Header:
TEXAS ADMINISTRATIVE CODE
TITLE 40. SOCIAL SERVICES AND ASSISTANCE
PART 1. DEPARTMENT OF AGING AND DISABILITY SERVICES
CHAPTER 9. INTELLECTUAL DISABILITY SERVICES--MEDICAID STATE OPERATING AGENCY RESPONSIBILITIES
SUBCHAPTER D. HOME AND COMMUNITY
Date:
03/07/2014
Document:
§ 9.190. Local Authority Requirements for Providing Service Coordination in the HCS Program
(a) In addition to the requirements described in Chapter 2, Subchapter L, of this title (relating to Service Coordina-tion for Individuals with an Intellectual Disability), a local authority must, in the provision of service coordination in the HCS Program, ensure compliance with the requirements in this subchapter.
(b) The local authority must employ service coordinators who:
(1) meet the minimum qualifications and local authority staff training requirements specified in Chapter 2, Sub-chapter L of this title; and
(2) have received training about the HCS Program, including the requirements of this subchapter and the HCS Program service components as specified in § 9.154 of this subchapter (relating to Description of the Home and Community-based Services (HCS) Program).
(c) A local authority must have a process for receiving and resolving complaints from a program provider related to the local authority's provision of service coordination or the local authority's process to enroll an applicant in the HCS Program.
(d) If, as a result of monitoring, the service coordinator identifies a concern with the implementation of the PDP, the local authority must ensure that the concern is communicated to the program provider and attempts made to resolve the concern. The local authority may refer an unresolved concern to DADS Consumer Rights and Services.
(e) A service coordinator must:
(1) assist an individual or LAR in exercising the legal rights of the individual as a citizen and as a person with a dis-ability;
(2) provide an applicant or individual, LAR, or family member with a written copy of the rights of the individual as described in § 9.173(b) of this subchapter (relating to Certification Principles: Rights of Individuals) and the booklet titled Your Rights In a Home and Community-Based Services Program (which is found at www.dads.state.tx.us.) and an oral explanation of such rights:
(A) upon enrollment in the HCS program;
(B) upon revision of the booklet;
(C) upon request; and
(D) upon change in an individual's legal status (that is when the individual turns 18 years of age, is appointed a guardian, or loses a guardian);
(3) document the provision of the rights described in § 9.173(b) of this subchapter and the booklet and oral ex-planation required by paragraph (2) of this subsection and ensure that the documentation is signed by:
(A) the individual or LAR; and
(B) the service coordinator;
(4) ensure that, at the time an applicant is enrolled, the applicant or LAR is informed orally and in writing of the following processes for filing complaints:
(A) processes for filing complaints with the local authority about the provision of service coordination; and
(B) processes for filing complaints about the provision of HCS Program services including: (i) the telephone number of the local authority to file a complaint; (ii) the toll-free telephone number of DADS to file a complaint; and (iii) the toll-free telephone number of DFPS (1-800-647-7418) to report an allegation of abuse, neglect, or exploitation;
(5) maintain for an individual for an IPC year:
(A) a copy of the IPC;
(B) the PDP;
(C) a copy of the ID/RC Assessment;
(D) documentation of the activities performed by the service coordinator in providing service coordination; and
(E) any other pertinent information related to the individual;
(6) initiate, coordinate, and facilitate person-directed planning;
(7) develop for an individual a full range of services and resources using generic service agencies, non-HCS Pro-gram service providers, and advocates or other actively involved persons to meet the needs of the individual as those needs are identified;
(8) ensure that the PDP for an applicant or individual is developed, reviewed, and updated in accordance with:
(A) § 9.158(k)(3) of this subchapter (relating to Process for Enrollment of Applicants);
(B) § 9.166 of this subchapter (relating to Renewal and Revision of an IPC); and
(C) § 2.556 of this title (relating to MRA's Responsibilities);
(9) participate in the development, renewal, and revision of an individual's IPC in accordance with § 9.158 of this subchapter and § 9.166 of this subchapter;
(10) ensure that the service planning team participates in the renewal and revision of the IPC for an individual in accordance with § 9.166 of this subchapter and ensure that the service planning team completes other responsibilities and activities as described in this subchapter;
(11) notify the service planning team of the information conveyed to the service coordinator pursuant to § 9.178(v)(3)(C) and (4)(B) of this subchapter (relating to Certification Principle: Quality Assurance);
(12) if a change to an individual's PDP is needed, other than as required by § 9.166 of this subchapter:
(A) communicate the need for the change to the individual or LAR, the program provider, and other appropriate persons; and
(B) revise the PDP as necessary;
(13) provide an individual's program provider a copy of the individual's current PDP;
(14) monitor the delivery of HCS Program and non-HCS Program services to an individual;
(15) document whether an individual progresses toward desired outcomes identified on the individual's PDP;
(16) together with the program provider, ensure the coordination and compatibility of HCS Program services with non-HCS Program services;
(17) for an individual who has had a guardian appointed, determine, at least annually, if the letters of guardianship are current;
(18) for an individual who has not had a guardian appointed, make a referral of guardianship to a court, if appro-priate;
(19) immediately notify the program provider if the service coordinator becomes aware that an emergency neces-sitates the provision of an HCS Program service to ensure the individual's health or safety and the service is not on the IPC or exceeds the amount on the IPC;
(20) if informed by the program provider that an individual's HCS Program services have been suspended:
(A) request the program provider enter necessary information in CARE to inform DADS of the suspension;
(B) review the individual's status and document in the individual's record the reasons for continuing the suspen-sion, at least every 90 calendar days after the effective date of the suspension; and
(C) to continue suspension of the services for more than 270 calendar days, submit to DADS written documenta-tion of each review made in accordance with subparagraph (B) of this paragraph and a request for approval by DADS to continue the suspension;
(21) if notified by the program provider that an individual or LAR has refused a nursing assessment and that the program provider has determined it cannot ensure the individual's health, safety, and welfare in the provision of a service as described in § 9.174(e) of this title (relating to Certification Principles: Service Delivery):
(A) inform the individual or LAR of the consequences and risks of refusing the assessment, including that the re-fusal will result in the individual not receiving: (i) nursing services; or (ii) foster companion care, residential support, supervised living, supported home living, respite, supported employment, or day habilitation, if the individual needs one of those services and the program provider has determined that it cannot ensure the health and safety of the in-dividual in the provision of the service; and
(B) notify the program provider if the individual or LAR continues to refuse the assessment after the discussion with the service coordinator;
(22) notify the program provider if the service coordinator becomes aware that an individual has been admitted to a setting described in § 9.155(d) of this subchapter (relating to Eligibility Criteria and Suspension of HCS Program Services);
(23) if the service coordinator determines that HCS Program services provided to an individual should be termi-nated, including for a reason described in § 9.158(l)(11) of this subchapter:
(A) document a description of: (i) the situation that resulted in the service coordinator's determination that ser-vices should be terminated; (ii) the attempts by the service coordinator to resolve the situation; and
(B) send a written request to terminate the individual's HCS Program services to DADS and include the documen-tation required by subparagraph (A) of this paragraph;
(C) provide a copy of the written request and the documentation required by subparagraph (A) of this paragraph to the program provider;
(24) if an individual requests termination of all HCS Program services, the service coordinator must, within ten calendar days after the individual's request:
(A) inform the individual or LAR of: (i) the individual's option to transfer to another program provider; (ii) the consequences of terminating HCS Program services; and (iii) possible service resources upon termination; and
(B) submit documentation to DADS that: (i) states the reason the individual is making the request; and (ii) demon-strates that the individual or LAR was provided the information required by subparagraph (A)(ii) and (iii) of this para-graph;
(25) manage the process to transfer an individual's HCS Program services from one program provider to another or one CDSA to another in accordance with DADS instructions, including:
(A) informing the individual or LAR who requests a transfer to another program provider or CDSA that the service coordinator will manage the transfer process;
(B) informing the individual or LAR that the individual or LAR may choose to receive HCS Program services from any available program provider (that is, a program provider whose enrollment has not reached its service capacity in CARE) or CDSA; and
(C) if the individual or LAR has not selected another program provider or CDSA, provide the individual or LAR a list of available HCS Program providers and CDSAs and contact information in the geographic locations preferred by the individual or LAR;
(26) be objective in assisting an individual or LAR in selecting a program provider or CDSA;
(27) at the time of assignment and as changes occur, ensure that an individual and LAR and program provider are informed of the name of the individual's service coordinator and how to contact the service coordinator;
(28) unless contraindications are documented with justification by the service planning team, ensure that a school-age individual receives educational services in a six-hour-per-day program, five days per week, provided by the local school district and that no individual receives educational services at a state supported living center or at a state center;
(29) unless contraindications are documented with justification by the service planning team, ensure that an adult individual under retirement age is participating in a day activity of the individual's choice that promotes achievement of PDP outcomes for at least six hours per day, five days per week;
(30) unless contraindications are documented with justification by the service planning team, ensure that a pre-school-age individual receives an early childhood education with appropriate activities and services, including small group and individual play with peers without disabilities;
(31) unless contraindications are documented with justification by the service planning team, ensure that an indi-vidual of retirement age has opportunities to participate in day activities appropriate to individuals of the same age and consistent with the individual's or LAR's choice;
(32) unless contraindications are documented with justification by the service planning team, ensure that each individual is offered choices and opportunities for accessing and participating in community activities and experiences available to peers without disabilities;
(33) assist an individual to meet as many of the individual's needs as possible by using generic community services and resources in the same way and during the same hours as these generic services are used by the community at large;
(34) for an individual receiving foster/companion care, residential support, or supervised living, ensure that the individual or LAR is involved in planning the individual's residential relocation, except in a case of an emergency;
(35) if the program provider notifies the service coordinator that the program provider is unable to locate the parent or LAR in accordance with § 9.174(a)(8)(D) of this subchapter (relating to Certification Principles: Service Deliv-ery) or the local authority notifies the service coordinator that the local authority is unable to locate the parent or LAR in accordance with § 9.167(b)(9) of this subchapter (relating to Permanency Planning):
(A) make reasonable attempts to locate the parent or LAR by contacting a person identified by the parent or LAR in the contact information described in paragraph (37)(A) - (B) of this subsection; and
(B) notify DADS, no later than 30 calendar days after the date the service coordinator determines the service co-ordinator is unable to locate the parent or LAR, of the determination and request that DADS initiate a search for the parent or LAR;
(36) if the service coordinator determines that a parent's or LAR's contact information described in paragraph (37)(A) of this subsection is no longer current:
(A) make reasonable attempts to locate the parent or LAR by contacting a person identified by the parent or LAR in the contact information described in paragraph (37)(B) of this subsection; and
(B) notify DADS, no later than 30 calendar days after the date the service coordinator determines the service co-ordinator is unable to locate the parent or LAR, of the determination and request that DADS initiate a search for the parent or LAR;
(37) request from and encourage the parent or LAR of an individual under the age of 22 years requesting or re-ceiving supervised living or residential support to provide the service coordinator with the following information:
(A) the parent's or LAR's: (i) name; (ii) address; (iii) telephone number; (iv) driver license number and state of is-suance or personal identification card number issued by the Department of Public Safety; and (v) place of employment and the employer's address and telephone number;
(B) name, address, and telephone number of a relative of the individual or other person whom DADS or the ser-vice coordinator may contact in an emergency situation, a statement indicating the relationship between that person and the individual, and at the parent's or LAR's option: (i) that person's driver license number and state of issuance or personal identification card number issued by the Department of Public Safety; and (ii) the name, address, and tele-phone number of that person's employer; and
(C) a signed acknowledgement of responsibility stating that the parent or LAR agrees to: (i) notify the service co-ordinator of any changes to the contact information submitted; and (ii) make reasonable efforts to participate in the individual's life and in planning activities for the individual;
(38) within three business days after initiating supervised living or residential support to an individual under 22 years of age:
(A) provide the information listed in subparagraph (B) of this paragraph to the following: (i) the CRCG for the county in which the individual's LAR lives (see www.hhsc.state.tx.us for a listing of CRCG chairpersons by county); and (ii) the local school district for the area in which the three- or four-person residence is located, if the individual is at least three years of age, or the early childhood intervention (ECI) program for the county in which the residence is located, if the individual is less than three years of age (see http://www.dars.state.tx.us/ecis/searchprogram.asp to search for an ECI program by zip code or by county); and
(B) as required by subparagraph (A) of this paragraph, provide the following information to the entities described in subparagraph (A) of this paragraph: (i) the individual's full name; (ii) the individual's gender; (iii) the individual's eth-nicity; (iv) the individual's birth date; (v) the individual's social security number; (vi) the LAR's name, address, and county of residence; (vii) the date of initiation of supervised living or residential support; (viii) the address where su-pervised living or residential support is provided; and (ix) the name and phone number of the person providing the information; and
(39) for an applicant or individual under 22 years of age seeking or receiving supervised living or residential sup-port:
(A) make reasonable accommodations to promote the participation of the LAR in all planning and decision making regarding the individual's care, including participating in: (i) the initial development and annual review of the individu-al's PDP; (ii) decision making regarding the individual's medical care; (iii) routine service planning team meetings; and (iv) decision making and other activities involving the individual's health and safety;
(B) ensure that reasonable accommodations include: (i) conducting a meeting in person or by telephone, as mu-tually agreed upon by the program provider and the LAR; (ii) conducting a meeting at a time and location, if the meet-ing is in person, that is mutually agreed upon by the program provider and the LAR; (iii) if the LAR has a disability, providing reasonable accommodations in accordance with the Americans with Disabilities Act, including providing an accessible meeting location or a sign language interpreter, if appropriate; and (iv) providing a language interpreter, if appropriate;
(C) provide written notice to the LAR of a meeting to conduct an annual review of the individual's PDP at least 21 calendar days before the meeting date and request a response from the LAR regarding whether the LAR intends to participate in the annual review;
(D) before an individual who is under 18 years of age, or who is 18-22 years of age and has an LAR, moves to an-other residence operated by the program provider, attempt to obtain consent for the move from the LAR unless the move is made because of a serious risk to the health or safety of the individual or another person; and
(E) document compliance with subparagraphs (A) - (D) of this paragraph in the individual's record.
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