Local Intellectual and Developmental Disability Authority Handbook

 

Section 1000, LIDDA Overview

Revision 19-4; Effective September 9, 2019

 

House Bill 3 of the 59th Legislature (1965) created the structure now known as the local intellectual and developmental disability authority (LIDDA). In the 1960s, the state moved to provide mental health and intellectual disability services in the community rather than in institutions. Community centers were created to provide community-based services and address the needs of persons returning to their communities from state supported living centers (SSLCs), Medicaid-certified nursing facilities and state hospitals. Each center has a designated local service area comprised of one or more Texas counties.

The LIDDA was developed as a means for the state to delegate its authority and responsibilities related to planning, policy development, coordination, resource allocation, resource development, and oversight of community intellectual and developmental disability (IDD) services throughout the state. The state is required to contract with the designated LIDDAs and provides funding for the delegated functions and for required community-based services to be provided in each service area.

In the Texas Health and Safety Code, Title 7, Subtitle A, Chapter 533A, §533A.0355, and in Texas Administrative Code, Title 40, Part 1, Chapter 2, Subchapter G, §2.305 (LIDDA’s Role and Responsibilities), each LIDDA serves as the single point of access to certain publicly funded services and supports for the residents within the LIDDA's local service area. A LIDDA's responsibilities include:

Section 2000, Acronyms

Revision 19-4; Effective September 9, 2019

 

ABL Adaptive Behavioral Level
APC Admission Placement Coordinator
CARE Client Assignment and Registration System
CCAD  Community Care for Aged and Disabled
CDS Consumer Directed Services
CFC Community First Choice
CLASS Community Living Assistance and Support Services
CLCP Community Living Discharge Plan
CMS Claims Management Services
CPS Child Protective Services
CSIL Community Services Interest List
DBMD Deaf Blind with Multiple Disabilities
DFPS Department of Family and Protective Services
DID  Determination of Intellectual Disability
ECC Enhanced Community Coordination
HCS Home and Community-based Services
HHSC Texas Health and Human Services Commission
HPO Health Plan Operations
ICF/IID Intermediate Care Facility for Individuals with an Intellectual Disability or Related Conditions
ICAP Inventory for Client and Agency Planning
IDD Intellectual and Developmental Disability
IDD-PES Intellectual and Developmental Disability – Program Eligibility and Support
IDD-EVPS Intellectual and Developmental Disability – Eligibility Verification and Program Support
ID/RC Intellectual Disability/Related Condition Assessment
IP Implementation Plan
IPC Individual Plan of Care
LAR Legally Authorized Representative
LIDDA Local Intellectual and Developmental Disability Authority
LOC Level of Care
LON  Level of Need
LPDS Local Procedure Development and Support
LTC Long Term Care
MCO Managed Care Organization
MDCP Medically Dependent Children Program
MEPD Medicaid for the Elderly and People with Disabilities
MERP Medicaid Estate Recovery Program
MRA This acronym is still used in the CARE System but has been replaced with LIDDA.
NF Nursing Facility
PACE Program of All-Inclusive Care for the Elderly
PASRR Preadmission Screening and Resident Review
PCP Person-Centered Planning
PDP Person-Directed Plan
PPI Program Enrollment/Utilization Review
QIDP Qualified Intellectual Disability Professional
SA Service Authorization
SASO Service Authorization System Online
SC Service Coordinator
SG Service Group
SPT Service Planning Team
SPW STAR+PLUS Waiver
SSA Social Security Administration
SSI Supplemental Security Income
SSLC State Supported Living Center
TCM Targeted Case Management
TIERS Texas Integrated Eligibility Redesign System
TMHP Texas Medicaid & Healthcare Partnership
TxHmL Texas Home Living

 

Section 3000, Person-Directed Plan (PDP)

Revision 19-4; Effective September 9, 2019

 

Local intellectual and developmental disability authorities (LIDDAs) are responsible for conducting person-directed planning as the foundation for service delivery for persons receiving general-revenue (GR) funded services, Community First Choice (CFC) and persons enrolling in the Home and Community-based Services (HCS) and Texas Home Living (TxHmL) programs.

LIDDAs must use a person-directed planning process that is consistent with Texas Health and Human Services Commission (HHSC) Person Directed Planning Guidelines.

Person directed planning is an ongoing process that empowers the person, and the legally authorized representative (LAR) on the person’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 person’s desired life in sufficient detail, so the program provider understands how to provide services to meet the person’s outcomes.

HHSC approved Person-Directed Planning training is found online at Person-Centered Planning (PCP) Training for Providers.

 

3100 Discovering the Person

Revision 19-4; Effective September 9, 2019

 

The person’s strengths and 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 person directing the plan. This activity is often called “discovery.” The local intellectual and developmental disability authority (LIDDA) 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 person, legally authorized representative (LAR) and others who know and support the person, such as caregivers, close family members, current provider staff, friends and teachers. Effective discovery includes:

The person-directed planning Discovery Guide and Discovery Tool are central resources to utilize when beginning the discovery process.

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

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

 

3200 PDP

Revision 19-4; Effective September 9, 2019

 

Before developing the Person-Directed Plan (PDP), the service coordinator (SC) should discuss with the person and legally authorized representative (LAR) the importance of the provider being included when the person discusses his/her preferences and outcomes. Since the provider will be responsible for designing and providing the services to the person, understanding the person’s strengths, capabilities and desires is critical to providing services that are meaningful to the person. The SC should request permission from the person/LAR to invite the provider to the planning meeting to develop the PDP. The SC should also ask the person/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 program services are decided upon. Or, it can be a meeting in which the discovery information is presented and clarified and then program services are negotiated.

The SC should have a thorough understanding of the services in the program so that connections can be made between what the person wants to have happen and the program service array. Reviewing the Program Billing Guidelines for Targeted Case Management, Home and Community based Services (HCS) and Texas Home Living (TxHmL), discussions with the person’s program provider and consultation with the LIDDA’s service coordination supervisor can support this understanding.

 

3210 Developing the PDP for Persons in GR

Revision 19-4; Effective September 9, 2019

 

If the designated local intellectual and developmental disability authority (LIDDA) determines a person is eligible for, and desires service coordination, the LIDDA must develop and implement policies and procedures related to enrollment into general revenue (GR) services that address:

 

3220 Developing the PDP for Persons in HCS and TxHmL

Revision 19-4; Effective September 9, 2019

 

The Person-Directed Plan (PDP) has two elements plus instructions:

The Service Planning Team (SPT) is responsible for determining whether a person’s program service is critical to meeting the person’s health and safety needs. The program provider must develop a written backup plan for each program service identified on the PDP as critical to meeting a person’s health and safety. Because Home and Community-based Services (HCS) program providers must ensure that trained and qualified staff are always available for the provision of residential support and supervised living, a backup plan is not needed for these services. Backup plans for host home must be documented in the service agreement the host home provider has with the program provider.

The SPT is responsible for documenting that the services on the PDP:

For an enrollment PDP, the service coordinator (SC) is responsible for justifying both the need and the amount for each service type in the PDP.

For PDP renewals and PDP updates, refer to the Home and Community-based Services Handbook.

Section 4000, Service Authorization for Targeted Case Management (TCM)

Revision 19-4; Effective September 9, 2019

 

A service authorization (SA) for Targeted Case Management (TCM) is created in the Service Authorization System Online (SASO) for all Medicaid recipients receiving service coordination from a local intellectual and developmental disability authority (LIDDA).

 

4100 Creating a TCM Service Authorization in SASO

Revision 19-4; Effective September 9, 2019

 

For persons enrolled in Home and Community-based Services (HCS) or Texas Home Living (TxHmL), or Medicaid recipients receiving service coordination from a local intellectual and developmental disability authority (LIDDA), the first billing for a Target Case Management (TCM) event results in a service authorization, which is effective for one year after the first TCM event.

The service authorization (SA) is identified in SASO as Service Group (SG) 14 or “SG 14 SA,” which is associated with TCM provided by a LIDDA.

 

4200 Requesting an Existing TCM Service Authorization be Closed

Revision 19-4; Effective September 9, 2019

 

If a person with SG 14 service authorization (SA) enrolls in another Texas Health and Human Services Commission (HHSC) program in which receiving Target Case Management (TCM) is mutually exclusive with receiving services through the other program, such as Community Living Assistance and Support Services (CLASS), the person’s existing TCM SA must be closed. If the SG 14 SA is open, the SA for the other program cannot be entered in the Service Authorization System Online (SASO) because the two are mutually exclusive. Furthermore, the local intellectual and developmental disability authority (LIDDA) has no ability to manually close the TCM SA.

 

4210 HHSC Staff Requests

Revision 19-4; Effective September 9, 2019

 

If Texas Health and Human Services Commission (HHSC) is notified that a person who has an open service authorization (SA) for Targeted Case Management (TCM) will be enrolling in another HHSC program that is mutually exclusive with TCM, the appropriate regional HHSC Regional Claims Management Services (CMS) coordinator is contacted to resolve the mutually exclusive SA issue. The regional CMS coordinator contacts the designated HHSC staff in the Local Procedure Development and Support Unit. The designated staff:

The regional CMS coordinator enters an end date for the SG 14 SA in Service Authorization System Online (SASO).

 

4220 LIDDA Requests

Revision 19-4; Effective September 9, 2019

 

If the local intellectual and developmental disability authority (LIDDA) is notified that a person with an SG 14 service authorization (SA) will be enrolled in a Texas Health and Human Services Commission (HHSC) program that is mutually exclusive to Targeted Case Management (TCM), the LIDDA:

The regional CMS coordinator enters an end date for the SG 14 SA in SASO.

 

4300 List of Regional CMS Coordinators

Revision 19-4; Effective September 9, 2019

 

Texas Health and Human Services Commission (HHSC) regional Claims Management Services (CMS) coordinators are assigned to specific regions in the state. The list of coordinators by region and their contact information is found here.

 

4400 Billing Resolutions Request

Revision 19-4; Effective September 9, 2019

 

Form 1595, Billing Resolutions Request, is available for a local intellectual and developmental disability authority (LIDDA) to communicate billing issues to the regional Claims Management Services (CMS) coordinator.

Section 5000, Guidelines for Determining and Changing Designated LIDDA

Revision 19-4; Effective September 9, 2019

 

5100 HCS, TxHmL, or PASRR Persons with IDD

Revision 19-4; Effective September 9, 2019

 

For a person enrolled in the Home and Community-based Services (HCS) Program, Texas Home Living (TxHmL) Program or a resident of a nursing facility (NF), the person’s designated local intellectual and developmental disability authority (LIDDA) is the LIDDA for the local service area in which the person resides.

 

5200 Community First Choice (CFC)

Revision 19-4; Effective September 9, 2019

 

For a person determined eligible for, enrolling in, or enrolled in CFC services provided through a Medicaid managed care organization (MCO), the person’s designated local intellectual and developmental disability authority (LIDDA) is the LIDDA for the local service area in which the person resides.

 

5300 All Others

Revision 19-4; Effective September 9, 2019

 

For a person who is not described previously in this section, the following guidelines are used to determine the person’s designated local intellectual and developmental disability authority (LIDDA):

 

5400 Unique Situations

Revision 19-4; Effective September 9, 2019

 

At its discretion, Texas Health and Human Services Commission (HHSC) may determine the designated local intellectual and developmental disability authority (LIDDA) for any person or assign a LIDDA the duties of the designated LIDDA for any person.

A non-designated LIDDA is not prohibited from serving a person who is currently being served by his/her designated LIDDA. In such a situation, the designated LIDDA must enter in an agreement with the non-designated LIDDA to provide the service. The designated LIDDA reports all service encounters for the person.

The determination of the designated LIDDA, for intellectual and developmental disability (IDD) services, is not relevant to a person’s admission to a state mental health facility.

Section 6000, Options for Intellectual and Developmental Disability Services and Supports

Revision 19-4; Effective September 9, 2019

 

6100 Definitions

Revision 19-4; Effective September 9, 2019

 

In this section, the following terms are defined as follows:

Actively involved party – For a person who lacks the ability to provide legally adequate consent and who does not have a legally authorized representative, someone whose significant and ongoing involvement with the person is supportive of the person, as determined by the local intellectual and developmental disability authority (LIDDA). The LIDDA’s determination is based on:

Legally authorized representative (LAR) – Has the meaning assigned in the Continuity of Services Rule – State Facilities, Title 40, Texas Administrative Code, Chapter 2, Subchapter F. A person authorized by law to act on behalf of a person with regard to a matter described in this subchapter, and may include a parent, guardian, or managing conservator of a minor, or the guardian of an adult.

LIDDA community services and supports – Services and supports funded by state general revenue and local funds through the LIDDA Performance Contract.

Person – Someone seeking or receiving services and supports.

Primary correspondent – Used frequently in the Client Assignment and Registration (CARE) System. It means the person with whom the LIDDA communicates regarding services for a person. A primary correspondent can be the person. If it is not the person, then it is usually the LAR, a family member of the person, or an actively involved party. For the intake process, the primary correspondent is the person who identifies the preferred services for the information on Form 8648, Identification of Preferences.

 

6200 Inquiries for Information

Revision 19-4; Effective September 9, 2019

 

In response to an inquiry for information about programs and services for a person with IDD, the local intellectual and developmental disability (LIDDA) must provide or mail to the person and legally authorized representative (LAR) or actively involved party:

Although the LIDDA is required to provide the person and LAR or actively involved party an explanation of services and supports, the primary correspondent may choose to identify preferred services and supports before receiving the explanation. In such cases, the LIDDA will provide the oral explanation and provide or mail the preceding documents after Form 8648, Identification of Preferences, has been completed.

The LIDDA must ensure encounter data is captured and must document via contact notes the following:

If the LIDDA provides an explanation of programs and services to an LAR who is not a family member of the person, the LIDDA must provide an oral and written explanation of programs and services to at least one family member of the person, if possible, per Texas Government Code, §531.042 and 40 Texas Administrative Code, Chapter 2, Subchapter G, §2.307(b)(1)(A).

 

6300 Documenting and Maintaining a Record of a Person’s Preferences for Services and Supports

Revision 19-4; Effective September 9, 2019

 

When a person and legally authorized representative (LAR) or actively involved party is ready to identify a preference for services and supports, the local intellectual and developmental disability authority (LIDDA) will:

 

6400 LIDDAs and the Primary Correspondent

Revision 19-4; Effective September 9, 2019

 

The local intellectual and developmental disability authority (LIDDA) must inform the person who identified a preference for services and supports on Form 8648, Identification of Preferences, the following:

 

6500 Identified Services and Supports

Revision 19-4; Effective September 9, 2019

 

If the preferred service and support identified on Form 8648, Identification of Preferences, is:

Section 7000, HCS and TxHmL Interest Lists

Revision 19-4; Effective September 9, 2019

 

Home and Community-based Services (HCS) and Texas Home Living (TxHmL) interest lists are a collection of persons’ data who have requested program services and must wait until resources become available for their services. The interest list is collected and managed using the Client Assignment and Registration (CARE) System. CARE compiles the HCS and TxHmL information throughout the state to create the statewide HCS and TxHmL interest lists. Texas Health and Human Services Commission (HHSC) uses the statewide interest lists to offer HCS and TxHmL program services to persons on the lists. The person with the longest time on the interest list is served first.

Separate interest lists are maintained for other HHSC programs such as the Medically Dependent Children Program (MDCP), Community Living Assistance and Support Services (CLASS) and Deaf Blind with Multiple Disabilities (DBMD) waiver programs.

The data for the other lists are maintained in the Community Services Interest List (CSIL) database. A person’s begin date on the interest list in CSIL is referred to as the “Request Date.” Though the HCS and TxHmL interest lists are visible in CSIL, CARE is the system of record for HCS and TxHmL.

The CSIL hotline is 877-438-5658. It is recommended the person, LAR or actively involved party make the call to complete the questionnaire, when requesting placement on other interest lists.

Per the local intellectual and developmental disability authority (LIDDA) Performance Contract, all LIDDAs are required to maintain continuous access to CSIL.

 

7100 Definitions

Revision 19-4; Effective September 9, 2019

 

In this section, the following terms are defined as follows:

Actively involved party – For a person who lacks the ability to provide legally adequate consent and who does not have a legally authorized representative, someone whose significant and ongoing involvement with the person is supportive of the person, as determined by the local intellectual and developmental disability authority (LIDDA). The LIDDA’s determination is based on:

Legally authorized representative (LAR) – Has the meaning assigned in the Continuity of Services Rule – State Facilities, Title 40, Texas Administrative Code, Chapter 2, Subchapter F. A person authorized by law to act on behalf of a person with regard to a matter described in this subchapter, and may include a parent, guardian, or managing conservator of a minor, or the guardian of an adult.

Person – Someone seeking or receiving services and supports.

Primary correspondent – Used frequently in the Client Assignment and Registration (CARE) System. It means the person with whom the LIDDA communicates regarding services for a person. A primary correspondent can be the person. If it is not the person, then it is usually the person’s LAR, a family member of the person, or an actively involved person. For a person whose name is on the Home and Community-based Services (HCS) and Texas Home Living (TxHmL) interest list, it’s the person with whom the LIDDA maintains contact with for biennial contacts and to make an offer for HCS or TxHmL services when resources become available.

 

7200 Maintenance of the HCS and TxHmL Interest Lists

Revision 19-4; Effective September 9, 2019

 

Each local intellectual and developmental disability authority (LIDDA) is responsible for maintaining the Home and Community-based Services (HCS) and Texas Home Living (TxHmL) interest lists for its local service area. Using the Client Assignment and Registration (CARE) System, LIDDAs are responsible for:

 

7210 Active Military Status Families

Revision 19-4; Effective September 9, 2019

 

Texas Health and Human Services Commission (HHSC) adopted rules to ensure active duty military members and their dependents who have declared and maintained Texas as the member’s home of record maintain their position on interest lists or other waiting lists for certain health and human services assistance programs.

If the person’s family has temporarily moved out of Texas due to active military service and the family wants the person’s name to remain on the interest list, the person’s family must provide non-Texas contact information to enable the local intellectual and developmental disability authority (LIDDA) to make biennial contact. A non-Texas contact is acceptable in this situation.

LIDDAs will:

If the person or primary correspondent is no longer interested in HCS or TxHmL services and is a Status 1 (interested), see Section 7700, Removing a Person’s Name from the HCS or TxHmL Interest List.

If the person or primary correspondent is no longer interested in HCS or TxHmL services and is a Status 10 (active military), the LIDDA will:

 

7300 Adding a Person’s Name to the HCS or TxHmL Interest Lists

Revision 19-4; Effective September 9, 2019

 

Eligibility for the Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Programs is determined by Texas Health and Human Services Commission (HHSC) only at the time the person has been offered the opportunity to enroll in the waiver program.

If the person, LAR or actively involved party identifies HCS or TxHmL as preferred services on Form 8648, Identification of Preferences, the LIDDA will:

 

7310 Creating an Interest List Record in CARE

Revision 19-4; Effective September 9, 2019

 

A person must be registered in the Client Assignment and Registration (CARE) System for an interest list record to be created. If the person has a CARE ID, the registration has been completed.

Before creating any interest list record, verify the person does not already have an interest list record. The information may be found on the last screen of CARE screen 397, Client ID Information. All interest list status information is maintained within the CARE System and may be viewed on a person’s CARE screen 397. If a record exists, see Section 7800, When to Transfer a Person’s Interest List Record.

A person’s statewide interest list rank is available in CARE screen W26, Interest List – Services Inquiry by Person, if an interest list record is created.

 

7320 Two or More Interest List Records for the Same Person

Revision 19-4; Effective September 9, 2019

 

If one person has two or more interest list records because of multiple Client Assignment and Registration (CARE) System ID numbers, the local intellectual and developmental disability authority (LIDDA) must:

 

7330 Persons Under 22 Years of Age Regarding ICF/IID and NFs – For HCS Only

Revision 19-4; Effective September 9, 2019

 

If the person is under 22 years of age and is being admitted into an intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID), including a state supported living center (SSLC) or a nursing facility (NF), the local intellectual and developmental disability authority (LIDDA) must inform the LAR of the state statute requiring the person’s name to be on the HCS interest list.

The LIDDA should give the LAR the option of declining the biennial contact. See Section 7510, Exception to Biennial Contact.

 

7400 Returned Interest List Notification Letters

Revision 19-4; Effective September 9, 2019

 

Texas Health and Human Services Commission (HHSC) mails out letters via the U.S. Postal Service (USPS) to persons whose names were recently added to the Home and Community-based Services (HCS) and Texas Home Living (TxHmL) interest lists.

The letter serves as documentation for the person that their name is on the HCS or TxHmL interest list. The letter is sent to the primary correspondent using the address for the primary correspondent in the Client Assignment and Registration (CARE) System. If the primary correspondent’s address is incomplete (e.g., no ZIP code), then the letter is sent to the person using the address for the person in CARE.

When an address in CARE is incomplete or outdated, the letter is returned to HHSC as undeliverable. Periodically, HHSC sends the undeliverable letters it received from USPS to the local intellectual and developmental disability authority (LIDDA).

The LIDDA must:

To ensure that notification letters are not returned, the LIDDA must:

 

7500 Biennial Contact

Revision 19-4; Effective September 9, 2019

 

Each person whose name is on the Home and Community-based Services (HCS) and Texas Home Living (TxHmL) interest lists with a Status 1, which indicates the person is interested in receiving HCS or TxHmL services, or a status 10, which indicates active military status, must be contacted by their designated local intellectual and developmental disability authority (LIDDA) during each term of the LIDDA Performance Contract. The LIDDA is required to:

If contact with a person with a Status 10 (active military) cannot be made, contact the Biennial Contact Monitor at LIDDAServiceCoordination@hhsc.state.tx.us.

 

7510 Exception to Biennial Contact

Revision 19-4; Effective September 9, 2019

 

There is one exception for the biennial contact: persons under 22 years of age receiving services in an intermediate care facility (ICF/IID) or nursing facility (NF) whose LARs do not want a biennial contact. Since state statute requires the person’s name to be on the Home and Community-based Services (HCS) interest list, Texas Health and Human Services Commission (HHSC) provides the LARs of these persons with the option of declining the biennial contact. That information is then entered in the Client Assignment and Registration (CARE) System W21 screen, in the Yes/No box following the question “Biennial contact declined?” If the LAR answers “yes” to decline the biennial contact, then the LIDDA does not conduct a biennial contact with the LAR.

 

7520 CARE XPTR Reports for Managing Biennial Contacts

Revision 19-4; Effective September 9, 2019

 

Several reports exist in the Client Assignment and Registration (CARE) System XPTR for managing interest list biennial contact requirements. These reports must be used to manage the interest list.

 

7530 Preparation for Biennial Contact

Revision 19-4; Effective September 9, 2019

 

It is important that a LIDDA have documentation that a person requested to be added to the Home and Community-based Services (HCS) or Texas Home Living (TxHmL) interest list(s). Before a biennial contact, a LIDDA should verify that the person’s record contains documentation supporting the request to add the person’s name to the interest list(s). In most cases, the supporting documentation will be Form 8648, Identification of Preferences. Sometimes, the documentation will only be a progress note recording the intake visit.

If supporting documentation is not available, then the local intellectual and developmental disability authority (LIDDA) staff must document in the person’s record the reason why supporting documentation is not available. For instance:

 

7540 Effort for Contacting the Primary Correspondent

Revision 19-4; Effective September 9, 2019

 

Telephone or face-to-face contact with the primary correspondent is preferable. If a person whose name is on the Home and Community-based Services (HCS) and Texas Home Living (TxHmL) interest lists is currently receiving some services or supports through the local intellectual and developmental disability authority (LIDDA), the biennial contact with the primary correspondent could be conducted face-to-face at the service site. For persons not currently receiving services or supports, a combination of telephone and mail contacts might be necessary in order to arrange for a discussion for the biennial contact.

The following steps may be helpful in finding a person or primary correspondent who has been difficult to locate:

 

7550 Discussions and Documentation

Revision 19-4; Effective September 9, 2019

 

For every biennial contact, the local intellectual and developmental disability authority (LIDDA) must:

The date of the discussion is considered the “Biennial Contact Date.”

The LIDDA must capture the encounter data and document the person specific discussion in contact notes to include:

 

7560 Entering Biennial Contact Information into CARE  

Revision 19-4; Effective September 9, 2019

 

Biennial contact information can be entered into the Client Assignment and Registration (CARE) System at any time, without limitations on data entry dates. Biennial contact is entered in CARE screen W21, Interest List - Services, along with pertinent information gathered during the discussion to include updated contact information and military status. The date of the discussion is considered the “Biennial Contact Date.”

Important: The status date does not change unless the status changes.

To update the person’s and primary correspondent’s mailing addresses in CARE:

 

7570 Unable to Make Biennial Contact

Revision 19-4; Effective September 9, 2019

 

If efforts for contacting the primary correspondent do not result in a contact between the local intellectual and developmental disability authority (LIDDA) and the primary correspondent or person, the LIDDA must:

If the LIDDA receives a response from the person or primary correspondent, the LIDDA will:

If the LIDDA does not receive a response from the person or primary correspondent, the person’s status remains a Status 6 (inactive) until the person is offered HCS or TxHmL services, or the person or primary correspondent contacts a LIDDA. The LIDDA will:

 

7580 Unable to Make Biennial Contact Regarding Facility Residents

Revision 19-4; Effective September 9, 2019

 

If all methods to contact the primary correspondent of a resident of an intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID), including a state supported living center (SSLC) or nursing facility (NF), are unsuccessful, the local intellectual and developmental disability authority (LIDDA) should confirm that the person continues to reside in the ICF/IID, SSLC or NF.

If the person is still a resident, the LIDDA should not change the Status 1 (active) assignment.

If the person is no longer a resident of the facility or any other facility, see Section 7570, Unable to Make Biennial Contact.

 

7600 HCS and TxHmL Interest List Status Designations

Revision 19-4; Effective September 9, 2019

 

The following are status designations in the Client Assignment and Registration (CARE) System for the Home and Community-based Services (HCS) and Texas Home Living (TxHmL) interest lists.

Important: The status date does not change unless the status changes.

Status 1 – Interested

This status indicates that the person is actively interested in HCS or TxHmL services, as applicable. The local intellectual and developmental disability authority (LIDDA) enters this status when a person or the person’s primary correspondent expresses a desire for the person to receive the service. A LIDDA must make a biennial contact with the primary correspondent of every person with a Status 1. The begin date must match the “date of discussion” on Form 8648, Identification of Preferences.

Status 2 – Pending

This status indicates the person has been authorized by Texas Health and Human Services Commission (HHSC) to receive an offer for HCS or TxHmL, as applicable. HHSC will change the person’s interest list status from a Status 1 (interested) to a Status 2 (pending) on the day HHSC sends the LIDDA the letter authorizing the LIDDA to offer HCS or TxHmL to the person.

Note: Although a Status 2 is not assigned by a LIDDA, a person with a Status 2 may be transferred from one LIDDA to another.

Status 3 – Enrolled

This status indicates the person has been enrolled in the HCS or TxHmL program. When a person is enrolled, a Status 3 (enrolled) and a new status date are automatically posted to the person’s interest list record by CARE.

Status 4 – Denied

This status indicates the person has been denied eligibility for the HCS or TxHmL program. A Status 4 (denied) is automatically posted to the record by CARE, if HHSC determines that the person is not eligible for the program.

Status 5 – Voluntarily Withdrawn (Initiated by the Person or Primary Correspondent)

This status indicates the primary correspondent has voluntarily withdrawn the person’s name from the interest list. The LIDDA changes a person’s interest list status to a Status 5 (voluntarily withdrawn) when the primary correspondent voluntarily withdraws due to one of the following situations:

Status 6 – Inactive (Cannot be Contacted)

Beginning Nov. 21, 2014, this status indicates the primary correspondent cannot be contacted because he or she cannot be located or is not responsive to the biennial contact. Refer to Section 7570, Unable to Make Biennial Contact, for instructions prior to assigning a Status 6. A LIDDA is able to change a Status 6 (inactive) to another more appropriate status any time after the Status 6 (inactive) is entered in CARE.

Note for HCS only: If the person is under 22 years of age and living in an intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID) or nursing facility (NF) and has been offered an opportunity to enroll in the HCS Program, but the primary correspondent could not be contacted, Status 6 (inactive), an automated CARE action will occur to reinstate a Status 1 (interested) with the new “begin date” being the status date of the Status 6 (inactive). This status was not authorized for use between April 1, 2013, and Nov. 21, 2014.  

Status 7 – Removed

This status indicates the person has been removed from the HCS or TxHmL interest list. HHSC assigns this status on a case-by-case basis, such as when HHSC confirms that a letter withdrawing an offer has been delivered to a person or LAR. See Section 7700, Removing a Person’s Name from the HCS or TxHmL Interest List.

Status 8 – Declined

This status indicates the person or LAR completed and signed Form 8601, indicating the person has declined the opportunity to enroll in the program. The LIDDA must enter the Status 8 (declined) using the date of the person’s signature on the form as the status date. A Status 8 (declined) is not assigned for the following reasons:

If a person requests to remain on the HCS or TxHmL interest list after declining the offer to enroll in the program and a Status 8 (declined) is assigned, the LIDDA will:

Status 9 – Transferred

This status indicates the person moved to the local service area of another LIDDA. The LIDDA changes the person’s HCS and TxHmL interest list Status 1 (interested) to a Status 9 (transferred) when the person or LAR moves to the local service area of another LIDDA. A Status 6 (inactive) must be returned to a Status 1 (interested) before an interest list record can be transferred. See Section 7800, When to Transfer a Person’s Interest List Record.
 

Status 10 – Active Military

HHSC assigns this status to indicate the person is unable to complete enrollment into the HCS or TxHmL program, as documented on Form 8601 because the person resides out of the state due to the family’s active military status.  

 

7610 When to Change the Status of a Person’s HCS or TxHmL Interest List Record

Revision 19-4; Effective September 9, 2019

 

A person’s status on the Home and Community-based Services (HCS) and Texas Home Living (TxHmL) interest list is changed when there is a change in the person’s status, as described in Section 7600, HCS and TxHmL Interest List Status Designations. Once a person is registered with a Status 1, the local intellectual and developmental disability authority (LIDDA) does not change the status unless one of the following occurs:

 

7700 Removing a Person’s Name from the HCS or TxHmL Interest List

Revision 19-4; Effective September 9, 2019

 

The local intellectual and developmental disability authority (LIDDA) changes the person’s interest list status to a Status 5 (voluntarily withdrawn) due to one of the following situations.

If the primary correspondent requests that the person’s name be removed from the Home and Community-based Services (HCS) or Texas Home Living (TxHmL) interest list, the LIDDA must provide a new Form 8648, Identification of Preferences, for the primary correspondent to complete. The primary correspondent must:

Upon receiving a completed, signed and dated Form 8648, indicating that the person’s name be removed from the HCS or TxHmL interest list, the LIDDA will:

If the person moves out of Texas, the LIDDA will:

If the person dies, the LIDDA will:

 

7800 When to Transfer a Persons Interest List Record

Revision 19-4; Effective September 9, 2019

 

When a local intellectual and developmental disability authority (LIDDA) is informed that a person with a Status 1 (interested) or Status 2 (pending) on the Home and Community-based Services (HCS) and Texas Home Living (TxHmL) interest list is moving or has moved to another LIDDA’s service area, then the transferring LIDDA must:

The receiving LIDDA will:

 

7900 Requesting Changes to a Person’s HCS or TxHmL Interest List

Revision 19-4; Effective September 9, 2019

 

A request for Texas Health and Human Services Commission (HHSC) to change a person’s Home and Community-based Services (HCS) and Texas Home Living (TxHmL) interest list information, due to an input or procedural error, must be made by the local intellectual and developmental disability authority’s (LIDDA), Intellectual and Developmental Disability (IDD) Director.

The LIDDA must:

If HHSC determines the documentation supports the request, HHSC will change the person’s interest list information and notify the LIDDA.

If HHSC determines the documentation does not support the request, HHCS will not change the interest list information and notify the LIDDA.

If a person identifies the HCS or TxHmL Program as a preferred service and the person informs the LIDDA the he or she was determined ineligible for a waiver (other than HCS or TxHmL) due to a reason other than financial ineligibility, the LIDDA will request that HHSC change the person’s begin date for HCS or TxHmL to be the person’s “Request Date/Time” in the Community Services Interest List (CSIL) for the waiver for which the person was denied. If the person is already on the interest lists for HCS or TxHmL, the LIDDA will only request a begin date change if the HCS or TxHmL begin date is later than the person’s “Request Date/Time” in CSIL for the waiver for which the person was denied. The request must be typed and:

Section 8000, Permanency Planning

Revision 19-4; Effective September 9, 2019

 

The local intellectual and developmental disability authority (LIDDA) must conduct and document permanency planning for persons under age 22 years enrolling in, or currently residing in, an intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID) or Home and Community-based Services (HCS) residential setting in accordance with 40 Texas Administrative Code, Chapter 9, Subchapter D and Subchapter E.

 

8100 Permanency Planning Instruments

Revision 19-4; Effective September 9, 2019

 

The local intellectual and developmental disability authority (LIDDA) must develop permanency plans using the permanency planning instruments located on Texas Health and Human Services webpage, Permanency Planning for Children, which includes:

If a person is 18 to 22 years of age and does not have a legally authorized representative (LAR), but does have an actively-involved family member, include the actively-involved family member in permanency planning unless the person is opposed to such inclusion.

 

8200 Enrollment Permanency Planning

Revision 19-4; Effective September 9, 2019

 

For persons who are enrolling from a family-based setting into an intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID), including a state supported living center (SSLC) or a Home and Community-based Services (HCS) residential setting, the local intellectual and developmental disability authority (LIDDA) must:

 

8300 Continued Permanency Planning

Revision 19-4; Effective September 9, 2019

 

For persons who currently reside in an intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID), including a state supported living center (SSLC) or a Home and Community-based Services (HCS) residential setting, the local intellectual and developmental disability authority (LIDDA) must:

 

8400 Permanency Planning Reports

Revision 19-4; Effective September 9, 2019

 

Use the following Client Assignment and Registration (CARE) System XPTR reports to identify the persons in need of permanency planning:

These CARE XPTR reports indicate persons newly identified as needing permanency planning. The local intellectual and developmental disability authority (LIDDA) has 20 days to conduct permanency planning starting the first business day a person’s name first appears on either report.

 

8500 Submission Requirements

Revision 19-4; Effective September 9, 2019

 

Submit a copy of Form 2260, Permanency Planning Instrument (PPI) for Children Under 22 Years of Age (Family Directed Plan), to the intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID) or Home and Community-based Services (HCS) provider and legally authorized representative (LAR) or family by the plan of care implementation date.

The local intellectual and developmental disability authority (LIDDA) must enter into the Client Assignment and Registration (CARE) System screen 309, Permanency Planning Review/Add/Change/Delete:

To view the status of a permanency plan submitted in CARE, go to screen 249, PPR Approval Status View.

For persons who are younger than ten years of age, the LIDDA should email the permanency planning information (initial and reviews) encrypted to the IDD Contract Accountability and Oversight mailbox at localauthoritycao@hhsc.state.tx.us.

Questions about permanency planning in ICF/IIDs, including state supported living centers (SSLCs) and HCS may also be submitted to localauthoritycao@hhsc.state.tx.us.

Section 9000, Enhanced Community Coordination (ECC) Responsibilities for SSLC Diversions and Transitions

Revision 19-4; Effective September 9, 2019

 

This program helps adults and children with intellectual and/or developmental disabilities move from state supported living centers (SSLCs) to homes in the community.

Note: Refer to the Intellectual and Developmental Disability Preadmission Screening and Resident Review (IDD-PASRR) Handbook for ECC responsibilities related to diversion from admission to, or transition from, a nursing facility.

 

9100 Duties Related to Transitioning from an SSLC

Revision 19-4; Effective September 9, 2019

 

For all persons receiving a crisis diversion or transitioning from a state supported living center (SSLC), the local intellectual and developmental disabilities authority (LIDDA) must ensure an assigned enhanced community coordinator:

 

9110 Reporting Requirements

Revision 19-4; Effective September 9, 2019

 

The local intellectual and developmental disability authority (LIDDA) must submit quarterly reporting to the LIDDA Performance Contract’s mailbox by the 15th day of the month that follows the previous fiscal quarter, using a format prescribed by Texas Health and Human Services Commission (HHSC). A quarterly report must contain:

 

9200 Enrollment in HCS as a Crisis Diversion

Revision 19-4; Effective September 9, 2019

 

For a person enrolling in Home and Community-based Services (HCS) as a crisis diversion, a local intellectual and developmental disabilities authority (LIDDA) enrolls the person in the HCS Program in accordance with the requirements in the HCS rules and Section 13000, Medicaid Program Enrollment Requirements. A LIDDA ensures an assigned enhanced community coordinator completes the following:

 

9300 Post Enrollment in HCS as a Crisis Diversion

Revision 19-4; Effective September 9, 2019

 

For one year after a person has enrolled in the Home and Community-based Services (HCS) Program as a crisis diversion, an assigned enhanced community coordinator must:

 

9400 Enrollment in HCS as an SSLC Transition

Revision 19-4; Effective September 9, 2019

 

For a person planning to transition from a state supported living center (SSLC) to the Home and Community-based Services (HCS) Program, a local intellectual and developmental disability authority (LIDDA) must ensure an assigned enhanced community coordinator:

 

9500 Post Enrollment in HCS as an SSLC Transition

Revision 19-4; Effective September 9, 2019

 

For one year following a person’s transition from a state supported living center (SSLC) to the Home and Community-based Services (HCS) Program, a local intellectual and developmental disability authority (LIDDA) must ensure an enhanced community coordinator:

 

9600 Transition Planning from an SSLC to a Setting Other than the HCS Program

Revision 19-4; Effective September 9, 2019

 

For a person transitioning from a state supported living center (SSLC) to a setting other than the Home and Community-based Services (HCS) Program, such as a community intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID) or family’s home, a local intellectual and developmental disability authority (LIDDA) must ensure an assigned enhanced community coordinator:

 

9700 Post Transition from an SSLC to a Setting Other than the HCS Program

Revision 19-4; Effective September 9, 2019

 

For one year following a person’s transition from a state supported living center (SSLC) to a setting other than the Home and Community-based Services (HCS) Program, a local intellectual and developmental disability authority (LIDDA) must ensure an enhanced community coordinator:

Section 10000, Community Living Options Information Process (CLOIP)

Revision 19-4; Effective September 9, 2019

 

Contracted local intellectual and developmental disability authorities (LIDDAs) perform activities to provide information and education about community living options to persons who are 22 years of age or older residing in a state supported living center, or to the person’s legally authorized representative.

 

10100 Definitions

Revision 19-4; Effective September 9, 2019

 

In this section, the terms below have the following meanings.

Contracted local intellectual and developmental disability authority (LIDDA) – One of 13 LIDDAs that have a state supported living center (SSLC) in its local service area and with which Texas Health and Human Services Commission (HHSC) will contract for provision of the Community Living Options Information Process (CLOIP).

Designated LIDDA – The LIDDA identified in the Client Assignment and Registration (CARE) System as the adult resident’s county of residence LIDDA.

Person – An adult resident who resides in an SSLC and who is 22 years of age or older.

Legally Authorized Representative (LAR) – Has the meaning assigned in the Continuity of Services Rule – State Facilities, Title 40, Texas Administrative Code (TAC), Chapter 2, Subchapter F. A person authorized by law to act on behalf of a person with regard to a matter described in this subchapter, and may include a parent, guardian, or managing conservator of a minor, or the guardian of an adult.

Interdisciplinary Team (IDT) – Has the meaning assigned in the Continuity of Services Rule – State Facilities, Title 40, TAC Chapter 2, Subchapter F. IDD professionals and paraprofessionals and other concerned persons, as appropriate, who assess a person’s treatment, training, and habilitation needs and make recommendations for services, including recommendations of whether the person is best served in a facility or in a community setting.

 

10200 Standardized Information Materials

Revision 19-4; Effective September 9, 2019

 

Contracted local intellectual and developmental disability authorities (LIDDAs) will provide and explain the Explanation of IDD Services and Supports publication and the Long Term Services and Supports publication to all persons and LARs.

In addition to the required material in the preceding paragraph, contracted LIDDAs will provide and explain other informational and educational materials developed and approved by Texas Health and Human Services Commission (HHSC) that provides a more complete explanation of specific types of services. Educational and informational materials will be person friendly and in a format that provides for easy interpretation and can include written, audio, Power Point, CD or DVD formats. The style and substance of the materials are crucial to education and awareness. Communication devices and techniques (including the use of sign language) will be used, as appropriate, to facilitate the involvement of the person and legally authorized representative (LAR).

HHSC will provide coordination, support and funding for these standardized materials. HHSC will assure the development of curriculum and the provision of training for contract LIDDAs and state supported living center (SSLC) staff regarding the Community Living Options and Information Process (CLOIP), the developed materials and their use.

Designated LIDDAs, upon request by the contracted LIDDA, will provide information about specific programs and services available where the person or their LAR, on behalf of the person, is interested in living. This may include, but is not limited to, specific information about services, supports and providers in the local service area. Designated LIDDAs may provide the information directly to the person and LAR or to the contracted LIDDA.

In addition to the materials described above, a person and/or LAR will be offered the opportunity to visit living options available in the community and to visit with persons/peers using these options with their prior consent.

 

10300 LIDDA Responsibilities

Revision 19-4; Effective September 9, 2019

 

The contracted local intellectual and developmental disability authority (LIDDA) will:

 

10400 LIDDA and SSLC Collaborative Relationship

Revision 19-4; Effective September 9, 2019

 

The state supported living center (SSLC) will assist Texas Health and Human Services Commission (HHSC) staff to identify the annual planning meeting date for each adult resident of the SSLC. An annual calendar of scheduled or tentatively scheduled meetings will be provided to the contracted local intellectual and developmental disability authority (LIDDA).

Post implementation of the Community Living Options and Information Process (CLOIP), the SSLC qualified intellectual disability professional (QIDP) will provide the contracted LIDDA service coordinator with 45-days’ notice of annual planning meetings.

When a planning meeting is requested at a time other than the annual meeting in which the person or legally authorized representative (LAR) needs information about community living options, all efforts will be made by the SSLC QIDP to notify the LIDDA service coordinator no later than 45 days prior to the meeting date so the CLOIP can be initiated with the person and/or LAR.

The SSLC QIDP will facilitate access by the contracted LIDDA service coordinator to the person and/or LAR for the purpose of establishing a positive relationship between them and the LIDDA service coordinator.

To the extent not otherwise prohibited by state or federal confidentiality laws, the SSLC QIDP will facilitate access by the contracted LIDDA service coordinator to the resident’s records. The results of the person’s most recent annual planning meeting will be copied for the contracted LIDDA record for preparation and use in CLOIP discussions with the person and/or LAR. An additional copy will be provided to the person or LAR by the contracted LIDDA service coordinator at the beginning of the CLOIP. If the person and/or the LAR has determined they are not interested in community options, these records would not need to be accessed.

The contracted LIDDA service coordinator will provide documentation of the results of the CLOIP to the SSLC QIDP no later than 14 calendar days prior to the annual planning meeting.

The SSLC QIDP will continue to be responsible for contacting the person and/or LAR and the designated LIDDA of the date, time and location of the annual planning meeting no later than 45 days in advance.

The SSLC QIDP will continue to have responsibility for discussions with the person or LAR that is needed prior to the annual planning meeting, other than the CLOIP.

The contracted LIDDA service coordinator will participate in the SSLC planning meeting in addition to the person or LAR. It is strongly preferred the LIDDA service coordinator attend in person, but for purposes of meeting the performance measures, a teleconference will be accepted.

The designated LIDDA service coordinator may participate in the SSLC planning meeting when placement or continuity of service issues is pending.

The SSLC and the contracted LIDDA will work together to provide persons, and/or LARs and SSLC staff, information about community living options and about the risk of moving to a community living option. This can be accomplished through organized activities or functions held at the SSLC or at the contracted LIDDA.

 

10500 LIDDA and Adult Resident, LAR and/or Interested Family Member Collaborative Relationship

Revision 19-4; Effective September 9, 2019

 

The contracted local intellectual and developmental disability authority (LIDDA) will use the annual planning meeting schedule at the state supported living center (SSLC) to assign staff caseloads. Contracted LIDDA service coordinators should be assigned in such a way as to meet with, and complete, the Community Living Options and Information Process (CLOIP) for SSLC persons.

The contracted LIDDA service coordinator will contact each person or legally authorized representative (LAR) on their caseload in person or by phone, as circumstances allow, to begin to establish a positive working relationship. A person and/or the LAR can designate any other significant person in their life, such as some other interested family member or friend, to be involved in the discussions. The contracted LIDDA may develop an interlocal agreement with a designated LIDDA to meet its contract obligations in this process due to the location of the LAR. This process may require several contacts in the months prior to the annual interdisciplinary team (IDT) staffing. If the person or LAR expresses they have no interest in community living options, no further contact, other than annually, will be made by the LIDDA.

The LIDDA service coordinator will provide the person and/or LAR with the standardized informational and educational materials on community living options. The LIDDA service coordinator will discuss the options in a way that allows them to express an understanding and awareness of the options discussed.

If the person or LAR wishes to know specific details of options and supports in a specific location, the LIDDA service coordinator will make this information available and coordinate visits to community living options, at their request, prior to the deadline for completion of the CLOIP.

All telephone and in-person contacts made for purposes of the CLOIP, including those by a designated LIDDA, will be documented with a progress note and the appropriate encounter code provided by Texas Health and Human Services Commission (HHSC). These will be part of the contracted LIDDA’s record, along with the previous year’s planning meeting results, the LIDDA person’s identifying information record and a summary of the CLOIP, as described in this section. The contracted LIDDA may include any other documents in the contracted LIDDA record at their discretion.

The LIDDA service coordinator will document the results of the CLOIP to include the following:

The LIDDA service coordinator will document these results on the CLOIP Instrument, Local Authority Service Coordinator Community Living Options Information Process Worksheet.

 

10600 SSLC Annual IDT Staffing

Revision 19-4; Effective September 9, 2019

 

The annual state supported living center (SSLC) interdisciplinary team (IDT) meeting will review the Community Living Options and Information Process (CLOIP) Instrument, Local Authority Service Coordinator Community Living Options Information Process Worksheet, and identify and document:

Except as provided below, the SSLC IDT will develop, as part of the Personal Support Plan, an action plan to address one or more of the following:

IDT-created action plans and goals are available through the SSLC whether or not the person prefers to remain at the facility.

If there is not consensus by the IDT, regarding the most appropriate living option at the current time, the SSLC will implement Division 4, Section 2.276 of the Continuity of Services Rule – State Facilities, which allows for the head of the SSLC to name a review team to evaluate the situation and make a consensus recommendation to the head of the SSLC within 21 calendar days. The person or actively involved party may request a review of the head of the SSLC's decision by the Office of the Independent Ombudsman for SSLCs.

Section 11000, Determination of Intellectual Disability

Revision 19-4; Effective September 9, 2019

 

Local intellectual and developmental disability authorities (LIDDAs) must conduct assessments to determine if persons seeking services and supports meet the criteria for a diagnosis of intellectual disability, in accordance with 40 Texas Administrative Code, Chapter 5, Subchapter D, Diagnostic Assessment.

 

11100 DFPS Request for DID

Revision 19-4; Effective September 9, 2019

 

The Department of Family and Protective Services (DFPS) may request a local intellectual and developmental disability authority (LIDDA) conduct a determination of intellectual disability (DID) for a person placed into Child Protective Services (CPS), or a person referred for guardianship with Texas Health and Human Services Commission (HHSC). The LIDDA where the person currently resides will conduct the DID. To identify which LIDDA serves the area where the person resides, search Where do I Call to Get HHS Services?

DFPS will use Form 1051, Request for Determination of Intellectual Disability for an Individual Referred for Guardianship by DFPS, to make a request for a LIDDA to conduct a DID.  If the LIDDA receives a request to conduct a DID from DFPS without using Form 1051, immediately notify LIDDAServiceCoordination@hhsc.state.tx.us.

The LIDDA must:

The LIDDA must maintain a copy of all emails and faxes related to a request for a DID from DFPS.

Note: HHSC Guardianship requires DIDs to be update or endorsed within the last 24 months prior to a hearing date. 

Section 12000, Protocol for Offering an HCS Crisis Diversion Slot

Revision 19-4; Effective September 9, 2019

 

The number of offers for a Home and Community-based Services (HCS) Crisis Diversion slot made each month is based on budgetary guidelines, in accordance with the legislative allocation for the biennium.

 

12100 Purpose

Revision 19-4; Effective September 9, 2019

 

Texas Health and Human Services Commission (HHSC) may offer an HCS Crisis Diversion slot to a person with an intellectual or developmental disability:

 

12200 Definition of Imminent Risk of Admission to an Institution

Revision 19-4; Effective September 9, 2019

 

A person is at imminent risk of admission to an institution if one or more of the following exists:

 

12300 Qualifications for the HCS Reserved Capacity Group for Crisis Diversion

Revision 19-4; Effective September 9, 2019

 

A person qualifies as a member of the Home and Community-based Services (HCS) Reserved Capacity Group for Crisis Diversion if:

Note: Persons who only meet the criteria for ICF/IID LOC VIII are not eligible.

 

12400 Process

Revision 19-4; Effective September 9, 2019

 

The local intellectual and developmental disability authority (LIDDA) conducts an interview with the person and legally authorized representative (LAR) or an actively involved party about the circumstances creating imminent risk of the person’s admission to an institution. The LIDDA provides an explanation of intellectual or developmental disability (IDD) services and supports.

If the LIDDA determines the person is at imminent risk of admission to an institution, as described in Section 12200, Definition of Imminent Risk of Admission to an Institution, and meets the criteria for a community intermediate care facility for individuals with intellectual disabilities or related conditions (ICF/IID) level of care (LOC) I, and that adequate and appropriate community resources are not available, as evidenced by attempts to locate and use community-based services and supports, the LIDDA begins the process for requesting a Home and Community-based Services (HCS) Crisis Diversion slot.

The LIDDA requests an HCS Crisis Diversion Slot request to the designated staff person in Texas Health and Human Services Commission (HHSC) IDD Services by submitting a packet that includes:

Upon receipt, designated HHSC staff reviews the packet for completeness.

HHSC staff will meet to discuss the request and determine whether the person meets the qualifications described in Section 12300, Qualifications for the HCS Reserved Capacity Group for Crisis Diversion.

The LIDDA initiates the enrollment process within three working days of receipt of the authorization letter from HHSC. The LIDDA is required to complete the enrollment process, in accordance with the rules governing the HCS Program, specifically 40 Texas Administrative Code, §9.157, Process of Enrollment of an Applicant, within the time frames as required by the LIDDA Performance Contract.

If, while waiting for an offer of an HCS Crisis Diversion slot, HHSC determines the person no longer meets the qualifications for the HCS Reserved Capacity Group for Crisis Diversion, as described in Section 12300, HHSC will, within one business day, notify the LIDDA and the person or LAR in writing of the denial of an HCS Crisis Diversion slot and provide the person or LAR with an opportunity for an appeal through a fair hearing.

Section 13000, Medicaid Program Enrollment Requirements

Revision 19-4; Effective September 9, 2019

 

The local intellectual and developmental disability authority (LIDDA) designates staff to complete enrollments for persons into specified Medicaid programs.

 

13100 LIDDA Required Training

Revision 19-4; Effective September 9, 2019

 

All designated staff at a local intellectual and developmental disability authority (LIDDA) must complete all Texas Health and Human Services Commission (HHSC) online enrollment training before performing enrollment activities, and at least annually thereafter, for as long as the staff performs enrollment activities for the LIDDA. The training includes:

The trainings are found at LIDDA Training Opportunities.

 

13200 Enrollment into the HCS and TxHmL Programs

Revision 19-4; Effective September 9, 2019

 

The local intellectual and developmental disability authority (LIDDA) will complete the enrollment process for each authorized person into the Home and Community based Services (HCS) and Texas Home Living (TxHmL) Programs in accordance with Texas Health and Human Services Commission (HHSC) rules and within the time frames stated in this section. The enrollment process is complete when the person’s status in the Client Assignment and Registration (CARE) System screen C61, Consumer Demographics Inquiry, reads “active” or “denied.”

The LIDDA must request an extension for the enrollment if the time frames listed below cannot be met. HHSC will grant an extension for good cause for a person:

Prior to enrollment, the LIDDA must:

If the person is enrolled in a Medicaid waiver program or a service that is mutually exclusive to the program that the LIDDA is offering, the LIDDA must:

If the person being offered a program vacancy in HCS or TxHmL is enrolled in the STAR+PLUS Waiver Program (SPW), the LIDDA must:

Within the same time frames, the LIDDA must have:

Note: A request for extension received by HHSC after the 15th day of the last month of a quarter will not be approved for that quarter.

If the LIDDA that is authorized to offer an HCS or TxHmL Program vacancy to a person anticipates the person’s HCS or TxHmL enrollment will not be completed by the required date, the LIDDA must:

Once the receiving LIDDA receives the information from the authorized LIDDA, then the receiving LIDDA is responsible for meeting required time frames for enrollment.

If the person being offered a program vacancy is currently receiving general revenue-funded services from the LIDDA, the LIDDA must inform the person and LAR that if they decline the offer of waiver services identified by HHSC (i.e., HCS or TxHmL), the LIDDA will terminate the general revenue-funded services in accordance with rules governing the HCS or TxHmL Program.

The information below pertains to a person with Medicare and Medicaid (referred to as “full-dual eligible”). A person with only Medicaid is not affected by the Medicare Prescription Drug Program and will continue to receive his or her drugs through Medicaid.

If the person is a Medicare beneficiary, the LIDDA must verify that the person:

If the person is not already enrolled in a drug plan, the LIDDA must explain to the person and LAR that the person must enroll in a drug plan in order to receive prescription medications and that upon enrollment in the waiver program, he or she will be auto-enrolled in a drug plan, which may or may not be the drug plan that is most beneficial. The LIDDA must:

The LIDDA must explain to the person and LAR that:

The LIDDA must explain to the person and LAR the following information, and then document on Form 8601, Verification of Freedom of Choice, that:

For a person who has declined to participate in the HCS or TxHmL Program, the LIDDA must:

For a person who has chosen to participate in the HCS or TxHmL Program, the LIDDA must:

If the HCS or TxHmL Program operated by the LIDDA is selected by the person or the LAR to be the person’s program provider, the LIDDA must complete Form 1052, Public Provider Choice Request. The LIDDA must then determine whether the requested LIDDA program is operating at, or over, its capacity as identified in CARE.  
 

For a person who is being enrolled in the TxHmL Program, the LIDDA service coordinator must facilitate the completion of Form 8586, TxHmL Program Service Coordination Notification.

The LIDDA must maintain the following completed forms in the person’s records:

 

13300 Enrollment into the ICF/IID Program

Revision 19-4; Effective September 9, 2019

 

The local intellectual and developmental disability authority (LIDDA) must:

If the person is a Medicare beneficiary, the LIDDA must do the following:

If the person is enrolled in both Medicaid and Medicare, the LIDDA must explain to the person and LAR that the person will:

Section 14000, Medicaid Estate Recovery Program (MERP) Overview

Revision 19-4; Effective September 9, 2019

 

Texas Health and Human Services Commission (HHSC) must operate a MERP to recover the costs of Medicaid long-term care benefits received by certain Medicaid recipients, in accordance with the Texas Administrative Code, Title 1, Part 15, Chapter 373.

The local intellectual and developmental disability authority (LIDDA) must require its enrollment staff to:

Information regarding MERP is found on the HHS website or by emailing MERP@hhsc.state.tx.us.

For information regarding a specific case, call toll-free at 800-641-9356.

Section 15000, Pre-Enrollment Activities and Financial Eligibility Related to HCS and TxHmL

Revision 19-4; Effective September 9, 2019

 

15100 Research Preventing Dual Enrollment

Revision 19-4; Effective September 9, 2019

 

The local intellectual and developmental disability authority (LIDDA) must determine if a person is already enrolled in another waiver program. A person cannot be enrolled in more than one waiver at a time, as determined by Texas Health and Human Services Commission (HHSC) and Appendix I, Mutually Exclusive Services. The LIDDA will:

 

15200 Persons Enrolled in STAR+PLUS Waiver (SPW)

Revision 19-4; Effective September 9, 2019

 

If a person is enrolled in the SPW program (service group 19) and chooses to enroll in Home and Community-based Services (HCS) or Texas Home Living (TxHmL), the local intellectual and developmental disability authority (LIDDA) will:

 

15300 Determine if the Person is a Medicare Beneficiary    

Revision 19-4; Effective September 9, 2019

 

The US Government site for Medicare is Medicare.gov.

The local intellectual and developmental disability authority (LIDDA) will:

 

15400 Financial Eligibility

Revision 19-4; Effective September 9, 2019

 

Texas Health and Human Services Commission (HHSC) requires all persons to meet financial eligibility for enrollment in the Home and Community-based Services (HCS) and Texas Home Living (TxHmL) waiver program. After enrollment, financial eligibility must be maintained for the person to continue participation in the program. Persons eligible for certain types of Medicaid coverage are financially eligible for the program; however, not all types of Medicaid coverage ensure eligibility.

 

15410 Financial Eligibility at Pre-Enrollment

Revision 19-4; Effective September 9, 2019

 

The local intellectual and developmental disability authority (LIDDA) checks the Client Assignment and Registration (CARE) System screen C63, Medicaid Eligibility Search. The screen displays the Medicaid eligibility information for a person as it appears in the Texas Integrated Eligibility Redesign System (TIERS).

Note: The LIDDA must enter the person’s Social Security number and Medicaid number exactly as they appear in the C63 screen later during enrollment when entering CARE screen L09, Register Client Update.

If a person does not currently have Medicaid, or the type of Medicaid the person has is not acceptable for Home and Community-based Services (HCS) or Texas Home Living (TxHmL) enrollment, the LIDDA must determine whether the person should apply for Supplemental Security Income (SSI) benefits through the Social Security Administration (SSA) or apply for Medicaid through Texas Health and Human Services Commission (HHSC).  

Note: There are monthly income limits that can affect Medicaid eligibility.

If the person’s monthly income does not exceed the Medicaid income limit, the LIDDA should assist the person with completing an application for SSI benefits through the SSA. If a person is determined eligible for SSI benefits, the person is categorically eligible for SSI Medicaid, which is acceptable for HCS and TxHmL.

If the person’s monthly income exceeds the Medicaid income limit, the LIDDA should assist the person in completing an application for Medicaid through HHSC. The LIDDA must complete Form H1746-A, MEPD Referral Cover Sheet, and fax it, along with Form H1200, Application for Assistance – Your Texas Benefits, to the HHS Document Processing Center at 877-236-4123.

If Form 8578, Intellectual Disability/Related Condition Assessment, and Form 3608, Individual Plan of Care (IPC) – HCS/CFC, (for HCS), or Form 8582, Individual Plan of Care – TxHmL/CFC, (for TxHmL), have been completed, the LIDDA should include a copy of these forms with the application. If Form 8578, Form 3608 (for HCS), and Form 8582 (for TxHmL) have not been completed, proceed with submitting Form H1200 and Form H1746-A. Form 8578, Form 3608 and Form 8582 can be submitted later. Do not wait for these forms to be completed before submitting Form H1200.

If the person or legally authorized representative (LAR) prefers to submit Form H1200 himself or herself, the LIDDA must still complete Form H1746-A. After the person or LAR submits Form H1200, the LIDDA submits the completed Form H1746-A with a note in the comments section stating that Form H1200 was submitted separately.

Do not submit both an SSI application and a Medicaid application. HHSC Medicaid for the Elderly and People with Disabilities (MEPD) will not process a Medicaid application for the person if the SSA is processing an application for SSI.

Note: The process outlined above does not apply to persons leaving an intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID), state hospital or state supported living center (SSLC) to enroll in the HCS Waiver.

 

15420 Persons Leaving an ICF/IID, State Hospital or SSLC to Enroll in HCS

Revision 19-4; Effective September 9, 2019

 

When a person is discharged from an intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID), state hospital or state supported living center (SSLC) to enroll in Home and Community-based Services (HCS), a Texas Health and Human Services Commission (HHSC) Program Enrollment advisor submits a request for a Medicaid “program transfer” to HHSC Medicaid for Elderly and People with Disabilities (MEPD). [Example: D14 to R14 or I14 to R14.]

Note: The Program Enrollment advisor cannot request a “program transfer” until all of the HCS Client Assignment and Registration (CARE) System enrollment screens (L01, Consumer Enrollment; L23, IDRC Assessment; L02, Individual Plan of Care; L03, Enrollment Packet Checklist; L09, Register Client Update; and L05, Provider Choice) have been entered in CARE by the local intellectual and developmental disability authority (LIDDA). Also, a program transfer request cannot be submitted to HHSC prior to the HCS enrollment date.

For persons receiving Supplemental Security Income (SSI) benefits, CARE screen C63, Medicaid Eligibility Search, will show the person’s Medicaid coverage code and program type as D13 or I13. The representative payee must contact the Social Security Administration (SSA) to notify it of the person’s discharge from the facility and provide a current address for the person before the Program Enrollment advisor can request the program transfer to R13 for HCS enrollment. If the program transfer is not completed timely, the person may be denied SSI Medicaid and must reapply.

For persons being discharged from an ICF/IID, state hospital, or SSLC who have lost Medicaid eligibility, or do not have an acceptable type of Medicaid for HCS enrollment, the LIDDA must determine whether the person should apply for SSI benefits through the SSA or apply for Medicaid through HHSC.

Note: There are monthly income limits that can affect Medicaid eligibility.

If the person’s monthly income does not exceed the Medicaid income limit, the LIDDA should assist the person with completing an application for SSI benefits through the SSA. If a person is determined eligible for SSI benefits, the person is categorically eligible for SSI Medicaid, which is acceptable for HCS and Texas Home Living (TxHmL).

If the person’s monthly income exceeds the Medicaid income limit, the LIDDA should assist the person with completing an application for Medicaid through HHSC. The LIDDA must complete Form H1746-A, MEPD Referral Cover Sheet, and fax it, along with Form H1200, Application for Assistance – Your Texas Benefits, to the HHS Document Processing Center at 877-236-4123.

If Form 8578, Intellectual Disability/Related Condition Assessment, and Form 3608, Individual Plan of Care (IPC) – HCS/CFC, (for HCS), or Form 8582, Individual Plan of Care – TxHmL/CFC, (for TxHmL), have been completed, the LIDDA should include a copy of these forms with the application. If Form 8578, Form 3608 (for HCS), and Form 8582 (for TxHmL) have not been completed, proceed with submitting Form H1200 and Form H1746-A. Form 8578, Form 3608 and Form 8582 can be submitted later. Do not wait for these forms to be completed before submitting Form H1200.

If the person or legally authorized representative (LAR) prefers to submit Form H1200 himself or herself, the LIDDA must still complete Form H1746-A. After the person or LAR submits Form H1200, the LIDDA submits the completed Form H1746-A with a note in the comments section stating that Form H1200 was submitted separately.

Do not submit both an SSI application and a Medicaid application. HHSC MEPD will not process a Medicaid application for the person if the SSA is processing an application for SSI.

 

15500 Chart of Acceptable Types of Medicaid for HCS and TxHmL

Revision 19-4; Effective September 9, 2019

 

The following chart indicates the acceptable Medicaid coverage code and type program to enroll in Home and Community-based Services (HCS) and Texas Home Living (TxHmL). If a person does not have the proper Medicaid, the local intellectual and developmental disability authority (LIDDA) must determine if the person needs to apply for Supplemental Security Income (SSI) through the Social Security Administration (SSA) or Medicaid.

Note: Q24 and B23 are not applicable for HCS or TxHmL enrollment.

Required Medicaid Codes and Type Program
Coverage Code Type Program HCS TxHmL Coverage Code Type Program HCS TxHmL
R or P 01 Yes Yes R or P 21 Yes Yes
R or P 02 Yes Yes R or P 22 Yes Yes
R or P 03 Yes Yes R or P 29 Yes Yes
R or P 07 Yes No R or P 37 Yes No
R or P 08 Yes Yes R or P 40 Yes Yes
R or P 09 Yes Yes R or P 43 Yes Yes
R or P 10 Yes Yes R or P 44 Yes Yes
R or P 11 Yes Yes R or P 45 Yes Yes
R or P 12 Yes Yes R or P 47 Yes Yes
R or P 13 Yes Yes R or P 48 Yes Yes
R or P 14 Yes No R or P 51 Yes No
R or P 15 Yes Yes R or P 55 Yes Yes
R or P 18 Yes Yes R or P 61 Yes Yes
R or P 19 Yes Yes R or P 82 Yes Yes
R or P 20 Yes Yes R or P 87 Yes Yes

 

15600 Appointment of an Authorized Representative

Revision 19-4; Effective September 9, 2019

 

A person may allow someone else to be his or her authorized representative and help with the benefits case at Texas Health and Human Services Commission (HHSC). The person can complete Form H1003, Appointment of an Authorized Representative, and designate an authorized representative for a specific period of time. The person may only have one other person acting on his or her behalf as an authorized representative.

Form H1003 is submitted to HHSC by using Form H1746-A, MEPD Referral Cover Sheet. Complete Form H1746-A and check the “Supporting Documents” box under the section titled “Action.” Fax Form H1746-A and Form H1003 together. HHSC will add the authorized representative information to the person’s case information.

 

15700 Medicaid Forms

Revision 19-4; Effective September 9, 2019

 

 

 

15710 Form H1746-A, MEPD Referral Cover Sheet

Revision 19-4; Effective September 9, 2019

 

Form H1746-A, MEPD Referral Cover Sheet, is completed by the local intellectual and developmental disability authority (LIDDA) to share case information and supporting documentation with MEPD staff.

Form H1746-A is a “smart form” (an electronic form with capabilities beyond a traditional paper form). Do not photocopy this form. You may print the form in bulk from a personal computer.

If Form H1746-A is not included with Form H1200, Application for Assistance – Your Texas Benefits, Form H1200, the MEPD worker may not know that the application should be tested for Medicaid Waivers. This may result in denial of Medicaid for some persons. When Form H1200 is submitted for a person, Form H1746-A must be included. The form should be the first document in the packet.

Form H1746-A and Form H1200 should be faxed to the Document Processing Center at 1-877-236-4123. If mailing, send to Document Processing Center, P.O. Box 149024, Austin, TX 78714-9968.

Note: Medicaid for the Elderly and People with Disabilities (MEPD) staff may not reject Form H1746-A and Form H1200 if the forms are submitted by LIDDAs. MEPD staff must accept Form H1746-A and Form H1200 as if both were received from a local HHSC office.

 

15720 Completing Sections on Form H1746-A, MEPD Referral Cover Sheet

Revision 19-4; Effective September 9, 2019

 

Applicant/Person Information

Action

Program

Information for MEPD Worker

Sender

Additional Comments

Submission of Forms

Follow-up

 

15800 Financial Eligibility After Enrollment - HCS and TxHmL

Revision 19-4; Effective September 9, 2019

 

Persons must maintain financial eligibility to remain eligible for the waiver program. If a person 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 Home and Community-based Services (HCS) Program provider is the representative payee, the provider is responsible for ensuring action is taken to reestablish Medicaid eligibility.

If the person or family is the representative payee, the local intellectual and developmental disability authority (LIDDA) service coordinator will assist, if requested.

 

15810 Medicaid Redetermination

Revision 19-4; Effective September 9, 2019

 

Texas Health and Human Services Commission (HHSC) requires persons to submit a Medicaid redetermination packet to HHSC at least annually. HHSC mails the redetermination packet to the person’s mailing address on file in the Texas Integrated Eligibility Redesign System (TIERS) 60 days in advance of the redetermination due date. It is important that the packet be completed and returned to HHSC before the due date; otherwise, Medicaid eligibility will be denied.

Local intellectual and developmental disability authorities (LIDDA) can review the Client Assignment and Registration (CARE) System screen C63, Medicaid Eligibility Search, to determine a person’s review date. This information is displayed in the “Periodic Review Date” field in this screen.

Note: Persons who receive Supplemental Security Income (SSI) Medicaid are not required to submit a redetermination packet because their eligibility is based on their SSI eligibility. The Social Security Administration (SSA) reports SSI recipient information directly to TIERS for these persons.

 

15820 Reestablishing Medicaid

Revision 19-4; Effective September 9, 2019

 

Loss of Medicaid for Elderly and People with Disabilities (MEPD) Medicaid

If a person loses financial eligibility, it is the responsibility of the person or legally authorized representative (LAR) to reestablish financial eligibility as soon as possible. It is also in the provider’s best interest to assist the person or LAR with reestablishing the person’s financial eligibility to prevent an interruption in services and payment. The local intellectual and developmental disability authority (LIDDA) may provide assistance. LIDDAs should offer assistance to persons who have chosen Consumer Directed Services (CDS).

Loss of Supplemental Security Income (SSI) Medicaid

If a person loses SSI benefits, the person will also lose SSI Medicaid. It is the responsibility of the person or their representative payee to contact the Social Security Administration (SSA) to determine the necessary action to reinstate SSI benefits. If the provider is the representative payee, the provider is responsible for ensuring immediate action is taken to reestablish financial eligibility. The LIDDA may assist a person or the representative payee. If SSI benefits will not be reinstated, the person must submit a Medicaid application to Texas Health and Human Services Commission (HHSC). Adults who lose SSI benefits because they became eligible for Retirement, Survivors and Disability Insurance (RSDI) benefits, and their income is now over the income limit for SSI benefits, may be eligible for Disabled Adult Children’s Medicaid. It is in the provider’s best interest to assist the person or LAR with submitting the Medicaid application to HHSC to prevent interruption in services and payment. The provider must include a completed Form H1746-A, MEPD Referral Cover Sheet. The LIDDA may provide assistance, if requested by the person. LIDDAs should offer assistance to persons who have chosen CDS.

Loss of Department of Family and Protective Services (DFPS) Medicaid

When a person “ages out” of DFPS conservatorship, the person will lose Medicaid. The person must submit an application to the SSA for SSI benefits or a Medicaid application to HHSC. It is in the provider’s best interest to assist the person or LAR, if any, with reestablishing financial eligibility to prevent interruption in services and payment. The LIDDA may provide assistance, if requested by the person. LIDDAs should offer assistance to persons who have chosen CDS.

Section 16000, Guidelines for Determining Less Restrictive Setting

Revision 19-4; Effective September 9, 2019

 

The guidelines set forth in this section describe the procedures to be used by the local intellectual and developmental disability authority’s (LIDDA’s) interdisciplinary team (IDT) for determining the less restrictive setting for persons who are requesting admission, or on whose behalf admission is requested, to a state supported living center. The determination of a less restrictive setting is only one part of the admission criteria that must be considered by the IDT.

 

16100 Instructions

Revision 19-4; Effective September 9, 2019

 

The local intellectual and developmental disability authority (LIDDA) must ensure interdisciplinary team (IDT) members:

To ensure the “key issues” from these guidelines are documented in IDT reports, the LIDDA will:

 

16200 Discussion of Key Issues Using Probing Questions

Revision 19-4; Effective September 9, 2019

 

The interdisciplinary team (IDT) will discuss the following key issues using the provided probing questions in a manner understood by the person and legally authorized representative (LAR) or someone else actively involved with the person.

Issue: Preferences of the Person, LAR and/or Someone Else Actively Involved with the Person

Issue: Medical

Issue: Behavioral or Psychiatric

Issue: Quality of Life

Issue: Persons Under 22 Years of Age

Issue: History of Services and Supports

Issue: Other

Issue: LIDDA Recommendations

 

16300 Additional Guidelines for Quality of Life

Revision 19-4; Effective September 9, 2019

 

The environment should:

 

16400 Documentation

Revision 19-4; Effective September 9, 2019

 

Documentation in the interdisciplinary team (IDT) staffing summary will include:    

Section 17000, Non-Waiver Community First Choice (CFC)

Revision 19-4; Effective September 9, 2019

 

Non-waiver CFC provides certain services and supports through managed care organizations (MCOs) to persons living in the community who are enrolled in the Medicaid program and meet CFC eligibility requirements.

 

17100 Initial Eligibility Determination Activities

Revision 19-4; Effective September 9, 2019

 

For persons referred to the local intellectual and developmental disability authority (LIDDA) for assessments of eligibility for Community First Choice (CFC) services based on an intellectual disability (ID), the LIDDA must complete all assessment activities required by Texas Health and Human Services Commission (HHSC) to determine whether the persons meet an intermediate care facility for individuals with intellectual disabilities or related conditions (ICF/IID) level-of-care (LOC) including:

The LIDDA must submit the assessment information to HHSC using the Client Assignment and Registration (CARE) System for an LOC determination.

If the person’s primary diagnosis is a related condition, the LIDDA must:

 

17110 Person Does Not Meet ICF/IID LOC Criteria

Revision 19-4; Effective September 9, 2019

 

For all persons for whom Texas Health and Human Services Commission (HHSC) has determined does not meet the criteria for an intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID) level-of-care (LOC), the local intellectual and developmental disability authority (LIDDA) must compile a packet with the following documentation and submit it to the Medicaid managed care organization (MCO) via the secure file transfer protocol (SFTP) site:

 

17120 Person Meets ICF/IID Criteria Under Age 21

Revision 19-4; Effective September 9, 2019

 

For persons under the age of 21 years for whom Texas Health and Human Services Commission (HHSC) has determined does meet the criteria for an intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID) level-of-care (LOC), the local intellectual and developmental disability authority (LIDDA) must compile a packet with the following documentation and submit it to the Medicaid managed care organization (MCO) via the secure file transfer protocol (SFTP) site:

The LIDDA does not provide service coordination for persons under 21 years of age and receiving Community First Choice (CFC) through the MCO.

 

17130 Person Meets ICF/IID Criteria Age 21 and Older

Revision 19-4; Effective September 9, 2019

 

For persons with an intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID) level-of-care (LOC), the local intellectual and developmental disability authority (LIDDA) must conduct the initial service planning activities and assign a service coordinator no later than 30 days after Texas Health and Human Services Commission (HHSC) authorizes the person’s ICF/IID LOC.

The LIDDA must conduct person-centered service planning with the person and the legally authorized representative (LAR). The LIDDA will contact the person or LAR to schedule a time to meet and complete the Community First Choice (CFC) assessment. The meeting is conducted face-to-face with the person and LAR. The LAR may attend by telephone if the LAR is unable to attend in person. The time and location of the meeting must be convenient to the person and LAR.

At the scheduled meeting, the LIDDA must:

The LIDDA must compile a packet with the following documentation and submit it to the MCO via the secure file transfer protocol (SFTP) site:

When the MCO receives the packet from the LIDDA, the MCO determines if the person has a need for CFC services.

If no services are on the recommended service plan (i.e., Form H6516 completed by the LIDDA, the MCO denies the request for services and sends the person an adverse determination letter, which includes an offer for a fair hearing. The LIDDA must participate in a fair hearing, if requested by the person or LAR, to explain why no services were recommended.

If there are services on the recommended service plan, but the MCO does not agree with the services recommended, the MCO service coordinator contacts the LIDDA to discuss the service plan and to reach an agreement about changes to the service plan that will be presented to the person. Following an agreement, the MCO service coordinator, person, LAR and LIDDA meet to jointly review the services for which the person will be authorized. The MCO then authorizes services and notifies the person. The MCO also notifies the LIDDA of the selected provider.

If there are services on the recommended service plan and the MCO service coordinator agrees with the services being recommended:

The LIDDA must ensure an assigned service coordinator provides service coordination to a person age 21 or older while the person is receiving CFC services through an MCO in the LIDDA’s local service area (LSA).

 

17200 Annual Reassessment

Revision 19-4; Effective September 9, 2019

 

No later than 60 calendar days prior to the expiration of the intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID) level-of-care (LOC) for a person, the local intellectual and developmental disability authority (LIDDA) must communicate with the appropriate managed care organization (MCO) to determine whether the person is or is not receiving Community First Choice (CFC) services.
For persons who are not receiving CFC services, the LIDDA has no reassessment responsibilities.

For persons who are receiving CFC services, the LIDDA must:

The LIDDA should consider this if the person’s current determination of intellectual disability (DID) was completed when the person was under the age of 22 years and the testing was done more than five years ago. Information about conducting DIDs is found in the DID Best Practice Guidelines.

The LIDDA must submit the assessment information to HHSC using the Client Assignment and Registration (CARE) System for a LOC determination.

 

17210 Person No Longer Meets ICF/IID LOC Criteria

Revision 19-4; Effective September 9, 2019

 

For all persons for whom Texas Health and Human Services Commission (HHSC) has determined does not continue meet the criteria for an intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID) level-of-care (LOC), the local intellectual and developmental disability authority (LIDDA) must compile a packet with the following documentation and submit it to the managed care organization (MCO) via the secure file transfer protocol (SFTP) site:

 

17220 Person Continues to Meet ICF/IID Criteria Under Age 21

Revision 19-4; Effective September 9, 2019

 

For persons under the age of 21 years for whom Texas Health and Human Services Commission (HHSC) has determined does meet the criteria for an intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID) level-of-care (LOC), the local intellectual and developmental disability authority (LIDDA) must compile a packet with the following documentation and submit it to the managed care organization (MCO) via the secure file transfer protocol (SFTP) site:

The LIDDA does not provide service coordination for persons under 21 years of age and receiving Community First Choice (CFC) through the MCO.

 

17230 Person Continues to Meet ICF/IID Criteria Age 21 and Older

Revision 19-4; Effective September 9, 2019

 

The local intellectual and developmental disability authority (LIDDA) service coordinator is responsible for completing the annual service planning and continuation of LIDDA services for persons 21 years of age or older who continue to have an intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID) level-of-care (LOC).
The LIDDA must:

The meeting is conducted face-to-face with the person and LAR. The LAR may attend by telephone if the LAR is unable to attend in person. The time and location of the meeting must be convenient to the person and LAR.

At the scheduled meeting, the LIDDA must:

No later than 45 calendar days prior to the expiration of a person’s ICF/IID LOC, the LIDDA must compile a packet with the following documentation and submit it to the MCO via the secure file transfer protocol(SFTP) site:

When the MCO receives the packet from the LIDDA, the MCO determines if the person continues to have a need for Community First Choice (CFC) services.

If no services are on the recommended service plan (i.e., completed Form H6516), the MCO denies the request for services and sends the person an adverse determination letter, which includes an offer for a fair hearing. The LIDDA must participate in a fair hearing, if requested by the person or LAR, to explain why no services were recommended.

If there are services on the recommended service plan, but the MCO does not agree with the services recommended, the MCO service coordinator contacts the LIDDA to discuss the service plan and to reach an agreement about changes to the service plan that will be presented to the person. Following the agreement, the MCO service coordinator, person, LAR and LIDDA meet to jointly review the services for which the person will be authorized. The MCO then authorizes services and notifies the person.  

If there are services on the recommended service plan and the MCO service coordinator agrees with the services being recommended:

 
If the person selected a different provider, the MCO notifies the LIDDA of the name of the selected provider.

The LIDDA continues to provide service coordination to the person while they are receiving CFC services through an MCO in the LIDDA’s local service area.

 

17300 LIDDA Responsibilities When a Person Appeals an MCO’s Denial of Services

Revision 19-4; Effective September 9, 2019

 

If a managed care organization (MCO) denies a person’s request for service because there were no services on the person’s recommended service plan [i.e., Form H6516 completed by the local intellectual and developmental disability authority (LIDDA)] and the person requests a fair hearing to appeal the denial, the LIDDA must participate in the fair hearing to explain why no services were recommended.

Section 18000, Voter Registration

Revision 19-4; Effective September 9, 2019

 

A local intellectual and developmental disability authority (LIDDA) must offer everyone who is 18 years of age or older the opportunity to register to vote:

A LIDDA must provide the same degree of assistance, including bilingual assistance, to help a person complete the voter registration forms, as is provided with the completion of any Texas Health and Human Services Commission (HHSC) or LIDDA form.

LIDDA staff may not determine a person’s eligibility for voter registration other than a determination of whether the person is of voting age, which is 18 years of age, or is a U.S. citizen. A person’s age or citizenship may be verified by a LIDDA if the age or citizenship can be readily determined from information filed with HHSC or the LIDDA for purposes other than voter registration. A person must be offered voter registration assistance even if the person’s age or citizenship cannot be determined.

A LIDDA must not:

If the person has any questions regarding the voter registration process that the LIDDA cannot answer, the LIDDA must:

A LIDDA must follow the guidelines for voters with special needs, which may be accessed at VoteTexas.gov.

 

18100 Registering to Vote

Revision 19-4; Effective September 9, 2019

 

If a person expresses a desire to register to vote, a local intellectual and developmental disability authority (LIDDA) provides the person with:

If the person wants to complete the voter registration form at the time the offer to register is made, the LIDDA must review the form for completeness in the presence of the person. If the form does not contain all the required information, including the required signature, the LIDDA staff returns it to the person for completion.

The person may choose to be responsible for mailing the form or may request the LIDDA to mail the form. If the person requests the LIDDA to mail the from, the LIDDA must mail the form within five days following completion of the form.

 

18200 Declining to Register

Revision 19-4; Effective September 9, 2019

 

If the person declines to complete a voter registration form, the local intellectual and developmental disability authority (LIDDA) will request that the person complete and sign Form 1019, Opportunity to Register to Vote/Declination. If the person refuses to sign Form 1019, the LIDDA must document the refusal on the form.

A LIDDA must maintain the completed form for 22 months and in a confidential location that is not a part of the person’s medical or clinical record.

 

18300 Ordering Voter Registration Forms

Revision 19-4; Effective September 9, 2019

LIDDA designated staff can order voter registration cards in English and Spanish through the HHS Pinnacle Cart.

Section 19000, Crisis Intervention Specialist

Revision 19-5; Effective September 27, 2019

 

The 84th Session of the Texas Legislature provided local intellectual and disability development authorities (LIDDAs) with funds to support persons with intellectual and developmental disabilities (IDD) with significant behavioral and psychiatric challenges. These persons often exhibit significant needs requiring additional support beyond the array of services typically provided within community programs. The funds expanded resources to address crisis situations with persons who have IDD.

 

19100 Definitions

Revision 19-5; Effective September 27, 2019

 

In this section, the terms below have the following meanings.

Crisis – A situation in which:

Crisis respite – Means short-term (up to 14 calendar days) respite for intellectual and developmental disabilities (IDD) as follows:

MCOT – Mobile Crisis Outreach Team funded by DSHS pursuant to its contracts with local mental health authorities, specifically, Information Item V, available on the Texas Department of State Health Services website.

Therapeutic support – A flexible array of services, including behavioral support provided for persons with IDD who require varying therapeutic and habilitative levels of intervention to holistically address the stressors that result in challenging behaviors. Support may include training in:

Transition Support Team – (formerly referred to as the "Medical, Behavioral, and Psychiatric Support Team") means a team of professionals, regionally constituted, to provide educational activities, technical assistance, and de-identified case-specific peer review support to local intellectual and disability development authorities (LIDDAs) and IDD providers within a region.

 

19200 Duties of a Crisis Intervention Specialist

Revision 19-5; Effective September 27, 2019

 

The local intellectual and developmental disability authority (LIDDA) must ensure a crisis intervention specialist provides information about intellectual and developmental disability (IDD) programs and services to:

The LIDDA must ensure the specialist collaborates with appropriate LIDDA staff and Transition Support Team members to identify persons with IDD in the LIDDA’s local service area who are at risk of requiring crisis services, such as persons who exhibit repeated and severe behavior disturbances that jeopardize the person’s safety or current living arrangement.

The LIDDA must ensure that for a person identified in the above paragraph:

The LIDDA must ensure a crisis intervention specialist (CIS) provides education about the manner in which to engage persons with IDD and their unique needs to:

The LIDDA must ensure a CIS:

 

19300 Communicating to Stakeholders

Revision 19-5; Effective September 27, 2019

 

The local intellectual and developmental disability authority (LIDDA) is responsible for communicating to stakeholders, including intellectual and developmental disability providers, advocacy organizations, law enforcement and schools about the creation of the crisis intervention specialist (CIS) position and the general duties of the position.

 

19400 Required Training for a CIS and Staff

Revision 19-5; Effective September 27, 2019

 

The local intellectual and developmental disability authority (LIDDA) must ensure a crisis intervention specialist (CIS) completes the training modules available on the Mental Health Wellness for Individuals with Intellectual and Developmental Disabilities website within 30 calendar days after being assigned as a CIS. The LIDDA must ensure the CIS completes additional training modules within 45 days of the posting of new modules on this site.

Appendices

Appendix I, Mutually Exclusive Services

Appendix II, Long Term Services and Supports

Appendix III, Solicitation Prohibition

Appendix IV, Abuse, Neglect, and Exploitation Training and Competency Test

Revision 19-2; Effective June 5, 2019

 

1. Requirement to Train Staff Members, Service Providers, and Volunteers

As required by the Local Intellectual and Developmental Disability Authority (LIDDA) Performance Contract and 40 TAC §§4.554 and 4.560, a LIDDA must ensure their employees, agents and subcontractors are:

  1. trained on:
    • acts that constitute abuse, neglect and exploitation;
    • signs and symptoms of abuse, neglect and exploitation; and
    • methods to prevent abuse, neglect and exploitation; and
  2. knowledgeable of:
    • acts that constitute abuse, neglect and exploitation;
    • signs and symptoms of abuse, neglect and exploitation; and
    • methods to prevent abuse, neglect and exploitation; and
  3. instructed to report to Department of Family and Protective Services (DFPS) immediately, but not later than one hour, after having knowledge or suspicion that an individual has been, or is being, abused, neglected or exploited by:
  4. provided with these instructions described in paragraphc of this section, in writing.

 

2. Optional Computer-Based Training and Competency Test

A LIDDA has the option of having their employees, agents and subcontractors complete HHSC’s ANE Competency Training. The completion of the computer-based training by employees, agents, and subcontractors meets the requirement in Section 1a of this appendix.

If employees, agents and subcontractors complete HHSC’s ANE Competency Final Test, they must receive a score of at least 80 percent.

The completion of the competency test by employees, agents and subcontractors meets the requirement in Section 1b of this appendix.

Employees, agents and subcontractors must first sign up on the Learning Portal to have access to HHSC approved trainings, including this ANE training, entitled ANE Competency Training and Exam (online). The ANE training is found in Medicaid Long Term Services and Supports Training under the Health and Human Services Commission Courses tab.

Link to the Learning Portal homepage: https://learningportal.dfps.state.tx.us/

 

3. Documentation Requirements

LIDDAs must maintain records documenting employees, agents and subcontractors have received training on ANE. If using HHSC’s ANE Competency Training as evidence of ANE training, the LIDDA must maintain a copy of the certificate generated from the HHSC’s ANE Competency Final Test for each employee, agent and subcontractor.

Resources

Revision 19-4; Effective September 9, 2019

 

211 Texas- Connecting People and Services

211texas.org

A Message for Families Brochures

https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/local-intellectual-developmental-disability-authority/permanency-planning-children

Approved Diagnostic Codes for Persons with Related Conditions List

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

CARE Intellectual Disability, MRA User Guide and MRA Data Entry Forms

https://hhsportal.hhs.state.tx.us/helpGuide/Content/16_CARE/IntellectualDisability.htm

CARE JHS/XPTR User Guide and More

https://hhsportal.hhs.state.tx.us/helpGuide/Content/16_CARE/JHSXPTR.htm

CARE (WebCARE) Reference Manual, Forms and More

https://hhsportal.hhs.state.tx.us/helpGuide/Content/16_CARE/CARE.htm

Community First Choice-Choosing a Provider

https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/providers/resources/cfc/cfc-choosingaprovider.pdf

Department of Family and Protective Services

http://www.dfps.state.tx.us/

Determination of Intellectual Disability (DID): Best Practice Guidelines (March 2018)

https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/providers/long-term-care/lidda/did-best-practice-guidelines.pdf

Discovery Guide

https://hhs.texas.gov/laws-regulations/handbooks/hcs/appendices/appendix-iii-discovery-guide

Discovery Tool

https://hhs.texas.gov/laws-regulations/handbooks/hcs/appendices/appendix-iv-discovery-tool

Enterprise Portal- Health and Human Services

https://hhsportal.hhs.state.tx.us/helpGuide/Content/Home.htm

Explanation of IDD Services and Supports

https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/local-idd-authority-lidda

Health Human Services- Long-term Services and Supports Contact Numbers Listed by County

https://apps.hhs.texas.gov/contact/DADSServicesByCounty.html

Health and Human Services – Office of the Ombudsman

https://hhs.texas.gov/about-hhs/your-rights/hhs-office-ombudsman

Health and Human Services- Overview

https://hhs.texas.gov/about-hhs/find-us

Health and Human Services – Where Do I Call to Get Services?

https://apps.hhs.texas.gov/contact/search.cfm

Home and Community-based Services Handbook

https://hhs.texas.gov/laws-regulations/handbooks/home-community-based-services-handbook

Home and Community-based Services Program Billing Guidelines

https://hhs.texas.gov/laws-regulations/handbooks/home-community-based-services-hcs-program-billing-guidelines

Inventory for Client and Agency Planning (ICAP) Training Video

https://hhs.texas.gov/doing-business-hhs/provider-portals/resources/idd-waivers-program-enrollmentutilization-review/inventory-client-agency-planning-resources

ICAP/SIB-R Adaptive Behavior Scale Guidelines

https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/providers/long-term-care/lidda/icapguidelines.pdf

LIDDA Initial Meeting Packet Checklist

https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/providers/long-term-care/lidda/initial-meeting-checklist.pdf

LIDDA Training Opportunities

https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/local-intellectual-developmental-disability-authority-lidda/lidda-training-opportunities

Medicaid Estate Recovery Program Guide

https://hhs.texas.gov/laws-regulations/legal-information/your-guide-medicaid-estate-recovery-program

Permanency Planning Instruction Manual (September 2017)

https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/providers/long-term-care/nf/HHSC_Permanency_Planning_Instruction_Manual.pdf

Permanency Planning Technical Assistance Guide (August 2017)

https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/providers/long-term-care/nf/PP_Technical_Assistance_Guide-EC.PDF

Person-Centered Service Plan- Community First Choice (Texas Administrative Code, June 2, 2016)

http://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=T&app=9&p_dir=N&p_rloc=177897&p_tloc=&p_ploc=1&pg=8&p_tac=&ti=1&pt=15&ch=354&rl=1360

Person-Centered Planning PowerPoint (HHSC June 28, 2016)

https://hhs.texas.gov/sites/default/files/documents/services/health/medicaid-chip/hcbs/20160725-person-centered-planning.pdf

Person-Centered Planning Training- HHS Minimum Requirements

https://hhs.texas.gov/services/disability/person-centered-planning/waiver-program-providers/minimum-requirements-pcp-training

Person-Centered Planning Training- Providers

https://hhs.texas.gov/services/disability/person-centered-planning/waiver-program-providers/person-centered-planning-pcp-training-providers

Person Directed Planning Guidelines (DADS)

https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/providers/long-term-care/lidda/persondirectedplanningguidelines.pdf

Pinnacle Cart

https://hhsc.pinnaclecart.com/hhsc/

Regional Claims Management Services Coordinators

https://hhs.texas.gov/sites/default/files/documents/laws-regulations/handbooks/lidda/res/CMS_Coordinators.pdf

Residential Options

https://hhs.texas.gov/services/disability/intellectual-or-developmental-disabilities-idd-long-term-care

Social Security

www.ssa.gov

STAR+PLUS Overview

https://hhs.texas.gov/services/health/medicaid-chip/programs/starplus

Targeted Case Management Billing Guidelines

https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/providers/long-term-care/lidda/tcmbillingguidelines.pdf

Texas Benefits

https://www.yourtexasbenefits.com/ssp/SSPHome/ssphome.jsp

Texas Home Living Program Billing Guidelines

https://hhs.texas.gov/laws-regulations/handbooks/texas-home-living-txhml-program-billing-guidelines

TMHP (LTC) Helpdesk

800-626-4117, Option 1

Vendor Drug Program

https://www.txvendordrug.com/

Voters with Special Needs

VoteTexas.gov

Forms

ES = Spanish version available.

Form Title  
1019 Opportunity to Register to Vote/Declination  
1040 CFC Non-Waiver Packet Information and Checklist  
1042 Pre-Move Site Review  
1043 Post-Move Monitoring  
1045 HCS/TxHmL Request for Enrollment Extension  
1049 Initial Documentation of Provider Choice ES
1050 Nursing Facility or Crisis Diversion Plan  
1051 Request for Determination of Intellectual Disability for an Individual Referred for Guardianship by DFPS  
1052 Public Provider Choice Request ES
1058 Request for Home and Community-based Services Crisis Diversion Slot  
1570 ICF Request for Medical Need Assessment or Verification of RUG-III Category  
1580-IDD Texas Money Follows the Person Demonstration (MFPD) Project Agreement of Participation ES
1581 Consumer Directed Services (CDS) Option Overview ES
1582 Consumer Directed Services Responsibilities ES
1586 Acknowledgement of Information Regarding Support Consultation Services in the Consumer Directed Services (CDS) Option ES
1595 Billing Resolutions Request  
2060-B Needs Assessment Addendum ES
2260 Permanency Planning Instrument (PPI) for Children Under 22 Years of Age (Family Directed Plan) ES
3608 Individual Plan of Care (IPC) – HCS/CFC ES
5842 TxHmL Financial Eligibility Information  
8001 Medicaid Estate Recovery Program Receipt Acknowledgement ES
8510 HCS/TxHmL CFC PAS/HAB Assessment  
8511 Understanding Program Eligibility and Services ES
8571 Request to Change Interest List Information for Home and Community-based Services (HCS) or Texas Home Living (TxHmL)  
8577 Questionnaire for LTSS Waiver Program Interest Lists  
8578 Intellectual Disability/Related Condition Assessment  
8578-CFC Intellectual Disability/Related Condition Assessment for CFC  
8582 Individual Plan of Care – TxHmL/CFC  
8586 TxHmL Service Coordination Notification ES
8592 Deadline Notification ES
8601 Verification of Freedom of Choice ES
8630 Continuity of Care  
8647 Service Coordination Assessment  
8648 Identification of Preferences ES
8654 State Supported Living Center (SSLC) Admission Application  
8662 Related Conditions Eligibility Screening Instrument  
8665 Person-Directed Plan ES
8665-ID Individual Data  
H1003 Appointment of an Authorized Representative ES
H1200 Application for Assistance – Your Texas Benefits ES
H1746-A MEPD Referral Cover Sheet  
H6516 Community First Choice Assessment ES
SSA-1020 Application for Extra Help with Medicare Prescription Drug Plan Costs  

Revisions

19-5, Section 19000 Added

Revision Notice 19-5; Effective September 27, 2019

 

The following changes were made:

Revised Title Title Change
19000 Crisis Intervention Specialist Adds section to the handbook.

19-4, Entire Handbook Revised

Revision Notice 19-4; Effective September 9, 2019

 

The following change(s) were made:

Revises the format of the entire handbook for local intellectual and developmental disability authority service coordinators to use in the field.

19-3, Documents Removed

Revision Notice 19-3; Effective July 22, 2019

 

The following change(s) were made:

Section Title Change
Request for Targeted Waiver Slot Request for Nursing Facility Transition and Request for Nursing Facility Diversion Removes both documents as they no longer apply to the handbook.

19-2, Appendix Added

Revision Notice 19-2; Effective June 5, 2019

 

The following change(s) were made:

Section Title Change
Appendix IV Abuse, Neglect, and Exploitation Training and Competency Test Adds a new appendix requiring training for LIDDA employees, agents and subcontractors.

Contact Us

For questions about the Local Intellectual and Developmental Disability Authority Handbook, email: LIDDAservicecoordination@hhsc.state.tx.us.

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