| (a) Community support provides services and supports
in an individual's home and at other community locations that are
necessary to achieve outcomes identified in an individual's PDP.
(1) Community support provides:
(A) habilitative or support activities that:
(i) provide or foster improvement of or facilitate
an individual's ability to perform functional living skills and other
activities of daily living;
(ii) assist an individual to develop competencies in
maintaining the individual's home life;
(iii) foster improvement of or facilitate an individual's
ability and opportunity to:
(I) participate in typical community activities including
activities that lead to successful employment;
(II) access and use of services and resources available
to all citizens in the individual's community;
(III) interact with members of the community;
(IV) access and use available non-TxHmL Program services
or supports for which the individual may be eligible; and
(V) establish or maintain relationships with people
who are not paid service providers that expand or sustain the individual's
natural support network;
(B) transportation; and or
(C) assistance in obtaining transportation.
(2) Community support, as determined by an assessment
conducted by an RN, provides assistance with medications and the performance
of tasks delegated by an RN in accordance with state law and rules,
unless a physician has delegated the task as a medical act under Texas
Occupations Code, Chapter 157, as documented by the physician.
(3) Community support does not include payment for
room or board.
(4) Community support may not be provided to the individual
at the same time that any of the following services are provided:
(A) respite;
(B) day habilitation;
(C) employment assistance with the individual present;
or
(D) supported employment with the individual present.
(b) Day habilitation assists an individual to acquire,
retain, or improve self-help, socialization, and adaptive skills necessary
to live successfully in the community and participate in home and
community life.
(1) Day habilitation provides:
(A) individualized activities consistent with achieving
the outcomes identified in the individual's PDP;
(B) activities necessary to reinforce therapeutic outcomes
targeted by other waiver services, school, or other support providers;
(C) services in a group setting other than the individual's
home for normally up to five days a week, six hours per day;
(D) personal assistance for an individual who cannot
manage personal care needs during the day habilitation activity;
(E) as determined by an assessment conducted by an
RN, assistance with medications and the performance of tasks delegated
by an RN in accordance with state law and rules, unless a physician
has delegated the task as a medical act under Texas Occupations Code,
Chapter 157, as documented by the physician; and
(F) transportation during the day habilitation activity
necessary for the individual's participation in day habilitation activities.
(2) Day habilitation may not be provided at the same
time that any of the following services are provided:
(A) respite;
(B) community support;
(C) employment assistance with the individual present;
(D) supported employment with the individual present;
or
(E) CFC PAS/HAB.
(c) Nursing provides treatment and monitoring of health
care procedures ordered or prescribed by a practitioner and as required
by standards of professional practice or state law to be performed
by an RN or LVN. Nursing includes:
(1) administering medication;
(2) monitoring an individual's use of medications;
(3) monitoring an individual's health risks, data,
and information, including ensuring that an unlicensed service provider
is performing only those nursing tasks identified in a nursing assessment;
(4) assisting an individual or LAR to secure emergency
medical services for the individual;
(5) making referrals for appropriate medical services;
(6) performing health care procedures as ordered or
prescribed by a practitioner and required by standards of professional
practice or law to be performed by an RN or LVN;
(7) delegating nursing tasks assigned to an unlicensed
service provider and supervising the performance of those tasks in
accordance with state law and rules;
(8) teaching an unlicensed service provider about the
specific health needs of an individual;
(9) performing an assessment of an individual's health
condition;
(10) an RN doing the following:
(A) 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;
(B) documenting information from performance of a nursing
assessment;
(C) if an individual is receiving a service through
CDS, providing a copy of the documentation described in described
in subparagraph (B) of this paragraph to the individual's service
coordinator;
(D) developing the nursing service portion of an individual's
implementation plan required by §9.578(c)(2) of this subchapter
(relating to Program Provider Certification Principles: Service Delivery),
which includes developing a plan and schedule for monitoring and supervising
delegated nursing tasks; and
(E) making and documenting decisions related to the
delegation of a nursing task to an unlicensed service provider;
(11) in accordance with Texas Human Resources Code,
Chapter 161:
(A) 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:
(I) an oral medication;
(II) a topical medication; or
(III) 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:
(I) trained by an RN or an LVN under the direction
of an RN regarding the proper administration of medication; or
(II) 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
(B) 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.
(d) Employment assistance:
(1) is assistance provided to an individual to help
the individual locate competitive employment in the community;
(2) consists of a service provider performing the following
activities:
(A) identifying an individual's employment preferences,
job skills, and requirements for a work setting and work conditions;
(B) locating prospective employers offering employment
compatible with an individual's identified preferences, skills, and
requirements;
(C) contacting a prospective employer on behalf of
an individual and negotiating the individual's employment;
(D) transporting the individual to help the individual
locate competitive employment in the community; and
(E) participating in service planning team meetings;
(3) is not provided to an individual with the individual
present at the same time that respite, community support, day habilitation,
or supported employment, or CFC PAS/HAB is provided;
(4) does not include using Medicaid funds paid by HHSC
to the program provider for incentive payments, subsidies, or unrelated
vocational training expenses, such as:
Cont'd... |
