Current through Reg. 49, No. 38; September 20, 2024
(a)
The Texas General Appropriations Act authorizes reimbursement to the enrolled
child's family for respite services that are not directly related to IFSP
goals.
(b) Respite services are
defined as the care of an enrolled child by a relative or substitute caregiver
on a short-term or intermittent basis to provide the child's parent with a
break from caring for his or her child. Respite services do not include the
routine care of a child for the purposes of allowing a parent to attend work or
school.
(c) The contractor must
develop and implement a process for administering the state funded
reimbursement of respite services.
(1) The
contractor may collaborate with other ECI contractors within their respective
consortium to administer the funds.
(2) The contractor must identify existing
respite resources in the community, including potential respite service
providers and additional funding sources before authorizing state funded
respite reimbursement.
(3) The
contractor may provide reimbursement for up to 20 hours of respite per child
per month, based on the individual needs of the family. The contractor may
exceed the 20 hours respite limit only if:
(A) the family has more than one child
enrolled in the ECI program; and
(B) the IFSP team determines that the
children cannot be cared for by a single respite provider.
(4) If the parent and the service coordinator
do not agree on the complexity of care, based on the needs of the child, and
the ECI reimbursement rate, the program director decides the complexity of care
and reimbursement rate.
(5) The
contractor must have a process for prioritizing requests for state funded
respite reimbursement. The process must include consideration of:
(A) how respite will benefit the family
relationship; and
(B) past use of
respite services.
(6) If
state respite funds are not available at the time of a request, the contractor
places the eligible family on a waiting list for respite funds.
(7) State respite funds cannot be used to
pay:
(A) insurance co-payments, insurance
deductibles, or insurance premiums;
(B) a parent to provide respite services to
his or her own child;
(C)
individuals who live in the same household as the child;
(D) individuals under 18 years of age;
or
(E) costs for the care of
siblings of the eligible child.
(d) The contractor must maintain auditable
records of state funded respite reimbursement.
(e) The contractor must report the number of
children whose families received state funded reimbursement of respite services
for each month of the contract period as directed by HHSC .
(f) The service coordinator must:
(1) assist the parent in identifying
available family and community resources;
(2) assist the parent in determining the type
(for example, individual setting, group setting, care in the child's home, or
care out of the child's home) and frequency of respite needed;
(3) assist the parent in applying for
available state funds for reimbursement of respite services, if
needed;
(4) determine the
complexity of care, based on the needs of the child;
(5) inform the parent of the following:
(A) state funds under this provision are
limited;
(B) the state's annual
hourly limits per child;
(C) the
hourly co-pay based on family size and income;
(D) the state's level of reimbursement based
upon the complexity of care, frequency, and hourly co-pay;
(E) the contractor's criteria for
prioritizing requests for state funds for reimbursement of respite services and
placement on the waiting list; and
(F) the process for requesting a review and
decision by the program director if the parent and the service coordinator do
not agree on the frequency and complexity of care, based on the needs of the
child, and the ECI reimbursement rate.
(g) The service coordinator must explain to
the parent their responsibility regarding state funded reimbursement for
respite services. The parent is responsible for:
(1) selecting and supervising a respite
provider;
(2) scheduling the
respite care with the provider;
(3)
paying the provider after the respite care is provided;
(4) submitting the completed respite voucher
to the contractor within one month of the voucher's expiration date;
(5) assuming any liability for the selection
and use of specific respite providers; and
(6) complying with any potential tax or IRS
requirements related to the use of state funded respite
reimbursement.
(h) The
following events must occur in order:
(1) the
contractor determines the number of hours and the level of care for each month,
the number of months approved, the beginning and ending dates of the agreement,
and the hourly co-pay required;
(2)
the contractor completes all required information on the respite funding
agreement;
(3) the parent, the
service coordinator or other assigned staff member, and the program director
(or designee), sign the completed respite funding agreement;
(4) the contractor gives the parent a respite
voucher for each calendar month in which respite services are
approved;
(5) the parent schedules
respite with the respite provider;
(6) the respite provider signs the respite
voucher after providing the respite care;
(7) the parent completes, signs, and returns
the voucher to the contractor within one month of the voucher's expiration
date; and
(8) the contractor
reimburses the parent within 30 days of receipt of an accurately completed
voucher.
