New Rules in Texas that Must Be Followed

As a result of SB 1804, effective for Dates of Service 9/1/2011 and after, all WHEELED MOBILITY SYSTEMS provided to Medicaid beneficiaries will require the involvement of a Qualified Rehab Professional (QRP) at the clinical evaluation and delivery/ final fitting.  Wheeled Mobility Systems include Pediatric Manual Wheelchairs (and stroller type wheelchairs), Custom Manual Wheelchairs (ultralight and tilt in space), Scooters, Power Wheelchairs and any major modification to these mobility systems.

In order to enroll as a QRP, an individual must meet the following criteria:

        Holds certification as an ATP, RET or SMS

        Holds certification as a CRTS

An individual CANNOT enroll with Texas Medicaid as a QRP unless they are doing under a Wheeled Mobility Systems Provider (WMSP)

A DME Company CANNOT enroll with Texas Medicaid as Wheeled Mobility Systems Provider unless they provide proof of employing an individual who qualifies as a QRP*

        Upon enrollment in the program (approval of application to TMHP) the DME will receive a Wheeled Mobility Systems Provider TPI number and the QRP will receive a TPI number

        Each individual that wishes to enroll as a QRP with Texas Medicaid needs to apply for an NPI number on the NPPES website at https://nppes.cms.hhs.gov/NPPES/Welcome.do with Taxonomy code 247200000X (Technician, other)

The NPI will be needed for the QRP enrollment process

        Adhere to shortened Prior Auth span dates (resulting from QRP implementation) as noted on the release from TMHP on 4/22/2011 http://www.tmhp.com/News

*A DME company can contract a QRP for this process.  However, they will still have to go through the enrollment process with TMHP to obtain a TPI number for their company as a WMSP and also the QRP as a performing provider under their group.

The enrollment process currently takes approximately 45 days.

A PT or OT who also meets the above criteria can enroll as a QRP (if employed by a DME company).  However, they can only perform ONE role during the clinical evaluation – either therapist or QRP.

A QRP is required to be present at the clinical evaluation and direct the final fitting.  It must be the SAME QRP for both.

All PA forms (T19, CCP form, Wheelchair Assessment) have been updated to capture the QRP information, as has the DME certification form required at delivery.

The T19 and CCP form will also require documentation of the Wheeled Mobility Provider’s information.

Attached are pertinent forms released by TMHP/ HHSC regarding this process.   

Additionally, there will be a session at the TXRPC Annual Conference (next Friday) where HHSC personnel will be doing a presentation about and answering questions regarding the QRP implementation process and guidelines.  The Conference Brochure and registration forms for the TXRPC Annual conference are also attached.

DME and QRP Provider Enrollment Forms Now Available

July 2011 Benefit Changes for CCP and Home Health Mobility Aids Services

September 2011 Benefit Changes for Texas Medicaid Mobility Aids Services

2011 TXRPC Annual Meeting Brochure

2011 TXRPC Annual Meeting Registration