40 Tex. Admin. Code § 48.2918 - Primary Home Care or Community Attendant Services
(a) To be eligible for primary home care or
community attendant (CA) services, the applicant/client must:
(1) be eligible for Medicaid in a community
setting or be eligible under the provisions of the Social Security Act,
§1929(b)(2)(B);
(2) meet the
minimum functional need criteria as set by the department. The department uses
a standardized assessment instrument to measure the client's ability to perform
activities of daily living. This yields a score, which is a measure of the
client's level of functional need. The department sets the minimum required
score for a client to be eligible, which the department may periodically adjust
commensurate with available funding. The department will seek stakeholder input
before making any change in the minimum required score for functional
eligibility;
(3) have a medical
need for assistance with personal care.
(A)
The client's medical condition must be the cause of the client's functional
impairment in performing personal care tasks.
(B) Persons diagnosed with mental illness,
mental retardation, or both, are not considered to have established medical
need based solely on such diagnosis. The diagnoses do not disqualify a client
for eligibility as long as the client's functional impairment is related to a
coexisting medical condition;
(4) have a signed and dated practitioner's
statement that includes a statement that the client has a current medical need
for assistance with personal care tasks and other activities of daily living;
and
(5) require at least six hours
of service per week. An applicant/client requiring fewer than six hours of
service per week may be eligible if the applicant/client:
(A) requires primary home care or community
attendant services to provide respite care to the caregiver;
(B) lives in the same household as another
individual receiving primary home care, community attendant services, family
care, or community based alternatives personal assistance services;
(C) receives one or more of the following
services (through the department or other resources):
(i) congregate or home-delivered
meals;
(ii) assistance with
activities of daily living from a home health aide;
(iii) day activity and health services;
or
(iv) special services to persons
with disabilities in adult day care;
(D) receives aid-and-attendance benefits from
the Veterans Administration;
(E)
receives services through the department's In-home and Family Support
Program;
(F) receives services
through the Medically Dependent Children Program (MDCP); or
(G) is determined, based upon the functional
assessment, to be at high risk of institutionalization without primary home
care or community attendant care services.
(b) To receive services, the applicant/client
must reside in a place other than:
(1) a
hospital;
(2) a skilled nursing
facility;
(3) an intermediate care
facility;
(4) an assisted living
facility;
(5) a foster care
setting;
(6) a jail or
prison;
(7) a state
school;
(8) a state hospital;
or
(9) any other setting where
sources outside the primary home care program are available to provide personal
care.
(c) A client with
priority status may receive no more than 42 hours of service per week. A client
without priority status may receive no more than 50 hours of service per
week.
(d) The community care case
manager establishes a priority status for each client based on the functional
assessment. An individual is considered to have priority status if the
following criteria are met:
(1) The
individual is completely unable to perform one or more of the following
activities without hands-on assistance from another person:
(A) transferring himself into or out of bed
or a chair or on off a toilet;
(B)
feeding himself;
(C) getting to or
using the toilet;
(D) preparing a
meal; or
(E) taking
self-administered prescribed medications.
(2) During a normally scheduled service
shift, no one is readily available who is capable and who is willing to provide
the needed assistance other than the attendant.
(3) The community care case manager
determines that there is a high likelihood the individual's health, safety, or
well-being would be jeopardized if services were not provided on a single given
shift.
Notes
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No prior version found.