Provider Alert! Irreparably Damaged DME Prosthetics, Orthotics, & Supplies during Hurricane Laura

Attention: DME Providers

Date: September 9, 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: Texas Children’s Health Plan (TCHP) aligns with the guidance from Health & Human Services Commission (HHSC) regarding replacement of durable medical equipment (DME) supplies
that may have been destroyed or lost in the course of emergency evacuations related to Hurricane Laura. Current Medicaid policy allows for the replacement of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) only with specific documentation to support the need for replacement.

How this impacts providers: Texas Medicaid policies allow TCHP to expedite processing and waive submission timeframes and documentation requirements for new prior authorization requests if the request is to replace DMEPOS that were lost or damaged as a result of Hurricane Laura. This is limited to providers serving Texas Medicaid and CHIP eligible clients with a permanent residence in a declared disaster county and only for the duration of the disaster declaration. For counties included in the disaster declaration: Governor Abbott Adds 3 Counties to State Disaster Declaration in the Wake of Hurricane Laura

Next steps for providers: Providers must include in the prior authorization request that the need is a result of Hurricane Laura with a narrative description explaining why the equipment must be replaced. Providers must keep documentation that indicates whether the DMEPOS were lost, destroyed, irreparably damaged, or otherwise rendered unusable as a result of the hurricane. The DMEPOS replacement may still be subject to retrospective review for medical necessity.

Resource:
TMPPM Durable Medical Equipment (DME), Medical Supplies, and Nutritional Products Handbook, Section 2.2.2.2 Prior Authorization

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.