Section 354.1281 - Benefits and Limitations(a) Subject to the specifications, conditions, requirements, and limitations established by the Texas Health and Human Services Commission (HHSC) or its designee, psychological counseling and services are covered.(b) To qualify for reimbursement the services must be provided by a: (1) Licensed psychologist who is licensed by the Texas State Board of Examiners of Psychologists (TSBEP), if: (A) The services are within the psychologist's scope of practice, as defined by state law; and(B) The services would be covered by the Texas Medicaid program when they are provided by a licensed physician (MD or DO).(2) Licensed psychological associate (LPA) who is licensed by TSBEP, if: (A) The services are performed under the direct 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.(3) Provisionally licensed psychologist (PLP) who is licensed by TSBEP, if: (A) The services are performed under the direct 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 PLP performing the service must be an employee of either the licensed psychologist or the legal entity that employs the licensed psychologist.(c) To be payable, the services must be reasonable and medically necessary as determined by HHSC.(d) Covered services provided by an LPA or a PLP must be billed under the Texas Medicaid program provider number of the supervising psychologist or the legal entity employing the supervising psychologist.(e) Licensed psychologists who are employed by or remunerated by a physician, hospital, facility, or other provider may not bill the Texas Medicaid program directly for psychologists' services if that billing would result in 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 Medicaid 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 Medicaid program as appropriate for the services and provider(s) involved.1 Tex. Admin. Code § 354.1281
The provisions of this §354.1281 adopted to be effective February 19, 1990, 15 TexReg 658; transferred effective September 1, 1993, as published in the Texas Register September 7, 1993, 18 TexReg 5978; transferred effective September 1, 2001, as published in the Texas Register May 24, 2002, 27 TexReg 4561; Amended to be effective September 1, 2003, 28 TexReg 7289; Amended to be effective December 1, 2005, 30 TexReg 7849; Amended to be effective September 1, 2009, 34 TexReg 3930; Amended to be effective September 1, 2013, 38 TexReg 4886