Texas Health and Human Services



To implement Texas Government Code, Section 531.0601, Long-term Care Services Waiver Program Interest Lists, the Health and Human Services Commission (HHSC) will propose amendments in:Texas Administrative Code (TAC), Title 40, Chapter 9, Subchapter D, Home and Community-based Services (HCS) Program and Community First Choice (CFC), §§9.157 and 9.158, and Subchapter N, Texas Home Living (TxHmL) Program and Community First Choice (CFC), §§9.566 and 9.567;40 TAC Chapter 42, Deaf Blind with Multiple Disabilities (DBMD) Program and Community First Choice (CFC) Services, §§42.202, 42.211 and 42.402;40 TAC Chapter 45, Community Living Assistance and Support Services and Community First Choice (CFC) Services, §§45.202 and 45.211; and1 TAC Chapter 353, §353.1155 Medically Dependent Children Program.This draft includes those amendments.TITLE 40SOCIAL SERVICES AND ASSISTANCEPART 1DEPARTMENT OF AGING AND DISABILITY SERVICESCHAPTER 9INTELLECTUAL DISABILITY SERVICES--MEDICAIDSTATE OPERATING AGENCY RESPONSIBILITIESSUBCHAPTER D HOME AND COMMUNITY-BASED SERVICES (HCS)PROGRAM AND COMMUNITY FIRST CHOICE (CFC)§9.157. HCS Interest List.(a) A LIDDA must maintain an up-to-date interest list of applicants interested in receiving HCS Program services for whom the LIDDA is the applicant's designated LIDDA in the HHSC DADS data system. (b) A person may request that an applicant's name be added to the HCS interest list by contacting the LIDDA serving the Texas county in which the applicant or person resides. (c) If a request is made in accordance with subsection (b) of this section, a LIDDA must add an applicant's name to the HCS interest list: (1) if the applicant resides in Texas; and (2) using with an interest list request date of the date the LIDDA receives the request as the HCS interest list date is received. (d) For an applicant under 22 years of age who is residing in an ICF/IID or nursing facility located in Texas, HHSC adds the applicant's name to the HCS interest list using the date of admission to the ICF/IID or nursing facility as the HCS interest list date. (e) For an applicant determined diagnostically or functionally ineligible during the enrollment process for the Community Living Assistance and Support Services (CLASS) Program, Deaf-Blind with Multiple Disabilities (DBMD) Program, or Medically Dependent Children Program (MDCP):(1) if the applicant’s name is not on the HCS interest list, at the request of the applicant or LAR, HHSC adds the applicant’s name to the HCS interest list using the applicant’s interest list date for the program for which the applicant was determined ineligible as the HCS interest list date;(2) if the applicant’s name is on the HCS interest list and the applicant’s interest list date for the program for which the applicant was determined ineligible is earlier than the applicant’s HCS interest list date, at the request of the applicant or LAR, HHSC changes the applicant’s HCS interest list date to the applicant’s interest list date for the program for which the applicant was determined ineligible; or(3) if the applicant’s name is on the HCS interest list and the applicant’s HCS interest list date is earlier than the applicant’s interest list date for the program for which the applicant was determined ineligible, HHSC does not change the applicant’s HCS interest list date. (d) DADS adds an applicant's name to the HCS interest list with a request date as follows: (1) for an applicant under 22 years of age and residing in an ICF/IID or nursing facility located in Texas, based on the date of admission to the ICF/IID or nursing facility; or (2) for an applicant determined diagnostically or functionally ineligible for another DADS waiver program, one of the following dates, whichever is earlier: (A) the request date of the interest list for the other waiver program; or (B) an existing request date for the HCS Program for the applicant. (f) This subsection applies to an applicant who was enrolled in MDCP and, because the applicant did not meet the level of care criteria for medical necessity for nursing facility care or did not meet the age requirement of being under 21 years of age, was determined ineligible for MDCP after November 30, 2019 and before the date Texas Government Code §531.0601 expires.(1) At the request of the applicant or LAR, HHSC adds the applicant’s name to the HCS interest list:(A) using the MDCP interest list date as the HCS interest list date, if the applicant’s name is not on the HCS interest list but it was previously on the HCS interest list; or(B) using the date HHSC receives the request as the HCS interest list date, if the applicant’s name is not on the HCS interest list and it never has been on the HCS interest list. (2) At the request of the applicant or LAR, HHSC changes the HCS interest list date to the MDCP interest list date if the applicant’s MDCP interest list date is earlier than the applicant’s HCS interest list date.(g) (e) HHSC DADS or the LIDDA removes an applicant's name from the HCS interest list if: (1) the applicant or LAR requests in writing that the applicant's name be removed from the HCS interest list, unless the applicant is under 22 years of age and residing in an ICF/IID or nursing facility; (2) the applicant moves out of Texas, unless the applicant is a military family member living outside of Texas: (A) while the military member is on active duty; or (B) for less than one year after the former military member's active duty ends; (3) the applicant declines the offer of HCS Program services or, as described in §9.158(f) of this subchapter (relating to Process for Enrollment of Applicants), an offer of HCS Program services is withdrawn, unless: (A) the applicant is a military family member living outside of Texas: (i) while the military member is on active duty, or (ii) for less than one year after the former military member's active duty ends; or (B) the applicant is under 22 years of age and residing in an ICF/IID or nursing facility; (4) the applicant is a military family member living outside of Texas for more than one year after the former military member's active duty ends; (5) the applicant is deceased; or (6) HHSC DADS has denied the applicant enrollment in the HCS Program and the applicant or LAR has had an opportunity to exercise the applicant's right to appeal the decision in accordance with §9.169 of this subchapter (relating to Fair Hearing) and did not appeal the decision, or appealed and did not prevail. (h) (f) If HHSC DADS or the LIDDA removes an applicant's name from the HCS interest list in accordance with subsection (g)(1) - (4) (e)(1) - (4) of this section and, within 90 calendar days after the name was removed, the LIDDA receives an oral or written request from a person to add reinstate the applicant's name to on the HCS interest list: (1) the LIDDA must notify HHSC DADS of the request; and (2) HHSC DADS: (A) adds reinstates the applicant's name to the HCS interest list using based on the HCS interest list original request date that was in effect at the time the applicant’s name was removed from the HCS interest list described in subsection (c) or (d) of this section; and (B) notifies the applicant or LAR in writing that the applicant's name has been added reinstated to the HCS interest list in accordance with subparagraph (A) of this paragraph. (i) (g) If HHSC DADS or the LIDDA removes an applicant's name from the HCS interest list in accordance with subsection (g)(1) - (4) (e)(1) - (4) of this section and, more than 90 calendar days after the name was removed, the LIDDA receives an oral or written request from a person to add reinstate the applicant's name to on the HCS interest list: (1) the applicant's name is added to placed on the HCS interest list: (A) by the LIDDA using based on the date the LIDDA receives the oral or written request as the HCS interest list date, unless subparagraph (B) of this paragraph applies; or (B) by HHSC using DADS based on the HCS interest list original request date that was in effect at the time the applicant’s name was removed from the HCS interest list as the HCS interest list date described in subsection (c) or (d) of this section because of extenuating circumstances as determined by HHSC DADS; and (2) HHSC DADS notifies the applicant or LAR in writing that the applicant's name has been added to the HCS interest list in accordance with paragraph (1) of this subsection. (j) (h) If HHSC DADS or the LIDDA removes an applicant's name from the HCS interest list in accordance with subsection (g)(6) (e)(6) of this section and the LIDDA subsequently receives an oral or written request from a person to add reinstate the applicant's name to on the HCS interest list: (1) the LIDDA must add the applicant's name to the HCS interest list using based on the date the LIDDA receives the oral or written request as the HCS interest list date; and (2) HHSC DADS notifies the applicant or LAR in writing that the applicant's name has been added to the HCS interest list in accordance with paragraph (1) of this subsection. §9.158. Process for Enrollment of Applicants.(a) HHSC DADS notifies a LIDDA, in writing, when the opportunity for enrollment in the of the availability of HCS Program becomes available services in the LIDDA's local service area and directs the LIDDA to offer enrollment HCS Program services to an applicant: (1) whose interest list request date, assigned in accordance with §9.157 §9.157(c)(2) and (d) of this subchapter (relating to HCS Interest List), is earliest on the statewide interest list for the HCS Program as maintained by HHSC DADS; or (2) who is a member of a target group identified in the approved HCS waiver application. (b) Except as provided in subsection (c) of this section, a the LIDDA must offer enrollment in the make the offer of HCS Program services in writing and deliver it to the applicant or LAR by regular United States mail or by hand delivery. (c) A The LIDDA must offer enrollment in the make the offer of HCS Program services to an applicant described in subsection (a)(2) of this section in accordance with HHSC’s DADS procedures. (d) A The LIDDA must include in a written offer that is made in accordance with subsection (a)(1) of this section: (1) a statement that: (A) if the applicant or LAR does not respond to the offer of enrollment in the HCS Program services within 30 calendar days after the LIDDA's written offer, the LIDDA withdraws the offer; and (B) if the applicant is currently receiving services from the LIDDA that are funded by general revenue and the applicant or LAR declines the offer of enrollment in the HCS Program services, the LIDDA terminates those services that are similar to services provided in under the HCS Program; and (2) information regarding the time frame requirements described in subsection (f) of this section using the HHSC Deadline Notification form, which is available on the HHSC website found at dads.state.tx.us. (e) If an applicant or LAR responds to an offer of enrollment in the HCS Program services, a the LIDDA must: (1) provide the applicant, LAR, and, if the LAR is not a family member, at least one family member (if possible) both an oral and written explanation of the services and supports for which the applicant may be eligible, including the ICF/IID Program (both state supported living centers and community-based facilities), waiver programs authorized under §1915(c) of the Social Security Act, and other community-based services and supports, using the HHSC . The LIDDA must use the Explanation of Services and Supports document, which is available on the HHSC website found at dads.state.tx.us; (2) using an HHSC a DADS form, provide the applicant and LAR both an oral and a written explanation of all HCS Program services and CFC services; and (3) give the applicant or LAR the HHSC Waiver Program Verification of Freedom of Choice form, which is available on the HHSC website Form, Waiver Program which is found at dads.state.tx.us, to document the applicant's choice between regarding the HCS Program or the and ICF/IID Program. (f) A The LIDDA must withdraw an offer of enrollment in the HCS Program services made to an applicant or LAR if: (1) within 30 calendar days after the LIDDA's offer made to the applicant or LAR in accordance with subsection (a)(1) of this section, the applicant or LAR does not respond to the offer of enrollment in the HCS Program services; (2) within seven calendar days after the applicant or LAR receives the HHSC Waiver Program Verification of Freedom of Choice , Waiver Program form from the LIDDA , in accordance with subsection (e)(3) of this section, the applicant or LAR does not use the form to document the applicant’s choice of the HCS Program services over the ICF/IID Program using the Verification of Freedom of Choice, Waiver Program form; (3) within 30 calendar days after the applicant or LAR receives the contact information for all program providers in the LIDDA's local service area in accordance with subsection (j)(3) of this section, the applicant or LAR does not document the choice of a program provider using the HHSC Documentation of Provider Choice form, which is available on the HHSC website; or (4) the applicant or LAR does not complete the necessary activities to finalize the enrollment process and HHSC DADS has approved the withdrawal of the offer. (g) If a the LIDDA withdraws an offer of enrollment in the HCS Program services made to an applicant, the LIDDA must notify the applicant or LAR of such action, in writing, by certified United States mail. (h) If an the applicant is currently receiving services from a the LIDDA that are funded by general revenue and the applicant declines the offer of enrollment in the HCS Program services, the LIDDA must terminate those services that are similar to services provided in under the HCS Program. (i) If a the LIDDA terminates an applicant's services in accordance with subsection (h) of this section, the LIDDA must notify the applicant or LAR of the termination, in writing, by certified United States mail and provide an opportunity for a review in accordance with §2.46 of this title (relating to Notification and Appeals Process). (j) If an the applicant or LAR accepts the offer of enrollment in the HCS Program services, the LIDDA must compile and maintain information necessary to process the applicant’s the request for enrollment in the HCS Program. (1) If the applicant's financial eligibility for the HCS Program must be established, the LIDDA must initiate, monitor, and support the processes necessary to obtain a financial eligibility determination. (2) The LIDDA must complete an ID/RC Assessment in accordance with §9.161 of this subchapter (relating to LOC Determination) and §9.163 of this subchapter (relating to LON Assignment) (relating to LOC Determination and LON Assignment, respectively). (A) The LIDDA must: (i) perform or endorse a determination that the applicant has an intellectual disability in accordance with Chapter 5, Subchapter D of this title (relating to Diagnostic Assessment) (relating to Diagnostic Eligibility for Services and Supports--Intellectual Disability Priority Population and Related Conditions); or (ii) verify that the applicant has been diagnosed by a licensed physician as having a related condition as defined in the Texas Administrative Code, Title 26§261.203 §9.203 of this chapter (relating to Definitions). (B) The LIDDA must administer the ICAP and recommend an LON assignment to HHSC DADS in accordance with §9.163 of this subchapter and §9.164 of this subchapter (relating to DADS Review of LON). (C) The LIDDA must electronically transmit the completed ID/RC Assessment to HHSC DADS for approval in accordance with §9.161(a) and §9.163(a) of this subchapter and, if applicable, submit supporting documentation as required by §9.164(c) of this subchapter. (3) The LIDDA must provide names and contact information to the applicant or LAR for all program providers in the LIDDA's local service area. (4) The LIDDA must assign a service coordinator who, together with other members of the applicant's service planning team, must: (A) develop a PDP; (B) if CFC PAS/HAB is included on the PDP, complete the HHSC DADS HCS/TxHmL CFC PAS/HAB Assessment form, which is available on the HHSC website, to determine the number of CFC PAS/HAB hours the applicant needs; and (C) develop a proposed initial IPC in accordance with §9.159(c) of this subchapter (relating to IPC). (5) A service coordinator must discuss the CDS option with the applicant or LAR in accordance with §9.168(a) and (b) of this subchapter (relating to CDS Option). (k) A The service coordinator must: (1) arrange for meetings and visits with potential program providers as requested by an the applicant or LAR; (2) review the proposed initial IPC with potential program providers as requested by the applicant or LAR; (3) ensure that the applicant's or LAR's choice of a program provider is documented on the HHSC Documentation of Provider Choice Form and that the form is signed by the applicant or LAR; (4) negotiate and finalize the proposed initial IPC and the date services will begin with the selected program provider, consulting with HHSC DADS if necessary to reach agreement with the selected program provider on the content of the proposed initial IPC and the date services will begin; (5) determine whether the applicant meets the following criteria: (A) is being discharged from a nursing facility, an ICF/IID, or a GRO; and (B) anticipates needing TAS; (6) if the service coordinator determines that the applicant meets the criteria described in paragraph (5) of this subsection: (A) complete, with the applicant or LAR and the selected program provider, the HHSC DADS Transition Assistance Services (TAS) Assessment and Authorization form, which is available on the HHSC website, found at dads.state.tx.us in accordance with the form's instructions, which includes: (i) identifying the TAS the applicant needs; and (ii) estimating the monetary amount for each TAS identified, which must be within the service limit described in §9.192(a)(5) of this subchapter (relating to Service Limits); (B) submit the completed form to HHSC DADS to determine if TAS is authorized; (C) send the form authorized by HHSC DADS to the selected program provider; and (D) include the TAS and the monetary amount authorized by HHSC DADS on the applicant's proposed initial IPC; (7) determine whether an applicant meets the following criteria: (A) is being discharged from a nursing facility, an ICF/IID, or a GRO; (B) has not met the maximum service limit for minor home modifications as described in §9.192(a)(3)(A) of this subchapter; and (C) anticipates needing pre-enrollment minor home modifications and a pre-enrollment minor home modifications assessment; (8) if the service coordinator determines that an applicant meets the criteria described in paragraph (7) of this subsection: (A) complete, with the applicant or LAR and selected program provider, the HHSC DADS Home and Community-based Services (HCS) Program Pre-enrollment MHM Authorization Request form, which is available on the HHSC website, found at dads.state.tx.us in accordance with the form's instructions, which includes: (i) identifying the pre-enrollment minor home modifications the applicant needs; (ii) identifying the pre-enrollment minor home modifications assessments conducted by the program provider as required by §9.174(h)(1)(A) of this subchapter (relating to Certification Principles: Service Delivery); (iii) based on documentation provided by the program provider as required by the HCS Program Billing Guidelines, stating the cost of: (I) the pre-enrollment minor home modifications identified on the form, which must be within the service limit described in §9.192(a)(3)(A) of this subchapter; and (II) the pre-enrollment minor home modifications assessments conducted; (B) submit the completed form to HHSC DADS to determine if pre-enrollment minor home modification and pre-enrollment minor home modifications assessments are authorized; (C) send the form authorized by HHSC DADS to the selected program provider; and (D) include the pre-enrollment minor home modifications, pre-enrollment minor home modifications assessments, and the monetary amount for these services authorized by HHSC DADS on the applicant's proposed initial IPC; (9) if an applicant or LAR chooses a program provider to deliver supported home living, nursing, host home/companion care, residential support, supervised living, respite, employment assistance, supported employment, day habilitation, or CFC PAS/HAB, ensure that the initial proposed IPC includes a sufficient number of RN nursing units for the a program provider’s RN provider nurse to perform an initial nursing assessment unless, as described in §9.174(c) of this subchapter: (A) nursing services are not on the proposed IPC and the applicant individual or LAR and selected program provider have determined that no nursing tasks will be performed by an unlicensed service provider will not perform a nursing task as documented on the HHSC Nursing Task Screening Tool form DADS form "Nursing Task Screening Tool"; or (B) an unlicensed service provider will perform a nursing task and a physician has delegated the task as a medical act under Texas Occupations Code, Chapter 157, as documented by the physician; (10) if an applicant or LAR refuses to include on the initial proposed IPC a sufficient number of RN nursing units for the program provider’s RN to perform an initial nursing assessment as required by paragraph (9) of this subsection: (A) inform the applicant or LAR that the refusal: (i) will result in the applicant not receiving nursing services from the program provider; and (ii) if the applicant needs host home/companion care, residential support, supervised living, supported home living, respite, employment assistance, supported employment, day habilitation, or CFC PAS/HAB from the program provider, will result in the individual not receiving that service unless, as described in §9.174(d)(2) of this subchapter: (I) the program provider's unlicensed service provider does not perform nursing tasks in the provision of the service; and (II) the program provider determines that it can ensure the applicant's health, safety, and welfare in the provision of the service; and (B) document the refusal of the RN nursing units on the proposed initial IPC for an initial nursing assessment by the program provider's RN in the applicant's record; (11) ensure that the applicant or LAR signs and dates the proposed initial IPC; (12) ensure that the selected program provider signs and dates the proposed initial IPC, demonstrating agreement that the services will be provided to the applicant; (13) sign and date the proposed initial IPC, which indicates that the service coordinator agrees that the requirements described in §9.159(c) of this subchapter have been met; (14) using an HHSC a DADS form, provide an oral and written explanation to the applicant or LAR of: (A) the eligibility requirements for HCS Program services as described in §9.155(a) of this subchapter (relating to Eligibility Criteria and Suspension of HCS Program Services and of CFC Services); and (B) if the applicant's PDP includes CFC services: (i) the eligibility requirements for CFC services as described in §9.155(c) of this subchapter to applicants who do not receive MAO Medicaid; and (ii) the eligibility requirements for CFC services as described in §9.155(d) of this subchapter to applicants who receive MAO Medicaid; and (15) inform the applicant or LAR, orally and in writing: (A) that HCS Program services may be terminated if: (i) the individual no longer meets the eligibility criteria described in §9.155(a) of this subchapter; or(ii) the individual or LAR requests termination of HCS Program services; and (B) if the applicant's PDP includes CFC services, that CFC services may be terminated if: (i) the individual no longer meets the eligibility criteria described in §9.155(c) or (d) of this subchapter; or (ii) the individual or LAR requests termination of CFC services. (l) A LIDDA must conduct permanency planning in accordance with §9.167(a) of this subchapter (relating to Permanency Planning). (m) After a the proposed initial IPC is finalized and signed in accordance with subsection (k) of this section, the LIDDA must: (1) electronically transmit the proposed initial IPC to HHSC;DADS and: (2) (A) keep the original proposed initial IPC in the individual's record; and (3) (B) ensure the electronically transmitted proposed initial IPC contains information identical to the information that on the original proposed initial IPC; and (4) (2) submit other required enrollment information to HHSC DADS. (n) HHSC DADS notifies the applicant or LAR, the selected program provider, the FMSA, if applicable, and the LIDDA of its approval or denial of the applicant's enrollment. When the enrollment is approved, HHSC DADS authorizes the applicant's enrollment in the HCS Program through the HHSC DADS data system and issues an enrollment letter to the applicant that includes the effective date of the applicant's enrollment in the HCS Program. (o) Prior to the applicant's service begin date, the LIDDA must provide to the selected program provider and FMSA, if applicable: , (1) copies of all enrollment documentation and associated supporting documentation, including relevant assessment results and recommendations; , (2) the completed ID/RC Assessment; , (3) the proposed initial IPC; , and(4) the applicant's PDP; and , and , (5) if CFC PAS/HAB is included on the PDP, the completed HHSC DADS HCS/TxHmL CFC PAS/HAB Assessment form. (p) Except for the provision of TAS, pre-enrollment minor home modifications, and a pre-enrollment minor home modifications assessment, as required by §9.174(g) and (h) of this subchapter, the selected program provider must not initiate services until notified of HHSC’s DADS approval of the applicant's enrollment. (q) The selected program provider must develop: (1) an implementation plan for: (A) HCS Program services, except for transportation as a supported home living activity, that is based on the individual's PDP and IPC; and (B) CFC services, except for CFC support management, that is based on the individual's PDP, IPC, and if CFC PAS/HAB is included on the PDP, the completed HHSC DADS HCS/TxHmL CFC PAS/HAB Assessment form; and (2) a transportation plan, if transportation as a supported home living activity is included on the PDP. (r) A The LIDDA must retain in an the applicant's record: (1) the HHSC Waiver Program Verification of Freedom of Choice , Waiver Program form documenting the applicant's or LAR's choice of services; (2) the HHSC Documentation of Provider Choice form documenting the applicant's or LAR's choice of a program provider, if applicable; (3) the HHSC Deadline Notification form; and (4) any other correspondence related to the offer of enrollment in the HCS Program services. (s) Copies of the following forms referenced in this section are available at dads.state.tx.us: (1) Verification of Freedom of Choice , Waiver Program form; (2) Documentation of Provider Choice form; (3) Deadline Notification form; (4) Transition Assistance Services (TAS) Assessment and Authorization form; and (5) Home and Community-based Services (HCS) Program Pre-enrollment MHM Authorization Request form. TITLE 40SOCIAL SERVICES AND ASSISTANCEPART 1DEPARTMENT OF AGING AND DISABILITY SERVICESCHAPTER 9INTELLECTUAL DISABILITY SERVICES--MEDICAIDSTATE OPERATING AGENCY RESPONSIBILITIESSUBCHAPTER NTEXAS HOME LIVING (TXHML) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)§9.566. TxHmL Interest List.(a) A LIDDA must maintain an up-to-date interest list of applicants interested in receiving TxHmL Program services for whom the LIDDA is the applicant's designated LIDDA in the HHSC DADS data system. (b) A person may request that an applicant's name be added to the TxHmL interest list by contacting the LIDDA serving the Texas county in which the applicant or person resides. (c) If a request is made in accordance with subsection (b) of this section, a LIDDA must add an applicant's name to the TxHmL interest list: (1) if the applicant resides in Texas; and (2) using the date the LIDDA receives the request as the TxHmL with an interest list request date of the date the request is received. (d) For an applicant determined diagnostically or functionally ineligible during the enrollment process for the Community Living Assistance and Support Services (CLASS) Program, Deaf-Blind with Multiple Disabilities (DBMD) Program, or Medically Dependent Children Program (MDCP):(1) if the applicant’s name is not on the TxHmL interest list, at the request of the applicant or LAR, HHSC adds the applicant’s name to the TxHmL interest list using the applicant’s interest list date for the program for which the applicant was determined ineligible as the TxHmL interest list date;(2) if the applicant’s name is on the TxHmL interest list and the applicant’s interest list date for the program for which the applicant was determined ineligible is earlier than the applicant’s TxHmL interest list date, at the request of the applicant or LAR, HHSC changes the applicant’s TxHmL interest list date to the applicant’s interest list date for the program for which the applicant was determined ineligible as the TxHmL interest list date; or(3) if the applicant’s name is on the TxHmL interest list and the applicant’s TxHmL interest list date is earlier than the applicant’s interest list date for the program for which the applicant was determined ineligible, HHSC does not change the applicant’s TxHmL interest list date. (d) For an applicant determined diagnostically or functionally ineligible for another DADS waiver program, DADS adds the applicant's name to the TxHmL interest list with a request date based on one of the following, whichever is earlier: (1) the request date of the interest list for the other waiver program; or (2) an existing request date for the TxHmL Program for the applicant.(e) This subsection applies to an applicant who was enrolled in MDCP and, because the individual did not meet the level of care criteria for medical necessity for nursing facility care or did not meet the age requirement of being under 21 years of age, was determined ineligible for MDCP after November 30, 2019 and before the date Texas Government Code §531.0601 expires.(1) At the request of the applicant or LAR, HHSC adds the applicant’s name to the TxHmL interest list:(A) using the MDCP interest list date as the TxHmL interest list date, if the applicant’s name is not on the TxHmL interest list but it was previously on the TxHmL interest list; or(B) using the date HHSC receives the request as the TxHmL interest list date, if the applicant’s name is not on the TxHmL interest list and it never has been on the TxHmL interest list. (2) At the request of the applicant or LAR, HHSC changes the TxHmL interest list date to the MDCP interest list date if the applicant’s MDCP interest list date is earlier than the applicant’s TxHmL interest list date. (f) (e) HHSC DADS or the LIDDA removes an applicant's name from the TxHmL interest list if: (1) the applicant or LAR requests in writing that the applicant's name be removed from the TxHmL interest list; (2) the applicant moves out of Texas, unless the applicant is a military family member living outside of Texas: (A) while the military member is on active duty; or (B) for less than one year after the former military member's active duty ends; (3) the applicant declines the offer of TxHmL Program services or, as described in §9.567(f) of this subchapter (relating to Process for Enrollment), an offer of TxHmL Program services is withdrawn, unless the applicant is a military family member living outside of Texas: (A) while the military member is on active duty; or (B) for less than one year after the former military member's active duty ends; (4) the applicant is a military family member living outside of Texas for more than one year after the former military member's active duty ends; (5) the applicant is deceased; or (6) HHSC DADS has denied the applicant enrollment in the TxHmL Program and the applicant or LAR has had an opportunity to exercise the applicant's right to appeal the decision in accordance with §9.571 of this subchapter (relating to Fair Hearings) and did not appeal the decision, or appealed and did not prevail. (g) (f) If HHSC DADS or the LIDDA removes an applicant's name from the TxHmL interest list in accordance with subsection (f)(1) - (4) (e)(1) - (4) of this section and, within 90 calendar days after the name was removed, the LIDDA receives an oral or written request from a person to add reinstate the applicant's name to on the TxHmL interest list: (1) the LIDDA must notify HHSC DADS of the request; and (2) HHSC DADS: (A) adds reinstates the applicant's name to the TxHmL interest list using based on the TxHmL interest list original request date that was in effect at the time the applicant’s name was removed from the TxHmL interest list described in subsection (c) or (d) of this section; and (B) notifies the applicant or LAR in writing that the applicant's name has been added reinstated to the TxHmL interest list in accordance with subparagraph (A) of this paragraph. (h) (g) If HHSC DADS or the LIDDA removes an applicant's name from the TxHmL interest list in accordance with subsection (f)(1) - (4) (e)(1) - (4) of this section and, more than 90 days after the name was removed, the LIDDA receives an oral or written request from a person to add reinstate the applicant's name to on the TxHmL interest list: (1) the applicant's name is added placed on the TxHmL interest list: (A) by the LIDDA using based on the date the LIDDA receives the oral or written request as the TxHmL interest list date, unless subparagraph (B) of this paragraph applies; or (B) by HHSC using DADS based on the TxHmL interest list original request date that was in effect at the time the applicant’s name was removed from the TxHmL interest list as the TxHmL interest list date described in subsection (c) or (d) of this section because of extenuating circumstances as determined by HHSC DADS; and (2) HHSC DADS notifies the applicant or LAR in writing that the applicant's name has been added to the TxHmL interest list in accordance with paragraph (1) of this subsection. (i) (h) If HHSC DADS or the LIDDA removes an applicant's name from the TxHmL interest list in accordance with subsection (f)(6) (e)(6) of this section and the LIDDA subsequently receives an oral or written request from a person to add reinstate the applicant's name on the TxHmL interest list: (1) the LIDDA must add the applicant's name to the TxHmL interest list using based on the date the LIDDA receives the oral or written request as the TxHmL interest list date; and (2) HHSC DADSnotifies the applicant or LAR in writing that the applicant's name has been added to the TxHmL interest list in accordance with paragraph (1) of this subsection. §9.567. Process for Enrollment.(a) HHSC DADS notifies a LIDDA, in writing, when the opportunity for enrollment in the of the availability of TxHmL Program becomes available services in the LIDDA's local service area and directs the LIDDA to offer enrollment TxHmL Program services to the applicant: (1) whose interest list request date, assigned in accordance with §9.566 §9.566(c)(2) or (d) of this subchapter (relating to TxHmL Interest List), is earliest on the statewide interest list for the TxHmL Program as maintained by HHSC DADS; (2) whose name is not coded in the HHSC DADS data system as having been determined ineligible for the TxHmL Program and who is receiving services from the LIDDA that are funded by general revenue in an amount that would allow HHSC DADS to fund the services through the TxHmL Program; or (3) who is a member of a target group identified in the approved TxHmL waiver application. (b) Except as provided in subsection (c) of this section, a the LIDDA must offer enrollment in the make the offer of TxHmL Program services in writing and deliver it to the applicant or LAR by regular United States mail or by hand delivery. (c) A LIDDA must offer enrollment in the make the offer of TxHmL Program services to an applicant described in subsection (a)(2) or (3) of this section in accordance with HHSC’s DADS procedures. (d) A The LIDDA must include in a written offer that is made in accordance with subsection (a)(1) of this section: (1) a statement that: (A) if the applicant or LAR does not respond to the offer of enrollment in the TxHmL Program services within 30 calendar days after the LIDDA's written offer, the LIDDA withdraws the offer of TxHmL Program services; and (B) if the applicant is currently receiving services from the LIDDA that are funded by general revenue and the applicant or LAR declines the offer of enrollment in the TxHmL Program services, the LIDDA terminates those services that are similar to services provided in under the TxHmL Program; and (2) information regarding the time frame requirements described in subsection (f) of this section using the HHSC Deadline Notification form, which is available on the HHSC website at dads.state.tx.us. (e) If an applicant or LAR responds to an offer of enrollment in the TxHmL Program services, a the LIDDA must: (1) provide the applicant, LAR, and, if the LAR is not a family member, at least one family member (if possible) both an oral and a written explanation of the services and supports for which the applicant may be eligible, including the ICF/IID Program (both state supported living centers and community-based facilities), waiver programs authorized under §1915(c) of the Social Security Act, and other community-based services and supports, using the HHSC Explanation of Services and Supports document which is available on the HHSC website at dads.state.tx.us; (2) using an HHSC a DADS form, provide the applicant and LAR both an oral and a written explanation of all TxHmL Program services and CFC services; and (3) give the applicant or LAR the HHSC Waiver Program Verification of Freedom of Choice form, which is available on the HHSC website at dads.state.tx.us to document the applicant's choice between regarding the TxHmL Program or the and ICF/IID Program. (f) A The LIDDA must withdraw an offer of enrollment in the TxHmL Program services made to an applicant or LAR if: (1) within 30 calendar days after the LIDDA's offer made to the applicant or LAR in accordance with subsection (a)(1) of this section, the applicant or LAR does not respond to the offer of enrollment in the TxHmL Program services; (2) within seven calendar days after the applicant or LAR receives the HHSC Waiver Program Verification of Freedom of Choice form from the LIDDA in accordance with subsection (e)(2) of this section, the applicant or LAR does not use the form to document the applicant’s choice of the TxHmL Program services over the ICF/IID Program using the Verification of Freedom of Choice form; (3) within 30 calendar days after the applicant or LAR receives the contact information regarding all available program providers in the LIDDA’s LIDDA 's local service area in accordance with subsection (n)(1) of this section, the applicant or LAR does not document a choice of a program provider using the HHSC Documentation of Provider Choice form, which is available on the HHSC website; or (4) the applicant or LAR does not complete the necessary activities to finalize the enrollment process and HHSC DADS has approved the withdrawal of the offer. (g) If a the LIDDA withdraws an offer of enrollment in the TxHmL Program services made to an applicant, the LIDDA must notify the applicant or LAR of such action, in writing, by certified United States mail. (h) If an the applicant is currently receiving services from a the LIDDA that are funded by general revenue and the applicant declines the offer of enrollment in the TxHmL Program services, the LIDDA must terminate those services that are similar to services provided in under the TxHmL Program. (i) If a the LIDDA terminates an applicant's services in accordance with subsection (h) of this section, the LIDDA must notify the applicant or LAR of the termination, in writing, by certified United States mail and provide an opportunity for a review in accordance with §2.46 of this title (relating to Notification and Appeals Process). (j) A The LIDDA must retain in an the applicant's record: (1) the HHSC Waiver Program Verification of Freedom of Choice form documenting the applicant's or LAR's choice of services; (2) the HHSC Documentation of Provider Choice form documenting the applicant's or LAR's choice of program provider; and(3) the HHSC Deadline Notification form; and (4) (3) any correspondence related to the offer of enrollment in the TxHmL Program services. (k) If an applicant or LAR accepts the offer of enrollment chooses participation in the TxHmL Program, the LIDDA must compile and maintain information necessary to process the applicant's request for enrollment in the TxHmL Program. (1) The LIDDA must complete an ID/RC Assessment. (A) The LIDDA must: (i) determine or validate a determination that the applicant has an intellectual disability in accordance with Chapter 5, Subchapter D of this title (relating to Diagnostic Eligibility for Services and Supports--Intellectual Disability Priority Population and Related Conditions); or (ii) verify that the applicant has been diagnosed by a licensed physician as having a related condition as defined in the Texas Administrative Code, Title 26 §261.203§9.203 of this chapter (relating to Definitions). (B) The LIDDA must administer the ICAP Inventory for Client and Agency Planning (ICAP) or validate a current ICAP and recommend an LON assignment to HHSC DADS in accordance with §9.562 of this subchapter (relating to Level of Need (LON) Assignment). (2) The LIDDA must: (A) provide names and contact information to the applicant or LAR for regarding all program providers in the LIDDA's local service area; (B) arrange for meetings or visits with potential program providers as desired by the applicant or the LAR; and (C) ensure that the applicant's or LAR's choice of a program provider is documented, signed by the applicant or LAR, and retained by the LIDDA in the applicant's record. (3) The LIDDA must assign a service coordinator who, together with other members of the service planning team, must: (A) develop a PDP; and (B) if CFC PAS/HAB is included on the PDP, complete the HHSC DADS HCS/TxHmL CFC PAS/HAB Assessment form to determine the number of CFC PAS/HAB hours the applicant needs. (l) A The service coordinator must: (1) in accordance with Chapter 41, Subchapter D of this title (relating to Enrollment, Transfer, Suspension, and Termination): (A) inform the applicant or LAR of the applicant's right to participate in the CDS option; and (B) inform the applicant or LAR that the applicant or LAR may choose to have one or more services provided through the CDS option, as described in §41.108 of this title (relating to Services Available Through the CDS Option); and (2) if the applicant or LAR chooses to participate in the CDS option, comply with §9.583(s) of this subchapter (relating to TxHmL Program Principles for LIDDAs). (m) The service coordinator must develop a proposed IPC with the applicant or LAR based on the PDP and in accordance with §9.558 of this subchapter (relating to Individual Plan of Care (IPC)). (n) If an applicant or LAR chooses to receive a TxHmL Program service or CFC service provided by a program provider, the service coordinator must review the proposed IPC with potential program providers selected by the applicant or the LAR. (o) If transportation as a community support activity is included on the PDP, a transportation plan must be developed by: (1) the program provider if the individual chooses a program provider to provide transportation as a community support activity; or (2) the service planning team if the individual chooses to receive transportation as a community support activity through the CDS option. (p) A service coordinator must: (1) ensure that the proposed IPC includes a sufficient number of RN nursing units for the program provider's RN to perform an initial nursing assessment, unless, as described in §9.578(q) of this subchapter (relating to Program Provider Certification Principles: Service Delivery): (A) nursing services are not on the proposed IPC and the applicant or LAR and selected program provider have determined that no nursing tasks will be performed by an unlicensed service provider as documented on the HHSC Nursing Task Screening tool form DADS form "Nursing Task Screening Tool"; or (B) an unlicensed service provider will perform a nursing task will be performed by an unlicensed service provider and a physician has delegated the task as a medical act under Texas Occupations Code, Chapter 157, as documented by the physician; (2) if an applicant or LAR refuses to include a sufficient number of RN nursing units on the proposed IPC for the program provider's RN to perform an initial nursing assessment as required by paragraph (1) of this subsection: (A) inform the applicant or LAR that the refusal: (i) will result in the applicant not receiving nursing services from the program provider; and (ii) if the applicant needs community support, day habilitation, employment assistance, supported employment, respite, or CFC PAS/HAB from the program provider, will result in the applicant not receiving the service unless, as described in §9.578(r) of this subchapter: (I) the program provider's unlicensed service provider does not perform nursing tasks in the provision of the service; and (II) the program provider determines that it can ensure the applicant's health, safety, and welfare in the provision of the service; and (B) document the refusal of the RN nursing units on the proposed IPC for an initial nursing assessment by the program provider's RN in the applicant's record; and (3) negotiate and finalize the proposed IPC with the selected program provider. (q) A service coordinator must: (1) using an HHSC a DADS form, provide an oral and written explanation to an applicant or LAR of: (A) the eligibility requirements for TxHmL Program services as described in §9.556(a) of this subchapter (relating to Eligibility Criteria for TxHmL Program Services and CFC Services); and (B) if the applicant's PDP includes CFC services: (i) the eligibility requirements for CFC services as described in §9.556(b) of this subchapter to applicants who do not receive MAO Medicaid; and(ii) the eligibility requirements for CFC services as described in §9.556(c) of this subchapter to applicants who receive MAO Medicaid; and (2) provide an oral and written explanation to the applicant or LAR of: (A) the reasons TxHmL Program services may be terminated as described in §9.570(a)(1) of this subchapter (relating to Termination and Suspension of TxHmL Program Services and CFC Services); and (B) if the applicant's PDP includes CFC services, the reasons CFC services may be terminated as described in §9.570(a)(2) of this subchapter. (r) After the selected program provider agrees to provide the services listed on the proposed IPC, the LIDDA must submit to HHSC enrollment information, including the completed ID/RC Assessment and the proposed IPC to DADS. HHSC DADS notifies the applicant or LAR, the selected program provider, the and FMSA, if applicable, and the LIDDA of its approval or denial of the applicant's program enrollment based on the eligibility criteria described in §9.556 of this subchapter. (s) Prior to the applicant's service begin date, a the LIDDA must provide to the selected program provider and FMSA, if applicable: ,(1) copies of all enrollment documentation and associated supporting documentation, including relevant assessment results and recommendations;,(2) the completed ID/RC Assessment;, (3) the proposed IPC;,and(4) the applicant's PDP; and, (5) if CFC PAS/HAB is included on the PDP, a copy of the completed HHSC DADS HCS/TxHmL CFC PAS/HAB Assessment form. (t) If a selected program provider initiates services before HHSC’s DADS notification of enrollment approval, the program provider may not be reimbursed in accordance with §9.573(a)(5)(M) of this subchapter (relating to Reimbursement). TITLE 40 SOCIAL SERVICES AND ASSISTANCEPART 1 DEPARTMENT OF AGING AND DISABILITY SERVICESCHAPTER 42 DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICESSUBCHAPTER B ELIGIBILITY, ENROLLMENT, AND REVIEWDIVISION 1 ELIGIBILITY§42.202. DBMD Interest List.(a) HHSC DADS maintains an interest list that contains the names of individuals interested in receiving DBMD Program services. (b) A person may request an individual's name be added to the DBMD interest list by: (1) calling HHSC’s DADS toll-free number; or (2) submitting a written request to HHSC DADS. (c) If a request is made in accordance with subsection (b) of this section, HHSC adds an individual's name to the DBMD interest list:(1) if the individual resides in Texas; and (2) using the date HHSC receives the request as the DBMD interest list date. (d) For an individual determined diagnostically or functionally ineligible during the enrollment process for the Community Living Assistance and Support Services (CLASS) Program, Home and Community-based Services (HCS) Program, Texas Home Living (TxHmL) Program, or Medically Dependent Children Program (MDCP):(1) if the individual’s name is not on the DBMD interest list, at the request of the individual or LAR, HHSC adds the individual’s name to the DBMD interest list using the individual’s interest list date for the program for which the individual was determined ineligible as the DBMD interest list date;(2) if theindividual’s name is on the DBMD interest list and the individual’s interest list date for the program for which the individual was determined ineligible is earlier than the individual’s DBMD interest list date, at the request of the individual or LAR, HHSC changes the individual’s DBMD interest list date to the individual’s interest list date for the program for which the individual was determined ineligible; or(3) if theindividual’s name is on the DBMD interest list and the individual’s DBMD interest list date is earlier than the individual’s interest list date for the program for which the individual was determined ineligible, HHSC does not change the individual’s DBMD interest list date. (c) DADS adds an individual's name to the DBMD interest list:(1) if the individual resides in Texas; and (2) with an interest list request date as follows: (A) for an individual who requests to be added to the interest list in accordance with subsection (b) of this section, the date of the request; or (B) for an individual determined diagnostically or functionally ineligible for another DADS waiver program, one of the following dates, whichever is earlier: (i) the request date of the interest list for the other waiver program; or (ii) an existing request date for the DBMD Program for the individual.(e) This subsection applies to an individual who was enrolled in MDCP and, because the individual did not meet the level of care criteria for medical necessity for nursing facility care or did not meet the age requirement of being under 21 years of age, was determined ineligible for MDCP after November 30, 2019 and before the date Texas Government Code §531.0601 expires.(1) At the request of the individual or LAR, HHSC adds the individual’s name to the DBMD interest list:(A) using the MDCP interest list date as the DBMD interest list date, if the individual’s name is not on the DBMD interest list but it was previously on the DBMD interest list; or(B) using the date HHSC receives the request as the DBMD interest list date, if the individual’s name is not on the DBMD interest list and it never has been on the DBMD interest list. (2) At the request of the individual or LAR, HHSC changes the DBMD interest list date to the MDCP interest list date if the individual’s MDCP interest list date is earlier than the individual’s DBMD interest list date. (fd) HHSC DADS removes an individual's name from the DBMD interest list if: (1) the individual or LAR requests in writing that the individual's name be removed from the DBMD interest list; (2) the individual moves out of Texas, unless the individual is a military family member living outside of Texas: (A) while the military member is on active duty; or (B) for less than one year after the former military member's active duty ends; (3) the individual or LAR declines the offer of enrollment in the DBMD Program services, or, as described in §42.211(e) of this subchapter (relating to Written Offer of DBMD Program Services), HHSC DADS withdraws an offer of enrollment in the a DBMD Program Services as described in §42.211(e) of this subchapter (relating to Written Offer of DBMD Program Services), unless the individual is a military family member living outside of Texas: (A) while the military member is on active duty; or (B) for less than one year after the former military member's active duty ends; (4) the individual is a military family member living outside of Texas for more than one year after the former military member's active duty ends; (5) the individual is deceased; or (6) HHSC DADS has denied the individual enrollment in the DBMD Program and the individual or LAR has had an opportunity to exercise the individual's right to appeal the decision in accordance with §42.251 of this subchapter (relating to Individual's Right to a Fair Hearing) and did not appeal the decision, or appealed and did not prevail. (ge) If HHSC DADS removes an individual's name from the DBMD interest list in accordance with subsection (f)(1) - (4) (d)(1) - (4) of this section and, within 90 calendar days after the name was removed, HHSC DADS receives an oral or written request from a person to add reinstatethe individual’s name to onthe DBMD interest list, HHSC DADS: (1) adds reinstates the individual's name to the DBMD interest list using the DBMD interest list based on the original request date that was in effect at the time the individual’s name was removed from the DBMD interest list described in subsection (c)(2)(A) or (B) of this section; and (2) notifies the individual or LAR in writing that the individual's name has been added reinstatedto the DBMD interest list in accordance with paragraph (1) if this subsection. (h) (f) If HHSC DADS removes an individual's name from the DBMD interest list in accordance with subsection (f)(1) - (4) (d)(1) - (4) of this section and, more than 90 calendar days after the name was removed, HHSC DADS receives an oral or written request from a person to add reinstatethe individual's name to on the DBMD interest list, HHSC DADS: (1) adds the individual's name to the DBMD interest list using as the DBMD interest list date based on: (A) the date HHSC DADS receives the oral or written request; or (B) because of extenuating circumstances as determined by HHSC DADS, the DBMD interest list original request date that was in effect at the time the individual’s name was removed from the DBMD interest list described in subsection (c)(2)(A) or (B) of this section; and (2) notifies the individual or LAR in writing that the individual's name has been added to the DBMD interest list in accordance with paragraph (1) of this subsection. (i) (g) If HHSC DADS removes an individual's name from the DBMD interest list in accordance with subsection (f)(6) (d)(6) of this section and HHSC DADS subsequently receives an oral or written request from a person to add reinstate the individual’s applicant's name to on the DBMD interest list, HHSC DADS: (1) adds the individual's name to the DBMD interest list using based on the date HHSC DADS receives the oral or written request as the DBMD interest list date; and (2) notifies the individual or LAR in writing that the individual's name has been added to the DBMD interest list in accordance with paragraph (1) of this subsection. TITLE 40 SOCIAL SERVICES AND ASSISTANCEPART 1 DEPARTMENT OF AGING AND DISABILITY SERVICESCHAPTER 42 DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICESSUBCHAPTER B ELIGIBILITY, ENROLLMENT, AND REVIEWDIVISION 2 ENROLLMENT PROCESS§42.211. Written Offer of Enrollment in the DBMD Program.(a) HHSC sends a written offer of enrollment in the DBMD Program to: (1) the individual whose DBMD interest list request date, assigned in accordance with §42.202 §42.202(c)(2) of this subchapter (relating to DBMD Interest List), is earliest on the DBMD interest list, unless the individual is a military family member living outside of Texas; or (2) an individual who is residing in a nursing facility and requesting enrollment in the DBMD Program. (b) HHSC encloses with the written offer: (1) a list of DBMD program providers; (2) a Documentation of Provider Choice form; (3) in accordance with 1 TAC §351.15 (relating to Information Regarding Community-based Services), a document explaining other currently available community-based long-term support options that might be appropriate to the individual's needs; and (4) an Applicant Acknowledgement form. (c) An The individual or LAR accepts the offer of enrollment in the DBMD Program by: (1) selecting a program provider from the enclosed list and designating the selection on the Documentation of Provider Choice form; and (2) ensuring the completed Documentation of Provider Choice form and Applicant Acknowledgement form are submitted to HHSC and postmarked or faxed no later than 60 calendar days after the date on the offer letter. (d) Upon timely receipt of a Documentation of Provider Choice form and Applicant Acknowledgement form completed by the individual or LAR, HHSC notifies the program provider designated by the individual or LAR. (e) HHSC withdraws an offer of enrollment in the DBMD Program made to an individual if: (1) the completed Documentation of Provider Choice form and Applicant Acknowledgement form are postmarked or faxed more than 60 calendar days after the date on the offer letter; (2) the individual or LAR declines the offer of enrollment in the DBMD Program;(2) (3) the individual or LAR does not complete the enrollment process as described in §42.212 of this division (relating to Process for Enrollment of an Individual); or (3) (4) the individual was offered enrollment in the DBMD Program because while the individual was residing in a nursing facility, but was discharged from the nursing facility before the effective date of the enrollment IPC. TITLE 40 SOCIAL SERVICES AND ASSISTANCEPART 1 DEPARTMENT OF AGING AND DISABILITY SERVICESCHAPTER 42 DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICESSUBCHAPTER D ADDITIONAL PROGRAM PROVIDER PROVISIONS§42.402. Qualifications of Program Provider Staff.(a) A program provider must employ a program director who is responsible for the program provider's day-to-day operations. The program director must: (1) have a minimum of one year of paid experience in community programs planning and providing direct services to individuals with deafness, blindness, or multiple disabilities and have a master's degree in a health and human services related field; (2) have a minimum of two years of paid experience in community programs planning and providing direct services to individuals with deafness, blindness, or multiple disabilities, and have a bachelor's degree in a health and human services related field; or (3) have been the program director for a DBMD Program provider on or before June 15, 2010. (b) A program provider must ensure that a case manager: (1) has: (A) a bachelor's degree in a health and human services related field and a minimum of two years of experience in the delivery of direct services to individuals with disabilities; (B) an associate associate's degree in a health and human services related field and a minimum of four years of experience providing direct services to individuals with disabilities; or (C) a high school diploma or certificate recognized by a state as the equivalent of a high school diploma and a minimum of six years of experience providing direct services to individuals with disabilities; and (2) either: (A) is fluent in the communication methods used by an individual to whom the case manager is assigned (for example American sign language, tactile symbols, communication boards, pictures, and gestures); or (B) within six months after being assigned to an individual, becomes fluent in the communication methods used by the individual. (c) For purposes of subsection (d) of this section and consistent with Texas Government Code, §531.0973, "deafblind-related course work" means educational courses designed to improve a person's: (1) knowledge of deafblindness and its effect on learning; (2) knowledge of the role of intervention and ability to facilitate the intervention process; (3) knowledge of areas of communication relevant to deafblindness, including methods, adaptations, and use of assistive technology, and ability to facilitate the development and use of communication skills for a person with deafblindness; (4) knowledge of the effect that deafblindness has on a person's psychological, social, and emotional development and ability to facilitate the emotional well-being of a person with deafblindness; (5) knowledge of and issues related to sensory systems and ability to facilitate the use of the senses; (6) knowledge of motor skills, movement, orientation, and mobility strategies and ability to facilitate orientation and mobility skills; (7) knowledge of the effect that additional disabilities have on a person with deafblindness and the ability to provide appropriate support; or (8) professionalism and knowledge of ethical issues relevant to the role of an intervener. (d) A program provider must ensure that: (1) an intervener: (A) is at least 18 years of age; (B) is not: (i) the spouse of the individual to whom the intervener is assigned; or (ii) if the individual is under 18 years of age, a parent of the individual to whom the intervener is assigned; (C) holds a high school diploma or a certificate recognized by a state as the equivalent of a high school diploma equivalency certificate; (D) has at least a minimum of two years of experience working with individuals with developmental disabilities; and (E) has the ability to proficiently communicate in the functional language of the individual to whom the intervener is assigned; (2) an intervener I:(A) meets the requirements for an intervener as described in paragraph (1) of this subsection; (B) has at least a minimum of six months of experience working with persons who have deafblindness or function as persons with deafblindness; (C) has completed at least a minimum of eight semester credit hours in deafblind-related course work at a college or university accredited by: (i) a state agency recognized by the United States Department of Education; or (ii) a non-governmental entity recognized by the United States Department of Education; and(D) has completed a a one-hour practicum that is at least one semester credit hour in deafblind-related course work at a college or university accredited by a state agency or a non-governmental entity recognized by: (i) a state agency recognized by the United States Department of Education; or (ii) a non-governmental entity recognized by the United States Department of Education; (3) an intervener II: (A) meets the requirements for of an intervener I as described in paragraph (2)(A), (C), and (D) of this subsection; (B) has at least a minimum of nine months of experience working with persons who have deafblindness or function as persons with deafblindness; and (C) has completed at least an additional 10 semester credit hours in deafblind-related course work at a college or university accredited by: (i) a state agency recognized by the United States Department of Education; or (ii) a non-governmental entity recognized by the United States Department of Education; and (4) an intervener III: (A) meets the requirements for of an intervener II as described in paragraph (3)(A) of this subsection; (B) has at least a minimum of one year of experience working with persons with deafblindness or function as persons with deafblindness; and (C) holds an associate degree associate's or bachelor's degree in a course of study with a focus on deafblind-related course work from a college or university accredited by: (i) a state agency recognized by the United States Department of Education; or (ii) a non-governmental entity recognized by the United States Department of Education. ; (e) A program provider must ensure that a service provider who interacts directly with an individual is able to communicate with the individual. (f) A program provider must ensure that a service provider of a therapy described in §42.632(a) of this chapter (relating to Therapies) is licensed by the State of Texas as described in §42.632(b) of this chapter. (g) A program provider must ensure that a service provider of employment assistance or a service provider of supported employment: (1) is at least 18 years of age; (2) is not: (A) the spouse of the individual; or (B) a parent of the individual if the individual is under 18 years of age; and (3) has: (A) a bachelor's degree in rehabilitation, business, marketing, or a related human services field with six months of paid or unpaid experience providing services to people with disabilities; (B) an associate associate's degree in rehabilitation, business, marketing, or a related human services field with one year of paid or unpaid experience providing services to people with disabilities; or (C) a high school diploma or a certificate recognized by a state as the equivalent of a high school diploma, with two years of paid or unpaid experience providing services to people with disabilities. (h) Documentation of the experience required by subsection (g) of this section must include: (1) for paid experience, a written statement from a person who paid for the service or supervised the provision of the service; and (2) for unpaid experience, a written statement from a person who has personal knowledge of the experience. (i) A program provider must ensure that dental treatment is provided by a person licensed to practice dentistry or dental hygiene in accordance with Texas Occupations Code, Chapter 256.(j) (i) A program provider must ensure that a service provider not required to meet the other education or experience requirements described in this section: (1) is 18 years of age or older; (2) has: (A) a high school diploma; (B) a certificate recognized by a state as the equivalent of a high school diploma; or (C) the following: (i) documentation of a proficiency evaluation of experience and competence to perform job tasks including an ability to provide the required services needed by the individual as demonstrated through a written competency-based assessment; and (ii) at least three personal references from persons not related by blood that evidence the person's ability to provide a safe and healthy environment for the individual; and (3) except for a service provider of chore services, either: (A) is fluent in the communication methods used by the individual to whom the service provider is assigned (for example American sign language, tactile symbols, communication boards, pictures, and gestures); or (B) has the ability to become fluent in the communication methods used by an individual within three months after being assigned to the individual. (k) (j) A program provider must ensure that: (1) a vehicle in which a service provider transports an individual has a valid Vehicle Identification Certificate of Inspection, in accordance with state law; and (2) a service provider who transports an individual in a vehicle has: (A) a current Texas driver's license; and (B) vehicle liability insurance, in accordance with state law. (l) (k) A service provider: (1) must not be a parent of the individual to whom the service provider is providing any service, if the individual is under 18 years of age;: (A) the parent of an individual if the individual is under 18 years of age; or(2) (B) must not be the spouse of the an individual to whom the service provider is providing any service; (3) must not be a relative or guardian of the individual to whom the service provider is providing an adaptive aid; and (4) (2) must not , if an individual is an adult, be a relative or guardian of the individual to whom the service provider is providing any of the following services, if the individual is 18 years of age or older: (A) assisted living; (B) case management; (C) behavioral support; (D) dental treatment; (E) dietary services; (F) FMS, if the individual is participating in the CDS option; (G) occupational therapy; (H) orientation and mobility; (I) physical therapy; (J) speech, language, audiology therapy; and or (K) support consultation, if the individual is participating in the CDS option. ; and(3) may be, if an individual is an adult, a relative or guardian of the individual to whom the service provider is providing: (A) adaptive aids; (B) chore services; (C) day habilitation; (D) employment assistance; (E) intervener; (F) minor home modifications; (G) nursing; (H) residential habilitation; (I) respite; (J) supported employment; or (K) CFC PAS/HAB. (m) (l) A service provider of CFC PAS/HAB must: (1) have: (A) a high school diploma; (B) a certificate recognized by a state as the equivalent of a high school diploma; or (C) both of the following: (i) a successfully completed written competency-based assessment demonstrating the service provider's ability to perform CFC PAS/HAB tasks, including an ability to perform CFC PAS/HAB tasks required for the individual to whom the service provider will provide CFC PAS/HAB; and (ii) at least three written personal references from persons not related by blood that evidence the service provider's ability to provide a safe and healthy environment for the individual; and (2) meet any other qualifications requested by the individual or LAR based on the individual's needs and preferences. (n) (m) The program provider must maintain documentation in a service provider's employment, contract, or personal service agreement file that the service provider meets the requirements of this section. TITLE 40SOCIAL SERVICES AND ASSISTANCEPART 1DEPARTMENT OF AGING AND DISABILITY SERVICESCHAPTER 45COMMUNITY LIVING ASSISTANCE AND SUPPORT SERVICES AND COMMUNITY FIRST CHOICE (CFC) SERVICESSUBCHAPTER BELIGIBILITY, ENROLLMENT, AND REVIEWDIVISION 1ELIGIBILITY AND MAINTENANCE OF INTEREST LIST§45.202. CLASS Interest List.(a) HHSC DADS maintains an interest list that contains the names of individuals interested in receiving CLASS Program services. (b) A person may request an individual's name be added to the CLASS interest list by: (1) calling HHSC’s DADS toll-free number; or (2) submitting a written request to HHSC DADS. (c) If a request is made in accordance with subsection (b) of this section, HHSC DADS adds an individual's name to the CLASS interest list: (1) if the individual resides in Texas; and (2) using the date HHSC receives the request as the CLASS interest list date.with an interest list request date as follows:(A) for an individual who requests to be added to the interest list in accordance with subsection (b) of this section, the date of the request;(B) for an individual under 22 years of age residing in a nursing facility, the date of admission to the nursing facility; or(C) for an individual determined diagnostically or functionally ineligible for another DADS waiver program, one of the following dates, whichever is earlier:(i) the request date of the interest list for the other waiver program; or (ii) an existing request date for the CLASS Program for the individual.(d) For an individual under 22 years of age who is residing in a nursing facility located in Texas, HHSC adds the individual 's name to the CLASS interest list using the date of admission to the nursing facility as the CLASS interest list date.(e) For an individual determined diagnostically or functionally ineligible during the enrollment process for the Deaf-Blind with Multiple Disabilities (DBMD) Program, Home and Community-based Services (HCS) Program, Texas Home Living (TxHmL) Program, or Medically Dependent Children Program (MDCP):(1) if the individual’s name is not on the CLASS interest list, at the request of the individual or LAR, HHSC adds the individual’s name to the CLASS interest list using the individual’s interest list date for the program for which the individual was determined ineligible as the CLASS interest list date;(2) if the individual’s name is on the CLASS interest list and the individual’s interest list date for the program for which the individual was determined ineligible is earlier than the individual’s CLASS interest list date, at the request of the individual or LAR, HHSC changes the individual’s CLASS interest list date to the individual’s interest list date for the program for which the individual was determined ineligible; or(3) if theindividual’s name is on the CLASS interest list and the individual’s CLASS interest list date is earlier than the individual’s interest list date for the program for which the individual was determined ineligible, HHSC does not change the individual’s CLASS interest list date.(f) This subsection applies to an individual who was enrolled in MDCP and, because the individual did not meet the level of care criteria for medical necessity for nursing facility care or did not meet the age requirement of being under 21 years of age, was determined ineligible for MDCP after November 30, 2019 and before the date Texas Government Code §531.0601 expires.(1) At the request of the individual or LAR, HHSC adds the individual’s name to the CLASS interest list:(A) using the MDCP interest list date as the CLASS interest list date, if the individual’s name is not on the CLASS interest list but it was previously on the CLASS interest list; or(B) using the date HHSC receives the request as the CLASS interest list date, if the individual’s name is not on the CLASS interest list and it never has been on the CLASS interest list.(2) At the request of the individual or LAR, HHSC changes the CLASS interest list date to the MDCP interest list date if the individual’s MDCP interest list date is earlier than the individual’s CLASS interest list date.(g) (d) HHSC DADS removes an individual's name from the CLASS interest list if: (1) the individual or LAR requests in writing that the individual's name be removed from the CLASS interest list, unless the individual is under 22 years of age and residing in a nursing facility; (2) the individual moves out of Texas, unless the individual is a military family member living outside of Texas: (A) while the military member is on active duty; or (B) for less than one year after the former military member's active duty ends; (3) the individual declines the offer of CLASS Program services or, as described in §45.211(d) of this chapter (relating to Written Offer of CLASS Program Services), HHSC DADS withdraws an offer of enrollment in the CLASS Program Services, unless: (A) the individual is a military family member living outside of Texas: (i) while the military member is on active duty; or (ii) for less than one year after the former military member's active duty ends; or (B) the individual is under 22 years of age and residing in a nursing facility; (4) the individual is a military family member living outside of Texas for more than one year after the former military member's active duty ends; (5) the individual is deceased; or (6) HHSC DADS has denied the individual enrollment in the CLASS Program and the individual or LAR has had an opportunity to exercise the individual's right to appeal the decision in accordance with §45.301 of this subchapter (relating to Individual's Right to a Fair Hearing) and did not appeal the decision, or appealed and did not prevail. (h) (e) If HHSC DADS removes an individual's name from the CLASS interest list in accordance with subsection (g)(1) - (4) (d)(1) - (4) of this section and, within 90 calendar days after the name was removed, HHSC DADS receives an oral or written request from a person to add reinstate the individual's name to on the CLASS interest list, HHSC DADS: (1) adds reinstates the individual's name to the CLASS interest list using the CLASS interest list based on the original request date that was in effect at the time the individual’s name was removed from the CLASS interest list described in subsection (c)(2)(A) - (C) of this section; and (2) notifies the individual or LAR in writing that the individual's name has been added reinstated to the CLASS interest list in accordance with paragraph (1) of this subsection. (i) (f) If HHSC DADS removes an individual's name from the CLASS interest list in accordance with subsection (g)(1) - (4) (d)(1) - (4) of this section and, more than 90 calendar days after the name was removed, HHSC DADS receives an oral or written request from a person to add reinstate the individual's name to on the CLASS interest list, HHSC DADS: (1) adds the individual's name to the CLASS interest list using as the CLASS interest list date based on: (A) the date HHSC DADS receives the oral or written request; or (B) because of extenuating circumstances as determined by HHSC DADS, the CLASS interest list original request date that was in effect at the time the individual’s name was removed from the CLASS interest list described in subsection (c)(2)(A) - (C) of this section; and (2) notifies the individual or LAR in writing that the individual's name has been added to the CLASS interest list in accordance with paragraph (1) of this subsection. (j) (g) If HHSC DADS removes an individual's name from the CLASS interest list in accordance with subsection (g)(6) (d)(6) of this section and HHSC DADS subsequently receives an oral or written request from a person to add reinstate the individual's name to on the CLASS interest list, HHSC DADS: (1) adds the individual's name to the CLASS interest list using based on the date HHSC DADS receives the oral or written request as the CLASS interest list date; and (2) notifies the individual or LAR in writing that the individual's name has been added to the CLASS interest list in accordance with paragraph (1) of this subsection. TITLE 40SOCIAL SERVICES AND ASSISTANCEPART 1DEPARTMENT OF AGING AND DISABILITY SERVICESCHAPTER 45COMMUNITY LIVING ASSISTANCE AND SUPPORT SERVICES AND COMMUNITY FIRST CHOICE (CFC) SERVICESSUBCHAPTER BELIGIBILITY, ENROLLMENT, AND REVIEWDIVISION 2ENROLLMENT PROCESS§45.211. Written Offer of CLASS Program Services.(a) HHSC DADS sends a written offer in accordance with this subsection. (1) HHSC DADS sends a written offer of enrollment in the CLASS Program services to: (A) the individual whose CLASS interest list request date, assigned in accordance with §45.202 §45.202(c)(2) of this subchapter (relating to CLASS Interest List), is earliest on the CLASS interest list; or (B) an individual who is residing in a nursing facility and requesting CLASS Program services. (2) HHSC DADS encloses with the written offer: (A) a Selection Determination form which includes a list of CMAs and DSAs serving the catchment area in which the individual resides; and (B) a CLASS Applicant Acknowledgement form. (b) An The individual or LAR accepts the DADS offer of enrollment in the CLASS Program services by: (1) documenting the selection of one CMA and one DSA on the Selection Determination form; and (2) ensuring the completed Selection Determination form and CLASS Applicant Acknowledgement form are submitted to HHSC DADS and postmarked or faxed no later than 60 calendar days after the date of the written offer. (c) Upon timely receipt of the Selection Determination form and CLASS Applicant Acknowledgement form completed by the individual or LAR, HHSC DADS notifies the CMA and DSA selected by the individual or LAR. (d) HHSC DADS withdraws an offer of enrollment in the CLASS Program services made to an individual if: (1) the completed Selection Determination form and CLASS Applicant Acknowledgement form are postmarked or faxed more than 60 calendar days after the date of the written offer; (2) the individual or LAR does not complete the enrollment process as described in §45.212 of this division (relating to Process for Enrollment of an Individual); or (3) the individual was offered enrollment in the CLASS Program services because the individual was is residing in a nursing facility but and the individual was discharged from the nursing facility before the effective date of the enrollment IPC. TITLE 1 ADMINISTRATIONPART 15 TEXAS HEALTH AND HUMAN SERVICES COMMISSIONCHAPTER 353 MEDICAID MANAGED CARESUBCHAPTER M HOME AND COMMUNITY BASED SERVICES IN MANAGED CARE§353.1155. Medically Dependent Children Program.(a) This section applies to the Medically Dependent Children Program (MDCP) services provided under a Medicaid managed care program. The rules under 40 TAC, Chapter 51 (relating to Medically Dependent Children Program) do not apply to MDCP services provided under a Medicaid managed care program. (a) (b) An MCO assesses an individual's eligibility for MDCP. (1) To be eligible for MDCP, an individual must: (A) be under 21 years of age; (B) reside in Texas; (C) meet the level of care level-of-care criteria for medical necessity for nursing facility care as determined by HHSC; (D) have an unmet need for support in the community that can be met through one or more MDCP services service; (E) choose MDCP as an alternative to nursing facility services, as described in 42 CFR §441.302(d); (F) not be enrolled in one of the following another Medicaid HCBS waiver programs program approved by CMS: ; (i) the Community Living Assistance and Support Services (CLASS) Program;(ii) the Deaf Blind with Multiple Disabilities (DBMD) Program;(iii) the Home and Community-based Services (HCS) Program; (iv) the Texas Home Living (TxHmL) Program; or(v) the Youth Empowerment Services waiver; (G) live in:(i) the individual’s home; or(ii) an agency foster home; and (G) if the individual is under 18 years of age, reside: (i) with a family member; or (ii) in a foster home that includes no more than four children unrelated to the individual; and (H) be determined by HHSC to be financially eligible for Medicaid under Chapter 358 of this title (relating to Medicaid Eligibility for the Elderly and People with Disabilities), Chapter 360 of this title (relating to Medicaid Buy-In Program), or Chapter 361 of this title (relating to Medicaid Buy-In for Children Program). (2) An individual receiving Medicaid nursing facility services is approved for MDCP if the individual requests services while residing in a the nursing facility and meets the eligibility criteria listed in paragraph (1) of this subsection. If an the individual is discharged from a the nursing facility into for a community setting before being determined eligible for Medicaid nursing facility services and MDCP, the individual is denied immediate enrollment in the program. (b) (c) HHSC maintains a statewide interest list of individuals interested in receiving services through MDCP. (1) A person may request that an individual's name be added to the MDCP interest list by: (A) calling HHSC toll-free 1-877-438-5658; (B) submitting a written request to HHSC; or (C) generating a referral through the , Find Support Services screening and referral tool. (2) If a request is made in accordance with paragraph (1) of this subsection, HHSC adds an individual’s name to the MDCP interest list:(A) if the individual is a Texas resident; and(B) using the date HHSC receives the request as the MDCP interest list date. (3) For an individual determined diagnostically or functionally ineligible during the enrollment process for the CLASS Program, DBMD Program, HCS Program, or TxHmL Program:(A) if the individual’s name is not on the MDCP interest list, at the request of the individual or LAR, HHSC adds the individual’s name to the MDCP interest list using the individual’s interest list date for the waiver program for which the individual was determined ineligible as the MDCP interest list date;(B) if the individual’s name is on the MDCP interest list and the individual’s interest list date for the waiver program for which the individual was determined ineligible is earlier than the individual’s MDCP interest list date, at the request of the individual or LAR, HHSC changes the individual’s MDCP interest list date to the individual’s interest list date for the waiver program for which the individual was determined ineligible; or(C) if the individual’s name is on the MDCP interest list and the individual’s MDCP interest list date is earlier than the individual’s interest list date for the waiver program for which the individual was determined ineligible, HHSC does not change the individual’s MDCP interest list date.(4) This paragraph applies to an individual who is enrolled in MDCP and, because the individual does not meet the level of care criteria for medical necessity for nursing facility care, is determined ineligible for MDCP after November 30, 2019 and before the date Texas Government Code §531.0601 expires. The individual or the individual’s LAR may request one time that HHSC add the individual’s name to the first position on the MDCP interest list. (5) This paragraph applies to an individual who is enrolled in MDCP and, because the individual does not meet the level of care criteria for medical necessity for nursing facility care or the requirement to be under 21 years of age, is determined ineligible for MDCP after November 30, 2019 and before the date Texas Government Code §531.0601 expires. The individual or the individual’s LAR may request that HHSC add the individual’s name to the interest list for any of the following programs or change the individual’s interest list date for any of the following programs in accordance with:(A) 40 TAC §45.202 (relating to CLASS Interest List) for the CLASS Program; (B) 40 TAC §42.202 (relating to DBMD Interest List) for the DBMD Program;(C) 40 TAC §9.157 (relating to HCS Interest List) for the HCS Program; and(D) 40 TAC §9.566 (relating to TxHmL Interest List) for the TxHmL Program. (6) (2) HHSC removes an individual's name from the MDCP interest list if: (A) the individual is deceased; (B) the individual is assessed for MDCP the program and determined to be ineligible and has had an opportunity to exercise the individual’s right to a fair hearing, as described in Chapter 357 of this title (relating to Hearings); (C) the individual, medical consenter, or LAR requests in writing that the individual's name be removed from the interest list; or (D) the individual moves out of Texas, unless the individual is a military family member living outside of Texas as described in Texas Government Code §531.0931: (i) while the military member is on active duty; or (ii) for less than one year after the former military member's active duty ends.(7) An individual assessed for MCDP and determined to be ineligible, as described in paragraph (6)(B) of this subsection, may request to have the individual's name added to the MDCP interest list as described in paragraph (1) of this subsection. (3) An individual may request to be placed at the end of the interest list immediately following a determination of ineligibility.(c) (d) An The MCO develops a person-centered individual service plan (ISP) for each member in MDCP individual, and all applicable documentation, as described in the STAR Kids Handbook and the Uniform Managed Care Manual (UMCM). (1) An The ISP must: (A) include services described in the waiver approved by CMS; (B) include services necessary to protect a member’s the individual's health and welfare in the community; (C) include services that supplement rather than supplant the member’s individual's natural supports and other non-Medicaid supports and services for which the member individual may be eligible; (D) include services designed to prevent the member’s individual's admission to an institution; (E) include the most appropriate type and amount of services to meet the member’s individual's needs in the community; (F) be reviewed and revised if the member’s an individual's needs or natural supports change or at the request of the member or LAR individual or their legally authorized representative; and (G) be cost effective.(2) If a member’s If an individual's ISP exceeds 50 percent of the cost of the member’s individual's level of care in a nursing facility to safely serve the member’s individual's needs in the community, HHSC must review the circumstances and, when approved, provide funds through general revenue. (d) (e) An MCO is MCOs are responsible for conducting a reassessment reassessments and developing an ISP development for each member’s their enrollees' continued eligibility for MDCP, in accordance with the policies and procedures outlined in the STAR Kids Handbook, UMCM, or materials designated by HHSC and in accordance with the timeframes outlined in the MCO's contract. (e) (f) An MCO is MCOs are responsible for authorizing a provider of a member’s the individual's choosing to deliver services outlined in the member’s an individual's ISP. (f) (g) A member Individuals participating in MDCP has have the same rights and responsibilities as any member individual enrolled in managed care, as described in Subchapter C of this chapter title (relating to Member Bill of Rights and Responsibilities), including the right to appeal a decision made by HHSC or an MCO and the right to a fair hearing, as described in Chapter 357 of this title (relating to Hearings). (g) (h) HHSC conducts utilization reviews of MCOs providing MDCP services. ................
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