26 Tex. Admin. Code § 301.259 - Conditions Permitting LMHA Service Delivery
An LMHA may only provide services if one or more of the following conditions is present.
(1)
The LMHA determines that interested, qualified providers are not available to
provide services in the LMHA's service area or that no providers meet
procurement specifications.
(2)
The network of external providers does not provide the minimum level of
individual choice. A minimal level of individual choice is present if
individuals and their legally authorized representatives can choose from two or
more qualified providers.
(3) The
network of external providers does not provide individuals with access to
services that is equal to or better than the level of access in the local
network, including services provided by the LMHA, as of a date determined by
the department. An LMHA relying on this condition must submit the information
necessary for the department to verify the level of access.
(4) The combined volume of services delivered
by external providers is not sufficient to meet 100 percent of the LMHA's
service capacity for each level of care identified in the LMHA's plan.
(5) Existing agreements restrict
the LMHA's ability to contract with external providers for specific services
during the two-year period covered by the LMHA's plan. If the LMHA relies on
this condition, the department shall require the LMHA to submit copies of
relevant agreements.
(6) The LMHA
documents that it is necessary for the LMHA to provide specified services
during the two-year period covered by the LMHA's plan to preserve critical
infrastructure needed to ensure continuous provision of services. An LMHA
relying on this condition must:
(A) document
that it has evaluated a range of other measures to ensure continuous delivery
of services, including but not limited to those identified by the LANAC and the
department at the beginning of each planning cycle;
(B) document implementation of appropriate
other measures;
(C) identify a
timeframe for transitioning to an external provider network, during which the
LMHA shall procure an increasing proportion of the service capacity from
external provider in successive procurement cycles; and
(D) give up its role as a service provider at
the end of the transition period if the network has multiple external providers
and the LMHA determines that external providers are willing and able to provide
sufficient added service volume within a reasonable period of time to
compensate for service volume lost should any one of the external provider
contracts be terminated.
Notes
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