RSV infections in Texas typically occur during the fall and winter months. HHSC observed very little activity during the traditional 2020-21 season, likely due to the adoption of public health measures to reduce the spread of COVID-19 (e.g., physical distancing, masking, etc.). This period of unusually low activity has been followed during the late spring and summer months by an unusual resurgence of RSV activity. In response, on June 21, 2021, HHSC began opening DSHS regions for RSV prophylaxis with Palivizumab (Synagis) for clients currently meeting clinical criteria. Refer to the RSV Season schedule for more information.
On July 23, 2021, HHSC will open all DSHS regions, and providers may start monthly Palivizumab (Synagis) injections for RSV prophylaxis for clients who meet clinical criteria. This reopening is considered the start of a new RSV season, separate from the regular 2020-21 RSV season. At this time, clients who meet the prior authorization criteria qualify for up to 5 monthly shots of Palivizumab (Synagis).
HHSC cannot account for every exception or all potential clinical considerations applicable to an individual client’s case. Providers must work with the individual MCO for approval for clients with RSV infection risks not identified on the Medicaid RSV prior authorization form. The reconsideration process may require additional supporting documents, such as pertinent diagnostic, lab tests, or medical records.
The recent summertime resurgence in RSV activity is unprecedented and continues to evolve. At this time, it is not possible to anticipate how this inter-seasonal activity will impact the traditional 2021-22 RSV season. HHSC remains in active communication with DSHS, the Texas Pediatric Society, and the RSV Task Force. We will announce further guidance as new developments arise.