Texas Register February 24, 2023 Volume: 48 Number: 8

Governor

Proclamation 41-3959, renewing the disaster proclamation due to the ongoing COVID-19 crisis.

NOW, THEREFORE, in accordance with the authority vested by Section 418.014 of the Texas Government Code, the Governor hereby renews the disaster proclamation for all counties in Texas.

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Texas Health and Human Services Commission

Adopted Rules:

Amending 1 TAC §372.355, to delete subsections regarding certain Native American payments and Volunteers in Service to America (VISTA) program payments to align with HHSC policy and federal regulation, where such payments are already referenced.

CHAPTER 372. TEMPORARY ASSISTANCE FOR NEEDY FAMILIES AND SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAMS
SUBCHAPTER B. ELIGIBILITY
1 TAC §372.355

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts amendments to §372.355, concerning Treatment of Resources in SNAP; §372.406, concerning Countable and Excluded Income in SNAP; and §372.410, concerning Allowable Deductions from Countable Income in SNAP.

The amendments to §§372.355, 372.406, and 372.410 are adopted without changes to the proposed text as published in the October 21, 2022, issue of the Texas Register (47 TexReg 6949). The rules will not be republished.

BACKGROUND AND JUSTIFICATION

The amendment aligns the rule with the Food and Nutrition Service (FNS) decision to discontinue the Texas Integrated Eligibility Redesign System (TIERS) Rules Waiver. This waiver allowed HHSC to modify certain eligibility criteria for SNAP to align agency SNAP policy and system functionality with other HHSC programs. Because the waiver expired, HHSC must now follow federal regulations.

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Amending 1 TAC §372.406, §372.410, deleting some subsections to align with HHSC policy and federal regulations regarding the VISTA program and certain SNAP households.

CHAPTER 372. TEMPORARY ASSISTANCE FOR NEEDY FAMILIES AND SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAMS
SUBCHAPTER B. ELIGIBILITY
1 TAC §372.406, §372.410

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts amendments to §372.355, concerning Treatment of Resources in SNAP; §372.406, concerning Countable and Excluded Income in SNAP; and §372.410, concerning Allowable Deductions from Countable Income in SNAP.

The amendments to §§372.355, 372.406, and 372.410 are adopted without changes to the proposed text as published in the October 21, 2022, issue of the Texas Register (47 TexReg 6949). The rules will not be republished.

BACKGROUND AND JUSTIFICATION

The amendment aligns the rule with the Food and Nutrition Service (FNS) decision to discontinue the Texas Integrated Eligibility Redesign System (TIERS) Rules Waiver. This waiver allowed HHSC to modify certain eligibility criteria for SNAP to align agency SNAP policy and system functionality with other HHSC programs. Because the waiver expired, HHSC must now follow federal regulations.

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Amending 1 TAC §372.1507 to expand the TANF supplemental grandparent payment to include aunts, uncles, and siblings.

CHAPTER 372. TEMPORARY ASSISTANCE FOR NEEDY FAMILIES AND SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAMS
SUBCHAPTER F. BENEFITS
1 TAC §372.1507

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts an amendment to §372.1507, concerning TANF Supplemental Relative Payment.

The amendment to §372.1507 is adopted without changes to the proposed text as published in the October 14, 2022, issue of the Texas Register (47 TexReg 6710). This rule will not be republished.

BACKGROUND AND JUSTIFICATION

The amendment is necessary to comply with Senate Bill (S.B.) 263, 87th Texas Legislature, Regular Session, 2021, which required HHSC to expand who may receive a one-time $1,000 TANF Supplemental Payment from only grandparents to eligible caretakers, including aunts, uncles, and siblings.

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New 26 TAC §§262.1 – 262.9, describing the Texas Home Living (TxHmL) Program and the Community First Choice (CFC) Program.

CHAPTER 262. TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)
SUBCHAPTER A. GENERAL PROVISIONS
26 TAC §§262.1 – 262.9

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts in Texas Administrative Code Title 26, Part 1, Chapter 262, Texas Home Living (TxHmL) Program and Community First Choice (CFC), new Subchapters A – I, comprising new §§262.1 – 262.9, 262.101 – 262.107, 262.201, 262.202, 262.301 – 262.304, 262.401, 262.501 – 262.508, 262.601, 262.602, 262.701, and 262.801.

Sections 262.3, 262.5, 262.6, 262.8, 262.9, 262.103, 262.105, 262.106, 262.201, 262.202, 262.302, 262.401, 262.501, 262.502, 262.508, 262.601, 262.701, and 262.801 are adopted with changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5636). These rules will be republished.

Sections 262.1, 262.2, 262.4, 262.7, 262.101, 262.102, 262.104, 262.107, 262.301, 262.303, 262.304, 262.503, 262.504, 262.505, 262.506, 262.507, and 262.602 are adopted without changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5636). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The TxHmL Program is a Medicaid waiver program approved by the Centers for Medicare & Medicaid Services (CMS) under §1915(c) of the Social Security Act. This waiver program provides community-based services and supports to an eligible individual as an alternative to services provided in an institutional setting. The adopted rules move certain TxHmL Program rules from 40 TAC Chapter 9, Subchapter N to 26 TAC Chapter 262. The repeal of §§9.551, 9.552, 9.554, 9.556, 9.558, 9.560 – 9.563, 9.566 – 9.568, 9.570, 9.571, 9.573 – 9.575, 9.582, and 9.583 in 40 TAC Chapter 9, Subchapter N are proposed elsewhere in this issue of the Texas Register.

The adopted rules do not include §§9.572, 9.576, 9.578 – 9.581, and §§9.584 – 9.587. HHSC will propose rules containing the certification standards for the TxHmL Program in a different rule project.

The adopted rules ensure that the TxHmL Program complies with the requirements in Title 42, Code of Federal Regulations (CFR), Chapter IV, Subchapter C, Part 441, Subpart G, §441.301(c)(1) – (5). In 2014, CMS amended this regulation to establish new requirements for Home and Community-Based Services (HCBS) Medicaid Programs, including requirements for HCBS program settings and person-centered planning. CMS has given states until March 2023 to fully comply with the requirements in 42 CFR §441.301(c)(1) – (5). The adopted rules will also ensure compliance with the requirements in 42 CFR Chapter IV, Subchapter C, Part 441, Subpart K, §441.530, regarding Home and Community-Based Setting, §441.535, regarding Assessment of functional need; and §441.540 regarding the Person-centered service plan, for Community First Choice (CFC) services because CFC services are available to individuals enrolled in the TxHmL Program.

The adopted rules implement Texas Government Code §531.02161(b)(4) which requires HHSC to ensure that, if cost effective, clinically effective, and allowed by federal law, a Medicaid recipient has the option to receive certain services, including occupational therapy (OT), physical therapy (PT), and speech-language pathology as a telehealth service.

The adopted rules require the initial TxHmL eligibility assessments to be conducted in person and the CFC personal assistance services/habilitation (PAS/HAB) assessment to be completed in person unless certain conditions exist in which case the assessment may be completed by telehealth, telephone, or video conferencing. These requirements help ensure the assessments are thorough and accurate.

The adopted rules include provisions regarding the denial, suspension, reduction, or termination of an individual’s TxHmL Program services to explain HHSC’s process in taking one of these actions. The adopted rules change the existing service coordination monitoring requirement from 90 days to 30 days during an individual’s suspension.

The adopted rules require a program provider and local intellectual and developmental disability authority (LIDDA) to submit a translation of non-English documentation submitted to HHSC. The purpose of the adopted rule is to help ensure that HHSC’s reviews of documentation are efficient.

The adopted rules require a registered nurse (RN) to complete a comprehensive nursing assessment of an individual in person under specified circumstances. This requirement is included to ensure the comprehensive nursing assessment is clinically effective, thorough, and accurate and to help ensure the health and safety of an individual.

The adopted rules codify current practice related to individuals in the TxHmL Program transferring to another program provider or choosing a different service delivery option.

The adopted rules provide that HHSC may allow program providers and service coordinators to use one or more of the exceptions specified in the rule while an executive order or proclamation declaring a state of disaster under Texas Government Code §418.014 is in effect. This provision helps ensure that providers and service coordinators are able to provide services effectively during a disaster.

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New 26 TAC §§262.101 – 262.107, concerning eligibility criteria and the process for enrollment for TxHmL Program Services and CFC Services.

CHAPTER 262. TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)
SUBCHAPTER B. ELIGIBILITY, ENROLLMENT, AND REVIEW
26 TAC §§262.101 – 262.107

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts in Texas Administrative Code Title 26, Part 1, Chapter 262, Texas Home Living (TxHmL) Program and Community First Choice (CFC), new Subchapters A – I, comprising new §§262.1 – 262.9, 262.101 – 262.107, 262.201, 262.202, 262.301 – 262.304, 262.401, 262.501 – 262.508, 262.601, 262.602, 262.701, and 262.801.

Sections 262.3, 262.5, 262.6, 262.8, 262.9, 262.103, 262.105, 262.106, 262.201, 262.202, 262.302, 262.401, 262.501, 262.502, 262.508, 262.601, 262.701, and 262.801 are adopted with changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5636). These rules will be republished.

Sections 262.1, 262.2, 262.4, 262.7, 262.101, 262.102, 262.104, 262.107, 262.301, 262.303, 262.304, 262.503, 262.504, 262.505, 262.506, 262.507, and 262.602 are adopted without changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5636). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The TxHmL Program is a Medicaid waiver program approved by the Centers for Medicare & Medicaid Services (CMS) under §1915(c) of the Social Security Act. This waiver program provides community-based services and supports to an eligible individual as an alternative to services provided in an institutional setting. The adopted rules move certain TxHmL Program rules from 40 TAC Chapter 9, Subchapter N to 26 TAC Chapter 262. The repeal of §§9.551, 9.552, 9.554, 9.556, 9.558, 9.560 – 9.563, 9.566 – 9.568, 9.570, 9.571, 9.573 – 9.575, 9.582, and 9.583 in 40 TAC Chapter 9, Subchapter N are proposed elsewhere in this issue of the Texas Register.

The adopted rules do not include §§9.572, 9.576, 9.578 – 9.581, and §§9.584 – 9.587. HHSC will propose rules containing the certification standards for the TxHmL Program in a different rule project.

The adopted rules ensure that the TxHmL Program complies with the requirements in Title 42, Code of Federal Regulations (CFR), Chapter IV, Subchapter C, Part 441, Subpart G, §441.301(c)(1) – (5). In 2014, CMS amended this regulation to establish new requirements for Home and Community-Based Services (HCBS) Medicaid Programs, including requirements for HCBS program settings and person-centered planning. CMS has given states until March 2023 to fully comply with the requirements in 42 CFR §441.301(c)(1) – (5). The adopted rules will also ensure compliance with the requirements in 42 CFR Chapter IV, Subchapter C, Part 441, Subpart K, §441.530, regarding Home and Community-Based Setting, §441.535, regarding Assessment of functional need; and §441.540 regarding the Person-centered service plan, for Community First Choice (CFC) services because CFC services are available to individuals enrolled in the TxHmL Program.

The adopted rules implement Texas Government Code §531.02161(b)(4) which requires HHSC to ensure that, if cost effective, clinically effective, and allowed by federal law, a Medicaid recipient has the option to receive certain services, including occupational therapy (OT), physical therapy (PT), and speech-language pathology as a telehealth service.

The adopted rules require the initial TxHmL eligibility assessments to be conducted in person and the CFC personal assistance services/habilitation (PAS/HAB) assessment to be completed in person unless certain conditions exist in which case the assessment may be completed by telehealth, telephone, or video conferencing. These requirements help ensure the assessments are thorough and accurate.

The adopted rules include provisions regarding the denial, suspension, reduction, or termination of an individual’s TxHmL Program services to explain HHSC’s process in taking one of these actions. The adopted rules change the existing service coordination monitoring requirement from 90 days to 30 days during an individual’s suspension.

The adopted rules require a program provider and local intellectual and developmental disability authority (LIDDA) to submit a translation of non-English documentation submitted to HHSC. The purpose of the adopted rule is to help ensure that HHSC’s reviews of documentation are efficient.

The adopted rules require a registered nurse (RN) to complete a comprehensive nursing assessment of an individual in person under specified circumstances. This requirement is included to ensure the comprehensive nursing assessment is clinically effective, thorough, and accurate and to help ensure the health and safety of an individual.

The adopted rules codify current practice related to individuals in the TxHmL Program transferring to another program provider or choosing a different service delivery option.

The adopted rules provide that HHSC may allow program providers and service coordinators to use one or more of the exceptions specified in the rule while an executive order or proclamation declaring a state of disaster under Texas Government Code §418.014 is in effect. This provision helps ensure that providers and service coordinators are able to provide services effectively during a disaster.

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New 26 TAC §262.201, §262.202, detailing requirements for a service coordinator and service settings.

CHAPTER 262. TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)
SUBCHAPTER C. PERSON-CENTERED PLANNING AND SERVICE SETTINGS
26 TAC §262.201, §262.202

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts in Texas Administrative Code Title 26, Part 1, Chapter 262, Texas Home Living (TxHmL) Program and Community First Choice (CFC), new Subchapters A – I, comprising new §§262.1 – 262.9, 262.101 – 262.107, 262.201, 262.202, 262.301 – 262.304, 262.401, 262.501 – 262.508, 262.601, 262.602, 262.701, and 262.801.

Sections 262.3, 262.5, 262.6, 262.8, 262.9, 262.103, 262.105, 262.106, 262.201, 262.202, 262.302, 262.401, 262.501, 262.502, 262.508, 262.601, 262.701, and 262.801 are adopted with changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5636). These rules will be republished.

Sections 262.1, 262.2, 262.4, 262.7, 262.101, 262.102, 262.104, 262.107, 262.301, 262.303, 262.304, 262.503, 262.504, 262.505, 262.506, 262.507, and 262.602 are adopted without changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5636). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The TxHmL Program is a Medicaid waiver program approved by the Centers for Medicare & Medicaid Services (CMS) under §1915(c) of the Social Security Act. This waiver program provides community-based services and supports to an eligible individual as an alternative to services provided in an institutional setting. The adopted rules move certain TxHmL Program rules from 40 TAC Chapter 9, Subchapter N to 26 TAC Chapter 262. The repeal of §§9.551, 9.552, 9.554, 9.556, 9.558, 9.560 – 9.563, 9.566 – 9.568, 9.570, 9.571, 9.573 – 9.575, 9.582, and 9.583 in 40 TAC Chapter 9, Subchapter N are proposed elsewhere in this issue of the Texas Register.

The adopted rules do not include §§9.572, 9.576, 9.578 – 9.581, and §§9.584 – 9.587. HHSC will propose rules containing the certification standards for the TxHmL Program in a different rule project.

The adopted rules ensure that the TxHmL Program complies with the requirements in Title 42, Code of Federal Regulations (CFR), Chapter IV, Subchapter C, Part 441, Subpart G, §441.301(c)(1) – (5). In 2014, CMS amended this regulation to establish new requirements for Home and Community-Based Services (HCBS) Medicaid Programs, including requirements for HCBS program settings and person-centered planning. CMS has given states until March 2023 to fully comply with the requirements in 42 CFR §441.301(c)(1) – (5). The adopted rules will also ensure compliance with the requirements in 42 CFR Chapter IV, Subchapter C, Part 441, Subpart K, §441.530, regarding Home and Community-Based Setting, §441.535, regarding Assessment of functional need; and §441.540 regarding the Person-centered service plan, for Community First Choice (CFC) services because CFC services are available to individuals enrolled in the TxHmL Program.

The adopted rules implement Texas Government Code §531.02161(b)(4) which requires HHSC to ensure that, if cost effective, clinically effective, and allowed by federal law, a Medicaid recipient has the option to receive certain services, including occupational therapy (OT), physical therapy (PT), and speech-language pathology as a telehealth service.

The adopted rules require the initial TxHmL eligibility assessments to be conducted in person and the CFC personal assistance services/habilitation (PAS/HAB) assessment to be completed in person unless certain conditions exist in which case the assessment may be completed by telehealth, telephone, or video conferencing. These requirements help ensure the assessments are thorough and accurate.

The adopted rules include provisions regarding the denial, suspension, reduction, or termination of an individual’s TxHmL Program services to explain HHSC’s process in taking one of these actions. The adopted rules change the existing service coordination monitoring requirement from 90 days to 30 days during an individual’s suspension.

The adopted rules require a program provider and local intellectual and developmental disability authority (LIDDA) to submit a translation of non-English documentation submitted to HHSC. The purpose of the adopted rule is to help ensure that HHSC’s reviews of documentation are efficient.

The adopted rules require a registered nurse (RN) to complete a comprehensive nursing assessment of an individual in person under specified circumstances. This requirement is included to ensure the comprehensive nursing assessment is clinically effective, thorough, and accurate and to help ensure the health and safety of an individual.

The adopted rules codify current practice related to individuals in the TxHmL Program transferring to another program provider or choosing a different service delivery option.

The adopted rules provide that HHSC may allow program providers and service coordinators to use one or more of the exceptions specified in the rule while an executive order or proclamation declaring a state of disaster under Texas Government Code §418.014 is in effect. This provision helps ensure that providers and service coordinators are able to provide services effectively during a disaster.

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New 26 TAC §§262.301 – 262.304, concerning IPC requirements, renewal and revision of an IPC, and service limits.

CHAPTER 262. TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)
SUBCHAPTER D. DEVELOPMENT AND REVIEW OF AN IPC
26 TAC §§262.301 – 262.304

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts in Texas Administrative Code Title 26, Part 1, Chapter 262, Texas Home Living (TxHmL) Program and Community First Choice (CFC), new Subchapters A – I, comprising new §§262.1 – 262.9, 262.101 – 262.107, 262.201, 262.202, 262.301 – 262.304, 262.401, 262.501 – 262.508, 262.601, 262.602, 262.701, and 262.801.

Sections 262.3, 262.5, 262.6, 262.8, 262.9, 262.103, 262.105, 262.106, 262.201, 262.202, 262.302, 262.401, 262.501, 262.502, 262.508, 262.601, 262.701, and 262.801 are adopted with changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5636). These rules will be republished.

Sections 262.1, 262.2, 262.4, 262.7, 262.101, 262.102, 262.104, 262.107, 262.301, 262.303, 262.304, 262.503, 262.504, 262.505, 262.506, 262.507, and 262.602 are adopted without changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5636). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The TxHmL Program is a Medicaid waiver program approved by the Centers for Medicare & Medicaid Services (CMS) under §1915(c) of the Social Security Act. This waiver program provides community-based services and supports to an eligible individual as an alternative to services provided in an institutional setting. The adopted rules move certain TxHmL Program rules from 40 TAC Chapter 9, Subchapter N to 26 TAC Chapter 262. The repeal of §§9.551, 9.552, 9.554, 9.556, 9.558, 9.560 – 9.563, 9.566 – 9.568, 9.570, 9.571, 9.573 – 9.575, 9.582, and 9.583 in 40 TAC Chapter 9, Subchapter N are proposed elsewhere in this issue of the Texas Register.

The adopted rules do not include §§9.572, 9.576, 9.578 – 9.581, and §§9.584 – 9.587. HHSC will propose rules containing the certification standards for the TxHmL Program in a different rule project.

The adopted rules ensure that the TxHmL Program complies with the requirements in Title 42, Code of Federal Regulations (CFR), Chapter IV, Subchapter C, Part 441, Subpart G, §441.301(c)(1) – (5). In 2014, CMS amended this regulation to establish new requirements for Home and Community-Based Services (HCBS) Medicaid Programs, including requirements for HCBS program settings and person-centered planning. CMS has given states until March 2023 to fully comply with the requirements in 42 CFR §441.301(c)(1) – (5). The adopted rules will also ensure compliance with the requirements in 42 CFR Chapter IV, Subchapter C, Part 441, Subpart K, §441.530, regarding Home and Community-Based Setting, §441.535, regarding Assessment of functional need; and §441.540 regarding the Person-centered service plan, for Community First Choice (CFC) services because CFC services are available to individuals enrolled in the TxHmL Program.

The adopted rules implement Texas Government Code §531.02161(b)(4) which requires HHSC to ensure that, if cost effective, clinically effective, and allowed by federal law, a Medicaid recipient has the option to receive certain services, including occupational therapy (OT), physical therapy (PT), and speech-language pathology as a telehealth service.

The adopted rules require the initial TxHmL eligibility assessments to be conducted in person and the CFC personal assistance services/habilitation (PAS/HAB) assessment to be completed in person unless certain conditions exist in which case the assessment may be completed by telehealth, telephone, or video conferencing. These requirements help ensure the assessments are thorough and accurate.

The adopted rules include provisions regarding the denial, suspension, reduction, or termination of an individual’s TxHmL Program services to explain HHSC’s process in taking one of these actions. The adopted rules change the existing service coordination monitoring requirement from 90 days to 30 days during an individual’s suspension.

The adopted rules require a program provider and local intellectual and developmental disability authority (LIDDA) to submit a translation of non-English documentation submitted to HHSC. The purpose of the adopted rule is to help ensure that HHSC’s reviews of documentation are efficient.

The adopted rules require a registered nurse (RN) to complete a comprehensive nursing assessment of an individual in person under specified circumstances. This requirement is included to ensure the comprehensive nursing assessment is clinically effective, thorough, and accurate and to help ensure the health and safety of an individual.

The adopted rules codify current practice related to individuals in the TxHmL Program transferring to another program provider or choosing a different service delivery option.

The adopted rules provide that HHSC may allow program providers and service coordinators to use one or more of the exceptions specified in the rule while an executive order or proclamation declaring a state of disaster under Texas Government Code §418.014 is in effect. This provision helps ensure that providers and service coordinators are able to provide services effectively during a disaster.

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New 26 TAC §262.401, describing how a program provider is reimbursed for services provided by the TxHmL Program.

CHAPTER 262. TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)
SUBCHAPTER E. REIMBURSEMENT BY HHSC
26 TAC §262.401

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts in Texas Administrative Code Title 26, Part 1, Chapter 262, Texas Home Living (TxHmL) Program and Community First Choice (CFC), new Subchapters A – I, comprising new §§262.1 – 262.9, 262.101 – 262.107, 262.201, 262.202, 262.301 – 262.304, 262.401, 262.501 – 262.508, 262.601, 262.602, 262.701, and 262.801.

Sections 262.3, 262.5, 262.6, 262.8, 262.9, 262.103, 262.105, 262.106, 262.201, 262.202, 262.302, 262.401, 262.501, 262.502, 262.508, 262.601, 262.701, and 262.801 are adopted with changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5636). These rules will be republished.

Sections 262.1, 262.2, 262.4, 262.7, 262.101, 262.102, 262.104, 262.107, 262.301, 262.303, 262.304, 262.503, 262.504, 262.505, 262.506, 262.507, and 262.602 are adopted without changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5636). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The TxHmL Program is a Medicaid waiver program approved by the Centers for Medicare & Medicaid Services (CMS) under §1915(c) of the Social Security Act. This waiver program provides community-based services and supports to an eligible individual as an alternative to services provided in an institutional setting. The adopted rules move certain TxHmL Program rules from 40 TAC Chapter 9, Subchapter N to 26 TAC Chapter 262. The repeal of §§9.551, 9.552, 9.554, 9.556, 9.558, 9.560 – 9.563, 9.566 – 9.568, 9.570, 9.571, 9.573 – 9.575, 9.582, and 9.583 in 40 TAC Chapter 9, Subchapter N are proposed elsewhere in this issue of the Texas Register.

The adopted rules do not include §§9.572, 9.576, 9.578 – 9.581, and §§9.584 – 9.587. HHSC will propose rules containing the certification standards for the TxHmL Program in a different rule project.

The adopted rules ensure that the TxHmL Program complies with the requirements in Title 42, Code of Federal Regulations (CFR), Chapter IV, Subchapter C, Part 441, Subpart G, §441.301(c)(1) – (5). In 2014, CMS amended this regulation to establish new requirements for Home and Community-Based Services (HCBS) Medicaid Programs, including requirements for HCBS program settings and person-centered planning. CMS has given states until March 2023 to fully comply with the requirements in 42 CFR §441.301(c)(1) – (5). The adopted rules will also ensure compliance with the requirements in 42 CFR Chapter IV, Subchapter C, Part 441, Subpart K, §441.530, regarding Home and Community-Based Setting, §441.535, regarding Assessment of functional need; and §441.540 regarding the Person-centered service plan, for Community First Choice (CFC) services because CFC services are available to individuals enrolled in the TxHmL Program.

The adopted rules implement Texas Government Code §531.02161(b)(4) which requires HHSC to ensure that, if cost effective, clinically effective, and allowed by federal law, a Medicaid recipient has the option to receive certain services, including occupational therapy (OT), physical therapy (PT), and speech-language pathology as a telehealth service.

The adopted rules require the initial TxHmL eligibility assessments to be conducted in person and the CFC personal assistance services/habilitation (PAS/HAB) assessment to be completed in person unless certain conditions exist in which case the assessment may be completed by telehealth, telephone, or video conferencing. These requirements help ensure the assessments are thorough and accurate.

The adopted rules include provisions regarding the denial, suspension, reduction, or termination of an individual’s TxHmL Program services to explain HHSC’s process in taking one of these actions. The adopted rules change the existing service coordination monitoring requirement from 90 days to 30 days during an individual’s suspension.

The adopted rules require a program provider and local intellectual and developmental disability authority (LIDDA) to submit a translation of non-English documentation submitted to HHSC. The purpose of the adopted rule is to help ensure that HHSC’s reviews of documentation are efficient.

The adopted rules require a registered nurse (RN) to complete a comprehensive nursing assessment of an individual in person under specified circumstances. This requirement is included to ensure the comprehensive nursing assessment is clinically effective, thorough, and accurate and to help ensure the health and safety of an individual.

The adopted rules codify current practice related to individuals in the TxHmL Program transferring to another program provider or choosing a different service delivery option.

The adopted rules provide that HHSC may allow program providers and service coordinators to use one or more of the exceptions specified in the rule while an executive order or proclamation declaring a state of disaster under Texas Government Code §418.014 is in effect. This provision helps ensure that providers and service coordinators are able to provide services effectively during a disaster.

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New 26 TAC §§262.501 – 262.508, describing the process for transfers, denials, suspensions, reductions, and terminations of the TxHmL and CFC Services.

CHAPTER 262. TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)
SUBCHAPTER F. TRANSFERS, DENIALS, SUSPENSIONS, REDUCTIONS, AND TERMINATIONS
26 TAC §§262.501 – 262.508

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts in Texas Administrative Code Title 26, Part 1, Chapter 262, Texas Home Living (TxHmL) Program and Community First Choice (CFC), new Subchapters A – I, comprising new §§262.1 – 262.9, 262.101 – 262.107, 262.201, 262.202, 262.301 – 262.304, 262.401, 262.501 – 262.508, 262.601, 262.602, 262.701, and 262.801.

Sections 262.3, 262.5, 262.6, 262.8, 262.9, 262.103, 262.105, 262.106, 262.201, 262.202, 262.302, 262.401, 262.501, 262.502, 262.508, 262.601, 262.701, and 262.801 are adopted with changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5636). These rules will be republished.

Sections 262.1, 262.2, 262.4, 262.7, 262.101, 262.102, 262.104, 262.107, 262.301, 262.303, 262.304, 262.503, 262.504, 262.505, 262.506, 262.507, and 262.602 are adopted without changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5636). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The TxHmL Program is a Medicaid waiver program approved by the Centers for Medicare & Medicaid Services (CMS) under §1915(c) of the Social Security Act. This waiver program provides community-based services and supports to an eligible individual as an alternative to services provided in an institutional setting. The adopted rules move certain TxHmL Program rules from 40 TAC Chapter 9, Subchapter N to 26 TAC Chapter 262. The repeal of §§9.551, 9.552, 9.554, 9.556, 9.558, 9.560 – 9.563, 9.566 – 9.568, 9.570, 9.571, 9.573 – 9.575, 9.582, and 9.583 in 40 TAC Chapter 9, Subchapter N are proposed elsewhere in this issue of the Texas Register.

The adopted rules do not include §§9.572, 9.576, 9.578 – 9.581, and §§9.584 – 9.587. HHSC will propose rules containing the certification standards for the TxHmL Program in a different rule project.

The adopted rules ensure that the TxHmL Program complies with the requirements in Title 42, Code of Federal Regulations (CFR), Chapter IV, Subchapter C, Part 441, Subpart G, §441.301(c)(1) – (5). In 2014, CMS amended this regulation to establish new requirements for Home and Community-Based Services (HCBS) Medicaid Programs, including requirements for HCBS program settings and person-centered planning. CMS has given states until March 2023 to fully comply with the requirements in 42 CFR §441.301(c)(1) – (5). The adopted rules will also ensure compliance with the requirements in 42 CFR Chapter IV, Subchapter C, Part 441, Subpart K, §441.530, regarding Home and Community-Based Setting, §441.535, regarding Assessment of functional need; and §441.540 regarding the Person-centered service plan, for Community First Choice (CFC) services because CFC services are available to individuals enrolled in the TxHmL Program.

The adopted rules implement Texas Government Code §531.02161(b)(4) which requires HHSC to ensure that, if cost effective, clinically effective, and allowed by federal law, a Medicaid recipient has the option to receive certain services, including occupational therapy (OT), physical therapy (PT), and speech-language pathology as a telehealth service.

The adopted rules require the initial TxHmL eligibility assessments to be conducted in person and the CFC personal assistance services/habilitation (PAS/HAB) assessment to be completed in person unless certain conditions exist in which case the assessment may be completed by telehealth, telephone, or video conferencing. These requirements help ensure the assessments are thorough and accurate.

The adopted rules include provisions regarding the denial, suspension, reduction, or termination of an individual’s TxHmL Program services to explain HHSC’s process in taking one of these actions. The adopted rules change the existing service coordination monitoring requirement from 90 days to 30 days during an individual’s suspension.

The adopted rules require a program provider and local intellectual and developmental disability authority (LIDDA) to submit a translation of non-English documentation submitted to HHSC. The purpose of the adopted rule is to help ensure that HHSC’s reviews of documentation are efficient.

The adopted rules require a registered nurse (RN) to complete a comprehensive nursing assessment of an individual in person under specified circumstances. This requirement is included to ensure the comprehensive nursing assessment is clinically effective, thorough, and accurate and to help ensure the health and safety of an individual.

The adopted rules codify current practice related to individuals in the TxHmL Program transferring to another program provider or choosing a different service delivery option.

The adopted rules provide that HHSC may allow program providers and service coordinators to use one or more of the exceptions specified in the rule while an executive order or proclamation declaring a state of disaster under Texas Government Code §418.014 is in effect. This provision helps ensure that providers and service coordinators are able to provide services effectively during a disaster.

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New 26 TAC §262.601, §262.602, describing the fair hearing requirement and the program provider’s right to an administrative hearing.

CHAPTER 262. TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)
SUBCHAPTER G. HEARINGS
26 TAC §262.601, §262.602

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts in Texas Administrative Code Title 26, Part 1, Chapter 262, Texas Home Living (TxHmL) Program and Community First Choice (CFC), new Subchapters A – I, comprising new §§262.1 – 262.9, 262.101 – 262.107, 262.201, 262.202, 262.301 – 262.304, 262.401, 262.501 – 262.508, 262.601, 262.602, 262.701, and 262.801.

Sections 262.3, 262.5, 262.6, 262.8, 262.9, 262.103, 262.105, 262.106, 262.201, 262.202, 262.302, 262.401, 262.501, 262.502, 262.508, 262.601, 262.701, and 262.801 are adopted with changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5636). These rules will be republished.

Sections 262.1, 262.2, 262.4, 262.7, 262.101, 262.102, 262.104, 262.107, 262.301, 262.303, 262.304, 262.503, 262.504, 262.505, 262.506, 262.507, and 262.602 are adopted without changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5636). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The TxHmL Program is a Medicaid waiver program approved by the Centers for Medicare & Medicaid Services (CMS) under §1915(c) of the Social Security Act. This waiver program provides community-based services and supports to an eligible individual as an alternative to services provided in an institutional setting. The adopted rules move certain TxHmL Program rules from 40 TAC Chapter 9, Subchapter N to 26 TAC Chapter 262. The repeal of §§9.551, 9.552, 9.554, 9.556, 9.558, 9.560 – 9.563, 9.566 – 9.568, 9.570, 9.571, 9.573 – 9.575, 9.582, and 9.583 in 40 TAC Chapter 9, Subchapter N are proposed elsewhere in this issue of the Texas Register.

The adopted rules do not include §§9.572, 9.576, 9.578 – 9.581, and §§9.584 – 9.587. HHSC will propose rules containing the certification standards for the TxHmL Program in a different rule project.

The adopted rules ensure that the TxHmL Program complies with the requirements in Title 42, Code of Federal Regulations (CFR), Chapter IV, Subchapter C, Part 441, Subpart G, §441.301(c)(1) – (5). In 2014, CMS amended this regulation to establish new requirements for Home and Community-Based Services (HCBS) Medicaid Programs, including requirements for HCBS program settings and person-centered planning. CMS has given states until March 2023 to fully comply with the requirements in 42 CFR §441.301(c)(1) – (5). The adopted rules will also ensure compliance with the requirements in 42 CFR Chapter IV, Subchapter C, Part 441, Subpart K, §441.530, regarding Home and Community-Based Setting, §441.535, regarding Assessment of functional need; and §441.540 regarding the Person-centered service plan, for Community First Choice (CFC) services because CFC services are available to individuals enrolled in the TxHmL Program.

The adopted rules implement Texas Government Code §531.02161(b)(4) which requires HHSC to ensure that, if cost effective, clinically effective, and allowed by federal law, a Medicaid recipient has the option to receive certain services, including occupational therapy (OT), physical therapy (PT), and speech-language pathology as a telehealth service.

The adopted rules require the initial TxHmL eligibility assessments to be conducted in person and the CFC personal assistance services/habilitation (PAS/HAB) assessment to be completed in person unless certain conditions exist in which case the assessment may be completed by telehealth, telephone, or video conferencing. These requirements help ensure the assessments are thorough and accurate.

The adopted rules include provisions regarding the denial, suspension, reduction, or termination of an individual’s TxHmL Program services to explain HHSC’s process in taking one of these actions. The adopted rules change the existing service coordination monitoring requirement from 90 days to 30 days during an individual’s suspension.

The adopted rules require a program provider and local intellectual and developmental disability authority (LIDDA) to submit a translation of non-English documentation submitted to HHSC. The purpose of the adopted rule is to help ensure that HHSC’s reviews of documentation are efficient.

The adopted rules require a registered nurse (RN) to complete a comprehensive nursing assessment of an individual in person under specified circumstances. This requirement is included to ensure the comprehensive nursing assessment is clinically effective, thorough, and accurate and to help ensure the health and safety of an individual.

The adopted rules codify current practice related to individuals in the TxHmL Program transferring to another program provider or choosing a different service delivery option.

The adopted rules provide that HHSC may allow program providers and service coordinators to use one or more of the exceptions specified in the rule while an executive order or proclamation declaring a state of disaster under Texas Government Code §418.014 is in effect. This provision helps ensure that providers and service coordinators are able to provide services effectively during a disaster.

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New 26 TAC §262.701, regarding LIDDA requirements for providing service coordination in the TxHmL Program.

CHAPTER 262. TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)
SUBCHAPTER H. LIDDA REQUIREMENTS
26 TAC §262.701

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts in Texas Administrative Code Title 26, Part 1, Chapter 262, Texas Home Living (TxHmL) Program and Community First Choice (CFC), new Subchapters A – I, comprising new §§262.1 – 262.9, 262.101 – 262.107, 262.201, 262.202, 262.301 – 262.304, 262.401, 262.501 – 262.508, 262.601, 262.602, 262.701, and 262.801.

Sections 262.3, 262.5, 262.6, 262.8, 262.9, 262.103, 262.105, 262.106, 262.201, 262.202, 262.302, 262.401, 262.501, 262.502, 262.508, 262.601, 262.701, and 262.801 are adopted with changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5636). These rules will be republished.

Sections 262.1, 262.2, 262.4, 262.7, 262.101, 262.102, 262.104, 262.107, 262.301, 262.303, 262.304, 262.503, 262.504, 262.505, 262.506, 262.507, and 262.602 are adopted without changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5636). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The TxHmL Program is a Medicaid waiver program approved by the Centers for Medicare & Medicaid Services (CMS) under §1915(c) of the Social Security Act. This waiver program provides community-based services and supports to an eligible individual as an alternative to services provided in an institutional setting. The adopted rules move certain TxHmL Program rules from 40 TAC Chapter 9, Subchapter N to 26 TAC Chapter 262. The repeal of §§9.551, 9.552, 9.554, 9.556, 9.558, 9.560 – 9.563, 9.566 – 9.568, 9.570, 9.571, 9.573 – 9.575, 9.582, and 9.583 in 40 TAC Chapter 9, Subchapter N are proposed elsewhere in this issue of the Texas Register.

The adopted rules do not include §§9.572, 9.576, 9.578 – 9.581, and §§9.584 – 9.587. HHSC will propose rules containing the certification standards for the TxHmL Program in a different rule project.

The adopted rules ensure that the TxHmL Program complies with the requirements in Title 42, Code of Federal Regulations (CFR), Chapter IV, Subchapter C, Part 441, Subpart G, §441.301(c)(1) – (5). In 2014, CMS amended this regulation to establish new requirements for Home and Community-Based Services (HCBS) Medicaid Programs, including requirements for HCBS program settings and person-centered planning. CMS has given states until March 2023 to fully comply with the requirements in 42 CFR §441.301(c)(1) – (5). The adopted rules will also ensure compliance with the requirements in 42 CFR Chapter IV, Subchapter C, Part 441, Subpart K, §441.530, regarding Home and Community-Based Setting, §441.535, regarding Assessment of functional need; and §441.540 regarding the Person-centered service plan, for Community First Choice (CFC) services because CFC services are available to individuals enrolled in the TxHmL Program.

The adopted rules implement Texas Government Code §531.02161(b)(4) which requires HHSC to ensure that, if cost effective, clinically effective, and allowed by federal law, a Medicaid recipient has the option to receive certain services, including occupational therapy (OT), physical therapy (PT), and speech-language pathology as a telehealth service.

The adopted rules require the initial TxHmL eligibility assessments to be conducted in person and the CFC personal assistance services/habilitation (PAS/HAB) assessment to be completed in person unless certain conditions exist in which case the assessment may be completed by telehealth, telephone, or video conferencing. These requirements help ensure the assessments are thorough and accurate.

The adopted rules include provisions regarding the denial, suspension, reduction, or termination of an individual’s TxHmL Program services to explain HHSC’s process in taking one of these actions. The adopted rules change the existing service coordination monitoring requirement from 90 days to 30 days during an individual’s suspension.

The adopted rules require a program provider and local intellectual and developmental disability authority (LIDDA) to submit a translation of non-English documentation submitted to HHSC. The purpose of the adopted rule is to help ensure that HHSC’s reviews of documentation are efficient.

The adopted rules require a registered nurse (RN) to complete a comprehensive nursing assessment of an individual in person under specified circumstances. This requirement is included to ensure the comprehensive nursing assessment is clinically effective, thorough, and accurate and to help ensure the health and safety of an individual.

The adopted rules codify current practice related to individuals in the TxHmL Program transferring to another program provider or choosing a different service delivery option.

The adopted rules provide that HHSC may allow program providers and service coordinators to use one or more of the exceptions specified in the rule while an executive order or proclamation declaring a state of disaster under Texas Government Code §418.014 is in effect. This provision helps ensure that providers and service coordinators are able to provide services effectively during a disaster.

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New 26 TAC §262.801, outlining exceptions to certain requirements during the declaration of a disaster.

CHAPTER 262. TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)
SUBCHAPTER I. DECLARATION OF DISASTER
26 TAC §262.801

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts in Texas Administrative Code Title 26, Part 1, Chapter 262, Texas Home Living (TxHmL) Program and Community First Choice (CFC), new Subchapters A – I, comprising new §§262.1 – 262.9, 262.101 – 262.107, 262.201, 262.202, 262.301 – 262.304, 262.401, 262.501 – 262.508, 262.601, 262.602, 262.701, and 262.801.

Sections 262.3, 262.5, 262.6, 262.8, 262.9, 262.103, 262.105, 262.106, 262.201, 262.202, 262.302, 262.401, 262.501, 262.502, 262.508, 262.601, 262.701, and 262.801 are adopted with changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5636). These rules will be republished.

Sections 262.1, 262.2, 262.4, 262.7, 262.101, 262.102, 262.104, 262.107, 262.301, 262.303, 262.304, 262.503, 262.504, 262.505, 262.506, 262.507, and 262.602 are adopted without changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5636). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The TxHmL Program is a Medicaid waiver program approved by the Centers for Medicare & Medicaid Services (CMS) under §1915(c) of the Social Security Act. This waiver program provides community-based services and supports to an eligible individual as an alternative to services provided in an institutional setting. The adopted rules move certain TxHmL Program rules from 40 TAC Chapter 9, Subchapter N to 26 TAC Chapter 262. The repeal of §§9.551, 9.552, 9.554, 9.556, 9.558, 9.560 – 9.563, 9.566 – 9.568, 9.570, 9.571, 9.573 – 9.575, 9.582, and 9.583 in 40 TAC Chapter 9, Subchapter N are proposed elsewhere in this issue of the Texas Register.

The adopted rules do not include §§9.572, 9.576, 9.578 – 9.581, and §§9.584 – 9.587. HHSC will propose rules containing the certification standards for the TxHmL Program in a different rule project.

The adopted rules ensure that the TxHmL Program complies with the requirements in Title 42, Code of Federal Regulations (CFR), Chapter IV, Subchapter C, Part 441, Subpart G, §441.301(c)(1) – (5). In 2014, CMS amended this regulation to establish new requirements for Home and Community-Based Services (HCBS) Medicaid Programs, including requirements for HCBS program settings and person-centered planning. CMS has given states until March 2023 to fully comply with the requirements in 42 CFR §441.301(c)(1) – (5). The adopted rules will also ensure compliance with the requirements in 42 CFR Chapter IV, Subchapter C, Part 441, Subpart K, §441.530, regarding Home and Community-Based Setting, §441.535, regarding Assessment of functional need; and §441.540 regarding the Person-centered service plan, for Community First Choice (CFC) services because CFC services are available to individuals enrolled in the TxHmL Program.

The adopted rules implement Texas Government Code §531.02161(b)(4) which requires HHSC to ensure that, if cost effective, clinically effective, and allowed by federal law, a Medicaid recipient has the option to receive certain services, including occupational therapy (OT), physical therapy (PT), and speech-language pathology as a telehealth service.

The adopted rules require the initial TxHmL eligibility assessments to be conducted in person and the CFC personal assistance services/habilitation (PAS/HAB) assessment to be completed in person unless certain conditions exist in which case the assessment may be completed by telehealth, telephone, or video conferencing. These requirements help ensure the assessments are thorough and accurate.

The adopted rules include provisions regarding the denial, suspension, reduction, or termination of an individual’s TxHmL Program services to explain HHSC’s process in taking one of these actions. The adopted rules change the existing service coordination monitoring requirement from 90 days to 30 days during an individual’s suspension.

The adopted rules require a program provider and local intellectual and developmental disability authority (LIDDA) to submit a translation of non-English documentation submitted to HHSC. The purpose of the adopted rule is to help ensure that HHSC’s reviews of documentation are efficient.

The adopted rules require a registered nurse (RN) to complete a comprehensive nursing assessment of an individual in person under specified circumstances. This requirement is included to ensure the comprehensive nursing assessment is clinically effective, thorough, and accurate and to help ensure the health and safety of an individual.

The adopted rules codify current practice related to individuals in the TxHmL Program transferring to another program provider or choosing a different service delivery option.

The adopted rules provide that HHSC may allow program providers and service coordinators to use one or more of the exceptions specified in the rule while an executive order or proclamation declaring a state of disaster under Texas Government Code §418.014 is in effect. This provision helps ensure that providers and service coordinators are able to provide services effectively during a disaster.

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New 26 TAC §§263.1 – 263.9, describing HCS and CFC services programs.

CHAPTER 263. HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)
SUBCHAPTER A. GENERAL PROVISIONS
26 TAC §§263.1 – 263.9

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts Title 26, Part 1, new Chapter 263, Home and Community-based Services (HCS) Program and Community First Choice (CFC), consisting of Subchapters A – K, comprising new §§263.1 – 263.9; 263.101 – 263.108; 263.201; 263.301 – 263.304; 263.401; 263.501 – 263.503; 263.601; 263.701 – 263.708; 263.801; 263.802; 263.901 – 263.903; and 263.1000.

Sections 263.3, 263.5, 263.8, 263.9, 263.104, 263.107, 263.201, 263.302, 263.501, 263.502, 263.503, 263.601, 263.701, 263.702, 263.707, 263.708, 263.901, 263.902 and 263.1000 are adopted with changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5667). These rules will be republished.

Sections 263.1, 263.2, 263.4, 263.6, 263.7, 263.101, 263.102, 263.103, 263.105, 263.106, 263.108, 263.301, 263.303, 263.304, 263.401, 263.703, 263.704, 263.705, 263.706, 263.801, 263.802, and 263.903 are adopted without changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5667). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The HCS Program is a Medicaid waiver program approved by the Centers for Medicare & Medicaid Services (CMS) under §1915(c) of the Social Security Act. This waiver program provides community-based services and supports to an eligible individual as an alternative to services provided in an institutional setting. One purpose of the new sections is to move certain HCS Program rules from 40 TAC Chapter 9, Subchapter D to 26 TAC Chapter 263. The repeals of §§9.151, 9.152, 9.154 – 9.170, 9.186, and 9.189 – 9.192 in 40 TAC Chapter 9, Subchapter D, are adopted elsewhere in this issue of the Texas Register.

The adopted rules do not include program provider certification principles that are currently in 40 TAC Chapter 9, Subchapter D, §§9.173 – 9.175 and §§9.177 -9.183. HHSC will propose rules containing the certification standards for the HCS Program in 26 TAC Chapter 565 in a different rule project.

The adopted rules are necessary to comply with Title 42, Code of Federal Regulations (CFR), Chapter IV, Subchapter C, Part 441, Subpart G, §441.301(c)(1) – (5). In 2014, CMS amended this regulation to establish new requirements for Home and Community-based Services (HCBS) Medicaid Programs, including requirements for HCBS settings and person-centered planning. CMS has given states until March 17, 2023, to fully comply with the requirements in 42 CFR §441.301(c)(1) – (5). The adopted rules also ensure compliance with the requirements in 42 CFR Chapter IV, Subchapter C, Part 441, Subpart K, §441.530, regarding Home and Community-Based Setting; §441.535, regarding Assessment of functional need; and §441.540, regarding the Person-centered service plan, for Community First Choice (CFC) services because CFC services are available to individuals enrolled in the HCS Program.

The adopted rules implement Texas Government Code §531.02161(b)(4) which requires HHSC to ensure that, if cost effective, clinically effective, and allowed by federal law, a Medicaid recipient has the option to receive certain services, including occupational therapy (OT), physical therapy (PT), and speech-language pathology as a telehealth service.

The adopted rules require the initial HCS eligibility assessments to be conducted in person and the CFC personal assistance services/habilitation (PAS/HAB) assessment to be completed in person unless certain conditions exist in which case the assessment may be completed by telehealth, telephone, or video conferencing. These requirements help ensure the assessments are thorough and accurate.

The adopted rules include provisions regarding the denial, suspension, reduction, or termination of an individual’s services in the HCS Program to explain HHSC’s process in taking one of these actions. The adopted rules also change the existing service coordination monitoring requirement from 90 days to 30 days during an individual’s suspension.

The adopted rules require a program provider and local intellectual and developmental disability authority (LIDDA) to submit a translation of non-English documentation submitted to HHSC. The adopted rules help ensure that HHSC’s reviews of documentation are efficient.

The adopted rules require a registered nurse (RN) to complete a comprehensive nursing assessment of an individual in person under specified circumstances. This requirement is included to ensure the comprehensive nursing assessment is clinically effective, thorough, and accurate and to help ensure the health and safety of an individual.

The adopted rules codify HHSC’s current practice of increasing a level of need (LON) 1, 5, or 8 to the next LON because of an individual’s high medical needs if the individual meets certain criteria. The adopted rules also codify current practice related to individuals in the HCS Program transferring to another program provider or choosing a different service delivery option.

The adopted rules provide that HHSC may allow program providers and service coordinators to use one or more of the exceptions specified in the rule while an executive order or proclamation declaring a state of disaster under Texas Government Code §418.014 is in effect. This provision helps to ensure that program providers and service coordinators are able to provide services effectively during a disaster.

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New 26 TAC §§263.101 – 263.108, describing the eligibility criteria for HCS Programs Services and CFC Services and enrollment processes.

CHAPTER 263. HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)
SUBCHAPTER B. ELIGIBILITY, ENROLLMENT, AND REVIEW
26 TAC §§263.101 – 263.108

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts Title 26, Part 1, new Chapter 263, Home and Community-based Services (HCS) Program and Community First Choice (CFC), consisting of Subchapters A – K, comprising new §§263.1 – 263.9; 263.101 – 263.108; 263.201; 263.301 – 263.304; 263.401; 263.501 – 263.503; 263.601; 263.701 – 263.708; 263.801; 263.802; 263.901 – 263.903; and 263.1000.

Sections 263.3, 263.5, 263.8, 263.9, 263.104, 263.107, 263.201, 263.302, 263.501, 263.502, 263.503, 263.601, 263.701, 263.702, 263.707, 263.708, 263.901, 263.902 and 263.1000 are adopted with changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5667). These rules will be republished.

Sections 263.1, 263.2, 263.4, 263.6, 263.7, 263.101, 263.102, 263.103, 263.105, 263.106, 263.108, 263.301, 263.303, 263.304, 263.401, 263.703, 263.704, 263.705, 263.706, 263.801, 263.802, and 263.903 are adopted without changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5667). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The HCS Program is a Medicaid waiver program approved by the Centers for Medicare & Medicaid Services (CMS) under §1915(c) of the Social Security Act. This waiver program provides community-based services and supports to an eligible individual as an alternative to services provided in an institutional setting. One purpose of the new sections is to move certain HCS Program rules from 40 TAC Chapter 9, Subchapter D to 26 TAC Chapter 263. The repeals of §§9.151, 9.152, 9.154 – 9.170, 9.186, and 9.189 – 9.192 in 40 TAC Chapter 9, Subchapter D, are adopted elsewhere in this issue of the Texas Register.

The adopted rules do not include program provider certification principles that are currently in 40 TAC Chapter 9, Subchapter D, §§9.173 – 9.175 and §§9.177 -9.183. HHSC will propose rules containing the certification standards for the HCS Program in 26 TAC Chapter 565 in a different rule project.

The adopted rules are necessary to comply with Title 42, Code of Federal Regulations (CFR), Chapter IV, Subchapter C, Part 441, Subpart G, §441.301(c)(1) – (5). In 2014, CMS amended this regulation to establish new requirements for Home and Community-based Services (HCBS) Medicaid Programs, including requirements for HCBS settings and person-centered planning. CMS has given states until March 17, 2023, to fully comply with the requirements in 42 CFR §441.301(c)(1) – (5). The adopted rules also ensure compliance with the requirements in 42 CFR Chapter IV, Subchapter C, Part 441, Subpart K, §441.530, regarding Home and Community-Based Setting; §441.535, regarding Assessment of functional need; and §441.540, regarding the Person-centered service plan, for Community First Choice (CFC) services because CFC services are available to individuals enrolled in the HCS Program.

The adopted rules implement Texas Government Code §531.02161(b)(4) which requires HHSC to ensure that, if cost effective, clinically effective, and allowed by federal law, a Medicaid recipient has the option to receive certain services, including occupational therapy (OT), physical therapy (PT), and speech-language pathology as a telehealth service.

The adopted rules require the initial HCS eligibility assessments to be conducted in person and the CFC personal assistance services/habilitation (PAS/HAB) assessment to be completed in person unless certain conditions exist in which case the assessment may be completed by telehealth, telephone, or video conferencing. These requirements help ensure the assessments are thorough and accurate.

The adopted rules include provisions regarding the denial, suspension, reduction, or termination of an individual’s services in the HCS Program to explain HHSC’s process in taking one of these actions. The adopted rules also change the existing service coordination monitoring requirement from 90 days to 30 days during an individual’s suspension.

The adopted rules require a program provider and local intellectual and developmental disability authority (LIDDA) to submit a translation of non-English documentation submitted to HHSC. The adopted rules help ensure that HHSC’s reviews of documentation are efficient.

The adopted rules require a registered nurse (RN) to complete a comprehensive nursing assessment of an individual in person under specified circumstances. This requirement is included to ensure the comprehensive nursing assessment is clinically effective, thorough, and accurate and to help ensure the health and safety of an individual.

The adopted rules codify HHSC’s current practice of increasing a level of need (LON) 1, 5, or 8 to the next LON because of an individual’s high medical needs if the individual meets certain criteria. The adopted rules also codify current practice related to individuals in the HCS Program transferring to another program provider or choosing a different service delivery option.

The adopted rules provide that HHSC may allow program providers and service coordinators to use one or more of the exceptions specified in the rule while an executive order or proclamation declaring a state of disaster under Texas Government Code §418.014 is in effect. This provision helps to ensure that program providers and service coordinators are able to provide services effectively during a disaster.

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New 26 TAC §263.201, which requires a service coordinator and program provider to ensure the person-centered planning process is led by an individual as much as possible.

CHAPTER 263. HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)
SUBCHAPTER C. PERSON-CENTERED PLANNING
26 TAC §263.201

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts Title 26, Part 1, new Chapter 263, Home and Community-based Services (HCS) Program and Community First Choice (CFC), consisting of Subchapters A – K, comprising new §§263.1 – 263.9; 263.101 – 263.108; 263.201; 263.301 – 263.304; 263.401; 263.501 – 263.503; 263.601; 263.701 – 263.708; 263.801; 263.802; 263.901 – 263.903; and 263.1000.

Sections 263.3, 263.5, 263.8, 263.9, 263.104, 263.107, 263.201, 263.302, 263.501, 263.502, 263.503, 263.601, 263.701, 263.702, 263.707, 263.708, 263.901, 263.902 and 263.1000 are adopted with changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5667). These rules will be republished.

Sections 263.1, 263.2, 263.4, 263.6, 263.7, 263.101, 263.102, 263.103, 263.105, 263.106, 263.108, 263.301, 263.303, 263.304, 263.401, 263.703, 263.704, 263.705, 263.706, 263.801, 263.802, and 263.903 are adopted without changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5667). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The HCS Program is a Medicaid waiver program approved by the Centers for Medicare & Medicaid Services (CMS) under §1915(c) of the Social Security Act. This waiver program provides community-based services and supports to an eligible individual as an alternative to services provided in an institutional setting. One purpose of the new sections is to move certain HCS Program rules from 40 TAC Chapter 9, Subchapter D to 26 TAC Chapter 263. The repeals of §§9.151, 9.152, 9.154 – 9.170, 9.186, and 9.189 – 9.192 in 40 TAC Chapter 9, Subchapter D, are adopted elsewhere in this issue of the Texas Register.

The adopted rules do not include program provider certification principles that are currently in 40 TAC Chapter 9, Subchapter D, §§9.173 – 9.175 and §§9.177 -9.183. HHSC will propose rules containing the certification standards for the HCS Program in 26 TAC Chapter 565 in a different rule project.

The adopted rules are necessary to comply with Title 42, Code of Federal Regulations (CFR), Chapter IV, Subchapter C, Part 441, Subpart G, §441.301(c)(1) – (5). In 2014, CMS amended this regulation to establish new requirements for Home and Community-based Services (HCBS) Medicaid Programs, including requirements for HCBS settings and person-centered planning. CMS has given states until March 17, 2023, to fully comply with the requirements in 42 CFR §441.301(c)(1) – (5). The adopted rules also ensure compliance with the requirements in 42 CFR Chapter IV, Subchapter C, Part 441, Subpart K, §441.530, regarding Home and Community-Based Setting; §441.535, regarding Assessment of functional need; and §441.540, regarding the Person-centered service plan, for Community First Choice (CFC) services because CFC services are available to individuals enrolled in the HCS Program.

The adopted rules implement Texas Government Code §531.02161(b)(4) which requires HHSC to ensure that, if cost effective, clinically effective, and allowed by federal law, a Medicaid recipient has the option to receive certain services, including occupational therapy (OT), physical therapy (PT), and speech-language pathology as a telehealth service.

The adopted rules require the initial HCS eligibility assessments to be conducted in person and the CFC personal assistance services/habilitation (PAS/HAB) assessment to be completed in person unless certain conditions exist in which case the assessment may be completed by telehealth, telephone, or video conferencing. These requirements help ensure the assessments are thorough and accurate.

The adopted rules include provisions regarding the denial, suspension, reduction, or termination of an individual’s services in the HCS Program to explain HHSC’s process in taking one of these actions. The adopted rules also change the existing service coordination monitoring requirement from 90 days to 30 days during an individual’s suspension.

The adopted rules require a program provider and local intellectual and developmental disability authority (LIDDA) to submit a translation of non-English documentation submitted to HHSC. The adopted rules help ensure that HHSC’s reviews of documentation are efficient.

The adopted rules require a registered nurse (RN) to complete a comprehensive nursing assessment of an individual in person under specified circumstances. This requirement is included to ensure the comprehensive nursing assessment is clinically effective, thorough, and accurate and to help ensure the health and safety of an individual.

The adopted rules codify HHSC’s current practice of increasing a level of need (LON) 1, 5, or 8 to the next LON because of an individual’s high medical needs if the individual meets certain criteria. The adopted rules also codify current practice related to individuals in the HCS Program transferring to another program provider or choosing a different service delivery option.

The adopted rules provide that HHSC may allow program providers and service coordinators to use one or more of the exceptions specified in the rule while an executive order or proclamation declaring a state of disaster under Texas Government Code §418.014 is in effect. This provision helps to ensure that program providers and service coordinators are able to provide services effectively during a disaster.

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New 26 TAC §§263.301 – 263.304, describing IPC requirements, renewals, and revisions as well as service limits for HCS Program services.

CHAPTER 263. HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)
SUBCHAPTER D. DEVELOPMENT AND REVIEW OF AN IPC
26 TAC §§263.301 – 263.304

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts Title 26, Part 1, new Chapter 263, Home and Community-based Services (HCS) Program and Community First Choice (CFC), consisting of Subchapters A – K, comprising new §§263.1 – 263.9; 263.101 – 263.108; 263.201; 263.301 – 263.304; 263.401; 263.501 – 263.503; 263.601; 263.701 – 263.708; 263.801; 263.802; 263.901 – 263.903; and 263.1000.

Sections 263.3, 263.5, 263.8, 263.9, 263.104, 263.107, 263.201, 263.302, 263.501, 263.502, 263.503, 263.601, 263.701, 263.702, 263.707, 263.708, 263.901, 263.902 and 263.1000 are adopted with changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5667). These rules will be republished.

Sections 263.1, 263.2, 263.4, 263.6, 263.7, 263.101, 263.102, 263.103, 263.105, 263.106, 263.108, 263.301, 263.303, 263.304, 263.401, 263.703, 263.704, 263.705, 263.706, 263.801, 263.802, and 263.903 are adopted without changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5667). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The HCS Program is a Medicaid waiver program approved by the Centers for Medicare & Medicaid Services (CMS) under §1915(c) of the Social Security Act. This waiver program provides community-based services and supports to an eligible individual as an alternative to services provided in an institutional setting. One purpose of the new sections is to move certain HCS Program rules from 40 TAC Chapter 9, Subchapter D to 26 TAC Chapter 263. The repeals of §§9.151, 9.152, 9.154 – 9.170, 9.186, and 9.189 – 9.192 in 40 TAC Chapter 9, Subchapter D, are adopted elsewhere in this issue of the Texas Register.

The adopted rules do not include program provider certification principles that are currently in 40 TAC Chapter 9, Subchapter D, §§9.173 – 9.175 and §§9.177 -9.183. HHSC will propose rules containing the certification standards for the HCS Program in 26 TAC Chapter 565 in a different rule project.

The adopted rules are necessary to comply with Title 42, Code of Federal Regulations (CFR), Chapter IV, Subchapter C, Part 441, Subpart G, §441.301(c)(1) – (5). In 2014, CMS amended this regulation to establish new requirements for Home and Community-based Services (HCBS) Medicaid Programs, including requirements for HCBS settings and person-centered planning. CMS has given states until March 17, 2023, to fully comply with the requirements in 42 CFR §441.301(c)(1) – (5). The adopted rules also ensure compliance with the requirements in 42 CFR Chapter IV, Subchapter C, Part 441, Subpart K, §441.530, regarding Home and Community-Based Setting; §441.535, regarding Assessment of functional need; and §441.540, regarding the Person-centered service plan, for Community First Choice (CFC) services because CFC services are available to individuals enrolled in the HCS Program.

The adopted rules implement Texas Government Code §531.02161(b)(4) which requires HHSC to ensure that, if cost effective, clinically effective, and allowed by federal law, a Medicaid recipient has the option to receive certain services, including occupational therapy (OT), physical therapy (PT), and speech-language pathology as a telehealth service.

The adopted rules require the initial HCS eligibility assessments to be conducted in person and the CFC personal assistance services/habilitation (PAS/HAB) assessment to be completed in person unless certain conditions exist in which case the assessment may be completed by telehealth, telephone, or video conferencing. These requirements help ensure the assessments are thorough and accurate.

The adopted rules include provisions regarding the denial, suspension, reduction, or termination of an individual’s services in the HCS Program to explain HHSC’s process in taking one of these actions. The adopted rules also change the existing service coordination monitoring requirement from 90 days to 30 days during an individual’s suspension.

The adopted rules require a program provider and local intellectual and developmental disability authority (LIDDA) to submit a translation of non-English documentation submitted to HHSC. The adopted rules help ensure that HHSC’s reviews of documentation are efficient.

The adopted rules require a registered nurse (RN) to complete a comprehensive nursing assessment of an individual in person under specified circumstances. This requirement is included to ensure the comprehensive nursing assessment is clinically effective, thorough, and accurate and to help ensure the health and safety of an individual.

The adopted rules codify HHSC’s current practice of increasing a level of need (LON) 1, 5, or 8 to the next LON because of an individual’s high medical needs if the individual meets certain criteria. The adopted rules also codify current practice related to individuals in the HCS Program transferring to another program provider or choosing a different service delivery option.

The adopted rules provide that HHSC may allow program providers and service coordinators to use one or more of the exceptions specified in the rule while an executive order or proclamation declaring a state of disaster under Texas Government Code §418.014 is in effect. This provision helps to ensure that program providers and service coordinators are able to provide services effectively during a disaster.

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New 26 TAC §263.401, describing the specified activities for service coordinators and informing an applicant about the CDS option.

CHAPTER 263. HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)
SUBCHAPTER E. CDS OPTION
26 TAC §263.401

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts Title 26, Part 1, new Chapter 263, Home and Community-based Services (HCS) Program and Community First Choice (CFC), consisting of Subchapters A – K, comprising new §§263.1 – 263.9; 263.101 – 263.108; 263.201; 263.301 – 263.304; 263.401; 263.501 – 263.503; 263.601; 263.701 – 263.708; 263.801; 263.802; 263.901 – 263.903; and 263.1000.

Sections 263.3, 263.5, 263.8, 263.9, 263.104, 263.107, 263.201, 263.302, 263.501, 263.502, 263.503, 263.601, 263.701, 263.702, 263.707, 263.708, 263.901, 263.902 and 263.1000 are adopted with changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5667). These rules will be republished.

Sections 263.1, 263.2, 263.4, 263.6, 263.7, 263.101, 263.102, 263.103, 263.105, 263.106, 263.108, 263.301, 263.303, 263.304, 263.401, 263.703, 263.704, 263.705, 263.706, 263.801, 263.802, and 263.903 are adopted without changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5667). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The HCS Program is a Medicaid waiver program approved by the Centers for Medicare & Medicaid Services (CMS) under §1915(c) of the Social Security Act. This waiver program provides community-based services and supports to an eligible individual as an alternative to services provided in an institutional setting. One purpose of the new sections is to move certain HCS Program rules from 40 TAC Chapter 9, Subchapter D to 26 TAC Chapter 263. The repeals of §§9.151, 9.152, 9.154 – 9.170, 9.186, and 9.189 – 9.192 in 40 TAC Chapter 9, Subchapter D, are adopted elsewhere in this issue of the Texas Register.

The adopted rules do not include program provider certification principles that are currently in 40 TAC Chapter 9, Subchapter D, §§9.173 – 9.175 and §§9.177 -9.183. HHSC will propose rules containing the certification standards for the HCS Program in 26 TAC Chapter 565 in a different rule project.

The adopted rules are necessary to comply with Title 42, Code of Federal Regulations (CFR), Chapter IV, Subchapter C, Part 441, Subpart G, §441.301(c)(1) – (5). In 2014, CMS amended this regulation to establish new requirements for Home and Community-based Services (HCBS) Medicaid Programs, including requirements for HCBS settings and person-centered planning. CMS has given states until March 17, 2023, to fully comply with the requirements in 42 CFR §441.301(c)(1) – (5). The adopted rules also ensure compliance with the requirements in 42 CFR Chapter IV, Subchapter C, Part 441, Subpart K, §441.530, regarding Home and Community-Based Setting; §441.535, regarding Assessment of functional need; and §441.540, regarding the Person-centered service plan, for Community First Choice (CFC) services because CFC services are available to individuals enrolled in the HCS Program.

The adopted rules implement Texas Government Code §531.02161(b)(4) which requires HHSC to ensure that, if cost effective, clinically effective, and allowed by federal law, a Medicaid recipient has the option to receive certain services, including occupational therapy (OT), physical therapy (PT), and speech-language pathology as a telehealth service.

The adopted rules require the initial HCS eligibility assessments to be conducted in person and the CFC personal assistance services/habilitation (PAS/HAB) assessment to be completed in person unless certain conditions exist in which case the assessment may be completed by telehealth, telephone, or video conferencing. These requirements help ensure the assessments are thorough and accurate.

The adopted rules include provisions regarding the denial, suspension, reduction, or termination of an individual’s services in the HCS Program to explain HHSC’s process in taking one of these actions. The adopted rules also change the existing service coordination monitoring requirement from 90 days to 30 days during an individual’s suspension.

The adopted rules require a program provider and local intellectual and developmental disability authority (LIDDA) to submit a translation of non-English documentation submitted to HHSC. The adopted rules help ensure that HHSC’s reviews of documentation are efficient.

The adopted rules require a registered nurse (RN) to complete a comprehensive nursing assessment of an individual in person under specified circumstances. This requirement is included to ensure the comprehensive nursing assessment is clinically effective, thorough, and accurate and to help ensure the health and safety of an individual.

The adopted rules codify HHSC’s current practice of increasing a level of need (LON) 1, 5, or 8 to the next LON because of an individual’s high medical needs if the individual meets certain criteria. The adopted rules also codify current practice related to individuals in the HCS Program transferring to another program provider or choosing a different service delivery option.

The adopted rules provide that HHSC may allow program providers and service coordinators to use one or more of the exceptions specified in the rule while an executive order or proclamation declaring a state of disaster under Texas Government Code §418.014 is in effect. This provision helps to ensure that program providers and service coordinators are able to provide services effectively during a disaster.

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New 26 TAC §§263.501 – 236.503, describing requirements for service settings, program provider owned or controlled residential settings, and residential agreements.

CHAPTER 263. HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)
SUBCHAPTER F. REQUIREMENTS FOR SERVICE SETTINGS AND PROGRAM PROVIDER OWNED OR CONTROLLED RESIDENTIAL SETTINGS
26 TAC §§263.501 – 263.503

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts Title 26, Part 1, new Chapter 263, Home and Community-based Services (HCS) Program and Community First Choice (CFC), consisting of Subchapters A – K, comprising new §§263.1 – 263.9; 263.101 – 263.108; 263.201; 263.301 – 263.304; 263.401; 263.501 – 263.503; 263.601; 263.701 – 263.708; 263.801; 263.802; 263.901 – 263.903; and 263.1000.

Sections 263.3, 263.5, 263.8, 263.9, 263.104, 263.107, 263.201, 263.302, 263.501, 263.502, 263.503, 263.601, 263.701, 263.702, 263.707, 263.708, 263.901, 263.902 and 263.1000 are adopted with changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5667). These rules will be republished.

Sections 263.1, 263.2, 263.4, 263.6, 263.7, 263.101, 263.102, 263.103, 263.105, 263.106, 263.108, 263.301, 263.303, 263.304, 263.401, 263.703, 263.704, 263.705, 263.706, 263.801, 263.802, and 263.903 are adopted without changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5667). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The HCS Program is a Medicaid waiver program approved by the Centers for Medicare & Medicaid Services (CMS) under §1915(c) of the Social Security Act. This waiver program provides community-based services and supports to an eligible individual as an alternative to services provided in an institutional setting. One purpose of the new sections is to move certain HCS Program rules from 40 TAC Chapter 9, Subchapter D to 26 TAC Chapter 263. The repeals of §§9.151, 9.152, 9.154 – 9.170, 9.186, and 9.189 – 9.192 in 40 TAC Chapter 9, Subchapter D, are adopted elsewhere in this issue of the Texas Register.

The adopted rules do not include program provider certification principles that are currently in 40 TAC Chapter 9, Subchapter D, §§9.173 – 9.175 and §§9.177 -9.183. HHSC will propose rules containing the certification standards for the HCS Program in 26 TAC Chapter 565 in a different rule project.

The adopted rules are necessary to comply with Title 42, Code of Federal Regulations (CFR), Chapter IV, Subchapter C, Part 441, Subpart G, §441.301(c)(1) – (5). In 2014, CMS amended this regulation to establish new requirements for Home and Community-based Services (HCBS) Medicaid Programs, including requirements for HCBS settings and person-centered planning. CMS has given states until March 17, 2023, to fully comply with the requirements in 42 CFR §441.301(c)(1) – (5). The adopted rules also ensure compliance with the requirements in 42 CFR Chapter IV, Subchapter C, Part 441, Subpart K, §441.530, regarding Home and Community-Based Setting; §441.535, regarding Assessment of functional need; and §441.540, regarding the Person-centered service plan, for Community First Choice (CFC) services because CFC services are available to individuals enrolled in the HCS Program.

The adopted rules implement Texas Government Code §531.02161(b)(4) which requires HHSC to ensure that, if cost effective, clinically effective, and allowed by federal law, a Medicaid recipient has the option to receive certain services, including occupational therapy (OT), physical therapy (PT), and speech-language pathology as a telehealth service.

The adopted rules require the initial HCS eligibility assessments to be conducted in person and the CFC personal assistance services/habilitation (PAS/HAB) assessment to be completed in person unless certain conditions exist in which case the assessment may be completed by telehealth, telephone, or video conferencing. These requirements help ensure the assessments are thorough and accurate.

The adopted rules include provisions regarding the denial, suspension, reduction, or termination of an individual’s services in the HCS Program to explain HHSC’s process in taking one of these actions. The adopted rules also change the existing service coordination monitoring requirement from 90 days to 30 days during an individual’s suspension.

The adopted rules require a program provider and local intellectual and developmental disability authority (LIDDA) to submit a translation of non-English documentation submitted to HHSC. The adopted rules help ensure that HHSC’s reviews of documentation are efficient.

The adopted rules require a registered nurse (RN) to complete a comprehensive nursing assessment of an individual in person under specified circumstances. This requirement is included to ensure the comprehensive nursing assessment is clinically effective, thorough, and accurate and to help ensure the health and safety of an individual.

The adopted rules codify HHSC’s current practice of increasing a level of need (LON) 1, 5, or 8 to the next LON because of an individual’s high medical needs if the individual meets certain criteria. The adopted rules also codify current practice related to individuals in the HCS Program transferring to another program provider or choosing a different service delivery option.

The adopted rules provide that HHSC may allow program providers and service coordinators to use one or more of the exceptions specified in the rule while an executive order or proclamation declaring a state of disaster under Texas Government Code §418.014 is in effect. This provision helps to ensure that program providers and service coordinators are able to provide services effectively during a disaster.

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New 26 TAC §263.601, concerning program provider reimbursement.

CHAPTER 263. HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)
SUBCHAPTER G. REIMBURSEMENT BY HHSC
26 TAC §263.601

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts Title 26, Part 1, new Chapter 263, Home and Community-based Services (HCS) Program and Community First Choice (CFC), consisting of Subchapters A – K, comprising new §§263.1 – 263.9; 263.101 – 263.108; 263.201; 263.301 – 263.304; 263.401; 263.501 – 263.503; 263.601; 263.701 – 263.708; 263.801; 263.802; 263.901 – 263.903; and 263.1000.

Sections 263.3, 263.5, 263.8, 263.9, 263.104, 263.107, 263.201, 263.302, 263.501, 263.502, 263.503, 263.601, 263.701, 263.702, 263.707, 263.708, 263.901, 263.902 and 263.1000 are adopted with changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5667). These rules will be republished.

Sections 263.1, 263.2, 263.4, 263.6, 263.7, 263.101, 263.102, 263.103, 263.105, 263.106, 263.108, 263.301, 263.303, 263.304, 263.401, 263.703, 263.704, 263.705, 263.706, 263.801, 263.802, and 263.903 are adopted without changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5667). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The HCS Program is a Medicaid waiver program approved by the Centers for Medicare & Medicaid Services (CMS) under §1915(c) of the Social Security Act. This waiver program provides community-based services and supports to an eligible individual as an alternative to services provided in an institutional setting. One purpose of the new sections is to move certain HCS Program rules from 40 TAC Chapter 9, Subchapter D to 26 TAC Chapter 263. The repeals of §§9.151, 9.152, 9.154 – 9.170, 9.186, and 9.189 – 9.192 in 40 TAC Chapter 9, Subchapter D, are adopted elsewhere in this issue of the Texas Register.

The adopted rules do not include program provider certification principles that are currently in 40 TAC Chapter 9, Subchapter D, §§9.173 – 9.175 and §§9.177 -9.183. HHSC will propose rules containing the certification standards for the HCS Program in 26 TAC Chapter 565 in a different rule project.

The adopted rules are necessary to comply with Title 42, Code of Federal Regulations (CFR), Chapter IV, Subchapter C, Part 441, Subpart G, §441.301(c)(1) – (5). In 2014, CMS amended this regulation to establish new requirements for Home and Community-based Services (HCBS) Medicaid Programs, including requirements for HCBS settings and person-centered planning. CMS has given states until March 17, 2023, to fully comply with the requirements in 42 CFR §441.301(c)(1) – (5). The adopted rules also ensure compliance with the requirements in 42 CFR Chapter IV, Subchapter C, Part 441, Subpart K, §441.530, regarding Home and Community-Based Setting; §441.535, regarding Assessment of functional need; and §441.540, regarding the Person-centered service plan, for Community First Choice (CFC) services because CFC services are available to individuals enrolled in the HCS Program.

The adopted rules implement Texas Government Code §531.02161(b)(4) which requires HHSC to ensure that, if cost effective, clinically effective, and allowed by federal law, a Medicaid recipient has the option to receive certain services, including occupational therapy (OT), physical therapy (PT), and speech-language pathology as a telehealth service.

The adopted rules require the initial HCS eligibility assessments to be conducted in person and the CFC personal assistance services/habilitation (PAS/HAB) assessment to be completed in person unless certain conditions exist in which case the assessment may be completed by telehealth, telephone, or video conferencing. These requirements help ensure the assessments are thorough and accurate.

The adopted rules include provisions regarding the denial, suspension, reduction, or termination of an individual’s services in the HCS Program to explain HHSC’s process in taking one of these actions. The adopted rules also change the existing service coordination monitoring requirement from 90 days to 30 days during an individual’s suspension.

The adopted rules require a program provider and local intellectual and developmental disability authority (LIDDA) to submit a translation of non-English documentation submitted to HHSC. The adopted rules help ensure that HHSC’s reviews of documentation are efficient.

The adopted rules require a registered nurse (RN) to complete a comprehensive nursing assessment of an individual in person under specified circumstances. This requirement is included to ensure the comprehensive nursing assessment is clinically effective, thorough, and accurate and to help ensure the health and safety of an individual.

The adopted rules codify HHSC’s current practice of increasing a level of need (LON) 1, 5, or 8 to the next LON because of an individual’s high medical needs if the individual meets certain criteria. The adopted rules also codify current practice related to individuals in the HCS Program transferring to another program provider or choosing a different service delivery option.

The adopted rules provide that HHSC may allow program providers and service coordinators to use one or more of the exceptions specified in the rule while an executive order or proclamation declaring a state of disaster under Texas Government Code §418.014 is in effect. This provision helps to ensure that program providers and service coordinators are able to provide services effectively during a disaster.

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New 26 TAC §§263.701 – 263.708, concerning transfers, denials, suspensions, reductions, and terminations of the HCS and CFC Programs.

CHAPTER 263. HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)
SUBCHAPTER H. TRANSFER, DENIALS, SUSPENSION, REDUCTION, AND TERMINATION
26 TAC §§263.701 – 263.708

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts Title 26, Part 1, new Chapter 263, Home and Community-based Services (HCS) Program and Community First Choice (CFC), consisting of Subchapters A – K, comprising new §§263.1 – 263.9; 263.101 – 263.108; 263.201; 263.301 – 263.304; 263.401; 263.501 – 263.503; 263.601; 263.701 – 263.708; 263.801; 263.802; 263.901 – 263.903; and 263.1000.

Sections 263.3, 263.5, 263.8, 263.9, 263.104, 263.107, 263.201, 263.302, 263.501, 263.502, 263.503, 263.601, 263.701, 263.702, 263.707, 263.708, 263.901, 263.902 and 263.1000 are adopted with changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5667). These rules will be republished.

Sections 263.1, 263.2, 263.4, 263.6, 263.7, 263.101, 263.102, 263.103, 263.105, 263.106, 263.108, 263.301, 263.303, 263.304, 263.401, 263.703, 263.704, 263.705, 263.706, 263.801, 263.802, and 263.903 are adopted without changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5667). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The HCS Program is a Medicaid waiver program approved by the Centers for Medicare & Medicaid Services (CMS) under §1915(c) of the Social Security Act. This waiver program provides community-based services and supports to an eligible individual as an alternative to services provided in an institutional setting. One purpose of the new sections is to move certain HCS Program rules from 40 TAC Chapter 9, Subchapter D to 26 TAC Chapter 263. The repeals of §§9.151, 9.152, 9.154 – 9.170, 9.186, and 9.189 – 9.192 in 40 TAC Chapter 9, Subchapter D, are adopted elsewhere in this issue of the Texas Register.

The adopted rules do not include program provider certification principles that are currently in 40 TAC Chapter 9, Subchapter D, §§9.173 – 9.175 and §§9.177 -9.183. HHSC will propose rules containing the certification standards for the HCS Program in 26 TAC Chapter 565 in a different rule project.

The adopted rules are necessary to comply with Title 42, Code of Federal Regulations (CFR), Chapter IV, Subchapter C, Part 441, Subpart G, §441.301(c)(1) – (5). In 2014, CMS amended this regulation to establish new requirements for Home and Community-based Services (HCBS) Medicaid Programs, including requirements for HCBS settings and person-centered planning. CMS has given states until March 17, 2023, to fully comply with the requirements in 42 CFR §441.301(c)(1) – (5). The adopted rules also ensure compliance with the requirements in 42 CFR Chapter IV, Subchapter C, Part 441, Subpart K, §441.530, regarding Home and Community-Based Setting; §441.535, regarding Assessment of functional need; and §441.540, regarding the Person-centered service plan, for Community First Choice (CFC) services because CFC services are available to individuals enrolled in the HCS Program.

The adopted rules implement Texas Government Code §531.02161(b)(4) which requires HHSC to ensure that, if cost effective, clinically effective, and allowed by federal law, a Medicaid recipient has the option to receive certain services, including occupational therapy (OT), physical therapy (PT), and speech-language pathology as a telehealth service.

The adopted rules require the initial HCS eligibility assessments to be conducted in person and the CFC personal assistance services/habilitation (PAS/HAB) assessment to be completed in person unless certain conditions exist in which case the assessment may be completed by telehealth, telephone, or video conferencing. These requirements help ensure the assessments are thorough and accurate.

The adopted rules include provisions regarding the denial, suspension, reduction, or termination of an individual’s services in the HCS Program to explain HHSC’s process in taking one of these actions. The adopted rules also change the existing service coordination monitoring requirement from 90 days to 30 days during an individual’s suspension.

The adopted rules require a program provider and local intellectual and developmental disability authority (LIDDA) to submit a translation of non-English documentation submitted to HHSC. The adopted rules help ensure that HHSC’s reviews of documentation are efficient.

The adopted rules require a registered nurse (RN) to complete a comprehensive nursing assessment of an individual in person under specified circumstances. This requirement is included to ensure the comprehensive nursing assessment is clinically effective, thorough, and accurate and to help ensure the health and safety of an individual.

The adopted rules codify HHSC’s current practice of increasing a level of need (LON) 1, 5, or 8 to the next LON because of an individual’s high medical needs if the individual meets certain criteria. The adopted rules also codify current practice related to individuals in the HCS Program transferring to another program provider or choosing a different service delivery option.

The adopted rules provide that HHSC may allow program providers and service coordinators to use one or more of the exceptions specified in the rule while an executive order or proclamation declaring a state of disaster under Texas Government Code §418.014 is in effect. This provision helps to ensure that program providers and service coordinators are able to provide services effectively during a disaster.

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New 26 TAC §263.801, §263.802, concerning fair hearings and a program provider’s right to an administrative hearing.

CHAPTER 263. HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)
SUBCHAPTER I. HEARINGS
26 TAC §263.801, §263.802

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts Title 26, Part 1, new Chapter 263, Home and Community-based Services (HCS) Program and Community First Choice (CFC), consisting of Subchapters A – K, comprising new §§263.1 – 263.9; 263.101 – 263.108; 263.201; 263.301 – 263.304; 263.401; 263.501 – 263.503; 263.601; 263.701 – 263.708; 263.801; 263.802; 263.901 – 263.903; and 263.1000.

Sections 263.3, 263.5, 263.8, 263.9, 263.104, 263.107, 263.201, 263.302, 263.501, 263.502, 263.503, 263.601, 263.701, 263.702, 263.707, 263.708, 263.901, 263.902 and 263.1000 are adopted with changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5667). These rules will be republished.

Sections 263.1, 263.2, 263.4, 263.6, 263.7, 263.101, 263.102, 263.103, 263.105, 263.106, 263.108, 263.301, 263.303, 263.304, 263.401, 263.703, 263.704, 263.705, 263.706, 263.801, 263.802, and 263.903 are adopted without changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5667). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The HCS Program is a Medicaid waiver program approved by the Centers for Medicare & Medicaid Services (CMS) under §1915(c) of the Social Security Act. This waiver program provides community-based services and supports to an eligible individual as an alternative to services provided in an institutional setting. One purpose of the new sections is to move certain HCS Program rules from 40 TAC Chapter 9, Subchapter D to 26 TAC Chapter 263. The repeals of §§9.151, 9.152, 9.154 – 9.170, 9.186, and 9.189 – 9.192 in 40 TAC Chapter 9, Subchapter D, are adopted elsewhere in this issue of the Texas Register.

The adopted rules do not include program provider certification principles that are currently in 40 TAC Chapter 9, Subchapter D, §§9.173 – 9.175 and §§9.177 -9.183. HHSC will propose rules containing the certification standards for the HCS Program in 26 TAC Chapter 565 in a different rule project.

The adopted rules are necessary to comply with Title 42, Code of Federal Regulations (CFR), Chapter IV, Subchapter C, Part 441, Subpart G, §441.301(c)(1) – (5). In 2014, CMS amended this regulation to establish new requirements for Home and Community-based Services (HCBS) Medicaid Programs, including requirements for HCBS settings and person-centered planning. CMS has given states until March 17, 2023, to fully comply with the requirements in 42 CFR §441.301(c)(1) – (5). The adopted rules also ensure compliance with the requirements in 42 CFR Chapter IV, Subchapter C, Part 441, Subpart K, §441.530, regarding Home and Community-Based Setting; §441.535, regarding Assessment of functional need; and §441.540, regarding the Person-centered service plan, for Community First Choice (CFC) services because CFC services are available to individuals enrolled in the HCS Program.

The adopted rules implement Texas Government Code §531.02161(b)(4) which requires HHSC to ensure that, if cost effective, clinically effective, and allowed by federal law, a Medicaid recipient has the option to receive certain services, including occupational therapy (OT), physical therapy (PT), and speech-language pathology as a telehealth service.

The adopted rules require the initial HCS eligibility assessments to be conducted in person and the CFC personal assistance services/habilitation (PAS/HAB) assessment to be completed in person unless certain conditions exist in which case the assessment may be completed by telehealth, telephone, or video conferencing. These requirements help ensure the assessments are thorough and accurate.

The adopted rules include provisions regarding the denial, suspension, reduction, or termination of an individual’s services in the HCS Program to explain HHSC’s process in taking one of these actions. The adopted rules also change the existing service coordination monitoring requirement from 90 days to 30 days during an individual’s suspension.

The adopted rules require a program provider and local intellectual and developmental disability authority (LIDDA) to submit a translation of non-English documentation submitted to HHSC. The adopted rules help ensure that HHSC’s reviews of documentation are efficient.

The adopted rules require a registered nurse (RN) to complete a comprehensive nursing assessment of an individual in person under specified circumstances. This requirement is included to ensure the comprehensive nursing assessment is clinically effective, thorough, and accurate and to help ensure the health and safety of an individual.

The adopted rules codify HHSC’s current practice of increasing a level of need (LON) 1, 5, or 8 to the next LON because of an individual’s high medical needs if the individual meets certain criteria. The adopted rules also codify current practice related to individuals in the HCS Program transferring to another program provider or choosing a different service delivery option.

The adopted rules provide that HHSC may allow program providers and service coordinators to use one or more of the exceptions specified in the rule while an executive order or proclamation declaring a state of disaster under Texas Government Code §418.014 is in effect. This provision helps to ensure that program providers and service coordinators are able to provide services effectively during a disaster.

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New 26 TAC §§263.901 – 263.903, regarding LIDDA requirements for providing service coordination.

CHAPTER 263. HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)
SUBCHAPTER J. LIDDA REQUIREMENTS
26 TAC §§263.901 – 263.903

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts Title 26, Part 1, new Chapter 263, Home and Community-based Services (HCS) Program and Community First Choice (CFC), consisting of Subchapters A – K, comprising new §§263.1 – 263.9; 263.101 – 263.108; 263.201; 263.301 – 263.304; 263.401; 263.501 – 263.503; 263.601; 263.701 – 263.708; 263.801; 263.802; 263.901 – 263.903; and 263.1000.

Sections 263.3, 263.5, 263.8, 263.9, 263.104, 263.107, 263.201, 263.302, 263.501, 263.502, 263.503, 263.601, 263.701, 263.702, 263.707, 263.708, 263.901, 263.902 and 263.1000 are adopted with changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5667). These rules will be republished.

Sections 263.1, 263.2, 263.4, 263.6, 263.7, 263.101, 263.102, 263.103, 263.105, 263.106, 263.108, 263.301, 263.303, 263.304, 263.401, 263.703, 263.704, 263.705, 263.706, 263.801, 263.802, and 263.903 are adopted without changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5667). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The HCS Program is a Medicaid waiver program approved by the Centers for Medicare & Medicaid Services (CMS) under §1915(c) of the Social Security Act. This waiver program provides community-based services and supports to an eligible individual as an alternative to services provided in an institutional setting. One purpose of the new sections is to move certain HCS Program rules from 40 TAC Chapter 9, Subchapter D to 26 TAC Chapter 263. The repeals of §§9.151, 9.152, 9.154 – 9.170, 9.186, and 9.189 – 9.192 in 40 TAC Chapter 9, Subchapter D, are adopted elsewhere in this issue of the Texas Register.

The adopted rules do not include program provider certification principles that are currently in 40 TAC Chapter 9, Subchapter D, §§9.173 – 9.175 and §§9.177 -9.183. HHSC will propose rules containing the certification standards for the HCS Program in 26 TAC Chapter 565 in a different rule project.

The adopted rules are necessary to comply with Title 42, Code of Federal Regulations (CFR), Chapter IV, Subchapter C, Part 441, Subpart G, §441.301(c)(1) – (5). In 2014, CMS amended this regulation to establish new requirements for Home and Community-based Services (HCBS) Medicaid Programs, including requirements for HCBS settings and person-centered planning. CMS has given states until March 17, 2023, to fully comply with the requirements in 42 CFR §441.301(c)(1) – (5). The adopted rules also ensure compliance with the requirements in 42 CFR Chapter IV, Subchapter C, Part 441, Subpart K, §441.530, regarding Home and Community-Based Setting; §441.535, regarding Assessment of functional need; and §441.540, regarding the Person-centered service plan, for Community First Choice (CFC) services because CFC services are available to individuals enrolled in the HCS Program.

The adopted rules implement Texas Government Code §531.02161(b)(4) which requires HHSC to ensure that, if cost effective, clinically effective, and allowed by federal law, a Medicaid recipient has the option to receive certain services, including occupational therapy (OT), physical therapy (PT), and speech-language pathology as a telehealth service.

The adopted rules require the initial HCS eligibility assessments to be conducted in person and the CFC personal assistance services/habilitation (PAS/HAB) assessment to be completed in person unless certain conditions exist in which case the assessment may be completed by telehealth, telephone, or video conferencing. These requirements help ensure the assessments are thorough and accurate.

The adopted rules include provisions regarding the denial, suspension, reduction, or termination of an individual’s services in the HCS Program to explain HHSC’s process in taking one of these actions. The adopted rules also change the existing service coordination monitoring requirement from 90 days to 30 days during an individual’s suspension.

The adopted rules require a program provider and local intellectual and developmental disability authority (LIDDA) to submit a translation of non-English documentation submitted to HHSC. The adopted rules help ensure that HHSC’s reviews of documentation are efficient.

The adopted rules require a registered nurse (RN) to complete a comprehensive nursing assessment of an individual in person under specified circumstances. This requirement is included to ensure the comprehensive nursing assessment is clinically effective, thorough, and accurate and to help ensure the health and safety of an individual.

The adopted rules codify HHSC’s current practice of increasing a level of need (LON) 1, 5, or 8 to the next LON because of an individual’s high medical needs if the individual meets certain criteria. The adopted rules also codify current practice related to individuals in the HCS Program transferring to another program provider or choosing a different service delivery option.

The adopted rules provide that HHSC may allow program providers and service coordinators to use one or more of the exceptions specified in the rule while an executive order or proclamation declaring a state of disaster under Texas Government Code §418.014 is in effect. This provision helps to ensure that program providers and service coordinators are able to provide services effectively during a disaster.

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New 26 TAC §263.1000, outlining exceptions to certain requirements during the declaration of a disaster.

CHAPTER 263. HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)
SUBCHAPTER K. DECLARATION OF DISASTER
26 TAC §263.1000

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts Title 26, Part 1, new Chapter 263, Home and Community-based Services (HCS) Program and Community First Choice (CFC), consisting of Subchapters A – K, comprising new §§263.1 – 263.9; 263.101 – 263.108; 263.201; 263.301 – 263.304; 263.401; 263.501 – 263.503; 263.601; 263.701 – 263.708; 263.801; 263.802; 263.901 – 263.903; and 263.1000.

Sections 263.3, 263.5, 263.8, 263.9, 263.104, 263.107, 263.201, 263.302, 263.501, 263.502, 263.503, 263.601, 263.701, 263.702, 263.707, 263.708, 263.901, 263.902 and 263.1000 are adopted with changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5667). These rules will be republished.

Sections 263.1, 263.2, 263.4, 263.6, 263.7, 263.101, 263.102, 263.103, 263.105, 263.106, 263.108, 263.301, 263.303, 263.304, 263.401, 263.703, 263.704, 263.705, 263.706, 263.801, 263.802, and 263.903 are adopted without changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5667). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The HCS Program is a Medicaid waiver program approved by the Centers for Medicare & Medicaid Services (CMS) under §1915(c) of the Social Security Act. This waiver program provides community-based services and supports to an eligible individual as an alternative to services provided in an institutional setting. One purpose of the new sections is to move certain HCS Program rules from 40 TAC Chapter 9, Subchapter D to 26 TAC Chapter 263. The repeals of §§9.151, 9.152, 9.154 – 9.170, 9.186, and 9.189 – 9.192 in 40 TAC Chapter 9, Subchapter D, are adopted elsewhere in this issue of the Texas Register.

The adopted rules do not include program provider certification principles that are currently in 40 TAC Chapter 9, Subchapter D, §§9.173 – 9.175 and §§9.177 -9.183. HHSC will propose rules containing the certification standards for the HCS Program in 26 TAC Chapter 565 in a different rule project.

The adopted rules are necessary to comply with Title 42, Code of Federal Regulations (CFR), Chapter IV, Subchapter C, Part 441, Subpart G, §441.301(c)(1) – (5). In 2014, CMS amended this regulation to establish new requirements for Home and Community-based Services (HCBS) Medicaid Programs, including requirements for HCBS settings and person-centered planning. CMS has given states until March 17, 2023, to fully comply with the requirements in 42 CFR §441.301(c)(1) – (5). The adopted rules also ensure compliance with the requirements in 42 CFR Chapter IV, Subchapter C, Part 441, Subpart K, §441.530, regarding Home and Community-Based Setting; §441.535, regarding Assessment of functional need; and §441.540, regarding the Person-centered service plan, for Community First Choice (CFC) services because CFC services are available to individuals enrolled in the HCS Program.

The adopted rules implement Texas Government Code §531.02161(b)(4) which requires HHSC to ensure that, if cost effective, clinically effective, and allowed by federal law, a Medicaid recipient has the option to receive certain services, including occupational therapy (OT), physical therapy (PT), and speech-language pathology as a telehealth service.

The adopted rules require the initial HCS eligibility assessments to be conducted in person and the CFC personal assistance services/habilitation (PAS/HAB) assessment to be completed in person unless certain conditions exist in which case the assessment may be completed by telehealth, telephone, or video conferencing. These requirements help ensure the assessments are thorough and accurate.

The adopted rules include provisions regarding the denial, suspension, reduction, or termination of an individual’s services in the HCS Program to explain HHSC’s process in taking one of these actions. The adopted rules also change the existing service coordination monitoring requirement from 90 days to 30 days during an individual’s suspension.

The adopted rules require a program provider and local intellectual and developmental disability authority (LIDDA) to submit a translation of non-English documentation submitted to HHSC. The adopted rules help ensure that HHSC’s reviews of documentation are efficient.

The adopted rules require a registered nurse (RN) to complete a comprehensive nursing assessment of an individual in person under specified circumstances. This requirement is included to ensure the comprehensive nursing assessment is clinically effective, thorough, and accurate and to help ensure the health and safety of an individual.

The adopted rules codify HHSC’s current practice of increasing a level of need (LON) 1, 5, or 8 to the next LON because of an individual’s high medical needs if the individual meets certain criteria. The adopted rules also codify current practice related to individuals in the HCS Program transferring to another program provider or choosing a different service delivery option.

The adopted rules provide that HHSC may allow program providers and service coordinators to use one or more of the exceptions specified in the rule while an executive order or proclamation declaring a state of disaster under Texas Government Code §418.014 is in effect. This provision helps to ensure that program providers and service coordinators are able to provide services effectively during a disaster.

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New 26 TAC §§272.1, 272.3, 272.5, 272.7, replacing references to “DADS” with “HHSC.”

CHAPTER 272. TRANSITION ASSISTANCE SERVICES
SUBCHAPTER A. INTRODUCTION
26 TAC §§272.1, 272.3, 272.5, 272.7

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts amendments to §272.1, concerning Purpose; §272.3, concerning Definitions; §272.5, concerning Service Description; §272.7, concerning Transition Assistance Services (TAS) in the HCS Program; §272.11, concerning Contracting Requirements; §272.33, concerning Service Delivery; and §272.41, concerning Record Keeping.

The amendments to §§272.3, 272.7, and 272.33 are adopted with changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5713). These rules will be republished.

The amendments to §§272.1, 272.5, 272.11, and 272.41 are adopted without changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5713), and therefore will not be republished.

BACKGROUND AND JUSTIFICATION

The adopted amendments replace the reference to the Department of Aging and Disability Services (DADS) with the Texas Health and Human Services Commission (HHSC), revise references to program rules, and make minor editorial changes for clarity.

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New 26 TAC §272.11, revising a rule reference related to Transition Assistance Services.

CHAPTER 272. TRANSITION ASSISTANCE SERVICES
SUBCHAPTER B. TAS PROVIDER REQUIREMENTS
26 TAC §272.11

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts amendments to §272.1, concerning Purpose; §272.3, concerning Definitions; §272.5, concerning Service Description; §272.7, concerning Transition Assistance Services (TAS) in the HCS Program; §272.11, concerning Contracting Requirements; §272.33, concerning Service Delivery; and §272.41, concerning Record Keeping.

The amendments to §§272.3, 272.7, and 272.33 are adopted with changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5713). These rules will be republished.

The amendments to §§272.1, 272.5, 272.11, and 272.41 are adopted without changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5713), and therefore will not be republished.

BACKGROUND AND JUSTIFICATION

The adopted amendments replace the reference to the Department of Aging and Disability Services (DADS) with the Texas Health and Human Services Commission (HHSC), revise references to program rules, and make minor editorial changes for clarity.

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New 26 TAC §272.33, replacing “DADS” to “HHSC.”

CHAPTER 272. TRANSITION ASSISTANCE SERVICES
SUBCHAPTER D. SERVICE DELIVERY REQUIREMENTS
26 TAC §272.33

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts amendments to §272.1, concerning Purpose; §272.3, concerning Definitions; §272.5, concerning Service Description; §272.7, concerning Transition Assistance Services (TAS) in the HCS Program; §272.11, concerning Contracting Requirements; §272.33, concerning Service Delivery; and §272.41, concerning Record Keeping.

The amendments to §§272.3, 272.7, and 272.33 are adopted with changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5713). These rules will be republished.

The amendments to §§272.1, 272.5, 272.11, and 272.41 are adopted without changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5713), and therefore will not be republished.

BACKGROUND AND JUSTIFICATION

The adopted amendments replace the reference to the Department of Aging and Disability Services (DADS) with the Texas Health and Human Services Commission (HHSC), revise references to program rules, and make minor editorial changes for clarity.

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New 26 TAC §272.41, revising rule references.

CHAPTER 272. TRANSITION ASSISTANCE SERVICES
SUBCHAPTER E. CLAIM PAYMENTS AND DOCUMENTATION
26 TAC §272.41

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts amendments to §272.1, concerning Purpose; §272.3, concerning Definitions; §272.5, concerning Service Description; §272.7, concerning Transition Assistance Services (TAS) in the HCS Program; §272.11, concerning Contracting Requirements; §272.33, concerning Service Delivery; and §272.41, concerning Record Keeping.

The amendments to §§272.3, 272.7, and 272.33 are adopted with changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5713). These rules will be republished.

The amendments to §§272.1, 272.5, 272.11, and 272.41 are adopted without changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5713), and therefore will not be republished.

BACKGROUND AND JUSTIFICATION

The adopted amendments replace the reference to the Department of Aging and Disability Services (DADS) with the Texas Health and Human Services Commission (HHSC), revise references to program rules, and make minor editorial changes for clarity.

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Review of Agency Rules Re:

Title 26, Part 1, concerning day and health services requirements.

The Health and Human Services Commission (HHSC) adopts the review of the chapter below in Title 26, Part 1, of the Texas Administrative Code:

Chapter 559, Day Activity and Health Services Requirements

Subchapter A, Introduction

Subchapter B, Application Procedures

Subchapter C, Facility Construction Procedures

Subchapter D, Licensure and Program Requirements

Subchapter E, Inspections, Surveys, and Visits

Subchapter F, Abuse, Neglect, And Exploitation: Complaint and Incident Reports and Investigations

Subchapter G, Enforcement

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In Addition Re:

Notice of Public Hearing on Proposed Payment Rates for the STAR Kids/STAR Health Medically Dependent Children’s Program (MDCP) Out-of-Home Respite Retroactive to December 1, 2022

OVERVIEW

The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on March 14, 2023, at 9:00 a.m. to receive public comments on proposed payment rates for STAR Kids/STAR Health MDCP Out-of-Home Respite, retroactive to December 1, 2022.

The public hearing will be held in the HHSC North Austin Complex Building, Public Hearing Room 1.401, First Floor, at 4601 W. Guadalupe St., Austin, Texas 78751. Free parking is available in the adjacent parking garage. HHSC will also broadcast the public hearing; the broadcast can be accessed at https://hhs.texas.gov/about-hhs/communications-events/live-archived-meetings. The broadcast will be archived and accessible on demand on the same website. The hearing will be held in compliance with Texas Human Resources Code, Section 32.0282, which requires public notice of hearings on proposed Medicaid reimbursements.

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Public Notice – Texas State Plan for Medical Assistance Amendment

OVERVIEW

The Texas Health and Human Services Commission (HHSC) announces its intent to submit amendments to the Texas State Plan for Medical Assistance, under Title XIX of the Social Security Act. The proposed amendments will be effective March 1, 2023.

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Department of Aging and Disability Services

Adopted Rules Re:

Repealing 40 TAC §§9.151, 9.152, 9.154 – 9.170, 9.186, 9.189 – 9.192, concerning rules covering topics addressed in the new proposed rule.

CHAPTER 9. INTELLECTUAL DISABILITY SERVICES–MEDICAID STATE OPERATING AGENCY RESPONSIBILITIES
SUBCHAPTER D. HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)
40 TAC §§9.151, 9.152, 9.154 – 9.170, 9.186, 9.189 – 9.192

OVERVIEW

As required by Texas Government Code §531.0202(b), the Department of Aging and Disability Services (DADS) was abolished effective September 1, 2017, after all of its functions were transferred to the Texas Health and Human Services Commission (HHSC) in accordance with Texas Government Code §531.0201 and §531.02011. Rules of the former DADS are codified in Texas Administrative Code (TAC), Title 40, Part 1, and will be repealed or administratively transferred to 26 TAC, Health and Human Services, as appropriate. Until such action is taken, the rules in Title 40, Part 1 govern functions previously performed by DADS that have transferred to HHSC. Texas Government Code §531.0055, requires the Executive Commissioner of HHSC to adopt rules for the operation and provision of services by the health and human services system, including rules in Title 40, Part 1.

Therefore, the Executive Commissioner of HHSC adopts the repeal of §§9.151, 9.152, 9.154 – 9.170, 9.186, and 9.189 – 9.192 in 40 TAC Chapter 9, Subchapter D related to the Home and Community-based Services (HCS) Program and Community First Choice (CFC).

The repeal of §§9.151, 9.152, 9.154 – 9.170, 9.186, and 9.189 – 9.192 is adopted without changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5769). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The adoption repeals, in 40 TAC Chapter 9, Subchapter D, §§9.151, 9.152, 9.154 – 9.170, 9.186, and 9.189 – 9.192 for the HCS Program. HHSC is adopting new rules regarding the HCS Program in 26 TAC Chapter 263 elsewhere in this issue of the Texas Register.

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Repealing 40 TAC §§9.551, 9.552, 9.554, 9.556, 9.558, 9.560 – 9.563, 9.566 – 9.568, 9.570, 9.571, 9.573 – 9.575, 9.582, 9.583, to remove rules that concern a Medicaid waiver program because they are covered in the new rules.

CHAPTER 9. INTELLECTUAL DISABILITY SERVICES–MEDICAID STATE OPERATING AGENCY RESPONSIBILITIES
SUBCHAPTER N. TEXAS HOME LIVING (TXHML) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)
40 TAC §§9.551, 9.552, 9.554, 9.556, 9.558, 9.560 – 9.563, 9.566 – 9.568, 9.570, 9.571, 9.573 – 9.575, 9.582, 9.583

OVERVIEW

As required by Texas Government Code §531.0202(b), the Department of Aging and Disability Services (DADS) was abolished effective September 1, 2017, after all of its functions were transferred to the Texas Health and Human Services Commission (HHSC) in accordance with Texas Government Code §531.0201 and §531.02011. Rules of the former DADS are codified in Texas Administrative Code (TAC) Title 40, Part 1, and will be repealed or administratively transferred to 26 TAC, Health and Human Services, as appropriate. Until such action is taken, the rules in 40 TAC, Part 1 govern functions previously performed by DADS that have transferred to HHSC. Texas Government Code §531.0055 requires the Executive Commissioner of HHSC to adopt rules for the operation and provision of services by the health and human services system, including rules in 40 TAC, Part 1.

Therefore, the Executive Commissioner of HHSC adopts the repeal of §§9.551, 9.552, 9.554, 9.556, 9.558, 9.560 – 9.563, 9.566 – 9.568, 9.570, 9.571, 9.573 – 9.575, 9.582 and 9.583 in 40 TAC Chapter 9, Subchapter N, concerning Texas Home Living (TxHmL) Program and Community First Choice (CFC).

The repeal of §§9.551, 9.552, 9.554, 9.556, 9.558, 9.560 – 9.563, 9.566 – 9.568, 9.570, 9.571, 9.573 – 9.575, 9.582 and 9.583 are adopted without changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5770). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The adoption repeals, in 40 TAC Chapter 9, Subchapter N, §§9.551, 9.552, 9.554, 9.556, 9.558, 9.560 – 9.563, 9.566 – 9.568, 9.570, 9.571, 9.573 – 9.575, 9.582 and 9.583 for the TxHmL Program. HHSC is adopting new rules regarding the TxHmL Program in 26 TAC Chapter 262 elsewhere in this issue of the Texas Register.

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Texas Department of State Health Services

Review of Agency Rules Re:

Title 25, Part 1, regarding emergency medical care licensure and training.

The Health and Human Services Commission (HHSC), on behalf of the Texas Department of State Health Services (DSHS), adopts the review of the chapter below in Title 25, Part 1, of the Texas Administrative Code:

Chapter 157, Emergency Medical Care

Subchapter A, Emergency Medical Services – Part A

Subchapter B, Emergency Medical Services Provider Licenses

Subchapter C, Emergency Medical Services Training and Course Approval

Subchapter D, Emergency Medical Services Personnel Certification

Subchapter G, Emergency Medical Services Trauma Systems

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