(a) In accordance with §412.407 of this title (relating to MH Case Management Services Standards), a billable event is a face-to-face contact during which the case manager provides an MH case management service to an:      
        (1) individual who is Medicaid eligible; or       
        (2) LAR on behalf of a child or adolescent who is Medicaid eligible.       
      (b) A unit of service for MH case management services is 15 continuous minutes.     
      (c) The department shall not reimburse a provider for Medicaid MH case management services if:      
        (1) the individual who was provided the service did not meet the eligibility requirements set forth in §412.405 of this title  (relating to Eligibility for MH Case Management Services) at the time the service was provided;       
        (2) the service provided was an integral and inseparable part of another service;       
        (3) the service was provided by a person who was not qualified in accordance with §412.411(a) of this title (relating to MH Case Management Employee Qualifications);       
        (4) the service provided was not the type, amount, and duration authorized by the department or its designee;       
        (5) the service was not provided or documented in accordance with this subchapter;       
        (6) the service provided is in excess of eight hours per individual per day; or       
        (7) the services  provided do not conform to the requirements set forth in the department's                 MH Case Management Billing Guidelines.        
      (d) The department shall not reimburse a provider for Medicaid MH case management services for coordination activities that are included in the provision of:      
        (1) rehabilitative crisis intervention services, as described in Chapter 419, Subchapter L, specifically §419.457 of this title (relating to Crisis Intervention Services); or       
        (2) psychosocial rehabilitative services, as described in Chapter 419, Subchapter L, specifically §419.459 of this title (relating to Psychosocial Rehabilitative Services).       
      (e) If Medicaid-funded MH case management  services are continued prior to a fair hearing, as required by 1 TAC §357.11 (relating to Notice and Continued Benefits), the provider may file a claim for such services.     
      (f) An individual is eligible for Medicaid-funded MH case management services if, in addition to the criteria set forth in §412.405 of this title, the individual is:      
        (1) eligible for Medicaid;       
        (2) not an inmate of a public institution, as defined in 42 CFR §435.1009;       
        (3) not a resident of an intermediate care facility for persons with mental retardation as described in 42 CFR §440.150;       
        (4) not a resident of an IMD;       
        (5) not a resident of a  Medicaid-certified nursing facility, unless the individual has been determined through a pre-admission screening and resident review assessment to be eligible for the specialized service of MH case management services or the individual is expected to be discharged to a non-institutional setting within 180 days;       
        (6) not a recipient of MH case management services under another Medicaid program (e.g., the Home and Community Services waiver program or Texas Health Steps); and       
        (7) not a patient of a general medical hospital.       
     Source Note:        The provisions of this §306.277 adopted to be effective February 14, 2013, 38 TexReg 647; transferred effective February 15, 2020, as published in the Texas Register January 17, 2020, 45 TexReg 469