| (a) HHSC notifies a LIDDA, in writing, when the opportunity
for enrollment in the TxHmL Program becomes available in the LIDDA's
local service area and directs the LIDDA to offer enrollment to the
applicant:
(1) whose interest list date, assigned in accordance
with §262.102 of this subchapter (relating to TxHmL Interest
List), is earliest on the statewide interest list for the TxHmL Program
as maintained by HHSC;
(2) whose name is not coded in the HHSC data system
as having been determined ineligible for the TxHmL Program and who
is receiving services from the LIDDA that are funded by general revenue
in an amount that would allow HHSC to fund the services through the
TxHmL Program; or
(3) who is a member of a target group identified in
the approved TxHmL waiver application.
(b) Except as provided in subsection (c) of this section,
a LIDDA must offer enrollment in the TxHmL Program in writing and
deliver it to the applicant or LAR by United States mail or by hand
delivery.
(c) A LIDDA must offer enrollment in the TxHmL Program
to an applicant described in subsection (a)(2) or (3) of this section
in accordance with HHSC's procedures.
(d) A LIDDA must include in a written offer that is
made in accordance with subsection (a)(1) of this section:
(1) a statement that:
(A) if the applicant or LAR does not respond to the
offer of enrollment in the TxHmL Program within 30 calendar days after
the LIDDA's written offer, the LIDDA withdraws the offer; and
(B) if the applicant is currently receiving services
from the LIDDA that are funded by general revenue and the applicant
or LAR declines the offer of enrollment in the TxHmL Program, the
LIDDA terminates those services that are similar to services provided
in the TxHmL Program; and
(2) the HHSC Deadline Notification form, which is available
on the HHSC website.
(e) If an applicant or LAR responds to an offer of
enrollment in the TxHmL Program, a LIDDA must:
(1) provide the applicant, LAR, and, if the LAR is
not a family member, at least one family member (if possible) both
an oral and a written explanation of the services and supports for
which the applicant may be eligible, including the ICF/IID Program
(both state supported living centers and community-based facilities),
waiver programs authorized under §1915(c) of the Social Security
Act, and other community-based services and supports, using the HHSC
Explanation of Services and Supports document which is available on
the HHSC website;
(2) provide the applicant and LAR both an oral and
a written explanation of all TxHmL Program services and CFC services
using the HHSC Understanding Program Eligibility and Services form,
which is available on the HHSC website; and
(3) give the applicant or LAR the HHSC Waiver Program
Verification of Freedom of Choice form, which is available on the
HHSC website to document the applicant's choice between the TxHmL
Program or the ICF/IID Program.
(f) A LIDDA must withdraw an offer of enrollment in
the TxHmL Program made to an applicant or LAR if:
(1) within 30 calendar days after the LIDDA's offer
made to the applicant or LAR in accordance with subsection (a)(1)
of this section, the applicant or LAR does not respond to the offer
of enrollment in the TxHmL Program;
(2) within seven calendar days after the applicant
or LAR receives the HHSC Waiver Program Verification of Freedom of
Choice form from the LIDDA in accordance with subsection (e)(3) of
this section, the applicant or LAR does not use the form to document
the applicant's choice of the TxHmL Program;
(3) within 30 calendar days after the applicant or
LAR receives the contact information regarding all available program
providers in the LIDDA's local service area in accordance with subsection
(k)(2)(A) of this section, the applicant or LAR does not document
a choice of a program provider using the HHSC Documentation of Provider
Choice form, which is available on the HHSC website;
(4) the applicant or LAR does not complete the necessary
activities to finalize the enrollment process and HHSC has approved
the withdrawal of the offer; or
(5) the applicant has moved out of the State of Texas.
(g) If a LIDDA withdraws an offer of enrollment in
the TxHmL Program made to an applicant, the LIDDA must notify the
applicant or LAR of such action, in writing, by certified United States
mail.
(h) If an applicant is currently receiving services
from a LIDDA that are funded by general revenue and the applicant
declines the offer of enrollment in the TxHmL Program, the LIDDA must
terminate those services that are similar to services provided in
the TxHmL Program.
(i) If a LIDDA terminates an applicant's services in
accordance with subsection (h) of this section, the LIDDA must notify
the applicant or LAR of the termination, in writing, by certified
United States mail and provide an opportunity for a review in accordance
with 40 TAC §2.46 (relating to Notification and Appeals Process).
(j) A LIDDA must retain in an applicant's record:
(1) the HHSC Waiver Program Verification of Freedom
of Choice form;
(2) the HHSC Documentation of Provider Choice form;
(3) the HHSC Deadline Notification form; and
(4) any correspondence related to the offer of enrollment
in the TxHmL Program.
(k) If an applicant or LAR accepts the offer of enrollment
in the TxHmL Program, the LIDDA must compile and maintain information
necessary to process the applicant's request for enrollment in the
TxHmL Program.
(1) The LIDDA must complete an ID/RC Assessment in
accordance with §262.104(a)(1) of this subchapter (relating to
LOC Determination).
(A) The LIDDA must:
(i) do one of the following:
(I) conduct a DID in accordance with §304.401
of this title (relating to Conducting a Determination of Intellectual
Disability) except that the following activities must be conducted
in person:
(-a-) a standardized measure of the individual's intellectual
functioning using an appropriate test based on the characteristics
of the individual; and
(-b-) a standardized measure of the individual's adaptive
abilities and deficits reported as the individual's adaptive behavior
level; or
(II) review and endorse a DID report in accordance
with §304.403 of this title (relating to Review and Endorsement
of a Determination of Intellectual Disability Report); and
(ii) determine whether the applicant has been diagnosed
by a licensed physician as having a related condition.
(B) The LIDDA must:
(i) conduct an ICAP assessment in person; and
(ii) recommend an LON assignment to HHSC in accordance
with §262.105 of this subchapter (relating to LON Assignment).
(C) The LIDDA must enter the information from the completed
ID/RC Assessment in the HHSC data system and electronically submit
the information to HHSC in accordance with §262.104(a)(2) of
this subchapter and §262.105(a) of this subchapter and submit
supporting documentation as required by §262.106 of this subchapter
(relating to HHSC Review of LON).
(2) The LIDDA must:
(A) provide names and contact information to the applicant
or LAR for all program providers in the LIDDA's local service area;
(B) arrange for meetings or visits with potential program
providers as requested by the applicant or the LAR; and
(C) ensure that the applicant's or LAR's choice of
a program provider is documented on the HHSC Documentation of Provider
Choice form and that the form is signed by the applicant or LAR and
retained by the LIDDA in the applicant's record.
(3) The LIDDA must assign a service coordinator who,
together with other members of the service planning team, must:
(A) develop a PDP; and
(B) if CFC PAS/HAB is included on the PDP, complete
the HHSC HCS/TxHmL CFC PAS/HAB Assessment form, which is available
on the HHSC website, to determine the number of CFC PAS/HAB hours
the applicant needs.
(4) The CFC PAS/HAB assessment form required by paragraph
(3)(B) of this subsection must be completed in person with the individual
unless the following conditions are met, in which case the form may
be completed by videoconferencing or telephone:
(A) the service coordinator gives the individual the
opportunity to complete the form in person in lieu of completing it
by videoconferencing or telephone and the individual agrees to the
form being completed by videoconferencing or telephone; and
Cont'd... |
