Child & Family Services

Definitions

Advocacy Services

After School Group Supports

Art Therapy

Audiology

Behavioral Aide

Behavioral Therapy

Camp

Case Management

Child Care/Supervision

Counseling

Crisis Intervention and Support

Dance/Movement Therapy

Dietary

In-patient Substance Abuse Services

Interpretation/Translation Services

Life Skills Training

Massage Therapy

Medication Management

Mentoring

Music Therapy

Nursing

Occupational Therapy

Other Basic Needs

Other Wellness Therapies

Parent Coaching

Physical Therapy

Psychiatric Assessment and Evaluation

Psychological Assessment/Evaluation

Recreation Therapy

Respite

Shelter Care

Speech-Language Pathology

Substance Abuse Outpatient Services

Team Meeting

Therapeutic Foster Care

Transportation

Tutoring

Advocacy Services: Services designed to support the Covered Individual/Family Member and his/her Guardian in decision making, accessing needed services, and exercising their legal rights within service delivery systems and the larger community. Advocacy Services:

Must be provided on behalf of the Covered Individual/Family Member
Are provided in the home, community, school, or institutional environments.
Addresses identified advocacy needs of the Individual/Family as determined by the Child and Family Team
Cannot be billed simultaneously with another Community Support Service
Do not include the travel time of the Service Provider to-and-from the location of service, unless the Covered Individual/Family Member is present in the Provider’s vehicle
Cannot be provided by someone who resides in the same residence as the Covered Individual/Family
Do not include time waiting to provide service
Cannot exceed more than four consecutive hours per billable event, unless pre-authorized by the Care Coordinator.
Unit of Service: 15 minutes
Credentialing Requirement: Minimum of a High School Diploma or GED with one years experience with the target population and demonstrated understanding of the rights of individuals/families within service delivery systems and the larger community.

After School Group Supports: A structured program that bridges the gap between regularly scheduled school and home by engaging the Covered Individual/Family Member in organized group activities that promote the development of appropriate socialization, recreation, communication, problem solving, an/or life skills in a safe and supervised environment. After School Group Supports are provided only to children whose after school care needs cannot be met in a generic community after school program due to behavioral or emotional needs. After School Group Supports:

Must be provided face-to-face with the Covered Individual/Family Member
Can be provided in the community or in a site-based facility.
Address an identified need for after school group support services as determined by the Child and Family Team
Are provided in groups of two to five Covered Individuals/Family Members per staff person in a community-based program and in groups of two to six Covered Individuals/Family Members per staff person in a facility-based program.
Support, rather than supplant, the Family’s natural resources and support network
Cannot be provided when a Parent, Guardian, or Primary Caregiver is available
Do not include the travel time of the Service Provider to-and-from the location of service, unless the Covered Individual/Family Member is present in the Provider’s vehicle
Cannot be provided by someone who resides in the same residence as the Covered Individual/Family
Do not include time waiting to provide service
Unit of Service: 15 minutes
Credentialing Requirement: Minimum of a High School Diploma or GED with at least one year of related experience with the target population.

Art Therapy: A therapeutic intervention that utilizes art media, images, the creative process, and the Covered Individual/Family Member’s response to creative artworks as the primary modality of active treatment. Art Therapy is focused on individualized therapy goals and is based on a knowledge of human developmental and psychological theories which are implemented within the full spectrum of assessment and treatment, including educational, psychodynamic, cognitive, transpersonal, and other therapeutic means of reconciling emotional conflicts, fostering self awareness, developing social skills, managing behavior, solving problems, reducing depression, stress, and anxiety, aiding reality orientation, and increasing self-esteem. Art Therapy:

Must be delivered consistent with professional standards of practice
Can be delivered in the Covered Individual/Family’s home, the Provider’s office, or in the community
Requires face-to-face contact with the Covered Individual/Family Member to conduct assessments or provide therapy
Addresses identified individual needs as determined by assessment and in conjunction with the Child and Family Team
Is provided as a 1:1 service, unless specifically authorized by the Care Coordinator as a group service
Does not include time waiting to provide services.
Does not include the travel time of the Service Provider to-and-from the location of service, unless the Covered Individual/Family Member is present in the Provider’s vehicle
Does not include supervision of services or tasks outside the scope of professional certification
Cannot exceed more than four consecutive hours per billable event, unless pre-authorized by the Care Coordinator.
Unit of Service: 15 minutes
Credentialing Requirement: Registered as a Board Certified Art Therapist (ATR-BC) or Registered Art Therapist (ATR) by the Art Therapy Credentials Board

Audiology: The assessment, evaluation, counseling, habilitation, or rehabilitation of a Covered Individual/Family Member who has, or is suspected of having, hearing disorders or vestibular function disorders by a professional licensed in Audiology. Audiologists are also licensed to dispense, sell, and manage fittings for hearing instruments.

Must be delivered consistent with professional standards of practice
Requires face-to-face contact with the Covered Individual/Family Member to conduct assessments or fit, dispense, and manage hearing devices
Is typically delivered in the Practitioner’s office
Addresses identified individual needs as determined by assessment and in conjunction with the Child and Family Team
Is provided as a 1:1 service
Does not include transportation of an individual, travel time, or time waiting to provide services
Does not include supervision of services or tasks outside the scope of professional certification/licensure
Cannot exceed more than two consecutive hours per billable event, unless pre-authorized by the Care Coordinator
Unit of Service: 15 minutes
Credentialing Requirement: Licensed as an Audiologist or Licensed Assistant in Audiology or Licensed Intern in Audiology by the Texas State Board of Examiners for Speech-Language Pathology and Audiology

Behavioral Aide Services: Direct support services provided to a Covered Individual/Family Member that specifically focus on the reduction or elimination of maladaptive behaviors in the home, school, and community, thereby reducing stress within the family and/or reducing delinquent or criminal behaviors that may result in placement in a more restrictive setting. Behavioral Aide Services provide direct support and assistance to the Covered Individual/Family Member to interact appropriately within multiple environments by implementing Individual Behavior Support Programs and strategies that reinforce positive behaviors, teach socially appropriate replacement behaviors, and develop coping and anger management skills. Behavioral Aide services:

Must generally be provided face-to-face with the Covered Individual/Family Member
Can be provided over the telephone in a behavioral crises that is more expediently handled by telephone than in person
May be delivered in the Practitioner’s office, the Covered Individual/Family Member’s home, or the community
Is generally not provided in a school setting unless specifically authorized by the Care Coordinator, pending approval or after denial of school funded behavioral supports.
Is not provided in a 24 hour residential setting
Address identified behavioral needs of the individual as determined by the Child and Family Team
Cannot be billed simultaneously with another Community Support Service
Must be provided as a 1:1 service, unless authorized as a group service by the Care Coordinator
Do not include the travel time of the Service Provider to-and-from the location of service, unless the Covered Individual/Family Member is present in the Provider’s vehicle
Cannot be provided by someone who resides in the same residence as the Covered Individual/Family Member
Do not include time waiting to provide service
Unit of Service: 15 minutes
Credentialing Requirement: High School Diploma or GED with a minimum of one year experience with the target population.

Behavioral Therapy: Specialized interventions that assist a Covered Individual/Family Member to increase adaptive behaviors and to replace or modify maladaptive and socially unacceptable behaviors that prevent or interfere with his/her inclusion in home and community life. Behavior Therapy includes assessment and analysis of the behavior(s) to be targeted for change and development of an Individual Behavior Support Plan consistent with outcomes identified by the Child and Family Team. This service also provides training and consultation with Family Members, Support Providers, and the Covered Individual in the purpose, goals, methods, and documentation of the Individual Behavioral Support Plan. Additionally, Behavior Therapists monitor and evaluate the success of the Individual Behavioral Support Plan and make modifications of the Plan as necessary based on documented progress or lack of progress.

Must be delivered consistent with professional standards of practice
Typically requires face-to-face contact with, or observation of, the Covered Individual or Family to conduct assessments or provide specialized interventions to increase adaptive behaviors and/or replace or modify maladaptive or socially unacceptable behaviors
May be delivered in the Practitioner’s office, the Covered Individual’s home, or the community
Includes Face-to-face or telephone contact with a Psychiatrist/Psychologist regarding the behavior and/or mental health condition of a specific individual
Addresses identified individual needs as determined by assessment, the Child and Family Team, and in conjunction with a Licensed Physician/Psychologist, as appropriate
Is provided as a 1:1 service
Does not include the travel time of the Service Provider to-and-from the location of service, unless the Covered Individual/Family Member is present in the Provider’s vehicle
Does not include time waiting to provide service
Does not include supervision of services or tasks outside the scope of professional licensure
Assessments/Evaluations are paid at a different hourly rate and are billable up to a maximum of four hours
Unit of Service: 15 minutes
Licensed Psychologist (PhD) or Licensed Psychological Associate (LPA) by the Texas Board of Psychological Examiners, Board Certified Behavior Analyst (BCBA), Board Certified Associate Behavior Analyst (BCABA).

Camp Services: A time-limited day enrichment program operating during scheduled school breaks that incorporates a wide range of structured group recreation and leisure activities designed to assist a Covered Individual/Family Member in developing positive self-expression and self-esteem by providing opportunities for social interaction ,teamwork, creativity, skills acquisition, exercise, and play in a safe and supervised environment. Camp Services:

Must be provided face-to-face with the Covered Individual/Family Member
May include community activities as part of the camp itinerary.
Address an identified need for camp services as determined by the Child and Family Team
Are provided in groups of two or more with a minimum of one staff person to every six individuals at the camp facility and/or one staff person to every five individuals while engaged in community activities.
Support, rather than supplant, the Family’s natural resources and support network
Do not include the travel time of the Service Provider to-and-from the location of service, unless the Covered Individual/Family Member is present in the Provider’s vehicle
Cannot be provided by someone who resides in the same residence as the Covered Individual/Family
Does not include time waiting to provide service
Unit of Service: daily
Credentialing Requirement: Minimum of a High School Diploma or GED with at least one year of related experience with the target population or providing a similar service

Case Management: Systematic, outcome focused needs-based activity that assists Covered Individuals and their Families by locating, linking, coordinating, and facilitating access to needed services. The primary focus of Case Management is on linkage and coordination of community supports and resources and not on the direct delivery of those supports and resources by the Case Manager. Case Management:

Generally must be provided face-to-face or by telephone contact with the Covered Individual and/or Family.
May include time spent by the Provider in collateral contacts
Can be provided in the Covered Individual/Family’s home, school, community, or institutional setting.
Addresses identified needs of the Individual/Family as determined by the Child and Family Team
Activities must directly benefit the Covered Individual
Must be provided as a 1:1 service with the Covered Individual and/or Family
Does not include the travel time of the Service Provider to-and-from the location of service, unless the Covered Individual/Family Member is present in the Provider’s vehicle
Cannot be provided by someone who resides in the same residence as the Covered Individual/Family
Does not include time waiting to provide service
Unit of Service: 15 minutes
Credentialing Requirement: Minimum of a High School Diploma or GED with at least one year experience with the target population or Bachelors Degree in a Human Service field.

Child Care/Supervision: Routine supervision and monitoring of a Covered Individual/Family Member’s basic needs when the Primary Caregiver(s) are absent from the home due to the routine demands of the Family schedule. Childcare/Supervision is usually provided after school and occasionally on weekends. Child Care/Supervision:

Must be provided face-to-face with the Covered Individual/Family Member
Can be provided in the Covered Individual’s home, in the Provider’s home, or in a community setting.
Addresses an identified need for Child Care Services as determined by the Child and Family Team
May be provided as a 1:1 or group service with the Covered Individual/Family Member.
No more than five individuals can be provided child care/supervision by a single provider staff person when billed as a group service.
Supports, rather than supplants, the family’s natural resources and support network
Cannot be provided when a Parent, Guardian, or Primary Caregiver is available
Does not include the travel time of the Service Provider to-and-from the location of service, unless the Covered Individual/Family Member is present in the Provider’s vehicle
Cannot be provided by someone who resides in the same residence as the Covered Individual/Family
Does not include time waiting to provide service
Unit of Service: For hourly child care: 15 minutes up to 6 hrs
For daily child care 6 or more consecutive hours
Credentialing Requirement: Minimum of a High School Diploma or GED with at least one year of related experience

Counseling: The assessment, evaluation, and treatment of a Covered Individual/Family Member through the therapeutic relationship, using a combination of mental health, psychotherapeutic, and human development principles, methods, and techniques, including the use of psychotherapy, to achieve the goal-directed development of an individual, sibling, parent/guardian, or family emotionally, socially, morally, educationally, spiritually, or vocationally. Counseling may focus on a wide range of issues based upon the assessed need of the Covered Individual/Family including problem resolution, physical and sexual abuse, substance abuse, lack of trust, anger, depression, anxiety, fear, family interactions, personal interactions, attachment, and cognitive thinking which interferes with successful integration in family and community life. Counseling:

Must be delivered consistent with professional standards of practice
Requires face-to-face contact with the Covered Individual or Family Member to conduct assessments or provide Counseling Services
Includes Face-to-face or telephone contact with a Licensed Psychiatrist/Psychologist regarding the behavior and/or mental health condition of a specific individual
Addresses identified individual and family needs as determined by assessment, the Child and Family Team, and in conjunction with a Licensed Physician/Psychologist, as appropriate
May be provided in the practitioner’s office, in the community, or in the individual’s home.
Is provided as a 1:1 service, unless otherwise authorized as a group service by the Care Coordinator
Provided in groups must consist of a minimum of two individuals and a maximum of seven individuals
Does not include the travel time of the Service Provider to-and-from the location of service, unless the Covered Individual/Family Member is present in the Provider’s vehicle
Does not include time waiting to provide services.
Does not include supervision of services or tasks outside the scope of professional licensure
Cannot exceed more than two consecutive hours per billable event, unless pre-authorized by the Care Coordinator.
Unit of Service: 15 minutes
Credentialing Requirement: Licensed Medical Doctor (MD/Psychiatrist) or Licensed Doctor of Osteopathic Medicine (DO/Psychiatrist) or Licensed Psychologist (PhD) or Licensed Professional Counselor (LPC) or Licensed Clinical Social Worker (LCSW) or Licensed Marriage and Family Counselor (LMFT), or Master’s Level Clinician with a graduate degree in a human services field (psychology, social work, counseling) working toward licensure under the direct clinical supervision of one of the above licensed professionals.. Outpatient substance abuse counseling may also be provided by a Licensed Chemical Dependency Counselor (LCDC)

Crisis Intervention and Support: None-clinical activities, interventions, and supports provided to the Covered Individual/Family in an emergent situation. Crisis Intervention and Support includes the coordination of emergency services, preventative measures, and problem solving before, during, or after the crisis event to assist the Covered Individual and their Family in averting a crises or responding to the crisis in an effective manner. Crisis Support:

Must be provided face-to-face or by telephone contact with the Covered Individual and/or Family.
May include time spent by the Provider in collateral contacts during the crisis
Can be provided in the Covered Individual/Family’s home, school, institution, or community
Cannot be billed simultaneously with another Community Support Service
Must be provided as a 1:1 service with the Covered Individual or Family
Does not include the travel time of the Service Provider to-and-from the location of service, unless the Covered Individual/Family Member is present in the Provider’s vehicle
Cannot be provided by someone who resides in the same residence as the Covered Individual/Family
Does not include time waiting to provide service
Unit of Service: 15 minutes
Credentialing Requirement: Minimum of a High School Diploma or GED with at least one year experience with the target population.

Dance/Movement Therapy: A therapeutic intervention that utilizes dance and movement as the primary modality of active treatment. Dance/Movement Therapy focuses on individualized therapy goals and uses dance and movement as a psychotherapeutic process to further the emotional, cognitive, and physical integration of the individual. Dance/Movement Therapy is based on knowledge of movement observation and analysis, human development, and psychological theory and is designed to effect positive changes in a Covered Individual/Family Member’s emotional well-being, cognition, physical functioning and behavior. Dance/Movement Therapy:

Must be delivered consistent with professional standards of practice
Can be delivered in the Covered Individual/Family’s home, the Provider’s office, or in the community
Requires face-to-face contact with the Covered Individual/Family Member to conduct assessments or provide therapy
Addresses identified individual needs as determined by assessment and in conjunction with the Child and Family Team
Is provided as a 1:1 service, unless specifically authorized by the Care Coordinator as a group service
Does not include time waiting to provide services.
Does not include the travel time of the Service Provider to-and-from the location of service, unless the Covered Individual/Family Member is present in the Provider’s vehicle
Does not include supervision of services or tasks outside the scope of professional certification
Cannot exceed more than four consecutive hours per billable event, unless pre-authorized by the Care Coordinator.
Unit of Service: 15 minutes
Credentialing Requirement: Dance Therapist Registered (DTR) or Academy of Dance Therapy Registered (ADTR) by the American Dance Therapy Association.

Dietary: The assessment and evaluation of the nutritional status and needs of a Covered Individual/Family Member, including the identification of resources and constraints in dietary practices, by a professional licensed to practice Dietetics. Dieticians’ establish priorities and goals that assist a Covered Individual/Family Member in meeting his/her nutritional needs and are consistent with available resources and constraints. Dietary services include the provision of nutrition education and counseling in health and disease and the development and implementation of nutritional plans.

Must be delivered consistent with professional standards of practice
Require face-to-face contact with the Covered Individual/Family Member to conduct assessments or provide education
May be delivered in the Practitioner’s office, the Covered Individual/Family Member’s home, or the community
Address identified individual needs as determined by assessment and in conjunction with the Child and Family Team and a Licensed Physician, as appropriate
Is provided as a 1:1 service
Do not include the travel time of the Service Provider to-and-from the location of service, unless the Covered Individual/Family Member is present in the Provider’s vehicle
Do not include time waiting to provide service
Do not include supervision of services or tasks outside the scope of professional licensure
Cannot exceed more than two consecutive hours per billable event, unless pre-authorized by the Care Coordinator
Unit of Service: 15 minutes
Credentialing Requirement: A person who is Licensed as a Dietician (LD) or Registered as a Dietician (RD) by the Texas State Board of Examiners of Dieticians

In-patient Substance Abuse Services: A 24 hour residential setting designed to provide In-patient Substance Abuse Treatment to a Covered Individual.

Level 1 Residential: An inpatient residential facility designed for detoxification, withdrawal, stabilization, and referral for ongoing treatment of a covered individual.
Level 2 Residential: An inpatient residential facility providing an average of twenty hours of structured services per week.
Level 3 Residential: An inpatient residential facility providing an average of ten hours of structured services per week.

In-patient Substance Abuse Services:

Must be provided face-to-face with the Covered Individual
Must include room, board, transportation, access to school services, access to medical care, and the appropriate level of supervision for the covered individual based on needs, age, and level
Must be provided as a facility-based residential service
Address an identified need for In-patient Substance Abuse Services as determined by the Child and Family Team and in conjunction with a Licensed Physician
Cannot be billed simultaneously with Respite, Therapeutic Foster Care, Shelter Care, Group After School Care, Camp, or Child Care/Supervision.
Must maintain minimum staffing ratios as per TCADA licensure rules
Must comply with all applicable local, state, and federal rules, regulations, and standards of care
Unit of Service: Daily
Credentialing Requirement: TCADA licensure/certification mandates qualifications.

Interpretation/Translation Services:

Interpretation: Facilitation of communication, verbally or thru sign language, for the benefit of the Covered Individual and/or Family when there is a language barrier between the Covered Individual/Family and a second party.
Translation: Conveying the meaning, ideas, and concepts in a document written in one language into a document written in another language for the benefit of the Covered Individual and/or Family.

Interpretation/Translation Services:

Must be provided face-to-face with the Covered Individual and/or Family (Interpretation only)
Can be provided in any setting
Address an identified need for Interpretation and/or Translation Services as determined by the Child and Family Team
Are provided as a one-on-one service
Are reimbursable only when the Provider of services is not obligated by law to provide interpretation and/or translation (i.e. schools, courts, hospitals, governmental agencies, etc).
Do not include the travel time of the Service Provider to-and-from the location of service, unless the Covered Individual/Family Member is present in the Provider’s vehicle
Cannot be provided by someone who resides in the same residence as the Covered Individual/Family
Unit of Service: 15 minutes
Credentialing Requirement: Certified as a level 2 interpreter of the target language or certified as a level three interpreter of the target language when interpreting/translating medical or psychiatric services, or as otherwise credentialed by exception.

Life Skills Training: Direct support services provided to a Covered Individual/Family Member that focus on the attainment of specific life skills and the development of generic community and non-paid support systems to enable an individual sixteen years or older to function independently and successfully in the community. Life skills Training may include support with employment/vocational training efforts, support for GED completion, budgeting and money management, household management, nutrition, and/or safety skills. Life Skills Training:

Is provided in the Covered Individual/Family Member’s home or in the community
Must be provided face-to-face with the Covered Individual/Family Member
Addresses identified life skill and transitional needs of the individual as determined by the Child and Family Team
Cannot be billed simultaneously with another Community Support Service
Must be provided as a 1:1 service, unless authorized as a group service by the Care Coordinator
Does not include the travel time of the Service Provider to-and-from the location of service, unless the Covered Individual/Family Member is present in the Provider’s vehicle
Cannot be provided by someone who resides in the same residence as the Covered Individual/Family Member
Does not include time waiting to provide service
Cannot exceed more than four consecutive hours per billable event, unless pre-authorized by the Care Coordinator.
Unit of Service: 15 minutes
Credentialing Requirement: Minimum of a High School Diploma or GED with demonstrated proficiency in the identified life skill area and one year experience with the target population.

Massage Therapy: A therapeutic health intervention that utilizes the manipulation of the soft tissue by hand or through a mechanical or electrical apparatus for the purpose of body massage and includes stroking, kneading, percussion, compression, vibration, friction, nerve strokes, and Swedish gymnastics as the primary modality of treatment. Massage Therapy is primarily used to reduce stress manifested in the soft tissues and promotes physical relaxation and emotional well-being. Massage Therapy:

Must be delivered consistent with professional standards of practice
May be provided in the Covered Individual/Family’s home or Provider office
Requires face-to-face contact with the Covered Individual/Family Member to provide therapy
Addresses identified individual needs as determined by the Child and Family Team
Is provided as a 1:1 service
Does not include transportation of an individual, travel time, or time waiting to provide services.
Does not include supervision of services or tasks outside the scope of professional certification
Cannot exceed more than one-and-one-half hours per billable event, unless pre-authorized by the Care Coordinator.
Unit of Service: 15 minutes
Credentialing Requirement: Registered as a Massage Therapist (RMT) by The Texas Department of State Health Services.

Medication Management Services: A medical service provided to a Covered Individual/Family Member to evaluate the need for treatment with medications used for psychiatric disorders. Medication Management includes the prescription and monitoring of psychiatric medications and must be provided by a Licensed Physician or Licensed Nurse Practitioner. Medication Management Services:

Must be delivered consistent with professional standards of practice
Requires face-to-face contact with the Covered Individual/Family Member to conduct assessment/evaluation
Address an identified individual need as determined by assessment, the Child and Family Team, and in conjunction with a Licensed Physician
May include time spent obtaining medical, behavioral, adaptive, psychosocial, historical, or other relevant information from collateral contacts
Include feedback, consultation, and education to the Family, Care Coordinator, and Covered Individual, as appropriate
Are conducted in the practitioner’s office
Do not include transportation of an individual, travel time, or time waiting to provide services.
Does not include supervision of services or tasks outside the scope of professional licensure
Unit of Service: 15 minutes
Credentialing Requirement: Licensed Medical Doctor (MD/Psychiatry) or Licensed Doctor of Osteopathic Medicine (DO/Psychiatry) or Licensed Nurse Practitioner (LNP).

Mentoring Services: There are three categories of Mentoring Services:

Individual Mentoring: A community based service in which a positive adult role model engages a Covered Individual/Family Member in a one-to-one relationship and functions as a friend, advocate and life coach.
Family Mentoring: A community based service in which a positive adult role model engages a Covered Individual and one or two of his/her Family Members in activities that focus on facilitating successful relationships between the Covered Individual and his/her Family Members, to improve the Individual’s ability to function successfully in the home.
Special Event Group Mentoring: A community based service in which a positive adult role model engages two or three Covered Individuals/Family Members in a scheduled special event for the purposes of facilitating social interaction, peer relationships, and/or personal development and growth.

Mentoring:

Must be provided face-to-face with the Covered Individual(s) and/or the Covered Individual and Family Members
Is primarily provided in the community
Addresses identified needs of the Covered Individual/Family as determined by the Child and Family Team
Cannot be billed simultaneously with another Community Support Service
Must be provided as a 1:1 service, unless authorized as Family Mentoring or Special Event Group Mentoring by the Care Coordinator
Is limited to the Covered Individual and no more than two additional Family Members for Family Mentoring
Is limited to three individuals for Special Event Group Mentoring
Does not include the travel time of the Service Provider to-and-from the location of service, unless the Covered Individual/Family Member is present in the Provider’s vehicle
Cannot be provided by someone who resides in the same residence as the Covered Individual/Family
Does not include time waiting to provide service
Cannot exceed more than four consecutive hours per billable event, unless pre-authorized by the Care Coordinator.
Unit of Service: 15 minutes
Credentialing Requirement: Minimum of a High School Diploma or GED with at least one year experience and the demonstrated ability to develop rapport with the target population.

Music Therapy: A therapeutic intervention that utilizes music as the primary modality of active treatment. Music Therapy focuses on individualized therapy goals and uses music within a therapeutic context to address physical, emotional, cognitive, communication, and socialization needs of the Covered Individual/Family Member. Music Therapists use both instrumental and vocal music strategies to facilitate desired outcomes. Music Therapy is based on knowledge of music theory and practice, human development, and psychological theory and is designed to effect positive changes in an individual’s emotional well-being, cognition, physical functioning, and behavior. Music Therapy:

Must be delivered consistent with professional standards of practice
Can be provided in the Covered Individual/Family’s home, Provider office, or other community location
Requires face-to-face contact with the Covered Individual/Family Member to conduct assessments or provide therapy
Addresses identified individual needs as determined by assessment and in conjunction with the Child and Family Team
Is provided as a 1:1 service, unless specifically authorized by the Care Coordinator as a group service
Does not include time waiting to provide services.
Does not include the travel time of the Service Provider to-and-from the location of service, unless the Covered Individual/Family Member is present in the Provider’s vehicle
Does not include supervision of services or tasks outside the scope of professional certification
Cannot exceed more than four consecutive hours per billable event, unless pre-authorized by the Care Coordinator.
Unit of Service: 15 minutes
Credentialing Requirement: Registered as a Music Therapist Board Certified (MT-BC), Registered Music Therapist (RMT), Certified Music Therapist (CMT), or Advanced Certified Music Therapist (ACMT) by the American Music Therapy Association.

Nursing: The performance of health care treatments and monitoring of health care procedures that requires specialized judgment and skill as ordered by a Physician/Licensed Medical Practitioner and/or required by standards of professional practice or state law to be performed by a Registered Nurse, a Licensed Vocational Nurse, or a Licensed Nurse Practitioner. Nursing includes the observation, assessment, intervention, evaluation, rehabilitation, care, counseling, and health related education of a Covered Individual/Family Member who is ill, injured, infirm, or experiencing a change in normal health processes.

Must be delivered consistent with professional standards of practice
Typically requires face-to-face contact with the Covered Individual/Family Member to conduct health-related education, assessment, monitoring, and/or provide treatment, including medication administration.
Includes Face-to-face or telephone contact with a Licensed Physician regarding the health/medical condition of a specific individual
Addresses identified individual needs as determined by assessment and the Child and Family Team in coordination with a Licensed Physician/Licensed Medical Practitioner.
Takes place in the home setting, unless specifically authorized by the Care Coordinator
Is provided as a 1:1 service
Includes training of non-licensed personnel by a Licensed Nurse in the performance, monitoring, reporting and documentation of health/medical interventions for a Covered Individual/Family Member
Does not include transportation of an individual, travel time, or time waiting to provide services.
Does not include arranging medical appointments
Does not include providing Nursing Services without established and documented medical necessity
Does not include reordering, refilling, or delivering medications
Does not include supervision of services or tasks outside the scope of professional licensure
Cannot exceed more than two consecutive hours per billable event, unless pre-authorized by the Care Coordinator.
Unit if Service: 15 minutes
Credentialing Requirement: Licensed by the Texas State Board of Nursing Examiners as a Licensed Vocational Nurse (LVN) or Registered Nurse (RN) or Licensed Nurse Practitioner (LNP).

Occupational Therapy: The use of purposeful activity or intervention to facilitate the restoration of a Covered Individual/Family Member’s greatest possible level of independence by a person licensed in Occupational Therapy. Occupational Therapy provides services to individuals limited by physical injury or illness, cognitive impairment, psychosocial dysfunction, mental illness, developmental/learning disabilities or adverse environmental conditions. Occupational Therapy services include the evaluation/assessment, treatment, and education of an individual directed toward developing , improving, or restoring daily living skills, play and leisure skills, and work/school performance through intervention methodologies designed to develop, restore, or maintain sensorimotor, oral-motor, perceptual or neuromuscular functioning, joint range of motion; and the emotional, cognitive, or psychosocial components of performance.

Must be delivered consistent with professional standards of practice
Requires face-to-face contact with the Covered Individual/Family Member to conduct assessments or provide therapy
May be delivered in the Practitioner’s Office, Covered Individual/Family Member’s home, or in the community
Addresses identified individual needs as determined by assessment by a Licensed or Registered Occupational Therapist, (OTR or LOT), the Child and Family Team and a Licensed Physician
Is provided as a 1:1 service, unless otherwise authorized as a group service by the Care Coordinator
Does not include the travel time of the Service Provider to-and-from the location of service, unless the Covered Individual/Family Member is present in the Provider’s vehicle
Does not include time waiting to provide service
Does not include supervision of services or tasks outside the scope of professional licensure
Cannot exceed more than two consecutive hours per billable event, unless pre-authorized by the Care Coordinator.
Unit of Service: 15 minutes
Credentialing Requirement: Licensed as an Occupational Therapist, Registered (OTR) by the Texas Board of Occupational Therapy Examiners or licensed as an Occupational Therapist (LOT) by the Texas Board of Occupational Therapy Examiners or licensed or certified as an Occupational Therapy Assistant (LOTA/COTA) by the Texas Board of Occupational Therapy Examiners.

Other Basic Needs: Other Basic Needs include those items and services needed to sustain a Covered Individual and his/her Family in the course of everyday life. Other basic needs may include, automotive, clothing, food, housing, utilities, etc. In most instances receipts must be provided to the MSO before payments can be processed.

Other Wellness Therapies: A Wellness Therapy is any of a wide variety of therapeutic interventions whose application promotes physical well being and good health and facilitates healing and wellness in the physical, mental, and/or emotional aspects of a Covered Individual/Family Member thereby enabling him/her to live a more healthful, balanced, and fulfilling life. Other Wellness Therapies:

Must be delivered consistent with professional standards of practice
Must be delivered in the Covered Individual/Family Member’s home or Provider office
Require face-to-face contact with the Covered Individual/Family Member to provide therapy
Address identified individual needs as determined by the Child and Family Team
Are provided as a 1:1 service
Do not include transportation of an individual, travel time, or time waiting to provide services.
Do not include supervision of services or tasks outside the scope of professional certification
Must have Care Coordination Supervisory approval to be authorized
Cannot exceed more than one-and-one-half hours per service event, unless pre-authorized by the Care Coordinator and approved by the Care Coordination Supervisor.
Unit of Service: 15 minutes
Credentialing Requirement: Certification, licensing, or registration by appropriate professional organization.

Parent Coaching: Services provided to the Parent of a Covered Individual to assist in the acquisition and development of effective parenting skills and techniques for management of the Covered Individual/Family Member’s behavior or symptoms. Parent Coaches also assist the Parents/Guardians of a Covered Individual in accessing needed services and in navigating through service delivery systems. Parent Coaching:

Must be provided face-to-face or by telephone contact with the Covered Individual’s Parent, Guardian, or Primary Caregiver.
Is provided in the Covered Individual’s home or in the community
Addresses identified parenting skills and needs as determined by the Child and Family Team
Cannot be billed simultaneously with another Community Support Service
Must be provided directly to the Parent, Guardian, or Primary Caregiver of a Covered Individual.
Does not include the travel time of the Service Provider to-and-from the location of service, unless the Covered Individual’s Parent, Guardian, or Primary Caregiver is present in the Provider’s vehicle
Cannot be provided by someone who resides in the same residence as the Covered Individual/Family.
Does not include time waiting to provide service
Cannot be provided for more than four consecutive hours, unless prior authorization is obtained from the Care Coordinator
Unit of Service: 15 minutes
Credentialing Requirement: Minimum of a High School Diploma or GED with at least one year experience with the target population and demonstrated proficiency in the provision of parenting skills training.

Physical Therapy: The examination, assessment, evaluation, and utilization of exercises, rehabilitative procedures, massage, manipulations, and physical agents including, but not limited to, mechanical devices, heat, cold, air, light, water, electricity, and sound to assist in the diagnosis and treatment of a Covered Individual/Family Member in acute or prolonged movement dysfunction or pain of anatomic or physiologic origin by a person licensed in Physical Therapy.

Must be delivered consistent with professional standards of practice
Requires face-to-face contact with the Covered Individual/Family Member to conduct assessments or provide therapy
Is typically delivered in the Practitioner’s office
Addresses identified individual needs as determined by assessment by a Licensed Physical Therapist (PT), the Child and Family Team, and in conjunction with a Licensed Physician
Is provided as a 1:1 service
Does not include transportation of an individual, travel time, or time waiting to provide services
Does not include transportation of an individual, travel time, or time waiting to provide services
Does not include supervision of services or tasks outside the scope of professional licensure
Cannot exceed more than two consecutive hours per billable event, unless pre-authorized by the Care Coordinator
Unit of Service: 15 minutes
Credentialing Requirement: Licensed as a Physical Therapist (PT) by the Texas Board of Physical Therapy Examiners or licensed as a Physical Therapy Assistant (PTA) by the Texas Board of Physical Therapy Examiners

Psychological Assessment/Evaluation: A face-to-face evaluation of a Covered Individual/Family Member, including the administration of psychological testing and evaluation instruments to determine a clinical diagnosis, eligibility status, optimal treatment interventions, and service needs. A written report of the assessment is provided by the Psychologist that includes DSM IV diagnosis, adaptive behavior level, clinical impressions, psychosocial history, and treatment recommendations. Psychological Assessment/Evaluation Services:

Must be delivered consistent with professional standards of practice
Requires face-to-face contact with the Covered Individual/Family Member to conduct assessment/evaluation
Address an identified individual need for Psychological Assessment/Evaluation as determined by the Child and Family Team
May include time spent obtaining behavioral, adaptive, psychosocial, historical, or other relevant information from family members or other collateral contacts
Include feedback and results interpretation to the Family, Care Coordinator, and Covered Individual, as appropriate
Are conducted in the practitioner’s office
Are billable at a maximum of five hours per assessment
Do not include transportation of an individual, travel time, or time waiting to provide services
Do not include supervision of services or tasks outside the scope of professional licensure
Unit of Service: 15 minutes
Credentialing Requirement: Licensed Psychologist (PhD) or Licensed Psychological Associate (LPA) by the Texas Board of Psychological Examiners

Psychiatric Assessment and Evaluation: A face-to-face evaluation of a Covered Individual/Family Member by a Licensed Psychiatrist to determine mental, emotional, or behavioral capabilities from a medical perspective. A psychiatric evaluation includes a description of presenting problems and symptoms; information about current and past physical and psychiatric illnesses treatments, and medications; family and social history; clinical impressions; diagnostic information; and treatment recommendations. Psychiatric Assessment/Evaluation Services:

Must be delivered consistent with professional standards of practice
Require face-to-face contact with the Covered Individual/Family Member to conduct assessment/evaluation
Address an identified individual need for Psychiatric Assessment/Evaluation as determined by the Child and Family Team
May include time spent obtaining information relevant to the evaluation from the Covered Individual’s family members and/or other collateral contacts
Include feedback and results interpretation to the Family, Care Coordinator, and Covered Individual, as appropriate
Are conducted in the practitioner’s office
Do not include transportation of an individual, travel time, or time waiting to provide services
Does not include supervision of services or tasks outside the scope of professional licensure
Unit of Service: 15 minutes
Credentialing Requirement: Licensed Medical Doctor (MD/Psychiatry) or Licensed Doctor of Osteopathic Medicine (DO/Psychiatry)

Recreation Therapy: A therapeutic intervention that utilizes recreation and leisure activities as the primary modality of active treatment for health restoration, remediation, habilitation, and/or rehabilitation for Covered Individuals/Family Members who are limited in their functional abilities due to illness, maladaptation, or disability. Recreation Therapy includes structured activities which target the reduction of specific symptoms and maladaptations and/or the enhancement of specific functional skills which necessitate intervention by a professional certified in Recreational Therapy. Recreation therapy:

Must be delivered consistent with professional standards of practice
Must be delivered in the community
Requires face-to-face contact with the Covered Individual/Family Member to conduct assessments or provide therapy
Addresses identified individual needs as determined by assessment and in conjunction with the Child and Family Team
Is provided as a 1:1 service, unless specifically authorized by the Care Coordinator as a group service
Does not include time waiting to provide services.
Does not include the travel time of the Service Provider to-and-from the location of service, unless the Covered Individual/Family Member is present in the Provider’s vehicle
Does not include supervision of services or tasks outside the scope of professional certification
Cannot exceed more than four consecutive hours per billable event, unless pre-authorized by the Care Coordinator.
Unit of Service: 15 minutes
Credentialing Requirement: Certification as a Therapeutic Recreation Specialist (CTRS) by the National Council for Therapeutic Recreation Certification or certification as a Therapeutic Recreation Specialist/Texas Certified (TRS/TXC) or Therapeutic Recreation Associate/Texas Certified (TRA/TXC) by the Consortium for Therapeutic Recreation/Activities Certification, Inc.

Respite Services: A service that provides for the planned or emergency, short-term, non-routine relief of the unpaid Caregiver of a Covered Individual/Family Member. Respite Services provide supervision of the Individual to ensure their health, safety, security, nutritional, social, and recreational needs are being met in the absence of the Primary Caregiver. Respite also includes habilitation and other community support activities that facilitate the individual’s inclusion in the community, social interaction, participation in leisure activities, and development of socially valued behaviors, daily living, and independent living skills. Respite Services:

Must be provided face-to-face to the Covered Individual/Family Member
Can be provided in the Covered Individual’s home, in the Provider’s home, in the community, or in a community-based facility
That are site-based can only be provided in a community-based facility or Service Provider’s home that has been prior approved by the MSO
Cannot be billed simultaneously with Community Support Services if billed hourly
Address an identified need of the Covered Individual’s Family for respite as determined by the Child and Family Team
Support, rather than supplant, the Family’s natural resources and support network
Can be provided as a 1:1 service with the Covered Individual/Family or in groups
Do not allow for more than 3 children in a Provider home-based Respite site at any given time.
Do not allow a staff -to-child ratio of less than one staff to five children in Community Based Respite programs.
Do not allow a staff-to-child ratio of less than one staff to six children in Facility Based Respite programs.
Do not include the travel time of the Service Provider to-and-from the location of service, unless the Covered Individual/Family Member is present in the Provider’s vehicle
Cannot be provided by someone who resides in the same residence as the Covered Individual/Family
Do not include time waiting to provide service
Cannot be provided to a Covered Individual/Family Member living independently in the community
Unit of Service: For hourly respite: 15 minute increments up to 10 hrs
For daily respite 10 or more consecutive hrs constitutes 1 day of respite
Credentialing Requirement: Minimum of a High School Diploma or GED with at least one year experience with the target population.

Shelter Care: Short-term, non-clinical 24 hour service for a Covered Individual/Family Member transitioning from one living situation to another or needing emergency and/or temporary housing and shelter. Shelter Care:

Must be provided face-to-face with the Covered Individual/Family Member
Must include room, board, transportation, access to school services, access to medical care, and the appropriate level of supervision for the Covered Individual/Family Member based on needs, age, and level of care.
Must be provided as a facility-based residential service or in a Service Provider’s home that has been prior approved by the MSO
Addresses an identified need for shelter care as determined by the Child and Family Team
Cannot be billed simultaneously with Respite, Therapeutic Foster Care, In-patient Substance Abuse Services, Group After School Care, Camp, or Child Care/Supervision.
Must maintain at a minimum a one-to-six staffing ratio, unless otherwise indicated by applicable standards of care
Must comply with all applicable local, state, and federal rules, regulations, and standards of care
Unit of Service: daily
Credentialing Requirement:
- For Facility-based Service: Organizational providers must comply with all applicable licensure/certification requirements. Licensing/Certification requirements will also determine staff qualifications.
- For Individual Providers: Minimum of a High School Diploma or GED with at least one year of related experience with the target population.

Speech-Language Pathology: The assessment, evaluation, counseling, habilitation or rehabilitation, of a Covered Individual/Family Member who has, or is suspected of having, a disorder of speech, voice, language, oral pharyngeal function, or speech-language related cognitive processes by a professional licensed in Speech-Language Pathology. Speech-Language Pathology:

Must be delivered consistent with professional standards of practice
Requires face-to-face contact with the Covered Individual/Family Member to conduct assessments or provide therapy
Is typically delivered in the Practitioner’s office
Addresses identified individual needs as determined by assessment by a Licensed Speech Pathologist and in conjunction with the Child and Family Team
Is provided as a 1:1 service
Does not include transportation of an individual, travel time, or time waiting to provide services.
Does not include supervision of services or tasks outside the scope of professional licensure
Cannot exceed more than two consecutive hours per billable event, unless pre-authorized by the Care Coordinator.
Unit of Service: 15 minutes
Credentialing Requirement: Licensed as a Speech-Language Pathologist or licensed as an Intern in Speech-Language Pathology or Licensed as an Assistant in Speech-Language Pathology by the Texas State Board of Examiners for Speech-Language Pathology and Audiology.

Substance Abuse Outpatient Treatment: A structured non-residential community-based program designed to assist the Covered Individual in attaining and/or maintaining chemical-free status by identifying and changing patterns of behavior that are maladaptive, destructive, or injurious to health and by restoring the individual to optimal levels of physical, psychological, and social functioning. Substance abuse outpatient services are categorized based on level of need as follows:

Intensive Outpatient Treatment (level 3) – Ten or more hours of structured service per week
Supportive Outpatient Treatment (level 4) – Two hours of structured activities per week
Pharmacological Outpatient Treatment – Medically supervised services designed for persons who are opiate/narcotic addicted that may include the administration of Methadone or LAAM.
Substance Abuse Outpatient Services:
- Must be delivered consistent with professional standards of practice
- Are conducted in a community outpatient setting
- Require face-to-face contact with the Covered Individual to provide services
- May be conducted 1:1 or in groups
- Address identified individual needs as determined by assessment, the Child and Family Team, and in conjunction with a Licensed Physician, as appropriate
- Consist of a minimum of two individuals and a maximum of seven individuals when provided as a group service
- Can only be provided to covered individuals who have a DSM-IV diagnosis of Substance Abuse or Substance Dependence and the appropriate to level of care
- Do not include transportation of an individual, travel time, or time waiting to provide services.
- Do not include supervision of services or tasks outside the scope of professional licensure
- Unit of Service: 15 minutes
- Credentialing Requirement: Licensed Chemical Dependency Counselor (LCDC)

Team Meeting: A scheduled face-to-face meeting between Child and Family Team Members for the purpose of coordinating services, developing service delivery strategies, assessing the Covered Individual/Family’s response to services, and modifying the Plan of Care as needed. Team Meetings must include at a minimum the Covered Individual’s Parent/Guardian/Primary Caregiver and the Care Coordinator. Meeting participants may also include the Covered Individual, Direct Service Providers, Agency/System Representatives, Family Members, Friends, and Advocates. Team Meetings:

Is provided in the home, school, community, or institutional setting
Cannot be billed simultaneously with another Community Support Service
Must be provided face-to-face with the Covered Individual’s Parent/Guardian/Primary Caregiver and the Care Coordinator at a minimum.
Does not include the travel time of the Service Provider to-and-from the location of service, unless the Covered Individual/Family is present in the Provider’s vehicle
Does not include time waiting to provide service
Cannot be provided simultaneously with a public school Admission, Review, and Dismissal (ARD) meeting.
Cannot exceed more than three hours per billable event, unless authorized by the Care Coordinator.
Unit of Service: 15 minutes
Credentialing Requirement: NA

Therapeutic Foster Care: A living arrangement providing twenty-four hour intensive support services and supervision in a homelike environment to a Covered Individual/Family Member with a serious emotional disturbance who is temporarily unable to live in the home of his/her Family or Primary Caregiver. Therapeutic foster care:

Must be provided face-to-face with the Covered Individual/Family Member
Must include room, board, transportation, access to school services, access to medical care, and the appropriate level of supervision for the Covered Individual/Family Member based on needs, age, and level of care.
Must be provided as a Facility-based Residential Service or in an individual service Provider’s home that has been prior approved by DFPS
Addresses an identified need for Therapeutic Foster Care as determined by the Child and Family Team
Cannot be billed simultaneously with Respite, Shelter Care, In-patient Substance Abuse Services, Group After School Care, Camp, or Child Care/Supervision.
Must maintain at a minimum a one-to-six staffing ratio, unless otherwise indicated by applicable standards of care
Must comply with all applicable local, state, and federal rules, regulations, and standards of care
Unit of Service: daily
Credentialing Requirement: Must be certified by DFPS as a therapeutic foster home.

Transportation: Transporting a Covered Individual and/or Family Member from one location to another location for the purpose of accessing a needed service. Transportation does not include the delivery of any other service during the time of transport, including linkage, assistance in applying for the needed service, or monitoring the delivery of the needed service. Transportation may also include the provision of taxi vouchers or bus passes to the Covered Individual/Family. Transportation:

Must be provided face-to-face with the Covered Individual/Family Member
Addresses an identified need for transportation services as determined by the Child and Family Team
May be provided as a 1:1 or group service with the Covered Individual/Family Member.
If more than one individual is being transported in the same vehicle, the Provider should bill for each individual separately by dividing the total transportation time by the number of individuals being transported and rounding this time to the nearest quarter hour.
Supports, rather than supplants, the Family’s natural resources and support network
Does not include the travel time of the Service Provider when the Covered Individual/Family Member is not present in the Provider’s vehicle
Cannot be provided by someone who resides in the same residence as the Covered Individual/Family
Does not include time waiting to provide transportation services.
If provided through the use of a taxi voucher must include a receipt or other form of supporting documentation for billing.
Unit of Service: 15 minutes
Credentialing requirement: Minimum of a High School Diploma or GED with a valid Texas Driver’s License, good driving record, and vehicle liability insurance as required by law. Must be at least 21 years old.

Tutoring: Educational training, support, and remedial assistance during non-school hours to bring a covered individual up to academic grade level by a Provider with knowledge or expertise in the subject area. Tutoring must be based on assessed academic need and does not include the instruction of non-academic skills. Tutoring:

Must be provided face-to-face with the Covered Individual/Family Member
Is provided in the Covered Individual/Family Member’s home or in the community
Addresses identified academic needs of the individual as determined by assessment and the Child and FamilyTeam
Cannot be billed simultaneously with another Community Support Service
Must be provided as a 1:1 service
Does not include the travel time of the Service Provider to-and-from the location of service, unless the Covered Individual/Family Member is present in the Provider’s vehicle
Cannot be provided by someone who resides in the same residence as the Covered Individual/Family Member
Does not include time waiting to provide service
Cannot exceed more than three consecutive hours per billable event, unless pre-authorized by the Care Coordinator.
Unit of Service: 15 minutes
Credentialing Requirement: Minimum of a High School Diploma or GED with demonstrated proficiency in the identified academic skill area and one year experience with the target population.


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