To ensure that cost-effective, quality, appropriate medical
and related services are available and delivered to clients, the program
may establish a system of program evaluation. Program evaluation may
include information obtained from management about the program's operation
and effectiveness, may establish guidelines and standards for program
health care services, may monitor compliance with these established
standards and guidelines, may identify and analyze patterns and trends
in provider billing and service delivery, and may develop systems
which promote family-centered, community-based alternatives that nurture
and support children with special health care needs.
(1) Quality assurance. The program may establish a
system of monitoring the quality, medical necessity, and effectiveness
of services.
(A) Standards and guidelines. The program may develop
standards and guidelines for services and providers reimbursed by
the program to ensure that quality services are available.
(B) Review of services. The program may conduct or
contract for concurrent and/or retrospective review of client care
services reimbursed by the program.
(C) Provider review. The program may conduct periodic
quality assurance reviews for provider services.
(D) Survey of clients and families. The program shall
survey clients periodically to assess the availability, appropriateness,
effectiveness, accessibility, and cultural sensitivity of provided
services.
(2) Utilization review. Utilization review will assess
the appropriateness of services provided to program clients by monitoring
systems developed or contracted by the program.
(3) Task forces. The program may establish advisory
task forces.
(4) Cooperation with other agencies. The department
cooperates with public and private agencies and with persons interested
in the welfare of children with special health care needs. The program
will make every effort to establish cooperative agreements with other
state agencies to define the responsibilities of each agency in relation
to specific programs to avoid duplication of services.
(5) Collaboration with stakeholders. The program values
the participation of all stakeholders who have an interest in children
with special health care needs and will make every effort to work
collaboratively with stakeholders in the design, development, and
implementation of program rules and policies.
(6) Systems development activities. The program may
conduct population-based systems development activities to improve
and support the state's infrastructure for serving all children with
special health care needs and their families by program staff or through
contractors. Population-based systems development activities include,
but are not limited to the development and maintenance of community-based
systems such as case management, parent case management, parent networks,
parent resource centers, parent or provider training, voucher programs,
wellness centers, permanency planning, or other systems that may directly
or indirectly support any family in Texas with the program.
|
| Source Note: The provisions of this §351.14 adopted to be effective July 1, 2001, 26 TexReg 2979; amended to be effective June 1, 2006, 31 TexReg 4200; amended to be effective October 3, 2010, 35 TexReg 8921; amended to be effective April 21, 2013, 38 TexReg 2362; transferred effective March 15, 2022, as published in the February 25, 2022 issue of the Texas Register, 47 TexReg 982 |
