reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 270 - CONTRACTING TO PROVIDE PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) › Section 270.16 - Medical Necessity Assessments

Current through Reg. 49, No. 28; July 12, 2024
(a)
				The provider agency must complete a medical necessity and level of care
				assessment based on the client's total needs.
(b) The provider agency must electronically
				transmit the medical necessity and level of care assessment to the agency with
				which the Texas Health and Human Services Commission (HHSC) contracts for
				medical necessity determinations.
(c) The provider agency must enroll any
				eligible applicant within 60 calendar days after the date of the medical
				necessity and level of care assessment.
(d) The provider agency must complete another
				medical necessity and level of care assessment and submit it to the agency with
				which HHSC contracts for medical necessity determinations 12 months after the
				initial assessment.
(1) If the client meets
				the state's medical necessity criteria and the client has an irreversible or
				progressive diagnosis, or a terminal illness that could reasonably be expected
				to result in death in the next six months, and the Department of Aging and
				Disability Services (DADS) determines that there is no reasonable expectation
				of improvement or significant change in the client's condition because of
				severity of a chronic condition or the degree of impairment of functional
				capacity, DADS will permanently waive the annual recertification requirement
				and the client may be deemed to be continually eligible for PACE. The medical
				necessity and level of care assessment must have sufficient documentation to
				substantiate the client's prognosis and the client's functional
				capacity.
(2) In addition, if DADS
				determines that a PACE client no longer meets the medical necessity criteria
				for nursing facility care, the client may be deemed to continue to be eligible
				for PACE until the next annual reassessment, if, in the absence of PACE
				services, it is reasonable to expect that the client would meet the nursing
				facility medical necessity criteria within the next six months.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 270 - CONTRACTING TO PROVIDE PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) › Section 270.18 - Program Benefits

Current through Reg. 49, No. 28; July 12, 2024
A provider agency must provide a client the services, listed
				  in 42 Code of Federal Regulations §460.92, that are approved by the
				  Interdisciplinary Team.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 270 - CONTRACTING TO PROVIDE PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) › Section 270.20 - Right to Appeal

Current through Reg. 49, No. 28; July 12, 2024
(a) Internal
				appeal.
(1) Any client who is denied program
				services is entitled to an appeal through the provider agency.
(2) If the client also chooses to file an
				external appeal, the provider agency must assist the client in filing an
				external appeal.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 270 - CONTRACTING TO PROVIDE PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) › Section 270.22 - Medicaid Capitation Payments

Current through Reg. 49, No. 28; July 12, 2024
(a) The
				provider agency must accept the Medicaid capitation payment as payment in full
				for all services to a Medicaid eligible client.
(b) If the client is also a Medicare
				beneficiary, the Centers for Medicare and Medicaid Services will also pay a
				Medicare capitation payment to the provider agency.
(c) An exception to subsection (a) of this
				section occurs when a client enters a nursing facility and the client has
				applied income. To receive this exception:
(1) the provider agency must collect the
				client's applied income, unless the purpose of the stay is for the client to
				receive respite care; and
(2) the
				applied income must be determined in accordance with §§15.100,
				15.450, 15.501-15.503, and 15.506 of this title (relating to Definitions;
				General Principles Concerning Income; Vendor Living Arrangements; Allowable
				Deductions; Protection of Spousal Income and Resources; and Mandatory Payroll
				Deductions from Earned Income).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 270 - CONTRACTING TO PROVIDE PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) › Section 270.24 - Enrollment and Disenrollment

Current through Reg. 49, No. 28; July 12, 2024
(a) The
				provider agency determines whether the applicant meets enrollment
				requirements.
(b) The enrollment
				effective date is the first day of the month after the provider agency receives
				the signed enrollment form.
(c) The
				client may voluntarily disenroll from Programs of All-Inclusive Care for the
				Elderly (PACE) at any time, but the effective date of disenrollment must be the
				last day of the month.
(d) The
				provider agency may recommend involuntary disenrollment of a client for the
				reasons described in 42 Code of Federal Regulations §460.164. To
				involuntarily disenroll a client:
(1) the
				documentation of the recommendation must be sent to the PACE program manager in
				the Texas Department of Human Services (DHS) state office; and
(2) the disenrollment becomes effective only
				when DHS confirms the provider agency adequately documented acceptable grounds
				for disenrollment.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 270 - CONTRACTING TO PROVIDE PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) › Section 270.26 - Data Collection and Reporting

Current through Reg. 49, No. 28; July 12, 2024
The provider agency must:
(1) collect and enter data into the DataPACE
				system;
(2) generate and maintain
				monthly reports from the DataPACE system; and
(3) make the reports available to the Texas
				Department of Human Services.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 272 - TRANSITION ASSISTANCE SERVICES › Subchapter A - INTRODUCTION › Section 272.1 - Purpose

Current through Reg. 49, No. 28; July 12, 2024
This chapter:
(1)
				  establishes the requirements for transition assistance services (TAS) provided
				  through:
(A) the Community Living Assistance
				  and Support Services Program;
(B)
				  the Medically Dependent Children Program; and
(C) the Deaf Blind with Multiple Disabilities
				  Program; and
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 272 - TRANSITION ASSISTANCE SERVICES › Subchapter A - INTRODUCTION › Section 272.3 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms have the following meanings
					 when used in this chapter, unless the context clearly indicates
					 otherwise:
(1) Business day--Any day
				  except a Saturday, a Sunday, or a national or state holiday listed in Texas
				  Government Code §
										662.003(a) or
				  (b).
(2) Case manager--The person who is
				  responsible for case management activities in the Community Living Assistance
				  and Support Services (CLASS), Medically Dependent Children Program (MDCP), and
				  Deaf Blind with Multiple Disabilities (DBMD) Programs.
(3) CLASS Program--Community Living
				  Assistance and Support Services Program. A Medicaid waiver program authorized
				  by the Centers for Medicare and Medicaid Services in accordance with
				  §1915(c) of the Social Security Act and operated by the Texas Health and
				  Human Services Commission (HHSC) under Chapter 259 of this title (relating to
				  Community Living Assistance and Support Services (CLASS) Program and Community
				  First Choice (CFC) Services).
(4)
				  Day--A calendar day, unless otherwise specified in the text. A calendar day
				  includes Saturday, Sunday, and a national or state holiday listed in Texas
				  Government Code §
										662.003(a) or
				  (b).
(5) DBMD Program--Deaf Blind with Multiple
				  Disabilities Program. A Medicaid waiver program authorized by the Centers for
				  Medicare and Medicaid Services in accordance with §1915(c) of the Social
				  Security Act and operated by HHSC under Chapter 260 of this title (relating to
				  Deaf Blind with Multiple Disabilities (DBMD) Program and Community First Choice
				  (CFC) Services).
(6) Facility--
(A) a nursing facility, for an individual
				  enrolling in MDCP; or
(B) a nursing
				  facility or an intermediate care facility for individuals with an intellectual
				  disability or related conditions (ICF/IID), for an individual enrolling in the
				  DBMD Program or CLASS Program.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 272 - TRANSITION ASSISTANCE SERVICES › Subchapter A - INTRODUCTION › Section 272.5 - Service Description

Current through Reg. 49, No. 28; July 12, 2024
(a) TAS assists an
				  individual in setting up a household in the community before being discharged
				  from:
(1) a nursing facility and enrolling in
				  MDCP; or
(2) a nursing facility or
				  an ICF/IID and enrolling in the DBMD Program or CLASS
				  Program.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 272 - TRANSITION ASSISTANCE SERVICES › Subchapter A - INTRODUCTION › Section 272.7 - TAS in the HCS Program

Current through Reg. 49, No. 28; July 12, 2024
(a) An individual
				  being discharged from a nursing facility, an ICF/IID, or a GRO and enrolling in
				  the HCS Program may receive TAS from an HCS program provider in accordance with
				  40 TAC Chapter 9, Subchapter D (relating to Home and Community-based Services
				  (HCS) Program and Community First Choice (CFC)).
(b) An HCS program provider may contract with
				  a TAS provider to provide TAS in accordance with 40 TAC Chapter 9, Subchapter
				  D.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 272 - TRANSITION ASSISTANCE SERVICES › Subchapter B - TAS PROVIDER REQUIREMENTS › Section 272.11 - Contracting Requirements

Current through Reg. 49, No. 28; July 12, 2024
A TAS provider must comply with this chapter and 40 TAC
					 Chapter 49 (relating to Contracting for Community Services).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 272 - TRANSITION ASSISTANCE SERVICES › Subchapter C - STAFF REQUIREMENTS › Section 272.21 - Staff Requirements

Current through Reg. 49, No. 28; July 12, 2024
A TAS provider must ensure that an employee or contractor
					 who delivers TAS under this chapter:
(1) is at least 18 years old;
(2) has a high school diploma or a
				  certificate recognized by a state as the equivalent of a high school
				  diploma;
(3) is not the
				  individual's:
(A) relative;
(B) LAR; or
(C) in MDCP, the primary caregiver;
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 272 - TRANSITION ASSISTANCE SERVICES › Subchapter D - SERVICE DELIVERY REQUIREMENTS › Section 272.33 - Service Delivery

Current through Reg. 49, No. 28; July 12, 2024
(a) A TAS provider
				  must:
(1) deliver TAS to an individual for
				  whom the TAS provider receives, from the individual's case manager, a completed
				  Transition Assistance Services (TAS) Assessment and Authorization form
				  authorized by HHSC;
(2) deliver to
				  the individual the specific TAS authorized on the form;
(3) purchase TAS for the individual within
				  the monetary amount authorized on the form; and
(4) submit a service claim to HHSC only after
				  all of the authorized TAS has been delivered to the individual.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 272 - TRANSITION ASSISTANCE SERVICES › Subchapter E - CLAIM PAYMENTS AND DOCUMENTATION › Section 272.41 - Record Keeping

Current through Reg. 49, No. 28; July 12, 2024
(a) A TAS provider
				  must maintain service delivery documentation in the individual's record,
				  including:
(1) the individual's name and
				  Medicaid number;
(2) the TAS
				  provider's name and contract number;
(3) a description of the TAS
				  delivered;
(4) the date the TAS was
				  purchased;
(5) the date the TAS was
				  delivered;
(6) the total monetary
				  amount of the TAS purchased, including taxes and delivery fees;
(7) the original purchase receipts;
				  and
(8) the dated signature of the
				  employee or contractor who delivered the TAS.
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 A - INTRODUCTION › Section 275.1 - Purpose

Current through Reg. 49, No. 28; July 12, 2024
This chapter establishes contract requirements for
					 providers and participation requirements for individuals in the Texas
					 Department of Aging and Disability Services (DADS) Consumer Managed Personal
					 Attendant Services (CMPAS) Program.
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 A - INTRODUCTION › Section 275.3 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms have the following meanings
					 when used in this chapter, unless the context clearly indicates
					 otherwise:
(1) Abuse--Any of the
				  following:
(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 275 - CONSUMER MANAGED PERSONAL ATTENDANT SERVICES (CMPAS) PROGRAM › Subchapter A - INTRODUCTION › Section 275.5 - Description of the CMPAS Program

Current through Reg. 49, No. 28; July 12, 2024
The CMPAS Program is a non-Medicaid program that provides
					 attendant care services to enhance and maintain an individual's integration
					 into the community, including participation in employment and education or
					 training opportunities, and community volunteering designed to help the
					 individual enter and remain in the workforce and in the community. The CMPAS
					 Program includes a co-payment provision based on income to allow an individual
					 to participate in the program regardless of income. The program empowers an
					 individual to self-direct services to the greatest extent possible under one of
					 three service delivery options: the traditional service option, the block grant
					 option, or the consumer directed services option.
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 B - ELIGIBILITY AND SERVICE PLANS › Section 275.25 - Eligibility Criteria

Current through Reg. 49, No. 28; July 12, 2024
(a) To be eligible
				  to receive services under the CMPAS Program, an applicant must:
(1) be age 18 years of age or
				  older;
(2) obtain and submit to the
				  provider's assessor of need a completed practitioner's statement;
(3) be assessed under §
											44.203 of this subchapter
				  (relating to Assessment and Eligibility Determination) as needing assistance
				  with at least one personal care task and needing an allowable service for at
				  least five hours per week;
(4) be
				  able and willing to:
(A) self-direct the
				  attendant; or
(B) designate a
				  relative or friend who is willing and able to direct the attendant without
				  compensation;
(5) reside
				  in an area in which CMPAS Program services are available;
(6) have a service plan developed under
				  §
											44.203(a)(6)(A)
				  of this subchapter that does not exceed 52 hours per week of CMPAS Program
				  services;
(7) choose one of the
				  three service delivery options described in Subchapter D of this chapter
				  (relating to Service Delivery Options);
(8) not be receiving services in:
(A) a hospital;
(B) a nursing facility;
(C) a state supported living
				  center;
(D) a state mental health
				  facility; or
(E) an intermediate
				  care facility for individuals with an intellectual disability or related
				  conditions.
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 B - ELIGIBILITY AND SERVICE PLANS › Section 275.27 - CMPAS Interest Lists

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC
				  maintains a CMPAS interest list for each HHSC region. An interest list contains
				  the names of applicants who are interested in receiving services through the
				  CMPAS Program.
(b) A person may
				  request that an applicant's name be added to a CMPAS interest list in an HHSC
				  region by contacting:
(1) a
				  provider;
(2) an HHSC regional
				  office, or
(3) the 2-1-1 Texas
				  Program.
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 B - ELIGIBILITY AND SERVICE PLANS › Section 275.29 - Assessment and Eligibility Determination

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Within 30 days after the provider receives a referral from DADS regional
				  office, the provider must:
(1) ensure that
				  the assessor of need conducts an initial on-site assessment with the
				  applicant;
(2) determine CMPAS
				  Program eligibility in accordance with §
											44.201 of this subchapter
				  (relating to Eligibility Criteria);
(3) inform the applicant, both orally and in
				  writing, of all applicable publicly funded programs that offer attendant
				  services and allow the applicant to choose whether to participate in
				  CMPAS;
(4) keep in the applicant's
				  record a written record of the notification given in accordance with paragraph
				  (3) of this subsection and the applicant's signed and dated acknowledgement and
				  choice document;
(5) assess the
				  applicant's service needs by using the DADS Needs Assessment Questionnaire and
				  Task/Hour Guide form available at
www.dads.state.tx.us
; and
(6) for an eligible applicant:
(A) develop a service plan based on the
				  results of the assessment questionnaire that:
(i) includes the number of hours and tasks
				  negotiated between the applicant and the assessor of need; and
(ii) is agreed to and signed by the applicant
				  and assessor of need;
(B)
				  determine with the applicant the amount of the applicant's co-payment under
				  §
												44.501 of this chapter (relating
				  to Determining an Individual's Co-payment) and explain to the applicant that
				  making co-payments is required to remain eligible for CMPAS;
(C) explain orally and give written
				  information to the applicant on the available service delivery options
				  described in Subchapter D of this chapter (relating to Service Delivery
				  Options);
(D) have the applicant
				  sign and date a service delivery option choice document; and
(E) keep the signed and dated service
				  delivery choice document in the applicant's file.
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 B - ELIGIBILITY AND SERVICE PLANS › Section 275.31 - Reassessments

Current through Reg. 49, No. 28; July 12, 2024
A provider must reassess an individual annually and any
					 time there is a change in the individual's status, as follows:
(1) Annual reassessments. A provider must
				  annually reassess an individual in accordance with §
										44.203 of this subchapter
				  (relating to Assessment and Eligibility Determination). The provider must
				  complete each on-site annual reassessment no later than one year after the
				  service initiation date and no later than one year after each
				  reassessment.
(2) Reassessment upon
				  change in individual status. When a provider learns that an individual's status
				  may have changed in a way that may affect the individual's eligibility for or
				  receipt of services, the provider must reassess the individual. In doing so,
				  the provider may consider only those factors in §
										44.203 of this subchapter that
				  have changed since the previous assessment. A change in individual status that
				  requires reassessment may include a change in:
(A) income, deductions, or exclusions;
				  or
(B) the individual's need for
				  attendant care services, the service plan, or the hours of
				  service.
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 B - ELIGIBILITY AND SERVICE PLANS › Section 275.33 - Service Plan Changes

Current through Reg. 49, No. 28; July 12, 2024
(a) An individual
				  and the assessor of need must agree to and sign a service plan
				  change.
(b) A provider must:
(1) implement a change to an individual's
				  co-payment to be effective on the first day of the month following a
				  reassessment;
(2) notify the DADS
				  regional designee in writing of a service plan change within seven days after
				  the completion of a reassessment using a single document that contains:
(A) the date the notification document was
				  completed;
(B) the contract
				  number;
(C) the service plan change
				  and effective date of the service plan change;
(D) the name of the individual;
(E) the service tasks assigned to the
				  individual's attendant;
(F) the
				  name of the assessor of need;
(G)
				  the service schedule;
(H) the
				  signature of the assessor of need; and
(I) the date the notification document was
				  signed;
(3) provide a
				  copy of the service plan change to the individual including, if applicable, a
				  notice of the right to a fair hearing;
(4) document a service plan change:
(A) in the individual's file; and
(B) according to the terms of the contract;
				  and
(5) implement a
				  service plan change within three days after notification by the DADS regional
				  designee that the service plan has been entered into the service authorization
				  system.
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 B - ELIGIBILITY AND SERVICE PLANS › Section 275.35 - Service Plan and Co-payment Disagreements

Current through Reg. 49, No. 28; July 12, 2024
(a) Service plan disagreements. If a provider
				  and individual disagree on the number of hours of service or service tasks to
				  be on the individual's service plan:
(1) the
				  provider must offer the individual orally and in writing an informal dispute
				  resolution (IDR) process through a meeting of the individual's IDT;
				  and
(2) if the individual disagrees
				  with the provider's decision after going through the IDR process, the
				  individual may request a fair hearing as provided in §
											44.503 of this chapter (relating
				  to Fair Hearing).
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 C - SERVICE DELIVERY IN ALL CMPAS OPTIONS › Section 275.51 - Initiation of Services

Current through Reg. 49, No. 28; July 12, 2024
(a) When CMPAS
				  Program funding becomes available in a DADS region, the DADS regional designee:
(1) refers to the region's provider the
				  applicant whose interest list request date, assigned in accordance with §
											44.202(e) of this
				  chapter (relating to CMPAS Interest Lists), is earliest on the region's CMPAS
				  interest list; and
(2) informs the
				  provider of any other DADS program services the applicant is receiving, the
				  cost of those services, and the approved service period for those
				  services.
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 C - SERVICE DELIVERY IN ALL CMPAS OPTIONS › Section 275.53 - Provider Qualifications and Responsibilities in All CMPAS Service Delivery Options

Current through Reg. 49, No. 28; July 12, 2024
To participate as a provider in the CMPAS Program, the
					 provider must:
(1) maintain a license
				  from HHSC under 26 TAC Chapter 558 (relating to Licensing Standards for Home
				  and Community Support Services Agencies) in one or more of the following
				  categories of licensure:
(A) personal
				  assistance services;
(B) licensed
				  home health services; or
(C)
				  licensed and certified home health services;
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 C - SERVICE DELIVERY IN ALL CMPAS OPTIONS › Section 275.55 - Attendant Qualifications

Current through Reg. 49, No. 28; July 12, 2024
For a person to be an attendant in the CMPAS Program, the
					 person must:
(1) be age 18 years of
				  age or older;
(2) be able to work
				  part or all of the hours needed by the individual;
(3) agree to be interviewed by the
				  individual;
(4) have reliable
				  transportation to the individual's home;
(5) demonstrate to the satisfaction of the
				  individual that the person is capable of performing the tasks included in the
				  individual's service plan, including being able to take direction from the
				  individual or the individual's representative; and
(6) meet the requirements for unlicensed
				  personnel at §
										97.247 of this title (relating to
				  Verification of Employability and Use of Unlicensed Persons) and the
				  requirements of Texas Health and Safety Code, Chapter 250 concerning nurse aid
				  registry and criminal history checks.
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 C - SERVICE DELIVERY IN ALL CMPAS OPTIONS › Section 275.57 - Allowable and Unallowable Tasks

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Allowable tasks. Except as otherwise provided in subsection (b) of this
				  section, an attendant may perform one or more of the following tasks for an
				  individual enrolled in the CMPAS Program:
(1)
				  personal care tasks required to maintain the individual's physical health,
				  including:
(A) bathing;
(B) dressing and undressing;
(C) preparing meals;
(D) assisting with eating, including:
(i) assisting with eating and drinking
				  utensils and adaptive devices; and
(ii) providing standby assistance or
				  encouragement;
(E)
				  exercising;
(F) toileting,
				  including:
(i) changing an incontinence
				  brief;
(ii) assisting with the use
				  of a bedpan or urinal;
(iii)
				  assisting with feminine hygiene needs, including menstruation
				  supplies;
(iv) assisting with
				  clothing during toileting, including raising, lowering, removal or replacement
				  of garments for hygiene needs;
(v)
				  assisting with toilet hygiene, including the use of toilet paper and washing
				  hands;
(vi) changing an external
				  catheter;
(vii) preparing toileting
				  supplies and equipment but not preparing catheter equipment unless it is a
				  delegated task as described in paragraph (4) of this subsection; and
(viii) providing standby
				  assistance;
(G)
				  positioning;
(H) assisting with
				  self-administered medication, including administration through a permanently
				  placed feeding tube;
(I)
				  grooming;
(J) routine hair and skin
				  care; and
(K) transfer or
				  ambulation, including lifting;
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 C - SERVICE DELIVERY IN ALL CMPAS OPTIONS › Section 275.59 - Location of Tasks

Current through Reg. 49, No. 28; July 12, 2024
An attendant may perform an allowable task for an
					 individual in the individual's home, at a work site, or in another appropriate
					 location, including a shopping mall, a movie theater, or a community
					 event.
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 C - SERVICE DELIVERY IN ALL CMPAS OPTIONS › Section 275.61 - Individual Training by a Provider

Current through Reg. 49, No. 28; July 12, 2024
Before providing services to an individual, a provider must
					 educate and train the individual in:
(1) rights and responsibilities of the
				  individual;
(2) skills for
				  recruiting, selecting, instructing, supervising, and dismissing attendants, if
				  desired by the individual;
(3)
				  procedures for preparing attendant time sheets, as described in §
										44.504(b)(1) of
				  this chapter (relating to Records);
(4) procedures for the CMPAS Program service
				  delivery option that the individual chooses; and
(5) rights and responsibilities of the
				  attendant and the 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 C - SERVICE DELIVERY IN ALL CMPAS OPTIONS › Section 275.63 - Individual Responsibilities in All CMPAS Service Delivery Options

Current through Reg. 49, No. 28; July 12, 2024
An applicant, individual, or the LAR or representative of
					 an applicant or individual must:
(1)
				  obtain and submit a practitioner's statement to the assessor of need;
(2) negotiate with the assessor of need at an
				  assessment or reassessment to determine which allowable tasks in §
										44.304 of this subchapter
				  (relating to Allowable and Unallowable Tasks) are included in the individual's
				  service plan;
(3) select,
				  supervise, and release from service an attendant;
(4) train and supervise a personal attendant
				  in the specifics of the delivery of services;
(5) certify the attendant's time worked on or
				  after the last day of each recording period by:
(A) verifying, signing, dating, and
				  submitting to the provider the attendant's time sheet; or
(B) if applicable, submitting appropriate
				  certification of the attendant's time worked through a provider's electronic
				  service delivery documentation system;
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 C - SERVICE DELIVERY IN ALL CMPAS OPTIONS › Section 275.65 - Suspension of Services

Current through Reg. 49, No. 28; July 12, 2024
(a) A provider must
				  suspend services to an individual if:
(1) the
				  individual changes residence to outside the state of Texas;
(2) the individual moves to a location where
				  the provider does not provide CMPAS Program services to the individual except
				  as provided for in §
											44.403 of this chapter (relating
				  to Attendant Services Provided Outside the Provider Contracted Service Delivery
				  Area in the Traditional Services Option);
(3) the individual dies;
(4) the individual is admitted to:
(A) a hospital;
(B) a nursing facility;
(C) a state supported living
				  center;
(D) a state mental health
				  facility; or
(E) an intermediate
				  care facility for individuals with an intellectual disability or related
				  conditions;
(5) the
				  individual requests that services end;
(6) the individual, representative, or
				  someone in the individual's home, as applicable, refuses to:
(A) supervise the attendant;
(B) adhere to the service plan; or
(C) otherwise comply with a requirement of
				  the CMPAS Program;
(7)
				  the individual or representative, as applicable, does not have the ability to:
(A) supervise the attendant;
(B) adhere to the service plan; or
(C) otherwise comply with a requirement of
				  the CMPAS Program;
(8)
				  the individual does not submit a co-payment as required by §
											44.501 of this chapter (relating
				  to Determining an Individual's Co-payment);
(9) the individual does not provide a
				  practitioner's statement as required by §
											44.307 of this subchapter
				  (relating to Individual Responsibilities in All CMPAS Service Delivery
				  Options); or
(10) the provider
				  becomes aware that the individual no longer meets eligibility requirements for
				  the CMPAS Program.
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 C - SERVICE DELIVERY IN ALL CMPAS OPTIONS › Section 275.67 - Termination of Services

Current through Reg. 49, No. 28; July 12, 2024
A provider may terminate services for the same reasons for
					 suspending services, listed in §
										44.308 of this subchapter
					 (relating to Suspension of Services). If a provider intends to terminate
					 services the provider must:
(1) send
				  written notice of the termination to the individual;
(2) inform the individual in the written
				  notice of:
(A) the termination date;
(B) the reason for termination;
(C) the right to appeal the termination
				  decision in accordance with §
											44.503 of this chapter (relating
				  to Fair Hearing); and
(D) the
				  individual's right to continue to receive services pending a fair hearing;
				  and
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 C - SERVICE DELIVERY IN ALL CMPAS OPTIONS › Section 275.69 - 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 275 - CONSUMER MANAGED PERSONAL ATTENDANT SERVICES (CMPAS) PROGRAM › Subchapter C - SERVICE DELIVERY IN ALL CMPAS OPTIONS › Section 275.71 - Provider Responsibilities Related to the Abuse, Neglect, and Exploitation of an Individual in All CMPAS Service Delivery Options

Current through Reg. 49, No. 28; July 12, 2024
(a) A provider, before providing services to
				  an individual and on an annual basis, must:
(1) inform the individual and representative
				  of how to report allegations of abuse, neglect, or exploitation to DFPS and
				  provide the individual with the DFPS Abuse Hotline toll-free telephone number,
				  1-800-252-5400, in writing; and
(2)
				  educate the individual and representative about how to protect the individual
				  from abuse, neglect, and exploitation.
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 1 - TRADITIONAL SERVICE OPTION › Section 275.101 - Description of the Traditional Service Option

Current through Reg. 49, No. 28; July 12, 2024
In the traditional service option, the individual retains
						control over certain personnel decisions, including selecting, supervising, and
						dismissing the attendant, but the provider is the employer of record for the
						attendant and 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 1 - TRADITIONAL SERVICE OPTION › Section 275.103 - Provider Responsibilities in the Traditional Service Option

Current through Reg. 49, No. 28; July 12, 2024
In the traditional service option, a provider
						must:
(1) comply with the requirements
					 of §
											44.302 of this chapter (relating
					 to Provider Qualifications and Responsibilities in All CMPAS Service Delivery
					 Options);
(2) maintain and
					 supervise a pool of substitute attendants to provide attendant services upon
					 the individual's request;
(3) refer
					 prospective attendants to the individual until the individual selects an
					 attendant;
(4) hire an attendant
					 who meets the qualifications of §
											44.303 of this chapter (relating
					 to Attendant Qualifications) and whom the individual agrees to
					 supervise;
(5) if an individual has
					 not selected a prospective attendant within seven days after the date the
					 assessor of need determined the individual to be eligible for services:
(A) confer with the individual;
(B) identify the reasons the individual has
					 not selected an attendant; and
(C)
					 provide training when necessary to enable the individual to select an
					 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 1 - TRADITIONAL SERVICE OPTION › Section 275.105 - Attendant Services Provided Outside the Provider Contracted Service Delivery Area in the Traditional Services Option

Current through Reg. 49, No. 28; July 12, 2024
(a)
					 A provider may develop a service plan that includes, at the request of the
					 individual, services provided while the individual is temporarily staying at a
					 location outside the provider's contracted service delivery area but within the
					 State of Texas.
(b) The service
					 plan must not exceed the weekly authorized hours.
(c) The provider may accept or decline the
					 request of an individual for the provision of services while the individual is
					 temporarily staying at a location outside the contracted service delivery area
					 but within the State of Texas.
(1) If the
					 provider accepts the individual's request, the provider:
(A) may provide services to the individual
					 during a period of no more than 60 consecutive days;
(B) must, within three days after the
					 provider begins providing services to the individual, notify the DADS regional
					 designee in writing of the following:
(i)
					 that the individual is receiving services outside the provider's contracted
					 service delivery area;
(ii) the
					 location where the individual is receiving services;
(iii) the estimated length of time the
					 individual is expected to be outside the contracted service delivery area;
					 and
(iv) contact information for
					 the individual;
(C) must
					 notify the DADS regional designee in writing that the individual has returned
					 to the provider's contracted service delivery area within three working days
					 after becoming aware of the individual's return; and
(D) is not required to pay for expenses
					 incurred by attendants delivering services outside the contracted service
					 delivery area.
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 1 - TRADITIONAL SERVICE OPTION › Section 275.107 - Individual Responsibilities in the Traditional Service Option

Current through Reg. 49, No. 28; July 12, 2024
Individuals who choose the traditional service option
						must comply with the responsibilities listed in §
											44.307 of this chapter (relating
						to Individual Responsibilities in All CMPAS Service Delivery Options) and
						must:
(1) actively assist the provider
					 in recruiting attendants and substitute attendants by seeking out and referring
					 potential attendants to the provider;
(2) select an attendant from among the
					 potential attendants whom the provider refers to the individual;
(3) actively assist in delegating, directing,
					 and training for tasks being performed;
(4) not discriminate against any potential
					 attendant, attendant, or substitute attendant in violation of law;
					 and
(5) interview any prospective
					 attendant whom the provider refers to the individual and inform the provider
					 within seven days after the referral of whether the individual selects the
					 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 2 - BLOCK GRANT OPTION › Section 275.125 - Description of the Block Grant Option

Current through Reg. 49, No. 28; July 12, 2024
Effective September 1, 2013, an individual may not choose
						the block grant option. An individual receiving CMPAS services through the
						block grant option on that date may continue to receive services under this
						option but, if the individual chooses another service delivery option, the
						individual may not return to the block grant option. In the block grant option,
						the individual is the employer of record for an attendant and is responsible
						for payroll, filing tax-related reports, and developing a monthly budget. The
						provider is the employer of record for a 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 2 - BLOCK GRANT OPTION › Section 275.127 - Provider Responsibilities in the Block Grant Option

Current through Reg. 49, No. 28; July 12, 2024
In the block grant option, a provider must:
(1) comply with the requirements of §
											44.302 of this chapter (relating
					 to Provider Qualifications and Responsibilities in All CMPAS Service Delivery
					 Options);
(2) reimburse the
					 individual for attendant wages and employment taxes paid by the
					 individual;
(3) negotiate with the
					 individual and agree on an amount that the provider will retain from
					 reimbursements made under §
											44.505 of this chapter (relating
					 to Reimbursement) to compensate the provider for its services to the
					 individual, based on the provider's actual cost of providing services to the
					 individual, which may include:
(A) the cost of
					 providing substitute attendants;
(B) the cost of providing administrative
					 services;
(C) the history of the
					 individual's use of substitute attendants; and
(D) the need for provider
					 intervention;
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 2 - BLOCK GRANT OPTION › Section 275.129 - Individual Responsibilities in the Block Grant Option

Current through Reg. 49, No. 28; July 12, 2024
In the block grant option, an individual must:
(1) comply with the requirements of §
											44.307 of this chapter (relating
					 to Individual Responsibilities in All CMPAS Service Delivery
					 Options);
(2) select, hire, and pay
					 the individual's attendants as the employer of record;
(3) before the individual's attendant
					 provides a service and on an annual basis:
(A)
					 train an attendant regarding abuse, neglect, and exploitation, as described in
					 HHSC Form 1732, Management and Training of Service Provider;
(B) sign and date Form 1732 and have the
					 attendant sign and date the form to document completion of the training;
					 and
(C) 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;
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 275.151 - Description of the Consumer Directed Services Option

Current through Reg. 49, No. 28; July 12, 2024
In the consumer directed services option, an individual
						is the employer of record for an attendant and substitute attendant but the
						provider is responsible for payroll for attendants and substitute attendants
						and filing tax-related reports for attendants and substitute
						attendants.
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 275.153 - Provider Responsibilities in the CDS Option

Current through Reg. 49, No. 28; July 12, 2024
In the CDS option, a provider must:
(1) comply with the requirements of §
											44.302 of this chapter (relating
					 to Provider Qualifications and Responsibilities in All CMPAS Service Delivery
					 Options);
(2) function as an FMSA
					 to provide financial management services to an individual;
(3) approve and monitor a budget for services
					 delivered through the CDS option;
(4) manage payroll, including calculating
					 employee withholdings and employer contributions and depositing the funds with
					 the appropriate agencies;
(5)
					 comply with applicable government regulations concerning employee withholding,
					 garnishments, mandated withholding, and benefits;
(6) prepare and file required tax forms and
					 reports;
(7) pay allowable expenses
					 incurred by the individual;
(8)
					 obtain employer-agent status with the Internal Revenue Service, the Texas
					 Workforce Commission, and any other appropriate government agencies within the
					 time frame established by each agency;
(9) perform all employer-agent
					 responsibilities required by government agencies that regulate the relationship
					 between the employer-agent and the individual acting as the employer of record,
					 and maintain an original or a copy of each form required to document
					 compliance; and
(10) attend, at
					 least annually, HHSC's training for FMSAs.