| (a) A DSA must ensure that for each direct service
provided, except adaptive aids, dental treatment, minor home modifications,
CFC ERS, CFC support management, and a direct service that is documented
through an electronic visit verification system, as listed in 1 TAC §354.4005(b)
(relating to Applicability), a service provider:
(1) documents:
(A) the type of service provided;
(B) the date and the time the service begins and ends;
(C) the type of contact (phone or in-person);
(D) the name of the person with whom the contact occurred;
(E) a description of the activity performed, unless
the activity is a non-delegated task provided by an unlicensed service
provider that is documented on an IPP;
(F) the signature and title of the service provider;
and
(G) the progress or lack of progress in achieving a
goal or outcome in the individual's IPP in observable, measurable
terms that directly relate to the specific goal or outcome; and
(2) completes an HHSC Documentation of Services Delivered
form to document the provision of a direct service that is supported
by the documentation required in paragraph (1) of this subsection.
(b) A DSA must ensure that, after a service provider
makes the last entry on an HHSC Documentation of Services Delivered
form, a staff person other than the service provider signs and dates
the form as a timekeeper as verification of the accuracy of the information
on the form.
(c) A DSA must maintain a separate record for each
individual receiving CLASS Program services and CFC services from
the DSA. The individual's record must include:
(1) a copy of the individual's current IPC and any
other IPC authorized for the current IPC period;
(2) a copy of the individual's current IPP and any
other IPP developed for the current IPC period;
(3) a copy of the individual's current PAS/HAB plan;
(4) if transportation is included on the IPC as a habilitation
activity or as an adaptive aid, a copy of the individual's individual
transportation plan;
(5) a copy of the individual's current ID/RC Assessment;
(6) if the DSA was the individual's DSA when the individual
enrolled in the CLASS Program:
(A) the original ID/RC Assessment signed by a physician;
or
(B) the original level of care form signed by a physician
and was in use before the ID/RC Assessment;
(7) a copy of the current adaptive behavior screening
assessment;
(8) a copy of the current HHSC CLASS/DBMD Nursing Assessment
form;
(9) a copy of the current HHSC Related Conditions Eligibility
Screening Instrument form;
(10) any new or revised HHSC Provider Agency Model
Service Backup Plan form for the current IPC period;
(11) the documentation required by subsection (a)(1)
of this section;
(12) the completed HHSC Documentation of Services Delivered
forms signed and dated by a timekeeper as required by subsection (b)
of this section; and
(13) any other relevant documentation concerning the
individual.
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