1 Tex. Admin. Code § 355.313 - Reimbursement Methodology for Rehabilitative and Specialized Services
(a) Providers
other than nursing facilities delivering Medicaid specialized and
rehabilitative services, defined in 40 TAC § 19.1306, (relating to Payment
for Specialized and Rehabilitative Services), are reimbursed for physical
therapy evaluations, occupational therapy evaluations, speech therapy
evaluations, physical therapy sessions, occupational therapy sessions, and
speech therapy sessions in accordance with statewide fees determined by the
Texas Health and Human Services Commission (HHSC).
(1) The hourly fees for physical therapy and
occupational therapy sessions are based on the current Medicare nonfacility
Relative Value Units (RVUs) times the current Medicaid conversion factor times
four, since the Medicare RVUs for these sessions are based on 15-minute
increments.
(2) The hourly fee for
a speech therapy session is based on the current Medicare nonfacility RVU times
the current Medicaid conversion factor times two, since the Medicare RVUs for a
speech therapy session is based on 30-minute increments.
(3) The fees for physical therapy
evaluations, occupational therapy evaluations, and speech therapy evaluations
are the same as the hourly fees for each type of therapy session, as provided
in paragraphs (1) and (2) of this subsection.
(4) The fees for specialized and
rehabilitative services delivered by providers other than nursing facilities
are reviewed coincident with the biennium, with any fee adjustments made within
available funds.
(b)
Nursing facilities delivering Medicaid specialized and rehabilitative services
are reimbursed for physical therapy evaluations, occupational therapy
evaluations, speech therapy evaluations, physical therapy sessions,
occupational therapy sessions, and speech therapy sessions in accordance with
fees reviewed by the Texas Health and Human Services Commission (HHSC). The
fees for specialized and rehabilitative services delivered by nursing
facilities are reviewed coincident with the biennium, with any fee adjustments
made within available funds.
Notes
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