Effective Immediately: Removal of Prior Authorization for Targeted Case Management/Mental Health Rehabilitation Services
Date: 03/07/18
Effective Wednesday, March 7, 2018, TCM/MHR (SB 58 defined) services no longer require prior authorization. These services include Mental Health Targeted Case Management and Mental Health Rehabilitation services, available to all Superior HealthPlan Medicaid members under STAR, STAR+PLUS, STAR Health, STAR Kids and STAR+PLUS Medicare-Medicaid Plan (MMP). These codes include T1017, H2017, H2014, H2011, H0034, and H2012 and all applicable modifiers.
Superior will continue to follow the clinical guidelines required for TCM/MHR services, as defined in the Texas Department of State Health Services (DSHS) Resiliency and Recovery Utilization Management Guidelines (RRUMG). In addition, Superior will continue to require adherence to the clinical guidelines, and reserves the right to perform retrospective audits to ensure adherence to these requirements.
Please submit deviations as a notification only by fax to 1-866-469-0725.
Superior would also like assistance from providers in identifying members that may qualify for Community First Choice (CFC) services. These services are available to members enrolled in STAR Health, STAR Kids or STAR+PLUS, are under age 21, or age 65 or older with a severe and persistent mental illness or a severe emotional disturbance and meet other qualifying criteria. For these members, please fax any LOC 4 CANS/ANSA to the following numbers:
- STAR Health: 1-877-690-9328
- STAR Kids: 1-877-644-4561
- STAR+PLUS and STAR+PLUS IDD: 1-866-895-7856
- STAR+PLUS Nursing Facilities: 1-888-209-4584
- STAR+PLUS MMP: 1-855-277-5700
For any questions, please reach out to your local Account Manager or contact Provider Services at 1-877-391-5921.