Under Texas Labor Code §352.054, this rule adopts standards governing the determination of rates paid for medical services provided by the Agency. The rates determined under these standards are reevaluated annually:

1. (1) Rates shall be established based on Medicare and Medicaid schedules for current procedural terminology. Where Medicare and Medicaid schedules are not applicable, rates that represent best value shall be established based on factors that include reasonable and customary industry standards for each specific service.
2. (2) Rates shall be established at a level adequate to ensure that enough qualified providers are available to provide assessment and treatment within a geographic distribution that reflects customer or claimant distribution.
3. (3) Exceptions to established rates may be made on a case-by-case basis by the Agency's medical director or optometric consultant.

Source Note:The provisions of this §856.57 adopted to be effective August 21, 2018, 43 TexReg 5398.