Provider Alert! Timeframe for follow-up from an Inpatient Behavioral Health Facility

Date: November 17, 2023

Attention: Behavioral Health Providers and inpatient facilities

Call to action: Texas Children’s Health Plan (TCHP) request that all members receiving inpatient psychiatric services be scheduled prior to discharge for outpatient or lower level of care follow-up with an in network behavioral health provider. To search for TCHP network behavioral health providers, click here.

The timeframe requirements are as follows:

• Initial outpatient treatment after discharge must occur within seven (7) days from the date of discharge. The appointment should not occur on day of discharge.
• The second appointment after discharge must occur within thirty (30) days from the date of discharge.
• Due to appointment availability, it may be necessary to schedule the initial seven (7) day follow-up appointment with a therapist and continue treatment with the therapist until the psychiatric thirty (30) day follow-up appointment is met.
• The appointments described previously must be with a network psychiatrist, psychologist or therapist (LCSW, LPC, etc.).
• Missed appointments must be rescheduled within twenty-four (24) hours. Attempts to reschedule the member should be documented. Providers can make a referral to TCHP’s Behavioral Health Case Management if they experience difficulty contacting the member. Referrals to TCHP BH case management are made by completing the referral form available here.
  

How this impacts providers: Follow-up with a behavioral health provider within 7 days after discharge from inpatient psychiatric care is a HEDIS quality measure, Follow-up after Hospitalization for Mental Illness-7 Day (FUH-7DAY). HEDIS Toolkits available here.

TCHP rewards providers for quality of care. Participating behavioral health providers can earn an incentive for providing follow up care to members within 7 days of discharge from inpatient psychiatric care if the following requirements are met:

• Minimal panel requirement: five (5) compliant members per payment period (6 months).

• Population: STAR Kids Members age 6 and older who were hospitalized for treatment of selected Mental illness or intentional self-harm diagnoses between 1/1/2024-12/31/2024.

• Incentive: $100.00 once per member age 6 years and older who was hospitalized for treatment of selected mental illness or intentional self-harm diagnoses and who had a follow-up visit with a mental health practitioner within 7 days of discharge during calendar year 2024.

Next step for Providers: Providers should share these requirements with their staff and patients so that discharge plans are prepared accordingly. Providers are also encouraged to remind TCHP members of the following healthy rewards they can earn for receiving follow up care:

Behavioral Health Healthy Rewards Program for Members 2023-2024

Mental Health Post Hospital Stay
Patients seen for a follow-up appointment after a mental health hospitalization is an effective way for them to avoid readmissions. TCHP Members who qualify will receive a $25 reward card for completing a mental health follow-up visit with a behavioral health provider within 7 days of being discharged from the hospital.
Source: Mental Health Post Hospital Stay

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

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