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TITLE 26HEALTH AND HUMAN SERVICES
PART 1HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 565HOME AND COMMUNITY-BASED (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) CERTIFICATION STANDARDS
SUBCHAPTER ECERTIFICATION STANDARDS: SERVICE DELIVERY
RULE §565.11Service Delivery
Texas Register

(a) The program provider must:

  (1) serve an eligible applicant who has selected the program provider unless the program provider's enrollment has reached its service capacity as identified in the Texas Health and Human Services Commission (HHSC) data system;

  (2) serve an eligible applicant without regard to age, sex, race, or level of disability;

  (3) provide or obtain as needed and without delay all Home and Community-based Services Program (HCS) Program and Community First Choice (CFC) services for an individual;

  (4) maintain a system of delivering HCS Program and CFC services that is continuously responsive to changes in the individual's personal goals, condition, abilities, and needs as identified by the service planning team;

  (5) ensure that each applicant or individual, or legally authorized representative (LAR), chooses where the individual or applicant will reside from available options consistent with the applicant's or individual's needs;

  (6) ensure that an individual's rights as identified in §565.5 of this chapter (relating to Rights of Individuals) are not violated, unless contraindications are documented with justification in a Behavior Support Plan;

  (7) notify the service coordinator if a change in an individual's condition necessitates a change in residential, educational, or work settings;

  (8) inform appropriate staff members, service providers, and the service coordinator when a circumstance or event occurs in an individual's life or a change to an individual's condition affects the provision of services to the individual;

  (9) notify the service coordinator if the program provider has reason to believe that an individual is no longer eligible for HCS Program services or CFC services or an individual or LAR has requested termination of all HCS Program services or all CFC services;

  (10) ensure that the individual plan of care (IPC) for each individual:

    (A) is renewed or revised in accordance with §263.302 of this title (relating to Renewal and Revision of an IPC); and

    (B) is authorized by the Health and Human Services Commission in accordance with §263.303 of this title (relating to HHSC Review of an IPC);

  (11) ensure that HCS Program and CFC services identified in the individual's implementation plan and transportation plan are provided in an individualized manner and are based on the results of assessments of the individual's and the family's strengths, the individual's personal goals, the family's goals for the individual, and the individual's needs rather than which services are available;

  (12) ensure that each individual's progress or lack of progress toward desired outcomes is documented in observable, measurable, or outcome-oriented terms;

  (13) ensure that individuals who perform work for the program provider are paid on the basis of their production or performance and at a wage level commensurate with that paid to persons who are without disabilities and who would otherwise perform that work, and that compensation is based on local, state, and federal regulations, including Department of Labor regulations, as applicable;

  (14) ensure that individuals who produce marketable goods and services in habilitation training programs are paid at a wage level commensurate with that paid to persons who are without disabilities and who would otherwise perform that work. Compensation is based on requirements contained in the Fair Labor Standards Act, which include:

    (A) accurate recordings of individual production or performance;

    (B) valid and current time studies or monitoring as appropriate; and

    (C) prevailing wage rates;

  (15) ensure that individuals provide no training, supervision, or care to other individuals unless they are qualified and compensated in accordance with local, state, and federal regulations, including Department of Labor regulations;

  (16) ensure that adaptive aids are provided in accordance with the individual's person-directed plan (PDP), IPC, implementation plan, and Appendix C of the HCS Program waiver application, approved by the Centers for Medicare and Medicaid Services (CMS) and found on the HHSC website, and include the full range of lifts, mobility aids, control switches/pneumatic switches and devices, environmental control units, medically necessary supplies, and communication aids and repair and maintenance of the aids, as determined by the individual's needs;

  (17) ensure the coordination and compatibility of HCS Program and CFC services with non-HCS Program services and non-CFC services together with an individual's service coordinator;

  (18) ensure that an individual has a current implementation plan;

  (19) ensure professional therapies:

    (A) are provided in accordance with the individual's PDP, IPC, implementation plan, and Appendix C of the HCS Program waiver application approved by CMS and found on the HHSC website:

      (i) audiology services;

      (ii) speech/language pathology services;

      (iii) occupational therapy services;

      (iv) physical therapy services;

      (v) dietary services;

      (vi) social work services;

      (vii) behavioral support; and

      (viii) cognitive rehabilitation therapy; and

    (B) if the service planning team determines that an individual may need cognitive rehabilitation therapy, the program provider:

      (i) in coordination with the service coordinator, assists the individual in obtaining, in accordance with the Medicaid State Plan, a neurobehavioral or neuropsychological assessment and plan of care from a qualified professional as a non-HCS Program service; and

      (ii) use a qualified professional as described in §565.7 of this chapter (relating to Staff Member and Service Provider Requirements) to provide and monitor the provision of cognitive rehabilitation therapy to the individual in accordance with the plan of care described in clause (i) of this subparagraph;

  (20) ensure that individualized skills and socialization is provided in accordance with the individual's PDP, IPC, implementation plan, and Appendix C of the HCS Program waiver application approved by CMS and found on the HHSC website;

  (21) ensure that dental treatment is provided in accordance with the individual's PDP, IPC, implementation plan, and Appendix C of the HCS Program waiver application approved by CMS and found on the HHSC website including:

    (A) emergency dental treatment;

    (B) preventive dental treatment;

    (C) therapeutic dental treatment; and

    (D) orthodontic dental treatment, excluding cosmetic orthodontia;

  (22) ensure that minor home modifications are provided in accordance with the individual's PDP, IPC, implementation plan, and Appendix C of the HCS Program waiver application approved by CMS and found on the HHSC website but are limited to the following categories:

    (A) purchase and repair of wheelchair ramps;

    (B) modifications to bathroom facilities;

    (C) modifications to kitchen facilities;

    (D) specialized accessibility and safety adaptations or additions; and

    (E) repair and maintenance of minor home modifications not covered by a warranty;

  (23) ensure that supported home living:

    (A) is available only to an individual who is not receiving:

      (i) host home/companion care;

      (ii) supervised living; or

      (ii) residential support; and

    (B) is available to an individual who is receiving foster care services from DFPS;

  (24) ensure that supported home living is provided in accordance with the individual's PDP, IPC, implementation plan, transportation plan, and Appendix C of the HCS Program waiver application approved by CMS and found on the HHSC website and includes the following elements:

    (A) direct personal assistance with activities of daily living (grooming, eating, bathing, dressing, and personal hygiene);

    (B) assisting with meal planning and preparation;

    (C) providing transportation;

    (D) securing transportation;

    (E) assisting with housekeeping;

    (F) assisting with ambulation and mobility;

    (G) reinforcing professional therapy activities;

    (H) assisting with medications and the performing tasks delegated by a registered nurse (RN);

    (I) supervising of individuals' safety and security;

    (J) facilitating inclusion in community activities, use of natural supports, social interaction, participation in leisure activities, and development of socially valued behaviors; and

    (K) habilitation, exclusive of individualized skills and socialization;

  (25) ensure that HCS host home/companion care is provided:

    (A) by a host home/companion care provider who lives in the residence in which no more than three individuals or other persons receiving similar services are living at any one time; and

    (B) in a residence in which the program provider does not hold a property interest;

  (26) ensure that host home/companion care is provided in accordance with the individual's PDP, IPC, implementation plan, and Appendix C of the HCS Program waiver application approved by CMS and found on the HHSC website and includes the following elements:

    (A) direct personal assistance with activities of daily living (grooming, eating, bathing, dressing, and personal hygiene);

    (B) assisting with meal planning and preparation;

    (C) securing and providing transportation;

    (D) assisting with housekeeping;

    (E) assisting with ambulation and mobility;

    (F) reinforcing professional therapy activities;

    (G) assisting with medications and the performance of tasks delegated by an RN;

    (H) supervising of safety and security;

    (I) facilitating inclusion in community activities, use of natural supports, social interaction, participation in leisure activities, and development of socially valued behaviors; and

    (J) habilitation, exclusive of individualized skills and socialization;

  (27) ensure that supervised living is provided:

    (A) in a four-person residence that is approved in accordance with §565.23(i) of this chapter (relating to Residential Requirements) or a three-person residence;

    (B) by a service provider who provides services and supports as needed by the individuals residing in the residence and is present in the residence and able to respond to the needs of the individuals during normal sleeping hours; and

    (C) only with approval by the HHSC commissioner or designee for the initial six months and one six-month extension and only with approval by the HHSC Executive Commissioner after such 12-month period, if provided to an individual under 22 years of age;

  (28) ensure that supervised living is provided in accordance with the individual's PDP, IPC, implementation plan, and Appendix C of the HCS Program waiver application approved by CMS and found on the HHSC website and includes the following elements:

    (A) direct personal assistance with activities of daily living (grooming, eating, bathing, dressing, and personal hygiene);

    (B) assisting with meal planning and preparation;

    (C) securing and providing transportation;

    (D) assisting with housekeeping;

    (E) assisting with ambulation and mobility;

    (F) reinforcing professional therapy activities;

    (G) assisting with medications and the performance of tasks delegated by an RN;

    (H) supervising of individuals' safety and security;

    (I) facilitating inclusion in community activities, use of natural supports, social interaction, participation in leisure activities, and development of socially valued behaviors; and

    (J) habilitation, exclusive of individualized skills and socialization;

  (29) ensure that residential support is provided:

    (A) in a four-person residence that is approved in accordance with §565.23(i) of this chapter or in a three-person residence;

    (B) by a service provider who is present in the residence and awake whenever an individual is present in the residence;

    (C) by service providers assigned on a daily shift schedule that includes at least one complete change of service providers each day; and

Cont'd...

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