Section 260.113 - Mandatory Participation Requirements of an IndividualAn individual or LAR must comply with the following mandatory participation requirements:
(1) completing and submitting an application for Medicaid financial eligibility to HHSC in accordance with § 260.61(h)(2) of this subchapter (relating to Process for Enrollment of an Individual) or within another time frame permitted by § 260.61(i) of this subchapter if the individual does not have Medicaid financial eligibility;(2) participating on the service planning team to:(A) develop an enrollment IPP, as described in § 260.65 of this chapter (relating to Development of an Enrollment IPP);(B) develop a proposed enrollment IPC, as described in § 260.67 of this subchapter (relating to Development of a Proposed Enrollment IPC); and(C) review and revise the IPP and IPC, as described in § 260.77 of this subchapter (relating to Renewal and Revision of an IPP and IPC);(3) reviewing, agreeing to, signing, and dating an IPP and IPC;(4) utilizing natural supports and other non-waiver and non-CFC services and supports for which the individual may be eligible before accessing DBMD Program services and CFC services;(5) cooperating with the program provider in the delivery of DBMD Program services and CFC services listed on the individual's IPC, including: (A) working with the program provider to schedule meetings;(B) attending a scheduled meeting with the case manager or a service provider;(C) being available to receive DBMD Program services and CFC services;(D) notifying the program provider in advance if the individual or LAR is unable to keep an appointment or is unavailable to receive services in the individual's residence; and(E) admitting program provider representatives to the individual's residence for a scheduled meeting or to receive DBMD Program services and CFC services;(6) cooperating with the program provider's service providers to ensure progress toward achieving the goals and outcomes described in the IPP;(7) if found by HHSC to be financially eligible for DBMD Program services based on the special institutional income limit, paying the required co-payment in a timely manner;(8) notifying the program provider if the individual receives notice from HHSC of a change in the status of the individual's financial eligibility for Medicaid;(9) not engaging in criminal behavior in the presence of a service provider or, if the individual receives licensed assisted living or licensed home health assisted living, another individual residing in the same residence;(10) not permitting a person present in the individual's residence to engage in criminal behavior in the presence of a service provider or, if the individual receives licensed assisted living or licensed home health assisted living, another individual residing in the same residence;(11) not acting in a manner that is threatening to the health and safety of a service provider or, if the individual receives licensed assisted living or licensed home health assisted living, another individual residing in the same residence;(12) not permitting a person present in the individual's residence to act in a manner that is threatening to the health and safety of the case manager or a service provider or, if the individual receives licensed assisted living or licensed home health assisted living, of another individual residing in the same residence;(13) not exhibiting behavior or permitting a person present in the individual's residence to exhibit behavior that places the health and safety of a service provider in immediate jeopardy;(14) not initiating or participating in fraudulent health care practices;(15) not engaging in behavior that endangers the individual's health or safety;(16) not permitting a person present in the individual's residence to engage in behavior that endangers the individual's health or safety; and(17) paying room and board on time if the individual receives licensed assisted living.26 Tex. Admin. Code § 260.113
Adopted by Texas Register, Volume 48, Number 07, February 17, 2023, TexReg 0913, eff. 2/26/2023