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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 §9.190LIDDA Requirements for Providing Service Coordination in the HCS Program

(a) In addition to the requirements described in Chapter 2, Subchapter L of this title (relating to Service Coordination for Individuals with an Intellectual Disability), a LIDDA must ensure:

  (1) compliance with:

    (A) this subchapter;

    (B) Chapter 41 of this title (relating to Consumer Directed Services Option); and

    (C) Chapter 4, Subchapter L, of this title (relating to Abuse, Neglect, and Exploitation in Local Authorities and Community Centers); and

  (2) a rights protection officer, as required by §4.113 of this title (relating to Rights Protection Officer at a State MR Facility or MRA), who receives a copy of an HHSC initial intake report or a final investigative report from an FMSA, in accordance with §41.702 of this title (relating to Requirements Related to HHSC Investigations When an Alleged Perpetrator is a Service Provider) or §41.703 of this title (relating to Requirements Related to HHSC Investigations When an Alleged Perpetrator is a Staff Person or a Controlling Person of an FMSA), gives a copy of the report to the individual's service coordinator.

(b) A LIDDA must employ service coordinators who:

  (1) meet the minimum qualifications and LIDDA staff training requirements specified in Chapter 2, Subchapter L of this title; and

  (2) have received training about:

    (A) the HCS Program and CFC, including the requirements of this subchapter and the HCS Program services and CFC services described in §9.154 of this subchapter (relating to Description of the HCS Program and CFC); and

    (B) Chapter 41 of this title.

(c) A LIDDA must have a process for receiving and resolving complaints from a program provider related to the LIDDA's provision of service coordination or the LIDDA's process to enroll an applicant in the HCS Program.

(d) If, as a result of monitoring, the service coordinator identifies a concern with the implementation of the PDP, the LIDDA must ensure that the concern is communicated to the program provider and attempts are made to resolve the concern. The LIDDA may refer an unresolved concern to HHSC by calling the HHSC Complaint and Incident Intake toll-free telephone number at 1-800-458-9858.

(e) A service coordinator must:

  (1) assist an individual or LAR in exercising the legal rights of the individual as a citizen and as a person with a disability;

  (2) provide an individual, LAR, or family member with a written copy of the rights of the individual as described in §9.173(b) of this subchapter (relating to Certification Principles: Rights of Individuals) and the booklet Your Rights In the Home and Community-based Services (HCS) Program, available on the HHSC website,) and an oral explanation of such rights:

    (A) upon the individual's enrollment in the HCS Program;

    (B) upon revision of the booklet;

    (C) upon request; and

    (D) upon change in the individual's legal status (that is when the individual turns 18 years of age, is appointed a guardian, or loses a guardian);

  (3) document the provision of the rights described in §9.173(b) of this subchapter, and the booklet and oral explanation required by paragraph (2) of this subsection, and ensure that the documentation is signed by:

    (A) the individual or LAR; and

    (B) the service coordinator;

  (4) ensure that, upon enrollment of an individual and annually thereafter, the individual or LAR is informed orally and in writing of the following:

    (A) the telephone number of the LIDDA to file a complaint;

    (B) the toll-free telephone number of the HHSC Complaint and Incident Intake, 1-800-458-9858, to file a complaint; and

    (C) the toll-free telephone number of DFPS, 1-800-647-7418, to report an allegation of abuse, neglect, or exploitation;

  (5) maintain for an individual for an IPC year:

    (A) a copy of the IPC;

    (B) the PDP and, if CFC PAS/HAB is included on the PDP, the completed HHSC HCS/TxHmL CFC PAS/HAB Assessment form;

    (C) a copy of the ID/RC Assessment;

    (D) documentation of the activities performed by the service coordinator in providing service coordination; and

    (E) any other pertinent information related to the individual;

  (6) initiate, coordinate, and facilitate person-directed planning, including scheduling service planning team meetings;

  (7) to meet the needs of an individual as those needs are identified, develop for the individual a full range of services and resources using:

    (A) providers for services other than HCS Program services and CFC services; and

    (B) advocates or other actively involved persons;

  (8) ensure that the PDP for an applicant or individual:

    (A) is developed, reviewed, and updated in accordance with:

      (i) §9.158(j)(4)(A) of this subchapter (relating to Process for Enrollment of Applicants);

      (ii) §9.166 of this subchapter (relating to Renewal and Revision of an IPC); and

      (iii) §2.556 of this title (relating to LIDDA's Responsibilities);

    (B) states, for each HCS Program service, other than supervised living and residential support, and for each CFC service, whether the service is critical to the individual's health and safety as determined by the service planning team;

  (9) participate in the development, renewal, and revision of an individual's IPC in accordance with §9.158 and §9.166 of this subchapter;

  (10) ensure that the service planning team participates in the renewal and revision of the IPC for an individual in accordance with §9.166 of this subchapter and ensure that the service planning team completes other responsibilities and activities as described in this subchapter;

  (11) notify the service planning team of the information conveyed to the service coordinator pursuant to §9.178(q)(3)(C) and (4)(B) of this subchapter (relating to Certification Principle: Quality Assurance);

  (12) if a change to an individual's PDP is needed, other than as required by §9.166 of this subchapter:

    (A) communicate the need for the change to the individual or LAR, the program provider, and other appropriate persons; and

    (B) revise the PDP as necessary;

  (13) provide an individual's program provider a copy of the individual's current PDP;

  (14) monitor the delivery of HCS Program services, CFC services, and non-HCS Program and non-CFC services to an individual;

  (15) document whether an individual progresses toward desired outcomes identified on the individual's PDP;

  (16) together with the program provider, ensure the coordination and compatibility of HCS Program services and CFC services with non-HCS Program and non-CFC services, including, in coordination with the program provider, assisting an individual in obtaining a neurobehavioral or neuropsychological assessment and plan of care from a qualified professional as described in §9.174(a)(27)(B) of this subchapter (relating to Certification Principles: Service Delivery);

  (17) for an individual who has had a guardian appointed, determine, at least annually, if the letters of guardianship are current;

  (18) for an individual who has not had a guardian appointed, make a referral of guardianship to a court, if appropriate;

  (19) immediately notify the program provider if the service coordinator becomes aware that an emergency necessitates the provision of an HCS Program service or a CFC service to ensure the individual's health or safety and the service is not on the IPC or exceeds the amount on the IPC;

  (20) if informed by the program provider that an individual's HCS Program services or CFC services have been suspended:

    (A) request the program provider enter necessary information in the HHSC data system to inform HHSC of the suspension;

    (B) review the individual's status and document in the individual's record the reasons for continuing the suspension, at least every 90 calendar days after the effective date of the suspension; and

    (C) to continue suspension of the services for more than 270 calendar days, submit to HHSC written documentation of each review made in accordance with subparagraph (B) of this paragraph and a request for approval by HHSC to continue the suspension;

  (21) if notified by the program provider that an individual or LAR has refused a nursing assessment and that the program provider has determined it cannot ensure the individual's health, safety, and welfare in the provision of a service as described in §9.174(e) of this of this subchapter:

    (A) inform the individual or LAR of the consequences and risks of refusing the assessment, including that the refusal will result in the individual not receiving:

      (i) nursing services; or

      (ii) host home/companion care, residential support, supervised living, supported home living, respite, employment assistance, supported employment, day habilitation, or CFC PAS/HAB, if the individual needs one of those services and the program provider has determined that it cannot ensure the health and safety of the individual in the provision of the service; and

    (B) notify the program provider if the individual or LAR continues to refuse the assessment after the discussion with the service coordinator;

  (22) notify the program provider if the service coordinator becomes aware that an individual has been admitted to a setting described in §9.155(e) of this subchapter (relating to Eligibility Criteria and Suspension of HCS Program Services and of CFC Services);

  (23) if the service coordinator determines that HCS Program services or CFC services provided to an individual should be terminated, including for a reason described in §9.158(k)(15)(A) or (B) of this subchapter:

    (A) document a description of:

      (i) the situation that resulted in the service coordinator's determination that services should be terminated;

      (ii) the attempts by the service coordinator to resolve the situation; and

    (B) send a written recommendation to terminate the individual's HCS Program services or CFC services to HHSC and include the documentation required by subparagraph (A) of this paragraph;

    (C) provide a copy of the written recommendation and the documentation required by subparagraph (A) of this paragraph to the program provider;

  (24) if an individual requests termination of all HCS Program services or all CFC services, the service coordinator must, within ten calendar days after the individual's request:

    (A) inform the individual or LAR of:

      (i) the individual's option to transfer to another program provider;

      (ii) the consequences of terminating HCS Program services and CFC services; and

      (iii) possible service resources upon termination, including CFC services through a managed care organization; and

    (B) submit documentation to HHSC that:

      (i) states the reason the individual is making the request; and

      (ii) demonstrates that the individual or LAR was provided the information required by subparagraph (A)(ii) and (iii) of this paragraph;

  (25) in accordance with HHSC's instructions, manage the process to transfer an individual's HCS Program services and CFC services from one program provider to another or transfer from one FMSA to another, including:

    (A) informing the individual or LAR who requests a transfer to another program provider or FMSA that the service coordinator will manage the transfer process;

    (B) informing the individual or LAR that the individual or LAR may choose:

      (i) to receive HCS Program services and CFC services from any program provider that is in the geographic location preferred by the individual or LAR and whose enrollment has not reached its service capacity in the HHSC data system; or

      (ii) to transfer to any FMSA in the geographic location preferred by the individual or LAR; and

    (C) if the individual or LAR has not selected another program provider or FMSA, providing the individual or LAR with a list of and contact information for HCS Program providers and FMSAs in the geographic location preferred by the individual or LAR;

  (26) be objective in assisting an individual or LAR in selecting a program provider or FMSA;

  (27) at the time of assignment and as changes occur, ensure that an individual and LAR and program provider are informed of the name of the individual's service coordinator and how to contact the service coordinator;

  (28) unless contraindications are documented with justification by the service planning team, ensure that a school-age individual receives educational services in a six-hour-per-day program, five days per week, provided by the local school district and that no individual receives educational services at a state supported living center or at a state center;

Cont'd...

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