reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 365 - KIDNEY HEALTH CARE › Section 365.4 - Applications

Current through Reg. 49, No. 28; July 12, 2024
Persons meeting the eligibility requirements set forth in
				  §
									61.3(a)
				  - (c) of this title (relating to Client Eligibility Requirements) must submit
				  an application packet for benefits.
(1) A complete application packet must be
				submitted by an authorized entity and include all of the following:
(A) a completed, signed and dated program
				application;
(B) a copy of the
				completed, signed and dated Centers for Medicare and Medicaid Services (CMS)
				End-Stage Renal Disease Medical Evidence Report or, with program approval, the
				Kidney Health Care Physician Assessment Form;
(C) documentation of Texas residency as
				required by §
										61.3
				of this title;
(D) a copy of the
				applicant's social security card issued by the Social Security Administration
				(SSA), or an allowable substitute, as follows:
(i) a copy of a SSA document which verifies
				the social security number; or
(ii)
				a copy of a valid Medicare card, if the Medicare account is established in the
				applicant's own social security number and the social security number is
				printed on the Medicare card; and
(E) applicant's financial data. The applicant
				or the person(s) legally obligated to support the applicant must verify income
				by providing one of the following:
(i) a copy
				of the first page of the federal individual income tax return for the most
				recent tax year, if self-employed; or
(ii) a statement of estimated or declared
				income for the current tax year, and supporting documentation.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 365 - KIDNEY HEALTH CARE › Section 365.5 - Benefits and Limitations

Current through Reg. 49, No. 28; July 12, 2024
(a)
				Benefits.
(1) Outpatient drugs and supplies
				listed on the current KHC formulary.
(2) Transportation reimbursement for
				ESRD-related medical services.
(3)
				Medical benefits, including:
(A) access
				surgery-related services; and
(B)
				chronic maintenance dialysis.
(4) Medicare Part A and B premium payment. To
				qualify for this benefit, clients must:
(A)
				be 65 years of age or older;
(B) be
				accepted for Medicare hospital and medical insurance;
(C) be obligated to pay the Part A
				premium;
(D) not be eligible for
				the following types of Medicare savings programs:
(i) QMB;
(ii) SLMB; or
(iii) QI; and
(E) promptly submit all Medicare premium due
				notice statements to the program for payment.
(5) Medicare Part B immunosuppressive drug
				co-insurance amounts. To qualify for this benefit, clients must:
(A) be eligible for program drug
				benefits;
(B) be accepted for
				Medicare hospital and medical insurance;
(C) enroll in a Texas Medicare Part D
				Stand-Alone Plan;
(D) not be
				enrolled in a Medigap plan;
(E) not
				be enrolled in a Medicare Advantage Plan with drug coverage; and
(F) not be eligible for the QMB Medicare
				Savings Program.
(6)
				Limited Medicare Part D out-of-pocket expenses. To qualify for this benefit,
				clients must:
(A) be eligible for program
				drug benefits;
(B) be accepted for
				Medicare Part D benefits;
(C)
				enroll in a Texas Medicare Part D stand-alone plan;
(D) not be eligible for LIS from Medicare
				that covers full premium and deductible amounts; and
(E) not be enrolled in a Medicare Advantage
				Plan with drug coverage.
(7) Benefits are payable beyond the Medicare
				three-month qualifying period for eligible clients who have applied for and
				have been denied Medicare coverage based on ESRD. Clients must submit a copy of
				the official Social Security Administration Medicare denial notification (based
				on chronic renal disease) to the department.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 365 - KIDNEY HEALTH CARE › Section 365.7 - Claims Submission and Payment Rates

Current through Reg. 49, No. 28; July 12, 2024
(a) Drug benefit claims must be submitted
				electronically by the pharmacy to the designated claims processor for the
				program, except when paper submissions are allowed or required.
(b) Medical benefit claims must be submitted
				to the program by the provider who rendered the service(s) to the program
				client or by the provider's designee.
(c) Transportation benefit claims must be
				submitted to the program by the client or an authorized entity. Claims must be
				submitted electronically through the current automated claims payment system,
				except when the program allows or requires paper submissions.
(d) Payments are made using the rates in
				effect on the date the service is rendered.
(e) Claims for medical benefits will not be
				considered for payment by the program until the program has a fully executed
				agreement with the provider.
(f)
				Incomplete or incorrect claims will not be considered for payment.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 365 - KIDNEY HEALTH CARE › Section 365.8 - Claim Filing Deadlines

Current through Reg. 49, No. 28; July 12, 2024
(a) The program
				must receive all claims within the claim filing deadlines established in this
				section.
(1) Claims must be received no later
				than 95 days from the last day of the month in which services were
				provided.
(2) Claims must be
				received no later than 60 days from the date on the program's notice of
				eligibility for newly approved clients.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 365 - KIDNEY HEALTH CARE › Section 365.9 - Rights and Responsibilities

Current through Reg. 49, No. 28; July 12, 2024
(a)
				An applicant and client have the right to:
(1)
				apply for eligibility determination;
(2) choose providers subject to program
				limitations;
(3) be notified of the
				program's decisions relating to modifications, suspensions, denials, or
				terminations; and
(4) appeal the
				program's decisions and receive a response within the deadline as described in
				§
										61.11
				of this title (relating to Rights of Appeal).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 365 - KIDNEY HEALTH CARE › Section 365.10 - Modifications, Suspensions, Denials, and Terminations

Current through Reg. 49, No. 28; July 12, 2024
(a) An applicant's or client's eligibility
				for benefits may be modified, suspended, or denied for failing to comply with
				the applicant and client responsibilities listed in §
									61.3
				of this title (relating to Client Eligibility Requirements) and §
									61.9(c)
				of this title (relating to Rights and Responsibilities).
(b) A provider's participation may be
				modified, suspended or denied for failing to comply with the provider
				responsibilities listed in 1 TAC §
									392.605(relating
				to Kidney Health Care Provider Requirements and Effective Dates) and §
									61.9(d)
				of this title.
(c) A client's
				eligibility may be terminated for any of the following reasons:
(1) failing to maintain Texas residency or to
				furnish evidence upon demand of residency using the criteria in §
										61.3
				of this title;
(2) failing to
				continue to meet the income requirements for program eligibility or to provide
				income data as requested by the department to determine continued program
				eligibility;
(3) failing to
				reimburse the department as requested for overpayments made to the
				client;
(4) failing to apply for
				medical, drug, and transportation benefits under Title XIX, Social Security Act
				(Medicaid);
(5) becoming eligible
				for drug, transportation, and medical benefits under the Medicaid
				Program;
(6) regaining native
				kidney function;
(7) voluntarily
				discontinuing treatment for ESRD;
(8) becoming incarcerated by or in the
				custody of a city, county, state, or federal entity;
(9) becoming a ward of the state;
(10) determination by the program that the
				client made a material misstatement or misrepresentation on their application
				or any document required to support their application;
(11) determination by the program that the
				client submitted false claim(s); or
(12) lack of a claim for benefits paid by the
				program on behalf of the client for a minimum period of 12 consecutive
				months.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 368 - INTELLECTUAL AND DEVELOPMENTAL DISABILITIES (IDD) HABILITATIVE SPECIALIZED SERVICES › Subchapter A - GENERAL PROVISIONS › Section 368.101 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this chapter,
					 have the following meanings, unless the context clearly indicates
					 otherwise.
(1) Abuse--
(A) physical abuse;
(B) sexual abuse; or
(C) verbal or emotional abuse.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 368 - INTELLECTUAL AND DEVELOPMENTAL DISABILITIES (IDD) HABILITATIVE SPECIALIZED SERVICES › Subchapter A - GENERAL PROVISIONS › Section 368.102 - Right to Administrative Hearing

Current through Reg. 49, No. 28; July 12, 2024
A service provider agency may request an administrative
					 hearing in accordance with 1 TAC Chapter 357, Subchapter I (relating to
					 Hearings Under the Administrative Procedure Act) if HHSC takes or proposes to
					 take one or more of the following actions or sanctions:
(1) vendor hold;
(2) contract termination;
(3) recoupment of payments made to the
				  service provider agency; or
(4)
				  denial of the service provider agency's request for payment.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 368 - INTELLECTUAL AND DEVELOPMENTAL DISABILITIES (IDD) HABILITATIVE SPECIALIZED SERVICES › Subchapter B - SERVICES DESCRIPTION AND INITIATION › Section 368.201 - Description of IHSS

Current through Reg. 49, No. 28; July 12, 2024
(a) IHSS are
				  Medicaid state plan services that are authorized by HHSC prior to
				  delivery.
(b) IHSS listed in this
				  subsection are selected for inclusion in a designated resident's plan of care
				  to help the designated resident partially or fully attain, maintain, improve,
				  or slow or prevent a decline in skills that were not fully acquired because of
				  a congenital, genetic, or early acquired health condition.
(1) Behavioral support:
(A) is assistance provided for a designated
				  resident to increase adaptive behaviors and to replace or modify maladaptive
				  behaviors that prevent or interfere with the designated resident's
				  interpersonal relationships across all service and social settings;
(B) is delivered in the NF or in a community
				  setting; and
(C) consists of:
(i) assessing the behaviors to be targeted in
				  an appropriate behavior support plan and analyzing those assessment
				  findings;
(ii) developing and
				  getting the designated resident's or LAR's written consent to an individualized
				  behavior support plan that reduces or eliminates the target behaviors,
				  assisting the designated resident in achieving the outcomes identified in the
				  HSP;
(iii) training and consulting
				  with the LAR, family members, NF staff, other support providers, and the
				  designated resident about the purpose, objectives, and methods of the behavior
				  support plan;
(iv) documenting and
				  implementing the behavior support plan or revisions to the behavior support
				  plan;
(v) monitoring and evaluating
				  the success of the behavior support plan implementation;
(vi) revising the behavior support plan as
				  necessary; and
(vii) participating
				  in SPT and IDT meetings.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 368 - INTELLECTUAL AND DEVELOPMENTAL DISABILITIES (IDD) HABILITATIVE SPECIALIZED SERVICES › Subchapter B - SERVICES DESCRIPTION AND INITIATION › Section 368.202 - Eligibility Criteria

Current through Reg. 49, No. 28; July 12, 2024
(a) A
				  designated resident is eligible for IHSS funded by Medicaid if the designated
				  resident:
(1) resides in a NF; and
(2) requires the provision of at least one
				  IHSS.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 368 - INTELLECTUAL AND DEVELOPMENTAL DISABILITIES (IDD) HABILITATIVE SPECIALIZED SERVICES › Subchapter B - SERVICES DESCRIPTION AND INITIATION › Section 368.203 - Process for Provider Selection

Current through Reg. 49, No. 28; July 12, 2024
(a) The habilitation coordinator must:
(1) provide the designated resident or LAR
				  the names and contact information of all service provider agencies that are in
				  the contract area of the designated resident's NF, no later than the initial
				  IDT meeting;
(2) arrange for phone
				  calls or meetings with the potential service provider agencies as requested by
				  the designated resident or LAR;
(3)
				  review the HSP developed in accordance with § 368.204(b)(3) of this
				  subchapter (relating to Process for Service Initiation) with potential service
				  provider agencies as requested by the designated resident or LAR;
(4) ensure the designated resident's or LAR's
				  choice of service provider agency is documented on the Documentation of
				  Provider Choice Form and signed by the designated resident or LAR;
				  and
(5) notify the chosen service
				  provider agency in writing and provide a copy of the designated resident's HSP
				  and NF baseline or comprehensive care plan, whichever is most current, within
				  three business days after the habilitation coordinator is notified of selection
				  by the designated resident or LAR.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 368 - INTELLECTUAL AND DEVELOPMENTAL DISABILITIES (IDD) HABILITATIVE SPECIALIZED SERVICES › Subchapter B - SERVICES DESCRIPTION AND INITIATION › Section 368.204 - Process for Service Initiation

Current through Reg. 49, No. 28; July 12, 2024
(a) A LIDDA must comply with §
										303.302
				  of this title (relating to LIDDA, LMHA, and LBHA Responsibilities Related to
				  the PASRR Process).
(b) At the
				  initial IDT meeting, the habilitation coordinator, in conjunction with the IDT,
				  must:
(1) review the IHSS recommended on the
				  PE and identify which IHSS:
(A) the designated
				  resident, or LAR on the designated resident's behalf, wants to receive;
				  and
(B) the IDT agrees the
				  designated resident should receive;
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 368 - INTELLECTUAL AND DEVELOPMENTAL DISABILITIES (IDD) HABILITATIVE SPECIALIZED SERVICES › Subchapter C - SERVICE AUTHORIZATIONS › Section 368.301 - Plan of Care

Current through Reg. 49, No. 28; July 12, 2024
(a) A plan of care
				  must be developed for each designated resident in accordance with §
				  368.204 of this chapter (relating to Process for Service Initiation) and
				  reviewed and revised for each designated resident whenever the designated
				  resident's needs for services and supports change, but no less than annually,
				  in accordance with § 368.302 of this subchapter (relating to Renewal and
				  Revision of a Plan of Care).
(b) A
				  plan of care must specify the frequency, amount, and duration of each IHSS to
				  be provided for a designated resident, as well as non-PASRR services and
				  supports to be provided during the plan year. Each service in the plan of care
				  must:
(1) be necessary to help the designated
				  resident partially or fully attain, maintain or improve skills, or slow or
				  prevent a decline in skills;
(2)
				  not be available for the designated resident through any other source,
				  including other state plan services, governmental programs, private insurance,
				  or other resources; and
(3) be
				  supported by at least one outcome in the HSP as necessary to enable community
				  integration and maximize independence.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 368 - INTELLECTUAL AND DEVELOPMENTAL DISABILITIES (IDD) HABILITATIVE SPECIALIZED SERVICES › Subchapter C - SERVICE AUTHORIZATIONS › Section 368.302 - Renewal and Revision of a Plan of Care

Current through Reg. 49, No. 28; July 12, 2024
(a) Renewal of the plan of care. At least
				  annually, and no earlier than 334 calendar days after the date of the previous
				  initial or annual SPT meeting, the SPT must:
(1) review the HSP and plan of care to
				  determine whether the outcomes and IHSS previously identified remain relevant;
				  and
(2) determine whether the
				  current assessment accurately reflects the designated resident's need for an
				  IHSS in the identified frequency, amount, and duration, or if an IHSS requires
				  a new assessment.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 368 - INTELLECTUAL AND DEVELOPMENTAL DISABILITIES (IDD) HABILITATIVE SPECIALIZED SERVICES › Subchapter D - SERVICE PROVIDER AGENCY REQUIREMENTS › Section 368.401 - Service Initiation and Delivery

Current through Reg. 49, No. 28; July 12, 2024
(a) The service provider agency must serve
				  each designated resident who selects the service provider agency unless:
(1) enrollment has reached its service
				  capacity identified in the contract; or
(2) HHSC approves the service provider
				  agency's request to waive this requirement.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 368 - INTELLECTUAL AND DEVELOPMENTAL DISABILITIES (IDD) HABILITATIVE SPECIALIZED SERVICES › Subchapter D - SERVICE PROVIDER AGENCY REQUIREMENTS › Section 368.402 - Service Provider Agency Responsibilities

Current through Reg. 49, No. 28; July 12, 2024
(a) The service provider agency must comply
				  with:
(1) all applicable state and federal
				  laws and rules; and
(2) HHSC
				  Information Letters and HHSC Provider Letters regarding PASRR found on the HHSC
				  website.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 368 - INTELLECTUAL AND DEVELOPMENTAL DISABILITIES (IDD) HABILITATIVE SPECIALIZED SERVICES › Subchapter D - SERVICE PROVIDER AGENCY REQUIREMENTS › Section 368.404 - Ensuring the Safety of Designated Residents

Current through Reg. 49, No. 28; July 12, 2024
(a) The service provider agency must:
(1) ensure any restriction affecting the
				  designated resident is approved by the SPT and has written consent of the
				  designated resident or LAR before the imposition of the restriction, except
				  when an immediate threat to the designated resident's or another individual's
				  health and safety exists; and
(2)
				  receive and act on complaints about the service provider agency's own staff
				  members, individual service providers, or volunteers.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 368 - INTELLECTUAL AND DEVELOPMENTAL DISABILITIES (IDD) HABILITATIVE SPECIALIZED SERVICES › Subchapter D - SERVICE PROVIDER AGENCY REQUIREMENTS › Section 368.405 - Abuse, Neglect, and Exploitation of a Designated Resident

Current through Reg. 49, No. 28; July 12, 2024
(a) The service
				  provider agency must:
(1) ensure that a
				  designated resident and LAR are, before initiation of IHSS and at least
				  annually thereafter:
(A) informed of how to
				  report allegations of abuse, neglect, or exploitation to DFPS Statewide Intake
				  and are provided with the toll-free telephone number in writing; and
(B) educated about protecting the designated
				  resident from abuse, neglect, and exploitation;
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 368 - INTELLECTUAL AND DEVELOPMENTAL DISABILITIES (IDD) HABILITATIVE SPECIALIZED SERVICES › Subchapter D - SERVICE PROVIDER AGENCY REQUIREMENTS › Section 368.406 - Provider Qualifications

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  The service provider agency must maintain a continuous and adequate network of
				  qualified individual service providers and must allow for choice whenever
				  possible.
(b) The service provider
				  agency must ensure the continuous availability of trained and qualified
				  individual service providers to provide the IHSS on a designated resident's
				  plan of care.
(c) The service
				  provider agency must ensure that individual service providers are not the LAR
				  of the designated resident and are not related to the designated resident in
				  anything less than a third degree by blood or second degree by
				  marriage.
(d) The service provider
				  agency must comply with applicable laws and rules to ensure that:
(1) its operations meet necessary
				  requirements; and
(2) individual
				  service providers possess legally necessary licenses, certifications,
				  registrations, or other credentials and are in good standing with the
				  appropriate professional agency before performing any function or delivering
				  services.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 368 - INTELLECTUAL AND DEVELOPMENTAL DISABILITIES (IDD) HABILITATIVE SPECIALIZED SERVICES › Subchapter D - SERVICE PROVIDER AGENCY REQUIREMENTS › Section 368.407 - Quality Assurance

Current through Reg. 49, No. 28; July 12, 2024
(a) In the
				  provision of IHSS for a designated resident, the service provider agency must
				  cooperate with:
(1) providers of services
				  other than IHSS, including:
(A) LIDDAs;
				  and
(B) NFs;
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 368 - INTELLECTUAL AND DEVELOPMENTAL DISABILITIES (IDD) HABILITATIVE SPECIALIZED SERVICES › Subchapter E - TRANSFERS › Section 368.501 - Transfer between Service Provider Agencies

Current through Reg. 49, No. 28; July 12, 2024
(a) The habilitation coordinator must, upon
				  receiving notice of a designated resident's or LAR's intention to transfer to
				  another service provider agency:
(1) confirm
				  the designated resident or LAR wants to transfer;
(2) explain that the designated resident or
				  LAR may transfer to the service provider agency of the designated resident's or
				  LAR's choice and provide the designated resident or LAR the names and contact
				  information of all service provider agencies that are in the contract area of
				  the designated resident's NF;
(3)
				  document in the designated resident's record the date the transfer request was
				  received; and
(4) make transfer
				  arrangements, including completing appropriate documentation, in accordance
				  with the IDD PASRR Handbook with:
(A) the
				  designated resident or LAR;
(B) the
				  transferring service provider agency; and
(C) the receiving service provider
				  agency.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 368 - INTELLECTUAL AND DEVELOPMENTAL DISABILITIES (IDD) HABILITATIVE SPECIALIZED SERVICES › Subchapter E - TRANSFERS › Section 368.502 - Transfer between Nursing Facilities in the Same Contract Area and Local Service Area

Current through Reg. 49, No. 28; July 12, 2024
(a) When a
				  designated resident moves from one NF to another NF within the same contract
				  area and the same local service area without an intervening hospital stay, the
				  habilitation coordinator must determine whether the designated resident, or LAR
				  on the designated resident's behalf, wants to select a new service provider
				  agency or continue receiving IHSS from the current service provider
				  agency.
(b) If the designated
				  resident or LAR elects to have IHSS delivered by the current service provider
				  agency:
(1) the habilitation coordinator must
				  document the designated resident's or LAR's choice and ensure the service
				  provider agency is invited to the SPT meeting;
(2) the designated resident may continue
				  receiving, or suspend, any authorized IHSS that was delivered at the
				  transferring NF until:
(A) the receiving NF
				  has convened the initial IDT meeting;
(B) the IHSS assessments have been reviewed
				  in accordance with § 368.302 of this chapter (relating to Renewal and
				  Revision of a Plan of Care); and
(C) HHSC has authorized the IHSS to be
				  delivered at the receiving NF; and
(3) at the initial IDT meeting:
(A) the IDT reviews the designated resident's
				  IHSS;
(B) the IDT may request a new
				  assessment for any IHSS;
(C) the
				  habilitation coordinator develops an initial plan of care and obtains
				  signatures from the required parties; and
(D) the habilitation coordinator revises the
				  HSP as necessary.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 368 - INTELLECTUAL AND DEVELOPMENTAL DISABILITIES (IDD) HABILITATIVE SPECIALIZED SERVICES › Subchapter E - TRANSFERS › Section 368.503 - Transfer between Nursing Facilities in Different Contract Areas and the Same Local Service Area

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  When a designated resident moves from one NF to another NF within the same
				  local service area but in a different contract area without an intervening
				  hospital stay, the habilitation coordinator must:
(1) notify the service provider agency and
				  determine whether the service provider agency has a contract in the new
				  contract area; and
(2) if the
				  service provider agency has a contract in the new contract area, determine
				  whether the designated resident wants to select a new service provider agency
				  or continue receiving IHSS from the current service provider
				  agency.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 368 - INTELLECTUAL AND DEVELOPMENTAL DISABILITIES (IDD) HABILITATIVE SPECIALIZED SERVICES › Subchapter E - TRANSFERS › Section 368.504 - Transfer between Nursing Facilities in the Same Contract Area and Different Local Service Areas

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  When a designated resident moves from a NF in one local service area to a NF in
				  a different local service area but the same contract area without an
				  intervening hospital stay, the transferring LIDDA must:
(1) within three business days of learning
				  that the designated resident will move or has moved:
(A) determine whether the designated
				  resident, or LAR on the designated resident's behalf, wants to select a new
				  service provider agency or continue receiving IHSS from the current service
				  provider agency; and
(B) notify the
				  receiving LIDDA of the move date and whether the designated resident or LAR
				  wants to select a new service provider agency;
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 368 - INTELLECTUAL AND DEVELOPMENTAL DISABILITIES (IDD) HABILITATIVE SPECIALIZED SERVICES › Subchapter E - TRANSFERS › Section 368.505 - Transfer between Nursing Facilities in Different Contract Areas and Local Service Areas

Current through Reg. 49, No. 28; July 12, 2024
(a) When a
				  designated resident moves from a NF in one local service area to a NF in a
				  different contract area and a different local service area without an
				  intervening hospital stay, the transferring LIDDA must:
(1) within three business days of learning
				  that the designated resident will move or has moved:
(A) notify the service provider agency and
				  determine whether the service provider agency has a contract in the new local
				  service area;
(B) determine whether
				  the designated resident wants to select a new service provider agency or
				  continue receiving IHSS from the current service provider agency, if the
				  service provider agency has a contract in the new local service area;
				  and
(C) notify the receiving LIDDA
				  of the move date and whether the designated resident must select a new service
				  provider agency;
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 368 - INTELLECTUAL AND DEVELOPMENTAL DISABILITIES (IDD) HABILITATIVE SPECIALIZED SERVICES › Subchapter F - SERVICE SUSPENSION, TERMINATION, OR DENIAL › Section 368.601 - Suspension and Termination of IHSS

Current through Reg. 49, No. 28; July 12, 2024
(a) A designated resident's IHSS are
				  suspended if:
(1) the designated resident is
				  admitted to an acute care hospital for fewer than 30 days and is returning to
				  the same NF;
(2) the designated
				  resident loses Medicaid eligibility;
(3) the designated resident or LAR requests
				  that IHSS be suspended when transferring from one NF to another NF without an
				  intervening hospital stay; or
(4)
				  the designated resident has a change in health condition that temporarily
				  prohibits participation in IHSS.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 368 - INTELLECTUAL AND DEVELOPMENTAL DISABILITIES (IDD) HABILITATIVE SPECIALIZED SERVICES › Subchapter F - SERVICE SUSPENSION, TERMINATION, OR DENIAL › Section 368.602 - Fair Hearings

Current through Reg. 49, No. 28; July 12, 2024
(a) A
				  designated resident is entitled to a fair hearing in accordance with 1 TAC
				  Chapter 357, Subchapter A (relating to Uniform Fair Hearing Rules) if HHSC:
(1) denies or does not act upon a designated
				  resident's request for IHSS with reasonable promptness; or
(2) suspends or terminates a designated
				  resident's IHSS and the designated resident or LAR does not agree with the
				  suspension or termination.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 368 - INTELLECTUAL AND DEVELOPMENTAL DISABILITIES (IDD) HABILITATIVE SPECIALIZED SERVICES › Subchapter G - VENDOR PAYMENT › Section 368.701 - Payment

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC pays a
				  service provider agency for independent living skills training, day
				  habilitation, employment assistance, supported employment, and behavioral
				  support in accordance with the fee-for-service rate for the specific service,
				  which can be found on the HHSC website.
(b) To be paid for the provision of a
				  service, the service provider agency must submit a service claim that meets the
				  requirements in 40 TAC §
										49.311(relating to
				  Claims Payment) and the IDD Habilitative Specialized Services Billing
				  Guidelines.
(c) If a designated
				  resident's IHSS are suspended or terminated, the service provider agency must
				  not submit a claim for services provided during the period of the designated
				  resident's suspension or after the termination, except that the service
				  provider agency may submit a claim for the first day of the designated
				  resident's suspension or termination.
(d) HHSC does not pay the service provider
				  agency for a service if:
(1) the service is
				  provided for a designated resident when there is not a signed, dated, and
				  authorized plan of care for the designated resident; or
(2) the designated resident is ineligible for
				  Medicaid benefits at the time the service is provided.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 368 - INTELLECTUAL AND DEVELOPMENTAL DISABILITIES (IDD) HABILITATIVE SPECIALIZED SERVICES › Subchapter H - LIDDA REQUIREMENTS › Section 368.801 - LIDDA Requirements for Providing Habilitation Coordination

Current through Reg. 49, No. 28; July 12, 2024
(a) A LIDDA
				  provides habilitation coordination, in accordance with Chapter 303, Subchapter
				  E of this title (relating to Habilitation Coordination) and Chapter 303,
				  Subchapter F of this title (relating to Habilitative Service Planning for a
				  Designated Resident), for a designated resident who agrees to receive
				  habilitation coordination.
(b) The
				  LIDDA must, in the provision of habilitation coordination, ensure compliance
				  with the requirements in this chapter, in addition to the requirements
				  described in Chapter 303 of this title (relating to Preadmission Screening and
				  Resident Review (PASRR)).
(c) The
				  habilitation coordinator must notify the service provider agency if the
				  habilitation coordinator becomes aware that a designated resident has
				  discharged from the NF or has transferred from one NF to another NF.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 370 - HUMAN TRAFFICKING RESOURCE CENTER › Section 370.1 - Human Trafficking Prevention Training Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) For a human trafficking prevention
				training course to become approved by the Executive Commissioner, or designee,
				the course must meet the human trafficking training standards established by
				the Health and Human Services Commission.
(b) The human trafficking prevention training
				course, at a minimum, must include:
(1) types
				of human trafficking, including definitions;
(2) vulnerability factors;
(3) health impact;
(4) identification;
(5) assessment;
(6) response; and
(7) resources.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 371 - BREAST AND CERVICAL CANCER SERVICES › Section 371.1 - Purpose

Current through Reg. 49, No. 28; July 12, 2024
These sections implement requirements and policies for the
				  access and delivery of breast and cervical cancer screening and diagnostic
				  services through the Texas Health and Human Services Commission Breast and
				  Cervical Cancer Services Program.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 371 - BREAST AND CERVICAL CANCER SERVICES › Section 371.3 - Federal Authorization and Requirements

Current through Reg. 49, No. 28; July 12, 2024
The Breast and Cervical Cancer Mortality Prevention Act of
				  1990 (Act), Public Law
				  101-354, and its amendments (Public Law 103-183
				  and Public Law
				  105-340) establish a program of grants to states,
				  territories, and tribal organizations for early detection of and prevention of
				  mortality from breast and cervical cancer. The Texas Health and Human Services
				  Commission, through a cooperative agreement with the Centers for Disease
				  Control and Prevention and in compliance with the Act and its amendments,
				  manages the delivery of breast and cervical cancer services statewide through
				  the Breast and Cervical Cancer Services Program.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 371 - BREAST AND CERVICAL CANCER SERVICES › Section 371.5 - Providers

Current through Reg. 49, No. 28; July 12, 2024
(a) Health care
				providers must be enrolled in Texas Medicaid in order to apply as providers and
				be reimbursed for services provided in the Breast and Cervical Cancer Services
				(BCCS) Program, except in very limited circumstances.
(b) If the Texas Health and Human Services
				Commission (HHSC) is unable to locate a sufficient number of eligible providers
				offering services in a certain region, HHSC may compensate other local
				providers for the provision of breast and cervical cancer screening and
				diagnostic services. Methodologies for determining if a certain region has a
				sufficient number of eligible providers may include:
(1) estimated number of clients in
				need;
(2) amount of funds available
				for allocation;
(3) service
				capacity of the proposed provider for the provision of breast and cervical
				cancer screening and diagnostic services;
(4) distance and/or time clients must travel
				to receive services; and
(5) any
				other relevant factors HHSC deems relevant for determining provider
				access.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 371 - BREAST AND CERVICAL CANCER SERVICES › Section 371.7 - Client Eligibility Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) In order for a woman to be eligible for
				Breast and Cervical Cancer Services, the woman must:
(1) have a gross household income at or below
				200% of the adopted federal poverty level; and
(2) be uninsured (not have access to health
				insurance) or underinsured (whose health insurance does not fully cover breast
				and cervical cancer screening and/or diagnostic services).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 371 - BREAST AND CERVICAL CANCER SERVICES › Section 371.9 - Screening Requirements

Current through Reg. 49, No. 28; July 12, 2024
Participating providers shall provide or assure the provision
				  of screening services in accordance with the most current evidence-based
				  clinical guidance, as detailed in the Breast and Cervical Cancer Services
				  policy manual.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 371 - BREAST AND CERVICAL CANCER SERVICES › Section 371.11 - Follow-up and Case Management Requirements

Current through Reg. 49, No. 28; July 12, 2024
Participating providers shall:
(1) provide or assure provision of follow-up
				and case management services that comply with the Breast and Cervical Cancer
				Services policy manual; and
(2)
				ensure that women eligible for services who have abnormal breast or cervical
				cancer screening or diagnostic results, receive follow-up services, including
				case management, until a diagnosis is reached and/or treatment for cancer is
				initiated.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 371 - BREAST AND CERVICAL CANCER SERVICES › Section 371.13 - Payment for Services

Current through Reg. 49, No. 28; July 12, 2024
(a) Payment for
				clinical screening and diagnostic services shall be on a fee-for-service
				basis.
(b) Payment will be subject
				to audit by the Texas Health and Human Services (HHSC). HHSC shall approve
				covered services at payment rates that shall not exceed the maximum state
				Medicare rate for that procedure. A list of procedures approved for payment
				shall be included in all requests for proposals and contracts.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 371 - BREAST AND CERVICAL CANCER SERVICES › Section 371.15 - Client Fees

Current through Reg. 49, No. 28; July 12, 2024
Participating providers may charge clients fees for services
				  in accordance with the Breast and Cervical Cancer Services policy
				  manual.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 374 - MENTAL HEALTH EARLY INTERVENTION AND TREATMENT GRANT › Section 374.1 - Purpose and Objectives

Current through Reg. 49, No. 28; July 12, 2024
(a) Purpose. This
				chapter implements Texas Government Code §
									531.09915, which
				authorizes the Health and Human Services Commission to implement a competitive
				matching grant program to support the initial establishment and operation of
				community-based initiatives that promote identification of mental health issues
				and improve access to early intervention and treatment for children and
				families.
(b) Grant objectives. The
				grants awarded under this chapter are intended to assist with the establishment
				or operation of community-based initiatives that may:
(1) be evidence-based or otherwise
				demonstrate positive outcomes, including:
(A)
				improved relationship skills;
(B)
				improved self-esteem;
(C) reduced
				involvement in the juvenile justice system;
(D) participation in the relinquishment
				avoidance program under Texas Family Code Chapter 262, Subchapter E;
				and
(E) avoidance of emergency room
				use; and
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 374 - MENTAL HEALTH EARLY INTERVENTION AND TREATMENT GRANT › Section 374.2 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this chapter,
				  have the following meanings unless the context clearly indicates
				  otherwise.
(1) Applicant--An entity
				eligible to apply for a grant.
(2)
				Children--Individuals who are younger than 18 years of age.
(3) Commission--The Health and Human Services
				Commission.
(4) Early
				intervention--Services to identify and provide effective early support to
				children who are at risk of poor outcomes.
(5) Grantee--A recipient of a grant awarded
				under this chapter.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 374 - MENTAL HEALTH EARLY INTERVENTION AND TREATMENT GRANT › Section 374.3 - Eligibility Criteria for Applicants

Current through Reg. 49, No. 28; July 12, 2024
The following entities are eligible to apply for a
				  grant:
(1) a hospital licensed under
				Texas Health and Safety Code Chapter 241;
(2) a mental hospital licensed under Texas
				Health and Safety Code Chapter 577;
(3) a hospital district;
(4) a local mental health authority, as
				defined in Texas Health and Safety Code §
									571.003;
(5) a child-care facility, as defined in
				Texas Human Resources Code §
									42.002;
(6) a county or municipality; and
(7) a nonprofit organization that is exempt
				from taxation under §501(a), Internal Revenue Code of 1986, as an exempt
				entity described in §501(c)(3) of that code.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 374 - MENTAL HEALTH EARLY INTERVENTION AND TREATMENT GRANT › Section 374.4 - Application and Selection Process

Current through Reg. 49, No. 28; July 12, 2024
(a) Application and
				selection process.
(1) An applicant must
				submit an application for a grant directly to the Commission in the time and
				manner specified by the Commission.
(2) An application received after the
				deadline will not be considered.
(3) A panel selected by the Commission
				reviews and evaluates eligible, complete, and timely applications in accordance
				with the evaluation methodology published in the request for proposal or other
				notice of potential grant award issued by the Commission.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 500 - COVID-19 EMERGENCY HEALTH CARE FACILITY LICENSING › Subchapter A - HOSPITALS › Section 500.4 - Participating in the Centers for Medicare and Medicaid Services Acute Hospital Care at Home Program During the COVID-19 Pandemic

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Notwithstanding hospital functions and services requirements at 25 TAC §
										133.41 (relating to Hospital
				  Functions and Services) and hospital physical plant and construction
				  requirements at 25 TAC §§
										133.161 -
				  133.169 (relating to Physical
				  Plant and Construction Requirements), a hospital may treat an eligible patient
				  at that patient's residence as part of the Centers for Medicare & Medicaid
				  Services (CMS) Acute Hospital Care at Home program if the hospital:
(1) obtains CMS approval to participate in
				  the Acute Hospital Care at Home program;
(2) submits an application as specified by
				  the Texas Health and Human Services Commission (HHSC) via email at
				  infohflc@hhs.texas.gov to participate in the Acute Hospital Care at Home
				  program;
(3) provides a copy of the
				  CMS approval and any additional information HHSC requires in its review of the
				  request; and
(4) receives written
				  approval from HHSC to participate in the CMS Acute Hospital Care at Home
				  program.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 506 - SPECIAL CARE FACILITIES › Subchapter A - GENERAL PROVISIONS › Section 506.1 - Purpose

Current through Reg. 49, No. 28; July 12, 2024
The purpose of this chapter is to implement the Texas
					 Special Care Facility Licensing Act as authorized under the Health and Safety
					 Code, Chapter 248, and provide minimum standards for the licensing of special
					 care facilities.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 506 - SPECIAL CARE FACILITIES › Subchapter A - GENERAL PROVISIONS › Section 506.3 - Occupancy Classification

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  The level of care that the resident requires determines the facility's
				  occupancy classification.
(b) A new
				  facility shall be classified into one of the following two occupancy
				  classifications:
(1) Limited care facility
				  (LCF). A LCF provides medical and nursing care, treatment and other services to
				  residents who require staff attendance and supervision, including staff
				  assistance to evacuate the facility. These residents are not able to
				  participate in fire drills because they are either physically unable to respond
				  to the fire alarm or they are incapable of following directions under emergency
				  conditions.
(2) Residential board
				  and care facility (RBCF). A RBCF provides medical and nursing care, treatment
				  and other services for residents who do not require routine or continuous staff
				  attendance and supervision, and are physically and mentally able to evacuate
				  the facility. These residents must be able to participate in fire drills, be
				  able to transfer and evacuate themselves and be capable of following directions
				  under emergency conditions. A RBCF is further classified as either small or
				  large.
(A) A small RBCF provides sleeping
				  accommodations for up to 16 residents.
(B) A large RBCF provides sleeping
				  accommodations for more than 16 residents.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 506 - SPECIAL CARE FACILITIES › Subchapter B - FACILITY LICENSING › Section 506.11 - General Licensing Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) License required.
(1) A facility shall obtain a license prior
				  to admitting patients.
(2) A
				  facility shall only admit and provide services for the number of residents
				  which may be accommodated based on the approved number of licensed
				  beds.
(3) All residents receiving
				  services under the license must be admitted for 24-hour residential
				  care.