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.