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.
The following Medicaid and Children’s Health Insurance Program (CHIP) COVID-19 flexibilities have been extended through December 31, 2020:
- “Correction to ‘COVID-19 Guidance: Targeted Case Management Through Remote Delivery’”
- “Waiver Extension for DME Certification and Receipt Form”
- “Claims for Telephone (Audio-Only) Behavioral Health Services”
- “Claims for Telephone (Audio-Only) Medical Services”
- “RHC Reimbursement for Telemedicine and Telehealth Services”
- “SHARS Services Provided Through Telemedicine or Telehealth”
- “Claims for Telehealth Service for Occupational, Physical, and Speech Therapy”
- “Claims for Telephone (Audio-Only) Early Childhood Intervention Specialized Skills Training”
- “Claims for Telephone (Audio-Only) Nutritional Counseling Services”
- “Texas Health Steps Checkup Guidance Extended Through July 31, 2020”
Effective December 1, 2020, reimbursement for telemedicine (physician delivered) and telehealth (non-physician delivered) services for federally qualified health centers (FQHCs) became benefits of Texas Medicaid. Providers can refer to the articles “Benefits for Telemedicine Services to Change for Texas Medicaid December 1, 2020,” and “Benefits for Telehealth Services to Change for Texas Medicaid December 1, 2020,” for additional information about the benefit changes.
For more information, call the TMHP Contact Center at 1-800-925-9126.