Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.
Beginning October 1, 2018, TMHP will remove references to the Texas Medicaid Wellness Program (TMWP) from the Texas Medicaid Provider Procedures Manual (TMPPM), Client Eligiblilty Handbook, Section 4.8, “Texas Medicaid Wellness Program,” as this program no longer exists.
The term disease management program will also be removed in reference to TMWP from the TMPPM, Telecommunication Services Handbook, Section 3.6.1, “Documentation Requirements for Telemonitoring Providers,” and the Children with Special Health Care Needs (CSHCN) Services Program Provider Manual, Telecommunication Services Chapter, subsection 22.214.171.124, “Prior Authorization Guidelines.”
For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.