UPDATED 9/3/2025: This news post has been edited to reflect updated guidance from HHSC. The information below applies to all Texas Medicaid clients impacted by the 2025 Texas flooding regardless of whether the clients are permanent residents of a declared disaster county. This guidance is effective from July 2, 2025, through Sept. 29, 2025.
In response to the widespread impacts of the 2025 Texas flooding, Texas Health and Human Services (HHSC) is temporarily extending certain existing prior authorizations (PAs) to help reduce barriers to care for affected Members. This extension aims to support continuity of essential medical services without requiring recertification for eligible providers and members. The extension applies only to active PAs that meet specific criteria during the defined disaster period and must be requested by either the provider or the member.
Key Details:
This extension applies to existing prior authorizations that require recertification and are set to expire between July 2, 2025, and September 29, 2025. It is available only upon request by a Provider or member who has been impacted by the 2025 Texas flooding.
To qualify, the PA must be related to ongoing services that are part of the Texas Medicaid State Plan. Eligible services include:
- Personal Assistance Services (PAS)
- Personal Care Services (PCS)
- Community First Choice (CFC)
- Private Duty Nursing
- Physical, Occupational, and Speech Therapy
- Day Activity and Health Services (DAHS)
The extension will match the original authorization in both service frequency and quantity.
Please note: This extension is not automatic. Providers must submit a request and indicate that it is flood-related for the extension to be considered.
This updated guidance now applies to all Texas Medicaid Members affected by the 2025 flooding, even if they don’t live in a disaster-declared county.
If services are subject to Electronic Visit Verification (EVV), providers must ensure the updated authorization details are entered into the EVV system.
What’s Not Included:
This extension does not apply to:
- One-time services (e.g., a single non-emergency ambulance trip)
- Pharmacy PAs
- Nursing facility services
- New PA requests
Provider Requirements:
To request an extension, Providers must clearly indicate that the need is a result of the 2025 Texas flooding. Supporting documentation must be obtained and maintained to justify the continued medical necessity of the services.
Although the extension temporarily removes the need for immediate recertification, services delivered under the extended authorization may still be subject to retrospective review. It is the provider’s responsibility to ensure that all documentation is complete and available prior to submitting claims for reimbursement.
Resources:
- TMHP homepage: https://www.tmhp.com/
- Contact: managed_care_initiatives@hhs.texas.gov
Providers are encouraged to share this information with their staff. If you have any questions about this notice, please email Provider Relations at ProviderRelations@cfhp.com or call 210-358-6030. You can also contact your Provider Relations Representative directly.
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