Texas Register, Volume 24, Number 17, Pages 3153-3263, April 23, 1999 Page: 3,191
3153-3263 p. ; 28 cm.View a full description of this periodical.
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(2) If only one household member meets the eligibility
criteria, only the eligible household member may receive the grant.
The ineligible household member's moving-related expenses and
household start-up costs may be included in the eligible household
member's grant, subject to the $2,500 limit, provided the ineligible
household member is moving to the same community setting as the
eligible household member.
(i) Payments may be made directly to the eligible individual,
or his authorized representative. The payee must obtain a vendor
identification number from the Texas State Comptroller of Public
Accounts before payment can be made.
44.104. Transition to Life in the Community Client Rights.
(a) The individual requesting Transition to Life in the Com-
munity (TLC) funds and/or the authorized representative will receive
written notification of the eligibility decision for TLC from the case
manager. If the individual is determined eligible, the written notice
states the amount of the grant the individual will receive.
(b) The individual requesting TLC funds and/or the autho-
rized representative may also request a hearing to appeal the denial
of eligibility or the level of benefits if the request is made within 90
days of the date of notification of the eligibility decision.
This agency hereby certifies that the proposal has been re-
viewed by legal counsel and found to be within the agency's
legal authority to adopt.
Filed withe Offic of the of the Secretary of State, on April 9, 1999.
TRD-9902100
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date date of adoption: May 23, 1999
For further information, please call: (512) 438-3765
Subchapter C. Presumptive Eligibility Through
the Project CHOICE Program
40 TAC 44.201-44.207
The new sections are proposed under the Human Resources
Code, Title 2, Chapters 22 and 32, which authorizes the de-
partment to administer public assistance programs and under
Texas Government Code 531.021, which provides the Health
and Human Services Commission with the authority to admin-
ister federal medical assistance funds.
The new sections implement the Human Resources Code,
22.001-22.030 and 32.001-32.042.
44.201. Client Eligibility Criteria for Project CHOICE Presump-
tive Eligibility Services.
To be eligible through the Project CHOICE (Consumers Have
Options for Independence in Community Environments) program for
presumptive eligibility benefits of limited program services through
the Community Based Alternatives (CBA), Community Living and
Support Services (CLASS), or 1929(b) programs, an individual must
meet the all of the criteria specified in paragraphs (1)-(11) of this
section:
(1) not be currently certified in a Medicaid program
which makes the individual financially eligible for the program from
which he is requesting services;(2) submit a completed, signed, and dated application for
Medicaid financial eligibility;
(3) be appropriate to consider for services with regard to
waiting lists for the program services requested and the availability
of program funds; specifically, to bypass the CBA program interest
list, an individual must be eligible for presumptive eligibility services,
and be able to be served within available Project CHOICE funds;
(4) participate in and cooperate with the Texas Depart-
ment of Human Services (DHS) staff or contractors in the face-to-face
interview and assessment process, including the provision of financial
and medical information necessary to make a presumptive eligibility
decision;
(5) not have reported income or resources in excess of
the thresholds established by DHS;
(6) not have circumstances requiring evaluation of
trust(s), annuities, spousal impoverishment or protected resource
amount(s);
(7) appear to meet the medical necessity/level of care
criteria required by the program for which he is applying;
(8) be determined by case management staff authorized
to make presumptive eligibility decisions to be likely to meet all
eligibility criteria for the program through which the individual
will receive services pending final verification and determination of
eligibility;
(9) sign a presumptive eligibility service agreement;
(10) be at risk of institutional placement; and
(11) reside in a Project CHOICE pilot county.
44.202. Period of Presumptive Eligibility.
The period of presumptive eligibility continues until the final deci-
sion regarding eligibility is reached, but in no case will presumptive
eligibility services be authorized for more than 90 days, except in the
situations of short-term continuation of services to ineligible indi-
viduals. Individuals receiving program services through presumptive
eligibility who are determined ineligible for ongoing program bene-
fits may continue to receive the presumptive eligibility services for 30
days after the ineligibility decision. Presumptive eligibility services
will not be continued beyond the 30-day continuation of benefits pe-
riod even if the decision of ineligibility is appealed.
44.203. Presumptive Eligibility Program Benefits.
(a) Presumptive eligibility program benefits are contingent
upon the availability to the Texas Department of Human Services
(DHS) of special or temporary funds for this program.
(b) Services available through a presumptive eligibility
determination are limited to:
(1) personal assistance services, nursing services, and
medical supplies (not including prescription drugs) for the Commu-
nity Living and Support Services waiver program;
(2) personal assistance services, nursing services, medical
supplies (not including prescription drugs), adult foster care, and
assisted living/residential care services for the Community Based
Alternatives program; and
(3) personal assistance services in the 1929(b) program.
(c) Individuals receiving presumptive eligibility services are
not eligible to receive Medicaid benefits until and unless a final
determination of eligibility for ongoing program services is made.PROPOSED RULES April 23, 1999 24 TexReg 3191
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Texas. Secretary of State. Texas Register, Volume 24, Number 17, Pages 3153-3263, April 23, 1999, periodical, April 23, 1999; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth113888/m1/40/: accessed July 16, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.