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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 : 2.2.11.6 Replacement

2.2.11.6
Beds rails and frames that have been purchased are anticipated to last a minimum of five years.
2.2.11.6.1 Prior Authorization
Prior authorization for replacement may be considered within five years of purchase when one of the following occurs:
Replacement of equipment may be considered when loss or irreparable damage has occurred. A copy of the police or fire report, when appropriate, and the measures to be taken to prevent reoccurrence must be submitted.
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) Health Screening and Case Management unit will be made by the Home Health Services prior authorization unit for clients who are 20 years of age and younger. 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 equipment.

Texas Medicaid & Healthcare Partnership
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