By applying utilization management, the provider aims to have a balance between the demand for services, availability of resources and the needs and well-being of people who need behavioral health services.
The Texas Resilience and Recovery model of care requires the development of standardized, evidenced-based practices that are provided to address a person's needs. The clinical guidelines identify:
- The evidence-based services
- Amount, duration and scope of delivery for the services
- Population being served
The Utilization Management Program Manual is a resource for technical assistance to providers to develop and monitor their local UM programs and processes.
Providers of behavioral health services can use the UM Guidelines to implement a UM program. The guidelines contain HHS-approved processes and procedures for key program components.