reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 263 - HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter A - GENERAL PROVISIONS › Section 263.7 - Requirement for Translation

Current through Reg. 49, No. 28; July 12, 2024
If a program provider or LIDDA submits documentation to
					 HHSC containing information that is not in English, the program provider or
					 LIDDA must, at the same time, submit a translation of the information in
					 English.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 263 - HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter A - GENERAL PROVISIONS › Section 263.8 - Comprehensive Nursing Assessment

Current through Reg. 49, No. 28; July 12, 2024
(a) An RN must
				  complete a comprehensive nursing assessment of an individual in person:
(1) if the initial IPC includes a sufficient
				  number of RN nursing units for the program provider's RN to perform a
				  comprehensive nursing assessment as described in §
											263.104(k)(9) of
				  this chapter (relating to Process for Enrollment of Applicants);
(2) if there is a significant change in an
				  individual's health or functional status:
(A)
				  that, based on a determination by the RN, will not normally resolve itself
				  without further intervention; and
(B) requires review or revision of the
				  IPC;
(3) at least
				  annually if a nursing service is on the individual's renewal IPC;
(4) before an unlicensed service provider
				  performs a delegated nursing task; and
(5) if the RN who completed the most recent
				  comprehensive nursing assessment of the individual is no longer providing a
				  nursing service to the individual, except as provided in subsection (b) of this
				  section.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 263 - HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter A - GENERAL PROVISIONS › Section 263.9 - Providing Physical Therapy, Occupational Therapy, and Speech and Language Pathology as a Telehealth Service

Current through Reg. 49, No. 28; July 12, 2024
(a) Except as
				  described in subsection (c) of this section, a service provider of physical
				  therapy, occupational therapy, or speech and language pathology may provide
				  physical therapy, occupational therapy, or speech and language pathology to an
				  individual as a telehealth service.
(b) If a service provider of physical
				  therapy, occupational therapy, or speech and language pathology provides
				  physical therapy, occupational therapy, or speech and language pathology to an
				  individual as a telehealth service, a program provider must ensure that the
				  service provider:
(1) uses a synchronous
				  audio-visual platform to interact with the individual, supplemented with or
				  without asynchronous store and forward technology;
(2) does not use an audio-only platform to
				  provide the service; and
(3) before
				  providing the telehealth service:
(A) obtains
				  the written informed consent of the individual or LAR to provide the service;
				  or
(B) obtains the individual or
				  LAR's oral consent to receive the telehealth service and documents the oral
				  consent in the individual's record.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 263 - HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW › Section 263.102 - Calculation of Co-payment

Current through Reg. 49, No. 28; July 12, 2024
(a) Individuals and
				  eligible couples determined to be financially eligible based on the special
				  institutional income limit may be required to share in the cost of HCS Program
				  services. The method for determining the individual's or couple's co-payment is
				  described in subsections (b) and (c) of this section and documented on the HHSC
				  Waiver Program Co-Pay Worksheet.
(b) The co-payment amount as determined by
				  HHSC is the individual's or couple's remaining income after all allowable
				  expenses have been deducted. The co-payment amount is applied only to the cost
				  of HCS Program services specified on each individual's IPC. The co-payment must
				  not exceed the cost of services actually delivered. The co-payment must be paid
				  by the individual or couple, authorized representative, or trustee directly to
				  the program provider in accordance with the HHSC determination. When
				  calculating the co-payment amount for an individual or a couple whose income
				  exceeds the maximum personal needs allowance, the following are deducted:
(1) the cost of the individual's or couple's
				  maintenance needs, which must be equivalent to the special institutional income
				  limit for eligibility under the Texas Medicaid program;
(2) the cost of the maintenance needs of the
				  individual's or couple's dependent children, which is an amount equivalent to
				  the TANF basic monthly grant for children or a spouse with children, using the
				  recognizable needs amounts in the TANF Budgetary Allowances Chart;
				  and
(3) the costs incurred for
				  medical or remedial care that are necessary but are not subject to payment by
				  Medicare, Medicaid, or any other third party, which include the costs of health
				  insurance premiums, deductibles, and co-insurance.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 263 - HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW › Section 263.103 - HCS Interest List

Current through Reg. 49, No. 28; July 12, 2024
(a) A LIDDA must
				  maintain an up-to-date interest list of applicants interested in receiving HCS
				  Program services for whom the LIDDA is the applicant's designated LIDDA in the
				  HHSC data system.
(b) A person may
				  request that an applicant's name be added to the HCS interest list by
				  contacting the LIDDA serving the Texas county in which the applicant or person
				  resides.
(c) If a request is made
				  in accordance with subsection (b) of this section for an applicant who resides
				  in Texas, a LIDDA must add the applicant's name to the HCS interest list using
				  the date the LIDDA receives the request as the HCS interest list
				  date.
(d) For an applicant under 22
				  years of age who is residing in an ICF/IID or nursing facility located in
				  Texas, HHSC adds the applicant's name to the HCS interest list using the date
				  of admission to the ICF/IID or nursing facility as the HCS interest list
				  date.
(e) For an applicant
				  determined diagnostically or functionally ineligible during the enrollment
				  process for the Community Living Assistance and Support Services (CLASS)
				  Program, Deaf-Blind with Multiple Disabilities (DBMD) Program, or Medically
				  Dependent Children Program (MDCP):
(1) if the
				  applicant's name is not on the HCS interest list, at the request of the
				  applicant or LAR, HHSC adds the applicant's name to the HCS interest list using
				  the applicant's interest list date for the program for which the applicant was
				  determined ineligible as the HCS interest list date;
(2) if the applicant's name is on the HCS
				  interest list and the applicant's interest list date for the program for which
				  the applicant was determined ineligible is earlier than the applicant's HCS
				  interest list date, at the request of the applicant or LAR, HHSC changes the
				  applicant's HCS interest list date to the applicant's interest list date for
				  the program for which the applicant was determined ineligible; or
(3) if the applicant's name is on the HCS
				  interest list and the applicant's HCS interest list date is earlier than the
				  applicant's interest list date for the program for which the applicant was
				  determined ineligible, HHSC does not change the applicant's HCS interest list
				  date.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 263 - HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW › Section 263.104 - Process for Enrollment of Applicants

Current through Reg. 49, No. 28; July 12, 2024
(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.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 263 - HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW › Section 263.105 - LOC Determination

Current through Reg. 49, No. 28; July 12, 2024
(a) A LIDDA must
				  request an LOC from HHSC for an applicant in accordance with this subsection.
(1) The LIDDA must complete an ID/RC
				  Assessment for an applicant that:
(A) includes
				  the LOC recommended by a person qualified to perform an initial evaluation of
				  LOC in accordance with Appendix B of the HCS Program waiver application
				  approved by CMS; and
(B) is signed
				  and dated in accordance with the instructions for completing the ID/RC
				  Assessment.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 263 - HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW › Section 263.106 - LON Assignment

Current through Reg. 49, No. 28; July 12, 2024
(a) A LIDDA must
				  request an LON for an applicant from HHSC at the time an applicant is enrolled
				  into the HCS Program. The LON is requested by entering the information from a
				  completed ID/RC Assessment, that includes the recommended LON and is signed and
				  dated by the service coordinator, in the HHSC data system and electronically
				  submitting the information to HHSC. The electronically submitted ID/RC
				  Assessment must contain information identical to the information on the signed
				  and dated ID/RC Assessment.
(b) A
				  program provider must request an LON for an individual from HHSC in accordance
				  with this subsection.
(1) Before the
				  expiration of an ID/RC Assessment, the program provider must enter the
				  information from the completed ID/RC Assessment in the HHSC data system and
				  electronically submit the information to HHSC that includes the recommended LON
				  and is signed and dated by the program provider.
(2) The program provider must ensure the
				  information from the completed ID/RC Assessment entered in the HHSC data system
				  and electronically submitted contains information that is identical to the
				  information on the signed and dated ID/RC Assessment.
(3) The program provider must, within three
				  calendar days after submission, provide the service coordinator with a copy of
				  the signed and dated ID/RC Assessment.
(4) If applicable, the program provider must
				  submit supporting documentation to HHSC as required by §
											263.107(c) of
				  this chapter (relating to HHSC Review of LON).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 263 - HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW › Section 263.107 - HHSC Review of LON

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC may review
				  a recommended or assigned LON at any time to determine if it is appropriate. If
				  HHSC reviews an LON, documentation supporting the LON must be submitted to HHSC
				  in accordance with HHSC's request. HHSC may modify an LON and recoup or deny
				  payment based on its review.
(b)
				  Before assigning an LON, HHSC reviews documentation supporting the recommended
				  LON if:
(1) an LON is requested that is an
				  increase from the individual's current LON;
(2) an LON 9 is requested in accordance with
				  §
											263.106(j) of
				  this subchapter (relating to LON Assignment);
(3) an LON is requested in accordance with
				  §
											263.106(i) of
				  this subchapter; or
(4) an LON is
				  requested in accordance with §
											263.106(k) and
				  (l) of this subchapter.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 263 - HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW › Section 263.108 - Reconsideration of LON Assignment

Current through Reg. 49, No. 28; July 12, 2024
(a) If a program
				  provider disagrees with an LON assignment, the program provider may request
				  that HHSC reconsider the assignment.
(b) The program provider may receive
				  reconsideration only if the program provider submitted documentation supporting
				  the recommended LON as required by §
										263.107(c) of
				  this subchapter (relating to HHSC Review of LON).
(c) To request reconsideration of an LON
				  assignment, the program provider must submit a written request for
				  reconsideration to HHSC within 10 calendar days after receipt of the
				  notification from HHSC that the recommended LON was denied. A program provider
				  may send HHSC documentation, in addition to that required by §
										263.107(c) of
				  this subchapter, to support the request for reconsideration of an LON
				  assignment.
(d) Within 21 calendar
				  days after receipt of a request for reconsideration, HHSC electronically
				  approves the recommended LON or sends written notification that the recommended
				  LON has been denied to the program provider and the service coordinator. A
				  written notification that the recommended LON has been denied gives the program
				  provider the right to request an administrative hearing in accordance §
										263.802 of this chapter (relating
				  to Program Provider's Right to Administrative Hearing).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 263 - HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter C - PERSON-CENTERED PLANNING › Section 263.201 - Person-Centered Planning Process

Current through Reg. 49, No. 28; July 12, 2024
(a) Person-centered
				  planning is a process that empowers an applicant or individual to plan the
				  applicant's or individual's services and supports to achieve desired
				  outcomes.
(b) The service
				  coordinator and program provider must ensure the person-centered planning
				  process is led by the individual to the maximum extent possible. The
				  individual's LAR has a participatory role, as needed and as defined by the
				  individual, unless State law confers decision-making authority to the
				  LAR.
(c) The person-centered
				  planning process must be used to develop a PDP, implementation plan, initial
				  IPC, renewal IPC, revised IPC, service backup plan, and transportation
				  plan.
(d) The person-centered
				  planning process must:
(1) include people
				  chosen by the applicant, individual, or LAR;
(2) provide the information and support the
				  applicant or individual needs to lead the planning process and make informed
				  choices and decisions;
(3) occur at
				  a time and location convenient to the applicant or individual and
				  LAR;
(4) consider the applicant's
				  or individual's cultural preferences;
(5) provide information in plain language to
				  the applicant or individual in a manner that is accessible to:
(A) the applicant or individual through the
				  provision of an auxiliary aid at no cost to the applicant or individual in
				  accordance with the Americans with Disabilities Act and Section 504 of the
				  Rehabilitation Act; and
(B) the
				  applicant or individual with limited English proficiency through the provision
				  of language services at no cost to the applicant or individual, including oral
				  interpretation and written translations;
(6) use strategies for solving conflict or
				  disagreement within the person-centered planning process;
(7) provide information to the individual or
				  LAR to allow the individual or LAR to make informed decisions including:
(A) a written and oral description of the
				  services available in the HCS Program; and
(B) the name and qualifications of the
				  individual's service providers, in writing; and
(8) inform the individual or LAR that the
				  individual or LAR may request revisions to the PDP, implementation plan,
				  initial IPC, renewal IPC, revised IPC, service backup plan, and transportation
				  plan at any time by communicating the request to the service coordinator or the
				  program provider.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 263 - HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter D - DEVELOPMENT AND REVIEW OF AN IPC › Section 263.301 - IPC Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) An IPC must be
				  based on the PDP and specify:
(1) the type and
				  amount of each HCS Program service and CFC service to be provided to an
				  individual during an IPC year;
(2)
				  the services and supports to be provided to the individual through resources
				  other than HCS Program services or CFC services during an IPC year, including
				  natural supports, medical services, day activity, and educational
				  services;
(3) if an individual will
				  receive CFC support management; and
(4) if there are any HCS Program services or
				  CFC services identified on the PDP as critical, requiring a service backup
				  plan.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 263 - HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter D - DEVELOPMENT AND REVIEW OF AN IPC › Section 263.302 - Renewal and Revision of an IPC

Current through Reg. 49, No. 28; July 12, 2024
(a) Renewal of an
				  IPC. At least annually and before the expiration of an individual's IPC, an
				  individual's IPC must be renewed in accordance with this subsection and HHSC's
				  instructions.
(1) At least 60 but no more
				  than 90 calendar days before the expiration of an individual's IPC, the service
				  coordinator must:
(A) notify the service
				  planning team that the individual's PDP must be reviewed and updated;
(B) convene a meeting of the service planning
				  team to:
(i) review and update the
				  individual's PDP; and
(ii) if CFC
				  PAS/HAB is included on the PDP, complete the HHSC HCS/TxHmL CFC PAS/HAB
				  Assessment form to determine the number of CFC PAS/HAB hours the individual
				  needs; and
(C) use the
				  HHSC Understanding Program Eligibility and Services form to provide the
				  individual or LAR both an oral and written explanation of:
(i) the eligibility requirements for the HCS
				  Program as described in §
													263.101(a) of
				  this chapter (relating to Eligibility Criteria for HCS Program Services and CFC
				  Services);
(ii) if the individual's
				  PDP includes CFC services:
(I) the eligibility
				  requirements for CFC services as described in §
														263.101(c) of
				  this chapter to individuals who do not receive MAO Medicaid; and
(II) the eligibility requirements for CFC
				  services as described in §
														263.101(d) of
				  this chapter to individuals who receive MAO Medicaid;
(iii) all HCS Program services and CFC
				  services as described in §
													263.4 of this chapter (relating to
				  Description of the HCS Program and CFC);
(iv) the reason HCS Program services and CFC
				  services may be suspended as described in §
													263.705(a) of
				  this chapter (relating to Suspension of HCS Program Services and CFC Services);
				  and
(v) the reason HCS Program
				  services and CFC services may be terminated as described in §
													263.707 of this chapter (relating
				  to Termination of HCS Program Services and CFC Services with Advance Notice)
				  and §
													263.708 of this chapter (relating
				  to Termination of HCS Program Services and CFC Services Without Advance
				  Notice).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 263 - HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter D - DEVELOPMENT AND REVIEW OF AN IPC › Section 263.303 - HHSC Review of an IPC

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC may review
				  an IPC to determine if the type and amount of HCS Program services and CFC
				  services specified in the IPC meet the requirements described in §
										263.301(c) of
				  this subchapter (relating to IPC Requirements).
(1) If an IPC submitted to HHSC exceeds 100
				  percent of the estimated annualized average per capita cost for ICF/IID Program
				  services, a LIDDA or program provider must immediately submit documentation
				  supporting the IPC to HHSC, including a copy of the signed and dated IPC, the
				  PDP, the implementation plans for the services on the IPC, and assessments. A
				  LIDDA or program provider must submit additional documentation as requested by
				  HHSC.
(2) If requested by HHSC for
				  an IPC other than one described in paragraph (1) of this subsection:
(A) a LIDDA must submit documentation
				  supporting an initial IPC to HHSC; and
(B) a LIDDA or program provider must submit
				  documentation supporting a renewal or revised IPC to
				  HHSC.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 263 - HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter D - DEVELOPMENT AND REVIEW OF AN IPC › Section 263.304 - Service Limits

Current through Reg. 49, No. 28; July 12, 2024
(a) The following
				  limits apply to an individual's HCS Program services:
(1) for adaptive aids, $10,000 during an IPC
				  year;
(2) for dental treatment,
				  $2,000 during an IPC year;
(3) for
				  minor home modifications and pre-enrollment minor home modifications combined:
(A) $7,500 during the time the individual is
				  enrolled in the HCS Program, which may be paid in one or more IPC years;
				  and
(B) a maximum of $300 for
				  repair and maintenance during an IPC year;
(4) for respite and in-home respite combined,
				  300 hours during an IPC year;
(5)
				  for day habilitation and in-home day habilitation combined, 260 units during an
				  IPC year; and
(6) for TAS:
(A) $2,500 if the applicant's initial IPC
				  does not include residential support, supervised living, or host home/companion
				  care; or
(B) $1,000 if the
				  applicant's initial IPC includes residential support, supervised living, or
				  host home/companion care.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 263 - HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter E - CDS OPTION › Section 263.401 - CDS Option

Current through Reg. 49, No. 28; July 12, 2024
(a) If supported
				  home living, respite, nursing, employment assistance, supported employment,
				  cognitive rehabilitation therapy, or CFC PAS/HAB is included in an applicant's
				  PDP, and the applicant's PDP does not include residential support, supervised
				  living, or host home/companion care, the service coordinator must:
(1) inform the applicant or LAR of the
				  applicant's right to participate in the CDS option or discontinue participation
				  in the CDS option at any time, except as provided in 40 TAC §
											41.405(a)
				  (relating to Suspension of Participation in the CDS Option);
(2) inform the applicant or LAR that the
				  applicant or LAR may choose to have supported home living, respite, nursing,
				  employment assistance, supported employment, cognitive rehabilitation therapy,
				  or CFC PAS/HAB provided through the CDS option;
(3) provide the applicant or LAR a copy of
				  the HHSC Consumer Directed Services Option Overview form, the HHSC Consumer
				  Directed Services Responsibilities form, and the HHSC Employee Qualification
				  Requirements form, which are found at the HHSC website and which contain
				  information about the CDS option, including a description of FMS and support
				  consultation;
(4) provide an oral
				  explanation of the information contained in the HHSC Consumer Directed Services
				  Option Overview form, the HHSC Consumer Directed Services Responsibilities
				  form, and the HHSC Employee Qualification Requirements form to the applicant or
				  LAR; and
(5) provide the applicant
				  or LAR the opportunity to choose to participate in the CDS option and document
				  the applicant's or LAR's choice on the HHSC Consumer Participation Choice form,
				  which is available on the HHSC website.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 263 - HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter F - REQUIREMENTS FOR SERVICE SETTINGS AND PROGRAM PROVIDER OWNED OR CONTROLLED RESIDENTIAL SETTINGS › Section 263.501 - Requirements for Home and Community-Based Settings

Current through Reg. 49, No. 28; July 12, 2024
(a) A home and
				  community-based setting is a setting in which an individual resides or receives
				  HCS Program services or CFC services. A home and community-based setting must
				  have all of the following qualities, based on the needs and preferences of an
				  individual as documented in the individual's PDP.
(1) The setting is integrated in and supports
				  the individual's access to the greater community to the same degree as a person
				  not enrolled in a Medicaid waiver program, including opportunities for the
				  individual to:
(A) seek employment and work in
				  a competitive integrated setting;
(B) engage in community life;
(C) control personal resources; and
(D) receive services in the
				  community.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 263 - HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter F - REQUIREMENTS FOR SERVICE SETTINGS AND PROGRAM PROVIDER OWNED OR CONTROLLED RESIDENTIAL SETTINGS › Section 263.502 - Requirements for Program Provider Owned or Controlled Residential Settings

Current through Reg. 49, No. 28; July 12, 2024
(a) The
				  requirements in this section are in addition to the requirements described in
				  §
										263.501 of this subchapter
				  (relating to Requirements for Home and Community-Based Service
				  Settings).
(b) In each residence in
				  which a program provider provides residential support, supervised living, or
				  host home/companion care, the program provider must ensure that, except as
				  provided in subsection (c) of this section:
(1) an individual has privacy in the
				  individual's bedroom;
(2) an
				  individual has the option not to share a bedroom with a roommate;
(3) an individual sharing a bedroom has a
				  choice of roommates;
(4) a lock is
				  installed on the individual's bedroom door at no cost to the individual and
				  that:
(A) the lock is operable by the
				  individual; and
(B) only the
				  individual, a roommate of the individual, and staff designated by the program
				  provider have keys to the individual's bedroom door;
(5) an individual can furnish and decorate
				  the individual's bedroom;
(6) while
				  in the residence, an individual has the freedom and support:
(A) to control the individual's schedule and
				  activities that are not part of the implementation plan; and
(B) to have access to food at any
				  time;
(7) an individual
				  may have visitors of the individual's choosing at any time; and
(8) the residence is physically accessible
				  and free of hazards to the individual.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 263 - HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter F - REQUIREMENTS FOR SERVICE SETTINGS AND PROGRAM PROVIDER OWNED OR CONTROLLED RESIDENTIAL SETTINGS › Section 263.503 - Residential Agreements

Current through Reg. 49, No. 28; July 12, 2024
(a) During a
				  service planning team meeting to develop or update an individual's PDP, a
				  service coordinator must inform an individual or LAR of the following if the
				  individual is interested in receiving residential assistance:
(1) that the residential setting options
				  available in the HCS Program consist of:
(A)
				  a residence in which the individual receives host home/companion
				  care;
(B) a three-person residence
				  in which the individual receives residential support or supervised living;
				  or
(C) a four-person residence in
				  which the individual receives residential support or supervised
				  living;
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 263 - HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter G - REIMBURSEMENT BY HHSC › Section 263.601 - Program Provider Reimbursement

Current through Reg. 49, No. 28; July 12, 2024
The following requirements apply to program provider
					 reimbursement.
(1) HHSC pays a program
				  provider as described in this paragraph.
(A)
				  HHSC pays for supported home living, professional therapies, nursing, respite,
				  in-home respite, employment assistance, supported employment, and CFC PAS/HAB
				  in accordance with the reimbursement rate for the specific service.
(B) HHSC pays for host home/companion care,
				  residential support, supervised living, in-home day habilitation and day
				  habilitation in accordance with the individual's LON and the reimbursement rate
				  for the specific service.
(C) HHSC
				  pays for adaptive aids, minor home modifications, and dental treatment based on
				  the actual cost of the item and, if requested, a requisition fee in accordance
				  with the HCS Program Billing Requirements available on the HHSC
				  website.
(D) HHSC pays:
(i) for TAS based on a Transition Assistance
				  Services (TAS) Assessment and Authorization form authorized by HHSC and the
				  actual cost of the TAS as evidenced by purchase receipts required by the HCS
				  Program Billing Requirements; and
(ii) if requested, a TAS service fee in
				  accordance with the HCS Program Billing Requirements.
(E) HHSC pays for pre-enrollment minor home
				  modifications and a pre-enrollment minor home modifications assessment based on
				  a Home and Community-based Services (HCS) Program Pre-enrollment MHM
				  Authorization Request form authorized by HHSC and the actual cost of the
				  pre-enrollment minor home modifications and a pre-enrollment minor home
				  modifications assessment, as evidenced by documentation required by the HCS
				  Program Billing Requirements.
(F)
				  Subject to the requirements in the HCS Program Billing Requirements, HHSC pays
				  for TAS, pre-enrollment minor home modifications, and a pre-enrollment minor
				  home modifications assessment regardless of whether the applicant enrolls with
				  the program provider.
(G) HHSC pays
				  for CFC ERS based on the actual cost of the service, not to exceed the
				  reimbursement rate ceiling for CFC ERS.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 263 - HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter H - TRANSFER, DENIALS, SUSPENSION, REDUCTION, AND TERMINATION › Section 263.701 - Process for Individual to Transfer to a Different Program Provider or FMSA

Current through Reg. 49, No. 28; July 12, 2024
(a) If a service
				  coordinator receives information that an individual wants to transfer to a
				  different program provider or FMSA, or that an LAR wants the individual to
				  transfer to a different program provider or FMSA, the service coordinator must:
(1) if the information was received from the
				  individual or LAR, document the date the information was received in the
				  individual's record;
(2) if the
				  information was received from a person other than the individual or LAR, within
				  three business days after the information was received:
(A) contact the individual or LAR to confirm
				  whether the individual wants to transfer or the LAR wants the individual to
				  transfer to a different program provider or FMSA; and
(B) if the service coordinator makes the
				  confirmation described in subparagraph (A) of this paragraph, document such
				  confirmation in the individual's record; and
(3) within three business days after
				  receiving information from the individual or LAR that the individual wants to
				  transfer or the LAR wants the individual to transfer to a different program
				  provider or FMSA or making the confirmation described in paragraph (2)(A) of
				  this subsection:
(A) explain to the
				  individual or LAR that the individual may transfer to a program provider whose
				  enrollment has not reached its service capacity in the HHSC data system or FMSA
				  of the individual's or LAR's choice; and
(B) provide the individual or LAR the names
				  and contact information of all program providers or FMSAs in the geographic
				  location preferred by the individual or LAR.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 263 - HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter H - TRANSFER, DENIALS, SUSPENSION, REDUCTION, AND TERMINATION › Section 263.702 - Process for Individual to Receive a Service Through the CDS Option that the Individual is Receiving from a Program Provider

Current through Reg. 49, No. 28; July 12, 2024
(a) If a service
				  coordinator receives information that an individual wants to receive a service
				  through the CDS option that the individual is receiving from a program provider
				  or that an LAR wants the individual to receive a service through the CDS option
				  that the individual is receiving from a program provider, the service
				  coordinator must:
(1) if the information was
				  received from the individual or LAR, document the date the information was
				  received in the individual's record;
(2) if the information was received from a
				  person other than the individual or LAR, within three business days after the
				  information was received:
(A) contact the
				  individual or LAR to confirm whether the individual wants to receive or the LAR
				  wants the individual to receive a service through the CDS option that the
				  individual is receiving from a program provider; and
(B) if the service coordinator makes the
				  confirmation described in subparagraph (A) of this paragraph, document such
				  confirmation in the individual's record; and
(3) within three business days after
				  receiving information from the individual or LAR that the individual wants to
				  receive or the LAR wants the individual to receive a service through the CDS
				  option that the individual is receiving from a program provider or making the
				  confirmation described in paragraph (2)(A) of this subsection:
(A) explain to the individual or LAR that the
				  individual may select an FMSA of the individual's or LAR's choice;
				  and
(B) provide the individual or
				  LAR the names and contact information of all FMSAs in the geographic location
				  preferred by the individual or LAR.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 263 - HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter H - TRANSFER, DENIALS, SUSPENSION, REDUCTION, AND TERMINATION › Section 263.703 - Denial of a Request for Enrollment into the HCS Program

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC denies an
				  individual's request for enrollment into the HCS Program if the individual does
				  not meet the eligibility criteria described in §
										263.101 of this chapter (relating
				  to Eligibility Criteria for HCS Program Services and CFC Services).
(b) If HHSC denies an individual's request
				  for enrollment, HHSC sends written notice to the individual or LAR of the
				  denial of the individual's request for enrollment into the HCS Program and
				  includes in the notice the individual's right to request a fair hearing in
				  accordance with §
										263.801 of this chapter (Fair
				  Hearing).
(c) HHSC sends a copy of
				  the written notice to the individual's service coordinator and the program
				  provider.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 263 - HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter H - TRANSFER, DENIALS, SUSPENSION, REDUCTION, AND TERMINATION › Section 263.704 - Denial of HCS Program Services or CFC Services

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC denies an
				  HCS Program service or CFC service on an individual's IPC, based on a review
				  described in §
										263.303 of this chapter (relating
				  to HHSC Review of an IPC) or §
										263.302 of this chapter (relating
				  to Renewal and Revision of an IPC), if HHSC determines that the HCS Program
				  service or CFC service does not meet the requirements described in §
										263.301(c) of
				  this chapter (relating to IPC Requirements).
(b) HHSC denies residential support,
				  supervised living, or host home/companion care on an individual's IPC if:
(1) the individual was evicted from:
(A) a three-person residence;
(B) a four-person residence; or
(C) a residence in which host home/companion
				  care is provided; and
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 263 - HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter H - TRANSFER, DENIALS, SUSPENSION, REDUCTION, AND TERMINATION › Section 263.705 - Suspension of HCS Program Services and CFC Services

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC suspends
				  an individual's HCS Program services and CFC services if the individual is
				  under a temporary admission to one of the following facilities:
(1) a hospital;
(2) an ICF/IID;
(3) a nursing facility;
(4) an ALF;
(5) a residential child care facility
				  licensed by HHSC unless it is an agency foster home;
(6) an inpatient chemical dependency
				  treatment facility;
(7) a mental
				  health facility;
(8) a residential
				  facility operated by the Texas Workforce Commission; or
(9) a residential facility operated by the
				  Texas Juvenile Justice Department, a jail, or a prison.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 263 - HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter H - TRANSFER, DENIALS, SUSPENSION, REDUCTION, AND TERMINATION › Section 263.706 - Reduction of HCS Program Services or CFC Services

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC proposes a
				  reduction of an HCS Program service or CFC service on an individual's IPC,
				  based on a review described in §
										263.303 of this chapter (relating
				  to HHSC Review of an IPC) or §
										263.302 of this chapter (relating
				  to Renewal and Revision of an IPC), if HHSC determines that the HCS Program
				  service or CFC service does not meet the requirements described in §
										263.301(c) of
				  this chapter (relating to IPC Requirements).
(b) If HHSC proposes a reduction of an HCS
				  Program service or CFC service on the individual's IPC, HHSC sends written
				  notice to the individual or LAR of the proposed reduction of the service and
				  includes in the notice the individual's right to request a fair hearing in
				  accordance with §
										263.801 of this chapter (Fair
				  Hearing).
(c) HHSC sends a copy of
				  the written notice to the individual's service coordinator and the program
				  provider.
(d) If the individual or
				  LAR requests a fair hearing before the effective date of the reduction of an
				  HCS Program service or CFC service, as specified in the written notice, the
				  service is not reduced and the program provider must provide the service to the
				  individual in the amount authorized in the current IPC while the appeal is
				  pending.
(e) If the individual or
				  LAR does not request a fair hearing before the effective date of the reduction
				  of an HCS Program service or CFC service, HHSC modifies the IPC in the HHSC
				  data system.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 263 - HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter H - TRANSFER, DENIALS, SUSPENSION, REDUCTION, AND TERMINATION › Section 263.707 - Termination of HCS Program Services and CFC Services with Advance Notice

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC terminates
				  an individual's HCS Program services and CFC services if the individual does
				  not meet the eligibility criteria described in §263.101(a)(1) - (4), (6),
				  (c), and (d) of this chapter (relating to Eligibility Criteria for HCS Program
				  Services and CFC Services).
(b) If
				  a service coordinator becomes aware that a situation described in subsection
				  (a) of this section exists, the service coordinator must, as soon as
				  practicable, convene a service planning team meeting to discuss the situation.
				  If after the meeting, the service coordinator determines that the situation
				  cannot be resolved, the service coordinator must request that HHSC terminate
				  the individual's services. To make this request, the service coordinator must
				  complete HHSC Request for Termination of Services form and submit the form to
				  HHSC.
(c) If HHSC receives a form
				  from a service coordinator requesting that HHSC terminate the individual's
				  services, HHSC sends written notice to the individual or LAR of the proposal to
				  terminate HCS Program services and CFC services. The notice includes the
				  individual's right to request a fair hearing in accordance with §
										263.801 of this chapter (relating
				  to Fair Hearing).
(d) If the
				  individual or LAR requests a fair hearing before the effective date of the
				  termination of HCS Program services and CFC services, as specified in the
				  written notice, the program provider must provide services to the individual in
				  the amounts authorized in the IPC while the appeal is pending.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 263 - HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter H - TRANSFER, DENIALS, SUSPENSION, REDUCTION, AND TERMINATION › Section 263.708 - Termination of HCS Program Services and CFC Services Without Advance Notice

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC terminates
				  an individual's HCS Program services and CFC services if any of the following
				  situations exists:
(1) the individual is
				  admitted to one of the facilities listed in §263.705(a)(1) - (9) of this
				  subchapter (relating to Suspension of HCS Program Services and CFC Services):
(A) for more than 270 consecutive calendar
				  days; and
(B) HHSC has not extended
				  the individual's suspension in accordance with §
												263.705(h) of
				  this subchapter;
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 263 - HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter I - HEARINGS › Section 263.801 - Fair Hearing

Current through Reg. 49, No. 28; July 12, 2024
An applicant whose request for eligibility for the HCS
					 Program is denied or is not acted upon with reasonable promptness, or an
					 individual whose HCS Program services or CFC services have been terminated,
					 suspended, denied, or reduced by HHSC, receives notice of the right to request
					 a fair hearing in accordance with 1 TAC Chapter 357, Subchapter A (relating to
					 Uniform Fair Hearing Rules).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 263 - HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter I - HEARINGS › Section 263.802 - Program Provider's Right to Administrative Hearing

Current through Reg. 49, No. 28; July 12, 2024
(a) A program
				  provider may request an administrative hearing if HHSC takes or proposes to
				  take the following action:
(1) vendor
				  hold;
(2) contract
				  termination;
(3) recoupment of
				  payments made to the program provider; or
(4) denial of a program provider's claim for
				  payment, including denial of a retroactive LOC and denial of a recommended
				  LON.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 263 - HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter J - LIDDA REQUIREMENTS › Section 263.901 - LIDDA Requirements for Providing Service Coordination in the HCS Program

Current through Reg. 49, No. 28; July 12, 2024
(a) In addition to
				  the requirements described in Chapter 331 of this title (relating to LIDDA
				  Service Coordination), a LIDDA must:
(1)
				  comply with:
(A) this chapter;
(B) 40 TAC Chapter 41 (relating to Consumer
				  Directed Services Option); and
(C)
				  40 TAC Chapter 4, Subchapter L (relating to Abuse, Neglect, and Exploitation in
				  Local Authorities and Community Centers); and