TMPPM 2008 > Texas Medicaid Services > Hospital (Medical/Surgical Acute Care Facility) > Inpatient

25.2.3.3 Psychiatric Services

Inpatient admissions for adults and children to acute care hospitals for psychiatric conditions are a benefit of the Texas Medicaid Program. Admissions must be medically necessary and are subject to the Texas Medicaid Program's retrospective UR requirements. The UR requirements are applicable regardless of the hospital's designation of the psychiatric unit versus medical/surgical unit.

Admissions for the single diagnosis of chemical dependency or abuse (such as alcohol, opioids, barbiturates, and amphetamines) without an accompanying medical complication are not a benefit of the Texas Medicaid Program. Additionally, admissions for chronic diagnoses such as mental retardation, organic brain syndrome, or chemical dependency or abuse are not a benefit for acute care hospitals without an accompanying medical complication or medical condition. The UB-04 CMS-1450 claim form must indicate all relevant diagnoses that necessitate the inpatient stay.

Additional coverage may be allowed for clients who are eligible for Medicaid and younger than 21 years of age through THSteps-CCP.

Note: NorthSTAR is a managed care program in the Dallas service area that covers behavioral health services. Psychiatrists who provide behavioral health services to clients in NorthSTAR must be members of the NorthSTAR behavioral health organization (BHO).

Refer to: "THSteps-Comprehensive Care Program (CCP)" for more information.

"Medicaid Managed Care" for more information or contact the client's BHO.

Providers rendering services to STAR and STAR+PLUS clients must contact the respective managed care plan.