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December 2016 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 : 2.2.1 Home Health Services : Client Eligibility
Home health clients do not have to be homebound to qualify for services.
To qualify for home health services, the Medicaid client must be eligible on the DOS and must:
Have a medical need for home health professional services, DME, or supplies that is documented in the client’s POC and considered a benefit under home health services.
Unless otherwise noted in this handbook, certain DME/supplies may be obtained without prior authorization although providers must retain a Home Health Services (Title XIX) Durable Medical Equipment (DME)/Medical Supplies Physician Order Form that has been reviewed, signed, and dated by the treating physician for these clients.
Refer to:
“Automated Inquiry System (AIS)” in “State, Federal, and TMHP Contact Informaiton” (Vol. 1, General Information).
Section 6: Claims Filing in the Children’s Services Handbook (Vol. 2, Provider Handbooks) for more information on clients who are 20 years of age and younger.

Texas Medicaid & Healthcare Partnership
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