(a) IHSS are Medicaid state plan services that are authorized by HHSC prior to delivery.
(b) IHSS listed in this subsection are selected for inclusion in a designated resident's plan of care to help the designated resident partially or fully attain, maintain, improve, or slow or prevent a decline in skills that were not fully acquired because of a congenital, genetic, or early acquired health condition.
  (1) Behavioral support:
    (A) is assistance provided for a designated resident to increase adaptive behaviors and to replace or modify maladaptive behaviors that prevent or interfere with the designated resident's interpersonal relationships across all service and social settings;
    (B) is delivered in the NF or in a community setting; and
    (C) consists of:
      (i) assessing the behaviors to be targeted in an appropriate behavior support plan and analyzing those assessment findings;
      (ii) developing and getting the designated resident's or LAR's written consent to an individualized behavior support plan that reduces or eliminates the target behaviors, assisting the designated resident in achieving the outcomes identified in the HSP;
      (iii) training and consulting with the LAR, family members, NF staff, other support providers, and the designated resident about the purpose, objectives, and methods of the behavior support plan;
      (iv) documenting and implementing the behavior support plan or revisions to the behavior support plan;
      (v) monitoring and evaluating the success of the behavior support plan implementation;
      (vi) revising the behavior support plan as necessary; and
      (vii) participating in SPT and IDT meetings.
  (2) Day habilitation:
    (A) is assistance provided for a designated resident to acquire, retain, or improve self-help, socialization, and adaptive skills necessary to successfully and actively participate in all service and social settings;
    (B) is delivered in a setting other than the designated resident's NF;
    (C) does not include services provided under the Day Activity and Health Services program;
    (D) includes expanded interactions, skills training activities, and programs of greater intensity or frequency beyond those a NF is required to provide by 42 CFR §483.24; and
    (E) consists of:
      (i) individualized activities consistent with achieving the outcomes identified in a designated resident's HSP to attain, learn, maintain, or improve skills;
      (ii) activities necessary to reinforce therapeutic outcomes targeted by other support providers and other specialized services;
      (iii) services in a group setting at a location other than a designated resident's NF for up to five days per week, six hours per day, on a regularly scheduled basis;
      (iv) personal assistance for a designated resident who cannot manage personal care needs during the day habilitation activity;
      (v) transportation between the NF and the day habilitation site, as well as during the day habilitation activity necessary for a designated resident's participation in day habilitation activities; and
      (vi) participating in SPT and IDT meetings.
  (3) Employment assistance:
    (A) is assistance provided for a designated resident who requires intensive help locating competitive employment in the community; and
    (B) consists of:
      (i) identifying a designated resident's employment preferences, job skills, and requirements for a work setting and work conditions;
      (ii) locating prospective employers offering employment compatible with a designated resident's identified preferences, skills, and requirements;
      (iii) contacting prospective employers on a designated resident's behalf and negotiating the designated resident's employment;
      (iv) transporting a designated resident between the NF and the site where employment assistance services are provided and as necessary to help the designated resident locate competitive employment in the community; and
      (v) participating in SPT and IDT meetings.
  (4) Independent living skills training:
    (A) is assistance provided for a designated resident that is consistent with the designated resident's HSP;
    (B) is provided in the designated resident's NF or in a community setting;
    (C) includes expanded interactions, skills training activities, and programs of greater intensity or frequency beyond those a NF is required to provide by 42 CFR §483.24; and
    (D) consists of:
      (i) habilitation and support activities that foster improvement of or facilitate a designated resident's ability to attain, learn, maintain, or improve functional living skills and other daily living activities;
      (ii) activities that help preserve the designated resident's bond with family members;
      (iii) activities that foster inclusion in community activities generally attended by people without disabilities;
      (iv) transportation to facilitate a designated resident's employment opportunities and participation in community activities, and between the designated resident's NF and a community setting; and
      (v) participating in SPT and IDT meetings.
  (5) Supported employment:
    (A) is assistance provided for a designated resident:
      (i) who requires intensive, ongoing support to be self-employed, work from the designated resident's residence, or work in an integrated community setting at which people without disabilities are employed; and
      (ii) to sustain competitive employment in an integrated community setting; and
    (B) consists of:
      (i) making employment adaptations, supervising, and providing training related to the designated resident's assessed needs;
      (ii) transporting the designated resident between the NF and the site where the supported employment services are provided and as necessary to support the designated resident to be self-employed, work from the designated resident's residence, or work in an integrated community setting; and
      (iii) participating in SPT and IDT meetings.

Source Note: The provisions of this §368.201 adopted to be effective September 1, 2021, 46 TexReg 4151