SECTION 260.53. DBMD Interest List

(a) HHSC maintains an interest list that contains the names of individuals interested in receiving DBMD Program services.

(b) A person may request an applicant's name be added to the DBMD interest list by:

(1) calling HHSC's toll-free number; or

(2) submitting a written request to HHSC.

(c) If a request is made in accordance with subsection (b) of this section for an individual who resides in Texas, HHSC adds the individual's name to the DBMD interest list:

(1) if the individual resides in Texas; and

(2) using the date HHSC receives the request as the DBMD interest list date.

(d) For an individual determined diagnostically or functionally ineligible during the enrollment process for the Community Living Assistance and Support Services (CLASS) Program, Home and Community-based Services (HCS) Program, Texas Home Living (TxHmL) Program, or Medically Dependent Children Program (MDCP):

(1) if the individual's name is not on the DBMD interest list, at the request of the individual or LAR, HHSC adds the individual's name to the DBMD interest list using the individual's interest list date for the program for which the individual was determined ineligible as the DBMD interest list date;

(2) if the individual's name is on the DBMD interest list and the individual's interest list date for the program for which the individual was determined ineligible is earlier than the individual's DBMD interest list date, at the request of the individual or LAR, HHSC changes the individual's DBMD interest list date to the individual's interest list date for the program for which the individual was determined ineligible; or

(3) if the individual's name is on the DBMD interest list and the individual's DBMD interest list date is earlier than the individual's interest list date for the program for which the individual was determined ineligible, HHSC does not change the individual's DBMD interest list date.

(e) This subsection applies to an individual who was enrolled in MDCP and, because the individual did not meet the level of care criteria for medical necessity for nursing facility care or did not meet the age requirement of being under 21 years of age, was determined ineligible for MDCP after November 30, 2019.

(1) At the request of the individual or LAR, HHSC adds the individual's name to the DBMD interest list:

(A) using the MDCP interest list date as the DBMD interest list date, if the individual's name is not on the DBMD interest list but it was previously on the DBMD interest list; or

(B) using the date HHSC receives the request as the DBMD interest list date, if the individual's name is not on the DBMD interest list and it never has been on the DBMD interest list.

(2) At the request of the individual or LAR, HHSC changes the DBMD interest list date to the MDCP interest list date if the individual's MDCP interest list date is earlier than the individual's DBMD interest list date.

(f) HHSC removes an individual's name from the DBMD interest list if:

(1) the individual or LAR requests, in writing, that the individual's name be removed from the DBMD interest list;

(2) the individual moves out of Texas, unless the individual is a military family member living outside of Texas:

(A) while the military member is on active duty; or

(B) for less than one year after the former military member's active duty ends;

(3) the individual or LAR declines an offer of enrollment in the DBMD Program or, as described in §260.55(e) of this subchapter (relating to Written Offer of Enrollment in the DBMD Program), HHSC withdraws an offer of enrollment in the DBMD Program, unless the individual is a military family member living outside of Texas:

(A) while the military member is on active duty; or

(B) for less than one year after the former military member's active duty ends;

(4) the individual is a military family member living outside of Texas for more than one year after the former military member's active duty ends;

(5) the individual is deceased; or

(6) HHSC has denied the individual enrollment in the DBMD Program and the individual or LAR:

(A) has had an opportunity to exercise the individual's right to appeal the decision in accordance with §260.111 of this subchapter (relating to Individual's Right to a Fair Hearing), and

(B) either:

(i) did not appeal the decision; or

(ii) appealed and did not prevail.

(g) If HHSC removes an individual's name from the DBMD interest list in accordance with subsection (f)(1) - (4) of this section, HHSC receives an oral or written request from a person to add the individual's name to the DBMD interest list within 90 calendar days after the name was removed, and the request is the individual's first request, HHSC:

(1) adds the individual's name to the DBMD interest list using the DBMD interest list date that was in effect at the time the individual's name was removed from the DBMD interest list; and

(2) notifies the individual or LAR, in writing, that the individual's name has been added to the DBMD interest list in accordance with paragraph (1) of this subsection.

(h) If HHSC removes an individual's name from the DBMD interest list in accordance with subsection (f)(1) - (4) of this section, HHSC receives an oral or written request from a person to add the individual's name to the DBMD interest list more than 90 calendar days after the name was removed, and the request is the individual's first request, HHSC:

(1) adds the individual's name to the DBMD interest list using as the DBMD interest list date:

(A) the date HHSC receives the oral or written request; or

(B) because of extenuating circumstances as determined by HHSC the DBMD interest list date that was in effect at the time the individual's name was removed from the DBMD interest list; and

(2) notifies the individual or LAR, in writing, that the individual's name has been added to the DBMD interest list in accordance with paragraph (1) of this subsection.

(i) If HHSC removes an individual's name from the DBMD interest list in accordance with subsection (f)(6) of this section, HHSC receives an oral or written request from a person to add the individual's name to the DBMD interest list, and the request is not the individual's first request:

(1) HHSC adds the individual's name to the DBMD interest list using the date HHSC receives the oral or written request as the DBMD interest list date; and

(2) HHSC notifies the individual or LAR, in writing, that the individual's name has been added to the DBMD interest list in accordance with paragraph (1) of this subsection.

Source Note: The provisions of this §260.53 adopted to be effective February 26, 2023, 48 TexReg 896