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3.2.9.3 Home Health SN Services and HHA 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 Nursing 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. SN and/or HHA visits will not be prior 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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