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TMPPM Update for Health and Behavior Assessment and Intervention Criteria Effective June 1, 2023

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

On June 1, 2023, the Texas Medicaid & Healthcare Partnership (TMHP) will update the Texas Medicaid and Provider Procedures Manual (TMPPM), Children’s Services Handbook, section 2.10.1 of the “Health and Behavior Assessment and Intervention” benefit to remove the phrase “in-person from the criteria for completion of the evaluation for services. This change is in compliance with the telehealth and telemedicine updates that implemented September 1, 2022, as mandated by House Bill 4, 87th Legislature, Regular Session, 2021.

For more information, call the TMHP Contact Center at 800-925-9126.