Provider Alert! Mental Health and Substance Use Disorder Outpatient & Residential Services Co-Payments Prohibited

Date: June 29, 2022

Attention: Behavioral Health Providers

Effective date: July 1, 2022

Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with 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.

TCHP will apply updates and reprocess impacted claims as soon as possible. However, please allow up to sixty (60) business days for reprocessing. Providers are not required to appeal claims unless denied for other reasons.

Providers should direct questions to their Provider Relations Liaison or send an email inquiry to the Provider Relations Department at providerrelations@texaschildrens.org.

Call to action: TCHP would like to inform behavioral health providers of a mandate issued from the Health and Human Services Commission (HHSC) to comply with the Mental Health Parity and Addiction Equality Act (Pub. L. 110-343), HHSC will prohibit co-payments for CHIP mental health and substance use disorder (MH/SUD) outpatient and residential services.
As a reminder, CHIP providers are already prohibited from collecting co-pays for office visits during the COVID-19 public health emergency.

How this impacts providers: Effective July 1, 2022, providers should not collect copayments from CHIP members for MH/SUD outpatient and residential treatment services.

42 CFR § 457.496 – Parity in mental health and substance use disorder benefits, prohibits any financial requirement (e.g. co-payment) or treatment limitation for MH/SUD benefits in any classification that is more restrictive than the predominant financial requirement or treatment limitation of that type applied to medical or surgical benefits in the same classification.

Next steps for providers: Providers should share this communication with their staff.

• Providers must submit a completed template invoice with signed attestation for all office visit copayments not collected from members. The attestation must be submitted to TCHP by email to tchpfinance@texaschildrens.org by the end of the month following not collecting the copay or at any time prior to month end.
• TCHP has thirty (30) calendar days to pay the invoice received from a provider.
• In the situation that a provider has already collected a CHIP copay, a refund to the Member must be made before submitting to TCHP for reimbursement.

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