(a) The service provider is required to use the DARS
fee schedule and instructions to calculate the consumer's fee for
service.
(b) Factors that affect the consumer's fee for service
are:
(1) household size;
(2) annual gross income; and
(3) allowable deductions.
(c) The household size equals any person living inside
or outside of the home who is eligible to be claimed as a dependent
of the consumer on the consumer's federal income tax return, or, if
the consumer is a minor, any other person living inside or outside
of the home who is eligible to be claimed as a dependent of the consumer's
parent or guardian on the parent or guardian's federal income tax
return.
(d) The consumer's annual gross income:
(1) equals the total annual gross income received by
the household; and
(2) includes all income classified as taxable income
by the Internal Revenue Service before federally allowable deductions
are applied.
(e) The consumer's allowable deductions are limited
to the consumer's expenses in the following categories:
(1) attendant care;
(2) rent or home mortgage payments;
(3) court-ordered child support payments made by the
consumer for financially dependent children who were not included
in the calculation of household size; and
(4) medical or dental expenses for treatment primarily
intended to alleviate or prevent a physical or mental illness or manage
a disability, with the expenses limited to the cost of:
(A) diagnosis, cure, alleviation, treatment, or prevention
of disease;
(B) treatment of any affected body part or function;
(C) medical services legally delivered by physicians,
surgeons, dentists, and other medical practitioners;
(D) medications, medical supplies, and diagnostic devices;
(E) medical and dental health care insurance premiums;
(F) transportation to receive medical or dental care;
and
(G) medical or dental debt that the family is paying
on an established payment plan.
(f) The service provider calculates the allowable deductions
using the actual amounts the consumer paid during the previous 12-month
period.
(g) The consumer provides the most recent tax return
available as proof of annual gross income and allowable deductions.
If the consumer has no tax return, the consumer provides bank statements,
medical records, receipts, proof of benefits awards, and other documentation
to demonstrate annual gross income and allowable deductions.
(h) If the consumer does not provide documentation
supporting the household's allowable deductions, the service provider
determines the consumer's fee for service based on the consumer's
documented annual gross income with no allowable deductions.
(i) The consumer's fee for service is equal to the
amount on the DARS sliding fee scale according to the household's
annual adjusted income (that is, the annual gross income minus the
allowable deductions).
(j) The service provider uses the most current sliding
fee scale and instructions published by DARS to determine the consumer's
fee for service.
(k) The procedures, fee schedule, and instructions
that DARS uses to calculate a consumer's fee for service is available
from DARS, between 8:00 a.m. and 5:00 p.m. on business days.
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Source Note: The provisions of this §357.403 adopted to be effective August 31, 2016, 41 TexReg 6066; transferred effective March 15, 2021, as published in the Texas Register February 26, 2021, 46 TexReg 1387 |