1 Tex. Admin. Code § 363.212 - Documentation Requirements for Services Other Than Transportation Services

(a) A PPECC must obtain and maintain the following documentation in a participant's medical record to be eligible for reimbursement for non-transportation PPECC services provided to the participant:

(1) a physician's specific, written, signed, and dated orders prescribing PPECC services;

(2) an approved prior authorization from HHSC that includes:

(A) a Comprehensive Care Program (CCP) Prior Authorization Request Form;

(B) a PPECC Plan of Care (POC);

(C) a PPECC nursing assessment;

(D) a Nursing Addendum to POC for Private Duty Nursing (PDN) and/or PPECC;

(E) consent for PPECC services as described in the Texas Medicaid Provider Procedures Manual; and

(F) documentation of medical necessity;

(3) the daily attendance log required by subsection (b) of this section; and

(4) the documentation required by subsection (c) of this section.

(b) A PPECC must maintain a daily attendance log that includes:

(1) the date of attendance;

(2) the name of the participant;

(3) the signature of the responsible adult and the time when the PPECC assumes responsibility for the care of the participant which is:

(A) the time the participant boards the PPECC transport vehicle; or

(B) the time the participant is brought to the PPECC by a responsible adult;

(4) the signature of the responsible adult and time when the responsible adult assumes responsibility for the care of the participant which is:

(A) the time the participant is taken off the transport vehicle at the participant's return destination; or

(B) the time the participant is picked up from the PPECC by a responsible adult; and

(5) the name of the PPECC staff member riding in the transport vehicle when PPECC transportation services are utilized and whether the staff member is a registered nurse, licensed vocational nurse, or direct care staff.

(c) A PPECC must maintain the following documentation:

(1) notes from interdisciplinary team meetings;

(2) discrepancies between the weekly service hours scheduled and the service hours provided;

(3) the names of the staff member providing services;

(4) the date of service;

(5) the type of service performed; and

(6) the start and end times of the service performed.

(d) HHSC may request that a PPECC provide documentation to substantiate the provision of services in addition to that required by subsections (a) - (c) of this section.

(e) HHSC may recoup payment for services not substantiated by the documentation required in this section.

Notes

1 Tex. Admin. Code § 363.212

Adopted by Texas Register, Volume 50, Number 07, February 14, 2025, TexReg 0831, eff. 2/19/2025