Post-acute rehabilitation services (PARS) for traumatic brain injury (TBI) and traumatic spinal cord injury (TSCI) are advanced rehabilitation services provided through an interdisciplinary team approach. For residential services, the participant must have a TBI or have a TBI with a TSCI and for a non-residential setting, the participant may have a TBI or TSCI. For outpatient therapy services, the participant must have a TBI or a TSCI.
Services that are provided are based on an assessment of the individual's deficits. The goal is to achieve independence in the home and community and establish new patterns of cognitive activity or compensatory mechanisms. HHSC Rate Analysis sets PARS rates and can be located here.
13.2 Required Documentation
For a participant receiving PARS, the provider uses the Mayo Portland Adaptability Inventory (MPAI-4) or Functional Inventory Measure (FIM), as applicable, based on service:
- on admission;
- on discharge; and
- when the six-month follow-up is provided, after discharge.
The Individualized Program Plan (IPP) must document the progress or lack of progress that the participant is making toward reaching the measurable goals and objectives.
Activity schedules must facilitate participation and provide opportunities for the participant to be independent. Schedules must indicate the participant’s general activities for the day, including meals, therapeutic activities, recreation and leisure activities. The activity schedule must address the goals in the IPP and be made available to each participant. Copies of schedules for each participant must be made available to CRS counselors for review. The activity schedule directs the intensity of the daily work that the participant must do to implement the IPP, about both informal and formal training.
The provider must submit and maintain all documentation pertaining to billing. Providers for residential and non-residential services are required to submit service record details into the CRS Data Reporting System. The service record details must be submitted by the 10th working day of the month following service delivery (for example, services delivered in September must be uploaded by the tenth of October). Providers are supplied with an Excel file format or layout and with access to the web-based system to upload the service record details. The details required are outlined in Appendix D, Service Record for CRS Data Reporting System. (See Chapter 4, General Provider Responsibilities for additional documentation requirements.) For technical assistance related to issues with the CRS Data Reporting System contact CRS_Program@hhsc.state.tx.us.
13.3 Assessment, Planning and Interdisciplinary Meetings
An assessment (see Chapter 10.1) and Individualized Program Plan (IPP) (see Chapter 10.2) must be completed to address participant’s deficits. The CRS counselor may request additional supporting documentation as needed. All planned and needed services for the participant must be documented. This must be reviewed to preauthorize services.
The IDT reviews the IPP at each monthly meeting to determine whether to continue and possibly modify the services. The IDT may also meet as frequently as is prudent and necessary to maintain an effective treatment program. Adjustments to the IPP, including discharge planning, are made as necessary.
13.4 Outcome Measures
Providers of PARS residential and non-residential services for traumatic brain injury must administer the Mayo-Portland Adaptability Inventory (MPAI-4) to all CRS participants. For non-residential services for traumatic spinal cord injury, providers must administer the Functional Independence Measure (FIM) to all CRS participants. MPAI must be completed and signed by a licensed professional.
The MPAI-4 or FIM scores must be administered at:
- Six months after discharge (when possible) with documented effort to obtain it.
Providers must report all outcome measures and send the report to the CRS Program. Below are the state fiscal year quarters and due dates:
Table 1, State Fiscal Year Quarters and Due Dates
|Quarterly progression measures due Dec. 10|
|Quarterly progression measures due Mar. 10|
|Quarterly progression measures due Jun. 10|
|Quarterly progression measures due Sept. 10|
If the due date falls on a weekend or state holiday, the report is due the following business day.
13.5 Customer Satisfaction
All providers who provide PARS in a residential setting must include participation satisfaction measures based on input from participants about benefits received from the services.
Each provider may develop its own survey instrument and procedure. However, at a minimum, the survey instrument must include the following prompt:
Using the Likert scale in the table below, rate the following statements:
- I was treated in a friendly, caring, and respectful manner by the staff of [insert provider’s name].
- Services were provided in a timely manner.
- The services met my needs.
- I was satisfied with the services provided.
|3||Neither agree nor disagree|
Providers must give all participants, both successful and unsuccessful, an opportunity to respond upon discharge from the CRS program. Providers must keep in the participant's file all attempts to obtain participant response to the participant satisfaction survey. The CRS program may request the responses from the provider every six months.
PARS for participants who have a traumatic brain injury (TBI), or who have both a TBI and a traumatic spinal cord injury (TSCI), are provided in a residential setting and are based on a tiered billing system. Each tier is a preauthorized level of service.
The tiers are:
- Tier Base;
- Tier Base Plus; and
- Core Therapy services.
Post-acute rehabilitation non-residential services for traumatic brain injury and traumatic spinal cord injury offer the same core therapy as residential services. Also included are case management, community independence supports, medical team conferences, and a standard facility or community base fee for non-residential services which covers dietary and nutritional services, medical (nursing and physician) services, and administrative or operational costs. Staff qualifications for providing core services remains unchanged. See Appendix B for Post-Acute Rehabilitation Core Services – Modality and Staff Qualifications.
13.8 Outpatient Therapy
Outpatient therapy services are to be utilized as a continuum of services and do not include residential or non-residential base services. In order to provide outpatient therapy services, it must be outlined in the provider contract. Staff qualifications for providing core services remain unchanged. See Appendix B, Post-Acute Rehabilitation Core Services Modality and Staff Qualifications. See Chapter 12, Traumatic Brain Injury and Traumatic Spinal Cord Injury – Outpatient Therapy Services, for additional guidelines on outpatient services.