Tex.
Gov't Code Section 546.0454
Interest List Management for Certain Medicaid Waiver Programs
(a)
This section applies only to the following waiver programs:(1)
the community living assistance and support services (CLASS) waiver program;(2)
the home and community-based services (HCS) waiver program;(3)
the deaf-blind with multiple disabilities (DBMD) waiver program;(4)
the Texas home living (TxHmL) waiver program;(5)
the medically dependent children (MDCP) waiver program; and(6)
the STAR+PLUS home and community-based services (HCBS) program.(b)
The commission, in consultation with the Intellectual and Developmental Disability System Redesign Advisory Committee established under Section 542.0052 (Intellectual and Developmental Disability System Redesign Advisory Committee), the state Medicaid managed care advisory committee, and interested stakeholders, shall develop a questionnaire to be completed by or on behalf of an individual who requests to be placed on or is currently on an interest list for a waiver program.(c)
The questionnaire developed under Subsection (b) must, at a minimum, request the following information about an individual seeking or receiving services under a waiver program:(1)
contact information for the individual or the individual’s parent or other legally authorized representative;(2)
the individual’s general demographic information;(3)
the individual’s living arrangement;(4)
the types of assistance the individual requires;(5)
the individual’s current caregiver supports and circumstances that may cause the individual to lose those supports; and(6)
when the delivery of services under a waiver program should begin to ensure the individual’s health and welfare and that the individual receives services and supports in the least restrictive setting possible.(d)
If an individual is on a waiver program’s interest list and the individual or the individual’s parent or other legally authorized representative does not respond to a written or verbal request made by the commission to update information concerning the individual or otherwise fails to maintain contact with the commission, the commission:(1)
shall designate the individual’s status on the interest list as inactive until the individual or the individual’s parent or other legally authorized representative notifies the commission that the individual is still interested in receiving services under the waiver program; and(2)
at the time the individual or the individual’s parent or other legally authorized representative provides notice to the commission under Subdivision (1), shall designate the individual’s status on the interest list as active and restore the individual to the position on the list that corresponds with the date the individual was initially placed on the list.(e)
The commission’s designation of an individual’s status on an interest list as inactive under Subsection (d) may not result in the removal of the individual from that list or any other waiver program interest list.(f)
Not later than September 1 of each year, the commission shall provide to the Intellectual and Developmental Disability System Redesign Advisory Committee established under Section 542.0052 (Intellectual and Developmental Disability System Redesign Advisory Committee), or, if that advisory committee is abolished, an appropriate stakeholder advisory committee, as determined by the executive commissioner, the number of individuals, including individuals whose status is designated as inactive by the commission, who are on an interest list to receive services under a waiver program.(1)
the level of care criteria for medical necessity for nursing facility care; or(2)
the age requirement for the program.(b)
A legally authorized representative of a child who is notified by the commission that the child is no longer eligible for the medically dependent children (MDCP) waiver program following a Medicaid fair hearing, or without a Medicaid fair hearing if the representative opted in writing to forgo the hearing, may request that the commission:(1)
return the child to the interest list for the program unless the child is ineligible due to the child’s age; or(2)
place the child on the interest list for another Section 1915(c) waiver program.(c)
At the time a child’s legally authorized representative makes a request under Subsection (b), the commission shall:(1)
for a child who becomes ineligible for the reason described by Subsection (a)(1), place the child:(A)
on the interest list for the medically dependent children (MDCP) waiver program in the first position on the list; or(B)
except as provided by Subdivision (3), on the interest list for another Section 1915(c) waiver program in a position relative to other individuals on the list that is based on the date the child was initially placed on the interest list for the medically dependent children (MDCP) waiver program;(2)
except as provided by Subdivision (3), for a child who becomes ineligible for the reason described by Subsection (a)(2), place the child on the interest list for another Section 1915(c) waiver program in a position relative to other individuals on the list that is based on the date the child was initially placed on the interest list for the medically dependent children (MDCP) waiver program; or(3)
for a child who becomes ineligible for a reason described by Subsection (a) and who is already on an interest list for another Section 1915(c) waiver program, move the child to a position on the interest list relative to other individuals on the list that is based on the date the child was initially placed on the interest list for the medically dependent children (MDCP) waiver program, if that date is earlier than the date the child was initially placed on the interest list for the other waiver program.(d)
Notwithstanding Subsection (c)(1)(B) or (c)(2), a child may be placed on an interest list for a Section 1915(c) waiver program in the position described by those subsections only if the child has previously been placed on the interest list for that waiver program.(e)
At the time the commission provides notice to a legally authorized representative that a child is no longer eligible for the medically dependent children (MDCP) waiver program following a Medicaid fair hearing, or without a Medicaid fair hearing if the representative opted in writing to forgo the hearing, the commission shall inform the representative in writing about:(1)
the options under this section for placing the child on an interest list; and(2)
the process for applying for the Medicaid buy-in program for children with disabilities implemented under Section 532.0353 (Buy-in Programs for Certain Individuals with Disabilities).(1)
is diagnosed as having a condition included in the list of compassionate allowances conditions published by the United States Social Security Administration; or(2)
receives Medicaid hospice or palliative care services.(b)
If the commission determines a child is eligible for a waiver program under Subsection (a), the child’s enrollment in the applicable program is contingent on the availability of a slot in the program. If a slot is not immediately available, the commission shall place the child in the first position on the interest list for the medically dependent children (MDCP) waiver program or deaf-blind with multiple disabilities (DBMD) waiver program, as applicable.
Source:
Section 546.0454 — Interest List Management for Certain Medicaid Waiver Programs, https://statutes.capitol.texas.gov/Docs/GV/htm/GV.546.htm#546.0454 (accessed May 18, 2024).
