Comprehensive Rehabilitation Services (CRS) Policy Manual

CRS, Chapter 1: Overview

CRS, 1.1 Overview of Manual

The Comprehensive Rehabilitation Services (CRS) Manual is designed to provide a framework for counselors to use when making decisions and delivering quality services to eligible consumers.

Links within this manual provide additional information, including:

  • examples;
  • tools; and
  • practical application guides.

First-time users should read the manual sequentially from beginning to end to get a broad perspective of the organization and content of policy.

In this manual, the word "you" refers to the counselor or the rehabilitation services technician, as appropriate. The term "consumer" refers to anyone who applies for or receives services through the CRS program.

This manual follows the phases of the rehabilitation process from initial contact with a potential consumer to the provision of Closure and Post-Closure services. Each chapter describes the activities that may take place during that phase of the rehabilitation process. However, the rehabilitation process may not always be linear, and you may need to repeat activities, skip activities until later in the process, or begin more than one process at the same time. For example, once the Individualized Written Rehabilitation Plan is completed and services are being provided, you may need to revisit the plan if circumstances change for the consumer.

The section below identifies important key terms used throughout this manual and describes activities associated with the CRS program.

CRS, 1.2 Key Terms

The following definitions apply, unless the context clearly indicates otherwise.

Abuse – The negligent or willful infliction of injury, unreasonable confinement, intimidation, or threat thereof, or cruel punishment with resulting physical or emotional harm or pain; or sexual abuse, including any involuntary or nonconsensual sexual conduct that would constitute the offenses of indecent exposure or assault, committed by the person's caretaker, family member, or other individual who has an ongoing relationship with the person.

Agency – The Department of Assistive and Rehabilitative Services (DARS) or its successor agencies.

Ancillary services – Goods and services that support core services for CRS but are not primary interventions. Examples of ancillary services include providing a wheelchair or assistive brace.

Appeal – Timely filing of Form 1505, Request for Due Process Hearing and/or Mediation because of a consumer's dissatisfaction with a CRS decision about furnishing or denying services.

Appellant – A consumer who has filed a Form 1505, Request for Due Process Hearing and/or Mediation.

Applicant – A person who has applied for rehabilitation services but for whom an eligibility determination has not been made. As used in this procedure, the term consumer includes an applicant.  

Aquatic therapy – A type of therapy that involves an exercise method in water to improve a person's range of motion, flexibility, muscular strength and toning, cardiovascular endurance, fitness, and/or mobility.

Art therapy – A type of therapy in which persons use art media, the creative process, and the resulting artwork to explore their feelings, reconcile emotional conflicts, foster self-awareness, manage behavior, develop social skills, improve reality orientation, reduce anxiety, and/or increase self-esteem.

Audiological services – The evaluation and treatment of disorders related to hearing and balance.

Authorized representative – The person authorized by the consumer to represent the consumer in an appeal. Completing and submitting Form 1487, Designation of Applicant or Consumer Representative, designates the representative.

Behavior management – A set of coordinated services that provide a person with specialized interventions designed to improve adaptive behaviors and reduce maladaptive or socially unacceptable behaviors, including violent dyscontrol, that prevent or interfere with the person's inclusion at home and in the community.

Case management – Services that help consumers plan, coordinate, monitor, and evaluate the services they receive, with emphasis on the quality of care, continuity of services, and cost-effectiveness.

Case manager – A case manager collaborates with the consumer’s interdisciplinary team and with external entities to assess, coordinate, implement, and evaluate all services required to meet the consumer's needs.

Certified professional – A person who has the knowledge, experience, and skills to perform a specific job and is paid to do the job. The person's expertise is verified by a certificate earned by passing an exam that is accredited by an organization or association that monitors and upholds prescribed standards for the profession involved. Examples of certified professionals include a certified brain injury specialist, certified nursing assistant, certified medical assistant, certified medication aide, and certified nurse aide.

Chemical dependency services – Planned services that are structured to help a person abstain from using drugs and/or alcohol. Services include identifying and changing behavior patterns that are maladaptive, destructive, or injurious to health and are related to or result from substance-related disorders, and identifying and changing behavior patterns to restore appropriate levels of physical, psychological, and social functioning.

Cognitive rehabilitation therapy (CRT) – A type of therapy intended to enable a person to compensate for lost cognitive functions. CRT includes reinforcing, strengthening, or re-establishing previously learned patterns of behavior, or establishing new patterns of cognitive activity or compensatory mechanisms for impaired neurological systems.

Consumer – A person who is interested in, is eligible for, or is receiving services. The term may also include consumer’s guardians or family members who are interested in or are advocating for the consumer.

Core services – Services that are provided by a licensed or certified therapist in post-acute rehabilitation and are provided in residential or non-residential settings.

CRS central office program specialist – A person who supervises CRS counselors in the field and provides them with technical assistance on program policy and procedures.

CRS program – A state-funded program that provides services to enhance the quality of life for persons who have a traumatic brain injury or traumatic spinal cord injury, or both and to enable them to function as independently as possible at home and in the community by improving their mobility, self-care, and communication skills.

Waiting list – A list of consumers who have completed and signed an Individualized Written Rehabilitation Plan, but have not started receiving services.

Dietary and nutritional services – Services that include developing a prescribed diet to meet a consumer’s basic or special therapeutic nutritional needs.

Discovery – A process by which a party may obtain evidence and other information for possible use in a hearing.

Due process hearing – A formal process conducted by an impartial hearing officer to review the allegations made by a consumer in the Form 1505, Request for Due Process Hearing and/or Mediation. The purpose of the process is to resolve a consumer's dissatisfaction with a decision made by you or by a CRS program staff member about providing or denying services.

Durable medical equipment and supplies – Items that provide therapeutic benefits to a person who has a medical condition.

Exploitation – The illegal or improper act or process of a caretaker, family member, or other individual who has an ongoing relationship with a person with a disability and uses the resources of the person, including the person’s Social Security number and other identifying information, without the person’s informed consent, for monetary or personal benefit, profit, or gain.

Family Therapy – A specialized type of psychotherapy that facilitates education, training, and support to families and caregivers to nurture healing and development. 

Functional Independence Measure (FIM) – An 18-item, 7-level functional assessment designed to measure the level of an individual’s disability and indicate how much assistance is required for the individual to carry out the activities of daily living.

Group Therapy – A type of therapy that is conducted by a therapist for two or more persons who have a common therapeutic purpose or goal.

Hearing completion date – The later of the dates set by the impartial hearing officer (IHO) that closes the period during which the parties may submit further evidence into the record, or the date that the IHO receives the hearing transcript.

HHSC Legal Services – An office of the Health and Human Services Commission that provides administrative support to the impartial hearing officer during the appeal process and is the point of contact for an appellant's questions about due process hearings.

HHSC or CRS representative – The person who represents the CRS program during a due process hearing. In the CRS program hearings, the CRS program manager is the CRS representative.

Home modification – Installing assistive or adaptive equipment or devices in a person's home to enable the person to perform household tasks. This equipment must be removable from the residence without causing permanent damage to the property. Examples include grab bars in bathrooms or portable ramps for persons who use wheelchairs or who have other mobility impairments.

Impartial hearing officer (IHO) – A qualified person appointed to conduct a due process hearing.

Individual therapy – A collaborative process between a therapist and one person that is intended to facilitate change and improve the person’s quality of life.

Individualized program plan (IPP) – A document developed by a consumer’s interdisciplinary team for the consumer, based on the consumer’s individual needs. At a minimum, the IPP identifies the consumer’s long-term and short-term goals and objectives, the treatment modalities to be used in achieving the goals and objectives, the individuals responsible for each treatment modality, the target date by which each goal and objective is to be achieved, and the discharge plan.

Individualized Written Rehabilitation Plan (IWRP) – A Plan developed by CRS program staff members and the eligible consumer that outlines the goals, services, and other aspects of services provided by the CRS program. 

Inpatient comprehensive medical rehabilitation services– services as recommended by an interdisciplinary team and provided in a hospital setting, to address medical and rehabilitation issues that require 24-hour-a-day nursing services; These services are available to people who have a traumatic brain injury, traumatic spinal cord injury, or both.

Interdisciplinary team (IDT) – A team of professionals that coordinate services to achieve treatment goals that minimize a consumer's physical or cognitive disabilities and maximize the consumer’s ability to function.

Interest list – A list of the consumers who have made an initial contact with CRS program staff members about receiving services, but who have not completed or signed an Individualized Written Rehabilitation Plan.

Lawful permanent resident – A person who is not a U.S. citizen but lives in the United States and has legally recognized and lawfully recorded documentation identifying himself or herself as a lawful permanent resident. A lawful permanent resident is also known as a permanent resident alien, resident alien permit holder, or a green card holder.

Licensed professional – A person who has completed a prescribed program of study in a health field and who has obtained a license indicating his or her competence to practice in that field. Examples of licensed professionals include a registered nurse, physician, and social worker.

Limited skilled-nursing – Limited skilled nursing is a temporary service that is provided for no more than 30 days. It involves providing or delegating personal care services and administering medication according to the rules established by the Texas Board of Nursing. It also involves assessing a patient to determine the care required. Limited skilled nursing is provided for minor illnesses, for injuries, or in emergencies.

Massage therapy – A type of therapy involving the manipulation of soft tissue by hand or through a mechanical or electrical apparatus for therapeutic purposes. Massage therapy constitutes a health care service, if the massage is for therapeutic purposes.

Mediation – A voluntary process by which an appellant and CRS representative may agree to use a trained mediator to resolve a dispute about determinations affecting rehabilitation services. 

Medical Services – Services or supplies that are needed for the diagnosis or treatment of medical conditions.

Mental restoration services – Limited or short term psychiatric services, including treatment and psychotherapy, for mental conditions that are stable or slowly progressive.

Music therapy – A Type of therapy using musical or rhythmic interventions to restore, maintain, or improve a person's social or emotional functioning, mental processing, or physical health.

Neglect – The failure of a caretaker or provider, through indifference or carelessness, to provide goods or services, including medical services, that are necessary to avoid physical or emotional harm or pain.

Net monthly income – Monthly take-home pay after taxes and other payroll deductions.

Neuropsychological and neuropsychiatric services – A comprehensive battery of tests to evaluate neurocognitive, behavioral, and emotional strengths and weaknesses and their relationship to normal and abnormal functioning of the central nervous system.

Occupational therapy – A type of therapy using evaluation and treatment to develop, recover, or maintain the daily living skills of persons who have a physical, mental, and/or cognitive disorder consistent with the Occupational Therapy Practice Act, Texas Occupations Code, Chapter 454.

Orthosis – A custom-fabricated or custom-fitted medical device designed to provide for the support, alignment, prevention, or correction of a neuromuscular or musculoskeletal disease, injury, or deformity consistent with the Orthotics and Prosthetics Act, Texas Occupations Code, Chapter 605.

Outpatient therapy services – Medical treatment without admittance to a hospital that corrects or modifies a stable or slowly progressive physical or mental impairment which constitutes a substantial impediment to independence; these services are available to people who have a traumatic brain injury, traumatic spinal cord injury, or both.

Over-the-counter medication – Medication that can be obtained without a prescription.

Paraprofessional – A person who is responsible for a particular aspect of a professional task, but is not licensed as a fully qualified professional. Paraprofessional services can be provided for all service arrays, for approved medical needs only, but are provided in the home only when necessary to enable consumer participation. Services may include assisting with medication or therapeutic regimens; preparing and serving meals; assuring that health and safety needs are met; assisting with activities of daily living, such as hygiene and laundry; providing supervision and other care to meet a consumer’s basic needs; and ensuring evacuation in case of an emergency.

Party – The appellant, CRS representative, or other person or agency named or admitted to participate in a due process hearing.

Physical restoration services – Services that correct or substantially modify, within a reasonable period of time, a physical condition that is stable or slowly progressive.

Physical Therapy – Type of therapy that prevents, identifies, corrects, or alleviates acute or prolonged movement dysfunction or pain of anatomical or physiological origin.

Post-acute brain injury (PABI) – A brain injury at the post-acute stage, which is when the patient is medically stable and deemed ready for intensive rehabilitation.

Post-acute brain injury (PABI) services – Services provided as recommended by an interdisciplinary team to address deficits in functional and cognitive skills based on a consumer’s assessed needs. Services may include behavior management, coping skills development, and compensatory strategies. The services may be provided in a residential or non-residential setting.

Post-acute rehabilitation services – Services for post-acute brain injury and post-acute spinal cord injury.

Post-acute spinal cord injury services – Services provided as recommended by an interdisciplinary team to address deficits in functional skills based on a consumer’s assessed needs. The services are provided in the home and in the community (non-residential settings).

Pre-authorization – Approval by a CRS counselor before services are provided.

Prescription medication – A medicine that legally requires a medical prescription to be dispensed.

Prosthesis – A custom-fabricated or custom-fitted medical device used to replace a missing limb, appendage, or other external human body part that is not surgically implanted, as consistent with the Orthotics and Prosthetics Act, under the Texas Occupations Code, Chapter 605. Accordingly, the term includes an artificial limb, hand, or foot.

Provider type – The certified professionals, licensed professionals, and paraprofessionals who contract with the CRS program to provide services.

Rancho Los Amigos Levels of Cognitive Functioning Scale – A scale developed at the Rancho Los Amigos Hospital in Downey, California, that describes eight levels of cognitive function experienced by persons who have a post-acute brain injury. For example, at Level IV Confused/Agitated, the patient is in a heightened state of activity with severely decreased ability to process information. The patient is detached from the present and responds primarily to his or her own internal confusion. Behavior is frequently bizarre and not purposeful relative to the patient's immediate environment.

Record – The official record of a due process hearing. HHSC Legal Services maintains the record.

Recreational therapy – A type of therapy involving recreational or leisure activities that help restore, remediate, or rehabilitate a person's level of functioning and independence, promote health and wellness, and reduce or eliminate the limitations on activity that are associated with traumatic brain injury, traumatic spinal cord injury, or both.

Rehabilitation technology – Equipment or technology designed to help persons with disabilities perform tasks that would otherwise require assistance.

ReHabWorks (RHW) – The electronic case management system for managing a case from initial contact to post closure. RHW is used to update and maintain case information, staff notes, and purchasing activities. RHW interfaces with the office of the Texas Comptroller of Public Accounts to track and authorize payments for consumer goods and services. The data that is entered in RHW is used for responding to inquiries and providing data reports for program monitoring.

Room and Board – Shelter, facilities, and food, including the customary and usual diets in residential settings and any prescribed nutritional meals or supplements.

Service Array – A set of services provided to eligible persons who have a traumatic brain injury, traumatic spinal cord injury, or both. Services are based on assessed individualized rehabilitation needs. The service arrays for traumatic brain injury and traumatic spinal cord injury are outpatient therapy, inpatient comprehensive medical rehabilitation, post-acute rehabilitation, and ancillary goods and services.

Speech-language pathology (speech therapy) – The application of nonmedical principles, methods, and procedures for measurement, testing, evaluation, prediction, counseling, habilitation, rehabilitation, or instruction related to the development and disorders of communication; including speech, voice, language, oral pharyngeal function, or cognitive processes, for the purpose of evaluating, preventing, or modifying or offering to evaluate, prevent, or modify those disorders and conditions in an individual or a group consistent with the Orthotics and Prosthetics Act, Texas Occupations Code, Chapter 605

Texas resident – A person who lives in Texas as evidenced by one of the following unexpired documents: a Texas driver's license, an identification card with an address issued by a governmental entity, a utility bill with an address, a voter registration card, a vehicle registration receipt, or another document approved by the Department of Assistive and Rehabilitative Services or its successor agency.

Therapeutic Pass – A planned activity used to facilitate a consumer's transition from a residential facility to the consumer's home and community. Staff members from the residential facility are available to provide guidance and instruction, usually by phone, to a consumer, a consumer's family, or others while a consumer is on a therapeutic pass.

Tier – A pre-authorized level number of hours allotted for providing core therapy services.

Transportation - Travel and related expenses.

Traumatic brain injury (TBI) -– An injury to the brain that is not degenerative or congenital and is caused by an external physical force that produces a diminished or altered state of consciousness, resulting in temporary or permanent impairment of cognitive abilities and/or physical functioning and partial or total functional disability and/or psychosocial maladjustment.

Traumatic spinal cord injury (TSCI) -– An acute, traumatic lesion of neural elements caused by an external physical force in the spinal canal resulting in any degree of temporary or permanent sensory or motor deficit, and/or bladder or bowel dysfunction.

Utilization review – An evaluation of the necessity, quality, effectiveness, or efficiency of therapeutic services, procedures, and facilities. Reviews may include prospective, concurrent, or retrospective reviews to ensure that services provided to consumers are consistent with the policies and standards for the CRS program.

Vision services – A sequence of neurosensory and neuromuscular activities individually prescribed and monitored by a doctor to develop, rehabilitate, and enhance visual skills.

Waiting list – A list of consumers who have completed and signed an Individualized Written Rehabilitation Plan, but have not started receiving services.

CRS, Chapter 2: CRS Principles

CRS, 2.1 Overview

This chapter introduces CRS program staff members to the philosophies and principles of the CRS program as they apply to the consumer. The chapter defines the terms initial contact and Interest List. It explains the application for services, diagnostic interview, eligibility determination, the Individualized Written Rehabilitation Plan, and the Waiting List. It also explains the importance of building strong ethical relationships with consumers, empowering consumers to make informed choices, practicing good stewardship, and maintaining quality documentation.

CRS, 2.2 Purpose

The purpose of the CRS program is to assist eligible consumers who have a traumatic brain injury (TBI), traumatic spinal cord injury (TSCI), or both, function independently in the home and community in regard to communication, mobility, and self-care.

The CRS program offers the following service arrays to address functional ability for TBI and TSCI:

  • Inpatient Comprehensive Medical Rehabilitation Services
  • Outpatient Therapy Services
  • Post-Acute Rehabilitation Services:
    • residential services (TBI Only)
    • non-residential services (both TBI and TSCI)
  •  Ancillary Goods and Services

CRS, 2.3 Philosophy

The CRS program is committed to ensuring that Texans with disabilities:

  • enjoy the same opportunities as other Texans;
  • pursue rehabilitation goals that are suitable and are according to their choice;
  • live as independently as possible; and
  • lead productive lives.

Although many policies and procedures in this manual are mandatory, a consumer's application is individualized to his or her situation and rehabilitation needs. Every interaction with a consumer is unique and therefore requires a unique response and the consumer’s informed choice.

At any point while receiving services, a consumer has the right to decline services or withdraw from services without financial penalty, excluding the consumer’s previously agreed cost of participation.  

CRS, 2.4 Understanding the CRS Process

The CRS process begins with the initial contact, followed by the application for services, diagnostic interview, eligibility determination, creation of the Individualized Written Rehabilitation Plan, the provision of services, and closure. Assessing and planning and/or counseling and guidance occur between each step of the process.

CRS, 2.4.1 Initial Contact

Initial contact is the term used to describe the point at which the consumer or consumer’s representative contacts the CRS program to express an interest in receiving services for CRS. You will document the contact by creating an initial contact entry in ReHabWorks and then schedule your first appointment.

CRS, 2.4.2 Interest List

Once an initial contact has been created in ReHabWorks, consumers are considered interested in receiving services for CRS and are placed on the Interest List. Consumers remain on the Interest List until an Individualized Written Rehabilitation Plan has been completed and signed.

CRS, 2.4.3 Application and Diagnostic Interview

During the consumer’s first appointment, complete the application process and the diagnostic interview. During this appointment, you will complete the application-related tasks outlined in ReHabWorks (RHW). The application process consists of obtaining demographic information about the consumer, and information on the consumer’s financial situation and disability. A consumer moves on to the application phase after signing the Application for Services, either in RHW or on the paper application.

Next is the diagnostic interview, which is your first opportunity to investigate the impact of the consumer’s disability on the consumer and the consumer’s ability to live independently. A sound diagnostic interview assists in determining the consumer’s eligibility for services. The diagnostic interview is a means for collecting information because it allows the consumer to provide you with his or her social, medical, and rehabilitation history.

If you have not sufficiently collected information, you may fail to realize the need for a medical or neuropsychological evaluation, a failure that could lead to a poor eligibility decision or developing a less than optimal plan for independence. The diagnostic interview is a critical part of planning and decision-making. Your role in conducting the interview is to listen effectively and ask questions, as needed. Observation can also provide invaluable insight into the consumer's personality, mood, social functioning, and other characteristics and key attributes. The outcome of the diagnostic interview should be that you have a better understanding of the consumer's situation and that the consumer has increased his or her self-awareness.

CRS, 2.4.4 Eligibility

Eligibility is determined through your review of documents substantiating what the consumer expressed during the diagnostic interview. Supporting documents may include medical records or neuropsychological evaluations. You will receive supporting documents either directly from the consumer or medical provider, or from a records request.

CRS, 2.4.5 Individualized Written Rehabilitation Plan (IWRP)

The IWRP is developed based on discussions held between you and the eligible consumer during the assessment and planning process.

The IWRP outlines services agreed upon between you and the consumer or the consumer’s representative. Services outlined on the IWRP are meant to assist the consumer in reaching the goal of independence, particularly in regard to self-care, mobility, and communication.

CRS, 2.4.6 Waiting List

Consumers are considered to be on the Waiting List for services when an Individualized Written Rehabilitation Plan (IWRP) has been developed and signed but funding for the services described in the IWRP has not yet been issued. ReHabWorks automatically removes the consumer from the Interest List and assigns them a Waiting List number.

Consumers are removed from the Waiting List by the CRS central office staff members on a first-come, first-serve basis when funding is available. Consumers are removed from the Waiting List, when funds for the consumer’s services have been allocated or when you close their case.

CRS, 2.5 Building Ethical Relationships

Solution-focused, respectful, nonexploitative, and empowering counseling relationships are built on high ethical standards. Understanding the principles listed in the Code of Professional Ethics for Rehabilitation Counselors (the code) is at the heart of the ethical decision-making process. The code defines the level of competency needed in professional relationships to promote and protect the spirit of caring and respect for individuals with disabilities.

It is essential that staff members adhere to the ethical standards stated in the code, as well as to policy and procedure, and that they be accountable to those standards.

The code defines the following six basic principles of ethical behavior:

  1. Autonomy: to honor a consumer’s right to make decisions
  2. Beneficence: to do good to others
  3. No malfeasance: to do no harm to others
  4. Justice: to be fair and give equal justice to all
  5. Fidelity: to be loyal and keep promises
  6. Veracity: to be honest

Counselors who violate the code are subject to the actions defined in agency policies for performance management. Counselors certified through the Commission on Rehabilitation Counselor Certification are also subject to a commission action.

CRS, 2.6 Principles of Informed Choice

It is important for each person involved in the rehabilitation process to apply consistently the concept of informed consumer choice.

The principles of informed consumer choice require that the counselor inform the consumer about, and involve the consumer in, choosing among alternative:

  • goals;
  • objectives;
  • services;
  • entities providing services; and
  • methods used to provide or procure services.

The consumer should enjoy the same rights as any person to make decisions that affect his or her life. To achieve positive outcomes, the consumer must be involved in decision-making at the greatest level at which the consumer is capable.

Informed consumer choice begins at the first meeting, when you explain:

  • the concept of informed choice;
  • the concept of an effective partnership between you and the consumer; and
  • the CRS process for receiving services.

Together, you and the consumer choose the providers who will provide assessments and other types of information necessary to determine the consumer’s eligibility.

During the development of the Individualized Written Rehabilitation Plan (IWRP), you and the consumer jointly:

  • consider a variety of suitable goals that will help the consumer overcome impediments to independence; and
  • assess which goals are most consistent with the consumer’s needs, abilities, and other key attributes.

After you have identified the consumer’s rehabilitation needs, give the consumer information about the services that are available to meet the consumer's needs and are consistent with laws, policies, and the highest ethical standards. Your good judgment leads to the development of reasonable options to discuss with the consumer, facilitating his or her ability to make an informed choice. In some cases, there may be only one appropriate alternative that meets the consumer's needs and supports the policy.

If the alternatives developed are not acceptable to the consumer, or if preferences expressed by the consumer are not among the alternatives presented, discuss the options until you and the consumer reach a mutually acceptable decision. If you and the consumer cannot reach a compromise, inform the consumer of his or her right to appeal.

CRS, 2.7 Principles of Good Stewardship

Counselors make purchasing decisions using principles of good stewardship.

Before using CRS funds, you must use available comparable services and benefits to pay for services in whole or in part. You must provide the consumer with information on available public and private comparable services and benefits. The consumer, as a partner in the CRS process, must use comparable services and benefits from other programs for which he or she is eligible. Using comparable services and benefits ensures that CRS dollars are spent efficiently.

CRS, 2.8 Quality Program Management in Documentation

How well you document each consumer’s case directly affects the quality of the services that you provide the consumer.

A key to the CRS program’s success is your ability to document accurately and in a timely manner the decisions that:

  • comply with the law and with state rules;
  • are made in partnership with the consumer;
  • result in the eligible consumer receiving services; and
  • result, ultimately, in the consumer’s increased independence at home and in the community.

The type of documentation kept in the case file includes:

  • information contained in ReHabWorks (RHW), including case notes; and
  • information contained in the consumer’s paper case file.

Create case notes in RHW to compile information gleaned from other sources, and from your interactions with the consumer, the consumer's family or representative, referral sources, service providers, and others, in order to:

  • convey compliance with state laws regarding the:
    • use of funds; and
    • decisions made about service delivery;
  • document your decision-making and application of the CRS process;
  • provide a clear and concise explanation of the consumer's progress through the rehabilitation process;
  • make clear the outcomes of planned interventions;
  • ensure the ability to seamlessly provide services to the consumer in the absence of the counselor of record; and
  • establish a sound record of the program’s effectiveness and efficiency.

Clearly written information is required to achieve these expectations. This manual often refers to the need for writing incidental case notes to explain or justify a course of action. When writing case notes, be objective, and write clearly and concisely enough for the reasonable reader to understand.

Your documentation must add value to the CRS program by revealing relevant information about:

  • the consumer’s participation in and progress made through the CRS process;
  • the staff member’s considered decisions; and
  • the outcomes of planned interventions.

In addition to prescribed incidental case notes, at a minimum, every RHW case file must document the actions taken on behalf of or with the consumer, as described in the following table.

Activity

Documentation

Completing an application and diagnostic interview

A case note or series of case notes that describes pertinent information obtained from the consumer, or the consumer's family or representative, and any available records, including :

  • information after a thorough examination of the consumer's medical history;
  • information or identified gaps in information needed to determine eligibility; and
  • information that may be used later during assessment to develop the Individualized Written Rehabilitation Plan (IWRP) for the eligible consumer.

Opening or reopening a previously closed case

A case note or series of case notes that describes the:

  • circumstances leading to previous closures and the need for opening a case;
  • changes needed for a successful case outcome; and
  • consultation with the manager, if applicable.

Determining eligibility

A case note or series of case notes that describes:

  • how the criteria for eligibility are met; or
  • the reasons for a consumer’s determination of ineligibility.

Assessing and planning

A case note or series of case notes that show how the assessment resulted in the:

  • identification of potential goals;
  • decisions that support the goals, objectives, and services of the IWRP;
  • consumer's informed choice; and
  • development of the plan for contact with the consumer.

Making changes to the original IWRP that result from:

  • a Joint Annual Review; or
  • other amendments.

A case note or series of case notes that describes the:

  • results of the IWRP review;
  • reasons for any changes that do not require amendment; or
  • reasons for an amendment and the nature and scope of the changes, including how objectives, services, and a plan for communicating with the consumer were developed, when applicable.

Service delivery notes

A case note or series of case notes that describe:

  • the decisions that support the necessary provision, extension, or addition of a service; or
  • actions taken to provide the service, such as:
    • using best-value information;
    • completing technical tasks or purchasing-related tasks;
    • making contacts; or
    • following up.

General contact notes

A case note or series of case notes that describes the consumer's rehabilitation story by reflecting conversations, observations, decisions, actions taken that support the consumer's progress, and the consumer’s opportunities to make informed choices.

Counseling and guidance

A case note or series of case notes that explains how counseling strategies and interventions were skillfully applied to support the consumer; for example, were applied to:

  • remove barriers;
  • help solve problems;
  • provide information and support to help the consumer make an informed choice;
  • help the consumer adjust to a disability; and
  • educate the consumer.

Joint annual review (JAR)

A case note or series of case notes that describe JAR activities, such as reviewing and discussing the consumer's:

  • personal information;
  • progress in achieving independence;
  • intermediate goals; and
  • responsibilities.

Closing a case

A case note or series of case notes that describe:

  • the reason the case was closed;
  • the circumstances that led to the decision to close; and
  • how the case meets the criteria for closing a case.

Specific documentation is needed before certain actions can be taken. The following table describes the minimum documentation required.

Action

Documentation

Services to family members or caretakers

A case note or series of case notes that describe:

  • why the services are needed;
  • which family members or caretakers need the services (include names and, if provided, include Social Security numbers);
  • what services are needed; and
  • how the services are expected to contribute to the consumer's goal of independence.

Identification and/or use of comparable benefits

A case note or series of case notes that explains the progress made toward accessing and applying for identified comparable services and benefits.

Making data corrections (maintaining data integrity)

A case note or series of case notes that describes data corrections in ReHabWorks, including the justification for the corrections and the approval obtained.

Adding "Consumer requires special attention"

A specific and factual report of the event that lead to the determination that the consumer poses a threat, including:

  • the date of the event;
  • the location of the event;
  • the names and addresses of witnesses and people involved;
  • an account of what was said or done; and
  • the names of those willing to testify.

Removing "Consumer requires special attention"

A case note or series of case notes that describes why the consumer no longer poses a threat.

Resetting of a Personal Identification Number (PIN) by a CRS program manager

A case note or series of case notes entered by a manager to:

  • note that the manager reset the PIN; and
  • explain the reason for resetting the PIN.

Obtaining management approval

A case note or series of case notes entered by the approving manager to explain the:

  • decision for approval;
  • parameters of approval; and/or
  • extent to which a policy is being waived.

CRS, Chapter 3: Roles and Responsibilities of the Rehabilitation Team

CRS, 3.1 Overview

This chapter explains the roles and responsibilities of the many partners who support the consumer during the rehabilitation process.

The partners share responsibility for informing and educating consumers, advocating and facilitating for them, and encouraging them. Each partner must contribute his or her expertise to make the professional relationships with the consumer as productive as possible. Partnership building is an active process.

You must:

  • think creatively to consider alternatives; and
  • practice the art of leadership.

To model the behavior expected of others effectively, leaders must first establish clear guiding principles and must lead from those principles. You must lead according to what you believe. You must lead in partnerships that contribute to the success of the consumer, such as the partnerships that you build with consumers, schools, families, businesses, other agencies, and the community. You must inform other staff members, consultants, the consumer or consumer's representative, and CRS providers about the consumer’s goals and the responsibility that each person has in attaining the goals.

CRS, 3.2 Roles of Key Players

CRS, 3.2.1 Consumer

The consumer-counselor relationship is valued and the following consumer roles are encouraged:

  • Owner: taking ownership of his or her rehabilitation.
  • Active partner: demonstrating motivation by actively participating in rehabilitation, throughout the phases of the process.
  • Decision-maker: engaging in the process of making an informed choice and decision.
  • Active participant: committing to following through with activities that lead to a successful rehabilitation outcome.

CRS, 3.2.2 Counselor

Your roles as a counselor are as follows:

  • Source of encouragement: building confidence in partners to help the consumer live independently.
  • Role model: setting expectations for the consumer by modeling accountability, responsibility, and full engagement.
  • Problem-solver: providing tools for the consumer to accommodate or reduce the impediment to independence and to empower him or her to reach the consumer’s goals.
  • Team player: fostering a culture of honesty and respect among partners.
  • Model of competence: modeling competence in your job performance to inspire partners and consumers.
  • Advocate: advocating for consumers and putting the consumer's best interest first.
  • Source of empowerment: empowering the consumer to grow and make a difference in his or her own life by making informed choices.
  • Helper: taking a skilled-helper approach to counseling to engage the consumer fully in developing new rehabilitation opportunities and developing the skills needed for daily living.
  • Educator: conducting outreach activities to educate community partners about how services for CRS can be a valuable asset.
  • Partner: developing strong community partnerships that are built on trust and cooperation.
  • Myth breaker: clarifying with vendors, school staff, and the community any misconceptions about the consumer’s knowledge, skills, abilities, and attributes.
  • Master of alternatives: finding services, providers, and ways to overcome barriers so that the consumer can be a successful and live an independent life.

CRS, 3.2.3 Manager

As a vital partner in facilitating quality, the CRS program manager's roles are as follows:

  • Leader: directing and having concern for his or her staff members and the consumers.
  • Builder of competency: building competency in his or her staff members in order for the CRS program to best serve consumers, families, community members, and taxpayers.
  • Teacher: teaching and coaching both new and experienced staff members who want to continue to learn more about the rehabilitation process and improve his or her skills and abilities.
  • Talent developer: committing to and searching out challenging opportunities for staff members to grow, innovate, and improve his or her abilities.
  • Motivator: encouraging and motivating staff members to become decision-makers and creative thinkers.
  • Visionary: enlisting others in a common vision by appealing to their values, interests, hopes, and dreams to create a cultural climate of excellence in service.
  • Source of empowerment: strengthening the CRS process and empowering the counselor to become a decision-maker by sharing information and by discussing the decisions the counselor has made and the actions he or she has taken regarding the consumer’s case.
  • Reflector: providing ongoing feedback to the counselor about how to improve accountability in order to deliver quality services.
  • Role model: exhibiting the self-confidence that it takes to provide quality services and ensure the consumer’s satisfaction.

CRS, 3.3 Responsibilities of the Courtesy Counselor

A CRS courtesy counselor, who may perform courtesy work at one or more organizations, manages timely delivery of services described in the consumer’s Individualized Written Rehabilitation Plan (IWRP).

The courtesy counselor:

  • has access to pertinent electronic documents in ReHabWorks (RHW) and paper documents in the case file, such as the consumer’s IWRP and medical reports;
  • may contact the consumer and provide counseling and guidance;
  • communicates with the home CRS counselor, as needed, to maintain continuity of the consumer’s progress;
  • makes sure that funds are available and that the encumbrance complies with current policy (coordinates with the medical services coordinator assigned to the facility or region); and
  • confers, in accordance with policy, with the home counselor to decide which counselor will make a change in the services called for in the consumer’s IWRP. If the home CRS counselor is not available, contacts the manager of the home counselor for approval.

If a consumer requires services that are offered in an assigned service area that is not the assigned service area in which the consumer lives, a CRS courtesy counselor may do as follows for another CRS counselor:

  1. Enter information under Initial Contact in RHW (for instructions, see RHW Users Guide, Chapter 5 Initial Contact).
  2. Staff the case with the home CRS counselor.
  3. Assign the case to that CRS counselor in RHW (for instructions, see RHW Users Guide, Chapter 5 Initial Contact, 5.4 Assign Case) to create a system-generated action indicating that a case has been added to the assigned counselor’s caseload.
  4. Coordinate with the home CRS counselor to identify a time for the counselor to call in and participate with the application process or assessments.
  5. Complete the application with the consumer to ensure that it is documented in RHW, as required (for instructions, see RHW Users Guide, Chapter 10 Application).
  6. Explain that the home CRS counselor will work with the consumer to:
    • determine the consumer’s eligibility and complete the eligibility documentation in RHW (for instructions, see RHW Users Guide, Chapter 13 Eligibility);
    • conduct assessments;
    • develop the IWRP and complete the IWRP-related documentation in RHW (for instructions, see RHW Users Guide, Chapter 14 Plan); and
    • issue service authorizations for services, equipment, and related services
  7. Create a case note in RHW (for instructions, see RHW Users Guide, Chapter 7 Case Notes, 7.2.1 Adding a Case Note) describing the consumer; his or her disability; how, according to consumer, the disability is interfering with his or her independence, and other information that may help the CRS counselor understand the consumer's situation.
  8. Send an email to the CRS counselor informing the counselor of the referral; and
  9. Get completed releases of information.
  10. Create a paper file to include all medical information obtained from the consumer.

A courtesy counselor helps the home CRS counselor, as necessary, by:

  • documenting that the consumer agrees with the content of the IWRP or other documents;
  • delivering equipment; and
  • arranging services locally.

CRS, 3.4 Responsibilities of the Medical Services Coordinator

The medical services coordinator (MSC):

  • reviews referral information and discusses with the counselor problems encountered, additional medical information needed, or related medical questions;
  • confirms the availability of comparable services and benefits, and seeks out other comparable services and benefits;
  • consults with CRS central office staff members;
  • informs the counselor about the estimated costs for medical services before encumbering funds;
  • discusses with the provider or the provider's staff members the payment allowances for related medical services;
  • coordinates services;
  • issues service authorizations;
  • communicates with the consumer, the counselor, and providers about ongoing services;
  • notifies the counselor, service provider, and the consumer if needed, about the date, time, and location for scheduled services;
  • provides the counselor with documentation on significant events in the medical services process;
  • approves claims for payment after deducting other payments;
  • processes documents on encumbrances for medical services;
  • maintains effective working relationships with CRS program staff members and the medical community;
  • recruits medical providers and consultants; and
  • serves as a resource to CRS program staff members in field offices when coordinating medical services for the consumer.

CRS, 3.4.1 Medical Services Arranged by the Medical Service Coordinator

The medical service coordinator (MSC) arranges:

  • services provided by a hospital or ambulatory surgical center;
  • services for post-acute rehabilitation; and
  • evaluations and treatment provided by medical schools.

CRS, 3.4.2 Procedures to Request Services of a Medical Service Coordinator

Complete the steps below to request the services of a medical service coordinator (MSC):

  1. Send an email message or delegate an action item to the assigned MSC. If you do not know who is assigned as the MSC, contact your manager.
  2. Enter a case note identifying the service to be arranged and the hospital or facility selected.
  3. Provide to the MSC:
    • pertinent medical records;
    • a completed DARS3101, Consultant Review (if applicable);
    • a completed DARS3110, Surgery and Treatment Recommendations (if applicable);
    • information about comparable benefits, including a copy of the consumer’s insurance card, Medicare or Medicaid documentation, and so on; and
    • information about the consumer’s prescriptions (if applicable).

Note: If necessary, the MSC uses the application, Individualized Written Rehabilitation Plan, and pertinent case notes in ReHabWorks and, when applicable, gets the necessary manager approvals.

  1. Confirm, when notified by the MSC, that there are adequate funds to cover the cost of the requested medical services and any unexpected medical complications.
  2. If contacted by a medical provider about services arranged by the MSC, refer the provider to the MSC.

Note: To arrange for out-of-region medical services, send an email message or delegate an action item, then enter a case note and send the information to your home MSC. If you are unsure who is assigned as your home MSC, contact a CRS central office staff member. The home MSC refers the request to the appropriate MSC for out-of-region service and asks the MSC to coordinate the requested medical services.

Refer to the Medical Services Required Practices Handbook for more information on the roles and responsibilities of the MSC and procedures for coordinating medical services for consumers.

CRS, 3.5 Responsibilities of the Medical Services Technician

The role of the medical services technician (MST) is to perform advanced and complex technical support work using ReHabWorks to help the medical service coordinator (MSC) provide medical services to a consumer while establishing and maintaining appropriate business relationships with providers, consumers, and CRS program staff members.

The duties of an MST include:

  • providing information on the CRS program and services;
  • supporting the MSC in the delivery of services;
  • providing courtesy budget management;
  • purchasing goods;
  • monitoring consumer purchasing and using best business practices, as outlined in the CRS monitoring plan;
  • providing advanced levels of caseload management assistance to the MSC;
  • using automated systems; and
  • handling and safeguarding confidential information.

CRS, 3.6 Responsibilities of the CRS Liaison Counselor

The primary responsibility of the CRS liaison counselor is to develop a positive working relationship with CRS providers. The CRS liaison counselor serves as a resource to the provider on issues pertaining to implementing standards, invoicing for services, addressing individual consumer case issues, and helping with other topics of mutual interest.

The CRS program manager assigns a liaison counselor to each provider. The CRS liaison counselor is the primary communication link between the provider and the CRS program.

The CRS liaison counselor must know about:

  • the provider and the services it provides for consumers;
  • the terms and conditions outlined in the provider’s contract; and
  • CRS policies related to provider operation and service delivery.

Duties of the CRS liaison counselor vary, according to the provider being served.

At least quarterly, the CRS liaison counselor must:

  1. spot check CRS case files to ensure compliance with CRS standards regarding reports, documentation, confidentiality, and so on;
  2. review any changes in staff;
  3. review any changes in the physical plant, with particular attention to safety factors and accessibility;
  4. review other safety and health issues, if applicable;
  5. address questions provider staff members may have about CRS policies and procedures;
  6. address with provider staff members any questions or concerns received from agency staff members; and
  7. review the provider's Unusual Incidents Reports, if applicable.

CRS, 3.6.1 Documenting Quarterly Visits

The CRS liaison counselor:

  • documents quarterly visits on the DARS3821, CRP Liaison Counselor Quarterly Monitoring Summary;
  • maintains the summary in the CRS liaison counselor’s file; and
  • submits a copy of the form to the CRS program manager for review and analysis.

The CRS liaison counselor reports any significant irregularities or trends he or she identifies to the CRS program manager.

When a provider regularly provides three or more hours of service a day (for example, when providing post-acute brain injury (PABI), residential services), the CRS liaison counselor interviews 10 percent of the total number of consumers quarterly.

The CRS liaison counselor must immediately report to the home CRS counselor any concerns related to or raised by a particular consumer.

To ensure compliance with 24-hour supervision requirements, at least one of the liaison counselor's quarterly visits each year for residential providers must be unannounced and outside of normal working hours (for example, during evenings or weekends).

CRS, 3.6.2 Providers with Permanent Locations for Delivering Consumer Services

If a CRS liaison counselor is assigned to a provider that maintains a physical location and serves CRS consumers in that location, the CRS liaison counselor must visit the location at least quarterly.

If a provider has not served consumers for an extended period, the CRS liaison counselor may request an exception to the regular quarterly monitoring cycle. The CRS program manager must approve a request for exception.

The CRS liaison counselor must copy the contract manager on communications containing exception requests and approvals.

CRS, Chapter 4: Initial Contact

CRS, 4.1 Overview

This chapter explains how to gather information necessary to develop a case and to support the eligibility determination. The initial contact date is very important to the consumer because it may affect the services received. The chapter explains the appropriate steps taken to complete an initial contact for a consumer who is seeking services for CRS.

CRS, 4.2 Sources of Incoming Referrals

Numerous community sources, such as organizations, schools, clinics, employers, hospital case managers, and doctors, refer persons to the CRS program for assistance. Outreach efforts by CRS program staff members inform potential referral sources of the services available and the purpose of the CRS program. Accurately record the referral source in ReHabWorks.

The CRS program and Texas Workforce Solutions Vocational Rehabilitation Services (VRS) collaborate on referrals.

If you receive a referral from VRS:

  1. enter the initial contact in ReHabWorks (RHW), with VRS entered as the referral source; and
  2. keep a separate running log outside of RHW to track the VRS referrals that will be submitted to the CRS central office.

CRS, 4.3 Outgoing Referrals to Other Resources or Vocational Rehabilitation Services

If a consumer applies for services and you close the case before determining eligibility, refer the consumer to another community resource program if the consumer is available and needs other services.

You may use the 211 Texas Information and Referral Network (Finding Help in Texas) to identify other resources the consumer may be available for or needs.

Once you have confirmed that services are available from another community resource:

  1. describe the services to the consumer;
  2. contact the other resource to set up an appointment for the consumer; and
  3. provide the other resource with information requested about the consumer, when appropriate.

If the consumer is not eligible for services from the CRS program or decides whether to apply for community-based services, you must provide the consumer with ample information on alternatives. Information related to community-based services can be vast and can include options such as comparable benefits and living in an institution (such as a group home or nursing home).

When helping a consumer make an informed choice about where to live, you must inform the consumer about any community support that may help him or her function in the most independent setting possible. Such support services vary by community.

By definition, settings such as nursing homes, intermediate care facilities for individuals with intellectual disabilities, sub-acute programs for coma management, and group homes are considered institutional residency.

When the consumer needs vocational rehabilitation, refer the consumer to Texas Workforce Solutions Vocational Rehabilitation Services (VRS). The CRS program and VRS collaborate on referrals.

For outgoing referrals, the CRS program and VRS share:

  • contact information about the consumer and the consumer’s family;
  • demographic information about the consumer; and
  • disability information about the consumer.

If available, additional information is shared, including:

  • details about the type of injury the consumer sustained;
  • the date of the consumer’s injury;
  • historic details about the injury, including the results of physical examinations; and
  • recommendations from CRS or VRS.

The CRS program or VRS provides the consumer with education and guidance on the referral process and the contact information for the receiving state agency.

The CRS program and VRS tracks the referrals made and received.

CRS, 4.4 Completing the Initial Contact

The first contact that a consumer makes with the CRS program is a critical point in the rehabilitation process. It is a time for the consumer not only to exchange information with a CRS program staff member, but also to form an impression about the staff member's sincerity, concern, and professionalism. A successful exchange of information means that both the counselor and consumer fully understand what is being discussed. You are responsible to communicate in a way that best accommodates the consumer’s limitations.

During this contact with a consumer:

  1. develop an understanding of the consumer's needs;
  2. identify the CRS service that seems most suited to meet those needs; and
  3. explain the purpose of the CRS program to the consumer.

The initial contact date for the CRS program is the date that the consumer or the consumer's representative first contacts the CRS program about services.

Document the consumer’s initial contact in ReHabWorks (RHW). Complete the Initial Contact entry (for instructions, see the RHW Users Guide, Chapter 5 Initial Contact, regardless of the consumer's current level of functioning. Once the Initial Contact is documented in RHW, the consumer is added to the Interest List. Once the case is assigned to the appropriate counselor, the case status updates to Initial Contact with Case Assignment status.

As soon as you determine that a case is not warranted, close the Initial Contact case by coding it as Ineligible (for instructions, see RHW Users Guide, Chapter 21 Closure, 21.1 Closure Before Case Assignment and Before or After Application). This action removes the consumer's name from the Interest and/or Waiting List. If an Initial Contact is created but an application is not completed, the consumer’s initial contact information is not automatically removed from RHW.

CRS, 4.5 Purchases Made While on the Interest and Waiting Lists

Only items and services listed in this section may be purchased while a consumer is on the Interest and Waiting Lists.

You may purchase medical records and assessments for all consumers on the Interest and Waiting Lists.

You may purchase services in this section for consumers who have been determined eligible but have one or more of the conditions listed:

If a consumer experiences contractures that are expected to cause permanent damage if not treated in a timely manner (as documented in a case note), CRS may sponsor services to address this issue only. The consumer remains on the Interest and Waiting Lists for all other purchased services, and the services provided under this exception:

  • are included in the total limit of 120 hours of outpatient therapy; and
  • may be provided without an Individualized Written Rehabilitation Plan (IWRP).

If a consumer experiences violent behavioral dyscontrol to the extent that the consumer risks significant bodily harm, incarceration, or psychiatric commitment (as documented in a case note) CRS may sponsor up to 14 days of inpatient medical behavior management at:

  • a comprehensive medical rehabilitation hospital specializing in brain injury; or
  • a residential post-acute brain injury rehabilitation facility.

If necessary, the service:

  • may be extended for an additional seven days; and
  • may include medication, and as needed, medical follow-up appointments;

The consumer remains on the Interest and Waiting Lists for all other purchased services, and services provided under this exception:

  • are included in the total limit of 90 days of inpatient rehabilitation or six months of post-acute brain injury rehabilitation; and
  • may be provided without an IWRP.

When funds become available and a consumer can be removed from the CRS Waiting List, the CRS central office staff member or a designee must allocate funds for any services other than those referred to in this section.

CRS, 4.6 When CRS Is Not the Right Resource

Individuals referred to the CRS program must be given the opportunity to apply for CRS services and meet with a counselor, regardless of whether the information obtained during the initial contact or application for services appears to support the individual's eligibility for the CRS program. Only a counselor can decide whether an individual is eligible or needs to be referred to a more appropriate community resource.

For additional information about how to appropriately refer consumers, see 4.3 Outgoing Referrals to Other Resources and or Vocational Rehabilitation Services.

CRS, 4.7 Consumer Needs CRS Services

If the CRS program is appropriate for the consumer, obtain the information necessary to document the Initial Contact in ReHabWorks (RHW).

The consumer must be assigned to a caseload when the initial contact is entered into RHW (for instructions, see RHW Users Guide, Chapter 5 Initial Contact, 5.4 Assign Case).

If the consumer cannot be seen for an application at the time of the initial contact, schedule an appointment with the consumer for the earliest date available.

An application for services must be completed within 30 calendar days of initial contact. If the application cannot be completed within 30 calendar days, the documentation in the case file must indicate a good-faith effort to meet the 30-day standard.

CRS, 4.8 Social Security Numbers

When entering an initial contact in ReHabWorks (RHW), ask for the consumer for his or her Social Security number (SSN), but do not deny services to a consumer solely because the consumer does not provide a Social Security card or SSN.

Section 7(a) of the Federal Privacy Act of 1974 prohibits "any federal, state or local government agency" from denying any "right, benefit, or privilege provided by law" because a person refuses to disclose his or her Social Security number.

If the consumer does not have a SSN or does not provide it, RHW assigns a temporary SSN when the initial contact is saved. For instructions, see RHW Users Guide, Chapter 5 Initial Contact, 5.1.2 Completing the Initial Contact Using a Temporary SSN.

If the consumer later presents a Social Security card or provides a SSN, replace the temporary number with the consumer’s SSN. For instructions, see RHW Users Guide, Chapter 9 Other Case Management, 9.2 Change SSN.

Chapter 5: Application

CRS, 5.1 Overview

This chapter explains the application process, which includes determining whether the CRS program is the appropriate resource, collecting demographic information, collecting financial information, collecting needed medical documentation, and following the procedures to get a PIN.

CRS, 5.2 Scheduling the Application Appointment

When scheduling an appointment for a consumer to apply for services, determine the consumer's language preference and decide whether the consumer needs a translator, interpreter services for the deaf, reasonable accommodations, and/or assignment to a specialty caseload.

The CRS program provides language services if necessary to ensure that all consumers have meaningful access to programs, services, and information.

Language services are provided at no cost to the consumer and may include:

  • spoken interpretation (over-the-phone and face-to-face);
  • written translation; and
  • sign language interpretation.

CRS program staff members must assist consumers who require language services by:

  • determining the type, amount, and cost of the language services;
  • getting approval to provide the services;
  • submitting a service authorization; and
  • documenting the need and details about the consumer’s use of the service in the consumer record. 

Additional information on how to access language services can be found at HHS Circular C-013, Health and Human Services System Language Services Policy.

Use DARS5003, Application Appointment Letter in ReHabWorks (RHW) to schedule the appointment. For instructions, see RHW Users Guide, Chapter 5 Initial Contact, 5.5 Initial Appointment. (DARS5003 is available only in RHW).

Ask the consumer to bring appropriate records to the application appointment, including:

  • a photo ID, such as driver's license, state issued ID, school ID, passport, or military ID;
  • an original Social Security card or other proof of identification, as explained in 5.3 Identification;
  • the names and addresses of two people who know how to contact the consumer;
  • the dates of medical treatment and the medical providers’ names, addresses, and phone numbers;
  • the consumer’s rehabilitation history;
  • a list of agencies from which the consumer has received services, by the time of application);
  • proof of income for the consumer and the consumer's spouse (or the consumer's parents, if the parents claim the consumer as a dependent on their federal income tax), such as copies of the latest pay stub, proof of Supplemental Security Income, proof of Social Security Disability Income, a U.S. Department of Veterans Affairs award letter, or a workers' compensation Notice of Payment;
  • proof of expenses related to monthly mortgage or rental payments, prescribed diets and medicines, debts imposed by court order, and medical costs and other disability related expenses;
  • proof of medical insurance, including Medicaid and Medicare; and
  • other items that may help with the application and eligibility process.
 

CRS, 5.3 Identification

The consumer is to provide original documents that establish that the consumer is either a resident or permanent legal resident of Texas and the United States.

The consumer must present one original, unexpired document from Column A or one each from Column B and C when applying for services.

Original Documents to Be Provided by the Consumer

Column A

Column B

Column C

  • U.S. Passport or U.S. Passport Card
  • Foreign passport that contains a temporary I-551 stamp or temporary I-551 printed notation on a machine-readable immigrant visa
  • Permanent Resident Card or Alien Registration Receipt Card (INS Form I-551)
  • Employment Authorization Card that contains a photograph (Form I-766)
  • For nonimmigrants authorized to work for a specific employer: a foreign passport with an Arrival-Departure Record, Form I-94 or I-94A, bearing the same name as the passport and containing an unexpired endorsement of the individual's nonimmigrant status.
  • Passport from the Federated States of Micronesia (FSM) or the Republic of the Marshall Islands (RMI) with Form I-94 or Form I-94A, indicating nonimmigrant admission under the compact of Free Association between the United States and the FSM or RMI.
  • Driver's license or ID card issued by a state or outlying possession of the United States provided it contains a photograph or information such as name, date of birth, sex, height, eye color, and address
  • ID card issued by federal, state or local government agencies or entities provided it contains a photograph or information such as name, date of birth, sex, height, eye color, and address
  • School ID card with a photograph
  • Voter's registration card
  • U.S. Military card or draft record
  • Military dependent's ID card
  • U.S. Coast Guard Merchant Mariner Card
  • Native American tribal document
  • Driver's license issued by a Canadian government authority
  • For persons under age 18 who are unable to present a document listed above:
  • School record or report card
  • Clinic, doctor, or hospital record
  • Day-care or nursery school record.
  • Social Security Account Number card other than a card stating it is not valid for employment
  • Certification of Birth Abroad issued by the Department of State (Form FS-545)
  • Certification of Report of Birth issued by the Department of State (Form DS-1350)
  • Original or certified copy of a birth certificate issued by a state, county, municipal authority, or outlying possession of the United States bearing an official seal
  • Native American tribal document
  • U.S. Citizen ID Card (Form I-197)
  • ID Card for use of Resident Citizen in the United States (Form I-179)
  • Employment authorization document issued by the Department of Homeland Security.

Even if the consumer does not have the documents listed in this section:

  • allow the consumer to complete the application; and
  • explain that the documents are required before the CRS program can determine the consumer’s eligibility for services.

If the consumer has the documents, examine the documents presented. Expired documents cannot be accepted. If the documents are not expired, but will expire in the near future, counsel the consumer about the importance of keeping the documents up to date.

Place a copy of each document provided in the consumer’s case file. If the consumer is reluctant to allow you to make copies of the documents, or if you do not have immediate access to a copy machine, enter the following in a case note in ReHabWorks for each document examined:

  • The document’s title
  • The issuing authority
  • The document’s number (for example, a form number or driver’s license number)
  • The expiration date of the document

CRS, 5.4 Voter Registration Requirements

A CRS program staff member offers the consumer the opportunity to register to vote at the time of application for services or when the consumer reports a change of address.

A CRS program staff member is prohibited from:

  1. influencing a consumer’s political preference or party registration;
  2. displaying political preference or party affiliation; or
  3. making any statement or taking any action to discourage a consumer from registering to vote.

5.5 Completing the Application

The application must be completed in a private location that maintains the confidentiality of the information provided by the consumer.

Explain to the consumer the circumstances under which information about him or her will not be kept confidential. For example, confidential records are released “… to prevent imminent harm to you [the consumer] or someone else.”

Explain to the consumer that if the consumer says that he or she plans to hurt someone or has hurt someone, you must report it to the authorities. This requirement to report includes situations involving child abuse and abuse of the elderly.

Fill out the consumer’s application in ReHabWorks (RHW). For instructions, see RHW Users Guide, Chapter 10 Application.

When RHW is not available, apply by using DARS5056, DRS Application for Services and DARS5059, DRS Application Statement—CRS .

Ensure that all information entered in the application is accurate.

CRS, 5.6 Types of Income, Liquid Assets, and Required Proof

The table below lists the types of income and corresponding proof required of the consumer, spouse, and parents (if the consumer is claimed as a dependent).

Table: Types of Income, Liquid Assets, and Required Proof

Income

Proof Required

Net wages and net income from other enterprises

  • pay verification;
  • check stubs;
  • bank statements; or
  • earnings statement.

Social Security disability benefits (Supplemental Security Income (SSI) or Social Security Disability Income (SSDI)) received by consumer

None required for a consumer's Social Security disability benefits.

All other Social Security benefits (for example, survivor or retirement benefits received by consumer or the consumer's spouse or parents, or Social Security disability received by consumer's spouse or parents)

  • award letter;
  • check stub;
  • income tax return; or
  • bank statement.

Income from other sources, such as public support payments, unemployment compensation income, Workers' Compensation income, private disability insurance, annuities

  • award letter;
  • check stub;
  • income tax return; or
  • bank statement.

Child support payments

  • award letter;
  • check stub;
  • income tax return;
  • court order; or
  • bank statement.

Liquid assets, such as cash and assets from savings or other accounts.

Account statements

CRS, 5.7 Basic Living Requirements (BLR)

CRS, 5.7.1 Calculating Consumer Participation

ReHabWorks (RHW) is designed to automatically calculate the amount a consumer must contribute toward the cost of services. The cost is based on 200 percent of the federal poverty guidelines issued by the U.S. Department of Health and Human Services and the information that you enter into RHW about the consumer's income, family status, and economic need. See the guidelines for the state’s latest fiscal year.

Table: BLR Table (as of March 2016)

*Based on for 2016 Health and Human Services Federal Poverty Guidelines

Number of Dependents Supported by Net Income or Liquid Assets

Monthly Net Income Level

Liquid Assets Level

1

$1,980

$13,860

2

$2,670

$18,690

3

$3,360

$23,520

4

$4,050

$28,350

5

$4,740

$33,180

6

$5,430

$38,010

7

$6,122

$42,854

8

$6,815

$47,705

9

$7,508

$52,556

10

$8,202

$5,7414

11

$8,895

$62,265

12

$9,588

$67,116

13

$10,282

$71,974

14

$10,975

$76,825

15

$11,668

$81,676

16

$12,362

$86,534

17

$13,055

$91,385

18

$13,748

$96,236

19

$14,442

$101,094

20

$15,135

$105,945

*The BLR table is based on the federal poverty guidelines issued by the U.S. Department of Health and Human Services. The table is updated each year to reflect annual adjustments.

RHW uses net monthly income and family size as they relate to the poverty guidelines for the state’s current fiscal year to determine the amount a consumer must contribute to the cost of services. The amount is paid monthly, but is applied only when a consumer receives goods and services that require a contribution.

CRS, 5.7.2 Allowable Additions to Basic Living Requirements

The total monthly costs of the allowable additions listed below are automatically added to the Basic Living Requirements (BLR) table when a new case is entered in ReHabWorks.

Table: Allowable Additions to BLR

Allowable Additions

Proof Required

Monthly home mortgage or rental payments

Statement;

Canceled check;

Money order stub;

Contract; or

Lease, etc.

Prescribed diets and medicines used by the consumer

Itemized receipts; or

Canceled checks

Debts imposed by court order

Court record

Medical costs and disability-related expenses

Itemized statements; or

Canceled checks

CRS, 5.8 Selecting Disability Information

Disabling conditions are classified according to a structure that combines impairment with a specific cause or source. Using prescribed categories, select the impairment and then select the cause or source that best describes the consumer's primary disability; that is, the physical or mental impairment that results in a substantial impediment to the rehabilitation goals in the CRS program.

To select the disability code:

  1. select the impairment category table that best identifies the disability; that is:
    • sensory-communicative;
    • physical; or
    • mental;
  2. select the specific impairment subcategory within the table, such as:
    • cognitive impairments-learning, thinking, processing/concentration;
    • other mental; or
    • psychosocial impairments-interpersonal/behavioral, difficulty coping; and
  3. select the specific cause or source of the disabling condition in the cause or source table, such as:
    • traumatic spinal cord injury; or
    • traumatic brain injury.

Using the same sequence of actions, you select the secondary impairment that contributes to, but is not the primary basis of, the impediment to the consumer’s rehabilitation goals.

*If this information is not available at the time of application, it must be completed at the time of eligibility determination.

CRS, 5.9 Application Statements

Before the application is signed, discuss with the consumer:

  • the purpose and expectations of the CRS program;
  • the roles and participation of the counselor and consumer throughout the CRS process; and
  • the consumer's role in making informed choices when choosing a rehabilitation goal, services, service providers, and application statement.

Provide a copy of the application statement to the consumer.

Approval by the counselor and signed approval by the consumer or the consumer's representative verify that the consumer was given the information.

If a consumer’s representative is signing the application statement for the consumer, explain to the consumer that information in his or her case file will be made available to the representative. For more information, see the chart below concerning representative types.

Although the consumer may choose whomever he or she wants as a representative, inform the consumer that you will not purchase goods or services from a provider who serves as his or her representative because of the conflict of interest.

Table: Representative Types and the Requirements for Case File Documentation.

Representative Type

Documentation Required for the Paper Case File

The consumer’s representative

  • A completed DARS1487, Designation of Applicant or Consumer Representative;
  • Proof showing the power of attorney; or
  • A statement written by the consumer designating a representative

The consumer’s court appointed guardian or representative

Current legal documentation showing proof of guardianship or representation

CRS, 5.10 Application Signatures

Record the application signature in ReHabWorks (RHW). When RHW is not available, use DARS5059, DRS Application Statement—CRS, to record the application signature.

The consumer signs the application electronically by using a personal identification

CRS, 5.10.1 Assigning a PIN

When you enter a consumer’s contact information in ReHabWorks (RHW) during initial contact, RHW automatically assigns the last four digits of the consumer's Social Security number (SSN) as a temporary PIN. During the application phase, or at any time that the PIN is reset, the consumer must choose a new PIN to replace the temporary PIN.

The consumer, or the consumer’s parent, guardian, or representative, chooses and enters a four-digit PIN as a signature of authorization on the application and all other electronic documents that require a signature of authorization (for example, the application and the consumer’s Individualized Written Rehabilitation Plan).

Encourage the consumer to use a number that is easy to remember. Do not record the PIN in the case note; instead, encourage the consumer or the consumer’s representative to record the PIN and keep it for reference.

CRS, 5.10.2 When a Consumer Cannot Remember the PIN

If the consumer cannot remember his or her PIN and ReHabWorks (RHW) is available:

  1. contact the manager or the manager's designee to reset the PIN to the last four digits of the consumer’s Social Security number and document the reason for resetting the PIN in a case note; and
  2. have the consumer reset the PIN to a new number.

To learn how to reset a PIN for a consumer or the consumer’s representative, parent, or guardian, refer to the RHW Users Guide, Chapter 8 PINS.

CRS, 5.10.3 The Parent’s or Guardian’s Signature

The signature or PIN of a parent or guardian is required when the consumer is:

  • a minor (under 18 years of age); or
  • legally incompetent and assigned a legal guardian.

Note: Usually a foster parent is not the legal guardian for his or her foster child and cannot sign an application for services, releases, or the consumer’s Individualized Written Rehabilitation Plan on behalf of the child. The child's managing conservator has the legal authority to sign these documents. Locate the conservator through the Texas Department of Family and Protective Services. A person under 18 years of age and legally married is not considered a minor under Texas law.

CRS, 5.10.4 A Consumer Representative’s Signature

A consumer may designate someone as his or her representative for all or part of the rehabilitation process. The representative may be authorized to sign documents, speak on the consumer's behalf, or serve in other capacities indicated on DARS1487, Designation of Applicant or Consumer Representative. In some cases, a representative can play an important role in facilitating communication and helping the consumer meet his or her rehabilitation outcome.

CRS, 5.11 When CRS Program Staff Members May Enter a PIN on Behalf of a Consumer

There are only three circumstances when CRS program staff members may enter a PIN on behalf of a consumer or the consumer’s parent, guardian, or representative; that is, when:

  1. ReHabWorks is not available;
  2. the consumer is not present; or
  3. the consumer cannot physically enter a PIN.

In any of these instances, follow the procedures outlined below.

ReHabWorks Is Not Available

When ReHabWorks (RHW) is not available, do as follows:

  1. Print one of the following forms or any other applicable forms, fill out the form, and ask the consumer to sign it:
    • DARS5059, DRS Application Statement—CRS
    • DARS5164, DRS Individualized Written Rehabilitation Plan (IWRP)—CRS
    • DARS5160, DRS Individualized Written Rehabilitation Plan (IWRP) Amendment—CRS
  2. Tell the consumer that a temporary PIN will be used to enter the information from the application into RHW as soon as possible.
  3. Create a temporary PIN as soon as you have access to RHW, by using one of the following two procedures:
    • If the consumer has already set his or her PIN, have the manager or the manager's designee:
      • reset the PIN to the last four digits of the consumer's Social Security number (SSN); and
      • document the action in a case note; or
    • If the consumer has not already set his or her PIN, you can sign the document for the consumer by using the last four digits of the consumer's SSN.
  4. Enter the information from the signed paper form into RHW, and enter the temporary PIN to sign the electronic form.
  5. Document the use of the temporary PIN and the reason for it in a case note.
  6. Keep the signed paper forms in the paper case file, even after recording the information in RHW.
  7. Have the consumer reset the PIN on his or her next visit, when RHW is available.

Consumer Is Not Present

If the consumer is not present and with the consumer's permission:

  1. contact the manager or the manager's designee to:
    • independently verify permission directly with the consumer;
    • reset the PIN to the last four digits of the consumer's SSN;
    • document the reason for resetting the PIN in a case note;
  2. when the consumer is present and RHW is available:
    • have the consumer reset the PIN to a new number; and
    • document the action in a case note.

Consumer Cannot Physically Enter the PIN

When a consumer cannot physically enter a PIN:

  1. enter a PIN for the consumer;
  2. have the action witnessed; and
  3. enter the witness's name in RHW, in the appropriate space.

CRS, 5.12 Forms to Be Signed at Application

The following forms, in addition to the application, are signed to permit the exchange of information needed during the rehabilitation process:

  1. and, DARS5061, Notice and Consent for Disclosure of Personal Information, and when a specific need is identified, a current DARS5060, Permission to Collect Information; and
  2. DARS1517-2, Authorization for Release of Confidential Consumer Records and Information, when needed to release specific information in accordance with Business Procedures Manual, Chapter 20: Confidentiality and Use of Consumer Records and Information.

File the signed forms in the consumer's case file.

CRS, Chapter 6: Diagnostic Interview

CRS, 6.1 Overview

The diagnostic interview is one of the most important clinical aspects of the CRS process. The diagnostic interview gives the counselor an opportunity to develop a working relationship with the consumer, get to know the consumer’s history, and begin discussing the consumer’s rehabilitation goals.

CRS, 6.2 How to Conduct a Diagnostic Interview

The counselor must conduct a diagnostic interview with every consumer. The interview can be completed at the same time as the application for services. The primary purpose of the diagnostic interview is to get information that is relevant to determining eligibility.

The interview is an opportunity to find out:

  • whether the consumer has a traumatic brain injury or traumatic spinal cord injury;
  • when the injury occurred;  
  • what symptoms the consumer’s is experiencing;  
  • what treatments are being used; and
  • the consumer’s rehabilitation goals from the consumer’s perspective.

A diagnostic interview includes:

  • a thorough examination of the consumer's medical history and/or disability history;
  • the information needed to determine whether the consumer is eligible for services; and
  • information that may be used later, during assessment, to develop an Individualized Written Rehabilitation Plan for eligible consumers.

Prepare for the diagnostic interview by:

  • reviewing existing information already provided by the consumer or the consumer's family or representative; and
  • identifying specific focus questions to ask the consumer about the consumer's disability history and treatment and the consumer’s perspective on its impact.

Encourage the consumer to speak freely since only the consumer can describe what he or she has been experiencing about perceptions of disability and rehabilitation impact.

To accomplish the purpose of the interview, you must direct the course of the interview to gather the information needed to establish eligibility.

In addition to the consumer's perspective, record your impressions of the consumer's behavior and how that behavior will:

  • impact the consumer's ability to benefit from the CRS program; or
  • help the consumer choose an appropriate rehabilitation goal.

Through probing and exploration, the productive diagnostic interview establishes information that helps you understand:

  • how well the consumer is adjusting to his or her disability;
  • the consumer’s support system; and
  • the consumer's available resources.

Exploring disability history may reveal the need for further diagnostic review. Order records and/or purchase evaluations as necessary.

CRS, Chapter 7: Determining Eligibility

CRS, 7.1 Overview

Only the counselor may make an eligibility determination. The counselor does so by carefully reviewing information provided by the consumer, the consumer’s family or representative, physicians who have examined or treated the consumer, and data from other professional agencies who have knowledge of the consumer. CRS program staff members also use existing information from previous episodes of care.

If additional assessments are necessary to determine whether a consumer is eligible, the assessment must be conducted in the most integrated setting possible and be consistent with the consumer's needs and informed choice.

Do not use CRS funds to pay for assessments that require inpatient hospitalization.

CRS, 7.2 Basic Eligibility Criteria

To meet the basic eligibility criteria for the CRS program, there must a reasonable expectation that services will benefit the person by improving his or her ability to function within the home or community, and the person must:

  • have a traumatic brain injury (TBI) or traumatic spinal cord injury (TSCI) that constitutes or results in a substantial impediment to the person's ability to function within the home environment or the community;
  • be at least 15 years of age;
  • be a U.S. citizen or lawful permanent resident, and a Texas resident as evidenced by a Texas driver's license, an identification card with an address issued by a governmental entity, a utility bill with an address, a voter registration card, a vehicle registration receipt, or other document approved by CRS; as defined in 1.2 Key Terms; 
  • not be participating in, or be eligible for and able to access, another rehabilitation program offering similar rehabilitation treatment or therapy services; however the person may participate in rehabilitation programs that offer complementary rehabilitation services;
  • be willing to participate in services; and
  • be medically stable, including no progression of deficits, no deterioration of physical and cognitive status, or both; not be in imminent need of any acute care; and be functioning at a Level IV of the Rancho Los Amigos Levels of Cognitive Functioning Scale or equivalent.

The person's continued eligibility for the CRS program will be reviewed and, if he or she no longer meets all criteria explained in this section, program services may be discontinued.

NOTE: Equivalent to Rancho Level IV

When medical service providers do not clearly indicate the Rancho level, you may:

  • review the medical records with medical professionals and determine the level of functioning;
  • use the documented Glasgow Coma Scale score (a score of 9-15 is equivalent to a Level IV on the Rancho Los Amigos Levels of Cognitive Functioning Scale; or
  • document the level of functioning in a case note.

If the Rancho Los Amigos level or Glasgow Coma Scale score cannot be found, consult with the consumer’s treating medical professional to get the necessary information.

If you must use alternative documentation, clearly document what was used, how you made your determination, and what medical professional supports your determination.

CRS, 7.3 Insufficient Documentation to Determine Eligibility

When documentation from the consumer's treatment providers is not conclusive, and you cannot determine eligibility, begin assessments necessary to help determine eligibility.

When there is insufficient documentation to determine eligibility, assessments must include:

  • an appraisal of the consumer's general medical condition;
  • documentation of a traumatic brain injury (TBI) and/or traumatic spinal cord injury;
  • a determination of whether the consumer is medically stable enough to actively participate in planned services; and
  • a recent appraisal of psychological and other factors that relate to the consumer's ability to participate in planned services, such as a psychological evaluation or neuropsychological evaluation, and a neuropsychological evaluation for individuals with TBIs.

You may spend funds for assessments without removing the consumer from the Interest and Waiting Lists.

CRS, 7.4 CRS Eligibility Statement

The rationale for the eligibility decision must be evident in ReHabWorks (RHW). If the consumer meets CRS eligibility criteria, complete DARS5107, Comprehensive Rehabilitation Services Eligibility Statement in RHW. This document becomes available in RHW upon confirming eligibility in the system. The eligibility decision must clearly indicate what you used to determine eligibility and must confirm that the individual meets each eligibility criterion. (DARS5107 is available only in RHW)

CRS, 7.5 Nondiscrimination

Determine eligibility for services without regard to gender, age, race, religion, color, national origin, type of expected rehabilitation outcome, type of disability, source of referral, particular services needed, or anticipated cost of services required by a consumer.

CRS, Chapter 8: Individualized Written Rehabilitation Plan (IWRP)

CRS, 8.1 Overview

This chapter outlines the important steps associated with creating an Individualized Written Rehabilitation Plan (IWRP), how to amend an IWRP, and when to perform a Joint Annual Review. The IWRP is an agreement of necessary services, identified funding sources, and description of goals between the consumer, the consumer’s representative, if any, and the counselor. The services agreed to in the IWRP are detailed and outlined policies are followed as they pertain to each service. Each IWRP is unique and is written to meet each consumer’s specific rehabilitation needs.

The assessment of the consumer’s rehabilitation needs drives the selection and delivery of services that will help the consumer prepare for his or her planned rehabilitation goals.

CRS, 8.2 Defining Roles and Responsibilities

As in other partnerships, the Individualized Written Rehabilitation Plan (IWRP) should clearly define the roles and responsibilities of all partners. Review policies related to disability-specific responsibilities to ensure that the consumer is fully informed and the IWRP is developed in compliance with policy and the approved service array.

The role of the consumer is largely defined on the IWRP and must be adequately described so that the consumer can follow through successfully. The specific activities or tasks that the consumer is expected to complete must be objective and measurable; for example, acquire documented evidence that the consumer regularly attends physical therapy.

CRS, 8.3 Creation of the IWRP

When creating the Individualized Written Rehabilitation Plan (IWRP) and using the template provided in ReHabWorks, select one or more of the following independent living goals: increased ability to perform self-care activities, increased mobility, and/or increased ability to communicate with others.

CRS, 8.3.1 Intermediate Objectives

The intermediate objectives and services outlined on the Individualized Written Rehabilitation Plan (IWRP) must clearly support the achievement of the consumer’s independent living goals.

The IWRP decision-making process should include deliberation of:

  • the cost, accessibility, type, and duration of the services;
  • the consumer’s satisfaction with the proposed services;
  • the providers’ compliance with the Americans with Disabilities Act;
  • the qualifications of the service providers;
  • the setting in which the services are provided; and
  • the providers’ history of success with other consumers.

You document in a case note that the consumer or the consumer's representative made an informed choice and participated in the decision-making process.

CRS, 8.3.2 Reasonable and Necessary Services

The Individualized Written Rehabilitation Plan (IWRP) may contain any of the following services that are reasonable and necessary for the consumer to reach his or her rehabilitation goal.

The specific services available, but not limited to, include:

  • comprehensive rehabilitation counseling and guidance;
  • physical therapy; occupational therapy, cognitive therapy, and speech therapy;
  • rehabilitation technology assessments and services, including telecommunication, sensory, and other technological aids and devices;
  • paraprofessional services;
  • physical restoration services, including corrective surgery or therapeutic treatments, prosthetic and orthotic devices, eyeglasses, and visual services;
  • transportation necessary to participate in the CRS program; and
  • recommended and prescribed durable medical equipment.

When discussing IWRP creation with the consumer, explain the CRS program best-value purchasing guidelines and the impact they may have on selecting the goods and services necessary to achieve the rehabilitation goal. You must provide each service in accordance with the policies that govern that service. Review the policies carefully before adding the service to the IWRP to ensure that the consumer's unique rehabilitation needs can be met.

CRS, 8.3.3 Procedure to Develop the IWRP

Use the following procedure to develop the Individualized Written Rehabilitation Plan (IWRP):

  1. Before beginning services for CRS, you and the consumer (and/or the consumer’s representative) must complete a DARS5164, DRS Individualized Written Rehabilitation Plan (IWRP)—CRS. See 8.3.4 Items to Consider and Document When Completing the Individualized Written Rehabilitation Plan (IWRP).
  2. When completing DARS5164 and identifying the appropriate agreed-upon services, use detailed information outlining policy and indicate that services will be provided within the policy limits.
  3. Ensure that the dates on the IWRP realistically reflect the anticipated start and end dates of each service. The duration of the plan should adequately support both the individual services and the eventual rehabilitation outcome. For example, if the consumer is on the Waiting List and receives post-acute rehabilitation services, and you estimate that the consumer will not be removed from the waiting list for another month, address the dates accordingly.
  4. Review the entire IWRP with the consumer (and/or the consumer's representative) at least annually and perform a Joint Annual Review. See 8.10 Joint Annual Review for more information.
  5. Amend the IWRP, as necessary, with the consumer (and/or the consumer's representative) using DARS5160, CRS Individualized Written Rehabilitation Plan (IWRP) Amendment—CRS.
  6. Give a copy of the completed IWRP to the consumer (and/or the consumer’s representative).
  7. Inform the consumer and/ or the consumer’s representative that upon completion of the IWRP the consumer is now on the Waiting List. Provide the consumer and/or representative with the consumer’s number on the Waiting List and explain how to track the consumer’s progress on the waiting list.

CRS, 8.3.4 Items to Consider and Document When Completing the Individualized Written Rehabilitation Plan (IWRP)

Consider the method by which the services are provided and the period in which the services will be implemented.

Services should be provided in the most integrated setting possible, and you may:

  • deliver them directly; pay for them or have the consumer pay for them;
  • arrange for them to be provided by a different organization;
  • coordinate them with options for cost sharing; or
  • use a combination of the methods above.

CRS, 8.4 Funding, Comparable Benefits, and Exceptions

CRS, 8.4.1 Identify the Appropriate Funding Source

When completing DARS5160, CRS Individualized Written Rehabilitation Plan (IWRP) Amendment—CRS and outlining services, you will identify and select the funding source.

Types of funding sources include the following:

  • Provided – A service provided directly by CRS program staff members.
  • Purchased – A service purchased with CRS funds.
  • Arranged – A service provided through a comparable benefit or resource.
  • Provided and purchased – A service that was both provided directly by CRS program staff members and purchased with CRS funds from another provider.
  • Provided and arranged – A service that was both provided directly by CRS program staff members and arranged through a comparable benefit or resource.
  • Purchased and arranged – A service that was both purchased with CRS funds and arranged through a comparable benefit or resource.

Provided, purchased, and arranged – A service that was provided directly by CRS program staff members, purchased with CRS funds from another provider, and arranged through a comparable benefit or resource.

CRS, 8.4.2 Funding

Before using CRS funds, use comparable services and benefits. Do not delay services while an application for comparable services and benefits is pending.

Use CRS funds:

  1. for consumers who are currently receiving services for CRS;
  2. to assess consumers who are on the Interest List and Waiting List; and
  3. for all other consumers on the Waiting List who are ready for services.

CRS, 8.4.3 Exceptions to Comparable Benefits

While assessing the availability of or applying for comparable benefits, purchase services only when one or more of the following circumstances exists:

  • The consumer's progress toward achieving the rehabilitation goal identified on the Individualized Written Rehabilitation Plan (IWRP) would be interrupted or delayed without the purchased service.
  • The consumer's medical condition is likely to deteriorate, unless the service is provided more promptly at another hospital or clinic. The treating or examining physician must document the likely deterioration of a condition.
  • The physician who already has a relationship with the consumer does not have privileges to perform the service at the facility where the comparable services and benefits are available.
  • Specialty facilities are required, such as facilities for traumatic brain injury, traumatic spinal cord injury, or brain surgery.

When a consumer is eligible for comparable benefits that are not yet available at the time needed to ensure the consumer's progress toward the rehabilitation goal, purchase those services until comparable services and benefits become available.

CRS, 8.5 Documenting the Use of Comparable Services and Benefits

The exploration of and use of comparable services and benefits should be thoroughly documented throughout the case file. This includes documentation in ReHabWorks (RHW), in the form of case notes, service records, the consumer’s Individualized Written Rehabilitation Plan (IWRP), and the Closure Services page.

You must also keep in the consumer's paper case file copies of documents related to approval or denial of comparable services and benefits.

The following comparable benefits can be selected to document the use of comparable benefits when you develop service records, develop IWRPs, and complete the Closure Services pages in RHW:

  • Medicaid
  • Medicare
  • Worker's compensation medical benefits
  • Indigent health care services through the county
  • Private insurance
  • Veterans Administration hospitals or clinics
  • Scholarships
  • Other sources

Determine the consumer's responsibility for the cost of services. A consumer's eligibility for the CRS program does not depend on the consumer's income or liquid assets. However, if the consumer's net income or liquid assets exceed the basic living requirements, the consumer must participate in the cost of services, unless the:

  1. consumer receives Social Security disability benefits (Supplemental Security Income or Social Security Disability Income); or
  2. your manager grants an exception when the consumer's participation would prevent the consumer from receiving a necessary service.

CRS, 8.6 Consumer “Client” Participation

To determine whether a consumer must participate in the cost of services and if the consumer has the financial ability to do so, use the following four-step procedure:

Step 1 - Determine the Requirement to Participate

When determining whether the consumer is required to participate in the cost of services:

  • consider the monthly net income and liquid assets of:
    • the consumer and the consumer's spouse; and
    • the consumer’s parents (or foster parents, legal guardian, or conservator), if the consumer's parents claims the consumer as a dependent for purposes of federal income taxes; and
  • compare the consumer's (combined with the parents’, if appropriate) monthly net income and liquid assets with the basic living requirement (BLR) levels. See Chapter 5: Application, 5.7 Basic Living Requirements for more information. 

Step 2 - If Consumer Refuses to Disclose Income

Consumers have the right not to disclose their financial information. However, when a consumer declines to provide this information, you must assume that the consumer has resources that exceed the BLR level after including any allowable BLR additions. In such a case, the consumer must fully participate in the cost of planned services, except for the costs listed in 8.7 Services Exempt from Consumer Cost Participation.

Step 3 - Get Proof of Income and Expenses

When a person applies for services, request documented proof of:

  • income (exclude any payment in-kind, such as food stamps or housing subsidies);
  • liquid assets (cash, plus assets that are easily converted to cash);
  • expenses; and/or
  • any allowable additions to the BLR.

See 5.6 Types of Income, Liquid Assets, and Required Proof.

A person eligible for Social Security disability benefits (Supplemental Security Income or Social Security Disability Income) must provide only proof of Social Security eligibility.

When a parent claims the consumer as a dependent on the parent's income tax, get proof of income and expenses from both the consumer and the consumer's parent.

Step 4 - Calculate the Consumer's Contribution

The amount that the consumer pays for goods and/or services is the amount that the consumer's liquid assets exceed the BLR level, after including any allowable BLR additions. The consumer pays the amount monthly.

The consumer must contribute the difference between the consumer's monthly net income and the BLR level after including any allowable BLR additions. The consumer's contribution must not exceed the cost of the goods and services.

Inform the consumer that failure to provide complete and accurate financial information violate federal and Texas law and results in a denial or delay of services.

If you determine that the consumer must participate in the cost of goods and/or services, then:

  1. inform the consumer that he or she must pay the service provider directly; and
  2. document in ReHabWorks that the consumer understands.

CRS, 8.6.1 Documenting Consumer Participation

In the CRS program, consumer participation is reported as a service record with payment method type 'Arranged.' For instructions, see ReHabWorks Users Guide, Chapter 16 Case Service Record, 16.2.8.11 Creating, Updating, and Canceling Line Items When Payment Method Is "Arranged".

Be sure to:

  • select an appropriate Level 1-4 description, according to the documented service in the Individualized Written Rehabilitation Plan;
  • enter only "FCS 2017" in the Specification Description text box;
  • use only English (no other language) in the Specification Description text box;
  • select "Arranged" as the payment method; and
  • enter the date range for services for the entire quarter or remainder of a quarter—not for more than one quarter and not for crossing quarters.

This is the only circumstance in which service records are identified as "Arranged' in the CRS program.

CRS, 8.6.2 Document Consumer Participation in a Service Record

Table: How to Build a Service Record to Document Consumer Participation.

Step

Process

Notes

1

Select Specification for Service Record

Open ReHabWorks.

Select "Case Management" from the top left corner of the menu.

Enter the case ID and select "search."

Select name of the consumer, which is hyperlinked.

Select "Case Service Records" from menu on the left side of the page.

Select "Service Record List."

Select "New" button.

Search by "Level 1-4 Description":

  • From the Level 1 Description, select the appropriate service.
  • From the Level 2 description, select the appropriate description based on the description selected in the previous step.
  • From the Level 3 description, select the appropriate description based on the description selected in the previous step.
  • From the Level 4 description, select the appropriate description based on the description selected in the previous step.

Select Search.

NOTE: Please select appropriate the Level 1–4 description according to the service documented in the consumer’s IWRP.

2

Select the appropriate service entered

Select the check box next to the service.

Select the "OK" button.

3

Enter the state fiscal year in the "Specification Description" text box

Enter only the following: "FCS 2017."

NOTE: Use English only, in the Specification Description text box. Do not enter any other language.

4

Enter the payment method

Select "Arranged."

NOTE: This is the only circumstance in which service records are identified as "Arranged' in the CRS program.

5

Search for a vendor

Select the search method.

Enter the information needed to search for a vendor.

NOTE: If you search by a vendor’s name, put an asterisk (*) at the end of the name.

6

Select a vendor

Select the desired vendor by clicking selecting the button to the left of the vendor’s name.

Select "OK."

7

Add a line item for service

Select "New Line Item."

8

Enter the dates of service

Enter the date range.

Select "OK."

NOTE: Select the date range for the entire quarter or for the remainder of a quarter. Do not create service records for more than one quarter and do not cross quarters.

9

Enter the quantity

Enter "1."

10

Enter the unit cost

Enter the calculated amount of the consumer’s participation.

11

Select the program

Select 2017 115 DRS CRS Comprehensive Rehabilitation Services.

12

Select the service category

Select the appropriate service category.

Select "OK."

13

Choose a line item

Select a line item by selecting the check box to the left of the appropriate item.

Select "OK."

14

Save the service record

Select "Save."

Select "Save" again.

CRS, 8.6.3 Periodically Review the Consumer’s Proof of Income and Expenses

You must at least annually review the consumer’s income, liquid assets, and expenses and document the review results in a case note.

If the consumer's income, liquid assets, or expenses change significantly during the life of the case:

  1. reassess whether the consumer must still participate in the cost;
  2. document proof of the changes (if documentation is not available, note the reason in a case note);
  3. change the consumer's application; and
  4. document in a case note the reason for the change.

If you develop a consumer’s IWRP before you receive proof of the consumer’s income and expenses, do not include services that require consumer participation in the cost.

When you receive proof of the consumer’s income and expenses, amend the IWRP as needed.

CRS, 8.7 Services Exempt from Consumer Cost Participation

Review with the consumer the extent of his or her agreement to pay for the cost of services.

Services exempt from consumer cost participation include:

  • an assessment to determine the consumer’s eligibility for services;
  • an assessment to determine the consumer’s rehabilitation needs, including associated maintenance and transportation;
  • rehabilitation-related counseling and guidance and referral for other services;
  • personal assistance services; and
  • any auxiliary aid or service (for example, interpreter services) that a consumer with a disability requires to participate in the CRS program.

Exception: Consumers eligible for Supplemental Security Income or Social Security Disability Income because of a disability are exempt from required cost participation. In addition, do not apply payment limitations. However, you must apply policy regarding use of comparable services and benefits.

CRS, 8.8 Documentation to Providers

Once the Individualized Written Rehabilitation Plan (IWRP) has been completed, begin issuing referrals as needed. When issuing a referral to a service provider, include a copy of the consumer’s IWRP, along with other pertinent referral information that will help the provider assess the provider’s ability to meet the consumer’s needs. Sending complete information helps coordinate services between the consumer, providers, and the CRS program.

CRS, 8.9 Amending the Individualized Written Rehabilitation Plan (IWRP)

As a counselor, you have considerable latitude in determining which services are reasonable and necessary to help the consumer reach his or her chosen rehabilitation goals. Therefore, there are circumstances in which you are required to make changes and amend the previously agreed-upon IWRP.

It is important to amend the IWRP every time you and the consumer agree on a substantial change in services. If an amendment is necessary, document the reasons in ReHabWorks. Explain the nature and scope of the changes being made to the objectives, services, or other parts of the plan and why they are necessary.

Before adding or changing the services called for in an IWRP, you must discuss with the consumer the specific policies related to the implementation of services and the approvals required.  

CRS, 8.9.1 When to Amend an IWRP

Amend an Individualized Written Rehabilitation Plan (IWRP) when substantial changes are needed or when there is potential for misunderstanding about the consumer’s rehabilitation goals, services, and/or service providers.

Use the IWRP amendment in ReHabWorks. As with the original IWRP, the consumer may use alternate resources (for example, friends, family members, or private counselors) for the development process. The IWRP amendment is not in effect until you and the consumer agree to it and sign it.

After agreeing to and signing the IWRP amendment, provide a copy to the consumer or the consumer's representative.

CRS, 8.9.2 Consumer Informed Choice

As when you and the consumer created the initial Individualized Written Rehabilitation Plan, provide the consumer with ample information about services and various providers. This will better enable the consumer to make an informed decision concerning services, methods of delivery, and providers.

CRS, 8.9.3 Amending the IWRP When a Consumer Is Not Present

If the consumer cannot attend a meeting in person but agrees to an Individualized Written Rehabilitation Plan (IWRP) amendment, write the amendment and follow the procedures to electronically sign the amendment for the consumer. (See 5.10 Application Signatures for additional guidance.)

CRS, 8.10 Joint Annual Review

The Joint Annual Review (JAR) is one of the most important tools in the counselor’s toolbox. The JAR is performed at least every 12 months. When performing a JAR with the consumer, review the consumer’s demographic information and the IWRP. Update any information that has changed. Review the consumer's progress in achieving the rehabilitation goal and determine whether you must set additional intermediate goals or adjust existing goals. Review the consumer's responsibilities and adjust as necessary.

Document the JAR in a case note in ReHabWorks. If the IWRP requires an amendment, explain how the changes are necessary to allow the consumer to achieve his or her rehabilitation goals.

CRS, Chapter 9: Counseling and Guidance

CRS, 9.1 Overview

Counseling and guidance (C&G) is the most important service provided during rehabilitation and in some cases may be the only substantial service needed.

A qualified counselor provides C&G throughout the rehabilitation process to:

  • promote a successful relationship between the consumer and counselor; and
  • help the consumer achieve his or her rehabilitation goal.

C&G is short-term and problem-centered. It is not therapy. Refer a consumer who needs intensive counseling to an appropriate resource.

CRS, 9.2 Outcome of Counseling and Guidance

The outcome expected from counseling and guidance for a consumer during rehabilitation is to encourage the consumer to make decisions about the services that the consumer will receive and to be responsible for those decisions.  

The counselor works one-on-one with the consumer to:

  • understand the consumer’s problems;
  • recognize the consumer’s potential; and
  • follow a plan of self-improvement leading to the best possible outcome and personal and social adjustment.

Rehabilitation counselors are professional counselors. While their goals, roles, and skills may be similar to those used by other counselors, rehabilitation counseling often poses additional challenges related to the consumer’s disability. Disability related challenges must be identified so that counseling strategies can be incorporated into the counseling relationship to help the consumer.

Counseling and guidance is important to the success of our consumers. The rehabilitation counselor’s knowledge of disability issues, available program services, and community resources can help the consumer decide how to overcome barriers.

Counseling and guidance is a core rehabilitation service and written in the Individualized Written Rehabilitation Plan as a planned service.

Counseling and guidance is an essential component of any case that is closed as successfully rehabilitated and this component is documented in the case file.

CRS, 9.3 Informed Choice and Counseling and Guidance

Counseling and guidance includes information and support services to help the consumer make an informed choice. For more information about informed choice, refer to Chapter 2: CRS Principles, 2.6 Principles of Informed Choice.

Counseling and guidance is provided to assist the consumer in making informed choices and is offered throughout the rehabilitation process, from application through case closure. Counseling and guidance must be included as a planned service on every consumer’s Individualized Written Rehabilitation Plan.

Informed choice is a decision-making process in which the consumer analyzes relevant information and selects a primary goal, intermediate rehabilitation objectives, services, and service providers. Information about services and programs is provided to the consumer whenever it is necessary for the consumer to make an informed choice. A partnership between the consumer and the counselor empowers the consumer to make decisions that result in a successful rehabilitation outcome. 

CRS, 9.4 Ethics of Rehabilitation Counseling and Guidance

Understanding the principles in the Code of Professional Ethics for Rehabilitation Counselors (the code) is critical to the ethical decision-making process. The code outlines the elements of professional relationships that promote and protect the spirit of caring and respect for individuals with disabilities.

The code comprises the following six basic principles of ethical behavior. See Chapter 2: CRS Principles, 2.5 Building Ethical Relationships.

CRS counselors who violate the code are subject to the actions defined by agency policies for performance management. Counselors certified through the Commission on Rehabilitation Counselor Certification, are also subject to a commission action.

CRS, 9.5 The Scope of Rehabilitation Counseling and Guidance

The essential aspects of counseling and guidance are:

  • the continual assessment of the consumer’s progress throughout the rehabilitation process;
  • identifying the consumer’s rehabilitation needs and providing the consumer with information to meet those needs;
  • helping the consumer develop compensatory strategies to reach a successful outcome;
  • addressing issues as they arise; and
  • assisting the consumer in learning the options and resources for dealing with various problems related to the consumer’s disabilities.

Counseling and guidance includes helping the consumer to:

  • understand his or her disability and related impediments;
  • understand physical and mental restoration procedures;
  • get accurate information to make an informed choice;
  • make informed choices from among alternative goals, objectives, services, and service providers;
  • identify strengths on which to capitalize to achieve the goal,
  • acquire new skills;
  • develop a realistic action plan to address a problem;
  • use rehabilitation technology;
  • develop residual capabilities;
  • identify and use community resources and relevant support services;
  • resolve barriers impacting the consumer’s planned rehabilitation needs, such as resolving transportation issues, child care issues, or family issues;
  • modify the consumer’s attitudes and behaviors;
  • develop self-advocacy skills;
  • cope successfully with disability related stressors; and/or
  • maintain progress toward the rehabilitation goal.

Counseling and guidance helps consumers learn to identify and use their options and resources to handle problems related to their disabilities. Learning to adapt to personal limitations and capitalizing on individual strengths leads to an improvement in self-esteem. The counselor encourages the consumer by establishing a relationship of mutual respect within which the counselor can both support and challenge the consumer to develop the skills needed to achieve positive outcomes.

CRS, 9.6 The Frequency of Counseling and Guidance

Base the frequency and extent of counseling and guidance on such factors as:

  • the complexity of the case;
  • the consumer's disability;
  • the consumer's adjustment to the disability;
  • the consumer’s progress or lack of progress toward his or her planned goals;
  • diagnostic information;
  • the need to engage the consumer; and
  • the need to maintain a working partnership.

The effective use of the counselor’s time in addressing the barriers identified by the assessment will allow the counselor to provide a level of counseling that is sufficient to meet the consumer’s goals and objectives.

When the consumer appears to have severe thought disturbances or need an unusual amount of counseling, refer the consumer to another agency, such as a local Texas Department of State Health Services center, university psychology clinic, or other resource.

9.7 Documenting Counseling and Guidance

Counseling and guidance is documented in a series of case notes throughout the rehabilitation process. Effective counseling and guidance, and the documentation that follows it, helps to tell the consumer’s story.

Use a case note titled "counseling and guidance" in ReHabWorks to document that counseling and guidance is provided.

When counseling and guidance is provided in addition to another activity that requires documentation, such as resetting a PIN, document the two activities in separate case notes to ensure that a reviewer can tell that both services were provided.

Review the most recent case note before contacting the consumer to ensure that all issues are addressed.

CRS, 9.8 Counseling and Guidance as a Substantial Service

Counseling and guidance must be an essential component of any case closed as a successful closure and needs to be documented in the case file.

If counseling and guidance is the only rehabilitation service, the case can meet the criteria for a successful closure only if documentation in the case file shows that counseling and guidance was provided as a substantial service.

Ensuring that counseling was a substantial service may include focusing on topics that:

  • help the consumer understand his or her strengths and limitations in relation to his or her disability and impediments;
  • explore with the consumer any transferable skills and how he or she may apply them in overcoming impediments;
  • help the consumer select and/or maintain suitable and realistic goals by providing information that allows the consumer to make informed choices;
  • maximize the consumer’s self-awareness regarding barriers to productivity and possible reasonable accommodations;
  • empower the consumer through confidence building;
  • assist the consumer in developing the self-advocacy skills needed for taking responsibility for his or her continued success; and
  • provide the consumer with information about relevant support services and facilitate access to those services.

CRS, Chapter 10: Evaluating the CRS Consumer's Progress through Interdisciplinary Team Meetings

CRS, 10.1 Overview

Evaluating the consumer’s progress throughout the rehabilitation process is essential. Evaluate the consumer’s progress by making regular phone calls to the consumer, the provider, and the consumer’s family members and by reviewing the documentation submitted.

When consumers participate in post-acute rehabilitation services, you are a part of the interdisciplinary team (IDT). As a participant of the IDT, you are an advocate for the consumer. As an advocate, you are empowered to ask questions and ensure that the consumer is receiving the agreed upon services.

CRS, 10.2 Participating in the Interdisciplinary Team Meetings

You must ensure that the consumer is benefiting from treatment. If the consumer is participating in post-acute rehabilitation services, then you are a member of an interdisciplinary team (IDT) and must follow the consumer’s progress through treatment-related team meetings. If you cannot physically attend team meetings, consider teleconferencing, asking another counselor who is familiar with the consumer to attend the meetings, or ask the liaison counselor to attend the meetings.

When a rehabilitation treatment is not leading to increased independence, work with other members of the IDT and consider making appropriate modifications. When this is not possible, you may discontinue sponsorship of the treatment.

When complex issues evolve and treatment providers are distant from your office, you may request that the CRS liaison counselor for the provider be present at a particular meeting.

CRS, 10.3 Frequency of Communication with the Consumer

You must contact the consumer (and/or consumer's representative) at least every 30 days throughout the case.

Note: Contact with the consumer and/or the consumer’s representative may be made through face-to-face contact, when feasible; telephone conversation; email; text messages; and so on, as preferred by the consumer and/or the representative.

CRS, Chapter 11: Consumers Who Require Special Attention

CRS, 11.1 Overview

This chapter outlines the steps for notifying other CRS program staff members about consumers who require special attention. Consumers who require special attention are consumers who verbally or physically threaten CRS program staff members or have a recent history of threatening behavior.

CRS, 11.2 Reporting Special Attention in ReHabWorks

Select the Requires Special Attention action item in ReHabWorks (RHW) at any time during the rehabilitation process, if the consumer:

  • verbally or physically threatens a CRS program staff member; or
  • has a recent history of actual or threatened physical abuse.

The action item alerts any staff member who reads the consumer’s case file in RHW.

Consider carefully whether to use the action item to avoid unnecessarily labeling of a person.

If you are later convinced that the person no longer poses a threat, delete the action item, and explain the circumstances in a case note.

When a CRS program staff member or other reliable source observes such behavior, document the behavior in a case note as specifically and as factually as possible.

Include in the case note:

  • the date that the event took place;
  • the location where the event took place;
  • the names and addresses of witnesses and people involved;
  • an account of what was said or done; and
  • the names of those willing to testify.

Report any incident affecting the security of a CRS program staff member or CRS property to CRS management and to local law enforcement, if appropriate. Place a copy of the police report in the case file if the police were involved.

Chapter 12: Closing a Case as Ineligible or before Determining Eligibility

12.1 Overview

This chapter explains what to do when closing a case as ineligible or before determining eligibility. Cases closed before determining eligibility may include cases that you have determined to be ineligible or cases needing to be closed before you are able to determine eligibility.

If you close the case before determining eligibility and you determine that the consumer may benefit from other resources, then refer them to other resources.

12.2 Closing a Case before Determining Eligibility

To close a case before determining eligibility:

  • notify the consumer(in writing, if the mailing address is known) that you are closing the case and that the consumer has a right to appeal (use the closure letter available in ReHabWorks);
  • ensure that the case file contains the justification for closing the case; and
  • use the appropriate reason for closure, as explained in the table in 12.3 Reasons for Closing a Case without Determining Eligibility. 

12.3 Reasons for Closing a Case without Determining Eligibility

Table: Reason for Closure without Determining Eligibility

Reason

Definition

Additional Closure Procedure

Death

 

No notification is required.

No Longer Interested in Services

The consumer chooses not to participate in or continue with services, or the consumer's actions (or lack of action) make it impossible for the consumer to begin or continue services. Examples include repeated missing appointments for assessment, counseling, or other services.

Make sure that the consumer is aware of the services that are available.

Advise the consumer that he or she may reapply for services in the future, if needed.

Incarcerated in Prison or Jail

The consumer is in a prison, jail, or other criminal correction facility.

Advise the consumer or the consumer’s representative that the consumer may reapply for services when the consumer is released.

Institutionalized

The consumer is in an institution such as a hospital, nursing home, or treatment centers).

Provide information about community-based services, when appropriate.

Other

Services may be denied or ended for other reasons. For example, the consumer has achieved independence at home and in the community without receiving substantial services for CRS.

Document the reason for closure.

Referred to Another Agency or Program

Services of another agency or other program are more appropriate.

Follow the procedures in Chapter 4: Initial Contact, 4.3 Outgoing Referrals to Other Resources or Vocational Rehabilitation Services. 

Transportation Not Feasible

Suitable transportation for accepting or maintaining rehabilitation is either not available or not feasible (for example, too costly, inaccessible, and so on).

Document:

  • that you considered transportation alternatives; and
  • the reasons that alternatives are not available or feasible.

Unable to Locate or Moved Out of State

Contact with the consumer is lost after repeated attempts by telephone and mail has failed over a reasonable period, and the attempts are documented.

Also used when the consumer moves out of state and gives little evidence of returning any time soon.

Document your attempts to contact the consumer over a reasonable period.

If the consumer moves to another state and additional services for CRS are necessary:

  • when possible, provide the consumer with information about the services for traumatic brain injury or traumatic spinal cord injury that are available in the state where the consumer is moving; and
  • provide the out-of-state agency with copies of appropriate case file materials, upon request.

After closing the case in ReHabWorks (RHW), complete and print the closure letter available in RHW and mail it to the consumer.

12.4 Closing a Case after Determining the Consumer Is Ineligible

Before closing any case as ineligible:

  • discuss with the consumer and/or the consumer's representative the reason for the closure;
  • ensure that the justification for the decision is fitting for the case; and

12.4.1 Ineligibility Letter

If the consumer does not meet the CRS eligibility criteria, check the appropriate box on DARS5108, CRS Ineligibility Letter (DARS5108 available only in ReHabWorks), and give the consumer a copy of the letter.

12.5 Reasons and Procedures for Closing a Case Because of Ineligibility

Table: Reason for Closing a Case as Ineligible

Reason Closed

Procedure

Severity of the Disability – The severity of the disability prevents the CRS program from helping the person function more independently at home and in the community.

Notify the consumer that the case is closed.

Send a letter to advise the consumer in writing about the decision and, if appropriate, refer him or her to another agency.

Other – Services may be denied or ended for reasons other than those described in this table.

Describe the reason for closure in a case note.

Notify the consumer that the case is closed.

Send a letter to advise the consumer in writing about the decision and, if appropriate, refer him or her to another agency.

Unable to Locate or Moved out of State

Document:

  • that repeated attempts to contact the consumer or the consumer’s family or representative by telephone and mail have failed over a reasonable period; and/or
  • that the consumer has moved out of state and explain why you believe there is no evidence that the consumer is going to return.

Consumer Is Not Functioning More Independently (valid after confirming eligibility) – You cannot verify that the consumer is functioning more independently at home and in the community.

Notify the consumer that the case is closed.

Send a letter to advise the consumer in writing about the decision and, if appropriate, refer him or her to another agency.

Services for CRS are Not Required

The consumer:

  • does not need services to function more independently at home and in the community;
  • is already receiving needed services or services are readily available without the CRS program arranging, coordinating, paying for, and/or providing the services; or
  • does not need CRS counseling and guidance.

Notify the consumer that the case is closed.

Send a letter to advise the consumer in writing about the decision and, if appropriate, refer him or her to another agency.

Refused Services – The consumer does not intend to follow through with the program.

Be certain that the consumer:

  • knows about available services; and
  • has consistently refused services.

Notify the consumer that the case is closed.

Send a letter to advise the consumer in writing about the decision and, if appropriate, refer him or her to another agency.

Failure to Cooperate -- The consumer fails to follow through with the program.

Document examples of failure to cooperate.

Notify the consumer about:

  • your intent to close the case; and
  • his or her right to appeal.

Send a letter to advise the consumer in writing about the decision and, if appropriate, refer him or her to another agency.

Institutionalized

The consumer:

  • entered an institution (such as a hospital, nursing home, or treatment center);
  • will not be available for services for an indefinite or considerable time; and
  • will not benefit from keeping the case open.

Provide information about community-based services and document the action in a case note, as appropriate.

Notify the consumer that the case is closed.

Send a letter to advise the consumer in writing about the decision. Describe the circumstances in the case notes.

Death

Contact the family only to reclaim equipment that the CRS program purchased. Be sensitive. Minimize disruption to the family.

Consult with the CRS central office program specialist about which items to reclaim.

Transferred to Another Agency or Program

When it is apparent that services from another program or agency are more appropriate than the CRS program:

  • discuss the transfer with the consumer;
  • discuss the case with the counselor from the other agency or set up an appointment for the consumer with the other agency, if appropriate; and
  • provide the other agency with any appropriate information requested.

Notify the consumer that the case is closed.

Send a letter to advise the consumer in writing about the decision. Describe the reasons for transfer in the case notes.

After closing the case in ReHabWorks (RHW), complete and print the closure letter available in RHW and mail it to the consumer.

Chapter 13: Case Closure and Post-Closure Services

13.1 Overview

This chapter discusses different closure scenarios and appropriate ways to address those scenarios. It also outlines when and how to use the post-closure services option.

13.2 Closing a CRS Case as Successful

Close a case as successful:

  • when the goals documented in the consumer’s Individualized Written Rehabilitation Plan are met to the fullest extent of the consumer's abilities;
  • when the services provided have improved the consumer's ability to function independently at home and in the community;
  • when documentation in the case file shows how the consumer functions more independently as a result of the services provided; and
  • after reviewing the case for open service authorizations and associated financial actions that are no longer needed.

Notify the consumer in person, by telephone, and/or in writing that the case is closed.

13.3 Closing a CRS Counseling and Guidance-Only Case

Before closing a CRS counseling and guidance-only case as successful, confirm that the consumer has received one or more of the following treatments as a comparable benefit or an arranged service, from:

  • Traumatic Brain Injury (TBI) or Traumatic Spinal Cord Injury (TSCI) inpatient hospitalization;
  • TBI or TSCI outpatient services; and/or
  • TBI or TSCI Post-acute rehabilitation injury (PARS) rehabilitation services.

If counseling and guidance is the only service provided for CRS, explicitly document in the case file that:

  • the consumer received counseling and guidance;
  • the counseling and guidance helped the consumer function more independently in terms of mobility, self-care, and/or communication; and
  • the counseling and guidance helped the consumer and the consumer’s family to:
    • select and/or maintain suitable, realistic independent living goals;
    • select suitable treatment providers and use comparable services and benefits;
    • adjust to treatment, as circumstances required; and/or
    • access relevant support services.

13.4 Closing a CRS Case as Unsuccessful

End the consumer's services and close the case as unsuccessful when you determine that the consumer cannot benefit from services for CRS and/or improve his or her ability to function more independently at home and in the community.

Make this decision only after considering all of the facts and circumstances and exhausting every appropriate resource and service.

13.5 Documenting CRS Closure in ReHabWorks

Use the table below to determine the appropriate reason for closing the case and follow the procedure for closing it. Document the closure in ReHabWorks.

Table: Required Closure Documentation and Procedures

Reason Closed

Procedure

Severity of the Disability – The severity of the disability prevents the CRS program from helping the person function more independently at home and in the community.

Document how the disability prevents the CRS program from helping the person function more independently.

Notify the consumer or the consumer’s guardian or representative that the case is closed.

Other -- Services may be denied or ended for reasons other than those described in this list.

Describe the reason for closure in a case note.

Notify the consumer that the case is closed.

Unable to Locate or Moved out of State

Document:

  • that repeated attempts to contact the consumer, the consumer’s family or representative by telephone and mail have failed over a reasonable period; and/or
  • that the consumer moved out of state and explain the reason that you believe there is no evidence that the consumer is going to return.

Consumer Is Not Functioning More Independently (valid after confirming eligibility) – You cannot verify that the consumer is functioning more independently at home and in the community.

Notify the consumer that the case is closed.

Services for CRS are Not Required --

The consumer:

  • does not need services from CRS to function more independently at home and in the community;
  • is receiving needed services or services are readily available without the CRS program arranging, coordinating, paying for, and/or providing the services; or
  • does not need CRS counseling and guidance.

Notify the consumer that the case is closed.

Refused Services – The consumer does not intend to follow through with the program.

Be certain that the consumer:

  • knows about available services; and
  • has consistently refused services.

Notify the consumer that the case is closed.

Failure to Cooperate – The consumer fails to follow through with the program.

Document examples of the consumer’s failure to cooperate.

Notify the consumer about:

  • your intent to close the case; and
  • his or her right to appeal.

Institutionalized

The consumer:

  • entered an institution (such as a hospital, nursing home, or treatment center);
  • will not be available for services for an indefinite or considerable time; and
  • will not benefit from keeping the case open.

Provide information about community-based services, and document the action in a case note, as appropriate.

For more information, see Chapter 4: Initial Contact, 4.3 Outgoing Referrals to Other Resources or Vocational Rehabilitation Services.

Notify the consumer that the case is closed.

Death

Contact the family only to reclaim equipment that the CRS program purchased. Be sensitive. Minimize disruption to the family.

Consult with the CRS central office program specialist for rehabilitation technology about which items to reclaim.

Transferred to Another Agency or Program

When it is apparent that services from another program or another agency are more appropriate than the CRS program:

  • discuss the transfer with the consumer;
  • set up an appointment for the consumer with the other agency, if appropriate; and
  • provide the other agency with any appropriate information requested.

Notify the consumer that the case is closed.

13.6 Post-Closure Comprehensive Rehabilitation Services

When post-closure services are combined with services previously provided, the post-closure services must not exceed the following time limits:

Services

Time Limit

Inpatient comprehensive medical rehabilitation

90 days

Outpatient comprehensive rehabilitation

120 hours

Post-acute rehabilitation services

180 days

To provide time-limited post-closure services, one of the following criteria must be met:

  • A planned service was inadvertently not provided before case closure.
  • The consumer did not receive the full complement of services for CRS, and you later determine that the consumer could benefit from post-closure services.
  • Post-closure services are needed to protect the initial investment made by the CRS program.

13.7 Post-Closure Procedure

When the consumer’s Individualized Written Rehabilitation Plan (IWRP) does not list post-closure services, complete an amendment to the IWRP.

Following completion of post-closure services, notify the consumer that the case is closed by sending the form letter DARS5210 CRS Successful Closure. (DARS5210 available only in ReHabWorks)

Chapter 14: Reopening or Adjusting the Phase of a Previously Closed Case

14.1 Overview

To re-establish a case or open a new case for a previous CRS consumer, use one of the following functions in ReHabWorks (RHW):

Reopen—Opens a new case for a previous CRS consumer. Verify and complete the information in the Initial Contact in RHW and enter application information the same way as you would for any new case.

Phase adjustment—Re-establishes a case and moves it from the Closed Plan Initiated phase to the Plan Initiated phase. This function removes closure information.

14.2 Consumer Reapplying for CRS

Situation

If …

then …

A CRS consumer with a case previously closed as successful reapplies for services

the consumer has a new injury …

Complete a new application and use the most recent initial contact date.

ReHabWorks places the person's name on the Interest and Waiting List.

A CRS consumer with a case previously closed as successful reapplies for services

the consumer has the same traumatic brain injury (TBI) and/or Traumatic Spinal Cord Injury (TSCI) …

See Chapter 21: Closure, 21.6 Post-Closure.

Note: If the case was successfully closed within the last 12 months, you must get the manager approval before opening the case.

A CRS consumer whose previous case was closed as unsuccessful or who was on the Waiting List reapplies for services

a new injury …

Complete a new application.

Use the most recent initial contact date.

ReHabWorks places the person's name on the Interest and Waiting List.

Note: You must consult with the manager before opening a new case for a consumer who has had two or more cases closed as unsuccessful after being found eligible for services.

A CRS consumer whose previous case was closed as unsuccessful or who was on the Waiting List reapplies for services

the same TBI and/or TSCI …

Determine whether a phase adjustment is appropriate (that is, whether previous information regarding the injury is recent and accurate).

The manager must approve a phase adjustment for a previous case that was closed within the last 12 months, if the case was closed as unsuccessful after the consumer’s Individualized Written Rehabilitation Plan (IWRP) was initiated.

If a phase adjustment is appropriate, notify the CRS central office and adjust the phase.

If a phase adjustment not appropriate, open a new case.

Note: When adjusting the phase, use the date that the consumer's original IWRP was signed. The date is used to place the consumer on the Waiting List. The consumer is served in order, according to that date.

A CRS consumer with a case previously closed as ineligible or closed before or after application reapplies for services

A new injury …

Complete a new application; and use the most recent initial contact date.

ReHabWorks places the person's name on the Interest and Waiting Lists.

A CRS consumer with a case previously closed as ineligible or closed before or after application reapplies for services

the same TBI and/or TSCI …

Open a new case.

Use the earliest initial contact date from the previous case.

Explain in a case note.

Note: When a consumer has a second TBI and/or TSCI, the consumer may be eligible for the full complement of services, regardless of any services he or she previously received.

14.3 Reopening a Case

When starting a new file on a case that was previously active, copy significant documents from the closed case file for placement in the new case file. Do not remove forms, reports, and other data from the old case file.

14.4 Adjusting the Phase of a Previously Closed Case

A phase adjustment is a ReHabWorks (RHW) process that changes a closed case with a completed Individualized Written Rehabilitation Plan (IWRP) back to an active case.

Phase adjustments must be used only when the:

  • case was closed either successfully or unsuccessfully after the IWRP was signed;
  • initial closure date is within the current federal fiscal year; and
  • date the case returned to active status is within the current federal fiscal year.

Note: A federal fiscal year begins October 1 and ends September 30.

Closure after IWRP Is Returned to Active Status

To request and complete a phase adjustment to change a case from a closed status after an IWRP is signed back to an active status, use the procedure outlined below.

The counselor:

  1. reviews the case and gathers information from the consumer to ensure that a phase adjustment is appropriate;
  2. selects the Phase Adjustment Request tab from within the case file in RHW;
  3. selects the Save tab to set the approval status to pending and to generate an action for the area manager in RHW; and
  4. documents the justification for the phase adjustment in the case note that automatically opens in RHW when the Phase Adjustment request is saved.

The CRS manager:

  1. reviews and approves or denies the phase adjustment request in RHW by selecting the Phase Adjustment Approval tab from within the case file in RHW;
  2. documents the approval or nonapproval of the decision for the phase adjustment in a case note in RHW; and
  3. notifies the counselor that the phase adjustment was approved or denied.

Chapter 15: CRS Service Array

15.1 Overview

The CRS program service arrays may be provided to eligible persons who have a traumatic brain injury (TBI), traumatic spinal cord injury (TSCI), or both.

The CRS program offers the following service arrays for TBI and TSCI:

  1. Inpatient Comprehensive Medical Rehabilitation Services
  2. Outpatient Therapy Services
  3. Post-Acute Rehabilitation Services
  4. Ancillary Goods and Services

Additional details concerning specific services provided within the service arrays can be found in the CRS Standards for Providers Manual.

15.2 Inpatient Comprehensive Medical Rehabilitation Services

Inpatient Comprehensive Medical Rehabilitation Services for Traumatic Brain Injury (TBI) and Spinal Cord Injury (TSCI) are specialized services recommended by an interdisciplinary team in a hospital setting to address medical and rehabilitation issues that require 24-hour-a-day nursing services. An interdisciplinary team of professionals closely coordinates services to achieve team treatment goals in order to minimize a person's physical or cognitive disabilities, and maximize a person's functional capacity. The Texas Department of Assistive and Rehabilitative Services (DARS), or its successor agency, negotiates contracts with inpatient facilities to provide services based on data from the Centers for Medicare & Medicaid Services (CMS) Healthcare Cost Report Information System (HCRIS). Any goods or services approved by CRS that are not part of the contracted rate for inpatient comprehensive medical rehabilitation are considered “ancillary.” Ancillary goods and services must be pre-authorized by CRS staff and are reimbursed based on fee for service in accordance with 1 TAC §355.9040.

Prior to a service authorization being issued, the counselor will need to obtain a written prescription or physician’s recommendation for Inpatient Comprehensive Medical Rehabilitation Services.

15.2.1 Duration of Services

Inpatient comprehensive medical rehabilitation services may be sponsored only when there is no more than one year between the date of injury and the date of initial contact. There is a 90-day limit on inpatient comprehensive medical rehabilitation services, which is measured from the first day of services sponsored by the CRS program. These services are indicated on the consumer’s Individualized Written Rehabilitation Plan (IWRP) as "up to 30 days of services." When recommended by the interdisciplinary team, the services may be extended to a maximum of 90 days without an IWRP amendment.

Some facility-based providers choose to divide inpatient comprehensive medical rehabilitation services into phases. Discharges may occur during the course of treatment to give the consumer time to recover and practice newly acquired skills.

The consumer then often returns to complete the remaining treatment.

The CRS program may sponsor periods of hospitalization, up to a cumulative total of 90 days. No more than six months may lapse between being the time that a consumer is discharged from the program's first phase and re-enters the program.  

Providers of inpatient comprehensive medical rehabilitation services must meet the requirements outlined in Chapter 24: Purchasing Goods and Services for Consumers, 24.22 Health Care Professionals—Required Qualifications, and are authorized in accordance with Chapter 26: Physical Restoration Services, 26.2 Professional Medical Services, and Chapter 27 Hospital and Ambulatory Surgery Center Services.

15.3 Outpatient Therapy Services

Outpatient therapy services are provided on a one to one basis by licensed therapists to consumers who have a traumatic brain injury, a traumatic spinal cord injury, or both. These medical services must be prescribed by a physician and are provided without admittance to a hospital.

Outpatient therapy aims to correct or modify a stable or slowly progressive physical or mental impairment that constitutes a substantial impediment to independence. These services are authorized by CRS counselors and are reimbursed according to reimbursement methodology described in 1 TAC §355.9040. Other goods and services, not delivered under contract and not considered Outpatient Therapy Services, are considered “ancillary.” Ancillary goods and services must be pre-authorized by CRS staff and are reimbursed based on fee for service in accordance with 1 TAC §355.9040.

Prior to a service authorization being issued for outpatient services, the counselor must obtain a written prescription or physician’s order outlining recommended therapies and requesting treatment and evaluation. Services can be approved once the consumer has been evaluated and the counselor has received written recommendations from the provider.

15.3.1 Types of Outpatient Therapy Services

Common therapies provided as outpatient therapy services include occupational therapy, physical therapy, and speech therapy.

Purchase occupational therapy and physical therapy when the consumer must increase coordination, strength, or range of motion.

Purchase speech therapy to address speech, language, voice, communication, and/or auditory processing. Speech-language pathologists may also provide speech training in both expressive (speech and language production) and receptive (lip or speech reading) systems and evaluation and training in the use of speech augmentation devices.

15.3.2 Duration of Outpatient Therapy Services

Outpatient therapy services may be sponsored only when there is no more than two years between the date of injury and the date of initial contact. These services are limited to a maximum of 120 hours.

Providers of outpatient therapy must meet the requirements outlined in Chapter 24: Purchasing Goods and Services for Consumers, 24.22 Health Care Professionals—Required Qualifications. Services are authorized in accordance with Chapter 26: Physical Restoration Services, 26.2 Professional Medical Services, and Chapter 27 Hospital and Ambulatory Surgery Center Services.

 

15.4 Post-Acute Rehabilitation Services

Post-acute rehabilitation services (PARS) for Traumatic Brain Injury (TBI) and Spinal Cord Injury (SCI) are advanced rehabilitation services provided through an interdisciplinary team approach to people who have a TBI, TSCI, or both. For residential services, the consumer must have a TBI or a TBI with a TSCI; and for non-residential settings, the consumer may have a TBI or TSCI. Services are based on an assessment of the individual's assessed deficits. The goal of PARS is to achieve independence in the home and community and/or establish new patterns of cognitive activity or compensatory mechanisms.

Before issuing a service authorization for post-acute rehabilitation services, the counselor must obtain a pre-admission evaluation and written prescription or a physician’s recommendation for needed specific therapies. A post-acute rehabilitation services facility-based provider conducts the pre-admission evaluation. A medical professional provides the prescription or physician’s order.

15.4.1 Duration of Post-Acute Rehabilitation Services

Post-acute rehabilitation services are not limited by the time passed since the onset of the traumatic brain injury or traumatic spinal cord injury and the date in which initial contact was recorded in ReHabWorks. The 180-day limit on post-acute rehabilitation services is measured from the first day of services sponsored by the CRS program.

Post-acute rehabilitation services are indicated on the Individualized Written Rehabilitation Plan (IWRP) as approved for "up to 90 days." When recommended by the interdisciplinary team, services may be extended to a maximum of 180 days, without an IWRP amendment.

It may be necessary for a post-acute rehabilitation facility-based provider to divide its program into two phases. The CRS program may sponsor both periods of post-acute brain injury (PABI) services up to a cumulative total of 180 days.

15.4.2 Post-Acute Rehabilitation Services and the Counselor’s Role

Use only CRS-approved providers of post-acute rehabilitation services.

To find a provider:

  1. create a service record (use Residential Rehabilitation Services; Room, Board, and Supervised Living for the Level 1 specification); and
  2. use the "Go to Vendor Search" option to select an approved provider.

Post-acute rehabilitation providers must adhere to the standards documented in the CRS Standards for Providers, and CRS counselors must be familiar with the standards. Elements explained in the sections of this chapter require close coordination with the CRS counselor.

15.4.3 Assessment

Each staff member of the interdisciplinary team (IDT), as appropriate, assesses a consumer's abilities and limitations in relation to his or her specific area of expertise. The case manager compiles the results of this assessment into a report within 30 days of a consumer's admission into the program. Copies of the final report are provided to each member of the IDT.

The assessment must address each of the areas in this chapter that are noted in the CRS Standards for Providers.

15.4.4 Developing the Individualized Program Plan

Following assessments the IDT meets to create the Individualized Program Plan (IPP.) The IPP is based on the findings of the assessment and must address all deficit areas noted therein. All planned and needed services must be documented in the IPP. All IDT members must participate in the IPP development, which must be documented by attendance sheets with signatures. The IDT meets after all the assessments are completed, but no later than 30 days after a consumer's admission to the program. This meeting is held to develop the IPP.

Note: The word participate means to provide input through whatever means is necessary to ensure that the consumer’s IPP meets the consumer’s needs. The IDT process is designed to allow team members to review and discuss information and make recommendations relevant to the consumer’s needs. The IDT reaches decisions as a team, rather than individually, about how best to address the consumer’s needs.

15.4.5 Provider’s Reports to the CRS Program

A copy of the assessment report and the Individualized Program Plan (IPP) are provided to the CRS program staff member within 10 working days after the IPP meeting, which is held within the first 30 days of services following admission. A copy is available to the consumer and the consumer's representative. Results of the assessment and the IPP may be combined into a single report. All pertinent members of the interdisciplinary team sign the report. The provider must be able to verify by proof of fax, email, or post, or by signature of the CRS program staff member that the report was available to the CRS program within 10 working days of the IPP meeting.

15.4.6 IPP Review

The goals and objectives on the Individualized Program Plan (IPP) include long-term and short-term goals that specify measurable terms and relate to increasing a consumer's functional ability to live more independently.

A CRS program staff member and the consumer's representative, if applicable, are notified at least one week in advance of the date, time, and location of the IPP review meeting.

15.4.7 Activity Schedules

A schedule of daily activities, which addresses the goals identified in the Individualized Program Plan (IPP), must be developed and made available to each consumer. Copies of schedules for each consumer must be made available to CRS counselors or CRS program staff members in order to monitor for review.

The activity schedule directs the intensity of the daily work the consumer must do to follow the IPP, including both informal and formal training activities.

15.4.8 Emergency Restrictive Procedures

Emergency restrictive procedures are the least-restrictive procedures used for the briefest time necessary to control severely aggressive or destructive behavior that place an individual or others in imminent danger and that could not have been reasonably anticipated. Emergency restrictive procedures are used only when necessary within the context of positive behavioral programming.

The provider may use restraint as an emergency measure only if absolutely necessary to protect the consumer or others from injury.

The provider's policy must include the provision of training in appropriate physical restraint procedures and techniques for staff members with direct consumer contact. The procedures must identify the training provided to all staff members at hire and at least annually thereafter.

Each time a consumer is restrained, a written report must document the details surrounding the incident. This written report must be kept in the consumer’s file that is maintained by the provider. The interdisciplinary team reviews each report at the next scheduled monthly team meeting to determine whether modifications to the treatment plan are needed.

15.4.9 Behavior Management

Licensed professionals or board-certified professionals develop and monitor a behavior management plan (BMP). Plans may include therapeutic medication; interventions that include positive reinforcement, verbal cues, and rewards; and other evidence-based therapeutic modalities planned to improve appropriate communication, frustration tolerance, anger management, or other necessary social skills. A board-certified behavior analyst, psychiatrist, or psychologist develops a BMP.

A BMP is:

  • developed and approved before it is implemented by the interdisciplinary team (IDT);
  • written in a manner that can be understood by the consumer and the provider’s staff members; and
  • signed by a psychologist, psychiatrist, or board-certified behavior analyst; and
  • part of the IPP.

For consumers who are minors, get informed consent from the consumer’s parent or legal guardian for use of restrictive programs, practices, or procedures. For consumer’s who are legally incompetent but have no appointed legal guardian, get informed consent from some person or agency that is designated by the state, in accordance with state law, to act as the representative of the consumer’s interests.

If restrictive procedures are used as a behavior modification technique:

  • the provider's policies and procedures must clearly state when and how restrictive procedures are implemented; and
  • signed consent must be obtained from the consumer (or guardian, if the consumer is a minor or is legally incompetent).

Note: Standing or blanket program restrictions such as chemical restraint, physical restraint, and seclusion to control inappropriate behavior are not permitted.

All interventions addressing the control of inappropriate behaviors must be justified by the Functional Behavioral Assessment and the current level of behavior.

If chemical restraints are used to control inappropriate behavior, they must be:

  • approved by the IDT;
  • used only as an integral part of the consumer’s IPP that is directed specifically toward the reduction of and eventual elimination of the behaviors for which the chemical restraints are employed;
  • justified that the harmful effects of the behavior clearly outweigh the potentially harmful effects of the restraint; and
  • monitored closely in conjunction with the physician and the IDT to ensure that the chemical restraints have desired responses and no adverse consequences.

Each time a consumer is restrained, a written report must document the details surrounding the incident. This written report must be filed in the case file maintained by the provider. Each report must be reviewed by the IDT at the next scheduled monthly team meeting to determine whether modifications to the treatment plan are needed.

15.4.10 Reporting Substance Abuse

Any observations or other evidence of the use of alcohol or drugs by a CRS consumer with the disability of substance abuse must be reported immediately to the CRS counselor. The provider must maintain documentation that the counselor was informed.

15.4.11 Chemical Dependency Services

Chemical dependency services may only be delivered to consumers who have a traumatic brain injury (TBI), and may be delivered on an individual basis or in a group setting. Licensed professionals with experience in service delivery to individuals with TBI may provide services, and this may include licensed chemical dependency counselors, licensed professional counselors, or psychologists.

Chemical dependency services must be:

  • provided based on assessed needs;
  • developed and approved by the interdisciplinary team; and
  • a part of the Individualized Program Plan.

15.4.12 Monthly IDT Meetings on the Individualized Program Plan

The consumer’s interdisciplinary team (IDT) meets formally at least monthly to:

  • review a consumer's progress in terms of attaining the identified goals and objectives; and
  • determine whether modifications are needed to the goals and objectives, timelines, and persons designated as responsible.

All IDT members routinely participate in the monthly meetings, and the IDT member’s attendance must be documented. The CRS program staff member, consumer, and consumer's legally authorized representative and/or advocate, as applicable, participate in the meeting when available.

The CRS program staff member, the consumer, and the consumer's legally authorized representative and/or advocate must be notified of the date, time, and location of the meeting at least one week in advance.

The IDT reviews the consumer’s Individualized Program Plan (IPP) at each monthly meeting and the IPP may be modified, if necessary, at that time.

Adjustments to the IPP, including discharge planning, are made as necessary.

The results of this meeting, which occurs within the first 30 days after admission, are documented in a written report, and a copy of the report is provided to the CRS program staff member within 10 working days after the meeting. A copy must be available to the consumer and/or the consumer's representative.

In addition to the required monthly meeting and based on need, the IDT may meet as frequently as is prudent and necessary in order to maintain an effective treatment program.

15.5 Post-Acute Rehabilitation Services - Residential

Post-acute rehabilitation residential services for traumatic brain injury (TBI) are authorized based on a tiered rate structure. Each tier represents a preauthorized number of hours for core therapy services. A week is defined as Sunday through Saturday.

The initial tier level is Tier 2, not to exceed 14 hours per week. Once assessments are complete, the tier, with prior authorization, may be changed to the tier recommended on a weekly basis by the interdisciplinary team (IDT). Supporting documentation must include information relating to a consumer’s needs, goals, and recommended core therapy services.

15.5.1 Licensure and Accreditation

All providers who provide post-acute rehabilitation services in a residential setting that do business with the CRS program must be licensed by at least one of the following regulatory agencies, as appropriate:

The providers must maintain accreditation from:

  • the Commission on Accreditation of Rehabilitation Facilities;
  • the Joint Commission on Accreditation of Healthcare Organizations; or
  • the Disease-Specific Care Certification in Brain Injury Rehabilitation Program.

New facility-based providers doing business with the CRS program that do not already meet the accreditation requirement are granted up to two years from the date of their CRS contract for post-acute brain injury or post-acute spinal cord injury services to obtain the accreditation.

15.5.2 Co-Pay/Co-Insurance

Co-Pay/Co-Insurance Tier is covered when the consumer has third-party insurance being billed for services. All other pay sources must be exhausted before CRS is billed for services.

15.5.3 Tier Base and Tier Base-Plus

Tier Base services include administrative costs, room and board, paraprofessional services, medical services (that is, physician and nursing services), dietary and nutritional services, and case management. These services may not be billed separately to the CRS program.

Tier Base-Plus services include base services plus one- to three-quarter hours of core therapy services.

The CRS program does not expect that consumers will be approved for Tier Base or Tier Base-Plus services. The tier levels are provided to account for days of service that fall below the authorized tier.

15.5.4 Core Therapy Services

Core therapy services include physical therapy, occupational therapy, speech therapy, cognitive therapy, and neuropsychological services.

Core therapy services are based on the recommended tier and must be provided by a licensed or certified professional. If an identified core therapy service is provided by a non-licensed or non-certified professional, the service is not billable as part of the core therapy service for the tier.

For example, nursing services are considered part of base services and therefore are not billable as part of core therapy services. Goods and services that are not considered base or core therapy services are defined as ancillary and must be authorized by the CRS counselor. See the CRS Standards for Providers, Chapter 11: Traumatic Brain Injury and Traumatic Spinal Cord Injury – Inpatient Comprehensive Medical Rehabilitation Services for details. See Appendix B in CRS Standards for Providers for a complete list of core therapy services and provider qualifications.

15.5.5 Preauthorization for Changing Tiers

Changes in the approved tier require preauthorization from a CRS program staff member. The provider must document in the consumer’s record why a consumer received less than the preauthorized or approved tier and/or why it is clinically recommended to increase the tier.

The CRS program may not reimburse unauthorized services. Providers must justify changes in a tier by providing supporting documentation. A CRS program staff member may request documentation supporting the provider’s request. If requested, the documentation must be submitted prior to delivering services at the newly requested tier; otherwise, the change in tier is considered unauthorized. 

15.5.6 Documenting Changing Tiers

Upon receipt of the DARS3149, Request for Tier Change and review of the documentation requesting a change in a tier level, the counselor takes the following steps.

Approval

If the counselor approves the change in a tier level, the counselor:

  1. documents the change in a service justification case note in ReHabWorks; and
  2. adds the subheading:
    • Initial Tier: “Approved Tier 2”; or
    • Changed Tier: “Changed Tier x to Tier x”.

It is important for recording purposes that it is written exactly as described above.

The counselor then creates an approval case note and:

  1. identifies the previous tier;
  2. identifies the new tier; and
  3. explains the reason for the change.

Seeking Additional Information

If the counselor needs to seek additional information, the counselor documents the need in a Vendor Contact case note with the subheading Seeking Additional Information and includes in the case note the counselor’s request for more information and the reason the counselor requests this information.

Denial

If the counselor denies a change to a tier, the counselor documents the decision in a Vendor Contact case note with a subheading “Denial of Tier Change.”

The counselor:

  1. identifies the current tier;
  2. explains the change being requested; and
  3. explains the reason for denying the change.

15.5.7 Utilization Review

A utilization review is required only when post-acute rehabilitation for traumatic brain injury is provided in a residential setting. See Chapter 16: Utilization Review for Post-Acute Rehabilitation Services - Residential.

15.5.8 Billing Limitations

Tier Base

If a consumer does not receive core therapy services on a given day, the provider bills the therapy as Tier Base for that day to indicate that the provider is being reimbursed only for the base services and that no core therapy services were provided.

Tier Base-Plus

A consumer receives one- to three-quarter hours of a core therapy service per day.

Core Individual and/or Group Therapy

One hour of individual therapy or two hours of group therapy counts as one hour toward a tier. The total number of hours applied to a tier equals the sum of the individual and group hours; for example: One hour of individual and one hour of group equals 1.5 hours total and is billed as Tier 1; one hour of individual and four hours of group equals three hours total and is billed as Tier 3.

Billing Core Services

Two therapists cannot bill for the same period of time. Therapy units and/or time are divided by the number of therapists delivering the service to determine the number of hours attributed to each; for example, if a physical therapist and an occupational therapist deliver one hour of individual therapy to a consumer together, the therapy counts as one hour toward the tier. On the supporting documentation, the therapy is shown as .5 hours of physical therapy and .5 hours of occupational therapy. (The providers may split the hour differently, such as three-quarter hours of physical therapy and one quarter hours of occupational therapy, if the sum does not exceed one hour. For staff member qualifications, see the CRS Standards for Providers, Appendix B: Post-Acute Rehabilitation Core Services – Modality and Staff Qualifications.

Billing for a Partial Week

If billing for fewer than seven calendar days, the billing guidelines for the maximum number of hours provided at the approved tier apply; for example, if approved for Tier 4, the sum must not exceed 28 hours, regardless of the number of days involved.

Copays

Providers bill a third party or the consumer’s insurance company for services. The CRS program pays the consumer’s required copay or coinsurance for the service. Tiered rates do not apply; however, the provider must still submit detailed billing information on the services delivered to the consumer.

Day of Admission or Discharge

Admission and discharge days are handled the same as any other service day. If no core therapy services are delivered, the provider bills for Tier Base services. If core therapy services are delivered, the provider bills for the appropriate tier for the number of hours delivered, in accordance with the prior authorization.

Therapeutic Passes

A therapeutic pass allows a consumer to leave a residential facility for up to eight hours to attend a planned activity, unaccompanied by facility staff members. The consumer must return to the facility by 10 p.m. If a consumer is away from the facility for more than eight hours and does not return by 10 pm, the consumer is considered absent and the facility-based provider cannot bill for services. If a consumer has more than two therapeutic passes per month, the facility-based provider must notify the CRS counselor. During a month, a consumer can take no more than three therapeutic passes. Therapeutic pass days are billed at the Tier Base rate.

A therapeutic pass must be planned and included in the consumer’s Individualized Program Plan. The purpose of the therapeutic pass is to facilitate a consumer’s transition from a residential facility to his or her own home and the community; for example, a consumer may go shopping with family members or practice taking the bus or metro lift into town.

While a consumer is on therapeutic pass, staff members from the residential facility must be available to provide the consumer and the consumer’s family or others with guidance and instruction, usually by phone.

Within one day of the consumer’s return to the facility, the facility team reviews with the consumer the issues noted during the pass. If the facility team determines that changes in the consumer’s core therapy services or ancillary services are required, a team member notifies the CRS counselor, and the counselor arranges for the consumer’s interdisciplinary team to meet. If the counselor and the interdisciplinary team approve, the facility team incorporates techniques into the consumer’s therapy and/or ancillary services to address the issues.

15.5.9 Base Services and Tier Structure

The base services provided for post-acute rehabilitation residential services are shown in the table below.

Base Services: Traumatic Brain Injury (TBI)
Post-Acute Rehabilitation—Residential

Case Management

Dietary and Nutritional Services

Medical (Nursing & Physician) Services

Administrative Cost

Paraprofessional Services (services by CNA,CA)

Room and Board

Core Services: Traumatic Brain Injury(TBI)
Post-Acute Rehabilitation Services-Residential

Tiers

Description

Copay

Residential copay only

Base

Tier base—no billable core

Base Plus

greater than 0 but less than 1 hour

1

greater than or equal to 1 hour per day but less than 2 hours per day, not exceeding 7 hours per week

2

greater than or equal to 2 hours per day but less than 3 hours per day, not exceeding 14 hours per week

3

greater than or equal to 3 hours per day but less than 4 hours per day, not exceeding 21 hours per week

4

greater than or equal to 4 hours per day but less than 5 hours per day, not exceeding 28 hours per week

5

greater than or equal to 5 hours per day but less than 6 hours per day, not exceeding 35 hours per week

6

greater than or equal to 6 hours per day but less than 7 hours per day, not exceeding 42 hours per week

7

greater than or equal to 7 hours per day but less than 8 hours per day, not exceeding 49 hours per week

8

greater than or equal to 8 hours per day but less than 9 hours per day, not exceeding 56 hours per week

15.6 Post-Acute Rehabilitation Services – Non-Residential

Post-acute rehabilitation services for traumatic brain injury and traumatic spinal cord injury (TSCI) non-residential rehabilitation services are provided through non-residential settings and encompass the same core services as residential services. Also included is a standard facility or community base fee for non-residential which covers the coordination of services by the IDT and appropriate personal assistance, administration, and facility and operations costs. Staff qualifications for providing core services remains unchanged (see CRS Standards for Providers, Appendix B: Post-Acute Rehabilitation Core Services – Modality and Staff Qualifications for provider qualifications).

15.6.1 Licensure and Accreditation

A post-acute rehabilitation non-residential service provider that does business with the CRS Program and is not licensed by the Department of Aging and Disability Services (DADS) as an assisted living facility or nursing home, and are not licensed by the Department of State Health Services (DSHS) as a hospital or chemical dependency center, must be:

15.6.2 Billing Guidelines

DARS, or its successor agency, negotiates contracts with providers which are reimbursed in accordance with 1 TAC §355.9040.

Post-acute rehabilitation non-residential services for traumatic brain injury and traumatic spinal cord injury can be either facility based or community based. The base rate covers administrative services, paraprofessional services, and facility and operations costs. Providers will bill a standard facility ($11.21) or community ($10) base fee plus an hourly rate for the core therapy services provided to the consumer using CPT codes.

For example, a consumer receives services in a non-residential setting on Monday. The consumer receives one hour of physical therapy, one hour of occupational therapy, one hour of speech therapy, and one hour of art therapy. The provider bills for four hours of therapy, submitting a separate bill for each therapy with supporting CPT code(s) and providing supporting documentation for each i.e., therapy notes, assessments, and/or reports. The provider submits a separate bill for four hours at the base rate to cover administrative services, paraprofessional services, and facility and operations costs.

If the consumer does not receive therapy services from an approved certified or licensed professional while at the facility, the provider bills only for the time that the consumer is at the facility and bills only at the base rate. For example, the consumer attends the program for four hours, but does not receive any therapy services. The provider submits a bill for four hours at the base rate.

Bills for services must be submitted monthly. Data supporting the service must accompany each invoice. See CRS Standards for Providers, Chapter 6: General Billing Guidelines for additional billing guidelines.

 

15.6.3 Exceptions and Limitations

Post-acute rehabilitation services are limited to 180 days starting on the first day that services are sponsored by the CRS program.

15.7 Ancillary Goods and Services

Goods and services related to the individual’s TBI or SCI, which are not outpatient therapy services and are not delivered as part of Inpatient Comprehensive Medical Rehabilitation Services or Post-Acute Rehabilitation Services, are considered ancillary. Ancillary services are prior authorized by CRS counselors in accordance with program policy, reimbursed according to reimbursement methodology described in 1TAC §355.9040, and may include but are not limited to:  orthotics, prosthetics, assistive technology devices, medications if not part of contract, medical equipment & supplies, home modifications, transportation when required to enable participation in a CRS approved service, paraprofessional services when required to enable participation in therapies or post-acute non- residential rehabilitation, etc.

15.7.1 Exceptions/Limitations

If a consumer requires medical treatment for an injury sustained while receiving rehabilitation services or requires treatment for an illness that is not related to the consumer’s traumatic brain injury or traumatic spinal cord injury, the consumer is considered medically unstable and the services are not covered by the CRS program as post-acute rehabilitation services.

Chapter 16: Utilization Review for Post-Acute Rehabilitation Services-Residential

16.1 Overview

Utilization reviews help ensure that the appropriate scope and level of services are provided to CRS consumers The utilization review may be performed as a prospective, concurrent, or retrospective review.

16.2 Types of Utilization Reviews

Prospective Reviews - Services are reviewed before authorization of the Individual Program Plan to determine the appropriate level and scope. These reviews may be conducted face-to-face.

Concurrent Reviews – Services are reviewed when the consumer is receiving services.

Retrospective Reviews – Services are reviewed after delivery or discontinuation of services, or after decisions have been made for authorization. These reviews ensure that services billed according to the tiered rate were delivered specified by the rate and if services were provided as recommended by the Individualized Program Plan and interdisciplinary team.

16.3 Utilization Review Processes

Reviews of a consumer’s records, services, and billing can occur from the point of entry into the CRS program until after the consumer ends or completes treatment and may include prospective, concurrent and retrospective review activities.

The purpose of a CRS utilization review is to:

  • ensure the program fiscal integrity of the provider;
  • address the state laws and regulations that program funds be spent only as allowed; and
  • ensure that services are provided based on medical necessity and are continued based on their efficacy.

A consumer’s records may be chosen for review through a random sample or based on billing issues noted by CRS program staff members.

16.3.1 Prospective Reviews

During a prospective review, services are reviewed before they are authorized to determine if the consumer and/or current processes were followed.

The purpose is to ensure that:

  • a consumer meets eligibility requirements;
  • services will meet the consumer’s needs; and
  • CRS program staff members are following CRS policies and procedures.

CRS program managers perform prospective reviews. The types of documentation and activities reviewed include:

  • intake and assessment information;
  • a diagnostic interviews;
  • consumer’s records to support eligible diagnosis or diagnoses;
  • a determination of eligibility by a CRS counselor;
  • basic eligibility requirements, as they apply to the consumer’s unique case and circumstances;
  • the consumer’s Individualized Written Rehabilitation Plan;
  • assessments made at the request of or by the CRS counselor; and
  • interviews held with the consumer, consumer’s family and/or guardian.

Managers complete a prospective review using case review documents. If a case is chosen for prospective review, the counselor is notified and is given a copy of the review.

16.3.2 Concurrent and/or Retrospective Reviews

Utilization reviews can be conducted while the consumer is receiving services or reviews can be conducted retrospectively.

The reviews are conducted to ensure that:

  • a consumer received services;
  • the services were provided as often and for as long as specified in the consumer’s Individualized Written Rehabilitation Plan (IWRP) and treatment plan;
  • the treatment met the consumer’s needs;
  • billing occurred as specified in policy and standards; and
  • CRS policies and procedures were followed by CRS program staff members.

The reviews may include:

  • the Individualized Program Plan and IWRP;
  • medical and/or nursing assessment and diagnoses;
  • therapy assessments and therapy notes, along with treatment plans, and treatment data;
  • changes in treatment strategies based on data and assessments;
  • interdisciplinary team meeting summaries;
  • tier billing logs;
  • consumer schedules;
  • consent forms;
  • consumer’s restraints reports;
  • care provided by the facility, paraprofessionals, and professionals;
  • discharge planning notes;
  • documentation confirming all billing activities;
  • interviews held with the consumer and the consumer’s family or guardian;
  • notes from on-site visits;
  • outings taken by the consumer; and
  • documentation to support billing or care, as required for review by CRS policy and standards.

CRS program staff members will conduct concurrent and/or retrospective utilization reviews and then document the results of each review in ReHabWorks.

16.4 Review Outcomes

Recoupment of Overpayments

Recoupment is required if the results of a utilization review indicate overpayment for services delivered, payment made for services not delivered, or payment made for services provided without preauthorization. The appropriate agency or agency designee notifies the provider in writing about the overpayment identified and explains the method of recoupment to be used.

Administrative Actions and Sanctions

The administrative actions or sanctions form a utilization review may result in one or more of the following being taken by the agency or agency's designee:

  1. Closure of the review with written notification to the provider.
  2. Discussion and interpretation of results of the review with the provider.
  3. Referral to the appropriate state licensing board or the Texas Office of the Inspector General.
  4. Any other remedies authorized by rule, regulation, statute, or contract.

16.5 Appeal Process for Providers

The provider may appeal the findings of a utilization review; specifically, billing for services. For detailed information pertaining to the appeals process for providers, refer to the CRS Standards for Providers, Chapter 8: Utilization Review for Post-Acute Rehabilitation Residential Services for Traumatic Brain Injury, 8.5 Appeals Process for Providers.

 

 

Chapter 17: Paraprofessional Services

17.1 Overview

This chapter describes when to use paraprofessional services, how to plan for services, how to locate and train paraprofessionals, and when to use comparable benefits.

17.2 When to Use Paraprofessional Services

Services provided by paraprofessionals may include:

  • assisting with medication or therapeutic regimens;
  • preparing and serving meals;
  • assuring that health and safety needs are met;
  • assisting with the activities of daily living, including assisting with hygiene and laundry;
  • providing supervision and care to meet basic needs; and
  • ensuring evacuation in case of an emergency.

Paraprofessional services can be provided in all service arrays, for approved medical needs only, but are provided in the home only when necessary to enable consumer participation. The CRS program provides personal attendant care when necessary to enable the consumer to participate in outpatient therapies or post-acute rehabilitation non-residential services for traumatic brain injury or traumatic spinal cord injury.

Paraprofessional services are provided as outlined in the provider’s contract for both inpatient comprehensive medical rehabilitation services and post-acute rehabilitation residential services.

17.3 Planning for Paraprofessional Services

In determining the rehabilitation goal, consider that the consumer will eventually assume financial responsibility for attendant services.

Consider providing services that allow the consumer to do things independently (for example, an environmental control system or an automatic patient lift). The initial cost for assistive technology usually is higher than purchasing attendant care, but may be more economical in the long term.

17.4 Locating and Training Paraprofessionals

You and the consumer share the responsibility for locating a suitable paraprofessional. However, because of the individualized nature of these services, the consumer should assume primary responsibility for instructing the personal attendant regarding his or her specific needs. The consumer should also inform you about the attendant's job performance.

17.5 Comparable Benefits

Use comparable benefits when they are appropriate for the consumer’s needs and are available in a timely manner before service funds for the case are available. When service funds are available, you may use them to supplement comparable services, as necessary.

Chapter 18: Mental Restoration Services

18.1 Overview

This chapter provides an overview of mental restoration services and policy on purchasing services, provider qualifications, and limitations on providing services.

Mental restoration services are provided when clinically necessary to achieve a planned rehabilitation outcome.

18.2 Purchasing Mental Restoration Services

Mental restoration services are purchased when comparable benefits, such as community based behavioral health and developmental disability service centers or indigent care services, are not available to provide these services.

18.3 Provider Qualifications

If a licensed psychologist or psychiatrist recommends or prescribes mental restoration services, you may purchase these services from:

  • psychiatrists licensed by the Texas Medical Board;
  • psychologists licensed by the Texas State Board of Examiners of Psychologists;
  • licensed clinical social workers who are licensed by the Texas State Board of Social Worker Examiners;
  • licensed master social workers who are licensed by the Texas State Board of Social Worker examiners and are supervised by a licensed clinical social worker; or
  • licensed professional counselors who are licensed by the Texas State Board of Examiners of Professional Counselors.

Note: Mental restoration services provided by an intern who is working under the supervision of a licensed provider are purchased at the supervising licensed provider's payment rate. Comprehensive Rehabilitation Services (CRS) does not pay for inpatient psychiatric treatment.

Chapter 19: Applied Behavior Analysis

19.1 Overview

Applied behavior analysis (ABA) is used to address problem behavior that is an impediment to rehabilitation. ABA is typically used for consumers who have autism spectrum disorder or have cognitive or developmental disorders. ABA includes evaluating the problem behavior, identifying the cause, and developing a treatment plan to increase desired behaviors and decrease problem behaviors. ABA is not always indicated for autism.

19.2 Appropriate Referrals for ABA

To determine whether Applied Behavior Analysis is an appropriate intervention for the consumer, consider the following:

  • When does the problem behavior occur or likely to occur?
  • Does this behavior issue go beyond the expertise or skills of the provider? Would the provider be willing to collaborate with the behavior analyst?
  • Can the problem behavior be resolved or substantially reduced within a relatively short period of time?

Upon acknowledgement of the provider using restraints, issue a referral for consultation.

19.3 Provider Qualifications

Purchase applied behavior analysis based on the scope of the provider's practice; that is, a provider who:

  • performs functional behavioral analysis;
  • develops behavioral intervention plan; and
  • implements the behavior intervention plan.

A board certified behavior analyst (BCBA®) with a master's degree performs functional behavior analysis, develops the behavior intervention plan, and implements the behavior intervention plan.

A board certified assistant behavior analyst (BCaBA®) with a bachelor's degree implements the intervention plan under the supervision of a board certified behavior analyst or a board certified behavior analyst who has a doctorate(BCBA-D ®). A graduate student in a behavior analysis program implements the intervention plan under the supervision of a BCBA-D or BCBA.

19.4 Description of Services

For comprehensive rehabilitation services, applied behavior analysis consists of behavior intervention.

19.5 Behavior Intervention

Purchase behavior intervention services for consumers whose behaviors create an impediment to rehabilitation.

19.5.1 Functional Behavior Assessment with Report

The functional behavior assessment (FBA) analyzes a consumer's behavior in a particular environment (such as, at a post-acute rehabilitation services facility) to determine what factors are causing problem behaviors. An FBA typically takes a minimum of four hours, and is limited to a maximum of eight hours.

The FBA report summarizes data collected and provides information to assist in the planning of comprehensive rehabilitation services, such as:

  • creating a detailed definition of the consumer's behavior that is causing an obstacle to rehabilitation;
  • summarizing data collected;
  • determining the cause for each problem behavior;
  • determining the environments to avoid;
  • making recommendations related to the consumer's disability; and
  • making recommendations for possible intervention.

Meet with the behavior analyst and consumer to discuss the FBA results and recommendations. If intervention is necessary, develop a behavior intervention plan.

19.5.2 Behavior Intervention Plan

In the behavior intervention plan (BIP), the behavior analyst summarizes the findings of the functional behavior assessment (FBA) and describes:

  • the strategies to prevent problem behaviors;
  • the strategies to address problem behaviors when they occur;
  • the behaviors that the consumer can substitute for problem behaviors;
  • the goals and objectives related to successful rehabilitation;
  • a plan to monitor the consumer's progress; and
  • recommendations for individual, group, or a combination of interventions and the number of intervention hours necessary to achieve the goals.

Development of the BIP should not exceed four hours. Intervention may vary from two to 10 or more hours a week, but should not exceed 30 hours.

If an intervention is not effective within the time frame recommended in the BIP, discuss with the behavior analyst whether a new FBA and BIP would be appropriate. The approval of the manager is required for a new FBA and BIP.

19.5.3 Documentation

For assessment or intervention, a written progress report, signed by the board certified behavior analyst (BCBA®) or board certified behavior analyst–Doctoral (BCBA-D®) is required before payment is made to the provider

During behavior intervention, a written progress report documenting the number of hours of intervention and the progress made toward the planned goals must be submitted at least monthly to the counselor before payment is made to the provider.

The report on behavior intervention must contain:

  • targeted behaviors (for example, "Goal: Julia will respond to a person's question with a variety of appropriate responses four out of five times by August 2011");
  • an update on mastery (for example, "As of 6/16/11, Julia has mastered four new responses that are commonly asked of her in the work setting");
  • a summary of the steps to be taken next and changes to be made in the plan, if any; and
  • measurable data to confirm the progress or lack of progress.

The progress report must be signed by the person doing the direct intervention and, if the service is being provided by a board certified assistant behavior analyst or graduate student, it must be signed by the supervising BCBA® or BCBA-D®.

Chapter 20: Home Modification Services

20.1 Overview

The purpose of this chapter is to explain CRS policy on paying for modifications to a consumer’s home. This chapter outlines how to evaluate the need for a modification, how to get recommendations, how to get CRS program approval, and how to purchase the modifications

20.2 When to Provide Home Modification Services

Provide home modifications when changes to a consumer's physical environment are needed for the consumer to perform activities of daily living that improve the consumer's ability to function independently in the home and community.

The process begins with a full assessment of needs, followed by consideration of accommodation alternatives, including the need for consumer training and/or education on the use of rehabilitation technology.

For a consumer to make an informed choice about how best to meet his or her technology needs, the consumer must consider the advantages of low-tech equipment over high-tech equipment, the need to maintain the equipment, the possibility of maintenance costs, and the timeliness with which the equipment can be purchased.

20.3 Requesting an Assessment of the Home

Before changing the consumer's home, pre-authorize the purchase of an assessment from a licensed occupational therapist (OT), physical therapist (PT), or professional engineer (PE) specializing in assistive technology. An assessment identifies the options that will allow the consumer to function as independently as possible.

To assess the potential for making modifications to a consumer's home:

  1. review information in Home Modification: Assessment and Implementation, as needed;
  2. complete DARS3395, Home Modification Assessment Referral;
  3. negotiate a rate for assessment consistent with the Maximum Affordable Payment Schedule (MAPS), for services from a licensed OT and PT; and
  4. pay upon receipt of the assessment report, which is usually provided within 10 days of service.

If applicable, ensure that the consumer signs DARS3395, Home Modification Assessment Referral, specifying the information about the consumer that the OT, PT, or PE may provide to a provider, and gives you a copy.

Exceptions to Obtaining an Assessment

The CRS program manager may grant an exception to the requirement to have an OT, PT, or

20.4 Approvals and Other Requirements for Home Modifications

Before committing to home modification on the Individualized Written Rehabilitation Plan, you must meet the following requirements.

Table: Approvals and Other Requirements for Home Modifications

Service

Approvals

Other Requirements

Home modification

Home modifications costing more than $1,000 require manager approval and documentation in the case file.

Adaptive equipment may require installation, but usually does not result in permanent structural changes. Household equipment may be specially designed, selected, or altered to enable the consumer to perform homemaker duties despite his or her functional limitations.

Modifications are limited to equipment that can be removed from the residence without permanent damage to the property should the consumer move or fail to cooperate in achieving the planned objective.

20.5 Procedure for Purchasing a Home Modification

Table: Required Procedures when Purchasing Home Modification

Service Description Procedure

Creating or enhancing access to the house or apartment or making residential features more accessible (that is, those features critical to participation in rehabilitation services or necessary for the consumer's independence).

May include construction of ramps, adaptive equipment such as stair glides and lifts, and household equipment.

Consult with a CRS central office staff member as needed to ensure that the most practical modification equipment is used.

If equipment such as a porch or ramp is attached (for example, bolted or nailed) to the property, obtain a written agreement using the format and language in DARS3403, Consumer Residence Modification Agreement, from the property owner.

If the modification costs more than $700, clearly justify that the modification supports the consumer's planned rehabilitation outcome.

If the modification costs more than $1,000, purchase a lien-examination from either a title insurance company or another source, such as a law office.

If there is a lien, provide a copy of DARS3403, Consumer Residence Modification Agreement, to the lien holder, and request that the lien holder expressly disclaim in writing any interest in the equipment installed in the residence by the CRS program using DARS3426, Residence or Job Site Modification, Express Waiver of Right to DRS Equipment.

If the lien holder will not sign the disclaimer, contact Legal Services for guidance.

When circumstances require minor changes in the agreement, contact Legal Services for guidance as to whether the property is owned by the consumer or another person.

Provide one copy of DARS3403, Consumer Residence Modification Agreement, to the property owner. Keep the original DARS3403 in the case file.

Chapter 21: Transportation Services

21.1 Overview

This chapter outlines general transportation guidelines, when to provide transportation, transportation providers, and different types of transportation for consumers.

21.2 General Transportation Guidelines

Transportation consists of travel and related expenses that are necessary for a consumer to:

  • participate in a service provided by the CRS program under an Individualized Written Rehabilitation Plan; or
  • be assessed to determine eligibility.

Transportation of a consumer for any purpose must be by the most economical and effective carrier.

State law prohibits the Texas Comptroller of Public Accounts from issuing a transportation warrant directly to a person who owes the state or federal government delinquent taxes or a defaulted debt (for example, a Texas Guaranteed Student Loan).

Transportation warrants are mailed directly to the consumer or third party payee. In exceptional circumstances and only with the CRS program manager’s approval, to the field office.

21.3 Transportation Providers

Public Carrier

A public carrier is a vehicle or fleet of vehicles in the business of transporting the public; for example, city transit service, airline (see Chapter 24: Purchasing Goods and Services for Consumers and 21.6: Planning and Processing Central Billing for Consumer Airfare, bus company, and taxi company.

Private or Third-Party Carrier

A private carrier is a vehicle not customarily for hire, owned by a person or private organization other than the consumer. For example, you may pay the consumer's family member, a neighbor, or a residential service provider to transport the consumer if he or she has no car or is otherwise unable to drive because of his or her disability and has no access to other, less expensive transportation.

21.4 Transporting the Consumer in a Staff Member's Personal Vehicle

Transport the consumer in your personal vehicle only when transporting the consumer coincides with travel when performing your regular duties or if a sudden, urgent, unexpected, and usually dangerous situation that calls for immediate action exists. If neither of these situations exists, do not transport the consumer in your personal vehicle. Do not accept reimbursement from the consumer.

Exercise particular care when transporting a consumer in your personal vehicle. Under the Texas Tort Claims Act, a CRS program staff member can be liable if the consumer is injured because of a wrongful act or the negligence of the CRS program staff member. The CRS program staff member must exercise the degree of care that a reasonable and prudent person would exercise under the same circumstances.

Notify your CRS program manager in advance if it is necessary to transport the consumer in a CRS program staff member's personal vehicle.

21.5 Types of Transportation

There are two types of maintenance: recurring transportation and nonrecurring transportation.

You may authorize and pay transportation in advance.

Types of Transportation

Transportation Type

When Provided

Limits

Required Documentation

Recurring transportation

Recurring payments to the consumer or a third party to offset the consumer's ongoing expenses that are necessary for the consumer to participate in CRS assessments or to receive the services identified in the consumer’s Individualized Written Rehabilitation Plan (IWRP).

Actual cost to consumer for public transportation.

Actual mileage multiplied by a maximum of .55 cents per mile, when paid directly to a private or third party.

Actual mileage multiplied by a maximum of .21 cents per mile,* not to exceed $50 per week, when paid directly to a consumer.

A service justification case note that includes calculations and identifies the source used to define "actual mileage"

Verification of the consumer’s financial participation in the cost of the service

Nonrecurring transportation

One-time payment to the consumer or a third party for transportation that is necessary for the consumer to participate in CRS assessments or to receive services identified in the consumer’s IWRP.

Manager approval required over $400.

If the payment is over $400, contact the CRS program manager to have the consumer established as a provider.

For nonrecurring transportation that exceeds $400, do not use the temporary Social Security number (automatically created by ReHabWorks when the consumer’s is not known) to create a service record.

A service justification case note that includes calculations and identifies the source used to define "actual mileage"

Verification of the consumer’s financial participation in the cost of the service

21.6 Planning and Processing Central Billing for Consumer Airfare

Central Billing

Consumer airfare purchases are completed using the Consumer Central Billed Account (CBA).

Using the CBA for consumer airfare purchases allows caseload-carrying staff members to purchase consumer airfare at state-contracted rates.

In addition to reducing airfare costs for consumer travel, using the CBA has the following benefits:

  • Advance purchase is not necessary.
  • There is no minimum or maximum length of stay.
  • Tickets are 100 percent refundable if cancelled or unused.

When using the CBA, reservations must be made at least 14 days in advance and ticketed at least seven days in advance to allow for review and to ensure that the itinerary is acceptable to the consumer. For travel being requested during holiday periods, reservations should be made 30 days in advance.

Requesting Consumer Air Travel

The caseload-carrying staff member or designee must:

  1. complete and sign a DARS1762, Central Billing Request for Consumer Airfare, and include the service authorization number in the “comments” field;
  2. email the signed DARS 1762 to Accounting Group—Consumer Airfare Team at consumerairfare@dars.state.tx.us; or
  3. fax the signed DARS1762 to General Accounting—Consumer Airfare Team at (512) 424-4360.

Note on the DARS1762 any special needs or requirements the consumer or passenger may have. For example, document if the consumer:

  • needs to be on a specific flight in order to travel with a group;
  • requires accommodations; or
  • requires special seating (describe the circumstances).

Procedure

The following procedure is used to book and verify the travel:

  1. Accounting Group—the Consumer Airfare Team authorizes the charge to the Consumer CBA.
  2. The travel agency:
    • books the airfare; and
    • emails the reservation and ticket confirmation itinerary to the Accounting Group—Consumer Airfare Team.
  3. Accounting Group - Consumer Airfare Team:
    • maintains a printed copy of the itinerary in the Consumer CBA; and
    • forwards the confirmation by email to you (the CRS staff person who requested the travel).
  4. You must respond by email to the DARS Consumer Airfare mailbox to confirm that the forwarded itinerary is acceptable.
  5. Upon confirming the itinerary as acceptable, complete a service record and service authorization using the date, purchase price, and fees information provided.
  6. Do not authorize the service authorization for payment at this time.
  7. At the airport, the consumer or passenger must provide:
  8. Once the consumer travel is shown on the bank statement you will receive a mass email from the Accounting Group staff paying the bank statement. The email will show consumers that traveled within that bank statement period, and will instruct you to add the service authorization number in the appropriate column for your consumer.
  9. The accounting staff accountant will verify and audit the service authorization and then reply back when you can receive and authorize payment for the consumers travel.

Creating the Service Record and SA

When you (the CRS program staff member who requested travel) receive confirmation of travel information from General Accounting—Consumer Airfare Team, you must complete a service record and service authorization in ReHabWorks. (See ReHabWorks Users Guide, Chapter 16 Case Service Record, 16.2.10 Consumer Airfare for details.)

Processing the Payment

In order for Accounting Group—Consumer Airfare Team to process payment for consumer travel, you (the CRS program staff member) must have created the service record and service authorization in ReHabWorks.

If any discrepancies are noted between the service record, service authorization, and/or invoice received by Accounting Group—Consumer Airfare Team, it will email you to resolve any differences.

Cancelled Flights

All flight itineraries are paid with a HHSC CBA credit card. If the consumer's ticket requires cancellation, you (the CRS program staff member who requested the travel) must notify Accounting Group—Consumer Airfare Team immediately by email at DARS Consumer Airfare or by phone at 1-866-440-0423, press option 7 for immediate assistance.

The following responsibilities and conditions apply:

  • Accounting Group—Consumer Airfare Team is responsible for contacting the travel agency to cancel the travel request.
  • If a consumer changes or cancels a flight itinerary in anyway, at any time for any reason, any additional costs incurred will be the responsibility of the consumer to pay.
  • You are responsible for closing the service authorization in ReHabWorks.
  • For Short's Travel itineraries, there is a cancellation fee.

Air Travel Questions

If you have questions about consumer airfare procedures, contact General Accounting—Consumer Airfare Team for clarification and/or assistance by:

Chapter 22: Assistive Technology

22.1 Overview

You may purchase an assistive or adaptive device when your consumer's therapeutic need requires it. Be aware, however, that many assistive and adaptive products on the market today do not meet the CRS program’s best-value purchasing criteria (see Chapter 24: Purchasing Goods and Services for Consumers, 24.3.2 Best Value Purchasing).

For example, technologically advanced products that are not shown to be safe and effective by independent clinical evidence do not meet best-value criteria and must not be purchased. If the requested device is questionable or if you are uncertain about whether a product meets CRS best-value criteria, contact the CRS central office staff member for guidance.

22.2 The Scope of Rehabilitation Technology Services

The CRS program sponsors:

  • rehabilitation engineering;
  • assistive technology devices; and
  • assistive technology services.

You may use rehabilitation technology services once the consumer is removed from the Waiting List, as necessary, to assist the consumer in achieving his or her planned goal, and objectives and to provide authorized services to consumer family members.

Consultation is available from the CRS central office program specialist.

22.3 Rehabilitation Engineering Services

Only licensed professional engineers may provide rehabilitation engineering services. Consider using an engineer's services when the service includes design or modification of a product.

Before you commit CRS funds, it is important to reach an understanding with the provider about price and delivery. For rehabilitation engineering services provided before plan development, use the following specification levels:

  • Level 1—Evaluation Services
  • Level 2—Other Evaluation Services
  • Level 3—Other Evaluation Services
  • Level 4—Other Evaluation Services

Consult with the CRS central office program specialist to gather information about providers from whom the CRS program has purchased services, and to help when problems are encountered.

22.4 Assistive Technology Services

Professionals other than rehabilitation engineers may provide assistive technology services. These professionals include physical therapists, occupational therapists and speech therapists.

Chapter 23: Unusual Incidents, Including Abuse, Exploitation, or Neglect of People with Disabilities

23.1 Overview

Consumer safety is of the utmost importance to the CRS program. This chapter provides the guidelines for appropriate steps when the counselor knows of any unusual incidents, including abuse, exploitation, or neglect of CRS consumers.

Texas law requires that the provider immediately reports all allegations or suspected incidents of abuse, neglect, or exploitation of persons with disabilities to the appropriate investigatory agency, or, if taking place in other than a residential situation, the local law enforcement agency. If a licensed professional is involved, a provider reports to the appropriate professional licensure agency and the local law enforcement agency.

23.2 Reporting and Documenting Allegations of Abuse, Neglect, or Exploitation

To report allegations of abuse, neglect, or exploitation, the person who has cause to believe that abuse, neglect, or exploitation has occurred:

  1. immediately contacts law enforcement, if the incident is a threat to health or safety;
  2. immediately reports the incident to the appropriate investigatory agency;
  3. documents in the consumer’s case file which investigatory agency was contacted, including the reference number provided by the investigatory agency; and
  4. notifies his or her manager, supervisor, or the appropriate contract manager of the allegation.

The supervisor, manager, or the appropriate contract manager:

  1. consults with the Health and Human Services (HHS) Employee Relations Unit staff member assigned to the CRS program for next steps;
  2. consults with HHS Legal Services, as appropriate; and
  3. fills out an HHS-4740 Security Incident Report within 48 hours of the date the allegation was made and forwards it by email to:

If a licensed professional is involved as an alleged perpetrator, the information must be reported to the appropriate professional licensure agency as well.

If injuries are sustained as the result of an alleged incident, the employee, supervisor, manager, or appropriate contract manager must also:

  1. enter an Accident/Incident report in CAPPS, then download and email an electronic copy to the CRS Incident Report mailbox; or
  2. complete HR0805, Accident/Incident Investigation Report, and submit the form to

23.3 Provider Responsibilities

The provider must develop policies and procedures regarding the recognition and appropriate reporting of such allegations or incidents. If a CRS consumer is involved in an allegation of abuse, exploitation, or neglect, these procedures must also require notification of the appropriate CRS counselor and the liaison counselor within one business day. Procedures must also ensure cooperation with investigations conducted by the CRS program.

The appropriate investigating agency's toll-free number and the CRS liaison counselor's office number must be posted in a location that is readily accessible to consumers and to the staff.

Upon notification of abuse, neglect, and exploitation allegations that involve a CRS consumer, the provider must cooperate with the CRS program staff member with respect to providing information about the incident.

23.4 Reporting to Investigatory Agencies

A CRS program staff member who has cause to believe that a minor child, an adult with a disability, or a person 65 years of age or older is at risk of or in a state of harm due to abuse, neglect, or exploitation shall immediately report the information to the appropriate investigatory agency. (See the table in 23.5 Reporting Process Table.) If the incident is a threat to health or safety, also immediately report the incident to the local law enforcement agency.

It is required to report suspected abuse, neglect, or exploitation to the appropriate investigatory agency directly, regardless of the circumstances.

23.5 Reporting Process Table

If the alleged abuse, neglect, or exploitation occurs in:

The CRS program staff member who has cause to believe abuse, neglect, or exploitation has occurred, reports the information to:

  • A Texas Department of Family and Protective Services licensed childcare operation, including a residential childcare operation.
  • A state licensed facility or community center that provides services for mental health, intellectual disabilities, or related conditions;
  • An adult foster home (with three or fewer consumers, which is not licensed by DADS);
  • An unlicensed room and board facility;
  • A school; or
  • A person's home.

Texas Department of Family and Protective Services Statewide Intake
P.O. Box 149030
Austin, Texas 78714-9030
Voice 1-800-252-5400
Fax (512) 832-2090

www.txabusehotline.org

A Texas Department of Aging and Disability Services (DADS) licensed assisted living care facility, nursing home, adult day care, private intermediate care facility for individuals with intellectual disability (ICF/ID), or adult foster care

Texas Department of Aging and Disability Services
Complaints Management & Investigations
P.O. Box 149030, Mail Code E-340
Austin, Texas 78714-9030
1-800-458-9858

A Texas Department of State Health Services licensed substance abuse facility or program

Texas Department of State Health Services
Substance Abuse Compliance Group
Investigations
1100 W. 49th St.
Austin, Texas 78756
Mail Code 2823
1-800-832-9623

The Criss Cole Rehabilitation Center, Texas Department of Assistive and Rehabilitative Services,
4800 N. Lamar Blvd.
Austin, Texas 78756

Report incident to DARS Incident Report Mailbox at: DARS.IncidentReport@dars.state.tx.us

Follow relevant policy found in the Criss Cole Rehabilitation Center Policy Manual Section 3.6

A Texas Department of State Health Service licensed hospital

Texas Department of State Health Services
Facility Licensing Group
1100 W. 49th St.
Austin, TX 78756
Complaint Hotline
1-888- 973-0022

23.6 Allegations Involving a Comprehensive Rehabilitation Services Provider as Alleged Perpetrator

To report consumer allegations of abuse, neglect, or exploitation that involve a CRS provider as the alleged perpetrator, the:

  1. CRS program staff member or manager contacts law enforcement if the incident is a threat to health or safety;
  2. CRS program staff member or manager consults with the contract manager to determine a course of action;
  3. the manager or supervisor consults with Health and Human Services (HHS) Legal Services, as appropriate; and
  4. the CRS program staff member or manager fills out an HHS-4740 Security Incident Report within 48 hours of the date the allegation was made and forwards it by email to:

If injuries are sustained as the result of an alleged incident, the CRS program staff member or manager must also:

  1. enter an Accident/Incident report in CAPPS, and send an electronic copy to the CRS Incident Report mailbox; or
  2. complete HR0805, Accident/Incident Investigation Report, and submit to:
    • HHS Enterprise Risk Management by interagency mail to Mail Code 1529 or by fax to (512) 706-7353; and
    • the CRS Incident Report mailbox.

Chapter 24: Purchasing Goods and Services for Consumers

24.1 Overview of Purchasing Policies and Procedures

The policies and procedures in this chapter describe the requirements for purchasing of goods and services for CRS consumers. Information about goods and services that have additional requirements (such as approvals, consultations, or specific documentation) are located within the specific section of the policy manual for that service (for example, assistive technology or in-house providers).

Policy establishes basic statewide operating principles for programs that:

  • define services and service limitations; and
  • support the highest possible compliance with federal and state law through:
    • best-value purchasing;
    • comparable benefits before authorizing and or paying for consumer goods and services;
    • documentation in ReHabWorks and/or the consumer case file;
    • informed consumer choice;
    • professional and ethical obligations (see Chapter 2: CRS Principles, 2.5 Building Ethical Relationships);
    • provider and facility qualifications (see CRS Standards for Providers Manual); and
    • Individualized Written Rehabilitation Plan (see Chapter 8: Individualized Written Rehabilitation Plan (IWRP).
 

24.1.1 Staff Responsibilities

All agency staff members are responsible for ensuring compliance with purchasing processes. The caseload carrying staff member and his or her supervisor are responsible for all service authorizations.

The authorization for a good or service must be documented clearly in a case note in ReHabWorks before initiating a purchase with a service authorization. Authorization and/or exceptions to policy will not be granted for certain goods and services. For more information on restricted goods and services see 24.6 Purchasing Thresholds and Restrictions.

Purchasing Thresholds and Restrictions

All purchasing activities are subject to internal and or external review, audit, and investigation at any time. As public servants responsible for assisting Texans and serving the taxpayers of this state, CRS staff members are expected to maintain the highest level of ethical conduct. Violation of these policies may result in disciplinary action, up to and including dismissal, and, in some cases, referral to state or federal law enforcement agencies.

Internal Program Resource Staff

The CRS program provides additional support to assist staff in the purchase of goods and services for consumers. The following individuals are available to provide specialized oversight, support, and consultation as needed:

  • medical services coordinator;
  • managers and management teams; and
  • central office program specialists.

If subject matter experts have questions that are not addressed in this chapter, manual, or in other policy and procedure manuals, they must consult with the appropriate internal program resource staff members before completing a service authorization for a good or service.

24.1.2 Documentation

ReHabWorks is the electronic case management system that interfaces with the state comptroller to track and authorize payments for all consumer goods and services.

Purchasing documentation is maintained in both ReHabWorks and in the paper case file.

For more information on documentation requirements, see Chapter 2: CRS Principles, 2.8 Quality Program Management in Documentation, and Chapter 8: Individualized Written Rehabilitation Plan (IWRP).

Paper Case File Documentation

All documents related to the purchasing process are legal records and must be maintained in the consumer's paper case file.

Purchasing documents include:

  • bids;
  • invoices;
  • reports;
  • service authorizations; and
  • related correspondence.

Purchasing documentation must be date-stamped on the date that it is received in the CRS program office. Purchasing documentation must be filed in the consumer's paper case file once the purchasing documentation has been processed.

ReHabWorks does not maintain copies of service authorizations (SA) as they are revised. Print, sign, and file a paper copy of the SA in the consumer's paper case file when the SA is generated.

To ensure that the provider's file accurately reflects the purchasing activities in ReHabWorks, a copy of the SA must be sent to the provider when it is generated. If an SA is changed in any manner, a copy of the new signed SA must also be kept in the consumer's paper case file and sent to the provider as notification of the change. A staff member also must send documentation to service providers when the remaining open-balance quantity is reduced or reaches zero.

24.1.3 Legislation, Policy, Procedures, and Resources

Legislation

Purchasing of goods and services for CRS consumers is subject to state and federal laws. These include, but are not limited to:

  • 34 TAC, Part 1, Chapter 20 Texas Procurement and Support Services;
  • Texas Government Code, Annotated, Section 2155.382(d); and
  • Texas Government Code, Chapter 2155.

The CRS program does not discriminate on the basis of race, color, sex, national origin, age, disability, or veteran status in purchasing consumer goods and services.

Policy and Procedure Manuals

CRS counselors, designated technicians, and other CRS staff members that purchase goods and services for consumers are also subject to the policies and procedures throughout the following manuals:

  • Comprehensive Rehabilitation Services Manual – General Services
  • CRS Standards for Providers Manual
  • Contracting Processes and Procedures Manual
  • Medical Services Required Practices Handbook
  • ReHabWorks User’s Guide

24.2 Key Terms

After-the Fact Purchase – This occurs when a good or service is provided before to the issue of a valid service authorization in ReHabWorks.

Arranged (Services) – A good or service that will be purchased by some source other than the CRS program; for example, a referral to a Community Mental Health Center for ongoing mental health services.

Backdated Ancillary Service Authorization – An additional service authorization issued after the service has been provided when additional services are needed to directly supports the existing service authorization.

Backdated Replacement Service Authorization – A service authorization that is issued to replace an existing service authorization after the delivery of services or goods. This occurs when there is a need to change the level four description on an existing service authorization in ReHabWorks.

Begin Date – The date that the service is expected to start or that the initial delivery of a good is expected.

Best-Value Purchasing – A purchasing decision that is based on a balance between quality, timeliness, service after the sale, and cost;

Comparable Benefits – Benefits are similar to services provided by the CRS program but are provided or paid for by another entity such as Child Protective Services, Employers, Medicaid Programs, Medicaid Waivers, mental health providers, Medicare, private health insurance, workers compensation or another agency or service.

Competitive Bid – An offer to contract with the State submitted in response to a bid invitation. Specific products that are available for purchase through multiple dealers or distributors for the manufacturer or owner of the services.

Competitive Purchase – Specific products that are available for purchase through multiple dealers or distributors for the manufacturer or owner of the services.

Community Rehabilitation Program – Program that provides directly or facilitates the provision of one or more of the following vocational rehabilitation services to individuals with disabilities to enable those individuals to maximize their opportunities for independence, including:

  • medical, psychiatric, psychological, and social services that are provided under one management;
  • testing, fitting, or training in the use of prosthetic and orthotic devices;
  • recreational therapy;
  • physical and occupational therapy;
  • speech, language, and hearing therapy;
  • psychiatric, psychological, and social services, including positive behavior management;
  • assessment for determining eligibility and comprehensive rehabilitation needs;
  • rehabilitation technology;
  • psychosocial rehabilitation services;
  • services to family members if necessary to enable the applicant or eligible individual to achieve a therapeutic outcome; and
  • paraprofessional services.

Date Payment Authorized – The date the pay request is recorded in ReHabWorks.

Discount – A predetermined reduction in the price of a purchased product or service offered by a vendor in exchange for quick payment of an invoiced item. When the discount amount is applied to the invoiced price, the cost of the purchased product or service is reduced.

End Date – The anticipated date that a good is to be delivered or a service is to end. An end date on a service record must fall within the fiscal year for the program selected.

Free on Board (FOB) destination – A designation applied to the delivery of goods whereby the receiver does not own the goods until they arrive at their destination. The FOB destination refers to the point at which the title to goods transfers. This term does not relate to freight charges.

Health Care Provider – A professional providing health care services to consumers. See 24.22 Health Care Professionals—Required Qualifications for more information. 

Health Care Facility – Facility such as a general or specialty hospital, or ambulatory surgical center providing inpatient or outpatient medical services to consumers. See 24.23 Health Care Facilities—Required Qualifications for more information. 

Individualized Written Rehabilitation Plan (IWRP) – A plan developed by CRS staff members and the eligible consumer, which outlines the goals, services, and other aspects of service provision in the CRS program.

Informed Choice –An ongoing process in the CRS program in which the consumer and the counselor cooperate to gather and evaluate information that the consumer uses to make informed choices about outcomes, objectives, and services that could lead to a positive therapeutic outcomes. For more information see Chapter 2: CRS Principles, 2.6 Principles of Informed Choice.

Interagency Transaction Voucher (ITV) – A request for payment from one state agency to another; the state comptroller transfers funds from one agency to another instead of issuing a warrant.

Invoice Date – The date an invoice was date-stamped by the CRS program office that is named on the service authorization. If the invoice had an error, the invoice date is the date the corrected invoice was received and date stamped.

Non-competitive Purchase – Purchase of goods or services involving direct dealing with the interested entity (vendor) using an application or enrollment process. Also see spot purchase.

Obligating Funds – Funds which are committed, through a service authorization, to pay a provider for goods and/or services provided.

Payee – Individual or entity who receives payment from the CRS program for goods or services.

Periodic payment – An expenditure used when a service is provided and paid over a defined but recurring period of time. For example, training programs that bill on a monthly basis.

Program year – The period that begins September 1st of a calendar year and ends August 31st of the next calendar year.

Proprietary Purchase – The proposed purchase allows only one product or service to be supplied, and preclude any other product or supplier or provider from meeting the specifications.

Provided Good and/or Service A service that is delivered directly by a member of the CRS program, such as counseling and guidance by a CRS counselor. This can also be a good that is provided directly to the consumer with no direct cost to the agency.

Provider – Any individual or business that the CRS program can purchase goods and services from for consumers (also see vendor).

Purchased Good and/or Service – A good or service that will be purchased using CRS funds;

Receive Date – The date a good was received or a service was completed. For detailed information on determining the appropriate date to use for the receive date, (See ReHabWorks Users Guide, Chapter 18 Case Acknowledgement of Receipt ).

Rehabilitation Technology – The systematic application of technologies, engineering methodologies, or scientific principles to meet the needs of, and address the barriers confronted by, individuals with disabilities in areas that include education, rehabilitation, employment, transportation, independent living, recreation, and home and vehicular modification. It refers also to other assistive devices including, but not limited to hearing aids, low vision aids, and wheelchairs. Rehabilitation technology includes rehabilitation engineering, assistive technology devices, and assistive technology services.

Report Receive Date – The date entered in ReHabWorks to indicate that an acceptable, complete, and accurate report and all required forms or other documentation were received from the provider.

Restricted Donation – A cash donation made to the CRS program for use in providing services to CRS consumers. The donor can specify a specific purpose, program, CRS program office, or caseload, where the funds are to be utilized. If accepted in accordance with the donor's wishes, the funds may be used only for the stated purpose.

Separation of Duties – A minimum of two staff members to complete each consumer purchase—one staff person to make the purchase and another one to authorize payment.

Service Authorization (SA) – A request for a provider to supply goods or services to meet the stated specifications in accordance with the defined terms and conditions; A service authorization obligates funds from the case load budget. It is the only valid way to authorize purchases (previously referred to as a purchase order).

Service Completion Date – The date the consumer product is received, the date the consumer service is completed (including receipt of the provider's written report if applicable), or the date the provider's invoice is received, whichever is later.

Service Justification Case Note – A case note or series of case notes that is entered into ReHabWorks to authorize a service or good for a consumer. It must include the type of service, goal of service, specific provider, begin and end dates of service, information about any available comparable benefits, and information about how the consumer exercised informed choice.

Service Record – A planning document created in ReHabWorks for services and/or goods that are arranged, provided, or purchased for the consumer. The Service Records in a case also help document the substantial services provided to a consumer. For a purchased good or service, a Service Record contains information that is used to create a service authorization. Caseload-carrying staff (or their support staff) may need to create Service Records to request services from an in-house vendor.

Sole Source – Product or service is only available for purchase through the specific identified vendor. These vendors are usually the manufacturer. For example, a type of software that is only available from one provider.

Specification – A description of the good or service that tells the vendor exactly what will be purchased.

Specification customization – The process of adding detailed information to a level four specification so the provider has a clear understanding of CRS expectations. See also specification and specification levels. For additional information, see ReHabWorks Users Guide, Chapter 16 Case Service Record, 16.2.4, Select Specification.

Specification levels – Descriptions of goods or services used when creating a service record in ReHabWorks that go from general (level one) to detailed (level four) allowing buyers to drill down to what they need to buy. See also specification.

Spot purchase – The purchase of anon-contracted good or service costing less than $5,000.00.

Start date (service record) – The date a good is ordered or the date a service is expected to begin. For more information see ReHabWorks Users Guide, Chapter 17 Case Purchase Order.

State fiscal year – The twelve months beginning September 1 and ending August 31.

Third Party Payment – Payment received from comparable benefits utilized for goods or services arranged for consumers. For example, Medicaid or private insurance as payer for a medical good or service instead of the CRS program.

Texas Identification Number (TIN) – A 14-digit number issued to entities (i.e., sole owner, individual recipient, partnership, corporation or other organization) billing the CRS program for goods or services. The state comptroller requires the TIN on requests from any party receiving payment from the State of Texas.

Vendor – An individual or business entity that offers goods or services to the state for sale, lease, lease-purchase, or contract. Vendors are sometimes referred to as providers. Characteristics of a vendor include when the organization:

  • provides the goods and services within normal business operations;
  • provides similar goods or services to many different purchasers;
  • operates in a competitive environment;
  • provides goods or services that are ancillary to the operation of the federal/state program; and
  • is not subject to compliance requirements of the federal/state program.

Note: A vendor may also be referred to as a provider, particularly when the entity provides services to CRS consumers.

24.3 Principles of Purchasing

All purchases must be authorized by a counselor or his or her designee in the consumer’s valid Individualized Written Rehabilitation Plan (IWRP) and/or in a service justification case note. The IWRP and/or service justification case note must be entered into ReHabWorks before obligating funds with a service authorization.

24.3.2 Best Value Purchasing

A CRS staff member must apply the best-value purchasing approach when making consumer purchases. This approach ensures that staff members authorizing a purchase are not restricted to considering only the initial cost of a purchase; they must also evaluate the factors that will influence the total cost and value to the consumer and the agency.

These factors include but are not limited to:

  • installation costs;
  • warranties;
  • life-cycle costs;
  • quality and reliability;
  • delivery costs and terms;
  • timeliness of the delivery;
  • the cost of training associated with a purchase; and
  • indicators of probable provider performance (for example, the provider's past performance, financial resources, ability to perform, experience, responsibility, reputation, and ability to provide reliable maintenance and support).

24.3.3 Informed Consumer Choice

A consumer and the consumer’s representative, as appropriate, must be involved in decision making in all aspects of services for CRS for the consumer, including selecting the goods, services, and providers during the purchasing process.

You must document the consumer’s involvement in selection of goods, services, and/or providers in a case note.

For more information about informed choice, refer to Chapter 2: CRS Principles, 2.6 Principles of Informed Choice.

 

24.3.4 Use of Comparable Benefits

Available comparable benefits must be used prior to authorizing or encumbering CRS funds for a purchase.

Exploration and/or use of comparable benefits must be documented in a case note prior to completing a service authorization for a good or service.

24.3.5 Separation of Duties

A minimum of two staff members are required to complete—issue, receive and authorize payment— each consumer purchase to ensure that integrity is maintained throughout the purchasing process.

ReHabWorks (RHW) is designed so that the same person cannot authorize payment for a service authorization they created or made changes to at any point in the purchasing process.

24.3.1 Making Purchasing Decisions

The decision-making process should include consideration of:

  • the cost, accessibility, type, and duration of the services;
  • consumer satisfaction with the proposed services;
  • compliance of the providers with the Americans with Disabilities Act;
  • the qualifications of service providers;
  • the setting in which the services are provided; and
  • the history of success with other consumers.

24.4 Purchasing Process Steps

The process of purchasing a good or service for a consumer is primarily initiated by a counselor.

Purchases must support a consumer’s Therapeutic outcome. Purchases made prior to the completion of the Individualized Written Rehabilitation Plan (IWRP) are limited to diagnostics and services needed to complete diagnostics.

Purchases initiated before the IWRP is completed are documented in a service justification case note.

Purchases made after the IWRP is completed must be included on IWRP, an IWRP amendment, or service justification case note.

24.4.1 Purchasing Process Steps

Step 1

Identify needed purchase of a good or service.

Research and collect required approvals and authorizations by referencing appropriate program manuals.

For information about types of purchases see 24.10 Types of Purchases. For additional information about specific goods and services consult appropriate program manuals.

Step 2

Document the need and type of purchase in:

  • a service justification case note;
  • an Individualized Written Rehabilitation Plan (IWRP); or
  • an IWRP amendment.

Step 3

Create a service record. For more information see ReHabWorks Users Guide, Chapter 16 Case Service Record.

Complete the specification on the service record to identify precisely the item or service. Document required approvals according to policy.

Edit the level-four specification descriptions to match what you want to buy. All specifications can be customized except:

  • Maximum Affordable Payment Schedule; and
  • specifications flagged by Health and Human Services Procurement Services, which usually are contracted items.

Step 4

Create a service authorization to obligate budget. For more information see ReHabWorks Users Guide, Chapter 17 Case Purchase Order.

Step 5

Print the SA. The printed SA must be signed by the issuer, and then sent to the vendor by mail, fax, or encrypted email. Depending on the manner in which the SA is sent to the vendor, the staff member files the original signed SA or a copy of it in the consumer's case folder.

Any time the SA is revised, these steps must be completed again and the new or updated SA must be sent to the vendor and filed in the paper case file. For more information about revising a SA, see 24.5.1 After-the-Fact Purchases.

Step 6

If it becomes apparent that the total committed budget will not be used reduce the quantity and/or unit cost in the SA. For information on closing out a service authorization refer to ReHabWorks Users Guide, Chapter 17 Case Purchase Order.

Step 7

Receive and document the receipt of goods and services. Verify that goods and/or services were delivered in good condition and met specifications.

Step 8

Within seven days, process the invoice (See section 24.9 Invoices for more information).

 

24.5 After-the-Fact Purchases and Revisions to a Service Authorization

Before contacting the vendor to order, request, or schedule the delivery of goods or the provision of services, it is the requester's responsibility to ensure a service authorization was generated and sent to the service provider.

In accordance with the General Appropriations Act (GAA), a state agency must not obligate funds in an amount greater than the amount listed on the service authorization. If it is determined that a staff member obligated funds without following policy, the comptroller is required to deduct the amount of the over-obligation from the salary or other compensation due to the responsible employee with the deducted amount being applied to payment of the obligation.

24.5.1 After-the-Fact Purchases

When a delay of services may endanger a consumer’s well-being, the counselor may authorize hospital or medical services prior to the completion of a service authorization. A CRS program manager must approve an exception before the staff member obligates the budget. Approval must be documented in a case note before the service authorization is generated in RHW.

Management exceptions to after the fact purchases are not permitted.

24.5.2 Backdated Ancillary Service Authorization

A backdated ancillary service authorization is issued after the service has been provided and additional services are needed to directly support the existing service authorization.

When this happens, you can:

  • document the change to the service authorization in the "Comments" section of the original SA, provided a change in services is not significant; or
  • replace the existing SA with a new one (for example, when the specification or the provider changed).

Backdated ancillary service authorizations do not require management approval, but must be justified in a case note before generating the SA in ReHabWorks.

The case note must include the SA number of the original related SA.

The comments section of the backdated ancillary service authorization must include the SA number of the original SA.

For more information about revising a SA, see ReHabWorks Users Guide, Chapter 17 Case Purchase Order, 17.10 PO Change.

24.5.3 Backdated Replacement Service Authorization

The specifications in a service authorization (SA) may change after the delivery of services. If services are delivered by the same vendor and there is a revision to services, such as a change in Maximum Affordable Payment Schedule codes, and manager or medical director approval was required on the initial SA, manager or medical director approval is required on the backdated replacement service authorization.

Approval by the manager or medical director must be documented in the paper case file before the replacement service authorization is issued. If no approvals were required for the original service authorization or the new service authorization, then no additional approvals are required.

Staff must document the need for the backdated replacement service authorization in a case note before generating the replacement SA. The comments section of the backdated replacement service authorization must reference the original SA number.

24.5.4 No Show Payments

A "no-show" occurs when a CRS consumer:

  • misses an appointment for a CRS sponsored service being provided by a psychiatrist, social worker, licensed professional counselor, or psychologist; and
  • does not properly cancel the appointment.

The CRS program accepts for consideration only the no-show billings received from a psychiatrist, social worker, licensed professional counselor, or psychologist. No-show occurrences for other disciplines, specialties, and contractors are not subject to or eligible for no-show payments from the CRS program as described in the above policy. The CRP must notify the counselor within one working day of the consumer’s failure to appear. For more information, see CRS Standards for Providers Manual.

Process the No-Show Payment

If a no-show occurs and if the provider chooses to bill the CRS program for the no-show, the acceptable fee is limited to 50 percent of the payment allowed by the Maximum Affordable Payment Schedule for the codes authorized on the service authorization.

No-show payments are processed in the same manner as any other provider payment. For more information see ReHabWorks Users Guide, Chapter 16 Case Service Record.

24.6 Purchasing Thresholds and Restrictions

Purchasing thresholds are established to ensure management oversight of high cost and high risk purchases. Review associated policy in the CRS Manual, in addition to reviewing the charts in this section.

If the product or service is not under contract or a Maximum Affordable Payment Schedule purchase and the cost is less than $5,000.00, the purchase should be completed using a commercial source. This process is known as a "spot" purchase.

Purchasing restrictions apply to all CRS purchases.

For more information on exceptions to policies, refer to Chapter 33: Required Approvals, 33.2 Required Approvals and/or Consultations.

24.6.1 CRS Purchasing Threshold Approval Requirements

Purchase costs per item

Approval needed from …

Competitive bids required

$2,000 or less

Counselor

No

$2,000 to $5,000

Manager

No

$5,000 and more

Manager

Required for goods or services greater than $5,000 if the purchase is:

  • Not a contracted item; and/or
  • Not using the Maximum Affordable Payment Schedule fee schedule

For all purchases over $2,000, approval and review by management must be noted in ReHabWorks and TxROCS. For additional information, see Chapter 34: Case Reviews.

For additional information about required approvals, refer to the Chapter 33: Required Approvals, 33.2 Required Approvals and/or Consultations.

24.6.2 Purchasing Restrictions

The following goods and services may not be purchased by the CRS program for consumer use (management exceptions are not permitted):

  • bonding fees;
  • buildings or other structures that requires a fixed foundation and/or that is not movable;
  • criminal or civil fines or penalties, including traffic ticket fines;
  • fees for registration of inventions, patents, trademarks, or copyrights;
  • fees for use of a franchise name;
  • firearms of any kind or components that are part of a firearm;
  • insurance;
  • land;
  • operating capital (for example, for self-employment);
  • state or municipal tax assessments on occupations;
  • vehicles to be used on public roads or highways that have not or will not be modified for accessibility and require a certificate of title or registration to be used on roads (check with the Department of Public Safety for more information); and
  • trailers, boats, or other items that require a certificate of title or registration to be used on public roads, highways, or waterways (check with the Department of Public Safety for more information; for example, many small trailers do not require a title of ownership).

Check with the Department of Public Safety for information about specific regulations (for example, some small trailers do not require a title of ownership).

24.6.3 Payee Restrictions

To prevent a conflict of interest, the CRS program must not purchase goods or services for the consumer from a provider who is serving as the consumer's representative.

Goods and services may be purchased from a provider who is serving as the consumer's representative only:

  • before the consumer designates the provider as his or her representative; or
  • after the consumer has revoked the provider's authority to act as his or her representative.

The manager must not make an exception to this policy.

24.7 Ordering Goods for Consumers

Goods and services must be authorized with a service authorization prior to the good or service being ordered or provided. The Issue Date of the service authorization must be on or before the Start Date.

24.7.1 Free On Board (FOB) destination

When issuing a service authorization for goods that will be shipped to the office or directly to the consumer, you must include “FOB destination” on the service authorization as a condition of the purchase.

If the provider will not ship FOB destination, locate another resource, if possible.

FOB applies to the purchase of goods such that the CRS program does not own the goods until they arrive and are accepted at the destination identified on the service authorization. The risk of loss to goods does not pass to the CRS program until the goods are delivered and the shipment is accepted.

When the goods are damaged in transit or are not accepted or received, the provider is responsible for shipping new or replacement goods without additional expense to the CRS program.

24.8 Verifying Receipt of Goods and Services

Verifying receipt and accuracy of orders is an essential part of the purchasing process that actively confirms either that:

  • the goods were delivered in good condition and met specifications; or
  • the services were completed according to specifications.

24.8.1 Accepting Delivery of Goods

When consumer purchases are delivered to a CRS program office, process the deliveries the same way other administrative deliveries are processed. A CRS program staff member follows the procedure below.

Before accepting the delivery:

  • verify that the shipment is addressed to the appropriate office;
  • inspect the shipping packages for any visible damage; and
  • ensure that the shipment contains the correct number of packages as stated on the shipping documentation.

Acknowledge the shipment by signing the shipping document if the shipment:

  • appears undamaged;
  • matches the quantity on the shipping document; and
  • is correctly addressed to the receiving CRS program office.

Assess and document the shipment status in a ReHabWorks case note.

If the shipment appears damaged but the damage seems minor:

  • accept the shipment, noting the number of damaged packages on the shipping document; or
  • refuse the shipment, noting that the refusal is due to damages to the shipment.

If the damage is or appears to be severe:

  • refuse the shipment, noting the refusal and the damages on the shipping document; and
  • notify the vendor and the caseload carrying staff of the damaged shipment.

Do not accept collect or cash on delivery (COD) deliveries or deliveries made to the wrong office. If a vendor erroneously ships collect or COD, refuse the shipment.

If goods or services do not meet the appropriate conditions listed above, initiate corrections. When the goods or services meet the conditions, document their receipt in ReHabWorks.

24.8.2 Documenting Receipt of Services

Contact the consumer to gather the appropriate service verification.

If the consumer is not available initially to verify receipt of the service, you must document in case notes your attempts to verify receipt of the service, as follows:

  1. You attempt to contact the consumer to verify that the service met the specifications and document this in a case note.
  2. Continue to attempt contact with the consumer, after 20 days have elapsed since the receipt of the invoice. Record in case notes each attempt to contact the consumer.
  3. When contacted, you get the consumer's signature, if required, that the service met specifications and file this in the paper case file. If signature is not required, you record the consumer's response in case notes.

If the consumer cannot be contacted, consult the area manager for guidance.

If required, you get the consumer's signature that the service met specifications and file this in the paper case file. If signature is not required, you record the consumer's response in case notes.

For a one-time maintenance or transportation payment, ReHabWorks automatically creates the receive record(s) once a service authorization is generated. Therefore, the buyer needs to verify only the payment authorization.

Provider Reports

In some cases, the CRS program purchases a service that requires the provider to develop and submit a report. For example, a medical examination results in a medical report. The receipt date is the date the exam (service) takes place. The report receive date is an additional date required for all services with reports. The report receive date is the date the report is received in the CRS program office listed on the authorizing service authorization.

Enter the date in ReHabWorks within seven working days of receipt of an acceptable, complete, and accurate report.

24.9 Invoices

Vendors must submit invoices to the office address listed on the CRS service authorization.

The invoice must comply with:

  • applicable contract;
  • CRS Standards for Providers;
  • CRS Manual; and
  • service authorization terms and conditions.

Within seven calendars days of receiving an invoice, the staff member must:

24.9.1 Date Stamping Invoices

The front of all invoices must be date-stamped upon receipt in the CRS program office. If the envelope is date-stamped, keep the envelope as part of the paper case file. If the invoice is received via email, print the invoice and stamp it with the date received in the office. For faxed invoices, if the date on the fax tagline is correct and up-to–date, then that date reflects the date received in the office. Document the fax in the paper case file.

24.9.2 Elements of an Invoice

At a minimum, the invoice must include:

  • vendor's complete name and address;
  • vendor's 14-digit Texas Identification number (TIN);
  • vendor's contact name and telephone number;
  • CRS program service authorization number;
  • CRS program office delivery address;
  • CRS program contract number, if applicable;
  • a description of the goods or services provided including the dates of service;
  • quantity, unit cost being billed and as documented on the original order; and
  • other relevant information supporting and explaining the payment requested or identifying a successor organization to an original vendor, if necessary.

Additional documentation may be required to accompany invoices, subject to the specific program’s published standards.

Optional Information on the invoice may include:

  • the provider's invoice number;
  • the provider’s fax number; and
  • the name of the counselor or other staff involved.

24.9.3 Incomplete Invoices

Do not authorize payment for a product or service without an accurate and complete invoice from the provider.

When an invoice is inaccurate or incomplete, use the following process to return it to the vendor for correction:

  1. Return the invoice to the vendor within 21 days of receipt using the DARS3460 Vendor Invoice Additional Data Request. This form is the means by which the CRS program indicates to the vendor what additional information the state agency requires in order to process payment to the vendor.
  2. Create a ReHabWorks case note to document the date on which the invoice was sent back to the vendor and why it had to be returned.
  3. Upon receipt of the corrected invoice, it should be date-stamped, and used as the invoice of record for the purchase.
  4. Do not acknowledge receipt of the invoice in ReHabWorks until the provider submits a corrected invoice or until the disputed point is resolved. The date of resolution should be used as the invoice received date in ReHabWorks and invoice should be date-stamped with that date.

Note: The date of resolution should be used as the invoice received date in ReHabWorks, and the invoice should be date-stamped with that date.

For medical billing invoices, attach the ReHabWorks-generated invoice to the medical billing invoice.

24.9.4 Invoice is Not Received

Do not enter an invoice received date in ReHabWorks prior to receiving the invoice.

When vendors do not submit invoices in a timely manner, follow-up with the service provider by contacting their accounts payable department.

If the provider does not have their own invoicing system or template, the service authorization issuer should:

  • print the RHW standard invoice for the service authorization; and
  • send it to the provider so they can complete and resubmit it to the CRS program.

24.9.5 Invoice Includes Late Payment Fee

Late fees are automatically calculated and paid by the State Comptroller based on the Texas Prompt Payment Act. The determination of a late fee is based on the receive date and invoice date that are entered into ReHabWorks. The CRS program does not pay late fees that are directly invoiced by the provider.

If a provider submits an invoice that includes a late payment fee:

  • do not pay the late fee;
  • make a note on the invoice;
  • subtract the late fee amount from the invoice total; and
  • authorize payment for the corrected amount.

24.9.6 Acknowledging Receipt of an Invoice in ReHabWorks

See ReHabWorks Users Guide, Chapter 18 Case Acknowledgement of Receipt, 18.1.3 Adding or Updating a Receive Item for detailed instructions.

24.10 Types of Purchases

Goods and services can be purchased for consumers from a variety of community rehabilitation programs and vendors, including, but not limited to contracted providers, non-contracted providers, and medical service providers.

A Community Rehabilitation Program provides directly or facilitates the provision of one or more of the following rehabilitation services to individuals with disabilities so that they can maximize their opportunities for therapeutic advancement. For more information see 24.2 Key Terms.

Each type of purchase has specific steps that must be completed to ensure compliance with state comptroller purchasing requirements.

24.10.1 Non-competitive Purchases

Purchases of goods and/or services in the amount of $5,000 or less from a single vendor are not required to have competitive bids, but must conform to the purchasing guidelines and principles detailed in this chapter. All purchases, except contracted services such as power wheelchairs, costing more than $5,000, must be competitively bid or approved as a Proprietary or Sole Source Purchase (See 24.10.2 Proprietary/Sole Source Purchases).

When a Service Authorization for more than $5,000 is entered into the ReHabWorks, ReHabWorks will automatically create a draft Service Authorization (See ReHabWorks Users Guide, Chapter 19 Case Authorizing Payment, 19.6 PO Close).

The draft SA (called a draft purchase order in ReHabWorks) generates an action for Health and Human Services Procurement Services Customer Services to get bids and assign a buyer if appropriate. (See ReHabWorks Users Guide, Chapter 19 Case Authorizing Payment, 19.6 PO Close.)

 

24.10.2 Proprietary/Sole Source Purchases

A proprietary or sole source purchase occurs when only one brand name (manufacturer), or only one provider, can meet the agency’s specifications for the product or service because of distinctive features or characteristics that are not shared or provided by competing companies, similar products, or comparable services. When the specification limits consideration to one product or supplier, the case file must contain a written and approved DARS1322, Proprietary Purchase Justification.

A proprietary or sole source purchase justification is required, if the above and one or more of the following, applies:

  • the planned purchase exceeds $5,000;
  • the planned purchase does not involve Maximum Affordable Payment Schedule;
  • the planned purchase not is for tuition; and
  • no contract is applicable.

In this case, use DARS1322, Proprietary Purchase Justification, for consumer or consumer-related purchases.

A Proprietary Purchase or Sole Source Transaction may not exceed $25,000 and this is not subject to area manager exception.

24.10.3 Contracted Goods/Services

When purchasing contracted goods and services, you must refer to the:

Contract administration staff members solicit and manage contracts for CRS program goods and services. Some goods or services must be purchased under contract. Before purchasing a good or service, use ReHabWorks to find out if a contract is required. When the service authorization is generated, ReHabWorks assigns the contract number based on the vendor and the type of purchase. Refer to the ReHabWorks User's Guide, Chapter 16 Case Service Record for more information about creating a service record.

Consumer goods and services that are purchased under contract include, but are not limited to:

  • rehabilitation technology, such as:
    • hospital services;
    • inpatient or outpatient services; and
    • inpatient comprehensive medical rehabilitation services;
  • post-acute rehabilitation services; and
  • nonresidential services and equipment, such as:
    • some medical equipment;
    • durable medical equipment;
    • manual wheelchairs (fully functional chairs);
    • scooters;
    • seating and positioning systems;
    • patient lifts;
    • power wheelchairs (fully functional chairs);
    • hospital beds;
    • power units and controllers; and
    • hearing aids.

Ensuring a Contract is Valid

The CRS program must note the contract numbers related to the goods or services purchased under contract and ensure that the contract is current on the service authorization.

When creating a service record in ReHabWorks to purchase goods or services that require a contract, make sure the contract for the selected good or service is valid during the entire planned period of service by using the procedure below.

Review the provider contract information in ReHabWorks from the Service Record page by:

  • selecting the Vendor Detail button;
  • accessing the vendor's details by selecting the vendor's name; and
  • viewing the contract details by selecting the contract number.

Read the contract details carefully to ensure that the contracted good or service is included in the contract and the dates of service are within the contract start and end dates.

If the contract is not valid when the good or service is purchased or delivered, do not use that good or service. Instead, be sure to:

  • continue to search in ReHabWorks for a valid good or service; and
  • consult with your manager if you are unable to locate a valid good or service.

In the comments section of the service authorization, enter all special instructions or requirements for the specific good or service being purchased. Refer to the ReHabWorks User’s Guide, Chapter 16 Case Service Record for more information about creating a service record.

24.11 Medical and Psychological Services Billing

Payment for medical and psychological services must be authorized by CRS program staff members and must support the rehabilitation services and goals.

Medical and psychological services, including medical goods and supplies, are purchased using Maximum Affordable Payment Schedule (MAPS) coding and pricing. MAPS codes establish the maximum payment that can be authorized for these services. Staff should work closely with the provider to ensure payment corresponds to the correct MAPS code(s). Treatment decisions and accurate identification of the applicable MAPS code are the responsibility of the consumer's healthcare provider and designated program staff or consultants.

The CRS program utilizes the Medical Services Required Practices Handbook to provide guidance to the medical services coordinator, medical services technician, counselor, and rehabilitation services technician who coordinate medical services for consumers.

Fees in excess of the contracted fee for a specific service or for MAPS fees are not authorized; managers may not authorize an exception.

24.12 Exceptions to Contracts

24.12.1 Providers Without a Contract

Contracts are the required instrument to purchase most goods or services. Before creating a service record, check ReHabWorks to verify whether a contract is required.

If a contract is required, case-by-case exceptions to a contract requirement may be approved only in situations where the exception is:

  • in the best interest of the CRS program;
  • in the best interest of the CRS consumer;
  • necessary and appropriate;
  • in accordance with the consumer’s plan; and
  • in accordance with state or federal laws.

The CRS program manager reviews exceptions.

24.12.2 Process for Exceptions to Contracts

The following process applies to all contracts except for hospital contracts. For more information about exceptions to hospital contracts.

Counselor

  1. documents a contract-exception request in an email or memo that describes the consumer's need for a specific contracted good or service. (The request explains that a non-contracted vendor is needed to best serve the consumer in achieving his or her plan objective.); and
  2. sends the contract exception request email or memo to the manager for review and approval.

Manager

  1. reviews and concurs with the request or denies the contract exception request; and
  2. sends the requested documentation to the CRS program manager for review and concurrence or denial.

CRS Program Manager

  1. reviews and concurs with or denies the request; and
  2. sends the request documentation to the appropriate executive staff for review and approval.

Executive Staff

  1. reviews and approves or denies the request;
  2. make final approval; and
  3. sends the approved exception to the CRS program manager.

CRS Program Manager

  1. returns the approval through the chain of command to the counselor.

If at any time the request for a contract exception is denied, the document is returned through the chain of command to the caseload carrying staff member.

Hospitals without CRS Program Contracts

If a consumer needs a medical service at a hospital that does not have a CRS program contract, the assigned medical service coordinator must contact the CRS central office program manager to negotiate a payment rate for the medical service. A DARS3423, Exception to Contracted Hospital Purchase must be completed and submitted through the CRS program manager.

24.12.3 Exceptions to Hospital Contracts

Hospital contracts allow for payments below the contracted rate or in addition to the contracted rate when the consumer's circumstances warrant. See "Exceptions to payment rate limits" in the Chapter 27: Hospital and Ambulatory Surgery Center Services for instructions including use of DARS3422, Reduced Payment Agreement.

24.12.4 Process for Documenting Modifications to Contracts

When the caseload carrying staff member's manager reviews and concurs with an exception to a policy regarding a service provided under a contract, such as changes in the service description so that the service is individualized for a specific consumer, approval must be recorded on the DARS3472, Contracted Service Modification Request.

The DARS3472, Contracted Service Modification Request, must be:

  • signed by the Program Executive; and
  • countersigned by the contractor.

A copy of the completed DARS3472 must be retained in the consumer file.

The counselor forwards a copy of the completed DARS3472 to the contract manager.

Exceptions to Contracted Fees

Fees in excess of the contracted fee for a specific service are not allowed and managers may not authorize an exception.

24.13 Noncontract Purchases from Contract Providers

Goods or services that do not require a contract can be purchased from a provider that also supplies contracted goods or services to the CRS consumers. In this instance, when creating a service record and service authorization in ReHabWorks, do not select a contract number; instead choose “none” when prompted.

24.14 Program Year

To determine the program year for services when creating a service record:

  • select the program year in which the service occurs; and
  • prorate when crossing program years. Then follow the steps below in numerical order.

Services

Select the program year in which the service will be provided.

Goods and Supplies

Select the program year in which you order the goods.

24.15 Crossing State Fiscal Years

The fiscal year for federally funded programs starts October 1 and ends September 30. The fiscal year for state-funded programs starts September 1 and ends August 31.

Ordering and Receiving

Charge goods to the state fiscal year in which they were ordered. The receive date does not have to fall within the start and end dates and may be in the following fiscal year.

Example: A special order of a wheelchair on August 3, 2015, using Program 2015 VR Basic Support. The start date is the date the order was placed—06/03/2015.

The end date is the anticipated receipt date and, because of ReHabWorks requirement, must be within the state fiscal year. In this case, the anticipated receipt date is after the end of the fiscal year, so enter in ReHabWorks the end date of the fiscal year, 08/31/2015.

Since the chair is a good, the chair's receive date can be later than the anticipated end date. If the chair arrives September 27, 2015, enter 09/27/2015 as the receive date.

24.15.1 Prorating Services

If there are funds available in the budget in ReHabWorks, it is not necessary to prorate services across fiscal years.

Charge most services to the state fiscal year in which the service occurred. For more information, see 24.14 Program Year.

When part of a service falls in the next state fiscal year, charge that part to that state fiscal year. When setting up the service record, create two line items—one for each state fiscal year—and prorate the charge proportionately.

Example: When one week of service occurs in August and two weeks in September, charge one-third to August and two-thirds to September.

Tips for Prorating

When prorating:

  • do not put zero in the Unit Amount or Unit Cost. Make an informed estimate of the cost and increase or decrease the amount in the service authorization later;
  • use 30 days for all months when prorating a monthly payment; and
  • enter amounts for line items (Line-item amounts do not have to be precise, but the total of the line items must equal the total amount due.)

For more information about prorating payment see ReHabWorks Users Guide, Chapter 16 Case Service Record, 16.2 Service Record, 16.2.8 Service Record Line Item 16.2.8.4 Prorating Payments for Services.

24.16 Other Types of Payments and Purchases

24.16.1 Periodic Payments

Periodic payments are used when a consumer service is provided and paid over a defined but recurring period of time such as training programs that bill monthly, consumer maintenance, and reader services.

The receive date for periodic payments is the last day of the billing period. When the periodic payment is for one month, for example, the receive date for each payment is the last day of the month.

For information about how to enter a periodic payment in ReHabWorks. See ReHabWorks User Guide, Chapter 19: Case Authorizing Payment.

24.16.2 Paying in Advance

Advance payment or prepayment occurs when payment for a consumer service is issued before the service is delivered. Payment usually is not made in advance of service.

In many cases, advance payments are issued directly to the consumer or a member of the consumer's family.

Consumer services for which advance payment may be authorized include:

  • consumer maintenance;
  • consumer transportation (such as airfare, train tickets, and bus tickets);
  • weekly or monthly bus passes;
  • child care; and
  • tuition.

The table below lists the only circumstances when advanced pay may be issued. Advance payments may be received and authorized anytime from the "as early as date" to the actual completion date of the service. The date entered in the receipt acknowledgment in ReHabWorks is the receive date.

Advanced Pay Situations

Pay as early as

Maintenance and transportation paid to the customer

Seven days before the start date

Academic and vocational training and training-related services (when provided by an accredited college or university over a semester or quarter)

Examples:

  • Tuition at an accredited college
  • RN or LVN training at a tax-supported hospital

Time of enrollment

Vocational or technical training (when provided by an accredited college or university)

Time of enrollment

Room and board paid to an accredited college or university

14 days before the start date

State board licenses

14 days before the start date

For example, if room and board had a start date of 8/16/2015 and an end date of 12/17/2015, caseload carrying staff could receive payment any day between 8/2/2015 and 12/17/2015. If the receipt is entered on 8/7/2015, the receipt date is 8/7/2015.

24.16.3 Setting Up and Paying Providers

Individuals may need to be set up as providers to issue payment for services such as reader services, maintenance, or transportation.

Before the service record is generated and before the service authorization is issued, you must ensure that the individual has been:

  • set up as a provider; and
  • linked to the appropriate specification(s).

State law prohibits the state comptroller from issuing a warrant to pay funds directly to anyone who owes the state for delinquent taxes or a defaulted debt, such as a guaranteed student loan.

If the consumer is not already set up as a provider, complete a DARS1768, Application for Payee Identification Number, as follows:

  1. Complete Section 1 of the form.
  2. Use Federal Facility Code 12 if the payee is a consumer or Federal Facility Code 13 if the payee is the consumer's parent or legal guardian.
  3. Do as follows, in Section 4:
    • Indicate if the payee is a consumer or the parent/legal guardian of a consumer
    • Specify the type of payments that will be made to the payee
    • Request that the payee be tied to the specifications for that type of payment

When advance payment is authorized, payment authorization must be delegated in accordance with current ReHabWorks procedures.

24.16.4 Restricted Donations

A restricted donation is a cash donation made to the CRS program for use in providing services to CRS consumers that specifies a purpose, program, DARS office, or caseload for use. When a restricted donation is received, the receiving office immediately forwards it, along with any accompanying instructions, to the DARS accounting office in accordance with the published cash receipts procedures found in Business Procedure Manual, Chapter 23: Accounting, 23.1 Cash Receipts.

The following process describes the approvals required for the use of a restricted donation.

CRS Accounting

  1. Records the information pertaining to the donation on the deposit, including:
  • donor name; and
  • donation amount
  1. Assigns unique donation number if not specified by receiving office
  2. Deposits funds in appropriate CRS budget
  3. Notifies the CRS program manager that the donation has been received
  4. Updates Regular and Restricted Donation spreadsheet monthly and sends to and CRS budget office
  5. CRS program manager sends a letter of appreciation to the donor

Using Restricted Donation Funds

For more information regarding restricted donations see ReHabWorks Users Guide, Chapter 16 Case Service Record, 16.1 Service Record List.

24.16.5 Payment discounts

For information on how to apply payment discounts, See ReHabWorks Users Guide, Chapter 18 Case Acknowledgement of Receipt, 18.1 Receive, 18.1.1 Payment Discounts.

24.16.6 Multiple Consumer Purchases

Multi-consumer purchases can be completed when services from a single provider are purchased for multiple consumers on the same caseload or for multiple consumers on different caseloads. A multi-consumer service record completed in ReHabWorks serves the same function as an individual service record and is used to create a multi-consumer service authorization.

An invoice with multiple consumers’ names is kept in a separate file. Under no circumstances should information with multiple consumers’ names be filed in an individual consumer file.

For additional information on creating a multi-consumer service record and multi-consumer service authorization, refer to the ReHabWorks Users Guide, Chapter 20 Multiconsumer Purchases, 20.1 Multiconsumer Service Record.

24.16.7 Used Goods

The CRS program purchases new equipment unless it is necessary or advantageous to purchase used equipment and supplies. Used equipment is most frequently purchased because:

  • new equipment is unavailable; and/or
  • used equipment meets the consumer's needs and provides significant savings.

When you buy used and demonstration equipment, process the order according to the applicable procurement method, which is based on the estimated cost of the equipment.

Provide the following information in the paper case file of used goods:

  • A description of the condition and value of the equipment
  • A statement in the paper case file that the equipment has been examined
  • Verification of inability to secure new equipment and/or substantial savings

24.17 Contractor Performance Issues

CRS staff members, other than the contract manager, routinely work closely with contractors and may identify a contractor performance issue or noncompliance outside the scope of the formal statewide monitoring process led by Consumer Services Monitoring Unit. If the staff determines that the performance issue is significant, the staff must notify the contract manager regardless of whether the issue was resolved.

The staff must send this notification in writing and include the:

  • name of the contractor;
  • contract number assigned by the CRS program, if known;
  • Texas payee identification number (TIN), if known;
  • type of service provided by the contractor;
  • date the noncompliance or performance issue occurred;
  • description of the noncompliance or performance issue; and
  • chronology of actions taken by the CRS staff member and contractor to address or correct the issue.

The staff should use the DARS1303, Contractor Performance Report to document the report and invoice issues. The form can also be used to document exceptional contractor performance. The DARS1303 is an internal document.

When the contract manager is notified of a contractor performance issue, the contract manager takes appropriate action and may need to request a remedial action review.

24.18 When RHW is Not Available

If ReHabWorks is not functioning, staff will receive direction and mitigation strategies through communication from CRS central office staff member.

24.19 Using Provider Credit Accounts

A service authorization (SA) is the only valid authorization by which purchases are made. No purchase may be made using provider credit account cards.

Some providers (for example, Wal-Mart, Sears, Home Depot, Office Depot, and Hobby Lobby) require the use of a credit account.

For such providers, each individual CRS program office should have an assigned account number. See the ReHabWorks ADMIN “Accounts Menu” for a list of existing numbers for the user’s office. Before using one of these accounts, the issuer should verify with vendor that the account is still active.

When the issuer's office has an account number with the provider, the account number automatically prints on the SA. If an account number does not print on the SA, the office does not have an account and that vendor should not be used.

24.20 Interagency Transfer Vouchers

Texas state agencies provide a variety of goods and services for each other. For example, the Department of Aging and Disability Services provides medical records, and the Texas Cosmetology Commission provides state cosmetology licenses.

For some agencies, the state comptroller transfers funds from one agency to another through interagency transfer vouchers (ITV) instead of issuing a warrant to make the payment.

Receiving and Paying Interagency Transfer Vouchers (ITVs)

When receiving and paying interagency transfer vouches (ITVs), the staff member in the field office:

  1. verifies its accuracy (see 24.9 Invoices for more information); 

Note: If the invoice or ITV does not have a recurring transaction index (RTI) number, call the performing agency to get the RTI number and write it on the invoice or ITV.

  1. verifies that the goods or services have been received (RHW Users Guide, Chapter 18 Case Acknowledgment of Receipt, 18.1.5 Verifying and Acknowledging Receipt of the Invoice);
  2. acknowledges receipt of the invoice, goods, and/or services, and documents (if applicable) in ReHabWorks:
    • the invoice number in the Invoice Number field in the Receive Items List window if the performing agency provided an invoice number (if an invoice number is not provided, the consumer's Social Security number); and
    • the 6-digit RTI number; and
  3. writes the voucher document number assigned in ReHabWorks on the invoice or ITV (the number begins with a T).

Note: Request payment using the SA Payment Authorization window. If the invoice includes fees for late payment, do not pay them.

The state comptroller maintains an Interagency Transactions Contact List, which is a list of agency contacts for Recurring Transaction Indicator numbers.

 

24.21 Purchasing Reviews and TxROCS

The CRS program completes case reviews as a part of routine oversight and monitoring of consumer purchasing activities. Refer to Chapter 34 Case Reviews.

 

24.22 Health Care Professionals – Required Qualifications

Listed below are the required qualifications for physicians, specialists, and other health care professionals.

The CRS program manager verifies the required qualifications of health care professionals in ReHabWorks.

For questions about certification or licensure of other health care professionals, contact the CRS program manager.

Note: When an intern working under the supervision of a licensed provider provides counseling services, they are purchased at the supervising licensed provider's payment rate.

Table: List of Professionals, their job functions and required qualifications

Professional

Job Function

Required Qualifications

Advanced practice nurse

Provides medical evaluation and/or treatment.

Licensed by the Texas Board of Nursing.

Audiologist

Provides audiological examinations.

May dispense hearing aids.

May provide basic audiometric assessments.

Licensed by the State Board of Examiners for Speech-Language Pathology and Audiology.

To dispense hearing aids, the audiologist also must be licensed by the State Committee of Examiners in the Fitting and Dispensing of Hearing Instruments.

Certified registered nurse anesthetist (CRNA)

Administers anesthesia.

Certified by the American Association of Nurse Anesthetists.

Chiropractor

Provides manipulative treatment of the spine and functional capacity assessments.

Licensed by the Texas Board of Chiropractic Examiners.

Cognitive rehabilitation therapist

Provides cognitive rehabilitation therapy, which focuses on the development of cognitive skills (the ability to perceive, recognize, conceive, judge, imagine and reason) lost or altered as a result of neurological damage.

The aim of treatment is to enhance functional competence in real-world situations.

The process includes:

  • direct retraining;
  • use of compensatory strategies; and/or
  • use of cognitive tools.

One of the following:

  • A psychologist licensed by the State Board of Examiners of Psychologists.
  • A psychiatrist licensed by the State Board of Medical Examiners.
  • An occupational therapist licensed by the Executive Council of Physical Therapy and Occupational Therapy Examiners.
  • A speech and language pathologist certified by the State Committee of Examiners for Speech and Language Pathologists and Audiologists.

Dentist

Provides dental evaluations and/or treatment.

Licensed by Texas State Board of Dental Examiners to practice in the state where services are rendered.

Hearing aid specialist

Dispenses hearing aids.

May provide basic audiometric assessments (MAPS 92551 – 92559).

May provide hearing aid evaluations.

Licensed by the Texas Board of Examiners in the Fitting and Dispensing of Hearing Aids.

Licensed marriage and family therapist (LMFT)

Provides goal-oriented or problem-centered counseling services as recommended or prescribed by a psychiatrist or psychologist.

Licensed by the Texas State Board of Examiners of Marriage and Family Therapists.

Licensed professional counselor

Provides goal-oriented or problem-centered counseling services as recommended or prescribed by a psychiatrist or psychologist.

Licensed by the Texas State Board of Examiners of Professional Counselors.

Licensed surgical assistant (LSA)

Provides assistant surgeon services.

Licensed by the Texas Medical Board.

Occupational therapist

Provides:

  • occupational therapy services recommended or prescribed by a physician;
  • home modifications assessment; and/or
  • job analysis and job-site modifications assessment.

Licensed by the Executive Council of Physical Therapy and Occupational Therapy Examiners to practice in the state where services are rendered.

Optometrist

Provides vision examinations.

Licensed by the Texas Optometry Board.

Ophthalmologist

Specializes in diagnosis, treatment, and surgery for diseases of the eye

M.D. (doctor of medicine) licensed by the state of Texas State Board of Medical Examiners to practice in the state where services are rendered.

Pedorthist

Fabricates and supplies below-the-ankle orthotics.

Certified by the Board for the Certification in Pedorthics. (C.Ped: certified pedorthists).

Physical therapist

Provides:

  • physical therapy services recommended or prescribed by a physician;
  • home modifications assessment; and/or
  • job analysis and job-site modifications assessment.

Licensed by the Board of Physical Therapy and Occupational Therapy Examiners to practice in the state where services are rendered.

Physician

Provides medical examinations and/or treatment.

conditions.

M.D. (doctor of medicine) or D.O. (doctor of osteopathy) licensed by the Texas State Board of Medical Examiners to practice in the state where services are rendered.

Physician assistant

Provides medical examinations, medication management, and/or treatment.

Licensed by the Texas Physician Assistant Board.

Podiatrist

Provides medical examinations and treatment for foot conditions.

Licensed by the Podiatric Medical Examiners Board. (D.P.M.: doctor of podiatric medicine).

Prosthetist and orthotist

Fabricates and supplies prostheses and orthotics.

Licensed by the State Board of Orthotics and Prosthetics.

Psychiatric-mental health advanced practice nurse

Provides evaluation, goal-oriented or problem-centered counseling services, and/or medication management.

Licensed by the Texas Board of Nursing.

Psychologist

Provides or supervises the provision of psychological services.

When an individual under the supervision of the licensed psychologist provides services, the licensed psychologist must sign all reports.

Licensed by the Texas State Board of Examiners of Psychologists or licensed to practice in the state where service rendered (unless exempt).

Community-based behavioral health and developmental disability services centers and some state agencies are exempt from the licensing act.

Registered nurse first assistant (RNFA)

Provides assistant surgeon services.

Licensed by the Texas Board of Nursing.

Social Worker

Provides goal-oriented or problem-centered counseling services for DRS consumers as recommended or prescribed by a psychiatrist and/or psychologist.

Licensed Clinical Social Worker (LCSW) licensed by the Texas State Board of Social Work Examiners.

Community-based behavioral health and developmental disability services centers and some state agencies are exempt from the licensing act.

Specialist physician

Performs examinations, treatment, and/or surgery.

Physician certified by an American Medical Specialty Board, or the American Osteopathy Specialty Board in the needed specialty.

When a board certified physician is not available, refer the consumer to the Texas Medical Board Look Up a License page to gather information about the education and experience of physician without board certification.

Speech and language pathologist

Provides, with concurrence of a physician, speech and hearing therapy after surgery or trauma affecting speech.

Certified as a speech-language pathologist by the State Board of Examiners for Speech-Language Pathology and Audiology.

Speech trainer

Provides speech training in both expressive (speech language production) and receptive (lip and speech reading) language.

May also evaluate and provide training in the use of speech augmentation devices.

Certified as a speech-language pathologist by the State Board of Examiners for Speech-Language Pathology and Audiology.

24.23 Health Care Facilities – Required Qualifications

Listed below are the required qualifications for health care facilities.

The CRS program manager will verify the required qualifications of health care facilities in ReHabWorks.

For questions about certification or licensure of health care facilities, contact the CRS central office program manager.

Table: Health Care Facilities – Required Qualifications

Health Care Facility

Activity

Required Qualifications

General hospital

Provides inpatient and outpatient hospital services.

A current contract with the CRS program and:

  • Medicare certification;
  • accreditation by the Joint Commission for Accreditation of Health Care Organizations (JCAHO); or
  • accreditation by the American Osteopathic Association.

General or specialty hospital providing inpatient comprehensive medical rehabilitation services

Provides inpatient comprehensive medical rehabilitation services.

A current contract with the CRS program, and:

  • licensure by the Texas Department of State Health Services for comprehensive medical rehabilitation services, unless exempt by law (for example, University of Texas Medical Branch);
  • accreditation by the JCAHO; or
  • accreditation by the Commission on Accreditation of Rehabilitation Facilities (CARF). CARF accreditation must be as a:
    • "Medical Rehabilitation Program—Comprehensive Inpatient Category One" if accredited before July 1, 1998; or
    • "Comprehensive Integrated Inpatient Rehabilitation Program" if accredited July 1, 1998, or later.

Ambulatory surgical center

Primarily provides surgical services to patients who do not require overnight hospital care.

Requires a:

  • Current licensure as an "ambulatory surgical center" by the Texas Department of State Health Services; or
  • Accreditation by the American Association for Accreditation of Ambulatory Surgery Facilities.

Nursing home

Provides nursing home or convalescent care.

Licensed by the Nursing Home division of Texas Department of Aging and Disability Services.

Approved by Medicare and Medicaid.

Chapter 25: Purchasing Medical Assistive Devices and Supplies

25.1 Overview

This chapter provides policies and procedures for purchasing medical assistive devices and supplies. Medical assistive devices and supplies fall into three categories:

  1. Medical assistive devices and supplies, noncontract
  2. Medical assistive devices and supplies, contract
  3. Medical assistive devices and supplies, nonspecific

Apply the policies in this chapter to medical assistive devices and supplies, regardless of category.

25.1.1 Bids

Unless the item is under contract or is listed in Maximum Affordable Payment Schedule (MAPS), bids are required when a single purchase is expected to exceed $5,000. Follow the purchasing guidelines in Chapter 24: Purchasing Goods and Services for Consumers in addition to the applicable guidelines in this section.

25.1.2 Specifications

The purchase order must include a complete description of the items to be purchased.

25.1.3 Purchases from Hospitals

Medical assistive devices and supplies purchased from contracted hospitals must be pre-authorized by a CRS program staff member, and listed on the hospital invoice, and paid for under the terms of the hospital contract.

To determine the proper procedure to purchase items that are not listed here, contact the CRS central office staff member.

25.1.4 Ownership of Medical Assistive Devices

Medical assistive devices purchased for a consumer by the CRS program are the property of the State of Texas.

25.1.5 Salvage of Used Medical Assistive Devices

When a CRS program staff member or a consumer’s authorized representative, determines that the assistive device has no salvage value, you or the CRS program manager may decide to relinquish ownership.

25.2 Medical Assistive Devices and Supplies—Non-contract

The following examples are noncontract medical assistive devices and supplies:

  • Continuous airway pressure devices
  • Nebulizers
  • Ventilators
  • Blood glucose monitors
  • Casts, molds, and finished orthoses for feet deformities
  • Dentures
  • Orthopedic shoes
  • Canes, crutches, and walkers
  • Intermittent positive pressure breathing respirators

25.2.1 Procedures for Purchasing Non-contract Medical Assistive Devices

For each item listed above, use the following processes:

  1. Determine if a written recommendation or prescription is required. Written recommendations are required for the initial purchase of medical assistive devices and supplies, and replacement items when the medical condition is progressive.
  2. If required, obtain and place a written recommendation and/or prescription in the case file from a:
  • physician;
  • physician assistant;
  • advanced practice nurse;
  • dentist; or
  • optometrist.

When the written recommendation and/or prescription does not describe the item, obtain a letter of specification from an appropriate, certified paramedical specialist such as physical or occupational therapist, orthotist, or prosthetist.

  1. Follow procedures outlined in 25.2.2 Table: Noncontract Items Requiring Special Consideration Table, if applicable.
 

25.2.2 Table: Noncontract Items Requiring Special Consideration

Item

Required Consideration

Dentures or dental appliances

Obtain approval from the manager.

Prescription drugs

Obtain a prescription from a physician (medical doctor or doctor of osteopathic medicine), physician’s assistant, or advanced practice nurse, or get the prescription number from the named pharmacy.

Repairs

Repairs to prosthetic or orthotic devices do not require a medical professional's recommendation or prescription. Payment for repair labor charges must not exceed $50 per hour.

Transcutaneous electrical nerve stimulator (TENS)

The device must be rented for 7–14 days before you may purchase it. If you purchase a TENS, the vendor must agree to apply the rental fees to its total cost.

25.3 Medical Assistive Devices and Supplies—Contract

The following items must be purchased from a contracted service provider:

  • Hearing aids
  • Hospital beds
  • Patient lifts
  • Manual and power wheelchairs (fully functional chairs) that are fully constructed or fabricated durable medical equipment units that can be operated immediately by the consumer for whom it was specified
  • Power units and controllers
  • Seating and positioning systems
  • Scooters

25.3.1 Procedures for Purchasing Contracted Medical Assistive Devices, Excluding Hearing Aids

Use the following procedure to buy contracted medical assistive devices except for hearing aids.

  1. Determine whether a written recommendation or prescription is required. Written recommendations are required for:
    • the initial purchase of contracted medical assistive devices; and
    • replacement items when the medical condition is progressive.
  2. If a written recommendation or prescription is required, obtain one from a physician, physician assistant, or advanced practice nurse and place it in the case file.

To enable verification of contracted discount, obtain a copy of the manufacturer's (suggested retail) price (MSRP) or order form along with the invoice.

  1. Review and follow item-specific requirements listed below.

25.3.2 Table: Contract Items Requiring Special Consideration

Item

Required Consideration

Dentures or dental appliances

Obtain approval from the CRS program manager.

Prescription drugs

Obtain a prescription from a physician (medical doctor or doctor of osteopathic medicine), physician assistant, or advanced practice nurse, or the prescription number from the named pharmacy.

Repairs

Repairs to prosthetic or orthotic devices do not require a medical professional's recommendation or prescription. Payment for repair labor charges must not exceed $50 per hour.

Transcutaneous electrical nerve stimulator (TENS)

The device must be rented for 7–14 days before you may purchase it. If you purchase a TENS, the vendor must agree to apply the rental fees to its total cost.

25.3.3 Hospital Beds, Patient Lifts, Manual Wheelchairs, Power Wheelchairs, Scooters, or Seating and Positioning Systems

After an initial prescription is received, obtain specifications (type, size, and special features) by arranging for the consumer to be evaluated by a physiatrist, a physical or occupational therapist, or by another qualified service professional.

Replacement Wheelchairs

Obtain from the local provider of wheelchair repair services an estimate of the cost for refurbishing the original chair.

Apply best value considerations when considering whether repair or replacement is the more cost-effective course.

When you purchase a replacement chair that differs in size and other features from the chair previously prescribed for and currently in use by the consumer, have the consumer reevaluated by a physiatrist or physical or occupational therapist.

Sports Chairs

The CRS program generally does not purchase non-folding competition sports chairs intended primarily for sports-related activities.

When a consumer requests a non-folding chair that appears appropriate for the consumer's needs, the CRS program sponsorship requires that:

  • you ensure that the consumer can use the non-folding chair as effectively as a folding chair in activities related to completing the rehabilitation goal (Examples include driving and loading and unloading the chair into an automobile.);
  • a physiatrist or physical therapist evaluate, or you observe, the consumer's ability to use such a chair in the above activities; and
  • you ensure that purchasing a non-folding chair will not result in additional CRS expense, such as modifying a van, home, or worksite to accommodate the new chair.

Lightweight Wheelchairs

Purchase a lightweight wheelchair when appropriate for the consumer's needs.

Do not purchase:

  • more than one set of front casters (for example, 5" hard, 8" pneumatic);
  • more than one set of arm rests (for example, desk type, sloped); or
  • sports-related options (for example, spoke guards and anti-tip front casters).

Wet-weather guards are not considered sports-related items.

Wheelchair Accessories

When purchasing a wheelchair you may receive requests for additional items or replacement parts known as wheelchair accessories. When considering purchase of these items note that except for power units and controllers or seating and positioning systems, replacement parts do not have to be purchased from a contract provider.

Repairs

Repairs do not have to be purchased from a contract provider. For information on repairs to wheelchairs, scooters, and other equipment, see Chapter 25: Purchasing Medical Assistive Devices and Supplies, 25.3.2 Table: Contract Items Requiring Special Consideration.

25.3.4 Hearing Aids

The CRS program purchases hearing aids from contracted manufacturers. There may be exceptions in certain circumstances. Examples of exceptions are when:

  • access to services from a contracted manufacturer is not readily available without creating a hardship for the consumer (such as requiring the consumer to travel a significant distance to obtain services); or
  • a licensed audiologist or hearing aid specialist provides a clinical opinion that an aid not available from a contracted manufacturer would best suit the consumer's rehabilitation needs.

In such situations, you must request an exception through your CRS program management.

For help with hearing aid purchases, contact Health and Human Services Medical Services. Also make sure to review Applying Insurance as a Comparable Benefit to the Purchase of Hearing Aids.

For assistance with hearing aid invoicing/billing issues, refer to the Hearing Aid Manufacturer Contacts, August 2015.

Use the following procedure to purchase a hearing aid:

  1. The counselor refers the consumer to a licensed audiologist or hearing aid specialist for evaluation and testing. When making that referral they also mail to the audiologist or specialist:
    • Form 3105, Hearing Evaluation Report (Section 3. Audiometric Evaluation);
    • DARS3105, Hearing Evaluation Report (Section 4. Hearing Aid Recommendations); and
    • service authorization (SA) for services.
  2. The hearing aid specialist or audiologist (dispenser) recommends a hearing aid by providing a letter of specification to the counselor (Use Form 3105, Hearing Evaluation Report Section 4. Hearing Aid Recommendations, or the equivalent).
  3. Upon receipt of the DARS3105 which outlines the Hearing Aid Specialist or Audiologists recommendations, the counselor obtains product and price information by selecting the following provider and manufacturer links:
  • GN Hearing Care Corporation (formerly Beltone)
  • GN ReSound Corporation
  • Oticon Inc.
  • Phonak
  • Rexton International
  • Sivantos Hearing Instruments Inc. (formerly Siemens Hearing)
  • Sonic Innovations
  • Starkey Laboratories Inc.
  • Unitron Hearing Inc.
  • Widex USA Inc.
  1. After the counselor reviews the recommendation and researches product and price information, he or she approves the purchase. The CRS program staff member then issues a SA to the manufacturer, and includes on the SA:
    • the contract number;
    • delivery instructions directing the manufacturer to send the product to the dispenser; and
    • shipping instructions that include the dispenser's address and telephone number.

Note: The SA does not include a separate line item for shipping and handling, as these charges are included in the contracted product price.

  1. The CRS program staff member then mails the SA to the dispenser (hearing aid specialist or audiologist), not to the manufacturer.
  2. Upon receipt of the items mailed from the CRS program staff member, the hearing aid specialist or audiologist (dispenser) mails impressions and the CRS post office box number to the manufacturer.
  3. The manufacturer, upon receipt fills the request and sends the product to the dispenser and product invoice to the counselor.
  4. The counselor, upon receipt of manufacturer's product invoice, contacts the dispenser to verify receipt of the correct product and pays the manufacturer for the product.
  5. Once the hearing aid specialist or audiologist (dispenser) confirms with the counselor the receipt and payment of the invoice, he or she administers the fitting of the hearing aid.
  6. The hearing aid specialist or audiologist (dispenser) provides the counselor with a signed post-fitting evaluation (Form 3105, Hearing Evaluation Report  5. Post fitting Documentation, or the equivalent).
  7. When the counselor receives the signed post-fitting evaluation from the hearing aid specialist or audiologist (dispenser), he or she pays the dispenser's service charge.

Refunds

When requesting a refund from a hearing aid manufacturer, complete the Refund Request Form and forward it to the assigned representative as listed at the top of each price list. If you have questions, contact a CRS central office staff member.

25.4 Medical Assistive Devices and Supplies—Nonspecific

A verbal recommendation from a physician, physician’s assistant, or advanced practice nurse is the only requirement to purchase other medical assistive device or supply not listed in this chapter, such as:

  • catheters;
  • colostomy supplies;
  • leg bags; and
  • latex tubing.

Ensure and document that the medical professional recommends that the consumer have the specified item or items.

Chapter 26 Physical Restoration Services

26.1 Overview

This chapter describes the physical restoration services purchased by the CRS program. It also presents the general policies that apply to those purchases and the specific policies that apply to various conditions and procedures.

Physical restoration includes a range of services provided in a variety of settings. The CRS program provides physical restoration services, when necessary, to correct or substantially modify, within a reasonable time, a physical condition that is stable or slowly progressive and that prevents the consumer from moving through the therapeutic process.

When planning any physical restoration services, you must:

  • ensure that the consumer understands the recommended treatment;
  • document the expected impact of the services on the therapeutic program;
  • assess and plan for needed post-treatment or procedure follow-up, including medication; and
  • identify long-term or ongoing medical needs after CRS program involvement ends and discuss with the consumer plans for meeting those needs.

For additional information about the consumer's condition and treatment and the condition's possible effect on rehabilitation, consult the Medical Disability Guidelines.

26.1.1 Services Not Authorized

The CRS program does not authorize payment for certain services, because the conditions they address:

  • have no therapeutic impact;
  • are not related to the consumers traumatic brain injury or traumatic spinal cord injury; or
  • are addressed by comparable services and benefits.

Services not authorized include:

  • general medical care (that is, medical or surgical services that are not directly related to the therapeutic objective or do not support other services for CRS);
  • maternity care; and
  • medical or surgical treatment associated with:
    • active tuberculosis;
    • sexually transmitted diseases;
    • cancer;
    • organ transplantation;
    • AIDS; or
    • end-stage renal disease.

26.1.2 Physical Restoration Services Procedures

Use the following procedures when providing physical restoration services:

  1. Document how the planned services address impediments to the therapeutic process.
  2. Obtain a written recommendation for planned services (for surgery, use DARS3110, Surgery and Treatment Recommendations).
  3. When you plan surgical services, have a CRS central office staff member review the DARS3110 or treatment plan before you approve the purchase of services.
  4. When you plan certain dental procedures, have the CRS central office staff member review the treatment plan before you approve the purchase.
  5. If you plan physical restoration services that will be provided in a hospital, ambulatory surgical center, post-acute brain injury facility, or medical school, use a medical services coordinator to arrange the services.
  6. For those services requiring CRS program manager approval, get the approval before providing the services.
  7. Before committing to sponsor medical services not listed in Maximum Affordable Payment Schedule (MAPS), you must consult with the CRS program manager.
  8. If the provider requests payment that exceeds MAPS rates, get approval from the CRS program manager.
  9. Following the completion of services, get information about changes in functional abilities from the service provider, either verbally or in writing.

Document how the impediment to the therapeutic process has changed as a result of the physical restoration service using one of the following in a case notes or other written means such as clinic notes or progress notes.

Exception: Intercurrent illness and dental treatment do not require assessment of residual functional limitations.

If diagnostic hospitalization exceeds seven days, explain this in the case notes.

26.1.3 Consumer Changes Physician or Hospital

If a consumer wants to change treating physicians or hospitals after admission, he or she must discuss this with the counselor and the counselor documents this change.

26.1.4 Comparable Services and Benefits for Restoration Services

Consumers requiring physical restoration services must apply for comparable services when they live in an area served by tax-supported hospitals and/or clinics, and have an income that qualifies the consumer for services at no cost to the CRS program, or at a reduced rate.

You must assess the availability of comparable services and benefits, advise the consumer to apply for them, and help the consumer with the applications, as needed.

If comparable services and benefits are available, the CRS program may participate in the cost of services if the combination of CRS payment and the comparable benefit payment amount does not exceed, as appropriate, the maximum amount allowed by the:

  • Maximum Affordable Payment Schedule (MAPS);
  • contracted payment rate; or
  • retail or negotiated lower price (for non-MAPS, noncontract items).

If the comparable benefit is:

  • major medical insurance, a health maintenance organization (HMO), or preferred provider organization (PPO), the CRS program may pay the consumer's portion (co-payment, coinsurance, and any unmet deductible) not to exceed the MAPS rate, contract rate, or retail price, as applicable;
  • Medicare, the CRS program may pay the consumer's portion (co-payment, coinsurance, and any unmet deductible) not to exceed the MAPS rate, contract rate, or retail price, as applicable; or
  • Medicaid, the CRS program pays nothing, and the CRS program does not supplement a Medicaid payment for a specific service or procedure.

When the consumer is determined eligible for services, use the following and any other available benefits before using CRS funds:

  • Medicaid
  • Medicare
  • Health insurance (including major medical insurance, an HMO, or a PPO)
  • TRICARE®, formerly the Civilian Health and Medical Program of the Uniformed Services in the United States
  • Workers' compensation medical benefits
  • The Children with Special Health Care Needs program
  • Services at no cost to the CRS program, or services at a reduced rate, at a tax-supported hospital or clinic
  • County Indigent Health Care program
  • Department of Veterans Affairs hospitals
  • University of Texas Medical Branch at Galveston
  • M.D. Anderson Cancer Center
  • Kidney Health Care program
  • State tuberculosis facilities

Exceptions to Using Comparable Services and Benefits for Restoration Services

Diagnostic services and rehabilitation technology, including hearing aids, sensory aids, and other technological aids and devices, do not require the use of comparable services and benefits.

See Chapter 8: Individualized Written Rehabilitation Plan (IWRP), 8.4.3 Exceptions to Comparable Benefits for circumstances of exceptions.

 

26.2 Professional Medical Services

Medical treatment may include the services of:

  • attending physicians;
  • surgeons;
  • anesthesiologists;
  • assistant surgeons;
  • consultants;
  • radiologists;
  • pathologists;
  • physician assistants; and
  • advanced practice nurses.

26.2.1 Payment to Medical Professionals

The following conditions apply to payment for professional medical services:

  • Payment for medical treatment must be the professional's usual fees and may not exceed the Maximum Affordable Payment Schedule (MAPS) maximum.
  • Before providing the recommended medical services, the professional performing the procedure must agree to accept the CRS allowance in MAPS as payment in full.
  • For additional payment for unusually difficult or complicated cases to be considered, you must consult the CRS program manager.
  • Before you commit to providing medical services not listed in MAPS, consult the CRS program manager.
  • When the CRS program is participating in the cost of physical restoration services, the combined total contribution by the CRS program, the consumer, and/or a third party may not exceed the MAPS maximum. Exception: If the third party is a health maintenance organization (HMO) or preferred provider organization (PPO), the CRS program may pay the consumer's co-payment amount for professional medical services, as defined in MAPS, if the co-payment amount does not exceed the established MAPS rate.

26.2.2 Treatment of Medical Complications

A medical complication, either acute or chronic, that results from the physical restoration services or is inherent in the condition under treatment, is considered a part of the physical restoration service.

When severe complications arise and the consumer is no longer eligible for services from the CRS program, refer the consumer to other resources, if possible. Terminate services after arrangements have been made with the consumer, consumer’s family, hospital, and attending physician.

26.2.3 Postoperative Care

When you arrange a surgery, make sure to plan for postoperative care. In a hospital, post-operative care is ordinarily included in the surgery fee. When post-operative care occurs after the consumer is discharged from the hospital and is not included in the surgery fee, you may authorize an additional payment.

Some types of surgery require the services of other physicians (for example, a cardiologist or internist). Fees for these services are not part of the surgery fee. Plan to pay for these costs in addition to the surgical fee.

26.2.4 Unanticipated Charges

The CRS program pays for unanticipated professional services ordered during the physical restoration process. The attending physician usually orders these services "on-the-spot." Prior authorization could jeopardize the timely provision of needed services.

Typical unanticipated services include, for example:

  • charges for interpretations of electrocardiograms (ECG or EKG);
  • X-rays;
  • laboratory tests;
  • consultations; or
  • treatment for medical complications (either acute or chronic).

26.3 Physical Restoration Services or Procedures with Special Requirements

26.3.1 Back Surgery and Steroid Injections

The CRS program manager must review and approve all back surgery and steroid injections for the treatment of back conditions.

If the back disorder was caused by an on-the-job injury, determine whether workers' compensation insurance medical benefits are available as a comparable benefit. If necessary, contact the Texas Department of Insurance, Division of Workers' Compensation, or the workers' compensation insurance carrier to determine the status of the consumer's coverage.

The CRS program does not provide surgery for consumers who have no radiographic evidence of a traumatic spinal cord injury.

26.3.2 Dental Treatment

Dental treatment may be provided as:

  • a means to address an intercurrent illness;
  • a component of maxillofacial surgery; or
  • a supportive service that allows the consumer to participate in planned services.

The CRS program manager approval is required.

26.3.3 Diabetes Insulin Pumps

The CRS program does not purchase insulin pumps for the medical management of diabetes.

26.3.4 Discograms

The CRS program does not usually pay for a discogram because the test is of limited diagnostic value. The CRS program manager approves discograms on a case-by-case basis. You must get a written justification for a discogram from the treating physician before submitting the case to the medical director for review and approval.

26.3.5 Electrical Bone Stimulators (EBS)

The CRS program manager must review electrical bone stimulators therapy.

If prescribed for cases of non-union fractures, confirm that it has been six months since the initial fracture before authorizing service.

26.3.6 Eyeglasses and Contact Lenses

The purchase of single vision, bifocal, and trifocal glasses and contact lenses requires a prescription from an ophthalmologist or optometrist.

Frames must be the least expensive serviceable type available. The consumer may supplement the additional cost for frames if the cost exceeds the Maximum Affordable Payment Schedule maximum.

Lenses may have tint and/or be impact-resistant when specified in the prescription.

You may provide glasses if needed to complete diagnostic studies.

Before purchasing contact lenses:

 

26.3.7 Functional Electrical Stimulation (FES) Devices

The CRS program may purchase lower extremity functional electrical stimulation (FES) devices (for example, the Bioness L300 or the WalkAide) only for consumers:

The CRS program may consider only lower extremity FES devices that are medically necessary to enable consumers with a traumatic spinal cord injury  to ambulate when all of the clinical criteria are met. FES is not considered medically necessary for all other indications, including disuse atrophy.

To purchase an FES device for a CRS consumer with a traumatic spinal cord injury:

  1. consult with the CRS program manager to address questions about the clinical criteria (see directly above); and
  2. submit a courtesy case to the CRS program manager to review. ‘

FES devices are not purchased for consumers with a traumatic brain injury.

26.3.8 Gym Memberships and Home Exercise Equipment

The CRS program does not purchase gym memberships or home exercise equipment, including home equipment for water therapy or strengthening.

26.3.9 Prescription Drugs and Medical Supplies

The CRS program may provide prescription drugs and medical supplies, as needed and when pre-authorized by the CRS counselor, when a consumer cannot buy or obtain them from comparable services or benefits.

When a consumer is discharged from a medical rehabilitation facility or hospital that has an in-house pharmacy, the CRS program may pay for a 30-day take-home supply of the prescription drugs and medical supplies provided to the consumer.

If prescription drugs and supplies are needed beyond 30 days, arrange with a pharmacy in the consumer's home area. Buy from the least expensive available source. When specialized prescription drugs or supplies are not readily available from a local source, buy from the hospital pharmacy.

26.3.10 Spinal Cord Stimulator or Dorsal Column Stimulator

The CRS program manager must approve sponsorship of a trial or permanent implantation of a spinal cord stimulator or dorsal column stimulator.

26.3.11 Wound Care

Wound care may be authorized for a consumer when:

  • it is needed due to a complication of CRS-sponsored surgery; or
  • there is a reasonable probability that a short course of wound care treatment will result in wound healing of decubitus ulcers or diabetic foot ulcers sufficient to allow the consumer to complete planned services.

Since wound care often involves complicated treatment with an uncertain prognosis, consultation with the CRS program manager is required before sponsoring treatment.

26.4 Orthoses and Prostheses

For orthoses, a physician's examination is required before the purchase of an initial orthosis or if the consumer is having difficulty using the current orthosis.

Orthoses include:

  • corsets;
  • orthopedic shoes;
  • braces;
  • splints; and
  • artificial muscles.

For prostheses, an orthopedist's or physiatrist's examination is required before the purchase of the first prosthesis. If the consumer has difficulty using his or her current prosthesis, an orthopedist's or physiatrist's evaluation is required before planning the purchase of a second prosthesis.

All providers of orthoses and prostheses must:

  • be currently licensed by the Texas Board of Orthotics and Prosthetics;
  • perform all measurements, fittings, alignments, and final checkouts for devices purchased through the CRS program;
  • fabricate or directly supervise the fabrication of these devices; and
  • provide final delivery and instructions for use.

26.4.1 Purchasing Orthoses and Prostheses

Purchase the most basic orthotic or prosthetic device that allows a consumer to meet his or her rehabilitation needs. Consider purchasing more technologically advanced devices or components only if required by the consumer's unique rehabilitation or medical needs.

Purchase orthotic or prosthetic devices when you receive:

  • a physician's written prescription; and
  • a letter of specification from an orthotist or prosthetist licensed by the Texas Board of Orthotics and Prosthetics, a podiatrist, or a physician.

The letter of specification reflects the physician's written prescription. It lists the basic orthosis or prosthesis to be fabricated for the consumer and each add-on component with the:

  • Healthcare Common Procedure Coding System (HCPCS) codes;
  • number of units;
  • procedure descriptions; and
  • itemized charges.

With the letter of specification, the provider includes a medical or rehabilitation justification for all additions to the basic device.

If the orthosis or prosthesis is a replacement, the letter must fully describe the design and components of the current device.

The letter should also:

  • identify problems that have limited the consumer's ability to use the device; and
  • explain the necessity and rationale of the proposed treatment.

Develop a service record for a recommended orthosis or prosthesis using the letter of specification.

Payments for orthoses or prostheses may not exceed the Maximum Affordable Payment Schedule (MAPS).

If the CRS program’s cost equals or exceeds $12,500 and the letter of specification contains no unlisted MAPS codes, then a technical review of the letter or specification by the CRS program manager is required.

If the letter of specification contains unlisted MAPS codes, then, regardless of cost, approval by the CRS program manager is required.

26.4.2 Approval Procedure for Purchasing a Prosthesis Costing $12,500 or More without Unlisted MAPS Codes

If the CRS program’s cost for the prosthesis is $12,500 or more and there are no unlisted Maximum Affordable Payment Schedule (MAPS) codes, the case is reviewed by the CRS program manager. Follow the procedures below.

  1. The counselor prepares a packet containing the following required information:
    • A Prosthetic Review Cover Sheet
    • The prescription for the prosthesis
    • The Letter of Specification for the prosthesis
    • Prosthetist’s notes
    • DARS3602, Lower-Extremity Amputation Checklist, or DARS3601, Upper-Extremity Amputation Checklist
    • Additional pertinent medical or rehabilitation records
  1. The CRS central office staff member reviews the packet to ensure required information is provided and in order to make a determination to purchase the prosthesis. Upon the determination, the packet is submitted to the CRS central office staff member makes an approval or denial case note in ReHabWorks.

The counselor reviews the approval or denial from the CRS program manager with the prosthetist, and negotiates an amended letter of specification if needed and documents justification in a case note, and purchases the prosthesis.

26.4.3 Approval Procedure for Purchasing an Orthosis or Prosthesis with Unlisted MAPS Codes

If the L-code for a device or component is not listed in Maximum Affordable Payment Schedule (MAPS) when the service record is generated, the Orthotics and Prosthetics Review Committee (OPRC) must approve the purchase of the specialized device or component regardless of cost. OPRC approval for purchase of a specialized device or component does not require a technical review by the CRS program manager. Use the procedures in this chapter to submit a case to the OPRC for approval.

26.4.4 Warranties on Orthoses and Prostheses

Provider Warranty

The provider agrees to replace, without cost to the CRS program, defective parts and materials within 90 days of the consumer receiving the completed orthosis or prosthesis.

Exclusions: The following are not covered by and do not create exclusions to the provider's warranty:

  • Straps and evidence that the appliance has been altered by anyone other than the provider
  • Changes in the consumer's condition that affect use of the device

The provider honors the manufacturer warranties and pays all costs associated with warranty replacements.

Extended Warranty

The consumer pays all costs associated with extended warranties.

26.4.5 Repair of Orthoses and Prostheses

Repair the current orthosis or prosthesis unless the repair cost is more than 60 percent of the replacement cost.

Calculate labor charges at prevailing hourly rates for individual providers, not to exceed $50 per hour.

26.4.6 Training on Prostheses

You must arrange training in the use of above-knee prostheses to consumers who:

  • have not worn one previously;
  • will have a different type; or
  • have not worn one for a long time.

A prosthetist may provide training in the use of below-knee prosthesis. If the prosthetist recommends additional training, arrange for it from a qualified physical or occupational therapist.

A qualified physical or occupational therapist may provide training in the use of an upper-extremity prosthesis.

Chapter 27: Hospital and Ambulatory Surgery Center Services

27.1 Overview

Both hospitals and ambulatory surgical centers (ASC) provide medical services; however, procedures performed in an ASC do not require an overnight stay and are usually less complicated than those requiring hospitalization.

This section covers such considerations for medical services as:

  • contracts with hospitals;
  • selecting the appropriate facility;
  • paying for hospital services by contract;
  • paying for ASC services by Maximum Affordable Payment Schedule codes;
  • exceptions to payment limits;
  • limits on the duration of hospitalization; and
  • additional services.

27.2 Hospital Contracts

Hospital contracts define the business relationship between the CRS program and the hospitals from which CRS purchases consumer services. The contract specifies the allowable payment methods for all services purchased from the hospital, which may include:

  • inpatient or outpatient services;
  • post-acute rehabilitation services;
  • psychological services;
  • community rehabilitation program services; and
  • medical records.

The Contract Monitoring Unit (CMU) maintains CRS hospital contracts. If a consumer needs a medical service at a hospital that does not have a CRS contract, the assigned medical service coordinator must contact the regional consumer contract specialist to negotiate a payment rate for the medical service. If a DARS3423, Exception to Contracted Hospital Purchase, must be completed, submit the completed request through the regional director for final approval by the CRS program director or as specified in this manual. If you need to purchase medical services from a hospital that does not currently have a contract with the CRS program, contact the CMU.

27.3 Comparable Services and Benefits for Restoration Services

See Chapter 26.1.4 Comparable Services and Benefits for Restoration Services for more information concerning Comparable Services and Benefits for Restoration Services.

 

27.4 Selecting the Appropriate Facility

The consumer's treating physician can provide guidance to help you decide whether a hospital or ambulatory surgical centers will best meet your consumer's needs. In either case, consider the:

  • consumer's informed choice;
  • availability of comparable services and benefits to pay for all or part of costs;
  • proximity of the facility to the consumer's home and family; and
  • best value.

27.5 Payment

Hospitals must have a written contract with the CRS program in order to receive payment. Payment may not exceed the hospital's current payment rate under the contract. Consult the hospital contract comments in ReHabWorks to obtain the hospital's current payment rate. Obtain a copy of the operative report or discharge summary before authorizing payment.

Use Maximum Affordable Payment Schedule (MAPS) codes to pay for services provided at ambulatory surgical centers (ASCs). The MAPS codes for paying a physician and for paying an ASC facility are identical except that the code for an ASC facility is preceded by "ASC." Refer to Procedure for Purchasing Services from Ambulatory Surgical Centers and ASC Fees for further information. Obtain a copy of the operative report or discharge summary before authorizing payment.

27.6 Exceptions to the Payment Rate Limits

Hospital contracts allow payments by comparable benefits in lieu of the contracted rate when the consumer's circumstances warrant. A special agreement with the hospital may be executed under the terms of the hospital contract. Before providing services by special agreement, complete DARS3422, Reduced Payment Agreement. The DARS3422 must be signed by authorized hospital representatives and by the CRS program staff member, and placed in the consumer's case file.

27.7 Limits on the Duration of Hospitalization

If the treating physician expects the recommended hospitalization to exceed 30 days, you must assess the case and staff it with the receiving counselor, if one is involved, as well as with your manager.

When the consumer requires hospitalization beyond what the CRS program originally agreed to and CRS payment will not continue, you must make other arrangements to pay for the additional hospitalization.

Give written notification to:

  • the consumer;
  • the hospital;
  • the attending physicians; and
  • all other parties concerned.

27.8 Other Services

Blood

If a consumer needs blood, arrange for replacement, if the physician has not done so. Purchase blood when replacement is impossible.

Replacement blood is when an individual donates his or her blood before surgery to be used to replace any that is lost during surgery. Purchased blood comes from the hospital blood bank. If a physician predicts that a consumer may need blood, this is indicated on the surgery and treatment form.

Personal Items

The CRS program does not pay for personal items such as:

  • television rental;
  • telephone calls;
  • gourmet meals;
  • cots; and
  • guest trays.

Private Room

The CRS program does not pay for a private room unless the physician orders it as medically necessary and/or no other room is available.

Social Work Charges

The CRS program pays for hospital charges for social work services at the hospital contract rate when they are prescribed by attending physicians.

27.9 Comprehensive Medical Treatment for Traumatic Spinal Cord Injury

For acute complications of a traumatic spinal cord injury, such as substantial decubitus ulcers, severe urinary tract infections, severe respiratory conditions, or similar severe medical complications:

  • ensure that the complications are successfully treated before sponsoring the consumer in a comprehensive rehabilitation center; and
  • do not sponsor treatment for complications unless the complications:
    • are expected to prevent maximum benefit from comprehensive rehabilitation treatment; or
    • hamper completing other planned services and the prognosis is that a reasonably short period of treatment will resolve the problem and allow the consumer to achieve the rehabilitation objective.

27.10 Prescription Drugs and Medical Supplies

The CRS program may provide prescription drugs and medical supplies, as needed, when a consumer cannot buy or obtain them from comparable services or benefits.

When a consumer is discharged from a medical rehabilitation facility or hospital that has an in-house pharmacy, the CRS program may pay for a 30-day take-home supply of the prescription drugs and medical supplies provided to the consumer.

If prescription drugs and supplies are needed beyond 30 days, arrange with a pharmacy in the consumer's home area. Buy from the least expensive available source. When specialized prescription drugs or supplies are not readily available from a local source, buy from the hospital pharmacy.

27.11 Procedures for Pregnant Consumers

If an eligible consumer is pregnant, ensure that she understands that the CRS program provides only disability-related services. The CRS program does not pay for medical services related to the pregnancy.

Planning childcare with the consumer will help her to participate successfully in the CRS program.

27.12 Consumer Changes Physician or Hospital

If a consumer wants to change treating physicians or hospitals after admission, he or she must inform the CRS program staff member verbally, in writing, or through the representative. A CRS program staff member records this request in ReHabWorks.

Chapter 28: Case File Maintenance

28.1 Overview

The purpose of this section is to describe processes necessary for case file uniformity. You are ultimately responsible for the:

  • management of the caseload;
  • location of case files; and
  • case correction activities.

The case file system consists of an electronic case file in ReHabWorks and paper case file.

28.2 Preparing and Using the Paper Case File

Paper case files must be prepared and maintained as follows.

The counselor must:

  • secure all documents from the consumer case file to the folder jacket;
  • record on the tab label of each case file folder jacket, the consumer’s:
    • last name and first name (for example, Smith, John A.); and
    • case ID;
  • stamp “Confidential” on the front and back of the case file folder jacket;
  • ensure that all documents are date stamped or otherwise marked with the date generated and or received in the office;
  • date stamp the first and last pages of the packets for documents with a large number of pages (such as packets of medical records); and
  • file documents so that the first document is on the bottom and the most recent is on the top.

File the following documents from bottom to top on the left side of the case file in the order received. Be sure that:

  • all financial documents are grouped together, including:
    • invoices;
    • bidding documentation;
    • signed itemized receipts;
    • all service authorizations; and
    • correspondence with providers regarding billing; and
  • all other documents relating to consumer purchases.

File the following documents from bottom to top on the right side of the case file in the order received, as follows:

  • Signed release forms
  • Signed paper  Individualized Written Rehabilitation Plan (IWRP) or IWRP amendments
  • Correspondence
  • All records and reports and assessments
  • Copies of documents verifying the consumer’s identity and authorization for employment in the United States
  • Financial records used to verify consumer income and expenses for calculating participation in cost of services
  • Verification of eligibility for SSI/SSDI benefits
  • All other documents related to the consumer’s vocational rehabilitation program.

Exceptions

Documents associated with billing for multiple consumer purchases may be placed in a centralized file in the field office.

Do not put documents that contain other consumers’ names or identifying information into a consumer’s case file. If necessary, make copies of the documents and redact the identifying information of other consumers before filing the documents in each consumer’s file.

When a medical service coordinator or a courtesy counselor is involved, the courtesy file becomes an extension of the main case file. The courtesy counselor forwards copies of all pertinent documents to the home counselor.

Additional Case Files

When the paperwork on a consumer no longer fits into a case file, additional case files may be used.

28.3 Reopening a Case

When starting a new file on a case that was previously active, copy significant documents from the closed case file for placement in the new case file. Do not remove forms, reports, and other data from the old case file.

28.4 Maintaining Closed Case Files

Keep all documents, including financial records, in the closed consumer paper case file, which is stored for five years.

Field offices store files for cases closed in the current and preceding fiscal year.

Ship all other closed consumer paper case files to the DARS Records Center in accordance with procedures in Business Procedures Manual, Chapter 13: Records Management, 13.6 Closed Consumer Case Files.

Retrieve closed consumer paper case files from the DARS Records Center in accordance with policy (see Business Procedures Manual, Chapter 13: Records Management, 13.7 Records Retrieval).

Chapter 29: Transfer of Cases and Caseloads

29.1 Overview

During the CRS program process, a consumer’s case may have to be transferred. Cases may be transferred from one office to another and by caseload, and they may be open or closed. The information in this chapter describes how to handle each situation.

29.2 When to Transfer Files between Offices

You may transfer a paper case file for a closed case from one office to another. Make the transfer when the consumer requests it, either verbally or in writing, by contacting a new counselor or by contacting a previous counselor.

At the time of a request for transfer by a consumer, you must take action to ensure that the transfer does not delay services or cause undue hardship for the consumer.

You may transfer an active case to another caseload when the consumer changes permanent residence to a location closer to that other CRS caseload or when management decides that a case must be transferred.

Whether the transfer is of an active or closed case, you may use DARS1025, Case Transfer Letter, to inform the consumer of the transfer.

29.3 How to Transfer an Active Case

Use the following procedure to transfer an active case.

  1. The sending counselor submits to his or her manager:
    • a request to authorize the transfer; and
    • supporting documentation.
  2. Within five business days of receiving the request to transfer, the transferring manager:
    • completes the compliance sections only of a paper DARS3454, Compliance and Quality Case Review;
    • summarizes the case status in the "Overall Comments" section of the form and notes the:
      • reason for the transfer;
      • pertinent information on any compliance issues; and
      • consumer's current contact information; and
    • sends the completed compliance case review to the receiving manager.
  3. The transferring manager writes a statement that:
    • verifies the consumer's eligibility;
    • summarizes the case status;
    • notes the consumer's current contact information; and
    • sends the statement to the receiving manager.
  4. The transferring manager mails the paper case file within three business days of the completed case review to minimize delay or disruption of consumer services.
  5. The receiving manager assigns the case to the receiving counselor in ReHabWorks.

Each step in the transfer should be completed timely to avoid delay or disruption of services to the consumer.

If the managers cannot agree on the case transfer, they refer the issue to the appropriate regional operations director for programs.

29.4 How to Transfer a Caseload

To transfer an entire caseload, the CRS program specialist sends a memorandum to the CRS program manager requesting approval and coordination of the transfer.

Chapter 30: Consumer Rights and Legal Issues

30.1 Overview

The CRS program places the highest priority on maintaining the consumer's rights while he or she participates in the rehabilitation process. The consumer should know that CRS counselors and staff safeguard the consumer's personal information and safety.

The CRS program has systems to monitor service delivery, including processes for maintaining a safe and secure environment within which the consumer progresses toward goals. When you and the consumer do not agree about furnishing or denying services, systems exist to safeguard the consumer's:

  • right to appeal;
  • access to mediation; and
  • process for resolving disagreements.

Maintaining these rights supports key values of Health and Human Services Commission  and the CRS program.

30.2 The Confidentiality and Use of Consumer Records and Information

The CRS program may use a consumer's personal information only for purposes directly connected with administering the rehabilitation program, unless the consumer authorizes its release.

The CRS program may not share information with advisory or other bodies that do not have official responsibility for administering the program.

30.3 Appeal and Mediation Procedures

30.3.1 Overview

The CRS program fairly and impartially addresses a consumer's complaints about furnishing or denying services. To avoid an interruption of services, the CRS program handles complaints promptly and at the lowest possible management level.

When you receive a complaint, explore all options in CRS program policy to resolve the complaint. If you or your supervisor cannot resolve the complaint, tell the consumer he or she has a right to appeal.

This policy addresses procedures for resolving a consumer's complaint through due-process hearing and mediation.

These procedures apply to consumer appeals involving services for CRS.

The appeal procedures supplement the procedures required by law and do not permit class actions.

30.3.2 Impact on Services

A pending appeal decision by a mediator or impartial hearing officer (IHO) does not suspend, reduce, or stop services being provided for an appellant, including evaluation and assessment services and plan development, unless the:

  • appellant or the appellant's representative requests it; or
  • services have been obtained through misrepresentation, fraud, collusion, or criminal conduct by the appellant or the appellant's representative.

If a consumer completes a term of training or similar services before the appeal, and the next term has not yet begun (before the current appeal), it is understood that training or services are not "being provided."

30.3.3 Providing Reasonable Access

During the appeal process, the CRS program provides reasonable access on request to the consumer or other people who have disabilities, as required by the Rehabilitation Act of 1973, as amended, Section 101(a)(6)(B) and Section 504.

Hearings or proceedings are held, when possible, by telephone, but always at a time and place that is reasonably accessible to the appellant and any witnesses, and convenient for the parties. 

During the appeal process, the impartial hearing officer must require that the CRS program provide, upon reasonable notice and request, and at CRS program’s expense, special communication help, including translators, readers (for blind or visually-impaired consumers) or interpreters (for deaf and hard of hearing consumers) during proceedings.

For an appellant who is deaf and has sign language skills, use certified interpreters when possible.

A CRS staff member may not serve as an interpreter during an appeal process.

An appellant who has a different hearing and/or speech impairment may need communication help such as special environmental arrangements or other communication technologies.

You may obtain technical assistance with interpreters and other communication alternatives from the CRS program manager.

30.3.4 Designating an Appellant's Representative

An appellant may represent himself or herself, or may designate someone to act as a representative, by completing DARS1487, Designation of Applicant or Consumer Representative. The representative may be an attorney licensed to practice law in Texas.

The appellant's representative:

  • speaks for the appellant;
  • handles the hearing for the appellant; and
  • holds the same status in the appeals process as the:
    • CRS representative; or
    • Health and Human Services Commission Legal Services attorney.

Once the appellant has designated a representative, provide copies of all notices, pleadings, and other correspondence to the appellant's representative.

When the appellant's representative is an attorney an attorney-client privilege relationship exists, and all communication with the appellant must occur through the appellant’s representative.

30.3.5 Duration of the Representative's Designation

The appellant's authorized representative remains the representative of record in absence of a formal request to withdraw and an order approving the withdrawal issued by the impartial hearing officer.

When the appellant or the appellant's representative states orally that a representative designation is no longer in effect:

  • stop communicating with the representative about the case;
  • document the appellant's oral notice in a case note; and
  • ask the appellant to provide the request for revocation in writing.

30.3.6 Computing Time

In computing any period stated in these procedures, do not include the date of the act, event, or default—the period begins on the next day. Include the last day of the period, unless it falls on a Saturday, Sunday, or legal holiday. The period lasts until the end of the next day that is not a Saturday, Sunday, or legal holiday.

Unless stated otherwise, "days" refers to calendar days.

30.3.7 The Legal Authority for Appeals

The CRS program appeal procedures are authorized by:

  • Health and Human Services Commission (HHSC) rules in 1 TAC, Part 15, Chapter 357, Subchapter A; and
  • Texas Government Code, Chapter 2001, as amended.

If there are inconsistencies between the policies and procedures in this chapter and the HHSC rules for appeals, the rules prevail. Copies of HHSC rules may be obtained from HHSC Legal Services.

30.3.8 Notifying the Consumer of the Appeals Process

The CRS program provides a consumer (or as appropriate, the consumer's representative) written notice of the:

  • right to a review of the CRS program determinations that affects the services provided to the consumer through an impartial due-process hearing as described in this chapter;
  • right to pursue mediation with respect to the CRS program determinations that affects the consumer's services for CRS;
  • address of Health and Human Services Commission Legal Services, with whom the consumer may file a request for mediation or a due-process hearing; and
  • manner in which a mediator or impartial hearing officer may be selected consistent with the requirements of this chapter.

Provide the written notice when:

  • the consumer applies for services for CRS;
  • you assign the consumer to a category in the state's order of selection (for programs with an established order of selection);
  • you and the consumer develop the Individualized Written Rehabilitation Plan (IWRP); and
  • you deny, reduce, suspend, or end a consumer's services.

The following decisions are subject to review by appeal:

  • denial, reduction, suspension, or termination of services for CRS;
  • the nature or content of the consumer's IWRP; or
  • the delivery or quality of comprehensive rehabilitation counseling services or other services provided by the CRS program.

Other decisions made in the course of providing services are not subject to review by appeal.

30.4 The Due-Process Hearing

30.4.1 Overview

An appeal, also known as a due-process hearing, provides the opportunity to:

  • resolve disputes about your decisions concerning furnishing or denying services; and
  • submit additional evidence and information to an impartial hearing officer, who makes a decision on the issues in dispute.

The following sources and authorities govern the appeals process:

  • Texas Human Resources Code Annotated Chapter 91 and 111;
  • CRS policy;
  • 40 TAC Chapter 101, Subchapter J; and
  • Texas Government Code, Chapter 2001.

30.4.2 The Prehearing Procedure

Notification of Appeal

An appeal is made when the consumer files a DARS1505, Request for Due Process Hearing and/or Mediation, with Health and Human Services Commission (HHSC) Legal Services. A consumer may file an appeal when the consumer disagrees with your determination affecting the provision of rehabilitation services.

Timeliness of an Appeal

A consumer who is dissatisfied with a determination by the CRS program must file the appeal within 180 days of the date on which the CRS program made the determination. Otherwise, the appeal is not timely.

Selection of the Impartial Hearing Officer (IHO)

After receiving DARS1505, Request for Due Process Hearing and/or Mediation, HHSC Legal Services randomly selects an impartial hearing officer (IHO) from a pool of IHOs.

Time Limit for the Hearing

An IHO must conduct a hearing within 60 days of the CRS program’s receipt of a consumer's request for a due-process hearing, unless the parties to the dispute:

  • achieve informal resolution or a mediation agreement before the 60th day; or
  • agree to a specific time extension, which must be:
    • in writing;
    • signed by the appellant; and
    • filed with HHSC Legal Services.

The IHO may grant reasonable time extensions for good cause at the request of either party.

CRS Representative

If the appellant is not represented by an attorney, the CRS representative prepares and presents the case, and HHSC Legal Services provides requested support to the CRS representative.

If an attorney represents the appellant, these roles change. See 30.4.6 Roles and Responsibilities in a Due-Process Hearing for more information.

Client Legal Services

You, or the hearings coordinator, must ensure that the appellant is aware of the Client Assistance Program (CAP), including the address and telephone number of the nearest CAP office.

Other free legal service may be available through Legal Aid, or other similar programs.

Ex Parte Communications

Unless authorized by law, the CRS representative or the appellant may not communicate directly or indirectly with the IHO about any issue of fact or law unless all parties may participate in the communication.

Witness Mileage and Fees

The party who requests the witness's appearance or deposition pays witness mileage and fees.

CRS staff members’ expenses are paid by the office to which they are assigned.

Any witness who is not a CRS staff member and is subpoenaed by the CRS program is entitled to:

  • mileage based on state travel rates for travel to and from the hearing or deposition, if the place is more than 25 miles from the person's residence; and
  • a fee of at least $10 a day for each day or part of a day the person is required to be present; or
  • a fee equal to the per diem and travel allowances of a state employee, if an overnight stay is required.

Actions before the Hearing

The IHO sets the date, time, and place for the hearing and notifies the parties. The location is usually the field office nearest the appellant's residence, or a place agreed to by both parties.

The IHO schedules a prehearing conference to acquaint all parties with the laws, regulations, and rules to be followed during the hearing. The prehearing conference also allows all parties to raise and address concerns about any relevant matter, including:

  • pending motions;
  • stipulations;
  • issues;
  • witnesses;
  • disclosures;
  • reasonable access; or
  • settings.

Names and addresses of witnesses must be filed before the hearing date set by the IHO.

The IHO may order that the parties be prepared to do the following at the prehearing conference:

  • Discuss the prospects of settlement and report on them at the prehearing conference.
  • File and discuss preliminary motions.
  • Specify the facts and legal issues in the case.
  • State concisely the disputed facts and issues.

All or part of the discovery, prehearing conference, and due-process hearing is electronically recorded. The CRS program provides one copy of the recording at no cost to the appellant. A charge is made for additional copies or transcripts.

30.4.3 Discovery

The CRS program must provide to the appellant, or the appellant's representative, a copy of the appellant's case file without the appellant having to request it.

A party may request in writing that:

  • the other party provide the names of potential witnesses, including experts;
  • summarize briefly, the anticipated testimony of the witnesses;

state the issues as the party sees them and the

30.4.4 Action during the Due-Process Hearing

The appellant and the CRS program may:

  • offer into evidence any relevant information;
  • examine all material offered into evidence;
  • object to any evidence offered;
  • provide testimony;
  • call witnesses to testify; and
  • cross-examine witnesses.

Conduct of All Parties

The impartial hearing officer (IHO) maintains and enforces standards of conduct. Every party, witness, attorney, and representative must participate in all proceedings with dignity, courtesy, and respect for all other parties.

Order of Procedure

The appellant may state:

  • the claim or defense;
  • what the appellant expects to prove; and
  • the relief sought.

The CRS program then may make a similar statement. The IHO may allow others to make statements.

The appellant introduces evidence. The CRS program and any other parties may cross-examine each of the appellant's witnesses.

Parties may redirect and re-cross-examine.

Unless the statement has already been made, the CRS program may state:

  • the claim or defense;
  • what the CRS program expects to prove; and
  • the relief sought.

The CRS program introduces evidence, if any. The appellant and any other parties may cross-examine each of CRS program’s witnesses.

The parties then may present rebuttal evidence.

The IHO may allow the parties to make their closing statements.

The IHO may deviate from this order of procedure in the interest of justice or to expedite the proceedings.

Parties must provide four copies of each exhibit offered as evidence.

No evidence may be admitted that is irrelevant, immaterial, or unduly repetitious.

30.4.5 The Impartial Hearing Officer's Decision

The impartial hearing officer (IHO) renders a decision within 30 days after the hearing completion date.

Motion for Reconsideration

Either party to a hearing may file a motion for reconsideration with Health and Human Services Commission Legal Services within 20 days after the IHO issues a decision.

The motion for reconsideration must specify the matters in the IHO's decision that the party considers erroneous. The opposing party must file a response to the motion within 15 days of the date the motion was served upon the opposing party.

The Finality of the Department's Decision

The IHO acts for the CRS program, and the IHO's decision is final.

Civil Action or Judicial Review

Any party aggrieved by an IHO's final decision may bring a civil action for review of the decision. Without regard to the amount in controversy, the action may be brought in any state court of competent jurisdiction, or a district court of the United States of competent jurisdiction.

In any such action, the court receives the records relating to the hearing; hears additional evidence at the request of a party to the action; and bases a decision on the preponderance of the evidence, and grants appropriate relief.

Exhausting all administrative remedies, including a motion for reconsideration, is a prerequisite to judicial review. A party seeking judicial review of the final decision for the CRS program must begin civil action no later than 30 days after the date of the final decision.

If a party brings a civil action to challenge an IHO's final decision, the IHO's final decision must be implemented pending a court's review.

30.4.6 Roles and Responsibilities in a Due-Process Hearing

Impartial Hearing Officer (IHO)

The IHO's authority is limited to reviewing the appellant's dissatisfaction with the furnishing or denial of services by you or a CRS staff member.

The IHO may not:

  • change the CRS program rules, policies, or procedures;
  • hear alleged violations of the Americans with Disabilities Act, Section 504 of the Rehabilitation Act, or other federal laws;
  • hear or decide class actions; or
  • grant compensatory or monetary relief.

Health and Human Services Commission (HHSC) Legal Services

HHSC Legal Services:

  • provides administrative support to the IHO during the appeal process; and
  • is the point of contact for the appellant's questions about the due-process hearing.

The role of the HHSC Legal Services depends on whether the appellant represents himself or herself or designates an attorney as a representative.

If the appellant represents himself or herself, or is represented by someone who is not an attorney, HHSC Legal Services' role is primarily that of advisor to the CRS representative. The CRS representative prepares and presents the case. HHSC Legal Services provides all requested support to the CRS representative.

Before the hearing, HHSC Legal Services is available to meet with the CRS representative to discuss:

  • developing the issues;
  • gathering the evidence;
  • preparing witnesses; and
  • preparing exhibits.

If the appellant's representative is an attorney, HHSC Legal Services prepares and presents the case with the CRS representative's help.

CRS Representative

The CRS program manager serves as the CRS representative.

If the appellant is not represented by an attorney, the CRS representative:

  • has the authority to settle the dispute with the appellant;
  • prepares and presents the case;
  • represents the CRS program at the due-process hearing;
  • fields all content calls; and
  • may request support from HHSC Legal Services.

If the appellant is represented by an attorney, the CRS representative:

  • no longer has total responsibility for the due-process hearing;
  • supports HHSC legal staff who are representing the CRS program;
  • is the rehabilitation content and case file expert; and
  • helps HHSC legal staff reach a settlement.

The CRS representative is the contact person for witnesses who are CRS staff members regarding the date, time, and location of the hearing and for any changes that occur.

The Appellant

The appellant is a consumer who has filed an appeal and is the primary party to the hearing process. The purpose of the hearing is to resolve the issues that the appellant raised in the petition.

When the appellant does not have a representative, he or she presents the case (for example, presents all the evidence, witness testimony) alone.

Witness

A witness has personal knowledge of the facts, or special knowledge (expert) of the alleged facts and issues.

The extent to which a witness conveys that knowledge is critical to the development of each party's position, and to the full and complete development of the record. An underdeveloped record can be unfavorable to either party and inhibits the IHO's ability to make a decision.

A witness is usually prepared for testimony by the party's representative. An untrained witness may be asked to provide "impressions," and an expert is often asked to render an opinion based on a hypothetical question. All admissible witness testimony is entered into the record.

The appellant's counselor is likely to be called as a witness.

30.5 Mediation

Any party in an appeal may request mediation. Mediation is a voluntary process by which an appellant and a CRS representative may work with a trained mediator to resolve a dispute about determinations that affect the appellant's services from the CRS program.

Participation in the mediation process is voluntary on the part of a consumer and the CRS program.

The mediation process cannot deny or delay:

  • the appellant's right to pursue resolution of the dispute through an impartial hearing held 60 days from receipt of the appellant's request for a due-process hearing; or
  • any other rights described in this chapter.

At any point during mediation, either party or the mediator may decide to end the mediation. When mediation is ended, either party may pursue resolution through an impartial hearing.

When the CRS hearings coordinator receives a request for mediation, the Hearings Coordinator selects an individual from a list of qualified mediators who are knowledgeable about the laws and regulations concerning services from the CRS program.

Mediation sessions are scheduled and conducted timely, and are held in a location and manner that is convenient to parties to the dispute.

Discussions that occur during the mediation process are kept confidential, and are not used as evidence in any subsequent due-process hearing or civil proceedings. The parties to the mediation process may be required to sign a confidentiality pledge before the process begins.

Any agreement reached during the mediation must be in writing and signed by all parties. The agreement becomes a part of the consumer's case file.

The CRS program pays the cost of a mediation session. However, the CRS program does not pay for costs related to the appellant's representation by counsel or other advocate selected by the appellant.

Chapter 31: Subrogation

31.1 Overview

Subrogation is the process of recovering claims for medical and rehabilitation service costs.

The CRS program usually does not purchase goods or services for consumers when there are other sources to cover these expenses. However, CRS funds can be used before a settlement or judgment is reached in a workers' compensation or liability case when third party funds are not available at the time needed to ensure that the consumer's progress toward the rehabilitation goal is not delayed.

When CRS funds are expended on behalf of a consumer who has filed litigation or other legal claims, the CRS program helps recover those funds through the subrogation process

31.2 Types of Subrogation

The CRS program pursues recovery of expenditures in the following two types of cases:

  • Workers' compensation cases where the CRS program encumbrances have been made for medical or medically related expenditures, usually while the case is in litigation, and the insurance carrier refuses to pay for medical expenses.
  • Liability insurance cases, usually involving a lawsuit or claim between the drivers of two vehicles, the driver of a vehicle and a passenger in the vehicle, or the driver of a vehicle and a passenger in another vehicle. Medical and training services may be subrogated in liability cases.

31.3 Responsibilities

31.3.1 Counselor

There are three instances in which you must ask the consumer if he or she has retained an attorney or is pursuing a claim related to his or her disability:

  • at the time of application;
  • when completing the Individualized Written Rehabilitation Plan (IWRP); and
  • when amending or reviewing the IWRP.

If the consumer has retained an attorney or is pursuing a claim related to his or her disability:

  1. complete DARS3500, Subrogation Report;
  2. give the consumer a copy of page 3 of the Subrogation Report;
  3. review the page with the consumer to answer any questions; and
  4. send the Subrogation Report to Legal Services by:

Subrogation Coordinator
Legal Services, also known as the Office of the General Counsel (OGC)
Health and Human Services
4800 N. Lamar Blvd., Ste. 300 MC1419
Austin, TX 78756-3178

CRS field staff members are not required to track a subrogated case through settlement.

31.3.2 Legal Services

Legal Services provides all legal support and representation regarding subrogation, including legal intervention in lawsuits. In addition, the office acts as a liaison with the Office of the Attorney General.

Within Legal Services, the subrogation coordinator:

  • helps identify cases that are appropriate for subrogation;
  • begins efforts to recover costs when they are notified of a subrogation case; and
  • communicates with field counselors and private attorneys to facilitate reimbursement.

31.3.3 When to Use DARS3500

Use DARS3500, Subrogation Report, when the:

  • consumer is pursuing a claim against another party for personal injury and related damages caused by the other party's negligence or wrongdoing, and the CRS program has or will spend funds for rehabilitation services because of the negligence or wrongdoing;
  • Texas Department of Insurance, Division of Workers' Compensation has denied the consumer's claim; the consumer is appealing the denial either to the Texas Department of Insurance, Division of Workers' Compensation or in court; and the CRS program has provided or will provide diagnostic or restorative services related to the injury; or
  • consumer was injured on the job, but there was no workers' compensation coverage, and the consumer has filed a liability claim or lawsuit.

Upon receiving notification of a subrogation case, the subrogation coordinator begins efforts to recover costs.

31.4 When Recovery Begins for CRS funds

CRS recovery of funds begins when:

  • funds that are recoverable have been encumbered; and
  • CRS program staff members learn that a consumer has filed:
    • a lawsuit or claim, or will file a lawsuit, against a third party for injuries; or
    • a lawsuit appealing the decision of the Texas Department of Insurance, Division of Workers' Compensation in a workers' compensation case.

31.5 The Recovery Process

When Legal Services finalizes a settlement of a subrogation claim, the consumer's attorney often submits a request for a waiver of all or part of the CRS program subrogation lien.

When this happens, the subrogation coordinator:

  • communicates with the consumer’s attorney regarding the subrogation claim; and
  • sends a list of assessment questions to the counselor of record or the manager of that unit.

The counselor or manager of record:

  • completes the list of assessment questions; and
  • faxes the completed document to the subrogation coordinator at (512) 424-4059 within three workdays.

When all necessary documents, including the counselor's assessment responses, are received, Legal Services uses the information to negotiate an appropriate settlement amount for the subrogation claim, if warranted.

The final settlement amount may range from 0 percent to 100 percent of the total lien amount claimed by the CRS program.

Chapter 32: Civil Rights Compliance

32.1 Overview

In compliance with Health and Human Services policy, the CRS program does not exclude, deny benefits, limit participation, or otherwise discriminate against any person in the administration of services on the basis of:

  • race;
  • color;
  • sex;
  • national origin;
  • age;
  • disability; or
  • religion.

32.2 Implementing the Policy

The CRS management takes necessary steps to ensure that our commitment to civil rights is reflected in both words and actions.

Civil Rights Complaints

Any discrimination complaint the CRS program receives, either directly from a consumer or through an external compliance agency, must be forwarded to the HHSC Civil Rights Office within 10 calendar days of receipt by the CRS program staff member receiving the complaint.

Detailed information about policies, services, and procedures may be found at the HHSC Civil Rights Office under Policies and Services.

Chapter 33: Required Approvals

33.1 Overview

Throughout the CRS program process, the counselor may receive requests that require additional approval. The information below outlines statewide operating principles associated with required approvals and/or consultations.

33.2 Required Approvals and/or Consultations

Policy establishes basic statewide operating principles that:

  • define services and service limitations; and
  • support the highest possible compliance with state law through:
    • informed consumer choice;
    • best-value purchasing; and
    • sound decision making.

Management review, consultation, and in some cases approval are necessary to implement some actions and/or decisions, including:

  • exceptions to established:
    • policies procedures;
    • payment limitations; and
  • decisions concerning the best course of action for complex services.

Specific procedures are required for some exceptions.

Policy must not create an immovable barrier to a consumer's rehabilitation. Counselors should seek waivers to policy where limitations create such a barrier. Managers and consultants must provide expertise in mastering alternatives.

The manager may make an exception to any mandatory policy except to those:

  • based state law;
  • where it is stated that manager exceptions are not permitted; or
  • that requires a different approval source.

In most cases, approvals are documented in a case note within ReHabWorks. Approvals received electronically, such as by email, should be copied and pasted into ReHabWorks. Counselors must file paper approvals in the paper case file. All approvals must include a clear description of the basis for the approval.

Chapter 34: Case Reviews

34.1 Overview

The purpose of a case review is:

  • to determine whether a case complies with federal requirements and CRS policy;
  • to assess the quality of decision making, understanding of the vocational rehabilitation process, and ability to explain a consumer's progress clearly and concisely in the case record;
  • to help counselors and support staff members improve their decision making about the rehabilitation process, increase their use of community resources, and improve how well they manager their casework and caseload; and
  • to help managers develop performance management information.

34.2 Key Terms

Case Reading Review – A review that allows users to quickly review a case, or a specific aspect of a case, when a more detailed case review is not necessary. Refer to the TxROCS User’s Guide for instructions on entering a case reading review in TxROCS.

Compliance – Adhering to the federal and state laws, regulations, guidelines, and specifications that are outlined in this manual and in the CRS Standards for Providers Manual, Contracting Processes and Procedures Manual, and DARS Procurement Manual. A case is compliant if it meets all of the requirements. For information about evaluating compliance, refer to the MOSAIC Process Guide, Appendix C: Compliance and Quality Case Review Guide, Section III: MOSAIC - Case Review Guide.

Compliance and Quality Review (C&Q) – A review of the compliance and quality aspects of a vocational rehabilitation case. C&Q reviews can be completed using an entire or partial approach. Refer to the TxROCS User’s Guide for instructions on entering a C&Q review in TxROCS.

Entire Review Approach – A case review approach that requires the reviewer to answer all questions in the review before the review can be considered complete. The approach can be used for compliance and quality reviews, technical and purchasing reviews, and full reviews.

Full Review – A review that includes both a technical and purchasing (T&P) review and a compliance and quality (C&Q) review of a case that is started as a single full review in TxROCS. The reviewer must answer all questions in both the T&P and C&Q sections of the review before the review can be considered complete. Refer to the TxROCS User’s Guide for instructions on entering a full review in TxROCS.

Monitoring, Oversight, and Internal Controls (MOSAIC) Process Guide – A guide that describes the quality assurance system and monitoring processes. The MOSAIC guide provides information about the risk assessment model. It explains how reviewers use the model to develop quarterly monitoring plans and how regions use it to develop and report on action plans to address monitoring results.

Partial Review Approach – A case review approach that allows the reviewer to complete and finalize a case review without answering all of the questions in the review. The approach can be used for compliance and quality reviews or technical and purchasing reviews. It cannot be used for full reviews.

Quality – An assessment of the level of service and other forms of support provided to a consumer throughout the consumer’s case. Quality casework is demonstrated by values- based decision making, active participation by the consumer, and compliance with all required policies and standards. Quality is assessed based on a thorough review of all related casework and documentation. Quality is rated as exceeds expectations, meets expectations, or needs improvement. For more information about quality assessments, refer to the MOSAIC Process Guide, Appendix C: Compliance and Quality Case Review, Section III: MOSAIC - Case Review Guide.

Technical and Purchasing Review (T&P) – A review of the technical and purchasing aspects of a vocational rehabilitation case. T&P reviews can be completed using an entire or partial approach. Refer to the TxROCS User’s Guide for instructions on entering a T&P review in TxROCS.

TxROCS Users Guide – A technical guide that explains how to navigate through the TxROCS application. The TxROCS User’s Guide is not a policy manual.

TxROCS User Role – Distinct roles that define what the user is allowed to use in TxROCS. User roles prohibit reviewers from viewing case reviews and reports that are not within the reviewer’s assigned management unit. For more information on user roles, refer to the TxROCS User’s Guide.

Validate – To verify that required corrective actions have been completed appropriately. When the validator is satisfied that the corrective actions have been completed appropriately, he or she selects the "Completed Validation" button on the Actions page in TxROCS. When the validation is complete, the case review is final and no further changes may be made to the case review.

34.3 Compliance and Quality Reviews

The compliance portion of a compliance and quality (C&Q) review is used to evaluate whether specific elements of a case adhere to the federal and state laws, regulations, guidelines, and specifications that are outlined in the this manual and in the CRS Standards for Providers Manual, Contracting Processes and Procedures Manual, and DARS Procurement Manual.

The quality portion of a C&Q review is used to assess the level of service and other forms of support provided to the consumer throughout the consumer’s case. Quality casework is demonstrated by values-based decision making, active participation by the consumer, and compliance with all required policies and standards. It is based on a thorough review of all related casework and documentation.

C&Q reviews are documented by completing DARS3456, Compliance and Quality Case Review in TxROCS. Only managers, program specialists, and their designees may complete a C&Q review. C&Q reviews cannot be completed by administrative support staff members.

For help when completing a C&Q review, see the MOSAIC Case Review.

34.4 Technical and Purchasing Review

The technical portion of a technical and purchasing (T&P) review is used to evaluate whether all required information is included in the electronic and or paper case file.

The purchasing portion of a T&P review is used to evaluate whether the appropriate purchasing policies and procedures were followed and documented, as required by the applicable federal and state laws, regulations, guidelines, and specifications that are outlined in the CRS Standards for Providers Manual, Contracting Processes and Procedures Manual, and DARS Procurement Manual.

T&P reviews are documented by completing DARS3399, Technical and Purchasing Review in TxROCS. Managers, program specialists, and their designees may complete T&P reviews. Designees may include management support staff members; however, managers must review a designee’s work to ensure that the designee accurately represents the findings.

All managers are required to monitor the operation of their units. Case reviews are a required part of monitoring. To identify the type and quantity of required reviews, managers refer to the unit’s monitoring plan for the current fiscal year. The regional director and designated regional office staff members oversee each unit in their region, including monitoring of activities related to case review.

The program director or program manager of Consumer Services Support (CSS) manages and oversees the case review process statewide to ensure that the process is applied consistently. Direct all questions about the case review process and unit monitoring plan to the CSS program director or a designee.

Refer to the MOSAIC Case Review Guide for information on the unit monitoring plan and the reporting requirements and other roles and responsibilities of unit, regional, and central office staff members.

34.5 TxROCS

The CRS program uses TxROCS to capture and organize data from case reviews that are conducted statewide.

The CRS program uses the data captured in TxROCS to:

  • examine statewide activity and trends; and
  • respond to ad-hoc requests requiring case review data.

Using TxROCS allows the CRS program to:

  • record case review data efficiently and accurately;
  • create one repository for data, in place of many repositories;
  • provide timely and accurate reporting, at all organizational levels; and
  • provide auditors, quickly and accurately, with a comprehensive list of the vocational rehabilitation cases that have been reviewed.

Responsibilities and Roles in TXROCS

All reviews of vocational rehabilitation cases must be entered into TxROCS. The reviews are maintained in TxROCS for a minimum of two state fiscal years. The review process is audited each year.

The supervisor:

  • determines the appropriate user role for all staff members based on the standard descriptions in the TxROCS User’s Guide; and
  • submits a completed DARS1260, Service Request for an Individual.

Exceptions to a standard user role require the approval of the regional director.

Reviewers (or their designees):

  • document the case review in TxROCS;
  • identify areas of non-compliance (if applicable);
  • establish the corrective actions to be taken;
  • notify staff members about their reviews and assigned corrective actions;
  • monitor the progress made on taking corrective actions;
  • validate that corrective actions have been completed;
  • document the validation in TxROCS; and
  • report serious findings (that is, illegal, immoral, or unethical practices) immediately to the regional director.

After completing a review, the reviewer enters a case note in the consumer's electronic file to document the type of review conducted. Specific findings and assigned corrective actions are not entered in the case note.

Caseload carrying staff members (or their designees):

  • review completed case reviews;
  • complete all assigned corrective actions; and
  • acknowledge that they have completed these steps of the review in TxROCS.