Provider Notices from HHSC

Omnipod 5 Added to Medicaid, CHIP Drug Formularies On Feb. 2024

Coverage of Elevidys Begins Jan. 2024; Prior Authorization Effective Feb. 2024

Coverage of Vyjuvek Begins Jan. 2024; Prior Authorization Effective Feb. 2024

12-Month Postpartum Extension for Medicaid and CHIP Pregnant Members: Information and FAQs – Effective March 1, 2024

Educational Video and Infographics Now Available to Providers: Telemedicine and Telehealth Delivery

Hepatitis C Educational Webinar For Prescribers Occurs March 6, 2024

Health Benefit Plan Coverage Of Prescription Contraceptive Drugs Finalized, Implements Jan. 2024

Change in Preferred Drug List Status for Glucocorticoids, Inhaled Drug Class Takes Effect Dec. 15 **Action Required and Informational

Change in Preferred Drug List Status for the Macrolides-Ketolides Drug Class Effective Nov. 7, 2023

Reimbursement Rate Changes and Updates for Texas Medicaid Procedure Codes Effective June 1, 2023** Informational

Reimbursement Rate Updates for RSV Vaccines Procedure Codes 90678 and 90679 Effective October 1, 2023

Prior Authorization Criteria for Leqembi Begins Nov. 1, 2023** Action Required and Informational

HTW Benefit Information Will Be Updated on November 1, 2023

Lecanemab-irmb (Leqembi) a Benefit of Texas Medicaid Effective July 6, 2023

Reimbursement Rate Updates for Drug Procedure Codes J7214 and J9345 Effective October 1, 2023

New Texas Medicaid & Healthcare Partnership (TMHP) Contracts

Texas Medicaid Provider Procedures Manual (TMPPM) Language-Only Update to Clarify Solid Organ Transplants Benefit in Texas Medicaid

Collaborative Care Model (CoCM) in Texas Medicaid Billing Case Study Videos

HHSC Implements APR-DRG Grouper 40 for Inpatient FFS Provider Reimbursements

HHSC to Add Zynteglo as Medicaid and CHIP Benefit July 1, Prior
Authorization Effective Sept. 1

HHSC to Add Skysona as Medicaid and CHIP Benefit July 1, Prior
Authorization Effective Sept. 1

HHSC to Add Tzield as Medicaid and CHIP Benefit July 1, Prior Authorization Effective Aug. 1

Noninvasive Prenatal Screening Benefits to Change for Texas Medicaid July 1, 2023

Preferred Mavyret for Hepatitis C Infection Treatment and Change to Quantity Limit for Hepatitis C M**Action Required and Informational

HHSC Requires Pharmacies to Update Email Addresses in PEMS

Hydroxyprogesterone Caproate (Makena) Procedure Code J1726 No Longer a Benefit Effective June 1, 2023

Makena Products No Longer Covered as of April 7, 2023

COVID-19 Guidance: Fair Hearing Determination Extensions

COVID-19 Guidance: Fair Hearing Request Extensions

Update to COVID-19 Accommodations for the Member State Fair Hearing Process

Medicaid Autism Services Family Flyer: Applied Behavior Analysis Services

Collaborative Care Model (CoCM) in Texas Medicaid computer-based training (CBT)

CHIP Copay Non-Risk Payment Reimbursement Criteria

EVV Cures Act Home Health Care Services Implementation Confirmed for Jan. 1, 2024

CHIP Office Visit Co-Payments, Updated Reimbursement Process

HHSC External Medical Review (EMR) Provider Training

MCO Notice: Hurricane Ida Information For Medicaid Providers

MCO Notice: Implementation Deadline for Provider Recoupment Policy

MCO Notice: Update to COVID-19 Testing Billing

MCO Notice: 2021 HIV Prevention in Healthcare Webinar Learning Series 2

OFF CYCLE MCO Notice - June 2 2020 COVID-19 and Applicability of EPSDT for Some Adults

Thsteps-Telemedicine-Guidance-Providers May 8 2020

HHSC CARES Information Sheet April 2020

HHSC Notice COVID April 2020

Texas Expands Opioid Misuse Prevention and Treatment Efforts

Governor Abbott Announces Approval Of 1135 Medicaid Waiver

Requests Section 1135 Waiver To Support Health Care Workforce In Medicaid Program

SLP Provider Notification March 2020

HHSC MCO FAQs COVID-19 Version 2 March 2020

HHSC Health Alert - Coronavirus Feb 2020