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Prior Authorization No Longer Required for CPW Program Services Effective July 1, 2024

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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.

Effective for dates of service on or after July 1, 2024, prior authorization will no longer be required for fee-for-service Case Management for Children and Pregnant Women (CPW) program services.

The initial intake service requirements will be updated. Providers must complete a comprehensive visit within seven business days if the CPW initial intake indicates that the client is eligible and has a need for CPW services.

All CPW services will still require documentation to support the medical necessity of the service rendered. All records are subject to retrospective review.

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