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.