8600, FMSA Transfer and Changing Service Delivery Option

Revision 22-2; Effective May 1, 2022

Sections 8610 through 8660 describe the requirements for transferring to another FMSA and changing service delivery options.

8610 Confirming the Desire to Transfer or Change Service Delivery Option

Revision 22-2; Effective May 1, 2022

Service Coordinator Action

Step	Action
1	Within three days after receiving information that an individual/LAR wants to transfer to another FMSA or change their service delivery option, the SC must contact the individual/LAR to: confirm the individual/LAR wants to transfer or change their service delivery option; and explain that the individual/LAR may choose any FMSA or receiving program provider, as appropriate.
2	If the SC confirms that the individual/LAR wants to transfer or change their service delivery option, the SC must: complete the individual's identifying information on Form 3617, Request for Transfer of Waiver Program Services, check the appropriate box for the type of transfer using the form instructions, and obtain the signature of the individual/LAR, indicating the desire to transfer or change the service delivery option; and determine if the individual/LAR has selected a receiving FMSA/program provider, as appropriate.

Step

Action

Within three days after receiving information that an individual/LAR wants to transfer to another FMSA or change their service delivery option, the SC must contact the individual/LAR to:

confirm the individual/LAR wants to transfer or change their service delivery option; and
explain that the individual/LAR may choose any FMSA or receiving program provider, as appropriate.

If the SC confirms that the individual/LAR wants to transfer or change their service delivery option, the SC must:

complete the individual's identifying information on Form 3617, Request for Transfer of Waiver Program Services, check the appropriate box for the type of transfer using the form instructions, and obtain the signature of the individual/LAR, indicating the desire to transfer or change the service delivery option; and
determine if the individual/LAR has selected a receiving FMSA/program provider, as appropriate.

8620 Selecting a Receiving FMSA or Receiving Program Provider

Revision 22-2; Effective May 1, 2022

Service Coordinator Action

Step	Action
1	The SC must inform the individual/LAR that they have a choice of FMSAs/program providers, even if the individual/LAR has already selected a receiving FMSA/program provider.
2	If the individual/LAR has not selected a receiving FMSA/program provider, the SC must give the individual/LAR a list of FMSAs/program providers, and contact information in the geographic locations preferred by the individual/LAR within five days after the date the SC confirms the individual/LAR wants to transfer or change their service delivery option.
3	After the individual/LAR has selected a receiving FMSA/program provider, the SC must document the individual/LAR's choice of a receiving FMSA/program provider in Section II/Section IV on Form 3617.

8630 Ensuring Agreement on Transfer Effective Date

Revision 22-2; Effective May 1, 2022

Service Coordinator Action

Step	Action
1	At the time the individual/LAR selects a receiving FMSA/program provider, the SC must obtain a proposed transfer effective date from the individual/LAR. (For a change of service delivery option, the transfer effective date is also the date the change of service delivery option would become effective.)
2	The SC must contact the receiving FMSA/program provider to determine if the date proposed by the individual/LAR is acceptable.
3	Once the receiving FMSA/program provider and individual/LAR agree on a transfer effective date, the SC must contact the transferring FMSA/program provider to determine if that date is agreeable to the transferring FMSA/program provider. If the date is agreeable, the SC completes the steps in 8640, Completing Form 3617.
4	If the date is not agreeable, the SC must facilitate communication between the individual/LAR and all involved FMSAs/program providers to reach a mutually agreeable transfer effective date.
5	If a transfer effective date is not agreed upon within five days after the date the individual/LAR selects a receiving FMSA/program provider, the SC must consult HHSC PES for direction.

Receiving FMSA or Program Provider Action

Step	Action
1	When contacted by the SC, the receiving FMSA/program provider must comply with the SC's request for a transfer effective date. (For a change of service delivery option, the transfer effective date is also the date the change of service delivery option would become effective.)
2	If the proposed transfer effective date is not acceptable to the receiving FMSA/program provider, the FMSA/program provider must have a valid reason for not accepting the date, and must suggest an alternate date to be discussed with the individual/LAR and transferring FMSA/program provider.

Transferring FMSA or Program Provider Action

Step	Action
1	When contacted by the SC, the transferring FMSA/program provider must comply with the SC's request for a transfer effective date. (For a change of service delivery option, the transfer effective date is also the date the change of service delivery option would become effective.)
2	If the proposed transfer effective date is not acceptable to the transferring FMSA/program provider, the FMSA/program provider must have a valid reason for not accepting the date, and must suggest an alternate date to be discussed with the individual/LAR and receiving FMSA/program provider.

8640 Completing Form 3617

Revision 22-2; Effective May 1, 2022

Service Coordinator Action

Step	Action
1	The SC must enter the mutually agreed upon transfer effective date in the appropriate sections on Form 3617 as follows: Section I, Transferring Program Provider's Information; Section II, Receiving Program Provider's Information; Section III, Transferring FMSA's Information; and Section IV, Receiving FMSA's Information.
2	Depending on the FMSAs/program providers involved, the SC must ensure the appropriate sections of Form 3617 are completed in the following order: Section I, Transferring Program Provider's Information; Section III, Transferring FMSA's Information; Section II, Receiving Program Provider's Information; and Section IV, Receiving FMSA's Information. The SC is responsible for faxing Form 3617 to the involved FMSA/program provider in the above order and to request that the FMSA/program provider complete its section of the form and return it to the SC within three business days.
3	The SC must ensure all signatures are on the same copy of Form 3617. The SC must sign Form 3617 after the involved FMSAs/program providers have completed their sections.

Step

Action

The SC must enter the mutually agreed upon transfer effective date in the appropriate sections on Form 3617 as follows:

Section I, Transferring Program Provider's Information;
Section II, Receiving Program Provider's Information;
Section III, Transferring FMSA's Information; and
Section IV, Receiving FMSA's Information.

Depending on the FMSAs/program providers involved, the SC must ensure the appropriate sections of Form 3617 are completed in the following order:

Section I, Transferring Program Provider's Information;
Section III, Transferring FMSA's Information;
Section II, Receiving Program Provider's Information; and
Section IV, Receiving FMSA's Information.

The SC is responsible for faxing Form 3617 to the involved FMSA/program provider in the above order and to request that the FMSA/program provider complete its section of the form and return it to the SC within three business days.

The SC must ensure all signatures are on the same copy of Form 3617. The SC must sign Form 3617 after the involved FMSAs/program providers have completed their sections.

Transferring FMSA or Program Provider Action

Step	Action
1	The transferring FMSA/program provider must accurately complete Section I/Section III of Form 3617, in accordance with the form's instructions, and sign and date the form, indicating agreement with the information in Section I/Section III.
2	The transferring FMSA/program provider must return the completed and signed Form 3617 to the SC within three business days after receiving it from the SC.

Receiving FMSA or Program Provider Action

Step	Action
1	The receiving FMSA/program provider must accurately complete Section II/Section IV of Form 3617, in accordance with the form's instructions, and sign and date the form, indicating agreement with the information in Section II/Section IV.
2	The receiving FMSA/program provider must return the completed and signed Form 3617 to the SC within three business days after receiving it from the SC.

8650 Developing the Transfer IPC

Revision 22-2; Effective May 1, 2022

Service Coordinator Action

Step	Action
1	On or before the transfer effective date, the SC must meet with the CDS employer (individual/LAR) and the receiving program provider, if applicable, to review the individual's current IPC and develop a transfer IPC. This must be a face-to-face meeting, if feasible.
2	The SC must ensure that the transfer IPC includes services already provided by the transferring FMSA/program provider, as well as those to be provided by the transferring FMSA/program provider before the transfer effective date. This information can be found in: the HHSC data system; and Column 3 of the completed Form 3617 (services provided but not yet billed and services not yet provided). The SC must also ensure that the transfer IPC includes services to be provided beginning on the day of the transfer effective date.
3	The SC must ensure the transfer IPC: complies with the requirements described in Section 9.159(c); and is signed and dated by the individual/LAR, receiving FMSA/program provider and SC.

Step

Action

On or before the transfer effective date, the SC must meet with the CDS employer (individual/LAR) and the receiving program provider, if applicable, to review the individual's current IPC and develop a transfer IPC. This must be a face-to-face meeting, if feasible.

The SC must ensure that the transfer IPC includes services already provided by the transferring FMSA/program provider, as well as those to be provided by the transferring FMSA/program provider before the transfer effective date. This information can be found in:

the HHSC data system; and
Column 3 of the completed Form 3617 (services provided but not yet billed and services not yet provided).

The SC must also ensure that the transfer IPC includes services to be provided beginning on the day of the transfer effective date.

The SC must ensure the transfer IPC:

complies with the requirements described in Section 9.159(c); and
is signed and dated by the individual/LAR, receiving FMSA/program provider and SC.

Receiving Program Provider Action

Step	Action
1	The receiving program provider must meet with the CDS employer and SC to develop and sign a transfer IPC, as requested by the SC.

Receiving FMSA Action

Step	Action
1	The receiving FMSA must sign a transfer IPC, as requested by the SC.

8660 Completing Data Entry in the HHSC Data System and Submitting Documents to HHSC

Revision 22-2; Effective May 1, 2022

LIDDA Action

Step	Action
1	Within 10 days after the transfer effective date, the LIDDA must complete all data entry to finalize a transfer.
2	Following data entry, but within 10 days after the transfer effective date, the SC must submit the completed transfer IPC and Form 3617 to HHSC PES.

Receiving FMSA or Program Provider Action

Step	Action
1	The receiving FMSA/program provider must assign a local case number for its component code for the individual for data entry by the LIDDA. If the individual already has a local case number with the FMSA’s/program provider's component code, use the existing local case number. Do not create a new local case number.