Current through Reg. 49, No. 38; September 20, 2024
(a) HHSC maintains
an interest list that contains the names of individuals interested in receiving
DBMD Program services.
(b) A person
may request an applicant's name be added to the DBMD interest list by:
(1) calling HHSC's toll-free number;
or
(2) submitting a written request
to HHSC.
(c) If a request
is made in accordance with subsection (b) of this section for an individual who
resides in Texas, HHSC adds the 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
the individual'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 the individual'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.
(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.
(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.
(f) HHSC 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 an offer
of enrollment in the DBMD Program or, as described in §
260.55(e) of this
subchapter (relating to Written Offer of Enrollment in the DBMD Program), HHSC
withdraws an offer of enrollment in the DBMD Program, 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
has denied the individual enrollment in the DBMD Program and the individual or
LAR:
(A) has had an opportunity to exercise
the individual's right to appeal the decision in accordance with §
260.111 of this subchapter
(relating to Individual's Right to a Fair Hearing), and
(B) either:
(i) did not appeal the decision; or
(ii) appealed and did not prevail.
(g) If HHSC
removes an individual's name from the DBMD interest list in accordance with
subsection (f)(1) - (4) of this section, HHSC receives an oral or written
request from a person to add the individual's name to the DBMD interest list
within 90 calendar days after the name was removed, and the request is the
individual's first request, HHSC:
(1) adds the
individual's name to the DBMD interest list using the DBMD interest list date
that was in effect at the time the individual's name was removed from the DBMD
interest list; 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.
(h) If HHSC
removes an individual's name from the DBMD interest list in accordance with
subsection (f)(1) - (4) of this section, HHSC receives an oral or written
request from a person to add the individual's name to the DBMD interest list
more than 90 calendar days after the name was removed, and the request is the
individual's first request, HHSC:
(1) adds the
individual's name to the DBMD interest list using as the DBMD interest list
date:
(A) the date HHSC receives the oral or
written request; or
(B) because of
extenuating circumstances as determined by HHSC the DBMD interest list date
that was in effect at the time the individual's name was removed from the DBMD
interest list; 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) If HHSC
removes an individual's name from the DBMD interest list in accordance with
subsection (f)(6) of this section, HHSC receives an oral or written request
from a person to add the individual's name to the DBMD interest list, and the
request is not the individual's first request:
(1) HHSC adds the individual's name to the
DBMD interest list using the date HHSC receives the oral or written request as
the DBMD interest list date; and
(2) HHSC 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.
