26 Tex. Admin. Code § 259.361 - Respite and Dental Treatment

(a) An individual may receive a maximum of 30 days of in-home and out-of-home respite combined, during an IPC period.

(b) A DSA must ensure that:

(1) in-home respite is provided in the individual's residence or the residence of a relative or friend that is not one of the settings listed in paragraph (2) of this subsection;

(2) out-of-home respite is provided in one of the following settings:

(A) an agency foster home;

(B) a nursing facility;

(C) an ICF/IID;

(D) an approved outdoor camp accredited by the American Camping Association;

(E) the residence of another person receiving a Medicaid waiver service; or

(F) an ALF; and

(3) the setting in which out-of-home respite is provided is:

(A) acceptable to the individual or LAR; and

(B) an accessible, safe, and comfortable environment for the individual and promotes the individual's health and welfare.

(c) If a DSA provides out-of-home respite in a residence described in subsection (b)(2)(E) of this section, the DSA must:

(1) obtain written approval from each person residing in the residence who is receiving a Medicaid waiver service, or LAR, for the provision of respite in the residence; and

(2) ensure that no more than four persons receiving a Medicaid waiver service are residing in the residence.

(d) The maximum amount HHSC approves as payment to a DSA for all dental treatment and adaptive aids combined for an individual is $10,000 per IPC period.

(e) A DSA must follow the process for requesting authorization to purchase dental treatment described in the Community Living Assistance and Support Services Provider Manual.

Notes

26 Tex. Admin. Code § 259.361

Adopted by Texas Register, Volume 48, Number 04, January 27, 2023, TexReg 0388, eff. 1/30/2023