Deaf Blind with Multiple Disabilities (DBMD) Program Manual

DBMD, Section 1000, Adaptive Aids/Vehicle Modification Services

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:

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.

DBMD, Section 2000, Minor Home Modification Services

Revision 10-1; Effective June 14, 2010
 

 

Minor Home Modification Services

This is an all-inclusive list of minor home modifications. For
specific procedures related to 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:

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

  1. Home Modifications
    1. floor leveling, only in residences owned by the individual and/or
      family and only when the installation of a ramp is not possible
    2. 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
    3. medically necessary steam cleaning of walls, carpet, support equipment and upholstery
    4. roll-in showers
    5. sink modifications
    6. sink cut-outs
    7. bathtub modifications
    8. water faucet controls
    9. toilet modifications
    10. floor urinal and bidet adaptations
    11. plumbing modifications
    12. turnaround space modifications
    13. work table/work surface adjustments
    14. cabinet development/adjustments
  2. Specialized Accessibility/Safety Adaptations/Additions (including repair and maintenance)
    1. ramps (constructed to provide access into and within the home)
    2. protective awnings over ramps
    3. door widening
    4. widening/enlargement of garage and/or carport to accommodate primary
      transportation vehicle and to allow persons using wheelchairs to enter
      and exit their adapted vehicles safely
    5. installation of sidewalk for access from non-connected garage and/or
      driveway to residence when existing surface condition is a safety
      hazard for the person with a disability
    6. porch/patio leveling, only when the installation of a ramp is not possible
    7. grab bars and handrails
    8. door bells, door scopes and adaptive wall switches
    9. safety glass, safety alarms, (does not include home security
      systems) security door locks, fire safety approved window locks,
      security window screens, visual alert systems
    10. security fencing for residence or play area for those persons with
      cognitive impairment or persons whose safety would be compromised if
      they wandered
    11. medically necessary air filtering devices
    12. protective padding and corner guards for walls
    13. recessed lighting with mesh covering and metal dome light covers
    14. emergency gas-powered generators (limited to critical medical equipment)
    15. medically necessary noise abatement renovations to provide increased sound proofing for persons with sensory impairments
    16. lever door handles
    17. door replacement only when required for accessibility
    18. intercom systems for persons with limited mobility or visual impairment
    19. motion sensory lighting
  3. Repair and Maintenance of Items (on the authorized list above as allowable by rule)

DBMD, Section 3000, Consumer Rights Booklet

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:

www.dads.state.tx.us/news_info/publications/brochures/DADS273YourRightsCommunity.pdf

DBMD, Section 4000, DBMD Texas Administrative Code and Statutes Links

Revision 10-1; Effective June 14, 2010

 

 

DBMD Texas Administrative Code and Statutes Links

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.

DBMD, Section 5000, Reimbursement Rate Links

Revision 10-1; Effective June 14, 2010

Reimbursement Rate Links

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.

DBMD, Section 6000, Resources Links

Revision 10-1; Effective June 14, 2010

 

 

Resources Links

 

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.

Division for Blind Services (DBS) is a division of the Department of Assistive and Rehabilitative Services (DARS). DBS staff work in partnership with Texans who are blind or visually impaired (including people who are deafblind) to get high quality jobs, live independently or help a child receive the training needed to be successful in school and beyond. Information about the program can be found on the DARS website, including a list of local DBS offices under the heading "DBS Offices in Your Area." Deafblind specialists work in partnership with DBS counselors and caseworkers to serve consumers who are deafblind. For more information, call 512-377-0566.

Helen Keller National Center (HKNC) offers a model 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 calling the president at 432-263-1658 or by referring them to the DBMAT website and clicking on the membership tab.

The National Consortium on Deaf-Blindness DB-LINK has services including an extensive library of materials and access to information specialists who are available to help answer questions. Call 1-800-438-9376 for copies of materials on the website or information specific to working with a deafblind individual.

Specialized Telecommunications Assistance Program (STAP) is a voucher program that provides financial assistance for the purchase of specialized assistive equipment or services for individuals whose disability interferes with the ability to access the telephone network.

DBMD, Section 7000, Non-Medicaid Deafblind Services

Revision 14-1; Effective September 22, 2014

 

Non-Medicaid Deafblind Services

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:

 

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:

DBMD, Section 8000, DADS Operated Program DBMD Mutually Exclusive List

Revision 13-1; Effective November 1, 2013

 

DADS Operated Program DBMD Mutually Exclusive List

See Appendix V, Mutually Exclusive Services.

DBMD, Section 9000, Approved Diagnostic Codes for Persons with Related Conditions

Revision 18-1; Effective February 14, 2018
 

 

List of ICD-10 Approved Diagnostic Codes for Persons with Related Conditions (use for assessments with effective dates on or after Oct. 1,2017):

https://hhs.texas.gov/sites/default/files//documents/doing-business-with-hhs/providers/health/icd10-codes.pdf

DBMD, Section 10000, Miscellaneous

Revision 10-1; Effective June 14, 2010
 

 

Miscellaneous

Deaf Blind with Multiple Disabilities Program Brochure

 

Appendices

DBMD, Appendix I, DADS Contract Management

DBMD, Appendix II, HIV/AIDS in the Workplace

DBMD, Appendix III, Medicaid for the Elderly and People with Disabilities

DBMD, Appendix IV, List of Excluded Individuals and Entities (LEIE)

DBMD, Appendix V, Mutually Exclusive Services

DBMD, Appendix VI, Advance Directives

DBMD, Appendix VII, Retired Information Letters

Revision 15-1; Effective December 17, 2015

 

The Department of Aging and Disability Services (DADS) will from time to time retire Information Letters (ILs) when policy has expired, retired or been replaced with new information.

Content in this manual and the Texas Administrative Code (TAC) supersedes any previous ILs or similar guidance published by DADS. The ILs retired as a result are listed below. DADS recommends that providers remove these ILs from their records to ensure they reference the most current information. Any letters or program guidance issued prior to Internet accessibility is null and void, including policy previously sent by U.S. mail.

Number Title Date Posted Date Removed
09-162 Personal Care Services and DBMD Residential Habilitation 12/11/2009 11/03/2015
09-153 Personal Care Services (PCS) and Waiver Services Replaced by IL 2015-71 10/30/2009 11/03/2015

DBMD, Appendix VIII, Case Manager's Review Schedule

Revision 16-3; Effective June 24, 2016


 

Individual Plan of Care (IPC)Renewal Date First Case Manager Review Due Date Second Case Manager Review Due Date Third Case Manager Review  Due Date Earliest Renewal Meeting Date Latest Date to Submit IPC to DADS
Jan 1 Mar 31 June 30 Sept 30 Oct 3 Dec 2
Feb 1 April 30 July 31 Oct 31 Nov 3 Jan 2
Mar 1 May 31 Aug 31 Nov 30 Dec 1 Jan 30
April 1 June 30 Sept 30 Dec 31 Jan 1 Mar 2
May 1 July 31 Oct 31 Jan 31 Jan 31 April 1
June 1 Aug 31 Nov 30 Feb 28 Mar 3 May 2
July 1 Sept 30 Dec 31 Mar 31 April 2 June 1
Aug 1 Oct 31 Jan 31 April 30 May 3 July 2
Sept 1 Nov 30 Feb 28 May 31 June 3 Aug 2
Oct 1 Dec 31 Mar 31 June 30 July 3 Sept 1
Nov 1 Jan 31 April 30 July 31 Aug 3 Oct 2
Dec 1 Feb 28 May 31 Aug 31 Sept 2 Nov 1

Note: The fourth case manager’s review of the IPC year is combined with the meeting of the Service Planning Team to develop a renewal IPC.

DBMD, Forms

Form Title
1581 Informacion en espanol Consumer Directed Services Option Overview
1582 Informacion en espanol Consumer Directed Services Responsibilities
1583 Informacion en espanol Employee Qualification Requirements
1584 Informacion en espanol Consumer Participation Choice
1586 Informacion en espanol Acknowledgement of Information Regarding Support Consultation Services in the Consumer Directed Services (CDS) Option
1740 Informacion en espanol Service Backup Plan
2067 Case Information
2124 Community Support Transportation Log
3594 Individual Plan of Care (IPC) Cover Sheet
3596 PAS/Habilitation Plan - CLASS/DBMD/CFC
3598 Individual Transportation Plan
3627 Specialized Nursing Certification
3628 Provider Agency Model Service Backup Plan
4800-D Fair Hearing Request Summary
4800-DA 4800-D Addendum
6500 Individual Plan of Care (IPC) - DBMD/CFC
6500-T IPC Service Delivery Transfer Worksheet
6501 Individual Program Plan
6502 Denial of Application for DBMD
6503 DBMD Summary of Services Delivered
6504 Prior Authorization for Dental Services
6505 Daily Census Documentation
6507 Rationale for Adaptive Aids, Medical Supplies, and Minor Home Modifications
6508 Specifications for Minor Home Modifications
6509 CLASS/DBMD Coordination of Care
6510 Decline of Offer for Deaf Blind with Multiple Disabilities (DBMD) Program Enrollment
6515 CLASS/DBMD Nursing Assessment
8001 Informacion en espanol Medicaid Estate Recovery Program Receipt Acknowledgement
8493 Notification Regarding a Death in HCS, TxHmL and DBMD Programs
8507 Understanding Program Eligibility - CLASS/DBMD
8578 Intellectual Disability/Related Condition Assessment
8598 Non-Waiver Services
8601 Informacion en espanol Verification of Freedom of Choice
8604 Transition Assistance Services (TAS) Assessment and Authorization
8605 Documentation of Completion of Purchase
8662 Related Conditions Eligibility Screening Instrument
H1010 Informacion en espanol Texas Works Application for Assistance - Your Texas Benefits (English and Spanish)
H1200 Application for Assistance - Your Texas Benefits
H1200-EZ Application for Assistance - Aged and Disabled (Large Print)
H1746-A MEPD Referral Cover Sheet
H1746-B Batch Cover Sheet
H3034 Informacion en espanol Disability Determination Socio-Economic Report
H3035 Informacion en espanol Medical Information Release/Disability Determination

Informacion in espanol = form also available in Spanish.

DBMD, Revisions

DBMD, 18-1, February 14, 2018, Section 9000 Revised

Revision Notice 18-1; Effective February 14, 2018

 

The following changes were made:

Revises Section 9000, Approved Diagnostic Codes for Persons with Related Conditions, with an updated website link to the List of ICD-10 Approved Diagnostic Codes.

DBMD, 16-3, June 24, 2016, Appendix Revised

Revision Notice 16-3; Effective June 24, 2016

 

The following changes were made:

Revises Appendix VIII, Case Manager's Review Schedule.

DBMD, 16-2, May 23, 2016, Appendix Added

Revision Notice 16-2; Effective May 23, 2016
 

 

The following changes were made:

Adds Appendix VIII, Case Manager’s Review Schedule.

DBMD, 16-1, March 14, 2016, Approved Diagnostic Codes

Revision Notice 16-1; Effective March 14, 2016
 

 

The following changes were made:

Revises Section 9000, Approved Diagnostic Codes for Persons with Related Conditions.

DBMD, Info Letters

Letters to DADS Services Providers

DBMD, Contact Us

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: handbookfeedback@hhsc.state.tx.us