Part I.
Texas Department of Human Services
Chapter 45.
Community Living Assistance and Support Services
Subchapter D. Fiscal Monitoring
40 TAC §45.401
The Texas Department of Human Services (DHS) proposes an
amendment to §45.401, concerning Administrative Errors, in its Community
Living Assistance and Support Services chapter. The purpose of the amendment
is to make non-substantive changes to the section. This rule is being amended
because it was found that inclusion of some of the rule was inappropriate.
Eric M. Bost, commissioner, has determined that for the first five- year
period the proposed section will be in effect there will be no fiscal implications
for state or local government as a result of enforcing or administering the
section.
Mr. Bost also has determined that for each year of the first five years
the section is in effect the public benefit anticipated as a result of enforcing
the section will be to promote quality of services, and provide better accessibility
for clients and consumer satisfaction. There will be no effect on small businesses
because the changes are clarifications to existing rules. There is no anticipated
economic cost to persons who are required to comply with the proposed section.
Questions about the content of the proposal may be directed to Gerardo
Cantu at (512) 438-3693 in DHS's Community Care Services section. Written
comments on the proposal may be submitted to Supervisor, Rules and Handbooks
Unit-178, 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 section 2007.003(b) of the Texas Government Code, the department
has determined that Chapter 2007 of the Government Code does not apply to
this rule. Accordingly, the department is not required to complete a takings
impact assessment regarding this rule.
The amendment is proposed under the Human Resources Code, Title
2, Chapters 22 and 32, which provides the department with the authority 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 §§22.001-22.030 and §§32.001-32.042
of the Human Resources Code.
§45.401.Administrative Errors.
A recoupment of 12% of the paid unit rate is the administrative error
exception for services billed [
(1)
Administrative errors on documentation of services delivered
form
or the facsimile
:
(A)-(J)
(No change.)
(K)
The attendant, nurse, therapist, other professional, or
other agency representative fails to sign the documentation of services delivered
form or [
(L)-(M)
(No change.)
(2)-(3)
(No change.)
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of the Secretary of State, on
June 29, 1999.
TRD-9903887
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Proposed date of adoption: September 1, 1999
For further information, please call: (512) 438-3765
Subchapter B. Service Requirements
40 TAC §§47.2902, 47.2910-47.2912
The Texas Department of Human Services (DHS) proposes amendments
to §§47.2902, 47.2910, and 47.2912, concerning requesting prior
approval for primary home care, service breaks, and service plan changes;
and proposes new §47.2911, concerning orientation of attendants, in its
Primary Home Care chapter. The purpose of the amendments and new section is
to add performance standards currently contained in the provider manual and
include procedures for orientation of attendants, service plan changes, and
additional documentation requirements for service breaks.
Eric M. Bost, commissioner, 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.
Mr. Bost also 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 promote quality of services, and provide better accessibility
for clients and consumer satisfaction. There will be no effect on small businesses
because the program standards are currently being followed by providers. There
is no anticipated economic cost to persons who are required to comply with
the proposed sections.
Questions about the content of the proposal may be directed to Gerardo
Cantu at (512) 438-3693 in DHS's Community Care Services section. Written
comments on the proposal may be submitted to Supervisor, Rules and Handbooks
Unit-178, 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 section 2007.003(b) of the Texas Government Code, the department
has determined that Chapter 2007 of the Government Code does not apply to
these rules. Accordingly, the department is not required to complete a takings
impact assessment regarding these rules.
The amendments and new section are proposed under the Human Resources
Code, Title 2, Chapters 22 and 32, which provides the department with the
authority to administer public and medical assistance programs and under Texas
Government Code §531.021, which provides the Health and Human Services
Commission with the authority to administer federal medical assistance funds.
The amendments and new section implement §§22.001-22.030 and
§§32.001-32.042 of the Human Resources Code.
§47.2902.Requesting Prior Approval for Primary Home Care.
(a)-(e)
(No change.)
(f)
Using the service plan form, the RN must develop a service
plan for the client.
The service plan must be agreed upon and signed
by the client/client's family and agency.
The service plan must include:
(1)
(No change.)
(2)
tasks and hours; [
(3)
the attendant service schedule
; and
[
(4)
frequency of supervisory visits.
(g)-(i)
(No change.)
§47.2910.Service Breaks.
(a)
(No change.)
(b)
Verbal approval for a service break extension beyond 14
days must be obtained from the caseworker before obtaining written approval.
The provider agency must request written approval by submitting a case information
form to the caseworker within seven days of the date verbal approval was given.
Subsequent approval(s) for service break(s) are not needed if the initial
break(s) extend another 15 days or more. Regardless of how long the service
break lasts, it is considered only one service break if the break is consecutive.
(c)
The provider agency must ensure that a Priority 1 client
is not without authorized/scheduled services after service initiation unless:
(1)
the service break is caused by circumstances described
in §47.2914(a) and (b) of this title (relating to Suspension of Services);
or
(2)
(No change.)
(3)
the client requests that services not be provided
on a specific day(s)
; or
(4)
the client agrees to less than scheduled
hours as documented in the record; and
(5)
the provider agency notified the
caseworker on the case information form (or facsimile) of the reason within
seven days of the break.
(d)
(No change.)
§47.2911.Orientation of Attendants.
(a)
The supervisor, who is a registered nurse (RN) for a licensed
home health agency, or is not an RN for a personal assistance services (PAS)
agency, must orient that attendant before or when services for the client
begin. The supervisor must meet with the attendant and the client at the client's
home to give the attendant a general orientation about the client. The purpose
of the orientation is to:
(1)
provide the attendant with information needed to provide
the authorized services;
(2)
ensure that the attendant is able to recognize and
report any changes in the client's health (such as shortness of breath, swelling
of feet, or chest pains in the presence of certain health conditions); and
(3)
ensure that the attendant is competent to provide
authorized tasks.
(b)
The supervisor is not required to give this onsite orientation
to the special (substitute) attendant, but must give the special attendant
verbal or written orientation before the special attendant goes to the client's
home.
§47.2912.Service Plan Changes.
(a)
No later than the first Texas Department of Human Services
(DHS)
workday after becoming aware of the change, the provider agency
must verbally notify the caseworker or staff in the caseworker's office about
any change that may require an increase in hours or service termination. The
provider agency must follow up this verbal notification with further notification
in writing, to the caseworker, using the attendant orientation/supervisory
visit form. Written notification must occur within seven days after verbal
notification.
(b)
When a caseworker initiates an increase
or decrease
in hours
or service termination
, he
sends the approval
for Community Care for Aged and Disabled (CCAD) services-referral response
form to the provider agency to:
[
(1)
authorize the change if the client receives
family care or primary home care under Medicaid eligibility status; and
(2)
notify the provider agency to request
authorization of the change from DHS's regional nurse when the change is for
a client who is eligible for primary home care under the provisions of the
Social Security Act, §1929(b). To request approval of the change, the
provider agency must forward to DHS's regional nurse the approval for CCAD
services-referral response form and the attendant orientation/supervisory
visit form within seven days of the receipt of the approval for CCAD services-referral
response form from the caseworker.
(c)-(e)
(No change.)
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on
June 29, 1999.
TRD-9903888
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Proposed date of adoption: September 1, 1999
For further information, please call: (512) 438-3765
Subchapter J. 1915(c) Medicaid Home and Community-Based Waiver Services for Aged and Disabled Adults Who Meet Criteria for Alternatives to Nursing Facility Care
on an hourly basis
]. It represents
the administrative portion of the rate. Administrative errors are applied
to the documentation reviewed and are not extrapolated. Administrative errors
include, but are not limited to, the items in paragraph (1)-(2) of this section:
approved
] facsimile. DHS applies the error to the total
number of units documented on the time sheet.
Chapter 47.
Primary Home Care
and
]
.
]
authorizes the increase in hours
on the prior approval/confirmation of services form.
]
Chapter 48.
Community Care for Aged and Disabled