SECTION 354.1033. Provider Participation Requirements

(a) Home Health Agencies. To participate in the Texas Medical Assistance (Medicaid) Program, a home health agency must:

(1) be certified for participation as a home health agency in the Medicare program;

(2) agree to operate and furnish services in compliance with all federal, state, and local laws and regulations. This includes holding a valid state license as a home and community support services agency with the category of service of licensed and certified home health services;

(3) be enrolled and approved for participation in the Medicaid program;

(4) enter into and agree to comply with the terms of the written Medicaid Provider Agreement;

(5) comply with all state and federal regulations and rules relating to the Medicaid program;

(6) comply with the requirements of the Texas Medicaid Provider Procedures Manual that is received upon enrollment, and all revisions and updates of the manual, and all handbooks, standards, and guidelines published by the department;

(7) comply with accepted professional standards and principles that apply to health professionals providing services for a home health agency;

(8) submit claims for covered services in the manner and format prescribed by the department; and

(9) maintain written policies and procedures for informing all adult individuals of their rights under state and federal law, in advance of their receiving care by or through the home health agency. The policies and procedures must:

(A) contain procedures for providing written information regarding the individual's right to refuse, withhold, or withdraw medical treatment under the following state and federal common law and statutes:

(i) the individual's right to self determination in making health care decisions;

(ii) the individual's rights under the Natural Death Act (Health and Safety Code, Chapter 672) to execute an advance written Directive to Physicians, or to make a non-written directive regarding their right to withhold or withdraw life sustaining procedures in the event of a terminal condition;

(iii) the individual's rights under Health and Safety Code, Chapter 674, concerning written and non-written Out-of-Hospital Do-Not-Resuscitate Orders;

(iv) the individual's right to execute a Durable Power of Attorney for Health Care under the Civil Practice and Remedies Code, Chapter 135, regarding their right to appoint an agent to make medical treatment decisions on their behalf; and

(v) the agency's policy regarding the implementation of the individual's rights;

(B) ensure the agency's compliance with the requirements of Texas laws relating to advance directives;

(C) document in the individual's medical record whether or not the individual has executed an advance directive;

(D) not condition giving services or otherwise discriminate against an individual based on whether or not the individual has or has not executed an advance directive; and

(E) educate staff (individually or with others) and the community on issues concerning advance directives.

(b) Durable medical equipment and medical supplies providers. To participate as a supplier of durable medical equipment and expendable medical supplies under home health services, the provider must:

(1) meet any applicable standards established for durable medical equipment and medical supply providers, and be participating in the Medicare program;

(2) agree to operate and furnish equipment and supplies in compliance with all federal, state, and local laws and regulations;

(3) be enrolled and approved for participation in the Medicaid program;

(4) enter into and agree to comply with the terms of the written Medicaid Provider Agreement;

(5) comply with all state and federal regulations and rules relating to the Medicaid program;

(6) comply with the requirements of the Texas Medicaid Provider Procedures Manual that is received upon enrollment, and all revisions and updates of the manual, and all handbooks, standards, and guidelines published by the department; and

(7) submit claims for covered services in the manner and format prescribed by the department.

(c) Surety bond requirements. To participate in the Texas Medicaid Program's home health services, providers must provide the department with a surety bond in the form specified by the Secretary of the Department of Health and Human Services (Secretary). The amount of surety bond must be no less than $50,000 or an amount comparable to that specified by the Secretary for home health services providers in the Medicare program.

Source Note: The provisions of this §354.1033 adopted to be effective June 26, 1997, 22 TexReg 5826; amended to be effective January 1, 1998, 23 TexReg 1953; transferred effective September 1, 2001, as published in the Texas Register May 24, 2002, 27 TexReg 4561