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TITLE 25HEALTH SERVICES
PART 1DEPARTMENT OF STATE HEALTH SERVICES
CHAPTER 412LOCAL MENTAL HEALTH AUTHORITY RESPONSIBILITIES
SUBCHAPTER PPROVIDER NETWORK DEVELOPMENT
RULE §412.756Local Network Development Plan

(a) Requirement to develop a plan. Each LMHA shall develop a local network development plan to guide the configuration and development of the LMHA's provider network. The plan shall reflect local needs and priorities and shall be designed to maximize consumer choice and consumer access to services provided by qualified providers.

(b) Schedule for plan submission. DSHS will establish a schedule for biennial submission of local network development plans that allows each LMHA at least 180 days to develop its plan.

(c) Community involvement. The LMHA's planning process shall incorporate the diversity of opinion, culture, and ethnicity of the local service area and shall ensure:

  (1) active involvement of the LMHA's Planning and Network Advisory Committee; and

  (2) effective participation of stakeholders.

(d) State list of interested providers. DSHS will develop a list of interested providers for each local service area.

  (1) DSHS will post minimum service requirements and the service capacity information for each local service area on its website and provide a mechanism for provider response. Service capacity information will include:

    (A) the overall service targets for the number of adults and children/adolescents to be served listed in the current DSHS performance contract;

    (B) the current state funding allocation for the LMHA; and

    (C) the number of adults and children/adolescents served in each Resiliency and Disease Management (RDM) service package for the previous fiscal year and for the current year through the most recent closed quarter.

  (2) Providers may submit a description of their qualifications, including their experience as it relates to the same or similar services and populations defined in the RDM service packages, and indicate their interest in providing services in each local service area.

  (3) Information submitted by interested providers will be posted on the DSHS website. This list will be available to inform procurement decisions made by LMHAs, but shall not be construed as conclusive evidence of the existence of interested qualified providers for purposes of determining that procurement is required.

(e) Assessment of network expansion. The LMHA shall assess the potential for securing external providers for the LMHA's network by using available information, including the state list of interested providers.

(f) Strategies to maximize dollars available to provide services. The LMHA shall maximize dollars available to provide services by minimizing overhead and administrative costs and achieving purchasing efficiencies. Strategies that an LMHA shall consider in achieving this objective include joint efforts with other local authorities on planning, administrative, purchasing and procurement, other authority functions, and service delivery activities.

(g) Plan content. The LMHA's local network development plan shall include the following components.

  (1) A description of the process used to identify and obtain information from stakeholders and the results of community involvement.

  (2) A list of the organizations and numbers of individuals by category (e.g., consumers, family members, interested citizens) who participated in the planning process.

  (3) The LMHA's projected service capacity for each RDM service package based on service data from the previous fiscal year and the current year through the most recent closed quarter for services controlled by the DSHS performance contract.

  (4) Baseline data, as defined by DSHS, showing the type and quantity of services provided by the LMHA and by external providers.

  (5) A summary of any written inquiries received by the LMHA from external providers interested in contracting with the LMHA and the LMHA's response.

  (6) An assessment of the availability of current and potential external providers, and a decision whether or not to assemble or expand an external provider network by service type and population served.

  (7) Rationale for the decision whether or not to assemble or expand the external provider network.

    (A) If only selected services are included in plans for network assembly or expansion, the rationale shall address each service type and population served.

    (B) The rationale for a decision not to assemble or expand the external provider network shall be based on one or more of the conditions identified in §412.758(a) of this title (relating to LMHA Provider Status) or on a determination that the current network of external providers serves 100 percent of the service capacity and meets levels of consumer choice and access specified in §412.758(a)(2) and (3) of this title (relating to LMHA Provider Status).

    (C) If the plan includes service provision by the LMHA, the rationale shall specify and support the volume necessary to make provision of services by the LMHA financially viable as required by §412.758(f) of this title.

  (8) When the decision is to assemble or expand the external provider network, a description of the LMHA's plans for procurement, including:

    (A) adult and child/adolescent services and combinations of services to be procured;

    (B) percentage of service capacity to be procured for each RDM service package;

    (C) the procurement methods to be used;

    (D) timelines for conducting the procurement;

    (E) steps and timelines for securing consumer choice decisions and transitioning consumers to new providers;

    (F) for each service package, an estimate of the time needed to re-establish the service volume lost should a contract be terminated. This timeframe may be used as the minimum notice period for contract termination by an external provider; and

    (G) any individual practitioner qualification(s) beyond those specified in the DSHS performance contract that the LMHA will establish as a minimum standard.

  (9) Identification of services to be provided by a single provider due to economic factors that prevent an LMHA from offering consumers a choice of more than one provider.

  (10) A description of how the LMHA will address consumer choice and access.

  (11) A description of how service dollars will be preserved while maintaining the LMHA's ability to continue performing authority functions and administrative services related to the authority functions, which shall include a description of the LMHA's strategies, as described in subsection (f) of this section, for maximizing dollars available to provide services.

  (12) A description of how the LMHA will address issues of cultural and linguistic diversity in the local community.

  (13) A description of relevant past efforts to develop an external provider network and the results of those efforts.

  (14) A description of barriers to attracting new external providers, the conditions that must be present to attract new external providers to the local service area, and the LMHA's plans to address any identified barriers, which may include any applicable existing agreements or circumstances identified by the LMHA pursuant to §412.758(a)(6) of this title.

  (15) Plans and timeframes (covering at least two years) for developing the external provider network beyond the period covered by the current plan.

(h) Distribution of the draft plan. The LMHA shall send its draft local network development plan to local consumer and advocacy groups and shall also make it available to the public through its website and other accessible media. The LMHA shall invite public comment on the draft plan for a period of not less than 14 days and shall consider all comments received and make any revisions it deems appropriate to produce the proposed plan.

(i) Submission to DSHS. The LMHA shall submit its proposed local network development plan to DSHS with a summary of the public comments received and the LMHA's response to the comments. The LMHA shall also update its website with the proposed version of the plan, if applicable, and the date submitted to DSHS.

(j) Review by DSHS. DSHS will review each local network development plan to ensure compliance with the requirements of this subchapter and to determine whether the LMHA is making reasonable attempts to solicit the development of an available and appropriate provider base that is sufficient to meet the needs of consumers in its local service area.

  (1) Key elements addressed in the review process will include:

    (A) the LMHA's assembly or expansion of a network of external providers;

    (B) the procurement method(s) selected by the LMHA;

    (C) maximization of access and consumer choice;

    (D) preservation of critical infrastructure for ensuring the continuous provision of services;

    (E) preservation of service dollars while maintaining the LMHA's financial viability to continue performing authority functions; and

    (F) timeframes for implementation.

  (2) In reviewing an LMHA's local network development plan, DSHS will evaluate the level of effort made by the LMHA to achieve compliance and the rationale and supporting documentation for its decisions and plans, including the LMHA's response to public comment. This evaluation will include a review of any previous efforts or plans of the LMHA to determine the level of implementation and progress toward assembling a network of external providers.

  (3) DSHS will review each LMHA's local network development plan with consideration of the specific context of the local service area, including population density and distribution, existing service organizations, linguistic and cultural characteristics, and local priorities.

  (4) DSHS will review any plan amendment submitted in accordance with subsection (m) of this section when the results of procurement do not achieve the planned provider network assembly or expansion. This review shall include examination of the rationale for the LMHA's decision not to procure part or all of the services planned for procurement, as well as the proposed scope of the LMHA's role as a service provider in the plan amendment.

  (5) DSHS will establish a mechanism for stakeholder involvement in the review process.

  (6) If DSHS determines that an LMHA's local network development plan demonstrates that the LMHA is in compliance with the requirements of this subchapter and is making reasonable attempts to solicit the development of an available and appropriate provider base that is sufficient to meet the needs of consumers in its local service area, DSHS will approve the plan within 60 days of receipt. DSHS may require the LMHA to make revisions before DSHS approves the plan and will contact the LMHA within 60 days of receipt and include a timeframe for resubmission, which shall be negotiated with the LMHA.

(k) Approval of plan. After DSHS approves the local network development plan, the LMHA shall update public postings with the approved version of the plan and notice of the plan's approval by DSHS.

(l) Public access to plans. DSHS will provide a mechanism through the DSHS website for the public to access approved local network development plans.

(m) Post procurement plan amendment. If the results of a procurement alter the type or volume of services to be provided by the LMHA as described in its local network development plan, the LMHA shall submit a plan amendment to DSHS and update all publicly available copies of the plan after receiving approval from DSHS.


Source Note: The provisions of this §412.756 adopted to be effective July 5, 2007, 32 TexReg 4000

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