25 TAC §§621.151 - 621.153
The Texas Interagency Council On Early Childhood Intervention
adopts new §§621.151 - 621.153, concerning the General Provision
for Developmental Rehabilitation Therapy Services for Infants and Toddlers
with Disabilities or Developmental Delays, with changes to the proposed text
as published in the November 3, 2000, issue of the
Texas Register
(25 TexReg 10868).
The purpose of the rules is to establish procedures for Developmental Rehabilitation
Services (DRS) providers to deliver developmentally appropriate individualized
skills training and support to foster, promote, and enhance child engagement
in daily activities, functional independence, and social interaction.
In conjunction with these new sections, The Health and Human Services Commission
is simultaneously adopting new §355.113, concerning the reimbursement
methodology for Developmental Rehabilitation Services for Children with Disabilities
or Developmental Delays elsewhere in this issue of the
Texas Register
.
ECI received comments from the Texas Physical Therapy Association, program
administrators from ECI of Tarrant County and ECI of Dallas Metrocare Services,
and an individual physical therapy provider from an ECI program in Longview,
Texas.
Comment: One commenter was concerned that the word "therapy" in the name
of the service would imply services were being provided by a licensed therapist,
which is misleading to program consumers. They were concerned that this would
create and foster a public misunderstanding of the qualifications and skills
of early intervention personnel as opposed to physical therapists.
Response: ECI agrees, and has amended the rule to change the name of the
service from Developmental Rehabilitation Therapy to Developmental Rehabilitation
Services. Providers of this service will not be referred to as "Developmental
Rehabilitation Therapists."
Comment: The same commenter was concerned that early intervention specialists
(EIS) may not be adequately qualified to provide DRS and should not be labeled
as "therapists" as they are only required to have a bachelor's degree and
may not have had the adequate early intervention coursework.
Response: ECI is changing the name of the service to eliminate the term
"therapy." In addition, ECI currently requires EIS professionals to complete
and earn certification through a comprehensive Competency Demonstration System
administered by the state ECI office in order to assure qualification as providers
of early intervention services.
Comment: Two commenters were concerned that the rules do not require adequate
supervision of EIS professionals and teachers in providing developmental rehabilitation
services, or for providing services to create a change in motor skills.
Response: ECI requires programs to provide support through supervision
and mentoring as necessary to EIS professionals to ensure all services are
provided in an appropriate and qualified manner. ECI agrees that EIS professionals
are not qualified to provide physical therapy. Developmental Rehabilitation
Services are not physical therapy services but rather assistance to caregivers
in the identification and utilization of opportunities to incorporate therapeutic
intervention strategies into daily life activities.
DRS is provided as per an individualized family service plan recommended
and developed by an interdisciplinary team that must consist of at least one
licensed practitioner of the healing arts. The licensed practitioner provides
case supervision and monitoring of the child's progress with accomplishing
therapy goals to ensure quality provision of the service.
Comment: The commenter was also concerned that the continuing education
requirement of only 10 contact hours a year is too low for purposes of learning
necessary techniques.
Response: ECI recognizes the importance of requiring the highest level
of certification for individual providers of early intervention services.
In addition to requiring EIS professionals to obtain certification through
the Competency Demonstration System, ECI requires programs to provide support
through supervision and mentoring as necessary to EIS professionals to ensure
all services are provided in an appropriate and qualified manner. In addition
to the required continuing education, early intervention professionals participate
in numerous trainings, including quarterly statewide videoconferences and
a summer training institute.
Comment: One commenter was concerned that prohibiting these services for
children with developmental disabilities would exclude the large majority
of ECI clients.
Response: Developmental Rehabilitation Services are available to all ECI
children; however, this service is not reimbursed by Medicaid when provided
to children diagnosed with a developmental disability in accordance with federal
Medicaid regulations.
Comment: One commenter was concerned that this rule would change the present
Medicaid billing of services provided by physical and other therapists, and
that this rule would infringe on the Physical Therapy and Occupational Therapy
Practice Acts.
Response: DRS is a distinct and separate service from the therapies required
to be provided by physical and occupational therapists, and will have no impact
on the rate for physical therapy or occupational therapies or the Physical
Therapy or Occupational Therapy Practice Acts.
Comment: One commenter requested that psychological associates be included
in the list of qualified providers of DRS.
Response: ECI agrees and has amended the rules to include psychological
associates.
Comment: One commenter requested that Licensed Master Social Workers -
Advanced Clinical Practitioners and Licensed Professional Counselors be included
in the list of required providers and/or supervisors of DRS.
Response: ECI agrees and has amended the rule to include these providers.
In addition, based on concerns expressed by the federal Health Care Financing
Administration (HCFA) regarding assurances that children in all areas of the
state, including rural areas, will have access to DRS, the rules were amended
to require that these services be provided in "natural environments."
In response to HCFA concerns regarding teacher qualifications to provide
DRS the rules have been amended to require that teachers be certified through
the ECI Competency Demonstration System.
The new sections are adopted under Chapter 73 of the Human Resources
Code, §73.0051 and §73.022, which provides the agency with the authority
to administer public programs for developmentally delayed children.
§621.151.Reimbursable Services.
(a)
Developmental Rehabilitation Services are reimbursable
to Medicaid providers who meet the conditions for provider participation as
specified in §621.153 of this title (relating to Conditions for Developmental
Rehabilitation Provider Participation). Developmental Rehabilitation Services
are diagnostic, evaluative, and consultative services for the purposes of
identifying or determining the nature and extent of, and rehabilitating an
individual's medical or other health-related condition. They are medical and/or
remedial services that integrate therapeutic interventions into the daily
routines of the child and family in order to restore or maintain function
and/or to reduce dysfunction resulting from a mental or physical disability
or developmental delay. Developmental Rehabilitation services are designed
to enhance development in the physical/motor, communication, adaptive, cognitive,
social or emotional and sensory domains, or to teach compensatory skills for
deficits that directly result from medical, developmental or other health-related
conditions. Developmental Rehabilitation Services are provided as specified
in the active Individualized Family Service Plan (IFSP) developed in accordance
with §621.23(5)(A)-(K) of this title (relating to Service Delivery Requirements
for Comprehensive Services). The services include:
(1)
developmentally appropriate individualized skills training
and support to foster, promote, and enhance child engagement in daily activities,
functional independence, and social interaction;
(2)
assistance to caregivers in the identification and utilization
of opportunities to incorporate therapeutic intervention strategies into daily
life activities that are natural and normal for the child and family;
(3)
continuous monitoring of child progress in the acquisition
and mastery of functional skills to reduce or overcome limitations resulting
from disability or developmental delays.
(b)
The services listed in subsection (a)(1)-(3) are performed
by or under the supervision of a licensed physician, registered nurse, licensed
physical therapist, licensed occupational therapist, licensed speech language
pathologist, licensed professional counselors, or licensed master social workers-advanced
clinical practitioners acting within their scope of practice. Supervision
in this section means participation in the initial and annual comprehensive
assessment of the child as well as participation in the initial and annual
development of the IFSP and any subsequent revisions of the plan that result
in service changes.
(c)
Developmental Rehabilitation Services are not reimbursable
as Medicaid services when:
(1)
provided to children with a diagnosis of a developmental
disability defined as a severe, chronic disability of a person which:
(A)
is attributable to mental or physical impairment or combination
of mental and physical impairments;
(B)
is manifested before the person attains age 22;
(C)
is likely to continue indefinitely;
(D)
results in substantial functional limitations in three
or more of the following areas of major life activity: self-care, receptive
and expressive language, learning, mobility, self-direction, capacity for
independent living, or economic self-sufficiency, or a diagnosis of mental
retardation; or
(2)
the services are guaranteed under the provisions of IDEA
Part B.
§621.152.Recipient Eligibility for Developmental Rehabilitation Services
In order to receive Developmental Rehabilitation services, the recipient:
(1)
must be enrolled in the Texas Medical Assistance Program;
(2)
must be age 21 and under;
(3)
must demonstrate the need for these services as documented
in an active Individualized Family Service Plan (IFSP) developed in accordance
with §621.23(5)(A)-(K) of this title (relating to Service Delivery Requirements
for Comprehensive Services) .
§621.153.Conditions for Developmental Rehabilitation Services Provider Participation
(a)
In accordance with the regulations at 42 CFR §431.51,
all willing and qualified providers may participate in this program.
(b)
In order to be reimbursed for developmental rehabilitation
services as specified in §621.151 of this title (relating to Reimbursable
Services), a provider must:
(1)
meet applicable state and federal laws governing the participation
of providers in the Medicaid Program;
(2)
sign a provider agreement with the single state agency;
(3)
be certified by the Texas Interagency Council on Early
Childhood Intervention, the state program for infants and toddlers with developmental
delays;
(4)
provide services under the supervision of a licensed physician,
registered nurse, licensed physical therapist, licensed occupational therapist,
licensed speech language pathologist, licensed professional counselors, or
licensed master social workers-advanced clinical practitioners acting within
their scope of practice who are employed as agency or contract staff. Developmental
rehabilitation services may be provided by:
(A)
Licensed Therapists,
(B)
Licensed Counselors,
(C)
Licensed Social Workers,
(D)
Registered Nurses,
(E)
Early Intervention Specialist (EIS) professionals participating
in or certified through the ECI Competency Demonstration System,
(F)
Certified Teachers certified through the ECI Competency
Demonstration System;
(G)
Psychological Associates;
(5)
provide services to all eligible children in natural environments.
Natural environments are settings that individual families identify as natural
or normal for their family, including the home, neighborhood, and community
settings in which children without disabilities participate; and
(6)
deliver services in accordance with the scope and duration
of the Individualized Family Service Plan (IFSP).
This agency hereby certifies that the adoption has been
reviewed by legal counsel and found to be a valid exercise of the agency's
legal authority.
Filed with the Office of
the Secretary of State on May 3, 2001.
TRD-200102527
Donna Samuelson
Deputy Executive Director
Interagency Council on Early Childhood Intervention
Effective date: May 23, 2001
Proposal publication date: November 3, 2000
For further information, please call: (512) 424-6750