|(a) To participate in the HCBS-AMH program, an assessor
must conduct an HCBS-AMH assessment on each individual for HHSC to
determine that the individual meets the needs-based eligibility criteria
(1) The assessor must consult with the individual,
the individual's LAR, if applicable, treatment team, providers, and
other persons according to the needs and desire of the individual
to conduct the HCBS-AMH assessment.
(2) The HCBS-AMH assessment must:
(A) be conducted face-to-face as permitted under Medicaid
(B) take into account the ability of the individual
to perform two or more activities of daily living; and
(C) assess the individual's need for HCBS-AMH.
(b) For HHSC to determine an individual eligible to
participate in HCBS-AMH, the individual must meet criteria in accordance
with applicable state legislative direction and eligibility requirements
as set forth in the Medicaid state plan, including:
(1) having three years or more of consecutive or cumulative
inpatient psychiatric hospitalizations during the five years before
initial enrollment in the HCBS-AMH program;
(2) having two or more psychiatric crises and four
or more discharges from correctional facilities during the three years
before initial enrollment in HCBS-AMH; or
(3) having two or more psychiatric crises and fifteen
or more total emergency department documented contacts in which services
are delivered during the three years before initial enrollment in
(c) The HCBS-AMH assessment must be repeated at least
annually for each individual, and when circumstances necessitate a
re-assessment, using the same requirements outlined in subsections
(a) and (b) of this section.
(d) HHSC approves each HCBS-AMH initial eligibility
assessment, annual assessment, and assessment conducted based on a
change in circumstances.