Current through Reg. 50, No. 13; March 28, 2025
(a) A participant may be admitted to a PPECC if:
(1) the
participant is eligible for the Texas Health Steps Comprehensive Care Program (THSteps-CCP);
(2) the
participant is 20 years of age or younger;
(3) the participant requires ongoing skilled nursing care and
supervision and skilled observations, judgments, and therapeutic interventions all or part of the day to correct or ameliorate the participant's
health status, such that delayed skilled intervention is expected to result in:
(A) deterioration of a chronic
condition;
(C) imminent risk to health
status due to medical fragility; or
(4) the participant is considered to be medically dependent or technologically dependent;
(5) the participant meets the criteria in 26 TAC §
550.601 (relating to Admission
Criteria);
(6) the participant has a physician's order prescribing PPECC services signed and dated by the
ordering physician who has examined the participant in person within 30 calendar days prior to admission and reviewed all appropriate medical
records, unless the physician waives this examination because the physician:
(A) has already established a
diagnosis for the participant;
(B) is providing continuing care and medical supervision to the
participant; and
(C) has stated in writing that an examination of the participant 30 calendar days prior
to admission is not medically necessary;
(7) the participant resides with the responsible adult
and does not reside in a 24-hour inpatient facility, including a:
(A) general acute hospital;
(B) skilled nursing facility;
(C) intermediate care facility;
or
(D) special care facility, including sub-acute units or facilities for the treatment of acquired
immune deficiency syndrome; and
(8) the PPECC has consent for admission to the PPECC signed and
dated by the participant or by the participant's responsible adult.
(b) If a participant's
ordering physician waives the examination of the participant in accordance with subsection (a)(6) of this section:
(1) the physician must examine the participant in person within 365 calendar days after the date of the
participant's last examination; and
(2) the physician and PPECC must maintain documentation of the waived
examination and the information described in subsection (a)(6) of this section in the participant's medical record.
(c) THSteps-CCP participants are eligible for all medically necessary PPECC services that are required to meet the
participant's documented needs.
(d) Admission must be voluntary, based on the participant's, or the
participant's responsible adult's choice for PPECC services.
(e) An authorized admission for PPECC
services is not intended to supplant the right to a Medicaid Private Duty Nursing benefit, when medically necessary.
