Effective September 10, 2017

 

Revises §19.101, §19.1301, §19.1302, §19.1304, §19.1306, §19.2701, §19.2703, §19.2704, §19.2706 and §19.2709

Subchapter B, Definitions

§19.101 adds definitions for qualified mental health professional – community services and rehabilitative services. For (28) DADS, adds or the Health and Human Services as its successor agency and for (31) Department, adds Health and Human Services Commission.  Reorganizes the definitions of medical necessity (MN), registered nurse (RN), and residential assessment instrument (RAI).

Subchapter N, Rehabilitative Services

§19.1301 makes editorial changes for clarity and consistency with terminology used in Chapter 19.

§19.1302 sets forth the requirements a person must meet to provide rehabilitative services to a resident.

§19.1304 states that rehabilitative services covered by Medicaid include physical therapy, occupational therapy, and speech therapy, and requires a nursing facility to provide these services with the expectation that the resident’s functioning will improve measurably in 30 days.

§19.1306 sets forth the requirements of a nursing facility related to the submission and payment of claims for rehabilitative services provided by a nursing facility and the requirements to request a fair hearing regarding any decision related to the provision of rehabilitative services.

Subchapter BB, Nursing Facility Responsibilities Related to Preadmission Screening and Resident Review (PASRR)

§19.2701 explains that Subchapter BB includes the requirements a nursing facility must meet when providing nursing facility specialized services to a designated resident.

§19.2703 adds definitions for CMWC – Customized manual wheelchair, DME – Durable Medical Equipment, HHSC and therapy services.  Adds “or HHSC” as DADS successor agency and amends DADS to state that, for purposes of PASRR, HHSC is the state authority for intellectual and developmental disabilities.

§19.2704(7) requires a nursing facility to submit a request for nursing facility specialized services in the LTC Online Portal within 20 business days after the date of the IDT meeting.

§19.2704(i)(8), renumbered to §19.2704(i)(11), adds the “designated” to clarify that the facility must document annually in the Long-Term Care Online Portal all nursing facility specialized services, local intellectual and developmental disabilities authority specialized services, and local mental health authority (LMHA) specialized services for a designated resident.

§19.2706 makes editorial changes to the section for clarity and consistency.

§19.2709 requires a nursing facility to notify the LMHA representative of an incident or complaint involving a designated resident receiving LMHA specialized services.

Adds §19.1300, §19.2704(i)(8),(9) and (10), §19.2750, §19.2751, §19.2752, §19.2753, §19.2754, §19.2755 and §19.2756

Subchapter N

§19.1300 explains that Subchapter N contains the requirements related to rehabilitative services provided to a resident in a nursing facility and that Subchapter BB contains the requirements related to nursing facility specialized services provided to a designated resident. The change clarifies the scope of Subchapters N and BB.

Subchapter BB

§19.2704(i)(8) requires a nursing facility to provide a therapy service within 3 business days after receiving approval from HHSC in the LTC Online Portal.

§19.2704(i)(9) requires a nursing facility to order DME or a CMWC for a designated resident in accordance with §19.2754(e) of the subchapter.

§19.2704(i)(10) requires a nursing facility to provide on-going therapy services as approved by HHSC.

§19.2750 requires a nursing facility to request authorization from HHSC to provide a nursing facility specialized service if the service is agreed to by a designated resident’s interdisciplinary team (IDT) or service planning team (SPT). The section also requires a nursing facility to request and receive authorization from HHSC before providing a nursing facility specialized service.

§19.2751 contains the requirements a nursing facility must ensure are met before providing specialized therapy services to a designated resident. The new section also permits a designated resident to request a fair hearing if HHSC denies authorization for a specialized therapy service.

§19.2752 sets forth the qualifications for a person who provides nursing facility specialized therapy services to a designated resident.

§19.2753 sets forth the requirements a nursing facility must meet related to the submission and payment of claims for nursing facility specialized therapy services provided by a nursing facility.

§19.2754 sets forth the requirements a nursing facility must meet to request prior authorization and purchase durable medical equipment or a customized manual wheelchair for a designated resident.

§19.2755 sets forth the requirements a nursing facility must meet related to the submission and payment of claims for durable medical equipment and a customized manual power wheelchair.

§19.2756 sets forth the administrative requirements a nursing facility must meet related to the use, maintenance and disposition of durable medical equipment or a customized manual wheelchair for a designated resident.

Repeals §19.1303

§19.1303 is repealed to remove the rule regarding specialized services in Medicaid-certified facilities from Subchapter N. Requirements for nursing facilities related to specialized services are in proposed new §19.2750 – 19.2756 in Subchapter BB.