Lost or Irreparably Damaged DMEPOS During Central Texas Flooding (July 2025)

Date: July 17, 2025

Attention: Providers serving Texas Medicaid clients who permanently live in a declared disaster county

Effective date: July 2, 2025 until 90 days after the disaster declaration has ended

Background information:

Providers may have difficulty meeting the current requirements for replacement of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) that may have been destroyed or lost as a result of flooding in Central Texas in July 2025. Current Medicaid policy allows for the replacement of DMEPOS only with specific documentation to support the need for replacement.

Medicaid medical policy:

Currently allows for replacement of DEPMOS. As outlined in the Texas Medicaid Provider Procedures manual (Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook, Section 2.2.2.2), DEPMOS are anticipated to last a minimum of five years, unless otherwise noted, and may be considered for replacement under certain circumstances including when loss or irreparable damage has occurred.
Texas Medicaid policies allow MCOs like Texas Children’s Health Plan to expedite processing and waive submission timeframes and documentation requirements for new prior authorization (PA) requests if the request is to replace DMEPOS lost or damaged as a result of a Federal Emergency Management Agency (FEMA) or State of Texas Governor-declared disaster. This notice is limited to providers serving Texas Medicaid clients who permanently live in a declared disaster county and is effective from July 2, 2025, until 90 days after the disaster declaration has ended.

How this impacts providers: Providers must include in the PA request that the need is a result of the Central Texas flooding with a narrative description explaining why the equipment must be replaced. Providers must keep documentation that indicates whether the DMEPOS were lost, destroyed, irreparably damaged, or otherwise rendered unusable as a result of this disaster. The DMEPOS replacement may still be subject to retrospective review for medical necessity.

Next step for Providers: Providers should this communication with their staff.

If you have any questions, please email Provider Relations at:providerrelations@texaschildrens.org.

For access to all provider alerts:www.texaschildrenshealthplan.org/provideralerts.