TITLE 26. HEALTH AND HUMAN SERVICES

PART 1. HEALTH AND HUMAN SERVICES COMMISSION

CHAPTER 259. COMMUNITY LIVING ASSISTANCE AND SUPPORT SERVICES (CLASS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES

SUBCHAPTER B. ELIGIBILITY, ENROLLMENT, AND REVIEW

DIVISION 1. ELIGIBILITY AND MAINTENANCE OF THE CLASS INTEREST LIST

The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts an amendment to §259.51, concerning Eligibility Criteria for CLASS Program Services and CFC Services.

Section 259.51 is adopted with changes to the proposed text as published in the July 11, 2025, issue of the Texas Register (50 TexReg 3987). This rule will be republished.

BACKGROUND AND JUSTIFICATION

This amendment is necessary to increase the waiver cost limit for an individual's individual plan of care (IPC) in the Community Living Assistance and Support Services (CLASS) waiver program. The 2026-2027 General Appropriations Act, Senate Bill 1, 89th Texas Legislature, Regular Session, 2025 (Article II, HHSC Rider 23) includes appropriations to increase the attendant wage for personal attendant services. This attendant wage increase impacts Medicaid personal attendant reimbursement rates.

As a result of this direction and prior reimbursement rate increases, the amendment increases the waiver cost limit for an individual's IPC in the CLASS waiver program to off-set the cost of higher personal attendant reimbursement rates. The increase allows the individual to continue to qualify for services in the CLASS waiver program without exceeding the cost limit for the IPC.

HHSC's amendments to the cost limit rules for an individual's IPC in the Deaf Blind with Multiple Disabilities and Texas Home Living Programs, and the cost limits in the Home and Community-based Services Program, are published in this same issue of the Texas Register .

COMMENTS

The 21-day comment period ended August 1, 2025.

During this period, HHSC received one comment regarding the proposed rule from one individual. A summary of the comment relating to the rule and HHSC's response follows.

Comment: The commentor supported the rule amendment and recommended that HHSC conduct a biennial review of the CLASS IPC cost limit.

Response: HHSC thanks the commentor for the commentor's support and recommendation to conduct a biennial review of the CLASS IPC cost limit. However, HHSC clarifies that biennial waiver cost limit reviews fall outside the scope of this rule project and are dependent on available levels of appropriated state and federal funds. HHSC did not revise the rule in response to this comment.

HHSC revised §259.51(a)(4) to add the new dollar amount of the IPC cost limit in the CLASS Program is $149,774.00. This dollar amount, added to the rule for clarity, is based on the final September 1, 2025 reimbursement rates for the Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions Program.

STATUTORY AUTHORITY

The amendment is adopted under 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, and Texas Human Resources Code §32.021, which provides HHSC with the authority to administer the federal medical assistance program in Texas and to adopt rules and standards for program administration.

§259.51. Eligibility Criteria for CLASS Program Services and CFC Services.

(a) An individual is eligible for CLASS Program services if:

(1) the individual meets the financial eligibility criteria described in Appendix B of the CLASS Program waiver application approved by CMS and available on the HHSC website;

(2) the individual is determined by HHSC to meet the LOC VIII criteria described in §261.239 of this title (relating to ICF/MR Level of Care VIII Criteria);

(3) the individual demonstrates a need for CFC PAS/HAB;

(4) the individual's IPC has an IPC cost for CLASS Program services at or below 210 percent of the annualized cost of care in an ICF/IID using the unweighted average of the current non-state operated small facility daily rates for level of need, as defined by the ICF/IID program rules in §261.203 of this title (relating to Definitions), 1, 5, and 8 rounded to the nearest dollar, which as of September 1, 2025 is $149,774;

(5) the individual is not enrolled in another waiver program or receiving a service that may not be received if the individual is enrolled in the CLASS Program, as identified in the Mutually Exclusive Services table in Appendix III of the Community Living Assistance and Support Services Provider Manual available on the HHSC website;

(6) the individual resides in the individual's own home or family home; and

(7) the individual requires the provision of:

(A) at least one CLASS Program service per month or a monthly monitoring by a case manager; and

(B) at least one CLASS Program service during an IPC period.

(b) Except as provided in subsection (c) of this section, an individual is eligible for a CFC service under this chapter if the individual:

(1) meets the criteria described in subsection (a) of this section;

(2) requires the provision of the CFC service; and

(3) is not receiving SFS or CFS.

(c) To be eligible for a CFC service under this chapter, an individual receiving MAO Medicaid must, in addition to meeting the eligibility criteria described in subsection (b) of this section, receive a CLASS Program service at least monthly, as required by 42 CFR §441.510(d).

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on August 28, 2025.

TRD-202503116

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: September 17, 2025

Proposal publication date: July 11, 2025

For further information, please call: (512) 438-2910

CHAPTER 260. DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES

SUBCHAPTER B. ELIGIBILITY, ENROLLMENT, AND REVIEW

DIVISION 1. ELIGIBILITY AND MAINTENANCE OF THE DBMD INTEREST LIST

26 TAC §260.51

The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts an amendment to §260.51, concerning Eligibility Criteria for DBMD Program Services and CFC Services.

Section 260.51 is adopted with changes to the proposed text as published in the July 11, 2025, issue of the Texas Register (50 TexReg 3988). This rule will be republished.

BACKGROUND AND JUSTIFICATION

This amendment is necessary to increase the waiver cost limit for an individual's individual plan of care (IPC) in the Deaf Blind with Multiple Disabilities (DBMD) waiver program. The 2026-2027 General Appropriations Act, Senate Bill 1, 89th Texas Legislature, Regular Session, 2025 (Article II, HHSC Rider 23) includes appropriations to increase the attendant wage for personal attendant services. This attendant wage increase impacts Medicaid personal attendant reimbursement rates.

As a result of this direction and prior reimbursement rate increases, the amendment increases the waiver cost limit for an individual's IPC in the DBMD waiver program to off-set the cost of higher personal attendant reimbursement rates. This increase allows the individual to continue to qualify for services in the DBMD waiver program without exceeding the cost limit for the IPC.

HHSC's amendments to the cost limit rules for an individual's IPC in the Community Living Assistance and Support Services and Texas Home Living Programs, and the cost limits in the Home and Community-based Services Program, are published in this same issue of the Texas Register .

COMMENTS

The 21-day comment period ended August 1, 2025.

During this period, HHSC received one comment regarding the proposed rule from one individual. A summary of the comment relating to the rule and HHSC's response follows.

Comment: The commentor supported the rule amendment and recommended that HHSC conduct a biennial review of the DBMD IPC cost limit.

Response: HHSC thanks the commentor for the commentor's support and recommendation to conduct a biennial review of the DBMD IPC cost limit. However, HHSC clarifies that biennial waiver cost limit reviews fall outside the scope of this rule project and are dependent on available levels of appropriated state and federal funds. HHSC did not revise the rule in response to this comment.

HHSC revised §260.51(a)(4) to add the new dollar amount of the IPC cost limit in the DBMD program which is $149,774.00. The dollar amount, added to the rule for clarity, is based on the final September 1, 2025 reimbursement rates for the Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions Program.

STATUTORY AUTHORITY

§260.51. Eligibility Criteria for DBMD Program Services and CFC Services.

(a) An individual is eligible for DBMD Program services if:

(1) the individual meets the financial eligibility criteria as described in Appendix B of the DBMD Program waiver application approved by CMS and available on the HHSC website;

(2) the individual is determined by HHSC to meet the LOC VIII criteria described in §261.239 of this title (relating to ICF/MR Level of Care VIII Criteria);

(3) the individual, as documented on the ID/RC Assessment:

(A) has one or more diagnosed related conditions and, as a result:

(i) has deafblindness;

(ii) has been determined to have a progressive medical condition that will result in deafblindness; or

(iii) functions as a person with deafblindness; and

(B) has one or more additional disabilities that result in impairment to independent functioning;

(4) the individual has an IPC with a cost for DBMD Program services at or below 210 percent of the annualized cost of care in an ICF/IID using the unweighted average of the current non-state operated small facility daily rates for level of need, as defined by the ICF/IID program rules in §261.203 of this title (relating to Definitions), 1, 5, and 8 rounded to the nearest dollar, which as of September 1, 2025 is $149,774;

(5) the individual is not enrolled in another waiver program or receiving a service that may not be received if the individual is enrolled in the DBMD Program, as identified in the Mutually Exclusive Services table in Appendix V of the Deaf Blind with Multiple Disabilities Program Manual;

(6) the individual does not reside in:

(A) an ICF/IID;

(B) a nursing facility;

(D) a residential child-care facility unless it is an agency foster home;

(E) a hospital;

(F) a mental health facility;

(G) an inpatient chemical dependency treatment facility;

(H) a residential facility operated by the Texas Workforce Commission;

(I) a residential facility operated by the Texas Juvenile Justice Department;

(J) a jail; or

(K) a prison;

(7) at least one program provider is willing to provide DBMD Program services to the individual;

(8) the individual resides or moves to reside in a county served by a program provider; and

(9) the individual requires the provision of:

(A) at least one DBMD Program Service per month or a monthly monitoring by a case manager; and

(B) at least one DBMD Program Service during an IPC period.

(b) Except as provided in subsection (c) of this section, an individual is eligible for a CFC service under this chapter if the individual:

(1) meets the criteria described in subsection (a) of this section;

(2) requires the provision of the CFC service; and

(3) is not receiving licensed assisted living or licensed home health assisted living.

(c) To be eligible for a CFC service under this chapter, an individual receiving MAO Medicaid must, in addition to meeting the eligibility criteria described in subsection (b) of this section, receive a DBMD Program service at least monthly, as required by 42 CFR §441.510(d).

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on August 28, 2025.

TRD-202503117

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: September 17, 2025

Proposal publication date: July 11, 2025

For further information, please call: (512) 438-2910

CHAPTER 262. TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)

SUBCHAPTER B. ELIGIBILITY, ENROLLMENT, AND REVIEW

26 TAC §262.101

The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts an amendment to §262.101, concerning Eligibility Criteria for TxHmL Program Services and CFC Services.

Section 262.101 is adopted with changes to the proposed text as published in the July 11, 2025, issue of the Texas Register (50 TexReg 3990). This rule will be republished.

BACKGROUND AND JUSTIFICATION

This amendment is necessary to increase the waiver cost limit for an individual's individual plan of care (IPC) in the Texas Home Living (TxHmL) waiver program. The 2026-2027 General Appropriations Act, Senate Bill 1, 89th Texas Legislature, Regular Session, 2025 (Article II, HHSC Rider 23) includes appropriations to increase the attendant wage for personal attendant services. This attendant wage increase impacts Medicaid personal attendant reimbursement rates.

As a result of this direction and prior reimbursement rate increases, the amendment increases the waiver cost limit for an individual's IPC in the TxHmL waiver program to off-set the cost of higher personal attendant reimbursement rates. The increase allows the individual to continue to qualify for services in the TxHmL waiver program without exceeding the cost limit for the IPC.

HHSC's amendments to the cost limit rules for an individual's IPC in the Community Living Assistance and Support Services, Deaf Blind with Multiple Disabilities, and the cost limits in the Home and Community-based Services Program, are published in the same issue of the Texas Register .

COMMENTS

The 21-day comment period ended August 1, 2025.

During this period, HHSC received one comment regarding the proposed rule from one individual. A summary of the comment relating to the rule and HHSC's response follows.

Comment: The commentor supported the rule amendment and recommended that HHSC conduct a biennial review of the TxHmL IPC cost limit.

Response: HHSC thanks the commentor for the commentor's support and recommendation to conduct a biennial review of the TxHmL IPC cost limit. However, HHSC clarifies that biennial waiver cost limit reviews fall outside the scope of this rule project and are dependent on available levels of appropriated state and federal funds. HHSC did not revise the rule in response to this comment.

HHSC revised §262.101(a)(4) to add the new dollar amount of the IPC cost limit in the TxHmL Program, which is $31,684. This dollar amount, added to the rule for clarity, is based on the final September 1, 2025 reimbursement rates for Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions. HHSC also revised this rule to correctly spell "non-state operated."

STATUTORY AUTHORITY

§262.101. Eligibility Criteria for TxHmL Program Services and CFC Services.

(a) An applicant or individual is eligible for TxHmL Program services if:

(1) the applicant or individual meets the financial eligibility criteria as described in Appendix B of the TxHmL waiver application approved by CMS and available on the HHSC website;

(2) the applicant or individual meets one of the following criteria:

(A) based on a DID and as determined by HHSC in accordance with §262.104 of this subchapter (relating to LOC Determination), the applicant or individual qualifies for an ICF/IID LOC I as defined in §261.238 of this title (relating to ICF/MR Level of Care I Criteria); or

(B) meets the following criteria:

(i) based on a DID and as determined by HHSC in accordance with §262.105 of this subchapter (relating to LON Assignment), qualifies for one of the following levels of care:

(I) an ICF/IID LOC I as defined in §261.238 of this title; or

(II) an ICF/IID LOC VIII as defined in §261.239 of this title (relating to ICF/MR Level of Care VIII Criteria);

(ii) meets one of the following:

(I) resides in a nursing facility immediately before enrolling in the TxHmL Program; or

(II) is at imminent risk of entering a nursing facility as determined by HHSC; and

(iii) is offered TxHmL Program services designated for a member of the reserved capacity group "Individuals with a level of care I or VIII residing in a nursing facility" included in Appendix B of the TxHmL Program waiver application approved by CMS and available on the HHSC website;

(3) the applicant or individual has been assigned an LON in accordance with §262.105 of this subchapter;

(4) the applicant or individual has an IPC cost that does not exceed 50 percent of the annualized cost of care in an ICF/IID using the current non-state operated small facility daily rate for LON 1, rounded to the nearest dollar, which as of September 1, 2025 is $31,684;

(5) the applicant or individual is not enrolled in another waiver program and is not receiving a service that may not be received if the individual is enrolled in the TxHmL Program, as identified in the Mutually Exclusive Services table in Appendix I of the TxHmL Handbook available on the HHSC website;

(6) the applicant or individual has chosen, or the applicant's or individual's LAR has chosen, participation in the TxHmL Program over participation in the ICF/IID Program;

(7) the applicant's or individual's service planning team concurs that the TxHmL Program services and, if applicable, non-TxHmL Program services for which the applicant or individual may be eligible are sufficient to ensure the applicant's or individual's health and welfare in the community;

(8) the applicant or individual does not reside in:

(A) a hospital;

(B) an ICF/IID;

(D) an assisted living facility licensed or subject to being licensed in accordance with THSC Chapter 247;

(E) a residential child care facility licensed by HHSC unless it is an agency foster home;

(F) an inpatient chemical dependency treatment facility;

(G) a mental health facility;

(H) a residential facility operated by the Texas Workforce Commission; or

(I)

a residential facility operated by the Texas Juvenile Justice Department, a jail, or a prison; and

(9) the applicant or individual requires the provision of:

(A) at least one TxHmL Program service per month or a monthly monitoring visit by a service coordinator as described in §262.701(o) of this chapter (relating to LIDDA Requirements for Providing Service Coordination in the TxHmL Program); and

(B) at least one TxHmL Program service per IPC year.

(b) Except as provided in subsection (c) of this section, an applicant or individual is eligible for a CFC service under this subchapter if the applicant or individual:

(1) meets the criteria described in subsection (a) of this section; and

(2) requires the provision of the CFC service.

(c) To be eligible for a CFC service under this chapter, an applicant or individual receiving MAO Medicaid must, in addition to meeting the eligibility criteria described in subsection (b) of this section, receive a TxHmL Program service at least monthly, as required by 42 CFR §441.510(d), which may not be met by a monthly monitoring visit by a service coordinator as described in §262.701(o)(1) and (2) of this chapter.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on August 28, 2025.

TRD-202503118

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: September 17, 2025

Proposal publication date: July 11, 2025

For further information, please call: (512) 438-2910

CHAPTER 263. HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)

SUBCHAPTER B. ELIGIBILITY, ENROLLMENT, AND REVIEW

26 TAC §236.101

The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts an amendment to §236.101, concerning Eligibility Criteria for HCS Program Services and CFC Services.

Section 263.101 is adopted with changes to the proposed text as published in the July 11, 2025, issue of the Texas Register (50 TexReg 3992). This rule will be republished.

BACKGROUND AND JUSTIFICATION

This amendment is necessary to increase the waiver cost limit for an individual's individual plan of care (IPC) in the Home and Community-based Services (HCS) waiver program. The 2026-2027 General Appropriations Act, Senate Bill 1, 89th Texas Legislature, Regular Session, 2025 (Article II, HHSC Rider 23) includes appropriations to increase the attendant wage for personal attendant services. This attendant wage increase impacts Medicaid personal attendant reimbursement rates.

As a result of this direction and prior reimbursement rate increases, the amendment increases the waiver cost limit for an individual's IPC in the HCS waiver program to off-set the cost of higher personal attendant reimbursement rates. The increase allows the individual to continue to qualify for services in the HCS waiver program without exceeding the cost limit for the IPC.

HHSC's amendments to the cost limit rules for an individual's IPC in the Community Living Assistance and Support Services, Deaf Blind with Multiple Disabilities, and Texas Home Living Programs, are published in this same issue of the Texas Register .

COMMENTS

The 21-day comment period ended August 1, 2025.

During this period, HHSC received one comment regarding the proposed rule from one individual. A summary of the comment relating to the rule and HHSC's response follows.

Comment: The commentor supported the rule amendment and recommended that HHSC conduct a biennial review of the HCS IPC cost limits.

HHSC revised §263.101(a)(3)(A) - (C) to add the new dollar amounts of the IPC cost limits in the HCS Program, which are $169,182, $211,822, and $392,318 respectively. These dollar amounts, added to the rules for clarity, are based on the final September 1, 2025 reimbursement rates for Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions. HHSC also revised these rules to correctly spell "non-state operated."

STATUTORY AUTHORITY

§263.101. Eligibility Criteria for HCS Program Services and CFC Services.

(a) An applicant or individual is eligible for HCS Program services if the applicant or individual:

(1) meets the financial eligibility criteria as described in Appendix B of the HCS Program waiver application approved by CMS and available on the HHSC website;

(2) meets one of the following criteria:

(A) based on a DID and as determined by HHSC in accordance with §263.105 of this subchapter (relating to LOC Determination), qualifies for an ICF/IID LOC I, as defined in §261.238 of this title (relating to ICF/MR Level of Care I Criteria);

(B) as determined by HHSC in accordance with §263.105 of this subchapter, qualifies for an ICF/IID LOC I as defined in §261.238 of this title or ICF/IID LOC VIII, as defined in §261.239 of this title (relating to ICF/MR Level of Care VIII Criteria), and has been determined by HHSC:

(i) to have an intellectual disability or a related condition;

(ii) to need specialized services; and

(iii) to be inappropriately placed in a Medicaid certified nursing facility based on an annual resident review conducted in accordance with the requirements of Chapter 303 of this title (relating to Preadmission Screening and Resident Review (PASRR); or

(i) based on a DID and as determined by HHSC in accordance with §261.237 of this title (relating to Level of Care) qualifies for one of the following levels of care:

(I) an ICF/IID LOC I as defined in §261.238 of this title; or

(II) an ICF/IID LOC VIII as defined in §261.239 of this title;

(ii) meets one of the following:

(I) resides in a nursing facility immediately before enrolling in the HCS Program; or

(II) is at imminent risk of entering a nursing facility as determined by HHSC; and

(iii) is offered HCS Program services designated for a member of the reserved capacity group "Individuals with a level of care I or VIII residing in a nursing facility" included in Appendix B of the HCS Program waiver application approved by CMS and available on the HHSC website;

(3) has an IPC cost that does not exceed:

(A) 210 percent of the annualized cost of care in an ICF/IID using the current non-state operated small facility daily rate for LON 8, rounded to the nearest dollar for an applicant or individual with an LON 1, LON 5, or LON 8, which as of September 1, 2025, is $169,182;

(B) 210 percent of the annualized cost of care in an ICF/IID using the current non-state operated small facility daily rate for LON 6, rounded to the nearest dollar for an applicant or individual with an LON 6, which as of September 1, 2025, is $211,822; or

(C) 210 percent of the annualized cost of care in an ICF/IID using the current non-state operated small facility daily rate for LON 9, rounded to the nearest dollar for an applicant or individual with an LON 9, which as of September 1, 2025, is $392,318;

(4) is not enrolled in another waiver program and is not receiving a service that may not be received if the individual is enrolled in the HCS Program as identified in the Mutually Exclusive Services table in Appendix II of the HCS Handbook available on the HHSC website;

(5) does not reside in:

(A) a hospital;

(B) an ICF/IID;

(D) an ALF;

(E) a residential child care facility licensed by HHSC unless it is an agency foster home;

(F) an inpatient chemical dependency treatment facility;

(G) a mental health facility;

(H) a residential facility operated by the Texas Workforce Commission; or

(I) a residential facility operated by the Texas Juvenile Justice Department, a jail, or a prison; and

(6) requires the provision of:

(A) at least one HCS Program service per month or a monthly monitoring visit by a service coordinator as described in §263.901(e)(40) of this chapter (relating to LIDDA Requirements for Providing Service Coordination in the HCS Program); and

(B) at least one HCS Program service per IPC year.

(b) For applicants or individuals with spouses who live in the community, the income and resource eligibility requirements are determined according to the spousal impoverishment provisions in §1924 of the Social Security Act and as specified in the Medicaid State Plan.

(c) Except as provided in subsection (d) of this section, an applicant or individual is eligible for a CFC service under this chapter if the applicant or individual:

(1) meets the criteria described in subsection (a) of this section;

(2) requires the provision of the CFC service; and

(3) is not receiving host home/companion care, supervised living, or residential support.

(d) To be eligible for a CFC service under this chapter, an applicant or individual receiving MAO Medicaid must, in addition to meeting the eligibility criteria described in subsection (c) of this section, receive an HCS Program service at least monthly, as required by 42 CFR §441.510(d), which may not be met by a monthly monitoring visit by a service coordinator as described in §263.901(e)(40) of this chapter.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on August 28, 2025.

TRD-202503119

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: September 17, 2025

Proposal publication date: July 11, 2025

For further information, please call: (512) 438-2910