1 Tex. Admin. Code § 363.603 - Provider Participation Requirements
(a) Personal care services (PCS) must be
provided by an individual who:
(1) is 18
years of age or older;
(2) is an
attendant who:
(A) is an employee of a
provider organization licensed as a home and community support services agency
(HCSSA) per 40 TAC Chapter 97 (relating to Licensing Standards for Home and
Community Support Services Agencies); or
(B) if the recipient is receiving PCS through
the consumer directed services (CDS) option described in 40 TAC Chapter 41
(relating to Consumer Directed Services Option), is an employee of:
(i) the recipient; or
(ii) the recipient's responsible adult or
legally authorized representative (LAR);
(3) has demonstrated the competence
necessary, when competence cannot be demonstrated through education and
experience, to perform the personal assistance tasks assigned by the provider
organization supervisor or by the recipient or the recipient's responsible
adult or LAR acting as employer through the CDS option described in 40 TAC
Chapter 41;
(4) is not the
responsible adult of the recipient if the recipient is under the age of 18;
and
(5) is not the legal spouse of
the recipient.
(b) HHSC
may establish rates of reimbursement based on the level of care required by the
recipient and the qualifications of and tasks performed by the PCS
attendant.
(c) An organization that
employs attendants who provide PCS must meet the licensing standards set out in
40 TAC Chapter 97 for one of the following license categories or special
service types:
(1) Licensed Home Health
Services, as set out in 40 TAC § 97.401(relating to Standards Specific to
Licensed Home Health Services);
(2)
Licensed and Certified Home Health Services, as set out in 40 TAC §
97.402(relating to Standards Specific to Licensed and Certified Home Health
Services); or
(3) agencies licensed
to provide personal assistance services, as set out in 40 TAC §
97.404(relating to Standards Specific to Agencies Licensed to Provide Personal
Assistance Services).
(d)
An organization serving as a Financial Management Services Agency (FMSA)
providing financial management services and other employer support services to
a recipient receiving PCS through the CDS option must meet the FMSA contracting
requirements specified in 40 TAC Chapters 41 and 49 (relating to Consumer
Directed Services Option and Contracting for Community Services).
(e) Provider organizations and FMSAs must
successfully enroll as Texas Medicaid providers prior to seeking authorization
or payment for PCS.
(f) Any
organization that employs attendants who provide PCS and any organization
serving as an FMSA must comply with all documentation requirements as specified
in PCS program policy.
(g) Provider
organizations, recipients, and responsible adults or LARs of recipients who
employ attendants for PCS must:
(1) pay each
attendant at least the base wage specified in §
355.7051 of this title (relating to
Base Wage for a Personal Attendant); and
(2) notify any person employed as an
attendant of the requirement that the provider organizations, recipients, and
responsible adults or LARs of recipients who employ attendants for PCS must pay
each attendant at least the base wage specified in §
355.7051 of this
title.
Notes
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