(a) Prerequisites to providing services. With the exception of crisis intervention services:
(1) the provider must obtain prior authorization from the department or its designee for the MH rehabilitative services to be provided in accordance with the uniform assessment, which is referenced in §416.17 of this title (relating to Guidelines); and the utilization management guidelines, which are referenced in §416.17 of this title; and
(2) an LPHA must determine whether the need for MH rehabilitative services meets the definition of medical necessity.
(b) Recovery planning.
(1) In collaboration with the individual or LAR, develop a recovery plan in accordance with §412.322(e) of this title (relating to Provider Responsibilities for Treatment Planning and Service Authorization) that also includes a list of the type(s) of MH rehabilitative services authorized in accordance with subsection (a)(1) of this section.
(2) A provider must develop the recovery plan required by paragraph (1) of this subsection within 10 days after the authorization date.
(c) Documenting medical necessity for crisis intervention services.
(1) An LPHA must, within two business days after crisis intervention services are provided:
(2) A provider is not required to develop a recovery plan for providing crisis intervention services.
(d) Reauthorization of MH rehabilitative services.
(1) Prior to the expiration of the authorization period or depleting the amount of services authorized:
(2) If the determination is that the individual continues to need MH rehabilitative services and that such services are medically necessary, the provider must:
(e) Recovery plan review.
(1) In collaboration with the individual or LAR or primary caregiver, the provider must, review the recovery plan to determine if the plan adequately assists the individual in achieving recovery through the identified goals, objectives, and needs:
(2) At the time the recovery plan is reviewed, the provider must:
(f) Revisions to the recovery plan. If, after review of the recovery plan, the provider in collaboration with the individual or LAR determines that the recovery plan does not adequately address the needs of the individual, the provider must, as appropriate:
(1) revise the content of the recovery plan; or
(2) must document medical necessity if there is a change in an LOC; and
(3) request authorization for a change in the type or amount of the MH rehabilitative services authorized consistent with subsection (d)(2) of this section.
Source Note: The provisions of this §306.311 adopted to be effective January 22, 2014, 39 TexReg 299; transferred effective March 15, 2020, as published in the February 21, 2020 issue of the Texas Register, 45 TexReg 1239