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Home Health Services Signature Requirements to Be Updated in the TMPPM

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

Effective July 1, 2024, language in the Texas Medicaid Provider Procedures Manual (TMPPM) will be updated to reflect the rule changes implemented by the Texas Health and Human Services Commission (HHSC). The rule changes apply to nonphysician signatures on prior authorization requests for home health services and became effective on September 21, 2022.

The changes are in alignment with 42 Code of Federal Regulations §440.70 and bring Texas into compliance with the Centers for Medicare & Medicaid Services CMS-5531-Interim Final Rule with Comment (IFC). Information about this change was published on October 19, 2022, (see link below).

Change to Signature Requirements for Title XIX (Medicaid) Home Health Services | TMHP

Prior Authorization Form Updates

Existing prior authorization forms were updated to align with the changes and included “allowed practitioners,” effective July 1, 2023. An allowed practitioner is a physician assistant (PA) or an advanced practice registered nurse (APRN) who is licensed as a certified nurse practitioner (CNP) or clinical nurse specialist (CNS).

Information about the prior authorization request form changes was published on June 22, 2023, (see link below).

Signature Updates to Home Health Prior Authorization Request Forms | TMHP

Note: When submitting prior authorizations, the ordering or prescribing PA, CNP, or CNS must include their own National Provider Identifier (NPI) in the request, not the group’s or physician’s NPI. Prior authorizations without the correct NPI will be returned as incomplete.

For more information, call the TMHP Contact Center at 800-925-9126.