(a) A program provider must ensure that nursing:
  (1) is ordered or prescribed by a physician or other medical practitioner acting within the scope of the practitioner's license; and
  (2) is provided in accordance with:
    (A) Texas Occupations Code Chapter 301;
    (B) 22 TAC Chapter 217;
    (C) 22 TAC Chapter 224; and
    (D) 22 TAC Chapter 225.
(b) If an individual requires specialized licensed vocational nursing or specialized registered nursing, a program provider's RN must complete the HHSC Specialized Nursing Certification form as described in the Deaf Blind with Multiple Disabilities Program Manual and obtain HHSC authorization before providing specialized licensed vocational nursing or specialized registered nursing.
  (1) The RN must indicate on the form that a physician has determined the individual requires:
    (A) use of a ventilator at least six hours per day; or
    (B) tracheostomy care at least once per day to include cleansing, dressing, and suctioning of the tracheostomy.
  (2) The program provider must:
    (A) ensure the case manager submits the completed form to HHSC with the IPC; and
    (B) keep the original completed form in the individual's record.
(c) If HHSC approves specialized licensed vocational nursing or specialized registered nursing for an individual, the program provider must bill for specialized licensed vocational nursing or specialized registered nursing provided to the individual after the date of HHSC's authorization of these services.
(d) If an individual's IPC includes nursing, a program provider must ensure compliance with §260.213 of this chapter (relating to Service Backup Plans).
(e) A program provider may bill HHSC at the RN, LVN, specialized RN, or specialized LVN rates only for the following nursing activities:
  (1) interacting in person or by telephone with an individual to provide professional or vocational nursing for which there is a documented or immediate medical necessity, including:
    (A) preparing and administering medication or treatment ordered by a physician, podiatrist, or dentist;
    (B) assisting or observing self-administration of medication; and
    (C) assessing an individual's health status;
  (2) interacting in person or by telephone with a person, except a service provider of nursing, case management, or a therapy, regarding the health status of an individual;
  (3) performing health care procedures ordered or prescribed by a physician or medical practitioner and required by standards of professional practice or law to be performed by licensed nursing personnel;
  (4) delegating, verifying the competency of, and supervising an unlicensed person in the performance of a task delegated in accordance with 22 TAC Part 11 (relating to Texas Board of Nursing);
  (5) providing training to a service provider that is specific to an individual;
  (6) providing training or orientation to an individual, LAR, family member, or service provider concerning an adaptive aid or minor home modification; and
  (7) participating in service planning team meetings.
(f) A program provider may bill HHSC at a nursing rate for a nurse's performance of delegated tasks if:
  (1) a service provider to whom a nurse has delegated the performance of delegated tasks is unavailable to perform those tasks;
  (2) a backup service provider is unavailable; and
  (3) the individual's health and welfare would be endangered if those tasks are not delivered.
(g) If a program provider bills HHSC as described in subsection (f) of this section, the program provider:
  (1) must not bill for more than 10 hours of such services per IPC period;
  (2) must document in the individual's record:
    (A) efforts made to find a service provider who is not an RN or LVN to perform the delegated tasks; and
    (B) reasons the failure to provide the delegated tasks would endanger the individual's health and welfare.

Source Note: The provisions of this §260.347 adopted to be effective February 26, 2023, 48 TexReg 896