Common use of Service Determination Clause in Contracts

Service Determination. (1) In determining services to be provided to the adult MH Priority Population, the choice of and admission to medically necessary services is determined jointly by the individual seeking service and Grantee. (2) Criteria used to make these determinations are the Level of Care Recommended (i.e., LOC-R) of the individual as derived from the Uniform Assessment (UA), incorporated by reference and posted at xxxxx://xxx.xxx.xxxxx.xxx/doing-business- hhs/provider-portals/behavioral-health-services-providers/local-mental-health- authorities/adult-needs-strengths-assessment, the needs of the individual, Texas Resiliency and Recovery (TRR) Utilization Management (UM) Guidelines, incorporated by reference and posted at xxxxx://xxx.xxx.xxxxx.xxx/doing-business- hhs/provider-portals/behavioral-health-services-providers/behavioral-health-provider- resources/utilization-management-guidelines-manual, and the availability of resources. Clients authorized for care by Grantee through a clinical override are eligible for the duration of the authorization.

Service Determination. (1) In determining services to be provided to the adult MH Priority Population, the choice of and admission to medically necessary services is determined jointly by the individual seeking service and Grantee. (2) Criteria used to make these determinations are the Level of Care Recommended (i.e., LOC-R) of the individual as derived from the Uniform Assessment (UA), incorporated by reference and posted at xxxxx://xxx.xxx.xxxxx.xxx/doing-business- xxxxx://xxx.xxx.xxxxx.xxx/doing- business-hhs/provider-portals/behavioral-health-services-providers/local-mentalmental- health-health- authorities/adult-needs-strengths-assessment, the needs of the individual, Texas Resiliency and Recovery (TRR) Utilization Management (UM) Guidelines, incorporated by reference and posted at xxxxx://xxx.xxx.xxxxx.xxx/doing-business- xxxxx://xxx.xxx.xxxxx.xxx/doing- business-hhs/provider-portals/behavioral-health-services-providers/behavioral-behavioral- health-provider- provider-resources/utilization-management-guidelines-manual, and the availability of resources. Clients authorized for care by Grantee through a clinical override are eligible for the duration of the authorization.