[dbmat] Re: My answer to Heather's Question about therapies in DB-MD waiver

  • From: Heather Withrow <skyhex@xxxxxxx>
  • To: dbmat@xxxxxxxxxxxxx
  • Date: Tue, 30 Dec 2014 17:47:48 -0600


(My original question was about hippotherapy, aquatic therapy, music therapy 
not being provided until 18 years but it turns out it’s not even provided under 
DBMD but under CLASS.  That’s fine with me.  We have other ways.)

I reviewed the link Steve sent us that led to Dental Treatment under Division 
3- Requirement for Other DBMD Program Services-  Rule 42.624 Dental Treatment 
where it spells out the plan and, good news, yes, they do cover individuals 
under 21 years of age if the specific steps are followed.  Check it out.  

Also I see that, of course, if it’s in the child’s plan, program providers may 
provide OT, PT, Speech Language and Audiogoligy therapy plus dietary services. 
So yeah, these therapies may be provided at any age since there isn’t any 
mention of age under Division 3, rule 42.632 “Therapies”.  

I’m still learning, so thank you guys for your input.  Glad to help clear 
things up, too.  The link to Division 3 is below:

>>> http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=5&ti=40&pt=1&ch=42&sch=F

Orion’s Mom

On Dec 30, 2014, at 8:26 AM, Heidi May (Redacted sender "hbarr1970@xxxxxxxxx" 
for DMARC) <dmarc-noreply@xxxxxxxxxxxxx> wrote:

> I didn't originally see Heather's question but let me expand on Steve's 
> answer by saying the DBMD waiver does not cover therapies or dental for 
> minors either. This is because it is already covered by Medicaid and, even if 
> you don't like the Medicaid provider, the waiver won't pay for anything if 
> there is a non-waiver resource available. There's my 2 cents. Have a great 
> day! 
> Heidi. 
> Sent from my iPhone
> On Dec 29, 2014, at 11:21 PM, Heather Withrow <skyhex@xxxxxxx> wrote:
>> Thank you so much for clarifying this for me, Steve!  The link helped. Much 
>> appreciated!
>> We have private health insurance (although it is crummy) for the basic OT/PT 
>> therapies but like Lauren’s mom said earlier- go for the DBMD waiver for the 
>> interveners.  I can’t imagine anyone NOT going for the intervener 
>> enlightenment!  The DBMD waiver is the first of any waiver that even 
>> contacted us about the opening, it’s a no-brainer.  It’s a question of which 
>> agency I pick to work through.  I appreciate all the other assistance we can 
>> get.  I’m seeing the light at last!
>> Many, many thanks for the input.  I’m listening. 
>> Heather,
>> Orion’s mom
>> On Dec 29, 2014, at 10:08 PM, Stephen Schoen <stephenschoen351@xxxxxxxxx> 
>> wrote:
>>> I'm taking the liberty of answering Heather's question.   I'm not sure what 
>>> the case manager for the DB-MD provider is referring to by "recreational 
>>> therapy."  There is no such service for people of any age in the DB-MD 
>>> waiver.   The one service which adults can get and children can't in the 
>>> DB-MD waiver is Assisted Living.   Assisted living means living in a 
>>> residence other than your families (such as a small 6 or fewer bed group 
>>> home.)  
>>> The DB-MD waiver does not (and never has)  provide hippo therapy, aqua 
>>> therapy, and music therapy for people of any age. The only Medicaid Waiver 
>>> which provides those services is the CLASS waiver.   Here is a link to 
>>> description of the DB-MD Waiver services directly from the current Texas 
>>> Administrative Code.  It is worth the time to read all of these services, 
>>> and ask questions about any which are not clear.  (Division 3 has the 
>>> majority of services and definitions.)
>>> http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=5&ti=40&pt=1&ch=42&sch=F
>>> Steve Schoen

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