The amendment is proposed under the Human Resources Code, Title 2, Chapters 22 and 32, which authorizes the department to administer public and medical assistance programs; and under Texas Government Code §531.021, which provides the Health and Human Services Commission with the authority to administer federal medical assistance funds.

The amendment implements the Human Resources Code, §§22.001-22.030 and §§32.001-32.042.

§19.801.Resident Assessment.

The facility must conduct initially and periodically a comprehensive accurate, standardized, reproducible assessment of each resident's functional capacity. In Medicaid nursing facilities, admission, annual, quarterly and significant change assessments must be transmitted electronically to the Texas Department of Human Services (DHS).

(1)

Admission orders. At the time each resident is admitted, the facility must have physician orders for the resident's immediate care.

(2)

Comprehensive assessments.

(A)

A facility must make a comprehensive assessment of a resident's needs, using the Resident Assessment Instrument (RAI), including the Minimum Data Set (MDS), specified by DHS. Licensed-only facilities do not have to complete Medicaid-specific sections.

(B)

The assessment must include at least the following information:

(i)

identification and demographic information;

(ii)

customary routine;

(iii)

cognitive patterns;

(iv)

communication;

(v)

vision;

(vi)

mood and behavior patterns;

(vii)

psychosocial well-being;

(viii)

physical functioning and structural problems;

(ix)

continence;

(x)

disease diagnoses and health conditions;

(xi)

dental and nutritional status;

(xii)

skin condition;

(xiii)

activity pursuit;

(xiv)

medications;

(xv)

special treatments and procedures;

(xvi)

discharge potential;

(xvii)

documentation of summary information regarding the additional assessment performed through the resident assessment protocols; and

(xviii)

documentation of participation in assessment. The assessment process must include direct observation and communication with the resident, as well as communication with licensed and nonlicensed direct care staff members on all shifts.

(C)

A facility must conduct a comprehensive assessment of a resident as follows:

(i)

within 14 calendar days after admission, excluding readmissions in which there is no significant change in the resident's physical or mental condition. For purposes of this section, "readmission" means a return to the facility following a temporary absence for hospitalization or for therapeutic leave.

(ii)

within 14 calendar days after the facility determines, or should have determined, that there has been a significant change in the resident's physical or mental condition. For purposes of this section, a "significant change" means a major decline or improvement in the resident's status that will not normally resolve itself without further intervention by staff or by implementing standard disease-related clinical interventions, that has an impact on more than one area of the resident's health status, and requires interdisciplinary review or revision of the care plan, or both.

(iii)

not less often than once every 12 months.

(3)

Quarterly review assessment. A facility must assess a resident using the quarterly review instrument specified by DHS and approved by the Health Care Financing Administration (HCFA) not less frequently than once every three months.

(4)

Use. A facility must maintain all resident assessments completed within the previous 15 months in the resident's active record and use the results of the assessments to develop, review, and revise the resident's comprehensive plan of care as specified in §19.802 of this title (relating to Comprehensive Care Plans).

(5)

Preadmission Screening and Resident Review (PASARR). A Medicaid-certified facility must coordinate assessments with the PASARR program under Medicaid in Part 483, Subpart C to the maximum extent practicable to avoid duplicative testing and effort.

(6)

Automated data processing requirement.

(A)

Encoding data. Within seven days after a facility completes a resident's assessment, a facility must encode the following information for each resident in the facility:

(i)

admission assessment;

(ii)

annual assessment updates;

(iii)

significant change in status assessments;

(iv)

quarterly review assessments;

(v)

a subset of items upon a resident's transfer, reentry, discharge, and death, using the reentry tracking form and/or discharge tracking form; and

(vi)

background (face-sheet) information, if there is no admission assessment.

(B)

Transmitting data. Within seven days after a facility completes a resident's assessment, a facility must be capable of transmitting to DHS information for each resident contained in the MDS in a format that conforms to standard record layouts and data dictionaries, and that passes standardized edits defined by HCFA and DHS.

(C)

Monthly transmittal requirements. A facility must electronically transmit, at least monthly (within 31 days of the lock date), encoded, accurate, complete MDS data to DHS for all assessments conducted during the previous month, including the following:

(i)

admission assessment;

(ii)

annual assessment;

(iii)

significant change in status assessment;

(iv)

significant correction of prior full assessment;

(v)

significant correction of prior quarterly assessment;

(vi)

quarterly review;

(vii)

a subset of items upon a resident's transfer, reentry, discharge, and death; and

(viii)

background (face-sheet) information, for an initial transmission of MDS data on a resident that does not have an admission assessment;

(D)

Data format. The facility must transmit data in the format specified by DHS and approved by HCFA.

(E)

Resident-identifiable information.

(i)

A facility may not release information that is resident-identifiable to the public.

(ii)

The facility may release information that is resident-identifiable to an agent only in accordance with a contract under which the agent agrees not to use or disclose the information except to the extent the facility itself is permitted to do so.

(7)

Accuracy of assessments. The assessment must accurately reflect the resident's status.

(8)

Coordination. A registered nurse must conduct or coordinate each assessment with the appropriate participation of health professionals.

(9)

Certification.

(A)

A registered nurse must sign and certify that the assessment is completed.

(B)

Each individual who completes a portion of the assessment must sign and certify the accuracy of that portion of the assessment.

(10)

Penalty for falsification in Medicaid-certified facilities.

(A)

An individual who willfully and knowingly:

(i)

certifies a material and false statement in a resident assessment is subject to a civil money penalty of not more than $1,000 for each assessment; or

(ii)

causes another individual to certify a material and false statement in a resident assessment is subject to a civil money penalty of not more than $5,000 for each assessment.

(B)

Clinical disagreement does not constitute a material and false statement.

(11)

Use of independent assessors in Medicaid-certified facilities. If DHS determines, under a certification survey or otherwise, that there has been a knowing and willful certification of false statements under paragraph (10) of this section, DHS may require (for a period specified by DHS) that resident assessments under this paragraph be conducted and certified by individuals who are independent of the facility and who are approved by DHS.

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 April 1, 1999.

TRD-9901964

Paul Leche

General Counsel, Legal Services

Texas Department of Human Services

Proposed date of adoption: July 1, 1999

For further information, please call: (512) 438-3765

The Texas Department of Human Services (DHS) proposes the repeal of §41.1, concerning Level of Care; §41.2, concerning Day of Discharge Payment; §41.3, concerning Certified Out-of-State Patients; §41.4, concerning SSI Recipient Payment; §41.5, concerning Out-of-State Payment; §41.201, concerning Activities of Health Insuring Agent; §41.301, concerning Preadmissions; §41.302, concerning Admissions; §41.401, concerning Continued Stay Reviews for Utilization Review Committee; §41.402, concerning Continued Stay Reviews by the LTCU (Long Term Care Unit) (Skilled Recipients); §41.403, concerning Confidentiality; §41.501, concerning Continued Stay Review for Utilization Review Committee; §41.502, concerning Continued Stay Reviews by the LTCU (ICF Recipients); §41.503, concerning Confidentiality; §41.601, concerning Development of Utilization Review Committees; §41.701, concerning Preadmissions; §41.702, concerning Admissions; §41.703, concerning Continued Stay Review Appeals Procedure; §41.704, concerning Waiver Procedure; §41.801, concerning Definitions; and §41.802, concerning Criteria for Medicaid Level-of-Care Determination, in its Utilization Review chapter. The purpose of the repeal is to delete obsolete material.

Eric M. Bost, commissioner, has determined that for the first five-year period the repeals are in effect there will be no fiscal implications for state or local government as a result of enforcing or administering the repeals.

Mr. Bost also has determined that for each year of the first five years the repeals are in effect the public benefit anticipated as a result of enforcing the sections will be that obsolete rules will be repealed. There will be no effect on small businesses, because the rules are obsolete. There is no anticipated economic cost to persons who are required to comply with the proposed repeals.

Questions about the content of this proposal may be directed to Susan Syler at (512) 438-3111 in DHS's Long Term Care section. Written comments on the proposal may be submitted to Supervisor, Rules and Handbooks Unit-137, Texas Department of Human Services E-205, P.O. Box 149030, Austin, Texas, 78714-9030, within 30 days of publication in the Texas Register .

Subchapter A. Out-of-State Vendor Payments on Behalf of Texas Residents

The Texas Department of Human Services (DHS) proposes the repeal of §43.1, concerning federal regulations; §43.11, concerning exceptions; §43.21, concerning review of utilization of care and services; §43.31, concerning ongoing review; §43.41, concerning effective health care; §43.51, concerning pharmacy unit responsibility; §43.61, concerning investigation of efficacy and bioequivalency of new drugs; §43.71, concerning administration; §43.81, concerning actions and regulatory mandates; §43.91, concerning interpretations; and §43.101, concerning establishing exceptions, in its Utilization Control chapter. The purpose of the repeal is to delete obsolete material.

Eric M. Bost, commissioner, has determined that for the first five-year period the repeals are in effect there will be no fiscal implications for state or local government as a result of enforcing or administering the repeals.

Mr. Bost also has determined that for each year of the first five years the repeals are in effect the public benefit anticipated as a result of enforcing the sections will be that obsolete rules will be repealed. There will be no effect on small businesses, because the rules are obsolete. There is no anticipated economic cost to persons who are required to comply with the proposed repeals.

Questions about the content of this proposal may be directed to Susan Syler at (512) 438-3111 in DHS's Long Term Care section. Written comments on the proposal may be submitted to Supervisor, Rules and Handbooks Unit-137, Texas Department of Human Services E-205, P.O. Box 149030, Austin, Texas 78714-9030, within 30 days of publication in the Texas Register .

Subchapter A. Management Responsibilities

Subchapter A. Provision of Vocational Rehabilitation Services