Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, precertification, 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 January 1, 2023, providers (physicians, physician assistants, nurse practitioners, and clinic/group practices) of Collaborative Care Model (CoCM) services must attest that they have an established CoCM program prior to delivering CoCM services and that they are actively providing CoCM services consistent with the core principles and specific functional requirements of the model, as described in the “Collaborative Care Model (CoCM)” benefit in the Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook (Vol. 2, Provider Handbooks) in the Texas Medicaid Provider Procedures Manual (TMPPM).
Providers must complete an attestation form at the start of every new episode of care for each person receiving CoCM services to ensure adherence to the CoCM core principles and the specific functional requirements of the model. The attestation form must be maintained in the medical record of each person receiving CoCM services and made available to Texas Medicaid or its designee upon request.
The attestation form that is released on January 1, 2023, will serve as an interim process while HHSC explores the approach to use the Provider Enrollment and Management System (PEMS).
The “Attestation Form for Collaborative Care Model (CoCM) in Texas Medicaid” will be available on the Texas Medicaid & Healthcare Partnership (TMHP) website for primary care physicians beginning December 1, 2022.
For more information, call the TMHP Contact Center at 800-925-9126.