| (4) negotiate and finalize the initial IPC and the
date services will begin with the selected program provider, consulting
with HHSC if necessary to reach agreement with the selected program
provider on the content of the initial IPC and the date services will
begin;
(5) determine whether the applicant meets the following
criteria:
(A) is being discharged from a nursing facility, an
ICF/IID, or a GRO; and
(B) anticipates needing TAS;
(6) if the service coordinator determines that the
applicant meets the criteria described in paragraph (5) of this subsection:
(A) complete, with the applicant or LAR and the selected
program provider, the HHSC Transition Assistance Services (TAS) Assessment
and Authorization form, which is available on the HHSC website, in
accordance with the form's instructions, which includes:
(i) identifying the TAS the applicant needs; and
(ii) estimating the monetary amount for each transition
assistance service identified, which must be within the service limit
described in §263.304(a)(6) of this chapter (relating to Service
Limits);
(B) submit the completed form to HHSC to determine
if TAS is authorized;
(C) send the form authorized by HHSC to the selected
program provider; and
(D) include the TAS and the monetary amount authorized
by HHSC on the applicant's initial IPC;
(7) determine whether an applicant meets the following
criteria:
(A) is being discharged from a nursing facility, an
ICF/IID, or a GRO;
(B) has not met the maximum service limit for minor
home modifications as described in §263.304(a)(3)(A) of this
chapter; and
(C) anticipates needing pre-enrollment minor home modifications
and a pre-enrollment minor home modifications assessment;
(8) if the service coordinator determines that an applicant
meets the criteria described in paragraph (7) of this subsection:
(A) complete, with the applicant or LAR and selected
program provider, the HHSC Home and Community-based Services (HCS)
Program Pre-enrollment MHM Authorization Request form, which is available
on the HHSC website, in accordance with the form's instructions, which
includes:
(i) identifying the pre-enrollment minor home modifications
the applicant needs;
(ii) identifying the pre-enrollment minor home modifications
assessments conducted by the program provider; and
(iii) based on documentation provided by the program
provider as required by the HCS Program Billing
Requirements, stating the cost of:
(I) the pre-enrollment minor home modifications identified
on the form, which must be within the service limit described in §263.304(a)(3)(A)
of this chapter; and
(II) the pre-enrollment minor home modifications assessments
conducted;
(B) submit the completed form to HHSC to determine
if pre-enrollment minor home modification and pre-enrollment minor
home modifications assessments are authorized;
(C) send the form authorized by HHSC to the selected
program provider; and
(D) include the pre-enrollment minor home modifications,
pre-enrollment minor home modifications assessments, and the monetary
amount for these services authorized by HHSC on the applicant's initial
IPC;
(9) if an applicant or LAR chooses a program provider
to deliver supported home living, nursing, host home/companion care,
residential support, supervised living, respite, employment assistance,
supported employment, in-home day habilitation, day habilitation,
or CFC PAS/HAB, ensure that the initial IPC includes a sufficient
number of RN nursing units for the program provider's RN to perform
a comprehensive nursing assessment unless:
(A) nursing services are not on the IPC and the applicant
or LAR and selected program provider have determined that no nursing
tasks will be performed by an unlicensed service provider as documented
on the HHSC Nursing Task Screening Tool form; or
(B) an unlicensed service provider will perform a nursing
task and a physician has delegated the task as a medical act under
Texas Occupations Code Chapter 157, as documented by the physician;
(10) if an applicant or LAR refuses to include on the
initial IPC a sufficient number of RN nursing units for the program
provider's RN to perform a comprehensive nursing assessment as required
by paragraph (9) of this subsection:
(A) inform the applicant or LAR that the refusal:
(i) will result in the applicant not receiving nursing
services from the program provider; and
(ii) if the applicant needs host home/companion care,
residential support, supervised living, supported home living, respite,
employment assistance, supported employment, in-home day habilitation,
day habilitation, or CFC PAS/HAB from the program provider, will result
in the individual not receiving that service unless:
(I) the program provider's unlicensed service provider
does not perform nursing tasks in the provision of the service; and
(II) the program provider determines that it can ensure
the applicant's health, safety, and welfare in the provision of the
service; and
(B) document the refusal of the RN nursing units on
the initial IPC for a comprehensive nursing assessment by the program
provider's RN in the applicant's record;
(11) ensure that the applicant or LAR signs and dates
the initial IPC and provides the signed and dated IPC to the service
coordinator in person, electronically, by fax, or by United States
mail;
(12) ensure that the selected program provider signs
and dates the initial IPC, demonstrating agreement that the services
will be provided to the applicant;
(13) sign and date the initial IPC, which indicates
that the service coordinator agrees that the requirements described
in §263.301(c) of this chapter have been met;
(14) using the HHSC Understanding Program Eligibility
and Services form, which is available on the HHSC website, provide
an oral and written explanation to the applicant or LAR:
(A) of the eligibility requirements for HCS Program
services as described in §263.101(a) of this subchapter (relating
to Eligibility Criteria for HCS Program Services and CFC Services);
(B) if the applicant's PDP includes CFC services:
(i) of the eligibility requirements for CFC services
as described in §263.101(c) of this subchapter to applicants
who do not receive MAO Medicaid; and
(ii) of the eligibility requirements for CFC services
as described in §263.101(d) of this subchapter to applicants
who receive MAO Medicaid;
(C) that HCS Program services may be terminated if:
(i) the individual no longer meets the eligibility
criteria described in §263.101(a) of this subchapter; or
(ii) the individual or LAR requests termination of
HCS Program services; and
(D) if the applicant's PDP includes CFC services, that
CFC services may be terminated if:
(i) the individual no longer meets the eligibility
criteria described in §263.101(c) or (d) of this subchapter;
or
(ii) the individual or LAR requests termination of
CFC services.
(l) A LIDDA must conduct permanency planning in accordance
with §263.902(a) - (f) of this chapter (relating to Permanency
Planning).
(m) After an initial IPC is finalized and signed in
accordance with subsection (k) of this section, the LIDDA must:
(1) enter the information from the initial IPC in the
HHSC data system and electronically submit it to HHSC;
(2) keep the original initial IPC in the individual's
record;
(3) ensure the information from the initial IPC entered
in the HHSC data system and electronically submitted to HHSC contains
information identical to the information on the initial IPC; and
(4) submit other required enrollment information to
HHSC.
(n) HHSC notifies the applicant or LAR, the selected
program provider, the FMSA, if applicable, and the LIDDA of its approval
or denial of the applicant's enrollment. When the enrollment is approved,
HHSC authorizes the applicant's enrollment in the HCS Program through
the HHSC data system and issues an enrollment letter to the applicant
that includes the effective date of the applicant's enrollment in
the HCS Program.
(o) Before the applicant's service begin date, the
LIDDA must provide to the selected program provider and FMSA, if applicable:
(1) copies of all enrollment documentation and associated
supporting documentation, including relevant assessment results and
recommendations;
(2) the completed ID/RC Assessment;
Cont'd... |
