SECTION 357.401. Consumer Participation System

(a) The service provider administers the consumer participation system in accordance with the rules in this chapter, the standards, and the contract requirements.

(b) The service provider provides independent living core services, as defined in §104.311(d)(1) of this chapter (relating to Scope of Services), at no cost to the consumer.

(c) Independent living services defined in §104.311(d)(2) of this chapter are subject to the rules in this subchapter.

(d) The service provider gathers financial information about the consumer to determine the consumer's adjusted gross income and the percentage of the federal poverty level for that income.

(e) The service provider charges the consumer a fee for each service provided in §104.311(d)(2) of this chapter, according to the consumer's percentage of the federal poverty level.

(f) The consumer or consumer's representative signs a consumer participation agreement. Signing the agreement acknowledges the amount of the consumer's fee for services and provides written agreement that:

(1) the information provided by the consumer or the consumer's representative about the consumer's household size, annual gross income, allowable deductions, and comparable services or benefits is true and accurate; or

(2) the consumer or the consumer's representative chooses not to provide information about the consumer's household size, annual gross income, allowable deductions, and comparable services or benefits.

(g) The service provider does not initiate or authorize independent living services subject to §104.311(d)(2) of this chapter until the consumer or the consumer's representative signs the consumer's participation agreement.

(h) If the consumer chooses not to provide information on the consumer's household size, annual gross income, allowable deductions, and comparable services or benefits, the consumer agrees to pay the entire cost of services.

(i) The consumer reports to the service provider as soon as possible all changes to household size, annual gross income, allowable deductions, and comparable services or benefits and signs a new consumer's participation agreement.

(j) When the consumer signs a new participation agreement, the new amount of the consumer's fee for service takes effect the beginning of the following month. The new amount is not retroactive.

(k) The service provider must develop a process to reconsider and adjust the consumer's fee for service based on circumstances that are both extraordinary and documented. This may include assessing the consumer's ability to pay the consumer's fee for service.

(l) Only the service provider's executive director or designee has authority to reconsider and adjust a consumer's fee for service.

(m) Extraordinary circumstances are:

(1) an increase or decrease in income;

(2) unexpected medical expenses;

(3) unanticipated disability related expenses;

(4) a change in family size;

(5) catastrophic loss, such as a fire, flood, or tornado;

(6) short-term financial hardship, such as a major repair to the consumer's home or personally owned vehicle; or

(7) other extenuating circumstances for which the consumer makes a request and provides supporting documentation.

(n) The consumer's calculated fee for service remains in effect during the reconsideration and adjustment process.

(o) The service provider:

(1) uses program income that is received from the consumer participation system only to provide the independent living services that are outlined in §104.311(d)(2) of this chapter; and

(2) reports fees collected to DARS as program income.

(p) The service provider does not use program income received from the consumer participation system to supplant any other fund sources.

(q) DARS does not pay any portion of the consumer's fee for service.

(r) The consumer's participation agreement and all financial information collected by the service provider are subject to any data use agreement between DARS and the service provider.

(s) The consumer's participation agreement and all financial information collected by the service provider are subject to subpoena.

Source Note: The provisions of this §357.401 adopted to be effective August 31, 2016, 41 TexReg 6066; transferred effective March 15, 2021, as published in the Texas Register February 26, 2021, 46 TexReg 1387