§9.554: Description of the Txhml Program

(a) The TxHmL Program is a Medicaid waiver program approved by the CMS pursuant to §1915(c) of the Social Security Act. It provides community-based services and supports to eligible individuals who live in their own homes or in their family homes. The TxHmL Program is operated by DADS under the authority of HHSC.

(b) Enrollment in the TxHmL Program is limited to the number of individuals in specified target groups approved by CMS.

(c) DADS has grouped the counties of the state of Texas into geographical areas, referred to as "local service areas," each of which is served by an MRA. DADS has further grouped the local service areas into "waiver contract areas." A list of the counties included in each local service area and waiver contract area is available at http://www.dads.state.tx.us.

(1) A program provider may provide TxHmL Program services only to persons residing in the counties specified in its program provider agreement.

(2) A program provider must have a separate program provider agreement for each waiver contract area served by the program provider.

(3) A program provider may have a program provider agreement to serve one or more local service areas within a waiver contract area, but the program provider must serve all of the counties within each local service area covered by the program provider agreement.

(4) A program provider may not have more than one program provider agreement per waiver contract area.

(d) A program provider's program provider agreement must:

(1) specify which of the following service components will be provided by a person who is employed, not contracted with, the program provider:

(A) community support;

(B) day habilitation;

(C) supported employment; or

(D) respite; and

(2) be amended before changing the service component specified in accordance with paragraph (1) of this subsection.

(e) The MRA must provide service coordination to an individual who is enrolled in the TxHmL Program in accordance with this subchapter. Service coordination is reimbursed in accordance with 1 TAC §355.746 (relating to Reimbursement Methodology for Mental Retardation (MR) Service Coordination).

(f) TxHmL Program service components, as defined in §9.555 of this subchapter (relating to Definitions of TxHmL Program Service Components), are selected by the service planning team for inclusion in an applicant's or individual's IPC to:

(1) ensure the applicant's or individual's health and welfare in the community;

(2) supplement rather than replace the applicant's or individual's natural supports and other non-TxHmL Program sources for which the applicant or individual may be eligible; and

(3) prevent the applicant's or individual's admission to institutional services.

(g) TxHmL Program service components, as defined in §9.555 of this subchapter, are divided into two service categories, the Community Living Service Category and the Technical and Professional Supports Service Category. Each category has an annual cost limit referred to as the service category limit. The combined cost of the two service categories must not exceed the combined cost limit per individual per IPC year specified in Appendix C of the TxHmL Program waiver application approved by CMS, which is available at http://www.dads.state.tx.us.

(1) The service category limit for the Community Living Service Category per individual per IPC year is specified in Appendix C of the TxHmL Program waiver application approved by CMS, unless an exception is approved in accordance with §9.559 of this subchapter (relating to Request to Increase Service Category Limits). This service category includes the following service components:

(A) community support;

(B) day habilitation;

(C) employment assistance;

(D) supported employment;

(E) respite;

(F) financial management services, if the individual is participating in CDS; and

(G) support consultation, if the individual is participating in CDS.

(2) The service category limit for the Professional and Technical Supports Service Category per individual per IPC year is specified in Appendix C of the TxHmL Program waiver application approved by CMS, unless an exception is made in accordance with §9.559 of this subchapter. This service category includes the following service components:

(A) nursing;

(B) behavioral support;

(C) adaptive aids;

(D) minor home modifications;

(E) specialized therapies; and

(F) dental treatment.

(h) CDS is a service delivery option, as described in Chapter 41 of this title (relating to Consumer Directed Services Option), in which an individual or LAR employs and retains service providers and directs the delivery of one or more service components. If an individual is receiving community support and respite and chooses to have one of these service components provided through CDS, the other service component must also be provided through CDS.

Comments

Source Note: The provisions of this §9.554 adopted to be effective January 5, 2003, 27 TexReg 12254; amended to be effective March 11, 2004, 29 TexReg 2317; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective March 1, 2007, 32 TexReg 544; amended to be effective June 1, 2008, 33 TexReg 4340