Section 262.101 - Eligibility Criteria for TxHmL Program Services and CFC Services(a) An applicant or individual is eligible for TxHmL Program services if: (1) the applicant or individual meets the financial eligibility criteria as described in Appendix B of the TxHmL waiver application approved by CMS and available on the HHSC website;(2) the applicant or individual meets one of the following criteria:(A) based on a DID and as determined by HHSC in accordance with § 262.104 of this subchapter (relating to LOC Determination), the applicant or individual qualifies for an ICF/IID LOC I as defined in § 261.238 of this title (relating to ICF/MR Level of Care I Criteria); or(B) meets the following criteria: (i) based on a DID and as determined by HHSC in accordance with § 262.105 of this subchapter (relating to LON Assignment), qualifies for one of the following levels of care: (I) an ICF/IID LOC I as defined in § 261.238 of this title; or(II) an ICF/IID LOC VIII as defined in § 261.239 of this title (relating to ICF/MR Level of Care VIII Criteria);(ii) meets one of the following: (I) resides in a nursing facility immediately before enrolling in the TxHmL Program; or(II) is at imminent risk of entering a nursing facility as determined by HHSC; and(iii) is offered TxHmL Program services designated for a member of the reserved capacity group "Individuals with a level of care I or VIII residing in a nursing facility" included in Appendix B of the TxHmL Program waiver application approved by CMS and available on the HHSC website;(3) the applicant or individual has been assigned an LON in accordance with § 262.105 of this subchapter;(4) the applicant or individual has an IPC cost that does not exceed $17,000;(5) the applicant or individual is not enrolled in another waiver program and is not receiving a service that may not be received if the individual is enrolled in the TxHmL Program, as identified in the Mutually Exclusive Services table in Appendix I of the TxHmL Handbook available on the HHSC website;(6) the applicant or individual has chosen, or the applicant's or individual's LAR has chosen, participation in the TxHmL Program over participation in the ICF/IID Program;(7) the applicant's or individual's service planning team concurs that the TxHmL Program services and, if applicable, non-TxHmL Program services for which the applicant or individual may be eligible are sufficient to ensure the applicant's or individual's health and welfare in the community;(8) the applicant or individual does not reside in:(D) an assisted living facility licensed or subject to being licensed in accordance with THSC Chapter 247;(E) a residential child care facility licensed by HHSC unless it is an agency foster home;(F) an inpatient chemical dependency treatment facility;(G) a mental health facility;(H) a residential facility operated by the Texas Workforce Commission; or(I) a residential facility operated by the Texas Juvenile Justice Department, a jail, or a prison; and(9) the applicant or individual requires the provision of:(A) at least one TxHmL Program service per month or a monthly monitoring visit by a service coordinator as described in § 262.701(o) of this chapter (relating to LIDDA Requirements for Providing Service Coordination in the TxHmL Program); and(B) at least one TxHmL Program service per IPC year.(b) Except as provided in subsection (c) of this section, an applicant or individual is eligible for a CFC service under this subchapter if the applicant or individual: (1) meets the criteria described in subsection (a) of this section; and(2) requires the provision of the CFC service.(c) To be eligible for a CFC service under this chapter, an applicant or individual receiving MAO Medicaid must, in addition to meeting the eligibility criteria described in subsection (b) of this section, receive a TxHmL Program service at least monthly, as required by 42 CFR § 441.510(d), which may not be met by a monthly monitoring visit by a service coordinator as described in § 262.701(o)(1) and (2) of this chapter.26 Tex. Admin. Code § 262.101
Adopted by Texas Register, Volume 48, Number 08, February 24, 2023, TexReg 1066, eff. 3/1/2023