Flu Season Alert!Alerta de temporada de influenza:
Don’t let germs win this season – protect yourself and your family!
The flu vaccine is your best defense against flu and related complications – PLUS, it is a covered benefit for Texas Children’s Health Plan members! Learn more!
¡No permitas que los gérmenes ganen esta temporada! ¡Protégete a ti y a tu familia!
La vacuna contra la influenza es tu mejor defensa contra la influenza y sus complicaciones. Además, ¡es un beneficio cubierto para los miembros de Texas Children's Health Plan! Aprende más
CHIP $20,000 CAP for Durable Medical Equipment (DME), Prosthetic Devices and Disposable Medical Supplies Now Active
Date: August 22, 2023
Attention: CHIP Providers
Effective date: May 23, 2023
Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that in accordance with the Uniform Managed Care Manual, for CHIP Members, there is a $20,000 12-month period limit for DME, prosthetics, devices and disposable medical supplies limitation (diabetic supplies and equipment are not counted against this cap). Covered services require prior authorization and physician prescription when in excess of benefit limitations for members 20 years of age and under. A co-payment is not required.
How this impacts providers: Covered services include DME (equipment that can withstand repeated use and is primarily and customarily used to serve a medical purpose, generally is not useful to a person in the absence of Illness, Injury, or Disability, and is appropriate for use in the home), including devices and supplies that are medically necessary and necessary for one or more activities of daily living and appropriate to assist in the treatment of a medical condition, including but not limited to:
Orthotic braces and orthotics
Dental Devices
Prosthetic devices such as artificial eyes, limbs, braces, and external breast prostheses
Prosthetic eyeglasses and contact lenses for the management of severe ophthalmologic disease
Other artificial aids including surgical implants
Hearing aids
Implantable devices are covered under Inpatient and Outpatient services and do not count towards the DME 12-month period limit.
Diagnosis-specific disposable medical supplies, including diagnosis-specific prescribed specialty formula and dietary supplements.
Next step for Providers: Providers should adhere to this guidance and submit prior authorization requests when applicable.
