Revision 08-1

 

 

§46.31 Staff Requirements

 

The facility must have staff as described in §92.41 of this title (relating to Standards for Type A, Type B, and Type E AssistedLiving Facilities).

 

§46.33 Staff Training

 

(a) General training requirements. The facility must provide all staff with training as described in §92.41 of this title (relating to Standards for Type A, Type B, and Type E Assisted Living Facilities).

(b) Facility manager. In addition to the requirements described in subsection (a) of this section, the facility must train thefacility manager on the following topics:

(1) facility requirements for the Community Care for Aged and Disabled (CCAD) Residential Care (RC) or Community Based Alternatives (CBA) Assisted Living/Residential Care (AL/RC) programs or both, as applicable; and

(2) client characteristics and needs.

(c) Attendants. In addition to the requirements described in subsection (a) of this section, the facility must train the attendant in performing the tasks identified on the service plan described in §46.39(d) of this chapter (relating to Service Initiation).

(d) Training of new staff. The facility must provide training to new staff hired after the initial orientation described in §49.3(b) of this title (relating to General Contractual Requirements).

 

§46.35 Interdisciplinary Team

 

(a) Interdisciplinary Team (IDT). The IDT is a designated group that includes the following individuals who meet when the needarises to discuss service delivery issues:

(1) the client or the client's representative, or both;

(2) a facility representative; and

(3) a Texas Department of Human Services (DHS) representative. A DHS representative may be:

(A) the case manager (or designee);

(B) the contract manager (or designee); or

(C) the regional nurse (or designee).

(b) Convening an IDT meeting.

(1) The facility must convene an IDT meeting within three working days of the date the facility identifies a service delivery issue.

(2) If the facility is unable to convene an IDT meeting with all the members described in subsection (a) of this section, the facility must send the documentation of the IDT meeting described in subsection (e) of this section to the Regional Administrator for the DHS region in which the client resides.

(A) The documentation must be sent within five working days of the date of the IDT meeting.

(B) Further action may be required by the facility, based on a review of the IDT meeting documentation.

(c) IDT meeting.

(1) The IDT meeting may be conducted by telephone conference call or in person.

(2) The IDT must:

(A) evaluate the issue;

(B) identify any solutions to resolve the issue; and

(C) make recommendations to the facility.

(d) IDT meeting outcome. The facility must do one of the following within two working days after the IDT meeting:

(1) implement the recommendations of the IDT; or

(2) discharge the client from the facility and refer the case back to the case manager for referral to another facility.

(e) Documentation of the IDT meeting. The facility must document the IDT meeting in the client file, including the:

(1) specific reasons for calling the IDT meeting;

(2) participants of the IDT meeting. If all members described in subsection (a) of this section are unable to participate, the facility must document all efforts made to convene an IDT meeting with all the members;

(3) recommendations of the IDT;

(4) efforts made to resolve the issue;

(5) facility's action as a result of the IDT recommendations; and

(6) reasons for the facility's actions.

 

§46.37 Copayment and Room and Board

 

(a) Amount. The facility must collect the copayment and room and board amounts indicated on the Texas Department of Human Services'(DHS's) Notification of Community Care Services form or DHS's Notification of Community Based Alternatives (CBA) Servicesform. This subsection does not apply to clients who receive Community Care for Aged and Disabled emergency care service.

(b) Due date.

(1) The facility must designate a due date for copayment and room and board in writing. The due date must be during the same month the copayment and room and board is applied.

(2) The facility must collect the entire copayment and room and board on or before the due date. If the due date falls on a weekend or a holiday, the facility must collect the entire copayment and room and board on or before the first working day thereafter.

(3) If the client or the client's representative fails to pay the entire copayment and room and board by the due date, the facility must notify the client or the client's representative and the case manager in writing no later than the first working day after the due date.

(c) Credit balances.

(1) A credit balance is an amount due to the client or the client's representative when there is an overpayment by the client or the client's representative.

(2) The facility must handle credit balances as follows:

(A) The facility must provide written notice of a credit balance (client notice) to the client or the client's representative within 35 days of receipt of the payment resulting in a credit balance. The client notice may be the first monthly statement following the receipt of the payment resulting in a credit balance, if the monthly statement specifies the credit balance.

(B) The facility must offer the client or the client's representative the following options in the client notice:

(i) the client or the client's representative may choose to provide the corrected payment, and the facility will return the original amount paid;

(ii) the facility will provide the client or the client's representative with a refund of the credit balance; or

(iii) the client or the client's representative may choose to have the credit balance applied to the following month's payment. The client may choose to spread the credit balance over several months.

(C) If the client or the client's representative fails to contact the facility within 35 days of the date of the client notice, the facility must, on the 35th day:

(i) provide the client or the client's representative with a refund of the credit balance or apply the credit balance to the following month's payment; and

(ii) provide written notice of the facility's choice of action to the client or the client's representative. The written notice of the facility's choice of action may be a monthly statement if the monthly statement specifies the facility's choice of action.

(d) Copayment and room and board receipts.

(1) The facility must provide receipts for all copayment and room and board payments received from or on behalf of clients at the time the payment is received.

(2) The facility must keep a copy of all copayment and room and board receipts.

(3) Copayment and room and board receipts must contain the following elements if the elements are not contained in the copayment and room and board ledger described in subsection (e) of this section:

(A) the name of the client;

(B) the month, day, and year the payment was received;

(C) the total amount collected;

(D) the specific amounts of copayment and room and board collected; and

(E) the month and year of the coverage period for the payment received.

(4) Copayment receipts may be in any format.

(e) Copayment and room and board ledger. The facility must maintain a copayment and room and board ledger system in any format for each client.

(1) The facility may keep the copayment and room and board ledger systems as separate ledgers, or the facility may combine both ledgers into a single ledger system. If the facility chooses to keep a single ledger system, a separate entry must be made for each copayment and room and board entry.

(2) The copayment and room and board ledger system must reflect the following:

(A) all charges for copayment and room and board by client;

(B) all payments for copayment and room and board made by or on behalf of a client;

(C) all credits for copayment and room and board by client, including the:

(i) specific amount credited;

(ii) month and year of the coverage period of the credit;

(iii) type of payment credited; and

(iv) reason for the credit; and

(D) a running balance by client.

(3) The facility must record all activities on the copayment and room and board ledger system within 35 days or by the next billing cycle, whichever is sooner.

(4) The copayment and room and board ledger must be maintained in accordance with generally accepted accounting principles (GAAP).

(f) Refunds upon discharge. The facility must refund the client's copayment and room and board for the remaining days of the month following the date of discharge or death. The refund must be made within ten working days of awareness that the client will be discharged or is deceased. The facility must document the date of awareness of the client's discharge from the facility.

 

§46.39 Service Initiation

 

(a) Negotiated move-in date. The facility must negotiate a move-in date with the Texas Department of Human Services (DHS) casemanager and the client or the client's representative.

(b) Reserved space. The facility must reserve a living unit for three days from the agreed upon move-in date for each referredclient. The facility may request another referral after three days if the move-in date is not re-negotiated.

(c) Client and facility agreement. The facility must have a written agreement with the client or the client's representative.Both parties must sign the written agreement before or at the time of admission. The written agreement must include the following:

(1) bedhold policies for hospital and nursing facility stays;

(2) personal leave policies and charges;

(3) eviction procedures;

(4) all available services in the facility; and

(5) charges for services not paid by DHS and charges not included in the facility's basic daily rate, as described in §46.15 of this chapter (relating to Additional Services and Fees).

(d) Health assessment and service plan.

(1) The facility must complete a health assessment and develop an individual service plan as described in §92.41(c) of this title (relating to Standards for Type A, Type B, and Type E Assisted Living Facilities).

(2) In addition to the items described in §92.41(c) of this title, the health assessment developed by the facility must contain the following items:

(A) vision patterns;

(B) skin conditions;

(C) body control problems; and

(D) vital signs, height, and weight.

(3) The health assessment and individual service plan must be completed:

(A) within 72 hours of admission to the facility; and

(B) by the appropriate person(s).

(i) The facility manager or a nurse must complete the health assessment and individual service plan.

(ii) A nurse must complete the medication administration portion of the health assessment for Community Based Alternatives (CBA) Assisted Living/Residential Care (AL/RC) clients. If the nurse is a licensed vocational nurse (LVN), a registered nurse (RN) must sign off on the medication administration portion of the health assessment.

 

§46.41 Required Services

 

(a) Service delivery. The facility must provide services according to the service plan completed for the client.

(b) Required services. Services include:

(1) Personal care. The facility must provide or assist with personal care services identified on the service plan completed for the client. Personal care services are activities related to the care of the client's physical health that include at a minimum:

(A) bathing;

(B) dressing;

(C) grooming;

(D) routine hair and skin care;

(E) exercising;

(F) toileting;

(G) medication administration, including injections, except in the Community Care for Aged and Disabled (CCAD) Residential Care (RC) Program;

(H) transferring/ambulating, except in a Type A assisted living facility;

(I) twenty-four-hour supervision, which means the facility must:

(i) conduct checks or visits to each client as identified in the client's service plan, to ensure that each client is safe and well; and

(ii) document the checks and visits in the client's file;

(J) meal services, which means the facility must:

(i) provide meal services as described in §92.41(m) of this title (relating to Standards for Type A, Type B, and Type E Assisted Living Facilities);

(ii) offer dietary counseling and nutrition education to the client;

(iii) modify food texture, including:

(I) chopping, grinding, and mashing foods for clients who have trouble chewing; and

(II) cutting up food into bite size pieces for clients who have trouble cutting food; and

(iv) assist with eating, including:

(I) assistance with spoon-feeding in instances when the client is temporarily ill;

(II) bread buttering; and

(III) opening containers or pouring liquids for clients with hand deformities, paralysis, or hand tremors.

(2) Home management. The facility must provide or assist with activities related to housekeeping that are essential to the client's health and comfort, including:

(A) changing bed linens;

(B) housecleaning;

(C) laundering;

(D) shopping;

(E) storing purchased items in the client's living unit, including medical supplies delivered to Community Based Alternatives (CBA) Assisted Living/Residential Care (AL/RC) clients; and

(F) washing dishes.

(3) Transportation and escort.

(A) The facility must provide the client with transportation, escort, or both to:

(i) local community areas where a client may purchase items to meet his or her personal needs or conduct personal business according to the facility's published schedule;

(ii) recreational activities, field/community trips according to the facility's published schedule; and

(iii) the nearest available medical provider for medical appointments, therapies, and other medical care.

(B) The facility must make arrangements for other transportation for the client to the medical care provider of the client's choice if the client's medical provider is not the nearest available provider.

(4) Social and recreational activities. The facility must provide a minimum of four scheduled social and recreational activities per week.

(A) Activity requirements. The social and recreational activities must be:

(i) planned to meet the social needs and interests of the clients; and

(ii) listed on a monthly calendar that is posted in plain view at the facility at least one week in advance.

(B) Types of activities. Social and recreational activities include:

(i) activities that require group and client-initiated activities;

(ii) opportunities to interact with other people;

(iii) interaction, cultural enrichment, educational, or recreational activities; and

(iv) other social activities on site or in the community.

(5) Participation in the client assessment. The facility must designate someone who is familiar with the CBA AL/RC client's needs and service plan to participate in the client's assessment by a home and community support services agency's licensed nurse. A facility is not required to designate someone to participate in a client's assessment in the CCAD RC program.

(6) Emergency care. The facility must provide emergency care as authorized by the case manager.

(A) Emergency care is assisted living services provided to clients while the case manager seeks a permanent living arrangement.

(B) Emergency care services do not apply to the CBA AL/RC program.

 

§46.43 Service Plan Changes

 

(a) The facility must complete a new service plan anytime there is a need for a change in the client's service plan.

(b) The facility must implement service plan changes within seven days from the assessment date.

 

§46.45 Required Notifications

 

(a) The facility must notify the Department of Aging and Disability Services (DADS) when one of the following happens:

(1) significant changes in the client's health and/or condition;

(2) the client temporarily enters an institution;

(3) serious occurrences or emergencies involving the client or facility staff;

(4) the client or the client's representative requests that services end;

(5) the client refuses to comply with the service plan;

(6) the client engages in discrimination in violation of applicable law;

(7) the client or the client's representative fails to pay copayment;

(8) the client uses ten personal leave days in the current calendar year;

(9) the client or the client's representative requests to move to another facility; or

(10) the facility believes that a client's functional needs have changed such that it will impact the client's level of care, if the facility provides assisted living services under the Community Based Alternatives (CBA) Assisted Living/Residential Care (AL/RC) Program and participates in the attendant compensation rate option.

(b) The facility must notify the client's DADS case manager orally or by facsimile about the change no later than one DADS working day after the change happens. If the facility's first notification is oral, the facility must send written notification to the case manager within five working days of the initial notification.

 

§46.47 Suspension of Services

 

(a) The facility must suspend services when one of the following happens:

(1) the client dies;

(2) the client moves from the facility;

(3) the client is discharged because he threatens the health or safety of himself or other clients in the facility;

(4) the client is permanently admitted to an institution;

(5) the Texas Department of Human Services (DHS) enforces sanctions against the facility by terminating the contract;

(6) the client's eligibility is denied; or

(7) the case manager requests that services be suspended or terminated.

(b) The facility must notify the client's DHS case manager orally or by facsimile about the suspension no later than one DHS workday after services are suspended. If the facility's first notification is oral, the facility must send written notification to the case manager within five working days of the initial notification.

 

§46.49 Institutional Leave

 

(a) Institution. An institution is defined as a hospital, nursing facility, state school, state hospital, or intermediate carefacility serving persons with mental retardation or a related condition.

(b) Institutional leave. Institutional leave is when clients are absent from the facility because they temporarily enter an institution.

(c) Bedhold. The facility must hold the client's bed:

(1) for a Community Care for Aged and Disabled (CCAD) Residential Care (RC) client for:

(A) 60 days if the client is in a hospital; or

(B) 30 days if the client is in any other type of institution; and

(2) for a Community Based Alternatives (CBA) Assisted Living/Residential Care (AL/RC) client for 60 days if the client is in any type of institution.

(d) Bedhold charges. The facility must charge the client or the client's representative for bedhold during institutional leave.

(1) Bedhold charges for a CCAD RC client are the bedhold rate established by the Texas Department of Human Services (DHS), plus room and board charges.

(2) Bedhold charges for a CBA AL/RC client are the room and board charges.

(e) Refund of copayment. The facility must not charge the client or the client's representative more than the maximum amount allowed by DHS for bedhold. The facility must refund the client's copayment for the days the client uses institutional leave.

(1) The facility must refund any copayment paid by a CCAD RC client or the client's representative that is in excess of the bedhold amount. If the client's copayment amount is less than the bedhold charge, DHS pays the difference as described in §46.21 of this chapter (relating to Reimbursement).

(2) The facility must refund all copayments paid by a CBA AL/RC client or the client's representative.

(3) The refund must be made according to the procedures in §46.37(c) of this chapter (relating to Copayment and Room and Board).

(f) Billing during institutional leave. The facility must charge the client or the client's representative only the bedhold amount for the date of admission to an institution. The facility must charge the client or the client's representative the full rate for date of return.

(g) Notification of institutional leave. The facility must notify the DHS case manager of any institutional leave as describedin §46.45 of this chapter (relating to Required Notifications).

 

§46.51 Personal Leave

 

(a) Personal leave. A client is entitled to 14 days of personal leave per calendar year.

(b) Client charges. The facility must collect the entire copayment and room and board charges for all personal leave days.

(c) Texas Department of Human Services (DHS) payment during personal leave. The facility must not bill DHS for more than 14 daysof personal leave taken by the client each calendar year.

(d) Notification of personal leave days. The facility must notify the DHS case manager of personal leave days as described under§46.45 of this chapter (relating to Required Notifications).

(e) Charge for exceeding personal leave days. The client is responsible for all charges for services if he exceeds the allowablelimit of personal leave days.

 

§46.53 Client Terminations

 

(a) Client discharge. The facility must convene an Interdisciplinary Team (IDT) meeting, as described in §46.35 of this chapter(relating to Interdisciplinary Team) before discharging a client, except when the client threatens the health or safety ofothers or himself. The facility must notify the DHS case manager as described under §46.47 of this chapter (relating to Suspensionof Services).

(b) Assistance with move. The facility must help the client prepare for transfer or discharge.

(c) Refunds. The facility must refund the following:

(1) copayment and room and board, as described in §46.37(f) of this chapter (relating to Copayment and Room and Board); and

(2) trust fund balances, as described in §46.71 of this chapter (relating to Trust Fund Procedures for Client Discharge).