OIG inspects mental health services

The OIG conducted an inspection of mental health targeted case management and mental health rehabilitative services in managed care. The inspection objectives were to determine whether local mental health authorities (LMHAs) or local behavioral health authority (LBHA) contracted providers:

  • Provided members in Texas Medicaid programs with the opportunity to receive services.
  • Met select Texas Administrative Code requirements when providing mental health targeted case management and mental health rehabilitative services to Texas Medicaid members.
  • Communicated member’s mental health assessment results to the applicable managed care organization (MCO) for service coordination.
  • Identified potential causes for Texas Medicaid members not receiving mental health targeted case management and mental health rehabilitative services.

The inspection scope covered Texas Medicaid recipients enrolled in the State of Texas Access Reform Plus (STAR+PLUS) program through an MCO who were assessed during the period from March 1, 2019 through May 31, 2019 but had not received recommended core services as of November 30, 2019.

LMHAs and LBHA-contracted providers reviewed as part of this inspection have policies and procedures to share mental health information with each member’s MCO. However, LMHAs and LBHA-contracted providers reviewed as part of this inspection did not always meet documentation requirements for some types of required information. Specifically:

  • 35 of the 115 member files reviewed did not contain the required treatment plan.
  • 58 of the 115 member files reviewed did not include documentation that the eligible members refused recommended core services and the member did not receive services.
  • 38 of the 115 member files reviewed did not include the mental health assessor’s documentation to indicate that core services were discussed with the member so an informed decision could be made.

The OIG offered recommendations to LMHAs and LBHA-contracted providers, which, if implemented, will correct deficiencies in compliance with Texas Administrative Code and Texas Resilience and Recovery Utilization Management Guidelines: Adult Mental Health Services for documentation in member files to (a) develop written treatment plans, (b) identify why eligible members did not receive core services and (c) document that core services were discussed with the member.

Read the full inspection report on the OIG website.

https://oig.hhs.texas.gov/sites/default/files/documents/targeted-case-management-lmha-lbha-final-8-30-21.pdf