|(a) To request authorization to provide DME or a CMWC
to a designated resident, a nursing facility must ensure that a physical
therapist or occupational therapist licensed in Texas assesses the
designated resident for the DME or CMWC. If, based on the assessment,
the physical or occupational therapist recommends DME or a CMWC, the
nursing facility must request authorization to provide the DME or
CMWC through the LTC Online Portal. The assessment required by this
subsection must be completed within 30 days before the nursing facility
requests authorization through the LTC Online Portal.
(b) The request for authorization to provide DME or
a CMWC made through the LTC Online Portal must include:
(1) the assessment of the designated resident described
in subsection (a) of this section;
(2) a statement signed by the designated resident's
attending physician that the DME or CMWC is medically necessary; and
(3) detailed specifications of the DME or CMWC from
a DME supplier.
(c) The documentation of the physical or occupational
therapy assessment required by subsection (a) of this section must
(1) a diagnosis of the designated resident relevant
to the need for DME or a CMWC;
(2) the specific DME or CMWC, including any adaptations
recommended for the designated resident; and
(3) a description of how the DME or CMWC will meet
the specific needs of the designated resident.
(d) After a nursing facility submits a request for
authorization to provide DME or a CMWC to a designated resident:
(1) the nursing facility receives a written approval
or denial of its request through the LTC Online Portal; and
(2) HHSC notifies the designated resident or the designated
resident's LAR that the request has been approved or denied.
(e) If HHSC approves a request to provide DME or a
CMWC to a designated resident, the nursing facility must order the
DME or CMWC from a DME supplier within 5 business days after receiving
notification of the approval through the LTC Online Portal.
(f) If HHSC denies a request to provide DME or a CMWC
to a designated resident, the designated resident may request a fair
hearing in accordance with 1 TAC Chapter 357, Subchapter A (relating
to Uniform Fair Hearing Rules), to appeal the denial.
|Source Note: The provisions of this §554.2754 adopted to be effective September 10, 2017, 42 TexReg 4468; transferred effective January 15, 2021, as published in the Texas Register December 11, 2020, 45 TexReg 8871