(a) The following services are not covered as mental
health targeted case management:
(1) case management activities that are an integral
component of another covered Medicaid service;
(2) the provision of a medical, educational, social/behavioral,
or another service to which an individual has been referred, including
foster care services;
(3) performing an activity that does not directly assist
an individual in gaining or coordinating access to needed services;
(4) providing medical or nursing services;
(5) performing pre-admission or intake activities;
(6) providing services to the LAR or primary caregiver
of the individual outside of the services allowable under this subchapter;
(7) transporting the individual, LAR, or primary caregiver
outside of what is allowable under this subchapter;
(8) monitoring the individual's general health status;
(9) performing outreach activities;
(10) performing quality oversight of a service provider;
(11) conducting utilization review or utilization management
activities;
(12) conducting quality assurance activities; and
(13) authorizing services or authorizing the provision
of services.
(b) The following activities are included in the mental
health targeted case management rate and, therefore, Medicaid payment
is not made separately for the following activities:
(1) documenting the provision of mental health targeted
case management services;
(2) on-going assessment to determine the amount, duration,
and type of mental health targeted case management for each individual;
(3) travel time required to provide mental health targeted
case management services at a location not owned, operated or under
arrangement with the comprehensive provider agency; and
(4) quality assurance activities that are specific
to mental health targeted case management.
(c) Texas Medicaid does not reimburse for mental health
targeted case management services provided before the establishment
of a diagnosis of mental illness and the authorization of services.
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