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Updated Accreditation Requirements for Psychiatric Facilities

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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.

Effective immediately, enrollment guidelines for psychiatric facilities have been updated for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program.

Psychiatric facilities will no longer be limited to accreditation by The Joint Commission. Texas Medicaid and the CSHCN Services Program will accept accreditation from any approved Accrediting Organization for psychiatric facilities by the Centers for Medicare and Medicaid Services (CMS).

On September 1, 2024, the Texas Medicaid & Healthcare Partnership (TMHP) will update language in the Texas Medicaid Provider Procedures Manual, Inpatient and Outpatient Hospital Services Handbook, subsection 3.4.1, “Enrollment” to reflect the new accreditation requirements.

For a current list of Accrediting Organizations for psychiatric facilities, refer to CMS-Approved Accrediting Organization.

For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.