Behavioral Health In Action

Integrated Care Practice in Child Welfare

January 21st, 2024

While historically the Department of Family and Protective Services has been ill perceived as an entity not supportive of thriving families, the Department is moving into a new phase of its history with the inclusion of strategically led behavioral health initiatives that are undergirded by an integrated care philosophy. Often times care in today’s behavioral health system is fragmented requiring those seeking help for their care to tend to their needs by seeking help within a system that is rife with provider shortages, limited payer sources and distressed continuity in overall care. Receipt of care or programming developed by a Biodyne trained clinician offers a person-centered, wholistic approach to helping those in need. This is particularly important for youth who come into care with DFPS as historically placement challenges have exacerbated behavioral health care access issues.

What sets the Department aside today from its yesterday approach is the inclusion of programming that is informed by practices such as family voice and youth voice and diversion efforts offering programs that encourage coordination of care amongst all the providers in a youth and/or caregiver’s life. Other strategies are to create a first line of support that increases the probability of stability for a youth potentially improving the trajectory of their lives. This is being actualized via the efforts of a newly formed division in DFPS led by a Biodyne clinician in training and in collaboration with other key stakeholders within DFPS as well as other state agency partners. This sets the work done within the Department apart from historical efforts in that this role is unique in the history of Texas’s child welfare system. The inclusion of this role has been lauded by many external stakeholders as a significant point in time in the history of the department in which important progress may be made.

As I move forward in this role and laying the foundation for the future in the role of Chief Strategist for Behavioral Health, I intend to use my training as Doctor of Behavioral Health candidate to infuse key training elements related to trauma, integrated care and innovation to move the needle forward in diminishing negative outcomes for youth in care and laying the foundation for a better, brighter tomorrow for those youth.
State Level Perspective: Defining the Worth of a Doctor of Behavioral Health (DBH)

May 24th, 2026
When operating as a Doctor of Behavioral Health integrated care practitioner in Texas, I will bring an approach to patient care that prioritizes individual need and preferences. My approach bridges physical health, behavioral health, and other support systems to improve overall well-being for individuals being served. I am outcome focused anchored in a passion for treating the whole person. This translates into experience leading state system level transformation that is sustainable in the long-term.

With experience leading multidisciplinary teams both as a practitioner and at the state level, I have worked closely with physicians, therapists, case managers, and community organizations to ensure optimal care for patients. Continuity of care and reducing access to care barriers that often prevent patients from achieving preferred health outcomes will be guiding principles for me as a DBH. I have an intimate understanding of the diverse healthcare challenges facing Texas’s most vulnerable citizens and strive to provide solutions that are both practical and responsive to what is most essential in controlling costs while optimizing care. This is evident in my stewardship responsibility with contracted Local Mental Health and Behavioral Health (LMHA/LBHA) in Texas that are Certified Community Behavioral Health Clinics (CCBHCs). To learn more about Texas CCBHCs please use the following link: https://www.hhs.texas.gov/providers/behavioral-health-services-providers-programs/texas-certified-community-behavioral-health-clinics.

My approach emphasizes individual agency, prevention, and education at the state level. I believe patients achieve better outcomes when they are active participants in their healthcare experience and demonstrate this by informing policy standards accentuating that point. While patient care is front and center in my approach, I recognize that adequate budgetary pathways are critical to sustaining an integrated care model of service. Therefore, development of tools and provider technical assistance plans that optimize billing at the state level will be a priority. This will aid in building operational practices that ensure sustainability of a state level integrated model of care.

To meet today’s demands in an evolving healthcare environment, integrated care is essential for improving quality, reducing costs, and enhancing patient satisfaction. Advancing comprehensive service delivery and care model such as CCBHC that promotes efficacy, cost effectiveness, and quality care is aligned the principles of a DBH and integrated care. I do not deliver services at the practitioner level, but am enclosing a link for information outlining outpatient behavioral codes for Texas providers: https://www.tmhp.com/sites/default/files/file-library/resources/provider-manuals/cshcn/2020-09-september/29_Out_Behav_Health_0.pdf.

The additional information below outlines listing of common codes for reference as well.

Additional Considerations/Notes:
1. Fee schedule amounts are based on the fee-for-service fee schedule and based on one provider type. Some services are available through multiple provider types, and rates may vary. Additionally, rates may vary by managed care organization as MCOs have the authority to negotiate lower or high rates than fee-for-service.
2. The DPP BHS does not pay fee-for-service rates. Rather the DPP BHS functions as an additional payment based on the volume of services delivered using one of the DPP BHS procedure codes. The uniform dollar rate increase in the current fiscal year is $25.82 per unit of service.
3. The CCBHC model is not limited to a specific set of diagnoses or the level of functional impairment. People cannot be turned away due to their diagnosis; however, in Texas we allow T-CCBHCs to connect a person with another appropriate provider if the T-CCBHC feels they are not the best place for the person to be served.
Common ICD-10 codes aligned to people served in CCBHCs across the U.S. (any ICD-10 codes can be present as long as at least one code is for a mental health or substance use diagnosis):

F01-F99 – Mental and behavioral disorders due to psychoactive substance use

F20-F29 – Other specified and unspecified mental disorders

F30-F39 – Mood disorders

F40-F48 – Anxiety, obsessive-compulsive, and related disorders

F49-F59 – Schizophrenia and other psychotic disorders

F60-F69 – Neurotic, stress-related, and somatoform disorders

F70-F79 – Trauma and stressor-related disorders

Texas DPP BHS procedure codes:

H0005 – Medication assisted treatment for Opioid Treatment Providers

Fee-for-service fee schedule: $27.85

H0020 – Medication assisted treatment

Fee-for-service fee schedule: $9.84

H0034 – Medication training and support

H2011 – Crisis intervention

H2014 – Skills training and development

Fee-for-service fee schedule: $5.00

T1017 – Mental health targeted case management

Fee-for-service fee schedule: $24.07 (modifier TF), $19.83 (modifier TF), $31.69 (modifier TG)

H2017 – Psychosocial rehabilitation services

Fee-for-service fee schedule: $26.93

90791 – Psychiatric diagnostic evaluation with medical services

Fee-for-service fee schedule: $28.07 (21 and under), $26.73 (over 21)

90792 – Psychiatric diagnostic evaluation without medical services

Fee-for-service fee schedule: $28.07 (21 and under), $26.73 (over 21)

90834 – Individual psychotherapy, 45 minutes

Fee-for-service fee schedule: $28.07 (21 and under), $26.73 (over 21)

90837 – Individual psychotherapy, 60 minutes

Fee-for-service fee schedule: $28.07 (21 and under), $26.73 (over 21)

96372 – Injection administration

Fee-for-service fee schedule: $28.07 (21 and under), $26.73 (over 21)

99213 – Established patient office or other outpatient visit requiring a medically appropriate history and/or examination and low level of medical decision making

Fee-for-service fee schedule: $39.90 (21 and under), $33.95 (over 21)

99214 – Evaluation and management, established patient

Fee-for-service fee schedule: $56.03 (21 and under), $47.68 (over 21)

99215 – High complexity evaluation and management for established patients

Fee-for-service fee schedule: $86.26 (21 and under), $73.40 (over 21)

*Additional common codes that align with T-CCBHC required services and are not in the current DPP BHS:

·       H0004 (Behavioral health counseling and therapy, used in Texas Medicaid for outpatient substance use treatment)

·       H0038 (peer specialist services)

·       S9482 (certified family partner services)

·       H2012 (Day program for acute needs – part of the TCM/Rehab suite of services)

·       90832 and 90834 (individual psychotherapy – additional billable codes)

·       90846 and 90847 (family psychotherapy – additional billable codes)

·       99408, G2011, and H0049 (SBIRT)

·       H0001, H0004, H0033, J0570, J0577, J0578, J2315, Q9991, Q9992 (MAT – note MAT is not a T-CCBHC required service but there are currently two MAT codes used in the DPP BHS)

Federal CCBHC billing codes (not used in Texas at this time):

T1040 – CCBHC services per day T1041 – CCBHC services per month
Bridging Systems: Integrating Mental Health and Substance Use at the State Level

May 24th, 2026

State level integrated behavioral health care requires coordinated, collaborative partnership across multiple agencies and systems. Public health entities, behavioral health authorities, hospitals, community organizations, advocacy entities, and primary care providers all must take part in building a system of care that optimizes its resources and assets towards providing quality services. Successful integration efforts acknowledge that client outcomes in behavioral health are not just tethered to medical needs but also non-medical drivers of health such as housing stability, familial support, vocational opportunity, transportation, education, and other community support services.

States are revisioning how behavioral health systems deliver services by moving towards bridging behavioral health models by focusing on greater integration. Instead of delivering siloed care for mental health, substance use disorders, and physical health practitioners are focusing more on coordinating a holistic array of care inclusive of the patient’s full needs. This more person-centered shift is becoming more important as states are confronted with rising patient needs, workforce shortages, growing insurance costs, and persistent disparities in access to care.

Access to services and how to effectuate change that prioritizes patient need as first are at the center of this discussion. Best practices and models such as Certified Community Behavioral Health Clinics (CCBHCs) are helping states expand coordinated treatment and improve continuity of care. Texas Local Mental Health and Behavioral Health Authorities are certified as CCBHCs signaling the prioritization of integrated care for the state. While the model of CCBHC has been prioritized at the policy level further steps towards full integration of care may to be in order to enhance outcomes for persons served in the Texas safety net system with comorbid health issues.

Should policy makers determine that full integration at the state level is an appropriate priority, existing state level assets/resources as well as the provider community would need to be activated. This type of activation would likely require legislative direction specifying the scope. Establishment of a project management plan that is inclusive of stakeholders both internal and external would be essential for the responsible state agency. Potential considerations and topics to address include data usage/sharing/interoperability, clinical standards alignment, fiscal integration and financing, and quality outcomes. Technology and data sharing are central to statewide integration efforts. A balance between innovation and practicality acknowledging needs for strong privacy protections are imperative when considering federal standards such as HIPAA. As important to privacy protections are financing and funding opportunities that support the sustainability of long-term system transformation.

Healthcare reform initiatives like state level integrated care are transformative and require methodical planning that consider stakeholder impact with none being more important than the clients who are being served. Such a transformative investment must also be inclusive of persons with lived experience to better position these efforts to improve health outcomes and strengthen communities for the future.
Compasssionate Leadership Beyond Patient Care

March 10th, 2024

Integrated Care Practice in Child Welfare

State Level Perspective: Defining the Worth of a Doctor of Behavioral Health (DBH)

Bridging Systems: Integrating Mental Health and Substance Use at the State Level

Compasssionate Leadership Beyond Patient Care