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24.5.4.2 Home Health Skilled Nursing Services and Home Health AIDE Services that will not be Prior Authorized
SN visits requested primarily to provide the following will not be prior authorized:
• Respite care.
•Child care.
•Activities of daily living for the client.
•Housekeeping services.
•Routine post-operative disease, treatment, or medication teaching after a physician visit.
•Routine disease, treatment, or medication teaching after a physician visit.
•Individualized, comprehensive case management beyond the service coordination required by the Texas Nurse Practice Act.
HHA visits requested primarily to provide the following will not be prior authorized:
•Housekeeping services.
•Services provided to a client residing in a hospital, SN facility or intermediate care facility.
Certain facilities are required by licensure to meet all the medical needs of the client. SNV and/or HHA visits will not be authorized for clients receiving care in any of the following facilities:
•Hospitals.
•SN facilities.
•Intermediate care facilities for the mentally retarded (ICF-MR).
•Special care facilities, including but not limited to, sub-acute units, and facilities for the treatment of acquired immunodeficiency syndrome (AIDS).
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