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TITLE 40SOCIAL SERVICES AND ASSISTANCE
PART 1DEPARTMENT OF AGING AND DISABILITY SERVICES
CHAPTER 45COMMUNITY LIVING ASSISTANCE AND SUPPORT SERVICES AND COMMUNITY FIRST CHOICE (CFC) SERVICES
SUBCHAPTER BELIGIBILITY, ENROLLMENT, AND REVIEW
DIVISION 1ELIGIBILITY AND MAINTENANCE OF INTEREST LIST
RULE §45.201Eligibility Criteria for CLASS Program Services and CFC Services

(a) An individual is eligible for CLASS Program services if:

  (1) the individual meets the financial eligibility criteria described in Appendix B of the CLASS Program waiver application approved by CMS and found on the HHSC website;

  (2) the individual is determined by HHSC to meet the LOC VIII criteria as described in §9.239 of this title (relating to ICF/MR Level of Care VIII Criteria);

  (3) the individual demonstrates a need for CFC PAS/HAB;

  (4) the individual has an IPC cost for CLASS Program services at or below $114,736.07;

  (5) the individual is not enrolled in another waiver program or receiving a service that may not be received if the individual is enrolled in the CLASS Program, as identified in the Mutually Exclusive Services table in Appendix III of the CLASS Provider Manual available on the HHSC website;

  (6) the individual resides in the individual's own home or family home; and

  (7) the individual requires the provision of:

    (A) at least one CLASS Program service per month or monthly monitoring; and

    (B) at least one CLASS Program service during an IPC period.

(b) An individual is not considered to reside in the individual's own home or family home if the individual is admitted to one of the facilities listed in subparagraphs (A) - (G) in the definition of "own home or family home" in §45.103 of this chapter (relating to Definitions) for more than 180 consecutive calendar days.

(c) Except as provided in subsection (d) of this section, an individual is eligible for a CFC service under this chapter if the individual:

  (1) meets the criteria described in subsections (a) and (b) of this section;

  (2) requires the provision of the CFC service; and

  (3) is not receiving support family services or continued family services.

(d) To be eligible for a CFC service under this chapter, an individual receiving MAO Medicaid must, in addition to meeting the eligibility criteria described in subsection (c) of this section, receive a CLASS Program service at least monthly, as required by 42 CFR §441.510(d).


Source Note: The provisions of this §45.201 adopted to be effective March 21, 2011, 36 TexReg 1840; amended to be effective July 1, 2015, 40 TexReg 2768; amended to be effective November 15, 2015, 40 TexReg 7883; amended to be effective March 20, 2016, 41 TexReg 1952; amended to be effective October 1, 2019, 44 TexReg 5118

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