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.
This is a correction to the current Texas Medicaid Provider Procedures Manual, Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook, subsection 2.2.4 “Augmentative Communication Device (ACD) System.” The subsection will be updated to remove Access device and Mounting device from the list of items included in the reimbursement. This update clarifies, but does not change the Medicaid benefit described in subsection 2.2.4.
To clarify, separate reimbursement is available as a benefit, but Access device and Mounting device will be removed from the list of items included with the ACD as indicated in the portion of Section 2.2.4 excerpted below:
Items included in the reimbursement for an ACD system and not reimbursed separately include, but are not limited to, the following:
- Basic, essential software (except for software purchased specifically to enable a client-owned computer or personal digital assistant [PDA] to function as an ACD system)
- Battery charger
- Power supplies
- Interface cables
- Moisture guard
- Alternating current (A/C) or other adapters
- Adequate memory to allow for system expansion within a three-year timeframe
- All basic operational training necessary to instruct the client and family/caregivers in the use of the ACD system
- Manufacturer’s warranty
This update has no impact on the access and mounting devices currently being processed through prior authorization or claims.
Refer to: Subsection 184.108.40.206 “ACD System Accessories” for information that specifies access and mounting devices are separately reimbursable.
For more information, call the TMHP Contact Center at 1-800-925-9126.