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.
On June 14, 2021, Philips Respironics initiated a voluntary recall notification for specific models of continuous positive airway pressure (CPAP), bilevel positive airway pressure (BPAP), and mechanical ventilator devices to ensure patient safety.
The recall is to address potential health risks related to the polyester-based polyurethane (PE-PUR) sound abatement foam used in certain devices. Please see the recall notification on the Philips Respironics website for additional information and a complete list of models.
Additional clinical information for physicians and other medical care providers is available at philips-recall-clinical-information-for-physicians-and-providers.pdf
When contacting TMHP, providers must state that the device is under recall.
For existing prior authorizations, previously submitted documentation supporting medical necessity is sufficient to request the replacement of a rental device. Prior authorization requests for the replacement of a purchased respiratory device may also be processed with documentation used to support the medical necessity of the previous purchase.
Durable medical equipment (DME) providers should be prepared to contact ordering providers and clients to facilitate a smooth equipment transition.
For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413. Questions may be submitted to MedicaidBenefitRequest@hhsc.state.tx.us