Section 262.103 - Process for Enrollment of Applicants(a) HHSC notifies a LIDDA, in writing, when the opportunity for enrollment in the TxHmL Program becomes available in the LIDDA's local service area and directs the LIDDA to offer enrollment to the applicant:(1) whose interest list date, assigned in accordance with § 262.102 of this subchapter (relating to TxHmL Interest List), is earliest on the statewide interest list for the TxHmL Program as maintained by HHSC;(2) whose name is not coded in the HHSC data system as having been determined ineligible for the TxHmL Program and who is receiving services from the LIDDA that are funded by general revenue in an amount that would allow HHSC to fund the services through the TxHmL Program; or(3) who is a member of a target group identified in the approved TxHmL waiver application.(b) Except as provided in subsection (c) of this section, a LIDDA must offer enrollment in the TxHmL 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 TxHmL Program to an applicant described in subsection (a)(2) or (3) 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 TxHmL 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 TxHmL Program, the LIDDA terminates those services that are similar to services provided in the TxHmL 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 TxHmL 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 a 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 TxHmL 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 TxHmL Program or the ICF/IID Program.(f) A LIDDA must withdraw an offer of enrollment in the TxHmL 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 TxHmL 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 of the TxHmL Program;(3) within 30 calendar days after the applicant or LAR receives the contact information regarding all available program providers in the LIDDA's local service area in accordance with subsection (k)(2)(A) of this section, the applicant or LAR does not document a 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 TxHmL 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 declines the offer of enrollment in the TxHmL Program, the LIDDA must terminate those services that are similar to services provided in the TxHmL 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) A LIDDA must retain in an applicant's record:(1) the HHSC Waiver Program Verification of Freedom of Choice form;(2) the HHSC Documentation of Provider Choice form;(3) the HHSC Deadline Notification form; and(4) any correspondence related to the offer of enrollment in the TxHmL Program.(k) If an applicant or LAR accepts the offer of enrollment in the TxHmL Program, the LIDDA must compile and maintain information necessary to process the applicant's request for enrollment in the TxHmL Program. (1) The LIDDA must complete an ID/RC Assessment in accordance with § 262.104(a)(1) of this subchapter (relating to LOC Determination). (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 § 262.105 of this subchapter (relating to LON Assignment).(C) The LIDDA must enter the information from the completed ID/RC Assessment in the HHSC data system and electronically submit the information to HHSC in accordance with § 262.104(a)(2) of this subchapter and § 262.105(a) of this subchapter and submit supporting documentation as required by § 262.106 of this subchapter (relating to HHSC Review of LON).(2) The LIDDA must: (A) provide names and contact information to the applicant or LAR for all program providers in the LIDDA's local service area;(B) arrange for meetings or visits with potential program providers as requested by the applicant or the LAR; and(C) 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 and retained by the LIDDA in the applicant's record.(3) The LIDDA must assign a service coordinator who, together with other members of the service planning team, must: (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.(4) The CFC PAS/HAB assessment form required by paragraph (3)(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.(l) A service coordinator must:(1) in accordance with 40 TAC Chapter 41, Subchapter D (relating to Enrollment, Transfer, Suspension, and Termination):(A) inform the applicant or LAR of the applicant's right to participate in the CDS option; and(B) inform the applicant or LAR that the applicant or LAR may choose to have one or more services provided through the CDS option, as described in 40 TAC § 41.108(relating to Services Available Through the CDS Option); and(2) if the applicant or LAR chooses to participate in the CDS option, comply with § 262.701(r) of this chapter (relating to LIDDA Requirements for Providing Service Coordination in the TxHmL Program).(m) The service coordinator must develop an initial IPC with the applicant or LAR based on the PDP and in accordance with § 262.301 of this chapter (relating to IPC Requirements).(n) If an applicant or LAR chooses to receive a TxHmL Program service or CFC service provided by a program provider, the service coordinator must review the initial IPC with potential program providers as requested by the applicant or the LAR.(o) A service coordinator must: (1) ensure that the initial IPC includes a sufficient number of RN nursing units for the program provider's RN to perform a comprehensive nursing assessment, unless: (A) nursing services are not on the initial IPC and the applicant or LAR and selected program provider have determined that no nursing tasks will be performed by an unlicensed service provider as documented on the HHSC Nursing Task Screening Tool form; or(B) an unlicensed service provider will perform a nursing task and a physician has delegated the task as a medical act under Texas Occupations Code Chapter 157, as documented by the physician;(2) if an applicant or LAR refuses to include a sufficient number of RN nursing units on the initial IPC for the program provider's RN to perform a comprehensive nursing assessment as required by paragraph (1) of this subsection: (A) inform the applicant or LAR that the refusal: (i) will result in the applicant not receiving nursing services from the program provider; and(ii) if the applicant needs community support, day habilitation, employment assistance, supported employment, respite, or CFC PAS/HAB from the program provider, will result in the applicant not receiving the service unless:(I) the program provider's unlicensed service provider does not perform nursing tasks in the provision of the service; and(II) the program provider determines that it can ensure the applicant's health, safety, and welfare in the provision of the service; and(B) document the refusal of the RN nursing units on the initial IPC for a comprehensive nursing assessment by the program provider's RN in the applicant's record;(3) negotiate and finalize the initial IPC and the date services will begin with the selected program provider, consulting with HHSC if necessary to reach agreement with the selected program provider on the content of the initial IPC and the date services will begin;(4) ensure that the applicant or LAR signs and dates the initial IPC and provides the signed and dated IPC to the service coordinator in person, electronically, by fax, or by United States mail;(5) ensure that the selected program provider signs and dates the initial IPC, demonstrating agreement that the services will be provided to the applicant; and(6) sign and date the initial IPC to demonstrate that the service coordinator agrees that the requirements described in § 262.301(c) of this chapter have been met.(p) A service coordinator must: (1) provide an oral and written explanation to the applicant or LAR of the following information using the HHSC Understanding Program Eligibility and Services form, which is available on the HHSC website:(A) the eligibility requirements for TxHmL Program services as described in § 262.101(a) of this subchapter (relating to Eligibility Criteria for TxHmL Program Services and CFC Services); and(B) if the applicant's PDP includes CFC services:(i) the eligibility requirements for CFC services as described in § 262.101(b) of this subchapter to applicants who do not receive MAO Medicaid; and(ii) the eligibility requirements for CFC services as described in § 262.101(c) of this subchapter to applicants who receive MAO Medicaid; and(2) provide an oral and written explanation to the applicant or LAR of:(A) the reasons TxHmL Program services may be terminated as described in § 262.507 of this chapter (relating to Termination of TxHmL Program Services and CFC Services with Advance Notice) and § 262.508 of this chapter (relating to Termination of TxHmL Program Services and CFC Services without Advance Notice); and(B) if the applicant's PDP includes CFC services, the reasons CFC services may be terminated as described in § 262.507 and § 262.508 of this chapter.(q) After an initial IPC is finalized and signed in accordance with subsection (o) of this section, the LIDDA must:(1) enter the information from the initial IPC in the HHSC data system and electronically submit the information to HHSC;(2) keep the original initial IPC in the individual's record;(3) ensure the information from the initial IPC entered in the HHSC data system and electronically submitted to HHSC contains information identical to the information on the initial IPC; and(4) submit other required enrollment information to HHSC;(r) HHSC notifies the applicant or LAR, the selected program provider, the FMSA, if applicable, and the LIDDA of its approval or denial of the applicant's enrollment. If the enrollment is approved, HHSC authorizes the applicant's enrollment in the TxHmL Program through the HHSC data system and issues an enrollment letter to the applicant that includes the effective date of the applicant's enrollment in the TxHmL Program.(s) The selected program provider and the individual or LAR must develop: (1) an implementation plan for: (A) TxHmL Program services, except for community support, that is based on the individual's PDP and initial IPC; and(B) CFC services, except for CFC support management, that is based on the individual's PDP, IPC, and if CFC PAS/HAB is included on the PDP, the completed HHSC HCS/TxHmL CFC PAS/HAB Assessment form; and(2) a transportation plan, if community support is included on the PDP.(t) Before the applicant's service begin date, a LIDDA must provide to the selected program provider and FMSA, if applicable:(1) copies of all enrollment documentation and associated supporting documentation, including relevant assessment results and recommendations;(2) the completed ID/RC Assessment;(4) the applicant's PDP; and(5) if CFC PAS/HAB is included on the PDP, a copy of the completed HHSC HCS/TxHmL CFC PAS/HAB Assessment form.(u) In accordance with § 262.401(a)(5)(N) of this chapter (relating to Program Provider Reimbursement), if a selected program provider provides services before the date of an applicant's enrollment into the TxHmL Program, HHSC does not pay the program provider for the services.26 Tex. Admin. Code § 262.103
Adopted by Texas Register, Volume 48, Number 08, February 24, 2023, TexReg 1066, eff. 3/1/2023