SECTION 260.337. Case Management

(a) A program provider must ensure that case management is provided in accordance with an individual's IPP, IPC, and Appendix C of the DBMD Program waiver application approved by CMS and available on the HHSC website, including:

(1) initiating and overseeing the process of assessment and reassessment of the individual's LOC;

(2) initiating and overseeing the process of the review of service plans at enrollment, annually, and as needed, including if requested by the individual or LAR;

(3) observing the individual in the individual's home and determining the intent and level of the individual's communication;

(4) if necessary, determining from the individual's non-verbal communication, the individual's likes and dislikes;

(5) leading the service planning team to use the person-centered planning process to develop a service plan that optimizes the opportunities for the individual to use the individual's abilities and to integrate in community settings;

(6) using the individual's knowledge of sign language and other communication systems to make the individual as aware as possible of the individual's service plan and options;

(7) communicating with service planning team members to ensure that the service plan is carried out appropriately;

(8) monitoring the success of the service plan by observing the individual at home and in the community;

(9) monitoring the provision of services included in the service plan on an ongoing basis; and

(10) monitoring services that assist the individual in gaining access to needed waiver and other state plan services, including medical, social, educational, and non-wavier services.

(b) The only activities that a program provider may bill as case management are:

(1) an in-person, email, phone call, or text message contact with an individual;

(2) an in-person, email, phone call, or text message contact with the LAR, primary caregiver, or an actively involved person regarding the individual's services;

(3) a phone call, text message, email, letter, or meeting with HHSC or community resources regarding the individual's services; and

(4) working with service providers regarding the individual, including:

(A) reviewing services, goals, and outcomes, as described in the individual's IPC and IPP;

(B) providing the training described in §260.205(g) of this chapter (relating to Training);

(C) monitoring training strategies used by service providers to carry out the goals and outcomes described in the IPP; and

(D) activities performed as a member of the service planning team.

Source Note: The provisions of this §260.337 adopted to be effective February 26, 2023, 48 TexReg 896