The purpose of this letter is to remind Medicaid-certified nursing facilities (NFs) of the need to have prior authorization for Preadmission Screening and Resident Review (PASRR) specialized services, power wheelchairs, and rehabilitative services. Effective March 1, 2015, Medicaid- certified NF services are provided through STAR+PLUS managed care organizations (MCOs). MCOs will pay for most NF services for residents enrolled with a STAR+PLUS MCO.
Prior Authorization of Specialized Services for PASRR Positive Medicaid Residents
A NF must provide authorized specialized services for PASRR positive Medicaid residents with an intellectual or developmental disability as required by 40 TAC §17.201 and §17.302. A PASRR positive resident is an individual who is confirmed of having an intellectual or developmental disability during the PASRR Evaluation or a Resident Review completed by the local intellectual and developmental disability authority. The NF can bill for the specialized services above the resident’s daily rate through Texas Medicaid and Healthcare Partnership (TMHP).
The following Texas Department of Aging and Disability Services (DADS) forms are used to obtain prior authorization for durable medical equipment (DME), customized manual wheelchairs, or specialized habilitative therapies (occupational, physical, or speech therapy):
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Form 1017, Specialized Services Durable Medical Equipment (DME) Authorization Request
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Form 1018, Specialized Services Customized Manual Wheelchair (CMWC) Authorization Request
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Form 2465, Specialized Services Request (S-Form)
The NF must complete and submit Form 1017, Form 1018, and/or Form 2465 to DADS on behalf of residents in fee for service (FFS) Medicaid or in STAR+PLUS managed care. For information about PASRR and assistance with PASRR specialized services requests, NFs should contact DADS at PASRR@dads.state.tx.us.
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