Revision 14-1; Effective September 1, 2014

 

 

4100 Provider Requirements

Revision 14-1; September 1, 2014

 

Rule: 40 Texas Administrative Code (TAC), Chapter 51, Subchapter D, Provider Requirements

All providers must follow all rules in Divisions 1 and 2 of Subchapter D. In addition, providers follow the rules that are relevant to them in Divisions 3 through 8, which require compliance based on the service each Medically Dependent Children Program (MDCP) provider has contracted with the Texas Department of Aging and Disability Services (DADS) to provide.

 

4200 Individuals with Qualified Income Trusts

Revision 14-1; September 1, 2014

 

Individuals with a qualified income trust (QIT) may be determined eligible for the MDCP even though their incomes are greater than the Medicaid income limit for waiver programs if they also meet all other MDCP eligibility criteria. Income diverted to the trust does not count for the purpose of financial eligibility determination, but is calculated for the determination of the co-payment for MDCP services.

MDCP providers are responsible for collecting co-payment amounts from individuals who have a QIT and are receiving respite or flexible family support services through MDCP. 42 Code of Federal Regulations (CFR), §435.726 (a) and (b) states:

  1. “The agency must reduce its payment for home and community-based services provided to an individual specified in paragraph (b) of this section, by the amount that remains after deducting the amounts specified in paragraph (c) of this section from the individual's income.
  2. This section applies to individuals who are eligible for Medicaid under CFR §435.217 and are receiving home and community-based services furnished under a waiver of Medicaid requirements specified in part 441, subpart G or H of this subchapter.”

For individuals receiving MDCP services who have income from a QIT, the Medicaid for the Elderly and People with Disabilities (MEPD) staff determine if the individual must pay a co-payment amount prior to receiving MDCP services. When this occurs, the DADS case manager enters this amount on Form 2401, Qualified Income Trust (QIT) Co-Payment Agreement, or Form 2065-B, Notification of Waiver Services. The provider must collect this co-payment amount monthly, prior to billing for MDCP services through the Texas Medicaid & Healthcare Partnership (TMHP). The trustee must pay the co-payment directly to the provider by the 10th of the month, or no later than 10 days after MDCP services have started in situations when services did not start on the first of the month. The provider must also notify the DADS case manager within one working day of the ten-day time frame if the co-payment amount has not been collected by submitting Form 2067, Case Information, to the DADS case manager.

 

4300 Electronic Verification Visit (EVV)

Revision 14-1; September 1, 2014

 

40 TAC Chapter 68, Electronic Visit Verification (EVV) System, §68.101(5), Application, applies to in-home respite and flexible family support services as they relate to MDCP. Providers can access and view all EVV requirements and a list of areas in which MDCP providers are required to utilize EVV at the DADS EVV website.

 

4400 Attendant Orientation

Revision 14-1; September 1, 2014

 

All unlicensed attendants must receive orientation to tasks specific to the individual participating in the MDCP program at the individual's place of residence prior to providing services. This requirement is found in 40 TAC, Chapter 51, §51.421, Requirements for Attendants Providing Respite and Flexible Family Support Services.

 

4500 Service Backup Plan

Revision 14-1; September 1, 2014

 

Rule: 40 TAC Chapter 51, Subchapter D, Division 2, §51.411(c), General Service Delivery

A provider must have a backup plan in case the provider is unable to deliver respite or flexible family support services, as specified on the service schedule.

Within 14 days after a provider receives an initial assessment or annual reassessment service authorization form or the backup plan changes, a provider must send the DADS case manager a copy of the provider's backup plan for service delivery.

Within 14 days after a provider receives an initial assessment or annual reassessment service authorization form, or the backup plan changes, a provider must give an individual a written copy of the provider's backup plan for service delivery, if the provider is unable to provide services as scheduled, and information on the individual's right to change providers.