Aging and Disability Services Council Sharon Swift Butterworth ...

(A) an individual who is 21 years of age and:
(i) has been receiving Medically Dependent Children Program (MDCP) services and
is no longer eligible for MDCP; or
(ii) has been receiving nursing services through the Texas Health Steps Program and
is no longer eligible for Texas Health Steps Program services; or
(B) an individual described in paragraph (3) of this subsection.
(2) Except for an individual described in paragraph (1)(A) and (B) of this subsection,
DADS suspends enrollment of individuals whose names are on the CBA Program interest list
into the CBA Program while the census of enrolled individuals exceeds funded limits.
(3) An individual receiving services reimbursed through the Texas Medicaid Nursing
Facility Program will be approved for the CBA Program if the individual requests services while
residing in the nursing facility and meets all eligibility criteria for the CBA Program. If the
individual is discharged from the nursing facility for a community setting before being
determined eligible for Medicaid nursing facility services and the CBA Program, the individual
will be denied immediate enrollment in the CBA Program.
(d) An individual transferring from a nursing facility or from MDCP is exempt from
subsection (b)(12) of this section.
§48.6006. Individual [begin addition] Service [end addition] Plan [begin deletion] of Care [end
deletion].
(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) A CBA [begin deletion] Program [end deletion] provider must coordinate with an
interdisciplinary team to develop an [begin addition] ISP [end addition] [begin deletion]
individual plan of care (IPC) [end deletion] that is based on assessments conducted in accordance
with §48.6020 and §48.6022 of this subchapter (relating to Pre-Enrollment Health Assessment;
and Community Based Alternatives Annual Reassessment) and that meets the criteria in
subsection (d) of this section.
(c) Before providing CBA Program services in accordance with the [begin addition] (ISP)
[end addition] [begin deletion] IPC [end deletion], the CBA [begin deletion] Program [end
deletion] provider must obtain approval from the Department of Aging and Disability Services
(DADS).
(d) To be approved by DADS, CBA Program services in the [begin addition] ISP [end
addition] [begin deletion] IPC [end deletion] must:
(1) be necessary to protect the individual's health and welfare in the community;
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