The Local Authority designates staff to complete Texas Home Living Program enrollments and requires designated staff to complete Texas Health and Human Services enrollment training as described in Attachment K of the Performance Contract. This training outlines the steps the designated LA staff will complete for each TxHmL enrollment from the time HHS notifies the LA to make the offer of TxHmL to an individual to their final enrollment in the TxHmL program. The training also identifies the documentation that must be retained in the individual's record pertaining to their enrollment.
II. Enrollment Timeframes
HHS will notify the LA, in writing, when TxHmL enrollment is to be offered to an individual. The LA completes the enrollment process for each individual within the time frames listed below:
- for an individual residing in a nursing facility — 180 calendar days after the LA was notified of the TxHmL program vacancy; (For interest list offers only)
- for an individual residing in a community ICF — 90 calendar days after the LA was notified of the TxHmL program vacancy; or (For interest list offers only)
- for an individual residing in his or her own or family's home — 75 calendar days after the LA was notified of the TxHmL program vacancy.
(Note: The enrollment process is complete when the individual’s status in CARE screen C61 is "active" or "denied.")
III. Notification of TxHmL Offer
- HHS notifies the LA when a TxHmL enrollment is authorized for an individual. The notification is sent by secure email to the LA.
- Upon receipt of the notification from HHS, the LA will check CARE screens 397 and/or W-26 to obtain the individual's contact information. CARE screen C63 may be referenced for the address to which the Medicaid card is being sent for those individuals who have Medicaid.
- After the LA has obtained the individual's contact information they will make the offer of program vacancy, in writing, and deliver it to the individual or LAR by regular United States mail or by hand delivery. If the LA is unsure of the individual's current contact information, the LA must send an offer letter to all credible addresses. HHS strongly recommends the written notification be sent to the individual within three working days after HHS' notification to the LA.
- The LA may use one of the two following methods for the written notification:
- A letter template for the "TxHmL Offer Letter," in English and Spanish, which contains the required information, can be found at the following link. There are two types of offer letters: interest list offers and refinance offers. Please choose the letter that corresponds to the offer being made. The letter template is to be completed on LA letterhead.
- Create your own TxHmL offer letter, that complies with 40 TAC, Chapter 9, Subchapter N, §9.566(c).
- The Explanation of the Texas Home Living Program brochure must be included in with the offer letter. An English and Spanish version are available on the TxHmL publications page.
- The Form 8592, Deadline Notification, containing information relating to the enrollment timeframe requirements must be attached to the written TxHmL offer letter whether the template is used or the LA creates their own.
- The LA may use one of the two following methods for the written notification:
- In addition to sending the notification letter described above, the LA should call or visit the individual or LAR to inform them of the TxHmL program vacancy and what actions they will need to take to accept or decline the offer.
- For refinance offers only – If the LA attempts to contact the individual or LAR and learns that the individual has relocated to another LA's local service area, the LA will not attempt to contact the individual because the TxHmL vacancy is no longer available to the individual. An exception to this provision is for an individual who is in CPS conservatorship, in which case the LA must contact HHS LA Section, Local Procedure Development and Support Unit for further instruction. If the individual's name is on the HCS interest list, the LA will transfer the individual's interest list record to the new LA.
For interest list offers only – If the LA attempts to contact the individual or LAR and learns that the individual has relocated to another LA's LSA, the LA must determine the individual's designated LA using the "Guidelines for Determining and Changing Designated LA" (LA Performance Contract, Attachment O). If the LA is the designated LA, then the LA will continue with all enrollment activities. If the LA determines that another LA is the designated LA, then the original LA must forward to the designated LA the following:
- a copy of the authorization letter; and
- a copy of any extensions already obtained.
The original LA must notify Julie Gunter at 512-438-5037 of the transfer. Once the designated LA receives the information from the original LA, then the designated LA becomes responsible for meeting required timeframes for enrollment or requesting an extension.
- If the individual or LAR does not respond to the notification letter within 30 calendar days, then the LA follows the instructions in Section VII.D. of this training to withdraw the offer.
- If the individual or LAR responds to the notification letter, the LA will schedule an initial meeting to discuss TxHmL in more detail with the individual or LAR and will complete the following activities before the meeting.
- Access the Service Authorization System Online to determine if the individual is currently enrolled in a Medicaid waiver program, and if so, notify the individual/LAR that they must choose between the waiver program they are currently enrolled in and TxHmL. The LA also provides program comparison information found at https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/resources/compare-long-term-services-supports-ltss-programs.
- Review CARE screen C63 to determine the individual's Medicaid eligibility status and to determine if the individual is enrolled in the STAR+PLUS waiver. For TxHmL services the individual must have coverage code R plus one of the following type programs: 01, 02, 03, 08, 09, 10, 12, 13, 15, 18, 19, 21, 22, 29, 44, 47, 48 or 61. For interest list offers only - If the individual does not have Medicaid or is not receiving the correct coverage code or type, refer to Section VII.A. of this training for detailed instructions.
- For interest list offers only – Review the LA local data system to determine if the individual is receiving general revenue services from the LA.
- Assemble the documents as specified on the Initial Meeting Packet checklist (PDF).
IV. Initial Meeting
- Using the documents from the Initial Meeting Packet checklist (PDF) the LA will provide both an oral and a written explanation of the services and supports to the individual or LAR, or actively involved family member. The individual must live in his/her own home or family home to be eligible for TxHmL. An individual who lives in an assisted living facility is not eligible for TxHmL.
- For interest list offers only — If the individual being offered TxHmL is currently receiving general revenue services from the LA, the LA will inform the individual or LAR if they decline the offer of TxHmL services the LA will terminate the GR services that are similar to services provided under the TxHmL Program.
For refinance offers only — The LA will notify the individual/LAR that to continue to receive services, the individual must enroll in the TxHmL program.
- If the individual or LAR accepts the offer of TxHmL enrollment, the LA will have the individual or LAR document the decision on the Form 8601, Verification of Freedom of Choice.
- If the individual accepts the offer of TxHmL enrollment the LA will discuss the provider selection process with the individual or LAR. The LA will:
- provide the individual or LAR with a current list (i.e., dated within seven days) from CARE (JHSXPTR-HC062097) of all the contracted TxHmL Program providers in the LA's local service area. The list will include local contact information for each TxHmL Program provider, if available, for use by the individual or LAR. For interest list offers only — If the LA's TxHmL Program is operating at or above its capacity (as indicated in CARE screen C70), the LA may not include its TxHmL Program in the list of available providers. For refinance offers only —The LA's TxHmL Program may be included on the list of available providers even if the LA's TxHmL Program is operating at or above its capacity;
- explain to the individual or LAR that they will need to select a program provider within 30 calendar days from the date they received the provider contact information from the LA and they may choose any contracted TxHmL Program provider in the local service area on the list provided. Although the LA may not direct the individual or LAR to choose a specific provider, the LA may offer assistance with the following activities:
- identifying what is important to them about a provider (e.g., location, staffing patterns, provider experience with certain disabilities);
- developing additional or more specific questions to ask the providers. (The Explanation of IDD Services and Supports (PDF) contains suggested questions they may use to interview the provider); and
- contacting and/or arranging visits to the providers the individual or LAR has indicated they would like to know more about;
- instruct the individual or LAR to document their selection of the program provider on the Documentation of Provider Choice Form 1049 and return to the identified LA staff. Note: Form 1049, Documentation of Provider Choice, is available on the HHS website.
- The LA will ensure the individual or LAR is provided information about the Medicaid Estate Recovery Program once they have chosen to enroll in TxHmL as described in the LA Performance Contract, Attachment R (Medicaid Estate Recovery Program) using Form 8001, Medicaid Estate Recovery Program Receipt Acknowledgement.
- If the individual or LAR declines TxHmL, the LA will ensure the reason for the decline is clearly selected, stated, and documented on the Form 8601, Verification of Freedom of Choice. (The LA must ensure the reason for the decline is clearly documented on Form 8601.)
- After the initial meeting, the LA will take the following steps based on the individual or LAR's decision to accept or decline TxHmL:
- If the individual accepts TxHmL:
- Enter Consumer Enrollment CARE screen L01 and ensure the slot type and county of service are correct. The individual will be considered in a "Pre-Enroll" status in CARE after this activity;
- Scan the completed Form 8601, Verification of Freedom of Choice and Form 8001, Medicaid Estate Recovery Program Receipt Acknowledgement as separate PDF documents and post to the LA Enrollment FTP site. The LA will follow the instructions given in Section VII.H of this training for using the LA Enrollment FTP site; and
- Complete the activities in Section V, Enrollment Process;
- If the individual declines TxHmL:
- Enter a status code "8" for the decline and a comment stating the individual declined and the date of the decline in the individual's Interest List CARE screen W21 under TxHmL;
- Scan the completed Form 8601, Verification of Freedom of Choice as a PDF document and post it to the LA Enrollment FTP site. (The LA must ensure the reason for the decline is clearly documented on Form 8601.) The LA will follow the instructions given in Section VII.H. of this training for using the LA Enrollment FTP site; and
- If the individual is receiving GR services, the LA will terminate the individual's GR services and notify the individual or LAR in writing, by certified United States mail of the termination and the individual’s opportunity for a review in accordance with 40 TAC Chapter 2, Subchapter A, §2.46 (relating to LA Notification and Appeal Process).
- If the individual accepts TxHmL:
V. Enrollment Process
The LA will conduct the following activities to prepare for an applicant's enrollment into TxHmL:
A. Disability Determination
Review records to determine if the individual has a diagnosis of an intellectual disability or verify that the individual has been diagnosed by a licensed physician as having a "related condition" and meets specific requirements for intelligence quotient. Verify the presence of a diagnosis of an intellectual disability through a Determination of Intellectual Disability. Verify the presence of a "related condition" diagnosis with documentation from a physician.
- If there is a DID, the LA must verify that the document is in the individual's record and update the diagnostic information, if necessary; or
- If there is not a DID or Comprehensive Diagnosis and Evaluation, the LA must schedule and complete a DID.
The following links may be helpful:
- DID Best Practices Guidelines
- HHS Program Enrollment and Utilization Review information (includes links to LON resources, Related Conditions List, Behavior Support Plan information, ICAP supplemental information, etc.)
B. Level of CARE/Level of Need
The LA will administer the Inventory for Client and Agency Planning (ICAP) and recommend the LOC and a LON assignment to HHS by completing the Form 8578, Intellectual Disability/Related Condition Assessment and entering CARE screen L23, Waiver ID/RC Assessment (purpose code 2). (Signature dates must be prior to the enrollment effective date.) HHS Program Enrollment/Utilization Review will review the electronic ID/RC and, within a couple of working days, approve or request additional information or documentation. The LA can check CARE screens C68 or C83 for the status of the ID/RC. If the LOC is denied, PE/UR mails a letter to the individual or LAR notifying them of the eligibility denial and their right to request a fair hearing to appeal the decision. For additional guidance on ICAP, LON and ID/RC, an LA may refer to Program Enrollment Utilization Review.
C. Person Directed Plan
The LA Service Coordinator develops the PDP with the individual or LAR. (Refer to the HHS website for additional guidance on the Person Directed Planning (PDF) process. Also refer to the Discovery Guide and the Discovery Tool).
D. Consumer Directed Services
Because all TxHmL services may be consumer directed, the LA offers the CDS option by reviewing the following HHS forms with the individual:
- Form 1581, Consumer Directed Services Option Overview
- Form 1582, Consumer Directed Services Responsibilities
- Form 1583, Employee Qualification Requirements
- Form 1584, Consumer Participation Choice
- Form 1586, Acknowledgement of Information Regarding Support Consultation Services in the Consumer Directed Services Option
The purpose of Form 1581 is to introduce the CDS option. Form 1581 gives an overview of the differences between the CDS option and the provider-managed option. This form, when signed, provides acknowledgement that the LA has provided both orally and in writing an overview of the benefits and responsibilities of the CDS option in TxHmL.
- If the individual chooses at this point to decline the CDS Option, the LA completes Form 1584, indicating the choice of the "Agency Option." The LA does not complete HHS Forms 1582, 1583 or 1586.
- If the individual wants to know more about the CDS option, the LA continues to Form 1582.
The purpose of Form 1582 is to provide more detailed information to the individual or LAR about the responsibilities assumed if the CDS option is selected. It concludes with the CDS Consumer Self-Assessment. The purpose of the self-assessment is to:
- assist the individual or LAR to determine if they want to self-direct their services; and
- determine what support might be needed for the individual/LAR to self-direct services.
The self-assessment may not be used to determine that an individual/LAR cannot use the CDS option. If individuals or their LARs have difficulty responding to the self-assessment questions, they will probably need a designated representative (DR) to help them implement the CDS option, but it is the CDSA's responsibility to assist them with appointing a DR.
- If the individual chooses at this point to decline the CDS Option, the LA completes Form 1584, indicating the choice of the "Agency Option." The LA does not complete HHS Forms 1583 or 1586.
- If the individual wants to know more about the CDS option, the LA continues to Form 1583.
The purpose of Form 1583 is to provide important definitions of terms used with CDS. This form includes information about who can be the CDS employer, who can be a designated representative and who can and cannot be hired as an employee in the CDS option for TxHmL.
If the individual chooses at this point to decline the CDS Option, the LA completes Form 1584, indicating the choice of the "Agency Option." The LA does not complete HHS Form 1586.
If the individual wants to select the CDS option, the LA continues to Form 1584.
The purpose of Form 1584 is to document the individual's/LAR's choice of service delivery option. If the individual or LAR is selecting the CDS option, the individual must also select a Consumer Directed Services Agency of his or her choice.
The LA will provide a list of CDSAs serving the individual's waiver contract area. The CDSA choice lists can be found on the HHS website at: https://apps.hhs.texas.gov/providers/cds/cdsas/txhml.cfm — (Select the county, click on "search for CDSAs," then click on "printable list.") The LA should encourage the individual or LAR to call and interview several CDSAs before selecting one.
Important: CDSAs are not required to be located in the same town in which the individual resides. CDSAs provide Financial Management Services. This service does not require ongoing face-to-face contact. While CDSAs are required to make one visit to the individual's home to conduct the CDS orientation prior to service initiation, the CDSA conducts the remainder of their business via e-mail or fax machine with the individual or LAR, or designated representative if one has been appointed.
The purpose of Form 1586 is to provide information to the individual or LAR regarding the availability of support consultation in the TxHmL Program. The use of support consultation is optional. If, during the development of the Person-Directed Plan, the individual or LAR requests support consultation, this service must be included in the PDP. During the development of the Individual Plan of Care, the number of units of support consultation must be determined for inclusion in the IPC.
Support consultation includes practical skills training, coaching and assistance related to:
- principles of self-determination;
- recruiting, screening and hiring workers;
- completing documents and assessments required to employ a person, retain a contractor or vendor, and manage service providers;
- negotiating service agreements, including pricing and scheduling services, goods and items;
- effective communication, decision-making and problem-solving skills to meet employer responsibilities;
- tools for accessing information, resources and assistance;
- contacting appropriate persons or entities based on their roles, responsibilities and eligibility related to the individual's program or the CDS option;
- participating in service planning team meetings at the employer's request; and
- complying with requirements of the individual's program as related to services delivered through the CDS option.
If the individual or LAR chooses to participate in the CDS option, the LA must document in the individual's PDP, a description of the service components provided through CDS and a description of the individual's service back-up plan.
E. Individual Plan of Care
- The LA service coordinator will document the units/hours (amounts) of the service components identified on the IPC and the PDP that will be needed for a 12-month period. The IPC will include both TxHmL Program and non-program services. The TxHmL Program services identified on the IPC must:
- be based on the PDP;
- be billable according to the TxHmL Service Definitions and Billing Guidelines; and
- not be available through an alternate funding source.
- The exceptions to the service components needed for a 12-month period are nursing, physical therapy, occupational therapy, speech, dietary, audiology and psychology. For these services, the service coordinator would only identify enough hours to conduct a professional assessment. After enrollment and based on the assessment recommendations the service coordinator can request additional hours to address the recommendations.
- The LA must schedule a meeting with the individual or LAR and the selected provider's designated staff to complete final negotiations of the IPC. The LA must also ensure all the appropriate persons have signed the hard copy IPC.
F. CARE Entry
- In addition to entering CARE screens L01 and L23 as instructed in previous steps, after the ID/RC has been approved in CARE, the LA must enter the following TxHmL enrollment screens and information in CARE:
- L02, IPC — HHS UR will review the IPC information and notify the LA enrollment contact person if additional documentation is needed for review.
- L03, Enrollment Packet Checklist – Make sure the service begin date is accurate. If the service begin date changes after entry, the LA must use “C” as the type of entry in the L03 screen to change it and then notify PE/UR.
- L09, Register Client Update — If the individual will not be receiving services from the public provider, contact the provider for the local case number assigned to the individual. If the individual is self-directing any services, contact the FMSA (also referred to as CDSA) for the local case number assigned to the individual.
- L05, Provider Choice — Contact the provider for the contract number and location code with which the individual will be associated. If the individual is self-directing any services, contact the FMSA for the contract number. The location code is always OHFH for an individual who is self-directing services.
Note: For detailed instructions about CARE entry refer to the CARE MRA User Guide at http://www2.mhmr.state.tx.us/655/cis/training/MRAGuide.html.
- The LA should check CARE JHSXPTR report HC062490.W, LA Enrollment Packet Exceptions, on a regular basis. This report is updated once a week and lists, per individual, missing enrollment information could delay the TxHmL enrollment.
Note: The individual's name does not appear on PE/UR's pending enrollment report until ALL of the above screens have been entered by the LA. The LA must ensure all of these screens have been completed before contacting PE/UR about the status of an enrollment. The LA can use the C61 screen to check the status of an enrollment.
G. HHS Activities
HHS PE/UR completes CARE screens A05 and A06 to recommend and authorize or deny enrollment.
- If the enrollment is denied, PE/UR mails a letter to the individual or LAR notifying them of the enrollment denial and their option to request a fair hearing to appeal the decision. The individual's interest list status is changed to "denied" (status 4) for TxHmL.
- If the enrollment is authorized, the CARE System will automatically change the individual's interest list status to "enrolled" (status 3) and PE/UR mails a letter to the individual or LAR notifying them of the enrollment.
- The enrollment process is complete when the individual's status in CARE screen C61 is "active" or "denied." The LA must use this screen to check the status of an enrollment before contacting PE/UR.
- Prior to the individual beginning services, the LA enrollment staff must provide the provider and LA service coordinator with the following information:
- the PDP which includes written justification for, and outcome of, each service identified in the individual's IPC;
- other individual-related information (e.g., previous services plan, medical information, assessment results, DID) that will assist the provider in serving the individual;
- the individual's ID/RC Assessment; and
- the individual's ICAP Assessment booklet and scoring.
- The LA must retain the following documents in the individual's record:
- the Form 8601, Verification of Freedom of Choice, Waiver Program, documenting the individual's or LAR's choice;
- the Documentation of Provider Choice form documenting the individual's or LAR's choice of a program provider, if applicable; and
- any other correspondence related to the TxHmL offer.
VII. Additional Procedures
A. For interest list offers only— Assisting with Medicaid Eligibility
The LA reviews CARE screen C63 (Medicaid Eligibility Search) for the individual's Medicaid eligibility status.
- If the individual does not currently have an acceptable type of Medicaid for the TxHmL waiver or they do not have Medicaid, a MEPD Referral Cover Sheet (Form H1746-A) and Medicaid application (Form 1200) must be submitted to Health and Human Services Commission Medicaid for Elderly and Persons with Disabilities (MEPD). The forms are available in the MEPD Handbook. QMB (Q24) and SLMB (B23) do not pay for waiver services. For a list of acceptable Medicaid types and additional information regarding financial eligibility at pre-enrollment in the LIDDA Handbook.
Follow-up: HHSC MEPD generally has up to 45 days to process an application once it is submitted. The LA must document the date the application was submitted to HHSC MEPD. If assistance from HHSC is needed while the application is pending review, the LA can call 2-1-1, the HHSC Medicaid Hotline (800-252-8263) or the HHSC Ombudsman Office (877-787-8999). If financial eligibility has not been determined within 50 days after submission of the application and attempts to receive a status update from HHSC have been unsuccessful, the LA can contact Program Enrollment/Utilization Review for assistance at 512-438-5055.
- The individual can apply for Supplemental Security Income through the Social Security Administration in person at their local Social Security Administration Office or at http://www.ssa.gov/applyfordisability. If the individual meets eligible for this benefit, they will receive SSI Medicaid which pays for TxHmL services. Be advised that HHSC MEPD cannot process any Medicaid applications for the individual while Social Security Administration is making their eligibility determination.
Note: Individuals who are receiving Retirement, Survivors and Disability Insurance benefits because their father or mother died or retired may be eligible for Disabled Adult Child Medicaid through HHSC. A Form H1746-A, MEPD Referral Cover Sheet, and Form 1200, Medicaid application, should be submitted to HHSC MEPD.
B. Individual is enrolled in the STAR+PLUS Waiver
If the individual is enrolled in SPW, they must be dis-enrolled from the program prior to being enrolled into TxHmL. The LA staff will:
- inform the individual and LAR that dis-enrollment from SPW is required to enroll in TxHmL;
- ensure the individual's IPC begin date is on the first day of the month; and
- complete data entry of all TxHmL enrollment screens in CARE no later than the 20th day of the preceding month (e.g., data entry would need to be completed by June 20 for an IPC begin date of July 1), so dis-enrollment from SPW can occur prior to the last day of the month. This will ensure there is no break or overlap in services to the individual.
After successful completion of the steps listed above, HHS PE staff will recommend the enrollment and communicate with the Texas Health and Human Services Commission Health Plan Operations staff to request dis-enrollment from SPW.
If the LA staff cannot complete the data entry of all TxHmL enrollment screens in CARE by the 20th day of the preceding month, the "service begin date" must be changed so the individual's enrollment in SPW will continue for one more month.
If the HHS PE staff identify issues (problems with the IPC, MR/RC, etc.) and are unable to recommend enrollment, they will call or email the LA enrollment contact person to discuss the identified issues needing resolution and advise if the service begin date for the individual must be changed to allow for the individual's continued enrollment in SPW while the issues are being resolved. If the identified issues cannot be resolved by the end of the month, the LA will be advised that the actual "service begin date" will be changed to the first of the next month and will continue to change each month until the identified issues are resolved. For example, the original IPC and service begin date is July 1. Due to an unresolved issue with the IPC, HHS PE staff was unable to recommend enrollment before the end of the month, so the LA was advised to change the "service begin date" to August 1.
If the LA receives notice from the provider, individual, or LAR that the enrollment must be delayed or if the individual or LAR changes their mind about enrolling in TxHmL and SPW has already received notification to dis-enroll the individual from SPW, the LA must contact their assigned HHS PE staff immediately so the HHS PE staff can request that HHSC HPO continue the individual's enrollment in SPW for another month.
C. Medicare Requirements
The LA determines whether the individual is a Medicare beneficiary. If the individual is a Medicare beneficiary, the LA must comply with requirements in Attachment K (Medicaid Program Enrollment Requirements) of the Performance Contract concerning the Medicare prescription drug program.
- The LA may withdraw the TxHmL offer made to an individual if:
- the individual or LAR does not respond to the TxHmL offer within 30 calendar days after the notification letter was sent by the LA;
- the individual or LAR does not document their choice of TxHmL Program services using the Form 8601, Verification of Freedom of Choice, Waiver Program, within seven calendar days after the receipt of the form; or
- the individual or LAR does not document their choice of program provider using the Documentation of Provider Choice form within 30 calendar days after their receipt of contact information for all program providers in the LA's local service area.
- The LA must notify the individual or LAR of the withdrawal of the TxHmL offer in writing, by certified United States mail. The LA may choose one of the two following methods for the written notification of withdrawal of offer:
- A letter template for the "TxHmL Withdrawal Letter," in English and Spanish, which contains the required information, can be found at the following link. The letter template is to be completed on LA letterhead.
- Create your own TxHmL withdrawal letter, that complies with 40 TAC, Chapter 9, Subchapter N, §9.566(f).
- The LA must fax a copy of the withdrawal letter with the USPS certified letter tracking number to the HHS LA Section at 512-438-5220. HHS confirms the letter of withdrawal has been delivered.
E. Delays in Enrollment
For an individual whose enrollment process is not complete within the time frames listed in Section II. Enrollment Timeframes, the LA must have:
- submitted to HHS a Form 8601, Verification of Freedom of Choice, Waiver Program, with the individual's or LAR's signature and date declining the HCS Program;
- submitted to HHS documentation that the LA sent a letter of withdrawal in accordance with HHS rules; or
- received from HHS an approval of the LA's request to extend the time frames for enrollment.
F. Requesting an Extension
- If the LA that is authorized to offer HCS to an individual anticipates the individual's enrollment will not be completed by the due date as specified by HHS in the LA's notification letter, the LA must request that HHS approve an extension.
- The LA will use Form 1045, Request for HCS/TxHmL Enrollment Extension, to request that HHS approve an extension to the time allowed for the enrollment and provide a reason for the delay. The completed form must be faxed to HHS, LA, Local Procedure Development and Support unit at 512-438-5220.
Please note that an extension request received by HHS after the 15th day of the last month of a quarter will not be approved for that quarter.
G. Individual Selects Provider in Another LA's Local Service Area
- If the authorized LA contacts the individual or LAR and begins the enrollment process and the individual or LAR selects a provider in a different LA's LSA, then the authorized LA must conduct all pre-enrollment activities such as:
- explanation of services;
- obtaining signature on the Verification of Freedom of Choice form;
- conducting diagnostic activities and ID/RC;
- assisting with Medicaid eligibility information to include submitting an application, if needed;
- completion of enrollment person-directed plan; and
- development of the IPC.
- The authorized LA must also complete the following activities:
- request an extension on the enrollment if the enrollment will not be competed in the originally assigned or extended time frame;
- transfer the individual to the LA in which the selected provider operates;
- provide the PDP to the provider and complete the IPC negotiations with the provider; and
- send hard copies of all enrollment documents, including the provider choice form and any enrollment extensions already obtained, to the receiving LA.
- Once the receiving LA has the information from the authorized LA, then the receiving LA is responsible for meeting required time frames for enrollment. The receiving LA must complete the data entry of all enrollment screens in a timely manner and request an extension if enrollment is not expected to be approved by the required timeframe.
H. Instructions for Use of LA Enrollment SFTP
To access the SFTP site, the user must have been granted access by HHS Security and must have access to the internet. Open your web browser, e.g., Internet Explorer, and type in the following path: ftp://ftp2.mhmr.state.tx.us/dnloads/XXX/LAEnrollment/. Replace the XXX with the component code for your LA.
After the file opens you will find two folders, IN and OUT. The IN folder is where you will retrieve files from HHS. To retrieve them, you must either copy them to a folder on your computer or click and drag the file to a folder on your computer. You cannot put anything in the IN folder.
The OUT folder is where you will place files to be sent to HHS. The same procedure applies. You must either copy the files from a folder on your computer to the OUT folder or click and drag the files from your computer to the OUT folder. HHS staff will post files to the IN folder and retrieve files from the OUT folder. HHS recommends files be retrieved and copied to your computer within seven calendar days and deleted from the SFTP site folder within one month. HHS staff are responsible for deleting files from the IN folder and the LAs are responsible for deleting files from the OUT folder. The SFTP site is for "transferring" files, not for "storing" them.
Note: All forms to be posted on the SFTP site must be scanned and saved as a PDF document. The file to be posted MUST be closed before it can be copied to the FTP site. (This is a common problem some staff have with posting a document.)
To file the documents in a manner that will allow for easy access and retrieval, the LA must name the document according to the following examples.
File name requirements:
Verification of Freedom of Choice – The file name will be the consumer's last name; first initial; VFC; Slot Type, e.g., 30; and A for acceptance or D for decline. Do not put spaces, dashes or any other symbol. (The slot type is indicated on the form sent with the initial authorization.)
Medicaid Estate Recovery Program – The file name will be the consumer's last name; first name; and MERP. Do not put spaces, dashes or any other symbol.
Examples for consumer Jerry Smith:
- Verification of Freedom of Choice, Slot Type 30 (Acceptance):
- Verification of Freedom of Choice, Slot Type 31 (Decline):
- Medicaid Estate Recovery Program
The LA designated staff must complete this test after reviewing the Enrollment Process for Persons Authorized to Enroll in TxHmL from the Interest List training document. The LA designated staff must score at least 92 percent to receive credit for having completed this training.
Please choose one of the formats below. If using the PDF version, it must be printed and marked by hand. The Word version may be completed using your computer.
Once completed, send to your contract manager by email at: email@example.com OR by fax to: 512-438-5220.