Deaf Blind with Multiple Disabilities (DBMD) Program Manual

1000, Adaptive Aids/Vehicle Modification Services

Revision 10-1; Effective June 14, 2010

Adaptive Aids/Vehicle Modification Services

This is an all-inclusive list of adaptive aids and vehicle modification services. For specific procedures related to the procurement of adaptive aids and vehicle modifications, refer to Texas Administrative Code (TAC) Title 40, Part 1, Chapter 42.

For the items on this list, the Deaf Blind with Multiple Disabilities (DBMD) program provider must obtain written specifications for the adaptive aid or vehicle modification from the appropriate licensed professional as listed below:

  • Audiologist
  • Behavioral Support Specialist
  • Dietician
  • Registered Nurse
  • Physician
  • Orientation and Mobility Specialist
  • Occupational Therapist
  • Ophthalmologist
  • Optometrist
  • Physical Therapist
  • Speech Therapist
  • Dentist

The following adaptive aids/medical supplies may include repair and maintenance not covered by warranty:

  1. Lifts
    1. wheelchair lifts
    2. porch or stair lifts
    3. stairway lifts (only in residences owned by the individual/family)
    4. bathtub seat lifts
    5. ceiling lifts which transport the individual around the home via tracks (only in-residences owned by the individual and/or family)
    6. other hydraulic, manual or electronic lifts
  2. Mobility Aids (including batteries and chargers)
    1. manual/electric wheelchairs and necessary accessories
    2. adult strollers/travel chairs/three-wheel scooters
    3. mobility bases for customized chairs
    4. braces, crutches, walkers, canes (to include white canes) and necessary accessories
    5. materials to construct adaptive mobility aids for individuals with visual impairments (i.e., PVC pipes to construct an adapted cane or pre-cane device)
    6. color contrast or reflective tape (to mark paths, drop-offs, etc.)
    7. prescribed prosthetic devices
    8. orthopedic shoes and other prescribed footwear
    9. prescribed exercise equipment and therapy aids
    10. bus passes, metro transit services, and taxi services (for non-medical transportation only)
    11. portable ramps that do not require installation
    12. automatic door openers
    13. gait trainers
    14. global positioning systems (GPS) designed for individuals with visual impairments and appropriate accessories to allow an individual with visual impairments to independently travel within the community
    15. service animals and maintenance to include veterinary expenses
    16. tinted glasses, visors and sunshields to regulate glare for an individual with visual impairments
    17. flashlights
    18. magnifying devices
  3. Position Devices
    1. standing frames/boards
    2. removable bathtub rails
    3. toilet chairs
    4. orthotic devices
    5. hospital beds and necessary accessories (must meet Medicaid standards/specifications)
    6. egg crate mattresses, sheepskin and other medically-related padding
    7. lift recliners
    8. trapeze bars
  4. Communication Aids
    1. communicators
      1. direct selection communicators
      2. alphanumeric communicators
      3. scanning communicators
      4. adapted telephones for an individual with visual and/or hearing impairments (i.e., amplified telephones, phones with enlarged keypads, phones with braille displays, captioned telephones, speaker phones)
      5. telecommunications device for the deaf (TDD) or telephone typewriters/teletypewriter (TTY), to include TDD/TTY machines with braille displays
      6. large visual displays for TDD/TTY machines
      7. video relay phones/equipment for video relay service (the monthly service fee would not be included or covered)
      8. face-to-face communication devices
      9. telebraille and teletype machines
      10. materials to construct communication aids
      11. encoding communicators
      12. communication books, communication symbols, experience books and calendar systems (to include calendar boxes, shelves and charts)
    2. speech amplifiers and assistive listening devices
    3. interpreters
    4. hearing aids beyond the Medicaid limit
    5. hearing aid supplies beyond the Medicaid limit
    6. FM communication systems
  5. Computers and Appropriate Accessories (for assistance with activities of daily living (ADL), communication and environmental control)
    1. computers and appropriate accessories
    2. appropriate software to address the needs listed above (limited to three per year)
    3. adapted workstations/chairs
    4. computer evaluations, specifications and training (may be completed by the prescribing professional)
    5. computer literacy training for educating an individual in the use of adaptive software necessary to perform ADL and avoid institutionalization (limited to 10 sessions per software unit)
    6. braille displays
    7. braille printers/embossers
    8. electronic braille notetakers
  6. Environmental Controls
    1. electronic environmental control devices
    2. voice activated, light activated and motion activated devices (to include amplified features)
    3. control switches/pneumatic switches and devices
      1. sip and puff controls
      2. adaptive switches/devices
      3. sensory adaptations
  7. Adaptive Equipment for ADL (based on the needs of the individual as authorized on the Individual Program Plan)
    1. assistive devices
      1. reachers
      2. stabilizing devices
      3. weighted equipment holders (i.e., book stands, page turners, cup holder)
      4. signature stamps or signature guides
      5. electric self-feeders
      6. microwave ovens (only for persons with muscular weakness or who lack manual dexterity and those persons who cannot use conventional ovens)
      7. food processors and blenders (for persons with muscular weakness in upper body who lack manual dexterity and are unable to use manual conventional kitchen appliances or for individuals with visual impairment that would be necessary for the individual's safety)
      8. variations of everyday equipment
        1. shaped, bent, built-up utensils
        2. long-handed equipment
        3. addition of friction coverings
        4. coated feeding equipment
        5. count-a-dose systems/manual medication reminder systems
        6. pill crushers/splitters
        7. specially adapted kitchen appliances
        8. toilet seat reducer rings
        9. food preparation utensils
        10. specially-adapted clocks/wristwatches for persons with visual or hearing impairment
        11. adapted scales
      9. prescribed therapy aids (to be utilized with therapist oversight)
      10. service animals and maintenance to include veterinary expenses
      11. quad gloves
      12. specialized lighting and flashlights
      13. braille displays, braille labelers, braille embossers and braille printers
      14. magnifying devices
      15. electric toothbrushes
      16. water pics
      17. specialized toothpastes (requiring a prescription)
      18. braille writers
    2. safety devices
      1. bed rails
      2. safety padding
      3. helmets
      4. walking belts/gait belts
      5. flutter boards
      6. personal floatation devices/lifejackets
      7. elbow and knee pads
      8. emergency response systems
      9. water walkers
      10. adapted fire extinguishers
      11. adapted smoke and carbon dioxide detectors
      12. visual alert systems
      13. vibrating alert systems
    3. shower chairs/transfer benches
    4. electric razors
    5. flexible, disposable drinking straws for persons with muscular weakness or who cannot drink from a regular drinking glass or cup
    6. hand-held shower attachments that are portable and do not require installation
  8. Medically Necessary Supplies
    1. tracheostomy care
    2. decubitus care
    3. ostomy care
    4. respirator/ventilator care
    5. catheterization supplies
    6. diapers, linens and other incontinence supplies not covered by the Medicaid state plan
    7. prescribed nutritional supplements as approved by Medicaid
    8. enteral feeding formulas and supplies
    9. transcutaneous electrical nerve stimulation (TENS) units/supplies/repairs
    10. specialized thermometers
    11. diabetic supplies (beyond Medicaid limit)
    12. glucose monitors
    13. medical supply cabinets
    14. humidifiers
    15. suctioning devices
    16. prescription eyeglasses/accessories (beyond Medicaid limit)
    17. muscle stimulators
    18. medically necessary heating and cooling units prescribed by a physician for individuals with respiratory or cardiac problems or people who cannot regulate their body temperature
    19. urinary incontinent devices and supplies
    20. blood pressure monitors
    21. vitamins with a prescription
    22. gloves (beyond Medicaid limit)
    23. medication cups (beyond Medicaid limit)
  9. Modification/Additions to Primary Transportation Vehicles
    1. van lifts
    2. driving controls
      1. brake/accelerator hand controls
      2. dimmer relays/switches
      3. horn buttons
      4. wrist supports
      5. hand extensions
      6. left-foot gas pedals
      7. right turn levers
      8. gear shift levers
      9. steering spinners
    3. medically necessary air conditioning units prescribed by a physician for individuals with respiratory or cardiac problems or people who cannot regulate their body temperature
    4. removal or placement of seats to accommodate a wheelchair
    5. installation, adjustment or placement of mirrors to overcome visual obstructions of wheelchair in vehicle
    6. raising of the roof of the vehicle to accommodate an individual riding in a wheelchair
    7. wheelchair tie-downs
    8. seat belt covers
    9. automatic door openers
  10. Repair and Maintenance of Items (on the authorized list above as allowable by rule)
  11. Temporary Lease/Rental of Medically Necessary Durable Medical Equipment (to allow for repair, purchase or replacement of essential support system or while non-waiver resources review the medical necessity). Lease/rental shall not exceed 90 days.

2000, Minor Home Modification Services

Revision 22-2; Effective Sept. 1, 2022

Minor Home Modification Services

This is an all-inclusive list of minor home modifications. For specific procedures about the procurement of minor home modifications, refer to Texas Administrative Code (TAC) Title 40, Part 1, Chapter 42.

For the items on this list, the Deaf Blind with Multiple Disabilities (DBMD) program provider must obtain written specifications and a recommendation from the appropriate licensed professional as listed below:

  • Audiologist
  • Behavioral Support Specialist
  • Dietician
  • Registered Nurse
  • Physician
  • Orientation and Mobility Specialist
  • Occupational Therapist
  • Ophthalmologist
  • Optometrist
  • Physical Therapist
  • Speech Therapist

Home modifications, such as the following, include the installation, maintenance and repair of approved items not covered by warranty:

  • Home Modifications
    • floor leveling, only in residences owned by the individual, family, or both and only when the installation of a ramp is not possible
    • vinyl flooring or industrial grade carpet necessary to ensure the safety of the individual, prevent falling, improve mobility and adapt a living space occupied by a beneficiary who is unable to safely use existing floor surface
    • medically necessary steam cleaning of walls, carpet, support equipment and upholstery
    • roll-in showers
    • sink modifications
    • sink cut-outs
    • bathtub modifications
    • water faucet controls
    • toilet modifications
    • floor urinal and bidet adaptations
    • plumbing modifications
    • turnaround space modifications
    • work table or work surface adjustments
    • cabinet development or adjustments
  • Specialized Accessibility, Safety Adaptations and Additions (including repair and maintenance)
    • ramps (constructed to provide access into and within the home)
    • protective awnings over ramps
    • door widening
    • widening or enlargement of garage, carport or both, to accommodate primary transportation vehicle and to allow people using wheelchairs to enter and exit their adapted vehicles safely
    • installation of sidewalk for access from non-connected garage, driveway or both to residence when existing surface condition is a safety hazard for the person with a disability
    • porch or patio leveling, only when the installation of a ramp is not possible
    • grab bars and handrails
    • door bells, door scopes and adaptive wall switches
    • safety glass, safety alarms, (does not include home security systems) security door locks, fire safety approved window locks, security window screens, visual alert systems
    • security fencing for residence or play area for those people with cognitive impairment or people whose safety would be compromised if they wandered
    • medically necessary air filtering devices
    • protective padding and corner guards for walls
    • recessed lighting with mesh covering and metal dome light covers
    • emergency generators (limited to critical medical equipment)
    • medically necessary noise abatement renovations to provide increased sound proofing for persons with sensory impairments
    • lever door handles
    • door replacement only when required for accessibility
    • intercom systems for persons with limited mobility or visual impairment
    • motion sensory lighting
  • Repair and Maintenance of Items (on the authorized list above as allowable by rule)

3000, Consumer Rights Booklet

Revision 10-1; Effective June 14, 2010

Consumer Rights Booklet

This publication explains consumer rights and responsibilities for
the following Department of Aging and Disability Services programs:

  • Community Attendant Services
  • Community Based Alternatives
  • Community Living Assistance and Support Services
  • Consolidated Waiver Program
  • Consumer Managed Personal Assistant Services
  • Day Activity and Health Services
  • Deaf Blind with Multiple Disabilities Program
  • Family Care
  • Hospice Services
  • Integrated Care Management
  • Medically Dependent Children Program
  • Primary Home Care
  • Program of All-Inclusive Care for the Elderly
  • Special Services to Persons with Disabilities

Your Rights Community Handbook (PDF)

4000, DBMD Texas Administrative Code and Statutes Links

Revision 10-1; Effective June 14, 2010

Texas Administrative Code (TAC)

40 TAC Chapter 41, Consumer Directed Services Option

40 TAC Chapter 42, Deaf Blind with Multiple Disabilities (DBMD) Program

40 TAC Chapter 49, Contracting for Community Care Services

40 TAC Chapter 62, Contracting to Provide Transition Assistance Services

40 TAC Chapter 92, Licensing Standards for Assisted Living Facilities

40 TAC Chapter 97, Licensing Standards for Home and Community Support Services Agencies

Statutes

Health and Safety Code Chapter 250, Nurse Aide Registry and Criminal History Checks of Employees and Applicants for Employment in Certain Facilities Serving the Elderly or Persons with Disabilities

Human Resources Code, Sec. 22.036, Programs for Deaf Blind Multi-handicapped Individuals and Their Parents

Other

Your Texas Benefits — Provides information related to Medicaid benefits and local Medicaid eligibility offices.

5000, Reimbursement Rate Links

Revision 10-1; Effective June 14, 2010

Rate Analysis Department DBMD Webpage — Includes information on DBMD rates, Accountability Reports, etc.

Texas Administrative Code (TAC) Related to DBMD program rates:

General Cost Reporting Process — Includes general information on the calculation of rates in the DBMD program, including costs that may or may not be reported on the Rate Enhancement Accountability Reports, etc.

Reimbursement Methodology for DBMD — Specific information regarding the calculation of rates for the DBMD program.

Reimbursement Methodology for Professional Services — Specific information regarding the calculation of rates for Professional Services (nursing, therapies, audiology, dietary and behavioral support) in all waiver programs.

Reimbursement Methodology for Transition Assistance Services — Specific information regarding the calculation of rates for Transition Assistance Services in all waiver programs.

6000, Resources Links

Revision 19-4; Effective October 18, 2019

Resources for Individuals with Deafblindness

The Texas Deafblind Project is funded by a federal grant to provide information and training about deafblindness to families and the professionals who work with them. The Deafblind Outreach team provides technical assistance to families and schools involved with children with both a vision and hearing impairment. The Deafblind Outreach team also provides training directly to DBMD provider agencies. Additional information about the program can be found on the Texas Deafblind project website.

HHS Blind and Visually Impaired Services works with people of all ages who are blind and visually impaired to help them reach their independence goals.

The Texas Workforce Commission Vocational Rehabilitation program helps people with disabilities prepare for, find or retain employment and helps youths and students prepare for post-secondary opportunities. The program also helps businesses and employers recruit, retain and accommodate employees with disabilities.

Helen Keller National Center (HKNC) offers a comprehensive rehabilitation program at its New York Center. Regional HKNC representatives can refer individuals to the national HKNC. They can also provide consultation and training to provider agencies. To contact the regional representative who serves the Texas area, call 972-490-9677.

The Deaf-Blind Multihandicapped Association of Texas (DBMAT) is an organization formed by parents and professionals to improve the quality of life for all Texans who are deafblind with multiple disabilities. Parents from around the state can find peer support, encouragement and advice. The DBMD case manager can refer parents to the organization by emailing president@dbmat-tx.org or calling 713-231-7508.

The National Consortium on Deaf-Blindness DB-LINK has services including an extensive library of webinars, materials and access to information specialists who are available to help answer questions.

National Center of Deaf-Blindness Open Hands, Open Access (OHOA) Deaf-Blind Intervener Learning Modules are a national resource designed to increase awareness, knowledge and skills related to intervention for students (ages 3 through 21) who are deaf-blind and being served in educational settings. En Español

Specialized Telecommunications Assistance Program (STAP) helps people who have a disability that interferes with their access to telephone networks purchase basic specialized assistive equipment or services.

STAP typically covers the cost of most phones included in our voucher categories.

7000, Non-Medicaid Deafblind Services

Revision 14-1; Effective September 22, 2014

Outdoor Camping Experience

The Texas Department of Aging and Disability Services (DADS) is mandated by the Human Resource Code, Chapter 22, Section 22.036 (c), to fund outdoor camping for individuals who are deafblind. These individuals would otherwise be unable to participate in summer camps. DADS procures a vendor through an invitation to bid process. The vendor enters into a contract for one year with three additional one-year terms. The vendor agrees to provide:

  • a five-day summer camp for up to 80 people who are deafblind with multiple disabilities;
  • eligibility determination of campers;
  • two licensed registered nurses;
  • a 1:2 staff-individual ratio;
  • arrangements and payment for transportation;
  • room and board;
  • two qualified deafblind specialist providers who are present for consultation and training with service providers; and
  • camping activities, including at a minimum:
    • swimming,
    • water sports,
    • horseback riding,
    • arts and crafts, and
    • nature studies.

Annual Family Training and Conference

DADS is mandated in the Human Resource Code, Chapter 22, Section 22.036 (b), to fund training for families of individuals who are deafblind with multiple disabilities. This training encourages parents to network with each other. It also presents educational subjects relating to deafblindness. Deafblind individuals are given an opportunity for socialization outside of educational and adaptive behavior training. This training is coordinated with the Deaf Blind Multi-handicapped Association of Texas. It is also coordinated with the Helen Keller National Center, Texas School for the Blind, Texas Deaf Blind Project and the Department of Assistive and Rehabilitative Services. DADS procures a vendor through an invitation for bid process. The vendor enters into a contract for one year with three additional one-year terms. The vendor agrees to provide:

  • facilities for a three-day conference, including:
    • air conditioned cabins (or hotel rooms) to accommodate at least 230 participants and staff;
    • a camp accessible to individuals who are deafblind and to people who have severe disabilities;
    • a dining room that can accommodate at least 230 participants and staff;
    • a meeting room that can comfortably accommodate at least 125 people for two days of training sessions; and
    • an infirmary with an exam area and sick bay.
  • the following activities at a level appropriate for individuals who are deafblind with multiple disabilities, and their siblings:
    • an accessible swimming pool and/or challenge course, as needed;
    • arts and crafts;
    • nature education; and
    • sports and games; and
  • staff, to include:
    • an on-site camp director;
    • a licensed registered nurse;
    • a child care coordinator;
    • lifeguards;
    • direct care staff (1:2 ratio); and
    • interpreters (Spanish and Sign Language).

10000, Miscellaneous

Revision 10-1; Effective June 14, 2010

Deaf Blind with Multiple Disabilities Program Brochure

11000, Billing/Record Keeping Requirements

Revision 22-1; Effective February 7, 2022

11100 Billing DBMD and CFC Services

Revision 20-2; Effective October 9, 2020

The following Deaf Blind with Multiple Disabilities (DBMD) and Community First Choice (CFC) services are available to an individual enrolled in the DBMD program:

  • Adaptive Aids
  • Audiology
  • Behavioral Support
  • Case Management
  • Chore Services
  • CFC Emergency Response Services (ERS)
  • CFC Personal Assistance Services/Habilitation (PAS/HAB)
  • Day Habilitation
  • Dental Treatment
    • Services
    • Sedation
  • Dietary Services
  • Employment Assistance
  • Intervener Services
    • Intervener    
    • Intervener I
    • Intervener II
    • Intervener III
  • Minor Home Modifications
  • Nursing Services
    • Licensed Vocational Nurse
    • Specialized Nursing (LVN)
    • Registered Nurse
    • Specialized Nursing (RN)
  • Occupational Therapy
  • Orientation and Mobility
  • Physical Therapy
  • Residential Services
    • Licensed Assisted Living Services
    • Licensed Home Health Assisted Living
  • Respite:
    • In-Home
    • Out-of-Home
  • Speech, Hearing and Language Therapy
  • Supported Employment
  • Transition Assistance Services
  • Transportation-Residential Habilitation
  • Services for individuals who choose the Consumer Directed Services (CDS) option:
    • Financial Management Services or CFC Financial Management Services
    • Support Consultation or CFC Support Consultation

A DBMD program provider must bill for a DBMD service or CFC service in accordance with 40 Texas Administrative Code (TAC) Chapter 42. Some services are defined in 40 TAC §42.103, Definitions. DBMD services are also described in Appendix C of the DBMD Waiver Application.

A DBMD service or CFC service provided to an individual must be recorded as a distinct event by each service provider. A service provider must document services provided, except for adaptive aids, dental treatment, minor home modifications, CFC ERS and CFC Support Management on Form 6503, DBMD Summary of Services Delivered, or via the Electronic Visit Verification (EVV) System.

A service provider must complete Form 6503 according to the form’s instructions.  

A program provider must ensure that after a service provider makes the last entry on Form 6503, a staff person other than the service provider signs and dates the form as a timekeeper as verification of accuracy of the information on the form.

For DBMD services requiring EVV, providers must follow EVV billing requirements for relevant claims. Providers may refer to HHSC’s EVV website for more information.

Current rates for DBMD services may be found at: https://pfd.hhs.texas.gov/long-term-services-supports/deaf-blind-multiple-disabilities-waiver-dbmd.

 

 

11200 Billable Units

Revision 20-2; Effective October 9, 2020

A program provider or financial management services agency (FMSA) bills for a DBMD or CFC service using billable units that are based on the time spent providing the service or the cost incurred for the service.

 

 

11210 Services Unit Measurements

Revision 20-2; Effective October 9, 2020

The following chart shows which DBMD and CFC services use a billable unit based on time.

ServiceBillable Unit
Audiologyone hour
Behavioral Supportone hour
Case Managementone hour
Chore Servicesone hour
CFC Personal Assistance Services/Habilitation (PAS/HAB)one hour
Day Habilitation Servicesone hour
Dietary Servicesone hour
Employment Assistanceone hour
Intervener Services 
Intervenerone hour
Intervener Ione hour
Intervener IIone hour
Intervener IIIone hour
Nursing Services 
Licensed Vocational Nurseone hour
Specialized Nursing (LVN)one hour
Registered Nursingone hour
Specialized Nursing (RN)one hour
Occupational Therapyone hour
Orientation and Mobilityone hour
Physical Therapyone hour
Residential Services 
Licensed Assisted Living Servicesone hour (no partial units)
Licensed Home Health Assisted Livingone hour (no partial units)
18-Hour Assisted Livingone hour (no partial units)
Respite 
In-Home Respite24 hours
Out-of-Home Respite24 hours
Speech, Hearing and Language Therapyone hour
Supported Employmentone hour
Transportation-Residential Habilitationone hour

The following services are billed using the cost of the service, along with any allowable requisition fees:

  • Adaptive Aids
  • Minor Home Modifications
  • Dental Treatment
  • Transition Assistance Services

 

 

11300 Determining Billable Units for an Hourly Service

Revision 20-2; Effective October 9, 2020

For a service that has a billable unit of one hour, a program provider must determine the billable units using the amount of time that a service provider spent providing the service in accordance with the table below.

Service TimeBillable Unit(s) of Service
Less than 8 minutes0.00
At least 8 minutes, but less than 23 minutes 0.25
At least 23 minutes, but less than 38 minutes0.50
At least 38 minutes, but less than 53 minutes0.75
At least 53 minutes, but less than 1 hour 8 minutes1.00
At least 1 hour 8 minutes, but less than 1 hour 23 minutes1.25
At least 1 hour 23 minutes, but less than 1 hour 38 minutes1.50
At least 1 hour 38 minutes, but less than 1 hour 53 minutes1.75
At least 1 hour 53 minutes, but less than 2 hours 8 minutes2.00
At least 2 hours 8 minutes, but less than 2 hours 23 minutes2.25
At least 2 hours 23 minutes, but less than 2 hours 38 minutes2.50
At least 2 hours 38 minutes, but less than 2 hours 53 minutes2.75
At least 2 hours 53 minutes, but less than 3 hours 8 minutes3.00
At least 3 hours 8 minutes, but less than 3 hours 23 minutes3.25
At least 3 hours 23 minutes, but less than 3 hours 38 minutes3.50
At least 3 hours 38 minutes, but less than 3 hours 53 minutes3.75
At least 3 hours 53 minutes, but less than 4 hours 8 minutes4.00
At least 4 hours 8 minutes, but less than 4 hours 23 minutes4.25
At least 4 hours 23 minutes, but less than 4 hours 38 minutes4.50
At least 4 hours 38 minutes, but less than 4 hours 53 minutes4.75
At least 4 hours 53 minutes, but less than 5 hours 8 minutes5.00
At least 5 hours 8 minutes, but less than 5 hours 23 minutes5.25
At least 5 hours 23 minutes, but less than 5 hours 38 minutes5.50
At least 5 hours 38 minutes, but less than 5 hours 53 minutes5.75
At least 5 hours 53 minutes, but less than 6 hours 8 minutes6.00
At least 6 hours 8 minutes, but less than 6 hours 23 minutes6.25
At least 6 hours 23 minutes, but less than 6 hours 38 minutes6.50
At least 6 hours 38 minutes, but less than 6 hours 53 minutes6.75
At least 6 hours 53 minutes, but less than 7 hours 8 minutes7.00
At least 7 hours 8 minutes, but less than 7 hours 23 minutes7.25
At least 7 hours 23 minutes, but less than 7 hours 38 minutes7.50
At least 7 hours 38 minutes, but less than 7 hours 53 minutes7.75
At least 7 hours 53 minutes, but less than 8 hours 8 minutes8.00
At least 8 hours 8 minutes, but less than 8 hours 23 minutes8.25
At least 8 hours 23 minutes, but less than 8 hours 38 minutes8.50
At least 8 hours 38 minutes, but less than 8 hours 53 minutes8.75
At least 8 hours 53 minutes, but less than 9 hours 8 minutes9.00
At least 9 hours 8 minutes, but less than 9 hours 23 minutes9.25
At least 9 hours 23 minutes, but less than 9 hours 38 minutes9.50
At least 9 hours 38 minutes, but less than 9 hours 53 minutes9.75
At least 9 hours 53 minutes, but less than 10 hours 8 minutes10.00
At least 10 hours 8 minutes, but less than 10 hours 23 minutes10.25
At least 10 hours 23 minutes, but less than 10 hours 38 minutes10.50
At least 10 hours 38 minutes, but less than 10 hours 53 minutes10.75
At least 10 hours 53 minutes, but less than 11 hours 8 minutes11.00
At least 11 hours 8 minutes, but less than 11 hours 23 minutes11.25
At least 11 hours 23 minutes, but less than 11 hours 38 minutes11.50
At least 11 hours 38 minutes, but less than 11 hours 53 minutes11.75
At least 11 hours 53 minutes, but less than 12 hours 8 minutes12.00
At least 12 hours 8 minutes, but less than 12 hours 23 minutes12.25
At least 12 hours 23 minutes, but less than 12 hours 38 minutes12.50
At least 12 hours 38 minutes, but less than 12 hours 53 minutes12.75
At least 12 hours 53 minutes, but less than 13 hours 8 minutes13.00
At least 13 hours 8 minutes, but less than 13 hours 23 minutes13.25
At least 13 hours 23 minutes, but less than 13 hours 38 minutes13.50
At least 13 hours 38 minutes, but less than 13 hours 53 minutes13.75
At least 13 hours 53 minutes, but less than 14 hours 8 minutes14.00
At least 14 hours 8 minutes, but less than 14 hours 23 minutes14.25
At least 14 hours 23 minutes, but less than 14 hours 38 minutes14.50
At least 14 hours 38 minutes, but less than 14 hours 53 minutes14.75
At least 14 hours 53 minutes, but less than 15 hours 8 minutes15.00
At least 15 hours 8 minutes, but less than 15 hours 23 minutes15.25
At least 15 hours 23 minutes, but less than 15 hours 38 minutes15.50
At least 15 hours 38 minutes, but less than 15 hours 53 minutes15.75
At least 15 hours 53 minutes, but less than 16 hours 8 minutes16.00
At least 16 hours 8 minutes, but less than 16 hours 23 minutes16.25
At least 16 hours 23 minutes, but less than 16 hours 38 minutes16.50
At least 16 hours 38 minutes, but less than 16 hours 53 minutes16.75
At least 16 hours 53 minutes, but less than 17 hours 8 minutes17.00
At least 17 hours 8 minutes, but less than 17 hours 23 minutes17.25
At least 17 hours 23 minutes, but less than 17 hours 38 minutes17.50
At least 17 hours 38 minutes, but less than 17 hours 53 minutes17.75
At least 17 hours 53 minutes, but less than 18 hours 8 minutes18.00
At least 18 hours 8 minutes, but less than 18 hours 23 minutes18.25
At least 18 hours 23 minutes, but less than 18 hours 38 minutes18.50
At least 18 hours 38 minutes, but less than 18 hours 53 minutes18.75
At least 18 hours 53 minutes, but less than 19 hours 8 minutes19.00
At least 19 hours 8 minutes, but less than 19 hours 23 minutes19.25
At least 19 hours 23 minutes, but less than 19 hours 38 minutes19.50
At least 19 hours 38 minutes, but less than 19 hours 53 minutes19.75
At least 19 hours 53 minutes, but less than 20 hours 8 minutes20.00
At least 20 hours 8 minutes, but less than 20 hours 23 minutes20.25
At least 20 hours 23 minutes, but less than 20 hours 38 minutes20.50
At least 20 hours 38 minutes, but less than 20 hours 53 minutes20.75
At least 20 hours 53 minutes, but less than 21 hours 8 minutes21.00
At least 21 hours 8 minutes, but less than 21 hours 23 minutes21.25
At least 21 hours 23 minutes, but less than 21 hours 38 minutes21.50
At least 21 hours 38 minutes, but less than 21 hours 53 minutes21.75
At least 21 hours 53 minutes, but less than 22 hours 8 minutes22.00
At least 22 hours 8 minutes, but less than 22 hours 23 minutes22.25
At least 22 hours 23 minutes, but less than 22 hours 38 minutes22.50
At least 22 hours 38 minutes, but less than 22 hours 53 minutes22.75
At least 22 hours 53 minutes, but less than 23 hours 8 minutes23.00
At least 23 hours 8 minutes, but less than 23 hours 23 minutes23.25
At least 23 hours 23 minutes, but less than 23 hours 38 minutes23.50
At least 23 hours 38 minutes, but less than 23 hours 53 minutes23.75
At least 23 hours 53 minutes, but less than 24 hours 8 minutes24.00

 

 

11310 Determining Billable Units for Multiple Service Events

Revision 20-2; Effective October 9, 2020

For a service with a billable unit of one hour, if there is more than one service event of the same service in a calendar month, a program provider must determine total billable units for the month by determining the billable units for each service event and adding the billable units together.

Example:

Service ProviderTime Service BeginsTime Service EndsDuration of Service EventBillable Units
Service Provider A8:00 a.m.4:05 p.m.8 hours 5 minutes8.00 
Service Provider B4:45 p.m.6:07 p.m.1 hour 22 minutes1.25
Service Provider B8:50 p.m.11:01 p.m.2 hours 11 minutes2.25
Total Billable Units   11.50

 

 

11320 Determining Billable Units for More than One Service Provider or More than One Individual

Revision 20-2; Effective October 9, 2020

If a service with a billable unit of one hour is provided during the same time period by more than one service provider to more than one individual, or both, a program provider must use the following formula to calculate the billable units by multiplying the number of service providers by the time spent providing the service, and dividing the result by the number of individuals being provided the service.

Number of service providersxTime spent providing the service÷Number of individuals being provided service=Billable units
Examples:      
Two service providersx1 hour÷1 individual=2 billable units
One service providerx1 hour÷2 individuals=1/2 (0.5) billable unit per individual
One service providerx1 hour÷3 individuals=1/3 (0.33) billable unit per individual
Two service providersx1 hour÷3 individuals=2/3 (0.67) billable unit per individual

 

 

11400 Determining Billable Units for Respite

Revision 20-2; Effective October 9, 2020

The billable unit of service for respite is defined as a 24-hour period. A program provider must determine billable units of respite in accordance with the table below, using the amount of time that an individual received respite.

Examples:

One individual in a respite setting for 24 hours = 1 billable unit
Two individuals in a respite setting for 24 hours = 1 billable unit per individual
Three individuals in a respite setting for 24 hours = 1 billable unit per individual

 

 

11410 Billing Units of Respite Service

Revision 20-2; Effective October 9, 2020

Partial units of respite are calculated as follows:

1 hour of service= 1/24 unit (.04)
2 hours of service= 2/24 unit (.08)
3 hours of service= 3/24 unit (.12)
4 hours of service= 4/24 unit (.17)
5 hours of service= 5/24 unit (.21)
6 hours of service= 6/24 unit (.25)
7 hours of service= 7/24 unit (.29)
8 hours of service= 8/24 unit (.33)
9 hours of service= 9/24 unit (.37)
10 hours of service= 10/24 unit (.42)
11 hours of service= 11/24 unit (.46)
12 hours of service= 12/24 unit (.50)
13 hours of service= 13/24 unit (.54)
14 hours of service= 14/24 unit (.58)
15 hours of service= 15/24 unit (.62)
16 hours of service= 16/24 unit (.67)
17 hours of service= 17/24 unit (.71)
18 hours of service= 18/24 unit (.75)
19 hours of service= 19/24 unit (.79)
20 hours of service= 20/24 unit (.83)
21 hours of service= 21/24 unit (.87)
22 hours of service= 22/24 unit (.92)
23 hours of service= 23/24 unit (.96)
24 hours of service= 24/24 unit (1.0)

A program provider determines billable units of respite separately for each individual. The number of billable units of respite are not affected by the number of other individuals or service providers in a respite setting at the same time.

Examples:

Respite provided to one individual for 24 hours by one service provider = 1 billable unit
Respite provided to two individuals for 12 hours by one service provider = 0.5 billable unit per individual
Respite provide to three individuals for 24 hours by two service providers = 1 billable unit per individual

Appendix VII, Retired Information Letters

Revision 15-1; Effective December 17, 2015

 

The Department of Aging and Disability Services (DADS) will from time to time retire Information Letters (ILs) when policy has expired, retired or been replaced with new information.

Content in this manual and the Texas Administrative Code (TAC) supersedes any previous ILs or similar guidance published by DADS. The ILs retired as a result are listed below. DADS recommends that providers remove these ILs from their records to ensure they reference the most current information. Any letters or program guidance issued prior to Internet accessibility is null and void, including policy previously sent by U.S. mail.

Number Title Date Posted Date Removed
11-31 Complaints Regarding Solicitation 04/15/2011 04/30/2019
09-162 Personal Care Services and DBMD Residential Habilitation 12/11/2009 11/03/2015
09-153 Personal Care Services (PCS) and Waiver Services Replaced by IL 2015-71 10/30/2009 11/03/2015

Appendix VIII, Case Manager's Review Schedule

Revision 16-3; Effective June 24, 2016


 

Individual Plan of Care (IPC)Renewal Date First Case Manager Review Due Date Second Case Manager Review Due Date Third Case Manager Review  Due Date Earliest Renewal Meeting Date Latest Date to Submit IPC to DADS
Jan 1 Mar 31 June 30 Sept 30 Oct 3 Dec 2
Feb 1 April 30 July 31 Oct 31 Nov 3 Jan 2
Mar 1 May 31 Aug 31 Nov 30 Dec 1 Jan 30
April 1 June 30 Sept 30 Dec 31 Jan 1 Mar 2
May 1 July 31 Oct 31 Jan 31 Jan 31 April 1
June 1 Aug 31 Nov 30 Feb 28 Mar 3 May 2
July 1 Sept 30 Dec 31 Mar 31 April 2 June 1
Aug 1 Oct 31 Jan 31 April 30 May 3 July 2
Sept 1 Nov 30 Feb 28 May 31 June 3 Aug 2
Oct 1 Dec 31 Mar 31 June 30 July 3 Sept 1
Nov 1 Jan 31 April 30 July 31 Aug 3 Oct 2
Dec 1 Feb 28 May 31 Aug 31 Sept 2 Nov 1

Note: The fourth case manager’s review of the IPC year is combined with the meeting of the Service Planning Team to develop a renewal IPC.

Appendix XI, Abuse, Neglect, and Exploitation Training and Competency Test

Revision 19-3; Effective June 7, 2019

 

1. Requirement to Train DBMD Program Directors, Service Providers, Staff Persons and Volunteers

A DBMD program provider must ensure their program directors, service providers, staff persons and volunteers are:

  1. trained on:
    • acts that constitute abuse, neglect and exploitation;
    • signs and symptoms of abuse, neglect and exploitation; and
    • methods to prevent abuse, neglect and exploitation; and
  2. knowledgeable of:
    • acts that constitute abuse, neglect and exploitation;
    • signs and symptoms of abuse, neglect and exploitation; and
    • methods to prevent abuse, neglect and exploitation; and
  3. instructed to report to Department of Family and Protective Services (DFPS) immediately, but not later than 24 hours, after having knowledge or suspicion that an individual has been, or is being, abused, neglected or exploited by:
  4. provided with these instructions described in paragraph c of this section, in writing.

 

2. Optional Computer-Based Training

A DBMD program provider has the option of requiring their DBMD program directors, staff persons, service providers and volunteers to complete HHSC’s ANE Competency Training.

The completion of the computer-based training by DBMD program directors, service providers, staff persons and volunteers meets the requirements in Section 1a of this appendix.

Staff members, service providers, and volunteers must first sign up on the Learning Portal to have access to HHSC approved trainings, including this ANE training, entitled ANE Competency Training and Exam (online). The ANE training is found in Medicaid Long Term Services and Supports Training under the Health and Human Services Commission Courses tab.

Link to the Learning Portal homepage: https://learningportal.hhs.texas.gov/

 

3. Mandatory Computer-Based Competency Test

A DBMD program provider must ensure that a person trained on abuse, neglect and exploitation, as required by Section 1a of this appendix, completes HHSC’s ANE Competency Final Test and receives a score of at least 80 percent.

Compliance with this section by DBMD program directors, service providers, staff persons and volunteers meets the requirement in Section 1b of this appendix.

Section 2 provides information on how to access the Competency Test on the Learning Portal.

 

4. When Compliance Must Begin and Frequency of Training

A DBMD program provider must ensure that the requirements in Section 1 of this appendix are met:

  • for a program director, service provider, staff person or volunteer who is hired on or after July 1, 2019, before the DBMD program director, service provider, staff person or volunteer assumes job duties, and annually thereafter; and
  • for a program director, service provider, staff person or volunteer who is hired before July 1, 2019, within one year after the person’s most recent training on abuse, neglect and exploitation, and annually thereafter.

 

5. Documentation Requirements

A DBMD program provider must:

  1. document:
    • the name of the person who received the training required by Section 1a of this appendix;
    • the date the training was conducted; and
    • one of the following:
      • the name of the person who conducted the training; or
      • if the training is not in-person training, a description of the type of training provided; and
  2. maintain a copy of the certification generated from the HHSC ANE Competency Final Test for each DBMD program director, service provider, staff person and volunteer.

Appendix XII, Value-added Services

Revision 19-5; Effective November 25, 2019 

 

Value-added services (VAS) are extra benefits offered by managed care organizations (MCOs) beyond the Medicaid-covered services. VAS may include routine dental, vision, podiatry, and health and wellness services. VAS may be actual health care services, benefits or positive incentives that Texas Health and Human Services Commission determines will promote healthy lifestyles and improve health outcomes among members. Each MCO offers a different set of VAS and the MCO can change the VAS it offers once per fiscal year beginning September 1.
 
MCOs must cover all benefits in Medicaid managed care programs, such as STAR+PLUS, STAR Kids and STAR Health. The MCOs utilize VAS as an incentive to assist the member in making the best plan choice. In addition, members may use VAS to help choose which MCO has the added benefits best suited for their needs. 

VAS are not considered non-waiver resources and therefore, waiver program providers do not consider VAS offered by the MCO when considering third-party resources. VAS is an added benefit available to individuals from the MCO providing their acute care services.

Appendix XIII, Definition of the Term “Relative”

Revision 21-1; Effective June 23, 2021

A person is considered to be a relative if the person is related within the fourth degree of consanguinity or within the second degree of affinity.

Relationships of Consanguinity

Two people are related to each other by consanguinity if one is a descendant of the other or if they share a common ancestor. An adopted child is considered to be a child of the adoptive parent for this purpose.

Degrees of Consanguinity

Individual1st Degree2nd Degree3rd Degree4th Degree
Personchild
parent
grandchild,
sister, brother,
grandparent
great grandchild, niece,
nephew,
*aunt, *uncle,
great grandparent
great-great grandchild,
grandniece, grandnephew, first
cousin,
*great aunt, *great uncle,
great-great grandparent

*An aunt, uncle, great aunt or great uncle is related to a person by consanguinity only if he or she is the sibling of the person's parent or grandparent.

Example: Person A is related by the third degree of consanguinity to person B if person B is person A's uncle (brother of person A's father) because they share a common ancestor. However, person A is not related by consanguinity to person C if person C is the uncle's spouse because person A and person C share no common ancestor.

Relationships of Affinity

Two people are related by affinity if they are married to each other, or if one person’s spouse is related by consanguinity to the other person.

The ending of a marriage between two people by divorce or the death of a spouse ends relationships by affinity created by that marriage, unless a child of that marriage is living, in which case the marriage is considered to continue as long as a child of that marriage lives.

Degrees of Affinity

Individual1st Degree2nd Degree
Personspouse
spouse’s child (stepchild)
spouse’s parent
child’s spouse
parent’s spouse (stepparent)
spouse's grandchild (step grandchild)
spouse's brother, spouse’s sister
spouse's grandparent
grandchild's spouse
brother’s spouse, sister’s spouse
grandparent’s spouse (step grandparent)

Example: Person A is related by the second degree of affinity to the brother of person A's spouse because the brother and Person A’s spouse are related by the second degree of consanguinity.

Forms

ES = form also available in Spanish.

FormTitle 
1581Consumer Directed Services Option OverviewES
1582Consumer Directed Services ResponsibilitiesES
1583Employee Qualification RequirementsES
1584Consumer Participation ChoiceES
1586Acknowledgement of Information Regarding Support Consultation Services in the Consumer Directed Services (CDS) OptionES
1740Service Backup PlanES
2067Case Information 
2124Supported Home Living/Community Support Transportation LogES
3594Individual Plan of Care (IPC) Cover Sheet 
3596PAS/Habilitation Plan - CLASS/DBMD/CFC 
3598Individual Transportation Plan 
3627Specialized Nursing Certification 
3628Provider Agency Model Service Backup Plan 
4800-DFair Hearing Request Summary 
4800-DA4800-D Addendum 
6500Individual Plan of Care (IPC) - DBMD/CFC 
6500-TIPC Service Delivery Transfer Worksheet 
6501Individual Program Plan 
6502Denial of Application for DBMD 
6503DBMD Summary of Services Delivered 
6504Prior Authorization for Dental Services 
6505Daily Census Documentation 
6507Rationale for Adaptive Aids, Medical Supplies, and Minor Home Modifications 
6508Specifications for Minor Home Modifications 
6509CLASS/DBMD Coordination of Care 
6510Decline of Offer for Deaf Blind with Multiple Disabilities (DBMD) Program Enrollment 
6515CLASS/DBMD Nursing Assessment 
6517Individual Program Plan (IPP) Service Review 
6518Record of Completion for Individual Specific Training 
8001Medicaid Estate Recovery Program Receipt AcknowledgementES
8401Employment First Discovery Tool 
8493Notification Regarding a Death in HCS, TxHmL and DBMD Programs 
8507Understanding Program Eligibility - CLASS/DBMD 
8557CLASS/DBMD Corrective Action Plan 
8578Intellectual Disability/Related Condition Assessment 
8598Non-Waiver Services 
8601Verification of Freedom of ChoiceES
8604Transition Assistance Services (TAS) Assessment and Authorization 
8605Documentation of Completion of Purchase 
8662Related Conditions Eligibility Screening Instrument 
H1200Application for Assistance - Your Texas Benefits 
H1200-EZApplication for Assistance - Aged and Disabled (Large Print) 
H1746-AMEPD Referral Cover Sheet 
H1746-BBatch Cover Sheet 
H1826Case Information ReleaseES
H3034Disability Determination Socio-Economic ReportES
H3035Medical Information Release/Disability DeterminationES

22-3, Section 9000 Changes

Revision Notice 22-3; Effective Oct. 1, 2022

The following change(s) were made:

Section Title Change
9000 Approved Diagnostic Codes for Persons with Related Conditions Updates effective date and link for ICD-10 Approved Diagnostic Codes for Persons with Related Conditions.

22-2, Section 2000 Changes

Revision Notice 22-2; Effective Sept. 1, 2022

The following change(s) were made:

Section Title Change
2000 Minor Home Modification Services Updates all-inclusive list of minor home modifications.

22-1, Section 9000 Change and New Form 6518

Revision Notice 22-1; Effective February 7, 2022

The following change(s) were made:

Section Title Change
9000 Approved Diagnostic Codes for Persons with Related Conditions Updates the ICD-10 codes effective Oct. 1, 2021 to Sept. 30, 2022.
Form 6518 Record of Completion for Individual Specific Training Adds a form to assist program providers with documenting the completion of required training, as outlined in 40 TAC Section 42.403(g).

21-1, Appendix XIII Added

Revision Notice 21-1; Effective June 23, 2021

The following change(s) were made:

Section Title Change
Appendix XIII Definition of the Term “Relative” Adds an appendix explaining a person is considered to be a relative if the person is related within the fourth degree of consanguinity or within the second degree of affinity.