| (a) A program provider must ensure that case management
is provided in accordance with an individual's IPP, IPC, and Appendix
C of the DBMD Program waiver application approved by CMS and available
on the HHSC website, including:
(1) initiating and overseeing the process of assessment
and reassessment of the individual's LOC;
(2) initiating and overseeing the process of the review
of service plans at enrollment, annually, and as needed, including
if requested by the individual or LAR;
(3) observing the individual in the individual's home
and determining the intent and level of the individual's communication;
(4) if necessary, determining from the individual's
non-verbal communication, the individual's likes and dislikes;
(5) leading the service planning team to use the person-centered
planning process to develop a service plan that optimizes the opportunities
for the individual to use the individual's abilities and to integrate
in community settings;
(6) using the individual's knowledge of sign language
and other communication systems to make the individual as aware as
possible of the individual's service plan and options;
(7) communicating with service planning team members
to ensure that the service plan is carried out appropriately;
(8) monitoring the success of the service plan by observing
the individual at home and in the community;
(9) monitoring the provision of services included in
the service plan on an ongoing basis; and
(10) monitoring services that assist the individual
in gaining access to needed waiver and other state plan services,
including medical, social, educational, and non-wavier services.
(b) The only activities that a program provider may
bill as case management are:
(1) an in-person, email, phone call, or text message
contact with an individual;
(2) an in-person, email, phone call, or text message
contact with the LAR, primary caregiver, or an actively involved person
regarding the individual's services;
(3) a phone call, text message, email, letter, or meeting
with HHSC or community resources regarding the individual's services;
and
(4) working with service providers regarding the individual,
including:
(A) reviewing services, goals, and outcomes, as described
in the individual's IPC and IPP;
(B) providing the training described in §260.205(g)
of this chapter (relating to Training);
(C) monitoring training strategies used by service
providers to carry out the goals and outcomes described in the IPP;
and
(D) activities performed as a member of the service
planning team.
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