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RULE §9.555Description of TxHmL Program Services

  (5) modification, as necessary, of the behavioral support plan based on documented outcomes of the plan's implementation.

(g) Adaptive aids enable an individual to increase mobility, the ability to perform activities of daily living, or the ability to perceive, control, or communicate with the environment in which the individual lives. Adaptive aids include devices, controls, appliances, or supplies and the repair or maintenance of such aids, if not covered by warranty, as specified in the TxHmL Program Billing Guidelines.

  (1) Adaptive aids are provided to address specific needs identified in an individual's PDP and are limited to:

    (A) lifts;

    (B) mobility aids;

    (C) positioning devices;

    (D) control switches/pneumatic switches and devices;

    (E) environmental control units;

    (F) medically necessary supplies;

    (G) communication aids;

    (H) adapted/modified equipment for activities of daily living; and

    (I) safety restraints and safety devices.

  (2) Adaptive aids may be provided up to a maximum of $10,000 per individual per IPC year.

  (3) Adaptive aids do not include items or supplies that are not of direct medical or remedial benefit to the individual or that are available to the individual through the Medicaid State Plan, through other governmental programs, or through private insurance.

(h) Minor home modifications are physical adaptations to the individual's home that are necessary to ensure the health, welfare, and safety of the individual or to enable the individual to function with greater independence in the home and the repair or maintenance of such adaptations, if not covered by warranty.

  (1) Minor home modifications may be provided up to a lifetime limit of $7,500 per individual. After the $7,500 lifetime limit has been reached, an individual is eligible for an additional $300 per IPC year for additional modifications or maintenance of home modifications.

  (2) Minor home modifications do not include adaptations or improvements to the home that are of general utility, are not of direct medical or remedial benefit to the individual, or add to the total square footage of the home.

  (3) Minor home modifications are limited to:

    (A) purchase and repair of mobility/wheelchair ramps;

    (B) modifications to bathroom facilities;

    (C) modifications to kitchen facilities; and

    (D) specialized accessibility and safety adaptations.

(i) Dental treatment may be provided up to a maximum of $1,000 per individual per IPC year for the following treatments:

  (1) emergency dental treatment;

  (2) preventive dental treatment;

  (3) therapeutic dental treatment; and

  (4) orthodontic dental treatment, excluding cosmetic orthodontia.

(j) Respite is provided for the relief of an unpaid caregiver of an individual when the caregiver is temporarily unavailable to provide supports.

  (1) Respite includes:

    (A) assistance with activities of daily living and functional living tasks;

    (B) assistance with planning and preparing meals;

    (C) transportation or assistance in securing transportation;

    (D) assistance with ambulation and mobility;

    (E) as determined by an assessment conducted by an RN, assistance with medications and the performance of tasks delegated by an RN in accordance with state law and rules, unless a physician has delegated the task as a medical act under Texas Occupations Code, Chapter 157, as documented by the physician;

    (F) habilitation and support that facilitate:

      (i) an individual's inclusion in community activities, use of natural supports and typical community services available to all people;

      (ii) an individual's social interaction and participation in leisure activities; and

      (iii) development of socially valued behaviors and daily living and independent living skills.

  (2) Reimbursement for respite provided in a setting other than the individual's residence includes payment for room and board.

  (3) Respite may be provided in the individual's residence or, if certification principles stated in §9.578(o) of this subchapter are met, in other locations.

(k) Professional therapies provide assessment and treatment by a licensed professional who meets the qualifications specified in §9.579 of this subchapter (relating to Certification Principles: Staff Member and Service Provider Requirements) and include training and consultation with an individual's LAR, family members or other support providers. Professional therapies available under the TxHmL Program are:

  (1) audiology services;

  (2) speech/language pathology services;

  (3) occupational therapy services;

  (4) physical therapy services;

  (5) dietary services; and

  (6) behavioral support.

(l) FMS are provided if the individual's IPC includes at least one TxHmL Program service to be delivered through the CDS option.

(m) Support consultation is provided at the request of the individual or LAR if the individual's IPC includes at least one TxHmL Program service to be delivered through the CDS option.

Source Note: The provisions of this §9.555 adopted to be effective January 5, 2003, 27 TexReg 12254; amended to be effective March 11, 2004, 29 TexReg 2317; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective March 1, 2007, 32 TexReg 544; amended to be effective December 1, 2013, 38 TexReg 8673; amended to be effective September 1, 2014, 39 TexReg 6549; amended to be effective November 15, 2015, 40 TexReg 7827; amended to be effective March 20,2016, 41 TexReg 1867; amended to be effective October 1, 2019, 44 TexReg 5062

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