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TITLE 40SOCIAL SERVICES AND ASSISTANCE
PART 1DEPARTMENT OF AGING AND DISABILITY SERVICES
CHAPTER 9INTELLECTUAL DISABILITY SERVICES--MEDICAID STATE OPERATING AGENCY RESPONSIBILITIES
SUBCHAPTER DHOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)
RULE §9.174Certification Principles: Service Delivery

(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 DADS 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 HCS Program services and CFC services;

  (4) ensure that each applicant or individual, or LAR, chooses where the individual or applicant will reside from available options consistent with the applicant's or individual's needs;

  (5) encourage involvement of the LAR or family members and friends in all aspects of the individual's life and provide as much assistance and support as is possible and constructive;

  (6) request from and encourage the parent or LAR of an individual under 22 years of age receiving supervised living or residential support to provide the program provider with the following information:

    (A) the parent's or LAR's:

      (i) name;

      (ii) address;

      (iii) telephone number;

      (iv) driver license number and state of issuance or personal identification card number issued by the Department of Public Safety; and

      (v) place of employment and the employer's address and telephone number;

    (B) name, address, and telephone number of a relative of the individual or other person whom DADS or the program provider may contact in an emergency situation, a statement indicating the relationship between that person and the individual, and at the parent's or LAR's option:

      (i) that person's driver license number and state of issuance or personal identification card number issued by the Department of Public Safety; and

      (ii) the name, address, and telephone number of that person's employer; and

    (C) a signed acknowledgement of responsibility stating that the parent or LAR agrees to:

      (i) notify the program provider of any changes to the contact information submitted; and

      (ii) make reasonable efforts to participate in the individual's life and in planning activities for the individual;

  (7) inform the parent or LAR that if the information described in paragraph (6) of this subsection is not provided or is not accurate and the service coordinator and DADS are unable to locate the parent or LAR as described in §9.190(e)(35) of this subchapter (relating to LIDDA Requirements for Providing Service Coordination in the HCS Program) and §9.189 of this subchapter (relating to Referral to DFPS), DADS refers the case to DFPS;

  (8) for an individual under 22 years of age receiving supervised living or residential support:

    (A) make reasonable accommodations to promote the participation of the LAR in all planning and decision-making regarding the individual's care, including participating in meetings conducted by the program provider;

    (B) take the following actions to assist a LIDDA in conducting permanency planning:

      (i) cooperate with the LIDDA responsible for conducting permanency planning by:

        (I) allowing access to an individual's records or providing other information in a timely manner as requested by the local authority or HHSC;

        (II) participating in meetings to review the individual's permanency plan; and

        (III) identifying, in coordination with the individual's LIDDA, activities, supports, and services that can be provided by the family, LAR, program provider, or the LIDDA to prepare the individual for an alternative living arrangement;

      (ii) encourage regular contact between the individual and the LAR and, if desired by the individual and LAR, between the individual and advocates and friends in the community to continue supportive and nurturing relationships;

      (iii) keep a copy of the individual's current permanency plan in the individual's record; and

      (iv) refrain from providing the LAR with inaccurate or misleading information regarding the risks of moving the individual to another institutional setting or to a community setting;

    (C) if an emergency situation occurs, attempt to notify the parent or LAR and service coordinator as soon as the emergency situation allows and request a response from the parent or LAR; and

    (D) if the program provider determines it is unable to locate the parent or LAR, notify the service coordinator of such determination;

  (9) allow the individual's family members and friends access to an individual without arbitrary restrictions unless exceptional conditions are justified by the individual's service planning team and documented in the PDP;

  (10) notify the service coordinator if changes in an individual's age, skills, attitudes, likes, dislikes, or conditions necessitate a change in residential, educational, or work settings;

  (11) ensure that the individual who is living outside the family home is living in a residence that maximizes opportunities for interaction with community members to the greatest extent possible;

  (12) ensure that the IPC for each individual:

    (A) is renewed or, revised in accordance with §9.166 of this subchapter (relating to Renewal and Revision of an IPC); and

    (B) is authorized by DADS in accordance with §9.160 of this subchapter (relating to DADS Review of a Proposed IPC);

  (13) ensure that HCS Program services 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 and the family's goals for the individual, and the individual's needs rather than which services are available;

  (14) ensure that each individual's progress or lack of progress toward desired outcomes is documented in observable, measurable, or outcome-oriented terms;

  (15) ensure that each individual has opportunities to develop relationships with peers with and without disabilities and receives support if the individual chooses to develop such relationships;

  (16) 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;

  (17) 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;

  (18) 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;

  (19) unless contraindications are documented with justification by the service planning team, ensure that an individual's routine provides opportunities for leisure time activities, vacation periods, religious observances, holidays, and days off, consistent with the individual's choice and the routines of other members of the community;

  (20) unless contraindications are documented with justification by the service planning team, ensure that an individual of retirement age has opportunities to participate in day activities appropriate to individuals of the same age and consistent with the individual's or LAR's choice;

  (21) unless contraindications are documented with justification by the service planning team, ensure that each individual is offered choices and opportunities for accessing and participating in community activities and experiences available to peers without disabilities;

  (22) assist the individual to meet as many of the individual's needs as possible by using generic community services and resources in the same way and during the same hours as these generic services are used by the community at large;

  (23) ensure that, for an individual receiving host home/companion care, residential support, or supervised living:

    (A) the individual lives in a home that is a typical residence within the community;

    (B) the residence, neighborhood, and community meet the needs and choices of the individual and provide an environment that ensures the health, safety, comfort, and welfare of the individual;

    (C) there is a sufficient supply of hot water at sinks and in bathing facilities to meet the needs of individuals;

    (D) the temperature of the hot water at sinks and bathing facilities does not exceed 120 degrees Fahrenheit unless the program provider, in accordance with subsection (i) of this section, conducts a competency-based skills assessment evidencing that all individuals in the residence can independently regulate the temperature of the hot water from the sinks and bathing facilities;

    (E) unless contraindications are documented with justification by the service planning team, the individual lives near family and friends and needed or desired community resources consistent with the individual's choice, if possible;

    (F) the individual or LAR is involved in planning the individual's residential relocation, except in the case of an emergency;

    (G) unless contraindications are documented with justification by the service planning team, the individual has a door lock on the inside of the individual's bedroom door, if requested by the individual or LAR; and

    (H) the door lock installed in accordance with subparagraph (G) of this paragraph:

      (i) is a single-action lock;

      (ii) can be unlocked with a key from the outside of the door by the program provider; and

      (iii) is not purchased and installed at the individual's or LAR's expense;

  (24) ensure that adaptive aids are provided in accordance with the individual's PDP, IPC, implementation plan, and with Appendix C of the HCS Program waiver application approved by CMS and found at www.dads.state.tx.us 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;

  (25) together with an individual's service coordinator, ensure the coordination and compatibility of HCS Program services and CFC services with non-HCS Program services and non-CFC services;

  (26) ensure that an individual has a current implementation plan;

  (27) ensure that:

    (A) the following professional therapy services are provided in accordance with the individual's PDP, IPC, implementation plan, and with Appendix C of the HCS Program waiver application approved by CMS and found at www.dads.state.tx.us:

      (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) has a qualified professional as described in §9.177(q) of this subchapter (relating to Certification Principles: Staff Member and Service Provider Requirements) 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;

  (28) ensure that day habilitation is provided in accordance with the individual's PDP, IPC, implementation plan, and with Appendix C of the HCS Program waiver application approved by CMS and found at www.dads.state.tx.us, including:

    (A) assisting individuals in acquiring, retaining, and improving self-help, socialization, and adaptive skills necessary to reside successfully in the community;

    (B) providing individuals with age-appropriate activities that enhance self-esteem and maximize functional level;

    (C) complementing any professional therapies listed in the IPC;

Cont'd...

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