Texas Administrative Code

Texas Administrative Code

TITLE 1	ADMINISTRATION
PART 15	TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 363	TEXAS HEALTH STEPS COMPREHENSIVE CARE PROGRAM
SUBCHAPTER C	PRIVATE DUTY NURSING SERVICES
RULE §363.307	Medical Necessity

(a) PDN services are available to EPSDT-eligible recipients when the services are medically necessary to correct or ameliorate the recipient's disability or physical or mental illness or condition. The services correct or ameliorate when they improve, maintain, or slow the deterioration of the recipient's health status.

(b) Medical necessity must be documented in the recipient's prior authorization request.

Source Note: The provisions of this §363.307 adopted to be effective October 15, 2015, 40 TexReg 7056