March 22 issue (all sections) - Texas Secretary of State

§106.1459. Eligibility for BCVDD Program Case Management Ser-
vices.
In order to receive BCVDD Program case management services, the
recipient must meet the criteria established in §106.1423 of this sub-
chapter (relating to Eligibility), have an identified need for case man-
agement, and agree to receive services.
§106.1461. Due Process.
(a) Medicaid-eligible people. Any Medicaid-eligible person
whose request for eligibility for case management is denied or is not
acted upon with reasonable promptness, or whose case management
has been terminated, suspended, or reduced is entitled to a fair hearing
in accordance with 1 TAC Chapter 357, Subchapter A (relating to Uniform
Fair Hearing Rules).
(b) All children. If BCVDD Program denies, involuntarily reduces,
or terminates case management for a child, the child and family
have all rights to file complaints in accordance with Texas Human Resources
Code §117.028 and §117.072, and Division 6 of this subchapter
(relating to Complaint Resolution Process).
§106.1463. Case Management Reimbursement Charges.
(a) DARS bills for case management contacts at a case-management
bundled monthly rate equal to the rate set annually for casemanagement
reimbursements to the Texas Health and Human Services
Commission for Medicaid recipients.
(b) A family who does not have Medicaid is billed on a sliding
scale, based on the family's gross income and the number of persons
residing in the household for whom the parent or legal guardians
have legal and/or financial responsibility. Written information about
the different levels at which families are billed is available according
to §106.1407 of this subchapter (relating to Public Access to Information,
Forms, and Documents).
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of the Secretary of State on March 5, 2013.
TRD-201300986
Sylvia F. Hardman
General Counsel
Department of Assistive and Rehabilitative Services
Earliest possible date of adoption: April 21, 2013
For further information, please call: (512) 424-4050
♦ ♦ ♦
DIVISION 4. ECONOMIC RESOURCES AND
CONSUMER PARTICIPATION
40 TAC §106.1471
STATUTORY AUTHORITY
The new rule is proposed under the authority of Texas Human
Resources Code, Chapters 91 and 117, and in accordance with
HHSC's statutory rulemaking authority under Texas Government
Code, Chapter 531, §531.0055(e), which provides the executive
commissioner of the Texas Health and Human Services Commission
with the authority to promulgate rules for the operation
and provision of health and human services agencies.
No other statute, article, or code is affected by this proposal.
§106.1471. Determination of Economic Resources.
(a) The parent's economic resources must be determined before
DARS DBS authorizes the purchase of certain services contained
in Division 3 of this subchapter (relating to Services).
(b) A child in the managing conservatorship of the Department
of Family and Protective Services is considered to be a one-member
family with no income.
(c) Parents have the right to not disclose their economic resources.
When this information is not disclosed, DARS DBS determines
economic resources to be in excess of the allowable amount.
(d) To determine the parent's participation in the cost of services
that require an expenditure of BCVDD Program funds, DARS
DBS considers the parent's gross monthly income, the number of family
members for which the parent has financial responsibility, and the
type of services the child is receiving. These factors shall be applied
to percentages of the currently applicable federal poverty guidelines.
Information about the currently applicable federal poverty guidelines,
categories of services, and percentages in use by DARS DBS is available
as described in §106.1407 of this subchapter (relating to Public
Access to Information, Forms, and Documents).
(e) Parents with gross monthly incomes at or below the percentage
of federal poverty guidelines in use by DARS DBS are not
required to pay part of the cost of services that require an expenditure
of BCVDD Program funds.
(f) Parents with gross monthly incomes above the federal
poverty guidelines are required to pay part of the cost for services.
In making this decision, DARS DBS considers extenuating circumstances
that may prohibit the parents' ability to pay, such as medical
costs and debts resulting from a permanent disability or chronic illness
of the child or family member.
(g) Gross monthly income is any funds available to the child
and the child's parent, which includes, but is not limited to, the following:
(1) wages or salary;
(2) contributions from relatives, individuals, or organizations
received on a regular basis;
(3) child support payments;
(4) net rentals from property;
(5) scholarships and fellowships;
(6) public assistance payments, including Social Security
Income (SSI) and Temporary Assistance for Needy Families (TANF);
(7) assistance from private welfare agencies;
(8) income from stock dividends and bond interest;
(9) any available pension, annuity, compensation, or
insurance, including SSDI, health or hospitalization insurance plans,
Worker's Compensation, veteran's benefits, Old Age and Survivors
Insurance (OASI) from the Social Security Administration, labor
union insurance and health and welfare benefits, and unemployment
compensation;
(10) participation in savings plans and deductions for savings
bonds;
(11) income from self-employment, which is defined as
gross receipts, minus allowable Internal Revenue Service expenses,
from one's own business that results in income. Gross receipts include
PROPOSED RULES March 22, 2013 38 TexReg 1965