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2018 TMPPM Release Notes

Last updated on 9/11/2020

The following tables show the section and handbooks that were changed in the Texas Medicaid Provider Procedures Manual through September 2018. The changes are listed in reverse chronological order (newest first).

December 2018 TMPPM Release Notes
Handbook	Related Articles and Notes
Volume 1: Section 1: Provider Enrollment and Responsibilities	Replaced “DADS” and “DARS” references with appropriate agencies.
Volume 1: Section 4: Client Eligibility	Replaced “DADS” and “DARS” references with appropriate agencies.
Volume 1: Section 6: Claims Filing	Replaced “DADS” and “DARS” references with appropriate agencies. Updated CHIP FPL Percentages in section 6.19, “Children’s Health Insurance Program (CHIP) Perinatal Claims,” and subsection 6.19.1, “CHIP Perinatal Newborn Transfer Hospital Claims.”
Volume 1: Section 7: Appeals	Removed the word “unit” from subsection 7.3.4.2, “Provider Complaint Process.”
Volume 1: Section 8: Third Party Liability (TPL)	Replaced “DADS” and “DARS” references with appropriate agencies.
Volume 1: Appendix A: State, Federal, and TMHP Contact Information	Replaced “DADS” and “DARS” references with appropriate agencies
Volume 1: Appendix C: HIV/AIDS	Replaced “DADS” and “DARS” references with appropriate agencies.
Volume 1: Appendix D: Acronym Dictionary	Replaced “DADS” and “DARS” references with appropriate agencies.
Behavioral Health and Case Management Services Handbook	Replaced “DADS” and “DARS” references with appropriate agencies.
Certified Respiratory Care Practitioner (CRCP) Services Handbook	Updated the TAC reference in section 4.1, “Services, Benefits, Limitations, and Prior Authorization.”
Children’s Services Handbook: Medical services (Sections 1-3 and 5-9) and THSteps Dental services (Section 4)	Removed references to DADS and replaced with Health and Human Services Commission (HHSC) in sections 2.11.1, “Enrollment,” and 2.11.2.2, “Client Eligibility.” Removed references to DADS and replaced with Health and Human Services Commission (HHSC), replaced “Texas Home Living (Uxmal)” with Texas Home Living (TXHmL), and removed “school based services” in sections 2.14.1, “Services, Benefits, and Limitations,” and 2.14.1.1.1, “Initial Authorization Requests.” Removed references to DADS and replaced with Health and Human Services Commission (HHSC) in sections 4.2.1, “THSteps Dental Services,” 4.2.6, “ICF-IID Dental Services,” 4.2.29.1, “Long Term Care (LTC) Emergency Dental Services,” and updated DADS phone number as 1-800-252-9240.
Clinician-Administered Drugs (CAD) Handbook	Quantity Limitation to Change for Botulinum Toxin Type A Procedure Code J0586 Information posted October 26, 2018
Home Health Nursing and Private Duty Nursing Services Handbook	Updated acronyms within sections 4.1.3, “PDN Providers,” and 4.1.4.3, “PDN Provider Requirements.”
Inpatient and Outpatient Hospital Services Handbook	Updated CHIP FPL Percentages in subsection 3.2.3.1, “Emergency Coverage,” subsection 3.2.3.3, “Children’s Health Insurance Program (CHIP) Perinatal Coverage,” and subsection 3.2.4.1, “Newborn Eligibility.”
Medicaid Managed Care Handbook	Replaced “DADS” and “DARS” references with appropriate agencies. Updated CHIP FPL Percentages in section 3.1, “STAR Program Clients.”
Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook	In section 7.1, “Provider Enrollment,” revised the state agency name as Texas Department of State Health Services. Removed the DADS and DARS references and replaced with Texas Health and Human Services Commission (HHSC) within sections 9.2.57.8.1, “Referral Requirements for Children with Disabilities,” 9.2.58, “Physician Services in a Long Term Care (LTC) Nursing Facility,” and 9.2.66, “Sign Language Interpreting Services.” Updated DADS web address as hhs.texas.gov. Updated TAC reference in section 9.3, “Doctor of Dentistry Practicing as a Limited Physician, and 9.3.2.4, “Dental Anesthesia by a Doctor of Dentistry Practicing as a Limited Physician.”
Vision and Hearing Services Handbook	Language update to the Texas Medicaid Provider Procedures Manual, Vision and Hearing Services Handbook Information posted November 09, 2018 Updated “DARS” reference with appropriate agency.
Women’s Health Services Handbook	Benefit Changes for HHSC Family Planning Program and Healthy Texas Women Program Effective November 1, 2018 Information posted October 9, 2018

November 2018 TMPPM Release Notes
Handbook	Related Articles and Notes
Volume 1: Section 2: Texas Medicaid Fee-for-Service Reimbursement	Removed TAC references in section 2.2.4, “Hospitals.”
Volume 1: Section 4: Client Eligibility	Updated language in section 4.4.4.4, “Process,” and updated link in section 4.9.1, “Initial MBCC Program Enrollment.”
Volume 1: Appendix A: State, Federal, and TMHP Contact Information	Added “TX” to section A.2, “HHSC Access and Eligibility Services (AES).”
Behavioral Health and Case Management Services Handbook	2018 ICD-10 Special Bulletin, No. 14 Information posted September 28, 2018
Children’s Services Handbook: Medical services (Sections 1-3 and 5-9)	Update to Texas Medicaid Provider Procedures Manual, Children’s Services Handbook Information posted October 26, 2018 Created new claim form example titled “Postpartum Depression Screening During an Infant THSteps Checkup.” Link added to Section 9 Claim Form Examples.
Clinician-Administered Drugs (CAD) Handbook	Third Quarter 2018 HCPCS Updates for Texas Medicaid Information posted September 28, 2018 2018 ICD-10 Special Bulletin, No. 14 Information posted September 28, 2018 New Prior Authorization Criteria for Benralizumab for Texas Medicaid November 1, 2018 Information posted September 21, 2018
Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook	2018 ICD-10 Special Bulletin, No. 14 Information posted September 28, 2018
Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook	Added statement to the Nurse Practitioner (NP) and Clinical Nurse Specialist (CNS) section 8.1, Enrollment, “APRNs may be included as primary care providers in the provider network for Medicaid and CHIP programs (both fee-for-service and managed care), regardless of whether the physician supervising the APRN is enrolled in Medicaid or in the provider network.” 2018 ICD-10 Special Bulletin, No. 14 Information posted September 28, 2018 Made edits to Durable Medical Equipment (DME) language in subsection 9.2.77.1, “Prior Authorization,” for Wearable Cardiac Defibrillator to align with DME Handbook. Added statement to the Physician Assistant section 10.1, Enrollment, “PAs may be included as primary care providers in the provider network for Medicaid and CHIP programs (both fee-for-service and managed care), regardless of whether the physician supervising the APRN is enrolled in Medicaid or in the provider network.”
Radiology and Laboratory Services Handbook	2018 ICD-10 Special Bulletin, No. 14 Information posted September 28, 2018
Vision and Hearing Services Handbook	2018 ICD-10 Special Bulletin, No. 14 Information posted September 28, 2018 Benefit and Policy Language Will Change for Hearing Devices, Effective November 1, 2018 Information posted September 21, 2018 Benefit and Policy Language for Otology and Audiometry Services Will Change, Effective November 1, 2018 Information posted September 21, 2018

October 2018 TMPPM Release notes
Handbook	Related Articles and Notes
Volume 1: Section 4: Client Eligibility	Update to TMPPM and CSHCN Services Program Provider Manual for Texas Medicaid Wellness Program Information posted September 7, 2018
Volume 1: Section 5: Fee-for-Service Prior Authorizations	Removed “(Abuse and Dependence)” language from subsection 5.5.1, “Prior Authorization Requests Through the TMHP website.”
Volume 1: Appendix A: State, Federal, and TMHP Contact Information	Updated the contact information table in section A.2, “HHSC Regional Offices of Access and Eligibility (AES).”
Ambulance Services Handbook	Added language regarding electronic or wet signatures to subsection 2.2.2, "Nonemergency Ambulance Transport Services.”
Behavioral Health and Case Management Services Handbook	Removed “(Abuse and Dependence)” language from the title in section 8, “Substance Use Disorder (SUD) Services,” and from the “refer to” in section 7, “Screening, Brief Intervention, and Referral to Treatment (SBIRT).”
Children’s Services Handbook: Medical services (Sections 1-3 and 5-9)	Update to TMPPM Children’s Services Handbook Information posted September 28, 2018
Clinician-Administered Drugs (CAD) Handbook	Added electronic signature section to reflect the acceptance of electronic signatures throughout Medicaid Mobility Aids medical policy. Claims Reprocessing for Procedure Code J1626 When Submitted With Diagnosis Code Z5189 Information posted August 9, 2018 Update to TMPPM Clinician-Administered Drugs Handbook Information posted September 7, 2018
Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook	Removed language regarding electronic signatures in subsection 2.2.16.10.2, “Documentation Requirements.” Removed language regarding electronic signatures in subsection 2.2.27.4, “Authorization Requirements.” Correction to the TMPPM about Enteral Supplies in the Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook Information posted September 14, 2018
Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook	Added statement about postpartum depression screening in subsection 4.1.14, “Antenatal and Postnatal Care Visits.”
Inpatient and Outpatient Hospital Services Handbook	Updated TAC references and other grammar throughout handbook. Neonatal Level of Care Designation Required for Hospital Providers Rendering Neonatal Inpatient Services Information posted July 6, 2018 Added language regarding electronic or wet signatures to subsection 3.2.5.1.1, "Out-Of-State Transplant Facilities,” and subsection 3.2.5.3, “Prior Authorization for Organ and Transplant Services.”
Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook	Added electronic signature section to reflect the acceptance of electronic signatures throughout Medicaid Mobility Aids medical policy.
Telecommunication Services Handbook	Telemedicine and Telehealth Services Benefit Policy Language Updated, Effective October 1, 2018 Information posted August 17, 2018 Update to TMPPM and CSHCN Services Program Provider Manual for Texas Medicaid Wellness Program Information posted September 7, 2018 Added electronic signature language to subsection 3.5.1, “Prior Authorization of Telemonitoring Services,” to reflect the acceptance of electronic signatures throughout the Medicaid Mobility Aids medical policy.
Vision and Hearing Services Handbook	Added language regarding electronic or wet signatures to subsection 3.2.1.1, "Prior Authorization.” Added language regarding electronic or wet signatures to subsection 4.3.9, "Prior Authorization.” Removed the “medically necessary table” and revised introductory statement in subsection 4.3.5.4, “Ophthalmic Ultrasound.”

September 2018 TMPPM Release Notes
Handbook	Related Articles and Notes
Volume 1: Section 1: Provider Enrollment and Responsibilities	Provider Practice Location Requirements for Moderate and High Risk Providers; PEP Enhancement for Facilities that Require Licensure, Effective August 24, 2018 Information posted July 6, 2018 Update to TMPPM Certified Respiratory Care Practitioners (CRCP) Services Handbook Information posted August 10, 2018
Volume 1: Section 2: Texas Medicaid Fee-for-Service Reimbursement	Revised Hearing Aid and Audiometric Evaluations language in section 2.2.1, “Online Fee Lookup (OFL) and Static Fee Schedules.”
Volume 1: Section 5: Fee-for-Service Prior Authorizations	Providers are Required to Fax Client Prior Authorization Requests Separately Information posted July 18, 2018
Behavioral Health and Case Management Services Handbook	Removed language in the diagnosis code tables “(submitted as stand-alone diagnosis codes)” from subsection 8.6.2, “Ambulatory (Outpatient) Treatment Services.”
Certified Respiratory Care Practitioner (CRCP) Services Handbook	Update to TMPPM Certified Respiratory Care Practitioners (CRCP) Services Handbook Information posted August 10, 2018
Children’s Services Handbook: Appendix C: Lead Screening	Removed stand-alone diagnosis code text from appendix section C.4.2, “Services, Benefits, Limitations, and Prior Authorization,” as this information is no longer applicable.
Clinician-Administered Drugs (CAD) Handbook	Luxturna™ Procedure Code C9032 is a Benefit of Texas Medicaid Effective July 1, 2018 Information posted August 24, 2018
Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook	Benefit Changes for Procedure Code A6250 without a Modifier for Texas Medicaid Information posted June 27, 2018 Removed language in the diagnosis code tables “(submitted as stand-alone diagnosis codes)” from subsection 2.2.14.6.2, “Intermittent Catheters and Related Insertion Supplies.”
Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook	Benefit Language for Hydroxyprogesterone Caproate Procedure Codes J1726 and J1729 will be Updated for Texas Medicaid Information posted August 10, 2018
Women’s Health Services Handbook	Removed procedure code 90703 from section 2.3, “Services, Benefits, Limitations, and Prior Authorization.”