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December 2016 Texas Medicaid Provider Procedures Manual

Behavioral Health, Rehabilitation, and Case Management Services Handbook : 4 Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), and Licensed Professional Counselor (LPC) : 4.2 *Services, Benefits, Limitations, and Prior Authorization : 4.2.1 Prior Authorization : Subsequent Prior Authorization Request for Encounters or Visits after the Initial Prior Authorized Encounters
The following documentation requirements indicating the client’s condition must be submitted when requesting prior authorization for subsequent encounters or visits.
All of the requirements for the initial authorized treatment sessions must be met in addition to an assessment of the client’s response to treatment, which indicates one of the following:
The client has not achieved the discharge goals necessary to conclude treatment, but the client’s progress indicates that treatment can be concluded within a short period of time.
The client’s psychiatric condition has not responded to a trial of short-term outpatient therapy and there is potential for serious regression or admission to a more intensive setting without ongoing outpatient management (requiring several months or longer of outpatient therapy).
There must be an assessment that explains why the client was unable to achieve the expected treatment objectives that were previously set. The assessment must address the following:
Discharge planning must reflect the following:

Texas Medicaid & Healthcare Partnership
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