Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, precertification, 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.
Signature requirements for Title XIX (Medicaid) Home Health Services have recently changed. Medicaid-enrolled physicians and allowed practitioners can now sign prior authorizations and order covered Medicaid Home Health Services, including skilled nursing, home health aide services, durable medical equipment and supplies, and adult physical and occupational therapy services.
An allowed practitioner is a physician assistant (PA) or an advanced practice registered nurse who is licensed as a certified nurse practitioner (CNP) or clinical nurse specialist (CNS).
Amendments to 1 Texas Administrative Code rules 354.1031, 354.1035, 354.1037, 354.1039, 354.1040, and 354.1043 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).
Language in the Texas Medicaid Provider Procedures Manual (TMPPM) will be updated to reflect this change. The adopted rules for home health services became effective on September 21, 2022. To ensure a seamless transition for providers, the Texas Medicaid & Healthcare Partnership has started processing prior authorization requests in accordance with updated rules.
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.