Texas Administrative Code
Title 26 - HEALTH AND HUMAN SERVICES
Part 1 - HEALTH AND HUMAN SERVICES COMMISSION
Chapter 352 - COMPREHENSIVE REHABILITATION SERVICES
Section 352.14 - Consumer (Client) Participation

Universal Citation: 26 TX Admin Code ยง 352.14

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

(a) The consumer (client) participation is a monthly contribution the consumer (client) may be required to pay for participation in the Comprehensive Rehabilitation Services (CRS) Program. Consumer participation applies to consumers in active services, as well as those on the interest list who are both eligible and receiving services.

(b) The consumer participation is required only for CRS consumers when the consumer's liquid assets exceed the basic living requirement (BLR) level calculated by the CRS Program, and consequently require the consumer to contribute an amount equal to this excess toward the cost of the goods and services provided by the CRS Program. The BLR calculation is based on:

(1) 200 percent of current U. S. Department of Health and Human Services Poverty Guidelines;

(2) DARS BLR tables for the current fiscal year;

(3) DARS policies relating to consumer participation and BLR; and

(4) information regarding the consumer's income, family status, and economic need.

(c) The CRS Program calculates the amount of the consumer participation owed by the consumer for the goods and services that are provided, regardless of the availability of private insurance or other third-party payer reimbursements. The consumer's obligation for payment of any deductible, co-payment, or coinsurance is limited to the monthly consumer participation amount.

(d) The consumer participation calculation will take into account:

(1) the net monthly income and liquid assets of the consumer and the consumer's spouse, parents, or legal guardian or conservator;

(2) allowable expenses, such as monthly home mortgage or rental payments, prescribed diets and medicines used by the consumer, debts imposed by court order; and

(3) family size.

(e) The consumer participation must not exceed the cost of the services provided by the CRS Program in a given month, and it is applied only in months that billable goods and services are provided by the CRS Program.

(f) The consumer participation must be paid to the service provider by the consumer directly.

(g) The consumer participation will be deducted from the amount paid to the service provider by the CRS Program and must be reflected in the service authorization given to the provider by the CRS Program.

(h) The consumer may choose not to disclose financial information, but doing so may result in the presumption that the consumer has adequate resources to participate fully in the cost of CRS goods and services.

(i) The consumer participation does not apply:

(1) when the consumer is eligible for Supplemental Security Income or Social Security Disability Income.

(2) to certain services, including:
(A) assessments for determining eligibility;

(B) assessments for determining rehabilitation needs, including associated maintenance and transportation;

(C) rehabilitation counseling and guidance and referral for other services;

(D) personal assistance services; and

(E) any auxiliary aid or service that a consumer with a disability requires to participate in the CRS Program.

(j) DARS management may waive the consumer participation when the consumer's participation towards the cost of services would prevent the consumer from receiving a necessary service.

(k) The consumer participation must be reviewed annually by the CRS Program.

(l) To the extent that the consumer is entitled to insurance-payment for services or receives payment for services from other governmental programs, third-party payers, or other private sources, DARS funds must not be used to pay for the services.

(m) If the consumer, consumer's representative, or a court appointed guardian or representative disagrees with the calculated consumer participation amount, they can:

(1) request a review by DARS;

(2) contact the DARS Inquiries Line at 1-800-628-5115 for help resolving a problem or concern; or

(3) file a formal complaint with DARS as noted in §107.715 of this chapter (relating to Complaint Resolution Process).

(n) Information about CRS consumer participation procedures and BLR used to administer the CRS Program are available on the DARS website and for viewing at DARS, 4800 North Lamar Boulevard, Austin, Texas, between 8:00 a.m. and 5:00 p.m. on business days.

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.
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