SECTION 363.607. Place of Service

(a) Personal care services (PCS) may be provided in an individual or group setting.

(b) PCS may be authorized for the following place(s) of service:

(1) The recipient's home;

(2) The home of the primary or alternate care giver;

(3) The recipient's school;

(4) The recipient's day care facility; or

(5) Any community setting in which the recipient is located.

(c) PCS may not be authorized in hospitals, nursing facilities, or intermediate care facilities for individuals with intellectual or developmental disabilities.

(d) Texas Medicaid does not reimburse providers for PCS that duplicate services that are the legal responsibility of school districts. The school district, through the Individuals with Disabilities Education Act (IDEA), is required to meet the recipient's personal care needs while the recipient is at school. If those needs cannot be met by the school district, the school district must submit documentation to the Department of State Health Services case manager indicating the school district is unable to provide necessary services.

Source Note: The provisions of this §363.607 adopted to be effective September 1, 2007, 32 TexReg 5355; amended to be effective September 1, 2014, 39 TexReg 5890