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December 2016 Texas Medicaid Provider Procedures Manual

Home Health Nursing and Private Duty Nursing Services Handbook : 1 General Information : 1.1 Client Eligibility for Home Health Nursing and Aide Services

It is the provider’s responsibility to determine the type of coverage (Medicare, Medicaid, or private insurance) that the client is eligible to receive. To verify client Medicaid eligibility and retroactive eligibility, the home health agency, durable medical equipment (DME), or medical supplier must contact the Automated Inquiry System (AIS) at 1-800-925-9126 or the Texas Medicaid & Healthcare Partnership (TMHP) Electronic Data Interchange (EDI) Help Desk at 1-888-863-3638.
Home health clients do not need to be homebound to qualify for services.
The Medicaid client must be eligible on the date of service (DOS) and must meet all of the following requirements to qualify for home health services:
Have a medical need for home health professional services, DME, or medical supplies that is documented in the client’s plan of care (POC) and considered a benefit under home health services
Refer to:
Subsection A.12.3, “Automated Inquiry System (AIS)” in “Preliminary Information” (Vol. 1, General Information).
Texas Health Steps (THSteps)-eligible clients who qualify for medically necessary services beyond the limits of this home health services benefit may receive those services through the Comprehensive Care Program (CCP).

Texas Medicaid & Healthcare Partnership
CPT only copyright 2014 American Medical Association. All rights reserved.