Service Determination. (1) In determining services to be provided to the priority population, the choice of and admission to medically necessary services is determined jointly by the individual seeking service and Contractor. (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), the needs of the individual, Texas Resiliency and Recovery (TRR) Utilization Management (UM) Guidelines, and the availability of resources. Clients authorized for care by Contractor through a clinical override are eligible for the duration of the authorization.
Appears in 11 contracts
Sources: Local Mental Health Authority Performance Agreement, Local Mental Health Authority Performance Agreement, Local Mental Health Authority Performance Agreement