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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 §9.192Service Limits

(a) The service limits listed in subsection (b) of this section are in effect through August 31, 2013.

(b) Subject to an exception granted by DADS in accordance with §9.193 of this subchapter (relating to Exception to Service Limits), the following limits apply to an individual's services:

  (1) An individual may receive, during an IPC year, adaptive aids having a maximum cost of $1,057. The program provider may request, in accordance with the HCS Program Billing Guidelines, authorization of a requisition fee that is in addition to the $1,057 service limit.

  (2) The maximum number of hours of a specialized therapy that an individual may receive during an IPC year is as follows:

    (A) for audiology, three hours;

    (B) for dietary services, three hours;

    (C) for occupational therapy services, eight hours;

    (D) for physical therapy, 30 hours;

    (E) for social work, ten hours; and

    (F) for speech and language pathology, 49 hours.

  (3) An individual may receive a maximum of 126 hours of supported employment during an IPC year.

  (4) The maximum number of hours of supported home living that an individual may receive during an IPC year is as follows:

    (A) for an individual with an LON 1: 923 hours;

    (B) for an individual with an LON 5: 1,337 hours;

    (C) for an individual with an LON 8: 1,868 hours;

    (D) for an individual with an LON 6: 2,098 hours; and

    (E) for an individual with an LON 9: 3,546 hours.

(c) The following limits apply to an individual's services and are not subject to an exception granted by DADS in accordance with §9.193 of this subchapter.

  (1) An individual may receive dental treatment having a maximum cost of $1,000 during an IPC year. The program provider may request, in accordance with the HCS Program Billing Guidelines, authorization of a requisition fee that is in addition to the $1,000 service limit.

  (2) During the time an individual is enrolled in the HCS Program, an individual may receive minor home modifications that have a maximum cost of $7,500, which may be paid in one or more IPC years.

    (A) The program provider may request, in accordance with the HCS Program Billing Guidelines, authorization of a requisition fee that is in addition to the service limit.

    (B) After reaching the maximum cost of $7,500, an individual may receive, during an IPC year, a maximum of $300 for repair and maintenance.

  (3) An individual may receive a maximum of 300 hours of respite during an IPC year.

(d) Effective September 1, 2013, the following service limits apply to the individual:

  (1) for adaptive aids, $10,000 during an IPC year;

  (2) for dental treatment, $1,000 during an IPC year;

  (3) for minor home modifications, $7,500 during the time period the individual is enrolled in the HCS Program, which may be paid in one or more IPC years;

  (4) for respite, 300 hours during an IPC year; and

  (5) for supported employment, 150 hours during an IPC year.


Source Note: The provisions of this §9.192 adopted to be effective December 1, 2011, 36 TexReg 8043

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