(a) Subject to the specifications, conditions, requirements,
and limitations established by the Texas Health and Human Services
Commission (HHSC) or its designee, psychological counseling and services
are covered.
(b) To qualify for reimbursement the services must
be provided by a:
(1) Licensed psychologist who is licensed by the Texas
State Board of Examiners of Psychologists (TSBEP), if:
(A) The services are within the psychologist's scope
of practice, as defined by state law; and
(B) The services would be covered by the Texas Medicaid
program when they are provided by a licensed physician (MD or DO).
(2) Licensed psychological associate (LPA) who is licensed
by TSBEP, if:
(A) The services are performed under the direct supervision
of a licensed psychologist. The supervising psychologist must be in
the same office, building, or facility when and where the service
is provided and must be immediately available to furnish assistance
and direction; and
(B) The LPA performing the service must be an employee
of either the licensed psychologist or the legal entity that employs
the licensed psychologist.
(3) Provisionally licensed psychologist (PLP) who is
licensed by TSBEP, if:
(A) The services are performed under the direct supervision
of a licensed psychologist. The supervising psychologist must be in
the same office, building, or facility when and where the service
is provided and must be immediately available to furnish assistance
and direction; and
(B) The PLP performing the service must be an employee
of either the licensed psychologist or the legal entity that employs
the licensed psychologist.
(c) To be payable, the services must be reasonable
and medically necessary as determined by HHSC.
(d) Covered services provided by an LPA or a PLP must
be billed under the Texas Medicaid program provider number of the
supervising psychologist or the legal entity employing the supervising
psychologist.
(e) Licensed psychologists who are employed by or remunerated
by a physician, hospital, facility, or other provider may not bill
the Texas Medicaid program directly for psychologists' services if
that billing would result in duplicate payment for the same services.
If the services are covered and reimbursable by the program, payment
may be made to the physician, hospital, or other provider (if approved
for participation in the Texas Medicaid program) who employs or reimburses
the licensed psychologist. The basis and amount of Medicaid reimbursement
depends on the services actually provided, who provided the services,
and the reimbursement methodology utilized by the Texas Medicaid program
as appropriate for the services and provider(s) involved.
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Source Note: The provisions of this §354.1281 adopted to be effective February 19, 1990, 15 TexReg 658; transferred effective September 1, 1993, as published in the Texas Register September 7, 1993, 18 TexReg 5978; transferred effective September 1, 2001, as published in the Texas Register May 24, 2002, 27 TexReg 4561; amended to be effective September 1, 2003, 28 TexReg 7289; amended to be effective December 1, 2005, 30 TexReg 7849; amended to be effective September 1, 2009, 34 TexReg 3930; amended to be effective September 1, 2013, 38 TexReg 4886 |