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Effective Date: 
2/2012

Documents

 

Instructions

Updated: 2/2012

 

Procedure

To be eligible for the Texas Home Living (TxHmL) Program, an individual's annual Individual Plan of Care (IPC) cost cannot exceed $17,000. The Texas Health and Human Services Commission (HHSC), Access and Intake, Utilization Management and Review, IDD Waivers, Program Enrollment/Utilization Review (PE/UR), will review any IPC in which the cost exceeds the maximum cost ceiling to determine whether the individual's needs can be met within the rules of the TxHmL Program.

 

Detailed Instructions

The Local Authority (LA) will complete all the information on Form 8627 and submit to HHSC PE/UR, along with a copy of the signed IPC (all pages), screen print of Client Assignment and REgistration (CARE) system screen L02, and service justifications.

Provider and LA Contact Information

Provider Name — Enter the name of the program provider.

Provider Contact — Enter the name of the person who will act as the contact for the program provider. The provider contact should be someone who can answer questions about the action being requested.

Fax Area Code and Telephone No. — Enter the fax area code and telephone number for the person who will act as the contact for the program provider.

Area Code and Telephone No. — Enter the area code and telephone number for the person who will act as the contact for the program provider.

Component Code — Enter the program provider component code.

Contract No. — Enter the contract number for the program provider.

LA Name — Enter the name of the LA.

LA Contact — Enter the name of the person who will act as the contact for the LA. The LA contact should be someone who can answer questions about the action being requested.

LA Fax Area Code and Telephone No. — Enter the fax area code and telephone number for the person who will act as the contact for the LA.

LA Area Code and Telephone No. — Enter the area code and telephone number of the person who will act as the contact for the LA.

Individual Information

Individual's Last Name — Enter the individual's last name.

Individual's First Name — Enter the individual's first name.

CARE ID No. — Enter the individual's CARE system identification number.

Medicaid No. — Enter the individual's Medicaid number.

Date of Birth — Enter the individual's date of birth.

Age — Enter the individual's age.

IPC Begin Date — Enter the date the IPC began or will begin.

IPC Effective Date — Enter the effective date of the IPC to be reviewed (for renewals, this is the IPC begin date; for revisions and transfers, it is the revision date).

Legally authorized representative (LAR) contact information, if applicable. If no LAR, list individual's information. — Enter the name, area code and telephone number, as well as the street address, city, state and ZIP Code of the LAR, if there is one. If there is no LAR, enter the individual's information.

Does any correspondence sent to the LAR or individual need to be translated into another language? — Mark the appropriate box and indicate the language needed if other than English.

LA Service Coordinator Action

The LA service coordinator will:

  • document the need for the increased service(s);
  • submit an IPC packet to the HHSC PE/UR unit that includes:
    • the IPC cover sheet;
    • a copy of the IPC indicating the revised amounts;
    • justification for the increase; and
    • any additional supporting documentation; and
  • ensure the IPC revision reflecting the requested increase is entered in the CARE system.

PE/UR Action (for State Office Use Only)

HHSC PE/UR will:

  • review the submitted information;
  • notify the service coordinator of any additional non-TxHmL program resources that can and should be used to meet the individual's needs, if applicable;
  • request the service coordinator submit any additional documentation not previously submitted;
  • make a determination regarding whether any services should be reduced or denied and the individual's eligibility for the TxHmL Program;
  • if the IPC cost is more than $17,000, advise the service coordinator to ensure the appropriate screens are entered in the CARE system in order to begin the process of requesting a permanent discharge from the TxHmL Program. This involves entering CARE screen C18 (completed by program provider) and L18 (completed by LA); and
  • send written notification to the individual/LAR advising them of any adverse determination and their right to a fair hearing.