| (a) A program provider must ensure that:
(1) a full-time case manager is assigned to provide
case management services to no more than 30 individuals or other persons
receiving services through another Medicaid waiver at one time;
(2) a part-time case manager is assigned to provide
case management services to no more than 15 individuals or other persons
receiving services through another Medicaid waiver at one time; and
(3) for a month in which a case manager does not meet
with an individual or LAR as required by §260.77(a) of this chapter
(relating to Renewal and Revision of an IPP and IPC), the case manager
has contact with the individual, LAR, primary caregiver, or actively
involved person in person, by videoconferencing, or by telephone,
to provide case management.
(b) In determining the number of individuals or other
persons receiving services through another Medicaid waiver at one
time to whom a case manager will be assigned, a program provider must
take into consideration:
(1) the intensity of needs of each individual or person;
(2) the frequency and duration of contacts the case
manager will need to make with the individual or person; and
(3) the amount of travel time involved in making such
contacts.
(c) A program provider must have:
(1) a sufficient number of case managers available
at all times to ensure the provision of case management services;
and
(2) a written process that ensures a case manager can
readily become familiar with an individual to whom the case manager
is not ordinarily assigned but to whom the case manager may be required
to provide case management services.
(d) A program provider must have written policies and
procedures that ensure backup service providers are or can readily
become familiar with individuals to whom they are not ordinarily assigned
but to whom they may be required to deliver services.
(e) A program provider must provide each DBMD Program
service and CFC service authorized in an individual's IPC in accordance
with:
(1) the individual's current IPC;
(2) the individual's current IPP; and
(3) the requirements in this chapter.
(f) A program provider must ensure a copy of an individual's
IPP is distributed or made available to each service provider who
provides a service on the IPP.
(g) A program provider must:
(1) provide or ensure the provision of each DBMD Program
service listed in §260.7(c) of this chapter (relating to Description
of the DBMD Program and CFC);
(2) provide the assisted living service as either licensed
assisted living or licensed home health assisted living in accordance
with §260.351 of this chapter (relating to Residential Services);
(3) provide or ensure the provision of each CFC service
listed in §260.7(e) of this chapter; and
(4) ensure that CFC support management is provided
to an individual or LAR as described in the Deaf
Blind with Multiple Disabilities Program Manual if:
(A) the individual is receiving CFC PAS/HAB; and
(B) the individual or LAR requests to receive CFC support
management.
(h) A program provider must offer an individual choices
and opportunities for accessing and participating in community activities,
including employment opportunities and experiences available to peers
without disabilities, and provide supports necessary for an individual
to participate in those activities consistent with an individual's
or LAR's choice and the individual's IPC and IPP.
(i) A program provider may accept or decline the request
of an individual or LAR for the provision of transportation provided
as a residential habilitation activity, nursing, out-of-home respite
in a camp, case management, adaptive aids, intervener services, or
CFC PAS/HAB to the individual while the individual is staying at a
location outside the program provider's contracted service delivery
area but within the state of Texas.
(j) If a program provider accepts the request of an
individual or LAR, as described in subsection (i) of this section,
the program provider:
(1) may provide transportation provided as a residential
habilitation activity, nursing, out-of-home respite in a camp, adaptive
aids, intervener services, CFC PAS/HAB, and case management services
at the requested location;
(2) must document in the service delivery log:
(A) that the individual is receiving services outside
the program provider's contracted service delivery area;
(B) the location where the individual is receiving
the services;
(C) the estimated length of time the individual is
expected to be outside the program provider's contracted service delivery
area; and
(D) contact information for the individual or LAR;
(3) must, if the individual receives services outside
the program provider's contracted service delivery area for 30 consecutive
days, inform the individual or LAR, on or before the 35th day, that:
(A) to ensure the continued provision of the services,
the individual must do one of the following before the 61st day:
(i) transfer to a program provider that has a contracted
service delivery area that includes the area in which the individual
is receiving the services; or
(ii) return to the program provider's contracted service
delivery area; and
(B) if the individual receives services outside the
program provider's contracted service delivery area during a period
of 60 consecutive days, the individual must return to the contracted
service delivery area and receive services in that area before the
program provider may accept another request from the individual or
LAR for the provision of the services outside the program provider's
contracted service delivery area; and
(4) must, if the individual or LAR expresses a desire
for the individual to transfer to a program provider that has a contracted
service delivery area that includes the area in which the individual
is receiving services:
(A) give the individual and LAR the HHSC Documentation
of Provider Choice form for the contracted service delivery area in
which the individual is receiving the services;
(B) have the individual or LAR select a program provider
and designate that selection on the HHSC Documentation of Provider
Choice form; and
(C) coordinate the individual's transfer in accordance
with §260.79 of this chapter (relating to Coordination of Transfers).
(k) If the program provider declines the request of
an individual or LAR, as described in subsection (i) of this section,
the program provider must:
(1) inform the individual or LAR orally or in writing:
(A) of the reasons for declining the request; and
(B) that the individual may request a service planning
team meeting to discuss the reasons for declining the request; and
(2) document the discussion and the final outcome if
the service planning team meeting is held.
(l) If a program provider or case manager is unable
to meet a time frame specified in this chapter, it must be for a reason
not directly caused by the program provider or case manager, or for
a reason beyond the program provider's or case manager's control,
such as a man-made or natural disaster. The program provider or case
manager must document the program provider's or case manager's efforts
to meet a time frame and maintain the documentation in the individual's
record. The documentation must include:
(1) the reason the time frame could not be met, which
must be beyond the program provider's or case manager's control; and
(2) a description of the program provider's or case
manager's ongoing efforts to meet a time frame.
|
