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December 2016 Texas Medicaid Provider Procedures Manual

Section 4: Client Eligibility : 4.8 Texas Medicaid Wellness Program

High-cost/high-risk fee-for-service (FFS) and managed care clients may be eligible to receive targeted care management services through the Texas Medicaid Wellness Program. The Wellness Program replaces the Disease Management program that was mandated by Human Resources Code 32.057 & 059. The Wellness Program administrator is McKesson Health Solutions.
The goal of the Wellness Program is to promote improved health outcomes by supporting and sustaining the client-provider relationship. The Wellness Program will contact Medicaid high-cost/high-risk clients to provide comprehensive care management services regardless of disease condition. The Wellness Program also has a diabetes self-management training (DSMT) component and will offer 10 hours of DSMT plus 3 hours nutritional counseling to all clients who have diabetes. Additionally, clients who have a body mass index (BMI) above 25 will receive vouchers for a weight loss program.
The Wellness Program offers the following:
Providers must submit claims and prior authorization requests for Wellness Program clients following the guidelines for Medicaid FFS services as defined in this manual or modified by website articles.
Providers may refer potential clients to the Wellness Program at 1-877-530-7756.

Texas Medicaid & Healthcare Partnership
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