| (A) is currently licensed without restriction as a
physician assistant by the Texas Medical Board-Physician Assistant
Board, under TOC, Chapter 204 (relating to Physician Assistants);
and
(B) practices under a current and executed prescriptive
authority agreement with a qualified physician in accordance with
TOC, Chapter 157, Subchapter B.
(33) PCP--Primary care physician. A person who is a
qualified physician who:
(A) has agreed with a Medicaid health care managed
care organization to provide a medical home to Medicaid enrolled members;
and
(B) is responsible for providing on-going primary care
services to Medicaid members, maintaining the continuity of patient
care, and initiating referrals for care.
(34) Person-centered--An approach to health care services
that:
(A) is based on the clinically assessed needs of the
child, in collaboration with all relevant and available service providers,
that focuses on the child as an individual and supports those who
are closest to the child, as applicable;
(B) uses a documented service planning process that
includes the child and those who are closest to the child, as applicable,
that:
(i) is directed by the child to the greatest extent
possible;
(ii) enables the child to make choices and decisions,
including who provides the services and supports they receive;
(iii) reflects cultural considerations;
(iv) includes strategies for solving conflict or disagreement
within the service provision process;
(v) provides services which are timely and occur at
times and locations convenient to the child and those closest to the
child; and
(vi) includes a method for them to require updates
to the treatment plan; and
(C) involves a continual process by the provider of
listening, testing new approaches, and changing routines and organizational
approaches to individualize and de-institutionalize the care environment.
(35) Physician--A medical doctor or a doctor of osteopathy
who is currently licensed without restriction by the Texas Medical
Board under TOC, Chapter 155 (relating to License to Practice Medicine)
to practice medicine or osteopathy.
(36) PT--Physical therapy. PT is the discipline and
services of physical therapy, where the services are regulated by
the Executive Council of Physical Therapy and Occupational Therapy
Examiners, Texas Board of Physical Therapy Examiners, under TOC, Chapter
453 (relating to Physical Therapists).
(37) Rendering provider--For the purposes of Medicaid
claim submission for ABA evaluation and treatment services for ASD,
an LBA is the only Medicaid enrolled rendering provider as described
in §354.5011 of this subchapter (relating to Providers of Applied
Behavior Analysis (ABA) Services).
(38) Speech-language pathology--The discipline and
services of speech-language pathology. In documents related to services
under this subchapter and the Autism Section, these services are also
called speech therapy, interchangeably. These services are regulated
by TDLR under TOC, Chapter 401 (relating to Speech-Language Pathologists
and Audiologists).
(39) ST--Speech therapy. The discipline and services
of speech therapy or speech-language pathology. In documents related
to services under this subchapter and the Autism Section, these services
are also called speech-language pathology, interchangeably. These
services are regulated by TDLR under TOC, Chapter 401.
(40) Supervision of ABA services rendered by an LaBA
or BT--Means:
(A) the LBA must:
(i) provide direct and indirect supervision of the
ABA services of the LaBA or BT, who is included in the formal ABA
supervision documentation; and
(ii) deliver appropriate supervision in accordance
with state licensing requirements, in TOC, Chapter 506 (relating to
Behavior Analysts) and 16 TAC Chapter 121 (relating to Behavior Analyst),
and the Autism Section in the TMPPM;
(B) the LaBA, if applicable, must:
(i) provide direct and indirect supervision of the
ABA services of the BT, where both the LaBA and BT are identified
in the formal ABA supervision documentation and in which the services
delegated to each are specified; and
(ii) deliver appropriate supervision in accordance
with state licensing requirements, in TOC, Chapter 506 (relating to
Behavior Analysts) and 16 TAC Chapter 121 (relating to Behavior Analyst);
and
(C) a Medicaid reimbursable direct supervision session
by the LBA, or LaBA, as applicable, must occur when the LaBA or BT
is currently and actively providing in-person ABA treatment services
to a child, and requires the LBA, or LaBA, as applicable, to consider
any necessary ABA service protocol modification, as described in the
appropriate Current Procedural Terminology code.
(41) TAC--Texas Administrative Code.
(42) TDLR--Texas Department of Licensing and Regulation.
The Texas licensing agency that regulates and issues licenses for
LBAs, LaBAs, and certain other professionals.
(43) THSteps--Texas Health Steps. A Medicaid program
defined in 25 TAC Chapter 33. The State of Texas has adopted the name
Texas Health Steps for its EPSDT program.
(44) THSteps-CCP--Texas Health Steps-Comprehensive
Care Program. The Texas Medicaid EPSDT-CCP, described in Chapter 363
of this title.
(45) TMHP--Texas Medicaid and Healthcare Partnership.
(46) TMPPM--Texas Medicaid Provider Procedures Manual.
The current manual published by TMHP, that:
(A) is a comprehensive guide for Texas Medicaid providers
for fee-for-service benefits, policies, and procedures; and
(B) is updated monthly to include all published updates,
including those made available to providers through bulletins, banners,
or other means, and any revisions of published updates which became
effective in the month prior.
(47) TOC--Texas Occupations Code.
(48) Trauma-informed--A program, organization, or system
that is trauma-informed realizes the widespread impact of trauma and:
(A) understands potential paths for recovery from trauma;
(B) recognizes the signs and symptoms of trauma in
members, families, staff, and others involved with the system; and
(C) responds by fully integrating knowledge about trauma
into policies, procedures, and practices, and seeks to actively resist
traumatization and re-traumatization.
(49) Treatment plan--A plan for ABA services for a
child that:
(A) is tailored to the specific needs of the child,
and those who are closest to the child, as applicable;
(B) meets all requirements under this subchapter and
the Autism Section in the TMPPM; and
(C) must be authorized.
(50) U.S.C.--United States Code.
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