| (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.
(b) Except as provided in subsection (c) of this section,
an applicant or individual is eligible for a CFC service under this
subchapter if the applicant or individual:
(1) meets the criteria described in subsection (a)
of this section; and
(2) requires the provision of the CFC service.
(c) To be eligible for a CFC service under this chapter,
an applicant or individual receiving MAO Medicaid must, in addition
to meeting the eligibility criteria described in subsection (b) of
this section, receive a TxHmL Program service at least monthly, as
required by 42 CFR §441.510(d), which may not be met by a monthly
monitoring visit by a service coordinator as described in §262.701(o)(1)
and (2) of this chapter.
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