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24.5.11 Medical Supplies
Medical supplies are benefits of the Home Health Services Program if they meet the following criteria:
• A completed Home Health Services (Title XIX) Durable Medical Equipment (DME)/Medical Supplies Physician Order Form, prescribing the DME and/or supplies must be signed and dated by a physician familiar with the client before requesting prior authorization for all DME and supplies. All signatures and dates must be current, unaltered, original, and handwritten. Computerized or stamped signatures and dates will not be accepted. The completed Home Health Services (Title XIX) Durable Medical Equipment (DME)/Medical Supplies Physician Order Form must include the procedure codes and quantities for the services requested. A copy of the completed Home Health Services (Title XIX) Durable Medical Equipment (DME)/Medical Supplies Physician Order Form must be maintained by the DME provider and the original must be kept by the prescribing physician in the client's medical file.
•The provider must contact TMHP within three business days of providing the supplies to the client and obtain authorization, if required.
•The requesting provider and ordering physician must keep all Home Health Services (Title XIX) Durable Medical Equipment (DME)/Medical Supplies Physician Order Forms and Addendum to Home Health Services (Title XIX) DME/Medical Supplies Physician Order Forms on file. The physician must maintain the original signed and dated Home Health Services (Title XIX) Durable Medical Equipment (DME)/Medical Supplies Physician Order Form copy in their records. Providers must retain individual delivery slips or invoices for each DOS that document the date of delivery for all supplies provided to a client and must disclose them to HHSC or its designee upon request. Documentation of delivery must include one of the following:
•Delivery slip or invoice signed and dated by client/caregiver
•The delivery slip or invoice must contain the client's full name and address to which the supplies were delivered, the item description and the numerical quantities that were delivered to the client.
•A dated carrier tracking document with shipping date and delivery date must be printed from the carrier's website as confirmation that the supplies were shipped and delivered. The dated carrier tracking document must be attached to the delivery slip or invoice.
The dated delivery slip or invoice must include an itemized list of goods that includes the descriptions and numerical quantities of the supplies delivered to the client. This document could also include prices, shipping weights, shipping charges, and any other description.
Note: These records and claims must be retained for a minimum of five years from the DOS or until audit questions, appeals, hearings, investigations, or court cases are resolved. Use of these services is subject to retrospective review.
•The requesting provider or ordering physician must document medical supplies as medically necessary in the client's POC or on a completed Home Health Services (Title XIX) Durable Medical Equipment (DME)/Medical Supplies Physician Order Form and Addendum to Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form. TMHP must prior authorize most medical supplies. They must be used for medical or therapeutic purposes, and supplied through an enrolled DMEH provider in compliance with the client's POC.
HHSC/TMHP reserves the right to request the Home Health Services (Title XIX) Durable Medical Equipment (DME)/Medical Supplies Physician Order Form and/or Addendum to Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form at any time.
•Some medical supplies may be obtained without prior authorization; however, the provider must retain a copy of the completed POC or Home Health Services (Title XIX) Durable Medical Equipment (DME)/Medical Supplies Physician Order Form in the client's file. For medical supplies not requiring prior authorization, a completed Home Health Services (Title XIX) Durable Medical Equipment (DME)/Medical Supplies Physician Order Form may be valid for a maximum of six months, unless the physician indicates the duration of need is less. If the physician indicates the duration of need is less than six months, then a new Home Health Services (Title XIX) Durable Medical Equipment (DME)/Medical Supplies Physician Order Form is required at the end of the determined duration of need.
Refer to: The list of DME/medical supplies that may be provided without prior authorization are located in "Diabetic Supplies/Equipment" ; "Nebulizers" ; "Vaporizers" ; "Incontinence Supplies" ; and "Procedure Codes That Do Not Require Prior Authorization" . The items must be used for therapeutic purposes and directly relate to the client's needs and POC.
All purchased equipment must be new upon delivery to client. Used equipment may be utilized for lease, but when purchased, must be replaced with new equipment.
Note: Client eligibility can change monthly. Providers are responsible for verifying eligibility before providing supplies.
•Clients with ongoing needs may receive up to six months of prior authorizations for some expendable medical supplies under Home Health Services when requested on a Home Health Services (Title XIX) Durable Medical Equipment (DME)/Medical Supplies Physician Order Form. Providers may deliver medical supplies as ordered on a Home Health Services (Title XIX) Durable Medical Equipment (DME)/Medical Supplies Physician Order Form for up to six months from the date of the physician's signature. In these instances, a review of the supplies requested by the physician familiar with the client's condition, and a new Home Health Services (Title XIX) Durable Medical Equipment (DME)/Medical Supplies Physician Order Form is required for each new prior authorization request. Requests for authorization can be made up to 60 days before the start of the new authorization period. Professional Home Health Services prior authorization requests require a review by the physician familiar with the client's condition and a physician signature every 60 days when requested on a POC.
Note: These records and claims must be retained for a minimum of five years from the DOS or until audit questions, appeals, hearings, investigations, or court cases are resolved. Use of these services is subject to retrospective review.
•If a client or caregiver has been instructed and supervised on proper wound care technique and no longer requires SN services, the home health agency (enrolled as a DMEH provider) can continue to provide supplies that enable the client or caregiver to administer care. Supplies may be provided as long as the client meets home health services criteria. The following supplies are those considered essential to the physician-prescribed treatment of an ill or injured client in their own home. Items not listed may, in selected instances, be required for a particular client. Consideration is given on an individual case basis to items not on this list that are medically documented by the physician's POC. An RN must evaluate the client in the home setting before the initiation of the POC or have a Home Health Services (Title XIX) Durable Medical Equipment (DME)/Medical Supplies Physician Order Form completed and signed by a treating physician serving as a POC for DME and/or supplies.
The DOS is the date on which supplies are delivered to the client and/or shipped by a carrier to the client as evidenced by the dated tracking document attached to the invoice for that date. The provider must maintain the signed and dated records supporting documentation that an item was not billed before delivery. These records are subject to retrospective review.
Note: THSteps-eligible clients who qualify for medically necessary services beyond the limits of this home health benefit will receive those services through THSteps-CCP. Refer to: "Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form Instructions (2 Pages)" and "Home Health Services (Title XIX) Durable Medical Equipment (DME)/Medical Supplies Physician Order Form" for copies of forms.
"Durable Medical Equipment Supplier (THSteps-CCP Only)" for specific information about certain DME and medical supplies.
"Medicare/Medicaid Authorization" for a list of supplies that do not require prior authorization.
"Eligibility" .
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