40 TAC §48.6003, §48.6030
The Texas Department of Human Services (DHS) adopts an amendment
to §48.6030 with changes to the proposed text published in the January
22, 1999, issue of the
Texas Register
(24
TexReg 377). An amendment to §48.6003 is adopted without changes and
will not be republished.
Justification for the amendment to §48.6003 is that currently individuals
with greater care needs must enter a nursing facility to have their needs
met when their cost of care exceeds greater than 95% of what it would cost
in a nursing facility. This amendment would allow such individuals to have
the same funding available in the community as available for the individual's
care in a nursing facility, 100% of the individual's actual Texas Index for
Level of Effort (TILE) payment rate. Additionally, this would divert admissions
from nursing facilities and provide the affordability and an available choice
for individuals to choose to remain in the community.
The amendment to §48.6003 will function by allowing an individual's
service plan in the 1915(c) Medicaid waiver program to have the same cost
limits as individuals in nursing facilities, not to exceed 100% of the individual's
actual Texas Index for Level of Effort payment rate.
Justification for the amendment to §48.6030 is that home and community
support services (HCSS) agencies commented that it would not be cost effective
to maintain a parent or branch office under licensure in each region. Additionally,
support was received from HCSS agencies for serving CBA clients under the
licensed home health category of licensure, as this category of licensure
parallels the CBA program expectations. This was clarified by specifying that
CBA services must be served under the licensed home health category of licensure
in §48.6030(3).
The amendment to §48.6030 will function by establishing HCSS agencies'
qualifications for contracting with DHS to provide (CBA) services. The amendment
deletes the requirement for HCSS agencies to be licensed and certified. It
maintains the requirement that services must be provided through the licensed
home health category of licensure and requires the HCSS agency license to
cover each county specified in the DHS contract.
The department received the following comments regarding proposed rule
§48.6030 from North Central Texas Home Care, Visiting Nurses of Del Rio,
Inc., and the Texas Association of Home Care.
Comment: In opposition to having a parent or branch office physically located
in each region due to the cost to agencies. Texas Association of Home Care
recommended that either this requirement be deleted or that language be replaced
with the current handbook language which states that agencies may have a physical
location in the region or that records must be made available in the region.
Response: The department agrees and has deleted the requirement, proposed
as §48.6030(2), for a parent or branch office in each region.
Comment: In support of the proposed deletion of the requirement that agencies
must have a licensed and certified category of licensure.
Response: The department agrees.
The department received the following comment from the Texas Association
of Home Care regarding proposed §48.6030(4).
Comment: In support of CBA services being delivered through the "licensed
home health" category of licensure.
Response: The department agrees and has clarified in §48.6030(3) the
category of licensure needed for HCSS agencies.
The department received the following comment regarding proposed rule §48.6003
from the Texas Association of Home Care.
Comment: In support of raising the CBA client's individual cost ceiling
from 95% to 100%. This could actually recognize additional cost savings since
a person costing between 95% and 100% could otherwise be denied community
care and forced to spend more in the nursing home.
Response: The department agrees and recommends adoption as proposed.
Comment: The department received a letter from an individual in support
of the rules as written.
The amendments are adopted under the Human Resources Code, Title
2, Chapters 22 and 32, which authorizes the department to administer public
and medical assistance programs; and under Texas Government Code §531.021,
which provides the Health and Human Services Commission with the authority
to administer federal medical assistance funds.
The amendments implement the Human Resources Code, §§22.001-
22.030 and §§32.001-32.042.
§48.6030.Home and Community Support Services Provider Qualifications.
To be qualified as a home and community support services (HCSS) provider
to deliver Community Based Alternatives (CBA) services under contract with
the Texas Department of Human Services (DHS), a HCSS agency must:
(1)
have a separate contract to provide CBA services in each
DHS region in which services are to be delivered;
(2)
deliver CBA services through the licensed home health
category of licensure;
(3)
have the counties in the DHS contract for CBA services
included in the identified service area on file at the Texas Department of
Health (TDH) with the licensed home health category of licensure; and
(4)
be authorized by the secretary of state to do business
in the State of Texas (if an out-of-state corporation).
This agency hereby certifies that the adoption has been
reviewed by legal counsel and found to be a valid exercise of the agency's
legal authority.
Filed with the Office of the Secretary of State on March
19, 1999.
TRD-9901673
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Effective date: April 8, 1999
Proposal publication date: January 22, 1999
For further information, please call: (512) 438-3765