Part 1.
TEXAS DEPARTMENT OF HUMAN SERVICES
Chapter 19.
NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION
Subchapter T. ADMINISTRATION
40 TAC §19.1926
The Texas Department of Human Services (DHS) proposes new §19.1926,
concerning medicaid hospice services, in its Nursing Facility Requirements
for Licensure and Medicaid Certification chapter. DHS is simultaneously filing
a related proposal in Chapter 30 in this issue of the
Texas Register
.
The purpose of the new section is to delineate the responsibilities nursing
facilities have when they contract with a hospice provider because there has
been some confusion in this area. The new section addresses the content of
the contract between the nursing facility and hospice, the responsibilities
of both providers, the plan of care, and the documentation that must be a
part of the nursing facility's clinical records.
Eric M. Bost, commissioner, has determined that for the first five-year
period the new section is in effect there will be no fiscal implications for
state or local government as a result of enforcing or administering the new
section.
Mr. Bost also has determined that for each year of the first five years
the new section is in effect the public benefit anticipated as a result of
enforcing the new section will be ensured accountability and consistency of
service delivery among the hospice and nursing facility providers. Nursing
facility providers will be more accountable to the department in that they
must ensure that required documentation is on file and that there are joint
procedures with the hospice provider regarding the ordering and paying for
medications. The economic impact will be minimal and will be the same for
large, small, and micro- businesses. Currently, providers must follow the
federal Medicaid rules and state licensing rules. This rule will encourage
the nursing facility and hospice provider base to communicate and work with
each other to ensure that the needs of the recipients are met.
Questions about the content of this proposal may be directed to Maxcine
Tomlinson at (512) 438-3169 in DHS's Long Term Care Policy Section. Written
comments on the proposal may be submitted to Supervisor, Rules and Editing
Unit-212, Texas Department of Human Services E-205, P.O. Box 149030, Austin,
Texas 78714-9030, within 30 days of publication in the
Texas Register
.
Under §2007.003(b) of the Texas Government Code, the department has
determined that Chapter 2007 of the Government Code does not apply to this
rule. Accordingly, the department is not required to complete a takings impact
assessment regarding this rule.
The new section is proposed 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 new section implements the Human Resources Code, §§22.001-22.030
and §§32.001-32.042.
§19.1926.Medicaid Hospice Services.
(a)
When a nursing facility (NF) contracts for hospice services
for residents, the nursing facility must:
(1)
have a written contract for the provision of arranged services.
Authorized representatives of the NF and hospice must sign the contract. The
contract must include the following:
(A)
the services to be provided;
(B)
a stipulation that hospice-related services performed by
NF staff may be provided only with the express authorization of the hospice;
(C)
how the contracted services are to be coordinated, supervised,
and evaluated by the hospice and the NF;
(D)
delineation of the roles of the hospice and the NF in the
admission process, recipient and family assessment, and the interdisciplinary
team case conferences;
(E)
a requirement for documentation of services furnished;
and
(F)
the qualifications of the personnel providing the services;
(2)
provide room and board services, which include the performance
of personal care services including: assistance in the activities of daily
living, administration of medication, socializing activities, maintaining
the cleanliness of a resident's room, and supervision and assisting in the
use of durable medical equipment and prescribed therapies.
(3)
immediately notify the hospice of any significant changes
in the hospice recipient's condition;
(4)
have joint procedures with the hospice provider for ordering
medications that ensure the proper payor is billed and for reconciling billing
between NF and hospice, including:
(A)
contacting the hospice prior to filling a new prescription;
and
(B)
ensuring that drugs unrelated to the terminal illness are
ordered through the Vendor Drug program; and
(5)
ensure that hospice documentation is a part of the current
clinical record. At a minimum, documentation will include the current and
past:
(A)
Texas Medicaid Hospice Recipient Election/Cancellation
form;
(B)
Texas Medicaid Hospice - Nursing Facility Assessment form;
(C)
Physician Certification of Terminal Illness form;
(D)
Medicare Election Statement, if dually eligible;
(E)
verification that the recipient does not have Medicare
Part A;
(F)
hospice interdisciplinary assessments;
(G)
hospice plan of care; and
(H)
current interdisciplinary notes, which include the following:
(i)
nurses notes and summaries;
(ii)
physician orders and progress notes; and
(iii)
medication and treatment sheets during the hospice certification
period.
(b)
The NF and hospice must ensure that the coordinated plan
of care reflects the participation of the hospice, the NF, the recipient,
and the recipient's legal representative to the extent possible. The plan
of care must include directives for managing pain and other uncomfortable
symptoms, and must be revised and updated as necessary to reflect the individual's
current status.
(c)
The recipient has the right to refuse any services from
the nursing facility and the hospice provider.
(d)
The hospice retains overall professional management responsibility
for directing the implementation of the plan of care related to the terminal
illness and related conditions, which includes:
(1)
designation of a hospice registered nurse to coordinate
the implementation of the plan of care;
(2)
provision of substantially all core services (physician,
nursing, medical social work, and counseling services) that must be routinely
provided directly by the hospice employees, and cannot be delegated to the
NF, as outlined under 42 Code of Federal Regulations §418.80;
(3)
provision of drugs and medical supplies as needed for palliation
and management of the terminal illness and related conditions; and
(4)
involvement of NF personnel in assisting with the administration
of prescribed therapies in the plan of care only to the extent that the hospice
would routinely use the services of a hospice patient's family or caregiver
in the home setting.
(e)
The hospice may arrange to have non-core hospice services
provided by the NF if the hospice assumes professional management responsibility
for the services and assures these services are performed in accordance with
the policies of the hospice and the recipient's plan of care.
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of
the Secretary of State, on July 21, 2000.
TRD-200005032
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: September 3, 2000
For further information, please call: (512) 438-3108
The Texas Department of Human Services (DHS) proposes the repeal of §30.101,
concerning program administration; §30.103, concerning program coverage;
and §30.105, concerning eligibility, and proposes new §30.2, concerning
program basis; §30.4, concerning definitions; §30.10, concerning
eligibility requirements; §30.12, concerning duration of hospice care
coverage-election periods; §30.14, concerning certification of terminal
illness; §30.16, concerning election of hospice care; §30.18, concerning
revoking the election of hospice care; §30.20, concerning change of the
designated hospice; §30.30, concerning requirements for participation
as a medicaid hospice provider; §30.32, concerning disclosure requirements
for a Medicaid hospice provider; §30.34, concerning change of ownership; §30.36,
concerning effective dates of provider contracts; §30.40, concerning
condition of participation-physical therapy, occupational therapy, and speech-language
pathology; §30.50, concerning requirements for reimbursement; §30.52,
concerning waiver requirements for nursing services or occupational, physical,
and speech therapies; §30.54, concerning special coverage requirements; §30.60,
concerning Medicaid hospice payments and limitations; §30.62, concerning
medicaid hospice claims processing requirements; §30.70, concerning procedural
requirements; §30.80, concerning enforcement generally; §30.82,
concerning sanctions; §30.84, concerning referral to the attorney general; §30.90,
concerning utilization review and control activities performed by Texas Health
and Human Services Commission (HHSC) utilization review (UR) department; §30.92,
concerning Texas index for level of effort (TILE) assessments; and §30.100,
concerning additional requirements, in its Medicaid Hospice Program chapter.
DHS is simultaneously filing a related proposal in Chapter 19 in this issue
of the
Texas Register
.
The purpose of the proposal for both the repeals and new sections is to
provide current rules that address Medicaid contracting in the Medicaid Hospice
Program. The rules delineate hospice providers' contractual responsibilities
when they contract with the department as a Medicaid hospice provider. The
rules specifically address eligibility, election periods, certification of
terminal illness, election of hospice care, selection of a hospice, Medicaid
contracts and applications, reimbursement, payments and limitations, continuous
home care, levels of care, claims processing, inspections, enforcement, utilization
review, documentation in a nursing facility, and solicitation.
Eric M. Bost, commissioner, has determined that for the first five-year
period the repeals and new sections are in effect there will be no fiscal
implications for state or local government as a result of enforcing or administering
the repeals and new sections.
Mr. Bost also has determined that for each year of the first five years
the repeals and new sections are in effect the public benefit anticipated
as a result of enforcing the repeals and new sections will be ensured accountability
and consistency of service delivery among the hospice providers. There will
be an effect on large, micro, and small businesses. Most of these rules are
not additional requirements. Providers are required to follow federal guidelines.
The department is putting the federal guidelines into state rules with additional
requirements. New requirements that may have a fiscal impact on the businesses
are as follows: (1) Providers will be required to conduct a client-specific
comprehensive assessment for subsequent physician certifications after the
first year on hospice. Additional staff time will be needed to meet this requirement.
(2) Continuous Home Care may be provided for up to five days. Additional days
may be provided upon approval by the department. Providers may appeal denial
to extend continuous home care days. Currently, providers can provide an unlimited
amount of continuous home care, assuming that the department will pay for
those days. The department may decline to pay for these days. This rule will
assure them that at least five days may be paid for and the department will
advise them if additional days will be covered. Additional staff time and
money will be spent on copying and overnight expressing the documentation
to the department when a waiver request or a request for reconsideration is
sought. (3) Providers must chart procedures in the nursing facility clinical
record and notify staff of changes in the recipients' conditions. The hospice
must have joint procedures with the nursing facility for ordering medications
that ensure the proper biller is paid and for reconciling billing between
the hospice and nursing facility. The economic impact in this area will be
minimal for providers.
Questions about the content of this proposal may be directed to Maxcine
Tomlinson at (512) 438-3169 in DHS's Long Term Care Policy Section. Written
comments on the proposal may be submitted to Supervisor, Rules and Editing
Unit-212, Texas Department of Human Services E-205, P.O. Box 149030, Austin,
Texas 78714-9030, within 30 days of publication in the
Texas Register
.
Under §2007.003(b) of the Texas Government Code, the department has
determined that Chapter 2007 of the Government Code does not apply to these
rules. Accordingly, the department is not required to complete a takings impact
assessment regarding these rules.
Subchapter A. INTRODUCTION
40 TAC §30.2, §30.4
The new sections are proposed 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 new sections implement the Human Resources Code, §§22.001-22.030
and §§32.001-32.042.
§30.2.Program Basis.
The Texas Department of Human Services (DHS) manages the Texas Medicaid
Program on behalf of the Texas Health and Human Services Commission. Hospice
providers participating in the Medicaid hospice program must comply with all
federal and state regulations that govern the Medicaid hospice program, including
the federal regulations in 42 Code of Federal Regulations Part 418.
§30.4.Definitions.
The following words and terms, when used in this chapter, shall have
the following meanings, unless the context clearly indicates otherwise. Individual
subchapters may have definitions which are specific to the subchapter.
(1)
Adverse action - As defined under §79.1601 of this
title (relating to Definitions).
(2)
Attending physician - A physician who:
(A)
is a doctor of medicine or osteopathy; and
(B)
is identified by the individual, at the time the individual
elects to receive hospice care, as having the most significant role in the
determination and delivery of the individual's medical care.
(3)
Bereavement counseling - Counseling services provided to
the individual's family after the individual's death.
(4)
Cap period - The 12-month period ending October 31 used
in the application of the cap on overall hospice reimbursement specified in §30.60
of this title (relating to Medicaid Hospice Payments and Limitations).
(5)
Curative care - Care designed to restore a person to health.
(6)
Employee - An employee (defined by the Social Security
Act, Section 210(j)) of the hospice or, if the hospice is a subdivision of
an agency or organization, an employee of the agency or organization who is
appropriately trained and assigned to the hospice unit. "Employee" also refers
to a volunteer under the jurisdiction of the hospice.
(7)
Hospice - A public agency or private organization or subdivision
of either of these that is primarily engaged in providing care to terminally
ill individuals.
(8)
Palliative care - Care designed to relieve or reduce intensity
of uncomfortable symptoms but not to produce a cure.
(9)
Physician - As defined in 42 Code of Federal Regulations §410.20.
(10)
Representative - An individual who has been authorized
under state law to terminate medical care or to elect or revoke the election
of hospice care on behalf of a terminally ill individual who is mentally or
physically incapacitated.
(11)
Social worker - A person who has at least a bachelor's
degree from a school accredited or approved by the Council on Social Work
Education.
(12)
Terminally ill - The individual has a medical prognosis
that his or her life expectancy is six months or less if the illness runs
its normal course.
(13)
Vendor hold - Temporarily withholding a provider agency's
payment.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of
the Secretary of State, on July 21, 2000.
TRD-200005034
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: September 3, 2000
For further information, please call: (512) 438-3108
40 TAC §§30.10, 30.12, 30.14, 30.16, 30.18, 30.20
The new sections are proposed 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 new sections implement the Human Resources Code, §§22.001-22.030
and §§32.001-32.042.
§30.10.Eligibility Requirements.
(a)
In order to be eligible to elect hospice care under Medicaid,
an individual must:
(1)
be certified as Medicaid eligible by the Texas Department
of Human Services (DHS) or the Social Security Administration (SSA);
(2)
be certified as being terminally ill in accordance with §30.14
of this title (relating to Certification of Terminal Illness); and
(3)
have an identified need documented on the comprehensive
assessment for one or more of the following:
(A)
medical care;
(B)
skilled nursing care related to the management of pain
and symptom control;
(C)
medical social services; or
(D)
emotional or spiritual care.
(b)
If dually eligible, the recipient must elect the hospice
benefit under both the Medicare and Medicaid programs.
§30.12.Duration of Hospice Care Coverage: Election Periods.
(a)
Subject to the conditions set forth in this subchapter,
an individual may elect to receive hospice care for a six-month period.
(b)
The periods of care are six-month increments of time and
may be elected consecutively or separately at different times.
§30.14.Certification of Terminal Illness.
(a)
Timing of certification.
(1)
Except as provided in paragraph (2) of this subsection,
the hospice must obtain the written certification of terminal illness from
a physician no later than two calendar days after the period begins.
(2)
For the initial period, if the hospice cannot obtain the
written certification within two calendar days, it must obtain oral certifications
within two calendar days and written certification no later than eight calendar
days after the period begins.
(3)
Upon receipt of the certification, hospice staff must:
(A)
make an appropriate entry in the patient's medical record
as soon as they receive an oral certification; and
(B)
file written certifications in the medical record.
(b)
Content of certification. The certification must specify
that the individual's prognosis is for a life expectancy of six months or
less if the terminal illness runs its normal course.
(c)
Sources of certification.
(1)
For the initial period, the hospice must obtain written
certification statements, and oral certification statements if required under
subsection (a)(2) of this section, from:
(A)
the medical director of the hospice or the physician member
of the hospice interdisciplinary group; and
(B)
the individual's attending physician if the individual
has an attending physician.
(2)
For subsequent periods after the first year, the hospice
must conduct a client-specific comprehensive assessment that:
(A)
identifies the client's need for hospice services in the
areas of medical, nursing, social, emotional, and spiritual care. Hospice
services include, but are not limited to, the palliation and management of
the terminal illness and conditions related to the terminal illness; and
(B)
contains a narrative from the physician which clearly identifies
the reasons the patient is considered terminally ill; with a prognosis of
less than six months to live.
(3)
The assessment must be done no earlier than 30 workdays
prior to the recertification date. The hospice provider must retain copies
of all physician's certification statements, a current Hospice - Nursing Facility
Assessment form, if applicable, and the client-specific comprehensive assessment
in both the hospice's records for the recipient and the recipient's nursing
facility clinical record, if applicable.
§30.16.Election of Hospice Care.
(a)
Filing an election statement. An individual who meets the
eligibility requirement of §30.10 of this title (relating to Eligibility
Requirements) may file an election statement with a particular hospice. If
the individual is physically or mentally incapacitated, the individual's representative
may file the election statement.
(b)
Content of election statement. The election statement must
include the following:
(1)
identification of the particular hospice that will provide
care to the individual;
(2)
the individual's or representative's acknowledgment that
he has been given a full explanation of the palliative rather than curative
nature of hospice care as it relates to the individual's terminal illness;
(3)
acknowledgment that certain Medicaid services, as set forth
in subsection (d) of this section, are waived by the election;
(4)
the effective date of the election, which may be the first
day of hospice care or a later date, but must be no earlier than the date
of the election statement; and
(5)
the signature of the individual or representative.
(c)
Duration of election. An election to receive hospice care
will continue through the initial election period and through the subsequent
election periods without a break in care as long as the individual:
(1)
remains in the care of a hospice; and
(2)
does not revoke the election under the provisions of §30.18
of this title (relating to Revoking the Election of Hospice Care).
(d)
Waiver of other benefits. For the duration of an election
of hospice care, an individual waives all rights to Medicaid payments for
the following services:
(1)
hospice care provided by a hospice other than the hospice
designated by the individual (unless provided under arrangements made by the
designated hospice); and
(2)
any Medicaid services related to the treatment of the terminal
condition for which hospice care was elected, or a related condition for which
the hospice care was elected, or that are equivalent to hospice care except
for services:
(A)
provided by the designated hospice;
(B)
provided by another hospice under arrangements made by
the designated hospice; and
(C)
provided by the individual's attending physician if that
physician is not an employee of the designated hospice or receiving compensation
from the hospice for those services.
(e)
Re-election of hospice benefits. If an election has been
revoked in accordance with §30.18 of this title (relating to Revoking
the Election of Hospice Care), the individual (or the individual's representative,
if the individual is mentally or physically incapacitated) may at any time
file an election in accordance with this section.
(f)
Record Maintenance. The hospice provider must retain copies
of all election forms in the hospice records for the recipient and the recipient's
nursing facility clinical record, if applicable.
§30.18.Revoking the Election of Hospice Care.
(a)
An individual or representative may revoke the individual's
election of hospice care at any time during an election period. If the recipient
is dually eligible, the individual must revoke the Medicaid and Medicare hospice
benefit at the same time.
(b)
To revoke the election of hospice care, the individual
or representative must file a statement with the hospice that includes the
following information:
(1)
a signed statement that the individual or representative
revokes the individual's election for Medicaid coverage of hospice care for
the remainder of that election period; and
(2)
the date that the revocation is to be effective. An individual
or representative may not designate an effective date earlier than the date
that the revocation is made.
(c)
An individual, upon revocation of the election of Medicaid
coverage of hospice care for a particular election period:
(1)
is no longer covered under Medicaid for hospice care;
(2)
resumes Medicaid coverage of the benefits waived under §30.16(d)(2)
of this title (relating to Election of Hospice Care); and
(3)
may at any time elect to receive hospice coverage as long
as he meets eligibility requirements.
§30.20.Change of the Designated Hospice.
(a)
An individual or representative may change, once in each
election period, the designation of the particular hospice from which hospice
care will be received.
(b)
The change of the designated hospice is not a revocation
of the election for the period in which it is made.
(c)
To change the designation of hospice programs, the individual
or representative must file, with both the hospice from which care has been
received and with the newly designated hospice, a statement that includes
the following information:
(1)
the name of the hospice from which the individual has received
care and the name of the hospice from which the individual plans to receive
care; and
(2)
the date the change is to be effective.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed
with the Office of the Secretary of State, on July 21, 2000.
TRD-200005035
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: September 3, 2000
For further information, please call: (512) 438-3108
40 TAC §§30.30, 30.32, 30.34, 30.36
The new sections are proposed 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 new sections implement the Human Resources Code, §§22.001-22.030
and §§32.001-32.042.
§30.30.Requirements for Participation as a Medicaid Hospice Provider.
(a)
The provider must meet the following conditions to be approved
by the Texas Department of Human Services (DHS) for participation in the Medicaid
Hospice Program and receive state and federal reimbursement for services to
Medicaid recipients:
(1)
the provider is currently licensed in Texas as a hospice
provider;
(2)
the provider has filed a complete application with the
Facility Enrollment Section of DHS for participation as a Medicaid hospice
provider in the Medicaid Hospice program; and
(3)
the provider has a valid certification from DHS that the
provider meets the conditions of participation for the Medicaid hospice program.
(b)
Only a provider with a fully-executed current contract
with DHS may receive state and federal reimbursement for services to Medicaid
recipients.
(c)
Each hospice provider must comply with the state requirements
for participation and the provider's contract on a continuing basis.
(d)
The contracting hospice provider agrees to:
(1)
comply with the Civil Rights Act of 1964 (Public Law 88-352),
Title VI; the Rehabilitation Act of 1973 (Public Law 93-112), §504; the
Age Discrimination Act of 1975; the Americans with Disabilities Act of 1990
(Public Law 101-336); the Safe Medical Devices Act of 1990; and all amendments
to each and all requirements imposed by the regulations issued pursuant to
these acts. In addition, the contractor agrees to comply with Chapter 73 of
this title (relating to Civil Rights). These provide in part that no persons
shall, on the grounds of race, color, national origin, sex, age, disability,
political beliefs or religion be excluded from participation in, or denied
any aid, care, service or other benefits provided by federal and/or state
funding, or otherwise be subjected to discrimination.
(2)
comply with Texas Health and Safety Code, Chapter 85, Subchapter
E (relating to Workplace and Confidentiality Guidelines Regarding AIDS and
HIV).
(3)
comply with 42 Code of Federal Regulations Part 455.
(e)
A provider must not have restrictive policies or practices,
including:
(1)
requiring the recipient to execute a will, with the provider
named as legatee or devisee;
(2)
requiring the recipient to assign his life insurance to
the provider;
(3)
requiring the recipient to transfer property to the provider;
(4)
requiring the recipient to pay a lump sum or make any other
payment or concession to the provider beyond the recognized Medicaid rate;
(5)
controlling or restricting the recipient, the recipient's
guardian, or responsible party in the use of the recipient's personal needs
allowance while in a nursing facility;
(6)
restricting the recipient from transferring or withdrawing
from the hospice program at will except as provided by state law;
(7)
denying appropriate care to a recipient on the basis of
that recipient's race, religion, color, national origin, sex, age, disability,
marital status, or source of payment; and
(8)
preventing or requiring the execution of written or unwritten
directives to reject life-sustaining procedures by adult recipients.
(f)
DHS reserves the right to reject the provider's participation
or to cancel an existing contract if the provider charges the Medicaid recipient
or any member of his family, except as allowed within DHS policies and regulations.
(g)
To appeal the termination of a Medicaid hospice contract,
a provider must submit a written request for a contract appeals hearing that
is received by DHS within 15 days of the provider's receipt of the letter
notifying the provider of the proposed action. The provider must send the
request for a hearing to the Texas Department of Human Services, P.O. Box
149030, Mail Code W- 613, Austin, Texas 78714-9030. Hearings will be held
in Austin, Texas.
(h)
DHS's interpretations of the requirements for participation
or the contract may not be appealed to DHS's hearings department unless the
interpretation has caused an adverse action for the provider.
(i)
Providers must allow representatives of DHS, the Medicaid
Fraud Control Unit, and the Texas Department of Health and Human Services
to enter the premises at any time to make inspections or privately interview
the recipients of Medicaid assistance.
§30.32.Disclosure Requirements for a Medicaid Hospice Provider.
(a)
Medicaid providers must disclose in accordance with 42
CFR Part 455, Subpart B.
(b)
Failure to comply with 42 CFR Part 455. Subpart B, may
result in suspension, termination, or other contract action including but
not limited to holding Medicaid payments. To appeal a sanction, a Medicaid
hospice provider must submit a written request for an appeal hearing to the
Texas Department of Human Services (DHS), P.O. Box 149030, Mail Code W-613,
Austin, Texas, 78714-9030. Hearings will be held in Austin, Texas.
§30.34.Change of Ownership.
(a)
Definitions. The following words and terms, when used in
this section, have the following meanings, unless the context clearly indicates
otherwise.
(1)
Prior owner - The legal entity licensed to operate the
hospice before the change ownership.
(2)
New owner - The legal entity licensed to operate the hospice
after the change of ownership.
(3)
Agreed change date - The date of transfer of ownership
agreed to between the prior owner and the new owner.
(b)
Notification.
(1)
The hospice must notify the Texas Department of Human Services
(DHS) in writing prior to the agreed change date. DHS will recognize the ownership
change effective on the agreed change date if DHS receives the written notice
of the change postmarked at least 30 days before the agreed change date.
(2)
If the written notice is received after the agreed change
date, DHS will recognize the change effective on the date DHS receives written
notice of the change.
(c)
Payment of services during transfer of ownership.
(1)
In no case will DHS recognize a change date that would
cause DHS to make double payments for the same services.
(2)
If written notice of a change of ownership is not received
by DHS postmarked at least 30 days before the agreed change date, DHS is not
responsible for payments made to the prior owner or new owner that do not
reflect the agreed change date. DHS will not request repayment of such payments
on behalf of either entity nor will DHS issue a duplicate payment. It is the
responsibility of the prior owner and the new owner to make arrangements between
themselves for such contingencies.
(3)
After receipt of the notice of proposed or actual change
of ownership, DHS may place Medicaid payments to the prior owner and the new
owner on hold until completion of a billing and claims reconciliation, or
up to 12 months, whichever is sooner. Any money owed to DHS will be recouped
from the funds placed on hold. Medicaid payments may be released prior to
the reconciliation if DHS receives information sufficient to verify the ownership
change.
(d)
Payment agreements.
(1)
Medicaid hospice payments are not transferable or assignable
at law or in equity. DHS will not allow non-split agreements in the case of
ownership changes. Non-split agreements are arrangements where DHS does not
interrupt payments to old and new owners but continues reimbursements as though
no ownership change has occurred. A split in pay agreement ensures payments
to the prior owner stop on a certain date and payments for services thereafter
go to the new owner.
(2)
The new owner and the prior owner of a hospice may reach
any agreement they wish, but DHS will not participate in a non-split procedure
which would allow the new owner to receive the prior owner's accrued Medicaid
hospice payments.
(e)
Filing deadline. If the application is postmarked by the
filing deadline, the application will be considered to be timely filed if
received in the Texas Department of Human Services, Facility Enrollment Section,
Long Term Care Regulatory, Post Office Box 149030, Mail Code E-342, Austin,
Texas 78714-9030, within 15 days of postmark.
§30.36.Effective Dates of Provider Contracts.
The effective date of the provider contract for an initial certification
is the first day of the month following the receipt of the HCFA certification
letter, a copy of the license, and a completed application packet.
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed
with the Office of the Secretary of State, on July 21, 2000.
TRD-200005036
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: September 3, 2000
For further information, please call: (512) 438-3108
40 TAC §30.40
The new section is proposed 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 new section implements the Human Resources Code, §§22.001-22.030
and §§32.001-32.042.
§30.40.Condition of Participation--Physical Therapy, Occupational Therapy, and Speech-language Pathology.
(a)
Physical therapy services, occupational therapy services,
and speech-language pathology services must be available and, when provided,
offered in a manner consistent with accepted standards of practice.
(b)
Lab services must be provided under the following conditions:
(1)
If the hospice engages in laboratory testing outside of
the context of assisting an individual in self-administering a test with an
appliance that has been cleared for that purpose by the FDA, such testing
must be in compliance with all applicable requirements of 42 Code of Federal
Regulations (CFR) Part 493.
(2)
If the hospice chooses to refer specimens for laboratory
testing to another laboratory, the referral laboratory must be certified in
the appropriate specialties and sub-specialties of services in accordance
with the applicable requirements of 42 CFR Part 493.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed
with the Office of the Secretary of State, on July 21, 2000.
TRD-200005037
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: September 3, 2000
For further information, please call: (512) 438-3108
40 TAC §§30.50, 30.52, 30.54
The new sections are proposed 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 new sections implement the Human Resources Code, §§22.001-22.030
and §§32.001-32.042.
§30.50.Requirements for Reimbursement.
To be reimbursed through Medicaid, hospice services must meet the following
requirements:
(1)
services must be reasonable and necessary for the palliation
or management of the terminal illness, as well as conditions related to the
terminal illness;
(2)
the individual must elect hospice care in accordance with §30.16
of this title (relating to Election of Hospice Care);
(3)
a plan of care must be established before services are
provided. The services must be consistent with the plan of care; and
(4)
a certification that the individual is terminally ill must
be completed as set forth in §30.14 of this title (relating to Certification
of Terminal Illness).
§30.52.Waiver Requirements for Nursing Services or Occupational, Physical, and Speech Therapies.
(a)
The Health Care Financing Administration (HCFA) may approve
a waiver for nursing services or occupational, physical, and speech therapies
provided by a hospice which is located in a non-urbanized area. The location
of a hospice that operates in several areas is considered to be the location
of its central office. The hospice must provide evidence that it was operational
on or before January 1, 1983, and that it made a good faith effort to hire
a sufficient number of nurses or therapists to provide services directly.
HCFA bases its decision on whether to approve a waiver application on the
following:
(1)
the current Bureau of the Census designations for determining
non-urbanized areas;
(2)
evidence that a hospice was operational on or before January
1, 1983, including:
(A)
proof that the organization was established to provide
hospice services on or before January 1, 1983;
(B)
evidence that hospice-type services were furnished to patients
on or before January 1, 1983; and
(C)
evidence that the hospice care was a discrete activity
rather than an aspect of another type of provider's patient care program on
or before January 1, 1983; and
(3)
evidence that a hospice made a good faith effort to hire
nurses or therapists, including:
(A)
copies of advertisements in local newspapers that demonstrate
recruitment efforts;
(B)
job descriptions for nurse employees or therapists;
(C)
evidence that salary and benefits are competitive for the
area; and
(D)
evidence of any other recruiting activities, such as recruiting
efforts at health fairs and contacts with nurses or therapists at other providers
in the area.
(b)
A waiver request for occupational, physical, and speech
therapies, must be submitted in writing to Home and Community Support Services,
Texas Department of Human Services (DHS), P.O. Box 149030, Mail Code E-217,
Austin, Texas 78714-9030.
(c)
The department will recommend in writing, approval or disapproval
of the requested waiver for occupational, physical, and speech therapies,
to the Health Care Financing Administration in Dallas, Texas within 30 days
of receiving the request.
(d)
HCFA receives requests for waivers of nursing services
without the involvement of the department.
(e)
Any waiver request is deemed to be granted unless it is
denied within 60 days after it is received.
(f)
Waivers will remain effective for one year at a time.
(g)
HCFA may approve a maximum of two one-year extensions for
each initial waiver. If a hospice wishes to receive a one-year extension,
the hospice must submit a certification to HCFA, prior to the expiration of
the waiver period, that the employment market for nurses and therapists has
not changed significantly since the time the initial waiver was granted.
§30.54.Special Coverage Requirements.
(a)
Continuous home care. Continuous care is to be provided
only during periods of crisis to maintain the recipient at the recipient's
place of residence. A period of crisis is a period in which a recipient requires
continuous care which is primarily skilled nursing care to achieve palliation
or management of acute medical symptoms.
(1)
A minimum of eight hours of continuous home care must be
provided during a 24-hour day which begins and ends at midnight. The care
need not be continuous, for example, four hours could be provided in the morning
and another four hours in the evening of that day.
(2)
Skilled nursing care must be provided for more than half
of the continuous home care period and must be provided by either a registered
nurse or licensed vocational nurse.
(3)
Homemaker, home health aide services, medical social work,
or chaplain services may be provided to supplement the nursing care. The provider
must document why social work or chaplain services were needed and what was
accomplished during continuous home care. While on call, staff may be used
to provide continuous home care; staff, however, must be on site, providing
care to the recipient in their place of residence to be considered for inclusion
in continuous home care hours.
(4)
The services may be provided for up to five consecutive
days.
(5)
The provider must have a physician's order and a documented
medical need for skilled nursing care in the recipient's record and in the
plan of care. The plan of care must be established by the attending physician,
hospice medical director or designee, and the interdisciplinary team, and
coordinated by the hospice registered nurse. The plan of care must include
the needs of the recipient; identification of the services, including management
of discomfort and symptom relief; and the scope and frequency of the services
needed to meet the needs of both the recipient and family.
(6)
Prior to providing continuous home care, the provider must
advise and discuss with the family or responsible party that temporary alternate
placement may be necessary at the end of the five consecutive days. The provider
must document the discussion with the family or responsible party in the recipient's
records.
(7)
If the provider believes that the crisis period will extend
beyond the five consecutive days, the interdisciplinary team must discuss
the temporary placement alternatives available to meet the needs of the recipient
during the crisis period, such as a hospital or nursing facility. This discussion
must be documented. If, after this discussion, the provider believes that
an extension of continuous home care is necessary instead of alternative placement,
the provider must submit a written request for an extension of continuous
care to DHS.
(A)
The written request must be sent to Texas Department of
Human Services, Long-Term Care Policy, P.O. Box 149030, Mail Code Y-519, Austin,
Texas, 78714-9030.
(B)
The written request must include:
(i)
documentation of all continuous home care provided during
the previous five days;
(ii)
physician's orders;
(iii)
documentation of daily physician care plan oversight;
(iv)
documentation that skilled nursing care was provided as
more than half of the care given in a 24-hour period for each of the five
days of continuous care;
(v)
the number of days of continuous home care requested for
the extension; and
(vi)
documentation of the interdisciplinary team's discussion
regarding alternate placement, including why continuous home care must be
extended and why temporary alternate placement is not presently warranted.
(8)
The Texas Department of Human Services (DHS) may extend
continuous home care if it deems it medically necessary. Providers will be
notified in writing of the department's decision within eight work hours after
the department's receipt of the written request and documentation.
(9)
If DHS denies the request for an extension of continuous
home care, the provider will be paid at the routine home care rate or inpatient
care rate, if applicable, for subsequent days of care.
(10)
Request for reconsideration. If the provider does not
agree with the department's denial of the request for an extension of continuous
home care, the provider may request a reconsideration of the decision at the
state office level. The written request for reconsideration and all supporting
documentation must be submitted to DHS at the address in paragraph (7)(A)
of this subsection no later than the tenth calendar day after the provider's
receipt of the denial of the request for an extension. DHS's reconsideration
will be limited to a review of the documentation submitted. DHS will complete
the reconsideration no later than the tenth calendar day after receipt of
the request for reconsideration.
(b)
Respite care.
(1)
Respite care is short-term inpatient care provided to the
individual at home only when necessary to relieve the family members or other
persons caring for the individual at home.
(2)
Respite care may not be reimbursed for more than five consecutive
days.
(3)
Respite care can be provided by:
(A)
a hospice that meets the condition of participation for
providing inpatient care directly; or
(B)
a hospital or nursing facility that also meets the Medicare
standards regarding 24-hour nursing service and patient areas.
(4)
Respite care may be provided only on an occasional basis
and may not be reimbursed for more than five consecutive days at a time.
(5)
Respite care may not be provided when the hospice patient
is a nursing home resident.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed
with the Office of the Secretary of State, on July 21, 2000.
TRD-200005038
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: September 3, 2000
For further information, please call: (512) 438-3108
40 TAC §30.60, §30.62
The new sections are proposed 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 new sections implement the Human Resources Code, §§22.001-22.030
and §§32.001-32.042.
§30.60.Medicaid Hospice Payments and Limitations.
(a)
Medicaid hospice per diem rates. For each day that an individual
is under the care of a hospice, the hospice will be reimbursed an amount applicable
to the type and intensity of the services furnished to the individual for
that day. For continuous home care, the amount of payment is determined based
on the number of hours of continuous care furnished to the beneficiary on
that day.
(1)
Routine Home Care. The hospice will be paid the routine
home care rate for each day the recipient is at home, under the care of the
hospice, and not receiving continuous home care. This rate is paid without
regard to the volume or intensity of routine home care services provided on
any given day.
(2)
Continuous Home Care. The hospice will be paid the continuous
home care rate when continuous home care is provided. The continuous home
care rate is divided by 24 hours in order to arrive at an hourly rate. A minimum
of 8 hours must be provided. For every hour or part of an hour of continuous
care furnished, the hourly rate will be reimbursed to the hospice up to 24
hours a day. A maximum of five consecutive days are allowed for reimbursement.
Additional days may be allowed with approval from the Texas Department of
Human Services (DHS).
(3)
Inpatient Respite Care. The hospice will be paid at the
inpatient respite care rate for each day on which the beneficiary is in an
approved inpatient facility and is receiving respite care. Payment for respite
care may be made for a maximum of 5 days at a time including the date of admission
but not counting the date of discharge. Payment for the sixth and any subsequent
days is to be made at the routine home care rate.
(A)
A hospice recipient who receives hospice respite care in
a nursing facility and returns home after the respite does not have to be
in a Medicaid bed in the nursing facility.
(B)
Respite care days are subject to the limitation on total
hospice inpatient care days, as outlined in subsection (h) of this section.
(C)
If the hospice recipient dies as an inpatient, DHS pays
the inpatient rate for the day of death.
(4)
General Inpatient Care. Payment is made at the general
inpatient rate when general inpatient care is provided.
(A)
The Inpatient Care rate is paid for the date of admission
and all subsequent inpatient days except day of discharge.
(B)
For the day of discharge, DHS pays the routine home care
rate.
(C)
If the hospice recipient dies as an inpatient, DHS pays
the inpatient rate for the day of death.
(D)
Inpatient care days are subject to the limitation on total
hospice inpatient care days, as outlined in subsection (h) of this section.
(b)
Medicaid payments for physician services.
(1)
The Medicaid Hospice Program makes payments to the Medicaid
hospice provider for hospice physician services according to the customary
and reasonable Texas Medicaid physician charges.
(2)
The Medicaid Hospice Program does not pay when hospice
physician services are provided by physicians who are not on staff with the
Medicaid hospice provider or for independent contractors, who are under contract
with the hospice.
(3)
Payments for non-hospice physician services to Medicaid
hospice recipients are made directly to physicians by Medicaid through the
National Heritage Insurance Company (NHIC).
(4)
The Medicaid hospice provider must include physician services
in the hospice plan of care and clinical records and must inform physicians
on how to bill for services to hospice recipients.
(c)
Medicaid hospice-nursing facility per diem rates. The Medicaid
Hospice Program pays the Medicaid hospice provider a hospice- nursing facility
rate that is 95% of the Medicaid nursing facility rate for each hospice recipient
in a nursing facility. When the hospice-nursing facility rate is paid to the
hospice provider, Medicaid vendor payment to the nursing facility is not paid.
Room and board services include performance of personal care services, including
assistance in the activities of daily living, in socializing activities, administration
of medication, maintaining the cleanliness of a resident's room, and supervision
and assisting in the use of durable medical equipment and prescribed therapies.
(d)
Medicaid time limitations for DHS hospice payment.
(1)
To receive payment of the hospice-nursing facility rate,
the Medicaid hospice provider must complete and submit an initial Hospice-Nursing
Facility Assessment to the Provider Claims Payment Unit within 20 days of
either or both hospice election or entrance to the nursing facility.
(2)
Nursing Facility Assessment forms not received by the Provider
Claims Payment Unit within 20 calendar days will be reimbursed at a default
rate until the form is received.
(e)
Medicaid payments on Medicare coinsurance for drugs and
biologicals. For Medicare-Medicaid recipients only, the Medicaid Hospice Program
pays the Medicaid hospice provider a 5.0% coinsurance on prescription drugs
and biologicals, not to exceed $5 per prescription.
(f)
Medicaid payments for Medicare respite coinsurance. For
Medicare-Medicaid recipients only, the Medicaid Hospice Program pays the hospice
provider a 5.0% coinsurance for each day of respite care for up to five consecutive
days of a hospice coinsurance period.
(g)
Third party resources. Medicaid pays only after all third-party
resources have been used.
(h)
Medicaid payment limitations for inpatient care. During
the 12- month period beginning November 1 of each calendar year and ending
October 31 of the following calendar year (the cap year), the aggregate number
of inpatient hospice care days must not exceed 20% of the aggregate total
number of all hospice care days for the same cap year. This limitation is
applied once each year, at the end of the cap year for each Medicaid hospice
provider. If it is determined that the inpatient rate should not be paid,
any days for which the hospice receives payment at a home care rate are not
counted as inpatient days. The limitation is calculated as follows:
(1)
The maximum allowable number of inpatient days is calculated
by multiplying the total number of days of Medicaid hospice care by 0.2.
(2)
If the total number of days of inpatient care furnished
to Medicaid hospice patients is less than or equal to the maximum, no adjustment
is necessary.
(3)
If the total number of days of inpatient care exceeds the
maximum allowable number, the limitation is determined by:
(A)
calculating a ratio of the maximum allowable days to the
number of actual days of inpatient care and multiplying this ratio by the
total reimbursement for inpatient care (general inpatient and inpatient respite
reimbursement) that was made;
(B)
multiplying excess inpatient care days by the routine home
care rate;
(C)
adding together the amounts calculated in subparagraphs
(A) and (B) of this paragraph; and
(D)
comparing the amount in subparagraph (C) of this paragraph
with interim payments made to the hospice inpatient care during the "cap period."
(4)
If the inpatient care maximum has been exceeded, DHS recoups
excess payments from subsequent Medicaid hospice provider claims.
§30.62.Medicaid Hospice Claims Processing Requirements.
(a)
Requirement for payment. To receive Medicaid hospice payments,
an entity must be licensed as a hospice, Medicare certified by the Health
Care Financing Administration (HCFA) as a hospice, and Medicaid certified
by the Texas Department of Human Services (DHS).
(b)
Submittal and forms completion requirements. To receive
Medicaid Hospice payments, the provider must submit the following documents
to Provider Claims Payment:
(1)
Texas Medicaid Hospice Program Recipient Election/Cancellation
Notice form;
(2)
Texas Medicaid Hospice Program Physician Certification
of Terminal Illness form; and
(3)
Texas Medicaid Hospice Program Hospice-Nursing Facility
Assessment form, if applicable.
(c)
Denials. DHS will deny the following provider claims to
the Medicaid Hospice Program and/or to other DHS programs:
(1)
claims for hospice service days prior to a valid Medicaid
Hospice Election Notice and a Physician Certification of Terminal Illness(es);
(2)
claims which have been returned to the provider or recipients
who have revoked the election of the Medicaid Hospice Program;
(3)
claims for recipients who have been denied Medicaid eligibility;
(4)
claims for Medicare-Medicaid recipients who are covered
by the Medicare Hospice benefit; and
(5)
claims by hospice providers whose Medicaid hospice contract
has been cancelled.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed
with the Office of the Secretary of State, on July 21, 2000.
TRD-200005039
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: September 3, 2000
For further information, please call: (512) 438-3108
40 TAC §30.70
The new section is proposed 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 new section implements the Human Resources Code, §§22.001-22.030
and §§32.001-32.042.
§30.70.Procedural Requirements.
The Texas Department of Human Services (DHS) will conduct contract
management visits annually. The hospice provider must submit all information
requested to DHS, as outlined in their contract.
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed
with the Office of the Secretary of State, on July 21, 2000.
TRD-200005040
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: September 3, 2000
For further information, please call: (512) 438-3108
40 TAC §§30.80, 30.82, 30.84
The new sections are proposed 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 new sections implement the Human Resources Code, §§22.001-22.030
and §§32.001-32.042.
§30.80.Enforcement Generally.
The Texas Department of Human Services (DHS), as the operating agency
for the Medicaid hospice program, may impose certain sanctions on the Medicaid
hospice provider.
§30.82.Sanctions.
(a)
The Texas Department of Human Services (DHS) may take sanctions
against a hospice for failure to comply with the terms of the contract or
program rules or both.
(b)
Sanctions may include one or more of the following at the
discretion of DHS:
(1)
Vendor hold.
(A)
DHS may place a vendor hold upon one or all of a hospice
provider's DHS contracts for reasons including, but not limited to:
(i)
the hospice's failure to follow an agreed upon audit resolution
payment plan;
(ii)
the hospice's failure to provide service according to
contract or program requirements;
(iii)
the hospice's failure to comply with their corrective
action plan;
(iv)
DHS's recoupment of overpayments to a hospice and restitution
of audit exceptions assessed against a hospice; or
(v)
DHS's determination that client health and safety is jeopardized
by the hospice's failure to comply with the terms of the contract or program
requirements or both.
(B)
DHS may accept an irrevocable letter of credit, in a format
and an amount approved by DHS, to allow the release of all or a portion of
vendor payments on hold. Vendor holds are released after resolution of all
the reasons cited for the vendor hold.
(C)
Held funds may be offset against any overpayments or audit
exceptions attributable to the hospice.
(2)
Contract termination. DHS may initiate contract termination
for one or more reasons including, but not limited to:
(A)
the hospice's failure to comply with the terms of the contract,
rules, or program requirements;
(B)
the hospice's failure to maintain a current required license;
(C)
DHS's determination that client health and safety is jeopardized
by the hospice's failure to comply with the terms of the contract or program
requirements or both;
(D)
the hospice's failure to comply with corrective action
plans after receiving a warning from DHS that continued failure to comply
with the corrective action plan, within 30 days of receiving the warning letter,
could jeopardize their contract;
(E)
the hospice's exclusion from contracting for Medicare or
Medicaid services; or
(F)
the hospice having validated reports of abuse, neglect,
or exploitation when the perpetrator is an employee, volunteer, or owner who
has or will have access to clients served through the contract.
(c)
If the hospice has outstanding overpayments or audit exceptions
upon termination of its contract, DHS can place vendor hold upon one or all
of the hospice contracts that DHS has with a hospice that have the same owner
as the terminated hospice contract and take the balance owed from funds being
held.
(d)
The provider agency has the right to appeal any adverse
action against its contract by filing a written request for a hearing so that
DHS receives the request within 15 calendar days after the provider agency
receives DHS's written notification of adverse action. The provider must send
the request for a hearing to the Texas Department of Human Services (DHS),
P.O. Box 149030, Mail Code W-615, Austin, Texas 78714-9030. Hearings will
be held in Austin, Texas.
§30.84.Referral to the Attorney General.
Suspected or alleged Medicaid fraud will be referred to the Attorney
General's office and the Health and Human Services Commission, Office of Investigations.
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed
with the Office of the Secretary of State, on July 21, 2000.
TRD-200005041
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: September 3, 2000
For further information, please call: (512) 438-3108
40 TAC §30.90, §30.92
The new sections are proposed 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 new sections implement the Human Resources Code, §§22.001-22.030
and §§32.001-32.042.
§30.90.Utilization Review and Control Activities Performed by Texas Health and Human Services Commission (HHSC) Utilization Review (UR) Department.
(a)
According to federal regulations and State Plan requirements,
HHSC UR staff will conduct required on-site activities related to utilization
review and control in nursing facilities receiving Medicaid reimbursement
through the hospice provider for hospice services.
(b)
Hospice provider staff must cooperate with HHSC UR staff
during on-site inspections regarding personal contact with hospice recipients
and the review of their clinical records.
§30.92.Texas Index for Level of Effort (TILE) Assessments.
(a)
Recipient assessment. Hospice nurse assessors assess recipients
for TILE determination by completing the Hospice Nursing Facility Assessment
(H-NF). These assessments establish TILE classifications as described in paragraphs
(1)-(4) of this subsection. Effective January 1, 2001, nurse assessors must
have completed a Health and Human Services Commission (HHSC) TILE training
course and must be registered with the National Heritage Insurance Company
(NHIC).
(1)
Admissions assessments. The provider must complete and
submit to the Texas Department of Human Services, Provider Claims Payment
Unit, Post Office Box 149030, Mail Code Y-948, Austin, Texas 78714- 9030,
the H-NF assessment on the hospice recipient or applicant in a nursing facility
within 20 days of the date that hospice care starts in the nursing facility.
The assessment period is four weeks prior to the assessment date. Assessments
received after the 20th day will have as the effective date the stamp-in date.
(2)
Continued stay reviews. The provider must complete and
submit a continued stay review every 180 days on a Medicaid hospice recipient
residing in a nursing facility. The following provisions apply:
(A)
The provider must complete and submit the H-NF assessment
to the Texas Department of Human Services, Provider Claims Payment Unit, Post
Office Box 149030, Mail Code Y-948, Austin, Texas 78714- 9030. The provider
may submit the assessment up to 45 days prior to the 180th day. H-NF assessments
received earlier than the 135th day will be rejected.
(B)
The H-NF assessment will be effective the 181st day, the
day after the current H-NF Assessment expires.
(C)
H-NF assessments received by the Texas Department of Human
Services (DHS) Provider Claims Payment Unit after the current assessment expires
will be effective the stamped date of receipt.
(D)
The Medicaid hospice program will pay the default hospice-
nursing facility rate for time periods when an H-NF Assessment is not current.
(3)
Off-cycle assessment. If a recipient's medical condition
deteriorates to the extent that he qualifies for a different TILE, the providers
may submit an off-cycle assessment. Only one off- cycle assessment is permitted
per recipient during a six month current assessment period.
(A)
The off-cycle assessment will be effective the date received
(stamp-in date) by DHS, thereby changing the review cycle.
(B)
The provider must complete and submit another H-NF assessment
every 180 days thereafter, as outlined under paragraph (2) of this subsection.
(4)
Error correction. A new H-NF assessment may be submitted
for the purpose of correcting errors previously made in the assessment portion
of the form. The submission of the correction does not change the schedule
for the submission of forms or necessarily change the TILE group. HHSC will
not accept requests for changes submitted:
(A)
over 60 days from the date of assessment on the incorrect
form; or
(B)
after notification of an on-site review date.
(b)
Review and appeal of case-mix assessments. HHSC nurse reviewers
conduct desk reviews and on-site reviews of H-NF Assessments to verify TILE
information and determine that the recipient's status is accurately reflected.
Forms expired over 12 months will not be reviewed.
(1)
HHSC nurse reviewers notify nursing facilities and hospice
providers in advance of routine onsite visits. Notice is given of recipients
whose medical records will be reviewed, the time period covered by the review,
the parts of the records of all hospice recipients necessary for review, and
the accommodations necessary for the review. Nursing facilities and hospice
providers receive a minimum of two work days notice prior to a routine visit.
Less than two days notice may be given to providers whose last two on-site
visits resulted in monitoring, compliance, or vendor hold. No notice is required
for visits for investigation of TILE issues, including suspected fraud, or
for visits requested by another state agency. If nurse reviewers are prevented
from conducting a review based on a provider's actions, TILE rates on the
recipients chosen for review will be lowered to the default TILE rate until
the review can be accomplished.
(2)
When an HHSC nurse reviewer determines that the TILE classification
is not substantiated and/or does not accurately reflect the recipient's status,
the reviewer will discuss the error and propose corrections with the hospice
provider staff and make appropriate corrections during the review. An exit
conference is held with the nursing facility and hospice provider staff following
the review. Additional documentation to support the provider's assessment
may be presented at any time during the review process or the exit conference
and adjustments may be made. The provider is given formal notification of
all TILE changes within 15 working days of the exit conference.
(A)
DHS recoups funds previously paid to the provider under
incorrect TILE classification. DHS will pay the hospice provider any increase
due to a change in TILE classification.
(B)
The change in TILE classification and per diem rate is
effective retroactively to the "effective date" of the assessment reviewed.
(3)
If the HHSC nurse reviewer and the hospice nurse assessor
are unable to agree about an assessment, the provider may submit a written
request for a reconsideration by a state office reconsideration nurse.
(A)
The request for the reconsideration and all documentation
supporting the requested changes must be received by the state office reconsideration
nurse within 15 days of receipt of formal notification of TILE changes.
(B)
The state office reconsideration nurse will review all
material submitted by the provider and all information collected during the
utilization review (UR).
(C)
The TILE classification and associated per diem rate specified
by the HHSC nurse reviewer remain in effect during the reconsideration period.
(D)
If the reconsideration establishes that HHSC has changed
a TILE classification in error, HHSC corrects the error retroactively.
(4)
If the provider disagrees with the findings of the state
office reconsideration nurse, the provider may initiate a formal appeal, as
stated in Chapter 79, Subchapter Q of this title (relating to Contract Appeals
Process), by submitting a request to the Director, Hearings Department, Mail
Code W-613, Texas Department of Human Services, P.O. Box 149030, Austin, Texas
78714-9030 within 15 days of receipt of notification of the results of the
reconsideration.
(A)
The TILE classification and associated per diem specified
by the state office reconsideration nurse supervisor remain in effect during
the formal contract appeal.
(B)
If the informal review or contract appeal process establishes
that HHSC changed a TILE classification in error, HHSC corrects the error
retroactively.
(c)
Monitoring. Tile error rates on the assessment forms reviewed
may result in a provider's undergoing a monitoring period. Decisions to institute
monitoring will be made by the UR staff in state office.
(1)
During the monitoring period, providers must submit all
H-NF assessments to regional nurse reviewers. Assessments may not be submitted
to the Provider Claims Payment Unit.
(2)
The length of the monitoring period is 60 days. If accuracy
of forms is still at an unacceptable level at the end of 60 days, HHSC state
office staff will give a one-time, 30-day extension if the provider has shown
an attempt to improve their accuracy. If forms are not accurate at the end
of 90 days, HHSC places the provider on compliance.
(d)
Compliance.
(1)
A decision to place a provider on compliance will be made
by UR staff in state office. Compliance may result when a provider has errors
on the current assessment forms reviewed and one of the following:
(A)
ongoing errors at the end of the monitoring period;
(B)
lack of documentation regarding key assessment items;
(C)
a history of noncompliance; or
(D)
medical records which contain alterations in areas designed
to lower the TILE level and increase the payment.
(2)
Within a 30-day compliance period, providers must complete
new assessment forms on all recipients not in the original review. Any forms
scheduled to expire prior to the scheduled compliance visit should be completed
pursuant to the TILE form instructions. Original TILE forms must be submitted,
with copies of supporting medical record documentation for the assessment
period, to the UR regional nurse one week prior to the scheduled visit date.
(3)
If a provider has continuing errors by the end of the compliance
period, per diem payments to the hospice provider will be held until the provider
has corrected the errors.
(4)
The hospice nurse assessor must attend an HHSC TILE training
within 60 days of the beginning of the compliance period.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed
with the Office of the Secretary of State, on July 21, 2000.
TRD-200005042
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: September 3, 2000
For further information, please call: (512) 438-3108
40 TAC §30.100
The new section is proposed 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 new section implements the Human Resources Code, §§22.001-22.030
and §§32.001-32.042.
§30.100.Additional Requirements.
(a)
Hospice providers must chart procedures in the nursing
facility clinical record and advise the nursing facility staff of changes
in the recipient's condition as necessary.
(b)
The hospice provider must have joint procedures with the
nursing facility for ordering medications that ensure the proper payor is
billed and for reconciling billing between the nursing facility and hospice
provider.
(c)
The recipient has the right to refuse any service provided
by a nursing facility or a hospice provider.
(d)
The provider shall comply with the provisions of §49.23
of this title (relating to Advertising and Solicitation of Clients).
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed
with the Office of the Secretary of State, on July 21, 2000.
TRD-200005043
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: September 3, 2000
For further information, please call: (512) 438-3108
40 TAC §30.101, §30.103, §30.105
(Editor's note: The text of the following sections proposed for
repeal will not be published. The sections may be examined in the offices
of the Texas Department of Human Services or in the Texas Register office,
Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)
The repeals are proposed 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 repeals implement the Human Resources Code, §§22.001- 22.030
and §§32.001-32.042.
§30.101.Program Adminsitrations.
§30.103.Program Coverage.
§30.105.Eligibility.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed
with the Office of the Secretary of State, on July 21, 2000.
TRD-200005033
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: September 3, 2000
For further information, please call: (512) 438-3108
Subchapter F. IN-HOME AND FAMILY SUPPORT PROGRAM
40 TAC §48.2703
The Texas Department of Human Services (DHS) proposes an
amendment to §48.2703, concerning income eligibility, in its Community
Care for Aged and Disabled chapter. The purpose of the amendment is to exempt
certain sources of income from calculations used to determine eligibility
for the In-Home and Family Support Program (IHFSP).
Eric M. Bost, commissioner, has determined that for the first five-year
period the section is in effect there will be no fiscal implications for state
or local government as a result of enforcing or administering the section.
Mr. Bost also has determined that for each year of the first five years
the section is in effect the public benefit anticipated as a result of enforcing
the section will be an increased number of individuals who are potentially
eligible for IHFSP services because their sources of income are exempted from
calculations used to determine eligibility. There will be no effect on large,
small, or micro businesses because the rule only addresses eligibility requirements
considered in processing IHFSP applications. There is no anticipated economic
cost to persons who are required to comply with the proposed section.
Questions about the content of this proposal may be directed to Debbie
Berliner at (512) 438-3199 in DHS' Community Care for Aged and Disabled Division.
Written comments on the proposal may be submitted to Supervisor, Rules and
Handbooks Unit-279, Texas Department of Human Services E-205, P.O. Box 149030,
Austin, Texas 78714-9030, within 30 days of publication in the
Texas Register.
Under §2007.003(b) of the Texas Government Code, the department has
determined that Chapter 2007 of the Government Code does not apply to these
rules. Accordingly, the department is not required to complete a takings impact
assessment regarding these rules.
The amendment is proposed under the Human Resources Code, Title
2, Chapters 22 and 35, which authorizes the department to administer public
assistance and support services for persons with disabilities.
The amendment implements the Human Resources Code, §§22.001-22.030
and §§35.001-35.012.
§48.2703.Income Eligibility.
(a)-(d)
(No change.)
(e)
Applicants must provide to the caseworker all required
documentation of earned or unearned income or both. This income is considered
in determining financial eligibility.
The following income is exempt
from income eligibility calculation:
(1)
Proceeds of either a commercial
or an informal loan for which repayment is required with or without interest.
To claim exemption of the proceeds of a loan, a client must prove that he
acknowledges an obligation to repay and that some plan for repayment exists.
If these can be verified, no written contract is required.
(2)
Payments from the Agent Orange
Settlement Fund or any other fund established in the settlement of the Agent
Orange Product liability litigation (Public Law 101-239).
(3)
Any payment received under
the Radiation Exposure Compensation Act (Public Law 101-246).
(4)
Value of any housing assistance
paid on a house under the United States Housing Act of 1937, the National
Housing Act, §101 of the Housing and Urban Development Act of 1965, or
Title V of the Housing Act of 1949 as authorized by Public Law 94-347.
(5)
Payment from any source made
to individuals because of their status as victims of Nazi persecution (Public
Law 103-286).
(f)-(i)
(No change.)
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of
the Secretary of State, on July 24, 2000.
TRD-200005074
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: September 3, 2000
For further information, please call: (512) 438-3108
Chapter 101.
GENERAL RULES
40 TAC §101.24
The Texas Rehabilitation Commission (TRC) proposes new §101.24,
concerning general rules. The section is being proposed to comply with the
provisions of House Bill 2641.
Charles E. Harrison, Jr., Deputy Commissioner for Financial Services, has
determined that for the first five-year period the section is in effect, there
will be no fiscal implications for state or local government.
Mr. Harrison also has determined that for each year of the first five years
the section is in effect the public benefit anticipated as a result of enforcing
the section will be the agency's compliance with House Bill 2641. There will
be no effect on small businesses. There is no anticipated economic cost to
persons who are required to comply with the section as proposed.
Comments on the proposal may be submitted to Roger Darley, Assistant General
Counsel, Texas Rehabilitation Commission, 4900 North Lamar Boulevard, Suite
7300, Austin, Texas 78751.
The new section is proposed under the Texas Human Resources Code,
Title 7, Chapter 111, §111.018 and §111.023, which provides the
Texas Rehabilitation Commission with the authority to promulgate rules consistent
with Title 7, Texas Human Resources Code.
No other statute, article, or code is affected by this proposal.
§101.24.Responsibilities of the Commissioner.
(a)
The Commissioner is the executive head of the Commission,
and is subject to the oversight and evaluation of the Commissioner of the
Health and Human Services Commission (HHSC).
(b)
The Commissioner's management responsibilities include:
(1)
making all decisions regarding the daily operations of
the Commission;
(2)
implementing all policies and/or rules adopted by the Board;
(3)
making long-range and intermediate plans for the scope
and development of the program, and making decisions regarding allocation
of resources;
(4)
certification of funds for disbursement;
(5)
delegation of authority to officers and employees of the
Commission to carry out responsibilities of the Commissioner;
(6)
doing all acts necessary to manage the Commission;
(7)
executing all authority delegated by the Board;
(8)
developing and implementing the provisions of an MOU with
HHSC;
(9)
advising the Commissioner of HHSC and HHSC key staff in
a timely manner on matters relating to the operation of the Commission;
(10)
establishing a flexible, responsible and accountable relationship
with HHSC; and
(11)
through open and timely communication and mutual respect
for the separate missions of HHSC and the Commission, assisting HHSC accomplish
its mandates with minimal resources and minimal interference in the day-to-day
operation of the Commission.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of
the Secretary of State, on July 24, 2000.
TRD-200005067
Charles Schiesser
Chief of Staff
Texas Rehabilitation Commission
Earliest possible date of adoption: September 3, 2000
For further information, please call: (512) 424-4050
Chapter 181.
GENERAL RULES OF PRACTICE AND PROCEDURE
Subchapter A. GENERAL PROVISIONS
40 TAC §181.55
The Texas Commission for the Deaf and Hard of Hearing proposes
new §181.55. The proposal establishes the task forces of the Commission
and their importance to the Commission.
David W. Myers, Executive Director, has determined that for each year of
the first five years the rule is in effect there will be no fiscal implications
for state or local government as a result of enforcing or administering the
rule.
Mr. Myers has also determined that for each year of the first five years
the rule is in effect the public benefit anticipated as a result of this rule
will be a better understanding of the task forces of the Commission. There
will be no effect on small businesses. There is no anticipated economic hardship
to persons required to comply with the rule as proposed.
Comments on this proposed rule may be submitted to Billy Collins, Texas
Commission for the Deaf and Hard of Hearing, P.O. Box 12904, Austin, Texas
78711-2904.
The rule is proposed under the Texas Administrative Code, §81.006(b)
(3), which provides the Texas Commission for the Deaf and Hard of Hearing
with the authority to adopt rules for administration and programs.
No other statute, code or article is affected by this proposed rule.
§181.55.Task Force Purpose.
The Hard of Hearing Task Force, Hispanic Tri-lingual Task Force, Deafness
Task Force and Educational Interpreter Task Force are advisory committees
appointed by the Texas Commission for the Deaf and Hard of Hearing. Each committee
is responsible for advising and assisting in developing programs and services
for persons who are deaf and hard of hearing in the state. The Task Forces
remain in existence through state fiscal year 2005.
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of
the Secretary of State, on July 19, 2000.
TRD-200004977
David Myers
Executive Director
Texas Commission for the Deaf and Hard of Hearing
Earliest possible date of adoption: September 3, 2000
For further information, please call: (512) 407-3250
40 TAC §181.56
The Texas Commission for the Deaf and Hard of Hearing proposes
new §181.56. The proposal establishes the responsibilities of the task
forces of the Commission.
David W. Myers, Executive Director, has determined that for each year
of the first five years the rule is in effect there will be no fiscal implications
for state or local government as a result of enforcing or administering the
rule.
Mr. Myers has also determined that for each year of the first five years
the rule is in effect the public benefit anticipated as a result of this
rule will be a better understanding of the responsibilities of the task forces
of the Commission. There will be no effect on small businesses. There is
no anticipated economic hardship to persons required to comply with the rule
as proposed.
Comments on this proposed rule may be submitted to Billy Collins, Texas
Commission for the Deaf and Hard of Hearing, P.O. Box 12904, Austin, Texas
78711-2904.
The rule is proposed under the Texas Administrative Code, §81.006(b)
(3), which provides the Texas Commission for the Deaf and Hard of Hearing
with the authority to adopt rules for administration and programs.
No other statute, code or article is affected by this proposed rule.
§181.56. Responsibility of Task Force members.
(a)
Task Forces may recommend to the commission any rules which
are necessary for the performance of its duties or the program and which
are consistent with the laws of this state;
(b)
Task Forces may make recommendations to the commission
for approval to establish ad hoc committees to assist in the consideration
of pertinent matters. These ad hoc committees may make recommendations to
the task force for its consideration and approval.
(c)
The Task Forces' decision-making process is independent
of the administrative staff of the commission. The commission has final decision
on all actions.
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of
the Secretary of State, on July 19, 2000.
TRD-200004978
David Myers
Executive Director
Texas Commission for the Deaf and Hard of Hearing
Earliest possible date of adoption: September 3, 2000
For further information, please call: (512) 407-3250
40 TAC §181.57
The Texas Commission for the Deaf and Hard of Hearing proposes
new §181.57. The proposal establishes membership requirements and length
of term for members of the task forces of the Commission.
David W. Myers, Executive Director, has determined that for each year of
the first five years the rule is in effect there will be no fiscal implications
for state or local government as a result of enforcing or administering the
rule.
Mr. Myers has also determined that for each year of the first five years
the rule is in effect the public benefit anticipated as a result of this rule
will be a better understanding of the membership requirements and length of
term for members of the task forces of the Commission. There will be no effect
on small businesses. There is no anticipated economic hardship to persons
required to comply with the rule as proposed.
Comments on this proposed rule may be submitted to Billy Collins, Texas
Commission for the Deaf and Hard of Hearing, P.O. Box 12904, Austin, Texas
78711-2904.
The rule is proposed under the Texas Administrative Code, §81.006(b)
(3), which provides the Texas Commission for the Deaf and Hard of Hearing
with the authority to adopt rules for administration and programs.
No other statute, code or article is affected by this proposed rule.
§181.57.Term of Membership, Vacancies and Officers.
(a)
Term of members shall be three years. A member of a task
force who is appointed for a full three-year term is eligible for reappointment
for a second consecutive term. The commission shall fill any vacancy for the
length of an unexpired term. A member of a task force who is appointed to
fill an unexpired term may be reappointed to two consecutive full terms.
(b)
A vacancy on a task force will be created through the expiration
of a term, resignation of a member, incapacity of a member to the extent that
the member is unable to fulfill the obligations of the position, or absence
of a member for three consecutively scheduled and announced meetings. To fill
vacancies, the task force may review qualifications of candidates and recommend
appointments of such candidates to the commission.
(c)
Task Force members shall not receive any compensation for
their services, but can receive reimbursement for expenses in performing the
duties of the office, subject to availability of funding by the commission
and in accord with state travel regulations. Committee members must receive
prior approval to be reimbursed for expenses incurred while attending a task
force meeting or other functions as authorized by the commission.
(d)
The task forces shall elect a chairperson, a vice-chairperson,
of whom each shall serve for at least one year. The election shall be held
at the first regular meeting following January 1.
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of
the Secretary of State, on July 19, 2000.
TRD-200004979
David Myers
Executive Director
Texas Commission for the Deaf and Hard of Hearing
Earliest possible date of adoption: September 3, 2000
For further information, please call: (512) 407-3250
40 TAC §181.58
The Texas Commission for the Deaf and Hard of Hearing proposes
new §181.58. The proposal establishes qualifications of the members of
the task forces of the Commission.
David W. Myers, Executive Director, has determined that for each year of
the first five years the rule is in effect there will be no fiscal implications
for state or local government as a result of enforcing or administering the
rule.
Mr. Myers has also determined that for each year of the first five years
the rule is in effect the public benefit anticipated as a result of this rule
will be a better understanding of the qualifications of the members of the
task forces of the Commission. There will be no effect on small businesses.
There is no anticipated economic hardship to persons required to comply with
the rule as proposed.
Comments on this proposed rule may be submitted to Billy Collins, Texas
Commission for the Deaf and Hard of Hearing, P.O. Box 12904, Austin, Texas
78711-2904.
The rule is proposed under the Texas Administrative Code, §81.006(b)
(3), which provides the Texas Commission for the Deaf and Hard of Hearing
with the authority to adopt rules for administration and programs.
No other statute, code or article is affected by this proposed rule.
§181.58.Qualifications of Task Force Members.
(a)
The Hard of Hearing Task Force shall be comprised of ten
members appointed by the commission. Qualifications of members: Each member
of the task force shall be a resident of the state; be a consumer; or in a
position of providing services to individuals who are hard of hearing; and
have knowledge of the needs of individuals with hearing loss and of the services
available.
(b)
The Hispanic Tri-lingual Task Force shall be comprised
of at least five and no more than fifteen members pursuant to the needs established
by the commission. Qualifications of members: Members of the task force shall
have the experience of providing or utilizing Hispanic tri-lingual interpreting
services; must be a resident of the state; at least two members must be persons
who are deaf and a frequent consumer of interpreter services; all members
must demonstrate knowledge of the field of interpreting and the special needs
of the tri-lingual interpreter and consumer.
(c)
The Deafness Task Force shall be comprised of ten members
appointed by the commission. Qualifications of members: Each member of the
task force shall be a resident of the state; be a frequent consumer of interpreter
services who demonstrates knowledge of the field of deafness and the special
needs of the consumer who is deaf.
(d)
The Educational Interpreter Task Force shall be comprised
of at least five and no more than fifteen members pursuant to the needs established
by the commission. Qualifications of members: Each member of the task force
shall have the experience of providing educational interpreting services;
or be a consumer of educational interpreter services; or be in a position
closely associated with the use of educational interpreters; be a resident
of the state; at least two members must be persons who are deaf and be frequent
consumers of interpreter services; all members must demonstrate knowledge
of the field of interpreting and the special needs of the educational interpreter
and the consumers.
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of
the Secretary of State, on July 19, 2000.
TRD-200004980
David Myers
Executive Director
Texas Commission for the Deaf and Hard of Hearing
Earliest possible date of adoption: September 3, 2000
For further information, please call: (512) 407-3250
40 TAC §181.830
The Texas Commission for the Deaf and Hard of Hearing proposes
amendment to §181.830. The amendment is proposed to modify how fees for
interpreter services are determined in accordance with Texas Administrative
Code, §81.006.
David W. Myers, Executive Director, has determined that for each year of
the first five years the amendment to this section is in effect there will
be no fiscal implications for state or local government as a result of enforcing
or administering the amendment.
Mr. Myers has also determined that for each year of the first five years
the amendment is in effect the public benefit anticipated as a result of this
amendment will be a better understanding of how fees for interpreter services
are determined. There will be no effect on small businesses. There is no anticipated
economic hardship to persons required to comply with the amendment as proposed.
Comments on this proposed amendment may be submitted to Billy Collins,
Texas Commission for the Deaf and Hard of Hearing, P.O. Box 12904, Austin,
Texas 78711-2904.
The amendment is proposed under the Texas Administrative Code, §81.006(b)
(3), which provides the Texas Commission for the Deaf and Hard of Hearing
with the authority to adopt rules for administration and programs.
No other statute, code or article is affected by this proposed amendment.
§181.830.[
(a)
[
[
Scheduled Assignments-$30
per hour.]
[
Scheduled After-Hour, Weekend
or Non-Scheduled (less than 24 hour notice)-$45 per hour.]
[
Emergency/Holiday-$60 per
hour.]
[
Administrative costs of collection
that are inclusive in those fees.]
(b)
The Commission defines the following:
[
[
Other types of interpreting
settings. Fees for interpreting services in settings, other than formal, governmental,
civil, and criminal proceedings, are applicable to certified interpreter services
for the deaf and hard of hearing who function in a variety of settings including,
but not limited to, health, vocational, educational, and welfare activities.]
[
(1)
After Hours[
(2)
Weekend Interpreting services
is any scheduled interpreting situation which occurs anytime on Saturday or
Sunday.
(3)
[
(4)
[
(5)
Portal to portal is the time
an interpreter leaves scheduled headquarters and returns to headquarters at
the completion of the assignment. Headquarters is the site of the contracted
service provider or the home base of the contracted interpreter whichever
is closer to the assignment. Service providers will not be reimbursed mileage
costs whenever portal to portal costs are charged unless otherwise specified.
(6)
Guaranteed minimum assignment
is the least amount of time a service provider will be reimbursed and presently
is established as two hours.
(7)
Late cancellation means providing
less than twenty-four hours notice of the cancellation of an assignment. Cancellation
must be made Monday through Friday during regular business hours unless otherwise
specified.
[
Interpreting fees for services
rendered to deaf-blind persons. It is recommended that interpreting services
provided for persons who are deaf and blind be reimbursed according to the
fee scales and policies in this section.]
[
Recommended practices in fee
determination. The fees and related practices set forth throughout this section
are the commission's recommendation issued pursuant to its statutory mandate.
These recommendations do not serve to regulate other contractual fees paid
to interpreters for the deaf in the State of Texas. Local, county, and state
governmental units, as well as schools, agencies, and individuals, may negotiate
contracts for a fee arrangements with particular interpreters on an hourly,
daily, weekly, monthly, or annual basis.]
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of
the Secretary of State, on July 19, 2000.
TRD-200004989
David Myers
Executive Director
Texas Commission for the Deaf and Hard of Hearing
Earliest possible date of adoption: September 3, 2000
For further information, please call: (512) 407-3250
Chapter 827.
COMMUNITIES IN SCHOOLS PROGRAM
Subchapter D. FUNDING OF CIS LOCAL PROGRAMS
Chapter 30.
MEDICAID HOSPICE PROGRAM
Subchapter B. ELIGIBILITY REQUIREMENTS
Subchapter C. PROVIDER REQUIREMENTS FOR ENTRANCE INTO THE TEXAS MEDICAID HOSPICE PROGRAM; DISCLOSURE REQUIREMENTS
Subchapter D. PROVIDERS' CONDITIONS OF PARTICIPATION: OTHER SERVICES
Subchapter E. COVERED SERVICES
Subchapter F. REIMBURSEMENT
Subchapter G. INSPECTIONS, SURVEYS, AND VISITS
Subchapter H. ENFORCEMENT
Subchapter I. MEDICAL REVIEW AND RE-EVALUATION
Subchapter J. MISCELLANEOUS PROVISIONS
Subchapter A. REQUIREMENTS
Chapter 48.
COMMUNITY CARE FOR AGED AND DISABLED
Part 2.
TEXAS REHABILITATION COMMISSION
Part 6.
TEXAS COMMISSION FOR THE DEAF AND HARD OF HEARING
Subchapter F. FEES Fees Schedules for the Payment of ] Interpreter Services for the Deaf and Hard of Hearing
Fees.
] Under the authority of the Texas Code
of Criminal Procedure, Article 38.31, and the Texas
Administrative
[
Human Resources
] Code, Chapter 81, §[
1
]81.006(a)
[
and (c),
] the Commission
establishes
[
established
the following
] maximum allowable fees for the payment of interpreter
services for
persons who are
[
the
] deaf and hard of
hearing which must be provided by law in proceedings of state agencies, courts,
and political subdivisions.
Under the authority of the Texas Administrative
Code, Chapter 81 §81.006(c) other state agencies shall adopt the schedule
of fees established by the Commission. The fees are established as the best
value through competitive bid on a biennial basis and may be reviewed and
or revised as deemed necessary by the Commission. The schedule of fees and
any changes will be posted on the agency website.
[
This fee schedule
must be adhered to unless a superseding contractual arrangement exists between
the employing entity and the service provider. For the services of a certified
interpreter the commission sets the following maximum fees:
]
(1)
(2)
(3)
(4)
Minimum fee payment. The services of a certified interpreter should be reimbursed
a guaranteed two-hour minimum with time calculated portal to portal.
]
(c)
(d)
After Hours/Weekend, Emergency/Holiday interpreting
service fees.]
/Weekend,
] Interpreting
services
is any scheduled interpreting
[
service fees should be paid in any
] situation which begins between the hours of 6:00 p.m. and 6:00 a.m,
Monday through Friday
[
or on Saturday and Sunday
].
(2)
] Emergency interpreting service
situations within proceedings of state agencies, courts, and political subdivisions
are defined as essential situations which are potentially life threatening
or pose a threat to the clients' well-being during any time of the day or
night. In this definition of
an
emergency interpreting service
situation, all interpreting service situations which can reasonably be delayed
to allow adequate planning, or which can be planned for in advance and do
not pose a special hardship for the service provider are not considered to
be emergency interpreting service situations. Lateness in planning on the
part of the consumer or client are not emergency situations as defined in
this subsection. The designation "emergency interpreting service situation"
is to be used prudently in view of its potential for abuse.
(3)
] Holiday
Interpreting service
situations are defined as applying to
[
fees are paid for
]
any federally observed holiday.
(e)
(f)
Part 20.
TEXAS WORKFORCE COMMISSION