1 TAC §355.8081
The Texas Health and Human Services Commission (HHSC)
proposes to amend §355.8081, Payments for Laboratory and X-ray
Services, Radiation Therapy, Physical Therapists' Services, Physician
Services, Podiatry Services, Chiropractic Services, Optometric Services,
Ambulance Services, Dentists' Services, and Psychologists' Services,
under Title 1, Part 15, Chapter 355, Subchapter J, Division 5 of the
Texas Administrative Code, to add Medicaid reimbursement for services
provided by a licensed psychological associate (LPA) under the direct
supervision of a licensed psychologist.
Background and Justification
The Texas State Board of Examiners of Psychologists requires an
LPA to work under the supervision of a licensed psychologist and does
not allow an LPA to engage in independent practice. Currently, Texas
Medicaid does not reimburse licensed psychologists for services provided
by an LPA who works under the supervision of a licensed psychologist
and does not allow an LPA to enroll as a Medicaid provider.
Medicare allows reimbursement to clinical psychologists for services
performed by an LPA under the direct supervision of the clinical psychologist.
The Code of Federal Regulations (42 CFR §410.71) states that
the services performed by an LPA are covered under Medicare if: the
services are performed under the direct supervision of a licensed
psychologist; the licensed psychologist is immediately available to
provide assistance and direction throughout the time the service is
being performed; and the LPA performing the service is an employee
of either the licensed psychologist or the legal entity that employs
the licensed psychologist.
The proposed rule revision aligns Medicaid policy with Medicare
by allowing a licensed psychologist to be reimbursed for services
performed by an LPA when the LPA is under the direct supervision of
the licensed psychologist. The supervising psychologist will be reimbursed
70 percent of the Medicaid fee that would be paid to a psychologist
for the same service. The proposed rule also remains consistent with
the Texas State Board of Examiners of Psychologists rules that prohibit
an LPA from engaging in independent practice. Allowing Medicaid reimbursement
for services provided by an LPA is expected to expand access to behavioral
health services because it allows a new provider type to perform Medicaid
reimbursable services.
Section-by-Section Summary
The proposed revision to the title of §355.8081 adds the reference
to Licensed Psychological Associates' Services.
The proposed new §355.8081(c) allows Medicaid reimbursement
to a supervising licensed psychologist or the legal entity employing
the supervising licensed psychologist for services provided by an
LPA under the direct supervision of the licensed psychologist at 70
percent of the fee paid to psychologists for the same service.
Fiscal Note
Thomas M. Suehs, Deputy Executive Commissioner for Financial Services,
has determined that during the first five-year period the proposed
rule amendment is in effect there will be a fiscal impact to state
government of $1,315,297 (SFY2010); $2,778,136 (SFY2011); $3,747,011
(SFY2012); $4,403,025 (SFY2013); and $4,362,424 (SFY2014). The proposed
rule will not result in any fiscal implications for local health and
human services agencies. Local governments will not incur additional
costs.
Public Benefit
Carolyn Pratt, Director of Rate Analysis, has determined that for
each year of the first five years the proposed rule is in effect,
the public will benefit by increased access to behavioral and mental
health services for Medicaid clients provided by LPAs.
Small and Micro-business Impact Analysis
Mr. Suehs has also determined that there will be no effect on small
businesses or micro businesses that are Medicaid providers. Providers
will not be required to alter their business practices as a result
of the rule. There are no significant other costs to persons who are
required to comply with the proposed rule. There is no anticipated
negative impact on local employment.
Regulatory Analysis
HHSC has determined that this proposal is not a "major environmental
rule" as defined by §2001.0225 of the Texas Government Code.
A "major environmental rule" is defined to mean a rule the specific
intent of which is to protect the environment or reduce risk to human
health from environmental exposure and that may adversely affect,
in a material way, the economy, a sector of the economy, productivity,
competition, jobs, the environment or the public health and safety
of a state or a sector of the state. This proposal is not specifically
intended to protect the environment or reduce risks to human health
from environmental exposure.
Takings Impact Assessment HHSC has determined that this proposal
does not restrict or limit an owner's right to his or her property
that would otherwise exist in the absence of government action and,
therefore, does not constitute a taking under §2007.043 of the
Government Code.
Public Comment
Written comments on the proposal may be submitted to Dan Huggins,
Director of Acute Care Services, Rate Analysis Department, Texas Health
and Human Services Commission, P.O. Box 85200, MC-H400, Austin, Texas
78708-5200; by fax to (512) 491-1998; or by e-mail to Dan.Huggins@hhsc.state.tx.us
within 30 days of publication of this proposal in the Texas Register.
Statutory Authority
The amendment is proposed under Texas Government Code §531.033,
which provides the Executive Commissioner of HHSC with broad rulemaking
authority; Human Resources Code §32.021 and Texas Government
Code §531.021(a), which provide HHSC with the authority to administer
the federal medical assistance (Medicaid) program in Texas; and Texas
Government Code §531.021(b), which provides HHSC with the authority
to propose and adopt rules governing the determination of Medicaid
reimbursements.
The proposed amendment affects the Human Resources Code, Chapter
32, and the Texas Government Code, Chapter 531. No other statutes,
articles, or codes are affected by this proposal.
§355.8081.Payments for Laboratory and X-ray Services, Radiation Therapy, Physical Therapists' Services, Physician Services, Podiatry Services, Chiropractic Services, Optometric Services, Ambulance Services, Dentists' Services, [and] Psychologists' Services, and Licensed Psychological Associates' Services.
(a) Subject to qualifications, limitations, and exclusions
as provided in this chapter, payment to eligible providers must not
exceed the lesser of the provider's billed amount or the amount derived
from the methodology described in §355.8085 of this title (relating
to Texas Medicaid Reimbursement Methodology (TMRM) for Physicians
and Certain Other Practitioners).
(b) Reimbursement for ambulance services is described
in §355.8600 of this title (relating to
Reimbursement for Ambulance
Services). Reimbursement for clinical laboratory services is described
in §355.8610 of this title (relating to
Reimbursement for Clinical
Laboratory Services).
(c) Reimbursement for services
provided by a licensed psychologist is described in §355.8085
of this title. Reimbursement for services provided by a licensed psychological
associate (LPA) under the supervision of a licensed psychologist is
reimbursed to the licensed psychologist at 70 percent of the fee paid
to the licensed psychologist for the same service.
This agency hereby certifies that the proposal has
been reviewed by legal counsel and found to be within the agency's
legal authority to adopt.
Filed with the Office of the Secretary of State on June 15, 2009.
TRD-200902401
Steve Aragón
Chief Counsel
Texas Health and Human Services Commission
Earliest possible date of adoption: July 26, 2009
For further information, please call: (512) 424-6900