(a) Individualized skills and socialization is an HCS Program service described in this section.
(b) On-site and off-site individualized skills and socialization:
(1) provide person-centered activities related to:
(2) supports the individual's pursuit and achievement of employment through school, vocational rehabilitation, the HCS Program service of employment assistance, or the HCS Program service of supported employment;
(3) provides personal assistance for an individual who cannot manage personal care needs during an individualized skills and socialization activity;
(4) as determined by an assessment conducted by a registered nurse, provides assistance with medications and the performance of tasks delegated by a registered nurse in accordance with state law and rules, unless a physician has delegated the task as a medical act under Texas Occupations Code Chapter 157, as documented by the physician; and
(5) does not include activities in which an individual:
(c) On-site individualized skills and socialization:
(1) is provided in a building or a portion of a building that is owned or leased by an individualized skills and socialization provider;
(2) includes transportation of an individual from one on-site individualized skills and socialization location to another on-site individualized skills and socialization location;
(3) promotes an individual's development of skills and behavior that support independence and personal choice; and
(4) is not provided in:
(d) An individualized skills and socialization provider must ensure that individualized skills and socialization is not provided in a setting that is presumed to have the qualities of an institution. A setting is presumed to have the qualities of an institution if the setting:
(1) is located in a building in which a state supported living center or a certified intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID) operated by a local intellectual and developmental disability authority (LIDDA) is located but is distinct from the state supported living center or the certified ICF/IID operated by a LIDDA;
(2) is located in a building that is on the grounds of or immediately adjacent to a state supported living center or a certified ICF/IID operated by a LIDDA;
(3) is located in a building in which a licensed private ICF/IID, a hospital, a nursing facility, or other institution is located but is distinct from the ICF/IID, hospital, nursing facility, or other institution;
(4) is located in a building that is on the grounds of or immediately adjacent to a hospital, a nursing facility, or other institution except for a licensed private ICF/IID; or
(5) has the effect of isolating individuals from the broader community of persons not receiving Medicaid HCBS.
(e) An individualized skills and socialization provider may provide individualized skills and socialization to an individual in a setting that is presumed to have the qualities of an institution as described in subsection (d) of this section, if CMS determines through a heightened scrutiny review that the setting:
(1) does not have the qualities of an institution; and
(2) does have the qualities of home and community-based settings.
(f) The setting in which on-site individualized skills and socialization is provided must:
(1) allow an individual to:
(2) be physically accessible and free of hazards to an individual.
(g) If an individualized skills and socialization provider becomes aware that a modification to a requirement described in subsection (f)(1) of this section is needed based on a specific assessed need of an individual, the individualized skills and socialization provider must inform the individual's program provider of the needed modification.
(1) The program provider must:
(2) A service coordinator must, if notified by the program provider of a needed modification, convene a service planning team meeting to update the individual's PDP to include the following:
(3) After the service planning team updates the PDP as required by paragraph (2) of this subsection, the individualized skills and socialization provider may implement the modifications.
(h) Off-site individualized skills and socialization:
(1) provides activities that:
(2) is provided in a community setting chosen by the individual from among available community setting options;
(3) includes transportation of an individual from an on-site individualized skills and socialization location to an off-site individualized skills and socialization location and between off-site individualized skills and socialization locations; and
(4) is not provided in:
Source Note: The provisions of this §263.2005 adopted to be effective January 1, 2023, 47 TexReg 8698