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.
The Texas Health and Human Services Commission (HHSC) has directed TMHP to expedite processing and waive submission timeframes and documentation requirements for new prior authorization (PA) requests if the request is to replace durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) that were lost or damaged as a result of Hurricane Laura.
A provider must include in the PA request that the need is a result of Hurricane Laura and a narrative description explaining why the equipment requires replacement. This is limited to providers serving Texas Medicaid eligible clients with a permanent residence in a declared disaster county and only for the duration of the disaster declaration.
Note: Providers must keep documentation that indicates whether the DMEPOS was lost, destroyed, irreparably damaged, or otherwise rendered unusable as a result of the hurricane. The DMEPOS replacement may still be subject to retrospective review for medical necessity.
For more information, call the TMHP Contact Center at 800-925-9126.