Texas Administrative Code
Title 26 - HEALTH AND HUMAN SERVICES
Part 1 - HEALTH AND HUMAN SERVICES COMMISSION
Chapter 262 - TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)
Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW
Section 262.101 - Eligibility Criteria for TxHmL Program Services and CFC Services
Universal Citation: 26 TX Admin Code ยง 262.101
Current through Reg. 49, No. 38; September 20, 2024
(a) An applicant or individual is eligible for TxHmL Program services if:
(1) the applicant or individual meets the
financial eligibility criteria as described in Appendix B of the TxHmL waiver
application approved by CMS and available on the HHSC website;
(2) the applicant or individual meets one of
the following criteria:
(A) based on a DID and
as determined by HHSC in accordance with §
262.104 of this subchapter
(relating to LOC Determination), the applicant or individual qualifies for an
ICF/IID LOC I as defined in §
261.238 of this title (relating to
ICF/MR Level of Care I Criteria); or
(B) meets the following criteria:
(i) based on a DID and as determined by HHSC
in accordance with §
262.105 of this subchapter
(relating to LON Assignment), qualifies for one of the following levels of
care:
(I) an ICF/IID LOC I as defined in
§
261.238 of this title;
or
(II) an ICF/IID LOC VIII as
defined in §
261.239 of this title (relating to
ICF/MR Level of Care VIII Criteria);
(ii) meets one of the following:
(I) resides in a nursing facility immediately
before enrolling in the TxHmL Program; or
(II) is at imminent risk of entering a
nursing facility as determined by HHSC; and
(iii) is offered TxHmL Program services
designated for a member of the reserved capacity group "Individuals with a
level of care I or VIII residing in a nursing facility" included in Appendix B
of the TxHmL Program waiver application approved by CMS and available on the
HHSC website;
(3) the applicant or individual has been
assigned an LON in accordance with §
262.105 of this
subchapter;
(4) the applicant or
individual has an IPC cost that does not exceed $17,000;
(5) the applicant or individual is not
enrolled in another waiver program and is not receiving a service that may not
be received if the individual is enrolled in the TxHmL Program, as identified
in the Mutually Exclusive Services table in Appendix I of the TxHmL Handbook
available on the HHSC website;
(6)
the applicant or individual has chosen, or the applicant's or individual's LAR
has chosen, participation in the TxHmL Program over participation in the
ICF/IID Program;
(7) the
applicant's or individual's service planning team concurs that the TxHmL
Program services and, if applicable, non-TxHmL Program services for which the
applicant or individual may be eligible are sufficient to ensure the
applicant's or individual's health and welfare in the community;
(8) the applicant or individual does not
reside in:
(A) a hospital;
(B) an ICF/IID;
(C) a nursing facility;
(D) an assisted living facility licensed or
subject to being licensed in accordance with THSC Chapter 247;
(E) a residential child care facility
licensed by HHSC unless it is an agency foster home;
(F) an inpatient chemical dependency
treatment facility;
(G) a mental
health facility;
(H) a residential
facility operated by the Texas Workforce Commission; or
(I) a residential facility operated by the
Texas Juvenile Justice Department, a jail, or a prison; and
(9) the applicant or individual requires the
provision of:
(A) at least one TxHmL Program
service per month or a monthly monitoring visit by a service coordinator as
described in §
262.701(o) of
this chapter (relating to LIDDA Requirements for Providing Service Coordination
in the TxHmL Program); and
(B) at
least one TxHmL Program service per IPC year.
(b) Except as provided in subsection (c) of this section, an applicant or individual is eligible for a CFC service under this subchapter if the applicant or individual:
(1) meets the criteria described in
subsection (a) of this section; and
(2) requires the provision of the CFC
service.
(c) To be eligible for a CFC service under this chapter, an applicant or individual receiving MAO Medicaid must, in addition to meeting the eligibility criteria described in subsection (b) of this section, receive a TxHmL Program service at least monthly, as required by 42 CFR § 441.510(d), which may not be met by a monthly monitoring visit by a service coordinator as described in § 262.701(o)(1) and (2) of this chapter.
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