§9.567: Process for Enrollment

(a) If an applicant or LAR chooses participation in the TxHmL Program, the MRA must assign a service coordinator who develops, in conjunction with the service planning team, a PDP. At a minimum, the PDP must include the following:

(1) a description of the services and supports the applicant requires to continue living in the applicant's own home or family home;

(2) a description of the applicant's current existing natural supports and non-TxHmL Program services that will be available if the applicant is enrolled in the TxHmL Program;

(3) a description of individual outcomes to be achieved through TxHmL Program service components and justification for each service component to be included in the IPC;

(4) documentation that the type and amount of each service component included in the applicant's IPC do not replace existing natural supports or non-TxHmL Program sources for the service components for which the applicant may be eligible;

(5) a description of actions and methods to be used to reach identified service outcomes, projected completion dates, and person(s) responsible for completion;

(6) a statement that the applicant was provided the information regarding CDS as required by subsection (b) of this section;

(7) if the applicant chooses to participate in CDS, a description of the service components provided through CDS, as required by subsection (e) of this section; and

(8) if the applicant chooses to participate in CDS, a description of the applicant's service back-up plan, as required by subsection (e) of this section.

(b) The MRA must:

(1) inform the applicant or LAR of the applicant's right to participate in CDS and discontinue participation in CDS at any time, except as provided in §41.405(a) of this title (relating to Suspension of Participation in CDS);

(2) inform the applicant or LAR that:

(A) except as provided in subparagraph (B) of this paragraph, the applicant or LAR may choose to have one or more service components provided through CDS; and

(B) if the applicant 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;

(3) provide the applicant or LAR a copy of Forms 1581, 1582, and 1583, which are available at http://www.dads.state.tx.us/handbooks/forms/default.asp?HB=CDS and which contain information about CDS, including a description of financial management services and support consultation;

(4) provide an oral explanation of the information contained in Forms 1581, 1582, and 1583 to the applicant or LAR; and

(5) provide the applicant or LAR the opportunity to choose to participate in CDS and document the applicant's or LAR's choice on Form 1584, which is available at http://www.dads.state.tx.us/handbooks/forms/default.asp?HB=CDS.

(c) The MRA must compile and maintain information necessary to process the applicant's or LAR's request for enrollment in the TxHmL Program.

(1) The MRA must complete an MR/RC Assessment.

(A) The MRA must:

(i) determine or validate a determination that the applicant has mental retardation in accordance with Chapter 5, Subchapter D of this title (relating to Diagnostic Eligibility for Services and Supports--Mental Retardation Priority Population and Related Conditions); or

(ii) verify that the individual has been diagnosed by a licensed physician as having a related condition as defined in §9.203 of this chapter (relating to Definitions).

(B) The MRA must administer the Inventory for Client and Agency Planning (ICAP) or validate a current ICAP and recommend an LON assignment to DADS in accordance with §9.562 of this subchapter (relating to Level of Need (LON) Assignment).

(2) The MRA must develop a proposed IPC with the applicant or LAR based on the PDP and §9.555 of this subchapter (relating to Definitions of TxHmL Program Service Components).

(d) For applicants notified of a program vacancy in accordance with §9.566 of this subchapter (relating to Notification of Applicants), the MRA:

(1) provides names and contact information to the applicant or LAR regarding all available program providers in the MRA's local service area (i.e., program providers operating below their service capacity as identified in the Client Assignment and Registration System (CARE));

(2) reviews the proposed IPC with potential program providers selected by the applicant or the LAR;

(3) arranges for meetings or visits with potential program providers as desired by the applicant or the LAR;

(4) ensures that the applicant's or LAR's choice of a program provider is documented, signed by the individual or LAR, and retained by the MRA in the applicant's record; and

(5) negotiates and finalizes the proposed IPC with the selected program provider.

(e) If an applicant or LAR chooses to participate in CDS, the MRA must:

(1) provide names and contact information to the applicant or LAR regarding all CDSAs providing services in the MRA's local service area;

(2) document the applicant's or LAR's choice of CDSA on Form 1584;

(3) document, in the applicant's PDP, a description of the service component provided through CDS; and

(4) document, in the applicant's PDP, a description of the applicant's service back-up plan.

(f) When the selected program provider and CDSA, if applicable have agreed to deliver those services delineated on the IPC, the MRA transmits to DADS enrollment information, including the completed MR/RC Assessment, the proposed IPC, and, if applicable, a request for an increase in a service category limit as described in §9.559 of this subchapter (relating to Request to Increase Service Category Limits). DADS notifies the applicant or LAR, the selected program provider and CDSA, if applicable, and the MRA of its approval or denial of the applicant's program enrollment based on the eligibility criteria described in §9.556 (relating to Eligibility Criteria).

(g) If a selected program provider initiates services before DADS' notification of enrollment approval, the program provider may not be reimbursed in accordance with §9.573(a)(11)(K) of this subchapter (relating to Reimbursement).

Comments

Source Note: The provisions of this §9.567 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