SECTION 856.57. Alternative Purchasing Methods - Rates for Medical Services

Under Texas Labor Code, §352.054, this section sets forth the standards governing the determination of rates paid for medical services provided by the Agency. The rates determined under these standards are reevaluated annually:

(1) Rates shall be established based on Medicare and Medicaid schedules for current procedural terminology. 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 that enough qualified providers are available to provide assessment and treatment within a geographic distribution that reflects customer or claimant distribution.

(3) Notification of the proposed schedule of rates shall be published in the Texas Register to allow interested persons to present comments to the Agency before the rates are established.

(4) After the reevaluation process is completed in accordance with the requirements in paragraphs (1) and (2) of this section, the Agency's executive director or deputy executive director may establish the rates for medical services.

(5) Exceptions to established rates may be made on a case-by-case basis by the Vocational Rehabilitation counselor after consultation with the Agency's medical director or optometric consultant. Exceptions contrary to the Agency's medical director's or optometric consultant's recommendation require approval by the Vocational Rehabilitation Division (VRD) deputy director or VRD director.

Source Note: The provisions of this §856.57 adopted to be effective August 21, 2018, 43 TexReg 5398; amended to be effective December 26, 2022, 47 TexReg 8740