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2.2.3 Services/Benefits and Limitations
Payment is considered for any health-care service that is medically necessary and for which FFP is available. CCP benefits are allowable services not currently covered under Texas Medicaid (e.g., speech-language pathology [SLP] services for nonacute conditions, PDN, prosthetics, orthotics, apnea monitors and some durable medical equipment [DME], some specific medical nutritional products, medical nutrition services, inpatient rehabilitation, travel strollers, and special needs car seats). CCP benefits also include expanded coverage of current Texas Medicaid services where services are subject to limitations (e.g., diagnosis restrictions for total parenteral nutrition [TPN] or diagnosis restrictions for attendant care services).
Requests for services that require a prior authorization must be submitted to TMHP. Prior authorization is a condition for reimbursement, not a guarantee of payment. For information about specific benefits, providers can refer to provider-specific sections of this manual.
Payment cannot be made for any service, supply, or equipment for which FFP is not available. The following are some examples:
• Vehicle modification, mechanical, or structural (such as wheelchair lifts)
•Structural changes to homes, domiciles, or other living arrangements
•Environmental equipment, supplies, or services, such as room dehumidifiers, air conditioners, filters, space heaters, fans, water purification systems, vacuum cleaners, and treatments for dust mites, rodents, and insects
•Ancillary power sources and other types of standby equipment (except for technology-dependent clients such as those who are ventilator-dependent for more than six hours per day)
•Educational programs, supplies, or equipment (such as a personal computer or software)
•Equine or hippotherapy
•Exercise equipment, home spas or gyms, toys, therapeutic balls, or tricycles
•Tennis shoes
•Respite care (relief to caregivers)
•Aids for daily living (toothbrushes, spoons, reachers, and foot stools)
•Take-home drugs from hospitals (Eligible hospitals may enroll in and bill Vendor Drug Program (VDP). Pharmacies that want to enroll should call 1-512-491-1429)
•Therapy involving any breed of animal
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