Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.
The Texas Health and Human Services Commission (HHSC) implemented rule changes in September 2022 related to nonphysician signatures on prior authorization requests for home health services.
Medicaid-enrolled physicians and allowed practitioners can now sign prior authorizations and order Medicaid home health services, including skilled nursing, home health aide services, durable medical equipment and supplies, and adult physical and occupational therapy services.
Effective July 1, 2023, existing prior authorization forms will be updated to align with the changes and will include “allowed practitioners.”
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).
The changes 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). Information about this change was published on October 19, 2022, (see link below).
TMHP will continue to accept older home health prior authorization forms for 30 days after July 1, 2023. After this transition period ends, only the updated forms will be accepted. Forms are available on tmhp.com under “Forms” and on TMHP’s Prior Authorization on the Portal.
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.