Revision 17-1; Effective October 16, 2017

 

 

14100 Waiver Survey and Certification Overview

Revision 17-1; Effective October 16, 2017

 

Waiver Survey and Certification (WSC) is a unit of Regulatory Services with the Texas Health and Human Services Commission (HHSC). WSC conducts certification reviews for the Home and Community-based Services (HCS) and Texas Home Living (TxHmL) waiver programs, and residential visits for Host Home/Companion Care and three- and four-person homes in the HCS program. WSC also reviews complaints and deaths in the HCS, TxHmL, and Deaf Blind with Multiple Disabilities (DBMD) waiver programs and follows up on abuse, neglect and exploitation (ANE) allegations related to individuals served in the HCS and TxHmL waiver programs.

 

14200 Home and Community-based Services Certification Reviews

Revision 17-1; Effective October 16, 2017

 

In accordance with Title 40, Texas Administrative Code (TAC), Chapter 9, Subchapter D (link is external), §9.171(a), all HCS program providers must be in continuous compliance with the HCS Program certification principles. (See §§9.172-174 and §§9.177-180.)

In accordance with 40 TAC, Chapter 9, Subchapter D, §9.171(e), WS&C may conduct announced or unannounced reviews of HCS program providers at any time to ensure compliance with the HCS program certification principles.

 

14210 Types of Certification Reviews

Revision 17-1; Effective October 16, 2017

 

WSC conducts on-site certification reviews of HCS program providers, at least annually, to evaluate evidence of the program provider’s compliance with certification principles.

Provisional Certification

A prospective provider for the HCS Program must complete an application packet and attend provider applicant training to obtain a contract with HHSC. If the applicant passes a competency exam at the end of the training, HHSC provisionally certifies the contract.

Initial Certification Review

After a program provider has obtained a provisional contract, WSC conducts an initial on-site certification review within 120 days after the date HHSC approves the enrollment or transfer of the first individual to receive HCS Program services from the provider under the provisional contract.

Annual Certification Review

An HCS program provider's certification period is for no more than 365 calendar days and must be renewed annually prior to the expiration of the current certification period.

Principles of noncompliance that were cited during the previous review visit and not corrected prior to the exit conference will be reviewed at the next annual certification or intermittent review. The provider must be in compliance with the previously cited principles by the end of the current certification period in order to be re-certified. If principles cited during the previous review remain in noncompliance at the time of the exit conference of the following review, the program provider must submit an evidence of correction (EoC) within 14 days, or another time period determined by WSC, with supporting evidence that these principles have been corrected.

30 Day Follow-Up Review, Vendor Hold and Denial of Certification

If WSC determines at the end of a review that a program provider is not in compliance with one or more of the certification principles that results in a condition of a serious nature, WSC will require the program provider to complete corrective action within 30 calendar days after the date of the review exit conference. An on-site follow-up review will be conducted after the 30-day period to determine if the program provider completed the corrective action.

If the program provider fails to correct all principles of noncompliance remaining from the 30-day follow-up review, WSC will require that an EoC is sent to the program manager showing that all principles have been corrected for the contract within 14 days or another time period determined by WSC. If the EoC is not sent in, or approved by WSC, then WSC will deny certification and recommend a vendor hold or termination of the contract.

If a vendor hold is imposed for a program provider with a provisional contract, HHSC will initiate termination of the program provider's contract in accordance with Texas Administrative Code (TAC) §49.534 (link is external), Termination of Contract by DADS.

If a vendor hold is imposed for a program provider with a standard contract, WSC will conduct a follow-up review to determine if the program provider completed the corrective action required to release the vendor hold. If the program provider completed the corrective action, HHSC will release the vendor hold. If the program provider has not completed the corrective action, WSC will deny certification and recommend termination of the contract.

See 40 TAC, Chapter 9, Subchapter D (link is external), §9.185, Program Provider Compliance and Corrective Action.

Intermittent Reviews

Intermittent reviews are conducted at the discretion of WSC and are based on:

  • complaints;
  • follow up to abuse, neglect or exploitation (ANE) allegations;
  • deaths;
  • ANE Trending Report; or
  • residential visits.

 

14220 Overview of the Home and Community-based Services Certification Review Process

Revision 17-1; Effective October 16, 2017

 

HCS program providers will generally be contacted before a certification review by the review facilitator, unless there is cause for WSC to conduct an unannounced review of the program. WSC can and may conduct unannounced certification reviews or on-site visits at any time.

When the review facilitator contacts the HCS program provider of an upcoming certification review, the facilitator will fax a copy of the Provider Information Request form to the program provider.

The facilitator will also fax Form 8576, Individual Profile Information, to the HCS program provider with a requested date for the information to be completed and returned to the review facilitator.

Entrance Conference

At the beginning of every certification review, the WSC review team will conduct an entrance conference with the program provider and any program staff who are present. The WSC review facilitator will explain the review process and summarize the tentative review schedule.

The review team will review a sample of 10% or more of the individuals in the HCS program provider's contract. The team uses standardized checklists to ensure that all principles are reviewed for compliance. These checklists can be found at https://hhs.long-term-care-providers/home-and-community-based-services-hcbs/waiver-survey-and-certification-review-tools-and-formsl.

Certification review activities include, but are not limited to:

  • talking with individuals, family members, Legally Authorized Representatives (LARs) and staff;
  • visiting homes and day habilitation sites;
  • reviewing individuals' records (including medical records);
  • reviewing personnel and staff training records;
  • reviewing financial records of the individuals for which the program provider handles finances;
  • reviewing complaint information, satisfaction surveys and Consumer Advocacy Meeting minutes;
  • reviewing information regarding any deaths, discharges (permanent or temporary over 90 days) and allegations of abuse, neglect and exploitation;
  • reviewing fire drills and emergency evacuation plans, as well as four-person home approvals and fire marshal inspections for four-person homes; and
  • reviewing critical incident data, restraints and restrictive behavior support plans.

As a part of WSC reviews, reviewers note any issues related to service coordination and forward any concerns to HHSC Contract Accountability and Oversight (CAO) for follow up. HCS program providers may view notations related to their programs in the C-97 screen of the CARE system.

The review team will hold a final debriefing at the end of the review. The program provider is allowed to submit evidence to show compliance prior to the exit conference. A citation can only be cleared if the original instance of noncompliance has been remediated, a new sample of individuals, or records, are in compliance for that principle, and the provider can show a change in process or policy that ensures no future occurrences of noncompliance.

Exit Conference

WSC conducts an exit conference at the end of all on-site reviews, at a time and location determined by WSC. WSC gives the program provider a written preliminary review report at the exit conference.

Note: If the review team determines any of the individuals enrolled in the program are in imminent danger due to a hazard that threatens their health, safety or welfare, the program provider is expected to eliminate this hazard before the end of the review exit conference. If the hazard cannot be eliminated, WSC will deny certification and coordinate with the local intellectual and development disability authority the immediate provision of alternative services for the individuals.

Informal Review

If a program provider disagrees with any of the findings in the preliminary review report, the program provider may request that HHSC conduct an informal review of those findings.

To request an informal review of any of the findings in the preliminary review report, the program provider must submit a completed Form 3610, Informal Review Request, to HHSC, as instructed on the form. HHSC must receive the completed form within seven calendar days after the date of the review exit conference. If HHSC receives a timely request for an informal review, HHSC will notify the program provider in writing of the results of the informal review within 10 calendar days of receipt of the request and send the program provider a final review report within 21 calendar days after the date of the review exit conference.

If a program provider does not request an informal review, WSC will send the program provider a final review report within 21 calendar days after the date of the review exit conference.

 

14230 Corrective Action Plan

Revision 17-1; Effective October 16, 2017

 

The program provider must submit Form 8581, Corrective Action Plan (CAP), for each HCS principle that is found out of compliance at the end of the review and is determined to be non-serious in nature. The CAP is a written plan that establishes a process by which the program provider will prevent reoccurrence of the issues that resulted in the principle being found out of compliance. The CAP must be submitted to WSC for approval. A copy of Form 8581 will be given to the provider during the review.

HHSC must receive the CAP no later than 14 calendar days following the program provider's receipt of the review report. The time line for the provider's completion of the CAP must not exceed 90 calendar days from the date of the exit conference.

If the CAP is submitted by the due date, and is approved, the provider will be certified.

If the CAP is submitted by the due date but is inadequate, the program manager will notify the program provider and offer detailed information as to why the CAP is inadequate. If the program manager is unable to assist the program provider to reach compliance within two months of the review exit, written notification that its contract may be terminated will be sent to the program provider if an approvable CAP is not received within seven days of receipt of the letter.

If the program provider does not submit a CAP as required, or HHSC does not approve the CAP, HHSC will either impose a vendor hold against the program provider until the program provider submits a corrective action plan approved by HHSC or deny certification and recommend termination of the program provider’s contract.

 

14240 Home and Community-based Services Review Checklists

Revision 17-1; Effective October 16, 2017

 

Go to https://hhs.long-term-care-providers/home-and-community-based-services-hcbs/waiver-survey-and-certification-review-tools-and-formsl to view checklists and reports used by HHSC during the certification review process.

 

14300 Texas Home Living Certification Reviews

Revision 17-1; Effective October 16, 2017

 

In accordance with 40 TAC, Chapter 9, Subchapter N (link is external), §9.576(a), all TxHmL program providers must be in continuous compliance with the TxHmL Program certification principles. See §§9.578-9.580.

Per 40 TAC, Chapter 9, Subchapter N, §9.576(e), WSC may conduct announced or unannounced reviews of TxHmL program providers at any time ensure compliance with the TxHmL program certification principles.

 

14400 Residential Visits

Revision 17-1; Effective October 16, 2017

 

Effective Sept. 1, 2009, the 81st Texas Legislature, Regular Session, required HHSC to conduct annual unannounced inspections of HCS three- and four-person residences. In addition, the legislature funded annual inspections of HCS Host Home/Companion Care residences. In accordance with 40 TAC, Chapter 9, Subchapter D (link is external), §9.171(h), HHSC WSC conducts annual unannounced visits to each residence in which Host Home/Companion Care, Residential Support Services or Supervised Living is provided to verify that these residences offer environments that comply with the Form 3609, Waiver Survey and Certification Residential Checklist. Host Home/Companion Care visits may be announced or unannounced.

 

14410 Residential Visit Policy and Procedures

Revision 17-1; Effective October 16, 2017

 

Upon arrival at the residence, a residential reviewer will present their HHSC identification to the Host Home/Companion Care provider or the staff at the three-person or four-person home and explain the reason for the visit.  The residential reviewer will also leave a business card at the residence. The residential reviewer has letters written in languages other than English to use as an introduction if arriving at a residence in which no one speaks English and the residential reviewer is unable to speak the language of the people living in the residence. The letter notes the reviewer will need to secure interpreting services through the available resource of the agency in order to interpret for the Host Home/Companion Care provider or staff at the three- or four- person home. Each residential reviewer will have a copy of the Letter of Authorization signed by the Associate Commissioner for Regulatory Services and the Director of Survey Operations. This letter explains the legislative mandates that require WSC to conduct residential visits and notes that each Host Home/Companion Care provider, supervised living staff, or residential support staff should have been informed by their HCS program provider of the residential visits that are being conducted.

See Information Letter #2009-99 at: https://apps.hhs.texas.gov/providers/communications/2009/letters/IL2009-99.pdf.

Residential reviewers use Form 3609, Waiver Survey and Certification Residential Checklist, to conduct each residential visit. Each item on the checklist should be marked yes, no or not applicable (N/A). Some of the checklist items require talking with the supervised living staff or residential support staff or the Host Home/Companion Care provider to assess knowledge of the specific needs of the individuals in the home and to confirm training on areas such as abuse, neglect, and exploitation (ANE), emergency plans, medications, behavior support plans and other required service provision areas.

Residential reviewers may take photographs to substantiate noncompliance with certification principles in the HCS and TxHmL program, when appropriate.

Residential reviewers will leave a letter with a link to an online survey for the Host Home/Companion Care giver, or provider, to give feedback about the residential visit. Providers are encouraged to share their experience so WSC can continue to work on improving the residential visit process and training for the reviewers.

If the Address in CARE is Invalid

If the residential reviewer arrives at a home that is no longer associated with the HCS Program, or cannot find the address provided for a location code in CARE, the residential reviewer will fill out Form 3609 noting the incorrect address. A letter notifying the provider of the inaccuracy in CARE will be sent to the HCS program provider's CEO.

If No One is Home

If a residential reviewer finds no one at home after two attempts to visit the home, the reviewer contacts the program provider to find out when the residential staff is most likely to be home. Residential reviewers may call Host Home providers to verify times of the week that they will be available for a residential visit.

If the Residential Reviewer Is Not Allowed to Access the Home

If a residential reviewer is not allowed access to a three-person or a four-person home or a Host Home/Companion Care home, the residential reviewer will notify the program provider for resolution. It is the program provider's responsibility to ensure that regular or contracted employees cooperate with the residential visit process.

 

14411 Residential Visit Results

Revision 17-1; Effective October 16, 2017

 

Calculating the Score from a Residential Visit

A program provider receives a score as a result of a residential visit.

  • A program provider’s score for a visit is calculated by deducting the following from 100 points (the total points on the Residential Review Checklist):
    • the total points for items on the checklist that are marked “fail” during the visit; and
    • ten points for each significant risk identified during the visit.
  • The value of each item on a checklist is calculated by dividing 100 points by the number of items on the checklist that are applicable to the visit.

Example: A residential visit of a program provider is conducted, and there are 30 items on the checklist that are applicable to the visit. During the visit, three items on the checklist are marked “fail,” and two significant risks are identified.

  • The value of each item on the checklist is calculated as follows:

100 points ÷ 30 applicable items = 3.33 points/item

  • The program provider’s score is calculated as follows:

100 points – [(3 items marked fail x 3.33) + (2 significant risks x 10)] =

100 – [9.99 + 20] =

100 – 29.99 =

70.01 (Score)

No Evidence of Correction Required and No Follow-Up Action Taken

If a program provider has no items marked “fail” on the Residential Review Checklist, WSC does not require evidence of correction (EoC) and does not conduct follow-up activities.

No Evidence of Correction Required but Follow-Up Action Taken

If a program provider receives a score of 90 or above and there is no significant risk identified during the residential visit, WSC does not require EoC to be submitted. At the next residential visit, WSC examines the items marked “fail” at the previous visit and requires EoC for any of those items that have not been corrected. If the program provider does not submit EoC as required, or WSC does not approve the EoC, WSC may conduct a certification review in accordance with 40 TAC §9.171.

Evidence of Correction Required

If a program provider receives a score below 90 or there is an identified significant risk, WSC requires EoC for all items marked “significant risk” or “fail.” WSC also requires the program provider to take immediate action or prompt action for an identified significant risk, as described below. If the program provider does not submit EoC as required, or WSC does not approve the EoC, WSC may conduct a certification review in accordance with 40 TAC §9.171.

A program provider must mail, email or fax the EoC to WSC using Form 1573, Residential Review Evidence of Correction. The reference number for the residential visit and the instructions for submission of documentation relating to the EoC, including the time frame by which WSC must receive the EoC, are included on a report HHSC mails to the provider after the residential visit. A provider must include the reference number on Form 1573. WSC will not accept EoC without the correct reference number included.

Significant Risk Identified

A significant risk is an act or failure to act by the program provider that could have a major adverse effect on the health, safety or welfare of one or more individuals, including emotional or physical harm, or death. If WSC determines that an item marked “fail” on the Residential Review Checklist results in a significant risk, WSC requires the program provider to take immediate or prompt action.

  • Immediate Action is an intervention or correction that must be taken while the residential reviewer is on-site. If WSC concludes that the significant risk requires immediate action, such as movement of one or more of the individuals from the residence, the residential reviewer will not leave the residence until the program provider has taken immediate action and the significant risk is removed.
  • Prompt Action is an intervention or correction that must be taken within 48 hours after the conclusion of the residential visit. If WSC concludes that the significant risk requires prompt action, WSC contacts the persons identified in the Client Assignment and Registration (CARE) screen C70 as the “program provider contract contacts” (the HCS provider or a representative of the HCS provider) and informs such persons of the following:
    • the significant risk requiring prompt action; and
    • the date, as determined by WSC, by which the program provider must submit evidence to WSC showing that prompt action has been taken and the significant risk removed.

 

14500 Death Reviews

Revision 17-1; Effective October 16, 2017

 

Note: See also Section 17000, Critical Incident and Death Reporting.

In accordance with 40 TAC, Chapter 9, Subchapter D (link is external), §9.178(w), HCS program providers must report the death of an individual in their HCS program to HHSC and the service coordinator by the end of the next business day following the death or the program provider's learning of the death. Form 8493, Notification Regarding a Death in HCS, TxHmL and DBMD Programs, must be faxed to WSC at 512-438-4148.  The risk assessment coordinators (RACs) collect specific information regarding the death from the program provider and may request additional records, depending on the conditions existing at the time of death. The Death Review Group (DRG), which is made up of the WSC RACs, RAC RNs and RAC manager, meets routinely to review the circumstances surrounding each death. Additional regulatory follow up, including an on-site review, may be scheduled to evaluate the program provider's compliance with HCS or Texas Home Living certification principles as the result of the DRG review.

 

14510 Death Review Policy and Procedures

Revision 17-1; Effective October 16, 2017

 

Risk assessment coordinators collect the following information:

  • Date of death
  • Provider contract number and component code
  • Person reporting the death, including contact telephone, email address and fax number
  • Individual's Client Assignment and Registration (CARE) System identification number
  • Type of setting ─ HCS, Texas Home Living (TxHmL) or Deaf Blind with Multiple Disabilities (DBMD)
  • Cause of death
  • Date provider notified of death
  • Admission date to the provider
  • Dates of hospitalizations in the last three months (if applicable)
  • Dates of hospice (if applicable)
  • If the Department of Family and Protective Services (DFPS) was notified
  • Types of residence (Family Care, 3-Person, 4-Person, Own Home or Family Home)
  • Place of death
  • Type of death (expected, unexpected, or accident)
  • Description of events surrounding the death
  • If an autopsy was ordered

Information Gathering

  • If abuse or neglect is suspected in relation to the death of the individual, the risk assessment coordinator will immediately contact DFPS.

Requests for Additional Information

The following records may be requested by the risk assessment coordinator for specified time frames, depending on the conditions existing at the time of death.

  • Most recent person directed plan and implementation plan(s)
  • Any training regarding the individual’s special needs provided to service providers
  • Last two months of medication administration records
  • Most current nursing assessment
  • Last three months of nursing notes, physician orders and lab work
  • Last three weeks of Residential Support Services, Supported Home Living, Community Support or Foster/Companion Care notes
  • Last week of day habilitation notes
  • State supported living center transition notes (if applicable)
  • Hospice notes (if applicable)
  • RN/LVN names/signature sample key

Additional documents may be requested after the initial review by the WSC risk assessment coordinator nurse.

Suspicious Deaths

If any circumstances surrounding the death are suspicious, WSC may take further actions, including, but not limited to, referral to local police departments and DFPS, completion of an intermittent certification review or referral to HHSC to pursue contract actions. The WSC director or assistant director is informed immediately of suspicious circumstances surrounding a death or if other issues of concern are noted.

Follow-up Activities

Risk assessment coordinators may conduct a desk review based on the information received from the provider, requested records and/or the information received from DFPS.

The WSC risk assessment manager may authorize an on-site visit based on the circumstances of the death, information obtained from a desk review or information obtained from DFPS. If the review team determines that the provider is in non-compliance with one or more of the HCS program certification principles during an on-site visit, an intermittent review will be opened.

 

14600 Abuse, Neglect and Exploitation Follow Up

Revision 17-1; Effective October 16, 2017

 

WSC receives investigative reports related to allegations of abuse, neglect or exploitation of individuals who receive HCS, TxHmL or ICF/ID program services. The reports are reviewed by WSC risk assessment coordinators to determine whether regulatory follow-up is required. Additional documentation may be requested from the program provider to verify that the program provider managed the allegation of abuse, neglect and exploitation according to program standards. In addition, on-site follow up may be scheduled.

 

14610 Abuse, Neglect and Exploitation Policy and Procedures

Revision 17-1; Effective October 16, 2017

 

The final HHSC report is reviewed by risk assessment coordinators (RACs) to determine what actions are to be taken by WSC. Actions to be taken are determined by:

  • the severity of the allegation;
  • the disposition of the allegation;
  • the concerns/recommendations of the investigator; and
  • indicators of non-compliance noted by the risk assessment coordinators during the review of the final report narrative.

HHSC sends a final report to the program provider, unless the administrator and the secondary designee are the alleged perpetrator. The program provider has 14 calendar days from the receipt of the investigation findings to notify WSC of its response to the findings by submitting Form 8494, Notification Regarding a Death in HCS, TxHmL and DBMD Programs, by fax to 512-438-4148. Form 8494 should include:

  • the provider name;
  • contract number;
  • component code;
  • date submitted to WSC;
  • who submitted the form, as well as area code and phone number and fax;
  • DFPS case number;
  • date the DFPS report was received;
  • Client Assignment and Registration (CARE) System ID number;
  • date of allegation;
  • type of allegation;
  • disposition of allegation;
  • concurrence with the disposition;
  • what actions were taken by the provider; and
  • if the provider will be requesting a methodological review or a review of the finding.

The provider is responsible for attaching documentation when submitting Form 8494 to include a response for how the provider handled any confirmed allegations or HHSC concerns or recommendations.

When deemed serious, WSC receives the intake report from Consumer Rights and Services, and it is reviewed by the risk assessment coordinators to determine what actions are to be taken by WSC. Actions to be taken are determined by:

  • the severity of the allegation;
  • whether the individual or the alleged perpetrator has been involved in multiple prior allegations; and
  • whether the program provider has had multiple recent intakes or investigations.

One of the following actions is taken by WSC:

  • Desk review – A desk review is conducted if there is low risk to the individual(s). The determination of low risk is made if the allegation does not pose a risk to the health or safety of the individual(s) served.
  • On-site visit – On-site visits are conducted if it is determined that significant risk exists for one or more individuals. RACs review the allegation with the WSC risk assessment manager, assistant director, and director or designee prior to scheduling an on-site visit.

 

14700 Additional Monitoring Related to Risk Factors

Revision 17-1; Effective October 16, 2017

 

Each quarter, risk assessment coordinators (RACs) compile a report of risk factors for all HCS and Texas Home Living (TxHmL) waiver contracts. This risk factor report includes:

  • number of confirmed abuse/neglect/exploitation allegations entered into the abuse/neglect database that meet or exceed 5% of all confirmed findings out of the total number of allegations for contract;
  • number of complaints entered into the complaint database; and
  • number of deaths of individuals entered into the death database.

The RACs assess the circumstances related to the identified contracts reflected in this report for two quarters in the last calendar year. If they identify patterns or trends that indicate a possible increased risk to the health, safety or welfare of the individuals in this contract, follow-up actions are taken.

 

14800 Complaints

Revision 17-1; Effective October 16, 2017

 

HHSC Consumer Rights and Services refers complaints to the WSC risk assessment coordinators when the complaint is related to non-compliance with the HCS or TxHmL certification principles. HHSC departments refer internal complaints or concerns directly to the WSC risk assessment manager. The complaints are reviewed by the coordinators and appropriate follow-up actions are identified and completed.

 

14810 Complaints Policy and Procedures

Revision 17-1; October 16, 2017

 

If WSC staff receive a complaint from an external complainant, the person making the complaint should be immediately referred to Consumer Rights and Services at 512-438-9858.  

Consumer Rights and Services tries to resolve the complaint with the external complainant and the program provider. If the complaint cannot be resolved and it impacts the HCS principles, Consumer Rights and Services will refer it to WSC. The complaint is received by the risk assessment coordinators, who review it to determine what actions are to be taken by WSC. The actions are determined by:

  • severity of the complaint; and
  • number and severity of other complaints received about that contract.

Actions to be taken by WSC are:

  • Enter the complaint into the complaint database, for follow up on the next certification review.
  • Desk Review – A desk review is conducted if there is low risk to the individual(s). The determination of low risk is made if the complaint did not involve issues that relate to the health or safety of the individual(s) served or if initial contact with the program provider indicates the situation has been satisfactorily resolved.
  • On-site visits are conducted if it is determined that significant risk exists for one or more individuals. Risk assessment coordinators review the complaint with the risk assessment manager or designee prior to scheduling an on-site visit.

 

14900 Four-Person Home Approvals

Revision 17-1; Effective October 16, 2017

 

Home and Community-based Services (HCS) providers must request and obtain approval of all four-person residences from HHSC. WSC Residential Review coordinators are responsible for reviewing and approving all four-person home requests in accordance with 40 TAC, Chapter 9, Subchapter D (link is external), §9.188.

 

14910 Four-Person Home Approval Policy and Procedures

Revision 17-1; Effective October 16, 2017

 

To obtain approval of a four-person residence, the program provider must complete the following steps:

Complete Form 8491, Request for a Four-Person Residence Approval, and email waiversurvey.certification@HHSC.state.tx.us or mail the completed form to:  

Texas Health and Human Services Commission
WSC Residential Review Coordinators, Mail Code E-348
P.O. Box 149030
Austin, TX 78714-9030

Include the following information:

  1. For a new home, enter information into the Client Assignment and Registration System (CARE) Screen C25 Provider Location Type Modification (two screens).
    • Header Screen (first screen) – Enter the Component Code, Location Code, "A" for Add and press enter.
    • Data Entry Screen (second screen) – Cursor will be blinking at Location Type; enter "4"; cursor will move to the next line; enter the effective date. The cursor then moves to "Ready to Add?" Enter "Y" and press enter.
  2. Establish location in CARE Screen C24 Provider Location (for new homes only). Refer to the User's Guide for data entry questions: http://www2.mhmr.state.tx.us/655/cis/training/WaiverGuide.html (link is external) (Note: The CARE User's Guide is only available for those with access to the CARE system.)
  3. Send a letter to:
  • Current date;
  • Name of the agency;
  • Contact person and area code and phone number;
  • Component code and contract number;
  • Location code for the home;
  • Address and county of the residence (including the ZIP code);
  • Certification from the program provider that the program provider intends to provide residential support to one or more individuals who will live in the residence; and
  • Written certification from the program provider that the residence to be approved is not the residence of any person except a person permitted to live in the residence, as described in 40 TAC, Chapter 9, Subchapter D (link is external), §9.153(20), relating to definitions.
  1. Indicate that the home is certified (per certifications required by 40 TAC, Chapter 9, Subchapter D (link is external), §9.178(e)(1)(A), relating to certification principles and quality assurance) by:
    • the local fire safety authority having jurisdiction in the location of the residence as being in compliance with the applicable portions of the National Fire Protection Association (NFPA) 101: Life Safety Code, as determined by the local fire safety authority;
    • the local fire safety authority having jurisdiction in the location of the residence as being in compliance with the applicable portions of the International Fire Code (IFC), as determined by the local fire safety authority; or
    • the Texas State Fire Marshal’s Office as being in compliance with the applicable portions of the Life Safety Code, as determined by the Texas State Fire Marshal’s Office; or
    • the Texas Health and Human Services Commission (HHSC) as being in compliance with the portions of the Life Safety Code applicable to small residential board and care facilities and most recently adopted by the Texas Fire Marshal’s Office.

The program provider may ask the local fire authority to complete Form 5606, Life Safety Code Certification, to verify the inspection, if needed.

If the local fire authority refuses to inspect the home, the program provider must ask the State Fire Marshal to inspect the home. If both the local fire authority and the State Fire Marshal refuse to inspect the home, a request may be made to HHSC to complete the inspection. Program providers must use Form 5604, HCS Program Provider Request for Life Safety Inspection, to request the inspection.

After initial full approval of a four-person home, the program provider is required to maintain annual fire marshal certifications required by 40 TAC §9.178(e)(1)(A) in order to maintain HHSC approval of the home. The certifications must remain current and the provider must adhere to the requirements outlined in 40 TAC §9.178(e)(1)(A).

The HCS program provider can check CARE screen C84 to see if the home has been approved.

For questions, contact HHSC Regulatory Services, Waiver Survey and Certification, at 512-438-4163 or email waiversurvey.certification@HHSC.state.tx.us.