(a) The following words and terms, when used in this
chapter, have the following meanings, unless the context clearly indicates
otherwise:
(1) Waiver program--A program administered by the Department
of Aging and Disability Services (DADS), other than the Texas Home
Living Program, that provides services under a waiver granted by the
Centers for Medicare and Medicaid Services in accordance with §1915(c)
of the Social Security Act.
(2) General revenue--State funds appropriated by the
Texas Legislature for use by DADS.
(3) Individual--A person applying for or enrolled in
a waiver program.
(b) DADS may use general revenue to pay for services
above the individual cost limit of a waiver program for an individual
if DADS determines:
(1) the individual needs services that exceed the individual
cost limit because the individual's health and safety cannot be protected
by the services provided within the individual cost limit;
(2) the individual receives waiver services at the
individual cost limit;
(3) federal financial participation is not available
to pay for services above the individual cost limit; and
(4) there is no other available living arrangement
in which the individual's health and safety can be protected, as evidenced
by:
(A) an assessment conducted by DADS clinical staff;
and
(B) supporting documentation, including the individual's
medical and service records.
(c) Services funded by general revenue must be:
(1) the same service array offered by the waiver program
in which the individual is enrolled;
(2) necessary to protect the individual's health and
safety;
(3) authorized using the waiver program's criteria;
and
(4) unavailable through other funding sources.
(d) For an individual who has been receiving waiver
program services since September 1, 2005, at a cost that exceeded
the individual cost limit of the waiver program, DADS uses general
revenue to pay for services above the individual cost limit if:
(1) the services above the individual cost limit are
necessary for the individual to live in the most integrated setting
appropriate to the individual's needs; and
(2) federal financial participation is not available
to pay for the services above the individual cost limit.
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Source Note: The provisions of this §285.1 adopted to be effective September 1, 2008, 33 TexReg 7283; transferred effective July 31, 2024, as published in the July 5, 2024, issue of the Texas Register, 49 TexReg 4932 |