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December 2016 Texas Medicaid Provider Procedures Manual

Inpatient and Outpatient Hospital Services Handbook : 3 Inpatient Hospital (Medical/Surgical Acute Care Inpatient Facility) : 3.4 Services, Benefits, Limitations, and Prior Authorization - Inpatient Psychiatric Services : 3.4.2 General Information

3.4.2
Inpatient admissions to acute care hospitals, freestanding psychiatric facilities, and state psychiatric facilities for psychiatric conditions may be a benefit of Texas Medicaid as outlined in the following table:
 
When a client requires admission, or once the client becomes Medicaid eligible while in the facility, a certification of need must be completed and placed in the client’s record within 14 days of the admission.
Inpatient psychiatric treatment is a benefit of Texas Medicaid if all of the following are met:
Client services must be provided in the most appropriate setting and in a timely manner to meet the mental health needs of the client.
Inpatient admissions to acute care hospitals, freestanding, and state psychiatric facilities are subject to the Texas Medicaid retrospective utilization review (UR) requirements. The UR requirements are applicable, regardless of the hospital’s designation as a psychiatric unit versus a medical or surgical unit.

Texas Medicaid & Healthcare Partnership
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