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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) : 8.8 Prior Authorization : 8.8.4 Prior Authorization for Residential Treatment Services : Residential Treatment Services for Adolescents
Clients who are 13 through 17 years of age must meet all above conditions and the following conditions in order to receive treatment in an adolescent residential treatment service program:
Documented history of inability to function within the expected age norms despite normal cognitive and physical maturation (e.g., refusal to interact with family members, overt prostitution, felony, or other criminal charges).
A recent history of moderate to severe conduct disorder, as defined in the Diagnostic and Statistical Manual for Professional Practitioners, or impulsive disregard for social norms and rights of others.
Documented difficulty in meeting developmental expectations in a major area of functioning (e.g., social, academic, or psychosexual) to an extent that interferes with the capacity to remain behaviorally stable.

Texas Medicaid & Healthcare Partnership
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