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2012 Texas Medicaid Provider Procedures Manual

Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook : 2. Texas Medicaid (Title XIX) Home Health Services : 2.2 Services, Benefits, Limitations and Prior Authorization : 2.2.5 Bath and Bathroom Equipment : 2.2.5.5 Documentation Requirements

2.2.5.5
To request prior authorization for bath or bathroom equipment, the following documentation must be provided:
Accurate diagnostic information pertaining to the underlying diagnosis or condition, including the client’s overall health status, any other medical needs, developmental level, and functional mobility skills and why regular bath or bathroom equipment will not meet the client’s needs
2.2.5.5.1 Toilet Seat Lifts
The submitted documentation for a toilet seat lift must include an assessment completed by a physician, physical therapist, or occupational therapist that includes all of the following:
A list of the mobility related activities of daily living (MRADLs) the client will be able to perform with the toilet seat lift mechanism that the client is unable to perform without the toilet seat lift mechanism and how the device will increase the client's independence
Supporting documentation must be kept in the client’s record that all appropriate therapeutic modalities (e.g., medication or physical therapy) have been tried and that they failed to enable the client to transfer from a chair to a standing position.

Texas Medicaid & Healthcare Partnership
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