Provider Alert! Healthy Texas Women Program Launches Enhanced Postpartum Care Servicestcph
Attention: Chemical dependency treatment facilities, opioid treatment programs, licensed professional counselors, licensed clinical social workers, psychologists and psychology groups, psychiatrists, and cardiologists
Effective Date: December 29, 2020
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 ensure network providers are aware of the new postpartum services package Health and Human Services Commission (HHSC) has introduced for Healthy Texas Women clients called Health Texas Women Plus. To qualify for HTW Plus benefits, HTW clients must have been pregnant within the last 12 months. Benefits available through HTW Plus focus on treating health conditions that contribute to maternal morbidity and mortality, including the following:
- Postpartum depression and other mental health conditions
- Services include individual, family and group psychotherapy services; and peer specialist services
- Cardiovascular and coronary conditions
- Services include imaging studies; blood pressure monitoring; and anticoagulant, antiplatelet, and antihypertensive medications.
- Substance use disorders, including drug, alcohol and tobacco use
- Services include screening, brief intervention, and referral for treatment (SBIRT), outpatient substance use counseling, smoking cessation services, medication-assisted treatment (MAT), and peer specialist services.
New covered services include:
- Individual, family and group psychotherapy services
- Peer Specialist services
- Imaging studies, blood pressure monitoring, and anticoagulant, antiplatelet, and antihypertensive medications
- Screening, brief intervention, and referral for treatment
- Outpatient substance use counseling
- Smoking cessation services
- Medication-assisted treatment
Click here to view a table containing the procedure codes that are effective for dates of service beginning September 1, 2020.
To qualify for HTW Plus benefits, HTW clients must have been pregnant within the last 12 months.
- are age 15 through 44 (women age 15 through 17 must have parental or legal guardian consent to apply and receive services);
- are U.S. citizens or qualified immigrants;
- reside in Texas;
- do not have private health insurance, Medicaid, or CHIP coverage; and
- are not currently pregnant.
To view pharmacy benefits for HTW Plus, providers can visit the HHSC Vendor Drug Program website and click on HTW Plus delimited file: www.txvendordrug.com/resources/downloads.
How this impacts providers: HTW Plus Provider Enrollment
Given the expanded services offered with the HTW Plus program, new provider types are needed:
- Chemical dependency treatment facilities
- Opioid treatment programs
- Licensed professional counselor
- Licensed clinical social workers
- Psychologists and psychology groups
There is no additional requirement for current HTW providers to provide HTW Plus services. To become an HTW provider, providers must enroll in Texas Medicaid through the Texas Medicaid & Healthcare Partnership (TMHP). Providers can choose one of the following enrollment methods:
- Apply online. Go to TMHP.com and select “providers” in the banner at the top of the page, and then select “Enroll Today!” in the banner at the top of the page. Follow the onscreen instructions.
- Submit a paper application. Go toTMHP.com and follow the instructions above, then go to the Forms page. Scroll down to “Provider Enrollment – Applications” to access and download the enrollment forms for printing.
Request an enrollment package from TMHP by phone at 800-925-9126, or by mail at:
Texas Medicaid & Healthcare Partnership ATTN: Provider Enrollment
PO Box 200795
Austin, TX 78720-0795
Important: To serve HTW Plus members, providers must first enroll as Medicaid providers by following the steps above, and then be certified by HTW.
Next steps for providers: Providers are encouraged to complete the enrollment process in order to support this program and their eligible patients achieve improved health outcomes.
Healthy Texas Women Plus Services Available September 1, 2020 HHSC Notice
If you have any questions, please email Provider Network Management at: email@example.com.