4200, Units of Service

Revision 19-1; Effective September 19, 2019

A billable unit of service is the method for calculating the amount the habilitation coordinator may bill HHSC. HHSC established the habilitation coordination rate based on an assumption of a caseload of 26 individuals served within any given calendar month. For the first year of implementation, HHSC will not be imposing a contractual requirement that LIDDAs maintain a caseload of 26 individuals. HHSC encourages and expects that LIDDAs will maintain manageable caseloads that continue to support the integrity and quality of habilitation coordination that PASRR residents receive. Rate information is published by procedure code in the applicable Texas Medicaid Fee Schedule located on the Texas Medicaid website (see Fee Schedules).

The number of habilitation coordination units needed by the individual are determined by the IT or SPT and documented on the HSP. The monthly habilitation coordination fee may only be billed during a month when a billable activity has occurred. Habilitation coordination progress notes must include the following elements:

• the date of habilitation coordination encounter;
• description of the service provided (e.g., assessment, service planning and coordination, monitoring, or crisis prevention and management);
• place of encounter;
• actual begin time and duration of encounter;
• detailed description of the encounter;
• the person with whom the contact occurred; and
• the habilitation coordinator who provided the contact including name and title.

Elements noted above do not necessarily have to be contained within the narrative describing the encounter as long as they are contained within the progress note that also contains the narrative (e.g., billing strip).

4210 SASO Codes

Revision 19-0; Effective July 7, 2019

A service authorization for habilitation coordination is created in the Service Authorization System Online (SASO) by designated HHSC staff for one unit per month requested, for up to 12 months, with effective the date of the IDT or the date that the habilitation coordinator meets with the individual. The service authorization is identified as a Service Group (SG) 14 or “SG 14,” which means the LIDDA is the provider. The service code for which is associated with “habilitation coordination” is 10H provided by a LIDDA.