TMPPM 2008 > Texas Medicaid Services > Texas Medicaid (Title XIX) Home Health Services > Benefits

24.5.12 Diabetic Supplies/Equipment

Diabetic supplies and equipment are a benefit through Home Health Services. Diabetic supplies and related testing equipment do not require prior authorization unless otherwise specified. The following requirements must be met to qualify for reimbursement:

•The client must be eligible for home health benefits.

•The equipment must be medically necessary.

•The criteria appropriate for the requested equipment must be met.

•Federal financial participation must be available.

•The requested equipment or supplies must be safe for use in the home.

The DME Certification and Receipt Form is required and must be completed before reimbursement can be made for any DME delivered to a client. The certification form must include the name of the item, the date the client received the DME, and the signatures of the provider and the client or primary caregiver. This signed and dated form must be maintained by the DME provider in the client's medical record.

Glucose monitors and external insulin pumps that have been purchased are anticipated to last a minimum of five years and may be considered for replacement when five years have passed and/or the equipment is no longer repairable. The DME may then be considered for prior authorization. Replacement of equipment may also be considered when loss or irreparable damage has occurred. A copy of the police or fire report when appropriate or applicable, and the measures to be taken to prevent reoccurrence must be submitted. Additional services may be reimbursed with prior authorization based on documentation of medical necessity.

In situations where the equipment has been abused or neglected by the client, the client's family or the caregiver, a referral to the Department of State Health Services (DSHS) THSteps Case Management Department will be made by the Home Health Services Prior Authorization Department for clients under 21 years of age. Providers will be notified that the state will be monitoring this client's services to evaluate the safety of the environment for both the client and the equipment.

A Texas Medicaid-eligible client may obtain diabetic supplies and related testing equipment through Home Health Services. The following requirements must be met to qualify for reimbursement under Home Health Services:

A completed Home Health Services (Title XIX) Durable Medical Equipment (DME)/Medical Supplies Physician Order Form that prescribes the DME and/or medical supplies must be signed and dated by a prescribing physician who is familiar with the client before supplying any medical equipment or supplies. All signatures must be current, unaltered, original, and hand written. Computerized or stamped signatures and dates will not be accepted. The completed, signed, and dated Home Health Services (Title XIX) Durable Medical Equipment (DME)/Medical Supplies Physician Order Form must be maintained by the provider and the prescribing physician in the client's medical record. The physician must maintain the original signed and dated copy of the Home Health Services (Title XIX) Durable Medical Equipment (DME)/Medical Supplies Physician Order Form. The completed Home Health Services (Title XIX) Durable Medical Equipment (DME)/Medical Supplies Physician Order Form is valid for a period up to six months from the physician's signature date.

The physician must indicate on the Home Health Services (Title XIX) Durable Medical Equipment (DME)/Medical Supplies Physician Order Form how many times a day the client is required to test blood glucose levels.