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TITLE 40SOCIAL SERVICES AND ASSISTANCE
PART 1DEPARTMENT OF AGING AND DISABILITY SERVICES
CHAPTER 9INTELLECTUAL DISABILITY SERVICES--MEDICAID STATE OPERATING AGENCY RESPONSIBILITIES
SUBCHAPTER DHOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM
RULE §9.159IPC

(a) A local authority must initiate development of a proposed initial IPC for an applicant as required by §9.158(k)(4) of this subchapter (relating to Process for Enrollment of Applicants).

(b) A program provider must initiate development of a proposed renewal and proposed revised IPC for an individual as required by §9.166 of this subchapter (relating to Renewal and Revision of an IPC).

(c) An IPC must be based on the PDP and specify the type and amount of each service to be provided to an individual, as well as services and supports to be provided by other sources during the IPC year. Each HCS program service in the IPC:

  (1) must be necessary to protect the individual's health and welfare in the community;

  (2) must not be available to the individual through any other source, including the Medicaid State Plan, other governmental programs, private insurance, or the individual's natural supports;

  (3) must be the most appropriate type and amount to meet the individual's needs;

  (4) must be cost effective;

  (5) must be necessary to enable community integration and maximize independence;

  (6) if an adaptive aid or minor home modification, must:

    (A) be included on DADS approved list in the HCS Program Billing Guidelines; and

    (B) be within the service limit described in §9.192 of this subchapter (relating to Service Limits);

  (7) if an adaptive aid costing $500 or more, must be supported by a written assessment from a licensed professional specified by DADS in the HCS Program Billing Guidelines;

  (8) if a minor home modification costing $1,000 or more, must be supported by a written assessment from a licensed professional specified by DADS in the HCS Program Billing Guidelines; and

  (9) if dental services, must be within the service limit described in §9.192 of this subchapter.

(d) With the exception of an HCS program service provided through the CDS option, a program provider must:

  (1) provide an HCS Program service in accordance with an individual's authorized IPC; and

  (2) retain in an individual's record, results and recommendations of individualized assessments that support the individual's current need for each service included in the IPC.


Source Note: The provisions of this §9.159 adopted to be effective June 1, 2010, 35 TexReg 4441; amended to be effective December 1, 2011, 36 TexReg 8043; amended to be effective September 1, 2014, 39 TexReg 6516

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