Revision 19-4; Effective September 9, 2019

 

The number of offers for a Home and Community-based Services (HCS) Crisis Diversion slot made each month is based on budgetary guidelines, in accordance with the legislative allocation for the biennium.

 

12100 Purpose

Revision 19-4; Effective September 9, 2019

 

Texas Health and Human Services Commission (HHSC) may offer an HCS Crisis Diversion slot to a person with an intellectual or developmental disability:

  • who is determined to be at imminent risk of admission to an institution, as defined in Section 12200, Definition of Imminent Risk of Admission to an Institution;
  • who is, as specified in the HCS Medicaid Waiver application, a person:
    • at risk of institutionalization;
    • at risk of institutionalization in a state supported living center (SSLC); or
    • leaving a state hospital who is at risk of re-institutionalization; and
  • who meets the qualifications described in Section 12300, Qualifications for the HCS Reserved Capacity Group for Crisis Diversion.

 

12200 Definition of Imminent Risk of Admission to an Institution

Revision 19-4; Effective September 9, 2019

 

A person is at imminent risk of admission to an institution if one or more of the following exists:

  • loss or incapacity of the person’s primary caregiver;
  • loss of the person’s placement in a community residential facility;
  • the person exhibits repeated and severe behavior disturbances that jeopardize the person’s safety or current living arrangement, but does not need:
    • inpatient mental health treatment; or
    • care in a behavioral health facility, such as Texana Center’s Behavior Treatment and Training Facility or Bayes Achievement Center; or
  • the person is recommended for discharge from a state hospital and unable to return to family or community-based care.

 

12300 Qualifications for the HCS Reserved Capacity Group for Crisis Diversion

Revision 19-4; Effective September 9, 2019

 

A person qualifies as a member of the Home and Community-based Services (HCS) Reserved Capacity Group for Crisis Diversion if:

  • The person is at imminent risk of admission to an institution, as defined in Section 12200, Definition of Imminent Risk of Admission to an Institution;
  • The person is not being court-committed to a facility for competency evaluation, such as an SSLC or state hospital;
  • Adequate and appropriate community resources are not available, as evidenced by attempts to locate and use community-based services and supports, such as community intermediate care facilities for individuals with intellectual disabilities or related conditions (ICF/IIDs), general revenue-funded services, Community First Choice services, Crisis Intervention Services, other Medicaid waiver programs, or for a minor, supports through the local school district; and
  • The person meets the criteria for ICF/IID level of care (LOC) I. The person must have an LOC I, which requires either a diagnosis of intellectual disability (ID) or related condition (RC). Along with the diagnosis of an RC, the person’s intelligence quotient (IQ) score must be below 76. The specific requirements for LOC I are in the ICF/IID Contracting rules, 40 Texas Administrative Code, Chapter 9, Subchapter E, specifically §9.238.

Note: Persons who only meet the criteria for ICF/IID LOC VIII are not eligible.

 

12400 Process

Revision 19-4; Effective September 9, 2019

 

The local intellectual and developmental disability authority (LIDDA) conducts an interview with the person and legally authorized representative (LAR) or an actively involved party about the circumstances creating imminent risk of the person’s admission to an institution. The LIDDA provides an explanation of intellectual or developmental disability (IDD) services and supports.

If the LIDDA determines the person is at imminent risk of admission to an institution, as described in Section 12200, Definition of Imminent Risk of Admission to an Institution, and meets the criteria for a community intermediate care facility for individuals with intellectual disabilities or related conditions (ICF/IID) level of care (LOC) I, and that adequate and appropriate community resources are not available, as evidenced by attempts to locate and use community-based services and supports, the LIDDA begins the process for requesting a Home and Community-based Services (HCS) Crisis Diversion slot.

The LIDDA requests an HCS Crisis Diversion Slot request to the designated staff person in Texas Health and Human Services Commission (HHSC) IDD Services by submitting a packet that includes:

  • A completed Form 1058, Request for Home and Community-based Services Crisis Diversion Slot;
  • Copy of the person’s Determination of Intellectual Disability (DID);
  • Copy of the person’s Inventory for Client and Agency Planning (ICAP) booklet/scoring sheet; and
  • Other documents, as appropriate.

Upon receipt, designated HHSC staff reviews the packet for completeness.

  • If the packet is incomplete, HHSC staff will notify the LIDDA and arrange for additional necessary documentation to be submitted.
  • If the packet is complete, HHSC staff will convene a meeting to discuss the request for an HCS Crisis Diversion slot with other staff persons of HHSC IDD Services.

HHSC staff will meet to discuss the request and determine whether the person meets the qualifications described in Section 12300, Qualifications for the HCS Reserved Capacity Group for Crisis Diversion.

  • If it is determined the person does not qualify, HHSC, within one business day, will notify the LIDDA and the person or LAR in writing of the denial of an HCS Crisis Diversion slot and provide the person or LAR with an opportunity for an appeal through a fair hearing.
  • If it is determined the person qualifies and a slot is immediately available, HHSC will, within one business day, send a letter authorizing the LIDDA to offer the person the opportunity to enroll in HCS.
  • If it is determined the person qualifies, but a slot is not immediately available, HHSC will notify the LIDDA within one business day that the person qualifies, but a slot is not immediately available. HHSC will maintain contact with the LIDDA until a slot becomes available, at which point HHSC will send a letter authorizing the LIDDA to offer the person the opportunity to enroll in HCS.

The LIDDA initiates the enrollment process within three working days of receipt of the authorization letter from HHSC. The LIDDA is required to complete the enrollment process, in accordance with the rules governing the HCS Program, specifically 40 Texas Administrative Code, §9.157, Process of Enrollment of an Applicant, within the time frames as required by the LIDDA Performance Contract.

If, while waiting for an offer of an HCS Crisis Diversion slot, HHSC determines the person no longer meets the qualifications for the HCS Reserved Capacity Group for Crisis Diversion, as described in Section 12300, HHSC will, within one business day, notify the LIDDA and the person or LAR in writing of the denial of an HCS Crisis Diversion slot and provide the person or LAR with an opportunity for an appeal through a fair hearing.