Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 354 - MEDICAID HEALTH SERVICES
Subchapter A - PURCHASED HEALTH SERVICES
Division 30 - IN-HOME TOTAL PARENTERAL HYPERALIMENTATION SERVICES
Section 354.1391 - In-Home Total Parenteral Hyperalimentation Services

(a) Subject to the specifications, conditions, limitations, and requirements established by HHSC or its designee, in-home total parenteral hyperalimentation services shall be available to eligible recipients who require long-term nutritional support because of extensive bowel resection and/or severe advanced bowel disease in which the bowel cannot absorb nutrition. Covered services must be reasonable, medically necessary, and prescribed by the recipient's physician (M.D. or D.O.). The physician must be licensed in the state in which the physician practices.

(b) HHSC or its designee must prior authorize the services. Prior authorization requests must include all pertinent medical records and other documentation as required by HHSC or its designee to justify the medical necessity of the long-term total parenteral hyperalimentation. Prior authorization is a mandatory requirement for payment.

(c) Covered services include, but are not necessarily limited to:

(d) Providers of in-home total parenteral hyperalimentation must:

(e) HHSC or its designee shall not reimburse more than a one-week supply of solutions and additives if the solutions and additives are shipped and not used because of the recipient's loss of eligibility, change in treatment, or inpatient hospitalization. The provider must exclude from its monthly billing any days that the recipient is an inpatient in a hospital or other medical facility or institution. Payment for partial months will be prorated based upon actual days of administration. Hospital outpatient departments furnishing in-home total parenteral nutrition must be separately enrolled as a provider meeting all requirements stipulated in subsection (d) of this section.