Certain supplies are covered benefits of Texas Medicaid and can be provided by a pharmacy enrolled in VDP. This limited set of home health supplies are classified as a Title XIX (Medicaid) home health benefit and as durable medical equipment or medical supplies. These products are available to people enrolled in Medicaid, the Children’s Health Insurance Program (CHIP), the Children with Special Health Care Needs (CSHCN) Services program, and the Kidney Health Care (KHC) program.
Pharmacies are not required to enroll as a durable medical equipment (DME) provider to provide access to supplies. Pharmacies already enrolled as a Medicaid DME provider have the choice to submit claims for home health supply products to the Texas Medicaid Healthcare Partnership as a medical benefit or as a pharmacy benefit. Refer to the Home Health Supplies chapter of the Pharmacy Provider Procedure Manual to learn more.
- Claims for Traditional Medicaid, CSHCN Services Program, and KHC program are submitted to VDP. Pharmacy staff should refer to the Pharmacy Benefit Chart in the procedure manual for covered products (including those only available to people enrolled in the KHC program), quantity guidelines, refill limitations, and reimbursement rates.
- Claims for Medicaid managed care and CHIP are submitted to the managed care organization (MCO). Pharmacy staff must work with the MCO's pharmacy benefit manager to determine the billing requirements, reimbursement rates, and coverage limitations for these products.