Effective Date: 
3/2017

Documents

 

Instructions

Updated: 3/2017

Purpose

A provider of home-delivered meals (HDM) funded through the Older Americans Act (OAA), Title III, or Social Security Act (SSA), Title XX, completes Form 2027 to request a waiver of the Texas Health and Human Services Commission (HHSC) HDM requirements including delivery of a hot meal five days a week and observation of holidays. Providers may request waivers for one or more of the following:

  • To deliver meals less than five days a week.
  • To deliver a combination of hot, frozen and/or chilled meals.
  • To observe more than 10 holidays during the waiver period.

The waiver must address:

  • circumstances necessitating the waiver request,
  • service area or location affected,
  • pattern and type of meal delivery the provider is requesting, and
  • steps the provider will take to ensure the health and welfare of individuals affected by the modified delivery schedule and use of alternate meals.

The waiver is an amendment to the provider’s contract for federal fiscal year (FFY) 2018 when the waiver request is submitted to and approved by HHSC.

An HHSC case manager must give authorization when an individual receiving meals through Title XX requires delivery of fewer than five meals a week. In those cases, the provider does not submit Form 2027.

Shelf-stables meals provided during emergency or inclement weather situations do not require waiver approval. Shelf-stable meals will not be an approved alternate meal.

Basis for a Waiver Request

SSA, Title XX

Texas Administrative Code (TAC), Title 40, Part 1, Chapter 55, §55.21
Frozen, Chilled, or Shelf-Stable Meals

A provider agency may use frozen, chilled, or shelf-stable meals for emergency or inclement weather situations, emergency situations, and for situations approved by the contract manager on a case-by-case basis, if the following conditions exist:

  1. Sanitary and safe conditions for storage, thawing, and preparation of the meal can be provided by the provider agency and the client.
  2. Meals can be safely handled by the client, or by another available person if the client is unable to do so.

Home-Delivered Meals Provider Manual
Section 4310, Waiver Request

Provider agencies must submit a waiver request to the HHSC contract manager during the rate negotiation process if it determines that delivery of frozen or shelf-stable meals is required for certain individuals within its contracted service area. Any waivers granted will be effective for a period not to exceed one fiscal year.

OAA, Title III

40 TAC §85.302
Nutrition Services

  1. Service days. A AAA must ensure that a service provider:
    1. provides meals in accordance with the Older Americans Act, §331 and §336; and
    2. obtains, in accordance with DADS Program Instruction AAA - PI 300 Older Americans Act Nutrition Waiver Requests, prior approval from the AAA and DADS if service frequency is less than five days per week.
  1. Emergency or inclement weather or service frequency less than five days a week. If a service provider delivers frozen, chilled, or shelf-stable meals for emergency or inclement weather situations, or if the service provider's service frequency is less than five days per week, a AAA must ensure that the service provider:
    1. delivers the meals only if the program participant has sanitary and safe conditions for storing, thawing, and reheating the meals;
    2. determines the meals can be safely handled by the program participant or another available person if the participant is unable to safely handle the meal; and
    3. complies with the DADS Program Instruction AAA - PI 300 Older Americans Act Nutrition Waiver Requests.

Procedure

When to Prepare

Form 2027 is completed for each service area that requires a waiver and as a result the provider may submit multiple waiver requests.

One waiver may be submitted for the HDM agency to request more than 10 holidays during the waiver period.

Transmittal

The provider must complete the form in its entirety and submit it to the HHSC contract specialist and area agency on aging (AAA) contract manager by the date specified at the beginning of the rate setting process and thereafter as needed. The waiver will be approved or denied and returned to the provider.

Detailed Instructions

Name of Legal Entity — Enter the legal entity’s name as it appears on the contract.

Signature Authority — Enter the name of the person who has signature authority for the legal entity.

Mailing Address, City, State, ZIP — Enter the provider's address as it appears on the contract.

Funding Source — Select Title III only, Title XX only, or both Title III and Title XX.

Common Provider — A provider that contracts to provide both Title XX and Title III meals to eligible individuals. Select Yes or No to indicate whether the provider meets the definition of a common provider.

AAA Name, if applicable — Select the name of the AAA if Title III is a funding source for the provider.

HDM Waiver, if applicable — Check the box to request a waiver and complete the HDM waiver specific information.

Waiver Area  Describe the city and county or the portions of the city and county that the waiver will cover.

Meal Delivery Pattern

Using the drop-down menu, select the number of hot, frozen and/or chilled meals delivered to individuals each week. — Select 0-7 to indicate the number of hot, frozen and/or chilled meals an individual will receive each week.

Contacting Individuals

How many times per week will the provider contact the individual in person or by telephone? — Select 0-7 to indicate the number of times each week the provider will contact the individual.

Additional Comments — Add comments, if desired.

Alternate Meals

Record the estimated number of individuals who will receive alternate meals under this waiver each week — Enter the estimated number of individuals who will receive alternate meals on a modified delivery schedule.

What is the shortest distance (number of miles) from the meal preparation site to an individual served under this waiver? — The minimum mileage from the meal preparation site to the closest distribution point must be no less than 10 miles. Enter the number of driving miles from the meal preparation site to the individual.

Select all circumstances necessitating this waiver. — Select one or more of the listed circumstances to indicate why the provider is requesting a waiver. If other was selected, explain the circumstances that make this waiver necessary.

Holiday Waiver, if applicable — Check the box to request a waiver to use more than ten days per year for observing holidays. Refer to Program Instruction AAA- PI 300.

Describe the agency’s plan for meeting the meal needs of the older individuals being served when the agency is closed. — Explain in the space provided.

Assurances

Name of Legal Entity — Type or print clearly the legal entity's name as it appears on the contract.

Printed/Typed Name – Signature Authority — Type or print clearly the name of the person who has signature authority for the provider.

Signature – Signature Authority — The person who has signature authority for the provider must sign on this line.

Date — Type or print clearly the date the person with signature authority for the provider signs the form.

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