| (a) Introduction. This section describes the Texas
Medicaid reimbursement methodology that the Texas Health and Human
Services Commission (HHSC) uses to calculate payments for covered
therapy services provided by home health agencies, comprehensive outpatient
rehabilitation facilities or outpatient rehabilitation facilities,
independent therapists (including Early Childhood Intervention) and
physicians and other practitioners.
(b) HHSC reviews the fees for individual services at
least every two years based upon:
(1) analysis of Medicare fees for the same or similar
item or service;
(2) analysis of Medicaid fees for the same or similar
item or service in other states; and
(3) analysis of fees paid under commercial insurance
for the same or similar item or service.
(c) HHSC may use data sources or methodologies other
than those listed in subsection (b) of this section to establish Medicaid
fees for physical, occupational, and speech therapy services when
HHSC determines that those methodologies are unreasonable or insufficient.
(d) Medicaid reimbursement methodologies for other
applicable provider types are as follows:
(1) freestanding psychiatric facilities, under §355.8060
of this subchapter (relating to Reimbursement Methodology for Freestanding
Psychiatric Facilities); and
(2) outpatient hospitals, under §355.8061 of this
subchapter (relating to Outpatient Hospital Reimbursement).
(e) Reimbursement for services provided under the supervision
of a licensed physical therapist, licensed occupational therapist,
or licensed speech language pathologist. Reimbursement for services
provided by a physical therapy assistant, occupational therapy assistant,
or speech language pathologist assistant under the supervision of
a licensed physical therapist, licensed occupational therapist, or
licensed speech language pathologist is reimbursed at 80 percent of
the fee paid to a licensed therapist for the same service.
(f) Fees for physical, occupational, and speech therapy
services are adjusted within available funding as described in §355.201
of this title (relating to Establishment and Adjustment of Reimbursement
Rates for Medicaid).
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