO MCO must offer licensed practitioners of the healing arts (defined in 25 T.A.C., Part 21, Chapter 419, Subchapter L), who are part of the Member’s 's treatment team for rehabilitation services, services (the Treatment Team) the opportunity to participate in the HMO’s MCO's Network. The practitioner must agree to accept the HMO’s MCO's Provider reimbursement rate, meet the credentialing requirements, and comply with all the terms and conditions of the HMO’s MCO's standard Provider contract. HMOs MCOs must allow Members receiving rehabilitation services to choose the licensed practitioners of the healing arts who are currently a part of the Member’s treatment team for rehabilitation services to provide Covered Services's Treatment Team. If the Member chooses to receive these services from Out-of-Network licensed practitioners of the healing arts who are part of the Member’s rehabilitation services treatment team but are not part of the HMO’s Network's Treatment Team, the HMO MCO must reimburse the Local Mental Health Authority provider through Out-of-Network reimbursement arrangements. Nothing in this section diminishes the potential for the Local Mental Health Authority to seek best value for rehabilitative services by providing these services under arrangement, where possible, as specified is 25 T.A.C. §419.455.

Local Mental Health Authority. (LMHA) 1. Describe describe the Behavioral Health Services indicated in detail in the Provider Procedures Manual and in the Texas Medicaid Bulletin, include the amount, duration, and scope of basic and Value-added Services, and the HMOMCO’s responsibility to provide these services; 2. Describe describe criteria, protocols, procedures and instrumentation for referral of Medicaid Members from and to the HMO MCO and the LMHA; 3. Describe describe processes and procedures for referring Members with SPMI or SED to the LMHA for assessment and determination of eligibility for rehabilitation or targeted case management servicesTargeted Case Management Services; 4. Describe describe how the LMHA and the HMO MCO will coordinate providing Behavioral Health Services to Members with SPMI or SED; 5. Establish establish clinical consultation procedures between the HMO MCO and LMHA including consultation to effect referrals and on-going ongoing consultation regarding the Member’s progress; 6. Establish establish procedures to authorize release and exchange of clinical treatment records; 7. Establish establish procedures for coordination of assessment, intake/triage, utilization review/utilization management and care for persons with SPMI or SED; 8. Establish establish procedures for coordination of inpatient psychiatric services (including Court- ordered Commitment of Members under 21birth through age 20) in state psychiatric facilities within the LMHA’s catchment area; 9. Establish establish procedures for coordination of emergency and urgent services to Members; 10. Establish establish procedures for coordination of care and transition of care for new Members who are receiving treatment through the LMHA; and 11. Establish that establish that, when Members are receiving Behavioral Health Services from the Local Mental Health Authority that Authority, the HMO MCO is using the same UM guidelines as those prescribed for use by local mental health authorities Local Mental Health Authorities by DSHS which are DSHS, published at: xxxx://xxx.xxxx.xxxxx.xx.xx/centraloffice/behavioralhealthservices/RDMClinGuide.html. The HMO MCO must offer licensed practitioners of the healing arts (defined in 25 T.A.C., Part 21, Chapter 419, Subchapter L), who are part of the Member’s treatment team for rehabilitation services, services (the “Treatment Team”) the opportunity to participate in the HMOMCO’s Network. The practitioner must agree to accept the HMOMCO’s Provider reimbursement rate, meet the credentialing requirements, and comply with all the terms and conditions of the HMOMCO’s standard Provider contract. HMOs MCOs must allow Members receiving rehabilitation services to choose the licensed practitioners of the healing arts who are currently a part of the Member’s treatment team for rehabilitation services to provide Covered ServicesTreatment Team. If the Member chooses to receive these services from Out-of-Network licensed practitioners of the healing arts who are part of the Member’s rehabilitation services treatment team but are not part of the HMO’s NetworkTreatment Team, the HMO MCO must reimburse the Local Mental Health Authority provider through Out-of-Network reimbursement arrangements. Nothing in this section diminishes the potential for the Local Mental Health Authority to seek best value for rehabilitative services by providing these services under arrangement, where possible, as specified is 25 T.A.C. §419.455.