17.3 Benefits, Limitations, and Authorization Requirements

The CSHCN Services Program must authorize all requests for both standard and custom DME. Requests must be submitted on the CSHCN Services Program Durable Medical Equipment Authorization Request Form.

Note: The physician’s signature is only required on page 1 of the form in the Statement of Medical Necessity section. Providers must submit page 1 of the form to TMHP. Pages 2 through 5 are only required for certain DME requests. Refer to the text under the form title to determine which of these pages must be submitted in addition to page 1.

Custom DME and more complex equipment requires prior authorization; all other and standard DME must be authorized. The sections below identify the equipment that requires authorization and the equipment that requires prior authorization. Authorization requests and prior authorization requests should be submitted on a “CSHCN Services Program Prior Authorization and Authorization Request for Durable Medical Equipment (DME)” form.

The custom DME prior authorization period is no more than 75 days from the date of approval. If the client’s eligibility is due to end before the 75 days, providers will still receive a 75-day authorization from the date of the approval.

Refer to:

Chapter 4, “Prior Authorizations and Authorizations,” on page 4‑1 for more information about authorizations and prior authorizations.

Appendix B, “Forms,” on page B‑1.