Results from OIG inspection of local mental health authorities

The OIG conducted an inspection of local mental health authorities (LMHAs). The inspection objective was to determine whether the change in service level of Medicaid members' mental health services by LMHAs was documented and in compliance with Texas Administrative Code and Texas Resilience and Recovery Utilization Management Guidelines: Adult Mental Health Services. The inspection scope covered the period from September 1, 2017 through August 31, 2018.

LMHA staff documented the reason for deviating member services from Level of Care 4 to Level of Care 1S in 256 of the 258 member files reviewed; however, 17 of 31 LHMAs did not always meet documentation requirements for other types of required information. Of the 258 member files reviewed, 116 of the 258 members did not include documentation of all required information, such as provider credentials and signature, or an explanation of Level of Care 4 services, culminating in 159 unique instances of missing information. Most significantly:

  • 33 of the 159 instances of missing information were treatment plans or incomplete treatment plans.
  • 58 of the 159 instances of missing information were documentation to verify that LMHA staff provided the member with the information necessary to make an informed decision about mental health services.

Additionally, 186 of 258 members refused the recommended Level of Care 4 services offered by LMHAs. The OIG offered recommendations to LMHAs, which, if implemented, will correct documentation deficiencies and may result in increased insight as to why services are refused.

Read the full inspection on the OIG website.