reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 261 - INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS (ICF/IID) PROGRAM-CONTRACTING › Subchapter F - PERSONAL FUNDS › Section 261.263 - Informal Review and Administrative Hearing

Current through Reg. 49, No. 28; July 12, 2024
(a) Informal review.
(1) A program provider that disputes the
				  report of findings described in § 261.262(d) of this chapter (relating to
				  Trust Fund Monitoring and Audits) may request an informal review. The purpose
				  of an informal review is to provide for the informal and efficient resolution
				  of the matters in dispute. An informal review is conducted according to the
				  following procedures:
(A) DADS must receive a
				  written request for an informal review by United States (U.S.) mail, hand
				  delivery, special mail delivery, or fax no later than 15 days after the date on
				  the written notification of the report of findings described in §
				  261.262(d) of this chapter.
(i) If the 15th
				  day is a Saturday, Sunday, national holiday, or state holiday, then the first
				  working day after the 15th day is the final day the written request is
				  accepted.
(ii) A request for an
				  informal review that is not received by the stated deadline is not
				  accepted.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 261 - INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS (ICF/IID) PROGRAM-CONTRACTING › Subchapter G - PROVIDER AGREEMENT SANCTIONS › Section 261.266 - DADS Review of Inspection or Survey Findings

Current through Reg. 49, No. 28; July 12, 2024
(a) DADS may impose a directed plan of
				  correction (DPoC) on one or more of a program provider's facilities, a vendor
				  hold on payments due under one or more of a program provider's agreements, or
				  both if:
(1) the program provider is
				  determined as a result of an inspection or survey to not meet one or more of
				  the federal ICF/IID standards of participation (SoPs) or conditions of
				  participation (CoPs) and DADS determines that the program provider's failure to
				  meet such SoPs or CoPs resulted in or may result in serious injury to or death
				  of an individual residing in the program provider's facility;
(2) the program provider is determined as a
				  result of an inspection or survey to not meet one or more of the SoPs and DADS
				  determines that the program provider's failure to meet such SoPs indicates a
				  pervasive lack of active treatment;
(3) the program provider is determined as a
				  result of an inspection or survey to not meet one of more of the SoPs or CoPs
				  or to not be compliant with one or more state rules applicable to the ICF/IID
				  program and DADS determines, based on its review of previous inspection or
				  survey findings related to the program provider, that the program provider's
				  failure to meet the SoPs or CoPs or noncompliance with state rules indicates:
(A) a pattern of error in a particular
				  discipline, such as nursing or psychology; or
(B) deficient program provider practices or
				  procedures, such as inadequate staffing or insufficient staff training;
				  or
(4) it is determined:
(A) during a follow-up certification review
				  that the program provider failed to correct previous findings of the survey and
				  did not meet one or more additional SoPs, CoPs, or state rules; and
(B) that the program provider's continued
				  failure to meet the SoPs, CoPs, or state rules indicates significant deficient
				  practices that resulted in or may result in serious injury to or death of an
				  individual residing in the program provider's facility.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 261 - INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS (ICF/IID) PROGRAM-CONTRACTING › Subchapter G - PROVIDER AGREEMENT SANCTIONS › Section 261.267 - Directed Plan of Correction and Vendor Hold Based on State Survey Agency Findings

Current through Reg. 49, No. 28; July 12, 2024
(a) The department
				  will send written notice to the program provider of its intent to impose a
				  DPoC, a vendor hold, or both in accordance with § 261.266 of this chapter
				  (relating to Department Review of State Survey Agency Findings).
(b) Within 10 days after receipt of a notice
				  of intent to impose a DPoC sent in accordance with subsection (a) of this
				  section, a program provider may submit written recommendations to the
				  department regarding the content of the DPoC.
(c) The department will send the final DPoC
				  to the program provider within 30 days after the date of the notice sent in
				  accordance with subsection (a) of this section.
(d) The department will monitor a program
				  provider to determine if the program provider has implemented or completed the
				  DPoC. Such monitoring may include reviews of documentation and on-site facility
				  visits.
(e) If a facility is the
				  subject of a DPoC and the facility fails to implement the DPoC, the department
				  may impose a vendor hold on payments due under the provider agreement for that
				  facility.
(f) The department will
				  release a vendor hold imposed in accordance with subsection (e) of this section
				  if the department determines that the program provider has implemented the
				  DPoC.
(g) The department will
				  release a vendor hold imposed in accordance with § 261.266 of this chapter
				  if the state survey agency determines that the program provider meets the SoPs,
				  CoPs, or state rules that caused the vendor hold. Prior to such a
				  determination, the department may release such a vendor hold if the state
				  survey agency determines that circumstances of immediate jeopardy identified by
				  the state survey agency have been removed.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 261 - INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS (ICF/IID) PROGRAM-CONTRACTING › Subchapter G - PROVIDER AGREEMENT SANCTIONS › Section 261.268 - Termination of Provider Agreement

Current through Reg. 49, No. 28; July 12, 2024
(a) DADS
				  may terminate a provider agreement:
(1) for
				  reasons set forth in federal or state laws, rules or regulations, including
				  this chapter and 1 TAC Chapter 355 (relating to Reimbursement Rates);
(2) if the program provider fails to comply
				  with the terms of the provider agreement, including failure of the program
				  provider's facility to maintain ICF/IID Program certification;
(3) if federal or state laws, rules or
				  regulations are enacted, amended, repealed or judicially interpreted so as to
				  render the fulfillment of the provider agreement by either the program provider
				  or DADS unfeasible or impossible, and DADS and program provider cannot agree
				  upon amendments to the provider agreement necessary to comply with such changes
				  to laws, rules or regulation;
(4)
				  if a certification made by the program provider in the provider agreement is
				  false or becomes inaccurate;
(5) if
				  DADS determines that a program provider has failed to implement a DPoC in
				  accordance with § 261.267 of this chapter (relating to Directed Plan of
				  Correction and Vendor Hold Based on State Survey Agency Findings); or
(6) if, during an 18-month period, three
				  vendor holds are imposed on payments due under that provider agreement in
				  accordance with § 261.267 of this chapter.
(A) A vendor hold may be used to terminate a
				  provider agreement in accordance with this paragraph regardless of whether
				  there was an actual interruption of payment to the program provider.
(B) A vendor hold may be used no more than
				  once to terminate a provider agreement in accordance with this
				  paragraph.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 261 - INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS (ICF/IID) PROGRAM-CONTRACTING › Subchapter G - PROVIDER AGREEMENT SANCTIONS › Section 261.269 - Audits

Current through Reg. 49, No. 28; July 12, 2024
(a) The department will periodically audit a
				  program provider to monitor compliance with § 261.219 of this chapter
				  (relating to Provider Reimbursement) and Division Six (relating to Personal
				  Funds). The department will notify the program provider of the audit
				  date.
(b) A program provider must
				  maintain the following records;
(1) personal
				  funds records, as described in § 261.256(h) of this chapter (relating to
				  Program Provider-Managed Personal Funds);
(2) trust fund account ledgers, as described
				  in § 261.256(c)(1)(A) and (c)(2)(A) of this chapter (relating to Program
				  Provider-managed Personal Funds);
(3) statements from financial institutions
				  regarding trust fund accounts;
(4)
				  petty cash fund ledgers as described in § 261.256(d)(3) of this chapter
				  (relating to Program Provider-Managed Personal Funds);
(5) written requests for personal funds from
				  trust fund accounts, as described in § 261.257 of this chapter (relating
				  to Requests for Personal Funds from Trust Fund Accounts);
(6) documentation of expenditures and
				  deposits of personal funds, as described in § 261.256(i) of this chapter
				  (relating to Program Provider-Managed Personal Funds);
(7) documentation of an individual's ability
				  to manage personal funds and decisions regarding management of personal funds,
				  as described in § 261.253 of this chapter (relating to Determining
				  Management of Personal Funds);
(8)
				  documentation regarding requests for specific types or brands of items and
				  services, as described in § 261.255(a) of this chapter (relating to Items
				  and Services Purchased With Personal Funds);
(9) applied income ledgers, as described in
				  § 261.260(c) of this chapter (relating to Applied Income);
(10) applied income payment plans from
				  TDHS;
(11) agreements to hold the
				  individual's residential placement in the facility as described in §
				  261.227(j) of this chapter (relating to Discharge From a Facility);
(12) statements from financial institutions
				  regarding operating accounts;
(13)
				  facility census and admission/discharge records;
(14) leave records as described in §
				  261.226 of this chapter (relating to Leaves); and
(15) IPP's and supporting
				  documentation.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 261 - INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS (ICF/IID) PROGRAM-CONTRACTING › Subchapter G - PROVIDER AGREEMENT SANCTIONS › Section 261.270 - Suspension of Payments

Current through Reg. 49, No. 28; July 12, 2024
(a) DADS suspends
				  payments owed to a program provider under a provider agreement if DADS is
				  notified by the Health and Human Services Commission Office of Inspector
				  General (OIG) that payments must be withheld because of receipt of reliable
				  evidence involving fraud or willful misrepresentation under the Medicaid
				  Program in accordance with
				  42 CFR §
											455.23(a).
(b) DADS suspends payments in accordance with
				  subsection (a) of this section until:
(1) OIG
				  notifies DADS that it must pay amounts suspended and resume payment under the
				  provider agreement; or
(2) OIG
				  notifies DADS that it must terminate the provider agreement in accordance with
				  § 261.268 of this chapter (relating to Termination of Provider
				  Agreement.)
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 261 - INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS (ICF/IID) PROGRAM-CONTRACTING › Subchapter H - ADMINISTRATIVE HEARINGS › Section 261.273 - Administrative Hearings

Current through Reg. 49, No. 28; July 12, 2024
(a) A program
				  provider may request an administrative hearing in accordance with Chapter 9,
				  Subchapter B of Title 40 (relating to Adverse Actions) if the department takes
				  or proposes to take the following action:
(1)
				  vendor hold;
(2) termination of a
				  provider agreement;
(3) recoupment
				  of payments made to the program provider; or
(4) denial of a program provider's request
				  for payment.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 261 - INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS (ICF/IID) PROGRAM-CONTRACTING › Subchapter I - HOSPICE SERVICES › Section 261.274 - Hospice Services

Current through Reg. 49, No. 28; July 12, 2024
(a) An individual
				  may elect to receive hospice care in a facility if the individual is eligible
				  for such care in accordance with 40 TAC §
										30.10
				  (relating to Eligibility Requirements). An individual's LAR or surrogate
				  decision-maker, appointed in accordance with § 405.237 of this title
				  (relating to Appointment and Qualifications of a Surrogate Decision-Maker)
				  [does not exist], may elect hospice care for the individual.
(b) If hospice care is elected for an
				  individual in accordance with 40 TAC §
										30.16 of
				  (relating to Election of Hospice Care), the program provider for the individual
				  must contract with the designated hospice or discharge the individual in
				  accordance with § 261.227 of this chapter (relating to Discharge from a
				  Facility).
(c) Before hospice care
				  is provided to an individual at a facility:
(1) the program provider and the hospice must
				  execute a contract, as described in subsection (d) of this section;
(2) the program provider and the hospice must
				  review the individual's MR/RC Assessment to determine if a revision to the
				  individual's LON is needed in accordance with § 261.246 of this chapter
				  (relating to Renewal and Revision of Level of Need);
(3) the program provider must provide a
				  signed copy of the completed MR/RC Assessment to the hospice; and
(4) the program provider must notify the
				  TDMHMR Help Desk at (888) 952-4357 that the individual has elected to receive
				  hospice care.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 261 - INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS (ICF/IID) PROGRAM-CONTRACTING › Subchapter J - SURROGATE DECISION-MAKING › Section 261.281 - Purpose

Current through Reg. 49, No. 28; July 12, 2024
(a) The purpose of this subchapter is to
				  describe a process by which certain treatment decisions are made by an IDT,
				  surrogate decision-maker, or surrogate consent committee on behalf of an
				  individual who lacks the capacity to make an informed decision about the
				  proposed treatment, medication, or procedure and has no LAR. A treatment
				  decision involves giving or denying consent for a treatment, medication, or
				  procedure for an individual.
(b)
				  The process described in this subchapter applies only to a treatment decision
				  for an individual regarding:
(1) the use of a
				  psychoactive medication;
(2) a
				  highly restrictive procedure;
(3)
				  major medical treatment;
(4) major
				  dental treatment;
(5) a risk to
				  individual protection and rights; or
(6) the release of records related to the
				  individual's condition or treatment to facilitate the treatment to which a
				  surrogate decision-maker or surrogate consent committee has
				  consented.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 261 - INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS (ICF/IID) PROGRAM-CONTRACTING › Subchapter J - SURROGATE DECISION-MAKING › Section 261.282 - Application

Current through Reg. 49, No. 28; July 12, 2024
This subchapter applies to a community program provider. It
					 does not apply to a program provider acting on behalf of a campus-based
					 facility.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 261 - INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS (ICF/IID) PROGRAM-CONTRACTING › Subchapter J - SURROGATE DECISION-MAKING › Section 261.283 - Informed Decision Assessment

Current through Reg. 49, No. 28; July 12, 2024
(a) If a
				  community program provider is seeking a decision regarding any of the matters
				  described in § 261.281(b)(1) - (5) of this chapter (relating to Purpose)
				  for an adult individual who does not have an LAR, the community program
				  provider must conduct an assessment of the individual to determine whether the
				  individual has the capacity to make an informed decision.
(b) To conduct the assessment, the community
				  program provider must:
(1) provide the
				  following information to the individual:
(A)
				  a description of the condition that the proposed treatment, medication, or
				  procedure is intended to improve or cure;
(B) a description of the proposed treatment,
				  medication, or procedure, including:
(i) the
				  individual's need for it; and
(ii)
				  the potential benefits and risks of it to the individual;
(C) a description of any generally accepted
				  alternatives to the proposed treatment, medication, or procedure, including the
				  risks and potential benefits of the alternatives to the individual;
(D) the reasons the alternatives were not
				  proposed for the individual, if applicable;
(E) the time frames involved, such as
				  immediacy of the need for the proposed treatment, medication, or procedure and
				  the length of time that consent will be effective; and
(F) that the individual has the right to
				  refuse to give consent or withdraw consent;
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 261 - INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS (ICF/IID) PROGRAM-CONTRACTING › Subchapter J - SURROGATE DECISION-MAKING › Section 261.284 - Making Informed Decisions

Current through Reg. 49, No. 28; July 12, 2024
(a) If,
				  based on the assessment described in § 261.283 of this chapter (relating
				  to Informed Decision Assessment), a community program provider determines that
				  an individual has the capacity to make an informed decision and to communicate
				  the decision, free from coercion or undue influence, about the proposed
				  treatment, medication, or procedure, the community program provider must allow
				  the individual to consent to or refuse the proposed treatment, medication, or
				  procedure.
(b) If, based on the
				  assessment described in § 261.283 of this chapter, the community program
				  provider determines that the individual does not have the capacity to make an
				  informed decision about the proposed treatment, medication, or procedure, the
				  community program provider must obtain an informed decision from:
(1) the individual's IDT, in accordance with
				  § 261.285 of this chapter (relating to IDT Decisions);
(2) a surrogate decision-maker in accordance
				  with § 261.286 of this chapter (relating to Surrogate Decision-Maker);
				  or
(3) a surrogate consent
				  committee in accordance with § 261.288 of this chapter (relating to
				  Surrogate Consent Committee Decisions), § 261.289 of this chapter
				  (relating to Submission of Application Packet for Surrogate Consent Committee),
				  § 261.291 of this chapter (relating to Notice of Hearing and Documents
				  Provided to Surrogate Consent Committee), and § 261.293 of this chapter
				  (relating to Surrogate Consent Committee Hearing).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 261 - INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS (ICF/IID) PROGRAM-CONTRACTING › Subchapter J - SURROGATE DECISION-MAKING › Section 261.285 - IDT Decisions

Current through Reg. 49, No. 28; July 12, 2024
(a) An IDT may:
(1) consent to the following changes
				  regarding administration of a psychoactive medication subsequent to the initial
				  consent for the medication given by a surrogate consent committee, if such
				  changes pose no significant risk to an individual based on the judgment of the
				  prescribing health care professional and other health care professionals
				  involved in the individual's care:
(A) an
				  increase or decrease in the dosage of the medication; and
(B) a change of medication within the same
				  therapeutic drug class; and
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 261 - INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS (ICF/IID) PROGRAM-CONTRACTING › Subchapter J - SURROGATE DECISION-MAKING › Section 261.286 - Surrogate Decision-Maker

Current through Reg. 49, No. 28; July 12, 2024
(a) A community
				  program provider must develop and implement written procedures for identifying
				  and using a surrogate decision-maker in accordance with the provisions of this
				  subchapter.
(b) A surrogate
				  decision-maker may:
(1) consent to major
				  medical treatment;
(2) consent to
				  major dental treatment;
(3) consent
				  to release of records related to the individual's condition or treatment to
				  facilitate the treatment to which the surrogate decision-maker has consented;
				  and
(4) make a decision that
				  involves risk to individual protection and rights.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 261 - INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS (ICF/IID) PROGRAM-CONTRACTING › Subchapter J - SURROGATE DECISION-MAKING › Section 261.287 - Provider Responsibilities Regarding Surrogate Decision-Maker

Current through Reg. 49, No. 28; July 12, 2024
(a) A community program provider must provide
				  the following information to a person identified as a surrogate decision-maker
				  in accordance with § 261.286 of this chapter (relating to Surrogate
				  Decision-Maker):
(1) a description of the
				  condition that the proposed treatment, medication, or procedure is intended to
				  improve or cure;
(2) a description
				  of the proposed treatment, medication, or procedure, including:
(A) the individual's need for it;
				  and
(B) the potential benefits and
				  risks of it to the individual;
(3) a description of any generally accepted
				  alternatives to the proposed treatment, medication, or procedure, including the
				  risks and potential benefits of the alternatives to the individual;
(4) the reasons the alternatives were not
				  proposed for the individual, if applicable;
(5) the time frames involved, such as
				  immediacy of the need for the proposed treatment, medication, or procedure and
				  the length of time that consent will be effective; and
(6) that the surrogate decision-maker may:
(A) refuse to give consent or withdraw
				  consent after it is given;
(B)
				  defer to a surrogate consent committee for a specific decision; and
(C) withdraw as the surrogate
				  decision-maker.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 261 - INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS (ICF/IID) PROGRAM-CONTRACTING › Subchapter J - SURROGATE DECISION-MAKING › Section 261.288 - Surrogate Consent Committee Decisions

Current through Reg. 49, No. 28; July 12, 2024
A surrogate consent committee may:
(1) consent to the use of a psychoactive
				  medication;
(2) consent to the use
				  of a highly restrictive procedure;
(3) consent to major medical
				  treatment;
(4) consent to major
				  dental treatment;
(5) make a
				  decision that involves risk to individual protection and rights; and
(6) consent to release of records related to
				  the individual's condition or treatment to facilitate the treatment to which
				  the surrogate consent committee has consented.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 261 - INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS (ICF/IID) PROGRAM-CONTRACTING › Subchapter J - SURROGATE DECISION-MAKING › Section 261.289 - Submission of Application Packet for Surrogate Consent Committee

Current through Reg. 49, No. 28; July 12, 2024
(a) A community program provider must submit
				  an application packet for a treatment decision by a surrogate consent
				  committee, as described in § 261.288 of this chapter (relating to
				  Surrogate Consent Committee Decisions), if:
(1) the community program provider is unable
				  to identify a surrogate decision-maker in accordance with § 261.286(d) of
				  this chapter (relating to Surrogate Decision-Maker), including because of an
				  unresolved dispute described in § 261.286(e) of this chapter;
(2) an identified surrogate decision-maker
				  has deferred a specific decision to the surrogate consent committee;
				  or
(3) the community program
				  provider is seeking a decision regarding the use of a psychoactive medication
				  or a highly restrictive procedure.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 261 - INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS (ICF/IID) PROGRAM-CONTRACTING › Subchapter J - SURROGATE DECISION-MAKING › Section 261.290 - Appointment and Qualifications of a Surrogate Consent Committee

Current through Reg. 49, No. 28; July 12, 2024
(a) If DADS approves an application packet
				  for a treatment decision, DADS appoints a surrogate consent committee that:
(1) is composed of at least three but not
				  more than five volunteers who:
(A) are 18
				  years of age or older;
(B) are not
				  employees or contractors of the community program provider;
(C) do not manage or exercise supervisory
				  control over:
(i) the community program
				  provider or the employees of the community program provider; or
(ii) any company, corporation, or other legal
				  entity that manages or exercises control over the community program provider or
				  the employees of the community program provider;
(D) do not have a financial interest in the
				  community program provider or in any company, corporation, or other legal
				  entity that has a financial interest in the community program
				  provider;
(E) are not parents,
				  siblings, spouses, or children of the individual for whom a treatment decision
				  is being sought; and
(F) have
				  completed a training program conducted by DADS; and
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 261 - INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS (ICF/IID) PROGRAM-CONTRACTING › Subchapter J - SURROGATE DECISION-MAKING › Section 261.291 - Notice of Hearing and Documents Provided to Surrogate Consent Committee

Current through Reg. 49, No. 28; July 12, 2024
(a) DADS sends notice of a surrogate consent
				  committee hearing to:
(1) each volunteer on
				  the surrogate consent committee; and
(2) the community program provider.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 261 - INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS (ICF/IID) PROGRAM-CONTRACTING › Subchapter J - SURROGATE DECISION-MAKING › Section 261.292 - Review and Consultation Prior to Hearing

Current through Reg. 49, No. 28; July 12, 2024
(a) Before a surrogate consent committee
				  hearing, the chairperson of the committee must review the documentation
				  described in § 261.291(c) of this chapter (relating to Notice of Hearing
				  and Documents Provided to Surrogate Consent Committee) and determine if
				  additional information is needed to assist the committee in making a treatment
				  decision.
(b) If the chairperson
				  determines that additional information is needed, the chairperson must request
				  the information from DADS.
(c)
				  Before the hearing, a volunteer on the surrogate consent committee may
				  interview and observe the individual for whom the treatment decision is sought
				  and consult with a person who may be able to provide information to assist the
				  committee in making the treatment decision, including information about the
				  personal opinions, beliefs, and values of the individual.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 261 - INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS (ICF/IID) PROGRAM-CONTRACTING › Subchapter J - SURROGATE DECISION-MAKING › Section 261.293 - Surrogate Consent Committee Hearing

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  A person notified of a surrogate consent committee hearing, as required by
				  § 261.291(a) and (d) of this chapter (relating to Notice of Hearing and
				  Documents Provided to Surrogate Consent Committee), is entitled to be present
				  at the hearing and to present evidence or testimony personally or through a
				  representative.
(b) A community
				  program provider must ensure that:
(1) the
				  individual for whom the treatment decision is sought is present at the hearing,
				  if practicable;
(2) the
				  individual's record is at the hearing; and
(3) an audio recording of the hearing is
				  made.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 261 - INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS (ICF/IID) PROGRAM-CONTRACTING › Subchapter J - SURROGATE DECISION-MAKING › Section 261.294 - Notice of Guardianship Proceeding

Current through Reg. 49, No. 28; July 12, 2024
(a) If
				  before a surrogate consent committee makes a treatment decision, the committee
				  is informed that an application for a guardianship proceeding for an individual
				  has been filed with a court, the chairperson of the committee must suspend the
				  committee proceeding for five days unless a medical necessity exists that
				  requires a treatment decision to be made during the five-day period.
(b) If the chairperson suspends a committee
				  proceeding and a person has not been appointed guardian for the individual
				  within five days after the suspension, the chairperson must resume the
				  committee proceeding.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 261 - INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS (ICF/IID) PROGRAM-CONTRACTING › Subchapter J - SURROGATE DECISION-MAKING › Section 261.295 - Liability for Treatment Decision

Current through Reg. 49, No. 28; July 12, 2024
A surrogate decision-maker or volunteer on a surrogate
					 consent committee who consents or denies consent on behalf of an individual and
					 who acts in good faith, reasonably, and without malice is not criminally or
					 civilly liable for that action.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 262 - TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter A - GENERAL PROVISIONS › Section 262.1 - Purpose

Current through Reg. 49, No. 28; July 12, 2024
The purpose of this subchapter is to describe certain
					 policies, procedures, and requirements of the TxHmL Program.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 262 - TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter A - GENERAL PROVISIONS › Section 262.2 - Application

Current through Reg. 49, No. 28; July 12, 2024
This chapter applies to:
(1) a program provider;
(2) a LIDDA;
(3) an applicant and the applicant's LAR;
				  and
(4) an individual and the
				  individual's LAR.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 262 - TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter A - GENERAL PROVISIONS › Section 262.3 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this
					 subchapter, 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 262 - TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter A - GENERAL PROVISIONS › Section 262.4 - Description of the TxHmL Program and CFC

Current through Reg. 49, No. 28; July 12, 2024
(a) The TxHmL
				  Program is a Medicaid waiver program approved by CMS pursuant to §1915(c)
				  of the Social Security Act. It provides community-based services and supports
				  to eligible individuals who live in their own homes or in their family
				  homes.
(b) Enrollment in the TxHmL
				  Program is limited to the number of individuals in specified target groups and
				  to the geographic areas approved by CMS.
(c) TxHmL Program services described in
				  §
										262.5 of this subchapter (relating
				  to Description of TxHmL Program Services) are selected for inclusion in an
				  individual's IPC to ensure the individual's health, safety, welfare, and
				  integration in the community. TxHmL Program services and CFC Services
				  supplement rather than replace the individual's natural supports and other
				  community services for which the individual may be eligible and prevent the
				  individual's admission to an institutional setting.
(d) CFC is a state plan option governed by 42
				  CFR Chapter 441, Subpart K, regarding Home and Community-Based Attendant
				  Services and Supports State Plan Option (Community First Choice) that provides
				  the following services to individuals:
(1)
				  CFC PAS/HAB;
(2) CFC ERS;
				  and
(3) CFC support management for
				  an individual receiving CFC PAS/HAB.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 262 - TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter A - GENERAL PROVISIONS › Section 262.6 - Description of CFC Services

Current through Reg. 49, No. 28; July 12, 2024
CFC services are described in this subsection and in the
					 Medicaid State Plan approved by CMS and available on the HHSC website.
(1) CFC PAS/HAB:
(A) consists of:
(i) personal assistance services that provide
				  assistance to an individual in performing ADLs and IADLs based on the
				  individual's person-centered service plan, including:
(I) non-skilled assistance with the
				  performance of the ADLs and IADLs;
(II) household chores necessary to maintain
				  the home in a clean, sanitary, and safe environment;
(III) escort services, which consist of
				  accompanying and assisting an individual to access services or activities in
				  the community, but do not include transporting an individual; and
(IV) assistance with health-related tasks;
				  and
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 262 - TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter A - GENERAL PROVISIONS › Section 262.7 - Requirement for Translation

Current through Reg. 49, No. 28; July 12, 2024
If a program provider or LIDDA submits documentation to
					 HHSC containing information that is not in English, the program provider or
					 LIDDA must, at the same time, submit a translation of the information in
					 English.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 262 - TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter A - GENERAL PROVISIONS › Section 262.8 - Comprehensive Nursing Assessment

Current through Reg. 49, No. 28; July 12, 2024
(a) An RN must
				  complete a comprehensive nursing assessment of an individual in person:
(1) if the initial IPC includes a sufficient
				  number of RN nursing units for the program provider's RN to perform a
				  comprehensive nursing assessment as described in §
											262.103(o)(1) of
				  this chapter (relating to Process for Enrollment of Applicants);
(2) if there is a significant change in an
				  individual's health or functional status:
(A)
				  that, based on a determination by the RN, will not normally resolve itself
				  without further intervention; and
(B) requires review or revision of the
				  IPC;
(3) at least
				  annually if a nursing service is on the individual's renewal IPC;
(4) before an unlicensed service provider
				  performs a delegated nursing task; and
(5) if the RN who completed the most recent
				  comprehensive nursing assessment of the individual is no longer providing a
				  nursing service to the individual, except as provided in subsection (b) of this
				  section.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 262 - TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter A - GENERAL PROVISIONS › Section 262.9 - Providing Physical Therapy, Occupational Therapy, and Speech and Language Pathology as a Telehealth Service

Current through Reg. 49, No. 28; July 12, 2024
(a) Except as
				  described in subsection (c) of this section, a service provider of physical
				  therapy, occupational therapy, or speech and language pathology may provide
				  physical therapy, occupational therapy, or speech and language pathology to an
				  individual as a telehealth service.
(b) If a service provider of physical
				  therapy, occupational therapy, or speech and language pathology provides
				  physical therapy, occupational therapy, or speech and language pathology to an
				  individual as a telehealth service, a program provider must ensure that the
				  service provider:
(1) uses a synchronous
				  audio-visual platform to interact with the individual, supplemented with or
				  without asynchronous store and forward technology;
(2) does not use an audio-only platform to
				  provide the service; and
(3) before
				  providing the telehealth service:
(A) obtains
				  the written informed consent of the individual or LAR to provide the service;
				  or
(B) obtains the individual or
				  LAR's oral consent to receive the telehealth service and documents the oral
				  consent in the individual's record.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 262 - TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW › Section 262.102 - TxHmL Interest List

Current through Reg. 49, No. 28; July 12, 2024
(a) A LIDDA must
				  maintain an up-to-date interest list of applicants interested in receiving
				  TxHmL Program services for whom the LIDDA is the applicant's designated LIDDA
				  in the HHSC data system.
(b) A
				  person may request that an applicant's name be added to the TxHmL interest list
				  by contacting the LIDDA serving the Texas county in which the applicant or
				  person resides.
(c) If a request is
				  made in accordance with subsection (b) of this section for an applicant who
				  resides in Texas, a LIDDA must add the applicant's name to the TxHmL interest
				  list using the date the LIDDA receives the request as the TxHmL interest list
				  date.
(d) For an applicant
				  determined diagnostically or functionally ineligible during the enrollment
				  process for the Community Living Assistance and Support Services (CLASS)
				  Program, Deaf-Blind with Multiple Disabilities (DBMD) Program, or Medically
				  Dependent Children Program (MDCP):
(1) if the
				  applicant's name is not on the TxHmL interest list, at the request of the
				  applicant or LAR, HHSC adds the applicant's name to the TxHmL interest list
				  using the applicant's interest list date for the program for which the
				  applicant was determined ineligible as the TxHmL interest list date;
(2) if the applicant's name is on the TxHmL
				  interest list and the applicant's interest list date for the program for which
				  the applicant was determined ineligible is earlier than the applicant's TxHmL
				  interest list date, at the request of the applicant or LAR, HHSC changes the
				  applicant's TxHmL interest list date to the applicant's interest list date for
				  the program for which the applicant was determined ineligible as the TxHmL
				  interest list date; or
(3) if the
				  applicant's name is on the TxHmL interest list and the applicant's TxHmL
				  interest list date is earlier than the applicant's interest list date for the
				  program for which the applicant was determined ineligible, HHSC does not change
				  the applicant's TxHmL interest list date.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 262 - TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW › Section 262.103 - Process for Enrollment of Applicants

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC notifies a
				  LIDDA, in writing, when the opportunity for enrollment in the TxHmL Program
				  becomes available in the LIDDA's local service area and directs the LIDDA to
				  offer enrollment to the applicant:
(1) whose
				  interest list date, assigned in accordance with §
											262.102 of this subchapter
				  (relating to TxHmL Interest List), is earliest on the statewide interest list
				  for the TxHmL Program as maintained by HHSC;
(2) whose name is not coded in the HHSC data
				  system as having been determined ineligible for the TxHmL Program and who is
				  receiving services from the LIDDA that are funded by general revenue in an
				  amount that would allow HHSC to fund the services through the TxHmL Program;
				  or
(3) who is a member of a target
				  group identified in the approved TxHmL waiver application.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 262 - TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW › Section 262.104 - LOC Determination

Current through Reg. 49, No. 28; July 12, 2024
(a) A LIDDA must
				  request an LOC from HHSC for an applicant in accordance with this subsection.
(1) The LIDDA must complete an ID/RC
				  Assessment for an applicant that:
(A) includes
				  the LOC recommended by a person qualified to perform an initial evaluation of
				  LOC in accordance with Appendix B of the TxHmL Program waiver application
				  approved by CMS; and
(B) is signed
				  and dated in accordance with the instructions for completing the ID/RC
				  Assessment.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 262 - TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW › Section 262.105 - LON Assignment

Current through Reg. 49, No. 28; July 12, 2024
(a) A LIDDA must
				  request that HHSC assign an LON for an applicant or individual by entering the
				  information from the completed ID/RC Assessment in the HHSC data system and
				  electronically submitting the information to HHSC that includes the recommended
				  LON and, as appropriate, submitting supporting documentation in accordance with
				  §
										262.106(b) of
				  this subchapter (relating to HHSC Review of LON). The electronically submitted
				  ID/RC Assessment must contain information identical to the information on the
				  signed and dated ID/RC Assessment.
(b) A LIDDA must, in accordance with §
										262.106(a) of
				  this subchapter, submit supporting documentation to HHSC as requested by HHSC
				  for a review of a recommended or assigned LON.
(c) A LIDDA must maintain the applicant's or
				  individual's ICAP assessment booklet supporting the recommended LON in the
				  applicant's or individual's record and other documentation supporting the
				  requested LON, including:
(1) the individual's
				  PDP, including the deliberations and conclusions of the applicant's or
				  individual's service planning team;
(2) assessments and interventions by
				  qualified professionals; and
(3)
				  behavior support plans.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 262 - TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW › Section 262.106 - HHSC Review of LON

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC may review
				  a recommended or assigned LON at any time to determine if it is appropriate. If
				  HHSC reviews an LON, a LIDDA must submit documentation supporting the LON to
				  HHSC in accordance with HHSC's request. Based on its review, HHSC may modify an
				  LON.
(b) Documentation supporting a
				  recommended LON must be submitted by the LIDDA and received by HHSC within
				  seven calendar days after the LIDDA has entered the information from the
				  completed ID/RC Assessment in the HHSC data system and electronically submitted
				  the information to HHSC.
(c) Within
				  21 calendar days after receiving the supporting documentation, HHSC:
(1) requests additional
				  documentation;
(2) electronically
				  approves the recommended LON and establishes the effective date; or
(3) notifies the service coordinator in the
				  HHSC data system that the recommended LON has been denied.