CRITERIA, PURPOSE, AND LIMITATIONS The In-Home and Family Support Program-MR was developed pursuant to the Texas Health and Safety Code, Chapter 535, to provide assistance to eligible persons and families to expend on items that meet the following criteria. The item meets a need that exists solely because of the person's mental disability or co-occurring physical disability and: directly supports the person to live in his or her natural home; integrates the person into the community; or promotes the person's self-sufficiency.The item is:not an unallowable cost; and not paid for in full or reimbursed in full by a third-party resource. The In-Home and Family Support Program-MR provides assistance to eligible persons and families in accordance with DADS rules (40 TAC, Chapter 1, Subchapter I) and to the extent funds are available. The In-Home and Family Support Program-MR does not provide assistance solely to improve the living conditions of eligible persons or families living at or below the poverty level. Assistance is neither an entitlement nor an income supplement. The In-Home and Family Support Program-MR is a program of last resort; therefore, assistance may not be used to supplant items available to an eligible person or family through any other support program or third-party resource. However, assistance may be used to: supplement items provided through any other support program;supplement items paid for or reimbursed by a third-party resource; or to assist eligible persons and families who are currently waiting for items to be provided through any other support program.
ELIGIBILITY DETERMINATION A person or family is eligible for assistance if Pecan Valley MHMR Region determines that the requirements of the diagnosis, residency, financial, and need factors as described by rule are met. Eligibility for assistance must be re-determined each fiscal year that a person or family receives assistance.
ALLOWABLE COSTS Assistance may be used to pay for any item described below if the item meets the criteria for the In-Home and Family Support Program-MR.
Special equipment as follows: Therapy equipment, as recommended by a physical or occupational therapist following evaluation;Motorized or hand-powered lift;Mobility equipment,as recommended by a physician, or physical or occupational therapist following evaluation;Medical equipment,as prescribed by a physician; and Assistive technology (as defined by rule), as recommended by a physical, occupational, or speech therapist following evaluation.
Architectural modifications to the person's natural home as follows: Ramp, porch, or sidewalk;handrail;room construction, with the limitations described below; and House renovation.
Health services as follows: Therapy as recommended by a physician, or physical, occupational, or speech therapist following evaluation;Diagnostic service;Medication, as prescribed by a physician, with the limitations described below;
Surgery as recommended by a physician, or oral surgery, as recommended by a dentist. Laboratory service as prescribed by a physician. Dental as recommended by a dentist. Non-durable or disposable supply Adaptive aid (as defined by rule),as recommended by a physical or occupational therapist following evaluation. Specialized nutritional product as prescribed by a physician, with the limitations described below.
Counseling and training services as follows: Counseling, Behavior therapy,Behavioral coach service provided under the supervision of a behavior therapist, Independent or daily living training,Family or caregiver training, Job coach services; and Remedial education for an adult.
Home care services as follows: Home health aide service, as prescribed by a physician,Homemaker service,Personal assistant service.
Attendant support for participation in after-school activities for: A person 17 years of age or under; or A person age 18, 19, 20, 21, or 22 years who is enrolled and attends public school. Attendant support for participation in summer activities for: A person 17 years of age or under; or A person age 18, 19, 20, or 21 years who is enrolled to attend public school in the fall semester following that summer;Specialized child care for a person age 13 years or older; and Specialized child care for a person under age 13 years, with limitations described below.
Transportation as follows: Out-of-town transportation, room, and board for evaluation and treatment, Public transportation Mileage reimbursement, with limitations described below;
Short-term vehicle rental; and Major vehicle repair,with limitations described below.
Respite care as follows: In-home respite; and Out-of-home respite.
Other items as agreed upon by the person or family and Pecan Valley MHMR that meet the criteria for the In-Home and Family Support Program-MR.,including: Housing-related expenses, with limitations described below,as follows:Housing start-up, which is rent and rent deposit,utilities and utilities deposit, and minimal furniture and appliances; and housing; and vendor fiscal intermediary fees that are related to an eligible person or family being an employer of a service provider who is paid with assistance, as determined in accordance with §1.408(d) of the rule.
Limitations are placed on the following costs listed above.
Allowable costs for room construction are limited to situations in which:House renovation is not feasible; and the room constructed will be used primarily by the person on a daily basis. Psychoactive medications are limited to no more than a two-month supply per fiscal year. Allowable costs for a specialized nutritional product (as defined by rule) are limited to those costs in excess of routine food and nutritional costs. Allowable costs for specialized child care for a child under the age of 13 years are limited to those costs in excess of the prevailing rate for routine child care. Mileage reimbursement may not exceed the state-reimbursed mileage rate. Limitations on major vehicle repair. Allowable costs for major vehicle repair are limited to costs necessary:for the vehicle to be legally operational; or to repair the vehicle's air conditioning if the vehicle is the person's primary mode of transportation and a physician determines that the person requires air conditioning while traveling in the vehicle. (Major vehicle repair does not include routine vehicle maintenance.) Housing-related expenses are limited to no more than two months per fiscal year.
UNALLOWABLE COSTS: Assistance may not be used to pay for any item listed below: Purchase or long-term lease of a vehicle, or routine vehicle maintenance. An expense that is incurred before the written plan is approved.
Income or property tax. Abortion or emergency room service. A segregated service or activity (i.e., a service or activity that is targeted solely to persons with a mental disability or physical disability), except for health services and counseling and training services as described as an allowable cost. Any insurance premium; a burial or funeral expense; food that is not a specialized nutritional product. Routine shelter, routine utilities, routine home repair, routine home appliance, routine home furnishing, and yard work over-the-counter medication. Architectural modifications to any building except the person's natural home;an expense related to the person's recreation; school tuition or fee, or any educational support item required by law to be provided by the public school system; school tuition or fee, or any educational support item for a child who is enrolled in private school or who is Home-schooled, Restraint device (as defined by rule), Routine child-care for a child under the age of 13 years Any service provided by an individual under the age of 18 years or by an individual who resides in the same household as the person; and general medical care that is not related to a mental disability or co-occurring physical disability,as determined by DADS,including but not limited to:Physical examination;Cancer treatment, Heart disease treatment, Sleep apnea treatment, Treatment for diabetes.
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