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Behavioral Health, Rehabilitation, and Case Management Services Handbook
Table of Contents
1. General Information BH-7
2. Blind Children's Vocational Discovery and Development Program (BCVDDP) BH-7
2.1 Enrollment BH-7
2.1.1 Medicaid Managed Care Enrollment BH-7
2.2 Services/Benefits, Limitations, and Prior Authorization BH-7
2.2.1 Prior Authorization BH-8
2.3 Documentation Requirements BH-8
2.4 Claims Filing and Reimbursement BH-8
3. Case Management for Children and Pregnant Women (CPW) BH-9
3.1 Overview BH-9
3.1.1 Eligibility BH-9
3.1.2 Referral Process BH-9
3.2 Enrollment BH-9
3.2.1 Medicaid Managed Care Enrollment BH-10
3.3 Services/Benefits, Limitations, and Prior Authorization BH-10
3.3.1 Prior Authorization BH-11
3.4 Technical Assistance BH-11
3.4.1 Assistance with Program Concerns BH-11
3.5 Documentation Requirements BH-11
3.6 Claims Filing and Reimbursement BH-11
3.6.1 Assistance with Claims Concerns BH-11
3.6.2 Claims Information BH-11
4. Early Childhood Intervention (ECI) Targeted Case Management Services BH-12
4.1 Overview BH-12
4.2 Enrollment BH-12
4.2.1 Medicaid Managed Care Enrollment BH-13
4.3 Services/Benefits, Limitations, and Prior Authorization BH-13
4.3.1 ECI Referral Requirement BH-13
4.3.2 Prior Authorization BH-13
4.4 Documentation Requirements BH-13
4.5 Claims Filing and Reimbursement BH-14
5. Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), and Licensed Professional Counselor (LPC) BH-14
5.1 Enrollment BH-14
5.1.1 LCSW BH-14
5.1.2 LMFT BH-14
5.2 Services/Benefits, Limitations, and Prior Authorization BH-15
5.2.1 Prior Authorization BH-18
5.2.1.1 Initial Prior Authorization Request for Encounters/Visits beyond the 30-Encounter/Visit Limit BH-18
5.2.1.1.1 Client Condition Requirements BH-19
5.2.1.1.2 Initial Assessment Requirements BH-19
5.2.1.1.3 Active Treatment Plan Requirements BH-19
5.2.1.1.4 Discharge Plan Requirements BH-19
5.2.1.2 Subsequent Prior Authorization Request for Encounters/Visits after the Initial Prior Authorized Encounters BH-19
5.2.1.2.1 Client Condition Requirements BH-19
5.2.1.2.2 Active Treatment Plan Requirements BH-20
5.2.1.2.3 Discharge Plan Requirements BH-20
5.2.1.2.4 Prior Authorization for Court-Ordered and Department of Family and Protective Services (DFPS)-Directed Services BH-20
5.3 Documentation Requirements BH-21
5.4 Claims Filing and Reimbursement BH-21
6. Mental Health Rehabilitation, Mental Health Case Management, and Mental Retardation Service Coordination BH-22
6.1 Enrollment BH-22
6.1.1 Medicaid Managed Care Enrollment BH-22
6.2 Services/Benefits, Limitations, and Prior Authorization BH-22
6.2.1 Service Coordination and Case Management BH-22
6.2.2 MH Rehabilitative Services BH-24
6.2.2.1 Rehabilitative Services Limitations BH-25
6.2.2.2 Billing Units BH-25
6.2.3 Prior Authorization BH-26
6.3 Documentation Requirements BH-26
6.4 Claims Filing and Reimbursement BH-26
7. Physician, Psychologist, and Licensed Psychological Associate (LPA) Providers BH-26
7.1 Enrollment BH-26
7.1.1 Physicians BH-26
7.1.2 Psychologists BH-27
7.1.3 Licensed Psychological Associate (LPA) BH-27
7.2 Services/Benefits, Limitations, and Prior Authorization BH-28
7.2.1 Physicians BH-28
7.2.2 Psychologists and LPAs BH-28
7.3 The 12-Hour System Limitation BH-28
7.3.1 Retrospective Review of Behavioral Health Services Billed in Excess of 12 hours per Day BH-29
7.3.2 Procedure Codes included in the 12-hour System Limitation BH-29
7.3.3 Formula Applied BH-31
7.4 Outpatient Behavioral Health Services BH-32
7.4.1 Annual Encounters/Visits Limitations BH-32
7.4.2 Prior Authorization Requirements after the Annual Encounter/Visit Limitations Has Been Met BH-32
7.5 Chemical Dependency Treatment Facility (CDTF) BH-34
7.6 Court-Ordered and DFPS-Directed Services BH-34
7.7 Electroconvulsive Therapy (ECT) BH-35
7.8 Family Therapy/Counseling Services BH-35
7.9 Pharmacological Regimen Oversight and Pharmacological Management Services BH-36
7.9.1 Indications for Pharmacological Regimen Oversight and Pharmacological Management Services BH-37
7.9.2 Prior Authorization BH-37
7.9.3 Documentation Requirements BH-37
7.9.4 Reimbursement BH-38
7.10 Psychiatric Diagnostic Interviews BH-38
7.10.1 Prior Authorization BH-39
7.10.2 Documentation Requirements BH-40
7.10.3 Domains of a Clinical Evaluation BH-40
7.10.4 Reimbursement BH-41
7.11 Psychological and Neuropsychological Testing BH-42
7.11.1 Prior Authorization BH-44
7.11.2 Documentation Requirements BH-44
7.11.3 Reimbursement BH-45
7.12 Psychotherapy/Counseling BH-46
7.12.1 Prior Authorization BH-47
7.12.2 Documentation Requirements BH-48
7.12.3 Initial Outpatient Psychotherapy/Counseling for an Individual, Group, or Family BH-48
7.12.4 Subsequent Outpatient Psychotherapy/Counseling for an Individual, Group or Family BH-49
7.12.4.1 Active Treatment Plan Requirements BH-49
7.12.4.2 Discharge Plan Requirements BH-50
7.12.5 Insight Oriented Behavior Modifying and/or Supportive Outpatient Psychotherapy/Counseling BH-51
7.13 Narcosynthesis BH-51
7.14 Non-covered Services BH-52
7.15 Inpatient Behavioral Health Services BH-52
7.16 Psychiatric Services for Hospitals BH-53
7.16.1 Prior Authorization Requirements BH-53
7.16.2 Documentation Requirements BH-54
7.16.3 Psychological and Neuropsychological Testing Services BH-54
7.16.4 Inpatient Hospital Discharge BH-54
7.16.5 Inpatient Consultations BH-54
7.17 Claims Filing and Reimbursement BH-54
8. Screening, Brief Intervention, and Referral to Treatment (SBIRT) BH-55
8.1 Screening BH-56
8.2 Brief Intervention BH-56
8.3 Brief Treatment BH-56
8.4 Referral to Treatment BH-57
8.5 Reimbursement and Limitations BH-57
8.6 Documentation Requirements BH-58
8.7 Claims Filing and Reimbursement BH-58
9. Claims Resources BH-59
10. Contact TMHP BH-60
11. Forms BH-60
BH.1 Outpatient Psychotherapy/Counseling Form BH-61
BH.2 Psychological/Neuropsychological Testing Request Form BH-62
12. Claim Form Examples BH-63
BH.3 Blind Children's Vocational Discovery and Development Program (BCVDDP) BH-64
BH.4 Case Management for Children and Pregnant Women (CPW) BH-65
BH.5 Case Management for Early Childhood Intervention (ECI) BH-66
BH.6 Licensed Clinical Social Worker (LCSW) BH-67
BH.7 Licensed Marriage and Family Therapist (LMFT) BH-68
BH.8 Licensed Professional Counselor (LPC) BH-69
BH.9 Mental Health Case Management BH-70
BH.10 Psychologist BH-71
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