Home and Community-based Services Handbook

HCS, Section 1000, Introduction

Revision 10-0; Effective June 1, 2010

 

 

1100 Letter from DADS Commissioner

Revision 10-0; Effective June 1, 2010

 

PDF Letter

 

1200 Philosophy of Service Delivery

Revision 10-0; Effective June 1, 2010

 

A Historical Overview of Service and Supports for Individuals with Intellectual or Developmental Disabilities

Prior to 1960, the prominent model for providing services to individuals with intellectual or developmental disabilities (IDDs) was a medical model with services typically provided in an institutional setting. In the 1960s, a paradigm shift began that resulted in the development of other models of service delivery. In particular, Congress began to provide funds to states to begin developing services in community settings for the first time. Texas established community mental health and IDD centers in tandem with these changes in federal funding and expectations.

By the 1970s the federal government developed regulations and standards for treatment of individuals with intellectual or developmental disabilities who lived in institutions, which included requirements for developing Individual Program Plans (IPPs). These regulations and standards marked the shift from what was largely “custodial care” to a system that promoted “active treatment.” Active treatment, while still requiring that basic care needs be met, is notably different from custodial care by emphasizing the teaching of new skills to individuals with intellectual or developmental disabilities. Active treatment guidelines also required the individual to participate in the interdisciplinary team (IDT) that develops the individual’s IPP.

Following the adoption of the active treatment model, professionals and other stakeholders in the field began developing tools and resources to facilitate person-centered planning. The ultimate outcome of person-centered planning is to further improve the quality of life for people with disabilities. Person-centered planning represented a fundamental shift from service planning that required providers to keep people with disabilities safe to a service planning and service delivery system that provides supports necessary for individuals to achieve their desired outcomes.

In the 1980s the U.S. Health Care Financing Administration (HCFA), now the Centers for Medicare & Medicaid Services (CMS), started granting waivers from the existing Medicaid rules. Waivers allow states the flexibility to design alternatives to institutional services, including the option for states to provide services in community settings as an alternative to institutional settings. In 1985 the Home and Community-based Services (HCS) waiver program was developed by Texas to waive the requirements of intermediate care facilities for individuals with an intellectual disability or related conditions (ICF/IID) services. HCS allows flexibility in the development of services for individuals who have intellectual and developmental disabilities that choose to receive their services in the community instead of an institutional setting. The federal government requires HCS be cost-effective and to include safeguards to protect participants’ health and safety.

Current and Future Direction

Today we strive to support individuals with intellectual and developmental disabilities in achieving their desired lifestyles and in becoming valued members of the community by:

Thus, waiver services are shifting from prescribing service delivery to outlining minimum requirements that must be met when designing services to support people to achieve the lifestyles they desire. Developing services that capture what is important to and for individuals who receive HCS services, as well as balancing choice and protection of health and safety, is a challenge for the service delivery system.

The Department of Aging and Disability Services (DADS) uses the term person-directed planning instead of person-centered planning to talk about the ongoing planning process that helps to determine an individual’s life path. Person-directed planning ensures it is the individual who is directing the process.

DADS supports the expectation that every individual should have the opportunity to participate in the community, gain and maintain relationships of their choosing, express preferences, make choices, fulfill goals, and live with dignity and respect. Person-directed planning is used to represent an individual and their family’s vision about how the person wishes to live, including aspirations for the future. Person-directed planning challenges DADS, HCS providers and Local Authorities (LAs) to work in cooperation to provide meaningful services and supports for the individuals who receive services.

Person-Directed Planning in the Home and Community-based Services Waiver Program

The LA service coordinator (SC) uses a person-directed planning process to gather information necessary to develop a Person-Directed Plan (PDP) that accurately reflects the individual’s goals and desires. The PDP is a written plan developed for an applicant or individual in accordance with Form 8665, HCS Person-Directed Plan, and Appendix IV, Discovery Tool. It describes the supports and services necessary to preserve the applicant’s or individual’s health and safety, and to achieve the desired outcomes identified by the applicant or individual or legally authorized representative (LAR) on behalf of the applicant or individual. The person-directed planning process:

The SC, using the PDP Discovery Tool as a basis for information gathering, conducts interviews with the individual, LAR, provider staff or others who know the person well. The results of these information-gathering interviews are compiled to:

The individual, SC and the HCS provider develop the Individual Plan of Care (IPC) based on the PDP. The provider is then responsible for developing an Implementation Plan (IP) with the individual and LAR. The IP is a written document developed for each HCS Program service on the individual’s IPC not provided through the Consumer Directed Services option that identifies how HCS services will be implemented to accomplish the outcomes identified in the PDP.

The SC is expected to implement an ongoing person-directed planning process, not a single event planning process. In order to accomplish that, the SC will need to monitor and update the PDP as preferences or needs change and additional information is learned about the individual. When an individual’s preferences or needs change or additional information is discovered, the SC will notify the HCS provider and submit a copy of the HCS Person-Directed Plan Outcome Summary (Page 10 of Form 8665) that will identify the desired addition/change/deletion based on the individual’s preferences/needs. The program provider may then have to revise the IP(s) and/or IPC.

The system must be flexible enough to keep up with the current needs and wishes of the individuals who receive HCS services.

The desired outcome of the HCS service delivery model is to promote services and supports that contribute to the acquisition of meaningful outcomes for each individual. The success of this model depends on the individuals who receive HCS services, their LARs and family members, the program provider, the service coordinator and DADS.

 

1300 Overview of Service Delivery System

Revision 10-0; Effective June 1, 2010

 

June 1, 2010, brings major changes to the Home and Community-based Services (HCS) service delivery system. The purpose of this section is to introduce program providers and Local Authorities to what HCS services will look like in the future. The success of HCS services will depend on individuals, their legally authorized representatives (LARs) and family members, the program providers, Local Authorities and Department of Aging and Disability Services (DADS) staff understanding the concepts behind the new system and developing the relationships that will support individuals in the HCS Program.

For the individuals who receive services, their LARs and family members: The transition from an Individual Service Plan (ISP) to a Person-Directed Plan (PDP) will require that personal outcomes be communicated to the service planning team (SPT). In the past, the interdisciplinary team, which included the individual, the LAR and often family members of the individual, decided what would be included in the ISP. The PDP will place even more emphasis on the results the individual desires from services and supports. Development of an effective PDP is dependent on the SPT knowing what is important to and for the individual who is receiving HCS services. Communication between the individual, the LAR, the individual’s family and the Local Authority service coordinator is critical to the development of a PDP that is meaningful for the individual. It is important that the SPT act not only on preferences that are communicated through words, but also on those preferences that are communicated through body language and maladaptive behaviors. Identifying natural supports and their roles and limits in supporting an individual is essential when linking an individual to HCS services and non-HCS services. Communication is also needed from individuals, their LARs and family members to determine whether the services being delivered are meeting the individual’s needs and preferences or whether revisions are necessary.

For the Local Authorities: Delivery of effective service coordination requires commitment to the individual who receives HCS services and to the collaboration with HCS and non-HCS service providers. A concerted effort must be made to get to know the individual and their natural supports very well. Collecting information from HCS and non-HCS service providers is essential in developing a PDP that is meaningful and will result in the desired outcomes. The ability to recognize service needs, to communicate the service needs to natural supports and HCS and non-HCS service providers, to link the individual to available resources, and to analyze the effectiveness of service delivery is essential to successful service coordination.

Service coordinators must also have extensive knowledge of non-HCS service resources to develop a PDP and to determine what HCS services need to be purchased on behalf of an individual. Knowledge of the HCS Program Billing Guidelines is critical in order to ensure that the services being purchased from the HCS program provider can be reimbursed.

For the HCS program providers: Eliminating the case management function from the array of services offered by the HCS program provider will likely require many changes to the program provider’s organizational structure. Most program providers assigned case management duties that exceeded HCS rule requirements. However, many of the case management functions that previously were defined in rule, including coordinating the development and implementation of the service plan, coordinating and monitoring the delivery of HCS and non-HCS services, integrating various aspects of services delivered through HCS and non-HCS services, recording progress and lack of progress, record-keeping, and developing a pre-discharge plan, are now the responsibility of the Local Authority service coordinator. The program provider will need to perform some parallel functions to ensure that services are effective and that individuals are healthy, safe and satisfied with their services. For example, the program provider is responsible for developing the Implementation Plan (IP) that describes specifically how the program provider’s services will achieve the assigned desired outcomes. In addition, program providers will be responsible for supervising their employees and contracted staff to ensure that they are following the IP and that progress or lack of progress is documented. If an individual receives foster/companion care, Supervised Living or Residential Support Services and possibly Supported Home Living or Respite, it is probable that the program provider’s staff will communicate and collaborate with the non-HCS service provider to integrate various aspects of service delivery. The program provider will be required to maintain a record that contains documentation relevant to the delivery of the program provider’s HCS services.

In cases in which the program provider provides foster/companion care, Supervised Living or Residential Support Services, the program provider must be able to respond to emergency situations 24 hours per day, seven days per week. The program provider may also be required to provide emergency services to an individual who lives in their own home or family home, as documented in the PDP. In the event that an unanticipated emergency arises and emergency services not included in the individual’s IPC are required, it is expected that the program provider will be responsive to that emergency and that units are added to the IPC later (if necessary) to allow reimbursement to the provider.

Program providers are encouraged to maintain frequent communication with the individuals to whom they provide services, as well as LARs and family members, to evaluate their satisfaction and to determine if changes are needed to the IP. Since case management is no longer included in the program provider’s array of HCS services, it is critical to develop effective communication systems among program provider staff and that staff know when and how to contact the individual’s service coordinator.

For DADS employees: DADS staff must prepare for these changes in the service delivery system. All DADS staff who serve individuals who receive HCS services must be knowledgeable of how the elimination of the case management function from the program provider’s array of services and the assignment of Local Authority service coordination to individuals receiving HCS services will affect the way they perform their jobs. These DADS staff must understand the concepts of person-directed planning and how to promote the acquisition of outcomes. New monitoring processes and tools will be used by the following DADS areas:

Click here for a table describing many of the major changes that result from the removal of case management services from the program providers’ service array and the performance of service coordination by the Local Authorities.

HCS, Section 2000, Service Coordination

Revision 14-1; Effective June 9, 2014

 

 

2100 Service Coordination Responsibilities

Revision 10-0; Effective June 1, 2010

 

 

2110 Service Coordination Assignment

Revision 10-0; Effective June 1, 2010

 

The Local Authority (LA) must assign a service coordinator (SC) to each enrolling Home and Community-based Services (HCS) applicant and HCS participant.

The LA must notify the HCS participant (individual), legally authorized representative (LAR) and the HCS provider of the name and contact information of the assigned SC at time of assignment and as changes occur using Form 8583, Contact Information. The LA is required to have a backup system for absences of the assigned SC that designates a staff person as the contact during the time the SC is unavailable.

The LA enters the SC assignment into CARE screen 490 and updates the assignment in CARE when the SC assignment is changed.

 

2120 Person-Directed Plan Development

Revision 10-0; Effective June 1, 2010

 

Introduction

The SC uses person-directed planning to gather information for the Person-Directed Plan (PDP). Person-directed planning is a process that empowers the individual or the LAR, on the individual's behalf, to direct the development of a plan of supports and services that meets the individual's personal outcomes (preferences and needs). The PDP process:

Additional guidance and information about person-directed planning can be found at:

In addition to understanding person-directed planning, the SC must be familiar with the HCS Program Billing Guidelines to facilitate the gathering of outcome information necessary for justifying the type of supports and services to be provided through the HCS Program.

Procedure for Completing the Person-Directed Plan

The SC assists the individual and the LAR to designate members of the individual's service planning team (SPT). The required members of the SPT are the individual, LAR and the SC. Any other members are identified by the individual and the LAR and may include a provider representative, a teacher, a friend or a neighbor.

The SC conducts interviews with the individual, LAR, advocate, provider staff and others, as appropriate, who can provide information about the individual's desired outcomes and needs. The interviews are conducted using the probes in the PDP Discovery Tool (Appendix IV) to guide the information-gathering interviews.

The results of the information-gathering interviews identify the individual's preferences and needs, including the individual's desire to use the Consumer Directed Services (CDS) option. The preferences and needs form the basis for the individual's desired outcomes. The desired outcomes are included in the individual's PDP. The PDP must identify which desired outcomes will be met through HCS services and which will be met through non-HCS services. The SPT is responsible for documenting that the HCS services and non-HCS services on the PDP:

To document that HCS service components are justified*, the SC must determine that the:

* Note: The SC is responsible for justifying the need for each HCS service type in the PDP and the HCS program provider is responsible for justifying the amount of each HCS service type in the Implementation Plan (IP).

The required minimum service coordination face-to-face contact for an HCS participant is quarterly, but individual situations may necessitate more frequent contact. The PDP Discovery Tool, used by the SC for PDP development, assists the SC in determining frequency of contact for service coordination activities.

 

2130 Enrollment Activities

Revision 10-0; Effective June 1, 2010

 

LA training for enrolling individuals from the HCS Interest List is found at: www.dads.state.tx.us/providers/mra/training/interestlist/index.html

 

2140 Service Coordination Monitoring

Revision 10-0; Effective June 1, 2010

 

The SC must conduct and document monitoring activities, including:

If, as a result of monitoring, the SC identifies a concern with an individual's progress toward outcomes in the PDP, the delivery of HCS services, or the individual's health and safety, the SC must communicate such concern to the provider via a mechanism determined by the LA and HCS provider. The SC and the provider are responsible for resolving any identified concern. If the concern cannot be resolved, the SC may report the concern to Consumer Rights and Services at the Department of Aging and Disability Services (DADS).

The SC maintains the following for an individual for an Individual Plan of Care (IPC) year:

Suggestions for Monitoring

The SC is responsible for monitoring progress or lack of progress toward desired outcomes in the PDP and determining whether the HCS services on the IPC are being delivered. The documentation of progress or lack of progress toward desired outcomes should include references to all outcomes on the PDP. If the SC contact frequency is more often than quarterly, each desired outcome should be referenced at least once in the quarter. The SC may use CARE screen C72, which contains information about utilized services, against the individual's IPC to help determine if HCS services are being delivered.

As a result of ongoing monitoring, the SC revises the PDP, as appropriate, as the individual's preferences and needs change. The SC uses the PDP and the Discovery Tool (Appendix IV) as guides to determine the individual's progress toward outcomes identified in the PDP, whether HCS Program services are being delivered and whether outcomes in the PDP need to be updated.

The SC does not monitor the HCS provider's Implementation Plan.

 

2150 Service Coordinator Role

Revision 10-0; Effective June 1, 2010

 

 

2151 Individual Plan of Care Renewal

Revision 14-1; Effective June 9, 2014

 

At least 60 but no more than 90 calendar days before an individual's IPC expires, the SC is responsible for notifying the service planning team of the need to review and update the individual’s PDP.

The SC should provide the LAR at least a 21-day notice that the PDP needs to be reviewed.

The SC notifies the SPT that the PDP must be reviewed. The SC should provide the LAR at least a 21-day notice that the PDP needs to be reviewed.

The SPT must review the PDP to determine if the information is accurate and reflects the individual’s current preferences and needs. The SC updates the PDP using instructions and forms provided by the Department of Aging and Disability Services (DADS) to indicate the necessary changes to the PDP. The SC must send the HCS provider a copy of the updated PDP within 10 calendar days after the PDP is updated.

At least 30 but no more than 60 calendar days before the expiration of the IPC, the SPT and the HCS provider must review the PDP and develop the renewal IPC, including completion of the CDS portion of the renewal IPC, if applicable, and the non-HCS services. For an individual under age 21 who is not receiving foster/companion care, supervised living or residential support, the SC should inform the individual or LAR, per DADS instructions, about the option of receiving attendant care services through HCS Supported Home Living or the Department of State Health Services (DSHS) Personal Care Services (PCS) program.

The HCS provider is responsible for developing an Implementation Plan for the HCS services identified in the PDP and renewal IPC that will be delivered by the provider. The Implementation Plan must provide information that justifies the amount of each HCS service component on the renewal IPC.

The HCS provider is required to sign and date the renewal IPC and ensure that the IPC is signed and dated by the individual and LAR. If the SC is physically present when the renewal IPC is developed, the SC signs the IPC and obtains a copy of the IPC. The SC is not required to sign the IPC before it is entered in CARE.

The HCS provider is responsible for entering the renewal IPC data into CARE. The HCS provider keeps the original renewal IPC in the individual's record. If the SC is not physically present when the renewal IPC is developed, the provider is responsible for sending the SC a paper copy of the IPC within three calendar days after the HCS provider completes data entry into CARE.

Within seven calendar days after the HCS provider enters the renewal IPC data into CARE, the SC must review the renewal IPC in CARE screen L31. The SC can send the IPC back to the HCS provider to correct obvious typographical errors on the IPC; however, the SC must notify the HCS provider of such. If the SC sends the IPC back for an error correction, the seven calendar-day time frame begins again once the HCS provider re-transmits the IPC. The SC must review the IPC in CARE, enter their name and date, and indicate whether they agree or disagree with the renewal IPC. The foundation of the SC's agreement or disagreement is:

If the SC disagrees with the renewal IPC, the SC must notify DADS and the HCS provider using Form 8579, Notification of Service Coordinator (SC) Disagreement. See form instructions. The SC must also notify the individual/LAR.

 

2152 Individual Plan of Care Revision

Revision 10-0; Effective June 1, 2010

 

The SC or the HCS provider may initiate a revision to the IPC to add a new HCS service or increase the amount of an existing service. A revision to the IPC must be done prior to the delivery of a new service or increased service amount, except in an emergency as described in Section 2153, Role of Service Coordinator Related to Emergency Provisions of Home and Community-based Services and Individual Plan of Care Revision.

If the SC disagrees with the revised IPC, the SC must notify DADS and the HCS provider by using Form 8579, Notification of Service Coordinator (SC) Disagreement. See form instructions. The SC must also notify the individual/LAR.

 

2153 Emergency Provision of Home and Community-based Services and Individual Plan of Care Revision

Revision 10-0; Effective June 1, 2010

 

If an emergency necessitates the provision of an HCS service to ensure the individual's health and welfare, and the service is not on the IPC or exceeds the amount on the IPC, the HCS provider may provide the service before revising the IPC. Within one business day after providing the service the HCS provider is responsible for:

Within seven calendar days after providing the service, the SC and the HCS provider must work together to revise the IPC.

If the SC disagrees with the revised IPC, the SC must notify DADS and the HCS provider by using Form 8579, Notification of Service Coordinator (SC) Disagreement. See form instructions. The SC must also notify the individual/LAR.

 

2154 Level of Care/Level of Need Renewal and Lapsed LOC/LON

Revision 10-0; Effective June 1, 2010

 

The HCS provider is responsible for ensuring an individual's level of care/level of need (LOC/LON) is current by electronically transmitting to DADS Form 8578, Intellectual Disability/Related Condition Assessment, at least annually. If the HCS provider fails to transmit the ID/RC assessment before the LOC/LON expires, the HCS provider must transmit an ID/RC assessment for renewal and transmit an ID/RC assessment for the time period between the LOC/LON expiration date and the date the renewal became effective. This is the "lapsed" time period.

Within three calendar days after an HCS provider transmits an ID/RC assessment, either for renewal or lapsed, the HCS provider is responsible for providing the SC with a paper copy of the signed and dated assessment.

Within seven calendar days after an HCS provider transmits an ID/RC assessment, either for renewal or lapsed, the SC is responsible for:

If the SC disagrees with the ID/RC assessment, the SC must notify DADS and the HCS provider by using Form 8579, Notification of Service Coordinator (SC) Disagreement. See form instructions. The SC must also notify the individual/LAR.

 

2155 Home and Community-based Services Program Suspension (Previously Referred to as Temporary Discharge)

Revision 10-0; Effective June 1, 2010

 

An individual's HCS services are suspended if the individual is temporarily admitted into one of the following settings:

If the SC becomes aware that an individual's HCS services should be suspended, the SC must notify the HCS provider of the need to suspend the individual's HCS services. The SC must ensure the HCS provider enters the suspension data in CARE screen C18.

If the HCS provider becomes aware that an individual's HCS services should be suspended, the HCS provider is responsible for suspending the individual's HCS services and notifying the SC that the HCS provider has suspended the individual's HCS services. The SC must ensure the HCS provider enters the suspension data in CARE screen C18.

The SC reviews the suspension at least every 90 days following the effective date of the suspension by reviewing the individual's status and documenting in the individual's record the reasons for the continuing suspension.

To continue an individual's suspension past 270 days, the SC submits a completed Form 3615, Request to Continue Suspension of Waiver Program Services, requesting that the individual's suspension continue and includes documentation of the SC's periodic reviews.

For additional information about suspensions, refer to Section 9000, Suspensions (Previously Temporary Discharges).

 

2156 Termination of Home and Community-based Services (Previously Referred to as Permanent Discharge)

Revision 10-0; Effective June 1, 2010

 

Involuntary Termination of HCS Services

If the SC determines that a situation may lead to the termination of the individual's HCS services, the SC must discuss the situation with the individual and LAR and attempt to resolve the situation.

If the SC determines that an individual's HCS services should be terminated, the SC documents a description of the:

The SC submits a written request to involuntarily terminate the individual's HCS services to DADS using Form 3616, Request for Termination of Services Provided by HCS/TxHmL Waiver Provider, in accordance with Section 10000, Terminations.

Voluntary Termination of HCS Services

If an individual or LAR requests termination of all HCS program services, then within 10 calendar days of the request, the SC must inform the individual or LAR of:

The SC submits a written request to DADS voluntarily terminating the individual's HCS services using Form 3616 in accordance with Section 10000.

For additional information about terminations, refer to Section 10000 Terminations (Previously Permanent Discharges).

 

2157 Transfers

Revision 10-0; Effective June 1, 2010

 

The SC is responsible for managing the following types of transfers in accordance with Section 8000, Transfers and Local Authority (LA) Reassignments:

For an individual or LAR who has requested a transfer, the SC must inform the individual and LAR that the:

If the individual or LAR has not selected another HCS provider or CDSA, the SC must provide the individual or LAR a list of available HCS providers or CDSAs and contact information in the geographic locations preferred by the individual or LAR.

The SC may not influence the individual or LAR selection of an HCS provider or CDSA, but may assist the individual or LAR in identifying important aspects in an HCS provider or CDSA and considering those aspects in the selection of a provider or CDSA.

The SC submits a written request to transfer the individual's HCS services to DADS using Form 3617, Request for Transfer of Waiver Program Services, in accordance with Section 8000.

For additional information about transfers, refer to Section 8000.

 

2158 Consumer Directed Services

Revision 10-0; Effective June 1, 2010

 

The SC's role is described in Section 13000, Consumer Directed Services.

 

2160 Additional Service Coordinator Responsibilities

Revision 10-1; Effective September 27, 2010

 

Communication of Rights and Complaint Process

The service coordinator (SC) must assist an individual or legally authorized representative (LAR) in exercising the legal rights of the individual as a citizen and as a person with a disability.

The HCS rules require the SC to provide an individual, LAR or family member with a copy of the rights of the individual as described in §9.173(b), as well as a booklet entitled Your Rights in a Home and Community-Based Services Program (available here) and an oral explanation of such rights upon:

Note: DADS has developed a publication with the rights of the individual as described in §9.173(b) of the HCS rule for the SC to provide to the individual, LAR or family member. The publication, entitled Rights of Individuals to be Protected and Promoted by the HCS Provider, can be found at https://hhs.texas.gov/laws-regulations/handbooks/local-intellectual-and-developmental-disability-authority-handbook/publications/lidda-rights-individuals-be-protected-and-promoted-hcs-provider.

In accordance with DADS rules governing rights of individuals with intellectual disability (40 Texas Administrative Code, Chapter 4, Subchapter C), the LA is responsible for providing an individual, LAR or family member with a copy of the rights of the individual as described in the booklet entitled Your Rights in Local Authority Services and an oral explanation of such rights upon enrollment into local authority services and annually thereafter. However, to provide a meaningful and complete explanation of all rights to individuals receiving HCS services on an annual basis, the SC is also expected to give a copy of Your Rights in a Home and Community-based Services (HCS) Program and the DADS publication titled Rights of Individuals to be Protected and Promoted by the HCS Provider to the individual or the individual's LAR, and an oral explanation of such rights annually.

The SC must document every time the SC gives the booklets to the individual, LAR or family member and provides an oral explanation of the rights. The documentation must be signed by the individual or LAR and the SC.

The SC must ensure that, at the time an individual is enrolled, the individual or LAR is informed orally and in writing of the processes for:

Activities Related to Individuals Under 22 Years of Age Seeking or Receiving Supervised Living or Residential Support

Using Form 3605, HCS Parent or Legally Authorized Representative (LAR) Contact Information for Individuals Under 22 Years of Age, the SC requests the LAR of an individual under the age of 22 receiving Supervised Living or Residential Support to provide the SC with the following information:

If the HCS provider notifies the SC that the provider is unable to locate the LAR, or the LA staff who are responsible for permanency planning notify the SC that the LA staff are unable to locate the LAR, the SC must:

Within three business days after initiating Supervised Living or Residential Support to an individual under 22 years of age, the SC must:

For an applicant or individual under 22 years of age seeking or receiving Supervised Living or Residential Support, the SC will:

Activities Related to Guardianship

The SC is responsible for determining if the guardianship for an individual is current. The letter of guardianship is required to be renewed in the county court annually.

The SC must document in the PDP whether the letter of guardianship is current.

If the letter of guardianship is not current, the SC must provide a reminder to the guardian that a renewal needs to be completed and document that the guardian was provided this reminder.

HCS, Section 3000, Enrollments

Revision 15-6; Effective November 6, 2015

 

Enrollment Process and Test

 

Local Intellectual and Developmental Disability Authorities (LIDDAs) are responsible for completing all enrollment activities for individuals seeking Texas Home Living (TxHmL) and Home and Community-based Services (HCS) waiver services. Each LIDDA must designate staff to complete all enrollment activities, and these staff must complete the Department of Aging and Disability Services (DADS) online enrollment training, with at least one staff person designated to receive training on an annual basis.

 

Enrollment Section of CARE User's Guide

The enrollment section of the MRA CARE User's Guide includes instructions for data entry of an HCS or TxHmL enrollment. It is available at:

http://www2.mhmr.state.tx.us/655/cis/training/files/waiver/mra%20guide/enrollment%20in%20a%20waiver%20program.pdf.

Note: The CARE User's Guide is only available to those who have access to the CARE system.

 

Transition Assistance Services (TAS), Pre-Enrollment Minor Home Modifications (MHM) and Pre-Enrollment MHM and Assessments

Applicants enrolling in the HCS Program who are being discharged from a nursing facility, an intermediate care facility for applicants with an intellectual disability or related conditions, or a general residential operation (a child-care facility regulated by the Texas Department of Family and Protective Services) are now eligible to receive TAS, pre-enrollment MHM and pre-enrollment MHM assessments. 

For TAS, see Form 8604, Transition Assistance Services (TAS) Assessment and Authorization.

For pre-enrollment MHM and pre-enrollment MHM assessments, see Form 8611, Pre-Enrollment MHM Authorization Request, and Form 8612, TAS/MHM Payment Exception Request.

HCS, Section 4000, Person-Directed Plan

Revision 13-2; Effective September 3, 2013

 

Person-Directed Planning Guidelines

 

Person directed planning is an ongoing process that empowers an individual, and the legally authorized representative (LAR) on the individual's behalf, to direct the development of a plan of services and supports that:

The result of person-directed planning must reflect the essential elements of the individual’s desired life in sufficient detail so the Home and Community-based Services (HCS) provider understands how to provide HCS services to meet the individual’s outcomes. The Person-Directed Planning Guidelines on the Department of Aging and Disability Services (DADS) website provide a more detailed description of the principles of person-directed planning. See https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/providers/long-term-care/lidda/persondirectedplanningguidelines.pdf and www.learningcommunity.us.

 

Discovering the Individual

The individual and his or her needs are the basis for the entire process and must be involved in all aspects of the process, as well as the focus. The foundation of person-directed planning is to listen, acknowledge and discover the personal outcomes, preferences, choices and abilities of the individual directing the plan. This activity is often called “discovery.” The local authority (LA) service coordinator (SC) has the responsibility to facilitate the process of discovery as preparation for developing the Person-Directed Plan (PDP).

There are many ways to conduct discovery. The most common method is to have conversations with the individual, LAR and others who know and support the individual, such as caregivers, close family members, current provider staff, friends and teachers. Part I of Appendix III, Discovery Guide, provides guidance for effective discovery, including:

Other methods of discovery are activities from:

Discovery can be done using a combination of these methods.

Documentation of the information gathered during discovery is important. The SC is responsible for documenting the information gathered from the individual, family, provider and other participants.

Although person-directed planning is not a linear process, discovery is important preparation for developing the PDP.

 

PDP

Before developing the PDP, the SC should discuss with the individual and LAR the importance of the HCS provider being included when the individual discusses his/her preferences and outcomes. Since the provider will be responsible for designing and providing the services to the individual, understanding the individual’s strengths, capabilities and desires is critical to providing services that are meaningful to the individual. The SC should request permission from the individual/LAR to invite the HCS provider to the planning meeting to develop the PDP. The SC should also ask the individual/LAR if they would like to invite anyone else to participate in the service planning process.

The SC is responsible for convening and facilitating a meeting to develop the PDP. There is not a single way to approach developing the PDP. It can be a brainstorming session where the purpose of services and desired outcomes are discussed while HCS services are decided upon. Or, it can be a meeting in which the discovery information is presented and clarified and then HCS services are negotiated.

The SC should have a thorough understanding of the services in the HCS program so that connections can be made between what the individual wants to have happen and the HCS service array. This understanding can be supported by reviewing the HCS Program Billing Guidelines, discussions with the individual’s HCS program provider and consultation with the LA’s HCS service coordination supervisor.

 

Developing the PDP

The PDP has two elements plus instructions:

 

Form 8665-ID, Individual Data

This page is completed by the SC at the time of enrollment and updated as necessary thereafter. The SC is required to provide the program provider a copy of Form 8665-ID:

 

Form 8665, Person-Directed Plan

Pages 1, 2 and 3 are completed using the information gathered through the discovery process. These pages include:

Page 4, Action Plan:


*Note: The service planning team is responsible for determining whether an individual’s waiver service is critical to meeting the individual’s health and safety. The program provider must develop a written backup plan for each waiver service identified on the PDP as critical to meeting an individual’s health and safety. Because HCS program providers must ensure that trained and qualified staff are available at all times for the provision of residential support and supervised living, a backup plan is not needed for these services. Backup plans for foster/companion care must be documented in the service agreement the foster/companion care provider has with the HCS program provider.

The Service Planning Team is responsible for documenting that the services on the PDP:

Note: For an enrollment PDP, the SC is responsible for justifying both the need and the amount for each HCS service type in the PDP. For PDP renewals and PDP updates, the SC is responsible for justifying the need for each HCS service type in the PDP and the HCS program provider is responsible for justifying the amount of each HCS service type in the Implementation Plan (IP).

 

PDP Update for IPC Renewal

The PDP is treated as a new plan at the time of the individual plan of care (IPC) renewal. Although the current PDP may be used as a template for the updated PDP, the:

 

PDP Update Within the IPC Year

If an individual’s PDP must be updated within the IPC year, the SC must clearly indicate what was updated. The PDP date is updated at top of Page 1 and, if an Action Plan is also updated, then the new PDP date is included on the top of that Action Plan page.

New information is added at the beginning of the narrative on Page 1 (rather than at the end of the narrative). Begin the new information with the following notations:

Example: PDP Update, Jan. 22, 2013, Sarah Smith, SC

If it is necessary to add a new Action Plan page or change information on a current Action Plan page on the PDP within an IPC year, then the SC makes the following notations at the bottom of the Action Plan page that has been updated:

The SC must send any new or updated page(s) of the PDP to the HCS provider in a timely manner. The HCS provider is responsible for creating or revising the individual’s IP to address the new information.

HCS, Section 5000, Level of Care and Level of Need

Revision 11-5; Effective September 1, 2011

 

The following sections provide information related to Form 8578, Intellectual Disability/Related Condition Assessment.

 

5100 Intellectual Disability/Related Condition Assessment Process

Revision 10-0; Effective June 1, 2010

 

The Home and Community-based Services (HCS) program provider must annually renew an individual's level of care (LOC) and level of need (LON) by completing and signing Form 8578, Intellectual Disability/Related Condition Assessment, and entering the information into CARE. Instructions for renewing an LOC/LON may be found in Title 40, Texas Administrative Code, Chapter 9, Subchapter D, Home and Community-based Services (HCS) Program, and the instructions for completing Form 8578.

Providers may use the C65 screen (displayed below) to determine when an individual's LOC/LON will expire.

 

The C65 screen is used to determine when an individual's level or care or level of need will expire.<p><img  data-cke-saved-src=

 

The detail screen (displayed below) includes the name of each individual with an LOC/LON expiring by the date requested, and date range of their current LOC/LON.

 

This screen includes the name of each individual with a level of care or level or need expiring by the date requested, as well as date range of the current level of care or level of need.<p><img alt=

Once the program provider has entered the information into CARE, the SC will have seven days to review the LOC/LON information and enter an agreement or disagreement with what was entered.

CARE screen L82 has been developed to assist an LA with tracking ID/RCs that need to be reviewed by the SC. LAs are expected to review each ID/RC and must determine how frequently they will need to produce the list in order to meet this expectation.

The new screen L82 will look something like the following examples.

 

This screen assists Local Authorities track assessments that need to be reviewed by the service coordinator.

 

All ID/RCs waiting for the SC review will be displayed.

 

This screen assists Local Authorities track assessments that need to be reviewed by the service coordinator.

 

The SC will access screen L32 (displayed below) to view the ID/RC and enter an agreement or disagreement and any comments.

 

The service coordinator accesses this screen to view the assessment and enter an agreement or disagreement and comments.

 

The information that was entered by the program provider will be displayed followed by a screen for the SC to enter an agreement, disagreement and any comments.

After viewing the ID/RC assessment information, the final L32 screen for the SC data entry will be displayed, as shown below.

This is an example of the final L32 screen for the service coordination data entry.

If an SC does not agree that the information is accurate, the SC will indicate a disagreement by answering the question "Local Authority agrees with information on this ID/RC?" with "N" for no. Any time a disagreement is noted, the SC must notify DADS Program Enrollment (PE) and the program provider by completing Form 8579, Notification of SC Disagreement, and faxing it to DADS PE and sending a copy to the program provider. This notification should be done the same day of the data entry. Errors made on the SC review screen may only be corrected during the LA review time period (within seven days of the data entry).

Program providers will not be prevented from entering billing because an SC does not review the ID/RC assessment in a timely manner. If the SC does not review an ID/RC assessment within seven days of data entry, CARE will automatically send the ID/RC assessment to DADS for approval. Reports will be available for state office and LA management staff noting those ID/RC assessments not reviewed by the SC.

DADS PE will continue to approve or deny an individual's LOC/LON. The SC's agreement or disagreement does not ensure any action will be taken or not taken by DADS PE. The SC may be used as an informant if DADS PE determines an LON review is necessary.

 

ID/RC and LON Resources

Additional information regarding ID/RC assessments and requesting a LON from DADS PE may be found at:

https://hhs.texas.gov/doing-business-hhs/provider-portals/resources/idd-waivers-program-enrollmentutilization-review/idrc-faqs

https://hhs.texas.gov/doing-business-hhs/provider-portals/resources/idd-waivers-program-enrollmentutilization-review/level-need-lon-resources

 

5200 Service Coordinator Review of Intellectual Disability/Related Condition

Revision 11-5; Effective September 1, 2011

 

The HCS program provider is responsible for completing Form 8578, Intellectual Disability/Related Condition Assessment, and transmitting it to DADS. This document consists of the individual's LOC and LON. The SC does not approve or deny an individual's LOC or LON, but is responsible for reviewing the document in CARE, entering their name and date of review, and entering whether or not they agree with the information. In order to review the ID/RC assessment, the SC must have a basic understanding of the ID/RC assessment and the Inventory for Client and Agency Planning (ICAP) assessment.

 

Level of Care

The LOC determines the individual's programmatic eligibility for the HCS program. Individuals enrolling into HCS must have a LOC 1, which requires either a diagnosis of intellectual disability or diagnosis of a related condition (RC). Along with the diagnosis of an RC, the individual's IQ score must be below 76. There is a small group of individuals initially enrolled under the HCS-Omnibus Budget Reconciliation Act program with a LOC 8. An individual's LOC is established at the time of enrollment and does not typically change.

 

Level of Need

An individual's LON is used to determine the reimbursement rate a provider will receive for some of the HCS program services. The LON is obtained by completing and scoring an ICAP assessment for each individual.

A brief overview of the ICAP is provided in this document, but is not intended to be comprehensive. More extensive ICAP training is provided by DADS PE staff at the applicable waiver conferences.

 

Review of the ID/RC

Information from the ICAP is entered on the ID/RC (Form 8578) to request a LON for an individual. In some cases it may be necessary for the SC to request a copy of the individual's current ICAP booklet in order to ensure that the appropriate LON has been requested by the provider.

The ID/RC assessment notes the ICAP service level (Item #33). The service level translates to the LON as follows:

The ICAP consists of two parts: the adaptive skills section and the problem behavior section. Generally, the higher the service level, the more adaptive skills the individual possesses. Exceptions exist for individuals who have more cognitive skills and limited physical abilities. The person acting as the respondent for the ICAP should be someone familiar with the individual's abilities.

The adaptive section of the ICAP is reflected on the ID/RC assessment under "Broad Independence" (Item #31), and the problem behavior section score is noted as "General Maladaptive" (Item #32) and is scored as a negative number. A score lower than -25 (as in temperatures, -26 is lower than -25) generally indicates that the individual's behaviors are serious enough to have a formal program in place.

The section rating an individual's adaptive skills is divided into four categories:

These items are scored 0-3, with 0 meaning the individual is not capable of completing the task and 3 meaning the individual is able to perform the task independently.

The problem behavior section consists of eight categories of behaviors. If a behavior occurs in any of these categories, the frequency and severity is scored:

A program provider must have a method of addressing behaviors if they feel the behavior is severe enough to be rated more than slightly serious. A formal behavior support plan must be in place targeting any behavior noted to be very or extremely serious, and a training objective is required to address any behavior rated as moderately serious.

Individuals may be "bumped" to a higher LON if they display behaviors severe enough to warrant additional staffing resources to address the behavior, and the program provider is providing these additional resources. The provider requests this bump by noting on the ID/RC that the individual has a behavior support plan and notes a "1" in one of the behavioral status questions (Items #35-38). If a LON 9 is requested the provider will enter a "2" in the appropriate field.

If the LON changes, the SC should be aware of the reason for the change. The individual's LOC/LON history can be viewed by using the C68 screen in CARE, and the entire ID/RC assessment is displayed on the C83 screen.

In order to assist in reviewing the accuracy of the individual's ICAP levels of need, the following profiles were developed. These general descriptions are intended to give a basic overview of the skill level/behavioral severity of an individual in that LON range, and are not an absolute requirement for an individual with that LON. The SC should not make the assumption that a LON should be bumped up if the individual seems to meet one or two items in a different LON category. To secure an initial behavior increase to another level, the provider must submit documentation that supports that increase.

 

Individual Profiles

Varied skill levels are noted here. This is less than one percent of the population. Individuals require staff supervision 16 hours a day during waking hours to assure this individual's safety or the safety of others due to the individual's life-threatening behavior. Due to the threatening nature of this behavior, most individuals in this LON category live in shift pattern residential homes. Significant documentation supporting this LON assignment must be submitted by the provider in order to be approved. DADS PE staff must review all initial LON 9 requests.

This individual may have limited self-help skills or some independent basic self-help skills, but may demonstrate challenging behavior as well. Usually an individual in this category will have a behavioral program or intervention strategies in place regardless of the absence of self-help skills. (The author of the ICAP, Brad Hill, used this analogy: a newborn infant requires extensive care throughout the day but a child in his/her "terrible twos" requires a more intense level of supervision to assure this child's safety due to his ambulation and adventuresome behavior.) Individuals in this LON may even require 1:1 supervision or care, though not 16 hours a day for safety reasons. Other individuals with more skills may bump from the extensive category to this category due to behavioral intervention. All living environments are noted with this LON.

This individual has skills ranging from no self-help skills (due to physical limitations) to demonstrating some basic self-help skills. Staff intervention includes personal care assistance utilizing hands-on techniques. Other individuals with more skills may bump from the limited category to this category due to behavioral intervention (all programs) or medical issues (intermediate care facility for persons with intellectual disability (ICF/ID) only). This individual typically lives in all possible living arrangements.

This is probably the largest number of individuals served who have the most varied skill levels within the same level of need. This individual has skills ranging from fairly independent to some personal care reminders/guidance required. Behavior intervention may be required or hands-on personal care assistance. Individuals may have psychiatric disorders but are fairly controlled with medications. Staff intervention varies from reminders to 24-hour guidance and support. This individual may possibly be living in an apartment with support, with natural or foster care families or in a shift pattern residence setting.

This individual does not need 24-hour care and demonstrates very independent living skills, with no significant maladaptive behavior noted. Staff intervention is typically reminders with some guidance required. This individual may live in an apartment with support, at home with family, in a foster/companion residence or receive Supervised Living in a group home. They generally do not require the level of supervision or assistance provided in Residential Support.

HCS, Section 6000, Individual Plan of Care (IPC)

Revision 14-1; Effective June 9, 2014

 

 

6100 Overview of the IPC

Revision 11-2; Effective March 1, 2011

 

The individual plan of care (IPC) documents an individual's Home and Community-based Services (HCS) program services and non-HCS services. An IPC is completed at the time an individual enrolls in the HCS program and is valid for 365 days (the IPC year), as long as the individual remains eligible for HCS. An IPC must be renewed prior to the current IPC end date and may be revised at any time during the IPC year if changes are needed. A transfer IPC is completed if an individual changes to another HCS contract or chooses a different service delivery option (meaning Consumer Directed Services is added or removed as a service delivery option).

The IPC is entered in CARE using one of the following users' guides:

The HCS services listed on the IPC are based on the individual's person-directed plan (PDP) and must be supported by documentation in the PDP that other sources for the service are unavailable and the service does not replace existing supports, including natural supports or other sources for the service. The services must be necessary for the individual to live in the community, to ensure the individual's health, safety and welfare in the community, and to prevent the need for institutional services.

See Section 4000, Person-Directed Plan, for more information on the PDP, and Form 8665, Person-Directed Plan, and instructions.

An IPC is developed during the IPC meeting by:

 

6110 IPC Form and Instructions

Revision 11-2; Effective March 1, 2011

 

Review Form 3608, Individual Plan of Care (IPC) – HCS/CFC, and instructions before completing the form.

 

6120 IPC Begin, End and Effective Dates

Revision 11-2; Effective March 1, 2011

 

Each IPC has an IPC begin date, an IPC end date and an IPC effective date.

The IPC begin date is the first day of the IPC year.

The IPC end date is 365 days after the IPC begin date. In most cases, an individual's IPC will renew on the same date every year, with leap year being the exception since the IPC is valid for 365 days, not one calendar year. (Note: If there is a gap between the current IPC end date and the renewal IPC meeting date, the provider will not be authorized to bill for services provided to the individual during that gap.)

The IPC begin date and IPC effective date are the same date for an initial IPC and a renewal IPC. If the IPC is revised, the date of the IPC revision then becomes the new IPC effective date, but the IPC begin date and IPC end date do not change.

 

6130 IPC Meeting

Revision 11-2; Effective March 1, 2011

 

An IPC meeting occurs when the SPT and the provider meet at the same time, either in person or by telephone, to review the individual's PDP and to discuss and identify necessary units of HCS and non-HCS services to support PDP outcomes. It is important that all parties be able to communicate and discuss openly with one another during the IPC meeting. In most instances, an IPC meeting is necessary to develop the IPC. The exceptions are for an IPC revision to increase or decrease an existing HCS service and for an IPC to add/change a requisition fee only.

 

6140 IPC Types

Revision 11-2; Effective March 1, 2011

 

A new IPC form is completed at designated events. The event determines the IPC type, which are:

The IPC types are described in the following sections.

 

6150 Consumer Directed Services (CDS) and IPCs

Revision 11-2; Effective March 1, 2011

 

If the individual uses the CDS option, the SC is responsible for:

If an individual only uses the CDS option and does not have a program provider, the Local Authority (LA) is responsible for entering the IPC into CARE.

The SC sends a copy of the completed Form 3608 to the CDS agency.

 

6160 Department of Aging and Disability Services (DADS) Role

Revision 11-2; Effective March 1, 2011

 

DADS will continue to authorize, reduce or deny services on an individual's IPC. The SC's agreement or disagreement with the IPC does not ensure a specific action will be taken by DADS Program Enrollment (PE). The SC may be used as an informant if DADS PE determines an IPC utilization review is necessary.

 

6200 Initial (Enrollment) IPC

Revision 11-2; Effective March 1, 2011

 

 

6210 Initial (Enrollment) IPC Overview

Revision 11-2; Effective March 1, 2011

 

The initial IPC is completed by the Local Authority (LA) before an individual is enrolled in the HCS program.

An LA service coordinator meets with the individual and others who know the individual to develop the PDP. This document describes the individual's desired outcomes and is the basis for determining the HCS service components on the initial IPC.

The service components and amount of each service included on the initial IPC are determined from discussions with:

 

6220 Local Authority (LA) and Service Coordinator Responsibilities for Initial IPC

Revision 11-2; Effective March 1, 2011

 

 

6221 IPC Meeting to Develop Initial IPC

Revision 11-2; Effective March 1, 2011

 

After the SPT has developed the PDP, including the "Justifications for Waiver Services and Supports" section of the PDP, the SC schedules an IPC meeting with the provider and SPT to develop the initial IPC.

 

6222 Initial IPC Effective Date

Revision 11-2; Effective March 1, 2011

 

The initial IPC effective date is the same as the IPC begin date. The IPC meeting must be held on or before the IPC effective date. Services provided prior to the initial IPC effective date may not be reimbursed.

 

6223 Units of Service

Revision 11-2; Effective March 1, 2011

 

The SC brings to the IPC meeting justification for units of the services identified on the individual's PDP.

 

6224 Non-HCS Services

Revision 11-2; Effective March 1, 2011

 

The SC includes all non-HCS services the individual is receiving (and will be receiving) on the IPC form for the initial IPC.

 

6225 Initial IPC Signatures and Signature Dates

Revision 11-2; Effective March 1, 2011

 

The SC signs and dates the initial IPC and is responsible for obtaining the signature and date of the provider representative and individual/LAR. The date must be the date the IPC meeting occurred. If present, the individual/LAR and SC sign and date on the appropriate lines of the form. If the LAR participates by phone, the SC checks the box to indicate such and enters the date the LAR participated in the IPC meeting. The SC then sends a copy of the form for the LAR's signature.

 

6226 Transmission of Initial IPC

Revision 11-2; Effective March 1, 2011

 

The LA enters the initial IPC in CARE as part of completing an individual's enrollment activities. The SC ensures the individual/LAR and provider receive a copy of the IPC.

 

6230 Provider Responsibilities for Initial IPC

Revision 11-2; Effective March 1, 2011

 

For an initial IPC, the SC contacts the provider to schedule an IPC meeting. The provider attends the IPC meeting, participates in the development of the initial IPC, and signs and dates the initial IPC. The provider's signature date on the initial IPC must be the date of the IPC meeting.

 

6300 Renewal IPC

Revision 11-2; Effective March 1, 2011

 

 

6310 Renewal IPC Overview

Revision 14-1; Effective June 9, 2014

 

The rules governing the HCS Program (Title 40, Texas Administrative Code (TAC), Chapter 9, Subchapter D) direct the SC to notify the service planning team that the individual’s PDP must be reviewed and updated at least 60 but no more than 90 calendar days before the expiration of the individual's IPC. The SC is responsible for arranging for the SPT to review and update the individual's PDP.

The LA may use CARE screen L64 to generate a list of individuals whose IPCs will expire by a specific date (for example, a date 90 days in the future). After the SPT reviews and updates the PDP, the SC ensures that the program provider has a copy of the individual's current PDP. The provider schedules an IPC meeting with the SPT to develop a renewal IPC.

Although the provider representative is responsible for completing the renewal IPC (Form 3608), the SC is responsible for completing the portions related to CDS, if applicable, and non-HCS services.

 

6320 Provider Responsibilities for Renewal IPC

Revision 14-1; Effective June 9, 2014

 

 

6321 IPC Meeting to Develop Renewal IPC

Revision 14-1; Effective June 9, 2014

 

The provider schedules an IPC meeting to occur no later than 30 days before the current IPC end date to develop the renewal IPC.

 

6322 Renewal IPC Effective Date

Revision 14-1; Effective June 9, 2014

 

The renewal IPC effective date is the same as the IPC begin date. The IPC meeting must be held on or before the IPC effective date. The IPC effective date may not be before the IPC meeting date.

 

6323 Units of Service

Revision 14-1; Effective June 9, 2014

 

The provider brings to the IPC meeting justification for units of the services identified on the individual's PDP.

 

6324 Renewal IPC Signatures and Signature Dates

Revision 14-1; Effective June 9, 2014

 

The provider representative signs and dates the renewal IPC on the day of the IPC meeting and is responsible for obtaining the signature of the individual/LAR. If present, the individual/LAR and SC sign and date on the appropriate lines of the form. If the LAR participates by phone, the provider checks the box to indicate such and enters the date the LAR participated in the IPC meeting. The provider then sends a copy of the form for the LAR's signature.

If the SC participates in the IPC meeting by phone, the provider enters "participated by phone" on the SC's signature line, prints the name of the SC on the appropriate line and enters the date the SC participated.

 

6325 Transmission of Renewal IPC

Revision 14-1; Effective June 9, 2014

 

The provider enters the IPC into CARE on or before the IPC begin date and ensures that the SC has a hard copy of the IPC (Form 3608) within three days after entering the IPC in CARE.

 

6330 Service Coordinator Responsibilities for Renewal IPC

Revision 14-1; Effective June 9, 2014

 

The SC participates in the renewal IPC meeting that is scheduled by the provider. This is done after the SPT has reviewed and updated the PDP, in accordance with Section 2151, Individual Plan of Care Renewal.

The SC is not required to provide justification for the amount of HCS services on the renewal IPC; this is the responsibility of the HCS program provider. Neither is the SC responsible for conducting utilization review activities.

If the individual has chosen to self-direct SHL or respite through CDS, the SC includes the units necessary to address the PDP outcome(s) in the CDS section of the IPC as determined by the employer.

 

6331 Non-HCS Services

Revision 11-2; Effective March 1, 2011

 

The SC ensures all non-HCS services the individual is receiving are included on the IPC form.

 

6400 IPC Revision

Revision 11-2; Effective March 1, 2011

 

6410 IPC Revision Overview

Revision 11-2; Effective March 1, 2011

 

Either the HCS program provider or the SC may determine that a revision to an individual's IPC is necessary. An IPC revision may be necessary due to a change in the individual's needs, a change in the type of residential services or a miscalculation of units necessary to meet the individual's needs. The provider or the SC notifies the other as soon as possible that services included in the individual's IPC must be added, deleted, increased or decreased.

The provider completes a new IPC (Form 3608) for an IPC revision in accordance with the instructions. The exception is when only a CDS service needs to be revised, in which case the SC completes the IPC for the IPC revision. The form must always include the service units for the entire year, including the services being revised.

An IPC revision may or may not require an IPC meeting.

 

6411 Provider Responsibilities for IPC Revision

Revision 11-2; Effective March 1, 2011

 

If the provider determines that an individual's services on the IPC need to be revised, they must first determine:

Once this determination is made, the provider follows the procedures associated with the appropriate type of IPC revision as described in Section 6420, Section 6430 or Section 6440.

 

6412 Service Coordinator Responsibilities for IPC Revision

Revision 11-2; Effective March 1, 2011

 

If the SC becomes aware of a need to revise an individual's IPC, the SC:

If only a CDS service needs to be revised, the SC meets with the individual/LAR to develop the revised IPC.

If the provider initiates the IPC revision, the provider notifies the SC by:

If the IPC revision adds or changes a requisition fee only, the provider does not notify the SC.

The SC is not required to provide justification for the amount of HCS services on the revised IPC; this is the responsibility of the HCS program provider. Neither is the SC responsible for conducting utilization review activities.

 

6420 IPC Revision to Reflect PDP Change

Revision 11-2; Effective March 1, 2011

 

If the IPC revision will reflect a PDP change, such as adding or deleting an HCS service or increasing or decreasing an existing HCS service that requires a new PDP outcome, an IPC meeting is necessary to discuss the reason(s) for the revision and to develop the IPC revision.

Further, if the IPC revision is in response to the emergency provision of services as allowed by 40 TAC 9.166(d), the provider ensures documentation supporting such emergency provision of services meets the definition of "emergency" in the HCS rule.

 

6421 Provider Responsibilities for IPC Revision That Reflects a PDP Change

Revision 11-2; Effective March 1, 2011

 

If the revision reflects a PDP change, the provider schedules an IPC meeting with the SPT to discuss the reason(s) for the revision and to develop the IPC.

Further, if the IPC revision is in response to the emergency provision of services as allowed by 40 TAC 9.166(d), the provider ensures documentation supporting such emergency provision of services meets the definition of "emergency" in the HCS rule. (The definition of "emergency" is an unexpected situation in which the absence of an immediate response [i.e., adding or increasing an HCS service] could reasonably be expected to result in risk to the health and safety of an individual or another person.)

 

6421.1 IPC Effective Date for IPC Revision That Reflects a PDP Change

Revision 11-2; Effective March 1, 2011

 

Except for the emergency provision of services, the IPC effective date may only be on or after the date of the IPC meeting; it may not be before the IPC meeting date.

For an IPC revision for the emergency provision of services, the effective date is the date of the emergency provision of services.

If the IPC revision is due to a change in the type of residential services, the IPC effective date must be the date the individual begins receiving the new residential service.

 

6421.2 Signatures and Signature Dates for IPC Revision That Reflects a PDP Change

Revision 11-2; Effective March 1, 2011

 

The provider representative signs and dates the IPC revision on the day of the IPC meeting and is responsible for obtaining the signature of the individual/LAR. If present, the individual/LAR and SC sign and date on the appropriate lines of the form. If the LAR participates by phone, the provider checks the box to indicate such and enters the date the LAR participated in the IPC meeting. The provider then sends a copy of the form for the LAR's signature.

If the SC participates in the IPC meeting by phone, the provider enters "participated by phone" on the SC's signature line, prints the name of the SC on the appropriate line and enters the date.

 

6421.3 Transmission of IPC Revision That Reflects a PDP Change

Revision 11-2; Effective March 1, 2011

 

Except for the emergency provision of services, the provider enters the completed IPC in CARE. Within three days after data entry, the provider ensures the SC has a hard copy of the IPC.

 

6421.4 Activity Following Transmission of IPC Revision That Reflects a PDP Change

Revision 11-2; Effective March 1, 2011

 

The provider revises the implementation plan to be consistent with the IPC revision.

 

6422 Service Coordinator Responsibilities for IPC Revision That Reflects a PDP Change

Revision 11-2; Effective March 1, 2011

 

If the revision reflects a PDP change, such as adding or deleting an HCS service or increasing or decreasing an existing HCS service that requires a new PDP outcome, then the IPC revision requires an IPC meeting. In this situation, the provider is responsible for scheduling an IPC meeting to discuss and develop the IPC revision. The SC is responsible for making reasonable efforts to be available in a timely manner for the IPC meeting.

The SPT ensures the PDP is consistent with the IPC revision.

 

6430 Revision to Increase/Decrease an Existing HCS Service

Revision 12-1; Effective January 16, 2012

 

If the IPC revision is to increase/decrease an existing HCS service and is supported by a current outcome in the PDP, an IPC meeting is not necessary.

For the purposes of this type of IPC revision, service components related to nursing (i.e., RN, RN specialized, LVN and LVN specialized) are all considered "nursing" services. Therefore, any of the four components may be added, increased or decreased in accordance with this section as long as at least one of the components is on the current IPC and the IPC revision does not reflect a PDP change.

The provider completes the IPC (Form 3608) in accordance with the form's instructions. The provider obtains the individual/LAR's agreement by signature and notifies the SC of the IPC revision by submitting a hard copy of the completed Form 3608 by fax or email to the SC on the same day that the provider enters the SC's signature date on the form. (Each Local Authority and provider should determine the preferred method of notifying the SC, either fax or email.) A phone call or voice message to the SC is not adequate notification.

If the SC agrees with the IPC revision and that an IPC meeting is not required, the SC:

The SC also reviews the electronically transmitted IPC in CARE in accordance with Section 6600, Service Coordinator Review Process.

If the SC determines further discussion is necessary, the SC contacts the provider as soon as possible to discuss concerns. If no consensus can be reached after this discussion, the SC checks the box indicating an IPC meeting is needed and returns the completed Form 3608 to the provider within two business days after receiving the form from the provider. The SC is responsible for scheduling the IPC meeting to occur as soon as possible, but no later than 14 calendar days after the provider sent the IPC revision to the SC.

Specific instructions for the provider to notify the SC of the need for a revision and the SC's response can be found in the instructions for Form 3608.

 

6431 Provider Responsibilities for IPC Revision to Increase/Decrease an Existing HCS Service

Revision 11-2; Effective March 1, 2011

 

If the IPC revision increases or decreases an existing HCS service and is supported by a current outcome in the PDP, an IPC meeting is not necessary.

Note: The provider meets with the individual/LAR to discuss the reason for an IPC revision and obtain the individual/LAR's agreement when an IPC meeting is not held.

The provider completes IPC Form 3608 in accordance with the form's instructions, indicating that no meeting is required, noting the reason for the increase/decrease and making the change(s) to the service units. (The service component(s) being revised are identified with an "I" or "D" for increased or decreased.) It is important that the provider state a reason for the revision on Page 1 of Form 3608 and indicate which current outcome in the PDP supports the service component(s) being revised.

The provider obtains the individual/LAR's agreement by signature. The provider notifies the SC of the IPC revision by faxing or emailing the completed Form 3608 to the SC on the same day that the provider enters the SC's signature date on the form. A phone call or voice message to the SC is not adequate notification.

 

6431.1 IPC Effective Date for IPC Revision to Increase/Decrease an Existing HCS Service

Revision 11-2; Effective March 1, 2011

 

Since the IPC revision does not require an IPC meeting, the IPC effective date may only be on or after the date the provider notifies the SC by faxing or emailing the completed Form 3608 to the SC.

 

6431.2 Signatures and Signature Dates for IPC Revision to Increase/Decrease an Existing HCS Service

Revision 11-2; Effective March 1, 2011

 

The provider representative signs and dates the revision IPC and obtains the signature of the individual/LAR after discussion and agreement. If the agreement is in person, the individual/LAR signs, prints their name and enters date of agreement. If the individual/LAR agrees by phone, the provider checks the box and enters date of agreement. The provider sends a copy of the form for the individual's/LAR's signature.

The provider writes "notified SC" on the SC signature line, prints the SC's name and enters the date the form was faxed or emailed to the SC. (Faxing or emailing the form to the SC serves as notification of an IPC revision that does not require an IPC meeting.)

Note: If the individual/LAR agrees by phone and the provider sends a copy of the form for signature, the provider may notify the SC of the revision prior to receiving the individual's/LAR's signature.

 

6431.3 Transmission of IPC Revision to Increase/Decrease an Existing HCS Service

Revision 11-2; Effective March 1, 2011

 

The provider may enter the revised IPC in CARE after faxing or emailing IPC Form 3608 to the SC. The provider does not have to wait for the SC to reply before entering the revision into CARE.

However, if the IPC is already entered and the SC determines that an IPC meeting is needed, the SC returns the IPC to the provider in CARE during the SC's required review of the IPC.

 

6431.4 Activity Following Transmission of IPC Revision to Increase/Decrease an Existing HCS Service

Revision 11-2; Effective March 1, 2011

 

If the SC responds by checking the box indicating agreement with the IPC revision, the provider revises the implementation plan to be consistent with the IPC revision.

If the SC responds by checking the box indicating that an IPC meeting is needed, the provider:

 

6432 Service Coordinator Responsibilities for IPC Revision to Increase/Decrease Existing HCS Service

Revision 11-2; Effective March 1, 2011

 

If the IPC revision is to increase/decrease an existing HCS service and is supported by a current outcome in the PDP, the provider completes the IPC (Form 3608) in accordance with the form's instructions. The provider notifies the SC of the IPC revision by submitting the completed Form 3608 to the SC by fax or email. The SC responds within two business days to the IPC revision by completing the "Service Coordinator Response" section on the bottom of Page 2 of the IPC form.

 

6432.1 Service Coordinator Response Section of Form 3608

Revision 11-2; Effective March 1, 2011

 

If the SC receives an IPC revision on Form 3608 by fax or email with "notified SC" on the SC's signature line, the SC immediately reviews the form to ensure:

 

6432.2 If Service Coordinator Agrees with IPC Revision to Increase/Decrease Existing HCS Service

Revision 11-2; Effective March 1, 2011

 

If the SC agrees with the IPC revision and that an IPC meeting is not required, the SC:

 

6432.3 If Service Coordinator Has Concerns with IPC Revision to Increase/Decrease Existing HCS Service

Revision 11-2; Effective March 1, 2011

 

If the SC has concerns with the reason for the revision, believes a PDP update is necessary or has some reason to believe that the revision is not in accordance with the individual's/LAR's desired outcomes, the SC immediately contacts the provider to discuss concerns.

If the SC's concerns are resolved after contacting the provider and the SC agrees with the IPC revision and that an IPC meeting is not required, the SC follows the procedures described in Section 6432.2.

 

6432.4 Service Coordinator Determines IPC Meeting is Needed

Revision 11-2; Effective March 1, 2011

 

If the SC continues to have concerns after contacting the provider and determines that an IPC meeting is needed, the SC:

 

6440 Revision to Add/Change Requisition Fee Only

Revision 11-2; Effective March 1, 2011

 

If the IPC revision is to add/change a requisition fee only, an IPC meeting is not necessary and the provider is not required to obtain agreement from the individual/LAR.

 

6441 Provider Responsibilities for IPC Revision to Add/Change a Requisition Fee Only

Revision 11-2; Effective March 1, 2011

 

If the IPC revision is to add/change a requisition fee only, the provider completes a new Form 3608 in accordance with the form's instructions, indicating that the IPC revision is to add/change a requisition fee only.

 

6441.1 IPC Effective Date for IPC Revision to Add/Change a Requisition Fee Only

Revision 11-2; Effective March 1, 2011

 

The IPC effective date is the date the provider completes the form.

 

6441.2 Signatures and Signature Dates for IPC Revision to Add/Change a Requisition Fee Only

Revision 11-2; Effective March 1, 2011

 

The provider representative completing the form signs and dates the form. On the individual's/LAR's signature line and the SC's signature line, the provider enters "requisition fee only" and enters the IPC effective date as the signature date.

 

6441.3 Transmission of IPC Revision to Add/Change a Requisition Fee Only

Revision 11-2; Effective March 1, 2011

 

The provider enters the IPC revision in CARE and within three days after data entry the provider ensures the SC has a hard copy of the IPC revision. Note: The IPC will not be sent to the SC for review in CARE. It will go straight to DADS for authorization.

 

6442 Service Coordinator Responsibilities for IPC Revision to Add/Change a Requisition Fee Only

Revision 11-2; Effective March 1, 2011

 

The SC has no responsibilities for an IPC revision to add/change a requisition fee only.

 

6500 Transfer IPC

Revision 11-2; Effective March 1, 2011

 

 

6510 Transfer IPC Overview

Revision 11-2; Effective March 1, 2011

 

If an individual wishes to transfer to another provider agency or a different contract within the same provider agency or change service delivery options (that is, add or remove CDS), a transfer IPC must be completed. The SC is responsible for completing the transfer IPC. The SPT and receiving provider hold an IPC meeting to develop the transfer IPC, which must include services already provided by the transferring provider as well as those to be provided by the receiving provider.

See Section 8000, Transfers and Local Authority (LA) Reassignments, for specific procedures related to transfers.

 

6520 Local Authority (LA) and Service Coordinator Responsibilities for Transfer IPC

Revision 11-2; Effective March 1, 2011

 

 

6521 IPC Meeting to Develop Transfer IPC

Revision 11-2; Effective March 1, 2011

 

The SC schedules and conducts an IPC meeting with the SPT and receiving provider to develop the transfer IPC. The SC is responsible for completing a new Form 3608. The SC invites the transferring provider to the transfer IPC meeting, but its participation is optional. The receiving provider's participation in the transfer IPC meeting is required.

The SC ensures that the transfer IPC includes all services provided by the transferring provider, as well as those to be provided by the receiving provider.

 

6522 Transfer IPC Effective Date

Revision 11-2; Effective March 1, 2011

 

Except for an emergency transfer (see Section 6525), the IPC effective date of a transfer IPC may only be on or after the date of the IPC meeting; it may not be before the IPC meeting date. The receiving provider will not be reimbursed for services provided prior to the IPC effective date.

 

6523 Transfer IPC Signatures and Signature Dates

Revision 11-2; Effective March 1, 2011

 

The SC is responsible for obtaining the signature and date of the receiving provider on the day of the IPC meeting on the transfer IPC. The SC is also responsible for obtaining the signature of the individual/LAR on the transfer IPC. If present, the individual/LAR signs and dates on the appropriate lines of the form. If the LAR participates by phone, the SC checks the box to indicate such and enters the date the LAR participated in the IPC meeting. The SC then sends a copy of the form for the LAR's signature.

 

6524 Transmission of Transfer IPC

Revision 11-2; Effective March 1, 2011

 

The LA enters the transfer IPC in CARE and faxes a copy to DADS PE. The SC ensures that the receiving provider has a hard copy of the completed IPC Form 3608.

If the LA is unable to complete the data entry, it sends a secure email to the DADS PE contact for the receiving provider that includes the error message from CARE. PE staff will instruct the LA as to how to complete the data entry.

 

6525 Emergency Transfer

Revision 11-2; Effective March 1, 2011

 

If the individual has already begun receiving services from the potential receiving provider and the transfer meets the criteria for an "emergency" (as defined by the HCS rule, see box below), the SC:

40 TAC, §9.153 Definitions

(14) Emergency – An unexpected situation in which the absence of an immediate response could reasonably be expected to result in risk to the health and safety of an individual or another person.

 

6530 Provider Responsibilities for Transfer IPC

Revision 11-2; Effective March 1, 2011

 

 

6531 Transferring Provider

Revision 11-2; Effective March 1, 2011

 

The transferring provider completes the appropriate section of Form 3617, Request for Transfer of Waiver Program Services, in accordance with the form's instructions and Section 8000, Transfers and Local Authority (LA) Reassignments. The information related to reserved service units/dollars on Form 3617 provided by the transferring provider is essential for the development of the transfer IPC. The transferring provider may participate in the IPC meeting to develop the transfer IPC unless the individual/LAR objects to its participation.

 

6532 Receiving Provider

Revision 11-2; Effective March 1, 2011

 

The receiving provider participates in the transfer IPC meeting, participates in the development of the transfer IPC, and signs and dates the transfer IPC. The provider's signature date on the transfer IPC must be the date of the IPC meeting.

 

6600 Service Coordinator Review Process

Revision 11-2; Effective March 1, 2011

 

 

6610 Service Coordinator Review Process Overview

Revision 11-2; Effective March 1, 2011

 

The SC is responsible for reviewing in CARE all IPC renewals and all IPC revisions, except IPC revisions that add or change a requisition fee only. After the provider enters the IPC in CARE, the SC has six days to review it in CARE. Within three days after entering the IPC, the provider is responsible for sending the SC a hard copy of the IPC (i.e., completed Form 3608).

The SC reviews the IPC in CARE by ensuring:

If an SC does not review an IPC within six days after data entry, CARE will automatically send the IPC to DADS for authorization without an SC review. Reports will be available for state office and LA management staff noting those IPCs not reviewed by the SC.

 

6611 Reasons the IPC is Returned to the Provider

Revision 11-2; Effective March 1, 2011

 

The SC returns the IPC electronically in CARE to the provider if the SC is unable to agree or disagree with the IPC because:

 

6612 Service Coordinator's Agreement/Disagreement with IPC

Revision 11-2; Effective March 1, 2011

 

The SC agrees with the IPC if the SC attests that the HCS services on the IPC are:

 

6620 Service Coordinator Responsibilities

Revision 11-2; Effective March 1, 2011

 

 

6621 If the IPC is Returned to Provider

Revision 11-2; Effective March 1, 2011

 

If the SC returns the IPC to the provider, the SC enters a comment in CARE to explain the reason for returning the IPC. Additionally, the SC contacts the provider the same day that an IPC is returned and discusses with the provider how to resolve the issue.

 

6622 Service Coordinator's Agreement/Disagreement with IPC

Revision 11-2; Effective March 1, 2011

 

If the SC does not return the IPC in CARE to the provider, the SC completes the review by entering the agreement or disagreement in CARE before the IPC proceeds to DADS for authorization.

 

6622.1 Agreement with IPC

Revision 11-2; Effective March 1, 2011

 

If the SC is able to make the attestation required by Section 6612, the SC indicates agreement by answering "Y" (yes) to the question "Local Authority agrees with information on this IPC?".

 

6622.2 Disagreement with IPC

Revision 11-2; Effective March 1, 2011

 

If an SC is unable to make the attestation required by Section 6612, the SC contacts the provider and discusses concerns related to the HCS services in the IPC for which the SC is unable to attest.

If the SC's concerns are not resolved and the SC continues to be unable to make the attestation, the SC indicates disagreement by answering "N" (no) to the question "Local Authority agrees with information on this IPC?". Any time a disagreement is noted, the SC completes Form 8579, Notification of Service Coordinator Disagreement, and fax it to DADS PE, and send a copy to the provider. The SC completes the form on the same day that the SC enters the disagreement in CARE.

 

6623 CARE Screens for Service Coordinator Review

Revision 11-2; Effective March 1, 2011

 

The following sections provide general instructions for viewing an IPC and entering the SC's review in CARE. See CARE User Guide for detailed data entry instructions at https://hhsportal.hhs.state.tx.us/helpGuide/Content/16_CARE/IntellectualDisability.htm.

 

6623.1 CARE Screen L83

Revision 11-2; Effective March 1, 2011

 

CARE screen L83 has been developed to assist an LA with tracking IPCs that need to be reviewed by the SC. Since DADS expects LAs to review each IPC, LAs must determine how frequently to print CARE screen L83 in order to meet this expectation.

Figure 3 in Section 6635 displays an example of CARE screen L83 (Header).

Figure 4 in Section 6635 displays an example of CARE screen L83 (Detail). All renewal and revised IPCs waiting for SC review are displayed. Initial or transfer IPCs do not require SC review because they are data entered by the LA.

 

6623.2 CARE Screen L31

Revision 11-2; Effective March 1, 2011

 

If an individual has more than one IPC pending (a revision to the current IPC and the renewal IPC have been entered, but not yet reviewed), the IPC effective date being reviewed must be entered. Figure 5 in Section 6635 displays CARE screen L31 (Header).

The IPC information is displayed on subsequent CARE screen L31 (Detail) in order for the SC to ensure that what was entered into CARE matches the hard copy. The last CARE screen L31 (Detail) is for the SC's data entry. Figure 6 in Section 6635 displays the last CARE screen L31 (Detail).

If the SC intends to return the IPC to the provider, the SC:

If the SC does not intend to return the IPC to the provider, the SC:

The SC answers the question "MR Authority agrees with information on this IPC?" and enters the SC's name.

 

6630 Provider Responsibilities

Revision 11-2; Effective March 1, 2011

 

The provider ensures that the SC has a hard copy of the IPC within three days after the provider enters the IPC data into CARE.

 

6631 Service Coordinator Returns IPC in CARE

Revision 11-2; Effective March 1, 2011

 

If the SC returns an IPC to the provider in CARE, the SC notifies the provider that same day of the returned IPC. Additionally, the SC enters a comment in CARE to explain the reason for returning the IPC. A provider may view this comment in CARE screen C62 or the provider may use the C103 screen and select status code "X -RETURNED TO PROVIDER FOR MORE INFORMATION" to see if any IPCs have been returned by the SC and the reason for the return.

 

6632 Activity to Address a Returned IPC

Revision 11-2; Effective March 1, 2011

 

The IPC remains in "Returned to Provider" status until the provider takes some action in CARE to address the returned IPC. Depending on the reason the IPC was returned, the provider may take one of the following CARE actions:

Before taking CARE action to send the IPC on to the SC for review again, the provider is responsible for resolving the issue that was the basis for the IPC being returned.

 

6633 Error Correction

Revision 11-2; Effective March 1, 2011

 

An error correction may be used to address an IPC in "Returned to Provider" status if the IPC was returned because:

If an error was made to a unit of service or signature name or date, the provider makes the necessary correction using the error correction action. This action sends the IPC to the SC for review again. The provider is responsible for notifying the SC as soon as possible after the correction has been made.

If there is nothing to correct in CARE (because the error was made on the hard copy, the SC has now received a hard copy or the SC and provider have resolved any issues), the provider completes the error correction action in CARE. A provider accesses CARE screen C02 and completes the error correction action without actually making any changes or corrections. Completing this action sends the IPC to the SC for review again.

 

6634 Delete and Re-enter IPC

Revision 11-2; Effective March 1, 2011

 

The provider deletes and re-enters an IPC to address an IPC in "Returned to Provider" status if the IPC was returned because:

If the SC was not notified of an IPC revision to increase or decrease an existing HCS service, the SC determined an IPC meeting was necessary for an IPC revision to increase or decrease an existing HCS service, the SC did not participate in an IPC meeting, or the IPC effective date is not in accordance with the requirements of this handbook, the provider:

 

6635 CARE Screen Examples

Revision 11-2; Effective March 1, 2011

 

Figure 1. Screen C64

 

 

Figure 2. Detail Screen C64

 

 

Figure 3. Screen L83

 

 

Figure 4. Detail Screen L83

 

 

Figure 5. L31 Header Screen

 

 

Figure 6. Final L31 Screen

 

HCS, Section 7000, Implementation Plan and Service Backup Plan

Revision 13-2; Effective September 3, 2013

 

 

7100 Implementation Plan Overview

Revision 13-2; Effective September 3, 2013

 

The Implementation Plan (IP) is developed by the individual, the individual’s legally authorized representative (LAR), members of the individual’s support network and the program provider. The IP addresses every Home and Community-based Services (HCS) service the individual receives through the provider agency service delivery option (see list in paragraph below). An IP is not required for an HCS service provided though the Consumer Directed Services (CDS) service delivery option.

The program provider must develop an IP for each HCS service for which there is an Action Plan on the individual’s Person-Directed Plan (PDP). See the HCS services below for examples of IPs:

The IP clearly illustrates how the individual will be supported in achieving his or her outcomes/purposes identified in the PDP and details how HCS program services will be delivered to achieve the identified outcomes/purposes. The IP describes and directs the delivery of services, including when, where and by whom services will be provided. A copy of the IP is provided to the service coordinator (SC) upon request.

An HCS provider may use Form 2125, Implementation Plan - HSC/TxHmL/CFC, or another document that includes the same elements in Form 2125. A comprehensive nursing plan, a behavior support plan or other assessments/plans completed by HCS service providers may serve as the IP as long as those plans include all required elements.

 

7200 Implementation Plan Elements

Revision 13-2; Effective September 3, 2013

 

 

7210 Desired Outcome(s)/Purposes(s)

Revision 13-2; Effective September 3, 2013

 

The desired outcome(s)/purpose(s) for an HCS service that are included on the IP are taken directly from the PDP.

 

7220 Conversation, Observation and Formal Assessment

Revision 13-2; Effective September 3, 2013

 

In addition to the PDP, the development of implementation strategies may be based on:

Documentation must be maintained regarding the information gathered through conversation, observation and formal assessments.

 

7230 Implementation Strategies

Revision 13-2; Effective September 3, 2013

 

The implementation strategies are individualized and allow for evaluation of progress in achieving each desired outcome. Strategies are the steps that contribute to reaching desired outcomes. Depending on the outcome, the IP may contain one or more strategies that lead to the individual's acquisition of additional skills or describe actions to be completed by paid supports to achieve an outcome. There is no prescribed number of strategies for each outcome. Strategies are based on conversations, observations and/or formal assessments and are written in observable, measurable or outcome-oriented terms. Measurable means a person can consistently and reliably determine whether or not an action or event has occurred. Observable means the action or event can be detected using one or more of the five senses: sight, hearing, touch, taste or smell. Outcome-oriented means that it can be determined when a desired result has been achieved.

 

7240 Signing the Implementation Plan (IP)

Revision 13-2; Effective September 3, 2013

 

Once the IP has been developed, signatures are obtained from the individual, the individual’s legally authorized representative (LAR) or a member of the individual’s support network, and the individual’s program provider to verify that they have participated in the development of the IP. These signatures may be on a separate signature sheet that is kept on file or may be on the IP itself.

 

7300 Provider Monitoring of Service Delivery

Revision 13-2; Effective September 3, 2013

 

The provider is responsible for ensuring that the IP is effective and services are provided according to the IP. Ongoing communication between the program provider’s staff and the individual and LAR is necessary to ensure that the IP reflects services and approaches that meet the needs and desires of the individual and LAR.

The provider must document services provided as specified in the implementation plan and to verify that the requirements for reimbursement, as defined in the HCS Program Billing Guidelines, have been met. The IP and documentation related to service delivery may also be used by DADS utilization review staff when determining whether to authorize the IPC.

 

HCS Certification Principles references for IP and related documentation:

§9.174

(a) the program provider must:

(13) ensure that HCS Program services identified in the individual's implementation plan are provided in an individualized manner and are based on the results of assessments of the individual's and the family's strengths, the individual's personal goals and the family's goals for the individual, and the individual's needs rather than which services are available;

(14) Ensure that each individual's progress or lack of progress toward desired outcomes is documented in observable, measurable, or outcome-oriented terms;

(26) Ensure that an individual has a current implementation plan;

(46) Maintain a system of delivering HCS Program services that is continuously responsive to changes in the individual's personal goals, condition, abilities, and needs as identified by the service planning team.

Documentation regarding delivery of services defined by the IP must be written to be observable, measurable or outcome oriented.

 

7310 Example of Documenting Observable Strategies

Revision 13-2; Effective September 3, 2013

 

Observable: Staff use one or more of the five senses (sight, hearing, touch, smell or taste) to evaluate performance on implementation strategy.

Example: Johnny will independently select and purchase items using the correct amount at the local convenience store. (Based on the PDP, which reflects that it is important to Johnny to be able to go independently to the store and purchase items of his choice.)

Staff Documentation: I observed Johnny at the 7-11. He selected three items to purchase and approached the register, greeted the cashier and received the total for his purchase. The purchase price was $3.42. Johnny presented the cashier with $3.00. Staff prompted Johnny to give the cashier an additional dollar. The purchase was then complete.

This example indicates that Johnny is able to perform many of the steps associated with making a purchase, but he was not completely independent in making these purchases. The program provider is responsible for comparing staff documentation to determine if Johnny’s abilities have increased and must document progress or lack of progress.

 

7320 Example of Measurable Strategies

Revision 13-2; Effective September 3, 2013

 

Measurable: Calculations are made to determine progress on implementation strategy.

Example: Johnny will use a walker. (Based on the PDP, which reflects that it is important to Johnny to be able to go from place to place without help.)

Staff Documentation: Johnny used his walker to go a total of 25 feet this afternoon.

Note: When using data sheets for measuring progress, be sure that the criteria does not “lock” the individual into a perpetual loop. The individual should be able to celebrate success and strategies should be adjusted to assist the individual to do so. When success is not occurring, staff should note their observations on the data sheet.

Example: Johnny is not motivated to use his walker inside the house (perhaps because of the number of obstacles). He is much more motivated to walk down the driveway, especially if the mail needs to be checked.

 

7330 Example of Documenting Outcome Oriented Strategies

Revision 13-2; Effective September 3, 2013

 

Outcome Oriented: Progress is defined by occurrence of an event identified in the implementation strategy.

Example: Johnny wants to participate in the annual cancer research walk/run. (Based on the PDP, which indicated that Johnny’s sister died from cancer, he wants to help raise money for the cause.)

Staff Documentation: I took Johnny to the American Cancer Society today so that he could sign up to participate in the annual cancer research walk/run. On the way to the car, he convinced his neighbor, Mrs. Olson, to sponsor him by donating $2 for each mile he walks or runs.

 

7400 Revising the Implementation Plan

Revision 13-2; Effective September 3, 2013

 

The program provider is expected to routinely review the services provided to an individual and share information regarding progress or lack of progress on the implementation strategies with the individual and the individual’s LAR, if applicable. Lack of progress on an implementation strategy indicates that the strategy needs to be reviewed to determine if revision is warranted.

The HCS provider revises an individual's IP whenever there is a change in the outcomes/purposes identified in the PDP, or when changes in implementation strategies, or frequency or duration of HCS program services are needed.

 

7500 Service Backup Plan

Revision 13-2; Effective September 3, 2013

 

A program provider must develop a written backup plan for each waiver service identified on the PDP as critical to meeting an individual’s health and safety. HCS providers may use Form 1742, Service Backup Plan for HCS, TxHmL and CFC Services, to develop a service backup plan or may use their own documentation that includes the required elements of a service backup plan. A backup plan must:

If a backup plan is implemented, the program provider must document whether the plan was effective. If the program provider determines the plan was ineffective, the program provider must revise the plan.

Note: Because HCS program providers must ensure that trained and qualified staff are available at all times for the provision of residential support and supervised living, a backup plan is not needed for these services. Backup plans for foster/companion care must be documented in the service agreement the foster/companion care provider has with the HCS program provider.

HCS, Section 8000, Transfers and Local Authority (LA) Reassignments

Revision 11-1; Effective January 20, 2011

 

 

8100 Overview

Revision 10-1; Effective September 27, 2010

 

Section 8000 describes the requirements for:

Texas Administrative Code Title 40, Chapter 9, Subchapter D, requires the service coordinator (SC) to manage the transfer process as stated in §9.190.

§9.190. MRA Requirements for Providing Service Coordination in the HCS Program.

(e) A service coordinator must:

(24) manage the process to transfer an individual's HCS Program services from one program provider to another or one CDSA to another in accordance with DADS instructions, including:

(A) informing the individual or LAR who requests a transfer to another program provider or CDSA that the service coordinator will manage the transfer process;

(B) informing the individual or LAR that the individual or LAR may choose to receive HCS Program services from any available program provider (i.e., a program provider whose enrollment has not reached its service capacity in CARE) or CDSA; and

(C) if the individual or LAR has not selected another program provider or CDSA, provide the individual or LAR a list of available HCS Program providers and CDSAs and contact information in the geographic locations preferred by the individual or LAR;

 

8200 Requirement for Program Provider to Notify Service Coordinator (SC)

Revision 11-1; Effective January 20, 2011

 

 

 

8210 Transfers Must be Planned

Revision 11-1; Effective January 20, 2011

 

The Department of Aging and Disability Services (DADS) requires an individual's transfer to be planned in order for the receiving provider to be knowledgeable about the individual's needs and to be prepared to deliver necessary services. Therefore, the transfer effective date must be a future date to allow for adequate planning. An exception to this requirement may be made when a transfer meets the criteria for an emergency (as described in Section 8230, Emergency Transfer). If an individual/LAR requests a transfer, the program provider or the SC must inform the individual/LAR or family that the transfer must be scheduled for a future date in order to ensure appropriate planning occurs.

If an individual's program provider receives information that the individual/LAR wants to transfer to another program provider or CDSA, including information from another program provider or CDSA, the program provider must, within 24 hours, notify the individual's SC of such information.

If the program provider does not know who the individual's SC is, it must notify the HCS service coordination supervisor with the LA currently providing service coordination of the individual/LAR's desire for transfer.

If a potential receiving provider is contacted by an individual/LAR who requests to transfer to its contract, the provider must direct the individual/LAR to notify his/her SC of the request. The potential receiving provider must let the individual/LAR know that a transfer will not be valid until the SC conducts a transfer individual plan of care (IPC) meeting. The potential receiving program provider is not authorized to begin providing services and will not be reimbursed for services provided before meeting with the individual/LAR and SC to develop and sign the transfer IPC. An exception to this requirement may be made when a transfer meets the criteria for an emergency (as described in Section 8230).

 

8220 No Prior SC Notification

Revision 11-1; Effective January 20, 2011

 

If an SC is notified that an individual is already receiving services from a potential receiving provider/contract without going through the transfer process, the SC must document the date they were notified and by whom. The SC must contact the individual/LAR no later than three business days after receiving this notification to verify the individual wanted to transfer, and to determine their choice of providers. If the individual does not agree with the transfer and wants to remain with his or her previous provider or contract, the SC arranges for such. If the individual indicates this was their choice or chooses another provider, the SC has an additional five business days to conduct the transfer IPC meeting. The receiving provider should be aware that the transfer effective date will not be before the date the transfer IPC is signed unless the situation meets the criteria for an emergency transfer.

 

8230 Emergency Transfer

Revision 11-1; Effective January 20, 2011

 

The HCS rule defines emergency as "an unexpected situation in which the absence of an immediate response could reasonably be expected to result in risk to the health and safety of an individual or another person." For an emergency transfer, the "immediate response" referenced would be a transfer before an IPC meeting can be held. If an individual's transfer to another contract must occur before the transfer IPC meeting can be held, the transfer may be considered an "emergency transfer." If an IPC meeting is held before the transfer takes place, then the transfer is not processed as an emergency transfer.

If the SC is unaware that the individual requires an emergency transfer, the provider is responsible for notifying the SC as soon as the emergency situation allows in order to complete the transfer process.

The SC completes the transfer process with the transfer effective date as the date the individual began receiving services from the new provider or new contract. Signature dates on the transfer IPC will be the date of the IPC meeting. This means the transfer effective date may be earlier than the IPC meeting dates and the IPC signature dates.

The SC must submit with the transfer packet to DADS Program Enrollment (PE) supporting documentation that shows the transfer meets the criteria for an emergency. Whoever addressed the emergency situation is responsible for providing the supporting documentation. Based on the supporting documentation, DADS PE determines whether or not the criteria for an emergency transfer have been met.

If DADS PE determines the criteria for an emergency transfer have been met, the receiving provider may be reimbursed for services provided before the transfer IPC meeting.

 

8231 CARE Data Entry of Emergency Transfer

Revision 11-1; Effective January 20, 2011

 

The LA enters the transfer data in CARE for all transfers except an emergency transfer.

For an emergency transfer, DADS PE enters the transfer data in CARE.

 

8300 Miscellaneous Information and Requirements

Revision 10-1; Effective September 27, 2010

 

 

 

8310 Simultaneous Transfer of Program Provider and CDSA

Revision 10-1; Effective September 27, 2010

 

If an individual/LAR wants to transfer to another program provider and to another CDSA, the SC, the LA and the transferring and receiving program providers must follow the steps in Section 8600, CDSA Transfer and Changing Service Delivery Option, Section 8400, Program Provider Transfer Involving One Local Authority (LA), or Section 8500, Program Provider Transfer Involving Two Local Authorities (LAs), at the same time using one Form 3617, Request for Transfer of Waiver Program Services.

 

8320 Form 3617 and Instructions

Revision 10-1; Effective September 27, 2010

 

Form 3617, Request for Transfer of Waiver Program Services, is used to document transfer information. The persons required to complete portions of this form must do so in accordance with the instructions.

 

8330 CARE Data Entry

Revision 10-1; Effective September 27, 2010

 

The CARE User's Guide includes step-by-step instructions for entering an individual's transfer data and is online at: https://hhsportal.hhs.state.tx.us/helpGuide/Content/16_CARE/TrainingPDFS/icfmrall.pdf

Note: The CARE User's Guide is only available to those who have access to the CARE system.

 

8340 Verification of Guardianship

Revision 10-1; Effective September 27, 2010

 

To prevent a delay in the authorization of a transfer, the SC must determine whether an individual has a legal guardian and verify that guardianship information is correct in CARE by checking Screen C61.

 

8350 Transfer Process Checklist

Revision 10-1; Effective September 27, 2010

 

When completing transfer activities, the SC may use Form 3612, Transfer Process Checklist.

 

8360 Contacting DADS

Revision 11-1; Effective January 20, 2011

 

The LA may, at any time during the transfer process, consult with the DADS PE contact assigned to the receiving program provider if the LA encounters problems completing the process.

The SC must consult with the DADS PE contact when a program provider does not submit required documentation within the time frames described in this section.

 

8400 Program Provider Transfer Involving One Local Authority (LA)

Revision 10-1; Effective September 27, 2010

 

Sections 8410 through 8470 describe the requirements for a program provider transfer involving one LA.

 

8410 Confirming the Desire to Transfer

Revision 10-1; Effective September 27, 2010

 

Step Service Coordinator Action
1 Within three days after receiving information that an individual/LAR wants to transfer to another program provider, the SC must contact the individual/LAR to:

 

  • confirm the individual/LAR wants to transfer; and
  • explain that the individual/LAR may transfer to the program provider of his/her choice.
2 If the SC confirms that the individual/LAR wants to transfer, the SC must:

 

  • complete the individual's identifying information on Form 3617, Request for Transfer of Waiver Program Services, check the appropriate box for the type of transfer and obtain the signature of the individual/LAR, indicating the desire to transfer;
  • determine if the individual/LAR has selected a receiving program provider; and
  • notify the state support living center (SSLC) admissions placement coordinator that the individual wants to transfer, if the individual is on community placement from an SSLC and is being monitored in accordance with a community living discharge plan (CLDP).

 

8420 Selecting a Receiving Program Provider

Revision 10-1; Effective September 27, 2010

 

Step Service Coordinator Action
1 The SC must inform the individual/LAR that they have a choice of program providers, even if the individual/LAR has already selected a receiving program provider.
2 If the individual/LAR has not selected a receiving program provider, the SC must give the individual/LAR a list of program providers and contact information in the geographic locations preferred by the individual/LAR within five days after the date the SC confirms the individual/LAR wants to transfer.
3 After the individual/LAR has selected a receiving program provider, the SC must document the individual/LAR's choice of a receiving program provider in Section II on Form 3617.

 

8430 Ensuring Agreement on Transfer Effective Date

Revision 10-1; Effective September 27, 2010

 

Step Service Coordinator Action
1 At the time the individual/LAR selects a receiving program provider, the SC must obtain a proposed transfer effective date from the individual/LAR.
2 The SC must contact the receiving program provider to determine if the date proposed by the individual/LAR is acceptable.
3 Once the receiving program provider and individual/LAR agree on a transfer effective date, the SC must contact the transferring program provider to determine if that date is agreeable to the transferring program provider. If the date is agreeable, the SC completes the steps in Section 8440, Completing Form 3617.
4 If the date is not agreeable, the SC must facilitate communication between the individual/LAR and the transferring and receiving program providers to reach a mutually agreeable transfer effective date.
5 If a transfer effective date is not agreed upon within five days after the date the individual/LAR selects a receiving program provider, the SC must consult DADS Program Enrollment for direction.
Step Receiving Program Provider Action
1 When contacted by the SC, the receiving program provider must comply with the SC's request for a transfer effective date.
2 If the proposed transfer effective date is not acceptable to the receiving program provider, the provider must have a valid reason for not accepting the date, and must suggest an alternate date to be discussed with the individual/LAR and transferring program provider.
Step Transferring Program Provider Action
1 When contacted by the SC, the transferring program provider must comply with the SC's request for a transfer effective date.
2 If the proposed transfer effective date is not acceptable to the transferring program provider, the provider must have a valid reason for not accepting the date, and must suggest an alternate date to be discussed with the individual/LAR and receiving program provider.

 

8440 Completing Form 3617

Revision 11-1; Effective January 20, 2011

 

Step Service Coordinator Action
1 The SC must enter the mutually agreed upon transfer effective date in Section I, Transferring Program Provider's Information, and Section II, Receiving Program Provider's Information, of Form 3617.
2 The SC must send Form 3617 to the transferring program provider and request that the provider complete Section I and return it to the SC within three business days.
3 After receiving a completed copy of Form 3617 from the transferring program provider, the SC must send the same Form 3617 to the receiving program provider and request that the provider complete Section II and return it to the SC within three business days.
4 The SC must ensure all signatures are on the same copy of Form 3617. The SC must sign Form 3617 after both program providers have completed their sections.
Step Transferring Program Provider Action
1 The transferring program provider must accurately complete Section I of Form 3617 in accordance with the form's instructions and sign and date the form indicating agreement with the information in Section I.
2 The transferring program provider must return the completed and signed Form 3617 to the SC within three business days after receiving it from the SC.
Step Receiving Program Provider Action
1 The receiving program provider must accurately complete Section II of Form 3617 in accordance with the form's instructions and sign and date the form indicating agreement with the information in Section II.
2 The receiving program provider must return the completed and signed Form 3617 to the SC within three business days after receiving it from the SC.

 

8450 Developing the Transfer IPC

Revision 11-1; Effective January 20, 2011

 

Step Service Coordinator Action
1 On or before the transfer effective date, the SC must meet with the individual/LAR and the receiving program provider to review the individual's current IPC and develop a transfer IPC. This must be a face-to-face meeting, if feasible.
2 The SC must ensure that the transfer IPC includes services already provided by the transferring program provider, and services to be provided by the transferring program provider before the transfer effective date. This information can be found in:

 

  • CARE Screen C72 (Services provided and billed); and
  • Section I of the completed Form 3617 (services provided but not yet billed, and services not yet provided).

The SC must also ensure that the transfer IPC includes services to be provided by the receiving program provider.

3 The SC must ensure the transfer IPC:

 

  • complies with the requirements described in §9.159(c); and
  • is signed and dated by the individual/LAR, receiving program provider, and SC.
4 At the transfer IPC meeting, the SC ensures the receiving program provider completes Section II of Form 3617 and returns it to the SC.
Step Receiving Program Provider Action
1 The receiving program provider must meet with the individual/LAR and SC to develop and sign a transfer IPC, as requested by the SC.
2 The receiving program provider must complete Section II of Form 3617 and return it to the SC.

 

8460 Sharing Documents

Revision 11-1; Effective January 20, 2011

 

Step Service Coordinator Action
1 The SC must submit current copies of the following documents to the receiving program provider before the transfer effective date:
  • IPC
  • ID/RC assessment
  • person-directed plan (PDP)
2 Before the transfer effective date, the SC must request from the transferring program provider the current (or the most recent) copies of the following documents for the individual:
  • pertinent medication records and/or medical information, including:
    • a list of medications
    • scheduled medical appointments
    • list of medical professionals
    • skilled nursing routines
    • therapy evaluations
    • major illnesses/injuries, surgeries or hospitalizations in the past year
    • drug allergies
    • lab results, including blood sugars
    • adaptive equipment
    • current medication administration records and immunization records
    • records of current weight and vital signs
  • Medicaid card
  • Medicare information, if applicable
  • Inventory for Client and Agency Planning (ICAP) booklet and summary sheet
  • trust fund/financial records and any money due the individual
  • behavior support plan, if applicable
  • guardianship information, if applicable
  • any other pertinent information to ensure health and safety or continuity of services.
3 The SC must submit the documents listed in Step 2 to the receiving program provider within two days after receiving them from the transferring program provider. If the SC does not receive all documents from the transferring program provider within three days after requesting them, the SC must notify DADS PE.
Step Transferring Program Provider Action
1 The transferring program provider must submit copies of the documents listed in Step 2 to the SC within three days after the SC's request.

 

8470 Completing CARE Data Entry and Faxing Documents to DADS

Revision 11-1; Effective January 20, 2011

 

Step LA Action
1 Within 10 days after the transfer effective date, the LA must complete all data entry to finalize a transfer. See Section 8330, CARE Data Entry, for more information. For an emergency transfer, DADS PE enters the transfer data in CARE.
2 If the individual is transferring to a group home or foster care setting and the receiving program provider does not have access to the CARE system to set up a location, the LA should contact DADS PE for assistance.
3 After the LA has completed the data entry described in Step 1, but within 10 days after the transfer effective date, the SC must fax the completed transfer IPC and Form 3617 to the DADS PE staff handling the transfer (i.e., the DADS PE staff assigned to the receiving program provider).
Step Receiving Program Provider Action
1 If the individual is transferring to a group home or foster care setting, the receiving program provider must assign a location code for the individual's residence and set up the location in CARE. If the individual will be assigned to a location that has already been set up, the program provider must ensure that the status of the location is "open" and will not exceed the capacity for that residence. If the receiving program provider does not have access to CARE, the program provider must notify the LA of such.
2 The receiving program provider must assign a local case number for its component code for the individual for data entry by the LA. If the individual already has a local case number with the program provider's component code, no additional number is required.

 

8500 Program Provider Transfer Involving Two Local Authorities (LAs)

Revision 10-1; Effective September 27, 2010

 

Sections 8510 through 8570 describe the requirements for a program provider transfer involving two LAs. The SC for the transferring LA and the SC for the receiving LA must both be involved to coordinate the individual's transfer.

 

8510 Confirming the Desire to Transfer

Revision 10-1; Effective September 27, 2010

 

Step Transferring Service Coordinator Action
1 If the individual has not already relocated to the receiving LA's local service area, the transferring SC must:
  • complete the steps in Section 8410, Confirming the Desire to Transfer; and
  • contact the receiving LA to identify the receiving SC (by accessing CARE Screen C87 for the receiving LA's information, or by contacting DADS PE for this information).
Step Receiving LA/Service Coordinator Action
1 The receiving LA must assign an SC to the individual transferring to the LA's local service area.
2 If the individual has already relocated to the receiving LA's local service area, the receiving SC must complete the steps in Section 8410.

 

8520 Selecting a Receiving Program Provider

Revision 10-1; Effective September 27, 2010

 

Step Transferring Service Coordinator Action
1 If the individual has not already relocated to the receiving LA's local service area, the transferring SC must complete the steps in Section 8420, Selecting a Receiving Program Provider.
Step Receiving Service Coordinator Action
1 If the individual has already relocated to the receiving LA's local service area, the receiving SC must complete the steps in Section 8420.

 

8530 Ensuring Agreement on Transfer Effective Date

Revision 10-1; Effective September 27, 2010

 

Step Transferring Service Coordinator Action
1 If the individual has not already relocated to the receiving LA's local service area, the transferring SC must complete the steps in Section 8430, Ensuring Agreement on Transfer Effective Date.
Step Receiving Service Coordinator Action
1 If the individual has already relocated to the receiving LA's local service area, the receiving SC must complete the steps in Section 8430.
Step Receiving Program Provider Action
1 The receiving program provider must complete the steps in Section 8430.
Step Transferring Program Provider Action
1 The transferring program provider must complete the steps in Section 8430.

 

8540 Completing Form 3617

Revision 10-1; Effective September 27, 2010

 

Step Transferring Service Coordinator Action
1 If the individual has not already relocated to the receiving LA's local service area, the transferring SC must complete the steps in Section 8440, Completing Form 3617.
Step Receiving Service Coordinator Action
1 If the individual has already relocated to the receiving LA's local service area, the receiving SC must complete the steps in Section 8440.

 

8550 Developing the Transfer IPC

Revision 10-1; Effective September 27, 2010

 

Step Transferring Service Coordinator Action
1 If the individual has not already relocated to the receiving LA's local service area, on or before the transfer effective date, the transferring SC must complete the steps in Section 8450, Developing the Transfer IPC.
Step Receiving Service Coordinator Action
1 If the individual has already relocated to the receiving LA's local service area, on or before the transfer effective date, the receiving SC must complete the steps in Section 8450.
2 The receiving SC must fax the following documents to the transferring SC for data entry:

 

  • the completed and signed transfer IPC; and
  • the completed and signed Form 3617, Request for Transfer of Waiver Program Services.
Step Receiving Program Provider Action
1 The receiving program provider must complete the steps in Section 8450.

 

8560 Sharing Documents

Revision 11-1; Effective January 20, 2011

 

Step Transferring Service Coordinator Action
1 The transferring SC must submit current copies of the following documents to the receiving SC before the transfer effective date:

 

  • IPC
  • ID/RC assessment
  • PDP
2 Before the transfer effective date, the transferring SC must request from the transferring program provider the current (or the most recent) copies of the following documents for the individual:

 

  • pertinent medication records and/or medical information, including:
    • a list of medications
    • scheduled medical appointments
    • list of medical professionals
    • skilled nursing routines
    • therapy evaluations
    • major illnesses/injuries, surgeries or hospitalizations in the past year
    • drug allergies
    • lab results, including blood sugars
    • adaptive equipment
    • current medication administration records and immunization records
    • records of current weight and vital signs
  • Medicaid card
  • Medicare information, if applicable
  • ICAP booklet and summary sheet
  • trust fund/financial records and any money due the individual
  • behavior support plan, if applicable
  • guardianship information, if applicable
  • any other pertinent information to ensure health and safety or continuity of services.
3 The transferring SC must submit the documents listed in Step 2 to the receiving SC within two days after receiving them from the transferring program provider. If the SC does not receive all documents from the transferring program provider within three days after requesting them, the SC must notify DADS PE.
Step Receiving Service Coordinator Action
1 The receiving SC must submit to the receiving program provider the documents received from the transferring SC within two days after receiving them from the transferring SC.
Step Transferring Program Provider Action
1 The transferring program provider must submit copies of the documents listed in Step 2, Transferring Service Coordinator Action, to the SC within three days after the SC's request.

 

8570 Completing CARE Data Entry and Faxing Documents to DADS

Revision 11-1; Effective January 20, 2011

 

Step Transferring LA/Service Coordinator (SC) Action
1 Within 10 days after the transfer effective date, the transferring LA must complete all data entry to finalize a transfer. See Section 8330, CARE Data Entry, for more information. For an emergency transfer, DADS PE enters the transfer data in CARE.
2 If the individual is transferring to a group home or foster care setting and the receiving program provider does not have access to the CARE system to set up a location, the transferring LA must contact DADS PE for assistance.
3 No later than one day after the data is entered in CARE, the transferring SC must fax the transfer IPC and Form 3617 to the DADS PE staff handling the transfer (i.e., the DADS PE staff assigned to the receiving program provider) and then notify the receiving SC that data entry and document submission to DADS are both complete.
Step Receiving Program Provider Action
1 The receiving program provider must complete the steps in Section 8470, Completing CARE Data Entry and Faxing Documents to DADS.

 

8600 CDSA Transfer and Changing Service Delivery Option

Revision 10-1; Effective September 27, 2010

 

Sections 8610 through 8660 describe the requirements for transferring to another CDSA and changing service delivery options.

 

8610 Confirming the Desire to Transfer or Change Service Delivery Option

Revision 10-1; Effective September 27, 2010

 

Step Service Coordinator Action
1 Within three days after receiving information that an individual/LAR wants to transfer to another CDSA or change their service delivery option, the SC must contact the individual/LAR to:
  • confirm the individual/LAR wants to transfer or change their service delivery option; and
  • explain that the individual/LAR may choose any CDSA or receiving program provider, as appropriate.
2 If the SC confirms that the individual/LAR wants to transfer or change their service delivery option, the SC must:
  • complete the individual's identifying information on Form 3617, Request for Transfer of Waiver Program Services, check the appropriate box for the type of transfer using the form instructions, and obtain the signature of the individual/LAR, indicating the desire to transfer or change the service delivery option; and
  • determine if the individual/LAR has selected a receiving CDSA/program provider, as appropriate.

 

8620 Selecting a Receiving CDSA or Receiving Program Provider

Revision 10-1; Effective September 27, 2010

 

Step Service Coordinator Action
1 The SC must inform the individual/LAR that they have a choice of CDSAs/program providers, even if the individual/LAR has already selected a receiving CDSA/program provider.
2 If the individual/LAR has not selected a receiving CDSA/program provider, the SC must give the individual/LAR a list of CDSAs/program providers, and contact information in the geographic locations preferred by the individual/LAR within five days after the date the SC confirms the individual/LAR wants to transfer or change their service delivery option.
3 After the individual/LAR has selected a receiving CDSA/program provider, the SC must document the individual/LAR's choice of a receiving CDSA/program provider in Section II/Section IV on Form 3617.

 

8630 Ensuring Agreement on Transfer Effective Date

Revision 10-1; Effective September 27, 2010

 

Step Service Coordinator Action
1 At the time the individual/LAR selects a receiving CDSA/program provider, the SC must obtain a proposed transfer effective date from the individual/LAR. (For a change of service delivery option, the transfer effective date is also the date the change of service delivery option would become effective.)
2 The SC must contact the receiving CDSA/program provider to determine if the date proposed by the individual/LAR is acceptable.
3 Once the receiving CDSA/program provider and individual/LAR agree on a transfer effective date, the SC must contact the transferring CDSA/program provider to determine if that date is agreeable to the transferring CDSA/program provider. If the date is agreeable, the SC completes the steps in Section 8640, Completing Form 3617.
4 If the date is not agreeable, the SC must facilitate communication between the individual/LAR and all involved CDSAs/program providers to reach a mutually agreeable transfer effective date.
5 If a transfer effective date is not agreed upon within five days after the date the individual/LAR selects a receiving CDSA/program provider, the SC must consult DADS PE for direction.
Step Receiving CDSA/Program Provider Action
1 When contacted by the SC, the receiving CDSA/program provider must comply with the SC's request for a transfer effective date. (For a change of service delivery option, the transfer effective date is also the date the change of service delivery option would become effective.)
2 If the proposed transfer effective date is not acceptable to the receiving CDSA/program provider, the CDSA/program provider must have a valid reason for not accepting the date, and must suggest an alternate date to be discussed with the individual/LAR and transferring CDSA/program provider.
Step Transferring CDSA/Program Provider Action
1 When contacted by the SC, the transferring CDSA/program provider must comply with the SC's request for a transfer effective date. (For a change of service delivery option, the transfer effective date is also the date the change of service delivery option would become effective.)
2 If the proposed transfer effective date is not acceptable to the transferring CDSA/program provider, the CDSA/program provider must have a valid reason for not accepting the date, and must suggest an alternate date to be discussed with the individual/LAR and receiving CDSA/program provider.

 

8640 Completing Form 3617

Revision 10-1; Effective September 27, 2010

 

Step Service Coordinator Action
1 The SC must enter the mutually agreed upon transfer effective date in the appropriate sections on Form 3617 as follows:

 

  • Section I, Transferring Program Provider's Information;
  • Section II, Receiving Program Provider's Information;
  • Section III, Transferring CDSA's Information; and
  • Section IV, Receiving CDSA's Information.
2 Depending on the CDSAs/program providers involved, the SC must ensure the appropriate sections of Form 3617 are completed in the following order:

 

  • Section I, Transferring Program Provider's Information;
  • Section III, Transferring CDSA's Information;
  • Section II, Receiving Program Provider's Information; and
  • Section IV, Receiving CDSA's Information.

The SC is responsible for faxing Form 3617 to the involved CDSA/program provider in the above order and to request that the CDSA/program provider complete its section of the form and return it to the SC within three business days.

3 The SC must ensure all signatures are on the same copy of Form 3617. The SC must sign Form 3617 after the involved CDSAs/program providers have completed their sections.
Step Transferring CDSA/Program Provider Action
1 The transferring CDSA/program provider must accurately complete Section I/Section III of Form 3617, in accordance with the form's instructions, and sign and date the form, indicating agreement with the information in Section I/Section III.
2 The transferring CDSA/program provider must return the completed and signed Form 3617 to the SC within three business days after receiving it from the SC.
Step Receiving CDSA/Program Provider Action
1 The receiving CDSA/program provider must accurately complete Section II/Section IV of Form 3617, in accordance with the form's instructions, and sign and date the form, indicating agreement with the information in Section II/Section IV.
2 The receiving CDSA/program provider must return the completed and signed Form 3617 to the SC within three business days after receiving it from the SC.

 

8650 Developing the Transfer IPC

Revision 10-1; Effective September 27, 2010

 

Step Service Coordinator Action
1 On or before the transfer effective date, the SC must meet with the CDS employer (individual/LAR) and the receiving program provider, if applicable, to review the individual's current IPC and develop a transfer IPC. This must be a face-to-face meeting, if feasible.
2 The SC must ensure that the transfer IPC includes services already provided by the transferring CDSA/program provider, as well as those to be provided by the transferring CDSA/program provider before the transfer effective date. This information can be found in:

 

  • CARE Screen C72 (Services provided and billed); and
  • Section I and Section III of the completed Form 3617 (services provided but not yet billed and services not yet provided).

The SC must also ensure that the transfer IPC includes services to be provided beginning on the day of the transfer effective date.

3 The SC must ensure the transfer IPC:

 

  • complies with the requirements described in §9.159(c); and
  • is signed and dated by the individual/LAR, receiving CDSA/program provider and SC.
Step Receiving Program Provider Action
1 The receiving program provider must meet with the CDS employer and SC to develop and sign a transfer IPC, as requested by the SC.
Step Receiving CDSA Action
1 The receiving CDSA must sign a transfer IPC, as requested by the SC.

 

8660 Completing CARE Data Entry and Faxing Documents to DADS

Revision 10-1; Effective September 27, 2010

 

Step LA Action
1 Within 10 days after the transfer effective date, the LA must complete all data entry to finalize a transfer. See Section 8330, CARE Data Entry, for more information.
2 Following data entry, but within 10 days after the transfer effective date, the SC must fax the completed transfer IPC and Form 3617 to the DADS PE staff handling the transfer (i.e., the DADS PE staff assigned to the current or receiving program provider or, if the individual is only receiving the CDS option, the staff assigned to the LA's program provider).
Step Receiving CDSA/Program Provider Action
1 The receiving CDSA/program provider must assign a local case number for its component code for the individual for data entry by the LA. If the individual already has a local case number with the CDSA's/program provider's component code, no additional number is required.

 

8700 Notification by DADS Program Enrollment (PE)

Revision 10-1; Effective September 27, 2010

 

DADS PE reviews the completed Form 3617, Request for Transfer of Waiver Program Services, and the transfer IPC to determine if a transfer is authorized. If DADS authorizes a transfer, DADS PE notifies the individual/LAR of the authorization by mail, and notifies all involved program providers, CDSAs and LAs of the authorization in writing. A transfer under Section 8000 is not effective unless authorized by DADS.

 

8800 Local Authority (LA) Reassignment

Revision 10-1; Effective September 27, 2010

 

Step Transferring LA Action
1 If an individual moves to a different LA's service area without changing program provider within a waiver contract area*, the transferring LA must:

 

  • notify the receiving LA of the move by completing Form 8575, Notification of Local Authority (LA) Reassignment;
  • enter the data from the form into CARE Screen L30; and
  • notify the state supported living center (SSLC) admissions placement coordinator that the individual has moved to a different LA's service area, if the individual is on community placement from an SSLC and is being monitored in accordance with a community living discharge plan (CLDP).

* Click here and scroll to the last page to see a list of LAs by waiver contract area (WCA).

The CARE User's Guide includes step-by-step instructions for entering an individual's LA reassignment and may be found at: http://www2.mhmr.state.tx.us/655/cis/training/files/waiver/mra%20guide/mra%20assignment%20notification.pdf.

Note: The CARE User's Guide is only available to those who have access to the CARE system.

2 After the transferring LA has entered the data, the transferring LA must fax Form 8575 to the receiving LA.
3 Within three days after the transferring LA faxes Form 8575 to the receiving LA, the transferring SC must submit to the receiving SC a copy of the individual's:

 

  • current PDP (if developed because of recent enrollment or IPC renewal);
  • current ID/RC assessment;
  • current IPC;
  • current guardianship documents, if applicable; and
  • address and other contact information of the individual's LAR or actively involved family member.
Step Receiving LA Action
1 Within five days after receiving the faxed Form 8575 from the transferring LA, as described in Step 2 above, the receiving LA must:

 

  • complete its portion of the form; and
  • enter that data of the form in CARE Screen L30.

The CARE User's Guide includes step-by-step instructions for entering an individual's LA reassignment and may be found at: http://www2.mhmr.state.tx.us/655/cis/training/files/waiver/mra%20guide/mra%20assignment%20notification.pdf.

Note: The CARE User's Guide is only available to those who have access to the CARE system.

2 Within five days after receiving the faxed Form 8575 from the transferring LA, as described in Step 2 above, the receiving LA must assign an SC to the individual transferring to the LA's local service area.
 

 

Contact Information

Questions regarding these requirements may be directed to the DADS Program Enrollment general email box at: enrollmenttransferdischargeinfo@dads.state.tx.us or the DADS Program Enrollment general phone message line at 512-438-5055.

Texas Home Living (TxHmL) and Home and Community-based Services (HCS) reference material are available online at:
hhs.texas.gov/laws-regulations/handbooks/texas-home-living-txhml-program
hhs.texas.gov/laws-regulations/handbooks/texas-home-living-txhml-program/txhml-forms
hhs.texas.gov/laws-regulations/handbooks/home-and-community-based-services-handbook
https://hhsportal.hhs.state.tx.us/helpGuide/Content/16_CARE/WaiverPDF/HCS%20Provider%20User%20Guide.pdf
https://hhsportal.hhs.state.tx.us/helpGuide/Content/16_CARE/TxHML20Guide.pdf
https://hhsportal.hhs.state.tx.us/helpGuide/Content/16_CARE/WaiverPDF/MRA%20User%20Guide.pdf​​​​​​​
https://hhsportal.hhs.state.tx.us/helpGuide/Content/16_CARE/WaiverPDF/CDSA%20User%20Guide.pdf

HCS, Section 9000, Suspensions

Revision 12-2; Effective April 6, 2012

 

This section describes the process for suspending an individual's Home and Community-based Services (HCS) or Texas Home Living (TxHmL) Program waiver services and requesting a continuation of the suspension beyond 270 days.

A program advisor in the Department of Aging and Disability Services (DADS) Intellectual and Developmental Disability (IDD) Waivers Program Enrollment/Utilization Review (PE/UR) unit will request information from the service coordinator (SC) every 30 days, or as appropriate, during the period an individual's waiver program services are suspended.

The individual's services will remain suspended until it is appropriate for the individual's services to resume or the decision is made to terminate the individual's services.

DADS may request that an individual's HCS or TxHmL services be terminated at any time, if appropriate.

 

9100 Reasons for Suspension of Waiver Program Services

Revision 12-2; Effective April 6, 2012

 

There are situations that may cause an individual to become temporarily ineligible or unavailable for waiver program services. The following are valid reasons for suspending an individual's waiver program services. (The following reasons for suspension are listed in CARE Screen C18.)

Loss of Financial Eligibility – This reason is used only when an individual no longer meets the financial eligibility requirements for the program.

Hospitalization (Medical) – This reason is used only when an individual has been admitted to a medical hospital. (The individual's waiver program services must be suspended.)

Elopement (Unable to locate) – This reason is used when a program provider and SC have been unable to locate an individual or when an individual or the legally authorized representative (LAR) refuses to allow the program provider to provide waiver program services.

Crisis Stabilization – This reason is used only when an individual has been admitted to a non-state-operated psychiatric treatment center. (The individual's waiver program services must be suspended.)

Hospitalization (Psychiatric) – This reason is used only when an individual has been admitted to a state-operated psychiatric hospital. (The individual's waiver program services must be suspended.)

Vacation/Furlough – This reason is used when an individual is out of town/state or away on a vacation.

Incarceration – This reason is used only when an individual has been incarcerated. (The individual's waiver program services must be suspended.)

State School – This reason is used when an individual has been admitted to a state supported living center. (The individual's waiver program services must be suspended.)

Nursing Facility – This reason is used when an individual has been admitted to a nursing facility or rehabilitation center. (The individual's waiver program services must be suspended.)

ICF/MR – This reason is used when an individual has been admitted to a community intermediate care facility for persons with intellectual disability (ICF/ID). (The individual's waiver program services must be suspended.)

 

9200 Program Provider Responsibilities

Revision 11-2; Effective March 1, 2011

 

The program provider:

 

9300 DADS Activities

Revision 12-2; Effective April 6, 2012

 

DADS Program Enrollment/Utilization Review (PE/UR) program advisors request periodic status reports from the service coordinator for suspensions that exceed 30 days by sending a Suspension of Waiver Services Status Report form to the Local Authority (LA). The program advisor completes the top section and sends the form by secure email to the SC contact at the LA after an individual has been on suspension for 30 days or longer. Thereafter, the program advisor sends the form requesting a status update as often as the advisor determines is necessary, as long as the individual remains on suspension. All email communication between DADS and the LA regarding an individual's suspension must be via secure email.

 

9400 Service Coordinator Responsibilities

Revision 12-2; Effective April 6, 2012

 

The SC:

If the suspension continues for 270 days, the SC discusses with the individual/LAR or involved family members and the provider regarding whether the individual will be able to resume services or if services should be terminated.

DADS reviews all recommendations for terminations of services. If DADS agrees that termination is appropriate, DADS will contact the SC to advise the SC to submit a request for termination in accordance with Section 10100, Process for Requesting Termination of Waiver Services – Texas Home Living and Home and Community-based Services.

 

9410 Request to Continue Suspension of Waiver Program Services

Revision 12-2; Effective April 6, 2012

 

If it is foreseeable that the individual will be able to resume waiver program services, the SC requests that waiver program services be continued for 30 days by submitting the following documentation to DADS no later than the 277th day of suspension:

The request may be returned to the program advisor via secure email, faxed to 512-438-4249 or mailed to:

Department of Aging and Disability Services
IDD Waivers Program Enrollment/Utilization Review, Mail Code W-551
P.O. Box 149030
Austin, TX 78714-9030

 

Contact Information

Questions regarding this process should be directed to the DADS IDD Waivers Program Enrollment/Utilization Review general email box at enrollmenttransferdischargeinfo@dads.state.tx.us or telephone message line at 512-438-5055.

Texas Home Living and Home and Community-based Services reference materials are available online at:

hhs.texas.gov/laws-regulations/handbooks/texas-home-living-txhml-program
hhs.texas.gov/laws-regulations/handbooks/texas-home-living-txhml-program/txhml-forms
hhs.texas.gov/laws-regulations/handbooks/home-and-community-based-services-handbook
https://hhsportal.hhs.state.tx.us/helpGuide/Content/16_CARE/WaiverPDF/L03.pdf
https://hhsportal.hhs.state.tx.us/helpGuide/Content/16_CARE/TxHML20Guide.pdf
https://hhsportal.hhs.state.tx.us/helpGuide/Content/16_CARE/WaiverPDF/MRA%20User%20Guide.pdf
https://hhsportal.hhs.state.tx.us/helpGuide/Content/16_CARE/WaiverPDF/CDSA%20User%20Guide.pdf

HCS, Section 10000, Terminations

Revision 10-0; Effective June 1, 2010

 

 

10100 Process for Requesting Termination of Waiver Services – Texas Home Living and Home and Community-based Services

Revision 10-0; Effective June 1, 2010

 

A request to terminate an individual's waiver program services must be submitted by the individual's assigned service coordinator (SC) at the Local Authority (LA).

By submitting a request to terminate waiver program services, the SC is requesting that DADS end the individual's waiver program enrollment. By signing and dating Form 3616, Request for Termination of Services Provided by HCS/TxHmL Waiver Provider, all involved parties are indicating an agreement with the termination of services.

CARE Data Entry

The program provider must complete CARE screen C18 and the SC must review screen L18 prior to submitting required documentation for termination of waiver program services.

Required documentation for termination of waiver program services may be faxed to 512-438-4249 or mailed to:

Department of Aging and Disability Services
Program Enrollment, Mail Code W-551
P.O. Box 149030
Austin, TX 78714-9030

Reasons for Requesting a Termination

There are several valid reasons for requesting that an individual's waiver program services be terminated, and DADS Program Enrollment (PE) requires specific documentation depending on the reason for the termination. The required documentation for each reason is described below.

Death – When the SC has learned about the death of a waiver program participant, the SC must submit:

State Supported Living Center (SSLC) – When an individual is admitted to an SSLC, the individual's program provider must place the individual on suspension of waiver program services (temporary discharge) until after the SSLC makes a recommendation regarding the individual's continued placement at the individual's initial planning meeting, which occurs within 30 days after admission. If the SSLC recommends the individual's continued placement at the SSLC, the only required documentation the SC must submit is a completed Form 3616 (the termination date on the form must be the same date of the initial planning meeting at the SSLC).

Loss of Financial Eligibility (Medicaid) – The following documentation is required:

Voluntary Withdrawal – There are several reasons an individual or LAR may choose to voluntarily withdraw from the waiver program. In every instance a completed Form 3616 must be submitted. Additional required documentation is based upon the reason for the voluntary withdraw as explained below:

Institutionalization – There are several types of institutionalization. In every instance a completed Form 3616 must be submitted. Additional required documentation is based upon the type of institutional setting as explained below:

Individual Cannot Be Located – When an individual cannot be located, the SC must submit a completed Form 3616 and documentation of a final attempt to contact the individual. The SC must review the information available in CARE screen C63.The last screen in the C63 sequence shows the mailing address to which HHSC sends the individual's Medicaid card and the SSA sends the individual's Supplemental Security Income check. The SC must mail a letter (by both regular and certified mail) to that address as a final attempt to contact the individual or LAR. The letter must notify the individual or LAR that:

If the individual or LAR does not respond within four weeks from the date of the letter, the SC must submit documentation of all methods used to attempt to locate the individual or LAR and the dates of each attempt (for example, home visits, telephone calls and conversations with family members, neighbors, employers, friends, co-workers, apartment managers) and copies of all letters mailed to the individual/LAR (and a copy of certified return receipt if mailed certified).

Unable to Meet Health/Safety – If an SC believes an individual's health and safety needs cannot be met by the HCS Program, the SC must contact DADS PE for further instruction.

Role of DADS Program Enrollment – Upon receipt of a request for termination of waiver program services, DADS Program Enrollment will review all documentation submitted by the SC. If the documentation is not sufficient for termination of the individual's waiver program services, DADS staff will contact the SC for more information/documentation. If the documentation is sufficient for termination of the individual's waiver program services, Program Enrollment staff will notify the individual or LAR by certified mail of the decision to terminate waiver program services and the individual's right to request a fair hearing to appeal the decision. The program provider and SC will receive a copy of the notification letter.

Contact Information

Questions regarding this process should be directed to the DADS Program Enrollment general email box at: enrollmenttransferdischargeinfo@dads.state.tx.us or general message line at 512-438-5055.

TxHmL and HCS reference materials are available online at:
hhs.texas.gov/laws-regulations/handbooks/texas-home-living-txhml-program
hhs.texas.gov/laws-regulations/handbooks/texas-home-living-txhml-program/txhml-forms
hhs.texas.gov/laws-regulations/handbooks/home-and-community-based-services-handbook
https://hhsportal.hhs.state.tx.us/helpGuide/Content/16_CARE/WaiverPDF/HCS%20Provider%20User%20Guide.pdf
https://hhsportal.hhs.state.tx.us/helpGuide/Content/16_CARE/TxHML20Guide.pdf​​​​​​​
https://hhsportal.hhs.state.tx.us/helpGuide/Content/16_CARE/WaiverPDF/MRA%20User%20Guide.pdf​​​​​​​
https://hhsportal.hhs.state.tx.us/helpGuide/Content/16_CARE/WaiverPDF/CDSA%20User%20Guide.pdf

Termination Section of CARE User's Guide

Instructions for entering a termination in CARE can be found at: https://hhsportal.hhs.state.tx.us/helpGuide/Content/16_CARE/WaiverPDF/MRA%20User%20Guide.pdf

Note: The CARE User's Guide is only available to those who have access to the CARE system.

HCS, Section 11000, Maintaining Medicaid Eligibility

Revision 11-2; Effective March 1, 2011

 

 

11100 Financial Eligibility Guidelines for Texas Home Living and Home and Community-based Services

Revision 10-0; Effective June 1, 2010

 

The Texas Department of Aging and Disability Services (DADS) requires all individuals to meet financial eligibility for enrollment in the Texas Home Living (TxHmL) or Home and Community-based Services (HCS) waiver program. After enrollment, financial eligibility must be maintained in order for the individual to continue participation in the program. Individuals eligible for certain types of Medicaid coverage are financially eligible for the program; however, not all types of Medicaid coverage ensure eligibility.

There are several ways to meet the financial eligibility requirement for the TxHmL or HCS program through Medicaid certification.

Every individual certified for Medicaid benefits has a "coverage code" and a "type program" assigned to the individual's Medicaid record. The appropriate coverage code for participation in the TxHmL or HCS waiver program is "R" (regular Medicaid) or "P" (three months prior coverage); there are no other acceptable coverage codes. The only acceptable base plan is 13, except for individuals who receive Medicaid through DFPS, which does not have a base plan. There are several appropriate type programs for the waivers (see chart below). CARE Screen C63 (DHS Medicaid Eligibility Search) can be used to verify an individual's current and past Medicaid records.

Required Medicaid Codes and Type Program
Coverage Code Type Program HCS TxHmL Coverage Code Type Program HCS TxHmL
R or P 01 R or P 18
R or P 02 R or P 19
R or P 03 R or P 21
R or P 07   R or P 22
R or P 08 R or P 29
R or P 09 R or P 37  
R or P 10 R or P 44
R or P 12 R or P 47
R or P 13 R or P 48
R or P 14   R or P 51  
R or P 15 R or P 61

For specific questions regarding SSI, contact your local SSA office, call 1-800-772-1213 or visit the SSA website at www.ssa.gov.

For specific questions regarding MEPD or Texas Works, contact your local HHSC office, call 211 or visit the HHSC website at hhs.texas.gov.

For specific questions regarding DFPS, call 512-438-4800 or visit its website at www.dfps.state.tx.us.

 

11200 Responsibility to Reestablish Medicaid Eligibility

Revision 11-2; Effective March 1, 2011

 

If an individual loses Medicaid eligibility, it is the responsibility of the representative payee to contact the appropriate entity to determine necessary action to reinstate benefits.

If the HCS Program provider is the representative payee, the provider is responsible for ensuring action is taken to reestablish Medicaid eligibility.

If the individual or family is the representative payee, the service coordinator will assist, if requested.

HCS, Section 12000, Permanency Planning

Section 12000, Permanency Planning

Revision 10-0; Effective June 1, 2010

 

 

12100 Resources

Revision 10-0; Effective June 1, 2010

 

Requirement for Local Authority (LA) to Conduct Permanency Planning

The LA is required to conduct and document permanency planning for individuals under age 22 years of age who reside in an intermediate care facility for persons with intellectual disability (ICF/ID), a Home and Community-based Services (HCS) residential group home or nursing facility. Information regarding this requirement may be found at https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/texas-promoting-independence-plan

Forms and Tools

Permanency Planning forms and tools are available at: www.dads.state.tx.us/providers/pi/permanency/forms/index.html

CARE User’s Guide

Instructions for CARE data entry regarding Permanency Planning are included in the CARE User’s Guide at: https://hhsportal.hhs.state.tx.us/helpGuide/Content/16_CARE/IntellectualDisability.htm

Note: The CARE User’s Guide is only available to those who have access to the CARE system.

HCS, Section 13000, Consumer Directed Services

Revision 12-2; Effective April 6, 2012

 

 

13100 Overview of the Consumer Directed Services Option

Revision 10-0; Effective June 1, 2010

 

 

13110 Home and Community-based Services Available Through the Consumer Directed Services Option

Revision 10-0; Effective June 1, 2010

 

In the Home and Community-based Services (HCS) program, the Consumer Directed Services (CDS) option is available only to those who live in their own home or family home. Individuals who receive foster/companion care, Residential Support or Supervised Living are not eligible to use the CDS option.

The HCS services currently available for self-direction are:

When individuals select the CDS option, they are required to use Financial Management Services (FMS) and may access support consultation.

Financial Management Services (FMS) are provided by a Consumer Directed Services Agency (CDSA) chosen by the individual or legally authorized representative (LAR). FMS includes processing payroll and payables on behalf of the CDS employer. This includes serving as the CDS employer’s fiscal agent to ensure that federal, state and local employment taxes and labor and workers’ compensation requirements are implemented in an accurate and timely manner. FMS also includes orientation, training, support and assistance with and approval of CDS budgets.

Support consultation is an optional service that is provided by a support advisor and provides a level of assistance and training beyond that provided by the CDSA through FMS. Support consultation helps a CDS employer to meet the required employer responsibilities of the CDS option and to successfully deliver program services.

 

13120 Informing the Individual/LAR of the Consumer Directed Services (CDS) Option

Revision 11-3; Effective March 18, 2011

 

The service coordinator (SC) must inform an individual/legally authorized representative (LAR) of the CDS option:

Individuals have a choice in how their services are delivered:

The service delivery option individuals select will be based on their own preferences, as discussed during the person-directed planning process. It is important to tell individuals that they may switch service delivery options at any time. If they select the CDS option, they can switch to the provider-managed option at any time. However, if an individual switches from the CDS option to provider-managed option, they must wait 90 days before switching back to CDS.

The SC offers the CDS option by reviewing the following Department of Aging and Disability (DADS) forms with the individual:

The purpose of Form 1581 is to introduce the CDS option. Form 1581 gives an overview of the differences between the CDS option and the provider-managed option. This form, when signed, provides acknowledgement that the SC has provided both orally and in writing an overview of the benefits and responsibilities of the CDS option in HCS.

The purpose of Form 1582 is to provide more detailed information to the individual or LAR about the responsibilities assumed if the CDS option is selected. It concludes with the CDS Consumer Self-Assessment. The purpose of the self-assessment is to:

The self-assessment may not be used to determine that an individual/LAR cannot use the CDS option. If individuals or their LARs have difficulty responding to the self-assessment questions, they will probably need a designated representative (DR) to help them implement the CDS option, but it is the CDSA’s responsibility to assist them with appointing a DR.

The purpose of Form 1583 is to provide important definitions of terms used with CDS. This form includes information about who can be the CDS employer, who can be a designated representative and who can and cannot be hired as an employee in the CDS option for HCS.

The purpose of Form 1584 is to document the individual’s/LAR’s choice of service delivery option. If the individual or LAR is selecting the CDS option, the individual must also select a Consumer Directed Services Agency (CDSA) of his or her choice.

The SC will provide a list of CDSAs serving the individual’s waiver contract area. The CDSA choice lists can be found on the DADS website at: https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/consumer-directed-services-cds.

To locate CDSAs serving the individual’s area, type in the county in which the individual resides. The SC may use the list of CDSAs obtained on CARE screen C80. The SC should encourage the individual or LAR to call and interview several CDSAs before selecting one.

Important: CDSAs are not required to be located in the same town in which the individual resides. CDSAs provide FMS. This service does not require ongoing face-to-face contact. While CDSAs are required to make one visit to the individual’s home to conduct the CDS orientation prior to service initiation, the CDSA conducts the remainder of their business via email or fax machine with the individual or LAR, or designated representative if one has been appointed.

The purpose of Form 1586 is to provide information to the individual or LAR regarding the availability of support consultation in the HCS Program. The use of support consultation is optional. If, during the development of the Person-Directed Plan (PDP), the individual or LAR requests support consultation, this service must be included in the PDP. During the development of the Individual Plan of Care (IPC), the number of units of support consultation must be determined for inclusion in the IPC.

Support consultation includes practical skills training, coaching and assistance related to:

A support advisor provides support consultation. CDSAs are required to make support advisors available if the service is authorized on the IPC. The list of DADS certified support advisors can be found on the DADS website at: https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/consumer-directed-services-cds/certified-support-advisors.

The individual or LAR may select a certified support advisor provided by his or her CDSA, or may opt to use a certified support advisor who is not associated with the CDSA.

 

13121 Service Back-up Plans

Revision 10-0; Effective June 1, 2010

 

The CDS employer (individual or LAR) is responsible for developing a back-up plan for each service that the service planning team identifies as critical to the individual’s health and safety. During the person-directed planning process, the service planning team must identify those CDS services that require a back-up plan from the CDS employer. Critical services are defined as those that would place the health and/or welfare of the individual in jeopardy if they are not provided. CDS service back-up plans are documented on Form 1740, Service Backup Plan. The SC completes the top part of the form, indicating why a back-up plan is needed for that particular service. The CDS employer completes the back-up strategies section of the form. The CDS employer’s plan must be reviewed for feasibility by the service planning team and signed by the service planning team. It is the SC’s responsibility to review a CDS employer’s back-up plan and determine whether the strategies are reasonable and viable contingencies exist in the event an individual is unable to receive a critical program service by their regular direct service provider. If the SC determines the strategies are not reasonable and viable, the SC may support the CDS employer as needed to develop a viable plan. The SC may also suggest the CDS employer consider using support consultation to assist in the development of a back-up plan. The CDS employer is responsible for providing the CDSA with the copy of each service back-up plan after it has been approved by the service planning team.

Back-up plan strategies may include both formal and informal supports. If back-up services are to be purchased from an HCS provider, the CDS employer must include such costs in the CDS budget. In addition, persons who are paid to provide back-up services must pass all criminal history and registry checks. Funds must be allocated in the individual’s budget for criminal history checks of back-up service providers.

 

13130 Service Planning

Revision 10-0; Effective June 1, 2010

 

The CDSA does not play a role in the HCS service planning process. Any change in the amount of a service delivered through the CDS option must go through the service planning process. DADS may, at any time, request documentation to explain the basis upon which the amount of an HCS service on an individual’s IPC was determined. If DADS requests this documentation for a service the individual or LAR has chosen to self-direct using the CDS option, the CDS employer is responsible for providing the documentation to DADS. The CDS employer may request support from the SC to provide this documentation for DADS.

If the individual has an HCS provider, the service planning team and the HCS provider must revise the IPC to include the change in the amount of service(s). If the individual does not have an HCS provider, the service planning team will revise the IPC to include the change in the amount of service(s). For all IPC revisions, the SC must provide a copy of the IPC to the CDSA.

In contrast, a support advisor may participate in service planning meetings if requested by the individual or LAR. A support advisor must notify the individual’s SC:

The individual or LAR (that is, “employer”) is responsible for:

A support advisor may provide coaching in any of the areas listed above.

 

13140 Enrolling the Individual in the Consumer Directed Services Option

Revision 10-0; Effective June 1, 2010

 

To enroll an individual in the CDS option, the SC sends to the CDSA:

The CDSA needs the proposed IPC in order to conduct the required CDS orientation with the individual or LAR before services delivered via the CDS option can begin.

During the CDS orientation, several key activities must occur prior to services starting.

The CDSA will:

The CDSA will need to know the number of hours of SHL, Respite or support consultation on the proposed IPC in order to assist the employer with development of the CDS budget. The CDSA conducts the CDS orientation while the proposed IPC is under utilization review by DADS.

When the orientation has been completed the CDSA is required to notify the SC via DADS Form 2067, Case Information. The SC files the form in the individual’s record.

Services delivered through the CDS option may not begin until:

The CDSA will not allow service delivery to begin until it is notified by DADS that services are authorized in the CARE system. In the event that the number of hours authorized for SHL or Respite changes as a result of DADS utilization review, the SC will notify the CDSA of the change by sending Form 2067 to the CDSA.

 

13150 Entering Consumer Directed Services on the Individual Plan of Care

Revision 10-0; Effective June 1, 2010

 

CDSAs do not have access to enter information into CARE. If the individual has an HCS provider, the HCS provider is responsible for entering into CARE the individual's IPC data, including the individual's CDS and CDSA services. If the individual does not have an HCS provider, the SC is responsible for entering into CARE the individual's IPC data, which are the individual's CDS and CDSA services.

Financial Management Services

For individuals who use the CDS option, the IPC must include FMS. FMS is authorized as a monthly service. For example, for a 12-month period, 12 units of FMS must be included on the IPC.

Support Consultation

If the individual or LAR requests support consultation or the individual's service planning team determines that support consultation would be beneficial to provide employer coaching, hours for support consultation must also be included on the IPC.

Support consultation is to be used as needed. On average, an individual may be authorized for six to nine hours of support consultation per year. It is not the type of service to be used on a weekly basis.

Note: An HCS provider is not responsible for delivering or billing for a service delivered through the CDS option.

 

13160 Monitoring Consumer Directed Services

Revision 10-0; Effective June 1, 2010

 

The SC monitors CDS services in the same manner as non-HCS services. A key monitoring role is to determine whether the individual's health and safety is at risk in the environments in which the individual receives HCS and non-HCS services and, if necessary, to take action to protect the individual's health and safety. If the SC learns of a problem with the CDSA, the SC may report the CDSA to Consumer Rights and Services at DADS.

The CDSA is required to provide the SC and employer quarterly reports of expenditures for each consumer-directed service. The purpose of these reports is to determine over or under utilization of services. The CDSA will also note any areas of non-compliance with the CDS option on the quarterly report.

 

13170 Corrective Action Plans

Revision 10-0; Effective June 1, 2010

 

Based on review of the quarterly reports or a monitoring visit, the SC may request a corrective action plan from the employer. It is important to remember that it is the employer's responsibility, not the CDSA's, to ensure that services are delivered, that service goals are being met and that program rules are being followed.

At the request of the SC or the CDSA, the CDS employer must develop a corrective action plan using DADS Form 1741, Corrective Action Plan. The person requesting the corrective action plan completes the top part of the form indicating the specific reason a corrective action plan is needed (for example, over expenditure or failure to submit required documentation to the CDSA in a timely manner). The CDS employer completes the corrective action strategies section of the form. The CDS employer must provide written corrective action plans to the person requiring the plan within 10 calendar days after receiving the request. The CDS employer's plan must be reviewed for feasibility and signed by the service planning team. It is the SC's responsibility to review a CDS employer's corrective action plan to determine whether the resolution proposed in the plan represents a reasonable and viable solution to the identified problem. If the SC determines the resolution proposed in the plan is not a reasonable and viable solution to the identified problem, the SC may support the CDS employer as needed to develop a viable plan. The SC may also suggest the CDS employer consider using support consultation to assist in the development of a corrective action plan.

Corrective action plan information needs to be specific to the identified issue and identify specific strategies and time frames for improvement. The goal of a corrective action plan is to focus on needed supports to ensure the employer succeeds in using the CDS option.

 

13180 Termination from the Consumer Directed Services Option

Revision 12-2; Effective April 6, 2012

An individual or LAR may voluntarily request to switch from the CDS option to the provider-managed option (see Section 8600, CDSA Transfer and Changing Service Delivery Option). An individual must remain with the provider-managed option for at least 90 days before requesting to transfer back to the CDS option.

The service planning team may recommend the individual be involuntarily terminated from the CDS option. For an individual participating in CDS, the SC must recommend that DADS terminate the individual's participation in the CDS option if the SC determines that:

To recommend that DADS terminate an individual's participation in the CDS option, the SC:

The SC will notify the CDSA (using Form 2067, Case Information) that a request to terminate the CDS option has been sent to DADS for approval.

 

13190 Service Delivery Transfers from one Consumer Directed Services Agency to Another

Revision 10-1; Effective September 27, 2010

 

Refer to Section 8600, CDSA Transfer and Changing Service Delivery Option, when an individual requests to change CDSAs.

 

13200 Consumer Directed Services Resources

Revision 10-0; Effective June 1, 2010

 

The CDS rule is available at: http://texreg.sos.state.tx.us/public/readtac$ext.ViewTAC?tac_view=4&ti=40&pt=1&ch=41

Additional information regarding CDS may be found at: https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/consumer-directed-services-cds/cds-training-presentations

HCS, Section 14000, Waiver Survey and Certification

Revision 17-1; Effective October 16, 2017

 

 

14100 Waiver Survey and Certification Overview

Revision 17-1; Effective October 16, 2017

 

Waiver Survey and Certification (WSC) is a unit of Regulatory Services with the Texas Health and Human Services Commission (HHSC). WSC conducts certification reviews for the Home and Community-based Services (HCS) and Texas Home Living (TxHmL) waiver programs, and residential visits for Host Home/Companion Care and three- and four-person homes in the HCS program. WSC also reviews complaints and deaths in the HCS, TxHmL, and Deaf Blind with Multiple Disabilities (DBMD) waiver programs and follows up on abuse, neglect and exploitation (ANE) allegations related to individuals served in the HCS and TxHmL waiver programs.

 

14200 Home and Community-based Services Certification Reviews

Revision 17-1; Effective October 16, 2017

 

In accordance with Title 40, Texas Administrative Code (TAC), Chapter 9, Subchapter D (link is external), §9.171(a), all HCS program providers must be in continuous compliance with the HCS Program certification principles. (See §§9.172-174 and §§9.177-180.)

In accordance with 40 TAC, Chapter 9, Subchapter D, §9.171(e), WS&C may conduct announced or unannounced reviews of HCS program providers at any time to ensure compliance with the HCS program certification principles.

 

14210 Types of Certification Reviews

Revision 17-1; Effective October 16, 2017

 

WSC conducts on-site certification reviews of HCS program providers, at least annually, to evaluate evidence of the program provider’s compliance with certification principles.

Provisional Certification

A prospective provider for the HCS Program must complete an application packet and attend provider applicant training to obtain a contract with HHSC. If the applicant passes a competency exam at the end of the training, HHSC provisionally certifies the contract.

Initial Certification Review

After a program provider has obtained a provisional contract, WSC conducts an initial on-site certification review within 120 days after the date HHSC approves the enrollment or transfer of the first individual to receive HCS Program services from the provider under the provisional contract.

Annual Certification Review

An HCS program provider's certification period is for no more than 365 calendar days and must be renewed annually prior to the expiration of the current certification period.

Principles of noncompliance that were cited during the previous review visit and not corrected prior to the exit conference will be reviewed at the next annual certification or intermittent review. The provider must be in compliance with the previously cited principles by the end of the current certification period in order to be re-certified. If principles cited during the previous review remain in noncompliance at the time of the exit conference of the following review, the program provider must submit an evidence of correction (EoC) within 14 days, or another time period determined by WSC, with supporting evidence that these principles have been corrected.

30 Day Follow-Up Review, Vendor Hold and Denial of Certification

If WSC determines at the end of a review that a program provider is not in compliance with one or more of the certification principles that results in a condition of a serious nature, WSC will require the program provider to complete corrective action within 30 calendar days after the date of the review exit conference. An on-site follow-up review will be conducted after the 30-day period to determine if the program provider completed the corrective action.

If the program provider fails to correct all principles of noncompliance remaining from the 30-day follow-up review, WSC will require that an EoC is sent to the program manager showing that all principles have been corrected for the contract within 14 days or another time period determined by WSC. If the EoC is not sent in, or approved by WSC, then WSC will deny certification and recommend a vendor hold or termination of the contract.

If a vendor hold is imposed for a program provider with a provisional contract, HHSC will initiate termination of the program provider's contract in accordance with Texas Administrative Code (TAC) §49.534 (link is external), Termination of Contract by DADS.

If a vendor hold is imposed for a program provider with a standard contract, WSC will conduct a follow-up review to determine if the program provider completed the corrective action required to release the vendor hold. If the program provider completed the corrective action, HHSC will release the vendor hold. If the program provider has not completed the corrective action, WSC will deny certification and recommend termination of the contract.

See 40 TAC, Chapter 9, Subchapter D (link is external), §9.185, Program Provider Compliance and Corrective Action.

Intermittent Reviews

Intermittent reviews are conducted at the discretion of WSC and are based on:

 

14220 Overview of the Home and Community-based Services Certification Review Process

Revision 17-1; Effective October 16, 2017

 

HCS program providers will generally be contacted before a certification review by the review facilitator, unless there is cause for WSC to conduct an unannounced review of the program. WSC can and may conduct unannounced certification reviews or on-site visits at any time.

When the review facilitator contacts the HCS program provider of an upcoming certification review, the facilitator will fax a copy of the Provider Information Request form to the program provider.

The facilitator will also fax Form 8576, Individual Profile Information, to the HCS program provider with a requested date for the information to be completed and returned to the review facilitator.

Entrance Conference

At the beginning of every certification review, the WSC review team will conduct an entrance conference with the program provider and any program staff who are present. The WSC review facilitator will explain the review process and summarize the tentative review schedule.

The review team will review a sample of 10% or more of the individuals in the HCS program provider's contract. The team uses standardized checklists to ensure that all principles are reviewed for compliance. These checklists can be found at https://hhs.long-term-care-providers/home-and-community-based-services-hcbs/waiver-survey-and-certification-review-tools-and-formsl.

Certification review activities include, but are not limited to:

As a part of WSC reviews, reviewers note any issues related to service coordination and forward any concerns to HHSC Contract Accountability and Oversight (CAO) for follow up. HCS program providers may view notations related to their programs in the C-97 screen of the CARE system.

The review team will hold a final debriefing at the end of the review. The program provider is allowed to submit evidence to show compliance prior to the exit conference. A citation can only be cleared if the original instance of noncompliance has been remediated, a new sample of individuals, or records, are in compliance for that principle, and the provider can show a change in process or policy that ensures no future occurrences of noncompliance.

Exit Conference

WSC conducts an exit conference at the end of all on-site reviews, at a time and location determined by WSC. WSC gives the program provider a written preliminary review report at the exit conference.

Note: If the review team determines any of the individuals enrolled in the program are in imminent danger due to a hazard that threatens their health, safety or welfare, the program provider is expected to eliminate this hazard before the end of the review exit conference. If the hazard cannot be eliminated, WSC will deny certification and coordinate with the local intellectual and development disability authority the immediate provision of alternative services for the individuals.

Informal Review

If a program provider disagrees with any of the findings in the preliminary review report, the program provider may request that HHSC conduct an informal review of those findings.

To request an informal review of any of the findings in the preliminary review report, the program provider must submit a completed Form 3610, Informal Review Request, to HHSC, as instructed on the form. HHSC must receive the completed form within seven calendar days after the date of the review exit conference. If HHSC receives a timely request for an informal review, HHSC will notify the program provider in writing of the results of the informal review within 10 calendar days of receipt of the request and send the program provider a final review report within 21 calendar days after the date of the review exit conference.

If a program provider does not request an informal review, WSC will send the program provider a final review report within 21 calendar days after the date of the review exit conference.

 

14230 Corrective Action Plan

Revision 17-1; Effective October 16, 2017

 

The program provider must submit Form 8581, Corrective Action Plan (CAP), for each HCS principle that is found out of compliance at the end of the review and is determined to be non-serious in nature. The CAP is a written plan that establishes a process by which the program provider will prevent reoccurrence of the issues that resulted in the principle being found out of compliance. The CAP must be submitted to WSC for approval. A copy of Form 8581 will be given to the provider during the review.

HHSC must receive the CAP no later than 14 calendar days following the program provider's receipt of the review report. The time line for the provider's completion of the CAP must not exceed 90 calendar days from the date of the exit conference.

If the CAP is submitted by the due date, and is approved, the provider will be certified.

If the CAP is submitted by the due date but is inadequate, the program manager will notify the program provider and offer detailed information as to why the CAP is inadequate. If the program manager is unable to assist the program provider to reach compliance within two months of the review exit, written notification that its contract may be terminated will be sent to the program provider if an approvable CAP is not received within seven days of receipt of the letter.

If the program provider does not submit a CAP as required, or HHSC does not approve the CAP, HHSC will either impose a vendor hold against the program provider until the program provider submits a corrective action plan approved by HHSC or deny certification and recommend termination of the program provider’s contract.

 

14240 Home and Community-based Services Review Checklists

Revision 17-1; Effective October 16, 2017

 

Go to https://hhs.long-term-care-providers/home-and-community-based-services-hcbs/waiver-survey-and-certification-review-tools-and-formsl to view checklists and reports used by HHSC during the certification review process.

 

14300 Texas Home Living Certification Reviews

Revision 17-1; Effective October 16, 2017

 

In accordance with 40 TAC, Chapter 9, Subchapter N (link is external), §9.576(a), all TxHmL program providers must be in continuous compliance with the TxHmL Program certification principles. See §§9.578-9.580.

Per 40 TAC, Chapter 9, Subchapter N, §9.576(e), WSC may conduct announced or unannounced reviews of TxHmL program providers at any time ensure compliance with the TxHmL program certification principles.

 

14400 Residential Visits

Revision 17-1; Effective October 16, 2017

 

Effective Sept. 1, 2009, the 81st Texas Legislature, Regular Session, required HHSC to conduct annual unannounced inspections of HCS three- and four-person residences. In addition, the legislature funded annual inspections of HCS Host Home/Companion Care residences. In accordance with 40 TAC, Chapter 9, Subchapter D (link is external), §9.171(h), HHSC WSC conducts annual unannounced visits to each residence in which Host Home/Companion Care, Residential Support Services or Supervised Living is provided to verify that these residences offer environments that comply with the Form 3609, Waiver Survey and Certification Residential Checklist. Host Home/Companion Care visits may be announced or unannounced.

 

14410 Residential Visit Policy and Procedures

Revision 17-1; Effective October 16, 2017

 

Upon arrival at the residence, a residential reviewer will present their HHSC identification to the Host Home/Companion Care provider or the staff at the three-person or four-person home and explain the reason for the visit.  The residential reviewer will also leave a business card at the residence. The residential reviewer has letters written in languages other than English to use as an introduction if arriving at a residence in which no one speaks English and the residential reviewer is unable to speak the language of the people living in the residence. The letter notes the reviewer will need to secure interpreting services through the available resource of the agency in order to interpret for the Host Home/Companion Care provider or staff at the three- or four- person home. Each residential reviewer will have a copy of the Letter of Authorization signed by the Associate Commissioner for Regulatory Services and the Director of Survey Operations. This letter explains the legislative mandates that require WSC to conduct residential visits and notes that each Host Home/Companion Care provider, supervised living staff, or residential support staff should have been informed by their HCS program provider of the residential visits that are being conducted.

See Information Letter #2009-99 at: https://apps.hhs.texas.gov/providers/communications/2009/letters/IL2009-99.pdf.

Residential reviewers use Form 3609, Waiver Survey and Certification Residential Checklist, to conduct each residential visit. Each item on the checklist should be marked yes, no or not applicable (N/A). Some of the checklist items require talking with the supervised living staff or residential support staff or the Host Home/Companion Care provider to assess knowledge of the specific needs of the individuals in the home and to confirm training on areas such as abuse, neglect, and exploitation (ANE), emergency plans, medications, behavior support plans and other required service provision areas.

Residential reviewers may take photographs to substantiate noncompliance with certification principles in the HCS and TxHmL program, when appropriate.

Residential reviewers will leave a letter with a link to an online survey for the Host Home/Companion Care giver, or provider, to give feedback about the residential visit. Providers are encouraged to share their experience so WSC can continue to work on improving the residential visit process and training for the reviewers.

If the Address in CARE is Invalid

If the residential reviewer arrives at a home that is no longer associated with the HCS Program, or cannot find the address provided for a location code in CARE, the residential reviewer will fill out Form 3609 noting the incorrect address. A letter notifying the provider of the inaccuracy in CARE will be sent to the HCS program provider's CEO.

If No One is Home

If a residential reviewer finds no one at home after two attempts to visit the home, the reviewer contacts the program provider to find out when the residential staff is most likely to be home. Residential reviewers may call Host Home providers to verify times of the week that they will be available for a residential visit.

If the Residential Reviewer Is Not Allowed to Access the Home

If a residential reviewer is not allowed access to a three-person or a four-person home or a Host Home/Companion Care home, the residential reviewer will notify the program provider for resolution. It is the program provider's responsibility to ensure that regular or contracted employees cooperate with the residential visit process.

 

14411 Residential Visit Results

Revision 17-1; Effective October 16, 2017

 

Calculating the Score from a Residential Visit

A program provider receives a score as a result of a residential visit.

Example: A residential visit of a program provider is conducted, and there are 30 items on the checklist that are applicable to the visit. During the visit, three items on the checklist are marked “fail,” and two significant risks are identified.

100 points ÷ 30 applicable items = 3.33 points/item

100 points – [(3 items marked fail x 3.33) + (2 significant risks x 10)] =

100 – [9.99 + 20] =

100 – 29.99 =

70.01 (Score)

No Evidence of Correction Required and No Follow-Up Action Taken

If a program provider has no items marked “fail” on the Residential Review Checklist, WSC does not require evidence of correction (EoC) and does not conduct follow-up activities.

No Evidence of Correction Required but Follow-Up Action Taken

If a program provider receives a score of 90 or above and there is no significant risk identified during the residential visit, WSC does not require EoC to be submitted. At the next residential visit, WSC examines the items marked “fail” at the previous visit and requires EoC for any of those items that have not been corrected. If the program provider does not submit EoC as required, or WSC does not approve the EoC, WSC may conduct a certification review in accordance with 40 TAC §9.171.

Evidence of Correction Required

If a program provider receives a score below 90 or there is an identified significant risk, WSC requires EoC for all items marked “significant risk” or “fail.” WSC also requires the program provider to take immediate action or prompt action for an identified significant risk, as described below. If the program provider does not submit EoC as required, or WSC does not approve the EoC, WSC may conduct a certification review in accordance with 40 TAC §9.171.

A program provider must mail, email or fax the EoC to WSC using Form 1573, Residential Review Evidence of Correction. The reference number for the residential visit and the instructions for submission of documentation relating to the EoC, including the time frame by which WSC must receive the EoC, are included on a report HHSC mails to the provider after the residential visit. A provider must include the reference number on Form 1573. WSC will not accept EoC without the correct reference number included.

Significant Risk Identified

A significant risk is an act or failure to act by the program provider that could have a major adverse effect on the health, safety or welfare of one or more individuals, including emotional or physical harm, or death. If WSC determines that an item marked “fail” on the Residential Review Checklist results in a significant risk, WSC requires the program provider to take immediate or prompt action.

 

14500 Death Reviews

Revision 17-1; Effective October 16, 2017

 

Note: See also Section 17000, Critical Incident and Death Reporting.

In accordance with 40 TAC, Chapter 9, Subchapter D (link is external), §9.178(w), HCS program providers must report the death of an individual in their HCS program to HHSC and the service coordinator by the end of the next business day following the death or the program provider's learning of the death. Form 8493, Notification Regarding a Death in HCS, TxHmL and DBMD Programs, must be faxed to WSC at 512-438-4148.  The risk assessment coordinators (RACs) collect specific information regarding the death from the program provider and may request additional records, depending on the conditions existing at the time of death. The Death Review Group (DRG), which is made up of the WSC RACs, RAC RNs and RAC manager, meets routinely to review the circumstances surrounding each death. Additional regulatory follow up, including an on-site review, may be scheduled to evaluate the program provider's compliance with HCS or Texas Home Living certification principles as the result of the DRG review.

 

14510 Death Review Policy and Procedures

Revision 17-1; Effective October 16, 2017

 

Risk assessment coordinators collect the following information:

Information Gathering

Requests for Additional Information

The following records may be requested by the risk assessment coordinator for specified time frames, depending on the conditions existing at the time of death.

Additional documents may be requested after the initial review by the WSC risk assessment coordinator nurse.

Suspicious Deaths

If any circumstances surrounding the death are suspicious, WSC may take further actions, including, but not limited to, referral to local police departments and DFPS, completion of an intermittent certification review or referral to HHSC to pursue contract actions. The WSC director or assistant director is informed immediately of suspicious circumstances surrounding a death or if other issues of concern are noted.

Follow-up Activities

Risk assessment coordinators may conduct a desk review based on the information received from the provider, requested records and/or the information received from DFPS.

The WSC risk assessment manager may authorize an on-site visit based on the circumstances of the death, information obtained from a desk review or information obtained from DFPS. If the review team determines that the provider is in non-compliance with one or more of the HCS program certification principles during an on-site visit, an intermittent review will be opened.

 

14600 Abuse, Neglect and Exploitation Follow Up

Revision 17-1; Effective October 16, 2017

 

WSC receives investigative reports related to allegations of abuse, neglect or exploitation of individuals who receive HCS, TxHmL or ICF/ID program services. The reports are reviewed by WSC risk assessment coordinators to determine whether regulatory follow-up is required. Additional documentation may be requested from the program provider to verify that the program provider managed the allegation of abuse, neglect and exploitation according to program standards. In addition, on-site follow up may be scheduled.

 

14610 Abuse, Neglect and Exploitation Policy and Procedures

Revision 17-1; Effective October 16, 2017

 

The final HHSC report is reviewed by risk assessment coordinators (RACs) to determine what actions are to be taken by WSC. Actions to be taken are determined by:

HHSC sends a final report to the program provider, unless the administrator and the secondary designee are the alleged perpetrator. The program provider has 14 calendar days from the receipt of the investigation findings to notify WSC of its response to the findings by submitting Form 8494, Notification Regarding a Death in HCS, TxHmL and DBMD Programs, by fax to 512-438-4148. Form 8494 should include:

The provider is responsible for attaching documentation when submitting Form 8494 to include a response for how the provider handled any confirmed allegations or HHSC concerns or recommendations.

When deemed serious, WSC receives the intake report from Consumer Rights and Services, and it is reviewed by the risk assessment coordinators to determine what actions are to be taken by WSC. Actions to be taken are determined by:

One of the following actions is taken by WSC:

 

14700 Additional Monitoring Related to Risk Factors

Revision 17-1; Effective October 16, 2017

 

Each quarter, risk assessment coordinators (RACs) compile a report of risk factors for all HCS and Texas Home Living (TxHmL) waiver contracts. This risk factor report includes:

The RACs assess the circumstances related to the identified contracts reflected in this report for two quarters in the last calendar year. If they identify patterns or trends that indicate a possible increased risk to the health, safety or welfare of the individuals in this contract, follow-up actions are taken.

 

14800 Complaints

Revision 17-1; Effective October 16, 2017

 

HHSC Consumer Rights and Services refers complaints to the WSC risk assessment coordinators when the complaint is related to non-compliance with the HCS or TxHmL certification principles. HHSC departments refer internal complaints or concerns directly to the WSC risk assessment manager. The complaints are reviewed by the coordinators and appropriate follow-up actions are identified and completed.

 

14810 Complaints Policy and Procedures

Revision 17-1; October 16, 2017

 

If WSC staff receive a complaint from an external complainant, the person making the complaint should be immediately referred to Consumer Rights and Services at 512-438-9858.  

Consumer Rights and Services tries to resolve the complaint with the external complainant and the program provider. If the complaint cannot be resolved and it impacts the HCS principles, Consumer Rights and Services will refer it to WSC. The complaint is received by the risk assessment coordinators, who review it to determine what actions are to be taken by WSC. The actions are determined by:

Actions to be taken by WSC are:

 

14900 Four-Person Home Approvals

Revision 17-1; Effective October 16, 2017

 

Home and Community-based Services (HCS) providers must request and obtain approval of all four-person residences from HHSC. WSC Residential Review coordinators are responsible for reviewing and approving all four-person home requests in accordance with 40 TAC, Chapter 9, Subchapter D (link is external), §9.188.

 

14910 Four-Person Home Approval Policy and Procedures

Revision 17-1; Effective October 16, 2017

 

To obtain approval of a four-person residence, the program provider must complete the following steps:

Complete Form 8491, Request for a Four-Person Residence Approval, and email waiversurvey.certification@HHSC.state.tx.us or mail the completed form to:  

Texas Health and Human Services Commission
WSC Residential Review Coordinators, Mail Code E-348
P.O. Box 149030
Austin, TX 78714-9030

Include the following information:

  1. For a new home, enter information into the Client Assignment and Registration System (CARE) Screen C25 Provider Location Type Modification (two screens).
    • Header Screen (first screen) – Enter the Component Code, Location Code, "A" for Add and press enter.
    • Data Entry Screen (second screen) – Cursor will be blinking at Location Type; enter "4"; cursor will move to the next line; enter the effective date. The cursor then moves to "Ready to Add?" Enter "Y" and press enter.
  2. Establish location in CARE Screen C24 Provider Location (for new homes only). Refer to the User's Guide for data entry questions: http://www2.mhmr.state.tx.us/655/cis/training/WaiverGuide.html (link is external) (Note: The CARE User's Guide is only available for those with access to the CARE system.)
  3. Send a letter to:
  1. Indicate that the home is certified (per certifications required by 40 TAC, Chapter 9, Subchapter D (link is external), §9.178(e)(1)(A), relating to certification principles and quality assurance) by:
    • the local fire safety authority having jurisdiction in the location of the residence as being in compliance with the applicable portions of the National Fire Protection Association (NFPA) 101: Life Safety Code, as determined by the local fire safety authority;
    • the local fire safety authority having jurisdiction in the location of the residence as being in compliance with the applicable portions of the International Fire Code (IFC), as determined by the local fire safety authority; or
    • the Texas State Fire Marshal’s Office as being in compliance with the applicable portions of the Life Safety Code, as determined by the Texas State Fire Marshal’s Office; or
    • the Texas Health and Human Services Commission (HHSC) as being in compliance with the portions of the Life Safety Code applicable to small residential board and care facilities and most recently adopted by the Texas Fire Marshal’s Office.

The program provider may ask the local fire authority to complete Form 5606, Life Safety Code Certification, to verify the inspection, if needed.

If the local fire authority refuses to inspect the home, the program provider must ask the State Fire Marshal to inspect the home. If both the local fire authority and the State Fire Marshal refuse to inspect the home, a request may be made to HHSC to complete the inspection. Program providers must use Form 5604, HCS Program Provider Request for Life Safety Inspection, to request the inspection.

After initial full approval of a four-person home, the program provider is required to maintain annual fire marshal certifications required by 40 TAC §9.178(e)(1)(A) in order to maintain HHSC approval of the home. The certifications must remain current and the provider must adhere to the requirements outlined in 40 TAC §9.178(e)(1)(A).

The HCS program provider can check CARE screen C84 to see if the home has been approved.

For questions, contact HHSC Regulatory Services, Waiver Survey and Certification, at 512-438-4163 or email waiversurvey.certification@HHSC.state.tx.us.

HCS, Section 15000, Review of Authority

Revision 10-0; Effective June 1, 2010

 

 

15100 Quality Oversight of Home and Community-based Services Program Local Authority Responsibilities

Revision 10-0; Effective June 1, 2010

 

The Texas Department of Aging and Disability Services (DADS) ensures contract accountability and oversight of Local Authorities (LAs) through a variety of methods including, but not limited to, ongoing review and monitoring of CARE data, service encounter data, financial data and an annual Home and Community-based Services (HCS) on-site review.

Ongoing Monitoring

DADS conducts ongoing monitoring reviews in several areas. These activities are part of DADS' broad oversight of LA performance and include HCS authority functions. This includes review of enrollment activity, utilization review, data verification of service encounter data, data integrity review of service encounter data and review of financial data. Detailed information regarding DADS requirements for LAs can be found in the LA Performance Contract at https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/local-intellectual-and-developmental-disability-authority-lidda/lidda-performance-contract.

On-site Review of Requirements for Service Coordination

DADS will conduct an annual on-site review of HCS authority functions. This is an announced visit and includes the review of LA requirements for HCS service coordination. The review of HCS participants may also result in findings being cited in the DADS LA quality assurance review. This occurs if non-compliance with DADS rules or LA performance contract requirements is determined to be present, but is beyond the scope of the LA requirements for HCS service coordination.

Prior to the Review

DADS will assign a facilitator to coordinate the review activities for a given LA. The facilitator will draft an announcement letter to the LA executive director, which will also be copied to the LA board chair and the LA's designated contact person for coordinating the review. This letter is followed by direct communications between the facilitator and the LA contact person. The facilitator will randomly select the HCS sample of participants (meaning, the HCS individuals who will be participating in the review). The facilitator will send the LA contact person an authority review information and instructions packet that includes the sample of participants and forms to be completed and returned to the facilitator prior to the on-site review.

Entrance Conference

DADS staff conduct an entrance conference meeting at the beginning of the review. Occasionally some on-site activities may be scheduled to occur before the entrance conference. The entrance conference is between available review team members and key LA staff who will be involved in the on-site review. It serves as an opportunity to review the general agenda, provide information about the review and answer any questions.

Service Coordinator Qualifications and Training

Qualifications and training requirements for service coordinators assigned to HCS participants in the HCS sample are checked using the service coordination checklist.

Home and Community-based Services Participant Review

Each sample participant's record will be reviewed. DADS review team members will perform record reviews using the HCS documentation checklist. Follow-up meetings with assigned service coordinators will occur at the discretion of the review team members. Review team members may also determine whether there is a need to contact participants and their legally authorized representatives (LARs).

Formal Debriefing

Throughout the review process, the review team members may point out issues, identify potential findings, ask for additional information or seek clarification on issues. After completion of the review, the HCS Authority Review Report of Findings will be drafted. A formal debriefing is held and identified items of non-compliance will be shared with the LA. The LA is then given up to one hour following the formal debriefing to provide additional information that may alter or clear findings. A cited finding may be determined to be corrected on site by the review team with no further action to be taken on that item.

Exit Conference

At the conclusion of the HCS authority review, a final copy of the HCS Authority Review Report of Findings is provided to the LA at the exit conference. Barring a successful request for reconsideration of findings as described below, if any item is cited as "Not Met," a corrective action plan (CAP) will be required.

Reconsideration of Findings

An LA may request reconsideration of finding(s) of the HCS authority review based on the evidence originally submitted at the time of the on-site review. Instructions to the LA for requesting reconsideration are included at the bottom of the Report of Findings. This request for reconsideration must be submitted via email to the facilitator within 10 business days of receipt of the Report of Findings. Requests for reconsideration received later than 10 business days after the exit conference will not be considered. The facilitator will email a written response to the LA staff requesting reconsideration within 15 calendar days after receiving the LA's request. If a revision to the Report of Findings is necessary as a result of the reconsideration, the facilitator will ensure a written notification and copy of the revised report is emailed to the LA contact person. If changes in the CAP requirements result, the facilitator will email a revised CAP template to the LA contact person.

Amended Report of Findings

The Report of Findings is amended when the team determines that the final report shared at the exit conference contains an error. The correction is made and the corrected report becomes the Amended Report of Findings. The facilitator ensures any resulting changes in the CAP requirement will be forwarded with the amended report to the LA contact person with an amended CAP due date 30 days from the date of the amendment.

Corrective Action Plan

Submission of a CAP is required for any remaining items of non-compliance. The facilitator will provide the LA contact person with a CAP template and instructions and guidelines for completing the CAP. The CAP is due to Performance Contracts Management within 30 days after the date of the exit conference (or date of amended Report of Findings). The due date for the CAP is identified on the bottom of the final draft of the Report of Findings. The facilitator will coordinate DADS review of the CAP. If a need for revision to the CAP is identified, the facilitator will communicate that need to the LA contact person. Any revisions to the CAP are submitted by the LA to the facilitator until the review team approves the CAP.

Once the CAP is approved, the CAP acceptance letter is sent out.

HCS, Section 16000, Consumer Rights and Complaints

Revision 17-2; Effective October 20, 2017

 

 

16100 Overview of Consumer Rights and Services

Revision 17-2; Effective October 20, 2017

 

Provision of Consumer Rights Booklets

At the time an individual  is enrolled into the Home and Community-based Services (HCS) waiver program, the Local Intellectual and Developmental Disability Authority (LIDDA) must give a copy of Your Rights in Local Authority Services, Your Rights in A Home and Community-based Services (HCS) Program and the Texas Health and Human Services Commission (HHSC) publication titled Rights of Individuals to be Protected and Promoted by the HCS Provider to the individual or the individual's  legally authorized representative (LAR), as well as an oral explanation of such rights.

Annually thereafter, and in accordance with Texas Administrative Code (TAC) governing rights of individuals with intellectual disability (40 TAC, Chapter 4, Subchapter C), the LIDDA must provide an individual, LAR or family member with a copy of the rights of the individual as described in the booklet titled Your Rights In Local Authority Services, and an oral explanation of such rights. However, to provide a meaningful and complete explanation of all rights to individuals receiving HCS services on an annual basis, the LIDDA service coordinator (SC) is also expected to give a copy of Your Rights in a Home and Community-based Services (HCS) Program and the HHSC publication titled Rights of Individuals to be Protected and Promoted by the HCS Provider to the individual or the individual's LAR, and an oral explanation of such rights annually.

Consumer rights booklets are available on the HHS website at https://hhs.texas.gov/about-hhs/your-rights/consumer-rights-services/what-are-my-rights.

Consumer rights booklets may also be ordered by sending an email to crscomplaints@hhsc.state.tx.us.

The HHS publication titled Rights of Individuals to be Protected and Promoted by the HCS Provider is available on the HHS website at https://hhs.texas.gov/laws-regulations/handbooks/local-intellectual-developmental-disability-authority-handbook/publications/lidda-rights-individuals-be-protected-promoted-hcs-provider.

 

16200 General Complaint Information

Revision 17-2; Effective October 20, 2017

 

Local Intellectual and Developmental Disability Authority (LIDDA)

At the time of enrollment and annually thereafter, the LIDDA must inform the applicant and legally authorized representative (LAR), orally and in writing, of the processes for filing complaints about the provision of service coordination. This must be an easily understood process for persons and LARs to request a review of their concerns or dissatisfaction. The policy must explain how the person may receive assistance to request the review, the time frames for the review and the method by which the person is informed of the outcome of that review. The LIDDA must present this policy in the language with which the individual and LAR are most comfortable.

Each LIDDA must develop a process for receiving and resolving complaints from a program provider related to the LIDDA's provision of service coordination or the LIDDA's process to enroll an applicant in the Home and Community-based Services (HCS) Program. This process must include the LIDDA's telephone number and the toll-free number to Consumer Rights and Services (CRS).

HCS Program Provider

The HCS provider must publicize and make available a process for eliciting complaints. The HCS provider must maintain a record of all verifiable resolutions of complaints received from individuals, their families and their LARs, as well as staff members, service providers, Consumer Directed Services (CDS) providers, the general public and the LIDDA. The HCS provider must establish a consumer/advocate advisory committee that will solicit, address and review all complaints from individuals and LARs about the program provider's operations.

When to Call CRS

CRS receives complaints from individuals, family members and the general 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 service coordinator (SC) or HCS provider.

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

Written complaints may be mailed to:

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

Resolution of Issues Between LIDDAs and Program Providers

LIDDAs and HCS providers are encouraged to work together to resolve any issues regarding service provision.

If an SC identifies an issue of concern regarding an HCS provider, the SC should:

If an HCS provider identifies an issue of concern regarding an SC the program provider should:

CRS Website

The CRS website provides useful information regarding filing a complaint. Visit the website here: https://hhs.texas.gov/about-hhs/your-rights/consumer-rights-services.

Notification and Appeals Process (Regarding Complaints)

LIDDAs are required to develop processes for receiving complaints about the provision of LIDDA services. For the HCS Program, the LIDDA must notify individuals of the LIDDA's process for addressing concerns or dissatisfaction with service coordination, as required in TAC rules governing notification and appeal (40 TAC, Chapter 2, Subchapter A).

HCS, Section 17000, Critical Incident and Death Reporting

Revision 18-2; Effective June 8, 2018

 

 

17100 Information Letters and Reporting

Revision 18-2; Effective June 8, 2018

 

Home and Community-based Services (HCS) and Texas Home Living (TxHmL) providers are required to report critical incidents and any death of an HCS or TxHmL participant to the Texas Health and Human Services Commission. The following information letters discuss these requirements:
Information Letter No. 15-25, Revisions to Critical Incident Reporting Requirements
Information Letter No. 15-26, Revisions to Critical Incident Reporting Requirements

 

Critical Incident Reporting Section in Client Assignment and Registration (CARE) System User’s Guide

Critical Incidents must be entered in the CARE system. The following provides detailed instructions for entering this data:

Critical Incident Data Reporting for Home and Community-based Services PDF

Note: The CARE User's Guide is only available to those with access to the CARE system.

 

Information Letter Regarding Reporting Deaths

Providers are required to report the death of an individual receiving HCS or TxHmL services to HHSC by the end of the next business day following the death or the program provider’s learning of the death on Form 8493, Notification Regarding a Death in HCS, TxHmL and DBMD Programs. The information letter regarding reporting deaths is Information Letter No. 12-28, Notification of the Death of an Individual.

HCS, Section 18000, Investigations of Abuse, Neglect and Exploitation by the Department of Family and Protective Services

Revision 18-2; Effective June 8, 2018

 

The Department of Family and Protective Services (DFPS) investigates any reports of abuse, neglect or exploitation in the Home and Community-based Services Program. The following are rules that govern DFPS investigations, information letters and forms related to DFPS investigations: http://texreg.sos.state.tx.us/public/readtac$ext.ViewTAC?tac_view=4&ti=40&pt=19&ch=711

 

Information Letter No. 14-60, Transportation Requirements for Abuse, Neglect and Exploitation Investigations

Information Letter No. IL 12-27, Notification to DADS Regarding Department of Family and Protective Services (DFPS) Investigation

Form 8494, Notification Regarding An Investigation of Abuse, Neglect or Exploitation

Information Letter No. 12-81, Notification of Investigation Finding by the Texas Department of Family and Protective Services

 

Form 8608, Sample Appeal Letter

 

HCS, Section 19000, Communication

Revision 10-0; Effective June 1, 2010

 

 

19100  Notification Between the HCS Provider and Local Authority Service Coordinator

Revision 10-0; Effective June 1, 2010

 

Click here to view circumstances under which the HCS provider and Local Authority (LA) service coordinator (SC) should notify each other of important events or activities.

 

19200  Communication Between Local Authority and Home and Community-based Services Provider

Revision 10-0; Effective June 1, 2010

 

The Home and Community-based Services (HCS) model is dependent on a mutual understanding and respect of the individual's desires, the provider's role in service provision, and the service coordinator's role in planning and monitoring. Building relationships with each entity will be necessary to accomplish the HCS program objectives. Effective communication is necessary in building and maintaining good relationships.

 

19210  Management Considerations for Local Authorities

Revision 10-0; Effective June 1, 2010

Provide a forum for providers and LA staff to bring forward issues and concerns. When LAs and providers are able to solve problems together, the partnership is strengthened. Relevant input can be solicited in a number of ways, including the following:

Establish a climate of support. Each LA should clearly state that its goal is to be successful in the partnership.

Provide opportunities for providers, families, consumers and LA staff to meet and interact. These opportunities should be available not just during the provider choice process. Following are some ideas:

Ensure a balance between listening to provider concerns and asserting the needs of the LA and consumers. A well-rounded relationship between providers, LAs and consumers should be the goal of the LA.

Develop communication skills that foster good relationships between providers and consumers.Provide basic communication skills training to service coordinators and supervisors with goals to develop:

Implement strategies to assist service coordinators with provider communication. Service coordinators are responsible for communicating serious concerns, as well as ongoing information. Strategies for success may include developing:

 

19220  Helpful Hints for Service Coordinators

Revision 10-0; Effective June 1, 2010

 

Service coordinators must build relationships with HCS consumers, families and providers. Developing and maintaining good relationships will assist in understanding the likes and dislikes of the consumer, determining needed services and ensuring the development of a mutually satisfying partnership.

Relax and be yourself.

Be genuine and honest in all you say and do.

Be positive.

Improve skills.

Use respectful language at all times.

Avoid at all costs:

 

19230  Recommended Levels of Communication Between Local Authorities and Providers

Revision 10-0; Effective June 1, 2010

 

Communication needs between LAs, providers and individuals/families differ in different areas of the state. However, it is recommended that all LAs and providers use the standardized Form 8583, Contact Information. This form ensures individuals, their families, providers and service coordinators have accurate and current contact information for each other. The form should be completed at enrollment and updated as needed. Additionally, it is recommended that all LAs have procedures in place to address the following levels of communication:

Level I — Emergency/Crisis Notification. Level I includes communication about incidents that affect an individual’s health and safety, as well as events that disrupt normal procedures of individual care. This level of communication may need to occur after hours or as soon as possible during business hours, and may address the following:

Level II — Concerns and Changes in Service Needs. Level II includes discussions between the service coordinator and provider about an individual's issues (for example, an individual’s service array, the service provider or individual/family concerns). This level of communication will require regular meetings, as needed, and may address:

Level III — Relationships. Relationship building, courtesy and mutual cooperation should be an ongoing process that starts during transition and continues on a broader scale after program implementation.

HCS, Section 20000, CARE Data Entry and Reports

Revision 10-0; Effective June 1, 2010

CARE User’s Guide

The CARE User's Guide includes detailed instructions for entering all data into CARE. It may be found at: http://cisfieldsupport.hhsc.texas.gov/training/waiver.html.

Note: The CARE User's Guide is only available to those who have access to the CARE system.

HCS, Section 21000, Quality Assurance

Revision 10-0; Effective June 1, 2010

 

 

Quality Assurance — A Shared Responsibility

 

Quality assurance is a shared responsibility among all parties who have a stake in receiving, providing, coordinating, monitoring or funding services and supports for people with intellectual and developmental disabilities. Click here to see a modified version of the Centers for Medicare & Medicaid Services (CMS) Quality Framework for Home and Community-Based Services (2002). The information is used to outline this shared partnership. This framework provides a schema that focuses on person-directed desired outcomes along six dimensions by individual, provider, local authority and the Department of Aging and Disability Services (DADS). The six focused dimensions are:

The framework defines quality through the delineation of desired outcomes across the six dimensions. Acquisition of these measures indicates a successful service delivery system. The challenge for the partners is to identify areas of success and areas that require additional action. Solutions must be carefully crafted to address areas that need improvement. All partners must commit to sustaining a system of service delivery that promotes and supports individuals who receive Home and Community-based Services (HCS).

Reference: CMS Quality Framework for Home and Community-Based Services

HCS, Appendices

HCS, Appendix I, Information Letter: Process for Sending Medicaid Applications to the Health and Human Services Commission

Revision 10-0; Effective June 1, 2010

 

An application for Medicaid coverage must be submitted to the Texas Health and Human Services Commission in order for an individual to be determined financially eligible. Details regarding submitting a Medicaid application can be found at: https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/provider-portal/letters/2009/letters/il2009-100.pdf

HCS, Appendix II, Mutually Exclusive Services

HCS, Appendix III, Discovery Guide

Revision 13-2; Effective September 3, 2013

 

I. Overview of Discovery

Discovery is the process of listening to people and learning about what they want from their lives. It is getting to know people so that their personal outcomes, preferences, choices and abilities are understood, documented and form the foundation of planning their services and supports. Discovery is the basis for the Person-Directed Plan (PDP) and service delivery. It is an ongoing process that occurs each time the service coordinator talks to the person or those who know the person best. It is necessary to record the information learned so that it can be used when developing or updating the PDP. The service coordinator leads the discovery process, acting on behalf of the person whose services and supports are being planned.

The following core values guide the development of community supports and services for people with intellectual and developmental disabilities. These values form an essential foundation for the discovery process and service selection:

  • Self Determination. People should make decisions about things that affect their lives. The service coordinator supports the person in making choices. People should have information about directing their own services and supports and opportunities to do so.
  • Community Inclusion. People receiving services should have opportunities to lead a satisfying life – making friends, participating in preferred activities, and being involved in and valued in their community. The service coordinator recognizes the need for people to belong and examine opportunities for supporting connections.
  • Meaningful Relationships. People receiving services need opportunities to develop close relationships with others, maintain the relationships they have, and form new associations with persons and groups with similar interests and purposes. The service coordinator explores and advocates for ways the person may develop relationships and associations beyond staff and other existing relationships, based on the person’s interests and desires. Barriers to creating bonds with others should be addressed.
  • Maintaining Non-waiver Supports. Discovery includes identifying existing natural supports, such as supports provided by friends, family or others that are not to be replaced by paid services. The loss of these supports could leave the person without meaningful relationships or community connections. Non-waiver supports also include generic services and resources (e.g., the Department of Assistive and Rehabilitative Services (DARS), public education, Day Activity and Health Services, the Comprehensive Care Program, state plan Medicaid services, etc.) that must be used prior to accessing waiver services.

Building a trusting relationship is the means by which the service coordinator discovers what is important to the person. The following should be demonstrated when building relationships:

  • A caring attitude, interest in the person and respect for the wishes of the person and family.
  • Willingness to spend time with the person. When first supporting someone, the service coordinator often sees the person at least once a month to give sufficient time to get to know him/her.
  • Finding the positive and building on talents. Everyone wants to be liked for who they are. The service coordinator should not always focus on the person’s needs, but rather build the person’s confidence and self-esteem.
  • Ability to be trusted. Following through with promises is important to people and their families. Honor the individual’s request not to share private information. Trust will help the person to open up and talk about his/her life.
  • Willingness to admit mistakes.

Communication, listening and observation skills are indispensable for a service coordinator. These skills are needed when conducting discovery, facilitating meetings and when interacting with people receiving services, their families, providers and other community organizations (including the service coordinator’s own agency).

The best environment for a conversation about a person is a comfortable place without noise and distractions. Privacy must be maintained when discussing personal information. When the person is present, speak directly to the person. When other people are engaged in the conversation (including interpreters), be sure to look at the person who receives services so that you can see his/her reaction to the discussion through his/her facial expressions and body language.

It is important to engage different people in different ways to accommodate individual ways of communicating. Learning about a person’s communication abilities, including whether a person uses a communication device, is important when arranging a time to talk. It is also important to allow enough time to accommodate a person who communicates slowly or may require frequent breaks to remain engaged. Identifying preferences ahead of time, such as convenient times or days, may help guide successful questions and conversation.

  • Starting Conversations. Introduce yourself and explain the purpose of the visit (as obvious as this seems, it is often overlooked). Conversations with people receiving services can be started in many ways, depending on the interests and preferences of the person. Sometimes it may be necessary to start a conversation about an activity the person is interested in or participated in recently. A conversation may be started by asking about an item that belongs to the person or is present in his/her environment. Avoid immediately diving into questions that could seem too abrupt or too personal. Possible ways to start a conversation:
    • Tell me about yourself.
    • Tell me about your day.
    • What would you like me to know today?
    • You look so happy today. What put that smile on your face?
    • You look upset. Do you want to talk?
    • I see a lot of pictures in your room. Can you tell me about them?
    • What do you like to do?

If a person does not want to communicate, loses interest or does not have the tools necessary to communicate, ask if it would be better to come back later.

  • Gathering Information. Ask permission before asking personal questions. Questions should be centered on the concerns or interests of the person. You will not be able to get all important information immediately.

    Many people respond to opening requests, such as:
    • Tell me about your family.
    • Tell me about your friends.
    • I’m interested in knowing more about you.
    • Tell me about your favorite things.
    • Tell me about things you don’t like.

The person may have a specific issue that is dominating the conversation. Go with it and let the person feel and express himself. It helps the person to speak at his own pace. Learn to be silent, as this can also be a way to connect. If the conversation shifts away from the person, redirect the focus back to the person. If necessary, be persistent in keeping the person the center of conversation. Be careful not to ask too many questions and observe nonverbal communication to determine when the conversation needs to take a new direction.

  • Listening. Listening well can sometimes be challenging, but it is a critical skill in discovery. It is how we learn about people. Let people know you are listening.
    • Talk to the person, not around the person, if the person is not alone.
    • Ask the right questions. Avoid questions with yes or no answers that are not exploratory and do not provide opportunities for people to express themselves.
    • Allow adequate time for the person to respond.
    • Reflect back the last statement you heard.
    • Paraphrase and sum up what you have heard during the conversation
  • Observing and Nonverbal Communication. If a person is able to effectively communicate through conversation, discovery is often easier. However, a great deal can also be learned through nonverbal communication.
    • Body language often provides information about what a person is thinking or feeling.
    • Some people may use gestures, behavior or other means of getting their point across. Help may be needed from family or others who know and care about the person to interpret and learn from what he/she is saying.
    • Conversation can distract from nonverbal communication of feelings and emotions.
    • Some behavior may be a request for help or attention.
    • Facial and eye expressions provide much information – trust, affection, disapproval, sadness, pain, discomfort, fear, awareness, interest, joy, concern.
    • Eye contact is important communication and shows respect.
    • Clothing, grooming, and environment may tell a lot about the person’s life. It is especially important to visit people at their home and in other environments.

Identifying personal outcomes is the focus of service planning and must be informed by meaningful discovery. It is important for everyone to make plans in order to achieve the outcomes they desire. People need to dream about their future and how they can achieve what is important to them. When talking with a person or gathering information:

  • Allow the person to dream big. Don’t discourage the person from dreaming about his/her future, but explain how to break dreams into attainable short-term outcomes.
  • The person’s outcomes must be clearly identified so that service providers and natural supports can assist the person to achieve them.
  • Barriers should be recognized and the service coordinator should help the person identify ways to resolve or work around the barriers.
  • When a service coordinator learns about outcomes, he/she should think about possible methods of achieving these outcomes. Outcomes may be met with assistance from family members, friends, community resources, generic service agencies or waiver services. The service coordinator is responsible for looking for alternative solutions, in addition to considering waiver services.
  • Be positive. Reflect the outcomes in positive ways. Represent the person.
  • Ensure health and safety. The service coordinator should gather existing information necessary to identify safety or health issues. The service provider should assist the person with addressing those needs. Health and safety outcomes must not be ignored and the person should be assisted in understanding the importance.
  • The service coordinator asks permission from the person or legally authorized representative to include service providers in the discovery process. The provider may have day-to-day experience with the person and should be considered a significant source of discovery information to identify outcomes.
  • Involve other allies identified by the person.
  • Recognize that the outcomes may change as the service coordinator learns more about the person.

II. Using the Discovery Guide

This Discovery Guide is intended to support learning about what is important to the person and what others need to know to support the person for each person who receives services and supports. It is designed as a guide for exploration. The service coordinator supports a meaningful discovery process by helping people to speak for themselves, each in his or her own way about his or her own dreams and outcomes. The service coordinator encourages those present to listen and learn about what people want.

Examples offered in the Discovery Guide are intended to inspire thinking about the types of information that are important in creating true PDPs. They are only examples and while some may be relevant to a particular individual, information gained from the person and those close to the person will yield individualized results.

Gathering important information for those who support and assist the person. The service coordinator documents information that will be helpful for the service provider to know when providing services and supports to the person. This includes a broad profile of the person and important matters in his/her life based on observations, discussions and other relevant information. This information includes:

  • The people, places and things that give the person happiness, contentment and satisfaction, in the present and in outcomes and dreams for the future.
  • What people like and admire about the person. Sometimes this may take effort to learn because people are not always accustomed to talking about attributes. Notice the good things about the person and encourage him or her to recognize his or her own strengths and positive attributes.
  • Background experiences that affect the present. Record events such as milestones, celebrations, institutionalization, losses, trauma, etc. that affect the person today.
  • Who helps the person make important decisions? Who is a reliable source of information? Who does the person feel closest to? Who else does the person want to have involved in discussions and decisions? If the person is isolated or only talks about staff, it may be a sign that the person needs other relationships and connections. If the person has a guardian, ask if he or she is included in decision making and how.
  • Preferences for social inclusion and alone time. Don’t assume that every person wants to be social all the time. Some people like having many friends; others prefer only a few close relationships. Personal relationships are very important to most people.
  • Safety issues. Think beyond just supervision, even though that is important. Evaluate whether the environments where a person spends his/her time are healthy and safe. Observation is as important as asking questions. Consider what supports the person needs to be safe, e.g., adaptive aids, caregiver capacity, preparation for emergencies, etc.
  • Health issues. Document health issues that concern the person. Detailed health information will be reflected in the health assessments completed by the provider.

Identifying services to support outcomes. The service coordinator identifies services that support the person’s outcomes. Based on the information gathered during discovery, the service coordinator:

  • Identifies the services that will support the outcomes.
  • Explains the purpose and outcome of the service (what will the person gain from the service?).
  • Identifies what is important to the person and what others need to know and do to support the person so the program provider can use this information to design the implementation plan.

The examples below are meant to give service coordinators a general idea of how to use information gathered through the discovery process to identify services to support personal outcomes.

Example 1: Purpose/Outcome. What does the person want?

  • The person wants to join a choir.
  • The person wants to go to the singles class at church.
  • The person wants to take a class at the community college.
  • The person wants to take a vacation to Disneyland.

A possible support for these purposes/outcomes could be a person’s family or friends. An action plan is not needed unless a Home and Community-based Services waiver service is supporting the person to achieve the outcomes.

Example 2: Purpose/Outcome. What does the person want?

  • The person needs a safe place to be during the day.
  • The person enjoys being around other people and making friends.
  • The person wants to develop or reinforce a skill (educational skills, specialized therapies, socialization skills or other adaptive skills).

A possible waiver service to support these purposes/outcomes could be day habilitation.

The following information learned during the discovery process would be important to the provider of day habilitation services:

  • Important To. Information about preferences that are related to the service or the environment where the service will be delivered. This should help the provider to ensure a good experience for the person. Examples of areas related to quality of life issues:
    • The person wants to sit next to friends so he can visit with them.
    • The person wants to have frequent breaks so that he can walk around the building, get a drink of water and talk to people in other areas.
    • The person likes to eat meals at the same time each day.
    • The person likes to exercise.
  • What Others Need to Know and Do to Support the Person. Information about what others think is important for the day habilitation staff to know. Examples of information that often relate to communication or health and safety:
    • When the person starts to fidget, he often wants to take a break.
    • The person must take medication during the hours he receives day habilitation.
    • The staff must be trained to identify symptoms of high and low blood sugar.
    • The person does not have safety skills when working with equipment or machinery.
    • The person requires support to leave the building alone.
    • Transportation provider requires staff to be available to meet the van upon arrival to day habilitation services and to accompany the person to the van when leaving.

Example 3: Purpose/Outcome. What does the person want?

  • The person wants to get a driver license and needs help learning the Driver Handbook.
  • The family has requested assistance with the person’s grooming.
  • The person wants to explore recreational opportunities in his neighborhood and learn how to ride public transportation to these events.
  • The person needs transportation to attend classes.
  • The person wants to become her own payee and needs training on money management.
  • The person needs help to shop for groceries.
  • The person wants to improve abilities to do housekeeping tasks independently.

A possible waiver service to support these purposes/outcomes could be supported home living.

The following information learned during the discovery process would be important to the provider of supported home living services:

  • Important To. Information about what the person prefers about staff, schedules, criteria for providers to make a good match with staff, etc. Examples:
    • The person wants to work with female staff because she does not want a male to assist her with personal hygiene.
    • The person prefers that staff only come on Tuesday mornings because she is involved in other activities the rest of the week.
    • The person wants to interview and select any staff that will be coming to her home.
    • The person wants staff to call when they are on the way or if they are not able to make the appointment.
    • The person likes to be 10 minutes early to appointments.
  • What Others Need to Know and Do to Support the Person. Information about what is needed to ensure safety, health and well-being. Examples:
    • Due to the medication she takes, the person must drink plenty of water.
    • The person must have a backup plan if the assigned supported home living staff are unable to work to ensure the person receives adequate assistance during evening hours.
    • The person must be carefully supervised when crossing the street or in other non- safe environments.
    • The person needs supervision at all times when outside his/her home.
    • The person is unable to regulate water temperature and has been burned in the past when left to bathe without assistance.
    • The person will eat too fast if not prompted to eat slowly.

Example 4: Purpose/Outcome. What does the person want?

  • The person wants to eventually live alone but needs skills training in the areas of safety, money management and meal planning/preparation.
  • The person enjoys living with a family.
  • The person likes the foster/companion care (FCC) provider and wants to live with him/her.
  • The person wants to learn how to ride the public transportation system.

A possible waiver service to support these purposes/outcomes could be FCC.

The following information learned during the discovery process would be important to the provider of FCC services:

  • Important To. Information to help a provider in selecting the type of home, staff characteristics and supporting daily routine preferences. Examples:
    • The person likes to sleep late on weekends.
    • The person wants to remain close to his family’s home in the west part of the city.
    • The person does not like to be around people who smoke.
    • The person wants his own bedroom.
    • The person wants a long-term provider.
    • The person does not like animals.
    • The person wants a family that would allow him to keep his pet hamster.
    • The person wants to attend church.
  • What Others Need to Know and Do to Support the Person. Information about general health and safety issues. Examples:
    • The FCC setting should be within close proximity to the person’s family.
    • The staff should be fully aware of medical issues that are included in the Comprehensive Nursing Assessment.
    • The FCC provider should be available on-site any time the person is in the home.
    • The person has difficulty independently working kitchen appliances.
    • The FCC provider should receive training from the occupational therapists and physical therapists regarding how to support therapy.
    • The FCC provider should be aware of and follow behavioral guidelines prepared by the provider of behavioral supports.
    • The person’s blood sugar levels must be checked in the morning and evening.

Example 5: Purpose/Outcome. What does the person want?

  • The person wants to express his opinions without yelling.
  • The person wants to be able to calmly ask others to leave his room.
  • The person wants to continue living with his family.
  • The person wants friends and is finding it difficult to keep them.
  • The person wants a better relationship with his family.
  • The person wants to not feel lonely.

A possible waiver service to support these purposes/outcomes could be behavioral supports.

The following information learned during the discovery process would be important to the provider of behavioral supports:

  • Important To. Information to help staff understand what the person experiences as positive situations or negative situations. Examples:
    • The person likes to be asked (not told) to complete a task.
    • The person likes to be busy.
    • The person wants more friends and more fun.
    • The person likes privacy.
    • The person likes to take a break when faced with stressful situations.
    • The person does not like others taking or handling his possessions.
    • The person likes to be on time to his art class.
    • The person likes having friends and family, and likes to be in touch with them frequently.
    • When stressed, this person likes to talk to his best friend on the phone.
  • What Others Need to Know and Do to Support the Person. Information about supporting the person’s positive behavior. Examples:
    • The family has noticed that the person becomes more stressed when he is in a loud environment, is bored or the activity is too difficult.
    • Staff should remind the person to take deep breaths when trying to express his emotions.
    • Staff should remind others living in the home to knock on the person’s bedroom door before entering.
    • It is important for the person to have a safe place for his special belongings. He becomes very angry when they are lost.
    • Each morning, staff should tell the person what is planned for the day.
    • Staff must take the time to listen to what the person is trying to communicate.

Example 6: Purpose/Outcome. What does the person want?

  • The person wants to have supports at work.
  • The person needs to keep his job but needs some additional training. DARS is no longer available.

A possible waiver service to support these purposes/outcomes could be supported employment (SE).

The following information learned during the discovery process would be important to the provider of SE:

  • Important To. Information about preferences for how SE will be delivered. Examples:
    • The person likes to perform tasks as independently as possible.
    • The person would like to work mornings rather than evenings.
    • The person prefers to speak Spanish.
  • What Others Need to Know and Do to Support the Person. Information about supports necessary for success and well-being. Examples:
    • It is important for the SE staff to be aware of signs and symptoms of seizures.
    • It is important for the SE staff to support and reinforce the person’s work schedule.
    • It is important for the SE staff to arrive at the work site at the same time as the person.
    • It is important for the SE staff to ensure that the person takes his medication during the work day.
    • It is important for the person to arrive to work on time.
    • It is important for the SE staff to teach the person work-related conduct and expectations (e.g., call if you are ill or will be late, dress for the job, etc.).

The service coordinator develops the PDP using the information gathered from the discovery process.

Example 7: Purpose/Outcome. What does the person want?

  • The person wants to interact with others.
  • The person wants to be able to talk.
  • The person wants a mobile device to help him communicate.
  • The person wants the freedom to come and go without assistance.

A possible waiver service to support these purposes/outcomes could be adaptive aids.

The following information learned during the discovery process would be important to the provider of adaptive aid services:

  • Important To. Information about preferences that are related to the adaptive aids to be used should help the provider to ensure a good experience for the person. Examples of areas related to quality of life issues:
    • The person wants a small, lightweight speech device that is durable.
    • The person wants to choose the voice that the speech device uses.
    • The person wants access to the speech device at all times.
    • The person wants to go places whenever he wants without assistance.
  • What Others Need to Know and Do to Support the Person. Examples of information important for the staff to know:
    • It is important for staff to offer only the amount of assistance requested.
    • It is important for staff to be patient.
    • It is important that the speech device be received quickly and programmed according to the person’s wishes.
    • It is important that the speech device and electric wheelchair be charged and well maintained.

As a service coordinator gets to know a person, it will become apparent what is important to the person regardless of where he/she is, what he/she is doing, who is supporting him/her, and what others need to know and do to support him/her, regardless of the setting. The information that is not specific to a setting or a service are collected and included in the One-Page Profile of the PDP. The important to and the what others need to know and do to support the person information that is specific to a service is included in the Pertinent Information section of the PDP action plan for that service.

HCS, Appendix IV, Discovery Tool

Revision 13-2; Effective September 3, 2013

 

I. Introduction

The Discovery Tool is not intended to serve as an interview tool. Discovery is an ongoing process rooted in supportive relationships developed between service coordinators and the people they support. This optional tool can be used to suggest exploration and organization of information critical to completion of Form 8647, Service Coordination Assessment – Intellectual Disability Services. While the prompts in this tool may be useful to the Person Directed Plan (PDP) Discovery process, it should not be considered all-inclusive, exhaustive or as a substitute meaningful discovery. While service coordinators generally use ongoing face-to-face discussions, record reviews and communications with family members and staff (who know the person best) to gather discovery information. Appendix III, Discovery Guide, offers information and instruction for carrying out a robust, ongoing discovery process.

Person’s Preferences for Planning Activities

Person’s Communication Style:

  1. How does the person communicate (gestures, sounds, facial expressions, adaptive equipment, etc.)? What is the best way to determine if the person is expressing satisfaction/happiness/comfort/agreement as opposed to dissatisfaction/unhappiness, discomfort/disagreement?
  2. Among those who know the person best, who seems better able to interpret what the person is trying to communicate?
  3. What is the best way for others to learn how to communicate effectively with the person?

Person’s Resources for Support Planning and Service Provision:

  1. Participants/Support Planning Team (SPT): Who does the person/legally authorized representative (LAR) wish to directly involve in support planning? Note: The person can be anyone, including provider staff.
Name Relationship to Person Contact Address and Phone Preferred Method for SPT Member
to Participate in the Person’s Planning
(personal availability, phone availability, etc.)
       
       
       
       
       
       
  1. SPT Involvement: What would be the person’s/LAR’s reaction to participating in meetings or group planning activities via phone or other remote methods?
  2. Service Coordinator Involvement: Is the person/LAR comfortable with the service coordinator independently contacting involved people to explore the person’s preferences and outcomes?
  3. Places: Where is the person/LAR most comfortable when participating in planning activities such as PDP reviews or Individual Plan of Care (IPC)/Implementation Plan (IP) reviews? What would be the person’s/LAR’s preference for an alternate or backup location?
  4. Times: What is the person’s/LAR’s preference regarding the time or day that he or she wants to participate in planning activities?

Information Specific to the Consumer Directed Services (CDS) Option

  1. What is the person’s/LAR’s understanding of his/her freedom to choose a comprehensive provider or to personally direct provision of certain specified services?
  2. What additional information does the person want about CDS?

Discovery Information Related to Completion of the Service Coordination Assessment

Preferences for Living Environment – Always include a summary of discovery information that justifies conclusions:

  1. Where and with whom does the person currently live?
  2. How closely does the current living situation align with the person’s priorities/wishes?
    • What location meets the person’s preference (city/locale)?
    • What kind of living environment does the person prefer (group living arrangement, alone, roommate, own apartment, with family, etc.)?
    • If group living is the preference, does the person like having his/her own bedroom or sharing with a roommate?
    • What factors does the person/LAR prioritize when considering the choice of a place to live (e.g., proximity to family/work/public transportation/shopping/school, availability of supports to teach the person critical skills related to living in his/her environment, affordability, etc.)?
  3. Are there any personal issues that might present risk for harm in the person’s living arrangement (e.g., daily rituals, threats of suicide or physical harm to self or others, inability to handle a personal crisis)? What supports are needed to address these risks (increased personal supervision, limited proximity, etc.)? Is the person currently receiving these supports?
  4. Does the person live, work and pursue leisure activities in integrated environments that are safe? If not, what are the specific issues presented to the person by these environments (e.g., sanitation issues within environments, physical hazards such as inaccessibility, toxic substances, hot water, lack of safety equipment such as fire extinguishers, smoke detectors, door peephole, inability to use safety equipment and pedestrian safety skills)?
  5. Does the person know how to respond in an emergency situation such as fires, hazardous weather, natural disasters, illness, injury or threat of bodily harm? Does the person need support to ensure safety in emergency situations?
  6. Does the person need any modifications to the living environment to ensure safety/health/access needs are met (e.g., ramps, doors, doorways, bathroom modifications, etc.)?
  7. Does the person need any additional equipment (personal or environmental) to support accessibility and safety within any frequented environment (e.g., mobility devices, switches, lifts, etc.)?
  8. Does the person require specialized therapies (dietary, occupational therapy, physical therapy, speech therapy, nutrition, postural supports, food-texture modifications, psychological counseling, behavioral supports, etc.) to support safe access to preferred activities and environments?
  9. When the person receives supports, are there any specific characteristics that must be considered to honor the person’s preferences (e.g., male as opposed to female staff for certain activities, a preferred staff person for implementing services, preference for adaptive equipment transfers as opposed to personal transfers, soft-spoken interaction as opposed to loud voices, information that should be given in advance regarding upcoming changes in the person’s routine, etc.)?

Preferences for Financial Security – Always include a summary of discovery information that justifies conclusions:

  1. What financial resources are accessible to the person (review assets, sources of income as well as insurance coverage)?
  2. Does the person have adequate financial resources to meet his/her priority needs and preferences (food, shelter, medical and prioritized leisure activities)?
  3. What support does the person receive in managing his/her financial resources (e.g., parent/other serves as representative payee, a guardian appointed to manage financial affairs, etc.)? Include all supports: non-Home and Community-based Services (HCS)/natural or HCS.
  4. Describe any additional supports necessary to assist the person in addressing financial security/obligations.
  5. Is the person interested in acquiring additional knowledge, skills or abilities to increase control and choice regarding financial security? In which areas is he/she most interested?

Preferences for Physical/Emotional/Behavioral Health – Always include a summary of discovery information that justifies conclusions:

Physical/Emotional or Behavioral Health Concern (List all concerns, diagnoses, routine procedures, including dental.) Name/Specialty of Healthcare Professional Currently Addressing the Concern, if Applicable Thoroughly Describe the Intervention (medication, specialized therapy, frequency of visits, etc.) Who is Responsible (or needs to be responsible) for Ensuring this Concern is Addressed?
       
       
       
       
  1. What is the person’s/LAR’s preferences regarding the management of personal health?
  2. What issues impact the person’s ability to obtain necessary interventions (e.g., does not understand most medical issues and required interventions, is afraid of professionals, is combative during medical procedures, is uncooperative with taking medications as prescribed, etc.)?
  3. How does the person indicate physical distress or illness?
  4. Is the person/LAR satisfied with current supports?
  5. What change does the person/LAR wish to make with any of the supports currently provided?
  6. If the person takes medication, what assistance is required to ensure that they are taken as prescribed?
  7. If the person requires other interventions (e.g.,`positioning, nutritional management, etc.), what assistance is required to perform them?
  8. Does the person require medically necessary supplies? What are they and how are they obtained?
  9. Is the person interested in acquiring additional knowledge, skills and abilities that facilitate increased choice and control in meeting physical/emotional/behavioral health needs? Fully describe what the person is most interested in acquiring.

Preferences for Daily Living – Always include a summary of discovery information that justifies conclusions:

  1. What supports are necessary to assist the person in meeting physical needs (oral hygiene, physical hygiene, using the bathroom, eating assistance, positioning, shopping, cooking, etc.)?
  2. What supports are necessary to assist the person in maintaining possessions in the living environment (household tasks such as house cleaning, laundry, maintaining personal adaptive equipment, etc.)?
  3. What are the person’s preferences for his/her daily routine (includes the timing of daily events, the activities he/she does and the times in which he/she does those activities, the food he/she eats, etc.)?
  4. Is the person interested in acquiring additional knowledge, skills and abilities to increase control and choice regarding daily living? In which area is he/she most interested?

Preferences for Work and/or School – Always include a summary of discovery information that justifies conclusions:

  1. What are the person’s preferences regarding work, education and volunteer opportunities in the community?
  2. For a person under the age of 22, are educational/school services being provided? Where? What prioritized supports are being provided by the school? (Note: The person’s parent, teacher and individual education plan are excellent resources.) Are the school’s services reflecting the person’s/LAR’s priorities?
  3. For a school-age person receiving educational services, explain how current HCS and non-HCS supports could enhance and support the person’s educational service.
  4. If the person is not school age, what does the person do during the day (work, adult learning, etc.)?
  5. What is the person’s understanding of available options in the community to address his/her preferences for work or education?
  6. If the person expresses a preference, does the person currently possess the necessary skills, knowledge and abilities to address preferences? If not, what does the person require?
  7. Describe the services that would best assist the person in obtaining work/educational preferences.
  8. If the person is not interested in volunteering, working or going to school, describe what the person would like to do?

Preferences for Relationships – Always include a summary of discovery information that justifies conclusions:

  1. Using discovery information, describe any close relationships in the person’s life (who is the individual, what is the nature of the relationship, how often does the person wish to see the individual, etc.).
  2. Who are the person’s friends?
  3. Is the person satisfied with the number and types of relationships in his/her life?
  4. Is the person satisfied with the type and frequency of contact with friends and family? How do you know?
  5. In what new types of relationships is the person interested in exploring?
  6. Is the person interested in acquiring additional knowledge, skills or abilities to increase control and choice regarding relationships? Fully describe what the person is most interested in acquiring.

Preferences for Social Inclusion – Always include a summary of discovery information that justifies conclusions:

  1. Is the person aware of available community-based activities? If not, describe how the person could become more aware of options.
  2. In what community-based activities does the person actively participate (ongoing community activities such as going to movies, church, festivals or participating in clubs or other community-based organizations)?
  3. Is the person satisfied with the type and frequency of participation in community-based activities? What other activities would the person like to do?
  4. What activities does the person specifically dislike?
  5. Is transportation a barrier to the person’s participation in community activities? What resources are available to assist the person with transportation?
  6. What supports would the person require to participate in community-based activities to his/her satisfaction?
  7. Is the person interested in obtaining new knowledge, skills or abilities related to social inclusion? Fully describe what the person is most interested in acquiring.

Preferences for Rights/Legal Status – Always include a summary of discovery information that justifies conclusions:

  1. What rights does the person exercise (e.g., freedom of movement, accessibility, opening mail, privacy, phone calls, personal possessions, voting, exercising chosen religion, etc.)?
  2. What rights are not exercised? If the person is not exercising those rights, what are the reasons?
    • Is the person choosing not to exercise those rights? How do you know?
    • If the right is being limited by support staff, describe the reason for the limitation(s).
    • Did the SPT consider the limitation(s) and find that it was necessary to protect the person?
    • If there are limitations, describe the supports that are in place/necessary to restore the person’s rights.
    • Does the person need someone to assist in the exercise of rights (guardian, power of attorney, advocate, etc.)? If applicable, describe the supports targeted toward obtaining assistance.
  3. Describe the person’s ability and desire to advocate for himself.
  4. Would the person like to learn more about self-advocacy? What supports are in place/necessary to help the person learn?
  5. Does discovery provide any evidence that the person has been abused, neglected or exploited?
  6. If the person is still experiencing personal distress from a previous occurrence of abuse, neglect or exploitation, describe the supports the person is receiving (or needs/wants) to cope with the distress.
  7. Is there any information regarding the person’s vulnerability to abuse, neglect or exploitation that should be shared with staff supporting the person?
  8. Is the person interested in obtaining new knowledge, skills or abilities related to exercising rights or preventing abuse, neglect or exploitation? Fully describe what the person is most interested in acquiring.

Preferences for Other Personal Outcomes Desired by the Individual – Always include a summary of discovery information that justifies conclusions:

Using the Discovery Guide or other means adopted by your center, identify other priority personal outcomes that should be a focus (purpose) of either HCS or non-HCS supports.

HCS, Appendix V, HIV/AIDS in the Workplace

HCS, Appendix VI, Medicaid for the Elderly and People with Disabilities

HCS, Appendix VII, List of Excluded Individuals Entities (LEIE)

HCS, Appendix VIII, Advance Directives

HCS, Appendix IX, Retired Information Letters

Revision 17-3; Effective November 1, 2017

 

The Texas Health and Human Services Commission (HHSC) will from time to time retire Information Letters (ILs) when policy has expired, retired or been replaced with new information.

Content in this handbook and the Texas Administrative Code (TAC) supersedes any previous ILs or similar guidance published by HHSC. The ILs retired as a result are listed below. HHSC recommends that providers remove retired 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/Retired
09-155 Personal Care Services (PCS) and Home and Community-based Services (HCS) or Texas Home Living (TxHmL) Program Services Replaced by IL 2015-71 12/14/2009 11/3/2015
09-153 Personal Care Services (PCS) and Waiver Services Replaced by IL 2015-71 10/30/2009 11/3/2015
2009-01 Revisions to Texas Administrative Code Rules Governing Cost Reporting and Fiscal Accountability 01/08/2009 10/11/17
2015-24 Licensed Vocational Nurse On-Call Pilot Program Ends September 1, 2015 3/26/15 12/22/15
2015-20 DADS Home and Community-based Services and Texas Home Living Behavioral Support Service Provider Policy Training (Retired on December 22, 2015) 2/27/15 12/22/15
2015-07 Residential Visits and Water Temperatures in Host Home/Companion Care Residences and Three-Person and Four-Person Residences (Retired on December 22, 2015) 1/21/15 12/22/15
2014-67 Definition for Respite 10/20/14 12/22/15
2014-46 Licensed Vocational Nurse (LVN) On-Call Pilot Program Requirements (The Licensed Vocational On-Call Pilot Program expired September 1, 2015) 8/6/14 12/22/15
2014-30 Changes to HCS and TxHmL Certification Reviews Reports and to Certification Follow up Reviews Note: This letter was revised June 18, 2014 6/12/14 12/22/15
2014-09 Addition of Employment Assistance to the Home and Community-based Services Program and Changes to Provider Qualifications for Supported Employment (Retired on December 22, 2015) 3/11/14 12/22/15
2013-68 Changes Related to Persons Who May Reside in Four-Person Residences 10/1/13 12/22/15
2013-72 Online Training and Classroom Training Dates 11/12/2013 1/26/2016
2013-62 Four-Person Residence Life Safety Code Certification Process 9/17/13 12/22/15
2013-59 Notice of Direct Support Professionals Recognition Week 9/6/2013 1/26/2016
2013-47 Random Sampling for the Licensed Vocational Nurse (LVN) On-Call Pilot Program 8/12/2013 1/26/2016
2013-45 Fiscal Year 2013 Cutoff Dates for Year-end Closeout Processing 7/29/2013 1/26/2016
2013-02 2012 Cost Report and Cost Report Training Requirements 1/2/2013 1/26/2016
2012-87 2012 Online Training and Classroom Training Dates 12/7/2012 1/26/2016
2012-74 Implementation of the International Classification of Diseases, Tenth Revision, Clinical Modification 8/28/2012 1/26/2016
2012-73 Notice of Increased Activity of West Nile Virus in Texas 8/17/2012 1/26/2016
2012-71 FY12 Cutoff Dates for Year-end Closeout Processing 7/31/2012 1/26/2016
2012-50 2011 Cost Report Notification and Cost Report Training Reminders 5/7/2012 1/26/2016
2011-82 New Service Limits in the Home and Community-based Service (HCS) Program 9/8/2011 1/26/2016
2011-135 Cost Containment Initiative Update 10/28/2011 11/1/17
2011-120 New Convictions Barring Employment Added to Health and Safety Code, Chapter 250 09/29/2011 11/1/17
2011-116 Referral of Individuals Currently Enrolled in the Consolidated Waiver Program 09/07/2011 11/1/17
2011-108 Payment Rates Effective September 1, 2011 8/24/2011 1/26/2016
2011-105 Changes in the Texas Human Resources Code resulting from Senate Bill (SB) 1857, (82nd Legislature, Regular Session 2011), related to the Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Waiver Programs 09/20/2011 11/1/17
2011-92 FY11 Cutoff Dates for Year-end Closeout Processing 8/5/2011 1/26/2016
2011-85 Fiscal Year 2011 Miscellaneous Claims Cutoff Notice 7/19/2011 1/26/2016
2011-74 Change in Required Documentation for Renewals of Level of Need Increases 06/10/2011 11/1/17
2011-22 Per Diem Rates Effective February 1, 2011, for the Home and Community-based Services and Texas Home Living Programs 01/26/2011 10/11/17
2010-104 FY10 Cutoff Dates for Year-end Closeout Processing 7/29/2010 1/26/2016
2010-156 Proposed Home and Community-based Services and Texas Home Living Rate Reductions 12/27/2010 10/11/17
2010-142 Expansion of Utilization Management and Review Activities 11/05/2010 11/1/17
2010-140 Individual Plan of Care Revision Process 11/17/2010 11/1/17
2010-105 Correct Correction to HCS/TxHmL Non-Day Habilitation Services Enrollment Worksheets ion to HCS and TxHmL Non-Day Habilitation Enrollment Worksheets and Instructions for Attendant Compensation Rate Enhancement 07/23/2010 10/11/17
2010-80 Change in Notification of Approvals and Denials of Individual Plans of Care Services for Persons in the Home and Community-Based Services and Texas Home Living Programs 07/01/2010 11/1/17
2010-77 Per Diem Rates Effective June 1, 2010 for the Home and Community-Based Services and Texas Home Living Waiver Programs 05/28/2010 10/11/17
2010-68 Home and Community-Based Services Rule Language Regarding an Individual's Freedom of Choice of Direct Service Providers 06/04/2010 11/1/17
2010-49 Requesting a Review of Finding or Methodology Used to Conduct Department of Family and Protective Services Investigations 04/09/2010 11/1/17
2010-43 Dental Treatment Requisition Fees 04/19/2010 10/11/17
2010-32 Obligation to Screen Individuals or Entities Excluded from Participation in Federal Health Care Programs Prior to Hire by Employers under the Consumer Directed Services Option 05/10/2010 11/1/17
2010-27 Agency Directives and Required Timelines for the Transition of the Case Management Function to MRAs 02/26/2010 11/1/17
2010-11 HCS and TxHmL Prior Approval Amount Change 02/01/2010 11/1/17
2010-07 Proposed changes to rules regarding Fiscal Accountability 01/11/2010 10/11/17
2009-174 Regulatory Services Policy Clarification: 2009 National Fire Protection Association (NFPA) 101 Life Safety Code for Homes that Serve Four Individuals 01/08/2010 11/1/17
2009-100 Process for Sending Medicaid Applications to the Health and Human Services Commission (HHSC) 8/10/2009 11/1/17
2009-93 Communication Regarding the Redistribution of the HCS Monthly Administration and Operations Fee and HCS, TxHmL and CWP Payment Rates 07/15/2009 10/11/17
2009-92 Public Hearing Regarding Proposed Rates for the Home and Community-based Services (HCS), Texas Home Living (TxHmL) and Consolidated Waiver (CWP) waiver programs 07/09/2009 10/11/17
2009-86 Critical Incident Reporting 07/01/2009 11/1/17
2009-84 Process for HCS and TxHmL Program Providers and CDSAs to Maintain Current Information in the Client Assignment and Registration (CARE) System 06/18/2009 11/1/17
2009-48 Public Hearing Regarding Proposed Rule Amendment to the Reimbursement Methodology for HCS to Redistribute the HCS Monthly Administration and Operations Fee 04/08/2009 10/11/17
2009-39 Change in the Timeframe for Mental Retardation/Related Condition (MR/RC) Assessment, Purpose Code 3 Data Entry into the Client Assignment and Registration (CARE) System 4/29/2009 11/1/17
2009-28 Process for CDSAs to Obtain Access to the Client Assignment and Registration System (CARE) and Notification of the New CDSA CARE User Guide 2/18/2009 11/1/17
2009-21 Communication to all Foster/Companion Care Providers Regarding the Redistribution of the HCS Monthly Administration and Operations Fee 02/06/2009 10/11/17
2009-20 Communication Regarding the Redistribution of the HCS Monthly Administration and Operations Fee 02/06/2009 10/11/17
2009-08 Process for CDSAs to Obtain Access to the Client Assignment and Registration System (CARE) and Notification of the New CDSA CARE User Guide 02/18/2009 11/1/17
2008-175 Provider Requirements for Reporting the Death of an Individual Receiving HCS or TxHmL Services 1/15/2009 11/1/17
2008-167 Client Abuse and Neglect Reporting System (CANRS) 11/18/2008 11/1/17
2008-165 Data Entry Training Class for HCS and TxHmL Waiver Program Providers 11/13/2008 11/1/17
2008-156 Follow-up to IL No. 08-48, Regarding Critical Incident Reporting 11/03/2008 11/1/17
2008-143 Clarification Regarding Qualified Providers of the Behavioral Support Service Component 10/03/2008 11/1/17
2008-137 Waiver Survey and Certification (WS&C) Process to Initiate Alternative Services for Individuals Whose Health, Safety and Welfare Are at Risk 09/23/2008 11/1/17
2008-130 Notification of the Availability of Revised Individual Plan of Care (IPC) Forms 09/12/2008 11/1/17
2008-129 Clarification of Current Board of Nursing (BON) Rules that Impact the Delivery of HCS and TxHmL Services 10/23/2008 11/1/17
2008-103 Consumer Directed Services (CDS) Option Policy Clarifications and Notification of a Revision to the HCS and MRA User Guides 07/16/2008 11/1/17
2008-96 Criminal History, Employee Misconduct Registry and Nurse Aide Registry Checks 07/02/2008 11/1/17
2008-77 HCS and TxHmL Rule Amendment Effective Dates and Related Implementation Information 05/29/2008 10/11/17
2008-90 Provider Role Related to Investigations of Abuse, Neglect or Exploitation 07/22/2008 11/1/17
2008-89 Client Assignment and Registration System (CARE) Entry of Designated Alternate to Chief Executive Officer (CEO) 07/22/2008 11/1/17
2008-86 Written Notification to an Individual or Legally Authorized Representative (LAR) of the Denial of a Level of Need (LON) Assignment 07/15/2008 11/1/17
2008-35 New HCS and TxHmL Forms 3610 and 3611 for Involuntary Termination of the Consumer Directed Services (CDS) Option 03/28/2008 11/1/17
2008-20 HCS Individual Plan of Care (IPC) Form 3608 and TxHmL IPC Form 8582 02/13/2008 11/1/17
2008-18 HCS Transfer Process and Transfer Forms (Replaces IL #07-71) 02/06/2008 11/1/17
2008-14 Change to Forms 8571, 8626, 8627 and 8628 02/01/2008 11/1/17
2008-13 Implementation of Consumer-Directed Services (CDS) Reimbursement Rates 01/30/2008 10/11/17
2008-02 Elimination of Paper Forms 3618, 3619 and 3652-A Effective August 1, 2008 / Requirement for Electronic Submission Effective August 1, 2008 02/05/2008 11/1/17
2007-93 HCS and TxHmL Rate Increase Effective September 1, 2007 09/17/2007 10/11/17
2007-128 Transfer and Billing information related to the Client Assignment and Registration System (CARE) conversion for the implementation of Consumer Directed Services (CDS) 12/20/2007 11/1/17
2007-127 Medicare Prescription Drug Program (Medicare Rx) Related Incurred Medical Expenses for Waiver Consumers with Qualified Income Trusts 12/10/2007 11/1/17
2007-122 HCS Temporary and Permanent Discharge Process and Discharge Forms 12/01/2017 11/1/17
2007-105 Data Entry Training Class for HCS and TxHmL Waiver Program Providers 10/19/2007 11/1/17
2007-87 New Convictions Barring Employment Added to Health and Safety Code Chapter 250 09/14/2007 11/1/17
2007-80 Change in Required Documentation for Level of Need (LON) Increase 9/01/2007 11/1/17
2007-74 Individual Cost Limits for Certain Medicaid Waiver Programs 8/20/2007 11/1/17
2007-73 Billable Adaptive Aids 8/20/2007 11/1/17
2007-65 Training of Program Provider Personnel in the Use of Authorized Restraint Techniques 7/06/2007 11/1/17
2007-45 2006 NFPA 101 Life Safety Code for Homes that Serve Four Individuals 05/07/2007 11/1/17
2007-13 Abuse, Neglect, and Exploitation Investigations by Department of Family and Protective Services (DFPS) When the Administrator/Chief Executive Officer is the Alleged Perpetrator 06/15/2007 11/1/17
2006-37 LTC Online Portal (previously referred to as CARE Form System (CFS)) 06/02/2006 11/1/17
2006-29 Medicare Rx prescription drug coverage to resume for "dual eligible" individuals 3/24/2006 11/1/17
2005-41 Increase in Travel Reimbursements for Cost Reporting 10/10/2005 10/11/17
2005-35 Restraint and Seclusion Requirements in new Health and Safety Code, Chapter 322, added by Senate bill 325, 79th Legislature 01/02/2006 11/1/17

HCS, Appendix X, Approved Diagnostic Codes for Persons with Related Conditions List

View the Approved Diagnostic Codes for Persons with Related Conditions List at:

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

HCS, Revisions

HCS, 18-2, Sections 17000 and 18000 Changes

Revision Notice 18-2; Effective June 8, 2018

 

The following changes were made:

Section Title Change
17000 Critical Incident and Death Reporting Makes minor wording changes and removes obsolete information.
18000 Investigations of Abuse, Neglect and Exploitation by the Department of Family and Protective Services. Provides new links to Information Letters.

HCS, 18-1, Appendix X Added

Revision Notice 18-1; Effective February 14, 2018

 

The following changes were made:

Section

Title

Change

Appendix X

Approved Diagnostic Codes for Persons with Related Conditions List

Adds a website link to the Approved Diagnostic Codes List.

HCS, 17-3, Retired Information Letters

Revision Notice 17-3; Effective November 1, 2017

 

The following changes were made:

Section

Title

Change

Appendix IX

Retired Information Letters

Adds several retired letters removed from the website Nov. 1, 2017.

HCS, 17-2, Section 16000 and Appendix IX Changes

Revision Notice 17-2; Effective October 20, 2017

 

The following changes were made:

Section

Title

Change

16000 Consumer Rights and Complaints Updates the entire section describing the responsibilities of the local intellectual and developmental disability authority and program provider to help individuals make complaints and understand their rights.
Appendix IX Retired Information Letters Adds several retired letters removed from the website October 11, 2017.

HCS, Forms

Form Title
0702 Fax Cover Sheet for TxHmL and HCS
1570 ICF Request for Medical Need Assessment or Verification of RUG-III Category
1572 Nursing Tasks Screening Tool
1573 Residential Review Evidence of Correction
1581 Consumer Directed Services Option Overview
1582 Consumer Directed Services Responsibilities
1583 Employee Qualification Requirements
1584 Consumer Participation Choice
1586 Acknowledgement of Information Regarding Support Consultation Services in the Consumer Directed Services (CDS) Option
1588 HCS Review Report
1592 RN Delegation Checklist
1594 Individualized Skills Assessment for Regulating Water Temperature
1597 Level of Care Redetermination Cover Sheet
1740 Service Backup Plan
1741 Corrective Action Plan
1742 Service Backup Plan for HCS, TxHmL and CFC Services
1746 HCS/TxHmL/CFC Exit Conference
1748 HCS/CFC Entrance Conference
2067 Case Information
2124 Community Support Transportation Log
2125 Implementation Plan - HCS/TxHmL/CFC
3598 Individual Transportation Plan
3605 HCS Parent or Legally Authorized Representative (LAR) Contact Information for Individuals Under 22 Years of Age
3608 Individual Plan of Care (IPC) - HCS/CFC
3609 Waiver Survey and Certification Residential Checklist
3610 Informal Review Request
3611 Involuntary Termination of Consumer Directed Services (CDS) Individual Plan of Care (IPC) Cover Sheet (HCS and TxHmL)
3612 Transfer Process Checklist
3615 Request to Continue Suspension of Waiver Program Services
3616 Request for Termination of Services Provided by HCS/TxHmL Waiver Provider
3617 Request for Transfer of Waiver Program Services
4116-Dental Dental Summary Sheet
4116-MHM-AA Minor Home Modification/Adaptive Aids Summary Sheet
4122 Host/Companion Service Delivery Log
5604 HCS Program Provider Request for Life Safety Inspection
5606 Life Safety Code Certification
5607 Review of DFPS Reports and ANE Trends
5610 HCS Fire Drills, Four-Person Home Inspections and Approvals
5611 Personnel Checklist
8490 Medical Increase Worksheet
8491 Request for a Four-Person Residence Approval
8492 Random Sample Review of Nursing On-Call Required Submission of Documentation
8493 Notification Regarding a Death in HCS, TxHmL and DBMD Programs
8494 Notification Regarding An Investigation of Abuse, Neglect or Exploitation
8495 Exclusion of Host Home/Companion Care (HH/CC) Provider from the Board of Nursing (BON) Definition of Unlicensed Person
8509 Unlicensed Personnel Tracking of Delegated Tasks
8510 HCS/TxHmL CFC PAS/HAB Assessment
8511 Understanding Program Eligibility
8574 Administration of Medications by Unlicensed Personnel
8575 Notification of Local Authority (LA) Reassignment
8576 Individual Profile Information
8578 Intellectual Disability/Related Condition Assessment
8579 Notification of Service Coordinator (SC) Disagreement
8580 Request for Variance of Supported Employment - Employer Requirements
8581 Corrective Action Plan Form
8583 HCS and TxHmL Program Contact Information
8584 Nursing Comprehensive Assessment
8584-CDS Comprehensive Nursing Assessment and Plan of Care - HCS Program
8599 Individual Plan of Care (IPC) Cover Sheet
8601 Verification of Freedom of Choice
8603 Level of Need (LON) Review/Increase Cover Sheet
8604 Transition Assistance Services (TAS) Assessment and Authorization
8611 Pre-Enrollment MHM Authorization Request
8612 TAS/MHM Payment Exception Request
8647 Service Coordination Assessment -- Intellectual Disability Services
8662 Related Conditions Eligibility Screening Instrument
8665 Person-Directed Plan
8665-ID Individual Data

HCS, Acronyms (CARE)

Revision 10-0; Effective June 1, 2010

 

AA — adaptive aids

AAR — adaptive aid requisition fee

ACT — action code (what CARE screen do you want to go to?)

AU — Audiology

BES — Behavioral Support

CMM — case management (not self-directed)

CMMB — case management (self-directed)

COMP — component code

CS — Community Support

DE — Dental

DH — Day Habilitation

DI — Dietary

EA — Employment Assistance

FC — Foster/Companion Care

FMSV — Financial Management Services (self-directed service)

ICN — internal control number

LCN — local case number

MHM — minor home modification

MHMRE — minor home modification requisitions fee

NU — Nursing

NUL — Nursing LVN

NULS — Nursing Specialized LVN

NUR — Nursing RN

NURS — Nursing Specialized RN

OT — Occupational Therapy

PA — prior approval

POS — place of service

PS — Psychological Services

PT — Physical Therapy

RA — reimbursement authorization

RE — Respite

REH — Respite Hourly

RES Type — Residential Type

RSS — Residential Support Services

SCV — support consultation (self-directed)

SE — Supported Employment

SHL — Supported Home Living

SL — Supervised Living

SP — Speech/Language Pathology

HCS, Acronyms

Revision 10-0; Effective June 1, 2010

 

AAA — area agencies on aging

AAIDD — American Association of Intellectual and Developmental Disabilities

ABL — adaptive behavior level

ADA — Americans with Disabilities Act

AFC — Adult Foster Care

APS — Adult Protective Services

ARD — Admissions, Review and Dismissal Meeting

CAP — corrective action plan

CARE — Client Assignment and REgistration System

CDS — Consumer Directed Services

CDSA — Consumer Directed Services Agency

CFR — Code of Federal Regulations

CHIP — Children’s Health Insurance Program

CLASS — Community Living Assistance and Support Services

CLO — Community Living Option

CMS — Centers for Medicare and Medicaid Services (formerly HCFA)

CPS — Child Protective Services

CPT — current procedural terminology

CRCG — Community Resource Coordination Group

CSIL — Community Services Interest List

DADS — Department of Aging and Disability Services

DAHS — Day Activity and Health Services

DARS — Department of Assistive and Rehabilitative Services

DBMD — Deaf Blind with Multiple Disabilities

DD — developmental disability

DFPS — Department of Family and Protective Services

DID — determination of intellectual disability

DME — durable medical equipment

DSHS — Department of State Health Services

DVM — Data Verification Manual

ECI — Early Childhood Intervention

EMR — Employee Misconduct Registry

EPSDT — Early Periodic Screening, Diagnosis and Treatment

ETA — electronic transmission agreement

FDP — family directed plan

FFS — fee-for-service

FY — fiscal year

GR — general revenue

HCPCS — Healthcare Common Procedure Coding System

HCS — Home and Community-based Services Waiver

HCSSA — Home and Community Support Services Agency

HHSC — Health and Human Services Commission

HIPAA — Health Insurance Portability and Accountability Act

ICAP — Inventory for Client and Agency Planning

ICF/ID — intermediate care facility for persons with intellectual disability

ID — intellectual disability

ICF/ID-RC — intermediate care facility for persons with intellectual disability or related conditions

IDT — interdisciplinary team

IP — Implementation Plan

IPC — Individual Plan of Care

IQ — intelligence quotient

LAR — legally authorized representative

LOC — level of care

LON — level of need

LTC — Long Term Care

LVN — Licensed Vocational Nurse

MAO — medical assistance only

MCAC — Medical Care Advisory Committee

MDU — Multiple Disabilities Unit (State Hospitals)

ME — Medicaid eligibility

MEPD — Medicaid Eligibility for the Elderly and Persons with Disabilities (formerly MAO)

MERP — Medicaid Estate Recovery Program

MN — medical necessity

MR/RC — mental retardation/related condition

NAR — Nurse Aide Registry

NF — nursing facility

NPO — New Provider Orientation

OBRA — Omnibus Budget Reconciliation Act

OIG — Office of Inspector General

PAO — Licensed Vocational Nurse

PASARR — Preadmission Screening and Resident Review

PCP — primary care physician

PCS — Personal Care Services

PDP — Person-Directed Plan

PE — Program Enrollment

PI — Promoting Independence

PMRA — Persons with Mental Retardation Act

POC — plan of correction

PP — Permanency Planning

QA — Quality Assurance

QDDP — Qualified Developmental Disability Professional (used only in SSLCs)

QI — Quality Improvement

QIDP — Qualified Intellectual Disability Professional

QMB — Qualified Medicare Beneficiary

RC — related condition

RN — Registered Nurse

RSDI — Retirement Survivors Disability Income

SSLC — state supported living center

SASO — Service Authorization System Online

SAVERR — System for Application, Verification, Eligibility Referral and Reporting

SC — service coordination/coordinator

SDO — service delivery option

SPT — service planning team

SLMB — Specified Low-Income Medicare Beneficiary

SSA — Social Security Administration

SSDI — Social Security Disability Income

SSI — Supplemental Security Income

SW — social work

TAC — Texas Administrative Code

TANF — Temporary Assistance for Needy Families

TCM — targeted case management

TGC — Texas Government Code

GHRC — Texas Human Resources Code

THSC — Texas Health and Safety Code

TIERS — Texas Integrated Eligibility and Redesign System

TMHP — Texas Medicaid and Healthcare Partnership

TxHmL — Texas Home Living Waiver

VOFC — verification of freedom of choice

WCA — waiver contract area

WS/C — Waiver Survey and Certification

HCS, Contact Us

For questions about the Home and Community-based Services Handbook, email: hcspolicy@hhsc.state.tx.us

For technical or accessibility issues with this handbook, email: Editorial_Services@hhsc.state.tx.us