26 Tex. Admin. Code § 259.53

Current through Reg. 49, No. 49; December 6, 2024
Section 259.53 - CLASS Interest List
(a) HHSC maintains an interest list that contains the names of individuals interested in receiving CLASS Program services.
(b) A person may request an individual's name be added to the CLASS interest list by:
(1) calling HHSC's toll-free number; or
(2) submitting a written request to HHSC.
(c) If a request is made in accordance with subsection (b) of this section for an individual who resides in Texas, HHSC adds the individual's name to the CLASS interest list using the date HHSC receives the request as the CLASS interest list date.
(d) For an individual under 22 years of age who is residing in a nursing facility located in Texas, HHSC adds the individual's name to the CLASS interest list using the date of admission to the nursing facility as the CLASS interest list date.
(e) For an individual determined diagnostically or functionally ineligible during the enrollment process for the Deaf-Blind with Multiple Disabilities (DBMD) Program, Home and Community-based Services (HCS) Program, Texas Home Living (TxHmL) Program, or Medically Dependent Children Program (MDCP):
(1) if the individual's name is not on the CLASS interest list, at the request of the individual or LAR, HHSC adds the individual's name to the CLASS interest list using the individual's interest list date for the program for which the individual was determined ineligible as the CLASS interest list date;
(2) if the individual's name is on the CLASS interest list and the individual's interest list date for the program for which the individual was determined ineligible is earlier than the individual's CLASS interest list date, at the request of the individual or LAR, HHSC changes the individual's CLASS interest list date to the individual's interest list date for the program for which the individual was determined ineligible; or
(3) if the individual's name is on the CLASS interest list and the individual's CLASS interest list date is earlier than the individual's interest list date for the program for which the individual was determined ineligible, HHSC does not change the individual's CLASS interest list date.
(f) This subsection applies to an individual who was enrolled in MDCP and, because the individual did not meet the level of care criteria for medical necessity for nursing facility care or did not meet the age requirement of being under 21 years of age, was determined ineligible for MDCP after November 30, 2019.
(1) At the request of the individual or LAR, HHSC adds the individual's name to the CLASS interest list:
(A) using the MDCP interest list date as the CLASS interest list date, if the individual's name is not on the CLASS interest list but it was previously on the CLASS interest list; or
(B) using the date HHSC receives the request as the CLASS interest list date, if the individual's name is not on the CLASS interest list and it never has been on the CLASS interest list.
(2) At the request of the individual or LAR, HHSC changes the CLASS interest list date to the MDCP interest list date if the individual's MDCP interest list date is earlier than the individual's CLASS interest list date.
(g) HHSC removes an individual's name from the CLASS interest list if:
(1) the individual or LAR requests in writing that the individual's name be removed from the CLASS interest list, unless the individual is under 22 years of age and residing in a nursing facility;
(2) the individual moves out of Texas, unless the individual is a military family member living outside of Texas:
(A) while the military member is on active duty; or
(B) for less than one year after the former military member's active duty ends;
(3) the individual declines an offer of CLASS Program services or, as described in § 259.55(d) of this subchapter (relating to Written Offer of CLASS Program Services), HHSC withdraws an offer of enrollment in the CLASS Program, unless:
(A) the individual is a military family member living outside of Texas:
(i) while the military member is on active duty; or
(ii) for less than one year after the former military member's active duty ends; or
(B) the individual is under 22 years of age and residing in a nursing facility;
(4) the individual is a military family member living outside of Texas for more than one year after the former military member's active duty ends;
(5) the individual is deceased; or
(6) HHSC has denied the individual enrollment in the CLASS Program and the individual or LAR:
(A) has had an opportunity to exercise the individual's right to appeal the decision in accordance with § 259.101 of this chapter (relating to Individual's Right to a Fair Hearing), and:
(B) either:
(i) did not appeal the decision; or
(ii) appealed and did not prevail.
(h) If HHSC removes an individual's name from the CLASS interest list in accordance with subsection (g)(1) - (4) of this section, HHSC receives an oral or written request from a person to add the individual's name to the CLASS interest list within 90 calendar days after the name was removed, and the request is the individual's first request, HHSC:
(1) adds the individual's name to the CLASS interest list using the CLASS interest list date that was in effect at the time the individual's name was removed from the CLASS interest list; and
(2) notifies the individual or LAR in writing that the individual's name has been added to the CLASS interest list in accordance with paragraph (1) of this subsection.
(i) If HHSC removes an individual's name from the CLASS interest list in accordance with subsection (g)(1) - (4) of this section, HHSC receives an oral or written request from a person to add the individual's name to the CLASS interest list more than 90 calendar days after the name was removed, and the request is the individual's first request, HHSC:
(1) adds the individual's name to the CLASS interest list using as the CLASS interest list date:
(A) the date HHSC receives the oral or written request; or
(B) if HHSC determines extenuating circumstances exist, the CLASS interest list date that was in effect at the time the individual's name was removed from the CLASS interest list; and
(2) notifies the individual or LAR in writing that the individual's name has been added to the CLASS interest list in accordance with paragraph (1) of this subsection.
(j) If HHSC removes an individual's name from the CLASS interest list in accordance with subsection (g)(1) - (4) of this section, HHSC receives an oral or written request from a person to add the individual's name to the CLASS interest list, and the request is not the individual's first request:
(1) HHSC adds the individual's name to the CLASS interest list using the date HHSC receives the oral or written request as the CLASS interest list date; and
(2) HHSC notifies the individual or LAR in writing that the individual's name has been added to the CLASS interest list in accordance with paragraph (1) of this subsection.
(k) If HHSC removes an individual's name from the CLASS interest list in accordance with subsection (g)(6) of this section and HHSC subsequently receives an oral or written request from a person to add the individual's name to the CLASS interest list, HHSC:
(1) adds the individual's name to the CLASS interest list using the date HHSC receives the oral or written request as the CLASS interest list date; and
(2) notifies the individual or LAR in writing that the individual's name has been added to the CLASS interest list in accordance with paragraph (1) of this subsection.

26 Tex. Admin. Code § 259.53

Adopted by Texas Register, Volume 48, Number 04, January 27, 2023, TexReg 0375, eff. 1/30/2023