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, 2020, the Texas Medicaid Provider Procedures Manual (TMPPM) Clinician-Administered Drugs Handbook will be renamed Outpatient Drug Services Handbook. Additionally, the contents of Appendix B: Vendor Drug Program, currently located in Volume 1 of the TMPPM, will be merged into the renamed handbook.
The following changes will also be incorporated in the Outpatient Drug Services Handbook:
- Some tables will be reformatted and some sections will be reorganized.
- The CAD injections table will be removed, and a section will be created for each injection that is not currently in an existing section.
- Standard prior authorization language will be removed from some sections and a general prior authorization section will be created.
The following new information will be added to the Outpatient Drug Services Handbook:
- Pharmacy manufacturer information and instructions
- Retrospective Drug Utilization Reviews
For more information, call the TMHP Contact Center at 800-925-9126.