| (A) paying an employer:
(i) to encourage the employer to hire an individual;
or
(ii) for supervision, training, support, or adaptations
for an individual that the employer typically makes available to other
workers without disabilities filling similar positions in the business;
or
(B) paying the individual:
(i) as an incentive to participate in employment assistance
activities; or
(ii) for expenses associated with the start-up costs
or operating expenses of an individual's business; and
(5) as determined by an assessment conducted by an
RN, provides 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.
(e) Supported employment:
(1) is assistance provided to an individual:
(A) who, because of a disability, requires intensive,
ongoing support to be self-employed, work from home, or perform in
a work setting at which individuals without disabilities are employed;
and
(B) in order for the individual to sustain competitive
employment;
(2) consists of a service provider performing the following
activities:
(A) making employment adaptations, supervising, and
providing training related to an individual's assessed needs;
(B) transporting the individual to support the individual
to be self-employed, work from home, or perform in a work setting;
and
(C) participating in service planning team meetings;
(3) is not provided to an individual with the individual
present at the same time that respite, community support, day habilitation,
employment assistance, or CFC PAS/HAB is provided;
(4) does not include sheltered work or other similar
types of vocational services furnished in specialized facilities,
or using Medicaid funds paid by HHSC to the program provider for incentive
payments, subsidies, or unrelated vocational training expenses, such
as:
(A) paying an employer:
(i) to encourage the employer to hire an individual;
or
(ii) to supervise, train, support, or make adaptations
for an individual that the employer typically makes available to other
workers without disabilities filling similar positions in the business;
or
(B) paying the individual:
(i) as an incentive to participate in supported employment
activities; or
(ii) for expenses associated with the start-up costs
or operating expenses of an individual's business; and
(5) as determined by an assessment conducted by an
RN, provides 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) Behavioral support provides specialized interventions
that assist an individual to increase adaptive behaviors to replace
or modify challenging or socially unacceptable behaviors that prevent
or interfere with the individual's inclusion in home and family life
or community life. Behavioral support includes:
(1) assessment and analysis of assessment findings
of the behavior(s) to be targeted necessary to design an appropriate
behavioral support plan;
(2) development of an individualized behavioral support
plan consistent with the outcomes identified in the individual's PDP;
(3) training of and consultation with the LAR, family
members, or other support providers and, as appropriate, with the
individual in the purpose/objectives, methods and documentation of
the implementation of the behavioral support plan or revisions of
the plan;
(4) monitoring and evaluation of the success of the
behavioral support plan implementation; and
(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.
Cont'd... |
