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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

    (D) reinforcing skills or lessons taught in school, therapy, or other settings;

    (E) training and support activities that promote the individual's integration and participation in the community;

    (F) providing assistance for the individual who cannot manage personal care needs during day habilitation activities; and

    (G) providing transportation during day habilitation activities as necessary for the individual's participation in day habilitation activities;

  (29) ensure that dental treatment 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) emergency dental treatment;

    (B) preventive dental treatment;

    (C) therapeutic dental treatment; and

    (D) orthodontic dental treatment, excluding cosmetic orthodontia;

  (30) ensure that minor home modifications 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, limited to the following categories:

    (A) purchase and repair of wheelchair ramps;

    (B) modifications to bathroom facilities;

    (C) modifications to kitchen facilities;

    (D) specialized accessibility and safety adaptations or additions; and

    (E) repair and maintenance of minor home modifications not covered by a warranty;

  (31) ensure that nursing is provided in accordance with the individual's PDP; IPC; implementation plan; Texas Occupations Code, Chapter 301 (Nursing Practice Act); 22 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 CMS and found at www.dads.state.tx.us and consists of performing health care activities and monitoring the individual's health conditions, including:

    (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 an RN or 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) an RN doing the following:

      (i) performing 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) documenting information from performance of a nursing assessment;

      (iii) if an individual is receiving a service through the CDS option, providing a copy of the documentation described in clause (ii) of this subparagraph to the individual's service coordinator;

      (iv) developing 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) making and documenting 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 an LVN under the direction of an RN regarding the proper administration of medication; or

          (-b-) determined to be competent by an RN or an 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 an 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;

  (32) ensure that supported home living:

    (A) is available only to an individual who is not receiving:

      (i) host home/companion care;

      (ii) supervised living; or

      (ii) residential support; and

    (B) is available to an individual who is receiving foster care services from DFPS;

  (33) ensure that supported home living is provided in accordance with the individual's PDP, IPC, implementation plan, transportation plan, and with Appendix C of the HCS Program waiver application approved by CMS and found at www.dads.state.tx.us and includes the following elements:

    (A) direct personal assistance with activities of daily living (grooming, eating, bathing, dressing, and personal hygiene);

    (B) assistance with meal planning and preparation;

    (C) providing transportation;

    (D) securing transportation;

    (E) assistance with housekeeping;

    (F) assistance with ambulation and mobility;

    (G) reinforcement of professional therapy activities;

    (H) assistance with medications and the performance of tasks delegated by an RN;

    (I) supervision of individuals' safety and security;

    (J) facilitating inclusion in community activities, use of natural supports, social interaction, participation in leisure activities, and development of socially valued behaviors; and

    (K) habilitation, exclusive of day habilitation;

  (34) ensure that HCS host home/companion care is provided:

    (A) by a host home/companion care provider who lives in the residence in which no more than three individuals or other persons receiving similar services are living at any one time; and

    (B) in a residence in which the program provider does not hold a property interest;

  (35) ensure that host home/companion care 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, and includes the following elements:

    (A) direct personal assistance with activities of daily living (grooming, eating, bathing, dressing, and personal hygiene);

    (B) assistance with meal planning and preparation;

    (C) securing and providing transportation;

    (D) assistance with housekeeping;

    (E) assistance with ambulation and mobility;

    (F) reinforcement of professional therapy activities;

    (G) assistance with medications and the performance of tasks delegated by an RN;

    (H) supervision of individuals' safety and security;

    (I) facilitating inclusion in community activities, use of natural supports, social interaction, participation in leisure activities, and development of socially valued behaviors; and

    (J) habilitation, exclusive of day habilitation;

  (36) ensure that supervised living is provided:

    (A) in a four-person residence that is approved in accordance with §9.188 of this subchapter (relating to DADS Approval of Residences) or a three-person residence;

    (B) by a service provider who provides services and supports as needed by the individuals residing in the residence and is present in the residence and able to respond to the needs of the individuals during normal sleeping hours; and

    (C) only with approval by the DADS commissioner or designee for the initial six months and one six-month extension and only with approval by the HHSC executive commissioner after such 12-month period, if provided to an individual under 22 years of age;

  (37) ensure that supervised living 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, and includes the following elements:

    (A) direct personal assistance with activities of daily living (grooming, eating, bathing, dressing, and personal hygiene);

    (B) assistance with meal planning and preparation;

    (C) securing and providing transportation;

    (D) assistance with housekeeping;

    (E) assistance with ambulation and mobility;

    (F) reinforcement of professional therapy activities;

    (G) assistance with medications and the performance of tasks delegated by an RN;

    (H) supervision of individuals' safety and security;

    (I) facilitating inclusion in community activities, use of natural supports, social interaction, participation in leisure activities, and development of socially valued behaviors; and

    (J) habilitation, exclusive of day habilitation;

  (38) ensure that residential support is provided:

    (A) in a four-person residence that is approved in accordance with §9.188 of this subchapter or a three-person residence;

    (B) by a service provider who is present in the residence and awake whenever an individual is present in the residence;

    (C) by service providers assigned on a daily shift schedule that includes at least one complete change of service providers each day; and

    (D) only with approval by the DADS commissioner or designee for the initial six months and one six-month extension and only with approval by the HHSC executive commissioner after such 12-month period, if provided to an individual under 22 years of age;

  (39) ensure that residential support 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, and includes the following elements:

    (A) direct personal assistance with activities of daily living (grooming, eating, bathing, dressing, and personal hygiene);

    (B) assistance with meal planning and preparation;

    (C) securing and providing transportation;

    (D) assistance with housekeeping;

    (E) assistance with ambulation and mobility;

    (F) reinforcement of professional therapy activities;

    (G) assistance with medications and the performance of tasks delegated by an RN;

    (H) supervision of individuals' safety and security;

    (I) facilitating inclusion in community activities, use of natural supports, social interaction, participation in leisure activities, and development of socially valued behaviors; and

    (J) habilitation, exclusive of day habilitation;

  (40) if making a recommendation to the service planning team that the individual receive residential support, document the reasons for the recommendation, which may include:

    (A) the individual's medical condition;

    (B) a behavior displayed by the individual that poses a danger to the individual or to others; or

Cont'd...

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