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2.5.8.2 Prior Authorization and Documentation Requirements
Prior authorization is required for incontinence supplies through CCP.
A determination is made by HHSC or its designee as to the number of incontinence supplies prior authorized based on the client's medical needs.
A combination of diapers, briefs, pull-ons, and liners may be considered for prior authorization for clients who are birth through 3 years of age and are limited to 300 per month.
To request prior authorization for incontinence supplies, the following documentation must be provided for the item(s) requested:
• Accurate diagnostic information pertaining to the underlying diagnosis/condition as well as any other medical diagnoses/conditions, to include the client's overall health status
•Diagnosis/condition causing increased urination/stooling
•Client's height, weight, and waist size
•Number of times per day the physician has ordered the supply be used
•Quantity of disposable supplies requested per month
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