reglab/statecodes huggingface dataset:
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 262.107 - Reconsideration of LON Assignment

Current through Reg. 49, No. 28; July 12, 2024
(a) A LIDDA may
				  request that HHSC reconsider an LON assignment.
(b) A LIDDA may receive reconsideration only
				  if the LIDDA submitted documentation supporting the recommended LON as required
				  by §
										262.106(b) of
				  this subchapter (relating to HHSC Review of LON).
(c) To request reconsideration of an LON
				  assignment, the LIDDA 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 LIDDA may send HHSC documentation, in addition to
				  that required by §
										262.106(b) 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 service coordinator.
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 C - PERSON-CENTERED PLANNING AND SERVICE SETTINGS › Section 262.201 - 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 TxHmL 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 262 - TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter C - PERSON-CENTERED PLANNING AND SERVICE SETTINGS › Section 262.202 - 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 receives TxHmL
				  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 262 - TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter D - DEVELOPMENT AND REVIEW OF AN IPC › Section 262.301 - 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 TxHmL Program service and CFC service to be provided to the
				  individual during an IPC year;
(2)
				  the services and supports to be provided to the individual through resources
				  other than TxHmL 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 TxHmL 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 262 - TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter D - DEVELOPMENT AND REVIEW OF AN IPC › Section 262.302 - Renewal and Revision of an Individual's IPC

Current through Reg. 49, No. 28; July 12, 2024
(a) Renewal and
				  Revision of an IPC. At least annually, and before the expiration of an
				  individual's IPC, the individual's IPC must be renewed and revised in
				  accordance with this subsection and HHSC's instructions.
(1) At least 30 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 with the service
				  planning team to:
(i) review and update the
				  individual's PDP and develop a renewal IPC; 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;
(C) ensure the individual or LAR signs the
				  finalized PDP; and
(D) use the HHSC
				  Understanding Program Eligibility and Services form to provide an individual or
				  LAR both an oral and a written explanation of:
(i) the eligibility requirements for the
				  TxHmL Program as described in §
													262.101(a) of
				  this chapter (relating to Eligibility Criteria for TxHmL Program Services and
				  CFC Services);
(ii) if the
				  individual's PDP includes CFC services:
(I)
				  the eligibility requirements for CFC services as described in §
														262.101(b) of
				  this chapter to individuals who do not receive MAO Medicaid; and
(II) the eligibility requirements for CFC
				  services as described in §
														262.101(c) of
				  this chapter to individuals who receive MAO Medicaid;
(iii) all TxHmL Program services as described
				  in §
													262.5 of this chapter (relating to
				  Description of TxHmL Program Services) and all CFC services as described in
				  §
													262.6 of this chapter (relating to
				  Description of CFC Services);
(iv)
				  the reasons TxHmL Program services may be terminated as described in §
													262.507 of this chapter (relating
				  to Termination of TxHmL Program Services and CFC Services with Advance Notice)
				  and §
													262.508 of this chapter (relating
				  to Termination of TxHmL Program Services and CFC Services without advance
				  notice) or suspended as described in §
													262.505 of this chapter (relating
				  to Suspension of TxHmL Program Services and CFC Services); and
(v) if the individual's PDP includes CFC
				  services, the reasons CFC services may be terminated as described §
													262.507 of this chapter and §
													262.508 of this chapter or
				  suspended as described in §
													262.505 of this chapter.
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 D - DEVELOPMENT AND REVIEW OF AN IPC › Section 262.303 - HHSC Review of an IPC

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC may review
				  an IPC to determine if:
(1) the type and
				  amount of TxHmL Program services and CFC services specified in the IPC meet the
				  requirements described in §
											262.301 of this subchapter
				  (relating to IPC Requirements); and
(2) the IPC exceeds the cost limit as
				  described in §
											262.101(a)(4) of
				  this chapter (relating to Eligibility Criteria for TxHmL Program Services and
				  CFC Services).
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 D - DEVELOPMENT AND REVIEW OF AN IPC › Section 262.304 - Service Limits

Current through Reg. 49, No. 28; July 12, 2024
(a) The following
				  limits apply to an individual's TxHmL Program services:
(1) for adaptive aids, $10,000 during an IPC
				  year;
(2) for dental treatment,
				  $1,000 during an IPC year;
(3) for
				  minor home modifications:
(A) $7,500 during
				  the time the individual is enrolled in the TxHmL Program, which may be paid in
				  one or more IPC years; and
(B) a
				  maximum of $300 for repair and maintenance during the IPC year;
				  and
(4) for day
				  habilitation and in-home day habilitation combined, 260 units during an IPC
				  year.
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 E - REIMBURSEMENT BY HHSC › Section 262.401 - Program Provider Reimbursement

Current through Reg. 49, No. 28; July 12, 2024
(a) Program
				  provider reimbursement.
(1) HHSC pays a
				  program provider for services as described in this paragraph.
(A) HHSC pays for community support, nursing,
				  in-home respite, respite, day habilitation, in-home day habilitation,
				  employment assistance, supported employment, professional therapies, and CFC
				  PAS/HAB in accordance with the reimbursement rate for the specific
				  service.
(B) HHSC pays for adaptive
				  aids, minor home modifications, and dental treatment based on the actual cost
				  of the item or service and, if requested, a requisition fee in accordance with
				  the TxHmL Program Billing Requirements available on the HHSC website.
(C) 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 262 - TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter F - TRANSFERS, DENIALS, SUSPENSIONS, REDUCTIONS, AND TERMINATIONS › Section 262.501 - 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 262 - TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter F - TRANSFERS, DENIALS, SUSPENSIONS, REDUCTIONS, AND TERMINATIONS › Section 262.502 - 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) 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 262 - TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter F - TRANSFERS, DENIALS, SUSPENSIONS, REDUCTIONS, AND TERMINATIONS › Section 262.503 - Denial of a Request for Enrollment into the TxHmL Program

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC denies an
				  individual's request for enrollment into the TxHmL Program if the individual
				  does not meet the eligibility criteria described in §
										262.101 of this chapter (relating
				  to Eligibility Criteria for TxHmL 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 TxHmL Program and
				  includes in the notice the individual's right to request a fair hearing in
				  accordance with §
										262.601 of this chapter (relating
				  to 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 262 - TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter F - TRANSFERS, DENIALS, SUSPENSIONS, REDUCTIONS, AND TERMINATIONS › Section 262.504 - Denial of TxHmL Program Services or CFC Services

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC denies a
				  TxHmL Program service or CFC service on an individual's IPC, based on a review
				  described in §
										262.303 of this chapter (relating
				  to HHSC Review of an IPC) or §
										262.302 of this chapter (relating
				  to Renewal and Revision of an Individual's IPC), if HHSC determines that the
				  TxHmL Program service or CFC service does not meet the requirements described
				  in §
										262.301(c) of
				  this chapter (relating to IPC Requirements).
(b) If HHSC denies a TxHmL Program service or
				  CFC service on the individual's IPC, HHSC:
(1)
				  modifies the IPC in the HHSC data system; and
(2) sends written notice to the individual or
				  LAR of the denial of the service and includes in the notice the individual's
				  right to request a fair hearing in accordance with §
											262.601 of this chapter (relating
				  to Fair Hearing).
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 F - TRANSFERS, DENIALS, SUSPENSIONS, REDUCTIONS, AND TERMINATIONS › Section 262.505 - Suspension of TxHmL Program Services and CFC Services

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC suspends
				  an individual's TxHmL Program services or 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 assisted living facility licensed in
				  accordance with Texas Health and Safety Code Chapter 247, Assisted Living
				  Facilities;
(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 262 - TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter F - TRANSFERS, DENIALS, SUSPENSIONS, REDUCTIONS, AND TERMINATIONS › Section 262.506 - Reduction of TxHmL Program Services or CFC Services

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC proposes a
				  reduction of a TxHmL Program service or CFC service on an individual's IPC,
				  based on a review described in §
										262.303 of this chapter (relating
				  to HHSC Review of an IPC) or §
										262.302 of this chapter (relating
				  to Renewal and Revision of an Individual's IPC), if HHSC determines that the
				  TxHmL Program service or CFC service does not meet the requirements described
				  in §
										262.301(c) of
				  this chapter (relating to IPC Requirements).
(b) If HHSC proposes a reduction of a TxHmL
				  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 §
										262.601 of this chapter (relating
				  to 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 a TxHmL 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 a TxHmL 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 262 - TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter F - TRANSFERS, DENIALS, SUSPENSIONS, REDUCTIONS, AND TERMINATIONS › Section 262.507 - Termination of TxHmL Program Services and CFC Services with Advance Notice

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC terminates
				  an individual's TxHmL Program services and CFC services if:
(1) the individual does not meet the
				  eligibility criteria described in §262.101(a)(1) - (7) and (c) of this
				  chapter (relating to Eligibility Criteria for TxHmL Program Services and CFC
				  Services); or
(2) the individual or
				  LAR refuses to cooperate in the provision or planning of services and:
(A) the refusal is documented by the program
				  provider and the service coordinator; and
(B) the service coordinator has explained to
				  the individual or LAR, in writing, that the refusal may result in termination
				  of TxHmL Program services and CFC services.
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 F - TRANSFERS, DENIALS, SUSPENSIONS, REDUCTIONS, AND TERMINATIONS › Section 262.508 - Termination of TxHmL Program Services and CFC Services without Advance Notice

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC terminates
				  an individual's TxHmL Program services and CFC services if any of the following
				  situations exists:
(1) the individual is
				  admitted to one of the facilities listed in §262.505(a)(1) - (9) of this
				  subchapter (relating to Suspension of TxHmL 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 §
												262.505(h) of
				  this subchapter;
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 G - HEARINGS › Section 262.601 - Fair Hearing

Current through Reg. 49, No. 28; July 12, 2024
An applicant whose request for eligibility for the TxHmL
					 Program is denied or is not acted upon with reasonable promptness, or an
					 individual whose TxHmL 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 262 - TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter G - HEARINGS › Section 262.602 - Program Provider's Right to Administrative Hearing

Current through Reg. 49, No. 28; July 12, 2024
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.
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 H - LIDDA REQUIREMENTS › Section 262.701 - LIDDA Requirements for Providing Service Coordination in the TxHmL Program

Current through Reg. 49, No. 28; July 12, 2024
(a) A LIDDA must
				  offer TxHmL Program services to an applicant in accordance with §
										262.103 of this chapter (relating
				  to Process for Enrollment of Applicants).
(b) A LIDDA must process enrollments of
				  individuals in the TxHmL Program in accordance with §
										262.103 of this chapter.
(c) A LIDDA must be objective in the process
				  to assist an individual or LAR in the selection of a program provider or FMSA
				  and train all LIDDA staff who may assist an individual or LAR in the
				  process.
(d) A LIDDA must, upon the
				  enrollment of an individual and annually thereafter, inform the individual or
				  LAR orally and in writing of the following:
(1) the telephone number of the LIDDA to file
				  a complaint;
(2) the toll-free
				  telephone number of the HHSC IDD Ombudsman, 1-800-252-8154, to file a
				  complaint; and
(3) the toll-free
				  telephone number of DFPS, 1-800-647-7418, to report an allegation of abuse,
				  neglect, or exploitation.
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 I - DECLARATION OF DISASTER › Section 262.801 - Exceptions to Certain Requirements During Declaration of Disaster

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC may allow
				  program providers and service coordinators to use one or more of the exceptions
				  described in subsections (c) - (j) 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 and LIDDAs:
(1) if it 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 262 - TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter J - INDIVIDUALIZED SKILLS AND SOCIALIZATION › Section 262.903 - Types of Individualized Skills and Socialization

Current through Reg. 49, No. 28; July 12, 2024
The following are the three types of individualized skills
					 and socialization:
(1) on-site
				  individualized skills and socialization;
(2) off-site individualized skills and
				  socialization; and
(3) in-home
				  individualized skills and socialization.
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 J - INDIVIDUALIZED SKILLS AND SOCIALIZATION › Section 262.905 - Description of On-Site and Off-Site Individualized Skills and Socialization

Current through Reg. 49, No. 28; July 12, 2024
(a) Individualized
				  skills and socialization is a TxHmL Program service described in this
				  section.
(b) On-site and off-site
				  individualized skills and socialization:
(1)
				  provide person-centered activities related to:
(A) acquiring, retaining, or improving
				  self-help skills and adaptive skills necessary to live successfully in the
				  community and participate in home and community life; and
(B) gaining or maintaining independence,
				  socialization, community participation, current or future volunteer goals, or
				  employment goals consistent with achieving the outcomes identified in an
				  individual's PDP;
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 J - INDIVIDUALIZED SKILLS AND SOCIALIZATION › Section 262.907 - Description of and Criteria for an Individual to Receive In-Home Individualized Skills and Socialization

Current through Reg. 49, No. 28; July 12, 2024
(a) In-home
				  individualized skills and socialization is:
(1) assistance with acquiring, retaining, and
				  improving self-help, socialization, and adaptive skills necessary to reside and
				  participate successfully in the community;
(2) the provision of age-appropriate
				  activities that enhance self-esteem and maximize functional level;
(3) reinforcement of skills or lessons
				  taught:
(A) in school or other settings;
				  or
(B) during the provision of any
				  TxHmL Program service or non-waiver service;
(4) the provision of personal assistance for
				  an individual who cannot manage personal care needs during the provision of
				  in-home individualized skills and socialization; and
(5) as determined by an assessment conducted
				  by a registered nurse, assistance with medications and the performance of tasks
				  delegated by a registered nurse in accordance with state law and rules, unless
				  a physician has delegated the task as a medical act under Texas Occupations
				  Code Chapter 157, as documented by the physician.
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 J - INDIVIDUALIZED SKILLS AND SOCIALIZATION › Section 262.909 - Exceptions to Certain Requirements During Declaration of Disaster

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC may allow
				  program providers to use one or both of the exceptions in subsections (c) and
				  (d) 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 it
				  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 262 - TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter J - INDIVIDUALIZED SKILLS AND SOCIALIZATION › Section 262.911 - Provision of On-Site and Off-Site Individualized Skills and Socialization

Current through Reg. 49, No. 28; July 12, 2024
(a) On-site and
				  off-site individualized skills and socialization must be provided by an
				  individualized skills and socialization provider. An individualized skills and
				  socialization provider must be the program provider or a contractor of the
				  program provider.
(b) A program
				  provider must make both on-site individualized skills and socialization and
				  off-site individualized skills and socialization available to an
				  individual.
(c) An individualized
				  skills and socialization provider must provide on-site individualized skills
				  and socialization and off-site individualized skills and socialization in
				  accordance with an individual's PDP, IPC, and implementation plan.
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 J - INDIVIDUALIZED SKILLS AND SOCIALIZATION › Section 262.913 - Provision of In-Home Individualized Skills and Socialization

Current through Reg. 49, No. 28; July 12, 2024
(a) A program
				  provider must ensure that in-home individualized skills and socialization is
				  provided in the residence of the individual receiving the service.
(b) In-home individualized skills and
				  socialization is not required to be provided by an individualized skills and
				  socialization provider.
(c) Before
				  providing in-home individualized skills and socialization to an individual, a
				  program provider must obtain documentation:
(1) from a physician that the individual's
				  medical condition justifies the provision of in-home individualized skills and
				  socialization;
(2) from a licensed
				  professional or behavioral supports service provider that the individual's
				  behavioral issues justify the provision of in-home individualized skills and
				  socialization; or
(3) that the
				  individual is 55 years of age or older and requests to receive in-home
				  individualized skills and socialization.
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 J - INDIVIDUALIZED SKILLS AND SOCIALIZATION › Section 262.915 - Service Limit for On-Site, Off-Site, and In-Home Individualized Skills and Socialization

Current through Reg. 49, No. 28; July 12, 2024
The service limit for the combined total of on-site,
					 off-site, and in-home individualized skills and socialization is:
(1) 1,560 hours during an IPC year;
(2) six hours per calendar day; and
(3) five days per calendar week.
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 J - INDIVIDUALIZED SKILLS AND SOCIALIZATION › Section 262.917 - Staffing Ratios for Off-Site Individualized Skills and Socialization

Current through Reg. 49, No. 28; July 12, 2024
(a) The ratio of
				  service providers of off-site individualized skills and socialization to
				  persons receiving services off-site must be:
(1) no higher than one service provider of
				  off-site individualized skills and socialization to eight individuals with an
				  LON 1 or an LON 5 without an enhanced staffing rate and other persons receiving
				  off-site individualized skills and socialization or a similar service
				  (1:8);
(2) no higher than one
				  service provider of off-site individualized skills and socialization to two
				  individuals with an LON 8 or an LON 6 and other persons receiving off-site
				  individualized skills and socialization or a similar service (1:2);
(3) no higher than one service provider of
				  off-site individualized skills and socialization to two individuals with an LON
				  1 or an LON 5 with the level one enhanced staffing rate and other persons
				  receiving off-site individualized skills and socialization or a similar service
				  (1:2);
(4) no higher than one
				  service provider of off-site individualized skills and socialization to one
				  individual with an LON 1, LON 5, LON 8, or LON 6 with the level two enhanced
				  staffing rate and other persons receiving off-site individualized skills and
				  socialization or a similar service (1:1); and
(5) no higher than one service provider of
				  off-site individualized skills and socialization to one individual with an LON
				  9 and other persons receiving off-site individualized skills and socialization
				  or a similar service (1:1).
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 J - INDIVIDUALIZED SKILLS AND SOCIALIZATION › Section 262.919 - Discontinuation of Day Habilitation

Current through Reg. 49, No. 28; July 12, 2024
Notwithstanding other rules governing the TxHmL Program,
					 effective March 1, 2023, day habilitation, which includes in-home day
					 habilitation, is not a service in the TxHmL Program.
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 J - INDIVIDUALIZED SKILLS AND SOCIALIZATION › Section 262.921 - Including On-Site, Off-Site, and In-Home Individualized Skills and Socialization on an IPC

Current through Reg. 49, No. 28; July 12, 2024
(a) If an applicant
				  wants to receive on-site or off-site individualized skills and socialization,
				  or wants to receive and meets the criteria for in-home individualized skills
				  and socialization:
(1) a service coordinator
				  must include the type of individualized skills and socialization on the
				  applicant's PDP and the type and amount of individualized skills and
				  socialization on the initial IPC in accordance with the rules governing the
				  TxHmL Program; and
(2) a program
				  provider must develop an implementation plan for on-site, off-site, and in-home
				  individualized skills and socialization.
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 J - INDIVIDUALIZED SKILLS AND SOCIALIZATION › Section 262.923 - Service Provider Qualifications and Training for In-Home Individualized Skills and Socialization

Current through Reg. 49, No. 28; July 12, 2024
(a) A service
				  provider of in-home individualized skills and socialization must be at least 18
				  years of age and:
(1) have a high school
				  diploma or a certificate recognized by a state as the equivalent of a high
				  school diploma; or
(2) have
				  documentation of a proficiency evaluation of experience and competence to
				  perform the job tasks that includes:
(A) a
				  written competency-based assessment of the ability to document service delivery
				  and observations of the individuals to be served; and
(B) at least three written personal
				  references from persons not related by blood that indicate the ability to
				  provide a safe, healthy environment for the individuals being served.
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 J - INDIVIDUALIZED SKILLS AND SOCIALIZATION › Section 262.925 - Program Provider Reimbursement for On-Site, Off-Site, and In-Home Individualized Skills and Socialization

Current through Reg. 49, No. 28; July 12, 2024
(a) Except as
				  provided in subsection (b) of this section, HHSC pays for on-site, off-site,
				  and in-home individualized skills and socialization provided to an individual
				  at the reimbursement rates for on-site, off-site and in-home individualized
				  skills and socialization regardless of the individual's LON.
(b) If approved in accordance with §
										262.927 of this subchapter
				  (relating to Enhanced Staffing Rate) HHSC pays:
(1) a level one enhanced staffing rate for
				  off-site individualized skills and socialization for an individual with an LON
				  1 or LON 5; and
(2) a level two
				  enhanced staffing rate for off-site individualized skills and socialization for
				  an individual with an LON 1, LON 5, LON 8, or LON 6.
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 J - INDIVIDUALIZED SKILLS AND SOCIALIZATION › Section 262.927 - Enhanced Staffing Rate

Current through Reg. 49, No. 28; July 12, 2024
(a) A program
				  provider may request a level one enhanced staffing rate for off-site
				  individualized skills and socialization described in §
										262.925(b) of
				  this subchapter (relating to Program Provider Reimbursement for On-Site,
				  Off-Site, and In-Home Individualized Skills and Socialization) for an
				  individual with a LON 1 or LON 5 who receives off-site individualized skills
				  and socialization from the program provider.
(b) A program provider may request a level
				  two enhanced staffing rate for off-site individualized skills and socialization
				  described in §
										262.925(b) of
				  this subchapter for an individual with a LON 1, LON 5, LON 8, or LON 6 who
				  receives off-site individualized skills and socialization from the program
				  provider.
(c) A service coordinator
				  must request a level one enhanced staffing rate for an individual with a LON 1
				  or LON 5 or request a level two enhanced staffing rate for an individual with a
				  LON 1, LON 5, LON 8, or LON 6 for off-site individualized skills and
				  socialization described in §
										262.925(b) of
				  this subchapter for an individual who receives off-site individualized skills
				  and socialization through the CDS option if the CDS employer asks the service
				  coordinator to request the enhanced staffing rate.
(d) A program provider or service coordinator
				  makes the request described in subsections (a) - (c) of this section by
				  submitting the following documentation to HHSC:
(1) a completed HHSC Enhanced Staffing Rate
				  Request Form;
(2) the most recent
				  ICAP scoring booklet;
(3) the most
				  recent ID/RC Assessment;
(4) the
				  most recent PDP;
(5) the most
				  recent implementation plan for individualized skills and socialization;
				  and
(6) other documentation that
				  supports the individual's request for an enhanced staffing rate, which may
				  include:
(A) the behavior support
				  plan;
(B) a physician's
				  order;
(C) an assessment completed
				  by a service provider of a professional therapy;
(D) the nursing assessment; and
(E) the CFC PAS/HAB 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 A - GENERAL PROVISIONS › Section 263.1 - Purpose

Current through Reg. 49, No. 28; July 12, 2024
The purpose of this chapter is to describe certain
					 policies, procedures, and requirements of the HCS Program.
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 263.2 - Application

Current through Reg. 49, No. 28; July 12, 2024
This chapter applies to:
(1) a program provider;
(2) a LIDDA;
(3) an applicant and the applicant's LAR;
				  and
(4) an individual and the
				  individual's 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 A - GENERAL PROVISIONS › Section 263.3 - 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 263 - HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) › Subchapter A - GENERAL PROVISIONS › Section 263.4 - Description of the HCS Program and CFC

Current through Reg. 49, No. 28; July 12, 2024
(a) The HCS Program
				  is a Medicaid waiver program approved by CMS pursuant to §1915(c) of the
				  Social Security Act. It provides community-based services and supports to
				  eligible individuals as an alternative to the ICF/IID Program. The HCS Program
				  is operated by HHSC.
(b) Enrollment
				  in the HCS Program is limited to the number of individuals in specified target
				  groups and to the geographic areas approved by CMS.
(c) HCS Program services described in §
										263.5 of this subchapter (relating
				  to Description of HCS Program Services) and CFC services described in §
										263.6 of this subchapter (relating
				  to Description of CFC Services) are selected for inclusion in an individual's
				  IPC to ensure the individual's health, safety, welfare, and integration in the
				  community. HCS Program services and CFC Services supplement rather than replace
				  the individual's natural supports and other community services for which the
				  individual may be eligible and prevent the individual's admission to an
				  institutional setting.
(d) CFC is a
				  state plan option governed by 42 CFR Chapter 441, Subpart K, regarding Home and
				  Community-Based Attendant Services and Supports State Plan Option (Community
				  First Choice).
(e) HHSC has grouped
				  Texas counties into geographical areas, referred to as "local service areas,"
				  each of which is served by a LIDDA. HHSC has further grouped the local service
				  areas into "waiver contract areas." A list of the counties included in each
				  local service area and waiver contract area is available on the HHSC website.
(1) A program provider may provide HCS
				  Program services and CFC services only to persons residing in the counties
				  specified for the program provider in the HHSC automated enrollment and billing
				  system.
(2) A program provider must
				  have a separate contract for each waiver contract area served by the program
				  provider.
(3) A program provider
				  may have a contract to serve one or more local service areas within a waiver
				  contract area, but the program provider must serve all of the counties within
				  each local service area covered by the contract.
(4) A program provider may not have more than
				  one contract per waiver contract area.
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 263.6 - Description of CFC Services

Current through Reg. 49, No. 28; July 12, 2024
(a) CFC services
				  are described in this subsection and in the Medicaid State Plan approved by CMS
				  and available on the HHSC website.
(1) CFC
				  PAS/HAB:
(A) consists of:
(i) personal assistance services that provide
				  assistance to an individual in performing ADLs and IADLs based on the
				  individual's person-centered service plan, including:
(I) non-skilled assistance with the
				  performance of the ADLs and IADLs;
(II) household chores necessary to maintain
				  the home in a clean, sanitary, and safe environment;
(III) escort services, which consist of
				  accompanying and assisting an individual to access services or activities in
				  the community, but do not include transporting an individual; and
(IV) assistance with health-related tasks;
				  and