Aging and Disability Services Council Sharon Swift Butterworth ...

TITLE 40 SOCIAL SERVICES AND ASSISTANCE
PART 1 DEPARTMENT OF AGING AND DISABILITY SERVICES
CHAPTER 48 COMMUNITY CARE FOR AGED AND DISABLED
The Health and Human Services Commission (HHSC) proposes, on behalf of the Department of
Aging and Disability Services (DADS), amendments to §§48.6002, 48.6003, 48.6006, 48.6010,
48.6026, 48.6052, 48.6068, 48.6078, 48.6084, 48.6090, 48.6092, 48.6098, 48.6100, 48.6102, and
48.6104, concerning community based alternatives (CBA) definitions, eligibility criteria,
individual plan of care, client’s right to appeal, home and community support services agency
(HCSSA) qualifications, cost-effective purchases of adaptive aids, cost-effective purchases of
minor home modifications, billable units, service claim limits, fiscal monitoring and recoupment,
initiation of community based alternatives (CBA) home and community support services
(HCSS), circumstances requiring denial of services with advance notice, circumstances requiring
denial of services and Medicaid eligibility without advance notice, circumstances which may
result in denial of services and require advance notice, and crisis intervention requiring
immediate suspension or reduction of services without advance notice; and new §§48.6085,
48.6109, and 48.6110, concerning exception to service limit, denial of a CBA program service,
and reduction of a CBA program service, in Chapter 48, Community Care for Aged and
Disabled.
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 Based Alternatives (CBA) Program services, and make reductions related
to provider requisition and specification fees as cost saving measures for the state budget. The
rules in Chapter 48, Subchapter J describe the requirements for operation of the CBA Program.
Regarding the requirement to adjust community services, the amendments and new rules
establish service limits, effective through August 31, 2013, for the following CBA Program
services: adaptive aids, medical supplies, dental services, minor home modifications, respite,
occupational therapy, personal assistance services, physical therapy, speech, hearing and
language therapy. For each service, the service limit is based on the 90th percentile of paid units
for individuals who received the service during fiscal year 2010. These service limits describe
the maximum amount of services an individual in the CBA Program may receive without being
granted an exception. In addition, the amendments and new rules describe the exception process
by which DADS may allow an individual to receive services in excess of these service limits.
The new rules also provide that the current limits for adaptive aids and medical supplies, minor
home modifications, and respite remain in place even if DADS grants an exception to the new,
lower service limits. The new rules add limits for dental services that an exception granted by
DADS may not exceed. The amendments further provide that the current limits for adaptive aids,
medical supplies, and minor home modifications and new limits for dental services that were in
effect before December 1, 2011 will continue to be in effect as of September 1, 2013. Regarding
the requirement to reduce requisition fees, the amendments eliminate the process by which a
CBA provider requests and DADS authorizes payment for a specification fee for adaptive aids
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