26 Tex. Admin. Code § 301.277 - Individual Selection of Providers
(a)
Individual choice. An LMHA shall give consumers the opportunity to choose from
any available provider in the LMHA's provider network offering services for
which the individual is authorized at the time of admission and at least
annually thereafter.
(b) Changing
providers. Individuals may request and change providers at any time.
(c) Provider information. An LMHA shall
maintain a current list of providers and a provider profile for each provider
in the network, including the LMHA, on its website. The LMHA's website must
also provide instructions for requesting a change in providers as described in
§ 401.464 of Title 25 (relating to Notification and Appeals Processes).
(1) The provider list must include the
following information about each provider:
(A) name;
(B) service locations and the services
provided at each location; and
(C)
contact information, including the provider's website address.
(2) The provider profile is a
standardized form completed by the provider, may include information such as
staffing patterns, special features of service delivery, and cultural and
linguistic specialization. An LMHA shall use the provider profile template
established by the department at the beginning of the planning cycle. The LMHA
may add additional items to the provider profile based on input from the local
PNAC.
(d) Provider
selection process. The LMHA shall inform individuals, verbally and in writing,
that they may choose to receive services from any available provider in the
LMHA's network that offers the authorized services. The LMHA shall also provide
individuals with a neutral presentation of available providers consistent with
the plan to support consumer transition to the external network described in
subsection (f) of this section. When an individual is given the opportunity to
choose a provider, the LMHA shall:
(1) state
that the individual may change providers at any time;
(2) give the individual the provider list,
provider profiles, and a written copy of the procedures for requesting a change
in providers;
(3) allow a
reasonable period of time and make an area available for the individual to
review the materials and make a decision; and
(4) maintain documentation of the
individual's choice of provider.
(e) An LMHA shall not offer or schedule
services before the individual selects a provider. If an individual is unable
to select a provider or does not select a provider before leaving the first
appointment, the LMHA shall provide the consumer with an appointment for
ongoing services at an assigned provider. Except as provided in subsection (f)
of this section, assignments shall rotate equally among all available external
providers. In this situation, the LMHA shall also provide the individual with
information about how to have the appointment rescheduled with a different
provider.
(f) External network
transition plan. The LMHA shall develop and implement a plan to promote
consumer transition to the external network when a new provider joins the
network.
(1) The plan shall be developed with
input from the LMHA's PNAC, any local consumer-operated organization, and its
external providers.
(2) LMHAs may
emphasize benefits of receiving services from an external provider, but shall
not favor one provider over another except to identify service sites that may
be more convenient for a client.
(3) The plan may include reassigning
consumers to external providers based on geographic proximity, but must give
them the option of choosing a different provider instead.
(4) The plan may include directing new
individuals to choose an external provider, but must give them the option of
choosing an LMHA service site instead.
Notes
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