Current through Reg. 50, No. 13; March 28, 2025
(a) A PPECC must obtain and maintain the following
documentation in a participant's medical record to be eligible for reimbursement for non-transportation PPECC services provided to the participant:
(1) a physician's specific, written, signed, and dated orders prescribing PPECC services;
(2) an approved prior authorization from HHSC that includes:
(A) a Comprehensive
Care Program (CCP) Prior Authorization Request Form;
(B) a PPECC Plan of Care (POC);
(C) a PPECC nursing assessment;
(D) a Nursing Addendum to POC for
Private Duty Nursing (PDN) and/or PPECC;
(E) consent for PPECC services as described in the Texas
Medicaid Provider Procedures Manual; and
(F) documentation of medical necessity;
(3) the daily attendance log required by subsection (b) of this section; and
(4) the documentation required by subsection (c) of this section.
(b) A PPECC must maintain a daily attendance log that includes:
(1) the date of
attendance;
(2) the name of the participant;
(3) the
signature of the responsible adult and the time when the PPECC assumes responsibility for the care of the participant which is:
(A) the time the participant boards the PPECC transport vehicle; or
(B)
the time the participant is brought to the PPECC by a responsible adult;
(4) the signature of
the responsible adult and time when the responsible adult assumes responsibility for the care of the participant which is:
(A) the time the participant is taken off the transport vehicle at the participant's return destination;
or
(B) the time the participant is picked up from the PPECC by a responsible adult;
and
(5) the name of the PPECC staff member riding in the transport vehicle when PPECC
transportation services are utilized and whether the staff member is a registered nurse, licensed vocational nurse, or direct care
staff.
(c) A PPECC must maintain the following documentation:
(1) notes from interdisciplinary team meetings;
(2) discrepancies
between the weekly service hours scheduled and the service hours provided;
(3) the names of the staff
member providing services;
(5) the
type of service performed; and
(6) the start and end times of the service performed.
(d) HHSC may request that a PPECC provide documentation to substantiate the provision of services in addition to
that required by subsections (a) - (c) of this section.
(e) HHSC may recoup payment for services not
substantiated by the documentation required in this section.
