SECTION 72.202. Texas Department of Human Services (DHS)

(a) Financial and service responsibilities to persons with disabilities.

(1) Health care services.

(A) One of the most important Medicaid benefits provided to low-income individuals is comprehensive health care services. In Texas, Medicaid services are funded by a combination of approximately 40% state funds and 60% federal funds. The federal matching rate is based upon the state's average per capita income.

(B) Medicaid eligibility is linked by federal law to eligibility for supplemental security income (SSI), the financial assistance program for low-income aged and blind persons, and persons with disabilities; aid to families with dependent children (AFDC), the financial assistance program for low-income families; and Medicaid for low-income children and pregnant women. Eligibility for AFDC and Medicaid (low-income families) is determined by client self-support services (CSS) eligibility staff. Eligibility for SSI benefits is determined by the Social Security Administration (SSA) based on income and resource requirements and a determination of disability. The SSA contracts with the Texas Rehabilitation Commission (TRC) to perform the disability determinations. Of the three million Texans living in poverty, the Texas Medicaid program covers about 790,000 individuals. Of that number, more than 128,000 are persons with disabilities under age 65.

(C) Federal regulations specify which Medicaid services states must provide as well as a range of optional services states may elect to cover.

(i) Mandatory Medicaid services. The mandatory Medicaid services are long-term institutional care services in nursing facilities.

(ii) Optional Medicaid services. Optional Medicaid services include: day activity and health services and long-term institutional care services in intermediate care facilities (ICF); intermediate care facilities for the mentally retarded (ICF-MR); and skilled nursing facilities (SNF) for children under age 21.

(iii) Medicaid waiver services. Under the provisions of the Social Security Act, §1915(c), states have the option to provide certain home and community-based services to individuals who would otherwise require long-term institutional care. Pending approval of the waiver requests by the Health Care Financing Administration (HCFA), states may define the home and community-based services and make them available to a limited number of individuals on less than a statewide basis. The cost of these additional home and community-based services must be no greater than the cost of Medicaid services without a waiver. Texas currently has four 1915(c) Medicaid waiver programs which serve persons with disabilities.

(I) The waiver program for medically dependent children provides Medicaid benefits and in-home skilled nursing services to children under age 18 who would otherwise require nursing home care in an ICF or an SNF. Currently, this waiver program serves 517 children statewide. Eligible children are served on a first-come, first-served basis.

(II) The 1915(c) waiver program for mentally retarded individuals is designed to provide 11 different home and community-based services to individuals living in their own home or with family members, as alternatives to institutional care in an ICF-MR. Eligible clients use their SSI to pay room and board costs. Home and community-based services are delivered based on an individual plan of care. This waiver program is in its 11th year of operation and can serve a maximum of 1,350 clients located in 31 geographic catchment areas. This waiver program is administered through an inter-agency contract between DHS and the Texas Department of Mental Health and Mental Retardation (TXMHMR). The state matching funds are provided by TXMHMR.

(2) Office on Services to Persons with Disabilities (OSPD).

(A) In January 1991, the Texas Board of Human Services adopted a proactive position statement on community-based services to persons with disabilities. The philosophy of DHS became "... people with disabilities of all ages can live in the community when provided appropriate services and supports." DHS committed itself to take all appropriate and necessary actions to ensure the development of a system of community-based services and supports for persons with disabilities, and committed itself to the development of specific plans and policies whereby this philosophy would be implemented in all areas of DHS. The OSPD is responsible for coordination of this effort.

(B) To specify how OSPD would facilitate the implementation of this philosophy organization-wide, an OSPD strategic plan with specific goals, objectives, timeframes, and products was developed. Although it is located in the Health Care Services Division, which is one major program area of DHS, the OSPD's scope is within all DHS programs and services for persons with disabilities.

(C) OSPD staff have five major roles:

(i) advocating for persons with disabilities within DHS and externally;

(ii) advocating for the implementation of the DHS position statement organization-wide;

(iii) facilitating and coordinating the development of community-based programs and supports for persons with disabilities;

(iv) serving as a focal point for DHS staff, consumers, providers, advocates, and other agencies to raise issues and concerns; and

(v) providing technical assistance and education on disability-related issues.

(3) Client self-support services. Client self-support services is a group of DHS programs that provides basic maintenance services such as food stamps, AFDC, Medicaid coverage, nutrition, and energy assistance for eligible individuals, as well as services aimed at making clients self-sufficient, such as education, job training, child care, and transportation.

(4) Community care services for aged and disabled persons. Community care services are provided to low-income, elderly persons; persons with disabilities; and persons with chronic health conditions, to help these persons remain at home or in community settings. These services also provide a support system to families caring for their elderly or disabled members. Eligibility for community care services is based on age; income; financial resources; the degree of functional impairment; and, in some cases, medical need. The income eligibility ceiling for community care services is $1,302 per month and the resource limit is $5,000.

(A) In-home community care services.

(i) Primary home care (PHC) provides medically necessary personal care or supportive care, supervised by a registered nurse, in the client's home. DHS contracts with licensed home health agencies to provide these services to individuals for up to 50 hours per week.

(ii) Family care (FC) provides personal care, housekeeping, escort service, and meal preparation in the client's own home. These services are provided through contracts with home health agencies for up to 50 hours per week.

(iii) Congregate and home-delivered meals provide nutritious meals in a central location or a client's home through community-based provider agencies. All menus are approved by a registered dietitian or nutritionist.

(iv) The Emergency Response System (ERS) is a 24-hour electronic monitoring service that permits quick response to emergencies using a network of volunteers and remote telephone-calling capability to a base station. Services are available to functionally impaired elderly or disabled adults who live alone or who are physically isolated from the community.

(v) The In-home and Family Support Program (IHFSP) provides direct grant benefits to people with physical disabilities and their families who choose and purchase services which enable the person with the disability to remain in the community. Allowable services include pre-approved items and services that are directly related to the person's disability, such as special equipment; architectural modification of a home to improve access or facilitate the care of a person with a disability; medical services; counseling and training programs which help provide proper care for a person with a disability; attendant care; respite care; and transportation.

(vi) Respite services up to 336 hours per year of short-term care to elderly or disabled adults whose caregivers need temporary relief.

(B) Out-of-home community care services.

(i) Adult foster care (AFC) provides supervision and assistance with daily living to eligible adults in 24-hour living arrangements provided in enrolled foster homes, for up to four clients, and licensed group homes, for four to eight clients. Clients pay their own room and board costs, and DHS pays the caregiver for personal care and supervision.

(ii) Day activity and health services (DAHS) provide personal care, nursing services, physical rehabilitation, and nutrition and supportive services in adult day-care facilities licensed by the Texas Department of Health (TDH) and certified by DHS. These services are available at least 10 hours per weekday and can provide respite for families.

(iii) Special services for persons with disabilities provide counseling, personal care, help with independent living skills, and transportation.

(iv) Residential care services are provided to eligible adults who require access to personal care services on a 24-hour basis, but not daily nursing intervention. Services may include board, protective supervision, personal care, social and recreational services, housekeeping, laundry, and transportation.

(C) Client Managed Attendant Services Program. The Client Managed Attendant Services Program is targeted to the needs of younger persons with physical disabilities who need personal care services to continue living in the community. It allows clients to hire and supervise their own attendants and schedule care according to their daily routines. This project serves approximately 690 clients in nine sites throughout the state. The fiscal year 1993 budget is $5.5 million.

(5) Long-Term Care Program.

(A) The purpose of the statewide Long-term Care Program of DHS is to assure that quality care is provided to persons in long-term care and related facilities and that these facilities are properly utilized. DHS inspects and licenses nursing homes, custodial care homes, personal care homes, certain facilities for the mentally retarded, and certain adult day care and adult health care facilities. DHS surveys and certifies nursing homes and facilities for the mentally retarded that participate in Medicaid, and surveys and recommends certification of nursing home's participation in Medicare. DHS performs inspection of care visits relating to care and services provided to each Medicaid recipient in nursing homes and facilities for the mentally retarded and determines the appropriate level of care needed for each recipient.

(B) The contact for program information is the associate commissioner for long-term care, [phone].

(C) DHS will continue the following memoranda of understanding with:

(i) the Texas Department on Aging (TDoA) regarding that agency's ombudsman program and the responsibilities of both agencies in complaint investigations; and implementing the state long-term care plan for the elderly;

(ii) the Texas Board of Licensure for Nursing Home Administrators for training of nursing home administrators; and

(iii) TDoA to train ombudsmen and TDoA representatives on nursing facility standards and complaint investigation procedures.

(D) In addition, DHS has entered into an inter-agency contract with the Texas Department of Corrections (TDC) to microfiche old records.

(6) Other DHS services. All DHS services are available to low-income persons with disabilities based on the eligibility criteria associated with the various funding sources.

(b) Service delivery data. DHS has a variety of data identifying the type of services, the number of clients receiving services, and expenditure data for all programs. The most comprehensive DHS documents that contain service delivery and expenditure data are:

(1) Legislative appropriations request (LAR). The LAR is a document prepared and submitted to the Legislative Budget Board and the governor's Budget Office prior to each legislative session. It contains DHS's request for appropriations for the next biennium based on four levels of funding for each program and activity. It also provides a summary of DHS's request. Specifically, it provides the objective and a description of each program and activity as well as data for need indicators, performance measures, object of expense, and method of finance for a five-year period. This period includes two years of the appropriations request and the three previous years.

(2) Fiscal year operating plan. The fiscal year operating plan is the budget for DHS based on appropriations received. It contains a breakdown of budgeted dollars by program area and activity at the state level. For each program, the document states the need, the description of program activities, the budget allocation for each activity, the performance measures or units of service, and the method of finance. The allocation covers a three-year period consisting of the current fiscal year and two previous years.

(3) Annual report. The annual report is a fiscal-year description of DHS services, a review of the services, and an accounting of DHS's expenditures. The report contains a section of statistics that depicts estimated expenditures by method of finance; benefit expenditures by region; a summary by county of agency information; aged and disabled benefits, and families and children benefits; and data concerning the regulation of child care facilities.

(A) In addition to client data, DHS has demographic data from the 1990 United States Census, the 1989 Special Texas Census, and population estimates and projections from the state comptroller's office and Texas A&M University. The 1989 Special Texas Census was a mailout survey to the general population of Texas. It was a data-collection effort comprising a sample of 44,000 Texas households to identify human service needs in support of the DHS budget and planning process. With an adjusted response rate of about 66% of the valid sample, data was collected for more than 23,000 households. The data collected for each person concentrated on money; income; demographics (age, sex, race/ethnicity, marital status, language, and education); employment status; medical insurance coverage; medical utilization; disability; functional impairment; help available for persons with disabilities; child care; child support payment; knowledge about runaways; child abuse and/or neglect; and family violence shelters. Based on the response rate and the selection of data variables, data may provide adequate representation for the state and for DHS regions. DHS service delivery and demographic data may be requested from the Budget Management Services Department.

(B) The OSPD also develops an annual report containing the yearly activities of implementing the DHS position statement and recommendation of the task force on services to persons with disabilities and DHS advisory committee for the aged and disabled (ADAC). It describes the accomplishments toward achieving goals, objectives, and products detailed in the OSPD strategic plan.

Source Note: The provisions of this §72.202 adopted to be effective September 1, 1993, 18 TexReg 5595.