| (a) Case manager's review.
(1) Beginning the effective date of an individual's
IPC, as determined in accordance with §260.69(j) of this subchapter
(relating to HHSC's Review of Request for Enrollment), a case manager
must, in accordance with the schedule in the Deaf
Blind with Multiple Disabilities Program Manual, meet with
the individual and LAR in person at a time convenient to the individual
and LAR in the individual's home, or if requested by the individual
or LAR, in another location to:
(A) review whether the DBMD Program services and CFC
services are being provided in accordance with the IPC and IPP;
(B) review the individual's progress toward achieving
the goals and outcomes described in the IPP for each service listed
on the individual's IPC;
(C) determine if the services are meeting the individual's
needs;
(D) determine if the individual's needs have changed;
(E) review assessments, evaluations, and progress notes
prepared by service providers since the previous review;
(F) if the individual's IPC includes nursing, intervener
services, or CFC PAS/HAB, and none of these services are identified
as critical to the individual's health and safety, discuss with the
individual or LAR whether any of these services may now be critical
to the individual's health and safety and needs a service backup plan;
and
(G) if the individual has a service backup plan for
nursing, intervener services, or CFC PAS/HAB, discuss with the individual
or LAR:
(i) whether the service backup plan, if implemented,
was effective;
(ii) whether the service backup plan needs to be revised;
and
(iii) whether the service backup plan needs to be discontinued
because the service is no longer critical to the individual's health
and safety.
(2) A case manager must:
(A) document the results of a meeting described in
paragraph (1) of this subsection in the individual's record using
the HHSC IPP Service Review form or a form the program provider develops
that includes the information on the HHSC form;
(B) document on the HHSC IPP Service Review form or
a form the program provider developed:
(i) if nursing, intervener services, or CFC PAS/HAB
has become critical to the individual's health and safety, and the
individual does not have a service backup plan for the service, that
the individual now needs a service backup plan for nursing, intervener
services, or CFC PAS/HAB; and
(ii) if the individual has a service backup plan for
nursing, intervener services, or CFC PAS/HAB, document on the IPP
review form that:
(I) the service planning team did not revise the service
backup plan because it was effective;
(II) the service planning team revised the service
backup plan to address any problems or concerns regarding implementation
of the service backup plan; or
(III) the service planning team discontinued the service
backup plan because the service is no longer critical to the individual's
health and safety;
(C) ensure the individual or LAR signs and dates the
IPP review form; and
(D) provide a copy of the completed HHSC IPP Service
Review form or a form the program provider developed to the individual
or LAR within 10 business days after the date of the meeting described
in paragraph (1) of this subsection.
(3) A case manager, no later than five business days
after the date of a meeting described in paragraph (1) of this subsection,
must convene a service planning team meeting:
(A) if the case manager:
(i) identifies needed changes in the individual's services;
or
(ii) determines that nursing, intervener services,
or CFC PAS/HAB services may now be critical to the individual's health
and safety, as described in paragraph (1)(F) of this subsection, or
that the service backup plan was ineffective, as described in paragraph
(1)(G) of this subsection;
(B) if the individual or LAR requests a revision of
the IPP or IPC; or
(C) if the service planning team determines that any
of the requirements in §260.403(a)(1) - (6) of this chapter (relating
to Requirements for Program Provider-Owned Residential Settings) must
be modified.
(4) During a service planning team meeting described
in paragraph (3) of this subsection, using the person-centered planning
process, a case manager must:
(A) develop a revised IPP that meets the requirements
described in §260.65 of this subchapter (relating to Development
of an Enrollment IPP);
(B) develop a proposed revised IPC that meets the requirements
described in §260.67(a)(1) and (b) of this subchapter (relating
to Development of a Proposed Enrollment IPC); and
(C) if:
(i) the proposed revised IPC includes transportation
provided as a residential habilitation activity or as an adaptive
aid, develop an individual transportation plan; and
(ii) the proposed revised IPC includes nursing, intervener
services, or CFC PAS/HAB services, ensure compliance with §260.213
of this chapter (relating to Service Backup Plans).
(5) A case manager must:
(A) ensure the revised IPP and proposed revised IPC
is signed and dated by each member of the service planning team; and
(B) no later than 10 business days after the date of
the service planning team meeting, submit to HHSC:
(i) a copy of the signed and dated proposed revised
IPC ;
(ii) a copy of the signed and dated revision IPP;
(iii) an individual transportation plan, if required
by paragraph (4)(C)(i) of this subsection;
(iv) an HHSC Rationale for Adaptive Aids, Medical Supplies,
and Minor Home Modifications form, if required by §260.303 of
this chapter (relating to Requirements for Authorization to Purchase
or Lease an Adaptive Aid), §260.317 of this chapter (relating
to Requesting Authorization to Purchase a Minor Home Modification
that Costs Less than $1,000), or §260.319 of this chapter (relating
to Requesting Authorization to Purchase a Minor Home Modification
that Costs $1,000 or More);
(v) an HHSC Specifications for Minor Home Modifications
form, if required by §260.321 of this chapter (relating to Specifications
for a Minor Home Modification);
(vi) an HHSC Prior Authorization for Dental Services
form, if required by §260.339 of this chapter (relating to Dental
Treatment); and
(vii) an HHSC Specialized Nursing Certification form,
if required by §260.347 of this chapter (relating to Nursing).
(b) Annual review by the service planning team.
(1) No more than 90 calendar days before the end of
an individual's IPC period:
(A) the case manager must complete an ID/RC Assessment;
(B) an RN must complete an annual nursing assessment
of the individual using the HHSC CLASS/DBMD Nursing Assessment form;
(C) an RN or the case manager must complete a Related
Conditions Eligibility Screening Instrument;
(D) the case manager or an appropriate professional
described in the assessment instructions must complete an adaptive
behavior screening assessment:
(i) if at least five years have passed after the date
of the most current assessment; or
(ii) if significant changes have occurred in the individual's
functioning;
(E) the case manager must convene an in-person meeting
of the service planning team to:
(i) review the HHSC CLASS/DBMD Nursing Assessment form
completed by the RN;
(ii) address any information included in Addendum E
of the HHSC CLASS/DBMD Nursing Assessment form, Recommendations/Coordination
of Care, to ensure the individual's needs are met;
(iii) document on the HHSC CLASS/DBMD Coordination
of Care form how the information in Addendum E of the HHSC CLASS/DBMD
Nursing Assessment form was addressed;
(iv) develop a renewal IPP that meets the requirements
in §260.65 of this subchapter;
(v) develop a proposed renewal IPC that meets the requirements
described in §260.67(a)(1) and (b) of this subchapter;
(vi) develop the following if the proposed renewal
IPC:
(I) includes transportation provided as a residential
habilitation activity or as an adaptive aid, develop an individual
transportation plan; or
Cont'd... |
