Revision 10-1; Effective June 14, 2010

Adaptive Aids/Vehicle Modification Services

This is an all-inclusive list of adaptive aids and vehicle modification services. For specific procedures related to the procurement of adaptive aids and vehicle modifications, refer to Texas Administrative Code (TAC) Title 40, Part 1, Chapter 42.

For the items on this list, the Deaf Blind with Multiple Disabilities (DBMD) program provider must obtain written specifications for the adaptive aid or vehicle modification from the appropriate licensed professional as listed below:

• Audiologist
• Behavioral Support Specialist
• Dietician
• Registered Nurse
• Physician
• Orientation and Mobility Specialist
• Occupational Therapist
• Ophthalmologist
• Optometrist
• Physical Therapist
• Speech Therapist
• Dentist

The following adaptive aids/medical supplies may include repair and maintenance not covered by warranty:

1. Lifts
   1. wheelchair lifts
   2. porch or stair lifts
   3. stairway lifts (only in residences owned by the individual/family)
   4. bathtub seat lifts
   5. ceiling lifts which transport the individual around the home via tracks (only in-residences owned by the individual and/or family)
   6. other hydraulic, manual or electronic lifts
2. Mobility Aids (including batteries and chargers)
   1. manual/electric wheelchairs and necessary accessories
   2. adult strollers/travel chairs/three-wheel scooters
   3. mobility bases for customized chairs
   4. braces, crutches, walkers, canes (to include white canes) and necessary accessories
   5. materials to construct adaptive mobility aids for individuals with visual impairments (i.e., PVC pipes to construct an adapted cane or pre-cane device)
   6. color contrast or reflective tape (to mark paths, drop-offs, etc.)
   7. prescribed prosthetic devices
   8. orthopedic shoes and other prescribed footwear
   9. prescribed exercise equipment and therapy aids
   10. bus passes, metro transit services, and taxi services (for non-medical transportation only)
   11. portable ramps that do not require installation
   12. automatic door openers
   13. gait trainers
   14. global positioning systems (GPS) designed for individuals with visual impairments and appropriate accessories to allow an individual with visual impairments to independently travel within the community
   15. service animals and maintenance to include veterinary expenses
   16. tinted glasses, visors and sunshields to regulate glare for an individual with visual impairments
   17. flashlights
   18. magnifying devices
3. Position Devices
   1. standing frames/boards
   2. removable bathtub rails
   3. toilet chairs
   4. orthotic devices
   5. hospital beds and necessary accessories (must meet Medicaid standards/specifications)
   6. egg crate mattresses, sheepskin and other medically-related padding
   7. lift recliners
   8. trapeze bars
4. Communication Aids
   1. communicators
      1. direct selection communicators
      2. alphanumeric communicators
      3. scanning communicators
      4. adapted telephones for an individual with visual and/or hearing impairments (i.e., amplified telephones, phones with enlarged keypads, phones with braille displays, captioned telephones, speaker phones)
      5. telecommunications device for the deaf (TDD) or telephone typewriters/teletypewriter (TTY), to include TDD/TTY machines with braille displays
      6. large visual displays for TDD/TTY machines
      7. video relay phones/equipment for video relay service (the monthly service fee would not be included or covered)
      8. face-to-face communication devices
      9. telebraille and teletype machines
      10. materials to construct communication aids
      11. encoding communicators
      12. communication books, communication symbols, experience books and calendar systems (to include calendar boxes, shelves and charts)
   2. speech amplifiers and assistive listening devices
   3. interpreters
   4. hearing aids beyond the Medicaid limit
   5. hearing aid supplies beyond the Medicaid limit
   6. FM communication systems
5. Computers and Appropriate Accessories (for assistance with activities of daily living (ADL), communication and environmental control)
   1. computers and appropriate accessories
   2. appropriate software to address the needs listed above (limited to three per year)
   3. adapted workstations/chairs
   4. computer evaluations, specifications and training (may be completed by the prescribing professional)
   5. computer literacy training for educating an individual in the use of adaptive software necessary to perform ADL and avoid institutionalization (limited to 10 sessions per software unit)
   6. braille displays
   7. braille printers/embossers
   8. electronic braille notetakers
6. Environmental Controls
   1. electronic environmental control devices
   2. voice activated, light activated and motion activated devices (to include amplified features)
   3. control switches/pneumatic switches and devices
      1. sip and puff controls
      2. adaptive switches/devices
      3. sensory adaptations
7. Adaptive Equipment for ADL (based on the needs of the individual as authorized on the Individual Program Plan)
   1. assistive devices
      1. reachers
      2. stabilizing devices
      3. weighted equipment holders (i.e., book stands, page turners, cup holder)
      4. signature stamps or signature guides
      5. electric self-feeders
      6. microwave ovens (only for persons with muscular weakness or who lack manual dexterity and those persons who cannot use conventional ovens)
      7. food processors and blenders (for persons with muscular weakness in upper body who lack manual dexterity and are unable to use manual conventional kitchen appliances or for individuals with visual impairment that would be necessary for the individual's safety)
      8. variations of everyday equipment
         1. shaped, bent, built-up utensils
         2. long-handed equipment
         3. addition of friction coverings
         4. coated feeding equipment
         5. count-a-dose systems/manual medication reminder systems
         6. pill crushers/splitters
         7. specially adapted kitchen appliances
         8. toilet seat reducer rings
         9. food preparation utensils
         10. specially-adapted clocks/wristwatches for persons with visual or hearing impairment
         11. adapted scales
      9. prescribed therapy aids (to be utilized with therapist oversight)
      10. service animals and maintenance to include veterinary expenses
      11. quad gloves
      12. specialized lighting and flashlights
      13. braille displays, braille labelers, braille embossers and braille printers
      14. magnifying devices
      15. electric toothbrushes
      16. water pics
      17. specialized toothpastes (requiring a prescription)
      18. braille writers
   2. safety devices
      1. bed rails
      2. safety padding
      3. helmets
      4. walking belts/gait belts
      5. flutter boards
      6. personal floatation devices/lifejackets
      7. elbow and knee pads
      8. emergency response systems
      9. water walkers
      10. adapted fire extinguishers
      11. adapted smoke and carbon dioxide detectors
      12. visual alert systems
      13. vibrating alert systems
   3. shower chairs/transfer benches
   4. electric razors
   5. flexible, disposable drinking straws for persons with muscular weakness or who cannot drink from a regular drinking glass or cup
   6. hand-held shower attachments that are portable and do not require installation
8. Medically Necessary Supplies
   1. tracheostomy care
   2. decubitus care
   3. ostomy care
   4. respirator/ventilator care
   5. catheterization supplies
   6. diapers, linens and other incontinence supplies not covered by the Medicaid state plan
   7. prescribed nutritional supplements as approved by Medicaid
   8. enteral feeding formulas and supplies
   9. transcutaneous electrical nerve stimulation (TENS) units/supplies/repairs
   10. specialized thermometers
   11. diabetic supplies (beyond Medicaid limit)
   12. glucose monitors
   13. medical supply cabinets
   14. humidifiers
   15. suctioning devices
   16. prescription eyeglasses/accessories (beyond Medicaid limit)
   17. muscle stimulators
   18. medically necessary heating and cooling units prescribed by a physician for individuals with respiratory or cardiac problems or people who cannot regulate their body temperature
   19. urinary incontinent devices and supplies
   20. blood pressure monitors
   21. vitamins with a prescription
   22. gloves (beyond Medicaid limit)
   23. medication cups (beyond Medicaid limit)
9. Modification/Additions to Primary Transportation Vehicles
   1. van lifts
   2. driving controls
      1. brake/accelerator hand controls
      2. dimmer relays/switches
      3. horn buttons
      4. wrist supports
      5. hand extensions
      6. left-foot gas pedals
      7. right turn levers
      8. gear shift levers
      9. steering spinners
   3. medically necessary air conditioning units prescribed by a physician for individuals with respiratory or cardiac problems or people who cannot regulate their body temperature
   4. removal or placement of seats to accommodate a wheelchair
   5. installation, adjustment or placement of mirrors to overcome visual obstructions of wheelchair in vehicle
   6. raising of the roof of the vehicle to accommodate an individual riding in a wheelchair
   7. wheelchair tie-downs
   8. seat belt covers
   9. automatic door openers
10. Repair and Maintenance of Items (on the authorized list above as allowable by rule)
11. Temporary Lease/Rental of Medically Necessary Durable Medical Equipment (to allow for repair, purchase or replacement of essential support system or while non-waiver resources review the medical necessity). Lease/rental shall not exceed 90 days.

Revision 22-2; Effective Sept. 1, 2022

Minor Home Modification Services

This is an all-inclusive list of minor home modifications. For specific procedures about the procurement of minor home modifications, refer to Texas Administrative Code (TAC) Title 40, Part 1, Chapter 42.

For the items on this list, the Deaf Blind with Multiple Disabilities (DBMD) program provider must obtain written specifications and a recommendation from the appropriate licensed professional as listed below:

• Audiologist
• Behavioral Support Specialist
• Dietician
• Registered Nurse
• Physician
• Orientation and Mobility Specialist
• Occupational Therapist
• Ophthalmologist
• Optometrist
• Physical Therapist
• Speech Therapist

Home modifications, such as the following, include the installation, maintenance and repair of approved items not covered by warranty:

• Home Modifications
  • floor leveling, only in residences owned by the individual, family, or both and only when the installation of a ramp is not possible
  • vinyl flooring or industrial grade carpet necessary to ensure the safety of the individual, prevent falling, improve mobility and adapt a living space occupied by a beneficiary who is unable to safely use existing floor surface
  • medically necessary steam cleaning of walls, carpet, support equipment and upholstery
  • roll-in showers
  • sink modifications
  • sink cut-outs
  • bathtub modifications
  • water faucet controls
  • toilet modifications
  • floor urinal and bidet adaptations
  • plumbing modifications
  • turnaround space modifications
  • work table or work surface adjustments
  • cabinet development or adjustments
• Specialized Accessibility, Safety Adaptations and Additions (including repair and maintenance)
  • ramps (constructed to provide access into and within the home)
  • protective awnings over ramps
  • door widening
  • widening or enlargement of garage, carport or both, to accommodate primary transportation vehicle and to allow people using wheelchairs to enter and exit their adapted vehicles safely
  • installation of sidewalk for access from non-connected garage, driveway or both to residence when existing surface condition is a safety hazard for the person with a disability
  • porch or patio leveling, only when the installation of a ramp is not possible
  • grab bars and handrails
  • door bells, door scopes and adaptive wall switches
  • safety glass, safety alarms, (does not include home security systems) security door locks, fire safety approved window locks, security window screens, visual alert systems
  • security fencing for residence or play area for those people with cognitive impairment or people whose safety would be compromised if they wandered
  • medically necessary air filtering devices
  • protective padding and corner guards for walls
  • recessed lighting with mesh covering and metal dome light covers
  • emergency generators (limited to critical medical equipment)
  • medically necessary noise abatement renovations to provide increased sound proofing for persons with sensory impairments
  • lever door handles
  • door replacement only when required for accessibility
  • intercom systems for persons with limited mobility or visual impairment
  • motion sensory lighting
• Repair and Maintenance of Items (on the authorized list above as allowable by rule)

Revision 10-1; Effective June 14, 2010

Consumer Rights Booklet

This publication explains consumer rights and responsibilities for
the following Department of Aging and Disability Services programs:

• Community Attendant Services
• Community Based Alternatives
• Community Living Assistance and Support Services
• Consolidated Waiver Program
• Consumer Managed Personal Assistant Services
• Day Activity and Health Services
• Deaf Blind with Multiple Disabilities Program
• Family Care
• Hospice Services
• Integrated Care Management
• Medically Dependent Children Program
• Primary Home Care
• Program of All-Inclusive Care for the Elderly
• Special Services to Persons with Disabilities

Your Rights Community Handbook (PDF)

Revision 10-1; Effective June 14, 2010

Texas Administrative Code (TAC)

40 TAC Chapter 41, Consumer Directed Services Option

40 TAC Chapter 42, Deaf Blind with Multiple Disabilities (DBMD) Program

40 TAC Chapter 49, Contracting for Community Care Services

40 TAC Chapter 62, Contracting to Provide Transition Assistance Services

40 TAC Chapter 92, Licensing Standards for Assisted Living Facilities

40 TAC Chapter 97, Licensing Standards for Home and Community Support Services Agencies

Statutes

Health and Safety Code Chapter 250, Nurse Aide Registry and Criminal History Checks of Employees and Applicants for Employment in Certain Facilities Serving the Elderly or Persons with Disabilities

Human Resources Code, Sec. 22.036, Programs for Deaf Blind Multi-handicapped Individuals and Their Parents

Other

Your Texas Benefits — Provides information related to Medicaid benefits and local Medicaid eligibility offices.

Revision 10-1; Effective June 14, 2010

Rate Analysis Department DBMD Webpage — Includes information on DBMD rates, Accountability Reports, etc.

Texas Administrative Code (TAC) Related to DBMD program rates:

General Cost Reporting Process — Includes general information on the calculation of rates in the DBMD program, including costs that may or may not be reported on the Rate Enhancement Accountability Reports, etc.

Reimbursement Methodology for DBMD — Specific information regarding the calculation of rates for the DBMD program.

Reimbursement Methodology for Professional Services — Specific information regarding the calculation of rates for Professional Services (nursing, therapies, audiology, dietary and behavioral support) in all waiver programs.

Reimbursement Methodology for Transition Assistance Services — Specific information regarding the calculation of rates for Transition Assistance Services in all waiver programs.

Revision 19-4; Effective October 18, 2019

Resources for Individuals with Deafblindness

The Texas Deafblind Project is funded by a federal grant to provide information and training about deafblindness to families and the professionals who work with them. The Deafblind Outreach team provides technical assistance to families and schools involved with children with both a vision and hearing impairment. The Deafblind Outreach team also provides training directly to DBMD provider agencies. Additional information about the program can be found on the Texas Deafblind project website.

HHS Blind and Visually Impaired Services works with people of all ages who are blind and visually impaired to help them reach their independence goals.

The Texas Workforce Commission Vocational Rehabilitation program helps people with disabilities prepare for, find or retain employment and helps youths and students prepare for post-secondary opportunities. The program also helps businesses and employers recruit, retain and accommodate employees with disabilities.

Helen Keller National Center (HKNC) offers a comprehensive rehabilitation program at its New York Center. Regional HKNC representatives can refer individuals to the national HKNC. They can also provide consultation and training to provider agencies. To contact the regional representative who serves the Texas area, call 972-490-9677.

The Deaf-Blind Multihandicapped Association of Texas (DBMAT) is an organization formed by parents and professionals to improve the quality of life for all Texans who are deafblind with multiple disabilities. Parents from around the state can find peer support, encouragement and advice. The DBMD case manager can refer parents to the organization by emailing president@dbmat-tx.org or calling 713-231-7508.

The National Consortium on Deaf-Blindness DB-LINK has services including an extensive library of webinars, materials and access to information specialists who are available to help answer questions.

National Center of Deaf-Blindness Open Hands, Open Access (OHOA) Deaf-Blind Intervener Learning Modules are a national resource designed to increase awareness, knowledge and skills related to intervention for students (ages 3 through 21) who are deaf-blind and being served in educational settings. En Español

Specialized Telecommunications Assistance Program (STAP) helps people who have a disability that interferes with their access to telephone networks purchase basic specialized assistive equipment or services.

STAP typically covers the cost of most phones included in our voucher categories.

Revision 14-1; Effective September 22, 2014

Outdoor Camping Experience

The Texas Department of Aging and Disability Services (DADS) is mandated by the Human Resource Code, Chapter 22, Section 22.036 (c), to fund outdoor camping for individuals who are deafblind. These individuals would otherwise be unable to participate in summer camps. DADS procures a vendor through an invitation to bid process. The vendor enters into a contract for one year with three additional one-year terms. The vendor agrees to provide:

• a five-day summer camp for up to 80 people who are deafblind with multiple disabilities;
• eligibility determination of campers;
• two licensed registered nurses;
• a 1:2 staff-individual ratio;
• arrangements and payment for transportation;
• room and board;
• two qualified deafblind specialist providers who are present for consultation and training with service providers; and
• camping activities, including at a minimum:
  • swimming,
  • water sports,
  • horseback riding,
  • arts and crafts, and
  • nature studies.

Annual Family Training and Conference

DADS is mandated in the Human Resource Code, Chapter 22, Section 22.036 (b), to fund training for families of individuals who are deafblind with multiple disabilities. This training encourages parents to network with each other. It also presents educational subjects relating to deafblindness. Deafblind individuals are given an opportunity for socialization outside of educational and adaptive behavior training. This training is coordinated with the Deaf Blind Multi-handicapped Association of Texas. It is also coordinated with the Helen Keller National Center, Texas School for the Blind, Texas Deaf Blind Project and the Department of Assistive and Rehabilitative Services. DADS procures a vendor through an invitation for bid process. The vendor enters into a contract for one year with three additional one-year terms. The vendor agrees to provide:

• facilities for a three-day conference, including:
  • air conditioned cabins (or hotel rooms) to accommodate at least 230 participants and staff;
  • a camp accessible to individuals who are deafblind and to people who have severe disabilities;
  • a dining room that can accommodate at least 230 participants and staff;
  • a meeting room that can comfortably accommodate at least 125 people for two days of training sessions; and
  • an infirmary with an exam area and sick bay.
• the following activities at a level appropriate for individuals who are deafblind with multiple disabilities, and their siblings:
  • an accessible swimming pool and/or challenge course, as needed;
  • arts and crafts;
  • nature education; and
  • sports and games; and
• staff, to include:
  • an on-site camp director;
  • a licensed registered nurse;
  • a child care coordinator;
  • lifeguards;
  • direct care staff (1:2 ratio); and
  • interpreters (Spanish and Sign Language).

Revision 13-1; Effective November 1, 2013

See Appendix V, Mutually Exclusive Services.

Revision 22-3; Effective Oct. 1, 2022

List of ICD-10 Approved Diagnostic Codes for Persons with Related Conditions (use for assessments with effective dates on or after Oct. 1, 2022):

• ICD10-codes (PDF)

Revision 10-1; Effective June 14, 2010

Deaf Blind with Multiple Disabilities Program Brochure

Revision 22-1; Effective February 7, 2022

11100 Billing DBMD and CFC Services

Revision 20-2; Effective October 9, 2020

The following Deaf Blind with Multiple Disabilities (DBMD) and Community First Choice (CFC) services are available to an individual enrolled in the DBMD program:

• Adaptive Aids
• Audiology
• Behavioral Support
• Case Management
• Chore Services
• CFC Emergency Response Services (ERS)
• CFC Personal Assistance Services/Habilitation (PAS/HAB)
• Day Habilitation
• Dental Treatment
  • Services
  • Sedation
• Dietary Services
• Employment Assistance
• Intervener Services
  • Intervener    
  • Intervener I
  • Intervener II
  • Intervener III
• Minor Home Modifications
• Nursing Services
  • Licensed Vocational Nurse
  • Specialized Nursing (LVN)
  • Registered Nurse
  • Specialized Nursing (RN)
• Occupational Therapy
• Orientation and Mobility
• Physical Therapy
• Residential Services
  • Licensed Assisted Living Services
  • Licensed Home Health Assisted Living
• Respite:
  • In-Home
  • Out-of-Home
• Speech, Hearing and Language Therapy
• Supported Employment
• Transition Assistance Services
• Transportation-Residential Habilitation
• Services for individuals who choose the Consumer Directed Services (CDS) option:
  • Financial Management Services or CFC Financial Management Services
  • Support Consultation or CFC Support Consultation

A DBMD program provider must bill for a DBMD service or CFC service in accordance with 40 Texas Administrative Code (TAC) Chapter 42. Some services are defined in 40 TAC §42.103, Definitions. DBMD services are also described in Appendix C of the DBMD Waiver Application.

A DBMD service or CFC service provided to an individual must be recorded as a distinct event by each service provider. A service provider must document services provided, except for adaptive aids, dental treatment, minor home modifications, CFC ERS and CFC Support Management on Form 6503, DBMD Summary of Services Delivered, or via the Electronic Visit Verification (EVV) System.

A service provider must complete Form 6503 according to the form’s instructions.  

A program provider must ensure that after a service provider makes the last entry on Form 6503, a staff person other than the service provider signs and dates the form as a timekeeper as verification of accuracy of the information on the form.

For DBMD services requiring EVV, providers must follow EVV billing requirements for relevant claims. Providers may refer to HHSC’s EVV website for more information.

Current rates for DBMD services may be found at: https://pfd.hhs.texas.gov/long-term-services-supports/deaf-blind-multiple-disabilities-waiver-dbmd.

11200 Billable Units

Revision 20-2; Effective October 9, 2020

A program provider or financial management services agency (FMSA) bills for a DBMD or CFC service using billable units that are based on the time spent providing the service or the cost incurred for the service.

11210 Services Unit Measurements

Revision 20-2; Effective October 9, 2020

The following chart shows which DBMD and CFC services use a billable unit based on time.

The following services are billed using the cost of the service, along with any allowable requisition fees:

• Adaptive Aids
• Minor Home Modifications
• Dental Treatment
• Transition Assistance Services

11300 Determining Billable Units for an Hourly Service

Revision 20-2; Effective October 9, 2020

For a service that has a billable unit of one hour, a program provider must determine the billable units using the amount of time that a service provider spent providing the service in accordance with the table below.

11310 Determining Billable Units for Multiple Service Events

Revision 20-2; Effective October 9, 2020

For a service with a billable unit of one hour, if there is more than one service event of the same service in a calendar month, a program provider must determine total billable units for the month by determining the billable units for each service event and adding the billable units together.

Example:

11320 Determining Billable Units for More than One Service Provider or More than One Individual

Revision 20-2; Effective October 9, 2020

If a service with a billable unit of one hour is provided during the same time period by more than one service provider to more than one individual, or both, a program provider must use the following formula to calculate the billable units by multiplying the number of service providers by the time spent providing the service, and dividing the result by the number of individuals being provided the service.

11400 Determining Billable Units for Respite

Revision 20-2; Effective October 9, 2020

The billable unit of service for respite is defined as a 24-hour period. A program provider must determine billable units of respite in accordance with the table below, using the amount of time that an individual received respite.

Examples:

One individual in a respite setting for 24 hours = 1 billable unit
Two individuals in a respite setting for 24 hours = 1 billable unit per individual
Three individuals in a respite setting for 24 hours = 1 billable unit per individual

11410 Billing Units of Respite Service

Revision 20-2; Effective October 9, 2020

Partial units of respite are calculated as follows:

A program provider determines billable units of respite separately for each individual. The number of billable units of respite are not affected by the number of other individuals or service providers in a respite setting at the same time.

Examples:

Respite provided to one individual for 24 hours by one service provider = 1 billable unit
Respite provided to two individuals for 12 hours by one service provider = 0.5 billable unit per individual
Respite provide to three individuals for 24 hours by two service providers = 1 billable unit per individual

Revision 24-1; Effective March 14, 2024

A program provider must comply with 1 TAC Chapter 354, Subchapter O, Electronic Visit Verification, for any of the following services. The service must be provided in the person’s home to the person who has a residential type of own or family home: 

• Community First Choice Personal Assistance/Habilitation (CFC PAS/HAB)
• in-home respite;
• licensed vocational nursing;
• occupational therapy;
• physical therapy;
• registered nursing;
• specialized licensed vocational; and
• specialized registered nursing.

ES = form also available in Spanish.

For questions about the Deaf Blind with Multiple Disabilities Program Manual, email: dbmdpolicy@hhsc.state.tx.us

For technical or accessibility issues with this handbook, email: form.handbook.request@hhs.texas.gov