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TITLE 40SOCIAL SERVICES AND ASSISTANCE
PART 1DEPARTMENT OF AGING AND DISABILITY SERVICES
CHAPTER 98DAY ACTIVITY AND HEALTH SERVICES REQUIREMENTS
SUBCHAPTER HDAY ACTIVITY AND HEALTH SERVICES (DAHS) CONTRACTUAL REQUIREMENTS
RULE §98.210Financial Errors

(a) In the absence of acceptable secondary documentation, financial errors include the errors described in this section.

  (1) The DAHS facility is reimbursed for services, but DADS Daily Attendance and Daily Transportation Record form is missing for the period for which services are reimbursed. DADS applies the error to the total number of units reimbursed for the billing period.

  (2) The DAHS facility is reimbursed for units that exceed the units recorded on DADS Daily Attendance and Daily Transportation Record form. DADS applies the error to the total number of units reimbursed in excess of the units recorded.

  (3) The DAHS facility is reimbursed for units of service and the client did not receive services or was Medicaid ineligible (not applicable to Title XX clients). DADS applies the error to the total number of units reimbursed for the days the client did not receive services or was Medicaid ineligible.

(b) Corrections of critical omissions or errors in DAHS facility documentation must be postmarked or date stamped as received by DADS within 14 days after the regional nurse mails DADS Notification of Critical Omissions/Errors in Required Documentation form to the DAHS facility. If the DAHS facility fails to meet this time frame:

  (1) the date of prior approval can be no earlier than the postmark or DADS-stamped date on the corrected documentation; or

  (2) DADS may refer the individual to another DAHS facility of the individual's choice.

    (A) If there is space in another DAHS facility, the regional nurse notifies the case manager by the next workday to give the individual or individual's family/representative the option to be referred to another DAHS facility.

    (B) The case manager will contact the individual within three workdays after being notified by the regional nurse and refer the individual to another DAHS facility, if the individual or the individual's family/representative prefers this option.


Source Note: The provisions of this §98.210 adopted to be effective May 1, 1999, 24 TexReg 3100; amended to be effective April 1, 2007, 32 TexReg 1749; amended to be effective September 1, 2014, 39 TexReg 6679

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