SECTION 260.343. Day Habilitation, Residential Habilitation, and CFC PAS/HAB

(a) Day habilitation.

(1) Before including day habilitation on an individual's IPC, a program provider must ensure and maintain documentation in the individual's record that day habilitation is not available to the individual under a program funded under §110 of the Rehabilitation Act of 1973, as amended (29 U.S.C. §701 et seq.) or under a program funded under the Individuals with Disabilities Education Act (20 U.S.C. §1401 et seq.).

(2) A program provider must ensure that day habilitation includes:

(A) assistance in acquiring, retaining, or improving the self-help, socialization, and adaptive skills necessary to live successfully in the community and participate in home and community life;

(B) providing the individual with individualized activities:

(i) in environments designed to foster the development of skills and behavior supportive of greater independence and personal choice consistent with achieving the outcomes identified in the individual's IPP; and

(ii) designed to reinforce therapeutic outcomes targeted by other DBMD Program services, CFC services, school, or other support providers; and

(C) providing transportation necessary for the individual's participation in day habilitation activities, such as shopping, swimming, going to the park, or other community activities.

(3) A program provider must ensure day habilitation:

(A) is provided to an individual in a non-residential setting separate from the individual's own or family home or the residence in which the individual receives licensed assisted living or licensed home health assisted living that:

(i) is accessible to and usable by the individual;

(ii) is maintained in good repair;

(iii) has at least two means of egress; and

(iv) is in continuous compliance with applicable local building codes and ordinances and applicable state and federal laws, rules, and regulations;

(B) reinforces:

(i) therapeutic outcomes identified by other DBMD Program services and CFC services; and

(ii) for an individual eligible for public education services, education goals in the Individualized Education Program (IEP) and services provided by the school district;

(C) includes transportation necessary for the individual's participation in day habilitation activities; and

(D) is not provided to an individual at the same time that any of the following services are provided:

(i) employment assistance with the individual present;

(ii) supported employment with the individual present;

(iii) transportation provided as a residential habilitation activity;

(iv) 24-hour licensed assisted living;

(v) 24-hour licensed home health assisted living;

(vi) respite; or

(vii) CFC PAS/HAB.

(4) A program provider must ensure a day habilitation service provider works with one individual at a time unless the individual's service planning team documents on the IPP that the individual's needs can be met with a day habilitation service provider to individual ratio of one-to-two or one-to-three.

(5) A program provider must ensure that for a service-provider-to-individual ratio higher than one-to-three, that the IPP includes a recommendation from the service planning team and supporting documentation of the individual's ability to integrate and meaningfully participate in an environment with a ratio higher than one-to-three.

(6) A program provider may bill for time spent by a day habilitation service provider:

(A) in direct contact with an individual;

(B) participating as a member of an individual's service planning team; or

(C) performing tasks delegated by a physician or RN.

(b) Residential habilitation.

(1) A program provider must ensure:

(A) residential habilitation:

(i) is not provided to an individual receiving licensed assisted living or licensed home health assisted living;

(I) in the individual's own or family home; or

(II) in a setting outside the individual's own or family home appropriate for the type of residential habilitation activities described in the individual's IPP;

(ii) includes:

(I) transportation; or

(II) assistance in securing transportation;

(III) assistance with ambulation and mobility;

(IV) reinforcement of behavioral support or therapy activities;

(V) assistance with medications and the performance of tasks delegated by an RN in accordance with state law;

(VI) supervision of the individual's safety and security;

(VII) assistance with acquisition, retention, or improvement in skills related to activities of daily living, including:

(-a-) personal grooming and cleanliness;

(-b-) bed making and household chores; and

(-c-) preparation and consumption of food;

(VIII) use of natural supports and typical community services; and

(IX) social interaction and participation in leisure activities; and

(iii) is not provided to the individual at the same time that one of the following services are provided:

(I) employment assistance with the individual present;

(II) supported employment with the individual present;

(III) day habilitation;

(IV) respite; or

(V) CFC PAS/HAB; and

(B) a residential habilitation service provider works with no more than one individual at a time.

(2) A program provider may bill for time spent by a residential habilitation service provider transporting an individual.

(c) CFC PAS/HAB.

(1) A program provider must ensure CFC PAS/HAB is not provided to an individual receiving licensed assisted living or licensed home health assisted living.

(2) A program provider must ensure CFC PAS/HAB is not provided to an individual at the same time that one of the following services are provided:

(A) employment assistance with the individual present;

(B) supported employment with the individual present;

(C) day habilitation;

(D) respite; or

(E) transportation provided as a residential habilitation activity.

(3) A program provider must ensure a CFC PAS/HAB service provider works with no more than one individual at a time.

(4) If an individual's IPC includes CFC PAS/HAB, a program provider must ensure compliance with §260.213 of this chapter (relating to Service Backup Plans).

Source Note: The provisions of this §260.343 adopted to be effective February 26, 2023, 48 TexReg 896