Revision 12-2; Effective April 6, 2012

 

This section describes the process for suspending an individual's Home and Community-based Services (HCS) or Texas Home Living (TxHmL) Program waiver services and requesting a continuation of the suspension beyond 270 days.

A program advisor in the Department of Aging and Disability Services (DADS) Intellectual and Developmental Disability (IDD) Waivers Program Enrollment/Utilization Review (PE/UR) unit will request information from the service coordinator (SC) every 30 days, or as appropriate, during the period an individual's waiver program services are suspended.

The individual's services will remain suspended until it is appropriate for the individual's services to resume or the decision is made to terminate the individual's services.

DADS may request that an individual's HCS or TxHmL services be terminated at any time, if appropriate.

 

9100 Reasons for Suspension of Waiver Program Services

Revision 12-2; Effective April 6, 2012

 

There are situations that may cause an individual to become temporarily ineligible or unavailable for waiver program services. The following are valid reasons for suspending an individual's waiver program services. (The following reasons for suspension are listed in CARE Screen C18.)

Loss of Financial Eligibility – This reason is used only when an individual no longer meets the financial eligibility requirements for the program.

Hospitalization (Medical) – This reason is used only when an individual has been admitted to a medical hospital. (The individual's waiver program services must be suspended.)

Elopement (Unable to locate) – This reason is used when a program provider and SC have been unable to locate an individual or when an individual or the legally authorized representative (LAR) refuses to allow the program provider to provide waiver program services.

Crisis Stabilization – This reason is used only when an individual has been admitted to a non-state-operated psychiatric treatment center. (The individual's waiver program services must be suspended.)

Hospitalization (Psychiatric) – This reason is used only when an individual has been admitted to a state-operated psychiatric hospital. (The individual's waiver program services must be suspended.)

Vacation/Furlough – This reason is used when an individual is out of town/state or away on a vacation.

Incarceration – This reason is used only when an individual has been incarcerated. (The individual's waiver program services must be suspended.)

State School – This reason is used when an individual has been admitted to a state supported living center. (The individual's waiver program services must be suspended.)

Nursing Facility – This reason is used when an individual has been admitted to a nursing facility or rehabilitation center. (The individual's waiver program services must be suspended.)

ICF/MR – This reason is used when an individual has been admitted to a community intermediate care facility for persons with intellectual disability (ICF/ID). (The individual's waiver program services must be suspended.)

 

9200 Program Provider Responsibilities

Revision 11-2; Effective March 1, 2011

 

The program provider:

  • immediately informs the SC if the program provider becomes aware that an individual is ineligible or unavailable for waiver program services;
  • enters a "temporary discharge" record into CARE C18 screen;
  • keeps the SC informed by communicating any change(s) in the situation immediately upon becoming aware of the change(s);
  • updates the suspension record in CARE C18 screen to change the suspension reason if the reason changes during the suspension period; this is done without entering a new suspension record or changing the suspension begin date;
  • assists the individual or LAR with re-establishing financial eligibility, if the reason for suspension of waiver program services is loss of financial eligibility and the provider is the representative payee;
  • immediately informs the SC when an individual is able to resume participation in the waiver program; and
  • immediately ends the "temporary discharge" record in CARE C18 screen when an individual has resumed participation in the waiver program.

 

9300 DADS Activities

Revision 12-2; Effective April 6, 2012

 

DADS Program Enrollment/Utilization Review (PE/UR) program advisors request periodic status reports from the service coordinator for suspensions that exceed 30 days by sending a Suspension of Waiver Services Status Report form to the Local Authority (LA). The program advisor completes the top section and sends the form by secure email to the SC contact at the LA after an individual has been on suspension for 30 days or longer. Thereafter, the program advisor sends the form requesting a status update as often as the advisor determines is necessary, as long as the individual remains on suspension. All email communication between DADS and the LA regarding an individual's suspension must be via secure email.

 

9400 Service Coordinator Responsibilities

Revision 12-2; Effective April 6, 2012

 

The SC:

  • immediately informs the program provider if the SC becomes aware that an individual is ineligible or unavailable for waiver program services;
  • assists the individual or LAR with re-establishing financial eligibility, if the reason for suspension of waiver program services is loss of financial eligibility and the individual or LAR is the representative payee and requests assistance;
  • monitors the situation during the entire period of suspension;
  • when appropriate, discusses with the individual/LAR or involved family members and the provider regarding whether the individual will be able to resume services or if services should be terminated; and
  • completes and returns by secure email the Suspension of Waiver Services Status Report form documenting the individual’s current status on or before the Status Due Date designated on the form, noting whether the suspension will continue and for how long, or that the individual is not expected to resume services (i.e., termination of services is being recommended).

If the suspension continues for 270 days, the SC discusses with the individual/LAR or involved family members and the provider regarding whether the individual will be able to resume services or if services should be terminated.

  • If continuation of the suspension is recommended, the SC submits a request to continue the suspension of waiver program services for an additional 30 days in accordance with Section 9410 below.
  • If termination of services is recommended, the SC completes and returns by secure email the Suspension of Waiver Services Status Report form noting that the individual is not expected to resume services.

DADS reviews all recommendations for terminations of services. If DADS agrees that termination is appropriate, DADS will contact the SC to advise the SC to submit a request for termination in accordance with Section 10100, Process for Requesting Termination of Waiver Services – Texas Home Living and Home and Community-based Services.

 

9410 Request to Continue Suspension of Waiver Program Services

Revision 12-2; Effective April 6, 2012

 

If it is foreseeable that the individual will be able to resume waiver program services, the SC requests that waiver program services be continued for 30 days by submitting the following documentation to DADS no later than the 277th day of suspension:

  • a completed Form 3615, Request to Continue Suspension of Waiver Program Services; and
  • documentation explaining the reason for the requested continuation.

The request may be returned to the program advisor via secure email, faxed to 512-438-4249 or mailed to:

Department of Aging and Disability Services
IDD Waivers Program Enrollment/Utilization Review, Mail Code W-551
P.O. Box 149030
Austin, TX 78714-9030

 

Contact Information

Questions regarding this process should be directed to the DADS IDD Waivers Program Enrollment/Utilization Review general email box at enrollmenttransferdischargeinfo@dads.state.tx.us or telephone message line at 512-438-5055.

Texas Home Living and Home and Community-based Services reference materials are available online at:

hhs.texas.gov/laws-regulations/handbooks/texas-home-living-txhml-program
hhs.texas.gov/laws-regulations/handbooks/texas-home-living-txhml-program/txhml-forms
hhs.texas.gov/laws-regulations/handbooks/home-and-community-based-services-handbook
http://www2.mhmr.state.tx.us/655/cis/training/WaiverGuide.html
http://www2.mhmr.state.tx.us/655/cis/training/txhmlGuide.html
http://www2.mhmr.state.tx.us/655/cis/training/MRAGuide.html
http://www2.mhmr.state.tx.us/655/cis/training/CDSAGuide.html