Chapter 15: CRS Service Array

15.1 Overview

The CRS program service arrays may be provided to eligible persons who have a traumatic brain injury (TBI), traumatic spinal cord injury (TSCI), or both.

The CRS program offers the following service arrays for TBI and TSCI:

  1. Inpatient Comprehensive Medical Rehabilitation Services
  2. Outpatient Therapy Services
  3. Post-Acute Rehabilitation Services
  4. Ancillary Goods and Services

Additional details concerning specific services provided within the service arrays can be found in the CRS Standards for Providers Manual.

15.2 Inpatient Comprehensive Medical Rehabilitation Services

Inpatient Comprehensive Medical Rehabilitation Services for Traumatic Brain Injury (TBI) and Spinal Cord Injury (TSCI) are specialized services recommended by an interdisciplinary team in a hospital setting to address medical and rehabilitation issues that require 24-hour-a-day nursing services. An interdisciplinary team of professionals closely coordinates services to achieve team treatment goals in order to minimize a person's physical or cognitive disabilities, and maximize a person's functional capacity. The Texas Department of Assistive and Rehabilitative Services (DARS), or its successor agency, negotiates contracts with inpatient facilities to provide services based on data from the Centers for Medicare & Medicaid Services (CMS) Healthcare Cost Report Information System (HCRIS). Any goods or services approved by CRS that are not part of the contracted rate for inpatient comprehensive medical rehabilitation are considered “ancillary.” Ancillary goods and services must be pre-authorized by CRS staff and are reimbursed based on fee for service in accordance with 1 TAC §355.9040.

Prior to a service authorization being issued, the counselor will need to obtain a written prescription or physician’s recommendation for Inpatient Comprehensive Medical Rehabilitation Services.

15.2.1 Duration of Services

Inpatient comprehensive medical rehabilitation services may be sponsored only when there is no more than one year between the date of injury and the date of initial contact. There is a 90-day limit on inpatient comprehensive medical rehabilitation services, which is measured from the first day of services sponsored by the CRS program. These services are indicated on the consumer’s Individualized Written Rehabilitation Plan (IWRP) as "up to 30 days of services." When recommended by the interdisciplinary team, the services may be extended to a maximum of 90 days without an IWRP amendment.

Some facility-based providers choose to divide inpatient comprehensive medical rehabilitation services into phases. Discharges may occur during the course of treatment to give the consumer time to recover and practice newly acquired skills.

The consumer then often returns to complete the remaining treatment.

The CRS program may sponsor periods of hospitalization, up to a cumulative total of 90 days. No more than six months may lapse between being the time that a consumer is discharged from the program's first phase and re-enters the program.  

Providers of inpatient comprehensive medical rehabilitation services must meet the requirements outlined in Chapter 24: Purchasing Goods and Services for Consumers, 24.22 Health Care Professionals—Required Qualifications, and are authorized in accordance with Chapter 26: Physical Restoration Services, 26.2 Professional Medical Services, and Chapter 27 Hospital and Ambulatory Surgery Center Services.

15.3 Outpatient Therapy Services

Outpatient therapy services are provided on a one to one basis by licensed therapists to consumers who have a traumatic brain injury, a traumatic spinal cord injury, or both. These medical services must be prescribed by a physician and are provided without admittance to a hospital.

Outpatient therapy aims to correct or modify a stable or slowly progressive physical or mental impairment that constitutes a substantial impediment to independence. These services are authorized by CRS counselors and are reimbursed according to reimbursement methodology described in 1 TAC §355.9040. Other goods and services, not delivered under contract and not considered Outpatient Therapy Services, are considered “ancillary.” Ancillary goods and services must be pre-authorized by CRS staff and are reimbursed based on fee for service in accordance with 1 TAC §355.9040.

Prior to a service authorization being issued for outpatient services, the counselor must obtain a written prescription or physician’s order outlining recommended therapies and requesting treatment and evaluation. Services can be approved once the consumer has been evaluated and the counselor has received written recommendations from the provider.

15.3.1 Types of Outpatient Therapy Services

Common therapies provided as outpatient therapy services include occupational therapy, physical therapy, and speech therapy.

Purchase occupational therapy and physical therapy when the consumer must increase coordination, strength, or range of motion.

Purchase speech therapy to address speech, language, voice, communication, and/or auditory processing. Speech-language pathologists may also provide speech training in both expressive (speech and language production) and receptive (lip or speech reading) systems and evaluation and training in the use of speech augmentation devices.

15.3.2 Duration of Outpatient Therapy Services

Outpatient therapy services may be sponsored only when there is no more than two years between the date of injury and the date of initial contact. These services are limited to a maximum of 120 hours.

Providers of outpatient therapy must meet the requirements outlined in Chapter 24: Purchasing Goods and Services for Consumers, 24.22 Health Care Professionals—Required Qualifications. Services are authorized in accordance with Chapter 26: Physical Restoration Services, 26.2 Professional Medical Services, and Chapter 27 Hospital and Ambulatory Surgery Center Services.

 

15.4 Post-Acute Rehabilitation Services

Post-acute rehabilitation services (PARS) for Traumatic Brain Injury (TBI) and Spinal Cord Injury (SCI) are advanced rehabilitation services provided through an interdisciplinary team approach to people who have a TBI, TSCI, or both. For residential services, the consumer must have a TBI or a TBI with a TSCI; and for non-residential settings, the consumer may have a TBI or TSCI. Services are based on an assessment of the individual's assessed deficits. The goal of PARS is to achieve independence in the home and community and/or establish new patterns of cognitive activity or compensatory mechanisms.

Before issuing a service authorization for post-acute rehabilitation services, the counselor must obtain a pre-admission evaluation and written prescription or a physician’s recommendation for needed specific therapies. A post-acute rehabilitation services facility-based provider conducts the pre-admission evaluation. A medical professional provides the prescription or physician’s order.

15.4.1 Duration of Post-Acute Rehabilitation Services

Post-acute rehabilitation services are not limited by the time passed since the onset of the traumatic brain injury or traumatic spinal cord injury and the date in which initial contact was recorded in ReHabWorks. The 180-day limit on post-acute rehabilitation services is measured from the first day of services sponsored by the CRS program.

Post-acute rehabilitation services are indicated on the Individualized Written Rehabilitation Plan (IWRP) as approved for "up to 90 days." When recommended by the interdisciplinary team, services may be extended to a maximum of 180 days, without an IWRP amendment.

It may be necessary for a post-acute rehabilitation facility-based provider to divide its program into two phases. The CRS program may sponsor both periods of post-acute brain injury (PABI) services up to a cumulative total of 180 days.

15.4.2 Post-Acute Rehabilitation Services and the Counselor’s Role

Use only CRS-approved providers of post-acute rehabilitation services.

To find a provider:

  1. create a service record (use Residential Rehabilitation Services; Room, Board, and Supervised Living for the Level 1 specification); and
  2. use the "Go to Vendor Search" option to select an approved provider.

Post-acute rehabilitation providers must adhere to the standards documented in the CRS Standards for Providers, and CRS counselors must be familiar with the standards. Elements explained in the sections of this chapter require close coordination with the CRS counselor.

15.4.3 Assessment

Each staff member of the interdisciplinary team (IDT), as appropriate, assesses a consumer's abilities and limitations in relation to his or her specific area of expertise. The case manager compiles the results of this assessment into a report within 30 days of a consumer's admission into the program. Copies of the final report are provided to each member of the IDT.

The assessment must address each of the areas in this chapter that are noted in the CRS Standards for Providers.

15.4.4 Developing the Individualized Program Plan

Following assessments the IDT meets to create the Individualized Program Plan (IPP.) The IPP is based on the findings of the assessment and must address all deficit areas noted therein. All planned and needed services must be documented in the IPP. All IDT members must participate in the IPP development, which must be documented by attendance sheets with signatures. The IDT meets after all the assessments are completed, but no later than 30 days after a consumer's admission to the program. This meeting is held to develop the IPP.

Note: The word participate means to provide input through whatever means is necessary to ensure that the consumer’s IPP meets the consumer’s needs. The IDT process is designed to allow team members to review and discuss information and make recommendations relevant to the consumer’s needs. The IDT reaches decisions as a team, rather than individually, about how best to address the consumer’s needs.

15.4.5 Provider’s Reports to the CRS Program

A copy of the assessment report and the Individualized Program Plan (IPP) are provided to the CRS program staff member within 10 working days after the IPP meeting, which is held within the first 30 days of services following admission. A copy is available to the consumer and the consumer's representative. Results of the assessment and the IPP may be combined into a single report. All pertinent members of the interdisciplinary team sign the report. The provider must be able to verify by proof of fax, email, or post, or by signature of the CRS program staff member that the report was available to the CRS program within 10 working days of the IPP meeting.

15.4.6 IPP Review

The goals and objectives on the Individualized Program Plan (IPP) include long-term and short-term goals that specify measurable terms and relate to increasing a consumer's functional ability to live more independently.

A CRS program staff member and the consumer's representative, if applicable, are notified at least one week in advance of the date, time, and location of the IPP review meeting.

15.4.7 Activity Schedules

A schedule of daily activities, which addresses the goals identified in the Individualized Program Plan (IPP), must be developed and made available to each consumer. Copies of schedules for each consumer must be made available to CRS counselors or CRS program staff members in order to monitor for review.

The activity schedule directs the intensity of the daily work the consumer must do to follow the IPP, including both informal and formal training activities.

15.4.8 Emergency Restrictive Procedures

Emergency restrictive procedures are the least-restrictive procedures used for the briefest time necessary to control severely aggressive or destructive behavior that place an individual or others in imminent danger and that could not have been reasonably anticipated. Emergency restrictive procedures are used only when necessary within the context of positive behavioral programming.

The provider may use restraint as an emergency measure only if absolutely necessary to protect the consumer or others from injury.

The provider's policy must include the provision of training in appropriate physical restraint procedures and techniques for staff members with direct consumer contact. The procedures must identify the training provided to all staff members at hire and at least annually thereafter.

Each time a consumer is restrained, a written report must document the details surrounding the incident. This written report must be kept in the consumer’s file that is maintained by the provider. The interdisciplinary team reviews each report at the next scheduled monthly team meeting to determine whether modifications to the treatment plan are needed.

15.4.9 Behavior Management

Licensed professionals or board-certified professionals develop and monitor a behavior management plan (BMP). Plans may include therapeutic medication; interventions that include positive reinforcement, verbal cues, and rewards; and other evidence-based therapeutic modalities planned to improve appropriate communication, frustration tolerance, anger management, or other necessary social skills. A board-certified behavior analyst, psychiatrist, or psychologist develops a BMP.

A BMP is:

  • developed and approved before it is implemented by the interdisciplinary team (IDT);
  • written in a manner that can be understood by the consumer and the provider’s staff members; and
  • signed by a psychologist, psychiatrist, or board-certified behavior analyst; and
  • part of the IPP.

For consumers who are minors, get informed consent from the consumer’s parent or legal guardian for use of restrictive programs, practices, or procedures. For consumer’s who are legally incompetent but have no appointed legal guardian, get informed consent from some person or agency that is designated by the state, in accordance with state law, to act as the representative of the consumer’s interests.

If restrictive procedures are used as a behavior modification technique:

  • the provider's policies and procedures must clearly state when and how restrictive procedures are implemented; and
  • signed consent must be obtained from the consumer (or guardian, if the consumer is a minor or is legally incompetent).

Note: Standing or blanket program restrictions such as chemical restraint, physical restraint, and seclusion to control inappropriate behavior are not permitted.

All interventions addressing the control of inappropriate behaviors must be justified by the Functional Behavioral Assessment and the current level of behavior.

If chemical restraints are used to control inappropriate behavior, they must be:

  • approved by the IDT;
  • used only as an integral part of the consumer’s IPP that is directed specifically toward the reduction of and eventual elimination of the behaviors for which the chemical restraints are employed;
  • justified that the harmful effects of the behavior clearly outweigh the potentially harmful effects of the restraint; and
  • monitored closely in conjunction with the physician and the IDT to ensure that the chemical restraints have desired responses and no adverse consequences.

Each time a consumer is restrained, a written report must document the details surrounding the incident. This written report must be filed in the case file maintained by the provider. Each report must be reviewed by the IDT at the next scheduled monthly team meeting to determine whether modifications to the treatment plan are needed.

15.4.10 Reporting Substance Abuse

Any observations or other evidence of the use of alcohol or drugs by a CRS consumer with the disability of substance abuse must be reported immediately to the CRS counselor. The provider must maintain documentation that the counselor was informed.

15.4.11 Chemical Dependency Services

Chemical dependency services may only be delivered to consumers who have a traumatic brain injury (TBI), and may be delivered on an individual basis or in a group setting. Licensed professionals with experience in service delivery to individuals with TBI may provide services, and this may include licensed chemical dependency counselors, licensed professional counselors, or psychologists.

Chemical dependency services must be:

  • provided based on assessed needs;
  • developed and approved by the interdisciplinary team; and
  • a part of the Individualized Program Plan.

15.4.12 Monthly IDT Meetings on the Individualized Program Plan

The consumer’s interdisciplinary team (IDT) meets formally at least monthly to:

  • review a consumer's progress in terms of attaining the identified goals and objectives; and
  • determine whether modifications are needed to the goals and objectives, timelines, and persons designated as responsible.

All IDT members routinely participate in the monthly meetings, and the IDT member’s attendance must be documented. The CRS program staff member, consumer, and consumer's legally authorized representative and/or advocate, as applicable, participate in the meeting when available.

The CRS program staff member, the consumer, and the consumer's legally authorized representative and/or advocate must be notified of the date, time, and location of the meeting at least one week in advance.

The IDT reviews the consumer’s Individualized Program Plan (IPP) at each monthly meeting and the IPP may be modified, if necessary, at that time.

Adjustments to the IPP, including discharge planning, are made as necessary.

The results of this meeting, which occurs within the first 30 days after admission, are documented in a written report, and a copy of the report is provided to the CRS program staff member within 10 working days after the meeting. A copy must be available to the consumer and/or the consumer's representative.

In addition to the required monthly meeting and based on need, the IDT may meet as frequently as is prudent and necessary in order to maintain an effective treatment program.

15.5 Post-Acute Rehabilitation Services - Residential

Post-acute rehabilitation residential services for traumatic brain injury (TBI) are authorized based on a tiered rate structure. Each tier represents a preauthorized number of hours for core therapy services. A week is defined as Sunday through Saturday.

The initial tier level is Tier 2, not to exceed 14 hours per week. Once assessments are complete, the tier, with prior authorization, may be changed to the tier recommended on a weekly basis by the interdisciplinary team (IDT). Supporting documentation must include information relating to a consumer’s needs, goals, and recommended core therapy services.

15.5.1 Licensure and Accreditation

All providers who provide post-acute rehabilitation services in a residential setting that do business with the CRS program must be licensed by at least one of the following regulatory agencies, as appropriate:

The providers must maintain accreditation from:

  • the Commission on Accreditation of Rehabilitation Facilities;
  • the Joint Commission on Accreditation of Healthcare Organizations; or
  • the Disease-Specific Care Certification in Brain Injury Rehabilitation Program.

New facility-based providers doing business with the CRS program that do not already meet the accreditation requirement are granted up to two years from the date of their CRS contract for post-acute brain injury or post-acute spinal cord injury services to obtain the accreditation.

15.5.2 Co-Pay/Co-Insurance

Co-Pay/Co-Insurance Tier is covered when the consumer has third-party insurance being billed for services. All other pay sources must be exhausted before CRS is billed for services.

15.5.3 Tier Base and Tier Base-Plus

Tier Base services include administrative costs, room and board, paraprofessional services, medical services (that is, physician and nursing services), dietary and nutritional services, and case management. These services may not be billed separately to the CRS program.

Tier Base-Plus services include base services plus one- to three-quarter hours of core therapy services.

The CRS program does not expect that consumers will be approved for Tier Base or Tier Base-Plus services. The tier levels are provided to account for days of service that fall below the authorized tier.

15.5.4 Core Therapy Services

Core therapy services include physical therapy, occupational therapy, speech therapy, cognitive therapy, and neuropsychological services.

Core therapy services are based on the recommended tier and must be provided by a licensed or certified professional. If an identified core therapy service is provided by a non-licensed or non-certified professional, the service is not billable as part of the core therapy service for the tier.

For example, nursing services are considered part of base services and therefore are not billable as part of core therapy services. Goods and services that are not considered base or core therapy services are defined as ancillary and must be authorized by the CRS counselor. See the CRS Standards for Providers, Chapter 11: Traumatic Brain Injury and Traumatic Spinal Cord Injury – Inpatient Comprehensive Medical Rehabilitation Services for details. See Appendix B in CRS Standards for Providers for a complete list of core therapy services and provider qualifications.

15.5.5 Preauthorization for Changing Tiers

Changes in the approved tier require preauthorization from a CRS program staff member. The provider must document in the consumer’s record why a consumer received less than the preauthorized or approved tier and/or why it is clinically recommended to increase the tier.

The CRS program may not reimburse unauthorized services. Providers must justify changes in a tier by providing supporting documentation. A CRS program staff member may request documentation supporting the provider’s request. If requested, the documentation must be submitted prior to delivering services at the newly requested tier; otherwise, the change in tier is considered unauthorized. 

15.5.6 Documenting Changing Tiers

Upon receipt of the DARS3149, Request for Tier Change and review of the documentation requesting a change in a tier level, the counselor takes the following steps.

Approval

If the counselor approves the change in a tier level, the counselor:

  1. documents the change in a service justification case note in ReHabWorks; and
  2. adds the subheading:
    • Initial Tier: “Approved Tier 2”; or
    • Changed Tier: “Changed Tier x to Tier x”.

It is important for recording purposes that it is written exactly as described above.

The counselor then creates an approval case note and:

  1. identifies the previous tier;
  2. identifies the new tier; and
  3. explains the reason for the change.

Seeking Additional Information

If the counselor needs to seek additional information, the counselor documents the need in a Vendor Contact case note with the subheading Seeking Additional Information and includes in the case note the counselor’s request for more information and the reason the counselor requests this information.

Denial

If the counselor denies a change to a tier, the counselor documents the decision in a Vendor Contact case note with a subheading “Denial of Tier Change.”

The counselor:

  1. identifies the current tier;
  2. explains the change being requested; and
  3. explains the reason for denying the change.

15.5.7 Utilization Review

A utilization review is required only when post-acute rehabilitation for traumatic brain injury is provided in a residential setting. See Chapter 16: Utilization Review for Post-Acute Rehabilitation Services - Residential.

15.5.8 Billing Limitations

Tier Base

If a consumer does not receive core therapy services on a given day, the provider bills the therapy as Tier Base for that day to indicate that the provider is being reimbursed only for the base services and that no core therapy services were provided.

Tier Base-Plus

A consumer receives one- to three-quarter hours of a core therapy service per day.

Core Individual and/or Group Therapy

One hour of individual therapy or two hours of group therapy counts as one hour toward a tier. The total number of hours applied to a tier equals the sum of the individual and group hours; for example: One hour of individual and one hour of group equals 1.5 hours total and is billed as Tier 1; one hour of individual and four hours of group equals three hours total and is billed as Tier 3.

Billing Core Services

Two therapists cannot bill for the same period of time. Therapy units and/or time are divided by the number of therapists delivering the service to determine the number of hours attributed to each; for example, if a physical therapist and an occupational therapist deliver one hour of individual therapy to a consumer together, the therapy counts as one hour toward the tier. On the supporting documentation, the therapy is shown as .5 hours of physical therapy and .5 hours of occupational therapy. (The providers may split the hour differently, such as three-quarter hours of physical therapy and one quarter hours of occupational therapy, if the sum does not exceed one hour. For staff member qualifications, see the CRS Standards for Providers, Appendix B: Post-Acute Rehabilitation Core Services – Modality and Staff Qualifications.

Billing for a Partial Week

If billing for fewer than seven calendar days, the billing guidelines for the maximum number of hours provided at the approved tier apply; for example, if approved for Tier 4, the sum must not exceed 28 hours, regardless of the number of days involved.

Copays

Providers bill a third party or the consumer’s insurance company for services. The CRS program pays the consumer’s required copay or coinsurance for the service. Tiered rates do not apply; however, the provider must still submit detailed billing information on the services delivered to the consumer.

Day of Admission or Discharge

Admission and discharge days are handled the same as any other service day. If no core therapy services are delivered, the provider bills for Tier Base services. If core therapy services are delivered, the provider bills for the appropriate tier for the number of hours delivered, in accordance with the prior authorization.

Therapeutic Passes

A therapeutic pass allows a consumer to leave a residential facility for up to eight hours to attend a planned activity, unaccompanied by facility staff members. The consumer must return to the facility by 10 p.m. If a consumer is away from the facility for more than eight hours and does not return by 10 pm, the consumer is considered absent and the facility-based provider cannot bill for services. If a consumer has more than two therapeutic passes per month, the facility-based provider must notify the CRS counselor. During a month, a consumer can take no more than three therapeutic passes. Therapeutic pass days are billed at the Tier Base rate.

A therapeutic pass must be planned and included in the consumer’s Individualized Program Plan. The purpose of the therapeutic pass is to facilitate a consumer’s transition from a residential facility to his or her own home and the community; for example, a consumer may go shopping with family members or practice taking the bus or metro lift into town.

While a consumer is on therapeutic pass, staff members from the residential facility must be available to provide the consumer and the consumer’s family or others with guidance and instruction, usually by phone.

Within one day of the consumer’s return to the facility, the facility team reviews with the consumer the issues noted during the pass. If the facility team determines that changes in the consumer’s core therapy services or ancillary services are required, a team member notifies the CRS counselor, and the counselor arranges for the consumer’s interdisciplinary team to meet. If the counselor and the interdisciplinary team approve, the facility team incorporates techniques into the consumer’s therapy and/or ancillary services to address the issues.

15.5.9 Base Services and Tier Structure

The base services provided for post-acute rehabilitation residential services are shown in the table below.

Base Services: Traumatic Brain Injury (TBI)
Post-Acute Rehabilitation—Residential

Case Management

Dietary and Nutritional Services

Medical (Nursing & Physician) Services

Administrative Cost

Paraprofessional Services (services by CNA,CA)

Room and Board

Core Services: Traumatic Brain Injury(TBI)
Post-Acute Rehabilitation Services-Residential

Tiers

Description

Copay

Residential copay only

Base

Tier base—no billable core

Base Plus

greater than 0 but less than 1 hour

1

greater than or equal to 1 hour per day but less than 2 hours per day, not exceeding 7 hours per week

2

greater than or equal to 2 hours per day but less than 3 hours per day, not exceeding 14 hours per week

3

greater than or equal to 3 hours per day but less than 4 hours per day, not exceeding 21 hours per week

4

greater than or equal to 4 hours per day but less than 5 hours per day, not exceeding 28 hours per week

5

greater than or equal to 5 hours per day but less than 6 hours per day, not exceeding 35 hours per week

6

greater than or equal to 6 hours per day but less than 7 hours per day, not exceeding 42 hours per week

7

greater than or equal to 7 hours per day but less than 8 hours per day, not exceeding 49 hours per week

8

greater than or equal to 8 hours per day but less than 9 hours per day, not exceeding 56 hours per week

15.6 Post-Acute Rehabilitation Services – Non-Residential

Post-acute rehabilitation services for traumatic brain injury and traumatic spinal cord injury (TSCI) non-residential rehabilitation services are provided through non-residential settings and encompass the same core services as residential services. Also included is a standard facility or community base fee for non-residential which covers the coordination of services by the IDT and appropriate personal assistance, administration, and facility and operations costs. Staff qualifications for providing core services remains unchanged (see CRS Standards for Providers, Appendix B: Post-Acute Rehabilitation Core Services – Modality and Staff Qualifications for provider qualifications).

15.6.1 Licensure and Accreditation

A post-acute rehabilitation non-residential service provider that does business with the CRS Program and is not licensed by the Department of Aging and Disability Services (DADS) as an assisted living facility or nursing home, and are not licensed by the Department of State Health Services (DSHS) as a hospital or chemical dependency center, must be:

15.6.2 Billing Guidelines

DARS, or its successor agency, negotiates contracts with providers which are reimbursed in accordance with 1 TAC §355.9040.

Post-acute rehabilitation non-residential services for traumatic brain injury and traumatic spinal cord injury can be either facility based or community based. The base rate covers administrative services, paraprofessional services, and facility and operations costs. Providers will bill a standard facility ($11.21) or community ($10) base fee plus an hourly rate for the core therapy services provided to the consumer using CPT codes.

For example, a consumer receives services in a non-residential setting on Monday. The consumer receives one hour of physical therapy, one hour of occupational therapy, one hour of speech therapy, and one hour of art therapy. The provider bills for four hours of therapy, submitting a separate bill for each therapy with supporting CPT code(s) and providing supporting documentation for each i.e., therapy notes, assessments, and/or reports. The provider submits a separate bill for four hours at the base rate to cover administrative services, paraprofessional services, and facility and operations costs.

If the consumer does not receive therapy services from an approved certified or licensed professional while at the facility, the provider bills only for the time that the consumer is at the facility and bills only at the base rate. For example, the consumer attends the program for four hours, but does not receive any therapy services. The provider submits a bill for four hours at the base rate.

Bills for services must be submitted monthly. Data supporting the service must accompany each invoice. See CRS Standards for Providers, Chapter 6: General Billing Guidelines for additional billing guidelines.

 

15.6.3 Exceptions and Limitations

Post-acute rehabilitation services are limited to 180 days starting on the first day that services are sponsored by the CRS program.

15.7 Ancillary Goods and Services

Goods and services related to the individual’s TBI or SCI, which are not outpatient therapy services and are not delivered as part of Inpatient Comprehensive Medical Rehabilitation Services or Post-Acute Rehabilitation Services, are considered ancillary. Ancillary services are prior authorized by CRS counselors in accordance with program policy, reimbursed according to reimbursement methodology described in 1TAC §355.9040, and may include but are not limited to:  orthotics, prosthetics, assistive technology devices, medications if not part of contract, medical equipment & supplies, home modifications, transportation when required to enable participation in a CRS approved service, paraprofessional services when required to enable participation in therapies or post-acute non- residential rehabilitation, etc.

15.7.1 Exceptions/Limitations

If a consumer requires medical treatment for an injury sustained while receiving rehabilitation services or requires treatment for an illness that is not related to the consumer’s traumatic brain injury or traumatic spinal cord injury, the consumer is considered medically unstable and the services are not covered by the CRS program as post-acute rehabilitation services.