Current through Reg. 49, No. 38; September 20, 2024
(a) Except as provided in subsection (b) of
this section, only an MRA may request enrollment of an applicant by
DADS.
(b) A program provider may
request enrollment of an applicant by DADS in accordance with subsection (k) of
this section if the applicant:
(1) has
received ICF/MR services from a non-state operated facility during the 180 days
before the enrollment request; and
(2) is not moving from or seeking admission
to a state school or state center.
(c) An MRA must request an applicant's
enrollment if:
(1) the program provider
selected by the applicant or LAR notifies the MRA in writing that admission to
the program provider's facility has been offered to the applicant;
and
(2) the applicant or LAR
notifies the MRA that the applicant or LAR chooses to accept the admission
offered by the program provider.
(d) If an MRA receives the notifications
described in subsection (c) of this section, the MRA must comply with §5.159(c)
of Title 40 (relating to Assessment of Individual's Need for Services and
Supports) including providing an explanation to the applicant or LAR of the
services and supports for which the applicant may be eligible. For an applicant
under 22 years of age, an MRA must also comply with the following requirements:
(1) Except as provided in paragraphs (2) and
(3) of this subsection, before placement of an applicant in a facility, the MRA
must inform the LAR:
(A) of the benefits of
living in a family or community setting;
(B) that the placement of the applicant is
considered temporary; and
(C) that
an ongoing permanency planning process is required.
(2) If an MRA is notified of a request for
enrollment after the applicant is admitted to the facility, the MRA must
provide the information described in paragraph (1) of this subsection to the
LAR not later than the 14th working day after the date the MRA is notified of
the request for the enrollment, unless this time period is extended by the
LAR.
(3) An MRA does not have to
comply with paragraph (1) or (2) of this subsection if the applicant has been
committed to a facility under Chapter 46B, Code of Criminal Procedure, or
Chapter 55, Family Code.
(e) To request an applicant's enrollment, an
MRA must, within 15 working days after the MRA receives both notifications
described in subsection (c) of this section:
(1) initiate, monitor, and support the
processes necessary to obtain a financial eligibility determination for the
applicant if Medicaid financial eligibility has not been established;
(2) obtain an ICAP score for the applicant
by:
(A) reviewing and endorsing an existing
ICAP for the applicant; or
(B)
administering the ICAP if an ICAP score for the applicant does not exist, is
not available, or is not endorsed by the MRA; and
(3) request or review an LOC determination
and LON for the applicant by:
(A) completing
and electronically submitting an MR/RC Assessment, if the applicant does not
have a current LOC determination; or
(B) reviewing the existing MR/RC Assessment
for the applicant if the applicant has a current LOC determination and:
(i) if the MRA does not endorse the existing
MR/RC Assessment, completing and electronically submitting a new MR/RC
Assessment recommending a revised LOC or LON; or
(ii) if the MRA endorses the existing MR/RC
Assessment, notifying the selected program provider in writing that no changes
to the current LOC or LON are recommended.
(f) Upon notification of a request
for enrollment of an applicant under 22 years of age, an MRA must take or
ensure that the following actions are taken to conduct permanency planning:
(1) The MRA must convene a permanency
planning meeting with the LAR and, if possible, the applicant before admission
or, if notified of a request for enrollment after the applicant's admission,
not later than the 14th working day after the date the MRA is notified of the
request.
(2) Before the permanency
planning meeting, the MRA staff must review the applicant's records and, if
possible, meet the applicant.
(3)
During the permanency planning meeting, the meeting participants must discuss
and choose one of the following goals:
(A)
for an applicant under 18 years of age:
(i)
to live in the applicant's family home where the natural supports and strengths
of the applicant's family are supplemented, as needed, by activities and
supports provided or facilitated by the MRA or program provider; or
(ii) to live in a family-based alternative in
which a family other than the applicant's family:
(I) has received specialized training in the
provision of support and in-home care for an individual under 18 years of age
with mental retardation;
(II) will
provide a consistent and nurturing environment in a family home that supports a
continued relationship with the applicant's family to the extent possible;
and
(III) if necessary, will
provide an enduring, positive relationship with a specific adult who will be an
advocate for the applicant; or
(B) for an applicant 18-22 years of age, to
live in a setting chosen by the applicant or LAR in which the applicant's
natural supports and strengths are supplemented by activities and supports
provided or facilitated by the MRA or program provider, and to achieve a
consistent and nurturing environment in the least restrictive setting, as
defined by the applicant and LAR.
(4) To accomplish the goal chosen in
accordance with paragraph (3) of this subsection, the meeting participants must
discuss and identify:
(A) the problems or
issues that led the applicant or LAR to request admission to a
facility;
(B) the applicant's daily
support needs;
(C) for an applicant
under 18 years of age:
(i) barriers to having
the applicant reside in the family home;
(ii) supports that would be necessary for the
applicant to remain in the family home; and
(iii) actions that must be taken to overcome
the barriers and provide the necessary supports;
(D) for an applicant 18-22 years of age, the
barriers to the applicant moving to a consistent and nurturing environment as
defined by the applicant and LAR;
(E) the importance for the applicant to live
in a long-term nurturing relationship with a family;
(F) alternatives to the applicant living in
an institutional setting;
(G) the
applicant's and LAR's need for information and preferences regarding those
alternatives;
(H) how, after
admission to the facility, to facilitate regular contact between the applicant
and the applicant's family, and, if desired by the applicant and family,
between the applicant and advocates and friends in the community to continue
supportive and nurturing relationships;
(I) natural supports and family strengths
that will assist in accomplishing the identified permanency planning
goal;
(J) activities and supports
that can be provided by the family, MRA, or program provider to achieve the
permanency planning goal;
(K)
assistance needed by the applicant's family:
(i) in maintaining a nurturing relationship
with the applicant; and
(ii)
preparing the family for the applicant's eventual return to the family home or
move to a family-based alternative; and
(L) action steps, both immediate and long
term, for achieving the permanency plan goal.
(5) The MRA must make reasonable
accommodations to promote the participation of the LAR in a permanency planning
meeting, including:
(A) conducting a meeting
in person or by telephone, as mutually agreed upon by the MRA and
LAR;
(B) conducting a meeting at a
time and, if the meeting is in person, at a location that is mutually agreed
upon by the MRA and LAR;
(C) if the
LAR has a disability, providing reasonable accommodations in accordance with
the Americans with Disabilities Act, including providing an accessible meeting
location or a sign language interpreter, if appropriate; and
(D) providing a language interpreter, if
appropriate.
(6) The MRA
must develop a permanency plan using, as appropriate:
(A) the Permanency Planning Instrument for
Children Under 18 Years of Age; or
(B) the Permanency Planning Instrument for
Individuals 18-22 Years of Age.
(7) The MRA must:
(A) complete the Permanency Planning Review
Screen in CARE before an applicant is admitted to a facility unless the MRA is
not given prior notice of the admission;
(B) keep a copy of the Permanency Planning
Review Approval Status View Screen from CARE in the applicant's record;
and
(C) provide a copy of the
permanency plan to the program provider, the applicant, and the LAR.
(g) If an applicant is
under 22 years of age, the MRA must inform the applicant and LAR that they may
request a volunteer advocate to assist in permanency planning. The applicant or
LAR may:
(1) select a person who is not
employed by or under contract with the MRA or a program provider; or
(2) request the MRA to designate a volunteer
advocate.
(h) If an
applicant or LAR requests that the MRA designate a volunteer advocate or the
MRA cannot locate the LAR, the MRA must attempt to designate a volunteer
advocate to assist in permanency planning who is, in order of preference:
(1) an adult relative who is actively
involved with the applicant;
(2) a
person who:
(A) is part of the applicant's
natural support network; and
(B) is
not employed by or under contract with the MRA or a program provider;
or
(3) a person or a
child advocacy organization representative who:
(A) is knowledgeable about community services
and supports;
(B) is familiar with
the permanency planning philosophy and processes; and
(C) is not employed by or under contract with
the MRA or a program provider.
(i) If the MRA is unable to locate a
volunteer advocate locally, the MRA must request assistance from a statewide
advocacy organization in identifying an available volunteer advocate who meets
the requirements described in subsection (h) of this section. If the statewide
advocacy organization is unable to assist the MRA in identifying a volunteer
advocate, the MRA must document all efforts to designate a volunteer advocate
in accordance with subsection (h) of this section.
(j) If DADS notifies an MRA that it has
authorized an applicant's LOC, the MRA must immediately notify the applicant or
LAR of such authorization and provide the selected program provider with copies
of all enrollment documentation and associated supporting documentation
including relevant assessment results and recommendations and the applicant's
ICAP booklet and, if available, the applicant's service plan.
(k) To request an applicant's enrollment as
permitted by subsection (b) of this section, a program provider must ensure
that the applicant has a current LOC.
(1) If
an applicant does not have a current LOC, the program provider must complete
and electronically submit an MR/RC Assessment to DADS.
(2) If the program provider submits an MR/RC
Assessment, DADS notifies the program provider electronically if the LOC is
authorized or sends written notification to the program provider and the
applicant or LAR if the LOC is denied.
(l) An applicant's enrollment is complete if:
(1) DADS has authorized an LOC for the
applicant;
(2) the Social Security
Administration has determined that the applicant is eligible for SSI or the
Health and Human Services Commission determines the applicant is financially
eligible for Medicaid;
(3) the
program provider has electronically submitted a completed Client Movement Form
to DADS; and
(4) admission to the
facility has been approved by the DADS commissioner or designee for the
applicant who is under 22 years of age, based on information submitted as
described in subsection (f) of this section.
(m) A program provider must maintain a paper
copy of the completed MR/RC Assessment with all the necessary signatures and
documentation supporting the recommended LOC and LON.
