Texas Register, Volume 38, Number 25, Pages 3857-4052, June 21, 2013 Page: 3,904
3857-4052 p. ; 28 cm.View a full description of this periodical.
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(2) using the TAS Assessment and Authorization form, as-
sist the individual or LAR to:and
vices; and(A) identify the individual's essential needs for TAS;
(B) provide estimated amounts for TAS items and ser-(3) retain the completed TAS Assessment and Authoriza-
tion form in the individual's record for inclusion on the enrollment IPC
as described in 42.214 of this chapter (relating to Development of En-
rollment Individual Plan of Care (IPC)).
(f) The program provider must:
(1) gather and maintain the information necessary to
process the individual's request for enrollment in the DBMD Program
using forms prescribed by DADS in the DBMD Program Manual;
(2) assist the individual who does not have Medicaid finan-
cial eligibility or the individual's LAR to:
(A) complete an application for Medicaid financial eli-
gibility; and
(B) submit the completed application to HHSC within
30 calendar days after the case manager's initial face-to-face, in-home
visit;
(3) document in the individual's record any problems or
barriers the individual or LAR encounters that may inhibit progress
towards completing:
(A) the application for Medicaid financial eligibility;
and
(B) enrollment in DBMD Program services; and
(4) assist the individual or LAR to overcome problems or
barriers documented as described in paragraph (3) of this subsection.
(g) If an individual or LAR does not submit a completed Med-
icaid application to HHSC as described in subsection (f)(2)(B) of this
section as a result of problems or barriers documented in subsection
(f)(3) of this section but is making progress in collecting the documen-
tation necessary for an application, the program provider may grant one
or more 30 calendar day extensions.
(1) The program provider must ensure the case manager
documents the rationale for an extension in the individual's record.
(2) The program provider must not issue an extension that
will cause the period of Medicaid application preparation to exceed 12
months after the date of the case manager's initial face-to-face, in-home
visit.
(3) The program provider must notify DADS [DADS']
DBMD program specialist in writing if the individual or LAR:
(A) fails to submit a completed Medicaid application to
HHSC within 12 months after the date of the case manager's initial
face-to-face, in-home visit; or
(B) does not cooperate with the case manager in com-
pleting the enrollment process described in this section.
(h) A program provider must ensure:
(1) the related conditions documented on the ID/RC
[MR/RG] Assessment form for the individual are on DADS [DADS']
Approved Diagnostic Codes for Persons with Related Conditions list
contained in the DBMD Program Manual;(2) the ID/RC [MR/RG] Assessment is submitted to a
physician for review; and
(3) the DADS [DADS'] Prior Authorization for Dental Ser-
vices form is sent to a dentist as described in the DBMD Program Man-
ual if the individual or LAR requests dental services other than an initial
dental exam.
(i) After receiving the signed and dated ID/RC [MR/RC] As-
sessment from the physician establishing that the individual meets the
eligibility criteria described in 42.201(3) and (4) of this chapter (re-
lating to Eligibility Criteria), the case manager must:
(1) convene a service planning team meeting within 10
business days after receipt of the signed and dated ID/RC [MR/RG]
Assessment; and
(2) if a DADS [DADS'] Prior Authorization for Dental Ser-
vices form was submitted to a dentist as described in subsection (h)(3)
of this section, ensure that the signed and completed form is available
for the service planning team to review.
(j) During the service planning team meeting, the case man-
ager must ensure:
(1) if the individual or LAR is requesting dental services
other than an initial dental exam, the DADS [DADS'] Prior Authoriza-
tion for Dental Services form has been signed by the dentist as de-
scribed in 42.624(b) of this chapter (relating to Dental Treatment);
and
(2) an enrollment IPC is developed as described in 42.214
of this chapter.
(k) Within ten business days after the service planning team
meeting, the case manager must:
(1) complete an enrollment Individual Program Plan (IPP)
as described in 42.215 of this chapter (relating to Development of
Enrollment Individual Program Plan (IPP));
(2) provide a copy of the completed enrollment IPC and
IPP to the individual or LAR;
(3) submit a request for enrollment to DADS for review
as described in 42.216 of this chapter (relating to DADS Review of
Request for Enrollment) that includes the following:
(A) a copy of the completed enrollment IPC;
(B) a copy of the ID/RC [MR/RG] Assessment form
signed by a physician;
(C) a copy of the completed enrollment IPP;
(D) a copy of the adaptive behavior screening assess-
ment;
(E) a copy of the Related Conditions Eligibility Screen-
ing Instrument form;
(F) a copy of the DBMD Summary of Services Deliv-
ered form (for pre-assessment services) with supporting documenta-
tion;
(G) a copy of the Verification of Freedom of Choice,
Waiver Program form;
(H) a copy of the Non-Waiver Services form; [and]
(I) a copy of the Documentation of Provider Choice
form;
(J) [(1)] if applicable:38 TexReg 3904 June 21, 2013 Texas Register
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Texas. Secretary of State. Texas Register, Volume 38, Number 25, Pages 3857-4052, June 21, 2013, periodical, June 21, 2013; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth313177/m1/48/: accessed April 24, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.