26 Tex. Admin. Code § 554.2754 - Requesting Authorization to Provide Durable Medical Equipment and Customized Manual Wheelchairs

(a) To request authorization to provide DME or a CMWC to a designated resident, a nursing facility must ensure that a physical therapist or occupational therapist licensed in Texas assesses the designated resident for the DME or CMWC. If, based on the assessment, the physical or occupational therapist recommends DME or a CMWC, the nursing facility must request authorization to provide the DME or CMWC through the LTC Online Portal. The assessment required by this subsection must be completed within 30 days before the nursing facility requests authorization through the LTC Online Portal.

(b) The request for authorization to provide DME or a CMWC made through the LTC Online Portal must include:

(1) the assessment of the designated resident described in subsection (a) of this section;

(2) a statement signed by the designated resident's attending physician that the DME or CMWC is medically necessary; and

(3) detailed specifications of the DME or CMWC from a DME supplier.

(c) The documentation of the physical or occupational therapy assessment required by subsection (a) of this section must include:

(1) a diagnosis of the designated resident relevant to the need for DME or a CMWC;

(2) the specific DME or CMWC, including any adaptations recommended for the designated resident; and

(3) a description of how the DME or CMWC will meet the specific needs of the designated resident.

(d) After a nursing facility submits a request for authorization to provide DME or a CMWC to a designated resident:

(1) the nursing facility receives a written approval or denial of its request through the LTC Online Portal; and

(2) HHSC notifies the designated resident or the designated resident's LAR that the request has been approved or denied.

(e) If HHSC approves a request to provide DME or a CMWC to a designated resident, the nursing facility must order the DME or CMWC from a DME supplier within 5 business days after receiving notification of the approval through the LTC Online Portal.

(f) If HHSC denies a request to provide DME or a CMWC to a designated resident, the designated resident may request a fair hearing in accordance with 1 TAC Chapter 357, Subchapter A (relating to Uniform Fair Hearing Rules), to appeal the denial.

Notes

26 Tex. Admin. Code § 554.2754

Adopted by Texas Register, Volume 42, Number 35, September 1, 2017, TexReg 4479, eff. 9/10/2017; Entire chapter transferred from Title 40, Pt. 1, Ch. 19 by Texas Register, Volume 45, Number 50, December 11, 2020, TexReg 8871, eff. 1/15/2021