Texas Administrative Code
Title 26 - HEALTH AND HUMAN SERVICES
Part 1 - HEALTH AND HUMAN SERVICES COMMISSION
Chapter 357 - INDEPENDENT LIVING SERVICES
Subchapter D - CONSUMER PARTICIPATION
Section 357.403 - Fee Schedule Amount

Universal Citation: 26 TX Admin Code ยง 357.403

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

(a) The service provider is required to use the DARS fee schedule and instructions to calculate the consumer's fee for service.

(b) Factors that affect the consumer's fee for service are:

(1) household size;

(2) annual gross income; and

(3) allowable deductions.

(c) The household size equals any person living inside or outside of the home who is eligible to be claimed as a dependent of the consumer on the consumer's federal income tax return, or, if the consumer is a minor, any other person living inside or outside of the home who is eligible to be claimed as a dependent of the consumer's parent or guardian on the parent or guardian's federal income tax return.

(d) the consumer's annual gross income:

(1) equals the total annual gross income received by the household; and

(2) includes all income classified as taxable income by the Internal Revenue Service before federally allowable deductions are applied.

(e) The consumer's allowable deductions are limited to the consumer's expenses in the following categories:

(1) attendant care;

(2) rent or home mortgage payments;

(3) court-ordered child support payments made by the consumer for financially dependent children who were not included in the calculation of household size; and

(4) medical or dental expenses for treatment primarily intended to alleviate or prevent a physical or mental illness or manage a disability, with the expenses limited to the cost of:
(A) diagnosis, cure, alleviation, treatment, or prevention of disease;

(B) treatment of any affected body part or function;

(C) medical services legally delivered by physicians, surgeons, dentists, and other medical practitioners;

(D) medications, medical supplies, and diagnostic devices;

(E) medical and dental health care insurance premiums;

(F) transportation to receive medical or dental care; and

(G) medical or dental debt that the family is paying on an established payment plan.

(f) The service provider calculates the allowable deductions using the actual amounts the consumer paid during the previous 12-month period.

(g) The consumer provides the most recent tax return available as proof of annual gross income and allowable deductions. If the consumer has no tax return, the consumer provides bank statements, medical records, receipts, proof of benefits awards, and other documentation to demonstrate annual gross income and allowable deductions.

(h) If the consumer does not provide documentation supporting the household's allowable deductions, the service provider determines the consumer's fee for service based on the consumer's documented annual gross income with no allowable deductions.

(i) The consumer's fee for service is equal to the amount on the DARS sliding fee scale according to the household's annual adjusted income (that is, the annual gross income minus the allowable deductions).

(j) The service provider uses the most current sliding fee scale and instructions published by DARS to determine the consumer's fee for service.

(k) The procedures, fee schedule, and instructions that DARS uses to calculate a consumer's fee for service is available from DARS, 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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