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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 NTEXAS HOME LIVING (TXHML) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)
RULE §9.558Individual Plan of Care (IPC)

(a) An IPC must be developed for each applicant in accordance with §9.567 of this subchapter (relating to Process for Enrollment) and reviewed and revised for each individual whenever the individual's needs for services and supports change, but no less than annually, in accordance with §9.568 of this subchapter (relating to Revisions and Renewals of Individual Plans of Care (IPCs), Levels of Care (LOCs), and Levels of Need (LONs) for Enrolled Individuals).

(b) An IPC must be based on the PDP and specify the type and amount of each TxHmL Program service and CFC service to be provided to the individual, as well as non-TxHmL Program and non-CFC services and supports to be provided during the IPC year. The type and amount of each TxHmL Program service and CFC service in the IPC must be supported by:

  (1) documentation that non-TxHmL Program and non-CFC sources for the service are unavailable and the service supplements rather than replaces natural supports or non-TxHmL Program and non-CFC services;

  (2) assessments of the individual, including the DADS HCS/TxHmL CFC PAS/HAB Assessment form, that identify specific services necessary for the individual to continue living in the community, to ensure the individual's health and welfare in the community, and to prevent the individual's admission to institutional services; and

  (3) documentation of the deliberations and conclusions of the service planning team that the TxHmL Program services and CFC services are necessary for the individual to live in the community; are necessary to prevent the individual's admission to institutional services, and are sufficient, when combined with services or supports available from non-TxHmL Program and non-CFC sources (if applicable), to ensure the individual's health and welfare in the community.

(c) Before electronic transmission to DADS, an individual's IPC must be signed and dated by the required service planning team members indicating concurrence that the services recommended in the IPC meet the requirements of subsection (b) of this section.

(d) DADS reviews an electronically transmitted initial, revised, or renewal IPC and approves, modifies, or does not approve the IPC.

(e) An electronically transmitted IPC must contain information identical to the information contained on the signed copy of the IPC described in subsection (c) of this section.

(f) DADS may review an IPC at any time to determine if the type and amount of each service specified in the IPC are appropriate. The service coordinator must submit documentation supporting the IPC to DADS in accordance with a request from DADS for documentation.

(g) If an 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 individual will receive support consultation, CFC support consultation instead of support consultation.


Source Note: The provisions of this §9.558 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 June 1, 2008, 33 TexReg 4340; 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

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