Provider Alert! New Collaborative Care Model Medicaid Benefit

Date: July 1, 2022

Attention: All Providers

Effective Date: June 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.

Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that the Health and Human Services Commission (HHSC) has drafted a new Medicaid medical policy for the Collaborative Care Model (CoCM) services that includes coverage for four related Current Procedural Terminology (CPT) codes.

How this impacts providers: Effective June 1, 2022, the Primary Care Provider (PCP) must submit the following procedure codes and meet the designated time thresholds to bill for monthly CoCM services in all settings:

The CoCM is a systematic approach to the treatment of behavioral health conditions (mental health or substance use) in primary care settings. The model integrates the services of behavioral health care managers (BHCMs) and psychiatric consultants with PCP oversight to proactively manage behavioral health conditions as chronic diseases.

CoCM services must be provided under the direction of the PCP and are benefits when provided in an office, outpatient hospital, inpatient hospital, skilled nursing facility or intermediate care facility, extended care facility, and “other location” settings.

CoCM services are individually delivered, time-based, monthly services that include the following:

• Outreach and engagement
• Completing an initial assessment
• Developing an individualized and person-centered plan of care
• Providing brief interventions and other focused treatments
• Conducting weekly caseload reviews with the psychiatric consultant
• Monitoring and tracking a person’s progress using a registry

Only the PCP may submit claims for CoCM services. The BHCM and psychiatric consultant are reimbursed by the PCP via a contract, employment, or other arrangement.

Next steps for providers: To ensure providers have an established CoCM program, HHSC is developing an attestation form that fee-for-service providers will have to sign prior to the delivery of CoCM services. Providers will need to attest that they are actively providing care consistent with the CoCM’s core principles and specific function requirements, i.e., patient-centered care, team structure with identified staff, measurement-based treatment using validated tools, and accountable care using a registry, as described in the CoCM Medicaid medical policy. TCHP will share the form when it is available.

For more information on registry requirements, refer to Advancing Integrated Mental Health Solutions (AIMS) Center, University of Washington, Psychiatry and Behavioral Sciences Division of Population Health.

For more information on payment for CoCM in primary care, refer to the American Medical Association’s webinar titled “Experts on practical billing strategies for the collaborative care model”

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.