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.