Prior Authorization is Required for Certain Mental Health Targeted Case Management and Mental Health Rehabilitative Services

Date: October 9, 2024

Attention: All Providers

Effective date: Starting November 15, 2024

Call to action:Last updated 9/16/2024: Texas Children’s Health Plan (TCHP) previously informed network providers that prior authorization will be required for Mental Health Targeted Case Management (MHTCM) and Mental Health Rehabilitative (MHR) Services on October 15, 2024. TCHP is modifying this requirement for prior authorization as follows:

Prior authorization will be required for MHTCM and MHR Services under two (2) conditions: by age group AND when the amount of service exceeds a certain amount as outlined below. 

1. The requirement for prior authorization will be implemented by age groups starting on: 

• November 15, 2024: 18 years and older
• December 1, 2024: 17-16 years
• January 1, 2025: 15-14 years
• February 1, 2025: 13-12 years
• March 1, 2025: 11-10 years
• April 1, 2025: 9-8 years
• May 1, 2025: 7 years and under

2. AND when the provider determines a member needs TCH/MHR services in excess of the service hours (or units) in the table below:

How this impacts providers: Providers should submit prior authorization requests to TCHP according to the member’s age and requested level of service as above. 

Providers should also review the additional information provided below which addresses:

• covered services
• Texas Resilience and Recovery (TRR) Utilization Management Guidelines
• required provider training and certification
• opportunity for easy authorization submission in the TCHP Portal

Mental Health Targeted Case Management and the appropriate modifier for MHTCM: 

Procedure Code: T1017 Targeted Case Management

Mental Health Rehabilitative Services:

For procedure code H2011 (crisis intervention), prior authorization is not required. 

Training Requirements Reminder

Per Uniform Managed Care Manual (UMCM), Chapter 15.3 Mental Health Targeted Case Management and Mental Health Rehabilitative Services Training Requirements, all providers (including local mental health authorities and non-local mental health authorities) delivering mental health rehabilitation and mental health targeted case management must undergo the training outlined in Chapter 15.3 before delivering services, with the exception of training for the wraparound planning process. 

Child and Adolescent Needs and Strengths (CANS)andAdult Needs and Strengths Assessment (ANSA) Certification Requirement 

TCHP asks all MHTCM and MHR providers to please send us their certification of either CANS or ANSA training. A copy of your CANS and/or ANSA certification can been emailed to tchpnetworkmanagement@texaschildrens.org. TCHP requires MHTCM/MHR providers serving both children and adults to have either CANS or ANSA certifications. Providers must have documentation of current certification in the CANS or ANSA, and the certification must be updated annually. For more information, please view the Provider Alert on the CANS and ANSA certification requirement.

Texas Resilience and Recovery (TRR) Utilization Management Guidelines 

TRR is the service delivery system in Texas for community-based mental health services. The TRR Utilization Management Guidelines provide a recommended amount and duration of targeted case management and mental health rehabilitation based on TRR Level of Care. Providers can view the guidelines below:

• Texas Resilience and Recovery Utilization Management Guidelines: Adult Mental Health Services
• Texas Resilience and Recovery Utilization Management Guidelines: Child and Adolescent Services

Texas Children’s® Link: Efficiently Submit Prior Authorizations

TCHP would like to remind providers that they can submit prior authorizations securely online via Texas Children’s® Link, our online provider portal. Providers are encouraged to submit authorization requests on our portal since this is the most efficient way for our team to process authorizations. To access the portal, click here.

Important benefits of using the portal to submit authorizations include:

• Auto Authorizations: Certain medically necessary services can be submitted for auto authorizations.
• Faster Authorization Processing: Prior Authorization requests received in the portal are assessed by the Utilization Management team faster than any other method.
• Real-time Access to Authorization Status Information: Authorization and Appeal Status Update and Status History are immediately available and determinations can be reviewed on the portal in real-time.
• Easy Access for Providers and Staff: In addition to providers, both clinical staff and non-clinical staff may submit and review authorization requests on the portal on behalf of a requesting provider. 

Resources:

• UMCM, Chapter 15.3 Mental Health Targeted Case Management and Mental Health Rehabilitative Services Training Requirements
• Behavioral Health and Case Management Services Handbook of the Texas Medicaid Provider Procedures Manual (TMPPM)
• ANSA (HHSC website)
• CANS (HHSC website)
• Training Attestation Document
• Texas Children’s® Link provider portal
• Prior Authorization Information

Next step for Providers: Providers are encouraged to submit authorization requests on Texas Children’s® Link since this is the most efficient way for our team to process authorizations. If providers are experiencing any barriers to submitting prior authorizations on the portal, they are encouraged to reach out to their assigned Provider Relations Liaison (PRL).

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org. 

For access to all provider alerts: www.texaschildrenshealthplan.org/provideralerts