Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter AA - VENDOR PAYMENT › Section 554.2601 - Vendor Payment (Items and Services Included)

Current through Reg. 49, No. 28; July 12, 2024
(a) A facility provides, under the terms of
				  the contract, for the total medical, nursing, and psychosocial needs of each
				  recipient.
(b) The daily rate is
				  compatible with reasonable charges consistent with efficiency, economy, and
				  quality of total care. The facility must ensure that care meets the health
				  needs and promotes the maximum well-being of recipients. The following items
				  and services are included in the payment rate made to the facility by the
				  Department of Aging and Disability Services (DADS) and, therefore, the facility
				  must provide:
(1) nursing care;
(2) social services;
(3) regular, special, and supplemental diets,
				  including tube feedings;
(4)
				  nonlegend drugs, with the exception of insulin, and alcoholic beverages unless
				  prescribed for medicinal purposes. Alcoholic beverages:
(A) prescribed for medicinal purposes must
				  include the dosage and frequency of the alcohol; and
(B) not prescribed for medicinal purposes are
				  at the expense of the recipient or family;
(5) for a recipient who is not eligible for
				  Medicare Part D benefits, legend drugs that are not covered by the Medicaid
				  Vendor Drug Program;
(6) for a
				  recipient who is eligible for Medicare Part D benefits, legend drugs in a
				  category that is not covered by Medicare Part D and that are not covered by the
				  Medicaid Vendor Drug Program;
(7)
				  regular laundry services, except dry cleaning;
(8) medical accessories, such as canulas,
				  tubes, masks, catheters, ostomy bags and supplies, IV fluids, IV equipment, and
				  equipment that can be used by more than one person, such as wheelchairs,
				  adjustable chairs, crutches, canes, mattresses, hospital-type beds, enteral
				  pumps, trapeze bars, walkers, and oxygen equipment, such as tanks,
				  concentrators, tubing, masks, valves, and regulators.
(A) Facilities are required to maintain, in
				  good repair, equipment necessary to meet the needs of the recipient.
(B) If a recipient desires equipment for
				  exclusive use, its purchase is the responsibility of the recipient:
(i) Only the recipient can use the equipment,
				  and it must be identified as the personal property of the recipient.
(ii) Upon discharge from the facility, the
				  recipient retains the equipment he purchased. If the recipient dies, the
				  purchased equipment must be Transferred to the estate. If it is donated or sold
				  to the facility by the recipient or the estate, the transaction must be
				  documented. (See § 554.416 of Title 40 (relating to Personal
				  Property)).
(C) If a
				  recipient owns a piece of equipment that is medically necessary, the facility
				  must maintain and repair the equipment.
(D) When Part B Medicare benefits are
				  accessed to pay for equipment and accessories, the recipient or family may not
				  be charged by the facility or supply company for any portion of these
				  items;
(9) medical
				  supplies, including, but not limited to tongue depressors, swabs, bandaids,
				  cotton balls, and alcohol; and
(10)
				  basic personal hygiene items and services to meet the needs of the residents
				  (See § 554.405(h) of Title 40 (relating to Additional Requirements for
				  Trust Funds in Medicaid-Certified Facilities) for a list of such items and
				  services). The specific type or brand of personal hygiene items used by the
				  facility must be disclosed to the recipient; then, if a recipient prefers to
				  use a specific type or brand of a personal hygiene item(s) rather than the
				  item(s) furnished by the facility, he may use his personal funds to purchase
				  the item(s).
(A) Before purchasing or
				  charging for the preferred item(s), the facility must secure written
				  authorization from the recipient or family indicating his desired preference,
				  the date, and signature of the person requesting the preferred item(s). The
				  signature may not be that of an employee of the facility.
(B) If the recipient's personal funds are
				  used to purchase an item(s), the item(s) is for his sole use.
(C) When the facility purchases personal
				  hygiene item(s) with the recipient's personal funds, the facility must ensure
				  that the item(s) is in an individual container or package that is labeled with
				  the recipient's name. The facility is not held responsible for labeling
				  personal hygiene items brought into the facility and not reported to the
				  management.