Provider Alert! Update to Gait Trainers and Standers Guidelines

Attention: All Providers
Effective Date: July 22, 2020

Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.

Call to action: This is a reminder that Texas Children’s Health Plan (TCHP) requires authorization of all gait trainers and standers, including all accessories. There is one addition to the guideline, which aligns with Texas Medicaid Provider Procedure Manual (TMPPM), standers and gait trainers will not be prior authorized for a member within one year of each other.

How this impacts providers: TCHP wanted to bring attended to one major change in the guideline, this was removed: member demonstrates the ability to stand or ambulate with the device.

To request prior authorization for Standers, the following documentation must be provided:

• Diagnoses relevant to the requested equipment, including functioning level and ambulatory status
• Anticipated benefits of the equipment
• Frequency and duration of the client’s standing program
• Anticipated length of time the client will require this equipment
• Client’s height, weight, and age
• Anticipated changes in the client’s needs, anticipated modifications, or accessory needs, as well as the growth potential of the stander

To request prior authorization for Gait Trainers, the following documentation must be provided:

• All required documentation for a stander AND
• documentation that the member has ambulatory potential and benefits from a gait training program AND
• an assessment of the accessibility of the client’s residence to ensure that the gait trainer is usable in the home

Next steps for providers: Providers should inform their staff of these updates.
Resources:
Prior authorization form
Gait Trainers and Standers Guidelines

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.

For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers