1. (a) A PPECC must obtain and maintain the following documentation in a participant's medical record to be eligible for reimbursement for non-transportation PPECC services provided to the participant:

   1. (1) a physician's specific, written, signed, and dated orders prescribing PPECC services;

   2. (2) an approved prior authorization from HHSC that includes:

      1. (A) a Comprehensive Care Program (CCP) Prior Authorization Request Form;
      2. (B) a PPECC Plan of Care (POC);
      3. (C) a PPECC nursing assessment;
      4. (D) a Nursing Addendum to POC for Private Duty Nursing (PDN) and/or PPECC;
      5. (E) consent for PPECC services as described in the Texas Medicaid Provider Procedures Manual; and
      6. (F) documentation of medical necessity;
   3. (3) the daily attendance log required by subsection (b) of this section; and
   4. (4) the documentation required by subsection (c) of this section.

2. (b) A PPECC must maintain a daily attendance log that includes:

   1. (1) the date of attendance;
   2. (2) the name of the participant;

   3. (3) the signature of the responsible adult and the time when the PPECC assumes responsibility for the care of the participant which is:

      1. (A) the time the participant boards the PPECC transport vehicle; or
      2. (B) the time the participant is brought to the PPECC by a responsible adult;

   4. (4) the signature of the responsible adult and time when the responsible adult assumes responsibility for the care of the participant which is:

      1. (A) the time the participant is taken off the transport vehicle at the participant's return destination; or
      2. (B) the time the participant is picked up from the PPECC by a responsible adult; and
   5. (5) the name of the PPECC staff member riding in the transport vehicle when PPECC transportation services are utilized and whether the staff member is a registered nurse, licensed vocational nurse, or direct care staff.

3. (c) A PPECC must maintain the following documentation:

   1. (1) notes from interdisciplinary team meetings;
   2. (2) discrepancies between the weekly service hours scheduled and the service hours provided;
   3. (3) the names of the staff member providing services;
   4. (4) the date of service;
   5. (5) the type of service performed; and
   6. (6) the start and end times of the service performed.
4. (d) HHSC may request that a PPECC provide documentation to substantiate the provision of services in addition to that required by subsections (a) - (c) of this section.
5. (e) HHSC may recoup payment for services not substantiated by the documentation required in this section.

Source Note:The provisions of this §363.212 adopted to be effective February 19, 2025, 50 TexReg 831.