Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 260 - DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES › Subchapter I - INDIVIDUALIZED SKILLS AND SOCIALIZATION › Section 260.517 - Program Provider Reimbursement for Individualized Skills and Socialization

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC pays a
				  program provider for on-site individualized skills and socialization and
				  off-site individualized skills and socialization in accordance with the
				  reimbursement rates.
(b) If an
				  individual's DBMD Program services and CFC services are suspended or
				  terminated, a program provider must not submit a claim for on-site
				  individualized skills and socialization or off-site individualized skills and
				  socialization provided during the period of the individual's suspension or
				  after the termination, except the program provider may submit a claim for the
				  first calendar day of the individual's suspension or termination.
(c) A program provider must not bill for and
				  HHSC does not pay a program provider for on-site individualized skills and
				  socialization or off-site individualized skills and socialization, or recoups
				  any payments made to the program provider for on-site individualized skills and
				  socialization or off-site individualized skills and socialization:
(1) if individualized skills and
				  socialization is not provided in accordance with this subchapter and Chapter
				  559, Subchapter H of this title (relating to Individualized Skills and
				  Socialization Provider Requirements);
(2) if the individual receiving
				  individualized skills and socialization is, at the time individualized skills
				  and socialization was provided, ineligible for the DBMD Program;
(3) if individualized skills and
				  socialization is provided during a period of time for which there is not a
				  signed and dated ID/RC Assessment for the individual;
(4) if individualized skills and
				  socialization is provided during a period of time for which the individual did
				  not have an LOC determination;
(5)
				  if individualized skills and socialization is not provided in accordance with
				  the individual's IPP;
(6) if the
				  program provider did not comply with 40 TAC §
											49.305(relating to
				  Records);
(7) if the claim for the
				  service did not meet the requirements in 40 TAC §
											49.311(relating to Claims
				  Payment);
(8) if individualized
				  skills and socialization is provided by a service provider who did not meet the
				  qualifications to provide individualized skills and socialization as described
				  in §
											260.513 of this subchapter
				  (relating to Service Provider Qualifications and Training) and §
											559.227 of this title (relating to
				  Program Requirements);
(9) if the
				  program provider did not comply with the DBMD Program Manual;
(10) if HHSC determines that individualized
				  skills and socialization would have been paid for by a source other than the
				  DBMD Program if the program provider had submitted to the other source a
				  proper, complete, and timely request for payment for individualized skills and
				  socialization;
(11) if
				  individualized skills and socialization was not provided; or
(12) if individualized skills and
				  socialization is provided during a period of time that the individual produced
				  marketable goods and was paid below minimum wage for producing the goods in
				  accordance with Section 14(c) of the Fair Labor Standards Act.