TMPPM 2010 > Volume 1, General Information > Section 8: Managed Care > PCCM > Covered Services > Behavioral Health Services

8.6.12.2 Behavioral Health Services

Behavioral health services are provided for the treatment of mental disorders, emotional disorders, and chemical dependency disorders. Behavioral health services do not require a primary care provider referral. PCCM clients may self-refer to any Medicaid-enrolled behavioral health provider for treatment. A referral from the client's primary care provider is not required. A primary care provider may, in the course of treatment, refer a patient to a behavioral health provider for an assessment or for treatment of an emotional, mental, or chemical dependency disorder. A primary care provider may also provide behavioral health services within the scope of his practice.

PCCM clients may receive any behavioral health service that is medically necessary, currently covered by Texas Medicaid, and provided by a Medicaid-enrolled behavioral health provider. Behavioral health providers include psychiatrists, psychologists, LCSWs, LPCs, LMFTs, and CDTF licensed facilities.

Note: Licensed psychological associates (LPAs) are not Medicaid-enrolled providers, but they can render services and file claims under the supervising psychologist's provider number.
See each of the following individual sections for benefits and limitations.

Refer to: Section 7, "Physician, Psychologist, and Licensed Psychological Associate (LPA) Providers" in the Behavioral Health, Rehabilitation, and Case Management Services Handbook (Vol. 2, Provider Handbooks).

Section 5, "Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), and Licensed Professional Counselor (LPC)" in the Behavioral Health, Rehabilitation, and Case Management Services Handbook (Vol. 2, Provider Handbooks).

Section 4, "Early Childhood Intervention (ECI) Targeted Case Management Services" in the Behavioral Health, Rehabilitation, and Case Management Services Handbook (Vol. 2, Provider Handbooks).

Section 3, "Case Management for Children and Pregnant Women (CPW)" in the Behavioral Health, Rehabilitation, and Case Management Services Handbook (Vol. 2, Provider Handbooks).

Section 2, "Chemical Dependency Treatment Facility Services" in the Children's Services Handbook (Vol. 1, Provider Handbooks).

In addition, many services are offered through DADS and DSHS that do not require a referral. These include case management for mental health and mental retardation, mental health rehabilitative services, and mental retardation diagnosis and assessment.

Behavioral health providers are encouraged to contact a client's primary care provider to discuss the patient's general health. Primary care providers are encouraged to maintain contact with the behavioral health provider to document behavioral health assessments and treatments and to inform the behavioral health provider of any condition the client may have that could impact the behavioral health service delivery. However, client approval for any exchange of information between the primary care provider and behavioral health provider is required. Providers must use the Form 8.1, "Primary Care Case Management (PCCM) Behavioral Health Consent Form" of this section.

Primary care providers are responsible for documenting referrals to behavioral health providers and any known self-referrals for behavioral health services in each client's medical record.