Appendix IV, Workflow and Time Frames

You are here

Revision 17-3; Effective May 15, 2017

 

Workflow and Time Frames for a Routine Primary Home Care (PHC) Referral
Time Frames Action
  Intake is received.
Within 14 Calendar Days The case worker schedules a visit and assesses the applicant for services. The case worker has 30 calendar days from this date to complete the application.
Within 5 Business Days of the Home Visit

The case worker enters the assessment information in the Service Authorization System (SAS) and sends the provider a referral packet including:

  • Form 2059, Summary of Client's Need for Service;
  • Auto Form 2060, Needs Assessment Questionnaire and Task/Hour Guide (generated by SAS); and
  • Referral Form 2101, Authorization for Community Care Services, to begin Pre-Initiation Activities.
The date of the home visit is day "0."
Within 14 Calendar Days The provider completes the pre-initiation activities and obtains Form 3052, Practitioner's Statement of Medical Need, and sends to the case worker.
Within 5 Business Days of Receipt of Form 3052 The case worker reviews Form 3052 for completeness and if complete, sends the Authorization Form 2101, to the provider. The "Mail Date" (Item 1) and the "Begin Date" (Item 4) are the same

The date of receipt of Form 3052 is day "0."
Within 2 Business Days of the Begin Date on Form 2101 The case worker completes and sends Form 2065-A, Notification of Community Care Services, to the individual.
Within 30 Calendar Days of the Home Visit Date The application must be completed by sending the Authorization Form 2101, to the provider.
Within 7 Calendar Days of Receipt of the Authorization Form 2101 The provider initiates services.
Intake Received and Determined to be Expedited or Immediate The case worker schedules the visit and assesses the applicant within the time frames for an immediate referral (24 hours) or an expedited referral (5 calendar days).
By the Next Business Day from the Home Visit Date The case worker makes an oral request to the provider to begin pre-initiation activities and negotiates a date for the completion of pre-initiation activities (which is less than 14 days). The case worker sends the referral packet including Form 2059, Auto Form 2060, and Referral Form 2101 with the negotiation information in the comments.
By the Negotiated Date The provider calls the case worker and provides the information from the completed Form 3052. The case worker and the provider negotiate a start date.
Within 5 Business Days of the Negotiation Contact from the Provider The case worker sends the Authorization Form 2101 to the provider, entering the negotiated start date in Item 4 and sends Form 2065-A to the individual.
Within 7 Business Days from the Negotiation Contact The provider sends the case worker Form 3052.

 

Workflow and Time Frames for an Initial Referral for Community Attendant Services (CAS)
Time Frames Action
  Intake is received.
Within 14 Calendar Days The case worker schedules a visit and assesses the applicant for services.
Note: If the intake is immediate or expedited, the case worker schedules according to the appropriate time frame. Unless new intakes are being placed on the interest list by the region, a referral to Family Care is mandatory for immediate or expedited intakes.
Within 2 Business Days of Receipt of the Application Form The case worker hand delivers or faxes Form H1200-EZ, Application for Assistance – Aged and Disabled, to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist. Date of receipt is day "0."
Within 7 Business Days of Receipt of the Eligibility Notification from MEPD The case worker sends the provider a referral packet including Form 2059, Auto Form 2060 (generated by SAS) and Referral Form 2101.
Within 14 Calendar Days of Receipt of the Referral Packet The provider sends Form 3052 to the HHSC nurse. The provider may send a courtesy copy of Form 2101.
Within 5 Business Days of Receipt of Form 3052 The HHSC nurse enters the information in SAS and sends the provider Authorization Form 2101 with a copy to the case worker.

 

The date of receipt of Form 3052 is day "0."
Within 2 Business Days of Receipt of Form 2101 from the HHSC nurse The case worker sends the individual Form 2065-A.

 

The date of receipt is day "0."
Within 7 Calendar Days of Receipt of Authorization Form 2101 The provider initiates services.

 

Workflow and Time Frames for a CAS Reassessment
Time Frames Action
Within 12 Months of the Previous Assessment The case worker makes the home visit for the annual reassessment.
Within 5 Business Days of the Home Visit The case worker sends Referral Form 2101 to the provider and to the HHSC nurse. If there are no changes in the service plan, the case worker leaves the "Begin Date" blank. If there are changes in the service plan, the case worker enters the "Begin Date" according to the action:

 

  • The effective date for an increase is 7 calendar days from the "Mail Date" on Form 2101.
  • The effective date for a decrease is 13 days from the "Mail Date" on Form 2101. This date must match the date on Form 2065-A.

The case worker sends Form 2065-A to the individual to notify him of the change in the service plan.
Within 14 Calendar Days of Receipt of Form 2101 from the Case Worker The provider sends Form 2101 and the agreement or disagreement* with the plan to the HHSC regional nurse.
Within 5 Business Days of Receipt of Form 2101 from the Provider The HHSC nurse reviews the service plan and completes the authorization in the Authorization Wizard. The nurse sends Authorization Form 2101 to the provider and the case worker.

 

* If the provider disagrees with the service plan, the HHSC nurse negotiates with the provider and the case worker to arrive at an agreement.

If Form 2101 is not received from the provider within 21 calendar days, the HHSC nurse contacts the provider to request the form.

 

Workflow and Time Frames for a Day Activity and Health Services (DAHS) Referral
Time Frames Action
  Intake is received.
Within 14 Calendar Days The case worker schedules a visit or contacts the applicant by telephone and assesses the applicant for services.
Within 5 Business Days of the Assessment The case worker sends the provider a referral packet including Form 2059 and Referral Form 2101.
Within 14 Calendar Days of Receipt of the Referral Packet The provider sends the prior approval request packet to the HHSC regional nurse, which includes:
  • Referral Form 2101;
  • Form 3050, Day Activity and Health Services Health Assessment/Individual Service Plan; and
  • Form 3055, Physician's Orders (DAHS).
Within 5 Business Days of Receipt of the Packet The HHSC regional nurse determines if the applicant meets the medical criteria for DAHS and if so, enters the information in SAS. The nurse sends the provider Authorization Form 2101 with a copy to the case worker.

 

The date of receipt of the packet is day "0."
Within 2 Business Days of Receipt of Form 2101 from the HHSC Regional Nurse The case worker sends the individual Form 2065-A.

 

The date of receipt is day "0."
Within 7 Calendar Days of the Begin Date on Form 2101 The provider initiates services, unless the individual has been attending the facility under a facility-initiated referral.
Within 14 Calendar Days of the Begin Date on Form 2101