Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 354 - MEDICAID HEALTH SERVICES
Subchapter M - MENTAL HEALTH TARGETED CASE MANAGEMENT AND MENTAL HEALTH REHABILITATION
Division 2 - MENTAL HEALTH TARGETED CASE MANAGEMENT
Section 354.2659 - Exclusions

Universal Citation: 1 TX Admin Code § 354.2659

Current through Reg. 49, No. 38; September 20, 2024

(a) The following services are not covered as mental health targeted case management:

(1) case management activities that are an integral component of another covered Medicaid service;

(2) the provision of a medical, educational, social/behavioral, or another service to which an individual has been referred, including foster care services;

(3) performing an activity that does not directly assist an individual in gaining or coordinating access to needed services;

(4) providing medical or nursing services;

(5) performing pre-admission or intake activities;

(6) providing services to the LAR or primary caregiver of the individual outside of the services allowable under this subchapter;

(7) transporting the individual, LAR, or primary caregiver outside of what is allowable under this subchapter;

(8) monitoring the individual's general health status;

(9) performing outreach activities;

(10) performing quality oversight of a service provider;

(11) conducting utilization review or utilization management activities;

(12) conducting quality assurance activities; and

(13) authorizing services or authorizing the provision of services.

(b) The following activities are included in the mental health targeted case management rate and, therefore, Medicaid payment is not made separately for the following activities:

(1) documenting the provision of mental health targeted case management services;

(2) on-going assessment to determine the amount, duration, and type of mental health targeted case management for each individual;

(3) travel time required to provide mental health targeted case management services at a location not owned, operated or under arrangement with the comprehensive provider agency; and

(4) quality assurance activities that are specific to mental health targeted case management.

(c) Texas Medicaid does not reimburse for mental health targeted case management services provided before the establishment of a diagnosis of mental illness and the authorization of services.

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