26 Tex. Admin. Code § 277.63

Current through Reg. 49, No. 45; November 8, 2024

Section 277.63 - Service Delivery

(a) Service interruptions. A service interruption occurs when, on a particular day or time when services are scheduled:

(1) the individual requests that:

(A) no hours of service be provided;

(B) fewer hours of service than reflected in the service schedule be provided; or

(C) a specific attendant not provide services to the individual;

(2) the individual is not at home;

(3) services are suspended as described in § 47.71 of this subchapter (relating to Suspensions); or

(4) services are not delivered for other reasons beyond the control of the provider, such as acts of nature and other disasters.

(b) Delivery of services.

(1) A provider must ensure:

(A) services are delivered according to the service delivery plan described in § 47.45 of this chapter (relating to Pre-Initiation Activities);

(B) all authorized and scheduled services are provided to an individual, except in the case of a service interruption as described in subsection (a) of this section; and

(C) an individual does not receive, during a calendar month, more than five times the weekly authorized hours on HHSC's Authorization for Community Care Services form.

(2) A provider must not exceed the weekly authorized hours except in the case of a temporary increase if requested by an individual based on the individual's need due to an unusual circumstance.

(c) Service interruption documentation.

(1) In the case of an individual whose services are considered priority, the provider must document all service interruptions by the 30th day after the date the individual's services are scheduled but not delivered.

(2) In the case of an individual whose services are considered non-priority, the provider must document all service interruptions that exceed 14 consecutive days by the 30th day after the day service interruption exceeds 14 consecutive days.

(A) For a fixed service schedule, the service interruption begins on the first day services are scheduled but not delivered.

(B) For a variable service schedule, the service interruption begins the Sunday following the week the individual did not receive all the weekly hours on a service plan approved by the individual.

(3) The reason documented must be a reason listed in subsection (a) of this section.

(4) If the provider learns of a service interruption after the deadlines listed in paragraphs (1) and (2) of this subsection, the provider must document the following as soon as the provider learns of the service interruption:

(A) the reason for the service interruption ;

(B) the reason for the delay in documenting the service interruption; and

(C) the date the provider learned of the service interruption.

(d) Service delivery outside the individual's home but within a provider's contracted service delivery area.

(1) A provider may develop a service plan that includes services regularly delivered at a location other than the individual's home.

(2) A service plan must not exceed the weekly hours authorized on HHSC's Authorization for Community Care Services form.

(3) A provider may deliver services outside the individual's home when the service plan does not include the regular delivery of such services.

(4) A provider:

(A) may deliver services outside the individual's home only if the individual requests such services;

(B) is not required to pay for expenses incurred as a result of an attendant delivering services outside the individual's home;

(C) must make a reasonable effort to deliver services at a location other than an individual's home when requested by the individual;

(D) must maintain written justification if the individual's request was not granted; and

(E) must document in the individual's record:

(i) each instance when the individual requested services at a location other than the home;

(ii) whether the individual's request was granted;

(iii) what services were provided; and

(iv) where the services were delivered.

(e) Service delivery outside a provider's contracted service delivery area.

(1) A provider may develop a service plan that includes, at the request of the individual, services provided while the individual is temporarily staying at a location outside the provider's contracted service delivery area but within the state of Texas.

(2) A service plan must not exceed the weekly hours authorized on HHSC's Authorization for Community Care Services form.

(3) A provider may accept or decline the request of an individual for the provision of services while the individual is temporarily staying at a location outside the contracted service delivery area but within the state of Texas.

(A) If a provider accepts an individual's request, the provider:

(i) may provide services to the individual during a period of no more than 60 consecutive days;

(ii) must, within three days after the provider begins providing services to the individual outside the provider's contracted service delivery area, notify the individual's case worker in writing of the following:

(I) that the individual is receiving services outside the provider's contracted service delivery area;

(II) the location where the individual is receiving services;

(III) the estimated length of time the individual is expected to be outside the contracted service delivery area; and

(IV) contact information for the individual;

(iii) must notify the individual's case worker in writing that the individual has returned to the provider's contracted service delivery area within three working days after becoming aware of the individual's return; and

(iv) is not required to pay for expenses incurred by an attendant delivering services outside the contracted service delivery area.

(B) If a provider declines an individual's request, the provider must:

(i) inform the individual orally or in writing:

(I) of the reasons for declining the request; and

(II) that the individual may request a meeting with the case worker and the provider to discuss the reasons for declining the request; and

(ii) inform the individual's case worker in writing, within three days after declining the request, that the request was declined and the reasons for declining the request.

(4) If an individual receives services outside a provider's contracted service delivery area during a period of 60 consecutive days, the individual must return to the contracted service delivery area and receive services in that service delivery area before the provider may agree to another request from the individual for the provision of services outside the provider's contracted service delivery area.

(5) If an individual intends to remain outside a provider's contracted service delivery area for a period of more than 60 consecutive days, HHSC transfers the individual to a provider selected by the individual that has a contracted service delivery area that includes the area in which the individual is receiving services. HHSC coordinates the transfer in accordance with § 47.69 of this subchapter (relating to Transfers).

(f) Service delivery documentation.

(1) A provider must document the delivery of services electronically or on a paper timesheet, to include:

(A) the provider name;

(B) the provider vendor number;

(C) the attendant's name;

(D) the individual's name;

(E) the individual's HHSC number;

(F) the specific service delivery period, including month, day, and year, as applicable;

(G) the tasks assigned;

(H) the units of service delivered;

(I) the dates services were delivered; and

(J) certification that the attendant delivered the documented tasks.

(2) For electronic service delivery documentation systems, each attendant must enter a unique identifier to certify the services delivered.

(3) For paper service delivery documentation systems, a timesheet must have a specific service delivery period not exceeding one calendar month.

(A) Except as provided in subparagraph (B) of this paragraph, each attendant delivering services must sign the timesheet or make a mark representing the attendant's name to certify the services delivered and that the timesheet is correct.

(B) An attendant who is unable to sign or mark the timesheet may designate another person to sign the timesheet. A provider must maintain written documentation of the:

(i) reason an attendant is unable to sign or mark the timesheet; and

(ii) identity of the person designated to sign the timesheet on behalf of the attendant.

(g) Documentation of service delivery. A provider must maintain documentation of service delivery in an individual's record.

26 Tex. Admin. Code § 277.63

Transferred from 40 TAC § 47.63 Texas Register, Volume 49, Number 24, June 14, 2024, TexReg 4436, eff. 7/1/2024