TITLE 26. HEALTH AND HUMAN SERVICES

PART 1. HEALTH AND HUMAN SERVICES COMMISSION

CHAPTER 271. COMMUNITY CARE SERVICES ELIGIBILITY [ FOR AGED AND DISABLED ]

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §271.1, concerning Definitions of Program Terms; §271.5, concerning Community Care Interest Lists; §271.7, concerning Enrollment; §271.51, concerning Eligibility for Services; §271.53, concerning Income and Income Eligibles; §271.55, Determination of Countable Income; §271.57, concerning Income from Excludable Sources; §271.59, concerning Income from Exempt Sources; §271.61, concerning Age; §271.63, concerning Need; §271.65, concerning Indian-related Exemptions; §271.69, concerning Family Care; §271.71, concerning Home-Delivered Meals; §271.73, concerning Adult Foster Care; §271.75, concerning Special Services to Persons with Disabilities; §271.77, concerning Day Activity and Health Services; §271.79, concerning Case Management Services; §271.81, concerning Primary Home Care or Community Attendant Services; §271.83, concerning Time Allocation for Escort Services; §271.85, concerning Residential Care; §271.87, concerning Emergency Care; §271.89, concerning Resource Limits; §271.91, concerning Countable Resources; §271.93, concerning Resource Exclusions; §271.95, concerning Emergency Response Services; §271.97, concerning Residential Care Services; §271.151, concerning Application for Services; §271.153, concerning Recertification; §271.155, concerning Denial, Reduction, and Termination of Benefits; §271.159, concerning Adult Foster Care Client Rights and Responsibilities, and the repeal of §271.3, concerning Definitions.

BACKGROUND AND PURPOSE

Senate Bill (S.B.) 200, 84th Legislature, Regular Session, 2015, abolished the Texas Department of Aging and Disability Services (DADS) and transferred its functions to the Texas Health and Human Services Commission (HHSC), including Community Care for Aged and Disabled (CCAD). The program name was subsequently renamed to Community Care Services Eligibility (CCSE) on September 1, 2016. The rules for CCSE were administratively transferred from Title 40 Texas Administrative Code (TAC) to Title 26. The purpose of this proposal is to update references and terms in the rules to reflect the transition of the program from DADS to HHSC.

Currently, references to DADS and CCAD remain where HHSC and CCSE are the appropriate oversight agency and program. Additionally, there are references to outdated terms and program names such as "food stamps" or "aid to families with dependent children." The proposal updates those references to align 26 TAC, Part 1, Chapter 271, with both the agency's person-centered language policy and Texas Government Code Chapter 392. Eligibility requirements for the program are not changing.

SECTION-BY-SECTION SUMMARY

The proposal includes renaming the chapter title from Community Care for Aged and Disabled to Community Care Services Eligibility.

The proposed amendment to §271.1 makes grammatical changes for improved wording. References to DADS and CCAD have been replaced with HHSC and CCSE. Outdated or missing terms have been corrected and updated. Text has been updated to person-centered and plain language. References to outdated programs and terms have been removed. Definitions of abuse, neglect, and exploitation have been updated.

Section 271.3 is proposed for repeal. All relevant definitions are included in the proposed amendment to §271.1.

The proposed amendment to §271.5 makes grammatical changes for improved wording. References to DADS and CCAD have been replaced with HHSC and CCSE. Outdated or missing terms have been corrected and updated. Text has been updated to person-centered and plain language. References to outdated programs, their citations, and terms have been removed.

The proposed amendment to §271.7 updates the citations to sections of the subchapter, as it previously used §48.1302(d), when the chapter was in Title 40. The proposed amendment makes grammatical changes for improved wording. References to DADS and CCAD have been replaced with HHSC and CCSE. Outdated or missing terms have been corrected and updated. Text has been updated to person-centered and plain language. References to outdated programs and terms have been removed.

The proposed amendment to §271.51 makes grammatical changes for improved wording. References to DADS and CCAD have been replaced with HHSC and CCSE. Outdated or missing terms have been corrected and updated. Text has been updated to person-centered and plain language. References to outdated programs, their citations, and terms have been removed.

The proposed amendment to §271.53 makes grammatical changes for improved wording. References to DADS and CCAD have been replaced with HHSC and CCSE. Outdated or missing terms have been corrected and updated. Text has been updated to person-centered and plain language. References to outdated programs, their citations, and terms have been removed.

The proposed amendment to §271.55 updates the citations to sections of the subchapter, as the previous citation was §48.2904 and §48.2905 when the chapter was in Title 40. The proposed amendment makes grammatical changes for improved wording. References to DADS and CCAD have been replaced with HHSC and CCSE. Outdated or missing terms have been corrected and updated. Text has been updated to person-centered and plain language. References to outdated programs have been removed.

The proposed amendment to §271.57 makes grammatical changes for improved wording. References to DADS and CCAD have been replaced with HHSC and CCSE. Outdated or missing terms have been corrected and updated. Text has been updated to person-centered and plain language. The proposed amendment also amends a figure and renames it with the correct citation.

The proposed amendment to §271.59 makes grammatical changes for improved wording. References to DADS and CCAD have been replaced with HHSC and CCSE. Outdated or missing terms have been corrected and updated. Text has been updated to person-centered and plain language. References to outdated programs and terms have been removed.

The proposed amendment to §271.61 makes grammatical changes for improved wording. References to DADS and CCAD have been replaced with HHSC and CCSE. Outdated or missing terms have been corrected and updated. Text has been updated to person-centered and plain language.

The proposed amendment to §271.63 makes grammatical changes for improved wording. References to DADS and CCAD have been replaced with HHSC and CCSE. Outdated or missing terms have been corrected and updated. Text has been updated to person-centered and plain language.

The proposed amendment to §271.65 makes grammatical changes for improved wording. References to DADS and CCAD have been replaced with HHSC and CCSE. Outdated or missing terms have been corrected and updated. Text has been updated to person-centered and plain language. The proposed amendment also amends a figure and renames it with the correct citation. The proposed amendment adds the previously omitted income and resource exemptions of P.L. 103-444, payments made, or benefits granted by the Crow Boundary Settlement Act of 1994, and P.L. 108-270, per capita distribution judgment funds granted by the Western Shoshone Claims Distribution Act of 2004.

The proposed amendment to §271.69 makes grammatical changes for improved wording. References to DADS and CCAD have been replaced with HHSC and CCSE. Outdated or missing terms have been corrected and updated. Text has been updated to person-centered and plain language. References to outdated programs, their citations, and terms have been removed. The proposed amendment also updates the citations to sections of the subchapter, as §§48.2902, 48.2903, 48.2922, and 48.2923 were previously used when the chapter was in Title 40.

The proposed amendment to §271.71 makes grammatical changes for improved wording. Text has been updated to person-centered and plain language.

The proposed amendment to §271.73 makes grammatical changes for improved wording. References to CCAD have been replaced with CCSE. Text has been updated to person-centered and plain language.

The proposed amendment to §271.75 makes grammatical changes for improved wording. Text has been updated to person-centered and plain language.

The proposed amendment to §271.77 makes grammatical changes for improved wording. References to DADS and CCAD have been replaced with HHSC and CCSE. Outdated or missing terms have been corrected and updated. Text has been updated to person-centered and plain language. The location of the CCSE Handbook has been updated to www.hhs.texas.gov. The proposed amendment also updates the citations to sections of the subchapter, as §§48.2902, 48.2903, 48.2903, 48.2922, and 48.2923 were previously used when the chapter was in Title 40. The proposed amendment replaces references to §98.203 and §98.204 with §211.203 and §211.204.

The proposed amendment to §271.79 makes grammatical changes for improved wording. References to CCAD have been replaced with CCSE. Text has been updated to person-centered and plain language.

The proposed amendment to §271.81 makes grammatical changes for improved wording. References to DADS and CCAD have been replaced with HHSC and CCSE. Outdated or missing terms have been corrected and updated. Text has been updated to person-centered and plain language. References to outdated programs and terms have been removed.

The proposed amendment to §271.83 makes grammatical changes for improved wording. Text has been updated to person-centered and plain language.

The proposed amendment to §271.85 makes grammatical changes for improved wording. Text has been updated to person-centered and plain language.

The proposed amendment to §271.87 makes grammatical changes for improved wording. Text has been updated to person-centered and plain language.

The proposed amendment to §271.89 makes grammatical changes for improved wording. References to CCAD have been replaced with CCSE. Text has been updated to person-centered and plain language.

The proposed amendment to §271.91 makes grammatical changes for improved wording. References to CCAD have been replaced with CCSE. Text has been updated to person-centered and plain language.

The proposed amendment to §271.93 makes grammatical changes for improved wording. References to DADS and CCAD have been replaced with HHSC and CCSE. Outdated or missing terms have been corrected and updated. Text has been updated to person-centered and plain language. References to outdated programs and terms have been removed.

The proposed amendment to §271.95 makes grammatical changes for improved wording. References to Department of Human Services (DHS) and CCAD have been replaced with HHSC and CCSE. Text has been updated to person-centered and plain language.

The proposed amendment to §271.97 makes grammatical changes for improved wording. Text has been updated to person-centered and plain language.

The proposed amendment to §271.151 makes grammatical changes for improved wording. References to Department of Human Services (DHS) and CCAD have been replaced with HHSC and CCSE. Text has been updated to person-centered and plain language.

The proposed amendment to §271.153 makes grammatical changes for improved wording. References to CCAD have been replaced with HHSC and CCSE. Text has been updated to person-centered and plain language.

The proposed amendment to §271.155 makes grammatical changes for improved wording. References to Department of Human Services (DHS) and CCAD have been replaced with HHSC and CCSE. Text has been updated to person-centered and plain language. The proposed amendment also amends a figure and renames it with the correct citation.

The proposed amendment to §271.159 makes grammatical changes for improved wording. References to Department of Human Services (DHS) has been replaced with HHSC. Text has been updated to person-centered and plain language. Clarifies which investigatory agency should receive complaints about ANE.

FISCAL NOTE

Trey Wood, Chief Financial Officer, has determined that for each year of the first five years that the rules will be in effect, enforcing or administering the rules does not have foreseeable implications relating to costs or revenues of state or local governments.

GOVERNMENT GROWTH IMPACT STATEMENT

HHSC has determined that during the first five years that the rules will be in effect:

(1) the proposed rules will not create or eliminate a government program;

(2) implementation of the proposed rules will not affect the number of HHSC employee positions;

(3) implementation of the proposed rules will result in no assumed change in future legislative appropriations;

(4) the proposed rules will not affect fees paid to HHSC;

(5) the proposed rules will not create a new regulation;

(6) the proposed rules will not expand, limit, or repeal existing regulation(s);

(7) the proposed rules will not change the number of individuals subject to the rules; and

(8) the proposed rules will not affect the state's economy.

SMALL BUSINESS, MICRO-BUSINESS, AND RURAL COMMUNITY IMPACT ANALYSIS

Trey Wood has also determined that there will be no adverse economic effect on small businesses, micro-businesses, or rural communities because the amendments are merely codifying current procedures and there are no requirements to alter business processes.

LOCAL EMPLOYMENT IMPACT

The proposed rules will not affect a local economy.

COSTS TO REGULATED PERSONS

Texas Government Code §2001.0045 does not apply to these rules because the rules do not impose a cost on regulated persons.

PUBLIC BENEFIT AND COSTS

Haley Turner, Deputy Executive Commissioner, Community Services, has determined that for each year of the first five years the rules are in effect, the public benefit will be reduced confusion about the existence and authority of former agencies and programs (the Department of Human Services (DHS), the Department of Disability and Aging Services (DADS), Community Care of the Aged and Disabled (CCAD)) and clarity of the current administering agency, HHSC.

Trey Wood has also determined that for the first five years the rules are in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rules because the proposed rules are merely codifying current procedures.

TAKINGS IMPACT ASSESSMENT

HHSC has determined that the proposal does not restrict or limit an owner's right to the owner's property that would otherwise exist in the absence of government action and, therefore, does not constitute a taking under Texas Government Code §2007.043.

PUBLIC COMMENT

Written comments on the proposal may be submitted to Rules Coordination Office, P.O. Box 13247, Mail Code 4102, Austin, Texas 78711-3247, or street address 4601 West Guadalupe Street, Austin, Texas 78751; or emailed to HHSRulesCoordinationOffice@hhs.texas.gov.

To be considered, comments must be submitted no later than 31 days after the date of this issue of the Texas Register . Comments must be (1) postmarked or shipped before the last day of the comment period; (2) hand-delivered before 5:00 p.m. on the last working day of the comment period; or (3) emailed before midnight on the last day of the comment period. If the last day to submit comments falls on a holiday, comments must be postmarked, shipped, or emailed before midnight on the following business day to be accepted. When emailing comments, please indicate "Comments on Proposed Rule 24R094" in the subject line.

SUBCHAPTER A. DEFINITIONS

STATUTORY AUTHORITY

The amendment is authorized by Texas Government Code §524.0151, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies; and Texas Human Resources Code §117.080(e) which authorizes the Executive Commissioner of HHSC to adopt rules necessary to implement that section, including requirements applicable to Centers for Independent Living (CIL) providing independent living services under the program.

The amendment implements Texas Government Code §524.0151 and Texas Human Resources Code §117.080.

§ 271.1. Definitions of Program Terms.

The following words and terms have the following meanings when used in these sections, unless the context clearly indicates otherwise . [ : ]

(1) Abuse-- Means: [ The willful infliction of injury, unreasonable confinement, intimidation, or cruel punishment with resulting physical harm, pain, or mental anguish; or the willful deprivation by a caretaker or one's self of goods or services which are necessary to avoid physical harm, mental anguish, or mental illness. (Chapter 48, Human Resources Code) ]

(2) Activities of daily living (ADL)-- Fundamental tasks required for a person to care for themselves independently. Activities that are essential to daily self-care , [ ; ] including bathing, dressing, grooming, toileting, housekeeping, shopping, meal preparation, and others.

(3) Adult--A person at least 18 years of age, [ 18 or older, ] or an emancipated minor.

(5) Applicant--A person initially requesting services.

(6) Attendant--A person who is employed by a provider agency to give personal care or housekeeping services or both to a person [ an ] eligible for Community Attendant Services, Family Care, or Primary Home Care [ family care or primary home care client ], according to a service plan.

(7) Caregiver--A relative, guardian, representative payee, or person who has contact with the applicant or client that is frequent enough or regularly scheduled enough that a personal relationship exists or the applicant or client perceives that person as having a role in helping the applicant or client [ the client ] to meet basic needs.

(8) Caregiver support-- Relief or rest [ An interval of rest or relief ] from caregiving duties given to or arranged for the caregiver of an HHSC [ a DHS ] client.

(10) [ (9) ] Client--A person determined eligible for Community Care Services Eligibility (CCSE) [ Community Care for the Aged and Disabled (CCAD) ] services or programs .

(12) [ (10) ] Community care service or program --Services or programs provided within the client's own home, neighborhood, or community, as alternatives to institutional care. [ Community care is sometimes called alternate care. ]

(17) [ (13) ] Earned income--Cash or liquid resources that a person [ a client ] receives for services performed [ he performs ] as an employee or because [ as a result ] of self-employment. All other income is unearned income.

(18) [ (14) ] Emancipated minor--A person under 18 who has the power and capacity of an adult. This includes a minor who has had the disabilities of minority removed by a court of law or a minor who, with or without parental consent, has been married. Marriage includes common-law marriage.

(21) [ (15) ] Emotional or verbal abuse--Any use of verbal communication or other behavior to humiliate, intimidate, vilify, degrade, or threaten with harm.

(22) [ (16) ] Expedited response--A face-to-face or phone contact with an applicant by the caseworker within five calendar days of the date of the applicant's request for services.

(23) [ (17) ] Exploitation--The illegal or improper act or process of a caregiver , family member, or other person who has an ongoing relationship with an older adult or person with a disability that involves [ others ] using , or attempting to use, the [ an adult's income and ] resources of the older adult or person with a disability, including the person's social security number or other identifying information, for monetary or personal benefit, profit, or gain without the informed consent of the person.

(24) [ (18) ] Facility--A legal entity that contracts with HHSC [ the department ] to deliver [ to clients ] day services or 24-hour residential services to a client .

(27) [ (19) ] Fraud--A deliberate misrepresentation or intentional concealment of information [ in order ] to receive or [ to ] be reimbursed for the delivery of services to which the person [ individual ] is not entitled.

(28) [ (20) ] Functional need-- A person's [ An individual's ] requirement for assistance with activities of daily living, caused by a physical or mental limitation or disability.

(32) [ (21) ] Immediate response--A face-to-face or phone contact with an applicant by the caseworker within 24 hours of the applicant's request for services.

(33) [ (22) ] Income eligible[ (I.E.) ]--An adult who is not categorically eligible but [ , although neither a Medicaid recipient nor a food stamp head of household or spouse, nevertheless ] has income and resources equal to or less than the eligibility level established by HHSC [ the department ].

(34) [ (23) ] Institution--A nursing home, an intermediate care facility for people with intellectual and developmental disabilities [ the mentally retarded (ICF-MR) ], a state supported living center [ school ], or a state hospital.

(35) [ (24) ] Liquid resource--Cash or financial instruments that could be converted to cash within 20 workdays.

(36) [ (25) ] Medicaid-eligible [ Medicaid eligible ]-- A person [ An individual ] eligible for federal medical assistance [ as an SSI or TANF client ], or eligible for medical assistance only (MAO) in a nursing home or while living in the community or through a federally approved waiver.

(37) [ (26) ] Medicare [ eligible ]-- Federal health insurance for anyone at least 65 years of age and some people with certain disabilities or conditions [ An aged or disabled person who is a recipient of Social Security or railroad retirement benefit payments and meets eligibility criteria to have certain medical expenses paid by the federal Medicare program ].

(40) [ (27) ] Neglect--The failure to provide for oneself [ one's self ] the goods or services , including medical services, which are necessary to avoid physical or emotional harm or pain [ harm, mental anguish, or mental illness; ] or the failure of a caretaker to provide the goods or services. [ (Chapter 48, Human Resources Code) ]

(44) [ (28) ] Personal leave--Any leave from a residential care facility except for hospitalization or institutionalization. A day of personal leave is any period of 24 consecutive hours.

(46) [ (30) ] Provider agency--An agency that has contracted with HHSC [ DHS ] to provide programs or services that HHSC [ the CCAD services that DHS ] has authorized for people [ eligible clients ].

(49) [ (32) ] Resource--Any cash or other liquid assets or any real or personal property owned by a person [ an individual ] and spouse that could be converted to cash to use for support and maintenance.

(50) [ (33) ] Responder--A person who responds to an Emergency Response Services [ emergency response services ] (ERS) call activated by a client. Responders may include relatives, neighbors, volunteers, or staff of a sheriff's department, police department, emergency medical service, or fire department.

(53) [ (35) ] Supplemental Security Income [ security income ] (SSI)--Monthly payments made by the Social Security Administration (SSA) to an older person or person with disabilities [ an aged or disabled individual ] who meets the requirements for public aid. SSA determines eligibility for SSI.

(54) [ (37) ] Unearned income--Income received by a person [ client ] from sources other than self-employment or employee work activities.

(55) [ (38) ] Unmet need--A requirement for assistance with activities of daily living that cannot be met adequately on an ongoing basis by friends, relatives, volunteers, or service agencies other than HHSC [ DHS ].

(56) [ (39) ] Verbal referral--A referral made by the caseworker to the provider agency in person or by phone [ telephone ], no later than the first workday after the caseworker's determination that the applicant meets the criteria for an expedited response or an immediate response to a request for service[ , ] and needs immediate service initiation.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on April 29, 2025.

TRD-202501407

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: June 15, 2025

For further information, please call: (817) 458-1902

CHAPTER 271. COMMUNITY CARE FOR AGED AND DISABLED

SUBCHAPTER B. INTEREST LISTS

STATUTORY AUTHORITY

The repeal is authorized by Texas Government Code §524.0151, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies; and Texas Human Resources Code §117.080(e) which authorizes the Executive Commissioner of HHSC to adopt rules necessary to implement that section, including requirements applicable to Centers for Independent Living (CIL) providing independent living services under the program.

The repeal implements Texas Government Code §524.0151 and Texas Human Resources Code §117.080.

§ 271.3. Definitions.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on April 29, 2025.

TRD-202501408

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: June 15, 2025

For further information, please call: (817) 458-1902

CHAPTER 271. COMMUNITY CARE SERVICES ELIGIBILITY [ FOR AGED AND DISABLED ]

SUBCHAPTER B. INTEREST LISTS

STATUTORY AUTHORITY

The amendments are authorized by Texas Government Code §524.0151, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies; and Texas Human Resources Code §117.080(e) which authorizes the Executive Commissioner of HHSC to adopt rules necessary to implement that section, including requirements applicable to Centers for Independent Living (CIL) providing independent living services under the program.

The amendments implement Texas Government Code §524.0151 and Texas Human Resources Code §117.080.

§ 271.5. Community Services [ Care ] Interest Lists.

(a) HHSC [ DADS ] maintains, for each HHSC [ DADS ] region, a community services [ care ] interest list for each community care services eligibility service or program authorized under Title XX of the Social Security Act .

(b) A person or responsible person may request in person, by phone [ telephone ], or in writing that HHSC [ DADS ] add a person's [ an applicant's ] name to a Title XX of the Social Security Act community services [ care ] interest list. The person making the request must provide a Texas address for the person [ applicant ].

(c) HHSC [ DADS ] adds a person's [ an applicant's ] name to a community services [ care ] interest list if:

(1) a request is made in accordance with subsection (b) of this section; or

(2) an applicant's name is on the interest list for an HHSC [ a DADS ] region and the applicant or a responsible person [ party ] notifies HHSC [ DADS ] that the applicant has moved to another HHSC [ DADS ] region and requests that the applicant's name be added to the interest list for the HHSC [ DADS ] region to which the applicant has moved.

(d) HHSC [ DADS ] adds an applicant's name to a community services [ care ] interest list with an interest list request date as follows:

(1) for a request to add an applicant's name to the interest list made in accordance with subsection (b) of this section, the date of the request; or

(2) for a request to add an applicant's name to the interest list made in accordance with subsection (c)(2) of this section, the date of the original request made in accordance with subsection (b) of this section.

(e) HHSC [ DADS ] removes an applicant's name from a community services [ care ] interest list if:

(1) the applicant or responsible person [ party ] requests that the applicant's name be removed from the interest list;

(2) the applicant moves out of Texas, unless the applicant is a military family member living outside of Texas:

(A) while the military member is on active duty; or

(B) for less than one year after the former military member's active duty ends;

(3) the applicant is a military family member living outside of Texas for more than one year after the former military member's active duty ends;

(4) the applicant or responsible person [ party ] declines an offer of a community care service or program when contacted by HHSC [ DADS ], as described in §271.7 [ §48.1303 ] of this subchapter (relating to Interest Lists [ Enrollment) or §48.2702 of this chapter (relating to Eligibility Determination Process), ] unless the applicant is a military family member living outside of Texas:

(A) while the military member is on active duty; or

(B) for less than one year after the former military member's active duty ends;

(5) the applicant is deceased; or

(6) HHSC [ DADS ] denies an applicant's eligibility for the community care service or program and the applicant has had an opportunity to exercise the [ the applicant's ] right to appeal the decision in accordance with Title 1 Texas Administrative Code (TAC), Part 15, §357.3 (relating to Authority and Right to Appeal) [ §48.2710 of this chapter (relating to Right to Appeal) ] or §271.155 [ §48.3903 ] of this chapter (relating to Denial, Reduction, and Termination of Benefits) and did not appeal the decision, or appealed and did not prevail.

(f) If HHSC [ DADS ] removes an applicant's name from a community services [ care ] interest list in accordance with subsection (e)(1) - (4) of this section and, within 90 calendar days after the name was removed, HHSC [ DADS ] receives an oral or written request [ from a person ] to reinstate the applicant's name on the interest list, HHSC [ DADS ]:

(1) reinstates the applicant's name to the interest list with an interest list request date described in subsection (d)(1) or (2) of this section; and

(2) notifies the applicant in writing that the applicant's name has been reinstated to the interest list in accordance with paragraph (1) of this subsection.

(g) If HHSC [ DADS ] removes an applicant's name from a community services [ care ] interest list in accordance with subsection (e)(1) - (4) of this section and, more than 90 calendar days after the name was removed, HHSC [ DADS ] receives an oral or written request [ from a person ] to reinstate the applicant's name on the community services interest list, HHSC [ DADS ]:

(1) adds the applicant's name to the community services interest list with a [ an interest list ] request date of:

(A) the date HHSC [ DADS ] receives the oral or written request to reinstate ; or

(B) because of extenuating circumstances as determined by HHSC [ DADS ], the original request date described in subsection (d)(1) or (2) of this section; and

(2) notifies the applicant in writing that the applicant's name has been added to the community services interest list in accordance with paragraph (1) of this subsection.

(h) If HHSC [ DADS ] removes an applicant's name from a community services [ care ] interest list in accordance with subsection (e)(6) of this section and HHSC [ DADS ] subsequently receives an oral or written request [ from a person ] to reinstate the applicant's name on the community services interest list, HHSC [ DADS ]:

(1) adds the applicant's name to the community services interest list with a [ an interest list ] request date of the date HHSC [ DADS ] receives the oral or written request to reinstate ; and

(2) notifies the applicant in writing that the applicant's name has been added to the community services interest list in accordance with paragraph (1) of this subsection.

§ 271.7. Enrollment.

[(b)] When a community care service or program authorized under Title XX of the Social Security Act becomes available in a HHSC [ DADS ] region, HHSC [ DADS ] contacts the applicant whose community services interest list request date, assigned in accordance with §271.5 (d) [ §48.1302(d) ] of this subchapter (relating to [ Community Care ] Interest Lists), is earliest on the community services [ care ] interest list for the community care service or program that is available, and offers the community care service or program to the applicant.

(1) If the applicant or responsible person [ party ] declines the offer of the community care service or program, HHSC [ DADS ] removes the applicant's name from the community services interest list for the community care service or program, as described in §271.5(e)(4) [ §48.1302(e)(4) ] of this subchapter.

(2) If the applicant or responsible person [ party ] accepts the offer of the community care service or program, a caseworker [ case manager ] contacts the applicant to conduct an eligibility determination for the community care service or program.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on April 29, 2025.

TRD-202501409

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: June 15, 2025

For further information, please call: (817) 458-1902

SUBCHAPTER C. ELIGIBILITY

STATUTORY AUTHORITY

The amendments are authorized by Texas Government Code §524.0151, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies; and Texas Human Resources Code §117.080(e) which authorizes the Executive Commissioner of HHSC to adopt rules necessary to implement that section, including requirements applicable to Centers for Independent Living (CIL) providing independent living services under the program.

The amendments implement Texas Government Code §524.0151 and Texas Human Resources Code §117.080.

§ 271.51. Eligibility for Services.

(a) To receive Community Care Services Eligibility (CCSE) [ community care for aged and disabled (CCAD) ] services or programs , a person must meet income, resource, age, and need criteria.

(b) A person who lives in a nursing facility is not eligible to receive CCSE [ CCAD ] services or programs .

(c) A mandatory participant in the Medicaid Home and Community Based Services (HCBS) program [ Integrated Care Management (ICM) Program ] must receive Primary Home Care [ primary home care ] (PHC) and Title XIX of the Social Security Act Day Activity [ day activity ] and Health Services [ health services ] (DAHS) through the HCBS [ ICM ] Program.

§ 271.53. Income and Income Eligibles.

To receive Community Care Services Eligibility [ be eligible for community care for aged and disabled ] services or programs, a person [ the applicant/client ] must:

(1) be categorically eligible by receiving Supplemental Security Income (SSI) [ supplemental security income ], Temporary Assistance to Needy Families (TANF) [ aid to families with dependent children ], Supplemental Nutrition Assistance Program (SNAP) [ food stamps ], Medicaid, Specified Low-income [ specified low-income ] Medicare Beneficiary [ beneficiary ] (SLMB), or Qualified [ qualified ] Medicare Beneficiary [ beneficiary ] (QMB) benefits; or

(2) be income eligible. The person's [ applicant/client's ] and spouse's countable income must be equal to or less than the income limit set by HHSC [ the department ]. For an individual person , this amount is the same as the special income limit set for institutional care (medical assistance only) by the Texas Legislature. For a couple, the income limit is twice the special income limit.

§ 271.55. Determination of Countable Income.

Countable income is determined by totaling [ totalling ] gross income from all the following sources, less all applicable exclusions and exemptions. Applicable exclusions and exemptions [exclusions/exemptions] are specified in §271.57 and §271.59 [ §48.2904 and §48.2905 ] of this subchapter [ title ] (relating to Eligibility [ Income from Excludable Sources and Income from Exempt Sources ]).

(1) Total gross earnings including [ . This includes ] money, wages, commissions, tips, piece-rate payments, cash bonuses, or salary received for work performed as an employee is considered income . This also encompasses pay for members of the armed forces , including [ (including ] allotments from any armed forces pay received by a member of the family group from a person not living in the home [ household) ].

(2) Self-employment income , [ ( ]including farm income , is [ ). For earned income to be ] considered self-employment income when [ , ] either the applicant, client, [ client ] or spouse is [ must be ] actively involved or materially participating in producing the income.

(3) Social security and railroad retirement benefits are considered income .

(4) Dividends [ . This consists of dividends ] from stocks or membership in associations, and periodic receipts from estates of trust funds are considered income . These payments are averaged over a 12-month period.

(5) Rental [ income. This includes ] payments to the person [ individual ] from the rent of housing, store, or other property, as well as from boarders or lodgers , is considered income .

(6) Net income derived from oil, gas, or mineral rights is considered income and [ . This ] can include both lease and royalty payments. These payments are averaged over a 12-month period.

(7) Payments received [ Income ] from mortgages or contracts is considered income .

(8) Public assistance [ or welfare ] payments are considered income and include [ . ] Temporary Assistance to Needy Families, Supplemental Security Income, and general assistance . Cash [ (cash ] payments from a county or city[ ) ] are also included.

(9) Veterans' pensions and compensation checks are considered income and [ . This ] may include money paid periodically by the Veterans Administration to disabled members of the armed forces or to survivors of deceased veterans, subsistence allowances paid to veterans for education and on-the-job training, and refunds paid to ex-servicemen as GI insurance premiums.

(10) Educational loans, grants, fellowships, and scholarships are considered income .

(11) Unemployment compensation [ . Unemployment compensation may be ] received from government employment insurance agencies or private companies during periods of unemployment is considered income. Strike [ , and includes any strike ] benefits received from union funds are also included .

(12) Workers compensation and disability payments are considered income and include [ . This includes ] compensation received periodically from private or public insurance companies for injuries incurred at work.

(13) Alimony is considered income .

(14) Regular monthly cash support payments from friends or relatives is considered income .

(15) Pensions, annuities, and irrevocable trust fund payments [ funds. Payments may be ] paid to a retired person or the retired person's [ his ] survivors by a former employer or by a union, either directly or through an insurance company is considered income . Periodic payments from annuities, insurance, irrevocable trust fund payments, and civil service pensions are included.

(16) Payments received [ Income ] from the applicant's or client's share of a life estate are considered income .

§ 271.57. Income from Excludable Sources.

Income may be fully or partially countable[ , ] or may be excluded from the current eligibility budget. Excludable income will continue to be monitored by the caseworker at each financial review to determine how eligibility is affected. Excludable sources of income include:

(1) deductions from earned income, including social security payments, Medicare premium payments, bonds, pensions, and union dues;

(2) the first $65 of an applicant's, [ a ] client's , or couple's [ (or couple's) ] net earned income, plus 1/2 of the remainder;

(3) loans, grants, scholarships, and fellowship funds obtained and used under conditions that preclude the [ their ] use for current living costs ; any [ . Any ] portion used to pay any other expense [ (room, board, books, etc.) ] cannot be excluded;

(4) Veterans Administration aid-and-attendance benefits, homebound elderly benefits, and payments to certain eligible veterans for purchase of medications;

(5) infrequent or irregular income [ (income ] received less frequently than once a month[ ) ] that averages $20 per month or less;

(6) 1/3 of the total amount of child support payments for an eligible child; and

(7) allowable exclusions from self-employment income, as indicated on the following chart.

Figure: 26 TAC §271.57(7) (.pdf)

[ Figure: 26 TAC §271.57(7) ]

§ 271.59. Income from Exempt Sources.

Exempt income is not included in the income eligibility calculation. Once identified and documented, caseworkers will not be required to monitor exempt income at subsequent financial redeterminations. Sources of exempt income include:

(1) interest income ; [ . ]

(2) cash received from the sale of a resource [ . This cash ] is a resource, not income ; [ . ]

(3) income of minor children who are supported by or dependent upon the client ; [ . ]

(4) refunds from the Internal Revenue Service for earned income tax credit ; [ . ]

(5) reimbursement from an insurance company for health insurance claims ; [ . ]

(6) any cash from a non-governmental medical or social services organization if the cash is:

(A) for medical or social services already received by the applicant or client [ individual ] and approved by the organization, and which does not exceed the value of those services; or

(B) a payment restricted to the future purchase of a medical or social service ; [ . ]

(7) proceeds of either a commercial loan or an informal loan, for which repayment is required with or without interest : [ . ]

(A) the [ The proceeds ( ] amount borrowed is [ ) are ] not counted as income in the month in which it is [ they are ] received, but is [ are ] considered to be a resource in the following months; and [ month(s). ]

(B) to [ To ] claim exemption of the proceeds of a loan, an applicant or [ a ] client must prove that they acknowledge [ he acknowledges ] an obligation to repay and that a [ some ] plan for repayment exists ; if [ . If ] these conditions can be verified, no written contract is required ; [ . ]

(8) the amount of the cost-of-living increase in any pension or benefit, received on or after January 1, 1985, that would cause the client to be ineligible for continued community care services or programs . This exclusion applies only to [ community care ] clients who are already receiving community care services or programs, or case management , and would become ineligible because of the increase ; it [ . It ] does not apply to applicants ; [ . ]

(9) in-kind income, such as food, clothing, shelter, rent subsidies ; [ . ]

(10) one-time or lump-sum payments from any source ; [ . ]

(11) [ (12) ] payments from the Agent Orange Settlement Fund or any other fund established in settlement of the Agent Orange product liability litigation , as [ . ] Public Law 101-239 exempts the payments from countable income and resources ; the [ . The ] law is retroactive as of January 1, 1989 ; [ . ]

(12) [ (13) ] any payment received under the Radiation Exposure Compensation Act (Public Law 101-246) ; [ . ]

(13) [ (14) ] any payment received under the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 ; [ . ]

(14) [ (15) ] payments to volunteers under the Domestic Volunteer Services Act , this [ . This ] exclusion applies to :

(A) any payments to volunteers in the Retired Senior Volunteer Program, [ and ] Foster Grandparent Program, and the Senior Companion Program ; and

(B) [ . Also included are ] payments under Title III of the same act, which includes the Service Corps of Retired Executives (SCORE), the Active Corps of Executives (ACE), and the Action Cooperative Volunteer Program (ACV) ; [ . ]

(15) [ (16) ] interest or other earnings on any designated account established for Supplemental Security Income (SSI) clients under [ age ] 18 years of age for retroactive benefits, as required by Public Law 104-193, effective August 22, 1996 ; [ . ]

(16) [ (17) ] payments by the Federal Disaster Assistance Administration authorized by the Disaster Relief Act, as amended ; [ . ]

(17) [ (18) ] value of any housing assistance paid on a house under the United States Housing Act of 1937, the National Housing Act, the Housing and Urban Development Act of 1965, §101, or Title V of the Housing Act of 1949, as authorized by Public Law 94-375 ; [ . ]

(18) [ (19) ] home energy assistance, except food or clothing, under Public Laws 97-377 and 97-424 [ . Home energy assistance ] is assistance in cash or in-kind that is provided by a private, nonprofit organization or a utility company , and [ . Some ] examples include [ of home energy assistance are ] heating, cooling, weatherization, storm windows, and blankets ; [ . ]

(19) [ (20) ] reparation payments received by Holocaust survivors from the Federal Republic of Germany[ . The payments may be ] made periodically or as a lump sum , and HHSC [ .The Texas Department of Human Services ] accepts the applicant's or client's signed statement of amounts involved and dates of payment ; [ . ] Public Law 101-508 established this exemption effective January 1, 1991 ; [ . ]

(20) [ (21) ] payments from a state-administered fund to aid victims of crime ; [ . ] Public Law 101-508 established this exemption effective May 1, 1991 ; [ . ]

(21) [ (22) ] payments a state or local government may make as relocation assistance ; [ . ] Public Law 101-508 established this exemption effective October 15, 1990 ; [ . ]

(22) [ (23) ] hazardous duty pay of a spouse or parent absent from the home because of active military service ; [ . ]

(23) [ (24) ] restitution payments made by the United States government under Public Law 100-383 to Japanese-Americans [ Japanese-American ( ]or, [ if deceased, ] to the Japanese-Americans' [ their ] survivors[ ) ] , who were interned or relocated during World War II ; [ . ]

(24) [ (25) ] reparation payments received under §§500-506 of the Austrian General Social Insurance Act ; [ . ]

(25) [ (26) ] payments under the Netherlands' Act on Benefits for Victims of Persecution Wet Uitkering Vervolgingsslachtoffers (WUV) 1940-1945 ; or [ (Dutch acronym, WUV). ]

(26) [ (27) ] payment from any source made to an applicant or a client [ individuals ] because of the applicant's or client's [ their ] status as victims of Nazi persecution ; [ . ] Public Law 103-286 established this exemption effective August 1, 1994.

§ 271.61. Age.

(a) A person must be at least 18 years of age [ or older ], or an emancipated minor, to receive Community Care Services Eligibility (CCSE) [ Community Care for the Aged and Disabled (CCAD) ] services or programs , except:

(1) a person of any age may receive CCSE [ CCAD ] Medicaid-funded day activity and health services;

(2) a person of any age who is not eligible for the Texas STAR Kids [ Health Steps ] program may receive CCSE [ CCAD ] Medicaid-funded Community Attendant Services [ community attendant services ]; and

(3) a person must be at least 21 years of age [ or older ] to receive CCSE Primary Home Care [ CCAD primary home care ] services, except a current CCSE Primary Home Care [ CCAD primary home care ] services client [ consumer ] who is eligible for Texas STAR Kids [ Health Steps ] and who becomes 21 years of age on or before February 29, 2008.

(b) A person under 21 years of age who is eligible for the Texas STAR Kids [ Health Steps ] program may be eligible for community [ personal ] care services or programs provided through the Texas STAR Kids program [ Health and Human Services Commission ].

§ 271.63. Need.

(a) HHSC [ DADS ] uses the HHSC [ DADS ] Needs Assessment Questionnaire and Task/Hour Guide form to determine a person's [ an applicant's or individual's ] functional need and unmet need for:

(1) Community Attendant Services (CAS) [ community attendant services ];

(2) Family Care (FC) [ family care services ];

(3) Primary Home Care (PHC) [ Program ];

(4) Home Delivered Meals (HDM) [ Program ];

(5) Adult Foster Care (AFC) [ adult foster care ];

(6) Residential Care (RC) [ Program ];

(8) [ (7) ] Emergency Response Services (ERS) [ emergency response services ]; and

(9) [ (8) ] Special Services to Persons with Disabilities Program (SSPD) .

(b) To receive [ be eligible for ] a service or program described in subsection (a) of this section, a person [ an applicant or individual ] must have a functional need and an unmet need for the program or service.

§ 271.65. Indian-related Exemptions.

(a) Type of payment. The following statutes provide that some [ certain types of ] payments made to members of Indian tribes are exempt from income and resources as specified in paragraphs (1)-(4) of this subsection, or only from income as specified in paragraph (5) of this subsection.

(1) Indian Judgment Funds Distribution Act--Public Law 93-134. Effective October 19, 1973, per capita distribution payments to members of Indian tribes who are due judgment funds, according to a plan of the Secretary of the Interior [ ( ]or , legislation[ , ] when a plan cannot be prepared or is not approved by [ the ] Congress[ ) ] , are exempted from income and resources. This does not include payments of funds distributed or held in trust [ (i.e., in the possession or care of a trustee) ] according to public laws enacted before October 19, 1973.

(2) Distribution of Indian Judgment Funds--Public Law 97-458. Effective January 12, 1983, Indian judgment funds held in trust [ (i.e., in the possession or care of a trustee) ] or distributed per capita, pursuant to an approved plan, or the fund's [ their ] availability, are exempted from income and resources. Indian judgment funds include interest and investment income accrued while the funds are held in trust. Initial purchases made with distributed judgment funds are exempted from resources.

(3) Per Capita Act--Public Law 98-64.

(A) Effective August 2, 1983, per capita distributions of all funds held in trust by the Secretary of the Interior to members of an Indian tribe are exempted from income and resources.

(B) Any local tribal funds that a tribe distributes to individuals on a per capita basis, but which have not been held in trust by the Secretary of the Interior [ (e.g., tribally managed gaming revenues) ] are not exempted from income and resources under this provision. Example: Tribally-managed gaming revenues.

(4) Alaska Native Claims Settlement Act (ANCSA)--Public Law 100-241.

(A) Effective February 3, 1988, the following items received from a native corporation are exempted from income and resources:

(i) cash received from a native corporation , [ ( ]including cash dividends on stock received from a native corporation , [ ) ] to the extent it does not exceed $2,000, per individual per year;

(ii) stock , [ ( ]including stock issued or distributed by a native corporation as a dividend or distribution on stock[ ) ];

(iii) a partnership interest;

(iv) land or an interest in land , [ ( ]including land or an interest in land received from a native corporation as a dividend or distribution on stock[ ) ]; and

(v) an interest in a settlement trust.

(B) The ANCSA also provides that up to $2,000 in retained distributions from a native corporation may be exempted from resources for each year beginning with 1988.

(5) Payments from Individual Interests in Trust or Restricted Lands--Public Law 103-66.

(A) Effective January 1, 1994, up to $2,000 per year received by Indians that is derived from individual interests in trust or restricted lands is exempted from income.

(B) Interests of individual Indians in trust or restricted lands are exempted from resources.

(b) Payments to specific Indian tribes and groups. The following statutes provide that certain payments made to members of specified Indian tribes and groups are exempt from income and resources.

(1) Distribution of Per Capita Funds--Public Law 85-794. Effective August 28, 1958, per capita payments to members of the Red Lake Band of Chippewa Indians from the proceeds of the sale of timber and lumber on the Red Lake Reservation are exempted from income and resources.

(2) Distribution of Judgment Funds--Public Law 92-254. Effective March 18, 1972, per capita distribution payments by the Blackfeet and Gros Ventre tribal governments to members, which resulted from judgment funds to the tribes, are exempted from income and resources.

(3) Distribution of Claims Settlement Funds--Public Law 93-531 and Public Law 96-305. Effective December 22, 1974, settlement fund payments to members of the Hopi and Navajo Tribes, and the availability of such funds, are exempted from income and resources.

(4) Receipts from Lands Held in Trust for Indian Tribes--Public Law 94-114.

(A) Effective October 17, 1975, receipts derived from the following trust lands and distributed to members of designated Indian tribes are exempted from income and resources.

(B) The first four Indian groups had lands conveyed with mineral rights before [ prior to ] Public Law 94-114; that law conveyed the rest of the lands [ land ] to the remaining Indian groups.

Figure: 26 TAC §271.65(b)(4)(B) (.pdf)

[ Figure: 26 TAC §271.65(b)(4)(B) ]

(5) Distribution of Judgment Funds--Public Law 94-189. Effective December 31, 1975, judgment funds distributed per capita to, or held in trust for, members of the Sac and Fox Indian Nation, and the availability of such funds, are exempted from income and resources.

(6) Distribution of Judgment Funds--Public Law 94-540. Effective October 18, 1976, judgment funds distributed per capita to, or held in trust for, members of the Grand River Band of Ottawa Indians, and the availability of such funds, are exempted from income and resources.

(7) Distribution of Judgment Funds--Public Law 95-433. Effective October 10, 1978, any judgment funds distributed per capita to members of the Confederated Tribes and Bands of the Yakima Indian Nation or the Apache Tribe of the Mescalero Reservation are exempted from income and resources.

(8) Receipts from Lands Held in Trust--Public Law 95-498. Effective October 21, 1978, receipts derived from trust lands awarded to the Pueblo of Santa Ana and distributed to members of that tribe are exempted from income and resources.

(9) Receipts from Lands Held in Trust--Public Law 95-499. Effective October 21, 1978, receipts derived from trust lands awarded to the Pueblo of Zia and distributed to members of that tribe are exempted from income and resources.

(10) Distribution of Judgment Funds--Public Law 96-318. Effective August 1, 1980, any judgment funds distributed per capita or made available for programs for members of the Delaware Tribe of Indians and the absentee Delaware Tribe of Western Oklahoma are exempted from income and resources.

(11) Maine Indian Claims Settlement Act--Public Law 96-420. Effective October 10, 1980, all funds and distributions to members of the Passamaquoddy Tribe, the Penobscot Nation, and the Houlton Band of Maliseet Indians under the Maine Indian Claims Settlement Act, and the availability of such funds, are exempted from income and resources.

(12) Distribution of Judgment Funds--Public Law 97-95. Effective December 17, 1981, any distributions of judgment funds to members of the San Carlos Tribe of Arizona are exempted from income and resources.

(13) Distribution of Judgment Funds--Public Law 97-371. Effective December 20, 1982, any distributions of judgment funds to members of the Wyandot Tribe of Indians of Oklahoma are exempted from income and resources.

(14) Distribution of Judgment Funds--Public Law 97-372. Effective December 20, 1982, distributions of judgment funds to members of the Shawnee Tribe of Indians (Absentee Shawnee Tribe of Oklahoma, the Eastern Shawnee Tribe of Oklahoma, and the Cherokee Band of Shawnee descendants) are exempted from income and resources.

(15) Distribution of Judgment Funds--Public Law 97-376. Effective December 21, 1982, judgment funds distributed per capita or made available for programs for members of the Miami Tribe of Oklahoma and the Miami Indians of Indiana are exempted from income and resources.

(16) Distribution of Judgment Funds--Public Law 97-402. Effective December 31, 1982, distributions of judgment funds to members of the Clallam Tribe of Indians of the State of Washington (Port Gamble Indian Community, Lower Elwha Tribal Community, and the Jamestown Band of Clallam Indians) are exempted from income and resources.

(17) Distribution of Judgment of Funds--Public Law 97-403. Effective December 31, 1982, judgment funds distributed per capita or made available for programs for members of the Pembina Chippewa Indians (Turtle Mountain Band, Chippewa Cree Tribe, Minnesota Chippewa Tribe, and Little Shell Band of Chippewa Indians of Montana) are exempted from income and resources.

(18) Distribution of Judgment Funds--Public Law 97-408. Effective January 3, 1983, per capita distributions of judgment funds to members of the Gros Ventre and Assiniboine Tribes of Fort Belknap Indian Community, and the Papago Tribe of Arizona, are exempted from income and resources.

(19) Distribution of Judgment Funds--Public Law 97-436. Effective January 8, 1983, up to $2,000 of per capita distributions of judgment funds to members of the Confederated Tribes of the Warm Springs Reservation are exempted from income and resources.

(20) Distribution of Judgment Funds--Public Law 98-123. Effective October 13, 1983, judgment funds distributed to the Red Lake Band of Chippewa Indians are exempted from income and resources.

(21) Distribution of Judgment Funds--Public Law 98-124. Effective October 13, 1983, funds distributed per capita or family interest payments for members of the Assiniboine Tribe of the Fort Belknap Indian Community of Montana and the Assiniboine Tribe of the Fort Peck Indian Reservation of Montana are exempted from income and resources.

(22) Distribution of Claims Settlement Funds--Public Law 98-432. Effective September 28, 1984, judgment funds and income therefrom distributed to members of the Shoalwater Bay Indian Tribe are exempted from income and resources.

(23) Distribution of Claims Settlement Funds--Public Law 98-500. Effective October 19, 1984, all distributions to heirs of certain deceased Indians under the Old Age Assistance Claims Settlement Act are exempted from income and resources.

(24) Distribution of Judgment Funds--Public Law 98-602. Effective October 30, 1984, judgment funds distributed per capita or made available for any tribal program, for members of the Wyandotte Tribe of Oklahoma and the Absentee Wyandottes, are exempted from income and resources.

(25) Distribution of Judgment Funds--Public Law 99-130. Effective October 28, 1985, per capita and dividend payment distributions of judgment funds to members of the Santee Sioux Tribe of Nebraska, the Flandreau Santee Sioux Tribe, and the Prairie Island Sioux, Lower Sioux, and Shakopee Mdewakanton Sioux Communities of Minnesota are exempted from income and resources.

(26) Distribution of Judgment funds--Public Law 99-146. Effective November 11, 1985, funds distributed per capita or held in trust for members of the Chippewas of Lake Superior and the Chippewas of the Mississippi are exempted from income and resources.

(27) Distribution of Claims Settlement Funds--Public Law 99-264. Effective March 24, 1986, distributions of claims settlement funds to members of the White Earth Band of Chippewa Indians as allottees, or the member's [ their ] heirs, are exempted from income and resources.

(28) Distribution of Judgment Funds--Public Law 99-346. Effective June 30, 1986, payments or distributions of judgment funds, and the availability of any amount for such payments or distributions, to members of the Saginaw Chippewa Indian Tribe of Michigan are exempted from income and resources.

(29) Distribution of Judgment Funds--Public Law 99-377. Effective August 8, 1986, judgment funds distributed per capita or held in trust for members of the Chippewas of Lake Superior and the Chippewas of the Mississippi are exempted from income and resources.

(30) Distribution of Judgment Funds--Public Law 100-139. Effective October 26, 1987, judgment funds distributed to members of the Cow Creek Band of Umpqua Tribe of Indians are exempted from income and resources.

(31) Aleutian and Pribil of Islands Restitution Act--Public Law 100-383. Effective August 10, 1988, per capita restitution payments made to eligible Aleuts who were relocated or interned during World War II are exempted from income and resources.

(32) Distribution of Claims Settlement Funds--Public Law 100-411. Effective August 22, 1988, per capita payments of claims settlement funds to members of the Coushatta Tribe of Louisiana are exempted from income and resources.

(33) Hoopa-Yurok Settlement Act--Public Law 100-580. Effective October 31, 1988, funds distributed per capita for members of the Hoopa Valley Indian Tribe and the Yurok Indian Tribe are exempted from income and resources.

(34) Distribution of Judgment Funds--Public Law 100-581. Effective November 1, 1988, judgment funds held in trust by the United States, including interest and investment income accruing on such funds, and judgment funds made available for programs or distributed to members of the Wisconsin Band of Potawatomi (Hannahville Indian [ Indians ] Community and Forest County Potawatomi) are exempted from income and resources.

(35) Distribution of Money and Land--Public Law 101-41. Effective June 21, 1989, all funds, assets, and income from the trust fund transferred to the members of the Puyallup Tribe under the Puyallup Tribe of Indians Settlement Act of 1989 are exempted from income and resources.

(36) Distribution of Judgment Funds--Public Law 101-277. Effective April 30, 1990, judgment funds distributed per capita, or held in trust, or made available for programs, for members of the Seminole Nation of Oklahoma, the Seminole Tribe of Florida, the Miccosukee Tribe of Indians of Florida, and the independent Seminole Indians of Florida (plus any interest and investment income accruing on the funds held in trust), and the availability of those funds, are exempted from income and resources.

(37) Distribution of Settlement Funds--Public Law 101-503. Effective November 3, 1990, payments, funds, distributions, or income derived from them under the Seneca Nation Settlement Act of 1990 are exempted from income and resources.

(38) Distribution of Settlement Fund--Public Law 101-618. Effective November 16, 1990, per capita distributions of settlement funds under the Fallon Paiute Shoshone Indian Tribes Water Rights Settlement Act of 1990 are exempted from income and resources.

(39) Distribution of Settlement Funds--Public Law 103-116. Settlement funds, assets, income, payments or distributions from trust funds to members of the Catawba Indian Tribe under the Catawba Indian Tribe of South Carolina Land Claims Settlement Act of 1993 are exempted from income and resources.

(40) Distribution of Settlement Funds--Public Law 103-436. Effective November 2, 1994, settlement funds held in trust, including interest and investment income accruing on such funds, and payments made to members of the Confederated Tribes of the Colville Reservation under the Confederated Tribes of the Colville Reservation Grand Coulee Dam Settlement Act are exempted from income and resources.

§ 271.69. Family Care.

(a) To receive Family Care (FC) services, a person [ be eligible for family care, the applicant/client ] must meet the minimum functional need criteria as set by HHSC. HHSC uses a standardized assessment instrument to measure the person's ability to perform activities of daily living. This yields a score, which is a measure of the person's level of functional need. HHSC sets the minimum required score for a person to receive FC, which HHSC may periodically adjust commensurate with available funding. HHSC will seek stakeholder input before making any change in the minimum required score for functional eligibility. [ : ]

(1) A person must meet the income and resource guidelines established by HHSC [ the department ] in §§271.53, 271.55, 271.89, and 271.91 [ §§48.2902, 48.2903, 48.2922, and 48.2923 ] of this subchapter [ title ] (relating to Eligibility [ Income and Income Eligibles; Determination of Countable Income; Resource Limits; and Countable Resources ]); and

(2) [ (3) ] be ineligible to receive attendant care services funded through Medicaid.

(b) If eligible, a person [ an applicant/client ] may receive one or more of the following services:

(1) personal care;

(2) household tasks;

(3) meal preparation; and

(4) escort.

(c) Family Care [ care ] services are provided in a client's residence. A person [ client ] is not eligible to receive Family Care [ family care ] services while living in:

(1) a hospital;

(2) a skilled nursing facility;

(3) an intermediate care facility;

(4) an assisted living facility;

(5) a foster care setting;

(6) a jail or prison;

(7) a state supported living center [ school ];

(8) a state hospital; or

(9) any other setting where sources outside the family care program are available to provide care.

(d) The person [ applicant/client ] must require at least six hours of Family Care services [ family care ] per week to be eligible, unless the person [ applicant/client ]:

(1) requires Family Care [ family care ] to provide caregiver support [ respite ] to the caregiver;

(2) lives in the same home [ household ] as another client [ individual ] receiving Family Care (FC) services [ family care ], Home and Community-based Services (HBCS) [ community based alternatives ] personal assistance services, Community Attendant Services (CAS) [ community attendant services ], or Primary Home Care (PHC) services [ primary home care ];

(3) receives one or more of the following services [ ( ]through HHSC [ the department ] or other resources[ ) ]:

(A) Congregate [ congregate ] or Home Delivered Meals [ home-delivered meals ];

(B) assistance with activities of daily living from a home health aide;

(C) Day Activity [ day activity ] and Health Services [ health services ]; or

(D) Special Services [ special services ] to Persons [ persons ] with Disabilities [ disabilities ] in day activity and health services [ adult day care ];

(4) receives aid-and-attendance benefits from the Veterans Administration; or

(5) [ (6) ] is determined, based upon the functional assessment, to be at high risk of institutionalization without Family Care [ family care ].

(e) The caseworker [ community care case manager ] establishes a priority status for each person [ client ] based on the functional assessment. A person [ An individual ] is considered to have priority status if the following criteria are met . [ : ]

(1) The person [ individual ] is completely unable to perform one or more of the following activities without hands-on assistance from another person:

(A) transferring [ himself ] into or out of bed or a chair , or on or off a toilet;

(B) feeding [ himself ];

(C) getting to or using the toilet;

(D) preparing a meal; or

(E) taking self-administered prescribed medications.

(2) During a normally scheduled service shift, no one is readily available who is capable and who is willing to provide the needed assistance other than the family care attendant.

(3) The caseworker [ community care case manager ] determines that there is a high likelihood the person's [ individual's ] health, safety, or well-being would be jeopardized if family care services were not provided on a single given shift.

(f) A client with priority status may receive no more than 42 hours of service per week.

(g) A client without priority status may receive no more than 50 hours of service per week.

§ 271.71. Home Delivered [ Home-Delivered ] Meals.

To receive Home Delivered Meals (HDM) [ be eligible for home-delivered meals ], a person [ applicants and clients ] must meet the functional need criteria as set by HHSC [ the department ]. HHSC [ The department ] uses a standardized assessment instrument to measure a person's [ the client's ] ability to perform activities of daily living. This yields a score, which is a measure of the person's [ client's ] level of functional need. HHSC [ The department ] sets the minimum required score for a person [ client ] to receive HDM [ be eligible ], which HHSC [ the department ] may periodically adjust commensurate with available funding. HHSC [ The department ] will seek stakeholder input before making any change in the minimum required score for functional eligibility.

§ 271.73. Adult Foster Care.

To receive Adult Foster Care (AFC) [ be eligible for adult foster care ], a person [ applicants and clients ] must have the approval of the Community Care Services Eligibility [ Community Care for Aged and Disabled ] unit supervisor and meet the functional need criteria as set by HHSC [ the department ]. HHSC [ The department ] uses a standardized assessment instrument to measure the person's [ client's ] ability to perform activities of daily living. This yields a score, which is a measure of the person's [ client's ] level of functional need. HHSC [ The department ] sets the minimum required score for a person [ client ] to be eligible, which HHSC [ the department ] may periodically adjust commensurate with available funding. HHSC [ The department ] will seek stakeholder input before making any change in the minimum required score for functional eligibility.

§ 271.75. Special Services to Persons with Disabilities.

To receive Special Services [ be eligible for special services ] to Persons [ persons ] with Disabilities (SSPD) [ disabilities ], a person [ clients ] must meet the functional need criteria as set by HHSC [ the department ]. HHSC [ The department ] uses a standardized assessment instrument to measure a person's [ the client's ] ability to perform activities of daily living. This yields a score, which is a measure of a person's [ the client's ] level of functional need. HHSC [ The department ] sets the minimum required score for a person [ client ] to receive SSPD [ be eligible ], which HHSC [ the department ] may periodically adjust commensurate with available funding. HHSC [ The department ] will seek stakeholder input before making any change in the minimum required score for functional eligibility. An applicant [ Applicants ] may be admitted to the SSPD [ attendant services ] program only if the applicant's [ their ] needs do not exceed the program's available services.

§ 271.77. Day Activity and Health Services.

To be eligible for Day Activity [ day activity ] and Health Services [ health services ] (DAHS), a person [ an applicant or client ] must:

(1) be Medicaid-eligible [ Medicaid eligible ] or meet the income and resource guidelines established in §§271.53, 271.55, 271.89, and 271.91 [ §§48.2902, 48.2903, 48.2922, and 48.2923 ] of this subchapter [ chapter ] (relating to Eligibility [ Income and Income Eligibles; Determination of Countable Income; Resource Limits; and Countable Resources ]);

(2) have an unmet need for DAHS as determined by HHSC [ DADS ];

(3) while receiving DAHS, not receive a service that is identified as being mutually exclusive to DAHS in the Mutually Exclusive Services table in Appendix XX of the [ Case Manager ] Community Care Services Eligibility [ for Aged and Disabled ] Handbook available at www.hhs.texas.gov [ www.dads.state.tx.us ];

(4) have a chronic medical diagnosis and physician's orders for DAHS on the HHSC [ DADS ] Day Activity and Health Services (DAHS) Physician's Orders form; and

(5) have one or more functional limitations and the potential for receiving therapeutic benefit from DAHS as determined by HHSC [ DADS ] review of the Day Activity and Health Services (DAHS) Health Assessment/Individual Service Plan form completed in accordance with §211.203 [ §98.203 ] of this title (relating to Written Referrals for Services) or §211.204 [ §98.204 ] of this title (relating to DAHS Facility-Initiated Referrals).

§ 271.79. Case Management Services.

A person [ Clients ] must meet the eligibility criteria for Community Care Services Eligibility (CCSE) [ CCAD ] services or programs , but the person does [ they do ] not have to receive the services to receive case management. Ineligible applicants receiving only information and referral services are not eligible for case management.

§ 271.81. Primary Home Care or Community Attendant Services.

(a) To be eligible for Primary Home Care (PHC) [ primary home care ] or Community Attendant Services (CAS) a person [ community attendant (CA) services, the applicant/client ] must meet the minimum functional need criteria as set by HHSC. HHSC uses a standardized assessment instrument to measure the person's ability to perform activities of daily living. This yields a score, which is a measure of the person's level of functional need. HHSC sets the minimum required score for a person to receive PHC, which HHSC may periodically adjust commensurate with available funding. HHSC will seek stakeholder input before making any change in the minimum required score for functional eligibility. A person must also :

(1) be Medicaid-eligible [ eligible for Medicaid ] in a community setting or be eligible under the provisions of the Social Security Act, §1929(b)(2)(B);

(2) [ (3) ] have a medical need for assistance with personal care : [ . ]

(A) the person's [ The client's ] medical condition must be the cause of the person's [ client's ] functional impairment in performing personal care tasks ; and [ . ]

(B) a person [ Persons ] diagnosed with mental illness, intellectual and developmental disabilities [ mental retardation ], or both, are not considered to have established medical need based solely on such diagnosis , however, the [ . The ] diagnoses do not disqualify a person [ client ] for eligibility as long as the person's [ client's ] functional impairment is related to a coexisting medical condition;

(3) [ (4) ] have a signed and dated practitioner's statement that includes a statement that the person [ client ] has a current medical need for assistance with personal care tasks and other activities of daily living[ ; ] and :

(A) [ (5) ] requires [ require ] at least six hours of service per week ; or [ . ]

(B) requires [ An applicant/client requiring ] fewer than six hours of service per week and may be eligible if the person [ applicant/client ]:

(i) [ (A) ] requires primary home care or community attendant services to provide caregiver support [ respite care ] to the caregiver;

(ii) [ (B) ] lives in the same home [ household ] as another person [ individual ] receiving Primary Home Care, Community Attendant Services, Family Care, or Texas Home and Community-Based Services (HCBS) [ primary home care, community attendant services, family care, or community based alternatives ] personal assistance services;

(iii) [ (C) ] receives one or more of the following services [ ( ]through HHSC [ the department ] or other resources[ ) ]:

(I) [ (i) ] Congregate congregate ] or Home Delivered Meals [ home-delivered meals ];

(II) [ (ii) ] assistance with activities of daily living from a home health aide;

(III) [ (iii) ] Day Activity [ day activity ] and Health Services [ health services ]; or

(IV) [ (iv) ] Special Services [ special services ] to Persons [ persons ] with Disabilities [ disabilities ] in day activity and health services [ adult day care ];

(iv) [ (D) ] receives aid-and-attendance benefits from the Veterans Administration;

[(E)] [ receives services through the department's In-home and Family Support Program; ]

(v) [ (F) ] receives services through the Medically Dependent Children Program (MDCP); or

(vi) [ (G) ] is determined, based upon the functional assessment, to be at high risk of institutionalization without Primary Home Care [ primary home care ] or Community Attendant Services [ community attendant care services ].

(b) To receive services, a person [ the applicant/client ] must reside in a place other than:

(1) a hospital;

(2) a skilled nursing facility;

(3) an intermediate care facility;

(4) an assisted living facility;

(5) a foster care setting;

(6) a jail or prison;

(7) a state supported living center [ school ];

(8) a state hospital; or

(9) any other setting where sources outside the primary home care or community attendant program are available to provide personal care.

(c) A client with priority status may receive no more than 42 hours of service per week. A client without priority status may receive no more than 50 hours of service per week.

(d) The caseworker [ community care case manager ] establishes a priority status for each client based on the functional assessment. A client [ An individual ] is considered to have priority status if the following criteria are met . [ : ]

(1) The client [ individual ] is completely unable to perform one or more of the following activities without hands-on assistance from another person:

(A) transferring [ himself ] into or out of bed or a chair , or on or off a toilet;

(B) feeding [ himself ];

(C) getting to or using the toilet;

(D) preparing a meal; or

(E) taking self-administered prescribed medications.

(2) During a normally scheduled service shift, no one is readily available who is capable and who is willing to provide the needed assistance other than the attendant.

(3) The caseworker [ community care case manager ] determines that there is a high likelihood the client's [ individual's ] health, safety, or well-being would be jeopardized if services are [ were ] not provided on a single given shift.

§ 271.83. Time Allocation for Escort Services.

(a) Allocation of time for escort services on the client needs assessment is allowed only if it can be documented that one of the following occurs at least once a month:

(1) accompanying the client to a clinic, doctor's office, or other trips made for the purpose of obtaining medical diagnosis or treatment; or

(2) waiting in the doctor's office or clinic with a client when necessary due to the client's condition or [ and/or ] distance from home.

(b) Additional time may not be allocated for escort services for purposes other than those described in subsection (a) of this section. However, the client may elect to substitute escort services for time allotted to any other task.

§ 271.85. Residential Care.

(a) Eligibility for Residential Care (RC) [ residential care ] is based on the following criteria . [ : ]

(1) The person [ the applicant ] must be income eligible or Medicaid-eligible, [ Medicaid eligible ( ] not in an institution . [ ); ]

(2) The person [ the applicant ] must meet the functional need criteria as set by HHSC [ the department ]. HHSC [ The department ] uses a standardized assessment instrument to measure the person's [ client's ] ability to perform activities of daily living. This yields a score, which is a measure of the person's [ client's ] level of functional need. HHSC [ The department ] sets the minimum required score for a person [ client ] to receive RC [ be eligible ], which HHSC [ the department ] may periodically adjust commensurate with available funding. HHSC [ The department ] will seek stakeholder input before making any change in the minimum required score for functional eligibility . [ ; ]

(3) The person's [ the applicant's ] needs may not exceed the facility's capability under its licensed authority . [ ; and ]

(4) The person [ the applicant ] must have financial resources at or below the level established by HHSC [ the department ].

(b) The client must contribute to the total cost of the care that the client [ he ] receives, including payment for room and board. The room and board amount is calculated from the client's gross income. The client is responsible for paying this amount directly to the provider agency. The client may be required to pay a copayment based on the amount of income remaining after all allowances are deducted.

(1) The client keeps a monthly allowance for the client's [ his ] personal and medical expenses. The Medicaid client keeps $123; a qualified Medicare beneficiary , non-Medicaid, [ (non-Medicaid) ] keeps $182; and the non-Medicaid, non-QMB client keeps $211 and the part B Medicare premium fee.

(2) In addition to the monthly allowance, a client with earned income keeps all of the earned income up to a maximum of $65 per month.

(3) The client's [ In no case may the client's ] contribution must not , when added to HHSC's [ the department's ] payment, exceed the rate established for residential care.

(c) The client is eligible for 14 days of personal leave from the residential care facility each calendar year. If the client does not pay the bedhold charge for days of personal leave that exceed the limits, the client [ he ] may lose their [ his ] space in the facility.

(d) To reserve the client's [ his ] space in the facility during hospital, nursing home, or institutional stays, the client must pay the [ his ] copayment or the facility's bedhold charge, whichever is lower. If the copayment amount is less than the bedhold charge, HHSC [ the department ] pays the difference. Nursing home and institutional stays are limited to 30 days. There is no limit to the length of hospital stays.

§ 271.87. Emergency Care.

(a) Eligibility for Emergency Care (EC) [ emergency care ] is based on the following criteria : [ . ]

(1) the [ The ] applicant:

(A) has lost their [ his ] home or caregiver; or

(B) has been discharged from a hospital or institution; or

(C) is in a similar emergency situation; and

(2) the [ The ] applicant:

(A) is income-eligible or Medicaid-eligible, [ medicaid-eligible ( ] not in an institution [ ) ]; and

(B) meets the functional need criteria as set by HHSC [ the department ]. HHSC [ The department ] uses a standardized assessment instrument to measure the applicant's [ client's ] ability to perform activities of daily living. This yields a score, which is a measure of the applicant's [ client's ] level of functional need. HHSC [ The department ] sets the minimum required score for a person [ client ] to receive EC [ be eligible ], which HHSC [ the department ] may periodically adjust commensurate with available funding. HHSC [ The department ] will seek stakeholder input before making any change in the minimum required score for functional eligibility.

(3) The applicant's needs may not exceed the facility's capability under its licensed authority.

(b) A client receiving Emergency Care is [ care clients are ] eligible for services for up to and including 30 days while HHSC [ the department ] seeks a permanent care arrangement. If the client is not placed within the initial 30-day period, the client is [ he is ] eligible to receive services for up to one 30-day extension, for a total of 60 days.

(c) Emergency Care [ care ] is terminated by HHSC [ the department ] when the approved service period is over or when suitable care arrangements have been made. HHSC [ The department ] redetermines Emergency Care [ client ] eligibility each time a request for services is made.

§ 271.89. Resource Limits.

A person [ An individual applicant or client ] is not eligible for Community Care Services Eligibility (CCSE) [ community care for aged and disabled (CCAD) ] services or programs if the value of nonexempt resources owned by the person [ him ] exceeds $5,000. A couple is not eligible for CCSE [ CCAD ] services if the value of nonexempt resources the couple owns [ they own ] exceeds $6,000.

§ 271.91. Countable Resources.

In determining eligibility for Community Care Services Eligibility (CCSE) [ CCAD ] services or programs , HHSC [ the department ] considers the following to be resources.

(1) Liquid resources , including cash on hand, certificates of deposit, checking or savings accounts, money market funds, revocable trust funds, savings certificates, stocks, or bonds. Liquid resources also include the person's [ individual's ] or couple's portion of money in a checking or savings account or a money market fund held jointly with [ a ] another person.

(A) Jointly held liquid resources are the resources of the person [ applicant/client ] if the person [ he ] has unrestricted access to the funds regardless of the source. The person [ applicant/client ] may move the [ his ] portion of jointly held funds in a joint account to a new account. The new account may be jointly owned, but all funds in the new account are the person's [ his ].

(B) Money received as a nonrecurring lump sum payment is not considered a resource until 30 days after [ from ] the date of receipt. Lump sum payments include, but are not limited to, income tax refunds; earned income tax credits or rebates; one-time bonuses from mineral rights; retroactive lump sum social security, SSI, or railroad retirement benefits; lump sum insurance settlements; one-time gifts, awards, or prizes; and refunds from rental or utility deposits. The person [ applicant/client ] is responsible for reporting the receipt of a lump sum payment.

(2) Nonliquid resources , including nonexempt licensed or unlicensed vehicles; buildings and land not designated as homestead that are not producing income[ , ] or are producing income less than 6% [ 6.0% ] of the equity value; and any other property not specifically excluded.

§ 271.93. Resource Exclusions.

In determining eligibility for Community Care Services Eligibility (CCSE) [ CCAD ] services or programs , HHSC [ the department ] does not consider the following to be resources and [ . They ] are considered to be excluded for eligibility purposes. Any item not listed as an exclusion is considered a resource . [ : ]

(1) Homestead is any [ homestead. Any ] structure used by the person [ client ] as a home [ residence ], including other buildings and all contiguous land. Mobile homes, houseboats, and motor homes are considered structures. Vacant property is not a homestead. Contiguous land means all land adjacent to the home, including any land separated only by roads, rivers, and streams. Land is contiguous as long as it is not separated by property owned by another person. The homestead is excluded as a resource regardless of its location, even if the person [ client ] no longer lives there , [ ( ]unless the person [ he ] has purchased another residence[ ) ]. If the person [ he ] owns two houses, the person's [ his ] homestead is the property the person uses [ he uses ] as a home [ residence ]. Only one homestead may be excluded for each person [ client ] or couple . [ ; ]

(2) Personal [ personal ] property includes household [ . Household ] goods and personal effects . [ ; ]

(3) Property [ property ] essential to employment includes tools [ . Tools ] and equipment required for employment or self-employment . [ ; ]

(4) Prepaid [ prepaid ] burials include [ . Prepaid ] burial arrangements, burial insurance, and burial plots . [ ; ]

(5) Life [ life ] insurance is the [ . The ] cash surrender value of all life insurance . [ ; ]

(6) Vehicles include: [ vehicles. ]

(A) one [ One ] passenger car or other vehicle, such as a van or truck, used for transportation , [ ; ] or one unlicensed vehicle ; [ . ]

(B) [ (A) ] a [ A ] second vehicle may be excluded if it is:

(i) specially equipped to enable a person with a disability to drive; or

(ii) essential to the employment or self-employment of the family ; and [ . ]

(C) [ (B) ] any [ Any ] additional vehicles, licensed or unlicensed, are considered resources . [ ; ]

(7) Income-producing [ income-producing ] property [ . Property ] that annually produces net income equal to or greater than 6% [ 6.0% ] of the property's equity value. The equity value is the current market value of the property less any recorded encumbrances . [ ; ]

(8) Installment [ installment ] contracts from mortgages, notes, or loans are the [ . The ] value of installment contracts for the sale of land, other property, or repayment of loans, if the contract or agreement is producing income according to the fair market value at the time of the agreement. An installment is a mortgage or similar contract in which the buyer promises to pay a fixed amount over a period of time until the principal of the note is paid. Even though the seller retains legal title, the property is not considered a countable resource as long as the buyer is [ if ] fulfilling the contractual obligation. The payment is considered income . [ ; ]

(9) Disaster [ disaster ] assistance includes government [ . Government ] payments granted for the rebuilding of homes destroyed or damaged in a disaster . [ ; ]

(10) Energy [ energy ] assistance includes payments [ . Payments ] or allowances for energy assistance made under any federal, state, or local law . [ ; ]

(11) Supplemental Nutrition Assistance Program (SNAP) benefits are the [ food stamp allotments. The ] value of SNAP benefits [ food stamp allotments ] and USDA-donated foods . [ ; ]

(12) Inaccessible [ inaccessible ] resources are the [ . The ] cash value of resources inaccessible to the person [ client ], including [ , but not limited to, ] irrevocable trust funds, property in probate, and pension funds. Real property that the person [ client ] or family is making a good faith effort to sell is exempt. The person [ client ] or family must ask a fair price for the property, according to its current market value. Property is also exempt if it is jointly owned and the other co-owners refuse to sell . [ ; ]

(13) Mineral [ mineral ] rights are the [ . The ] value of mineral rights . [ ; ]

(14) [ life estates and remainder interests. ] A life estate is the right a person [ an individual ] has to property during a person's [ the individual's ] lifetime. A remainder interest is the right of ownership to the property when the life estate holder dies . [ ; ]

(15) Replacement [ replacement ] value of excluded resources [ . Replacement value of an excluded resource ] if [ it is ] lost, damaged, or stolen is the [ . The ] cash received from an insurance company for replacing the resource and is not considered for three months if it is real property. Any cash not spent within the specified time period is considered a resource . [ ; ]

(16) Monthly [ monthly ] gross income is all [ . All ] income received monthly and [ . Monthly gross income ] is counted as income in the month received and excluded as a resource in that month . [ ; ]

(17) Sale [ sale ] of a homestead are proceeds [ . Proceeds ] from the sale of a homestead up to six months after the proceeds [ they ] become available to the seller. The six months gives the person [ client ] time to acquire another homestead. If the person [ he ] does so, any balance from the original sale must be considered as an available resource. If, before the end of the six-month period, the person [ client ] declares the person [ he ] has no intention of acquiring another homestead, the proceeds from the sale must be counted as an available resource . [ ; ]

(18) Agent Orange settlement payments received [ . Payments ] from the Agent Orange settlement fund or any other fund established in settlement of the Agent Orange product liability litigation . [ ; ]

(19) Radiation [ radiation ] exposure compensation payments [ . Payments ] received under the Radiation Exposure Compensation Act (Public Law 101-246) . [ ; ]

(20) [ (21) ] livestock are not counted as a resource ;

(21) [ (22) ] earned income tax credit (EITC) refunds from the Internal Revenue Service are not counted as a resource .

§ 271.95. Emergency Response Services.

(a) To receive Emergency Response Services (ERS) [ be eligible for emergency response services ], a person [ client ] must[ : ]

[(1)] meet the functional need criteria as set by HHSC [ the department ]. HHSC [ The department ] uses a standardized assessment instrument to measure the person's [ client's ] ability to perform activities of daily living. This yields a score, which is a measure of the person's [ client's ] level of functional need. HHSC [ The department ] sets the minimum required score for a person [ client ] to receive ERS [ be eligible ], which HHSC [ the department ] may periodically adjust commensurate with available funding. HHSC [ The department ] will seek stakeholder input before making any change in the minimum required score for functional eligibility . [ ; and ]

(b) [ (2) ] The person must also meet the following requirements:

(1) [ (A) ] live alone, be alone routinely for eight or more hours each day, or live with a person [ an incapacitated individual ] who could not call for help or otherwise assist the applicant or client in an emergency;

(2) [ (B) ] be mentally alert enough to operate the equipment properly, in the judgment of the HHSC [ DHS ] caseworker;

(3) [ (C) ] have a phone [ telephone ] with a private line, if the system requires a private line to function properly;

(4) [ (D) ] be willing to sign a release statement that allows the responder to make a forced entry into the applicant's or client's home if the responder [ he ] is asked to respond to an activated alarm call and has no other means of entering the home to respond; and

(5) [ (E) ] live in a place other than a skilled institution, assisted living facility, foster care setting, or any other setting where 24-hour supervision is available.

§ 271.97. Residential Care Services.

A Residential Care [ residential care ] client cannot receive Residential Care services [ supervised living ] and Community Attendant Services, Family Care, or Primary Home Care services [ primary home care ] at the same time.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on April 29, 2025.

TRD-202501410

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: June 15, 2025

For further information, please call: (817) 458-1902

SUBCHAPTER D. CASE MANAGEMENT

STATUTORY AUTHORITY

The amendments are authorized by Texas Government Code §524.0151, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies; and Texas Human Resources Code §117.080(e) which authorizes the Executive Commissioner of HHSC to adopt rules necessary to implement that section, including requirements applicable to Centers for Independent Living (CIL) providing independent living services under the program.

The amendments implement Texas Government Code §524.0151 and Texas Human Resources Code §117.080.

§ 271.151. Application for Services.

(a) Information collected to determine eligibility for services, whether collected by HHSC [ DHS ] staff or provider agencies, is confidential.

(b) The applicant is entitled to an [ a face-to-face ] interview during HHSC's [ the department's ] determination of an applicant's [ his ] eligibility for Community Care Services Eligibility (CCSE) [ CCAD ] services. A person who is already receiving services from HHSC [ the Texas Department of Human Services (DHS) ] or for whom the Social Security Administration has already verified that income and resources [ income/resources ] are below the CCSE [ CCAD ] income or resource [ income/resource ] limit is not required to submit an application.

(c) An applicant [ Applicants ] or the applicant's responsible person [ their representatives ] applying for services provided with regard to income must sign an application for assistance form. A non-Medicaid applicant [ Non-Medicaid applicants ] or the applicant's responsible person [ their representatives ] applying for retroactive reimbursement for Medicaid-covered attendant services must also sign an application for assistance form. The date of application is the date HHSC [ the department ] receives the signed application. Applicants must provide accurate information about income and resources.

(d) Eligibility for CCSE [ CCAD ] services for an income-eligible applicant [ applicants ] is determined within 30 calendar days after a signed application is received. For categorically-eligible applicants, eligibility must be determined within 30 calendar days after either the applicant's [ client's ] assessment or face-to-face contact with the caseworker [ worker ], whichever comes first. No further action is needed if the person withdraws the request for services before the assessment is started or completed, an application form is received, or a face-to-face contact is made [ If the applicant withdraws from the program before an assessment is completed or a face-to-face interview is conducted, no further action is necessary ].

(e) Non-Medicaid applicants or the applicant's responsible person [ their representatives ] applying for Medicaid-covered attendant services may be reimbursed for services provided up to three months before [ prior to ] the month of receipt of a completed, signed, and dated application.

(f) The client must report promptly any changes in income, resources, or family size; loss of assistance grant or Medicaid benefits; or other changes in functional ability or circumstances that affect eligibility. The client is subject to fraud prosecution if the client [ he ] willfully fails to report changes and continues to receive services for which the client [ he ] is not eligible.

(g) A Medicaid-certified applicant for CCSE-purchased [ CCAD-purchased ] services who requires a verbal referral is eligible to receive CCSE-purchased [ CCAD-purchased ] services when the applicant's [ his ] eligibility for Medicaid is verified. A non-Medicaid certified applicant who meets the requirements for a verbal referral is eligible to receive CCSE-purchased [ CCAD-purchased ] services while income and resources are verified.

(1) To be eligible, this applicant must:

(A) be a new applicant for CCSE [ CCAD ] services or programs ;

(B) appear to be eligible based on the declaration of income and resources on the applicant's [ his ] application for services or have possession of a current Medicaid [ medical care identification ] card; and

(C) meet the age and need criteria for the CCSE [ CCAD ] service the applicant [ he ] requires.

(2) The eligibility period for non-Medicaid applicants begins on the date of application.

(3) To continue receiving services, a non-Medicaid client [ applicant ] must provide within 30 days of the application date the information needed to verify the client's [ the applicant's ] income and resource amounts.

§ 271.153. Recertification.

(a) To continue receiving services, the client must meet the Community Care Services Eligibility (CCSE) [ CCAD eligibility ] requirements at the time of recertification of financial eligibility and reassessment of needs.

(b) An applicant whose services were terminated in the past due to the applicant [ his ] or someone in the applicant's [ his ] home being a threat to the health or safety of the client, HHSC [ department ] staff, or provider agency staff may authorize [ be authorized ] services if the applicant signs a form authorizing release of information, and:

(1) the applicant or person [ The applicant/person ] in the home who posed the threat has been treated or is receiving treatment by a licensed or certified physician, psychiatrist, or psychologist and can furnish a letter saying that the applicant or person [ he ] is no longer a threat to self [ himself ] or others; or

(2) the applicant or person [ The applicant/person ] in the home allows a collateral contact with the applicant's or person in the home's [ his ] physician, psychiatrist, or psychologist, and the contact indicates that the applicant or person in the home is no longer a threat to self [ himself ] or others; or

(3) the [ The ] person in the home who posed the threat no longer poses the threat.

§ 271.155. Denial, Reduction, and Termination of Benefits.

(a) A person [ An applicant or client ] may request an appeal of any decision that denies, reduces, or ends the person's [ terminates his ] benefits. The effective date of the action depends on the situation, as shown in the following table.

Figure: 26 TAC §271.155(a) (.pdf)

[ Figure: 26 TAC §271.155(a) ]

(b) A client is entitled to be notified 10 calendar days before any reduction or termination of [ his ] services, or to have the notification mailed 12 calendar days before the date of reduction or termination. If a client threatened the client's [ his ] own health or safety or that of others, purchased services may be terminated without advance notice.

(c) A client is not eligible for Community Care Services Eligibility (CCSE) [ CCAD ] services or programs when the client :

(1) [ he ] dies;

(2) [ he ] is admitted to an institution;

(3) has a [ his ] physician who requests service termination , [ ( ]Medicaid services only[ ) ]; [ or ]

(4) [ he ] requests service termination or repeatedly refuses to accept help, except in an involuntary protective services case ; [ , ] or

(5) [ he ] refuses to comply with the [ his ] service plan.

(d) The client is not eligible for Emergency Response Services [ emergency response services ] if the client :

(1) [ he ] abuses the service by activating:

(A) four false alarms which result in a response by fire department, police, sheriff [ police/sheriff ], or ambulance personnel within a six-month period; or

(B) 20 false alarms of any kind within a six-month period;

(2) [ he ] is admitted to a skilled institution, personal care home, foster care setting, or any other setting where 24-hour supervision is available;

(3) in the caseworker's judgment, [ he ] is no longer mentally alert enough to operate the equipment properly , situations [ . Situations ] include [ , but are not limited to ]:

(A) damage to [ he damages ] the equipment;

(B) [ he disconnects ] the equipment is disconnected and the client [ has ] received two warnings that are documented in the case record;

(C) refusal [ he refuses ] to participate in the monthly system checks; or

(4) [ he ] is away from the home or is unable to participate in the service delivery for three consecutive months or more.

(e) The client is not eligible for Residential Care [ residential care ] if the client [ he ] is required to contribute to the cost of the client's [ his ] care[ , ] but refuses to do so.

(f) If the client repeatedly and directly or knowingly and passively condones the behavior of someone in the client's [ his ] home and thus, refuses , [ ( ]more than three times , [ ) ] to comply with service delivery provisions, the caseworker may terminate services. Refusal to comply with service delivery provisions includes actions by the client or someone in the client's home that prevent determining eligibility, carrying out the service plan, and monitoring the services. Before services are terminated, the client is entitled to receive written notification that [ his ] services will end [ be terminated ] if the client [ he ] does not comply with service delivery provisions or if the client [ he ] continues to condone someone's behavior that results in non-compliance with service delivery provisions. Also , before services are terminated, the caseworker must make a referral to Texas Department of Family and Protective Services [ APS is made ] if the caseworker suspects or knows that the client is being abused, neglected, or exploited by the person who prevents delivery provisions. Services continue pending the outcome of the APS investigation. If an applicant's services were terminated in the past due to the applicant's [ his ] failure to comply with a [ his ] service plan, the applicant must agree to cooperate with HHSC [ DHS ] staff to facilitate service delivery.

§ 271.159. Adult Foster Care Client Rights and Responsibilities.

(a) The Adult Foster Care [ adult foster care ] client must:

(1) provide accurate information about the client's [ his ] ability to function in the community and in a foster home setting;

(2) pay the amount of room and board specified in the client and provider agreement;

(3) report changes or occurrences that would affect the client or [ and/or ] provider; and

(4) participate in selecting an adult foster care home in which to live.

(b) The client and the client's [ his ] responsible person are entitled to:

(1) receive in writing, before authorization of adult foster care, a list of the client's rights and responsibilities;

(2) be informed of all available services in the home and of the charges for services not paid for by the HHSC [ Texas Department of Human Services (DHS) ];

(3) be informed that the client keeps a personal needs allowance;

(4) file complaints about abuse, neglect, exploitation, or inadequate care, as those terms are defined by the statute or rule that governs the investigation of ANE, without discrimination or reprisal for voicing grievances;

(A) with HHSC, Complaint and Incident Intake, when the AFC facility is licensed as an assisted living facility (ALF); or [ DHS ]

(B) with the Texas Department of Family and Protective Services, Adult Protective Services (APS) when the AFC serves three or fewer residents unrelated to the owner [ staff about abuse, neglect, exploitation, or inadequate care without discrimination or reprisal for voicing grievances ];

(5) privacy and confidentiality;

(6) have the client's [ his ] physical person and property treated with dignity and respect; and

(7) be free from physical or mental abuse, corporal punishment, and any physical or chemical restraints imposed for purposes of discipline or convenience.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on April 29, 2025.

TRD-202501411

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: June 15, 2025

For further information, please call: (817) 458-1902

CHAPTER 331. LIDDA SERVICE COORDINATION

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §331.1, concerning Purpose; §331.3, concerning Application; §331.5, concerning Definitions; §331.7, concerning Eligibility; §331.9, concerning Funding Service Coordination; §331.11, concerning LIDDA's Responsibilities; §331.13, concerning Caseloads; §331.15, concerning Termination of Service Coordination; §331.17, concerning Minimum Qualifications; §331.19, concerning Staff Person Training; §331.21, concerning Documentation of Service Coordination; and §331.23, concerning Review Process.

BACKGROUND AND PURPOSE

The purpose of the proposed amendments is to implement House Bill (H.B.) 4, 87th Legislature, Regular Session, 2021, which requires HHSC to ensure Medicaid recipients, child health care plan program enrollees, and other individuals receiving benefits under a public benefits program administered by HHSC or another health and human services agency have the option to receive services as telemedicine medical services, telehealth services, or other telecommunications or information technology to the extent it is cost effective and clinically effective. The proposed amendments include defining terms pertaining to the implementation of H.B. 4 and updating documentation requirements.

The proposed amendments clarify the minimum qualifications and training requirements for service coordinators and requirements regarding minimum contact. The proposed amendments update agency names and citations.

The proposed amendments also update citations to the Texas Government Code related to H.B. 4611, 88th Legislature, Regular Session, 2023, effective April 1, 2025, which made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature's ongoing statutory revision program.

SECTION-BY-SECTION SUMMARY

The proposed amendments to §331.1, Purpose, and §331.3, Application, update text to person-centered language and makes other non-substantive wording changes.

The proposed amendment to §331.5, Definitions, adds terms related to the implementation of H.B. 4: "audio-only," "audio-visual," and "in-person (or in person)." Throughout the rules, HHSC replaced the term "face-to-face" with the term "in person" or "in-person." The proposed amendment adds definitions for "comprehensive encounter," "follow-up encounter," "HHSC," and "TAC." The proposed amendment revises the definitions of "actively involved person," "CFC services," "Designated LIDDA," "ICF/IID level-of-care", "Frequency," "General revenue," "HCS Program," "ICF/IID level-of-care," "ICF/IID Program," "Institution," "Institution for mental diseases," "Intellectual disability," "LAR," "LIDDA," "LIDDA priority population," "local service area," "MCO," "Plan of services and supports," "Related condition," "Service coordination," "State hospital," "State supported living center," "Subaverage general intellectual functioning," and "TxHmL Program." The proposed amendment removes the following definitions no longer being used in the rules "CARE," "DADS," "Department," "Designated MRA," "ICF/MR Program," "Mental retardation," "Mental retardation priority population," "MRA," "Parent Case Management Program," and "Partners in Policy Making." The proposed amendment changes the term "Person-directed planning" to "Person-centered planning." The proposed amendment renumbers the rule to account for the new definitions, removed definitions, and revisions made to existing definitions.

The proposed amendment to §331.7, Eligibility, clarifies that the HHSC Service Coordination Assessment form is used to document that an individual meets the eligibility criteria for service coordination described in subsection (a)(1)(A). The proposed amendment also adds "a facility with an HHSC-contracted psychiatric bed" to subsection (a)(1)(F) to include service coordination responsibilities set forth in 26 Texas Administrative Code (TAC) §306.201 relating to Discharge Planning. The proposed amendment removes subsection (c) because the rule has been relocated and updated in the proposed amendment in §331.11(e). The proposed amendment uses the updated term "state hospital" to replace "MH facility" and makes other non-substantive wording changes.

The proposed amendment to §331.9, Funding Service Coordination, updates the citations from the previous locations in 40 TAC §2.554. The proposed amendment also makes other non-substantive wording changes.

The proposed amendment to §331.11, LIDDA's Responsibilities, changes the title to "Designated LIDDA's Responsibilities." The proposed amendment removes the subsection titles in current subsections (a) - (f). The proposed amendment to subsection (a) changes the reference to the DADS Person Directed Planning Guidelines to the HHSC Person-Centered Planning Guidelines and updates citations from the previous locations in 40 TAC §9.153 and §9.553. The proposed amendment to subsection (b) renumbers the rules on service coordination in new paragraphs (1) and (2) under subsection (b); renumbers subsection (b)(2) to organize the rule on crisis prevention and management in a new subsection (c); and removes paragraph (3) under subsection (b) to move the content of the rule to proposed new subsection (k). The proposed amendment to subsection (b) also replaces "staff person" with the term "employee." The proposed amendment to §331.11 adds new subsections, and therefore, renumbers some of the current subsections. New subsection (d) details LIDDA responsibilities related to when the HHSC Service Coordination Assessment form must be completed. New subsection (e) describes who must complete the HHSC Service Coordination Assessment and requires the HHSC Service Coordination Assessment form to identify the frequency of in-person service coordination contacts. Subsection (c), renumbered as subsection (f), is amended to replace "person-directed" with "person-centered," update agency names, better organize the requirements for a service coordinator to revise an individual's plan of services and supports, and makes other non-substantive wording changes. New subsection (g) contains the requirement from current subsection (d)(2), and clarifies that one of the four elements of service coordination is required for both comprehensive and follow-up encounters. The proposed amendment to subsection (d), renumbered as subsection (h), revises the minimum contact requirement to add that an in-person meeting may need to occur more frequently than once every 90 days in accordance with the HHSC Service Coordination Assessment form. New subsections (i) and (j) provide requirements for audio-visual or audio-only comprehensive encounters. New subsection (k) contains the requirement that was moved from subsection (b)(3), and clarifies that concerns identified during any service coordination activity, not just during monitoring, should be communicated to the entity providing services and supports. The proposed amendment to subsection (e), renumbered as subsection (l), and to subsection (f), renumbered as subsection (m), updates citations from the previous locations in 40 TAC Chapter 9, Subchapters D and N, and 40 TAC Chapter 41.

The proposed amendment to §331.13, Caseloads, updates text to person-centered language, changes "staff person" to "employee, and updates that the frequency of contacts to consider is the "frequency of in-person contacts."

The proposed amendment to §331.15, Termination of Service Coordination, updates text to person-centered language and updates a citation from the previous location in 40 TAC Chapter 2, §2.554.

The proposed amendment to §331.17, Minimum Qualifications, revises the grandfathering language in subsection (d), removes subsections (e) and (f) related to minimum qualifications for service coordinators, and updates the reference in subsection (b) to subsection (d) of this section. The proposed amendment also makes other non-substantive wording changes.

The proposed amendment to §331.19, Staff Person Training, retitles the rules as "Employee Training" and updates the term "staff person" to "employee" as needed throughout the rule. The proposed amendment also updates outdated rule language. The proposed amendment in subsection (b)(1) adds "additional trainings designated by HHSC" to allow for any new or temporary training requirements. The proposed amendment in subsection (b)(2) requires completion of person-centered training for service coordinators within the first six months of the hire date unless an extension is granted by HHSC, instead of within 2 years, to align with the training requirement in 26 TAC Chapter 263 for the Home and Community-based Services (HCS) Program. The amendment also clarifies that the person-centered training must be comprehensive and non-introductory.

The proposed amendment to §331.21, Documentation of Service Coordination, adds requirements for a service coordinator's documentation to include whether the contact with an individual was in person, via audio-visual communication, or via audio-only communication, and the location of the contact. The proposed amendment renumbers paragraphs (1) - (5) as paragraphs (3) - (7) because of adding the new documentation requirements. The proposed amendment in renumbered paragraph (4) references the definition of "service coordination" in proposed §331.5 to clarify that the service coordinator must document which element listed in the definition was provided. The proposed amendment updates text to person-centered language and makes other non-substantive wording changes.

The proposed amendment to §331.23, Review Process, removes the subsection titles in subsection (a) and (b), updates text to person-centered language, and updates a citation from the previous location in 40 TAC Chapter 2, §2.46.

FISCAL NOTE

Trey Wood, Chief Financial Officer, has determined that for each year of the first five years that the rules will be in effect, enforcing or administering the rules do not have foreseeable implications relating to costs or revenues of state or local governments.

GOVERNMENT GROWTH IMPACT STATEMENT

HHSC has determined that during the first five years that the rules will be in effect:

(1) the proposed rules will not create or eliminate a government program;

(2) implementation of the proposed rules will not affect the number of HHSC employee positions;

(3) implementation of the proposed rules will result in no assumed change in future legislative appropriations;

(4) the proposed rules will not affect fees paid to HHSC;

(5) the proposed rules will create new regulations;

(6) the proposed rules will expand existing regulations;

(7) the proposed rules will not change the number of individuals subject to the rules; and

(8) the proposed rules will not affect the state's economy.

SMALL BUSINESS, MICRO-BUSINESS, AND RURAL COMMUNITY IMPACT ANALYSIS

Trey Wood has also determined that there will be no adverse economic effect on small businesses, micro-businesses, or rural communities. The amendments do not require small businesses, micro-businesses, or rural communities to change current business practices.

LOCAL EMPLOYMENT IMPACT

The proposed rules will not affect a local economy.

COSTS TO REGULATED PERSONS

Texas Government Code §2001.0045 does not apply to these rules because the rules are necessary to protect the health, safety, and welfare of the residents of Texas, do not impose a cost on regulated persons, and are necessary to implement legislation that does not specifically state that §2001.0045 applies to the rules.

PUBLIC BENEFIT AND COSTS

Haley Turner, Deputy Executive Commissioner for Community Services, has determined that for each year of the first five years the rules are in effect, the public will benefit from a more person- and family-centered approach to LIDDA service delivery. Individuals receiving services, LARs, and LIDDAs will benefit from the availability of alternative methods of service delivery via the use of audio-only or audio-visual communications when appropriate.

Incorporating the H.B. 4 revisions into the rule affords service coordination recipients the option to receive services through telecommunications to the extent it is cost effective and clinically appropriate.

Trey Wood has also determined that for the first five years the rules are in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rules. The proposal does not impose new costs or fees on those required to comply.

TAKINGS IMPACT ASSESSMENT

HHSC has determined that the proposal does not restrict or limit an owner's right to his or her property that would otherwise exist in the absence of government action and, therefore, does not constitute a taking under Texas Government Code §2007.043.

PUBLIC COMMENT

Written comments on the proposal may be submitted to Rules Coordination Office, P.O. Box 13247, Mail Code 4102, Austin, Texas 78711-3247, or street address 701 W. 51st Street, Austin, Texas 78751; or emailed to HHSRulesCoordinationOffice@hhs.texas.gov.

To be considered, comments must be submitted no later than 31 days after the date of this issue of the Texas Register . Comments must be: (1) postmarked or shipped before the last day of the comment period; (2) hand-delivered before 5:00 p.m. on the last working day of the comment period; or (3) emailed before midnight on the last day of the comment period. If the last day to submit comments falls on a holiday, comments must be postmarked, shipped, or emailed before midnight on the following business day to be accepted. When emailing comments, please indicate "Comments on Proposed Rule 24R076" in the subject line.

STATUTORY AUTHORITY

The amendments are authorized by Texas Government Code §524.0151, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services system; Texas Government Code §532.0051, which provides HHSC with the authority to administer federal funds and plan and direct the Medicaid program in each agency that operates a portion of the Medicaid program; Texas Government Code §531.02161, which requires that HHSC ensure that Medicaid recipients and individuals receiving benefits under a public benefits program have the option to receive services as telemedicine medical services, telehealth services, or other telecommunications or information technology; Texas Human Resources Code §32.021, which provides that HHSC will adopt necessary rules for the proper and efficient administration of the Medicaid program; and Texas Health & Safety Code §533A.0355(a), which provides that the Executive Commissioner of HHSC shall adopt rules establishing the roles and responsibilities of LIDDAs.

The amendments implement Texas Government Code §§524.0151, 532.0051, and 531.02161, Texas Human Resources Code §32.021, and Texas Health & Safety Code §533A.0355(a).

§ 331.1. Purpose.

This chapter [ subchapter ] describes requirements for service coordination delivered by the LIDDA [ mental retardation authority (MRA) ] to an individual in the LIDDA [ mental retardation ] priority population [ (MR priority population) ] who desires services.

§ 331.3. Application.

This chapter [ subchapter ] applies to all LIDDAs [ mental retardation authorities (MRAs) ].

§ 331.5. Definitions.

The following words and terms, when used in this chapter [ subchapter ], have the following meanings, unless the context clearly indicates otherwise:

(1) Actively involved person--For an individual who lacks the ability to provide legally adequate consent and who does not have an LAR [ a legally authorized representative (LAR) ], a person whose significant and ongoing involvement with the individual is determined by the individual's designated LIDDA [ MRA ] to be supportive of the individual based on the person's:

(A) observed interactions with the individual;

(B) knowledge of and sensitivity to the individual's preferences, values, and beliefs;

(C) availability to the individual for assistance or support; and

(D) advocacy for the individual's preferences, values, and beliefs.

(4) [ (3) ] CFC services--Community First Choice services. State plan services described in 1 TAC [ Texas Administrative Code (TAC) ] Chapter 354, Subchapter A, Division 27 (relating to Community First Choice).

(6) Designated LIDDA--As identified in the HHSC [ DADS ] data system, the LIDDA responsible for assisting an individual and LAR or actively involved person to access services and supports.

(7) [ (8) ] Duration--The specified period of time during which service coordination is provided to an individual.

(8) [ (9) ] Frequency--The minimum number of times during a specified period that an individual is to be contacted by a service coordinator in person based on the individual's need for contacts as determined by person-centered [ person-directed ] planning.

(10) General revenue--Funds appropriated by the Texas Legislature for use by HHSC [ DADS ].

(11) HCS Program--The Home and Community-based Services Program. A program operated by HHSC [ DADS ] as authorized by the Centers for Medicare & [ and ] Medicaid Services in accordance with §1915(c) of the Social Security Act.

(13) [ (12) ] ICF/IID--Intermediate care facility for individuals with an intellectual disability or related conditions. An ICF/IID is a facility in which ICF/IID Program services are provided.

(14) [ (13) ] ICF/IID level-of-care--A level-of-care described in §261.238 [ §9.238 ] of this title (relating to ICF/MR Level of Care I Criteria) or §261.239 [ §9.239 ] of this title (relating to ICF/MR Level of Care VIII Criteria).

(15) [ (14) ] ICF/IID Program--[ The Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions Program. ] A program operated by HHSC [ DADS ] that provides Medicaid-funded residential services to individuals with an intellectual disability or related conditions, as described in §1905(d) of the Social Security Act.

(16) [ (15) ] ICF/MR--ICF/IID.

(18) [ (17) ] Individual--A person who is or is believed to be a member of the LIDDA priority population.

(19) [ (18) ] Institution--One of the following:

(A) an ICF/IID;

(B) a nursing facility licensed or subject to being licensed in accordance with THSC Chapter 242 ;

(C) an assisted living facility licensed or subject to being licensed in accordance with THSC[ , ] Chapter 247;

(D) a [ residential ] child-care operation [ licensed or ] subject to regulation [ being licensed ] by HHSC as a general residential operation under Texas Human Resources Code Chapter 42 [ the Department of Family and Protective Services unless it is a foster family home or a foster group home ];

(E) a hospital [ facility licensed or subject to being licensed by the Department of State Health Services ];

(H) [ (F) ] a facility operated by the Texas Workforce Commission [ Department of Assistive and Rehabilitative Services ]; or

(I) [ (G) ] a prison.

(20) [ (19) ] Institution for mental diseases [ (IMD) ]--As defined in 25 TAC §419.373, a hospital of more than 16 beds that is primarily engaged in providing psychiatric diagnosis, treatment, and care of individuals with mental diseases, including medical care, nursing care, and related services.

(21) [ (20) ] Intellectual disability--Consistent with THSC [ Texas Health and Safety Code (THSC), ] §591.003, significantly subaverage general intellectual functioning existing concurrently with deficits in adaptive behavior and manifested during the developmental period.

(22) [ (21) ] LAR --Legally authorized representative. [ (legally authorized representative)-- ] A person authorized by law to act on behalf of an individual with regard to a matter described in this chapter [ subchapter ], and who may be a parent, guardian, or managing conservator of a child ; [ , ] or the guardian of an adult.

(23) [ (22) ] LIDDA--Local intellectual and developmental disability authority. An entity designated by the executive commissioner of HHSC [ the Texas Health and Human Services Commission ] in accordance with THSC[ , ] §533A.035.

(24) [ (23) ] LIDDA priority population--A population as defined in §304.102 [ §5.153 ] of this title (relating to Definitions).

(25) [ (24) ] Local service area--A geographic area composed of one or more Texas counties defining the population that may receive services from a LIDDA .

(26) [ (25) ] MCO--Managed care organization. This term has the meaning set forth in Texas Government Code §543A.0001 [ , §536.001 ].

(27) [ (31) ] Permanency planning--A philosophy and planning process that focuses on the outcome of family support for an individual under 22 years of age by facilitating a permanent living arrangement in which the primary feature is an enduring and nurturing parental relationship.

(28) [ (32) ] Person-centered [ Person-directed ] planning--A philosophy and planning process that empowers an individual and, on the individual's behalf, an LAR or actively involved person, to direct the development of a plan of services and supports.

(29) [ (33) ] Plan of services and supports--A written plan that:

(A) describes the desired outcomes identified by an [ the ] individual, or an LAR or actively involved person on behalf of the individual;

(B) describes the services and supports to be provided to the individual, including service coordination; [ and ]

(C) identifies the frequency of in-person contacts to be provided to the individual , in accordance with §331.11(h) [ §2.556(d)(1) ] of this chapter [ subchapter ] (relating to Designated LIDDA's Responsibilities) ; [ , ] and

(D) identifies the duration of service coordination to be provided to the individual.

(30) [ (34) ] Related condition--Consistent with 42 CFR [ Code of Federal Regulations Title 42, ] §435.1010, a severe and chronic disability that:

(A) is attributable to:

(i) cerebral palsy or epilepsy; or

(ii) any other condition, other than mental illness, found to be closely related to an intellectual disability because the condition results in impairment of general intellectual functioning or adaptive behavior similar to that of people [ persons ] with [ an ] intellectual disabilities [ disability ], and requires treatment or services similar to those required for people [ those persons ] with [ an ] intellectual disabilities [ disability ];

(B) is manifested before the person reaches 22 years of age;

(C) is likely to continue indefinitely; and

(D) results in substantial functional limitation in three or more of the following areas of major life activity:

(i) self-care;

(ii) understanding and use of language;

(iii) learning;

(iv) mobility;

(v) self-direction; and

(vi) capacity for independent living.

(31) [ (35) ] Relative--A person related to the individual within the fourth degree of consanguinity or within the second degree of affinity.

(32) [ (36) ] Service coordination-- Through both comprehensive and follow-up encounters, service coordination consists of assistance [ Assistance ] in accessing medical, social, educational, and other appropriate services and supports that will help an individual achieve a quality of life and community participation acceptable to the individual (and LAR on the individual's behalf) as follows:

(A) crisis prevention and management--linking and assisting the individual and LAR or actively involved person to secure services and supports that will enable them to prevent or manage a crisis;

(B) monitoring--ensuring that the individual receives needed services, evaluating the effectiveness and adequacy of services, and determining if identified outcomes are meeting the individual's needs and desires as indicated by the individual and LAR or actively involved person;

(C) assessment--identifying the individual's needs and the services and supports that address those needs as they relate to the nature of the individual's presenting problem and disability; and

(D) service planning and coordination--identifying, arranging, advocating, collaborating with other agencies, and linking for the delivery of outcome-focused services and supports that address the individual's needs and desires as indicated by the individual and LAR or actively involved person.

(33) [ (37) ] State hospital [ MH facility (state mental health facility) ]-- Consistent with THSC §552.0011, a hospital operated by HHSC primarily to provide inpatient care and treatment for individuals with mental illness. [ A state hospital or state center with an inpatient psychiatric component operated by the Department of State Health Services. ]

(34) [ (38) ] State supported living center--A state-supported and structured residential facility that is an ICF/IID operated by HHSC [ DADS ] to provide persons with an intellectual disability a variety of services, including medical treatment, specialized therapy, and training in the acquisition of personal, social, and vocational skills, but does not include a community-based facility owned by HHSC [ DADS ].

(35) [ (39) ] Subaverage general intellectual functioning--Consistent with THSC[ , ] §591.003, measured intelligence on standardized general intelligence tests of two or more standard deviations (not including standard error of measurement adjustments) below the age-group mean for the tests used.

(37) [ (40) ] THSC--Texas Health and Safety Code.

(38) [ (41) ] TxHmL Program--The Texas Home Living Program. A program operated by HHSC [ DADS ] as authorized by the Centers for Medicare & [ and ] Medicaid Services in accordance with §1915(c) of the Social Security Act.

§ 331.7. Eligibility.

(a) To be eligible for service coordination, an individual must:

(1) be a member of the LIDDA priority population and [ must ] meet at least one of the following criteria:

(A) have two or more [ documented ] needs that require services and supports other than service coordination as documented [ evidenced ] by the HHSC Service Coordination Assessment form completed [ an assessment conducted ] by the designated LIDDA and not reside in an institution;

(B) be:

(i) in the process of enrolling in the ICF/IID Program; [ or ]

(ii) in the process of enrolling in the HCS or TxHmL Program or be currently enrolled in the HCS or TxHmL Program; or

(iii) in the process of enrolling in CFC services provided through an MCO;

(C) be 21 years of age or older with an ICF/IID level-of-care and receiving CFC services through an MCO;

(D) be seeking admission to a state supported living center;

(E) be transitioning from an ICF/IID or from a nursing facility to community-based services; or

(F) be transitioning from a state hospital or a facility with an HHSC-contracted psychiatric bed [ MH facility ] to community-based services; or

(2) be a nursing facility resident who is eligible for specialized services for an intellectual disability or a related condition pursuant to §1919(e)(7) of the Social Security Act ( U.S.C. [ United States Code ], Title 42, §1396r(e)(7)).

(b) Community-based services as referenced in subsection (a)(1)(E) and (F) of this section does not include services provided in an ICF/IID or nursing facility or services provided in another institutional setting.

§ 331.9. Funding Service Coordination.

(a) Service coordination may be funded by:

(1) personal funds or third-party insurance other than Medicaid;

(2) Medicaid targeted case management; or

(3) general revenue.

(b) Service coordination funded by Medicaid targeted case management:

(1) may be provided only to an individual who is a Medicaid recipient and only if:

(A) the individual meets at least one of the criteria described in §331.7(a)(1)(A) - (D) [ §2.554(a)(1)(A) - (D) ] of this chapter [ subchapter ] (relating to Eligibility); or

(B) the individual meets the criteria described in §331.7(a)(1)(E) [ §2.554(a)(1)(E) ] or (a)(2) of this chapter [ subchapter ] and the service coordination is provided during the last 180 days before the individual transitions to community-based services from an [ the ] ICF/IID or a nursing facility; and

(2) may not be provided to an individual:

(A) who resides in an institution for mental diseases; or

(B) who is enrolled in a Medicaid waiver program other than the HCS or TxHmL Program.

§ 331.11. Designated LIDDA's Responsibilities.

(a) [ Developing a plan of services and supports. ] If a [ the designated ] LIDDA determines an individual is eligible for and desires service coordination, the LIDDA must develop a plan of services and supports for the individual using person- centered [ directed ] planning that is consistent with the HHSC Person-Centered [ DADS Person Directed ] Planning Guidelines.

(1) For the [ HCS and ] TxHmL and HCS Programs, the person-directed plan (PDP), as defined in §262.3 [ §9.153 ] and §263.3 [ §9.553 ] of this title (relating to Definitions), respectively, qualifies as a plan of services and supports.

(2) For an individual receiving CFC services through an MCO, a completed HHSC Community First Choice Assessment form [ "Community First Choice Assessment" ] qualifies as a plan of services and supports.

(b) [ Provision of service coordination. ]

[(1)] A LIDDA must ensure that service coordination:

(1) [ (A) ] is provided to an [ the ] individual in accordance with the individual's plan of services and supports; and

(2) [ (B) ] is not provided by an employee [ a staff person ] who is a relative of the individual or who has the same residence as the individual.

(c) [ (2) ] A LIDDA may provide crisis prevention and management to an [ the ] individual without having first identified the need for such services in the individual's plan of services and supports.

(f) [ (c) ] [ Revising the plan of services and supports. ]

[(1)] A LIDDA must ensure that a service coordinator revises an individual's plan of services and supports :

(1) if:

(A) the individual's needs change; or

(B) the individual, LAR or actively involved person, service provider, or other person provides relevant information indicating the appropriateness of revising [ revision of ] the plan ; and [ is appropriate. ]

(2) [ A LIDDA must ensure that a service coordinator revises the plan ] using person-centered [ person-directed ] planning that is consistent with the HHSC Person-Centered [ DADS Person Directed ] Planning Guidelines.

(h) [ (d) ] [ Minimum contact. ]

[(1)] A LIDDA must ensure that a service coordinator meets [ face-to-face ] with an individual in person in accordance with one of the following, whichever is the most frequent:

(1) [ (A) ] at least once every 90 days or more frequently in accordance with the HHSC Service Coordination Assessment form ; or

(2) [ (B) ] for the minimum number of in-person [ face-to-face ] contacts required by:

(A) [ (i) ] rules or other requirements of the program or services in which the individual is enrolled; or

(B) [ (ii) ] a contract between HHSC [ DADS ] and the LIDDA.

(l) [ (e) ] [ Individuals enrolled in the TxHmL Program. ] In addition to the requirements in this chapter [ subchapter ], a LIDDA must ensure service coordination is provided to individuals enrolled in the TxHmL Program in accordance with :

(1) Chapter 262 [ 9, Subchapter N ] of this title (relating to Texas Home Living (TxHmL) Program and Community First Choice (CFC)) ; and

(2) Chapter 264 [ 41 ] of this title (relating to Consumer Directed Services Option)).

(m) [ (f) ] [ Individuals enrolled in the HCS Program. ] In addition to the requirements in this chapter [ subchapter ], a LIDDA must ensure service coordination is provided to individuals enrolled in the HCS Program in accordance with :

(1) Chapter 263 [ 9, Subchapter D, ] of this title (relating to Home and Community-based Services (HCS) Program and Community First Choice (CFC)) ; and

(2) Chapter 264 [ 41 ] of this title.

§ 331.13. Caseloads.

A LIDDA [ The MRA ] is responsible for determining the number of cases per employee [ staff person ] who provides service coordination based on factors such as individuals' needs, the frequency of in-person contacts, the [ and ] duration of contacts, and travel time.

§ 331.15. Termination of Service Coordination.

A LIDDA [ The MRA ] must terminate service coordination for an individual if:

(1) the individual no longer meets the eligibility criteria for service coordination as set forth in §331.7 [ §2.554 ] of this chapter [ title ] (relating to Eligibility); or

(2) the individual or the LAR no longer desires service coordination.

§ 331.17. Minimum Qualifications.

(a) Service coordination may be provided only by an employee of a [ the ] LIDDA.

(b) Except as provided by subsection (d) [ subsections (d), (e), and (f) ] of this section, an employee [ a staff person ] providing service coordination must have:

(1) a bachelor's or advanced degree from an accredited college or university;

(2) an associate degree in a social, behavioral, human service, or health-related field including, psychology, social work, medicine, nursing, rehabilitation, counseling, sociology, human development, gerontology, educational psychology, education, or [ and ] criminal justice; or

(3) a high school diploma or a certificate recognized by a state as the equivalent of a high school diploma, and two years of paid or unpaid experience with individuals with intellectual or developmental disabilities.

(c) A [ The ] LIDDA, at its discretion, may require additional education and experience for employees [ staff ] who provide service coordination.

(d) At the discretion of a [ the ] LIDDA, an employee [ a staff person ] who was authorized [ by a LIDDA ] to provide service coordination prior to October 16, 2022 [ April 1, 1999 ], pursuant to the rules in effect at the time the employee was hired, may provide service coordination without meeting the minimum qualifications described in subsection (b) of this section.

§ 331.19. Employee [ Staff Person ] Training.

(a) A LIDDA must ensure that the following employees [ staff persons ] complete the training as described in subsection (b) of this section:

(1) an employee [ a staff person ] who provides service coordination; and

(2) an employee [ a staff person ] who supervises or oversees the provision of service coordination.

(b) A LIDDA employee [ staff person ] described in subsection (a) of this section must:

(1) within the first 90 days of the service coordinator's date of hire [ performing service coordination duties ], complete training that addresses:

(A) appropriate LIDDA policies, procedures, and standards;

(B) the LIDDA's performance contract requirements regarding service coordination;

(C) plan of services and supports development and implementation;

(D) person-centered [ person-directed ] planning consistent with the HHSC Person-Centered [ DADS Person Directed ] Planning Guidelines;

(E) permanency planning;

(F) crisis prevention and management, monitoring, assessment, and service planning and coordination;

(G) community support services, including Medicaid state plan services such as CFC services; [ and ]

(H) advocacy for individuals; and

(2) within the first six months of the service coordinator's date of hire, complete a comprehensive non-introductory person-centered service planning training approved by HHSC , unless HHSC grants an extension of the six-month timeframe. [ : ]

(c) A LIDDA must document the training completed [ provided ] in accordance with this section in the personnel record of each employee [ staff person ] providing, supervising, or overseeing service coordination.

§ 331.21. Documentation of Service Coordination.

(a) A LIDDA [ The MRA ] must document the required contacts described in the individual's plan of services and supports, including:

(3) [ (1) ] the date of the contact;

(4) [ (2) ] a [ the ] description of which of the four elements [ element(s) ] of service coordination listed in the definition of "service coordination" in §331.5 of this chapter (relating to Definitions) were provided;

(5) [ (3) ] the progress or lack of progress in achieving goals or outcomes;

(6) [ (4) ] the person with whom the contact occurred; and

(7) [ (5) ] the name of the LIDDA employee [ staff ] who provided the contact and the employee's [ his or her ] professional discipline, if applicable.

(b) A LIDDA [ The MRA ] must ensure that service coordination activities are documented in the individual's record.

(c) A LIDDA [ The MRA ] must identify the appropriate service code in the HHSC data system [ CARE ] for all individuals receiving service coordination.

(d) A LIDDA [ The MRA ] must retain documentation in compliance with applicable federal and state laws, rules, and regulations.

§ 331.23. Review Process.

(a) [ Medicaid-eligible individuals. ] Any Medicaid-eligible individual whose request for eligibility for service coordination is denied or is not acted upon with reasonable promptness, or whose service coordination has been terminated, suspended, or reduced by HHSC [ the department ] is entitled to a fair hearing in accordance with 1 TAC Chapter 357, Subchapter A (relating to Uniform Fair Hearing Rules).

(b) [ Non-Medicaid-eligible individuals. ] If a LIDDA [ an MRA ] decides to deny, involuntarily reduce, or terminate service coordination for a non-Medicaid-eligible individual, the LIDDA [ MRA ] must notify the individual or LAR in writing of the decision and provide an explanation of the procedure for the individual or LAR to request a review by the LIDDA [ MRA ] as required by Chapter 301, Subchapter D of this title [ §2.46 of this chapter ] (relating to LIDDA, LMHA, and LBHA Notification and Appeal [ Appeals ] Process).

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on April 29, 2025.

TRD-202501413

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: June 15, 2025

For further information, please call: (512) 438-5609