Home and Community-based Services Handbook

1000, Introduction

1100 Letter from DADS Commissioner

Revision 10-0; Effective June 1, 2010

Commissioner Letter 2010 (PDF)

1200 Philosophy of Service Delivery

Revision 10-0; Effective June 1, 2010

A Historical Overview of Service and Supports for Individuals with Intellectual or Developmental Disabilities

Prior to 1960, the prominent model for providing services to individuals with intellectual or developmental disabilities (IDDs) was a medical model with services typically provided in an institutional setting. In the 1960s, a paradigm shift began that resulted in the development of other models of service delivery. In particular, Congress began to provide funds to states to begin developing services in community settings for the first time. Texas established community mental health and IDD centers in tandem with these changes in federal funding and expectations.

By the 1970s the federal government developed regulations and standards for treatment of individuals with intellectual or developmental disabilities who lived in institutions, which included requirements for developing Individual Program Plans (IPPs). These regulations and standards marked the shift from what was largely “custodial care” to a system that promoted “active treatment.” Active treatment, while still requiring that basic care needs be met, is notably different from custodial care by emphasizing the teaching of new skills to individuals with intellectual or developmental disabilities. Active treatment guidelines also required the individual to participate in the interdisciplinary team (IDT) that develops the individual’s IPP.

Following the adoption of the active treatment model, professionals and other stakeholders in the field began developing tools and resources to facilitate person-centered planning. The ultimate outcome of person-centered planning is to further improve the quality of life for people with disabilities. Person-centered planning represented a fundamental shift from service planning that required providers to keep people with disabilities safe to a service planning and service delivery system that provides supports necessary for individuals to achieve their desired outcomes.

In the 1980s the U.S. Health Care Financing Administration (HCFA), now the Centers for Medicare & Medicaid Services (CMS), started granting waivers from the existing Medicaid rules. Waivers allow states the flexibility to design alternatives to institutional services, including the option for states to provide services in community settings as an alternative to institutional settings. In 1985 the Home and Community-based Services (HCS) waiver program was developed by Texas to waive the requirements of intermediate care facilities for individuals with an intellectual disability or related conditions (ICF/IID) services. HCS allows flexibility in the development of services for individuals who have intellectual and developmental disabilities that choose to receive their services in the community instead of an institutional setting. The federal government requires HCS be cost-effective and to include safeguards to protect participants’ health and safety.

Current and Future Direction

Today we strive to support individuals with intellectual and developmental disabilities in achieving their desired lifestyles and in becoming valued members of the community by:

addressing health and safety issues in the context of their desired lifestyles;
offering opportunities to better achieve their goals; and
making the most efficient use of all available resources to accomplish these goals.

Thus, waiver services are shifting from prescribing service delivery to outlining minimum requirements that must be met when designing services to support people to achieve the lifestyles they desire. Developing services that capture what is important to and for individuals who receive HCS services, as well as balancing choice and protection of health and safety, is a challenge for the service delivery system.

The Department of Aging and Disability Services (DADS) uses the term person-directed planning instead of person-centered planning to talk about the ongoing planning process that helps to determine an individual’s life path. Person-directed planning ensures it is the individual who is directing the process.

DADS supports the expectation that every individual should have the opportunity to participate in the community, gain and maintain relationships of their choosing, express preferences, make choices, fulfill goals, and live with dignity and respect. Person-directed planning is used to represent an individual and their family’s vision about how the person wishes to live, including aspirations for the future. Person-directed planning challenges DADS, HCS providers and Local Authorities (LAs) to work in cooperation to provide meaningful services and supports for the individuals who receive services.

Person-Directed Planning in the Home and Community-based Services Waiver Program

The LA service coordinator (SC) uses a person-directed planning process to gather information necessary to develop a Person-Directed Plan (PDP) that accurately reflects the individual’s goals and desires. The PDP is a written plan developed for an applicant or individual in accordance with Form 8665, HCS Person-Directed Plan, and Appendix IV, Discovery Tool. It describes the supports and services necessary to preserve the applicant’s or individual’s health and safety, and to achieve the desired outcomes identified by the applicant or individual or legally authorized representative (LAR) on behalf of the applicant or individual. The person-directed planning process:

empowers the individual/LAR on behalf of the individual to direct the development of the plan of services and supports that meets the individual’s personal outcomes;
identifies existing supports and services necessary to achieve the individual’s desired outcomes;
identifies natural supports available to the individual and negotiates needed service system supports;
occurs with the support of a group of people chosen by the individual (and LAR on the individual’s behalf); and
accommodates the individual’s style of interaction and preferences regarding time and setting.

The SC, using the PDP Discovery Tool as a basis for information gathering, conducts interviews with the individual, LAR, provider staff or others who know the person well. The results of these information-gathering interviews are compiled to:

prioritize what outcomes and needs are included on the PDP; and
identify which outcomes and needs will be met through waiver services and which will be met through non-waiver services.

The individual, SC and the HCS provider develop the Individual Plan of Care (IPC) based on the PDP. The provider is then responsible for developing an Implementation Plan (IP) with the individual and LAR. The IP is a written document developed for each HCS Program service on the individual’s IPC not provided through the Consumer Directed Services option that identifies how HCS services will be implemented to accomplish the outcomes identified in the PDP.

The SC is expected to implement an ongoing person-directed planning process, not a single event planning process. In order to accomplish that, the SC will need to monitor and update the PDP as preferences or needs change and additional information is learned about the individual. When an individual’s preferences or needs change or additional information is discovered, the SC will notify the HCS provider and submit a copy of the HCS Person-Directed Plan Outcome Summary (Page 10 of Form 8665) that will identify the desired addition/change/deletion based on the individual’s preferences/needs. The program provider may then have to revise the IP(s) and/or IPC.

The system must be flexible enough to keep up with the current needs and wishes of the individuals who receive HCS services.

The desired outcome of the HCS service delivery model is to promote services and supports that contribute to the acquisition of meaningful outcomes for each individual. The success of this model depends on the individuals who receive HCS services, their LARs and family members, the program provider, the service coordinator and DADS.

1300 Overview of Service Delivery System

Revision 10-0; Effective June 1, 2010

June 1, 2010, brings major changes to the Home and Community-based Services (HCS) service delivery system. The purpose of this section is to introduce program providers and Local Authorities to what HCS services will look like in the future. The success of HCS services will depend on individuals, their legally authorized representatives (LARs) and family members, the program providers, Local Authorities and Department of Aging and Disability Services (DADS) staff understanding the concepts behind the new system and developing the relationships that will support individuals in the HCS Program.

For the individuals who receive services, their LARs and family members: The transition from an Individual Service Plan (ISP) to a Person-Directed Plan (PDP) will require that personal outcomes be communicated to the service planning team (SPT). In the past, the interdisciplinary team, which included the individual, the LAR and often family members of the individual, decided what would be included in the ISP. The PDP will place even more emphasis on the results the individual desires from services and supports. Development of an effective PDP is dependent on the SPT knowing what is important to and for the individual who is receiving HCS services. Communication between the individual, the LAR, the individual’s family and the Local Authority service coordinator is critical to the development of a PDP that is meaningful for the individual. It is important that the SPT act not only on preferences that are communicated through words, but also on those preferences that are communicated through body language and maladaptive behaviors. Identifying natural supports and their roles and limits in supporting an individual is essential when linking an individual to HCS services and non-HCS services. Communication is also needed from individuals, their LARs and family members to determine whether the services being delivered are meeting the individual’s needs and preferences or whether revisions are necessary.

For the Local Authorities: Delivery of effective service coordination requires commitment to the individual who receives HCS services and to the collaboration with HCS and non-HCS service providers. A concerted effort must be made to get to know the individual and their natural supports very well. Collecting information from HCS and non-HCS service providers is essential in developing a PDP that is meaningful and will result in the desired outcomes. The ability to recognize service needs, to communicate the service needs to natural supports and HCS and non-HCS service providers, to link the individual to available resources, and to analyze the effectiveness of service delivery is essential to successful service coordination.

Service coordinators must also have extensive knowledge of non-HCS service resources to develop a PDP and to determine what HCS services need to be purchased on behalf of an individual. Knowledge of the HCS Program Billing Guidelines is critical in order to ensure that the services being purchased from the HCS program provider can be reimbursed.

For the HCS program providers: Eliminating the case management function from the array of services offered by the HCS program provider will likely require many changes to the program provider’s organizational structure. Most program providers assigned case management duties that exceeded HCS rule requirements. However, many of the case management functions that previously were defined in rule, including coordinating the development and implementation of the service plan, coordinating and monitoring the delivery of HCS and non-HCS services, integrating various aspects of services delivered through HCS and non-HCS services, recording progress and lack of progress, record-keeping, and developing a pre-discharge plan, are now the responsibility of the Local Authority service coordinator. The program provider will need to perform some parallel functions to ensure that services are effective and that individuals are healthy, safe and satisfied with their services. For example, the program provider is responsible for developing the Implementation Plan (IP) that describes specifically how the program provider’s services will achieve the assigned desired outcomes. In addition, program providers will be responsible for supervising their employees and contracted staff to ensure that they are following the IP and that progress or lack of progress is documented. If an individual receives foster/companion care, Supervised Living or Residential Support Services and possibly Supported Home Living or Respite, it is probable that the program provider’s staff will communicate and collaborate with the non-HCS service provider to integrate various aspects of service delivery. The program provider will be required to maintain a record that contains documentation relevant to the delivery of the program provider’s HCS services.

In cases in which the program provider provides foster/companion care, Supervised Living or Residential Support Services, the program provider must be able to respond to emergency situations 24 hours per day, seven days per week. The program provider may also be required to provide emergency services to an individual who lives in their own home or family home, as documented in the PDP. In the event that an unanticipated emergency arises and emergency services not included in the individual’s IPC are required, it is expected that the program provider will be responsive to that emergency and that units are added to the IPC later (if necessary) to allow reimbursement to the provider.

Program providers are encouraged to maintain frequent communication with the individuals to whom they provide services, as well as LARs and family members, to evaluate their satisfaction and to determine if changes are needed to the IP. Since case management is no longer included in the program provider’s array of HCS services, it is critical to develop effective communication systems among program provider staff and that staff know when and how to contact the individual’s service coordinator.

For DADS employees: DADS staff must prepare for these changes in the service delivery system. All DADS staff who serve individuals who receive HCS services must be knowledgeable of how the elimination of the case management function from the program provider’s array of services and the assignment of Local Authority service coordination to individuals receiving HCS services will affect the way they perform their jobs. These DADS staff must understand the concepts of person-directed planning and how to promote the acquisition of outcomes. New monitoring processes and tools will be used by the following DADS areas:

Access and Intake – Local Authority Section, Contract Accountability and Oversight Unit; Utilization Management and Review, IDD Waivers, Program Enrollment and UR; and Billing and Fiscal Monitoring
Regulatory Services – Waiver Survey and Certification

Click here for a table describing many of the major changes that result from the removal of case management services from the program providers’ service array and the performance of service coordination by the Local Authorities.

1100, Letter from DADS Commissioner

Revision 10-0; Effective June 1, 2010

Commission Letter (PDF)

1200, Philosophy of Service Delivery

Revision 10-0; Effective June 1, 2010

A Historical Overview of Service and Supports for Individuals with Intellectual or Developmental Disabilities

Current and Future Direction

Today we strive to support individuals with intellectual and developmental disabilities in achieving their desired lifestyles and in becoming valued members of the community by:

addressing health and safety issues in the context of their desired lifestyles;
offering opportunities to better achieve their goals; and
making the most efficient use of all available resources to accomplish these goals.

Person-Directed Planning in the Home and Community-based Services Waiver Program

empowers the individual/LAR on behalf of the individual to direct the development of the plan of services and supports that meets the individual’s personal outcomes;
identifies existing supports and services necessary to achieve the individual’s desired outcomes;
identifies natural supports available to the individual and negotiates needed service system supports;
occurs with the support of a group of people chosen by the individual (and LAR on the individual’s behalf); and
accommodates the individual’s style of interaction and preferences regarding time and setting.

prioritize what outcomes and needs are included on the PDP; and
identify which outcomes and needs will be met through waiver services and which will be met through non-waiver services.

The system must be flexible enough to keep up with the current needs and wishes of the individuals who receive HCS services.

1300, Overview of Service Delivery System

Revision 10-0; Effective June 1, 2010

Service coordinators must also have extensive knowledge of non-HCS service resources to develop a PDP and to determine what HCS services need to be purchased on behalf of an individual. Knowledge of the HCS Program Billing Guidelines (PDF) is critical in order to ensure that the services being purchased from the HCS program provider can be reimbursed.

Access and Intake – Local Authority Section, Contract Accountability and Oversight Unit; Utilization Management and Review, IDD Waivers, Program Enrollment and UR; and Billing and Fiscal Monitoring
Regulatory Services – Waiver Survey and Certification

2000, Service Coordination

Revision 22-2; Effective May 1, 2022

All user guides are published to Texas Medicaid & Healthcare Partnership’s (TMHP’s) Learning Management System (LMS). All users must create an LMS account to access the materials.

There is a sign-up link on the LMS homepage. If you need assistance with registration, contact TMHP Training Support.

2100, Service Coordination Responsibilities

Revision 10-0; Effective June 1, 2010

2110 Service Coordination Assignment

Revision 22-2; Effective May 1, 2022

The Local Intellectual and Developmental Disability Authority (LIDDA) must assign a service coordinator (SC) to each enrolling Home and Community-based Services (HCS) applicant and HCS participant.

The LIDDA must notify the HCS participant (individual), legally authorized representative (LAR) and the HCS provider of the name and contact information of the assigned SC at time of assignment and as changes occur using Form 8583, Contact Information. The LIDDA is required to have a backup system for absences of the assigned SC that designates a staff person as the contact during the time the SC is unavailable.

The LIDDA enters the SC assignment into the HHSC data system and updates the assignment in the HHSC data system when the SC assignment is changed.

2120 Person-Directed Plan Development

Revision 22-2; Effective May 1, 2022

The SC uses person-directed planning to gather information for the Person-Directed Plan (PDP). Person-directed planning is a process that empowers the individual or the LAR, on the individual's behalf, to direct the development of a plan of supports and services that meets the individual's personal outcomes (preferences and needs). 3000, Person-Directed Plan, of the Local Intellectual and Developmental Disability Authority (LIDDA) Handbook instructs the SC on PDP. The PDP process:

identifies supports and services necessary to achieve the individual's desired outcomes;
identifies existing supports, including natural supports and other supports, available to the individual and negotiates needed services system supports;
occurs with the support of a group of people chosen by the individual and the LAR on the individual's behalf (for example, a provider representative, neighbor or friend); and
accommodates the individual's style of interaction and preferences regarding time and setting.

In addition to understanding person-directed planning, the SC must be familiar with the HCS Program Billing Requirements to facilitate the gathering of outcome information necessary for justifying the type of supports and services to be provided through the HCS Program.

Procedure for Completing Form 8665, Person-Directed Plan

The SC assists the individual and the LAR to designate members of the individual's service planning team (SPT). The required members of the SPT are the individual, LAR and the SC. Any other members are identified by the individual and the LAR and may include a provider representative, a teacher, a friend or a neighbor.

The SC conducts interviews with the individual, LAR, advocate, provider staff and others, as appropriate, who can provide information about the individual's desired outcomes and needs. The interviews are conducted using the probes in the PDP Discovery Tool (Appendix IV) to guide the information-gathering interviews.

The results of the information-gathering interviews identify the individual's preferences and needs, including the individual's desire to use the Consumer Directed Services (CDS) option. The preferences and needs form the basis for the individual's desired outcomes. The desired outcomes are included in the individual's PDP. The PDP must identify which desired outcomes will be met through HCS services and which will be met through non-HCS services. The SPT is responsible for documenting that the HCS services and non-HCS services on the PDP:

are necessary for the individual to continue living in the community;
ensure the individual's health and safety; and
prevent the need for institutional services.

To document that HCS service components are justified*, the SC must determine that the:

type of each service component in the PDP is appropriate to meet a desired outcome or need of the individual; and
HCS service components do not replace existing supports, natural supports or other sources for the service (such as the Texas Workforce Commission for funding of supported employment services).

* Note: The SC is responsible for justifying the need for each HCS service type in the PDP and the HCS program provider is responsible for justifying the amount of each HCS service type in the Implementation Plan (IP).

The required minimum service coordination face-to-face contact for an HCS participant is every 90 days, but individual situations may necessitate more frequent contact. The PDP Discovery Tool, used by the SC for PDP development, assists the SC in determining frequency of contact for service coordination activities.

Additional guidance and information about person-directed planning can be found in 3000 of the LIDDA Handbook and Person Directed Planning Guidelines.

2130 Enrollment Activities

Revision 22-2; Effective May 1, 2022

Refer to 13000, Medicaid Program Enrollment Requirements, of the LIDDA Handbook for requirements related to enrollment activities.

2140 Service Coordination Monitoring

Revision 22-2; Effective May 1, 2022

The SC must conduct and document monitoring activities, including:

determining whether the individual has made progress toward the outcomes identified on the PDP;
determining whether HCS service(s) are being delivered by the HCS provider or CDS provider, as appropriate;
determining whether non-HCS services (such as Texas Health Steps-funded nursing services) are being delivered;
ensuring coordination and compatibility of HCS and non-HCS services with the HCS provider; and
determining whether the individual's health or safety is at risk in the environments where the individual receives HCS and non-HCS services and, if necessary, taking action to protect the individual's health and safety. Action may include addressing the risk with the HCS provider or notifying the appropriate authorities.

If, as a result of monitoring, the SC identifies a concern with an individual's progress toward outcomes in the PDP, the delivery of HCS services, or the individual's health and safety, the SC must communicate such concern to the provider via a mechanism determined by the LIDDA and HCS provider. The SC and the provider are responsible for resolving any identified concern. If the concern cannot be resolved, the SC may report the concern to IDD Ombudsman at Texas Health and Human Services Commission (HHSC).

The SC maintains the following for an individual for an Individual Plan of Care (IPC) year:

a copy of the IPC (Form 3608);
the PDP (Form 8665);
a copy of Form 8578, Intellectual Disability/Related Condition Assessment;
documentation of the activities performed by the SC in providing service coordination; and
any pertinent information related to the individual and the services provided to the individual.

Suggestions for Monitoring

The SC is responsible for monitoring progress or lack of progress toward desired outcomes in the PDP and determining whether the HCS services on the IPC are being delivered. The documentation of progress or lack of progress toward desired outcomes should include references to all outcomes on the PDP. If the SC contact frequency is more often than quarterly, each desired outcome should be referenced at least once in the quarter. The SC may review information about utilized services in the HHSC data system, against the individual's IPC to help determine if HCS services are being delivered.

As a result of ongoing monitoring, the SC revises the PDP, as appropriate, as the individual's preferences and needs change. The SC uses the PDP and the Discovery Tool (Appendix IV) as guides to determine the individual's progress toward outcomes identified in the PDP, whether HCS Program services are being delivered and whether outcomes in the PDP need to be updated.

The SC conducts interviews with the individual, LAR, family and provider staff with a focus on the individual and the outcomes in the PDP. The SC should determine if the outcomes in the PDP are being achieved or have been accomplished. The SC should also focus on whether the outcomes previously identified in the PDP are still relevant or need to change.
For an individual who does not communicate with words, the SC will need to focus on the individual's actions by spending time observing the individual in different settings and developing a rapport with the individual. In some case, the SC may depend more on interviews with people who know the individual well to make decisions regarding whether the individual is making progress toward the desired outcomes.
The SC may access the individual's record maintained by the HCS provider, but this should usually be done to clarify information that was obtained through interviews and observations of the individual.

The SC does not monitor the HCS provider's Implementation Plan.

2150 Service Coordinator Role

Revision 10-0; Effective June 1, 2010

2151 Individual Plan of Care Renewal

Revision 22-2; Effective May 1, 2022

At least 60 but no more than 90 calendar days before an individual's IPC expires, the SC is responsible for notifying the service planning team of the need to review and update the individual’s PDP.

The SC should provide the LAR at least a 21-day notice that the PDP needs to be reviewed.

The SPT must review the PDP to determine if the information is accurate and reflects the individual’s current preferences and needs. The SC updates the PDP using instructions and forms provided by HHSC to indicate the necessary changes to the PDP. The SC must send the HCS provider a copy of the updated PDP within 10 calendar days after the PDP is updated.

At least 30 but no more than 60 calendar days before the expiration of the IPC, the SPT and the HCS provider must review the PDP and develop the renewal IPC, including the HCS Program services and Community First Choice (CFC), completion of the CDS portion of the renewal IPC, if applicable, and the non-HCS services.

The HCS provider is responsible for developing an Implementation Plan for the HCS services identified in the PDP and renewal IPC that will be delivered by the provider. The Implementation Plan must provide information that justifies the amount of each HCS service component on the renewal IPC.

The HCS provider is required to sign and date the renewal IPC and ensure that the IPC is signed and dated by the individual and LAR. If the SC is physically present when the renewal IPC is developed, the SC signs the IPC and obtains a copy of the IPC. The SC is not required to sign the IPC before it is entered in the HHSC data system.

The HCS provider is responsible for entering the renewal IPC data into the HHSC data system. The HCS provider keeps the original renewal IPC in the individual's record. If the SC is not physically present when the renewal IPC is developed, the provider is responsible for sending the SC a paper copy of the IPC within three calendar days after the HCS provider completes data entry into the HHSC data system.

Within seven calendar days after the HCS provider enters the renewal IPC into the HHSC data system, the SC must review the renewal IPC in the HHSC data system. The SC can send the IPC back to the HCS provider to correct obvious typographical errors on the IPC; however, the SC must notify the HCS provider of such. If the SC sends the IPC back for an error correction, the seven calendar-day time frame begins again once the HCS provider re-transmits the IPC. The SC must review the IPC in the HHSC data system, enter their name and date, and indicate whether they agree or disagree with the renewal IPC. The foundation of the SC's agreement or disagreement is:

whether the renewal IPC is based on the PDP;
if the IPC specifies the type and amount of each service component to be provided to the individual, as well as services and supports to be provided by other non-HCS sources during the IPC year; and
whether the type and amount of each service component is supported by:
- documentation that other non-HCS sources for the service component are unavailable and the service component does not replace existing supports, natural supports or other sources for the service;
- assessments of the individual that identify specific service components necessary for the individual to live in the community, to ensure the individual's health and welfare in the community, and to prevent the need for institutional services; and
- documentation of deliberations and conclusions of the SPT that the service components are based on the desired outcomes in the PDP and are necessary for the individual to live in the community, to ensure health and welfare in the community, and to prevent the need for institutional services.

If the SC disagrees with the renewal IPC, the SC must notify HHSC and the HCS provider using Form 8579, Notification of Service Coordinator (SC) Disagreement. See form instructions. The SC must also notify the individual/LAR.

2152 Individual Plan of Care Revision

Revision 22-2; Effective May 1, 2022

The SC or the HCS provider may initiate a revision to the IPC to add a new HCS service or increase the amount of an existing service. A revision to the IPC must be done prior to the delivery of a new service or increased service amount, except in an emergency as described in 2153, Role of Service Coordinator Related to Emergency Provisions of Home and Community-based Services and Individual Plan of Care Revision.

Whoever determines the IPC needs to be revised (the SC or the HCS provider) must notify the other. Within 14 days after notification, the SC and the HCS provider must work together to revise the IPC.
The SPT and the HCS provider must develop a proposed revised IPC to address the issue that caused the SC or HCS provider to determine the individual's IPC needed to be revised.
The HCS provider must develop an Implementation Plan for the HCS services identified in the proposed revised IPC. The Implementation Plan must provide information that justifies the amount of each HCS service component on the revised IPC.
The SPT must revise the PDP if the existing PDP does not support the service type on the revised IPC. If the PDP is not revised, the SC must document the reason for the IPC revision in a contact note.
The HCS provider is required to sign and date the revised IPC and ensure that the IPC is signed and dated by the individual and LAR. If the SC is physically present when the revised IPC is developed, the SC signs the IPC and obtains a copy of the IPC. The SC is not required to sign the IPC before it is entered into the HHSC data system.
The HCS provider is responsible for entering the revised IPC data into the HHSC data system. The HCS provider keeps the original revised IPC in the individual's record. If the SC is not physically present when the IPC is developed, the provider is responsible for sending the SC a paper copy of the proposed revised IPC within three calendar days after the HCS provider completes data entry into the HHSC data system.
Within seven calendar days after the HCS provider enters the revised IPC data into the HHSC data system, the SC must review the IPC in the HHSC data system. The SC can send the IPC back to the HCS provider to correct obvious typographical errors on the IPC; however, the SC must notify the HCS provider of such. If the SC sends the IPC back for an error correction, the seven calendar-day time frame begins again once the HCS provider re-transmits the IPC. The SC must review the IPC in the HHSC data system, enter their name and date, and indicate whether they agree or disagree with the revised IPC. The foundation of the SC's agreement or disagreement is:
- whether the IPC is based on the PDP;
- if the IPC specifies the type and amount of each service component to be provided to the individual, as well as services and supports to be provided by other non-HCS sources during the IPC year; and
- whether the type and amount of each service component is supported by:
  - documentation that other non-HCS sources for the service component are unavailable and the service component does not replace existing supports, natural supports or other sources for the service;
  - assessments of the individual that identify specific service components necessary for the individual to live in the community, to ensure the individual's health and welfare in the community, and to prevent the need for institutional services; and
  - documentation of deliberations and conclusions of the SPT that the service components are based on the desired outcomes in the PDP and are necessary for the individual to live in the community, to ensure health and welfare in the community, and to prevent the need for institutional services.

If the SC disagrees with the revised IPC, the SC must notify HHSC and the HCS provider by using Form 8579, Notification of Service Coordinator (SC) Disagreement. See form instructions. The SC must also notify the individual/LAR.

2153 Emergency Provision of Home and Community-based Services and Individual Plan of Care Revision

Revision 22-2; Effective May 1, 2022

If an emergency necessitates the provision of an HCS service to ensure the individual's health and welfare, and the service is not on the IPC or exceeds the amount on the IPC, the HCS provider may provide the service before revising the IPC. Within one business day after providing the service the HCS provider is responsible for:

documenting the circumstances that necessitated providing the new HCS service or the increase in the amount of the existing HCS service, including the type and amount of the service provided; and
notifying the SC of the emergency provision of the service and that the IPC must be revised. (The SC may request a copy of the documentation required in the bullet above.)

Within seven calendar days after providing the service, the SC and the HCS provider must work together to revise the IPC.

The SPT and the HCS provider must develop a proposed revised IPC to address the emergency.
The HCS provider must develop an Implementation Plan for the HCS services identified in the proposed revised IPC. The implementation plan must provide information that justifies the amount of each HCS service component on the revised IPC.
The SPT must revise the PDP, if the existing PDP does not support the revised IPC.
The HCS provider is required to sign and date the revised IPC and ensure that the IPC is signed and dated by the individual and LAR. If the SC is physically present when the revised IPC is developed, the SC signs the IPC and obtains a copy of the IPC. The SC is not required to sign the IPC before it is entered into the HHSC data system.
The HCS provider is responsible for entering the revised IPC data into the HHSC data system. The HCS provider keeps the original revised IPC in the individual's record. If the SC is not physically present when the IPC is developed, the provider is responsible for sending the SC a paper copy of the proposed revised IPC within three calendar days after the HCS provider completes data entry into the HHSC data system.
Within seven calendar days after the HCS provider enters the revised IPC data into the HHSC data system, the SC must review the IPC in the HHSC data system. The SC can send the IPC back to the HCS provider to correct obvious typographical errors on the IPC; however, the SC must notify the HCS provider of such. If the SC sends the IPC back for an error correction, the seven calendar-day time frame begins again once the HCS provider re-transmits the IPC. The SC must review the IPC in the HHSC data system, enter their name and date, and indicate whether they agree or disagree with the revised IPC. The foundation of the SC's agreement or disagreement is:
- whether the IPC is based on the PDP;
- if the IPC specifies the type and amount of each service component to be provided to the individual, as well as services and supports to be provided by other non-HCS sources during the IPC year; and
- whether the type and amount of each service component is supported by:
  - documentation that other non-HCS sources for the service component are unavailable and the service component does not replace existing supports, natural supports or other sources for the service;
  - assessments of the individual that identify specific service components necessary for the individual to live in the community, to ensure the individual's health and welfare in the community, and to prevent the need for institutional services; and
  - documentation of deliberations and conclusions of the SPT that the service components are based on the desired outcomes in the PDP and are necessary for the individual to live in the community, to ensure health and welfare in the community, and to prevent the need for institutional services.

2154 Level of Care/Level of Need Renewal and Lapsed LOC/LON

Revision 22-2; Effective May 1, 2022

The HCS provider is responsible for ensuring an individual's level of care/level of need (LOC/LON) is current by electronically transmitting to HHSC Form 8578, Intellectual Disability/Related Condition Assessment, at least annually. If the HCS provider fails to transmit the ID/RC assessment before the LOC/LON expires, the HCS provider must transmit an ID/RC assessment for renewal and transmit an ID/RC assessment for the time period between the LOC/LON expiration date and the date the renewal became effective. This is the "lapsed" time period.

Within three calendar days after an HCS provider transmits an ID/RC assessment, either for renewal or lapsed, the HCS provider is responsible for providing the SC with a paper copy of the signed and dated assessment.

Within seven calendar days after an HCS provider transmits an ID/RC assessment, either for renewal or lapsed, the SC is responsible for:

reviewing the ID/RC assessment in the HHSC data system and the paper copy (Form 8578) provided by the HCS provider; and
entering in the HHSC data system their name and date and indicating whether they agree or disagree with the ID/RC assessment.

If the SC disagrees with the ID/RC assessment, the SC must notify HHSC and the HCS provider by using Form 8579, Notification of Service Coordinator (SC) Disagreement. See form instructions. The SC must also notify the individual/LAR.

2155 Home and Community-based Services Program Suspension

Revision 22-2; Effective May 1, 2022

An individual's HCS program services are suspended if the individual is temporarily admitted into one of the following settings:

hospital;
intermediate care facility for individuals with an intellectual disability or related condition (ICF/IID);
nursing facility;
residential child care operation licensed or subject to being licensed by HHSC;
facility licensed or subject to being licensed by DSHS;
facility operated by the Texas Workforce Commission; or
residential facility operated by the Texas Juvenile Justice Department, a jail or a prison.

If the SC becomes aware that an individual's HCS services should be suspended, the SC must notify the HCS provider of the need to suspend the individual's HCS services. The SC must ensure the HCS provider enters the suspension data in the HHSC data system.

If the HCS provider becomes aware that an individual's HCS services should be suspended, the HCS provider is responsible for suspending the individual's HCS services and notifying the SC that the HCS provider has suspended the individual's HCS services. The SC must ensure the HCS provider enters the suspension data in the HHSC data system.

The SC reviews the suspension at least every 90 days following the effective date of the suspension by reviewing the individual's status and documenting in the individual's record the reasons for the continuing suspension.

To continue an individual's suspension past 270 days, the SC submits a completed Form 3615, Request to Continue Suspension of Waiver Program Services, requesting that the individual's suspension continue and includes documentation of the SC's periodic reviews.

For additional information about suspensions, refer to 9000, Suspensions.

2156 Termination of Home and Community-based Services

Revision 22-2; Effective May 1, 2022

Involuntary Termination of HCS Services

If the SC determines that a situation may lead to the termination of the individual's HCS services, the SC must discuss the situation with the individual and LAR and attempt to resolve the situation.

If the SC determines that an individual's HCS services should be terminated, the SC documents a description of the:

situation that resulted in the SC's determination that services should be terminated; and
attempts by the SC to resolve the situation.

The SC submits a written request to involuntarily terminate the individual's HCS services to HHSC using Form 3616, Request for Termination of Services Provided by HCS/TxHmL Waiver Provider, in accordance with 10000, Terminations.

Voluntary Termination of HCS Services

If an individual or LAR requests termination of all HCS program services, then within 10 calendar days of the request, the SC must inform the individual or LAR of:

the individual's option to transfer to another HCS provider;
the consequences of terminating HCS services; and
possible service resources upon termination.

The SC submits a written request to HHSC voluntarily terminating the individual's HCS services using Form 3616 in accordance with Section 10000.

For additional information about terminations, refer to 10000 Terminations.

2157 Transfers

Revision 22-2; Effective May 1, 2022

The SC is responsible for managing the following types of transfers in accordance with 8000, Transfers and Local Intellectual and Developmental Disability Authority (LIDDA) Reassignments:

HCS provider to HCS provider
HCS provider to Financial Management Services Agency (FMSA)
FMSA to HCS provider
FMSA to FMSA

For an individual or LAR who has requested a transfer, the SC must inform the individual and LAR that the:

SC is responsible for managing all transfer processes for the individual; and
individual or LAR may choose any available HCS provider (a program provider whose enrollment has not reached its service capacity) or FMSA.

If the individual or LAR has not selected another HCS provider or FMSA, the SC must provide the individual or LAR a list of available HCS providers or FMSAs and contact information in the geographic locations preferred by the individual or LAR.

The SC may not influence the individual or LAR selection of an HCS provider or FMSA, but may assist the individual or LAR in identifying important aspects in an HCS provider or FMSA and considering those aspects in the selection of a provider or FMSA.

For additional information about transfers, refer to 8000.

2158 Consumer Directed Services

Revision 22-2; Effective May 1, 2022

The SC's role is described in 13000, Consumer Directed Services.

2160 Additional Service Coordinator Responsibilities

Revision 22-2; Effective May 1, 2022

Communication of Rights and Complaint Process

The service coordinator (SC) must assist an individual or legally authorized representative (LAR) in exercising the legal rights of the individual as a citizen and as a person with a disability.

The HCS rules require the SC to provide an individual, LAR or family member with a copy of the rights of the individual as described in §9.173(b), as well as a booklet entitled Your Rights in a Home and Community-Based Services Program (available here (PDF) and an oral explanation of such rights upon:

enrollment in the HCS program;
revision of the booklet;
request; and
change in an individual's legal status (for example, when the individual turns 18 or gains or loses a guardian).

In accordance with HHSC rules governing rights of individuals with intellectual disability (40 Texas Administrative Code, Chapter 4, Subchapter C), the LIDDA is responsible for providing an individual, LAR or family member with a copy of the rights of the individual as described in the booklet entitled Your Rights in Local Authority Services (PDF) and an oral explanation of such rights upon enrollment into local authority services and annually thereafter. However, to provide a meaningful and complete explanation of all rights to individuals receiving HCS services, the SC is also expected to give a copy of the booklet, Your Rights in a Home and Community-based Services (HCS) Program (PDF), upon enrollment, as requested by the individual or LAR, as the booklet is revised, and if the individual’s legal status changes.

The SC must document every time the SC gives the booklets to the individual, LAR or family member and provides an oral explanation of the rights. The documentation must be signed by the individual or LAR and the SC.

The SC must ensure that, at the time an individual is enrolled, the individual or LAR is informed orally and in writing of the processes for:

filing complaints with the LIDDA about the provision of service coordination; and
filing complaints about the provision of HCS services, including the toll-free telephone number of:
- the LIDDA to file a complaint;
- HHSC to file a complaint; and
- DFPS (1-800-647-7418) to report an allegation of abuse, neglect or exploitation.

Activities Related to Individuals Under 22 Years of Age Seeking or Receiving Supervised Living or Residential Support

Using Form 3605, HCS Parent or Legally Authorized Representative (LAR) Contact Information for Individuals Under 22 Years of Age, the SC requests the LAR of an individual under the age of 22 receiving Supervised Living or Residential Support to provide the SC with the following information:

the LAR's name, address and telephone number;
the LAR's driver license number and state of issuance or personal identification card number issued by the Department of Public Safety (DPS);
the LAR's place of employment and the employer's address and telephone number;
the name, address and telephone number of a relative of the individual or other person HHSC or the SC may contact in an emergency, a statement indicating the relationship between that person and the individual and, at the LAR's option:
- that person's driver license number and state of issuance or personal identification card number issued by DPS; and
- the name, address and telephone number of that person's employer; and
a signed acknowledgement of responsibility stating that the LAR agrees to:
- notify the SC of any changes to the contact information submitted; and
- make reasonable efforts to participate in the individual's life and in planning activities for the individual.

If anyone, including the HCS program provider, notifies the SC that they are unable to locate the LAR, the SC must:

make reasonable attempts to locate the LAR by contacting a person identified by the LAR in the contact information described above; and
notify the IDD Ombudsman, no later than 30 calendar days after the date the SC is unable to locate the LAR of the determination, and request that HHSC initiate a search for the LAR.

Within three business days after initiating Supervised Living or Residential Support to an individual under 22 years of age, the SC must:

provide the information listed in the bullet below to the following:
- the CRCG for the county in which the individual's LAR lives (see hhs.texas.gov for a listing of CRCG chairpersons by county);
- if the individual is at least three years of age, the local school district for the area in which the three- or four-person residence is located; and
- if the individual is younger than three years of age, the early childhood intervention (ECI) program for the county in which the residence is located (see Early Childhood Intervention Services (ECI) for a listing of ECI programs by county); and
provide the following information to the entities described in the bullet above:
- the individual's full name;
- the individual's gender;
- the individual's ethnicity;
- the individual's birth date;
- the individual's Social Security number;
- the LAR's name, address and county of residence;
- the date of initiation of Supervised Living or Residential Support;
- the address where supervised living or residential support is provided; and
- the name and phone number of the person providing the information.

For an applicant or individual under 22 years of age seeking or receiving Supervised Living or Residential Support, the SC will:

make reasonable accommodations to promote the participation of the LAR in all planning and decision-making regarding the individual's care, including participating in:
- the initial development and annual review of the individual's person-directed plan (PDP);
- decision-making regarding the individual's medical care;
- routine service planning team meetings; and
- decision-making and other activities involving the individual's health and safety;
ensure that reasonable accommodations include:
- conducting a meeting in person or by telephone, as mutually agreed upon by the program provider and the LAR;
- conducting a meeting at a time and location, if the meeting is in person, that is mutually agreed upon by the program provider and the LAR;
- if the LAR has a disability, providing reasonable accommodations in accordance with the Americans with Disabilities Act, including providing an accessible meeting location or a sign language interpreter, if appropriate; and
- providing a language interpreter, if appropriate;
provide written notice to the LAR of a meeting to conduct an annual review of the individual's PDP at least 21 calendar days before the meeting date and request a response from the LAR regarding whether the LAR intends to participate in the annual review;
before an individual who is under 18 years of age, or who is 18-22 years of age and has an LAR, moves to another residence operated by the HCS provider, attempt to obtain consent for the move from the LAR unless the move is made because of a serious risk to the health and safety of the individual or another person; and
document compliance with the activities described above in the individual's record.

Activities Related to Guardianship

The SC is responsible for determining, at least annually, if the guardianship for an individual is current. The letter of guardianship may be required to be renewed in the county court annually. The SC must request the current letter of guardianship and keep a copy in the individual’s record.

The SC must document in the PDP whether the letter of guardianship is current.

If the letter of guardianship is not current, the SC must provide a reminder to the guardian that a renewal needs to be completed and document that the guardian was provided this reminder.

If the letter of guardianship is not current, the SC should obtain signatures of both the individual and the person listed as guardian until appropriate steps can be taken to verify current guardianship.

3000, Enrollments

Revision 22-2; Effective May 1, 2022

All user guides are published to Texas Medicaid & Healthcare Partnership’s (TMHP’s) Learning Management System (LMS). All users must create an LMS account to access the materials.

There is a sign-up link on the LMS homepage. If you need assistance with registration, contact TMHP Training Support.

Enrollment Process and Test

Local Intellectual and Developmental Disability Authorities (LIDDAs) are responsible for completing all enrollment activities for individuals seeking Texas Home Living (TxHmL) and Home and Community-based Services (HCS) waiver services. Each LIDDA must designate staff to complete all enrollment activities, and these staff must complete HHSC online enrollment training, with at least one staff person designated to receive training on an annual basis.

The LIDDA enrollment training link should point here.
The HHSC Program Enrollment Unit link should point here.

Transition Assistance Services (TAS), Pre-Enrollment Minor Home Modifications (MHM) and Pre-Enrollment MHM and Assessments

Applicants enrolling in the HCS Program who are being discharged from a nursing facility, an intermediate care facility for individuals with an intellectual disability or related conditions or a general residential operation are eligible to receive TAS, pre-enrollment MHM and pre-enrollment MHM assessments.

For TAS, see Form 8604, Transition Assistance Services (TAS) Assessment and Authorization.

For pre-enrollment MHM and pre-enrollment MHM assessments, see Form 8611, Pre-Enrollment MHM Authorization Request, and Form 8612, TAS/MHM Payment Exception Request.

4000, Person-Directed Plan

Revision 21-2; Effective November 8, 2021

Person-Directed Planning Guidelines

Person directed planning is an ongoing process that empowers an individual, and the legally authorized representative (LAR) on the individual's behalf, to direct the development of a plan of services and supports that:

identify supports and services necessary for the individual to achieve the individual’s preferred outcomes;
identify natural supports available to the individual and describe needed service system supports;
occur with the support of a group of people chosen by the individual and the LAR on the individual’s behalf; and
accommodate the individual’s style of interaction and preferences regarding time and setting.

The result of person-directed planning must reflect the essential elements of the individual’s desired life in sufficient detail so the Home and Community-based Services (HCS) provider understands how to provide HCS services to meet the individual’s outcomes. The Person-Directed Planning Guidelines on the Texas Health and Human Services (HHS) website provide a more detailed description of the principles of person-directed planning. See Person Directed Planning Guidelines (PDF).

Discovering the Individual

The individual's needs and desired outcomes are the basis for the entire process and the individual must be involved in all aspects of the process, as well as the focus. The foundation of person-directed planning is to listen, acknowledge and discover the personal outcomes, preferences, choices and abilities of the individual directing the plan. This activity is often called “discovery.” The local intellectual and developmental disability authority (LIDDA) service coordinator (SC) has the responsibility to facilitate the process of discovery as preparation for developing the Person-Directed Plan (PDP).

There are many ways to conduct discovery. The most common method is to have conversations with the individual, LAR and others who know and support the individual, such as caregivers, close family members, current provider staff, friends and teachers. Part I of Appendix III, Discovery Guide, provides guidance for effective discovery, including:

Useful communicating/listening skills;
Developing a relationship;
Creating a distraction-free environment; and
Non-verbal communication cues

Other methods of discovery are activities from:

Appendix III, Discovery Guide;
Appendix IV, Discovery Tool; and
Methods taught by The Learning Community for Person Centered Practices (TLCPCP).

Discovery can be done using a combination of these methods.

Documentation of the information gathered during discovery is important. The SC is responsible for documenting the information gathered from the individual, family, provider and other participants.

Although person-directed planning is not a linear process, discovery is important preparation for developing the PDP.

PDP

Before developing the PDP, the SC should discuss with the individual and LAR the importance of the HCS provider being included when the individual discusses their preferences and outcomes. Since the provider will be responsible for designing and providing the services to the individual, understanding the individual’s strengths, capabilities and desires is critical to providing services that are meaningful to the individual. The SC should request permission from the individual/LAR to invite the HCS provider to the planning meeting to develop the PDP. The SC should also ask the individual/LAR if they would like to invite anyone else to participate in the service planning process.

The SC is responsible for convening and facilitating a meeting to develop the PDP. There is not a single way to approach developing the PDP. It can be a brainstorming session where the purpose of services and desired outcomes are discussed while HCS services are decided upon. Or, it can be a meeting in which the discovery information is presented and clarified and then HCS services are negotiated.

The SC should have a thorough understanding of the services in the HCS program so that connections can be made between what the individual wants to have happen and the HCS service array. This understanding can be supported by reviewing the HCS Program Billing Requirements (PDF), discussions with the individual’s HCS program provider and consultation with the LIDDA’s HCS service coordination supervisor.

Developing the PDP

The PDP has two elements plus instructions:

Form 8665-ID, Individual Data, contains important data information about the individual that doesn’t change often.
Form 8665, Person-Directed Plan, is the form used to document an individual’s PDP.

Form 8665-ID, Individual Data

This page is completed by the SC at the time of enrollment and updated as necessary thereafter. The SC is required to provide the program provider a copy of Form 8665-ID:

at the time of enrollment;
when the individual transfers to a new provider; and
anytime information on Form 8665-ID is updated.

Form 8665, Person-Directed Plan

Pages 1, 2 and 3 are completed using the information gathered through the discovery process. These pages include:

identifying information;
method(s) of discovery;
important information about the individual;
a list of people in the individual’s life;
frequency of service coordination;
non-HCS services; and
additional comments.

Page 4, Action Plan:

identifies the services to be provided;
identifies the individual's preferences for service delivery options;
indicates if a backup plan is necessary for that service;*
explains the purpose and outcome of the services which address the individual’s preferences revealed during discovery;
describes the relevant background information that is important to understand about the individual receiving those services; and
communicates why the services are important to and for the individual.

*Note: The service planning team is responsible for determining whether an individual’s waiver service is critical to meeting the individual’s health and safety. The program provider must develop a written backup plan for each waiver service identified on the PDP as critical to meeting an individual’s health and safety. Because HCS program providers must ensure that trained and qualified staff are available at all times for the provision of residential support and supervised living, a backup plan is not needed for these services. Backup plans for host home/companion care must be documented in the service agreement the host home/companion care service provider has with the HCS program provider.

The service planning team is responsible for documenting that:

the services on the PDP are necessary for the individual to continue living in the community;
the services ensure the individual's health and safety;
the services prevent the need for institutional services;
each type of service component in the PDP is appropriate to meet a desired outcome or need of the individual;
each service component does not replace existing supports, natural supports or other sources for the service (such as Texas Workforce Commission (TWC) for funding of employment assistance services); and
the services are cost effective.

Note: For an enrollment PDP, the SC is responsible for justifying both the need and the amount for each HCS service type in the PDP. For PDP renewals and PDP updates, the SC is responsible for justifying the need for each HCS service type in the PDP and the HCS program provider is responsible for justifying the amount of each HCS service type in the Implementation Plan (IP).

PDP Update for IPC Renewal

The PDP is treated as a new plan at the time of the individual plan of care (IPC) renewal. Although the current PDP may be used as a template for the updated PDP, the:

PDP date is updated each IPC renewal year on the top of Page 1 and on the top of every Action Plan page; and
entire document must be reviewed and updated, as appropriate, to reflect the individual’s current situation and personal outcomes (e.g., an Action Plan that was discontinued in the previous IPC year is not included in the new PDP).

PDP Update Within the IPC Year

If an individual’s PDP must be updated within the IPC year, the SC must clearly indicate what was updated. The PDP date is updated at top of Page 1 and, if an Action Plan is also updated, then the new PDP date is included on the top of that Action Plan page.

New information is added at the beginning of the narrative on Page 1 (rather than at the end of the narrative). Begin the new information with the following notations:

PDP Update;
the date the new information was added to the PDP; and
name of the SC who is updating the information.

Example: PDP Update, Jan. 22, 2021, Sarah Smith, SC

If it is necessary to add a new Action Plan page or change information on a current Action Plan page on the PDP within an IPC year, then the SC makes the following notations at the bottom of the Action Plan page that has been updated:

checks the “changed” or “added” box and the date or the date of the decision to discontinue the service; and
enters the SC’s printed name and signature.

The SC must send any new or updated page(s) of the PDP to the HCS program provider in a timely manner. The HCS program provider is responsible for creating or revising the individual’s IP to address the new information.

5000, Level of Care and Level of Need

Revision 22-2; Effective May 1, 2022

All user guides are published to Texas Medicaid & Healthcare Partnership’s (TMHP’s) Learning Management System (LMS). All users must create an LMS account to access the materials.

There is a sign-up link on the LMS homepage. If you need assistance with registration, contact TMHP Training Support.

The following sections provide information related to Form 8578, Intellectual Disability/Related Condition Assessment.

Level of Care (LOC)

The LOC determines the individual's programmatic eligibility for the Home and Community-based Services (HCS) Program. Individuals enrolling into HCS must have an LOC I, or if the individual is transitioning or diverting from a nursing facility, may have an LOC VIII.

Level of Need (LON)

An individual's LON is used to determine the reimbursement rate a program provider receives for certain HCS program services. The LON is obtained by completing and scoring an Inventory for Client and Agency Planning (ICAP) assessment for each individual.

A brief overview of the ICAP is provided in this document but is not intended to be comprehensive.

5100, Intellectual Disability/Related Condition Assessment Process

Revision 22-2; Effective May 1, 2022

The HCS program provider must annually renew an individual's LOC and LON by completing Form 8578, Intellectual Disability/Related Condition (ID/RC) Assessment, and entering the information into the HHSC data system. Instructions for renewing an LOC/LON may be found in Title 40, Texas Administrative Code, Chapter 9, Subchapter D, Home and Community-based Services (HCS) Program, and the instructions for completing Form 8578.

Form 8578 must be signed by one of the following people – RN, LVN, qualified intellectual disability professional (QIDP), qualified developmental disability professional (QDDP), case manager, LIDDA service coordinator (SC) or HCS provider representative.
The program provider must enter the ID/RC assessment information into the HHSC data system.
The program provider must ensure that the SC receives a copy of the signed Form 8578 within three days after data entry.

Once the program provider has entered the information into the HHSC data system, the SC will have seven days to review the LOC/LON information and enter an agreement or disagreement with what was entered.

LIDDAs are expected to review each ID/RC.

The information entered by the program provider will be displayed in the HHSC data system for the SC to enter an agreement or disagreement and any comments.

If the SC believes the program provider made an error when entering data, the SC may return the ID/RC to the program provider for error correction. The SC will contact the program provider the same day that they return an ID/RC.
If the SC returns an ID/RC assessment to a provider, the SC must enter a comment in the HHSC data system as to why it is being returned.

After reviewing the ID/RC information, if the SC disagrees with the ID/RC assessment, the SC must notify HHSC Program Eligibility Support (PES) and the program provider by completing Form 8579, Notification of SC Disagreement, and faxing it to HHSC PES and sending a copy to the program provider. This notification should be done the same day of the data entry.

Program providers will not be prevented from entering billing because an SC does not review the ID/RC assessment in a timely manner. If the SC does not review an ID/RC assessment within seven days of data entry, the HHSC data system will automatically send the ID/RC assessment to HHSC for approval. Reports will be available for state office and LIDDA management staff noting those ID/RC assessments not reviewed by the SC. This will also be noted in the form history in the HHSC data system.

HHSC PES will continue to approve or deny an individual's LOC. For an LON review, HHSC PES will complete reviews for Purpose Code 2 and HHSC Utilization Review (UR) will complete reviews for Purpose Codes 3 and 4. The SC's agreement or disagreement does not ensure any action will be taken or not taken by HHSC PES or HHSC UR. HHSC UR may contact the SC to provide additional information if an LON review is necessary.

Review of the ID/RC

Information from the ICAP is entered on the ID/RC (Form 8578) to request an LON for an individual. In some cases, it may be necessary for the SC to request a copy of the individual's current ICAP booklet in order to ensure that the appropriate LON has been requested by the program provider.

The ID/RC assessment notes the ICAP service level (Item No. 33). The service level translates to the LON as follows:

LON 1 – ICAP service level 7, 8, 9
LON 5 – ICAP service level 4, 5, 6
LON 8 – ICAP service level 2, 3
LON 6 – ICAP service level 1

The ICAP consists of two parts: the adaptive skills section and the problem behavior section. Generally, the higher the service level, the more adaptive skills the individual possesses. Exceptions exist for individuals who have more cognitive skills and limited physical abilities. The person acting as the respondent for the ICAP should be familiar with the individual's abilities.

The adaptive section of the ICAP is reflected on the ID/RC assessment under "Broad Independence" (Item No. 31), and the problem behavior section score is noted as "General Maladaptive" (Item No. 32) and is scored as a negative number. A score lower than -25 (as in temperatures, -26 is lower than -25) generally indicates that the individual's behaviors are serious enough to have a formal program in place.

The section rating an individual's adaptive skills is divided into four categories:

Motor skills (Can they pick up an object, pull themselves into a standing position, print their name, etc.?)
Social and communication skills (Are they able to communicate basic needs, understand simple commands, etc.?)
Personal living skills (Can they assist with dressing, use the toilet, help with household chores, etc.?)
Community living skills (Do they understand the concept of purchasing an item from a vending machine, know how to navigate in the home/neighborhood, etc.?)

These items are scored 0 - 3, with 0 meaning the individual is not capable of completing the task and 3 meaning the individual is able to perform the task independently.

The problem behavior section consists of eight categories of behaviors. If a behavior occurs in any of these categories, the frequency and severity is scored:

Hurtful to self
Hurtful to others
Destructive to property
Disruptive behavior
Unusual or repetitive habits
Socially offensive behavior
Withdrawal or inattentive behavior
Uncooperative behavior

A program provider must have a method of addressing behaviors if they feel the behavior is severe enough to be rated more than slightly serious. A formal behavior support plan must be in place targeting any behavior noted to be very or extremely serious, and a training objective is required to address any behavior rated as moderately serious.

A program provider may request an increase in LON for an individual for medical or behavioral reasons. This is one level higher than the LON assessed by the ICAP tool.

5200, Service Coordinator Review of Intellectual Disability/Related Condition

Revision 22-2; Effective May 1, 2022

For renewals and mid-cycle Level of Need (LON) requests, the HCS program provider is responsible for completing Form 8578, Intellectual Disability/Related Condition Assessment, and transmitting it to HHSC. This document consists of the individual's Level of Care (LOC) and LON. The SC does not approve or deny an individual's LOC or LON but is responsible for reviewing the document in the HHSC data system and entering whether they agree with the information. To review the ID/RC assessment, the SC must have a basic understanding of the ID/RC assessment and the Inventory for Client and Agency Planning (ICAP) assessment.

ID/RC and LON Resources

Additional information regarding ID/RC assessments and requesting an LON from HHSC may be found at:

LON Resources

6000, Individual Plan of Care (IPC)

Revision 22-2; Effective May 1, 2022

All user guides are published to Texas Medicaid & Healthcare Partnership’s (TMHP’s) Learning Management System (LMS). All users must create an LMS account to access the materials.

There is a sign-up link on the LMS homepage. If you need assistance with registration, contact TMHP Training Support.

6100, Overview of the IPC

Revision 22-2; Effective May 1, 2022

Form 3608, Individual Plan of Care (IPC) – HCS/CFC, documents an individual's Home and Community-based Services (HCS) program services and non-HCS services. An IPC is completed at the time an individual enrolls in the HCS program and is valid for 365 days (the IPC year), as long as the individual remains eligible for HCS. An IPC must be renewed prior to the current IPC end date and may be revised at any time during the IPC year if changes are needed. A transfer IPC is completed if an individual transfers to another HCS contract or chooses a different service delivery option (meaning Consumer Directed Services is added or removed as a service delivery option).

The IPC is entered in the HHSC data system.

The HCS services listed on the IPC are based on the individual's person-directed plan (PDP) and must be supported by documentation in the PDP that other sources for the service are unavailable and the service does not replace existing supports, including natural supports or other sources for the service. The services must be necessary for the individual to live in the community, to ensure the individual's health, safety and welfare in the community, and to prevent the need for institutional services.

See Section 4000, Person-Directed Plan, for more information on the PDP, and Form 8665, Person-Directed Plan, and instructions.

An IPC is developed by:

the service planning team (SPT), which consists of the individual/legally authorized representative (LAR), the service coordinator (SC) and any other person invited by the individual/LAR; and
the program provider.

6110 IPC Form and Instructions

Revision 11-2; Effective March 1, 2011

Review Form 3608, Individual Plan of Care (IPC) – HCS/CFC, and instructions before completing the form.

6120 IPC Begin, End and Effective Dates

Revision 22-2; Effective May 1, 2022

Each IPC has an IPC begin date, an IPC end date and an IPC effective date.

The IPC begin date is the first day of the IPC year, the next day after the previous IPC ends.

The IPC end date is 365 days after the IPC begin date. In most cases, an individual's IPC will renew on the same date every year, with leap year being the exception since the IPC is valid for 365 days, not one calendar year. (Note: If there is a gap between the current IPC end date and the renewal IPC meeting date, the provider will not be authorized to bill for services provided to the individual during that gap.)

The IPC begin date and IPC effective date are the same date for an initial IPC and a renewal IPC. If the IPC is revised, the date of the IPC revision then becomes the new IPC effective date, but the IPC begin date and IPC end date do not change.

6130 IPC Meeting

Revision 22-2; Effective May 1, 2022

An IPC meeting occurs when the SPT and the provider meet at the same time, either in person or by telephone, to review the individual's PDP and to discuss and identify necessary units of HCS and non-HCS services to support PDP outcomes. It is important that all parties be able to communicate and discuss openly with one another during the IPC meeting. In most instances, an IPC meeting is necessary to develop the IPC. The exceptions are for an IPC revision to increase or decrease an existing HCS service that does not require a change to the PDP and for an IPC to add/change a requisition fee only.

6140 IPC Types

Revision 22-2; Effective May 1, 2022

A new IPC form is completed at designated events. The event determines the IPC type, which are:

initial IPC;
renewal IPC;
revision IPC; and
transfer IPC.

The IPC types are described in the following sections.

6150 Consumer Directed Services (CDS) and IPCs

Revision 22-2; Effective May 1, 2022

If the individual uses the CDS option, the service coordinator (SC) is responsible for:

ensuring that the HCS program services that are self-directed are included on the IPC any time an IPC is completed;
assisting the CDS employer with developing and maintaining justification for the amount of HCS program services on the IPC that are self-directed, if requested by the employer; and
sending a copy of the completed Form 3608, Individual Plan of Care (IPC) – HCS/CFD, to the Financial Management Services Agency (FMSA).

If an individual only uses the CDS option and does not have a program provider, the Local Intellectual and Developmental Disability Authority (LIDDA) is responsible for entering the IPC into the HHSC data system.

6160 Health and Human Services Commission (HHSC) Role

Revision 22-2; Effective May 1, 2022

HHSC may review any type of IPC at any time to determine if the appropriate type and amount of services are being requested and utilized. HHSC may take action on an IPC, reducing or denying services or amounts of services if there is not documentation to support the need for the requested services. The SC may be asked to provide information or documentation. The SC’s agreement or disagreement with the IPC does not ensure a specific action will be taken by HHSC Utilization Review.

6200, Initial (Enrollment) IPC

Revision 11-2; Effective March 1, 2011

6210 Initial (Enrollment) IPC Overview

Revision 22-2; Effective May 1, 2022

The initial IPC is completed by the LIDDA before an individual is enrolled in the HCS program.

A LIDDA representative meets with the individual and others who know the individual to develop the PDP. This document describes the individual's desired outcomes and is the basis for determining the HCS service components on the initial IPC.

The service components and amount of each service included on the initial IPC are determined from discussions with:

the individual;
the individual's LAR (if an LAR exists);
any other persons the individual/LAR chooses to be involved;
the LIDDA representative who is completing the enrollment activities; and
the program provider selected by the individual or the LAR on the individual's behalf.

6220 LIDDA and Service Coordinator Responsibilities for Initial IPC

Revision 22-2; Effective May 1, 2022

6221 IPC Meeting to Develop Initial IPC

Revision 22-2; Effective May 1, 2022

After the SPT has developed the PDP, including the "Justifications for Waiver Services and Supports" section of the PDP, the SC schedules an IPC meeting with the provider and SPT to develop the initial IPC.

6222 Initial IPC Effective Date

Revision 11-2; Effective March 1, 2011

The initial IPC effective date is the same as the IPC begin date. The IPC meeting must be held on or before the IPC effective date. Services provided prior to the initial IPC effective date may not be reimbursed.

6223 Units of Service

Revision 22-2; Effective May 1, 2022

The SC brings to the IPC meeting justification for units of the services identified on the individual's PDP.

Some service components, such as residential support services, supervised living and host home/companion care, are daily services and the total number of days will equal the days in the IPC year (i.e., 365).
If the individual participates in day habilitation full time (i.e., six hours a day, five days a week), the typical number of days of attendance is approximately 260. This allows for days off for major holidays and those days when day habilitation is not available for the individual.
Amounts of some services (e.g., nursing and professional therapies) may only include the number of units needed to complete an assessment, the results of which will determine the recommend number of hours/units. After the assessment is completed, a revision to the IPC can be completed.
Some services are limited in availability for individuals enrolling who are 20 years and younger because they must be accessed through State Plan Services. These services include nursing, professional therapies and dental.

6224 Non-HCS Services

Revision 22-2; Effective May 1, 2022

The SC includes all non-HCS services the individual is receiving (and will be receiving) on the IPC form for the initial IPC.

6225 Initial IPC Signatures and Signature Dates

Revision 22-2; Effective May 1, 2022

The SC signs and dates the initial IPC and is responsible for obtaining the signature and date of the provider representative and individual/LAR. The date must be the date the IPC meeting occurred. If present, the individual/LAR and SC sign and date on the appropriate lines of the form. If the LAR participates by phone, the SC checks the box to indicate such and enters the date the LAR participated in the IPC meeting. The SC then sends a copy of the form for the LAR's signature.

6226 Transmission of Initial IPC

Revision 22-2; Effective May 1, 2022

The LIDDA enters the initial IPC in the HHSC data system as part of completing an individual's enrollment activities. The SC ensures the individual/LAR and program provider receive a copy of the IPC.

6230 Provider Responsibilities for Initial IPC

Revision 22-2; Effective May 1, 2022

For an initial IPC, the SC contacts the program provider to schedule an IPC meeting. The program provider attends the IPC meeting, participates in the development of the initial IPC, and signs and dates the initial IPC. The program provider's signature date on the initial IPC must be the date of the IPC meeting.

6300, Renewal IPC

Revision 11-2; Effective March 1, 2011

6310 Renewal IPC Overview

Revision 22-2; Effective May 1, 2022

The rules governing the HCS Program direct the SC to notify the service planning team that the individual’s PDP must be reviewed and updated at least 60 but no more than 90 calendar days before the expiration of the individual's IPC. The SC is responsible for arranging for the SPT to review and update the individual's PDP .

After the SPT reviews and updates the PDP, the SC ensures that the program provider has a copy of the individual's current PDP. The provider schedules an IPC meeting with the SPT to develop a renewal IPC.

Although the provider representative is responsible for completing the renewal IPC (Form 3608), the SC is responsible for completing the portions related to CDS, if applicable, and non-HCS services.

6320 Program Provider Responsibilities for Renewal IPC

Revision 22-2; Effective May 1, 2022

6321 IPC Meeting to Develop Renewal IPC

Revision 22-2; Effective May 1, 2022

The program provider schedules an IPC meeting to occur no later than 30 days before the current IPC end date to develop the renewal IPC.

6322 Renewal IPC Effective Date

Revision 14-1; Effective June 9, 2014

The renewal IPC effective date is the same as the IPC begin date. The IPC meeting must be held on or before the IPC effective date. The IPC effective date may not be before the IPC meeting date.

6323 Units of Service

Revision 22-2; Effective May 1, 2022

The provider brings to the IPC meeting justification for units of the services identified on the individual's PDP.

Some service components, such as residential support services, supervised living and host home/companion care, are daily services and the total number of days will equal the days in the IPC year (i.e., 365).
If the individual participates in day habilitation full time (i.e., six hours a day, five days a week), the typical number of days of attendance is approximately 260. This allows for days off for major holidays and those days when day habilitation is not available for the individual.
Amounts of some services may be determined by an assessment completed by a licensed professional providing the service.
Some services are limited in availability for individuals enrolling who are 20 years and younger because they must be accessed through State Plan Services. These services include nursing, professional therapies and dental.

6324 Renewal IPC Signatures and Signature Dates

Revision 22-2; Effective May 1, 2022

The provider representative signs and dates the renewal IPC on the day of the IPC meeting and is responsible for obtaining the signature of the individual/LAR and SC. If present, the individual/LAR and SC sign and date on the appropriate lines of the form. If the LAR participates by phone, the program provider checks the box to indicate such and enters the date the LAR participated in the IPC meeting. The provider then sends a copy of the form for the LAR's signature.

If the SC participates in the IPC meeting by phone, the program provider enters "participated by phone" on the SC's signature line, prints the name of the SC on the appropriate line and enters the date the SC participated.

Then, the hard copy form is submitted to the SC for review.

6325 Transmission of Renewal IPC

Revision 22-2; Effective May 1, 2022

Once the required signatures have been obtained, the provider enters the IPC into the HHSC data system on or before the IPC begin date and ensures that the SC has a hard copy of the IPC (Form 3608) within three days after entering the IPC.

6330 Service Coordinator Responsibilities for Renewal IPC

Revision 22-2; Effective May 1, 2022

The SC participates in the renewal IPC meeting that is scheduled by the program provider. This is done after the SPT has reviewed and updated the PDP.

The SC is not required to provide justification for the amount of HCS services on the renewal IPC; this is the responsibility of the HCS program provider. However, it is important that the SC complete the PDP in a timely manner so the program provider can develop the implementation plan. The SC is also not responsible for conducting utilization review activities.

If the individual has chosen to self-direct services through CDS, the SC includes the units necessary to address the PDP outcome(s) in the CDS section of the IPC as determined by the employer.

6331 Non-HCS Services

Revision 11-2; Effective March 1, 2011

The SC ensures all non-HCS services the individual is receiving are included on the IPC form.

6400, IPC Revision

Revision 11-2; Effective March 1, 2011

6410 IPC Revision Overview

Revision 22-2; Effective May 1, 2022

Either the HCS program provider or the SC may determine that a revision to an individual's IPC is necessary. An IPC revision may be necessary due to a change in the individual's needs, a change in the type of residential services or a miscalculation of units necessary to meet the individual's needs. The provider or the SC notifies the other as soon as possible that services included in the individual's IPC must be added, deleted, increased or decreased.

The provider completes a new IPC (Form 3608) for an IPC revision in accordance with the instructions. The exception is when only a CDS service needs to be revised, in which case the SC completes the IPC for the IPC revision. The form must always include the service units for the entire year, including the services being revised. Requested units of services for an added service should be prorated, as needed, based on the time remaining in the IPC year.

6411 Provider Responsibilities for IPC Revision

Revision 22-2; Effective May 1, 2022

If the program provider determines that an individual's services on the IPC need to be revised, they must first determine:

if the revision reflects a PDP change, such as adding or deleting an HCS service;
if the revision increases or decreases an existing HCS service and is supported by a current outcome in the PDP; or
if the revision adds or changes a requisition fee only.

Once this determination is made, the provider follows the procedures associated with the appropriate type of IPC revision as described in 6420, 6430 or 6440.

6412 Service Coordinator Responsibilities for IPC Revision

Revision 22-2; Effective May 1, 2022

If the SC becomes aware of a need to revise an individual's IPC, the SC:

notifies the program provider as soon as possible to revise the IPC; and
schedules an IPC meeting with the program provider to discuss the reason for the revision.

If only a CDS service needs to be revised, the SC meets with the individual/LAR to develop the revised IPC.

If the program provider becomes aware of a need to revise an individual's IPC, the program provider notifies the SC by:

scheduling an IPC meeting to discuss the reason for the revision and to develop a revised IPC; or
submitting to the SC by fax or email a revised IPC (Form 3608) that only increases/decreases an existing HCS service that does not require a change to the PDP.

If the IPC revision adds or changes a requisition fee only, the provider does not need to notify the SC.

The SC is not required to provide justification for the amount of HCS services on the revised IPC; this is the responsibility of the HCS program provider. Neither is the SC responsible for conducting utilization review activities.

6420 IPC Revision to Reflect PDP Change

Revision 11-2; Effective March 1, 2011

If the IPC revision will reflect a PDP change, such as adding or deleting an HCS service or increasing or decreasing an existing HCS service that requires a new PDP outcome, an IPC meeting is necessary to discuss the reason(s) for the revision and to develop the IPC revision.

Further, if the IPC revision is in response to the emergency provision of services as allowed by 40 TAC 9.166(d), the provider ensures documentation supporting such emergency provision of services meets the definition of "emergency" in the HCS rule.

6421 Provider Responsibilities for IPC Revision That Reflects a PDP Change

Revision 22-2; Effective May 1, 2022

If the revision reflects a PDP change, the provider schedules an IPC meeting with the SPT to discuss the reason(s) for the revision and to develop the IPC.

6421.1 IPC Effective Date for IPC Revision That Reflects a PDP Change

Revision 11-2; Effective March 1, 2011

Except for the emergency provision of services, the IPC effective date may only be on or after the date of the IPC meeting; it may not be before the IPC meeting date.

For an IPC revision for the emergency provision of services, the effective date is the date of the emergency provision of services.

If the IPC revision is due to a change in the type of residential services, the IPC effective date must be the date the individual begins receiving the new residential service.

6421.2 Signatures and Signature Dates for IPC Revision That Reflects a PDP Change

Revision 22-2; Effective May 1, 2022

The provider representative signs and dates the IPC revision on the day of the IPC meeting and is responsible for obtaining the signature of the individual/LAR. If present, the individual/LAR and SC sign and date on the appropriate lines of the form. If the LAR participates by phone, the provider checks the box to indicate such and enters the date the LAR participated in the IPC meeting. The provider then sends a copy of the form for the LAR's signature.

If the SC participates in the IPC meeting by phone, the provider enters "participated by phone" on the SC's signature line, prints the name of the SC on the appropriate line and enters the date.

6421.3 Transmission of IPC Revision That Reflects a PDP Change

Revision 22-2; Effective May 1, 2022

Except for the emergency provision of services, the provider enters the completed IPC in the HHSC data system. Within three days after data entry, the program provider ensures the SC has a hard copy of the IPC.

For the emergency provision of services, the program provider faxes the completed hard copy of Form 3608, Individual Plan of Care (IPC) – HCS/CFC, to HHSC Utilization Review (UR), along with documentation of:
- the circumstances that necessitated providing the new HCS service or the increase in the amount of the existing HCS service; and
- the type and amount of the service provided.
Within three days after faxing the form to HHSC UR, the program provider ensures the SC has a hard copy of the completed Form 3608.

6421.4 Activity Following Transmission of IPC Revision That Reflects a PDP Change

Revision 11-2; Effective March 1, 2011

The provider revises the implementation plan to be consistent with the IPC revision.

6422 Service Coordinator Responsibilities for IPC Revision That Reflects a PDP Change

Revision 22-2; Effective May 1, 2022

If the revision reflects a PDP change, such as adding or deleting an HCS service or increasing or decreasing an existing HCS service that requires a new PDP outcome, then the IPC revision requires an IPC meeting. In this situation, the program provider is responsible for scheduling an IPC meeting to discuss and develop the IPC revision. The SC is responsible for making reasonable efforts to be available in a timely manner for the IPC meeting.

The SPT ensures the PDP is consistent with the IPC revision.

6430 Revision to Increase or Decrease an Existing HCS Service

Revision 22-2; Effective May 1, 2022

If the IPC revision is to increase/decrease an existing HCS service and is supported by a current outcome in the PDP, an IPC meeting is not necessary.

The program provider completes Form 3608, Individual Plan of Care (IPC) – HCS/CFC, in accordance with the form's instructions. The program provider obtains the individual/LAR’s agreement by signature and notifies the SC of the IPC revision by submitting a hard copy of the completed Form 3608 by fax or email to the SC on the same day that the provider enters the SC's signature date on the form. (Each LIDDA and program provider should determine the preferred method of notifying the SC, either fax or email.) A phone call or voice message to the SC is not adequate notification.

If the SC agrees with the IPC revision and that an IPC meeting is not required, the SC:

checks the appropriate box in the Service Coordinator Response section of the form;
signs and prints his/her name; and
returns the completed Form 3608 to the provider within two business days after the provider sent it to the SC.

The SC also reviews the electronically transmitted IPC in the HHSC data system.

If the SC determines further discussion is necessary, the SC contacts the program provider as soon as possible to discuss concerns. If no consensus can be reached after this discussion, the SC checks the box indicating an IPC meeting is needed and returns the completed Form 3608 to the program provider within two business days after receiving the form from the program provider. The SC is responsible for scheduling the IPC meeting to occur as soon as possible, but no later than 14 calendar days after the program provider sent the IPC revision to the SC.

Specific instructions for the provider to notify the SC of the need for a revision and the SC's response can be found in the instructions for Form 3608.

6431 Provider Responsibilities for IPC Revision to Increase/Decrease an Existing HCS Service

Revision 22-2; Effective May 1, 2022

The program provider meets with the individual/LAR to discuss the reason for an IPC revision and obtain the individual/LAR's agreement when an IPC meeting is not held.

If an IPC meeting is not held, the program provider completes Form 3608, Individual Plan of Care (IPC) – HCS/CFC, in accordance with the form's instructions, indicating that no meeting is required, noting the reason for the increase/decrease and making the change(s) to the service units. (The service component(s) being revised are identified with an "I" or "D" for increased or decreased.) It is important that the program provider state a reason for the revision on Page 1 of Form 3608 and indicate which current outcome in the PDP supports the service component(s) being revised.

The program provider obtains the individual/LAR's agreement by signature. The provider notifies the SC of the IPC revision by faxing or emailing the completed Form 3608 to the SC on the same day that the provider enters the SC's signature date on the form. A phone call or voice message to the SC is not adequate notification.

6431.1 IPC Effective Date for IPC Revision that Does Not Require an IPC Meeting

Revision 22-2; Effective May 1, 2022

If the IPC revision does not require an IPC meeting, the IPC effective date may only be on or after the date the provider notifies the SC by faxing or emailing the completed Form 3608, Individual Plan of Care (IPC) – HCS/CFC, to the SC.

6431.2 Signatures and Signature Dates for IPC Revision that Do Not Require an IPC Meeting

Revision 22-2; Effective May 1, 2022

The provider representative signs and dates the revision IPC and obtains the signature of the individual/LAR after discussion and agreement. If the agreement is in person, the individual/LAR signs their name and enters date of agreement. If the individual/LAR agrees by phone, the provider checks the box and enters date of agreement. The provider sends a copy of the form for the individual's/LAR's signature.

The provider writes "notified SC" on the SC signature line, prints the SC's name and enters the date the form was faxed or emailed to the SC. (Faxing or emailing the form to the SC serves as notification of an IPC revision that does not require an IPC meeting.)

Note: If the individual/LAR agrees by phone and the program provider sends a copy of the form for signature, the provider may notify the SC of the revision prior to receiving the individual's/LAR's signature.

6431.3 Transmission of IPC Revision that Does Not Require an IPC Meeting

Revision 22-2; Effective May 1, 2022

The program provider may enter the revised IPC in the HHSC data system after the individual’s or LAR’s signature is obtained on the revised IPC.

If the IPC is entered and the SC determines that an IPC meeting is needed, the SC returns the IPC to the program provider in the HHSC data system during the SC's required review of the IPC.

6431.4 Activity Following Transmission of IPC Revision that Does Not Require an IPC Meeting

Revision 22-2; Effective May 1, 2022

If the SC responds by checking the box indicating agreement with the IPC revision, the provider revises the implementation plan to be consistent with the IPC revision.

If the SC responds by checking the box indicating that an IPC meeting is needed, the provider:

follows the procedures in 6420 for revising an IPC; and
deletes the IPC in the HHSC data system that is in return status.

6432 Service Coordinator Responsibilities for IPC Revision that Do Not Require an IPC Meeting

Revision 22-2; Effective May 1, 2022

If the IPC revision is to increase/decrease an existing HCS service and is supported by a current outcome in the PDP, the provider completes Form 3608, Individual Plan of Care (IPC) – HCS/CFC, in accordance with the form's instructions. The provider notifies the SC of the IPC revision by submitting the completed Form 3608 to the SC by fax or email. The SC responds within two business days to the IPC revision by completing the "Service Coordinator Response" section on the bottom of Page 2 of the IPC form.

6432.1 Service Coordinator Response Section of Form 3608

Revision 22-2; Effective May 1, 2022

If the SC receives an IPC revision on Form 3608, Individual Plan of Care (IPC) – HCS/CFC, by fax or email with "notified SC" on the SC's signature line, the SC immediately reviews the form to ensure:

the reason for the increase/decrease stated by the provider on Page 1 of the form is supported by a current outcome in the individual PDP;
the service type is an existing HCS service; and
the IPC effective date is in accordance with the requirements in Section 6431.1.

6432.2 If Service Coordinator Agrees the IPC Revision Does Not Require an IPC Meeting

Revision 22-2; Effective May 1, 2022

If the SC agrees with the IPC revision and that an IPC meeting is not required, the SC:

checks the box stating such, and signs and prints their name at the bottom of Page 2 of the form in the "Service Coordinator Response" section; and
faxes or emails the form to the provider within two business day after the provider sent it to the SC.

6432.3 If Service Coordinator Has Concerns with the IPC Revision

Revision 22-2; Effective May 1, 2022

If the SC has concerns with the reason for the revision, believes a PDP update is necessary or has some reason to believe that the revision is not in accordance with the individual's/LAR’s desired outcomes, the SC immediately contacts the provider to discuss concerns. If the SC and the program provider cannot come to agreement about the amount of the services or supports being requested, the SC completes Form 8579, Notification of Service Coordinator (SC) Disagreement, and submits it to HHSC UR.

If the SC's concerns are resolved after contacting the provider and the SC agrees with the IPC revision and that an IPC meeting is not required, the SC follows the procedures described in 6432.2.

6432.4 Service Coordinator Determines IPC Meeting is Needed

Revision 11-2; Effective March 1, 2011

If the SC continues to have concerns after contacting the provider and determines that an IPC meeting is needed, the SC:

checks the box stating such, and signs and prints their name at the bottom of Page 2 of the form in the "Service Coordinator Response" section;
faxes or emails the form to the provider within two business days after the provider sent it to the SC; and
schedules an IPC meeting to occur as soon as possible but no later than 14 calendar days after the provider faxed or emailed the IPC revision to the SC.

6440 Revision to Add/Change Requisition Fee Only

Revision 11-2; Effective March 1, 2011

If the IPC revision is to add/change a requisition fee only, an IPC meeting is not necessary and the provider is not required to obtain agreement from the individual/LAR.

6441 Provider Responsibilities for IPC Revision to Add/Change a Requisition Fee Only

Revision 11-2; Effective March 1, 2011

If the IPC revision is to add/change a requisition fee only, the provider completes a new Form 3608, Individual Plan of Care (IPC) – HCS/CFC , in accordance with the form's instructions, indicating that the IPC revision is to add/change a requisition fee only.

6441.1 IPC Effective Date for IPC Revision to Add/Change a Requisition Fee Only

Revision 11-2; Effective March 1, 2011

The IPC effective date is the date the provider completes the form.

6441.2 Signatures and Signature Dates for IPC Revision to Add/Change a Requisition Fee Only

Revision 11-2; Effective March 1, 2011

The provider representative completing the form signs and dates the form. On the individual's/LAR's signature line and the SC's signature line, the provider enters "requisition fee only" and enters the IPC effective date as the signature date.

6441.3 Transmission of IPC Revision to Add/Change a Requisition Fee Only

Revision 22-2; Effective May 1, 2022

The provider enters the IPC revision in the HHSC data system and within three days after data entry, the provider ensures the SC has a hard copy of the IPC revision. Note: The IPC will not be sent to the SC for review in the HHSC data system. It will go straight to HHSC for authorization.

6442 Service Coordinator Responsibilities for IPC Revision to Add/Change a Requisition Fee Only

Revision 11-2; Effective March 1, 2011

The SC has no responsibilities for an IPC revision to add/change a requisition fee only.

6500, Transfer IPC

Revision 11-2; Effective March 1, 2011

6510 Transfer IPC Overview

Revision 22-2; Effective May 1, 2022

If an individual wishes to transfer to another provider agency or a different contract within the same provider agency or change service delivery options (that is, add or remove CDS), a transfer IPC must be completed. The SC is responsible for completing the transfer IPC. The SPT and receiving provider hold an IPC meeting to develop the transfer IPC, which must include services already provided by the transferring provider as well as those to be provided by the receiving provider.

See 8000, Transfers and Local Intellectual and Developmental Disability Authority (LIDDA) Reassignments, for specific procedures related to transfers.

6520 LIDDA and Service Coordinator Responsibilities for Transfer IPC

Revision 22-2; Effective May 1, 2022

6521 IPC Meeting to Develop Transfer IPC

Revision 11-2; Effective March 1, 2011

The SC schedules and conducts an IPC meeting with the SPT and receiving provider to develop the transfer IPC. The SC is responsible for completing a new Form 3608. The SC invites the transferring provider to the transfer IPC meeting, but its participation is optional. The receiving provider's participation in the transfer IPC meeting is required.

The SC ensures that the transfer IPC includes all services provided by the transferring provider, as well as those to be provided by the receiving provider.

6522 Transfer IPC Effective Date

Revision 11-2; Effective March 1, 2011

Except for an emergency transfer (see 6525), the IPC effective date of a transfer IPC may only be on or after the date of the IPC meeting; it may not be before the IPC meeting date. The receiving provider will not be reimbursed for services provided prior to the IPC effective date.

6523 Transfer IPC Signatures and Signature Dates

Revision 22-2; Effective May 1, 2022

The SC is responsible for obtaining the signature and date of the receiving provider on the day of the IPC meeting on the transfer IPC. The SC is also responsible for obtaining the signature of the individual/LAR on the transfer IPC. If present, the individual/LAR signs and dates on the appropriate lines of the form. If the LAR participates by phone, the SC checks the box to indicate such and enters the date the LAR participated in the IPC meeting. The SC then sends a copy of the form for the LAR's signature.

6524 Transmission of Transfer IPC

Revision 22-2; Effective May 1, 2022

The LIDDA enters the transfer IPC in the HHSC data system and faxes a copy to HHSC PES. The SC ensures that the receiving provider has a hard copy of the completed IPC Form 3608.

If the LIDDA is unable to complete the data entry, it sends an email to the HHSC PES contact for the receiving provider that includes the error message from the HHSC data system. HHSC PES staff will instruct the LIDDA as to how to complete the data entry.

If two LIDDAs are assisting with a transfer IPC, the transferring LIDDA sends the IPC to the receiving LIDDA for data entry.

For additional information on the transfer process, see 8000, Transfers and Local Intellectual and Developmental Disability Authority (LIDDA) Reassignments.

6525 Emergency Transfer

Revision 22-2; Effective May 1, 2022

If the individual has already begun receiving services from the potential receiving provider and the transfer meets the criteria for an "emergency" (as defined by the HCS rule, see box below), the SC:

enters the date the individual began receiving services from the receiving provider as the transfer IPC effective date; and
documents the circumstances that support the determination of an emergency transfer and faxes it to HHSC PES along with the transfer IPC.

40 TAC, §9.153 Definitions

(14) Emergency – An unexpected situation in which the absence of an immediate response could reasonably be expected to result in risk to the health and safety of an individual or another person.

6530 Provider Responsibilities for Transfer IPC

Revision 11-2; Effective March 1, 2011

6531 Transferring Provider

Revision 22-2; Effective May 1, 2022

The transferring provider completes the appropriate section of Form 3617, Request for Transfer of Waiver Program Services, in accordance with the form's instructions and 8000, Transfers and Local Intellectual and Developmental Disability Authority (LIDDA) Reassignments. The information related to reserved service units/dollars on Form 3617 provided by the transferring provider is essential for the development of the transfer IPC. The transferring provider may participate in the IPC meeting to develop the transfer IPC unless the individual/LAR objects to its participation.

6532 Receiving Provider

Revision 11-2; Effective March 1, 2011

The receiving provider participates in the transfer IPC meeting, participates in the development of the transfer IPC, and signs and dates the transfer IPC. The provider's signature date on the transfer IPC must be the date of the IPC meeting.

6600, Service Coordinator Review Process

Revision 11-2; Effective March 1, 2011

6610 Service Coordinator Review Process Overview

Revision 22-2; Effective May 1, 2022

The SC is responsible for reviewing in the HHSC data system all IPC renewals and all IPC revisions, except IPC revisions that add or change a requisition fee only. After the provider enters the IPC in the HHSC data system, the SC has six days to review it in the HHSC data system. Within three days after entering the IPC, the provider is responsible for sending the SC a hard copy of the IPC (i.e., completed Form 3608).

The SC reviews the IPC in the HHSC data system by ensuring:

the information in the HHSC data system is the same as the information on the hard copy of the IPC and reflects what was discussed during the IPC meeting, if appropriate; and
that the IPC effective date is in accordance with the requirements in 6323, 6421.1 or 6431.1, as appropriate.

If an SC does not review an IPC within six days after data entry, the HHSC data system will automatically send the IPC to HHSC for authorization without an SC review. Reports will be available for state office and LIDDA management staff noting those IPCs not reviewed by the SC.

6611 Reasons the IPC is Returned to the Provider

Revision 22-2; Effective May 1, 2022

The SC returns the IPC electronically in the HHSC data system to the provider if the SC is unable to agree or disagree with the IPC because:

the SC did not receive the IPC hard copy within the required time frame and the SC is unable to review the IPC in in the HHSC data system before the six-day review time frame ends;
an error was made in in the HHSC data system related to a unit of service, the name of the SC (not a just minor misspelling) or a signature date;
the SC was not notified by fax or email of an IPC revision for which an IPC meeting is not needed;
the SC determined an IPC meeting was necessary for an IPC revision in accordance with 6432.4;
the SC did not participate in the development of an IPC for which an IPC meeting is needed; or
the IPC effective date is not in accordance with the requirements in 6323, 6421.1 or 6431.1, as appropriate.

6612 Service Coordinator's Agreement/Disagreement with IPC

Revision 22-2; Effective May 1, 2022

The SC must agree that the HCS services on the IPC are:

not available through other resources, and do not replace existing and natural supports;
necessary to assure the individual's health and safety and prevent institutionalization; and
based on the outcomes in the individual's PDP.

6620 Service Coordinator Responsibilities

Revision 11-2; Effective March 1, 2011

6621 If the IPC is Returned to Provider

Revision 22-2; Effective May 1, 2022

If the SC returns the IPC to the provider, the SC enters a comment in the HHSC data system to explain the reason for returning the IPC. Additionally, the SC contacts the provider the same day that an IPC is returned and discusses with the provider how to resolve the issue.

6622 Service Coordinator's Agreement/Disagreement with IPC

Revision 22-2; Effective May 1, 2022

If the SC does not return the IPC in the HHSC data system to the provider, the SC completes the review by entering the agreement or disagreement in in the HHSC data system before the IPC proceeds to HHSC for authorization.

6622.1 Agreement with IPC

Revision 22-2; Effective May 1, 2022

The SC must agree with the IPC in the HHSC data system to move it forward for review.

6622.2 Disagreement with IPC

Revision 22-2; Effective May 1, 2022

If the SC does not agree with the requirements in 6612, Service Coordinator’s Agreement/Disagreement with IPC, the SC contacts the program provider to discuss concerns related to the HCS services in the IPC for which the SC is unable to agree.

If the SC's concerns are not resolved and the SC continues to disagree, the SC completes Form 8579, Notification of Service Coordinator Disagreement, and submits it to HHSC UR, and sends a copy to the program provider. The SC completes the form on the same day that the SC enters the disagreement in the HHSC data system.

6630 Provider Responsibilities

Revision 22-2; Effective May 1, 2022

The provider ensures that the SC has a hard copy of the IPC within three days after the provider enters the IPC data into the HHSC data system.

6631 Service Coordinator Returns IPC in the HHSC Data System

Revision 22-2; Effective May 1, 2022

If the SC returns an IPC to the provider in the HHSC data system, the SC notifies the provider that same day of the returned IPC. Additionally, the SC enters a comment in the HHSC data system to explain the reason for returning the IPC.

6632 Activity to Address a Returned IPC

Revision 22-2; Effective May 1, 2022

The IPC remains in "Returned to Provider" status until the provider takes some action in the HHSC data system to address the returned IPC. Depending on the reason the IPC was returned, the provider may take one of the following HHSC data system actions:

delete and re-enter the IPC; or
correct any errors.

Before taking HHSC data system action to send the IPC on to the SC for review again, the provider is responsible for resolving the issue that was the basis for the IPC being returned.

7000, Implementation Plan and Service Backup Plan

7100 Implementation Plan Overview

Revision 21-2; Effective November 8, 2021

The Implementation Plan (IP) is developed by the individual, the individual’s legally authorized representative (LAR) and the program provider. The IP addresses every Home and Community-based Services (HCS) service the individual receives through the program provider.

The program provider is not required to develop an IP for an HCS service provided though the Consumer Directed Services (CDS) Option. Developing an IP for HCS program services delivered through the CDS Option is a responsibility of the CDS employer.

The IP must clearly illustrate how the individual will be supported in achieving his or her outcomes identified in the Person Directed Plan (PDP) and how HCS program services will be delivered to achieve the identified outcomes. The IP describes and directs the delivery of services, including when, where and by whom services will be provided. A copy of the IP is provided to the service coordinator (SC) upon request.

An HCS provider may use Form 2125, Implementation Plan - HSC/TxHmL/CFC, or another document that includes the same elements in Form 2125. A nursing care plan, a behavior support plan or other plans completed by HCS service providers may serve as the IP if those plans include all required elements of the IP as defined in 40 Texas Administrative Code Section 9.153(51).

7200 Implementation Plan Elements

Revision 21-2; Effective November 8, 2021

7210 Desired Outcome(s)

Revision 21-2; Effective November 8, 2021

The desired outcome(s) for an HCS service included on the IP are taken directly from the PDP.

7220 Conversation, Observation and Formal Assessment

Revision 21-2; Effective November 8, 2021

In addition to the PDP, the development of implementation strategies may be based on:

Conversations with the individual, the individual’s LAR or any member of the individual’s support network, and/or staff who know the individual;
Observations; and
Formal assessments (including assessments by occupational therapists, physical therapists, nurses, behavioral support specialists, doctors, dentists, teachers, speech therapists, dietitians, job coaches, etc.).

Documentation must be maintained regarding the information gathered through conversation, observation and formal assessments.

7230 Implementation Strategies

Revision 21-2; Effective November 8, 2021

The implementation strategies are individualized and allow for evaluation of progress in achieving each desired outcome. Strategies are the steps that contribute to reaching desired outcomes. Depending on the outcome, the IP may contain one or more strategies that lead to the individual's acquisition of additional skills or describe actions to be completed by paid supports to achieve an outcome. There is no prescribed number of strategies for each outcome. Strategies are written in observable, measurable or outcome-oriented terms. Measurable means a person can consistently and reliably determine whether an action or event has occurred. Observable means the action or event can be detected using one or more of the five senses: sight, hearing, touch, taste or smell. Outcome-oriented means that it can be determined when a desired result has been achieved.

7240 Signing the Implementation Plan (IP)

Revision 21-2; Effective November 8, 2021

Once the IP has been developed, the IP must be signed and dated by the individual, LAR and the program provider to verify that they have participated in the development of the IP.

7300 Provider Monitoring of Service Delivery

Revision 21-2; Effective November 8, 2021

The program provider is responsible for ensuring that services are provided according to the IP. Ongoing communication between the program provider’s staff and the individual and LAR is necessary to ensure that the IP reflects services and implementation strategies that meet the needs and desires of the individual and LAR.

The program provider must document services provided as specified in the implementation plan and verify the requirements for reimbursement, as defined in the HCS Program Billing Requirements (PDF), have been met. The IP and documentation related to service delivery may also be used by HHSC utilization review staff when determining whether to authorize the Individual Plan of Care (IPC).

7310 Example of Documenting Observable Strategies

Revision 21-2; Effective November 8, 2021

Observable: Staff use one or more of the five senses (sight, hearing, touch, smell or taste) to evaluate performance on implementation strategy.

Example: Johnny will independently select and purchase items using the correct amount at the local convenience store. (Based on the PDP, which reflects that it is important to Johnny to be able to go independently to the store and purchase items of his choice.)

Staff Documentation: Staff observed Johnny at the 7-11. He selected three items to purchase and approached the register, greeted the cashier and received the total for his purchase. The purchase price was $3.42. Johnny presented the cashier with $3.00. Staff prompted Johnny to give the cashier an additional dollar. The purchase was then complete.

This example indicates that Johnny appropriately performed many of the steps associated with making a purchase, but he continues to require assistance with determining the total dollar amount to complete the purchase. The program provider is responsible for reviewing staff documentation to determine Johnny’s progress or lack of progress in reaching the desired outcome.

7320 Example of Measurable Strategies

Revision 21-2; Effective November 8, 2021

Measurable: Calculations are made to determine progress on implementation strategy.

Example: Johnny will use a walker. (Based on the PDP, which reflects that it is important to Johnny to be able to go from place to place without assistance.)

Staff Documentation: Johnny used his walker to go a total of 25 feet this afternoon.

Note: When using data sheets for measuring progress, be sure that the criteria does not “lock” the individual into a perpetual loop. The individual should be provided with the adequate support to reach their desired outcomes and strategies should be adjusted to assist the individual to do so. When success is not occurring, staff should note their observations on the data sheet and the program provider should assess whether the strategies remain effective.

Example: Staff documented that Johnny does not appear to be motivated to use his walker inside the house. However, Johnny expressed to staff that he enjoys checking the mailbox at the end of the driveway. Staff observed that he consistently uses his walker when he is provided the opportunity to complete this task.

7330 Example of Documenting Outcome Oriented Strategies

Revision 21-2; Effective November 8, 2021

Outcome Oriented: Progress is defined by occurrence of an event identified in the implementation strategy.

Example: Johnny wants to participate in the annual cancer research walk/run. (Based on the PDP, which indicated that Johnny’s sister died from cancer, he wants to help raise money for the cause.)

Staff Documentation: Staff took Johnny to the American Cancer Society today so that he could sign up to participate in the annual cancer research walk/run.

7400 Revising the Implementation Plan

Revision 21-2; Effective November 8, 2021

The program provider is expected to routinely review the services provided to an individual and share information regarding progress or lack of progress on the implementation strategies with the individual and the individual’s LAR, if applicable. Lack of progress on an implementation strategy indicates that the strategy needs to be reviewed to determine if revision is warranted.

The HCS program provider revises an individual's IP whenever there is a change in the outcomes identified in the PDP, or when changes in implementation strategies, or frequency or duration of HCS program services are needed.

7500 Service Backup Plan

Revision 21-2; Effective November 8, 2021

A program provider must develop a written backup plan for each waiver service identified on the PDP as critical to meeting an individual’s health and safety. HCS program providers may use Form 1742, Service Backup Plan for HCS, TxHmL and CFC Services, to develop a service backup plan or may use their own documentation that includes the required elements of a service backup plan. A backup plan must:

contain the name of the critical service;
specify the period of time in which an interruption to the critical service would result in an adverse effect to the individual’s health or safety; and
describe the actions the program provider will take to ensure the individual’s health and safety in the event of an interruption to the critical service.

If a backup plan is implemented, the program provider must document whether the plan was effective. If the program provider determines the plan was ineffective, the program provider must revise the plan.

Note: Because HCS program providers must ensure that trained and qualified staff are available at all times for the provision of residential support and supervised living, a backup plan is not needed for these services. Backup plans for host home/companion care service must be documented in the service agreement the host home/companion care provider has with the HCS program provider.

7100, Implementation Plan Overview

Revision 21-2; Effective November 8, 2021

7110 Service Delivery Modalities

Revision 22-3; Effective Oct. 19, 2022

As appropriate for the individual and as permitted by service-specific requirements, the modalities for delivering services to an individual includes:

In person
Synchronous audio-visual
Audio only

In addition to meeting service requirements, providers must defer to the needs of the individual receiving services, ensuring the mode of service delivery is accessible, person-centered, and not driven by provider convenience.

Per standards of care, any professional therapy service or nursing service delivered using synchronous audio-visual technology must be clinically appropriate, safe, and agreed to by the individual receiving services or by the LAR. Synchronous audio-visual technology requires consent from the individual or LAR. Verbal consent is permissible and should be documented in the individual’s record. Providers must ensure that the appropriate consent box on the IP is checked.

7200, Implementation Plan Elements

7210 Desired Outcome(s)

Revision 21-2; Effective November 8, 2021

The desired outcome(s) for an HCS service included on the IP are taken directly from the PDP.

7220 Conversation, Observation and Formal Assessment

Revision 21-2; Effective November 8, 2021

In addition to the PDP, the development of implementation strategies may be based on:

Conversations with the individual, the individual’s LAR or any member of the individual’s support network, and/or staff who know the individual;
Observations; and
Formal assessments (including assessments by occupational therapists, physical therapists, nurses, behavioral support specialists, doctors, dentists, teachers, speech therapists, dietitians, job coaches, etc.).

Documentation must be maintained regarding the information gathered through conversation, observation and formal assessments.

7230 Implementation Strategies

Revision 21-2; Effective November 8, 2021

7240 Signing the Implementation Plan (IP)

Revision 21-2; Effective November 8, 2021

Once the IP has been developed, the IP must be signed and dated by the individual, LAR and the program provider to verify that they have participated in the development of the IP.

7300, Provider Monitoring of Service Delivery

Revision 21-2; Effective November 8, 2021

7310 Example of Documenting Observable Strategies

Revision 21-2; Effective November 8, 2021

Observable: Staff use one or more of the five senses (sight, hearing, touch, smell or taste) to evaluate performance on implementation strategy.

7320 Example of Measurable Strategies

Revision 21-2; Effective November 8, 2021

Measurable: Calculations are made to determine progress on implementation strategy.

Example: Johnny will use a walker. (Based on the PDP, which reflects that it is important to Johnny to be able to go from place to place without assistance.)

Staff Documentation: Johnny used his walker to go a total of 25 feet this afternoon.

7330 Example of Documenting Outcome Oriented Strategies

Revision 21-2; Effective November 8, 2021

Outcome Oriented: Progress is defined by occurrence of an event identified in the implementation strategy.

Staff Documentation: Staff took Johnny to the American Cancer Society today so that he could sign up to participate in the annual cancer research walk/run.

7400, Revising the Implementation Plan

Revision 21-2; Effective November 8, 2021

7500, Service Backup Plan

Revision 21-2; Effective November 8, 2021

contain the name of the critical service;
specify the period of time in which an interruption to the critical service would result in an adverse effect to the individual’s health or safety; and
describe the actions the program provider will take to ensure the individual’s health and safety in the event of an interruption to the critical service.

8000, Transfers and Local Intellectual and Developmental Disability Authority (LIDDA) Reassignments

8100, Overview

Revision 22-2; Effective May 1, 2022

Section 8000 describes the requirements for:

transferring an individual's Home and Community-based Services (HCS) or Texas Home Living (TxHmL) program services from one program provider or Financial Management Services Agency (FMSA) to another;
transferring an individual's HCS or TxHmL program services to another waiver contract area whether or not the program provider changes;
changing an individual's HCS or TxHmL service delivery option to add or delete CDS; and
reassigning a Local Intellectual and Developmental Disability Authority (LIDDA) when an individual moves from one LIDDA's service area into another LIDDA's service area. Click here and scroll to the last page to see a list of LIDDAs by waiver contract area (WCA).

Texas Administrative Code Title 40, Chapter 9, Subchapter D, requires the service coordinator (SC) to manage the transfer process as stated in Section 9.190(e)(25) and (26).

8200, Requirement for Program Provider to Notify Service Coordinator (SC)

Revision 11-1; Effective January 20, 2011

8210 Transfers Must be Planned

Revision 22-2; Effective May 1, 2022

Texas Health and Human Services Commission (HHSC) requires an individual's transfer to be planned in order for the receiving provider to be knowledgeable about the individual's needs and to be prepared to deliver necessary services. Therefore, the transfer effective date must be a future date to allow for adequate planning. An exception to this requirement may be made when a transfer meets the criteria for an emergency (as described in Section 8230, Emergency Transfer). If an individual/LAR requests a transfer, the program provider or the SC must inform the individual/LAR or family that the transfer must be scheduled for a future date to ensure appropriate planning occurs.

If an individual or LAR informs their current program provider that the individual/LAR wants to transfer to another program provider or FMSA, or the individual’s current program provider receives information from another program provider or FMSA that the individual/LAR wants to transfer to another program provider or FMSA, the individual’s current program provider must, within 24 hours, notify the individual's SC or the LIDDA’s service coordination supervisor of the individual’s/LAR's desire for transfer.

If an individual or their LAR contacts a program provider and informs them of their desire to transfer to the program provider, the program provider must instruct the individual/LAR to notify his/her LIDDA or SC. The potential receiving provider must inform the individual/LAR that before the program provider can begin providing services to the individual, the SC must conduct a transfer individual plan of care (IPC) meeting and a transfer effective date must be agreed to by all parties involved in the transfer. The potential receiving program provider may not begin providing services until the transfer effective date. The potential program provider will not be reimbursed for services provided before the transfer effective date unless the situation meets the emergency transfer criteria described in Section 8230, Emergency Transfer.

8220 No Prior SC Notification

Revision 22-2; Effective May 1, 2022

If an SC is notified that an individual is already receiving services from a potential receiving program provider without going through the transfer process, the SC must document the date they were notified and the name of the person who provided notification. No more than three business days after receiving this notification, the SC must contact the individual/LAR to verify the individual requested a transfer and to confirm their choice of program provider.

If the individual/LAR says transferring was not their choice, the SC must confirm whether the individual want to remain with his or her previous program provider or select a different program provider.
If the individual/LAR says it was their decision to transfer, within five business days, the SC must conduct a transfer IPC meeting and inform the receiving program provider that the transfer effective date cannot be prior to the date of the transfer IPC meeting unless the situation meets the emergency transfer criteria described in Section 8230.

8230 Emergency Transfer

Revision 22-2; Effective May 1, 2022

40 Texas Administrative Code §9.153 defines emergency as follows:

Emergency – An unexpected situation in which the absence of an immediate response could reasonably be expected to result in risk to the health and safety of an individual or another person.
Emergency situation – An unexpected situation involving an individual's health, safety, or welfare, of which a person of ordinary prudence would determine that the LAR should be informed, such as:
1. an individual needing emergency medical care;
2. an individual being removed from his residence by law enforcement;
3. an individual leaving his residence without notifying a staff member or service provider and not being located; and
4. an individual being moved from his residence to protect the individual (for example, because of a hurricane, fire, or flood).

In an emergency, the individual must be transferred immediately; therefore, the transfer effective date will be prior to the transfer IPC meeting date.

If the SC is unaware that the individual is in an emergency situation that requires an emergency transfer, the receiving program provider must notify the SC as soon as the transfer has occurred to allow the SC to complete the transfer process.

In an emergency transfer, the transfer effective date is the date the individual began receiving services from the new program provider. The signature dates on the transfer IPC will be the date of the IPC meeting. This means the transfer effective date may be earlier than the IPC meeting dates and the IPC signature dates.

The SC must submit the transfer packet and documentation supporting the reason for the emergency transfer to HHSC Program Eligibility and Support (PES). HHSC PES determines whether the emergency transfer criteria is met based on the supporting documentation received from the SC.

If HHSC PES determines the documentation supports the emergency transfer criteria, the receiving provider may be reimbursed for services provided before the transfer IPC meeting.

8231 Data Entry of Emergency Transfer in the HHSC Data System

Revision 22-2; Effective May 1, 2022

For an emergency transfer, HHSC PES enters the transfer in the HHSC data system.

8300, Miscellaneous Information and Requirements

Revision 10-1; Effective September 27, 2010

8310 Simultaneous Transfer of Program Provider and FMSA

Revision 22-2; Effective May 1, 2022

If an individual/LAR wants to transfer to another program provider and to another FMSA, the SC, the LIDDA and the transferring and receiving program providers must follow the steps in 8600, FMSA Transfer and Changing Service Delivery Option, 8400, Program Provider Transfer Involving One Local Intellectual and Developmental Disability Authority (LIDDA), or 8500, Program Provider Transfer Involving Two Local Intellectual and Developmental Disability Authorities (LIDDAs), at the same time using one Form 3617 , Request for Transfer of Waiver Program Services (PDF).

8320 Form 3617 and Instructions

Revision 10-1; Effective September 27, 2010

Form 3617 , Request for Transfer of Waiver Program Services (PDF), is used to document transfer information. The persons required to complete portions of this form must do so in accordance with the instructions.

8330 Reserved for Future Use

Revision 22-2; Effective May 1, 2022

8340 Verification of Guardianship

Revision 22-2; Effective May 1, 2022

To prevent a delay in the authorization of a transfer, the SC must determine whether an individual has a legal guardian and verify that guardianship information is correct in the HHSC data system.

If the individual has a current legal guardian listed in the HHSC data system, then all forms must be signed by the guardian.
If the individual does not have a legal guardian listed in the HHSC data system, then all forms must be signed by the individual.
If the guardian listed in the HHSC data system is not current, the SC should obtain signatures of both the individual and the person listed as guardian, until appropriate steps can be taken to update guardianship information.

8350 Transfer Process Checklist

Revision 10-1; Effective September 27, 2010

When completing transfer activities, the SC may use the Transfer Process Checklist (PDF).

8360 Contacting HHSC

Revision 22-2; Effective May 1, 2022

The LIDDA may, at any time during the transfer process, consult with HHSC PES if the LIDDA encounters problems completing the process.

The SC must consult with HHSC PES when a program provider does not submit required documentation within the time frames described in this section.

8400, Program Provider Transfer Involving One Local Intellectual and Developmental Disability Authority (LIDDA)

Revision 22-2; Effective May 1, 2022

Sections 8410 through 8470 describe the requirements for a program provider transfer involving one LIDDA.

8410 Confirming the Desire to Transfer

Revision 10-1; Effective September 27, 2010

Step	Service Coordinator Action
1	Within three days after receiving information that an individual/LAR wants to transfer to another program provider, the SC must contact the individual/LAR to: confirm the individual/LAR wants to transfer; and explain that the individual/LAR may transfer to the program provider of his/her choice.
2	If the SC confirms that the individual/LAR wants to transfer, 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 and obtain the signature of the individual/LAR, indicating the desire to transfer; determine if the individual/LAR has selected a receiving program provider; and notify the state support living center (SSLC) admissions placement coordinator that the individual wants to transfer, if the individual is on community placement from an SSLC and is being monitored in accordance with a community living discharge plan (CLDP).

Step

Service Coordinator Action

Within three days after receiving information that an individual/LAR wants to transfer to another program provider, the SC must contact the individual/LAR to:

confirm the individual/LAR wants to transfer; and
explain that the individual/LAR may transfer to the program provider of his/her choice.

If the SC confirms that the individual/LAR wants to transfer, 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 and obtain the signature of the individual/LAR, indicating the desire to transfer;
determine if the individual/LAR has selected a receiving program provider; and
notify the state support living center (SSLC) admissions placement coordinator that the individual wants to transfer, if the individual is on community placement from an SSLC and is being monitored in accordance with a community living discharge plan (CLDP).

8420 Selecting a Receiving Program Provider

Revision 10-1; Effective September 27, 2010

Step	Service Coordinator Action
1	The SC must inform the individual/LAR that they have a choice of program providers, even if the individual/LAR has already selected a receiving program provider.
2	If the individual/LAR has not selected a receiving program provider, the SC must give the individual/LAR a list of 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.
3	After the individual/LAR has selected a receiving program provider, the SC must document the individual/LAR's choice of a receiving program provider in Section II on Form 3617.

8430 Ensuring Agreement on Transfer Effective Date

Revision 22-2; Effective May 1, 2022

Step	Service Coordinator Action
1	At the time the individual/LAR selects a receiving program provider, the SC must obtain a proposed transfer effective date from the individual/LAR.
2	The SC must contact the receiving program provider to determine if the date proposed by the individual/LAR is acceptable.
3	Once the receiving program provider and individual/LAR agree on a transfer effective date, the SC must contact the transferring program provider to determine if that date is agreeable to the transferring program provider. If the date is agreeable, the SC completes the steps in 8440, Completing Form 3617.
4	If the date is not agreeable, the SC must facilitate communication between the individual/LAR and the transferring and receiving 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 program provider, the SC must consult HHSC PES for direction.

Step	Receiving Program Provider Action
1	When contacted by the SC, the receiving program provider must comply with the SC's request for a transfer effective date.
2	If the proposed transfer effective date is not acceptable to the receiving program provider, the 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 program provider.

Step	Transferring Program Provider Action
1	When contacted by the SC, the transferring program provider must comply with the SC's request for a transfer effective date.
2	If the proposed transfer effective date is not acceptable to the transferring program provider, the 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 program provider.

8440 Completing Form 3617

Revision 11-1; Effective January 20, 2011

Step	Service Coordinator Action
1	The SC must enter the mutually agreed upon transfer effective date in Section I, Transferring Program Provider's Information, and Section II, Receiving Program Provider's Information, of Form 3617.
2	The SC must send Form 3617 to the transferring program provider and request that the provider complete Section I and return it to the SC within three business days.
3	After receiving a completed copy of Form 3617 from the transferring program provider, the SC must send the same Form 3617 to the receiving program provider and request that the provider complete Section II and return it to the SC within three business days.
4	The SC must ensure all signatures are on the same copy of Form 3617. The SC must sign Form 3617 after both program providers have completed their sections.

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

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

8450 Developing the Transfer IPC

Revision 22-2; Effective May 1, 2022

Step	Service Coordinator Action
1	On or before the transfer effective date, the SC must meet with the individual/LAR and the receiving program provider to review the individual's current IPC and develop a transfer IPC. This should be a face-to-face meeting, if feasible.
2	The SC must ensure that the transfer IPC includes services already provided by the transferring program provider, and services to be provided by the transferring 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 by the receiving program provider.
3	The SC must ensure the transfer IPC: complies with the requirements described in §9.159(c); and is signed and dated by the individual/LAR, receiving program provider, and SC.
4	At the transfer IPC meeting, the SC ensures the receiving program provider completes Section II of Form 3617 and returns it to the SC.

Step	Receiving Program Provider Action
1	The receiving program provider must meet with the individual/LAR and SC to develop and sign a transfer IPC, as requested by the SC.
2	The receiving program provider must complete Section II of Form 3617 and return it to the SC.

8460 Sharing Documents

Revision 22-2; Effective May 1, 2022

Step	Service Coordinator Action
1	The SC must submit current copies of the following documents to the receiving program provider before the transfer effective date: IPC ID/RC assessment person-directed plan (PDP)
2	Before the transfer effective date, the SC must request from the transferring program provider the current (or the most recent) copies of the following documents for the individual: pertinent medication records and/or medical information, including: a list of medications scheduled medical appointments list of medical professionals skilled nursing routines therapy evaluations major illnesses/injuries, surgeries or hospitalizations in the past year drug allergies lab results, including blood sugars adaptive equipment current medication administration records and immunization records records of current weight and vital signs Medicaid card Medicare information, if applicable Inventory for Client and Agency Planning (ICAP) booklet and summary sheet trust fund/financial records and any money due the individual behavior support plan, if applicable guardianship information, if applicable any other pertinent information to ensure health and safety or continuity of services.
3	The SC must submit the documents listed in Step 2 to the receiving program provider within two days after receiving them from the transferring program provider. If the SC does not receive all documents from the transferring program provider within three days after requesting them, the SC must notify HHSC PES.

Step

Service Coordinator Action

The SC must submit current copies of the following documents to the receiving program provider before the transfer effective date:

IPC
ID/RC assessment
person-directed plan (PDP)

Before the transfer effective date, the SC must request from the transferring program provider the current (or the most recent) copies of the following documents for the individual:

pertinent medication records and/or medical information, including:
- a list of medications
- scheduled medical appointments
- list of medical professionals
- skilled nursing routines
- therapy evaluations
- major illnesses/injuries, surgeries or hospitalizations in the past year
- drug allergies
- lab results, including blood sugars
- adaptive equipment
- current medication administration records and immunization records
- records of current weight and vital signs
Medicaid card
Medicare information, if applicable
Inventory for Client and Agency Planning (ICAP) booklet and summary sheet
trust fund/financial records and any money due the individual
behavior support plan, if applicable
guardianship information, if applicable
any other pertinent information to ensure health and safety or continuity of services.

The SC must submit the documents listed in Step 2 to the receiving program provider within two days after receiving them from the transferring program provider. If the SC does not receive all documents from the transferring program provider within three days after requesting them, the SC must notify HHSC PES.

Step	Transferring Program Provider Action
1	The transferring program provider must submit copies of the documents listed in Step 2 to the SC within three days after the SC's request.

8470 Completing Data Entry in the HHSC Data System and Submitting Documents to HHSC

Revision 22-2; Effective May 1, 2022

Step	LIDDA Action
1	Within 10 days after the transfer effective date, the LIDDA must complete all data entry to finalize a transfer. For an emergency transfer, HHSC PES enters the transfer data in HHSC data system.
2	If the individual is transferring to a three-person or four-person residence or host home/companion care setting and the receiving program provider does not have access to the HHSC data system to set up a location, the LIDDA should refer the receiving program provider to contact HHSC PES for assistance.
3	After the LIDDA has completed the data entry described in Step 1, but within 10 days after the transfer effective date, the SC must submit the completed transfer IPC and Form 3617 to HHSC PES through the IDD Operations Portal.

Step	Receiving Program Provider Action
1	If the individual is transferring to a group home or host home/companion care setting, the receiving program provider must assign a location code for the individual's residence and set up the location in the HHSC data system. If the individual will be assigned to a location that has already been set up, the program provider must ensure that the status of the location is "open" and will not exceed the capacity for that residence. If the receiving program provider does not have access to the HHSC data system, the program provider should contact HHSC PES for assistance.
2	The receiving 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 program provider's component code, use the existing local case number. Do not create a new local case number.

Step

Receiving Program Provider Action

If the individual is transferring to a group home or host home/companion care setting, the receiving program provider must assign a location code for the individual's residence and set up the location in the HHSC data system. If the individual will be assigned to a location that has already been set up, the program provider must ensure that the status of the location is "open" and will not exceed the capacity for that residence. If the receiving program provider does not have access to the HHSC data system, the program provider should contact HHSC PES for assistance.

The receiving 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 program provider's component code, use the existing local case number. Do not create a new local case number.

8500, Program Provider Transfer Involving Two Local Intellectual and Developmental Disability Authorities (LIDDAs)

Revision 22-2; Effective May 1, 2022

Sections 8510 through 8570 describe the requirements for a program provider transfer involving two LIDDAs. The SC for the transferring LIDDA and the SC for the receiving LIDDA must both be involved to coordinate the individual's transfer.

8510 Confirming the Desire to Transfer

Revision 22-2; Effective May 1, 2022

Step	Transferring Service Coordinator Action
1	If the individual has not already relocated to the receiving LIDDA’s local service area, the transferring SC must: complete the steps in Section 8410, Confirming the Desire to Transfer; contact the receiving LIDDA to identify the receiving SC; and submit an Individual Movement (IMT) form/LA reassignment form in the HHSC data system.

Step

Transferring Service Coordinator Action

If the individual has not already relocated to the receiving LIDDA’s local service area, the transferring SC must:

complete the steps in Section 8410, Confirming the Desire to Transfer;
contact the receiving LIDDA to identify the receiving SC; and
submit an Individual Movement (IMT) form/LA reassignment form in the HHSC data system.

Step	Receiving LIDDA/SC Action
1	The receiving LIDDA must assign an SC to the individual.
2	If the individual has already relocated to the receiving LIDDA’s local service area, the receiving SC must complete the steps in Section 8410.
3	The receiving LIDDA must acknowledge the IMT/LA reassignment form in the HHSC data system.

8520 Selecting a Receiving Program Provider

Revision 22-2; Effective May 1, 2022

Step	Transferring Service Coordinator Action
1	If the individual has not already relocated to the receiving LIDDA's local service area, the transferring SC must complete the steps in Section 8420, Selecting a Receiving Program Provider.

Step	Receiving SC Action
1	If the individual has already relocated to the receiving LIDDA's local service area, the receiving SC must complete the steps in Section 8420.

8530 Ensuring Agreement on Transfer Effective Date

Revision 22-2; Effective May 1, 2022

Step	Transferring Service Coordinator Action
1	If the individual has not already relocated to the receiving LIDDA's local service area, the transferring SC must complete the steps in Section 8430, Ensuring Agreement on Transfer Effective Date.

Step	Receiving SC Action
1	If the individual has already relocated to the receiving LIDDA's local service area, the receiving SC must complete the steps in Section 8430.

Step	Receiving Program Provider Action
1	The receiving program provider must complete the steps in Section 8430.

Step	Transferring Program Provider Action
1	The transferring program provider must complete the steps in Section 8430.

8540 Completing Form 3617

Revision 22-2; Effective May 1, 2022

Step	Transferring Service Coordinator Action
1	If the individual has not already relocated to the receiving LIDDA's local service area, the transferring SC must complete the steps in Section 8440, Completing Form 3617.

Step	Receiving SC Action
1	If the individual has already relocated to the receiving LIDDA's local service area, the receiving SC must complete the steps in Section 8440.

8550 Developing the Transfer IPC

Revision 22-2; Effective May 1, 2022

Step	Transferring Service Coordinator Action
1	If the individual has not already relocated to the receiving LIDDA's local service area, on or before the transfer effective date, the transferring SC must complete the steps in Section 8450, Developing the Transfer IPC.

Step	Receiving SC Action
1	If the individual has already relocated to the receiving LIDDA's local service area, on or before the transfer effective date, the receiving SC must complete the steps in Section 8450.
2	The receiving SC must email fax the following documents to the transferring SC for data entry: the completed and signed transfer IPC; and the completed and signed Form 3617, Request for Transfer of Waiver Program Services.

Step

Receiving SC Action

If the individual has already relocated to the receiving LIDDA's local service area, on or before the transfer effective date, the receiving SC must complete the steps in Section 8450.

The receiving SC must email fax the following documents to the transferring SC for data entry:

the completed and signed transfer IPC; and
the completed and signed Form 3617, Request for Transfer of Waiver Program Services.

Step	Receiving Program Provider Action
1	The receiving program provider must complete the steps in Section 8450.

8560 Sharing Documents

Revision 22-2; Effective May 1, 2022

Step	Transferring Service Coordinator Action
1	The transferring SC must submit current copies of the following documents to the receiving SC before the transfer effective date and submission of the IMT form in the HHSC data system: IPC ID/RC assessment PDP
2	Before the transfer effective date, the transferring SC must request from the transferring program provider the current (or the most recent) copies of the following documents for the individual: pertinent medication records and/or medical information, including: a list of medications scheduled medical appointments list of medical professionals skilled nursing routines therapy evaluations major illnesses/injuries, surgeries or hospitalizations in the past year drug allergies lab results, including blood sugars adaptive equipment current medication administration records and immunization records records of current weight and vital signs Medicaid card Medicare information, if applicable ICAP booklet and summary sheet trust fund/financial records and any money due the individual behavior support plan, if applicable guardianship information, if applicable any other pertinent information to ensure health and safety or continuity of services.
3	The transferring SC must submit the documents listed in Step 2 to the receiving SC within two days after receiving them from the transferring program provider. If the SC does not receive all documents from the transferring program provider within three days after requesting them, the SC must notify HHSC PES.

Step

Transferring Service Coordinator Action

The transferring SC must submit current copies of the following documents to the receiving SC before the transfer effective date and submission of the IMT form in the HHSC data system:

IPC
ID/RC assessment
PDP

Before the transfer effective date, the transferring SC must request from the transferring program provider the current (or the most recent) copies of the following documents for the individual:

pertinent medication records and/or medical information, including:
- a list of medications
- scheduled medical appointments
- list of medical professionals
- skilled nursing routines
- therapy evaluations
- major illnesses/injuries, surgeries or hospitalizations in the past year
- drug allergies
- lab results, including blood sugars
- adaptive equipment
- current medication administration records and immunization records
- records of current weight and vital signs
Medicaid card
Medicare information, if applicable
ICAP booklet and summary sheet
trust fund/financial records and any money due the individual
behavior support plan, if applicable
guardianship information, if applicable
any other pertinent information to ensure health and safety or continuity of services.

The transferring SC must submit the documents listed in Step 2 to the receiving SC within two days after receiving them from the transferring program provider. If the SC does not receive all documents from the transferring program provider within three days after requesting them, the SC must notify HHSC PES.

Step	Receiving SC Action
1	The receiving SC must submit to the receiving program provider the documents received from the transferring SC within two days after receiving them from the transferring SC.

Step	Transferring Program Provider Action
1	The transferring program provider must submit copies of the documents listed in Step 2 to the SC within three days after the SC's request.

8570 Completing Data Entry in the HHSC Data System and Faxing Documents to HHSC

Revision 22-2; Effective May 1, 2022

Step	Receiving LIDDA/Service Coordinator (SC) Action
1	Within 10 days after the transfer effective date, the receiving LIDDA must complete all data entry to finalize a transfer. For an emergency transfer, the LIDDA must send the transfer documents to HHSC PES. HHSC PES enters the emergency transfer in the HHSC data system.
2	If the individual is transferring to a three- or four-person residence or a host home/companion care setting and the receiving program provider does not have access to the HHSC data system to set up a location, the receiving LIDDA must contact HHSC PES for assistance.
3	Within a day after the data is entered in the HHSC data system, the receiving SC must submit the transfer IPC and Form 3617 to HHSC PES.

Step	Receiving Program Provider Action
1	The receiving program provider must complete the steps in Section 8470, Completing Data Entry in the HHSC Data System and Submitting Documents to HHSC.

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.

8700, Notification by HHSC Program Eligibility and Support (PES)

Revision 22-2; Effective May 1, 2022

HHSC PES reviews the completed Form 3617, Request for Transfer of Waiver Program Services, and the transfer IPC to determine if a transfer is authorized. A transfer under Section 8000 is not effective unless authorized by HHSC.

8800, Local Intellectual and Developmental Disability Authority (LIDDA) Reassignment

Revision 22-2; Effective May 1, 2022

Step	Transferring LIDDA Action
1	If an individual moves to a different LIDDA’s service area without changing program provider within a waiver contract area, the transferring LIDDA must: notify the receiving LIDDA of the move by completing Form 8575, Notification of Local Authority (LA) Reassignment; enter the data from the form into the HHSC data system; submit an Individual Movement (IMT) form/LA reassignment form in the HHSC data system; and notify the state supported living center (SSLC) admissions placement coordinator that the individual has moved to a different LIDDA’s service area, if the individual is on community placement from an SSLC and is being monitored in accordance with a community living discharge plan (CLDP). Click here and scroll to the last page to see a list of LIDDAs by waiver contract area (WCA).
2	After the transferring LIDDA has entered the data, the transferring LIDDA must send Form 8575 to the receiving LIDDA.
3	Within three days after the transferring LIDDA sends Form 8575 to the receiving LIDDA, the transferring SC must submit to the receiving SC a copy of the individual's: current PDP (if developed because of recent enrollment or IPC renewal); current ID/RC assessment; current IPC; current guardianship documents, if applicable; and address and other contact information of the individual's LAR or actively involved family member.

Step

Transferring LIDDA Action

If an individual moves to a different LIDDA’s service area without changing program provider within a waiver contract area*, the transferring LIDDA must:

notify the receiving LIDDA of the move by completing Form 8575, Notification of Local Authority (LA) Reassignment;
enter the data from the form into the HHSC data system;
submit an Individual Movement (IMT) form/LA reassignment form in the HHSC data system; and
notify the state supported living center (SSLC) admissions placement coordinator that the individual has moved to a different LIDDA’s service area, if the individual is on community placement from an SSLC and is being monitored in accordance with a community living discharge plan (CLDP).

* Click here and scroll to the last page to see a list of LIDDAs by waiver contract area (WCA).

After the transferring LIDDA has entered the data, the transferring LIDDA must send Form 8575 to the receiving LIDDA.

Within three days after the transferring LIDDA sends Form 8575 to the receiving LIDDA, the transferring SC must submit to the receiving SC a copy of the individual's:

current PDP (if developed because of recent enrollment or IPC renewal);
current ID/RC assessment;
current IPC;
current guardianship documents, if applicable; and
address and other contact information of the individual's LAR or actively involved family member.

Step	Receiving LIDDA Action
1	Within five days after receiving Form 8575 from the transferring LIDDA, as described in Step 2 above, the receiving LIDDA must: complete its portion of the form; acknowledge the IMT/LA reassignment form in the HHSC data system; and enter that data of the form in the HHSC data system.
2	Within five days after receiving Form 8575 from the transferring LIDDA, as described in Step 2 above, the receiving LIDDA must assign an SC to the individual transferring to the LIDDA’s local service area.

Step

Receiving LIDDA Action

Within five days after receiving Form 8575 from the transferring LIDDA, as described in Step 2 above, the receiving LIDDA must:

complete its portion of the form;
acknowledge the IMT/LA reassignment form in the HHSC data system; and
enter that data of the form in the HHSC data system.

Within five days after receiving Form 8575 from the transferring LIDDA, as described in Step 2 above, the receiving LIDDA must assign an SC to the individual transferring to the LIDDA’s local service area.

Contact Information

Questions regarding these requirements may be directed to the HHSC Program Eligibility and Support general email box at: enrollmenttransferdischargeinfo@hhs.texas.gov or the HHSC Program Eligibility and Support general phone message line at 512-438-2484.

Texas Home Living (TxHmL) and Home and Community-based Services (HCS) reference material are available online at:

9000, Suspensions

Revision 22-2; Effective May 1, 2022

All user guides are published to Texas Medicaid & Healthcare Partnership’s (TMHP’s) Learning Management System (LMS). All users must create an LMS account to access the materials.

There is a sign-up link on the LMS homepage. If you need assistance with registration, contact TMHP Training Support.

This section describes the process for suspending an individual's Home and Community-based Services (HCS) or Texas Home Living (TxHmL) Program waiver services and requesting a continuation of the suspension beyond 270 days.

A program advisor in the Texas Health and Human Services Commission (HHSC) Program Eligibility and Support (PES) unit will request information from the service coordinator (SC) every 30 days, or as appropriate, during the period an individual's waiver program services are suspended.

The individual's services will remain suspended until it is appropriate for the individual's services to resume or the decision is made to terminate the individual's services.

HHSC may request that an individual's HCS or TxHmL services be terminated at any time, if appropriate.

9100, Reasons for Suspension of Waiver Program Services

Revision 22-2; Effective May 1, 2022

There are situations that may cause an individual to become temporarily ineligible for HCS or TxHmL program services. If an individual is temporarily admitted to one of the following settings, the individual's HCS or TxHmL program services must be suspended in the HHSC data system:

a hospital;
an ICF/IID;
a nursing facility;
an ALF;
a residential child care facility licensed by HHSC unless it is an agency foster home;
an inpatient chemical dependency treatment facility;
a mental health facility;
a residential facility operated by the Texas Workforce Commission; or
a residential facility operated by the Texas Juvenile Justice Department, a jail or a prison.

9200, Program Provider Responsibilities

Revision 22-2; Effective May 1, 2022

The program provider must:

immediately inform the SC if the program provider becomes aware that an individual is ineligible for HCS or TxHmL program services;
enter a "suspension" in the HHSC data system;
keep the SC informed by communicating any change(s) in the situation immediately upon becoming aware of the change(s);
update the suspension record in the HHSC data system to change the suspension reason if the reason changes during the suspension period; this is done without entering a new suspension record or changing the suspension begin date; and
immediately inform the SC and end the "suspension" in the HHSC data system when an individual has resumed participation in the HCS or TxHmL program.

9300, HHSC Activities

Revision 22-2; Effective May 1, 2022

HHSC PES program advisors request periodic status reports from the service coordinator (SC) for suspensions that exceed 30 days by sending a Suspension of Waiver Services Status Report (PDF) form to the Local Intellectual and Developmental Disability Authority (LIDDA). The program advisor completes the top section and sends the form by secure email to the SC contact at the LIDDA after an individual has been on suspension for 30 days or longer. Thereafter, the program advisor sends the form requesting a status update as often as the advisor determines is necessary while the individual is on suspension.

9400, Service Coordinator Responsibilities

Revision 22-2; Effective May 1, 2022

The SC must:

immediately inform the program provider if the SC becomes aware that an individual is ineligible for HCS or TxHmL program services;
monitor the situation during the entire period of suspension; and
complete and return by secure email the Suspension of Waiver Services Status Report form documenting the individual’s current status on or before the status due date designated on the form, noting whether the suspension will continue and for how long, or that the individual is not expected to resume services (i.e., termination of services is being recommended).

If the suspension continues for 270 days, the SC discusses with the individual or LAR and the program provider whether the individual will be able to resume services or if services should be terminated.

If continuation of the suspension beyond 270 days is recommended, the SC submits a request to continue the suspension of HCS or TxHmL program services for an additional 30 days in accordance with Section 9410 below.
If termination of services is recommended, the SC completes and returns by secure email the Suspension of Waiver Services Status Report form noting that the individual is not expected to resume services.

HHSC PES reviews all recommendations for terminations of services. If HHSC agrees that termination is appropriate, HHSC will contact the SC to advise the SC to submit a request for termination in accordance with Section 10100, Process for Requesting Termination of Waiver Services – Texas Home Living and Home and Community-based Services.

9410 Request to Continue Suspension of Waiver Program Services

Revision 22-2; Effective May 1, 2022

If it is foreseeable that the individual will be able to resume HCS or TxHmL program services, the SC requests that program services be continued for 30 days by submitting the following documentation to HHSC no later than the 277th day of suspension:

a completed Form 3615, Request to Continue Suspension of Waiver Program Services; and
documentation explaining the reason for the requested continuation.

The request may be returned to the program advisor via secure email, faxed to 512-438-4249 or mailed to:

Health and Human Services Commission
Program Eligibility and Support, Mail Code W-551
P.O. Box 149030
Austin, TX 78714-9030

Contact Information

Questions regarding this process should be directed to the HHCS Program Eligibility Support general email box at HHSC IDD-Program Eligibility and Support IddProgEligSpt@hhs.texas.gov or telephone message line at 512-438-5055.

10000, Terminations

Revision 22-2; Effective May 1, 2022

All user guides are published to Texas Medicaid & Healthcare Partnership’s (TMHP’s) Learning Management System (LMS). All users must create an LMS account to access the materials.

There is a sign-up link on the LMS homepage. If you need assistance with registration, contact TMHP Training Support.

10100, Process for Requesting Termination of Waiver Services – Texas Home Living and Home and Community-based Services

Revision 22-2; Effective May 1, 2022

A request to terminate an individual's waiver program services must be submitted by the individual's assigned service coordinator (SC) at the Local Intellectual and Developmental Disability Authority (LIDDA).

By submitting a request to terminate waiver program services, the SC is requesting that HHSC end the individual's waiver program enrollment. By signing and dating Form 3616, Request for Termination of Services Provided by HCS/TxHmL Waiver Provider, all involved parties are indicating an agreement with the termination of services.

Data Entry in the HHSC data system

The program provider must complete the termination entry in the HHSC data system and the SC must review the termination entry in the HHSC data system prior to submitting required documentation for termination of waiver program services.

HHSC prefers to receive required documentation for the termination of waiver program services through the IDD Operations Portal, but it may be faxed to 512-438-4249 or mailed to:

Health and Human Services Commission
Program Eligibility and Support, Mail Code W-551
P.O. Box 149030
Austin, TX 78714-9030

Reasons for Requesting a Termination

There are several valid reasons for requesting that an individual's waiver program services be terminated, and HHSC Program Eligibility and Support (PES) requires specific documentation depending on the reason for the termination. The required documentation for each reason is described below.

Death – When the SC has learned about the death of a waiver program participant, the SC must submit:

Form 3616, Request for Termination of Services Provided by HCS/TxHmL Waiver Provider (only the program provider and SC are required to sign and date the form), and
a brief written summary regarding the circumstances surrounding the individual's death.

State Supported Living Center (SSLC) – When an individual is admitted to an SSLC, the individual's program provider must place the individual on suspension of waiver program services (temporary discharge) until after the SSLC makes a recommendation regarding the individual's continued placement at the individual's initial planning meeting, which occurs within 30 days after admission. If the SSLC recommends the individual's continued placement at the SSLC, the only required documentation the SC must submit is a completed Form 3616 (the termination date on the form must be the same date of the initial planning meeting at the SSLC).

Loss of Financial Eligibility (Medicaid) – The following documentation is required:

a completed Form 3616;
a written description of the service linkages in place following the individual's termination from the waiver program (if appropriate);
a copy of the denial letter from the Social Security Administration (SSA) or HHSC (if the denial letter is not available, the SC must document the reason that the letter is unavailable); and
written documentation of the following:
- a statement that the option of establishing an income or resource trust may allow the individual to have his or her Medicaid eligibility reinstated was explained to the individual or legally authorized representative (LAR) (only applicable if the SSA or HHSC denial was due to excess income or resources);
- the reason that the individual or LAR gave for not wanting to establish an income or resource trust (only applicable if the SSA or HHSC denial was due to excess income or resources);
- a statement of whether or not the individual or LAR intends to request a fair hearing to appeal the SSA or HHSC decision; and
- a signature sheet signed and dated by all involved parties as indication of understanding and agreement of all of the above.

Voluntary Withdrawal – There are several reasons an individual or LAR may choose to voluntarily withdraw from the waiver program. In every instance a completed Form 3616 must be submitted. Additional required documentation is based upon the reason for the voluntary withdraw as explained below:

If the individual or LAR has selected a different waiver or program, the SC must submit a description of the services available to the individual through the other waiver or program, the reason(s) the individual/LAR stated for choosing the other waiver or program, and how that program will better meet the individual's needs.
If the individual has moved out of state, the SC must submit written documentation regarding the stability of the move (for example, where, why and with whom the individual has moved).
If the individual no longer wishes to participate in the waiver program, the SC must submit records documenting all attempts to encourage the individual's participation and the specific reason(s) that the individual or LAR states for no longer wishing to participate.
If the individual or LAR has decided to reside in a nursing facility setting although the individual is capable of being served in a community setting, the SC must submit documentation regarding the diagnosis and prognosis and the specific reason(s) that the individual or LAR states for choosing a nursing facility setting.

Institutionalization – There are several types of institutionalization. In every instance a completed Form 3616 must be submitted. Additional required documentation is based upon the type of institutional setting as explained below:

If the individual is admitted to an intermediate care facility for persons with intellectual disability (ICF/ID), the SC must submit documentation regarding the specific reason(s) for the institutionalization (for example, specific behaviors), the date of the institutionalization and the name of ICF/ID.
If the individual is admitted to a medical hospital, a psychiatric hospital or nursing facility, the SC must submit documentation regarding the diagnosis and prognosis, the reason(s) the individual cannot be served in the community (for example, if the needs of the individual would cause the Individual Plan of Care (IPC) to exceed the cost ceiling, document which service(s) would cause this), the date of admission and the name of the facility.
If the individual has been incarcerated, the SC must submit documentation regarding the reason(s) for incarceration, the length of the individual's sentence, the type of facility (for example, county, federal, state), the possibility of early release (if appropriate), the original date of incarceration and the name of the facility.

Individual Cannot Be Located – When an individual cannot be located, the SC must submit a completed Form 3616 and documentation of a final attempt to contact the individual. The SC must review the information available in CARE screen C63.The last screen in the C63 sequence shows the mailing address to which HHSC sends the individual's Medicaid card and the SSA sends the individual's Supplemental Security Income check. The SC must mail a letter (by both regular and certified mail) to that address as a final attempt to contact the individual or LAR. The letter must notify the individual or LAR that:

the individual or LAR has the option of transferring to a different program provider if for any reason the individual or LAR is dissatisfied with the current program provider or Financial Management Services Agency (FMSA);
if the individual or LAR does not contact the SC within four weeks after the date of the letter, a request for termination of waiver services will be submitted to HHSC;
if HHSC terminates the individual's waiver enrollment, the individual will no longer be eligible to receive the waiver services, unlimited prescriptions and possibly Medicaid;
once an individual's Home and Community-based Services (HCS) waiver services have been terminated, the individual or LAR may request that the LIDDA add the individual's name to the end of the HCS interest list; however, due to the length of the HCS interest list, an offer for re-enrollment may not be available for several years (HCS only); and
if the individual or LAR agrees to voluntarily withdraw from the waiver program, the individual may do so by signing Form 3616, Request for Termination of Services Provided by HCS/TxHmL Waiver Provider, and returning it to the SC in the enclosed self-addressed, stamped envelope (remember to enclose a completed Form 3616 and a self addressed, stamped envelope).

If the individual or LAR does not respond within four weeks from the date of the letter, the SC must submit documentation of all methods used to attempt to locate the individual or LAR and the dates of each attempt (for example, home visits, telephone calls and conversations with family members, neighbors, employers, friends, co-workers, apartment managers) and copies of all letters mailed to the individual/LAR (and a copy of certified return receipt if mailed certified).

Unable to Meet Health/Safety – If an SC believes an individual's health and safety needs cannot be met by the HCS Program, the SC must contact HHSC PES for further instruction.

Role of HHSC PES – Upon receipt of a request for termination of waiver program services, HHSC PES will review all documentation submitted by the SC. If the documentation is not sufficient for termination of the individual's waiver program services, HHSC staff will contact the SC for more information/documentation. If the documentation is sufficient for termination of the individual's waiver program services, PES staff will notify the individual or LAR by certified mail of the decision to terminate waiver program services and the individual's right to request a fair hearing to appeal the decision. The program provider and SC will receive a copy of the notification letter.

Contact Information

Questions regarding this process should be directed to the HHSC PES general email box at: EnrollmentTransferDischargeInfo@hhs.texas.gov or general message line at 512-438-5055.

TxHmL and HCS reference materials are available online at:

11000, Maintaining Medicaid Eligibility

11100, Financial Eligibility Guidelines for Texas Home Living and Home and Community-based Services

Revision 22-2; Effective May 1, 2022

Texas Health and Human Services Commission (HHSC) requires all individuals to meet financial eligibility for enrollment in the Texas Home Living (TxHmL) or Home and Community-based Services (HCS) waiver program. After enrollment, financial eligibility must be maintained in order for the individual to continue participation in the program. Individuals eligible for certain types of Medicaid coverage are financially eligible for the program; however, not all types of Medicaid coverage ensure eligibility.

There are several ways to meet the financial eligibility requirement for the TxHmL or HCS program through Medicaid certification.

Individuals receiving Supplemental Security Income (SSI) from the Social Security Administration (SSA) are categorically eligible for SSI Medicaid.
Individuals in certain adoption or foster care cases through the Department of Family and Protective Services (DFPS) are eligible for DFPS Medicaid.
Individuals certified for Medicaid for the Elderly and People with Disabilities (MEPD), Texas Works Temporary Assistance for Needy Families (TANF) and certain other Medicaid programs HHSC are eligible.

Every individual certified for Medicaid benefits has a "coverage code" and a "type program" assigned to the individual's Medicaid record. The appropriate coverage code for participation in the TxHmL or HCS waiver program is "R" (regular Medicaid) or "P" (three months prior coverage); there are no other acceptable coverage codes. The only acceptable base plan is 13, except for individuals who receive Medicaid through DFPS, which does not have a base plan. There are several appropriate type programs for the waivers (see chart below). CARE Screen C63 (DHS Medicaid Eligibility Search) can be used to verify an individual's current and past Medicaid records.

Required Medicaid Codes and Type Program

Coverage Code	Type Program	HCS	TxHmL	Coverage Code	Type Program	HCS	TxHmL
R or P	01	√	√	R or P	18	√	√
R or P	02	√	√	R or P	19	√	√
R or P	03	√	√	R or P	21	√	√
R or P	07	√		R or P	22	√	√
R or P	08	√	√	R or P	29	√	√
R or P	09	√	√	R or P	37	√
R or P	10	√	√	R or P	44	√	√
R or P	12	√	√	R or P	47	√	√
R or P	13	√	√	R or P	48	√	√
R or P	14	√		R or P	51	√
R or P	15	√	√	R or P	61	√	√

For specific questions regarding SSI, contact your local SSA office, call 1-800-772-1213 or visit the SSA website at www.ssa.gov.

For specific questions regarding MEPD or Texas Works, contact your local HHSC office, call 211 or visit the HHSC website at hhs.texas.gov.

For specific questions regarding DFPS, call 512-438-4800 or visit its website at www.dfps.state.tx.us.

11200, Responsibility to Reestablish Medicaid Eligibility

Revision 11-2; Effective March 1, 2011

If an individual loses Medicaid eligibility, it is the responsibility of the representative payee to contact the appropriate entity to determine necessary action to reinstate benefits.

If the HCS Program provider is the representative payee, the provider is responsible for ensuring action is taken to reestablish Medicaid eligibility.

If the individual or family is the representative payee, the service coordinator will assist, if requested.

12000, Permanency Planning

Revision 22-2; Effective May 1, 2022

All user guides are published to Texas Medicaid & Healthcare Partnership’s (TMHP’s) Learning Management System (LMS). All users must create an LMS account to access the materials.

There is a sign-up link on the LMS homepage. If you need assistance with registration, contact TMHP Training Support.

12100, Resources

Revision 22-2; Effective May 1, 2022

Requirement for Local Intellectual and Developmental Disability Authority (LIDDA) to Conduct Permanency Planning

The LIDDA is required to conduct and document permanency planning for individuals under age 22 years of age who reside in an intermediate care facility for persons with intellectual disability (ICF/ID), a Home and Community-based Services (HCS) residential group home or nursing facility.

Forms and Tools

Permanency Planning forms and tools are available here.

13000, Consumer Directed Services

Revision 22-2; Effective May 1, 2022

All user guides are published to Texas Medicaid & Healthcare Partnership’s (TMHP’s) Learning Management System (LMS). All users must create an LMS account to access the materials.

There is a sign-up link on the LMS homepage. If you need assistance with registration, contact TMHP Training Support.

13100, Overview of the Consumer Directed Services Option

Revision 10-0; Effective June 1, 2010

13110 Home and Community-based Services Available Through the Consumer Directed Services Option

Revision 22-2; Effective May 1, 2022

In the Home and Community-based Services (HCS) program, the Consumer Directed Services (CDS) option is available only to those who live in their own home or family home. Individuals who receive host home/companion care, residential support or supervised living are not eligible to use the CDS option.

The HCS services currently available for the CDS option are:

Transportation-Supported Home Living (SHL)
Respite Services
Nursing Services
Cognitive Rehabilitation Therapy
Supported Employment
Employment Assistance
Support Consultation

When individuals select the CDS option, they are required to use Financial Management Services (FMS) and may access support consultation.

Financial Management Services (FMS) are provided by a Financial Management Services Agency (FMSA) chosen by the individual or legally authorized representative (LAR). FMS includes processing payroll and payables on behalf of the CDS employer. This includes serving as the CDS employer’s fiscal agent to ensure that federal, state and local employment taxes and labor and workers’ compensation requirements are implemented in an accurate and timely manner. FMS also includes orientation, training, support and assistance with and approval of CDS budgets.

Support consultation is an optional service that is provided by a support advisor and provides a level of assistance and training beyond that provided by the FMSA through FMS. Support consultation helps a CDS employer to meet the required employer responsibilities of the CDS option and to successfully deliver program services.

13120 Informing the Individual/LAR of the Consumer Directed Services (CDS) Option

Revision 22-2; Effective May 1, 2022

The service coordinator (SC) must inform an individual/legally authorized representative (LAR) of the CDS option:

at HCS program enrollment;
at the request of the individual/LAR;
at the time the individual moves out of a residential setting into his/her own or family home; and
annually if the individual is receiving supported home living or respite services.

Individuals have a choice in how their services are delivered:

Agency Option – The individual/LAR chooses to have an HCS provider deliver all of their HCS Program authorized services.
CDS Option – The individual/LAR serves as the employer of direct service providers for those services chosen to be delivered through CDS.

The service delivery option individuals select will be based on their own preferences, as discussed during the person-directed planning process. It is important to tell individuals that they may switch service delivery options at any time. If they select the CDS option, they can switch to the provider-managed option at any time. However, if an individual switches from the CDS option to provider-managed option, they must wait 90 days before switching back to CDS.

The SC offers the CDS option by reviewing the following Texas Health and Human Services Commission (HHSC) forms with the individual:

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

The purpose of Form 1581 is to introduce the CDS option. Form 1581 gives an overview of the differences between the CDS option and the provider-managed option. This form, when signed, provides acknowledgement that the SC has provided both orally and in writing an overview of the benefits and responsibilities of the CDS option in HCS.

If the individual chooses at this point to decline the CDS Option, the SC completes Form 1584, indicating the choice of the "Agency Option." The SC does not complete HHSC Forms 1582, 1583 or 1586.
If the individual wants to know more about the CDS option, the SC continues to Form 1582.

The purpose of Form 1582 is to provide more detailed information to the individual or LAR about the responsibilities assumed if the CDS option is selected. It concludes with the CDS Consumer Self-Assessment. The purpose of the self-assessment is to:

assist the individual or LAR to determine if they want to self-direct their services; and
determine what support might be needed for the individual/LAR to self-direct services.

If individuals or their LARs have difficulty responding to the self-assessment questions, they will need a designated representative (DR) to help them implement the CDS option, but it is the FMSA’s responsibility to assist them with appointing a DR.

If the individual chooses at this point to decline the CDS Option, the SC completes Form 1584, indicating the choice of the "Agency Option." The SC does not complete HHSC Forms 1583 or 1586.
If the individual wants to know more about the CDS option, the SC continues to Form 1583.

The purpose of Form 1583 is to provide important definitions of terms used with CDS. This form includes information about who can be the CDS employer, who can be a designated representative and who can and cannot be hired as an employee in the CDS option for HCS.

If the individual chooses at this point to decline the CDS Option, the SC completes Form 1584, indicating the choice of the "Agency Option." The SC does not complete HHSC Form 1586.
If the individual wants to select the CDS option, the SC continues to Form 1584.

The purpose of Form 1584 is to document the individual’s/LAR’s choice of service delivery option. If the individual or LAR is selecting the CDS option, the individual must also select an FMSA of his or her choice.

The SC will provide a list of FMSAs serving the individual’s waiver contract area. The FMSA choice lists can be found on the HHS website at https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/consumer-directed-services/how-become-a-cds-provider.

To locate FMSAs serving the individual’s area, type in the county in which the individual resides. The SC may use the list of FMSAs obtained from the HHSC data system. The SC should encourage the individual or LAR to call and interview several FMSAs before selecting one.

Important: FMSAs are not required to be located in the same town in which the individual resides. FMSAs provide FMS. This service does not require ongoing face-to-face contact. The FMSA conducts the majority of its business electronically, including via email or fax machine, with the individual or LAR, or designated representative if one has been appointed.

The purpose of Form 1586 is to provide information to the individual or LAR regarding the availability of support consultation in the HCS Program. The use of support consultation is optional. If, during the development of the Person-Directed Plan (PDP), the individual or LAR requests support consultation, this service must be included in the PDP. During the development of the Individual Plan of Care (IPC), the number of units of support consultation must be determined for inclusion in the IPC.

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 individual’s program or the CDS option;
participating in service planning team meetings at the employer’s request; and
complying with requirements of the individual’s program as related to services delivered through the CDS option.

A support advisor provides support consultation. FMSAs are required to make support advisors available if the service is authorized on the IPC. The list of HHS certified support advisors can be found on the HHS website here.

The individual or LAR may select a certified support advisor provided by his or her FMSA, or may opt to use a certified support advisor who is not associated with the FMSA.

13121 Service Back-up Plans

Revision 22-2; Effective May 1, 2022

The CDS employer (individual or LAR) is responsible for developing a back-up plan for each service that the service planning team identifies as critical to the individual’s health and safety. During the person-directed planning process, the service planning team must identify those CDS services that require a back-up plan from the CDS employer. Critical services are defined as those that would place the health and/or welfare of the individual in jeopardy if they are not provided. CDS service back-up plans are documented on Form 1740, Service Backup Plan. The SC completes the top part of the form, indicating why a back-up plan is needed for that particular service. The CDS employer completes the back-up strategies section of the form. The CDS employer’s plan must be reviewed for feasibility by the service planning team and signed by the service planning team. It is the SC’s responsibility to review a CDS employer’s back-up plan and determine whether the strategies are reasonable and viable contingencies exist in the event an individual is unable to receive a critical program service by their regular direct service provider. If the SC determines the strategies are not reasonable and viable, the SC may support the CDS employer as needed to develop a viable plan. The SC may also suggest the CDS employer consider using support consultation to assist in the development of a back-up plan. The CDS employer is responsible for providing the FMSA with the copy of each service back-up plan after it has been approved by the service planning team.

Back-up plan strategies may include both formal and informal supports. If back-up services are to be purchased from an HCS provider, the CDS employer must include such costs in the CDS budget. In addition, persons who are paid to provide back-up services must pass all criminal history and registry checks. Funds must be allocated in the individual’s budget for criminal history checks of back-up service providers.

13130 Service Planning

Revision 22-2; Effective May 1, 2022

The FMSA does not play a role in the HCS service planning process. Any change in the amount of a service delivered through the CDS option must go through the service planning process. HHSC may, at any time, request documentation to explain the basis upon which the amount of an HCS service on an individual’s IPC was determined. If HHSC requests this documentation for a service the individual or LAR has chosen to self-direct using the CDS option, the CDS employer is responsible for providing the documentation to HHSC. The CDS employer may request support from the SC to provide this documentation for HHSC.

If the individual has an HCS provider, the service planning team and the HCS provider must revise the IPC to include the change in the amount of service(s). If the individual does not have an HCS provider, the service planning team will revise the IPC to include the change in the amount of service(s). For all IPC revisions, the SC must provide a copy of the IPC to the FMSA.

In contrast, a support advisor may participate in service planning meetings if requested by the individual or LAR. A support advisor must notify the individual’s SC:

when support consultation service goals have been met;
if the person receiving support consultation is unable or unwilling to cooperate with service delivery; or
of the progress and status of the consumer-directed service required by the individual’s program.

The individual or LAR (that is, “CDS employer”) is responsible for:

ensuring that service delivery activities address the CDS employer’s goals;
developing an Implementation Plan; and
ensuring that service delivery documentation is accurate and reflects how services address the individual’s goals.

A support advisor may provide coaching in any of the areas listed above.

13140 Enrolling the Individual in the Consumer Directed Services Option

Revision 22-2; Effective May 1, 2022

To enroll an individual in the CDS option, the SC sends to the FMSA:

a completed Form 1584, Consumer Participation Choice, within five days after the individual or LAR selects the CDS option to notify the FMSA of an upcoming referral; and
a hard copy of the completed initial proposed IPC when it is transmitted to HHSC for authorization.

The FMSA needs the proposed IPC in order to conduct the required CDS orientation with the individual or LAR before services delivered via the CDS option can begin.

Several key activities must occur before service delivery begins.

The FMSA will:

explain the hiring process to the employer, including the required criminal history, registry and Medicaid exclusion checks;
ensure that the employer understands who can and cannot be hired to provide CDS services;
work with the employer to develop the draft CDS budget, which includes the hours direct service providers will work, wage rate and benefits for each employee hired and project expenditures for employer services and supports, including support consultation if included on the IPC (the draft CDS budget is based on the proposed IPC); and
explain that service delivery documentation must relate back to the goals identified and documented on the PDP.

The FMSA will need to know the number of hours of CDS services on the proposed IPC in order to assist the employer with development of the CDS budget. The FMSA conducts the CDS orientation while the proposed IPC is under utilization review by HHSC.

When the orientation has been completed the FMSA is required to notify the SC via HHSC Form 2067, Case Information. The SC files the form in the individual’s record.

Services delivered through the CDS option may not begin until:

the CDS orientation has been completed;
direct service provider eligibility has been determined and verified by the FMSA;
the service provider agreement(s) has been signed;
the CDS budget has been approved by the FMSA; and
the IPC has been authorized in the HHSC data system.

The FMSA will not allow service delivery to begin until it is notified by HHSC that services are authorized in the HHSC data system. In the event that the number of hours authorized for SHL or Respite changes as a result of HHSC utilization review, the SC will notify the FMSA of the change by sending Form 2067 to the FMSA.

13150 Entering Consumer Directed Services on the Individual Plan of Care

Revision 22-2; Effective May 1, 2022

FMSAs do not have access to enter information into HHSC data system. If the individual has an HCS provider, the HCS provider is responsible for entering into the HHSC data system the individual's IPC data, including the individual's CDS and FMSA services. If the individual does not have an HCS provider, the SC is responsible for entering into the HHSC data system the individual's IPC data, which are the individual's CDS and FMSA services.

Financial Management Services

For individuals who use the CDS option, the IPC must include FMS. FMS is authorized as a monthly service. For example, for a 12-month period, 12 units of FMS must be included on the IPC.

Support Consultation

If the individual or LAR requests support consultation or the individual's service planning team determines that support consultation would be beneficial to provide employer coaching, hours for support consultation must also be included on the IPC.

Support consultation is to be used as needed. On average, an individual may be authorized for six to nine hours of support consultation per year. It is not the type of service to be used on a weekly basis.

Note: An HCS provider is not responsible for delivering or billing for a service delivered through the CDS option.

13160 Monitoring Consumer Directed Services

Revision 22-2; Effective May 1, 2022

The SC monitors CDS services in the same manner as non-HCS services. A key monitoring role is to determine whether the individual's health and safety is at risk in the environments in which the individual receives HCS and non-HCS services and, if necessary, to take action to protect the individual's health and safety. This includes terminating the CDS option, if using CDS puts the individual’s health and safety at risk.

If the SC learns of a problem with the FMSA, the SC may report the FMSA to the IDD Ombudsman at HHSC.

The FMSA is required to provide the SC and employer quarterly reports of expenditures for each CDS service. The purpose of these reports is to determine over or under utilization of services. The FMSA will also note any areas of non-compliance with the CDS option on the quarterly report.

13170 Corrective Action Plans

Revision 22-2; Effective May 1, 2022

Based on review of the quarterly reports or a monitoring visit, the SC may request a corrective action plan from the employer. It is important to remember that it is the employer's responsibility to ensure that services are delivered, that service goals are being met and that program rules are being followed.

At the request of the SC or the FMSA, the CDS employer must develop a corrective action plan using HHSC Form 1741, Corrective Action Plan. The person requesting the corrective action plan completes the top part of the form indicating the specific reason a corrective action plan is needed (for example, over expenditure or failure to submit required documentation to the FMSA in a timely manner). The CDS employer completes the corrective action strategies section of the form. The CDS employer must provide written corrective action plans to the person requiring the plan within 10 calendar days after receiving the request. The CDS employer's plan must be reviewed for feasibility and signed by the service planning team. It is the SC's responsibility to review a CDS employer's corrective action plan to determine whether the resolution proposed in the plan represents a reasonable and viable solution to the identified problem. If the SC determines the resolution proposed in the plan is not a reasonable and viable solution to the identified problem, the SC may support the CDS employer as needed to develop a viable plan. The SC may also suggest the CDS employer consider using support consultation to assist in the development of a corrective action plan.

Corrective action plan information needs to be specific to the identified issue and identify specific strategies and time frames for improvement. The goal of a corrective action plan is to focus on needed supports to ensure the employer succeeds in using the CDS option.

13180 Termination from the Consumer Directed Services Option

Revision 22-2; Effective May 1, 2022

An individual or LAR may voluntarily request to switch from the CDS option to the agency option (see 8600, FMSA Transfer and Changing Service Delivery Option). An individual must remain with the agency option for at least 90 days before requesting to transfer back to the CDS option.

The service planning team may recommend the individual be involuntarily terminated from the CDS option. For an individual participating in CDS, the SC must recommend that HHSC terminate the individual's participation in the CDS option if the SC determines that:

the individual's continued participation in CDS poses a significant risk to the individual's health, safety or welfare;
the individual or LAR has not complied with the CDS rules in Title 40, Texas Administrative Code, Chapter 41, Subchapter B (relating to Responsibilities of Employers and Designated Representatives); or
the employer failed to implement a corrective action plan within required time frames.

To recommend that HHSC terminate an individual's participation in the CDS option, the SC:

initiates a change in the individual's service delivery option by following the activities described in Sections 8620-8660, as appropriate to the individual's situation; and
submits a written request to HHSC using Form 3611, Involuntary Termination of Consumer Directed Services (CDS) Individual Plan of Care (IPC) Cover Sheet, and include:
- a description of the service component(s) recommended for termination;
- a statement of the reasons why termination is recommended, including failure by the employer to implement the CDS corrective action plan (HHSC Form 1741, Corrective Action Plan);
- a copy of the CDS corrective action plan (Form 1741) describing the employer's attempts to resolve the issues before termination was recommended; and
- a copy of the revised IPC.

The SC will notify the FMSA (using Form 2067, Case Information) that a request to terminate the CDS option has been sent to HHSC for approval.

13190 Service Delivery Transfers from one Consumer Directed Services Agency to Another

Revision 22-2; Effective May 1, 2022

Refer to 8600, FMSA Transfer and Changing Service Delivery Option, when an individual requests to change FMSAs.

13200, Consumer Directed Services Resources

Revision 22-2; Effective May 1, 2022

CDS rules are available at: https://texreg.sos.state.tx.us/public/readtac$ext.ViewTAC?tac_view=4&ti=40&pt=1&ch=41

Additional information regarding CDS may be found at: https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/consumer-directed-services-cds/cds-training-presentations

14000, Long-Term Care Regulatory

14100, Long-Term Care Regulatory, HCS and TxHmL Overview

Revision 22-1; Effective February 4, 2022

The Home and Community-based Services (HCS) and Texas Home Living (TxHmL) waiver program providers undergo certification surveys completed by HHSC Long-Term Care Regulatory (LTCR) to ensure compliance with the certification principles located in the Texas Administrative Code (TAC). LTCR conducts initial certification and annual recertification surveys for contracts operated by program providers. In addition to these surveys, LTCR also completes residential visits for Host Home/Companion Care and three- and four-person residences in the HCS program. LTCR also reviews complaints and deaths in the HCS, TxHmL, and Deaf Blind with Multiple Disabilities (DBMD) waiver programs and follows up on abuse, neglect and exploitation (ANE) allegations related to individuals served in the HCS and TxHmL waiver programs.

14200, Home and Community-based Services Surveys

Revision 22-1; Effective February 4, 2022

In accordance with Title 40, Texas Administrative Code (TAC), Chapter 9, Subchapter D, §9.171(a), all HCS program providers must be in continuous compliance with the HCS program certification principles. (See §§9.172-9.175 and §§9.177-9.180.)

In accordance with 40 TAC, Chapter 9, Subchapter D, §9.171(d), LTCR may conduct an intermittent survey of HCS program providers at any time to ensure compliance with the HCS program certification principles.

14210 Types of Surveys

Revision 22-1; Effective February 4, 2022

LTCR conducts certification surveys of HCS program providers, at least annually, to evaluate evidence of the program provider’s compliance with certification principles.

Initial Certification Survey

After a program provider has obtained a provisional contract with HHSC, LTCR conducts an initial certification survey within 120 days after the date HHSC approves the enrollment or transfer of the first individual to receive HCS program services from the program provider under the provisional contract.

Recertification Survey

An HCS program provider's certification period is no more than 365 calendar days and must be renewed annually before the expiration of the current certification period.

The program provider must demonstrate compliance with all certification principles to be certified for another 365-day period. If the program provider is out of compliance with any certification principles, LTCR will send a final report with a list of violations to the program provider within 14 calendar days after the day of exit. The program provider must submit a plan of correction (PoC) within 14 calendar days of receipt of the report to demonstrate the actions the program provider will implement to demonstrate compliance.

Follow-Up Survey, Vendor Hold and Denial of Certification

If LTCR determines at the end of a survey that a program provider is not in compliance with one or more of the certification principles that results in a violation, LTCR will require the program provider to develop and submit an acceptable PoC. For a critical violation, the PoC must include that corrective action will be completed within 30 calendar days after the date of the survey exit conference. An on-site follow-up survey will be conducted after the 30-day period to determine if the program provider completed the corrective action in accordance with their PoC. For a violation that is not critical, the PoC must include that corrective action will be completed within 45 calendar days after the date of the survey exit conference. An on-site follow-up survey will be conducted after the 45-day period to determine if the program provider completed the corrective action in accordance with their PoC.

If LTCR determines that the program provider has not completed the corrective action or they have failed to submit an acceptable PoC, HHSC imposes a vendor hold against the program provider or denies or terminates the certification.

If a vendor hold is imposed for a program provider with a provisional contract, HHSC will initiate termination of the program provider's contract in accordance with Texas Administrative Code (TAC) §49.534, Termination of Contract by HHSC.

If a vendor hold is imposed for a program provider with a standard contract, LTCR will conduct a survey at least 31 calendar days after the effective date of the vendor hold to determine if the program provider completed the corrective action required to release the vendor hold. If the program provider completed the corrective action, HHSC will release the vendor hold. If the program provider has not completed the corrective action, HHSC will deny or terminate the certification.

See 40 TAC, Chapter 9, Subchapter D, §9.183, Program Provider Compliance and Corrective Action.

Intermittent Surveys

Intermittent surveys are always unannounced and conducted at the discretion of LTCR. These surveys are based on:

complaints;
follow up to abuse, neglect or exploitation (ANE) allegations;
deaths;
ANE Trending Report;
residential visits; or
internal HHSC referrals.

14220 Overview of the Home and Community-based Services Certification Survey Process

Revision 22-1; Effective February 4, 2022

LTCR may conduct unannounced certification surveys or on-site visits at any time.

When the survey team lead contacts the HCS program provider of an upcoming initial certification or recertification survey, the team lead will send a copy of the Provider Information Request form to the program provider.

The team lead will also send Form 8576, Individual Profile Information, to the HCS program provider with a date for the information to be completed and returned to the survey team lead.

Entrance Conference

At the beginning of every initial or recertification survey, the LTCR survey team will conduct an entrance conference with the program provider and any program staff who are present. The LTCR survey team lead will explain the survey process.

The survey team will review a sample of 10% or more of the individuals in the HCS program provider's contract. The team uses standardized checklists to ensure that all principles are reviewed for compliance. These checklists can be found on the HCS Provider Portal.

Certification survey activities include, but are not limited to:

interviewing individuals, family members, Legally Authorized Representatives (LARs), service providers and staff;
visiting residences and day habilitation sites;
reviewing individuals' records (including medical records);
reviewing personnel and staff training records;
reviewing financial records of the individuals for which the program provider handles finances;
reviewing complaint information, satisfaction surveys and Consumer Advocate Advisory Committee (CAAC) meeting minutes;
reviewing information regarding any deaths, discharges (permanent or temporary) and allegations of abuse, neglect and exploitation;
reviewing fire drills and emergency evacuation plans, as well as four-person residence approvals and fire marshal inspections for four-person residences; and
reviewing critical incident data, restraints and restrictive behavior support plans.

The survey team will hold a final debriefing at the end of the survey. The program provider is allowed to submit evidence to show compliance prior to the exit conference.

Exit Conference

LTCR conducts an exit conference at the end of all surveys, at a time and location determined by HHSC. LTCR gives the program provider a written statement of concern, Form 3701, Preliminary Findings Based on Survey, Inspection or Investigation, at the exit conference.

Note: If the survey team identifies an immediate threat, the program provider is expected to immediately provide the survey team with a plan of removal. If the immediate threat cannot be eliminated, HHSC will deny certification and coordinate with the local intellectual and developmental disability authority (LIDDA) for the immediate provision of alternative services for the individuals.

Informal Dispute Resolution

If a program provider disagrees with the survey results, they may request an informal dispute resolution (IDR). The IDR process is an informal process by which a program provider can dispute, before an independent third party, the findings on which a violation is based. The outcome of the IDR serves as the independent third party’s recommendation to HHSC regarding the program provider’s compliance or noncompliance with program rules. Information about the IDR process is found in Provider Letter 2021-07.

Note: The program provider must still submit an acceptable PoC no later than 14 calendar days after receiving Form 3724, Statement of Licensing Violations and Plan of Correction, from HHSC even if the program provider chooses to use the IDR process.

14230 Plan of Correction (PoC)

Revision 22-1; Effective February 4, 2022

Within 14 calendar days after receiving the final survey report, the program provider must submit a PoC to address each violation that was identified during the survey. This applies even if the provider disagrees with the findings of violations or requests an informal dispute resolution (IDR).

For violations that are critical, the PoC must include the corrective action(s) the program provider will take for each violation. The PoC must also have a completion date within 30 calendar days from the survey exit date.

For violations that are noncritical, the PoC must include the corrective action(s) the program provider will take for each violation. The PoC must have a completion date within 45 calendar days from the survey exit date. HHSC will review the PoC and the program provider will be notified in writing whether the plan has been approved or denied. If the plan is denied, the program provider must submit a revised plan within five business days of request for a revised PoC. Once the plan is approved, HHSC will request that the program provider submit evidence of the correction to HHSC and HHSC may conduct a follow-up survey to verify the corrections.

14300, Texas Home Living Certification Surveys

Revision 22-1; Effective February 4, 2022

In accordance with 40 TAC, Chapter 9, Subchapter N, §9.576(a), all TxHmL program providers must be in continuous compliance with the TxHmL Program certification principles. (See §§9.578-9.580 and §§9.584-9.585.)

Per 40 TAC, Chapter 9, Subchapter N, §9.576(d), LTCR may conduct an intermittent survey of TxHmL program providers at any time to ensure compliance with the TxHmL program certification principles.

14400, Residential Visits

Revision 22-1; Effective February 4, 2022

Effective Sept. 1, 2009, the 81st Texas Legislature, Regular Session, required HHSC to conduct annual unannounced inspections of HCS three- and four-person residences. In accordance with 40 TAC, Chapter 9, Subchapter D, §9.171(k), HHSC LTCR conducts annual unannounced visits to each residence in which Residential Support Services or Supervised Living is provided and may conduct unannounced visits to each residence in which Host Home/Companion Care services are provided. These visits are completed to verify that these residences offer environments that comply with Form 3609, Waiver Survey and Certification Residential Checklist.

14410 Residential Visit Policy and Procedures

Revision 22-1; Effective February 4, 2022

Upon arrival at the residence, LTCR staff will present their HHSC identification to the Host Home/Companion Care provider or the staff at the three-person or four-person residence and explain the reason for the visit. If the LTCR staff arrives at a residence in which no one speaks English and the LTCR staff is unable to speak the language of the people living in the residence, the LTCR staff member will secure interpreting services through HHSC to assist with interpreting for the Host Home/Companion Care provider or staff at the three- or four-person residence.

See Information Letter 2009-99 at: https://www.hhs.texas.gov/sites/default/files/documents/providers/communications/2009/letters/IL2009-99.pdf.

LTCR staff use Form 3609, Waiver Survey and Certification Residential Checklist, to conduct each residential visit. Each item on the checklist will be marked pass, fail or not applicable (N/A). Some of the checklist items require interviewing the supervised living staff, residential support staff or the Host Home/Companion Care service provider to assess knowledge of the specific needs of the individual(s) in the residence and to confirm training on areas such as abuse, neglect and exploitation (ANE), emergency plans, medications, behavior support plans and other required service provision areas.

LTCR staff may take photographs to substantiate identified concerns, when appropriate.

Provider Letter 2020-01 provides information for how the Host Home/Companion Care provider or HCS provider can give feedback about a residential visit.

If the Address in the HHSC Data System is Invalid

If LTCR staff arrive at a residence that is no longer associated with the HCS program, or cannot find the address provided for a location code in the HHSC data system, LTCR staff will fill out Form 3609 noting the incorrect address. A letter notifying the program provider of the inaccuracy in the HHSC data system will be sent to the program provider.

If No One is Home

If LTCR staff finds no one at the residence after two attempts to visit, LTCR staff contacts the program provider to find out when the residential service provider is most likely to be home. LTCR staff may call Host Home/Companion Care service providers to verify times of the week that they will be available for a residential visit.

If LTCR Staff are Not Allowed to Access the Residence

If LTCR staff are not allowed access to a three-person or a four-person residence or a Host Home/Companion Care residence, LTCR staff will notify the program provider for a resolution. It is the program provider's responsibility to ensure that regular or contracted employees cooperate with the residential visit process.

14411 Residential Visit Results

Revision 22-1; Effective February 4, 2022

Calculating the Score from a Residential Visit

A program provider receives a score as a result of a residential visit.

A program provider’s score for a visit is calculated by deducting the following from 100 points (the total points on the Residential Review Checklist):
- the total points for items on the checklist that are marked “fail” during the visit; and
- ten points for each significant risk identified during the visit.
The value of each item on a checklist is calculated by dividing 100 points by the number of items on the checklist that are applicable to the visit.

Example: A residential visit of a program provider is conducted, and there are 30 items on the checklist that are applicable to the visit. During the visit, three items on the checklist are marked “fail,” and two significant risks are identified.

The value of each item on the checklist is calculated as follows:
- 100 points ÷ 30 applicable items = 3.33 points/item
The program provider’s score is calculated as follows:
- 100 points – [(3 items marked fail x 3.33) + (2 significant risks x 10)] =
- 100 – [9.99 + 20] =
- 100 – 29.99 =
- 70.01 (Score)

No Evidence of Correction Required and No Follow-Up Action Taken

If a program provider has no items marked “fail” on the Residential Review Checklist, LTCR does not require evidence of correction (EoC) to be submitted and does not conduct follow-up activities.

No Evidence of Correction Required but Follow-Up Action Taken

If a program provider receives a score of 90 or above and there is no significant risk identified during the residential visit, LTCR does not require an EoC to be submitted. At the next residential visit, LTCR examines the items marked “fail” at the previous visit and requires an EoC for any of those items that have not been corrected. If the program provider does not submit an EoC as required, or LTCR does not approve the EoC, LTCR may conduct an intermittent survey in accordance with 40 TAC §9.171(l).

Evidence of Correction Required

If a program provider receives a score below 90 or there is an identified significant risk, LTCR requires an EoC for all items marked “significant risk” or “fail.” LTCR also requires the program provider to take action for an identified significant risk, as described below. If the program provider does not submit an EoC as required, or LTCR does not approve the EoC, LTCR may conduct an intermittent survey in accordance with 40 TAC §9.171(l)(4).

A program provider must submit an EoC to LTCR using the WSC Portal or by submitting Form 1573, Residential Review Evidence of Correction. If using Form 1573, the Residential Review ID must be listed on the form with accompanying evidence. The time frame to submit the EoC is included in the documentation received by the program provider. LTCR will not accept an EoC without the correct Residential Review ID.

Significant Risk Identified

A significant risk is an act or failure to act by the program provider that could have a major adverse effect on the health, safety or welfare of one or more individuals, including emotional or physical harm, or death. If LTCR determines that an item marked “fail” on the Residential Review Checklist results in a significant risk, LTCR requires the program provider to take action.

If LTCR concludes that the significant risk requires immediate corrective or mitigating action, such as locking up hazardous chemicals or securing a copy of the residence’s emergency plan, LTCR staff will not leave the residence until the program provider has taken immediate action and the significant risk is removed.
LTCR will also contact the persons identified in the HHSC data system as the “program provider contract contacts” (the HCS provider or a representative of the HCS provider) and informs such persons of the date, as determined by LTCR, by which the program provider must submit evidence of correction showing that action has been taken and the significant risk removed.

14500, Death Reviews

Revision 22-1; Effective February 4, 2022

See also 17000, Critical Incident and Death Reporting.

In accordance with 40 TAC, Chapter 9, Subchapter D, §9.178(r), and 40 TAC, Chapter 9, Subchapter N, §9.580(l), HCS and TxHmL program providers must report the death of an individual in their program to HHSC and the service coordinator by the end of the next business day following the death or the program provider's learning of the death. Form 8493, Notification Regarding a Death in HCS, TxHmL and DBMD Programs, must be faxed to LTCR at 512-206-3999 or submitted through the WSC Portal. The Risk Assessment coordinators (RACs) collect specific information regarding the death from the program provider and may request additional records, depending on the conditions existing at the time of death. The Death Review Group (DRG) meets routinely to review the circumstances surrounding each death. Additional regulatory follow up, including an on-site visit, may be scheduled to evaluate the program provider's compliance with HCS or TxHmL certification principles as the result of the DRG review.

14510 Death Review Policy and Procedures

Revision 22-1; Effective February 4, 2022

As part of the death review, the Risk Assessment coordinators (RACs) collect the following information:

Date of death;
Provider contract number and component code;
Person reporting the death, including contact telephone, email address and fax number;
Individual's identification number in the HHSC data system;
Type of setting ─ HCS, Texas Home Living (TxHmL) or Deaf Blind with Multiple Disabilities (DBMD);
Cause of death;
Date provider notified of death;
Admission date to the provider;
Dates of hospitalizations in the last three months (if applicable);
Dates of hospice (if applicable);
If the Department of Family and Protective Services (DFPS) Statewide Intake was notified;
Types of residence (Host Home/Companion Care, 3-Person, 4-Person, Own Home or Family Home);
Place of death;
Type of death (expected, unexpected, or accident);
Description of events surrounding the death; and
If an autopsy was ordered.

Information Gathering

If abuse or neglect is suspected in relation to the death of the individual, the RAC will immediately contact DFPS Statewide Intake.

Requests for Additional Information

The following records may be requested by the RAC for specified time frames, depending on the conditions existing at the time of death.

Most recent person directed plan and implementation plan(s);
Any training regarding the individual’s special needs provided to service providers;
Last two months of medication administration records;
Most current nursing assessment;
Last three months of nursing notes, physician orders and lab work;
Last three weeks of residential support services, supervised living, Community First Choice personal assistance services/habilitation, supported home living, community support or host home/companion care notes;
Last week of day habilitation notes;
State supported living center transition notes (if applicable);
Hospice notes (if applicable); and
RN/LVN names/signature sample key.

Additional documents may be requested after the initial review by the RAC nurse.

Suspicious Deaths

If any circumstances surrounding the death are suspicious, LTCR may take further actions, including, but not limited to, referral to local police departments and DFPS Statewide Intake, completion of an intermittent survey or referral to pursue contract actions. The regional director or assistant director is informed immediately of suspicious circumstances surrounding a death or if other issues of concern are noted.

Follow-up Activities

RACs may conduct a desk review based on the information received from the program provider, requested records and/or the information received from HHSC Provider Investigations (PI).

The RAC manager may recommend an on-site visit based on the circumstances of the death, information obtained from a desk review or information obtained from HHSC PI. If the survey team determines that the program provider is not in compliance with one or more of the certification principles during an on-site visit, an intermittent survey will be opened.

14600, Abuse, Neglect and Exploitation Follow Up

Revision 22-1; Effective February 4, 2022

The Risk Assessment coordinator (RAC) team receives investigative reports related to allegations of abuse, neglect or exploitation of individuals who receive HCS, TxHmL or ICF/IID program services. The reports are reviewed by RACs to determine whether regulatory follow-up is required. Additional documentation may be requested from the program provider to verify that the program provider responded to the allegation of abuse, neglect and exploitation according to program standards. In addition, an on-site visit may be scheduled.

14610 Abuse, Neglect and Exploitation Policy and Procedures

Revision 22-1; Effective February 4, 2022

The final HHSC Provider Investigations (PI) report is reviewed by RACs to determine if/or what actions need to be taken by LTCR Survey Operations. Actions to be taken are determined by:

the severity of the allegation;
the disposition of the allegation;
the concerns/recommendations of the investigator; and
indicators of noncompliance noted by the RACs during the review of the final report narrative.

HHSC sends a final report to the program provider, unless the administrator and the secondary designee are the alleged perpetrator. The program provider has 14 calendar days from the receipt of the investigation findings to notify the RACs of its response to the findings by submitting Form 8494, Notification Regarding an Investigation of Abuse, Neglect or Exploitation, in HCS and TxHmL programs, by fax to 512-206-3999 or through the WSC Portal. Form 8494 should include:

the program provider name;
contract number;
component code;
date submitted to LTCR;
who submitted the form, as well as area code and phone number and fax;
DFPS case number;
date the DFPS report was received;
HHSC data system ID number;
date of allegation;
type of allegation;
disposition of allegation;
concurrence with the disposition;
what actions were taken by the provider; and
if the provider will be requesting a methodological review or a review of the finding.

The program provider is responsible for attaching documentation when submitting Form 8494 to include a response for how the program provider handled any confirmed allegations or HHSC concerns or recommendations.

One of the following actions is taken by LTCR:

Desk review – A desk review is conducted if there is low risk to the individual(s). The determination of low risk is made if the allegation does not pose a risk to the health or safety of the individual(s) served.
On-site visit – On-site visits are conducted if it is determined that a significant risk exists for one or more individuals.

14700, Additional Monitoring Related to Risk Factors

Revision 22-1; Effective February 4, 2022

Each quarter, RACs compile a quarterly trending report for all HCS and TxHmL waiver contracts. This risk factor report includes:

number of confirmed abuse/neglect/exploitation allegations entered into the abuse/neglect database that meet or exceed 5% of all confirmed findings out of the total number of allegations for contract;
number of complaints entered into the complaint database; and
number of deaths of individuals entered into the death database.

The RACs assess the circumstances related to the identified contracts reflected in this report for two quarters in the last calendar year. If they identify patterns or trends that indicate a possible increased risk to the health, safety or welfare of the individuals in this contract, follow-up actions are taken as appropriate.

14800, Complaints

Revision 22-1; Effective February 4, 2022

The HHSC IDD Ombudsman refers complaints to the RACs when the complaint is related to noncompliance with the HCS or TxHmL certification principles. HHSC departments refer internal complaints or concerns directly to LTCR. Complaints are reviewed by the RACs and appropriate follow-up actions are identified and completed as appropriate.

14810 Complaints Policy and Procedures

Revision 22-1; February 4, 2022

If LTCR staff receive a complaint from an external complainant, the person making the complaint should be immediately referred to the IDD Ombudsman at 800-252-8154.

The IDD Ombudsman tries to resolve the complaint with the external complainant and the program provider. If the complaint cannot be resolved and it impacts the HCS certification principles, the IDD Ombudsman will refer it to LTCR. The complaint is received by the RACs, who review it to determine what actions are to be taken. The actions are determined by:

severity of the complaint; and
number and severity of other complaints received about that contract or program provider.

Actions to be taken include:

Enter the complaint into the LTCR database, for follow up on the next scheduled survey.
Desk Review – A desk review is conducted if there is low risk to the individual(s). The determination of low risk is made if the complaint did not involve issues that relate to the health or safety of the individual(s) served or if initial contact with the program provider indicates the situation has been satisfactorily resolved.
On-site visits are conducted if it is determined that significant risk exists for one or more individuals. RACs review the complaint with the RAC manager or designee prior to scheduling an on-site visit.

14900, Four-Person Residence Approvals

Revision 22-1; Effective February 4, 2022

Home and Community-based Services (HCS) providers must request and obtain approval of all four-person residences from HHSC. LTCR is responsible for reviewing and approving all four-person residence requests in accordance with 40 TAC, Chapter 9, Subchapter D, Section 9.188.

14910 Four-Person Residence Approval Policy and Procedures

Revision 22-1; Effective February 4, 2022

To obtain approval of a four-person residence, the program provider must complete the following steps:

Complete Form 8491, Request for a Four-Person Residence Approval, and send it using any of the following methods:

Email: HCSFourPersonResidenceRequests@hhs.texas.gov
Fax: 512-438-4148
Mailing address:
Texas Health and Human Services Commission
WSC Residential Survey Coordinators, Mail Code E-348
P.O. Box 149030
Austin, TX 78714-9030

Include the following information:

For a new home, enter information into the Client Assignment and Registration System (CARE) Screen C25 Provider Location Type Modification (two screens).
- Header Screen (first screen) – Enter the Component Code, Location Code, "A" for Add and press enter.
- Data Entry Screen (second screen) – Cursor will be blinking at Location Type; enter "4"; cursor will move to the next line; enter the effective date. The cursor then moves to "Ready to Add?" Enter "Y" and press enter.
Establish location in CARE Screen C24 Provider Location (for new homes only). Refer to the User's Guide for data entry questions: https://hhsportal.hhs.state.tx.us/helpGuide/Content/16_CARE/WaiverPDF/MRA%20User%20Guide.pdf (Note: The CARE User's Guide is only available for those with access to the CARE system.)
Send the following supporting documentation to HCSFourPersonResidenceRequests@hhs.texas.gov:
- Current date;
- Name of the agency;
- Contact person and area code and phone number;
- Component code and contract number;
- Location code for the residence;
- Address and county of the residence (including the ZIP code);
- Certification from the program provider that the program provider intends to provide residential support to one or more individuals who will live in the residence; and
- Written certification from the program provider that the residence to be approved is not the residence of any person except a person permitted to live in the residence, as described in 40 TAC, Chapter 9, Subchapter D, §9.153(39), relating to definitions.
A current copy of the residence’s certification as required by 40 TAC, Chapter 9, Subchapter D, §9.178(e)(1)(A), relating to certification principles and quality assurance:
- the local fire safety authority having jurisdiction in the location of the residence as being in compliance with the applicable portions of the National Fire Protection Association (NFPA) 101: Life Safety Code, as determined by the local fire safety authority;
- the local fire safety authority having jurisdiction in the location of the residence as being in compliance with the applicable portions of the International Fire Code (IFC), as determined by the local fire safety authority; or
- the Texas State Fire Marshal’s Office as being in compliance with the applicable portions of the Life Safety Code, as determined by the Texas State Fire Marshal’s Office; or
- the Texas Health and Human Services Commission (HHSC) as being in compliance with the portions of the Life Safety Code applicable to small residential board and care facilities and most recently adopted by the Texas Fire Marshal’s Office.

The program provider may ask the local fire authority to complete Form 5606, Life Safety Code Certification, to verify the inspection, if needed.

If the local fire authority refuses to inspect the residence, the program provider must ask the State Fire Marshal to inspect the residence. If both the local fire authority and the State Fire Marshal refuse to inspect the residence, a request may be made to HHSC to complete the inspection. Program providers must use Form 5604, HCS Program Provider Request for Life Safety Inspection, to request the inspection.

After initial full approval of a four-person residence, the program provider is required to maintain annual fire marshal certifications required by 40 TAC §9.178(e)(3)(A).

The HCS program provider can check the HHSC data system to see if the home has been approved.

For questions, contact HHSC Long-Term Care Regulation – HCS and TxHmL by email at HCSFourPersonResidenceRequests@hhs.texas.gov.

15000, Review of Authority

15100, Quality Oversight of Home and Community-based Services Program Local Intellectual and Developmental Disability Authority Responsibilities

Revision 22-2; Effective May 1, 2022

Texas Health and Human Services Commission (HHSC) ensures contract accountability and oversight of Local Intellectual and Developmental Disability Authorities (LIDDAs) through a variety of methods including, but not limited to, ongoing review and monitoring of the HHSC data system’s data, service encounter data, financial data and an annual Home and Community-based Services (HCS) review.

Ongoing Monitoring

HHSC conducts ongoing monitoring reviews in several areas. These activities are part of HHSC's broad oversight of LIDDA performance and include HCS authority functions. This includes review of enrollment activity, utilization review, verification of service encounter data, integrity review of service encounter data and review of financial data. Detailed information regarding HHSC requirements for LIDDAs can be found in the LIDDA Performance Contract.

Review of Requirements for Service Coordination

HHSC conducts an annual review of HCS authority functions. This review is announced and includes LIDDA requirements for HCS service coordination. The HCS authority review may result in findings cited in the HHSC LIDDA quality assurance review. This occurs if non-compliance with HHSC rules or LIDDA performance contract requirements is determined to be present, but is beyond the scope of the LIDDA requirements for HCS service coordination.

Prior to the Review

HHSC assigns a facilitator to coordinate the review activities for a given LIDDA. The facilitator drafts an announcement letter to the LIDDA executive director, which is copied to the LIDDA board chair and the LIDDA's designated contact person for coordinating the review. This letter is followed by direct communications between the facilitator and the LIDDA contact person. The facilitator sends the LIDDA contact person an authority review information and instructions packet that includes the sample of participants and forms to be completed and returned to the facilitator prior to the review.

Entrance Conference

HHSC staff conduct an entrance conference meeting at the beginning of the review. The entrance conference is between available review team members and key LIDDA staff who will be involved in the review. It serves as an opportunity to review the general agenda, provide information about the review and answer any questions.

Service Coordinator Qualifications and Training

Qualifications and training requirements for new service coordinators assigned to HCS sample participants are checked using the service coordination staff checklist.

Home and Community-based Services Participant Review

HHSC review team members perform record reviews using the HCS electronic tool. Follow-up meetings with assigned service coordinators occur at the discretion of the review team members. Review team members may also determine whether there is a need to contact participants and their legally authorized representatives (LARs).

Formal Debriefing

Throughout the review process, the review team members may point out concerns, identify potential findings, ask for additional information or seek clarification on issues. After completion of the review, the HCS Authority Review Report of Findings is drafted. A formal debriefing is held and identified items of non-compliance are shared with the LIDDA. The LIDDA is then given up to one hour following the formal debriefing to provide additional information that may alter or clear findings.

Exit Conference

After conclusion of the HCS authority review, a final copy of the HCS Authority Review Report of Findings is provided to the LIDDA. Barring a successful request for reconsideration of findings as described below, if any item is cited as "Not Met," a corrective action plan (CAP) is required.

Reconsideration of Findings

A LIDDA may request reconsideration of finding(s) of the HCS authority review based on the evidence originally submitted at the time of the review. Instructions to the LIDDA for requesting reconsideration are included at the bottom of the HCS Authority Review Report of Findings. This request for reconsideration must be submitted via email to the facilitator within 10 business days of receipt of the HCS Authority Review Report of Findings. Requests for reconsideration received later than 10 business days after the exit conference are not considered. The facilitator emails a written response to the LIDDA staff requesting reconsideration within 15 calendar days after receiving the LIDDA's request. If a revision to the HCS Authority Review Report of Findings is necessary as a result of the reconsideration, the facilitator ensures a written notification and copy of the revised report is emailed to the LIDDA contact person. If changes in the CAP requirements result, the facilitator emails a revised CAP template to the LIDDA contact person.

Amended Report of Findings

The HCS Authority Review Report of Findings is amended when the team determines that the final report shared at the exit conference contains an error. The correction is made and the corrected report becomes the Amended HSC Authority Review Report of Findings. The facilitator ensures any resulting changes in the CAP requirement are forwarded with the amended report to the LIDDA contact person with an amended CAP due date 30 days from the date of the amendment.

Corrective Action Plan

Submission of a CAP is required for any remaining items of non-compliance. The facilitator provides the LIDDA contact person with a CAP template and instructions and guidelines for completing the CAP. The CAP is due to Performance Contracts Management within 30 days after receipt of the HCS Authority Review Report of Findings. The due date for the CAP is identified on the bottom of the final draft of the HCS Authority Review Report of Findings. The facilitator coordinates HHSC review of the CAP. If a need for revision to the CAP is identified, the facilitator communicates that need to the LIDDA contact person. Any revisions to the CAP are submitted by the LIDDA to the facilitator until the review team recommends approval of the CAP by the contract manager.

Once the CAP is approved, the CAP acceptance letter is sent out.

16000, Individual Rights and Complaints

16100, Overview of Individual Rights and Services

Revision 21-1; Effective September 21, 2021

Rights Booklet and Handbook

The rights booklet, described in 40 Texas Administrative Code (TAC) Section 9.190 (e)(2) and the rights handbook, described in 40 TAC §4.117(c) may be found on the HHSC website at https://hhs.texas.gov/about-hhs/your-rights/office-ombudsman/hhs-ombudsman-publications. The booklet and handbook may also be obtained from HHSC by sending an email to OmbudsmanIDD@hhs.texas.gov.

16200, General Complaint Information

Revision 21-1; Effective September 21, 2021

Local Intellectual and Developmental Disability Authority (LIDDA)

At the time of enrollment and annually thereafter, the LIDDA must inform the applicant and legally authorized representative (LAR), orally and in writing, of the processes for filing complaints about the provision of service coordination. This must be an easily understood process for persons and LARs to request a review of their concerns or dissatisfaction. The policy must explain how the person may receive assistance to request the review, the time frames for the review and the method by which the person is informed of the outcome of that review. The LIDDA must present this policy in the language with which the individual and LAR are most comfortable.

Each LIDDA must develop a process for receiving and resolving complaints from a program provider related to the LIDDA's provision of service coordination or the LIDDA's process to enroll an applicant in the Home and Community-based Services (HCS) Program. This process must include the LIDDA's telephone number and the toll-free number to the Intellectual and Development Disabilities (IDD) Ombudsman.

HCS Program Provider

The HCS provider must publicize and make available a process for eliciting complaints. The HCS provider must maintain a record of all verifiable resolutions of complaints received from individuals, their families and their LARs, as well as staff members, service providers, Consumer Directed Services (CDS) providers, the general public and the LIDDA. The HCS provider must establish a consumer/advocate advisory committee that will solicit, address and review all complaints from individuals and LARs about the program provider's operations.

When to Call the IDD Ombudsman

The IDD Ombudsman receives complaints from individuals, family members and the general public about the care, treatment or services provided to an individual. Individuals receiving services or family members of the individual may prefer to call the IDD Ombudsman to assist in resolving an issue rather than speaking with their LIDDA service coordinator (SC) or HCS provider.

A complaint may be reported to the IDD Ombudsman by anyone by calling 800-252-8154 between 8 a.m. and 5 p.m. Monday through Friday. A complaint may also be emailed to OmbudsmanIDD@hhs.texas.gov.

Written complaints may be mailed to:

Texas Health and Human Services Commission
IDD Ombudsman
P.O. Box 13247
Austin, TX 78711-3247

Resolution of Issues Between LIDDAs and Program Providers

LIDDAs and HCS providers are encouraged to work together to resolve any issues regarding service provision.

If a LIDDA SC identifies an issue of concern regarding an HCS provider, the SC should:

discuss the issue with the HCS provider to attempt to come to a resolution;
if the issue is resolved, document the resolution;
if the issue is not resolved, file a formal complaint with the HCS provider;
if the formal complaint process with the provider resolves the issue, document the resolution; and
if the formal complaint process does not resolve the issue, file a complaint with the IDD Ombudsman.

If an HCS provider identifies an issue of concern regarding a LIDDA SC, the program provider should:

discuss the issue with the SC to attempt to come to a resolution;
if the issue is resolved, document the resolution;
if the issue is not resolved, file a formal complaint with the LIDDA;
if the formal complaint process with the LIDDA resolves the issue, document the resolution; and
if the formal complaint process does not resolve the issue, file a complaint with the IDD Ombudsman.

IDD Ombudsman Website

The IDD Ombudsman website provides useful information regarding filing a complaint. Visit the website here: https://hhs.texas.gov/idd-help.

Notification and Appeals Process (Regarding Complaints)

LIDDAs are required to develop processes for receiving complaints about the provision of LIDDA services. For the HCS Program, the LIDDA must notify individuals of the LIDDA's process for addressing concerns or dissatisfaction with service coordination, as required in TAC rules governing notification and appeal at TAC §2.46 (40 TAC, Chapter 2, Subchapter A).

State Protection and Advocacy Systems (P&A)

Public Law 106–402, 106th Congress: Developmental Disabilities Assistance and Bill of Rights Act of 2000

P&As are dedicated to promoting personal and civil rights of individuals with disabilities, including individuals with IDD. P&As are independent of service providers within the state and work at the state level to protect individuals with developmental disabilities by advocating on their behalf. P&As provide legal support to unserved or underserved populations to help them in the legal system for resolutions and systems change. In Texas, the P&A is Disability Rights Texas (DRTx) that provides legal services free of charge. The intake line is 800-252-9108 Monday through Friday, 9 a.m. to 4 p.m., or apply online at intake@DRTx.org. Individuals who are deaf or hard of hearing can call the toll-free video phone at 866-362-2851 or Purple 3 video phone at 512-271-9391.

17000, Critical Incident and Death Reporting

17100, Information Letters

Revision 21-1; Effective September 21, 2021

Home and Community-based Services (HCS) and Texas Home Living (TxHmL) providers are required to report critical incidents and any death of an HCS or TxHmL individual to the Texas Health and Human Services Commission. The following information letters discuss these requirements:

Program providers are required to report the death of an individual receiving HCS or TxHmL services to HHSC by the end of the next business day after the program provider becomes aware of the death on Form 8493, Notification Regarding a Death in HCS, TxHmL and DBMD Programs. The information letter regarding reporting deaths is Information Letter No. 12-28, Notification of the Death of an Individual.

Critical Incident Reporting

Critical Incidents must be entered in the CARE system. The following provides detailed instructions for entering this data:

Critical Incident Data Reporting for Home and Community-based Services PDF

18000, Reserved for Future Use

Revision 21-1; Effective September 21, 2021

19000, Communication

19100, Notification Between the HCS Program Provider and LIDDA Service Coordinator

Revision 21-1; Effective September 21, 2021

19200, Communication Between the LIDDA and HCS Program Provider

Revision 21-1; Effective September 21, 2021

The HCS program is dependent on a mutual understanding and respect of the individual's desires, the program provider's role in service provision, and the service coordinator's role in planning and monitoring. Building relationships and maintaining effective communication with each entity is necessary to accomplish HCS program objectives.

19210 Management Considerations for LIDDAs

Revision 21-1; Effective September 21, 2021

Provide a forum for program providers and LIDDA staff to bring forward issues and concerns. When LIDDAs and program providers are able to solve problems together, the partnership is strengthened. Relevant input can be solicited in a number of ways, including the following:

Appoint a program provider advisory group with responsibilities for problem solving.
Ensure program provider advisory group membership represent a variety of providers.
Open program provider advisory group membership to all HCS providers in the LIDDA waiver contract area, or ask for volunteers.
Select a communication forum best suited for the LIDDA (for example, local issues, size of the provider base, size of LIDDA service area, etc.).
Promote regular and relevant communication with program providers through websites or by other means.

Establish a climate of support. Each LIDDA should clearly state that its goal is to be successful in the partnership.

Avoid misunderstandings by considering program provider and individual input in the development of clear procedures and guidelines.
Identify staff that can communicate concerns and solve problems quickly.
Publish a formal complaint procedure. Additionally, develop and use more informal methods for complaint resolution.
Develop clear procedures for ensuring that problems are communicated to appropriate program provider and LIDDA staff.

Provide opportunities for program providers, families, individuals and LIDDA staff to meet and interact. These opportunities should be available not just during the program provider choice process. Following are some ideas:

Sponsor program provider fairs to give families opportunities to meet program providers face to face, and to give providers opportunities to present their unique characteristics to families.
Establish websites that allow program providers to post information about their programs.
Arrange for program provider and LIDDA staff to meet through a variety of venues (for example, open house events, informational meetings, shared training events).
Foster an understanding of program provider choice as a continuous option by inviting individuals who are currently enrolled in the HCS program to program provider fairs, open house events, etc.

Ensure a balance between listening to program provider concerns and asserting the needs of the LIDDA and individuals. A well-rounded relationship between program providers, LIDDAs and individuals should be the goal of the LIDDA.

Service coordinators should let program providers know the needs of the LIDDA and the needs of individuals.
Providers should be encouraged to let the LIDDA know their needs and the needs of their individuals.

Develop communication skills that foster good relationships between program providers and individuals. Provide basic communication skills training to service coordinators and supervisors with goals to develop:

listening skills;
recognition of barriers to good communication (for example, judging and moralizing);
compliance with simple conflict resolution rules (for example, respecting others, listening and stating others’ viewpoints); and
self-evaluation of staff performance during conflict resolution (for example, what worked and didn't work).

Implement strategies to assist service coordinators with program provider communication. Service coordinators are responsible for communicating serious concerns, as well as ongoing information. Strategies for success may include developing:

standard procedures regarding communication; and
forms with program provider input to handle categories of communication (for example, standard communication and service concerns).

19220 Helpful Hints for Service Coordinators

Revision 21-1; Effective September 21, 2021

Service coordinators must build relationships with individuals enrolled in the HCS program, families and program providers. Developing and maintaining good relationships will assist in understanding the likes and dislikes of the individual, determining needed services and ensuring the development of a mutually satisfying partnership.

Relax and be yourself.

It is part of the service coordinator’s job to get to know the individual and people who are important to the individual – including the program provider staff.
It takes time to develop relationships. Invest time with individuals and program providers to understand their needs.
Develop your own style.

Be genuine and honest in all you say and do.

Build a good reputation. Be honest, be prompt and return phone calls.
Build trust and mutual respect.
Don’t be afraid to admit mistakes – it makes you human.

Be positive.

People want to be liked for who they are.
Don’t always talk about needs – notice the unique characteristics of individuals.
Let your human side show. Understand mistakes.
Recognize what you learn from individuals, family members and program provider staff.
Respect the role of each partner.

Improve skills.

Listen more than you talk.
Attend to the person you are trying to understand by maintaining eye contact and open body language.
Reflect what you hear to ensure your understanding.

Use respectful language at all times.

Use person-first language. Refer to the individual, not a disability label.

Avoid at all costs:

Moralizing;
Criticizing; and
Giving advice.

19230 Recommended Levels of Communication Between LIDDAs and Program Providers

Revision 21-1; Effective September 21, 2021

Communication needs between LIDDAs, program providers and individuals/families differ in different areas of the state. However, it is recommended that all LIDDAs and program providers use the standardized Form 8583, Contact Information. This form ensures individuals, their families, program providers and service coordinators have accurate and current contact information for each other. The form should be completed at enrollment and updated as needed. Additionally, it is recommended that all LIDDAs have procedures in place to address the following levels of communication:

Level I — Emergency/Crisis Notification. Level I includes communication about incidents that affect an individual’s health and safety, as well as events that disrupt normal procedures of an individual’s care. This level of communication may need to occur after hours or as soon as possible during business hours, and may address the following:

emergency medical care;
behavioral crisis;
incidents that involve outside intervention (for example, police, fire, Provider Investigations, etc.); and
safety concerns that require immediate resolution.

Level II — Concerns and Changes in Service Needs. Level II includes communication between the service coordinator and program provider about an individual's issues (for example, an individual’s service array, the service provider or individual/family concerns). This level of communication will require regular meetings, as needed, and may address:

service outcomes;
adjustment to the individual’s service array (Individual Plan of Care, Person-Directed Plan);
level of need/level of care (ID/RC assessment);
individual, LAR or family concerns;
service planning meetings (with individual, LAR and family consent);
meetings between providers, LAs and/or families to resolve issues;
adjustment/change to Implementation Plan; and
staff changes that affect/change an individual’s service providers.

Level III — Relationships. Relationship building, courtesy and mutual cooperation should be an ongoing process that starts during transition and continues on a broader scale after program implementation.

20000, Reserved for Future Use

21000, Quality Assurance

Revision 10-0; Effective June 1, 2010

Quality Assurance — A Shared Responsibility

Quality assurance is a shared responsibility among all parties who have a stake in receiving, providing, coordinating, monitoring or funding services and supports for people with intellectual and developmental disabilities. Click here to see a modified version of the Centers for Medicare & Medicaid Services (CMS) Quality Framework for Home and Community-Based Services (2002). The information is used to outline this shared partnership. This framework provides a schema that focuses on person-directed desired outcomes along six dimensions by individual, provider, local authority and the Department of Aging and Disability Services (DADS). The six focused dimensions are:

Individual Access
Person-Directed Service Planning and Delivery
Provider Capacity and Capabilities
Individual Safeguards
Individual Outcomes and Satisfaction
System Performance

The framework defines quality through the delineation of desired outcomes across the six dimensions. Acquisition of these measures indicates a successful service delivery system. The challenge for the partners is to identify areas of success and areas that require additional action. Solutions must be carefully crafted to address areas that need improvement. All partners must commit to sustaining a system of service delivery that promotes and supports individuals who receive Home and Community-based Services (HCS).

Reference: CMS Quality Framework for Home and Community-Based Services

Appendices

Appendix I, Information Letter: Process for Sending Medicaid Applications to the Health and Human Services Commission

Revision 10-0; Effective June 1, 2010

An application for Medicaid coverage must be submitted to the Texas Health and Human Services Commission in order for an individual to be determined financially eligible. Details regarding submitting a Medicaid application can be found at https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/provider-portal/letters/2009/letters/il2009-100.pdf

Appendix II, Mutually Exclusive Services

Appendix III, Discovery Guide

Revision 13-2; Effective September 3, 2013

I. Overview of Discovery

Discovery is the process of listening to people and learning about what they want from their lives. It is getting to know people so that their personal outcomes, preferences, choices and abilities are understood, documented and form the foundation of planning their services and supports. Discovery is the basis for the Person-Directed Plan (PDP) and service delivery. It is an ongoing process that occurs each time the service coordinator talks to the person or those who know the person best. It is necessary to record the information learned so that it can be used when developing or updating the PDP. The service coordinator leads the discovery process, acting on behalf of the person whose services and supports are being planned.

The following core values guide the development of community supports and services for people with intellectual and developmental disabilities. These values form an essential foundation for the discovery process and service selection:

Self Determination. People should make decisions about things that affect their lives. The service coordinator supports the person in making choices. People should have information about directing their own services and supports and opportunities to do so.
Community Inclusion. People receiving services should have opportunities to lead a satisfying life – making friends, participating in preferred activities, and being involved in and valued in their community. The service coordinator recognizes the need for people to belong and examine opportunities for supporting connections.
Meaningful Relationships. People receiving services need opportunities to develop close relationships with others, maintain the relationships they have, and form new associations with persons and groups with similar interests and purposes. The service coordinator explores and advocates for ways the person may develop relationships and associations beyond staff and other existing relationships, based on the person’s interests and desires. Barriers to creating bonds with others should be addressed.
Maintaining Non-waiver Supports. Discovery includes identifying existing natural supports, such as supports provided by friends, family or others that are not to be replaced by paid services. The loss of these supports could leave the person without meaningful relationships or community connections. Non-waiver supports also include generic services and resources (e.g., the Department of Assistive and Rehabilitative Services (DARS), public education, Day Activity and Health Services, the Comprehensive Care Program, state plan Medicaid services, etc.) that must be used prior to accessing waiver services.

Building a trusting relationship is the means by which the service coordinator discovers what is important to the person. The following should be demonstrated when building relationships:

A caring attitude, interest in the person and respect for the wishes of the person and family.
Willingness to spend time with the person. When first supporting someone, the service coordinator often sees the person at least once a month to give sufficient time to get to know him/her.
Finding the positive and building on talents. Everyone wants to be liked for who they are. The service coordinator should not always focus on the person’s needs, but rather build the person’s confidence and self-esteem.
Ability to be trusted. Following through with promises is important to people and their families. Honor the individual’s request not to share private information. Trust will help the person to open up and talk about his/her life.
Willingness to admit mistakes.

Communication, listening and observation skills are indispensable for a service coordinator. These skills are needed when conducting discovery, facilitating meetings and when interacting with people receiving services, their families, providers and other community organizations (including the service coordinator’s own agency).

The best environment for a conversation about a person is a comfortable place without noise and distractions. Privacy must be maintained when discussing personal information. When the person is present, speak directly to the person. When other people are engaged in the conversation (including interpreters), be sure to look at the person who receives services so that you can see his/her reaction to the discussion through his/her facial expressions and body language.

It is important to engage different people in different ways to accommodate individual ways of communicating. Learning about a person’s communication abilities, including whether a person uses a communication device, is important when arranging a time to talk. It is also important to allow enough time to accommodate a person who communicates slowly or may require frequent breaks to remain engaged. Identifying preferences ahead of time, such as convenient times or days, may help guide successful questions and conversation.

Starting Conversations. Introduce yourself and explain the purpose of the visit (as obvious as this seems, it is often overlooked). Conversations with people receiving services can be started in many ways, depending on the interests and preferences of the person. Sometimes it may be necessary to start a conversation about an activity the person is interested in or participated in recently. A conversation may be started by asking about an item that belongs to the person or is present in his/her environment. Avoid immediately diving into questions that could seem too abrupt or too personal. Possible ways to start a conversation:
- Tell me about yourself.
- Tell me about your day.
- What would you like me to know today?
- You look so happy today. What put that smile on your face?
- You look upset. Do you want to talk?
- I see a lot of pictures in your room. Can you tell me about them?
- What do you like to do?

If a person does not want to communicate, loses interest or does not have the tools necessary to communicate, ask if it would be better to come back later.

Gathering Information. Ask permission before asking personal questions. Questions should be centered on the concerns or interests of the person. You will not be able to get all important information immediately.

Many people respond to opening requests, such as:
- Tell me about your family.
- Tell me about your friends.
- I’m interested in knowing more about you.
- Tell me about your favorite things.
- Tell me about things you don’t like.

The person may have a specific issue that is dominating the conversation. Go with it and let the person feel and express himself. It helps the person to speak at his own pace. Learn to be silent, as this can also be a way to connect. If the conversation shifts away from the person, redirect the focus back to the person. If necessary, be persistent in keeping the person the center of conversation. Be careful not to ask too many questions and observe nonverbal communication to determine when the conversation needs to take a new direction.

Listening. Listening well can sometimes be challenging, but it is a critical skill in discovery. It is how we learn about people. Let people know you are listening.
- Talk to the person, not around the person, if the person is not alone.
- Ask the right questions. Avoid questions with yes or no answers that are not exploratory and do not provide opportunities for people to express themselves.
- Allow adequate time for the person to respond.
- Reflect back the last statement you heard.
- Paraphrase and sum up what you have heard during the conversation
Observing and Nonverbal Communication. If a person is able to effectively communicate through conversation, discovery is often easier. However, a great deal can also be learned through nonverbal communication.
- Body language often provides information about what a person is thinking or feeling.
- Some people may use gestures, behavior or other means of getting their point across. Help may be needed from family or others who know and care about the person to interpret and learn from what he/she is saying.
- Conversation can distract from nonverbal communication of feelings and emotions.
- Some behavior may be a request for help or attention.
- Facial and eye expressions provide much information – trust, affection, disapproval, sadness, pain, discomfort, fear, awareness, interest, joy, concern.
- Eye contact is important communication and shows respect.
- Clothing, grooming, and environment may tell a lot about the person’s life. It is especially important to visit people at their home and in other environments.

Identifying personal outcomes is the focus of service planning and must be informed by meaningful discovery. It is important for everyone to make plans in order to achieve the outcomes they desire. People need to dream about their future and how they can achieve what is important to them. When talking with a person or gathering information:

Allow the person to dream big. Don’t discourage the person from dreaming about his/her future, but explain how to break dreams into attainable short-term outcomes.
The person’s outcomes must be clearly identified so that service providers and natural supports can assist the person to achieve them.
Barriers should be recognized and the service coordinator should help the person identify ways to resolve or work around the barriers.
When a service coordinator learns about outcomes, he/she should think about possible methods of achieving these outcomes. Outcomes may be met with assistance from family members, friends, community resources, generic service agencies or waiver services. The service coordinator is responsible for looking for alternative solutions, in addition to considering waiver services.
Be positive. Reflect the outcomes in positive ways. Represent the person.
Ensure health and safety. The service coordinator should gather existing information necessary to identify safety or health issues. The service provider should assist the person with addressing those needs. Health and safety outcomes must not be ignored and the person should be assisted in understanding the importance.
The service coordinator asks permission from the person or legally authorized representative to include service providers in the discovery process. The provider may have day-to-day experience with the person and should be considered a significant source of discovery information to identify outcomes.
Involve other allies identified by the person.
Recognize that the outcomes may change as the service coordinator learns more about the person.

II. Using the Discovery Guide

This Discovery Guide is intended to support learning about what is important to the person and what others need to know to support the person for each person who receives services and supports. It is designed as a guide for exploration. The service coordinator supports a meaningful discovery process by helping people to speak for themselves, each in his or her own way about his or her own dreams and outcomes. The service coordinator encourages those present to listen and learn about what people want.

Examples offered in the Discovery Guide are intended to inspire thinking about the types of information that are important in creating true PDPs. They are only examples and while some may be relevant to a particular individual, information gained from the person and those close to the person will yield individualized results.

Gathering important information for those who support and assist the person. The service coordinator documents information that will be helpful for the service provider to know when providing services and supports to the person. This includes a broad profile of the person and important matters in his/her life based on observations, discussions and other relevant information. This information includes:

The people, places and things that give the person happiness, contentment and satisfaction, in the present and in outcomes and dreams for the future.
What people like and admire about the person. Sometimes this may take effort to learn because people are not always accustomed to talking about attributes. Notice the good things about the person and encourage him or her to recognize his or her own strengths and positive attributes.
Background experiences that affect the present. Record events such as milestones, celebrations, institutionalization, losses, trauma, etc. that affect the person today.
Who helps the person make important decisions? Who is a reliable source of information? Who does the person feel closest to? Who else does the person want to have involved in discussions and decisions? If the person is isolated or only talks about staff, it may be a sign that the person needs other relationships and connections. If the person has a guardian, ask if he or she is included in decision making and how.
Preferences for social inclusion and alone time. Don’t assume that every person wants to be social all the time. Some people like having many friends; others prefer only a few close relationships. Personal relationships are very important to most people.
Safety issues. Think beyond just supervision, even though that is important. Evaluate whether the environments where a person spends his/her time are healthy and safe. Observation is as important as asking questions. Consider what supports the person needs to be safe, e.g., adaptive aids, caregiver capacity, preparation for emergencies, etc.
Health issues. Document health issues that concern the person. Detailed health information will be reflected in the health assessments completed by the provider.

Identifying services to support outcomes. The service coordinator identifies services that support the person’s outcomes. Based on the information gathered during discovery, the service coordinator:

Identifies the services that will support the outcomes.
Explains the purpose and outcome of the service (what will the person gain from the service?).
Identifies what is important to the person and what others need to know and do to support the person so the program provider can use this information to design the implementation plan.

The examples below are meant to give service coordinators a general idea of how to use information gathered through the discovery process to identify services to support personal outcomes.

Example 1: Purpose/Outcome. What does the person want?

The person wants to join a choir.
The person wants to go to the singles class at church.
The person wants to take a class at the community college.
The person wants to take a vacation to Disneyland.

A possible support for these purposes/outcomes could be a person’s family or friends. An action plan is not needed unless a Home and Community-based Services waiver service is supporting the person to achieve the outcomes.

Example 2: Purpose/Outcome. What does the person want?

The person needs a safe place to be during the day.
The person enjoys being around other people and making friends.
The person wants to develop or reinforce a skill (educational skills, specialized therapies, socialization skills or other adaptive skills).

A possible waiver service to support these purposes/outcomes could be day habilitation.

The following information learned during the discovery process would be important to the provider of day habilitation services:

Important To. Information about preferences that are related to the service or the environment where the service will be delivered. This should help the provider to ensure a good experience for the person. Examples of areas related to quality of life issues:
- The person wants to sit next to friends so he can visit with them.
- The person wants to have frequent breaks so that he can walk around the building, get a drink of water and talk to people in other areas.
- The person likes to eat meals at the same time each day.
- The person likes to exercise.

What Others Need to Know and Do to Support the Person. Information about what others think is important for the day habilitation staff to know. Examples of information that often relate to communication or health and safety:
- When the person starts to fidget, he often wants to take a break.
- The person must take medication during the hours he receives day habilitation.
- The staff must be trained to identify symptoms of high and low blood sugar.
- The person does not have safety skills when working with equipment or machinery.
- The person requires support to leave the building alone.
- Transportation provider requires staff to be available to meet the van upon arrival to day habilitation services and to accompany the person to the van when leaving.

Example 3: Purpose/Outcome. What does the person want?

The person wants to get a driver license and needs help learning the Driver Handbook.
The family has requested assistance with the person’s grooming.
The person wants to explore recreational opportunities in his neighborhood and learn how to ride public transportation to these events.
The person needs transportation to attend classes.
The person wants to become her own payee and needs training on money management.
The person needs help to shop for groceries.
The person wants to improve abilities to do housekeeping tasks independently.

A possible waiver service to support these purposes/outcomes could be supported home living.

The following information learned during the discovery process would be important to the provider of supported home living services:

Important To. Information about what the person prefers about staff, schedules, criteria for providers to make a good match with staff, etc. Examples:
- The person wants to work with female staff because she does not want a male to assist her with personal hygiene.
- The person prefers that staff only come on Tuesday mornings because she is involved in other activities the rest of the week.
- The person wants to interview and select any staff that will be coming to her home.
- The person wants staff to call when they are on the way or if they are not able to make the appointment.
- The person likes to be 10 minutes early to appointments.
What Others Need to Know and Do to Support the Person. Information about what is needed to ensure safety, health and well-being. Examples:

- Due to the medication she takes, the person must drink plenty of water.
- The person must have a backup plan if the assigned supported home living staff are unable to work to ensure the person receives adequate assistance during evening hours.
- The person must be carefully supervised when crossing the street or in other non- safe environments.
- The person needs supervision at all times when outside his/her home.
- The person is unable to regulate water temperature and has been burned in the past when left to bathe without assistance.
- The person will eat too fast if not prompted to eat slowly.

Example 4: Purpose/Outcome. What does the person want?

The person wants to eventually live alone but needs skills training in the areas of safety, money management and meal planning/preparation.
The person enjoys living with a family.
The person likes the foster/companion care (FCC) provider and wants to live with him/her.
The person wants to learn how to ride the public transportation system.

A possible waiver service to support these purposes/outcomes could be FCC.

The following information learned during the discovery process would be important to the provider of FCC services:

Important To. Information to help a provider in selecting the type of home, staff characteristics and supporting daily routine preferences. Examples:
- The person likes to sleep late on weekends.
- The person wants to remain close to his family’s home in the west part of the city.
- The person does not like to be around people who smoke.
- The person wants his own bedroom.
- The person wants a long-term provider.
- The person does not like animals.
- The person wants a family that would allow him to keep his pet hamster.
- The person wants to attend church.

What Others Need to Know and Do to Support the Person. Information about general health and safety issues. Examples:
- The FCC setting should be within close proximity to the person’s family.
- The staff should be fully aware of medical issues that are included in the Comprehensive Nursing Assessment.
- The FCC provider should be available on-site any time the person is in the home.
- The person has difficulty independently working kitchen appliances.
- The FCC provider should receive training from the occupational therapists and physical therapists regarding how to support therapy.
- The FCC provider should be aware of and follow behavioral guidelines prepared by the provider of behavioral supports.
- The person’s blood sugar levels must be checked in the morning and evening.

Example 5: Purpose/Outcome. What does the person want?

The person wants to express his opinions without yelling.
The person wants to be able to calmly ask others to leave his room.
The person wants to continue living with his family.
The person wants friends and is finding it difficult to keep them.
The person wants a better relationship with his family.
The person wants to not feel lonely.

A possible waiver service to support these purposes/outcomes could be behavioral supports.

The following information learned during the discovery process would be important to the provider of behavioral supports:

Important To. Information to help staff understand what the person experiences as positive situations or negative situations. Examples:
- The person likes to be asked (not told) to complete a task.
- The person likes to be busy.
- The person wants more friends and more fun.
- The person likes privacy.
- The person likes to take a break when faced with stressful situations.
- The person does not like others taking or handling his possessions.
- The person likes to be on time to his art class.
- The person likes having friends and family, and likes to be in touch with them frequently.
- When stressed, this person likes to talk to his best friend on the phone.
What Others Need to Know and Do to Support the Person. Information about supporting the person’s positive behavior. Examples:
- The family has noticed that the person becomes more stressed when he is in a loud environment, is bored or the activity is too difficult.
- Staff should remind the person to take deep breaths when trying to express his emotions.
- Staff should remind others living in the home to knock on the person’s bedroom door before entering.
- It is important for the person to have a safe place for his special belongings. He becomes very angry when they are lost.
- Each morning, staff should tell the person what is planned for the day.
- Staff must take the time to listen to what the person is trying to communicate.

Example 6: Purpose/Outcome. What does the person want?

The person wants to have supports at work.
The person needs to keep his job but needs some additional training. DARS is no longer available.

A possible waiver service to support these purposes/outcomes could be supported employment (SE).

The following information learned during the discovery process would be important to the provider of SE:

Important To. Information about preferences for how SE will be delivered. Examples:
- The person likes to perform tasks as independently as possible.
- The person would like to work mornings rather than evenings.
- The person prefers to speak Spanish.
What Others Need to Know and Do to Support the Person. Information about supports necessary for success and well-being. Examples:
- It is important for the SE staff to be aware of signs and symptoms of seizures.
- It is important for the SE staff to support and reinforce the person’s work schedule.
- It is important for the SE staff to arrive at the work site at the same time as the person.
- It is important for the SE staff to ensure that the person takes his medication during the work day.
- It is important for the person to arrive to work on time.
- It is important for the SE staff to teach the person work-related conduct and expectations (e.g., call if you are ill or will be late, dress for the job, etc.).

The service coordinator develops the PDP using the information gathered from the discovery process.

Example 7: Purpose/Outcome. What does the person want?

The person wants to interact with others.
The person wants to be able to talk.
The person wants a mobile device to help him communicate.
The person wants the freedom to come and go without assistance.

A possible waiver service to support these purposes/outcomes could be adaptive aids.

The following information learned during the discovery process would be important to the provider of adaptive aid services:

Important To. Information about preferences that are related to the adaptive aids to be used should help the provider to ensure a good experience for the person. Examples of areas related to quality of life issues:
- The person wants a small, lightweight speech device that is durable.
- The person wants to choose the voice that the speech device uses.
- The person wants access to the speech device at all times.
- The person wants to go places whenever he wants without assistance.
What Others Need to Know and Do to Support the Person. Examples of information important for the staff to know:
- It is important for staff to offer only the amount of assistance requested.
- It is important for staff to be patient.
- It is important that the speech device be received quickly and programmed according to the person’s wishes.
- It is important that the speech device and electric wheelchair be charged and well maintained.

As a service coordinator gets to know a person, it will become apparent what is important to the person regardless of where he/she is, what he/she is doing, who is supporting him/her, and what others need to know and do to support him/her, regardless of the setting. The information that is not specific to a setting or a service are collected and included in the One-Page Profile of the PDP. The important to and the what others need to know and do to support the person information that is specific to a service is included in the Pertinent Information section of the PDP action plan for that service.

Appendix IV, Discovery Tool

Revision 13-2; Effective September 3, 2013

I. Introduction

The Discovery Tool is not intended to serve as an interview tool. Discovery is an ongoing process rooted in supportive relationships developed between service coordinators and the people they support. This optional tool can be used to suggest exploration and organization of information critical to completion of Form 8647, Service Coordination Assessment – Intellectual Disability Services. While the prompts in this tool may be useful to the Person Directed Plan (PDP) Discovery process, it should not be considered all-inclusive, exhaustive or as a substitute meaningful discovery. While service coordinators generally use ongoing face-to-face discussions, record reviews and communications with family members and staff (who know the person best) to gather discovery information. Appendix III, Discovery Guide, offers information and instruction for carrying out a robust, ongoing discovery process.

Person’s Preferences for Planning Activities

Person’s Communication Style:

How does the person communicate (gestures, sounds, facial expressions, adaptive equipment, etc.)? What is the best way to determine if the person is expressing satisfaction/happiness/comfort/agreement as opposed to dissatisfaction/unhappiness, discomfort/disagreement?
Among those who know the person best, who seems better able to interpret what the person is trying to communicate?
What is the best way for others to learn how to communicate effectively with the person?

Person’s Resources for Support Planning and Service Provision:

Participants/Support Planning Team (SPT): Who does the person/legally authorized representative (LAR) wish to directly involve in support planning? Note: The person can be anyone, including provider staff.

Name	Relationship to Person	Contact Address and Phone	Preferred Method for SPT Member to Participate in the Person’s Planning (personal availability, phone availability, etc.)

SPT Involvement: What would be the person’s/LAR’s reaction to participating in meetings or group planning activities via phone or other remote methods?
Service Coordinator Involvement: Is the person/LAR comfortable with the service coordinator independently contacting involved people to explore the person’s preferences and outcomes?
Places: Where is the person/LAR most comfortable when participating in planning activities such as PDP reviews or Individual Plan of Care (IPC)/Implementation Plan (IP) reviews? What would be the person’s/LAR’s preference for an alternate or backup location?
Times: What is the person’s/LAR’s preference regarding the time or day that he or she wants to participate in planning activities?

Information Specific to the Consumer Directed Services (CDS) Option

What is the person’s/LAR’s understanding of his/her freedom to choose a comprehensive provider or to personally direct provision of certain specified services?
What additional information does the person want about CDS?

Discovery Information Related to Completion of the Service Coordination Assessment

Preferences for Living Environment – Always include a summary of discovery information that justifies conclusions:

Where and with whom does the person currently live?
How closely does the current living situation align with the person’s priorities/wishes?
- What location meets the person’s preference (city/locale)?
- What kind of living environment does the person prefer (group living arrangement, alone, roommate, own apartment, with family, etc.)?
- If group living is the preference, does the person like having his/her own bedroom or sharing with a roommate?
- What factors does the person/LAR prioritize when considering the choice of a place to live (e.g., proximity to family/work/public transportation/shopping/school, availability of supports to teach the person critical skills related to living in his/her environment, affordability, etc.)?
Are there any personal issues that might present risk for harm in the person’s living arrangement (e.g., daily rituals, threats of suicide or physical harm to self or others, inability to handle a personal crisis)? What supports are needed to address these risks (increased personal supervision, limited proximity, etc.)? Is the person currently receiving these supports?
Does the person live, work and pursue leisure activities in integrated environments that are safe? If not, what are the specific issues presented to the person by these environments (e.g., sanitation issues within environments, physical hazards such as inaccessibility, toxic substances, hot water, lack of safety equipment such as fire extinguishers, smoke detectors, door peephole, inability to use safety equipment and pedestrian safety skills)?
Does the person know how to respond in an emergency situation such as fires, hazardous weather, natural disasters, illness, injury or threat of bodily harm? Does the person need support to ensure safety in emergency situations?
Does the person need any modifications to the living environment to ensure safety/health/access needs are met (e.g., ramps, doors, doorways, bathroom modifications, etc.)?
Does the person need any additional equipment (personal or environmental) to support accessibility and safety within any frequented environment (e.g., mobility devices, switches, lifts, etc.)?
Does the person require specialized therapies (dietary, occupational therapy, physical therapy, speech therapy, nutrition, postural supports, food-texture modifications, psychological counseling, behavioral supports, etc.) to support safe access to preferred activities and environments?
When the person receives supports, are there any specific characteristics that must be considered to honor the person’s preferences (e.g., male as opposed to female staff for certain activities, a preferred staff person for implementing services, preference for adaptive equipment transfers as opposed to personal transfers, soft-spoken interaction as opposed to loud voices, information that should be given in advance regarding upcoming changes in the person’s routine, etc.)?

Preferences for Financial Security – Always include a summary of discovery information that justifies conclusions:

What financial resources are accessible to the person (review assets, sources of income as well as insurance coverage)?
Does the person have adequate financial resources to meet his/her priority needs and preferences (food, shelter, medical and prioritized leisure activities)?
What support does the person receive in managing his/her financial resources (e.g., parent/other serves as representative payee, a guardian appointed to manage financial affairs, etc.)? Include all supports: non-Home and Community-based Services (HCS)/natural or HCS.
Describe any additional supports necessary to assist the person in addressing financial security/obligations.
Is the person interested in acquiring additional knowledge, skills or abilities to increase control and choice regarding financial security? In which areas is he/she most interested?

Preferences for Physical/Emotional/Behavioral Health – Always include a summary of discovery information that justifies conclusions:

Physical/Emotional or Behavioral Health Concern (List all concerns, diagnoses, routine procedures, including dental.)	Name/Specialty of Healthcare Professional Currently Addressing the Concern, if Applicable	Thoroughly Describe the Intervention (medication, specialized therapy, frequency of visits, etc.)	Who is Responsible (or needs to be responsible) for Ensuring this Concern is Addressed?

What is the person’s/LAR’s preferences regarding the management of personal health?
What issues impact the person’s ability to obtain necessary interventions (e.g., does not understand most medical issues and required interventions, is afraid of professionals, is combative during medical procedures, is uncooperative with taking medications as prescribed, etc.)?
How does the person indicate physical distress or illness?
Is the person/LAR satisfied with current supports?
What change does the person/LAR wish to make with any of the supports currently provided?
If the person takes medication, what assistance is required to ensure that they are taken as prescribed?
If the person requires other interventions (e.g.,`positioning, nutritional management, etc.), what assistance is required to perform them?
Does the person require medically necessary supplies? What are they and how are they obtained?
Is the person interested in acquiring additional knowledge, skills and abilities that facilitate increased choice and control in meeting physical/emotional/behavioral health needs? Fully describe what the person is most interested in acquiring.

Preferences for Daily Living – Always include a summary of discovery information that justifies conclusions:

What supports are necessary to assist the person in meeting physical needs (oral hygiene, physical hygiene, using the bathroom, eating assistance, positioning, shopping, cooking, etc.)?
What supports are necessary to assist the person in maintaining possessions in the living environment (household tasks such as house cleaning, laundry, maintaining personal adaptive equipment, etc.)?
What are the person’s preferences for his/her daily routine (includes the timing of daily events, the activities he/she does and the times in which he/she does those activities, the food he/she eats, etc.)?
Is the person interested in acquiring additional knowledge, skills and abilities to increase control and choice regarding daily living? In which area is he/she most interested?

Preferences for Work and/or School – Always include a summary of discovery information that justifies conclusions:

What are the person’s preferences regarding work, education and volunteer opportunities in the community?
For a person under the age of 22, are educational/school services being provided? Where? What prioritized supports are being provided by the school? (Note: The person’s parent, teacher and individual education plan are excellent resources.) Are the school’s services reflecting the person’s/LAR’s priorities?
For a school-age person receiving educational services, explain how current HCS and non-HCS supports could enhance and support the person’s educational service.
If the person is not school age, what does the person do during the day (work, adult learning, etc.)?
What is the person’s understanding of available options in the community to address his/her preferences for work or education?
If the person expresses a preference, does the person currently possess the necessary skills, knowledge and abilities to address preferences? If not, what does the person require?
Describe the services that would best assist the person in obtaining work/educational preferences.
If the person is not interested in volunteering, working or going to school, describe what the person would like to do?

Preferences for Relationships – Always include a summary of discovery information that justifies conclusions:

Using discovery information, describe any close relationships in the person’s life (who is the individual, what is the nature of the relationship, how often does the person wish to see the individual, etc.).
Who are the person’s friends?
Is the person satisfied with the number and types of relationships in his/her life?
Is the person satisfied with the type and frequency of contact with friends and family? How do you know?
In what new types of relationships is the person interested in exploring?
Is the person interested in acquiring additional knowledge, skills or abilities to increase control and choice regarding relationships? Fully describe what the person is most interested in acquiring.

Preferences for Social Inclusion – Always include a summary of discovery information that justifies conclusions:

Is the person aware of available community-based activities? If not, describe how the person could become more aware of options.
In what community-based activities does the person actively participate (ongoing community activities such as going to movies, church, festivals or participating in clubs or other community-based organizations)?
Is the person satisfied with the type and frequency of participation in community-based activities? What other activities would the person like to do?
What activities does the person specifically dislike?
Is transportation a barrier to the person’s participation in community activities? What resources are available to assist the person with transportation?
What supports would the person require to participate in community-based activities to his/her satisfaction?
Is the person interested in obtaining new knowledge, skills or abilities related to social inclusion? Fully describe what the person is most interested in acquiring.

Preferences for Rights/Legal Status – Always include a summary of discovery information that justifies conclusions:

What rights does the person exercise (e.g., freedom of movement, accessibility, opening mail, privacy, phone calls, personal possessions, voting, exercising chosen religion, etc.)?
What rights are not exercised? If the person is not exercising those rights, what are the reasons?
- Is the person choosing not to exercise those rights? How do you know?
- If the right is being limited by support staff, describe the reason for the limitation(s).
- Did the SPT consider the limitation(s) and find that it was necessary to protect the person?
- If there are limitations, describe the supports that are in place/necessary to restore the person’s rights.
- Does the person need someone to assist in the exercise of rights (guardian, power of attorney, advocate, etc.)? If applicable, describe the supports targeted toward obtaining assistance.
Describe the person’s ability and desire to advocate for himself.
Would the person like to learn more about self-advocacy? What supports are in place/necessary to help the person learn?
Does discovery provide any evidence that the person has been abused, neglected or exploited?
If the person is still experiencing personal distress from a previous occurrence of abuse, neglect or exploitation, describe the supports the person is receiving (or needs/wants) to cope with the distress.
Is there any information regarding the person’s vulnerability to abuse, neglect or exploitation that should be shared with staff supporting the person?
Is the person interested in obtaining new knowledge, skills or abilities related to exercising rights or preventing abuse, neglect or exploitation? Fully describe what the person is most interested in acquiring.

Preferences for Other Personal Outcomes Desired by the Individual – Always include a summary of discovery information that justifies conclusions:

Using the Discovery Guide or other means adopted by your center, identify other priority personal outcomes that should be a focus (purpose) of either HCS or non-HCS supports.

Appendix V, HIV/AIDS in the Workplace

Appendix VI, Medicaid for the Elderly and People with Disabilities

Appendix VII, List of Excluded Individuals Entities (LEIE)

Appendix VIII, Advance Directives

Appendix IX, Retired Information Letters

Revision 17-3; Effective November 1, 2017

The Texas Health and Human Services Commission (HHSC) will from time to time retire Information Letters (ILs) when policy has expired, retired or been replaced with new information.

Content in this handbook and the Texas Administrative Code (TAC) supersedes any previous ILs or similar guidance published by HHSC. The ILs retired as a result are listed below. HHSC recommends that providers remove retired ILs from their records to ensure they reference the most current information. Any letters or program guidance issued prior to Internet accessibility is null and void, including policy previously sent by U.S. mail.

Number	Title	Date Posted	Date Removed/Retired
2015-24	Licensed Vocational Nurse On-Call Pilot Program Ends September 1, 2015	03/26/2015	12/22/2015
2015-20	DADS Home and Community-based Services and Texas Home Living Behavioral Support Service Provider Policy Training (Retired on December 22, 2015)	02/27/2015	12/22/2015
2015-07	Residential Visits and Water Temperatures in Host Home/Companion Care Residences and Three-Person and Four-Person Residences (Retired on December 22, 2015)	01/21/2015	12/22/2015
2014-67	Definition for Respite	10/20/2014	12/22/2015
2014-46	Licensed Vocational Nurse (LVN) On-Call Pilot Program Requirements (The Licensed Vocational On-Call Pilot Program expired September 1, 2015)	08/06/2014	12/22/2015
2014-30	Changes to HCS and TxHmL Certification Reviews Reports and to Certification Follow up Reviews Note: This letter was revised June 18, 2014	06/12/2014	12/22/2015
2014-09	Addition of Employment Assistance to the Home and Community-based Services Program and Changes to Provider Qualifications for Supported Employment (Retired on December 22, 2015)	03/11/2014	12/22/2015
2013-68	Changes Related to Persons Who May Reside in Four-Person Residences	10/01/2013	12/22/2015
2013-72	Online Training and Classroom Training Dates	11/12/2013	01/26/2016
2013-62	Four-Person Residence Life Safety Code Certification Process	09/17/2013	12/22/2015
2013-59	Notice of Direct Support Professionals Recognition Week	09/6/2013	01/26/2016
2013-47	Random Sampling for the Licensed Vocational Nurse (LVN) On-Call Pilot Program	08/12/2013	01/26/2016
2013-45	Fiscal Year 2013 Cutoff Dates for Year-end Closeout Processing	07/29/2013	01/26/2016
2013-02	2012 Cost Report and Cost Report Training Requirements	01/02/2013	01/26/2016
2012-87	2012 Online Training and Classroom Training Dates	12/7/2012	01/26/2016
2012-74	Implementation of the International Classification of Diseases, Tenth Revision, Clinical Modification	08/28/2012	01/26/2016
2012-73	Notice of Increased Activity of West Nile Virus in Texas	08/17/2012	01/26/2016
2012-71	FY12 Cutoff Dates for Year-end Closeout Processing	07/31/2012	01/26/2016
2012-50	2011 Cost Report Notification and Cost Report Training Reminders	05/7/2012	01/26/2016
2011-82	New Service Limits in the Home and Community-based Service (HCS) Program	09/8/2011	01/26/2016
2011-135	Cost Containment Initiative Update	10/28/2011	11/01/2017
2011-120	New Convictions Barring Employment Added to Health and Safety Code, Chapter 250	09/29/2011	11/01/2017
2011-116	Referral of Individuals Currently Enrolled in the Consolidated Waiver Program	09/07/2011	11/01/2017
2011-108	Payment Rates Effective September 1, 2011	08/24/2011	01/26/2016
2011-105	Changes in the Texas Human Resources Code resulting from Senate Bill (SB) 1857, (82nd Legislature, Regular Session 2011), related to the Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Waiver Programs	09/20/2011	11/01/2017
2011-92	FY11 Cutoff Dates for Year-end Closeout Processing	08/05/2011	01/26/2016
2011-85	Fiscal Year 2011 Miscellaneous Claims Cutoff Notice	07/19/2011	01/26/2016
2011-74	Change in Required Documentation for Renewals of Level of Need Increases	06/10/2011	11/01/2017
2011-31	Complaints Regarding Solicitation	04/15/2011	04/30/2019
2011-22	Per Diem Rates Effective February 1, 2011, for the Home and Community-based Services and Texas Home Living Programs	01/26/2011	10/11/2017
2010-104	FY10 Cutoff Dates for Year-end Closeout Processing	07/29/2010	01/26/2016
2010-156	Proposed Home and Community-based Services and Texas Home Living Rate Reductions	12/27/2010	10/11/2017
2010-142	Expansion of Utilization Management and Review Activities	11/05/2010	11/01/2017
2010-140	Individual Plan of Care Revision Process	11/17/2010	11/01/2017
2010-105	Correct Correction to HCS/TxHmL Non-Day Habilitation Services Enrollment Worksheets ion to HCS and TxHmL Non-Day Habilitation Enrollment Worksheets and Instructions for Attendant Compensation Rate Enhancement	07/23/2010	10/11/2017
2010-80	Change in Notification of Approvals and Denials of Individual Plans of Care Services for Persons in the Home and Community-Based Services and Texas Home Living Programs	07/01/2010	11/01/2017
2010-77	Per Diem Rates Effective June 1, 2010 for the Home and Community-Based Services and Texas Home Living Waiver Programs	05/28/2010	10/11/2017
2010-68	Home and Community-Based Services Rule Language Regarding an Individual's Freedom of Choice of Direct Service Providers	06/04/2010	11/01/2017
2010-49	Requesting a Review of Finding or Methodology Used to Conduct Department of Family and Protective Services Investigations	04/09/2010	11/01/2017
2010-43	Dental Treatment Requisition Fees	04/19/2010	10/11/2017
2010-32	Obligation to Screen Individuals or Entities Excluded from Participation in Federal Health Care Programs Prior to Hire by Employers under the Consumer Directed Services Option	05/10/2010	11/01/2017
2010-27	Agency Directives and Required Timelines for the Transition of the Case Management Function to MRAs	02/26/2010	11/01/2017
2010-11	HCS and TxHmL Prior Approval Amount Change	02/01/2010	11/01/2017
2010-07	Proposed changes to rules regarding Fiscal Accountability	01/11/2010	10/11/2017
2009-174	Regulatory Services Policy Clarification: 2009 National Fire Protection Association (NFPA) 101 Life Safety Code for Homes that Serve Four Individuals	01/08/2010	11/01/2017
2009-155	Personal Care Services (PCS) and Home and Community-based Services (HCS) or Texas Home Living (TxHmL) Program Services Replaced by IL 2015-71	12/14/2009	11/3/2015
2009-153	Personal Care Services (PCS) and Waiver Services Replaced by IL 2015-71	10/30/2009	11/03/2015
2009-100	Process for Sending Medicaid Applications to the Health and Human Services Commission (HHSC)	08/10/2009	11/01/2017
2009-93	Communication Regarding the Redistribution of the HCS Monthly Administration and Operations Fee and HCS, TxHmL and CWP Payment Rates	07/15/2009	10/11/2017
2009-92	Public Hearing Regarding Proposed Rates for the Home and Community-based Services (HCS), Texas Home Living (TxHmL) and Consolidated Waiver (CWP) waiver programs	07/09/2009	10/11/2017
2009-86	Critical Incident Reporting	07/01/2009	11/01/2017
2009-84	Process for HCS and TxHmL Program Providers and CDSAs to Maintain Current Information in the Client Assignment and Registration (CARE) System	06/18/2009	11/01/2017
2009-48	Public Hearing Regarding Proposed Rule Amendment to the Reimbursement Methodology for HCS to Redistribute the HCS Monthly Administration and Operations Fee	04/08/2009	10/11/2017
2009-39	Change in the Timeframe for Mental Retardation/Related Condition (MR/RC) Assessment, Purpose Code 3 Data Entry into the Client Assignment and Registration (CARE) System	04/29/2009	11/01/2017
2009-28	Process for CDSAs to Obtain Access to the Client Assignment and Registration System (CARE) and Notification of the New CDSA CARE User Guide	02/18/2009	11/01/2017
2009-21	Communication to all Foster/Companion Care Providers Regarding the Redistribution of the HCS Monthly Administration and Operations Fee	02/06/2009	10/11/2017
2009-20	Communication Regarding the Redistribution of the HCS Monthly Administration and Operations Fee	02/06/2009	10/11/2017
2009-08	Process for CDSAs to Obtain Access to the Client Assignment and Registration System (CARE) and Notification of the New CDSA CARE User Guide	02/18/2009	11/01/2017
2009-01	Revisions to Texas Administrative Code Rules Governing Cost Reporting and Fiscal Accountability	01/08/2009	10/11/2017
2008-175	Provider Requirements for Reporting the Death of an Individual Receiving HCS or TxHmL Services	01/15/2009	11/01/2017
2008-167	Client Abuse and Neglect Reporting System (CANRS)	11/18/2008	11/01/2017
2008-165	Data Entry Training Class for HCS and TxHmL Waiver Program Providers	11/13/2008	11/01/2017
2008-156	Follow-up to IL No. 08-48, Regarding Critical Incident Reporting	11/03/2008	11/01/2017
2008-143	Clarification Regarding Qualified Providers of the Behavioral Support Service Component	10/03/2008	11/01/2017
2008-137	Waiver Survey and Certification (WS&C) Process to Initiate Alternative Services for Individuals Whose Health, Safety and Welfare Are at Risk	09/23/2008	11/01/2017
2008-130	Notification of the Availability of Revised Individual Plan of Care (IPC) Forms	09/12/2008	11/01/2017
2008-129	Clarification of Current Board of Nursing (BON) Rules that Impact the Delivery of HCS and TxHmL Services	10/23/2008	11/01/2017
2008-103	Consumer Directed Services (CDS) Option Policy Clarifications and Notification of a Revision to the HCS and MRA User Guides	07/16/2008	11/01/2017
2008-96	Criminal History, Employee Misconduct Registry and Nurse Aide Registry Checks	07/02/2008	11/01/2017
2008-77	HCS and TxHmL Rule Amendment Effective Dates and Related Implementation Information	05/29/2008	10/11/2017
2008-90	Provider Role Related to Investigations of Abuse, Neglect or Exploitation	07/22/2008	11/01/2017
2008-89	Client Assignment and Registration System (CARE) Entry of Designated Alternate to Chief Executive Officer (CEO)	07/22/2008	11/01/2017
2008-86	Written Notification to an Individual or Legally Authorized Representative (LAR) of the Denial of a Level of Need (LON) Assignment	07/15/2008	11/01/2017
2008-35	New HCS and TxHmL Forms 3610 and 3611 for Involuntary Termination of the Consumer Directed Services (CDS) Option	03/28/2008	11/01/2017
2008-20	HCS Individual Plan of Care (IPC) Form 3608 and TxHmL IPC Form 8582	02/13/2008	11/01/2017
2008-18	HCS Transfer Process and Transfer Forms (Replaces IL #07-71)	02/06/2008	11/01/2017
2008-14	Change to Forms 8571, 8626, 8627 and 8628	02/01/2008	11/01/2017
2008-13	Implementation of Consumer-Directed Services (CDS) Reimbursement Rates	01/30/2008	10/11/2017
2008-02	Elimination of Paper Forms 3618, 3619 and 3652-A Effective August 1, 2008 / Requirement for Electronic Submission Effective August 1, 2008	02/05/2008	11/01/2017
2007-93	HCS and TxHmL Rate Increase Effective September 1, 2007	09/17/2007	10/11/2017
2007-128	Transfer and Billing information related to the Client Assignment and Registration System (CARE) conversion for the implementation of Consumer Directed Services (CDS)	12/20/2007	11/01/2017
2007-127	Medicare Prescription Drug Program (Medicare Rx) Related Incurred Medical Expenses for Waiver Consumers with Qualified Income Trusts	12/10/2007	11/01/2017
2007-122	HCS Temporary and Permanent Discharge Process and Discharge Forms	12/01/2017	11/01/2017
2007-105	Data Entry Training Class for HCS and TxHmL Waiver Program Providers	10/19/2007	11/01/2017
2007-87	New Convictions Barring Employment Added to Health and Safety Code Chapter 250	09/14/2007	11/01/2017
2007-80	Change in Required Documentation for Level of Need (LON) Increase	09/01/2007	11/01/2017
2007-74	Individual Cost Limits for Certain Medicaid Waiver Programs	08/20/2007	11/01/2017
2007-73	Billable Adaptive Aids	08/20/2007	11/01/2017
2007-65	Training of Program Provider Personnel in the Use of Authorized Restraint Techniques	07/06/2007	11/01/2017
2007-45	2006 NFPA 101 Life Safety Code for Homes that Serve Four Individuals	05/07/2007	11/01/2017
2007-13	Abuse, Neglect, and Exploitation Investigations by Department of Family and Protective Services (DFPS) When the Administrator/Chief Executive Officer is the Alleged Perpetrator	06/15/2007	11/01/2017
2006-37	LTC Online Portal (previously referred to as CARE Form System (CFS))	06/02/2006	11/01/2017
2006-29	Medicare Rx prescription drug coverage to resume for "dual eligible" individuals	03/24/2006	11/01/2017
2005-41	Increase in Travel Reimbursements for Cost Reporting	10/10/2005	10/11/2017
2005-35	Restraint and Seclusion Requirements in new Health and Safety Code, Chapter 322, added by Senate bill 325, 79th Legislature	01/02/2006	11/01/2017

Appendix X, Approved Diagnostic Codes for Persons with Related Conditions List

View the Approved Diagnostic Codes for Persons with Related Conditions List at:

icd10-codes (PDF)

Appendix XI, Solicitation Prohibition

Appendix XII, Abuse, Neglect, and Exploitation Training and Competency Test

Revision 19-2; Effective June 5, 2019

1. Requirement to Train Staff Members, Service Providers, and Volunteers

As required by program rule, a Home and Community-based Services (HCS) Program provider must ensure their staff members, service providers and volunteers are:

trained on:
- acts that constitute abuse, neglect and exploitation;
- signs and symptoms of abuse, neglect and exploitation; and
- methods to prevent abuse, neglect and exploitation; and
knowledgeable of:
- acts that constitute abuse, neglect and exploitation;
- signs and symptoms of abuse, neglect and exploitation; and
- methods to prevent abuse, neglect and exploitation; and
instructed to report to Department of Family and Protective Services (DFPS) immediately, but not later than one hour, after having knowledge or suspicion that an individual has been, or is being, abused, neglected or exploited by:
- calling the DFPS Abuse Hotline toll-free telephone number, 1-800-647-7418; or
- using the DFPS Abuse Hotline website; and
provided with these instructions described in paragraph c of this section, in writing.

2. Optional Computer-Based Training and Competency Test

An HCS Program provider has the option of having their staff members, service providers and volunteers complete the Health and Human Services Commission’s (HHSC’s) ANE Competency Training. The completion of the computer-based training by employees, agents, and subcontractors meets the requirement in Section 1a of this appendix.

If staff members, service providers and volunteers complete HHSC’s ANE Competency Final Test, they must receive a score of at least 80 percent.

The completion of the competency test by staff members, service providers and volunteers meets the requirement in Section 1b of this appendix.

Staff members, service providers and volunteers must first sign up on the Learning Portal to have access to HHSC approved trainings, including this ANE training, entitled ANE Competency Training and Exam (online). The ANE training is found in Medicaid Long Term Services and Supports Training under the Health and Human Services Commission Courses tab.

Link to the Learning Portal homepage: https://learningportal.hhs.texas.gov/

3. Documentation Requirements

Program providers must maintain records documenting staff members, service providers and volunteers have received training on ANE. If using HHSC’s ANE Competency Training as evidence of ANE training, the HCS program provider must maintain a copy of the certificate generated from the HHSC’s ANE Competency Final Test for each staff member, service provider and volunteer. The program provider must maintain training records in accordance with 40 TAC §49.307 Record Retention and Disposition.

Appendix XIII, Value-added Services

Revision 19-3; Effective November 25, 2019

Value-added services (VAS) are extra benefits offered by managed care organizations (MCOs) beyond Medicaid-covered services. VAS may include routine dental, vision, podiatry, health and wellness services. VAS may be actual health care services, benefits or positive incentives Texas Health and Human Services Commission determines to promote healthy lifestyles, improving health outcomes among its members. Each MCO offers a different set of VAS and the MCO can change the VAS it offers every six months.

MCOs must cover all benefits in Medicaid managed care programs, such as STAR+PLUS, STAR Kids and STAR Health. The MCO utilizes VAS to distinguish itself from another MCO. In addition, members may use VAS to help choose which MCO has the added benefits best suited for their needs.

VAS are not considered non-waiver resources and therefore, waiver program providers do not consider VAS offered by the MCO when considering third-party resources. VAS is an added benefit available to individuals from the MCO providing their acute care services.

Forms and Documents

ES = Spanish version available.

Form	Title
0702	Fax Cover Sheet for TxHmL and HCS
1570	ICF Request for Medical Need Assessment or Verification of RUG-III Category
1572	Nursing Tasks Screening Tool	ES
1573	Residential Review Evidence of Correction
1580	Texas Money Follows the Person Demonstration Project Informed Consent for Participation	ES
1581	Consumer Directed Services Option Overview	ES
1582	Consumer Directed Services Responsibilities	ES
1583	Employee Qualification Requirements	ES
1584	Consumer Participation Choice	ES
1586	Acknowledgement of Information Regarding Support Consultation Services in the Consumer Directed Services (CDS) Option	ES
1588	HCS Review Report
1592	RN Delegation Checklist
1594	Individualized Skills Assessment for Regulating Water Temperature
1597	Level of Care Redetermination Cover Sheet
1740	Service Backup Plan	ES
1741	Corrective Action Plan	ES
1742	Service Backup Plan for HCS, TxHmL and CFC Services
1748	HCS/CFC Entrance Conference
2067	Case Information
2124	Supported Home Living/Community Support Transportation Log	ES
2125	Home and Community-based Service (HCS), Texas Home Living (TxHmL) and Community First Choice (CFC) Implementation Plan
3598	Individual Transportation Plan
3605	HCS Parent or Legally Authorized Representative (LAR) Contact Information for Individuals Under 22 Years of Age	ES
3608	Individual Plan of Care (IPC) - HCS/CFC	ES
3610	Informal Review Request
3611	Involuntary Termination of Consumer Directed Services (CDS) Individual Plan of Care (IPC) Cover Sheet (HCS and TxHmL)
3615	Request to Continue Suspension of Waiver Program Services
3616	Request for Termination of Services Provided by HCS/TxHmL Waiver Provider
3617	Request for Transfer of Waiver Program Services
4116-Dental	Dental Summary Sheet
4116-MHM-AA	Minor Home Modification/Adaptive Aids Summary Sheet
4119	Residential Support Services (RSS) and Supervised Living (SL) Service Delivery Log
4121	Home and Community-based Services/Texas Home Living Community First Choice Personal Assistance Services/Habilitation	ES
4122	Host Home/Companion Care Service Delivery Log	ES
4123	Nurse Services Delivery Log - Billable Activities	ES
5604	HCS Program Provider Request for Life Safety Inspection
5606	Life Safety Code Certification
8401	Employment First Discovery Tool
8490	Medical Increase Worksheet
8491	Request for a Four-Person Residence Approval
8492	Random Sample Review of Nursing On-Call Required Submission of Documentation
8493	Notification Regarding a Death in HCS, TxHmL and DBMD Programs
8494	Notification Regarding An Investigation of Abuse, Neglect or Exploitation
8495	Exclusion of Host Home/Companion Care (HH/CC) Provider from the Board of Nursing (BON) Definition of Unlicensed Person
8509	Unlicensed Personnel Tracking of Delegated Tasks
8510	HCS/TxHmL CFC PAS/HAB Assessment
8511	Understanding Program Eligibility	ES
8574	Administration of Medications by Unlicensed Personnel
8575	Notification of Local Authority (LA) Reassignment
8576	Individual Profile Information
8578	Intellectual Disability/Related Condition Assessment
8579	Notification of Service Coordinator (SC) Disagreement
8580	Request for Variance of Supported Employment - Employer Requirements
8583	HCS and TxHmL Program Contact Information	ES
8584	Nursing Comprehensive Assessment
8584-CDS	Comprehensive Nursing Assessment and Plan of Care - HCS Program	ES
8599	Individual Plan of Care (IPC) Cover Sheet
8601	Verification of Freedom of Choice	ES
8603	Level of Need (LON) Review/Increase Cover Sheet
8604	Transition Assistance Services (TAS) Assessment and Authorization
8611	Pre-Enrollment MHM Authorization Request	ES
8612	TAS/MHM Payment Exception Request	ES
8647	Service Coordination Assessment – Intellectual Disability Services
8662	Related Conditions Eligibility Screening Instrument
8665	Person-Directed Plan	ES
8665-ID	Individual Data

Document Title
Transfer Process Checklist (PDF)

Revisions

22-3, Section 7000 Changes

Revision 22-3; Effective Oct. 19, 2022

The following changes(s) were made:

Section	Title	Change
7110	Service Delivery Modalities	Adds the modalities for delivering services in the HCS Program.
Form 2125 and Instructions	Implementation Plan — HCS/TxHmL/CFC	Updates Form 2125 and instructions to include consent for use of synchronous audio-visual technology. Changes title of Form 2125 Instructions to Home and Community-based Service (HCS), Texas Home Living (TxHmL) and Community First Choice (CFC) Implementation Plan.

22-2, Miscellaneous Changes

Revision 22-2; Effective May 1, 2022

The following changes(s) were made:

Section	Title	Change
2000	Service Coordination	Adds how to access the Texas Medicaid & Healthcare Partnership (TMHP) user guides. Throughout the section, deletes all references to specific CARE and replaces “CARE” with “HHSC data system,” Local Authority (LA)” with “Local Intellectual and Developmental Disability Authority (LIDDA),” “Department of Assistive and Rehabilitation Services (DARS)” with “Texas Workforce Commission (TWC),” “Consumer Rights and Services” with “IDD Ombudsman,” “Department of Aging and Disability (DADS)” with “Health and Human Services Commission (HHSC),” “Consumer Directed Services Agency (CDSA)” with “Financial Management Services Agency (FMSA),” and “Texas Youth Commission” with “Texas Juvenile Justice Department.”
2120	Person-Directed Plan Development	Deletes an external weblink and updates the name of the HCS Program Billing Requirements. Adds a link to Form 8665, Person-Directed Plan.
2130	Enrollment Activities	Makes minor wording changes.
2151	Individual Plan of Care Renewal	Deletes information about the 21-day notification and informing the individual/LAR about receiving attendant care.
2152	Individual Plan of Care Revision	Deletes the purpose information for documenting an Individual Plan of Care (IPC) revision in a contact note.
2155	Home and Community-based Services Program Suspension	Changes the section title and deletes “Previously Referred to as Temporary Discharge.”
2156	Termination of Home and Community-based Services	Changes the section title and deletes “Previously Referred to as Permanent Discharge.”
2157	Transfers	Deletes information about submitting a written request to transfer.
2160	Additional Service Coordinator Responsibilities	Deletes notice of the development of the “Rights of Individuals to be Protected and Promoted by the HCS Provider.” Specifies when the service coordinator (SC) should give a copy of the booklet, “Your Rights in a Home and Community-based Services (HCS) Program,” to an individual/legally authorized representative (LAR). Replaces the listed phone number with a weblink for listings of Early Childhood Intervention (ECI) programs by county. Adds how often the SC should determine if the guardianship for an individual is current. Adds that the SC must request the current letter of guardianship and keep a copy in the individual’s record and if the letter of guardianship is not current, to obtain signatures of both the individual and the person listed as guardian until appropriate steps can be taken to verify current guardianship.
3000	Enrollments	Adds how to access the TMHP user guides. Changes “Department of Aging and Disability Services (DADS)” to “Health and Human Services Commission (HHSC).” Deletes information about the CARE user guide and child care facility regulated by the Texas Department of Family and Protective Services.
5000	Level of Care and Level of Need	Deletes all references to specific CARE screens and CARE screen shots throughout the section. Adds information about accessing the TMHP user guides. Adds the descriptions of the Level of Care (LOC) and Level of Need (LON). Replaces “CARE” with “HHSC data system.”
5100	Intellectual Disability/Related Condition Assessment Process	Clarifies who must sign Form 8578, Intellectual Disability/Related Condition Assessment, and makes minor wording changes. Adds reports will also be noted in the form history in the HHSC data system. Moves information about the review of the ID/RC. Adds a program provider may request an increase in LON for an individual for medical and/or behavioral reasons. This is one level higher than the LON assessed by the ICAP tool.
5200	Service Coordinator Review of Intellectual Disability/Related Condition	Makes minor wording changes. Deletes the description of the LOC and LON, and information about the review of the ID/RC (now in Section 5100). Deletes individual profiles information and adds links to LON resources.
6000	Individual Plan of Care	Adds how to access the TMHP user guides. Throughout the section, deletes references to specific CARE screens and CARE screenshots and changes. Changes “Department of Aging and Disability Services (DADS)” to “Health and Human Services Commission (HHSC),” “CARE” to “HHSC data system,” ”Local Authority (LA)” to “Local Intellectual and Developmental Disability Authority (LIDDA),” “provider” to “program provider,” and “Program Enrollment (PE)” to “Utilization Review (UR)”
6100	Overview of the IPC	Adds Form 3608, Individual Plan of Care (IPC) – HCS/CFC, and replaces “changed” with “transfers.” Deletes the links to “HCS and MRA User Guides” and “during the IPC meeting.”
6120	IPC Begin, End and Effective Dates	Adds “the next day after the previous IPC ends.”
6130	IPC Meeting	Adds “that does not require a change to the PDP.”
6140	IPC Types	Makes a minor wording change.
6150	Consumer Directed Services (CDS) and IPCs	Replaces SC with service coordinator (SC), replaces “those” with “Adds program.” Modifies employer with “CDS” and deletes “(i.e., individual or LAR).” Makes minor wording changes.
6160	Health and Human Services Commission (HHSC) Role	Changes the section title. Adds that HHSC may review any type of IPC at any time to determine if the appropriate type and amount of services are being requested and utilized. HHSC may take action on an IPC, reducing or denying services or amounts of services if there is not documentation to support the need for the requested services.
6210	Initial (Enrollment) IPC Overview	Replaces “LA service coordinator” with “LIDDA representative.”
6220	LIDDA and Service Coordinator Responsibilities for Initial IPC	Changes the section title.
6221	IPC Meeting to Develop Initial IPC	Removes link to Acronyms.
6223	Units of Service	Changes the typical number of days of day habilitation attendance from “250” to “260” and changes “therapy” to “professional therapies.” Adds that a revision of IPC can be completed after an assessment is completed. Adds nursing, professional therapies and dental services are limited in availability for individuals enrolling who are 20 years and younger because they must be accessed through State Plan Services. Deletes information about additional planning to determine number of service hours.
6224	Non-HCS Services	Removes link to Acronyms.
6225	Initial IPC Signatures and Signature Dates	Removes link to Acronyms.
6226	Transmission of Initial IPC	Makes minor wording changes.
6230	Provider Responsibilities for Initial IPC	Makes minor wording changes.
6310	Renewal IPC Overview	Deletes Texas Administrative Code (TAC) reference and makes minor wording changes.
6320	Program Provider Responsibilities for Renewal IPC	Changes the section title.
6321	IPC Meeting to Develop Renewal IPC	Makes a minor wording change.
6323	Units of Service	Changes the typical number of days of day habilitation attendance from “250” to “260” and changes “health care professional” to “licensed professional.” Adds nursing, professional therapies and dental services are limited in availability for individuals enrolling who are 20 years and younger because they must be accessed through State Plan Services. Deletes information about additional planning to determine number of service hours.
6324	Renewal IPC Signatures and Signature Dates	Makes minor wording changes and adds “Then the hardcopy form is submitted to the SC for review.”
6325	Transmission of Renewal IPC	Adds ‘Once the required signatures have been obtained’ and makes minor wording changes.
6330	Service Coordinator Responsibilities for Renewal IPC	Deletes weblink and “in accordance with Section 2151, Individual Plan of Care Renewal.” Emphasizes the importance of the SC completing the Person-Directed Plan (PDP) in a timely manner and makes minor wording changes.
6410	IPC Revision Overview	Adds “requested units of services for an added service should be prorated as need based on the time remaining in the IPC year” and makes minor wording changes.
6411	Provider Responsibilities for IPC Revision	Deletes a weblink and makes minor wording changes.
6412	Service Coordinator Responsibilities for IPC Revision	Clarifies that when a program provider becomes aware of a need to revise an individual's IPC, the program provider submits a revised IPC to the SC that does not require a change to the PDP.
6421	Provider Responsibilities for IPC Revision That Reflects a PDP Change	Deletes information about IPC revision in response to emergency provision of services.
6421.2	Signatures and Signature Dates for IPC Revision That Reflects a PDP Change	Removes link to Acronyms.
6421.3	Transmission of IPC Revision That Reflects a PDP Change	Makes minor wording changes.
6422	Service Coordinator Responsibilities for IPC Revision that Reflects a PDP Change	Makes minor wording change and removes a weblink.
6430	Revision to Increase/Decrease an Existing HCS Service	Deletes information about nursing service component and “in accordance with Section 6600, Service Coordinator Review Process.” Adds a link to Form 3608 and makes minor wording changes.
6431	Provider Responsibilities for IPC Revision to Increase/Decrease an Existing HCS Service	Deletes “If the IPC revision increases or decreases an existing HCS service and is supported by a current outcome in the PDP, an IPC meeting is not necessary.” Adds “if an IPC meeting is not held” and makes minor wording changes.
6431.1	IPC Effective Date for IPC Revision that Does Not Require an IPC Meeting	Changes the section title and adds link to Form 3608.
6431.2	Signatures and Signature Dates for IPC Revision that Do Not Require an IPC Meeting	Changes the section title and makes a minor wording change.
6431.3	Transmission of IPC Revision that Does Not Require an IPC Meeting	Changes the section title and clarifies that the program provider may enter the revised IPC in the HHSC data system after the individual’s or LAR’s signature is obtained on the revised IPC.
6431.4	Activity Following Transmission of IPC Revision that Does Not Require an IPC Meeting	Changes the section title and makes a minor wording change.
6432	Service Coordinator Responsibilities for IPC Revision that Do Not Require an IPC Meeting	Changes the section title and adds link to Form 3608.
6432.1	Service Coordinator Response Section of Form 3608	Changes the section title and adds a link to Form 3608.
6432.2	If Service Coordinator Agrees the IPC Revision Does Not Require an IPC Meeting	Changes the section title.
6432.3	If Service Coordinator Has Concerns with the IPC Revision	Changes the section title and adds “If the SC and the program provider cannot come to agreement about the amount of the services or supports being requested, the SC completes Form 8579, Notification of Service Coordinator (SC) Disagreement, and submits it to HHSC UR.”
6441.3	Transmission of IPC Revision to Add/Change a Requisition Fee Only	Makes minor wording changes.
6510	Transfer IPC Overview	Makes minor wording changes.
6520	LIDDA and Service Coordinator Responsibilities for Transfer IPC	Changes the section title.
6523	Transfer IPC Signatures and Signature Dates	Removes link to Acronyms.
6524	Transmission of Transfer IPC	Adds “If two LIDDAs are assisting with a transfer IPC, the transferring LIDDA sends the IPC to the receiving LIDDA for data entry” and to refer to Section 8000, Transfers and Local Authority Reassignments for additional information on the transfer process.
6525	Emergency Transfer	Makes a wording changes.
6531	Transferring Provider	Makes minor wording changes.
6610	Service Coordinator Review Process Overview	Makes minor wording changes.
6611	Reasons the IPC is Returned to the Provider	Makes minor wording changes.
6612	Service Coordinator’s Agreement/Disagreement with IPC	Makes minor wording changes.
6621	If the IPC is Returned to Provider	Makes minor wording changes.
6622	Service Coordinator's Agreement/Disagreement with IPC	Changes “attest” to “agree” and makes minor wording changes.
6622.1	Agreement with IPC	Clarifies that the SC must agree with the IPC in the HHSC data system to move it forward for review.
6622.2	Disagreement with IPC	Makes minor wording changes.
6623	If Service Coordinator CARE Screens for Service Coordinator Review	Deletes section.
6623.1	CARE Screen L83	Deletes section.
6623.2	CARE Screen L31	Deletes section.
6630	Provider Responsibilities	Makes a minor wording change.
6631	Service Coordinator Returns IPC in the HHSC Data System	Changes the section title and deletes information about CARE screen.
6632	Activity to Address a Returned IPC	Makes minor wording changes.
6633	Error Correction	Deletes section.
6634	Delete and Re-enter IPC	Deletes section.
6635	CARE Screen Examples	Deletes section.
8000	Transfers and Local Intellectual and Developmental Disability Authority (LIDDA) Reassignments	Changes the section title.
8100	Overview	Deletes obsolete TAC information.
8210	Transfers Must be Planned	Modifies several sentences for clarity. Adds a transfer effective date must be agreed to by all parties involved in the transfer.
8220	No Prior SC Notification	Modifies several sentences for clarity.
8230	Emergency Transfer	Adds TAC definitions of “emergency” and “emergency situation.” Modifies several sentences for clarity. Clarifies in an emergency, the receiving provider notifies the SC if they are unaware of the emergency situation. Clarifies that the SC submits supporting documentation to HHSC. Deletes “contract.”
8231	Data Entry of Emergency Transfer in the HHSC Data System	Changes the section title and removes information about entry of non-emergency transfer.
8310	Simultaneous Transfer of Program Provider and FMSA	Changes the section title and makes minor wording changes.
8330	Reserved for Future Use	Deletes section formerly “Data Entry in the HHSC Data System.”
8340	Verification of Guardianship	Deletes references to CARE screens. Makes minor wording changes.
8360	Contacting HHSC	Changes the section title and makes minor wording changes.
8400	Program Provider Transfer Involving One Local Intellectual and Developmental Disability Authority (LIDDA)	Changes the section title.
8430	Ensuring Agreement on Transfer Effective Date	Makes a minor word change.
8450	Developing the Transfer IPC	Replaces “Section I” with “Column 3.”
8460	Sharing Documents	Makes a minor wording change.
8470	Completing Data Entry in the HHSC Data System and Submitting Documents to HHSC	Changes the section title and “group home” to “three-person or four-person residence.” Corrects forms should be submitted through the IDD Operations Portal and the receiving program provider should contact HHSC Program Eligibility and Support (PES) for assistance if they don’t have access to the HHSC data system. Adds to use the existing local case number if the individual already has one with the program provider's component code.
8500	Program Provider Transfer Involving Two Local Intellectual and Developmental Disability Authorities (LIDDAs)	Changes the section title.
8510	Confirming the Desire to Transfer	Deletes transferring SC contacting HHSC PES for SC information. Adds the transferring SC submits an Individual Movement (IMT) form/LA reassignment form in the HHSC data system and the receiving LIDDA must acknowledge the IMT/LA reassignment form in the HHSC data system.
8520	Selecting a Receiving Program Provider	Makes a minor wording change.
8530	Ensuring Agreement on Transfer Effective Date	Makes a minor wording change.
8540	Completing Form 3617	Makes a minor wording change.
8550	Developing the Transfer IPC	Makes a minor wording change.
8560	Sharing Documents	Adds that the transferring SC must submit current copies of documents to the receiving SC before the submission of the IMT form in the HHSC data system.
8570	Completing Data Entry in the HHSC Data System and Faxing Documents to HHSC	Changes that the receiving LIDDA/SC, not transferring LIDDA/SC, submits the transfer documents to HHSC PES and contacts HHSC PES for assistance if the receiving program provider does not have access to the HHSC data system.
8600	FMSA Transfer and Changing Service Delivery Option	Changes the section title.
8610	Confirming the Desire to Transfer or Change Service Delivery Option	Makes minor wording changes.
8620	Selecting a Receiving FMSA or Receiving Program Provider	Changes the section title.
8630	Ensuring Agreement on Transfer Effective Date	Makes minor wording changes.
8640	Completing Form 3617	Makes minor wording changes.
8650	Developing the Transfer IPC	Makes minor wording changes and replaces “Section I and Section III” with “Column 3.”
8660	Completing Data Entry in the HHSC Data System and Submitting Documents to HHSC	Changes the section title and changes “fax” to “submit.” Deletes information about sending documents to assigned HHSC staff. Adds to use the existing local case number if the individual already has one with the program provider's component code.
8700	Notification by HHSC Program Eligibility and Support (PES)	Deletes information about transfer authorization letters.
8800	Local Intellectual and Developmental Disability Authority (LIDDA) Reassignment	Changes the section title. Adds the transferring LIDDA submits an Individual Movement (IMT) form/LA reassignment form in the HHSC data system for a reassignment, and the receiving LIDDA acknowledges the IMT/LA reassignment in the HHSC data system. Deletes references to CARE user guide and updates the email and phone number for HHSC PES.
9000	Suspensions	Deletes all references to specific CARE screens. Adds information about accessing TMHP user guides. Throughout the section, changes “Department of Aging and Disability Services (DADS)” to “Health and Human Services Commission (HHSC),” “Intellectual and Developmental Disability (IDD) Waivers Program Enrollment/Utilization Review (PE/UR)” to “Program Eligibility and Support (PES).”
9100	Reasons for Suspension of Waiver Program Services	Deletes the listed reasons for suspension. Adds Home and Community-based Services (HCS)/Texas Home Living (TxHmL) services must be suspended when an individual is temporarily admitted to these settings: hospital; ICF/IID; nursing facility; ALF; residential child care facility licensed by HHSC unless it is an agency foster home; inpatient chemical dependency treatment facility; mental health facility; residential facility operated by the Texas Workforce Commission; or a residential facility operated by the Texas Juvenile Justice Department, a jail or a prison.
9200	Program Provider Responsibilities	Replaces “temporary discharge” with “suspension” and deletes information about suspension due to loss of financial eligibility and informing the SC that an individual can resume participation in the waiver program.
9300	HHSC Activities	Changes the section title, makes minor wording changes and deletes information about secure email communication.
9400	Service Coordinator Responsibilities	Deletes information about suspension due to loss of financial eligibility and discussing if the individual should be terminated. Specifies that a request to continue the suspension is submitted to HHSC if continuation of the suspension is recommended beyond 270 days.
9410	Request to Continue Suspension of Waiver Program Services	Makes minor wording changes and deletes links to handbooks and CARE user guides.
10000	Terminations	Adds information on how to access TMHP user guides. Throughout the section, replaces “CARE” with “HHSC data system,” Local Authority (LA)” with “Local Intellectual and Developmental Disability Authority (LIDDA),” “Consumer Directed Services Agency (CDSA)” with “Financial Management Services Agency (FMSA),” “Department of Aging and Disability Program Enrollment (DADS PE)” with “Health and Human Services Commission Program Eligibility and Support (HHSC PES).”
10100	Process for Requesting Termination of Waiver Services – Texas Home Living and Home and Community-based Services	Adds HHSC prefers to receive required documentation for the termination of waiver program services through the IDD Operations Portal. Updates HHSC PES general email box address. Deletes all links and references to the CARE user guides.
11100	Financial Eligibility Guidelines for Texas Home Living and Home and Community-based Services	Replaces “Texas Department of Aging and Disability Services (DADS)” with “Health and Human Services Commission (HHSC).”
12000	Permanency Planning	Adds information about accessing the TMHP user guides.
12100	Resources	Replaces “Local Authority (LA)” with “Local Intellectual and Developmental Disability Authority (LIDDA).” Updates link to Permanency Planning forms and tools. Deletes CARE user guide information.
13000	Consumer Directed Services	Replaces “Consumer Directed Services Agency (CDSA)” with “Financial Management Services Agency (FMSA),” “provider managed option” to “agency option,” “CARE” with “HHSC data system,” and “Department of Aging and Disability Services (DADS)” to “Health and Human Services Commission (HHSC)” throughout the section.
13110	Home and Community-based Services Available Through the Consumer Directed Services Option	Changes “foster/companion care” to “host home/companion care” and “self-direction” to “CDS option.” Updates the list of HCS services available through the CDS option.
13120	Informing the Individual/LAR of the Consumer Directed Services (CDS) Option	Deletes “the self-assessment may not be used to determine that an individual/LAR cannot use the CDS option” and “probably.” Deletes information about conducting orientation in the individual’s home prior to service initiation and clarifies that FMSA conducts majority of its business electronically.
13130	Service Planning	Deletes “SHL or Respite.”
13140	Enrolling the Individual in the Consumer Directed Services Option	Makes minor wording changes.
13160	Monitoring Consumer Directed Services	Adds “This includes terminating the CDS option, if using CDS puts the individual’s health and safety at risk.” Updates the link to the IDD ombudsman webpage.
13200	Consumer Directed Services Resources	Makes a minor wording change.
15000	Review of Authority	Replaces “Local Authority (LA)” with “Local Intellectual and Developmental Disability Authority (LIDDA)” and “CARE” with “HHSC data system” throughout the section.
15100	Quality Oversight of Home and Community-based Services Program Local Intellectual and Developmental Disability Authority Responsibilities	Changes the section title and deletes “on-site” and information about random selection of HCS sample of participants. Removes a broken link to the LIDDA Performance Contract. Clarifies only new SCs assigned to the sample participants are reviewed. Replaces “documentation checklist” with “electronic tool” and “Report of Findings” with “HCS Authority Review Report of Findings.” Deletes “cited finding may be determined to be corrected on site.” Clarifies the corrective action plan (CAP) is due within 30 days after receipt of the HCS Authority Review Report of Findings.

22-1, 14000 Changes

Revision Notice 22-1; Effective February 4, 2022

The following change(s) were made:

Section	Title	Change
14000	Long-Term Care Regulatory	Changes section title and throughout the section, changes “Waiver Survey and Certification (WSC)” with “Long-Term Care Regulatory (LTCR).” Changes “review” with “survey,” “talking with” to “interviewing,” “residential reviewer” to “LTCR staff,” “CARE” with “HHSC data system,” and “Consumer Rights and Services” with “IDD Ombudsman.”
14100	Long-Term Care Regulatory, HCS and TxHmL Overview	Clarifies the functions of LTCR, which includes completing initial certification and annual recertification surveys for contracts operated by program providers to ensure compliance with the certification principles located in the Texas Administrative Code (TAC), completing residential visits for Host Home/Companion Care and three- and four-person homes residences, and reviewing complaints and deaths in the program.
14200	Home and Community-based Services Surveys	Changes section title and corrects TAC references to certification principles. Replaces “announced or unannounced reviews” with “intermittent survey.”
14210	Types of Surveys	Changes section title and deletes provisional certification information. Adds that for recertification surveys, a program provider must demonstrate compliance with all certification principles to be certified for another 365-day period. Clarifies that if the program provider is out of compliance with any certification principles, LTCR sends a final report with a list of violations to the program provider within 14 calendar days after the day of exit and the program provider must submit a Plan of Correction (PoC ) within 14 calendar days of receipt of the report. Makes other minor wording changes and delineates the time frames needed for a critical and noncritical violation. For a critical violation, the PoC must include that corrective action will be completed within 30 calendar days after the date of the survey exit conference and an on-site follow-up survey will be conducted after the 30-day period to determine if the program provider completed the corrective action in accordance with their PoC. For a violation that is not critical, the PoC must include that corrective action will be completed within 45 calendar days after the date of the survey exit conference and an on-site follow-up survey is conducted after the 45-day period to determine if the program provider completed the corrective action in accordance with their PoC. If LTCR determines that the program provider has not completed the corrective action or they have failed to submit an acceptable PoC, HHSC imposes a vendor hold against the program provider or denies or terminates the certification. Adds that LTCR will conduct a follow-up survey at least 31 calendar days after the effective date of the vendor hold, and if the program provider has not completed the corrective action, HHSC will deny or terminate the certification. Adds that intermittent surveys are always unannounced and also based on internal HHSC referrals.
14220	Overview of the Home and Community-based Services Certification Survey Process	Changes section title and makes minor wording changes. Removes that HCS program providers will generally be contacted before a certification review by the review facilitator, unless there is cause to conduct an unannounced review of the program. Removes “over 90 days” in certification review activities and removes “as a part of WSC reviews, reviewers note any issues related to service coordination and forward any concerns to HHSC Contract Accountability and Oversight (CAO) for follow up. HCS program providers may view notations related to their programs in the C-97 screen of the CARE system.” Removes “a citation can only be cleared if the original instance of noncompliance has been remediated, a new sample of individuals or records are in compliance for that principle, and the provider can show a change in process or policy that ensures no future occurrences of noncompliance.” Clarifies that if the survey team identifies an immediate threat, the program provider must immediately provide the survey team with a plan of removal. Replaces “informal review process” with “informal dispute resolution (IDR)” and explains if a program provider disagrees with the survey results, they may request an IDR. The IDR is an informal process by which a program provider can dispute, before an independent third party, the findings on which a violation is based. The outcome of the IDR serves as the independent third party’s recommendation to HHSC regarding the program provider’s compliance or noncompliance with program rules. The program provider must still submit an acceptable PoC no later than 14 calendar days after receiving Form 3724 from HHSC even if it chooses to use the IDR process.
14230	Plan of Correction (PoC)	Changes section title from “Corrective Action Plan” to “Plan of Correction (PoC).” Clarifies within 14 calendar days after receiving the final survey report, the program provider must submit a PoC to address each violation that was identified during the survey. This applies even if the provider disagrees with the findings of violations or requests IDR. For violations that are critical, the PoC must include the corrective action(s) the program provider will take for each violation with a completion date within 30 calendar days from the survey exit conference. For violations that are noncritical, the PoC must include the corrective action(s) the program provider will take for each violation with a completion date within 45 calendar days from the survey exit conference. HHSC will review the PoC and the program provider will be notified in writing whether the plan has been approved or denied. If the plan is denied, the program provider must submit a revised plan within five business days. Once the plan is approved, HHSC will request that the program provider submit evidence of the correction to HHSC and HHSC can conduct a follow-up survey to verify the corrections.
14240	Home and Community-based Services Review Checklists	Deletes section.
14300	Texas Home Living Certification Surveys	Changes section title, adds a TAC reference and replaces “announced or unannounced review” with “intermittent survey.”
14400	Residential Visits	Deletes “the legislature funded annual inspections of HCS Host Home/Companion Care residences.” Clarifies that HHSC may conduct unannounced visits to each residence in which Host Home/Companion Care services are provided.
14410	Residential Visit Policy and Procedures	Corrects that Form 3609, Waiver Survey and Certification Residential Checklist, is marked pass or fail, not yes or no. Adds a link to Provider Letter 2020-01 that provides information for how the Host Home/Companion Care provider or HCS provider can give feedback about a residential visit. Corrects that a letter notifying the program provider of the inaccuracy in the HHSC data system is sent to the HCS program provider, not the CEO, if the address on the HHSC data system is invalid.
14411	Residential Visit Results	Clarifies that a program provider must submit an evidence of correction (EoC) to LTCR using the WSC Portal or by submitting Form 1573, Residential Review Evidence of Correction. If using Form 1573, the Residential Review ID must be listed on the form with accompanying evidence. The time frame to submit an EoC is included in the documentation received by the program provider. LTCR will not accept an EoC without the correct Residential Review ID. Clarifies the program provider must take action to address an item marked “fail” on the residential checklist. If a significant risk requires immediate corrective or mitigating action, such as locking up hazardous chemicals or securing a copy of the residence’s emergency plan, LTCR staff will not leave the residence until the program provider has taken immediate action and the significant risk is removed. LTCR will also contact the program provider contract contacts and inform such persons of the date, as determined by LTCR, by which the program provider must submit evidence of correction showing that action has been taken and the significant risk removed.
14500	Death Reviews	Corrects a TAC reference for reporting a death in the HCS program and adds a TAC reference for the TxHmL program. Adds that Form 8493, Notification Regarding a Death in HCS, TxHmL and DBMD Programs, must be faxed to LTCR at 512-206-3999 or submitted through the WSC Portal.
14510	Death Review Policy and Procedures	Adds “Statewide Intake” after Department of Family and Protective Services (DFPS) and replaces “family care” with “Host Home/Companion Care.”
14600	Abuse, Neglect and Exploitation Follow Up	Replaces WSC with the Risk Assessment coordinator (RAC) team.
14610	Abuse, Neglect and Exploitation Policy and Procedures	Replaces “DFPS” with “HHSC Provider Investigations (PI).” Deletes information related to the complaint process and deletes RACs review the allegation with the WSC risk assessment manager, assistant director, and director or designee prior to scheduling an on-site visit.
14700	Additional Monitoring Related to Risk Factors	Makes minor wording changes.
14800	Complaints	Replaces “Consumer Rights and Services” with “IDD Ombudsman.”
14810	Complaints Policy and Procedures	Updates the IDD Ombudsman phone number to 800-252-8154.
14900	Four-Person Residence Approvals	Makes minor wording changes.
14910	Four-Person Residence Approval Policy and Procedures	Adds an email address and fax number to send Form 8491, Request for a Four-Person Residence Approval, and supporting documents, and corrects a TAC reference.

21-2, Changes to 4000 and 7000

Revision Notice 21-2; Effective November 8, 2021

The following change(s) were made:

Section	Title	Change
4000	Person-Directed Plan	Makes minor wording changes for clarification and replaces “foster” with “host home.”
7000	Implementation Plan and Service Backup Plan	Clarifies in Section 7100 the program provider is not required to develop an Implementation Plan (IP) for an HCS service provided through the Consumer Directed Services (CDS) Option, which is a responsibility of the CDS employer. Also, clarifies in Section 7240 that once the IP has been developed, the IP must be signed and dated by the individual, LAR and the program provider to verify that they have participated in the development of the IP. Minor wording changes were made in other sections.

Acronyms (CARE)

Revision 10-0; Effective June 1, 2010

AA — adaptive aids

AAR — adaptive aid requisition fee

ACT — action code (what CARE screen do you want to go to?)

AU — Audiology

BES — Behavioral Support

CMM — case management (not self-directed)

CMMB — case management (self-directed)

COMP — component code

CS — Community Support

DE — Dental

DH — Day Habilitation

DI — Dietary

EA — Employment Assistance

FC — Foster/Companion Care

FMSV — Financial Management Services (self-directed service)

ICN — internal control number

LCN — local case number

MHM — minor home modification

MHMRE — minor home modification requisitions fee

NU — Nursing

NUL — Nursing LVN

NULS — Nursing Specialized LVN

NUR — Nursing RN

NURS — Nursing Specialized RN

OT — Occupational Therapy

PA — prior approval

POS — place of service

PS — Psychological Services

PT — Physical Therapy

RA — reimbursement authorization

RE — Respite

REH — Respite Hourly

RES Type — Residential Type

RSS — Residential Support Services

SCV — support consultation (self-directed)

SE — Supported Employment

SHL — Supported Home Living

SL — Supervised Living

SP — Speech/Language Pathology

Acronyms

Revision 10-0; Effective June 1, 2010

AAA — area agencies on aging

AAIDD — American Association of Intellectual and Developmental Disabilities

ABL — adaptive behavior level

ADA — Americans with Disabilities Act

AFC — Adult Foster Care

APS — Adult Protective Services

ARD — Admissions, Review and Dismissal Meeting

CAP — corrective action plan

CARE — Client Assignment and REgistration System

CDS — Consumer Directed Services

CDSA — Consumer Directed Services Agency

CFR — Code of Federal Regulations

CHIP — Children’s Health Insurance Program

CLASS — Community Living Assistance and Support Services

CLO — Community Living Option

CMS — Centers for Medicare and Medicaid Services (formerly HCFA)

CPS — Child Protective Services

CPT — current procedural terminology

CRCG — Community Resource Coordination Group

CSIL — Community Services Interest List

DADS — Department of Aging and Disability Services

DAHS — Day Activity and Health Services

DARS — Department of Assistive and Rehabilitative Services

DBMD — Deaf Blind with Multiple Disabilities

DD — developmental disability

DFPS — Department of Family and Protective Services

DID — determination of intellectual disability

DME — durable medical equipment

DSHS — Department of State Health Services

DVM — Data Verification Manual

ECI — Early Childhood Intervention

EMR — Employee Misconduct Registry

EPSDT — Early Periodic Screening, Diagnosis and Treatment

ETA — electronic transmission agreement

FDP — family directed plan

FFS — fee-for-service

FY — fiscal year

GR — general revenue

HCPCS — Healthcare Common Procedure Coding System

HCS — Home and Community-based Services Waiver

HCSSA — Home and Community Support Services Agency

HHSC — Health and Human Services Commission

HIPAA — Health Insurance Portability and Accountability Act

ICAP — Inventory for Client and Agency Planning

ICF/ID — intermediate care facility for persons with intellectual disability

ID — intellectual disability

ICF/ID-RC — intermediate care facility for persons with intellectual disability or related conditions

IDT — interdisciplinary team

IP — Implementation Plan

IPC — Individual Plan of Care

IQ — intelligence quotient

LAR — legally authorized representative

LOC — level of care

LON — level of need

LTC — Long Term Care

LVN — Licensed Vocational Nurse

MAO — medical assistance only

MCAC — Medical Care Advisory Committee

MDU — Multiple Disabilities Unit (State Hospitals)

ME — Medicaid eligibility

MEPD — Medicaid Eligibility for the Elderly and Persons with Disabilities (formerly MAO)

MERP — Medicaid Estate Recovery Program

MN — medical necessity

MR/RC — mental retardation/related condition

NAR — Nurse Aide Registry

NF — nursing facility

NPO — New Provider Orientation

OBRA — Omnibus Budget Reconciliation Act

OIG — Office of Inspector General

PAO — Licensed Vocational Nurse

PASARR — Preadmission Screening and Resident Review

PCP — primary care physician

PCS — Personal Care Services

PDP — Person-Directed Plan

PE — Program Enrollment

PI — Promoting Independence

PMRA — Persons with Mental Retardation Act

POC — plan of correction

PP — Permanency Planning

QA — Quality Assurance

QDDP — Qualified Developmental Disability Professional (used only in SSLCs)

QI — Quality Improvement

QIDP — Qualified Intellectual Disability Professional

QMB — Qualified Medicare Beneficiary

RC — related condition

RN — Registered Nurse

RSDI — Retirement Survivors Disability Income

SSLC — state supported living center

SASO — Service Authorization System Online

SAVERR — System for Application, Verification, Eligibility Referral and Reporting

SC — service coordination/coordinator

SDO — service delivery option

SPT — service planning team

SLMB — Specified Low-Income Medicare Beneficiary

SSA — Social Security Administration

SSDI — Social Security Disability Income

SSI — Supplemental Security Income

SW — social work

TAC — Texas Administrative Code

TANF — Temporary Assistance for Needy Families

TCM — targeted case management

TGC — Texas Government Code

GHRC — Texas Human Resources Code

THSC — Texas Health and Safety Code

TIERS — Texas Integrated Eligibility and Redesign System

TMHP — Texas Medicaid and Healthcare Partnership

TxHmL — Texas Home Living Waiver

VOFC — verification of freedom of choice

WCA — waiver contract area

WS/C — Waiver Survey and Certification

HCS Contact Us

For questions about the Home and Community-based Services Handbook, email: hcspolicy@hhsc.state.tx.us

For technical or accessibility issues with this handbook, email: form.handbook.request@hhs.texas.gov