Home and Community-Based Services – Adult Mental Health

Home and Community-Based Services-Adult Mental Health is a program that provides home and community-based services to adults with serious mental illness. The program provides an array of services, to match each person's needs. This helps the person to live and experience successful tenure in their chosen community. Services are designed to support long-term recovery from mental illness.

Forms/Handbooks/Rates

Program Forms

• Form 3006, No Reject Appeals
• Form 3007, Critical Incident Reporting
• Form 3023, Notification of Participant's Rights
• Form 3024, Respite Relative Provider
• Form 3036, Preauthorization Request for Conversion Services
• Form 3037, Good Faith Effort
• Form 3039, Authorization to Disclose Protected Health Information
• Form 3040, Review Findings and Plan of Improvement
• Form 8201, Recovery Manager Settings Checklist
• Form 8002, Transportation Log
• Form 8003, Documentation of Transportation as Part of HCBS-AMH Service
• Form 8200, Recovery Manager Education Requirement Waiver Request
• Form 8202, HCBS-AMH Program and YES Waiver Program Request for Technology Funding
• Form 8203, Subcontractor Attestation Form
• Form 8204, Subcontractor Credentialing Attestation Form
• Form 8206 HCBS-AMH Service Area Change Request
• Form 8207 Telehealth Services Attestation
• HCBS-AMH Provider Selection Form (PDF)
• Individual Recovery Plan Template (Excel)
• Pre-Engagement Performance Measures (Excel)
• Provider Agency Quarterly Reporting Template May 2024 (Excel)
• Recovery Manager Quarterly Reporting Template December 2023 (Excel)
• Annual Reporting Template (Excel)

Nursing Forms

• Form 3090, Nursing Health Screening Within 72 Hours of Community Placement
• Form 3091, HCBS-AMH Comprehensive Nursing Assessment
• Form 3092, Medication Administration Record
• Form 8509, Unlicensed Personnel Tracking of Delegated Tasks
• Form 8585, RN Delegation Worksheet for 22 TAC Chapter 225
• Form 8588, Nursing Supervision For Unlicensed Assistive Personnel (UAP)

HCBS-AMH Manual

HCBS-AMH Provider Manual December 2023 (PDF)

• Manual Change Log December 2023 (PDF)
• Manual Change Log May 2023 (PDF)
• Manual Change Log January 2022 (PDF)
• Manual Change Log January 2018 (PDF)
• Manual Change Log July 2017 (PDF)
• Manual Change Log December 2016 (PDF)
• Manual Change Log July 2016 (PDF)
• Manual Change Log October 2015 (PDF)

HCBS-AMH Marketing Toolkit and Other Resources

• HCBS-AMH Provider Brochure (PDF)
• HCBS-AMH Client Brochure (PDF in English)
• HCBS-AMH Client Brochure (PDF in Spanish)
• HCBS-AMH Participant Handbook (PDF in English)
• HCBS-AMH Participant Handbook (PDF in Spanish)
• HCBS-AMH Overview Flyer (PDF in English)
• HCBS-AMH Overview Flyer (PDF in Spanish)
• HCBS-AMH Poster (PDF in English)
• HCBS-AMH Poster (PDF in Spanish)
• HCBS-AMH LMHA Flyer (PDF)
• HCBS-AMH Sample Service Plan Flyer (PDF in English)
• HCBS-AMH Sample Service Plan Flyer (PDF in Spanish)
• HCBS-AMH Contact Sheet (PDF)
• HCBS-AMH Crisis Resource Booklet (PDF in English)
• HCBS-AMH Crisis Resource Booklet (PDF in Spanish)
• HCBS-AMH Questions to Ask Flyer (PDF)
• HCBS-AMH Acceptable Medicaid Plans (PDF)
   

Rates

Current payment rates were posted effective May 1, 2014. The Health and Human Services Commission has a comprehensive overview of the rate schedules.

Recovery management transitional day rate: After a period of three months, recovery management transitional services will be paid at a day rate. The recovery manager is not eligible to bill for recovery management transitional services provided after the person's stay exceeds 180 days. The day rate is $19.28.

• HCBS-AMH Encounter Invoice - July 2024 - Long (Excel)
• HCBS-AMH Encounter Invoice - July 2024 - Short (Excel)
• HCBS-AMH Pre-Engagement Encounter Invoice (Excel)

Billing Guidelines

HCBS-AMH Billing Guidelines - Dec 2023 (PDF)

• Guidelines Change Log Dec 2023 (PDF)
• Guidelines Change Log May 2023 (PDF)
• Guidelines Change Log June 2022 (PDF)
• Guidelines Change Log January 2022 (PDF)
• Guidelines Change Log May 2021 (PDF)
• Guidelines Change Log December 2020 (PDF)
• Guidelines Change Log November 2016 (PDF)
• Guidelines Change Log September 2016 (PDF)
• Guidelines Change Log July 2016 (PDF)
• Guidelines Change Log February 2016 (PDF)
• Guidelines Change Log October 2015 (PDF)

Statutes/Rules

• Social Security Act- 42 U.S.C. §1915(i)
• 26 Texas Administrative Code 307, Subchapter B Home and Community-Based Services-Adult Mental Health Program
• Medicaid State Plan 1915(i) HCBS-AMH (PDF) 
  If you have any questions or problems accessing the document, email HCBS-AMH staff.
• March 2022 Medicaid State Plan 1915(i) HCBS-AMH Amendment (PDF)
• May 2023 Medicaid State Plan 1915(i) HCBS-AMH Amendment (PDF)
• Electronic Code of Federal Regulations