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December 2016 Texas Medicaid Provider Procedures Manual

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

5.2
5.2.1
Texas Medicaid provides the following:
Service coordination for people who have an intellectual disability or a related condition (adult or child). Persons who have a related condition are eligible if they are being enrolled into the home and community based waiver (HCS); the Texas Home Living Waiver; or an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IID).
Service coordination funded by Medicaid as TCM is reimbursed by encounter.
There are two types of encounters:
Comprehensive encounter (Type A): A face-to-face contact with an individual to provide service coordination. The comprehensive encounter is limited to one billable encounter per individual per calendar month. DADS will not authorize payment for a comprehensive encounter that exceeds the cap of one encounter per individual per calendar month.
Supportive encounter (Type B): A face-to-face, telephone, or telemedicine contact with an individual or with a collateral on the individual’s behalf to provide service coordination.
A LIDDA is allowed up to three Type B encounters per calendar month for each Type A encounter that has occurred within the calendar month.
The Type B encounters are not limited to three per individual. Rather, the allowed Type B encounters may be delivered to any individual who needs a Type B encounter. These Type B encounters are allowable as long as the individual who received the Type B encounter also received a Type A encounter that same month.
For example, Sam and Mary receive a Type A encounter in June. It is allowable for the LIDDA to bill for one Type B encounter for Sam in June and five Type B encounters for Mary in June.
Payment for an individual’s Type B encounter is contingent on that individual having a Type A encounter within the same calendar month.
Within the calendar month, the Type A encounter does not have to occur on a date before any of the Type B encounters occur.

Texas Medicaid & Healthcare Partnership
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