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Update to the Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook

Last updated on 12/18/2020

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 January 1, 2021, TMHP will update the Texas Medicaid Provider Procedures Manual, Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook, section, “Services that are not a Benefit” for respiratory equipment and supplies, to read:

The following are not a benefit of Title XIX Home Health Services:

  • Respiratory equipment or supplies requested primarily for the convenience of the caregiver
  • Rental of:
    • Mucus clearance valved chamber
    • Medication small volume nebulizer
    • Intrapulmonary percussive ventilation (IPV) system
    • Ultrasonic nebulizers
    • Oxygen supplies for rented equipment
    • Intermittent or spot-check pulse oximetry
  • Purchase of:
    • Bi-level PAP with set backup respiratory rate
    • Intrapulmonary percussive ventilation (IPV)
    • Ventilators
    • Pulse oximeter as a Home Health benefit
    • Intermittent or spot-check pulse oximetry
    • Long-term (greater than 1 calendar month) pulse oximeter is not a benefit of Home Health services

Reminder: Requests for respiratory equipment and supplies that are not listed as a benefit under Title XIX Home Health Services may be considered through the Texas Health Steps—Comprehensive Care Program (CCP) for clients who are 20 years of age and younger, or under the Texas Medicaid Home Health—Durable Medical Equipment (DME) Exceptional Circumstances provision for clients who are 21 years of age and older.

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