reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 259 - COMMUNITY LIVING ASSISTANCE AND SUPPORT SERVICES (CLASS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES › Subchapter H - ADDITIONAL DSA REQUIREMENTS › Section 259.365 - Employment Assistance and Supported Employment

Current through Reg. 49, No. 28; July 12, 2024
(a) A DSA must
				  ensure that a service provider of employment assistance and a service provider
				  of supported employment meets the qualifications described in §
										259.355(d)(18) of
				  this subchapter (relating to Qualifications of DSA Staff Persons).
(b) Before including employment assistance on
				  an individual's IPC, a DSA must ensure and maintain documentation in the
				  individual's record that employment assistance is not available to the
				  individual under a program funded under §110 of the Rehabilitation Act of
				  1973 or under a program funded under the Individuals with Disabilities
				  Education Act (20 U.S.C.
				  §
											1401 et seq.).
(c) A DSA must ensure that employment
				  assistance:
(1) consists of an employment
				  assistance service provider performing the following activities:
(A) identifying an individual's employment
				  preferences, job skills, and requirements for a work setting and work
				  conditions;
(B) locating
				  prospective employers offering employment compatible with the individual's
				  identified preferences, skills, and requirements;
(C) contacting a prospective employer on
				  behalf of the individual and negotiating the individual's employment;
(D) transporting the individual to
				  help the individual locate competitive employment in the community; and
(E) participating in service
				  planning team meetings;
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 259 - COMMUNITY LIVING ASSISTANCE AND SUPPORT SERVICES (CLASS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES › Subchapter H - ADDITIONAL DSA REQUIREMENTS › Section 259.367 - Prohibition of Seclusion

Current through Reg. 49, No. 28; July 12, 2024
A DSA must not use seclusion.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 259 - COMMUNITY LIVING ASSISTANCE AND SUPPORT SERVICES (CLASS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES › Subchapter H - ADDITIONAL DSA REQUIREMENTS › Section 259.369 - DSA: Reporting Allegations of Abuse, Neglect, or Exploitation of an Individual

Current through Reg. 49, No. 28; July 12, 2024
If a DSA, service provider, staff person, volunteer, or
					 controlling person knows or suspects that an individual is being or has been
					 abused, neglected, or exploited, the DSA must report or ensure that the person
					 with knowledge or suspicion reports the allegation of abuse, neglect, or
					 exploitation to DFPS immediately, but not later than 24 hours after having
					 knowledge or suspicion, by:
(1)
				  calling the DFPS Abuse Hotline toll-free telephone number, 1-800-252-5400; or
(2) using the DFPS Abuse Hotline
				  website.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 259 - COMMUNITY LIVING ASSISTANCE AND SUPPORT SERVICES (CLASS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES › Subchapter H - ADDITIONAL DSA REQUIREMENTS › Section 259.371 - DSA: Requirements Related to the Abuse, Neglect, and Exploitation of an Individual

Current through Reg. 49, No. 28; July 12, 2024
(a) If a report
				  required by §
										259.369 of this subchapter
				  (relating to DSA: Reporting Allegations of Abuse, Neglect, or Exploitation of
				  an Individual) alleges abuse, neglect, or exploitation by a person who is not a
				  service provider, staff person, volunteer, or controlling person of a DSA, the
				  DSA must:
(1) as necessary:
(A) obtain immediate medical or psychological
				  services for the individual; and
(B) assist in obtaining ongoing medical or
				  psychological services for the individual;
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 259 - COMMUNITY LIVING ASSISTANCE AND SUPPORT SERVICES (CLASS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES › Subchapter H - ADDITIONAL DSA REQUIREMENTS › Section 259.373 - DSA: Requirement for Translation

Current through Reg. 49, No. 28; July 12, 2024
If a DSA submits documentation to HHSC in accordance with
					 this chapter containing information that is not in English, the DSA 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 259 - COMMUNITY LIVING ASSISTANCE AND SUPPORT SERVICES (CLASS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES › Subchapter I - FISCAL MONITORING › Section 259.401 - Financial Errors

Current through Reg. 49, No. 28; July 12, 2024
(a) Other than the
				  initial administrative fee, if HHSC reimburses a program provider for a claim
				  for services that were delivered before the effective date on an IPC, HHSC
				  applies the error to the total number of units reimbursed for such services.
(b) If HHSC reimburses a DSA for
				  more than four hours of nursing used to decide whether to delegate nursing
				  tasks to a CFC PAS/HAB service provider, HHSC applies the error to the total
				  number of units reimbursed in excess of the four hour maximum for such
				  services.
(c) If HHSC reimburses a
				  DSA for more than 10 hours during an individual's IPC year for nursing to
				  prevent service breaks caused by a CFC PAS/HAB service provider not being
				  available to provide delegated nursing tasks, HHSC applies the error to the
				  total number of units reimbursed in excess of the 10 hour maximum for such
				  services.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 259 - COMMUNITY LIVING ASSISTANCE AND SUPPORT SERVICES (CLASS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES › Subchapter J - DECLARATION OF DISASTER › Section 259.451 - Exceptions to Certain Requirements During Declaration of Disaster

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC may allow
				  a program provider to use one or more of the exceptions described in
				  subsections (c) - (p) of this section while an executive order or proclamation
				  declaring a state of disaster under Texas Government Code §
										418.014 is in effect.
				  HHSC notifies program providers:
(1) if HHSC
				  allows an exception to be used; and
(2) if an exception is allowed to be used,
				  the date the exception must no longer be used, which may be before the
				  declaration of a state of disaster expires.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 260 - DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES › Subchapter A - DEFINITIONS, DESCRIPTION OF SERVICES, AND EXCLUDED SERVICES › Section 260.5 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this chapter,
					 have the following meanings, unless the context clearly indicates
					 otherwise:
(1) Abuse--
(A) physical abuse;
(B) sexual abuse; or
(C) verbal or emotional
				  abuse.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 260 - DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES › Subchapter A - DEFINITIONS, DESCRIPTION OF SERVICES, AND EXCLUDED SERVICES › Section 260.7 - Description of the DBMD Program and CFC

Current through Reg. 49, No. 28; July 12, 2024
(a) The DBMD
				  Program is a Medicaid waiver program approved by CMS and operated by HHSC
				  pursuant to §1915(c) of the Social Security Act. It provides
				  community-based services and supports to an eligible individual as an
				  alternative to the ICF/IID Program. DBMD Program services are intended to:
(1) enhance the individual's integration into
				  the community;
(2) maintain or
				  improve the individual's independent functioning, and
(3) prevent the individual's admission to an
				  institution.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 260 - DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES › Subchapter A - DEFINITIONS, DESCRIPTION OF SERVICES, AND EXCLUDED SERVICES › Section 260.9 - Excluded Services

Current through Reg. 49, No. 28; July 12, 2024
The DBMD Program does not provide:
(1) room and board, except when out-of-home
				  respite is provided in an outdoor camp accredited by the American Camping
				  Association;
(2) special education
				  and related services defined in
				  20 United States Code §
											1401 that otherwise are available to the
				  individual through a state or local educational agency;
(3) vocational rehabilitation services that
				  otherwise are available to the individual through a program funded under 29
				  United States Code Chapter 16, Subchapter I; or
(4) a service not described in the DBMD
				  Program waiver application approved by CMS and available on the HHSC website or
				  this chapter.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 260 - DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES › Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW › Division 1 - ELIGIBILITY AND MAINTENANCE OF THE DBMD INTEREST LIST › Section 260.51 - Eligibility Criteria for DBMD Program Services and CFC Services

Current through Reg. 49, No. 28; July 12, 2024
(a) An individual is
					 eligible for DBMD Program services if:
(1)
					 the individual meets the financial eligibility criteria as described in
					 Appendix B of the DBMD Program waiver application approved by CMS and available
					 on the HHSC website;
(2) the
					 individual is determined by HHSC to meet the LOC VIII criteria described in
					 §
												261.239 of this title (relating to
					 ICF/MR Level of Care VIII Criteria);
(3) the individual, as documented on the
					 ID/RC Assessment:
(A) has one or more
					 diagnosed related conditions and, as a result:
(i) has deafblindness;
(ii) has been determined to have a
					 progressive medical condition that will result in deafblindness; or
(iii) functions as a person with
					 deafblindness; and
(B)
					 has one or more additional disabilities that result in impairment to
					 independent functioning;
(4) the individual has an IPC with a cost for
					 DBMD Program services at or below $114,736.07;
(5) the individual is not enrolled in another
					 waiver program or receiving a service that may not be received if the
					 individual is enrolled in the DBMD Program, as identified in the Mutually
					 Exclusive Services table in Appendix V of the
Deaf Blind with Multiple
					 Disabilities Program Manual
;
(6) the individual does not reside in:
(A) an ICF/IID;
(B) a nursing facility;
(C) an ALF, unless it provides licensed
					 assisted living in the DBMD Program;
(D) a residential child-care facility unless
					 it is an agency foster home;
(E) a
					 hospital;
(F) a mental health
					 facility;
(G) an inpatient chemical
					 dependency treatment facility;
(H)
					 a residential facility operated by the Texas Workforce Commission;
(I) a residential facility operated by the
					 Texas Juvenile Justice Department;
(J) a jail; or
(K) a prison;
(7) at least one program provider is willing
					 to provide DBMD Program services to the individual;
(8) the individual resides or moves to reside
					 in a county served by a program provider; and
(9) the individual requires the provision of:
(A) at least one DBMD Program Service per
					 month or a monthly monitoring by a case manager; and
(B) at least one DBMD Program Service during
					 an IPC period.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 260 - DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES › Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW › Division 1 - ELIGIBILITY AND MAINTENANCE OF THE DBMD INTEREST LIST › Section 260.53 - DBMD Interest List

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC maintains
					 an interest list that contains the names of individuals interested in receiving
					 DBMD Program services.
(b) A person
					 may request an applicant's name be added to the DBMD interest list by:
(1) calling HHSC's toll-free number;
					 or
(2) submitting a written request
					 to HHSC.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 260 - DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES › Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW › Division 2 - ENROLLMENT PROCESS, PERSON-CENTERED PLANNING, AND REQUIREMENTS FOR SERVICE SETTINGS › Section 260.55 - Written Offer of Enrollment in the DBMD Program

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC sends a
					 written offer of enrollment in the DBMD Program to:
(1) the individual whose DBMD interest list
					 request date, assigned in accordance with §
												260.53 of this subchapter
					 (relating to DBMD Interest List), is earliest, unless the individual is a
					 military family member living outside of Texas; or
(2) an individual who is residing in a
					 nursing facility and requesting enrollment in the DBMD Program.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 260 - DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES › Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW › Division 2 - ENROLLMENT PROCESS, PERSON-CENTERED PLANNING, AND REQUIREMENTS FOR SERVICE SETTINGS › Section 260.57 - Person-Centered Planning Process

Current through Reg. 49, No. 28; July 12, 2024
(a) Person-centered
					 planning is a process that empowers an individual to plan the individual's
					 services and supports to achieve desired outcomes.
(b) A program provider must ensure the
					 person-centered planning process is led by an individual to the maximum extent
					 possible. An individual's LAR has a participatory role, as needed and 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 an IPP, a PAS/HAB plan, an enrollment
					 IPC, a renewal IPC, a revised IPC, a service backup plan, and an individual
					 transportation plan.
(d) The
					 person-centered planning process must:
(1)
					 include people chosen by an individual, or LAR;
(2) provide the information and support the
					 individual needs to lead the planning process and make informed choices and
					 decisions;
(3) occur at a time and
					 location convenient to the individual and LAR;
(4) consider the individual's cultural
					 preferences;
(5) provide
					 information in plain language to the individual and in a manner that is
					 accessible to the individual:
(A) through the
					 provision of auxiliary aids and services at no cost to the individual in
					 accordance with the Americans with Disabilities Act and section 504 of the
					 Rehabilitation Act, if the individual requires such aids or services to
					 communicate; and
(B) through the
					 provision of language services at no cost to the individual, including oral
					 interpretation and written translations, if the individual has limited English
					 proficiency;
(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 decisions about DBMD Program and CFC services,
					 the settings in which the individual receives a DBMD Program service or a CFC
					 service, and service providers; and
(8) inform the individual or LAR that the
					 individual or LAR may request revisions to an IPP, a PAS/HAB plan, an
					 enrollment IPC, a renewal IPC, a revised IPC, a service backup plan, or an
					 individual transportation plan at any time by communicating the request to the
					 program provider.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 260 - DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES › Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW › Division 2 - ENROLLMENT PROCESS, PERSON-CENTERED PLANNING, AND REQUIREMENTS FOR SERVICE SETTINGS › Section 260.59 - 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
					 DBMD Program services or CFC services. A home and community-based setting must
					 have all of the following qualities based on the individual's strengths,
					 preferences, and needs as documented in the individual's IPP.
(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 260 - DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES › Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW › Division 2 - ENROLLMENT PROCESS, PERSON-CENTERED PLANNING, AND REQUIREMENTS FOR SERVICE SETTINGS › Section 260.61 - Process for Enrollment of an Individual

Current through Reg. 49, No. 28; July 12, 2024
(a) After HHSC
					 notifies a program provider, as described in §260.55(d) of this division
					 (relating to Written Offer of Enrollment in the DBMD Program), that an
					 individual selected the program provider, the program provider must assign a
					 case manager to the individual.
(b)
					 A program provider must ensure that the assigned case manager contacts the
					 individual or LAR by telephone, videoconferencing, or in person in the
					 individual's residence as soon as possible but no later than five business days
					 after the program provider receives the HHSC notification. During this initial
					 contact, the case manager must:
(1) verify
					 that the individual resides in a county for which the program provider has a
					 contract;
(2) determine if the
					 individual is currently enrolled in Medicaid;
(3) determine if the individual is currently
					 enrolled in another waiver program or receiving a service that may not be
					 received if the individual is enrolled in the DBMD Program, as identified in
					 the Mutually Exclusive Services table in Appendix V of the
Deaf Blind
					 with Multiple Disabilities Program Manual
available on the HHSC
					 website; and
(4) schedule an
					 initial in-person visit to be held in the individual's residence with the
					 individual and LAR or actively involved person at a time convenient to the
					 individual and LAR and no later than 30 calendar days after the program
					 provider receives the HHSC notification.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 260 - DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES › Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW › Division 2 - ENROLLMENT PROCESS, PERSON-CENTERED PLANNING, AND REQUIREMENTS FOR SERVICE SETTINGS › Section 260.63 - Program Provider Cannot Ensure Individual's Health and Welfare

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC requests an
					 individual or LAR to choose a different program provider if the program
					 provider chosen by the individual or LAR informs HHSC, in writing, that it
					 cannot ensure the individual's health and welfare and is not willing to provide
					 DBMD Program services or CFC services to the individual.
(1) The program provider must include in the
					 written notification to HHSC:
(A) a
					 description of the specific reasons the program provider cannot ensure the
					 individual's health and welfare; and
(B) a statement that the program provider is
					 not willing to provide DBMD Program services or CFC services to the
					 individual.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 260 - DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES › Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW › Division 2 - ENROLLMENT PROCESS, PERSON-CENTERED PLANNING, AND REQUIREMENTS FOR SERVICE SETTINGS › Section 260.65 - Development of an Enrollment IPP

Current through Reg. 49, No. 28; July 12, 2024
(a) To develop an
					 enrollment IPP, a case manager must convene an in-person meeting with the
					 service planning team in which the service planning team completes the
					 individual's enrollment IPP for each DBMD Program service and CFC service,
					 other than CFC support management, identified on the individual's proposed
					 enrollment IPC.
(b) A case manager
					 must ensure an enrollment IPP:
(1) identifies
					 whether an individual will reside in the individual's own home or family home
					 or in a DBMD residential setting described in §
												260.351 of this chapter (relating
					 to Residential Services);
(2)
					 includes justification for each service and the total units indicated for each
					 service;
(3) describes:
(A) the outcomes to be achieved through each
					 service; and
(B) the action and
					 methods to be used to achieve the outcomes for each service;
(4) describes individualized goals
					 for each service that:
(A) are
					 outcome-based;
(B) are measurable;
					 and
(C) have a start date and
					 projected completion date; and
(5) includes:
(A) a description of the individual's
					 strengths, preferences, and needs as identified by the individual, LAR, or
					 both;
(B) a description of the
					 services and supports the individual needs to continue living in a
					 community-based setting, as identified through the HHSC CLASS/DBMD Nursing
					 Assessment form, ID/RC Assessment, HHSC Related Conditions Eligibility
					 Screening Instrument form, and adaptive behavior screening
					 assessment;
(C) a description of
					 the individual's current natural supports and non-waiver and non-CFC services
					 that will be or are available;
(D)
					 documentation that the frequency and amount of each service included in the IPP
					 and IPC, do not replace existing natural supports or non-waiver and non-CFC
					 resources for which the individual may be eligible;
(E) if the IPC includes CFC PAS/HAB, whether
					 the individual would like to receive CFC support management;
(F) that the individual needs a service
					 backup plan for nursing, intervener services, or CFC PAS/HAB, if the service
					 planning team determined the service is critical to the individual's health and
					 safety; and
(G) that the case
					 manager is responsible for monitoring the individuals service plan.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 260 - DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES › Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW › Division 2 - ENROLLMENT PROCESS, PERSON-CENTERED PLANNING, AND REQUIREMENTS FOR SERVICE SETTINGS › Section 260.67 - Development of a Proposed Enrollment IPC

Current through Reg. 49, No. 28; July 12, 2024
(a) A program
					 provider must ensure that an individual's case manager convenes an in-person
					 meeting with the service planning team in which the service planning team:
(1) develops a proposed enrollment IPC that:
(A) documents the type of each DBMD Program
					 service and CFC service, other than CFC support management, to be provided by
					 the program provider;
(B) documents
					 the number of units or annual cost for each service;
(C) if the individual will receive a service
					 through the CDS option, documents:
(i) the
					 name of the individual's FMSA; and
(ii) the type and number of units for each
					 service to be provided through the CDS option;
(D) documents whether the individual will
					 receive CFC support management;
(E)
					 documents whether the individual needs a service backup plan for nursing,
					 intervener services, or CFC PAS/HAB critical to the individual's health and
					 safety;
(F) documents an effective
					 date of the IPC that:
(i) is at least 10
					 business days after the case manager submits the proposed enrollment IPC to
					 HHSC as described in §260.61(m)(1) of this division (relating to Process
					 for Enrollment of an Individual); and
(ii) does not overlap with the end date of
					 another Medicaid waiver program or another HHSC-operated program described in
					 the
Deaf Blind with Multiple Disabilities Program Manual,
other than the Day Activity and Health Services Program, in which the
					 individual may have been enrolled; and
(G) does not exceed the service limits
					 described in:
(i) Subchapter F, Divisions 1 -
					 3, of this chapter (relating to Service Descriptions and Requirements) if the
					 enrollment IPC includes adaptive aids, minor home modifications, dental
					 treatment, and respite;
(ii)
					 Subchapter F, Division 5, of this chapter (relating to CFC ERS) if the
					 enrollment IPC includes CFC ERS; or
(iii)
														§
														272.5(d) of this
					 title (relating to Service Description), if the enrollment IPC includes
					 TAS;
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 260 - DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES › Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW › Division 2 - ENROLLMENT PROCESS, PERSON-CENTERED PLANNING, AND REQUIREMENTS FOR SERVICE SETTINGS › Section 260.69 - HHSC's Review of Request for Enrollment

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC reviews a
					 request for enrollment submitted by a case manager in accordance with
					 §260.61(l)(1) of this division (relating to Process for Enrollment of an
					 Individual) to determine if:
(1) the
					 individual meets the requirements described in §
												260.51(a)(2) and
					 (3) of this subchapter (relating to
					 Eligibility Criteria for DBMD Program Services and CFC Services);
(2) the proposed enrollment IPC has a cost at
					 or below the amount in §
												260.51(a)(4) of
					 this subchapter;
(3) the goals and
					 outcomes documented in the enrollment IPP for each DBMD Program service and CFC
					 service, except for CFC support management, meet the criteria described in
					 §260.65(b)(3) and (4) of this division (relating to Development of an
					 Enrollment IPP);
(4) the DBMD
					 Program services and CFC services, except for CFC support management, specified
					 in the proposed enrollment IPC meet the requirements described in
					 §260.67(a)(1) and (b) of this division (relating to Development of a
					 Proposed Enrollment IPC);
(5) the
					 individual is Medicaid-eligible due to receipt of Supplemental Security Income
					 cash benefits or is determined by HHSC to be financially eligible for Medicaid;
					 and
(6) the individual meets the
					 requirement described in §
												260.51(a)(5) of
					 this subchapter.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 260 - DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES › Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW › Division 2 - ENROLLMENT PROCESS, PERSON-CENTERED PLANNING, AND REQUIREMENTS FOR SERVICE SETTINGS › Section 260.71 - CDS Option

Current through Reg. 49, No. 28; July 12, 2024
(a) A program
					 provider must ensure an individual's case manager informs the individual or
					 LAR:
(1) of the CDS option in accordance with
					 40 TAC Chapter 41, Subchapter D (relating to Enrollment, Transfer, Suspension,
					 and Termination);
(2) of the DBMD
					 Program services and the CFC services that may be provided through the CDS
					 option, as described in 40 TAC §
												41.108(relating to Services
					 Available Through the CDS Option); and
(3) that the individual may elect to have one
					 or more of those services provided through the CDS option.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 260 - DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES › Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW › Division 3 - REVIEW › Section 260.73 - Tracking Annual Renewal of an ID/RC Assessment and an IPC

Current through Reg. 49, No. 28; July 12, 2024
(a) A program
					 provider must have and implement written policies and procedures to ensure
					 compliance with §260.77(b)(1) of this division (relating to Renewal and
					 Revision of an IPP and IPC).
(b) A
					 program provider's written policies and procedures must include a written or
					 electronic tracking system that alerts the program provider to activities that
					 must occur for the program provider to timely submit documentation to HHSC as
					 required by §260.77(b)(2) of this division.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 260 - DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES › Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW › Division 3 - REVIEW › Section 260.75 - Utilization Review of an IPC by HHSC

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC conducts a
					 utilization review of an IPC to determine if:
(1) the cost of the IPC meets the criteria
					 described in §
												260.51(a)(4) of
					 this subchapter (relating to Eligibility Criteria for DBMD Program Services and
					 CFC Services); and
(2) the DBMD
					 Program services and CFC services specified in the IPC meet the requirements
					 described in §
												260.67(a)(1) and
					 (b) of this subchapter (relating to
					 Development of a Proposed Enrollment IPC).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 260 - DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES › Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW › Division 3 - REVIEW › Section 260.77 - Renewal and Revision of an IPP and IPC

Current through Reg. 49, No. 28; July 12, 2024
(a) Case manager's
					 review.
(1) Beginning the effective date of
					 an individual's IPC, as determined in accordance with §
												260.69(j) of this
					 subchapter (relating to HHSC's Review of Request for Enrollment), a case
					 manager must, in accordance with the schedule in the
Deaf Blind with
					 Multiple Disabilities Program Manual, meet with the individual.
and
					 LAR in person at a time convenient to the individual and LAR in the
					 individual's home, or if requested by the individual or LAR, in another
					 location to:
(A) review whether the DBMD
					 Program services and CFC services are being provided in accordance with the IPC
					 and IPP;
(B) review the
					 individual's progress toward achieving the goals and outcomes described in the
					 IPP for each service listed on the individual's IPC;
(C) determine if the services are meeting the
					 individual's needs;
(D) determine
					 if the individual's needs have changed;
(E) review assessments, evaluations, and
					 progress notes prepared by service providers since the previous
					 review;
(F) if the individual's IPC
					 includes nursing, intervener services, or CFC PAS/HAB, and none of these
					 services are identified as critical to the individual's health and safety,
					 discuss with the individual or LAR whether any of these services may now be
					 critical to the individual's health and safety and needs a service backup plan;
					 and
(G) if the individual has a
					 service backup plan for nursing, intervener services, or CFC PAS/HAB, discuss
					 with the individual or LAR:
(i) whether the
					 service backup plan, if implemented, was effective;
(ii) whether the service backup plan needs to
					 be revised; and
(iii) whether the
					 service backup plan needs to be discontinued because the service is no longer
					 critical to the individual's health and safety.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 260 - DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES › Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW › Division 4 - TRANSFER BETWEEN PROGRAM PROVIDERS › Section 260.79 - Coordination of Transfers

Current through Reg. 49, No. 28; July 12, 2024
(a) After receiving
					 written notice from an individual or LAR of the individual's intention to
					 transfer to another program provider, a program provider must:
(1) document in the individual's record the
					 date the transfer request was received;
(2) coordinate transfer arrangements,
					 including designating an effective date for transfer that is at least 14
					 calendar days after the date of the transfer request documented in the
					 individual's record, with:
(A) the individual
					 or LAR; and
(B) the receiving
					 program provider;
(3)
					 review and complete the Service Delivery Transfer Worksheet with the individual
					 or LAR and the receiving program provider; and
(4) arrange with the receiving program
					 provider to transfer the individual's personal funds, if applicable.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 260 - DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES › Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW › Division 4 - TRANSFER BETWEEN PROGRAM PROVIDERS › Section 260.81 - Personal Leave for Individual Receiving Licensed Assisted Living or Licensed Home Health Assisted Living

Current through Reg. 49, No. 28; July 12, 2024
(a) An individual
					 receiving licensed assisted living or licensed home health assisted living may
					 take personal leave days.
(b) The
					 program provider:
(1) may charge the
					 individual or LAR for room and board for each personal leave day
					 taken;
(2) may bill HHSC for the
					 daily rate for licensed assisted living facility or a licensed home health
					 assisted living for personal leave days taken by the individual during a
					 calendar year within the limit specified in the
Deaf Blind with
					 Multiple Disabilities Program Manual
; and
(3) must not bill the individual for the
					 licensed assisted living or licensed home health assisted living daily rate for
					 personal leave days.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 260 - DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES › Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW › Division 5 - DENIAL, SUSPENSION, REDUCTION, AND TERMINATION › Section 260.83 - Denial of Request for Enrollment in the DBMD Program or of a DBMD Program Service or a CFC Service

Current through Reg. 49, No. 28; July 12, 2024
(a) Denial of an
					 Individual's Request for Enrollment.
(1) HHSC
					 denies an individual's request for enrollment in the DBMD Program if:
(A) the individual does not meet the
					 eligibility criteria described in §
													260.51(a) of this
					 subchapter (relating to Eligibility Criteria for DBMD Program Services and CFC
					 Services);
(B) the individual or
					 LAR fails to submit a completed Medicaid application to HHSC within one
					 calendar year after the date of the case manager's initial in-person visit in
					 the individual's residence; or
(C)
					 the individual cannot obtain services from at least one program
					 provider.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 260 - DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES › Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW › Division 5 - DENIAL, SUSPENSION, REDUCTION, AND TERMINATION › Section 260.85 - Suspension of DBMD Program Services and CFC Services

Current through Reg. 49, No. 28; July 12, 2024
(a) Except as
					 described in §
											260.81 of this subchapter
					 (relating to Personal Leave for Individual Receiving Licensed Assisted Living
					 or Licensed Home Health Assisted Living) or if the individual receives
					 out-of-home respite, HHSC suspends an individual's DBMD Program services and
					 CFC services if the individual:
(1) is
					 admitted to one of the following facilities:
(A) an ICF/IID;
(B) a nursing facility;
(C) an ALF that does not provide licensed
					 assisted living in the DBMD Program;
(D) a residential child-care facility unless
					 it is an agency foster home;
(E) a
					 hospital;
(F) a mental health
					 facility;
(G) an inpatient chemical
					 dependency treatment facility;
(H)
					 a facility operated by the Texas Workforce Commission;
(I) a residential facility operated by the
					 Texas Juvenile Justice Department; or
(J) a jail or prison; or
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 260 - DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES › Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW › Division 5 - DENIAL, SUSPENSION, REDUCTION, AND TERMINATION › Section 260.87 - Reduction of a DBMD Program Service or a CFC Service

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC reduces an
					 individual's DBMD Program services or CFC services if, during review of an
					 individual's IPC conducted as described in §
											260.75 of this subchapter
					 (relating to Utilization Review of an IPC by HHSC), HHSC determines that the
					 amount or level of a service on the individual's IPC does not meet the
					 requirements described in §
											260.67(a)(1) and
					 (b) of this subchapter (relating to
					 Development of a Proposed Enrollment IPC).
(b) HHSC sends a written notice with the
					 effective date of the reduction to the program provider that the program
					 provider, upon receipt but no later than 12 calendar days before the effective
					 date of reduction, must send to the individual or LAR, copying the FMSA if
					 applicable.
(c) If an individual or
					 LAR requests a fair hearing before the effective date of the reduction
					 specified in the written notice, the program provider must provide the DBMD
					 Program service or the CFC service at the amount or level approved by HHSC on
					 the prior IPC while the appeal is pending.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 260 - DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES › Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW › Division 5 - DENIAL, SUSPENSION, REDUCTION, AND TERMINATION › Section 260.89 - Termination of DBMD Program Services and CFC Services With Advance Notice Due to Ineligibility or Leave from the State

Current through Reg. 49, No. 28; July 12, 2024
(a) Except as
					 provided in subsection (c) of this section, HHSC terminates:
(1) an individual's DBMD Program services if
					 the individual does not meet the eligibility criteria described in §
												260.51(a) of this
					 subchapter (relating to Eligibility Criteria for DBMD Program Services and CFC
					 Services);
(2) an individual's CFC
					 services if the individual does not meet the eligibility criteria described in
					 §
												260.51(b) or (c)
					 of this subchapter; and
(3) an
					 individual's DBMD Program services and CFC services if:
(A) the individual is admitted to one of the
					 facilities listed in §
													260.85(a) of this
					 subchapter (relating to Suspension of DBMD Program Services and CFC Services)
					 for more than 180 consecutive calendar days or beyond an extension of the
					 individual's suspension that HHSC approved in accordance with §
													260.85(g) of this
					 subchapter; or
(B) the individual
					 leaves the State of Texas for more than 180 consecutive calendar days and HHSC
					 has not extended the individual's suspension in accordance with §
													260.85(g) of this
					 subchapter.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 260 - DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES › Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW › Division 5 - DENIAL, SUSPENSION, REDUCTION, AND TERMINATION › Section 260.101 - Termination of DBMD Program Services and CFC Services with Advance Notice Due to Non-compliance with Mandatory Participation Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC may
					 terminate an individual's DBMD Program services and CFC services if the
					 individual refuses to comply with a mandatory participation requirement
					 described in §
											260.113 of this subchapter
					 (relating to Mandatory Participation Requirements of an Individual).
(b) If a program provider becomes aware that
					 an individual has not complied with a mandatory participation requirement, the
					 program provider must immediately attempt to resolve the situation including
					 facilitating at least one in-person meeting with the individual or
					 LAR.
(c) If attempts to resolve the
					 situation fail, the program provider must request, in writing, that HHSC
					 terminate DBMD Program services and CFC services for the individual. Within two
					 business days after concluding that the situation cannot be resolved, the
					 program provider must send the written request with written supporting
					 documentation to HHSC. The program provider must include in the written
					 documentation a description of:
(1) the
					 situation that resulted in the request to terminate DBMD Program services and
					 CFC services; and
(2) the attempts
					 by the program provider to resolve the situation, including in-person meetings
					 with the individual or LAR.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 260 - DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES › Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW › Division 5 - DENIAL, SUSPENSION, REDUCTION, AND TERMINATION › Section 260.103 - Termination of DBMD Program Services and CFC Services without Advance Notice for Reasons Other Than Behavior Causing Immediate Jeopardy

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC terminates
					 an individual's DBMD Program services and CFC services if any of the following
					 situations exist:
(1) the program provider has
					 factual information confirming the death of the individual;
(2) the program provider receives a clear
					 written statement signed by the individual that:
(A) the individual no longer wishes to
					 receive DBMD Program services and CFC services; or
(B) gives information that requires
					 termination of services and indicates that the individual understands that this
					 must be the result of supplying that information;
(3) the individual's whereabouts are unknown,
					 and the post office returns program provider mail directed to the individual or
					 LAR indicating no forwarding address; or
(4) the program provider establishes the fact
					 that the individual has been accepted for Medicaid services by another
					 state.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 260 - DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES › Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW › Division 5 - DENIAL, SUSPENSION, REDUCTION, AND TERMINATION › Section 260.105 - Termination of DBMD Program Services and CFC Services without Advance Notice Due to Behavior Causing Immediate Jeopardy

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC may
					 terminate an individual's:
(1) DBMD Program
					 services and CFC services if an individual or a person in the individual's
					 residence exhibits behavior that places the health and safety of the program
					 provider's service provider in immediate jeopardy; or
(2) DBMD Program services if an individual
					 receiving licensed assisted living or licensed home health assisted living
					 exhibits behavior that places the health and safety of another individual
					 residing in the same residence or a service provider in immediate
					 jeopardy.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 260 - DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES › Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW › Division 5 - DENIAL, SUSPENSION, REDUCTION, AND TERMINATION › Section 260.107 - Offering Access to Other Services

Current through Reg. 49, No. 28; July 12, 2024
If HHSC terminates an individual's DBMD Program services
						and CFC services, the program provider must ensure that the case manager
						informs the individual of:
(1)
					 alternative long-term services and supports in the community, including CFC
					 services through a managed care organization; and
(2) institutional services.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 260 - DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES › Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW › Division 5 - DENIAL, SUSPENSION, REDUCTION, AND TERMINATION › Section 260.109 - Individual Whose DBMD Program Services are Terminated May Request Name be Added to DBMD Interest List

Current through Reg. 49, No. 28; July 12, 2024
If HHSC terminates an individual's DBMD Program services,
						the individual or LAR may request the individual's name be placed on the DBMD
						interest list in accordance with §
											260.53(b) of this
						subchapter (relating to DBMD Interest List).