Texas Administrative Code
Title 26 - HEALTH AND HUMAN SERVICES
Part 1 - HEALTH AND HUMAN SERVICES COMMISSION
Chapter 261 - INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS (ICF/IID) PROGRAM-CONTRACTING
Subchapter D - PROVIDER SERVICE REQUIREMENTS
Section 261.221 - Durable Medical Equipment
Universal Citation: 26 TX Admin Code ยง 261.221
Current through Reg. 49, No. 38; September 20, 2024
(a) A program provider that arranges for durable medical equipment for an individual residing in the facility must ensure that:
(1) the individual receives the equipment
prescribed;
(2) the equipment fits
properly, if applicable; and
(3)
the individual's caregivers, as appropriate, receive instruction regarding the
equipment's use.
(b) To receive payment for a wheeled mobility system or for a major modification to a wheeled mobility system, a program provider must comply with paragraphs (1) - (5) of this subsection.
(1) The program
provider must ensure that an occupational therapist or a physical therapist:
(A) conducts a clinical assessment of the
individual receiving the wheeled mobility system;
(B) documents in detail the medical need for
a specific wheeled mobility system and all necessary accessories, as determined
during the clinical assessment; and
(C) signs and dates the written
assessment.
(2) The
program provider must ensure that a QRP who is directly employed by or
contracting with the program provider:
(A) is
present for and directly involved in the clinical assessment of the individual
described in paragraph (1) of this subsection;
(B) is not the same person who conducts the
clinical assessment described in paragraph (1) of this subsection;
(C) is present when the wheeled mobility
system is delivered, directs the fitting of the system, and ensures that the
system is appropriate for the individual; and
(D) verifies that the wheeled mobility system
functions correctly for the individual.
(3) The program provider must receive prior
authorization to obtain a wheeled mobility system for an individual by
submitting the following documentation to DADS in accordance with instructions
issued by DADS:
(A) a prescription, signed
and dated by a physician, that describes in detail the wheeled mobility system,
including all necessary components, needed by the individual;
(B) the clinical assessment described in
paragraph (1) of this subsection; and
(C) documentation that a QRP was present for
and involved in the clinical assessment of the individual.
(4) The program provider must submit to DADS,
in accordance with instructions issued by DADS, documentation that a QRP
conducted the activities described in paragraph (2)(C) and (D) of this
subsection.
(5) The program
provider must maintain a copy of the documentation described in paragraphs (3)
and (4) of this subsection in the individual's record.
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