TO:
DATE:
Medical Care Advisory Committee
February 14, 2013
FROM: Tim Villasana, Health and Human Services Commission
Agenda Item No.: 17
SUBJECT: Medicaid Reimbursement for Provisionally Licensed Psychologists. Amendments to: Title 1, Part 15, Chapter 355, Subchapter J, Division 5, §355.8081, Payments for Laboratory and X-ray Services, Radiation Therapy, Physical Therapists' Services, Physician Services,
Podiatry Services, Chiropractic Services, Optometric Services, Ambulance Services, Dentists'
Services, Psychologists' Services, Licensed Psychological Associates' Services, Maternity Clinic
Services, and Tuberculosis Clinic Services
BACKGROUND: Federal Requirement Legislative Requirement Other:
The proposed rule is a result of provider concerns regarding Medicaid policies and reimbursement for provisionally licensed psychologists (PLP). Services provided by a licensed psychological associate (LPA) supervised by a licensed psychologist are currently reimbursed by Medicaid. LPA is a profession that requires a master’s degree. However, if an LPA completes their doctoral degree and becomes a PLP providing services under the supervision of a licensed psychologist, they are no longer eligible for Medicaid reimbursement. This proposed rule amendment adds PLPs as reimbursable Medicaid providers.
The addition of PLPs as eligible Medicaid providers is not expected to increase Medicaid utilization or cost because they are already providing services to clients as LPAs before completing their doctoral degree and passing the required examinations. The rule proposes to reimburse PLPs at 70 percent of the Medicaid rate paid to licensed psychologists. This methodology is consistent with that for LPAs, whose services are currently reimbursed 70 percent of the Medicaid rate for licensed psychologists.
ISSUES AND ALTERNATIVES:
None.
STAKEHOLDER INVOLVEMENT:
This rule has been shared with stakeholders including: Federation of Texas Psychiatrists,
Disability Rights Texas, Mental Health America Texas, National Alliance on Mental Illness,
Texas Psychological Association and other interested stakeholders.
FISCAL IMPACT:
None Yes
RULE DEVELOPMENT SCHEDULE:

February 14, 2013 Present to the Medical Care Advisory Committee
February 28, 2013 Present to Health and Human Services Commission Council
May 2013 Publish proposed rule in the Texas Register
August 2013 Publish adopted rule in the Texas Register
September 1, 2013 Rule effective date
REQUESTED ACTION:
The MCAC recommends approval of the proposed rule for publication.
The Council recommends approval of this rule.
Information Only

TITLE 1
PART 15
CHAPTER 355
ADMINISTRATION
TEXAS HEALTH AND HUMAN SERVICES COMMISSION
REIMBURSEMENT RATES
SUBCHAPTER J PURCHASED HEALTH SERVICES
DIVISION 5 GENERAL ADMINISTRATION
RULE §355.8081
Payments for Laboratory and X-ray Services, Radiation Therapy, Physical
Therapists' Services, Physician Services, Podiatry Services, Chiropractic
Services, Optometric Services, Ambulance Services, Dentists' Services,
Psychologists' Services, Licensed Psychological Associates' Services,
Maternity Clinic Services, and Tuberculosis Clinic Services
PROPOSED PREAMBLE
The Texas Health and Human Services Commission (HHSC) proposes to amend §355.8081 concerning Payments for Laboratory and X-ray Services, Radiation Therapy, Physical
Therapists' Services, Physician Services, Podiatry Services, Chiropractic Services, Optometric
Services, Ambulance Services, Dentists' Services, Psychologists' Services, Licensed
Psychological Associates' Services, Maternity Clinic Services, and Tuberculosis Clinic Services.
The amended rule will allow HHSC to reimburse for the Medicaid services provided by a provisionally licensed psychologist (PLP) who is under the supervision of a licensed psychologist.
Background and Justification
The proposed rule is a result of provider concerns regarding Medicaid policies and reimbursement for PLPs. PLPs are one of three types of licensed psychological professionals: licensed psychological associate (LPA); PLP; and licensed psychologist. An LPA is a professional with a master's degree that is primarily psychological in nature, while a PLP is a professional with a doctoral degree in psychology. Both an LPA and a PLP must pass requisite examinations, but a PLP must obtain a higher score to pass. To obtain licensure as a psychologist, an individual must be a licensed PLP, have two years of supervised experience, and pass his or her oral examination. See
22 Tex. Admin. Code §§ 463.1, .10, .11 (Tex. State
Bd. of Exam'rs of Psychologists, Licensed Psychological Associate, Provisionally Licensed
Psychologists, Licensed Psychologist).
Currently, HHSC reimburses for Medicaid services provided by a LPA supervised by a licensed psychologist, while HHSC does not reimburse for Medicaid services provided by a PLP who is supervised by a licensed psychologist. Thus, under the current rules, if an LPA completes a doctoral degree program in psychology and becomes a PLP providing services under the supervision of a licensed psychologist, the PLP is no longer eligible for Medicaid reimbursement. The PLP is again eligible for Medicaid reimbursement once he or she becomes a licensed psychologist.
The rule proposes to reimburse PLPs at 70 percent of the Medicaid rate paid to licensed psychologists. This methodology is consistent with that for LPAs who are currently reimbursed
70 percent of the Medicaid rate for licensed psychologists.

The addition of PLPs as eligible Medicaid providers is not expected to increase Medicaid utilization or cost because they are already providing services to clients as LPAs before completing their doctoral degree and passing the required examinations.
Section-by-Section Summary
Proposed §355.8081(a) adds Provisionally Licensed Psychologists as an eligible provider type and updates a reference. The proposal also clarifies that psychologists and licensed psychological associates are eligible provider types and renumbers the remaining paragraphs.
Proposed §355.8081(c) adds PLPs as payable Medicaid providers at 70 percent of the rate payable to a licensed psychologist.
Fiscal Note
Greta Rymal, Deputy Executive Commissioner for Financial Services, has determined that during the first five-year period the amendment is in effect there will be no fiscal impact to state government or local governments.
Ms. Rymal does not anticipate that there will be any economic costs to persons who are required to comply with the amendment. There is no anticipated negative effect on local employment in geographic areas affected by the amendment.
Small and Micro-business Impact Analysis
HHSC has determined that there will be no adverse economic effect on small or microbusinesses as a result of enforcing or administering the amendment as there is no reduction to revenue or increase to costs of providers.
Public Benefit
Pam McDonald, Director of Rate Analysis, has determined that for each of the first five years the amendment is in effect, the expected public benefit is increased access to services for Medicaid beneficiaries as a result of adding provisionally licensed psychologists as payable Medicaid providers.
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 that is specifically intended 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 Dan Huggins, Director of Acute Care,
Rate Analysis Department, Texas Health and Human Services Commission, P.O. Box 85200,
MC-H400, Austin, Texas 78708-5200; by fax to (512) 491-1998; or by e-mail to
Dan.Huggins@hhsc.state.tx.us
within 30 days of publication of this proposal in the Texas
Register .
Statutory Authority
The amendment is proposed under Texas Government Code §531.033, which authorizes the
Executive Commissioner of HHSC to adopt rules necessary to carry out the commission’s duties;
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; and Texas Government Code §531.021(b), which establishes HHSC as the agency responsible for adopting reasonable rules governing the determination of fees, charges, and rates for medical assistance payments under the Human Resources Code, Chapter 32.
The amendment affects the Human Resources Code, Chapter 32, and the 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 ADMINISTRATION
PART 15
CHAPTER 355
TEXAS HEALTH AND HUMAN SERVICES COMMISSION
REIMBURSEMENT RATES
SUBCHAPTER J PURCHASED HEALTH SERVICES
DIVISION 5 GENERAL ADMINISTRATION
RULE §355.8081
Reimbursement Methodology [Payments] for Laboratory and X-ray
Services, Radiation Therapy, Physical Therapists' Services, Physician
Services, Podiatry Services, Chiropractic Services, Optometric
Services, Ambulance Services, Dentists' Services, Psychologists'
Services, Licensed Psychological Associates' Services, Provisionally
Licensed Psychologists’ Services, Maternity Clinic Services, and
Tuberculosis Clinic Services
(a) Subject to qualifications, limitations, and exclusions as provided in this chapter, payment to eligible providers must not exceed the lesser of the provider's billed amount or the amount derived from the methodology described in §355.8085 of this title (relating to [Texas Medicaid]
Reimbursement Methodology [(TMRM)] for Physicians and [Certain] Other Practitioners).
Eligible providers include:
(1) Providers of Laboratory and X-ray Services;
(2) Providers of Radiation Therapy;
(3) Physical Therapists;
(4) Physicians;
(5) Podiatrists;
(6) Chiropractors;
(7) Optometrists;
(8) Dentists;
(9) Psychologists;
(10) Licensed Psychological Associates;
(11) Provisionally Licensed Psychologists;
(12) [(9)] Maternity clinics; and
(13) [(10)] Tuberculosis clinics.
(b) Reimbursement for ambulance services is described in §355.8600 of this title (relating to
Reimbursement for Ambulance Services). Reimbursement for clinical laboratory services is described in §355.8610 of this title (relating to Reimbursement for Clinical Laboratory Services).

(c) Reimbursement for services provided by a licensed psychologist is described in §355.8085 of this title. Reimbursement for services provided by a licensed psychological associate (LPA) or a provisionally licensed psychologist (PLP) under the supervision of a licensed psychologist is reimbursed to the licensed psychologist at 70 percent of the fee paid to the licensed psychologist for the same service.