Part 1.
TEXAS DEPARTMENT OF HUMAN SERVICES
Chapter 62.
CONTRACTING TO PROVIDE TRANSITION ASSISTANCE SERVICES
The Texas Department of Human Services (DHS) proposes new Chapter
62, Contracting to Provide Transition Assistance Services, consisting of Subchapter
A, concerning introduction, §§62.1, 62.3, and 62.5; Subchapter B,
concerning provider agency requirements, §62.11; Subchapter C, concerning
staff requirements, §62.21; Subchapter D, concerning service delivery
requirements, §62.31 and §62.33; and Subchapter E, concerning claim
payments and documentation, §62.41 and §62.43.
The purpose of the new sections is to add rules for provider agencies contracting
to provide transition assistance services (TAS) as a §1915(c) Medicaid
waiver service. TAS will be offered to nursing facility residents who are
being discharged into the community under a Medicaid waiver program to assist
them in setting up a household. TAS include, but are not limited to, paying
security/utility deposits, moving expenses, and purchasing essential furnishings.
Nursing facility residents who are discharged from the facility into a waiver
program are eligible to receive up to $2,500 in TAS. These rules include requirements
for contracting and delivering TAS.
Gordon Taylor, Chief Financial Officer, has determined that, for the first
five-year period the proposed sections are in effect, there are no fiscal
implications for state or local government as a result of enforcing or administering
the sections. The addition of these services will not result in increased
costs because funds already appropriated to pay for the client's institutional
care will follow the client into the community care setting to pay for these
services. The addition of these services should enable more clients to move
out of nursing facilities and into community settings. Since the cost of nursing
facility care is greater than the cost of community care, the addition of
these services should result in a net savings to DHS. However, the amount
of savings cannot be reliably estimated.
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 is that nursing
facility residents who qualify for Medicaid waiver program services will have
the option of accessing this funding source to assist them in transitioning
more smoothly into the community. The funding provided for TAS is needed by
many nursing facility residents to help defray the costs associated with setting
up a household. There is no adverse economic effect on small or micro businesses
as a result of enforcing or administering the sections, because businesses
of any size will be able to apply to be a contracted provider of these new
services. 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 Gerardo
Cantu at (512) 438-3693 in DHS's Community Care Provider Services section.
Written comments on the proposal may be submitted to Supervisor, Rules Unit-092,
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. The changes
these rules make do not implicate a recognized interest in private real property.
Accordingly, DHS is not required to complete a takings impact assessment regarding
these rules.
These rules are proposed by DHS, subject to the subsequent transfer of
rulemaking authority to HHSC. DHS is currently scheduled to transition sometime
in 2004 into two successor agencies, the existing Texas Health and Human Services
Commission (HHSC) and a new agency, the Texas Department of Aging and Disability
Services (DADS).
This reorganization is mandated by House Bill 2292, 78th Leg., R.S. (2003).
At the inception of operations of DADS, the authority to adopt all rules for
the operation and provision of health and human services by DADS will lie
with HHSC. These changes may result in the migration of these rules from one
title of the Texas Administrative Code to another or other changes.
Subchapter A. INTRODUCTION
40 TAC §§62.1, 62.3, 62.5
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 affect the Human Resources Code, §§22.0001-22.040
and §§32.001-32.067.
§62.1.Purpose.
This chapter establishes the requirements for agencies contracting
to provide transition assistance services to eligible clients through the
following Texas Department of Human Services waiver programs:
(1)
Community Based Alternatives;
(2)
Community Living Assistance and Support Services;
(3)
Medically Dependent Children;
(4)
Deaf Blind with Multiple Disabilities; and
(5)
Consolidated Waiver.
§62.3.Definitions.
The following words and terms have the following meanings when used
in this chapter, unless the context clearly indicates otherwise:
(1)
Case manager--A Texas Department of Human Services (DHS)
employee or case management agency employee who is responsible for case management
activities. Activities include eligibility determination, client registration,
assessment and reassessment of a client's need, service plan development,
and intercession on a client's behalf.
(2)
Client--An individual who is eligible to receive DHS Medicaid
waiver services. References in this chapter to "client" include the client's
representative, unless the context indicates otherwise.
(3)
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)).
(4)
Community Living Assistance and Support Services (CLASS)--A
Medicaid program that provides home and community-based services to eligible
people with related conditions (developmental disabilities other than mental
retardation), as a cost-effective alternative to placement in an Intermediate
Care Facility for Persons with Mental Retardation or Related Conditions (ICF-MR/RC).
CLASS services are provided in accordance with the waiver provisions of §1915(c)
of the Social Security Act (42 U.S.C. §1396n(c)).
(5)
Consolidated Waiver Program (CWP)--A Medicaid program that
provides home and community-based services to people who are eligible for
care in a nursing facility or ICF-MR/RC as an alternative to institutional
placement. CWP services are provided in accordance with the waiver provisions
of §1915(c) of the Social Security Act (42 U.S.C. 1396n(c)).
(6)
Contract--The formal, written agreement between DHS and
a provider agency to provide services to DHS clients eligible under this chapter
in exchange for reimbursement.
(7)
Contract manager--A DHS employee who is responsible for
the overall management of the contract with the provider agency.
(8)
DHS--The Texas Department of Human Services.
(9)
Days--Any reference to days means calendar days, unless
otherwise specified in the text. Calendar days include weekends and holidays.
(10)
Deaf Blind with Multiple Disabilities (DBMD)--A Medicaid
program that provides home and community-based support services to persons
age 18 or older who are deaf-blind and have at least one other disability,
and who are eligible for institutional care, as a cost-effective alternative
to institutional care. DBMD services are provided in accordance with the waiver
provisions of §1915(c) of the Social Security Act (42 U.S.C. 1396n(c)).
(11)
Medically Dependent Children Program (MDCP)--A Medicaid
program that provides home and community-based support services to persons
under 21 years of age who are medically dependent and eligible for institutional
care, as a cost-effective alternative to institutional care. MDCP services
are provided in accordance with the waiver provisions of §1915(c) of
the Social Security Act (42 U.S.C. 1396n(c)).
(12)
Nursing facility--A facility licensed under the Health
and Safety Code, Chapter 242, that provides organized and structured nursing
care and services.
(13)
Provider agency--An agency that contracts with DHS to
provide transition assistance services to clients in exchange for reimbursement.
(14)
Waiver program--A DHS Medicaid program operated under
the waiver provisions of §1915(c) of the Social Security Act (42 U.S.C. §1396n(c)),
including: CBA, CLASS, MDCP, DBMD, and CWP.
(15)
Working days--Days DHS is open for business.
§62.5.Service Description.
(a)
Transition assistance services (TAS) assist Medicaid recipients
who are nursing facility residents discharged from the facility to set up
a household. TAS are only available to nursing facility residents who are
discharged from the facility into a waiver program. TAS are not available
to residents moving from a nursing facility who are approved for any of the
following waiver services:
(1)
assisted living services;
(2)
adult foster care services;
(3)
support family services;
(4)
24-hour residential habilitation; or
(5)
family surrogate services.
(b)
TAS include, but are not limited to:
(1)
payment of security deposits required to lease an apartment
or home, or to establish utility services for the home;
(2)
purchase of essential furnishings for the apartment or
home, including table, chairs, window blinds, eating utensils, and food preparation
items;
(3)
payment of moving expenses required to move into or occupy
the home or apartment; and
(4)
payment for services to ensure the health and safety of
the client in the apartment or home, such as pest eradication, allergen control,
or a one-time cleaning before occupancy.
(c)
A nursing facility resident who is discharged from the
facility into a waiver program is eligible to receive up to $2,500 in TAS.
(d)
TAS are available on a one-time basis only.
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 May 28, 2004.
TRD-200403622
Carey Smith
Deputy Commissioner, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: July 11, 2004
For further information, please call: (512) 438-3734
40 TAC §62.11
The new section 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 new section affects the Human Resources Code, §§22.0001-22.040
and §§32.001-32.067.
§62.11.Contracting Requirements.
(a)
General contracting requirements. The provider agency must
meet all provisions described in this chapter and Chapter 49 of this title
(relating to Contracting for Community Care Services).
(b)
Provider agency requirements. The provider agency must:
(1)
be a Center for Independent Living as defined by the Rehabilitation
Act of 1973, as amended; or
(2)
have a current Community Care contract; or
(3)
be currently designated as a Texas Area Agency on Aging.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed
with the Office of the Secretary of State on May 28, 2004.
TRD-200403623
Carey Smith
Deputy Commissioner, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: July 11, 2004
For further information, please call: (512) 438-3734
40 TAC §62.21
The new section 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 new section affects the Human Resources Code, §§22.0001-22.040
and §§32.001-32.067.
§62.21.Staff Requirements.
The provider agency employees who deliver services under this chapter
must:
(1)
be 18 years old;
(2)
have a high school diploma or its equivalent;
(3)
not be the client's spouse, the parent of a minor child,
have legal conservatorship of the client, or live in the client's household;
and
(4)
be capable of providing the required services.
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 May 28, 2004.
TRD-200403624
Carey Smith
Deputy Commissioner, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: July 11, 2004
For further information, please call: (512) 438-3734
Subchapter B. PROVIDER AGENCY REQUIREMENTS
Subchapter C. STAFF REQUIREMENTS
Subchapter D. SERVICE DELIVERY REQUIREMENTS