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13.d EPSDT Developmental Rehabilitation Services
Service Definition
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:
- Identifies the needs related to an individual's disability or chronic or complex condition(s) or developmental delay;
- Describes the course of action developed to meet those needs; and
- Identifies the person or persons responsible for each action in the plan.
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.
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Service Limitations
- These services are not provided to children with a diagnosisof Mental Retardation or Developmental Disability.
- These services do not include services guaranteed under the provisions of IDEA, Part B.
Client Eligibility
Eligibility criteria for Medicaid eligibles to receive Developmental Rehabilitation Services are:
- Under age 21;
- Demonstrates the need for these services as documented in an
active Individualized Family Service Plan (IFSP).
Providers
In accordance with the regulations at 42 CFR 431.51, all willing and
qualified providers may participate in this program.
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:
- Must meet applicable State and Federal laws governing the participation of providers in the Medicaid program;
- Must sign a provider agreement with the single state agency; and
- Must be certified by the Texas Interagency Council on Early Childhood Intervention, the State program for infants and toddlers with developmental delays.
Developmental Rehabilitation Services provider organizations must
ensure that Developmental Rehabilitation Services are:
- Provided on a statewide basis within designated service delivery areas to ensure continuity of services without duplication;
- Provided by or under the supervision of agency or contract staff practicing within the scope of their license or certification. This includes:
- Licensed Occupational Therapists,
- Licensed Physical Therapists,
- Licensed Speech Language Pathologists,
- Licensed Professional Counselors,
- Licensed Master Social Worker Advanced Clinical Practitioners, Registered Nurses.
Developmental Rehabilitation Services may be provided by:
- Licensed Occupational Therapists,
- Licensed Physical Therapists,
- Licensed Speech Language Pathologists,
- Licensed Counselors,
- Licensed Social Workers,
- Registered Nurses,
- Early Intervention Specialist (EIS) professionals participating in or certified through the ECI Competency Demonstration System, Certified Teachers certified through the ECI Competency Demonstration System or certified in early childhood, special education, or elementary education;
- Psychological Associates;
- Made available to all eligible children; and
- Delivered in accordance with the scope and duration of the Individualized Family Service Plan (IFSP).
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47. Reimbursement Methodology
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:
- Salaries and benefits for staff delivering developmental rehabilitation services are added to allocated costs for ECI overhead and host agency administration costs. Allocations are made using time study information from the TAFI reports.
- These total costs for developmental rehabilitation services are divided by the total direct service hours to calculate a cost per hour.
- The resulting total cost per hour for developmental rehabilitation services is projected from the historical reporting period to the prospective rate period using the Personal Consumption Expenditures (PCE) Chain-Type Index.
- The projected total cost per hour for developmental rehabilitation services is the proposed reimbursement rate. The reimbursement rate will be paid on an hourly basis, and will be pro-rated for 15-minute intervals.
- The providers' reported costs will be examined annually to determine if it is necessary to re-base the rate.
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.
