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 June 1, 2020, TMHP will update the Texas Medicaid Provider Procedures Manual, Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook to align with 42 C.F.R. § 440.70 (b)(3)(v), prohibiting states from having absolute exclusions of coverage on medical equipment, supplies, or appliances.
The changes are as follows:
- The following statement in subsection 22.214.171.124, “Feeder Seats, Floor Sitters, Corner Chairs, and Travel Chairs,” will be removed:
- Feeder seats, floor sitters, corner chairs, and travel chairs are not considered medically necessary and are not benefits of CCP. If a client requires seating support and meets the criteria for a seating system, a stroller may be considered for reimbursement with prior authorization through CCP, or a wheelchair may be considered through Texas Medicaid (Title XIX) Home Health Services.
- The following statement in subsection 126.96.36.199 “Procedure Codes and Limitations for Mobility Aids,” will be removed:
- Feeder seats, floor sitters, corner chairs, and travel chairs are not considered medically necessary devices.
For more information, call the TMHP Contact Center at 800-925-9126.