The Medicaid Comprehensive Care Program (CCP) can cover medically necessary drugs and supplies not available through VDP for clients from birth through 20 years of age. Pharmacies not enrolled with CCP should direct the client to call TMHP to locate a CCP provider. CCP providers submit claims to TMHP for medically necessary drugs, equipment, or supplies not covered by VDP, including over-the-counter drugs, nutritional products, and disposable or expendable medical supplies commonly found in pharmacies.
Pharmacies must complete an application at tmhp.com. Contact the TMHP Contact Center or email TMHP Provider Relations to request assistance from the local TMHP provider relations representative in your area. Refer to the TMHP Contact Center section for contact information.
All CCP services require prior authorization. The Texas Medicaid Provider Procedures Manual (TMPPM) includes prior authorization requirements for services through CCP. Refer to section 2.1.4 of the Children's Services Handbook of the Texas Medicaid Provider Procedures Manual (tmhp.com/resources/provider-manuals/tmppm). Pharmacies submit prior authorizations using CCP Prior Authorization Request Form (TMHP Form F00012). Refer to the Enrollment Forms for this and other enrollment forms.