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2012 Texas Medicaid Provider Procedures Manual

Medicaid Managed Care Handbook : 8. Carve-Out Services

8. Carve-Out Services
Some services are "carved out" of one or more of the managed care programs. Carved out services are those that are rendered to Medicaid managed care clients, but are processed for payment consideration by TMHP and not an MCO or dental plan.
The following table shows the services that are partially or completely carved out of the MCO and dental plan managed care program as well as services that are no longer carved out as of March 1, 2012:
Audiology Services including hearing aids for clients who are 20 years of age and younger (*see note below)
Services by Pharmacy (Immunization by Pharmacy) (*see note below)
Early Childhood Intervention (ECI) case management/service coordination
DARS Blind Children's Vocational Discovery and Development Program (TCB)
* Note: Audiology services and hearing aids for clients who are 20 years of age and younger, pharmacy services, ECI - Therapies (ST, PT, OT), and inpatient hospital services are no longer carved out for managed care clients for dates of service or inpatient dates of admission on or after March 1, 2012. Authorizations, if necessary, and claims for these services must be submitted to the client's MCO.
** Note: TMHP will continue to reimburse inpatient hospital claims on or after March 1, 2012, for STAR+PLUS Program clients whose inpatient date of admission was authorized through TMHP before March 1, 2012.
 
Orthodontia for most clients who are 20 years of age and younger
Orthodontia for clients who turned 21 years of age before March 1, 2012, and whose services were authorized by TMHP before March 1, 2012
Note:
Effective March 1, 2012, authorizations and claims for SSI clients who are enrolled in the STAR Program are submitted to the client's MCO or dental plan.

Texas Medicaid & Healthcare Partnership
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