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2019 News

June 1: New Prior Authorization update effective June 1, 2019.

Click here for the announcement.

May 1: Revised Texas Medicaid Standing Order for Mosquito Repellent Benefit

The Texas Medicaid Standing Order for Mosquito Repellent has been revised and is available for use with the mosquito repellent benefit for people enrolled in Medicaid (both traditional and managed care) and CHIP. Pharmacy staff must obtain a copy of the revised standing order, effective May 1, because of the change in prescribing authority of the standing order. The previous standing order expires Apr. 30. Pharmacies may request a copy of the standing order by emailing vdp-formulary@hhsc.state.tx.us.

  • • Pharmacies or pharmacists not operating under the standing order will require a prescription from a valid healthcare provider prior to dispensing mosquito repellent to people enrolled in Medicaid or CHIP.
  • • People enrolled in in the Children with Special Health Care Needs Services Program will always require a prescription for mosquito repellent from a health care provider.
  • • People enrolled in the Healthy Texas Women program do not require a prescription.
Neonatal Emergency Billing Address Requirements

In accordance with House Bill (HB) 15 (83R) and HB 3433 (84R), HHSC established rules for inpatient hospital designations for neonatal services and maternal services. Hospitals without designation will not be reimbursed for inpatient neonatal or maternal services except emergency services required to be provided or reimbursed under state or federal law. The level of care designation for each hospital will be reviewed by HHSC every three years and updated as appropriate.

Action: Providers who submit claims for inpatient newborn care must use the billing address that matches the facility address of the neonatal designation where neonatal services are rendered. To be considered for reimbursement of neonatal claims, providers must have their neonatal billing address. Business edits will set on encounters where the provider is billing incorrectly.

January 1: Peer Specialist

Background: This policy is a result of House Bill (H.B.) 1486, 85th Legislature, Regular Session, 2017, which requires HHSC to establish a Medicaid reimbursable peer service benefit and adopt rules establishing training and certification requirements for peer specialists to provide Medicaid-reimbursable peer specialist "services to persons with mental illness or services to persons

The attached Peer Specialist notification outlines the new benefit, requirements for eligibility and service delivery, as well as claims filing/reimbursement details effective Jan. 1, 2019.

January 1: Morphine Equivalent Dose Limitations for RightCare to Decrease in January

RightCare from Scott and White Health Plan will decrease the daily morphine equivalent dose limit for people enrolled in Medicaid Managed Care on January 1, 2019. The new limit will be set at 90, and apply to all opioid prescriptions with exceptions for those people diagnosed with cancer or those receiving palliative or hospice care. Prescribing providers and pharmacies should contact the Navitus Provider Hotline 1-877-908-6023 for dosage limitation override assistance.

SUD Policy

Background: The attached SUD Policy notification outlines the finalized Substance Use Disorder Services policy update to be effective Jan. 1, 2019.

This policy update includes:

    • Updated statement of benefits section
    • Addressed Mental Health Parity and Addiction Equity Act requirements by allowing limits to be exceeded for adults with prior authorization
    • Made Medication Assisted Treatment payable on same day as withdrawal management and treatment services
    • Made Vivitrol payable to Chemical Dependency Treatment Facilities
    • Made buprenorphine payable to Physician Assistants and Nurse Practitioners as allowed under the Comprehensive Addiction and Recovery Act of 2016
    • Updated Prior Authorization forms for Fee for Service Medicaid recipients: Qualified Credentialed Counselor signature now permissible consistently across all forms, and supporting documentation now required with all forms consistently.

2018 News

    October 31: Paper Claims Update Please note the RightCare mailroom has currently moved to 300 S. Riverside Plaza Suite 700, Chicago, IL 60606. All mail sent to P.O. Box 3757 Corpus Christi, Texas 78463 will be forwarded to Chicago. Providers whose mail cannot be forwarded will have mail returned. For more information, please contact RightCare customer service at 855 897-4448 (855-TX-Right). October 1: Ordering and Referring Providers NPI Requirements Implementation Date

    Background: As an update to the MCO notification sent June 18, 2018 about the ordering and referring provider’s (ORP) National Provider Identifier (NPI) requirement, the implementation date has been postponed. Previously set to be implemented on September 1, 2018, the new implementation date is October 1, 2018. Beginning October 1, 2018, HHSC will implement the requirement for the submission of the ORP NPI on all managed care encounters.

    Additional Information: The edits to be implemented are: 1. Ordering Provider Number (NPI) cannot be identified for Encounter FDOS < 01/01/3999. This edit will set under the following conditions:

          • No provider match found
          • Detail Ordering Provider NPI is NOT NULL
          • Detail Ordering Provider API is NOT Present OR present but first letter is not F/S/A
          • Detail Ordering Provider API is present and first letter is F/S/A but is not equal to 10 characters
          • OON Exception Code 3 or 4 is not submitted
          • OON Exception Code 3 or 4 is submitted but the submitted ordering provider NPI is not found on the NPPES table for the submitted FDOS
2. Referring provider number (NPI) is missing when billing provider is a non-person entity for Encounter FDOS < 01/01/3999. This edit will set under the following conditions.
      • Submitted billing provider taxonomy requires a referring provider and the submitted referring NPI is not submitted.
        Provider Education: Lead Exposure Screening and Treatment

        RightCare would like you to be aware of the following course from Texas Health Steps. This short course covers what you need to know to screen, test, and retest children; properly collect blood specimens; use the mandatory reporting system; and protect Texas children from being exposed to lead in the first place.

        Preventing Lead Exposure

        September 7: Wraparound Training Webpage Update for MH TCM/Rehab Providers. Wraparound training is a requirement for mental health (MH) targeted case management (TCM) providers to provide intensive targeted case management. In response to concerns brought by providers and health plans about accessing information on Wraparound training, HHSC is sharing that the Texas Center of the National Wraparound Implementation Center has updated its website to include more detailed information about the training .
        August 1: Anti-psychotics Clinic Prior Authorization Changes Begin September 1. RightCare from Scott and White Health Plan will revise the anti-psychotics clinical prior authorization for people enrolled in Managed Medicaid beginning 9/1/18. To learn more please review the antipsychotics clinical prior authorization guide (PDF).
        July 12: HHSC recently released an Op-Ed piece that features resources for women experiencing postpartum depression. This information was published in The Daily News and the Tyler Morning Telegraph.
      July 1: Mental Health Screenings to Change for Texas Health Steps

      Effective for dates of service on or after July 1, 2018, mental health screening benefits will change for Texas Health Steps. Mental health screening for behavioral, social and emotional development is required at each Texas Health Steps checkup birth through age 20. Major changes to this medical benefit policy include the following: Changes to limitation for initial health screening for clients 12 through 18 years of age; Update to mental health screening tools recognized by Texas Health Steps

      View the changes to Mental Health Screenings for Texas Health Steps .

      July 1: Postpartum Depression Screening During an Infant’s Texas Health Steps Checkup to Become a Benefit of Texas Medicaid

      Effective for dates of service on or after July 1, 2018, postpartum depression screening will be a benefit of Texas Medicaid.

      See information on benefits, guidelines, documentation requirements, and submitting claims here.

    2017 News

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