Texas Register, Volume 14, Number 4, Pages 235-293, January 13, 1989 Page: 267
235-293 p. ; 28 cm.View a full description of this periodical.
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Chapter 16. ICF/SNF
Compliance with State and
Local Laws
The Texas Department of Human Services
(DHS) adopts amendments to 16. 3801 and
16.6112 and new 16.1514, in its lntermedi-
ate Care Facility/Skilled Nursing Facility
chapter. The amendments and new section
are adopted to comply with the provisions of
the Omnibus Budget Reconciliation Act
(OBRA) of 1987.
These federally mandated rules are designed
to eliminate inappropriate placements in nurs-
ing facilities of individuals found to have a
diagnosis of mental illness or mental retarda-
tion or both (or a related condition), while
allowing an appeals process (beginning Janu-
ary 1, 1989) for those individuals adversely
affected by the preadmission screening and
annual review process. No vendor payment is
made to a facility for any Medicaid appli-
cant/recipient admitted to a nursing facility
after January 1, 1989, who has not received a
preadmission screening. No vendor payment
is made for any Medicaid applicant/recipient
residing in a nursing facility after April 1,
1990, who has not received an annual re-
view. Beginning January 1, 1989, the Texas
Department of Mental Health and Mental Re-
tardation (TDMHMR) will determine for those
individuals with a diagnosis of mental illness
and/or mental retardation (or a related condi-
tion) whether resadance in a nursing facility is
appropriate and whether active treatment is
required The amendments and new section
are adopted effective January 1, 1989, to
comply with federal requirements.
) 40 TAC 16.1514
The new section is adopted under the Human
Resources Code, Title 2, Chapters 22 and
32, which provides the department with the
authority to administer public and medical
assistance programs.
16.1514. Preadmission Screening and An-
nual Review Requirements (PASARR).(a) Effective January 1,
Medicaid applicants/recipients
screened prior to admission to
facility to determine whether:1989, all
must be
a nursing(1) the individual has mental ill-
ness (MI) and/or mental retardation (MR)
or a related condton;
(2) nursing facility placement is
appropriate; and
(3) the individual needs active
treatment.
(b) All Medicaid applicant/rhecipi-
ents residing in a nursing facility after Janu-
ary 1, 1989, must be screened to determine
whether:
(1) the individual has mental ill-
ness (MI) and/or mental retardation (MR)
or a related condition;(2) nursing facility placement is
appropriate; and
(3) the individual needs active
treatment.
(c) All Medicaid recipients deter-
mined to be mentally ill and/or mentally
retarded (or a related condition) and who
meet PASARR criteria for continued resi-
dence in a nursing facility are screened at
least annually.
(d) Nursing facilities are required to
refer residing Medicaid applicants/recipi-
ents identified as needing alternate care
placement and/or active treatment as a re-
sult of the PASARR determination to ap-
propriate alternate care options according to
163903 of this title (relating to Alternate
Care Requirements). The nursing facility
must refer these individuals to the local
mental health and mental retardation au-
thority.
This agency hereby certifies that the rule as
adopted has been reviewed by legal counsel
and found to be a valid exercise of the agen-
cy's legal authority.
issued in Austin, Texas, on January 6, 1989.TRD-900084
Martin W. Johnston
Commissioner
Texas Department of
Human ServcesEffective date: January 1, 1989.
For further information, please
4504-3765
Services and Supplies I
in the Vendor Paymer
* 40 TAC 16.3801
The amendment is adopted under t
Resources Code, Title 2, Chapte
32, which provides the department
authority to administer public an
assistance programs.
163801. Vendor Payment.
(a)-(f) (No change.)
(g) Vendor payments are
to Medicaid nursing facilities tha
retain recipients that have not bee
by the Texas Department of Met
and Mental Retardancn Vendor
made inadvertently to a nursing
immediately recoupcL.
This agency hereby certfies that
adopted has been reviewed by leg
and found to be a valid exercise o
cy's legal authority.
Issued in Austin, Texas, on Januacall: (512)
TRD48900085
Martin W. Johnston
Commissioner
Texas Department of
Human ServioesEffective date: January 1, 1989.
For further information, please call: (512)
450-3765
Recipient Rights
* 40 TAC 16.6112
The amendment is adopted under the Human
Resources Code, Title 2, Chapters 22 and
32, which provides the department with the
authority to administer public and medical
assistance programs.
16.6112. Discharges/Relocations.
(a) A facility may discharge a
recipient-patient only in the following situa-
tions:
(1)-(5) (No change.)
(6) if the Texas Department of
Mental Health and Mental Retardation
(TDMHMR) screens and determines that
the recipient has a diagnosis of mental ill-
ness and/or mental retardation (or a related
condition) and does not require the level of
service provided by a nursing facility and
does/does not require active treatment.
(b)-(e) (No change.)(f) Any recipient discharged as a
A result of a determination by the Texas De-
* partment of Mental Health and Mental Re-
tardation (TDMHMR) as described in
subsection (aX6) of this section is informed
nt of his right to request a fair hearing and to
be represented by an authonzed repre-
sentative. Fair hearings are conducted ac-
he Human cording to Chapter 79, Subchapters L, M,
rs 22 and and N of this ttle (r. iating t Fair Hearings,
nt with the Appeals Process, and !learig Procedure).
Applicants/recipirts have ;0 days to ap-
peal. If an apphca~n!rccipient currently re-
siding in a conuaced no srig facility
appeals within 10 days, payments to the
facility continue ur :I the hearing officer
makes a final determrlauon When deci-
not made sions are upheld, overpayments to the nurs-
at admit or ing facility are mnunediately recouped.
n screened
ntal Health This agency hereby c&rtlfies tha the rule as
adopted has boon reviewed by legal counsel
payments and foun to be a valid exerciSe of the agen-
faciity are cy's legal authonty
Issued in Austin, Texas, on January 6, 1989.
the rule as
al counsel TRD-8900086 Mariin W. Johnston
f the agen- Commissioner
Texas Department of
Human Services
ry 6, 1989. Effective date: January 1, 1989.
For further information, please call: (512)
450-3765* Adopted Secions January 13, 1989 14 TexReg 267
January 13, 1989 14 TexReg 267
* Adopted Sections
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Texas. Secretary of State. Texas Register, Volume 14, Number 4, Pages 235-293, January 13, 1989, periodical, January 13, 1989; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth215991/m1/33/: accessed April 18, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.