26 Tex. Admin. Code § 307.53 - Eligibility Criteria and HCBS-AMH Assessment
(a) To participate in the HCBS-AMH program,
an assessor must conduct an HCBS-AMH assessment on each individual for HHSC to
determine that the individual meets the needs-based eligibility criteria for
HCBS-AMH.
(1) The assessor must consult with
the individual, the individual's LAR, if applicable, treatment team, providers,
and other persons according to the needs and desire of the individual to
conduct the HCBS-AMH assessment.
(2) The HCBS-AMH assessment must:
(A) be conducted face-to-face as permitted
under Medicaid guidelines;
(B) take
into account the ability of the individual to perform two or more activities of
daily living; and
(C) assess the
individual's need for HCBS-AMH.
(b) For HHSC to determine an individual
eligible to participate in HCBS-AMH, the individual must meet criteria in
accordance with applicable state legislative direction and eligibility
requirements as set forth in the Medicaid state plan, including:
(1) having three years or more of consecutive
or cumulative inpatient psychiatric hospitalizations during the five years
before initial enrollment in the HCBS-AMH program;
(2) having two or more psychiatric crises and
four or more discharges from correctional facilities during the three years
before initial enrollment in HCBS-AMH; or
(3) having two or more psychiatric crises and
fifteen or more total emergency department documented contacts in which
services are delivered during the three years before initial enrollment in
HCBS-AMH.
(c) The
HCBS-AMH assessment must be repeated at least annually for each individual, and
when circumstances necessitate a re-assessment, using the same requirements
outlined in subsections (a) and (b) of this section.
(d) HHSC approves each HCBS-AMH initial
eligibility assessment, annual assessment, and assessment conducted based on a
change in circumstances.
Notes
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