Current through Reg. 49, No. 38; September 20, 2024
(a) The two types
of individualized skills and socialization are on-site individualized skills
and socialization and off-site individualized skills and
socialization.
(b) A program
provider must ensure that individualized skills and socialization is provided
by an individualized skills and socialization provider. An individualized
skills and socialization provider must be the program provider or a contractor
of the program provider.
(c) An
individualized skills and socialization provider must ensure that
individualized skills and socialization:
(1)
provides person-centered activities related to:
(A) acquiring, retaining, or improving
self-help skills and adaptive skills necessary to live successfully in the
community and participate in home and community life; and
(B) gaining or maintaining independence,
socialization, community participation, current or future volunteer goals, or
employment goals consistent with achieving the outcomes identified in an
individual's IPP;
(2)
supports the individual's pursuit and achievement of employment through school,
vocational rehabilitation, the DBMD Program service of employment assistance,
or the DBMD Program service of supported employment;
(3) provides personal assistance for an
individual who cannot manage personal care needs during an individualized
skills and socialization activity;
(4) as determined by an assessment conducted
by a registered nurse, provides assistance with medications and the performance
of tasks delegated by a registered nurse in accordance with state law and
rules, unless a physician has delegated the task as a medical act under Texas
Occupations Code, Chapter 157, as documented by the physician; and
(5) does not include activities in which an
individual:
(A) produces marketable goods;
and
(B) is paid below minimum wage
for producing the goods in accordance with Section 14(c) of the Fair Labor
Standards Act.
(d) An individualized skills and
socialization provider must ensure that on-site individualized skills and
socialization:
(1) is provided in a building
or a portion of a building that is owned or leased by an individualized skills
and socialization provider;
(2)
includes transportation of an individual from one on-site individualized skills
and socialization location to another on-site individualized skills and
socialization location;
(3)
promotes an individual's development of skills and behavior that support
independence and personal choice; and
(4) is not provided in:
(A) a setting in which an individual must not
reside, as set forth in the rules governing the DBMD Program; or
(B) the residence of an individual or another
person.
(e) An
individualized skills and socialization provider must ensure that
individualized skills and socialization is not provided in a setting that is
presumed to have the qualities of an institution. A setting is presumed to have
the qualities of an institution if the setting:
(1) is located in a building in which a state
supported living center or a certified intermediate care facility for
individuals with an intellectual disability or related conditions (ICF/IID)
operated by a local intellectual and developmental disability authority (LIDDA)
is located but is distinct from the state supported living center or the
certified ICF/IID operated by a LIDDA;
(2) is located in a building that is on the
grounds of or immediately adjacent to a state supported living center or a
certified ICF/IID operated by a LIDDA;
(3) is located in a building in which a
licensed private ICF/IID, a hospital, a nursing facility, or other institution
is located but is distinct from the ICF/IID, hospital, nursing facility, or
other institution;
(4) is located
in a building that is on the grounds of or immediately adjacent to a hospital,
a nursing facility, or other institution except for a licensed private ICF/IID;
or
(5) has the effect of isolating
individuals from the broader community of persons not receiving Medicaid
HCBS.
(f) An
individualized skills and socialization provider may provide individualized
skills and socialization to an individual in a setting that is presumed to have
the qualities of an institution as described in subsection (e) of this section,
if CMS determines through a heightened scrutiny review that the setting:
(1) does not have the qualities of an
institution; and
(2) does have the
qualities of home and community-based settings.
(g) The setting in which on-site
individualized skills and socialization is provided must:
(1) allow an individual to:
(A) control the individual's schedule and
activities related to on-site individualized skills and
socialization;
(B) have access to
the individual's food at any time; and
(C) have visitors of the individual's
choosing at any time; and
(2) be physically accessible and free of
hazards to an individual.
(h) If an individual's service planning team
determines that any of the requirements in subsection (g)(1) of this section
must be modified, the service planning team must revise the individual's IPP in
accordance with the rules governing the DBMD Program to include the following:
(1) a description of the specific and
individualized assessed need that justifies the modification;
(2) a description of any positive
interventions and supports that have been tried but did not work;
(3) a description of any less intrusive
methods of meeting the need that have been tried but did not work;
(4) a description of the condition that is
directly proportionate to the specific assessed need;
(5) a description of how data will be
routinely collected and reviewed to measure the ongoing effectiveness of the
modification;
(6) the established
time limits for periodic reviews to determine if the modification is still
necessary or can be terminated;
(7)
the individual's or LAR's signature on the IPP evidencing informed consent to
the modification; and
(8) the
program provider's assurance that the modification will cause the individual no
harm.
(i) An
individualized skills and socialization provider must ensure that off-site
individualized skills and socialization:
(1)
provides activities that:
(A) integrate an
individual into the community; and
(B) promote the individual's development of
skills and behavior that support independence and personal choice;
(2) is provided in a community
setting chosen by the individual from among available community setting
options;
(3) includes
transportation of an individual from an on-site individualized skills and
socialization location to an off-site individualized skills and socialization
location and between off-site individualized skills and socialization
locations; and
(4) is not provided
in:
(A) a building in which on-site
individualized skills and socialization is provided;
(B) a setting in which an individual must not
reside, as set forth in the rules governing the DBMD Program, unless:
(i) the off-site individualized skills and
socialization activity is a volunteer activity performed by an individual in
such a setting; or
(ii) off-site
individualized skills and socialization is provided in an event open to the
public; or
(C) the
residence of an individual or another person, unless the off-site
individualized skills and socialization activity is a volunteer activity
performed by an individual in the residence.
(j) An individualized skills and
socialization provider or the program provider is not responsible for the cost,
if any, of an individual to participate in an off-site activity.
