Current through Reg. 49, No. 38; September 20, 2024
(a) A program
provider must ensure that:
(1) a full-time
case manager is assigned to provide case management services to no more than 30
individuals or other persons receiving services through another Medicaid waiver
at one time;
(2) a part-time case
manager is assigned to provide case management services to no more than 15
individuals or other persons receiving services through another Medicaid waiver
at one time; and
(3) for a month in
which a case manager does not meet with an individual or LAR as required by
§
260.77(a) of this
chapter (relating to Renewal and Revision of an IPP and IPC), the case manager
has contact with the individual, LAR, primary caregiver, or actively involved
person in person, by videoconferencing, or by telephone, to provide case
management.
(b) In
determining the number of individuals or other persons receiving services
through another Medicaid waiver at one time to whom a case manager will be
assigned, a program provider must take into consideration:
(1) the intensity of needs of each individual
or person;
(2) the frequency and
duration of contacts the case manager will need to make with the individual or
person; and
(3) the amount of
travel time involved in making such contacts.
(c) A program provider must have:
(1) a sufficient number of case managers
available at all times to ensure the provision of case management services;
and
(2) a written process that
ensures a case manager can readily become familiar with an individual to whom
the case manager is not ordinarily assigned but to whom the case manager may be
required to provide case management services.
(d) A program provider must have written
policies and procedures that ensure backup service providers are or can readily
become familiar with individuals to whom they are not ordinarily assigned but
to whom they may be required to deliver services.
(e) A program provider must provide each DBMD
Program service and CFC service authorized in an individual's IPC in accordance
with:
(1) the individual's current
IPC;
(2) the individual's current
IPP; and
(3) the requirements in
this chapter.
(f) A
program provider must ensure a copy of an individual's IPP is distributed or
made available to each service provider who provides a service on the
IPP.
(g) A program provider must:
(1) provide or ensure the provision of each
DBMD Program service listed in §
260.7(c) of this
chapter (relating to Description of the DBMD Program and CFC);
(2) provide the assisted living service as
either licensed assisted living or licensed home health assisted living in
accordance with §
260.351 of this chapter (relating
to Residential Services);
(3)
provide or ensure the provision of each CFC service listed in §
260.7(e) of this
chapter; and
(4) ensure that CFC
support management is provided to an individual or LAR as described in the
Deaf Blind with Multiple Disabilities Program Manual if:
(A) the individual is receiving CFC PAS/HAB;
and
(B) the individual or LAR
requests to receive CFC support management.
(h) A program provider must offer an
individual choices and opportunities for accessing and participating in
community activities, including employment opportunities and experiences
available to peers without disabilities, and provide supports necessary for an
individual to participate in those activities consistent with an individual's
or LAR's choice and the individual's IPC and IPP.
(i) A program provider may accept or decline
the request of an individual or LAR for the provision of transportation
provided as a residential habilitation activity, nursing, out-of-home respite
in a camp, case management, adaptive aids, intervener services, or CFC PAS/HAB
to the individual while the individual is staying at a location outside the
program provider's contracted service delivery area but within the state of
Texas.
(j) If a program provider
accepts the request of an individual or LAR, as described in subsection (i) of
this section, the program provider:
(1) may
provide transportation provided as a residential habilitation activity,
nursing, out-of-home respite in a camp, adaptive aids, intervener services, CFC
PAS/HAB, and case management services at the requested location;
(2) must document in the service delivery
log:
(A) that the individual is receiving
services outside the program provider's contracted service delivery
area;
(B) the location where the
individual is receiving the services;
(C) the estimated length of time the
individual is expected to be outside the program provider's contracted service
delivery area; and
(D) contact
information for the individual or LAR;
(3) must, if the individual receives services
outside the program provider's contracted service delivery area for 30
consecutive days, inform the individual or LAR, on or before the 35th day,
that:
(A) to ensure the continued provision of
the services, the individual must do one of the following before the 61st day:
(i) transfer to a program provider that has a
contracted service delivery area that includes the area in which the individual
is receiving the services; or
(ii)
return to the program provider's contracted service delivery area;
and
(B) if the individual
receives services outside the program provider's contracted service delivery
area during a period of 60 consecutive days, the individual must return to the
contracted service delivery area and receive services in that area before the
program provider may accept another request from the individual or LAR for the
provision of the services outside the program provider's contracted service
delivery area; and
(4)
must, if the individual or LAR expresses a desire for the individual to
transfer to a program provider that has a contracted service delivery area that
includes the area in which the individual is receiving services:
(A) give the individual and LAR the HHSC
Documentation of Provider Choice form for the contracted service delivery area
in which the individual is receiving the services;
(B) have the individual or LAR select a
program provider and designate that selection on the HHSC Documentation of
Provider Choice form; and
(C)
coordinate the individual's transfer in accordance with §
260.79 of this chapter (relating
to Coordination of Transfers).
(k) If the program provider declines the
request of an individual or LAR, as described in subsection (i) of this
section, the program provider must:
(1) inform
the individual or LAR orally or in writing:
(A) of the reasons for declining the request;
and
(B) that the individual may
request a service planning team meeting to discuss the reasons for declining
the request; and
(2)
document the discussion and the final outcome if the service planning team
meeting is held.
(l) If a
program provider or case manager is unable to meet a time frame specified in
this chapter, it must be for a reason not directly caused by the program
provider or case manager, or for a reason beyond the program provider's or case
manager's control, such as a man-made or natural disaster. The program provider
or case manager must document the program provider's or case manager's efforts
to meet a time frame and maintain the documentation in the individual's record.
The documentation must include:
(1) the reason
the time frame could not be met, which must be beyond the program provider's or
case manager's control; and
(2) a
description of the program provider's or case manager's ongoing efforts to meet
a time frame.
