Information posted July 6, 2020
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 August 20, 2020, TMHP will update the Texas Medicaid Provider Procedure Manual, Medicaid Managed Care Handbook, section 8, “Carve-Out Services,” to include Home and Community Based Services–Adult Mental Health (HCBS-AMH). Certain services are carved-out of managed care plans and are processed under regular Medicaid instead of by the client’s assigned Managed Care Organization. Claims for these services are processed by TMHP.
Home and Community-Based Services-Adult Mental Health is a program that provides home and community-based services to adults with serious mental illness. The program provides an array of services to match each person's needs. This helps the person to live and experience successful tenure in their chosen community. Services are designed to support long-term recovery from mental illness.
Home and Community Based Services–Adult Mental Health (HCBS-AMH) is a carve-out service and will be added to the “carve-out services,” table following the Youth Empowerment Services (YES) Waiver at the bottom.
HCBS-AMH Job Aid
A HCBS-AMH Job Aid will be available on the TMHP Learning Management System (LMS).
The LMS can be found on this website, by clicking Provider Education on the left side of the Provider Home Page. This system instructs providers on how to enroll, view claims status, view Remittance and Status (R&S) Reports, and view Medicaid status of clients.
New providers will have to sign up for an account on the LMS.
For more information about the LMS, program providers can refer to the Learning Management System (LMS) Job Aid for Providers.
For more information, call the TMHP Contact Center at 800-925-9126.