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2012 Texas Medicaid Provider Procedures Manual

Inpatient and Outpatient Hospital Services Handbook : 3. Inpatient Hospital (Medical/Surgical Acute Care Inpatient Facility) : 3.4 Services, Benefits, Limitations, and Prior Authorization - Inpatient Psychiatric Services (IMD)

3.4 Services, Benefits, Limitations, and Prior Authorization - Inpatient Psychiatric Services (IMD)
Inpatient admissions to acute care hospitals for psychiatric conditions may be a benefit of Texas Medicaid for clients of any age.
Refer to:
Subsection 2.11, “Inpatient Rehabilitation Facility (Freestanding) (CCP),” in the Children’s Services Handbook (Vol.2, Provider Handbooks).
Admissions to acute care hospitals must be medically necessary. Admissions to freestanding and state psychiatric facilities must be medically necessary, unless the admission is for court-ordered services for mental health commitments or a condition of probation.
Inpatient admissions to acute care hospitals, freestanding, and state psychiatric facilities are subject to the Texas Medicaid retrospective utilization review (UR) requirements. The UR requirements are applicable, regardless of the hospital's designation as a psychiatric unit versus medical/surgical unit.
When a client requires admission, or once the client becomes Medicaid eligible while in the facility, a certification of need must be completed and placed in the client's record within 14 days of the admission.
Inpatient psychiatric treatment is a benefit of Texas Medicaid if:
Inpatient psychiatric treatment in a nationally accredited freestanding psychiatric facility or a nationally-accredited state psychiatric hospital is a benefit of Texas Medicaid for clients who are 20 years of age or younger, and who are eligible for THSteps benefits at the time of the service request and service delivery.
Client services must be provided in the most appropriate setting and in a timely manner to meet the mental health needs of the client.
Revenue code 124 must be used for inpatient psychiatric services for children and adolescents in freestanding and state psychiatric facilities.
Inpatient admissions without an accompanying medical complication or condition are not a benefit of Texas Medicaid including, but not limited to:
Supporting documentation (certification of need) must be documented in the individual client's record. This documentation must be maintained by each facility for a minimum of five years and be readily available for review when requested.

Texas Medicaid & Healthcare Partnership
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