FUNDERS - TEXAS HOME LIVING (TXHML)

According to the Texas Department of Aging and Disability Services ("DADS"), from brochure dated March 23, 2004:

The Texas Home Living (TxHmL) Program provides essential services and supports so that Texans with mental retardation can continue to live with their families or in their own homes in the community.

An adult or child is eligible for the Texas Home Living (TxHmL) Program if he or she:

• has mental retardation or a related condition and meets the criteria for a Level of Care I in an Intermediate Care Facility for Persons with Mental Retardation;
• is a current Medicaid recipient (i.e., has a Medicaid card);
• does not require intensive one-to-one supervision to prevent dangerous behavior;
• has an Individual Plan of Care (IPC) approved by the Texas Department of Mental Health and Mental Retardation (TDMHMR);
• is not enrolled in another Medicaid waiver program (such as the CLASS Program or the Medically Dependent Children Program);
• chooses to participate in the TxHmL program instead of the ICF/MR Program; and
• lives in his or her own home or family home.

Texas Home Living (TxHmL) offers a number of services to support people who live in their own homes or with their families. TxHmL services are intended to supplement instead of replace the services and supports a person may receive from other programs, such as the Texas Health Steps Program, or from natural supports such as his or her family, neighbors, or community organizations. TxHmL Program services are limited to a yearly cost of $10,000 per participant.

The Texas Home Living (TxHmL) Program does not offer out-of-home residential services, e.g., group home living. It is a different program from the Home and Community-based Services (HCS) program and if you or substitute decision makers choose to enroll in the TxHmL program, your name will stay on the HCS Program waiting list with no change to the date it was put on the list.

As a participant in the Texas Home Living (TxHmL) Program, you will have a service coordinator who works for the local community mental health and mental retardation center to help you plan your services. The service coordinator is interested only in what services and supports you need to help you continue to live in your own home or your family home. The service coordinator helps you or your family set up a service planning team that will develop a service plan. The team is made up of you, your guardian or family members, and other people you choose.

Together, the service planning team selects the TxHmL services that are needed and necessary to reach the outcomes or goals you or your representatives have identified. Your plan will identify services and supports you need from the TxHmL Program and those you may be getting from other people or programs.

TxHmL Program Services

The services and supports available through the Texas Home Living (TxHmL) Program are divided into two service categories. Each service category is made of several TxHmL Program service components. Each service category has an annual cost limit called a service category limit. This means that the annual cost of one or more service components in a service category must not exceed the service category limit unless TDMHMR has approved a request to increase a service category limit.

Even if TDMHMR gives permission to go over a service category limit, the total cost of an individual’s TxHmL services must not be more than $10,000 per year. This means that the combined yearly cost of all the service components in the two service categories must not be more than $10,000 per year. The service components included in each service category, along with the annual service category limits, are listed in the following chart.

TxHmL SERVICE CATEGORIES AND SERVICE COMPONENTS

Community Living Supports Annual Service Category Limit = $8,000

• Community Support
• Day Habilitation
• Employment Assistance
• Supported Employment
• Respite

Professional & Technical Supports Annual Service Category Limit =$2,000

• Skilled Nursing
• Behavioral Support
• Physical & Occupational Therapy
• Dietary
• Speech & Language Pathology
• Audiology
• Minor Home Modifications*
• Adaptive Aids*
• Dental Treatment*

*Service component cost limits.

TDMHMR will not approve a request to exceed these service component cost limits:

• Minor Home Modifications are limited to a life-time maximum of $7,500. Once that life-time maximum is reached, $300 per year may be used for additional modifications or repairs of modifications.
• Adaptive Aids are limited to $6,000 per year.
• Dental Treatment is limited to $1,000 per year.

Request to Increase Service Category Limits

When an individual’s need for a service or a combination of services in one service category is more than the annual service category limit, TDMHMR may approve a request to increase the service category limit as long as the total annual cost of the individual’s plan of care does not exceed $10,000. This means that, with TDMHMR approval, dollars that are not used in one service category may be moved to the other service category if the total annual cost of TxHmL Program services is not more than $10,000.

Based on decisions of the service planning team, a service coordinator may submit a request to increase a service category limit at the time an individual enrolls in the TxHmL Program or any time afterward.

You, your representative, or your TxHmL Program Provider can let your service coordinator know that there is a need to increase a service category limit.

Before a request to increase a service category limit is made, your service planning team should carefully consider the answers to the following questions.

• Are there any non-TxHmL sources for the services and supports required?
• Is the service category increase necessary? For the service category under consideration, are the amounts of other service components in that same service category appropriate and necessary or could one of these components be reduced or eliminated?
• Is the increase necessary to assure the individual’s health and welfare in the community or to prevent admission to institutional services?
• Has the individual’s program provider confirmed that there are sufficient unused dollars in the other service category that can be moved to the category to be increased?
• Has the team carefully considered the individual’s future needs for services covered in the service category that will be reduced if TDMHMR approves the request to increase the limit for the category under consideration?

Critical points to remember

• A service category increase cannot be approved if the total annual cost of an individual’s IPC exceeds $10,000.
• The annual service component cost maximum for adaptive aids and dental treatment cannot be increased.
• The life-time maximum limit (and the annual amount available after the life-time maximum is reached) for the minor home modifications service component cannot be increased.
• Service coordinators and program providers must work together to assure that sufficient unused dollars are available to be moved from one category to the other.
• Unused dollars include those dollars that:
  1. are not included on an individual’s current IPC, for example, the individual’s current IPC includes a combination of services in the Community Living Support category equal to $6,000 and no services in the Professional and Technical Support category, and
  2. are included on the IPC but have not yet been used, specifically, the dollars are associated with services that have not been provided.
• Unused dollars do not include dollars:
  1. for services that a program provider has billed and been paid or billed but not yet paid; and
  2. for services that the program provider has provided but has not yet billed.

For more information please see Texas Department of Aging and Disability Services (DADs) website at http://www.dads.state.tx.us/business/mental_retardation/txhml/index.html

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