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December 2016 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : 2 Medicaid Children’s Services Comprehensive Care Program (CCP) : 2.11 Personal Care Services (PCS) (CCP) : 2.11.4 * Coordination with PPECC Provider

2.11.4
When a DSHS case manager is notified by the client, client’s responsible adult, or client’s physician that PPECC services have been initiated, revised, or recertified, the DSHS case manager must conduct a PCS reassessment, and submit all documentation required for a revision, modification, or denial of the original PCS authorization request, including a Physician’s Statement of Need if there is a change in client condition. The new authorization request must be submitted within ten (10) business days of notification.
DSHS case managers must provide documentation to support medical necessity if PCS service hours do not decrease when PPECC services are initiated.
DSHS case managers must also document coordination with the PPECC provider, maintaining documentation that the client or the client’s responsible adult has participated in the development of the plan of care.
When a client receives both PCS and PPECC in a single day, and decides to receive fewer hours of service in a PPECC (i.e., shifts more services to the home setting), or terminates PPECC services, the PCS case manager must conduct a reassessment, and submit all documentation required for a revision, modification, or denial of the original PCS authorization request, including a Physician’s Statement of Need if there is a change in condition within ten (10) business days of notification by the client, client’s responsible adult, or client’s physician.
Similarly, if the client decides to receive fewer hours of PCS services in the home, and increase PPECC hours, the DSHS case manager must conduct a reassessment, and submit all documentation required for an modification of the authorization request, within ten (10) business days of notification by the client, client’s responsible adult, or client’s physician.
Note:
PCS services rendered in a client’s home may be billed before or after PPECC services on the same day, but not at the same time as PPECC services. PCS services required while a client is in a PPECC are considered part of the PPECC billable rate.

Texas Medicaid & Healthcare Partnership
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