Guardianship Services Handbook

Appendix II
Services and Placements

Revision 12-1; Effective February 1, 2012

Program Covered Services Eligibility Application
DADS local authority (LA) Home and Community-based Services (HCS) (Medicaid waiver program – operated by DADS state office) Provides individualized home and community-based services, including adaptive aids, case management, counseling, audiology, speech/language pathology, occupational therapy, physical therapy, dietary services, social work and psychology services, minor modifications, dental treatment, nursing, residential assistance, respite, day habilitation and supported employment. Case management services are provided by HCS provider. Living arrangements may include foster home or companion living for person who can function with a minimum level of support and supervision.
  • All ages
  • Meet income and resource limit requirements of SSI or Medical Assistance Only (MAO) programs
  • Have a determination of MR
  • Be eligible for ICF/ID LOC I, V or VI (See Table, ICF-ID Levels of Care)
  • Have an Individual Care Plan which does not exceed state financial limits (there are a limited number of "Multiple Disability Unit" slots available for persons leaving state hospitals who have intellectual disability. If eligible, these persons may bypass the HCS interest lists).
Contact LA (Additional information on DADS website: http://www.dads..state.tx.us)
DADS Intermediate Care Facilities for Persons with Intellectual Disability or a Related Condition (ICF-ID/RC) Provides Medicaid-funded residential and individualized services, including residential services, habilitation services, medical services, skills training, and adjunctive therapy services
  • All ages
  • Have a determination of MR or RC
  • Have a determination through the Social Security Administration that a disability exists
  • Meet income and resource limit requirements of SSI or MAO programs
Contact LA (Additional information on DADS website: http://www.dads.state.tx.us)
ID Service Coordination, as applicable Possible services which will assist Medicaid eligible individuals in gaining access to needed medical, social, educational and other appropriate services that will help them achieve or maintain quality of life and community participation acceptable to each individual, including assessment, service planning and coordination, crisis prevention and management, and monitoring
  • Medicaid eligible
  • Member of the adult intellectual disability priority population or a person with a related condition and
  • Has multiple needs; or
  • Be transitioning between community providers or placement; or
  • Be transitioning between an institution provider and a community provider; or
  • Be a resident of a Medicaid nursing facility and be eligible for OBRA '87 mandated services for mental illness, ID or RC
Contact LA (Additional information on DADS website: http://www.dads.state.tx.us)
Mental Health Case Management MH case management services assist an individual in gaining and coordinating access to necessary care and services appropriate to the individual's needs.
  1. An individual is eligible for general revenue-funded MH case management services if the individual:
    1. Is a resident of the state of Texas;
    2. Is an adult with a severe and persistent mental illness, or a child or adolescent with a serious emotional disturbance;
    3. Does not have a single diagnosis of intellectual disability, pervasive developmental disorder, or substance use disorder; and
    4. Qualifies for an LOC that includes MH case management services;
  2. An individual is eligible for Medicaid-funded MH case management services if, in addition to the criteria set forth in subsection a of this section, the individual is:
    1. Eligible for Medicaid; and
    2. Is not residing in a setting in which Medicaid payment is unavailable.
Contact LA
MH and ID Medicaid Rehabilitation Services Provides reimbursement for Mental Health rehabilitative services including Crisis Intervention Services, Medication Training and Support Services, Psychosocial Rehabilitation Services, Rehabilitative Counseling and Psychotherapy, Skills Training and Development and Day Programs for Acute Needs An individual is eligible for Medicaid MH rehabilitative services if the individual:
  1. Is a resident of the state of Texas;
  2. Is eligible for Medicaid;
  3. Is an adult with a severe and persistent mental illness or a child or adolescent with a serious emotional disturbance;
  4. Qualifies for a LOC;
  5. A Licensed Practitioner of the Healing Arts has determined the services to be medically necessary; and
  6. The individual is not residing in a setting in which Medicaid payment is unavailable.
Contact LA regarding consumer referrals
DADS Community Based Alternatives (CBA)
(Medicaid waiver program) 		Provides home and community-based services, including adaptive aids, medical supplies, adult foster care, assisted living/residential care services, dental, prescribed drugs, emergency response services, nursing services, minor home modification, occupational therapy, personal assistance services, transition assistance services, physical therapy, respite care, speech pathology, home-delivered meals
  • Be age 21 or older
  • Must be eligible for a Medicaid program as described in the waiver (i.e., be on Medicaid and receive SSI). Meet income and resource limit requirements of SSI or MAO programs
  • Meet the level of care criteria for NF care as determined by Texas Medicaid and Healthcare Partnership (TMHP)
  • Meet two or more of the criteria for nursing home risk, as specified in the Resident Assessment Instrument-Home Care Assessment for Nursing Home Risk
  • Have an Individual Service Plan for waiver services with an estimated annual cost not exceeding 200% of institutional care cost
Contact local DADS Community Care for Aged and Disabled Services office for eligibility information (Additional information on DADS website: http://www.dads.state.tx.us under "Resources for DADS Service Providers" link)
DADS Community Living Assistance and Support Services (CLASS) (Medicaid waiver program) Provides home and community-based services, including case-management, habilitation, respite care, nursing services, psychological services, physical therapy, occupational therapy, speech therapy, speech pathology, adaptive aids/supplies, minor home modifications, specialized therapies
  • All ages
  • Have a related condition other than intellectual disability
  • Meet income and resource limit requirements of SSI or MAO programs
  • Meet ICF-ID/RC LOC criteria
  • Have a demonstrated need for habilitation services and case management
  • Have an Individual Care Plan approved by DADS
  • Reside in the geographic catchment area
 Call CLASS Program Contact at 512-438-3078 or DADS CLASS Interest List at 1-877-438-5658 (Additional information on DADS website: http://www.dads.state.tx.us under "Resources for DADS Service Providers" link)
DADS Deaf Blind with Multiple Disabilities (DBMD) Program (Medicaid waiver program) Provides home and community-based services, including case management, assisted living, intervenor, habilitation, respite care, nursing services, orientation and mobility, behavior communication services, physical therapy, speech therapy, chore provider, adaptive aids/supplies, environmental accessibility, group home
  • Age 18 and older
  • Meet income and resource limit requirements of SSI or MAO programs
  • Meet ICF-ID LOC status
  • Have deafness/blindness with a third disability resulting in a demonstrated need for daily habilitation services
  • Have an Individual Care Plan for waiver services approved by DADS
Contact DBMD Program Consultant at 512-438-2622 or DADS Deaf Blind with Multiple Disabilities Interest List at 1-877-438-5658 (Additional information on DADS website: http://www.dads.state.tx.us under "Resources for DADS Service Providers" link)
DADS Program of All-Inclusive Care for the Elderly (PACE) — El Paso only Provides any and all health related services needed including in-patient and out-patient medical care, specialty services such as dentistry and podiatry, social services, in-home services, meals, transportation, day activity and housing assistance
  • Over age 55
  • Qualify for a nursing facility LOC
  • Meet income and resource limit requirements of SSI or MAO programs
Contact PACE Program Consultant at (512) 438-5391 or local DADS office (Additional information on DADS website: http://www.dads.state.tx.us under "Resources for DADS Service Providers" link)
DADS CBA Assisted Living/Residential Care Provides supervised living and emergency care, including personal care, home management, escort, 24-hour supervision, social and recreational activities, transportation, food and room.
  • Be 21 years of age or older
  • Meet the medical necessity for nursing facility admission
  • Have an Individual Plan of Care that does not exceed the nursing facility payment rate
  • Financial eligibility is determined by the Texas Health and Human Services Commission
Contact local DADS Community Care for Aged and Disabled Services office (Additional information on DADS website: http://www.dads.state.tx.us under "Resources for DADS Service Providers" link)
DADS Adult Foster Care (AFC) Provides a 24-hour living arrangement with supervision in a family home with three or fewer adults unrelated to the proprietor, including minimal assistance with personal care, help with activities of daily living and provision of or arrangement for transportation
  • Be 18 years of age or older
  • Meet functional assessment score
  • Financial eligibility is determined by the Texas Health and Human Services Commission
Contact local DADS Community Care for Aged and Disabled Services office
DADS Medically Dependent Children Program (MDCP) (Medicaid waiver program) Provides community-based services for medically involved children and young adults, including respite care, home modifications, adaptive aids, supports to enable children to participate in child care and supports to help young adults move toward independent living
  • Be under age 21
  • Meet the medical necessity criteria for nursing facility care
  • Financial eligibility for applicants not already receiving Medicaid coverage is determined by the Texas Health and Human Services Commission
Contact DADS MDCP Interest List at 1-877-438-5658 or local DADS office (Additional information on DADS website: http://www.dads.state.tx.us under "Resources for DADS Service Providers" link)
Child Protective Services (CPS) Extended Foster Care Provides a 24-hour living arrangement in a family home, group home, residential treatment center or other facility. Placements include DFPS licensed institutions for intellectual disability serving children with severe and profound ID who have deficits in adaptive behavior
  • Age 18 aging out of CPS conservatorship
  • High school education with graduation or completion of the Individual Education Plan expected to occur by 22nd birthday
  • Vocational or technical training classes with completion scheduled by 19th birthday
  • Ends upon completion of Special Education or vocational training
CPS staff in county of conservatorship of child
CPS Aftercare Room and Board Generally, provides an amount not to exceed $500 per month for room and board assistance. In an exceptional situation with approval from the CPSPA and PAL state office, an amount greater than $500 may be approved. The total amount of accumulated payments may not exceed $3,000. Allowable expenditures include:
  • Rent deposits and payments
  • Utility deposits and payments
  • Food / groceries
  • Residential housing deposits or residential payments at college
  • Rent payments to supportive landlords or financial compensation to host homes
  • Ages 18 – 21
  • Have aged out of CPS foster care system
  • Be in an educational program, employed or actively seeking employment
  • Not receiving adequate assistance for room and board from another source
Local CPS PAL coordinator
DARS Vocational Rehabilitation Provides services based on individual need, including medical, psychological and vocational evaluation; counseling and guidance; hearing examinations; purchase of hearing aids and other communication equipment; aural rehabilitation; interpreter services; assistive devices such as artificial limbs, braces, wheelchairs and hearing aids; rehabilitation technology devices and services to improve job functioning; training to learn job skills in trade school, college, university, on the job or at home; training to learn appropriate work behaviors and other skills to find and keep jobs; job placement assistance; follow-up after employment; assisting work-injured Texans to return to work
  • Substantial problems in getting employment
  • Vocational rehabilitation services are required to prepare for, get and/or keep a job
  • The person is able to get and/or keep a job after receiving services
  • May have a disability such as mental illness, hearing impairment, impaired functioning of arms or legs, back injury, alcoholism or drug addiction, intellectual disability, learning disability, traumatic brain injury, other physical or mental disabilities
Contact local DARS office (Additional information on DARS website at http://www.dars.state.tx.us)
DARS Extended Rehabilitation Helps Texans with significant disabilities who require extended ongoing support services in order to achieve and maintain employment. Offers choice of sheltered employment, although emphasis is placed on community integrated employment. Services include mobility assistance, job coaching, transportation to and from job, activities to improve daily living skills, assistance in developing self-help and adaptive skills, assistive technology necessary for employment
  • Being capable of achieving an employment outcome
  • 16 years of age or older
  • Legal resident of Texas
  • Capable of earning at least 15% of minimum wage
 Contact local DARS office (Additional information on DARS website at http://www.dars.state.tx.us)
DARS Independent Living (IL) Provides services to promote self-sufficiency despite significant disability to improve mobility, communication, personal adjustment and self-direction. Includes counseling and guidance; training and tutorial services; adult basic education; rehabilitation facility training; telecommunications, sensory and other technological aids for people who are deaf; vehicle modification; assistive devices such as artificial limbs, braces, wheelchairs and hearing; other services, such as transportation, interpreter services and maintenance
  • Certification by an Independent living counselor
  • A severe physical or mental disability which limits a person's ability to live independently in the family or community
  • Reasonable expectation that DARS/IL services will improve a person's ability to live independently
Contact local DARS office (Additional information on DARS website at http://www.dars.state.tx.us)
DARS Comprehensive Rehabilitation Services Provides services to promote independent living for individuals who survive traumatic injury to the spinal cord or brain. Services include in-patient comprehensive medical rehabilitation, such as a variety of therapies, medical care and other services; out-patient services; post-acute traumatic brain injury services to deal with injury-related cognitive difficulties such as memory loss and/or inappropriate behaviors
  • Have a traumatic brain and/or spinal cord injury that results in a substantial impediment to functioning independently
  • Reasonable expectation that the ability to function with the family and community will improve with the provision of services
  • A U.S. citizen
  • 16 years or older
  • Ability to actively participate in a program of services
  • Be functioning at a Level IV on the Rancho Los Amigos Levels of Cognitive functioning of equivalent
Contact local DARS office (Additional information on DARS website at http://www.dars.state.tx.us)
DARS Rehabilitation Technology Lab Provides the latest technology to enable persons with disabilities to perform jobs once thought "off limits" for them. Includes information and referral for latest products; assessment to determine what equipment works best; demonstration and loan of equipment; vehicle modifications   Contact local DARS office (Additional information on DARS website at http://www.dars.state.tx.us)
DSHS Medical Transportation Provides non-emergency transportation services to authorized medical and dental care. Enrollment in Medicaid with no other means of transportation to access a Medicaid-allowable service. Contact 1-877-633-8747 (Additional information on DSHS website at http://www.dshs.state.tx.us)
DSHS Texas Health Steps (THSteps) or Early and Periodic Screening, Diagnosis, Treatment (EPSDT) Provides comprehensive medical and dental prevention and treatment services, including comprehensive and periodic evaluation of the child's health, development and nutritional status, as well as vision, dental and hearing care. All children under 21 who are Medicaid eligible No application required; show Medicaid card to local Medicaid providers (e.g., dentists, doctors, etc.) (Additional information on DSHS website at http://www.dshs.state.tx.us)
DSHS Comprehensive Care Program (CCP) Provides medically necessary health services, outpatient, rehabilitation, nutritional services, occupational therapy, orthotic, and prosthetic devices, private duty nursing, speech therapy, and psychiatric hospitalization
  • Under 21 years
  • Medical necessity
  • Medicaid recipient
 No application required; show Medicaid card to local providers; ordered by physician (Additional information on DSHS website at http://www.dshs.state.tx.us)