The Texas Department of Human Services (DHS) proposes to repeal §48.2123, concerning changes in Community Living Assistance and Support Services (CLASS) services, and §48.6099, concerning changes in Community Based Alternatives (CBA) services; and proposes new §48.2123, concerning changes in Community Living Assistance and Support Services, and §48.6099, concerning changes in Community Based Alternatives services, in its Community Care for Aged and Disabled chapter. The purpose of the repeals and new sections is to replace the current rules with new rules that incorporate the addition of a cost ceiling to CLASS and CBA services, as required by a budget rider (Rider 7b(2)) that was attached to DHS's funding levels authorized for the 2004 - 2005 biennium.

The current rules state that if the estimated cost of CLASS and CBA services necessary for the client to live in the most integrated setting in the community exceeds the cost ceiling, DHS may not disallow or jeopardize community services for that person. Under the new rules, the estimated costs for the needed services, excluding minor home modifications and adaptive aids, may not exceed 133.3% of the cost ceiling in any month, nor may the costs exceed 100% of the cost ceiling in more than six months during a 12-month individual service plan (ISP) period. If the estimated cost exceeds either of these limits, then the client is no longer eligible for services, unless the client was already receiving services under DHS's budget rider (Rider 7) from the 77th legislative session. The proposed rules establish DHS's criteria for considering changes in the client's service plan and authorize the Texas Board of Human Services or the DHS commissioner to grant exemptions if warranted in individual cases.

New §48.6099 also stipulates that clients receiving waiver services through the Medically Dependent Children Program fall under the provisions of the new rule when they apply for transition to the CBA Program at age 21.

Gordon Taylor, Chief Financial Officer, has determined that, for the first five-year period the proposed sections are in effect, there are no fiscal implications for state or local government as a result of enforcing or administering the sections. Although the proposed new rules should result in a slight reduction in the average cost per client, which may enable DHS to serve a few additional clients, there is no net fiscal impact to the agency's budget.

Bettye M. Mitchell, Deputy Commissioner for Long Term Care, has determined that, for each year of the first five years the sections are in effect, the public benefit anticipated as a result of enforcing the sections is that the terms of Rider 7b(2) will be detailed in the Texas Administrative Code and that DHS will be in compliance with provisions of the 2004 - 2005 Legislative Appropriations Act. There may be a minimal adverse economic impact on some home and community support services provider agencies that deliver services to CLASS and CBA clients, because the rules will cut back services for some clients. The number of clients affected by the change is very small, however, and there would not be a disproportionate effect on small or micro businesses. There is no anticipated economic cost to persons who are required to comply with the proposed sections. There is no anticipated effect on local employment in geographic areas affected by these sections.

Questions about the content of the proposal concerning §48.2123 may be directed to Gerardo Cantú at (512) 438-3693 in DHS's Community Care Provider Services section. Questions about the content of the proposal concerning §48.6099 may be directed to Duanne Harris at (512) 438-5464 in DHS's Long-term Care Client Eligibility section. Written comments on either proposal may be submitted to Supervisor, Rules Unit-119, Texas Department of Human Services E-205, P.O. Box 149030, Austin, Texas 78714-9030, within 30 days of publication in the Texas Register .

Under Government Code, §2007.003(b), DHS has determined that Chapter 2007 of the Government Code does not apply to these rules. The changes these rules make do not implicate a recognized interest in private real property. Accordingly, DHS is not required to complete a takings impact assessment regarding these rules.

These rules are proposed by DHS, subject to the subsequent transfer of rulemaking authority to Texas Health and Human Services Commission (HHSC). DHS is currently scheduled to transition sometime in 2004 into two successor agencies, the existing HHSC and a new agency, the Texas Department of Aging and Disability Services (DADS).

This reorganization is mandated by House Bill 2292, 78th Legislature, Regular Session (2003). At the inception of operations of DADS, the authority to adopt all rules for the operation and provision of health and human services by DADS will lie with HHSC. These changes may result in the migration of these rules from one title of the Texas Administrative Code to another or other changes.

Subchapter C. MEDICAID WAIVER PROGRAM FOR PERSONS WITH RELATED CONDITIONS

The Texas Department of Human Services (DHS) proposes to repeal §50.50 and proposes new §50.50, concerning changes in Consolidated Waiver Program (CWP) services, in its §1915(c) Consolidated Waiver Program chapter. The purpose of the repeal and new section is to replace the current rule with a new rule that incorporates the addition of a cost ceiling to CWP services, as required by a budget rider (Rider 7b(2)) that was attached to DHS's funding levels authorized for the 2004 - 2005 biennium.

The current rule states that if the estimated cost of CWP services necessary for the client to live in the most integrated setting in the community exceeds the cost ceiling, DHS may not disallow or jeopardize community services for that person. Under the new rule, the estimated costs for the needed services, excluding minor home modifications and adaptive aids, may not exceed 133.3% of the cost ceiling in any month, nor may the costs exceed 100% of the cost ceiling in more than six months during a 12-month individual service plan (ISP) period. If the estimated cost exceeds either of these limits, then the client is no longer eligible for services, unless the client was already receiving services under DHS's budget rider (Rider 7) from the 77th legislative session. The proposed rule establishes DHS's criteria for considering changes in the client's service plan and authorizes the Texas Board of Human Services or the DHS commissioner to grant exemptions if warranted in individual cases.

Gordon Taylor, Chief Financial Officer, has determined that, for the first five-year period the proposed section is in effect, there are no fiscal implications for state or local government as a result of enforcing or administering the section. Although the proposed new rule should result in a slight reduction in the average cost per client, which may enable DHS to serve a few additional clients, there is no net fiscal impact to the agency's budget.

Bettye M. Mitchell, Deputy Commissioner for Long Term Care, has determined that, for each year of the first five years the section is in effect, the public benefit anticipated as a result of enforcing the section is that the terms of Rider 7b(2) will be detailed in the Texas Administrative Code and that DHS will be in compliance with provisions of the 2004 - 2005 Legislative Appropriations Act. There may be a minimal adverse economic impact on some home and community support services provider agencies that deliver services to CWP clients, because the rule will cut back services for some clients. The number of clients affected by the change is very small, however, and there would not be a disproportionate effect on small or micro businesses. There is no anticipated economic cost to persons who are required to comply with the proposed section. There is no anticipated effect on local employment in geographic areas affected by this section.

Questions about the content of this proposal may be directed to Gerardo Cantú at (512) 438-3693 in DHS's Community Care Provider Services section. Written comments on the proposal may be submitted to Supervisor, Rules Unit-122, Texas Department of Human Services E-205, P.O. Box 149030, Austin, Texas 78714-9030, within 30 days of publication in the Texas Register .

Under Government Code, §2007.003(b), DHS has determined that Chapter 2007 of the Government Code does not apply to this rule. The changes this rule makes do not implicate a recognized interest in private real property. Accordingly, DHS is not required to complete a takings impact assessment regarding this rule.

These rules are proposed by DHS, subject to the subsequent transfer of rulemaking authority to Texas Health and Human Services Commission (HHSC). DHS is currently scheduled to transition sometime in 2004 into two successor agencies, the existing HHSC and a new agency, the Texas Department of Aging and Disability Services (DADS).

This reorganization is mandated by House Bill 2292, 78th Legislature, Regular Session (2003). At the inception of operations of DADS, the authority to adopt all rules for the operation and provision of health and human services by DADS will lie with HHSC. These changes may result in the migration of these rules from one title of the Texas Administrative Code to another or other changes.