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Texas Administrative Code (Last Updated: March 27,2024) |
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TITLE 26. HEALTH AND HUMAN SERVICES |
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PART 1. HEALTH AND HUMAN SERVICES COMMISSION |
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CHAPTER 349. PURCHASE OF GOODS AND SERVICES FOR REHABILITATION, INDEPENDENCE, AND EARLY CHILDHOOD INTERVENTION |
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SUBCHAPTER A. RATE DETERMINATION FOR PURCHASE OF REHABILITATION, INDEPENDENCE, AND EARLY CHILDHOOD INTERVENTION MEDICAL SERVICES |
SECTION 349.1. Alternative Purchasing Methods - Rates for Medical Services
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Under Human Resources Code, §117.074, this rule adopts standards governing the determination of rates paid for medical services provided by DARS. The rates determined under these standards are reevaluated annually.
(1) Rates shall be established based on Medicare and Medicaid schedules for current procedural terminology (CPT). Where Medicare and Medicaid schedules are not applicable, rates that represent best value shall be established based on factors that include reasonable and customary industry standards for each specific service. (2) Rates shall be established at a level adequate to ensure availability of qualified providers, and in adequate numbers to provide assessment and treatment, and within a geographic distribution that mirrors consumer or claimant distribution. (3) Exceptions to established rates may be made on a case-by-case basis by the DARS medical director or optometric consultant. Source Note: The provisions of this §349.1 adopted to be effective March 12, 2012, 37 TexReg 1720; transferred effective June 15, 2021, as published in the May 28, 2021 issue of the Texas Register, 46 TexReg 3423