Revision 25-1; Effective Sept. 1, 2025

The DSA is responsible for verifying the person’s eligibility for the CLASS program by ensuring the following criteria are met:

• the person is determined by HHSC to meet the diagnostic and functional eligibility criteria for the CLASS program;
• the person has been diagnosed before 22 with a related condition. as described in the Texas Approved Diagnostic Codes for Persons with Related Conditions;
• the person has a qualifying adaptive behavior level (ABL) of II, III, or IV such as moderate to extreme deficits in adaptive behavior, obtained by administering a standardized assessment of adaptive behavior;
• the person demonstrates a need for CFC PAS/HAB;
• the person 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 person has an IPC cost for CLASS program services at or below $149,774;
• the person is not enrolled in another Medicaid waiver program; and
• the person resides in his own home or family home. Note: A person is not considered to reside in his own home or family home if he is admitted to one of the facilities outlined in 2430, Suspension, and 3430, Suspension, for more than 180 consecutive calendar days.

People who receive CLASS program and CFC services must maintain continuous eligibility as outlined above. The DSA must assess the person at the time of enrollment, at least annually, and as necessary when a person's situation changes that may result in the person no longer meeting all CLASS eligibility criteria.

The DSA must verify Medicaid eligibility each month by monitoring the Medicaid Eligibility Service Authorization Verification (MESAV) system. The DSA must verify the person is eligible in the month that is being checked. Documentation of this monthly verification of eligibility for Medicaid must be maintained by the DSA and available for review by HHSC staff. If a person is found to be ineligible for Medicaid, the DSA must notify the case manager no later than the next business day. The DSA must maintain verifiable evidence of notifying the case manager.

CLASS program and CFC services may be terminated if the person does not meet all eligibility criteria as outlined in Title 26 Subchapter D of the Texas Administrative Code (TAC). For more information regarding termination of services, refer to 3400, Denial, Reduction, Suspension and Termination.

Refer to Appendix V, ID/RC Processing, for additional information and detailed instructions for DSAs.