4700, Residential Care Services

4710 Description

Revision 17-1; Effective March 15, 2017

Residential Care (RC) services include RC and Emergency Care (EC).

Residential Care

  • Contracted facilities serve eligible adults who require round-the-clock access to services. In RC services, the individual must contribute to the cost of care, including a room and board payment and a copayment, if applicable.
  • For details about eligibility for RC, see Section 4721, Residential Care Eligibility.
  • For special casework procedures for RC, see Section 4730, Special Casework Procedures for Residential Care.

Emergency Care

  • EC is available to eligible individuals for as many as 30 days while the case worker seeks permanent care arrangements. EC may be provided in Adult Foster Care (AFC) homes and in RC facilities. If an individual is not placed in a permanent care arrangement within the initial 30-day period, he is eligible to receive services for one 30-day extension (for a total of as many as 60 days).
  • For details about eligibility for EC, see Section 4722, Emergency Care Eligibility.
  • For special casework procedures for EC, see Section 4770, Ongoing Casework Procedures.

4711 Required Services

Revision 17-1; Effective March 15, 2017

Refer to 40 Texas Administrative Code §46.41(b), Required services.

An individual in a Residential Care (RC) facility has access to services on an as-needed basis. The frequency of a task is therefore not designated.

4720 Eligibility for Service

Revision 17-1; Effective March 15, 2017

 

4721 Residential Care Eligibility

Revision 24-1; Effective March 1, 2024 

Eligibility for residential care is based on the following criteria:

  • A person must be income eligible or Medicaid eligible and not in an institution.
  • The person must meet the functional need criteria as set by HHSC.
  • The person’s needs may not exceed the facility’s capability under its licensed authority.
  • The person must have financial resources at or below the level established by HHSC.
  • The person must contribute to the total cost of care that they receive, including payment for room and board.  
  • The room and board amount is calculated from the person’s gross income. 
  • The person is responsible for paying this amount directly to the provider agency. 
  • The person may be required to pay a copayment based on the amount of income remaining after all allowances are deducted. 

A person must score at least 18 on Form 2060, Needs Assessment Questionnaire and Task/Hour Guide, and have adequate income to pay the required room and board payment to become or remain eligible for Residential Care (RC). For other eligibility requirements, review:

Related Policy

26 Texas Administrative Code Section 271.85 
 

4722 Emergency Care Eligibility

Revision 24-1; Effective March 1, 2024

Refer to 26 Texas Administrative Code Section 271.87, Eligibility for emergency care criteria.

4730 Special Casework Procedures for Residential Care

Revision 17-1; Effective March 15, 2017

 

4731 Assessment

Revision 17-1; Effective March 15, 2017

If an individual is requesting Residential Care (RC) services, determine if services are open and space in an RC facility is available. If services are not open at that time, place the individual on the interest list. If funding and RC spaces are available or if the individual is released from the interest list, proceed with the eligibility determination and assessment.

Advise the individual of spaces available in the RC facilities in his area, and recommend that the individual visit the facilities. If the individual selects a facility and wants to move to the facility, continue with eligibility determination.

To assess if an applicant qualifies for RC, interview the applicant to determine:

  • if he meets the Community Care Services Eligibility (CCSE) income and resource limits;
  • if he has adequate income to pay the required room and board payment;
  • the extent of the applicant's functional disability by scoring his response to Form 2060, Needs Assessment Questionnaire and Task/Hour Guide;
  • the applicant's appropriateness using the guidelines for appropriate and inappropriate mental and physical characteristics in Appendix VIII, Residential Care and Emergency Care Mental and Physical Characteristics; and
  • if his needs can be met adequately at an RC facility.

The Texas Health and Human Services Commission (HHSC) Licensing Standards for Assisted Living Facilities, in 40 Texas Administrative Code (TAC) §92.41(e)(1), specify that "A facility must not admit or retain: (A) residents whose needs cannot be met by the assisted living facility, or the necessary services secured by the resident. ..."

An individual is, therefore, inappropriate for placement if his needs exceed the facility's capability under its licensed authority. In general, an RC facility may provide services to an individual whose needs correspond with those listed in the Appropriate Characteristics column of the mental and physical characteristics in Appendix VIII. The facility may not be capable of providing services to an individual whose needs correspond with those listed in the Inappropriate Characteristics column. Because each individual's case must be reviewed according to the setting in which care is to be provided, the appropriate and inappropriate characteristics are only examples.

An assessment of an individual who is being considered for RC should include review of his personal abilities to perform activities of daily living, as measured by Form 2060, Needs Assessment Questionnaire and Task/Hour Guide, and other functional areas, such as the need:

  • for the routine daily care offered in a group-care setting;
  • for a structured environment and the ability to tolerate it;
  • and ability to interact with groups and to socialize daily;
  • for a home or for one different from his current living environment; and
  • for and ability to tolerate daily monitoring or supervision for behavior control or both.

By carefully assessing individuals in relation to the environment of RC facilities, the case worker will be able to develop care plans that make maximum use of the facilities' benefits.

Share findings with facility staff to determine whether the individual is a suitable candidate for RC and to facilitate a smooth transition.

Discuss money management with the individual during the assessment. If the individual expresses an interest in money management, inform the facility on Form 2067, Case Information, or in the comments section of Form 2101, Authorization for Community Care Services. According to 40 TAC §46.61, Trust Fund Management, the facility must provide assistance to the individual in managing his finances only if the individual requests help in writing. The facility is not permitted to assist an individual in writing checks without first establishing a trust fund account for him.

4732 Freedom of Choice

Revision 17-1; Effective March 15, 2017

The applicant maintains the freedom of choice among the facilities that serve the applicant's area.

The applicant can:

  • select the facility, or
  • choose to take the next facility on the rotation list.

The applicant must indicate his choice of available facilities before beginning the assessment process. If an applicant already has a facility in mind that does not have space available, he may elect to remain on the interest list until a space is available in that facility.

4733 Referral

Revision 17-3; Effective May 15, 2017

Once the applicant has met all eligibility requirements, selected a facility and has been determined appropriate for placement in Residential Care (RC), negotiate a move-in date with the individual and the facility.

Refer to 40 Texas Administrative Code §46.39, Service Initiation.

To refer the applicant to the facility:

  • complete Form 2059, Summary of Client's Need for Service, and Form 2101, Authorization for Community Care Services; and
  • send these forms to the facility administrator.

If the applicant needs assistance managing his money, inform the facility:

  • on Form 2067, Case Information, or
  • in the comments section of Form 2101.

4733.1 Delay of Entry into the Facility

Revision 17-1; Effective March 15, 2017

If the individual changes his mind, or for some other reason does not move into the facility on the negotiated date, advise the individual that he has three days from the negotiated date to enter the facility.

Inform the individual that if he does not move into the facility within three days from the negotiated date, the facility may give the bed space to another individual, the referral for services may be withdrawn, and his request for services will be denied. If there are extenuating circumstances and the facility is willing to re-negotiate a move-in date, the date may be changed.

4733.2 Termination

Revision 17-1; Effective March 15, 2017

If the individual does not move in and the move-in date is not re-negotiated, begin termination procedures. Inform the individual that his request for services will be denied and that if he wants to reconsider Residential Care (RC) placement at a later date, his name will be placed on the interest list with a new request date.

Send the individual Form 2065-A, Notification of Community Care Services, citing "Failure to follow the service plan" as the denial reason, and send the facility Form 2101, Authorization for Community Care Services, to close the referral.

4734 Inappropriate for Residential Care

Revision 17-1; Effective March 15, 2017

If an individual has been hospitalized, or has temporarily gone to a nursing facility or other institution, reassess the individual upon return to the Residential Care (RC) facility. Complete the reassessment using the list of appropriate characteristics in Appendix VIII, Residential Care and Emergency Care Mental and Physical Characteristics, to ensure that the individual's needs do not exceed the facility's licensed capability to provide service to the individual. Other circumstances may also require that the individual be assessed for appropriateness. If the individual no longer meets the appropriate characteristics, work closely with the facility to explore all available resources in making arrangements for the individual's move. Other resources to consider in making arrangements may include, but are not limited to:

  • other agencies involved with the individual,
  • the individual's family,
  • area ambulance service, or
  • the local sheriff's department.

4735 Duplication of Services

Revision 17-1; Effective March 15, 2017

A Residential Care (RC) individual may receive Day Activity and Health Services (DAHS) only if the services provided by the DAHS facility are medical services that cannot be provided by the RC facility. Documentation in the case record must clearly specify that at least one medical service is being provided at the DAHS facility that cannot be provided at the RC facility. For example, an individual's needs are being met at the RC facility except for a daily insulin injection. The individual goes to DAHS each morning for the DAHS nurse to administer the injection.

The number of units authorized to an RC individual must be limited to the time needed by the DAHS facility to provide the medical services. Because most RC individuals are not high medical need individuals, the authorized services are limited to one unit (three but less than six hours) per day.

4736 Transfers

Revision 17-1; Effective March 15, 2017

Once the individual is in a facility, he has the right to move from one contracted Residential Care (RC) facility to another. If the individual decides to move to another facility, contact the new facility to share information regarding the individual's needs and to ensure that his needs can be met in the new facility. If the individual is appropriate for the facility, negotiate a date of transfer, and update Form 2101, Authorization for Community Care Services, to reflect the change in facility. Send a copy of this form to the new facility and the former facility, noting in the comments section that the individual's transfer has been completed.

4740 Individual Contribution to the Cost of Care

Revision 24-1; Effective March 1, 2024

A person must contribute to the total cost of the care that they receive, including payment for room and board. The room and board amount is calculated from the person’s gross income. The person is responsible for paying this amount directly to the provider agency and may be required to pay a copayment based on the amount of income remaining after all allowances are deducted

A person is not eligible for residential care if they are required to contribute to the cost of their care but refuses to do so.

Related Policy 

26 Texas Administrative Code Section 271.85(b)
26 Texas Administrative Code Section 271.155(e)

 

4740.1 Room and Board Payments

Revision 17-1; Effective March 15, 2017

Individuals entering Residential Care (RC) are required to pay for room and board. The room and board payment is determined by a specific daily rate based on the type of residential setting. After deducting the room and board payment, the individual's copayment will be calculated based on personal needs allowance and any other approved deductions. The case worker must complete Form 1032, Residential Care Copayment Worksheet. Form 1032 is an automated calculation worksheet for determining room and board and copayment amounts. A copy of the worksheet must be filed in the case record.

4740.2 Copayments

Revision 17-1; Effective March 15, 2017

Residential Care (RC) includes a copayment system in which the individual is expected to contribute to the cost of care. (Emergency Care (EC) individuals do not contribute any copayment.) Under the copayment system, each individual is allowed certain monthly deductions for personal expenses and contributes the remainder of his income to the cost of care.

Withholding tax can be deducted from unearned income. Both withholding tax and Federal Insurance Contributions Act (FICA) tax can be deducted from earned income provided the deduction is mandatory. Other forms of mandatory deductions may be deducted if the case worker is able to obtain documentation from the employer to confirm that the individual does not have control of the expense being deducted. This includes mandatory repayments to the Social Security Administration (SSA) or other governmental agencies.

The copayment system takes into consideration the costs of non-Medicaid individuals who must pay for their own medical expenses. Medicaid individuals also keep a small allowance for medical expenses that are not covered by their Medicaid/Medicare insurance. If an individual chooses to receive RC services, inform him about the mandatory contribution to the cost of care, and implications for his income and eligibility.

See Form 1032, Residential Care Copayment Worksheet, and Instructions, for step-by-step instructions on how to calculate the individual's total contribution to the cost of care.

4741 Individuals on Services Before September 1, 2003

Revision 17-1; Effective March 15, 2017

Beginning Sept. 1, 2003, individuals in Residential Care (RC) are required to pay room and board. Individuals authorized for RC before that date were converted to the new payment system by dividing the current copayment into a room and board payment and a copayment.

For individuals authorized for RC before Sept. 1, 2003 with inadequate income to pay room and board, a special payment system was implemented using non-Title XX funds. Individuals in this category were automatically enrolled for the room and board payment with new service codes of 19O for the apartment setting or 19N for the non-apartment setting. The amount authorized is the difference between the individual's income and the room and board amount owed to the provider. Individuals receiving the special room and board payment continue to be eligible for the payment as long as they remain in RC without a break in service. However, these individuals must pursue all possible sources of income and report new income to the case worker. The new income is applied to the room and board fee.

State payment of room and board is available only for this group of individuals and does not apply to new applicants or individuals. Anyone authorized for RC after Sept. 1, 2003, must have adequate income to pay the room and board fee to be eligible for the program.

4742 Case Worker Calculation Procedures

Revision 17-1; Effective March 15, 2017

While the amount of the individual's room and board is a set amount, the copayment amount varies depending on his income and whether he is a Medicaid, Qualified Medicare Beneficiary (QMB) or Specified Low Income Medicare Beneficiary (SLMB) recipient. If a non-Medicaid, non-QMB or non-SLMB individual receives Social Security or Railroad Retirement benefits, his Medicare premium is deducted from the gross amount of the benefit before the allowances are deducted. No other deduction is allowed. If the individual has earned income, consider only the amount of net income over $65 per month. The net earned income is what the individual actually takes home after all the deductions for taxes, Social Security, etc. (See Form 1032, Residential Care Copayment Worksheet, and Instructions, for instructions on calculating copayments.)

Determine the amount that the individual must contribute and enter the amount in Items 20 and 21 of Form 2101, Authorization for Community Care Services. Item 20 reflects the amount of copayment due for the first month of service. Item 21 reflects the ongoing copayment amount. Whenever cost-of-living changes increase benefits, review the affected individuals' cases and increase the copayment amounts accordingly. Increases are effective the first day of the month following the end of the 12-day notification period.

Inform the individual, in writing, about the fees he must contribute and advise him that if fees are not paid he will no longer be eligible for Residential Care (RC). Send a copy of Form 2065-A, Notification of Community Care Services, to the individual and the RC provider whenever there are changes in the fees the individual must contribute.

The individual's contribution to the cost of care must never exceed the daily RC rate established by the department.

4743 Waiver of Copayment

Revision 17-1; Effective March 15, 2017

An individual's copayment (not the room and board payment) may be reduced or waived because of unusual financial obligations such as high medical expenses or a need to purchase mobility aids. Consult with the supervisor to determine who in the region has the authority to waive the copayment for a Residential Care (RC) individual.

Evaluate the individual's circumstances to determine whether his copayment should be reduced or waived. Regional staff may not allow a blanket reduction or waiver for all individuals served in an RC facility. Determine a specific period in which the reduction or waiver is applied.

If the copayment is reduced or waived, document the basis for the reduction or waiver in the individual's case folder and forward a copy of the documentation to the provider. Complete Items 20 and 21 on Form 2101, Authorization for Community Care Services, to reflect waived or reduced copayments and enter a statement in the comments section. Review the waiver or reduction before the waiver expires to determine whether it needs to be continued, and document any continuation of the waiver.

4744 Adjusting Payments

Revision 17-1; Effective March 15, 2017

Whenever there is a change in the individual's income or an increase in the room and board rates, the case worker is responsible for calculating the change in the individual's copayment amount.

Notify the individual about a copayment increase or room and board rate change by using Form 2065-A, Notification of Community Care Services. The individual must be given at least 12 days after the Form 2065-A date to appeal the increase. If the individual does not appeal, the increase is effective the first day of the following month.

The same day the individual is notified, send the facility a copy of Form 2065-A with the new amounts. For increases in copayment, send the facility Form 2101, Authorization for Community Care Services, showing the new copayment amount. This gives the facility time to prepare to collect the new amounts. If the individual appeals the increase during the 12-day notification period, send the facility another Form 2101 authorizing the original amount until the fair hearing is completed.

Room and board rates are set amounts based on the living arrangement and will not change unless there is an across-the-board rate change. Only individuals designated on Sept. 1, 2003, for receiving a room and board payment will have adjustments based on changes in their income. See Section 4741, Individuals on Services Before September 1, 2003, for additional details.

Copayments are based on the individual's income and will change at least yearly with the Retirement, Survivors and Disability Insurance (RSDI) or Supplemental Security Income (SSI) benefit cost-of-living increase. Case workers will be notified yearly of the increased amounts and procedures for adjusting the copayments.

4745 Collection of the Individual's Contribution to the Cost of Care

Revision 17-1; Effective March 15, 2017

The facility must collect the individual's room and board payment and copayment and must keep receipts for all copayments collected. The facility must deduct the copayment amount (entered on Form 2101, Authorization of Community Care Services, and in the Service Authorization System) from reimbursement claims submitted to the department.

The facility collects the room and board payment and copayment monthly from the individual by a set due date determined by the facility. If full payment is not made by the due date, the facility sends a notice to the individual and notifies the case worker using Form 2067, Case Information, by the first working day after the due date. When the due date falls on a holiday or a weekend, the facility collects the room and board payment by the first workday following the holiday or weekend.

When Form 2067 is received from the facility stating that the individual has failed to pay the required payments, refer to Section 4774.1, Termination Due to Failure to Pay the Required Contribution to the Cost of Care, for procedures.

The facility must:

  • keep receipts for each room and board payment collected;
  • keep receipts for each copayment collected; and
  • deduct all copayments from reimbursement claims submitted to the Texas Health and Human Services Commission (HHSC).

The individual must pay his entire room and board payment. The individual must also pay the entire copayment or request that the case worker ask for a waiver, if financially unable to pay. See Section 4743, Waiver of Copayment, for procedures.

4750 Personal Leave

Revision 24-1; Effective March 1, 2024

The person is eligible for 14 days of personal leave from the residential Care facility each calendar year. If the person does not pay the bedhold charge for days of personal leave that exceed the limits, they may lose their space in the facility.

Inform the person that they are allowed up to 14 days per year of personal leave from the facility. Vacations and visits with family or friends are examples of personal leave. The person must pay the copayment and room and board charges for personal days. The facility may not bill the Texas Health and Human Services Commission (HHSC) for more than 14 days of personal leave taken by a person each calendar year.

If a person exceeds the allowable limit of 14 days of personal leave, they are responsible for paying all charges for services, per any existing contract or agreement between the person and the facility.

People who use excessive additional days of personal leave, as many as 30 days per year, but continue to pay bed hold charges should be assessed to determine their need for Residential Care (RC). Determine if the institutional placement is still necessary, appropriate and in the person’s best interest.

Excessive use of personal leave may indicate that family members or friends are able and willing to have the person live with them, and this option should be explored. Discuss excessive use of personal leave with the person to ensure that they understand the limitations and requirements of the RC service.

Related Policy

26 Texas Administrative Code Section 271.85(c) 
 

4760 Hospital, Nursing Home or Institutional Facility Stays

Revision 24-1; Effective March 1, 2024

For the person to reserve their space in the facility during a hospital, nursing facility or institutional stay, the facility receives a bedhold charge payment. The bedhold charge is a set rate established by the Texas Health and Human Services Commission (HHSC). As part of the bedhold charge, the person is responsible for paying an amount equal to their room and board charge. HHSC then pays the difference up to the bedhold charge. The amount HHSC pays is called the bedhold rate.

The person does not pay their copayment while out of the facility for a hospital, nursing facility or institutional stay. If the copayment has been paid for the month and the person goes into a hospital, nursing home or institution, the facility must refund the copayment for the days the person is out of the facility.

After a hospital or nursing home stay, review the person’s condition to determine if the facility can continue to meet their needs per Appendix VIII, Residential Care and Emergency Care Mental and Physical Characteristics. Refer to Section 4734, Inappropriate for Residential Care, for other procedures if the person is no longer appropriate for residential care (RC). 

Related Policy

26 Texas Administrative Code Section 271.85(d)  

4770 Ongoing Casework Procedures

Revision 17-1; Effective March 15, 2017

 

4771 Facility Reporting and Notification Requirements

Revision 17-1; Effective March 15, 2017

Refer to 40 Texas Administrative Code §46.45, Required Notifications.

If you receive a notice from the facility regarding a significant change, you have to determine within 14 calendar days of receiving the notice whether the change is necessary. See Section 2811, Effective Dates, if the nature of the change requires a termination of services.

4772 Monitoring

Revision 17-1; Effective March 15, 2017

Monitor the individual's situation every six months. For monitoring procedures, see Section 2710, Monitoring Visits and Contacts. Assess the individual's satisfaction with the facility and services delivered and the appropriateness of the service plan. If the individual has any complaints regarding the facility or service delivery, report the situation to the facility directly or send Form 2067, Case Information. Work with the individual and the facility to resolve the problem.

Report chronic problems to the unit supervisor, who may forward the information to the program manager and the contract manager.

4773 Annual Reassessment

Revision 17-1; Effective March 15, 2017

The case worker must reassess the individual annually for functional eligibility and redetermine financial eligibility within 24 months of the previous determination of financial eligibility. See Section 2663, Reassessment of Functional Need, and Section 2662, Redetermination of Financial Eligibility, for additional information about reassessments. Update any information on Form 2059, Summary of Client's Need for Services, and any changes to services on Form 2101, Authorization for Community Care Services, and send to the Residential Care (RC) facility.

If the individual no longer meets eligibility requirements or is no longer appropriate for placement in RC, see Section 4774, Termination of Services, and Section 4734, Inappropriate for Residential Care, for procedures to assist the individual in relocation and termination.

4774 Termination of Services

Revision 17-1; Effective March 15, 2017

The Residential Care (RC) individual is not eligible for services if the individual:

  • dies;
  • is admitted to an institution for more than 30 days;
  • requests service termination;
  • refuses to comply with his service plan;
  • jeopardizes his or others' health or safety;
  • loses Medicaid or becomes financially ineligible for services; or
  • is able to contribute to the cost of his care, but refuses to do so.

Do not terminate services if there is an adverse change in the individual's health, but his needs can continue to be met by the facility.

When terminating services, follow procedures in Section 2800, Procedures for Denying or Reducing Services. Send the individual Form 2065-A, Notification of Community Care Services, 12 days before the effective date of denial, except in situations threatening the health or safety of the individual or other individuals. Terminate services immediately in situations threatening health/safety as outlined in Section 2840, Threats to Health and Safety, and Section 2811, Effective Dates for Service Reduction and Termination.

The individual has the right to appeal any adverse action within 90 days of the date of Form 2065-A. The individual may continue to receive services pending the outcome of the appeal hearing if the individual:

  • is provided with 12 days advance notice, as specified in Section 2800 and Appendix IX, Notification/Effective Date of Decision; and
  • notifies the case worker within those 12 days that he wants to appeal the decision.

If the individual does not appeal the service termination, the termination is final. If the individual appeals the service termination notice, follow the Texas Health and Human Services Commission (HHSC) appeal procedures in Section 2830, Appeal Procedures.

4774.1 Termination Due to Failure to Pay the Required Contribution to the Cost of Care

Revision 17-1; Effective March 15, 2017

If the individual fails to pay the required contribution to the cost of care (room and board and/or copayment) by the facility's due date, the facility must notify the individual/representative and the case worker in writing that payment was not received no later than the first working day after the due date. The facility may notify the case worker orally by the next workday, and follow up in writing within five calendar days of when the individual or the individual's representative fails to pay the required payments.

Upon receipt of the notice, the case worker will:

  • coordinate with the facility to convene a meeting of the interdisciplinary team (IDT) within five working days of receipt of the notification. The IDT must include the individual, a facility representative, the case worker and the individual's authorized representative(s), if applicable;
  • explore with the individual and IDT if there are new circumstances preventing the individual from making the required payment. Circumstances to consider are:
    • the individual has a situation involving a mandatory recoupment or other changes in income requiring an adjustment in countable income;
    • the individual meets any of the criteria for waiving the copayment amount, such as increased medical bills (See Section 4743, Waiver of Copayment);
    • circumstances indicate that the individual is being exploited by another person; and
    • other situations exist in which the individual and facility can work out an agreement for the individual to pay the required payments;
  • make every effort to resolve the problem with the individual and the facility;
  • advise the individual of the consequences that will result from refusal to make the required payments to the RC facility, including:
    • termination of eligibility,
    • eviction, and
    • being placed at the end of the interest list if he reapplies for services in the future; and
  • ask the individual to read and sign Form 2119, Residential Care, Adult Foster Care or Assisted Living Contribution Acknowledgement, if the situation cannot be resolved and the individual continues to refuse to pay the required payments. The form states that he refuses to pay the required payments and understands the consequences of not meeting this eligibility requirement. If the individual refuses to sign, document the refusal on the form and have a witness sign. Leave the individual a copy of the form and retain the original copy with the signature in the individual's case record. Advise the individual that he will receive a notice to terminate services. Also advise the individual that he will not be allowed to move to another RC facility while he has an outstanding balance at the current facility, and the current facility may evict the individual for refusal to pay. Coordinate the notice of termination with the facility.

After the IDT meeting, make any appropriate referrals to adjust countable income, request a waiver of copayment or refer to Adult Protective Services (APS), if exploitation is suspected.

If the situation cannot be resolved and the individual is refusing to pay for any reason, the case worker sends Form 2065-A, Notification of Community Care Services, giving the individual a 30-day notice that services will be terminated unless the individual pays the required payments. In the comments section of the form, advise the individual that services will end and the facility may evict the individual if payment is not made by the 30th day. Send the facility a copy of Form 2065-A.

The facility may initiate the eviction proceedings by giving the individual an eviction notice in writing.

If the individual does not appeal, terminate services 30 days from the Form 2065-A notice. The facility will receive payment from HHSC during the 30-day period. If the individual has not made other living arrangements at the end of the 30 days, make a referral to APS. Provided the facility is in compliance with the provisions of its license and contract regarding the eviction of individuals, the facility may evict the individual on the date provided on the written eviction notice.

4774.2 Services During the Appeal

Revision 17-1; Effective March 15, 2017

The individual may appeal the decision to terminate services. If the individual makes the appeal request on or before the date of the action to terminate services, the individual's case will remain open until a hearing decision is made. However, the facility has the right to continue with eviction proceedings and may evict the individual with appropriate notice to the individual, even if the hearing decision has not been made. No services will be provided.

4774.3 Requests to Transfer to Another Residential Care Facility

Revision 17-1; Effective March 15, 2017

The individual may not transfer to another Residential Care (RC) facility as long as the outstanding payment has not been made to the previous facility. The case worker must maintain clear documentation in the case record regarding the individual's refusal to pay and the subsequent actions.

If the individual contacts another facility or the case worker requests placement in a new facility, the gaining case worker must contact the current case worker to determine if the individual is current on all required payments. If the individual has outstanding payments to a facility, the case worker will not approve ongoing RC services at a new facility and the request to transfer will not be processed. The individual may receive other services, if determined eligible, but will remain ineligible for RC services until all outstanding payments are made.

4780 Special Casework Procedures for Emergency Care

Revision 17-1; Effective March 15, 2017

 

4781 Case Worker Assessment

Revision 17-1; Effective March 15, 2017

Respond to a request for Emergency Care (EC) on the same day the report is received. If an individual is in an emergency situation because he needs a home and no other care arrangement is available, determine whether he meets the remaining eligibility criteria for EC. If he does, complete the eligibility determination process within one workday after he enters the facility.

An individual who moves into a Residential Care (RC) facility or an Adult Foster Care (AFC) home for EC must meet eligibility requirements for EC and meet the mental and physical characteristics specified in Appendix VIII, Residential Care and Emergency Care Mental and Physical Characteristics. If necessary, consult the regional nurse.

4782 Immediate Placement

Revision 17-1; Effective March 15, 2017

To expedite the individual's move into the facility, make the referral by telephone. If space is available, help him and his caregivers arrange for transportation to the Adult Foster Care (AFC) home or the Residential Care (RC) facility. If the case worker determines that the individual does not meet the eligibility criteria and the appropriate characteristic criteria for Emergency Care (EC), help him make other arrangements. An ineligible individual must leave the EC facility within five days of the date he entered.

The provider is entitled to payment for EC services for up to five days after individual entry, regardless of the applicant's eligibility status.

If the provider determines that the individual's needs exceed the facility's capability under its licensed authority, the provider may request an additional review by the supervisor in consultation with the regional nurse. Regional staff are responsible for developing review procedures. The case worker is responsible for making the final decision on the individual's appropriateness for RC services.

4783 Length of Stay

Revision 17-1; Effective March 15, 2017

Residential Care (RC) is provided for up to 30 days while you seek a permanent care arrangement within the initial 30-day period. Obtain your supervisor's approval to extend Emergency Care (EC) beyond 30 days. Obtain this approval before the first 30-day period expires.

Note: An extension must not exceed 30 days.