Texas Child Protection Law Bench Book

2024 version: As effective October 1, 2024

C. Behavioral Health Benefits Provided by STAR Health

Medicaid-covered behavioral health benefits include:

•   Outpatient Mental Health Services to include psychotherapy (individual, group, and family), psychiatric diagnostic evaluation with and without medical services, psychological, neurobehavioral and neuropsychological testing, and pharmacological management;

•   For members 20 years of age and younger, Mental Health Targeted Case Management to include intensive and routine case management services;

•   Mental Health Rehabilitation Services to include crisis intervention services (including mobile crisis services), medication training and support, and skills training and development (can be provided to the child/youth, Legally Authorized Representative [LAR] or primary caregiver);

•   Inpatient psychiatric services that include admissions to acute care hospitals and institutions for mental disease (IMDs) (public or private psychiatric facility);^[110]

•   Substance use disorder services to include assessment, counseling (individual and group), residential treatment, and withdrawal management and Medication-Assisted Treatment (MAT) services;

•   Screening, Brief Intervention, and Referral to Treatment (SBIRT) services for persons 10 years of age and older;

•   For members 20 years of age and younger, Health and Behavior Assessment and Intervention (HBAI) services;

•   Collaborative Care Model (CoCM) services that integrate the services of behavioral healthcare managers (BHCMs) and psychiatric consultants with primary care provider oversight to proactively manage behavioral health conditions as chronic diseases, rather than treating acute symptoms;

•   Telemedicine/telehealth services (applies to certain procedure codes);

•   Court-ordered services (outpatient and inpatient), if the person is not considered to be incarcerated; and

•   In-lieu-of services (ILOSs) and settings offered by the STAR Health MCO that substitute for Medicaid state plan services or settings, as allowed under federal regulations. ILOSs must be a medically appropriate and cost-effective substitute for the covered service or setting under the Medicaid state plan. The Medicaid member must not be required by the MCO to use the ILOS and the MCO is not required to offer it. The following new services were added Medicaid ILOSs as part of the implementation of Senate Bill 1177 (86R): partial hospitalization services, intensive outpatient program services, and Coordinated Specialty Care.