Children's Programs

Qualifying Criteria

Payor Sources

Private Pay Home Service

Skilled Nursing Services

Qualifying Criteria

• Under 21 years of age
• Meet medical necessity criteria with supporting documentation from the provider.
  • PDN is considered medically necessary if a person requires continuous, skillful observation and judgment to maintain or improve health status, and the individual:
    • Is dependent on technology to sustain life and/or
    • Requires ongoing and frequent skilled interventions to maintain or improve health status, and delayed skilled intervention is expected to result in any of the following conditions:
      • Deterioration of chronic condition
      • Loss of function
      • Imminent risk to health status
      • Risk of death
• Have a primary physician who:
  • Provides a prescription for PDN
  • Establishes a plan of care
  • Provides a statement that PDN services are medically necessary
  • Provides ongoing health care and medical supervision by verifying that the client has been seen by the primary physician within 30 days of the start of care date and periodically thereafter
  • Provides specific written, dated orders for the client
• Require care beyond the level of services provided under Texas Medicaid Home Health services
• Have a designated primary caregiver who will provide a portion of the client's daily care
• Have an identified alternate caregiver, or a plan to be used if the primary caregiver is unable to care for the client
• Have a place where PDN services will be delivered which supports the health and safety of the client
  • PDN Authorizations are based on the need for skilled care in the client's home. A provider assessment includes, but is not limited to:
    • Nursing assessments (Patients over 18 years of age will require OASIS information)
    • Assessment of medical necessity for PDN
    • Client safety
    • Medical necessity of care in the Place of Service
    • Training and ability of the primary caregiver
    • All criteria for the authorization of PDN services
  • These services may follow the child and may be provided in any of the following settings:
    • The home of the primary or alternate caregiver
    • The home of the nurse provider
    • The client's school
    • A day care facility
    • The Place of Service must be able to support the health and safety needs of the client. It must be adequate to accommodate the use, maintenance, and cleaning of all medical devices, equipment, and supplies required by the client. Necessary primary and backup utilities, communication, fire and safety systems must be available at all times.
• Have appropriate emergency plans in place
• Have necessary backup utilities, communication, fire and safety systems available

MDCP

• Live in Texas
• Under 21 years of age
• Participate in no other §1915(c) Medicaid waiver program
• Meet the medical necessity criteria for nursing facility care
• Have a physician-approved Individual Plan of Care (IPC)
• Qualify for Supplemental Security Income (SSI)
• Meet both SSI disability criteria and financial criteria based on their income and resources (not those of the parents)
  

CCP

• Live in Texas
• Under 21 years of age
• Must be Medicaid-eligible
• May be coordinated with MDCP
  

CSHCN

CSHCN pays for medical care for any client with a condition that CSHCN covers. In general, these conditions are:

• Bone, muscle, and joint problems
• Cardiovascular (heart conditions)
• Neurological (nerve) disorders
• Cleft (split) lip, cleft palate (roof of mouth), or other cranio-facial anomalies (misshapen head and/or face)
• Congenital anomalies (problems a baby was born with) of the gastrointestinal tract (stomach and bowels)
• Cystic fibrosis
• Cancer
• Certain blood disorders, including hemophilia and sickle cell disease
• Certain hearing disorders
• Certain eye disorders
• Congenital anomalies of the genitalia (male and female sex organs) and genitourinary tract (bladder and connected parts), but not kidney problems
• Severe burns

What to Expect

Studies have shown that recovery occurs faster in the home. Within 48 hours of being released from the hospital, a trained Health Care Unlimited licensed professional will come to your home and conduct a thorough assessment comprised of over 100 questions. It will assist us to better take care of you or your loved ones.

Family Involvement

The family is an important part of your recovery, and Health Care Unlimited teaches them procedures and techniques to help you.