Texas Register, Volume 46, Number 38, Pages 5983-6306, September 17, 2021 Page: 6,001
5985-6306 p. ; 28 cm.View a full description of this periodical.
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(iv) the Texas Home Living (TxHmL) Program; or
(v) the Youth Empowerment Services waiver;
(G) live in:
(i) the individual's home; or
(ii) an agency foster home as defined in Texas Hu-
man Resource Code, 42.002, (relating to Definitions); and
{() if the individual is tnder -I years of age beside}
[(# with a family member; or}
{[i0 in a foster home that includes no more than four
children unrelated to the i 4diviua;and
(H) be determined by HHSC to be financially eligible
for Medicaid under Chapter 358 of this title (relating to Medicaid El-
igibility for the Elderly and People with Disabilities), Chapter 360 of
this title (relating to Medicaid Buy-In Program), or Chapter 361 of this
title (relating to Medicaid Buy-In for Children Program).
(2) An individual receiving Medicaid nursing facility ser-
vices is approved for MDCP if the individual requests services while
residing in a [the] nursing facility and meets the eligibility criteria listed
in paragraph (1) of this subsection. If an [the] individual is discharged
from a [the] nursing facility into [for] a community setting before being
determined eligible for Medicaid nursing facility services and MDCP,
the individual is denied immediate enrollment in the program.
(b} [#e)] HHSC maintains a statewide interest list of individu-
als interested in receiving services through MDCP.
(1) A person may request that an individual's name be
added to the MDCP interest list by:
(A) calling HHSC toll-free 1-877-438-5658;
(B) submitting a written request to HHSC; or
(C) generating a referral through the YourTexasBene-
fits.com, Find Support Services screening and referral tool.
(2) If a request is made in accordance with paragraph (1) of
this subsection, HHSC adds an individual's name to the MDCP interest
list:
(A) if the individual is a Texas resident; and
(B) using the date HHSC receives the request as the
MDCP interest list date.
(3) For an individual determined diagnostically or func-
tionally ineligible during the enrollment process for the CLASS Pro-
gram, DBMD Program, HCS Program, or TxHmL Program:
(A) if the individual's name is not on the MDCP interest
list, at the request of the individual or LAR, HHSC adds the individ-
ual's name to the MDCP interest list using the individual's interest list
date for the waiver program for which the individual was determined
ineligible as the MDCP interest list date;
(B) if the individual's name is on the MDCP interest list
and the individual's interest list date for the waiver program for which
the individual was determined ineligible is earlier than the individual's
MDCP interest list date, at the request of the individual or LAR, HHSC
changes the individual's MDCP interest list date to the individual's in-
terest list date for the waiver program for which the individual was
determined ineligible; or
(C) if the individual's name is on the MDCP interest list
and the individual's MDCP interest list date is earlier than the individ-
ual's interest list date for the waiver program for which the individ-ual was determined ineligible, HHSC does not change the individual's
MDCP interest list date.
(4) This paragraph applies to an individual who is enrolled
in MDCP and, because the individual does not meet the level of care
criteria for medical necessity for nursing facility care, is determined in-
eligible for MDCP after November 30, 2019 and before the date Texas
Government Code 531.0601 expires. The individual or the individ-
ual's LAR may request one time that HHSC add the individual's name
to the first position on the MDCP interest list.
(5) This paragraph applies to an individual who is enrolled
in MDCP and, because the individual does not meet the level of care
criteria for medical necessity for nursing facility care or the require-
ment to be under 21 years of age, is determined ineligible for MDCP
after November 30, 2019 and before the date Texas Government Code
531.0601 expires. The individual or the individual's LAR may request
that HHSC add the individual's name to the interest list for any of the
following programs or change the individual's interest list date for any
of the following programs in accordance with:
(A) 40 TAC 45.202 (relating to CLASS Interest List)
for the CLASS Program;
(B) 40 TAC 42.202 (relating to DBMD Interest List)
for the DBMD Program;
(C) 40 TAC 9.157 (relating to HCS Interest List) for
the HCS Program; and
(D) 40 TAC 9.566 (relating to TxHmL Interest List)
for the TxHmL Program.
(6) [(-2)] HHSC removes an individual's name from the
MDCP interest list if:
(A) the individual is deceased;
(B) the individual is assessed for MDCP [the program]
and determined to be ineligible and has had an opportunity to exercise
the individual's right to a fair hearing, as described in Chapter 357 of
this title (relating to Hearings);
(C) the individual, medical consenter, or LAR requests
in writing that the individual's name be removed from the interest list;
or
(D) the individual moves out of Texas, unless the indi-
vidual is a military family member living outside of Texas as described
in Texas Government Code 531.0931:
(i) while the military member is on active duty; or
(ii) for less than one year after the former military
member's active duty ends.
(7) An individual assessed for MCDP and determined to
be ineligible, as described in paragraph (6)(B) of this subsection, may
request to have the individual's name added to the MDCP interest list
as described in paragraph (1) of this subsection.
[(3) An individual may request to he placed at the end of
the interest list immediately following a deam nation of ineligibility]-
(c [(d)] An [The] MCO develops a person-centered individ-
ual service plan (ISP) for each member in MDCP [individual], and all
applicable documentation, as described in the STAR Kids Handbook
and the Uniform Managed Care Manual (UMCM).
(1) An [The] ISP must:
(A) include services described in the waiver approved
by CMS;PROPOSED RULES September 17, 2021 46 TexReg 6001
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Texas. Secretary of State. Texas Register, Volume 46, Number 38, Pages 5983-6306, September 17, 2021, periodical, September 17, 2021; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth1385246/m1/19/: accessed July 17, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu.; crediting UNT Libraries Government Documents Department.