Texas Administrative Code
Title 26 - HEALTH AND HUMAN SERVICES
Part 1 - HEALTH AND HUMAN SERVICES COMMISSION
Chapter 277 - Contracting to Provide Primary Home Care
Subchapter D - SERVICE DELIVERY PLAN DEVELOPMENT
Section 277.45 - Pre-Initiation Activities
Universal Citation: 26 TX Admin Code § 277.45
Current through Reg. 50, No. 13; March 28, 2025
(a) Pre-initiation activities.
(1) For each referral for the PHC
Program or CAS Program or for each authorization for the FC Program, a
supervisor must conduct an evaluation.
(A) An
evaluation must be a single document that includes the individual's self-report
of:
(i) the dates and reasons for any
hospitalization within the last three months; and
(ii) the assistance needed for the individual
to perform ADLs and IADLs, including any assistive devices or medical equipment
used by the individual.
(B) If the provider determines during the
evaluation that the individual exhibits reckless behavior that results in
imminent danger to the health and safety of the individual or provider staff,
the provider must convene an Interdisciplinary Team meeting as described in
§ 47.49 of this subchapter (relating to Interdisciplinary Team) to discuss
the barriers to service delivery.
(2) For each referral for the PHC Program or
CAS Program, or for each authorization for the FC Program, a supervisor must
develop a service delivery plan that:
(A) is
agreed upon and signed by the individual and the provider;
(B) indicates the location of service
delivery; and
(C) records the
following:
(i) the tasks which the individual
is authorized to receive;
(ii) the
total weekly hours of service HHSC authorizes the individual to
receive;
(iii) the service
schedule, which must include as necessary, based on an individual's needs,
certain time periods for the delivery of specified tasks;
(iv) frequency of supervisory visits;
and
(v) a statement that:
(I) only the tasks described in § 47.41
of this subchapter (relating to Allowable Tasks), and agreed to on the service
delivery plan, may be provided; and
(II) the provider is not responsible for
meeting the applicant's needs other than by providing the tasks described in
§ 47.41 of this subchapter and agreed to on the service delivery
plan.
(3) In the PHC Program or CAS Program, a
provider must obtain a complete Practitioner's Statement of Medical Need form
and submit the form for HHSCTs review as described in § 47.47 of this
subchapter (relating to Determination of Medical Need).
(A) Routine referrals.
(i) A provider must send a copy of a complete
Practitioner's Statement of Medical Need form to HHSC before HHSC may authorize
an individual to receive services.
(ii) A provider must send a copy of the form
by fax, secure email, or mail.
(B) Expedited referrals.
(i) HHSC may authorize services for an
individual if the provider notifies HHSC that the provider has received a
complete practitioner's statement that documents the individual's medical
condition is the cause of the individual's functional impairment.
(ii) After notification that a provider has
the completed practitioner's statement described in clause (i) of this
subparagraph, HHSC and the provider will negotiate a service initiation
date.
(iii) For HHSC to pay a
provider beginning on the negotiated service initiation date, the provider must
send the complete practitioner's statement to HHSC within 7 working days after
service initiation.
(iv) If a
provider does not send the complete practitioner's statement to HHSC within 7
working days after service initiation, HHSC does not pay the provider until
HHSC receives the completed practitionerTs statement. In this circumstance,
HHSC changes the service initiation date to the date HHSC receives the
completed practitioner's statement.
(v) The signature date of the practitioner
must be on or before the negotiated service initiation date.
(b) Service delivery plan variances.
(1) A provider in
the PHC Program and CAS Program must notify the case worker when the initial
service delivery plan developed by the provider:
(A) has more hours than the number of hours
on the referral portion of HHSC's Authorization for Community Care Services
form; or
(B) has no ADLs.
(2) A provider in the FC Program
must:
(A) notify the case worker when the
initial service delivery plan developed by the provider has more hours than the
number of hours authorized on HHSC's Authorization for Community Care Services
form; and
(B) provide services
according to HHSC's Authorization for Community Care Services form until the
provider receives a new form from the case worker.
(c) Pre-initiation activities due date. A provider must:
(1) in the PHC Program
or CAS Program complete the pre-initiation activities as follows:
(A) for routine referrals, within 14 days
after one of the following dates, whichever is later:
(i) the referral date on HHSCTs Authorization
for Community Care Services form; or
(ii) the date the provider receives the
referral, unless the provider fails to stamp the receipt date on HHSCTs
Authorization for Community Care Services form, in which case the referral date
will be used to determine timeliness; and
(B) for expedited referrals, by the date
negotiated between the case worker and provider, which must be less than 14
days after the oral request; and
(2) in the FC Program, complete the
pre-initiation activities within 14 days after the provider receives HHSC's
Authorization for Community Care Services form.
(d) Delay in pre-initiation activities.
(1) A provider may delay meeting the due
dates in subsection (c) of this section only for reasons beyond its control
such as natural or other disasters. The provider must continue efforts to
complete pre-initiation activities and set a date, if possible, for completion
of pre-initiation activities.
(2) A
provider must document any failure to complete the pre-initiation activities
for routine referrals by the due date, including:
(A) the reason for the delay;
(B) either the date the provider anticipates
it will complete the pre-initiation activities or specific reasons why the
provider cannot anticipate a completion date; and
(C) a description of the provider's ongoing
efforts to complete pre-initiation activities.
(3) A provider must notify the case worker of
any failure to complete the pre-initiation activities for expedited referrals
before the negotiated date for completion of pre-initiation activities. The
case worker may refer the individual to another provider.
(e) Documentation of pre-initiation activities.
(1) A provider may combine the
evaluation and service delivery plan into a single document, but each item must
be clearly identifiable.
(2) A
provider must maintain documentation of the pre-initiation activities in the
individual's file.
Disclaimer: These regulations may not be the most recent version. Texas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
