(a) The Texas General Appropriations Act authorizes
reimbursement to the enrolled child's family for respite services
that are not directly related to IFSP goals.
(b) Respite services are defined as the care of an
enrolled child by a relative or substitute caregiver on a short-term
or intermittent basis to provide the child's parent with a break from
caring for his or her child. Respite services do not include the routine
care of a child for the purposes of allowing a parent to attend work
or school.
(c) The contractor must develop and implement a process
for administering the state funded reimbursement of respite services.
(1) The contractor may collaborate with other ECI contractors
within their respective consortium to administer the funds.
(2) The contractor must identify existing respite resources
in the community, including potential respite service providers and
additional funding sources before authorizing state funded respite
reimbursement.
(3) The contractor may provide reimbursement for up
to 20 hours of respite per child per month, based on the individual
needs of the family. The contractor may exceed the 20 hours respite
limit only if:
(A) the family has more than one child enrolled in
the ECI program; and
(B) the IFSP team determines that the children cannot
be cared for by a single respite provider.
(4) If the parent and the service coordinator do not
agree on the complexity of care, based on the needs of the child,
and the ECI reimbursement rate, the program director decides the complexity
of care and reimbursement rate.
(5) The contractor must have a process for prioritizing
requests for state funded respite reimbursement. The process must
include consideration of:
(A) how respite will benefit the family relationship;
and
(B) past use of respite services.
(6) If state respite funds are not available at the
time of a request, the contractor places the eligible family on a
waiting list for respite funds.
(7) State respite funds cannot be used to pay:
(A) insurance co-payments, insurance deductibles, or
insurance premiums;
(B) a parent to provide respite services to his or
her own child;
(C) individuals who live in the same household as the
child;
(D) individuals under 18 years of age; or
(E) costs for the care of siblings of the eligible
child.
(d) The contractor must maintain auditable records
of state funded respite reimbursement.
(e) The contractor must report the number of children
whose families received state funded reimbursement of respite services
for each month of the contract period as directed by HHSC.
(f) The service coordinator must:
(1) assist the parent in identifying available family
and community resources;
(2) assist the parent in determining the type (for
example, individual setting, group setting, care in the child's home,
or care out of the child's home) and frequency of respite needed;
(3) assist the parent in applying for available state
funds for reimbursement of respite services, if needed;
(4) determine the complexity of care, based on the
needs of the child;
(5) inform the parent of the following:
(A) state funds under this provision are limited;
(B) the state's annual hourly limits per child;
(C) the hourly co-pay based on family size and income;
(D) the state's level of reimbursement based upon the
complexity of care, frequency, and hourly co-pay;
(E) the contractor's criteria for prioritizing requests
for state funds for reimbursement of respite services and placement
on the waiting list; and
(F) the process for requesting a review and decision
by the program director if the parent and the service coordinator
do not agree on the frequency and complexity of care, based on the
needs of the child, and the ECI reimbursement rate.
(g) The service coordinator must explain to the parent
their responsibility regarding state funded reimbursement for respite
services. The parent is responsible for:
(1) selecting and supervising a respite provider;
(2) scheduling the respite care with the provider;
(3) paying the provider after the respite care is provided;
(4) submitting the completed respite voucher to the
contractor within one month of the voucher's expiration date;
(5) assuming any liability for the selection and use
of specific respite providers; and
(6) complying with any potential tax or IRS requirements
related to the use of state funded respite reimbursement.
(h) The following events must occur in order:
(1) the contractor determines the number of hours and
the level of care for each month, the number of months approved, the
beginning and ending dates of the agreement, and the hourly co-pay
required;
(2) the contractor completes all required information
on the respite funding agreement;
(3) the parent, the service coordinator or other assigned
staff member, and the program director (or designee), sign the completed
respite funding agreement;
(4) the contractor gives the parent a respite voucher
for each calendar month in which respite services are approved;
(5) the parent schedules respite with the respite provider;
(6) the respite provider signs the respite voucher
after providing the respite care;
(7) the parent completes, signs, and returns the voucher
to the contractor within one month of the voucher's expiration date;
and
(8) the contractor reimburses the parent within 30
days of receipt of an accurately completed voucher.
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Source Note: The provisions of this §350.1108 adopted to be effective September 1, 2013, 38 TexReg 5524; amended to be effective June 30, 2019, 44 TexReg 3280; transferred effective March 1, 2021, as published in the Texas Register February 5, 2021, 46 TexReg 941 |