SECTION 259.257. Requirements for Authorization to Purchase an Adaptive Aid Costing $500 or More

(a) To purchase an adaptive aid costing $500 or more for an individual, a CMA must:

(1) ensure that the individual or LAR initiates a request for the adaptive aid by completing Part A of the HHSC Request for Adaptive Aids, Medical Supplies and Minor Home Modifications form described in the Community Living Assistance and Support Services Provider Manual;

(2) send the partially completed form to the DSA;

(3) ensure that the individual's service planning team includes the cost of the specifications for the adaptive aid, as described in §259.259 of this division (relating to Requirements for Specifications for an Adaptive Aid), in:

(A) the individual's proposed enrollment IPC, proposed renewal IPC, or proposed revised IPC, as applicable; and

(B) the individual's IPP; and

(4) no later than 14 calendar days after completing the requirements described in paragraph (3) of this subsection, submit to HHSC:

(A) the proposed enrollment IPC, proposed renewal IPC, or proposed revised IPC described in paragraph (3)(A) of this subsection, as applicable; and

(B) the individual's IPP described in paragraph (3)(B) of this subsection.

(b) The cost of the specifications included on an IPC and IPP as required by subsection (a)(3) of this section may not exceed an amount equal to three units of service of behavioral support, occupational therapy, physical therapy, or speech and language pathology, as applicable.

(c) HHSC reviews the documentation described in subsection (a)(4) of this section and determines whether the proposed IPC is authorized in accordance with §259.69 of this chapter (relating to HHSC's Review of a Proposed Enrollment IPC) or §259.79 of this chapter (relating to Renewal and Revision of an IPC).

(d) HHSC notifies a DSA in MESAV of whether the proposed IPC is authorized. HHSC notifies a CMA, in writing, of whether the proposed IPC is authorized.

(e) If HHSC approves the proposed IPC for payment of the specifications, the DSA must:

(1) no later than 30 calendar days after the date HHSC approves the IPC, obtain the specifications regarding the adaptive aid in accordance with §259.259 of this division and ensure that Part B of the HHSC Request for Adaptive Aids, Medical Supplies and Minor Home Modifications form is completed; and

(2) no later than 60 calendar days after obtaining the specifications:

(A) obtain bids from vendors in accordance with §259.261 of this division (relating to Requirements for Bids of an Adaptive Aid);

(B) select a vendor from which to purchase the adaptive aid; and

(C) complete Part C of the HHSC Request for Adaptive Aids, Medical Supplies and Minor Home Modifications form and send the form to the CMA.

(f) A CMA must, no later than 14 calendar days after receipt of the form described in subsection (e)(2)(C) of this section:

(1) complete Part D of the HHSC Request for Adaptive Aids, Medical Supplies and Minor Home Modifications form, evidencing that the criteria described in §259.65(b) of this chapter (relating to Development of an Enrollment IPC) are met;

(2) ensure that, in accordance with Subchapter B of this chapter (relating to Eligibility, Enrollment, and Review), the individual's service planning team includes the cost of the adaptive aid in:

(A) the individual's proposed enrollment IPC, proposed renewal IPC, or proposed revised IPC, as applicable; and

(B) the individual's IPP; and

(3) no later than 14 calendar days after completing the requirement described in paragraph (2) of this subsection, submit to HHSC:

(A) the completed HHSC Request for Adaptive Aids, Medical Supplies, and Minor Home Modifications form;

(B) the proposed enrollment IPC, proposed renewal IPC, or proposed revised IPC described in paragraph (2)(A) of this subsection, as applicable;

(C) the individual's IPP described in paragraph (2)(B) of this subsection; and

(D) documentation regarding bids required by §259.261 of this division.

(g) HHSC reviews the documentation described in subsection (f)(3) of this section and determines whether the proposed IPC is authorized in accordance with §259.69 or §259.79 of this chapter.

(h) HHSC notifies a DSA, in the electronic billing system, of whether the proposed IPC is authorized. HHSC notifies a CMA, in writing, of whether the proposed IPC is authorized.

Source Note: The provisions of this §259.257 adopted to be effective January 30, 2023, 48 TexReg 362