Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.
Beginning September 1, 2018, the statement “Department of State Health Services (DSHS) to practice under Texas Civil Statues, Article 4512L” will be updated to “Texas Medical Board to practice under Chapter 604 of the Texas Occupations Code” regarding certification requirements for providers of respiratory therapy services in the Texas Medicaid Provider Procedures Manual (TMPPM).
TMHP will update the TMPPM, Certified Respiratory Care Practitioner (CRCP) Services Handbook, subsection 3.1, “Services, Benefits, Limitations, and Prior Authorization” and Section 1: Provider Enrollment and Responsibilities Handbook, subsection 1.6.14, “Certified Respiratory Care Practitioner (CRCP) Services.”
For more information, call the TMHP Contact Center at 800-925-9126.