TO:
Medical Care Advisory Committee
DATE:
February 14, 2013
FROM:
Patricia Hervey, Associate Director for Operations Oversight,
Health and Human Services Commission
Agenda Item No.: 16
SUBJECT: Provisionally Licensed Psychologist Services. Amendments to: Title 1, Part 15,
Chapter 354, Subchapter A, Division 19, Psychologists’ Services, §354.1281.
BACKGROUND:
Initiative
Federal Requirement
Legislative Requirement
Other: HHSC
The Texas Health and Human Services Commission (HHSC) proposes to amend §354.1281,
concerning psychologists’ services benefits and limitations.
The Texas Medicaid program currently covers psychological counseling and services provided
by a licensed psychologist or by a licensed psychological associate (LPA) if: the LPA's services
are performed under the direct supervision of a licensed psychologist who is in the same office,
building, or facility when and where the service is provided and is immediately available to
furnish assistance and direction; and the LPA performing the service is an employee of either the
licensed psychologist or the legal entity that employs the licensed psychologist.
The proposed rule amendment adds provisionally licensed psychologists (PLP) as another type
of provider who can perform psychological counseling and services under the direct supervision
of a licensed psychologist. Under the rules of the Texas State Board of Examiners of
Psychologists (TSBEP), an individual who is a licensed psychologist is an individual who holds
a doctoral level license for the independent practice of psychology; a PLP is an individual who
holds a doctoral level license to practice under the supervision of a licensed psychologist; and an
LPA is an individual who holds a sub-doctoral license to practice psychology under the
supervision of a licensed psychologist.
Under the current rule, if an individual who is an LPA completes his or her doctoral degree and
becomes a PLP, the individual's services are not eligible for Medicaid reimbursement to the
licensed psychologist until the LPA becomes a licensed psychologist. Under the existing rule, a
Medicaid recipient under the care of an LPA has to find a new provider after the LPA becomes a
PLP. Therefore, HHSC proposes to amend the current rule to cover services provided by a PLP
under the same conditions as those provided by an LPA. Services provided by the PLP will be
reimbursed to the supervising psychologist or legal entity employing the supervising
psychologist at fees determined by HHSC.
The amendment is also proposed to clarify and update terminology.
ISSUES AND ALTERNATIVES:
The alternative to the proposed amendment is to not allow licensed psychologist to bill Medicaid
for PLP services.
STAKEHOLDER INVOLVEMENT:
The proposed rule amendment was sent to external stakeholders for review. Various stakeholders
who reviewed the proposed rule amendment voiced concerns both in favor of and against the
changes. Comments received from stakeholders were reviewed by HHSC staff and taken into
consideration. External stakeholders included:
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Council on Advising and Planning for Preventative Treatment of Mental and Substance
Abuse
Disability Rights Texas
Federation of Texas Psychiatrists
Local Authority Network Advisory Committee
Mental Health America Texas
National Alliance on Mental Illness
National Association of Social Workers Texas Chapter
Texas Council of Community Centers and LMHA Staff
Texas Hospital Association
Texas Psychological Association
Texas Medical Association
Texas Nurses Association
Behavioral Health Advocates of Texas
Texas Counseling Association
Texas Osteopathic Medical Association
FISCAL IMPACT:
None
Yes
RULE DEVELOPMENT SCHEDULE:
February 14, 2013
February 28, 2013
May 2013
August 2013
September 1, 2013
Present to the Medical Care Advisory Committee
Present to Health and Human Services Commission Council
Publish proposed rules in Texas Register
Publish adopted rules in Texas Register
Effective date
REQUESTED ACTION:
The MCAC recommends approval of the proposed rules for publication.
The Council recommends approval of this rule.
Information Only
TITLE 1
PART 15
CHAPTER 354
SUBCHAPTER A
DIVISION 19
RULE § 354.1281
ADMINISTRATION
TEXAS HEALTH AND HUMAN SERVICES COMMISSION
MEDICAID HEALTH SERVICES
PURCHASED HEALTH SERVICES
PSYCHOLOGISTS’ SERVICES
Benefits and Limitations
PROPOSED PREAMBLE
The Texas Health and Human Services Commission (HHSC) proposes to amend §354.1281,
concerning psychologists’ services benefits and limitations.
Background and Justification
The Texas Medicaid program currently covers psychological counseling and services provided
by a licensed psychologist or by a licensed psychological associate (LPA) if: the LPA's services
are performed under the direct supervision of a licensed psychologist who is in the same office,
building, or facility when and where the service is provided and is immediately available to
furnish assistance and direction; and the LPA performing the service is an employee of either the
licensed psychologist or the legal entity that employs the licensed psychologist.
The proposed rule amendment adds provisionally licensed psychologists (PLP) as another type
of provider who can perform psychological counseling and services under the direct supervision
of a licensed psychologist. Under the rules of the Texas State Board of Examiners of
Psychologists (TSBEP), an individual who is a licensed psychologist is an individual who holds
a doctoral level license for the independent practice of psychology; a PLP is an individual who
holds a doctoral level license to practice under the supervision of a licensed psychologist; and an
LPA is an individual who holds a sub-doctoral license to practice psychology under the
supervision of a licensed psychologist.
Under the current rule, if an individual who is an LPA completes his or her doctoral degree and
becomes a PLP, the individual's services are not eligible for Medicaid reimbursement to the
licensed psychologist until the LPA becomes a licensed psychologist. Under the existing rule, a
Medicaid recipient under the care of an LPA has to find a new provider after the LPA becomes a
PLP. Therefore, HHSC proposes to amend the current rule to cover services provided by a PLP
under the same conditions as those provided by an LPA. Services provided by the PLP will be
reimbursed to the supervising psychologist or legal entity employing the supervising
psychologist at fees determined by HHSC.
The amendment is also proposed to clarify and update terminology.
Section-by-Section Summary
In subsection (b) (1) and (2), the proposed amendment clarifies that a licensed psychologist and
an LPA are licensed by the Texas State Board of Examiners of Psychologist.
In subsection (b) (3), the proposed amendment explains the conditions under which the Texas
Medicaid program covers services provided by a provisionally licensed psychologist (PLP).
Throughout the proposed amendment, the term “Texas Medical Assistance Program” is revised
to “Texas Medicaid program” to reflect the program’s more common name.
Fiscal Note
Greta Rymal, Deputy Executive Commissioner for Financial Services, has determined that
during the first five-year period the proposed rule is in effect, there will be no fiscal impact to the
state or local governments.
There are no anticipated economic costs to persons who are required to comply with the
proposed rule as they will not be required to alter their current business practices in response to
this proposal. There is no anticipated negative impact on local employment.
Small and Micro-business Impact Analysis
Ms. Rymal has also determined that there will be no adverse economic effect on small businesses
or micro businesses to comply with the proposal, because the amendment will result in neither
revenue reductions nor cost increases to providers.
Public Benefit
Chris Traylor, Chief Deputy Commissioner, has determined that for each year of the first five
years the proposal is in effect, the public will benefit from the adoption of the amendment. The
anticipated public benefit as a result of enforcing the proposed amended rule will be to allow
Medicaid recipients to continue receiving services from the same individual during the interim
when the individual transitions from an LPA to a PLP to a licensed psychologist.
Regulatory Analysis
HHSC has determined that this proposal is not a “major environmental rule” as defined by
§2001.0225 of the Texas Government Code. A “major environmental rule” is defined to mean a
rule the specific intent of which is to protect the environment or reduce risk to human health
from environmental exposure and that may adversely affect, in a material way, the economy, a
sector of the economy, productivity, competition, jobs, the environment, or the public health and
safety of a state or a sector of the state. This proposal is not specifically intended to protect the
environment or reduce risks to human health from environmental exposure.
Takings Impact Assessment
HHSC has determined that this proposal does not restrict or limit an owner’s right to his or her
private real property that would otherwise exist in the absence of government action and,
therefore, does not constitute a taking under §2007.043 of the Government Code.
Public Comment
Written comments on the proposal may be submitted to Peggy Atkins, Senior Policy Analyst,
Operations Oversight, Medicaid/CHIP Division, Mail Code H390-91X, Texas Health and
Human Services Commission, P. O. Box 85200 Austin Texas, 78708-5200; by fax to (512)-2493707; or by e-mail to peggy.atkins@hhsc.state.tx.us within 30 days of publication of this
proposal in the Texas Register.
Public Hearing
A public hearing is scheduled for (Date) from (Start Time) to (End Time) (central time) in the
(Location and Address). Persons requiring further information, special assistance, or
accommodations should contact Leigh Van Kirk at (512) 491-2813.
Statutory Authority
The amendment is proposed under Texas Government Code §531.033, which provides the
Executive Commissioner of HHSC with broad rulemaking authority; and Texas Human
Resources Code §32.021 and Texas Government Code §531.021(a), which provide HHSC with
the authority to administer the federal medical assistance (Medicaid) program in Texas.
The proposed amendment affects Texas Human Resources Code Chapter 32, and Texas
Government Code Chapter 531. No other statutes, articles, or codes are affected by this
proposal.
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.
TITLE 1
PART 15
CHAPTER 354
SUBCHAPTER A
DIVISION 19
RULE §354.1281
ADMINISTRATION
TEXAS HEALTH AND HUMAN SERVICES COMMISSION
MEDICAID HEALTH SERVICES
PURCHASED HEALTH SERVICES
PSYCHOLOGISTS’ SERVICES
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 [when the following conditions are met]:
(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 [Medical Assistance
Program] when they are provided by a licensed physician (MD or DO).
(2) Licensed psychological associate (LPA) who is licensed by TSBEP, if [when the following
conditions are met]:
(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 [Medical Assistance 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 [Medical Assistance
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 [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
Medicaid program [Medical Assistance Program] as appropriate for the services and provider(s)
involved.