Provider Alert! MDCP Minor Home Modification Services Available through the CDS optionTexas Children's Health Plan
Date: June 23, 2021
Attention: FMSA Providers
Effective Date: December 1, 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: Effective December 1, 2020, Medically Dependent Children Program (MDCP), minor home modifications services are available through the Consumer Directed Services (CDS) option.
How this impacts providers: Minor Home Modifications (MHM) needs are determined during the Screening and Assessment Instrument (SAI) initial assessment or re-assessment, or at the time of a significant change in condition. Minor Home Modifications are limited to the following:
- Purchase and installation of permanent and portable ramps not covered by other sources; widening of doorways;
- Modification of bathroom facilities; and modifications related to the approved installation or modification of ramps, doorways or bathroom facilities.
Minor home modifications must:
- Adhere to Americans with Disabilities Act (ADA) requirements;
- Meet Texas Accessibility Standards;
- Meet all applicable state and/or local building codes; and have a minimum one-year warranty.
The service coordinator (SC) will review the Member’s need for the Minor Home Modification and add the CDS option for the Minor Home Modification to the member’s Individual Service Plan (ISP). The SC will ensure the CDS employer understands the process, is willing and able to perform the required functions of selecting a minor home modification provider of their choice.
If CDS employer does not already have a FMSA, they must choose a FMSA. The selected FMSA will be reimbursed for services provided. If CDS employer is currently being provided services by FMSA, FMSA will not receive any additional fees. Minor Home Modification services under the CDS option is already included in the contracted monthly fees.
- Minor Home Modifications: Maximum available during the member is under the program $7,500 or a portion of the $300 allowed per Individual Plan of Care (IPC) year for maintenance or repair of previously approved minor home modification.
Steps to complete for Minor Home Modifications through CDS Option:
- The LAR (Legally Authorized Representative) in conjunction with the MDCP Service Coordinator will obtain the prior authorization with written specifications and complete Form 2416 for Minor Home Modification.
- The LAR is responsible for obtaining at least two bids from vendors/contractors and ensure eligibility requirements are met for Minor Home Modification approval.
- FMSA (Financial Management Services Agency) will receive an authorization letter indicating the authorized total amount approved for payment for the minor home modification, a completed copy of form 2416 acknowledging any personal costs if applicable signed by all parties, and the updated Individual Service Plan.
- The LAR will notify the vendor/contractor to begin the Minor Home Modification.
- The vendor/contractor completes the authorized minor home modification.
- If the work is satisfactory to the CDS employer and Service Coordinator, the CDS employer then signs off on the invoice, complete form 8605 and submits it to the FMSA.
- After receiving the approved invoice and form 8605 acknowledging completion/satisfaction of the MHM, the FMSA submits invoice to Texas Children’s Health Plan Claims for payment.
- Claims should be sent to the following address, if not sent electronically via the provider portal:
Texas Children’s Health Plan Claims
PO Box 300286
Houston, TX 77230-0286
Reminder-Claims filing deadline is 95 days from date of service.
Vendor Selection: Once the MHM prior authorization is authorized, the FMSA cannot be changed. Payment is based on the FMSA listed on the approved authorization letter.
Next steps for providers: STAR Kids Billing Matrix for Members under the Agency option:
|Service||HCPC Codes||Modifier||Units||Service Description||Effective|
|S5165||UC||1 unit per service||Minor Home Modifications – CDS Option||12/1/2020|
How to handle unsatisfactory work results of an adaptive aid or minor home modification:
The LAR should indicate on the 8605 form if they are not satisfied with the MHM.
Per Health and Human Services Commission (HHSC) Guidance, the CDS employer/LAR should work directly with the vendor to resolve any issues if the CDS employer is unsatisfied with the vendor’s work, with assistance from Texas Children’s Health Plan’s Service Coordinator as needed.
The CDS employer may be responsible for payment owed to the vendor if the CDS employer approves the minor home modification and submits the invoice to the FMSA for payment, and later changes their mind regarding satisfaction with the minor home modification provided after the FMSA has paid the invoice.
The CDS employer must retain the original invoice in its file for the contractor. A copy is retained by the vendor/contractor and the FMSA.
If you have any questions, please email Provider Network Management at: email@example.com.
For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.