TITLE 40.SOCIAL SERVICES AND ASSISTANCE

Part 1. TEXAS DEPARTMENT OF HUMAN SERVICES

Chapter 49. CONTRACTING FOR COMMUNITY CARE SERVICES

40 TAC §49.13, §49.14

The Texas Department of Human Services (DHS) proposes an amendment to §49.13, concerning client rights and responsibilities and proposes new §49.14, concerning complaint procedures, in its Contracting for Community Care Services chapter. The purpose of the proposal is to make editorial changes which make community care generic contracting rules consistent with Day Activity and Health Services rules in Chapter 98, Adult Day Care and Day Activity and Health Services Requirements, of this title. These changes also include a new requirement that contractors maintain a log of client complaints which is accessible to DHS staff.

Eric M. Bost, Commissioner, has determined that for the first five-year period the sections are 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 that rules applicable to Community Care program will be more consistent. There will be no effect on large, small, or micro businesses, because the expenses to maintain the new requirement, accessible logs of complaints, are minimal. There is no anticipated economic cost to persons who are required to comply with the proposed sections.

Questions about the content of this proposal may be directed to Gerardo Cantu at (512) 438-3693 in DHS's Community Care for Aged and Disabled Division. Written comments on the proposal may be submitted to Supervisor, Rules and Handbooks Unit-239, Texas Department of Human Services E-205, P.O. Box 149030, Austin, Texas, 78714-9030, within 30 days of publication in the Texas Register .

Under §2007.003(b) of the Texas Government Code, the department has determined that Chapter 2007 of the Government Code does not apply to these rules. Accordingly, the department is not required to complete a takings impact assessment regarding these rules.

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

The amendment and new section implement the Human Resources Code, §§22.001-22.003 and §§32.001-32.042.

§49.13.Client Rights and Responsibilities.

(a)-(c)

(No change.)

(d)

The provider agency must not require clients to perform services for the provider agency or other clients.

[(d)

The provider agency must:]

[(1)

date stamp all written complaints received;]

[(2)

document verbal complaints;]

[(3)

investigate and resolve all complaints, problems, or deficiencies and noncompliance with policies, procedures, and standards, which are reported by the client or DHS staff, within the five workdays from the receipt of the report unless a different time frame is found in the service-specific manual. The documented complaint and resolution must be maintained by the provider agency and a copy submitted to DHS within 30 days of the receipt of the report;]

[(4)

obtain the client's initials when a client-initiated complaint is resolved or obtain a witness's signature when the client refuses to sign; and]

[(5)

not require clients to perform services for the provider agency or other clients.]

§49.14.Complaint Procedures.

The provider agency must investigate and document all complaints as follows:

(1)

date stamp all written complaints received;

(2)

document verbal complaints;

(3)

maintain a log of the client complaints. The log of complaints must be accessible to the department's contract manager;

(4)

investigate and resolve all complaints, problems, or deficiencies and noncompliance with policies, procedures, and standards, which are reported by the client or the Texas Department of Human Services (DHS) staff, within the five workdays from the receipt of the report unless a different time frame is found in the service-specific manual. The documented complaint and resolution must be maintained by the provider agency and a copy submitted to DHS within 30 days of the receipt of the report;

(5)

obtain the client's initials when a client-initiated complaint is resolved or obtain a witness's signature when the client refuses to sign; and

(6)

not require clients to perform services for the provider agency or other clients.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State, on June 16, 2000.

TRD-200004235

Paul Leche

General Counsel, Legal Services

Texas Department of Human Services

Earliest possible date of adoption: July 30, 2000

For further information, please call: (512) 438-3108


Chapter 98. ADULT DAY CARE AND DAY ACTIVITY AND HEALTH SERVICES REQUIREMENTS

Subchapter H. DAY ACTIVITY AND HEALTH SERVICES (DAHS) CONTRACTUAL REQUIREMENTS

40 TAC §§98.202, 98.203, 98.205

The Texas Department of Human Services (DHS) proposes amendments to §§98.202, 98.203, and 98.205, concerning program overview, written referrals for services, and initiation of services, in its Adult Day Care and Day Activity and Health Services Requirements chapter. The purpose of the proposal is to make Day Activity and Health Services rules consistent with the community care generic contracting rules on complaint procedures in Chapter 49, Contracting for Community Care Services, of this title. The proposal also changes the name of the written referral form which is used by the new DHS billing system, the Claims Management System.

Eric M. Bost, Commissioner, has determined that for the first five-year period the sections are 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 that rules applicable to Community Care programs will be more consistent. There will be no effect on large, small, or micro businesses, because these changes have no fiscal impact on contractors, but clarify information in current rules. There is no anticipated economic cost to persons who are required to comply with the proposed sections.

Questions about the content of this proposal may be directed to Gerardo Cantu at (512) 438-3693 in DHS's Community Care for Aged and Disabled Division. Written comments on the proposal may be submitted to Supervisor, Rules and Handbooks Unit-239, Texas Department of Human Services E-205, P.O. Box 149030, Austin, Texas, 78714-9030, within 30 days of publication in the Texas Register .

Under §2007.003(b) of the Texas Government Code, the department has determined that Chapter 2007 of the Government Code does not apply to these rules. Accordingly, the department is not required to complete a takings impact assessment regarding these rules.

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

The amendments implement the Human Resources Code, §§22.001-22.003 and §§32.001-32.042.

§98.202.Program Overview.

(a)

A Day Activity and Health Services (DAHS) facility must:

(1)-(5)

(No change.)

(6)

comply with complaint procedures in community care generic contracting rules §49.13(a)(4) of this title (relating to Client Rights and Responsibilities) and §49.13(b)-(c) of this title (relating to Client Rights and Responsibilities), and §49.14 of this title (relating to Complaint Procedures) [ inform clients in writing about the facility's complaint procedures within 10 calendar days of the initiation of service. The facility must also date-stamp all written complaints received and maintain accessible records of the complaint and resolution. The facility must register and evaluate client complaints brought to the facility's attention within three days of receipt of complaint. All incidents must be reported to the contract manager, with a report on the resolution of the complaint, within three workdays of resolution of the complaint. The facility must investigate and respond in writing to all written complaints received from DHS staff within 14 days of receipt of the complaint ].

(b)

(No change.)

§98.203.Written Referrals for Services.

(a)

(No change.)

(b)

When a facility receives a referral from the caseworker, the facility nurse must make every effort to request prior approval for the client within 14 days of the referral date on the Texas Department of Human Services' (DHS's) authorization for community care services [ Approval for CCAD Services--Referral Response ] form.

(c)

(No change.)

(d)

Within the same 14 days of receipt of DHS's authorization for community care services [ Approval for CCAD Services--Referral Response ] form from the caseworker and before requesting prior approval, the nurse must conduct a health assessment/plan of care with the client, using DHS's Client Health Assessment/Plan of Care form. If the client is unable to participate due to cognitive impairment, the client's responsible party should participate.

(e)

(No change.)

(f)

Within the same 14 days of receipt of DHS's authorization for community care services [ Approval for CCAD Services--Referral Response ] form from the caseworker, the nurse must obtain a physician's order for the client by sending DHS's Physician's Order for Day Activity and Health Services form to the client's physician. The nurse sends a copy of DHS's Client Health Assessment/Plan of Care form to the physician.

(g)-(h)

(No change.)

§98.205.Initiation of Services.

(a)-(b)

(No change.)

(c)

The facility must complete and return DHS's authorization for community services form [ Authorization for Community Care Services ], to the caseworker within 14 days from the beginning date of coverage in Item 4 of DHS's authorization for community services form [ Authorization for Community Care Services ]. The facility must indicate the date services were initiated, the schedule for delivering services, and the total units authorized for the client.

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 16, 2000.

TRD-200004236

Paul Leche

General Counsel, Legal Services

Texas Department of Human Services

Earliest possible date of adoption: July 30, 2000

For further information, please call: (512) 438-3108