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2012 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : 2. Medicaid Children’s Services Comprehensive Care Program (CCP) : 2.9 Private Duty Nursing (CCP) : 2.9.3 Prior Authorization and Documentation Requirements : 2.9.3.3 Prior Authorization of Initial Requests

2.9.3.3
Completed initial requests must be received and dated by CCP within three business days of the SOC. The request must be received by CCP no later than 5 p.m., Central Time, on the third day to be considered received within three business days. If a request is received more than three business days after the SOC, or after 5 p.m., Central Time, on the third day, authorization is given for dates of service beginning three business days before receipt of the completed request.
An initial PDN prior authorization request requires all of the following:
All forms must be completed, signed, and dated by the primary physician within 30 calendar days prior to the SOC. The RN who completes the assessment and the client, or responsible adult, must also sign the CCP Nursing Addendum to Plan of Care form.
The CCP Nursing Addendum to Plan of Care form must include all of the following:
Initial requests for PDN may be prior authorized for up to 90 days.
Refer to:
Form CH.3, “CCP Prior Authorization Private Duty Nursing 6-Month Authorization” in this handbook.
Form CH.7, “Home Health Plan of Care (POC)” in this handbook.

Texas Medicaid & Healthcare Partnership
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