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September 2016 Texas Medicaid Provider Procedures Manual

Behavioral Health, Rehabilitation, and Case Management Services Handbook : 5 Mental Health Rehabilitation, Mental Health Case Management, and Intellectual Disability Service Coordination : 5.2 Services, Benefits, Limitations, and Prior Authorization : 5.2.2 Mental Health Targeted Case Management

5.2.2
Texas Medicaid provides the following case management services:
Case management for people who have serious emotional disturbance (child, 3 through 17 years of age), which includes routine and intensive case management services.
Providers must use the following procedure code and applicable modifiers for MH targeted case management:
 
HZ -Funded by criminal justice agency (as appropriate)
32 units (8 hours) per calendar day for clients who are 18 years of age and older
HZ -Funded by criminal justice agency (as appropriate)
32 units (8 hours) per calendar day for clients who are 18 years of age
HZ -Funded by criminal justice agency (as appropriate)
32 units (8 hours) per calendar day for clients who are 17 years of age and younger
HZ -Funded by criminal justice agency (as appropriate)
Note:
Intensive case management services for individuals who are enrolled in the YES Waiver are available for clients who are 18 years of age. Intensive case management for YES Waiver clients must be authorized by DSHS.
An MH case management reimbursable contact is the provision of a case management activity by an authorized case manager during a face-to-face meeting with an individual who is authorized to receive that specific type of case management. A billable unit of case management is 15 continuous minutes of contact.
Service coordination and case management services are not reimbursable when they are provided to a client who is eligible for Medicaid and who receives services through the HCS waiver. These services are included in the waiver. Claims submitted to TMHP for people who receive services under the HCS waiver are identified quarterly by DADS and payments are recouped.
Texas Medicaid must not be billed for service coordination except for the purpose of discharge planning or waiver enrollments up to 180 days prior to the discharge for persons in ICF-IID facilities or state supported living centers, or case management services provided to people who are residents or inpatients of:
Nursing facilities (residents who have not been identified through the Preadmission Screening and Resident Review [PASRR] process as needing specialized mental health services.).
A Texas Medicaid-certified residence not already specified. Texas Medicaid must not be billed for ID service coordination provided to people enrolled in Community Living Assistance and Support Services (CLASS), Community-Based Alternatives (CBA), Program of All-inclusive Care for the Elderly (PACE), Deaf-Blind Multiple Disabilities (DBMD) or Medically Dependent Children Program (MDCP).
An institution for mental diseases, such as a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing the diagnosis, treatment, or care of people who have mental diseases, including medical attention, nursing care, and related services.
Note:
A contact by the service coordinator to assist in the discharge planning of some of the above may be reimbursed, if it is provided within 180 days before discharge. Service coordination services provided to people who are on predischarge furlough to the community from a nursing facility, intermediate care facility, or state-supported living centers may be reimbursed. Service coordination services provided to people who are on trial placement from a state supported living center to the community may be reimbursed if the person remains eligible for Texas Medicaid upon release from the facility and receives regular Texas Medicaid coverage.
Texas Medicaid must not be billed for MH case management services provided before the establishment of a diagnosis of mental illness and the authorization of services.
Note:
For more information about billing for MH Case Management, providers should refer to 25 TAC, Part 1, Chapter 412, Subchapter I and the Mental Health Case Management Billing Guidelines available through the DSHS Mental Health and Substance Abuse Program Services Division.

Texas Medicaid & Healthcare Partnership
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