Texas Administrative Code
Title 26 - HEALTH AND HUMAN SERVICES
Part 1 - HEALTH AND HUMAN SERVICES COMMISSION
Chapter 259 - COMMUNITY LIVING ASSISTANCE AND SUPPORT SERVICES (CLASS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES
Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW
Division 1 - ELIGIBILITY AND MAINTENANCE OF THE CLASS INTEREST LIST
Section 259.51 - Eligibility Criteria for CLASS Program Services and CFC Services
Universal Citation: 26 TX Admin Code ยง 259.51
Current through Reg. 49, No. 38; September 20, 2024
(a) An individual is eligible for CLASS Program services if:
(1)
the individual meets the financial eligibility criteria described in Appendix B
of the CLASS Program waiver application approved by CMS and available on the
HHSC website;
(2) the individual is
determined by HHSC to meet the LOC VIII criteria described in §
261.239 of this title (relating to
ICF/MR Level of Care VIII Criteria);
(3) the individual demonstrates a need for
CFC PAS/HAB;
(4) the individual's
IPC has an IPC cost for CLASS Program services at or below
$114,736.07;
(5) the individual is
not enrolled in another waiver program or receiving a service that may not be
received if the individual is enrolled in the CLASS Program, as identified in
the Mutually Exclusive Services table in Appendix III of the Community Living
Assistance and Support Services Provider Manual available on the HHSC
website;
(6) the individual resides
in the individual's own home or family home; and
(7) the individual requires the provision of:
(A) at least one CLASS Program service per
month or a monthly monitoring by a case manager; and
(B) at least one CLASS Program service during
an IPC period.
(b) Except as provided in subsection (c) of this section, an individual is eligible for a CFC service under this chapter if the individual:
(1) meets the criteria
described in subsection (a) of this section;
(2) requires the provision of the CFC
service; and
(3) is not receiving
SFS or CFS.
(c) To be eligible for a CFC service under this chapter, an individual receiving MAO Medicaid must, in addition to meeting the eligibility criteria described in subsection (b) of this section, receive a CLASS Program service at least monthly, as required by 42 CFR § 441.510(d).
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