Provider Alert! New Provider Type for Non-Local Mental Health Authority Providers of Mental Health Targeted Case Management/Rehab

Date: October 19, 2021

Attention: Billing Services for Behavioral Health Providers (Non-LMHAs)

Subject: New Provider Type for Non-Local Mental Health Authority Providers of Mental Health Targeted Case Management/Rehab

Deadline for provider enrollment: November 1, 2021

Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.

Call to action: Texas Children’s Health Plan (TCHP) would like to remind non-Local Mental Health Authority (LMHA) providers of Mental Health Targeted Case Management and Mental Health Rehabilitation (MH TCM/Rehab) of a new provider type/specialty that is identified as “MH Case Management/MH Rehabilitative Services—Non-LMHA” and that the Health and Human Services Commission (HHSC) is available to assist with their enrollment.

How this impacts providers:
Details about the new provider type/specialty are as follows:

• HHSC is coordinating with the Texas Medicaid and Healthcare Partnership (TMHP) to ensure all providers are informed of the change and understand the process for making the transition.

In order for  non-LMHA providers to contract with TCHP to supply these benefits, a provider would need to complete the following steps:

• As part of this transition, HHSC will require providers to sign an attestation form agreeing to comply with the Texas Administrative Code rules pertaining to the benefit, including the requirement to provide or subcontract for the full array of services under the benefit.
• The attestation form will be incorporated into the enrollment process for non-LMHA providers. Here is a link to the Provider Enrollment page of the TMHP website. The new provider type, MH Case Management/MH Rehabilitative Services—Non-LMHA must be on the TMHP provider enrollment form and then the provider should notify TCHP to begin the contract inclusion.
• Similar to the LMHA provider types for delivering MH TCM/Rehab, the new provider type is also a “facility” entity type.
  • Facilities do not require enrollment of performing or rendering providers.
  • While individuals working for or with the entity may be licensed or certified in their individual capacity, the enrollment of the facility applicant type is based on the licensure or certification of the entity, or the supervising licensed practitioner responsible for the facility’s operation.
  • Note that while an entity enrolled at the facility level does not need to enroll individual performing or rendering providers, they do need to enroll any individual health care provider who is an ordering, referring, prescribing provider (ORP) in their facility.

Next steps for providers: HHSC has assessed potential barriers to provider enrollment, including varying timelines during enrollment and credentialing. To allow for sufficient time for providers to complete their enrollment into the 12/PR provider type and to credential with TCHP, the deadline for providers to bill MH TCM/Rehab services exclusively under the 12/PR provider type is November 1, 2021.
The deadline for non-LMHA providers to bill for MH TCM/Rehab services under provider types outside of 12/PR is November 1, 2021. Beginning November 1, 2021, non-LMHA providers will no longer be eligible to receive reimbursement for these services under any other provider type and must bill under the 12/PR provider type.

Source: Section 1: Provider Enrollment and Responsibilities; Texas Medicaid Provider Procedures Manual

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

For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.