|(a) The consumer (client) participation is a monthly
contribution the consumer (client) may be required to pay for participation
in the Comprehensive Rehabilitation Services (CRS) Program. Consumer
participation applies to consumers in active services, as well as
those on the interest list who are both eligible and receiving services.
(b) The consumer participation is required only for
CRS consumers when the consumer's liquid assets exceed the basic living
requirement (BLR) level calculated by the CRS Program, and consequently
require the consumer to contribute an amount equal to this excess
toward the cost of the goods and services provided by the CRS Program.
The BLR calculation is based on:
(1) 200 percent of current U. S. Department of Health
and Human Services Poverty Guidelines;
(2) DARS BLR tables for the current fiscal year;
(3) DARS policies relating to consumer participation
and BLR; and
(4) information regarding the consumer's income, family
status, and economic need.
(c) The CRS Program calculates the amount of the consumer
participation owed by the consumer for the goods and services that
are provided, regardless of the availability of private insurance
or other third-party payer reimbursements. The consumer's obligation
for payment of any deductible, co-payment, or coinsurance is limited
to the monthly consumer participation amount.
(d) The consumer participation calculation will take
(1) the net monthly income and liquid assets of the
consumer and the consumer's spouse, parents, or legal guardian or
(2) allowable expenses, such as monthly home mortgage
or rental payments, prescribed diets and medicines used by the consumer,
debts imposed by court order; and
(3) family size.
(e) The consumer participation must not exceed the
cost of the services provided by the CRS Program in a given month,
and it is applied only in months that billable goods and services
are provided by the CRS Program.
(f) The consumer participation must be paid to the
service provider by the consumer directly.
(g) The consumer participation will be deducted from
the amount paid to the service provider by the CRS Program and must
be reflected in the service authorization given to the provider by
the CRS Program.
(h) The consumer may choose not to disclose financial
information, but doing so may result in the presumption that the consumer
has adequate resources to participate fully in the cost of CRS goods
(i) The consumer participation does not apply:
(1) when the consumer is eligible for Supplemental
Security Income or Social Security Disability Income.
(2) to certain services, including:
(A) assessments for determining eligibility;
(B) assessments for determining rehabilitation needs,
including associated maintenance and transportation;
(C) rehabilitation counseling and guidance and referral
for other services;
(D) personal assistance services; and
(E) any auxiliary aid or service that a consumer with
a disability requires to participate in the CRS Program.
(j) DARS management may waive the consumer participation
when the consumer's participation towards the cost of services would
prevent the consumer from receiving a necessary service.
(k) The consumer participation must be reviewed annually
by the CRS Program.
(l) To the extent that the consumer is entitled to
insurance-payment for services or receives payment for services from
other governmental programs, third-party payers, or other private
sources, DARS funds must not be used to pay for the services.
(m) If the consumer, consumer's representative, or
a court appointed guardian or representative disagrees with the calculated
consumer participation amount, they can:
(1) request a review by DARS;
(2) contact the DARS Inquiries Line at 1-800-628-5115
for help resolving a problem or concern; or
(3) file a formal complaint with DARS as noted in §107.715
of this chapter (relating to Complaint Resolution Process).
(n) Information about CRS consumer participation procedures
and BLR used to administer the CRS Program are available on the DARS
website and for viewing at DARS, 4800 North Lamar Boulevard, Austin,
Texas, between 8:00 a.m. and 5:00 p.m. on business days.
|Source Note: The provisions of this §352.14 adopted to be effective March 13, 2016, 41 TexReg 1713; transferred effective January 15, 2022, as published in the December 31, 2021 issue of the Texas Register, 46 TexReg 9422