Aging and Disability Services Council Sharon Swift Butterworth ...

(b) The DADS case manager grants an exception to a limit if, after a review of the
information received as described in subsection (a) of this section, the DADS case manager
determines that providing the service in excess of the limit is necessary for the ISP to meet the
criteria described in §48.6006(d)(1)-(5) of this subchapter.
(c) An exception granted under subsection (b) of this section is subject to:
(1) for adaptive aids and medical supplies, minor home modifications, and respite during
an ISP year, the maximum service ceilings described in §48.6003(b)(8)(A)-(C) of this
subchapter;
(2) for dental services during and ISP year, a maximum combined cost of $5,000 for
general dentistry and the services of an oral and maxillofacial surgeon and an additional
maximum cost of $5,000 for the services of an oral and maxillofacial surgeon; and
(3) the ISP cost as described in §48.6003(b)(6) of this subchapter (relating to Eligibility
Criteria). [end addition]
§48.6090. Fiscal Monitoring and Recoupment.
(a) Administrative errors. A recoupment of 12% of the paid unit rate is the administrative
error exception for services billed on an hourly basis. It represents the administrative portion of
the rate. Administrative errors are applied to the documentation reviewed and are not
extrapolated. Administrative errors include, but are not limited to [begin deletion] the items in
paragraphs (1)-(2) of this subsection [end deletion]:
(1) [begin deletion] administrative errors on the documentation of services delivered form
or the facsimile: [end deletion]
[begin deletion] (A) [end deletion] The [begin addition] CBA [end addition] provider
[agency] leaves the month and year of service blank. [begin addition] DADS [end addition]
[begin deletion] The Texas Department of Human Services (DHS) [end deletion] applies the
error to the total number of units documented on the time sheet.
[begin addition] (2) [end addition] [begin deletion] (B) [end deletion] The timekeeper fails to
enter a date of signature to certify the total number of hours the attendant, [begin addition] LVN,
RN [end addition] [begin deletion] nurse [end deletion], or therapist worked. [begin addition]
DADS [end addition] [DHS] applies the error to the total number of units documented on the
time sheet.
[begin addition] (3) [end addition] [begin deletion] (C) [end deletion] The timekeeper corrects
the date of signature, but fails to initial the correction. DHS applies the error to the number of
units reimbursed after the earliest signature date.
[begin addition] (4) [end addition] [begin deletion] (D) [end deletion] The timekeeper enters
an illegible date of signature or makes an illegible correction to the date. [begin addition] DADS
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