Current through Reg. 49, No. 38; September 20, 2024
(a) HHSC notifies a
LIDDA, in writing, when the opportunity for enrollment in the TxHmL Program
becomes available in the LIDDA's local service area and directs the LIDDA to
offer enrollment to the applicant:
(1) whose
interest list date, assigned in accordance with §
262.102 of this subchapter
(relating to TxHmL Interest List), is earliest on the statewide interest list
for the TxHmL Program as maintained by HHSC;
(2) whose name is not coded in the HHSC 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 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 LIDDA must offer enrollment in the TxHmL Program in writing and
deliver it to the applicant or LAR by United States mail or by hand
delivery.
(c) A LIDDA must offer
enrollment in the TxHmL Program to an applicant described in subsection (a)(2)
or (3) of this section in accordance with HHSC's procedures.
(d) A 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 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 TxHmL Program, the LIDDA terminates
those services that are similar to services provided in the TxHmL Program;
and
(2) the HHSC
Deadline Notification form, which is available on the HHSC
website.
(e) If an
applicant or LAR responds to an offer of enrollment in the TxHmL Program, a
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;
(2) provide the applicant and LAR both an
oral and a written explanation of all TxHmL Program services and CFC services
using the HHSC Understanding Program Eligibility and Services form, which is
available on the HHSC website; and
(3) give the applicant or LAR the HHSC Waiver
Program Verification of Freedom of Choice form, which is available on the HHSC
website to document the applicant's choice between the TxHmL Program or the
ICF/IID Program.
(f) A
LIDDA must withdraw an offer of enrollment in the TxHmL Program 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;
(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)(3) of this
section, the applicant or LAR does not use the form to document the applicant's
choice of the TxHmL Program;
(3)
within 30 calendar days after the applicant or LAR receives the contact
information regarding all available program providers in the LIDDA's local
service area in accordance with subsection (k)(2)(A) 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;
(4) the applicant or LAR
does not complete the necessary activities to finalize the enrollment process
and HHSC has approved the withdrawal of the offer; or
(5) the applicant has moved out of the State
of Texas.
(g) If a LIDDA
withdraws an offer of enrollment in the TxHmL Program 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
applicant is currently receiving services from a LIDDA that are funded by
general revenue and the applicant declines the offer of enrollment in the TxHmL
Program, the LIDDA must terminate those services that are similar to services
provided in the TxHmL Program.
(i)
If a 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 40 TAC §
2.46(relating to Notification and
Appeals Process).
(j) A LIDDA must
retain in an applicant's record:
(1) the HHSC
Waiver Program Verification of Freedom of Choice form;
(2) the HHSC Documentation of Provider Choice
form;
(3) the HHSC Deadline
Notification form; and
(4) any
correspondence related to the offer of enrollment in the TxHmL
Program.
(k) If an
applicant or LAR accepts the offer of enrollment 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 in accordance with §
262.104(a)(1) of
this subchapter (relating to LOC Determination).
(A) The LIDDA must:
(i) do one of the following:
(I) conduct a DID in accordance with §
304.401 of this title (relating to
Conducting a Determination of Intellectual Disability) except that the
following activities must be conducted in person:
(-a-) a standardized measure of the
individual's intellectual functioning using an appropriate test based on the
characteristics of the individual; and
(-b-) a standardized measure of the
individual's adaptive abilities and deficits reported as the individual's
adaptive behavior level; or
(II) review and endorse a DID report in
accordance with §
304.403 of this title (relating to
Review and Endorsement of a Determination of Intellectual Disability Report);
and
(ii) determine
whether the applicant has been diagnosed by a licensed physician as having a
related condition.
(B)
The LIDDA must:
(i) conduct an ICAP assessment
in person; and
(ii) recommend an
LON assignment to HHSC in accordance with §
262.105 of this subchapter
(relating to LON Assignment).
(C) The LIDDA must enter the information from
the completed ID/RC Assessment in the HHSC data system and electronically
submit the information to HHSC in accordance with §
262.104(a)(2) of
this subchapter and §
262.105(a) of
this subchapter and submit supporting documentation as required by §
262.106 of this subchapter
(relating to HHSC Review of LON).
(2) The LIDDA must:
(A) provide names and contact information to
the applicant or LAR for all program providers in the LIDDA's local service
area;
(B) arrange for meetings or
visits with potential program providers as requested by the applicant or the
LAR; and
(C) 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 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 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.
(4) The CFC PAS/HAB assessment form required
by paragraph (3)(B) of this subsection must be completed in person with the
individual unless the following conditions are met, in which case the form may
be completed by videoconferencing or telephone:
(A) the service coordinator gives the
individual the opportunity to complete the form in person in lieu of completing
it by videoconferencing or telephone and the individual agrees to the form
being completed by videoconferencing or telephone; and
(B) the individual receives appropriate
in-person support during the completion of the form by videoconferencing or
telephone.
(l)
A service coordinator must:
(1) in accordance
with 40 TAC Chapter 41, Subchapter D (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 40 TAC §
41.108(relating to Services
Available Through the CDS Option); and
(2) if the applicant or LAR chooses to
participate in the CDS option, comply with §
262.701(r) of
this chapter (relating to LIDDA Requirements for Providing Service Coordination
in the TxHmL Program).
(m) The service coordinator must develop an
initial IPC with the applicant or LAR based on the PDP and in accordance with
§
262.301 of this chapter (relating
to IPC Requirements).
(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 initial
IPC with potential program providers as requested by the applicant or the
LAR.
(o) A service coordinator
must:
(1) ensure that the initial IPC
includes a sufficient number of RN nursing units for the program provider's RN
to perform a comprehensive nursing assessment, unless:
(A) nursing services are not on the initial
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; 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;
(2) if an
applicant or LAR refuses to include a sufficient number of RN nursing units on
the initial IPC for the program provider's RN to perform a comprehensive
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:
(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 initial IPC for a comprehensive nursing assessment by the program
provider's RN in the applicant's record;
(3) negotiate and finalize the initial IPC
and the date services will begin with the selected program provider, consulting
with HHSC if necessary to reach agreement with the selected program provider on
the content of the initial IPC and the date services will begin;
(4) ensure that the applicant or LAR signs
and dates the initial IPC and provides the signed and dated IPC to the service
coordinator in person, electronically, by fax, or by United States
mail;
(5) ensure that the selected
program provider signs and dates the initial IPC, demonstrating agreement that
the services will be provided to the applicant; and
(6) sign and date the initial IPC to
demonstrate that the service coordinator agrees that the requirements described
in §
262.301(c) of
this chapter have been met.
(p) A service coordinator must:
(1) provide an oral and written explanation
to the applicant or LAR of the following information using the HHSC
Understanding Program Eligibility and Services form, which is available on the
HHSC website:
(A) the eligibility requirements
for TxHmL Program services as described in §
262.101(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 §
262.101(b) of
this subchapter to applicants who do not receive MAO Medicaid; and
(ii) the eligibility requirements for CFC
services as described in §
262.101(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 §
262.507 of this chapter (relating
to Termination of TxHmL Program Services and CFC Services with Advance Notice)
and §
262.508 of this chapter (relating
to Termination of TxHmL Program Services and CFC Services without Advance
Notice); and
(B) if the applicant's
PDP includes CFC services, the reasons CFC services may be terminated as
described in §
262.507 and §
262.508 of this chapter.
(q) After an initial IPC
is finalized and signed in accordance with subsection (o) of this section, the
LIDDA must:
(1) enter the information from the
initial IPC in the HHSC data system and electronically submit the information
to HHSC;
(2) keep the original
initial IPC in the individual's record;
(3) ensure the information from the initial
IPC entered in the HHSC data system and electronically submitted to HHSC
contains information identical to the information on the initial IPC;
and
(4) submit other required
enrollment information to HHSC;
(r) HHSC 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. If the enrollment is
approved, HHSC authorizes the applicant's enrollment in the TxHmL Program
through the HHSC data system and issues an enrollment letter to the applicant
that includes the effective date of the applicant's enrollment in the TxHmL
Program.
(s) The selected program
provider and the individual or LAR must develop:
(1) an implementation plan for:
(A) TxHmL Program services, except for
community support, that is based on the individual's PDP and initial 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 HCS/TxHmL CFC PAS/HAB
Assessment form; and
(2)
a transportation plan, if community support is included on the PDP.
(t) Before the applicant's service
begin date, a 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 IPC;
(4) the applicant's PDP; and
(5) if CFC PAS/HAB is included on the PDP, a
copy of the completed HHSC HCS/TxHmL CFC PAS/HAB Assessment
form.
(u) In accordance
with §
262.401(a)(5)(N)
of this chapter (relating to Program Provider Reimbursement), if a selected
program provider provides services before the date of an applicant's enrollment
into the TxHmL Program, HHSC does not pay the program provider for the
services.
