Aging and Disability Services Council Sharon Swift Butterworth ...

TITLE 40 SOCIAL SERVICES AND ASSISTANCE
PART 1 DEPARTMENT OF AGING AND DISABILITY SERVICES
CHAPTER 45 COMMUNITY LIVING ASSISTANCE AND SUPPORT SERVICES
The Health and Human Services Commission (HHSC) proposes, on behalf of the Department of
Aging and Disability Services (DADS), amendments to §§45.103, 45.104, 45.212, 45.214,
45.216, 45.223, 45.225, 45.403, 45.405, 45.602, 45.604, 45.605, 45.606, 45.609, 45.612, 45.613,
45.614, 45.615, 45.616, 45.617, 45.704, 45.804, 45.806, 45.901, and 45.902, concerning
definitions, process for enrollment of an individual, development of enrollment IPC, DADS
review of an enrollment IPC, renewal and revision of an IPC, utilization review of an IPC by
DADS, denial of a CLASS program service, reduction of a CLASS program service,
authorization limit for adaptive aids and amount for repair and maintenance, requirements for
authorization to purchase an adaptive aid costing $500 or more, requirements for specifications
for an adaptive aid, requirements for bids of an adaptive aid, requirements of DSA following
provision of adaptive aid, authorization limit for minor home modifications and amount for
repair and maintenance, requirements for authorization to purchase a minor home modification,
requirements for specifications for a minor home modification, bid requirements for a minor
home modification, inspection of a minor home modification, time frames for completion of
minor home modification, training of CMA staff persons, training of DSA staff persons, respite
and dental treatment, administrative errors, and financial errors; new §45.218, concerning service
limits, and new §45.219, concerning exception to service limits, in Chapter 45, Community
Living Assistance and Support Services.
BACKGROUND AND PURPOSE
The purpose of the amendments and new sections is to implement the 2012-2013 General
Appropriations Act (Article II, Special Provisions, Section 17, House Bill 1, 82nd Legislature,
Regular Session, 2011), which requires DADS to adjust the amount of all community services,
including Community Living and Assistance and Support Services (CLASS) Program services,
and make reductions related to provider requisition fees as cost-saving measures for the state
budget. The rules in Chapter 45 describe the requirements for operation of the CLASS Program.
Regarding the requirement to adjust community services, the amendments and new rules
establish service limits, effective through August 31, 2013, for the following CLASS Program
services: adaptive aids, dental treatment, behavioral support, minor home modifications,
occupational therapy, physical therapy, prevocational services, respite, speech therapy, and
specialized therapies. For each service, other than for specialized therapies, the service limit is
based on the 90th percentile of paid units for individuals who received the service during fiscal
year 2010. For specialized therapies, the service limit is based on the 75th percentile of paid units
for specialized therapy services, combined, for each individual who received the services during
fiscal year 2010. These service limits describe the maximum amount of services an individual in
the CLASS Program may receive without being granted an exception. In addition, the
amendments and new rules describe the exception process by which a case management agency
(CMA) (based on information from an individual, legally authorized representative (LAR), the
CMA, or a direct services agency (DSA)) requests that DADS allow an individual to receive
services in excess of these service limits and provide that if DADS denies an exception, the
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