(a) A program provider must ensure that case management is provided in accordance with an individual's IPP, IPC, and Appendix C of the DBMD Program waiver application approved by CMS and available on the HHSC website, including:
  (1) initiating and overseeing the process of assessment and reassessment of the individual's LOC;
  (2) initiating and overseeing the process of the review of service plans at enrollment, annually, and as needed, including if requested by the individual or LAR;
  (3) observing the individual in the individual's home and determining the intent and level of the individual's communication;
  (4) if necessary, determining from the individual's non-verbal communication, the individual's likes and dislikes;
  (5) leading the service planning team to use the person-centered planning process to develop a service plan that optimizes the opportunities for the individual to use the individual's abilities and to integrate in community settings;
  (6) using the individual's knowledge of sign language and other communication systems to make the individual as aware as possible of the individual's service plan and options;
  (7) communicating with service planning team members to ensure that the service plan is carried out appropriately;
  (8) monitoring the success of the service plan by observing the individual at home and in the community;
  (9) monitoring the provision of services included in the service plan on an ongoing basis; and
  (10) monitoring services that assist the individual in gaining access to needed waiver and other state plan services, including medical, social, educational, and non-wavier services.
(b) The only activities that a program provider may bill as case management are:
  (1) an in-person, email, phone call, or text message contact with an individual;
  (2) an in-person, email, phone call, or text message contact with the LAR, primary caregiver, or an actively involved person regarding the individual's services;
  (3) a phone call, text message, email, letter, or meeting with HHSC or community resources regarding the individual's services; and
  (4) working with service providers regarding the individual, including:
    (A) reviewing services, goals, and outcomes, as described in the individual's IPC and IPP;
    (B) providing the training described in §260.205(g) of this chapter (relating to Training);
    (C) monitoring training strategies used by service providers to carry out the goals and outcomes described in the IPP; and
    (D) activities performed as a member of the service planning team.

Source Note: The provisions of this §260.337 adopted to be effective February 26, 2023, 48 TexReg 896