1 Tex. Admin. Code § 354.4006 - Home Health Care Services that Require the Use of EVV
(a) A program provider
must ensure a service provider uses EVV to document the provision of the
following home health care services by the program provider on or after January
1, 2024:
(1) in the traditional Medicaid
service model also referred to as fee-for-service, for a member who does not
reside in a nursing facility, an ICF/IID, or an IMD, the following services
when provided in the residence of the member:
(A) any nursing service, other than
PDN;
(B) occupational therapy;
and
(C) physical therapy;
(2) in the CLASS Program, for a
member who does not receive support family services or continued family
services, the following services when provided in the residence of the member:
(A) any nursing service;
(B) occupational therapy; and
(C) physical therapy;
(3) in the DBMD Program, for a member who
does not receive licensed assisted living or licensed home health assisted
living, the following services when provided in the residence of the member:
(A) any nursing service;
(B) occupational therapy; and
(C) physical therapy;
(4) in the HCS Program, for a member whose
residential type is "own/family home," the following services when provided in
the residence of the member:
(A) any nursing
service;
(B) occupational therapy;
and
(C) physical therapy;
(5) in the HCBS-AMH Program, for a
member who does not receive host home/companion care, supervised living
services, or assisted living services, the following services when provided in
the residence of the member:
(A) nursing - RN;
and
(B) nursing - LVN;
(6) in the STAR Program, the
following services when provided in the residence of the member:
(A) home health nursing;
(B) occupational therapy;
(C) physical therapy; and
(D) personal care services provided by a home
health aide under the supervision of an RN, occupational therapist, or physical
therapist;
(7) in the
STAR Health Program, the following services when provided in the residence of
the member:
(A) home health nursing, other
than PDN;
(B) occupational
therapy;
(C) physical therapy;
and
(D) personal care services
provided by a home health aide under the supervision of an RN, occupational
therapist, or physical therapist;
(E) nursing delegation and supervision of PCS
and CFC tasks; and
(F) for a member
in STAR Health MDCP, the following services when provided in the residence of
the member:
(i) RN delegation and supervision
of personal care services and CFC tasks, other than PDN;
(ii) flexible family supports services
performed by RN or an LVN; and
(iii) in-home respite performed by RN or an
LVN;
(8) in
the STAR Kids Program, the following services when provided in the residence of
the member:
(A) home health nursing, other
than PDN;
(B) occupational
therapy;
(C) physical
therapy;
(D) personal care services
provided by a home health aide under the supervision of an RN, occupational
therapist, or physical therapist;
(E) nursing delegation and supervision of PCS
and CFC tasks; and
(F) for a member
in STAR Kids MDCP, the following services when provided in the residence of the
member:
(i) RN delegation and supervision of
personal care services and CFC tasks, other than PDN;
(ii) flexible family supports services
performed by an RN or LVN; and
(iii) in-home respite performed by an RN or
LVN;
(9) in
the STAR+PLUS Program, the following services when provided in the residence of
the member:
(A) home health nursing;
(B) occupational therapy;
(C) physical therapy; and
(D) personal care services provided by a home
health aide under the supervision of an RN, occupational therapist, or physical
therapist;
(10) in the
STAR+PLUS HCBS Program, for members not receiving adult foster care, assisted
living services - single occupancy, assisted living services - double
occupancy, or assisted living services - non-apartment, the following services
when provided in the residence of the member:
(A) home health nursing, including
SRO;
(B) occupational therapy,
including SRO;
(C) physical
therapy, including SRO; and
(D)
personal care services provided by a home health aide under the supervision of
an RN, occupational therapist, or physical therapist, including SRO;
(11) in the STAR+PLUS MMP, for
members not receiving adult foster care, assisted living services - single
occupancy, assisted living services - double occupancy, or assisted living
services - non-apartment, the following services when provided in the residence
of the member:
(A) home health nursing,
including SRO;
(B) occupational
therapy, including SRO;
(C)
physical therapy, including SRO; and
(D) personal care services provided by a home
health aide under the supervision of an RN, occupational therapist, or physical
therapist, including SRO;
(12) in the TxHmL Program, the following
services when provided in the residence of the member:
(A) any nursing service;
(B) occupational therapy; and
(C) physical therapy; and
(13) any other service required by
federal or state mandates.
(b) A CDS employer must ensure a service
provider uses EVV to document the provision of the following home health care
services using the CDS option on or after January 1, 2024:
(1) in the CLASS Program, the following
services when provided in the residence of the member:
(A) any nursing service;
(B) occupational therapy; and
(C) physical therapy;
(2) in the HCS Program, for a member whose
residential type is "own/family home," the following services when provided in
the residence of the member:
(A) any nursing
service;
(B) occupational therapy;
and
(C) physical therapy;
(3) in the STAR Health Program for
a member in STAR Health MDCP, the following services when provided in the
residence of the member:
(A) flexible family
supports services performed by any RN or any LVN; and
(B) in-home respite performed by any RN or
any LVN;
(4) in the STAR
Kids Program for a member in STAR Kids MDCP, the following services when
provided in the residence of the member:
(A)
flexible family supports services performed by any RN or any LVN; and
(B) in-home respite performed by any RN or
any LVN;
(5) in the
STAR+PLUS Program, the following services when provided in the residence of the
member:
(A) home health nursing;
(B) occupational therapy;
(C) physical therapy; and
(D) personal care services provided by a home
health aide under the supervision of an RN, occupational therapist, or physical
therapist;
(6) in the
STAR+PLUS HCBS Program, the following services when provided in the residence
of the member:
(A) home health
nursing;
(B) occupational
therapy;
(C) physical therapy;
and
(D) home health aide services
as an extension of physical therapy, occupational therapy, or nursing
services;
(7) in the
STAR+PLUS MMP, the following services when provided in the residence of the
member:
(A) home health nursing;
(B) occupational therapy;
(C) physical therapy; and
(D) home health aide services as an extension
of physical therapy, occupational therapy, or nursing services; and
(8) in the TxHmL Program, the
following services when provided in the residence of the member:
(A) any nursing service;
(B) occupational therapy; and
(C) physical therapy.
Notes
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