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
Prescribed Pediatric Extended Care Center (PPECC) Benefit Criteria Updates for Texas Medicaid
Date: December 31, 2024
Subject: Prescribed Pediatric Extended Care Center (PPECC) Benefit Criteria Updates for Texas Medicaid
Effective date: December 1, 2024
Call to action: The purpose of this communication is to inform providers that Texas Children’s Health Plan (TCHP) is in alignment with the Prescribed Pediatric Extended Care Center (PPECC) benefits have been updated to support the implementation of HB 3550, 88th Legislature, Regular Session, 2023. The benefit changes are effective December 1, 2024.
The benefit updates include changes to the following criteria:
The Plan of Care (POC) requirements
Prior Authorization Requirements
Recertification or Extension Request
Appeal of Authorization Decisions
Documentation Requirements
Coordination with Private Duty Nursing
Reimbursement
For more information on the prior authorization requirements and the benefit updates described please review the following.
How this impacts providers:TCHP is following Texas Medicaid’s guidance for prior authorization review and will adhere to the updated criteria for medical necessity for PPECC services.
Next step for Providers:Providers should share this communication with their staff and adhere to the updates.
