Current through Reg. 49, No. 38; September 20, 2024
(a) A program provider must serve an eligible
applicant or individual who selects the program provider unless the program
provider's enrollment has reached its service capacity as identified in the
DADS data system.
(b) The program
provider must maintain a separate record for each individual enrolled with the
provider. The individual's record must include:
(1) a copy of the individual's current PDP
and, if CFC PAS/HAB is included on the PDP, a copy of the completed DADS
HCS/TxHmL CFC PAS/HAB Assessment form as provided by the LIDDA;
(2) a copy of the individual's current IPC as
provided by the LIDDA; and
(3) a
copy of the individual's current ID/RC Assessment as provided by the
LIDDA.
(c) The program
provider must:
(1) participate as a member of
the service planning team, if requested by the individual or LAR;
(2) develop:
(A) in conjunction with the individual, the
individual's family or LAR, an implementation plan for:
(i) TxHmL Program services, except for
transportation as a community support activity; and
(ii) CFC services, except for CFC support
management; and
(B) a
transportation plan, if transportation as a community support activity is
included on the PDP.
(d) The program provider must provide:
(1) TxHmL Program services in accordance with
an individual's PDP, IPC, implementation plan, transportation plan, §
9.555
of this subchapter (relating to Description of TxHmL Program Services), and
Appendix C of the TxHmL Program waiver application approved by CMS and found at
www.dads.state.tx.us; and
(2) CFC
services in accordance with an individual's PDP, IPC, and implementation
plan.
(e) The program
provider must ensure that services and supports provided to an individual
assist the individual to achieve the outcomes identified in the PDP.
(f) The program provider must ensure that an
individual's progress or lack of progress toward achieving the individual's
identified outcomes is documented in observable, measurable terms that directly
relate to the specific outcome addressed, and that such documentation is
available for review by the service coordinator.
(g) The program provider must communicate to
the individual's service coordinator changes needed to the individual's PDP or
IPC as such changes are identified by the program provider or communicated to
the program provider by the individual or LAR.
(h) The program provider must ensure that an
individual who performs work for the program provider is paid at a wage level
commensurate with that paid to a person without disabilities who would
otherwise perform that work. The program provider must comply with local,
state, and federal employment laws and regulations.
(i) The program provider must ensure that an
individual provides no training, supervision, or care to another individual
unless the individual is qualified and compensated in accordance with local,
state, and federal regulations.
(j)
The program provider must ensure that an individual who produces marketable
goods and services during habilitation activities is paid at a wage level
commensurate with that paid to a person without disabilities who would
otherwise perform that work. Compensation must be paid in accordance with
local, state, and federal regulations.
(k) The program provider must offer an
individual opportunity for leisure time activities, vacation periods, religious
observances, holidays, and days off, consistent with the individual's choice
and the routines of other members of the community.
(l) The program provider must offer an
individual of retirement age opportunities to participate in activities
appropriate to individuals of the same age and provide supports necessary for
the individual to participate in such activities consistent with the
individual's or LAR's choice and the individual's PDP.
(m) The program provider must offer an
individual choices and opportunities for accessing and participating in
community activities including employment opportunities and experiences
available to peers without disabilities and provide supports necessary for the
individual to participate in such activities consistent with an individual's or
LAR's choice and the individual's PDP.
(n) A program provider must develop a written
service backup plan for a TxHmL Program service or a CFC service identified on
the PDP as critical to meeting an individual's health and safety.
(1) A service backup plan must:
(A) contain the name of the
service;
(B) specify the period of
time in which an interruption to the service would result in an adverse effect
to the individual's health or safety; and
(C) in the event of a service interruption
resulting in an adverse effect as described in subparagraph (B) of this
paragraph, describe the actions the program provider will take to ensure the
individual's health and safety.
(2) A program provider must ensure that:
(A) if the action in the service backup plan
required by paragraph (1) of this subsection identifies a natural support, that
the natural support receives pertinent information about the individual's needs
and is able to protect the individual's health and safety; and
(B) a person identified in the service backup
plan, if paid to provide the service, meets the qualifications described in
this subchapter.
(3) If
a service backup plan is implemented, a program provider must:
(A) discuss the implementation of the service
backup plan with the individual and the service providers or natural supports
identified in the service backup plan to determine whether or not the plan was
effective;
(B) document whether or
not the plan was effective; and
(C)
revise the plan if the program provider determines the plan was
ineffective.
(o) If respite is provided in a location
other than an individual's family home, the location must be acceptable to the
individual or LAR and provide an accessible, safe, and comfortable environment
for the individual that promotes the health and welfare of the individual.
(1) Respite may be provided in the residence
of another individual receiving TxHmL Program services or similar services if
the program provider has obtained written approval from the individuals living
in the residence or their LARs and:
(A) no
more than three individuals receiving TxHmL Program services or CFC services
and other persons receiving similar services are provided services at any one
time; or
(B) no more than four
individuals receiving TxHmL Program services or CFC services and other persons
receiving similar services are provided services in the residence at any one
time and the residence is approved in accordance with §
9.188
of this chapter (relating to DADS Approval of Residences).
(2) Respite may be provided in a respite
facility if the program provider provides or intends to provide respite to more
than three individuals receiving TxHmL Program services or CFC services or
persons receiving similar services at the same time; and
(A) the program provider has obtained written
approval from the local fire authority having jurisdiction stating that the
facility and its operation meet the local fire ordinances; and
(B) the program provider obtains such written
approval from the local fire authority having jurisdiction on an annual
basis.
(3) If respite is
provided in a camp setting, the program provider must ensure the camp is
accredited by the American Camp Association.
(4) Respite must not be provided in an
institution such as an ICF/IID, nursing facility, or hospital.
(p) The program provider must
ensure that nursing is provided in accordance with:
(1) Texas Occupations Code, Chapter 301
(Nursing Practice Act);
(2) 22 TAC
Chapter 217 (relating to Licensure, Peer Assistance, and Practice);
(3) 22 TAC Chapter 224 (relating to
Delegation of Nursing Tasks by Registered Professional Nurses to Unlicensed
Personnel for Clients with Acute Conditions or in Acute Care Environments);
and
(4) 22 TAC Chapter 225
(relating to RN Delegation to Unlicensed Personnel and Tasks Not Requiring
Delegation in Independent Living Environments for Clients with Stable and
Predictable Conditions).
(q) A program provider may determine that an
individual does not require a nursing assessment if:
(1) nursing services are not on the
individual's IPC and the program provider has determined that no nursing task
will be performed by the program provider's unlicensed service provider as
documented on DADS form "Nursing Task Screening Tool"; or
(2) a nursing task will be performed by the
program provider's unlicensed service provider and a physician has delegated
the task as a medical act under Texas Occupations Code, Chapter 157, as
documented by the physician.
(r) If an individual or LAR refuses a nursing
assessment described in §
9.555(c)(10)(A)
of this subchapter, the program provider must not:
(1) provide nursing services to the
individual; or
(2) provide
community support, day habilitation, employment assistance, supported
employment, respite, or CFC PAS/HAB to the individual unless:
(A) an unlicensed service provider does not
perform nursing tasks in the provision of the service; and
(B) the program provider determines that it
can ensure the individual's health, safety, and welfare in the provision of the
service.
(s)
If an individual or LAR refuses a nursing assessment and the program provider
determines that the program provider cannot ensure the individual's health,
safety, and welfare in the provision of a service as described in subsection
(r) of this section, the program provider must:
(1) immediately notify the individual or LAR
and the individual's service coordinator, in writing, of the determination;
and
(2) include in the notification
required by paragraph (1) of this subsection the reasons for the determination
and the services affected by the determination.
(t) If notified by the service coordinator
that the individual or LAR refuses the nursing assessment after the discussion
with the service coordinator as described in §
9.583(j)(6)
of this subchapter (relating to TxHmL Program Principles for LIDDAs), the
program provider must immediately send the written notification described in
subsection (s) of this section to DADS.
(u) The program provider must, if a physician
delegates a medical act to an unlicensed service provider in accordance with
Texas Occupations Code, Chapter 157, and the program provider has concerns
about the health or safety of the individual in performance of the medical act,
communicate the concern to the delegating physician and take additional steps
as necessary to ensure the health and safety of the individual.
(v) The program provider must:
(1) for an applicant 21 years of age or older
residing in a nursing facility who is enrolling in the TxHmL Program:
(A) participate as a member of the service
planning team, which includes attending service planning team meetings
scheduled by the service coordinator;
(B) assist in the implementation of the
applicant's transition plan as described in the plan; and
(C) be physically present for the pre-move
site review and assist the service coordinator during the review as requested;
and
(2) for 365 calendar
days after an individual 21 years of age or older has enrolled in the TxHmL
Program from a nursing facility or has enrolled in the TxHmL Program as a
diversion from admission to a nursing facility:
(A) be physically present for each post-move
monitoring visit and assist the service coordinator during the visit as
requested;
(B) assist in the
implementation of the individual's transition plan as described in the
plan;
(C) participate as a member
of the service planning team, which includes attending service planning team
meetings scheduled by the service coordinator; and
(D) within one calendar day after becoming
aware of an event or condition that may put the individual at risk of admission
or readmission to a nursing facility, notify the service planning team of the
event or condition.
(w) A program provider must ensure that CFC
PAS/HAB is provided in accordance with the individual's PDP, IPC, and
implementation plan.
(x) CFC ERS
must be provided in accordance with this subsection.
(1) A program provider must ensure that CFC
ERS is provided only to an individual who:
(A) lives alone, who is alone for significant
parts of the day, or has no regular caregiver for extended periods of time;
and
(B) would otherwise require
extensive routine supervision.
(2) A program provider must ensure that CFC
ERS is provided in accordance with the individual's PDP, IPC, and
implementation plan.
(3) A program
provider must ensure that CFC ERS equipment is installed within 14 business
days after one of the following dates, whichever is later:
(A) the date DADS authorizes the proposed IPC
that includes CFC ERS; or
(B) the
effective date of the individual's IPC as determined by the service planning
team.
(4) At the time
CFC ERS equipment is installed, a program provider must ensure that:
(A) the equipment is installed in accordance
with the manufacturer's installation instructions;
(B) an initial test of the equipment is
made;
(C) the equipment has an
alternate power source in the event of a power failure;
(D) the individual is trained on the use of
the equipment, including:
(i) demonstrating
how the equipment works; and
(ii)
having the individual activate an alarm call;
(E) an explanation is given to the individual
that the individual must:
(i) participate in
a system check each month; and
(ii)
contact the CFC ERS provider if:
(I) the
individual's telephone number or address changes; or
(II) one or more of the individual's
responders change; and
(F) the individual is informed that a
responder, in response to an alarm call, may forcibly enter the individual's
home if necessary.
(5) A
program provider must ensure that the date and time of the CFC ERS equipment
installation and compliance with the requirements in paragraphs (4) and (5) of
this subsection are documented in the individual's record.
(6) A program provider must ensure that, on
or before the date CFC ERS equipment is installed:
(A) an attempt is made to obtain from an
individual, the names and telephone numbers of at least two responders, such as
a relative or neighbor;
(B) public
emergency personnel:
(i) is designated as a
second responder if the individual provides the name of only one responder;
or
(ii) is designated as the sole
responder if the individual does not provide the names of any responders;
and
(C) the name and
telephone number of each responder is documented in the individual's
record.
(7) At least
once during each calendar month a program provider must ensure that a system
check is conducted on a date and time agreed to by the individual.
(8) A program provider must ensure that the
date, time, and result of the system check is documented in the individual's
record.
(9) If, as a result of the
system check:
(A) the equipment is working
properly but the individual is unable to successfully activate an alarm call,
the program provider must ensure that a request is made of the service
coordinator to convene a service planning team meeting to determine if CFC ERS
meets the individual's needs; or
(B) the equipment is not working properly,
the program provider must ensure that, within three calendar days of the system
check, the equipment is repaired or replaced.
(10) If a system check is not conducted in
accordance with paragraph (7) of this subsection, the program provider must
ensure that:
(A) the failure to comply is
because of good cause; and
(B) the
good cause is documented in the individual's record.
(11) A program provider must ensure that an
alarm call is responded to 24 hours a day, seven days a week.
(12) A program provider must ensure that, if
an alarm call is made, the CFC ERS provider:
(A) within 60 seconds of the alarm call,
attempts to contact the individual to determine if an emergency
exists;
(B) immediately contacts a
responder, if as a result of attempting to contact the individual:
(i) the CFC ERS provider confirms there is an
emergency; or
(ii) the CFC ERS
provider is unable to communicate with the individual; and
(C) documents the following information in
the individual's record when the information becomes available:
(i) the name of the individual;
(ii) the date and time of the alarm call,
recorded in hours, minutes, and seconds;
(iii) the response time, recorded in
seconds;
(iv) the time the
individual is called in response to the alarm call, recorded in hours, minutes,
and seconds;
(v) the name of the
contacted responder, if applicable;
(vi) a brief description of the reason for
the alarm call; and
(vii) if the
reason for the alarm call is an emergency, a statement of how the emergency was
resolved.
(13) If an alarm call results in a responder
being dispatched to the individual's home for an emergency, the program
provider must ensure that:
(A) the service
coordinator receives written notice of the alarm call within one business day
after the alarm call;
(B) if the
CFC ERS provider is a contracted provider, the program provider receives
written notice from the contracted provider within one business day after the
alarm call; and
(C) written notices
required by subparagraphs (A) and (B) of this paragraph is maintained in the
individual's record.
(14) A program provider must ensure that, if
an equipment failure occurs, other than during a system check required by
paragraph (7) of this subsection:
(A) the
individual is informed of the equipment failure; and
(B) the equipment is replaced within one
business day after the failure becomes known by the CFC ERS provider.
(15) If an individual is not
informed of the equipment failure and the equipment is not replaced in
compliance with paragraph (14) of this subsection, the program provider must
ensure that:
(A) the failure to comply is
because of good cause; and
(B) as
soon as possible, the individual is informed of the equipment failure and the
equipment is replaced.
(16) A program provider must ensure that, if
the CFC ERS equipment registers five or more "low battery" signals in a 72-hour
period:
(A) a visit to an individual's home
is made to conduct a system check within five business days after the low
battery signals occur; and
(B) if
the battery is defective, the battery is replaced during the visit.
(17) A program provider must
ensure that, if a system check or battery replacement is not made in accordance
with paragraph (16) of this subsection:
(A)
the failure to comply is because of good cause; and
(B) as soon as possible, a system check and
battery replacement is made.
(18) A program provider must ensure that the
following information is documented in an individual's record:
(A) the date the equipment failure or low
battery signal became known by the CFC ERS provider;
(B) the equipment or subscriber
number;
(C) a description of the
problem;
(D) the date the equipment
or battery was repaired or replaced; and
(E) the good cause for failure to comply as
described in paragraphs (15)(A) and (17)(A) of this subsection.
(y) A program provider
must ensure that CFC support management is provided to an individual or LAR if:
(1) the individual is receiving CFC PAS/HAB;
and
(2) the individual or LAR
requests to receive CFC support management.
