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 C - PROVIDER ADMINISTRATIVE REQUIREMENTS › Section 261.218 - Voluntary Facility Closure and Suspension of Certified Capacity

Current through Reg. 49, No. 28; July 12, 2024
(a) In this section, the terms "close" and
				  "closure" refer to a facility ceasing to operate. The terms do not include
				  temporarily relocating individuals who reside in a facility.
(b) Except as provided in subsection (c) of
				  this section, if a program provider intends to voluntarily close a facility,
				  the program provider must submit to DADS, at least 60 days before the facility
				  closes, written notice of the program provider's intent to close the facility,
				  which includes:
(1) the anticipated date of
				  closure; and
(2) a description of
				  how the facility will discharge and relocate an individual who resides in the
				  closing facility to a new residence.
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 C - PROVIDER ADMINISTRATIVE REQUIREMENTS › Section 261.219 - Provider Reimbursement

Current through Reg. 49, No. 28; July 12, 2024
(a) The
				  department will pay a program provider for ICF/ID Program services provided to
				  individuals enrolled in the ICF/ID Program. Such services include:
(1) room and board;
(2) active treatment; and
(3) medical services.
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 C - PROVIDER ADMINISTRATIVE REQUIREMENTS › Section 261.220 - Medicaid Bed Reallocation

Current through Reg. 49, No. 28; July 12, 2024
(a) Based on
				  Texas Health and Safety Code §
										533A.062(b-1)
				  (relating to Plan on Long-Term Care for Persons with an Intellectual
				  Disability), and as authorized by the Long-Term Care Plan for Individuals with
				  Intellectual Disabilities and Related Conditions, the Texas Health and Human
				  Services Commission (HHSC) must:
(1) review
				  the state-wide bed capacity of community intermediate care facilities for
				  individuals with an intellectual disability or related conditions (ICF/IID);
				  and
(2) develop a process to
				  reallocate beds held in suspension by HHSC.
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 D - PROVIDER SERVICE REQUIREMENTS › Section 261.221 - Durable Medical Equipment

Current through Reg. 49, No. 28; July 12, 2024
(a) A
				  program provider that arranges for durable medical equipment for an individual
				  residing in the facility must ensure that:
(1) the individual receives the equipment
				  prescribed;
(2) the equipment fits
				  properly, if applicable; and
(3)
				  the individual's caregivers, as appropriate, receive instruction regarding the
				  equipment's use.
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 D - PROVIDER SERVICE REQUIREMENTS › Section 261.222 - Permanency Planning and LAR Participation for Individuals Under 22 Years of Age

Current through Reg. 49, No. 28; July 12, 2024
(a) As required by
				  Texas Government Code, §
										531.153,
				  a program provider must incorporate permanency planning as an integral part of
				  the IPP for each individual under 22 years of age residing in the facility. In
				  order to accomplish the permanency planning goal in accordance with §
				  261.244(f) of this chapter (relating to Applicant Enrollment in the ICF/MR
				  Program), the program provider must identify in the IPP, as appropriate to the
				  individual's needs:
(1) for an individual
				  under 18 years of age, the activities, supports, and services that, when
				  provided or facilitated by the program provider or MRA, will enable the
				  individual to live with a family; or
(2) for an individual age 18 to 22 years of
				  age, the activities, supports, and services that, when provided or facilitated
				  by the program provider or MRA, will result in the individual having a
				  consistent and nurturing environment in the least restrictive setting, as
				  defined by the individual and LAR.
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 D - PROVIDER SERVICE REQUIREMENTS › Section 261.223 - Review of Living Options

Current through Reg. 49, No. 28; July 12, 2024
(a) At a
				  facility other than a state school or state center, the IDT must discuss living
				  options with the individual and LAR at least annually or upon the request of
				  the individual or LAR. The facility must use the Community ICF/MR Living
				  Options instrument, copies of which are available on the department's website
				  at www.mhmr.state.tx.us/CentralOffice/Medicaid/i.html or by contacting Office
				  of Medicaid Administration, Texas Department of Mental Health and Mental
				  Retardation, P.O. Box 12668, Austin, Texas 78711. State schools and state
				  centers must discuss living options with the individual and LAR in accordance
				  with § 2.274 of Title 40 (relating to Consideration of Living Options for
				  Individuals Residing in State MR Facilities).
(1) During the discussion, the IDT must use
				  information obtained from the MRA in whose local service area the facility is
				  located to inform the individual and LAR of the different types of alternative
				  living arrangements, including:
(A) other
				  ICF/MR Program providers--state schools and state centers and community-based
				  ICF/MRs;
(B) waiver services under
				  § 1915(c) of the Social Security Act; and
(C) other community-based services and
				  supports.
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 D - PROVIDER SERVICE REQUIREMENTS › Section 261.224 - Capacity Assessment

Current through Reg. 49, No. 28; July 12, 2024
(a) As described in
				  § 72.5001 of Title 40, (relating to Memorandum of Understanding Concerning
				  Capacity Assessment for Self Care and Financial Management) a program provider
				  must perform a capacity assessment for an individual receiving services from
				  that program provider if the program provider:
(1) believes a guardian of the person or the
				  estate for that individual may be appropriate and a referral to the appropriate
				  court for guardianship is anticipated; or
(2) is directed to do so by a
				  court.
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 D - PROVIDER SERVICE REQUIREMENTS › Section 261.225 - Reporting Incidents to DADS

Current through Reg. 49, No. 28; July 12, 2024
(a) In this
				  section, "serious physical injury" is defined as in Chapter 711 of Title 40
				  (relating to Investigations in DADS and DSHS Facilities and Related
				  Programs).
(b) A program provider
				  that, in accordance with THSC § 252.003, is exempt from licensure under
				  THSC § 252.031 must report the following incidents to DADS Consumer Rights
				  and Services at 1-800-458-9858 within one hour after suspecting or learning of
				  the incident:
(1) alleged (Class I) physical
				  abuse of an individual, as defined in Chapter 711 of Title 40, that caused or
				  may have caused serious physical injury;
(2) alleged (Class I) sexual abuse of an
				  individual, as defined in Chapter 711 of Title 40;
(3) sexual activity between individuals
				  resulting from coercion, physical force, or taking advantage of the disability
				  of an individual;
(4) sexual
				  activity involving an individual who is less than 18 years of age;
(5) the pregnancy of an individual;
(6) individual-to-individual aggression that
				  results in serious physical injury;
(7) the death of an individual; and
(8) the inability to locate an individual if:
(A) the individual's health or safety is at
				  risk; or
(B) the individual's
				  location has been unknown for more than eight hours.
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 D - PROVIDER SERVICE REQUIREMENTS › Section 261.226 - Leaves

Current through Reg. 49, No. 28; July 12, 2024
(a) An individual's absence from a facility
				  must meet the requirements of this section to be considered a therapeutic
				  leave, an extended therapeutic leave, or a special leave.
(b) An individual is on a therapeutic leave
				  if:
(1) the individual is absent from the
				  facility one full day or more but less than four consecutive full
				  days;
(2) the individual's IPP
				  provides for therapeutic leave; and
(3) except as provided in subsection (e) of
				  this section, the individual has stayed in the facility overnight since being
				  on a prior therapeutic leave or extended therapeutic leave.
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 D - PROVIDER SERVICE REQUIREMENTS › Section 261.227 - Discharge From a Facility

Current through Reg. 49, No. 28; July 12, 2024
(a) When a
				  discharge occurs, a program provider must comply with
				  42 CFR §
											483.440(b)(4) and (5) and
				  this section.
(b) The effective
				  date of a discharge is the first full day the individual is absent from the
				  facility.
(c) Prior to the
				  effective date of a discharge, a program provider must take the following
				  action or document why such action is not feasible:
(1) notify the individual, LAR, and the
				  individual's MRA of the proposed discharge in writing at least 30 days before
				  the effective date of the proposed discharge;
(2) document the reason for the proposed
				  discharge and, if the reason is that the facility can no longer meet the
				  individual's needs, explain why;
(3) counsel the individual or LAR about the
				  proposed discharge, including the potential outcomes of the proposed discharge;
				  and
(4) develop a final summary and
				  post-discharge plan in accordance with
				  42 CFR §
												483.440(b)(5) and provide a
				  copy of both documents to the individual, LAR, and the individual's
				  MRA.
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 D - PROVIDER SERVICE REQUIREMENTS › Section 261.228 - Augmentative Communication Device System

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  A specialized augmentative communication device system (ACD), also referred to
				  as a speech-generating device system, is reimbursable if purchased by a program
				  provider for a resident and all requirements of this section are met.
(b) A program provider must request and
				  receive authorization from DADS before purchasing an ACD, referred to in this
				  section as "prior authorization." The request for prior authorization must
				  include:
(1) an evaluation and recommendation
				  from a licensed speech therapist to purchase the ACD;
(2) a signed statement from the resident's
				  attending physician that the ACD is medically necessary for the resident to
				  maximize his functional communication; and
(3) a minimum of two bids for the ACD or a
				  request for an exception to the two-bid minimum if the recommended ACD is
				  available through only one vendor.
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 D - PROVIDER SERVICE REQUIREMENTS › Section 261.229 - Critical Incident Reporting

Current through Reg. 49, No. 28; July 12, 2024
(a) The
				  following definitions apply to this section:
(1) Critical incident means:
(A) a medication error;
(B) a serious physical injury;
(C) a behavior intervention plan that
				  authorizes restraint;
(D) an
				  emergency personal restraint;
(E)
				  an emergency mechanical restraint; or
(F) an emergency psychoactive medication
				  restraint.
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 D - PROVIDER SERVICE REQUIREMENTS › Section 261.230 - Requirements for a Day Habilitation Center

Current through Reg. 49, No. 28; July 12, 2024
(a) In
				  this section, the term "program provider" does not include a program provider
				  that operates a campus-based facility.
(b) In this section, the following terms have
				  the following meanings.
(1) Day habilitation
				  center--A building or a portion of a building:
(A) that is not located within a program
				  provider's facility;
(B) that the
				  program provider or a subcontractor of the program provider owns or leases; and
(C) in which active treatment is
				  provided to an individual by the program provider or a subcontractor of the
				  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 E - ELIGIBILITY, ENROLLMENT AND REVIEW › Section 261.236 - Eligibility Criteria

Current through Reg. 49, No. 28; July 12, 2024
(a) To be eligible
				  for the ICF/MR Program, a person must:
(1)
				  meet the LOC I or LOC VIII criteria described in § 261.238 of this chapter
				  (relating to Level of Care I Criteria) and § 261.239 of this chapter
				  (relating to Level of Care VIII Criteria);
(2) be in need of and able to benefit from
				  the active treatment provided in the 24-hour supervised residential setting of
				  an ICF/MR; and
(3) be eligible for
				  Supplemental Security Income (SSI) or be determined by TDHS to be financially
				  eligible for Medicaid.
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 E - ELIGIBILITY, ENROLLMENT AND REVIEW › Section 261.237 - Level of Care

Current through Reg. 49, No. 28; July 12, 2024
(a) An LOC for a
				  person must be requested from the department by electronically transmitting a
				  completed MR/RC Assessment, indicating the recommended LOC, to the department.
				  The electronically transmitted MR/RC Assessment must contain information
				  identical to the information on the signed MR/RC Assessment described in
				  subsection (b) of this section.
(b)
				  Information on the MR/RC Assessment must be supported by current data obtained
				  from standardized evaluations and formal assessments that measure physical,
				  emotional, social, and cognitive factors. A paper copy of the person's signed
				  MR/RC Assessment and documentation supporting the recommended LOC must be
				  maintained in the person's record.
(c) The department will make an LOC
				  determination in accordance with § 261.238 of this chapter (relating to
				  ICF/MR LOC I Criteria) and § 261.239 of this chapter (relating to ICF/MR
				  LOC VIII) based on the department's review of information reported on the
				  person's MR/RC Assessment.
(d) The
				  department will notify the requestor electronically if the LOC is authorized.
				  The department will send written notification to the requestor and the person
				  or LAR if the LOC is denied.
(e) An
				  initial LOC is valid for 180 days after its effective date.
(f) The effective date of a person's initial
				  LOC is the date requested by the MRA, which may be no earlier than 30 days
				  prior to the date the person's MR/RC Assessment is electronically transmitted
				  to the department.
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 E - ELIGIBILITY, ENROLLMENT AND REVIEW › Section 261.238 - ICF/MR Level of Care I Criteria

Current through Reg. 49, No. 28; July 12, 2024
(a) To meet
				  the LOC I criteria, a person must:
(1) meet
				  the following criteria:
(A) have a full scale
				  intelligence quotient (IQ) score of 69 or below, obtained by administering a
				  standardized individual intelligence test; or
(B) have a full scale IQ score of 75 or
				  below, obtained by administering a standardized individual intelligence test,
				  and have a primary diagnosis by a licensed physician of a related condition
				  that is included on the list of diagnostic codes for persons with related
				  conditions that are approved by DADS and posted on its website at
				  www.dads.state.tx.us; 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 E - ELIGIBILITY, ENROLLMENT AND REVIEW › Section 261.239 - ICF/MR Level of Care VIII Criteria

Current through Reg. 49, No. 28; July 12, 2024
To meet the LOC VIII criteria, a person must:
(1) have a primary diagnosis by a licensed
				  physician of a related condition that is included on the list of diagnostic
				  codes for persons with related conditions that are approved by DADS and posted
				  on its website at www.dads.state.tx.us; and
(2) have an adaptive behavior level of II,
				  III, or IV (i.e., moderate to extreme deficits in adaptive behavior) obtained
				  by administering a standardized assessment of adaptive behavior.
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 E - ELIGIBILITY, ENROLLMENT AND REVIEW › Section 261.240 - Level of Need

Current through Reg. 49, No. 28; July 12, 2024
(a) An LON for a
				  person must be requested from the department by electronically transmitting a
				  completed MR/RC Assessment, indicating the recommended LON, and submitting any
				  supporting documentation required by § 261.242 of this chapter (relating
				  to Supporting Documentation for Level of Need). The electronically transmitted
				  MR/RC Assessment must contain information identical to the information on the
				  signed MR/RC Assessment described in subsection (c) of this section.
(b) Supporting documentation must be received
				  by the department within seven days after the completed MR/RC Assessment is
				  electronically transmitted to the department.
(c) A paper copy of the person's signed MR/RC
				  Assessment and the supporting documentation must be maintained in the person's
				  record.
(d) The department will
				  assign an LON 1, LON 5, LON 6, LON 8, or LON 9, to a person in accordance with
				  the criteria described in § 261.241 of this chapter (relating to Level of
				  Need Criteria).
(e) The department
				  will assign an LON to a person based on the department's review of information
				  reported on the person's MR/RC Assessment, including the ICAP service level
				  score, and any supporting documentation required by § 261.242 of this
				  chapter (relating to Supporting Documentation for Level of Need).
(f) Within 21 days after receiving an MR/RC
				  Assessment and any supporting documentation, the department will request
				  additional documentation, electronically approve the recommended LON, or send
				  written notification to the requestor that the recommended LON has been
				  denied.
(g) If additional
				  documentation is requested, the department will review any additional
				  documentation submitted in accordance with its request and electronically
				  approve the recommended LON or send written notification to the requestor that
				  the recommended LON has been denied.
(h) The department may review a recommended
				  or assigned LON at any time to determine if it is appropriate. If the
				  department reviews a recommended or assigned LON, documentation supporting the
				  LON must be submitted to the department in accordance with the department's
				  request. The department may modify an LON and recoup or deny payment based on
				  its review.
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 E - ELIGIBILITY, ENROLLMENT AND REVIEW › Section 261.241 - Level of Need Criteria

Current through Reg. 49, No. 28; July 12, 2024
(a) The department
				  will assign one of five LONs as follows:
(1)
				  An intermittent LON (LON 1) will be assigned if the person's ICAP service level
				  score equals 7, 8, or 9;
(2) A
				  limited LON (LON 5) will be assigned if the person's ICAP service level score
				  equals 4, 5, or 6, or an LON 1 is increased in accordance with subsection (b)
				  or (d) of this section;
(3) An
				  extensive LON (LON 8) will be assigned if the person's ICAP service level score
				  equals 2 or 3, or an LON 5 is increased in accordance with subsection (b) or
				  (d) of this section;
(4) A
				  pervasive LON (LON 6) will be assigned if the person's ICAP service level score
				  equals 1, or an LON 8 is increased in accordance with subsection (b) or (d) of
				  this section; and
(5) Regardless of
				  a person's ICAP service level score, a pervasive plus LON (LON 9) will be
				  assigned if the person meets the criteria set forth in subsection (c) of this
				  section.
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 E - ELIGIBILITY, ENROLLMENT AND REVIEW › Section 261.242 - Supporting Documentation for Level of Need

Current through Reg. 49, No. 28; July 12, 2024
The following supporting documentation, at a minimum, must
					 be submitted to the department when requesting an LON:
(1) if a request is made to increase an LON
				  1, LON 5, or LON 8 in accordance with § 261.241(b) of this chapter
				  (relating to Level of Need Criteria), due to a person's dangerous behavior:
(A) the person's IPP;
(B) the person's ICAP assessment
				  booklet;
(C) the person's person
				  directed plan (PDP), if available;
(D) the person's behavior intervention plan;
				  and
(E) written descriptions (e.g.
				  incident reports or progress notes) of specific incidents of the dangerous
				  behavior and the staff interventions;
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 E - ELIGIBILITY, ENROLLMENT AND REVIEW › Section 261.243 - Reconsideration of Level of Need

Current through Reg. 49, No. 28; July 12, 2024
(a) If a
				  program provider who has requested an LON for a person disagrees with the LON
				  assigned by the department, the program provider may request that the
				  department reconsider the LON.
(b)
				  A program provider may receive reconsideration only if the program provider
				  submitted the supporting documentation as required by § 261.240(b) of this
				  chapter (relating to Level of Need).
(c) To request reconsideration of an LON
				  assigned by the department, a program provider must submit a written request
				  for reconsideration to the department within 10 days after receiving notice
				  that the recommended LON was denied. The program provider must include
				  additional clinical and supporting documentation with the request.
(d) Within 21 days after receiving a request
				  for reconsideration from a program provider, the department will electronically
				  approve the recommended LON or send written notification to the program
				  provider that the recommended LON has been denied.
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 E - ELIGIBILITY, ENROLLMENT AND REVIEW › Section 261.244 - Applicant Enrollment in the ICF/MR Program

Current through Reg. 49, No. 28; July 12, 2024
(a) Except as provided in subsection (b) of
				  this section, only an MRA may request enrollment of an applicant by
				  DADS.
(b) A program provider may
				  request enrollment of an applicant by DADS in accordance with subsection (k) of
				  this section if the applicant:
(1) has
				  received ICF/MR services from a non-state operated facility during the 180 days
				  before the enrollment request; and
(2) is not moving from or seeking admission
				  to a state school or state center.
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 E - ELIGIBILITY, ENROLLMENT AND REVIEW › Section 261.245 - Renewal of Level of Care

Current through Reg. 49, No. 28; July 12, 2024
(a) To avoid
				  interruption in payment from the department, a program provider must request to
				  renew an individual's existing LOC prior to its expiration date.
(b) To request to renew an individual's
				  existing LOC, a program provider must follow the procedures for requesting an
				  LOC described in § 261.237 of this chapter (relating to Level of
				  Care).
(c) The department will make
				  an LOC determination and notify the program provider of its determination in
				  accordance with § 261.237 of this chapter (relating to Level of
				  Care).
(d) The effective date of a
				  renewed LOC is:
(1) the date the MR/RC was
				  electronically transmitted to the department, if a different date is not
				  requested; or
(2) a requested
				  effective date within 45 days after the MR/RC was electronically transmitted to
				  the department.
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 E - ELIGIBILITY, ENROLLMENT AND REVIEW › Section 261.246 - Renewal and Revision of Level of Need

Current through Reg. 49, No. 28; July 12, 2024
(a) A
				  program provider must request to renew an individual's existing LON when
				  renewing an existing LOC in accordance with § 261.245(b) of this chapter
				  (relating to Renewal of Level of Care).
(b) A program provider must request to revise
				  an individual's existing LON if:
(1) the
				  individual's adaptive functioning or behavioral or medical condition changes
				  such that the individual's current LON is no longer accurate;
(2) the results of an ICAP assessment
				  indicate that the individual's current LON is no longer accurate; or
(3) the information submitted for the
				  individual's current LON resulted in an inaccurate LON.
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 E - ELIGIBILITY, ENROLLMENT AND REVIEW › Section 261.247 - Re-Administration of the ICAP

Current through Reg. 49, No. 28; July 12, 2024
(a) A program
				  provider must re-administer the ICAP to an individual if:
(1) three years have elapsed since the ICAP
				  was last administered to the individual;
(2) changes in the individual's functional
				  skills or behavior occur that are not expected to be of a short duration or
				  cyclical in nature; or
(3) the
				  individual's skills and behavior are inconsistent with the individual's
				  LON.
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 E - ELIGIBILITY, ENROLLMENT AND REVIEW › Section 261.248 - Lapsed Level of Care

Current through Reg. 49, No. 28; July 12, 2024
(a) The department
				  will not pay a program provider for ICF/MR Program services provided during a
				  period of time in which the individual's LOC lapsed unless the program provider
				  requests and is granted a reinstatement of the LOC in accordance with this
				  section.
(b) To request
				  reinstatement of an LOC, a program provider must electronically transmit to the
				  department an MR/RC Assessment indicating:
(1) a code "E" in the "Purpose" section;
				  and
(2) the beginning and ending
				  dates of the period of time for which the individual's LOC lapsed.
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 E - ELIGIBILITY, ENROLLMENT AND REVIEW › Section 261.249 - Fair Hearing

Current through Reg. 49, No. 28; July 12, 2024
Any individual whose request for eligibility for the ICF/MR
					 Program is denied or is not acted upon with reasonable promptness, or whose
					 ICF/MR Program services have been terminated, suspended or reduced by the
					 department is entitled to a fair hearing in accordance with Chapter 419,
					 Subchapter G of Title 40 (relating to Medicaid Fair Hearings) [now
					 repealed].
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 E - ELIGIBILITY, ENROLLMENT AND REVIEW › Section 261.250 - Permanency Planning Reviews

Current through Reg. 49, No. 28; July 12, 2024
An MRA must, within six months after the initial permanency
					 planning meeting and every six months thereafter until an individual either
					 turns 22 years of age or leaves the facility to live in a family
					 setting:
(1) provide written notice to
				  the LAR of a meeting to conduct a review of the individual's permanency plan no
				  later than 21 days before the meeting date and include a request for a response
				  from the LAR;
(2) convene a meeting
				  to review the individual's permanency plan in accordance with §
				  261.244(f)(2) - (5) of this chapter (relating to Applicant Enrollment in the
				  ICF/MR Program), with an emphasis on changes or additional information gathered
				  since the last permanency plan was developed;
(3) develop a permanency plan in accordance
				  with § 261.244(f)(6) of this chapter;
(4) perform actions regarding a volunteer
				  advocate as described in § 261.244(g) - (i) of this chapter;
(5) complete the Permanency Planning Review
				  Screen in CARE within 10 days after the meeting;
(6) ensure that approval for the individual
				  to continue to reside in the facility is obtained every six months from the
				  DADS commissioner and the Health and Human Services Commission executive
				  commissioner;
(7) keep a copy of
				  the Permanency Planning Review Approval Status View Screen from CARE in the
				  individual's record; and
(8)
				  provide a copy of the permanency plan to the program provider, the individual,
				  and the LAR.
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 261.251 - Protecting Individuals' Personal Funds

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  A program provider must implement this subchapter according to the generally
				  accepted accounting principles of the American Institute of Certified Public
				  Accountants.
(b) A program provider
				  must develop and implement written policies and procedures regarding personal
				  funds that protect the financial interest of an individual and, at a minimum,
				  require the program provider:
(1) to instruct
				  an individual in handling personal funds consistent with the individual's
				  abilities and understanding;
(2) to
				  allow an individual to hold and manage personal funds to the extent of the
				  individual's abilities; and
(3) to
				  comply with 20 CFR Part
				  404, Subpart U, and
				  20 CFR Part
				  416, Subpart F, if the Social Security
				  Administration has appointed the program provider as the representative
				  payee.
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 261.252 - Notice Regarding Personal Funds

Current through Reg. 49, No. 28; July 12, 2024
At the time of admission to a facility, and if changes to
					 services or charges occur, a program provider must provide each individual or
					 LAR with written notification containing the following information:
(1) a written explanation of §
				  261.253(d) and (e) of this chapter (relating to Determining Management of
				  Personal Funds), which describe who may manage personal funds;
(2) a list of items and services included in
				  the program provider's ICF/IID Program reimbursement rate for which the
				  individual will not be charged;
(3)
				  a list of items and services for which the individual may be charged;
(4) a statement that the individual or LAR
				  may have the Social Security Administration appoint a representative payee to
				  receive the individual's federal benefits in accordance with
				  20 CFR Part
				  404, Subpart U, and
				  20 CFR Part
				  416, Subpart F;
(5) a statement that, if the Social Security
				  Administration has appointed the program provider as the representative payee
				  for an individual's social security benefits, the provider must comply with
				  20 CFR Part
				  404, Subpart U, and
				  20 CFR Part
				  416, Subpart F;
(6) a statement that, if the program provider
				  manages the individual's personal funds, the program provider will make
				  available the individual's personal funds record, as described in §
				  261.256(h) of this chapter (relating to Program Provider-Managed Personal
				  Funds), upon the request of the individual or LAR within 72 hours after
				  receiving a request for a copy of the personal funds record from the individual
				  or LAR; and
(7) a statement that,
				  if the individual or LAR requests withdrawal of all personal funds managed by
				  the program provider, or if the individual is discharged from the facility, the
				  program provider will disburse funds managed by the program provider in
				  accordance with § 261.258 of this chapter (relating to Closing Trust Fund
				  Accounts) and, if the program provider is the representative payee, in
				  accordance with 20 CFR Part
				  404, Subpart U, and
				  20 CFR Part
				  416, Subpart F.
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 261.253 - Determining Management of Personal Funds

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Within 30 days after an individual is admitted to a facility, the IDT must
				  determine if the individual has the ability to:
(1) manage his or her personal funds;
				  and
(2) decide who manages his or
				  her personal funds.
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 261.254 - Items and Services Provided by the Program Provider

Current through Reg. 49, No. 28; July 12, 2024
A program provider must not charge an individual or require
					 an individual to expend personal funds for items and services that are the
					 program provider's responsibility to provide, except as authorized by §
					 261.255(a)(1) of this chapter (relating to Items and Services Purchased with
					 Personal Funds), because they are included in the ICF/MR Program reimbursement
					 rate or are covered by other Medicaid programs. These items and services
					 include:
(1) medical services and
				  therapies, e.g., physical exams, physical therapy, occupational therapy, and
				  nutritional, speech, audiological, psychological, social, and medical
				  evaluations;
(2) prescribed and
				  over-the-counter medication:
(A) for an
				  individual who is not eligible for Medicare Part D benefits; or
(B) for an individual who is eligible for
				  Medicare Part D benefits if the medication is prescribed and is in a category
				  that is not covered by Medicare Part D;
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 261.255 - Items and Services Purchased with Personal Funds

Current through Reg. 49, No. 28; July 12, 2024
(a) A program provider may charge an
				  individual or allow an individual to expend personal funds for the following
				  items and services:
(1) an item or service
				  that the program provider is responsible for providing, if the individual
				  requests a specific type or brand of item or service that the program provider
				  does not provide, and the program provider documents in the individual's
				  record:
(A) the individual's written, signed
				  request for a specific type or brand and the reason a specific type or brand
				  has been requested or if the individual is determined not to have the ability
				  to make such a request, the IDT's approval for a specific type or
				  brand;
(B) the type or brand that
				  is provided at the program provider's expense; and
(C) the reason the program provider does not
				  provide the type or brand requested;
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 261.256 - Program Provider-Managed Personal Funds

Current through Reg. 49, No. 28; July 12, 2024
(a) Accounting for personal funds. If a
				  program provider manages personal funds, the program provider must comply with
				  this section and ensure that:
(1) a complete
				  accounting of personal funds entrusted to the program provider is
				  maintained;
(2) personal funds are
				  not commingled with program provider funds or the funds of any person other
				  than another individual for whom the program provider manages personal funds;
				  and
(3) personal funds are only
				  expended for the individual's use and benefit and in a manner and for purposes
				  determined to be in the individual's best interest.
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 261.257 - Requests for Personal Funds from Trust Fund Accounts

Current through Reg. 49, No. 28; July 12, 2024
If a program provider receives a request from an individual
					 or other person except program provider staff to expend an individual's
					 personal funds without obtaining a receipt and the individual's IDT determines
					 that the expenditure is in the best interest of the individual, the program
					 provider may release such funds to the requestor.
(1) The request must be written, signed by
				  the requestor, and specify the amount and purpose of the expenditure.
(2) A check is not considered a written
				  request for personal funds, even if it is written and signed by 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 F - PERSONAL FUNDS › Section 261.258 - Closing Trust Fund Accounts

Current through Reg. 49, No. 28; July 12, 2024
(a) Ownership
				  change. Within 30 days after the effective date of a change in facility
				  ownership, the previous program provider must:
(1) reconcile each statement issued by a
				  financial institution with the account ledger and the personal
				  ledger;
(2) provide the new program
				  provider with a list of all individuals whose personal funds were managed by
				  the previous program provider and their trust fund account balances and
				  personal ledger balance as of the effective date of the transfer;
(3) transfer to the new program provider all
				  personal funds managed by the previous program provider;
(4) retain a receipt from the new program
				  provider indicating the amount of the transfer; and
(5) submit to the department any unidentified
				  personal funds.
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 261.259 - Refunds

Current through Reg. 49, No. 28; July 12, 2024
A program provider must refund any private payment it
					 received for services provided during a period covered by Medicaid, including
					 retroactive coverage, within 30 days after accepting the Medicaid
					 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 F - PERSONAL FUNDS › Section 261.260 - Applied Income

Current through Reg. 49, No. 28; July 12, 2024
(a) A program
				  provider may only collect applied income in accordance with the procedures
				  authorized by TDHS.
(b) If an
				  individual's applied income has not been determined or the individual's earned
				  or unearned income changes, a program provider must report such information to
				  the TDHS Medicaid eligibility worker.
(c) A program provider must maintain an
				  applied income ledger for each individual that includes the amount of:
(1) applied income owed by the
				  individual;
(2) applied income paid
				  by the individual;
(3) the
				  difference between the applied income owed and the applied income paid by the
				  individual; and
(4) charges paid by
				  the individual 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)
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 261.261 - Contributions

Current through Reg. 49, No. 28; July 12, 2024
If the individual or LAR makes a contribution to a program
					 provider using personal funds, the program provider and the contributor must
					 sign and date an acknowledgement that the program provider's services are not
					 predicated on a contribution and the contribution is voluntary. The
					 acknowledgement must be made a part of the individual's personal funds
					 record.
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 261.262 - Trust Fund Monitoring and Audits

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  DADS may periodically monitor a trust fund account to assure compliance with
				  this section. DADS notifies a program provider of monitoring plans and gives a
				  report of the findings to the program provider.
(b) DADS may, as a result of monitoring,
				  refer a program provider to the Health and Human Services Commission Office of
				  Inspector General (OIG) for an audit.
(c) The program provider must provide all
				  records and other documents required by § 261.256 of this chapter
				  (relating to Program Provider-Managed Personal Funds) to DADS upon
				  request.
(d) DADS provides the
				  program provider with a report of the findings, which may include corrective
				  actions that the program provider must take and internal control
				  recommendations that the program provider may follow.
(e) To dispute the report of findings, the
				  program provider may request:
(1) an informal
				  review in accordance with § 261.263(a) of this chapter (relating to
				  Informal Review and Administrative Hearing); or
(2) an administrative hearing in accordance
				  § 261.263(b) of this chapter.