Section 260.67 - Development of a Proposed Enrollment IPC(a) A program provider must ensure that an individual's case manager convenes an in-person meeting with the service planning team in which the service planning team: (1) develops a proposed enrollment IPC that: (A) documents the type of each DBMD Program service and CFC service, other than CFC support management, to be provided by the program provider;(B) documents the number of units or annual cost for each service;(C) if the individual will receive a service through the CDS option, documents:(i) the name of the individual's FMSA; and(ii) the type and number of units for each service to be provided through the CDS option;(D) documents whether the individual will receive CFC support management;(E) documents whether the individual needs a service backup plan for nursing, intervener services, or CFC PAS/HAB critical to the individual's health and safety;(F) documents an effective date of the IPC that:(i) is at least 10 business days after the case manager submits the proposed enrollment IPC to HHSC as described in §260.61(m)(1) of this division (relating to Process for Enrollment of an Individual); and(ii) does not overlap with the end date of another Medicaid waiver program or another HHSC-operated program described in the Deaf Blind with Multiple Disabilities Program Manual, other than the Day Activity and Health Services Program, in which the individual may have been enrolled; and(G) does not exceed the service limits described in:(i) Subchapter F, Divisions 1 - 3, of this chapter (relating to Service Descriptions and Requirements) if the enrollment IPC includes adaptive aids, minor home modifications, dental treatment, and respite;(ii) Subchapter F, Division 5, of this chapter (relating to CFC ERS) if the enrollment IPC includes CFC ERS; or(iii) § 272.5(d) of this title (relating to Service Description), if the enrollment IPC includes TAS;(2) if the proposed enrollment IPC includes transportation as a residential habilitation activity or as an adaptive aid, develops an individual transportation plan;(3) if the proposed enrollment IPC includes TAS, completes the HHSC Transition Assistance Services (TAS) Assessment and Authorization form; and(4) identifies the individual's non-waiver resources using the HHSC Non-Waiver Services form.(b) A program provider must ensure that a DBMD Program service and CFC service, other than CFC support management, on a proposed enrollment IPC:(1) are necessary to protect the individual's health and welfare in the community;(2) address at least one of the individual's related conditions or the additional disability that impairs independent functioning;(3) supplements rather than replaces the individual's natural supports and other non-waiver services and supports for which the individual is eligible;(4) prevents the individual's admission to an institution;(5) are the most appropriate type and amount of DBMD Program services and CFC services to meet the individual's needs; and(c) A program provider must:(1) ensure that a proposed enrollment IPC is signed and dated by each member of the service planning team;(2) submit a request for enrollment to HHSC as described in §260.61(l)(1) of this division; and(3) maintain in the individual's record the proposed enrollment IPC submitted to HHSC with the request for enrollment.(d) A program provider must maintain the following in the individual's record and provide a copy to HHSC upon request: (1) current data obtained from standardized evaluations and formal assessments related to the LOC VIII criteria and to support the individual's diagnoses, in accordance with § 260.51(a)(2) and (3) of this subchapter (relating to Eligibility Criteria for DBMD Program Services and CFC Services);(2) documentation, including assessments of the individual, that support the DBMD Program services and CFC services recommended on the proposed enrollment IPC; and(3) documentation that DBMD Program services or CFC services recommended on the proposed enrollment IPC are not available from another source.26 Tex. Admin. Code § 260.67
Adopted by Texas Register, Volume 48, Number 07, February 17, 2023, TexReg 0907, eff. 2/26/2023