Part 1.
TEXAS DEPARTMENT OF HUMAN SERVICES
Chapter 48.
COMMUNITY CARE FOR AGED AND DISABLED
Subchapter G. PROGRAM FOR ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)
40 TAC §§48.2801 - 48.2807, 48.2812
The Texas Department of Human Services (DHS) adopts the repeal
of Subchapter G, §§48.2801-48.2807, and 48.2812, without changes
to the proposed text published in the September 5, 2003, issue of the
The repeals were undertaken as part of a larger DHS project to rewrite
the rules governing Programs of All-Inclusive Care for the Elderly (PACE)
in plain English and to place PACE rules in their own chapter, making them
easier for provider agencies, facilities, and the public to access, use, and
understand. The new PACE rules in Chapter 60 are adopted elsewhere in this
issue of the
Texas Register
.
DHS received no comments regarding adoption of the repeals.
The repeals are adopted 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 affect the Human Resources Code, §§22.0001-22.040
and §§32.001- 32.067.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of
the Secretary of State on March 4, 2004.
TRD-200401707
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Effective date: March 24, 2004
Proposal publication date: September 5, 2003
For further information, please call: (512) 438-3734
40 TAC §§60.2, 60.4, 60.6, 60.8, 60.10, 60.12, 60.14, 60.16, 60.18, 60.20, 60.22, 60.24, 60.26
The Texas Department of Human Services (DHS) adopts new §§60.2,
60.4, 60.6, 60.8, 60.10, 60.12, 60.14, 60.16, 60.18, 60.20, 60.22, 60.24,
and 60.26, in its Contracting to Provide Programs of All-Inclusive Care for
the Elderly (PACE) chapter. DHS adopts new §60.16 with changes to the
proposed text published in the September 5, 2003, issue of the
Texas Register
(28 TexReg 7650). DHS adopts new §§60.2, 60.4,
60.6, 60.8, 60.10, 60.12, 60.14, 60.18, 60.20, 60.22, 60.24, and 60.26 without
changes to the proposed text.
The new sections were undertaken as part of a larger DHS project to rewrite
the rules governing Programs of All-Inclusive Care for the Elderly (PACE)
in plain English and to place PACE rules in their own chapter, making them
easier for provider agencies, facilities, and the public to access, use, and
understand. The repeals of PACE rules in Chapter 48, Subchapter G, are located
elsewhere in this issue of the
Texas Register
.
In addition, DHS implemented new policy in §§60.6, 60.12(d), 60.18,
60.20, and 60.24(c) and (d) to be in compliance with Medicaid state plan program
requirements. Effective October 1, 2003, PACE began operation as a Medicaid
state plan program.
DHS received one written comment from the Centers for Medicare and Medicaid
Services. A summary of the comment and DHS's response follow.
Comment: Concerning §60.16, a comment was received that the proposed
rule does not comply with federal PACE regulations that mandate that the state's
administering agency must reassess, on at least an annual basis, whether a
PACE participant meets the state's medical necessity criteria for nursing
home care, and whether the state can deem continued eligibility.
Response: DHS agrees and revised the rule to comply with 42 Code of Federal
Regulations §460.160.
The new sections are adopted 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.
§60.16.Medical Necessity Assessments.
(a)
The provider agency must complete a Client Assessment and
Review Evaluation (CARE) form based on the client's total needs.
(b)
The provider agency must electronically transmit or mail
the CARE form to the agency with which the Texas Department of Human Services
(DHS) contracts for medical necessity determinations.
(c)
The provider agency must enroll any eligible applicant
within 60 calendar days of the date of the CARE form.
(d)
The provider agency must complete another CARE form and
submit it to the agency with which DHS contracts for medical necessity determinations
12 months after the initial assessment.
(1)
If the client meets the state's medical necessity criteria
and the client has an irreversible or progressive diagnosis, or a terminal
illness that could reasonably be expected to result in death in the next six
months, and DHS determines that there is no reasonable expectation of improvement
or significant change in the client's condition because of severity of a chronic
condition or the degree of impairment of functional capacity, DHS will permanently
waive the annual recertification requirement and the client may be deemed
to be continually eligible for PACE. The CARE form must have sufficient documentation
to substantiate the client's prognosis and the client's functional capacity.
(2)
In addition, if DHS determines that a PACE client no longer
meets the medical necessity criteria for nursing facility care, the client
may be deemed to continue to be eligible for PACE until the next annual reassessment,
if, in the absence of PACE services, it is reasonable to expect that the client
would meet the nursing facility medical necessity criteria within the next
six months.
(e)
The provider agency's licensed nurse must complete the
CARE form for the provider agency. The licensed nurse must be registered with
the agency with which DHS contracts for medical necessity determinations as
having, within the last two years, received and passed a Texas Health and
Human Services Commission approved training on the Texas Index for Level of
Effort (TILE) assessment.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of
the Secretary of State on March 4, 2004.
TRD-200401708
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Effective date: March 24, 2004
Proposal publication date: September 5, 2003
For further information, please call: (512) 438-3734
Chapter 181.
GENERAL RULES OF PRACTICE AND PROCEDURE
Subchapter A. GENERAL PROVISIONS
40 TAC §181.28
The Texas Commission for the Deaf and Hard of Hearing adopts
amendment to §181.28 without changes to the text as published in the
December 26, 2003, issue of the
Texas Register
(28
TexReg 11513).
The amendments add requirements for Counselors in Training (CIT), adjust
how the camp fee may be paid, and modifies staffing and campsites sections
to be more precise.
No comments were received.
This rule is adopted under the Human Resources Code, §81.006(b)(3),
which provides the Texas Commission for the Deaf and Hard of Hearing with
the authority to adopt rules for administration and programs.
No other statute, code or article is affected by this adopted rule.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of
the Secretary of State on March 4, 2004.
TRD-200401710
David Myers
Assistant Commissioner
Texas Commission for the Deaf and Hard of Hearing
Effective date: March 24, 2004
Proposal publication date: December 26, 2003
For further information, please call: (512) 407-3250
Subchapter B. PROGRAM ELIGIBILITY
Chapter 60.
CONTRACTING TO PROVIDE PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)
Part 6.
TEXAS COMMISSION FOR THE DEAF AND HARD OF HEARING
Chapter 182.
SPECIALIZED TELECOMMUNICATIONS ASSISTANCE PROGRAM