Section 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 § RSA 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.1 Tex. Admin. Code § 355.313
The provisions of this §355.313 adopted to be effective January 20, 2008, 33 TexReg 363