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TMPPM Language Update for SHARS Reevaluation

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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.

On January 1, 2023, the Texas Medicaid & Healthcare Partnership (TMHP) will update the Texas Medicaid Provider Procedures Manual (TMPPM), School Health and Related Services (SHARS) Handbook, to clarify reevaluation referral and prescription language for some services.

A separate referral or prescription will replace a physician’s referral or prescription for reevaluation for the following services:

  • Audiology
  • Speech therapy
  • Occupational therapy
  • Physical therapy

As a reminder, a separate referral or prescription is not required for a reevaluation provided a referral or prescription is currently valid for these services.

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