Texas Health and Human Services Commission

What you get

Up to 12 hours a day of skilled nursing at a care center, medical and emotional care, development and therapy activities, plus transport when medically needed and safe.

How to start

Your social worker sends the referral. Have your doctor's letter ready.

Good to know

• Need is reassessed 90 days after initial authorization and every 180 days afterward, or sooner when the condition or service need changes.
• Your child needs skilled nursing care; a cancer diagnosis alone is not enough.

What help you may get

Check the main eligibility rules

• A provider must verify the patient or diagnosis.
• A PPECC registered nurse must complete the nursing assessment and plan of care.
• The ordering physician must personally examine the child within 30 calendar days before admission and sign and date the PPECC prescription and authorization documents.
• The PPECC or managed-care provider must obtain prior authorization before covered services begin.
• The child must be eligible for Texas Health Steps Comprehensive Care Program services through Texas Medicaid.

• PPECC does not publish a separate income test; the child must first have an eligible Texas Medicaid coverage type.
• No separate PPECC premium is published; any premium or cost-sharing obligation comes from the child's underlying Medicaid eligibility category.
• PPECC services and transportation are billed to Medicaid by enrolled providers and are not paid to the family as cash.

Where you live and where your child is treated

How to get started

Set up the ask for my care team

Does a social worker or care team need to start it? Yes. Ask your child’s social worker or care team to begin the request.

Who can start: Caregiver, Healthcare Team, Parent Or Guardian

1. Ask the managed-care service coordinator or treating team about a Nursing Care Assessment Module review and available contracted PPECC providers.
2. Confirm that the child is enrolled in an applicable Texas Medicaid and Texas Health Steps Comprehensive Care Program category.
3. Have the ordering physician complete the required examination, order, and signatures while the PPECC registered nurse prepares the nursing assessment and plan of care.
4. Select PPECC services voluntarily in place of some or all otherwise applicable private duty nursing hours and choose a licensed contracted center.
5. Sign the choice, information-sharing, and private-duty-nursing acknowledgment.
6. The PPECC or managed-care provider submits the complete prior-authorization packet through the applicable official route.

Documents to prepare

• CCP Prior Authorization Request signed and dated by the ordering physician
• Clinical documentation supporting medical necessity, skilled-intervention needs, requested schedule, and transportation need
• Nursing Addendum to Plan of Care signed and dated by the physician, assessing nurse, and child or responsible adult
• PPECC Plan of Care signed and dated by the ordering physician and PPECC registered nurse
• Signed consent choosing PPECC and consenting to necessary health-information sharing

• After approval, Medicaid pays the enrolled PPECC for authorized services and any qualifying center transportation.
• The PPECC or managed-care provider submits prior authorization to the claims administrator or managed-care organization.

Availability and timing

• The benefit and current May 2026 provider rules were active; access depends on prior authorization and a licensed contracted PPECC with capacity in the member's service area.
• Requests are driven by current medical need and require prior authorization before service.
• Current physician, nurse, and responsible-adult signatures generally must be dated within the 30-day period before the requested start of care.

Limitations and things to confirm

• A physician order, current examination, nursing assessment, plan of care, signed consent, and prior authorization are required.
• Access depends on a licensed center contracted with the child's plan and available in the service area.
• B-ALL, cancer, or receipt of chemotherapy alone does not establish the required skilled-nursing medical necessity.
• Choosing PPECC may reduce authorized private duty nursing hours, although both services may be used at different times.
• PPECC is not ordinary day care, respite, emergency care, or a cash benefit.
• The authorization requires detailed health information and consent to share it with other providers for care coordination.
• The child must already have applicable Texas Medicaid coverage and meet detailed medical, stability, living-arrangement, and age rules.

• Does the child have the specific Medicaid coverage and skilled-nursing medical necessity required for PPECC?
• How many hours will the plan authorize and how will PPECC affect existing private duty nursing?
• Which contracted PPECCs in the child's service area have capacity?
• Will the child safely use center transportation or need another transportation arrangement?

Official sources

Program details were last verified Aug 24, 2026. Availability can change, so check the official program before applying.

• TMHP Forms · checked Aug 24, 2026
• Texas Medicaid Provider Procedures Manual - Children's Services Handbook, May 2026 · checked Aug 24, 2026
• 4400, Prescribed Pediatric Extended Care Centers · checked Aug 27, 2026