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Behavioral Health Policy Updates: TX House Bill 4. 87th Legislature, Regular Session, 2021


This training has been designed to give you the most up-to-date information as of the publication date. It is your responsibility to regularly review the current Texas Medicaid Provider Procedures Manual (TMPPM) and all updated information as it is published on the Texas Medicaid & Healthcare Partnership (TMHP) website at

You have the opportunity to provide feedback regarding your online training experience. We value your opinions and ask that you complete a brief survey upon the conclusion of this training.

As mandated by House Bill 4, passed by the 87th Legislature, Regular Session 2021, the Texas Health and Human Services Commission, or HHSC, implemented changes to most Medicaid behavioral health medical policies.

These changes allow for the delivery of behavioral health services by synchronous audiovisual or synchronous telephone audio-only technology, henceforth referred to as audiovisual and audio only technology, if this delivery method is determined to be clinically appropriate and safe and is agreed to by the person receiving the services.

These changes took effect on September 1st, 2022.

To assist providers in understanding the changes, HHSC has created two infographics that highlight the services that may be provided using these modes of delivery. Each infographic shows the service group, service type, procedure codes for each service, and key information about additional requirements for delivering the service.

Additionally, HHSC has also created an instructional video outlining the new requirements for permanent audio-only delivery of some behavioral health services, as well as examples of clinical scenarios demonstrating how requirements can be met. Providers can find that video on the TMHP YouTube channel, located here:


YouTube Video