The comprehensive providers provide mental health targeted case management and mental health rehabilitation services to eligible children and adults with mental health concerns.
The comprehensive providers include:
- Local Mental/Behavioral Health Authorities: LMHA providers are authorized by the Behavioral Health Services section at Texas Health and Human Services Commission to provide mental health targeted case management and mental health rehabilitative services.
- Private Comprehensive Providers: Private comprehensive providers can also deliver mental health targeted case management and mental health rehabilitative services provided they comply with all applicable federal and local laws and all of the regulations related to provided services.
Mental Health Targeted Case Management
Targeted case management services are case management services for people within targeted groups. The priority population that can receive MHTCM as part of the Texas Medicaid Program must, regardless of age, have a single diagnosis of chronic mental illness or a combination of chronic mental illnesses (as defined in the latest edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders), and who have been determined via a uniform assessment process to be in need of MHTCM services.
MHTCM is also available to youth 3 to 17 years old with serious emotional disturbance (excluding a single diagnosis of substance abuse, intellectual or developmental disability, or autism spectrum disorder) who have a serious functional impairment or who:
- Are at risk of disruption of a preferred living or children care environment because of psychiatric symptoms, or
- Are enrolled in special education because of a serious emotional disturbance. People of any age with a single diagnosis of intellectual and developmental disabilities and related conditions, a single diagnosis of substance use disorder or diagnosis of dementia are not eligible for MHTCM services.
Mental health targeted case management services are furnished to assist clients in gaining access to needed medical, social and behavioral, educational, and other services and supports. To learn more, visit the Texas Medicaid & Healthcare Partnership website.
Mental Health Rehabilitative Services
Mental health rehabilitative services are defined as providing assistance in maintaining or improving functioning and can be considered rehabilitative when necessary to help a person achieve a rehabilitation goal as defined in the treatment plan.
Mental health rehabilitative services can be provided to a person with a serious mental illness as defined in the latest edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.
Crisis intervention services, medication training and support, and skills training and development mental rehabilitation services are available to:
- Youth 3 to 17 years old with serious emotional disturbance who have a serious functional impairment, or
- Are at risk of disruption of a preferred living or child care environment because of psychiatric symptoms, or
- Are enrolled in special education because of a serious emotional disturbance.
Become a Comprehensive Provider
- Enrollment as a Medicaid Targeted Case Management/Mental Health Rehabilitation services provider is managed by Texas Medicaid and Healthcare Partnership.
- TMHP requires proof that the LMHA are an authorized provider for mental health services before enrolling or re-enrolling them as a TCM/MHR provider
- Private providers must comply with all applicable federal and local laws and all of the regulations that are related to the services they provide. After receiving approval for enrollment in Texas Medicaid, the private provider must be credentialed by a Texas Medicaid managed care organization to provide services to people receiving Texas Medicaid benefits.
- Clinical Management for Behavioral Health Services Access Request and User Agreement Form (PDF) for Medicaid Managed Care Organization Mental Health Providers
Provider credentials for facilities delivering MHTCM services include following:
Community Services Specialist, Qualified Mental Health Professional - Community Services, family partners, and peer providers are eligible to deliver some or all of the mental health rehabilitative services and mental health targeted case management services. Licensed Practitioner of the Healing Arts are automatically certified as a QMHP-CS. The credentialing requirements and services each provider can deliver are provided in the Texas Behavioral Health and Case Management Service Handbook.
QMHP or LPHA staff administering the assessment instruments must have documentation of current certification in the Adult Needs and Strengths Assessment or Child and Adolescent Needs and Strengths Assessment. Certification must be updated annually through an approved entity.
Managed care organizations and their credentialed providers are required to follow the current Texas Resiliency and Recovery Utilization Management Guidelines for the delivery of mental health targeted case management and mental health rehabilitative services. The TRRUMG can be viewed at:
- Adult Mental Health Services Utilization Management Guidelines (PDF)
- Children and Adolescent Services Utilization Management Guidelines (PDF)
To learn more regarding additional provider certifications required for mental health rehabilitative services (PDF), visit the TMHP website.
LMHAs/LBHAs enrolled as a Medicaid provider to provide targeted case management and mental health rehabilitative services.
Private Comprehensive Providers
Private comprehensive providers consistently enroll with Texas Medicaid and Healthcare Partnership as MHTCM and mental health rehabilitation services providers in Texas.
Training and Technical Assistance
Providers who have questions, concerns or problems with program rule, policy, or procedure can contact HHSC program staff.
Providers should contact Texas Medicaid Healthcare Partnership provider relations staff as needed for assistance with Medicaid enrollment or fee-for-service claims problems.
Statutes and Rules
Senate Bill 58, 83rd Legislature - A managed care organization that contracts with the commission under this chapter shall develop a network of public and private providers of behavioral health services and ensure adults with serious mental illness and children with serious emotional disturbance have access to a comprehensive array of services.
- 25 Texas Administrative Code, Part 1, Chapter 412, Subchapter I, Mental Health Case Management
- 25 Texas Administrative Code, Part 1, Chapter 416, Subchapter A, Mental Health Rehabilitative Standards
To learn more about billing for mental health case management and mental health rehabilitation, providers should refer to:
- Mental Health Targeted Case Management Medicaid Billing Guidelines (PDF)
- Mental Health Rehabilitative Services Medicaid Billing Guidelines (PDF)
- Health and Human Services Commission: AdultMH@hhsc.state.tx.us
- TMHP Contact Center: 800-925-9126