This chapter establishes the requirements for facilities contracting to provide assisted living and residential care services to eligible clients through the Texas Department of Human Services Community Based Alternatives (CBA) Assisted Living/Residential Care (AL/RC) Program and the Community Care for the Aged and Disabled (CCAD) Residential Care (RC) Program. The requirements described in this chapter apply to both CBA AL/RC and CCAD RC, unless otherwise specified in the text.
The words and terms used in this chapter have the following meanings, unless the context clearly indicates otherwise.
(1) Assisted living services — Services provided in an assisted living facility to eligible Texas Department of Human Services (DHS) clients under the Community Based Alternatives (CBA) Assisted Living/Residential Care (AL/RC) or the Community Care for Aged and Disabled (CCAD) Residential Care (RC) programs.
(2) Assisted Living/Residential Care (AL/RC) Program — A 24-hour residential care program for CBA clients.
(3) Attendant — A facility employee who provides direct care to clients. An attendant may have other duties in addition to direct client care.
(4) Case manager — A DHS employee who is responsible for case management activities. Activities include eligibility determination, client registration, assessment and reassessment of client need, service plan development, and intercession on the client's behalf.
(5) Client — A CCAD or CBA client, as defined in Chapter 48 of this title (relating to Community Care for Aged and Disabled), who is eligible to receive services under this chapter.
(6) Community Based Alternatives(CBA) — A Medicaid program that provides services to eligible adults who are aged and/or disabled as an alternative to institutional care in a nursing facility. CBA services are provided in accordance with the waiver provisions of §1915(c) of the Social Security Act (42 U.S.C. §1396n(c)).
(7) Community Care for Aged and Disabled(CCAD) — A group of DHS programs that provides a variety of Title XIX and Title XX-funded community-based services.
(8) Contract — The formal, written agreement between DHS and an assisted living facility to provide services to DHS clients eligible under this chapter in exchange for reimbursement.
(9) Contract manager — A DHS employee who is responsible for the overall management of the contract with the assisted living facility.
(10) Contracted assisted living facility — An assisted living facility that contracts with DHS to provide CBA AL/RC services or CCAD RC services or both. Any reference to facility in this chapter means contracted assisted living facility, unless otherwise specified in the text.
(11) Copayment — The amount of personal income a client must pay to the facility toward the cost of care.
(12) Days — Any reference to days means calendar days, unless otherwise specified in the text. Calendar days include weekends and holidays.
(13) Facility manager — The facility employee who is responsible for the day-to-day operation of a facility.
(14) Licensed assisted living facility — A facility licensed by DHS Long Term Care Regulatory under the Health and Safety Code, Chapter 247.
(15) Personal leave day — A continuous 24-hour period, measured from midnight to midnight, when the client is absent from the facility for personal reasons.
(16) Representative — The client's spouse, other responsible party, or legal representative.
(17) Residential Care (RC) Program — An assisted living and emergency care program for CCAD clients.
(18) Room and board — The amount of personal income a client must pay to the facility toward the cost of lodging and food.
(19) Signature — A person's name or a mark representing his/her name on a document to certify it is correct. Initials are not an acceptable substitute for a signature.
(20) Trust fund — The services provided when the facility performs or assists with money management at the written request of the client or the client's representative.
(21) Witness — A person who signs to verify distribution to or from a trust fund. A witness is identified in the client file by name, address, and relationship to the client, the client's representative, or the facility. A witness can be any person except:
(A) the person(s) responsible for accounting for the client's trust fund;
(B) the supervisor of the person(s) responsible for the client's trust fund;
(C) a person supervised by the person(s) responsible for the client's trust fund; or
(D) the person(s) who accepts the withdrawn funds.
(22) Working days — Days DHS is open for business.