Monthly Archives - December 2023

Provider Alert!
22Dec

Provider Alert! Diabetic Equipment and Supplies-Home Health Policy & Monitoring Update

Date: December 22, 2023 Attention: All Providers Effective date: February 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to make providers aware that the Diabetic Equipment and Supplies-Home Health Policy has been updated effective February 1, 2024, to address the following changes: Changes in continuous glucose monitoring (CGM) client eligibility Prior authorization Follow up visits after initiating CGM utilization Removing the requirement to provide the make and model of the CGM on the Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form How...

By OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , 0 CommentsRead more...
Provider Alert!
21Dec

Provider Alert! Health and Human Services (HHSC) Launched Direct Care Careers Online Portal

Date: December 21, 2023 Attention: Personal Care Attendant, Community Attendant, Direct Care Staff Call to action: Texas Children’s Health Plan (TCHP would like to share an announcement from HHSC: HHSC is happy to announce the launch of Direct Care Careers, an optional, online portal that will connect potential employees with employers delivering home and community-based services through the state plan and HCBS authorities (1915(c), 1915(i), 1915(j), and 1115). Direct Care Careers Description: Direct Care Careers is an optional, online platform to connect employers with...

By Office Managers, Provider Alert, , , , 0 CommentsRead more...
Provider Alert!
20Dec

Provider Alert! CANS and ANSA Certification Requirement

Date: December 19, 2023 Attention: Mental Health Targeted Case Management and Mental Health Rehabilitation Providers Call to action: Texas Children’s Health Plan (TCHP) asks all Mental Health Targeted Case Management and Mental Health Rehabilitation (MHTCM/MHR) providers to please send us their certification of either Child and Adolescent Needs and Strengths (CANS) or Adult Needs and Strengths Assessment (ANSA) training. A copy of your CANS and/or ANSA certification can been emailed to tchpnetworkmanagement@texaschildrens.org. How this impacts providers: TCHP requires MHTCM/MHR providers serving both children...

By Office Managers, Provider Alert, Specialists, , , , 0 CommentsRead more...
Provider Alert!
18Dec

Provider Alert! Medicaid Preferred Drug List and Formulary Changes

Date: December 18, 2023 Attention: Providers Effective Date: January 25, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to notify providers that effective January 26, 2024, select medication(s) moved from “preferred” or “non-reviewed” to “non-preferred” status. A summary of the changes is included below. Resource: https://www.txvendordrug.com/formulary/preferred-drugs Changes with biggest impact to Texas Children Health Plan members and providers: The drugs listed below were either not previously reviewed (NR) and became non-preferred (NPD) or previously considered a preferred agent (PDL) but now have...

By OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , , 0 CommentsRead more...
Provider Alert!
18Dec

Provider Alert! EVV Reminder: Program Providers and FMSAs Must Download Visit Data by December 22

Date: December 18, 2023 Attention: Program Providers and FMSA Providers Call to action: Texas Children’s Health Plan (TCHP) would like to remind program providers and financial management services agencies (FMSAs) transitioning to HHAeXchange and who have visits in Vesta or AuthentiCare, that have not been successfully submitted to the EVV Aggregator, should download a copy of their visit data by December 22. The downloaded visit data can be used to support future Visit Maintenance Unlock Requests (VMURs). Data Availability Access to the state provided EVV vendor...

By Office Managers, Primary Care Providers, Provider Alert, Specialists, , , 0 CommentsRead more...
Provider Alert!
08Dec

Provider Alert! Change in Preferred Drug List Status for Glucocorticoids, Inhaled Drug Class

Date: December 8, 2023 Attention: Providers Effective date: December 15, 2023 Call to action: Effective December 15, 2023, the Texas Health and Human Services (HHS) removed non-preferred status from generic fluticasone hydrofluoroalkane (HFA) and brand Qvar products on the preferred drug list. This is in response to the discontinuation of the product by the manufacturer. The preferred status of the brand name Flovent HFA and Flovent Diskus will not change to allow for any remaining stock to be used. How this impacts providers: The change...

By OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, 0 CommentsRead more...
Provider Alert!
08Dec

Provider Alert! Important Dates: Complete EVV Visit Maintenance and Submit VMURs Before Losing Access

Date: December 8, 2023 Attention: STAR Kids Providers/Consumer Directed Services employers and FMSA Providers Call to action: Texas Children’s Health Plan (TCHP) would like to remind program providers, financial management services agencies (FMSAs) and Consumer Directed Services (CDS) employers who are transitioning to HHAeXchange, are responsible for completing all required visit maintenance, including Visit Maintenance Unlock Requests (VMURs), in their current EVV vendor system, DataLogic/Vesta or First Data/AuthentiCare by Dec. 22, 2023. Any visits for dates of service on or after the program providers,...

By Office Managers, Primary Care Providers, Provider Alert, Specialists, , 0 CommentsRead more...
Provider Alert!
07Dec

Provider Alert! Follow-Up Care for Children Prescribed ADHD Medication (ADD, ADD-E)

Date: December 7, 2023 Attention: All Providers Call to Action: Texas Children Health Plan (TCHP) would like to remind providers to continue to take measures to ensure that your patients with an Attention Deficit Hyperactivity Disorder (ADHD) diagnosis are receiving excellent care. ADHD is one of the most common behavioral health disorders in children (National Committee for Quality Assurance, 2023; Visser et al., 2014). To ensure that medication is prescribed and managed correctly, it is important that prescribing providers carefully monitor their pediatric...

By OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , 0 CommentsRead more...
Provider Alert!
07Dec

Provider Alert! Coverage of Vyjuvek (procedure code J3401) Begins January 2024; Prior Authorization Effective February 2024

Date: December 6, 2023 Attention: All Providers Prior Authorization Effective Date: February 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that on January 1, 2024, Vyjuvek will become a benefit of Medicaid and CHIP. Texas Health and Human Services Commission (HHSC) will require prior authorization for Vyjuvek (procedure code J3401) for Medicaid and CHIP, effective February 1, 2024. Vyjuvek is the first U.S. Food and Drug Administration (FDA) approved topical gene therapy that delivers new COL7A1 genes...

By OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , , , 0 CommentsRead more...
Provider Alert!
07Dec

Provider Alert! Coverage of Roctavian (procedure code J1412) Begins January 2024; Prior Authorization Effective February 2024

Date: December 6, 2023 Attention: All Providers Prior Authorization Effective Date: February 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that on January 1, 2024, Roctavian will become a benefit of Medicaid and CHIP. Texas Health and Human Services Commission (HHSC) will require prior authorization for Roctavian (procedure code J1412) for Medicaid and CHIP, effective February 1, 2024. Roctavian (valoctocogene roxaparvovec-rvox) is an adeno-associated virus vector-based gene therapy indicated to treat adult clients with severe hemophilia A...

By OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , 0 CommentsRead more...