Section 261.221 - Durable Medical Equipment(a) A program provider that arranges for durable medical equipment for an individual residing in the facility must ensure that: (1) the individual receives the equipment prescribed;(2) the equipment fits properly, if applicable; and(3) the individual's caregivers, as appropriate, receive instruction regarding the equipment's use.(b) To receive payment for a wheeled mobility system or for a major modification to a wheeled mobility system, a program provider must comply with paragraphs (1) - (5) of this subsection. (1) The program provider must ensure that an occupational therapist or a physical therapist: (A) conducts a clinical assessment of the individual receiving the wheeled mobility system;(B) documents in detail the medical need for a specific wheeled mobility system and all necessary accessories, as determined during the clinical assessment; and(C) signs and dates the written assessment.(2) The program provider must ensure that a QRP who is directly employed by or contracting with the program provider: (A) is present for and directly involved in the clinical assessment of the individual described in paragraph (1) of this subsection;(B) is not the same person who conducts the clinical assessment described in paragraph (1) of this subsection;(C) is present when the wheeled mobility system is delivered, directs the fitting of the system, and ensures that the system is appropriate for the individual; and(D) verifies that the wheeled mobility system functions correctly for the individual.(3) The program provider must receive prior authorization to obtain a wheeled mobility system for an individual by submitting the following documentation to DADS in accordance with instructions issued by DADS: (A) a prescription, signed and dated by a physician, that describes in detail the wheeled mobility system, including all necessary components, needed by the individual;(B) the clinical assessment described in paragraph (1) of this subsection; and(C) documentation that a QRP was present for and involved in the clinical assessment of the individual.(4) The program provider must submit to DADS, in accordance with instructions issued by DADS, documentation that a QRP conducted the activities described in paragraph (2)(C) and (D) of this subsection.(5) The program provider must maintain a copy of the documentation described in paragraphs (3) and (4) of this subsection in the individual's record.26 Tex. Admin. Code § 261.221
Adopted to be effective January 1, 2001, 25 TexReg 12790; Transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective November 4, 2013, 38 TexReg 7724; Transferred from Title 40, § 9.221 by Texas Register, Volume 45, Number 35, August 28, 2020, TexReg 6127, eff. 10/1/2020