Revision 17-1; Effective November 1, 2017

 

1000 Introduction

 

The Community Living Assistance and Support Services (CLASS) program provides home and community-based services to people with related conditions as defined in Texas Administrative Code (TAC), Chapter 45, Subchapter A, §45.104. The CLASS program is funded by Title XIX Medicaid through a federal waiver that provides the opportunity for the Texas Health and Human Services Commission (HHSC) to offer specialized services that are not available under the regular Medicaid program. Individuals who receive CLASS program services may not also receive services from a program included in Appendix III, HHSC Operated Program CLASS Mutually Exclusive Services.

HHSC supports the expectation that every person has the opportunity to participate in their community, gain and maintain relationships of their choosing, express preferences, make choices, fulfill goals, and live with dignity and respect. The fundamental framework for delivering program services to individuals is based on tailoring program services to the individual's needs and circumstances. Services offered in the CLASS program supplement, but do not supplant, other Medicaid services, generic services, and other family and community supports to assist individuals successfully live and work in the community.

The goal of the CLASS program is to support individuals with related conditions to achieve their desired lifestyles and to be valued members of the community by:

  • addressing health and safety;
  • offering opportunities to better achieve their goals; and
  • making the most efficient use of all available resources to accomplish these goals.

CLASS program services must:

  • protect the individual's health and welfare in the community;
  • address the individual's related condition;
  • not be available to the individual through any other source, including Medicaid state plan, other governmental programs, private insurance or the individual's natural supports;
  • prevent the individual's admission to an institution;
  • be the most appropriate type and amount to meet the individual's needs; and
  • be cost effective.

HHSC obtains Medicaid provider agreements with qualified provider agencies to deliver CLASS program services. The case management agency (CMA) provides case management services and the direct services agency (DSA) provides all other CLASS services, except Support Family Services (SFS), Transition Assistance Services (TAS) and Consumer Directed Services (CDS) delivery options. All provider agencies must work cooperatively to ensure that the individual's needs are met.

Rules governing the CLASS program are in Title 40 of the Texas Administrative Code (TAC), Chapter 45.

 

1100 Complaints and Consumer Rights and Services (CRS)

Revision 17-1; Effective November 1, 2017

 

When to Call HHS CRS

CRS receives complaints from individuals, family members, providers and the public about the care, treatment or services provided to an individual. Individuals receiving services or family members of the individual may prefer to call CRS to assist in resolving an issue rather than speaking with their case manager or DSA representative.

A complaint may be reported by anyone at any time to CRS by calling 1-800-458-9858. A complaint may be made online at crscomplaints@dads.state.tx.us.

Information about CRS can also be located on the HHS website at https://hhs.texas.gov/about-hhs/your-rights/consumer-rights-services/how-do-i-make-a-complaint-about-hhs-service-provider . Click on the relevant topic to obtain the needed information.  You may also direct your web browser to https://hhs.texas.gov/about-hhs/your-rights/consumer-rights-services/how-do-i-make-a-complaint-about-hhs-service-provider/.

Written complaints may be mailed to:

Texas Department of Health and Human Services
Consumer Rights and Services, Mail Code E-249
P.O. Box 149030
Austin, TX 78714

CRS Website

The CRS website provides useful information regarding filing a complaint; locating consumer rights booklets; reporting abuse, neglect and exploitation; and locating community services. Visit the website at https://hhs.texas.gov/about-hhs/your-rights/consumer-rights-services.

Provider Agency Complaint Process

The CLASS provider agencies are required to have processes for receiving and resolving complaints about the provision of CLASS services. The process by which a complaint may be filed with a CLASS provider agency regarding CLASS program services must be provided to the individual/legally authorized representative (LAR) at the time of enrollment and at least annually thereafter.

 

1200 Interest List

Revision 17-1;  Effective November 1, 2017

 

HHSC manages the capacity of the program in accordance with available funding and within federally approved program limits by offering enrollment to individuals registered on the interest list. Individuals interested in receiving services in the CLASS program must register via the CLASS interest list. Individuals may register on the CLASS interest list regardless of whether they meet program eligibility requirements and must participate in financial and functional eligibility assessments as part of the enrollment process. Individuals registered on the CLASS interest list must ensure current address and contact information is on file with HHSC/DADS.

If an applicant is denied waiver enrollment based on diagnosis, level of care, or other functional eligibility requirements, HHSC will place the applicant’s name on all other waiver program’s interest list, using the applicant’s original request date for the CLASS interest list.

To contact the CLASS interest list call 877-438-5658.

 

1300 CLASS Program Eligibility

Revision 17-1; Effective November 1, 2017

 

HHSC approves eligibility for the CLASS program for applicants/individuals with related conditions who meet all of the following eligibility requirements.

  • The individual is financially eligible for Medicaid because the individual receives Supplemental Security Income (SSI) cash benefits or HHSC determines the individual  to be financially eligible for Medicaid.
  • HHSC determines the individual meets the diagnostic/functional eligibility criteria for the CLASS program — Intermediate Care Facility for Persons with Intellectual Disability (ICF/ID) Level of Care VIII criteria.
  • The individual has been diagnosed prior to age 22 with a related condition as described in the Texas Approved Diagnostic Codes for Persons with Related Conditions.
  • The individual has a qualifying adaptive behavior level of II, III or IV (i.e., moderate to extreme deficits in adaptive behavior) obtained by administering the Inventory for Client and Agency Planning (ICAP), Vineland Adaptive Behavior Scales, Second Edition (Vineland-II), Scales of Independent Behavior – Revised (SIB-R), or American Association of Intellectual and Developmental Disabilities (AAIDD) Adaptive Behavior Scales (ABS).
  • The individual exhibits a substantial functional limitation in at least three of the following areas of major life activities as documented on the Related Conditions Eligibility Screening Instrument:
    • learning;
    • mobility;
    • self-care;
    • language;
    • self-direction (age 10 and over); and
    • independent living (age 10 and over).
  • The individual demonstrates a need for Community First Choice (CFC) PAS/HAB.
  • The individual requires and receives at least one CLASS Program service per month, and one CLASS service per year (monthly monitoring of services by a case manager meets this requirement).
  • The individual has an Individual Plan of Care (IPC) cost for CLASS program services at or below $114,736.07.
  • The individual is not enrolled in another Medicaid waiver program.
  • The individual resides in his or her own home or family home.