13.d EPSDT Developmental Rehabilitation Services
Developmental Rehabilitation Services include 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 intervention strategies into the daily routines of a 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. Developmental Rehabilitation 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. These services are performed per an active Individualized Family Service Plan (IFSP) established by or in consultation with a licensed physician, a licensed occupational therapist, licensed physical therapist, licensed speech language pathologist, licensed professional counselor, licensed master social worker-advanced clinical practitioner, or registered nurse.
An IFSP is the written plan of care which:
The IFSP is developed by an interdisciplinary team consisting of a minimum of two fully qualified professionals from different disciplines, the assigned service coordinator, and the parent(s) or guardian(s) of the child.
Developmental Rehabilitation Services are performed by or under the supervision of a licensed physician or other health care professional acting within their scope of practice. These rehabilitative services include, but are not limited to: developmentally appropriate individualized skills training and support to foster, promote, and enhance child engagement in daily activities, functional independence, and social interaction; 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; and continuous monitoring of child progress in the acquisition and mastery of functional skills to reduce or overcome limitations resulting from disabilities or developmental delays.
Developmental Rehabilitation Services Provider Conditions for Participation: Each Developmental Rehabilitation Services Provider organization must meet the following criteria established by the Texas Early Childhood Intervention Program to become a provider of developmental rehabilitation services to children with developmental delays:
Developmental Rehabilitation Services provider organizations must ensure that Developmental Rehabilitation Services are:
Developmental Rehabilitation Services may be provided by:
The Commission determines a prospective uniform reimbursement rate for the Texas Early Childhood Intervention Program (ECI) Medicaid programs. ECI reimburses Early Childhood Intervention program providers according to the reimbursement methodology. The Commission determines the rate based on costs contained in the ECI providers ' Time and Financial Information (TAFI) reports, which are reported on a quarterly basis. ECI staff develops the proposed statewide reimbursement rate and recommends it to HHSC. The recommended rate is determined in the following manner:
The Commission establishes the reimbursement rate in an open meeting after consideration of financial and statistical information and public testimony. The Commission sets a rate that, in its opinion, is within budgetary constraints, adequate to reimburse the cost of operations for an efficient and economic provider, and justifiable given current economic conditions.