| (a) A program provider must:
(1) ensure that nursing is provided in accordance with
the individual's person-directed plan (PDP); individual plan of care
(IPC); implementation plan; Texas Occupations Code Chapter 301 (Nursing
Practice Act); 22 Texas Administrative Code (TAC) Chapter 217 (relating
to Licensure, Peer Assistance and Practice); 22 TAC Chapter 224 (relating
to Delegation of Nursing Tasks by Registered Professional Nurses to
Unlicensed Personnel for Clients with Acute Conditions or in Acute
Care Environments); 22 TAC Chapter 225 (relating to RN Delegation
to Unlicensed Personnel and Tasks Not Requiring Delegation in Independent
Living Environments for Clients with Stable and Predictable Conditions);
and Appendix C of the HCS Program waiver application approved by the
Centers for Medicare and Medicaid Services (CMS) and found on the
Texas Health and Human Services Commission (HHSC) website, and consists
of performing health care activities and monitoring the individual's
health conditions;
(2) this includes:
(A) administering medication;
(B) monitoring the individual's use of medications;
(C) monitoring health risks, data, and information,
including ensuring that an unlicensed service provider is performing
only those nursing tasks identified from a nursing assessment;
(D) assisting the individual to secure emergency medical
services;
(E) making referrals for appropriate medical services;
(F) performing health care procedures ordered or prescribed
by a physician or medical practitioner and required by standards of
professional practice or law to be performed by a registered nurse
(RN) or licensed vocational nurse (LVN);
(G) delegating nursing tasks to an unlicensed service
provider and supervising the performance of those tasks in accordance
with state law and rules;
(H) teaching an unlicensed service provider about the
specific health needs of an individual;
(I) performing an assessment of an individual's health
condition;
(J) ensuring a registered nurse (RN):
(i) performs a nursing assessment for each individual:
(I) before an unlicensed service provider performs
a nursing task for the individual, unless a physician has delegated
the task as a medical act under Texas Occupations Code Chapter 157,
as documented by the physician; and
(II) as determined necessary by an RN, including if
the individual's health needs change;
(ii) documents information from performance of a nursing
assessment;
(iii) if an individual is receiving a service through
the consumer directed services (CDS) option, provides a copy of the
documentation described in clause (ii) of this subparagraph to the
individual's service coordinator;
(iv) develops the nursing service portion of an individual's
implementation plan, which includes developing a plan and schedule
for monitoring and supervising delegated nursing tasks; and
(v) makes and documents decisions related to the delegation
of a nursing task to an unlicensed service provider; and
(K) in accordance with Texas Human Resources Code Chapter
161:
(i) allowing an unlicensed service provider to provide
administration of medication to an individual without the delegation
or oversight of an RN if:
(I) an RN has performed a nursing assessment and based
on the results of the assessment, determined that the individual's
health permits the administration of medication by an unlicensed service
provider;
(II) the medication is:
(-a-) an oral medication;
(-b-) a topical medication; or
(-c-) a metered dose inhaler;
(III) the medication is administered to the individual
for a predictable or stable condition; and
(IV) the unlicensed service provider has been:
(-a-) trained by an RN or a licensed vocational nurse
(LVN) under the direction of an RN regarding the proper administration
of medication; or
(-b-) determined to be competent by an RN or LVN under
the direction of an RN regarding proper administration of medication,
including through a demonstration of proper technique by the unlicensed
service provider; and
(ii) ensuring that an RN or LVN under the supervision
of an RN reviews the administration of medication to an individual
by an unlicensed service provider at least annually and after any
significant change in the individual's condition.
(b) A program provider may determine that an individual
does not require a nursing assessment if:
(1) nursing services are not on the individual's IPC
and the program provider has determined that no nursing task will
be performed by an unlicensed service provider as documented on HHSC
form "Nursing Task Screening Tool"; or
(2) a nursing task will be performed by an unlicensed
service provider and a physician has delegated the task as a medical
act under Texas Occupations Code Chapter 157, as documented by the
physician.
(c) If an individual or LAR refuses a nursing assessment
described in subsection (a)(1)(J)(i) of this section, the program
provider must not:
(1) provide nursing services to the individual; or
(2) provide host home/companion care, residential support,
supervised living, supported home living, respite, employment assistance,
supported employment, individualized skills and socialization, or
CFC PAS/HAB to the individual unless:
(A) an unlicensed service provider does not perform
nursing tasks in the provision of the service; and
(B) the program provider determines that it can ensure
the individual's health, safety, and welfare in the provision of the
service.
(d) If an individual or LAR refuses a nursing assessment
and the program provider determines that the program provider cannot
ensure the individual's health, safety, and welfare in the provision
of a service as described in subsection (c) of this section, the program
provider must:
(1) immediately notify the individual or LAR and the
individual's service coordinator, in writing, of the determination;
and
(2) include in the notification required by paragraph
(1) of this subsection the reasons for the determination and the services
affected by the determination.
(e) If notified by the service coordinator that the
individual or LAR refuses the nursing assessment after the discussion
with the service coordinator as described in §263.901(e)(22)
of this title (relating to LIDDA Requirements for Providing Service
Coordination in the HCS Program), the program provider must immediately
send the written notification described in subsection (d) of this
section to HHSC.
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