Aging and Disability Services Council Sharon Swift Butterworth ...

September 2, 2011/11R11
TITLE 40 SOCIAL SERVICES AND ASSISTANCE
PART 1 DEPARTMENT OF AGING AND DISABILITY SERVICES
CHAPTER 9 MENTAL RETARDATION SERVICES--MEDICAID STATE
OPERATING AGENCY RESPONSIBILITIES
The Health and Human Services Commission (HHSC) proposes, on behalf of the Department of
Aging and Disability Services (DADS), amendments to §9.158, concerning process for
enrollment of applicants; §9.159, concerning IPC; and §9.166, concerning renewal and revision
of an IPC; new §9.192, concerning service limits; and new §9.193, concerning exception to
service limits, in Chapter 9, Mental Retardation Services--Medicaid State Operating Agency
Responsibilities.
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 Home and Community-Based Services (HCS) Program services. The rules in Chapter
9, Subchapter D, describe the requirements for operation of the HCS Program. Regarding the
requirement to adjust community services, the amendments and new rules establish service
limits, effective through August 31, 2013, for the following HCS Program services: adaptive
aids, audiology, behavioral support, dietary services, occupational therapy services, physical
therapy, social work, speech and language pathology, supported employment, and supported
home living. 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 HCS Program may receive without being
granted an exception. In addition, the amendments and new rules describe the exception process
by which a service coordinator or program provider (based on information from an individual,
legally authorized representative, service coordinator, or program provider) may request that
DADS allow an individual to receive services in excess of these service limits. Further, the new
rules provide that an exception may not be requested to the existing service limit for dental
treatment, minor home modifications, and respite. The new rules also provide that the current
limits for adaptive aids and supported employment remain in place even if DADS grants an
exception to the new, lower service limits.
SECTION-BY-SECTION SUMMARY
The proposed amendment to §9.158(n)(2) requires that a service coordinator, when submitting an
initial individual plan of care (IPC) that includes a service component for which a service limit is
described in new §9.192(b) is exceeded, submit a completed Request for Exception to Service
Limit form to DADS and keep a copy of the completed form in the individual's record.
The proposed amendment to §9.159(c) adds new paragraph (2) requiring a service coordinator or
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