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Section 1000 Program Description
- 1100 Program Introduction
- 1110 Legal Base
- 1120 Program Goals
- 1130 Definitions
- 1140 Disclosure of Information
- 1141 Confidential Nature of the Case Record
- 1142 Establishing Identity for Contact Outside the Interview Process
- 1143 Custody of Records
- 1144 Disposal of Records
- 1145 When and What Information May Be Disclosed
- 1146 Confidential Nature of Medical Information – HIPAA
- 1147 Privacy Notice
- 1148 Individual Authorization
- 1149 Minimum Necessary
- 1150 Personal Representatives
- 1160 Correcting Information
- 1170 Alternate Means of Communication
Section 2000 Case Management
- 2100 Case Management
- 2200 Intake Procedures
- 2300 Responding to Requests for Service
- 2310 Criteria for Immediate or Expedited Responses to Service Requests
- 2320 Case Worker Response
- 2330 Scheduling the Initial Interview
- 2340 The Initial Interview and Application Process
- 2341 Financial Application Process
- 2342 Screening for Primary Home Care and Community Attendant Services
- 2343 Confidentiality
- 2344 Individual Rights and Responsibilities
- 2345 Registering to Vote
- 2346 Service Delivery Options
- 2347 Texas Medicaid Estate Recovery Program (MERP)
- 2348 Retroactive Payments
- 2349 Procedures for Applicants Aging Out of PCS to PHC
- 2400 Assessment Process
- 2410 Overview of the Assessment Process
- 2420 Assessing the Applicant's Needs
- 2421 Review of the Community Care Intake Form
- 2422 Form 2059, Summary of Client's Need for Service
- 2422.1 Medical Diagnosis and Functional Limitations
- 2422.2 Home Environment
- 2422.3 Living Arrangement
- 2422.4 Documentation of Caregivers
- 2422.5 Attendant Policy for Individuals Transferring from Another Personal Attendant Services (PAS) Program
- 2422.6 Common Household Tasks, Duplicate Services and Services Provided to Other Family Members
- 2422.7 Assessment of Social and Community Resources
- 2423 Guardianship
- 2430 Functional Assessment
- 2440 Use of Form 2060, Part B, Task/Hour Guide, and Part C, Task/Minute and Subtask Guide
- 2500 Service Planning
- 2510 Service Plan Development
- 2520 Freedom of Choice
- 2530 Other Resource Services
- 2540 Priority Status Individuals
- 2550 Identifying Individuals at Risk
- 2600 Authorizing and Reassessing Services
- 2610 Application Processing and Notification
- 2620 Service Authorizations
- 2630 Referrals to the Provider
- 2640 Provider Requirements for Hiring a Paid Attendant
- 2650 Changes in Service Plans
- 2660 Reassessments and Recertification Procedures
- 2670 Notifications at Reassessment
- 2680 Recertification
- 2700 Service Monitoring, Changes and Transfers
- 2710 Monitoring Visits and Contacts
- 2710.1 Monitoring Initiation of Services
- 2710.2 Monitoring Ongoing Services
- 2710.3 Service Plan Changes at the Monitoring Contact
- 2710.4 Monitoring Documentation Requirements
- 2710.5 Actions Required After Monitoring
- 2711 Monitoring Community Attendant Services Individuals
- 2712 Six-Month Monitoring Contacts
- 2720 Interim Changes
- 2730 Special Procedures for Helping Individuals Enter or Leave a Nursing Facility, Institution, or Hospice
- 2731 Individuals Entering a Nursing Facility
- 2732 Closing Service Authorizations for Individuals Entering or Leaving a Nursing Facility
- 2733 Individuals Receiving Services through Local Authorities
- 2734 TDC Individuals Leaving TDC
- 2735 Individuals Who Need Hospice Services
- 2736 Complaints, Grievances or Suggestions
- 2740 Fraud Detection and Documentation
- 2750 Fraud Referral
- 2710 Monitoring Visits and Contacts
- 2800 Notifications, Suspensions, Denials and Terminations
- 2810 Individual Notification Procedures
- 2820 Service Suspensions
- 2830 Refusal to Comply with Service Delivery Provisions
- 2840 Threats to Health or Safety
- 2840.1 Monitoring or Annual Home Visit Delay Due to Unsafe Environmental Circumstances
- 2840.2 Chronic Contagion/Infestation Conditions
- 2840.3 Active Tuberculosis (TB) Diagnosis
- 2840.4 Sharing Information with New Providers Regarding Health and Safety Issues
- 2841 Reinstatement of Services Terminated for Threats to Health or Safety
- 2900 Appeals and Fair Hearings
- 2910 Individual’s Right to Appeal and Request a Fair Hearing
- 2920 Request for Increase in Services During an Appeal
- 2930 Fair Hearing Procedures
Section 3000 Eligibility for Services
Section 4000 Specific CCAD Services
- 4100 Adult Foster Care
- 4110 Description
- 4120 Eligibility
- 4130 Adult Foster Care Intake and Assessment
- 4131 Response to Request for Services
- 4132 Individual Rights and Responsibilities
- 4133 Assessing Potential Adult Foster Care Homes
- 4134 Placement on the Interest List
- 4135 Adult Protective Services Individuals in Adult Foster Care
- 4136 Private Pay Individuals and Retroactive Payment Procedures
- 4140 Adult Foster Care Case Worker Procedures
- 4150 Finalizing the Care Plan – Required Initial Home Visit
- 4160 Monitoring
- 4170 Significant Changes
- 4180 Annual Reassessment
- 4200 Day Activity and Health Services
- 4210 Description
- 4220 Eligibility
- 4230 DAHS Approval
- 4240 Facility Initiation of Services
- 4250 Monitoring
- 4260 Changes
- 4270 Reassessment
- 4300 Emergency Response Services
- 4400 Family Care Services
- 4410 Primary Home Care Program
- 4420 Eligibility
- 4430 Case Worker Procedures for Determining Eligibility
- 4440 Referral Process
- 4440.1 Types of Referrals
- 4441 Provider Responsibilities after Receipt of Referral
- 4442 Resolution of Service Plan Disagreement
- 4443 Change of Providers
- 4444 Reporting Significant Changes
- 4445 Service Plan Changes
- 4446 Suspension of Services and Interdisciplinary Team (IDT) Procedures
- 4447 Reassessment
- 4448 Complaints
- 4500 Meals Services
- 4600 Primary Home Care and Community Attendant Services
- 4610 Primary Home Care (PHC) and Community Attendant Services (CAS) Contracting
- 4620 Personal Attendant Services Description
- 4630 Eligibility
- 4640 Retroactive Payments
- 4641 Provider's Role
- 4642 Case Worker's Role
- 4643 Applicant Approved for Retroactive Payment and Continued Services
- 4644 Applicant Approved for Retroactive Payment and Denied Continued Services by the Case Worker
- 4645 Special Procedures for Community Attendant Services (CAS)
- 4646 CAS Applicant Determined Ineligible by MEPD Staff
- 4647 Notifications
- 4648 Reimbursement
- 4650 Service Planning
- 4660 Service Authorization
- 4670 Ongoing Case Management
- 4671 Ongoing Case Worker Responsibilities
- 4672 Transferring Individuals from Family Care to Title XIX Personal Attendant Services
- 4673 Interim Service Plan Changes
- 4674 Service Interruptions
- 4675 Interdisciplinary Team
- 4676 Change of Providers
- 4677 Suspension of Services and Interdisciplinary Team Procedures
- 4678 Annual Reassessments
- 4700 Residential Care Services
- 4710 Description
- 4720 Eligibility for Service
- 4730 Special Casework Procedures for Residential Care
- 4740 Individual Contribution to the Cost of Care
- 4750 Personal Leave
- 4760 Hospital, Nursing Home or Institutional Facility Stays
- 4770 Ongoing Casework Procedures
- 4780 Special Casework Procedures for Emergency Care
- 4800 Reserved for Future Use
- 4900 Special Services to Persons with Disabilities (SSPD)
Section 5000 Utilization Review in Community Care for Aged and Disabled Services
Section 6000 Service Delivery Options
- 6100 Agency Option (AO)
- 6200 Service Responsibility Option (SRO)
- 6300 Consumer Directed Services (CDS)
- 6310 Description
- 6320 Roles and Responsibilities
- 6330 Individual Decision
- 6331 Selection of the Financial Management Services Agency (FMSA)
- 6332 Initial Authorization of Services
- 6333 Service Initiation Directly into CDS for PHC or CAS
- 6333.1 Authorizing CDS for Ongoing Individuals
- 6333.1.1 Different Program Annual Review and Annual Service Plan Dates
- 6333.2 Transfers and Consumer Directed Services (CDS)
- 6333.3 Circumstances That Necessitate a Revised Annual Service Plan (ASP)
- 6333.4 Annual Recertification
- 6333.5 Ongoing CDS Monitoring
- 6333.6 Ensuring Individual Health and Safety
- 6333.1 Authorizing CDS for Ongoing Individuals
- 6400 State of Texas Access Reform Plus (STAR+PLUS) Managed Care
Section 7000 Long Term Care Automated Systems
Section 8000 Service Authorization System Help File
- 8100 Community Care Authorizations
- 8110 Authorizing CCAD Services Using the SAS Wizards
- 8111 Wizard Sequencing — CCAD
- 8112 Automatically Populated Folders by the SAS Wizards — CCAD
- 8113 Records that Require User Entries Prior to Completing the SAS Wizards — CCAD
- 8114 Address Folder — CCAD Services Using the SAS Wizard
- 8115 Case Ownership — CCAD Services Using the SAS Wizard
- 8116 Other Information — CCAD Services Using the SAS Wizard
- 8117 Phone/Community Care — CCAD Services Using the SAS Wizard
- 8118 Service Request /Community Care — CCAD Services Using the SAS Wizard
- 8120 Financial Wizard
- 8120.1 Service Request Window (Read Only) — Financial Wizard
- 8120.2 Categorical Eligibility Window — Financial Wizard — CCAD
- 8120.3 CAS Eligible Window — Financial Wizard — CCAD
- 8120.4 Decline QI1 Window — Financial Wizard — CCAD
- 8120.5 Urgent Need Window — Financial Wizard — CCAD
- 8120.6 Potential Eligibility Window — Financial Wizard — CCAD
- 8120.7 Couple Information Window — Financial Wizard — CCAD
- 8120.8 Income Window — Financial Wizard — CCAD
- 8120.9 Resources Window — Financial Wizard — CCAD
- 8120.10 Financial Totals Window — Financial Wizard — CCAD
- 8120.11 Financial Eligibility Summary Window — Financial Wizard — CCAD
- 8120.12 Workers Checklist Window — Financial Wizard — CCAD
- 8130 Functional Wizard — CCAD
- 8130.1 Service Request Window (Read Only) — Functional Wizard
- 8130.2 Interview Window — Functional Wizard — CCAD
- 8130.3 Household Window — Functional Wizard — CCAD
- 8130.4 Health Concerns Window — Functional Wizard — CCAD
- 8130.5 Depression Details Window — Functional Wizard — CCAD
- 8130.6 Impairment Scoring Window — Functional Wizard — CCAD
- 8130.7 Task Purchased Details Window(s) — Functional Wizard — CCAD
- 8130.8 Support Assisting Client Window — Functional Wizard — CCAD
- 8130.9 Caregiver Support Details Window — Functional Wizard — CCAD
- 8130.10 Paid Attendant Window — Functional Wizard — CCAD
- 8130.11 Other Agency Support Details Window — Functional Wizard — CCAD
- 8130.12 Task/Time Allocation Window — Functional Wizard — CCAD
- 8130.13 Task/Hour Guide Summary Window — Functional Wizard — CCAD
- 8130.14 Supervisor Window — Functional Wizard — CCAD
- 8130.15 CCAD Attendant Hours Adjustment Window — Functional Wizard
- 8130.16 Six Hour Window — Functional Wizard — CCAD
- 8130.17 Home Environment Window — Functional Wizard — CCAD
- 8130.18 Emergency Response Services Window — Functional Wizard — CCAD
- 8130.19 Eligibility Determination Window — Functional Wizard — CCAD
- 8140 Authorization Wizard
- 8141 Service Request Folder — Authorization Wizard — CCAD
- 8142 Eligibility Details Window — Authorization Wizard — CCAD
- 8143 Service Code Selection Window — Authorization Wizard — CCAD
- 8144 Service Arrangement Window — Authorization Wizard — CCAD
- 8145 Provider Selection Window — Authorization Wizard — CCAD
- 8146 Worker's BJN and Nurse's BJN Window — Authorization Wizard — CCAD
- 8147 Information for Authorize Window — Authorization Wizard — CCAD
- 8148 Information for Terminate Window — Authorization Wizard — CCAD
- 8149 Authorization Summary Window (Read Only) — Authorization Wizard — CCAD
- 8150 Nurse Authorizations Using the Wizards — CCAD
- 8160 Changes to CCAD Authorizations Using the Wizards
- 8161 Form 2060 Score Changes Using the Wizards — CCAD
- 8162 Adding, Changing or Terminating Services Within Service Group 7 Using the Wizards — CCAD
- 8163 Case Worker/Nurse Changes Using the Wizards — CCAD
- 8164 Change in Provider Agency Using the Wizards — CCAD
- 8165 Change in Co-Pay Using the Wizards — CCAD
- 8166 Deleting a Registered Task Using the Wizards — CCAD
- 8167 Increases or Decreases in the Number of Units Using the Wizards — CCAD
- 8168 Priority Changes Using the Wizards — CCAD
- 8169 Transfers from Service Group 7 to Another Service Group Using the Wizards — CCAD
- 8170 Monitoring Wizard
- 8171 Service Request Window — Monitoring Wizard
- 8172 Services Authorized Window — Monitoring Wizard— CCAD
- 8173 Contact Window — Monitoring Wizard — CCAD
- 8174 Monitor Detail Window — Monitoring Wizard — CCAD
- 8175 Reasons for Dissatisfaction Window — Monitoring Wizard — CCAD
- 8176 Actions Selection Window — Monitoring Wizard — CCAD
- 8177 Client Satisfaction Window — Monitoring Wizard — CCAD
- 8110 Authorizing CCAD Services Using the SAS Wizards
- 8200 Authorizing CCAD Services Without Using the Wizard
- 8200.1 Individual — CCAD Services Without the Wizards
- 8200.2 Address Folder — CCAD Services Without the Wizards
- 8200.3 Authorizing Agent/Case Worker — CCAD Services Without the Wizards
- 8200.4 Eligibility for Title XX Services — CCAD Services Without the Wizards
- 8200.5 Enrollment — CCAD Services Without the Wizards
- 8200.6 Location — CCAD Services Without the Wizards
- 8200.7 Phone — CCAD Services Without the Wizards
- 8200.8 Level of Service/Form 2060 — CCAD Services Without the Wizards
- 8210 Adult Foster Care (AFC) Without the Wizards
- 8220 Consumer Managed Personal Attendant Services (CMPAS) Without the Wizards
- 8221 Authorizing Agent/Contract Manager — CMPAS Services Without the Wizards
- 8222 Authorizing Agent/Agency — CMPAS Services Without the Wizards
- 8223 Applied Income/Co-Pay — CMPAS Services Without the Wizards
- 8224 Service Authorization/Agency Model — CMPAS Services Without the Wizards
- 8225 Service Authorization/CDS Model — CMPAS Services Without the Wizards
- 8230 Day Activity and Health Services (DAHS) Without the Wizards
- 8240 Emergency Response Services (ERS) Without the Wizards
- 8250 Family Care (FC) Without the Wizards
- 8260 Meals Without the Wizards
- 8270 Primary Home Care (PHC) Without the Wizards
- 8271 Level of Service/Priority — PHC Services Without the Wizards
- 8272 Service Item — PHC Services Without the Wizards
- 8273 Authorizing Agent/Nurse — CAS Services Without the Wizards
- 8274 Authorizing Agent /Practitioner — PHC Services Without the Wizards
- 8275 Service Authorization — PHC Services Without the Wizards
- 8280 Residential Care Services (RC or Emergency Care) Without the Wizards
- 8290 Special Services to Persons with Disabilities (SSPD) Without the Wizards
- 8300 Changes to CCAD Authorizations Without the Wizards
- 8310 Authorizing Agent Entered the Wrong Contract Number — CCAD Services Without the Wizards
- 8311 Change in Provider Agency — CCAD Services Without the Wizards
- 8312 Increases or Decreases in the Number of Units — CCAD Services Without the Wizards
- 8313 Transfers from One CCAD Service to Another Without Wizards
- 8314 Transfers from Service Group 7 to Another Service Group Without Wizards
- 8315 Closing Nursing Facility Records Due to Transitions to the Community — CCAD Services Without the Wizards
- 8310 Authorizing Agent Entered the Wrong Contract Number — CCAD Services Without the Wizards
- 8400 Draft Functionality in CCAD Wizards
- 8500 CCAD Information
- 8600 CCAD Forms Directory