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