26 Tex. Admin. Code § 263.2027 - Enhanced Staffing Rate
(a) A program
provider may request a level one enhanced staffing rate for off-site
individualized skills and socialization described in §
263.2025(b) of
this subchapter (relating to Program Provider Reimbursement for Individualized
Skills and Socialization) for an individual with a LON 1 or LON 5 by submitting
the following documentation to HHSC:
(1) a
completed HHSC Enhanced Staffing Rate RequestForm;
(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.
(b) A program provider
may request a level two enhanced staffing rate for off-site individualized
skills and socialization described in §
263.2025(b) of
this subchapter for an individual with a LON 1, LON 5, LON 8, or LON 6 by
submitting the documentation described in subsection (a) of this
section.
(c) HHSC approves a
request made in accordance with subsection (a) or (b) 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 would receive with the individual's
assigned LON. The requirement for additional support may be because of the
individual's mobility, medical, or behavioral needs.
(d) 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 must submit documentation supporting
the enhanced staffing rate to HHSC in accordance with HHSC's request.
(e) HHSC notifies a program provider that an
enhanced staffing rate is approved or denied through the HHSC data
system.
(f) 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 (d) of this section.
Notes
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