8.6 Consumer “Client” Participation

To determine whether a consumer must participate in the cost of services and if the consumer has the financial ability to do so, use the following four-step procedure:

Step 1 - Determine the Requirement to Participate

When determining whether the consumer is required to participate in the cost of services:

  • consider the monthly net income and liquid assets of:
    • the consumer and the consumer's spouse; and
    • the consumer’s parents (or foster parents, legal guardian, or conservator), if the consumer's parents claims the consumer as a dependent for purposes of federal income taxes; and
  • compare the consumer's (combined with the parents’, if appropriate) monthly net income and liquid assets with the basic living requirement (BLR) levels. See Chapter 5: Application, 5.7 Basic Living Requirements for more information. 

Step 2 - If Consumer Refuses to Disclose Income

Consumers have the right not to disclose their financial information. However, when a consumer declines to provide this information, you must assume that the consumer has resources that exceed the BLR level after including any allowable BLR additions. In such a case, the consumer must fully participate in the cost of planned services, except for the costs listed in 8.7 Services Exempt from Consumer Cost Participation.

Step 3 - Get Proof of Income and Expenses

When a person applies for services, request documented proof of:

  • income (exclude any payment in-kind, such as food stamps or housing subsidies);
  • liquid assets (cash, plus assets that are easily converted to cash);
  • expenses; and/or
  • any allowable additions to the BLR.

See 5.6 Types of Income, Liquid Assets, and Required Proof.

A person eligible for Social Security disability benefits (Supplemental Security Income or Social Security Disability Income) must provide only proof of Social Security eligibility.

When a parent claims the consumer as a dependent on the parent's income tax, get proof of income and expenses from both the consumer and the consumer's parent.

Step 4 - Calculate the Consumer's Contribution

The amount that the consumer pays for goods and/or services is the amount that the consumer's liquid assets exceed the BLR level, after including any allowable BLR additions. The consumer pays the amount monthly.

The consumer must contribute the difference between the consumer's monthly net income and the BLR level after including any allowable BLR additions. The consumer's contribution must not exceed the cost of the goods and services.

Inform the consumer that failure to provide complete and accurate financial information violate federal and Texas law and results in a denial or delay of services.

If you determine that the consumer must participate in the cost of goods and/or services, then:

  1. inform the consumer that he or she must pay the service provider directly; and
  2. document in ReHabWorks that the consumer understands.

8.6.1 Documenting Consumer Participation

In the CRS program, consumer participation is reported as a service record with payment method type 'Arranged.' For instructions, see ReHabWorks Users Guide, Chapter 16 Case Service Record, 16.2.8.11 Creating, Updating, and Canceling Line Items When Payment Method Is "Arranged".

Be sure to:

  • select an appropriate Level 1-4 description, according to the documented service in the Individualized Written Rehabilitation Plan;
  • enter only "FCS 2017" in the Specification Description text box;
  • use only English (no other language) in the Specification Description text box;
  • select "Arranged" as the payment method; and
  • enter the date range for services for the entire quarter or remainder of a quarter—not for more than one quarter and not for crossing quarters.

This is the only circumstance in which service records are identified as "Arranged' in the CRS program.

8.6.2 Document Consumer Participation in a Service Record

Table: How to Build a Service Record to Document Consumer Participation.

Step

Process

Notes

1

Select Specification for Service Record

Open ReHabWorks.

Select "Case Management" from the top left corner of the menu.

Enter the case ID and select "search."

Select name of the consumer, which is hyperlinked.

Select "Case Service Records" from menu on the left side of the page.

Select "Service Record List."

Select "New" button.

Search by "Level 1-4 Description":

  • From the Level 1 Description, select the appropriate service.
  • From the Level 2 description, select the appropriate description based on the description selected in the previous step.
  • From the Level 3 description, select the appropriate description based on the description selected in the previous step.
  • From the Level 4 description, select the appropriate description based on the description selected in the previous step.

Select Search.

NOTE: Please select appropriate the Level 1–4 description according to the service documented in the consumer’s IWRP.

2

Select the appropriate service entered

Select the check box next to the service.

Select the "OK" button.

3

Enter the state fiscal year in the "Specification Description" text box

Enter only the following: "FCS 2017."

NOTE: Use English only, in the Specification Description text box. Do not enter any other language.

4

Enter the payment method

Select "Arranged."

NOTE: This is the only circumstance in which service records are identified as "Arranged' in the CRS program.

5

Search for a vendor

Select the search method.

Enter the information needed to search for a vendor.

NOTE: If you search by a vendor’s name, put an asterisk (*) at the end of the name.

6

Select a vendor

Select the desired vendor by clicking selecting the button to the left of the vendor’s name.

Select "OK."

7

Add a line item for service

Select "New Line Item."

8

Enter the dates of service

Enter the date range.

Select "OK."

NOTE: Select the date range for the entire quarter or for the remainder of a quarter. Do not create service records for more than one quarter and do not cross quarters.

9

Enter the quantity

Enter "1."

10

Enter the unit cost

Enter the calculated amount of the consumer’s participation.

11

Select the program

Select 2017 115 DRS CRS Comprehensive Rehabilitation Services.

12

Select the service category

Select the appropriate service category.

Select "OK."

13

Choose a line item

Select a line item by selecting the check box to the left of the appropriate item.

Select "OK."

14

Save the service record

Select "Save."

Select "Save" again.

8.6.3 Periodically Review the Consumer’s Proof of Income and Expenses

You must at least annually review the consumer’s income, liquid assets, and expenses and document the review results in a case note.

If the consumer's income, liquid assets, or expenses change significantly during the life of the case:

  1. reassess whether the consumer must still participate in the cost;
  2. document proof of the changes (if documentation is not available, note the reason in a case note);
  3. change the consumer's application; and
  4. document in a case note the reason for the change.

If you develop a consumer’s IWRP before you receive proof of the consumer’s income and expenses, do not include services that require consumer participation in the cost.

When you receive proof of the consumer’s income and expenses, amend the IWRP as needed.