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