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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 EINTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS (ICF/IID) PROGRAM--CONTRACTING
DIVISION 6PERSONAL FUNDS
RULE §9.254Items and Services Provided by the Program Provider

A program provider must not charge an individual or require an individual to expend personal funds for items and services that are the program provider's responsibility to provide, except as authorized by §9.255(a)(1) of this title (relating to Items and Services Purchased with Personal Funds), because they are included in the ICF/MR Program reimbursement rate or are covered by other Medicaid programs. These items and services include:

  (1) medical services and therapies, e.g., physical exams, physical therapy, occupational therapy, and nutritional, speech, audiological, psychological, social, and medical evaluations;

  (2) prescribed and over-the-counter medication:

    (A) for an individual who is not eligible for Medicare Part D benefits; or

    (B) for an individual who is eligible for Medicare Part D benefits if the medication is prescribed and is in a category that is not covered by Medicare Part D;

  (3) medical equipment and supplies, e.g., nasogastric tubes, feeding pumps, catheters, sheepskins, and egg crate pads;

  (4) laboratory services;

  (5) eye exams and eyeglasses, except:

    (A) the difference between the Medicaid payment and the actual cost of the eyeglasses as authorized by §9.255(a)(2) of this title; or

    (B) as authorized by §9.255(a)(6) of this title;

  (6) non-cosmetic dental services and items, e.g., intra- and extra-oral examinations, prescribed dental treatments and follow-up visits, dentures, braces, crowns, toothbrushes, toothpaste, mouthwash, dental floss, and disclosing solution;

  (7) specialized equipment and adaptive devices that are medically necessary or are necessary to meet the objectives in the individual's IPP, e.g., hearing aids, hearing aid batteries, electric razor, shoe closures, and shoe insoles;

  (8) training and habilitation services, e.g., vocational training, congregate training, and day activity services;

  (9) behavioral reinforcers used in behavior modification programs, e.g., candy, soft drinks, cereal, coffee, toys, and magazines;

  (10) meals, snacks, and special diets, as listed on the program provider's menu, whether provided at the facility or elsewhere;

  (11) non-cosmetic personal hygiene items, e.g., shampoo, conditioner, soap, deodorant, anti-perspirant, body lotion, insect repellant, suncreen, shaving supplies, comb, hair brush, facial tissues, toilet tissue, sanitary napkins, tampons, and diapers;

  (12) shampooing, haircutting, basic hairstyling, and shaving, including mustache and beard trimming;

  (13) laundering personal clothing;

  (14) facility furnishings and housewares, e.g., bedroom furniture, kitchenware, bath towels, dish towels, and bed linens;

  (15) repairing and maintaining the facility's physical plant, including training and day activity areas;

  (16) expenses that are associated with activities that are part of the program provider's recreational program e.g., meals, lodging, registrations, and tickets;

  (17) transportation costs to and from:

    (A) an activity included in an individual's IPP, including health care services, congregate training, day activity services and supported employment, except for competitive employment; or

    (B) an activity that is part of the program provider's recreational program;

  (18) fees charged by financial institutions, including service fees and check printing charges, if an individual's personal funds are managed in a pooled account or if the program provider chooses to manage those funds in a separate account;

  (19) managing an individual's personal funds; and

  (20) a charge incurred if the program provider mismanages an individual's personal funds.


Source Note: The provisions of this §9.254 adopted to be effective January 1, 2001, 25 TexReg 12790; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective January 1, 2006, 30 TexReg 7890

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