Under Texas Labor Code, §352.054, this section sets forth
the standards governing the determination of rates paid for medical
services provided by the Agency. The rates determined under these
standards are reevaluated annually:
(1) Rates shall be established based on Medicare and
Medicaid schedules for current procedural terminology. Where Medicare
and Medicaid schedules are not applicable, rates that represent best
value shall be established based on factors that include reasonable
and customary industry standards for each specific service.
(2) Rates shall be established at a level adequate
to ensure that enough qualified providers are available to provide
assessment and treatment within a geographic distribution that reflects
customer or claimant distribution.
(3) Notification of the proposed schedule of rates
shall be published in the Texas Register to
allow interested persons to present comments to the Agency before
the rates are established.
(4) After the reevaluation process is completed in
accordance with the requirements in paragraphs (1) and (2) of this
section, the Agency's executive director or deputy executive director
may establish the rates for medical services.
(5) Exceptions to established rates may be made on
a case-by-case basis by the Vocational Rehabilitation counselor after
consultation with the Agency's medical director or optometric consultant.
Exceptions contrary to the Agency's medical director's or optometric
consultant's recommendation require approval by the Vocational Rehabilitation
Division (VRD) deputy director or VRD director.
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