Texas Skilled Nursing Services Policy Manual

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The Texas Skilled Nursing Services Policy Manual provides a comprehensive framework for delivering skilled nursing services to individuals in Texas, including those with acute or chronic medical conditions, disabilities, or post-surgical needs. This manual aligns with federal and state regulations, including the Texas Administrative Code (§97), Medicaid and Medicare Conditions of Participation (42 CFR Part 484), and policies established by the Texas Health and Human Services Commission (HHSC). It ensures compliance with legal mandates to provide high-quality, medically necessary nursing care that promotes health, recovery, and independence in home or community settings.
The manual outlines policies and procedures for assessing client needs, developing individualized care plans, delivering skilled nursing services, and maintaining compliance with state licensure and certification requirements. It emphasizes evidence-based practices, patient safety, and quality assurance to ensure effective service delivery.
Key areas covered in the manual include:
Eligibility and Enrollment: Guidelines for determining eligibility for skilled nursing services under Medicaid waiver programs such as STAR+PLUS or private insurance plans. Eligibility criteria include medical necessity for skilled interventions such as wound care, IV therapy, medication administration, or monitoring of complex medical conditions.
Service Delivery Standards: Policies for providing skilled nursing services such as wound care management, catheter care, tracheostomy care, enteral feeding support, medication administration, chronic disease management, and patient education on health maintenance.
Plan of Care Development: Procedures for conducting comprehensive assessments by registered nurses (RNs) to develop individualized plans of care (POCs). 
Provider Requirements: Standards for skilled nursing providers, including licensure under applicable Texas Administrative Code provisions, compliance with Medicaid billing requirements, and training in infection control, emergency preparedness, and patient rights.
Client Rights: Provisions to protect client rights, including informed consent for services, confidentiality of medical records, freedom from abuse or neglect, and access to grievance procedures. 
Safety Standards: Policies to ensure safe delivery of skilled nursing services through proper use of medical equipment, adherence to infection control protocols (e.g., hand hygiene), and emergency preparedness training for staff.
Documentation and Compliance: Requirements for maintaining accurate records of assessments, progress notes, incident reports, medication logs, and prior authorization requests for Medicaid-covered skilled nursing services.
Quality Assurance: Policies for monitoring service effectiveness through performance reviews, client satisfaction surveys, audits by HHSC or accrediting bodies, and corrective action plans to address deficiencies. Providers must also participate in quality improvement initiatives to enhance patient outcomes.
The Texas Skilled Nursing Services Policy Manual serves as an essential resource for agencies and providers to deliver high-quality skilled nursing care while adhering to state regulations. It supports improved client outcomes by fostering recovery, enhancing health management skills, ensuring continuity of care across settings, and maintaining compliance with regulatory standards.