| (a) DADS notifies a LIDDA, in writing, of the availability
of HCS Program services in the LIDDA's local service area and directs
the LIDDA to offer HCS Program services to an applicant:
(1) whose interest list request date, assigned in accordance
with §9.157(c)(2) and (d) of this subchapter (relating to HCS
Interest List), is earliest on the statewide interest list for the
HCS Program as maintained by DADS; or
(2) who is a member of a target group identified in
the approved HCS waiver application.
(b) Except as provided in subsection (c) of this section,
the LIDDA must make the offer of HCS Program services in writing and
deliver it to the applicant or LAR by regular United States mail or
by hand delivery.
(c) The LIDDA must make the offer of HCS Program services
to an applicant described in subsection (a)(2) of this section in
accordance with DADS procedures.
(d) The 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 HCS Program services 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 HCS Program services, the LIDDA terminates
those services that are similar to services provided under the HCS
Program; and
(2) information regarding the time frame requirements
described in subsection (f) of this section using the Deadline Notification
form, which is found at www.dads.state.tx.us.
(e) If an applicant or LAR responds to an offer of
HCS Program services, the 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 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 under §1915(c) of the Social Security Act, and other
community-based services and supports. The LIDDA must use the Explanation
of Services and Supports document, which is found at www.dads.state.tx.us;
(2) using a DADS form, provide the applicant and LAR
both an oral and a written explanation of all HCS Program services
and CFC services; and
(3) give the applicant or LAR the Verification of Freedom
of Choice Form, Waiver Program which is found at www.dads.state.tx.us,
to document the applicant's choice regarding the HCS Program and ICF/IID
Program.
(f) The LIDDA must withdraw an offer of HCS Program
services 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 HCS Program services;
(2) within seven calendar days after the applicant
or LAR receives the Verification of Freedom of Choice, Waiver Program
form from the LIDDA in accordance with subsection (e)(3) of this section,
the applicant or LAR does not document the choice of HCS Program services
over the ICF/IID Program using the Verification of Freedom of Choice,
Waiver Program form;
(3) within 30 calendar days after the applicant or
LAR receives the contact information for all program providers in
the LIDDA's local service area in accordance with subsection (j)(3)
of this section, the applicant or LAR does not document the choice
of a program provider using the Documentation of Provider Choice form;
or
(4) the applicant or LAR does not complete the necessary
activities to finalize the enrollment process and DADS has approved
the withdrawal of the offer.
(g) If the LIDDA withdraws an offer of HCS Program
services made to an applicant, the LIDDA must notify the applicant
or LAR of such action, in writing, by certified United States mail.
(h) If the applicant is currently receiving services
from the LIDDA that are funded by general revenue and the applicant
declines the offer of HCS Program services, the LIDDA must terminate
those services that are similar to services provided under the HCS
Program.
(i) If the 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 §2.46 of this title (relating to Notification and Appeals
Process).
(j) If the applicant or LAR accepts the offer of HCS
Program services, the LIDDA must compile and maintain information
necessary to process the request for enrollment in the HCS Program.
(1) If the applicant's financial eligibility for the
HCS Program must be established, the LIDDA must initiate, monitor,
and support the processes necessary to obtain a financial eligibility
determination.
(2) The LIDDA must complete an ID/RC Assessment in
accordance with §9.161 and §9.163 of this subchapter (relating
to LOC Determination and LON Assignment, respectively).
(A) The LIDDA must:
(i) perform or endorse a determination that the applicant
has an intellectual disability in accordance with Chapter 5, Subchapter
D of this title (relating to Diagnostic Eligibility for Services and
Supports--Intellectual Disability Priority Population and Related
Conditions); or
(ii) verify that the applicant has been diagnosed by
a licensed physician as having a related condition as defined in §9.203
of this chapter (relating to Definitions).
(B) The LIDDA must administer the ICAP and recommend
an LON assignment to DADS in accordance with §9.163 and §9.164
of this subchapter (relating to DADS Review of LON).
(C) The LIDDA must electronically transmit the completed
ID/RC Assessment to DADS for approval in accordance with §9.161(a)
and §9.163(a) of this subchapter and, if applicable, submit supporting
documentation as required by §9.164(c) of this subchapter.
(3) The LIDDA must provide names and contact information
to the applicant or LAR for all program providers in the LIDDA's local
service area.
(4) The LIDDA must assign a service coordinator who,
together with other members of the applicant's service planning team,
must:
(A) develop a PDP;
(B) if CFC PAS/HAB is included on the PDP, complete
DADS HCS/TxHmL CFC PAS/HAB Assessment form to determine the number
of CFC PAS/HAB hours the applicant needs; and
(C) develop a proposed initial IPC in accordance with §9.159(c)
of this subchapter (relating to IPC).
(5) A service coordinator must discuss the CDS option
with the applicant or LAR in accordance with §9.168(a) and (b)
of this subchapter (relating to CDS Option).
(k) The service coordinator must:
(1) arrange for meetings and visits with potential
program providers as requested by the applicant or LAR;
(2) review the proposed initial IPC with potential
program providers as requested by the applicant or LAR;
(3) ensure that the applicant's or LAR's choice of
a program provider is documented on the Documentation of Provider
Choice Form and signed by the applicant or LAR;
(4) negotiate and finalize the proposed initial IPC
and the date services will begin with the selected program provider,
consulting with DADS if necessary to reach agreement with the selected
program provider on the content of the proposed initial IPC and the
date services will begin;
(5) determine whether the applicant meets the following
criteria:
(A) is being discharged from a nursing facility, an
ICF/IID, or a GRO; and
(B) anticipates needing TAS;
(6) if the service coordinator determines that the
applicant meets the criteria described in paragraph (5) of this subsection:
(A) complete, with the applicant or LAR and the selected
program provider, DADS Transition Assistance Services (TAS) Assessment
and Authorization form found at www.dads.state.tx.us in accordance
with the form's instructions, which includes:
(i) identifying the TAS the applicant needs; and
(ii) estimating the monetary amount for each TAS identified,
which must be within the service limit described in §9.192(a)(5)
of this subchapter (relating to Service Limits);
(B) submit the completed form to DADS to determine
if TAS is authorized;
(C) send the form authorized by DADS to the selected
program provider; and
(D) include the TAS and the monetary amount authorized
by DADS on the applicant's proposed initial IPC;
(7) determine whether an applicant meets the following
criteria:
(A) is being discharged from a nursing facility, an
ICF/IID, or a GRO;
(B) has not met the maximum service limit for minor
home modifications as described in §9.192(a)(3)(A) of this subchapter;
and
(C) anticipates needing pre-enrollment minor home modifications
and a pre-enrollment minor home modifications assessment;
(8) if the service coordinator determines that an applicant
meets the criteria described in paragraph (7) of this subsection:
(A) complete, with the applicant or LAR and selected
program provider, DADS Home and Community-based Services (HCS) Program
Pre-enrollment MHM Authorization Request form found at www.dads.state.tx.us
in accordance with the form's instructions, which includes:
(i) identifying the pre-enrollment minor home modifications
the applicant needs;
(ii) identifying the pre-enrollment minor home modifications
assessments conducted by the program provider as required by §9.174(h)(1)(A)
of this subchapter (relating to Certification Principles: Service
Delivery);
(iii) based on documentation provided by the program
provider as required by the HCS Program Billing
Guidelines, stating the cost of:
(I) the pre-enrollment minor home modifications identified
on the form, which must be within the service limit described in §9.192(a)(3)(A)
of this subchapter; and
(II) the pre-enrollment minor home modifications assessments
conducted;
(B) submit the completed form to DADS to determine
if pre-enrollment minor home modification and pre-enrollment minor
home modifications assessments are authorized;
(C) send the form authorized by DADS to the selected
program provider; and
(D) include the pre-enrollment minor home modifications,
pre-enrollment minor home modifications assessments, and the monetary
amount for these services authorized by DADS on the applicant's proposed
initial IPC;
(9) if an applicant or LAR chooses a program provider
to deliver supported home living, nursing, host home/companion care,
residential support, supervised living, respite, employment assistance,
supported employment, day habilitation, or CFC PAS/HAB, ensure that
the initial proposed IPC includes a sufficient number of RN nursing
units for a program provider nurse to perform an initial nursing assessment
unless, as described in §9.174(c) of this subchapter:
(A) nursing services are not on the proposed IPC and
the individual or LAR and selected program provider have determined
that an unlicensed service provider will not perform a nursing task
as documented on DADS form "Nursing Task Screening Tool"; or
(B) an unlicensed service provider will perform a nursing
task and a physician has delegated the task as a medical act under
Texas Occupations Code, Chapter 157, as documented by the physician;
(10) if an applicant or LAR refuses to include on the
initial proposed IPC a sufficient number of RN nursing units to perform
an initial nursing assessment as required by paragraph (9) of this
subsection:
(A) inform the applicant or LAR that the refusal:
(i) will result in the applicant not receiving nursing
services from the program provider; and
(ii) if the applicant needs host home/companion care,
residential support, supervised living, supported home living, respite,
employment assistance, supported employment, day habilitation, or
CFC PAS/HAB from the program provider, will result in the individual
not receiving that service unless, as described in §9.174(d)(2)
of this subchapter:
(I) the program provider's unlicensed service provider
does not perform nursing tasks in the provision of the service; and
(II) the program provider determines that it can ensure
the applicant's health, safety, and welfare in the provision of the
service; and
(B) document the refusal of the RN nursing units on
the proposed IPC for an initial assessment by the program provider's
RN in the applicant's record;
(11) ensure that the applicant or LAR signs and dates
the proposed initial IPC;
(12) ensure that the selected program provider signs
and dates the proposed IPC, demonstrating agreement that the services
will be provided to the applicant;
Cont'd... |
