Reminder - Prior Authorization is Required for Mental Health Targeted Case Management and Mental Health Rehabilitative Services

Date: October 30, 2026 

Attention: All Providers  

Effective date: November 1, 2026

Call to Action

Texas Children’s Health Plan (TCHP) will enforce its existing prior authorization requirement for Mental Health Targeted Case Management (MHTCM) and Mental Health Rehabilitative (MHR) services when a member needs more service hours or units than the amounts listed in the table below, which align with the standard therapeutic levels defined by Texas Resilience and Recovery (TRR) Utilization Management Guidelines, the state’s utilization review guidelines for these services.

Providers should ensure all applicable services receive authorization approval prior to rendering services to help prevent unnecessary claim denials and payment delays.

How This Impacts Providers

The following MHTCM and MHR services require prior authorization from TCHP when the provider determines that a member needs more service hours or units than the amounts listed in the table below:

Authorization requests for Mental Health Targeted Case Management (MHTCM) must include the appropriate modifiers:

Procedure Code: T1017 - Targeted Case Management

Mental Health Rehabilitative Services

Prior authorization is not required for H2011 (Crisis Intervention) services.

Texas Resilience and Recovery (TRR) Utilization Management Guidelines

The Texas Resilience and Recovery (TRR) model serves as Texas' community-based mental health service delivery framework. The TRR Utilization Management Guidelines establish recommended service amounts and durations for targeted case management and mental health rehabilitative services based on an individual's assigned TRR Level of Care.

Providers should review the applicable guidelines before submitting authorization requests to support appropriate utilization of covered services in alignment with the TRR Level of Care.

Available resources include:

• Texas Resilience and Recovery Utilization Management Guidelines: Adult Mental Health Services
• Texas Resilience and Recovery Utilization Management Guidelines: Child and Adolescent Services
• Source:Texas Resilience and Recovery Utilization

Texas Children's® Link: The Fastest Way to Submit Prior Authorizations

TCHP strongly encourages providers to submit prior authorization requests through Texas Children's® Link, our secure online provider portal. Electronic submission through the portal is the most efficient method for authorization review and processing and helps reduce administrative burden for providers and staff. To access the portal, click here.

Benefits of Using Texas Children's® Link

• Auto Authorizations: Certain medically necessary services may qualify for automatic authorization approval through the portal.
• Faster Processing: Authorization requests submitted through Texas Children's® Link are reviewed and processed more efficiently than requests received through other submission methods.
• Real-Time Status Visibility: Providers can view authorization status, appeal status, determination letters, and status history in real time without having to contact TCHP.
• Expanded Staff Access: Authorized clinical and non-clinical staff may submit, monitor, and review authorization requests on behalf of the requesting provider.

Next Steps for Providers

Providers should verify prior authorization requirements before rendering applicable MHTCM and MHR services and submit authorization requests through Texas Children's® Link whenever possible. Utilizing the provider portal helps ensure faster review, timely determinations, and greater visibility into authorization status.

Providers experiencing challenges with portal access or authorization submission are encouraged to contact their assigned Provider Relations Account Lead or Provider Relations Liaison for assistance.

If you have questions regarding this requirement, please contact Provider Relations at providerrelations@texaschildrens.org.

For access to all provider alerts, visit: www.texaschildrenshealthplan.org/for-providers.

Available resources include:

• UMCM, Chapter 15.3 - Mental Health Targeted Case Management and Mental Health Rehabilitative Services Training Requirements
• Behavioral Health and Case Management Services Handbook of the Texas Medicaid Provider Procedures Manual (TMPPM)
• Texas Children’s® Link Provider Portal
• Prior Authorization Information