This is a clone of the Texas Administrative Code (TAC) for educational purposes. It is not the official version and should not be used for legal purposes. Site created Wed, 21 May 2025 21:16:36 GMT
(a) A PPECC must obtain and maintain the following documentation in a participant's medical record to be eligible for reimbursement for non-transportation PPECC services provided to the participant:(1) a physician's specific, written, signed, and dated orders prescribing PPECC services;(2) an approved prior authorization from HHSC that includes:(A) a Comprehensive Care Program (CCP) Prior Authorization Request Form;(B) a PPECC Plan of Care (POC);(C) a PPECC nursing assessment;(D) a Nursing Addendum to POC for Private Duty Nursing (PDN) and/or PPECC;(E) consent for PPECC services as described in the Texas Medicaid Provider Procedures Manual; and(F) documentation of medical necessity;(3) the daily attendance log required by subsection (b) of this section; and(4) the documentation required by subsection (c) of this section.(b) A PPECC must maintain a daily attendance log that includes:(1) the date of attendance;(2) the name of the participant;(3) the signature of the responsible adult and the time when the PPECC assumes responsibility for the care of the participant which is:(A) the time the participant boards the PPECC transport vehicle; or(B) the time the participant is brought to the PPECC by a responsible adult;(4) the signature of the responsible adult and time when the responsible adult assumes responsibility for the care of the participant which is:(A) the time the participant is taken off the transport vehicle at the participant's return destination; or(B) the time the participant is picked up from the PPECC by a responsible adult; and(5) the name of the PPECC staff member riding in the transport vehicle when PPECC transportation services are utilized and whether the staff member is a registered nurse, licensed vocational nurse, or direct care staff.(c) A PPECC must maintain the following documentation:(1) notes from interdisciplinary team meetings;(2) discrepancies between the weekly service hours scheduled and the service hours provided;(3) the names of the staff member providing services;(4) the date of service;(5) the type of service performed; and(6) the start and end times of the service performed.(d) HHSC may request that a PPECC provide documentation to substantiate the provision of services in addition to that required by subsections (a) - (c) of this section.(e) HHSC may recoup payment for services not substantiated by the documentation required in this section.