Guidance on Medicaid Coverage of Generators

Date: March 29, 2022 Attention: All Providers Effective date: June 27, 2022Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. TCHP will apply updates and reprocess impacted claims as soon as possible. However, please allow up to sixty (60) business days for reprocessing. Providers are not required to appeal claims unless denied for other reasons. Providers should direct questions to their Provider Relations Liaison or send an email inquiry to the Provider Relations Department at providerrelations@texaschildrens.org. Call to action: Texas Children’s Health Plan (TCHP) would like to provide clarification on Texas Medicaid coverage of generators. Generators help medically fragile members plan for emergencies that may impact life-sustaining medical equipment. Effective June 27, 2022, a prior authorization is required to obtain a generator for TCHP Members. Click here for the Texas Standard Authorization Form. TCHP follows guidance on the medical criteria per Texas Medicaid Provider Procedure Manual (TMPPM). How this impacts providers: Generators requested through the Medically Dependent Children Program (MDCP) must be purchased from a Medicaid-enrolled provider. The exception is if the generator is requested through the consumer-directed services option under a waiver, the member can receive it from a non-Medicaid enrolled generator supplier. Generators requested for STAR/CHIP members will be reviewed for authorization on a case-by-case basis considering:

demonstrated medical necessity
cost-effectiveness
the wishes of the member or the member’s legally authorized representative (LAR)
the potential for improved health status of the member

Next steps for providers: Providers should share this guidance with their staff. If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.For access to all provider alerts,log into: www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.