Part 1.
TEXAS DEPARTMENT OF HUMAN SERVICES
Chapter 46.
LICENSED PERSONAL CARE FACILITIES CONTRACTING WITH THE TEXAS DEPARTMENT OF HUMAN SERVICES TO PROVIDE RESIDENTIAL CARE SERVICES
The Texas Department of Human Services (DHS) proposes to repeal Subchapter
A, concerning scope, §46.1; Subchapter B, concerning definitions, §46.1001;
Subchapter C, concerning provider participation, §§46.2001, 46.2005,
and 46.2006; Subchapter D, concerning claims payment, §§46.3001,
46.3005, and 46.3007; Subchapter E, concerning provider contracts, §§46.4004
- 46.4006; Subchapter F, concerning records, §46.5001; Subchapter G,
concerning support documents, §46.7002; and Subchapter H, concerning
administrative and financial errors, §§46.8001 - 46.8003. DHS proposes
new Subchapter A, concerning introduction, §46.1 and §46.3; Subchapter
B, concerning provider contracts, §§46.11, 46.13, 46.15, 46.17,
46.19, 46.21, 46.23, 46.25, 46.27; Subchapter C, concerning provider requirements, §§46.31,
46.33, 46.35, 46.37, 46.39, 46.41, 46.43, 46.45, 46.47, 46.49, 46.51; and
Subchapter D, concerning trust funds, §§46.61, 46.63, 46.65, 46.67,
46.69, 46.71, in its renamed Contracting to Provide Assisted Living and Residential
Care Services chapter.
The purpose of the repeals and new sections is to rewrite the chapter in
plain language so that the sections are easier to understand. The new sections
also incorporate existing policy into rule language. These incorporations
of existing policy include: a new definition of personal leave day; a list
of additional items the client may request and for which the facility may
charge; directions for the facility when a credit balance exists on the client's
copayment and room and board account; documentation requirements for a copayment
and room and board ledger system; improved trust fund guidelines patterned
after nursing facility trust fund guidelines; receipt requirements; clarification
of reasons for service suspension to ensure consistency with other Community
Care for Aged and Disabled (CCAD) programs; a listing of required financial
records the facility is expected to keep for audit purposes, and; a clarification
of facility monitoring methods.
Bobby Halfmann, Chief Financial Officer, has determined that, for the first
five-year period the proposed sections will be in effect, there will be no
fiscal implications for state or local government as a result of enforcing
or administering the sections.
Bettye M. Mitchell, Deputy Commissioner for Long Term Care, has determined
that, for each year of the first five years the sections are in effect, the
public benefit anticipated as a result of enforcing the sections will be to
have rules that providers, facilities, and the public can more easily navigate
and understand. Rule consistency will help service providers and agency staff
ensure quality services for clients. Current provider requirements for the
Community Based Alternatives (CBA) Assisted Living/Residential Care (AL/RC)
program and the Community Care Residential Care (RC) program are in different
rule chapters. The proposal incorporates provider requirements for the CBA
AL/RC and RC programs into the same rule chapter. There will be no adverse
economic effect on small or micro businesses as a result of enforcing or administering
the sections, because the proposal does not add any new requirements that
would have a negative economic impact on businesses. The majority of policy
additions to this chapter are already program policy. New and enhanced requirements
for trust funds will also better protect both clients and facilities when
a trust fund exists. There is no anticipated economic cost to persons who
are required to comply with the proposed sections. There is no anticipated
effect on local employment in geographic areas affected by these sections.
Questions about the content of this proposal may be directed to Cathryn
Horton at (512) 438-4259 in DHS's Long Term Care section. Written comments
on the proposal may be submitted to Supervisor, Rules and Handbooks Unit-116,
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 Government Code, DHS has determined that
Chapter 2007 of the Government Code does not apply to these rules. Accordingly,
DHS is not required to complete a takings impact assessment regarding these
rules.
Subchapter A. SCOPE
40 TAC §46.1
(Editor's note: The text of the following section proposed for
repeal will not be published. The section 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 repeal is proposed under the Human Resources
Code, Chapters 22 and 32, which authorizes DHS to administer public and medical
assistance programs, and under Government Code, §531.021, which provides
the Texas Health and Human Services Commission with the authority to administer
federal medical assistance funds.
The repeal implements the Human Resources Code, §§22.0001 - 22.038
and §§32.001 - 32.053.
§46.1.Scope
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 March 14, 2003.
TRD-200301753
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: April 27, 2003
For further information, please call: (512) 438-3734
40 TAC §46.1001
(Editor's note: The text of the following section proposed for
repeal will not be published. The section 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 repeal is proposed under the Human Resources
Code, Chapters 22 and 32, which authorizes DHS to administer public and medical
assistance programs, and under Government Code, §531.021, which provides
the Texas Health and Human Services Commission with the authority to administer
federal medical assistance funds.
The repeal implements the Human Resources Code, §§22.0001 - 22.038
and §§32.001 - 32.053.
§46.1001.Definitions of Program Terms.
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 March 14, 2003.
TRD-200301754
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: April 27, 2003
For further information, please call: (512) 438-3734
40 TAC §§46.2001, 46.2005, 46.2006
(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, Chapters 22 and 32, which authorizes DHS to administer public and medical
assistance programs, and under Government Code, §531.021, which provides
the Texas Health and Human Services Commission with the authority to administer
federal medical assistance funds.
The repeals implement the Human Resources Code, §§22.0001 - 22.038
and §§32.001 - 32.053.
§46.2001.Required Services.
§46.2005.Standards for Operation.
§46.2006.Facility Reporting and Notification Requirements.
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 March 14, 2003.
TRD-200301755
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: April 27, 2003
For further information, please call: (512) 438-3734
40 TAC §§46.3001, 46.3005, 46.3007
(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, Chapters 22 and 32, which authorizes DHS to administer public and medical
assistance programs, and under Government Code, §531.021, which provides
the Texas Health and Human Services Commission with the authority to administer
federal medical assistance funds.
The repeals implement the Human Resources Code, §§22.0001 - 22.038
and §§32.001 - 32.053.
§46.3001.General Billings/Claims Payment Requirements.
§46.3005.Claims Requirements.
§46.3007.Copayment.
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 March 14, 2003.
TRD-200301756
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: April 27, 2003
For further information, please call: (512) 438-3734
40 TAC §§46.4004 - 46.4006
(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, Chapters 22 and 32, which authorizes DHS to administer public and medical
assistance programs, and under Government Code, §531.021, which provides
the Texas Health and Human Services Commission with the authority to administer
federal medical assistance funds.
The repeals implement the Human Resources Code, §§22.0001 - 22.038
and §§32.001 - 32.053.
§46.4004.Unit Rate Contracts.
§46.4005.Facility Charges for Hospital/Nursing Facility Stays.
§46.4006.Termination of 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 March 14, 2003.
TRD-200301757
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: April 27, 2003
For further information, please call: (512) 438-3734
40 TAC §46.5001
(Editor's note: The text of the following section proposed for
repeal will not be published. The section 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 repeal is proposed under the Human Resources
Code, Chapters 22 and 32, which authorizes DHS to administer public and medical
assistance programs, and under Government Code, §531.021, which provides
the Texas Health and Human Services Commission with the authority to administer
federal medical assistance funds.
The repeal implements the Human Resources Code, §§22.0001 - 22.038
and §§32.001 - 32.053.
§46.5001.Record Requirements.
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 March 14, 2003.
TRD-200301758
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: April 27, 2003
For further information, please call: (512) 438-3734
40 TAC §46.7002
(Editor's note: The text of the following section proposed for
repeal will not be published. The section 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 repeal is proposed under the Human Resources
Code, Chapters 22 and 32, which authorizes DHS to administer public and medical
assistance programs, and under Government Code, §531.021, which provides
the Texas Health and Human Services Commission with the authority to administer
federal medical assistance funds.
The repeal implements the Human Resources Code, §§22.0001 - 22.038
and §§32.001 - 32.053.
§46.7002.Reimbursement Methodology for Residential 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 March 14, 2003.
TRD-200301759
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: April 27, 2003
For further information, please call: (512) 438-3734
40 TAC §§46.8001 - 46.8003
(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, Chapters 22 and 32, which authorizes DHS to administer public and medical
assistance programs, and under Government Code, §531.021, which provides
the Texas Health and Human Services Commission with the authority to administer
federal medical assistance funds.
The repeals implement the Human Resources Code, §§22.0001 - 22.038
and §§32.001 - 32.053.
§46.8001.Administrative Errors.
§46.8002.List of Administrative Errors.
§46.8003.Financial Errors.
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 March 14, 2003.
TRD-200301760
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: April 27, 2003
For further information, please call: (512) 438-3734
Subchapter A. INTRODUCTION
40 TAC §46.1, §46.3
The new sections are proposed under the Human Resources Code,
Chapters 22 and 32, which authorizes DHS to administer public and medical
assistance programs, and under Government Code, §531.021, which provides
the Texas Health and Human Services Commission with the authority to administer
federal medical assistance funds.
The new sections implement the Human Resources Code, §§22.0001
- 22.038 and §§32.001 - 32.053.
§46.1.Purpose.
This chapter establishes the requirements for facilities contracting
to provide assisted living and residential care services to eligible clients
through the Texas Department of Human Services Community Based Alternatives
(CBA) Assisted Living/Residential Care (AL/RC) Program and the Community Care
for the Aged and Disabled (CCAD) Residential Care (RC) Program. The requirements
described in this chapter apply to both CBA AL/RC and CCAD RC, unless otherwise
specified in the text.
§46.3.Definitions.
The words and terms used in this chapter have the following meanings,
unless the context clearly indicates otherwise.
(1)
Attendant--A facility employee who provides direct care
to clients.
(2)
Assisted living services--Services provided in an assisted
living facility to eligible Texas Department of Human Services (DHS) clients
under the Community Based Alternatives (CBA) Assisted Living/Residential Care
(AL/RC) or the Community Care for Aged and Disabled (CCAD) Residential Care
(RC) programs.
(3)
Assisted Living/Residential Care (AL/RC) Program--A 24-hour
residential care program for CBA clients.
(4)
Case manager--A DHS employee who is responsible for case
management activities. Activities include eligibility determination, client
registration, assessment and reassessment of client need, service plan development,
and intercession on the client's behalf.
(5)
Client--A CCAD or CBA client, as defined in Chapter 48
of this title (relating to Community Care for Aged and Disabled), who is eligible
to receive services under this chapter.
(6)
Community Based Alternatives (CBA)--A Medicaid program
that provides services to eligible adults who are aged and/or disabled as
an alternative to institutional care in a nursing facility. CBA services are
provided in accordance with the waiver provisions of §1915(c) of the
Social Security Act (42 U.S.C. 1396n(c)).
(7)
Community Care for Aged and Disabled (CCAD)--A group of
DHS programs that provides a variety of state-funded and Title XIX-funded
community-based services.
(8)
Contract--The formal, written agreement between DHS and
an assisted living facility to provide services to DHS clients eligible under
this chapter in exchange for reimbursement.
(9)
Contract manager--A DHS employee who is responsible for
the overall management of the contract with the assisted living facility.
(10)
Contracted assisted living facility--An assisted living
facility that contracts with DHS to provide CBA AL/RC services or CCAD RC
services or both. Any reference to facility in this chapter means contracted
assisted living facility, unless otherwise specified in the text.
(11)
Copayment--The amount of personal income a client must
pay to the facility toward the cost of care.
(12)
Days--Any reference to days means calendar days, unless
otherwise specified in the text. Calendar days include weekends and holidays.
(13)
Facility manager--The facility employee who is responsible
for the day-to-day operation of a facility.
(14)
Licensed assisted living facility--A facility licensed
by DHS Long Term Care Regulatory under the Health and Safety Code, Chapter
247.
(15)
Personal leave day--A continuous 24-hour period, measured
from midnight to midnight.
(16)
Representative--The client's spouse, other responsible
party, or legal representative.
(17)
Residential Care (RC) Program--An assisted living and
emergency care program for CCAD clients.
(18)
Room and board--The amount of personal income a client
must pay to the facility toward the cost of lodging and food. Room and board
payments do not apply to the CCAD RC Program.
(19)
Signature--The regular signature of the person signing.
Initials are not an acceptable substitute for a signature.
(20)
Trust fund--The account required when the facility holds
the client's personal funds and performs money management at the written request
of the client or the client's representative.
(21)
Witness--A person who signs to verify distribution to
or from a trust fund. A witness is identified in the client file by name,
address, and relationship to the client, the client's representative, or the
facility. A witness can be any person except:
(A)
the person(s) responsible for accounting for the client's
trust fund;
(B)
the supervisor of the person(s) responsible for the client's
trust fund;
(C)
a person supervised by the person(s) responsible for the
client's trust fund; or
(D)
the person(s) who accepts the withdrawn funds.
(22)
Working days--Days DHS is open for business.
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 March 14, 2003.
TRD-200301761
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: April 27, 2003
For further information, please call: (512) 438-3734
40 TAC §§46.11, 46.13, 46.15, 46.17, 46.19, 46.21, 46.23, 46.25, 46.27
The new sections are proposed under the Human Resources Code,
Chapters 22 and 32, which authorizes DHS to administer public and medical
assistance programs, and under Government Code, §531.021, which provides
the Texas Health and Human Services Commission with the authority to administer
federal medical assistance funds.
The new sections implement the Human Resources Code, §§22.0001
- 22.038 and §§32.001 - 32.053.
§46.11.Contracting Requirements.
(a)
General contracting requirements. A facility must meet
all provisions described in this chapter and Chapter 49 of this title (relating
to Contracting for Community Care Services).
(b)
Assisted living services contracting requirements. To qualify
to provide assisted living services under contract with the Texas Department
of Human Services (DHS), a facility must comply with the following requirements:
(1)
The facility must be licensed as defined in §92.4
of this title (relating to Types of Assisted Living Facilities). The facility
must be allowed under licensure to provide the required services described
in §46.39 of this chapter (relating to Required Services). Due to the
licensure requirements, Type C and Type E facilities are not able to provide
the required services under this chapter.
(2)
The facility must have a separate contract for each facility
that provides assisted living services.
(3)
The facility must specify the number of beds for DHS clients
in its contract, as follows:
(A)
The facility must ensure that the number of beds contracted
meets the requirements in §46.13 of this chapter (relating to Housing
Options).
(B)
The facility must ensure the number of DHS clients served
by the facility does not exceed the number of contracted DHS beds.
(C)
The facility may adjust the number of beds for DHS clients
by contract amendment.
(4)
The facility must comply with all other applicable DHS
rules and regulations.
(c)
Designated rooms. The facility may designate specific rooms
or apartments for DHS clients.
(1)
In addition to the requirements described in subsection
(b)(3) of this section, the facility must list in its contract the specific
rooms or apartments designated for DHS clients.
(2)
The facility may change the specific rooms or apartments
designated for DHS clients by amending its contract.
(d)
Disclosure statement requirements. The facility must ensure
that the Assisted Living Disclosure Statement, as required by Chapter 92 of
this title (relating to Licensing Standards for Assisted Living Facilities),
does not conflict with the program requirements.
(e)
Client referrals. The facility must accept all DHS referrals
unless:
(1)
the referral would cause the facility to exceed licensed
capacity;
(2)
the referral would cause the facility to exceed the number
of beds for DHS clients that the facility has specified in its contract;
(3)
there are no specific DHS designated rooms or apartments
available at the time of the referral; or
(4)
the facility is unable to meet the client's needs and DHS
has approved the refusal in writing.
(f)
Contract assignment. In addition to the procedures described
in §49.5 of this title (relating to Contract Assignment), the facility
must follow the procedures described in §46.71 of this chapter (relating
to Trust Fund Procedures for Client Discharge) for assignment of the trust
fund account and records.
§46.13.Housing Options.
(a)
Setting. A facility must specify in the contract the type(s)
of setting(s) it uses to provide assisted living services according to the
following guidelines.
(1)
Assisted living apartment. An assisted living apartment
setting is a living unit that is a private space with living and sleeping
areas, a kitchen, a bathroom, and adequate storage space. The bedroom must
be single occupancy, except when the participant requests double occupancy
in writing. The living unit must have private kitchen and bath facilities.
(A)
Size. Assisted living apartments must have a minimum of
220 square feet, not including the bathroom. Current contracted assisted living
apartments that do not meet the square footage requirement may remain at their
current size unless the apartment is remodeled. Remodeling includes:
(i)
the construction, removal, or relocation of walls and partitions;
(ii)
the construction of foundations, floors, or ceiling-roof
assemblies;
(iii)
the expansion or alteration of safety systems, including:
(I)
sprinkler;
(II)
fire alarm; and
(III)
emergency systems; or
(iv)
the conversion of space in a facility to a different use.
(B)
Kitchen. The kitchen is an area equipped with a sink, refrigerator,
a cooking appliance, adequate space for food preparation, and storage space
for utensils and supplies. The cooking appliance must be a stove, microwave,
or built-in surface unit. The cooking appliance must be able to be removed
or disconnected.
(C)
Bathroom. The bathroom must be a separate room in the individual's
living area with a toilet, sink, and an accessible bath.
(2)
Residential care apartment. A residential care apartment
setting is a living unit that is a private space with connected sleeping,
kitchen, and bathroom areas and adequate storage space. The bedroom must be
double occupancy. The living unit must have private kitchen and bath facilities.
(A)
Size. Residential care apartments must have a minimum of
350 square feet of space per client. Indoor common areas used by Texas Department
of Human Services (DHS) clients must be included in computing the minimum
square footage. The portion of the common area allocated must not exceed usable
square footage divided by the maximum number of individuals who have access
to the common areas.
(B)
Kitchen. The kitchen is an area equipped with a sink, refrigerator,
a cooking appliance, adequate space for food preparation, and storage space
for utensils and supplies. The cooking appliance must be a stove, microwave,
or built-in surface unit. The cooking appliance must be able to be removed
or disconnected.
(C)
Bathroom. The bathroom must contain a toilet, sink, and
an accessible bath.
(3)
Residential care non-apartment. A residential care non-apartment
setting is a living unit that does not meet either the definition of an assisted
living apartment or a residential care apartment. A residential care non-apartment
must be double occupancy.
(A)
The facility that specifies the residential care non-apartment
setting must be a freestanding building not physically attached to another
licensed facility.
(B)
The facility must be licensed as an assisted living facility
with a capacity of 16 or fewer beds.
(4)
Personal Care 3. A Personal Care 3 setting is only available
in the Community Based Alternatives (CBA) Assisted Living/Residential Care
(AL/RC) Program, and must meet the following qualifications:
(A)
The facility must be licensed for four to 16 beds in a
residential care non-apartment setting.
(B)
The facility must provide 60% or more of its CBA clients
with a single occupancy bedroom.
(C)
The facility must maintain a minimum staffing ratio of
one direct care staff member for every:
(i)
four clients, including private pay clients, during the
day and evening shifts; and
(ii)
eight clients, including private pay clients, during the
night shift.
(D)
Sixty percent or more of the total clients served each
month must require one-to-one staff assistance. One-to-one assistance is determined
by a value of three or more on the DHS Client Assessment, Review, and Evaluation
form in one or more of the following activities of daily living:
(i)
transferring;
(ii)
eating; or
(iii)
toileting.
(b)
Occupancy. The facility must provide each client with a
private (singe occupancy) or semi-private (double occupancy) living unit.
§46.15.Additional Services and Fees.
(a)
The facility may charge the client or the client's representative
for additional items or services that the Texas Department of Human Services
(DHS) does not require the facility to provide. The client or the client's
representative must request and approve the additional items or services in
writing.
(b)
The facility must not charge the client or the client's
representative for any service provided to the client as required by its contract
with DHS.
(c)
The facility must inform the client or the client's representative
of the additional items or services and the charges for those items or services
at the following times:
(1)
at admission;
(2)
before a change in the additional items, services, or charges;
and
(3)
when the client requests the additional items or services.
(d)
The facility may charge the client or the client's representative
for additional items or services, including:
(1)
private telephone;
(2)
television and/or radio for personal use;
(3)
cable television services;
(4)
personal comfort items, including smoking materials, notions
and novelties, and confections;
(5)
cosmetics and grooming items and services in excess of
those required;
(6)
personal clothing;
(7)
personal reading material;
(8)
gifts purchased on behalf of a client;
(9)
flowers and plants;
(10)
social events and entertainment outside the scope of the
required activities program;
(11)
the cost of being a single occupant in a double occupancy
room, except for:
(A)
a therapeutically required single occupancy room, such
as isolation for infection control; or
(B)
services provided in the assisted living apartment setting,
as defined in §46.13(a)(1) of this chapter (relating to Housing Options);
(12)
specially prepared or alternative food requested instead
of the food generally prepared by the facility;
(13)
the actual amount of the fee charged by the bank for checks
written by the client or the client's representative that are returned for
non-sufficient funds;
(14)
charges for damage to the facility beyond expected wear
and tear. The facility must not charge a security/damage deposit to DHS clients;
and
(15)
pet deposit. A pet deposit does not apply to service animals.
A service animal is any guide dog, signal dog, or other animal trained to
provide assistance to an individual with a disability.
§46.17.Termination of Contract.
(a)
General requirements for termination. The Texas Department
of Human Services (DHS) will terminate the facility's contract as described
in Chapter 49 of this title (relating to Contracting for Community Care Services)
or as otherwise described in this chapter or the facility's contract with
DHS.
(b)
Physical location. DHS will terminate the facility's contract
if the facility loses the right to occupy the physical premises identified
as the service delivery location. The contract termination is effective on
the date the facility loses its right to occupy the physical premises, unless
DHS notifies the facility of a later termination date. DHS will not pay for
services provided after the termination date.
(c)
Payment suspension. DHS may suspend the facility's payments
if the contract is terminated for any reason at any time other than the last
day of a month. Payments will remain suspended until the facility has refunded
all unearned copayment and room and board payments and all trust fund balances
to all clients served.
§46.19.Recordkeeping.
(a)
General documentation requirements. The facility must maintain
the documentation described in Chapter 49 of this title (relating to Contracting
for Community Care Services).
(b)
Record retention requirements. The facility must retain
records for the time periods described in §69.205 of this title (relating
to Contractor's Records).
(c)
Daily service delivery documentation. The facility must
document the client's daily service delivery.
(1)
The daily service delivery documentation must contain the:
(A)
client name;
(B)
facility vendor number issued by Texas Department of Human
Services (DHS);
(C)
coverage period of the daily service delivery documentation;
(D)
tasks assigned;
(E)
tasks performed during the coverage period;
(F)
signature of the facility manager or supervisor; and
(G)
date of signature of the facility manager or supervisor.
(2)
The daily service delivery documentation must be on a single
document. If services delivered during the coverage period exceed the space
on the single document, the facility may use multiple pages. The daily service
delivery document must clearly indicate the number of pages used for the coverage
period.
(d)
Daily census documentation. The facility must document
the daily census of clients.
(1)
The daily census documentation must contain the:
(A)
name of the facility;
(B)
facility vendor number issued by DHS;
(C)
coverage period of the daily census documentation;
(D)
name of each client served during the coverage period;
(E)
daily status of each client for each day during the coverage
period. Types of daily status are:
(i)
admission;
(ii)
discharge;
(iii)
present;
(iv)
personal leave;
(v)
institutional leave;
(vi)
emergency care (emergency care applies only to the Community
Care for Aged and Disabled (CCAD) Residential Care (RC) program); and
(vii)
ineligible emergency care (ineligible emergency care
applies only to the CCAD RC program);
(F)
total of each type of daily status during the coverage
period;
(G)
signature of the authorized timekeeper; and
(H)
date of the authorized timekeeper's signature.
(2)
The daily census documentation must be on a single document.
If the number of clients served during the coverage period exceeds the space
on the single document, the facility may use multiple pages. The daily census
document must clearly indicate the number of pages used for the coverage period.
(e)
Financial records. The facility must maintain the following:
(1)
records that support billing for payment;
(2)
records that document DHS reimbursement in accounting records.
The documentation must include:
(A)
amount of reimbursement;
(B)
voucher number;
(C)
warrant number;
(D)
date of receipt; and
(E)
sufficient direct deposit information to trace deposits
through the facility's accounting system; and
(3)
additional financial records including, but not limited
to:
(A)
documents such as deposit slips, bank statement, cancelled
checks, program income/client fee ledgers, donation ledgers, and receipts;
(B)
purchase orders;
(C)
receipts, invoices, statements, and delivery receipts;
(D)
journals, ledgers, and other books of account and other
supporting documentation;
(E)
payroll and tax records;
(F)
inventory records for food and other supplies;
(G)
timesheets;
(H)
Internal Revenue Service and Department of Labor records
and forms;
(I)
insurance payments and documentation of persons and vehicles
covered (for example, medical, liability, fire and casualty, and workmen's
compensation);
(J)
equipment inventory records;
(K)
the facility's internal accounting procedures;
(L)
chart of accounts; and
(M)
company policies.
(f)
Subcontractor records. The facility must maintain invoices,
contracts, and service delivery records of all subcontractors. Maintenance
of all records to support subcontractor claims is the responsibility of the
facility, as the prime contractor.
(g)
Registered nurse access. The facility must allow the Home
and Community Support Services Agency's registered nurse access to the client's
medical and service plan records for use in the assessment.
§46.21.Reimbursement.
(a)
The facility must bill for services provided as described
in Chapter 49 of this title (relating to Contracting for Community Care Services).
(b)
The Texas Department of Human Services (DHS) will pay for
eligible services provided and billed in compliance with this chapter.
(c)
A unit of service is one billable day of authorized service
delivered to a client.
(d)
The facility must agree to accept the unit rate authorized
by DHS, plus any applicable room and board payments, as payment in full for
services required by DHS.
(e)
The unit rate reimbursed by DHS includes any copayment.
In no case may the combined reimbursement from DHS and the client or the client's
representative exceed the unit rate specified for each type of setting.
(f)
The facility must deduct the copayment amount from reimbursement
claims submitted to DHS.
(g)
The facility must not bill DHS for the day of discharge,
unless the discharge is due to the death of the client.
(h)
The facility must bill the double occupancy (Residential
Care Apartment) rate for clients in the single occupancy (Assisted Living
Apartment) setting who request double occupancy.
(i)
The facility must bill for the balance of the bedhold charge
for any clients whose daily copayment is less than the maximum bedhold charge
allowed by DHS.
(1)
The facility must determine the client's daily copayment
amount by dividing the client's monthly copayment charge by the number of
days in the month.
(2)
The facility must deduct the client's daily copayment amount
from the bedhold rate and submit the claim to DHS.
(3)
This subsection does not apply to the Community Based Alternatives
(CBA) Assisted Living/Residential Care (AL/RC) Program.
(j)
The facility may bill DHS for emergency care provided to
clients for:
(1)
up 60 days per authorization for eligible clients; or
(2)
five days for a client ineligible for emergency care.
(k)
The facility must not bill for services provided before
or after the authorized effective dates for CBA AL/RC or Community Care for
Aged and Disabled (CCAD) Residential Care (RC) services, as those dates are
determined by DHS.
(l)
When the facility requests a Texas Index of Level of Effort
(TILE) reset, the facility may bill DHS at the new TILE level effective the
date of the TILE assessment. The facility may request only two TILE resets
during each calendar year for each CBA client for the following time periods:
(1)
January through June; and
(2)
July through December.
(m)
CCAD RC services will be reimbursed at the double occupancy
rate, regardless of the actual occupancy.
§46.23.Monitoring Reviews.
Monitoring reviews are conducted through an on-site review and in accordance
with Chapter 49 of this title (relating to Contracting for Community Care
Services). The Texas Department of Human Services (DHS) reviews records on
a regular and systematic basis, and as often as DHS deems necessary. DHS conducts
the following types of monitoring:
(1)
Compliance monitoring. Compliance monitoring is a review
to determine if the facility is delivering services according to the rules
in this chapter. Compliance monitoring includes:
(A)
review of consumer satisfaction surveys conducted;
(B)
review of client records;
(C)
interviews with clients and staff;
(D)
observation of clients and staff; and
(E)
consultations with others as appropriate.
(2)
Fiscal monitoring. Fiscal monitoring is a review of documentation
that supports the facility's billing. The facility is liable for recoupment
of payment if monitoring errors indicate the monthly claims do not correspond
with the daily census documentation and daily service delivery documentation.
Fiscal monitoring includes:
(A)
Financial errors. DHS applies the error to the entire unit
of service. Financial errors include:
(i)
The facility is reimbursed for services, but the daily
census documentation and the daily service delivery documentation are missing
for the period for which services are reimbursed. DHS applies the error to
the total number of units reimbursed for the billing period for which forms
are missing.
(ii)
The facility is reimbursed for units that exceed the units
recorded on daily census documentation and daily service delivery documentation.
DHS applies the error to the total number of units reimbursed in excess of
units recorded.
(iii)
The facility is reimbursed for units of service and the
client did not receive services. DHS applies the error to the total number
of units reimbursed for the days the client did not receive services.
(iv)
The facility is reimbursed for units of service and the
client was Medicaid ineligible. DHS applies the error to the total number
of units reimbursed for the days the client was Medicaid ineligible. This
does not apply to the Community Care for Aged and Disabled (CCAD) Residential
Care (RC) program.
(B)
Administrative errors. Documentation is reviewed for administrative
errors as they exist at the time DHS staff arrive to conduct the monitoring
review. DHS applies the error to the administrative portion of the unit of
service. The administrative portion is 12% of the paid unit rate. Administrative
errors include:
(i)
The facility enters a date of signature on the daily census
documentation that is before the date the last day services are provided.
DHS applies the error to the total number of units reimbursed after the signature
date.
(ii)
The facility fails to sign the daily census documentation.
DHS applies the error to the total number of units reimbursed on the unsigned
form.
(iii)
The facility fails to enter a date of signature on the
daily census documentation to certify total number of units provided to the
client. DHS applies the error to the number of units reimbursed on the undated
form.
(iv)
The facility corrects the date of signature on the daily
census documentation, but fails to initial the correction. DHS applies the
error to the total number of units reimbursed after the earliest signature
date.
(v)
The facility uses a signature stamp on the daily census
documentation, but fails to initial the stamped signature. DHS applies the
error to the total number of units reimbursed on the signature stamped form.
(vi)
The facility makes an illegible entry or illegible correction
to any portion of the record of time on the daily census documentation. DHS
applies the error to the total number of units reimbursed for the days in
which entries are illegible.
(vii)
The facility enters an illegible date of signature or
makes an illegible correction to the date of signature on the daily census
documentation. DHS applies the error to the total number of units on the form.
(viii)
The facility fails to complete the entire daily census
documentation in ink, as described in §49.11(d) of this title (relating
to Record Documentation Requirements). DHS applies the error to the total
number of units reimbursed that were not completed in ink.
(ix)
The facility uses a method other than crossing out and
initialing to change an entry on the daily census documentation. DHS applies
the error to the total number of units reimbursed that were corrected in a
manner other than crossing out and initialing.
(x)
The facility fails to list the client on the daily census
documentation, but the client was listed on the daily service delivery documentation.
DHS applies the error to the total number of units reimbursed for the period
the client was left off the daily census documentation.
(xi)
The facility leaves the daily status blank on the daily
census documentation, but daily activity can be verified on the daily service
delivery documentation. DHS applies the error to the total number of units
reimbursed for which the daily status is left blank on the daily census documentation.
§46.25.Complaints.
A facility must comply with the complaint procedures described in §49.13
of this title (relating to Client Rights and Responsibilities) and §49.14
of this title (relating to Complaint Procedures).
§46.27.Reimbursement Methodology for Residential Care.
(a)
General requirements. The Texas Department of Human Services
(DHS), or its designee, applies the general principles of cost determination
as specified in §20.101 of this title (relating to Introduction).
(b)
Cost reporting.
(1)
Providers must follow the cost-reporting guidelines as
specified in §20.105 of this title (relating to General Reporting and
Documentation Requirements, Methods, and Procedures).
(2)
All contracted providers must submit a cost report unless
the number of days between the date the first DHS client received services
and the provider's fiscal year end is 30 days or fewer.
(3)
The provider may be excused from submitting a cost report
if circumstances beyond the control of the provider make cost report completion
impossible, such as the loss of records due to natural disasters or removal
of records from the provider's custody by any regulatory agency. Requests
to be excused from submitting a cost report must be received by the Texas
Health and Human Services Commission's (HHSC) Rate Analysis department before
the due date of the cost report.
(c)
Reimbursement determination.
(1)
Reporting and verification of allowable costs.
(A)
Providers are responsible for reporting only allowable
costs on the cost report, except where cost report instructions indicate that
other costs are to be reported in specific lines or sections. Only allowable
cost information is used to determine recommended reimbursements. DHS or its
designee excludes from reimbursement determination any unallowable expenses
included in the cost report and makes the appropriate adjustments to expenses
and other information reported by providers. The purpose is to ensure that
the database reflects costs and other information that are necessary for the
provision of services and that are consistent with federal and state regulations.
(B)
Individual cost reports may not be included in the database
used for reimbursement determination if:
(i)
there is reasonable doubt as to the accuracy or allowability
of a significant part of the information reported; or
(ii)
an auditor determines that reported costs are not verifiable.
(C)
When material pertinent to proposed reimbursements is made
available to the public, the material will include the number of cost reports
eliminated from reimbursement determination for the reason stated in subparagraph
(B)(i) of this paragraph.
(2)
Residential care reimbursement. Recommended per diem reimbursement
for residential care is determined as follows.
(A)
Reported allowable expenses are combined into four cost
areas:
(i)
attendant;
(ii)
other direct care;
(iii)
facility; and
(iv)
administration and transportation.
(B)
Facility, transportation (vehicle), and administration
expenses are lowered to reflect expenses for a provider at the lower of:
(i)
85% occupancy rate; or
(ii)
the overall average occupancy rate for licensed beds in
facilities included in the database during the cost-reporting periods included
in the base. The occupancy adjustment is applied if the provider's occupancy
rate is below 85% or the overall average, whichever is lower. The occupancy
adjustment is determined by the individual provider occupancy rate being divided
by .85 or the average occupancy rate of all providers in the database.
(C)
Payroll taxes and employee benefits are allocated to each
salary line item on the cost report on a pro rata basis based on the portion
of that salary line item to the amount of total salary expense for the appropriate
group of staff. Employee benefits will be charged to a specific salary line
item if the benefits are reported separately. The allocated payroll taxes
and employee benefits are Federal Insurance Contributions Act or Social Security,
Medicare contributions, Workers' Compensation Insurance, the Federal Unemployment
Tax Act, and the Texas Unemployment Compensation Act.
(D)
Allowable salaries paid to the director, administrator,
assistant administrator, owner, or partner who work for the Residential Care
contracted provider may be limited to the 90th percentile of an array of salary
costs for the director, administrator, assistant administrator, owner, or
partner.
(E)
The attendant cost area from subparagraph (A)(i) of this
paragraph will be calculated as specified in §20.112 of this title (relating
to Attendant Compensation Rate Enhancement).
(F)
The following applies to the cost areas from subparagraph
(A)(ii) - (iv) of this paragraph:
(i)
Each provider's total reported allowable costs, excluding
depreciation and mortgage interest, are projected from the historical cost-reporting
period to the prospective reimbursement period as described in §20.108
of this title (relating to Determination of Inflation Indices). The prospective
reimbursement period is the period of time that the reimbursement is expected
to be in effect.
(ii)
Cost area per diem expenses are calculated by dividing
total reported allowable costs for each cost area by the total days of service.
Cost area per diem expenses are rank ordered from low to high to produce projected
per diem expense arrays.
(iii)
Reimbursement is determined by selecting from each cost
area the median day of service and the corresponding per diem expense times
1.07. The resulting cost area amounts are totaled to determine the per diem
reimbursement.
(3)
Exceptions to the reimbursement determination methodology.
Reimbursement may be adjusted in accordance with §20.109 of this title
(relating to Adjusting Reimbursement When New Legislation, Regulations, or
Economic Factors Affect Costs) when new legislation, regulations, or economic
factors affect costs.
(d)
Authority to determine reimbursement. The authority to
determine reimbursement is specified in §20.101 of this title.
(e)
Allowable and unallowable costs. In determining whether
a cost is allowable or unallowable, providers must follow the guidelines as
specified in §20.102 of this title (relating to General Principles of
Allowable and Unallowable Costs) and §20.103 of this title (relating
to Specifications for Allowable and Unallowable Costs). In addition to these
sections, the following allowable and unallowable costs are applicable in
the Residential Care (RC) program.
(1)
Allowable costs. Medical supplies required to provide residential
care services are allowable. Allowable medical costs include supply costs
associated with the administration of medications, such as medication cups,
syringes for insulin injections, stethoscopes, blood pressure cuffs, and thermometers.
(2)
Unallowable costs. Unallowable costs include prescription
drugs; non-legend drugs; medical records costs; and compensation for physicians,
pharmacists, and medical directors.
(f)
Reporting revenue. Revenues must be reported on the cost
report in accordance with §20.104 of this title (relating to Revenues).
(g)
Reviews and field audits of cost reports. Desk reviews
or field audits are performed on cost reports of all contracted providers.
The frequency and nature of the field audit are determined by DHS or its designee
to ensure the fiscal integrity of the program. Desk reviews and field audits
will be conducted in accordance with §20.106 of this title (relating
to Basic Objectives and Criteria for Audit and Desk Review of Cost Reports),
and providers will be notified of the results of a desk review or a field
audit in accordance with §20.107 of this title (relating to Notification
of Exclusions and Adjustments). Providers may request an informal review and,
if necessary, an administrative hearing to dispute an action taken under §20.110
of this title (relating to Informal Reviews and Formal Appeals).
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 March 14, 2003.
TRD-200301762
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: April 27, 2003
For further information, please call: (512) 438-3734
40 TAC §§46.31, 46.33, 46.35, 46.37, 46.39, 46.41, 46.43, 46.45, 46.47, 46.49, 46.51
The new sections are proposed under the Human Resources Code,
Chapters 22 and 32, which authorizes DHS to administer public and medical
assistance programs, and under Government Code, §531.021, which provides
the Texas Health and Human Services Commission with the authority to administer
federal medical assistance funds.
The new sections implement the Human Resources Code, §§22.0001
- 22.038 and §§32.001 - 32.053.
§46.31.Staff Requirements.
The facility must have staff as described in §92.41 of this title
(relating to Standards for Type A, Type B, and Type E Assisted Living Facilities).
§46.33.Staff Training.
(a)
General training requirements. The facility must provide
all staff with training as described in §92.41 of this title (relating
to Standards for Type A, Type B, and Type E Assisted Living Facilities).
(b)
Facility manager. In addition to the requirements described
in subsection (a) of this section, someone in the facility with knowledge
of the contracted programs must train the facility manager on the following
topics before the facility manager can assume duties:
(1)
service-specific training for the Community Care for Aged
and Disabled (CCAD) Residential Care (RC) or Community Based Alternatives
(CBA) Assisted Living/Residential Care (AL/RC) programs or both, as applicable;
and
(2)
client characteristics and needs.
(c)
Attendants. An attendant is a facility employee who provides
direct care to clients.
(1)
Initial training. In addition to the requirements found
in subsection (a) of this section, the facility must provide the attendant
with initial training on performing authorized tasks as identified on the
Texas Department of Human Services' Health Assessment/Individual Service Plan
form before the attendant can assume duties.
(2)
Ongoing training. The facility must evaluate the attendant's
ongoing performance and provide training as follows:
(A)
assess the ongoing performance and training needs of each
attendant;
(B)
develop a plan for correcting deficiencies in attendant
performance; and
(C)
train the attendant on the areas of identified deficiencies
according to the performance plan.
(d)
Training documentation. The facility must maintain training
documentation, including the:
(1)
name(s) of attendee(s);
(2)
trainer;
(3)
topics covered; and
(4)
date the training was provided.
(e)
Performance evaluation documentation. The facility must
maintain performance evaluation documentation, including the:
(1)
name of the attendant;
(2)
name of the person evaluating the attendant's performance;
(3)
date of the performance evaluation;
(4)
results of the performance evaluation, including any specific
areas of deficiency identified;
(5)
training plan to remedy the deficiencies; and
(6)
date the training plan was implemented.
§46.35.Copayment and Room and Board.
(a)
Amount. The facility must collect the copayment and room
and board amounts indicated on the Texas Department of Human Services' (DHS's)
Notification of Community Care Services form or DHS's Notification of Community
Based Alternatives (CBA) Services form with the following exceptions:
(1)
Room and board charges do not apply to the Community Care
for Aged and Disabled (CCAD) Residential Care (RC) Program.
(2)
Clients who receive emergency care do not pay a copayment.
(3)
Emergency care services do not apply to the Community Based
Alternatives (CBA) Assisted Living/Residential Care (AL/RC) Program.
(b)
Due date. The facility must collect the entire copayment
and room and board for the current month on or before the end of the month.
(1)
If the end of the month falls on a weekend or a holiday,
the facility must collect the entire copayment and room and board on the first
working day thereafter.
(2)
If the client or the client's representative fails to pay
the entire copayment and room and board by the due date, the facility must
notify the client or the client's representative and the case manager in writing
no later than the first working day after the due date.
(c)
Credit balances.
(1)
A credit balance is an amount due to the client or the
client's representative when there is an overpayment by the client or the
client's representative.
(2)
The facility must handle credit balances as follows:
(A)
The facility must contact the client or the client's representative
within 14 days of receipt of the payment resulting in a credit balance.
(B)
The facility must refund the credit balance the month the
facility receives the payment that results in a credit balance, and offer
the client or the client's representative the following options:
(i)
the client or the client's representative provides the
corrected payment, and the facility returns the original payment;
(ii)
the facility provides the client or the client's representative
with a refund of the credit balance; or
(iii)
the client or the client's representative has the credit
balance applied to the following month's payment. If the client or the client's
representative pays an incorrect amount the following month, the facility
must issue a refund check for the credit balance within 14 days of receipt
of the incorrect payment.
(d)
Copayment and room and board receipts.
(1)
The facility must provide receipts for all copayment and
room and board payments received from or on behalf of clients at the time
the payment is received.
(2)
The facility must keep a copy of all copayment and room
and board receipts.
(3)
Copayment and room and board receipts must contain the
following:
(A)
the name of the client;
(B)
the name of the person making the payment (if not the client);
(C)
the month, day, and year the payment was received;
(D)
the total amount collected;
(E)
the specific amounts of copayment and room and board collected;
(F)
the month and year of the coverage period for the payment
received; and
(G)
the specific information on any credits applied, including
the:
(i)
specific amount credited;
(ii)
month and year of the coverage period of the credit;
(iii)
type of payment credited; and
(iv)
reason for the credit.
(e)
Copayment and room and board ledger. The facility must
maintain a copayment and room and board ledger system for each client.
(1)
The facility may keep the copayment and room and board
ledger systems as separate ledgers, or the facility may combine both ledgers
into a single ledger system. If the facility chooses to keep a single ledger
system, a separate entry must be made for each copayment and room and board
entry.
(2)
The copayment and room and board ledger system must reflect
the following:
(A)
all charges for copayment and room and board by client;
(B)
all payments for copayment and room and board made by or
on behalf of a client;
(C)
all credits for copayment and room and board by client;
and
(D)
a running balance by client.
(3)
The facility must record all activities on the copayment
and room and board ledger system within 14 days of occurrence.
(4)
The copayment and room and board ledger must be maintained
in accordance with generally accepted accounting principles (GAAP).
(f)
Refunds upon discharge. The facility must refund the client's
copayment and room and board for the remaining days of the month following
the date of discharge or death. The refund must be made within five working
days of awareness that the client will be discharged or is deceased.
§46.37.Service Initiation.
(a)
Negotiated move-in date. The facility must negotiate a
move-in date with the Texas Department of Human Services (DHS) case manager
and the client or the client's representative.
(b)
Reserved space. The facility must reserve a living unit
for three days from the agreed upon move-in date for each referred client.
The facility may request another referral after three days if the move-in
date is not re-negotiated.
(c)
Client and facility agreement. The facility must have a
written agreement with the client or the client's representative. Both parties
must sign the written agreement before or at the time of admission. The written
agreement must include the following:
(1)
bedhold policies for hospital and nursing facility stays;
(2)
personal leave policies and charges;
(3)
eviction procedures;
(4)
all available services in the facility; and
(5)
charges for services not paid by DHS and charges not included
in the facility's basic daily rate, as described in §46.15 of this chapter
(relating to Additional Services and Fees).
(d)
Initial health assessment. The facility must complete a
health assessment and develop an individual service plan with the client.
The facility must provide the client or the client's representative with a
copy of the health assessment and individual service plan. The health assessment
and individual service plan must be completed:
(1)
within 72 hours of admission to the facility;
(2)
on DHS's Health Assessment/Individual Service Plan form;
and
(3)
by the appropriate facility staff:
(A)
The facility manager or facility nurse must complete DHS's
Health Assessment/Individual Service Plan form.
(B)
A registered nurse must complete the medication administration
section of DHS's Health Assessment/Individual Service Plan form for Community
Based Alternatives (CBA) Assisted Living/Residential Care (AL/RC) clients.
§46.39.Required Services.
(a)
Service delivery. The facility must provide services according
to the Texas Department of Human Services' (DHS's) Health Assessment/Individual
Service Plan form completed for the client.
(b)
Required services. Services include:
(1)
Personal care. The facility must provide or assist with
personal care services identified on DHS's Health Assessment/Individual Service
Plan form completed for the client. Personal care services are activities
related to the care of the client's physical health that include at a minimum:
(A)
bathing;
(B)
dressing;
(C)
grooming;
(D)
routine hair and skin care;
(E)
exercising;
(F)
toileting;
(G)
medication administration, including injections. This does
not apply to the Community Care for Aged and Disabled (CCAD) Residential Care
(RC) Program;
(H)
transferring/ambulating. This does not apply to clients
residing in a Type A assisted living facility;
(I)
twenty-four-hour supervision. The facility must conduct
and document in the client file checks or visits to each client to ensure
that each client is safe and well. The checks or visits must be made as identified
on DHS's Health Assessment/Individual Service Plan form completed for the
client; and
(J)
meal services. The facility must:
(i)
plan, cook, and serve at least three meals per day. The
meals must;
(I)
supply 100% of the United States Department of Agriculture's
recommended dietary allowance (RDA) for adults; and
(II)
provide adequate nutrition, and achieve and sustain the
client's health;
(ii)
provide therapeutic medical diets as prescribed by the
client's physician;
(iii)
offer dietary counseling and nutrition education to the
client;
(iv)
modify food texture, including:
(I)
chopping, grinding, mashing, and pureeing foods for clients
who have trouble chewing; and
(II)
cutting up food into bite size pieces for clients who
have trouble cutting food; and
(v)
assist with eating, including:
(I)
assistance with spoon-feeding in instances when the client
is temporarily ill;
(II)
bread buttering; and
(III)
opening containers or pouring liquids for clients with
hand deformities, paralysis, or hand tremors.
(2)
Home management. The facility must provide or assist with
activities related to housekeeping that are essential to the client's health
and comfort, including:
(A)
changing bed linens;
(B)
housecleaning;
(C)
laundering;
(D)
shopping;
(E)
storing purchased items in the client's living unit. This
includes medical supplies delivered to Community Based Alternatives (CBA)
Assisted Living/Residential Care (AL/RC) clients; and
(F)
washing dishes.
(3)
Transportation and escort.
(A)
The facility must provide the client with transportation,
escort, or both to:
(i)
local community shopping areas where a client may purchase
items to meet his or her personal needs according to the facility's published
schedule;
(ii)
recreational activities, field/community trips according
to the facility's published schedule; and
(iii)
the nearest available medical provider for medical appointments,
therapies, and other medical care.
(B)
The facility must make arrangements for other transportation
for the client to the medical care provider of the client's choice if the
client's medical provider is not the nearest available provider.
(4)
Social and recreational activities. The facility must provide
a minimum of four scheduled social and recreational activities per week.
(A)
Activity requirements. The social and recreational activities
must be:
(i)
planned to meet the social needs and interests of the clients;
and
(ii)
listed on a monthly calendar that is posted in plain view
at the facility at least one week in advance.
(B)
Types of activities. Social and recreational activities
include:
(i)
activities that require group and client-initiated activities;
(ii)
opportunities to interact with other people;
(iii)
interaction, cultural enrichment, educational, or recreational
activities; and
(iv)
other social activities on site or in the community.
(5)
Participation in the client assessment. The facility must
designate someone who is familiar with the CBA AL/RC client's needs and service
plan to participate with the client's assessment. The assessment will determine
the Texas Index of Level of Effort (TILE) at both the annual assessment, and
a requested re-TILE. Participation in the client assessment does not apply
to the CCAD RC Program.
(6)
Emergency care. The facility must provide emergency care
as authorized by the case manager.
(A)
Emergency care is assisted living services provided to
clients while the case manager seeks a permanent living arrangement.
(B)
Emergency care services do not apply to the CBA AL/RC program.
§46.41.Service Plan Changes.
(a)
The facility must complete a new Texas Department of Human
Services Health Assessment/Individual Service Plan form anytime there is a
need for a change in the client's service plan.
(b)
The facility must implement service plan changes within
seven days from the assessment date.
§46.43.Required Notifications.
(a)
The facility must notify the Texas Department of Human
Services (DHS) when one of the following happens:
(1)
significant changes in the client's health and/or condition;
(2)
the client temporarily enters an institution;
(3)
serious occurrences or emergencies involving the client
or facility staff;
(4)
discharge of a client who threatens the health or safety
of himself, herself, or other clients in the facility;
(5)
the client or the client's representative requests that
services end;
(6)
the client refuses to comply with the service plan;
(7)
the client racially discriminates against facility staff
or other residents;
(8)
the client sexually harasses facility staff or other residents;
(9)
the client or the client's representative fails to pay
copayment;
(10)
the client uses ten personal leave days in the current
calendar year;
(11)
the client or the client's representative requests to
move to another facility; or
(12)
when the facility believes that a client's functional
needs have changed such that it will impact the client's Texas Index of Level
of Effort (TILE). This only applies to facilities providing assisted living
services under the Community Based Alternatives (CBA) Assisted Living/Residential
Care (AL/RC) Program that participate in the attendant compensation rate option.
(b)
The facility must notify the client's DHS case manager
orally or by facsimile about the change no later than one DHS workday after
the change happens. If the facility's first notification is oral, the facility
must send written notification to the case manager within five working days
of the initial notification.
§46.45.Suspension of Services.
(a)
The facility must suspend services when one of the following
happens:
(1)
the client dies;
(2)
the client moves from the facility;
(3)
the client is discharged because he threatens the health
or safety of himself or other clients in the facility;
(4)
the client is permanently admitted to an institution;
(5)
the Texas Department of Human Services (DHS) enforces sanctions
against the facility by terminating the contract;
(6)
the client's eligibility is denied; or
(7)
the case manager requests that services be suspended or
terminated.
(b)
If the facility suspends services, the facility must notify
the DHS case manager no later than one working day after the suspension of
services.
(1)
The facility must notify the client's case manager orally
or by facsimile about the reason for service suspension.
(2)
If the facility's first notification is oral, the facility
must send written notification to the case manager within five working days
of the initial notification.
§46.47.Institutional Leave.
(a)
Institution. An institution is defined as a hospital, nursing
facility, state school, state hospital, or intermediate care facility serving
persons with mental retardation or a related condition.
(b)
Institutional leave. Institutional leave is when clients
are absent from the facility because they temporarily enter an institution.
(c)
Bedhold. The facility must hold the client's bed:
(1)
for a Community Care for Aged and Disabled (CCAD) Residential
Care (RC) client for:
(A)
60 days if the client is in a hospital; or
(B)
30 days if the client is in any other type of institution;
and
(2)
for a Community Based Alternatives (CBA) Assisted Living/Residential
Care (AL/RC) client for 60 days if the client is in any type of institution.
(d)
Bedhold charges. The facility must charge the client or
the client's representative for bedhold during institutional leave.
(1)
Bedhold charges for a CCAD RC client are the maximum amount
established by the Texas Department of Human Services (DHS).
(2)
Bedhold charges for a CBA AL/RC client are the room and
board charge.
(e)
Refund of copayment. The facility must not charge the client
or the client's representative more than the maximum amount allowed by DHS
for bedhold. The facility must refund the client's copayment for the days
the client uses institutional leave.
(1)
The facility must refund any copayment paid by a CCAD RC
client or the client's representative that is in excess of the bedhold amount.
If the client's copayment amount is less than the bedhold charge, DHS pays
the difference as described in §46.21 of this chapter (relating to Reimbursement).
(2)
The facility must refund all copayments paid by a CBA AL/RC
client or the client's representative.
(3)
The refund must be made according to the procedures in §46.35(c)
of this chapter (relating to Copayment and Room and Board).
(f)
Billing during institutional leave. The facility must charge
the client or the client's representative only the bedhold amount for the
date of admission to an institution. The facility must charge the client or
the client's representative the full rate for date of return.
(g)
Notification of institutional leave. The facility must
notify the DHS case manager of any institutional leave as described in §46.43
of this chapter (relating to Required Notifications).
§46.49.Personal Leave.
(a)
Personal leave. A client is entitled to 14 days of personal
leave per calendar year.
(b)
Client charges. The facility must collect the entire copayment
and room and board charges for all personal leave days.
(c)
Texas Department of Human Services (DHS) payment during
personal leave. The facility must not bill DHS for more than 14 days of personal
leave taken by the client each calendar year.
(d)
Notification of personal leave days. The facility must
notify the DHS case manager of personal leave days as described under §46.43
of this chapter (relating to Required Notifications).
(e)
Charge for exceeding personal leave days. The client is
responsible for all charges for services if he exceeds the allowable limit
of personal leave days.
§46.51.Client Terminations.
(a)
Client discharge. The facility must obtain prior written
approval from the Texas Department of Human Services (DHS) before discharging
a client, except when the client threatens the health or safety of others
or himself. The facility must notify the DHS case manager as described under §46.45
of this chapter (relating to Suspension of Services).
(b)
Assistance with move. The facility must help the client
prepare for transfer or discharge.
(c)
Refunds. The facility must refund the following:
(1)
copayment and room and board, as described in §46.35(f)
of this chapter (relating to Copayment and Room and Board); and
(2)
trust fund balances, as described in §46.71 of this
chapter (relating to Trust Fund Procedures for Client Discharge).
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 March 14, 2003.
TRD-200301763
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: April 27, 2003
For further information, please call: (512) 438-3734
40 TAC §§46.61, 46.63, 46.65, 46.67, 46.69, 46.71
The new sections are proposed under the Human Resources Code,
Chapters 22 and 32, which authorizes DHS to administer public and medical
assistance programs, and under Government Code, §531.021, which provides
the Texas Health and Human Services Commission with the authority to administer
federal medical assistance funds.
The new sections implement the Human Resources Code, §§22.0001
- 22.038 and §§32.001 - 32.053.
§46.61.Trust Fund Management.
(a)
Clients have the right to:
(1)
manage their financial affairs;
(2)
request that the facility manage their financial affairs;
or
(3)
designate another person to manage their financial affairs.
(b)
The facility must not require clients to deposit their
personal funds with the facility. The facility must:
(1)
have the client's or the client's representative's written
authorization to manage the client's personal funds; and
(2)
upon written request of the client or the client's representative,
hold, safeguard, manage, and account for the personal funds of the client
deposited with the facility.
(c)
The facility must provide each client or client's representative
a written statement of the trust fund rights and responsibilities regarding
the client's financial affairs at the time of admission. The statement must
include the following:
(1)
the facility cannot require clients to deposit their personal
funds with the facility;
(2)
upon written authorization, the facility must hold, safeguard,
manage, and account for the personal funds of the client deposited with the
facility; and
(3)
any charge by the facility for handling a client's personal
funds is included in the facility's basic rate.
§46.63.Trust Fund Bank Account.
(a)
Bank account. The contacted assisted living facility must
keep funds received from or on behalf of a client for a trust fund in a separate
bank account from the facility's operating funds. The account must be identified
as "Trustee, (Name of Facility), Client's Trust Fund Account."
(b)
Commingled funds. A facility may commingle the trust funds
of private-pay clients and Texas Department of Human Services (DHS) clients.
(1)
Each private-pay client or the client's representative
whose funds are commingled with DHS client funds must sign and date a permission
form upon admission or at the time of request for trust fund services. The
permission form must include:
(A)
permission for the facility to commingle the personal funds
of the private pay client with DHS clients;
(B)
permission for the facility to maintain trust fund records
of private-pay clients in the same manner as the DHS client's trust fund records;
and
(C)
a provision allowing inspection of the private-pay client's
trust fund records by DHS staff.
(2)
The facility must keep financial records of private pay
clients with commingled funds in the same manner as the financial records
of DHS clients as specified in this chapter.
(c)
Banking charges.
(1)
The facility may use the following type of checking accounts
for the trust fund:
(A)
a pooled checking account, which is a single checking account
that contains all the personal funds received from each client utilizing the
trust fund;
(B)
a client-choice individual checking account, which is a
single checking account that contains only the personal funds of a single
client. The client or the client's representative must request this type of
trust fund in writing; or
(C)
facility-choice individual checking account, which is a
single checking account that contains only the funds of a single client. This
type of trust fund is set up for the convenience of the facility.
(2)
The facility is responsible for bank fees for the trust
fund kept in a pooled checking account or in facility-choice individual checking
accounts. The facility must not charge these fees to the client or the client's
representative. The facility may report these fees as allowable costs on its
cost report.
(3)
The client or the client's representative is responsible
for bank fees for the trust fund kept in client-choice individual checking
accounts.
(4)
The facility must not charge the client or the client's
representative for the administrative handling of any allowable type of checking
account. The facility may report these costs on its cost report.
(d)
Interest earned. The facility must distribute the interest
earned on the pooled checking account to all clients utilizing the trust fund.
The facility must prorate the actual interest earned to each client's account:
(1)
at the time the financial institution pays the interest;
and
(2)
on the basis of the client's balance at the time the financial
institution pays the interest.
§46.65.Trust Fund Transactions.
(a)
Transactions.
(1)
The facility must keep records of all trust fund transactions.
(2)
Facility staff must record on the client's trust-fund ledger
or deposit/withdrawal document at least the following:
(A)
the date and amount of each deposit;
(B)
the source of each deposit;
(C)
the date and amount of each withdrawal;
(D)
the reason for each withdrawal;
(E)
the name of the person or entity who accepted the withdrawn
funds; and
(F)
the balance after each transaction.
(3)
The client or the client's representative must sign for
each withdrawal transaction at the time of the transaction.
(A)
The signature must be on the trust-fund ledger, deposit/withdrawal
document, or trust fund receipt.
(B)
At least one witness must sign for each withdrawal transaction
if the client or the client's representative cannot sign.
(C)
A signature is not required if the payment meets the definition
of a recurring payment as described in subsection (c) of this section.
(4)
The facility must record transactions within 14 days of
occurrence.
(b)
Bulk purchases. The facility may make bulk purchases for
items used by multiple clients.
(1)
The bulk purchase must be traceable to individual clients.
(2)
The receipt for the bulk purchase must show the following:
(A)
the names of the clients for whom the purchase was made;
and
(B)
the portion of the total price charged to each client.
(3)
The facility must not charge the client or the client's
representative more than the actual cost of the client's portion of items
that are purchased in bulk.
(c)
Recurring payments.
(1)
The facility must obtain the client's or the client's representative's
written request and authorization to make recurring payments on behalf of
the client. The written authorization must include the:
(A)
name of the business or entity to which the recurring payment
is made;
(B)
amount of the recurring payment. If the recurring payment
is not a set amount, the authorization must include the method for determining
the amount of the recurring payment;
(C)
date the payment will begin; and
(D)
signature and signature date of the client or the client's
representative.
(2)
The client or the client's representative must request
and authorize the facility to stop recurring payments on behalf of the client.
(A)
The authorization may be oral or written.
(B)
The facility must document the request, including the:
(i)
name of the business or entity to which the recurring payment
is made; and
(ii)
date the payment will stop.
(3)
The facility is not required to have a receipt for recurring
payments made on behalf of the client.
(d)
Petty cash fund.
(1)
A petty cash fund is part of the trust fund kept on hand
in cash by the facility. The petty cash fund is used for disbursement to clients
for the purchase of minor items.
(2)
The petty cash fund is based upon the type of trust fund
account the facility keeps and is:
(A)
a single pooled petty cash fund; or
(B)
individual petty cash funds for each client.
(3)
The facility must keep the petty cash fund locked.
(4)
The facility must set a dollar limit for petty cash transactions.
(A)
The facility must document:
(i)
the dollar limit of petty cash transactions; and
(ii)
a list of any exceptions to the petty cash transaction
limit, if applicable.
(B)
The facility must follow the procedures in subsection (a)
of this section for withdrawals that exceed the petty cash transaction limit.
(5)
The facility must keep records of all petty cash fund transactions.
The petty cash fund record must be a:
(A)
petty cash fund ledger; or
(B)
petty cash fund receipt.
(6)
A petty cash fund ledger or receipt must include the:
(A)
name of the client;
(B)
date of the withdrawal;
(C)
amount of the withdrawal; and
(D)
signature of client or the client's representative, or
at least one witness if the client or the client's representative cannot sign.
(7)
The facility must use the following guidelines to replenish
the petty cash fund:
(A)
Count the money in the petty cash fund.
(B)
Determine the difference between amount in the petty cash
fund and the amount needed in the petty cash fund.
(C)
Cash a check for the difference between the amount in the
petty cash fund and the amount needed in the petty cash fund.
(i)
Write the check for cash on the appropriate checking account,
either the:
(I)
pooled trust fund checking account; or
(II)
individual client trust fund checking account.
(ii)
Indicate "petty cash fund" in the "memo" line of the check.
(D)
Put the cash in the petty cash fund.
(8)
The facility must reconcile the petty cash fund at least
once every 14 days.
(9)
The facility must follow the requirements for transactions
in subsection (a) of this section to post petty cash fund transactions to
the trust fund ledger. However, the client's or the client's representative's
signature is not required on the trust fund ledger or trust fund receipt if
the client's or the client's representative's signature is on the petty cash
fund ledger or receipt.
(e)
Receipts.
(1)
A trust fund receipt is required when a direct payment
is made from the client's trust fund. The facility may use printed receipts
from vendors as trust fund receipts only if:
(A)
all elements from paragraph (4) of this subsection are
present; or
(B)
any missing elements from paragraph (4) of this subsection
are added.
(2)
A trust fund receipt is required when a payment is received
by the facility on behalf of a client. This is not applicable to funds direct
deposited to the trust fund account.
(3)
A trust fund receipt is not required when the client or
the client's representative makes a direct purchase with funds withdrawn from
the trust fund. The withdrawn funds must meet the requirements listed in subsection
(a) of this section.
(4)
A trust fund receipt must contain the:
(A)
name of the client;
(B)
month, day, and year the receipt was written or created;
(C)
total amount of money spent or received for the client;
(D)
specific item(s) purchased; and
(E)
name of the business or entity from which the purchase
was made or the payment received.
(5)
A trust fund receipt may contain the signature of the client
or the client's representative for payments made from the trust fund. At least
one witness must sign for each payment made if the client or the client's
representative cannot sign.
(f)
Limitations on withdrawals. The facility must not use the
client's personal funds to purchase any item or service that the Texas Department
of Human Services requires the facility to provide. The facility must purchase
additional items or service with the client's personal funds only as described
in §46.15 of this chapter (relating to Additional Services and Fees).
§46.67.Trust Fund Documentation.
(a)
Accounting and records.
(1)
The facility must keep written records of all financial
transactions involving the client's personal funds that the facility is holding,
safeguarding, and accounting.
(2)
The facility must keep the accounting records in accordance
with generally accepted accounting principles (GAAP).
(3)
The facility must keep records in accordance with its fiduciary
duties for client trust funds.
(4)
The facility must include at least the following in the
accounting records:
(A)
each client's name;
(B)
identification of each client's representative or person
assigned to receive the client's income, if any;
(C)
admission date;
(D)
each client's earned interest, if any;
(E)
documentation of each transaction; and
(F)
receipts for purchases and payments, including cash register
tapes or sales statements from a seller.
(b)
Quarterly statement.
(1)
The facility must provide quarterly statements to the client
or the client's representative.
(2)
The quarterly statement must reflect any client funds held
by the facility in an account or in a petty cash account. The quarterly statement
must include at least the following:
(A)
the statement coverage period;
(B)
the balance at the beginning of the statement period;
(C)
all deposits and withdrawals;
(D)
the interest earned;
(E)
the ending balance; and
(F)
the identification number and location of any account in
which the client's personal funds have been deposited.
(c)
Access to trust fund records.
(1)
The facility must make individual client's financial record
and supporting documents available at any time during working hours to the
client, the client's representative, and the Texas Department of Human Services.
(2)
This review can be made without prior notification.
§46.69.Trust Fund Refunds.
(a)
The facility must return the full balance of the client's
personal funds held in the facility to the client or the client's representative
immediately upon request if the request is made during normal business hours.
For purposes of this subsection, normal business hours are 8:00 a.m. to 5:00
p.m. on working days, or at the beginning of the next normal business hours
if the request is received during hours other than normal business hours.
(b)
The facility must return the full balance of the client's
personal funds that the facility has deposited in any bank account to the
client or the client's representative within five working days of request.
This refund must include any interest accrued.
§46.71.Trust Fund Procedures for Client Discharge.
(a)
Client transfer.
(1)
The facility must transfer the client's personal funds
to the new facility either:
(A)
in person; or
(B)
by mail via certified return receipt.
(2)
The facility must complete the transfer within five working
days of the effective date of the transfer.
(3)
The facility must not make any payments out of a client's
trust fund after the effective date of transfer, except as described in this
subsection.
(4)
The new facility must provide a receipt to the old facility
for the transferred funds, which must contain the following elements:
(A)
the name of the client;
(B)
the name of the new facility;
(C)
the date of the transfer of funds. The date of the transfer
of funds is either the:
(i)
date the personal funds of the client are transferred to
the new facility in person; or
(ii)
date the certified return receipt shows the transfer of
funds was mailed;
(D)
the amount received by the new facility; and
(E)
the check number for the transfer of funds.
(b)
Client discharge.
(1)
The facility must refund the discharged client's personal
funds and provide a final accounting of those funds to the client or the client's
representative either:
(A)
in person; or
(B)
by mail via certified return receipt.
(2)
The facility must complete the refund and provide a final
accounting within five working days of the date of discharge, or the date
of the facility's awareness of the client's discharge, whichever is later.
(3)
The facility must not make any payment out of a discharged
client's trust fund, except as described in this subsection.
(4)
The facility must maintain the following documentation
in the client's trust fund record:
(A)
a copy of the final accounting of the client's personal
funds;
(B)
the amount refunded to the discharged client or the client's
representative;
(C)
the date the refund was made. The date the refund was made
is either:
(i)
the date the funds were refunded in person; or
(ii)
the date the certified return receipt shows the refund
was mailed; and
(D)
the method of refund. The facility must:
(i)
obtain the signature of the client or the client's representative
if the refund was in cash; or
(ii)
document the check number if the refund was made by check.
(c)
Client death.
(1)
The facility must refund the deceased client's personal
funds and provide a final accounting of those funds to the beneficiary, heir,
or executor of the deceased client's estate either:
(A)
in person; or
(B)
by mail via certified return receipt.
(2)
The facility must complete the refund and provide a final
accounting within 30 days of awareness of the client's death.
(3)
The facility must not make any payments out of a deceased
client's trust fund, except as described in this subsection.
(4)
The facility must maintain the following documentation
in the client trust fund record:
(A)
a copy of the final accounting of the client's personal
funds;
(B)
the amount refunded to the beneficiary, heir, or executor
of the deceased client's estate;
(C)
the date the refund was made. The date the refund was made
is either:
(i)
the date the funds were refunded in person; or
(ii)
the date the certified return receipt shows the refund
was mailed; and
(D)
the method of refund. The facility must:
(i)
obtain the signature of the client or the client's representative
if the refund was in cash; or
(ii)
document the check number if the refund was made by check.
(5)
The facility must make a bona fide effort to locate the
beneficiary, heir, or executor of a deceased client's estate.
(6)
The facility must use the following procedures to clear
the client's account if it is unable to locate or identify the beneficiary,
heir, or executor of a deceased client's estate:
(A)
The facility must send the personal funds of the deceased
client to the Texas Department of Human Services (DHS), Fiscal Division, P.O.
Box 149055, Austin, Texas 78714-9055 with the following information:
(i)
the client's name;
(ii)
the client's social security number; and
(iii)
the amount of money being submitted to DHS for escheat.
(B)
The facility must maintain the following in the client
trust fund record:
(i)
documentation of the facility's efforts to locate the beneficiary,
heir, or executor of a deceased client's estate; and
(ii)
proof of submission of the personal funds of a deceased
client to DHS.
(d)
Contract assignment.
(1)
The assignor (the facility transferring the contract) must
transfer the bank balances of the trust fund to the assignee (the facility
to which the contract assignment is made) either:
(A)
in person; or
(B)
by mail via certified return receipt.
(2)
The assignor must complete the transfer within five working
days of the effective date of the contract assignment.
(3)
The assignor must not make any payments out of a client's
trust fund after the effective date of the contract assignment, except as
described in this subsection.
(4)
The assignor must provide the assignee with a list of the
clients who are utilizing the trust fund and their balances.
(5)
The assignee must provide the assignor with a receipt for
the transfer of these funds. The receipt must contain the following elements:
(A)
the date of the transfer of funds. The date the transfer
was made is either the:
(i)
date the funds were refunded in person; or
(ii)
date the certified return receipt shows the refund was
mailed;
(B)
the name of the assignor;
(C)
the amount received by the assignee; and
(D)
the check number for the transfer of funds.
(6)
The assignor must keep the receipt for audit purposes.
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 March 14, 2003.
TRD-200301764
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: April 27, 2003
For further information, please call: (512) 438-3734
Chapter 115.
MEMORANDA OF UNDERSTANDING WITH OTHER STATE AGENCIES
The Texas Rehabilitation Commission (TRC) proposes a change to Title
40, Chapter 115, concerning memoranda of understanding with other state agencies.
The proposal repeals and replaces §115.8 to update a memorandum of understanding
dealing with the provision of services needed to prepare students enrolled
in special education to transition from public school to adult life, which
was first adopted in 1990.
Texas Education Code (TEC), §29.011, requires that the Texas Education
Agency (TEA), the Texas Department of Mental Health and Mental Retardation
(TDMHMR), and TRC, by a cooperative effort, develop and by rule adopt an MOU.
TEC, §29.011, specifies that the TEA shall coordinate the development
of the MOU and that the TEA, the TDMHMR, and the TRC may request other appropriate
agencies to participate in the development of the MOU. Accordingly, the adopted
MOU includes the participation of the following agencies: Texas Commission
for the Blind, Texas Commission for the Deaf and Hard of Hearing, Texas Department
of Health, Texas Department of Housing and Community Affairs, Texas Department
of Human Services, Texas Department of Mental Health and Mental Retardation,
Texas Department of Protective and Regulatory Services, Texas Education Agency,
Texas Higher Education Coordinating Board, Texas Juvenile Probation Commission,
Texas Rehabilitation Commission, Texas Workforce Commission, and Texas Youth
Commission.
The adopted new MOU (codified as 19 TAC §89.1110) addresses respective
roles and responsibilities of participating agencies in the sharing of information
about, and coordination of services to, eligible students with disabilities
receiving special education services. The new MOU clarifies and adds definitions
and better addresses information sharing and agency participation, regional
and local collaboration, cross-agency training, and dispute resolution. Other
terms of the MOU provide for the MOU to be reviewed and considered for expansion,
modification, or amendment at any time the executive officers of the parties
agree or at least every four years.
Bill Wheeler, Deputy Commissioner for Financial Services, has determined
that for the first five-year period the section is in effect, there will be
no material fiscal implications for state or local government.
Mr. Wheeler 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 Chapter 111, Human Resources
Code. There will be no material effect on small businesses. There is no material
anticipated economic cost to persons who are required to comply with the section
as proposed. In accordance with Government Code section 2001.022, TRC has
determined that the proposed rule will not affect a local economy.
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.
Subchapter B. DEFINITIONS
Subchapter C. PROVIDER PARTICIPATION
Subchapter D. CLAIMS PAYMENT
Subchapter E. PROVIDER CONTRACTS
Subchapter F. RECORDS
Subchapter G. SUPPORT DOCUMENTS
Subchapter H. ADMINISTRATIVE AND FINANCIAL ERRORS
Chapter 46.
CONTRACTING TO PROVIDE ASSISTED LIVING AND RESIDENTIAL CARE SERVICES
Subchapter B. PROVIDER CONTRACTS
Subchapter C. PROVIDER REQUIREMENTS
Subchapter D. TRUST FUNDS
Part 2.
TEXAS REHABILITATION COMMISSION