(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:
  (1) parenteral hyperalimentation solutions and additives as ordered by the recipient's physician;
  (2) supplies and equipment including refrigeration, if necessary, that are required for the administration of prescribed solutions and additives;
  (3) education of the recipient and/or appropriate caregivers regarding the in-home administration of total parenteral hyperalimentation before administration initially begins. Education must include the use and maintenance of required supplies and equipment;
  (4) visits by a registered nurse (RN) appropriately trained in the administration of hyperalimentation. The RN must visit the recipient at least once per month to monitor the recipient's status and to provide ongoing education to the recipient and/or caregivers regarding the administration of hyperalimentation; and
  (5) enteral supplies, nutritional products and equipment used in conjunction with total parenteral hyperalimentation.
(d) Providers of in-home total parenteral hyperalimentation must:
  (1) comply with all applicable federal, state, and local laws and regulations;
  (2) be enrolled in and participating in Medicare as a supplier of in-home total parenteral hyperalimentation;
  (3) be enrolled and approved for participation in the Texas Medical Assistance Program;
  (4) sign a written provider agreement with HHSC or its designee. By signing the agreement, the provider agrees to comply with the terms of the agreement and all requirements of the Texas Medical Assistance Program including regulations, rules, handbooks, standards, and guidelines published by HHSC or its designee; and
  (5) bill for covered services in the manner and format prescribed by HHSC or its designee.
(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.

Source Note: The provisions of this §354.1391 adopted to be effective February 17, 2004, 29 TexReg 1343