Current through Reg. 50, No. 13; March 28, 2025
(a)
HHSC notifies a LIDDA, in writing, when the opportunity for enrollment in the
HCS Program becomes available in the LIDDA's local service area and directs the
LIDDA to offer enrollment to an applicant:
(1)
whose interest list date, assigned in accordance with §
263.103 of this subchapter
(relating to HCS Interest List), is earliest on the statewide interest list for
the HCS Program maintained by HHSC; or
(2) who is a member of a target group
identified in the HCS Program waiver application approved by
CMS.
(b) Except as
provided in subsection (c) of this section, a LIDDA must offer enrollment in
the HCS 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 HCS
Program to an applicant described in subsection (a)(2) 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 HCS 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 HCS Program, the LIDDA terminates
those services funded by general revenue that are similar to services provided
in the HCS 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 HCS 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 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 HCS 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 HCS Program or the
ICF/IID Program.
(f) A
LIDDA must withdraw an offer of enrollment in the HCS 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 HCS 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, the HCS Program or the ICF/IID Program;
(3) within 30 calendar days after the
applicant or LAR receives the contact information for all program providers in
the LIDDA's local service area in accordance with subsection (j)(3) of this
section, the applicant or LAR does not document the 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 HCS 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 or LAR declines the offer of enrollment in the HCS Program,
the LIDDA must terminate those services funded by general revenue that are
similar to services provided in the HCS 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 §
301.155 of this title (relating to
Notification and Appeals Process).
(j) If an applicant or LAR accepts the offer
of enrollment in the HCS Program, the LIDDA must compile and maintain
information necessary to process the applicant's request for enrollment.
(1) If the applicant's financial eligibility
for the HCS Program must be established, the LIDDA must initiate, monitor, and
support the processes necessary to obtain a financial eligibility
determination.
(2) The LIDDA must
complete an ID/RC Assessment in accordance with §
263.105 of this subchapter
(relating to LOC Determination) and §
263.106 of this subchapter
(relating to LON Assignment).
(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 §
263.106 of this
subchapter.
(C) The LIDDA
must enter the information from the completed ID/RC Assessment and
electronically submit the information to HHSC for approval in accordance with
§
263.105(a) of
this subchapter and §
263.106(a) of
this subchapter and, if applicable, submit supporting documentation as required
by §
263.107(c) of
this subchapter (relating to HHSC Review of LON).
(3) The LIDDA must provide names and contact
information to the applicant or LAR for all program providers in the LIDDA's
local service area.
(4) The LIDDA
must assign a service coordinator who, together with other members of the
applicant's service planning team, must:
(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; and
(C) develop an initial IPC in accordance with
§
263.301(c) of
this chapter (relating to IPC Requirements).
(5) The CFC PAS/HAB Assessment form required
by paragraph (4)(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.
(6) A service
coordinator must discuss the CDS option with the applicant or LAR in accordance
with §
263.401(a) and
(b) of this chapter (relating to CDS
Option).
(k) A service
coordinator must:
(1) arrange for meetings and
visits with potential program providers as requested by an applicant or
LAR;
(2) review the initial IPC
with potential program providers as requested by the applicant or
LAR;
(3) 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;
(4) 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;
(5) determine
whether the applicant meets the following criteria:
(A) is being discharged from a nursing
facility, an ICF/IID, or a GRO; and
(B) anticipates needing
TAS;
(6) if the service
coordinator determines that the applicant meets the criteria described in
paragraph (5) of this subsection:
(A)
complete, with the applicant or LAR and the selected program provider, the HHSC
Transition Assistance Services (TAS) Assessment and Authorization form, which
is available on the HHSC website, in accordance with the form's instructions,
which includes:
(i) identifying the TAS the
applicant needs; and
(ii)
estimating the monetary amount for each transition assistance service
identified, which must be within the service limit described in §
263.304(a)(6) of
this chapter (relating to Service Limits);
(B) submit the completed form to HHSC to
determine if TAS is authorized;
(C)
send the form authorized by HHSC to the selected program provider;
and
(D) include the TAS and the
monetary amount authorized by HHSC on the applicant's initial
IPC;
(7) determine
whether an applicant meets the following criteria:
(A) is being discharged from a nursing
facility, an ICF/IID, or a GRO;
(B)
has not met the maximum service limit for minor home modifications as described
in §
263.304(a)(3)(A)
of this chapter; and
(C)
anticipates needing pre-enrollment minor home modifications and a
pre-enrollment minor home modifications assessment;
(8) if the service coordinator determines
that an applicant meets the criteria described in paragraph (7) of this
subsection:
(A) complete, with the applicant
or LAR and selected program provider, the HHSC Home and Community-based
Services (HCS) Program Pre-enrollment MHM Authorization Request form, which is
available on the HHSC website, in accordance with the form's instructions,
which includes:
(i) identifying the
pre-enrollment minor home modifications the applicant needs;
(ii) identifying the pre-enrollment minor
home modifications assessments conducted by the program provider; and
(iii) based on documentation provided by the
program provider as required by the
HCS Program Billing
Requirements, stating the cost of:
(I) the pre-enrollment minor home
modifications identified on the form, which must be within the service limit
described in §
263.304(a)(3)(A)
of this chapter; and
(II) the
pre-enrollment minor home modifications assessments
conducted;
(B)
submit the completed form to HHSC to determine if pre-enrollment minor home
modification and pre-enrollment minor home modifications assessments are
authorized;
(C) send the form
authorized by HHSC to the selected program provider; and
(D) include the pre-enrollment minor home
modifications, pre-enrollment minor home modifications assessments, and the
monetary amount for these services authorized by HHSC on the applicant's
initial IPC;
(9) if an
applicant or LAR chooses a program provider to deliver supported home living,
nursing, host home/companion care, residential support, supervised living,
respite, employment assistance, supported employment, employment readiness,
in-home day habilitation, day habilitation, or CFC PAS/HAB, 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 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;
(10) if an
applicant or LAR refuses to include on the initial IPC a sufficient number of
RN nursing units for the program provider's RN to perform a comprehensive
nursing assessment as required by paragraph (9) 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 host
home/companion care, residential support, supervised living, supported home
living, respite, employment assistance, supported employment, employment
readiness, in-home day habilitation, day habilitation, or CFC PAS/HAB from the
program provider, will result in the individual not receiving that 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;
(11) 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;
(12) ensure that the selected
program provider signs and dates the initial IPC, demonstrating agreement that
the services will be provided to the applicant;
(13) sign and date the initial IPC, which
indicates that the service coordinator agrees that the requirements described
in §
263.301(c) of
this chapter have been met;
(14)
using the HHSC Understanding Program Eligibility and Services form, which is
available on the HHSC website, provide an oral and written explanation to the
applicant or LAR:
(A) of the eligibility
requirements for HCS Program services as described in §
263.101(a) of
this subchapter (relating to Eligibility Criteria for HCS Program Services and
CFC Services);
(B) if the
applicant's PDP includes CFC services:
(i) of
the eligibility requirements for CFC services as described in §
263.101(c) of
this subchapter to applicants who do not receive MAO Medicaid; and
(ii) of the eligibility requirements for CFC
services as described in §
263.101(d) of
this subchapter to applicants who receive MAO Medicaid;
(C) that HCS Program services may be
terminated if:
(i) the individual no longer
meets the eligibility criteria described in §
263.101(a) of
this subchapter; or
(ii) the
individual or LAR requests termination of HCS Program services;
and
(D) if the
applicant's PDP includes CFC services, that CFC services may be terminated if:
(i) the individual no longer meets the
eligibility criteria described in §
263.101(c) or (d)
of this subchapter; or
(ii) the
individual or LAR requests termination of CFC
services.
(l) A LIDDA must conduct permanency planning
in accordance with §
263.902(a) - (f)
of this chapter (relating to Permanency Planning).
(m) After an initial IPC is finalized and
signed in accordance with subsection (k) of this section, the LIDDA must:
(1) enter the information from the initial
IPC in the HHSC data system and electronically submit it 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.
(n)
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. When the enrollment is approved, HHSC authorizes the applicant's
enrollment in the HCS 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 HCS Program.
(o) Before the applicant's service begin
date, the 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;
(4) the applicant's PDP; and
(5) if CFC PAS/HAB is included on the PDP,
the completed HHSC HCS/TxHmL CFC PAS/HAB Assessment form.
(p) Except for the provision of TAS,
pre-enrollment minor home modifications, and a pre-enrollment minor home
modifications assessment, the selected program provider must not initiate
services until notified of HHSC's approval of the applicant's
enrollment.
(q) The selected
program provider and the individual or LAR must develop:
(1) an implementation plan for:
(A) HCS Program services, except for
supported home living, that is based on the individual's PDP and 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 supported home living is included on the
PDP.
(r) 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, if applicable;
(3) the HHSC
Deadline Notification form; and
(4)
any other correspondence related to the offer of enrollment in the HCS
Program.