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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

    (C) the individual's need for assistance with activities of daily living during normal sleeping hours;

  (41) ensure that respite is available on a 24-hour increment or any part of that increment to individuals living in their family homes;

  (42) ensure that respite 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:

    (A) includes:

      (i) training in self-help and independent living skills;

      (ii) providing room and board when respite is provided in a setting other than the individual's normal residence;

      (iii) assisting with:

        (I) ongoing provision of needed waiver services; and

        (II) securing and providing transportation; and

    (B) is only provided:

      (i) to individuals who are not receiving residential support, supervised living, or host home/companion care; and

      (ii) when the unpaid caregiver is temporarily unavailable to provide supports;

  (43) provide respite in the residence of an individual or in other locations, including residences in which host home/companion care, supervised living, or residential support is provided or in a respite facility or camp, that meet HCS Program requirements and afford an environment that ensures the health, safety, comfort, and welfare of the individual.

    (A) If respite is provided in the residence of another individual, the program provider must obtain permission from that individual or LAR and ensure that the respite visit will cause no threat to the health, safety, or welfare of that individual.

    (B) If respite is provided in the residence of another individual, the program provider must ensure that:

      (i) no more than three individuals receiving HCS Program services or CFC services and persons receiving similar services for which the program provider is reimbursed are served in a residence in which host home/companion care is provided;

      (ii) no more than three individuals receiving HCS Program services or CFC services and persons receiving similar services for which the program provider is reimbursed are served in a residence in which only supervised living is provided; and

      (iii) no more than four individuals receiving HCS Program services or CFC services and persons receiving similar services for which the program provider is reimbursed are served in a residence in which residential support is provided.

    (C) If respite is provided in a respite facility, the program provider must:

      (i) ensure that the facility is not a residence;

      (ii) ensure that no more than six individuals receive services in the facility at any one time; and

      (iii) obtain written approval from the local fire authority having jurisdiction stating that the facility and its operation meet the local fire ordinances before initiating services in the facility if more than three individuals receive services in the facility at any one time.

    (D) If respite is provided in a camp setting, the program provider must ensure the camp is accredited by the American Camp Association.

    (E) The program provider must not provide respite in an institution such as an ICF/IID, nursing facility, or hospital;

  (44) ensure that employment assistance:

    (A) is assistance provided to an individual to help the individual locate competitive employment in the community;

    (B) consists of a service provider performing the following activities:

      (i) identifying an individual's employment preferences, job skills, and requirements for a work setting and work conditions;

      (ii) locating prospective employers offering employment compatible with an individual's identified preferences, skills, and requirements;

      (iii) contacting a prospective employer on behalf of an individual and negotiating the individual's employment;

      (iv) transporting an individual to help the individual locate competitive employment in the community; and

      (v) participating in service planning team meetings;

    (C) is provided in accordance with an 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;

    (D) is not provided to an individual with the individual present at the same time that respite, supported home living, day habilitation, supported employment, or CFC PAS/HAB is provided; and

    (E) does not include using Medicaid funds paid by DADS to the program provider for incentive payments, subsidies, or unrelated vocational training expenses, such as:

      (i) paying an employer:

        (I) to encourage the employer to hire an individual; or

        (II) for supervision, training, support, or adaptations for an individual that the employer typically makes available to other workers without disabilities filling similar positions in the business; or

      (ii) paying an individual:

        (I) as an incentive to participate in employment assistance activities; or

        (II) for expenses associated with the start-up costs or operating expenses of the individual's business;

  (45) ensure that supported employment:

    (A) is assistance provided to an individual:

      (i) who, because of a disability, requires intensive, ongoing support to be self-employed, work from home, or perform in a work setting at which persons without disabilities are employed;

      (ii) in order for the individual to sustain competitive employment; and

      (iii) 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;

    (B) consists of a service provider performing the following activities:

      (i) making employment adaptations, supervising, and providing training related to an individual's assessed needs;

      (ii) transporting an individual to support the individual to be self-employed, work from home, or perform in a work setting; and

      (iii) participating in service planning team meetings;

    (C) is not provided to an individual with the individual present at the same time that respite, supported home living, day habilitation, supported employment, or CFC PAS/HAB is provided; and

    (D) does not include:

      (i) sheltered work or other similar types of vocational services furnished in specialized facilities; or

      (ii) using Medicaid funds paid by DADS to the program provider for incentive payments, subsidies, or unrelated vocational training expenses such as:

        (I) paying an employer:

          (-a-) to encourage the employer to hire an individual; or

          (-b-) to supervise, train, support, or make adaptations for an individual that the employer typically makes available to other workers without disabilities filling similar positions in the business; or

        (II) paying an individual:

          (-a-) as an incentive to participate in supported employment activities; or

          (-b-) for expenses associated with the start-up costs or operating expenses of the individual's business;

  (46) ensure that CFC PAS/HAB is available only to an individual who is not receiving host home/companion care, supervised living, or residential support;

  (47) ensure that CFC PAS/HAB is provided in accordance with the individual's PDP, IPC, and implementation plan;

  (48) ensure that CFC support management is provided to an individual or LAR if:

    (A) the individual is receiving CFC PAS/HAB; and

    (B) the individual or LAR requests to receive CFC support management;

  (49) inform the service coordinator of changes related to an individual's residential setting that do not require a change to the individual's IPC;

  (50) maintain a system of delivering HCS Program services and CFC services that is continuously responsive to changes in the individual's personal goals, condition, abilities, and needs as identified by the service planning team;

  (51) ensure that appropriate staff members, service providers, and the service coordinator are informed of a circumstance or event that occurs in an individual's life or a change to an individual's condition that may affect the provision of services to the individual;

  (52) maintain current information in the DADS data system about the individual and the individual's LAR, including:

    (A) the individual's full name, address, location code, and phone number; and

    (B) the LAR's full name, address, and phone number;

  (53) maintain a single record related to HCS Program services and CFC services provided to an individual for an IPC year that includes:

    (A) the IPC;

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

    (C) the implementation plan;

    (D) a behavior support plan, if one has been developed;

    (E) a transportation plan, if one is required;

    (F) documentation that describes the individual's progress or lack of progress on the implementation plan;

    (G) documentation that describes any changes to an individual's personal goals, condition, abilities, or needs;

    (H) the ID/RC Assessment;

    (I) documentation supporting the recommended LON, including the ICAP booklet, assessments and interventions by qualified professionals, and time sheets of service providers;

    (J) results and recommendations from individualized assessments that support the individual's current need for each service included in the IPC;

    (K) documentation concerning any use of restraint as described in §9.179(c)(2) and (3) of this subchapter (relating to Certification Principles: Restraint);

    (L) documentation related to the suspension of an individual's HCS Program services or CFC services;

    (M) for an individual under 22 years of age, a copy of the permanency plan; and

    (N) documentation required by subsections (g)(2)(A) and (h)(2)(A) of this section;

  (54) upon request by the service coordinator:

    (A) permit the service coordinator access to the record that is required by paragraph (53) of this subsection; and

    (B) provide the service coordinator a legible copy of a document in the record at no charge to the service coordinator;

  (55) provide a copy of the following documents to the service coordinator:

    (A) an individual's IPC; and

    (B) an individual's ID/RC Assessment;

  (56) notify the service coordinator if the program provider has reason to believe that an individual is no longer eligible for HCS Program services or CFC services or an individual or LAR has requested termination of all HCS Program services or all CFC services;

  (57) if a physician delegates a medical act to an unlicensed service provider in accordance with Texas Occupations Code, Chapter 157, and the program provider has concerns about the health or safety of the individual in performance of the medical act, communicate the concern to the delegating physician and take additional steps as necessary to ensure the health and safety of the individual;

  (58) for an HCS Program service or CFC service identified on the PDP as critical to meeting the individual's health and safety:

    (A) develop a service backup plan that:

      (i) contains the name of the critical service;

      (ii) specifies the period of time in which an interruption to the critical service would result in an adverse effect to the individual's health or safety; and

      (iii) in the event of a service interruption resulting in an adverse effect as described in clause (ii) of this subparagraph, describes the actions the program provider will take to ensure the individual's health and safety;

    (B) ensure that:

      (i) if the action in the service backup plan required by subparagraph (A) of this paragraph identifies a natural support, that the natural support receives pertinent information about the individual's needs and is able to protect the individual's health and safety; and

      (ii) a person identified in the service backup plan, if paid to provide the service, meets the qualifications described in this subchapter; and

    (C) if the service backup plan required by subparagraph (A) of this paragraph is implemented:

      (i) discuss the implementation of the service backup plan with the individual and the service providers or natural supports identified in the service backup plan to determine whether or not the plan was effective;

Cont'd...

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