Revisions

20-1, Chapter 13 Changes

Effective February 25, 2020

 

The following changes were made:

Chapter Title Change
Chapter 13,
13.1
Overview Adds for outpatient therapy services, the participant must have a traumatic brain injury (TBI) or a traumatic spinal cord injury (TSCI).
Chapter 13,
13.5
Customer Satisfaction Corrects the word “Neither” in the Likert Scale.
Chapter 13,
13.6.1
Licensure and Accreditation Updates required licensure for post-acute rehabilitation services (PARS) residential.
Chapter 13,
13.7.1
Licensure and Accreditation Deletes “registered with the Executive Council of Physical Therapy and Occupational Therapy Examiners” and adds “licensed by HHS as a home and community support services agency.”
Chapter 13,
13.8
Outpatient Therapy Adds Chapters 13.8, 13.8.1, 13.8.2 and 18.8.3 regarding outpatient therapy, including licensure and accreditation, billing guidelines, and exceptions and limitations.

19-2, Miscellaneous Changes

Effective June 1, 2019

 

The following changes were made:

Chapter Title Change
Chapter 10 Section 4 Interdisciplinary Team Meetings Adds that Interdisciplinary Team Meeting is the same as Medical Team Conference.
Appendix A Definitions Adds Medical Team Conference.
Appendix B Post-Acute Rehabilitation Core Services Modality and Staff Qualifications

Adds Certified Music Therapist to Music Therapy under Core Services.

Adds Case Management to Modality and Staff Qualifications for PARS Non-Residential.

19-1, May 1, 2019

Effective May 1, 2019

 

The following changes were made:

Chapter Title Change
Chapter 1 CRS Program Overview Updates CRS contact information.
Chapter 1 Section 2 Referrals to CRS Adds the referral form, process and contact information.
Chapter 3 Section 2 Language Services Adds Language Services Standard for providers.
Chapter 3 Section 4 Facility Safety Protocol
  • Updates when and where to report incidents to CRS.
  • Adds substance abuse, inappropriate behavior that may have participant dismissed from facility, and elopement.
Chapter 4 Section 5 Staff Training Adds Cardiopulmonary arrest (CPR), Basic Life Support (BLS) training and Fall Prevention.
Chapter 4 Section 6 Staff Qualifications Adds qualification of Community Independence Supports (CIS).
Chapter 5 Section 1 Overview Updates when and where to report incidents to CRS.
Chapter 5 Section 3 CRS Service Number Adds ombudsman’s number and CRS email because CRS does not have a direct phone line.
Chapter 5 Section 4 Grievance Procedure Updates ombudsman’s contact information.
Chapter 6 Section 4 Invoices
  • Updates to match updated TAC §20.487.
  • Adds CRS Program responsibility.
Chapter 6 Section 5 Use of Comparable Benefits or Third Party Billing Adds amount CRS pays if a participant is using their insurance's out of network provider.
Chapter 7 Section 2 Quality Reviews Adds services that are billed and paid based on services and contracted rate.
Chapter 8 Compliance and Quality Review for Traumatic Brain Injury Changes Utilization Review to Compliance and Quality Review.
Chapter 8 Section 2 Review Types
  • Notes changes to types of review names.
  • Adds purchasing review.
Chapter 8 Section 4 Prospective Reviews Changes title to Clinical Reviews and adds detail of what a clinical review covers.
Chapter 8 Section 5 Concurrent and/or Retrospective Reviews Changes title to Purchasing Reviews and adds detail of what a clinical review covers.
Chapter 9 Section 1 Overview
  • Adds changes and updates to provider’s admission policies and procedures including that they need to be reported to CRS when complete.
  • Moves referral information to Chapter 1, Section 2.
Chapter 9 Section 2 Intake Process Adds information that providers must have participants sign an intake acknowledgement form and must place the form in the participant’s file.
Chapter 10 Section 2 Assessment
  • Adds information about discharge planning utilizing the wraparound approach.
  • Adds mental health and substance misuse needs.
Chapter 10 Section 3 Development of Individualized Service Plan Adds this section.
Chapter 10 Section 4 Interdisciplinary Team Meetings
  • Adds the professional staff who are included in the IDT team and credentialing information needed.
  • Adds IDT team process including changing meetings to every 30 days, what needs reviewing for the participant and how to notify the IDT team.
Chapter 10 Section 5 Behavior Management Plans
  • Adds information about behavior management plans and what they address.
  • Adds information about who signs the informed conformed consent.
Chapter 10 Section 6 Emergency Restrictive Procedures Adds procedure for minors who receive chemical or physical restraints more than once within 30 days.
Chapter 11 Section 2 Required Documentation Adds that PM&R physician overseeing the participant’s care while in ICMRS is a separate service requiring pre-authorization.
Chapter 11 Section 3 Assessment, Planning and Interdisciplinary Meetings Adds Assessment, Planning and Interdisciplinary Meetings section.
Chapter 11 Section 4 Billing Guidelines Updates billing guidelines and when invoices must be submitted.
Chapter 12 Section 1 Overview Clarifies what outpatient therapy services refer to and where they are referenced.
Chapter 12 Section 3 Assessment, Planning and Interdisciplinary Meetings
  • Adds Assessment, Planning and Interdisciplinary Meetings section.
  • Notes that outpatient services differ from Post-acute rehabilitation services (PARS) non-residential services.
Chapter 12 Section 4 Billing Guidelines Updates billing guidelines and when invoices must be submitted.
Chapter 13 Section 1 Overview Adds link for updated rates.
Chapter 13 Section 2 Required Documentation Adds information for providers about required documentation.
Chapter 13 Section 3 Assessment and Planning
  • Changes title to Assessment, Planning and Interdisciplinary Meetings.
  • Moves part of this section to Chapter 10, Section 2.
Chapter 13 Section 6 Item 1 Licensure and Accreditation Changes Department of Aging and Disability Services to Texas Health and Human Services.
Chapter 13 Section 6 Item 7 Utilization Review Removes this section.
Chapter 13 Section 6 Item 7 Exceptions and Limitations Updates therapeutic passes.
Chapter 13 Section 7 Non-Residential Adds post-acute rehabilitation non-residential services to also include case management, community independence supports, medical team conferences.
Chapter 13 Section 7 Item 1 Licensure and Accreditation Changes Department of Aging and Disability Services to Texas Health and Human Services.
Chapter 13 Section 7 Item 3 Billing Guidelines Adds uploading into CRS Data Reporting System.
Chapter 14 Section 1 Overview Adds information about meeting treatment goals.
Chapter 14 Section 2 Durable Medical Equipment Adds this section.
Chapter 14 Section 3 Home Modification Adds this section.
Chapter 14 Section 4 Required Documentation Adds requirements for receiving durable medical equipment.
Chapter 14 Section 5 Billing Guidelines Updates billing guideline requirements for providers for ancillary goods and services and DME.
Chapter 14 Section 6 Exceptions and Limitations Updates this section with what is covered under the CRS program as well as when competitive bids are required.
Chapter 15 Section 1 Overview Adds information about discharge planning.
Chapter 15 Section 3 Termination from Program Adds information about providers documenting attempted interventions.
Appendix A Definitions Adds the following terms:
  • Abuse
  • Ancillary services
  • Assistive Technology
  • Authorized representative
  • Certified Brain Injury Specialist (CBIS)
  • Community Independence Supports (CIS)
  • Comparable benefits
  • Competitive bid
  • Compliance
  • Glasgow Coma Scale (GCS)
  • Texas Identification Number (TIN)
Edits the following terms:
  • Mental restoration services to mental health counseling
  • Paraprofessional
Removes the following:
  • Utilization Review
Appendix B Post-Acute Rehabilitation Core Services Modality and Staff Qualifications
  • Changes code numbering.
  • Changes Mental Restoration to Mental Health Counseling.
  • Changes Modality and Staff Qualifications for PARS Non-Residential.
Appendix C Base Services and Tier Structure Changes title to PARS Residential Base Services and Tier Structure
Appendix D Service Record for CRS Data Reporting System Adds clarification text.

17-1, Chapter 13.6.2, Billing Guidelines - Tiers

Effective September 1, 2017

 

The following changes were made:

Chapter Title Change
13.6.2 Billing Guidelines - Tiers Adds based on the consumer’s need, which will be determined during the initial pre-admission assessment, the provider may request an admission tier of level 2 through level 8. This request is to be submitted in writing using Form 3149, Comprehensive Rehabilitation Services Request for Tier Change, or included in the pre-admission evaluation, which identifies services needed, frequency, duration and requested tier. Explains when submitting an invoice, Post-Acute Rehabilitation providers are required to submit a monthly summary that includes a descriptive breakdown of services provided; frequency, duration, progress, or lack of progress made towards the consumer's goals; actions to be taken; and preliminary discharge information. Providers are also required to upload service record details of daily services provided in the CRS Data Reporting System, per Chapter 13.2, Required Documentation. Providers will only be required to submit daily therapy documentation if a consumer's file is randomly selected for utilization review. The provider will receive a written request with a time frame outlining when documentation is to be returned to the CRS requestor.