13000, Medicaid Program Enrollment Requirements

Revision 22-1; Effective February 11, 2022

In accordance with Texas Health and Human Services Commission (HHSC) rules, the local intellectual and developmental disability authority (LIDDA) must complete the processes described in this section for each person authorized by HHSC to receive a Home and Community-based Services (HCS) or Texas Home Living (TxHmL) enrollment offer.

13100 LIDDA Required Training

Revision 22-2; Effective July 22, 2022

Per the local intellectual and developmental disability authority (LIDDA) Performance Contract, the LIDDA must designate staff to complete enrollments for the Home and Community-based Services (HCS) Program, Texas Home Living (TxHmL) Program and the Community First Choice (CFC) Program. The LIDDA must require all designated staff to complete all Texas Health and Human Services Commission (HHSC) online enrollment training before performing enrollment activities, and at least annually thereafter, for as long as the staff performs enrollment activities for the LIDDA.

Training is found at found at LIDDA Training Opportunities and includes:

  • Authority Waiver Enrollment Training
  • CFC in Medicaid Managed Care Organizations (MCO) Web-based Training
  • CFC in the HCS and TxHmL Programs Web-based Training
  • CFC Personal Assistant Services/Habilitation (PAS/HAB) Assessment for HCS and TxHmL Service Coordinators

13200 Persons Authorized to Enroll from the HCS Interest List

Revision 20-4; Effective October 15, 2020

Texas Health and Human Services Commission (HHSC) notifies the local intellectual and developmental disability authority (LIDDA) in writing when the LIDDA is authorized to offer a person enrollment into the Home and Community based Services (HCS) Program.

13210 Notification of HCS Offer

Revision 22-2; Effective July 22, 2022

Texas Health and Human Services Commission (HHSC) strongly encourages local intellectual and developmental disability authorities (LIDDAs) to notify the person or their legally authorized representative (LAR) of a Home and Community-based Services (HCS) enrollment offer within three working days of receiving the notice from HHSC.

If the LIDDA is unable to reach the person or LAR using the contact information on the person’s Community Services Interest List (CSIL) record, the LIDDA must check the following systems for additional addresses and phone numbers: 

HHS applications:

  • Client Assignment and Registration (CARE) system screen C63, Medicaid Eligibility Search
  • Service Authorization System Online (SASO)

Texas Medicaid & Healthcare Partnership (TMHP) applications:

  • TexMed Connect - Medicaid Eligibility and Service Authorization Verification (MESAV); and 
  • Long-Term Care (LTC) Online Portal

The LIDDA must mail the notice to all addresses and attempt to contact the person or LAR at all available phone numbers. 

The LIDDA makes a written offer of HCS enrollment to the person or LAR by regular U.S. Postal Service (USPS) mail or hand delivery using one of the following:

  • Form 1067, Offer of Home and Community-based Services (HCS) Program (recommended); or
  • its own HCS offer letter, which contains the same information as HHSC’s Form 1067 and complies with 40 Texas Administrative Code (TAC) Section 9.1589(d).

Note: The LIDDA must also include Form 8592, Deadline Notification.

If the LIDDA learns the person has relocated to another LIDDA’s local service area (LSA), the LIDDA must follow the instructions in 13211, Person Relocated to Another LIDDA’s Local Service Area (LSA). If the person or LAR does not respond to the offer of HCS notification within 30 calendar days, the LIDDA follows the instructions in 13212, Withdrawal of HCS Offer.

If the person or LAR responds to the notification letter, the LIDDA schedules a meeting to discuss HCS in detail with the person or LAR. Refer to 15000, Pre-Enrollment Activities and Financial Eligibility Related to HCS and TxHmL. Refer to the Initial Meeting Packet checklist (PDF).

If a person is currently receiving LIDDA services funded by General Revenue (GR), the LIDDA must inform the person that, in accordance with 40 TAC Section 9.158(h) and (i), if the person declines the HCS program, the LIDDA is required to end the GR services that are like services provided in the HCS program. 

13211 Person Relocated to Another LIDDA’s Local Service Area (LSA)

Revision 22-2; Effective July 22, 2022

Per the local intellectual and developmental disability authority (LIDDA) Performance Contract, if the authorized LIDDA attempts to contact a person or their legally authorized representative (LAR) and learns that the person or LAR has relocated to another LIDDA’s local service area (LSA), the authorized LIDDA must determine the person’s designated LIDDA. See 5000, Guidelines for Determining and Changing Designated LIDDA.

If the authorized LIDDA is the designated LIDDA, the authorized LIDDA must continue with all enrollment activities.

If the authorized LIDDA determines that another LIDDA is the designated LIDDA, then the authorized LIDDA must notify the assigned slot monitor at Texas Health and Human Services Commission (HHSC) by email. The authorized LIDDA must:

  • transfer the person’s CSIL record to the designated LIDDA, see Section 7800, When to Transfer a Person’s CSIL Record; and
  • forward the following to the designated LIDDA:
    • a copy of the authorization letter;
    • Form 1049, Initial Documentation of Provider Choice; and
    • a copy of any extensions already obtained.

Once the designated LIDDA receives the information from the authorized LIDDA, the designated LIDDA becomes the authorized LIDDA and is responsible for meeting required time frames for enrollment or requesting an extension, if needed.

Form 8590, Request for Approval to Withdraw an Enrollment Offer, if the person or legally authorized representative (LAR) does not:

  • respond to the HCS offer within 30 calendar days after the notification letter was mailed by the LIDDA;
  • document their choice of HCS Program services using Form 8601, Verification of Freedom of Choice, within seven calendar days after the receipt of the form;
  • document their choice of program provider using Form 1049, Initial Documentation of Provider Choice, within 30 calendar days after their receipt of contact information for all program providers in the LIDDA's local service area (LSA); or
  • complete the necessary activities to finalize the enrollment process. 

The LIDDA must email the completed Form 8590 to the designated slot monitor using a secure email method. The LIDDA must include the slot type number for the enrollment offer and the type of request in the subject line. Example: “Slot Type 114 - Request for Approval to Withdraw an Enrollment Offer.”

A completed Form 8590 must be submitted in separate attachments for each person and the LIDDA must name each completed Form 8590 with the following file naming convention: 

  • Person's last name
  • Person's first name
  • Slot type number
  • WD
  • Date of the withdrawal letter

Example: SmithBob114WD10-05-2021

Multiple withdrawal requests sent in one PDF will be returned without being processed.

If Form 8590 is approved, the LIDDA must notify the person or LAR of the withdrawal of HCS offer in writing, by certified U.S. Postal Service (USPS) mail using one of the following:

  • Form 1068, Withdrawal of Offer for Home and Community-Based(HSC) Services Program (recommended); or
  • its own HCS withdrawal letter, which must contain the same information as Form 1068.

The LIDDA must email a copy of Form 1068, including the certified mail receipt, to the assigned slot monitor.

If Form 8590 is denied, the LIDDA must follow the instructions provided by the slot monitor. 

When the slot monitor receives a copy of the withdrawal letter and certified mail receipt and confirms the withdrawal notice has been delivered, HHSC changes the interest list status to “Closed” and assigns the appropriate closure reason. A person younger than 22  and living in an institution is automatically placed back on the HCS interest list with a new request date. See Section 7600, CSIL Status Designations. 

13213 Declining the Offer

Revision 22-2; Effective July 22, 2022

If the person or legally authorized representative (LAR) declines the Home and Community-based Services (HCS) enrollment offer, the local intellectual and developmental disability authority (LIDDA):

  • ensures the person or LAR clearly documents the reason for the decline on Form 8601, Verification of Freedom of Choice;
  • uploads the signed and dated form as a PDF file to the LIDDA Enrollment Secure File Transfer Protocol (SFTP) site (See Section 13255, Use of LIDDA Enrollment SFTP Site Instructions); and
  • if the person is receiving General Revenue (GR) services, the LIDDA terminates the person’s GR services that are like services provided in the HCS program and notifies the person or LAR in writing, by certified U.S. Postal Service (USPS) mail of the termination and the person’s opportunity for a review in accordance with 40 Texas Administrative Code Section 2.46.

As mentioned in 13210, Notification of HCS Offer, the LIDDA must inform a person who is receiving GR funded services and receiving an HCS offer that the LIDDA is required to end the GR services if the person declines the HCS enrollment offer.

Texas Health and Human Services Commission (HHSC) may request the LIDDA provide additional information or documentation for review. HHSC changes the program interest list on the person’s CSIL record to “Closed” and assigns an appropriate closure reason. See Section 7600, CSIL Status Designations. 

If a person requests to remain on the HCS interest list after declining the offer to enroll in the program, the LIDDA must:

  • complete a new Form 8648, Identification of Preferences indicating the person wants HCS; and
  • add the program’s interest list back to the person’s CSIL record with a new request date. The request date must be at least one day after the date the person declined the program. See Section 7000, HCS and TxHmL Interest Lists.

If the person is under 22 and living in an ICF/IID or NF, HCS will be added back to the person’s CSIL record by HHSC Information Technology (IT) Field Support with the new request date being the facility admission date.

13214 Accepting the Offer

Revision 22-2; Effective July 22, 2022
If the person or legally authorized representative (LAR) accepts the Home and Community-based Services (HCS) enrollment offer, the local intellectual and developmental disability authority (LIDDA) gives the person or their LAR Form 8601 , Verification of Freedom of Choice. The person or their LAR must sign and complete Form 8601 within seven days. The LIDDA must:

  • upload the signed and dated Form 8601 as a PDF file to the LIDDA Enrollment Secure File Transfer Protocol (SFTP) site (See Section 13255, Use of LIDDA Enrollment SFTP Site Instructions); and
  • submit the HCS or TxHmL Pre-enrollment Form on the Texas Medicaid & Healthcare Partnership (TMHP) Long-Term Care (LTC) Online Portal unless the person is currently enrolled in the Texas Home Living (TxHmL) program. 
    • If the person is enrolled in TxHmL and wants to be discharged from TxHmL to enroll in HCS, the LIDDA must submit Form 3616, Request for Termination of Services by HCS/TxHmL Program Provider on the LTC Online Portal. When the status of Form 3616 is “Processed/Complete,” the LIDDA must update the person’s contact information in the Community Services Interest List (CSIL) application before submitting the HCS or TxHmL Pre-enrollment Form on the LTC Online Portal for the HCS enrollment. The LIDDA must not submit the HCS or TxHmL Pre-enrollment Form until the TxHmL discharge is processed.

The LIDDA must discuss the provider selection process with the person or LAR in addition to:

  • retrieving a current list of HCS program providers in the LIDDA’s local service area from the Client Assignment and Registration (CARE) screen C95, Provider Roster Inquiry;
  • providing the list to the person or LAR; and
  • explaining to the person or LAR that they:
    • may choose any contracted HCS program provider identified on the list who has not reached its service capacity; and 
    • must select a program provider within 30 calendar days from the date they received the list from the LIDDA.

Although the LIDDA must not direct the person or LAR to choose a specific program provider, the LIDDA may assist the person or LAR with the following:

  • identifying what is important to the person or LAR about a provider (e.g., location, staffing patterns, provider experience with certain disabilities);
  • recommending specific questions to ask the providers. The Explanation of IDD Services and Supports document contains suggested questions they may use to interview the provider; and
  • contacting and arranging visits to the providers the person or LAR has indicated they would like to know more about.

The LIDDA must instruct the person or LAR to document their selection of the program provider on Form 1049, Initial Documentation of Provider Choice.

If the LIDDA operates an HCS public provider program and is selected by the person or LAR as the HCS program provider, the LIDDA must complete Form 1052, Public Provider Choice Request.

Before submitting the form, the LIDDA must determine whether its HCS public provider program is operating at or over its capacity as identified in CARE Screen C70 as “CAP.”

  • If the LIDDA HCS public provider program is operating under its capacity, only the top section and Section IV of Form 1052 must be completed. 
  • If the LIDDA HCS public provider program is operating at or over its capacity, Form 1052 must be completed in its entirety. 
  • Note: If the LIDDA HCS public provider program is operating at or over its capacity, the LIDDA must not:
    • Initiate an offer of its capped waiver services to a family or person nor prompt a family or person to consider its services; 
    • Participate as an available provider in any provider fairs or other provider marketing opportunities; or
    • Include its waiver services on the list of providers shared with families and persons.

Regardless of whether the LIDDA is over or under its capacity, the Individual Plan of Care (IPC) Effective Date in the top section of Form 1052 must be filled out with a date. Entries such as “To Be Determined,” “Unknown,” or blank will be returned for correction. If the IPC effective date is unknown, the LIDDA must enter the date the form is being completed. The LIDDA submits Form 1052 to LIDDARequests@hhs.texas.gov with the subject line “Form 1052.” If a secure email is needed, the LIDDA can request one.  

  • Note: The LIDDA must not submit the initial enrollment Form 3608, Individual Plan of Care (IPC) - HCS/CFC on the LTC Online Portal until Form 1052 has been approved by HHSC.

13220 Initial Meeting

Revision 20-4; Effective October 15, 2020

The initial meeting is conducted with the person or legally authorized representative (LAR) or actively involved family member. The local intellectual and developmental disability authority (LIDDA) shall provide both an oral and a written explanation of the services and supports for which the person may be eligible using Texas Health and Human Services Commission (HHSC) documents listed in the LIDDA Initial Meeting Packet Checklist (PDF). The LIDDA must also ensure the person or LAR is provided information about the Medicaid Estate Recovery Program (MERP) once they have chosen to enroll in the Home and Community-based Services (HCS) program, as described in 14000, Medicaid Estate Recovery Program (MERP) Overview, using Form 8001, Medicaid Estate Recovery Program Receipt Acknowledgement.

13221 Person Selects Provider in Another LIDDA’s LSA

Revision 22-2; Effective July 22, 2022

Per the local intellectual and developmental disability authority (LIDDA) Performance Contract, if the authorized LIDDA contacts a person or legally authorized representative (LAR) and begins the enrollment process and the person or LAR selects a provider in a different LIDDA’s local service area (LSA), the authorized LIDDA must conduct all applicable pre-enrollment activities, such as:

  • explaining services;
  • obtaining the person’s or LAR’s signature on Form 8601, Verification of Freedom of Choice;
  • submitting the signed Form 8601 to HHSC using the Secure File Transfer Protocol (SFTP) site (See Section 13255, Use of LIDDA Enrollment SFTP Site Instructions);
  • submitting the HCS or TxHmL Pre-enrollment form on the Texas Medicaid & Healthcare Partnership (TMHP) Long-Term Care (LTC) Online Portal;
  • conducting diagnostic activities and completing the determination of intellectual disability;
  • submitting the 8578 ID/RC Assessment on the TMHP LTC Online Portal;
  • collecting Medicaid eligibility information;
  • completing an initial person-directed plan (PDP);
  • completing a proposed individual plan of care (IPC);
  • requesting an enrollment extension if the enrollment will not be completed by the originally assigned or extended time frame;
  • updating the address and county of residence on the “Personal Information” page of the person’s Community Services Interest List (CSIL) record to transfer the person’s CSIL record to the LIDDA in which the selected provider operates;
  • providing the initial PDP to the provider and completing the IPC negotiations with the provider; and
  • sending hard copies of all enrollment documents to the receiving LIDDA, including Form 1049, Initial Documentation of Provider Choice, and any enrollment extensions already obtained.

IMPORTANT: The LIDDA must change the county of residence on the “Personal Information” page in CSIL. Changing the county of residence on the “Interest List” page will only transfer that program interest list. See Section 7800, When to Transfer a Person’s CSIL Record.

Once the receiving LIDDA receives the information from the authorized LIDDA, the receiving LIDDA is responsible for meeting required time frames for enrollment.

The receiving LIDDA must: 

  • determine if the person is currently enrolled in another waiver program as described in Section 15100, Research Preventing Dual Enrollment and Section 15200, Persons Enrolled in STAR+PLUS Waiver (SPW) or MDCP;
  • submit the enrollment Form 3608, Individual Plan of Care on the LTC Online Portal;
  • meet required time frames for enrollment; and
  • request an extension if the enrollment is not expected to be approved by the required time frame. See 13232, Requesting an Extension.

Note: If the transferring LIDDA did not submit the HCS or TxHmL Pre-enrollment Form and Form 8578 on the LTC Online Portal before transferring the person’s CSIL record, the receiving LIDDA must submit the HCS or TxHmL Pre-enrollment form and Form 8578 on the LTC Online Portal before submitting Form 3608 on the LTC Online Portal. See Section 13241, Form Submission for Enrollment.

13222 Person is Enrolled in a Mutually Exclusive Waiver Program

Revision 22-2; Effective July 22, 2022

When a person accepts a Home and Community-based Services (HCS) enrollment offer, the local intellectual and developmental disability authority (LIDDA) must determine if the person is currently enrolled in a mutually exclusive waiver program. See Appendix I , Mutually Exclusive Services.

The LIDDA must check the following systems:

HHS applications:

  • Client Assignment and Registration (CARE) – C63, Medicaid Eligibility Search
  • Service Authorization System Online (SASO) (See Section 15100 , Research Preventing Dual Enrollment for SASO instructions)

Texas Medicaid & Healthcare Partnership (TMHP) applications:

  • TexMed Connect - Medicaid Eligibility and Service Authorization Verification (MESAV)
  • Long-Term Care (LTC) Online Portal

Enrollment information for the Medically Dependent Children Program (MDCP) is only available on the LTC Online Portal.
 
To allow Program Eligibility and Support enough time to process the enrollment before the first day of the month, by the 20th day of the month before the HCS begin date, the LIDDA must submit the HCS or TxHmL Pre-enrollment Form, 8578 ID/RC Assessment, and 3608 Individual Plan of Care on the Texas Medicaid & Healthcare Partnership Long-Term Care Online Portal. See 13241 , Form Submission for Enrollment. Example: A person is enrolled in the STAR+PLUS Waiver on March 15. The MCO has been paid to provide STAR+PLUS services through March 31. The person cannot discharge from STAR+PLUS before March 31. The HCS enrollment begin date is April 1. The LIDDA must submit the forms on the LTC Online Portal by March 20. If the forms are not submitted on the LTC Online Portal by March 20, the STAR+PLUS discharge date must be changed to April 30, the HCS enrollment begin date must be changed to May 1, and the LIDDA must submit the forms on the LTC Online Portal by April 20.

13222.1 If Person is in Texas Home Living (TxHmL)

Revision 22-2; Effective July 22, 2022

For a person enrolled in Texas Home Living (TxHmL), as soon as the Home and Community-based Services (HCS) begin date is agreed on by the person or their legally authorized representative (LAR) and HCS program provider, the local intellectual and developmental disability authority (LIDDA) service coordinator must complete Form 3616, Request for Termination of Services by HCS/TxHmL Program Provider. The TxHmL termination date is the day before the HCS begin date. The LIDDA obtains the signature from the person or LAR and the TxHmL program provider on the form.

The LIDDA must submit Form 3616 on the Texas Medicaid & Healthcare Partnership (TMHP) Long-Term Care (LTC) Online Portal before submitting the signed Form 3616 to Program Eligibility and Support (PES) through the IDD Operations Portal.

After the status of Form 3616 is displaying as “Processed/Complete” on the LTC Online Portal, the LIDDA must update the person’s Community Services Interest List (CSIL) record, if needed and submit the HCS or TxHmL Pre-enrollment Form on the LTC Online Portal for the HCS enrollment. The LIDDA must NOT submit the HCS or TxHmL Pre-enrollment Form unless the status of Form 3616 is “Processed/Complete.”

13230 Enrollment Process

Revision 20-4; Effective October 15, 2020

The local intellectual and developmental disability authority (LIDDA) must conduct pre-enrollment activities outlined in 15000, Pre-enrollment Activities and Financial Eligibility Related to HCS and TxHmL, and 14000, Medicaid Estate Recovery Program (MERP) Overview.

13231 Enrollment Due Dates

Revision 22-2; Effective July 22, 2022

An enrollment due date is the date Texas Health and Human Services Commission (HHSC) expects the local intellectual and developmental disability authority (LIDDA) to complete the enrollment process for a person. The LIDDA must complete the enrollment process by the enrollment due date described below or have an enrollment extension approved by HHSC. Enrollment due dates are:

  • 75 calendar days from the date of HHSC’s notice for a person who is residing in their own home or family member’s home; or
  • 90 calendar days from the date of HHSC’s notice for a person who is currently residing in a facility, including a nursing facility, state hospital, state supported living center or intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID).

The LIDDA must notify the assigned slot monitor if the person resides in a facility.

The LIDDA must request an extension if it cannot meet the enrollment due date. See Section 13232, Requesting an Extension of the Enrollment Due Date.

HHSC considers the enrollment process to be “complete” when the person’s enrollment has been processed by HHSC and the person’s Community Services Interest List (CSIL) record for the program is “Closed” with the applicable closure reason. See Section 7600, CSIL Status Designations.

13232 Requesting an Extension of the Enrollment Due Date

Revision 22-2; Effective July 22, 2022

Texas Health and Human Services Commission (HHSC) may approve an extension of the enrollment due date if the local intellectual and developmental disability authority (LIDDA) is able to demonstrate, in writing, the LIDDA attempted to complete the process timely but unavoidable circumstances resulted in delays the LIDDA could not prevent. To request an extension, the LIDDA must submit a completed Form 1045, Request for Extension of Enrollment Offer Due Date, to HHSC. The LIDDA must not wait for the outcome of a pending Medicaid application to submit the HCS or TxHmL Pre-enrollment Form, Form 8578, Intellectual Disability/Related Condition (ID/RC), and Form 3608, Individual Plan of Care on the Texas Medicaid & Healthcare Partnership (TMHP) Long-Term Care (LTC) Online Portal. See Section 13241, Form Submission for Enrollment.

Note: HHSC does not approve an extension request for a quarter if it is received after the 15th day of the last month of the quarter.

13233 Processing the Offer Before the Due Date

Revision 20-4; Effective October 15, 2020

The local intellectual and developmental disability authority (LIDDA) must submit one of the following to Texas Health and Human Services Commission (HHSC) by the due date described in 13231, Enrollment Due Dates:

  • Form 8601, Verification of Freedom of Choice (See 13214, Accepting the Offer, and 13213, Declining the Offer);  
  • A request to withdraw the HCS slot offer (See 13212, Withdrawal of HCS Offer; or
  • Have an approved extension from HHSC (See 13232, Requesting an Extension).

13234 Determination of Intellectual Disability (DID)

Revision 20-4; Effective October 15, 2020

The local intellectual and developmental disability authority (LIDDA) reviews records to determine if the person has a diagnosis of an intellectual disability. The LIDDA must use the Determination of Intellectual Disability (DID) Best Practice Guidelines and conduct a new DID or endorse a previous DID.

  • If there is a DID on record, the LIDDA must update the diagnostic information, if necessary; or
  • If there is no DID or comprehensive diagnosis and evaluation on record, the LIDDA must schedule and complete a new DID.

Related Conditions: The LIDDA verifies a related condition diagnosis with documentation from a physician. The LIDDA verifies that the person has been diagnosed by a licensed physician as having a related condition and meets specific requirements for intelligence quotient (IQ).

13235 Level of Care (LOC) and Level of Need (LON)

Revision 22-2; Effective July 22, 2022

An LOC is a person’s eligibility determination based on the diagnostic and functional data submitted on the Intellectual Disability and Related Conditions (ID/RC) Assessment. An LON corresponds to the payment rate the provider receives for providing certain Home and Community-based Services to the person. LON is not a criterion for program enrollment.

The local intellectual and developmental disability authority administers the Inventory for Client and Agency Planning for the person to determine a recommended LOC and LON. The LIDDA submits Form 8578, Intellectual Disability/Related Condition Assessment on the Texas Medicaid & Healthcare Partnership Long-Term Care Online Portal. See Section 13241, Form Submission for Enrollment.

13235.1 HHSC Activities

Revision 22-2; Effective July 22, 2022

Texas Health and Human Services Commission (HHSC) Program Eligibility and Support (PES) conducts a preliminary review of Form 8578, Intellectual Disability/Related Condition Assessment to determine level of care (LOC) eligibility. If supporting documentation is needed for PES to conduct a full review, PES remands the form to the LIDDA with a note requesting that the LIDDA submit supporting documentation. The LIDDA uses the Form Search Inquiry (FSI) tab on the Long-Term Care (LTC) Online Portal to search for Form 8578 with a purpose code 2 and a “Remanded to Submitter” form status. The LIDDA must immediately submit the requested documentation to PES through the IDD Operations Portal .

  • If PES determines that the program’s LOC eligibility criteria is NOT met, PES denies Form 8578 on the LTC Online Portal. The form status is “LOC Denied.” The HCS or TxHmL Pre-enrollment Form status automatically updates to “Denied – Not Functionally Eligible” and the person’s Community Services Interest List (CSIL) record for the program is “Closed” with the applicable closure reason. See Section 7600, CSIL Status Designations. PES mails a letter to the person or legally authorized representative (LAR) notifying them of the enrollment denial. 
  • If PES determines that the program’s LOC eligibility criteria is met, PES approves Form 8578 and assigns an appropriate level of need (LON). The form status is “Pending IPC Match.” The LIDDA submits Form 3608, Individual Plan of Care (IPC) - HCS/CFC on the LTC Online Portal. See Section 13241, Form Submission for Enrollment.

PES conducts a preliminary review of Form 3608 for programmatic eligibility. If PES determines that a full review is necessary, PES makes a referral to Utilization Review (UR). If supporting documentation is needed for UR to conduct a full review, UR remands the form to the LIDDA with a note requesting that the LIDDA submit supporting documentation. The LIDDA uses the FSI tab on the LTC Online Portal to search for Form 3608 with an IPC Type of “Initial Enrollment” and a “Remanded to Submitter” form status. The LIDDA must immediately submit the requested documentation to UR through the IDD Operations Portal.

While Form 3608 is under review, PES attempts to verify financial eligibility (Medicaid). PES authorizes enrollment only if Form 3608 is approved and Medicaid has been verified. 

  • If enrollment is authorized, the status of Form 3608 and Form 8578 is “Processed/Complete.” The HCS or TxHmL Pre-enrollment Form status is “Enrolled” and the person’s CSIL record for the program is “Closed” with the applicable closure reason. See Section 7600, CSIL Status Designations. PES mails a letter to the person or LAR notifying them of the enrollment authorization and begin date.
  • If enrollment is denied, the status of Form 3608 and Form 8578 is “Denied Due to Financially Ineligibility.” The HCS or TxHmL Pre-enrollment Form status is “Denied-Not Financially Eligible.” and the person’s CSIL record for the program is “Closed” with the applicable closure reason. See Section 7600, CSIL Status Designations. PES mails a letter to the person or LAR notifying them of the enrollment denial and their right to request a fair hearing to appeal PES’ decision.

The LIDDA may contact PES for more guidance on Inventory for Client and Agency Planning, LOC, LON or ID/RC. 

13236 Permanency Planning

Revision 20-4; Effective October 15, 2020

If a person is under age 22 and enrolling in Home and Community-based Services (HCS) from a family-based setting into an HCS residential setting (i.e., residential support services or supervised living), the LIDDA must conduct permanency planning at the time of the person’s enrollment. A description of his/her permanency planning outcomes must be included in the person-directed plan (PDP). The permanency plan must be completed in accordance with the rules governing the HCS program, specifically 40 Texas Administrative Code §9.167, and the LIDDA Performance Contract.

Note: Refer to the HHSC website for guidance and required forms on Permanency Planning for Children.

13237 Consumer Directed Services

Revision 20-4; Effective October 15, 2020

If a person lives in his/her own home or a family's home (OHFH) and supported home living, respite, nursing, cognitive rehabilitation therapy, supported employment, employment assistance or Community First Choice Personal Assistance Services/Habilitation (CFC PAS/HAB) is identified on the person-directed plan (PDP), the local intellectual and developmental disability authority (LIDDA) service coordinator must inform the person or their legally authorized representative (LAR) of the right to participate in the Consumer Directed Services (CDS) option. The LIDDA must review the following HHSC forms with the person or LAR:

  • Form 1581, Consumer Directed Services (CDS) Option Overview;
  • Form 1582, Consumer Directed Services Responsibilities;
  • Form 1583, Employee Qualification Requirements;
  • Form 1584, Consumer Participation Choice; and
  • Form 1586, Acknowledgment of Information Regarding Support Consultation Services in the Consumer Directed Services (CDS) Option.

The LIDDA starts with Form 1581 and if the person or LAR is interested in the CDS option, moves to the next form. However, at any point, if the person or LAR declines the CDS option, the LIDDA can complete Form 1584 indicating the person’s choice is the "Agency Option" and omit the remaining forms.

Form 1581 is an introduction to the CDS option. It includes an explanation of the differences between the CDS option and the provider-managed option. The person or LAR signs this form to acknowledge having received a verbal and written explanation of the CDS option in the Home and Community-based Services (HCS) program from the LIDDA.

Form 1582 provides detailed information about the responsibilities of using the CDS option. It includes a CDS Consumer Self-Assessment to be used by the LIDDA to:

  • assist the person or LAR to decide if they want to self-direct services; and
  • determine supports the person or LAR might need to successfully self-direct services.

The self-assessment is not meant to determine whether a person or LAR is able to self-direct services. If a person or their LAR has difficulty responding to the self-assessment questions, it is likely a designated representative (DR) is needed to assist the person or LAR to implement the CDS option. If the person or LAR chooses to self-direct services, they must select a financial management services agency (FMSA). It is the FMSA’s responsibility to assist the person or LAR with appointing a DR.

Form 1583 provides important definitions used with the CDS option. It includes information about who can be a CDS employer, who can be a DR and who can and cannot be hired as an employee in the CDS option for HCS.

Form 1584 is used to document the person’s or LAR’s service delivery option.

If the person or LAR chooses to self-direct services, they must select an FMSA. The LIDDA prints a list of FMSAs serving the person’s local service area from the HHSC financial management services agency website. The LIDDA should encourage the person or LAR to call and interview several FMSAs before selecting one.

FMSAs are not required to be in the town where the person resides. FMSAs provide a monthly financial management services (FMS) to the person. FMS does not require ongoing face-to-face contact. While FMSAs are required to make one visit to the person’s home to conduct the CDS orientation prior to initiating service, the FMSA conducts the remainder of their business electronically with the person or LAR or, if appointed, the DR.

Form 1586 provides information to the person or LAR about support consultation in the HCS program, which is optional. Support consultation includes practical skills training, coaching and assistance related to:

  • principles of self-determination;
  • recruiting, screening and hiring workers;
  • completing documents and assessments required to employ a person, retain a contractor or vendor, and manage service providers;
  • negotiating service agreements, including pricing and scheduling services, goods and items;
  • effective communication, decision-making and problem-solving skills to meet employer responsibilities;
  • tools for accessing information, resources and assistance;
  • contacting appropriate persons or entities based on their roles, responsibilities and eligibility related to the person’s program or the CDS option;
  • participating in service planning team meetings at the employer's request; and
  • complying with requirements of the person’s program as related to services delivered through the CDS option.

If the person or LAR requests support consultation, it must be included in the PDP and the individual plan of care (IPC).

If the person or LAR chooses to participate in the CDS option, the LIDDA must document a description of the service components provided through CDS in the person’s PDP and whether the service is critical to meeting the person’s health and safety and would need a service back-up plan.

13238 Money Follows the Person Demonstration Participation Process

Revision 24-1; Effective March 1, 2024

Money Follows the Person Demonstration (MFPD) is a federal initiative that helps older adults and people with disabilities move from institutional settings back into their communities to receive services.

Participating in MFPD enables the state to receive matching funds from Medicaid for eligible services, which helps expand community living opportunities to other people with intellectual and developmental disabilities. Participation provides funding for initiatives such as Enhanced Community Coordination (ECC) and Transition Support Teams (TSTs).

The local intellectual and developmental disability authority (LIDDA) must determine if each person is eligible to participate. 

To participate in MFPD, a person must:

  • be receiving Medicaid;
  • be living in a nursing facility, state supported living center (SSLC) or medium or large, nine or more beds, intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID) for at least 60 straight days; 
    Note: Days spent in a hospital or skilled nursing facility count toward these 60 days.
  • be eligible for one of the following Texas Medicaid waiver programs: 
    • Home and Community-based Services (HCS);
    • STAR+PLUS Home and Community Based Services (HCBS); and
  • be planning to transition out of a nursing facility, SSLC or ICF/IID.

13238.1 Form 1580, Texas Money Follows the Person Demonstration (MFPD) Project Informed Consent for Participation

Revision 24-1; Effective March 1, 2024

If the person is eligible for the MFPD Project, the local intellectual and developmental disability authority (LIDDA) must:

  • present the MFPD brochure and provide the person or legally authorized representative (LAR) with a brief explanation of the project using the information in the brochure;
  • inform the person or LAR there are no requirements for participation other than to agree to participate and sign the form; 
  • complete Form 1580, Texas Money Follows the Person Demonstration Project Informed Consent for Participation, to make sure consent or lack of consent is indicated; 
  • get the person’s or LAR’s signature and information, regardless of their decision;
  • attest that the LIDDA has verified the person resided in an institutional setting for 60 continuous days before enrolling in Home and Community-based Services (HCS) by signing the form; and 
  • complete the area “For Official Use Only,” compare admission dates to the discharge date to verify the person spent at least 60 days of residency in an institution. 

The LIDDA must complete the form as soon as possible and use an encrypted email to send it to MFPProject@hhsc.state.tx.us and IDDMFPSubmissions@hhs.texas.gov immediately after completion. The LIDDA must send the form by two weeks before the facility discharges the person.

Texas Health and Human Services Commission (HHSC) will return any submitted forms with errors or omissions to the LIDDA for revision. 

The LIDDA must check the MFP box located on the Pre-Enrollment Form in Texas Medicaid and Healthcare Partnership (TMHP) for people who agree to participate in the MFPD project.

Participation in the MFPD Project is voluntary. People who decline to participate still may receive Medicaid home and community-based waiver services if they qualify.

The LIDDA must keep a copy in the person’s files and follow the retention schedule in the LIDDA Performance Contract. The LIDDA must provide a copy of the signed Form 1580 to the person or LAR.

13239 Person-Directed Plan (PDP)

Revision 20-4; Effective October 15, 2020

The local intellectual and developmental disability authority (LIDDA) service coordinator develops a PDP after the authorization for enrollment into the Home and Community-based Services (HCS) program has been approved, with the person or legally authorized representative (LAR) using the Person Directed Planning Guidelines (PDF), the Discovery Guide and the Appendix IV, Discovery Tool. Form 8665, Person Directed Plan, is used to document the information gathered through the discovery process.

13240 Individual Plan of Care (IPC)

Revision 20-4; Effective October 15, 2020

The local intellectual and developmental disability authority (LIDDA) service coordinator initiates development of a proposed individual plan of care (IPC) to document the number of units or hours of each service component identified on the person-directed plan (PDP) that will be needed for an IPC year. The IPC must include both Home and Community-based Services (HCS) and non-waiver services.

After the person has chosen an HCS program provider and/or a financial management services agency (FMSA), the service coordinator must conduct a meeting with the program provider to review the initial proposed IPC and develop a final proposed IPC.

If the person or legally authorized representative (LAR) chooses a program provider to deliver supported home living, nursing, host home/companion care, residential support, supervised living, respite, employment assistance, supported employment, day habilitation or Community First Choice (CFC) PAS/HAB, the LIDDA must ensure the initial proposed IPC complies with 40 Texas Administrative Code (TAC), §9.158(9) and (10).

The IPC must comply with the requirements in 40 TAC, §9.159. The LIDDA ensures all the appropriate persons have signed the hard copy IPC.

After enrollment, a program provider can initiate development of a proposed revised IPC for the person as required by 40 TAC, §9.166.

13241 Form Submission for Enrollment

Revision 22-2; Effective July 22, 2022

To request a person’s Home and Community-based Services (HCS) enrollment, the local intellectual and developmental disability authority (LIDDA) must submit the following forms on the Texas Medicaid & Healthcare Partnership (TMHP) Long-Term Care (LTC) Online Portal in sequential order:

  • HCS or TxHmL Pre-Enrollment Form;
  • 8578 ID/RC Assessment with 2=No Current Assessment selected in the Purpose Code field; and
  • 3608 Individual Plan of Care with Initial Enrollment selected in the IPC Type field.

The LIDDA must only submit 3608 Individual Plan of Care on the LTC Online Portal if the status of 8578 ID/RC Assessment is “Pending IPC Match.”

When the LIDDA has submitted both 8578 ID/RC Assessment and 3608 Individual Plan of Care, the status of the HCS or TxHmL Pre-enrollment Form is automatically updated to “Pending Enrollment.”

The LIDDA must use Form Search Inquiry on the LTC Online Portal weekly to check the status of 8578 ID/RC Assessment and 3608 Individual Plan of Care.

  • If the status of 8578 ID/RC Assessment or 3608 Individual Plan of Care is “Remanded to Submitter,” the LIDDA must immediately submit the requested documentation through the IDD Operations Portal and click the “Add Note” button on the form on the LTC Online Portal to resubmit the form to HHSC.
  • If the status of 8578 ID/RC Assessment or 3608 Individual Plan of Care is “Rejected by SAS,” the LIDDA must contact Program Eligibility and Support (PES) at enrollmenttransferdischargeinfo@hhsc.state.tx.us for assistance.
  • If the status of 8578 ID/RC Assessment and 3608 Individual Plan of Care is “Processed/Complete,” the enrollment process is complete. The status of the HCS or TxHmL Pre-Enrollment Form is automatically updated based on the action taken on 8578 ID/RC Assessment and 3608 Individual Plan of Care and the person’s CSIL record for the program is “Closed” with the applicable closure reason. See Section 7600, CSIL Status Designations.

PES reviews HCS pending enrollments twice per week. The LIDDA must ensure all three forms have been submitted on the LTC Online Portal before contacting PES about the status of an enrollment or requesting an extension of the enrollment due date from Local Procedure Development and Support. See Section 13232, Requesting an Extension of the Enrollment Due Date.

13242 Records

Revision 20-4; Effective October 22, 2020

Prior to the service begin date, the local intellectual and developmental disability authority (LIDDA) must provide the program provider and with the following information:

  • Person-Directed Plan (PDP);
  • Individual Plan of Care (IPC);
  • Intellectual Disability/Related Condition (ID/RC) assessment;
  • Inventory for Client and Agency Planning (ICAP) assessment booklet and scoring sheet; and
  • Other documents or information pertinent to the person that is helpful in assisting the provider in serving the person [e.g., previous services plan, medical information, assessment results, determination of intellectual disability (DID)].

The LIDDA must retain the following documents in the person’s record:

  • Form 8601, Verification of Freedom of Choice;
  • Form 1049, Initial Documentation of Provider Choice; and
  • Any other correspondence related to the Home and Community-based Services (HCS) offer.

13250 Additional Procedures for HCS

Revision 20-4; Effective October 15, 2020

13251 Nursing Facility Diversion and Transition

Revision 22-2; Effective July 22, 2022

See the Intellectual and Developmental Disability Preadmission Screening and Resident Review (IDD-PASRR) Handbook for details on a nursing facility (NF) diversion or NF transition, criteria and the process for requesting a NF slot.

13252 Enrollment from an ICF/IID

Revision 20-4; Effective October 15, 2020

For persons enrolling from an intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID), the enrollment process is the same as listed in Section 13230, Enrollment Process. However, the LIDDA must notify the person or legally authorized representative (LAR) of the requirement to respond to the opportunity to enroll within 20 days of the notification.

For information regarding enrollments into the Home and Community-based Services (HCS) program from a State Support Living Center (SSLC), see Section 9400, Enrollment in HCS as an SSLC Transition.

13253 Assisting with Medicaid Eligibility

Revision 20-4; Effective October 15, 2020

A person must be verified for an eligible Medicaid program that pays for Home and Community-based Services (HCS) on the individual plan of care (IPC) begin date for the enrollment to be approved. Refer to Section 15000, Pre-Enrollment Activities and Financial Eligibility Related to HCS and TxHmL, for the Medicaid program types accepted for the HCS program.

13254 Medicare Requirements

Revision 20-4; Effective October 15, 2020

The local intellectual and developmental disability authority (LIDDA) determines whether the person is a Medicare beneficiary. Refer to Section 15000, Pre-Enrollment Activities and Financial Eligibility Related to HCS and TxHmL, for the steps to take if someone is a Medicare beneficiary.

13255 Use of LIDDA Enrollment SFTP Site Instructions

Revision 20-4; Effective October 15, 2020

The secure file transfer protocol (SFTP) is a secure site that Texas Health and Human Services Commission (HHSC) requires the local intellectual and developmental disability authority (LIDDA) to use for submission of certain documents related to HCS and TxHmL slot releases and the Medicaid Estate Recovery Program (MERP) forms within the MRA Enrollment folder. To gain access to SFTP, send an email to LIDDARequests@hhsc.state.tx.us.

Documents must be uploaded to the SFTP as a portable document format (PDF). To upload a document, it must be closed; this is a common oversight. The SFTP is used to transfer documents; not for storage. HHSC recommends documents be claimed within seven calendar days from posting and deleted within one month.

To access the SFTP, the user must have been granted access by HHSC Information Technology Security and must be able to access to the internet. Once access to the SFTP has been granted, copy/paste or type the following path into the internet web browser: https://sftp.hhs.texas.gov/EFTClient/Account/Login.htm. In the MRA Enrollment folder, there are two subfolders, the IN folder and the OUT folder:

  • IN folder:
    • HHSC uploads files for the LIDDA in this folder;
    • The LIDDA copies or drags the files from the folder within seven calendar days, as recommended by HHSC;
    • The LIDDA deletes the files from the folder within one month, as recommended by HHSC; and
    • The LIDDA does not upload documents to this folder.
  • OUT folder:
    • The LIDDA uploads scans, and uploads or drags files, from their computer to the OUT folder;
    • HHSC copies or drags the files from the folder within seven calendar days; and
    • HHSC deletes the files from the folder within one month.

When uploading VFC or MERP forms to HHSC via the SFTP, the LIDDA must use the following naming conventions:

  • Form 8601, Verification of Freedom of Choice – Last name, first initial, VFC, slot number, A or D. The slot number is on the offer notice form HHSC.
    Examples: SmithJVFC30A.pdf (for acceptance) or SmithJVFC30D.pdf (for decline)
     
  • Medicaid Estate Recovery Program – Last name, first name, MERP.
    Example: SmithJerryMERP.pdf

13300 Persons Authorized to Enroll in the TxHmL Program

Revision 20-4; Effective October 15, 2020

Texas Health and Human Services Commission (HHSC) notifies the local intellectual and developmental disability authority (LIDDA), in writing, when the LIDDA is authorized to offer a person enrollment into the Texas Home Living (TxHmL) Program.

13310 Notification of TxHmL Offer

Revision 22-2; Effective July 22, 2022

Texas Health and Human Services Commission (HHSC) strongly encourages local intellectual and developmental disability authorities (LIDDAs) to notify a person or their legally authorized representative (LAR) of a Texas Home Living (TxHmL) enrollment offer within three working days of receiving the notice from HHSC.  

If the LIDDA is unable to reach the person or LAR using the contact information on the person’s Community Services Interest List (CSIL) record, the LIDDA must check the following systems for additional addresses and phone numbers:

HHS applications:

  • Client Assignment and Registration (CARE) system screen C63, Medicaid Eligibility Search
  • Service Authorization System Online (SASO)

Texas Medicaid & Healthcare Partnership (TMHP) applications:

  • TexMed Connect - Medicaid Eligibility and Service Authorization Verification (MESAV)
  • Long-Term Care (LTC) Online Portal

The LIDDA must mail the notice to all addresses and attempt to contact the person or LAR at all available phone numbers. The LIDDA makes a written offer of TxHmL enrollment to the person or LAR by regular U.S. Postal Service (USPS) mail or hand delivery using one of the following:

  • Form 1070, Offer of Texas Home Living (TxHmL) Program (recommended); or
  • its own TxHmL offer letter, which contains the same information as HHSC’s Form 1070 and complies with 40 Texas Administrative Code (TAC), Section 9.1589(d).

Note: The LIDDA must also include Form 8592, Deadline Notification. 

If the LIDDA learns that the person has relocated to another LIDDA’s local service area (LSA), the LIDDA must follow the instructions in Section 13311, Person Relocated to Another LIDDA’s Local Service Area (LSA). If the person or LAR does not respond to the offer of TxHmL notification within 30 calendar days, the LIDDA follows the instructions in Section 13312, Withdrawal of TxHmL Offer.

If the person or LAR responds to the notification letter, the LIDDA schedules a meeting to discuss the TxHmL program and services in detail with the person or LAR. Refer to Section 15000, Pre-Enrollment Activities and Financial Eligibility Related to HCS and TxHmL. Refer to the Initial Meeting Packet checklist (PDF).

If a person is currently receiving LIDDA services funded by General Revenue (GR), the LIDDA must inform the person that, in accordance with 40 TAC Section 9.567(h) and (i), if the person declines the TxHmL program, the LIDDA is required to end the GR services that are like services provided in the TxHmL program.

13311 Person Relocated to Another LIDDA’s Local Service Area (LSA)

Revision 22-2; Effective July 22, 2022

In accordance with the local intellectual and developmental disability authority (LIDDA) Performance Contract, if the authorized LIDDA attempts to contact a person or their legally authorized representative (LAR) and learns that the person or LAR has relocated to another LIDDA’s LSA, the authorized LIDDA must determine the person’s designated LIDDA. See Section 5000, Guidelines for Determining and Changing Designated LIDDA.

If the authorized LIDDA is the designated LIDDA, the authorized LIDDA must continue with all enrollment activities.

If the authorized LIDDA determines that another LIDDA is the designated LIDDA, then the authorized LIDDA must notify the assigned slot monitor at Texas Health and Human Services Commission (HHSC) by email. The authorized LIDDA must :

  • transfer the person’s CSIL record to the designated LIDDA, see Section 7800, When to Transfer a Person’s CSIL Record; and
  • forward the following to the designated LIDDA:
    • a copy of the authorization letter;
    • Form 1049, Initial Documentation of Provider Choice; and
    • a copy of any extensions already obtained.

Once the designated LIDDA receives the information from the authorized LIDDA, the designated LIDDA becomes the authorized LIDDA and is responsible for meeting required time frames for enrollment or requesting an extension, if needed.

13312 Withdrawal of TxHmL Offer

Revision 22-2; Effective July 22, 2022

In accordance with 40 Texas Administrative Code Section 9.567(f), the local intellectual and developmental disability authority (LIDDA) may request that Texas Health and Human Services Commission (HHSC) withdraw the Texas Home Living (TxHmL) offer using Form 8590, Request for Approval to Withdraw an Enrollment Offer, if the person or legally authorized representative (LAR) does not:

  • respond to the TxHmL offer within 30 calendar days after the notification letter was mailed by the LIDDA;
  • document their choice of TxHmL program services using Form 8601, Verification of Freedom of Choice, within seven calendar days after the receipt of the form; 
  • document their choice of program provider using the Form 1049, Initial Documentation of Provider Choice, within 30 calendar days after their receipt of contact information for all program providers in the LIDDA's local service area (LSA); or
  • complete the necessary activities to finalize the enrollment process.

The LIDDA must email the completed Form 8590 to the designated slot monitor using a secure email method. The LIDDA must include the slot type number for the enrollment offer and the type of request in the subject line. Example: “Slot Type 115 - Request for Approval to Withdraw an Enrollment Offer.”

A completed Form 8590 must be submitted in separate attachments for each person, and the LIDDA must name each completed Form 8590 with the following file naming convention: 

  • Person's last name
  • Person's first name
  • Slot type number
  • WD
  • Date of the withdrawal letter

Example: SmithBob115WD10-05-2021

Multiple withdrawal requests sent in one PDF will be returned without being processed.

If Form 8590 is approved, the LIDDA must notify the person or LAR of the withdrawal of TxHmL offer in writing, by certified U.S. Postal Service (USPS) mail using one of the following: 

  • Form 1069, Withdrawal of Offer of Texas Home Living Program (recommended); or
  • its own TxHmL withdrawal letter, which must contain the same information as Form 1069.
     

The LIDDA must email a copy of Form 1069, including the certified mail receipt, to the assigned slot monitor.

If Form 8590 is denied, the LIDDA must follow the instructions provided by the slot monitor. 

When the slot monitor receives a copy of the withdrawal letter and certified mail receipt and confirms the withdrawal notice has been delivered, HHSC changes the interest list status to “Closed” and assigns the appropriate closure reason.

13313 Declining the Offer

Revision 22-2; Effective July 22, 2022

If the person or legally authorized representative (LAR) declines the Texas Home Living (TxHmL) enrollment offer, the local intellectual and developmental disability authority (LIDDA):

  • ensures the person or LAR clearly documents the reason for the decline on Form 8601, Verification of Freedom of Choice;
  • uploads the signed and dated form as a PDF file to the LIDDA Enrollment Secure File Transfer Protocol (SFTP) site (See Section 13255, Use of LIDDA Enrollment SFTP Site Instructions); and
  • if the person is receiving General Revenue (GR) services, the LIDDA terminates the person’s GR services like TxHmL services and notifies the person or LAR in writing by certified U.S. Postal Service (USPS) mail of the termination and the person’s opportunity for a review in accordance with 40 Texas Administrative Code Section 2.46.

As mentioned in Section 13310, Notification of TxHmL Offer, the LIDDA must inform a person who is receiving GR funded services  that, if the person declines the TxHmL enrollment offer, the LIDDA is required to end GR services that are similar to services provided in the TxHmL program. 

Texas Health and Human Services Commission (HHSC) may request the LIDDA provide additional information or documentation for review. HHSC changes the program interest list on the person’s CSIL record to “Closed” and assigns an appropriate closure reason. See Section 7600, CSIL Status Designations.  

If a person requests to remain on the TxHmL interest list after declining the offer to enroll in the program, the LIDDA must:

  • complete a new Form 8648, Identification of Preferences indicating the person wants TxHmL; and
  • add the program’s interest list back to the person’s CSIL record with a new request date. The request date must be at least one day after the date the person declined the program. See Section 7000, HCS and TxHmL Interest Lists.

13314 Accepting the Offer

Revision 22-2; Effective July 22, 2022

If the person or legally authorized representative (LAR) accepts the Texas Home Living (TxHmL) enrollment offer, the local intellectual and developmental disability authority (LIDDA) gives the person or their LAR Form 8601, Verification of Freedom of Choice. The person or their LAR must sign and complete Form 8601 within seven days. The LIDDA must:

  • upload the signed and dated form as a PDF file to the LIDDA Enrollment Secure File Transfer Protocol (SFTP) site. (See Section 13255, Use of LIDDA Enrollment SFTP Site Instructions); and
  • submit the HCS or TxHmL Pre-enrollment Form on the Texas Medicaid & Healthcare Partnership (TMHP) Long-Term Care (LTC) Online Portal.

The LIDDA must discuss the provider selection process with the person or LAR in addition to:

  • retrieving a current list of TxHmL program providers in the LIDDA’s local service area from the Client Assignment and Registration (CARE) screen C95, Provider Roster Inquiry;
  • providing the list to the person or LAR; and
  • explaining to the person or LAR that they may choose any contracted TxHmL program provider identified on the list who has not reached its service capacity and they must select a program provider within 30 calendar days from the date they received the list from the LIDDA.

Although the LIDDA must not direct the person or LAR to choose a specific program provider, the LIDDA may assist the person or LAR with the following:

  • identifying what is important to the person or LAR about a provider (e.g., location, staffing patterns, provider experience with certain disabilities);
  • recommending specific questions to ask the providers – the Explanation of IDD Services and Supports document contains suggested questions they may use to interview the provider; and
  • contacting and arranging visits to the providers the person or LAR has indicated they would like to know more about.

The LIDDA must instruct the person or LAR to document their selection of the program provider on Form 1049, Initial Documentation of Provider Choice.

If the person or LAR chooses to self-direct all their services using the Consumer Directed Services (CDS) option, this form is not required. See Section 13336, Consumer Directed Services (CDS).

If the LIDDA operates a TxHmL public provider program and is selected by the person or LAR as the TxHmL program provider, the LIDDA must complete Form 1052, Public Provider Choice Request.

Before submitting the form, the LIDDA must determine whether its TxHmL public provider program is operating at or over its capacity as identified in CARE Screen C70 as “CAP.”

  • If the LIDDA TxHmL public provider program is operating under its capacity, only the top section and Section IV of Form 1052 must be completed. 
  • If the LIDDA TxHmL public provider program is operating at or over its capacity, Form 1052 must be completed in its entirety. 
  • Note: If the LIDDA HCS public provider program is operating at or over its capacity, the LIDDA must not:
    • initiate an offer of its capped waiver services to a family or person nor prompt a family or person to consider its services; 
    • participate as an available provider in any provider fairs or other provider marketing opportunities; or
    • include its waiver services on the list of providers shared with families and persons.
  • Regardless of whether the LIDDA is over or under its capacity, the Individual Plan of Care (IPC) Effective Date in the top section of Form 1052 must be filled out with a date. Entries such as “To Be Determined,” “Unknown,” or blank will be returned for correction. If the IPC effective date is unknown, the LIDDA must enter the date the form is being completed. The LIDDA submits Form 1052 to  LIDDARequests@hhs.texas.gov  with the subject line “Form 1052.” If a secure email is needed, the LIDDA can request one.
    • Note: The LIDDA must not submit the initial enrollment Form 8582 , Individual Plan of Care on the LTC Online Portal until Form 1052 has been approved by HHSC.

13320 Initial Meeting

Revision 20-4; Effective October 15, 2020

The initial meeting is to be conducted with the person and their legally authorized representative (LAR), or actively involved family member. The local intellectual and developmental disability authority (LIDDA) shall provide both an oral and a written explanation of the services and supports for which the person may be eligible using Texas Health and Human Services Commission (HHSC) documents listed in the LIDDA Initial Meeting Packet Checklist (PDF). The LIDDA must also ensure the person or LAR is provided information about the Medicaid Estate Recovery Program (MERP) once they have chosen to enroll in the Texas Home Living (TxHmL) program as described in Section 14000, Medicaid Estate Recovery Program (MERP) Overview, using Form 8001, Medicaid Estate Recovery Program Receipt Acknowledgement.

13321 Person Selects Provider in Another LIDDA’s LSA

Revision 22-2; Effective July 22, 2022

In accordance with the local intellectual and developmental disability authority (LIDDA) Performance Contract, if the authorized LIDDA contacts a person or legally authorized representative (LAR) and begins the enrollment process and the person or LAR selects a provider or financial management services agency (FMSA) in a different LIDDA’s local service area (LSA), the authorized LIDDA must conduct all applicable pre-enrollment activities, such as:

  • explaining services;
  • obtaining the person’s or LAR’s signature on Form 8601, Verification of Freedom of Choice;
  • submitting signed Form 8601 to HHSC using the Secure File Transfer Protocol (SFTP) site (See Section 13255, Use of LIDDA Enrollment SFTP Site Instructions);
  • submitting the HCS or TxHmL Pre-enrollment Form on the Texas Medicaid & Healthcare Partnership (TMHP) Long-Term Care (LTC) Online Portal;
  • conducting diagnostic activities and completing the determination of intellectual disability; 
  • submitting the 8578 Intellectual ID/RC Assessment on the TMHP LTC Online Portal; 
  • collecting Medicaid eligibility information;
  • completing an initial person-directed plan (PDP);
  • completing a proposed individual plan of care (IPC);
  • requesting an enrollment extension if the enrollment will not be completed by the originally assigned or extended time frame;
  • updating the county of residence and address on the “Personal Information” page in the person’s Community Services Interest List (CSIL) record to transfer the person’s CSIL record to the LIDDA in which the selected provider operates;
  • providing the initial PDP to the provider and completing the IPC negotiations with the provider; and
  • sending hard copies of all enrollment documents to the receiving LIDDA, including Form 1049, Initial Documentation of Provider Choice, and any enrollment extensions already approved.

Important: The LIDDA must change the county of residence on the “Personal Information” page in CSIL. Changing the county of residence on the “Interest List” page will only transfer that program interest list. See Section 7800, When to Transfer a Person’s CSIL Record.
Once the receiving LIDDA receives the information from the authorized LIDDA, the receiving LIDDA must: 

  • determine if the person is currently enrolled in another waiver program as described in Section 15100 , Research Preventing Dual Enrollment and Section 15200 , Persons Enrolled in STAR+PLUS Waiver (SPW) or MDCP ;
  • submit the enrollment IPC on the THMP LTC Online Portal; 
  • meet required time frames for enrollment; and
  • request an extension if the enrollment is not expected to be approved by the required time frame. See Section 13332, Requesting an Extension.

If the transferring LIDDA did not submit the HCS or TxHmL Pre-enrollment Form and Form 8578 on the LTC Online Portal before transferring the person’s CSIL record, the receiving LIDDA must submit the HCS or TxHmL Pre-enrollment form and Form 8578 on the LTC Online Portal before submitting Form 8582 on the LTC Online Portal. See Section 13339, Form Submission for Enrollment.

13322 Person is Enrolled in a Mutually Exclusive Waiver Program

Revision 22-2; Effective July 22, 2022

When a person accepts a Texas Home Living (TxHmL) enrollment offer, the local intellectual and developmental disability authority (LIDDA) must determine if the person is currently enrolled in a mutually exclusive program. See Appendix I, Mutually Exclusive Services.

The LIDDA must check the following systems:

HHS applications: 

  • Client Assignment and Registration (CARE) – C63, Medicaid Eligibility Search
  • Service Authorization System Online (SASO) (See Section 15100 , Research Preventing Dual Enrollment for SASO instructions)

Texas Medicaid & Healthcare Partnership (TMHP) applications:

  • TexMed Connect - Medicaid Eligibility and Service Authorization Verification (MESAV)
  • Long-Term Care (LTC) Online Portal

Enrollment information for the Medically Dependent Children Program (MDCP) is only available on the LTC Online Portal.

To allow Program Eligibility and Support enough time to process the enrollment before the first day of the month, by the 20th day of the month before the TxHmL begin date, the LIDDA must submit the HCS or TxHmL Pre-enrollment Form, 8578 ID/RC Assessment and 8582 Individual Plan of Care on the Texas Medicaid & Healthcare Partnership Long-Term Care Online Portal. See Section 13339, Form Submission for Enrollment.

Example: A person is enrolled in the STAR+PLUS Waiver on March 15. The MCO has been paid through March 31. The person can discharge from STAR+PLUS on March 31 and enroll in HCS on April 1 if the LIDDA completed the enrollment process and submitted all enrollment forms on the TMHP LTC Online Portal by March 20. Otherwise, the STAR+PLUS discharge date must be changed to April 30. The TxHmL enrollment begin date must change to May 1 and the LIDDA must complete the forms on the TMHP LTC Online Portal by April 20. 

13330 Enrollment Process

Revision 20-4; Effective October 15, 2020

The local intellectual and developmental disability authority (LIDDA) must conduct pre-enrollment activities outlined in Section 15000, Pre-enrollment Activities and Financial Eligibility Related to HCS and TxHmL, and Section 14000, Medicaid Estate Recovery Program (MERP) Overview.

13331 Enrollment Due Dates

Revision 22-2; Effective July 22, 2022

An enrollment due date is the date Texas Health and Human Services Commission (HHSC) expects the local intellectual and developmental disability authority (LIDDA) to complete the enrollment process for a person. The LIDDA must complete the process by the enrollment due date as described below or have an extension approved by HHSC. Due dates are:

  • 75 calendar days from the date of HHSC’s notice for a person who is residing in their own home or family member’s home; or
  • 90 calendar days from the date of HHSC’s notice for a person who is currently residing in a facility, including a nursing facility, state hospital, state supported living center or intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID).

Note: The LIDDA must notify the assigned slot monitor if the person resides in a facility.

The LIDDA must request an extension if the process cannot be completed by the due date. See Section 13332, Requesting an Extension.

HHSC considers the enrollment process to be “complete” when the person’s enrollment has been processes by HHSC and the person’s Community Services Interest List (CSIL) record for the program is “Closed” with the applicable closure reason. See Section 7600, CSIL Status Designations. 

13332 Requesting an Extension of the Enrollment Due Date

Revision 22-2; Effective July 22, 2022

Texas Health and Human Services Commission (HHSC) may approve an extension of the enrollment due date if the local intellectual and developmental disability authority (LIDDA) is able to demonstrate, in writing, the LIDDA attempted to complete the process timely but unavoidable circumstances resulted in delays the LIDDA could not prevent. To request an extension, the LIDDA must submit a completed Form 1045, Request for Enrollment Extension of Enrollment Offer Due Date, to HHSC. If the reason for delay is due to a The LIDDA must not wait for the outcome of a pending Medicaid application to submit the HCS or TxHmL Pre-enrollment Form, Form 8578, Intellectual Disability/Related Condition (ID/RC), and Form 8582, Individual Plan of Care on the Texas Medicaid & Healthcare Partnership (TMHP) Long-Term Care (LTC) Online Portal. See Section 13339, Form Submission for Enrollment.

Note: HHSC does not approve an extension request for a quarter if it is received after the 15th day of the last month of the quarter.

13333 Processing the Offer Before the Due Dates

Revision 20-4; Effective October 15, 2020

The local intellectual and developmental disability authority (LIDDA) must submit one of the following to Texas Health and Human Services Commission (HHSC) by the due date described in Section 13331, Enrollment Due Dates:

13334 Determination of Intellectual Disability (DID)

Revision 20-4; Effective October 15, 2020

The local intellectual and developmental disability authority (LIDDA) reviews a person’s records to determine if the person has a diagnosis of an intellectual disability. The LIDDA must use the Determination of Intellectual Disability (DID) Best Practice Guidelines and conduct a new DID or endorse a previous DID.

  • If there is a DID on record, the LIDDA must update the diagnostic information, if necessary; or
  • If there is no DID or comprehensive diagnosis and evaluation on record, the LIDDA must schedule and complete a new DID.

Related Conditions: The LIDDA verifies a related condition (PDF) diagnosis with documentation from a physician. The LIDDA verifies that the person has been diagnosed by a licensed physician as having a related condition and meets specific requirements for intelligence quotient (IQ).

13335 Level of Care (LOC) and Level of Need (LON)

Revision 22-2; Effective July 22, 2022

An LOC is a person’s eligibility determination based on the diagnostic and functional data submitted on the Intellectual Disability and Related Conditions (ID/RC) Assessment. An LON is a payment rate the provider receives for providing Texas Home Living services to the person. LON is not a criterion for program enrollment.

To determine a recommended LOC/LON, the local intellectual and developmental disability authority (LIDDA) administers the Inventory for Client and Agency Planning for the person The LIDDA submits Form 8578, Intellectual Disability/Related Condition (ID/RC) Assessment on the Texas Medicaid & Healthcare Partnership Long-Term Care Online Portal. See Section 13339, Form Submission for Enrollment.

13335.1 HHSC Activities

Revision 22-2; Effective July 22, 2022

Texas Health and Human Services Commission (HHSC) Program Eligibility and Support (PES) conducts a preliminary review of Form 8578 , Intellectual Disability and Related Condition (ID/RC) Assessment, for level of care (LOC) eligibility. If supporting documentation is needed for PES to conduct a full review, PES returns the form to the local intellectual and developmental disability authority (LIDDA) on the Texas Medicaid & Healthcare Partnership (TMHP) Long-Term Care (LTC) Online Portal with a note requesting the LIDDA to submit supporting documentation. The LIDDA must use the Form Search Inquiry (FSI) tab on the TMHP LTC Online Portal to search for Form 8578 with a Purpose Code 2 and a “Remanded to Submitter” form status. The LIDDA must immediately submit the requested documentation to PES through the IDD Operations Portal.

  • If PES determines that the program’s LOC eligibility criteria is not met, PES denies Form 8578 on the LTC Online Portal. The form status is “LOC Denied.” The HCS or TxHmL Pre-enrollment Form status automatically updates to “Denied – Not Functionally Eligible” and the person’s Community Services Interest List (CSIL) record for the program is “Closed” with the applicable closure reason. See Section 7600, CSIL Status Designations. PES mails a letter to the person or legally authorized representative (LAR) notifying them of the enrollment denial.

If PES determines that the program’s LOC eligibility criteria is met, PES approves Form 8578 and assigns an appropriate level of need (LON). The LIDDA submits Form 8582, Individual Plan of Care on the LTC Online Portal. See Section 13339, Form Submission for Enrollment. PES conducts a preliminary review of Form 8582 for programmatic eligibility. If PES determines that a full review is necessary, PES makes a referral to Utilization Review (UR). If supporting documentation is needed for UR to conduct a full review, UR remands the form to the LIDDA with a note requesting that the LIDDA submit supporting documentation. The LIDDA uses the FSI tab on the LTC Online Portal to search for Form 8582 with an IPC Type of “Initial Enrollment” and a “Remanded to Submitter” form status. The LIDDA must immediately submit the requested documentation to UR through the IDD Operations Portal.

While Form 8582 is under review, PES attempts to verify financial eligibility (Medicaid). PES authorizes enrollment only if Form 8582 is approved and Medicaid has been verified.

  • If enrollment is authorized, the status of Form 8582 and Form 8578 is “Processed/Complete.” The HCS or TxHmL Pre-enrollment Form status is “Enrolled” and the person’s CSIL record for the program is “Closed” with the applicable closure reason. See Section 7600, CSIL Status Designations. PES mails a letter to the person or LAR notifying them of the enrollment authorization and begin date.
  • If enrollment is denied, the status of Form 8582 and Form 8578 is “Denied Due to Financially Ineligibility.” The HCS or TxHmL Pre-enrollment Form status is “Denied-Not Financially Eligible.” and the person’s CSIL record for the program is “Closed” with the applicable closure reason. See Section 7600, CSIL Status Designations. PES mails a letter to the person or LAR notifying them of the enrollment denial and their right to request a fair hearing to appeal PES’ decision.

For additional guidance on Inventory for Client and Agency Planning, LOC, LON  or ID/RC, the LIDDA may contact PES .

13336 Consumer Directed Services (CDS)

Revision 20-4; Effective October 15, 2020

The local intellectual and developmental disability authority (LIDDA) service coordinator must inform the person or their legally authorized representative (LAR) of the right to participate in the CDS option. The LIDDA must review the following HHSC forms with the person or LAR:

  • Form 1581, Consumer Directed Services (CDS) Option Overview;  
  • Form 1582, Consumer Directed Services Responsibilities;
  • Form 1583, Employee Qualification Requirements;
  • Form 1584, Consumer Participation Choice; and
  • Form 1586, Acknowledgment of Information Regarding Support Consultation Services in the Consumer Directed Services (CDS) Option.

The LIDDA starts with Form 1581 and if the person or LAR is interested in the CDS option, moves to the next form. However, at any point, if the person or LAR declines the CDS option, the LIDDA can complete Form 1584 indicating the person’s choice is the "Agency Option" and omit the remaining forms.

Form 1581 is an introduction to the CDS option. It includes an explanation of the differences between the CDS option and the provider-managed option. The person or LAR signs this form to acknowledge having received a verbal and written explanation of the CDS option in the Texas Home Living (TxHmL) program from the LIDDA.

Form 1582 provides detailed information about the responsibilities of using the CDS option. It includes a CDS Consumer Self-Assessment to be used by the LIDDA to:

  • assist the person or LAR to decide if they want to self-direct services; and
  • determine supports the person or LAR might need to successfully self-direct services.

The self-assessment is not meant to determine whether a person or LAR is able to self-direct services. If a person or their LAR has difficulty responding to the self-assessment questions, it is likely a designated representative (DR) is needed to assist the person or LAR to implement the CDS option. If the person or LAR chooses to self-direct services, they must select a financial management services agency (FMSA). It is the FMSA’s responsibility to assist the person or LAR with appointing a DR.

Form 1583 provides important definitions used with the CDS option. It includes information about who can be a CDS employer, who can be a DR and who can and cannot be hired as an employee in the CDS option for TxHmL.

Form 1584 is used to document the person’s or LAR’s service delivery option.
If the person or LAR chooses to self-direct services, they must select an FMSA. The LIDDA prints a list of FMSAs serving the person’s local service area from the HHSC financial management services agency website. The LIDDA should encourage the person or LAR to call and interview several FMSAs before selecting one.

FMSAs are not required to be in the town where the person resides. FMSAs provide a monthly financial management services (FMS) to the person. FMS does not require ongoing face-to-face contact. While FMSAs are required to make one visit to the person’s home to conduct the CDS orientation prior to initiating service, the FMSA conducts the remainder of their business electronically with the person or LAR or, if appointed, the DR.

Form 1586 provides information to the person or LAR about support consultation in the TxHmL program, which is optional. Support consultation includes practical skills training, coaching and assistance related to:

  • principles of self-determination;
  • recruiting, screening and hiring workers;
  • completing documents and assessments required to employ a person, retain a contractor or vendor, and manage service providers;
  • negotiating service agreements, including pricing and scheduling services, goods and items;
  • effective communication, decision-making and problem-solving skills to meet employer responsibilities;
  • tools for accessing information, resources and assistance;
  • contacting appropriate persons or entities based on their roles, responsibilities and eligibility related to the person’s program or the CDS option;
  • participating in service planning team meetings at the employer's request; and
  • complying with requirements of the person’s program as related to services delivered through the CDS option.

If the person or LAR requests support consultation, it must be included in the PDP and the individual plan of care (IPC).

If the person or LAR chooses to participate in the CDS option, the LIDDA must document a description of the service components provided through CDS in the person’s PDP and whether the service is critical to meeting the person’s health and safety and would need a service back-up plan.

13337 Person-Directed Plan (PDP)

Revision 20-4; Effective October 15, 2020

The local intellectual and developmental disability authority (LIDDA) service coordinator develops a PDP after the authorization for enrollment into the Texas Home Living (TxHmL) program has been approved with the person or legally authorized representative (LAR) using the Person Directed Planning Guidelines (PDF), the Discovery Guide and the Discovery Tool. Form 8665, Person-Directed Plan, is used to document the information gathered through the discovery process.

13338 Individual Plan of Care (IPC)

Revision 20-4; Effective October 15, 2020

The local intellectual and developmental disability authority (LIDDA) service coordinator initiates development of a proposed individual plan of care (IPC) to document the number of units or hours of each service component identified on the person-directed plan (PDP) that will be needed for an IPC year. The IPC must include both Texas Home Living (TxHmL) and non-waiver services.

After the person has chosen a TxHmL program provider and/or a financial management services agency (FMSA), the service coordinator must conduct a meeting with the program provider to review the initial proposed IPC and develop a final proposed IPC.

If the person or legally authorized representative (LAR) chooses a program provider to deliver supported home living, nursing, host home/companion care, residential support, supervised living, respite, employment assistance, supported employment, day habilitation, or Community First Choice (CFC) PAS/HAB, the LIDDA must ensure the initial proposed IPC complies with 40 Texas Administrative Code (TAC) §9.567.

The IPC must comply with the requirements in 40 TAC §9.558. The LIDDA ensures all the appropriate persons have signed the hard copy IPC.

After enrollment, a program provider can initiate development of a proposed revised IPC for the person as required by 40 TAC §9.568.

13339 Form Submission for Enrollment

Revision 22-2; Effective July 22, 2022
To request a person’s Texas Home Living (TxHmL) enrollment, the local intellectual and developmental disability authority (LIDDA) must submit the following forms on the Texas Medicaid & Healthcare Partnership (TMHP) Long-Term Care (LTC) Online Portal in sequential order: :

  • The HCS or TxHmL Pre-enrollment Form
  • 8578 ID/RC Assessment with 2=No Current Assessment selected in the Purpose Code field; and
  • 8582 Individual Plan of Care with Initial Enrollment selected in the IPC Type field. 

The LIDDA must only submit the 8582 Individual Plan of Care on the LTC Online Portal if the status of the 8578 ID/RC Assessment status is “Pending IPC Match.”
When the LIDDA has submitted both the 8578 ID/RC Assessment and 8582 Individual Plan of Care forms, the status of the HCS or TxHmL Pre-enrollment Form is automatically updated to “Pending Enrollment.”

The LIDDA must use Form Search Inquiry on the LTC Online Portal weekly to check on the status of 8578 ID/RC and 8582 IPC forms. 

  • If the status of 8578 ID/RC Assessment or 8582 Individual Plan of Care is “Remanded to Submitter,” the LIDDA must immediately submit the requested documentation through the IDD Operations Portal  and click the “Add Note” button on the form on the LTC Online Portal to resubmit the form to HHSC.
  • If the status of 8578 ID/RC Assessment or 8582 Individual Plan of Care is “Rejected by SAS,” the LIDDA must contact Program Eligibility and Support (PES) at enrollmenttransferdischargeinfo@hhsc.state.tx.us for assistance.
  • If the status of 8578 ID/RC Assessment and 8582 Individual Plan of Care is “Processed/Complete”, the enrollment process is complete. The status of the HCS or TxHmL Pre-Enrollment Form is automatically updated based on the action taken on 8578 ID/RC Assessment and 8582 Individual Plan of Care, and the person’s CSIL record for the program is “Closed” with the applicable closure reason. See Section 7600, CSIL Status Designations.

PES reviews TxHmL pending enrollments twice per week. The LIDDA must ensure all three forms have been submitted on the LTC Online Portal before contacting PES about the status of an enrollment or requesting an extension of the enrollment due date from Local Procedure Development and Support. See Section 13332, Requesting an Extension of the Enrollment Due Date.

13340 Records

Revision 20-4; Effective October 15, 2020

Prior to the service begin date, the local intellectual and developmental disability authority (LIDDA) must provide the program provider and with the following information:

  • Person-Directed Plan (PDP);
  • Individual Plan of Care (IPC);
  • Intellectual Disability/Related Condition (ID/RC) Assessment;
  • Inventory for Client and Agency Planning (ICAP) assessment booklet and scoring sheet; and
  • Other documents or information pertinent to the person that is helpful in assisting the provider in serving the person [e.g., previous services plan, medical information, assessment results, determination of intellectual disability (DID)].

The LIDDA must retain the following documents in the person’s record:

  • Form 8601, Verification of Freedom of Choice;
  • Form 1049, Initial Documentation of Provider Choice; and
  • Any other correspondence related to the Texas Home Living (TxHmL) offer.

13350 Additional Procedures for TxHmL

Revision 20-4; Effective October 15, 2020

13351 Enrollment from an ICF/IID

Revision 20-4; Effective October 15, 2020

For persons enrolling from an intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID), the enrollment process is the same as listed in Section 13330, Enrollment Process. However, the LIDDA must notify the person or legally authorized representative (LAR) of the requirement to respond to the opportunity to enroll within 20 days of the notification.

13352 Assisting with Medicaid Eligibility

Revision 20-4; Effective October 15, 2020

A person must be verified for an eligible Medicaid program that pays for Texas Home Living (TxHmL) services on or before the individual plan of care (IPC) begin date for enrollment to be approved. Refer to Section 15000, Pre-Enrollment Activities and Financial Eligibility Related tor HCS and TxHmL, for the Medicaid program types accepted for the TxHmL program. If the person is not certified for an eligible Medicaid program that pays for TxHmL services on or before the individual plan of care (IPC) begin date, the provider may choose to delay service provision until Medicaid can be verified and the IPC begin date may be changed.

13353 Medicare Requirements

Revision 20-4; Effective October 15, 2020

The local intellectual and developmental disability authority (LIDDA) determines whether the person is a Medicare beneficiary. Refer to Section 15000, Pre-Enrollment Activities and Financial Eligibility Related to HCS and TxHmL, for the steps to take if someone is a Medicare beneficiary.

13354 Use of LIDDA Enrollment SFTP Site Instructions

Revision 20-4; Effective October 15, 2020

The secure file transfer protocol (SFTP) is a secure site that Texas Health and Human Services Commission (HHSC) requires the local intellectual and developmental disability authority (LIDDA) to use for submission of certain documents related to HCS and TxHmL slot releases and the Medicaid Estate Recovery Program (MERP) forms to the MRA Enrollment folder. To gain access to SFTP, send an email to LIDDARequest@hhsc.state.tx.us.

Documents must be uploaded to the SFTP as a portable document format (PDF). To upload a document, it must be closed; this is a common oversight. The SFTP is used to transfer documents; not for storage. HHSC recommends documents be claimed within seven calendar days from posting and deleted within one month.

To access the SFTP, the user must have been granted access by HHSC Information Technology Security and must be able to access to the internet. Once access to the SFTP has been granted, copy/paste or type the following path into the internet web browser: https://sftp.hhs.texas.gov/EFTClient/Account/Login.htm. In the MRA Enrollment folder, there are two subfolders, the IN folder and the OUT folder:

  • IN folder:
    • HHSC uploads files for the LIDDA in this folder;
    • The LIDDA copies or drags the files from the folder within seven calendar days, as recommended by HHSC;
    • The LIDDA deletes the files from the folder within one month, as recommended by HHSC; and
    • The LIDDA does not upload documents to this folder.
  • OUT folder:
    • The LIDDA uploads scans, and uploads or drags files, from their computer to the OUT folder;
    • HHSC copies or drags the files from the folder within seven calendar days; and
    • HHSC deletes the files from the folder within one month.

When uploading VFC or MERP forms to HHSC via the SFTP, the LIDDA must use the following naming conventions:

  • Form 8601, Verification of Freedom of Choice – Last name, first initial, VFC, slot number, A or D. The slot number is on the offer notice form HHSC.
    Examples: SmithJVFC30A.pdf (for acceptance) or SmithJVFC30D.pdf (for decline)
     
  • Medicaid Estate Recovery Program – Last name, first name, MERP.
    Example: SmithJerryMERP.pdf

13400 Enrollment in the ICF/IID Program

Revision 20-4; Effective October 15, 2020

The local intellectual and developmental disability authority (LIDDA) must:

  • complete enrollment of a person into the intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID) program in accordance with HHSC rules;
  • prior to enrollment, ensure the person and legally authorized representative (LAR) are provided information about the Medicaid Estate Recovery Program, as described in Section 14000, Medicaid Estate Recovery Program (MERP) Overview; and
  • prior to enrollment, determine whether the person is a Medicare beneficiary.

Note: A person with Medicaid only is not affected by the Medicare Prescription Drug Program and will continue to receive his or her drugs through Medicaid.

13410 Medicare Requirements

Revision 20-4; Effective October 15, 2020

The local intellectual and developmental disability authority (LIDDA) determines whether the person is a Medicare beneficiary. Refer to Section 15000, Pre-Enrollment Activities and Financial Eligibility Related to HCS and TxHmL, for the steps to take if someone is a Medicare beneficiary.