Texas Administrative Code › Title 40 - SOCIAL SERVICES AND ASSISTANCE › Part 1 - DEPARTMENT OF AGING AND DISABILITY SERVICES › Chapter 48 - COMMUNITY CARE FOR AGED AND DISABLED › Subchapter H - ELIGIBILITY › Section 48.2918 - Primary Home Care or Community Attendant Services

Current through Reg. 49, No. 28; July 12, 2024
(a) To be eligible for primary home care or
				  community attendant (CA) services, the applicant/client must:
(1) be eligible for Medicaid in a community
				  setting or be eligible under the provisions of the Social Security Act,
				  §1929(b)(2)(B);
(2) meet the
				  minimum functional need criteria as set by the department. The department uses
				  a standardized assessment instrument to measure the client's ability to perform
				  activities of daily living. This yields a score, which is a measure of the
				  client's level of functional need. The department sets the minimum required
				  score for a client to be eligible, which the department may periodically adjust
				  commensurate with available funding. The department will seek stakeholder input
				  before making any change in the minimum required score for functional
				  eligibility;
(3) have a medical
				  need for assistance with personal care.
(A)
				  The client's medical condition must be the cause of the client's functional
				  impairment in performing personal care tasks.
(B) Persons diagnosed with mental illness,
				  mental retardation, or both, are not considered to have established medical
				  need based solely on such diagnosis. The diagnoses do not disqualify a client
				  for eligibility as long as the client's functional impairment is related to a
				  coexisting medical condition;
(4) have a signed and dated practitioner's
				  statement that includes a statement that the client has a current medical need
				  for assistance with personal care tasks and other activities of daily living;
				  and
(5) require at least six hours
				  of service per week. An applicant/client requiring fewer than six hours of
				  service per week may be eligible if the applicant/client:
(A) requires primary home care or community
				  attendant services to provide respite care to the caregiver;
(B) lives in the same household as another
				  individual receiving primary home care, community attendant services, family
				  care, or community based alternatives personal assistance services;
(C) receives one or more of the following
				  services (through the department or other resources):
(i) congregate or home-delivered
				  meals;
(ii) assistance with
				  activities of daily living from a home health aide;
(iii) day activity and health services;
				  or
(iv) special services to persons
				  with disabilities in adult day care;
(D) receives aid-and-attendance benefits from
				  the Veterans Administration;
(E)
				  receives services through the department's In-home and Family Support
				  Program;
(F) receives services
				  through the Medically Dependent Children Program (MDCP); or
(G) is determined, based upon the functional
				  assessment, to be at high risk of institutionalization without primary home
				  care or community attendant care services.