(a) An applicant or individual is eligible for TxHmL Program services if:
  (1) the applicant or individual meets the financial eligibility criteria as described in Appendix B of the TxHmL waiver application approved by CMS and available on the HHSC website;
  (2) the applicant or individual meets one of the following criteria:
    (A) based on a DID and as determined by HHSC in accordance with §262.104 of this subchapter (relating to LOC Determination), the applicant or individual qualifies for an ICF/IID LOC I as defined in §261.238 of this title (relating to ICF/MR Level of Care I Criteria); or
    (B) meets the following criteria:
      (i) based on a DID and as determined by HHSC in accordance with §262.105 of this subchapter (relating to LON Assignment), qualifies for one of the following levels of care:
        (I) an ICF/IID LOC I as defined in §261.238 of this title; or
        (II) an ICF/IID LOC VIII as defined in §261.239 of this title (relating to ICF/MR Level of Care VIII Criteria);
      (ii) meets one of the following:
        (I) resides in a nursing facility immediately before enrolling in the TxHmL Program; or
        (II) is at imminent risk of entering a nursing facility as determined by HHSC; and
      (iii) is offered TxHmL Program services designated for a member of the reserved capacity group "Individuals with a level of care I or VIII residing in a nursing facility" included in Appendix B of the TxHmL Program waiver application approved by CMS and available on the HHSC website;
  (3) the applicant or individual has been assigned an LON in accordance with §262.105 of this subchapter;
  (4) the applicant or individual has an IPC cost that does not exceed $17,000;
  (5) the applicant or individual is not enrolled in another waiver program and is not receiving a service that may not be received if the individual is enrolled in the TxHmL Program, as identified in the Mutually Exclusive Services table in Appendix I of the TxHmL Handbook available on the HHSC website;
  (6) the applicant or individual has chosen, or the applicant's or individual's LAR has chosen, participation in the TxHmL Program over participation in the ICF/IID Program;
  (7) the applicant's or individual's service planning team concurs that the TxHmL Program services and, if applicable, non-TxHmL Program services for which the applicant or individual may be eligible are sufficient to ensure the applicant's or individual's health and welfare in the community;
  (8) the applicant or individual does not reside in:
    (A) a hospital;
    (B) an ICF/IID;
    (C) a nursing facility;
    (D) an assisted living facility licensed or subject to being licensed in accordance with THSC Chapter 247;
    (E) a residential child care facility licensed by HHSC unless it is an agency foster home;
    (F) an inpatient chemical dependency treatment facility;
    (G) a mental health facility;
    (H) a residential facility operated by the Texas Workforce Commission; or
    (I) a residential facility operated by the Texas Juvenile Justice Department, a jail, or a prison; and
  (9) the applicant or individual requires the provision of:
    (A) at least one TxHmL Program service per month or a monthly monitoring visit by a service coordinator as described in §262.701(o) of this chapter (relating to LIDDA Requirements for Providing Service Coordination in the TxHmL Program); and
    (B) at least one TxHmL Program service per IPC year.
(b) Except as provided in subsection (c) of this section, an applicant or individual is eligible for a CFC service under this subchapter if the applicant or individual:
  (1) meets the criteria described in subsection (a) of this section; and
  (2) requires the provision of the CFC service.
(c) To be eligible for a CFC service under this chapter, an applicant or individual receiving MAO Medicaid must, in addition to meeting the eligibility criteria described in subsection (b) of this section, receive a TxHmL Program service at least monthly, as required by 42 CFR §441.510(d), which may not be met by a monthly monitoring visit by a service coordinator as described in §262.701(o)(1) and (2) of this chapter.

Source Note: The provisions of this §262.101 adopted to be effective March 1, 2023, 48 TexReg 1055