(a) A program provider that arranges for durable medical equipment for an individual residing in the facility must ensure that:
  (1) the individual receives the equipment prescribed;
  (2) the equipment fits properly, if applicable; and
  (3) the individual's caregivers, as appropriate, receive instruction regarding the equipment's use.
(b) To receive payment for a wheeled mobility system or for a major modification to a wheeled mobility system, a program provider must comply with paragraphs (1) - (5) of this subsection.
  (1) The program provider must ensure that an occupational therapist or a physical therapist:
    (A) conducts a clinical assessment of the individual receiving the wheeled mobility system;
    (B) documents in detail the medical need for a specific wheeled mobility system and all necessary accessories, as determined during the clinical assessment; and
    (C) signs and dates the written assessment.
  (2) The program provider must ensure that a QRP who is directly employed by or contracting with the program provider:
    (A) is present for and directly involved in the clinical assessment of the individual described in paragraph (1) of this subsection;
    (B) is not the same person who conducts the clinical assessment described in paragraph (1) of this subsection;
    (C) is present when the wheeled mobility system is delivered, directs the fitting of the system, and ensures that the system is appropriate for the individual; and
    (D) verifies that the wheeled mobility system functions correctly for the individual.
  (3) The program provider must receive prior authorization to obtain a wheeled mobility system for an individual by submitting the following documentation to DADS in accordance with instructions issued by DADS:
    (A) a prescription, signed and dated by a physician, that describes in detail the wheeled mobility system, including all necessary components, needed by the individual;
    (B) the clinical assessment described in paragraph (1) of this subsection; and
    (C) documentation that a QRP was present for and involved in the clinical assessment of the individual.
  (4) The program provider must submit to DADS, in accordance with instructions issued by DADS, documentation that a QRP conducted the activities described in paragraph (2)(C) and (D) of this subsection.
  (5) The program provider must maintain a copy of the documentation described in paragraphs (3) and (4) of this subsection in the individual's record.

Source Note: The provisions of this §261.221 adopted to be effective January 1, 2001, 25 TexReg 12790; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective November 4, 2013, 38 TexReg 7724; transferred effective October 1, 2020, as published in the Texas Register August 28, 2020, 45 TexReg 6127