2200, Intake Procedures

Revision 17-1; Effective March 15, 2017

For interest list procedures involving managed care, see the STAR+PLUS Handbook.

2210 Requests for Services

Revision 17-1; Effective March 15, 2017

A request for services may begin with

telephone or written referrals from other agencies, organizations, and HHSC divisions; or
telephone, written, or walk-in requests from individuals or their relatives, friends, or other interested persons.

2211 Applications and Referrals Routed from the Austin Document Processing Center

Revision 17-1; Effective March 15, 2017

When the Austin Document Processing Center (DPC) receives an application in which a request for an HHSC referral exists, the DPC will fax the first three pages of the application and a cover sheet to the HHSC local office. Upon receipt of the application, HHSC staff will review each of the referrals and contact the individual to determine if the individual is interested in HHSC services and take the following actions:

If it is determined the individual is interested in an HHSC program without an interest list, HHSC staff will complete an intake for the services requested and access the HHSC Benefits Portal to print out the rest of the application.

To print out the application, access the HHSC Benefits Portal. Click on the PT Inquiry tab. Once the PT Inquiry is open, click on Inbound Correspondence Image Repository Search and search for the individual. Select the appropriate document and click "view." When the PDF document opens, click on the printing icon to print the document.
If the individual is only interested in a program with an interest list, the individual will be placed on the interest list and staff will not need to print the remainder of the application.
If the individual is not interested in an HHSC program or a program with an interest list, file the fax from DPC following local office procedures.

The document processing center address is:
Document Processing Center
P.O. Box 149024
Austin, TX 78714-9024
Fax Number: 877-236-4123

2220 Response to Requests for Service

Revision 18-1; Effective June 15, 2018

When a request for service is received by telephone, written referral or in person, the HHSC staff who conducts intake for community care services or who receives a request for service gives the requester information about HHSC CCSE services and determines what service is being requested and whether HHSC provides that service.

Upon receipt of a written/faxed referral, the applicant or responsible party may be contacted by intake staff or the referral may be accepted, entered in the Intake (NTK) system and assigned to a case worker. The case worker would then make the initial contact, provide information about HHSC and screen for appropriate services.

The intake staff or case worker who conducts intake for community care services or who receives a request for service:

gives the requester information about HHSC, including CCSE services, as needed;
determines what service is being requested and whether HHSC provides that service;
refers the request for non-HHSC services to the appropriate state or community agency and documents the request;
refers individuals who are currently in nursing facilities and still require skilled services, but would like to return to the community, to STAR+PLUS Home and Community Based Services (HCBS);
screens all applicants indicating a need for skilled services for a nursing facility diversion (NFD) slot placement when slots are available and completes the NFD tab in NTK if the applicant responds there is a chance he would have to move to a facility. If slots are not available, refer the individual to the STAR+PLUS HCBS interest list;
transfers to appropriate staff any requests for HHSC services other than community care services;
identifies reports of suspected need for Adult Protective Services (APS) and immediately provides these reports to APS staff;
obtains eligibility-related financial information about the applicant; and
gives the requester general information about CCSE eligibility, emphasizing that exact eligibility information cannot be given until the individual is interviewed by a case worker.

If the requester does not want to apply for CCSE services, the requester is transferred to appropriate staff for requests for HHSC services other than community care services or referred to other appropriate resources. See Appendix XV, Services Available from Other State Agencies, and 2530, Other Resource Services. The information is not entered into NTK and an intake is not completed. This information is recorded in an Information and Referral Log.

If the individual wishes to apply for CCSE services, the intake person:

completes the intake by entering the information into the automated system for intakes or completes Form 2110, Community Care Intake, according to the form instructions, completing only the required sections if some information is not available;
documents on the form or on a log any requests for information and referral according to regional procedures;
refers walk-in requesters to the appropriate unit for the completion of applications;
determines whether the requester can and will complete an application for the applicant;
identifies a responsible party who will help with the application process;
identifies and documents which persons have no relative or responsible person to help with the application process;
assesses the urgency of the request and immediately routes all requests to appropriate units for further action (See 2310, Criteria for Immediate or Expedited Responses to Service Requests); and
informs the requester that a case worker will contact the applicant to further discuss the application process.

For all individuals who currently do not receive Supplemental Security Income (SSI) or SSI-related Medicaid and are requesting personal attendant services (PAS), the intake screener must assign the intake to a case worker as an application for Community Attendant Services (CAS). Intake screeners must not screen applicants for a specific service or determine if an applicant should only be assigned for Family Care or placed on the interest list for Family Care services. The intake screener does not place the individual on the Family Care interest list. The case worker determines whether the individual will be placed on the interest list, as described below.

All individuals who are not currently receiving Medicaid and wish to apply for PAS must be seen by a case worker and assessed for CAS. During the initial interview, the case worker screens all applicants for potential eligibility for CAS and determines whether or not the applicant will be referred to MEPD for CAS.

Certain services require special intake procedures. For details, see 4000, Specific CCSE Services.

2221 Requests for Services in STAR+PLUS Areas

Revision 18-1; Effective June 15, 2018

When the Texas Health and Human Services Commission (HHSC) receives a request for services, staff must assess whether the request for services should be forwarded for processing to the:

appropriate HHSC unit;
Program Support Unit (PSU); or
managed care organization (MCO).

Refer to the charts in the STAR+PLUS Handbook for additional information.

Individuals awaiting managed care enrollment may be assessed for interim services from HHSC.

HHSC will enroll individuals into Primary Home Care (PHC) who meet the PHC immediate or expedited criteria, as described in 2310, Criteria for Immediate or Expedited Responses to Service Requests, when they are listed in the Texas Integrated Eligibility Redesign System (TIERS) as a candidate for STAR+PLUS enrollment. However, mandatory STAR+PLUS individuals who are not yet enrolled with an MCO, and do not meet immediate or expedited criteria, will be referred to the Enrollment Broker. Individuals who are already enrolled with an MCO and request PHC or Day Activity and Health Services (DAHS) from HHSC must be advised to contact their MCO.

HHSC will not enroll individuals in DAHS when they are listed in TIERS as a candidate for STAR+PLUS enrollment. Since there are no immediate or expedited criteria for DAHS enrollment, individuals seeking these services will be available upon enrollment into the STAR+PLUS program. DAHS facility initiated referrals which take place for individuals pending STAR+PLUS enrollment will not be reimbursed by HHSC.

For a list of mandatory and non-mandatory STAR+PLUS participants, refer to the STAR+PLUS Handbook, Section 3221, Mandatory Groups, and Section 3222, Excluded Groups.

2222 Reinstatement Procedures for Individuals Reapplying for Services After Loss of Financial Eligibility

Revision 17-1; Effective March 15, 2017

If an individual has lost categorical or financial eligibility creating a gap in service, the following procedures are applicable.

If financial or categorical eligibility is re-established within 60 days of the denial date and the individual reapplies for services, the case worker may use the information currently on file to determine eligibility. A new Form 2110, Community Care Intake, must be completed. The case worker must note in the Comments section of Form 2110 that reinstatement procedures are being used within 60 days of the denial date. See 3441.2, Reinstatement Procedures After Denial, for complete procedures.

2223 Caregiver Support Assessment Initiative

Revision 17-1; Effective March 15, 2017

Background

Senate Bill (SB) 271, 81st Legislature, Regular Session, 2009, relating to informal caregiver support services, directs Texas Health and Human Services Commission (HHSC) staff to:

raise awareness of services available to caregivers;
perform outreach functions to informal caregivers; and
gather information about the needs of caregivers, including the:
- collection of profile data on informal caregivers;
- referral provided to support services, when appropriate; and
- implementation of a standardized caregiver assessment tool to evaluate the needs of caregivers.

SB 271 requires HHSC to use the information collected to refer informal caregivers to available support services and to:

evaluate the needs of assessed informal caregivers;
measure the effectiveness of certain informal caregiver support interventions;
improve existing programs;
develop new services, as necessary, to sustain informal caregivers; and
determine the effect of informal caregiving on employment and employers.

The Caregiver Status Questionnaire (CSQ) is designed to meet the requirements of SB 271. The information collected will be analyzed and included in the HHSC report to the governor and the Legislative Budget Board. HHSC is required to submit this report in December of each even-numbered year, beginning Dec. 1, 2012.

Completion of the CSQ

The CSQ is available in the Long Term Care Services Intake (NTK) System and is completed at the time of the intake contact, when possible. The CSQ and a script for the interview are available in English and Spanish in Appendix XXXVIII, Caregiver Support Assessment Initiative. If not feasible, one additional contact with the caregiver must be attempted within five business days. (In situations where it is necessary to go beyond the five-business-day period, document the reason in the comments section of the CSQ.) When a follow-up contact is made, enter the date on the top right corner of the CSQ, just under the NTK menu bar. Check the appropriate box to indicate if the attempt to contact failed or if the caregiver declined to participate.

Staff should always assume there is no assessment and proceed as usual. If the caller states he has completed the caregiver assessment in the past, staff should not ask him to complete the assessment again. Staff may exit the caregiver screen by selecting "yes" at the top of the page to the question: "Caregiver declined to answer?", In the comments section at the bottom of the page, document that an assessment has already been conducted for that caregiver.

The purpose of the CSQ is to collect the information described above. This information is not being used to determine if the unmet need criteria for Community Care services has been met, and will not be forwarded to the case worker.

Question Sensitivity

Some staff may find it awkward to ask some of the questions on the CSQ. While understandable, all the questions must be asked and a response recorded for each. It is not acceptable to skip a question. If an individual seems resistant to answer any of the questions, do not insist on a response. Simply document the individual refuses to answer and continue to the next question.

Caregiver Employment

Check boxes have been provided as a means to record the ways caregiving responsibilities have affected the caregiver's employment. After asking the open-ended question, listen to the caregiver's comments and check all of the boxes that apply. You are not expected to read aloud each possible response to the employment question; however, the list can be used as a prompt if the responder is unsure how to answer. If the individual seems uncertain, you may read aloud the response category headings. Example: "Has caregiving affected your employment schedule, pay, leave, performance or work relationships?" If further clarification is necessary, you may ask, "For example, have you had to take extra leave or change your work schedule to meet your caregiver responsibilities?"

Referral to the Area Agency on Aging (AAA)

If the individual meets one of the following criteria, he may qualify for services from the AAA. If so, and if the individual indicates he would like assistance, make the referral according to regional procedures.

AAA Eligibility Screening Criteria

The individual may qualify for services from AAA if the individual is:

60 years of age or older and is caring for an individual of any age;
55 years of age or older and is caring for a grandchild under the age of 18 in his/her home because:
- the biological or adoptive parents are unable or unwilling, or
- he/she has legal custody or guardianship, or is raising the child informally; or
- he/she is caring for an individual age 19-59 with severe disabilities; or
- he/she is a caregiver for an individual of any age who has Alzheimer's or dementia.

Accessing the CSQ

The manual copy of the CSQ should be used when the automated system is unavailable; however, all information must be entered in the automated system as soon as possible. The version of the CSQ, which includes a script and instructions on recording responses, may be useful for staff completing the CSQ for the first few times. Follow the instructions below to complete the CSQ.

Conduct intake per usual procedures using the NTK system.
At the Client Information screen, document whether the individual requesting services has a caregiver. If there is a caregiver, the CSQ must be completed at the end of the intake process if the caregiver is available. If the caregiver is not available, document the caregiver contact information. At least one follow-up attempt must be made to contact the caregiver at a later date.
Select the "Caregiver" tab on the NTK section selection menu.
Enter the information on the Caregiver screens, as requested.
If, at the end of the CSQ, it appears the individual requesting services may qualify for services from the AAA, make a referral following regional procedures.

Collection of legislatively mandated information will enable the state to refer caregivers to available support services and to develop additional services to meet caregiver needs.

2230 Interest List Procedures

Revision 18-1; Effective June 15, 2018

Individuals who express interest in a Community Services program which has an interest list will be registered on the Community Services Interest List (CSIL), regardless of the program’s enrollment status. CSIL will record the date and time of the expressed interest. If the individual is first on the list and the region is releasing and enrolling for that program, the individual may be immediately released and assigned for the enrollment process.

If no Title XX funds are available, consult with the individual to decide whether his needs can be met through other services. If the individual agrees, add the individual’s name to the appropriate interest lists by entering the information in the CSIL system if no other service is available or suitable. Individuals who request placement on an interest list must reside in the state of Texas. An out-of-state address can be used as a contact if the power of attorney/guardian or legally authorized representative is residing out of state. Additional exceptions may be made for individuals who have been placed on an interest list while residing in Texas, and who then move temporarily out of the state because of military assignments.

Individuals on military assignments who are temporarily out of state include:

Military member - A member of the United States military serving in the Army, Navy, Air Force, Marine Corps or Coast Guard on active duty who has declared and maintains Texas as the member's state of legal residence in the manner provided by the applicable military branch;
Military family member - A person who is the spouse or child (regardless of age) of a military member or a former military member; or
Former military member - A person who served in the United States Army, Navy, Air Force, Marine Corps or Coast Guard who declared and maintained Texas as the person’s state of legal residence in the manner provided by the applicable military branch while on active duty or who was killed in action or died while in service, or whose active duty otherwise ended.

Individuals are released from the interest list on a first-come, first-served basis; eligibility determinations are conducted when an individual is released from the interest list.

When an individual on an interest list transfers from one region to another, he must be added to the receiving region's list using the original intake date for the service as documented by the losing region. The staff person who first becomes aware that the individual has transferred to another region (whether losing or gaining) is responsible for notifying the other region. This ensures that both regions' lists are accurate.

When an individual is released from the interest list, the case worker must contact the individual to determine his continued interest in services and if interested, schedule a home visit if required by the service. If the individual is no longer interested in services and voluntarily withdraws, the case worker enters the appropriate CSIL closure code in the CSIL system. No entries in the Service Authorization System Online (SASO) are required and Form 2065-A, Notification of Community Care Services, is not sent.

During routine interest list contacts, individuals on the interest list who do not reside in Texas should be removed from the list and informed they must be a resident of Texas to be on an interest list. Exceptions may be made for individuals on military assignments who are temporarily residing out of state.

If the individual is interested in services, the case will be processed as a routine intake.

For more information regarding the CSIL system, refer to:

2231, Community Services Interest List Bypass Criteria; and
2232, The Community Services Interest List System.

Note: The Area Agencies on Aging (AAA) can refer individuals to available services. Service needs, resources and available service providers vary across the state; not all of the services identified by AAA may be available in every area. The applicant/individual should contact the local AAA to determine whether a specific service is available. To find the telephone number for the local AAA, call 1-800-252-9240.

When the Texas Health and Human Services Commission (HHSC) intake staff determine a request is for STAR+PLUS Home and Community Based Services (HCBS), they may place the individual on the STAR+PLUS HCBS interest list.

2230.1 Adding Individual's Name Back to CSIL

Revision 17-1; Effective March 15, 2017

An individual's name may be added back to the Community Services Interest List (CSIL) at any time within 90 days after the CSIL service has been closed if the individual contacts the Texas Health and Human Services Commission (HHSC):

within 90 calendar days of the closure date, the original date of request can be used; or
more than 90 calendar days following the closure date, the current date must be used.

If a CSIL closure occurred during "release" or "assigned" status and the individual is added back to the interest list, the name may be released for eligibility determination, as needed, to ensure the region is fully utilizing its slot allocation.

Any exceptions for adding names back to CSIL with the original date after a 90-day period must be approved by the state office CSIL manager.

When an applicant or individual has been denied for a service, the earliest date the applicant/individual may be added back to CSIL for the same program is the date the applicant/individual is determined to be ineligible or is no longer eligible for the program.

If the individual's name is added back to CSIL prior to the last date of program eligibility, the CSIL interface match with the Service Authorization System Online (SASO) will cause the name to be removed from the interest list for that program. Example: An individual's Family Care (FC) services are denied and end on Aug. 13, 2015. The first date the individual can be added back to the FC interest list is Aug. 14, 2015. If the individual is already on the Home-Delivered Meals (HDM) interest list, the denial date for FC services would not impact the individual's original date on the HDM interest list.

2231 Community Services Interest List Bypass Criteria

Revision 17-1; Effective March 15, 2017

Under certain circumstances, individuals are allowed to bypass the interest list to start the enrollment process. The bypass must meet specific criteria and be approved by the regional director.

2231.1 Individuals Who May Receive Title XX Services with Regional Director Approval

Revision 18-1; Effective June 15, 2018

In the following circumstances, an individual may be given a bypass code to be placed at the top of the interest list. The regional director makes the decision if the individual may bypass the interest list and begin the enrollment process.

Personal Attendant Services (PAS)

Individuals who meet criteria for immediate or expedited intakes and need immediate service initiation may be given a bypass code and go to the top of the interest list. Individuals in the following programs may be considered for the criteria:

Family Care.
STAR+PLUS Home and Community Based Services (HCBS) individuals denied STAR+PLUS HCBS.
Individuals who have been denied Primary Home Care (PHC) due to loss of Medicaid.
Individuals denied Community Attendant Services (CAS) due to denial of financial eligibility by Medicaid for the Elderly and People with Disabilities (MEPD) for reasons other than failure to cooperate or refusal to sign up for the Medicaid Estate Recovery Program (MERP).

The criteria are:

the applicant has no available caregiver; and
has personal care needs that are not being met; and
cannot go without personal care services for a full day; or
the applicant needs personal care and the need for services has increased during the five days prior to the service request, or will increase during the five days following the service request. (See 2310, Criteria for Immediate or Expedited Responses to Service Requests, for additional information).
An individual authorized for any Title XX service who is transferring to a new region will be allowed to continue receiving that service.
An individual in a STAR+PLUS HCBS Residential Care facility who is denied STAR+PLUS HCBS may go to CCSE Residential Care. If a bed is not available, the individual is placed on the Community Services Interest List (CSIL) and given a bypass code to move to the top of the interest list.

All individuals meeting bypass criteria will be placed at the top of the specific program interest list. Additionally, the bypass criteria will now apply to individuals meeting the criteria who are no longer eligible for STAR+PLUS or STAR+PLUS HCBS, or individuals denied financial eligibility for CAS. The Regional Director will make the decision whether an individual can be released immediately or will remain on the interest list until the next slot is available. The decision must be documented in the case record.

2231.2 Bypass Criteria for Additional Services

Revision 18-1; Effective June 15, 2018

Individuals in the following circumstances may be given a bypass code and placed at the top of an interest list. The regional director makes the decision whether the individual can be released immediately or will remain on the interest list until the next slot is available. The decision must be documented in the case record.

Title XIX Day Activity and Health Services (DAHS) individuals denied Medicaid but who remain eligible for Title XX DAHS.
Individuals in a STAR+PLUS Home and Community Based Services (HCBS) Residential Care facility who are denied STAR+PLUS HBCS may go to Community Care Services Eligibility (CCSE) Residential Care. If a bed is not available, the individual remains at the top of the interest list until a placement is available.
Individuals in an STAR+PLUS HCBS Adult Foster Care (AFC) who are denied STAR+PLUS HCBS may go to a CCSE AFC. If a bed is not available, the individual is placed at the top of the interest list until a placement becomes available.
Individuals denied STAR+PLUS HCBS who had received additional services through STAR+PLUS HCBS, such as Home-Delivered Meals or Emergency Response Services, may be given a bypass code for those services.

Individuals authorized for any Title XX service that transfer to a new region will be allowed to continue receiving that service.

2231.3 Individuals Who May Not Bypass the Interest List

Revision 17-1; Effective March 15, 2017

An individual who has been denied Primary Home Care (PHC) because he does not need assistance with a personal care task should be placed on the Family Care (FC) interest list using the date of the PHC denial. He may not bypass the FC interest list.

Individuals leaving a nursing facility are not eligible to bypass the interest list unless they meet the criteria for immediate or expedited as listed in 2231.1, Individuals Who May Receive Services with Regional Director Approval.

For individuals who have a temporary loss of categorical status or financial eligibility, follow the procedures in 3441, Loss of Categorical Status or Financial Eligibility, and 3441.1, Procedures Pending Reinstatement.

2231.4 Bypass Approval

Revision 17-1; Effective March 15, 2017

The final decision on whether an individual is approved to bypass the interest list will be made by the regional director or his designee, rather than the regional budget officer or the contract manager. Releasing a name from the interest list and offering services to an individual still remains subject to available regional funds and slots.

2232 The Community Services Interest List System

Revision 17-1; Effective March 15, 2017

Interest lists for community care services are registered on the Community Services Interest List (CSIL) system.

Initial requests for services are documented using Form 2110, Community Care Intake, or the Long Term Care Service Intake (NTK) system, regardless of whether slots for the requested service exist. If the individual needs a service that is currently unavailable, use the interface on the NTK system or enter the individual on the CSIL. Complete and send the individual:

Form 2111, Interest List Notification, and
Appendix XXXV, Long Term Services and Supports.

Only individuals who reside in the state of Texas may be placed on an interest list for Texas Health and Human Services Commission (HHSC) community services. An out-of-state address can be used as a contact if the power of attorney/guardian or legally authorized representative is residing out of state.

Information provided by the individual for the interest list must include a Texas address as the contact location for the individual requesting services. Exceptions may be made for individuals who are temporarily out of the state due to military assignments.

Exceptions involving military members and military family members, as described in 2230, Interest List Procedures, apply when:

the applicant is a military family member living outside of Texas:
- while the military member is on active duty; or
- for less than one year after the former military member’s active duty ends; or
the applicant declines the offer of a Community Services program with an interest list and the applicant is a military family member living outside of Texas:
- while the military member is on active duty; or
- for less than one year after the former military member's active duty ends.

If the case worker is making a home visit to assess the individual for other services, it is preferable for the case worker to assist in completing appropriate application forms at that time. If not, this task may be accomplished by mail. If Form 2111 and Appendix XXXV are mailed, they must be sent within two workdays of intake. Forms being filled out in person at the time of the home visit must be completed within the time frames as indicated in 2320, Case Worker Response, as determined by intake priority.

Within five workdays of intake, staff enter all relevant data into the CSIL. Staff may choose to use Form 2113, Community Services Interest List Registration and Follow-Up, to manually record interest list information to be data entered. Although use of Form 2113 is not mandatory, regional staff are responsible for entering all applicable data fields it contains into the CSIL.

Staff may not perform functional or financial determinations at the time the individual is being added to the interest list, even if staff are not using the determination to screen the applicant off the interest list. If an individual insists that he be assessed for eligibility immediately, even though staff have assured him that no slot is currently available, staff are required to do so. This action is considered an application, not an interest list case; all notification and civil rights procedures apply.

Individuals on an interest list are contacted annually to confirm that they wish to remain on the list. Form 2247, Interest List Contact Letter, is mailed to the individual.

If an individual does not respond and no update is made to the annual contact date in CSIL within 120 days past the annual contact due date, CSIL will automatically update the individual’s record as inactive. An annual contact is no longer required for individuals in an inactive status. An individual with a status of inactive will not lose his place on the interest list. If/when the CSIL individual record is updated with a current contact date, the record will automatically go back into an active status.

Staff are reminded the CSIL must also be updated within five workdays of the case worker’s determination and the date that a completed Form 2065-A, Notification of Community Care Services, is mailed/given to the individual. Within five workdays of the case action, the case worker records whether the case was certified, application denied or closed without application. If the case was closed or denied, the reason for closure/denial must be indicated.

See Appendix XXV, Community Services Interest List (CSIL) Closure Code User's Guide, or the CSIL User’s Guide found on the intranet (for staff use only).

2240 Regional Procedures

Revision 17-1; Effective March 15, 2017

2241 Supervisor Responsibilities

Revision 17-1; Effective March 15, 2017

CCSE unit supervisors ensure that their units have procedures for

receiving service requests;
mailing applications to requesters of service, when appropriate; calling requesters to ensure that applications were received; and instructing applicants or their families or both about completing applications;
assigning service requests to appropriate case workers, within required time frames;
when appropriate, notifying case workers about applicants who may need help in completing applications;
ensuring that the intake priority is accurate and reassigning the response category if documentation indicates the need; and
monitoring and tracking requests for service, beginning with the date the request is received or assigned.

2242 Case Worker Responsibilities

Revision 17-1; Effective March 15, 2017

CCSE case workers are responsible for:

establishing a date for a home visit by calling an individual, when feasible;
determining if the applicant is categorically eligible through the HHSC automated systems and printing verification, if eligible;
mailing an application to the non-categorically eligible applicant who requires a routine response to his service request, if the applicant is capable of completing the form or has assistance available;
informing an applicant about the financial documentation, if any, that must be available at the time of the visit, such as verification needed when the applicant is applying for Community Attendant Services (CAS);
requesting that a person with knowledge of the individual's financial affairs be available at the time of the visit, if possible and appropriate;
requesting that the individual's caregiver be present at the time of the visit, if possible;
mailing the appropriate individual letter; and
changing the intake priority, if additional information warrants. (Initial and date any changes using a different color ink.)

2243 Conflicts of Interest

Revision 19-1; Effective January 25, 2019

Texas Health and Human Services Commission (HHSC) staff control and direct significant amounts of public funds and must avoid the appearance of impropriety or conflict of interest. This applies to the awarding of Community Care for Aged and Disabled (CCSE) benefits and in determining how these benefits are to be provided.

Staff must not work on or review an ongoing CCSE case, nor assist an applicant or individual to receive CCSE benefits, if the applicant or individual is a relative (by blood or marriage), roommate, dating companion, supervisor or someone under the individual's supervision. Staff may not determine eligibility, need for CCSE services nor the amount of service they may receive. HHSC staff may provide anyone with an application for services and inform them how and where to apply. It is also permissible to help any person gather documents needed to verify eligibility and the need for services. Staff must not perform any other role in determining eligibility for CCSE services.

Case workers must consult with their supervisors if the applicant or individual is a friend or an acquaintance. Generally, staff should not work on cases or applications involving these individuals, but the degree and nature of the relationship should be taken into account.

If staff have a relative (by blood or marriage), roommate, dating companion or close friend who owns or is employed by a provider that contracts with HHSC to provide CCSE services, he must not demonstrate any special consideration toward that provider. Referrals of individuals to a provider must be based strictly on individual preference and the individual's need for the service provided. In addition, instructions (or lack of instructions) to the provider concerning the delivery of service must be based solely on the individual's needs and HHSC policy.

If a staff member suspects that a conflict exists, use intranet Form 2035, Employee Disclosure Statement, to notify the supervisor that a conflict of interest may exist that could result in an unethical or biased business relationship. The supervisor will record on the Supervisory Response section what action, if any, may be necessary and return the signed/dated form to the sender.

All CCSE staff are required to complete Form 2035 regardless of potential conflict of interest when:

hired;
the annual performance review occurs;
transferring between units and/or programs; and
assigned to another supervisor.

The form is also used to notify the first-line supervisor whether or not a potential conflict of interest exists that involves provider employees, applicants or individuals, even if staff are not involved in the eligibility determination for the applicant or individual. Staff must complete Form 2035 if the potential conflict involves an individual who is:

residing in his/her home;
a dating companion;
his/her supervisor;
a relative; or
reporting directly to him/her.