Revision 17-1; Effective March 15, 2017

 

 

1100 Program Introduction

Revision 17-1; Effective March 15, 2017

 

 

1110 Legal Base

Revision 17-1; Effective March 15, 2017

 

Community Care for Aged and Disabled (CCAD) is a group of services purchased by the Texas Health and Human Services Commission (HHSC) in response to recommendations of the Texas Legislature. CCAD provides services in a person's own home or community for aged or disabled Texans who are not self-sufficient, and who might otherwise be subject to premature institutionalization or to abuse, neglect or exploitation. CCAD includes the following direct services for eligible individuals (detailed descriptions of the services are in Section 4000, Specific CCAD Services):

  • Adult Foster Care (AFC) — 24-hour care in a family home or small group home.
  • Day Activity and Health Services (DAHS) — up to 10 hours of care per day in a licensed facility, with supervision by a licensed nurse.
  • Emergency Response Services (ERS) — an electronic signaling device for use in emergencies.
  • Meals Services — Home-Delivered Meals (HDM).
  • Personal Attendant Services (PAS) — assistance with personal care and housekeeping tasks:
    • Community Attendant Services (CAS) — provides in-home attendant services to individuals with an approved medical need for assistance with personal care tasks. CAS Services are provided under Title XIX of the Social Security Act.
    • Family Care (FC) — provides in-home attendant services to eligible adults. FC serves individuals who may or may not need personal care.  FC services are provided under Title XX of the Social Security Act. 
    • Primary Home Care (PHC) — provides in-home attendant services to an individual with an approved medical need for assistance with personal care tasks.  PHC serves individuals with Supplemental Security Income Medicaid benefits. PHC services are provided under Title XIX of the Social Security Act.
  • Residential Care — 24-hour care in a group setting, including
    • Emergency Care (EC) — care given to individuals who need immediate shelter or 24-hour care, or
    • Residential Care (RC) — 24-hour care in licensed assisted living facilities.
  • Special Services to Persons with Disabilities (SSPD) — a variety of in-home care and advocacy services for disabled individuals.

HHSC also provides CCAD case management, information and referral (I&R) to other service resources. Case management is direct assistance to eligible individuals in managing the services that have been mutually planned and that use the individuals’ own resources as well as community resources. These services are planned to enable individuals to carry out activities of daily living and to continue living in the community. (For details see Section 2000, Case Management.)

See also Appendix XXIV, Legal Basis for Community Care Programs.

 

1120 Program Goals

Revision 17-1; Effective March 15, 2017

 

CCAD goals are:

  • to enable aged and disabled individuals to achieve or maintain personal self-sufficiency, to help them reduce or prevent dependency, and to help them accept and understand dependency when it occurs because of illness, accident, or normal aging;
  • to prevent or reduce unnecessary institutional care by providing home-based and other less intensive care and to help individuals access institutional services when necessary and appropriate; and
  • to prevent abuse and neglect, including adult self-neglect, and to refer to Adult Protective Services (APS) those adults who appear to be victims of abuse, neglect, or exploitation by others.

 

1130 Definitions

Revision 17-1; Effective March 15, 2017

 

Definitions are located in 40 Texas Administrative Code (TAC) §48.1201.

 

1140 Disclosure of Information

Revision 17-1; Effective March 15, 2017

 

 

1141 Confidential Nature of the Case Record

Revision 17-1; Effective March 15, 2017

 

Information that is collected in determining initial or continuing eligibility is confidential. The restriction on disclosing information is limited to information about individuals. HHSC may disclose general information about policies, procedures, or other methods of determining eligibility, and any other information that is not about or does not specifically identify an individual.

An individual may review all information in the case record and in HHSC handbooks that contributed to the decision about his eligibility.

 

1141.1 Confidential Information on Notifications

Revision 17-1; Effective March 15, 2017

 

HHSC is committed to protecting all confidential information supplied by the applicant or individual during the eligibility determination process. This covers inclusion of confidential information by HHSC staff to third parties who receive a copy of a notification of eligibility form. Staff must ensure they do not include confidential information on the eligibility notice that should not be shared with the service provider or another third party. For example:

An individual is being denied Family Care due to an increase in income. It is a violation of confidentiality to record on Form 2065-A, Notification of Community Care Services, "Your income of $2,892 exceeds the eligibility limit of $2,022." The comment should simply state, "Your income exceeds the eligibility limit."

Another applicant is being denied Primary Home Care services because he does not meet the medical diagnosis criterion. It is a violation of confidentiality to record on Form 2065-A, "Your diagnosis of Schizophrenia does not meet the medical diagnosis criterion for eligibility for the Primary Home Care Program." The comment should simply state, "You do not have a medical diagnosis resulting in a functional limitation, as required for eligibility."

In the examples above, revealing the amount of the individual's income or his diagnosis is a violation of his right to confidentiality. In all cases, HHSC staff must assess any information provided by the individual to determine if its release would be a confidentiality violation.

 

1142 Establishing Identity for Contact Outside the Interview Process

Revision 17-1; Effective March 15, 2017

 

Keep all information HHSC has about an individual or any individual on the individual's case confidential. Confidential information includes, but is not limited to, individually identifiable health information.

Before discussing or releasing information about an individual or any individual on the individual's case, take steps to be reasonably sure the individual receiving the confidential information is either the individual or a person the individual has authorized to receive confidential information (for example, an attorney or personal representative).

 

1142.1 Telephone Contact

Revision 17-1; Effective March 15, 2017

 

Establish the identity of an individual who identifies himself as an individual using his knowledge of the individual's:

  • Social Security number (SSN),
  • date of birth,
  • other identifying information, or
  • call back to the individual.

Establish the identity of a personal representative by using the individual's knowledge of the individual's:

  • SSN,
  • date of birth,
  • other identifying information,
  • call back to the individual, or
  • the knowledge of the same information about the individual's representative.

Establish the identity of attorneys or legal representatives by asking for the individual to provide Form 1826-D, Case Information Release, completed and signed by the individual.

Establish the identity of legislators or their staff by following regional procedures.

 

1142.2 In-Person Contact

Revision 17-1; Effective March 15, 2017

 

Establish the identity of the individual who presents himself as an individual or individual's representative at an HHSC office by using sources such as:

  • driver's license,
  • date of birth,
  • Social Security number, or
  • other identifying information.

Establish the identity of other HHSC staff, federal agency staff, researchers, or contractors by using sources such as:

  • employee badge, or
  • government-issued identification card with a photograph.

Identify the need for other HHSC staff, federal staff, research staff, or contractors to access confidential information through:

  • official correspondence or a telephone call from a state or regional office.
  • contact with regional attorney.

Contact appropriate regional or state office staff when federal agency staff, contractors, researchers, or other HHSC staff come to the office without prior notification or adequate identification and request permission to access HHSC records.

 

1142.3 Verification and Documentation

Revision 17-1; Effective March 15, 2017

 

If disclosing individually identifiable health information, document how the identity of the person was verified when contact is outside the interview.

Verify the identity of the person who requests disclosure of individually identifiable health information using sources such as:

  • valid driver's license or Department of Public Safety ID card,
  • birth certificate,
  • hospital or birth record,
  • adoption papers or records,
  • work or school ID card,
  • voter registration card,
  • wage stubs, and
  • U.S. passport.

 

1143 Custody of Records

Revision 17-1; Effective March 15, 2017

 

Records must be safeguarded. Use reasonable diligence to protect and preserve records and to prevent disclosure of the information they contain, except as provided by HHSC regulations.

"Reasonable diligence" for employees responsible for records includes:

  • keeping records in a locked office when the building is closed;
  • keeping records properly filed during office hours; and
  • keeping records in the office at all times, except when authorized to remove or transfer them.

 

1144 Disposal of Records

Revision 17-1; Effective March 15, 2017

 

To dispose of documents with individual-specific information, follow the HHSC procedures for destruction of confidential data in the Records Management Manual.

 

1145 When and What Information May Be Disclosed

Revision 17-1; Effective March 15, 2017

 

Reasonable efforts must be made to limit the use, request, or disclosure of individually identifiable health information to the minimum necessary to determine eligibility and operate the program. The disclosure of individual medical information from HHSC records must be limited to the minimum necessary to accomplish the requested disclosure. For example, if an individual authorizes release of income verification, including disability income, do not release related case medical information unless specifically authorized by the individual.

Give individual addresses or other case information only to a person who has written permission from the individual to obtain the information. The individual authorizes the release of information by completing and signing:

  • Form 1826-D, Case Information Release; or
  • a document containing all of the following information:
    • the applicant/individual's full name (including middle initial) and case number, or full name (including middle initial) and either his date of birth or Social Security number;
    • a description of the information to be released. If a general release is authorized, provide the information that can be disclosed to the individual. Withhold confidential information from the case record, such as names of persons who disclosed information about the household without the household's knowledge, and the nature of pending criminal prosecution;
    • a statement specifically authorizing HHSC to release the information;
    • the name of the person or entity where the information will be released;
    • the purpose of the release;
    • an expiration event that is related to the individual, the purpose of the release, or an expiration date of the release;
    • a statement about whether refusal to sign the release affects eligibility for delivery of services;
    • a statement describing the applicant's or individual's right to revoke the authorization to release information;
    • the date the document is signed; and
    • the signature of the applicant, individual or legally authorized representative (LAR).

If the case information to be released includes individually identifiable health information, the document must also tell the applicant or individual that information released under the document may no longer be private, and may be released further by the person receiving the information.

Occasionally requests for information from the case records of deceased individuals are received. In these instances, protect the confidentiality of the former individuals and their survivors.

The Office of the General Counsel handles questions about the release of information under the Open Records Act. All questions and problems encountered by individuals concerning release of information should be referred to the Office of the General Counsel, State Office, W-615. Regional staff should direct questions and problems to the regional attorney.

Note: See Section 1146, Confidential Nature of Medical Information – HIPAA, for restrictions on the release of an individual's protected health information under Health Insurance Portability and Accountability Act regulations.

 

1145.1 Request for Release of Information Related to a Deceased Individual

Revision 17-1; Effective March 15, 2017

 

This section provides guidance for handling requests for release of information related to a deceased applicant/individual. A request for such information is likely to occur in relation to the Medicaid Estate Recovery Program. HHSC does not provide a form to document when someone requests information. In lieu of a form, the following methods are acceptable for documenting the request for this type of release of information to the requestor:

  • A release form or statement signed by the applicant/individual prior to death, and not revoked by the applicant/individual, authorizing release of information to the specific person requesting the information.
  • A copy of an order from a probate court appointing the requestor as estate administrator or guardian.
  • A copy of another type of order from a court authorizing the requestor to administer the affairs of the deceased.
  • Documentation demonstrating the requestor has authority under Texas law to act for the deceased.

A person who has authority under Texas law to act on behalf of a deceased applicant/individual or the deceased's estate includes a surviving spouse, an adult child, a parent or an heir.

Regional staff should first ask the requestor for any available document (noted above). If a document is not available, staff must determine and document if the requestor has authority under Texas law to act for the deceased applicant/individual. Regional staff may release information to the requestor if one of the documentation requirements above is met and filed/recorded in the case record.

 

1146 Confidential Nature of Medical Information – HIPAA

Revision 17-1; Effective March 15, 2017

 

Health Insurance Portability and Accountability Act (HIPAA) is a federal law that sets additional standards to protect the confidentiality of individually identifiable health information. Individually identifiable health information is information that identifies or could be used to identify an individual and that relates to the:

  • past, present, or future physical or mental health or condition of the individual;
  • provision of health care to the individual; or
  • past, present, or future payment for the provision of health care to the individual.

 

1147 Privacy Notice

Revision 17-1; Effective March 15, 2017

 

HHSC staff must send each individual the HHS Agencies Notice of Privacy Practices, upon certification. The HHS Agencies Notice of Privacy Practices is available in both English and Spanish as printable PDF documents:

Link to printable English PDF

Link to printable Spanish PDF

This form tells the individual about:

  • his privacy rights;
  • the duties of HHSC to protect health information; and
  • how HHSC may use or disclose health information without his authorization. (Examples of use or disclosure include: health care operations (for example, Medicaid), public health purposes, reporting victims of abuse, law enforcement purposes, sharing with HHSC contractors, and coordinating government programs that provide benefits.)

 

1148 Individual Authorization

Revision 17-1; Effective March 15, 2017

 

The individual may authorize the release of his health information from HHSC records by using a valid authorization form. Form 1826-D, Case Information Release, includes all the authorization elements required by HIPAA privacy regulations.

 

1149 Minimum Necessary

Revision 17-1; Effective March 15, 2017

 

Reasonable efforts must be made to limit the use, request, or disclosure of individually identifiable health information to the minimum necessary to determine eligibility and operate the program. The disclosure of individual medical information from HHSC records must be limited to the minimum necessary to accomplish the requested disclosure. Example: If an individual authorizes release of income verification, including disability income, do not release related case medical information unless specifically authorized by the individual.

 

1150 Personal Representatives

Revision 17-1; Effective March 15, 2017

 

Only the individual or the individual's personal representative can exercise the individual's rights with respect to individually identifiable health information. Therefore, only the individual or individual's personal representative may authorize the use or disclosure of individually identifiable health information or obtain individually identifiable health information on behalf of an individual.

Exception: HHSC is not required to disclose the information to the personal representative if the individual is subjected to domestic violence, abuse, or neglect by the personal representative. Consult the regional attorney if it is believed that health information should not be released to the personal representative.

Note: A responsible party is not automatically a personal representative.

 

1151 Adults and Emancipated Minors

Revision 17-1; Effective March 15, 2017

 

If the individual is an adult or emancipated minor, including married minors, the individual's personal representative is a person who has the authority to make health care decisions about the individual and includes a:

  • person the individual has appointed under a medical power of attorney, a durable power of attorney with the authority to make health care decisions, or a power of attorney with the authority to make health care decisions;
  • court-appointed guardian for the individual; or
  • person designated by law to make health care decisions when the individual is in a hospital or nursing home and is incapacitated or mentally or physically incapable of communication. Follow regional procedures to contact the regional attorney for approval.

 

1152 Unemancipated Minors

Revision 17-1; Effective March 15, 2017

 

A parent is the personal representative for a minor child except when:

  • the minor child can consent to medical treatment by him or herself. Under these circumstances, do not disclose to a parent information about the medical treatment to which the minor child can consent. A minor child can consent to medical treatment by him or herself when the:
    • minor is on active duty with the U.S. military;
    • minor is age 16 or older, lives separately from the parents, and manages his own financial affairs;
    • consent involves diagnosis and treatment of disease that must be reported to local health officer or state health services;
    • minor is unmarried and pregnant and the treatment (other than abortion) relates to the pregnancy;
    • minor is age 16 years or older and the consent involves examination and treatment for drug or chemical addiction, dependency, or use at a treatment facility licensed by the Texas Council on Alcohol and Drug Abuse;
    • consent involves examination and treatment for drug or chemical addiction, dependency, or use by a physician or counselor at a location other than a treatment facility licensed by the Texas Council on Alcohol and Drug Abuse;
    • minor is unmarried, is the parent of a child, has actual custody of the child, and consents to treatment for the child; or
    • consent involves suicide prevention or sexual, physical, or emotional abuse.
  • a court is making health care decisions for the minor child or has given the authority to make health care decisions for the minor child to an adult other than a parent or to the minor child. Under these circumstances, do not disclose to a parent information about the health care decisions not made by the parent.

 

1153 Deceased Individuals

Revision 17-1; Effective March 15, 2017

 

The personal representative for a deceased individual is an executor, administrator, or other person with authority to act on behalf of the individual or the individual's estate. These include:

  • an executor, including an independent executor;
  • an administrator, including a temporary administrator;
  • a surviving spouse;
  • a child;
  • a parent; and
  • an heir.

Consult the regional attorney if there are questions about whether a particular person is the personal representative of an applicant or individual.

 

1160 Correcting Information

Revision 17-1; Effective March 15, 2017

 

An individual has a right to correct any information that HHSC has about the individual and any other individual on the individual's case.

A request for correction must be in writing and:

  • identify the individual asking for the correction;
  • identify the disputed information about the individual;
  • state why the information is wrong;
  • include any proof that shows the information is wrong;
  • state what correction is requested; and
  • include a return address, telephone number, or email address at which HHSC can contact the individual.

If HHSC agrees to change individually identifiable health information, the corrected information is added to the case record, but the incorrect information remains in the file with a note that the information was amended per the individual's request.

Notify the individual in writing within 60 days (using current HHSC letterhead) that the information is corrected, or will not be corrected, and the reason. Inform the individual if HHSC needs to extend the 60-day period by an additional 30 days to complete the correction process or obtain additional information.

If HHSC makes a correction to individually identifiable health information, ask the individual for permission before sharing with third parties. HHSC will make a reasonable effort to share the correct information with persons who received the incorrect information from HHSC if they may have relied or could rely on it to the disadvantage of the individual. Follow regional procedures to contact the HHSC Privacy Officer for a record of disclosures.

Note: Do not follow above procedures when the accuracy of information provided by an individual is determined by another review process, such as a:

  • fair hearing,
  • civil rights hearing, or
  • other appeal process.

The decision in that review process is the decision on the request to correct information.

 

1170 Alternate Means of Communication

Revision 17-1; Effective March 15, 2017

 

HHSC must accommodate an individual's reasonable requests to receive communications by alternative means or at alternate locations.

The individual must specify in writing the alternate mailing address or means of contact, and include a statement that using the home mailing address or normal means of contact could endanger the individual.