Texas Children's Health Plan will be closed on Friday, July 4th, in observance of Independence Day. In our absence, you can reach our after-hours nurse help line at 1-800-686-3831. We will resume normal business hours on Monday, July 7th. Wishing you a safe and happy Independence Day!
El Plan de Salud Infantil de Texas estará cerrado el viernes 4 de julio por el Día de la Independencia. Durante nuestra ausencia, puede comunicarse con nuestra línea de ayuda disponible las 24 horas, los 7 días de la semana, al 1-800-686-3831. Reanudaremos nuestro horario habitual el lunes 7 de julio. ¡Le deseamos un feliz y seguro 4 de julio!
Cold and flu seasonTemporada de influenza y resfriados
ALERT:Stay healthy this cold and flu season!Learn more
ALERTA: ¡Mantente sano durante esta temporada de influenza y resfriados!Más información
MCO Compliance with H.B. 2822 provisions related to PA for Antipsychotic Drugs Required by May 20
Date: April 21, 2022
Attention: Behavioral Health Providers
Effective Date: May 20, 2022Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.Call to action: Managed care contracts require MCOs to comply with Texas Government Code § 531.073 under the section titled “Compliance with State and Federal Prior Authorization Requirements” (UMCC 8.1.8.1, etc.). H.B. 2822 (87th Legislature, Regular Session) amends Texas Government Code § 531.073, adding subsections related to the availability of antipsychotic prescription drugs. This notice describes HHSC’s expectations for MCO compliance with this statute as amended.
How this impacts providers: MCOs must comply with the provisions under subsection (a-5) by updating pharmacy claims systems to:
Fully automate clinical prior authorization processes for drugs in the antipsychotic class.
Ensure prior authorization denial messaging for drugs in the antipsychotic class include:
specific contact information necessary for the pharmacist to submit a prior authorization request for the prescription, and
instructions to the pharmacist to dispense a 72-hour supply of the prescription if clinically appropriate under federal or state law.