To ensure the health and safety of participants who receive CRS and the employees who provide services to CRS participants, providers must ensure that information is kept confidential and that there is appropriate staff and staff-training.
The general provider guidelines explained in this chapter apply to all CRS services. For information related to a specific service, see the chapter on that service.
4.2 Participant Records
A provider must make available to CRS program staff members all documents and records related to the CRS participant.
Provider records must document compliance with applicable CRS standards. These records must be legible, reflective of services rendered to the participant, easily retrievable, and made readily available to CRS program staff members.
Required documentation for both the participant’s case records and the services purchased must include the following, as applicable to the service offered:
- participant referral information that includes the Individualized Written Rehabilitation Plan received from the CRS counselor;
- documentation of admission, including initial assessments that must include the Mayo Portland Adaptability Inventory or the Functional Inventory Measure;
- documentation reflecting that the CRS counselor, participant, and provider are jointly involved in the planning of services, and measurable goals and objectives;
- documentation of all interdisciplinary team meetings and participant participation in meetings, including admission, revisions to the treatment plan that occur at least monthly, and discharge meetings;
financial records, including copies of service authorizations, copies of invoices submitted for payment of services, and records of CRS payments;
- evidence of communication with all pertinent interdisciplinary team members;
- evidence of participant participation in the planning and implementation of the rehabilitation process;
- documentation that the Individualized Program Plan (IPP) was signed by the CRS counselor, or evidence that the IPP was provided to the CRS counselor by fax, email, or post;
- documentation that the IPP was signed by the participant or representative;
- documentation that the IPP was signed by the case manager;
- prior approval for services (if applicable);
- correspondence and collaborative of services with other providers;
- consents; and
- critical incident reports, including the use of physical or chemical restraint.
The provider must ensure that documentation of interventions is based on desired treatment goals and objectives that are measurable and reflect changes to the participant’s status.
Documentation of daily progress and efficacy to support services must include:
- the date, time or duration of the service;
- signature of the person providing the service and credentials (if person’s position or certification requires clinical supervision, the supervisor must also sign the documentation);
- clear details regarding the service provided and how the provided service is related to treatment plan goals and objections;
- the subjective and objective dates, which may include symptoms, participant statements and clinical observations;
- interventions and methods used to address goals and objectives;
- information on the participant’s progress or lack of progress toward meeting the treatment goals and objectives; and
- plans that may be necessary to help the participant meet the treatment goals and objectives.
Additional information may be requested from CRS program staff members, as required to support the services provided.
4.3 Confidentiality of Participant or Employee Information
To protect the integrity and dignity of each participant, staff members must maintain confidentiality with respect to participant or employee information, when applicable, as required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The provider must have policy and procedures in place that facilitate access to confidential records.
The provider must develop and maintain a recordkeeping system that includes a separate record for each participant, and must keep confidential all information contained in the participants' records, regardless of the form or storage method of the records.
The provider must develop and use physical safeguards for confidential records and ensure that the records are available to authorized staff members only. Participant case records must be locked in a location where maximum protection against fire, water damage, and other hazards is in place.
4.4 Staff Ratios
The provider must provide sufficient direct-care staff members, per state licensing requirements, to manage and supervise participants in accordance with their Individualized Program Plan (IPP). The provider must have enough direct-care staff members to provide care and services so that participants do not injure themselves, do not injure others, and do not destroy property. Special staffing needs identified by the IPP (for example, one-to-one ratios) must be provided. Adequate numbers of direct-care staff members must be available to supervise participants when other direct-care staff members are unavailable (for example, during breaks, meals, meetings, and training).
4.5 Staff Training
Before assuming job responsibilities, and at least annually thereafter, direct-care staff members must receive in-service training in the following areas:
- reporting abuse, neglect or exploitation;
- maintaining confidentiality of participant information, including data use agreements;
- taking universal precautions (that is, following the approach to infection control established by the Occupational Safety and Health Administration);
- conditions in which they should notify the facility manager;
- understanding the participants' rights;
- following emergency and evacuation procedures;
- taking safety measures to prevent accidents and injuries;
- following emergency first-aid procedures, including the Heimlich maneuver and what actions to take when a participant falls, suffers a laceration, or experiences a sudden change in physical or mental status;
managing disruptive behavior and implementing behavior management (for example, prevention of aggressive behavior and de-escalation techniques, practices to decrease the frequency of the use of restraint, and alternatives to restraints);
- appropriate physical restraint procedures and techniques for staff members with direct participant contact;
- fall prevention;
- cardiopulmonary arrest (CPR) and basic life support (BLS) training; and
- substance abuse training, including how to recognize substance abuse and understanding reporting protocols.
4.6 Staff Qualifications
Services are provided by qualified staff members who are licensed in accordance with Texas state law and applicable licensing boards, or as specified in the standards explained in this chapter.
Aquatic therapy services must be delivered by a licensed physical or occupational therapist, or licensed physical or occupational therapist assistant.
Art therapy services must be provided in accordance with state law by a licensed professional counselor art therapist (LPC-AT) or licensed clinical social worker - art therapist (LCSW-AT).
Behavior Management Plans
Behavior management plans must be developed by a board-certified behavior analyst (BCBA), licensed clinical social worker (LCSW), licensed professional counselor (LPC), licensed psychiatrist or licensed psychologist. The licensed professional responsible for developing the interventions must train staff members who implement behavior management interventions.
Chemical Dependency Services
Chemical dependency services must be provided by a licensed professional with experience delivering services to participants who have a brain or spinal cord injury or both, such as a licensed chemical dependency counselor (LCDC), licensed professional counselor (LPC), licensed clinical social worker (LCSW), licensed masters social worker (LMSW), licensed psychologist or licensed psychiatrist.
Cognitive Rehabilitation Therapy
Cognitive rehabilitation therapy services must be provided directly by or supervised in accordance with licensing requirements by a licensed occupational therapist, licensed speech and language pathologist, licensed psychologist or licensed psychiatrist.
Community Independence Supports (CIS)
Community independence supports must be provided by a certified brain injury specialist (CBIS) or a paraprofessional with at least one year of documented experience working with people with traumatic brain injury (TBI), traumatic spinal cord injury (TSCI) or both, but do not have a professional license themselves.
Dietary services must be provided by a professional who applies and integrates scientific principles of nutrition in social, cultural, psychological, and physical conditions and is licensed by the Texas State Board of Examiners of Dieticians.
Prior to transporting a participant, the provider must ensure that employees who transport them have the type of driver's license that is appropriate for the type of vehicle used (Class B or C). Prior to transporting a participant, a driver who transports CRS participants in motorized vehicles must prove that they have an acceptable driving record by providing an official document from the Texas Department of Public Safety showing that the driver has:
- a valid driver's license;
- no more than one at-fault accident within the past three years;
- no more than three moving violation convictions within the past three years; and
- vehicle liability insurance that meets or exceeds the minimum coverage required by state law.
Family therapy services must be provided by a licensed or certified professional, such as a psychologist, licensed marriage and family therapist (LMFT), licensed professional counselor (LPC), licensed master’s social worker (LMSW), or licensed clinical social worker (LCSW).
Massage therapy services must be provided by a licensed physical therapist (PT), licensed physical therapy assistant (PTA), licensed occupational therapist (OT), or licensed occupational therapy assistant (OTA), as specified in the guidelines of the Executive Council of Physical and Occupational Therapy Examiners.
Music therapy services must be provided by a person who is certified by the Certification Board for Music Therapists or listed with the National Music Therapy Registry and is a licensed professional, such as a licensed clinical social worker (LCSW), licensed masters social worker (LMSW), licensed professional counselor (LPC), or licensed marriage and family therapist (LMFT).
Neuropsychiatric services must be provided by a person who is licensed by the Texas Medical Board. This category of licensed professional includes neurologists, psychiatrists, and others who are permitted to provide neuropsychiatric services in their scope of professional practice, as designated by the appropriate licensing board.
Neuropsychological services must be provided by a person who is licensed by the Texas State Board of Examiners of Psychologists. This category of licensed professional includes psychologists whose professional experience, education, and background permit neuropsychological services in the scope of their professional practice, as designated by the appropriate licensing board.
Occupational therapy services must be provided by a person who is licensed by the Executive Council of Physical and Occupational Therapy Examiners. This category of licensed professional includes licensed occupational therapists and licensed occupational therapy assistants. The appropriate licensing board designates the practice of occupational therapy.
Paraprofessional services must be provided by a person who is qualified by their experience, training, or both, and has at least a high school diploma or its equivalent.
Physical therapy services must be provided by a person who is licensed by the Executive Council of Physical Therapy and Occupational Therapy Examiners. This category of licensed professional includes licensed physical therapists and licensed occupational therapy assistants. The appropriate licensing board designates the practice of physical therapy.
Recreational therapy services must be provided by a person who has a current certification from the National Council for Therapeutic Recreation Certification.
Speech-language pathology (speech therapy) services must be provided by a licensed speech language pathologist (SLP) or a licensed speech language pathologist assistant (SLPA), under the supervision of an SLP who is licensed by the State Board of Examiners for Speech-Language Pathology and Audiology.
4.7 Background Checks
A provider is directly responsible for obtaining and maintaining for agency review the criminal history records of any staff member or employee of a provider and sub-contractor or employee of a sub-contractor who provides services to participants under the terms of a contract.
The provider shall conduct criminal background checks and maintain this information for the agency no later than 30 days after execution of the contract for all employees and prior to any contact with participants for new employees. The provider is responsible for reporting to the agency all changes to an employee’s criminal history, in writing within three business days of the provider discovering the change in the criminal history.