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16.3 Benefits and Limitations
TMHP must prior authorize all in-home respiratory therapy services.
Respiratory therapy services provided by a Medicaid provider enrolled as a CRCP may be reimbursed when services are reasonable, medically necessary, and prescribed by the client's physician. These services are for all age groups and do not require the client to be homebound.
Medicaid coverage of CRCP services is available to clients who meet the following criteria:
• Are ventilator-dependent for life support at least six hours per day.
•Are ventilator-dependent for at least 30 consecutive days as an inpatient in one or more hospitals, skilled nursing facilities (SNF), or intermediate care facilities (ICF).
•Require respiratory care as an inpatient in a hospital, SNF, or ICF and would be eligible to have payment made for such inpatient care.
•Have adequate social support services available for care at home.
•Prefer care at home.
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