Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 262 - TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW › Section 262.101 - Eligibility Criteria for TxHmL Program Services and CFC Services

Current through Reg. 49, No. 28; July 12, 2024
(a) An applicant or
				  individual is eligible for TxHmL Program services if:
(1) the applicant or individual meets the
				  financial eligibility criteria as described in Appendix B of the TxHmL waiver
				  application approved by CMS and available on the HHSC website;
(2) the applicant or individual meets one of
				  the following criteria:
(A) based on a DID and
				  as determined by HHSC in accordance with §
												262.104 of this subchapter
				  (relating to LOC Determination), the applicant or individual qualifies for an
				  ICF/IID LOC I as defined in §
												261.238 of this title (relating to
				  ICF/MR Level of Care I Criteria); or
(B) meets the following criteria:
(i) based on a DID and as determined by HHSC
				  in accordance with §
													262.105 of this subchapter
				  (relating to LON Assignment), qualifies for one of the following levels of
				  care:
(I) an ICF/IID LOC I as defined in
				  §
														261.238 of this title;
				  or
(II) an ICF/IID LOC VIII as
				  defined in §
														261.239 of this title (relating to
				  ICF/MR Level of Care VIII Criteria);
(ii) meets one of the following:
(I) resides in a nursing facility immediately
				  before enrolling in the TxHmL Program; or
(II) is at imminent risk of entering a
				  nursing facility as determined by HHSC; and
(iii) is offered TxHmL Program services
				  designated for a member of the reserved capacity group "Individuals with a
				  level of care I or VIII residing in a nursing facility" included in Appendix B
				  of the TxHmL Program waiver application approved by CMS and available on the
				  HHSC website;
(3) the applicant or individual has been
				  assigned an LON in accordance with §
											262.105 of this
				  subchapter;
(4) the applicant or
				  individual has an IPC cost that does not exceed $17,000;
(5) the applicant or individual is not
				  enrolled in another waiver program and is not receiving a service that may not
				  be received if the individual is enrolled in the TxHmL Program, as identified
				  in the Mutually Exclusive Services table in Appendix I of the TxHmL Handbook
				  available on the HHSC website;
(6)
				  the applicant or individual has chosen, or the applicant's or individual's LAR
				  has chosen, participation in the TxHmL Program over participation in the
				  ICF/IID Program;
(7) the
				  applicant's or individual's service planning team concurs that the TxHmL
				  Program services and, if applicable, non-TxHmL Program services for which the
				  applicant or individual may be eligible are sufficient to ensure the
				  applicant's or individual's health and welfare in the community;
(8) the applicant or individual does not
				  reside in:
(A) a hospital;
(B) an ICF/IID;
(C) a nursing facility;
(D) an assisted living facility licensed or
				  subject to being licensed in accordance with THSC Chapter 247;
(E) a residential child care facility
				  licensed by HHSC unless it is an agency foster home;
(F) an inpatient chemical dependency
				  treatment facility;
(G) a mental
				  health facility;
(H) a residential
				  facility operated by the Texas Workforce Commission; or
(I) a residential facility operated by the
				  Texas Juvenile Justice Department, a jail, or a prison; and
(9) the applicant or individual requires the
				  provision of:
(A) at least one TxHmL Program
				  service per month or a monthly monitoring visit by a service coordinator as
				  described in §
												262.701(o) of
				  this chapter (relating to LIDDA Requirements for Providing Service Coordination
				  in the TxHmL Program); and
(B) at
				  least one TxHmL Program service per IPC year.