SECTION 351.14. Development and Improvement of Standards and Services

To ensure that cost-effective, quality, appropriate medical and related services are available and delivered to clients, the program may establish a system of program evaluation. Program evaluation may include information obtained from management about the program's operation and effectiveness, may establish guidelines and standards for program health care services, may monitor compliance with these established standards and guidelines, may identify and analyze patterns and trends in provider billing and service delivery, and may develop systems which promote family-centered, community-based alternatives that nurture and support children with special health care needs.

(1) Quality assurance. The program may establish a system of monitoring the quality, medical necessity, and effectiveness of services.

(A) Standards and guidelines. The program may develop standards and guidelines for services and providers reimbursed by the program to ensure that quality services are available.

(B) Review of services. The program may conduct or contract for concurrent and/or retrospective review of client care services reimbursed by the program.

(C) Provider review. The program may conduct periodic quality assurance reviews for provider services.

(D) Survey of clients and families. The program shall survey clients periodically to assess the availability, appropriateness, effectiveness, accessibility, and cultural sensitivity of provided services.

(2) Utilization review. Utilization review will assess the appropriateness of services provided to program clients by monitoring systems developed or contracted by the program.

(3) Task forces. The program may establish advisory task forces.

(4) Cooperation with other agencies. The department cooperates with public and private agencies and with persons interested in the welfare of children with special health care needs. The program will make every effort to establish cooperative agreements with other state agencies to define the responsibilities of each agency in relation to specific programs to avoid duplication of services.

(5) Collaboration with stakeholders. The program values the participation of all stakeholders who have an interest in children with special health care needs and will make every effort to work collaboratively with stakeholders in the design, development, and implementation of program rules and policies.

(6) Systems development activities. The program may conduct population-based systems development activities to improve and support the state's infrastructure for serving all children with special health care needs and their families by program staff or through contractors. Population-based systems development activities include, but are not limited to the development and maintenance of community-based systems such as case management, parent case management, parent networks, parent resource centers, parent or provider training, voucher programs, wellness centers, permanency planning, or other systems that may directly or indirectly support any family in Texas with the program.

Source Note: The provisions of this §351.14 adopted to be effective July 1, 2001, 26 TexReg 2979; amended to be effective June 1, 2006, 31 TexReg 4200; amended to be effective October 3, 2010, 35 TexReg 8921; amended to be effective April 21, 2013, 38 TexReg 2362; transferred effective March 15, 2022, as published in the February 25, 2022 issue of the Texas Register, 47 TexReg 982