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RULE §9.154Description of the HCS Program and CFC

(a) The HCS Program is a Medicaid waiver program approved by CMS pursuant to §1915(c) of the Social Security Act. It provides community-based services and supports to eligible individuals as an alternative to the ICF/IID Program. The HCS Program is operated by DADS under the authority of HHSC.

(b) Enrollment in the HCS Program is limited to the number of individuals in specified target groups and to the geographic areas approved by CMS.

(c) HCS Program services listed in this subsection are selected for inclusion in an individual's IPC to ensure the individual's health, safety, and welfare in the community, supplement rather than replace that individual's natural supports and other community services for which the individual may be eligible, and prevent the individual's admission to institutional services. The following HCS Program services are defined in Appendix C of the HCS Program waiver application approved by CMS and found at www.dads.state.tx.us. Services available under the HCS Program are:

  (1) TAS;

  (2) professional therapies provided by appropriately licensed or certified professionals as follows:

    (A) physical therapy, including a pre-enrollment minor home modifications assessment;

    (B) occupational therapy, including a pre-enrollment minor home modifications assessment;

    (C) speech and language pathology;

    (D) audiology;

    (E) social work;

    (F) behavioral support, including a pre-enrollment minor home modifications assessment;

    (G) dietary services; and

    (H) cognitive rehabilitation therapy;

  (3) nursing provided by an RN or LVN;

  (4) residential assistance, excluding room and board, provided in one of the following three ways:

    (A) host home/companion care;

    (B) supervised living; or

    (C) residential support;

  (5) supported home living, which is not a reimbursable service for individuals receiving host home/companion care, supervised living, or residential support;

  (6) respite, which includes room and board when provided in a setting other than the individual's home, but is not a reimbursable service for individuals receiving host home/companion care, supervised living, or residential support;

  (7) day habilitation, provided exclusive of any other separately funded service, including public school services, rehabilitative services for persons with mental illness, other programs funded by DADS, or programs funded by DARS;

  (8) employment assistance;

  (9) supported employment;

  (10) adaptive aids;

  (11) minor home modifications, including pre-enrollment minor home modifications;

  (12) dental treatment; and

  (13) if the individual's IPC includes at least one HCS Program service to be delivered through the CDS option:

    (A) FMS; and

    (B) support consultation.

(d) A program provider may only provide and bill for supported home living if the activity provided is transportation as described in §9.174(a)(33)(C) of this subchapter (relating to Certification Principles: Service Delivery).

(e) CFC is a state plan option governed by Code of Federal Regulations, Title 42, Chapter 441, Subchapter K, regarding Home and Community-Based Attendant Services and Supports State Plan Option (Community First Choice) that provides the following services to individuals:

  (1) CFC PAS/HAB;

  (2) CFC ERS; and

  (3) CFC support management for an individual receiving CFC PAS/HAB.

(f) DADS has grouped Texas counties into geographical areas, referred to as "local service areas," each of which is served by a LIDDA. DADS has further grouped the local service areas into "waiver contract areas." A list of the counties included in each local service area and waiver contract area is found at www.dads.state.tx.us.

  (1) A program provider may provide HCS Program services and CFC services only to persons residing in the counties specified for the program provider in DADS automated enrollment and billing system.

  (2) A program provider must have a separate contract for each waiver contract area served by the program provider.

  (3) A program provider may have a contract to serve one or more local service areas within a waiver contract area, but the program provider must serve all of the counties within each local service area covered by the contract.

  (4) A program provider may not have more than one contract per waiver contract area.

(g) A program provider must comply with:

  (1) all applicable state and federal laws, rules, and regulations, including Chapter 49 of this title (relating to Contracting for Community Services); and

  (2) DADS Information Letters regarding the HCS Program found at www.dads.state.tx.us.

(h) The CDS option is a service delivery option, described in Chapter 41 of this title (relating to Consumer Directed Services Option), in which an individual or LAR employs and retains service providers and directs the delivery of a service through the CDS option, as described in §41.108 of this title (relating to Services Available Through the CDS Option).

Source Note: The provisions of this §9.154 adopted to be effective March 1, 2000, 25 TexReg 1649; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective June 1, 2006, 31 TexReg 4442; amended to be effective March 1, 2007, 32 TexReg 537; amended to be effective June 1, 2008, 33 TexReg 4334; amended to be effective June 1, 2010, 35 TexReg 4441; amended to be effective April 1, 2014, 39 TexReg 2296; amended to be effective September 1,2014, 39 TexReg 6516; amended to be effective November 15, 2015, 40 TexReg 7827; amended to be effective March 20, 2016, 41 TexReg 1867

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