| (a) HHSC notifies a LIDDA, in writing, when the opportunity
for enrollment in the HCS Program becomes available in the LIDDA's
local service area and directs the LIDDA to offer enrollment to an
applicant:
(1) whose interest list date, assigned in accordance
with §263.103 of this subchapter (relating to HCS Interest List),
is earliest on the statewide interest list for the HCS Program maintained
by HHSC; or
(2) who is a member of a target group identified in
the HCS Program waiver application approved by CMS.
(b) Except as provided in subsection (c) of this section,
a LIDDA must offer enrollment in the HCS Program in writing and deliver
it to the applicant or LAR by United States mail or by hand delivery.
(c) A LIDDA must offer enrollment in the HCS Program
to an applicant described in subsection (a)(2) of this section in
accordance with HHSC's procedures.
(d) A LIDDA must include in a written offer that is
made in accordance with subsection (a)(1) of this section:
(1) a statement that:
(A) if the applicant or LAR does not respond to the
offer of enrollment in the HCS Program within 30 calendar days after
the LIDDA's written offer, the LIDDA withdraws the offer; and
(B) if the applicant is currently receiving services
from the LIDDA that are funded by general revenue and the applicant
or LAR declines the offer of enrollment in the HCS Program, the LIDDA
terminates those services funded by general revenue that are similar
to services provided in the HCS Program; and
(2) the HHSC Deadline Notification form, which is available
on the HHSC website.
(e) If an applicant or LAR responds to an offer of
enrollment in the HCS Program, a LIDDA must:
(1) provide the applicant, LAR, and, if the LAR is
not a family member, at least one family member if possible, both
an oral and written explanation of the services and supports for which
the applicant may be eligible, including the ICF/IID Program, both
state supported living centers and community-based facilities, waiver
programs authorized under §1915(c) of the Social Security Act,
and other community-based services and supports, using the HHSC Explanation
of Services and Supports document, which is available on the HHSC
website;
(2) provide the applicant and LAR both an oral and
a written explanation of all HCS Program services and CFC services
using the HHSC Understanding Program Eligibility and Services form,
which is available on the HHSC website; and
(3) give the applicant or LAR the HHSC Waiver Program
Verification of Freedom of Choice form, which is available on the
HHSC website, to document the applicant's choice between the HCS Program
or the ICF/IID Program.
(f) A LIDDA must withdraw an offer of enrollment in
the HCS Program made to an applicant or LAR if:
(1) within 30 calendar days after the LIDDA's offer
made to the applicant or LAR in accordance with subsection (a)(1)
of this section, the applicant or LAR does not respond to the offer
of enrollment in the HCS Program;
(2) within seven calendar days after the applicant
or LAR receives the HHSC Waiver Program Verification of Freedom of
Choice form from the LIDDA in accordance with subsection (e)(3) of
this section, the applicant or LAR does not use the form to document
the applicant's choice, the HCS Program or the ICF/IID Program;
(3) within 30 calendar days after the applicant or
LAR receives the contact information for all program providers in
the LIDDA's local service area in accordance with subsection (j)(3)
of this section, the applicant or LAR does not document the choice
of a program provider using the HHSC Documentation of Provider Choice
form, which is available on the HHSC website;
(4) the applicant or LAR does not complete the necessary
activities to finalize the enrollment process and HHSC has approved
the withdrawal of the offer; or
(5) the applicant has moved out of the State of Texas.
(g) If a LIDDA withdraws an offer of enrollment in
the HCS Program made to an applicant, the LIDDA must notify the applicant
or LAR of such action, in writing, by certified United States mail.
(h) If an applicant is currently receiving services
from a LIDDA that are funded by general revenue and the applicant
or LAR declines the offer of enrollment in the HCS Program, the LIDDA
must terminate those services funded by general revenue that are similar
to services provided in the HCS Program.
(i) If a LIDDA terminates an applicant's services in
accordance with subsection (h) of this section, the LIDDA must notify
the applicant or LAR of the termination, in writing, by certified
United States mail and provide an opportunity for a review in accordance
with 40 TAC §2.46 (relating to Notification and Appeals Process).
(j) If an applicant or LAR accepts the offer of enrollment
in the HCS Program, the LIDDA must compile and maintain information
necessary to process the applicant's request for enrollment.
(1) If the applicant's financial eligibility for the
HCS Program must be established, the LIDDA must initiate, monitor,
and support the processes necessary to obtain a financial eligibility
determination.
(2) The LIDDA must complete an ID/RC Assessment in
accordance with §263.105 of this subchapter (relating to LOC
Determination) and §263.106 of this subchapter (relating to LON
Assignment).
(A) The LIDDA must:
(i) do one of the following:
(I) conduct a DID in accordance with §304.401
of this title (relating to Conducting a Determination of Intellectual
Disability) except that the following activities must be conducted
in person:
(-a-) a standardized measure of the individual's intellectual
functioning using an appropriate test based on the characteristics
of the individual; and
(-b-) a standardized measure of the individual's adaptive
abilities and deficits reported as the individual's adaptive behavior
level; or
(II) review and endorse a DID report in accordance
with §304.403 of this title (relating to Review and Endorsement
of a Determination of Intellectual Disability Report); and
(ii) determine whether the applicant has been diagnosed
by a licensed physician as having a related condition.
(B) The LIDDA must:
(i) conduct an ICAP assessment in person; and
(ii) recommend an LON assignment to HHSC in accordance
with §263.106 of this subchapter.
(C) The LIDDA must enter the information from the completed
ID/RC Assessment and electronically submit the information to HHSC
for approval in accordance with §263.105(a) of this subchapter
and §263.106(a) of this subchapter and, if applicable, submit
supporting documentation as required by §263.107(c) of this subchapter
(relating to HHSC Review of LON).
(3) The LIDDA must provide names and contact information
to the applicant or LAR for all program providers in the LIDDA's local
service area.
(4) The LIDDA must assign a service coordinator who,
together with other members of the applicant's service planning team,
must:
(A) develop a PDP;
(B) if CFC PAS/HAB is included on the PDP, complete
the HHSC HCS/TxHmL CFC PAS/HAB Assessment form, which is available
on the HHSC website, to determine the number of CFC PAS/HAB hours
the applicant needs; and
(C) develop an initial IPC in accordance with §263.301(c)
of this chapter (relating to IPC Requirements).
(5) The CFC PAS/HAB Assessment form required by paragraph
(4)(B) of this subsection must be completed in person with the individual
unless the following conditions are met in which case the form may
be completed by videoconferencing or telephone:
(A) the service coordinator gives the individual the
opportunity to complete the form in person in lieu of completing it
by videoconferencing or telephone and the individual agrees to the
form being completed by videoconferencing or telephone; and
(B) the individual receives appropriate in-person support
during the completion of the form by videoconferencing or telephone.
(6) A service coordinator must discuss the CDS option
with the applicant or LAR in accordance with §263.401(a) and
(b) of this chapter (relating to CDS Option).
(k) A service coordinator must:
(1) arrange for meetings and visits with potential
program providers as requested by an applicant or LAR;
(2) review the initial IPC with potential program providers
as requested by the applicant or LAR;
(3) ensure that the applicant's or LAR's choice of
a program provider is documented on the HHSC Documentation of Provider
Choice form and that the form is signed by the applicant or LAR;
Cont'd... |
