hcs billing guidelines you can find the newest version on the dads website: 1
TRANSCRIPT
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HCS BILLING GUIDELINESHCS BILLING GUIDELINES
• You can find the newest version on the DADS website:
• You can find the newest version on the DADS website:
http://www.dads.state.tx.us/handbooks/hcsbg/http://www.dads.state.tx.us/handbooks/hcsbg/
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General InformationGeneral InformationDepartment of Aging and Disability Services (DADS) rules at 40 TAC §9.170 set forth requirements for Home and Community-based Services (HCS) Program providers to receive payment for HCS Program services. Specifically, 40 TAC §9.170(d) requires a program provider to prepare and submit service claims in accordance with the HCS Program Billing Guidelines. Also, Sections II. H. and II. T. of the HCS Program Provider Agreement require program providers to comply with the HCS Program Billing Guidelines. In addition, 40 TAC §9.170(k) sets forth circumstances under which a program provider will not be paid or Medicaid payments will be recouped from the program provider.
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General RequirementsGeneral RequirementsApplicable Service Components
• Specialized Therapies– Audiology; dietary; occupational therapy; physical therapy;
behavioral support; social work; and speech and language pathology.
• Day Habilitation• Nursing
– Registered; Licensed Vocational; Specialized Registered; and Specialized Licensed Vocational.
• Residential Assistance– Foster/Companion Care; Residential Support; Supervised
Living; and Supported Home Living.
• Respite • Supported Employment• Adaptive Aids• Minor Home Modifications• Dental Treatments
Applicable Service Components• Specialized Therapies
– Audiology; dietary; occupational therapy; physical therapy; behavioral support; social work; and speech and language pathology.
• Day Habilitation• Nursing
– Registered; Licensed Vocational; Specialized Registered; and Specialized Licensed Vocational.
• Residential Assistance– Foster/Companion Care; Residential Support; Supervised
Living; and Supported Home Living.
• Respite • Supported Employment• Adaptive Aids• Minor Home Modifications• Dental Treatments 3http://www.dads.state.tx.us/handbooks/hcsbg/3000/3000.htm#sec3100
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Specific Requirements
Specific Requirements
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Specialized Therapies
Specialized Therapies
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Specific RequirementsSpecific RequirementsSpecialized Therapies• Audiology services• Dietary services• Occupational therapy
services• Physical therapy services• Psychology services• Social work services• Speech and language
pathology services
Specialized Therapies• Audiology services• Dietary services• Occupational therapy
services• Physical therapy services• Psychology services• Social work services• Speech and language
pathology services23
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Specific RequirementsSpecific RequirementsSpecialized Therapies Billable
Activity• The only billable activities for the specialized therapies service
component are:• interacting face-to-face or by video conference or speaking by
telephone with an individual, based on the specialized therapies subcomponent provided, to conduct assessments or provide services within the scope of the service provider's practice;
• interacting face-to-face or by video conference or speaking by telephone with a person regarding a specialized therapies subcomponent provided to an individual, but not with: – a staff person who is not a service provider; or – a service provider of any nursing service component (registered
nursing, licensed vocational nursing, specialized registered nursing or specialized licensed vocational nursing), or specialized therapies;
• writing an individualized treatment plan for an individual's specialized therapies which, for behavioral support services, is a behavior support plan;
• reviewing documents, except for a written narrative or written summary of a service component as described in Section 3820, to evaluate the quality and effectiveness of an individual's specialized therapies;
Specialized Therapies Billable Activity
• The only billable activities for the specialized therapies service component are:
• interacting face-to-face or by video conference or speaking by telephone with an individual, based on the specialized therapies subcomponent provided, to conduct assessments or provide services within the scope of the service provider's practice;
• interacting face-to-face or by video conference or speaking by telephone with a person regarding a specialized therapies subcomponent provided to an individual, but not with: – a staff person who is not a service provider; or – a service provider of any nursing service component (registered
nursing, licensed vocational nursing, specialized registered nursing or specialized licensed vocational nursing), or specialized therapies;
• writing an individualized treatment plan for an individual's specialized therapies which, for behavioral support services, is a behavior support plan;
• reviewing documents, except for a written narrative or written summary of a service component as described in Section 3820, to evaluate the quality and effectiveness of an individual's specialized therapies;
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Specific RequirementsSpecific Requirements
Specialized Therapies Billable Activity
• training the following persons on how to provide specialized therapies treatment, including how to document the provision of treatment: – a service provider of foster/companion care, residential support,
supervised living, supported home living, day habilitation, respite, supported employment or employment assistance; or
– a person other than a service provider who is involved in serving an individual;
• reviewing documents in preparation for the training described in the bullet above;
• participating in a service planning team meeting; • participating in the development of an implementation plan; • participating in the development of an IPC; and
Specialized Therapies Billable Activity
• training the following persons on how to provide specialized therapies treatment, including how to document the provision of treatment: – a service provider of foster/companion care, residential support,
supervised living, supported home living, day habilitation, respite, supported employment or employment assistance; or
– a person other than a service provider who is involved in serving an individual;
• reviewing documents in preparation for the training described in the bullet above;
• participating in a service planning team meeting; • participating in the development of an implementation plan; • participating in the development of an IPC; and
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Specific RequirementsSpecific Requirements
Specialized Therapies Billable Activity
• for behavioral support services, in addition to the activities listed above: – assessing the targeted behavior so that a behavior support plan
may be developed; – training of and consulting with an individual, family member or
other persons involved in the individual's care regarding the implementation of the behavior support plan;
– monitoring and evaluating the effectiveness of the behavior support plan;
– modifying, as necessary, the behavior support plan based on the monitoring and evaluation of the plan's effectiveness; and
– educating an individual, family members or other persons involved in the individual's care about the techniques to use in assisting the individual to control maladaptive or socially unacceptable behaviors exhibited by the individual.
Specialized Therapies Billable Activity
• for behavioral support services, in addition to the activities listed above: – assessing the targeted behavior so that a behavior support plan
may be developed; – training of and consulting with an individual, family member or
other persons involved in the individual's care regarding the implementation of the behavior support plan;
– monitoring and evaluating the effectiveness of the behavior support plan;
– modifying, as necessary, the behavior support plan based on the monitoring and evaluation of the plan's effectiveness; and
– educating an individual, family members or other persons involved in the individual's care about the techniques to use in assisting the individual to control maladaptive or socially unacceptable behaviors exhibited by the individual.
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Specific RequirementsSpecific RequirementsNot Billable as Specialized
Therapies The following are examples of activities that are not billable for the specialized therapies service component:
– providing services outside the scope of the service provider's practice;
– providing services that are performed by a service coordinator or were performed by a former case manager;
– scheduling an appointment; – transporting an individual; – traveling or waiting to provide a specialized therapies
subcomponent; – training or interacting about general topics unrelated to a specific
individual, such as principles of behavior management, or general use and maintenance of an adaptive aid or equipment;
– creating written documentation as described in Section 4260; – reviewing a written narrative or written summary of a service
component as described in Section 3820; and
Not Billable as Specialized Therapies
The following are examples of activities that are not billable for the specialized therapies service component:
– providing services outside the scope of the service provider's practice;
– providing services that are performed by a service coordinator or were performed by a former case manager;
– scheduling an appointment; – transporting an individual; – traveling or waiting to provide a specialized therapies
subcomponent; – training or interacting about general topics unrelated to a specific
individual, such as principles of behavior management, or general use and maintenance of an adaptive aid or equipment;
– creating written documentation as described in Section 4260; – reviewing a written narrative or written summary of a service
component as described in Section 3820; and 27
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Specific RequirementsSpecific RequirementsNot Billable as Specialized Therapies The following are examples of activities that are not billable for the specialized therapies service component (continued):
– interacting with: • a staff person who is not a service provider; or • a service provider of any nursing service component
(registered nursing, licensed vocational nursing, specialized registered nursing or specialized licensed vocational nursing) or specialized therapies, if not during a service planning team meeting or during the development of an IPC or an implementation plan.
Activities in Section 3300 – The activities listed in Section 3300, Activity Not Billable, are not
billable for the specialized therapies service component.
Activities Not Listed in Section 4220 – Any activity not described in Section 4220, Billable Activity, is not
billable for the specialized therapies service component.
Not Billable as Specialized Therapies The following are examples of activities that are not billable for the specialized therapies service component (continued):
– interacting with: • a staff person who is not a service provider; or • a service provider of any nursing service component
(registered nursing, licensed vocational nursing, specialized registered nursing or specialized licensed vocational nursing) or specialized therapies, if not during a service planning team meeting or during the development of an IPC or an implementation plan.
Activities in Section 3300 – The activities listed in Section 3300, Activity Not Billable, are not
billable for the specialized therapies service component.
Activities Not Listed in Section 4220 – Any activity not described in Section 4220, Billable Activity, is not
billable for the specialized therapies service component.
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Specific RequirementsSpecific Requirements Examples of Activity Not Billable
– providing services outside the scope of the service provider's practice;
– providing services that are performed by a service coordinator or were performed by a former case manager;
– scheduling an appointment; – transporting an individual; – traveling or waiting to provide a specialized therapies
subcomponent; – training or interacting about general topics unrelated to a specific
individual, such as principles of behavior management, or general use and maintenance of an adaptive aid or equipment;
– creating written documentation as described in Section 4260; – reviewing a written narrative or written summary of a service
component as described in Section 3820; and – interacting with:
• a staff person who is not a service provider; or • a service provider of any nursing service component (registered
nursing, licensed vocational nursing, specialized registered nursing or specialized licensed vocational nursing) or specialized therapies, if not during a service planning team meeting or during the development of an IPC or an implementation plan.
Examples of Activity Not Billable– providing services outside the scope of the service provider's
practice; – providing services that are performed by a service coordinator or
were performed by a former case manager; – scheduling an appointment; – transporting an individual; – traveling or waiting to provide a specialized therapies
subcomponent; – training or interacting about general topics unrelated to a specific
individual, such as principles of behavior management, or general use and maintenance of an adaptive aid or equipment;
– creating written documentation as described in Section 4260; – reviewing a written narrative or written summary of a service
component as described in Section 3820; and – interacting with:
• a staff person who is not a service provider; or • a service provider of any nursing service component (registered
nursing, licensed vocational nursing, specialized registered nursing or specialized licensed vocational nursing) or specialized therapies, if not during a service planning team meeting or during the development of an IPC or an implementation plan.
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Specific RequirementsSpecific Requirements
Specialized Therapies Written Documentation
• Except as provided in Section 4270, Insurance Co-payment and Deductible (see No. 1, Item c and No. 2, Item c), a program provider must have written documentation to support a service claim for specialized therapies that:
• meets the requirements set forth in Section 3800, Written Documentation;
• includes the exact time the service event began and the exact time the service event ended documented by the service provider making the written service log; and
• for any activity performed by multiple service providers at the same time for the same individual, includes a written justification in the individual's implementation plan for the use of multiple service providers.
Specialized Therapies Written Documentation
• Except as provided in Section 4270, Insurance Co-payment and Deductible (see No. 1, Item c and No. 2, Item c), a program provider must have written documentation to support a service claim for specialized therapies that:
• meets the requirements set forth in Section 3800, Written Documentation;
• includes the exact time the service event began and the exact time the service event ended documented by the service provider making the written service log; and
• for any activity performed by multiple service providers at the same time for the same individual, includes a written justification in the individual's implementation plan for the use of multiple service providers. 30
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Common ErrorsCommon Errors• No begin and/or end times• No location of service provided• Reviewing or creating service delivery
records• Family paying for rate differential• No Progress Note
• No begin and/or end times• No location of service provided• Reviewing or creating service delivery
records• Family paying for rate differential• No Progress Note
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Day HabilitationDay Habilitation
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Specific RequirementsSpecific RequirementsDay Habilitation Billable Activity• The only billable activities for the day habilitation service
component are:• interacting face-to-face with an individual to assist the
individual in achieving objectives to: – acquire, retain or improve self-help skills, socialization skills or adaptive
skills that are necessary to for the individual to successfully reside, integrate and participate in the community;
– reinforce a skill taught in school, specialized therapies; and – develop opportunities for employment in the community (for example,
completing a job application, assessing employment skills and training on employment-related issues);
• transporting an individual between settings at which day habilitation is provided to the individual;
• assisting an individual with his or her personal care activities if the individual cannot perform such activities without assistance;
• participating in a service planning team meeting; • participating in the development of an implementation plan;
and • participating in the development of an IPC.
Day Habilitation Billable Activity• The only billable activities for the day habilitation service
component are:• interacting face-to-face with an individual to assist the
individual in achieving objectives to: – acquire, retain or improve self-help skills, socialization skills or adaptive
skills that are necessary to for the individual to successfully reside, integrate and participate in the community;
– reinforce a skill taught in school, specialized therapies; and – develop opportunities for employment in the community (for example,
completing a job application, assessing employment skills and training on employment-related issues);
• transporting an individual between settings at which day habilitation is provided to the individual;
• assisting an individual with his or her personal care activities if the individual cannot perform such activities without assistance;
• participating in a service planning team meeting; • participating in the development of an implementation plan;
and • participating in the development of an IPC.
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Specific RequirementsSpecific RequirementsNot Billable as Day
Habilitation
• Travel time (except from one Day Habilitation site to another)
• Written documentation• Reviewing records• Drafting Implementation
Plans• Staff Training/Conferences• Processing service claims• Assisting an individual for
the sole purpose of meeting vocational goals
Not Billable as Day Habilitation
• Travel time (except from one Day Habilitation site to another)
• Written documentation• Reviewing records• Drafting Implementation
Plans• Staff Training/Conferences• Processing service claims• Assisting an individual for
the sole purpose of meeting vocational goals
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Specific RequirementsSpecific Requirements
May not submit DH service claim for:
• An individual who refuses to participate
• An individual who is sleeping• Assisting an individual in
achieving goals not documented in their IP
• More than five units of service in a calendar week
• More than 260 units of service per IPC year
• Day habilitation that is funded by another source other than HCS
May not submit DH service claim for:
• An individual who refuses to participate
• An individual who is sleeping• Assisting an individual in
achieving goals not documented in their IP
• More than five units of service in a calendar week
• More than 260 units of service per IPC year
• Day habilitation that is funded by another source other than HCS
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Specific RequirementsSpecific RequirementsDay Habilitation Unit of
ServiceA unit of service for Day Habilitation is one day• One-quarter unit of service if service is
provided at least one and one-quarter hours of consecutive day habilitation on a calendar day
• One-half unit of service may be billed if service is provided for at least two and one-half hours on a calendar day. Two of the two and one-half hours must be consecutive.
• Three-quarters unit of service may be billed if service is provided for at least three and three-quarter hours on a calendar day. Two of the three and three-quarter hours must be consecutive.
• One unit may be billed if service is provided for at least five hours on a calendar day. Two of the five hours must be consecutive.
Day Habilitation Unit of Service
A unit of service for Day Habilitation is one day• One-quarter unit of service if service is
provided at least one and one-quarter hours of consecutive day habilitation on a calendar day
• One-half unit of service may be billed if service is provided for at least two and one-half hours on a calendar day. Two of the two and one-half hours must be consecutive.
• Three-quarters unit of service may be billed if service is provided for at least three and three-quarter hours on a calendar day. Two of the three and three-quarter hours must be consecutive.
• One unit may be billed if service is provided for at least five hours on a calendar day. Two of the five hours must be consecutive.
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Common ErrorsCommon Errors• Individual sleeping• Not signing individual out of Day Habilitation
for other services provided (NU, SHL, etc.)• No description of service provided (details
about interactions, activities, behaviors, successes, refusals, etc.)
• Vocational Goals – Sheltered Workshops• No Progress Note
• Individual sleeping• Not signing individual out of Day Habilitation
for other services provided (NU, SHL, etc.)• No description of service provided (details
about interactions, activities, behaviors, successes, refusals, etc.)
• Vocational Goals – Sheltered Workshops• No Progress Note
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Supported EmploymentSupported
Employment
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Specific RequirementsSpecific RequirementsSupported Employment• Supported employment is a
service that assists an individual to sustain competitive, integrated employment.
Supported Employment• Supported employment is a
service that assists an individual to sustain competitive, integrated employment.
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Specific RequirementsSpecific Requirements
Supported Employment Billable Activity
• The only billable activities for the supported employment service component are:
• interacting face-to-face with an individual at the individual's work site to provide training, support and intervention necessary to sustain the individual's employment;
• interacting face-to-face or by telephone with an individual's employment supervisor as necessary to sustain the individual's employment;
• transporting an individual to and from the individual’s work site;
• participating in a service planning team meeting; • participating in the development of an implementation
plan; and • participating in the development of an IPC.
Supported Employment Billable Activity
• The only billable activities for the supported employment service component are:
• interacting face-to-face with an individual at the individual's work site to provide training, support and intervention necessary to sustain the individual's employment;
• interacting face-to-face or by telephone with an individual's employment supervisor as necessary to sustain the individual's employment;
• transporting an individual to and from the individual’s work site;
• participating in a service planning team meeting; • participating in the development of an implementation
plan; and • participating in the development of an IPC.
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Specific RequirementsSpecific Requirements
Examples of Activities Not Billable under SE
• The following are examples of activities that are not billable for the supported employment service component:– interacting with an individual prior to the individual's
employment; – conducting employment interest assessments, assisting
with or arranging interviews, and completing job applications;
– interacting with an individual when the individual is not on duty; and
– transporting an individual to a job interview.
Examples of Activities Not Billable under SE
• The following are examples of activities that are not billable for the supported employment service component:– interacting with an individual prior to the individual's
employment; – conducting employment interest assessments, assisting
with or arranging interviews, and completing job applications;
– interacting with an individual when the individual is not on duty; and
– transporting an individual to a job interview.
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Specific RequirementsSpecific RequirementsRestrictions (SE):A program provider may not submit a service claim for supported employment provided to an individual:• while the individual is employed by the program
provider; • in excess of 600 units of service (150 hours) per IPC
year; or • if supported employment is available to the
individual through the public school system or the Department of Assistive and Rehabilitative Services.
Restrictions (SE):A program provider may not submit a service claim for supported employment provided to an individual:• while the individual is employed by the program
provider; • in excess of 600 units of service (150 hours) per IPC
year; or • if supported employment is available to the
individual through the public school system or the Department of Assistive and Rehabilitative Services.
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Common ErrorsCommon Errors• Training not occurring at the job site• Pre-vocational training• No Progress Note
• Training not occurring at the job site• Pre-vocational training• No Progress Note
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NursingNursing
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Specific RequirementsSpecific RequirementsRegistered Nursing Billable
Activity• The only billable activities for the registered nursing
service component are:• interacting face-to-face with an individual who has a
medical need for registered nursing, including: – preparing and administering medication or treatment
ordered by a physician, podiatrist or dentist; – assisting or observing administration of medication;
and – assessing the individual's health status, including
conducting a focused assessment or a comprehensive assessment;
• speaking by telephone with an individual who has a medical need for registered nursing, including assessing the individual's health status;
• interacting by video conference with an individual who has a medical need for registered nursing, including: – observing administration of medication; and – assessing the individual's health status, including
conducting a focused assessment or a comprehensive assessment;
Registered Nursing Billable Activity
• The only billable activities for the registered nursing service component are:
• interacting face-to-face with an individual who has a medical need for registered nursing, including: – preparing and administering medication or treatment
ordered by a physician, podiatrist or dentist; – assisting or observing administration of medication;
and – assessing the individual's health status, including
conducting a focused assessment or a comprehensive assessment;
• speaking by telephone with an individual who has a medical need for registered nursing, including assessing the individual's health status;
• interacting by video conference with an individual who has a medical need for registered nursing, including: – observing administration of medication; and – assessing the individual's health status, including
conducting a focused assessment or a comprehensive assessment;
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Specific RequirementsSpecific RequirementsRegistered Nursing Billable
Activity (cont.)• at the time an individual receives medication from a
pharmacy, ensuring the accuracy of: – the type and amount of medication; and – the dosage instructions;
• researching medical information for an individual who has a medical need for registered nursing, including: – reviewing documents, except for a written service log
or written summary log of a service component as described in Section 3820, to evaluate the quality and effectiveness of the medical treatment the individual is receiving; and
– completing a comprehensive assessment;
Registered Nursing Billable Activity (cont.)
• at the time an individual receives medication from a pharmacy, ensuring the accuracy of: – the type and amount of medication; and – the dosage instructions;
• researching medical information for an individual who has a medical need for registered nursing, including: – reviewing documents, except for a written service log
or written summary log of a service component as described in Section 3820, to evaluate the quality and effectiveness of the medical treatment the individual is receiving; and
– completing a comprehensive assessment;
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Specific RequirementsSpecific RequirementsRegistered Nursing Billable
Activity (cont.)• training the following persons how to perform nursing
tasks: – a service provider of foster/companion care,
residential support, supervised living, supported home living, day habilitation, respite, supported employment or employment assistance; or
– a person other than a service provider who is involved in serving an individual;
– reviewing documents in preparation for the training described in the bullet above;
Registered Nursing Billable Activity (cont.)
• training the following persons how to perform nursing tasks: – a service provider of foster/companion care,
residential support, supervised living, supported home living, day habilitation, respite, supported employment or employment assistance; or
– a person other than a service provider who is involved in serving an individual;
– reviewing documents in preparation for the training described in the bullet above;
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Specific RequirementsSpecific RequirementsRegistered Nursing Billable
Activity (cont.)• interacting face-to-face or by video conference or
speaking by telephone with a person regarding the health status of an individual, but not with: – a staff person who is not a service provider; or – a service provider of:
• registered nursing; • licensed vocational nursing unless supervised by
the registered nurse; • specialized registered nursing; • specialized licensed vocational nursing unless
supervised by the registered nurse; or • specialized therapies;
Registered Nursing Billable Activity (cont.)
• interacting face-to-face or by video conference or speaking by telephone with a person regarding the health status of an individual, but not with: – a staff person who is not a service provider; or – a service provider of:
• registered nursing; • licensed vocational nursing unless supervised by
the registered nurse; • specialized registered nursing; • specialized licensed vocational nursing unless
supervised by the registered nurse; or • specialized therapies;
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Specific RequirementsSpecific RequirementsRegistered Nursing Billable
Activity (cont.)• interacting face-to-face or speaking by telephone with a
pharmacist or representative of a health insurance provider, including the Social Security Administration, about an individual's insurance benefits for medication if the registered nurse justifies, in writing, the need for the registered nurse to perform the activity;
• instructing a service provider, except a service provider of registered nursing or specialized registered nursing, on a topic that is specific to an individual such as choking risks for an individual who has cerebral palsy;
• supervising a licensed vocational nurse regarding an individual's nursing services or health status;
• instructing, supervising or verifying the competency of an unlicensed person in the performance of a task delegated in accordance with rules of the Texas Board of Nursing at 22 TAC, Chapter 225 (relating to RN Delegation to Unlicensed Personnel and Tasks not Requiring Delegation in Independent Living Environments for Clients with Stable and Predictable Conditions) or the Human Resources Code, §§161.091-.093, as applicable;
Registered Nursing Billable Activity (cont.)
• interacting face-to-face or speaking by telephone with a pharmacist or representative of a health insurance provider, including the Social Security Administration, about an individual's insurance benefits for medication if the registered nurse justifies, in writing, the need for the registered nurse to perform the activity;
• instructing a service provider, except a service provider of registered nursing or specialized registered nursing, on a topic that is specific to an individual such as choking risks for an individual who has cerebral palsy;
• supervising a licensed vocational nurse regarding an individual's nursing services or health status;
• instructing, supervising or verifying the competency of an unlicensed person in the performance of a task delegated in accordance with rules of the Texas Board of Nursing at 22 TAC, Chapter 225 (relating to RN Delegation to Unlicensed Personnel and Tasks not Requiring Delegation in Independent Living Environments for Clients with Stable and Predictable Conditions) or the Human Resources Code, §§161.091-.093, as applicable;
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Specific RequirementsSpecific RequirementsRegistered Nursing Billable
Activity (cont.)• participating in a service planning team meeting; • participating in the development of an implementation
plan; and • participating in the development of an IPC.
Registered Nursing Billable Activity (cont.)
• participating in a service planning team meeting; • participating in the development of an implementation
plan; and • participating in the development of an IPC.
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Specific RequirementsSpecific RequirementsLicensed Vocational
Nursing Billable Activity • interacting face-to-face with an individual who has a
medical need for licensed vocational nursing, including: – preparing and administering medication or
treatment ordered by a physician, podiatrist or dentist;
– assisting or observing administration of medication; and
– conducting a focused assessment of the individual's health status;
• speaking by telephone with an individual who has a medical need for licensed vocational nursing, which may include conducting an assessment of an individual if: – the assessment is conducted using protocol
approved by DADS; and – the licensed vocational nurse has been trained
by a registered nurse on using the protocol;
Licensed Vocational Nursing Billable Activity
• interacting face-to-face with an individual who has a medical need for licensed vocational nursing, including: – preparing and administering medication or
treatment ordered by a physician, podiatrist or dentist;
– assisting or observing administration of medication; and
– conducting a focused assessment of the individual's health status;
• speaking by telephone with an individual who has a medical need for licensed vocational nursing, which may include conducting an assessment of an individual if: – the assessment is conducted using protocol
approved by DADS; and – the licensed vocational nurse has been trained
by a registered nurse on using the protocol;
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Specific RequirementsSpecific RequirementsLicensed Vocational
Nursing Billable Activity (cont.)
• interacting by video conference with an individual who has a medical need for licensed vocational nursing, including: – observing administration of medication; and – conducting a focused assessment of the
individual's health status; • at the time an individual receives medication from a
pharmacy, ensuring the accuracy of: – the type and amount of medication; and – the dosage instructions;
Licensed Vocational Nursing Billable Activity (cont.)
• interacting by video conference with an individual who has a medical need for licensed vocational nursing, including: – observing administration of medication; and – conducting a focused assessment of the
individual's health status; • at the time an individual receives medication from a
pharmacy, ensuring the accuracy of: – the type and amount of medication; and – the dosage instructions;
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Specific RequirementsSpecific Requirements
Licensed Vocational Nursing Billable Activity (cont.)
• researching medical information for an individual who has a medical need for licensed vocational nursing, including: – reviewing documents, except for a written
service log or written summary log of a service component as described in Section 3820, to evaluate the quality and effectiveness of the medical treatment the individual is receiving; and
– completing a focused assessment; • training a service provider of residential assistance,
day habilitation, respite or supported employment, or a person other than a service provider who is involved in serving an individual, regarding how to perform nursing tasks;
• reviewing documents in preparation for the training described in the bullet above;
Licensed Vocational Nursing Billable Activity (cont.)
• researching medical information for an individual who has a medical need for licensed vocational nursing, including: – reviewing documents, except for a written
service log or written summary log of a service component as described in Section 3820, to evaluate the quality and effectiveness of the medical treatment the individual is receiving; and
– completing a focused assessment; • training a service provider of residential assistance,
day habilitation, respite or supported employment, or a person other than a service provider who is involved in serving an individual, regarding how to perform nursing tasks;
• reviewing documents in preparation for the training described in the bullet above;
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Specific RequirementsSpecific Requirements
Licensed Vocational Nursing Billable Activity (cont.)
• researching medical information for an individual who has a medical need for licensed vocational nursing, including: – reviewing documents, except for a written
service log or written summary log of a service component as described in Section 3820, to evaluate the quality and effectiveness of the medical treatment the individual is receiving; and
– completing a focused assessment; • training a service provider of residential assistance,
day habilitation, respite or supported employment, or a person other than a service provider who is involved in serving an individual, regarding how to perform nursing tasks;
• reviewing documents in preparation for the training described in the bullet above;
Licensed Vocational Nursing Billable Activity (cont.)
• researching medical information for an individual who has a medical need for licensed vocational nursing, including: – reviewing documents, except for a written
service log or written summary log of a service component as described in Section 3820, to evaluate the quality and effectiveness of the medical treatment the individual is receiving; and
– completing a focused assessment; • training a service provider of residential assistance,
day habilitation, respite or supported employment, or a person other than a service provider who is involved in serving an individual, regarding how to perform nursing tasks;
• reviewing documents in preparation for the training described in the bullet above;
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Specific RequirementsSpecific Requirements
Licensed Vocational Nursing Billable Activity (cont.)
• interacting face-to-face or by video conference or speaking by telephone with a person regarding the health status of an individual, but not with: – a staff person who is not a service provider; or – a service provider of any nursing service
component (registered nursing, licensed vocational nursing, specialized registered nursing or specialized licensed vocational nursing) or specialized therapies;
• interacting face-to-face or speaking by telephone with a pharmacist or representative of a health insurance provider, including the Social Security Administration, about an individual's insurance benefits for medication if the licensed vocational nurse justifies, in writing, the need for the licensed vocational nurse to perform the activity;
Licensed Vocational Nursing Billable Activity (cont.)
• interacting face-to-face or by video conference or speaking by telephone with a person regarding the health status of an individual, but not with: – a staff person who is not a service provider; or – a service provider of any nursing service
component (registered nursing, licensed vocational nursing, specialized registered nursing or specialized licensed vocational nursing) or specialized therapies;
• interacting face-to-face or speaking by telephone with a pharmacist or representative of a health insurance provider, including the Social Security Administration, about an individual's insurance benefits for medication if the licensed vocational nurse justifies, in writing, the need for the licensed vocational nurse to perform the activity;
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Specific RequirementsSpecific Requirements
Licensed Vocational Nursing Billable Activity (cont.)
• instructing a service provider, except a service provider of registered nursing or specialized registered nursing, on a topic specific to an individual such as choking risks for an individual who has cerebral palsy;
• participating in a service planning team meeting; • participating in the development of an
implementation plan; and • participating in the development of an IPC.
Licensed Vocational Nursing Billable Activity (cont.)
• instructing a service provider, except a service provider of registered nursing or specialized registered nursing, on a topic specific to an individual such as choking risks for an individual who has cerebral palsy;
• participating in a service planning team meeting; • participating in the development of an
implementation plan; and • participating in the development of an IPC.
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Specific RequirementsSpecific RequirementsSpecialized Registered and Licensed Vocational Nursing• Follow respective sections only for an
individual who has a tracheostomy or is dependent on a ventilator.
Specialized Registered and Licensed Vocational Nursing• Follow respective sections only for an
individual who has a tracheostomy or is dependent on a ventilator.
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Specific RequirementsSpecific Requirements
Examples of Non-Billable Activities:
• performing or supervising an activity that does not constitute the practice of licensed vocational nursing, including:
• performing an activity that constitutes the practice of professional nursing and must be performed by a registered nurse;
• transporting an individual; • waiting to perform a billable activity; and • waiting with an individual at a medical appointment; • making a medical appointment; • instructing on general topics unrelated to a specific
individual, such as cardiopulmonary resuscitation, or infection control;
• preparing a treatment or medication for administration and not interacting face-to-face with an individual;
• storing, counting, reordering, refilling or delivering medication except as allowed in the fourth bullet of Section 4471.2;
• creating written documentation as described in Section 4471.7;
Examples of Non-Billable Activities:
• performing or supervising an activity that does not constitute the practice of licensed vocational nursing, including:
• performing an activity that constitutes the practice of professional nursing and must be performed by a registered nurse;
• transporting an individual; • waiting to perform a billable activity; and • waiting with an individual at a medical appointment; • making a medical appointment; • instructing on general topics unrelated to a specific
individual, such as cardiopulmonary resuscitation, or infection control;
• preparing a treatment or medication for administration and not interacting face-to-face with an individual;
• storing, counting, reordering, refilling or delivering medication except as allowed in the fourth bullet of Section 4471.2;
• creating written documentation as described in Section 4471.7;
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Specific RequirementsSpecific Requirements
Examples of Non-Billable Activities:
• reviewing a written service log or written summary log of a service component as described in Section 3820;
• interacting with: • a staff person who is not a service provider; or • a service provider of any nursing service component
(registered nursing, licensed vocational nursing, specialized registered nursing or specialized licensed vocational nursing), or specialized therapies, if not during a service planning team meeting or during the development of an IPC or an implementation plan; and
• performing an activity for which there is no medical need.
Examples of Non-Billable Activities:
• reviewing a written service log or written summary log of a service component as described in Section 3820;
• interacting with: • a staff person who is not a service provider; or • a service provider of any nursing service component
(registered nursing, licensed vocational nursing, specialized registered nursing or specialized licensed vocational nursing), or specialized therapies, if not during a service planning team meeting or during the development of an IPC or an implementation plan; and
• performing an activity for which there is no medical need.
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Specific RequirementsSpecific RequirementsNursing Rule of Thumb:
If it does not require a nursing license to perform a task, it is not billable.
Nursing Rule of Thumb:
If it does not require a nursing license to perform a task, it is not billable.
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Specific RequirementsSpecific Requirements
Nursing Unit of Service• 15 Minute of Service
A service claim cannot be made for a fraction of a unit of service
• Accumulation of Service TimesCan be accumulated for nursing provided to one individual on a single calendar day
Nursing Unit of Service• 15 Minute of Service
A service claim cannot be made for a fraction of a unit of service
• Accumulation of Service TimesCan be accumulated for nursing provided to one individual on a single calendar day
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Common ErrorsCommon Errors• Billing for creating and reviewing service records.• No medical necessity shown when residential staff
calls nurse to administer over the counter medication to individual
• No medical necessity for follow-up phone call• Billing for services without Face-to-Face, Telephone
or Video conferencing contact• Providing any activity not requiring a nursing license• One note used for multiple service events• No Progress Note
• Billing for creating and reviewing service records.• No medical necessity shown when residential staff
calls nurse to administer over the counter medication to individual
• No medical necessity for follow-up phone call• Billing for services without Face-to-Face, Telephone
or Video conferencing contact• Providing any activity not requiring a nursing license• One note used for multiple service events• No Progress Note
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Residential AssistanceResidential Assistance
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Specific RequirementsSpecific Requirements
Residential Assistance Residential Location
• Own Home/Family Home – if no foster/companion care, residential support or supervised living is provided to the individual
• Foster/Companion Care – is not owned or leased by the program provider, a service provider provides care to the individual; and the care provider and the individual have the same address
Residential Assistance Residential Location
• Own Home/Family Home – if no foster/companion care, residential support or supervised living is provided to the individual
• Foster/Companion Care – is not owned or leased by the program provider, a service provider provides care to the individual; and the care provider and the individual have the same address
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Specific RequirementsSpecific RequirementsResidential Assistance
Residential Location• 3-Person Home – the
individual’s residence is a 3-person residence and a service provider provides residential support or supervised living to the individual
• 4-person Home – the individual’s residence is a 4-person residence and a service provider provides residential support or supervised living to the individual (one must be RSS)
Residential Assistance Residential Location
• 3-Person Home – the individual’s residence is a 3-person residence and a service provider provides residential support or supervised living to the individual
• 4-person Home – the individual’s residence is a 4-person residence and a service provider provides residential support or supervised living to the individual (one must be RSS)
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Supported Home Living
Supported Home Living
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Specific RequirementsSpecific RequirementsSupported Home Living Billable
ActivityInteracting face-to-face with the individual:• to assist with activities of daily living• to assist with ambulation and mobility• to reinforce counseling and therapy subcomponents• to assist with administration of medication or tasks
delegated by an RN• to conduct habilitation activities• to secure transportation for the individual• to supervise the individual’s safety and security• interactions regarding an incident directly affecting
the individual's health or safety; • performing allowable non-face-to-face activities• participating in a service planning team meeting; • participating in the development of an implementation
plan; and • participating in the development of an IPC.
Supported Home Living Billable Activity
Interacting face-to-face with the individual:• to assist with activities of daily living• to assist with ambulation and mobility• to reinforce counseling and therapy subcomponents• to assist with administration of medication or tasks
delegated by an RN• to conduct habilitation activities• to secure transportation for the individual• to supervise the individual’s safety and security• interactions regarding an incident directly affecting
the individual's health or safety; • performing allowable non-face-to-face activities• participating in a service planning team meeting; • participating in the development of an implementation
plan; and • participating in the development of an IPC. 73http://www.dads.state.tx.us/handbooks/hcsbg/4000/4000.htm#sec4540
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Specific RequirementsSpecific RequirementsSupported Home Living claims
may not be submitted for:• An individual whose IPC does not have a residential
location of “own home/family home”• the sole activity of supervising the individual's safety and
security• Transporting an individual from one DH or SE site to
another– supporting home living provided to an individual:
• in a residence in which residential support or supervised living is provided to another individual;
• by a service provider who is simultaneously providing residential support, supervised living or foster/companion care to another individual;
• if the day habilitation service component is simultaneously provided to the individual by another service provider; or
• if the respite service component is simultaneously provided to the individual by another service provider.
Supported Home Living claims may not be submitted for:
• An individual whose IPC does not have a residential location of “own home/family home”
• the sole activity of supervising the individual's safety and security
• Transporting an individual from one DH or SE site to another– supporting home living provided to an individual:
• in a residence in which residential support or supervised living is provided to another individual;
• by a service provider who is simultaneously providing residential support, supervised living or foster/companion care to another individual;
• if the day habilitation service component is simultaneously provided to the individual by another service provider; or
• if the respite service component is simultaneously provided to the individual by another service provider.
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Specific RequirementsSpecific RequirementsSupported Home Living Unit
of Service
• 15 Minute of Service – may not include fraction of service
• Calculating transportation – use Method A or Method B (can only use one method on a single calendar day)
Supported Home Living Unit of Service
• 15 Minute of Service – may not include fraction of service
• Calculating transportation – use Method A or Method B (can only use one method on a single calendar day)
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Transportation Method ATransportation Method AIndividual Departure
TimeArrival Time
A. Dorothy N. Kansas
7:00am 9:00am
B. Dorothy N. Kansas
3:00pm 4:30pma. Transportation time of 120 minutes (7:00am-9:00am) with 6 passengers (Dorothy + 5 others) and 1 service provider for Trip A
SERVICE TIME = (1 X 120) ÷ 6 = 20 minutesb. Transportation time of 90 minutes (3:00pm-
4:30pm) with 5 passengers (Dorothy + 4 others) and 1 service provider
SERVICE TIME = (1 X 90) ÷ 5 = 18 minutes20 min + 18 min = 38 minutes (accumulation)
According to Attachment C:
38 minutes = 3 Units Billed (accumulation)
1 Unit (20 min) + 1 Unit (18 min)= 2 Units Billed (no accumulation)
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Transportation Method BTransportation Method BIndividual Departure
TimeArrival Time
Dorothy N. Kansas
7:00am 9:00am
Little B. Blue 7:15am 9:00am
Mary Q. Contrary 7:30am 9:00amTransportation time for Dorothy N. Kansas:a. Transportation time of 15 minutes (7:00am-7:15am) with one passenger (Dorothy only) and 1 service providerSERVICE TIME = (1 X 15) ÷ 1 = 15 minutes
b. Transportation time of 15 minutes (7:15am-7:30am) with two passengers (Dorothy and Little) and 1 service providerSERVICE TIME = (1 X 15) ÷ 2 = 7.5 minutes
c. Transportation time of 15 minutes (7:30am-9:00am) with three passengers (Dorothy, Little and Mary) and 1 service providerSERVICE TIME = (1 X 90) ÷ 3 = 30 minutes
15 min + 7.5 min + 30 min = 52.5 minutes
According to Attachment C: 52.5 minutes = 3 Units
Transportation time for Dorothy N. Kansas:a. Transportation time of 15 minutes (7:00am-7:15am) with one passenger (Dorothy only) and 1 service providerSERVICE TIME = (1 X 15) ÷ 1 = 15 minutes
b. Transportation time of 15 minutes (7:15am-7:30am) with two passengers (Dorothy and Little) and 1 service providerSERVICE TIME = (1 X 15) ÷ 2 = 7.5 minutes
c. Transportation time of 15 minutes (7:30am-9:00am) with three passengers (Dorothy, Little and Mary) and 1 service providerSERVICE TIME = (1 X 90) ÷ 3 = 30 minutes
15 min + 7.5 min + 30 min = 52.5 minutes
According to Attachment C: 52.5 minutes = 3 Units
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Common ErrorsCommon Errors• Overlapping times with other services• Transportation method completed incorrectly• Time not divided evenly between two or more
individuals receiving services at the same time• Non-qualified Service Provider (Proof of residence,
etc.)• No justification for receiving SHL in DH facility• No begin and/or end times on documentation• No location of services provided on
documentation• No Progress Note
• Overlapping times with other services• Transportation method completed incorrectly• Time not divided evenly between two or more
individuals receiving services at the same time• Non-qualified Service Provider (Proof of residence,
etc.)• No justification for receiving SHL in DH facility• No begin and/or end times on documentation• No location of services provided on
documentation• No Progress Note
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Foster CareFoster Care
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Specific RequirementsSpecific RequirementsFoster Care Requirements of
Setting• The program provider may not
lease or own the residence• The individual receiving care must
have a residence in which no more than three persons receive: foster/companion care, a non-HCS Program service similar to foster/companion care; and
• If the individual is a minor, the parent or step-parent may not provide this service
Foster Care Requirements of Setting
• The program provider may not lease or own the residence
• The individual receiving care must have a residence in which no more than three persons receive: foster/companion care, a non-HCS Program service similar to foster/companion care; and
• If the individual is a minor, the parent or step-parent may not provide this service
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Specific RequirementsSpecific RequirementsFoster Care Requirements
of Setting• The service provider must
have the same residence as the individual; and
• Ensure that foster/companion care is provided to an individual when necessary
Foster Care Requirements of Setting
• The service provider must have the same residence as the individual; and
• Ensure that foster/companion care is provided to an individual when necessary
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Specific RequirementsSpecific RequirementsFoster Care Unit of Service• Unit of service is one day• May not be for more than one
day • May not have a fraction of a
unit of service
Foster Care Unit of Service• Unit of service is one day• May not be for more than one
day • May not have a fraction of a
unit of service
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Specific RequirementsSpecific RequirementsFoster Care Billable
Activity• Assisting the individual with
activities of daily living (bathing, dressing, personal hygiene, eating, meal planning and preparation and housekeeping)
• Assisting the individual with ambulation and mobility
• Reinforcing any counseling and therapy subcomponent provided to the individual
• Assisting with the administration of the individual’s medication or to perform a task delegated by an RN
Foster Care Billable Activity
• Assisting the individual with activities of daily living (bathing, dressing, personal hygiene, eating, meal planning and preparation and housekeeping)
• Assisting the individual with ambulation and mobility
• Reinforcing any counseling and therapy subcomponent provided to the individual
• Assisting with the administration of the individual’s medication or to perform a task delegated by an RN
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Specific RequirementsSpecific RequirementsFoster Care Billable
Activity• Conducting habilitation
activities that train the individual to:– Develop or improve skills
that allow the individual to live more independently
– Develop socially valued behaviors
– Integrate into community activities
– Use natural supports and typical community services available to the public
– Participate in leisure activities
Foster Care Billable Activity
• Conducting habilitation activities that train the individual to:– Develop or improve skills
that allow the individual to live more independently
– Develop socially valued behaviors
– Integrate into community activities
– Use natural supports and typical community services available to the public
– Participate in leisure activities
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Specific RequirementsSpecific RequirementsFoster Care Service Claim for
an Individual on a Visit with Family or FriendA program provider may submit a service claim for an individual who is on a visit with a family member or friend away from their residence if the visit is for at least a calendar day. If the visit is for more than 14 consecutive calendar days, the program provider may submit a service claim for only 14 calendar days of the visit.
Foster Care Service Claim for an Individual on a Visit with Family or FriendA program provider may submit a service claim for an individual who is on a visit with a family member or friend away from their residence if the visit is for at least a calendar day. If the visit is for more than 14 consecutive calendar days, the program provider may submit a service claim for only 14 calendar days of the visit.
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Specific RequirementsSpecific RequirementsFoster Care Service Claim for an
Individual on a Visit with Family or Friend Written Documentation
Written documentation must include the individual’s name, the dates the individual was visiting the family member or friend, the location of the visit and the date and signature of the service provider.
Foster Care Service Claim for an Individual on a Visit with Family or Friend Written Documentation
Written documentation must include the individual’s name, the dates the individual was visiting the family member or friend, the location of the visit and the date and signature of the service provider.
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Common ErrorsCommon Errors• Failure to discharge individual while
in the hospital• Weekly summary exceeds seven
days• Not documenting location
information• No Progress Note
• Failure to discharge individual while in the hospital
• Weekly summary exceeds seven days
• Not documenting location information
• No Progress Note
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Residential Support Services
Residential Support Services
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Specific RequirementsSpecific Requirements
Residential Support Requirements of Setting
• The residence must be a Three or Four person residence
• The program provider may not have the same residence as the individual
• The service provider must be available to provide residential support to an individual as needed; and
• The service provider must be present and awake in the residence when the individual is present in the residence
Residential Support Requirements of Setting
• The residence must be a Three or Four person residence
• The program provider may not have the same residence as the individual
• The service provider must be available to provide residential support to an individual as needed; and
• The service provider must be present and awake in the residence when the individual is present in the residence
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Specific RequirementsSpecific RequirementsResidential Support Billable
Activity– assisting the individual with activities of daily living;– assisting the individual with ambulation and mobility; – reinforcing any specialized therapies subcomponent
provided to the individual; – assisting with the administration of the individual's
medication or to perform a task delegated by a registered nurse in accordance with rules of the Texas Board of Nursing at 22 TAC, Chapter 225 (relating to RN Delegation to Unlicensed Personnel and Tasks not Requiring Delegation in Independent Living Environments for Clients with Stable and Predictable Conditions) or the Human Resources Code, §161.091-.093, as applicable;
– conducting habilitation activities that train the individual;
– securing transportation for or transporting the individual; and
– supervising the individual's safety and security.
Residential Support Billable Activity– assisting the individual with activities of daily living;– assisting the individual with ambulation and mobility; – reinforcing any specialized therapies subcomponent
provided to the individual; – assisting with the administration of the individual's
medication or to perform a task delegated by a registered nurse in accordance with rules of the Texas Board of Nursing at 22 TAC, Chapter 225 (relating to RN Delegation to Unlicensed Personnel and Tasks not Requiring Delegation in Independent Living Environments for Clients with Stable and Predictable Conditions) or the Human Resources Code, §161.091-.093, as applicable;
– conducting habilitation activities that train the individual;
– securing transportation for or transporting the individual; and
– supervising the individual's safety and security.
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Specific RequirementsSpecific Requirements
Residential Support Unit of Service
• Unit of service is one day• A service claim may not be
for more than one day• A service claim may not
include a fraction of a unit of service
Residential Support Unit of Service
• Unit of service is one day• A service claim may not be
for more than one day• A service claim may not
include a fraction of a unit of service
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Specific RequirementsSpecific RequirementsResidential Support Service
Claim for an Individual on a Visit with Family or Friend
A program provider may submit a service claim for an individual who is on a visit with a family member or friend away from their residence if the visit is for at least a calendar day. If the visit is for more than 14 consecutive calendar days, the program provider may submit a service claim for only 14 calendar days of the visit.
Residential Support Service Claim for an Individual on a Visit with Family or Friend
A program provider may submit a service claim for an individual who is on a visit with a family member or friend away from their residence if the visit is for at least a calendar day. If the visit is for more than 14 consecutive calendar days, the program provider may submit a service claim for only 14 calendar days of the visit.
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Specific RequirementsSpecific RequirementsService Claim for an
Individual on a Visit with Family or Friend Written Documentation Written documentation must include the individual’s name, the dates the individual was visiting the family member or friend, the location of the visit and the date and signature of the service provider.
Service Claim for an Individual on a Visit with Family or Friend Written Documentation Written documentation must include the individual’s name, the dates the individual was visiting the family member or friend, the location of the visit and the date and signature of the service provider.
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Common ErrorsCommon Errors• Failure to discharge individual while in the hospital• Not providing location codes• Not providing staff signatures• Not showing night shift coverage activities
• Failure to discharge individual while in the hospital• Not providing location codes• Not providing staff signatures• Not showing night shift coverage activities
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Supervised Living
Supervised Living
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Specific RequirementsSpecific RequirementsSupervised Living Requirements
of Setting• The residence must be a 3 or
4-person residence• The service provider must be
available to provide residential support to an individual as needed; and
• The service provider must be present in the residence when the individual is present in the residence
Supervised Living Requirements of Setting
• The residence must be a 3 or 4-person residence
• The service provider must be available to provide residential support to an individual as needed; and
• The service provider must be present in the residence when the individual is present in the residence
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Specific RequirementsSpecific RequirementsSupervised Living Billable Activity
– assisting the individual with activities of daily living; – assisting the individual with ambulation and mobility; – reinforcing any specialized therapies subcomponent
provided to the individual; – assisting with the administration of the individual's
medication or to perform a task delegated by a registered nurse in accordance with rules of the Texas Board of Nursing at 22 TAC, Chapter 225 (relating to RN Delegation to Unlicensed Personnel and Tasks not Requiring Delegation in Independent Living Environments for Clients with Stable and Predictable Conditions) or the Human Resources Code, §161.091-.093, as applicable;
– conducting habilitation activities that train the individual;
– securing transportation for or transporting the individual; and
– supervising the individual's safety and security.
Supervised Living Billable Activity– assisting the individual with activities of daily living; – assisting the individual with ambulation and mobility; – reinforcing any specialized therapies subcomponent
provided to the individual; – assisting with the administration of the individual's
medication or to perform a task delegated by a registered nurse in accordance with rules of the Texas Board of Nursing at 22 TAC, Chapter 225 (relating to RN Delegation to Unlicensed Personnel and Tasks not Requiring Delegation in Independent Living Environments for Clients with Stable and Predictable Conditions) or the Human Resources Code, §161.091-.093, as applicable;
– conducting habilitation activities that train the individual;
– securing transportation for or transporting the individual; and
– supervising the individual's safety and security. 102
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Specific RequirementsSpecific RequirementsSupervised Living Unit of
Service• Unit of service is one day• A service claim may not be
for more than one day• A service claim may not
include a fraction of a unit of service
Supervised Living Unit of Service
• Unit of service is one day• A service claim may not be
for more than one day• A service claim may not
include a fraction of a unit of service
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Specific RequirementsSpecific RequirementsSupervised Living Service Claim
for an Individual on a Visit with Family or Friend
A program provider may submit a service claim for an individual who is on a visit with a family member or friend away from their residence if the visit is for at least a calendar day. If the visit is for more than 14 consecutive calendar days, the program provider may submit a service claim for only 14 calendar days of the visit.
Supervised Living Service Claim for an Individual on a Visit with Family or Friend
A program provider may submit a service claim for an individual who is on a visit with a family member or friend away from their residence if the visit is for at least a calendar day. If the visit is for more than 14 consecutive calendar days, the program provider may submit a service claim for only 14 calendar days of the visit.
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Specific RequirementsSpecific RequirementsService Claim for an
Individual on a Visit with Family or Friend Written DocumentationWritten documentation must include the individual’s name, the dates the individual was visiting the family member or friend, the location of the visit and the date and signature of the service provider.
Service Claim for an Individual on a Visit with Family or Friend Written DocumentationWritten documentation must include the individual’s name, the dates the individual was visiting the family member or friend, the location of the visit and the date and signature of the service provider.
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Common ErrorsCommon Errors• Failure to discharge consumer while
in the hospital • Not providing location• No Progress Note
• Failure to discharge consumer while in the hospital
• Not providing location• No Progress Note
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RespiteRespite
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Specific RequirementsSpecific RequirementsRespite– is the temporary provision of assistance and support
necessary for an individual to perform personal care, health maintenance and independent living tasks, participate in community activities, and develop, retain and improve community living skills; and
– provides relief for a caregiver of the individual who: • has the same residence as the individual; • routinely provides assistance and support
necessary for an individual to perform personal care, health maintenance and independent living tasks, participate in community activities, and develop, retain and improve community living skills;
• is temporarily unavailable to provide such assistance and support; and
• is not a service provider of foster/companion care, residential support or supervised living to the individual.
Respite– is the temporary provision of assistance and support
necessary for an individual to perform personal care, health maintenance and independent living tasks, participate in community activities, and develop, retain and improve community living skills; and
– provides relief for a caregiver of the individual who: • has the same residence as the individual; • routinely provides assistance and support
necessary for an individual to perform personal care, health maintenance and independent living tasks, participate in community activities, and develop, retain and improve community living skills;
• is temporarily unavailable to provide such assistance and support; and
• is not a service provider of foster/companion care, residential support or supervised living to the individual.
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Specific RequirementsSpecific RequirementsRespiteRoom and Board-
If respite is provided in a setting other than the individual's residence, the program provider must provide room and board to the individual free of charge.
RespiteRoom and Board-
If respite is provided in a setting other than the individual's residence, the program provider must provide room and board to the individual free of charge.
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Specific RequirementsSpecific RequirementsRespite Billable Activity• interacting face-to-face with an individual to:
– assist the individual with activities of daily living; – assist the individual with ambulation and mobility; – reinforce any specialized therapies subcomponent provided to
the individual; – assist with the administration of the individual's medication or
to perform a task delegated by a registered nurse in accordance with rules of the Texas Board of Nursing at 22 TAC, Chapter 225 (relating to RN Delegation to Unlicensed Personnel and Tasks not Requiring Delegation in Independent Living Environments for Clients with Stable and Predictable Conditions) or the Human Resources Code, §161.091-.093, as applicable;
– conduct habilitation activities that teach the individual;– secure transportation for the individual; – supervise the individual's safety and security; and – transport the individual, except from one day habilitation site
to another;
Respite Billable Activity• interacting face-to-face with an individual to:
– assist the individual with activities of daily living; – assist the individual with ambulation and mobility; – reinforce any specialized therapies subcomponent provided to
the individual; – assist with the administration of the individual's medication or
to perform a task delegated by a registered nurse in accordance with rules of the Texas Board of Nursing at 22 TAC, Chapter 225 (relating to RN Delegation to Unlicensed Personnel and Tasks not Requiring Delegation in Independent Living Environments for Clients with Stable and Predictable Conditions) or the Human Resources Code, §161.091-.093, as applicable;
– conduct habilitation activities that teach the individual;– secure transportation for the individual; – supervise the individual's safety and security; and – transport the individual, except from one day habilitation site
to another;
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Specific RequirementsSpecific RequirementsRespite Billable Activity• interacting face-to-face or by telephone with an
individual or an involved person regarding an incident that directly affects the individual's health or safety; and
• performing activities that does not involve interacting face-to-face with an individual described in Section 4620.
Respite Billable Activity• interacting face-to-face or by telephone with an
individual or an involved person regarding an incident that directly affects the individual's health or safety; and
• performing activities that does not involve interacting face-to-face with an individual described in Section 4620.
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Specific RequirementsSpecific RequirementsRespite must be provided:Residence • If an individual receives respite in a residence, the residence must
be:– the individual's residence; – a three-person residence; – a four-person residence; or – the residence of another person (other than a three-person
residence or a four-person residence) in which no more than three persons are receiving HCS Program services or a non-HCS program service similar to HCS Program services.
Non-residence • If an individual is receiving respite during an overnight stay in a
setting that is not the residence of any person, no more than six persons receiving HCS Program services or a non-HCS Program service similar to HCS Program services may be in the setting.
Respite must be provided:Residence • If an individual receives respite in a residence, the residence must
be:– the individual's residence; – a three-person residence; – a four-person residence; or – the residence of another person (other than a three-person
residence or a four-person residence) in which no more than three persons are receiving HCS Program services or a non-HCS program service similar to HCS Program services.
Non-residence • If an individual is receiving respite during an overnight stay in a
setting that is not the residence of any person, no more than six persons receiving HCS Program services or a non-HCS Program service similar to HCS Program services may be in the setting.
113http://www.dads.state.tx.us/handbooks/hcsbg/4000/4000.htm#sec4630
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Specific RequirementsSpecific Requirements
Submitting a Service Claim for Respite
Respite Provided in an Individual's Residence • If a program provider provides respite in an
individual's residence, the program provider may submit a service claim for no more than 96 units of service (24 hours) in one calendar day.
Respite Provided in Location Other Than the Individual's Residence • If a program provider provides 10 hours or
more of respite to an individual in one calendar day in a location other than the individual's residence, the program provider may submit a service claim for no more than 40 units of service.
Submitting a Service Claim for Respite
Respite Provided in an Individual's Residence • If a program provider provides respite in an
individual's residence, the program provider may submit a service claim for no more than 96 units of service (24 hours) in one calendar day.
Respite Provided in Location Other Than the Individual's Residence • If a program provider provides 10 hours or
more of respite to an individual in one calendar day in a location other than the individual's residence, the program provider may submit a service claim for no more than 40 units of service.
114http://www.dads.state.tx.us/handbooks/hcsbg/4000/4000.htm#sec4600
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Common ErrorsCommon Errors• Location of service not on documentation• Billing more than 10 hours for respite occurring
out of the individuals home• Individual lives alone without a live-in caregiver• No begin and/or end times • Non Qualified Service Provider (Proof of
residence, etc.)• Not providing location information• No Progress Note
• Location of service not on documentation• Billing more than 10 hours for respite occurring
out of the individuals home• Individual lives alone without a live-in caregiver• No begin and/or end times • Non Qualified Service Provider (Proof of
residence, etc.)• Not providing location information• No Progress Note
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Billing & Payment
Review Protocol117
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Billing and Payment Review•Conducted by DADS Billing and Payment staff
•Review of authorization and written documentation of service delivery maintained by program provider
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Purpose:To determine whether the program provider is in compliance with the HCS Program Billing Guidelines
Outcome:
DADS will recoup non-verified claims that were not supported by authorization and/or written documentation and may require a corrective action plan (CAP) by the program provider.
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Types of Reviews:• Routine
Once every 2 years, all services are reviewed with the number of individuals reviewed and review period determined by previous error rates or number of individuals served
• Special As determined by DADS, result of a complaint, referral or billing anomalies
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Routine or special review can be either:
• On-site – conducted at provider’s place of business
• Desk – conducted at DADS Headquarters (documentation submitted by mail )
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Samples are chosen based upon documentation error rate:
Error Rate = non-verified dollars divided by the total amount billed during the review period
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Example of Error Rate:
Non-Verified Claims Total..................$15,400.00
Total Claims Billed...............................$125,600.00
$15,400.00 ÷ $125,600.00 = .1226
Error Rate:12.26%
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BPR sample size:Error Rate Less Than Ten Percent (10%):
• Provider serves more than 10 individuals – 5 + 5% reviewed
• Provider serves less than 10 individuals – All reviewed
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BPR sample size--Error Rate More Than Ten Percent (10%):
• Provider serves more than 10 individuals – 10 + 10% reviewed
• Provider serves less than 10 individuals – All reviewed
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BPR sample sizeNever Reviewed:
• Provider serves more than 10 individuals-5 + 10%
• Provider serves less than 10 individuals-up to 5
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On-site Reviews:
Notification:
•Routine: • At least fourteen(14) days notice by phone and
followed by a faxed letter.• Individual sample list from outside of Waiver Contract
Area (WCA) of review location provided two business days prior to Entrance Conference.
•Special: • Will be conducted without notice.
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On-site Reviews:
List of individuals within the review location’s WCA are identified at Entrance Conference.
PROVIDERS ARE NOT PERMITTED TO CREATE ANY DOCUMENTATION AT ANY TIME WHILE REVIEW IS IN PROGRESS
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Error Sheet Forms
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Refuting – On-site Reviews
•Refuting is conducted while on-site.
•DADS will not accept additional documentation or refute any unverified claims after the Exit Conference.
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Demand for Payment-on-site review:
Following the Exit Conference, generally within 30 days, DADS will send a certified letter (Demand for Payment) to the provider detailing any unverified claims. The letter includes the amount to be recouped, any required corrective action and notice of the right to request an Administrative Hearing.
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On-Site Review:
Request for Administrative Hearing (appeal)
Must be made within 15 calendar days from receipt of certified green card from Demand for Payment letter
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Payment of unverified claims:
Recoupment is done electronically through the automated billing system (CARE)
Please do not send checks.
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Desk reviews:
Notification:
•Telephone and Certified Mail
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Timeframe to Provide Documentation-desk review
14 calendar days from receipt of certified green card from notification letter.
Documentation received after 14 days has elapsed will not be accepted and all services requested will be subject to recoupment.
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Results-desk review:
Provider notified of results in certified letter
Refuting-desk review:Additional documentation must be submitted within 14 calendar days of receipt of certified green card from results letter
Late submissions are not accepted
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Demand for Payment-desk review:
Certified letter notifies provider of final account of unverified claims after considering refuting documentation (if any submitted)
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Desk Reviews:
Request for Administrative Hearing (appeal):Must be made within 15 calendar days from receipt of certified green card from Demand for Payment letter
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Payment of unverified claims:
Recoupment is done electronically through the automated billing system.
Please do not send checks.
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HCS BILLING GUIDELINE REVISION
Misti J. Ackermann, Billing & Payment Manager
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2011 Billing Guidelines
Guidelines: http://www.dads.state.tx.us/handbooks/h
csbg/index.htm
Guideline Changes: http://www.dads.state.tx.us/handbooks/h
csbg/rmemo/11-1.htm
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Section Title Change2000 Definitions Adds definitions for competitive employment, comprehensive assessment, focused assessment,
integrated employment, service coordination and service coordinator.
3210 General Requirements Updated references.3230 Service Claim for Day Habilitation for
Individual Receiving Supported Employment
Deleted.
3230 Service Claim for Foster/Companion Care, Residential Support or Supervised Living for Individual on a Visit with Family or Friend
Section 3240 is renumbered to 3230.
3430 Relative, Guardian or Managing Conservator Qualified as Service Provider
Updates information in the first paragraph and deletes outdated information.
3610 15-Minute Unit of Service Defines “person” under No. 2, Service Time.3620 Daily Unit of Service Updates billable units of service.3700 Billing Service Components Provided at
the Same Time and Billing Day Habilitation Provided at the Same Time as Service Coordination
Revises section heading.
3730 Service Coordination and Day Habilitation Provided at the Same Time
Adds new section.
3810 General Requirements Adds new information and deletes outdated material.3820 Written Service Log and Written
SummaryUpdates section title; adds new information; deletes outdated material.
3850 Example Forms Updates title and adds new information.4210 General Description of Service
ComponentDefines specialized therapies subcomponents.
4220 Billable Activity Updates billable activities for the specialized therapies.4230 Activity Not Billable Updates examples of non-billable activities.4250 Unit of Service Adds service time information.4260 Written Documentation Updates documentation required to support a service claim for specialized therapies.4320 Requirements of Setting Adds retirement age as justification for providing day habilitation at the individual’s residence.
4370 Unit of Service Updates billable units of service.4380 Written Documentation Deletes outdated information and clarifies required documentation to support a service claim for day
habilitation.
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4390 Submitting a Service Claim for Individuals Receiving Supported Employment
Deleted.
4420 Billable Activity Updates billable activities for the licensed registered nursing service component.4430 Activity Not Billable Updates text.4450 Unit of Service Adds No. 3, Service Time.4470 Written Documentation Deletes outdated information.4471.2 Billable Activity Updates billable activities for the licensed vocational nursing service component.4471.3 Activity Not Billable Updates examples of non-billable activities.4471.5 Unit of Service Adds No. 3, Service Time.4471.7 Written Documentation Deletes outdated information.4472.2 Billable Activity Updates billable activities for the specialized registered nursing service component.4472.3 Activity Not Billable Updates text.4472.5 Unit of Service Adds No. 3, Service Time.4472.7 Written Documentation Deletes outdated information.4473.2 Billable Activity Updates bill activities for the specialized licensed vocational nursing service component.4473.3 Activity Not Billable Updates text.4473.5 Unit of Service Adds No. 3, Service Time.4473.7 Written Documentation Deletes outdated information.4540 Supported Home Living Subcomponent Updates rule citations; adds new requirements; deletes outdated information.4550 Foster/Companion Care Subcomponent Updates rule citations; clarifies requirements for service provider; updates text in No. 5, Restrictions
Regarding Submission of Claims for Foster/Companion Care; and clarifies required documentation in No. 8, Written Documentation.
4560 Residential Support Subcomponent Deletes text under No. 1(d), Service Provider Shifts; updates rule citations under No. 2, Billable Activity; updates information in No. 5, Restrictions Regarding Submission of Claims for Residential Support; adds new bullet under No. 8, Written Documentation; and makes minor wording changes to No. 9, Submitting a Service Claim for an Individual on a Visit with Family or Friend.
4570 Supervised Living Subcomponent Updates rule citations under No. 2, Billable Activity; updates information in No. 5, Restrictions Regarding Submission of Claims for Supervised Living; adds new bullet under No. 8, Written Documentation; and makes minor wording changes to No. 9, Submitting a Service Claim for an Individual on a Visit with Family or Friend.
4610 General Description of Service Component
Updates information in No. 1, Temporary Provision of Assistance, and No. 2, Room and Board.
4620 Billable Activity Updates rule citations.4651 Restrictions Regarding Submission of
Claims for RespiteAdds reasons for which a program provider may not submit a service claim.
4690 Written Documentation Deletes a bulleted item and makes minor wording changes.4710 General Description of Service
ComponentUpdates definition of supported employment.
4730 Billable Activity Adds transporting individual to and from the individual’s work site as a billable activity for the supported employment service component.
4740 Activity Not Billable Adds transporting an individual to a job interview as a non-billable activity.
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4760 Restrictions Regarding Submission of Claims for Supported Employment
Deletes outdated information.
4770 Unit of Service Adds No. 3, Service Time4780 Written Documentation Updates information.4790 Submitting a Service Claim for Day
HabilitationDeleted.
6160 Required Documentation for an Adaptive Aid
Updates section reference and removes prior approval requirement.
6170 Prior Approval Deleted.6170 Authorization for Payment Updates section number; adds new information and deletes outdated text. 6240 Payment Limit Deletes outdated information.6250 Required Documentation for a Minor
Home ModificationRemoves prior approval requirement.
6260 Prior Approval Deleted.6260 Authorization for Payment Updates section number; adds new information and deletes outdated material.Appendix IBilling and Payment Review Protocol Updates information.Appendix IV
Example of Service Delivery Log with Written Narrative
Deletes appendix and reserves it for future use.
Appendix VII
Billable Adaptive Aids Updates abbreviations and number codes.Appendix VIII
Instructions for AA/MHM Request for Prior Approval
Deletes appendix and reserves it for future use.
Appendix X
Billable Minor Home Modifications Updates abbreviations.Form 4116-Dental, Instructions
Home and Community-based Services/Texas Home Living Dental Summary Sheet
Deletes outdated information and adds instruction for signature/date line.
Form 4116-MHM-AA, Instructions
Home and Community-Based Services/Texas Home Living Minor Home Modification/Adaptive Aids Summary Sheet
Deletes outdated information, updates references and adds instruction for signature/date line.
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Changes to Billing Guidelines
Section 2000 - Definition Additions Competitive employment — Employment that pays an individual at or
above the greater of: (A) the applicable minimum wage; or (B) the prevailing wage paid to individuals without disabilities performing the same or
similar work.
Comprehensive Assessment: An extensive evaluation of an individual's health status that: (A) addresses anticipated changes in the conditions of the individual as well as emergent
changes in the individual's health status; (B) recognizes changes to previous conditions of the individual; (C) synthesizes the biological, psychological, spiritual and social aspects of the
individual's condition; (D) collects information regarding the individual's health status; (E) analyzes information collected about the individual's health status to make nursing
diagnoses and independent decisions regarding nursing services provided to the individual;
(F) plans nursing interventions and evaluates the need for different interventions; and (G) determines the need to communicate and consult with other service providers or
other persons who provide supports to the individual.
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Changes to Billing GuidelinesSection 2000 - Definition Addition Focused Assessment: An appraisal of an individual's current health
status that: (A) contributes to a comprehensive assessment conducted by a registered nurse; (B) collects information regarding the individual's health status; and (C) determines the appropriate health care professionals or other persons who
need the information and when the information should be provided.
Integrated employment — Employment at a work site at which an individual routinely interacts with people without disabilities other than the individual's work site supervisor or service providers.
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Changes to Billing GuidelinesSection 3000 Supported Employment/Day Habilitation Division of Time Between Individuals Service Coordination & Day Habilitation Written Documentation for non-nursing
services Other Changes to Section 3000
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Changes to Billing GuidelinesSection 4000 Specialized Therapies
Definitions Video Conference
Day Habilitation In-Home Exception Time Change Supported Employment Dual Billing Removal
Nursing (See Next Slides) Residential Services (See Next Slides) Respite
Clarification Supported Employment
Transportation included
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Changes to Billing GuidelinesSection 4400 – Nursing Services Registered Nursing
Assessments & Comprehensive AssessmentsMedication ReviewInsurance Provider CommunicationSupervising LVN (RN can only bill)
Licensed Vocational NursingFocused AssessmentsMedication ReviewInsurance Provider Communication
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Changes to Billing GuidelinesSection 4500 – Residential Services Foster Care & Supervised Living
No Significant Changes Residential Support Services
Service Provider ShiftsOff Duty RequirementNo Shifts of More than 24 Hours
Supported Home LivingSafety & SupervisionNo Volunteer Hour Limit
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Changes to Billing GuidelinesSection 6000 Adaptive Aids
Prior Approval RemovalAuthorization for Payment Requirements
Minor Home ModificationsPrior Approval RemovalAuthorization for Payment Requirements
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Changes to Billing GuidelinesOther Changes
Guideline FormatBilling and Payment Review ProcessForm Updates
○ 2122 Service Delivery Log with Written Narrative/Written Summary ○ 2124 Community Support Transportation Log ○ 4116-Dental Dental Summary Sheet ○ 4116-MHM-AA Minor Home Modification/Adaptive Aids Summary Sheet ○ 4117 HCS Supported Employment Service Delivery Log ○ 4118 HCS Respite Service Delivery Log ○ 4119 HCS Residential Support Services (RSS) and Supervised Living (SL) ○ 4120 HCS Day Habilitation (DH) ○ 4121 HCS Supported Home Living○ 4122 Foster/Companion Service Delivery Log
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Vivian Griffor, Billing and Payment Team Leader
Guide to Purchasing Adaptive Aids & Minor Home
Modifications
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http://www.dads.state.tx.us/handbooks/hcsbg/6000/index.htm
Adaptive Aids & Minor Home Modifications
Documentation required before purchasing any AA/MHM:Documentation required before purchasing any AA/MHM:
Written assessment Not required for AA under $500 or MHM under $1000
Individual and Program Provider Agreement
Three Bids 3 bids are required no matter the cost need an explanation if 3 bids have not been
obtained
Proof of non-coverage by private insurance, Medicare, and Medicaid (AA only-as applicable)
Written assessment Not required for AA under $500 or MHM under $1000
Individual and Program Provider Agreement
Three Bids 3 bids are required no matter the cost need an explanation if 3 bids have not been
obtained
Proof of non-coverage by private insurance, Medicare, and Medicaid (AA only-as applicable)
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http://www.dads.state.tx.us/handbooks/hcsbg/6000/index.htm
Adaptive Aids & Minor Home Modifications
The Written Assessment must:
• be based on a face-to-face evaluation
• be done in the home if a MHM is being requested
• be done by a qualified medical professional-
See Appendix VII for Adaptive Aids & Appendix X for Minor Home Modifications
• include a description of AND a recommendation for the specific AA/MHM being requested
• be based on a face-to-face evaluation
• be done in the home if a MHM is being requested
• be done by a qualified medical professional-
See Appendix VII for Adaptive Aids & Appendix X for Minor Home Modifications
• include a description of AND a recommendation for the specific AA/MHM being requested 155
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Assuming that a recommended item is a covered item
**Obtaining an assessment that is not current
**Obtaining an assessment that does not contain sufficient medical justification
Assuming that a doctor’s prescription is sufficient
**Obtaining an assessment that is not legible
**Obtaining an assessment done by an unauthorized professionalhttp://www.dads.state.tx.us/handbooks/hcsbg/6000/index.htm
Avoid These Common ErrorsAvoid These Common Errors
156
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http://www.dads.state.tx.us/handbooks/hcsbg/6000/index.htm
Adaptive Aids & Minor Home Modifications
Individual and Program Provider Agreement Must
• consider the written assessment
• document any discussion about the recommended item(s)
• agree that the recommended item is necessary and should be purchased
• document their agreement in writing
• consider the written assessment
• document any discussion about the recommended item(s)
• agree that the recommended item is necessary and should be purchased
• document their agreement in writing
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Failure to include signatures
Team meeting/Staffing/Individual and Program Provider Agreement
Failure to document discussion of need for item requested
http://www.dads.state.tx.us/handbooks/hcsbg/6000/index.htm
Avoid These Common ErrorsAvoid These Common Errors
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http://www.dads.state.tx.us/handbooks/hcsbg/6000/index.htm
Adaptive Aids & Minor Home Modifications
Bids :
• Three (3) bids are required, regardless of cost
• Bids must be comparable (for like or very similar items)
• Bids must state the total cost of the requested AA/MHM and, if it includes more than one AA/MHM, state the itemized cost of each AA/MHM listed by service code
• Bids must include the name, address and telephone number of the vendor/contractor
• Three (3) bids are required, regardless of cost
• Bids must be comparable (for like or very similar items)
• Bids must state the total cost of the requested AA/MHM and, if it includes more than one AA/MHM, state the itemized cost of each AA/MHM listed by service code
• Bids must include the name, address and telephone number of the vendor/contractor
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Exceptions to bid requirements:
Less than three bids for an AA/MHM may be acceptable IF there is written justification stating the AA/MHM is available from only a limited number of vendors/contractors
A single bid from the custom fitting vendor is acceptable for eyeglasses (220), hearing aids, batteries and repairs (260) and orthotic devices, orthopedic shoes, and braces (107)
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Annual Vendor:Will there still be an Annual Vendor?
Yes.
A Program Provider:May be exempted from bid requirement for
frequently purchased consumable items with an approval for Annual Vendor status
Will submit application for Annual Vendor by January 31 for current calendar year
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Failure to obtain three bids (no justification)*
Obtaining bids that contain items not recommended in the assessment**
Obtaining bids that contain items not covered on the waiver**
Obtaining bids that are not for the same item or list of items**
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Pursuing alternate funding sources:
Written proof of non-coverage from Medicare/Medicaid must be obtained for any AA denoted with a (1) or (2) on the “List of Billable (Reimbursable) Adaptive Aids”
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Obtaining a statement by a DME vendor that an item is not covered**
Obtaining a denial letter that indicates that insufficient documentation was submitted with claim**
Obtaining a Medicaid denial letter that indicates that consumer is eligible for Medicare (primary)**
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Texas Department of Aging and Disability Services Home and Community-Based Services/Texas Home Living
Minor Home Modification/Adaptive Aids Summary Sheet
Form 4116-MHM-AA September 2011
Service Month and Year Component Code Contract No. Contact Person Area Code and Telephone No.
September 2011 000 00100XXXX Ima Provider 512-555-5555
Name (Last, First, Initial) Client
Care ID No.
Service Date (MM,DD,YY)
Prior Approval
Tracking No.
Service Description Service Description
Minor Home Modification
Service Code
Dollars Spent
Req. Fee Adaptive Aids Service Code
Dollars
Spent Req. Fee
1. Anita N. Item 12345 09/01/11 N/A Leg Brace 107 $180.00 $18.00
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Total
I certify by submission of this form that it meets all requirements set forth in the Home and Community-Based Services/Texas Home Living Billing Guidelines.
Ima Provider 9/22/11
Signature Date
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Submit reimbursement claims (4116) to:
DADSProvider Claims ServicesPO BOX 149030 MC W-400Austin, TX 78714-9030
For questions contact Provider Claims Services at
512-438-2200 option 5http://www.dads.state.tx.us/handbooks/hcsbg/6000/index.htm
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ManagerMisti J. Ackermann [email protected]
HCS Team LeadersVivian Griffor -Adaptive Aids Contact [email protected]
Willie Mae Jones [email protected]. Sam Montgomery [email protected] Sifuentes [email protected] Solis – Cost Report Contact [email protected]
Program SpecialistsKarri Henager [email protected] Rehagen [email protected] Santos-Vela [email protected] Vekris– Cost Report Contact [email protected]
Additional InformationBilling and Payment Email & Hotline
[email protected] [512-438-5359]
Fax 512-438-2695
Mailing Address
Department of Aging and Disability ServicesCommunity Services, Billing and PaymentPO BOX 149030, Mail Code W-200Austin, Texas 78714-9030