SECTION 259.359. DSA: Service Delivery

(a) A DSA must ensure that:

(1) CLASS Program services and CFC services, other than CFC support management, are provided to an individual in accordance with:

(A) the individual's IPC;

(B) the individual's IPP for that service;

(C) the PAS/HAB plan, if applicable; and

(D) for CLASS Program services, Appendix C of the CLASS waiver application approved by CMS and available on the HHSC website;

(2) an adaptive aid, minor home modification, and CFC ERS meets the requirements described in Subchapter F of this chapter (relating to Adaptive Aids, Minor Home Modifications, and CFC ERS);

(3) transportation as a habilitation activity or as an adaptive aid is provided in accordance with the individual's individual transportation plan;

(4) if the individual obtains a plan of care as described in §259.311(h) of this chapter (relating to CMA Service Delivery), a qualified professional described in §259.355(d)(16) of this chapter (relating to Qualifications of DSA Staff Persons) provides and monitors the provision of cognitive rehabilitation therapy to the individual in accordance with the plan of care; and

(5) CFC support management is provided to an individual or LAR described in the Community Living Assistance and Support Services Provider Manual if:

(A) the individual is receiving CFC PAS/HAB; and

(B) the individual or LAR requests to receive CFC support management.

(b) A DSA must provide nursing, transportation as a habilitation activity, respite, an adaptive aid, dental treatment, or CFC PAS/HAB to an individual, even if not included on the individual's IPC, if an RN determines that the service is necessary to prevent the individual's health and safety from being placed in immediate jeopardy. If a DSA provides a service under this subsection, the DSA must submit documentation to the CMA as required by §259.81(a) of this chapter (relating to Revised IPC and Revised IPP for Services Provided to Prevent Immediate Jeopardy).

(c) A DSA must have a written process that ensures that staff persons are or can readily become familiar with individuals to whom they are not ordinarily assigned but to whom they may be required to provide a CLASS Program service or CFC service.

(d) A DSA must ensure that a DSA staff person participates as a member of an individual's service planning team in accordance with this chapter and the Community Living Assistance and Support Services Provider Manual.

(e) A DSA must inform the individual's case manager of changes needed to the individual's IPC or IPPs.

(f) Except as provided in subsection (i) of this section, a DSA may accept or decline the request of an individual or LAR for the DSA to provide transportation as a habilitation activity, out-of-home respite in a camp described in §259.361(b)(2)(D) of this subchapter (relating to Respite and Dental Treatment), adaptive aids, nursing, or CFC PAS/HAB to the individual while the individual is temporarily staying at a location outside the catchment area in which the individual resides but within the state of Texas.

(g) If a DSA accepts the request of an individual or LAR, as described in subsection (f) of this section, the DSA:

(1) may provide transportation as a habilitation activity, out-of-home respite in a camp described in §259.361(b)(2)(D) of this subchapter, adaptive aids, nursing, or CFC PAS/HAB to the individual outside the catchment area during a period of no more than 60 consecutive days;

(2) must, no later than three business days after the DSA begins providing services outside the catchment area, notify the individual's case manager in writing of the following:

(A) that the individual is receiving services outside the catchment area in which the individual resides;

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

(C) the estimated length of time the individual is expected to be outside the catchment area; and

(D) contact information for the individual or LAR; and

(3) must notify the individual's case manager in writing that the individual has returned to the catchment area in which the individual resides no later than three business days after becoming aware of the individual's return.

(h) If a DSA declines the request of an individual or LAR, as described in subsection (f) of this section, the DSA must:

(1) inform the individual or LAR:

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

(B) that the individual or LAR may request that the case manager convene a meeting of the service planning team to discuss the reasons for declining the request; and

(2) no later than three business days after declining the request, inform the individual's case manager, in writing, that the request was declined and the reasons for declining the request.

(i) If a DSA has provided transportation as a habilitation activity, out-of-home respite in a camp described in §259.361(b)(2)(D) of this subchapter, adaptive aids, nursing, or CFC PAS/HAB to an individual during a period of 60 consecutive days while the individual is temporarily staying at a location outside the catchment area in which the individual resides, the DSA may accept another request from the individual or LAR that the DSA provide services outside the catchment area only if the individual has returned to the catchment area in which the individual resides and received services in that catchment area.

Source Note: The provisions of this §259.359 adopted to be effective January 30, 2023, 48 TexReg 362