Home and Community-Based Health Services
Service Standard
Home and Community-Based Health Services Standards print version
Subcategories | Service Units |
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Professional | Per visit |
Durable Medical Conditions | Per unit |
Health Resources and Services Administration (HRSA) Description:
Home and Community-Based Health Services (HCBHS) are provided to an eligible client in an integrated setting appropriate to a client’s needs, based on a written plan of care established by a medical care team under the direction of a licensed clinical provider. Services include:
- Appropriate mental health, developmental, and rehabilitation services
- Day treatment or other partial hospitalization services
- Durable medical equipment
- Home health aide services and personal care services
- Skilled nursing medication administration including intravenous and aerosolized therapy
- Routine lab specimen collection and testing services
Program Guidance:
Inpatient hospitals, nursing homes, and other long-term care facilities are not considered integrated settings to provide Home and Community-Based Health Services.
Limitations:
Services cannot be provided in the following facilities: inpatient hospital facilities, nursing homes, and other long term care facilities.
Services:
Home and Community-Based Health Services are therapeutic, nursing, supportive, and/or health services provided by a licensed/certified home health agency in a licensed/certified home or community-based setting (e.g., adult daycare center) in accordance with a written, individualized plan of care established by a licensed physician.
Home and Community-Based Health Services include the following:
- Para–professional care: services by a home health aide, personal caretaker, or attendant. This also includes assistance with cooking and cleaning activities to help clients remain in their homes.
- Professional care: services in the home by licensed providers for mental health, development health care, and/or rehabilitation services.
Home and Community-Based Health Providers work closely with the multidisciplinary care team that includes the client's case manager, primary care provider, and other healthcare professionals as appropriate.
Universal Standards:
Services providers for Home and Community-Based Health Services must follow HRSA/DSHS Universal Standards 1-46 and 80-85.
Service Standard and Measures:
The following standards and measures are guides to improving healthcare outcomes for people living with HIV throughout the State of Texas within the Ryan White Part B and State Services Program.
Standard | Measure |
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Initial Orders and Assessment: The client will be contacted within 1 business day of agency receipt of referral with orders from a licensed medical provider. Services must be initiated per orders specified by the referring licensed medical care provider or within 2 business days of receipt of the referral with orders, whichever is earlier. Initiation of service must consist of a comprehensive assessment of the status of the client’s physical, psychosocial, and home safety. Components of assessments:
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Implementation of Care Plan: A care plan will be completed based on the primary medical care provider’s order and will include:
The care plan is updated at least every 60 calendar days. |
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Coordination of Services and Referrals: If referrals are deemed necessary the agency will:
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Transfer/Discharge: A transfer or discharge plan must be developed for any of the following circumstances:
All services transferred must be accompanied by a referral to an appropriate service provider. Note: Staff should not inactivate clients in Take Charge Texas (TCT) at the time of discharge, unless the case is being closed due to a deceased client. |
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References
Division of Metropolitan HIV/AIDS Programs, HIV/AIDS Bureau (HAB). Ryan White HIV/AIDS Program (RWHAP) National Monitoring Standards for RWHAP Part A Recipients. Health Resources and Services Administration, June 2022.
Division of State HIV/AIDS Programs, HIV/AIDS Bureau (HAB). Ryan White HIV/AIDS Program (RWHAP) National Monitoring Standards for RWHAP Part B Recipients. Health Resources and Services Administration, June 2022.
Ryan White HIV/AIDS Program. Policy Notice 16-02: Eligible Individuals & Allowable Uses of Funds. Health Resources and Services Administration, October 2022.
Centers for Medicare and Medicaid Services (CMS), Home and Community-Based Services. Home- and Community-Based Services | CMS. Centers for Medicare & Medicaid, January 2023.