(a) Definitions. The following words and terms, when used in this chapter, have the following meanings.
  (1) Deaf--The term "deaf" is defined in the Human Resources Code, Title 4, Services for the Deaf, Chapter 81, Texas Commission for the Deaf and Hard of Hearing, §81.001, Definitions.
  (2) Hard of Hearing--The term "hard of hearing" is defined in the Human Resources Code, Title 4, Services for the Deaf, Chapter 81, Texas Commission for the Deaf and Hard of Hearing, §81.001, Definitions.
  (3) Interpreter--An interpreter is an individual who possesses one of the following certification levels (i.e., levels A - H) issued by either the Department of Assistive and Rehabilitative Services, Office for Deaf and Hard of Hearing Services, Board for Evaluation of Interpreters (BEI) or the National Registry of Interpreters for the Deaf (RID):
    (A) Certification Level A:
      (i) Level I/Ii; and
      (ii) OC:B (Oral Certificate: Basic).
    (B) Certification Level B:
      (i) BEI Basic; and
      (ii) RID NIC (National Interpreter Certificate) Certified.
    (C) Certification Level C:
      (i) BEI Level II/IIi;
      (ii) RID CI (Certificate of Interpretation);
      (iii) RID CT (Certificate of Transliteration);
      (iv) RID IC, (Interpretation Certificate); and
      (v) RID TC (Transliteration Certificate).
    (D) Certification Level D:
      (i) BEI Level III/IIIi;
      (ii) BEI OC: C (Oral Certificate: Comprehensive);
      (iii) BEI OC: V (Oral Certificate: Visible);
      (iv) RID CSC (Comprehensive Skills Certificate);
      (v) RID IC/TC (Interpretation Certificate/Transliteration Certificate);
      (vi) RID CI/CT (Certificate of Interpretation/Certificate of Transliteration);
      (vii) RID RSC (Reverse Skills Certificate); and
      (viii) RID CDI (Certified Deaf Interpreter).
    (E) Certification Level E:
      (i) BEI Advanced; and
      (ii) RID NIC Advanced.
    (F) Certification Level F:
      (i) BEI IV/IVi;
      (ii) RID MCSC (Master Comprehensive Skills Certificate); and
      (iii) RID SC: L (Specialist Certificate: Legal).
    (G) Certification Level G is BEI V/VI.
    (H) Certification Level H:
      (i) BEI Master; and
      (ii) RID NIC Master.
  (4) Interpreting Services--The provision of voice-to-sign, sign-to-voice, gestural-to-sign, sign-to-gestural, voice-to-visual, visual-to-voice, sign-to-visual, or visual-to-sign services for communication access provided by a certified interpreter.
(b) Benefit and Limitations. Sign language interpreting services are a health care benefit of the State Medical Assistance (Medicaid) Program.
  (1) Sign language interpreting services must be requested by a physician and provided by a qualified interpreter to facilitate communication between:
    (A) A client who is deaf or hard of hearing and a physician during the course of a medically necessary medical examination or other medical services; or,
    (B) A client's parent or guardian who is deaf or hard of hearing and a physician during the course of the client's medically necessary medical examination or other medical services.
  (2) A physician's determination of the need for sign language interpreting services shall give primary consideration to the needs of the individual who is deaf or hard of hearing.
  (3) The physician requesting interpreting services must maintain documentation verifying the provision of interpreting services.
    (A) Documentation of the service must be included in the patient's medical record and must include the name of the sign language interpreter and the interpreter's certification level.
    (B) Documentation must be made available if requested by the Commission or its designee.
(c) Physician requirements for billing of and reimbursement for sign language interpreting services.
  (1) Physicians must be enrolled in the Texas Medicaid Program to be considered for reimbursement.
  (2) Reimbursement for sign language interpreting services is limited to physicians or physician groups employing fewer than fifteen employees.
  (3) Providers seeking reimbursement for sign language interpreting services must provide and bill for the service in the manner prescribed by the Texas Medicaid Program and in accordance with §355.8085 of this title (relating to Reimbursement Methodology for Physicians and Other Practitioners).

Source Note: The provisions of this §354.1069 adopted to be effective August 19, 2007, 32 TexReg 4964; amended to be effective March 15, 2017, 42 TexReg 1118