26 Tex. Admin. Code § 262.927 - Enhanced Staffing Rate
(a) A program
provider may request a level one enhanced staffing rate for off-site
individualized skills and socialization described in §
262.925(b) of
this subchapter (relating to Program Provider Reimbursement for On-Site,
Off-Site, and In-Home Individualized Skills and Socialization) for an
individual with a LON 1 or LON 5 who receives off-site individualized skills
and socialization from the program provider.
(b) A program provider may request a level
two enhanced staffing rate for off-site individualized skills and socialization
described in §
262.925(b) of
this subchapter for an individual with a LON 1, LON 5, LON 8, or LON 6 who
receives off-site individualized skills and socialization from the program
provider.
(c) A service coordinator
must request a level one enhanced staffing rate for an individual with a LON 1
or LON 5 or request a level two enhanced staffing rate for an individual with a
LON 1, LON 5, LON 8, or LON 6 for off-site individualized skills and
socialization described in §
262.925(b) of
this subchapter for an individual who receives off-site individualized skills
and socialization through the CDS option if the CDS employer asks the service
coordinator to request the enhanced staffing rate.
(d) A program provider or service coordinator
makes the request described in subsections (a) - (c) of this section by
submitting the following documentation to HHSC:
(1) a completed HHSC Enhanced Staffing Rate
Request Form;
(2) the most recent
ICAP scoring booklet;
(3) the most
recent ID/RC Assessment;
(4) the
most recent PDP;
(5) the most
recent implementation plan for individualized skills and socialization;
and
(6) other documentation that
supports the individual's request for an enhanced staffing rate, which may
include:
(A) the behavior support
plan;
(B) a physician's
order;
(C) an assessment completed
by a service provider of a professional therapy;
(D) the nursing assessment; and
(E) the CFC PAS/HAB assessment.
(e) HHSC approves a
request made in accordance with subsections (a) - (d) of this section if the
documentation submitted to HHSC demonstrates that to participate in off-site
individualized skills and socialization, the individual requires more service
provider support than the individual typically receives. The requirement for
additional support may be because of the individual's mobility, medical, or
behavioral needs.
(f) HHSC may
review an approved enhanced staffing rate at any time to determine if it is
appropriate. If HHSC reviews an enhanced staffing rate, a program provider or
service coordinator must submit documentation supporting the enhanced staffing
rate to HHSC in accordance with HHSC's request.
(g) HHSC notifies a program provider or
service coordinator that an enhanced staffing rate is approved or denied
through the HHSC data system.
(h) A
service coordinator must notify the CDS employer and FMSA of HHSC's approval or
denial described in subsection (g) of this section.
(i) A program provider may request an
administrative hearing in accordance with 1 TAC §
357.484(relating to Request for a
Hearing) if HHSC:
(1) denies a request made in
accordance with subsection (a) or (b) of this section; or
(2) denies an enhanced staffing rate based on
a review described in subsection (f) of this section.
Notes
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