reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 275 - CONSUMER MANAGED PERSONAL ATTENDANT SERVICES (CMPAS) PROGRAM › Subchapter D - SERVICE DELIVERY OPTIONS › Division 3 - CONSUMER DIRECTED SERVICE (CDS) OPTION › Section 275.155 - Individual Responsibilities in the CDS Option

Current through Reg. 49, No. 28; July 12, 2024
(a) In the CDS option, an individual must:
(1) comply with the requirements in §
												44.307 of this chapter (relating
					 to Individual Responsibilities in All CMPAS Service Delivery
					 Options);
(2) perform the employer
					 responsibilities described in Chapter 41 of this title (relating to Consumer
					 Directed Services Option), with the exception of the responsibilities described
					 in Chapter 41, Subchapter G of this title (relating to Allegations of Abuse,
					 Neglect and Exploitation);
(3)
					 train each attendant and substitute attendant, during the initial orientation
					 and on an annual basis, regarding abuse, neglect, and exploitation, as
					 described in HHSC Form 1732, Management and Training of Service
					 Provider;
(4) sign and date Form
					 1732 and have the attendant or substitute attendant sign and date the form to
					 document completion of the training; and
(5) send a copy of the signed form to the
					 provider within 30 days after the date the form is signed by the individual and
					 the attendant or substitute attendant.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 275 - CONSUMER MANAGED PERSONAL ATTENDANT SERVICES (CMPAS) PROGRAM › Subchapter D - SERVICE DELIVERY OPTIONS › Division 3 - CONSUMER DIRECTED SERVICE (CDS) OPTION › Section 275.157 - Provider and Individual Responsibilities in the CDS Option Related to HHSC Investigations When an Alleged Perpetrator is an Attendant or Substitute Attendant

Current through Reg. 49, No. 28; July 12, 2024
(a) This section
					 applies in the CDS option to alleged abuse, neglect, or exploitation by an
					 attendant or substitute attendant:
(1) when an
					 allegation is reported as required by §
												44.311(c) of this
					 chapter (relating to Provider Responsibilities Related to the Abuse, Neglect,
					 and Exploitation of an Individual in All CMPAS Service Delivery
					 Options);
(2) when an allegation is
					 reported as required by §44.442 of this division (relating to Individual
					 Responsibilities in the CDS Option); or
(3) if a provider or individual is notified
					 by HHSC of an allegation.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 275 - CONSUMER MANAGED PERSONAL ATTENDANT SERVICES (CMPAS) PROGRAM › Subchapter D - SERVICE DELIVERY OPTIONS › Division 3 - CONSUMER DIRECTED SERVICE (CDS) OPTION › Section 275.159 - Provider and Individual Responsibilities in the CDS Option Related to HHSC Investigations When an Alleged Perpetrator is a Staff Person or a Controlling Person of a Provider

Current through Reg. 49, No. 28; July 12, 2024
(a) This
					 section applies in the CDS option to an allegation of abuse, neglect, or
					 exploitation by a staff person or a controlling person:
(1) when the allegation is reported as
					 required by §
												44.311(c) of this
					 chapter (relating to Provider Responsibilities Related to the Abuse, Neglect,
					 and Exploitation of an Individual in All CMPAS Service Delivery
					 Options);
(2) when the allegation
					 is reported as required by §44.442 of this division (relating to
					 Individual Responsibilities in the CDS Option); or
(3) if a provider or individual is notified
					 by HHSC of an allegation.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 275 - CONSUMER MANAGED PERSONAL ATTENDANT SERVICES (CMPAS) PROGRAM › Subchapter E - ADDITIONAL PROGRAM REQUIREMENTS › Section 275.201 - Determining an Individual's Co-payment

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  An individual's co-payment is a percentage of the monthly cost of services
				  provided to the individual. To calculate an individual's co-payment, a provider
				  must:
(1) determine the individual's total
				  net monthly income in accordance with subsections (f) - (i) of this
				  section;
(2) determine the
				  individual's co-payment percentage by using the individual's net monthly income
				  and the CMPAS co-pay schedule located in the DADS
Consumer Managed
				  Personal Assistance Services Provider Manual;
(3) inform the individual of the individual's
				  estimated monthly co-payment by multiplying the authorized hours of service per
				  month by the hourly reimbursement rate, multiplied by the co-payment
				  percentage;
(4) calculate the
				  amount of the individual's actual monthly co-payment each month by multiplying
				  the individual's co-payment percentage amount by the reimbursement rate,
				  multiplied by the number of hours of service actually provided during the
				  month.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 275 - CONSUMER MANAGED PERSONAL ATTENDANT SERVICES (CMPAS) PROGRAM › Subchapter E - ADDITIONAL PROGRAM REQUIREMENTS › Section 275.203 - Convening an IDT

Current through Reg. 49, No. 28; July 12, 2024
(a) An IDT must
				  include:
(1) the individual;
(2) a provider representative; and
(3) other persons as requested by the
				  individual.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 275 - CONSUMER MANAGED PERSONAL ATTENDANT SERVICES (CMPAS) PROGRAM › Subchapter E - ADDITIONAL PROGRAM REQUIREMENTS › Section 275.205 - Fair Hearing

Current through Reg. 49, No. 28; July 12, 2024
(a) An individual
				  may request a fair hearing for any action that affects the co-payment of the
				  individual or that denies, reduces, or terminates benefits in accordance with 1
				  TAC Part 15, Chapter 357, Subchapter A. DADS does not continue services pending
				  a hearing if a suspension or termination is based on §
										44.308(b)(3) of
				  this chapter (relating to Suspension of Services). The individual's provider
				  must attend a hearing to explain any decision or action that led to the
				  hearing.
(b) The provider must
				  notify the DADS regional designee of a request for a fair hearing within 24
				  hours after the provider receives the request. DADS notifies the provider
				  whether to continue services pending the fair hearing officer's
				  decision.
(c) The provider must
				  notify the DADS regional designee of the fair hearing officer's decision and of
				  any action the provider takes as a result of that decision within 24 hours
				  after the provider receives the hearing decision.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 275 - CONSUMER MANAGED PERSONAL ATTENDANT SERVICES (CMPAS) PROGRAM › Subchapter E - ADDITIONAL PROGRAM REQUIREMENTS › Section 275.207 - Records

Current through Reg. 49, No. 28; July 12, 2024
(a) General requirements. A provider must
				  develop and maintain records in accordance with:
(1) this chapter; and
(2) Chapter 49, Subchapter C, of this title
				  (relating to Requirements of a Contractor).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 275 - CONSUMER MANAGED PERSONAL ATTENDANT SERVICES (CMPAS) PROGRAM › Subchapter E - ADDITIONAL PROGRAM REQUIREMENTS › Section 275.209 - Reimbursement

Current through Reg. 49, No. 28; July 12, 2024
(a) General billing requirements. A provider
				  must submit to HHSC a claim for services provided to an individual in
				  accordance with §
										49.311 of this title (relating to
				  Claims Payment).
(b) Billing
				  requirements relating to attendant tasks. A provider must bill HHSC:
(1) only for the allowable tasks described in
				  §
											44.304 of this chapter (relating
				  to Allowable and Unallowable Tasks) that comprise services actually delivered
				  to an individual in accordance with the individual's service plan authorized by
				  HHSC;
(2) in accordance with the
				  hourly rate negotiated by HHSC; and
(3) for attendant tasks in quarter-hour
				  increments, meaning that:
(A) time worked that
				  is not an exact quarter-hour must be rounded up to a quarter-hour if it is
				  eight minutes or more; and
(B) time
				  worked that is less than eight minutes must not be billed.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 277 - Contracting to Provide Primary Home Care › Subchapter A - INTRODUCTION › Section 277.1 - Purpose

Current through Reg. 49, No. 28; July 12, 2024
(a) This chapter establishes the requirements
				  for a provider contracting to provide community-based services to an individual
				  through the PHC Program, CAS Program, and FC Program. In these programs,
				  services may be provided through the provider option, the service
				  responsibility option (SRO), or the consumer directed services (CDS) option of
				  service delivery. The SRO is described in Chapter 43 of this title (relating to
				  Service Responsibility Option) and the CDS option is described in Chapter 41 of
				  this title (relating to Consumer Directed Services Option).
(b) The requirements in this chapter apply to
				  the PHC Program, CAS Program, and FC Program unless otherwise specified in the
				  text.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 277 - Contracting to Provide Primary Home Care › Subchapter A - INTRODUCTION › Section 277.3 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words, terms, and phrases have the following
					 meanings when used in this chapter, 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 277 - Contracting to Provide Primary Home Care › Subchapter B - PROVIDER CONTRACTS › Section 277.11 - Contracting Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) General
				  contracting requirements. A provider must comply with this chapter and Chapter
				  49 of this title (relating to Contracting for Community Services).
(b) Services provided. The provider must
				  deliver only personal assistance services, as defined in §
										97.2 of
				  this title (relating to Definitions).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 277 - Contracting to Provide Primary Home Care › Subchapter C - STAFF REQUIREMENTS › Section 277.21 - Supervisor Training Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  General training. A provider must train a supervisor as described in 26 TAC
				  § 558.245(relating to Staffing Policies).
(b) Program-specific training. The provider
				  must ensure the supervisor understands the applicable rules and procedures of
				  the PHC Program, CAS Program, and FC Program.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 277 - Contracting to Provide Primary Home Care › Subchapter C - STAFF REQUIREMENTS › Section 277.23 - Attendant Qualifications

Current through Reg. 49, No. 28; July 12, 2024
An attendant must:
(1) meet the requirements described in 26 TAC
				  § 558.404(c) (relating to Standards Specific to Agencies Licensed to
				  Provide Personal Assistance Services);
(2) not be a legal parent, foster parent, or
				  spouse of a parent of a minor who receives services in the CAS
				  Program;
(3) not be the spouse of
				  the individual who receives the service, except for services in the FC Program;
				  and
(4) not be designated by an
				  HHSC case worker on HHSC's Authorization for Community Care Services form as
				  "Do not hire."
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 277 - Contracting to Provide Primary Home Care › Subchapter C - STAFF REQUIREMENTS › Section 277.25 - Attendant Orientation

Current through Reg. 49, No. 28; July 12, 2024
(a) Orientation.
				  In addition to the requirements described in this section, a provider must
				  ensure each attendant is oriented as described in 26 TAC Chapter 558,
				  Subchapter C, (relating to Minimum Standards for All Home and Community Support
				  Services Agencies) and 26 TAC § 558.404(relating to Standards Specific to
				  Agencies Licensed to Provide Personal Assistance Services). Orientation is not
				  required for a supervisor when providing personal assistance
				  services.
(b) Method of
				  orientation.
(1) A supervisor must determine
				  the method of attendant orientation, which may be conducted:
(A) in person, with the participation of the
				  individual; or
(B) by telephone or
				  in person at any location without the participation of the individual at the
				  discretion of the supervisor, if the attendant:
(i) meets the requirements described in 26
				  TAC § 558.701(relating to Home Health Aides);
(ii) has six continuous months of experience
				  in delivering attendant care;
(iii)
				  has been oriented to the individual and there are service delivery plan
				  changes; or
(iv) has previously
				  provided services to the individual.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 277 - Contracting to Provide Primary Home Care › Subchapter D - SERVICE DELIVERY PLAN DEVELOPMENT › Section 277.41 - Allowable Tasks

Current through Reg. 49, No. 28; July 12, 2024
The PHC Program, CAS Program, and FC Program include the
					 following tasks:
(1) assistance with
				  ADLs, including:
(A) bathing, which is:
(i) drawing water in sink, basin, or
				  tub;
(ii) hauling or heating
				  water;
(iii) laying out
				  supplies;
(iv) assisting in or out
				  of tub or shower;
(v) sponge
				  bathing and drying;
(vi) bed
				  bathing and drying;
(vii) tub
				  bathing and drying; and
(viii)
				  providing standby assistance for safety;
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 277 - Contracting to Provide Primary Home Care › Subchapter D - SERVICE DELIVERY PLAN DEVELOPMENT › Section 277.43 - Referrals and Authorizations

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Referrals in the PHC Program and CAS Program. HHSC makes a referral to a
				  provider to begin pre-initiation activities in the PHC Program and CAS Program.
(1) Methods of referral.
(A) If an individual's needs require that a
				  provider complete pre-initiation activities in less than 14 days after a
				  referral, the case worker makes an expedited referral by oral notice and on
				  HHSC's Authorization for Community Care Services form.
(B) If an individual's needs do not require
				  that a provider complete pre-initiation activities in less than 14 days after a
				  referral, the case worker makes a routine referral on HHSC's Authorization for
				  Community Care Services form.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 277 - Contracting to Provide Primary Home Care › Subchapter D - SERVICE DELIVERY PLAN DEVELOPMENT › Section 277.45 - Pre-Initiation Activities

Current through Reg. 49, No. 28; July 12, 2024
(a) Pre-initiation
				  activities.
(1) For each referral for the PHC
				  Program or CAS Program or for each authorization for the FC Program, a
				  supervisor must conduct an evaluation.
(A) An
				  evaluation must be a single document that includes the individual's self-report
				  of:
(i) the dates and reasons for any
				  hospitalization within the last three months; and
(ii) the assistance needed for the individual
				  to perform ADLs and IADLs, including any assistive devices or medical equipment
				  used by the individual.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 277 - Contracting to Provide Primary Home Care › Subchapter D - SERVICE DELIVERY PLAN DEVELOPMENT › Section 277.47 - Determination of Medical Need

Current through Reg. 49, No. 28; July 12, 2024
(a) Determining
				  medical need. A provider must obtain and submit a complete Practitioner's
				  Statement of Medical Need form to HHSC for review, as described in §
										47.45
				  of this subchapter, (relating to Pre-Initiation Activities) for:
(1) an individual whom HHSC refers to the
				  provider, unless the individual requests and is to receive FC Program services
				  ;
(2) an individual currently
				  receiving FC Program services whom HHSC refers to the provider for the PHC
				  Program or CAS Program; and
(3) an
				  individual currently receiving services whom HHSC refers to the provider to
				  have medical need reassessed, as requested by the case worker, such as when the
				  initial medical need was established for a limited time.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 277 - Contracting to Provide Primary Home Care › Subchapter D - SERVICE DELIVERY PLAN DEVELOPMENT › Section 277.49 - Interdisciplinary Team

Current through Reg. 49, No. 28; July 12, 2024
(a) Interdisciplinary
				  Team (IDT). The IDT is a designated group that includes the following people
				  who meet when the provider identifies the need to discuss service delivery
				  issues or barriers to service delivery:
(1)
				  the individual or the individual's representative, or both;
(2) a provider representative; and
(3) an HHSC representative, who may be:
(A) the case worker or designee;
(B) the case worker's supervisor or designee
				  ;
(C) the contract manager or
				  designee; or
(D) the regional nurse
				  or designee.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 277 - Contracting to Provide Primary Home Care › Subchapter E - SERVICE REQUIREMENTS › Section 277.57 - Service Delivery Options

Current through Reg. 49, No. 28; July 12, 2024
An individual receiving services in the PHC Program, CAS
					 Program, or FC Program may choose one of the following three service delivery
					 options.
(1) Agency option. In the
				  agency option:
(A) the provider is responsible
				  for personnel decisions, such as selecting, supervising, and dismissing the
				  attendant who provides services to the individual, with input from the
				  individual;
(B) the provider is
				  responsible for:
(i) recruitment of attendants
				  and substitute attendants, a responsibility the individual may share;
(ii) payroll for attendants and substitute
				  attendants; and
(iii) filing
				  tax-related reports of attendants and substitute attendants;
(C) the provider is the employer
				  of record of attendants and substitute attendants; and
(D) the provider is responsible for providing
				  substitute attendants.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 277 - Contracting to Provide Primary Home Care › Subchapter E - SERVICE REQUIREMENTS › Section 277.61 - Service Initiation

Current through Reg. 49, No. 28; July 12, 2024
(a) Service
				  initiation. A provider must initiate services:
(1) in the PHC Program and CAS Program:
(A) for routine referrals described in §
												47.43 of
				  this chapter (relating to Referrals and Authorizations), within seven days
				  after the provider receives the authorization on HHSC's Authorization for
				  Community Care Services form; and
(B) for expedited referrals described in
				  §
												47.43 of
				  this chapter, on the date negotiated between the case worker and provider;
				  and
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 277 - Contracting to Provide Primary Home Care › Subchapter E - SERVICE REQUIREMENTS › Section 277.63 - Service Delivery

Current through Reg. 49, No. 28; July 12, 2024
(a) Service
				  interruptions. A service interruption occurs when, on a particular day or time
				  when services are scheduled:
(1) the
				  individual requests that:
(A) no hours of
				  service be provided;
(B) fewer
				  hours of service than reflected in the service schedule be provided;
				  or
(C) a specific attendant not
				  provide services to the individual;
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 277 - Contracting to Provide Primary Home Care › Subchapter E - SERVICE REQUIREMENTS › Section 277.65 - Supervisory Visits

Current through Reg. 49, No. 28; July 12, 2024
(a) Supervisory visits.
				  A supervisor must conduct in-person supervisory visits to assess and document
				  on a single form whether:
(1) the service
				  delivery plan is adequate;
(2) the
				  individual continues to need the services;
(3) the individual needs a service delivery
				  plan change;
(4) the attendant
				  continues to be competent to provide the authorized tasks; and
(5) the attendant is delivering the
				  authorized tasks.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 277 - Contracting to Provide Primary Home Care › Subchapter E - SERVICE REQUIREMENTS › Section 277.67 - Service Delivery Plan Changes

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Increase in hours or terminations.
(1) A
				  provider must submit written notification to the case worker within seven days
				  after learning of any change that may:
(A)
				  require an increase in hours in the individual's service delivery plan;
				  or
(B) result in the termination of
				  services due to the individual receiving no ADLs, except for the FC Program
				  .
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 277 - Contracting to Provide Primary Home Care › Subchapter E - SERVICE REQUIREMENTS › Section 277.69 - Transfers

Current through Reg. 49, No. 28; July 12, 2024
(a) Negotiation of an individual's transfer
				  from one provider to another. The providers involved in an individual's
				  transfer must coordinate with the case worker to negotiate the transfer
				  date.
(b) Initiation of services.
				  The receiving provider must initiate services on the negotiated date. The
				  negotiated date is the begin date on HHSC's Authorization for Community Care
				  Services form.
(c) Evaluation and
				  service delivery plan. On or before the begin date, the receiving provider
				  must:
(1) conduct an evaluation, as described
				  in §
											47.45
				  of this chapter (relating to Pre-Initiation Activities); and
(2) develop a service delivery plan, as
				  described in §
											47.45
				  of this chapter.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 277 - Contracting to Provide Primary Home Care › Subchapter E - SERVICE REQUIREMENTS › Section 277.71 - Suspensions

Current through Reg. 49, No. 28; July 12, 2024
(a) Required suspensions. A provider must
				  suspend services if:
(1) an individual
				  temporarily or permanently leaves the providerTs contracted service delivery
				  area during a time when the individual would routinely receive services and the
				  individual does not request the provision of services outside the provider's
				  contracted service delivery area;
(2) the provider declines the request of the
				  individual for the provision of services outside of the provider's contracted
				  service delivery area and the individual leaves the service delivery
				  area;
(3) the individual moves to a
				  location where services cannot be provided under the PHC Program, CAS Program,
				  or FC Program;
(4) the individual
				  dies;
(5) the individual is
				  admitted to an institution, which is a:
(A)
				  hospital;
(B) nursing
				  facility;
(C) state supported
				  living center;
(D) state
				  hospital;
(E) intermediate care
				  facility serving individuals with an intellectual disability or related
				  conditions; or
(F) correctional
				  facility.
(6) the
				  individual requests that services end;
(7) for individuals receiving services in the
				  PHC Program or CAS Program, HHSC denies the individual's Medicaid eligibility;
				  or
(8) the individual or someone in
				  the individual's home exhibits reckless behavior, which may result in imminent
				  danger to the health and safety of the individual, the attendant, or another
				  person, in which case the provider must make an immediate referral to:
(A) DFPS or other appropriate protective
				  services agency;
(B) local law
				  enforcement, if appropriate; and
(C) the individual's case worker.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 277 - Contracting to Provide Primary Home Care › Subchapter E - SERVICE REQUIREMENTS › Section 277.73 - Annual Reauthorization for the CAS Program

Current through Reg. 49, No. 28; July 12, 2024
(a) Reauthorization request.
(1) Upon receipt of the annual HHSC
				  Authorization for Community Care Services form, a provider must request annual
				  reauthorization for the CAS Program.
(2) The provider must send the following to
				  the regional nurse to obtain annual reauthorization:
(A) HHSC's Authorization for Community Care
				  Services form received from the case worker; and
(B) a signed statement indicating whether the
				  supervisor agrees or disagrees with the tasks and hours indicated on HHSC's
				  Authorization for Community Care Services form, and if the supervisor
				  disagrees, the statement must provide the specific reasons for disagreeing with
				  the hours and tasks on this form.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 277 - Contracting to Provide Primary Home Care › Subchapter E - SERVICE REQUIREMENTS › Section 277.74 - Prohibition of Restraint and Seclusion

Current through Reg. 49, No. 28; July 12, 2024
A provider must not use restraint or
					 seclusion.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 277 - Contracting to Provide Primary Home Care › Subchapter F - CLAIMS PAYMENT AND DOCUMENTATION › Section 277.81 - Monitoring Medicaid Eligibility

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Applicability. This section does not apply to individuals who are receiving FC
				  Program services.
(b) Verification
				  of Medicaid eligibility. A provider must verify each month that an individual
				  remains Medicaid eligible. A provider may verify the individual's current
				  Medicaid eligibility by:
(1) viewing the
				  individual's HHSC Medicaid Identification form; or
(2) using the current systems available to
				  verify the individual's Medicaid eligibility.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 277 - Contracting to Provide Primary Home Care › Subchapter F - CLAIMS PAYMENT AND DOCUMENTATION › Section 277.83 - Monitoring Reviews

Current through Reg. 49, No. 28; July 12, 2024
HHSC conducts monitoring reviews of a provider as described
					 in Chapter 49 of this title (relating to Contracting for Community Services)
					 and in this chapter.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 277 - Contracting to Provide Primary Home Care › Subchapter F - CLAIMS PAYMENT AND DOCUMENTATION › Section 277.85 - Retroactive Payment Procedures

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Applicability.
(1) This section does not
				  apply to the FC Program.
(2) A
				  provider that chooses to request retroactive payment must comply with the
				  requirements of this section.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 277 - Contracting to Provide Primary Home Care › Subchapter F - CLAIMS PAYMENT AND DOCUMENTATION › Section 277.89 - Reimbursement

Current through Reg. 49, No. 28; July 12, 2024
(a) Billing requirements. A provider must not
				  bill HHSC for:
(1) more hours than an
				  individual's weekly authorization, except when services are delivered as
				  described in §
											47.63(b)(2)
				  of this chapter (relating to Service Delivery);
(2) services delivered in a licensed
				  facility, if the facility is required by the license to provide those
				  services;
(3) services provided
				  outside the contracted service delivery area except if provided in compliance
				  with §
											47.63(e)
				  of this chapter; and
(4) services
				  or tasks that duplicate any services or tasks provided to the individual by
				  another source.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 277 - Contracting to Provide Primary Home Care › Subchapter G - UTILIZATION REVIEW › Section 277.91 - Utilization Review

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC conducts
				  utilization review of a service delivery plan and supporting documentation at
				  any time to:
(1) determine the
				  appropriateness of services;
(2)
				  validate a service provision; or
(3) evaluate the quality of
				  services.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 277 - Contracting to Provide Primary Home Care › Subchapter H - ALLEGATIONS OF ABUSE, NEGLECT, AND EXPLOITATION › Section 277.101 - Requirements for Providers Related to the Abuse, Neglect, or Exploitation of an Individual

Current through Reg. 49, No. 28; July 12, 2024
(a) A provider
				  must:
(1) ensure that an individual and
				  representative are, before or at the time the individual begins receiving
				  services and at least once every 12 months thereafter:
(A) informed of how to report allegations of
				  abuse, neglect, or exploitation to DFPS and are provided with the Abuse Hotline
				  toll-free telephone number, 1-800-252-5400, in writing; and
(B) educated about protecting the individual
				  from abuse, neglect, and exploitation;
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 277 - Contracting to Provide Primary Home Care › Subchapter H - ALLEGATIONS OF ABUSE, NEGLECT, AND EXPLOITATION › Section 277.103 - Requirements for Providers Related to the Abuse, Neglect, and Exploitation of an Individual Receiving Services in the PHC Program and CAS Program Through the Agency Option or the Service Responsibility Option

Current through Reg. 49, No. 28; July 12, 2024
(a) This section applies only when an
				  individual is receiving services in the PHC Program or CAS Program through the
				  agency option or the service responsibility option.
(b) If a report required by § 47.101(b)
				  of this subchapter (relating to Requirements for Providers Related to the
				  Abuse, Neglect, or Exploitation of an Individual) alleges abuse, neglect, or
				  exploitation of an individual by a staff person or controlling person or if a
				  provider is notified by HHSC of an allegation of abuse, neglect, or
				  exploitation of an individual by a staff person or controlling person, the
				  provider must:
(1) as necessary:
(A) obtain immediate medical or psychological
				  services for the individual; and
(B) assist in obtaining ongoing medical or
				  psychological services for the individual;
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 278 - ADULT FOSTER CARE (AFC) PROGRAM › Subchapter A - IN-HOME AND FAMILY SUPPORT PROGRAM › Section 278.1 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this
					 subchapter, shall have the following meanings, unless the context clearly
					 indicates otherwise.
(1) Adult--A
				  person who is 18 years of age or older.
(2) Applicant--A Texas resident interested in
				  receiving benefits through the IH/FSP.
(3) Calendar day--Any day, including weekends
				  and holidays.
(4) Case manager--A
				  DADS employee who is responsible for case management activities for an
				  individual, including eligibility determination, enrollment, assessment and
				  reassessment of the individual's need, service plan development, and
				  intercession on the individual's behalf.
(5) Disability--A physical impairment that:
(A) is likely to continue
				  indefinitely;
(B) results in
				  substantial functional limitations in one or more of the following areas of
				  major life activity as defined on the Disabilities Screening Instrument:
(i) self-care;
(ii) receptive and expressive
				  language;
(iii) learning;
(iv) mobility;
(v) self-direction; or
(vi) capacity for independent living;
				  and
(C) reflects the
				  person's need for treatment or services that are lifelong or of extended
				  duration.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 278 - ADULT FOSTER CARE (AFC) PROGRAM › Subchapter A - IN-HOME AND FAMILY SUPPORT PROGRAM › Section 278.3 - Eligibility Determination Process

Current through Reg. 49, No. 28; July 12, 2024
(a) When an opening in the IH/FSP becomes
				  available in a DADS region, DADS contacts the applicant whose interest list
				  request date, assigned in accordance with § 48.1302(d) of this chapter
				  (relating to Community Care Interest Lists), is earliest on the region's IH/FSP
				  interest list and offers the IH/FSP to the applicant.
(1) If the applicant or responsible party
				  declines the offer of the IH/FSP, DADS removes the applicant's name from the
				  region's IH/FSP interest list, as described in § 48.1302(e)(4) of this
				  chapter.
(2) If the applicant or
				  responsible party accepts the offer of the IH/FSP, DADS contacts the applicant
				  to conduct an initial interview or to schedule an appointment for the initial
				  interview. DADS may conduct the initial interview with an applicant or
				  responsible party either by telephone or face-to-face.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 278 - ADULT FOSTER CARE (AFC) PROGRAM › Subchapter A - IN-HOME AND FAMILY SUPPORT PROGRAM › Section 278.5 - Income Eligibility

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Applicants with household income at or below the Texas median income level are
				  eligible without a copayment requirement.
(b) Applicants with income at or above 105%
				  of the Texas median income level must contribute to the cost of services in the
				  IH/FSP.
(c) SSI recipients who are
				  determined to have a disability are categorically eligible and are exempt from
				  the copayment requirement.
(d)
				  Copayments are determined according to the State Median Income (SMI) for the
				  federal fiscal year. A client whose income is at or below the SMI for his
				  household size has no copayment. A client whose income is at or greater than
				  105% of the SMI will be assessed a copayment. The copayment begins at 10% of
				  the cost of the items/services and increases in 10% increments until 100% of
				  the cost of items/services is reached, at which point the client is ineligible.
				  The copayment is assessed as follows:
Attached
					 Graphic
(e)
				  Applicants must provide to the caseworker all required documentation of earned
				  or unearned income or both. This income is considered in determining financial
				  eligibility. The following income is exempt from income eligibility
				  calculation:
(1) Proceeds of either a
				  commercial or an informal loan for which repayment is required with or without
				  interest. To claim exemption of the proceeds of a loan, a client must prove
				  that he acknowledges an obligation to repay and that some plan for repayment
				  exists. If these can be verified, no written contract is required.
(2) Payments from the Agent Orange Settlement
				  Fund or any other fund established in the settlement of the Agent Orange
				  Product liability litigation (Public Law 101-239).
(3) Any payment received under the Radiation
				  Exposure Compensation Act (Public Law 101-246).
(4) Value of any housing assistance paid on a
				  house under the United States Housing Act of 1937, the National Housing Act,
				  §101 of the Housing and Urban Development Act of 1965, or Title V of the
				  Housing Act of 1949 as authorized by Public Law 94-347.
(5) Payment from any source made to
				  individuals because of their status as victims of Nazi persecution
				  (Public Law
				  103-286).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 278 - ADULT FOSTER CARE (AFC) PROGRAM › Subchapter A - IN-HOME AND FAMILY SUPPORT PROGRAM › Section 278.7 - Functional Eligibility

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Applicants must meet the definition of disabilities specified in the Human
				  Resources Code, Chapter 35.
(b) The
				  applicant or responsible party must sign the IH/FSP disabilties screening
				  instrument.
(c) The applicant must
				  give permission to obtain verification of the diagnosis, limitations, and
				  prognosis of his disability through either a signed physician's statement or
				  clinical, educational, medical, diagnostic, and evaluation records. If
				  clinical, educational, medical, diagnostic, or evaluation records are
				  questionable or do not clearly establish the disability, a signed physician's
				  statement must be provided.
(d)
				  Individuals who reside in intermediate care facilities, skilled nursing
				  facilities, personal care homes, ICF-MR/RC facilities, board and care homes, or
				  DHS foster homes with four or more adults are not eligible for IH/FSP services.
				  Individuals who reside in DHS foster homes which care for three or more minors
				  that are under the department's temporary or permanent managing conservatorship
				  are eligible for IH/FSP services.
(e) An applicant may not receive IH/FSP
				  services if he is receiving the same services from another support program. If
				  he is eligible for another program's services and not receiving them, the
				  applicant must provide documentation to the caseworker as to why the services
				  are not being provided from the other program.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 278 - ADULT FOSTER CARE (AFC) PROGRAM › Subchapter A - IN-HOME AND FAMILY SUPPORT PROGRAM › Section 278.9 - Service Plan

Current through Reg. 49, No. 28; July 12, 2024
(a) A client may
				  receive either or both of the following two categories of program benefits.
(1) The client may receive a one-time cash
				  grant for architectural renovation or other capital expenditure to improve or
				  facilitate the care, treatment, therapy, or general living conditions of the
				  person who has a disability. A capital expenditure is defined as any one-time
				  purchase costing more than $250. At its discretion and subject to available
				  funding, the Texas Department of Human Services (DHS) may set the maximum grant
				  at zero to $3,600.
(2) The client
				  may also receive a cash subsidy grant to purchase services covered under §
											48.2706
				  of this title (relating to Allowable In-Home and Family Support Program
				  (IH/FSP) Services). At its discretion and subject to available funding, the
				  Texas Department of Human Services (DHS) may set the maximum grant at zero to
				  $3,600.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 278 - ADULT FOSTER CARE (AFC) PROGRAM › Subchapter A - IN-HOME AND FAMILY SUPPORT PROGRAM › Section 278.11 - Allowable In-Home and Family Support Program (IH/FSP) Services

Current through Reg. 49, No. 28; July 12, 2024
The following IH/FSP services may be purchased with a
					 service subsidy:
(1) medical,
				  surgical, therapeutic, diagnostic, and other health services related to a
				  person's disability;
(2) counseling
				  or training programs that help a household to provide proper care for a
				  disabled family member, help a person with a disability in an independent
				  living situation, or provide for the special needs of the family or person with
				  a disability;
(3) attendant care,
				  home health aide services, homemaker services, and chore services that provide
				  assistance with training, routine body functions, dressing, preparing and
				  consuming food, and ambulating;
(4)
				  respite assistance for a family;
(5) transportation services for the person
				  with a disability;
(6)
				  transportation, room, and board costs incurred by a person with a disability or
				  his family during evaluation or treatment that has been preapproved by the
				  Texas Department of Human Services. Estimates of meals, travel, and lodging
				  costs must be submitted to the IH/FSP caseworker for prior approval. Travel
				  expense reimbursement should be made based on the current state rate allowed
				  for travel expenses;
(7) the
				  purchase or lease of special equipment or architectural modifications of a
				  home, if:
(A) the equipment or modification
				  costs less than $250.01; and
(B)
				  the equipment or modification is necessary to improve or facilitate the care,
				  treatment, therapy, or general living conditions of a person with a disability,
				  as it relates to the person's disability; and
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 278 - ADULT FOSTER CARE (AFC) PROGRAM › Subchapter A - IN-HOME AND FAMILY SUPPORT PROGRAM › Section 278.13 - Program Restrictions

Current through Reg. 49, No. 28; July 12, 2024
(a) The
				  In-Home and Family Support Program (IH/FSP) service subsidy and capital
				  expenditure cash grant must be used only for allowable goods, supplies, or
				  services that specifically and directly relate to the care of the person with a
				  physical disability.
(b) To
				  participate in the IH/FSP, an applicant or his responsible party must agree in
				  writing to provide receipts for all services, goods, or supplies purchased with
				  program funds and the amount of copayment, if applicable. If an applicant
				  refuses to sign the agreement, his application for program services is
				  denied.
(c) The applicant must
				  agree to submit receipts for service subsidy funds, and the copayment amount,
				  if any, at intervals designated by the Texas Department of Human Services (DHS)
				  during the 12-month certification period. A one-time submittal of receipts is
				  required for the capital expenditure grant. If the applicant fails to furnish
				  the required receipts, he is denied eligibility and may be required to make
				  restitution for amounts for which there are no receipts. The receipts that are
				  returned to verify how the program funds were spent must be approved allowable
				  purchases and must not be dated prior to the date the individual was certified
				  as eligible for the IH/FSP. Receipts are due within six months from date of
				  approved certification. The receipts must:
(1) include specifications of
				  modification/renovation, equipment or services to be purchased.
(2) include date item
				  delivered/purchased.
(3) include
				  vendor's name and identifying information;
(4) be marked paid.
(5) be an original;
(6) be for items or services provided after
				  the date of certification or eligibility determination.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 278 - ADULT FOSTER CARE (AFC) PROGRAM › Subchapter A - IN-HOME AND FAMILY SUPPORT PROGRAM › Section 278.15 - Service Subsidy and Capital Expenditure

Current through Reg. 49, No. 28; July 12, 2024
(a) The amounts of service subsidies and
				  capital expenditures are based on costs of services minus the required
				  copayment amounts up to the maximum grants set by the Texas Department of Human
				  Services.
(b) The service subsidy
				  is issued in intervals no greater than six months during the 12-month period of
				  eligibility. Continued program eligibility is contingent upon verification by
				  the IH/FSP caseworker that all program benefits, including the copayment
				  amount, are spent according to program requirements.
(c) If an applicant does not receive a
				  capital expenditure amount at the beginning of his first year of eligibility
				  and his need for the capital expenditure arises during that year, and if he has
				  already received the first subsidy less a copayment, if applicable, but has not
				  been issued a second subsidy, then the copayment factor is applied only to the
				  capital expenditure amount.
(d)
				  Should an applicant need the capital expenditure at the beginning of his second
				  year of eligibility, the copayment percentage is applied as outlined in
				  subsection (a) of this section.
(e)
				  The subsidy amount is distributed to consumers in a manner that does not affect
				  eligibility for other support programs.
(f) Consumers who use only a portion of their
				  capital expenditure or service subsidy may be issued the remainder of these
				  program benefits contingent upon the availability of program funds.
(g) After the initial certification, the
				  availability of program funds and the consumer's continued need for the
				  one-time grant determine the disbursement of the capital expenditure
				  subsidy.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 278 - ADULT FOSTER CARE (AFC) PROGRAM › Subchapter A - IN-HOME AND FAMILY SUPPORT PROGRAM › Section 278.17 - Payments

Current through Reg. 49, No. 28; July 12, 2024
In-Home and Family Support Program (IH/FSP) applicants or
					 their responsible parties must obtain a state payee identification number
					 before IH/FSP payments can be made.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 278 - ADULT FOSTER CARE (AFC) PROGRAM › Subchapter A - IN-HOME AND FAMILY SUPPORT PROGRAM › Section 278.19 - Right To Appeal

Current through Reg. 49, No. 28; July 12, 2024
(a) Applicants
				  have the right to appeal if they have been denied eligibility or have their
				  benefits reduced, or for any other adverse action.
(b) An applicant must exercise his right to
				  appeal within 90 calendar days from the effective date of the decision or from
				  the notice of adverse action date, whichever is later.
(c) If a consumer is already receiving IH/FSP
				  services and his benefits are denied or reduced, he must submit to the
				  caseworker a request for a hearing within 12 calendar days from the date on the
				  notification letter, to continue receiving services while the appeal is
				  pending. He may be able to continue receiving the subsidy until the hearing is
				  completed if the request is submitted within the 12-day time frame. If the
				  results of the appeal agree with the denial or reduction of benefits, the
				  consumer may be asked to pay back the amount of the subsidy provided during the
				  appeal period.
(d) The caseworker
				  must attend the hearing.