| (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;
Cont'd... |
