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December 2016 Texas Medicaid Provider Procedures Manual

Behavioral Health, Rehabilitation, and Case Management Services Handbook : 8 Substance Use Disorder (SUD) Services (Abuse and Dependence) : 8.7 Medication Assisted Therapy (MAT)

MAT may be a benefit of Texas Medicaid when using a drug or biological recognized in the treatment of SUD and provided as a component of a comprehensive treatment program per TAC §448.902, or as a conjunctive treatment regimen for individuals addicted to abusable substances who meet the current DSM criteria for a SUD.
MAT is considered part of detoxification (residential and ambulatory outpatient) and residential treatment except for the following:
Documentation requirements supporting the medical necessity for MAT must be maintained in the client’s medical record according to the requirements in Federal Regulation 42 CFR §8. MAT must be performed by a physician; however, the physician may delegate this responsibility to other licensed personnel under his supervision. Documentation must include the name and title of the physician performing or delegating other MAT services. The client’s medical records are subject to retrospective review.
Clients who are 17 years of age and younger may not be admitted to a narcotic maintenance program unless a parent, legal guardian, or responsible adult designated by the relevant state authority consents in writing to such treatment. To be eligible for narcotic maintenance treatment, clients who are 17 years of age and younger must have had two documented attempts at short-term detoxification or drug-free (non-opioid) treatment within a 12-month period. A waiting period of no less than seven days is required between the first and the second short-term detoxification treatment.
Every exception to the general age requirement must be clinically justified and documented by a QCC. The facility must maintain the supporting documentation, including the QCC admission approval in the client’s medical record.
MAT for the treatment of opioid addiction must comply with the requirements in Federal Regulation 42 CFR §8.
Refer to:
Subsection 8.10.3, “MAT Services” in this handbook for more information on claims filing.

Texas Medicaid & Healthcare Partnership
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