TITLE 40. SOCIAL SERVICES AND ASSISTANCE
PART 2. DEPARTMENT OF ASSISTIVE AND REHABILITATIVE SERVICES
CHAPTER 108. DIVISION FOR EARLY CHILDHOOD INTERVENTION
SERVICES
[SUBCHAPTER E. DEVELOPMENTAL REHABILITATION SERVICES]
[§108.501. Reimbursable Services
(a) Services that are covered under the Developmental Rehabilitation Services Program
are reimbursable to Medicaid providers who meet the conditions for provider
participation as specified in §108.505 of this subchapter (relating to Conditions for
Provider Participation in the Developmental Rehabilitation Services Program).
Developmental Rehabilitation Services are diagnostic, evaluative, and consultative
services for the purposes of identifying or determining the nature and extent of, and
rehabilitating an individual's medical or other health-related condition. They are medical
and/or remedial services that integrate therapeutic interventions into the daily routines of
the child and family in order to restore or maintain function and/or to reduce dysfunction
resulting from a mental or physical disability or developmental delay. Services are
designed to enhance development in the physical/motor, communication, adaptive,
cognitive, social or emotional and sensory domains, or to teach compensatory skills for
deficits that directly result from medical, developmental or other health-related
conditions. Developmental Rehabilitation Services are provided as specified in the active
Individualized Family Service Plan (IFSP) developed in accordance with 40 TAC §108.5
of this chapter (relating to Service Delivery Requirements for Early Intervention
Services). The services include:
(1) developmentally appropriate individualized skills training and support to foster,
promote, and enhance child engagement in daily activities, functional independence, and
social interaction;
(2) assistance to caregivers in the identification and utilization of opportunities to
incorporate therapeutic intervention strategies into daily life activities that are natural and
normal for the child and family;
(3) continuous monitoring of child progress in the acquisition and mastery of functional
skills to reduce or overcome limitations resulting from disability or developmental
delays.
(b) The services listed in subsection (a)(1) - (3) of this section are performed by or under
the supervision of a person authorized in the Texas Medicaid State Plan, including a
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licensed physician, registered nurse, licensed physical therapist, licensed occupational
therapist, licensed speech language pathologist, licensed professional counselors, or
licensed master social workers-advanced clinical practitioners acting within their scope of
practice. Supervision in this section means participation in the initial and annual
comprehensive assessment of the child as well as participation in the initial and annual
development of the IFSP and any subsequent revisions of the plan that result in service
changes.
(c) Developmental Rehabilitation Services are not reimbursable as Medicaid services
when:
(1) provided to children with a diagnosis of a developmental disability defined as a
severe, chronic disability of a person which:
(A) is attributable to mental or physical impairment or combination of mental and
physical impairments;
(B) is manifested before the person attains age 22;
(C) is likely to continue indefinitely;
(D) results in substantial functional limitations in three or more of the following areas of
major life activity: self-care, receptive and expressive language, learning, mobility, selfdirection, capacity for independent living, or economic self-sufficiency, or a diagnosis of
mental retardation; or
(2) the services are guaranteed under the provisions of Individuals with Disabilities
Education Act (IDEA) Part B.
§108.503. Recipient Eligibility for Services Funded by the Developmental Rehabilitation
Services Program
In order to receive Developmental Rehabilitation Services the recipient:
(1) must be enrolled in the Texas Medical Assistance Program;
(2) must be age 21 and under;
(3) must demonstrate the need for these services as documented in an active
Individualized Family Service Plan (IFSP) developed in accordance with 40 TAC §108.5
of this chapter (relating to Service Delivery Requirements for Early Intervention
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Services).§108.505. Conditions for Provider Participation in the Developmental
Rehabilitation Services Program(a) In accordance with the regulations at 42 CFR
§431.51, all willing and qualified providers may participate in this program.
(b) In order to be reimbursed for developmental rehabilitation services as specified in
§108.501 of this subchapter (relating to Reimbursable Services), a provider must:
(1) meet applicable state and federal laws governing the participation of providers in the
Medicaid Program;
(2) sign a provider agreement with the Medicaid single state agency;
(3) be certified by the Department;
(4) provide services under the supervision of a person authorized to supervise these
services in the Texas Medicaid State Plan, including a licensed physician, registered
nurse, licensed physical therapist, licensed occupational therapist, licensed speech
language pathologist, licensed professional counselor, or licensed master social workeradvanced clinical practitioner acting within their scope of practice who are employed as
agency or contract staff, or developmental rehabilitation services by a:
(A) licensed therapist,
(B) licensed counselor,
(C) licensed social worker,
(D) registered nurse,
(E) Early Intervention Specialist (EIS) professional participating in or certified through
the ECI Competency Demonstration System,
(F) certified teacher certified through the ECI Competency Demonstration System, or
(G) psychological associate;
(5) provide to the maximum extent appropriate to the needs of the child, early
intervention services in natural environments, including home and community settings in
which children without disabilities participate. Natural environments mean settings that
are natural or normal for the child's age peers who have no disabilities; and
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(6) deliver services in accordance with the scope and duration of the Individualized
Family Service Plan (IFSP).]
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TITLE 40. SOCIAL SERVICES AND ASSISTANCE
PART 2. DEPARTMENT OF ASSISTIVE AND REHABILITATIVE SERVICES
CHAPTER 108. DIVISION FOR EARLY CHILDHOOD INTERVENTION
SERVICES
SUBCHAPTER E. SPECIALIZED SKILLS TRAINING
§108.501. Specialized Skills Training (Developmental Services)
(a) Specialized skills training (developmental services) are rehabilitative services to
promote age-appropriate development by providing skills training to correct deficits and
teach compensatory skills for deficits that directly result from medical, developmental or
other health-related conditions.
(b) Services must:
(1) be designed to create learning environments and activities that promote the child’s
acquisition of skills in one or more of the following developmental areas:
physical/motor, communication, adaptive, cognitive, social/emotional and sensory;
(2) include skills training and anticipatory guidance for family members, or other
significant caregivers to ensure effective treatment and to enhance the child’s
development;
(3) be provided in the child’s natural environment, as defined in 34 CFR Part 303, unless
the criteria listed at 34 CFR §303.167 are met and documented in the case record; and
(4) be provided on an individual or group basis.
(c) In addition to the criteria in paragraph (b) of this section, group services must be:
(1) recommended by the interdisciplinary team and documented on the IFSP, only when
participation in the group will assist the child reach the outcomes in the IFSP;
(2) planned as part of an IFSP that also contains individual services; and
(3) be limited to no more than four children and their parent(s) or other significant
caregiver(s).
(d) Staff Qualifications. Specialized skills training must be provided by an Early
Intervention Specialist as defined in §108.3 of this chapter (relating to Definitions).
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(e) Service Authorization.
(1) Specialized skills training must be recommended by an interdisciplinary team that
includes a physician or licensed practitioner of the healing arts and be documented in an
Individualized Family Service Plan (IFSP) as defined in §108.17 of this chapter (relating
to Individualized Family Service Plan (IFSP).
(2) Services must be monitored at least once every six months to determine if services are
reducing the child’s functional limitations, promoting age appropriate growth and
development, and are responsive to the family’s identified goals for the child.
Monitoring should occur as part of the IFSP review and must be documented in the case
record.
(f) Documentation. Documentation of each specialized skills training contact must
include:
(1) the name of the child;
(2) the name of the ECI contractor and Early Intervention Specialist;
(3) the date, time, duration and place of service;
(4) type of service (individual or group);
(5) a description of the contact including a summary of activities and the family or
primary caregiver’s level of involvement;
(6) the IFSP goal which was the focus of the intervention;
(7) the child’s progress;
(8) relevant new information about the child provided by the family or other significant
caregiver; and
(9) the Early Intervention Specialist’s signature.
§108.503. Recipient Eligibility
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In order to receive ECI specialized skills training; the child must meet the following
criteria:
(1) eligibility criteria established in §108.7 of this chapter (relating to Client Eligibility),
and
(2) have a need for specialized skills training as determined by the interdisciplinary team
and identified on the IFSP which has been signed by a physician or licensed professional
of the healing arts.
§108.505. Conditions for Provider Agency Participation
In order to be reimbursed for services specified in §108.501 of this subchapter (relating to
Specialized Skills Training (Developmental Services), a provider must:
(1) be an Early Childhood Intervention contractor of the Department of Assistive and
Rehabilitative Services;
(2) comply with applicable federal and state laws and regulations governing the services
provided;
(3) ensure that services are provided by an Early Intervention Specialist defined in §108.3
of this chapter (relating to Definitions); and
(4) be responsible for the Early Intervention Specialist’s compliance with this subchapter.
§108.507. Due Process
(a) Medicaid-eligible individuals. Any Medicaid-eligible individual whose request for
eligibility for specialized skills training is denied or is not acted upon with reasonable
promptness, or whose specialized skills training has been terminated, suspended, or
reduced is entitled to a fair hearing in accordance with 1 TAC Chapter 357, Subchapter A
(relating to Uniform Fair Hearing Rules).
(b) All individuals. If an ECI contractor denies, involuntarily reduces, or terminates
specialized skills training for an individual, the individual has all rights to file complaints,
request mediation, or request a hearing in accordance with Subchapter B of this chapter
(relating to Procedural Safeguards and Due Process Procedures) and in accordance with
Chapter 101 of this title (relating to Administrative Rules and Procedures), Subchapter J,
Division 3.
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