Aging and Disability Services Council Sharon Swift Butterworth ...

§48.6003. Eligibility Criteria.
(a) In this section, the term "individual" means a person applying for or enrolled in the
Community Based Alternatives (CBA) Program, unless the context clearly indicates otherwise.
(b) To be determined eligible by the Department of Aging and Disability Services (DADS)
for the CBA Program, an individual must:
(1) be 21 years of age or older;
(2) meet the level-of-care criteria for medical necessity for nursing facility care in
accordance with §19.2401 of this title (relating to General Qualifications for Medical Necessity
Determinations);
(3) choose the CBA Program as an alternative to nursing facility services, as described in
the Code of Federal Regulations, Title 42, §441.302(d);
(4) not be enrolled in another Medicaid waiver program approved by the Centers for
Medicare and Medicaid Services (CMS) pursuant to §1915(c) of the Social Security Act and
operated by DADS;
(5) live in a county not included in a Medicaid managed care area;
(6) have an individual [begin addition] service [end addition] plan (ISP) [begin deletion] of
care (IPC) [end deletion] with a cost for CBA Program services at or below 200 percent of the
reimbursement rate that would have been paid for that same individual to receive nursing facility
services [begin addition], as of August 31, 2010, [end addition] considering all other resources,
including resources described in §40.1 of this title (relating to Use of General Revenue for
Services Exceeding the Individual Cost Limit of a Waiver Program;
(7) have been determined by the Texas Health and Human Services Commission to be
financially eligible for Medicaid;
(8) have ongoing needs for CBA Program services with projected costs, as indicated on the
[begin addition] ISP [end addition] [begin deletion] IPC [end deletion], that do not exceed the
following maximum service ceilings:
(A) adaptive aids and medical supplies service category must not exceed $10,000 per
individual per [begin addition] ISP [end addition] [begin deletion] IPC [end deletion] year
without approval by DADS;
(B) minor home modifications service category must not exceed a lifetime maximum of
$7,500 per individual without approval by DADS, [begin addition] and a maximum of [end
addition] [begin deletion] after which minor home modifications must not exceed [end deletion]
$300 per [begin addition] ISP [begin deletion] IPC [end deletion] year for [begin addition] repair
and [end addition] maintenance [begin addition] of a minor home modification [end addition]
- 8 -