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RULE §44.203Assessment and Eligibility Determination

(a) Within 30 days after the provider receives a referral from DADS regional office, the provider must:

  (1) ensure that the assessor of need conducts an initial on-site assessment with the applicant;

  (2) determine CMPAS Program eligibility in accordance with §44.201 of this subchapter (relating to Eligibility Criteria);

  (3) inform the applicant, both orally and in writing, of all applicable publicly funded programs that offer attendant services and allow the applicant to choose whether to participate in CMPAS;

  (4) keep in the applicant's record a written record of the notification given in accordance with paragraph (3) of this subsection and the applicant's signed and dated acknowledgement and choice document;

  (5) assess the applicant's service needs by using the DADS Needs Assessment Questionnaire and Task/Hour Guide form available at www.dads.state.tx.us; and

  (6) for an eligible applicant:

    (A) develop a service plan based on the results of the assessment questionnaire that:

      (i) includes the number of hours and tasks negotiated between the applicant and the assessor of need; and

      (ii) is agreed to and signed by the applicant and assessor of need;

    (B) determine with the applicant the amount of the applicant's co-payment under §44.501 of this chapter (relating to Determining an Individual's Co-payment) and explain to the applicant that making co-payments is required to remain eligible for CMPAS;

    (C) explain orally and give written information to the applicant on the available service delivery options described in Subchapter D of this chapter (relating to Service Delivery Options);

    (D) have the applicant sign and date a service delivery option choice document; and

    (E) keep the signed and dated service delivery choice document in the applicant's file.

(b) If the applicant's service plan includes a health-related task, the provider must:

  (1) before an attendant performs a health-related task, verify that the task:

    (A) may be performed under Texas Government Code, §531.051(e);

    (B) does not require nurse or physician delegation; or

    (C) is properly delegated under:

      (i) 22 TAC Part 11, Chapter 225; or

      (ii) Texas Occupations Code, Chapter 157; and

  (2) if a health-related task is delegated, maintain records in the applicant's file that:

    (A) identify and are signed and dated by the delegating physician or registered nurse;

    (B) include the name of the individual, the names of the attendants performing the delegated health-related tasks for the individual, and a description of the specific health-related tasks to be performed; and

    (C) comply with the Texas Nurse Practice Act, the Medical Practice Act, and any other applicable state or federal law.

(c) The provider must notify an applicant who is not eligible for services in writing by mailing the DADS Notification of Community Care Services form within three days after the date of the decision. This form notifies the applicant of the right to a fair hearing and explains how to request a fair hearing.

(d) The provider must send DADS written notice of the disposition of the referral. The provider must ensure that DADS receives the notice within 30 days after the provider receives the referral from DADS. If the provider does not notify DADS within the 30-day period, DADS may impose contract sanctions on the provider.

(e) The provider must document any failure to complete the assessment activities within the 30-day period, including the reasons for the delay, the provider's ongoing efforts to complete the assessment, and the anticipated date of completion. The reasons for delay must be beyond the provider's control. The provider must send the documentation of delays to the DADS regional designee by the due date in subsection (d) of this section.

(f) Upon receiving notice from the provider of an applicant's eligibility to receive services in the CMPAS Program, the DADS regional designee will enter the CMPAS authorization in DADS Service Authorization System.

Source Note: The provisions of this §44.203 adopted to be effective October 1, 2013, 38 TexReg 6606

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