| (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).
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| 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 |
