Date: September 3, 2025
Attention: Providers
Effective date: July 2, 2025, through September 29, 2025
Background: The purpose of this notice is to align the guidance from Health and Human Services Commission ( HHSC) issued in two notices on August 11, 2025, related to the 2025 Texas Flooding: “Prior Authorizations Extended Due to 2025 Texas Flooding” and “2025 Texas Flooding: Appeal and Continuation of Benefit Request Extensions”.
Previously published provider communication from Texas Children’s Health Plan (TCHP) is available at https://www.texaschildrenshealthplan.org/news/provider-alert/lost-or-irreparably-damaged-dmepos-during-central-texas-flooding-july-2025.
- In this communication MCOs like TCHP were directed to expedite replacement of DMEPOS and accept PA requests that include the need is due to the Central Texas flooding in July 2025, whether the DMEPOS were lost, destroyed, or damaged, and a narrative description of why the DMEPOS must be replaced as justification for the request.
- Additionally, the notice was limited to providers serving Texas Medicaid clients who permanently live in a declared disaster county and was effective from July 2, 2025, until 90 days after the disaster declaration ended.
How this impacts providers: HHSC issues the following updates:
- This guidance now applies to all Texas Medicaid clients impacted by the 2025 Texas flooding regardless of whether the clients are permanent residents of a declared disaster county.
- This guidance is effective from July 2, 2025, through September 29, 2025.
Resource: Texas Medicaid Provider Procedures Manual, Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook, Section 2.2.2.2 Prior Authorization.
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.
