Part 1.
TEXAS DEPARTMENT OF HUMAN SERVICES
Chapter 15.
MEDICAID ELIGIBILITY
Subchapter E. INCOME
40 TAC §15.450
The Texas Department of Human Services (DHS) proposes to
amend §15.450, concerning general principles concerning income, in its
Medicaid Eligibility chapter. The purpose of the amendment is to comply with
House Bill 154, in which the 77th Texas Legislature approved an increase in
the personal needs allowance (PNA) for Medicaid clients in nursing facilities
and ICF/MF facilities. The PNA increase to $60 per month is effective September
1, 2001. For Supplemental Security Income (SSI) clients who receive the $30
federal benefit rate, the state will supplement their incomes by $30 per month
so that they will have $60 per month for personal use.
Jerry W. Friedman, Executive Deputy Commissioner, has determined that for
the first five-year period the proposed section will be in effect there will
be no fiscal implications for local governments as a result of enforcing or
administering the section. There will be an effect on state government as
a result of enforcing or administering this section.
The effect on state government for the first five-year period the section
will be in effect is an estimated additional cost of $6,545,292 in fiscal
year (FY) 2002; $6,563,826 in FY 2003; $6,593,161 in FY 2004; $6,622,497 in
FY 2005; and $6,651,833 in FY 2006.
Mr. Friedman 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 adoption
of the proposed rule will be an additional $15 per month, a total of $60,
for clients' personal use. There will be no effect on small or micro businesses
as a result of enforcing or administering the section because the Medicaid
vendor payment will increase to offset the amount retained by the client for
personal use. 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 Judy Coker
at (512) 438-3227 in DHS's Long Term Care Section. Written comments on the
proposal may be submitted to Supervisor, Rules and Handbooks Unit-181, 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 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 amendment implements the Human Resources Code, §§22.001-22.030
and §§32.001-32.042.
§15.450.General Principles Concerning Income.
(a) - (g)
(No change.)
(h)
A personal needs allowance (PNA) is an amount of a client's
income that a client in an institutional setting may retain for his personal
use. It will not be applied against the costs of medical assistance furnished
in the facility. Clients in institutional settings may retain
$60
[
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 August 17, 2001.
TRD-200104834
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: September 30, 2001
For further information, please call: (512) 438-3734
Subchapter X. REQUIREMENTS FOR MEDICAID-CERTIFIED FACILITIES
40 TAC §19.2322
The Texas Department of Human Services (DHS) proposes to
amend §19.2322, concerning allocation, reallocation, and decertification
requirements, in its Requirements for Medicaid-Certified Facilities chapter.
The purpose of the amendment is to implement appropriations rider 38 passed
by the 77th Legislature. Rider 38 directs DHS to create a program for Medicaid-eligible
veterans that will enable those individuals to be placed in state veterans
homes.
The proposed rule allows an exemption from the Medicaid nursing facility
bed allocation rules for state veterans homes that are authorized and built
under the auspices of the Texas Veterans Land Board. The exemption will allow
the Texas Veterans Land Board to receive the allocation of Medicaid beds if
veterans homes meet the participation requirements of the Medicaid nursing
facility program.
Jerry W. Friedman, Executive Deputy Commissioner, has determined that for
the first five-year period the proposed section will be in effect, there will
be fiscal implications for state government as a result of enforcing or administering
the section. The effect on state government for the first five-year period
the sections will be in effect is an estimated additional cost of $146,042
in fiscal year (FY) 2002; $146,042 in FY 2003; $146,042 in FY 2004; $146,042
in FY 2005; and $146,042 in FY 2006. There will be no fiscal implications
for local governments as a result of enforcing or administering the section.
Mr. Friedman 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 adoption
of the proposed rule will be that Medicaid-eligible veterans and qualified
family members will be able to receive services in a state veterans home.
There will be no effect on small or micro businesses as a result of enforcing
or administering the section, because the amendment allows Medicaid funds
to be used for the care of Medicaid-eligible veterans and their family members.
It is anticipated that most veterans and their family members served in these
homes will transfer from veterans hospitals. There is no anticipated economic
cost to persons who are required to comply with the proposed section. There
also is no anticipated impact on local employment.
Questions about the content of this proposal may be directed to Susan Syler
at (512) 438-3111 in DHS's Long Term Care-Policy Section. Written comments
on the proposal may be submitted to Supervisor, Rules and Handbooks Unit-193,
Texas Department of Human Services E-205, P.O. Box 149030, Austin, Texas 78714-9030,
within 30 days of publication in the
Texas Register
.
The proposal is available for public review at local offices of DHS. For
further information, contact Susan Syler in DHS's Long Term Care-Policy Section
at (512) 438- 3111.
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 32, which authorizes the department to administer public
and medical assistance programs.
The amendment implements the Human Resources Code, §§22.001-
22.030 and §§32.001-32.042 and Government Code, §§531.033
and 531.021(b).
§19.2322.Allocation, Reallocation, and Decertification Requirements.
(a)-(d)
(No change.)
(e)
Exemptions. If the NFO meets all criteria, DHS may grant
the following exemptions from the policy stated in subsection (c) of this
section.
(1)-(9)
(No change.)
(10)
State veterans homes. State
veterans homes, authorized and built under the auspices of the Texas Veterans
Land Board, must meet all requirements for Medicaid participation.
(f)-(j)
(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 August 17, 2001.
TRD-200104814
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: September 30, 2001
For further information, please call: (512) 438-3734
40 TAC §41.114
The Texas Department of Human Services (DHS) proposes new §41.114,
concerning vendor fiscal intermediary payment option, in its Vendor Fiscal
Intermediary Payments chapter. The purpose of the new section is to create
a vendor fiscal intermediary (VFI) payment model for programs that offer personal
attendant services.
This proposal establishes the payment rate methodology used to determine
the consumer payment rate. The consumer can use the methodology to pay a personal
attendant, and use the VFI payment rate to pay for contracted VFI services.
The sum of these two payment rates cannot exceed the payment rate for contracted
providers who deliver services to clients who do not participate in the VFI
option. This option will be made available in the Consumer-Managed Personal
Attendant Services, Community Based Alternatives (CBA), Community Living Assistance
and Support Services (CLASS), Deaf- Blind with Multiple Disabilities, In-home
and Family Support, Medically Dependent Children, Primary Home Care, and Family
Care Services programs within DHS. The VFI model was piloted in DHS's Client
Managed Attendant Services program and the Personal Attendant Services program
of the Texas Rehabilitation Commission (TRC) under House Bill 2084 of the
75th Legislature. The pilot has been expanded to other Community Care for
the Aged and Disabled (CCAD) programs under Senate Bill 1586 of the 76th Legislature,
which directs the Health and Human Services Commission (HHSC) to expand this
model to other HHSC community programs.
Jerry W. Friedman, Executive Deputy 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 governments as a result of enforcing or administering
the section.
Mr. Friedman also has determined that for the first five years the section
is in effect, the public benefit anticipated as a result of adoption of the
proposed rule will be that consumers enrolled in these programs will be able
to determine the compensation of their attendants within an approved service
plan budget that is based on the consumer payment rate. There will be no effect
on small or micro businesses as a result of enforcing or administering the
section, because a limited number of consumers will take advantage of the
VFI payment option. A contracted provider who currently serves a consumer
who decides to participate in the option can choose to continue providing
some of the employer-related responsibilities, such as processing payroll
and maintaining records for business tax filings at the VFI payment rate.
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 Carolyn
Pratt at (512) 438-4057 in DHS's Rate Analysis Department. Written comments
on the proposal may be submitted to Supervisor, Rules and Handbooks Unit-202,
Texas Department of Human Services E-205, P.O. Box 149030, Austin, Texas 78714-9030,
within 30 days of publication in the
Texas Register
.
The proposal is available for public review at local offices of DHS. For
further information, contact Carolyn Pratt in DHS's Rate Analysis Department
at (512) 438-4057.
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 new section is proposed under Human Resources Code, Title 2, Chapters
22 and 32, which authorize DHS to administer public and medical assistance
programs; and under Texas Government Code §531.021(b), which provides
HHSC with the authority to administer federal medical assistance funds.
The section implements the Human Resources Code, §§22.001-22.030
and §§32.001-32.042.
§41.114.Vendor Fiscal Intermediary Payment Option.
(a)
The vendor fiscal intermediary (VFI) payment option is
made available to eligible consumers in the In-home and Family Support, Primary
Home Care (PHC), Family Care Services and Consumer-Managed Personal Assistance
Services programs.
(b)
The sum of the payment rate for the contracted VFI and
the payment rate for the consumer must not exceed the hourly attendant compensation
enhancement participant payment rate made to contracted providers in these
programs. The payment rate for the contracted VFI is determined by modeling
the estimated administrative cost to carry out the responsibilities of the
VFI. The payment rate for the consumer is determined by subtracting the contracted
VFI payment rate from the attendant compensation enhancement participation
payment rate made to contracted providers in these programs.
(c)
The VFI payment rate is paid to the VFI as a percentage
of the amount expended and claimed to the Texas Department of Human Services.
(d)
Consumers must expend on the average hourly compensation
of attendants, an amount equal to the calculated consumer payment rate per
hour of service divided by 1.07. Compensation includes salaries and wages,
payroll taxes, workers' compensation, employee benefits/insurance, and mileage
reimbursement.
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 August 17, 2001.
TRD-200104830
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: September 30, 2001
For further information, please call: (512) 438-3734
Chapter 260.
AREA AGENCY ON AGING ADMINISTRATIVE REQUIREMENTS
40 TAC §260.4
The Texas Department on Aging proposes new §260.4, concerning
Certification of Benefits Counselors Regarding the Preparation of Advanced
Directives.
Section 260.4 is proposed in order to conform to the requirements of House
Bill 1420 (HB 1420). HB 1420 was enacted during the 77th Legislative Session.
In accordance with this bill, the "practice of law" does not include technical
assistance, consultation, and documentation completion assistance relating
to medical power of attorney or other advance directives under Chapter 166,
Health and Safety Code or a designation of guardian before need arises under
Section 679, Texas Probate Code when the assistance is provided by an employee
or volunteer of an area agency on aging affiliated with the Texas Department
on Aging who meets the identified requirements under the bill. HB 1420 requires
the Texas Department on Aging by rule to develop certification procedures.
Barbara Zimmerman, Chief Fiscal Officer, 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.
Ms. Zimmerman also has determined that for each year of the first five
years the rule is in effect the public benefit anticipated as a result of
enforcing the rule will be to conform to the requirements of HB 1420, 77th
Legislative Session. There will be no effect on small businesses. There will
be no effect to individuals required to comply with the section as proposed.
Comments on the new rule may be submitted to Gary Jessee, Aging Network
Policy Coordinator, Texas Department on Aging, P.O. Box 12786, Austin, Texas
78711. All comments must be written and delivered via mail, in person, or
facsimile. E-mail and verbal comments cannot be accepted. All comments must
be received within 30 calendar days following the date of publication of the
proposed new rule in the
Texas Register
.
The new rule is proposed under Texas Government Code, §2161.003,
which provides the Texas Department on Aging with the authority to promulgate
rules governing the operation of the Department.
Texas Government Code, §2161.003 is affected and implemented by this
proposed action.
§260.4.Certification of Benefits Counselors Regarding the Preparation of Advanced Directives.
(a)
To be certified to provide services pursuant to Texas Government
Code §81.1011, a benefits counselor must meet the following requirements:
(1)
Be an employee or volunteer of an area agency on aging
affiliated with the Texas Department on Aging who provides benefits counseling
services through an area agency on aging system of access and assistance to
persons age 60 years and older and/or their family members or other caregivers,
and
(2)
Have received the training in providing technical advice,
consultation, and assistance, described in subsection (b) of this section.
(b)
The training referred to in subsection (a)(2) of this section
must:
(1)
Be approved by the Texas Department on Aging; and
(2)
Include the following components:
(A)
statutory, regulatory, and policy provisions applicable
to advance directives in Texas;
(B)
the use of letters, questionnaires, and checklists for
gathering information to provide technical advice, consultation and document
preparation for clients;
(C)
conducting the client interview (including confidentiality
and conflict of interest considerations);
(D)
how to complete, sign, and witness, the Advance Directives
provided for in the Texas Health and Safety Code, Chapter 166, and how to
complete, sign, and witness, the Designation of Guardian Before Need Arises
provided for in the Texas Probate Code §679;
(E)
how revocation of the documents referred to in subparagraph
(D) of this paragraph is accomplished; and
(F)
proper procedures for filing and informing health care
personnel about the documents referred to in subparagraph (D) of this paragraph.
(3)
Include an assessment tool approved by the Texas Department
on Aging that verifies that the employee or volunteer providing benefits counseling
through an area agency on aging system of access and assistance has sufficient
knowledge after the training described in paragraphs (1) and (2) of this subsection,
to provide high quality services that meet the needs of clients for technical
advice, consultation, and document preparation in regard to the Advance Directives
in Texas Health and Safety Code, Chapter 166, and in regard to the Designation
of Guardian Before Need Arises provided for in the Texas Probate Code §679.
The assessment tool shall require a score of 70% correct answers as the minimum
passing grade.
(c)
The Texas Department on Aging shall certify an employee
or volunteer providing benefits counseling through an area agency on aging
system of access and assistance who has completed the training described in
subsection (b)(1) and (2) of this section and who has completed the assessment
tool with a score of 70% or higher to provide services under Texas Government
Code §81.1011. Each area agency on aging has the discretion to decide
whether the services authorized under Texas Government Code §81.1011,
shall be offered by the area agency on aging.
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 August 16, 2001.
TRD-200104786
Gary Jessee
Aging Network Policy Coordinator
Texas Department on Aging
Earliest possible date of adoption: September 30, 2001
For further information, please call: (512) 424-6857
Chapter 362.
DEFINITIONS
40 TAC §362.1
The Texas Board of Occupational Therapy Examiners proposes
an amendment to §362.1, concerning Definitions. The amendment will add
a definition for a term which is used in the rules, but which is not defined.
The definition for the Practice Act makes the reference current.
John P. Maline, Executive Director of the Executive Council of Physical
Therapy and Occupational Therapy Examiners, has determined that for the first
five-year period 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. Maline also has determined that for each year of the first five years
the rule is in effect the public benefit anticipated as a result of enforcing
the rule will be clarification of terms used in the OT rules. There will be
no effect on small businesses. There are no anticipated economic costs to
persons who are required to comply with the rule as proposed.
Comments on the proposed rule may be submitted to Augusta Gelfand, OT Coordinator,
Texas Board of Occupational Therapy Examiners, 333 Guadalupe, Suite 2-510,
Austin, Texas, 78701, augusta.gelfand@mail.capnet.state.tx.us
The amendment is proposed under the Occupational Therapy Practice
Act, Title 3, Subchapter H, Chapter 456, Occupations Code, which provides
the Texas Board of Occupational Therapy Examiners with the authority to adopt
rules consistent with this Act to carry out its duties in administering this
Act.
Title 3, Subchapter H, Chapter 454 of the Occupations Code is affected
by this amended section.
§362.1.Definitions.
The following words, terms, and phrases, when used in this part shall
have the following meaning, unless the context clearly indicates otherwise.
(1)
Act--The Occupational Therapy Practice Act,
Title
3, Subtitle H, Chapter 454 of the Occupations Code
[
(2) - (18)
(No change.)
(19)
Face-to-face, real time--Refers to live
interactions either in person or via telecommunications.
(20)
[
(21)
[
(22)
[
(23)
[
(24)
[
(25)
[
(26)
[
(27)
[
(28)
[
(29)
[
(30)
[
(31)
[
(32)
[
(33)
[
(34)
[
(35)
[
(A)
The evaluation/assessment, treatment and education of or
consultation with the individual, family or other persons;
(B)
Interventions directed toward developing, improving or
restoring daily living skills, work readiness or work performance, play skills
or leisure capacities;
(C)
Intervention methodologies to develop restore or maintain
sensorimotor, oral-motor, perceptual or neuromuscular functioning; joint range
of motion; emotional, motivational, cognitive or psychosocial components of
performance.
(36)
[
(37)
[
(38)
[
(39)
[
(40)
[
(41)
[
(42)
[
(43)
[
(44)
[
(45)
[
(46)
[
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 August 17, 2001.
TRD-200104805
John Maline
Executive Director
Texas Board of Occupational Therapy Examiners
Earliest possible date of adoption: September 30, 2001
For further information, please call: (512) 305-6900
$45
] per month for their personal use. In couple cases, each spouse
may retain
$60
[
$45
]. For SSI clients who receive the
$30 reduced federal benefit, the state supplements their incomes by
$30
[
$15
] per month to allow a total of
$60
[
$45
] for personal needs. The effective date of the
$60
[
$45
] PNA is September 1,
2001.
[
1999; prior to that
date, the PNA was $30.
]
Chapter 19.
NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION
Chapter 41.
VENDOR FISCAL INTERMEDIARY PAYMENTS
Part 9.
TEXAS DEPARTMENT ON AGING
Part 12.
TEXAS BOARD OF OCCUPATIONAL THERAPY EXAMINERS
Texas Civil
Statutes, Article 8851
].
(19)
] First Available Examination--Refers
to the first scheduled Examination after successful completion of all educational
requirements.
(20)
] Health Care Condition--See
Medical Condition
(21)
] Investigation Committee--Reviews
and makes recommendations to the board concerning complaints and disciplinary
actions regarding licensees and facilities.
(22)
] Investigator--The employee
of the Executive Council who conducts all phases of an investigation into
a complaint filed against a licensee, an applicant, or an entity regulated
by the board.
(23)
] Jurisprudence Examination--An
examination covering information contained in the Texas Occupational Therapy
Practice Act and Texas Board of Occupational Therapy Examiners rules. This
test is an open book examination with multiple choice or true-false questions.
The passing score is 70%.
(24)
] License--Document issued
by the Texas Board of Occupational Therapy Examiners which authorizes the
practice of occupational therapy in Texas.
(25)
] Licensed Occupational Therapist
(LOT)--A person who holds a valid regular or provisional license to practice
or represent self as an occupational therapist in Texas.
(26)
] Licensed Occupational Therapy
Assistant (LOTA)--A person who holds a valid regular or provisional license
to practice or represent self as an occupational therapy assistant in Texas
and who is required to practice under the general supervision of an OTR or
LOT.
(27)
] Medical Condition--A condition
of acute trauma, infection, disease process, psychiatric disorders, addictive
disorders, or post surgical status
.
Synonymous with the term health
care condition
.
(28)
] Monitored Services--The checking
on the status/condition of students, patients, clients, equipment, programs,
services, and staff in order to make appropriate adjustments and recommendations.
Minimum contact for the purpose of monitoring will be one time a month.
(29)
] NBCOT (formerly AOTCB)--National
Board for Certification in Occupational Therapy (formerly American Occupational
Therapy Certification Board).
(30)
] Non-licensed Personnel--OT
Aide or OT Orderly or other person not licensed by this board who provides
support services to occupational therapists and occupational therapy assistants,
and whose activities require on-the-job training and close personal supervision.
(31)
] Non-Medical Condition--A
condition where the ability to perform occupational roles is impaired by developmental
disabilities, learning disabilities, the aging process, sensory impairment,
psychosocial dysfunction, or other such conditions which does not require
the routine intervention of a physician.
(32)
] Occupational Therapist (OT)--A
person who holds a Temporary License to practice as an occupational therapist
in the state of Texas, who is waiting to receive results of taking the first
available Examination, and who is required to be under continuing supervision
of an OTR or LOT.
(33)
] Occupational Therapist, Registered
(OTR)--An alternate term for a Licensed Occupational Therapist. An individual
who uses this term must hold a regular or provisional license to practice
or represent self as an occupational therapist in Texas. An individual who
uses this term is responsible for ensuring that he or she is otherwise qualified
to use it.
(34)
] Occupational Therapy--The
use of purposeful activity or intervention to achieve functional outcomes.
Achieving functional outcomes means to develop or facilitate restoration of
the highest possible level of independence in interaction with the environment.
Occupational Therapy provides services to individuals limited by physical
injury or illness, a dysfunctional condition, cognitive impairment, psychosocial
dysfunction, mental illness, a developmental or learning disability or an
adverse environmental condition, whether due to trauma, illness or condition
present at birth. Occupational therapy services include but are not limited
to:
(35)
] Occupational Therapy Assistant
(OTA)--A person who holds a Temporary License to practice as an occupational
therapy assistant in the state of Texas, who is waiting to receive results
of taking the first available Examination, and who is required to be under
continuing supervision of an OTR or LOT.
(36)
] Occupational Therapy Plan
of Care--A written statement of the planned course of Occupational Therapy
intervention for a patient/client. It must include goals, objectives and/or
strategies, recommended frequency and duration, and may also include methodologies
and/or recommended activities.
(37)
] Occupational Therapy Practitioners-Occupational
Therapists and Occupational Therapy Assistants licensed by this board.
(38)
] Place(s) of Business--Any
facility in which a licensee practices.
(39)
] Practice--Providing occupational
therapy as a clinician, practitioner, educator, or consultant. Only a person
holding a license from TBOTE may practice occupational therapy in Texas.
(40)
] Recognized Educational Institution--An
educational institution offering a course of study in occupational therapy
that has been accredited or approved by the American Occupational Therapy
Association.
(41)
] Regular License--A license
issued by TBOTE to an applicant who has met the academic requirements and
who has passed the Examination.
(42)
] Rules--Refers to the TBOTE
Rules.
(43)
] Screening--A process or tool
used to determine a potential need for occupational therapy interventions.
This information may be compiled using observation, medical or other records,
the interview process, self-reporting, and/or other documentation.
(44)
] Supervision--See Chapter
373[
-Supervision
] of this title (relating to Supervision)
(45)
] Temporary License--A license
issued by TBOTE to an applicant who meets all the qualifications for a license
except taking the first available Examination after completion of all education
requirements.
Chapter 374.
DISCIPLINARY ACTIONS/DETRIMENTAL PRACTICE/COMPLAINT PROCESS/CODE OF ETHICS