Texas Association of Psychological Associates
Representing All Masters-Degreed Psychology Professionals in Texas
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T.A.P.A.
P.O. Box 601374
Dallas, TX 75360
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817.588.0476
P.O. Box 601374
Dallas, TX 75360
Voicemail
817.588.0476
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6 Jul;y 2009
• Proposal of new Chapter 419, Subchapter A relating to Youth Empowerment Services (YES)
New rules in 25 TAC Chapter 419, Subchapter A concerning YES Medicaid waiver services will be proposed for public comment in the July 17, 2009, issue of the Texas Register. The proposed new rules are necessary to implement the pilot program, approved by the federal government under the waiver provisions of the federal Social Security Act, §1915(c), which is designed to prevent or reduce institutionalization of children and adolescents with severe emotional disturbance (SED), enable more flexibility in providing intensive community-based services for children and adolescents with SED, and provide support for their families by improving access to services. The YES Medicaid waiver program will provide services to children and adolescents that reside in Bexar and Travis Counties.
DSHS invites you to review, and submit via email, written comments, suggestions, or any questions on the proposed new rules concerning YES Medicaid waiver program services to MHSArules@dshs.state.tx.us by August 17, 2009. DSHS anticipates the adoption of the subchapter to be effective in Septem ber, 2009. Thank you in advance for your review and input.
• Proposal of new Chapter 419, Subchapter A relating to Youth Empowerment Services (YES)
New rules in 25 TAC Chapter 419, Subchapter A concerning YES Medicaid waiver services will be proposed for public comment in the July 17, 2009, issue of the Texas Register. The proposed new rules are necessary to implement the pilot program, approved by the federal government under the waiver provisions of the federal Social Security Act, §1915(c), which is designed to prevent or reduce institutionalization of children and adolescents with severe emotional disturbance (SED), enable more flexibility in providing intensive community-based services for children and adolescents with SED, and provide support for their families by improving access to services. The YES Medicaid waiver program will provide services to children and adolescents that reside in Bexar and Travis Counties.
DSHS invites you to review, and submit via email, written comments, suggestions, or any questions on the proposed new rules concerning YES Medicaid waiver program services to MHSArules@dshs.state.tx.us by August 17, 2009. DSHS anticipates the adoption of the subchapter to be effective in Septem ber, 2009. Thank you in advance for your review and input.
Blue titles are Links
27 February 2010
Sorting out the DARS changes
We have heard from LPAs around the state that DARS is limiting the assessment services that LPAs can provide. This will create longer waiting times for fewer services.
We have received a copy of this letter from the Directorate Manager - Medical Relations of the Disability Determination Services of the Texas Department of Assistive and Rehabilitative Services which gives the rationale for the change. It also states that "effective March 1, 2010, the Mental Status Exam portion of all psychological exams must be performed by a licensed psychologist, not an extender or intern."
One of the sources for information on the determination of disabilities regarding Social Security can be found in the Code of Federal Regulations: 20 CFR§404.1513 Medical and other evidence of your impairment(s).
Interestingly, the regulation does allow for information to be provided by a variety of sources, including
(d) Other sources. In addition to evidence from the acceptable medical sources listed in paragraph (a) of this section, we may also use evidence from other sources to show the severity of your impairment(s) and how it affects your ability to work. Other sources include, but are not limited to
(1) Medical sources not listed in paragraph (a) of this section (for example, nurse-practitioners, physicians' assistants, naturopaths, chiropractors, audiologists, and therapists); . . .
Please contact us if you have been affected by these changes.
24 August 2009
Medicaid has passed new rules that will allow reimbursement for LPAs.
They will take effect Sept.1, 2009. [Deleted wording is lined through; added wording is underlined]
We have put the wording relating to LPAs is in red.
We applaud the HHSC for taking this action, but we think the problems are obvious.
The Texas Administrative Code (TAC) will reflect these changes when they take effect on Sept. 1.
The proposed amendment affects Texas Human Resources Code Chapter32, and Texas Government Code Chapter 531. No other statutes, articles,or codes are affected by this proposal.
§354.1281.Benefits and Limitations.
(a) Subject to the specifications, conditions, requirements,and limitations established by the Texas Health and Human ServicesCommission (HHSC) or its designee, psychological counseling and services[provided by a licensed psychologist] are covered.[if the services:]
[(1) are within the psychologist'sscope of practice, as defined by state law; and]
[(2) would be covered bythe Texas Medical Assistance Program when they are provided by a licensedphysician (MD or DO).]
(b) To qualify for reimbursement the services must be provided by a:
(1) Licensed psychologist when the following conditions are met:
(A) The services are within the psychologist'sscope of practice, as defined by state law; and
(B) The services would be covered by theTexas Medical Assistance Program when they are provided by a licensedphysician (MD or DO).
(2) Licensed psychological associate (LPA)when the following conditions are met:
(A) The services are performed under thedirect 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.
(c) [(b)] To be payable, the services must be reasonable and medically [psychologically] necessary as determined by HHSC [or its designee]. [(c) The Texas Medical Assistance Program does not reimburse for the services of a psychological assistant working under the direction of a licensed psychologist.]
(d) Covered services provided by an LPA must be billed under the Texas Medical Assistance Program provider number of the supervising psychologist or the legal entity employing the supervising psychologist.
(e) [(d)] Licensed psychologists who are employed by or remunerated by a physician, hospital, facility,or other provider may not bill the Texas Medical Assistance Program directly for psychologists' services if that billing would resultin 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 Medical Assistance 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 Medical Assistance Program as appropriate for the services and provider(s) involved. 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.
The proposed amendment affects Texas Human Resources Code Chapter32, and Texas Government Code Chapter 531, Subchapter J, Division 5 General Administration.
§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
(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.
We understand that Blue Cross Blue Shield has adopted the same percentage for reimbursing LPAs.
Sorting out the DARS changes
We have heard from LPAs around the state that DARS is limiting the assessment services that LPAs can provide. This will create longer waiting times for fewer services.
We have received a copy of this letter from the Directorate Manager - Medical Relations of the Disability Determination Services of the Texas Department of Assistive and Rehabilitative Services which gives the rationale for the change. It also states that "effective March 1, 2010, the Mental Status Exam portion of all psychological exams must be performed by a licensed psychologist, not an extender or intern."
One of the sources for information on the determination of disabilities regarding Social Security can be found in the Code of Federal Regulations: 20 CFR§404.1513 Medical and other evidence of your impairment(s).
Interestingly, the regulation does allow for information to be provided by a variety of sources, including
(d) Other sources. In addition to evidence from the acceptable medical sources listed in paragraph (a) of this section, we may also use evidence from other sources to show the severity of your impairment(s) and how it affects your ability to work. Other sources include, but are not limited to
(1) Medical sources not listed in paragraph (a) of this section (for example, nurse-practitioners, physicians' assistants, naturopaths, chiropractors, audiologists, and therapists); . . .
Please contact us if you have been affected by these changes.
24 August 2009
Medicaid has passed new rules that will allow reimbursement for LPAs.
They will take effect Sept.1, 2009. [Deleted wording is lined through; added wording is underlined]
We have put the wording relating to LPAs is in red.
We applaud the HHSC for taking this action, but we think the problems are obvious.
The Texas Administrative Code (TAC) will reflect these changes when they take effect on Sept. 1.
The proposed amendment affects Texas Human Resources Code Chapter32, and Texas Government Code Chapter 531. No other statutes, articles,or codes are affected by this proposal.
§354.1281.Benefits and Limitations.
(a) Subject to the specifications, conditions, requirements,and limitations established by the Texas Health and Human ServicesCommission (HHSC) or its designee, psychological counseling and services[provided by a licensed psychologist] are covered.[if the services:]
[(1) are within the psychologist'sscope of practice, as defined by state law; and]
[(2) would be covered bythe Texas Medical Assistance Program when they are provided by a licensedphysician (MD or DO).]
(b) To qualify for reimbursement the services must be provided by a:
(1) Licensed psychologist when the following conditions are met:
(A) The services are within the psychologist'sscope of practice, as defined by state law; and
(B) The services would be covered by theTexas Medical Assistance Program when they are provided by a licensedphysician (MD or DO).
(2) Licensed psychological associate (LPA)when the following conditions are met:
(A) The services are performed under thedirect 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.
(c) [(b)] To be payable, the services must be reasonable and medically [psychologically] necessary as determined by HHSC [or its designee]. [(c) The Texas Medical Assistance Program does not reimburse for the services of a psychological assistant working under the direction of a licensed psychologist.]
(d) Covered services provided by an LPA must be billed under the Texas Medical Assistance Program provider number of the supervising psychologist or the legal entity employing the supervising psychologist.
(e) [(d)] Licensed psychologists who are employed by or remunerated by a physician, hospital, facility,or other provider may not bill the Texas Medical Assistance Program directly for psychologists' services if that billing would resultin 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 Medical Assistance 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 Medical Assistance Program as appropriate for the services and provider(s) involved. 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.
The proposed amendment affects Texas Human Resources Code Chapter32, and Texas Government Code Chapter 531, Subchapter J, Division 5 General Administration.
§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
We understand that Blue Cross Blue Shield has adopted the same percentage for reimbursing LPAs.
Archived News stories for
• 2009
• 2009
2 April 2010
The Texas Psychological Association's April E-Newsletter had this article on the recent DARS changes.
The Texas Psychological Association's April E-Newsletter had this article on the recent DARS changes.
26 July 2010
The American Psychological Association has distributed this Fact Sheet from the Department of Veterans Affairs concerning the effect of the new health care law on Veterans health care. The bottom line is that there will be NO change. However, this Fact Sheet may be helpful if you have clients who are concerned about this.
The American Psychological Association has distributed this Fact Sheet from the Department of Veterans Affairs concerning the effect of the new health care law on Veterans health care. The bottom line is that there will be NO change. However, this Fact Sheet may be helpful if you have clients who are concerned about this.