Behavioral Health

Behavioral Health Program

Blue Cross and Blue Shield of Texas manages behavioral health services for STAR, CHIP and STAR Kids members. Our Behavioral health program is integrated with our medical care management program. This integrated program helps members access their behavioral health benefits and improves coordination of care between medical and behavioral health providers.

This integration helps our clinical staff identify members who could benefit from coordination between their medical and behavioral health care and may result in:

Improved outcomes
Enhanced continuity of care
Greater clinical efficiencies
Reduced costs over time

Our program includes a portfolio of resources to help our members access benefits for behavioral health (mental health and substance use) conditions as part of an overall care management program.

Utilization Management Program and Prior Authorization Requirements

Prior Authorization is required for some services, please visit (Utilization Management page) for more information about the BH Utilization Management Program and process to obtain prior authorization.

Behavioral Health Services Hotlines

Our Behavioral Health Hotline is available to assist members in obtaining access to needed behavioral health care:

STAR & CHIP: 1-888-657-6061
STAR Kids: 1-877-688-1811

Behavioral Health Crisis Support

Additionally, Behavioral Health clinicians are available to provide crisis intervention and coordinate stabilization services 24-hours a day, 7 days a week through our Behavioral Health Services Hotline.

National Mental Health Hotlines

988 Suicide & Crisis Lifeline – provides support for those who are in distress, as well as prevention and crisis information.
National Maternal Mental Health Hotline – provides support before, during and after pregnancy for those who feel overwhelmed, anxious or depressed.

Connection to Service Coordination

Providers are encouraged to reach out to service coordination when services such as Behavioral Health, are identified or member expresses need for such services. In addition, providers can refer members for other services like disease management.

For questions or concerns related to service coordination feel free to contact our service delivery team.

Contact Information:

STAR/CHIP

Phone: 1-877-214-5630
Fax: 1-866-644-5456
Email: TX_Medicaid_HC@bcbstx.com

STAR Kids

Phone: 1-877-301-4394
Fax: 1-866-644-5456
Email: TX_Medicaid_HC@bcbstx.com

In Lieu of Services

What is an In Lieu of Service?

In-lieu-of services are services offered by MCOs that substitute for Medicaid state plan services or settings, as allowed by 42 Code of Federal Regulations (CFR) § 438.3(e)(2).

As allowed by 42 C.F.R § 438.6(e) and 42 C.F.R. § 438.3(e)(2), we provide services in the following HHSC-approved settings in lieu of an acute care inpatient hospital setting:

Inpatient services for acute psychiatric conditions in a freestanding psychiatric hospital for up to 15 calendar days per month for members aged 21-64 only.
Partial Hospitalization Services: Partial Hospitalization Programs may provide services for mental health, Substance Use Disorder, or both. These services resemble highly structured, short-term hospital inpatient programs. The treatment level is more intense than outpatient day treatment or psychosocial rehabilitation. Available for all members.
Intensive Outpatient Services: Intensive outpatient services, also referred to as IOP services are used to treat behavioral health issues that do not require detoxification or 24-hour supervision. IOPs are generally less intensive than PHPs. They may be delivered for mental health, SUD, or both. IOP services are organized non-residential services providing structured group and individual therapy, educational services, and life skills training which consists of at least 10 hours per week for four to 12 weeks, but less than 24 hours per Day. Available for all members

Prior Authorization process for ILOS:

Prior Authorization:
- Prior Authorization is required for inpatient services in an IMD, partial hospitalization and intensive outpatient program.
- BCBSTX will follow the service authorization notice requirements described in UMCM 3.21 and will provide written notice to both the provider and the member when in-lieu-of services are authorized, reduced, or denied. All in-lieu-of services require prior authorization and requests may be submitted by phone, fax, or through the Availity portal.
- All requests for inpatient services in an IMD, partial hospitalization and intensive outpatient services will be reviewed for medical necessity. For Mental Health MCG Guidelines 28^th Edition will be utilized. For Substance Use, ASAM 3^rd Edition will be utilized.
We will not require members to use in-lieu-of services or settings instead of a covered service or setting. We may offer members the option of these services or settings when medically appropriate and cost-effective. Members must agree to receive in-lieu-of services before we authorize the service. Provider contracts will require the provider to document member choice and consent to receive the ILOS and to provide this documentation to us upon request.

Autism Related Resources

Medicaid Applied Behavior Analysis (ABA) Services for Children and Youth with Autism (English)

Medicaid Applied Behavior Analysis (ABA) Services for Children and Youth with Autism (Spanish)

Applied Behavioral Analysis (ABA) Provider FAQ

Follow-up After Hospitalization for Behavioral Health Services

We require that all members who receive inpatient psychiatric services are scheduled for outpatient follow-up and/or continuing treatment prior to discharge. The outpatient treatment must occur within seven days from the date of discharge.

Mental Health Rehabilitation Services and Targeted Case Management

All crisis plans and assessments can be sent to Service Coordination via email TX_Medicaid_HC@bcbstx.com or faxed to 1-866-644-5456. The Service Coordination team should also be notified of any BH crisis respite or Mobile Crisis Outreach Team services.

Primary Care Physician Toolkit

Many times, primary care physicians are the first place a member goes when they have a problem. Our PCP toolkit represents our commitment to promote integration of medical and behavioral health services toward the goal of better overall outcomes for patients. Our Medical Providers’ Behavioral Health Toolkit gives medical practitioners the information and screening tools needed to assist in making behavioral health referrals.

Behavioral Health Quality Indicators

Behavioral Health providers have contractually agreed to offer appointments to our members according to specific appointment access standards. Learn more

Postpartum Depression Toolkit Available

Postpartum depression is a common, potentially serious and sometimes life-threatening condition. It is important to note that depression can occur during pregnancy as well as after the baby is born.

The new Texas Clinician’s Postpartum Depression Toolkit is intended to be a resource for Texas clinicians on screening, diagnosis and treatment of postpartum depression. The toolkit includes coverage and reimbursement options for postpartum depression through Medicaid, CHIP, the Healthy Texas Women Program, the Family Planning Program and other referral options.

You can download the toolkit here. Please email womenshealth@hhsc.state.tx.us with any questions.