40 Tex. Admin. Code § 700.905 - Reimbursement of Noncontracted Service Providers

(a) A parent who is required to complete a Family Service Plan may obtain services from a qualified or licensed noncontracted service provider, and this provider may be reimbursed by DFPS in an amount equal to the average cost for the specific service from DFPS contractors providing the service in the region where the parent resides. Only services where the parent is the direct client of the service provider are eligible for reimbursement. In addition, the rules relating to the reimbursement of noncontracted service providers are intended to further supplement and clarify Texas Family Code § 263.1021. This rule is operable to the extent that DFPS has existing resources to implement Texas Family Code § 263.1021.

(b) Definitions:

(1) Case Plan: a Case Plan, as defined by 42 U.S.C. 675, is a written document which meets the requirements 42 U.S.C. 675a. Texas has divided the federal requirement of a Case Plan into two separate plans, the Family Service Plan as defined in Texas Family Code § 263.101 and the Child's Plan of Service as defined in Texas Family Code § 264.128. For the purpose of this Rule, a Child's Plan (also referred to as a Child's Plan of Service) is not a Family Service Plan.

(2) Family Service Plan (also referred to as a "Family Plan of Service," "Family Plan" or "Individual Family Service Plan") is a written plan in which DFPS and a child's parents identify the actions, specific skills, knowledge, steps, and/or responsibilities that are necessary for the parents to achieve the Family Service Plan's goal during this Plan's service period and the assistance to be provided to the parents by the DFPS or other agency toward meeting that goal.

(3) Single Source Continuum Contract/Contractor (SSCC) is an entity, as described in Texas Family Code § 264.154, with whom DFPS enters into a contract for the provision of the full continuum of substitute care, case management, and reunification services in a Designated Community Area.

(4) Licensed Provider is an individual who is required by the State of Texas to be licensed to provide the professional service that the parent is receiving and DFPS is reimbursing.

(5) Qualified Provider is an individual who has completed certification or other training programs and has two (2) years of verified full-time experience in the professional service in which they are providing to the parent and DFPS is reimbursing.

(6) Noncontracted Service Provider is one who is not under a current contract with DFPS or SSCC for the service that they are seeking reimbursement for. They also cannot be an employee of DFPS or SSCC.

(c) SSCCs must adopt similar requirements relating to the manner in which noncontracted service providers are reimbursed that do not conflict with this Section.

(d) Only the noncontracted service provider may seek reimbursement from DFPS for services and must not have already been paid by the parent or a third party.

(e) To be reimbursed, services may be provided in-person or through an electronic communication platform.

(f) DFPS cannot use state funds to reimburse a noncontracted service provider for Medicaid services to a parent who is a Medicaid beneficiary, as described in Texas Human Resources Code Chapter 32. If the parent has Texas Medicaid, the noncontracted service provider must bill Medicaid and not seek reimbursement through DFPS.

(g) All the following requirements/conditions must be met in order for a noncontracted service provider to be reimbursed:

(1) Must be qualified or licensed provider and comply with the DFPS's guidelines and requirements for reimbursement pursuant to Texas Family Code § 263.1021.

(2) If a license is required, the service provider must maintain licensure and the license must remain in good standing while providing services that they are seeking reimbursement for.

(3) Services obtained from a service provider selected must be designed to achieve the stated goals of the Family Plan of Service for a child in DFPS conservatorship and the noncontracted service provider must certify whether the parent has satisfactorily completed the required service that is being sought for reimbursement.

(4) DFPS cannot reimburse for services that occur after DFPS is dismissed from the case, or the parental rights have been terminated (earlier of two). If a Family Service Plan is reinstated, then the service provider would have to seek reimbursement though a new claim under the reinstated Family Service Plan.

(5) The noncontracted service provider must be able to receive reimbursement from state or federal funds and not be debarred from receiving these funds.

(6) The noncontracted service provider cannot have had a prior DFPS contract to provide the specific service that they are seeking reimbursement for which DFPS terminated for cause.

(7) The noncontracted service provider cannot be related by consanguinity or affinity to the parent receiving services.

Notes

40 Tex. Admin. Code § 700.905

Adopted by Texas Register, Volume 49, Number 07, February 16, 2024, TexReg 0879, eff. 2/18/2024