Current through Reg. 49, No. 38; September 20, 2024
(a) A program
provider must ensure that nursing:
(1) is
ordered or prescribed by a physician or other medical practitioner acting
within the scope of the practitioner's license; and
(2) is provided in accordance with:
(A) Texas Occupations Code Chapter
301;
(B) 22 TAC Chapter
217;
(C) 22 TAC Chapter 224;
and
(D) 22 TAC Chapter
225.
(b) If an
individual requires specialized licensed vocational nursing or specialized
registered nursing, a program provider's RN must complete the HHSC Specialized
Nursing Certification form as described in the Deaf Blind with Multiple
Disabilities Program Manual and obtain HHSC authorization before providing
specialized licensed vocational nursing or specialized registered nursing.
(1) The RN must indicate on the form that a
physician has determined the individual requires:
(A) use of a ventilator at least six hours
per day; or
(B) tracheostomy care
at least once per day to include cleansing, dressing, and suctioning of the
tracheostomy.
(2) The
program provider must:
(A) ensure the case
manager submits the completed form to HHSC with the IPC; and
(B) keep the original completed form in the
individual's record.
(c) If HHSC approves specialized licensed
vocational nursing or specialized registered nursing for an individual, the
program provider must bill for specialized licensed vocational nursing or
specialized registered nursing provided to the individual after the date of
HHSC's authorization of these services.
(d) If an individual's IPC includes nursing,
a program provider must ensure compliance with §
260.213 of this chapter (relating
to Service Backup Plans).
(e) A
program provider may bill HHSC at the RN, LVN, specialized RN, or specialized
LVN rates only for the following nursing activities:
(1) interacting in person or by telephone
with an individual to provide professional or vocational nursing for which
there is a documented or immediate medical necessity, including:
(A) preparing and administering medication or
treatment ordered by a physician, podiatrist, or dentist;
(B) assisting or observing
self-administration of medication; and
(C) assessing an individual's health
status;
(2) interacting
in person or by telephone with a person, except a service provider of nursing,
case management, or a therapy, regarding the health status of an
individual;
(3) performing health
care procedures ordered or prescribed by a physician or medical practitioner
and required by standards of professional practice or law to be performed by
licensed nursing personnel;
(4)
delegating, verifying the competency of, and supervising an unlicensed person
in the performance of a task delegated in accordance with 22 TAC Part 11
(relating to Texas Board of Nursing);
(5) providing training to a service provider
that is specific to an individual;
(6) providing training or orientation to an
individual, LAR, family member, or service provider concerning an adaptive aid
or minor home modification; and
(7)
participating in service planning team meetings.
(f) A program provider may bill HHSC at a
nursing rate for a nurse's performance of delegated tasks if:
(1) a service provider to whom a nurse has
delegated the performance of delegated tasks is unavailable to perform those
tasks;
(2) a backup service
provider is unavailable; and
(3)
the individual's health and welfare would be endangered if those tasks are not
delivered.
(g) If a
program provider bills HHSC as described in subsection (f) of this section, the
program provider:
(1) must not bill for more
than 10 hours of such services per IPC period;
(2) must document in the individual's record:
(A) efforts made to find a service provider
who is not an RN or LVN to perform the delegated tasks; and
(B) reasons the failure to provide the
delegated tasks would endanger the individual's health and welfare.
