Revision 22-1; Effective February 4, 2022

The Home and Community-based Services (HCS) and Texas Home Living (TxHmL) waiver program providers undergo certification surveys completed by HHSC Long-Term Care Regulatory (LTCR) to ensure compliance with the certification principles located in the Texas Administrative Code (TAC). LTCR conducts initial certification and annual recertification surveys for contracts operated by program providers. In addition to these surveys, LTCR also completes residential visits for Host Home/Companion Care and three- and four-person residences in the HCS program. LTCR 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.

Revision 22-1; Effective February 4, 2022

In accordance with Title 40, Texas Administrative Code (TAC), Chapter 9, Subchapter D, §9.171(a), all HCS program providers must be in continuous compliance with the HCS program certification principles. (See §§9.172-9.175 and §§9.177-9.180.)

In accordance with 40 TAC, Chapter 9, Subchapter D, §9.171(d), LTCR may conduct an intermittent survey of HCS program providers at any time to ensure compliance with the HCS program certification principles.

 

 

14210 Types of Surveys

Revision 22-1; Effective February 4, 2022

LTCR conducts certification surveys of HCS program providers, at least annually, to evaluate evidence of the program provider’s compliance with certification principles.

Initial Certification Survey

After a program provider has obtained a provisional contract with HHSC, LTCR conducts an initial certification survey within 120 days after the date HHSC approves the enrollment or transfer of the first individual to receive HCS program services from the program provider under the provisional contract.

Recertification Survey

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

The program provider must demonstrate compliance with all certification principles to be certified for another 365-day period. If the program provider is out of compliance with any certification principles, LTCR will send a final report with a list of violations to the program provider within 14 calendar days after the day of exit. The program provider must submit a plan of correction (PoC) within 14 calendar days of receipt of the report to demonstrate the actions the program provider will implement to demonstrate compliance. 

Follow-Up Survey, Vendor Hold and Denial of Certification

If LTCR determines at the end of a survey that a program provider is not in compliance with one or more of the certification principles that results in a violation, LTCR will require the program provider to develop and submit an acceptable PoC. For a critical violation, the PoC must include that corrective action will be completed within 30 calendar days after the date of the survey exit conference. An on-site follow-up survey will be conducted after the 30-day period to determine if the program provider completed the corrective action in accordance with their PoC. For a violation that is not critical, the PoC must include that corrective action will be completed within 45 calendar days after the date of the survey exit conference. An on-site follow-up survey will be conducted after the 45-day period to determine if the program provider completed the corrective action in accordance with their PoC.

If LTCR determines that the program provider has not completed the corrective action or they have failed to submit an acceptable PoC, HHSC imposes a vendor hold against the program provider or denies or terminates the certification. 

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, Termination of Contract by HHSC.

If a vendor hold is imposed for a program provider with a standard contract, LTCR will conduct a survey at least 31 calendar days after the effective date of the vendor hold 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, HHSC will deny or terminate the certification.

See 40 TAC, Chapter 9, Subchapter D, §9.183, Program Provider Compliance and Corrective Action.

Intermittent Surveys

Intermittent surveys are always unannounced and conducted at the discretion of LTCR. These surveys are based on:

• complaints;
• follow up to abuse, neglect or exploitation (ANE) allegations;
• deaths;
• ANE Trending Report; 
• residential visits; or
• internal HHSC referrals.

 

 

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

Revision 22-1; Effective February 4, 2022

LTCR may conduct unannounced certification surveys or on-site visits at any time.

When the survey team lead contacts the HCS program provider of an upcoming initial certification or recertification survey, the team lead will send a copy of the Provider Information Request form to the program provider.

The team lead will also send Form 8576, Individual Profile Information, to the HCS program provider with a date for the information to be completed and returned to the survey team lead.

Entrance Conference

At the beginning of every initial or recertification survey, the LTCR survey team will conduct an entrance conference with the program provider and any program staff who are present. The LTCR survey team lead will explain the survey process.

The survey 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 on the HCS Provider Portal. 

Certification survey activities include, but are not limited to:

• interviewing individuals, family members, Legally Authorized Representatives (LARs), service providers and staff;
• visiting residences and day habilitation sites;
• reviewing individuals' records (including medical records);
• reviewing personnel and staff training records;
• reviewing financial records of the individuals for which the program provider handles finances;
• reviewing complaint information, satisfaction surveys and Consumer Advocate Advisory Committee (CAAC) meeting minutes;
• reviewing information regarding any deaths, discharges (permanent or temporary) and allegations of abuse, neglect and exploitation;
• reviewing fire drills and emergency evacuation plans, as well as four-person residence approvals and fire marshal inspections for four-person residences; and
• reviewing critical incident data, restraints and restrictive behavior support plans.

The survey team will hold a final debriefing at the end of the survey. The program provider is allowed to submit evidence to show compliance prior to the exit conference. 

Exit Conference

LTCR conducts an exit conference at the end of all surveys, at a time and location determined by HHSC. LTCR gives the program provider a written statement of concern, Form 3701, Preliminary Findings Based on Survey, Inspection or Investigation, at the exit conference.

Note: If the survey team identifies an immediate threat, the program provider is expected to immediately provide the survey team with a plan of removal. If the immediate threat cannot be eliminated, HHSC will deny certification and coordinate with the local intellectual and developmental disability authority (LIDDA) for the immediate provision of alternative services for the individuals.

Informal Dispute Resolution

If a program provider disagrees with the survey results, they may request an informal dispute resolution (IDR). The IDR process is an informal process by which a program provider can dispute, before an independent third party, the findings on which a violation is based. The outcome of the IDR serves as the independent third party’s recommendation to HHSC regarding the program provider’s compliance or noncompliance with program rules. Information about the IDR process is found in Provider Letter 2021-07. 

Note: The program provider must still submit an acceptable PoC no later than 14 calendar days after receiving Form 3724, Statement of Licensing Violations and Plan of Correction, from HHSC even if the program provider chooses to use the IDR process.

 

 

14230 Plan of Correction (PoC)

Revision 22-1; Effective February 4, 2022

Within 14 calendar days after receiving the final survey report, the program provider must submit a PoC to address each violation that was identified during the survey. This applies even if the provider disagrees with the findings of violations or requests an informal dispute resolution (IDR). 

For violations that are critical, the PoC must include the corrective action(s) the program provider will take for each violation. The PoC must also have a completion date within 30 calendar days from the survey exit date. 

For violations that are noncritical, the PoC must include the corrective action(s) the program provider will take for each violation. The PoC must have a completion date within 45 calendar days from the survey exit date. HHSC will review the PoC and the program provider will be notified in writing whether the plan has been approved or denied. If the plan is denied, the program provider must submit a revised plan within five business days of request for a revised PoC. Once the plan is approved, HHSC will request that the program provider submit evidence of the correction to HHSC and HHSC may conduct a follow-up survey to verify the corrections.

Revision 22-1; Effective February 4, 2022

In accordance with 40 TAC, Chapter 9, Subchapter N, §9.576(a), all TxHmL program providers must be in continuous compliance with the TxHmL Program certification principles. (See §§9.578-9.580 and §§9.584-9.585.)

Per 40 TAC, Chapter 9, Subchapter N, §9.576(d), LTCR may conduct an intermittent survey of TxHmL program providers at any time to ensure compliance with the TxHmL program certification principles.

Revision 22-1; Effective February 4, 2022

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 accordance with 40 TAC, Chapter 9, Subchapter D, §9.171(k), HHSC LTCR conducts annual unannounced visits to each residence in which Residential Support Services or Supervised Living is provided and may conduct unannounced visits to each residence in which Host Home/Companion Care services are provided. These visits are completed to verify that these residences offer environments that comply with Form 3609, Waiver Survey and Certification Residential Checklist.

14410 Residential Visit Policy and Procedures

Revision 22-1; Effective February 4, 2022

Upon arrival at the residence, LTCR staff will present their HHSC identification to the Host Home/Companion Care provider or the staff at the three-person or four-person residence and explain the reason for the visit.  If the LTCR staff arrives at a residence in which no one speaks English and the LTCR staff is unable to speak the language of the people living in the residence, the LTCR staff member will secure interpreting services through HHSC to assist with interpreting for the Host Home/Companion Care provider or staff at the three- or four-person residence.

See Information Letter 2009-99 at: https://www.hhs.texas.gov/sites/default/files/documents/providers/communications/2009/letters/IL2009-99.pdf.

LTCR staff use Form 3609, Waiver Survey and Certification Residential Checklist, to conduct each residential visit. Each item on the checklist will be marked pass, fail or not applicable (N/A). Some of the checklist items require interviewing the supervised living staff, residential support staff or the Host Home/Companion Care service provider to assess knowledge of the specific needs of the individual(s) in the residence 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.

LTCR staff may take photographs to substantiate identified concerns, when appropriate.

Provider Letter 2020-01 provides information for how the Host Home/Companion Care provider or HCS provider can give feedback about a residential visit.

If the Address in the HHSC Data System is Invalid

If LTCR staff arrive at a residence that is no longer associated with the HCS program, or cannot find the address provided for a location code in the HHSC data system, LTCR staff will fill out Form 3609 noting the incorrect address. A letter notifying the program provider of the inaccuracy in the HHSC data system will be sent to the program provider.

If No One is Home

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

If LTCR Staff are Not Allowed to Access the Residence

If LTCR staff are not allowed access to a three-person or a four-person residence or a Host Home/Companion Care residence, LTCR staff will notify the program provider for a 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 22-1; Effective February 4, 2022

Calculating the Score from a Residential Visit

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

• A program provider’s score for a visit is calculated by deducting the following from 100 points (the total points on the Residential Review Checklist):
  • the total points for items on the checklist that are marked “fail” during the visit; and
  • ten points for each significant risk identified during the visit.
• The value of each item on a checklist is calculated by dividing 100 points by the number of items on the checklist that are applicable to the 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.

• The value of each item on the checklist is calculated as follows:
  • 100 points ÷ 30 applicable items = 3.33 points/item
• The program provider’s score is calculated as follows:
  • 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, LTCR does not require evidence of correction (EoC) to be submitted 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, LTCR does not require an EoC to be submitted. At the next residential visit, LTCR examines the items marked “fail” at the previous visit and requires an EoC for any of those items that have not been corrected. If the program provider does not submit an EoC as required, or LTCR does not approve the EoC, LTCR may conduct an intermittent survey in accordance with 40 TAC §9.171(l).

Evidence of Correction Required

If a program provider receives a score below 90 or there is an identified significant risk, LTCR requires an EoC for all items marked “significant risk” or “fail.” LTCR also requires the program provider to take action for an identified significant risk, as described below. If the program provider does not submit an EoC as required, or LTCR does not approve the EoC, LTCR may conduct an intermittent survey in accordance with 40 TAC §9.171(l)(4).

A program provider must submit an EoC to LTCR using the WSC Portal or by submitting Form 1573, Residential Review Evidence of Correction. If using Form 1573, the Residential Review ID must be listed on the form with accompanying evidence. The time frame to submit the EoC is included in the documentation received by the program provider. LTCR will not accept an EoC without the correct Residential Review ID. 

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 LTCR determines that an item marked “fail” on the Residential Review Checklist results in a significant risk, LTCR requires the program provider to take action.

• If LTCR concludes that the significant risk requires immediate corrective or mitigating action, such as locking up hazardous chemicals or securing a copy of the residence’s emergency plan, LTCR staff will not leave the residence until the program provider has taken immediate action and the significant risk is removed.
• LTCR will also contact the persons identified in the HHSC data system as the “program provider contract contacts” (the HCS provider or a representative of the HCS provider) and informs such persons of the date, as determined by LTCR, by which the program provider must submit evidence of correction showing that action has been taken and the significant risk removed.

Revision 22-1; Effective February 4, 2022

See also Section 17000, Critical Incident and Death Reporting.

In accordance with 40 TAC, Chapter 9, Subchapter D, §9.178(r), and 40 TAC, Chapter 9, Subchapter N, §9.580(l), HCS and TxHmL program providers must report the death of an individual in their 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 LTCR at 512-206-3999 or submitted through the WSC Portal. 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) meets routinely to review the circumstances surrounding each death. Additional regulatory follow up, including an on-site visit, may be scheduled to evaluate the program provider's compliance with HCS or TxHmL certification principles as the result of the DRG review.

 

14510 Death Review Policy and Procedures

Revision 22-1; Effective February 4, 2022

As part of the death review, the Risk Assessment coordinators (RACs) collect the following information:

• Date of death;
• Provider contract number and component code;
• Person reporting the death, including contact telephone, email address and fax number;
• Individual's identification number in the HHSC data system;
• Type of setting ─ HCS, Texas Home Living (TxHmL) or Deaf Blind with Multiple Disabilities (DBMD);
• Cause of death;
• Date provider notified of death;
• Admission date to the provider;
• Dates of hospitalizations in the last three months (if applicable);
• Dates of hospice (if applicable);
• If the Department of Family and Protective Services (DFPS) Statewide Intake was notified;
• Types of residence (Host Home/Companion Care, 3-Person, 4-Person, Own Home or Family Home);
• Place of death;
• Type of death (expected, unexpected, or accident);
• Description of events surrounding the death; and
• If an autopsy was ordered.

Information Gathering

If abuse  or neglect is suspected in relation to the death of the individual, the RAC will immediately contact DFPS Statewide Intake.

Requests for Additional Information

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

• Most recent person directed plan and implementation plan(s);
• Any training regarding the individual’s special needs provided to service providers;
• Last two months of medication administration records;
• Most current nursing assessment;
• Last three months of nursing notes, physician orders and lab work;
• Last three weeks of residential support services, supervised living, Community First Choice personal assistance services/habilitation, supported home living, community support or host home/companion care notes;
• Last week of day habilitation notes;
• State supported living center transition notes (if applicable);
• Hospice notes (if applicable); and
• RN/LVN names/signature sample key.

Additional documents may be requested after the initial review by the RAC nurse.

Suspicious Deaths

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

Follow-up Activities

RACs may conduct a desk review based on the information received from the program provider, requested records and/or the information received from HHSC Provider Investigations (PI).

The RAC manager may recommend an on-site visit based on the circumstances of the death, information obtained from a desk review or information obtained from HHSC PI. If the survey team determines that the program provider is not in compliance with one or more of the certification principles during an on-site visit, an intermittent survey will be opened.

Revision 22-1; Effective February 4, 2022

The Risk Assessment coordinator (RAC) team receives investigative reports related to allegations of abuse, neglect or exploitation of individuals who receive HCS, TxHmL or ICF/IID program services. The reports are reviewed by RACs to determine whether regulatory follow-up is required. Additional documentation may be requested from the program provider to verify that the program provider responded to the allegation of abuse, neglect and exploitation according to program standards. In addition, an on-site visit may be scheduled.

 

14610 Abuse, Neglect and Exploitation Policy and Procedures

Revision 22-1; Effective February 4, 2022

The final HHSC Provider Investigations (PI) report is reviewed by RACs to determine if/or what actions need to be taken by LTCR Survey Operations. Actions to be taken are determined by:

• the severity of the allegation;
• the disposition of the allegation;
• the concerns/recommendations of the investigator; and
• indicators of noncompliance noted by the RACs during the review of the final report narrative.

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 the RACs of its response to the findings by submitting Form 8494, Notification Regarding an Investigation of Abuse, Neglect or Exploitation,  in HCS and TxHmL programs, by fax to 512-206-3999 or through the WSC Portal. Form 8494 should include:

• the program provider name;
• contract number;
• component code;
• date submitted to LTCR;
• who submitted the form, as well as area code and phone number and fax;
• DFPS case number;
• date the DFPS report was received;
• HHSC data system ID number;
• date of allegation;
• type of allegation;
• disposition of allegation;
• concurrence with the disposition;
• what actions were taken by the provider; and
• if the provider will be requesting a methodological review or a review of the finding.

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

One of the following actions is taken by LTCR:

• Desk review – A desk review is conducted if there is low risk to the individual(s). The determination of low risk is made if the allegation does not pose a risk to the health or safety of the individual(s) served.
• On-site visit – On-site visits are conducted if it is determined that a significant risk exists for one or more individuals.

Revision 22-1; Effective February 4, 2022

Each quarter, RACs compile a quarterly trending report for all HCS and TxHmL waiver contracts. This risk factor report includes:

• number of confirmed abuse/neglect/exploitation allegations entered into the abuse/neglect database that meet or exceed 5% of all confirmed findings out of the total number of allegations for contract;
• number of complaints entered into the complaint database; and
• number of deaths of individuals entered into the death database.

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 as appropriate.

Revision 22-1; Effective February 4, 2022

The HHSC IDD Ombudsman refers complaints to the RACs when the complaint is related to noncompliance with the HCS or TxHmL certification principles. HHSC departments refer internal complaints or concerns directly to LTCR. Complaints are reviewed by the RACs and appropriate follow-up actions are identified and completed as appropriate.

 

14810 Complaints Policy and Procedures

Revision 22-1; February 4, 2022

If LTCR staff receive a complaint from an external complainant, the person making the complaint should be immediately referred to the IDD Ombudsman at 800-252-8154.  

The IDD Ombudsman tries to resolve the complaint with the external complainant and the program provider. If the complaint cannot be resolved and it impacts the HCS certification principles, the IDD Ombudsman will refer it to LTCR. The complaint is received by the RACs, who review it to determine what actions are to be taken. The actions are determined by:

• severity of the complaint; and
• number and severity of other complaints received about that contract or program provider.

Actions to be taken include:

• Enter the complaint into the LTCR database, for follow up on the next scheduled survey.
• Desk Review – A desk review is conducted if there is low risk to the individual(s). The determination of low risk is made if the complaint did not involve issues that relate to the health or safety of the individual(s) served or if initial contact with the program provider indicates the situation has been satisfactorily resolved.
• On-site visits are conducted if it is determined that significant risk exists for one or more individuals. RACs review the complaint with the RAC manager or designee prior to scheduling an on-site visit.

Revision 22-1; Effective February 4, 2022

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

 

14910 Four-Person Residence Approval Policy and Procedures

Revision 22-1; Effective February 4, 2022

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 send it using any of the following methods:

Email: HCSFourPersonResidenceRequests@hhs.texas.gov 
Fax: 512-438-4148
Mailing address: 
Texas Health and Human Services Commission
WSC Residential Survey 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: https://hhsportal.hhs.state.tx.us/helpGuide/Content/16_CARE/WaiverPDF/MRA%20User%20Guide.pdf (Note: The CARE User's Guide is only available for those with access to the CARE system.)
3. Send the following supporting documentation to HCSFourPersonResidenceRequests@hhs.texas.gov:
   • Current date;
   • Name of the agency;
   • Contact person and area code and phone number;
   • Component code and contract number;
   • Location code for the residence;
   • Address and county of the residence (including the ZIP code);
   • Certification from the program provider that the program provider intends to provide residential support to one or more individuals who will live in the residence; and
   • Written certification from the program provider that the residence to be approved is not the residence of any person except a person permitted to live in the residence, as described in 40 TAC, Chapter 9, Subchapter D, §9.153(39), relating to definitions.
4. A current copy of the residence’s  certification as required by 40 TAC, Chapter 9, Subchapter D, §9.178(e)(1)(A), relating to certification principles and quality assurance:
   • 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 residence, the program provider must ask the State Fire Marshal to inspect the residence. If both the local fire authority and the State Fire Marshal refuse to inspect the residence, 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 residence, the program provider is required to maintain annual fire marshal certifications required by 40 TAC §9.178(e)(3)(A).

The HCS program provider can check the HHSC data system to see if the home has been approved.

For questions, contact HHSC Long-Term Care Regulation – HCS and TxHmL by email at HCSFourPersonResidenceRequests@hhs.texas.gov.