Texas Administrative Code
Title 26 - HEALTH AND HUMAN SERVICES
Part 1 - HEALTH AND HUMAN SERVICES COMMISSION
Chapter 285 - USE OF GENERAL REVENUE FOR SERVICES EXCEEDING THE INDIVIDUAL COST LIMIT OF A WAIVER PROGRAM
Section 285.1 - Use of General Revenue for Services Exceeding the Individual Cost Limit of a Waiver Program

Universal Citation: 26 TX Admin Code § 285.1

Current through Reg. 49, No. 38; September 20, 2024

(a) The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:

(1) Waiver program--A program administered by the Department of Aging and Disability Services (DADS), other than the Texas Home Living Program, that provides services under a waiver granted by the Centers for Medicare and Medicaid Services in accordance with §1915(c) of the Social Security Act.

(2) General revenue--State funds appropriated by the Texas Legislature for use by DADS.

(3) Individual--A person applying for or enrolled in a waiver program.

(b) DADS may use general revenue to pay for services above the individual cost limit of a waiver program for an individual if DADS determines:

(1) the individual needs services that exceed the individual cost limit because the individual's health and safety cannot be protected by the services provided within the individual cost limit;

(2) the individual receives waiver services at the individual cost limit;

(3) federal financial participation is not available to pay for services above the individual cost limit; and

(4) there is no other available living arrangement in which the individual's health and safety can be protected, as evidenced by:

(A) an assessment conducted by DADS clinical staff; and

(B) supporting documentation, including the individual's medical and service records.

(1) the same service array offered by the waiver program in which the individual is enrolled;

(2) necessary to protect the individual's health and safety;

(3) authorized using the waiver program's criteria; and

(4) unavailable through other funding sources.

(d) For an individual who has been receiving waiver program services since September 1, 2005, at a cost that exceeded the individual cost limit of the waiver program, DADS uses general revenue to pay for services above the individual cost limit if:

(1) the services above the individual cost limit are necessary for the individual to live in the most integrated setting appropriate to the individual's needs; and

(2) federal financial participation is not available to pay for the services above the individual cost limit.

Disclaimer: These regulations may not be the most recent version. Texas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.