Texas Administrative Code Title 40

Social Services and Assistance: As effective August 6, 2010

Chapter 44

Subchapter A

§44.1: What is the purpose of this chapter?

This chapter establishes requirements for agencies that contract to provide attendant services to eligible clients through the Texas Department of Human Services' Client Managed Personal Attendant Services Program.

Comments

Source Note: The provisions of this §44.1 adopted to be effective March 16, 2004, 29 TexReg 2683

§44.2: What do certain words and terms in this chapter mean?

The following words and terms have the following meanings when used in this chapter, unless the context clearly indicates otherwise.

(1) §1915(c) Medicaid waiver--Section of the Social Security Act that allows states to waive various Medicaid requirements. This section establishes alternative, community-based services for individuals who qualify to receive services in an institution.

(2) Agency model--One of three Client Managed Personal Attendant Services (CMPAS) Program payment models a client may choose. When a client chooses the agency model, the provider agency is the employer of record of the attendant and substitute attendant. The other two CMPAS Program payment models are the block grant model and the consumer directed services model.

(3) Applicant--A person who requests services under the CMPAS Program.

(4) Assessor of need--The provider agency employee responsible for determining an applicant's or client's need for client managed personal attendant services.

(5) Attendant--An employee who provides direct care to clients.

(6) Block grant model--One of three CMPAS Program payment models a client may choose. When a client chooses the block grant model, the client is the attendant's employer of record and the provider agency is the employer of record for the substitute attendant. The other two CMPAS Program payment models are the agency model and the consumer directed services model.

(7) Client--A person who is eligible to receive services under this chapter.

(8) Client Managed Personal Attendant Services (CMPAS) Program--The Texas Department of Human Services (DHS) program for personal attendant services in which clients manage their attendant services to varying degrees.

(9) Consumer directed services (CDS) model--One of three CMPAS Program payment models a client may choose. When a client chooses the CDS model, the client is the employer of record of the attendant and the substitute attendant. The other two CMPAS Program payment models are the agency model and the block grant model.

(10) Contract--The formal written agreement between DHS and a provider agency to provide services to DHS clients eligible under this chapter in exchange for reimbursement.

(11) Contract manager--A DHS employee who is responsible for the overall management of the contract with the provider agency.

(12) Days--Any reference to days means calendar days, unless otherwise specified in the text. Calendar days include weekends and holidays.

(13) Delegated health-related task--A service task the attendant may perform for the client only under a physician's or registered nurse's delegation. Such tasks:

(A) require a physician's order;

(B) must be delegated by a physician in accordance with the Texas Medical Practice Act or by a registered nurse in accordance with the Texas Nursing Practice Act;

(C) must be delegated specifically to the client and identify the attendant and task; and

(D) must be supervised by the delegating authority.

(14) DHS--The Texas Department of Human Services.

(15) Health-related task--A service task, such as those defined as health maintenance activities in 22 TAC, Chapter 225 (relating to RN Delegation to Unlicensed Personnel and Tasks Not Requiring Delegation in Independent Living Environments for Clients with Stable and Predictable Conditions), that involves a higher skill level than activities of daily living as defined in 22 TAC, Chapter 225, and may require a delegation order from a physician or registered nurse before an attendant may perform the task for a client.

(16) Interdisciplinary team (IDT)--A designated group of individuals that meets to discuss service delivery issues. An IDT includes:

(A) the client or the client's representative, or both;

(B) a provider agency representative;

(C) the regional nurse or contract manager or both; and

(D) other persons as necessary.

(17) Practitioner--A physician currently licensed in Texas, Louisiana, Arkansas, Oklahoma, or New Mexico; a physician assistant currently licensed in Texas; or a registered nurse approved by the Texas State Board of Nurse Examiners to practice as an advanced practice nurse.

(18) Practitioner's statement--A document such as the DHS Practitioner's Statement of Medical Need form that includes:

(A) a statement signed by a practitioner that the client has a current medical need for assistance with personal care tasks and other activities of daily living;

(B) certification that the provider agency verified with the U.S. Centers for Medicare and Medicaid Services that the practitioner is not excluded from participation in Medicare or Medicaid; and

(C) a statement that the disability is permanent or is expected to last at least six months.

(19) Provider agency--A home and community support services agency that contracts with DHS to provide services under the CMPAS Program.

(20) Representative--The client's spouse, other responsible party, or legal representative.

(21) Service plan--A document that lists the service tasks and states the units of services agreed to between the client and assessor of need.

(22) Service schedule--A schedule for delivering attendant services that is agreed upon and signed by the client or the client's representative.

(23) Service slot--An available position for an applicant to receive services under the CMPAS Program. The number of service slots is based on the amount of funds appropriated by the Texas Legislature for the CMPAS Program.

(24) Substitute attendant--The person who, on a temporary basis and in place of the attendant, provides services to the client.

(25) Unit of service--One hour of service delivered to a client under the CMPAS Program.

(26) Working days--Days DHS is open for business.

(27) Written--Information recorded on paper or other legible document. Written information may be sent by mail or fax, or hand delivered.

Comments

Source Note: The provisions of this §44.2 adopted to be effective March 16, 2004, 29 TexReg 2683

§44.3: How does a potential provider agency qualify to participate in the Cmpas Program?

To qualify to participate in the CMPAS Program, a potential provider agency must:

(1) maintain a license from DHS under Chapter 97 of this title (relating to Licensing Standards for Home and Community Support Services Agencies), under the personal assistance services category of licensure, in the counties to be served;

(2) meet the requirements described in Chapter 49 of this title (relating to Contracting for Community Care Services);

(3) enter into a contract with DHS to provide CMPAS Program services; and

(4) meet the requirements described in this chapter.

Comments

Source Note: The provisions of this §44.3 adopted to be effective March 16, 2004, 29 TexReg 2683

§44.4: What are the three Cmpas Program payment models and how do they differ?

Clients of the CMPAS Program have a choice of one of the following three payment models:

(1) Agency model--In the agency model:

(A) the client retains control over certain personnel decisions, such as selecting, supervising, and dismissing the attendant who provides services to the client;

(B) the provider agency is responsible for:

(i) recruitment of attendants and substitute attendants (a responsibility the client may share);

(ii) payroll for attendants and substitute attendants; and

(iii) filing tax-related reports of attendants and substitute attendants;

(C) the provider agency is the employer of record of attendants and substitute attendants; and

(D) the provider agency is responsible for providing substitute attendants.

(2) Block grant model--Clients receiving assistance through Medicaid or another program in which eligibility is based in whole or in part on income may not choose this model. In the block grant model:

(A) the client recruits, hires, manages, and dismisses attendants;

(B) the client is responsible for:

(i) payroll for attendants; and

(ii) filing tax-related reports of attendants;

(C) the client is the employer of record of attendants;

(D) the provider agency is the employer of record of substitute attendants;

(E) the provider agency is responsible for:

(i) providing substitute attendants;

(ii) payroll for substitute attendants; and

(iii) filing tax-related reports for substitute attendants;

(F) the provider agency is responsible for reimbursing the client for attendant wages and employment taxes paid by the client; and

(G) the provider agency is not required to be licensed under Chapter 97 of this title (relating to Licensing Standards for Home and Community Support Services Agencies) when performing the functions described in subparagraph (F) of this paragraph.

(3) Consumer directed services (CDS) model--In the CDS model:

(A) the client recruits, hires, manages, and dismisses attendants;

(B) the client is the employer of record of his or her attendant and substitute attendant;

(C) the client is responsible for providing substitute attendants; and

(D) the provider agency is responsible for:

(i) payroll for attendants and substitute attendants; and

(ii) filing tax-related reports of attendants and substitute attendants; and

(E) the provider agency is not required to be licensed under Chapter 97 of this title when performing the functions described in subparagraph (D) of this paragraph.

Comments

Source Note: The provisions of this §44.4 adopted to be effective March 16, 2004, 29 TexReg 2683

Subchapter B

Division 1

§44.11: What are the responsibilities under this chapter of all provider agencies in the Cmpas Program?

All provider agencies must comply with all of the requirements of:

(1) Divisions 3-7 of this subchapter (relating to Eligibility, Referral, and Assessment; Service Initiation; Reassessment; Co-payment Determination; and Tasks); and

(2) Subchapters E and F of this chapter (relating to Service Suspension, Termination, and Dispute Resolution; and Record Keeping and Reimbursement).

Comments

Source Note: The provisions of this §44.11 adopted to be effective March 16, 2004, 29 TexReg 2683

Division 2

§44.21: What are the requirements for a person to be an attendant in the Cmpas Program?

For a person to be an attendant in the CMPAS Program, the person must:

(1) be age 18 or older;

(2) be able to work part or all of the hours needed by the client;

(3) agree to be interviewed by the client;

(4) have reliable transportation to the client's home within the service schedule; and

(5) demonstrate to the satisfaction of the client that the person is capable of performing the tasks included in the client's service plan, as described in §44.71 of this chapter (relating to What tasks may an attendant perform for a client under the CMPAS Program, and where may the attendant perform the tasks?).

Comments

Source Note: The provisions of this §44.21 adopted to be effective March 16, 2004, 29 TexReg 2683

Division 3

§44.31: When is an applicant considered eligible to receive services under the Cmpas Program?

To be eligible to receive services under the CMPAS Program, a service slot must be available for the applicant, and the applicant must:

(1) be age 18 or older;

(2) obtain a practitioner's statement;

(3) be assessed under §44.33 of this division (relating to How does the provider agency determine an applicant's eligibility, co-payment, and service needs?) as needing assistance with at least one personal care task for at least five hours per week;

(4) be able and willing to:

(A) self-direct the attendant care; or

(B) designate a relative or friend to direct the care who is able and willing to do so without compensation;

(5) reside in an area in which CMPAS Program services are available;

(6) have a service plan that was developed under §44.33 of this division that does not exceed 52 hours per week of CMPAS Program services;

(7) choose one of the three payment models under this chapter;

(8) not be receiving Community Care for the Aged and Disabled services that, when added to the cost of the CMPAS Program services, would exceed the weighted average cost for nursing home care;

(9) not be receiving services under any of the following DHS programs:

(A) Primary Home Care;

(B) Residential Care; or

(C) Adult Foster Care;

(10) not be receiving services under a §1915(c) Medicaid waiver program;

(11) not be receiving regular or ongoing attendant services under either of the following DHS programs:

(A) Special Services to Persons with Disabilities; or

(B) In-Home and Family Support; and

(12) not choose the block grant payment model if the applicant is receiving assistance through Medicaid or another program in which eligibility is based in whole or in part on the applicant's income.

Comments

Source Note: The provisions of this §44.31 adopted to be effective March 16, 2004, 29 TexReg 2683

§44.32: How does a person express interest in and be referred for services under the Cmpas Program?

(a) A person who is interested in receiving services under the CMPAS Program may:

(1) directly contact a provider agency; or

(2) contact the DHS regional office.

(b) When a person directly contacts a provider agency, the provider agency, by the next working day, must forward to the DHS regional office the person's:

(1) name;

(2) address;

(3) birth date;

(4) phone number(s) (if available);

(5) social security number (if available);

(6) current living arrangements;

(7) DHS client number (if applicable);

(8) status regarding receipt of Supplemental Security Income (SSI); and

(9) date and time of referral.

(c) The DHS regional office determines whether any service slots are available for a person who is interested in receiving services under the CMPAS Program. If a service slot is available for an interested person, DHS refers the person to a provider agency to apply for services. When no service slots are available for the person, DHS staff place the person on an interest list by entering information about the person in the DHS Community Services Interest List (CSIL) system.

(d) When service slots become available on an interest list, DHS staff:

(1) release names from the interest list on a first-come, first-served basis;

(2) refer the next person on the interest list to a provider agency to apply for services under the CMPAS Program; and

(3) inform the provider agency of any other DHS program services the person is receiving, the cost of those services, and the approved service period for those services.

(e) When more than one provider agency is in the region, DHS gives applicants for whom a service slot is available information about each provider agency. The applicant may contact the provider agencies for additional information, and the applicant chooses the provider agency that best meets his or her needs.

(f) The provider agency must provide CMPAS Program services to all clients DHS refers to the provider agency unless the assessor of need determines:

(1) the provider agency and other sources of support are unable to meet the client's needs without risking the client's health and safety;

(2) the environment in the client's home is a serious threat to the health and safety of the attendant;

(3) the client, or someone in the client's home, seriously threatens the health and safety of the attendant; or

(4) the provider agency's contract does not require the provider agency to provide services under the payment model chosen by the client.

(g) When a client chooses a payment model not in the provider agency's contract, the provider agency must refer the client to a provider agency that offers the client's payment model of choice.

(h) The provider agency must conduct an interdisciplinary team (IDT) meeting in accordance with the requirements of §44.105 of this chapter (relating to Why does an interdisciplinary team (IDT) meet?) whenever it determines it cannot provide CMPAS Program services to a client for any of the reasons described in subsection (f)(1)-(3) of this section.

Comments

Source Note: The provisions of this §44.32 adopted to be effective March 16, 2004, 29 TexReg 2683

§44.33: How does the provider agency determine an applicant's eligibility, co-payment, and service needs?

(a) The assessor of need must conduct an initial on-site assessment of an applicant by the 14th day after the referral date from the DHS regional office and must:

(1) determine CMPAS Program eligibility. The applicant must meet all criteria in §44.31 of this division (relating to When is an applicant considered eligible to receive services under the CMPAS Program?);

(2) enable the applicant to make an informed choice of whether to participate in the CMPAS Program by discussing with the applicant all applicable publicly funded programs that offer attendant services. The provider agency may contact the DHS regional office for information about public programs that offer attendant services;

(3) assess the applicant's service needs by using the DHS Client Needs Assessment Questionnaire and Task/Hour Guide form;

(4) for each eligible applicant:

(A) develop a service plan based on the results of the assessment questionnaire that:

(i) includes the number of hours and tasks negotiated between the applicant and the assessor of need; and

(ii) is signed and agreed to by the applicant and assessor of need; and

(B) determine the applicant's co-payment under §44.61 of this chapter (relating to How is a client's co-payment determined and what are the procedures for collecting the co-payment?) and explain to the applicant the importance of making the co-payments as a condition of retaining eligibility; and

(5) explain to the applicant the three payment models described in §44.4 of this chapter (relating to What are the three CMPAS Program payment models and how do they differ?) and have the applicant choose a payment model.

(b) If the client service plan includes health-related tasks, the provider agency:

(1) verifies that the tasks do not require delegation or are properly delegated before an attendant performs any such tasks for the client under:

(A) 22 TAC, Chapter 225 (relating to RN Delegation to Unlicensed Personnel and Tasks Not Requiring Delegation in Independent Living Environments for Clients with Stable and Predictable Conditions); or

(B) Government Code §531.051; and

(2) maintains in the agency's client file records that:

(A) identify and are signed and dated by the delegating physician or registered nurse;

(B) include the name of the client, the names of the attendants delegated to perform the health-related tasks for the client, and a description of the specific health-related tasks to be performed; and

(C) are in accordance with the Texas Medical Practices Act, the Texas Nursing Practice Act, and any other applicable state or federal law.

(c) The provider agency notifies each applicant who is not eligible for services in writing using the DHS Notification of Community Care Services form within three days of the date of the decision. This form notifies the applicant of the applicant's right to appeal and explains how to file the appeal.

Comments

Source Note: The provisions of this §44.33 adopted to be effective March 16, 2004, 29 TexReg 2683

Division 4

§44.41: What training must the provider agency perform before beginning client managed personal attendant services to a client under the Cmpas Program?

Before beginning services for a client under the CMPAS Program, the provider agency must train the client in:

(1) client rights and responsibilities under DHS's Community Care for the Aged and Disabled programs;

(2) skills for recruiting, selecting, instructing, and supervising attendants;

(3) procedures for preparing attendant time sheets; and

(4) procedures for the CMPAS Program payment model he or she chooses.

Comments

Source Note: The provisions of this §44.41 adopted to be effective March 16, 2004, 29 TexReg 2683

§44.42: When must the provider agency begin the client managed personal attendant services?

The provider agency must:

(1) begin providing services to a client no later than the 14th day after DHS refers him or her to the provider agency; or

(2) begin providing services immediately when:

(A) the provider agency has received a practitioner's statement or oral information from a practitioner indicating that the applicant is disabled and in need of services under the CMPAS Program;

(B) the applicant otherwise qualifies as a client by meeting all other eligibility criteria described in §44.31 of this chapter (relating to When is an applicant considered eligible to receive services under the CMPAS Program?);

(C) the applicant has an immediate need for services under the CMPAS Program, which, if unmet, would result in institutionalization of the applicant; or

(D) the applicant has selected an attendant who can immediately begin providing the services or the provider agency can designate a substitute attendant to immediately begin providing the services pending the applicant's choice of attendant.

Comments

Source Note: The provisions of this §44.42 adopted to be effective March 16, 2004, 29 TexReg 2683

§44.43: When must the provider agency discontinue services to a client?

The provider agency must discontinue services and follow the procedures in §44.103 of this chapter (relating to What procedures must a provider agency follow to suspend and resume services?) if:

(1) services were initiated under §44.42(2)(A) of this division (relating to When must the provider agency begin the client managed personal attendant services); and

(2) the client fails to submit a practitioner's written statement within 30 days of the date services were initiated.

Comments

Source Note: The provisions of this §44.43 adopted to be effective March 16, 2004, 29 TexReg 2683

Division 5

§44.51: After a provider agency performs an initial assessment of a client under §44.33 of this chapter, how often must the provider agency reassess the client?

A provider agency must reassess a client annually and whenever there is a change in the client's status, as follows:

(1) Annual reassessments. A provider agency must annually reassess a client using all factors in §44.33 of this chapter (relating to How does the provider agency determine an applicant's eligibility, co-payment, and service needs?). The provider agency must complete each annual reassessment no later than the anniversary of the date the client began receiving services.

(2) Reassessment upon change in client status. When a provider agency learns that a client's status may have changed in a way that may affect the client's eligibility for or receipt of services, the provider agency must reassess the client. In doing so, the provider agency may consider only those factors in §44.33 of this chapter that have changed since the prior assessment. A change in client status that requires reassessment may include a change in:

(A) income, deductions, or exclusions; or

(B) the client's need for attendant care services, the service plan, or the units of service.

Comments

Source Note: The provisions of this §44.51 adopted to be effective March 16, 2004, 29 TexReg 2683

§44.52: How and when must a provider agency implement changes to a client's service plan that are prompted by a reassessment of the client?

A provider agency must:

(1) implement any change in a client's service plan within seven days of the reassessment;

(2) implement any change in a client's co-payment to be effective on the first day of the month following the reassessment;

(3) notify the contract manager in writing of any change to a client's service plan within seven days of the completion of the reassessment. The notification may be made by fax and must be on a single document that contains:

(A) date the document is completed;

(B) contract number;

(C) effective date of the service plan change;

(D) name of the client;

(E) service tasks assigned to the client's attendant;

(F) name of the assessor of need;

(G) service schedule;

(H) signature of the assessor of need; and

(I) date the document is signed; and

(4) document all service plan changes:

(A) in the client file; and

(B) according to the terms of the contract.

Comments

Source Note: The provisions of this §44.52 adopted to be effective March 16, 2004, 29 TexReg 2683

Division 6

§44.61: How is a client's co-payment determined and what are the procedures for collecting the co-payment?

(a) A client's co-payment is a percentage of the monthly cost for services provided to the client. To arrive at a client's co-payment, a provider agency must:

(1) determine the client's total monthly income in accordance with §44.62 of this division (relating to For purposes of calculating a client's co-payment, how must a provider agency determine a client's total monthly income?);

(2) determine the client's net monthly income in accordance with §44.65 of this division (relating to For purposes of calculating a client's co-payment, how must a provider agency determine a client's net monthly income?);

(3) determine the client's percentage amount by referencing the co-payment schedule located in the Community Care for Aged and Disabled handbook;

(4) determine the monthly cost for services by multiplying the number of units of service in the client's monthly service plan by the reimbursement rate contained in the contract; and

(5) arrive at the amount of the client's monthly co-payment by multiplying the client's percentage amount by the monthly cost for services.

(b) A client who suffers undue hardship as a result of financial obligations for reasons such as a catastrophic illness of the client or a family member may request that his or her co-payment be reduced or waived. The provider agency must reduce or waive the amount of the client's co-payment if the contract manager approves his or her request. To request a reduction or waiver of a co-payment:

(1) the client must make the request of the assessor of need;

(2) the assessor of need must submit the request to the contract manager and recommend approval or non-approval; and

(3) the contract manager must advise the assessor of need of whether the client's request is approved.

(c) The provider agency must collect each co-payment from the client on or before the end of the month. If payment is not made by the end of the month, the provider agency must send notice to the client by the first working day of the following month. The provider agency may not charge a client a fee for late payment. The provider agency may suspend services to the client under §44.103 of this chapter (relating to What procedures must a provider agency follow to suspend and resume services?) for failure to pay a co-payment if the client has not paid the co-payment by the 20th day of the following month.

(d) In collecting monthly co-payments, a provider agency must:

(1) provide the client a receipt containing the client's name, the amount paid, and the date of the payment, and retain a copy of the receipt;

(2) deduct the co-payment from reimbursement claims submitted to the Department of Aging and Disability Services under §44.112 of this chapter (relating to How are provider agencies reimbursed?); and

(3) maintain a current client co-payment ledger system, in accordance with generally accepted accounting principles, that reflects all charges to and all payments by the client.

Comments

Source Note: The provisions of this §44.61 adopted to be effective March 16, 2004, 29 TexReg 2683; amended to be effective December 1, 2008, 33 TexReg 9716

§44.62: For purposes of calculating a client's co-payment, how must a provider agency determine a client's total monthly income?

A provider agency must determine a client's total monthly income for purposes of calculating a client's co-payment by adding together all of the following:

(1) the gross monthly earnings of the client and the client's spouse, including:

(A) employee wages or salary; and

(B) commissions, tips, piece-rate payments, and cash bonuses;

(2) the net monthly receipts of the client and the client's spouse from non-farm self-employment, calculated by totaling gross receipts then subtracting business expenses.

(A) Gross receipts means the value of all goods sold and services provided by the non-farm self-employment enterprise.

(B) Business expenses means the actual operating expenses of the non-farm self-employment enterprise, including:

(i) purchased goods or services;

(ii) rent;

(iii) utilities;

(iv) depreciation charges;

(v) wages and salaries; and

(vi) business taxes (business taxes do not include personal income taxes);

(3) the net monthly receipts of the client and the client's spouse from farm self-employment, calculated by totaling gross receipts then subtracting business expenses.

(A) Gross receipts means the value of all goods sold and services provided by the farm self-employment enterprise, except for goods and services used for family living. Gross receipts include receipts from:

(i) the sale of crops;

(ii) the rental of farm equipment;

(iii) the sale of wood, sand, gravel, and similar items; and

(iv) government crop loans.

(B) Business expenses means the actual operating expenses of the farm self-employment enterprise, including:

(i) the cost of feed, fertilizer, seed, and other farming supplies;

(ii) wages and salaries;

(iii) depreciation charges;

(iv) rent;

(v) interest on farm mortgages;

(vi) farm building repairs; and

(vii) farm taxes (farm taxes do not include personal income taxes);

(4) the gross monthly benefits received by the client and the client's spouse, including:

(A) pensions, retirement, disability, and survivors' benefits;

(B) education loans, scholarships, and grants (to the extent funds are or may be applied to living costs);

(C) payments from annuities, insurance, and irrevocable trust funds;

(D) public assistance payments, such as Temporary Assistance to Needy Families or Supplemental Security Income, and including general assistance from a local government source;

(E) court-ordered support payments, such as alimony and child support payments for a minor child;

(F) unemployment compensation and union strike payments;

(G) workers' compensation payments or other compensation for work injuries;

(H) Veterans Administration payments, such as subsistence allowances and refunds of GI insurance premiums; and

(I) other monthly support, such as allotments or payments from friends or relatives; and

(5) the net monthly income from property of the client and the client's spouse, calculated by averaging receipts over a 12-month period, and including:

(A) dividends and interest payments;

(B) receipts from a life estate, other estate, or trust fund;

(C) income from a mortgage, promissory note, or other negotiable instrument;

(D) income from lease of mineral rights, calculated by subtracting the following prorated payments from gross royalties or lease payments:

(i) property taxes (not including windfall profit taxes); and

(ii) excise taxes; and

(E) income from rental property, including rent from boarders, calculated by subtracting the following prorated payments from gross receipts:

(i) mortgage interest;

(ii) property repair and maintenance expenses (not including improvements or depreciation charges);

(iii) property insurance; and

(iv) property taxes.

Comments

Source Note: The provisions of this §44.62 adopted to be effective March 16, 2004, 29 TexReg 2683

§44.63: For purposes of calculating a client's co-payment, what must a provider agency exclude from a client's total monthly income?

A provider agency must exclude the following from a client's total monthly income in calculating a client's co-payment:

(1) payments to satisfy a judgment of the Indian Claims Commission or its successor agency, the U.S. Court of Claims;

(2) any payment received under the federal Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970;

(3) education loan, grant, and scholarship funds that are not or cannot be applied to living costs;

(4) Veterans Administration payments, such as aid-and-attendance benefits, homebound elderly benefits, and payments for purchase of medications;

(5) in-kind credits, such as rent subsidies;

(6) infrequent or irregular payments from any source that occur no more often than once a quarter and that do not exceed $20 a month;

(7) reimbursements from an insurance company for health insurance claims; and

(8) grants, such as those made through the DHS In-Home and Family Support Program.

Comments

Source Note: The provisions of this §44.63 adopted to be effective March 16, 2004, 29 TexReg 2683

§44.64: For purposes of calculating a client's co-payment, what must a provider agency deduct from a client's total monthly income?

A provider agency must deduct the following from a client's total monthly income in calculating a client's co-payment:

(1) the prorated monthly cost of tuition and books;

(2) $93 for the client's spouse;

(3) $93 for each dependent of the client;

(4) $93 for the client;

(5) funds the law requires be withheld, such as deductions for income taxes or to comply with the Federal Insurance Contributions Act (FICA);

(6) amounts actually spent or dedicated to be spent on disability-related equipment that costs more than $500, such as wheelchair-compatible vans, vehicle modifications, and power wheelchairs;

(7) actual child-care costs, up to $350 per month for each child through age 5, and up to $200 per month for each child age 6-12; and

(8) actual monthly expenditures for health insurance premiums, and for medical treatment and prescriptions that are not reimbursed by insurance.

Comments

Source Note: The provisions of this §44.64 adopted to be effective March 16, 2004, 29 TexReg 2683

§44.65: For purposes of calculating a client's co-payment, how must a provider agency determine a client's net monthly income?

To determine a client's net monthly income for co-payment purposes, a provider agency must:

(1) determine the client's total monthly income in accordance with §44.62 of this division (relating to For purposes of calculating a client's co-payment, how must a provider agency determine a client's total monthly income?);

(2) subtract from that amount any applicable income exclusions in §44.63 of this division (relating to For purposes of calculating a client's co-payment, what must a provider agency exclude from a client's total monthly income?); and

(3) subtract from that amount any applicable income deductions in §44.64 of this division (relating to For purposes of calculating a client's co-payment, what must a provider agency deduct from a client's total monthly income?).

Comments

Source Note: The provisions of this §44.65 adopted to be effective March 16, 2004, 29 TexReg 2683

Division 7

§44.71: What tasks may an attendant perform for a client under the Cmpas Program, and where may the attendant perform the tasks?

(a) Allowable tasks. Except as otherwise provided in §44.72 of this division (relating to What tasks must an attendant not perform for a client under the CMPAS Program?), an attendant may perform any one or more of the following tasks for a client under the CMPAS Program:

(1) personal care tasks that relate to the client's physical health, such as the following:

(A) bathing the client, including:

(i) drawing water in sink, basin, or tub;

(ii) hauling or heating water;

(iii) laying out supplies;

(iv) assisting in or out of tub or shower;

(v) sponge bathing and drying;

(vi) bed bathing and drying;

(vii) tub bathing and drying; and

(viii) providing standby assistance for safety;

(B) dressing the client, including:

(i) dressing client;

(ii) undressing client; and

(iii) laying out clothes;

(C) preparing the client's meals, including:

(i) cooking a full meal;

(ii) warming up prepared food;

(iii) planning meals;

(iv) helping prepare meals; and

(v) cutting client's food for eating;

(D) assisting the client with eating, including:

(i) assisting with eating and drinking utensils and adaptive devices;

(ii) feeding through a permanently placed feeding tube inserted in a surgically created orifice or stoma; and

(iii) providing standby assistance or encouragement;

(E) assisting the client with exercising, including walking;

(F) assisting the client with grooming, including:

(i) shaving;

(ii) brushing teeth;

(iii) shaving underarms and legs, when requested;

(iv) caring for nails; and

(v) laying out supplies;

(G) caring for the client's routine hair and skin needs, including:

(i) washing hair;

(ii) drying hair;

(iii) assisting with setting, rolling, or braiding hair. This does not include styling, cutting, or chemical processing of hair;

(iv) combing or brushing hair;

(v) applying nonprescription lotion to skin;

(vi) washing hands and face;

(vii) applying makeup; and

(viii) laying out supplies;

(H) assisting the client with medications that normally are self-administered, including administration through a permanently placed feeding tube;

(I) assisting the client with toileting, including:

(i) changing diapers;

(ii) changing colostomy bag or emptying catheter bag;

(iii) assisting on or off bedpan;

(iv) assisting with the use of a urinal;

(v) assisting with feminine hygiene needs;

(vi) assisting with clothing during toileting;

(vii) assisting with toilet hygiene, including the use of toilet paper and washing hands;

(viii) changing external catheter;

(ix) preparing toileting supplies and equipment. This does not include preparing catheter equipment;

(x) providing standby assistance;

(xi) the administration of a bowel and bladder program, including suppositories, enemas, manual evacuation, intermittent catheterization, digital stimulation associated with a bowel program; and

(xii) tasks related to external stoma care, including pouch changes, measuring intake and output, and skin care surrounding the stoma area; and

(J) assisting the client with transferring and ambulating, including:

(i) non-ambulatory movement from one stationary position to another (transfer), which does not include carrying;

(ii) adjusting or changing the client's position in a bed or chair (positioning);

(iii) assisting in rising from a sitting to a standing position;

(iv) assisting in positioning for use of a walking apparatus;

(v) assisting with putting on and removing leg braces and prostheses for ambulation;

(vi) assisting with ambulation or using steps;

(vii) assisting with wheelchair ambulation; and

(viii) providing standby assistance;

(2) home management tasks that support the client's health and safety, such as the following:

(A) changing the client's bed linens and making the bed;

(B) housecleaning for the client, including:

(i) cleaning up after the client's personal care tasks;

(ii) emptying and cleaning the client's bedside commode;

(iii) cleaning the client's bathroom;

(iv) cleaning floor of living areas used by client;

(v) dusting areas used by client;

(vi) carrying out trash, setting out garbage for pick up;

(vii) cleaning stovetop and counters; and

(viii) cleaning refrigerator and stove;

(C) laundering the client's clothes, including:

(i) doing hand wash;

(ii) gathering and sorting;

(iii) loading and unloading machines in residence;

(iv) using Laundromat machines;

(v) hanging clothes to dry; and

(vi) folding and putting away clothes;

(D) shopping for the client, including:

(i) preparing a shopping list;

(ii) going to the store and purchasing or picking up items; and

(iii) picking up medication;

(E) storing the client's purchased items; and

(F) washing the client's dishes;

(3) client escorting tasks, including:

(A) accompanying the client outside the home to support the client in living in the community;

(B) arranging for transportation, but not providing transportation. The provider agency must have a policy addressing direct client transportation; however, direct client transportation is not a task DHS will reimburse under §44.112 of this chapter (relating to How are provider agencies reimbursed?);

(C) accompanying client to clinic, doctor's office, or other trips made for the purpose of obtaining medical diagnosis or treatment; and

(D) waiting in the doctor's office or clinic with a client when necessary due to client's condition or distance from home; and

(4) delegated health-related tasks or health-related tasks that do not require delegation under 22 TAC, Chapter 225 (relating to RN Delegation to Unlicensed Personnel and Tasks Not Requiring Delegation in Independent Living Environments for Clients with Stable and Predictable Conditions), including:

(A) inserting tubes in a body cavity or instilling or inserting substances into an indwelling tube, limited to:

(i) insertion or irrigation of urinary catheters for purpose of intermittent catheterization; and

(ii) irrigation of an indwelling tube, such as a urinary catheter or permanently placed feeding tube;

(B) administration of medications;

(C) care of broken skin with low risk of infection;

(D) changing sterile dressings; and

(E) tracheal care to include instilling normal saline and suctioning of a tracheotomy with routine supplemental oxygen administration.

(b) Location of tasks. An attendant may perform any allowable task for a client in the client's home or in any other appropriate location, such as while accompanying the client to a shopping mall, to a movie, or to a community event.

Comments

Source Note: The provisions of this §44.71 adopted to be effective March 16, 2004, 29 TexReg 2683

§44.72: What tasks must an attendant not perform for a client under the Cmpas Program?

An attendant must not perform any task for a client if:

(1) performing the task would require additional licensure beyond the license held by the provider agency under §44.3 of this chapter (relating to How does a potential provider agency qualify to participate in the CMPAS Program?), such as nursing services that have not been properly delegated to the attendant;

(2) the task is not among those listed in §44.71(a) of this division (relating to What tasks may an attendant perform for a client under the CMPAS Program, and where may the attendant perform the tasks?); or

(3) the task is not contained in the client's service plan.

Comments

Source Note: The provisions of this §44.72 adopted to be effective March 16, 2004, 29 TexReg 2683

Subchapter C

§44.81: What are the responsibilities under this chapter of the provider agency when a client chooses the agency payment model?

A provider agency in the agency model must comply with §44.11 of this chapter (relating to What are the responsibilities under this chapter of all provider agencies in the CMPAS Program?) and must:

(1) maintain and supervise a pool of substitute attendants to provide backup attendant services upon the client's request;

(2) hire an attendant who meets the qualifications of §44.21 of this chapter (relating to What are the requirements for a person to be an attendant in the CMPAS Program?) and whom the client agrees to supervise. Prospective attendants are referred to the client until a satisfactory match is achieved. If a client has not agreed to supervise a prospective attendant within seven days from the date the assessor of need determined the client to be eligible for services, the assessor of need must confer with the client. The parties must identify the reasons for failure to achieve a satisfactory match. The provider agency must provide training when necessary to enable the client to choose an attendant whom the client agrees to supervise;

(3) provide each attendant an initial orientation training before the attendant provides services to a client. The initial orientation training must include the following topics:

(A) basic interpersonal skills;

(B) needs of persons with disabilities;

(C) first aid;

(D) safety and emergency procedures;

(E) proper completion of required forms;

(F) explanation of the client's role as supervisor;

(G) explanation of the provider agency's responsibilities to attendants;

(H) attendant rights and responsibilities;

(I) specific information needed to provide tasks to the client;

(J) reporting changes in the client's condition to the provider agency; and

(K) instructions to provide only authorized tasks and hours, unless the client privately pays for additional hours;

(4) assume all responsibility for paying and filing attendant income and unemployment taxes and associated paperwork;

(5) assume liability for attendant work-related injuries to the same extent as any employer;

(6) prepare payroll and distribute payroll checks to attendants;

(7) complete the criminal history check required by the Health and Safety Code, Chapter 250, on an attendant before the attendant performs any direct care for a client;

(8) actively intervene to resolve problems between a client and the client's attendant when they cannot resolve problems on their own;

(9) determine the salary and benefit package of attendants;

(10) not discriminate against attendants or applicants in violation of applicable law;

(11) accept responsibility for acts of attendants on the job to the same extent as any employer; and

(12) conduct in-home visits in addition to those specified in §44.33 of this chapter (relating to How does the provider agency determine an applicant's eligibility, co-payment, and service needs?) and §44.51 of this chapter (relating to After a provider agency performs an initial assessment of a client under §44.33 of this chapter, how often must the provider agency reassess the client?). The assessor of need determines the frequency of in-home visits based on the specific needs of the client or attendant, but at least annually, to assess and document:

(A) that the client's service plan is adequate;

(B) that the client continues to need the services;

(C) whether the client needs a service plan change;

(D) that the attendant remains competent to perform the allowable tasks; and

(E) that the attendant is performing the allowable tasks.

Comments

Source Note: The provisions of this §44.81 adopted to be effective March 16, 2004, 29 TexReg 2683

§44.82: What are the responsibilities under this chapter of the provider agency when a client chooses the block grant model?

A provider agency in the block grant model must comply with the responsibilities listed in §44.11 of this chapter (relating to What are the responsibilities under this chapter of all provider agencies in the CMPAS Program?) and must:

(1) reimburse the client for attendant and substitute attendant wages and employment taxes paid by the client;

(2) negotiate with the client and agree on an amount that the provider agency will retain from reimbursements made under §44.112 of this chapter (relating to How are provider agencies reimbursed?) to compensate the provider agency for its services to the client. The agreed amount must be based on the provider agency's actual cost of providing services to the client. This may include:

(A) cost of providing substitute attendants;

(B) cost of providing administrative services;

(C) history of the client's use of substitute attendants; and

(D) need for provider agency intervention;

(3) maintain and supervise a pool of substitute attendants to provide backup attendant services upon the client's request. The provider agency must provide each substitute attendant an initial orientation training before the attendant provides services to a client. The initial orientation training must include the following topics:

(A) basic interpersonal skills;

(B) needs of persons with disabilities;

(C) first aid;

(D) safety and emergency procedures;

(E) proper completion of required forms;

(F) explanation of the client's role as supervisor;

(G) explanation of the provider agency's responsibilities to attendants;

(H) attendant rights and responsibilities;

(I) specific information needed to provide tasks to the client;

(J) reporting changes in the client's condition to the provider agency; and

(K) instructions to provide only authorized tasks and hours, unless the client privately pays for additional hours; and

(4) for any client the provider agency learns is failing to fully perform any duty the client is required to perform as the attendant's employer of record:

(A) counsel the client regarding the consequences of noncompliance; and

(B) in the absence of compliance by the client, offer the client the choice of another CMPAS Program payment model.

Comments

Source Note: The provisions of this §44.82 adopted to be effective March 16, 2004, 29 TexReg 2683

§44.83: What are the responsibilities under this chapter of a provider agency when a client chooses the consumer directed services (CDS) model?

(a) If the provider agency does not offer the CDS model, the provider agency must:

(1) comply with the responsibilities listed in §44.11 of this chapter (relating to What are the responsibilities under this chapter of all provider agencies in the CMPAS Program?);

(2) provide the client a list of provider agencies that offer the CDS model; and

(3) refer the client to the provider agency chosen by the client.

(b) If the provider agency offers the CDS model, the provider agency must comply with the responsibilities listed in §44.11 of this chapter and in §41.103 of this title (relating to Generic Contractor Responsibilities under the Vendor Fiscal Intermediary (VFI) Model).

Comments

Source Note: The provisions of this §44.83 adopted to be effective March 16, 2004, 29 TexReg 2683

Subchapter D

§44.91: What are the responsibilities under this chapter of all clients who receive services under the Cmpas Program, regardless of the payment model a client chooses?

Regardless of the payment model a client chooses, clients under the CMPAS Program must:

(1) obtain and submit a practitioner's statement to the assessor of need whenever requested;

(2) negotiate with the assessor of need at each assessment or reassessment to determine which allowable tasks in §44.71 of this chapter (relating to What tasks may an attendant perform for a client under the CMPAS Program, and where may the attendant perform the tasks?) are included in the client's service plan;

(3) select, supervise, and release from service his or her attendant;

(4) train his or her attendant in the specifics of the delivery of services;

(5) certify the attendant's recording of hours worked on or after the last day of each reporting period by:

(A) signing, dating, and submitting to the provider agency the attendant's time sheet; or

(B) if applicable, submitting appropriate certification of the attendant's hours worked through a provider agency's electronic service delivery documentation system;

(6) notify the provider agency within 10 days of any services the client is receiving under another DHS program that duplicate the services provided under the CMPAS Program. Such services include services provided under DHS's Primary Home Care Program;

(7) submit any required co-payment to the provider agency no later than the 20th working day of each month;

(8) provide proof of income to the assessor of need whenever requested;

(9) obtain and submit to the assessor of need a proper physician's order and physician's or registered nurse's documentation for any delegated health-related tasks to be included in the service plan before any such tasks are included in the service plan; and

(10) inform the provider agency and DHS within 10 days of a change in the client's:

(A) mailing or residence address;

(B) telephone number;

(C) physical condition that may affect the need for services;

(D) total monthly income as calculated under §44.62 of this chapter (relating to For purposes of calculating a client's co-payment, how must a provider agency determine a client's total monthly income?);

(E) income exclusions as calculated under §44.63 of this chapter (relating to For purposes of calculating a client's co-payment, what must a provider agency exclude from a client's total monthly income?); and

(F) monthly deductions as calculated under §44.64 of this chapter (relating to For purposes of calculating a client's co-payment, what must a provider agency deduct from a client's total monthly income?).

Comments

Source Note: The provisions of this §44.91 adopted to be effective March 16, 2004, 29 TexReg 2683

§44.92: What are the responsibilities under this chapter of clients who choose the agency model?

Clients who choose the agency model must comply with the responsibilities listed in §44.91 of this subchapter (relating to What are the responsibilities under this chapter of all clients who receive services under the CMPAS Program, regardless of the payment model a client chooses?) and must:

(1) actively assist the provider agency in recruiting attendants and substitute attendants by seeking out and referring potential attendants to the provider agency;

(2) select an attendant from among the potential attendants whom the provider agency refers to the client;

(3) not discriminate against any potential attendant, attendant, or substitute attendant in violation of applicable law; and

(4) interview any prospective attendant whom the provider agency refers to the client and inform the provider agency within seven days of the referral of whether the client agrees to the attendant.

Comments

Source Note: The provisions of this §44.92 adopted to be effective March 16, 2004, 29 TexReg 2683

§44.93: What are the responsibilities under this chapter of clients who choose the block grant model?

Clients who choose the block grant model must comply with the responsibilities listed in §44.91 of this subchapter (relating to What are the responsibilities under this chapter of all clients who receive services under the CMPAS Program, regardless of the payment model a client chooses?) and must:

(1) resolve any employment-related problems or disagreements directly with his or her attendant(s);

(2) not discriminate against attendants or applicants in violation of applicable law;

(3) assume liability for work-related attendant injuries and responsibility for work-related attendant conduct to the same extent as any employer. Because the attendant is not an employee of the provider agency or DHS, the provider agency and DHS are not responsible for the attendant's work-related conduct;

(4) spend all funds received from the provider agency that were reimbursed under §44.112 of this chapter (relating to How are provider agencies reimbursed?) only on attendant wages, employment-related tax payments, and employee benefits;

(5) prepare and sign an agreement with the attendant that includes:

(A) the tasks the attendant is to perform for the client;

(B) the schedule the attendant will work for the client;

(C) the hourly rate, at or above the minimum required by law, the client will pay the attendant;

(D) when the client will pay the attendant (at least twice a month);

(E) reasons the client may terminate the attendant's employment; and

(F) a requirement that the attendant provide the client at least 24 hours advance notice of not being able to work a scheduled shift;

(6) supervise the attendant's recording of hours worked. This includes signing, dating, and submitting the attendant's time sheet to the provider agency on or after the last day of the reporting period services were provided; and

(7) submit to the provider agency, in a timely manner, any employment-related government forms the provider agency files on behalf of the client. The client must submit Form 941 of the U.S. Internal Revenue Service and Form C3 of the Texas Workforce Commission to the provider agency no later than 30 days before the filing deadline.

Comments

Source Note: The provisions of this §44.93 adopted to be effective March 16, 2004, 29 TexReg 2683

§44.94: What are the responsibilities under this chapter of clients who choose the consumer directed services (CDS) model?

Clients who choose the CDS model must comply with the responsibilities listed in §44.91 of this subchapter (relating to What are the responsibilities under this chapter of all clients who receive services under the CMPAS Program, regardless of the payment model a client chooses?) and must comply with the responsibilities listed in §41.105 of this title (relating to Generic Consumer Responsibilities under the Vendor Fiscal Intermediary Model).

Comments

Source Note: The provisions of this §44.94 adopted to be effective March 16, 2004, 29 TexReg 2683

Subchapter E

§44.101: When must a provider agency suspend services to a client under the Cmpas Program?

A provider agency must suspend services to a client when:

(1) the client permanently leaves the state;

(2) the client moves to a location where the provider agency does not or cannot provide CMPAS Program services to the client;

(3) the client dies;

(4) the client is admitted to an institution. An institution is defined as a:

(A) hospital;

(B) nursing facility;

(C) state school;

(D) state hospital; or

(E) intermediate care facility serving persons with mental retardation or related conditions;

(5) the client or the client's representative requests that services end;

(6) the client's representative or someone in the client's home, as applicable, refuses to:

(A) supervise the attendant;

(B) adhere to the service plan; or

(C) otherwise comply with a mandatory requirement of the CMPAS Program;

(7) the client or the client's representative, as applicable, loses the ability to:

(A) supervise the attendant;

(B) adhere to the service plan; or

(C) otherwise comply with a mandatory requirement of the CMPAS Program;

(8) the client does not pay a co-payment by the 20th day of the month after it is due, as required in §44.61 of this chapter (relating to How is a client's co-payment determined and what are the procedures for collecting the co-payment?); or

(9) does not provide a practitioner's statement as required in §44.91 of this chapter (relating to What are the responsibilities under this chapter of all clients who receive services under the CMPAS Program, regardless of the payment model a client chooses?).

Comments

Source Note: The provisions of this §44.101 adopted to be effective March 16, 2004, 29 TexReg 2683

§44.102: When may a provider agency suspend services to a client under the Cmpas Program?

The provider agency may suspend services if:

(1) the client or someone in the client's home engages in discrimination in violation of applicable law;

(2) the client or representative fails to effectively manage his or her attendant care. This includes problems with:

(A) hiring, selecting, or retaining an attendant for reasons other than workforce issues;

(B) reaching an agreement on the amount of reimbursement the provider agency will retain (in the block grant model); and

(C) completing or submitting required program documentation; or

(3) the client or someone in the client's home exhibits reckless behavior that may result in imminent danger to the health or safety of the client, the attendant, or another person. If this occurs, the provider agency must make an immediate referral to:

(A) the Texas Department of Protective and Regulatory Services or other appropriate protective services agency;

(B) local law enforcement; and

(C) the contract manager.

Comments

Source Note: The provisions of this §44.102 adopted to be effective March 16, 2004, 29 TexReg 2683

§44.103: What procedures must a provider agency follow to suspend and resume services?

(a) Notification of service suspension. The provider agency must notify the contract manager of any suspension by the next working day.

(1) Written notice of a suspension must include:

(A) the date of service suspension;

(B) the reason(s) for the suspension;

(C) the duration of the suspension, if known; and

(D) an explanation of the provider agency's attempts to resolve the problem that caused the suspension, including the reasons why the problem was not resolved.

(2) The provider agency must initially notify the contract manager of a suspension orally or by fax.

(A) Oral notice means directly speaking with the contract manager and does not include a message left by voice mail.

(B) The provider agency must speak with a person designated by the contract manager if the contract manager is not available.

(3) When a provider agency's first notice of a suspension is oral, the provider agency must send written notice to the contract manager within seven days of the oral notice.

(b) Interdisciplinary team (IDT) meeting. The provider agency must convene an IDT meeting, as described in §44.105 of this subchapter (relating to Why does an interdisciplinary team (IDT) meet?) if services are suspended for any of the reasons described in §44.101 of this subchapter (relating to When must a provider agency suspend services to a client under the CMPAS Program?) or §44.102 of this subchapter (relating to When may a provider agency suspend services to a client under the CMPAS Program?).

(c) Resuming services.

(1) The provider agency must resume services after a suspension:

(A) upon the client's return home, if applicable; or

(B) on the date specified in writing by the contract manager; or

(C) as a result of a recommendation by the IDT; or

(D) upon the provider agency's receipt of notification from the contract manager that the provider agency must resume services pending the outcome of appeal.

(2) The provider agency must send written notice to the contract manager that services have resumed within seven days of the date services resume.

Comments

Source Note: The provisions of this §44.103 adopted to be effective March 16, 2004, 29 TexReg 2683

§44.104: What are the procedures for terminating services to a client under the Cmpas Program?

The provider agency must recommend to the contract manager whether a suspension should result in termination of services. If the provider agency recommends that services to a client be terminated, the provider agency must explain the reasons for the recommendation. Upon a recommendation of termination, the contract manager decides whether services will be terminated. The contract manager may investigate the matter and may arrange a meeting with the provider agency and client.

(1) If the contract manager approves the recommendation of termination, the contract manager:

(A) sends written notice to the client of the service termination, using the DHS Reduction, Denial, Termination, or Delay of Long Term Managed Care Services form;

(B) sends to the client notice of his or her right to a fair hearing, using the DHS Petition for Hearing form; and

(C) informs the client of his or her right to appeal the termination decision and the client's right to continue to receive services pending an appeal.

(2) If the contract manager does not approve the recommendation of termination, the contract manager:

(A) notifies the provider agency that the termination recommendation is not approved;

(B) directs the provider agency to resume services to the client; and

(C) advises the contract agency of the date that it must resume services.

Comments

Source Note: The provisions of this §44.104 adopted to be effective March 16, 2004, 29 TexReg 2683

§44.105: Why does an interdisciplinary team (IDT) meet?

(a) The provider agency must convene an IDT meeting by telephone conference call or in person within three working days of:

(1) suspending services to a client under §44.101 of this subchapter (relating to When must a provider agency suspend services to a client under the CMPAS Program?) or §44.102 of this subchapter (relating to When may a provider agency suspend services to a client under the CMPAS Program?); or

(2) identifying an issue that prevents the provider agency from carrying out a requirement of the CMPAS Program.

(b) If the provider agency is unable to convene an IDT meeting with all the members described in §44.2 of this chapter (relating to What do certain words and terms in this chapter mean?), the provider agency must convene the IDT meeting with the available members and send the documentation of the IDT meeting to the Regional Administrator for the DHS region in which the client resides.

(1) The documentation must be sent within five working days of the date of the IDT meeting.

(2) Further action may be required by the provider agency, based on a review of the IDT meeting documentation.

Comments

Source Note: The provisions of this §44.105 adopted to be effective March 16, 2004, 29 TexReg 2683

§44.106: What procedures do interdisciplinary teams (IDTs) follow?

(a) IDT evaluation and recommendation. The IDT must:

(1) evaluate the problem, ensuring that the problem is not due to discrimination in violation of applicable law;

(2) identify any possible solutions to the problem; and

(3) make recommendations to the provider agency.

(b) Meeting outcome. The provider agency must, within two days after the IDT meeting:

(1) implement the recommendations of the IDT; or

(2) request that the contract manager refer the client to another provider agency if available, or an alternative payment model; and

(3) submit to the contract manager the provider agency's records of the IDT meeting and its outcome.

Comments

Source Note: The provisions of this §44.106 adopted to be effective March 16, 2004, 29 TexReg 2683

§44.107: How are service plan and co-payment disagreements resolved?

(a) Service plan disagreements. When the number of units of service or service tasks on a service plan becomes a matter of disagreement between the provider agency and client:

(1) The provider agency must submit a copy of the proposed service plan to the contract manager with an explanation of the disagreement and must continue to provide services under any existing service plan while the matter is pending.

(2) The contract manager may contact the provider agency to discuss the matter and provide a written decision to the provider agency regarding the matter.

(3) If the provider agency disagrees with the contract manager's decision, the provider agency must notify the contract manager, who will refer the matter to the regional nurse. The regional nurse will provide a written decision to the contract manager and the provider agency.

(4) If the provider agency disagrees with the regional nurse's decision, the provider agency must notify the regional nurse, who refers the matter to DHS state office. DHS state office issues a written decision as the final decision regarding the matter. DHS state office provides a copy of the decision to the contract manager, the regional nurse, and the provider agency.

(5) If the DHS decision resolving the disagreement calls for changes in the service plan that was submitted to the contract manager to resolve the disagreement, the provider agency must submit to the contract manager a new service plan that complies with the DHS decision. The provider agency must provide services according to the final approved service plan.

(b) Co-payment disagreements. When the amount of a client's co-payment becomes a matter of disagreement between the provider agency and client, the provider agency must comply with the following procedure:

(1) The provider agency must submit to the contract manager the assessor of need's calculation of the co-payment, an explanation of the disagreement, and continue to charge the client any current co-payment while the matter is pending.

(2) The contract manager may contact the provider agency to discuss the matter and provide a written decision to the provider agency regarding the matter.

(3) If the provider agency disagrees with the contract manager's decision, the provider agency must notify the contract manager, who refers the matter to DHS state office. DHS state office issues a written decision as the final decision regarding the matter. DHS state office provides a copy of the decision to the contract manager and the provider agency.

(4) If the DHS decision resolving the disagreement calls for a change in the client's existing service plan, the provider agency must submit to the contract manager a new service plan that complies with the DHS decision. The provider agency must charge the co-payment according to the final approved service plan.

Comments

Source Note: The provisions of this §44.107 adopted to be effective March 16, 2004, 29 TexReg 2683

Subchapter F

§44.111: What records must a provider agency maintain?

(a) General requirements. The provider agency must maintain records according to:

(1) this chapter;

(2) Chapter 49 of this title (relating to Contracting for Community Care Services);

(3) Chapter 69 of this title (relating to Contracted Services); and

(4) the terms of the contract.

(b) Service delivery documentation. The provider agency must maintain records of the services delivered to the client, including records relating to disagreements, suspensions, and termination of services.

(1) Each client must periodically record on a time sheet the attendant's delivery of services to the client and must submit a copy of each completed time sheet to the provider agency. Each time sheet must be a single document that contains:

(A) name of the client;

(B) client's DHS identification number;

(C) name of the attendant who provided services to the client;

(D) beginning and ending dates of the service delivery period;

(E) tasks performed for the client;

(F) service schedule;

(G) specific days and times the attendant worked;

(H) signature of the attendant and the date signed. An attendant who is unable to complete or sign the time sheet may designate another person to complete or sign the time sheet. The provider agency must document in writing:

(i) reason the attendant was unable to complete or sign the time sheet; and

(ii) name of the person whom the attendant authorized to complete or sign the time sheet for the attendant;

(I) the signature of the client or representative and the date signed. A client or representative who is unable to complete or sign the time sheet may designate another person to complete or sign the time sheet. The provider agency must document in writing:

(i) reason the client or representative was unable to complete or sign the time sheet; and

(ii) name of the person whom the client or representative authorized to complete or sign the time sheet for the client.

(2) The provider agency must document any suspension or termination of services, as well as any interdisciplinary team (IDT) meeting held under §44.105 of this chapter (relating to Why does an interdisciplinary team (IDT) meet?). IDT meeting records must include:

(A) reason(s) for the IDT meeting;

(B) recommendations of the IDT resulting from the meeting; and

(C) provider agency's response to the IDT recommendations.

(3) The provider agency must document any service plan disagreement and must maintain records of the procedures it follows under §44.107 of this chapter (relating to How are service plan and co-payment disagreements resolved?) to resolve the disagreement.

(4) The provider agency must document each assessor of need visit performed in accordance with §44.81 of this chapter (relating to What are the responsibilities under this chapter of the provider agency when a client chooses the agency payment model?).

(c) Financial records. The provider agency must maintain financial records:

(1) to support its billings to DHS for payment under §44.112 of this subchapter (relating to How are provider agencies reimbursed?);

(2) to support each client's co-payment as calculated by the assessor of need under §44.61 of this chapter (relating to How is a client's co-payment determined and what are the procedures for collecting the co-payment?); and

(3) to document reimbursements made by DHS. The documentation must include:

(A) amount of reimbursement;

(B) voucher number;

(C) warrant number;

(D) date of receipt; and

(E) any other information necessary to trace deposits of reimbursements and payments made from the reimbursements in the provider agency's accounting system; and

(4) in accordance with generally accepted accounting principles (GAAP) and DHS procedures. A provider agency's financial records must include:

(A) deposit slips, bank statements, cancelled checks, and receipts;

(B) purchase orders;

(C) invoices;

(D) journals and ledgers;

(E) time sheets, payroll, and tax records;

(F) Internal Revenue Service, Department of Labor, and other government records and forms;

(G) records of insurance coverage, claims, and payments (for example, medical, liability, fire and casualty, and workers' compensation);

(H) equipment inventory records;

(I) records of the provider agency's internal accounting procedures;

(J) a chart of accounts, as defined by GAAP; and

(K) records of company policies.

(d) Subcontractor records. If a provider agency uses a subcontractor, the provider agency must maintain records of the subcontractor's activities. Maintaining all records to support subcontractor claims is the responsibility of the provider agency.

(e) Failure to maintain records. If the provider agency fails to maintain records in accordance with this section or other applicable DHS requirements, DHS may initiate corrective action plans and may pursue any appropriate sanction.

Comments

Source Note: The provisions of this §44.111 adopted to be effective March 16, 2004, 29 TexReg 2683

§44.112: How are provider agencies reimbursed?

(a) General billing requirements. The provider agency must bill DHS for services provided a client in accordance with §49.9 of this title (relating to Billings and Claims Payment).

(b) Unit rate. The provider agency must bill DHS in accordance with the unit rate authorized by DHS.

(c) Documentation. The provider agency must comply with all of the record-keeping requirements of §44.111 of this subchapter (relating to What records must a provider agency maintain?) to be eligible for reimbursement from DHS.

(d) Rounding. The provider agency must bill DHS for services in quarter-hour increments. Time worked that is not an exact quarter-hour must be rounded up to a quarter-hour if it is eight minutes or more, or not billed if it is seven minutes or less.

(e) Allowable tasks. The provider agency must bill DHS only for the tasks described in §44.71 of this chapter (relating to What tasks may an attendant perform for a client under the CMPAS Program, and where may the attendant perform the tasks?) that comprise services actually delivered to a client in accordance with the client's service plan. A provider agency may not bill DHS for services provided a client, through agreement with the client or otherwise, if DHS did not authorize the services.

Comments

Source Note: The provisions of this §44.112 adopted to be effective March 16, 2004, 29 TexReg 2683