Information Letter No. 18-07 – Addressed to Nursing Providers. Nursing Facility (NF) providers MUST ensure that a designated resident has a valid Daily Care service authorization reflected on the Medicaid Eligibility Service Authorization Verification (MESAV) at the significant steps in the submission and approval process for NF Specialized Services. The letter addresses how to minimize billing issues. NF staff must ensure all appropriate and necessary forms and assessment submissions have occurred and been processed by the Health and Human Services Commission (HHSC) throughout the process for requesting specialized services through the Authorization Request for PASRR Nursing Facility Specialized Services (NFSS) form.
ELIGIBILITY
To be eligible for NF specialized services, an individual must be a designated resident,1 which means a Medicaid recipient with an intellectual disability or developmental disability who is 21 years of age or older and who is a nursing facility resident. The Daily Care service authorization, verifies admission into the Medicaid program and is a prerequisite for consideration of the NF specialized services request. Authorization of the service within the Texas Medicaid and Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal does not guarantee payment. For more details review the provider information letter HERE.
