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TITLE 40SOCIAL SERVICES AND ASSISTANCE
PART 1DEPARTMENT OF AGING AND DISABILITY SERVICES
CHAPTER 9INTELLECTUAL DISABILITY SERVICES--MEDICAID STATE OPERATING AGENCY RESPONSIBILITIES
SUBCHAPTER DHOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)
RULE §9.159IPC

(a) A service coordinator must initiate development of a proposed initial IPC for an applicant as required by §9.158(j)(4)(C) of this subchapter (relating to Process for Enrollment of Applicants).

(b) A program provider must initiate development of a proposed renewal and proposed revised IPC for an individual as required by §9.166 of this subchapter (relating to Renewal and Revision of an IPC).

(c) An IPC must be based on the PDP and specify the type and amount of each HCS Program service and CFC service to be provided to an individual, except for CFC support management, as well as non-HCS Program and non-CFC services and supports to be provided during the IPC year. The type and amount of each HCS Program service and CFC service in the IPC:

  (1) must be necessary to protect the individual's health and welfare in the community;

  (2) must not be available to the individual through any other source, including the Medicaid State Plan, other governmental programs, private insurance, or the individual's natural supports;

  (3) must be the most appropriate type and amount to meet the individual's needs;

  (4) must be cost effective;

  (5) must be necessary to enable community integration and maximize independence;

  (6) if an adaptive aid or minor home modification, must:

    (A) be included on DADS approved list in the HCS Program Billing Guidelines; and

    (B) be within the service limit described in §9.192 of this subchapter (relating to Service Limits);

  (7) if an adaptive aid costing $500 or more, must be supported by a written assessment from a licensed professional specified by DADS in the HCS Program Billing Guidelines;

  (8) if a minor home modification costing $1,000 or more, must be supported by a written assessment from a licensed professional specified by DADS in the HCS Program Billing Guidelines;

  (9) if dental treatment, must be within the service limit described in §9.192 of this subchapter;

  (10) if respite, must be within the service limit described in §9.192 of this subchapter;

  (11) if TAS, must be:

    (A) supported by a Transition Assistance Services (TAS) Assessment and Authorization form authorized by DADS; and

    (B) within the service limit described in §9.192(a)(5)(A) or (B) of this subchapter;

  (12) if pre-enrollment minor home modifications, must be:

    (A) supported by a written assessment from a licensed professional if required by the HCS Program Billing Guidelines;

    (B) supported by a Home and Community-based Services (HCS) Program Pre-enrollment MHM Authorization Request form authorized by DADS;

    (C) within the service limit described in §9.192(a)(3)(A) of this subchapter;

  (13) if a pre-enrollment minor home modifications assessment, must be supported by a Home and Community-based Services (HCS) Program Pre-enrollment MHM Authorization Request form authorized by DADS; and

  (14) if CFC PAS/HAB, must be supported by the DADS HCS/TxHmL CFC PAS/HAB Assessment form.

(d) If an applicant's or individual's IPC includes only CFC PAS/HAB to be delivered through the CDS option, the service coordinator must include in the IPC:

  (1) CFC FMS instead of FMS; and

  (2) if the applicant or individual will receive support consultation, CFC support consultation instead of support consultation.


Source Note: The provisions of this §9.159 adopted to be effective June 1, 2010, 35 TexReg 4441; amended to be effective December 1, 2011, 36 TexReg 8043; 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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