Effective May 1, 2019

 

The following changes were made:

Chapter Title Change
Chapter 1 CRS Program Overview Updates CRS contact information.
Chapter 1 Section 2 Referrals to CRS Adds the referral form, process and contact information.
Chapter 3 Section 2 Language Services Adds Language Services Standard for providers.
Chapter 3 Section 4 Facility Safety Protocol
  • Updates when and where to report incidents to CRS.
  • Adds substance abuse, inappropriate behavior that may have participant dismissed from facility, and elopement.
Chapter 4 Section 5 Staff Training Adds Cardiopulmonary arrest (CPR), Basic Life Support (BLS) training and Fall Prevention.
Chapter 4 Section 6 Staff Qualifications Adds qualification of Community Independence Supports (CIS).
Chapter 5 Section 1 Overview Updates when and where to report incidents to CRS.
Chapter 5 Section 3 CRS Service Number Adds ombudsman’s number and CRS email because CRS does not have a direct phone line.
Chapter 5 Section 4 Grievance Procedure Updates ombudsman’s contact information.
Chapter 6 Section 4 Invoices
  • Updates to match updated TAC §20.487.
  • Adds CRS Program responsibility.
Chapter 6 Section 5 Use of Comparable Benefits or Third Party Billing Adds amount CRS pays if a participant is using their insurance's out of network provider.
Chapter 7 Section 2 Quality Reviews Adds services that are billed and paid based on services and contracted rate.
Chapter 8 Compliance and Quality Review for Traumatic Brain Injury Changes Utilization Review to Compliance and Quality Review.
Chapter 8 Section 2 Review Types
  • Notes changes to types of review names.
  • Adds purchasing review.
Chapter 8 Section 4 Prospective Reviews Changes title to Clinical Reviews and adds detail of what a clinical review covers.
Chapter 8 Section 5 Concurrent and/or Retrospective Reviews Changes title to Purchasing Reviews and adds detail of what a clinical review covers.
Chapter 9 Section 1 Overview
  • Adds changes and updates to provider’s admission policies and procedures including that they need to be reported to CRS when complete.
  • Moves referral information to Chapter 1, Section 2.
Chapter 9 Section 2 Intake Process Adds information that providers must have participants sign an intake acknowledgement form and must place the form in the participant’s file.
Chapter 10 Section 2 Assessment
  • Adds information about discharge planning utilizing the wraparound approach.
  • Adds mental health and substance misuse needs.
Chapter 10 Section 3 Development of Individualized Service Plan Adds this section.
Chapter 10 Section 4 Interdisciplinary Team Meetings
  • Adds the professional staff who are included in the IDT team and credentialing information needed.
  • Adds IDT team process including changing meetings to every 30 days, what needs reviewing for the participant and how to notify the IDT team.
Chapter 10 Section 5 Behavior Management Plans
  • Adds information about behavior management plans and what they address.
  • Adds information about who signs the informed conformed consent.
Chapter 10 Section 6 Emergency Restrictive Procedures Adds procedure for minors who receive chemical or physical restraints more than once within 30 days.
Chapter 11 Section 2 Required Documentation Adds that PM&R physician overseeing the participant’s care while in ICMRS is a separate service requiring pre-authorization.
Chapter 11 Section 3 Assessment, Planning and Interdisciplinary Meetings Adds Assessment, Planning and Interdisciplinary Meetings section.
Chapter 11 Section 4 Billing Guidelines Updates billing guidelines and when invoices must be submitted.
Chapter 12 Section 1 Overview Clarifies what outpatient therapy services refer to and where they are referenced.
Chapter 12 Section 3 Assessment, Planning and Interdisciplinary Meetings
  • Adds Assessment, Planning and Interdisciplinary Meetings section.
  • Notes that outpatient services differ from Post-acute rehabilitation services (PARS) non-residential services.
Chapter 12 Section 4 Billing Guidelines Updates billing guidelines and when invoices must be submitted.
Chapter 13 Section 1 Overview Adds link for updated rates.
Chapter 13 Section 2 Required Documentation Adds information for providers about required documentation.
Chapter 13 Section 3 Assessment and Planning
  • Changes title to Assessment, Planning and Interdisciplinary Meetings.
  • Moves part of this section to Chapter 10, Section 2.
Chapter 13 Section 6 Item 1 Licensure and Accreditation Changes Department of Aging and Disability Services to Texas Health and Human Services.
Chapter 13 Section 6 Item 7 Utilization Review Removes this section.
Chapter 13 Section 6 Item 7 Exceptions and Limitations Updates therapeutic passes.
Chapter 13 Section 7 Non-Residential Adds post-acute rehabilitation non-residential services to also include case management, community independence supports, medical team conferences.
Chapter 13 Section 7 Item 1 Licensure and Accreditation Changes Department of Aging and Disability Services to Texas Health and Human Services.
Chapter 13 Section 7 Item 3 Billing Guidelines Adds uploading into CRS Data Reporting System.
Chapter 14 Section 1 Overview Adds information about meeting treatment goals.
Chapter 14 Section 2 Durable Medical Equipment Adds this section.
Chapter 14 Section 3 Home Modification Adds this section.
Chapter 14 Section 4 Required Documentation Adds requirements for receiving durable medical equipment.
Chapter 14 Section 5 Billing Guidelines Updates billing guideline requirements for providers for ancillary goods and services and DME.
Chapter 14 Section 6 Exceptions and Limitations Updates this section with what is covered under the CRS program as well as when competitive bids are required.
Chapter 15 Section 1 Overview Adds information about discharge planning.
Chapter 15 Section 3 Termination from Program Adds information about providers documenting attempted interventions.
Appendix A Definitions Adds the following terms:
  • Abuse
  • Ancillary services
  • Assistive Technology
  • Authorized representative
  • Certified Brain Injury Specialist (CBIS)
  • Community Independence Supports (CIS)
  • Comparable benefits
  • Competitive bid
  • Compliance
  • Glasgow Coma Scale (GCS)
  • Texas Identification Number (TIN)
Edits the following terms:
  • Mental restoration services to mental health counseling
  • Paraprofessional
Removes the following:
  • Utilization Review
Appendix B Post-Acute Rehabilitation Core Services Modality and Staff Qualifications
  • Changes code numbering.
  • Changes Mental Restoration to Mental Health Counseling.
  • Changes Modality and Staff Qualifications for PARS Non-Residential.
Appendix C Base Services and Tier Structure Changes title to PARS Residential Base Services and Tier Structure
Appendix D Service Record for CRS Data Reporting System Adds clarification text.