Downloading a Form to Your Computer

Fillable forms cannot be viewed on mobile or tablet devices. Follow the steps below to download and view the form on a desktop PC or Mac.

  1. Right Click for PC or Ctrl + Click for Mac on the PDF link and click “Save link as” from the menu.
  2. Select the folder you want to save the file in and then click "Save."
  3. Navigate to the folder you saved the file in and Right Click for PC or Ctrl + Click for Mac, then select "Open With" from the menu and select Adobe Acrobat Reader DC.

    Note: Open the PDF file from your desktop or Adobe Acrobat Reader DC. Do not click on the downloaded file at the bottom of the browser since it will not open the PDF in Adobe Acrobat Reader DC. It will try to open the file in the browser that results in the same browser error message.

    If still having trouble viewing or downloading a form, click here.

Effective Date: 
3/2019

Documents

 

Instructions

 

Updated: 3/2019

Procedure

This form serves as notification that a person enrolled in one of the following waiver programs is moving into a LIDDA's service area and is used when the person receiving Home and Community-based Services (HCS) or Texas Home Living (TxHmL) services moves from one local and developmental disability authority (LIDDA) service area to another, but does not transfer to a new waiver provider contract.

General Instructions

The current LIDDA service coordinator (SC) for a person enrolled in HCS or TxHmL must complete Form 8575 before that person moves to a different LIDDA's service area and does not transfer to a new waiver contract.

The current LIDDA is referred to as the sending LIDDA and the LIDDA where the person will be moving to is considered the new or receiving LIDDA.

The form and Client Assignment and Registration (CARE) System data entry will be initiated by the sending LIDDA and completed by the receiving LIDDA.

The person’s current SC, with the sending LIDDA, must complete the top section of the form, and enter the person’s:

  • name;
  • CARE ID;
  • SC name;
  • SC phone number;
  • date of move;
  • new location code;
  • new county;
  • county code;
  • program provider name; and
  • program provider component code.

The SC should contact the program provider to obtain the location code and county where the person will be moving. The program provider must have already set up the location code in CARE. If the person is enrolled in TxHmL or resides in his own or family's home, the generic location code is OHFH.

Detailed Instructions for Care Data Entry

Sending LIDDA

Utilizing the person's information on Form 8575, the sending LIDDA representative enters the information into CARE screen L30: MRA ASSIGNMENT NOTIFICATION, using the "Add" action.
The sending LIDDA will enter into CARE:

  • date of move;
  • location and county codes;
  • name of the LIDDA representative completing the data entry; and
  • date the entry was completed.

Once the information is entered into CARE, the form must be faxed to the receiving LIDDA.

Receiving LIDDA

If the person has already moved, the receiving LIDDA may complete the following CARE data entry as soon as it receives the information. If the person has not yet moved, the receiving LIDDA should wait until the date of the move to do the CARE data entry.

To acknowledge the transfer, the receiving LIDDA uses the "Change" action on CARE screen L30: MRA ASSIGNMENT NOTIFICATION, and enters:

  • name of the LIDDA representative completing the data entry; and
  • date the entry was completed.

After completing CARE screen L30: MRA ASSIGNMENT NOTIFICATION, CARE screen L26: CLIENT ASSIGNMENTS, is displayed. The receiving LIDDA should confirm that the information being displayed is correct, and make any changes necessary.

Pending LIDDA Assignment Report

An LIDDA may access XPTR report number HC062860.W, PENDING MRA ASSIGNMENTS, to determine if another LIDDA has started this process on a person moving into their service area.

If an LIDDA does not complete CARE data entry as described in this document, the program provider may be unable to enter billing data in CARE. It is important that communication between the sending and receiving LIDDAs occur to ensure that both LIDDAs are aware of a person moving from one service area to another and to share information regarding the person's services.

Questions regarding entry of CARE screen L30: MRA ASSIGNMENT NOTIFICATION, should be directed to IDD Waivers Program Eligibility and Support at 512-438-2484 or enrollmenttransferdischargeinfo@hhsc.state.tx.us staff.