SECTION 260.67. Development of a Proposed Enrollment IPC

(a) A program provider must ensure that an individual's case manager convenes an in-person meeting with the service planning team in which the service planning team:

(1) develops a proposed enrollment IPC that:

(A) documents the type of each DBMD Program service and CFC service, other than CFC support management, to be provided by the program provider;

(B) documents the number of units or annual cost for each service;

(C) if the individual will receive a service through the CDS option, documents:

(i) the name of the individual's FMSA; and

(ii) the type and number of units for each service to be provided through the CDS option;

(D) documents whether the individual will receive CFC support management;

(E) documents whether the individual needs a service backup plan for nursing, intervener services, or CFC PAS/HAB critical to the individual's health and safety;

(F) documents an effective date of the IPC that:

(i) is at least 10 business days after the case manager submits the proposed enrollment IPC to HHSC as described in §260.61(m)(1) of this division (relating to Process for Enrollment of an Individual); and

(ii) does not overlap with the end date of another Medicaid waiver program or another HHSC-operated program described in the Deaf Blind with Multiple Disabilities Program Manual, other than the Day Activity and Health Services Program, in which the individual may have been enrolled; and

(G) does not exceed the service limits described in:

(i) Subchapter F, Divisions 1 - 3, of this chapter (relating to Service Descriptions and Requirements) if the enrollment IPC includes adaptive aids, minor home modifications, dental treatment, and respite;

(ii) Subchapter F, Division 5, of this chapter (relating to CFC ERS) if the enrollment IPC includes CFC ERS; or

(iii) §272.5(d) of this title (relating to Service Description), if the enrollment IPC includes TAS;

(2) if the proposed enrollment IPC includes transportation as a residential habilitation activity or as an adaptive aid, develops an individual transportation plan;

(3) if the proposed enrollment IPC includes TAS, completes the HHSC Transition Assistance Services (TAS) Assessment and Authorization form; and

(4) identifies the individual's non-waiver resources using the HHSC Non-Waiver Services form.

(b) A program provider must ensure that a DBMD Program service and CFC service, other than CFC support management, on a proposed enrollment IPC:

(1) are necessary to protect the individual's health and welfare in the community;

(2) address at least one of the individual's related conditions or the additional disability that impairs independent functioning;

(3) supplements rather than replaces the individual's natural supports and other non-waiver services and supports for which the individual is eligible;

(4) prevents the individual's admission to an institution;

(5) are the most appropriate type and amount of DBMD Program services and CFC services to meet the individual's needs; and

(6) are cost effective.

(c) A program provider must:

(1) ensure that a proposed enrollment IPC is signed and dated by each member of the service planning team;

(2) submit a request for enrollment to HHSC as described in §260.61(l)(1) of this division; and

(3) maintain in the individual's record the proposed enrollment IPC submitted to HHSC with the request for enrollment.

(d) A program provider must maintain the following in the individual's record and provide a copy to HHSC upon request:

(1) current data obtained from standardized evaluations and formal assessments related to the LOC VIII criteria and to support the individual's diagnoses, in accordance with §260.51(a)(2) and (3) of this subchapter (relating to Eligibility Criteria for DBMD Program Services and CFC Services);

(2) documentation, including assessments of the individual, that support the DBMD Program services and CFC services recommended on the proposed enrollment IPC; and

(3) documentation that DBMD Program services or CFC services recommended on the proposed enrollment IPC are not available from another source.

Source Note: The provisions of this §260.67 adopted to be effective February 26, 2023, 48 TexReg 896