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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 §9.178Certification Principles: Quality Assurance

(a) In the provision of HCS Program services and CFC services to an individual, the program provider must promote the active and maximum cooperation with:

  (1) providers of services other than HCS Program services or CFC services; and

  (2) advocates or other actively involved persons.

(b) The program provider must ensure personalized service delivery based upon the choices made by each individual or LAR and those choices that are available to persons without an intellectual disability or other disability.

(c) Before providing services to an individual in a residence in which host home/companion care, supervised living, or residential support is provided, and annually thereafter, the program provider must:

  (1) conduct an on-site inspection to ensure that, based on the individual's needs, the environment is healthy, comfortable, safe, appropriate, and typical of other residences in the community, suited for the individual's abilities, and is in compliance with applicable federal, state, and local regulations for the community in which the individual lives;

  (2) ensure that the service coordinator is provided with a copy of the results of the on-site inspection within five calendar days after completing the inspection;

  (3) complete any action identified in the on-site inspection for a residence in which supervised living or residential support will be provided to ensure that the residence meets the needs of the individual; and

  (4) ensure completion of any action identified in the on-site inspection for a residence in which host home/companion care will be provided to ensure that the residence meets the needs of the individual.

(d) The program provider must ensure that:

  (1) emergency plans are maintained in each residence in which host home/companion care, supervised living or residential support is provided;

  (2) the emergency plans address relevant emergencies appropriate for the type of service, geographic location, and the individuals living in the residence;

  (3) the individuals and service providers follow the plans during drills and actual emergencies; and

  (4) documentation of drills and responses to actual emergencies are maintained in each residence.

(e) A program provider must comply with the requirements in this subsection regarding a four-person residence.

  (1) Before providing residential support in a four-person residence, the program provider must:

    (A) ensure that the four-person residence meets one of the following:

      (i) is certified by:

        (I) the local fire safety authority having jurisdiction in the location of the residence as being in compliance with the applicable portions of the National Fire Protection Association 101: Life Safety Code (Life Safety Code) as determined by the local fire safety authority;

        (II) the local fire safety authority having jurisdiction in the location of the residence as being in compliance with the applicable portions of the International Fire Code (IFC) as determined by the local fire safety authority; or

        (III) the Texas State Fire Marshal's Office as being in compliance with the applicable portions of the Life Safety Code as determined by the Texas State Fire Marshal's Office; or

      (ii) as described in paragraph (2) of this subsection, is certified by HHSC as being in compliance with the portions of the Life Safety Code applicable to small residential board and care facilities and most recently adopted by the Texas State Fire Marshal's Office; and

    (B) obtain HHSC approval of the residence in accordance with §9.188 of this subchapter (relating to DADS Approval of Residences).

  (2) HHSC inspects for certification as described in paragraph (1)(A)(ii) of this subsection only if the program provider submits to the HHSC Architectural Unit:

    (A) one of the following:

      (i) if the four-person residence is located in a jurisdiction with a local fire safety authority:

        (I) a completed HHSC Form 5606 available on the HHSC website documenting that the local fire safety authority having jurisdiction refused to inspect for certification using the code (i.e. the Life Safety Code or IFC) for that jurisdiction; and

        (II) written documentation from the Texas State Fire Marshal's Office that it refused to inspect for certification using the Life Safety Code; or

      (ii) if the four-person residence is located in a jurisdiction without a local fire safety authority, written documentation from the Texas State Fire Marshal's Office that it refused to inspect for certification using the Life Safety Code; and

    (B) a completed HHSC form "Request for Life Safety Inspection-HCS Four-Person Home" available on the HHSC website.

  (3) The program provider must:

    (A) obtain the certification required by paragraph (1)(A) of this subsection annually; and

    (B) ensure that a four-person residence:

      (i) contains a copy of the most recent inspection of the residence by the local fire safety authority, Texas State Fire Marshal's Office, or HHSC; and

      (ii) is in continuous compliance with all applicable local building codes and ordinances and state and federal laws, rules, and regulations.

(f) The program provider must establish an ongoing consumer/advocate advisory committee composed of individuals, LARs, community representatives, and family members that meets at least quarterly. The committee:

  (1) at least annually, reviews the information provided to the committee by the program provider in accordance with subsection (k)(6) of this section; and

  (2) based on the information reviewed, makes recommendations to the program provider for improvements to the processes and operations of the program provider.

(g) The program provider must make available all records, reports, and other information related to the delivery of HCS Program services and CFC services as requested by HHSC, other authorized agencies, or CMS and deliver such items, as requested, to a specified location.

(h) The program provider must conduct, at least annually, a satisfaction survey of individuals and LARs and take action regarding any areas of dissatisfaction.

(i) The program provider must comply with §49.309 of this title (relating to Complaint Process).

(j) In all respite facilities and all residences in which a service provider of residential assistance or the program provider hold a property interest, the program provider must post in a conspicuous location:

  (1) the name, address, and telephone number of the program provider;

  (2) the effective date of the contract; and

  (3) the name of the legal entity named on the contract.

(k) At least annually, the program provider must:

  (1) evaluate information about the satisfaction of individuals and LARs with the program provider's services and identify program process improvements to increase the satisfaction;

  (2) review complaints, as described in §49.309 of this title, and identify program process improvements to reduce the filing of complaints;

  (3) review all final investigative reports from HHSC and, based on the review, identify program process improvements that help prevent the occurrence of abuse, neglect, and exploitation and improve the delivery of services;

  (4) review the reasons for terminating HCS Program services or CFC services and identify any related need for program process improvements;

  (5) evaluate critical incident data described in subsection (t) of this section and compare the program provider's use of restraint to aggregate data provided by HHSC on the HHSC website and identify program process improvements that help prevent the reoccurrence of restraints and improve service delivery;

  (6) provide all information the program provider reviewed, evaluated, and created as described in paragraphs (1) - (5) of this subsection to the consumer/advocate advisory committee required by subsection (f) of this section;

  (7) implement any program process improvements identified by the program provider in accordance with this subsection; and

  (8) review recommendations made by the consumer/advocate advisory committee as described in subsection (f)(2) of this section and implement the recommendations approved by the program provider.

(l) The program provider must ensure that all personal information concerning an individual, such as lists of names, addresses, and records obtained by the program provider is kept confidential, that the use or disclosure of such information and records is limited to purposes directly connected with the administration of the program provider's HCS Program or provision of CFC services, and is otherwise neither directly nor indirectly used or disclosed unless the consent of the individual to whom the information applies or his or her LAR is obtained beforehand.

(m) The program provider must comply with this subsection regarding charges against an individual's personal funds.

  (1) The program provider must, in accordance with this paragraph, collect a monthly amount for room from an individual who lives in a three-person or four-person residence. The cost for room must consist only of:

    (A) an amount equal to:

      (i) rent of a comparable dwelling in the same geographical area that is unfurnished; or

      (ii) the program provider's ownership expenses, limited to the interest portion of a mortgage payment, depreciation expense, property taxes, neighborhood association fees, and property insurance; and

    (B) the cost of:

      (i) shared appliances, electronics, and housewares;

      (ii) shared furniture;

      (iii) monitoring for a security system;

      (iv) monitoring for a fire alarm system;

      (v) property maintenance, including personnel costs, supplies, lawn maintenance, pest control services, carpet cleaning, septic tank services, and painting;

      (vi) utilities, limited to electricity, gas, water, garbage collection, and a landline telephone; and

      (vii) shared television and Internet service used by the individuals who live in the residence.

  (2) Except as provided in subparagraphs (B) and (C) of this paragraph, a program provider must collect a monthly amount for board from an individual who lives in a three-person or four-person residence.

    (A) The cost for board must consist only of the cost of food, including food purchased for an individual to consume while away from the residence as a replacement for food and snacks normally prepared in the residence, and of supplies used for cooking and serving, such as utensils and paper products.

    (B) A program provider is not required to collect a monthly amount for board from an individual if collecting such an amount may make the individual ineligible for the Supplemental Nutrition Assistance Program operated by HHSC.

    (C) A program provider must not collect a monthly amount for board from an individual if the individual chooses to purchase the individual's own food, as documented in the individual's implementation plan.

  (3) To determine the maximum room and board charge for each individual, a program provider must:

    (A) divide the room cost described in paragraph (1) of this subsection by the number of residents receiving HCS Program services or similar services that the residence has been developed to support plus the number of service providers and other persons who live in the residence;

    (B) divide the board cost described in paragraph (2) of this subsection by the number of persons consuming the food; and

    (C) add the amounts calculated in accordance with subparagraphs (A) and (B) of this paragraph.

  (4) A program provider must not increase the charge for room and board because a resident moves from the residence.

  (5) A program provider:

    (A) must not charge an individual a room and board amount that exceeds an amount determined in accordance with paragraphs (1) - (3) of this subsection; and

    (B) must maintain documentation demonstrating that the room and board charge was determined in accordance with paragraphs (1) - (3) of this subsection.

  (6) Before an individual or LAR selects a residence, a program provider must provide the room and board charge, in writing, to the individual or LAR.

  (7) Except as provided in paragraph (8) of this subsection, a program provider may not charge or collect payment from any person for room and board provided to an individual receiving host home/companion care.

  (8) If a program provider makes a payment to an individual's host home/companion care provider while waiting for the individual's federal or state benefits to be approved, the program provider may seek reimbursement from the individual for such payments.

  (9) A program provider who manages personal funds of an individual who receives host home/companion care:

Cont'd...

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