HCS Program Nursing through the CDS Option

Attachment C
Home and Community-based Services Program
Nursing through the Consumer Directed Services Option
Frequently Asked Questions for Consumer Directed Services Employers
Q. Who may receive nursing through the Consumer Directed Services (CDS) option?
A. Individuals who do not receive supervised living, residential support, or foster/companion
care may choose to receive nursing through the CDS option except as provided below.
An individual may not receive CDS nursing for a provider delivered service if a
provider’s unlicensed staff person needs to perform a nursing task during that service
An individual must have a medical need requiring nursing to have CDS nursing included
on the individual plan of care (IPC).
Q. Does a nursing task performed by an unlicensed CDS employee always have to be
delegated by an RN?
A. Not always. Texas Government Code, Section 531.051(e) allows an unlicensed CDS
employee to perform a nursing task, without Registered Nurse (RN) delegation, if:
1) the employee:
a) has not been denied a license under Texas Occupations Code, Chapter 301;
b) has not been issued a license under Texas Occupations Code, Chapter 301, that
is revoked or suspended;
2) the nursing task being performed is not expressly prohibited from delegation under
Board of Nursing(BON) rule at Texas Administrative Code (TAC), Title 22, Section
225.12 (relating to Tasks Prohibited by Delegation); and
3) the employer is capable of training the employee in the proper performance of the
task;
4) the employer directs the employee in performing the nursing task; and
5) if the employer is the LAR, the employer:
a) is present when the nursing task is performed or immediately accessible to the
employee performing the task; and
b) if not present when the nursing task is performed, has previously observed the
employee performing the task and has determined that the employee can
competently perform the task when the employer is not present.
.
For more information, ask your FMSA or see DADS Form 1733.
Q. Who do I talk to about including CDS nursing on my IPC?
A. You or your legally authorized representative (LAR) may talk with your service
coordinator about including CDS nursing on your IPC.
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Attachment C
Home and Community-based Services Program
Nursing through the Consumer Directed Services Option
Frequently Asked Questions for Consumer Directed Services Employers
Q. If I use CDS nursing and am receiving another service from an HCS program provider,
do I also need a provider nursing assessment?
A. It depends. If the individual receives an HCS program services from a program provider
in which nursing tasks may be performed by an unlicensed service provider, the program
provider nurse must perform a nursing assessment of the individual and make delegation
decisions. For example, if you receive provider-delivered day habilitation and need
medication while at day habilitation, the provider nurse must conduct an assessment to
determine the nursing tasks to be delivered (administration of medication) and delegate or
supervise the performance of that task by a day habilitation service provider.
Q. What are the CDS employer’s responsibilities?
A. The CDS employer will:
• Provide the necessary documentation or information to the FMSA to verify that the
CDS nurse applicant is qualified to be hired as required by 40 TAC, Section
41.227(relating to Required Registry Checks);
• At the time the CDS nurse is hired, provide to the nurse, as a suggested resource
“Home and Community-based Services Consumer Directed Service Option Nursing
Toolkit”;
• If the CDS employer chooses to use the exemption from RN delegation, complete
DADS Form 1733, as required by 40 TAC, Section 41.207 (relating to Initial
Orientation of an Employer);
• Obtain a completed DADS Form 1747, Acknowledgment of Nursing Requirements,
from the CDS nurse (RN or LVN) before any nursing services are delivered;
• Send a copy of the completed nursing assessment and plan of care completed by the
CDS nurse to the service coordinator; and
• Request the service coordinator or HCS provider to, if applicable, add nursing hours
to the IPC based on the CDS nursing assessment.
Q. What can I expect from my service coordinator?
A. If you do not receive supervised living, residential support, or foster/companion care and
the individual needs nursing, your service coordinator will:
• discuss the CDS option with you;
• if you or your LAR chooses to receive nursing through the CDS option, ensure the
proposed IPC includes a sufficient number of RN nursing units through the CDS
option to perform an initial nursing assessment; and
• following completion of the assessment, include nursing hours on your IPC based on
the CDS nursing assessment;
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Attachment C
Home and Community-based Services Program
Nursing through the Consumer Directed Services Option
Frequently Asked Questions for Consumer Directed Services Employers
Q. What can I expect from my FMSA when I use CDS nursing?
A. Your FMSA will:
• provide the “Home and Community-based Services Consumer Directed Service
Option Nursing Toolkit” as a suggested resource to the CDS employer and designated
representative if CDS nursing is included on the individual’s IPC;
• review with and explain to the CDS employer and designated representative, DADS
Form 1733, Employer and Employee Acknowledgement of Exemption from Nursing
Licensure for Certain Services Delivered through Consumer Directed Services, at the
initial Orientation in accordance with 40 TAC, Section 41.307 (relating to Initial
Orientation of an Employer) - future rule amendment;
• review with the CDS employer and designated representative DADS Form 1747
Acknowledgment of Nursing Requirements in accordance with 40 TAC §41.307
(relating to Initial Orientation of an Employer);
• verify that the CDS nurse applicant is qualified to be hired in accordance with 40
TAC, Section 41.327 (relating to Verification of Applicants for Employees,
Contractors, and Vendors); and
• conduct other registry checks as required by 40 TAC, Section 41. 325 (relating to
Required Registry Checks of an Applicant to Become an Employee).
Q. If I have both provider-delivered and CDS-delivered nursing, which nurse is responsible
for what activities?
A. If you use a combination of provider-delivered and CDS-delivered services, your CDS
nurse will not be responsible for any nursing services delivered by your provider and the
provider nurse will not have any responsibility for any nursing services delivered through
the CDS option.
Q. What is the difference between nursing and specialized nursing?
A. Specialized Nursing is available ONLY if the individual:
• has a tracheostomy, or;
• is dependent on a ventilator.
Q. What are the rates for nursing in the CDS option?
A. Rates are set by the Health and Human Services Commission and be found at:
https://www.hhsc.state.tx.us/Rad/long-term-svcs/downloads/2014-hcs-rates.pdf
Scroll to the BOTTOM of the website page to find the CDS rates.
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Attachment C
Home and Community-based Services Program
Nursing through the Consumer Directed Services Option
Frequently Asked Questions for Consumer Directed Services Employers
The hourly rate the CDS employer will pay the CDS nurse will be lower than the rate
established by HHSC to account for employer taxes and any employer supports the
employer designates.
Q. What can I expect the CDS Registered Nurse (RN) to do?
A: An RN:
• conducts an comprehensive assessment of the individual's health status,
• develops a nursing plan of care based on the assessment;
• provides training on how to perform nursing tasks to unlicensed staff, the individual
or family members, if required;
• performs nursing services;
• supervises an LVN to deliver nursing services;
• may participate in a service planning team meeting; and
• may participate in the development of an IPC.
Q. May I hire a licensed vocational nurse (LVN) instead of an RN?
A. No. If you hire an LVN, you must also hire an RN that supervises the LVN.
Q. Where can I find information about the nursing scope of practice?
A. Information regarding scope of practice for RNs and LVNs may be found at:
http://www.dads.state.tx.us/qualitymatters/qcp/nursedelegation/scopeofpractice.pdf
Q. What is a nursing assessment?
A. An assessment is conducted by an RN. An assessment typically includes the following:
• current status review including a review of medications, any recent changes in
medical condition, and vital signs;
• systems assessment including a head-to-toe assessment;
• additional health information such as immunizations, nutrition, sleep, and
behavior/communication;
• implementation assessment which includes a discussion of the degree to which the
Individual or CRA/LAR will assume responsibility for the provision of nursing tasks
(include medication delegation) and whether the RN will delegate to the CDS
unlicensed provider; and
• nursing plan of care which lists the nursing services to be delivered by a nurse.
See “Home and Community-based Services Consumer Directed Service Option Nursing
Toolkit” for a sample CDS nursing assessment.
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Attachment C
Home and Community-based Services Program
Nursing through the Consumer Directed Services Option
Frequently Asked Questions for Consumer Directed Services Employers
Q. How do I find a nurse?
A. There are multiple ways to look for a nurse. Here are some ideas:
• ask an RN or LVN you may know;
• ask friends or family members for references of nurses they might know;
• check with your doctor’s office, local hospitals, Texas Workforce Commission; or
• advertise in the local newspaper or local hospitals.
Q. How do I know the nurse I want to hire is qualified to provide nursing in the HCS
program?
A. When you interview an applicant nurse, let the applicant know that you or your FMSA
will verify with the BON that his or her license is valid. Send the name of the applicant
nurse to your FMSA and the FMSA will verify that the license is valid. Your FMSA will
obtain a criminal history report and also check the Office of Inspector General Medicaid
Fraud, Employee Misconduct Registry, and Nurse Aide Registry. You must not offer
employment to the nurse until your FMSA has informed you that the nurse may be hired.
Q. How do I talk about scope of practice with the nurses I hire?
A. Before you hire a nurse, review Form 1747 – Acknowledgement of Nursing Requirements
with the nurse.
Form 1747 lists the Board of Nursing (BON) rules that the nurse is required to follow and
lists the nurse’s responsibilities for the HCS program.
The CDS employer is not expected to understand all the BON rules. Nurses are required
by licensure to follow the BON rules.
When you hire the nurse, the nurse must sign Form 1747 acknowledging that he or she
understands and will follow the BON rules.
Q. What can an RN bill for in the HCS program?
A. See the HCS Program Billing Guidelines at:
http://www.dads.state.tx.us/handbooks/hcsbg/4000/4000.htm#sec4400
Q. What can an LVN bill for in the HCS program?
A. See the HCS Program Billing Guidelines at:
http://www.dads.state.tx.us/handbooks/hcsbg/4000/4000.htm#sec4471
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Attachment C
Home and Community-based Services Program
Nursing through the Consumer Directed Services Option
Frequently Asked Questions for Consumer Directed Services Employers
Q. What if I need to file a complaint about the nurse I hired?
A. If you believe that a nurse has not met the minimum standard of care or has violated laws
or rules, you may report the nurse to the Texas Board of Nursing Information about how
to file a complaint is available on the Board’s website, www.bon.texas.gov under
Disciplinary Action, then How to File a Complaint.
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