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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 : 2.2.11 Hospital Beds and Equipment : 2.2.11.1 Prior Authorization

2.2.11.1
Hospital beds may be considered for prior authorization for clients who cannot safely utilize a regular bed.
A fixed-height bed may be considered for prior authorization when the client requires the head of the bed to be elevated more than 30 degrees most of the time due to conditions such as congestive heart failure, chronic pulmonary disease, or problems with aspiration. Pillows or wedges must have been used and found to be ineffective.
A variable-height hospital bed may be considered for prior authorization if the client meets the criteria for a fixed-height hospital bed, and requires a bed height different than a fixed-height hospital bed to permit transfers to a chair or wheelchair or to a standing position.
A semi-electric hospital bed may be considered for prior authorization if the client meets the criteria for a variable-height bed and requires frequent changes in body position or has a need for rapid changes in body position.
A fully-electric bed may be considered for prior authorization only for clients with paraplegia or partial hemiplegia when the fully electric bed will allow for functional independence. Documentation must include that the bed will allow for the client's functional independence with self-care. A fully-electric bed will not be authorized for the convenience of the caregiver.
The following hospital beds may be considered for prior authorization if the client meets the criteria for a hospital bed and the weight requirements for a bariatric bed as listed below:

Texas Medicaid & Healthcare Partnership
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