§9.154: Description of the Hcs Program

(a) The HCS Program is a Medicaid waiver program approved by the Centers for Medicare and Medicaid Services (CMS) pursuant to §1915(c) of the Social Security Act. It provides community-based services and supports to eligible individuals as an alternative to the ICF/MR Program. The HCS Program is operated by DADS under the authority of HHSC.

(b) Enrollment in the HCS Program is limited to the number of individuals in specified target groups and to the geographic areas approved by CMS.

(c) HCS Program service components listed in this subsection are selected for inclusion in an individual's IPC to ensure the individual's health, safety, and welfare in the community, supplement rather than replace that individual's natural supports and other community services for which the individual may be eligible, and prevent the individual's admission to institutional services. The following service components are defined in Appendix C of the HCS Program waiver application approved by CMS and found at www.dads.state.tx.us. Service components available under the HCS Program are:

(1) specialized therapies provided by appropriately licensed or certified professionals, including:

(A) physical therapy;

(B) occupational therapy;

(C) speech and language pathology;

(D) audiology;

(E) social work;

(F) behavioral support; and

(G) dietary services;

(2) nursing provided by licensed nurses;

(3) residential assistance, excluding room and board, provided in one of the following three ways:

(A) foster/companion care;

(B) supervised living; or

(C) residential support;

(4) supported home living, which is not a reimbursable service for individuals receiving foster/companion care, supervised living, or residential support;

(5) respite, which includes room and board when provided in a setting other than the individual's home, but is not a reimbursable service for individuals receiving foster/companion care, supervised living, or residential support;

(6) day habilitation, provided exclusive of any other separately funded service, including public school services, rehabilitative services for persons with mental illness, other programs funded by DADS, or programs funded by DARS;

(7) supported employment, which may be provided if the service has been denied or is otherwise unavailable to an individual through a program operated by a state rehabilitation agency or the public school system;

(8) adaptive aids;

(9) minor home modifications;

(10) dental treatment;

(11) financial management services, if the individual is participating in CDS; and

(12) support consultation, if the individual is participating in CDS.

(d) DADS has grouped the counties of the state of Texas into geographical areas, referred to as "local service areas," each of which is served by an MRA. DADS has further grouped the local service areas into "waiver contract areas." A list of the counties included in each local service area and waiver contract area is found at www.dads.state.tx.us.

(1) A program provider may provide HCS Program services only to persons residing in the counties specified for the program provider in DADS' automated enrollment and billing system.

(2) A program provider must have a separate program provider agreement for each waiver contract area served by the program provider.

(3) A program provider may have a program provider agreement to serve one or more local service areas within a waiver contract area, but the program provider must serve all of the counties within each local service area covered by the program provider agreement.

(4) A program provider may not have more than one program provider agreement per waiver contract area.

(e) A program provider must comply with:

(1) all applicable state and federal laws, rules, and regulations; and

(2) DADS Information Letters regarding the HCS Program found at www.dads.state.tx.us.

(f) CDS is a service delivery option, described in Chapter 41 of this title (relating to Consumer Directed Services Option), in which an individual or LAR employs and retains CDS service providers and directs the delivery of supported home living, respite, or both.

Comments

Source Note: The provisions of this §9.154 adopted to be effective March 1, 2000, 25 TexReg 1649; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective June 1, 2006, 31 TexReg 4442; amended to be effective March 1, 2007, 32 TexReg 537; amended to be effective June 1, 2008, 33 TexReg 4334; amended to be effective June 1, 2010, 35 TexReg 4441