(a) Day habilitation.
  (1) Before including day habilitation on an individual's IPC, a program provider must ensure and maintain documentation in the individual's record that day habilitation is not available to the individual under a program funded under §110 of the Rehabilitation Act of 1973, as amended (29 U.S.C. §701 et seq.) or under a program funded under the Individuals with Disabilities Education Act (20 U.S.C. §1401 et seq.).
  (2) A program provider must ensure that day habilitation includes:
    (A) assistance in acquiring, retaining, or improving the self-help, socialization, and adaptive skills necessary to live successfully in the community and participate in home and community life;
    (B) providing the individual with individualized activities:
      (i) in environments designed to foster the development of skills and behavior supportive of greater independence and personal choice consistent with achieving the outcomes identified in the individual's IPP; and
      (ii) designed to reinforce therapeutic outcomes targeted by other DBMD Program services, CFC services, school, or other support providers; and
    (C) providing transportation necessary for the individual's participation in day habilitation activities, such as shopping, swimming, going to the park, or other community activities.
  (3) A program provider must ensure day habilitation:
    (A) is provided to an individual in a non-residential setting separate from the individual's own or family home or the residence in which the individual receives licensed assisted living or licensed home health assisted living that:
      (i) is accessible to and usable by the individual;
      (ii) is maintained in good repair;
      (iii) has at least two means of egress; and
      (iv) is in continuous compliance with applicable local building codes and ordinances and applicable state and federal laws, rules, and regulations;
    (B) reinforces:
      (i) therapeutic outcomes identified by other DBMD Program services and CFC services; and
      (ii) for an individual eligible for public education services, education goals in the Individualized Education Program (IEP) and services provided by the school district;
    (C) includes transportation necessary for the individual's participation in day habilitation activities; and
    (D) is not provided to an individual at the same time that any of the following services are provided:
      (i) employment assistance with the individual present;
      (ii) supported employment with the individual present;
      (iii) transportation provided as a residential habilitation activity;
      (iv) 24-hour licensed assisted living;
      (v) 24-hour licensed home health assisted living;
      (vi) respite; or
      (vii) CFC PAS/HAB.
  (4) A program provider must ensure a day habilitation service provider works with one individual at a time unless the individual's service planning team documents on the IPP that the individual's needs can be met with a day habilitation service provider to individual ratio of one-to-two or one-to-three.
  (5) A program provider must ensure that for a service-provider-to-individual ratio higher than one-to-three, that the IPP includes a recommendation from the service planning team and supporting documentation of the individual's ability to integrate and meaningfully participate in an environment with a ratio higher than one-to-three.
  (6) A program provider may bill for time spent by a day habilitation service provider:
    (A) in direct contact with an individual;
    (B) participating as a member of an individual's service planning team; or
    (C) performing tasks delegated by a physician or RN.
(b) Residential habilitation.
  (1) A program provider must ensure:
    (A) residential habilitation:
      (i) is not provided to an individual receiving licensed assisted living or licensed home health assisted living;
        (I) in the individual's own or family home; or
        (II) in a setting outside the individual's own or family home appropriate for the type of residential habilitation activities described in the individual's IPP;
      (ii) includes:
        (I) transportation; or
        (II) assistance in securing transportation;
        (III) assistance with ambulation and mobility;
        (IV) reinforcement of behavioral support or therapy activities;
        (V) assistance with medications and the performance of tasks delegated by an RN in accordance with state law;
        (VI) supervision of the individual's safety and security;
        (VII) assistance with acquisition, retention, or improvement in skills related to activities of daily living, including:
          (-a-) personal grooming and cleanliness;
          (-b-) bed making and household chores; and
          (-c-) preparation and consumption of food;
        (VIII) use of natural supports and typical community services; and
        (IX) social interaction and participation in leisure activities; and
      (iii) is not provided to the individual at the same time that one of the following services are provided:
        (I) employment assistance with the individual present;
        (II) supported employment with the individual present;
        (III) day habilitation;
        (IV) respite; or
        (V) CFC PAS/HAB; and
    (B) a residential habilitation service provider works with no more than one individual at a time.
  (2) A program provider may bill for time spent by a residential habilitation service provider transporting an individual.
(c) CFC PAS/HAB.
  (1) A program provider must ensure CFC PAS/HAB is not provided to an individual receiving licensed assisted living or licensed home health assisted living.
  (2) A program provider must ensure CFC PAS/HAB is not provided to an individual at the same time that one of the following services are provided:
    (A) employment assistance with the individual present;
    (B) supported employment with the individual present;
    (C) day habilitation;
    (D) respite; or
    (E) transportation provided as a residential habilitation activity.
  (3) A program provider must ensure a CFC PAS/HAB service provider works with no more than one individual at a time.
  (4) If an individual's IPC includes CFC PAS/HAB, a program provider must ensure compliance with §260.213 of this chapter (relating to Service Backup Plans).

Source Note: The provisions of this §260.343 adopted to be effective February 26, 2023, 48 TexReg 896