Revision 14-1; Effective June 9, 2014

 

 

6100 Overview of the IPC

Revision 11-2; Effective March 1, 2011

 

The individual plan of care (IPC) documents an individual's Home and Community-based Services (HCS) program services and non-HCS services. An IPC is completed at the time an individual enrolls in the HCS program and is valid for 365 days (the IPC year), as long as the individual remains eligible for HCS. An IPC must be renewed prior to the current IPC end date and may be revised at any time during the IPC year if changes are needed. A transfer IPC is completed if an individual changes to another HCS contract or chooses a different service delivery option (meaning Consumer Directed Services is added or removed as a service delivery option).

The IPC is entered in CARE using one of the following users' guides:

The HCS services listed on the IPC are based on the individual's person-directed plan (PDP) and must be supported by documentation in the PDP that other sources for the service are unavailable and the service does not replace existing supports, including natural supports or other sources for the service. The services must be necessary for the individual to live in the community, to ensure the individual's health, safety and welfare in the community, and to prevent the need for institutional services.

See Section 4000, Person-Directed Plan, for more information on the PDP, and Form 8665, Person-Directed Plan, and instructions.

An IPC is developed during the IPC meeting by:

  • the service planning team (SPT), which consists of the individual/legally authorized representative (LAR), the service coordinator (SC) and any other person invited by the individual/LAR; and
  • the program provider.

 

6110 IPC Form and Instructions

Revision 11-2; Effective March 1, 2011

 

Review Form 3608, Individual Plan of Care (IPC) – HCS/CFC, and instructions before completing the form.

 

6120 IPC Begin, End and Effective Dates

Revision 11-2; Effective March 1, 2011

 

Each IPC has an IPC begin date, an IPC end date and an IPC effective date.

The IPC begin date is the first day of the IPC year.

The IPC end date is 365 days after the IPC begin date. In most cases, an individual's IPC will renew on the same date every year, with leap year being the exception since the IPC is valid for 365 days, not one calendar year. (Note: If there is a gap between the current IPC end date and the renewal IPC meeting date, the provider will not be authorized to bill for services provided to the individual during that gap.)

The IPC begin date and IPC effective date are the same date for an initial IPC and a renewal IPC. If the IPC is revised, the date of the IPC revision then becomes the new IPC effective date, but the IPC begin date and IPC end date do not change.

 

6130 IPC Meeting

Revision 11-2; Effective March 1, 2011

 

An IPC meeting occurs when the SPT and the provider meet at the same time, either in person or by telephone, to review the individual's PDP and to discuss and identify necessary units of HCS and non-HCS services to support PDP outcomes. It is important that all parties be able to communicate and discuss openly with one another during the IPC meeting. In most instances, an IPC meeting is necessary to develop the IPC. The exceptions are for an IPC revision to increase or decrease an existing HCS service and for an IPC to add/change a requisition fee only.

 

6140 IPC Types

Revision 11-2; Effective March 1, 2011

 

A new IPC form is completed at designated events. The event determines the IPC type, which are:

  • initial IPC;
  • renewal IPC;
  • IPC revision; and
  • transfer IPC.

The IPC types are described in the following sections.

 

6150 Consumer Directed Services (CDS) and IPCs

Revision 11-2; Effective March 1, 2011

 

If the individual uses the CDS option, the SC is responsible for:

  • ensuring that those HCS services that are self-directed are included on the IPC any time an IPC is completed; and
  • assisting the employer (i.e., individual or LAR) with developing justification for the amount of HCS services on the IPC that are self-directed, if requested by the employer.

If an individual only uses the CDS option and does not have a program provider, the Local Authority (LA) is responsible for entering the IPC into CARE.

The SC sends a copy of the completed Form 3608 to the CDS agency.

 

6160 Department of Aging and Disability Services (DADS) Role

Revision 11-2; Effective March 1, 2011

 

DADS will continue to authorize, reduce or deny services on an individual's IPC. The SC's agreement or disagreement with the IPC does not ensure a specific action will be taken by DADS Program Enrollment (PE). The SC may be used as an informant if DADS PE determines an IPC utilization review is necessary.

 

6200 Initial (Enrollment) IPC

Revision 11-2; Effective March 1, 2011

 

 

6210 Initial (Enrollment) IPC Overview

Revision 11-2; Effective March 1, 2011

 

The initial IPC is completed by the Local Authority (LA) before an individual is enrolled in the HCS program.

An LA service coordinator meets with the individual and others who know the individual to develop the PDP. This document describes the individual's desired outcomes and is the basis for determining the HCS service components on the initial IPC.

The service components and amount of each service included on the initial IPC are determined from discussions with:

  • the individual;
  • the individual's LAR (if an LAR exists);
  • any other persons the individual/LAR chooses to be involved;
  • the LA service coordinator who is completing the enrollment activities; and
  • the program provider selected by the individual or the LAR on the individual's behalf.

 

6220 Local Authority (LA) and Service Coordinator Responsibilities for Initial IPC

Revision 11-2; Effective March 1, 2011

 

 

6221 IPC Meeting to Develop Initial IPC

Revision 11-2; Effective March 1, 2011

 

After the SPT has developed the PDP, including the "Justifications for Waiver Services and Supports" section of the PDP, the SC schedules an IPC meeting with the provider and SPT to develop the initial IPC.

 

6222 Initial IPC Effective Date

Revision 11-2; Effective March 1, 2011

 

The initial IPC effective date is the same as the IPC begin date. The IPC meeting must be held on or before the IPC effective date. Services provided prior to the initial IPC effective date may not be reimbursed.

 

6223 Units of Service

Revision 11-2; Effective March 1, 2011

 

The SC brings to the IPC meeting justification for units of the services identified on the individual's PDP.

  • Some service components, such as residential support services, supervised living and foster/companion care, are daily services and the total number of days will equal the days in the IPC year (i.e., 365).
  • If the individual participates in day habilitation full time (i.e., six hours a day, five days a week), the typical number of days of attendance is approximately 250. This allows for days off for major holidays and those days when day habilitation is not available for the individual.
  • Amounts of some services (e.g., nursing and therapy) may only include the number of units needed to complete an assessment, the results of which will determine the recommend number of hours/units.
  • Determining the number of hours of a service such as supported home living (SHL) requires additional planning. To determine the appropriate number of hours of SHL, the HCS provider, the individual/LAR and others, as appropriate, identify those tasks that require assistance and the estimated frequency and duration of these tasks. Developing a schedule is helpful to determine the appropriate number of SHL units.

 

6224 Non-HCS Services

Revision 11-2; Effective March 1, 2011

 

The SC includes all non-HCS services the individual is receiving (and will be receiving) on the IPC form for the initial IPC.

 

6225 Initial IPC Signatures and Signature Dates

Revision 11-2; Effective March 1, 2011

 

The SC signs and dates the initial IPC and is responsible for obtaining the signature and date of the provider representative and individual/LAR. The date must be the date the IPC meeting occurred. If present, the individual/LAR and SC sign and date on the appropriate lines of the form. If the LAR participates by phone, the SC checks the box to indicate such and enters the date the LAR participated in the IPC meeting. The SC then sends a copy of the form for the LAR's signature.

 

6226 Transmission of Initial IPC

Revision 11-2; Effective March 1, 2011

 

The LA enters the initial IPC in CARE as part of completing an individual's enrollment activities. The SC ensures the individual/LAR and provider receive a copy of the IPC.

 

6230 Provider Responsibilities for Initial IPC

Revision 11-2; Effective March 1, 2011

 

For an initial IPC, the SC contacts the provider to schedule an IPC meeting. The provider attends the IPC meeting, participates in the development of the initial IPC, and signs and dates the initial IPC. The provider's signature date on the initial IPC must be the date of the IPC meeting.

 

6300 Renewal IPC

Revision 11-2; Effective March 1, 2011

 

 

6310 Renewal IPC Overview

Revision 14-1; Effective June 9, 2014

 

The rules governing the HCS Program (Title 40, Texas Administrative Code (TAC), Chapter 9, Subchapter D) direct the SC to notify the service planning team that the individual’s PDP must be reviewed and updated at least 60 but no more than 90 calendar days before the expiration of the individual's IPC. The SC is responsible for arranging for the SPT to review and update the individual's PDP.

The LA may use CARE screen L64 to generate a list of individuals whose IPCs will expire by a specific date (for example, a date 90 days in the future). After the SPT reviews and updates the PDP, the SC ensures that the program provider has a copy of the individual's current PDP. The provider schedules an IPC meeting with the SPT to develop a renewal IPC.

Although the provider representative is responsible for completing the renewal IPC (Form 3608), the SC is responsible for completing the portions related to CDS, if applicable, and non-HCS services.

 

6320 Provider Responsibilities for Renewal IPC

Revision 14-1; Effective June 9, 2014

 

 

6321 IPC Meeting to Develop Renewal IPC

Revision 14-1; Effective June 9, 2014

 

The provider schedules an IPC meeting to occur no later than 30 days before the current IPC end date to develop the renewal IPC.

 

6322 Renewal IPC Effective Date

Revision 14-1; Effective June 9, 2014

 

The renewal IPC effective date is the same as the IPC begin date. The IPC meeting must be held on or before the IPC effective date. The IPC effective date may not be before the IPC meeting date.

 

6323 Units of Service

Revision 14-1; Effective June 9, 2014

 

The provider brings to the IPC meeting justification for units of the services identified on the individual's PDP.

  • Some service components, such as Residential Support Services, Supervised Living and foster/companion care, are daily services and the total number of days will equal the days in the IPC year (i.e., 365).
  • If the individual participates in day habilitation full time (i.e., six hours a day, five days a week), the typical number of days of attendance is approximately 250. This allows for days off for major holidays and those days when day habilitation is not available for the individual.
  • Amounts of some services may be determined by an assessment completed by a health care professional providing the service.
  • Determining the number of hours of a service such as SHL requires additional planning. To determine the appropriate number of hours of SHL, the HCS provider, the individual/LAR and others, as appropriate, identify those tasks that require assistance and the estimated frequency and duration of these tasks. Developing a schedule is helpful to determine the appropriate number of SHL units.

 

6324 Renewal IPC Signatures and Signature Dates

Revision 14-1; Effective June 9, 2014

 

The provider representative signs and dates the renewal IPC on the day of the IPC meeting and is responsible for obtaining the signature of the individual/LAR. If present, the individual/LAR and SC sign and date on the appropriate lines of the form. If the LAR participates by phone, the provider checks the box to indicate such and enters the date the LAR participated in the IPC meeting. The provider then sends a copy of the form for the LAR's signature.

If the SC participates in the IPC meeting by phone, the provider enters "participated by phone" on the SC's signature line, prints the name of the SC on the appropriate line and enters the date the SC participated.

 

6325 Transmission of Renewal IPC

Revision 14-1; Effective June 9, 2014

 

The provider enters the IPC into CARE on or before the IPC begin date and ensures that the SC has a hard copy of the IPC (Form 3608) within three days after entering the IPC in CARE.

 

6330 Service Coordinator Responsibilities for Renewal IPC

Revision 14-1; Effective June 9, 2014

 

The SC participates in the renewal IPC meeting that is scheduled by the provider. This is done after the SPT has reviewed and updated the PDP, in accordance with Section 2151, Individual Plan of Care Renewal.

The SC is not required to provide justification for the amount of HCS services on the renewal IPC; this is the responsibility of the HCS program provider. Neither is the SC responsible for conducting utilization review activities.

If the individual has chosen to self-direct SHL or respite through CDS, the SC includes the units necessary to address the PDP outcome(s) in the CDS section of the IPC as determined by the employer.

 

6331 Non-HCS Services

Revision 11-2; Effective March 1, 2011

 

The SC ensures all non-HCS services the individual is receiving are included on the IPC form.

 

6400 IPC Revision

Revision 11-2; Effective March 1, 2011

 

6410 IPC Revision Overview

Revision 11-2; Effective March 1, 2011

 

Either the HCS program provider or the SC may determine that a revision to an individual's IPC is necessary. An IPC revision may be necessary due to a change in the individual's needs, a change in the type of residential services or a miscalculation of units necessary to meet the individual's needs. The provider or the SC notifies the other as soon as possible that services included in the individual's IPC must be added, deleted, increased or decreased.

The provider completes a new IPC (Form 3608) for an IPC revision in accordance with the instructions. The exception is when only a CDS service needs to be revised, in which case the SC completes the IPC for the IPC revision. The form must always include the service units for the entire year, including the services being revised.

An IPC revision may or may not require an IPC meeting.

 

6411 Provider Responsibilities for IPC Revision

Revision 11-2; Effective March 1, 2011

 

If the provider determines that an individual's services on the IPC need to be revised, they must first determine:

  • if the revision reflects a PDP change, such as adding or deleting an HCS service;
  • if the revision increases or decreases an existing HCS service and is supported by a current outcome in the PDP; or
  • if the revision adds or changes a requisition fee only.

Once this determination is made, the provider follows the procedures associated with the appropriate type of IPC revision as described in Section 6420, Section 6430 or Section 6440.

 

6412 Service Coordinator Responsibilities for IPC Revision

Revision 11-2; Effective March 1, 2011

 

If the SC becomes aware of a need to revise an individual's IPC, the SC:

  • notifies the provider as soon as possible;
  • schedules an IPC meeting with the provider to discuss the reason for the revision; and
  • develops a revised IPC.

If only a CDS service needs to be revised, the SC meets with the individual/LAR to develop the revised IPC.

If the provider initiates the IPC revision, the provider notifies the SC by:

  • scheduling an IPC meeting to discuss the reason for the revision and to develop a revised IPC; or
  • submitting to the SC by fax or email a revised IPC (Form 3608) that only increases/decreases an existing HCS service (must reflect a current outcome on the individual's PDP).

If the IPC revision adds or changes a requisition fee only, the provider does not notify the SC.

The SC is not required to provide justification for the amount of HCS services on the revised IPC; this is the responsibility of the HCS program provider. Neither is the SC responsible for conducting utilization review activities.

 

6420 IPC Revision to Reflect PDP Change

Revision 11-2; Effective March 1, 2011

 

If the IPC revision will reflect a PDP change, such as adding or deleting an HCS service or increasing or decreasing an existing HCS service that requires a new PDP outcome, an IPC meeting is necessary to discuss the reason(s) for the revision and to develop the IPC revision.

Further, if the IPC revision is in response to the emergency provision of services as allowed by 40 TAC 9.166(d), the provider ensures documentation supporting such emergency provision of services meets the definition of "emergency" in the HCS rule.

 

6421 Provider Responsibilities for IPC Revision That Reflects a PDP Change

Revision 11-2; Effective March 1, 2011

 

If the revision reflects a PDP change, the provider schedules an IPC meeting with the SPT to discuss the reason(s) for the revision and to develop the IPC.

Further, if the IPC revision is in response to the emergency provision of services as allowed by 40 TAC 9.166(d), the provider ensures documentation supporting such emergency provision of services meets the definition of "emergency" in the HCS rule. (The definition of "emergency" is an unexpected situation in which the absence of an immediate response [i.e., adding or increasing an HCS service] could reasonably be expected to result in risk to the health and safety of an individual or another person.)

 

6421.1 IPC Effective Date for IPC Revision That Reflects a PDP Change

Revision 11-2; Effective March 1, 2011

 

Except for the emergency provision of services, the IPC effective date may only be on or after the date of the IPC meeting; it may not be before the IPC meeting date.

For an IPC revision for the emergency provision of services, the effective date is the date of the emergency provision of services.

If the IPC revision is due to a change in the type of residential services, the IPC effective date must be the date the individual begins receiving the new residential service.

 

6421.2 Signatures and Signature Dates for IPC Revision That Reflects a PDP Change

Revision 11-2; Effective March 1, 2011

 

The provider representative signs and dates the IPC revision on the day of the IPC meeting and is responsible for obtaining the signature of the individual/LAR. If present, the individual/LAR and SC sign and date on the appropriate lines of the form. If the LAR participates by phone, the provider checks the box to indicate such and enters the date the LAR participated in the IPC meeting. The provider then sends a copy of the form for the LAR's signature.

If the SC participates in the IPC meeting by phone, the provider enters "participated by phone" on the SC's signature line, prints the name of the SC on the appropriate line and enters the date.

 

6421.3 Transmission of IPC Revision That Reflects a PDP Change

Revision 11-2; Effective March 1, 2011

 

Except for the emergency provision of services, the provider enters the completed IPC in CARE. Within three days after data entry, the provider ensures the SC has a hard copy of the IPC.

  • For the emergency provision of services, the provider faxes the completed hard copy of Form 3608 to DADS PE, along with documentation of:
    • the circumstances that necessitated providing the new HCS service or the increase in the amount of the existing HCS service; and
    • the type and amount of the service provided.
  • Within three days after faxing the form to DADS PE, the provider ensures the SC has a hard copy of the completed IPC Form 3608.

 

6421.4 Activity Following Transmission of IPC Revision That Reflects a PDP Change

Revision 11-2; Effective March 1, 2011

 

The provider revises the implementation plan to be consistent with the IPC revision.

 

6422 Service Coordinator Responsibilities for IPC Revision That Reflects a PDP Change

Revision 11-2; Effective March 1, 2011

 

If the revision reflects a PDP change, such as adding or deleting an HCS service or increasing or decreasing an existing HCS service that requires a new PDP outcome, then the IPC revision requires an IPC meeting. In this situation, the provider is responsible for scheduling an IPC meeting to discuss and develop the IPC revision. The SC is responsible for making reasonable efforts to be available in a timely manner for the IPC meeting.

The SPT ensures the PDP is consistent with the IPC revision.

 

6430 Revision to Increase/Decrease an Existing HCS Service

Revision 12-1; Effective January 16, 2012

 

If the IPC revision is to increase/decrease an existing HCS service and is supported by a current outcome in the PDP, an IPC meeting is not necessary.

For the purposes of this type of IPC revision, service components related to nursing (i.e., RN, RN specialized, LVN and LVN specialized) are all considered "nursing" services. Therefore, any of the four components may be added, increased or decreased in accordance with this section as long as at least one of the components is on the current IPC and the IPC revision does not reflect a PDP change.

The provider completes the IPC (Form 3608) in accordance with the form's instructions. The provider obtains the individual/LAR's agreement by signature and notifies the SC of the IPC revision by submitting a hard copy of the completed Form 3608 by fax or email to the SC on the same day that the provider enters the SC's signature date on the form. (Each Local Authority and provider should determine the preferred method of notifying the SC, either fax or email.) A phone call or voice message to the SC is not adequate notification.

If the SC agrees with the IPC revision and that an IPC meeting is not required, the SC:

  • checks the appropriate box in the Service Coordinator Response section of the form;
  • signs and prints his/her name; and
  • returns the completed Form 3608 to the provider within two business days after the provider sent it to the SC.

The SC also reviews the electronically transmitted IPC in CARE in accordance with Section 6600, Service Coordinator Review Process.

If the SC determines further discussion is necessary, the SC contacts the provider as soon as possible to discuss concerns. If no consensus can be reached after this discussion, the SC checks the box indicating an IPC meeting is needed and returns the completed Form 3608 to the provider within two business days after receiving the form from the provider. The SC is responsible for scheduling the IPC meeting to occur as soon as possible, but no later than 14 calendar days after the provider sent the IPC revision to the SC.

Specific instructions for the provider to notify the SC of the need for a revision and the SC's response can be found in the instructions for Form 3608.

 

6431 Provider Responsibilities for IPC Revision to Increase/Decrease an Existing HCS Service

Revision 11-2; Effective March 1, 2011

 

If the IPC revision increases or decreases an existing HCS service and is supported by a current outcome in the PDP, an IPC meeting is not necessary.

Note: The provider meets with the individual/LAR to discuss the reason for an IPC revision and obtain the individual/LAR's agreement when an IPC meeting is not held.

The provider completes IPC Form 3608 in accordance with the form's instructions, indicating that no meeting is required, noting the reason for the increase/decrease and making the change(s) to the service units. (The service component(s) being revised are identified with an "I" or "D" for increased or decreased.) It is important that the provider state a reason for the revision on Page 1 of Form 3608 and indicate which current outcome in the PDP supports the service component(s) being revised.

The provider obtains the individual/LAR's agreement by signature. The provider notifies the SC of the IPC revision by faxing or emailing the completed Form 3608 to the SC on the same day that the provider enters the SC's signature date on the form. A phone call or voice message to the SC is not adequate notification.

 

6431.1 IPC Effective Date for IPC Revision to Increase/Decrease an Existing HCS Service

Revision 11-2; Effective March 1, 2011

 

Since the IPC revision does not require an IPC meeting, the IPC effective date may only be on or after the date the provider notifies the SC by faxing or emailing the completed Form 3608 to the SC.

 

6431.2 Signatures and Signature Dates for IPC Revision to Increase/Decrease an Existing HCS Service

Revision 11-2; Effective March 1, 2011

 

The provider representative signs and dates the revision IPC and obtains the signature of the individual/LAR after discussion and agreement. If the agreement is in person, the individual/LAR signs, prints their name and enters date of agreement. If the individual/LAR agrees by phone, the provider checks the box and enters date of agreement. The provider sends a copy of the form for the individual's/LAR's signature.

The provider writes "notified SC" on the SC signature line, prints the SC's name and enters the date the form was faxed or emailed to the SC. (Faxing or emailing the form to the SC serves as notification of an IPC revision that does not require an IPC meeting.)

Note: If the individual/LAR agrees by phone and the provider sends a copy of the form for signature, the provider may notify the SC of the revision prior to receiving the individual's/LAR's signature.

 

6431.3 Transmission of IPC Revision to Increase/Decrease an Existing HCS Service

Revision 11-2; Effective March 1, 2011

 

The provider may enter the revised IPC in CARE after faxing or emailing IPC Form 3608 to the SC. The provider does not have to wait for the SC to reply before entering the revision into CARE.

However, if the IPC is already entered and the SC determines that an IPC meeting is needed, the SC returns the IPC to the provider in CARE during the SC's required review of the IPC.

 

6431.4 Activity Following Transmission of IPC Revision to Increase/Decrease an Existing HCS Service

Revision 11-2; Effective March 1, 2011

 

If the SC responds by checking the box indicating agreement with the IPC revision, the provider revises the implementation plan to be consistent with the IPC revision.

If the SC responds by checking the box indicating that an IPC meeting is needed, the provider:

  • follows the procedures in Section 6420 for revising an IPC; and
  • deletes the IPC in CARE that is in return status.

 

6432 Service Coordinator Responsibilities for IPC Revision to Increase/Decrease Existing HCS Service

Revision 11-2; Effective March 1, 2011

 

If the IPC revision is to increase/decrease an existing HCS service and is supported by a current outcome in the PDP, the provider completes the IPC (Form 3608) in accordance with the form's instructions. The provider notifies the SC of the IPC revision by submitting the completed Form 3608 to the SC by fax or email. The SC responds within two business days to the IPC revision by completing the "Service Coordinator Response" section on the bottom of Page 2 of the IPC form.

 

6432.1 Service Coordinator Response Section of Form 3608

Revision 11-2; Effective March 1, 2011

 

If the SC receives an IPC revision on Form 3608 by fax or email with "notified SC" on the SC's signature line, the SC immediately reviews the form to ensure:

  • the reason for the increase/decrease stated by the provider on Page 1 of the form is supported by a current outcome in the individual PDP;
  • the service type is an existing HCS service; and
  • the IPC effective date is in accordance with the requirements in Section 6431.1.

 

6432.2 If Service Coordinator Agrees with IPC Revision to Increase/Decrease Existing HCS Service

Revision 11-2; Effective March 1, 2011

 

If the SC agrees with the IPC revision and that an IPC meeting is not required, the SC:

  • checks the box stating such, and signs and prints their name at the bottom of Page 2 of the form in the "Service Coordinator Response" section; and
  • faxes or emails the form to the provider within two business day after the provider sent it to the SC.

 

6432.3 If Service Coordinator Has Concerns with IPC Revision to Increase/Decrease Existing HCS Service

Revision 11-2; Effective March 1, 2011

 

If the SC has concerns with the reason for the revision, believes a PDP update is necessary or has some reason to believe that the revision is not in accordance with the individual's/LAR's desired outcomes, the SC immediately contacts the provider to discuss concerns.

If the SC's concerns are resolved after contacting the provider and the SC agrees with the IPC revision and that an IPC meeting is not required, the SC follows the procedures described in Section 6432.2.

 

6432.4 Service Coordinator Determines IPC Meeting is Needed

Revision 11-2; Effective March 1, 2011

 

If the SC continues to have concerns after contacting the provider and determines that an IPC meeting is needed, the SC:

  • checks the box stating such, and signs and prints their name at the bottom of Page 2 of the form in the "Service Coordinator Response" section;
  • faxes or emails the form to the provider within two business days after the provider sent it to the SC; and
  • schedules an IPC meeting to occur as soon as possible but no later than 14 calendar days after the provider faxed or emailed the IPC revision to the SC.

 

6440 Revision to Add/Change Requisition Fee Only

Revision 11-2; Effective March 1, 2011

 

If the IPC revision is to add/change a requisition fee only, an IPC meeting is not necessary and the provider is not required to obtain agreement from the individual/LAR.

 

6441 Provider Responsibilities for IPC Revision to Add/Change a Requisition Fee Only

Revision 11-2; Effective March 1, 2011

 

If the IPC revision is to add/change a requisition fee only, the provider completes a new Form 3608 in accordance with the form's instructions, indicating that the IPC revision is to add/change a requisition fee only.

 

6441.1 IPC Effective Date for IPC Revision to Add/Change a Requisition Fee Only

Revision 11-2; Effective March 1, 2011

 

The IPC effective date is the date the provider completes the form.

 

6441.2 Signatures and Signature Dates for IPC Revision to Add/Change a Requisition Fee Only

Revision 11-2; Effective March 1, 2011

 

The provider representative completing the form signs and dates the form. On the individual's/LAR's signature line and the SC's signature line, the provider enters "requisition fee only" and enters the IPC effective date as the signature date.

 

6441.3 Transmission of IPC Revision to Add/Change a Requisition Fee Only

Revision 11-2; Effective March 1, 2011

 

The provider enters the IPC revision in CARE and within three days after data entry the provider ensures the SC has a hard copy of the IPC revision. Note: The IPC will not be sent to the SC for review in CARE. It will go straight to DADS for authorization.

 

6442 Service Coordinator Responsibilities for IPC Revision to Add/Change a Requisition Fee Only

Revision 11-2; Effective March 1, 2011

 

The SC has no responsibilities for an IPC revision to add/change a requisition fee only.

 

6500 Transfer IPC

Revision 11-2; Effective March 1, 2011

 

 

6510 Transfer IPC Overview

Revision 11-2; Effective March 1, 2011

 

If an individual wishes to transfer to another provider agency or a different contract within the same provider agency or change service delivery options (that is, add or remove CDS), a transfer IPC must be completed. The SC is responsible for completing the transfer IPC. The SPT and receiving provider hold an IPC meeting to develop the transfer IPC, which must include services already provided by the transferring provider as well as those to be provided by the receiving provider.

See Section 8000, Transfers and Local Authority (LA) Reassignments, for specific procedures related to transfers.

 

6520 Local Authority (LA) and Service Coordinator Responsibilities for Transfer IPC

Revision 11-2; Effective March 1, 2011

 

 

6521 IPC Meeting to Develop Transfer IPC

Revision 11-2; Effective March 1, 2011

 

The SC schedules and conducts an IPC meeting with the SPT and receiving provider to develop the transfer IPC. The SC is responsible for completing a new Form 3608. The SC invites the transferring provider to the transfer IPC meeting, but its participation is optional. The receiving provider's participation in the transfer IPC meeting is required.

The SC ensures that the transfer IPC includes all services provided by the transferring provider, as well as those to be provided by the receiving provider.

 

6522 Transfer IPC Effective Date

Revision 11-2; Effective March 1, 2011

 

Except for an emergency transfer (see Section 6525), the IPC effective date of a transfer IPC may only be on or after the date of the IPC meeting; it may not be before the IPC meeting date. The receiving provider will not be reimbursed for services provided prior to the IPC effective date.

 

6523 Transfer IPC Signatures and Signature Dates

Revision 11-2; Effective March 1, 2011

 

The SC is responsible for obtaining the signature and date of the receiving provider on the day of the IPC meeting on the transfer IPC. The SC is also responsible for obtaining the signature of the individual/LAR on the transfer IPC. If present, the individual/LAR signs and dates on the appropriate lines of the form. If the LAR participates by phone, the SC checks the box to indicate such and enters the date the LAR participated in the IPC meeting. The SC then sends a copy of the form for the LAR's signature.

 

6524 Transmission of Transfer IPC

Revision 11-2; Effective March 1, 2011

 

The LA enters the transfer IPC in CARE and faxes a copy to DADS PE. The SC ensures that the receiving provider has a hard copy of the completed IPC Form 3608.

If the LA is unable to complete the data entry, it sends a secure email to the DADS PE contact for the receiving provider that includes the error message from CARE. PE staff will instruct the LA as to how to complete the data entry.

 

6525 Emergency Transfer

Revision 11-2; Effective March 1, 2011

 

If the individual has already begun receiving services from the potential receiving provider and the transfer meets the criteria for an "emergency" (as defined by the HCS rule, see box below), the SC:

  • enters the date the individual began receiving services from the receiving provider as the transfer IPC effective date; and
  • documents the circumstances that support the determination of an emergency transfer and faxes it to DADS PE along with the transfer IPC.

40 TAC, §9.153 Definitions

(14) Emergency – An unexpected situation in which the absence of an immediate response could reasonably be expected to result in risk to the health and safety of an individual or another person.

 

6530 Provider Responsibilities for Transfer IPC

Revision 11-2; Effective March 1, 2011

 

 

6531 Transferring Provider

Revision 11-2; Effective March 1, 2011

 

The transferring provider completes the appropriate section of Form 3617, Request for Transfer of Waiver Program Services, in accordance with the form's instructions and Section 8000, Transfers and Local Authority (LA) Reassignments. The information related to reserved service units/dollars on Form 3617 provided by the transferring provider is essential for the development of the transfer IPC. The transferring provider may participate in the IPC meeting to develop the transfer IPC unless the individual/LAR objects to its participation.

 

6532 Receiving Provider

Revision 11-2; Effective March 1, 2011

 

The receiving provider participates in the transfer IPC meeting, participates in the development of the transfer IPC, and signs and dates the transfer IPC. The provider's signature date on the transfer IPC must be the date of the IPC meeting.

 

6600 Service Coordinator Review Process

Revision 11-2; Effective March 1, 2011

 

 

6610 Service Coordinator Review Process Overview

Revision 11-2; Effective March 1, 2011

 

The SC is responsible for reviewing in CARE all IPC renewals and all IPC revisions, except IPC revisions that add or change a requisition fee only. After the provider enters the IPC in CARE, the SC has six days to review it in CARE. Within three days after entering the IPC, the provider is responsible for sending the SC a hard copy of the IPC (i.e., completed Form 3608).

The SC reviews the IPC in CARE by ensuring:

  • the information in CARE is the same as the information on the hard copy of the IPC and reflects what was discussed during the IPC meeting, if appropriate; and
  • that the IPC effective date is in accordance with the requirements in Section 6323, Section 6421.1 or Section 6431.1, as appropriate.

If an SC does not review an IPC within six days after data entry, CARE will automatically send the IPC to DADS for authorization without an SC review. Reports will be available for state office and LA management staff noting those IPCs not reviewed by the SC.

 

6611 Reasons the IPC is Returned to the Provider

Revision 11-2; Effective March 1, 2011

 

The SC returns the IPC electronically in CARE to the provider if the SC is unable to agree or disagree with the IPC because:

  • the SC did not receive the IPC hard copy within the required time frame and the SC is unable to review the IPC in CARE before the six-day review time frame ends;
  • an error was made in CARE related to a unit of service, the name of the SC (not a just minor misspelling) or a signature date;
  • the SC was not notified by fax or email of an IPC revision for which an IPC meeting is not needed;
  • the SC determined an IPC meeting was necessary for an IPC revision that increased or decreased an existing HCS service in accordance with Section 6432.4;
  • the SC did not participate in the development of an IPC for which an IPC meeting is needed; or
  • the IPC effective date is not in accordance with the requirements in Section 6323, Section 6421.1 or Section 6431.1, as appropriate.

 

6612 Service Coordinator's Agreement/Disagreement with IPC

Revision 11-2; Effective March 1, 2011

 

The SC agrees with the IPC if the SC attests that the HCS services on the IPC are:

  • not available through other resources, and do not replace existing and natural supports;
  • necessary to assure the individual's health and safety and prevent institutionalization; and
  • based on the outcomes in the individual's PDP.

 

6620 Service Coordinator Responsibilities

Revision 11-2; Effective March 1, 2011

 

 

6621 If the IPC is Returned to Provider

Revision 11-2; Effective March 1, 2011

 

If the SC returns the IPC to the provider, the SC enters a comment in CARE to explain the reason for returning the IPC. Additionally, the SC contacts the provider the same day that an IPC is returned and discusses with the provider how to resolve the issue.

 

6622 Service Coordinator's Agreement/Disagreement with IPC

Revision 11-2; Effective March 1, 2011

 

If the SC does not return the IPC in CARE to the provider, the SC completes the review by entering the agreement or disagreement in CARE before the IPC proceeds to DADS for authorization.

 

6622.1 Agreement with IPC

Revision 11-2; Effective March 1, 2011

 

If the SC is able to make the attestation required by Section 6612, the SC indicates agreement by answering "Y" (yes) to the question "Local Authority agrees with information on this IPC?".

 

6622.2 Disagreement with IPC

Revision 11-2; Effective March 1, 2011

 

If an SC is unable to make the attestation required by Section 6612, the SC contacts the provider and discusses concerns related to the HCS services in the IPC for which the SC is unable to attest.

If the SC's concerns are not resolved and the SC continues to be unable to make the attestation, the SC indicates disagreement by answering "N" (no) to the question "Local Authority agrees with information on this IPC?". Any time a disagreement is noted, the SC completes Form 8579, Notification of Service Coordinator Disagreement, and fax it to DADS PE, and send a copy to the provider. The SC completes the form on the same day that the SC enters the disagreement in CARE.

 

6623 CARE Screens for Service Coordinator Review

Revision 11-2; Effective March 1, 2011

 

The following sections provide general instructions for viewing an IPC and entering the SC's review in CARE. See CARE User Guide for detailed data entry instructions at http://www2.mhmr.state.tx.us/655/cis/training/WAIVER.html.

 

6623.1 CARE Screen L83

Revision 11-2; Effective March 1, 2011

 

CARE screen L83 has been developed to assist an LA with tracking IPCs that need to be reviewed by the SC. Since DADS expects LAs to review each IPC, LAs must determine how frequently to print CARE screen L83 in order to meet this expectation.

Figure 3 in Section 6635 displays an example of CARE screen L83 (Header).

Figure 4 in Section 6635 displays an example of CARE screen L83 (Detail). All renewal and revised IPCs waiting for SC review are displayed. Initial or transfer IPCs do not require SC review because they are data entered by the LA.

 

6623.2 CARE Screen L31

Revision 11-2; Effective March 1, 2011

 

If an individual has more than one IPC pending (a revision to the current IPC and the renewal IPC have been entered, but not yet reviewed), the IPC effective date being reviewed must be entered. Figure 5 in Section 6635 displays CARE screen L31 (Header).

The IPC information is displayed on subsequent CARE screen L31 (Detail) in order for the SC to ensure that what was entered into CARE matches the hard copy. The last CARE screen L31 (Detail) is for the SC's data entry. Figure 6 in Section 6635 displays the last CARE screen L31 (Detail).

If the SC intends to return the IPC to the provider, the SC:

  • answers the question "Send to DADS for authorization?" with "N" for no;
  • enters a comment at the bottom of the screen to explain the reason for returning the IPC;
  • enters his/her name; and
  • answers the question "ready to add" with "Y" for yes.

If the SC does not intend to return the IPC to the provider, the SC:

  • answers the question "Send to DADS for authorization?" with "Y" for yes; and
  • proceeds to the next question.

The SC answers the question "MR Authority agrees with information on this IPC?" and enters the SC's name.

 

6630 Provider Responsibilities

Revision 11-2; Effective March 1, 2011

 

The provider ensures that the SC has a hard copy of the IPC within three days after the provider enters the IPC data into CARE.

 

6631 Service Coordinator Returns IPC in CARE

Revision 11-2; Effective March 1, 2011

 

If the SC returns an IPC to the provider in CARE, the SC notifies the provider that same day of the returned IPC. Additionally, the SC enters a comment in CARE to explain the reason for returning the IPC. A provider may view this comment in CARE screen C62 or the provider may use the C103 screen and select status code "X -RETURNED TO PROVIDER FOR MORE INFORMATION" to see if any IPCs have been returned by the SC and the reason for the return.

 

6632 Activity to Address a Returned IPC

Revision 11-2; Effective March 1, 2011

 

The IPC remains in "Returned to Provider" status until the provider takes some action in CARE to address the returned IPC. Depending on the reason the IPC was returned, the provider may take one of the following CARE actions:

  • delete and re-enter the IPC; or
  • complete an "error correction" action.

Before taking CARE action to send the IPC on to the SC for review again, the provider is responsible for resolving the issue that was the basis for the IPC being returned.

 

6633 Error Correction

Revision 11-2; Effective March 1, 2011

 

An error correction may be used to address an IPC in "Returned to Provider" status if the IPC was returned because:

  • the SC did not receive the IPC hard copy within the required time frame and the SC is unable to review the IPC in CARE before the six-day review time frame ends; or
  • an error was made in CARE related to a unit of service, the name of the SC (not a just minor misspelling) or a signature date.

If an error was made to a unit of service or signature name or date, the provider makes the necessary correction using the error correction action. This action sends the IPC to the SC for review again. The provider is responsible for notifying the SC as soon as possible after the correction has been made.

If there is nothing to correct in CARE (because the error was made on the hard copy, the SC has now received a hard copy or the SC and provider have resolved any issues), the provider completes the error correction action in CARE. A provider accesses CARE screen C02 and completes the error correction action without actually making any changes or corrections. Completing this action sends the IPC to the SC for review again.

 

6634 Delete and Re-enter IPC

Revision 11-2; Effective March 1, 2011

 

The provider deletes and re-enters an IPC to address an IPC in "Returned to Provider" status if the IPC was returned because:

  • the SC was not notified by fax or email of an IPC revision for which an IPC meeting is not needed;
  • the SC did not participate in the development of an IPC for which an IPC meeting is needed; or
  • the IPC effective date is not in accordance with the requirements in Section 6323, Section 6421.1 or Section 6431.1, as appropriate.

If the SC was not notified of an IPC revision to increase or decrease an existing HCS service, the SC determined an IPC meeting was necessary for an IPC revision to increase or decrease an existing HCS service, the SC did not participate in an IPC meeting, or the IPC effective date is not in accordance with the requirements of this handbook, the provider:

  • follows the appropriate procedures for renewing or revising an IPC;
  • deletes the IPC that is in return status; and
  • enters the IPC that was developed using the appropriate procedures.

 

6635 CARE Screen Examples

Revision 11-2; Effective March 1, 2011

 

Figure 1. Screen C64

 

 

Figure 2. Detail Screen C64

 

 

Figure 3. Screen L83

 

 

Figure 4. Detail Screen L83

 

 

Figure 5. L31 Header Screen

 

 

Figure 6. Final L31 Screen