SECTION 275.25. Eligibility Criteria

(a) To be eligible to receive services under the CMPAS Program, an applicant must:

(1) be age 18 years of age or older;

(2) obtain and submit to the provider's assessor of need a completed practitioner's statement;

(3) be assessed under §44.203 of this subchapter (relating to Assessment and Eligibility Determination) as needing assistance with at least one personal care task and needing an allowable service for at least five hours per week;

(4) be able and willing to:

(A) self-direct the attendant; or

(B) designate a relative or friend who is willing and able to direct the attendant without compensation;

(5) reside in an area in which CMPAS Program services are available;

(6) have a service plan developed under §44.203(a)(6)(A) of this subchapter that does not exceed 52 hours per week of CMPAS Program services;

(7) choose one of the three service delivery options described in Subchapter D of this chapter (relating to Service Delivery Options);

(8) not be receiving services in:

(A) a hospital;

(B) a nursing facility;

(C) a state supported living center;

(D) a state mental health facility; or

(E) an intermediate care facility for individuals with an intellectual disability or related conditions.

(b) An individual is not eligible to receive services under the CMPAS Program if the individual is receiving:

(1) other community services and supports, either Medicaid or non-Medicaid, under a service plan that exceeds the reimbursement rate that would have been paid for the same individual to receive services in a nursing facility;

(2) services under any of the following DADS programs:

(A) Primary Home Care, including Family Care (FC) and Community Attendant Services (CAS);

(B) Residential Care; or

(C) Adult Foster Care;

(3) services under a §1915(c) Medicaid waiver program;

(4) regular or ongoing attendant services under either of the following DADS programs:

(A) Special Services to Persons with Disabilities; or

(B) In-Home and Family Support.

(c) An individual may not receive services under the CMPAS Program if the individual is Medicaid eligible and lives in a managed care service area, unless the individual's spouse was employed as the individual's attendant and the individual chose to remain in CMPAS when the managed care service area was expanded to include the individual's place of residence.

Source Note: The provisions of this §275.25 adopted to be effective October 1, 2013, 38 TexReg 6606; transferred effective August 1, 2022, as published in the Texas Register July 8, 2022, 47 TexReg 3983