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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 : 5.2.3 MH Rehabilitative Services : 5.2.3.6 Rehabilitative Services Limitations

5.2.3.6
Texas Medicaid must not be billed for the following:
Nursing facility residents who have not been identified through the Preadmission Screening and Resident Review (PASRR) process as needing specialized mental health services.
With the exception of Crisis Intervention Services and Psychosocial Rehabilitation Services delivered in a crisis situation, no reimbursement is available for a combination of MH rehabilitative services delivered in excess of eight hours per individual, per day.
Refer to:
25 TAC, Part I, Chapter 416, Subchapter A and the Medicaid MH rehabilitative billing guidelines, which are available through the DSHS Mental Health and Substance Abuse Division, for more information.

Texas Medicaid & Healthcare Partnership
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