| (a) A program provider that arranges for durable medical
equipment for an individual residing in the facility must ensure that:
(1) the individual receives the equipment prescribed;
(2) the equipment fits properly, if applicable; and
(3) the individual's caregivers, as appropriate, receive
instruction regarding the equipment's use.
(b) To receive payment for a wheeled mobility system
or for a major modification to a wheeled mobility system, a program
provider must comply with paragraphs (1) - (5) of this subsection.
(1) The program provider must ensure that an occupational
therapist or a physical therapist:
(A) conducts a clinical assessment of the individual
receiving the wheeled mobility system;
(B) documents in detail the medical need for a specific
wheeled mobility system and all necessary accessories, as determined
during the clinical assessment; and
(C) signs and dates the written assessment.
(2) The program provider must ensure that a QRP who
is directly employed by or contracting with the program provider:
(A) is present for and directly involved in the clinical
assessment of the individual described in paragraph (1) of this subsection;
(B) is not the same person who conducts the clinical
assessment described in paragraph (1) of this subsection;
(C) is present when the wheeled mobility system is
delivered, directs the fitting of the system, and ensures that the
system is appropriate for the individual; and
(D) verifies that the wheeled mobility system functions
correctly for the individual.
(3) The program provider must receive prior authorization
to obtain a wheeled mobility system for an individual by submitting
the following documentation to DADS in accordance with instructions
issued by DADS:
(A) a prescription, signed and dated by a physician,
that describes in detail the wheeled mobility system, including all
necessary components, needed by the individual;
(B) the clinical assessment described in paragraph
(1) of this subsection; and
(C) documentation that a QRP was present for and involved
in the clinical assessment of the individual.
(4) The program provider must submit to DADS, in accordance
with instructions issued by DADS, documentation that a QRP conducted
the activities described in paragraph (2)(C) and (D) of this subsection.
(5) The program provider must maintain a copy of the
documentation described in paragraphs (3) and (4) of this subsection
in the individual's record.
|
| Source Note: The provisions of this §261.221 adopted to be effective January 1, 2001, 25 TexReg 12790; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective November 4, 2013, 38 TexReg 7724; transferred effective October 1, 2020, as published in the Texas Register August 28, 2020, 45 TexReg 6127 |
