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Spindletop MHMR Services (STMHMR Services)
Request For Interest (RFI) - Private Providers of Mental Health Services
Mental Health General Revenue Funded Services
Spindletop MHMR Services (STMHMR Services), or The Center, the Local Mental Health Authority (LMHA)
for Southeast Texas, is a contractor of the Texas Department of State Health Services (DSHS) established to
plan, coordinate, develop policy, develop and allocate resources, supervise, and assure the provision of
community based mental health and mental retardation services for residents of Chambers, Hardin, Jefferson,
and Orange Counties, Texas.
Pursuant to Texas Administrative Code §412.60, Spindletop MHMR Services (STMHMR Services), as a
DSHS-designated Local Mental Health Authority (LMHA), has the responsibility to assemble a network of
service providers to provide services described in this Request For Interest (RFI) to the priority population of
persons with mental illness who reside in Chambers, Hardin, Jefferson, and Orange Counties of Southeast
Texas. The funds allocated by DSHS to STMHMR Services are referred to as General Revenue funds.
As you may recall, in 2009 STMHMR Services distributed a Request for Application (RFA) to providers that
had expressed interest in possibly providing services under this requirement. In response to this request, the
Center received NO RFAs from any provider.
Once again, STMHMR Services must develop a local planning and network development (LPND) plan for the
possible procurement of services in fiscal year 2011 (September 1, 2010 – August 31, 2011). Because the
Center received NO RFAs from providers in the 2009 LPND planning cycle, in this next 2011 cycle the Center
would like to determine if there are any providers that may be interested in submitting an RFA for services in
the 2011 network development planning cycle.
This Request For Interest (RFI) is designed to inform providers of the services that STMHMR Services may
possibly consider for contracting in fiscal year 2011, and to also provide information on the requirements that
must be met in order to provide the services.
The response to this RFI will enable STMHMR Services to more efficiently develop the next network
development plan for Southeast Texas. This Request For Interest (RFI) will be accepted by STMHMR Services
until April 15, 2010. This date allows approximately 45 days for providers to consider this RFI.
The attachments in this RFI include:
Attachment A:
Attachment B:
Attachment C:
Texas Resiliency and Disease Management (RDM) Service Package Definitions and
Services
Staff Credentialing Criteria
Interested Provider Application Form
Potential providers may submit the Interested Provider Application form (Attachment C) included in this RFI to
this name and address:
Sally Walden, Director
Network Services
Spindletop MHMR Services
2750 South 8th Street
Beaumont, Texas 77701
409-839-2230
[email protected]
Spindletop MHMR Services (STMHMR Services)
Request For Interest (RFI) - Private Providers of Mental Health Services
Mental Health General Revenue Funded Services
Goals Of The Local Network
The goals of the Spindletop MHMR Services local network of providers are:
1. To develop a comprehensive network of providers for consumers receiving mental health services funded by
Texas general revenue monies;
2. To increase consumer access and allow consumer choice in the selection of service providers;
3. To identify, implement, and evaluate successful programs so that these efforts can be replicated;
4. To create meaningful cooperative relationships between the Local Mental Health Authority (Spindletop
MHMR Services) and private service providers in the local community;
5. To provide a comprehensive community treatment system; and
6. To ensure best value for all services provided to local consumers.
Priority and Target Population
1.
Adult Mental Health (MH) Priority Population - Adults who have severe and persistent mental illnesses,
such as schizophrenia, major depression, bipolar disorder, or other severely disabling mental disorders that
require crisis resolution or ongoing and long-term support and treatment
2.
Adult Mental Health (MH) Target Population - Adults who have a diagnosis of schizophrenia, bipolar
disorder, and severe major depression
3.
Child and Adolescent Mental Health (MH) Priority Population - children ages 3 through 17 with a
diagnosis of mental illness (excluding a single diagnosis of substance abuse, mental retardation, autism or
pervasive developmental disorder) who exhibit serious emotional, behavioral or mental disorders and who:
a. have a serious functional impairment; or
b. are at risk of disruption of a preferred living or child care environment due to psychiatric
symptoms; or
c. or are enrolled in a school system’s special education program because of a serious emotional
disturbance.
Minimum Requirements
At a minimum, qualified providers must:
1.
2.
3.
4.
5.
6.
Meet the minimum qualifications of the Texas Department of State Health Services (DSHS)
performance contract and local plan;
Demonstrate the ability to provide services in compliance with DSHS contract requirements;
Comply with the Texas RDM (Resiliency and Disease Management) requirements; Provide services as
defined in the RDM utilization management guidelines – (See Attachment A)
Be able to provide services in the language and English proficiency as dictated by the person receiving
services;
Engage and involve consumers, legally authorized representatives, and families in the policy and
practice levels within the applicant’s organization or individual practice;
Provide services to consumers from Chambers, Hardin, Jefferson, and Orange Counties; and
7.
Have the ability to transition at a minimum 10% of the individuals receiving procured service within the
first 45 days; Thereafter, be able to transition consumers into services at a rate of 25% per month until
the applicant’s capacity is reached or utilization and referrals are not indicated.
Notwithstanding the above, providers must be eligible or registered to do business in Texas. In any situation
where a consortium of providers is applying, a single entity responsible for services must be identified and the
financial agent must be an organization with a demonstrated ability to manage funds.
Responsibilities
Local Mental Health Authority (LMHA) Responsibilities
The local mental health authority (LMHA) will be responsible for service coordination / case management and
facilitating an individual’s selection of service providers, authorizing services, reviewing claims, and paying for
appropriate, authorized services provided by the service providers in the network. The LMHA is also
responsible for utilization management and quality assurance. The LMHA ensures that contracted services that
address the needs of the priority population are provided as required by DSHS, comply with the rules and
standards adopted under Section 534.052 of the Texas Health and Safety Code, and Chapter 412, Subchapter G
of the Texas Administrative Code. The LMHA does not guarantee any referral volume to any service provider
within its network of providers.
To review the Spindletop MHMR Services targets and capacity go to:
www.dshs.state.tx.us/mhcommunity/LPND/LMHAs/spindletop.shtm
Service Provider Responsibilities
The service provider will be responsible for entering into the Center’s electronic health record all original
documentation reflecting service provision, and may maintain additional secondary records regarding treatment
or services provided to the LMHA’s individuals with mental Illness, and allow access to the LMHA to such
records upon request. The service provider is required to comply with all state and federal laws regarding the
confidentiality of consumer records and nondiscrimination. The service provider will actively assist in the
disbursement of consumer and advocate satisfaction surveys. The service provider will obtain prior
authorization, provide acceptable levels of care, and maintain acceptable levels of liability insurance,
appropriate licenses, and accreditations. The service provider also agrees that its name may be used, along with
a description of its facilities, care, and services in any information distributed by the LMHA’s list of service
providers. The service provider must comply with the rules and standards adopted under Section 534.052 of the
Texas Health and Safety Code and all applicable local, state, and federal laws, rules and regulations. The
service provider also agrees to comply with ongoing contract changes required of the Local Mental Health
Authority by the Texas Department of State Health Services (TDSHS) that must also be complied with by
LMHA network providers.
Spindletop MHMR Services
Request For Interest (RFI) - Private Providers of Mental Health Services
ATTACHMENT A: Texas RDM Service Package Definitions and Services
RDM Service Package Definitions And Service Descriptions
Service Package 1 – Adult
Service Package Definition
Services in this package are generally intended for individuals with major depressive disorder (GAF ≤ 50),
bipolar disorder, or schizophrenia and related disorders who present with very little risk of harm and who
have supports and a level of functioning that does not require higher levels of care.
The general focus of this array of services is to reduce or stabilize symptoms, improve the level of
functioning, and/or prevent deterioration of the person's condition. Natural and/or alternative supports are
developed to help the person move out of the public mental health system. Services are most often provided
in outpatient, office-based settings, and are primarily limited to medication, rehabilitative services, and
education.
Service Descriptions
Basic Services
1. Pharmacological management services
Supervision of administration of medication, monitoring of effects and side effects of medication,
assessment of symptoms. Includes one psychiatric evaluation per year.
2. Routine Case Management
Includes basic facilitation of access to resources and services, coordination of services with
consumer, as well as administration of TIMA scales. This service is generally facility-based and not
generally delivered in-vivo.
3. "Medication Training & Support Services"
(also referred to as "TIMA Patient and Family Education Program") Includes education on diagnosis,
medications, monitoring and management of symptoms, and side effects.
Specialty Services/Add-Ons
1. Skills Training & Development
The building of skills to facilitate community integration and tenure
2. Supported Employment
Provides individualized assistance in choosing and obtaining employment, at integrated work sites in
jobs in the community of the consumer's choice, and supports provided by identified staff who will
assist individuals in keeping employment and/or finding another job as necessary. This includes
"Skills Training & Development" related to addressing the symptoms of mental illness affecting an
individual's ability to obtain and retain employment, as well as non-billable vocational specific
training.
3. Supported Housing
Provides individualized assistance in choosing and obtaining integrated housing in the community of
the consumer's choice, and supports provided by identified staff who shall assist individuals in
retaining housing and/or finding new housing as necessary. This includes "Skills Training &
Development" related to addressing the symptoms of mental illnesses affecting an individual's ability
to obtain and retain housing, as well as non-billable housing specific support services (e.g., locating
housing, assistance with moving).
4. Crisis Intervention Services
These are individual interventions provided in response to a crisis in order to reduce symptoms of
severe and persistent mental illness or serious emotional disturbance and to prevent admission of an
individual to a more restrictive environment. This service may be delivered to anyone with a mental
health crisis. This service does not require prior authorization.
5.
Day Programs for Acute Needs
These are site-based rehabilitative day programs that provide short-term, intensive treatment in a
highly structured environment to individuals who require multidisciplinary treatment in order to
stabilize acute psychiatric symptoms and to facilitate crisis resolution in order avoid placement in a
more restrictive setting. This service is intended to stabilize individuals who are experiencing acute
distress and who would be unable to function independently in the community without this
intervention. Day Programs for Acute Needs are generally provided in settings such as Crisis
Stabilization Units and Crisis Residential Settings.
Service Package 2 – Adult
Service Package Definition
Services in this package are intended for individuals with residual symptoms of major depressive disorder,
with an intake GAF ≤50, who present very little risk of harm, who have supports, and a level of functioning
that does not require more intensive levels of care, and who can benefit from psychotherapy.
The general focus of services in this package is to improve level of functioning and/or prevent deterioration
of the person's condition. Natural and/or alternative supports are developed to help the person move out of
the public mental health system. Services are most often provided in outpatient, office-based settings and
include psychotherapy services in addition to those offered in Service Package 1.
Service Descriptions
Basic Services
1. Pharmacological Management Services
Supervision of administration of medication, monitoring of effects and side effects of medication,
assessment of symptoms. Includes 30 minutes of psychiatric evaluation per 180 days. For most
individuals in SP2, this is a continuation of a service from SP1.
2. Routine Case Management
Includes basic facilitation of access to resources and services, coordination of services with consumer
and family, administration of TIMA scales. For most individuals in SP2, this is a continuation of the
service from SP1.
3. Counseling (cognitive behavioral therapy – CBT)
Provided in order to resolve a concrete problem in daily functioning (problem focused, solution
oriented) or symptoms resulting from maladaptive thoughts, feelings, interpersonal disturbances,
and/or experiences consistent with DSM diagnosis. Counseling is intended to be brief, time-limited,
and focused.
4. Medication Training & Support Services
(Also referred to as "TIMA Patient and Family Education Program") This includes education on
diagnosis, medications, monitoring, and management of symptoms and side effects.
Specialty Services/Add-Ons
1. Skills Training & Development
The building of skills in order to facilitate community integration and tenure.
2. Supported Employment
Provides individualized assistance in selecting and obtaining employment, at integrated work sites in
jobs in the community of the consumer's choice, and supports provided by identified staff who shall
assist individuals in retaining employment and/or finding another job as necessary. This includes
"Skills Training & Development" related to addressing the symptoms of mental illnesses affecting an
individual's ability to obtain and retain employment, as well as non-billable vocational specific
training.
3. Supported Housing
Provides individualized assistance in choosing and obtaining integrated housing in the community of
their choice, and supports provided by identified staff who shall assist individuals in retaining housing
and/or finding new housing as necessary. This includes "Skills Training & Development" related to
addressing the symptoms of mental illnesses affecting an individual's ability to obtain and retain
housing, as well as non-billable housing specific support services (e.g., locating housing, assistance
with packing).
4. Crisis Intervention Services
These are individual interventions provided in response to a crisis in order to reduce symptoms of
severe and persistent mental illness or serious emotional disturbance and to prevent admission of an
individual to a more restrictive environment. This service may be delivered to anyone who is having /
experiencing a mental health crisis. This service does not require prior authorization.
5.
Day Programs for Acute Needs
These are site-based rehabilitative day programs that provide short-term, intensive treatment in a
highly structured environment to individuals who require multidisciplinary treatment in order to
stabilize acute psychiatric symptoms and to facilitate crisis resolution in order avoid placement in a
more restrictive setting. This service is intended to stabilize individuals who are experiencing acute
distress and who would be unable to function independently in the community without this
intervention. Day Programs for Acute Needs are generally provided in settings such as Crisis
Stabilization Units and Crisis Residential Settings.
Service Package 3 – Adult
Service Package Definition
Service Package 3 (SP-3) must utilize a team approach to providing more intensive rehabilitative services for
the individual. Services in this package are generally intended for individuals who enter the system of care
with moderate to severe levels of need (or for those whose LOC-R has increased) who require intensive
rehabilitation to increase community tenure, establish support networks, increase community awareness,
and develop coping strategies in order to function effectively in their social environment (family, peers,
school). This may include maintaining the current level of functioning. A rehabilitative case manager who is
a member of the therapeutic team must provide supported Housing and COPSD services. Supported
Employment services must be provided by both a Supported Employment specialist on the team and the
rehabilitative case manager.
The general focus of services in this package is to stabilize symptoms, improve functioning, develop skills in
self-advocacy, and increase natural supports in the community and / or sustain improvements made in more
intensive service packages. Service focus is on amelioration of functional deficits through skill training
activities focusing on symptom management, independent living, self-reliance, non-job-task specific
employment interventions, impulse control, and effective interaction with peers, family, and community.
Services are provided in outpatient office-based settings and community settings.
Service Descriptions
Basic Services
1. Integrated Rehabilitative Teams
This service package is a service delivery model that provides the defined services in an integrated
treatment team structure. All persons served in SP-3 must at a minimum receive the following
services unless the service is refused or is clinically contra-indicated (with documentation of the
reason noted in the individual's medical record):
a. Pharmacological management services
Supervision of administration of medication, monitoring of effects and side effects of
medication, assessment of symptoms. Includes a 30-minute psychiatric evaluation every 180
days.
2. Rehabilitative Services, which include:
a. "Medication Training & Support" that is education on diagnosis, medications, monitoring
and management of symptoms and side effects (also referred to as "TIMA Patient and Family
Education Program").
b. "Psychosocial Rehabilitative Services" (also referred to as Rehabilitative Case
Management) provide a variable level of integrated support to individuals assigned to this
package. Includes:
i.
Assistance in accessing medical, social, educational, or other appropriate support
services, as well as linkage to more intensive services if needed, in addition to
monitoring (monthly or weekly as needed), assessment of service needs, service
planning and coordination, administration of TIMA scales, and other TIMA medication
management functions.
3. A basic level of rehabilitative services addressing daily and independent living skills to persons
on their caseload.
4. Co-occurring Psychiatric and Substance use Disorder services.
5. Medical:
a. Psychosocial Rehabilitation
Medication related services – services to provide training regarding an individual's
medications in order to increase the individual's compliance with medication treatment. These
include training in self administration of the individual's medications, the importance of taking
one's medications as prescribed, determining the effectiveness of the individual's
medications, identifying side-effects of the individual's medications; and
b. Supplemental Nursing Services
Provided in support of services provided by the physician, including but not limited to taking
vital signs, weight monitoring, blood draws; etc. (Note: These services do not include nursing
services that are incidental to a physician's office visit.).
Specialty Services/Add-Ons
1. Supported Employment
Provides individualized assistance in choosing and obtaining employment at integrated work sites in
jobs in the community of one's choice, and supports provided by identified staff who will assist
individuals in retaining employment and/or finding other jobs as necessary. This includes
"Psychosocial Rehabilitative Services" related to addressing the symptoms of the mental illness
affecting the individual's ability to obtain and retain employment, as well as non-billable vocational
specific training. Need for Supported Employment is indicated by a score of 3-5 on Dimension 5:
Employment Problems of the TRAG. For a subset of the population served in SP3 who have a need
for Supported Employment, the following additional service will be provided based on selection by
the individual and the treatment team.
2. Supported Housing
Provides individualized assistance in choosing and obtaining integrated housing in the community of
one's choice and supports provided by designated staff who shall assist individuals in retaining
housing and/or finding new housing as necessary. This includes "Psychosocial Rehabilitative
Services" related to addressing the symptoms of mental illnesses affecting an individual's ability to
obtain and retain housing, as well as non-billable housing specific support services (e.g., locating
housing, assistance with moving). Need for Supported Housing is indicated by an allowable score on
Dimension 6: Housing Instability of the TRAG (see "Add-on Service Criteria for SP-3"). For individuals
who are a subset of the population served in SP3 and who have a need for Supported Housing, the
following additional service will be provided based on the individual's preference and the conclusions
of the treatment team.
3. Crisis Intervention Services
These are individual interventions provided by staff members other than members of the consumer's
therapeutic team (SP-3 Team) in response to a crisis in order to (a) reduce symptoms of severe and
persistent mental illnesses or serious emotional disturbances and (b) to prevent admission of an
individual to a more restrictive environment. This service may be delivered to anyone who is having /
experiencing a mental health crisis. This service does not require prior authorization. [NOTE: When
members of the SP-3 Team address a crisis situation, the services are billed as Psychosocial
Rehabilitation}
4. Day Programs for Acute Needs
These are site-based rehabilitative day programs that provide short-term, intensive treatment in a
highly structured environment to individuals who require multidisciplinary treatment in order to
stabilize acute psychiatric symptoms and to facilitate crisis resolution in order to avoid placement in
a more restrictive setting. This service is intended to stabilize individuals who are experiencing acute
distress and who would be unable to function independently in the community without this
intervention. Day Programs for Acute Needs are generally provided in settings such as Crisis
Stabilization Units and Crisis Residential Settings.
Service Package 4 – Adult
Service Package Definition
A self-contained program which is the fixed point of responsibility for providing treatment, rehabilitation, and
support services to identified consumers with severe and persistent mental illnesses and who have a history
of multiple hospitalizations. Individuals that have experienced multiple hospitalizations and have needs that
affect their ability to live independently in the community are appropriate for this level of care.
ACT is a comprehensive wrap-around service that includes Pharmacological Management, "Psychosocial
Rehabilitative Services," Medical Related Services (Includes both "Medication Training & Supports" and
"Psychosocial Rehabilitative Services" component "Medication related services"), Supported Employment,
Supported Housing, and Co-occurring Psychiatric and Substance Use Disorder services.
Service Descriptions
Basic Services
1. Pharmacological management services
Supervision of administration of medication, self-medication training for individual or family,
monitoring of effects and side effects of medication, assessment of symptoms.
2. Rehabilitative Services
"Psychosocial Rehabilitative Services" (also referred to as Rehabilitative Case Management) provides
a variable level of integrated support to individuals assigned to this service package. Includes:
Assistance in accessing medical, social, educational, or other appropriate support services as well as
linkage to more intensive services if needed, in addition to monitoring (weekly or monthly as
needed), assessment of service needs, service planning and coordination, administration of TIMA
scales, and other TIMA medication management functions.
3. A basic level of rehabilitative services
Addressing daily and independent living skills to persons on their caseload.
4. Co-occurring Psychiatric and Substance Use Disorder Services
When the symptoms of the mental illness are addressed in relation to substance use.
5. Supported Employment
This provides individualized assistance in choosing and obtaining employment at integrated work
sites in jobs in the community of one's choice, and supports provided by identified staff who shall
assist individuals in retaining employment and/or finding other jobs as necessary. This includes
"Psychosocial Rehabilitative Services" related to addressing the symptoms of any mental illness
affecting an individual's ability to obtain and retain employment, as well as non-billable vocational
specific training.
6. Supported Housing
These services assist clients in choosing, obtaining, and maintaining regular integrated housing. This
includes "Psychosocial Rehabilitation" services related to addressing the symptoms of mental
illnesses that affect an individuals ability to maintain housing, as well as non-billable activities that
assist individuals in locating and obtaining housing.
7. "Medication Training & Support"
This is education regarding the diagnoses, medications, monitoring, and management of symptoms
and side effects (also referred to as "TIMA Patient and Family Education Program").
8. Medical
a. Psychosocial Rehabilitation – Medication-related services
These include education and training regarding the individual's prescribed medications for the
purpose of enhancing compliance with pharmacological treatment. These focus on training in
self-administration of the individual's medications, the importance of taking the medications
as prescribed, determining the effectiveness of the individual's medications, identifying sideeffects of the individual's medications; and
b. Supplemental Nursing Services
Provided in support of services provided by the physician, including but not limited to taking
vital signs, weight monitoring, blood draws, etc. (Note: These services do not include nursing
services that are incidental to a physician's office visit.).
Specialty Services/Add-Ons
1. Crisis Intervention Services
Individual interventions provided by staff members other than members of the consumer's
therapeutic team (ACT Team) in response to a crisis in order to (a) reduce symptoms of severe and
persistent mental illness or serious emotional disturbance and (b) reduce the risk of admission to a
more restrictive environment. This service may be delivered to anyone who is having / experiencing
a mental health crisis. This service does not require prior authorization. [NOTE: When members of
the SP-4 (ACT) Team address a crisis situation, the services are billed as Psychosocial
Rehabilitation.]
2. Day Programs for Acute Needs
Site-based rehabilitative day programs that provide short-term, intensive treatment in a highly
structured environment to individuals who require multidisciplinary treatment in order to stabilize
acute psychiatric symptoms and to facilitate crisis resolution in order avoid placement in a more
restrictive setting. This service is intended to stabilize individuals who are experiencing acute distress
and who would be unable to function independently in the community without this intervention. Day
Programs for Acute Needs are generally provided in settings such as Crisis Stabilization Units and
Crisis Residential Settings.
Service Package 0 (Crisis Services) – Adult
Service Package Definition
Services in this package are brief interventions provided in the community that will ameliorate the crisis
situation and prevent utilization of more intensive services. The desired outcome is resolution of the crisis
and avoidance of more intensive and restrictive intervention.
Service Descriptions
Basic Services
1. "Crisis Intervention Services"
Includes face-to-face evaluation of risk, provision of skills training and guidance, and coordination of
emergency services and:
2. Psychiatric services
Include services provided by a physician, including injections, medication adjustments, evaluation,
and medical referrals.
3. Observation – Assessment
By a psychiatrist to avoid regular inpatient hospitalization. Placement based on need at time of crisis
screening. The desired outcome is to remove stressors and return to home.
Specialty Services/Add-Ons
1. Day Programs for Acute Needs
Site-based rehabilitative day programs that provide short-term, intensive treatment to individuals
who require multidisciplinary treatment in order to stabilize acute psychiatric symptoms or prevent
admission to more restrictive settings.
Service Package 5 (Crisis Follow-Up) – Adult
Brief interventions for individuals who are released from crisis services or hospitalization and are not eligible
for on-going services.
Service Package Definition
1. Routine Case Management
Includes basic facilitation of access to resources and services, coordination of services with individual
and family, and administration of TIMA scales.
2. Psychiatric services
Include services provided by a physician including injections, medication adjustments, evaluation,
and medical referrals.
RDM Service Package Definitions and Service Descriptions
Service Package 1.1 – Child/Adolescent
Service Package Definition
Basic Services
This level of care is targeted for children and adolescents with externalizing disorders (e.g., ADD/ADHD,
Conduct or Oppositional Defiant Disorder) and a moderate level of functional impairment. The focus of the
intervention is on psychosocial skill development in the child and the enhancement of parenting skills,
especially in child behavior management. Access to parent support groups is available. Information
regarding the diagnosis, medication, monitoring of symptoms and side effects is provided through
Medication Training and Support. This level of care is generally considered short-term and time-limited.
The general goal of services at this level of care is to reduce or stabilize symptoms, decrease functional
impairment or prevent deterioration of the child's condition. Family support is facilitated through linkage to
natural and community resources. Services are provided in the office, school, home or other community
setting.
Service Descriptions
Basic Services
1. Skills Training and Development
A structured intervention to provide and improve skills needed for the child to function appropriately
in the community, and to enhance child behavior management and increase the skills necessary to
manage/decrease the child's level of functional impairment.
2. Medication Training and Support
Information provided to the child and family on the mental health disorder, medications, monitoring
of symptoms and side effects.
3. Routine Case Management
Facilitation of child/family's access to community resources and continuity of care between services.
Parent Support Group: support and informational meetings for parents of children receiving services
that are facilitated and routinely scheduled.
Specialty Services/Add-Ons
1. Psychiatric Evaluation
Psychiatric clinical diagnostic interview
2. Medication Management
A service provided by a licensed medical professional to a child or family to determine symptom
remission and the medication regime needed to initiate and/or maintain the child's plan of care.
3. Skills Training and Development (Group)
A structured intervention provided in a group setting to provide and improve skills needed for the
child to function appropriately in the community and to enhance child behavior management and
increase the skills necessary to manage/decrease child's level of functional impairment. Group Skills
Training and Development is limited to no more than 6 children per group.
o
NOTE – Medicaid reimbursement for Skills Training and Development in groups is not
currently available.
Service Package 1.2 – Child/Adolescent
Service Package Definition
This level of care is targeted for children and adolescents with internalizing disorders (depressive or anxiety
disorders) and a moderate level of functional impairment. The focus of the intervention is on child and family
counseling using Cognitive Behavioral Therapy (CBT) for ages 9 & above and CBT or other therapy
approaches for children ages 3 through 8. Access to parent support groups is available. Information
regarding the diagnosis, medication, monitoring of symptoms and side effects is provided through
Medication Training and Support. This LOC is generally considered short-term and time-limited. The general
goal of services at this level of care is to reduce or stabilize symptoms, decrease functional impairment or
prevent deterioration of the child's condition. Family support is facilitated through linkage to natural and
community resources and parent support groups. Services are provided in the office, school, home or other
community setting.
Service Descriptions
Basic Services
1. Counseling
Provided in order to resolve a concrete problem in daily functioning (problem-focused, solutionoriented) or symptoms resulting from maladaptive thoughts, feelings, interpersonal disturbances,
and/or experiences consistent with DSM–IV diagnoses. Counseling is intended to be brief, timelimited and focused.
2. Medication Training and Support
Information provided to the child and family on the mental health disorder, medications, monitoring
of symptoms and side effects.
3. Routine Case Management
Facilitation of child/family's access to community resources and continuity of care between services.
4. Parent Support Group
Support and informational meetings for parents of children receiving services that are facilitated and
routinely scheduled.
Specialty Services/Add-Ons
1. Psychiatric Evaluation
A psychiatric clinical diagnostic interview
2. Group Counseling
Provided in a group setting in order to resolve a concrete problem in daily functioning (problemfocused, solution-oriented) or symptoms resulting from maladaptive thoughts, feelings, interpersonal
disturbances, and/or experiences consistent with DSM–IV diagnoses (CBT). Group Counseling is
intended to be brief, time-limited and focused and limited to no more than 6 children per group.
3. Family Counseling
Provided to children and their families order to resolve a concrete problem in daily functioning
(problem-focused, solution-oriented) or symptoms resulting from maladaptive thoughts, feelings,
interpersonal disturbances, and/or experiences consistent with DSM–IV diagnoses (CBT).
4. Medication Management
A service provided by a licensed medical professional to a child or family to determine symptom
remission and the medication regime needed to initiate and/or maintain the child's plan of care.
Service Package 2.2 – Child/Adolescent
Service Package Definition
This level of care is targeted at children and adolescents with externalizing disorders and moderate to high
functional impairment at home, school or in the community. The need for intensive case management and
significant parent support is indicated. The family service plan is developed using a wraparound planning
approach. Multi-Systemic Therapy is either not appropriate due to lack of juvenile justice involvement or
unavailable.
Service Descriptions
Basic Services
1. Intensive Case Management
Activities that assist the child/family including service planning and coordination, monitoring service
effectiveness, and proactive crisis planning and management.
2. Skills Training and Development
A structured intervention to provide and improve skills needed for the child to function appropriately
in the community and to enhance child behavior management and increase the skills necessary to
manage/decrease child's level of functional impairment.
3. Medication Training and Support
Information provided to the child and family on the mental health disorder, medications, monitoring
of symptoms and side effects.
4. Family Partner
Peer mentoring, education and support provided by an experienced parent to the caregivers of a
child in service.
5. Parent Support Group
Support and informational meetings for parents of children receiving services that are facilitated and
routinely scheduled.
Specialty Services/Add-Ons
1. Psychiatric Evaluation
A psychiatric clinical diagnostic interview
2. Medication Management
A service provided by a licensed medical professional to a child or family to determine symptom
remission and the medication regime needed to initiate and/or maintain the child's plan of care.
3. Skills Training and Development (Group)
A structured intervention provided in a group setting to provide and improve skills needed for the
child to function appropriately in the community and to enhance child behavior management and
increase the skills necessary to manage/decrease child's level of functional impairment. Group Skills
Training and Development is limited to no more than 6 children per group.
o
NOTE – Medicaid reimbursement for Skills Training and Development in groups is not
currently available.
4. Flex Funds
Non-clinical supports that that augment the service plan to reduce symptomatology and maintain
quality of life and family integration. The provider may request authorization of flex funds to
augment the family service plan, up to a $1,500/family cap. The UM manager may authorize an
exception to the $1,500 per family cap with documented justification.
Service Package 2.3 – Child/Adolescent
Service Package Definition
This level of care is targeted to children and adolescents with depressive or anxiety disorders and a
moderate to high level of problem severity or functional impairment. The focus of the intervention is on child
and family counseling using Cognitive Behavioral Therapy (CBT) for ages 9 & above and CBT or other
therapy approaches for children ages 3 through 8. Multiple family concerns and significant parental stress
indicate the need for intensive case management and the availability of parent-to-parent peer support. The
family service plan is developed using a wraparound planning approach.
Service Descriptions
Basic Services
1. Intensive Case Management
Activities that assist the child/family including service planning and coordination, monitoring service
effectiveness, and proactive crisis planning and management.
2. Counseling
Provided in order to resolve a concrete problem in daily functioning (problem-focused, solutionoriented) or symptoms resulting from maladaptive thoughts, feelings, interpersonal disturbances,
and/or experiences consistent with DSM–IV diagnoses. Counseling is intended to be brief, timelimited and problem-focused.
3. Medication Training and Support
Information provided to the child and family on the mental health disorder, medications, monitoring
of symptoms and side effects.
4. Family Partner
Peer mentoring, education and support provided by an experienced parent to the caregivers of a
child in service.
5. Parent Support Group
Support and informational meetings for parents of children receiving services that are facilitated and
routinely scheduled.
Specialty Services/Add-Ons
As clinically indicated, a psychiatric evaluation, medication management, group and family counseling, and
flex funds can be authorized in addition to LOC 2.3 services.
1. Psychiatric Evaluation
A psychiatric clinical diagnostic interview.
2. Medication Management
A service provided by a licensed medical professional to a child or family to determine symptom
remission and the medication regime needed to initiate and/or maintain the child's plan of care.
3. Group Counseling
Provided in a group setting in order to resolve a concrete problem in daily functioning (problemfocused, solution-oriented) or symptoms resulting from maladaptive thoughts, feelings, interpersonal
disturbances, and/or experiences consistent with DSM–IV diagnoses (CBT). Group Counseling is
intended to be brief, time-limited and focused and limited to no more than 6 children per group.
4. Family Therapy
Provided to children and their families order to resolve a concrete problem in daily functioning
(problem-focused, solution-oriented) or symptoms resulting from maladaptive thoughts, feelings,
interpersonal disturbances, and/or experiences consistent with DSM–IV diagnoses (CBT).
5. Flex Funds
Non-clinical supports that that augment the service plan to reduce symptomatology and maintain
quality of life and family integration. The provider may request authorization of flex funds to
augment the family service plan, up to a $1,500/family cap. The UM manager may authorize an
exception to the $1,500 per family cap with documented justification.
Service Package 2.4 – Child/Adolescent
Service Package Definition
This level of care is targeted for children and adolescents who are diagnosed with Bipolar Disorder,
Schizophrenia, Major Depression with Psychosis, or other psychotic disorders and are not yet stable on
medication. The major focus is on stabilizing the child and providing information and support to the family.
Service Descriptions
Basic Services
1. Intensive Case Management
Activities that assist the child/family including service planning and coordination, monitoring service
effectiveness, and proactive crisis planning and management.
2. Medication Training and Support
Information provided to the child and family on the mental health disorder, medications, monitoring
of symptoms and side effects.
3. Family Partner
Peer mentoring, education and support provided by an experienced parent to the caregivers of a
child in service.
4. Medication Management
A service provided by a licensed medical professional to a child or family to determine symptom
remission and the medication regime needed to initiate and/or maintain the child's plan of care.
5. Psychiatric Evaluation
A psychiatric clinical diagnostic interview.
6. Parent Support Group
Support and informational meetings for parents of children receiving services that are facilitated and
routinely scheduled.
Specialty Services/Add-Ons
As clinically indicated, flex funds may be authorized in addition to LOC 2.4 services.
1. Flex Funds
Non-clinical supports that that augment the service plan to reduce symptomatology and maintain
quality of life and family integration. The provider may request authorization of flex funds to
augment the family service plan, up to a $1,500/family cap. The UM manager may authorize an
exception to the $1,500 per family cap with documented justification.
Service Package 4 – Child/Adolescent
Service Package Definition
This level of care is targeted to children and adolescents who have stabilized in terms of problem severity
and functioning and require only medication and medication management to maintain their stability. If CATRAG scores indicate the need for a more intensive LOC, LOC 4 can only be authorized if 1) the parent
refuses the recommended LOC, wants medication-only services and medication is clinically indicated; or 2) if
the individual is NOT Medicaid eligible and the recommended LOC is not available due to limited resources
but severe presenting problems that are responsive to medication suggest an authorization for LOC 4 during
the waiting period.
Service Descriptions
Basic Services
1. Medication Management
A service provided by a licensed medical professional to a child or family to determine symptom
remission and the medication regime needed to initiate and/or maintain the child's plan of care.
2. Routine Case Management
Facilitation of child/family's access to community resources and continuity of care between services.
3. Parent Support Group
Support and informational meetings for parents of children receiving services that are facilitated and
routinely scheduled.
Service Package 0 – Crisis – Child/Adolescent
Service Package Definition
Services in this package are brief interventions provided in the community that will ameliorate the crisis
situation and prevent utilization of more intensive services. The desired outcome is resolution of the crisis
and avoidance of more intensive and restrictive intervention.
Service Descriptions
Basic Services
1. Crisis Intervention Services
Includes face-to-face evaluation of risk, provision of skills training and guidance, and coordination of
emergency services.
2. Psychiatric Services
Include services provided by a physician including injections, medication adjustments, evaluation,
and medical referral
Service Package 5 – Crisis Follow-Up – Child/Adolescent
The major focus for this SP is to provide flexible services that assist individuals in maintaining stability,
preventing further crisis, and engaging the individual into the appropriate LOC or assisting the individual in
obtaining appropriate community-based services. This SP is highly individualized and the level of service
intensity and length of stay is expected to vary dependent on individual need. This SP is available for up to
90 days.
Spindletop MHMR Services
Request For Interest (RFI) - Private Providers of Mental Health Services
ATTACHMENT B – Staff Credentialing Criteria
The following criteria, information, and components are required for a service provider to be included in the
Local Mental Health Authority’s network of providers.
1. Minimum Requirements For All Services Being Sought:
 Staff must be over 18, have a high school diploma or a General Education Development(GED)
credential; or has documentation of a proficiency evaluation of experience and competence to perform
the job tasks that includes:
o written competency-based assessment of the ability to document service delivery and
observations of the individuals to be served; and
o at least three personal references from persons not related by blood that indicate the ability to
provide a safe, healthy environment for the individuals being served.
 Current drivers license for each person that will potentially provide transportation to Local Authority
consumers.
 Current Insurance Verification including:
o Professional and general liability
o Vehicle (if transporting consumers is likely)
o Workers Compensation
 Verification of criminal history checks for all staff potentially working with Local Mental Health
Authority consumers.
 Life Safety code review for site assessment if not certified by a state agency
 If applicable, documentation from certifying agency:
o Texas Department of State Health Services (DSHS)
o Texas Department of Assistive and Rehabilitative Services (DARS)
2. Additional Required Information:
A. Qualifications of Providers – Adults
Adult Services must be delivered by staff with these minimum qualifications. In accordance with the Texas
Department of State Health Services (DSHS) Mental Health Community Services Standards, all staff must be
trained and competent in the tasks they perform prior to contact with the individual.
Pharmacological Management: MD, RN, PA, Pharm.D, APN, LVN
Psychiatric Diagnostic Interview Examination: LPHA
Counseling: LPHA or LPHA Intern
Routine Case Management: QMHP-CS, or CSSP
Rehabilitative Services: QMHP-CS, Licensed medical personnel, CSSP, or Peer Provider (consult Rule for
specific credential requirements for sub-component services)
Supported Employment: QMHP-CS or CSSP or Peer Provider
Supported Housing: QMHP-CS or CSSP or Peer Provider
Crisis Intervention Services: QMHP-CS
Crisis Transportation: No restrictions
B. Qualifications of Providers – Children
Skills Training and Development: QMHP-CS, CSSP
Medication Training and Support: QMHP-CS, CSSP
Routine Case Management: QMHP-CS, CSSP
Parent Support Group: paraprofessional, QMHP-CS
Psychiatric Diagnostic Interview Examination: MD psychiatrist (preferably a child psychiatrist)
Pharmacological Management: MD, RN, PA, Pharm. D, APN, LVN
Family Training: QMHP-CS, CSSP
Crisis Intervention Services: QMHP-CS
Safety Monitoring: QMHP-CS or trained and competent adult
Crisis Transportation: No restrictions
Crisis Respite: Trained and competent adult
Extended Observation: Meet staffing requirements in DSHS performance contract
Children’s Crisis Residential: Meet staffing requirements in DSHS performance contract
Spindletop MHMR Services
Request For Interest (RFI) - Private Providers of Mental Health Services
ATTACHMENT C – Interested Provider Application
The following Interested Provider Application form will be completed by providers interested in the possible
procurement of services by Spindletop MHMR Services and returned to the address cited above on the first
page of this RFI.
1. Name of Interested Provider_____________________________________________________
2. Name of Chief Executive Officer________________________________________________
3. Contact Person____________________________
Title__________________________
4. Business Address____________________________________________________________
City_____________________ State_____________ Zip Code______________________
Phone___________________
Fax_____________________________________________
5. List location where services are provided ___Office
___Home
6. Is your Service Address different from Business address?
If Yes, list it below:
___MHMR Facility
___Yes ___No
Address____________________________________________________________________
City_____________________ State_____________ Zip Code______________________
7. Do you qualify as a Historically Underutilized Business (HUB)?
If yes, have you applied for certification? ___Yes ___No
___Yes ___No
If yes, Certification#________________
8. Social Security # or Federal Tax ID #___________ Tax Code [Example: 501(c)(3)] ___________
9. Please list any certifications or accreditations, if applicable:  JCAHO  ICF/MR  CARF
 HCS  HCSO  CLASS  ACDD  TRC  ECI  TEA  DOL  Other, please specify:______
10. Please list any licensure specifying the license #, licensing agency as well as level(s) of service as
applicable: _________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
11. Do you provide emergency or after hours services?
___Yes ___No
If yes, please explain including telephone. #_______________________________________
__________________________________________________________________________
___________________________________________________________________________
12. In what languages, including American Sign Language or Signed English, are staff able to provide
services?_____________________________________________________________
13. Are you a Medicaid provider?
___Yes ___No
If Yes, Group or Individual Provider #____________________________
14. Are you a Medicare provider?
___Yes ___No
If Yes, Group or Individual Provider #_____________________________
15.
Types of Services:
___Adult
___Children
___Adult & Child.
___Pharmacological management
___Psychotherapy (CBT)
___Day Program for Skills Training (MH)
___Site-Based Habilitation.
___Early Childhood Intervention
___In-Home & Family Support
___Telemedicine
___Residential Services
___ Other_____________
Authorized Signature:
______________________________
Printed Name:
______________________________
Title:
______________________________
Date:
______________________________
___Rehab Services
___Supported Housing
___Respite Services
___ACT Team Services
___Counseling
___Consumer Peer Support
___Supported Employment
___ Other_____________
___Other_____________