FW: DADS Information Letters Update

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DADS has issued the following Information Letters:

*

<http://www.dads.state.tx.us/providers/communications/2007/letters/IL2007-74

..pdf> DADS Information Letter No. 07-74: Individual Cost Limits for Certain

Medicaid Waiver Programs

* Addressed to the following providers:

* Community Based Alternatives (CBA)

* Community Living Assistance and Support Services (CLASS)

* Consolidated Waiver Program (CWP)

* Deaf-Blind with Multiple Disabilities (DBMD)

* Home and Community-Based Services Waiver (HCS)

* Medically Dependent Children Program (MDCP)

COMMISSIONER Adelaide Horn

August 20, 2007

To: Community Services Waiver Providers

Subject: Information Letter No. 07-74

Individual Cost Limits for Certain Medicaid Waiver Programs

The 2008-09 General Appropriations Act (Article II, Department of Aging and

Disabilities Services, Rider 45, 80th Legislature, 2007) increased the

individual cost limits for six Medicaid waiver programs operated by the

Texas Department of Aging and Disability Services (DADS). To implement the

new individual cost limits, DADS will present program rules amendments to

the Medical Care Advisory Committee on November 8, 2007, and the DADS

Council on December 12, 2007.

The new individual cost limits, effective September 1, 2007, are:

Community-Based Alternatives (CBA) Program

Two hundred percent (200%) of the reimbursement rate that would have been

paid for that same individual to receive services in a nursing facility;

Community Living Assistance and Support Services (CLASS) Program

Two hundred percent (200%) of the estimated annualized per capita cost of

providing services in an Intermediate Care Facility for Persons with Mental

Retardation (ICF/MR) to an individual qualifying for an ICF/MR Level of Care

VIII;

Consolidated Waiver Program (CWP)

As applicable:

.

Two hundred percent (200%) of the reimbursement rate that would have been

paid for that same individual 21 years of age or more to receive services in

a nursing facility;

..

Fifty percent (50%) of the reimbursement rate that would have been paid for

that same individual under 21 years of age to receive services in a nursing

facility; or

..

Two hundred percent (200%) of the estimated annualized per capita cost of

providing services in an ICF/MR;

Deaf-Blind with Multiple Disabilities (DBMD) Program

Two hundred percent (200%) of the estimated annualized per capita cost of

providing services in an ICF/MR to an individual qualifying for an ICF/MR

Level of Care VIII;

Home and Community-based Services (HCS) Program

The greater of:

.

Two hundred percent (200%) of the reimbursement rate that would have been

paid for that same individual to receive services in an ICF/MR (DADS will

continue to interpret this to mean a small ICF/MR, as it has done under the

current rule); or

..

Two hundred percent (200%) of the estimated annualized per capita cost for

ICF/MR services; and

Medically Dependent Children Program (MDCP)

.

Fifty percent (50%) of the reimbursement rate that would have been paid for

that same individual to receive services in a nursing facility.

In compliance with Rider 45 provisions, DADS may use general revenue funds

to pay for services which exceed the waiver program's individual cost limit

if DADS determines:

.

such services are necessary to protect an individual's health and safety;

and

..

no other living arrangement is available in which the individual's health

and safety can be protected, as evidenced by an assessment by DADS' clinical

staff and supporting documentation, including the individual's medical and

service records.

Rider 45 requires DADS to use general revenue funds to continue providing

services to an individual who was receiving Medicaid waiver services on

September 1, 2005, at a cost that exceeded the waiver program's individual

cost limit if:

.

federal financial participation is not available to pay for such services;

and

..

such services are necessary for the individual to remain in the most

integrated setting appropriate for the person.

Rider 45 also requires DADS to employ utilization management and utilization

review practices to ensure that the Medicaid waiver services an individual

receives are appropriate and cost-effectiveness requirements are met.

If you have questions about the content of this letter, please contact:

Community-Based Alternatives (CBA) Program

Gilbert Estrada Gilbert.estrada@...

Community Living Assistance and Support Services (CLASS) Program

Carolyn Fleming Carolyn.fleming@...

Consolidated Waiver Program (CWP)

Mansbridge .mansbridge@...

Deaf-Blind with Multiple Disabilities (MDCP) Program

Carol Griebel Carol.griebel@...

Home and Community-based Services (HCS) Program

Cheryl Craddock-Melchor

Cheryl.craddockmelchor@...

Medically Dependent Children Program (MDCP)

Lynn Lynn.cooper@...

Sincerely,

Barry C. Waller

Assistant Commissioner

Provider Services

BCW:ss