Revision 19-4; Effective September 9, 2019

House Bill 3 of the 59th Legislature (1965) created the structure now known as the local intellectual and developmental disability authority (LIDDA). In the 1960s, the state moved to provide mental health and intellectual disability services in the community rather than in institutions. Community centers were created to provide community-based services and address the needs of persons returning to their communities from state supported living centers (SSLCs), Medicaid-certified nursing facilities and state hospitals. Each center has a designated local service area comprised of one or more Texas counties.

The LIDDA was developed as a means for the state to delegate its authority and responsibilities related to planning, policy development, coordination, resource allocation, resource development, and oversight of community intellectual and developmental disability (IDD) services throughout the state. The state is required to contract with the designated LIDDAs and provides funding for the delegated functions and for required community-based services to be provided in each service area.

In the Texas Health and Safety Code, Title 7, Subtitle A, Chapter 533A, §533A.0355, and in Texas Administrative Code, Title 40, Part 1, Chapter 2, Subchapter G, §2.305 (LIDDA’s Role and Responsibilities), each LIDDA serves as the single point of access to certain publicly funded services and supports for the residents within the LIDDA's local service area. A LIDDA's responsibilities include:

• providing information about IDD services and supports;
• ensuring a person’s access into IDD services and supports by:
  • conducting intake and eligibility activities for persons seeking services and supports; and
  • enrolling or admitting an eligible person into IDD services and supports, including the following Medicaid programs:
    • Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID), which includes SSLCs;
    • Home and Community-based Services (HCS);
    • Texas Home Living (TxHmL); and
    • Non-Waiver Community First Choice (CFC);
• conducting interest list management functions for HCS and TxHmL;
• performing safety net functions;
• ensuring the provision and oversight of general revenue services by:
  • developing and managing a network of general revenue services providers; and
  • establishing processes to monitor the performance of general revenue services providers;
• providing service coordination;
• conducting utilization management for general revenue services;
• planning for the local service area and ensuring involvement by a local advisory committee and other stakeholders;
• conducting permanency planning for certain persons under 22 years of age;
• conducting Preadmission Screening and Resident Review (PASRR) evaluations;
• protecting the health, safety and rights of a person; and
• for institutional residents:
  • presenting community living options to SSLC residents; and
  • providing a continuity of services for persons who are leaving an SSLC;
• for nursing facility (NF) residents, ensuring the provision of:
  • specialized services;
  • habilitation coordination; and
  • community living options (CLOs).

Revision 19-4; Effective September 9, 2019

Acronym	Definition
ABL	Adaptive Behavioral Level
APC	Admission Placement Coordinator
CARE	Client Assignment and Registration System
CCAD	Community Care for Aged and Disabled
CDS	Consumer Directed Services
CFC	Community First Choice
CLASS	Community Living Assistance and Support Services
CLCP	Community Living Discharge Plan
CMS	Claims Management Services
CPS	Child Protective Services
CSIL	Community Services Interest List
DBMD	Deaf Blind with Multiple Disabilities
DFPS	Department of Family and Protective Services
DID	Determination of Intellectual Disability
ECC	Enhanced Community Coordination
HCS	Home and Community-based Services
HHSC	Texas Health and Human Services Commission
HPO	Health Plan Operations
ICF/IID	Intermediate Care Facility for Individuals with an Intellectual Disability or Related Conditions
ICAP	Inventory for Client and Agency Planning
IDD	Intellectual and Developmental Disability
IDD-PES	Intellectual and Developmental Disability – Program Eligibility and Support
IDD-EVPS	Intellectual and Developmental Disability – Eligibility Verification and Program Support
ID/RC	Intellectual Disability/Related Condition Assessment
IP	Implementation Plan
IPC	Individual Plan of Care
LAR	Legally Authorized Representative
LIDDA	Local Intellectual and Developmental Disability Authority
LOC	Level of Care
LON	Level of Need
LPDS	Local Procedure Development and Support
LTC	Long Term Care
MCO	Managed Care Organization
MDCP	Medically Dependent Children Program
MEPD	Medicaid for the Elderly and People with Disabilities
MERP	Medicaid Estate Recovery Program
MRA	This acronym is still used in the CARE System but has been replaced with LIDDA.
NF	Nursing Facility
PACE	Program of All-Inclusive Care for the Elderly
PASRR	Preadmission Screening and Resident Review
PCP	Person-Centered Planning
PDP	Person-Directed Plan
PPI	Program Enrollment/Utilization Review
QIDP	Qualified Intellectual Disability Professional
SA	Service Authorization
SASO	Service Authorization System Online
SC	Service Coordinator
SG	Service Group
SPT	Service Planning Team
SPW	STAR+PLUS Waiver
SSA	Social Security Administration
SSI	Supplemental Security Income
SSLC	State Supported Living Center
TCM	Targeted Case Management
TIERS	Texas Integrated Eligibility Redesign System
TMHP	Texas Medicaid & Healthcare Partnership
TxHmL	Texas Home Living

Revision 19-4; Effective September 9, 2019

Local intellectual and developmental disability authorities (LIDDAs) are responsible for conducting person-directed planning as the foundation for service delivery for persons receiving general-revenue (GR) funded services, Community First Choice (CFC) and persons enrolling in the Home and Community-based Services (HCS) and Texas Home Living (TxHmL) programs.

LIDDAs must use a person-directed planning process that is consistent with Texas Health and Human Services Commission (HHSC) Person Directed Planning Guidelines.

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

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

The result of person-directed planning must reflect the essential elements of the person’s desired life in sufficient detail, so the program provider understands how to provide services to meet the person’s outcomes.

HHSC approved Person-Directed Planning training is found online at Person-Centered Planning (PCP) Training for Providers.

3100 Discovering the Person

Revision 19-4; Effective September 9, 2019

The person’s strengths and needs are the basis for the entire process and 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 person 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 person, legally authorized representative (LAR) and others who know and support the person, such as caregivers, close family members, current provider staff, friends and teachers. Effective discovery includes:

• communicating and listening skills;
• developing a relationship;
• creating a distraction-free environment; and
• identifying and acknowledging non-verbal communication cues.

The person-directed planning Discovery Guide and Discovery Tool are central resources to utilize when beginning the discovery process.

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

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

3200 PDP

Revision 19-4; Effective September 9, 2019

Before developing the Person-Directed Plan (PDP), the service coordinator (SC) should discuss with the person and legally authorized representative (LAR) the importance of the provider being included when the person discusses his/her preferences and outcomes. Since the provider will be responsible for designing and providing the services to the person, understanding the person’s strengths, capabilities and desires is critical to providing services that are meaningful to the person. The SC should request permission from the person/LAR to invite the provider to the planning meeting to develop the PDP. The SC should also ask the person/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 program services are decided upon. Or, it can be a meeting in which the discovery information is presented and clarified and then program services are negotiated.

The SC should have a thorough understanding of the services in the program so that connections can be made between what the person wants to have happen and the program service array. Reviewing the Program Billing Guidelines for Targeted Case Management, Home and Community based Services (HCS) and Texas Home Living (TxHmL), discussions with the person’s program provider and consultation with the LIDDA’s service coordination supervisor can support this understanding.

3210 Developing the PDP for Persons in GR

Revision 19-4; Effective September 9, 2019

If the designated local intellectual and developmental disability authority (LIDDA) determines a person is eligible for, and desires service coordination, the LIDDA must develop and implement policies and procedures related to enrollment into general revenue (GR) services that address:

• developing a written plan of services and supports that uses a person-directed planning process that is consistent with the Person-Directed Planning Guidelines, including:
  • current services and supports, including existing natural supports;
  • outcomes to be achieved by the person and the GR services to be provided to the person;
  • an assessment to be conducted after enrollment;
  • the reason for each GR service to be provided; and
  • the amount and duration of each GR service identified in the plan; and
• authorizing the provision of the GR services identified in the plan.

3220 Developing the PDP for Persons in HCS and TxHmL

Revision 19-4; Effective September 9, 2019

The Person-Directed Plan (PDP) has two elements plus instructions:

• Form 8665-ID, Individual Data, completed by the SC at the time of enrollment and updated as necessary thereafter.
• Form 8665, Person-Directed Plan, is the form used to document a person’s PDP.

The Service Planning Team (SPT) is responsible for determining whether a person’s program service is critical to meeting the person’s health and safety needs. The program provider must develop a written backup plan for each program service identified on the PDP as critical to meeting a person’s health and safety. Because Home and Community-based Services (HCS) program providers must ensure that trained and qualified staff are always available for the provision of residential support and supervised living, a backup plan is not needed for these services. Backup plans for host home must be documented in the service agreement the host home provider has with the program provider.

The SPT is responsible for documenting that the services on the PDP:

• are necessary for the person to continue living in the community;
• ensure the person’s health and safety;
• prevent the need for institutional services;
• meet each type of service component note in the PDP and is appropriate to meet desired outcomes or needs of the person;
• does not replace existing supports for each service, natural supports or other sources for the service, such as Texas Workforce Commission, for funding of supported employment services; and
• are cost effective.

For an enrollment PDP, the service coordinator (SC) is responsible for justifying both the need and the amount for each service type in the PDP.

For PDP renewals and PDP updates, refer to the Home and Community-based Services Handbook.

Revision 19-4; Effective September 9, 2019

A service authorization (SA) for Targeted Case Management (TCM) is created in the Service Authorization System Online (SASO) for all Medicaid recipients receiving service coordination from a local intellectual and developmental disability authority (LIDDA).

4100 Creating a TCM Service Authorization in SASO

Revision 19-4; Effective September 9, 2019

For persons enrolled in Home and Community-based Services (HCS) or Texas Home Living (TxHmL), or Medicaid recipients receiving service coordination from a local intellectual and developmental disability authority (LIDDA), the first billing for a Target Case Management (TCM) event results in a service authorization, which is effective for one year after the first TCM event.

The service authorization (SA) is identified in SASO as Service Group (SG) 14 or “SG 14 SA,” which is associated with TCM provided by a LIDDA.

4200 Requesting an Existing TCM Service Authorization be Closed

Revision 19-4; Effective September 9, 2019

If a person with SG 14 service authorization (SA) enrolls in another Texas Health and Human Services Commission (HHSC) program in which receiving Target Case Management (TCM) is mutually exclusive with receiving services through the other program, such as Community Living Assistance and Support Services (CLASS), the person’s existing TCM SA must be closed. If the SG 14 SA is open, the SA for the other program cannot be entered in the Service Authorization System Online (SASO) because the two are mutually exclusive. Furthermore, the local intellectual and developmental disability authority (LIDDA) has no ability to manually close the TCM SA.

4210 HHSC Staff Requests

Revision 19-4; Effective September 9, 2019

If Texas Health and Human Services Commission (HHSC) is notified that a person who has an open service authorization (SA) for Targeted Case Management (TCM) will be enrolling in another HHSC program that is mutually exclusive with TCM, the appropriate regional HHSC Regional Claims Management Services (CMS) coordinator is contacted to resolve the mutually exclusive SA issue. The regional CMS coordinator contacts the designated HHSC staff in the Local Procedure Development and Support Unit. The designated staff:

• follows up with the appropriate local intellectual and developmental disability authority (LIDDA) to ensure the LIDDA staff are aware of the person’s change in program and to confirm that TCM will not be provided after the person’s enrollment date for the other HHSC program; and
• notifies the regional CMS coordinator that the LIDDA is aware that the person’s TCM service authorization will be or has been closed.  

The regional CMS coordinator enters an end date for the SG 14 SA in Service Authorization System Online (SASO).

4220 LIDDA Requests

Revision 19-4; Effective September 9, 2019

If the local intellectual and developmental disability authority (LIDDA) is notified that a person with an SG 14 service authorization (SA) will be enrolled in a Texas Health and Human Services Commission (HHSC) program that is mutually exclusive to Targeted Case Management (TCM), the LIDDA:

• identifies the regional Claims Management Services (CMS) coordinator for the LIDDA’s area;
• informs the regional CMS coordinator that the person is enrolling in an HHSC program that is mutually exclusive to TCM;
• requests that the regional CMS coordinator close the person’s service authorization for TCM; and
• does not provide TCM to the person after their enrollment in the HHSC program that is mutually exclusive to TCM.

The regional CMS coordinator enters an end date for the SG 14 SA in SASO.

4300 List of Regional CMS Coordinators

Revision 19-4; Effective September 9, 2019

Texas Health and Human Services Commission (HHSC) regional Claims Management Services (CMS) coordinators are assigned to specific regions in the state. The list of coordinators by region and their contact information is found here.

4400 Billing Resolutions Request

Revision 19-4; Effective September 9, 2019

Form 1595, Billing Resolutions Request, is available for a local intellectual and developmental disability authority (LIDDA) to communicate billing issues to the regional Claims Management Services (CMS) coordinator.

Revision 19-4; Effective September 9, 2019

5100 HCS, TxHmL, or PASRR Persons with IDD

Revision 19-4; Effective September 9, 2019

For a person enrolled in the Home and Community-based Services (HCS) Program, Texas Home Living (TxHmL) Program or a resident of a nursing facility (NF), the person’s designated local intellectual and developmental disability authority (LIDDA) is the LIDDA for the local service area in which the person resides.

5200 Community First Choice (CFC)

Revision 19-4; Effective September 9, 2019

For a person determined eligible for, enrolling in, or enrolled in CFC services provided through a Medicaid managed care organization (MCO), the person’s designated local intellectual and developmental disability authority (LIDDA) is the LIDDA for the local service area in which the person resides.

5300 All Others

Revision 19-4; Effective September 9, 2019

For a person who is not described previously in this section, the following guidelines are used to determine the person’s designated local intellectual and developmental disability authority (LIDDA):

• If an adult person does not have a legally authorized representative (LAR), the person’s designated LIDDA is the LIDDA for the local service area in which the person resides.
• If an adult person does not have an LAR and resides in a state supported living center (SSLC), the person’s designated LIDDA is the LIDDA that recommended his or her admission to the SSLC.
• If an adult or minor person has an LAR, then the designated LIDDA is the LIDDA for the local service area in which the LAR resides.
• If an adult or minor person has an LAR who does not live in Texas, then the designated LIDDA is the LIDDA for the local service area in which the person resides.
• If an adult person’s LAR is the Health and Human Services Commission (HHSC), then the designated LIDDA is the LIDDA for the local service area in which the county court of jurisdiction for the guardianship is located.
• If a minor person’s LAR is the Department of Family and Protective Services (DFPS), then the designated LIDDA is the LIDDA for the local service area in which the minor person resides, if the minor person is receiving DFPS services and residing with a kin caregiver or in a foster family home or foster group home in which the primary caregiver is a foster parent living in the home; or the LIDDA for the local service area in which DFPS obtained conservatorship, if the minor person is receiving DFPS institutional services.

5400 Unique Situations

Revision 19-4; Effective September 9, 2019

At its discretion, Texas Health and Human Services Commission (HHSC) may determine the designated local intellectual and developmental disability authority (LIDDA) for any person or assign a LIDDA the duties of the designated LIDDA for any person.

A non-designated LIDDA is not prohibited from serving a person who is currently being served by his/her designated LIDDA. In such a situation, the designated LIDDA must enter in an agreement with the non-designated LIDDA to provide the service. The designated LIDDA reports all service encounters for the person.

The determination of the designated LIDDA, for intellectual and developmental disability (IDD) services, is not relevant to a person’s admission to a state mental health facility.

Revision 22-2; Effective July 22, 2022

6100 Definitions

Revision 22-2; Effective July 22, 2022

In this section, the following terms are defined as follows:

Actively involved party – For a person who lacks the ability to provide legally adequate consent and who does not have a legally authorized representative, someone whose significant and ongoing involvement with the person and is supportive of the person, as determined by the local intellectual and developmental disability authority (LIDDA). The LIDDA’s determination is based on:

• observed interactions between the actively involved party and the person;
• the actively involved party’s knowledge of, and sensitivity to, the person’s preferences, values and beliefs;
• the actively involved party’s availability to the person for assistance or support; and
• the actively involved party’s advocacy for the person’s preferences, values and beliefs.

Alternate correspondent – The person with whom the LIDDA communicates in an attempt to reach the primary correspondent should the LIDDA not be able to get in touch with the primary correspondent.

Legally authorized representative (LAR) – Has the meaning assigned in the Continuity of Services Rule – State Facilities, Title 40, Texas Administrative Code, Chapter 2, Subchapter F. A person authorized by law to act on behalf of a person in the manner described in this subchapter, and may include a parent, guardian, or managing conservator of a minor, or the guardian of an adult.

LIDDA community services and supports – Services and supports funded by state general revenue and local funds through the LIDDA Performance Contract.

Person – Someone seeking or receiving services and supports.

Primary correspondent – The person with whom the LIDDA communicates regarding services for a person. A primary correspondent can be the person. If it is not the person, then it is usually the LAR, a family member of the person, or an actively involved party. For the intake process, the primary correspondent is the person who identifies the preferred services for the information on Form 8648, Identification of Preferences.

6200 Inquiries for Information

Revision 20-4; Effective October 15, 2020

In response to an inquiry for information about programs and services for a person with intellectual and development disabilities (IDD), the local intellectual and developmental disability (LIDDA) must provide or mail to the person and legally authorized representative (LAR) or actively involved party:

• an explanation of services and support using the HHSC Explanation of IDD Services and Supports. The LIDDA may supplement the Explanation of IDD Services and Supports by adding a description of services and supports unique to the LIDDA’s local service area. LIDDAs must not delete or modify any information in the Explanation of IDD Services and Supports;
• a copy of Long Term Services and Supports;
• the current contact list for all LIDDAs, Area Agencies on Aging, and Texas Health and Human Services Commission (HHSC) local community services offices;
• an explanation of the different type of residential options using the Residential Options brochure, if the person is seeking residential services. The LIDDA must add its contact information to the document. LIDDAs must not delete or modify any other information in the brochure;
• a copy of the Employment Guide for People with Disabilities PDF, if the person is interested in employment; and
• an explanation of permanency planning using A Message for Families, if the person is under 22 years of age seeking residential services. The LIDDA must add its contact information to the document.

Although the LIDDA is required to provide the person and LAR or actively involved party an explanation of services and supports, the primary correspondent may choose to identify preferred services and supports before receiving the explanation, such as by phone or email. In such cases, the LIDDA will provide an oral explanation and provide or mail the preceding documents after Form 8648, Identification of Preferences, has been completed.

The LIDDA must ensure encounter data is captured and document the following from the contact notes:

• date of the inquiry;
• name of the person identified to received services and supports;
• name and address of the party making the inquiry and their relationship to the person;
• the summary of the discussion specific to the person (using a template is not person specific and should not be used);
• date of the mailing, if applicable; and
• other information, as needed.

If the LIDDA provides an explanation of programs and services to an LAR who is not a family member of the person, the LIDDA must provide an oral and written explanation of programs and services to at least one family member of the person, if possible, per Texas Government Code, §531.042 and 40 Texas Administrative Code, Chapter 2, Subchapter G, §2.307(b)(1)(A).

6300 Documenting and Maintaining a Record of a Person’s Preferences for Services and Supports

Revision 20-4; Effective October 15, 2020

When a person and legally authorized representative (LAR) or actively involved party is ready to identify a preference for services and supports, the local intellectual and developmental disability authority (LIDDA) will: 

• assist the person and LAR or actively involved party, face-to-face, if possible, to identify the types of services and supports being requested based on the person’s interests, needs and desired outcomes;
  • For minors-only, the LAR can identify types of services and supports.
• document the identified preferred services and supports on Form 8648, Identification of Preferences (detailed instructions are available online);
  • The “Date of Discussion” on Form 8648 is the date the person, LAR or actively involved party discussed the choice of preferred services with the LIDDA.
  • If the preferred services and supports are identified with the person, LAR or actively involved party present, the LIDDA must ensure completion of Form 8648 and the person, LAR or actively involved party must sign and date the form.
  • If the preferred services and supports are identified without the person, LAR or actively involved party present, the LIDDA must write "by phone" on the signature line. As a suggested best practice, a signature should be obtained at the next face-to-face meeting.
• give or mail the person, LAR or actively involved party a copy of the completed Form 8648;
• document the summary of the discussion specific to the person (using a template is not person specific and should not be used); and
• retain the original Form 8648, or an electronic copy of the original form in a PDF format, in the LIDDA’s file for the person until after the person has enrolled in, or received, every identified preferred service. The form should remain in an accessible LIDDA file.

6400 LIDDAs and the Primary Correspondent

Revision 20-4; Effective October 15, 2020

The local intellectual and developmental disability authority (LIDDA) must inform the following to a person who identified a preference for services and supports on Form 8648, Identification of Preferences:

• The name and contact information of a primary correspondent so the LIDDA can direct all inquiries which must be provided to the LIDDA and must be updated if the information changes.
• The primary correspondent may change service support preferences as documented on Form 8648 at any time upon request by completing a new Form 8648.

6500 LIDDAs and the Alternate Correspondent

Revision 20-4; Effective October 15, 2020

The local intellectual and developmental disability authority (LIDDA) may contact the alternate correspondent if they cannot reach the primary correspondent for inquiries. The primary correspondent is still the only person with the ability to change service support preferences documented on Form 8648, Identification of Preferences, at any time upon request by completing a new Form 8648.

6600 Identified Services and Supports

Revision 20-4; Effective October 15, 2020

If the preferred service and support identified on Form 8648, Identification of Preferences, is:

• Home and Community-based Services (HCS) or Texas Home Living (TxHmL), the local intellectual and developmental disability authority (LIDDA) will follow the instructions in 7000, HCS and TxHmL Interest Lists.
• HCS only, will complete Form 8577, Questionnaire for LTSS Waiver Program Interest Lists, with the person and LAR or actively involved party.
• State supported living center (SSLC) or intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID), the LIDDA will begin the enrollment or admission process described in 40 Texas Administrative Code Chapter 2, Subchapter F, or Chapter 9, Subchapter E, as appropriate.
• LIDDA community services, the LIDDA will begin the eligibility determination process as soon as possible as local resources allow.
• Community First Choice (CFC) Services, the LIDDA will refer the person to his or her Medicaid managed care organization (MCO).

Revision 22-2; Effective July 22, 2022

Texas Health and Human Services Commission (HHSC) maintains interest lists for Long-term Care Services and Supports (LTSS) waiver programs in the Community Services Interest List (CSIL) application on the HHS Enterprise Portal. Home and Community-based Services (HCS) and Texas Home Living (TxHmL) interest lists are a collection of persons’ data who have requested program services and must wait until resources become available for their services. CSIL compiles the HCS and TxHmL interest list information throughout the state to create the statewide HCS and TxHmL interest lists. HHSC uses the statewide interest lists to offer HCS and TxHmL program services to people on the lists. The person with the longest time on the interest list is served first.

A CSIL record is created for the person, which includes the person’s demographic and contact information and the information collected on Form 8577, Questionnaire for LTSS Waiver Program Interest List. After the CSIL record is created, each program identified as a program of interest by a person’s primary correspondent on Form 8648, Identification of Preferences is added to the person’s CSIL record.

If HCS or TxHmL is identified on Form 8648, the person’s designated local intellectual and developmental disability authority (LIDDA) adds the program’s interest list to the person’s CSIL record. A person’s interest list begin date is referred to as the “Request Date.” 

Other HHSC waiver program interest lists maintained in CSIL are Medically Dependent Children Program (MDCP), Community Living Assistance and Support Services (CLASS), Deaf Blind with Multiple Disabilities (DBMD), and State of Texas Access Reform Plus (STAR+PLUS) waiver programs.

To request placement on these HHSC waiver programs, the person, LAR or actively involved party must call the CSIL hotline at 877-438-5658.

Per the LIDDA Performance Contract, all LIDDAs are required to maintain continuous access to CSIL.

7100 Definitions

Revision 22-2; Effective July 22, 2022

In this section, the following terms are defined as follows:

Actively involved party – For a person who lacks the ability to provide legally adequate consent and who does not have a legally authorized representative, someone whose significant and ongoing involvement with the person is supportive of the person, as determined by the local intellectual and developmental disability authority (LIDDA). The LIDDA’s determination is based on:

• observed interactions between the actively involved party and the person;
• the actively involved party’s knowledge of, and sensitivity to, the person’s preferences, values and beliefs;
• the actively involved party’s availability to the person for assistance or support; and
• the actively involved party’s advocacy for the person’s preferences, values and beliefs.

Legally authorized representative (LAR) – Has the meaning assigned in the Continuity of Services Rule – State Facilities, Title 40, Texas Administrative Code, Chapter 2, Subchapter F. A person authorized by law to act on behalf of a person with regard to a matter described in this subchapter, and may include a parent, guardian, or managing conservator of a minor, or the guardian of an adult.

Person – Someone seeking or receiving services and supports.

Primary correspondent – The person with whom the LIDDA communicates regarding services for a person. A primary correspondent can be the person. If it is not the person, then it is usually the person’s LAR, a family member of the person, or an actively involved person. For a person on the Home and Community-based Services (HCS) and Texas Home Living (TxHmL) interest list, it’s the person with whom the LIDDA maintains contact with for biennial contacts and to make an offer for HCS or TxHmL services when resources become available.

7200 Maintenance of the HCS and TxHmL Interest Lists

Revision 22-2; Effective July 22, 2022

Each local intellectual and developmental disability authority (LIDDA) is responsible for maintaining the Home and Community-based Services (HCS) and Texas Home Living (TxHmL) interest lists for its local service area. Using the Community Services Interest List (CSIL) application, LIDDAs are responsible for:

• creating a new CSIL record or updating an existing CSIL record for persons who are interested in receiving HCS or TxHmL Program services;
• adding the HCS or TxHmL interest list to the person’s CSIL record; and
• conducting a biennial contact with the primary correspondent for each person on its HCS or TxHmL interest list to ensure the primary correspondent’s contact information is current and the person remains interested in the HCS or TxHmL Program.

7210 Active Military Families

Revision 22-2; Effective July 22, 2022

Texas Health and Human Services Commission (HHSC) adopted rules to ensure active duty military members and their dependents, who have declared and maintained Texas as the member’s home of record, maintain their position on interest lists or other waiting lists for certain health and human services assistance programs.

If the person’s family has temporarily moved out of Texas due to active military service and the family wants the person to remain on the interest list, the person’s family must provide non-Texas contact information to enable the local intellectual and developmental disability authority (LIDDA) to make biennial contact. A non-Texas contact is acceptable in this situation.

Following the instructions in the Community Services Interest List (CSIL) User Guide for LIDDAs, LIDDAs must:

• add the identified interest lists to a person’s CSIL record as mentioned in this section;
• contact the primary correspondent of each person whose HCS or TxHmL interest list status is “Interested” during each term of the LIDDA Performance Contract to verify continued interest in the HCS or TxHmL programs; 
• check or uncheck the “Active Military” checkbox to indicate the family’s current military duty status at each biennial contact, or any other time the LIDDA becomes aware of a change; and 
• update the person and primary correspondent contact information in CSIL at least biennially [see 7550, Discussions and Documentation, and 7560, Entering Biennial Contact in CSIL].

If the person or primary correspondent is no longer interested in HCS or TxHmL services and the “Active Military” checkbox is unchecked, see Section 7700, Closing a Person’s HCS or TxHmL Interest List.

If the person or primary correspondent is no longer interested in HCS or TxHmL services and the “Active Military” checkbox is checked, the LIDDA must:

• notify HHSC via email and submit documentation identified in Section 7700 to: LIDDARequests@hhs.texas.gov (HHSC will close the person’s interest list record; and
• follow the retention policy for Form 8648, Identification of Preferences, as stated in 6300, Documenting and Maintaining a Record of a Person’s Preferences for Services and Supports.

7300 Creating a CSIL Record

Revision 22-2; Effective July 22, 2022

Before creating any Community Services Interest List (CSIL) record, the LIDDA must do the following:

• Follow the steps in the CSIL User Guide for LIDDAs to verify whether the person has an existing CSIL record. If a CSIL record exists, the LIDDA must update the existing CSIL record instead of creating a new record.
• Create a new CSIL record or update the existing CSIL record. 
• If the person does not have a Client Assignment and Registration identification number (CARE ID), register the person in the CARE system to receive a system generated CARE ID and assign a local case number. A person must be registered in the CARE system for a CSIL record to be created.
• For HCS only: Complete Form 8577 , Questionnaire for LTSS Waiver Program Interest Lists and add the information collected on Form 8577 to the person’s CSIL record.

7310 Adding HCS or TxHmL to a CSIL Record

Revision 22-2; Effective July 22, 2022

Eligibility for the Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Programs is determined by Texas Health and Human Services Commission (HHSC) only at the time the person has been offered the opportunity to enroll in the waiver program.

If the person, LAR or actively involved party identifies HCS or TxHmL as preferred services on Form 8648, Identification of Preferences, the LIDDA must:

• Ensure the completion of all areas on Form 8591, Community Services Interest List (CSIL) Data Entry and retain a copy in the person’s record following the LIDDAs retention policy.
• Ensure the basic identifying information includes a Texas address for the primary correspondent or the person.
  • If the person’s family has temporarily moved out of Texas due to active military service and the family wants the person to be added to the interest list, the person’s family must provide contact information to enable the LIDDA to make biennial contact. A non-Texas contact is acceptable in this situation.
• Using the information collected on Form 8591, add the HCS or TxHmL interest list (or both) to the person’s CSIL record following the instructions in the CSIL User Guide for LIDDAs; and

Add the program interest list to the person’s CSIL record as soon as possible to avoid errors. CSIL only allows the LIDDA 60 days from the “Date of Discussion” on Form 8648 to add the program interest list to the person’s CSIL record. If the data entry is not done within 60 days, see 7900, Requesting Changes to a Person’s HCS or TxHmL Interest List.

The LIDDA must ensure the person’s exact date of birth is reflected in CSIL. It may not be an estimation.

A person’s statewide interest list rank will display the next business day after the program interest list is added to the person’s CSIL record.

7320 Two or More CSIL Records for the Same Person

Revision 22-2; Effective July 22, 2022

If a person has more than one CSIL record, the local intellectual and developmental disability authority (LIDDA) must:

• contact all other LIDDAs involved in the record duplicity; and
• send an email to LIDDARequests@hhs.texas.gov and request that the CSIL records be merged. HHSC will ensure the person’s earliest HCS or TxHmL interest list request dates are retained in the merged record.

7330 People Under 22 Years Old Regarding ICF/IID and NFs – For HCS Only

Revision 22-2; Effective July 22, 2022

If the person is under 22 years old and is admitted or admitting into an intermediate care facility for individuals with an intellectual disability or related conditions, including a state supported living center or a nursing facility, the local intellectual and developmental disability authority (LIDDA) must inform the LAR of the state statute requiring the person to be on the Home and Community-based Services (HCS) interest list.

If the person was not on the HCS interest list before the facility admission date, the person will be automatically added to the HCS interest list by HHSC’s Information Technology (IT) Field Support with the facility admission date as the interest list “request date.”

The LIDDA should give the LAR the option of declining the biennial contact. See 7510, Exception to Biennial Contact.

7400 Returned Interest List Notification Letters

Revision 22-2; Effective July 22, 2022

Texas Health and Human Services Commission (HHSC) mails out letters via the U.S. Postal Service (USPS) to people recently added to the Home and Community-based Services (HCS) and Texas Home Living (TxHmL) interest lists.

The letter serves as documented evidence that the person is on the HCS or TxHmL interest list. The letter is sent to the primary correspondent using the primary correspondent address on the person’s Community Services Interest List (CSIL) record. If the primary correspondent’s address is incomplete (e.g., no ZIP code), then the letter is sent to the person using the address for the person in CSIL.

When an address in CSIL is incomplete or outdated, the letter is returned to HHSC as undeliverable. Periodically, HHSC sends the undeliverable letters it received from USPS to the local intellectual and developmental disability authority (LIDDA).

The LIDDA must:

• contact the primary correspondent or person to get a current mailing address;
• resend the letter in an envelope with the LIDDA’s return address; and
• update the person’s mailing address in CSIL per the CSIL User Guide for LIDDAs.

To ensure notification letters are not returned, the LIDDA must:

• include a street address, city, state, and ZIP code;
• not enter “same” or “same as person” in the address fields for the primary correspondent;
• remember there is a 35-character limit for a street address; and
• use abbreviations as much as possible (e.g., Dr. for Drive, S. for South, # for Apt).

7500 Biennial Contact

Revision 22-2; Effective July 22, 2022

Each person on the Home and Community-based Services (HCS) and Texas Home Living (TxHmL) interest lists with an interest list status of “Interested” must be contacted by their designated local intellectual and developmental disability authority (LIDDA) during each term of the LIDDA Performance Contract. The LIDDA is required to:

• make at least one contact with the primary correspondent of all persons to verify continued interest in the HCS or TxHmL programs;
• document the contact in the person’s Community Services Interest List (CSIL) record, as instructed in the CSIL User Guide for LIDDAs; and
• update the person’s and primary correspondent’s contact information in CSIL, as instructed in the CSIL User Guide for LIDDAs.

7510 Exception to Biennial Contact

Revision 22-2; Effective July 22, 2022

There is one exception for the biennial contact: people younger than 22 receiving services in an intermediate care facility for individuals with intellectual disabilities or related conditions, including a state supported living center, or a nursing facility whose legally authorized representative (LAR) does not want a biennial contact. Since state statute requires the person to be on the Home and Community-based Services (HCS) interest list, Texas Health and Human Services Commission (HHSC) provides the LARs of these people with the option of declining the biennial contact. If the LAR declines contact, the LIDDA checks the “IDD Contact Declined” checkbox on the person’s Community Services Interest List (CSIL) record and does not conduct a biennial contact with the LAR.

7520 CSIL Reports for Managing Biennial Contacts

Revision 22-2; Effective July 22, 2022

Weekly, monthly, and quarterly reports are available in the Community Services Interest List (CSIL) application for managing interest list biennial contact requirements. These reports must be used to manage the interest list. To ensure the most current information is generated for the report, the local intellectual and developmental disability authority (LIDDA) selects the weekly report from the drop-down menu.

• HC027883.W/M/Q, Interest List Biennial Contacts-Summary shows the number of contacts required, contacts made, contacts not made, and the percentage of contacts completed.
• HC027884.W/M/Q, Interest List Biennial Contacts-Detail provides detailed information for all person’s listed on the HC027883.W/M/Q report. The report is designed to assist LIDDAs in confirming whether a person has been “Contacted” or “Not Contacted.” People younger than 22 residing in an intermediate care facility for individuals with an intellectual disability or related conditions  (including a state supported living center) or nursing facility  whose legally authorized representative has declined the biennial contact are not included in this report.

7530 Preparation for Biennial Contact

Revision 19-4; Effective September 9, 2019

It is important that a LIDDA have documentation that a person requested to be added to the Home and Community-based Services (HCS) or Texas Home Living (TxHmL) interest list(s). Before a biennial contact, a LIDDA should verify that the person’s record contains documentation supporting the request to add the person’s name to the interest list(s). In most cases, the supporting documentation will be Form 8648, Identification of Preferences. Sometimes, the documentation will only be a progress note recording the intake visit.

If supporting documentation is not available, then the local intellectual and developmental disability authority (LIDDA) staff must document in the person’s record the reason why supporting documentation is not available. For instance:

• the person’s name was added to the HCS interest list automatically when the person was under 22 years and residing in an institutional setting; or
• another LIDDA originally registered the person on the interest list.

7540 Effort for Contacting the Primary Correspondent

Revision 22-2; Effective July 22, 2022

Phone or face-to-face contact with the primary correspondent is preferable. If a person on the Home and Community-based Services (HCS) and Texas Home Living (TxHmL) interest lists is currently receiving some services or supports through the local intellectual and developmental disability authority (LIDDA), the biennial contact with the primary correspondent could be conducted face-to-face at the service site. For people not currently receiving services or supports, a combination of phone and mail contacts might be necessary to arrange for a discussion for the biennial contact. 

The following steps may be helpful in finding a person or primary correspondent who has been difficult to locate:

• Check Client Assignment and Registration (CARE) System screens 192 and 193, Medicaid Eligibility Information, which provide Medicaid recipient information, including the address used to mail the Medicaid card (which is under “DHS Case Address”).
• If the person resides in an intermediate care facility (ICF/IID), which includes state supported living centers (SSLCs) or nursing facilities (NFs), call the ICF/IID, SSLC or NF and request the LAR’s name, address and phone number.
• If the person is receiving LIDDA community services and supports, contact the service coordinator or the person directly.

7550 Discussions and Documentation

Revision 22-2; Effective July 22, 2022

For every biennial contact, the local intellectual and developmental disability authority (LIDDA) must:

• confirm with the primary correspondent the continued interest of Home and Community-based Services (HCS) and Texas Home Living (TxHmL) services, if applicable, for the person;
• verify or update contact information for the primary correspondent;
• inform the primary correspondent that it is the primary correspondent’s responsibility to notify the LIDDA of any contact information changes;
• update the person’s Community Services Interest List (CSIL) record to reflect the person’s current preferences; and
• enter the date the contact was made in the “Date of This Contact” field in CSIL.

7560 Entering Biennial Contact Information into CSIL

Revision 22-2; Effective July 22, 2022

The local intellectual and developmental disability authority (LIDDA) must follow the instructions in the Community Services Interest List (CSIL) User Guide for LIDDAs to enter biennial contact information into CSIL. Biennial contact information can be entered at any time, without limitations on data entry dates. The date of the discussion is considered the “Biennial Contact Date.”

After entering the biennial contact in CSIL, the LIDDA must follow instructions in the CSIL User Guide for LIDDAs to update the person’s and primary correspondent’s mailing addresses in CSIL.

7570 Unable to Make Biennial Contact

Revision 22-2; Effective July 22, 2022

If multiple attempts to contact the primary correspondent are unsuccessful the local intellectual and developmental disability authority (LIDDA) must:

• check the “Inactive-Unable to Contact” checkbox on the person’s Community Services Interest List (CSIL) record;
• document the steps taken to reach the primary correspondent and person in the comment field in CSIL; and
• mail a letter to the primary correspondent and person at the last known address.
  • The letter must state that the person’s status on the HCS or TxHmL interest list remains “Interested” but has been flagged as “Inactive-Unable to Locate” and the “Inactive-Unable to Locate” flag will remain in place until the primary correspondent or person responds to the letter.
  • The date on the letter must be the same date the LIDDA checked the “Inactive-Unable to Locate” checkbox in CSIL.

If the LIDDA receives a response from the person or primary correspondent, the LIDDA must:

• explain why the LIDDA changed the person’s status to “Inactive-Unable to Locate;”
• verify continued interest in the HCS or TxHmL programs;
• uncheck the “Inactive-Unable to Contact” checkbox in CSIL;
• update the person’s and primary correspondent’s contact information as noted in 7560, Entering Biennial Contact Information into CSIL;
• update the biennial contact date to be the date the LIDDA had a discussion with the person or primary correspondent;
• remind the person or primary correspondent of the responsibility to notify the LIDDA of any contact information changes; and
• apply Section 7550, Discussions and Documentation.

If the LIDDA does not receive a response from the person or primary correspondent, the “Inactive-Unable to Contact” checkbox remains checked until the person is offered HCS or TxHmL services.

The “Last Updated Date” and “Last Contact Date” fields are automatically generated to match the date the LIDDA updated the CSIL record.

7580 Unable to Make Biennial Contact Regarding Facility Residents

Revision 22-2; Effective July 22, 2022

If multiple attempts to contact the primary correspondent of a resident of an intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID), including a state supported living center (SSLC), or nursing facility (NF), are unsuccessful, the local intellectual and developmental disability authority (LIDDA) must confirm whether the person continues to reside in the ICF/IID, SSLC or NF.

If the person is still a resident, the LIDDA must not check the “Inactive-Unable to Contact” checkbox on the person’s Community Services Interest List (CSIL) record.

• The person must remain active on the interest list until Home and Community-based Services (HCS) or Texas Home Living (TxHmL) is offered.
• Document the steps taken to reach the primary correspondent, as referenced in 7540, Effort for Contacting the Primary Correspondent, can suffice as a biennial contact.
• The “Contact Attempted” date entered in CSIL must be the date the LIDDA was unable to contact the primary correspondent.
• The same steps, as described in Section 7540, must occur in each biennium to contact the primary correspondent.

If the person is no longer a resident of the facility or any other facility, see 7570, Unable to Make Biennial Contact.

7600 CSIL Status Designations

Revision 22-2; Effective July 22, 2022

The Community Services Interest List (CSIL) application maintains a “CARE Status” and an “Interest List Status” for the Home and Community-based Services (HCS) and Texas Home Living (TxHmL) interest lists.

CARE Statuses:

Active – Indicates successful biennial contacts with the primary correspondent.

Inactive – Indicates unsuccessful biennial contacts with the primary correspondent. The LIDDA checks the “Inactive-Unable to Contact” checkbox on the person’s CSIL record.

Interest List Statuses:

Interested

This status indicates that the person is actively interested in HCS or TxHmL services, as applicable. The Community Services Interest List (CSIL) application automatically assigns this status when the local intellectual and developmental disability authority (LIDDA) adds the HCS or TxHmL interest list to a person’s CSIL record.  A LIDDA must make a biennial contact with the primary correspondent of every person with an “Interested” status. The request date must match the “Date of Discussion” on Form 8648, Identification of Preferences.

Release

This status indicates the person has been authorized by Texas Health and Human Services Commission (HHSC) to receive an offer for HCS or TxHmL, as applicable. HHSC will change the person’s interest list status from “Interested” to “Release” on the day HHSC sends the LIDDA the letter authorizing the LIDDA to offer HCS or TxHmL to the person.

Note: Although a “Release” status is not assigned by a LIDDA, a person with a “Release” status may be transferred from one LIDDA to another.

Pre-enrolled

The CSIL application automatically assigns this status when the LIDDA successfully submits an HCS or TxHmL Pre-enrollment Form on the Texas Medicaid & Healthcare Partnership (TMHP) Long-Term Care (LTC) Online Portal for a person who has accepted an HCS or TxHmL offer.

Closed

This is the final interest list status. When a program interest list is closed on the person’s CSIL record, the applicable closure reason must be selected in CSIL. The LIDDA can only close an interest list if the current interest list status is “Interested.” If the current interest list status is anything other than “Interested,” the LIDDA must send an email to liddarequests@hhs.texas.gov. See Section 7700, Closing a Person’s HCS or TxHmL Interest List.

Closure Reasons:

• Client Receiving the Service - The CSIL application automatically closes the interest list and assigns this closure reason when HHSC authorizes a person’s enrollment in the LTC Online Portal.
• Not Functionally Eligible - The CSIL application automatically closes the interest list and assigns this closure reason when HHSC denies a person’s enrollment in the LTC Online Portal due to not meeting the program’s level of care eligibility criteria.
• Denied-Not Financially Eligible - The CSIL application automatically closes the interest list and assigns this closure reason when HHSC denies a person’s enrollment in the LTC Online Portal due to not meeting the program’s financial (Medicaid) eligibility criteria.
• Requested Removal from Interest List – This status indicates the primary correspondent has voluntarily withdrawn the person from the interest list. If a person’s primary correspondent submits a written request to withdraw from the interest list via a signed Form 8648 or signed and dated request, the LIDDA must change the person’s interest list status to closed and select this closure reason. The LIDDA can only close an interest list if the current interest list status is “Interested.” 
• Not a Texas Resident – If the person and the primary correspondent no longer have a Texas address, the LIDDA must change the person’s interest list status to closed and select this closure reason. The LIDDA can only close an interest list if the current interest list status is “Interested.”
  • If the person’s family has temporarily moved out of Texas due to active military service and the family wants the person to remain on the interest list, the person’s family must provide non-Texas contact information to enable the LIDDA to make the biennial contact. A biennial contact must be made, but a non-Texas contact may be used in this situation.
• Death – In the event of the death of a person, the LIDDA must complete the Client Assignment and Registration (CARE) screen 360, Death/Separation to close the person’s CARE records and change the person’s interest list status in CSIL to “Closed” and select this closure reason. The LIDDA can only close an interest list if the current interest list status is “Interested.”
• Opened in Error – This closure reason is available for limited use by the LIDDA in case an error is made when adding HCS or TxHmL to a CSIL record. 

The following Closure Reasons are used by HHSC only:

• Duplicate – HHSC assigns this closure reason when merging duplicate CSIL records.
• Mail Undeliverable/No Working Phone Number – This status indicates the person has been removed from the HCS or TxHmL interest list. HHSC assigns this status on a case-by-case basis, such as when HHSC confirms that a letter withdrawing an offer has been delivered to a person or LAR. See 7700, Removing a Person’s Name from the HCS or TxHmL Interest List.
• Needs Met Through…(other program or facility) – HHSC closes the program interest list on the person’s CSIL record and assigns this closure reason when the person or LAR completes and signs Form 8601, Verification of Freedom of Choice. This indicates the person has declined the opportunity to enroll in the program to remain enrolled in a different HHSC waiver program. HHSC closes the interest list using the date of the person’s signature on the form. 
• Person Refused Due to MERP Provisions – HHSC closes the program interest list on the person’s CSIL record and assigns this closure reason when the person or LAR completes and signs Form 8601. This indicates the person has declined the opportunity to enroll in the program due to the Medicaid Estate Recovery Program (MERP) provisions. HHSC closes the interest list using the date of the person’s signature on the form.
• Other– HHSC closes the program interest list on the person’s CSIL record and assigns this closure reason when the person or LAR completes and signs Form 8601. This indicates the person has declined the opportunity to enroll in the program for a reason other than “Needs Met Through...” or “Person Refused Due to MERP Provisions,” or HHSC assigns this status on a case-by-case basis, such as when HHSC confirms that a letter withdrawing an offer has been delivered to a person or LAR.

7610 When to Change the Status of a Person’s HCS or TxHmL Interest List

Revision 22-2; Effective July 22, 2022

A person’s Home and Community-based Services (HCS) and Texas Home Living (TxHmL) interest list is changed when there is a change in the person’s status, as described in 7600, CSIL Status Designations. Once a person is registered with an “Interested” status, the local intellectual and developmental disability authority (LIDDA) does not close the status unless one of the following occurs:

• Primary correspondent voluntarily withdraws the person from the HCS or TxHmL interest list;
• Person and primary correspondent no longer have a Texas address (unless the person’s family has temporarily moved out of Texas due to active military service as described in Section 7210, Active Military Families); 
• Death of the person; or
• Error was made when adding HCS or TxHmL to a Community Services Interest List (CSIL) record. Refer to 7600, CSIL Status Designations.

7700 Closing a Person’s HCS or TxHmL Interest List

Revision 22-2; Effective July 22, 2022

The local intellectual and developmental disability authority (LIDDA) closes a person’s interest list and assigns a closure reason of “Request Removal from Interest List” due to one of the following situations.

If the primary correspondent requests that the person be removed from the Home and Community-based Services (HCS) or Texas Home Living (TxHmL) interest list, the LIDDA must provide a new Form 8648, Identification of Preferences, for the primary correspondent to complete. The primary correspondent must:

• check the box indicating that he or she wants the person to be removed from the HCS or TxHmL interest list; and
• sign and date the form.

Upon receiving a completed, signed, and dated Form 8648, indicating that the person be removed from the HCS or TxHmL interest list, the LIDDA must:

• remove the person from the appropriate interest list by changing the interest list status to “Closed” and selecting the closure reason Request Removal from Interest List using the “Date of Discussion” on Form 8648. The “Date Close” on the Community Services Interest List (CSIL) record, is the date the LIDDA closed the record;
• apply 7550, Discussions and Documentation; and
• maintain, indefinitely, an accessible hard copy or an electronic copy of the new Form 8648 indicating the primary correspondent wanted the person to be removed from the HCS or TxHmL interest list.

If the person moves out of Texas, the LIDDA must:

• document the notification in the person’s record applying Section 7550; and
• remove the person from the appropriate interest list by changing the person’s "Interested” status to ”Closed” with the applicable closure reason —Not a Texas Resident – using the “Date of Discussion” from the received Form 8648. The “Date Closed” on the CSIL record is the date the LIDDA closed the record. Note: This does not apply to active military families.

If the person dies, the LIDDA must:

• contact the Biennial Contact Monitor at LIDDAServiceCoordination@hhsc.state.tx.us if the “Active Military” checkbox is checked; 
• complete CARE screen 360, Death/Separation of Client, to close the CARE records; and 
• change the “Interested” status to “Closed” and selecting the closure reason “Death.” The “Date Closed” on the CSIL record is the date the LIDDA closed the record.

7800 When to Transfer a Person's CSIL Record

Revision 22-2; Effective July 22, 2022

When a local intellectual and developmental disability authority (LIDDA) is informed that a person whose Home and Community-based Services (HCS) or Texas Home Living (TxHmL) interest list status is “Interested,” “Release,” or “Pre-enrolled” is moving or has moved to another LIDDA’s service area, the transferring LIDDA must:

• contact the receiving LIDDA about the transfer;
• fax or securely email all copies of the person’s completed Form 8648, Identification of Preferences, to the receiving LIDDA; and
• transfer the Community Services Interest List (CSIL) record by changing the person’s county of residence on the “Personal Information” page in CSIL. The person’s interest list request date will not change when a person’s CSIL record is transferred to another LIDDA. 
  • IMPORTANT: The LIDDA must change the county of residence on the “Personal Information” page in CSIL. Changing the county of residence on the “Interest List” page will only transfer that program interest list.

The receiving LIDDA must:

• acknowledge the transfer with the transferring LIDDA;
• contact the transferring LIDDA if the documents are not received or the transfer does not show in CSIL; 
• follow the retention policy for Form 8648, as stated in Section 6300, Documenting and Maintaining a Record of a Person’s Preferences for Services and Supports; and
• conduct enrollment activities if a slot was offered.

If a LIDDA needs to transfer a slot offer to another LIDDA, the transferring LIDDA must change the “Residence County” field on the person’s main CSIL record. Note: If the LIDDA changes the “Service County” field on the program interest list record, only that specific interest list will be transferred and not the full CSIL record. After the CSIL record has been transferred, the receiving LIDDA must:

• submit the HCS or TxHmL Pre-enrollment Form and 8578 ID/RC Assessment with a purpose code 2 on the Texas Medicaid & Heath Care Partnership (TMHP) Long-term Care (LTC) Online Portal if no forms have migrated from CARE or submitted on the TMHP LTC Online Portal. 
• submit 3608 or 8582, Individual Plan of Care once Program Enrollment and Support (PES) has approved the 8578 ID/RC Assessment with a purpose code 2 and the status is “Pending IPC Match.” 

If the L01 screen was entered in CARE prior to April 6, 2022, the information migrated to the LTC Online Portal for the HCS or TxHmL Pre-enrollment Form. There may also be an existing 8578 ID/RC Assessment with a purpose code 2 on the LTC Online Portal. The transferring LIDDA must not inactivate these forms. When the receiving LIDDA submits 3608 or 8582, Individual Plan of Care, the LTC Online Portal will automatically change the LIDDA information on 8578 ID/RC Assessment with a purpose code 2 to match the LIDDA information on 3608 or 8582, Individual Plan of Care.

The only time the HCS or TxHmL Pre-enrollment Form should be “Inactivated” is if the person declines the slot offer before PES has completed the enrollment approval. When this happens, the LIDDA must submit a new Form 8601, Verification of Freedom of Choice on the secure file transfer protocol site.

LIDDAs may only inactivate the HCS or TxHmL Pre-enrollment Form if the form status is “Pre-enrolled.” If there is an 8578 ID/RC Assessment with a purpose code 2 on the LTC Online Portal, the LIDDA must inactivate the 8578 ID/RC Assessment BEFORE inactivating the HCS or TxHmL Pre-enrollment Form. 

IMPORTANT: If the status of the HCS or TxHmL Pre-enrollment Form is “Enrolled,” it cannot be inactivated, deleted or backed out. If the person declines the slot offer after the enrollment has been approved, the LIDDA must follow the termination process in accordance with program rules and handbook. 

7900 Requesting Changes to a Person’s HCS or TxHmL Interest List

Revision 22-2; Effective July 22, 2022

A request for Texas Health and Human Services Commission (HHSC) to change a person’s Home and Community-based Services (HCS) or Texas Home Living (TxHmL) interest list information, due to an input or procedural error, must be made by the local intellectual and developmental disability authority’s (LIDDA) Intellectual and Developmental Disability (IDD) Director.

The LIDDA must:

• complete Form 8571, Request to Change Interest List Information for Home and Community-based Services (HCS) or Texas Home Living (TxHmL);
• provide documentation supporting the request to change the person’s interest list information;
• have the director attest to the accuracy and completion of the pending submission;
• submit a separate request for each person; and
• submit Form 8571 and all supporting documentation to LIDDARequests@hhs.state.tx.us.

If HHSC determines the documentation supports the request, HHSC will change the person’s interest list information and notify the LIDDA.

If HHSC determines the documentation does not support the request, HHCS will not change the interest list information and will notify the LIDDA.

If a person identifies the HCS or TxHmL Program as a preferred service and the person informs the LIDDA that they were determined ineligible for a waiver (other than HCS or TxHmL) due to a reason other than financial ineligibility, the LIDDA must request that HHSC change the person’s interest list request date for HCS or TxHmL to match the person’s interest list request date for the waiver for which the person was denied. If the person is already on the HCS or TxHmL interest list, the LIDDA must only request a change to the person’s HCS or TxHmL interest list request date if the HCS or TxHmL interest list request date is later than the person’s interest list request date for the waiver for which the person was denied. The request must be typed and:

• addressed to HHSC;
• provide an explanation that the person was determined ineligible for the waiver, including the name of the waiver;
• provide the person’s interest list request date for the waiver for which the person was denied eligibility;
• include written evidence supporting the change being requested (i.e., a copy of the letter addressed to the person stating the person is ineligible for the waiver program or other appropriate documentation);
• about an enrollment into a waiver and not a renewal (i.e., no longer meeting medical necessity or aging out of a program currently or previously enrolled in); and
• submitted to LIDDARequests@hhs.texas.gov.

Revision 19-4; Effective September 9, 2019

The local intellectual and developmental disability authority (LIDDA) must conduct and document permanency planning for persons under age 22 years enrolling in, or currently residing in, an intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID) or Home and Community-based Services (HCS) residential setting in accordance with 40 Texas Administrative Code, Chapter 9, Subchapter D and Subchapter E.

8100 Permanency Planning Instruments

Revision 19-4; Effective September 9, 2019

The local intellectual and developmental disability authority (LIDDA) must develop permanency plans using the permanency planning instruments located on Texas Health and Human Services webpage, Permanency Planning for Children, which includes:

• Form 2260, Permanency Planning Instrument (PPI) for Children Under 22 Years of Age (Family Directed Plan);
• HHSC Permanency Planning Instruction Manual; and
• Permanency Planning Technical Assistance Guide.

If a person is 18 to 22 years of age and does not have a legally authorized representative (LAR), but does have an actively-involved family member, include the actively-involved family member in permanency planning unless the person is opposed to such inclusion.

8200 Enrollment Permanency Planning

Revision 19-4; Effective September 9, 2019

For persons who are enrolling from a family-based setting into an intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID), including a state supported living center (SSLC) or a Home and Community-based Services (HCS) residential setting, the local intellectual and developmental disability authority (LIDDA) must:

• conduct initial permanency planning using Form 2260, Permanency Planning Instrument (PPI) for Children Under 22 Years of Age (Family Directed Plan), at the time of the person’s enrollment; and
• provide and review A Message for Families document with the person and family or LAR.

8300 Continued Permanency Planning

Revision 19-4; Effective September 9, 2019

For persons who currently reside in an intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID), including a state supported living center (SSLC) or a Home and Community-based Services (HCS) residential setting, the local intellectual and developmental disability authority (LIDDA) must:

• conduct a review of the permanency plan and update Form 2260, Permanency Planning Instrument (PPI) for Children Under 22 Years of Age (Family Directed Plan), within six months after the initial permanency plan was conducted, and every six months after the review, until the person reaches age 22 years or the person leaves the ICF/IID or HCS residential setting to live in a family-based setting;
• provide either an oral or written/email notice to the legally authorized representative (LAR) of a meeting to conduct a review of the person’s permanency plan no later than 21 days before the meeting date, and include a request for a response from the LAR; and
• provide and review A Message for Families document with the person and family or LAR.

8400 Permanency Planning Reports

Revision 19-4; Effective September 9, 2019

Use the following Client Assignment and Registration (CARE) System XPTR reports to identify the persons in need of permanency planning:

• HC021395.W, Perm. Planning – Reviews Needed;
• HC021311.W, Perm. Planning – Reviews Not Approved; and
• HC021393.W, Perm. Planning – Status by Person.

These CARE XPTR reports indicate persons newly identified as needing permanency planning. The local intellectual and developmental disability authority (LIDDA) has 20 days to conduct permanency planning starting the first business day a person’s name first appears on either report.

8500 Submission Requirements

Revision 19-4; Effective September 9, 2019

Submit a copy of Form 2260, Permanency Planning Instrument (PPI) for Children Under 22 Years of Age (Family Directed Plan), to the intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID) or Home and Community-based Services (HCS) provider and legally authorized representative (LAR) or family by the plan of care implementation date.

The local intellectual and developmental disability authority (LIDDA) must enter into the Client Assignment and Registration (CARE) System screen 309, Permanency Planning Review/Add/Change/Delete:

• the initial permanency planning information within ten days after meeting with the family; and
• the permanency planning review information within ten days after the review date.

To view the status of a permanency plan submitted in CARE, go to screen 249, PPR Approval Status View.

For persons who are younger than ten years of age, the LIDDA should email the permanency planning information (initial and reviews) encrypted to the IDD Contract Accountability and Oversight mailbox at localauthoritycao@hhsc.state.tx.us.

Questions about permanency planning in ICF/IIDs, including state supported living centers (SSLCs) and HCS may also be submitted to localauthoritycao@hhsc.state.tx.us.

Revision 24-1; Effective March 1, 2024

Enhanced Community Coordination (ECC) helps people with intellectual or developmental disabilities move to homes in the community from:

• state supported living centers (SSLCs); or
• private medium to large intermediate care facilities for individuals with an intellectual disability or related conditions (ICF/IIDs) with nine or more beds.

All people transitioning or diverting from an SSLC or private medium or large ICF/IID and enrolling in a 1915(c) waiver are eligible to receive ECC.

Note: Refer to the Intellectual and Developmental Disability Preadmission Screening and Resident Review (IDD-PASRR) Handbook for ECC responsibilities about diversion from admission to, or transition from, a nursing facility.

9100 Duties Related to Transitioning or Diverting from an ICF/IID or SSLC

Revision 24-1; Effective March 1, 2024

For all people receiving a crisis diversion or transitioning from a state supported living center (SSLC) or medium or large intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID), the local intellectual and developmental disability authority (LIDDA) must ensure an assigned Enhanced Community Coordination (ECC) coordinator:

• is assigned immediately once a 1915(c) waiver slot is received, and by three business days after the slot is received;
• complies with the rules governing service coordination for a person with an intellectual disability as required in 26 Texas Administrative Code (TAC) Chapter 331, LIDDA Service Coordination, and 26 TAC Section 263.901, LIDDA Requirements for Providing Service Coordination in the HCS Program;
• provides intensive and flexible support to achieve success in a community setting, including arranging for support needed to prevent and manage a crisis, such as Transition Support Team (TST) or crisis respite;
• provides pre- and post-transition services;
• monitors the person as required by the LIDDA Performance Contract, for the first 365 days* after transition or diversion;
• maintains a case load of no more than 30 people, even if the community coordinator provides service coordination to other people who are not covered under this section; and 
• enhances the person’s natural supports and promotes successful community living.

* Important: If, after 365 days of ECC, the service planning team (SPT) believes the person requires further enhanced monitoring, the ECC coordinator must contact IDDMFPSupport@hhs.texas.gov for guidance.

Note: SSLC transition monitoring must be performed by the Home and Community-based Services (HCS) service coordinator per 9540, Monitoring Activities for SSLC Transitions Only, of this handbook after the first year. 

9110 ECC Funds

Revision 24-1; Effective March 1, 2024

Enhanced Community Coordination (ECC) funds are available to local intellectual and developmental disability authorities (LIDDAs) through the performance contract for a person transitioning to the community. The funds enhance a person’s natural supports and promote successful community living. Funds are intended to pay for:

• one-time emergency assistance, such as:
  • rental or utility assistance;
  • nutritional supplements;
  • clothing; and
  • medication;
• items to address a person's special needs, including minor home modifications not funded by other sources;
• transportation to and from trial visits with community providers; and
• educational tuition assistance, such as vocational programs through community colleges so a person can develop job skills.

All other funds, including transition assistance services (TAS) and supplemental transition services (STS), must be exhausted, and all purchases must be approved before ECC designated funds may be used.

LIDDA staff may access ECC funds by completing Form 8658, Enhanced Community Coordination (ECC) Designated Funds Request and Authorization, and submitting it to the Money Follows the Person (MFP) unit at IDDMFPsupport@hhs.texas.gov.

9200 Enrollment in HCS as a Crisis Diversion

Revision 24-1; Effective March 1, 2024

For a person enrolling in Home and Community-based Services (HCS) as a crisis diversion, a local intellectual and developmental disability authority (LIDDA) must enroll the person in the HCS Program per the requirements in the HCS rules and 13000, Medicaid Program Enrollment Requirements. The LIDDA must ensure an assigned Enhanced Community Coordination (ECC) coordinator completes the following:

• develops and revises, as necessary, a diversion plan using Form 1050, Nursing Facility or Crisis Diversion Plan, with the person and legally authorized representative (LAR);
• develops a Person-Directed Plan (PDP) using Form 8665, Person-Directed Plan, per the HCS Program rules, using all available assessments and to include the person’s strengths and preferences; and
• conducts a pre-move site review using Form 1042*, Pre-Move Site Review, to determine if supports are in place and any areas of concern have been addressed before the person enrolls in the HCS Program.

*The receiving LIDDA is responsible for conducting the pre-move site review and post-move monitoring visits when a transfer of LIDDAs occurs due to enrollment in HCS. Both LIDDAs are responsible for collaborating to ensure a smooth transition of services.

9300 Post Enrollment in HCS as a Crisis Diversion

Revision 24-1; Effective March 1, 2024

For one year after a person has enrolled in the Home and Community-based Services (HCS) Program as a crisis diversion, an assigned Enhanced Community Coordination (ECC) coordinator must:

• conduct at least three onsite visits of community services delivery sites at the intervals described below to determine if supports continue to be in place, and  concerns are being addressed, using Form 1043, Post-Move Monitoring:
  • within seven days after enrollment in the HCS Program;
  • between eight and 45 days; and
  • between 46 and 90 days;
• conduct monthly in-person visits with the person and monitor the delivery of all services and supports;
• conduct HCS service planning team (SPT) meetings at least every 90 days, or more frequently if there is a change in the person’s needs or if requested by the person or legally authorized representative (LAR);
• ensure the person receives timely assessments of behavioral, medical, nursing, specialized therapies and nutritional management needs, as necessary and as indicated on Form 8665, Person-Directed Plan (PDP);
• monitor all services identified on the HCS PDP, including:
  • reviewing the HCS Program provider’s implementation plans and provider records, as well as visiting service delivery sites, as needed, to determine the person’s needs are being met; and
  • monitoring critical incidents involving the person and convening the HCS SPT to provide needed prevention or intervention services for the person; and
• monitor the person while on suspension from the HCS Program at least monthly, maintain communication with the program provider, and provide reports to Texas Health and Human Services Commission upon request.

9400 Enrollment in HCS as an ICF/IID or SSLC Transition

Revision 24-1; Effective March 1, 2024

9410 Enrollment in HCS as an ICF/IID Transition

Revision 24-1; Effective March 1, 2024

For a person planning to transition from a medium to large intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID) to the Home and Community-based Services (HCS) Program, a local intellectual and developmental disability authority (LIDDA) must ensure an assigned Enhanced Community Coordination (ECC) coordinator:

• completes the initial in-person visit within seven business days of being assigned;
• completes Form 1580, Texas Money Follows the Person Demonstration Project Informed Consent for Participation, as detailed in 13238,  Money Follows the Person Demonstration Participation Process of this handbook;
• develops and revises, as necessary, Form 8665, Person-Directed Plan (PDP), using all available assessments and identifying essential and non-essential supports, considering the PDP as the transition plan for ICF/IID transitions; and
• conducts a pre-move site review using Form 1042, Pre-Move Site Review, to determine if essential supports identified in the PDP are in place and any areas of concern were addressed before the person enrolls in the HCS Program.

9420 Enrollment in HCS as an SSLC Transition

Revision 24-1; Effective March 1, 2024

For a person planning to transition from a state supported living center (SSLC) to the Home and Community-based Services (HCS) Program, the local intellectual and developmental disability authority (LIDDA) must ensure an assigned Enhanced Community Coordination (ECC) coordinator:

• completes the initial in-person visit within seven business days of being assigned;
• completes Form 1580, Texas Money Follows the Person Demonstration Project Informed Consent for Participation, as detailed in Section 13238, Money Follows the Person Demonstration Participation Process, of this handbook;
• participates in developing the community living discharge plan (CLDP) with SSLC staff, as required by 26 Texas Administrative Code (TAC),  Section 904.107, Community Living/Discharge Plan for Alternative Living Arrangements; 
• develops and revises, as necessary, Form 8665, Person-Directed Plan, using all available assessments;
• gets and reviews a copy of the pre-move site review conducted by SSLC staff to determine if supports are in place and all areas of concern are being addressed; and
• complies with the requirements in 26 TAC, Section 904.105, Arrangements for the Move to an Alternative Living Arrangement of an Individual Residing in a State MR Facility, using Form 8630, Continuity of Care. 

9500 Post Enrollment in HCS as an ICF/IID or SSLC Transition

Revision 24-1; Effective March 1, 2024

9510 Post Enrollment in HCS as an ICF/IID Transition

Revision 24-1; Effective March 1, 2024

For a person who transitioned from a medium to large intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID) to the Home and Community-based Services (HCS) Program, an Enhanced Community Coordination (ECC) coordinator must:

• conduct at least three onsite visits of community services delivery sites* at the intervals described below to determine if all supports identified in the Person-Directed Plan (PDP) continue to be in place and any areas of concern are being addressed using Form 1043, Post-Move Monitoring:
  • within seven days after enrollment in the HCS Program;
  • between eight and 45 days; and
  • between 46 and 90 days;
• during the post-move monitoring visits:
  • assess if supports continue to be in place;
  • address any concerns of the person, program provider, staff or family member;
  • identify any gaps in care; and
  • address such gaps, if any, to reduce the risk of crisis, re-admission to an ICF/IID, or another negative outcome.

*Important: The ECC coordinator must conduct post-move monitoring at all sites where essential supports are provided. More frequent onsite visits may be required to determine if supports are still in place and any areas of concern are being addressed during the first 90 days after enrolling in HCS.

9520 Post Enrollment in HCS as an SSLC Transition

Revision 24-1; Effective March 1, 2024

For a person who transitioned from a state supported living center (SSLC) to the Home and Community-based Services (HCS) Program, an Enhanced Community Coordination (ECC) coordinator must:

• conduct and document on Form 1055, LIDDA State Supported Living Center (SSLC) Transition Reporting, at least three onsite post-move monitoring visits of community service delivery sites* during the first 90 days after the person’s move at the following times:
  • within the first seven days after enrollment in the HCS Program;
  • between eight and 45 days; 
  • between 46 and 90 days; and
• during the post-move monitoring visits:
  • make sure supports identified in the Community Living Discharge Plan (CLDP) are in place;
  • address any concerns of the person, program provider, staff or family member;
  • identify any gaps in care; and
  • address such gaps, if any, to reduce the risk of crisis, re-admission to an SSLC or another negative outcome.

*Important: The ECC coordinator must conduct post-move monitoring at all sites where essential supports are provided. More frequent onsite visits may be required to determine if supports are still in place and any areas of concern are being addressed during the first 90 days after enrolling in HCS.

Note: The receiving local intellectual and developmental disability authority (LIDDA) is responsible for conducting the post-move monitoring visits when a transfer of LIDDAs occurs because of enrollment in HCS. Both LIDDAs are responsible for collaborating to ensure a smooth transition of services.

9530 Monitoring Activities for One Year Post-Move

Revision 24-1; Effective March 1, 2024

For one year following a person’s transition from a state supported living center (SSLC) or medium to large intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID) to the Home and Community-based Services (HCS) Program, the local intellectual and developmental disability authority (LIDDA) must make sure an Enhanced Community Coordination (ECC) coordinator:

• conducts at least monthly in-person visits with the person; 
• conducts HCS service planning team (SPT) meetings at least every 90 days, or more frequently if the person’s needs change or the person or legally authorized representative (LAR) requests a meeting;
• revises Form 8665, Person-Directed Plan, as necessary, and coordinates the person’s services and supports;
• asks about any recent hospitalizations, emergency department contacts, increased physician visits or other crises, including medical crises. If the person experiences such, convene the HCS SPT to identify all necessary revisions to the person's Form 8665 to address the additional need for services;
• makes sure the person receives timely assessments of behavioral, medical, nursing, professional therapies and nutritional management needs, as necessary, and as indicated on Form 8665;
• records the person’s health care status sufficiently to readily identify when changes in the person’s status occurs;
• conducts service planning;
• makes sure the program provider implements services and monitors all services identified on Form 8665, including:
  • reviewing the HCS Program provider’s implementation plans and provider records;
  • visiting service delivery sites, as needed, to determine if the person’s needs are being met; and
  • monitoring critical incidents involving the person and convening the HCS SPT to develop a plan for needed prevention or intervention services for the person; and
• monitors the person while on suspension from the HCS Program at least monthly, maintains communication with the program provider and provides reports to HHSC upon request.

9540 Monitoring Activities for SSLC Transitions Only

Revision 24-1; Effective March 1, 2024

For one year following a person’s transition from a state supported living center (SSLC) to the Home and Community-based Services (HCS) Program, the local intellectual and developmental disability authority (LIDDA) must also make sure the Enhanced Community Coordination (ECC) coordinator:

• complies with the monitoring activities and agreement portions set forth in the community living discharge plan (CLDP);
• submits reports beginning 90 days from the date of discharge to IDDMFPSubmissions@hhs.texas.gov and at least every 90 days using the SSLC transition report Form 1055, LIDDA State Supported Living Center (SSLC) Transition Reporting*; and
• submits the written reports required above to the SSLC Admission Placement Coordinator (APC) and the HCS program.

For years two through five following a person’s transition from an SSLC to the HCS Program, the LIDDA must ensure an HCS service coordinator completes the following monitoring activities:

• conducts in-person monitoring at least every 90 days; and
• submits reports to IDDMFPSubmissions@hhs.texas.gov at least every 90 days using the SSLC transition report Form 1055.

*Important: Form 1055, along with the required monitoring notes are due the 15th of the month following the 90-day review period. Submissions received after the 15th day of the month will be considered late. If the 15th falls on a holiday or weekend, it is due the next business day. The in-person visit(s) must occur within the 90-day review period.

9600 Transition Planning from an SSLC to a Setting Other than the HCS Program

Revision 24-1; Effective March 1, 2024

For a person transitioning from a state supported living center (SSLC) to a setting other than the Home and Community-based Services (HCS) Program, a local intellectual and developmental disability authority (LIDDA) must make sure an assigned Enhanced Community Coordination (ECC) coordinator:

• participates in developing the community living discharge plan (CLDP) with SSLC staff, per 26 Texas Administrative Code (TAC), Section 904.107, Community Living/Discharge Plan for Alternative Living Arrangements;
• participates in the pre-move site review conducted by SSLC staff to determine if supports are in place and all areas of concern are being addressed; and
• complies with the requirements in 26 TAC, Section 904.105, Arrangements for the Move to an Alternative Living Arrangement of an Individual Residing in a State MR Facility, using Form 8630, Continuity of Care.

9700 Post Transition from an SSLC to a Setting Other than the HCS Program

Revision 24-1; Effective March 1, 2024

For one year following a person’s transition from a state supported living center (SSLC) to a setting other than the Home and Community-based Services (HCS) Program, a local intellectual and developmental disability authority (LIDDA) must make sure an Enhanced Community Coordination (ECC) coordinator:

• complies with the monitoring activities and agreement portions set forth in the community living discharge plan (CLDP);
• conducts in-person monitoring at least every 90 days, or more frequently if indicated;
• submits reports to IDDMFPSubmissions@hhs.texas.gov at least every 90 days using the SSLC transition report Form 1055, LIDDA State Supported Living Center (SSLC) Transition Reporting; and
• submits the written reports required above to the SSLC Admission Placement Coordinator (APC) and the program provider as required in the Performance Contract. 

9800 Readmission to an ICF/IID or SSLC

Revision 24-1; Effective March 1, 2024

If a person who has already received 365 days of Enhanced Community Coordination (ECC) is readmitted to a medium or large intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID) or state supported living center (SSLC) and wants to return to the community, the ECC coordinator must determine if the person: 

• was in the facility for more than 30 calendar days; or
• experienced a significant change of condition* during the readmission.

If the ECC coordinator determines the re-admission exceeded 30 calendar days or the person experienced a significant change of condition, the ECC coordinator must, per Sections 9400, 9510 and 9520 of this handbook:

• participate in developing the community living discharge plan (CLDP) with SSLC staff, as required by 26 Texas Administrative Code (TAC), Chapter 904, Continuity of Services - State Facilities (SSLCs only);
• develop and revise, as necessary, Form 8665, Person-Directed Plan (PDP), using all available assessments;
• conduct a pre-move site review using the designated Texas Health and Human Services (HHSC) form, to determine if supports are in place and any areas of concern have been addressed before the person returns to the community;
• conduct and document on the designated HHSC form at least three onsite post-move monitoring visits of community service delivery sites during the first 90 days after the person’s move at the following times:
  • within the first seven days after enrollment in the Home and Community-based Services (HCS) Program;
  • between eight and 45 days; 
  • between 46 and 90 days**; and
• during the post-move monitoring visits:
  • assess if supports identified in the CLDP or PDP are in place (Note: The CLDP is used only for SSLC transitions. The PDP is used as a transition plan for ICF/IID transitions);
  • Document on the designated HHSC form:
    • all concerns of the person, program provider, staff or family member;
    • all identified gaps in care; and
  • address any identified concerns or gaps in care to reduce the risk of crisis, re-admission to an ICF/IID or SSLC, or any other negative outcome.

*Significant change of condition: any change requiring additional services, equipment or minor home modifications such as new enteral feeding tube, respiratory equipment or wheelchair.

**If, by the 60th day after the person returns to the community, the service planning team (SPT) believes the person may require more than 90 days of enhanced monitoring, the ECC coordinator must contact IDDMFPSupport@hhs.texas.gov for more guidance.

For a qualified person who has never received ECC who is admitted or readmitted to an ICF/IID or SSLC from the community, if the stay is for at least 60 calendar days, an ECC coordinator must initiate one year of ECC as outlined in section 9500, Post Enrollment in HCS as an ICF/IID or SSLC Transition, of this handbook, about monitoring activities for ICF/IID and SSLC transitions. 

If a person is readmitted to an ICF/IID or SSLC while receiving their initial 365 days of ECC, ECC will resume upon discharge to the community. The 365-day time frame does not re-start. For example, if a person admits on day 181 of ECC and is put on suspension, when they discharge, ECC resumes on day 182. 

A person who is readmitted to an ICF/IID or SSLC for the purpose of respite does not qualify for ECC upon discharge unless they were already receiving ECC at the time of readmission. 

Revision 22-2; Effective July 22, 2022

Contracted local intellectual and developmental disability authorities (LIDDAs) perform activities to provide information and education about community living options to persons who are 22 years or older residing in a state supported living center, or to the person’s legally authorized representative.

10100 Definitions

Revision 22-2; Effective July 22, 2022

In this section, the terms below have the following meanings.

Contracted local intellectual and developmental disability authority (LIDDA) – One of 13 LIDDAs that have a state supported living center (SSLC) in its local service area and with which Texas Health and Human Services Commission (HHSC) will contract for provision of the Community Living Options Information Process (CLOIP).

Designated LIDDA – The LIDDA assigned to a person in accordance with Section 5000, Guidelines for Determining and Changing Designated LIDDA.

Person – An adult resident who resides in an SSLC and who is 22 or older.

Legally Authorized Representative (LAR) – Has the meaning assigned in the Continuity of Services Rule – State Facilities, Title 40, Texas Administrative Code (TAC), Chapter 2, Subchapter F. A person authorized by law to act on behalf of a person with regard to a matter described in this subchapter, and may include a parent, guardian, or managing conservator of a minor, or the guardian of an adult.

Interdisciplinary Team (IDT) – Has the meaning assigned in the Continuity of Services Rule – State Facilities, Title 40, TAC Chapter 2, Subchapter F. IDD professionals and paraprofessionals and other concerned persons, as appropriate, who assess a person’s treatment, training, and habilitation needs and make recommendations for services, including recommendations of whether the person is best served in a facility or in a community setting.

• Team membership always includes:
  • the person;
  • the person’s LAR, if any; and
  • persons specified by a LIDDA or SSLC, as appropriate, who are professionally qualified, certified or licensed with special training and experience in the diagnosis, management, needs, and treatment of people with intellectual and developmental disabilities (IDD).
• Other participants in IDT meetings may include:
  • other concerned people whose inclusion is requested by the person or the LAR;
  • at the discretion of the LIDDA or SSLC, people who are directly involved in the delivery of IDD services to the person; and
  • if the person is school eligible, representatives of the appropriate school district.

10200 Standardized Information Materials

Revision 19-4; Effective September 9, 2019

Contracted local intellectual and developmental disability authorities (LIDDAs) will provide and explain the Explanation of IDD Services and Supports publication and the Long Term Services and Supports publication to all persons and LARs.

In addition to the required material in the preceding paragraph, contracted LIDDAs will provide and explain other informational and educational materials developed and approved by Texas Health and Human Services Commission (HHSC) that provides a more complete explanation of specific types of services. Educational and informational materials will be person friendly and in a format that provides for easy interpretation and can include written, audio, Power Point, CD or DVD formats. The style and substance of the materials are crucial to education and awareness. Communication devices and techniques (including the use of sign language) will be used, as appropriate, to facilitate the involvement of the person and legally authorized representative (LAR).

HHSC will provide coordination, support and funding for these standardized materials. HHSC will assure the development of curriculum and the provision of training for contract LIDDAs and state supported living center (SSLC) staff regarding the Community Living Options and Information Process (CLOIP), the developed materials and their use.

Designated LIDDAs, upon request by the contracted LIDDA, will provide information about specific programs and services available where the person or their LAR, on behalf of the person, is interested in living. This may include, but is not limited to, specific information about services, supports and providers in the local service area. Designated LIDDAs may provide the information directly to the person and LAR or to the contracted LIDDA.

In addition to the materials described above, a person and/or LAR will be offered the opportunity to visit living options available in the community and to visit with persons/peers using these options with their prior consent.

10300 LIDDA Responsibilities

Revision 22-2; Effective July 22, 2022

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

• provide community living options information to all people living in the assigned state supported living center (SSLC) and their legally authorized representative (LAR) at least one time per year;
• complete the Community Living Options and Information Process (CLOIP) Instrument and provide a written report to the SSLC and designated LIDDA by 14 calendar days before the person’s SSLC annual planning meeting; 
• attend the SSLC annual planning meeting in person or by teleconference 100 percent of the time, unless the resident or their LAR has specifically requested the LIDDA not participate;
• submit through the Client Assignment and Registration (CARE) System and the Mental and Behavioral Health Outpatient Warehouse (MBOW); and
• update the Community Services Interest List (CSIL) application, if necessary. 

10400 LIDDA and SSLC Collaborative Relationship

Revision 19-4; Effective September 9, 2019

The state supported living center (SSLC) will assist Texas Health and Human Services Commission (HHSC) staff to identify the annual planning meeting date for each adult resident of the SSLC. An annual calendar of scheduled or tentatively scheduled meetings will be provided to the contracted local intellectual and developmental disability authority (LIDDA).

Post implementation of the Community Living Options and Information Process (CLOIP), the SSLC qualified intellectual disability professional (QIDP) will provide the contracted LIDDA service coordinator with 45-days’ notice of annual planning meetings.

When a planning meeting is requested at a time other than the annual meeting in which the person or legally authorized representative (LAR) needs information about community living options, all efforts will be made by the SSLC QIDP to notify the LIDDA service coordinator no later than 45 days prior to the meeting date so the CLOIP can be initiated with the person and/or LAR.

The SSLC QIDP will facilitate access by the contracted LIDDA service coordinator to the person and/or LAR for the purpose of establishing a positive relationship between them and the LIDDA service coordinator.

To the extent not otherwise prohibited by state or federal confidentiality laws, the SSLC QIDP will facilitate access by the contracted LIDDA service coordinator to the resident’s records. The results of the person’s most recent annual planning meeting will be copied for the contracted LIDDA record for preparation and use in CLOIP discussions with the person and/or LAR. An additional copy will be provided to the person or LAR by the contracted LIDDA service coordinator at the beginning of the CLOIP. If the person and/or the LAR has determined they are not interested in community options, these records would not need to be accessed.

The contracted LIDDA service coordinator will provide documentation of the results of the CLOIP to the SSLC QIDP no later than 14 calendar days prior to the annual planning meeting.

The SSLC QIDP will continue to be responsible for contacting the person and/or LAR and the designated LIDDA of the date, time and location of the annual planning meeting no later than 45 days in advance.

The SSLC QIDP will continue to have responsibility for discussions with the person or LAR that is needed prior to the annual planning meeting, other than the CLOIP.

The contracted LIDDA service coordinator will participate in the SSLC planning meeting in addition to the person or LAR. It is strongly preferred the LIDDA service coordinator attend in person, but for purposes of meeting the performance measures, a teleconference will be accepted.

The designated LIDDA service coordinator may participate in the SSLC planning meeting when placement or continuity of service issues is pending.

The SSLC and the contracted LIDDA will work together to provide persons, and/or LARs and SSLC staff, information about community living options and about the risk of moving to a community living option. This can be accomplished through organized activities or functions held at the SSLC or at the contracted LIDDA.

10500 LIDDA and Adult Resident, LAR and/or Interested Family Member Collaborative Relationship

Revision 19-4; Effective September 9, 2019

The contracted local intellectual and developmental disability authority (LIDDA) will use the annual planning meeting schedule at the state supported living center (SSLC) to assign staff caseloads. Contracted LIDDA service coordinators should be assigned in such a way as to meet with, and complete, the Community Living Options and Information Process (CLOIP) for SSLC persons.

The contracted LIDDA service coordinator will contact each person or legally authorized representative (LAR) on their caseload in person or by phone, as circumstances allow, to begin to establish a positive working relationship. A person and/or the LAR can designate any other significant person in their life, such as some other interested family member or friend, to be involved in the discussions. The contracted LIDDA may develop an interlocal agreement with a designated LIDDA to meet its contract obligations in this process due to the location of the LAR. This process may require several contacts in the months prior to the annual interdisciplinary team (IDT) staffing. If the person or LAR expresses they have no interest in community living options, no further contact, other than annually, will be made by the LIDDA.

The LIDDA service coordinator will provide the person and/or LAR with the standardized informational and educational materials on community living options. The LIDDA service coordinator will discuss the options in a way that allows them to express an understanding and awareness of the options discussed.

If the person or LAR wishes to know specific details of options and supports in a specific location, the LIDDA service coordinator will make this information available and coordinate visits to community living options, at their request, prior to the deadline for completion of the CLOIP.

All telephone and in-person contacts made for purposes of the CLOIP, including those by a designated LIDDA, will be documented with a progress note and the appropriate encounter code provided by Texas Health and Human Services Commission (HHSC). These will be part of the contracted LIDDA’s record, along with the previous year’s planning meeting results, the LIDDA person’s identifying information record and a summary of the CLOIP, as described in this section. The contracted LIDDA may include any other documents in the contracted LIDDA record at their discretion.

The LIDDA service coordinator will document the results of the CLOIP to include the following:

• The person or LAR received an explanation of community living options appropriate to their level of awareness and interest;
• Assessment of the awareness of the person or LAR of community living options. This assessment will be based on his or her experience with, information about, and exposure to community living options including visits to community options if requested; and
• Preferences of the person or LAR for remaining a resident of the SSLC where they presently reside, for moving to another SSLC, or for a specific community living option.

The LIDDA service coordinator will document these results on the CLOIP Instrument, Local Authority Service Coordinator Community Living Options Information Process Worksheet.

10600 SSLC Annual IDT Staffing

Revision 19-4; Effective September 9, 2019

The annual state supported living center (SSLC) interdisciplinary team (IDT) meeting will review the Community Living Options and Information Process (CLOIP) Instrument, Local Authority Service Coordinator Community Living Options Information Process Worksheet, and identify and document:

• Awareness by the person or legally authorized representative (LAR) of community living options, which must be based on his or her experience with, information about, and exposure to community living options;
• Preferences of the person or LAR for a specific living option;
• Supports and services needed by the person in the preferred living option related to safety, mobility, medical, behavioral, psychiatric and work/day activities;
• Local intellectual and developmental disability authority (LIDDA) input and recommendation; and
• Most appropriate living option for the person at the current time.

Except as provided below, the SSLC IDT will develop, as part of the Personal Support Plan, an action plan to address one or more of the following:

• Transition process with timelines to facilitate a timely, appropriate and successful transition from the SSLC to the community living option;
• Supports and services needed by the person to reside in the preferred community living option at a future date;
• Increasing the person’s awareness of the community living options; and
• Increasing the LAR’s awareness of the community living options.

IDT-created action plans and goals are available through the SSLC whether or not the person prefers to remain at the facility.

If there is not consensus by the IDT, regarding the most appropriate living option at the current time, the SSLC will implement Division 4, Section 2.276 of the Continuity of Services Rule – State Facilities, which allows for the head of the SSLC to name a review team to evaluate the situation and make a consensus recommendation to the head of the SSLC within 21 calendar days. The person or actively involved party may request a review of the head of the SSLC's decision by the Office of the Independent Ombudsman for SSLCs.

Revision 19-4; Effective September 9, 2019

Local intellectual and developmental disability authorities (LIDDAs) must conduct assessments to determine if persons seeking services and supports meet the criteria for a diagnosis of intellectual disability, in accordance with 40 Texas Administrative Code, Chapter 5, Subchapter D, Diagnostic Assessment.

11100 DFPS Request for DID

Revision 19-4; Effective September 9, 2019

The Department of Family and Protective Services (DFPS) may request a local intellectual and developmental disability authority (LIDDA) conduct a determination of intellectual disability (DID) for a person placed into Child Protective Services (CPS), or a person referred for guardianship with Texas Health and Human Services Commission (HHSC). The LIDDA where the person currently resides will conduct the DID. To identify which LIDDA serves the area where the person resides, search Where do I Call to Get HHS Services?

DFPS will use Form 1051, Request for Determination of Intellectual Disability (DID), to make a request for a LIDDA to conduct a DID.  If the LIDDA receives a request to conduct a DID from DFPS without using Form 1051, immediately notify LIDDAServiceCoordination@hhsc.state.tx.us.

The LIDDA must:

• conduct the DID and provide the DID report to DFPS as soon as possible, but no later than six months after receiving the request;
• adhere to the requirement of providing the written report to the person who requested the DID within 30 days after completing the interview and assessment;
• complete the LIDDA section of Form 1051, after conducting the DID and completing the DID report; and
• follow the form’s instructions regarding submissions.

The LIDDA must maintain a copy of all emails and faxes related to a request for a DID from DFPS.

Note: HHSC Guardianship requires DIDs to be update or endorsed within the last 24 months prior to a hearing date. 

Revision 19-4; Effective September 9, 2019

The number of offers for a Home and Community-based Services (HCS) Crisis Diversion slot made each month is based on budgetary guidelines, in accordance with the legislative allocation for the biennium.

12100 Purpose

Revision 19-4; Effective September 9, 2019

Texas Health and Human Services Commission (HHSC) may offer an HCS Crisis Diversion slot to a person with an intellectual or developmental disability:

• who is determined to be at imminent risk of admission to an institution, as defined in 12200, Definition of Imminent Risk of Admission to an Institution;
• who is, as specified in the HCS Medicaid Waiver application, a person:
  • at risk of institutionalization;
  • at risk of institutionalization in a state supported living center (SSLC); or
  • leaving a state hospital who is at risk of re-institutionalization; and
• who meets the qualifications described in 12300, Qualifications for the HCS Reserved Capacity Group for Crisis Diversion.

12200 Definition of Imminent Risk of Admission to an Institution

Revision 19-4; Effective September 9, 2019

A person is at imminent risk of admission to an institution if one or more of the following exists:

• loss or incapacity of the person’s primary caregiver;
• loss of the person’s placement in a community residential facility;
• the person exhibits repeated and severe behavior disturbances that jeopardize the person’s safety or current living arrangement, but does not need:
  • inpatient mental health treatment; or
  • care in a behavioral health facility, such as Texana Center’s Behavior Treatment and Training Facility or Bayes Achievement Center; or
• the person is recommended for discharge from a state hospital and unable to return to family or community-based care.

12300 Qualifications for the HCS Reserved Capacity Group for Crisis Diversion

Revision 19-4; Effective September 9, 2019

A person qualifies as a member of the Home and Community-based Services (HCS) Reserved Capacity Group for Crisis Diversion if:

• The person is at imminent risk of admission to an institution, as defined in 12200, Definition of Imminent Risk of Admission to an Institution;
• The person is not being court-committed to a facility for competency evaluation, such as an SSLC or state hospital;
• Adequate and appropriate community resources are not available, as evidenced by attempts to locate and use community-based services and supports, such as community intermediate care facilities for individuals with intellectual disabilities or related conditions (ICF/IIDs), general revenue-funded services, Community First Choice services, Crisis Intervention Services, other Medicaid waiver programs, or for a minor, supports through the local school district; and
• The person meets the criteria for ICF/IID level of care (LOC) I. The person must have an LOC I, which requires either a diagnosis of intellectual disability (ID) or related condition (RC). Along with the diagnosis of an RC, the person’s intelligence quotient (IQ) score must be below 76. The specific requirements for LOC I are in the ICF/IID Contracting rules, 40 Texas Administrative Code, Chapter 9, Subchapter E, specifically §9.238.

Note: Persons who only meet the criteria for ICF/IID LOC VIII are not eligible.

12400 Process

Revision 19-4; Effective September 9, 2019

The local intellectual and developmental disability authority (LIDDA) conducts an interview with the person and legally authorized representative (LAR) or an actively involved party about the circumstances creating imminent risk of the person’s admission to an institution. The LIDDA provides an explanation of intellectual or developmental disability (IDD) services and supports.

If the LIDDA determines the person is at imminent risk of admission to an institution, as described in 12200, Definition of Imminent Risk of Admission to an Institution, and meets the criteria for a community intermediate care facility for individuals with intellectual disabilities or related conditions (ICF/IID) level of care (LOC) I, and that adequate and appropriate community resources are not available, as evidenced by attempts to locate and use community-based services and supports, the LIDDA begins the process for requesting a Home and Community-based Services (HCS) Crisis Diversion slot.

The LIDDA requests an HCS Crisis Diversion Slot request to the designated staff person in Texas Health and Human Services Commission (HHSC) IDD Services by submitting a packet that includes:

• A completed Form 1058, Request for Home and Community-based Services Crisis Diversion Slot;
• Copy of the person’s Determination of Intellectual Disability (DID);
• Copy of the person’s Inventory for Client and Agency Planning (ICAP) booklet/scoring sheet; and
• Other documents, as appropriate.

Upon receipt, designated HHSC staff reviews the packet for completeness.

• If the packet is incomplete, HHSC staff will notify the LIDDA and arrange for additional necessary documentation to be submitted.
• If the packet is complete, HHSC staff will convene a meeting to discuss the request for an HCS Crisis Diversion slot with other staff persons of HHSC IDD Services.

HHSC staff will meet to discuss the request and determine whether the person meets the qualifications described in 12300, Qualifications for the HCS Reserved Capacity Group for Crisis Diversion.

• If it is determined the person does not qualify, HHSC, within one business day, will notify the LIDDA and the person or LAR in writing of the denial of an HCS Crisis Diversion slot and provide the person or LAR with an opportunity for an appeal through a fair hearing.
• If it is determined the person qualifies and a slot is immediately available, HHSC will, within one business day, send a letter authorizing the LIDDA to offer the person the opportunity to enroll in HCS.
• If it is determined the person qualifies, but a slot is not immediately available, HHSC will notify the LIDDA within one business day that the person qualifies, but a slot is not immediately available. HHSC will maintain contact with the LIDDA until a slot becomes available, at which point HHSC will send a letter authorizing the LIDDA to offer the person the opportunity to enroll in HCS.

The LIDDA initiates the enrollment process within three working days of receipt of the authorization letter from HHSC. The LIDDA is required to complete the enrollment process, in accordance with the rules governing the HCS Program, specifically 40 Texas Administrative Code, §9.157, Process of Enrollment of an Applicant, within the time frames as required by the LIDDA Performance Contract.

If, while waiting for an offer of an HCS Crisis Diversion slot, HHSC determines the person no longer meets the qualifications for the HCS Reserved Capacity Group for Crisis Diversion, as described in Section 12300, HHSC will, within one business day, notify the LIDDA and the person or LAR in writing of the denial of an HCS Crisis Diversion slot and provide the person or LAR with an opportunity for an appeal through a fair hearing.

Revision 22-1; Effective February 11, 2022

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

13100 LIDDA Required Training

Revision 22-2; Effective July 22, 2022

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

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

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

13200 Persons Authorized to Enroll from the HCS Interest List

Revision 20-4; Effective October 15, 2020

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

13210 Notification of HCS Offer

Revision 22-2; Effective July 22, 2022

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

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

HHS applications:

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

Texas Medicaid & Healthcare Partnership (TMHP) applications:

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

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

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

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

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

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

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

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

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

Revision 22-2; Effective July 22, 2022

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

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

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

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

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

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

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

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

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

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

Example: SmithBob114WD10-05-2021

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

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

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

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

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

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

13213 Declining the Offer

Revision 22-2; Effective July 22, 2022

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

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

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

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

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

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

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

13214 Accepting the Offer

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

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

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

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

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

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

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

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

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

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

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

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

13220 Initial Meeting

Revision 20-4; Effective October 15, 2020

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

13221 Person Selects Provider in Another LIDDA’s LSA

Revision 22-2; Effective July 22, 2022

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

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

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

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

The receiving LIDDA must: 

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

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

13222 Person is Enrolled in a Mutually Exclusive Waiver Program

Revision 22-2; Effective July 22, 2022

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

The LIDDA must check the following systems:

HHS applications:

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

Texas Medicaid & Healthcare Partnership (TMHP) applications:

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

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

13222.1 If Person is in Texas Home Living (TxHmL)

Revision 22-2; Effective July 22, 2022

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

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

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

13230 Enrollment Process

Revision 20-4; Effective October 15, 2020

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

13231 Enrollment Due Dates

Revision 22-2; Effective July 22, 2022

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

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

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

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

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

13232 Requesting an Extension of the Enrollment Due Date

Revision 22-2; Effective July 22, 2022

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

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

13233 Processing the Offer Before the Due Date

Revision 20-4; Effective October 15, 2020

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

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

13234 Determination of Intellectual Disability (DID)

Revision 20-4; Effective October 15, 2020

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

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

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

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

Revision 22-2; Effective July 22, 2022

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

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

13235.1 HHSC Activities

Revision 22-2; Effective July 22, 2022

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

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

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

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

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

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

13236 Permanency Planning

Revision 20-4; Effective October 15, 2020

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

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

13237 Consumer Directed Services

Revision 20-4; Effective October 15, 2020

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

13238 Money Follows the Person Demonstration Participation Process

Revision 24-1; Effective March 1, 2024

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

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

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

To participate in MFPD, a person must:

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

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

Revision 24-1; Effective March 1, 2024

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

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

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

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

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

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

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

13239 Person-Directed Plan (PDP)

Revision 20-4; Effective October 15, 2020

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

13240 Individual Plan of Care (IPC)

Revision 20-4; Effective October 15, 2020

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

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

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

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

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

13241 Form Submission for Enrollment

Revision 22-2; Effective July 22, 2022

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

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

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

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

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

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

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

13242 Records

Revision 20-4; Effective October 22, 2020

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

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

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

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

13250 Additional Procedures for HCS

Revision 20-4; Effective October 15, 2020

13251 Nursing Facility Diversion and Transition

Revision 22-2; Effective July 22, 2022

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

13252 Enrollment from an ICF/IID

Revision 20-4; Effective October 15, 2020

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

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

13253 Assisting with Medicaid Eligibility

Revision 20-4; Effective October 15, 2020

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

13254 Medicare Requirements

Revision 20-4; Effective October 15, 2020

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

13255 Use of LIDDA Enrollment SFTP Site Instructions

Revision 20-4; Effective October 15, 2020

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

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

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

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

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

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

13300 Persons Authorized to Enroll in the TxHmL Program

Revision 20-4; Effective October 15, 2020

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

13310 Notification of TxHmL Offer

Revision 22-2; Effective July 22, 2022

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

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

HHS applications:

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

Texas Medicaid & Healthcare Partnership (TMHP) applications:

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

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

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

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

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

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

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

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

Revision 22-2; Effective July 22, 2022

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

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

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

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

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

13312 Withdrawal of TxHmL Offer

Revision 22-2; Effective July 22, 2022

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

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

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

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

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

Example: SmithBob115WD10-05-2021

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

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

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

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

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

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

13313 Declining the Offer

Revision 22-2; Effective July 22, 2022

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

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

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

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

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

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

13314 Accepting the Offer

Revision 22-2; Effective July 22, 2022

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

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

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

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

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

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

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

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

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

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

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

13320 Initial Meeting

Revision 20-4; Effective October 15, 2020

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

13321 Person Selects Provider in Another LIDDA’s LSA

Revision 22-2; Effective July 22, 2022

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

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

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

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

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

13322 Person is Enrolled in a Mutually Exclusive Waiver Program

Revision 22-2; Effective July 22, 2022

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

The LIDDA must check the following systems:

HHS applications: 

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

Texas Medicaid & Healthcare Partnership (TMHP) applications:

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

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

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

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

13330 Enrollment Process

Revision 20-4; Effective October 15, 2020

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

13331 Enrollment Due Dates

Revision 22-2; Effective July 22, 2022

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

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

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

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

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

13332 Requesting an Extension of the Enrollment Due Date

Revision 22-2; Effective July 22, 2022

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

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

13333 Processing the Offer Before the Due Dates

Revision 20-4; Effective October 15, 2020

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

• Form 8601, Verification of Freedom of Choice (See Section 13314, Accepting the Offer, and Section 13313, Declining the Offer);  
• A request to withdraw the TxHmL slot offer (See Section 13312, Withdrawal of TxHmL Offer) or have an approved extension from HHSC (See Section 13332, Requesting an Extension).

13334 Determination of Intellectual Disability (DID)

Revision 20-4; Effective October 15, 2020

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

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

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

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

Revision 22-2; Effective July 22, 2022

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

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

13335.1 HHSC Activities

Revision 22-2; Effective July 22, 2022

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

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

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

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

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

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

13336 Consumer Directed Services (CDS)

Revision 20-4; Effective October 15, 2020

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

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

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

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

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

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

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

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

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

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

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

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

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

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

13337 Person-Directed Plan (PDP)

Revision 20-4; Effective October 15, 2020

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

13338 Individual Plan of Care (IPC)

Revision 20-4; Effective October 15, 2020

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

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

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

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

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

13339 Form Submission for Enrollment

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

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

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

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

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

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

13340 Records

Revision 20-4; Effective October 15, 2020

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

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

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

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

13350 Additional Procedures for TxHmL

Revision 20-4; Effective October 15, 2020

13351 Enrollment from an ICF/IID

Revision 20-4; Effective October 15, 2020

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

13352 Assisting with Medicaid Eligibility

Revision 20-4; Effective October 15, 2020

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

13353 Medicare Requirements

Revision 20-4; Effective October 15, 2020

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

13354 Use of LIDDA Enrollment SFTP Site Instructions

Revision 20-4; Effective October 15, 2020

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

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

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

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

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

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

13400 Enrollment in the ICF/IID Program

Revision 20-4; Effective October 15, 2020

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

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

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

13410 Medicare Requirements

Revision 20-4; Effective October 15, 2020

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

Revision 19-4; Effective September 9, 2019

Texas Health and Human Services Commission (HHSC) must operate a MERP to recover the costs of Medicaid long-term care benefits received by certain Medicaid recipients, in accordance with the Texas Administrative Code, Title 1, Part 15, Chapter 373.

The local intellectual and developmental disability authority (LIDDA) must require its enrollment staff to:

• Provide the MERP overview to all persons, and their authorized representatives or legal guardians, who seek enrollment in a state supported living center, a community intermediate care facility for persons with intellectual disabilities, Home and Community-based Services or Texas Home Living. The MERP overview is part of Form 8001, Medicaid Estate Recovery Program Receipt Acknowledgement.
• Facilitate completion of Form 8001 with the person and authorized representative or legal guardian and provide a copy of the completed form to:
  • the person and authorized representative or legal guardian; and
  • the Medicaid provider who will provide services to the person upon enrollment.
• File and maintain the completed Form 8001 in the LIDDA’s medical record for the person, indefinitely.
• Scan and post the completed form as a PDF to the MRA Enrollment Secure File Transfer Protocol (SFTP) site, using the following naming convention:
  • Person’s last name;
  • Person’s first name; and
  • MERP.  
    
    Note: Do not put spaces, dashes or any other symbol between the elements in the file name.
    Example: JonesSarahMERP.pdf

Information regarding MERP is found on the HHS website or by emailing MERP@hhsc.state.tx.us.

For information regarding a specific case, call toll-free at 800-641-9356.

Revision Notice 22-3; Effective Oct.17, 2022

15100 Research Preventing Dual Enrollment

Revision Notice 22-3; Effective Oct.17, 2022

A person cannot be simultaneously enrolled in more than one 1915c waiver. See Appendix II, Mutually Exclusive Services.

If a person accepts a Home and Community-based Services (HCS) or Texas Home Living (TxHmL) enrollment offer, the local intellectual and developmental disability authority (LIDDA) determines if the person is currently enrolled in a mutually exclusive waiver program before the HCS or TxHmL begin date can be determined. The LIDDA  asks the person or legally authorized representative (LAR) if they currently receive any Medicaid services and checks the following systems to verify if the person is currently enrolled in a mutually exclusive waiver program or service:

HHS applications: 

• Client Assignment and Registration (CARE) – C63, Medicaid Eligibility Search
• Service Authorization System Online (SASO) (see instructions below)

Texas Medicaid & Healthcare Partnership (TMHP) applications:

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

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

SASO instructions:

• In the “Client ID” field, enter the person’s Medicaid number, or enter their Social Security number in the “SSN” field.
• Verify the search results are for the correct person.
• Click on the hyperlink for the person’s Medicaid number.
• Scroll down on the left navigation list to “Program and Service” and click on “Enrollment.”
• In the search results, look at the columns labeled “Service Group,” “Begin Date” and “End Date.”
• If a service group code is indicated with a begin date but no end date, the person is receiving services for that service group.
• Use the chart below to determine which service the person receives or program the person is enrolled in. 

Service Group	Description
1	Nursing Facility
2	CLASS
4	SSLC
5	ICF/IID-State Operated
6	ICF/IID Non-State Operated
7	Community Care
8	Hospice
9	LTC Support Services
10	Swing Bed
11	PACE
21	HCS
14	LIDDA Targeted Case Management
22	TxHmL
16	DBMD
Only shown on the LTC Online Portal	MDCP
19	STAR+PLUS Waiver

If the person receives other Medicaid Services, the LIDDA uses Appendix I, Mutually Exclusive Services, to determine if the services being received are mutually exclusive to enrollment in HCS or TxHmL. When using the table, if an “x” appears in the square where two services intersect, the two may not be received at the same time. However, if the square is blank, the two services may be received at the same time. Some services may be received simultaneously if certain conditions apply—if the square shows a number, refer to the explanation for that number below the table.

If the LIDDA determines that the person is enrolled in a mutually exclusive waiver program or service, the LIDDA must:

• inform the person or LAR of the requirement to choose between the two programs;
• discuss and compare the services with the person and LAR, using the Long Term Services & Supports document to ensure that the person or LAR makes an informed decision; and
• if the person accepts the offer for HCS or TxHmL, coordinate with the service coordinator or case manager of the other program to determine the HCS or TxHmL begin date and the end date of the other program or service to:
  • ensure there is no service interruption; and
  • prevent dual enrollment in mutually exclusive waiver programs.

Note: People receiving Community First Choice (CFC) non-waiver services must transition over to HCS or TxHmL waiver services once enrolled. The LIDDA must instruct the person or LAR to work with the Managed Care Organization (MCO) to end current CFC non-waiver services before transitioning to HCS or TxHmL waiver services.

15200 Persons Enrolled in STAR+PLUS Waiver or Medically Dependent Children Program

Revision 22-2; Effective July 22, 2022

The State of Texas Access Reform Plus (STAR+PLUS) Waiver and the Medically Dependent Children Program (MDCP) STAR Kids programs operate through a managed care organization (MCO), which receives a monthly capitation payment. Therefore, a person must be not be discharged from STAR+PLUS or MDCP before the last day of the month that the MCO has already been paid to provide services to the person. Home and Community-based Services (HCS) and Texas Home Living (TxHmL) can begin on the first day of the month after the STAR+PLUS or MDCP discharge date.

If a person is enrolled in STAR+PLUS Waiver or MDCP and chooses to enroll in HCS or TxHmL, the local intellectual and developmental disability authority (LIDDA) must:

• inform the person and legally authorized representative (LAR) that disenrollment from SPW or MDCP must occur on the last day of a month;
• ensure the person's HCS or TxHmL Individual Plan of Care (IPC) begin date is on the first day of the month immediately following the SPW or MDCP end date; and
• submit in the Texas Medicaid & Healthcare Partnership (TMHP) Long-Term Care (LTC) Online Portal before the 20th day of the month before the enrollment begin date for HCS or TxHmL:
  • HCS or TxHmL Pre-enrollment Form;
  • 8578 ID/RC Assessment; and
  • 3608 Individual Plan of Care or 8582 Individual Plan of Care on the Texas Medicaid & Healthcare Partnership (TMHP) Long-Term Care (LTC) Online Portal before the 20th day of the month before the enrollment begin date for HCS or TxHmL.

If forms are submitted on the TMHP LTC Online Portal before the 20th day of the month before the HCS or TxHmL begin date, PES will notify HHSC Health Plan Operations of the person’s pending enrollment into HCS or TxHmL and request the person’s disenrollment from STAR+PLUS Wavier or MDCP.

However, if forms are not submitted on the LTC Online Portal before the 20th day of the month before the HCS or TxHmL begin date, the LIDDA must coordinate with the case manager or service coordinator of the other program again to change the STAR+PLUS Waiver or MDCP end date to the last day of the next month and change the HCS or TxHmL begin date to the first day of the following month.

15300 Determine if the Person is a Medicare Beneficiary

Revision 19-4; Effective September 9, 2019

The US Government site for Medicare is Medicare.gov.

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

• check to see if a person is a Medicare recipient and:
  • verify that the person is enrolled in a Medicare-sponsored prescription drug plan; and
  • assist the person in applying for extra help using the SSA-1020 form.
    Note: The person must enroll in a Medicare drug plan to receive prescription medications.
• inform the person that upon enrollment in a waiver or an intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID) program, he or she will be auto-enrolled into a Medicaid drug plan, which may or may not be the drug plan that is most beneficial. Medicaid will pay for a limited list of drugs that Medicare will not.
• inform the person that if they are enrolling in Home and Community-based Services (HCS), the program provider can assist them with changing drug plans and filing an exception, appeal or grievance with the drug plan.
• inform the person that if they are enrolling in Texas Home Living (TxHmL), the LIDDA service coordinator can assist them with changing drug plans and filing an exception, appeal or grievance with the drug plan.

15400 Financial Eligibility

Revision 19-4; Effective September 9, 2019

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

15410 Financial Eligibility at Pre-Enrollment

Revision 22-2; Effective July 22, 2022

The local intellectual and developmental disability authority (LIDDA) checks the Client Assignment and Registration System screen C63, Medicaid Eligibility Search or the Texas Medicaid & Healthcare Partnership (TMHP) TexMed Connect - Medicaid Eligibility and Service Authorization Verification (MESAV) system.

15411 No Medicaid

Revision 20-4; Effective October 15, 2020

If a person is not currently receiving Medicaid benefits or receives Medicaid benefits under a Medicaid program type that is not accepted for enrollment in the Home and Community-based Services (HCS) or Texas Home Living (TxHmL) programs, the person/legally authorized representative (LAR) must apply for Supplemental Security Income (SSI) benefits through the Social Security Administration (SSA) or apply for Medicaid through Texas Health and Human Services Commission (HHSC). The LIDDA must offer to assist the person/LAR with submitting the application and explain the time frame for enrollment again. To determine which application the person/LAR should submit, the LIDDA must know the person’s monthly income.

Note: There are monthly income limits that can affect Medicaid eligibility.

If the person’s monthly income does not exceed the monthly federal payment standard for SSI benefits by more than $20, the LIDDA must inform the person of the process for applying for SSI benefits and assist the person/LAR to apply. If the person’s SSI benefits are approved, SSI Medicaid is automatically approved, which is accepted for enrollment in the HCS or TxHmL program.

If the person’s monthly income exceeds the monthly federal payment standard for SSI benefits by more than $20, the LIDDA must assist the person/LAR with submitting Form H1200, Application for Assistance – Your Texas Benefits. The LIDDA can assist the person/LAR with creating an account and applying online at www.yourtexasbenefits.com. If the person/LAR applies online, the status of the application is available while under review. Also, if additional documentation is needed to complete the application process, the person/LAR will be informed of the needed documents through their online account. The LIDDA can assist the person/LAR with submitting documents through their online account. The online process is recommended; however, if preferred, the person/LAR or LIDDA may submit the application by fax.

When the application is submitted either online or by fax, the LIDDA must download Form H1746-A, MEPD Referral Cover Sheet, follow the form instructions to complete the form and fax it to the HHS Document Processing Center at 877-236-4123.

Note: Form H1746-A is a fillable “smart form” that must be downloaded each time and completed using Adobe Acrobat Reader DC. Each form has a unique bar code that captures the person’s information as the form is completed. This ensures the form is matched to the correct application upon submission. Form H1746-A is not to be photocopied.

If completed and when faxing Form H1746-A, the LIDDA should include a copy of the person’s Determination of Intellectual Disability (DID), Form 8578, Intellectual Disability/Related Condition Assessment, and Form 3608, Individual Plan of Care (IPC) – HCS/CFC, (for HCS), or Form 8582, Individual Plan of Care – TxHmL/CFC, (for TxHmL). Submission of these forms is encouraged before completion of Form H1200 and Form H1746-A.

Apply for SSI benefits if the person’s monthly income does not exceed the monthly federal payment standard for SSI benefits by more than $20. Medicaid should only be applied for if the person’s monthly income exceeds the monthly federal payment standard for SSI benefits by more than $20. The Medicaid application cannot be approved if the person may be eligible for SSI benefits.

A Medicaid application cannot be processed while the person has a pending application for SSI benefits or is appealing an SSI denial. If the person is denied SSI benefits and does not want to appeal, or the person appeals and is still denied, follow the process described above for submitting a Medicaid application.

15412 Qualified Medicare Beneficiary or Specified Low-Income Medicare Beneficiary

Revision 22-2; Effective July 22, 2022

Qualified Medicare Beneficiary (QMB) and Specified Low-Income Medicare Beneficiary (SLMB) are not “full” Medicaid benefit programs. QMB only pays for a person’s Medicare premiums, deductibles, and co-pays, while SLMB is an extension of QMB that only pays for Medicare Part B premiums. People receiving QMB or SLMB may also receive full Medicaid benefits. However, if the person’s Medicaid information in Client Assignment and Registration System screen C63, Medicaid Eligibility Search or the Texas Medicaid & Healthcare Partnership (TMHP) TexMed Connect - Medicaid Eligibility and Service Authorization Verification (MESAV) system, indicates the person only receives QMB (Q24) or SLMB (B23), the local intellectual and developmental disability authority (LIDDA) must follow the process described in Section 15411 No Medicaid.

The LIDDA can refer to the Medicaid for the Elderly and People with Disabilities Handbook for detailed information about Medicaid programs, timelines, procedures and forms.

15420 Persons Leaving an ICF/IID, State Hospital or SSLC to Enroll in HCS or TxHmL

Revision 22-2; Effective July 22, 2022

A person residing in an intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID), state hospital or state supported living center (SSLC) is certified for full Medicaid benefits under the institutional Medicaid program. 

• If a person is leaving the facility and enrolling in the Home and Community-based Services (HCS) and is currently receiving Supplemental Security Income (SSI) Medicaid (D13 or I13) or ME Institutional Medicaid (D14 or I14), when the LIDDA  has submitted the HCS or TxHmL Pre-enrollment Form; Form 8578, Intellectual Disability/Related Condition (ID/RC); and Form 3608, Individual Plan of Care on the Texas Medicaid & Healthcare Partnership (TMHP) Long-Term Care (LTC) Online Portal (see Section 13241, Form Submission for Enrollment), Program Eligibility and Support (PES) will submit Form 1746A, MEPD Referral Coversheet to Medicaid for the Elderly and People with Disabilities (MEPD) to request a Medicaid program transfer to “ME Waivers Medicaid,” which pays for HCS. However, if the person loses full Medicaid benefits before the LIDDA enters the enrollment  forms, the LIDDA must follow the process described above for submitting a new Medicaid application.
• If a person is leaving the facility and enrolling in the Texas Home Living (TxHmL) program, and is currently receiving SSI Medicaid (D13 or I13) when the LIDDA  has submitted the HCS or TxHmL Pre-enrollment Form; Form 8578, Intellectual Disability/Related Condition (ID/RC); and Form 8582, Individual Plan of Care on the LTC Online Portal (see Section 13339, Form Submission for Enrollment), PES submits a request to HHSC Texas Integrated Eligibility System (TIERS) Disposition to transfer the person’s Medicaid program to “SSI Waivers Medicaid,” which pays for services. However, if the person loses full Medicaid benefits before the LIDDA enters the enrollment forms, the LIDDA must follow the process described above for submitting a new Medicaid application.

Note: PES cannot submit a request for the Medicaid program change until the person is discharged from the facility and the LIDDA has submitted the required forms on the LTC Online Portal. See Section 13241, Form Submission for Enrollment and Section 13339, Form Submission for Enrollment. 

A person receiving Supplemental Security Income (SSI) benefits is automatically certified for SSI Medicaid. Client Assignment and Registration (CARE) screen 193, Medicaid Eligibility Information, displays a Medicaid coverage code and program type of “D13” or “I13” for people who reside in a facility and receive SSI Medicaid. Before PES can request a Medicaid program change for HCS or TxHmL to “R13,” the person’s representative payee must contact the Social Security Administration (SSA) to update the person’s address and inform the SSA of the person’s facility discharge date. The facility must submit a discharge form to the SSA. If the SSA receives the discharge form from the facility before the representative payee notifies the SSA of the change, SSI benefits may be suspended, which will result in suspension of SSI Medicaid. When the representative payee contacts the SSA to update the information, SSI will be unsuspended, which will automatically reinstate SSI Medicaid. When SSI Medicaid is reinstated, PES can request the Medicaid program change.

For people being discharged from an ICF/IID, state hospital, or SSLC who have lost SSI benefits or full Medicaid benefits before the HCS or TxHmL begin date, the LIDDA must follow the process described in Section 15411, No Medicaid.

15500 Chart of Acceptable Types of Medicaid for HCS and TxHmL

Revision 20-4; Effective October 15, 2020

The following chart indicates the acceptable Medicaid coverage codes and program types for enrollment in Home and Community-based Services (HCS) and Texas Home Living (TxHmL). If a person does not an acceptable Medicaid coverage/program, the local intellectual and developmental disability authority (LIDDA) must follow the process described in Section 15411, No Medicaid.

Required Medicaid Codes and Type Program

Coverage Code	Type Program	HCS	TxHmL	Coverage Code	Type Program	HCS	TxHmL
R or P	01	Yes	Yes	R or P	47	Yes	Yes
R or P	02	Yes	Yes	R or P	48	Yes	Yes
R or P	03	Yes	Yes	R or P	51	Yes	No
R or P	07	Yes	Yes	R or P	55	Yes	Yes
R or P	08	Yes	Yes	R or P	61	Yes	Yes
R or P	09	Yes	Yes	R or P	70	Yes	Yes
R or P	10	Yes	Yes	R or P	79	Yes	Yes
R or P	11	Yes	Yes	R or P	80	Yes	Yes
R or P	12	Yes	Yes	R or P	81	Yes	Yes
R or P	13	Yes	Yes	R or P	82	Yes	Yes
R or P	14	Yes	No	R or P	87	Yes	Yes
R or P	15	Yes	Yes	R or P	88	No	Yes
R or P	18	Yes	Yes	R or P	91	Yes	Yes
R or P	19	Yes	Yes	R or P	92	Yes	Yes
R or P	20	Yes	Yes	R or P	93	Yes	Yes
R or P	21	Yes	Yes	R or P	94	Yes	Yes
R or P	22	Yes	Yes	R or P	95	Yes	Yes
R or P	29	Yes	Yes	R or P	96	Yes	Yes
R or P	37	Yes	No	R or P	97	Yes	Yes
R or P	40	Yes	Yes	R or P	98	Yes	Yes
R or P	43	Yes	Yes
R or P	44	Yes	Yes
R or P	45	Yes	Yes

15600 Appointment of an Authorized Representative

Revision 20-4; Effective October 15, 2020

A person may allow designate another person to act on his or her behalf as a Medicaid authorized representative by completing Form H1003, Appointment of an Authorized Representative. Only one authorized representative may be appointed. To change or end a designated authorized representative, the person can log in to his/her Your Texas Benefits account or call 2-1-1.

An authorized representative must be familiar with the person and knowledgeable of their finances; therefore, a person should only designate a LIDDA staff person as a last resort. However, the person or their designated authorized representative may submit Form H1826, Case Information Release, to authorize HHSC to release information regarding the person’s Medicaid case to the LIDDA. To end this authorization, the person can log in to his/her Your Texas Benefits account or call 2-1-1. The LIDDA may also call 2-1-1 to end the authorization.

Form H1003 is submitted to HHSC with Form H1746-A, MEPD Referral Cover Sheet, and when submitting the required application and supporting documentation.

15700 Medicaid Forms

Revision 20-4; Effective October 15, 2020

Medicaid forms are found in the Medicaid for the Elderly and People with Disabilities Handbook.

15710 Form H1746-A, MEPD Referral Cover Sheet

Revision 22-2; Effective July 22, 2022

Form H1746-A, MEPD Referral Cover Sheet, is completed by the local intellectual and developmental disability authority (LIDDA) to share case information and provide supporting documentation with Access and Eligibility Services (AES) eligibility staff for applicants and recipients of Home and Community-based Services (HCS) and Texas Home Living (TxHmL) waiver services.

Form H1746-A is a fillable “smart form” that must be downloaded each time and completed using Adobe Acrobat Reader DC. Each form has a unique bar code that captures the person’s information as the form is completed. This ensures the form is matched to the correct application upon submission. 

Important: Form H1746-A should not be photocopied.

Form H1746-A must be included with all applications and documents submitted for an HCS or TxHmL applicant.

Form H1746-A must be the first document in the packet when mailing or faxing documents. Two-sided faxing must be used when possible. By faxing and mailing documents, duplication in the system occurs and delays the process. If sending more than one application, fax each application individually with one Form H1746-A per application, or mail applications in a batch using Form H1746-B, Batch Cover Sheet.

Not submitting Form H1746-A may result in a Medicaid denial for HCS/TxHmL services.

15720 Completing Sections on Form H1746-A, MEPD Referral Cover Sheet

Revision 22-2; Effective July 22, 2022

Applicant/ Consumer Information

• If known, fill in the Texas Integrated Eligibility System (TIERS) number. If the TIERS number is unknown, do not enter any other number and leave the field blank.
• If known, enter the Medicaid number in the Individual Number field. If the Medicaid number is unknown, do not enter any other number.
• The local intellectual and developmental disability authority (LIDDA) must enter the correct ZIP code, county, Social Security number, person’s last and first name, and date of birth. LIDDAs must not submit Form H1746-A without this information.

Action

• For pending enrollments, the LIDDA must mark “Application.”
• The LIDDA must review the instructions for Form H1746-A for details on using the other action statuses.

Program

• The LIDDA must select either Home and Community-based Services (HCS) or Texas Home Living (TxHmL). 

Information for MEPD Worker

• The LIDDA must leave this section blank.

Sender

The LIDDA must:

• select “MRA”; and
• enter the Date, From, Phone, City, County/Service Area and Fax information for the LIDDA staff helping with the Medicaid application process. 

Note: LIDDAs must not submit the form without this information.

Additional Comments

• If the person or legally authorized representative (LAR) submitted the application to Texas Health and Human Services Commission (HHSC) separately, the LIDDA should indicate “application submitted separately.” HHSC will link Form H1200, Application for Assistance – Your Texas Benefits, with Form H1746-A.  
• For HCS, LIDDAs must enter this statement:  
  • “Please test for Medicaid Waivers. Level of Care Authorized. Medical Necessity and Individual Service Plan questions below are not applicable for the HCS program.”  
• For TxHmL, LIDDAs must enter this statement:  
  • “Enrolling in TxHmL. Please test the applications for all Retirement Survivor and Disability Insurance (RSDI) Exclusion Programs. Level of Care Authorized. Medical Necessity and Individual Service Plan questions below are not applicable for the TxHmL program.” 

Note: LIDDAs must not complete the Medical Necessity (MN) section of Form H1746-A. 

Follow-up

• Generally, the Medicaid application process is completed within 45 days. However, some situations may prolong the process, such as requests for more documentation and disability determination reviews.
• The LIDDA must document in the person’s record the date the application was submitted to Health and Human Services Commission (HHSC).
• If assistance from HHSC is needed while the application is being processed, the LIDDA, person or legally authorized representative can call: 
  • 2-1-1; 
  • Medicaid Hotline at 800-252-8263; or 
  • HHSC Ombudsman Office at 800-252-8154.
• If all enrollment forms have been submitted, Medicaid eligibility has been pending for longer than 45 days, and the LIDDA has been unsuccessful using the contact information above, the LIDDA can contact Program Eligibility and Support (PES) at 512-438-2484 or email EnrollmentTransferDischargeInfo@hhs.texas.gov.

15800 Financial Eligibility After Enrollment - HCS and TxHmL

Revision 20-4; Effective October 15, 2020

Persons must maintain financial eligibility to remain eligible for the waiver program.

Supplemental Security Income (SSI) Medicaid

If a person loses SSI benefits, the person also loses SSI Medicaid. It is the person’s representative payee’s responsibility to contact the Social Security Administration (SSA) for assistance. If SSI benefits are reinstated, SSI Medicaid will be automatically reinstated. If the program provider is the representative payee, the provider is responsible for taking action to reestablish SSI benefits and SSI Medicaid.

Medical Assistance Only (MAO)

If a person loses MAO, the person or their authorized representative must call 2-1-1 for assistance. However, the local intellectual and developmental disability authority (LIDDA) must assist if requested by the person or authorized representative.

15810 Medicaid Redetermination

Revision 22-2; Effective July 22, 2022

For Medical Assistance Only (MAO) recipients (i.e., not applicable for Supplemental Security Income (SSI) recipients), Texas Health and Human Services Commission (HHSC) requires people to submit a Medicaid redetermination packet to HHSC at least annually. HHSC mails the redetermination packet to the person’s mailing address on file in the Texas Integrated Eligibility Redesign System (TIERS) 90 days in advance of the redetermination due date. It is important that the packet be completed and returned to HHSC before the due date; otherwise, Medicaid eligibility will be denied.

• Local intellectual and developmental disability authorities (LIDDAs) can review the Client Assignment and Registration (CARE) System screen C63, Medicaid Eligibility Search, to determine a person’s review date. This information is displayed in the “ME Annual Renewal Date” field in this screen. LIDDAs can also use “Due” and “Past Due” Dashboard tiles on the Texas Medicaid & Healthcare Partnership  Long-Term Care  Online Portal. 

Note: People who receive SSI Medicaid are not required to submit a redetermination packet because their eligibility is based on their SSI eligibility. The Social Security Administration (SSA) reports SSI recipient information directly to TIERS for these persons.

15820 Reestablishing Medicaid

Revision 20-4; Effective October 15, 2020

15821 Loss of Supplemental Security Income (SSI) Medicaid

Revision 20-4; Effective October 15, 2020

If a person loses SSI benefits, the person will also lose SSI Medicaid. It is the responsibility of the person or their representative payee to contact the Social Security Administration (SSA) to determine the necessary action to reinstate SSI benefits. Adults who lose SSI benefits because they became eligible for Retirement, Survivors and Disability Insurance (RSDI) benefits, and their income is now over the income limit for SSI benefits, may be eligible for Disabled Adult Children’s Medicaid. Therefore, if SSI benefits will not be reinstated due to receiving RSDI benefits, the person must submit a Medicaid application to Texas Health and Human Services Commission (HHSC).

If the provider is the representative payee, the provider is responsible for ensuring immediate action is taken to reestablish financial eligibility. If they are not the authorized representative, the provider is responsible for working with the person or authorized representative in assisting to maintain and reestablish the person’s financial eligibility. The local intellectual and developmental disability authority (LIDDA) must assist if requested by the person or authorized representative. If the LIDDA is assisting with the submission of the Medicaid application, they must include a completed Form H1746-A, MEPD Referral Cover Sheet.

15822 Loss of Medical Assistance Only (MAO) Medicaid

Revision 20-4; Effective October 15, 2020

If a person loses financial eligibility, it is the responsibility of the person, legally authorized representative (LAR) or authorized representative to reestablish financial eligibility as soon as possible. If the provider is the authorized representative, it is the provider’s responsibility to maintain and reestablish the person’s financial eligibility to prevent an interruption in services and payment. If they are not the authorized representative, the provider is responsible for working with the person or authorized representative in assisting to maintain and reestablish the person’s financial eligibility. The local intellectual and developmental disability authority (LIDDA) must assist if requested by the person or authorized representative.

15823 Loss of Department of Family and Protective Services (DFPS) Medicaid

Revision 20-4; Effective October 15, 2020

When a person “ages out” of DFPS conservatorship, the person may lose DFPS Medicaid. Typically, as the person reaches the age out date, DFPS submits a Supplemental Security Income (SSI) application to the Social Security Administration (SSA) on the person’s behalf. However, should a person lose DFPS Medicaid due to aging out of DFPS conservatorship, the person’s representative payee must submit an SSI application to the SSA.

Revision 20-1; Effective June 18, 2020

These guidelines describe the procedures used by the local intellectual and developmental disability authority’s (LIDDA’s) service coordinator by providing a preliminary summary to aid in the discussion of determining the less restrictive setting for persons requesting admission, or on whose behalf admission is considered or requested, to a state supported living center. Form 8515, Guidelines for Determining Less Restrictive Setting, is only one part of the admission criteria that must be considered by the service planning team (SPT).

16100 Instructions

Revision 20-1; Effective June 18, 2020

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

• Use Form 8515, Guidelines for Determining Less Restrictive Setting, to assist the service planning team (SPT) discussion regarding whether a person can be adequately and appropriately supported in an available, less restrictive setting;
• Use Form 8515 when admission to a state supported living center (SSLC) is considered or requested; and
• Use a person-centered approach when determining eligibility for an available, less restrictive setting.

To ensure the “key items” from these guidelines are documented in interdisciplinary team (IDT) reports, the LIDDA must:

• Incorporate the “key items” as essential elements of the LIDDA’s policy and procedure for IDTs;
• Develop an internal monitoring system to ensure that Form 8515 is used by IDTs; and
• Ensure that a completed Form 8515 accompanies any SSLC application.

16200 Discussion of Key Issues Using Probing Questions

Revision 20-1; Effective June 18, 2020

The service coordinator will use Form 8515, Guidelines for Determining Less Restrictive Setting, to discuss the following key items with, and in a manner understood by, the person, legally authorized representative (LAR), supported decision maker or someone else actively involved with the person.

Item: Preferences of the Person, LAR and/or Someone Else Actively Involved with the Person

Section 1 of Form 8515 ensures the local intellectual and developmental disability authority (LIDDA) provides to the person, current LAR and/or someone else actively involved with the person, the explanation of possible services and supports and an explanation of, and copy of, the “Rights in Local Authority Handbook,” as administered by the Texas Health and Human Services Commission (HHSC).

Section 2 of Form 8515 ensures the person, their current LAR, supported decision maker or someone else actively involved with the person has expressed to the LIDDA preferences for the possible types of services available to them. In the event the person cannot communicate or is not responsive, choose “Not Applicable” in the drop-down boxes.

Section 3 of Form 8515 ensures the LIDDA requests the history of services and supports provided for a person. This section also describes the person’s involvement in local resources and/or those administered under HHSC. In this section, a diversion slot refers to a nursing facility (NF) slot, or a Home and Community-based Services (HCS) crisis diversion slot.

Item: Medical

Section 4 of Form 8515 describes the types of medical and nursing needs the person requires. This section also describes behavior support requirements and/or any mental/behavioral health needs.

Item: Quality of Life

Section 5 of Form 8515 identifies factors important to the person, LAR, supported decision maker or actively involved person in choosing a place to live, including but not limited to family, friends, employment, leisure activities, living arrangements, daily routine, privacy, community integration, faith or religion, self-determination, safety, freedom of movement and dignity of risk.

This section should:

• Support the development of meaningful relationships and the continuity of current relationships;
• Promote the development of skills that foster independence, to the extent possible;
• Maximize opportunities for integration, relationships and involvement of people with and without disabilities;
• Balance safety, freedom of movement, with or without supports and assistance, and dignity of risk, as determined by the person’s preferences/needs;
• Provide opportunities for expression of faith or religion in a way or to the extent desired; and
• Provide opportunities to make personal decisions to the extent possible.

Item: Persons Under 22 Years of Age

Section 6 of Form 8515 outlines the needs and requirements for persons under the age of 22 concerning permanency planning (focuses on the outcome of family support for persons under 22 years of age by facilitating a permanent living arrangement in which the primary feature is an enduring and nurturing parental relationship).

Additional Information:

The final section of Form 8515 is to be used to provide additional information for any of the aforementioned sections.

16300 Documentation

Revision 20-1; Effective June 18, 2020

Documentation in the interdisciplinary team (IDT) staffing summary will include:

• Source of the information discussed;
• Relevant deliberation; and
• Outcome of the discussion of key items.

Revision 19-4; Effective September 9, 2019

Non-waiver CFC provides certain services and supports through managed care organizations (MCOs) to persons living in the community who are enrolled in the Medicaid program and meet CFC eligibility requirements.

17100 Initial Eligibility Determination Activities

Revision 19-4; Effective September 9, 2019

For persons referred to the local intellectual and developmental disability authority (LIDDA) for assessments of eligibility for Community First Choice (CFC) services based on an intellectual disability (ID), the LIDDA must complete all assessment activities required by Texas Health and Human Services Commission (HHSC) to determine whether the persons meet an intermediate care facility for individuals with intellectual disabilities or related conditions (ICF/IID) level-of-care (LOC) including:

• Form 8578-CFC, Intellectual Disability/Related Condition Assessment for CFC;
• Form 8662, Related Conditions Eligibility Screening Instrument, if the person’s primary diagnosis is a related condition;
• Determination of Intellectual Disability (DID) or endorse an existing DID; See DID Best Practice Guidelines.  

The LIDDA must submit the assessment information to HHSC using the Client Assignment and Registration (CARE) System for an LOC determination.

If the person’s primary diagnosis is a related condition, the LIDDA must:

• retain a physician’s attestation that the person has a condition listed on the approved list of related conditions; and
• confirm on CARE screen K23, CFC ID/RC Assessment Update, that the LIDDA has a physician’s attestation.

17110 Person Does Not Meet ICF/IID LOC Criteria

Revision 19-4; Effective September 9, 2019

For all persons for whom Texas Health and Human Services Commission (HHSC) has determined does not meet the criteria for an intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID) level-of-care (LOC), the local intellectual and developmental disability authority (LIDDA) must compile a packet with the following documentation and submit it to the Medicaid managed care organization (MCO) via the secure file transfer protocol (SFTP) site:

• completed Form 1040, CFC Non-Waiver Packet Information and Checklist;
• completed Form 8578-CFC, Intellectual Disability/Related Condition Assessment for CFC; and
• copy of the Determination of Intellectual Disability (DID) report.

17120 Person Meets ICF/IID Criteria Under Age 21

Revision 19-4; Effective September 9, 2019

For persons under the age of 21 years for whom Texas Health and Human Services Commission (HHSC) has determined does meet the criteria for an intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID) level-of-care (LOC), the local intellectual and developmental disability authority (LIDDA) must compile a packet with the following documentation and submit it to the Medicaid managed care organization (MCO) via the secure file transfer protocol (SFTP) site:

• completed Form 1040, CFC Non-Waiver Packet Information and Checklist;
• completed Form 8578-CFC, Intellectual Disability/Related Condition Assessment for CFC; and
• copy of the Determination of Intellectual Disability (DID) report; and
• any other related documentation that may need to be transmitted.

The LIDDA does not provide service coordination for persons under 21 years of age and receiving Community First Choice (CFC) through the MCO.

17130 Person Meets ICF/IID Criteria Age 21 and Older

Revision 19-4; Effective September 9, 2019

For persons with an intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID) level-of-care (LOC), the local intellectual and developmental disability authority (LIDDA) must conduct the initial service planning activities and assign a service coordinator no later than 30 days after Texas Health and Human Services Commission (HHSC) authorizes the person’s ICF/IID LOC.

The LIDDA must conduct person-centered service planning with the person and the legally authorized representative (LAR). The LIDDA will contact the person or LAR to schedule a time to meet and complete the Community First Choice (CFC) assessment. The meeting is conducted face-to-face with the person and LAR. The LAR may attend by telephone if the LAR is unable to attend in person. The time and location of the meeting must be convenient to the person and LAR.

At the scheduled meeting, the LIDDA must:

• complete Form H6516, Community First Choice Assessment;
• complete Form 2060-B, Needs Assessment Addendum;
• complete Form 1581, Consumer Directed Services (CDS) Option Overview;
• identify with the person and LAR, a date, time and location for the joint meeting with the Medicaid managed care organization (MCO) service coordinator, that is approximately three weeks after the completion of Form H6516;
• provide a copy of Community First Choice: Choosing a Provider;
• tell the person or LAR to expect a list of CFC providers from the MCO within the next two weeks;
• encourage the person or LAR to be prepared to identify the selected CFC provider at the joint meeting; and
• tell the person or LAR to contact the MCO with questions about providers.

The LIDDA must compile a packet with the following documentation and submit it to the MCO via the secure file transfer protocol (SFTP) site:

• a completed Form 1040, CFC Non-Waiver Packet Information and Checklist, which includes the date, time and location of the scheduled joint meeting, and where the MCO sends a list of CFC providers;
• a copy of the Determination of Intellectual Disability (DID) report;
• a completed Form 8578-CFC, Intellectual Disability/Related Condition Assessment for CFC;  
• completed Form H6516;
• completed Form 2060-B;  
• completed Form 1581; and
• any other related documentation that may need to be submitted.

When the MCO receives the packet from the LIDDA, the MCO determines if the person has a need for CFC services.

If no services are on the recommended service plan (i.e., Form H6516 completed by the LIDDA, the MCO denies the request for services and sends the person an adverse determination letter, which includes an offer for a fair hearing. The LIDDA must participate in a fair hearing, if requested by the person or LAR, to explain why no services were recommended.

If there are services on the recommended service plan, but the MCO does not agree with the services recommended, the MCO service coordinator contacts the LIDDA to discuss the service plan and to reach an agreement about changes to the service plan that will be presented to the person. Following an agreement, the MCO service coordinator, person, LAR and LIDDA meet to jointly review the services for which the person will be authorized. The MCO then authorizes services and notifies the person. The MCO also notifies the LIDDA of the selected provider.

If there are services on the recommended service plan and the MCO service coordinator agrees with the services being recommended:

• the MCO service coordinator, person, LAR and LIDDA meet to jointly review the services for which the person will be authorized;
• the MCO then authorizes services and notifies the person; and
• the MCO also notifies the LIDDA of the selected provider.

The LIDDA must ensure an assigned service coordinator provides service coordination to a person age 21 or older while the person is receiving CFC services through an MCO in the LIDDA’s local service area (LSA).

17200 Annual Reassessment

Revision 19-4; Effective September 9, 2019

No later than 60 calendar days prior to the expiration of the intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID) level-of-care (LOC) for a person, the local intellectual and developmental disability authority (LIDDA) must communicate with the appropriate managed care organization (MCO) to determine whether the person is or is not receiving Community First Choice (CFC) services.
For persons who are not receiving CFC services, the LIDDA has no reassessment responsibilities.

For persons who are receiving CFC services, the LIDDA must:

• conduct the reassessment activities described in this section and communicate with the MCOs as directed by Texas Health and Human Services Commission (HHSC);
• complete Form 8578-CFC, Intellectual Disability/Related Condition Assessment for CFC, to determine if the person continues to meet the ICF/IID LOC criteria.
  Note: The LIDDA may have to complete a new Determination of Intellectual Disability (DID).

The LIDDA should consider this if the person’s current determination of intellectual disability (DID) was completed when the person was under the age of 22 years and the testing was done more than five years ago. Information about conducting DIDs is found in the DID Best Practice Guidelines.

The LIDDA must submit the assessment information to HHSC using the Client Assignment and Registration (CARE) System for a LOC determination.

17210 Person No Longer Meets ICF/IID LOC Criteria

Revision 19-4; Effective September 9, 2019

For all persons for whom Texas Health and Human Services Commission (HHSC) has determined does not continue meet the criteria for an intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID) level-of-care (LOC), the local intellectual and developmental disability authority (LIDDA) must compile a packet with the following documentation and submit it to the managed care organization (MCO) via the secure file transfer protocol (SFTP) site:

• completed Form 1040, CFC Non-Waiver Packet Information and Checklist;
• completed Form 8578-CFC, Intellectual Disability/Related Condition Assessment for CFC; and
• Determination of Intellectual Disability (DID) report, if a new DID was completed.

17220 Person Continues to Meet ICF/IID Criteria Under Age 21

Revision 19-4; Effective September 9, 2019

For persons under the age of 21 years for whom Texas Health and Human Services Commission (HHSC) has determined does meet the criteria for an intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID) level-of-care (LOC), the local intellectual and developmental disability authority (LIDDA) must compile a packet with the following documentation and submit it to the managed care organization (MCO) via the secure file transfer protocol (SFTP) site:

• completed Form 1040, CFC Non-Waiver Packet Information and Checklist;
• completed Form 8578-CFC, Intellectual Disability/Related Condition Assessment for CFC;
• copy of the Determination of Intellectual Disability (DID) report; and
• any other related documentation that may need to be transmitted.

The LIDDA does not provide service coordination for persons under 21 years of age and receiving Community First Choice (CFC) through the MCO.

17230 Person Continues to Meet ICF/IID Criteria Age 21 and Older

Revision 19-4; Effective September 9, 2019

The local intellectual and developmental disability authority (LIDDA) service coordinator is responsible for completing the annual service planning and continuation of LIDDA services for persons 21 years of age or older who continue to have an intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID) level-of-care (LOC).
The LIDDA must:

• conduct person-centered service planning with the person to determine what services they need; and
• contact the person or legally authorized representative (LAR) to schedule a time to meet and complete Form H6516, Community First Choice Assessment.

The meeting is conducted face-to-face with the person and LAR. The LAR may attend by telephone if the LAR is unable to attend in person. The time and location of the meeting must be convenient to the person and LAR.

At the scheduled meeting, the LIDDA must:

• complete Form H6516;
• complete Form 2060-B, Needs Assessment Addendum;
• complete Form 1581, Consumer Directed Services (CDS) Option Overview;
• identify with the person and LAR a date, time and location for the joint meeting with the MCO service coordinator, that is approximately three weeks after the completion of Form H6516; and
• determine if the person or LAR wants to change providers, and if so, requests that the managed care organization (MCO) send the person a list of providers using Form 1040, CFC Non-Waiver Packet Information and Checklist.

No later than 45 calendar days prior to the expiration of a person’s ICF/IID LOC, the LIDDA must compile a packet with the following documentation and submit it to the MCO via the secure file transfer protocol(SFTP) site:

• completed Form 1040 that includes the date, time and location of the joint meeting, and where to send provider information, if applicable;
• completed Form 8578-CFC, Intellectual Disability/Related Condition Assessment for CFC;
• copy of the Determination of Intellectual Disability (DID) report, if a new DID was completed;
• completed Form H6516;
• completed Form 2060-B; and
• completed Form 1581.

When the MCO receives the packet from the LIDDA, the MCO determines if the person continues to have a need for Community First Choice (CFC) services.

If no services are on the recommended service plan (i.e., completed Form H6516), the MCO denies the request for services and sends the person an adverse determination letter, which includes an offer for a fair hearing. The LIDDA must participate in a fair hearing, if requested by the person or LAR, to explain why no services were recommended.

If there are services on the recommended service plan, but the MCO does not agree with the services recommended, the MCO service coordinator contacts the LIDDA to discuss the service plan and to reach an agreement about changes to the service plan that will be presented to the person. Following the agreement, the MCO service coordinator, person, LAR and LIDDA meet to jointly review the services for which the person will be authorized. The MCO then authorizes services and notifies the person.

If there are services on the recommended service plan and the MCO service coordinator agrees with the services being recommended:

• the MCO service coordinator, person, LAR and LIDDA meet to jointly review the services for which the person will be authorized; and
• the MCO then authorizes services and notifies the person.

If the person selected a different provider, the MCO notifies the LIDDA of the name of the selected provider.

The LIDDA continues to provide service coordination to the person while they are receiving CFC services through an MCO in the LIDDA’s local service area.

17300 LIDDA Responsibilities When a Person Appeals an MCO’s Denial of Services

Revision 19-4; Effective September 9, 2019

If a managed care organization (MCO) denies a person’s request for service because there were no services on the person’s recommended service plan [i.e., Form H6516 completed by the local intellectual and developmental disability authority (LIDDA)] and the person requests a fair hearing to appeal the denial, the LIDDA must participate in the fair hearing to explain why no services were recommended.

Revision 19-4; Effective September 9, 2019

A local intellectual and developmental disability authority (LIDDA) must offer everyone who is 18 years of age or older the opportunity to register to vote:

• upon entry into services;
• annually; and
• when notified of a person’s change of address.

A LIDDA must provide the same degree of assistance, including bilingual assistance, to help a person complete the voter registration forms, as is provided with the completion of any Texas Health and Human Services Commission (HHSC) or LIDDA form.

LIDDA staff may not determine a person’s eligibility for voter registration other than a determination of whether the person is of voting age, which is 18 years of age, or is a U.S. citizen. A person’s age or citizenship may be verified by a LIDDA if the age or citizenship can be readily determined from information filed with HHSC or the LIDDA for purposes other than voter registration. A person must be offered voter registration assistance even if the person’s age or citizenship cannot be determined.

A LIDDA must not:

• influence a person’s political party preference;
• display any political party preference or allegiance; or
• make any statement or take any action for the purpose or effect of:
  • discouraging the person from registering to vote; or
  • leading the person to believe that a decision of whether to register has any bearing on the availability of, or eligibility for, services or benefits.

If the person has any questions regarding the voter registration process that the LIDDA cannot answer, the LIDDA must:

• advise the person to call the Office of the Texas Secretary of State toll-free at 1-800-252-8683; or
• give the person the telephone number of the local county voter registrar.

A LIDDA must follow the guidelines for voters with special needs, which may be accessed at VoteTexas.gov.

18100 Registering to Vote

Revision 19-4; Effective September 9, 2019

If a person expresses a desire to register to vote, a local intellectual and developmental disability authority (LIDDA) provides the person with:

• a blank voter registration form; and
• assistance and privacy in the completion of the registration form.

If the person wants to complete the voter registration form at the time the offer to register is made, the LIDDA must review the form for completeness in the presence of the person. If the form does not contain all the required information, including the required signature, the LIDDA staff returns it to the person for completion.

The person may choose to be responsible for mailing the form or may request the LIDDA to mail the form. If the person requests the LIDDA to mail the from, the LIDDA must mail the form within five days following completion of the form.

18200 Declining to Register

Revision 19-4; Effective September 9, 2019

If the person declines to complete a voter registration form, the local intellectual and developmental disability authority (LIDDA) will request that the person complete and sign Form 1019, Opportunity to Register to Vote/Declination. If the person refuses to sign Form 1019, the LIDDA must document the refusal on the form.

A LIDDA must maintain the completed form for 22 months and in a confidential location that is not a part of the person’s medical or clinical record.

18300 Ordering Voter Registration Forms

Revision 19-4; Effective September 9, 2019

LIDDA designated staff can order voter registration cards in English and Spanish through the HHS Pinnacle Cart.

Revision 20-3; Effective August 21, 2020

The 84th Session of the Texas Legislature provided local intellectual and disability development authorities (LIDDAs) with funds to support persons with intellectual and developmental disabilities (IDD) with significant behavioral and psychiatric challenges. These persons often exhibit significant needs requiring additional support beyond the array of services typically provided within community programs. The funds expanded resources to address crisis situations with persons who have IDD.

19100 Definitions

Revision 20-3; Effective August 21, 2020

In this section, the terms below have the following meanings.

Crisis – A situation in which:

• the person presents an immediate danger to self or others; or
• the person’s mental or physical health is at risk of serious deterioration; or
• a person believes he or she presents an immediate danger to self or others; or
• that his or her mental or physical health is at risk of serious deterioration.

Crisis respite – Means short-term (up to 14 calendar days) respite for intellectual and developmental disabilities (IDD) as follows:

• Out-of-home crisis respite provides therapeutic support in a safe environment with staff on-site providing 24-hour supervision for a person who is demonstrating a crisis that cannot be stabilized in a less intensive setting. Out-of-home crisis respite is provided in a setting for which the state provides oversight (for example, an intermediate care facility (ICF), a Home and Community-based Services (HCS) group home, a Department of State Health Services (DSHS)-authorized crisis respite facility or crisis residential facility); and
• In-home crisis respite provides therapeutic support to a person who is demonstrating a crisis in the person’s home when it is deemed clinically appropriate for the person to remain in his or her natural environment and it is anticipated the crisis can be stabilized within a 72-hour period.

CMBHS – Clinical Management for Behavioral Health Services is a web-based software application designed specifically for documentation of community substance use services in an electronic health record format and submission of mental health services data for client eligibility determination, service planning and authorization. Substance use disorder services and mental health service providers submit claims for payment through CMBHS. CMBHS allows HHSC to fulfill responsibilities such as state and federal data reporting, contract oversight, clinical quality improvement and compliance monitoring.

MBOW – Mental and Behavioral Health Outpatient Warehouse that standardizes reporting and analysis across the state funded community-based mental health service network. Reports are available via a web interface and focus on utilization management and contract compliance.

MCOT – Mobile Crisis Outreach Team funded by HHSC to provide a combination of crisis services including emergency care, urgent care and crisis follow-up and relapse prevention to the child, youth or adult in the community.

Therapeutic support – A flexible array of services, including behavioral support provided for persons with IDD who require varying therapeutic and habilitative levels of intervention to holistically address the stressors that result in challenging behaviors. Support may include training in:

• Activities to strengthen appropriate developmental functioning in areas of socialization, self-advocacy and rights;
• Developing coping skills; and
• Reducing or avoiding stressors to prevent crisis events.

TLETS – Texas Law Enforcement Telecommunication System is a statewide telecommunications network composed of computer terminals, interfaces and databases representing city, county, state, federal, military law enforcement and criminal justice agencies in Texas. This network is controlled by a computerized electronic message switching system located at the Texas Department of Public Safety in Austin.

Transition Support Team – (formerly referred to as the "Medical, Behavioral, and Psychiatric Support Team") means a team of professionals, regionally constituted, to provide educational activities, technical assistance, and de-identified case-specific peer review support to local intellectual and disability development authorities (LIDDAs) and IDD providers within a region.

19200 Duties of a Crisis Intervention Specialist

Revision 20-3; Effective August 21, 2020

The local intellectual and developmental disability authority (LIDDA) must ensure a crisis intervention specialist provides information about intellectual and developmental disability (IDD) programs and services to:

• person’s with IDD and their families; and
• IDD providers in the local service area.

The LIDDA must ensure the specialist collaborates with appropriate LIDDA staff and Transition Support Team members to identify persons with IDD in the LIDDA’s local service area who are at risk of requiring crisis services, such as persons who exhibit repeated and severe behavior disturbances that jeopardize the person’s safety or current living arrangement.

The LIDDA must ensure that for a person identified in the above paragraph:

• collaborates with the service coordinator, other members of the service planning team, and paid provider, if any, to identify:
  • prevention strategies to avoid potential crisis events and to promote the person’s coping skills; and
  • training and support needs that provide the greatest chance of success of living in the community, such as scheduled respite services or planned crisis respite to avoid a potential crisis event; and
• supports the service coordinator’s provision of ongoing follow-up and monitoring activities, including assisting the service coordinator, other members of the service planning team and paid provider, if any, in addressing concerns and issues identified during follow-up and monitoring visits, such as involvement with law enforcement or emergency room visits.

The LIDDA must ensure a crisis intervention specialist (CIS) provides education about the manner in which to engage persons with IDD and their unique needs to:

• members of a Mobile Crisis Outreach Team (MCOT) to increase the competency of the members;
• law enforcement; and
• others as appropriate.

The LIDDA must ensure a CIS:

• is available to provide consultation to an MCOT as needed or as clinically indicated regarding a crisis event involving a person with IDD;
• collaborates with an MCOT to develop criteria for referring a person with IDD in crisis to crisis respite;
• for a person referred to crisis respite, develops a crisis respite service plan describing the therapeutic support needed by the person;
• collaborates with local law enforcement by utilizing the Mental and Behavioral Health Outpatient Warehouse (MBOW) to review jail match reports and assisting in discharge planning for persons processed into correctional institutions who have been identified as receiving services from the LIDDA in the past three years;
  • there is no three-year cutoff for persons who are under the age of 18 (youth);
• collaborates with the service coordinator, other members of the service planning team, paid provider, if any, and natural supports regarding crisis follow-up and relapse prevention activities, including;
  • assisting with a person’s transition from a crisis respite back to his or her home or other appropriate setting; and
  • addressing concerns and issues identified during follow-up and monitoring visits, such as involvement with the law enforcement or emergency room visits; and
• documents all activities, collaboration and consultation provided in accordance with this section.

Note: LIDDAs may continue to use existing agency staff to collaborate with law enforcement on discharge planning, as long as the CIS is involved/aware in some manner

19210 Continuity of Care for Persons in Jail

Revision 20-3; Effective August 21, 2020

The 86th Legislature appropriated funding for exceptional Item 44 to add information related to persons with a history of receiving services from a local intellectual and developmental disability authority (LIDDA) into the Department of Public Safety (DPS) Texas Law Enforcement Telecommunication System (TLETS).

When a person who has previously received services from a LIDDA is processed into a correctional institution, facility personnel will run a continuity of care query in the TLETS system to identify if the person has a history of receiving intellectual and/or developmental disability (IDD) services from a LIDDA. If an exact or probable match is made, facility personnel will contact the LIDDA.

19220 Jail Match Report and Data Exchange Process

Revision 20-3; Effective August 21, 2020

A jail match report is created and identifies persons who have been processed into a correctional institution, and for whom facility personnel used the Department of Public Safety (DPS) Texas Law Enforcement Telecommunication System (TLETS) to determine whether a person has received intellectual and/or developmental disability (IDD) services for the purposes of establishing continuity of care.

The DPS TLETS system uses an electronic data exchange process with the Texas Health and Human Services Commission (HHSC) Clinical Management Behavioral Health System (CMBHS) to search for matches based on the following demographic data:

• last name;
• first name;
• date of birth;
• Social Security number;
• gender; and
• race.

The results are compared against CMBHS, which searches for persons who within the last three years have been:

• hospitalized in a state psychiatric hospital;
• admitted to an HHSC-funded, contracted psychiatric hospital bed; or
• assessed, authorized and received services by a LIDDA, to include the grid codes identified below:
  • Service Coordination:
    • 351, Basic Service Coordination;
    • 341, Continuity of Services; and
    • 355, Service Authorization and Monitoring.
  • Habilitation Coordination:
    • 361, Habilitation Coordination; and
    • 362, Refusal Habilitation Coordination Services.

Note: There is no three-year cutoff for persons under the age of 18 (youth).

CMBHS provides an immediate response to the TLETS system indicating if an exact or probable match was located within CMBHS. CMBHS provides an additional piece of information that identifies the name of the LIDDA that provided the services that serves that county.

The jail match report is produced and available to LIDDAs as soon as the next day and identifies the persons whom the match occurred with. The jail match report separates searched persons into those served within the LIDDA’s catchment area, and persons who were last served outside of the LIDDA’s catchment area.

Note: Notification of a match will be sent via email to the chosen mailbox identified by the LIDDA.

The LIDDA responsible for continuity of care efforts is the LIDDA last authorized to provide services to the person. However, the LIDDA last authorized can coordinate with the LIDDA that serves the county in which the person is jailed to assist in continuity of care efforts.

Jail match reports are located in the following folders:

Public Folders ─ MBOW_Production ─ Enterprise ─ CA Continuity of Care ─ Jail Match
The jail match report process details folder contains screen shots on how to navigate the jail match report. This folder is located in the following folder:

Public Folders ─ MBOW_Production ─ Enterprise ─ CA Continuity of Care ─ Jail Match Report Process Details

The information in these reports is designed to assist the LIDDAs with the operation of local continuity of care and service activities and to divert persons from the criminal justice system into appropriate community-based treatment alternatives.

The jail match cross-reference and continuity of care report contains state fiscal year, query begin and end date, match type prompts and a multitude of drillable variables. The first two tabs of the jail match report (i.e., “Client Count by Match Type” and “Request Count by Match Type”) contain actuarial data. The last two tabs (i.e., “Detail by Responsible Component” and “Detail by Request”) contain details relevant to determining appropriateness for diversion. A detailed description of all variables is identified in the table below.

Variable	Description
Request ID	Unique identifier (ID) for a match request.
Query Date and Time	Date and time of the match request.
Match Type	Match result categorized into exact, probable or possible match type based on the number of components matching the data inquiry.
Resp Comp Code	Comp code identified in the match response record.
Last Name (Note: Last name, first name, Social Security number, date of birth, gender and race are data variables from the correctional institution.)	Client’s last name.
Resp Last Name	Last name on the response record.
First Name	Client’s first name.
Resp First Name	First name on the response record.
Birth Date	Client’s date of birth.
Resp Birth Date	Birth date on the response record.
SSN	The SSN on the jail match request.
Resp SSN	The SSN on the response record.
Race	The race code placed on the match request by the booking jail.
Resp Race	The race code on the response record.
Gender	The gender placed on the match request by the booking jail.
Resp Gender	The gender code on the response record.
C of C Comp Cd	The code center deemed most appropriate to follow up on the client’s treatment. Prioritized by the center with the last authorization, encounter or hospitalization.
C of C Territory Status	Indicates the jail match occurred in or out of the continuity of care territory.

Questions regarding the MBOW jail match report should be directed to CMBHS by emailing CMBHSTrainingTeam@hhsc.state.tx.us or calling 866-806-7806.

19230 Matching Criteria

Revision 22-2; Effective July 22, 2022

One of the following are used to match people in a Texas Law Enforcement Telecommunication System (TLETS) query to a people in Clinical Management for Behavioral Health Services (CMBHS):

• Exact match: The data inquiry matches last name, first name, date of birth, Social Security number, gender and race.
• Probable match: The data inquiry matches one of the following match criteria options listed below:
  • Option 1: Last name, first name, date of birth, and gender;
  • Option 2: Last name, first name initial, date of birth, and Social Security number;
  • Option 3: Last name, first name, date of birth (current age calculation is within five years), gender and Social Security number; or
  • Option 4: Seven or more digits of the Social Security number. 

19240 Duties of a LIDDA Related to TLETS

Revision 20-3; Effective August 21, 2020

The local intellectual and developmental disability authority (LIDDA) must ensure a crisis intervention specialist (CIS) and/or designee as determined by the LIDDA:

• accesses the jail match reports upon notification of an exact or probable match. The jail match reports are housed in the Mental and Behavioral Health Outpatient Warehouse (MBOW) and may be accessed via the Data Warehouse Web Portal;
  • Notification of a match will be sent via email to the chosen mailbox identified by the LIDDA.
• confirms the matched person received the specific services tied to the grid codes that TLETS identified and determines if the person is currently open to services or if they were served in the past three years;
  • There is no three-year cutoff for persons under the age of 18 (youth).
• coordinates with the person’s service coordinator, if applicable; and
• collaborates with the correctional institution to:
  • clarify the status of the person;
  • pull the person from the general population, if not already separated;
  • identify treatment or service needs; and
  • coordinate collaborative post release diversion initiatives to assist the person in discharging from the correctional institution.

Notes:

• Local mental health authorities/local behavioral health authorities (LMHAs/LBHAs) have jail diversion staff who work in collaboration with local law enforcement agencies. Many LMHAs/LBHAs have staff co-located with the LMHA/LBHA or in the correctional institution. The CIS and/or designee, as determined by the LIDDA, should establish a relationship with the staff to further support the continuity of care for people with IDD.
• Health and Safety Code Chapter 614 states “a LIDDA shall accept and disclose information relating to a special needs offender for the purposes of continuity of care and services.” This information includes data about the person’s identity, needs, treatment, social, criminal and vocational history.

19300 Communicating to Stakeholders

Revision 19-5; Effective September 27, 2019

The local intellectual and developmental disability authority (LIDDA) is responsible for communicating to stakeholders, including intellectual and developmental disability providers, advocacy organizations, law enforcement and schools about the creation of the crisis intervention specialist (CIS) position and the general duties of the position.

19400 Required Training for a CIS and Staff

Revision 19-5; Effective September 27, 2019

The local intellectual and developmental disability authority (LIDDA) must ensure a crisis intervention specialist (CIS) completes the training modules available on the Mental Health Wellness for Individuals with Intellectual and Developmental Disabilities website within 30 calendar days after being assigned as a CIS. The LIDDA must ensure the CIS completes additional training modules within 45 days of the posting of new modules on this site.

Revision 20-4; Effective October 15, 2020

General Revenue (GR) funded services are primarily intended to help persons remain in their own home or their family’s home. GR refers to state funds and GR funded services are paid by state funds and not federal funds. Not all GR funded services described in this section are available in all areas of the state. These services are provided by or through a local intellectual and developmental disability authority (LIDDA).

20100 Definitions

Revision 20-4; Effective October 15, 2020

In this section, the following terms are defined as follows:

Behavioral Supports – Specialized interventions by professionals with required credentials to assist a person to increase adaptive behaviors and to replace or modify maladaptive behaviors that prevent or interfere with the person’s inclusion in home and family life or community life. Supports include:

• assessing and analyzing assessment findings so that an appropriate behavior support plan can be designed;
• developing an individualized behavior support plan consistent with the outcomes identified in the person-directed plan;
• training and consulting with family members or other providers and, as appropriate, to the person; and
• monitoring and evaluating the success of the behavioral support plan and modifying it as necessary.

Community Support – Provides individualized activities for persons that are consistent with the person’s person-directed plan and provided in the person’s home and at community locations, (e.g., libraries and stores). Supports include:

• habilitation and support activities that foster improvement of, or facilitate, the person’s ability to perform daily living activities;
• activities for the person’s family that help preserve the family unit and prevent or limit out-of-home placement of the person;
• transportation for the person between home and his or her community employment site or day habilitation site; and
• transportation to facilitate the person’s employment opportunities and participation in community activities.

Day Habilitation – Assistance with attaining, retaining or improving self-help, socialization and adaptive skills necessary to live successfully in the community and to participate in home and community life. Individualized activities are consistent with achieving the outcomes identified in the person-directed plan and activities are designed to reinforce therapeutic outcomes targeted by other service components, school or other support providers. Day habilitation is normally furnished in a group setting, other than the person’s residence, for up to six hours a day, five days per week on a regularly scheduled basis. The service includes personal assistance for persons who cannot manage their personal care needs during the day habilitation activity, as well as assistance with medications and the performance of tasks delegated by a registered nurse in accordance with state law.

Eligibility Determination – An interview and assessment, or an endorsement, conducted in accordance with Texas Health and Safety Code, §593.005, and 40 Texas Administrative Code (TAC) Chapter 5, Subchapter D, to determine if a person has an intellectual disability or is a member of the intellectual and developmental disability (IDD) priority population.

Employment Assistance – Assistance to a person in locating paid, individualized competitive employment in the community, including:

• helping the person identify employment preferences, job skills, work requirements and work conditions; and
• identify prospective employers offering employment compatible with the person’s identified preferences, skills, and work requirements and conditions.

General Revenue (GR) Funded Services – IDD services funded by GR funding through the performance contract.

Nursing – Provided to people who require treatment and monitoring of health care procedures that are:

• prescribed by a physician or medical practitioner; or
• required by standards of professional practice or state law to be performed by licensed nursing personnel.

Respite – Planned or emergency short-term relief services to the person’s unpaid caregiver when the caregiver is temporarily unavailable to provide supports due to routine and non-routine circumstances. This service provides a person with personal assistance in daily living activities (e.g., grooming, eating, bathing, dressing and personal hygiene) and functional living tasks. The service includes assistance with:

• planning and preparing meals;
• transportation or assistance in securing transportation;
• assistance with medications and the performance of tasks delegated by a registered nurse in accordance with state law; and
• supervision of the person’s safety and security.

Respite also includes habilitation activities:

• use of natural supports and typical community services available to all people;
• social interaction and participation in leisure activities; and
• assistance in developing socially valued behaviors and daily living and functional living skills.

Residential Services – Twenty-four hour services provided to a person who does not live independently or with his or her natural family. These services are provided by employees or contractors of the LIDDA who regularly stay overnight in the person’s home.

Screening – Gathering information to determine a need for services. This service is performed face-to-face or by telephone contact with persons. Screening includes the process of documenting a person’s initial and updated preferences for services and the LIDDA’s biennial contact of persons on the Home and Community-based Services (HCS) Interest List and the Texas Home Living (TxHmL) Interest List.

Service Coordination – Assistance in accessing medical, social, educational, and other appropriate services and supports that will help a person achieve a quality of life and community participation acceptable to the person as described in the Plan of Services and Supports. Service coordination is provided by a LIDDA staff person who is referred to as a service coordinator. Service coordination functions are:

• Assessment – Identifying the person’s needs and the services and supports that address those needs as they relate to the nature of the person’s presenting problem and disability;
• Service Planning and Coordination – Identifying, arranging, advocating, collaborating with other agencies and linking for the delivery of outcome-focused services and supports that address the person’s needs and desires;
• Monitoring – Ensuring that the person receives needed services, evaluating the effectiveness and adequacy of services, and determining if identified outcomes are meeting the individual’s needs and desires; and
• Crisis Prevention and Management – Linking and assisting the person to secure services and supports that will prevent or manage a crisis.

Note: If the person has the appropriate type of Medicaid, this service should be billed as targeted case management.

Specialized Therapies – Training and consulting with family members or other providers and assessment and treatment by licensed or certified professionals for:

• social work services;
• counseling services;
• occupational therapy;
• physical therapy;
• speech and language therapy;
• audiology services;
• dietary services; and
• behavioral health services, other than those provided by a local mental health authority (LMHA) pursuant to its contract with the Department of State Health Services (DSHS).

Supported Employment – Provided to a person who has paid, individualized competitive employment in the community (i.e., a setting that includes non-disabled workers) to help the person sustain that employment. It includes individualized support services consistent with the person-directed plan as well as supervision and training.

Vocational Training – Day training services provided to a person in an industrial enclave, a work crew, a sheltered workshop or an affirmative industry to enable the person to obtain employment. Contract funds are not used for the cost of production.

20200 GR Services

Revision 20-4; Effective October 15, 2020

The local intellectual and developmental disability authority (LIDDA) determines which General Revenue (GR) optional services they will make available for GR eligible persons based on their local planning activities described in the LIDDA Performance Contract.

LIDDAs are not required by contract to provide any of the services listed below, except for screening, eligibility determination, respite and service coordination.

Services include:

• screening;
• eligibility determination;
• service coordination;
• community support;
• respite;
• employment assistance;
• supported employment;
• day habilitation;
• nursing;
• behavioral supports;
• specialized therapies;
• vocational training; and
• residential services.

Note: All GR funded services should be delivered in accordance with the Service Definition Manual.

20300 Eligibility

Revision 20-4; Effective October 15, 2020

To be eligible for General Revenue (GR) services, a person must have one of the following:

• A diagnosis of an intellectual disability, which is based on:
  • a measure of the person’s intelligence quotient (IQ);
  • a determination of the person’s adaptive behavior level (ABL); and
  • evidence of the disability that originated before the person’s 18th birthday.
• A diagnosis of autism spectrum disorder.
• Eligibility for early childhood intervention (ECI) services.

20400 LIDDA Responsibilities

Revision 20-4; Effective October 15, 2020

Each local intellectual and developmental disability authority (LIDDA) is responsible for ensuring the provision of, and oversight of, General Revenue (GR) services described above that is responsive to the needs of its local service area.

Each LIDDA must have policies and procedures that ensure ongoing assessments are conducted for a person, and the general revenue services in the person’s plan of services and supports are coordinated and monitored in accordance with 40 Texas Administrative Code (TAC) §2.556 and §2.561. There are no required Health and Human Services Commission (HHSC) forms to be used by the LIDDA at this time. Each LIDDA has the authority to create and use their own forms, if they encompass the requirements listed here.  

Each LIDDA must have policies and procedures related to respite (in-home, facility based, or both) funded by GR that:

• encourages the use of existing local providers of respite;
• encourages participation by the person and LAR or actively involved person in the choice of a qualified provider of in-home respite;
• describes how in-home respite providers are selected and trained;
• describes how emergency backup for in-home respite providers is provided;
• addresses admission procedures; and
• requires development of a respite plan prior to the delivery of respite except in an emergency.

In accordance with 40 TAC §2.556, the LIDDA must conduct an annual review of the person’s plan, which includes the services being provided and outcomes to be achieved.

20410 Termination of GR Services

Revision 20-4; Effective October 15, 2020

General Revenue (GR) services can be terminated if the person moves out of the local service area, the person no longer meets eligibility criteria or if the person chooses not to receive any GR services.

For people moving out of the local service area, once notified, the local intellectual and developmental disability authority (LIDDA) will assist the person or their legally authorized representative (LAR) with setting up an intake at the receiving LIDDA and transferring records, including changing the county of residence in the Client Assignment and Registration (CARE) System and transferring Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Interest List (IL) status. 

20420 GR Interest List

Revision 20-4; Effective October 15, 2020

Every local intellectual and developmental disability authority (LIDDA) must maintain a General Revenue (GR) Interest List (IL) for its local service area. The GR IL consists of persons who have completed eligibility determination with the LIDDA and requested GR funded services which were not available at the time of request. Persons are placed on the IL on a first-come, first-served basis.

In accordance with the LIDDA Performance Contract, since resources are insufficient to meet the service needs of every person in the priority population, services should be provided to meet the most intense needs first. Intense needs are determined as follows:

• a person is in danger or at risk of losing his or her support system, especially the living arrangement or support needed to maintain self;
• a person is at risk for abuse or neglect;
• a person’s basic health and safety needs are not being met through current supports;
• a person is a risk for functional loss without intervention or preventive or maintenance services; or
• a person demonstrates repeated criminal behavior.

Note: See the LIDDA Performance Contract for a description of the LIDDA priority population.

20421 GR Interest List Reporting Requirements

Revision 20-4; Effective October 15, 2020

The local intellectual and developmental disability authority (LIDDA) must submit their local General Revenue Interest List in a format approved by HHSC on a quarterly basis as indicated in the IDD Submission Calendar in the LIDDA Performance Contract.

Revision 24-1; Effective March 1, 2024

21100 Definitions

Revision 24-1; Effective March 1, 2024

In this section, the terms below have the following meanings:

Community Resource Coordination Group (CRCG) – County-based groups of local partners and community members. They work with parents, caregivers, youth and adults to identify and coordinate services and supports for people with complex needs. These needs include behavioral health, basic needs and caregiver support. CRCGs work with local partners to coordinate services through many agencies for people with needs that cannot be met by a single agency.

Contracted local intellectual and developmental disability authority (LIDDA) – One of 13 LIDDAs with a state supported living center (SSLC) in its local service area. Texas Health and Human Services Commission (HHSC) contracts with the LIDDA to deliver the community living options information process (CLOIP) for residents of the LIDDAs without an SSLC in their local service area.

Crisis – A situation where:

• the person presents an immediate danger to self or others; 
• the person’s mental or physical health is at risk of serious deterioration; 
• the person believes they present an immediate danger to self or others; or
• the person believes that their mental or physical health is at risk of serious deterioration.

Crisis Intervention Specialist (CIS) – Provides information about intellectual and developmental disability (IDD) programs and services. They collaborate with LIDDA staff and Transition Support Team (TST) members to identify people with IDD in the LIDDA’s local service area who are at risk of requiring crisis services. 

Crisis Respite – Short-term, up to 14 calendar days, respite for a person  with a diagnosis of IDD. Provided in an out-of-home or in-home setting when the crisis can be stabilized within 72 hours. Service helps the person stabilize in the community.

Designated LIDDA – The LIDDA identified in the Client Assignment and Registration (CARE) System is assigned based on the adult person’s county of residence.

Interdisciplinary Team (IDT) – IDD professionals, paraprofessionals and concerned people, as appropriate, who assess a person’s treatment, training and habilitation needs and recommend services. Also determine if the person is best served in a facility or in a community setting.

• Team membership always includes:
  • the person;
  • the person’s legally authorized representative (LAR), if any; and
  • people a LIDDA or SSLC specifies, as appropriate, who are professionally qualified, certified or licensed with special training and experience in the diagnosis, management, needs and treatment of people with IDD.
• Other participants in IDT meetings may include:
  • people the person or the LAR request;
  • people, at the discretion of the LIDDA or SSLC, who are directly involved in the delivery of IDD services to the person; and,
  • representatives of the appropriate school district if the person is eligible for public school education.

Legally Authorized Representative (LAR) – A person authorized by law to act on behalf of a person about a matter described in this subchapter. May include a parent, guardian managing conservator of a minor, or the guardian of an adult.

Permanency Planning – For people younger than 22 who are moving from a family-based setting into an intermediate care facility for individuals with an intellectual disability or related condition (ICF/IID), including an SSLC, a Home and Community-based Services (HCS) residential setting, or a nursing facility (NF). The process targets goal development and pathways to provide continuity of support for the youth temporarily living in an institutional setting. The plan includes specific supports for the youth to remain connected to their parents or other family and for them to return to their family home or another family-based alternative.

State Supported Living Center (SSLC) – Facilities providing campus-based services and supports to people with intellectual disabilities who are medically fragile or have significant behavioral health needs. Texas has 13 SSLCs in the state. The ICF/IID Medicaid program funds residential placement in SSLCs for qualified residents.

Transition Support Team (TST) – Team of professionals, regionally constituted, to provide educational activities, technical assistance and de-identified case-specific peer review support to LIDDAs and IDD service providers in a region.

21200 State Supported Living Center Services

Revision 24-1; Effective March 1, 2024

State Supported Living Center (SSLC) residents receive 24-hour services that provide comprehensive behavioral treatment and health care. Each resident receives an individualized plan of services and supports that authorizes services and supports to meet identified needs. Services may include: 

• medical;
• psychiatry;
• nursing;
• dental services;
• skills training;
• behavior supports;
• occupational therapy;
• physical therapy;
• speech therapy;
• adaptive aids;
• day habilitation;
• vocational programs;
• employment services;
• community activities; and
• services to maintain connections between residents and their families.

21300 Admission to an SSLC 

Revision 24-1; Effective March 1, 2024

For SSLC admissions, the local intellectual and developmental disability authority (LIDDA):

• serves as the point of entry for a person seeking admission or commitment to State Supported Living Center (SSLC);
• assesses eligibility for admission to an SSLC;
• provides information on community-based and residential services to the person or a legally authorized representative (LAR); and
• follows the guidelines outlined in 16000, Guidelines for Determining Less Restrictive Setting to determine if a person can be adequately and appropriately habilitated in an available, less restrictive setting when admission to an SSLC is requested.

Information about LIDDA responsibilities related to PIDA commitments without an Interdisciplinary Team (IDT) recommendation will be added to this subsection as rules are developed. If a LIDDA is requested to help access an SSLC admission under this commitment type, contact the SSLC Admissions and Placement Coordinator for their LIDDA catchment area.

Note: The LIDDA is not the point of entry for courts seeking restoration commitments related to competency to stand trial or fitness to proceed with charges.

21400 SSLC Admission Criteria

Revision 24-1 Effective March 1, 2024

26 TAC, Section 904.25

The Texas Health and Safety Code (THSC) establishes four mandatory State Supported Living Center (SSLC) admission criteria:

• the person has a diagnosis of intellectual disability (ID);
• evidence shows that because of the ID, the person: 
  • represents a substantial risk of physical impairment or injury to self or others; or
  • is unable to provide for and is not providing for their most basic personal physical needs;
• The person cannot adequately and appropriately habilitate in an available, less restrictive setting; and 
• The SSLC provides habilitation services, care, training and treatment appropriate to the person’s needs.

The Texas Health and Human Services Commission (HHSC) follows two standards to assess eligibility. The person must have:

• an Intelligence Quotient (IQ) four or more standard deviations below the mean, such as in the severe or profound range of an ID; and
• an Inventory for Client and Agency Planning (ICAP) service level of 1-4 or an ICAP service level of 5 or 6 with extraordinary medical needs that:
  • require at least 180 minutes per week of direct nursing treatment if the adult caregiver were not providing such treatment; or
  • would require intensive staff intervention and resources to prevent incidents of dangerous behavior and serious physical injury to the adult or others if the adult’s caregiver were not managing such incidents.

If the person is determined eligible and the person or legally authorized representative (LAR) chooses to pursue admission, the local intellectual and developmental disability authority (LIDDA) will submit an application packet to the SSLC that serves the person’s county of residence.

21500 Types of Admission to an SSLC

Revision 24-1 Effective March 1, 2024

State supported living center (SSLC) admission types fall into two categories:

• voluntary, without court commitment; and 
• involuntary, with court commitment.

21510 Voluntary Admissions to an SSLC

Revision 24-1 Effective March 1, 2024

Types of voluntary admissions include:

• emergency;
• respite; and
• regular.

21520 Emergency Admission of an Adult or a Minor to an SSLC

Revision 24-1 Effective March 1, 2024

26 TAC, Section 904.37

Emergency voluntary admission is a time-limited admission for a person with an urgent need for services for a period not to exceed 12 months. An emergency admission requires consent of the adult with the capacity to give legally adequate consent, the guardian of a person or the parent of a minor.

Note: Because of the permanency planning statute, an emergency admission for a person under 22 is limited to six months.

An emergency admission may occur if:

• persuasive evidence shows the person has a diagnosis of an intellectual disability (ID); 
• the person has an urgent need for services;
• appropriate space is available at the State Supported Living Center (SSLC); and 
• the SSLC can provide relief sufficient to address the emergency care need within a year after the date of admission for an adult, or within six months for a person under 22.

If a person with the capacity to give legally adequate consent or legally authorized representative (LAR) requests an emergency admission to an SSLC, the local intellectual and developmental disability authority (LIDDA) staff must submit Form 8654, State Supported Living Center (SSLC) Admission Application, to the Texas Health and Human Services Commission (HHSC) SSLC Continuity of Services (COS) coordinator to determine if conditions for this admission type have been met. If it is agreed all conditions listed above have been met , the SSLC COS coordinator provides the LIDDA with Form 8656, Emergency Admission/Discharge Agreement. The LIDDA completes the designated sections of the form and submits it, complete with signatures of LIDDA and the person or LAR, to the HHSC SSLC COS coordinator. The SSLC COS coordinator requests approval and signatures of the other parties. Form 8656 contains the agreements between the person or their LAR, the LIDDA and the SSLC.

The Emergency Admission/Discharge Agreement describes the:

• reason for admission, including the circumstances precipitating the need for admission and expected outcomes and must include permanency planning for minors;
• responsibilities of the person or legally authorized representative (LAR), LIDDA and SSLC about the care, treatment and the person’s discharge, including how the terms of the agreement will be monitored; and
• length of time of the emergency admission and anticipated date of discharge.

The HHSC commissioner or their designee must approve the Emergency Admission/Discharge Agreement before the person is admitted to an SSLC.

The Emergency Admission/Discharge Agreement, including the date of discharge, must not be changed unless the LIDDA gets approval from the commissioner or designee. The SSLC discharges the resident by the date specified in the Emergency Admission/Discharge Agreement.

If the resident or LAR, with input from the interdisciplinary team (IDT), agree the resident benefits from extending their stay beyond the emergency admission’s time limits, a civil commitment under the Persons with Intellectual Disabilities Act (PIDA) must be requested and in place before the emergency admission agreement expires.

21530 Respite Admission

Revision 24-1 Effective March 1, 2024

26 TAC, Section 904.55

Respite voluntary admission is a time-limited service to address the person or the person’s family’s need for assistance or relief. Respite admission can be requested by the person requesting the service or their legally authorized representative (LAR).

A respite admission may occur if:

• persuasive evidence shows the person has a diagnosis of an intellectual disability (ID); 
• the state supported living center (SSLC) has appropriate space available;
• the SSLC provides services that meet the needs of the person; and
• the person or the person’s family urgently needs help or relief provided within a period not more than 30 calendar days after the date of admission.

Note: One 30-day extension may be allowed if the relief sought has not been satisfied during the initial 30 days.

Process for respite admission to an SSLC is:

• The local intellectual and developmental disability authority (LIDDA) must complete Form 8654, State Supported Living Center (SSLC) Admission Application, and submit it to the SSLC serving their area.
• The SSLC identifies if there is space for the person’s respite stay.
• The SSLC notifies the LIDDA of the available space for the person’s respite stay and requests the LIDDA contact the person or their LAR to determine if they still need respite care.
• If respite admission is needed, the LIDDA completes and submits the Respite Admission/Discharge Agreement provided by the SSLC, which contains the agreements by the person or their LAR, the LIDDA and the SSLC. The person’s SSLC Admission Application also should be updated if there have been changes in medication, diagnoses or other issues.
• The person’s LIDDA service plan documents how the respite stay will be used to assist the person achieve the purpose identified in the Respite Admission/Discharge Agreement. 
• If it is determined an extension of the respite stay is needed, this request must be submitted at least three business days before the original Respite Admission/Discharge Agreement expires.
• The head of the SSLC must agree the space continues to be available and all parties must consent.

Note: Home and Community-based Services (HCS) rules prohibit the provider from providing respite to an HCS program recipient in an institution, such as an ICF/IID, nursing facility or hospital.

21540 Regular Voluntary Admission

Revision 24-1 Effective March 1, 2024

26 TAC, Section 904.25

Regular voluntary admission is placement for a person who requires habilitative services, care, treatment and training. State supported living centers (SSLCs) do not permit the regular voluntary admission of a minor, as noted in 26 TAC section 904.35.

Only an adult with the capacity to give legally adequate consent may request a regular voluntary admission to an SSLC for habilitative services, care, treatment and training. A court-appointed guardian may not request a regular voluntary admission on behalf of the ward.

For a person who does not have the legal capacity to consent to an admission, a voluntary admission is not available. If admission is determined necessary, the person must meet criteria for a civil commitment under the Persons with Intellectual Disability Act (PIDA).

The criteria for a regular voluntary admission are identified in 21400, SSLC Admission Criteria, with two additional criteria.

For a regular voluntary admission the:

• Texas Health and Human Services Commission (HHSC) must make sure space is available in an SSLC; and
• SSLC’s facility director must determine if the SSLC provides services that meet the person’s needs.

Local intellectual and developmental disability authority (LIDDA) staff must consult with HHSC SSLC Continuity of Services (COS) coordinator for guidance if a person requests a regular voluntary admission to an SSLC.

If the person requests voluntary admission to an SSLC and the LIDDA agrees the person meets criteria for voluntary admission, the LIDDA completes an SSLC Admission Application, Form 8654 for the person and submits it to the SSLC.

Note: The criteria for an involuntary commitment under the PIDA are the same as for the regular voluntary admission criteria, except for the civil commitment process. Review 21610, Civil Commitment of a Person under the PIDA for more information.

21600 Involuntary Admissions

Revision 24-1 Effective March 1, 2024

A court orders an involuntary admission for a person who has demonstrated a need for an institutional setting. These admissions occur because of one of the following court orders:

• civil commitments under the Persons with Intellectual Disability Act (PIDA);
• civil commitment under the PIDA without an interdisciplinary team (IDT) recommendation;
• forensic commitment under the Code of Criminal Procedure; and
• forensic commitment under the Family Code.

21610 Civil Commitment of a Person under the Persons with Intellectual Disability Act

Revision 24-1 Effective March 1, 2024

26 TAC, Sections 904.25 and 904.29

If the local intellectual and developmental disability authority (LIDDA) determines a person meets admission criteria and needs long-term habilitative services, care, treatment and training in a state supported living center (SSLC), the LIDDA coordinates completion of an:

• Form 8654, SSLC Admission Application packet; and
• an application to the court for a civil commitment under the Persons with Intellectual Disability Act (PIDA).

Note: Form 8515, Guidelines for Determining Less Restrictive Setting must be part of the SSLC application packet. Review 16000, Guidelines for Determining Less Restrictive Setting for more information.

A person may be committed to an SSLC for residential services if an interdisciplinary team (IDT) recommendation includes the following findings:

• the person is determined to have intellectual disability (ID) per Texas Administrative Code, Title 26, Chapter 304 relating to Diagnostic Assessment; 
• the person, because of an ID:
  • represents a substantial risk of physical impairment or injury to self or others; or
  • is unable to provide for and is not providing for their most basic personal physical needs;
• the person cannot be adequately and appropriately habilitated in an available, less restrictive setting; and
• the SSLC provides habilitative services, care, training and treatment appropriate to the adult's needs.

An IDT recommendation must be completed during the six months before the date of the commitment hearing per 26 Texas Administrative Code (TAC), Section 904.25.

A person represents a substantial risk of physical impairment or injury to self or others or is unable to provide for and is not providing for the person's most basic personal physical needs if:

• the person's intellectual quotient (IQ) is four or more standard deviations below the mean, such as in the severe or profound range of ID;
• the person's Inventory for Client and Agency Planning (ICAP) service level equals:
  • 1, 2, 3 or 4; or
  • 5 or 6 and the person:
    • has extraordinary medical needs that would require at least 180 minutes of direct nursing services if the person’s caregiver were not providing such treatment; or
    • exhibits incidents of dangerous behavior that would require intensive staff intervention and resources to prevent serious physical injury to the person or others if the person's caregiver were not managing such incidents; or 
  • the person meets other objective measures as determined by the department.

A minor may not be admitted to an SSLC on a civil commitment unless the following has been completed before admission:

• Community Resource Coordination Group (CRCG) completes a consultation for the minor and provides information to the minor’s family about available community supports that might serve as an alternative to an SSLC; or
• if the minor lives in a county not served by a CRCG, the LIDDA must inform the parent or guardian of all community-based services and any other service and support options the minor may be eligible for and complete the permanency planning process described in 26 TAC, Section 904.171; 
• available community supports that might serve as an alternative to admitting the minor to an SSLC were attempted; and 
• if there are indications the minor may have a serious emotional disturbance, a children’s mental health professional assessed the minor to determine if a serious emotional disturbance exists and services to address the serious emotional disturbance were attempted.

Further details about information supporting the application packet are available in 21700, LIDDA Responsibilities in Admissions to an SSLC.

Note: Civil commitments under the PIDA are not time limited. This does not, prevent an IDT from making a referral to the community following admission.

21620 Civil Commitment of a Person under the PIDA without an IDT recommendation

Revision 24-1 Effective March 1, 2024

Information will be added to this subsection as rules are developed. If a LIDDA is requested to help access an SSLC admission under this commitment type, contact the SSLC Admissions and Placement Coordinator for their LIDDA catchment area.

21630 Commitment of an Adult under the Texas Code of Criminal Procedure

Revision 24-1 Effective March 1, 2024

40 TAC, Section 2.256; Texas Code of Criminal Procedure, Chapter 16, Articles 46.02, Section 6B and 46C

An adult may be committed to a state supported living center (SSLC) if all charges pending against the adult have not been dismissed and one of the following criteria are met:

• the adult is found incompetent to stand trial and no substantial probability has been found that the adult will become competent in the near future; or
• the adult previously was committed to a maximum-security unit of a facility in connection with the same offense.

Note: The adult being committed to an SSLC must also meet admission criteria, per 21400, SSLC Admission Criteria.

The SSLC may request a civil commitment for an adult who has reached their maximum time served under a 46B commitment if the person is not determined to be appropriate to refer to the community.

The local intellectual and developmental disability authority (LIDDA) facilitates the application for the civil commitment. This process involves completing all steps in 21610, Civil Commitment of a Person under the PIDA.

21640 Forensic Commitments Under the Family Code

Revision 24-1 Effective March 1, 2024

26 TAC, Sections 904.31, 904.33 and 904.51; Texas Family Code, Sections 55.41 and 55.60

A minor in the juvenile justice system may be committed to a state supported living center (SSLC) if: 

• the minor is found to be unfit to proceed or to lack responsibility for the minor’s actions pursuant to juvenile charges; 
• the minor is determined to have a diagnosis of intellectual disability (ID) and because of this the minor is unfit to proceed or that the minor lacks responsibility for their actions; and 
• the minor meets all other criteria outlined in 21400, SSLC Admission Criteria.

When a juvenile court notifies the Texas Health and Human Services Commission (HHSC) that a placement order for a minor has been issued under Texas Family Code, HHSC notifies the appropriate local intellectual and developmental disability authority (LIDDA) of the placement order.

Before the minor’s admission under a placement order, the LIDDA must submit or obtain the following documents to share with the state supported living center (SSLC). This could require collaborating with the court, justice center, probation office, the legally authorized representative (LAR) and the independent school district (ISD) serving the youth:

• the original court order;
• an offense record;
• a determination of intellectual disability (DID), if available;
• a current medical assessment;
• a physician’s medication orders;
• a social history;
• a psychological history;
• an immunization record;
• a copy of social security card;
• a certified copy of birth certificate;
• the Admission, Review, and Dismissal (ARD) Committee report, Individual Education Plan (IEP) and Full Individual and Initial Evaluation (FIE);
• a copy of the Medicaid card, if applicable;
• any legal document dealing with custody of the minor;
• current letters of guardianship, order appointing a guardian and related orders, if the minor has a guardian;
• any documents concerning the minor’s immigration status;
• a completed Inventory for Client and Agency Planning (ICAP) booklet and intellectual disability/related condition (ID/RC) assessment form, if available; and
• any other available evaluation.

The SSLC coordinates admission arrangements with the juvenile probation department serving the LIDDA’s service area upon receipt of the required documents.

21650 Involuntary Admissions for Restoration

Revision 24-1 Effective March 1, 2024

The local intellectual and developmental disability authority (LIDDA) is not the point of entry for courts seeking restoration commitments related to competency to stand trial or fitness to proceed with charges. However, the state supported living center (SSLC) notifies the LIDDA when a person admits under a restoration commitment for service planning and coordination. An application is not required for restoration commitments, but the LIDDA may be asked to help gather information and coordinate services.

Code of Criminal Procedure Restoration: Admission of an adult for up to 60 days for misdemeanors and 120 days for felonies. The court may grant a one-time 60-day extension.

• The SSLC’s interdisciplinary team (IDT) submits a report to the court that describes:
  • the treatment provided to the adult;
  • the IDT’s opinion of if the adult is competent or not competent to stand trial; and
  • if the adult meets commitment criteria.

Family Code Restoration: Admission of a minor for up to 90 days.

• The SSLC’s IDT submits a report to the court that describes:
  • the treatment provided to the minor;
  • the IDT’s opinion of if the minor is fit or unfit to proceed with charges; and
  • if the minor meets commitment criteria.

The court may assign a LIDDA or the SSLC Director may request a LIDDA to facilitate a civil commitment following the person’s completion of their sentence or requirements of the criminal court. In this case, the LIDDA will follow the guidelines for civil commitment in 21610, Civil Commitment of a Person under the Persons with Intellectual Disability Act (PIDA).

21700 LIDDA Responsibilities in Admissions to an SSLC

Revision 24-1 Effective March 1, 2024

26 TAC, Chapter 904, Continuity of Services—State Facilities

The local intellectual and developmental disability authority (LIDDA) is responsible for referring an eligible person to a state supported living center (SSLC). That process includes the following preliminary steps to makes sure the person and their legally authorized representative (LAR) are provided with the following information: 

• a verbal and written explanation of residential services and supports for which the person may be eligible, including: 
  • SSLC; 
  • community intermediate care facilities for individuals with an intellectual disability (ID) or related conditions (ICFs/IID);
  • waiver services under Section1915(c) of the Social Security Act (SSA); 
  • other community-based services and supports;
• information relating to if appropriate residential services are available in each program that the person may be eligible, including SSLCs, community ICFs/IID, waiver services, or other services located nearest to the person’s residence; and
• if a person is under 22, provide the LAR an explanation of permanency planning. 

The LIDDA’s interdisciplinary team (IDT) should determine the least restrictive setting for the person being considered for admission to an SSLC.

During this process, the LIDDA engages with the following entities as appropriate to the person’s needs:

• regional Transition Support Team (TST) to obtain guidance and referrals to help the LIDDA consider other services, supports or approaches that could be attempted in a less restrictive setting;
• Crisis Intervention Specialist (CIS) and Crisis Respite (CR) to help address unmet needs of the person or the person’s support system or provider; and 
• for those under 22, their Community Resource Coordination Group (CRCG) on the discussion of options to assure all avenues for addressing unmet needs in the community have been explored.

Documentation of these efforts should be included in the SSLC packet and documented on Form 8515, Guidelines for Determining Less Restrictive Settings.

Information will be added to this subsection about LIDDA responsibilities related to PIDA commitments completed without an IDT recommendation as rules are developed. If a LIDDA is requested to help access an SSLC admission under this commitment type, contact the SSLC Admissions and Placement Coordinator for their LIDDA catchment area.

21710 Interdisciplinary Team Review of Appropriateness of Referral

Revision 24-1 Effective March 1, 2024

26 TAC, Chapter 904, Continuity of Services—State Facilities

When a person or their legally authorized representative (LAR) requests the person be admitted to a state supported living center (SSLC) and the local intellectual and developmental disability authority (LIDDA) has documented the sharing of information and the review of less restrictive options to meet the needs of the person, the LIDDA submits an SSLC application packet for the LIDDA’s Interdisciplinary Team (IDT) to review. The LIDDA’s IDT reviews the packet prepared to determine the appropriateness of the application.

A complete SSLC Admission Application packet, Form 8654, must include an IDT recommendation. This can also be used in court commitments to satisfy the need for an IDT recommendation as described in 26 Texas Administrative Code (TAC) Chapter 904, Continuity of Services—State Facilities.

Note: The SSLC Admission Application provides a list of additional items needed for each type of admission. Those documents are required to complete the application.  

If the LIDDA’s IDT determines an applicant meets the criteria for admission to an SSLC, the LIDDA:

• notifies the person or LAR in writing;
• contacts the SSLC serving the area where the applicant lives or, if the applicant requests an interstate transfer, the area where the person's LAR or family lives or intends to live;
• contacts the interstate compact coordinator at Texas Health and Human Services Commission (HHSC) if the applicant requests an interstate transfer for more information on transfer requirements;
• makes sure all information required for the admission packet is included with the completed SSLC Admission Application, Form 8654 and submits it to the SSLC assigned to their service area; and
• opens an assignment in Client Assignment and Registration (CARE) indicating the person is waiting for services in an SSLC.

If the LIDDA's IDT determines the applicant does not meet the criteria for commitment or voluntary admission to an SSLC, the LIDDA:

• notifies the applicant or LAR in writing of the determination and explains the procedure for the applicant or LAR to request a review of the IDT's determination by the LIDDA; or
• if the applicant requested interstate transfer, notifies the interstate compact coordinator in writing of the LIDDA’s determination.

If the applicant or their LAR requests a review of the IDT's determination by the LIDDA, the LIDDA completes a review of all information used to make this determination. The LIDDA provides the result of the review to the applicant or LAR in writing.

If a review by the LIDDA of the IDT’s determination results in the determination being upheld, the LIDDA notifies the applicant or LAR in writing that they may contact the IDD Ombudsman to request a review by:

• writing to IDD Ombudsman, Mail Code H-700, P.O. Box 13247, Austin, Texas 78714-3247;
• emailing ombudsmanidd@hhs.texas.gov; or 
• calling the IDD Ombudsman at 800-252-8154.

If the applicant or LAR makes this request, the IDD Ombudsman reviews relevant documentation provided by the applicant and LAR, the IDT and the LIDDA and determines if the LIDDA followed the processes described in this subchapter.

• If the ombudsman decides the processes in this subchapter were followed, the ombudsman helps the applicant gain access to an appropriate program that the applicant is eligible for or places the applicant on the waiting list of an appropriate program that the applicant is eligible.
• If the ombudsman decides the processes in this subchapter were not followed, then the LIDDA must take action to follow the processes in this subchapter.
• The ombudsman issues a written decision to the applicant, the applicant's LAR, and the LIDDA within 14 calendar days of the request.

Information will be added to this subsection about PIDA commitments completed without an IDT recommendation as rules are developed. If a LIDDA is requested to help access an SSLC admission under this commitment type, contact the SSLC Admissions and Placement Coordinator for their LIDDA catchment area.

21720 Process for Admission of an Adult or Minor Committed to an SSLC under the PIDA

Revision 24-1 Effective March 1, 2024

When it is determined that a person is in need of an involuntary commitment under the Persons with Intellectual Disability Act (PIDA), the local intellectual and developmental disability authority (LIDDA) must file an application for commitment if the person or their legally authorized representative (LAR) do not. 

The LIDDA must file the application with the county court where the person lives or last maintained residence. If the person is not enrolled in home and community-based services (HCS), their residence may be considered where their parent, conservator or LAR lives.

Note: Psychiatric hospitals, residential treatment centers, and jails or detention facilities are not considered “residences.” 

The application for a person’s commitment to a residential care facility, previously referred to as a state supported living center, under the PIDA must: 

• be notarized by the county clerk and include: 
  • the name, birth date, sex, and address of the proposed resident;
  • the name and address of the proposed resident’s parent or guardian, if applicable;
  • a short statement of facts that show commitment to a facility is necessary and appropriate; and
  • a short statement that explains why admission to less restrictive services is inappropriate.

The LIDDA must file an interdisciplinary team (IDT) recommendation with the county court as a separate document from the application for commitment. The LIDDA may use the IDT recommendation in the SSLC admission application. The recommendation must be a distinct document in this filing. If a person, their LAR or another concerned member of the community files the application for commitment, the LIDDA receives an order from the court for an IDT recommendation.

The IDT recommendation needs to include evidence gathered supporting the need for commitment, such as:

• SSLC Admission Application, Form 8654;
• legal, hospital, psychiatric treatment records;
• transition support team (TST) meeting minutes; 
• Community Resource Coordination Group (CRCG) minutes or letter for people under 22;
• determination of intellectual disability (DID) report; 
• Inventory for Client and Agency Planning (ICAP);
• Behavior Support Plan; and
• any other document supporting the person’s needs for services and supports.

The LIDDA needs to help the person complete an application for representation of an indigent person with the court officer. This is not needed if the person or their LAR has funds to pay court fees and attorneys associated with the hearing.

The LIDDA receives notice of the commitment hearing and the LIDDA representative who filed the application is expected to attend. If the LIDDA representative does not receive a subpoena, the LIDDA needs to obtain consent to participate in the hearing from the person or their LAR before the hearing.

The LIDDA representative needs to be prepared to answer questions from the attorneys and the judge about how it was decided the person needs to be committed to an institution. Questioners may ask about the less restrictive alternatives tried and why they inadequately addressed the person’s need for services and supports.

The court may subpoena the examiner who completed the person’s Determination of Intellectual Disability (DID) to answer questions about this report. If the DID examiner does not receive a subpoena, the LIDDA representative at the hearing needs to be prepared to verify the DID report is part of the person’s medical record at the LIDDA.

The person’s LAR will receive a notice compelling them to participate in the hearing. The person will participate unless their attorney chooses to request the court waive their appearance before the court.

If a court orders a person to be committed to an SSLC at the hearing, the LIDDA forwards a copy of the commitment order to the SSLC admission coordinator to add to the SSLC admission packet.

The Texas Health and Human Services Commission (HHSC) determines when a vacancy exists in an SSLC. HHSC decides which people are appropriate to fill the vacancy based on information provided in the application packets. HHSC notifies the LIDDA when a vacancy becomes available to meet the person’s needs.

Note: The LIDDA needs to anticipate alternate services and supports will be needed while the person waits for admission to an SSLC. It is recommended the LIDDA submit a complete admission packet to their designated SSLC while waiting on a commitment hearing. This gives HHSC more time to find an appropriate bed to meet the person’s needs.

When the LIDDA is notified a vacancy exists in an SSLC for the person, LIDDA staff will: 

• contact the person and their LAR or family to determine if the person is still seeking admission to an SSLC under the commitment;
• explain the arrangement that has been identified and ask the person or their LAR if they will accept the proposed admission to the SSLC; and
• update the information in the person's application packet, such as making sure the assessments reflect the person's current level of functioning.

If the LIDDA finds, after speaking with the person and their LAR, they no longer wish to pursue admission to an SSLC under the commitment order, the LIDDA notifies the court in writing and informs the SSLC so the vacancy may be used by another applicant.

When notifying the court in writing, the following guidance is provided:

• use agency letterhead and memorandum format;
• in the subject line, include the following information as listed on the PIDA commitment order:
  • name of the court;
  • cause number; and
  • name of the person;
• provide the reason the person or their LAR declined the vacancy, including information about the resources the person is using to meet their needs in lieu of SSLC services; and
• provide contact information for the person or LAR and the LIDDA representative should the court need additional information.

The SSLC will offer admission to the person under the commitment order if the LIDDA finds the person or their LAR on their behalf, will accept the admission. In this case, the LIDDA:

• Requests the applicant be enrolled in the intermediate care facility for individuals with intellectual disability and related conditions (ICF/IID) program and prepares Form 8578, Intellectual Disability/Related Conditions (ID/RC). A community physician must sign Form 8578 and it must be submitted to the SSLC within 15 days of admission. 
  • Note: The person’s community physician must sign the pre-admission (purpose code 2) ID/RC. It is best to do this before admission in the event the physician wants to visit the person before signing the form. 
• Coordinates the following with the SSLC admission staff:
  • transportation arrangements for the person on the day of admission appropriate to the need; 
  • arrangements for the person’s LAR, family member or staff familiar with the person if a LAR does not exist to be present at the admission; and
  • the exchange of essential information about the person, including any necessary training, to advise the SSLC staff of the person’s needs.

Information will be added to this subsection about any LIDDA responsibilities relevant to PIDA commitments completed without an IDT recommendation as rules are developed. If a LIDDA is requested to help access an SSLC admission under this commitment type, contact the SSLC Admissions and Placement Coordinator for their LIDDA catchment area.

21730 Responsibilities of LIDDAs for People Admitted to an SSLC

Revision 24-1 Effective March 1, 2024

Review 10000, Community Living Options Information Process, of this handbook for this information.

21800 Community Placement from an SSLC

Revision 24-1 Effective March 1, 2024

This section outlines local intellectual and developmental disability authority (LIDDA) responsibilities relevant to the community placement of a resident from a state supported living center (SSLC).

21810 Community Living Discharge Plan for Alternative Living Arrangements

Revision 24-1 Effective March 1, 2024

26 TAC, Section 904.107

Should a resident’s interdisciplinary team (IDT) determine community living would better help the resident achieve quality-of-life outcomes, a community living discharge plan (CLDP) for alternative living arrangements will be developed.

The state supported living center (SSLC) staff prepares the CLDP. The plan incorporates information provided by the resident, their legally authorized representative (LAR), the local intellectual and developmental disability authority (LIDDA), other facility staff and the resident’s anticipated provider.

The plan is customized to the abilities and needs of the resident and must specify:

• timelines and intervals for monitoring activities after the resident moves into the community;
• the designated LIDDA’s and proposed LIDDA’s responsibilities if the residential location is out of the designated LIDDA’s service area,
• the provider’s responsibilities; and
• the criteria for discharge from the SSLC related to involuntary commitment.

The plan outlines the resident’s outcomes for community living that are the basis for his or her person directed plan and service coordination plan.

The resident, their LAR, the SSLC IDT, the designated and proposed LIDDAs when both exist, and the provider representatives must approve the plan before the resident leaves the SSLC.

21820 Community Living

Revision 24-1 Effective March 1, 2024

Review 9000, Enhanced Community Coordination Responsibilities for SSLC and ICF/IID Diversions and Transitions of this handbook for LIDDA responsibilities for pre-move and post-move monitoring of a person who has transitioned from a state supported living center (SSLC) into a community placement.

21900 Discharge from an SSLC of a Person who Moves to an Alternative Living Arrangement

Revision 24-1 Effective March 1, 2024

26 TAC, Section 904.125

A person who has transitioned from a state supported living center (SSLC) into an alternate living arrangement, such as a community placement with intellectual and developmental disability (IDD) services, which include home and community-based services (HCS) and intermediate care facility for individuals with intellectual disabilities and related conditions (ICF/IID), may be discharged from their civil commitment to the SSLC if the SSLC documents in the person’s community living discharge plans (CLDP) record that:

• the person’s needs are better served in a setting other than an SSLC; and
• the person is being successfully treated and habilitated in the current community living arrangement.

The local intellectual and developmental disability authority (LIDDA)must report the person’s progress to the SSLC after:

• the person transitions to a community placement; and
• when they meet the established criteria for discharge in the CLDP.

When the LIDDA submits a recommendation for discharge from the commitment to the SSLC, the SSLC notes receipt in the person’s record. The LIDDA sends a notice of the intent to discharge to the person, the court that originally committed the person under the Persons with Intellectual Disability Act (PIDA) if such a commitment exists, and the person’s legally authorized representative (LAR) or actively involved family member.

If the person or LAR does not agree with the plan to discharge the person from commitment, an administrative hearing is arranged. If the person or their LAR agree to the discharge plan, the LIDDA initiates the discharge entry into the Client Assignment and Registration (CARE) System and notifies the person, LAR and actively involved family member or friend of the completed discharge. The LIDDA also notifies the committing court. The SSLC sends a written notice to the LIDDA and the provider when the discharge is finalized.

When notifying the court in writing, the following guidance is provided:

• use agency letterhead and memorandum format;
• in the subject line, clearly list the following information as listed on the PIDA commitment order:
  • name of the court;
  • cause number;
  • name of the person; and
  • the reason for the communication, which is “Discharge of Commitment”.
• provide justification for the court to discharge the commitment, including:
  • a description of the person’s successful community placement, including the names of any IDD program services the person is accessing;
  • a progress report on needs identified in the application for commitment of the person, particularly addressing any health and safety risks and how they are resolved or being addressed in the community;
  • a statement that the person has met the objectives of their community living discharge plan at the SSLC;
  • a request that the person be discharged from the court’s commitment by saying, for example, “We respectfully request”; and
  • contact information for the LIDDA representative.

Revision 24-1; Effective March 1, 2024

26 TAC, Sections 306.163 and 306.201

The local intellectual and developmental disability authority (LIDDA) must provide continuity of care services to help discharge planning when a person with an intellectual or developmental disability (IDD) in a community setting is admitted to a state hospital, also known as a state psychiatric hospital.

The LIDDA’s continuity of care staff:

• participates in treatment team reviews (TTR) for the person;
• identifies the person’s needs in preparation for discharge; and
• monitors the person’s progress in treatment.

Note: TTRs are the service planning meetings conducted by the state hospital for people who are admitted to their care. The state hospital unit social worker convenes these meetings.

Upon admission to a state hospital, the LIDDA’s continuity of care staff is notified of the admission. If the person was previously enrolled in a Medicaid waiver program or intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID), the LIDDA’s continuity of care staff makes sure the provider representatives are invited to participate in discharge planning. The continuity of care staff will support the provider’s efforts to identify additional supports needed to prepare the person for a successful re-entry to the community.

If the LIDDA’s continuity of care staff identifies any other services or supports to aid the person’s re-entry into the community, the staff needs to provide this information to the person and their treatment team. If the team agrees to add these services or supports, the LIDDA service coordinator must coordinate those referrals. When the person has a Medicaid waiver provider or ICF/IID provider, the provider representative is responsible for making these referrals.

If the person was not connected to community services before the state hospital admission, the LIDDA’s continuity of care staff coordinates the services and supports the person might need on re-entry into the community. This may include:

• providing information about access to food, clothing or utilities;
• locating specialists or services in the community the person was not previously receiving;
• requesting a Home and Community-based Services (HCS) crisis diversion or HCS nursing facility diversion slot;
• arranging for the crisis intervention specialist to train providers;
• making a referral to the regional transition support team (TST) to determine if additional supports could help address unmet needs that potentially could reduce risk for a return to an institutional setting;
• referring the person to a transitional crisis respite bed; and
• more, per the needs of the person.

The LIDDA’s continuity of care staff coordinates with the community provider, service coordinator and natural supports to make sure follow up for services and supports are identified in discharge planning. Continuity of care staff also makes sure services and supports are delivered as planned in the days immediately following the person’s return to the community.

Should the treatment team agree the state supported living center (SSLC) is the least restrictive environment where the person’s needs can be met, the LIDDA’s continuity of care staff facilitates the person’s application and commitment to an SSLC. If the person is admitted to a state hospital on a forensic commitment and is ordered to transfer to an SSLC under a 46B.103 commitment, the LIDDA’s continuity of care staff facilitates this process. The staff completes the application for SSLC admission and gathers the required support documents. Review 23000 Inter-Facility Transfers for more information.

Revision 24-1; Effective March 1, 2024

This section outlines the processes for transfers between state supported living centers (SSLCs) and state hospitals.

23100 State Hospital to SSLC

Revision 24-1; Effective March 1, 2024

26 TAC, Section 904.79

A person receiving inpatient services from a state hospital, also known as a state psychiatric hospital, may be transferred to a state supported living center (SSLC) under the following conditions:

• the person’s local intellectual and developmental disability authority (LIDDA) has determined they require services in an SSLC; and
• the process outlined in 21610, Civil Commitment of a Person under the Persons with Intellectual Disability Act (PIDA), has been followed and all conditions are met.

23200 SSLC to Another SSLC

Revision 24-1; Effective March 1, 2024

26 TAC, Section 904.75

A state supported living center (SSLC) resident may be transferred to another SSLC under the following conditions:

1. The request for the transfer is proposed by the:
   • person who can provide legally adequate consent;
   • person’s legally authorized representative (LAR); or
   • SSLC where the person lives.
2. The transfer of a person from one SSLC to another may be made if the SSLC serving the person finds the:
   • current SSLC is no longer appropriate to the person’s needs;
   • person can be treated or habilitated better in another SSLC; or
   • person can be treated and habilitated in an SSLC located geographically closer to that person’s family.

When a person or their LAR requests to transfer to another SSLC, the local intellectual and developmental disability authority (LIDDA) explains the process, as needed, to the person or their LAR. This process for evaluating a transfer includes:

• Before a transfer proposed by the resident’s current SSLC is processed, the SSLC sends a written notice to the resident or their LAR with an option to object to the transfer. The SSLC sends this notice at least 31 calendar days before the proposed transfer. The resident will not be transferred while waiting for the finding of the administrative hearing. If no objection is filed, information will be shared with the proposed receiving SSLC so they may see if they can meet the person’s needs.
• If a person’s or LAR’s request to transfer to another SSLC is denied, the SSLC notifies the person or LAR in writing. This notice also informs them of their right to an administrative hearing to contest the denial. If the SSLC approves such a transfer, the SSLC sends necessary documents about the person to the receiving SSLC.

If an administrative hearing approves the transfer or no objection is filed, the person’s SSLC of residence notifies the person or their LAR and the person’s LIDDA of the decision and the projected date of the vacancy. If the vacancy is not available for some time, the SSLC where the person lives provides periodic updates to the person or their LAR on the status of the transfer.

When the vacancy at the receiving SSLC becomes available, the person’s SSLC of residence notifies the person or their LAR about the availability. Either the SSLC of residence or the receiving SSLC may notify the person’s LIDDA of the anticipated transfer date. The receiving SSLC coordinates transportation arrangements.

23300 SSLC to State Hospital

Revision 24-1; Effective March 1, 2024

26 TAC, Section 904.77

A person committed to a state supported living center (SSLC) for residential services may be transferred to a state hospital for mental health care if a licensed physician of the SSLC finds, after an examination, that care, treatment, management and rehabilitation in a state hospital is in the person’s best interest.

The person will return to the SSLC within 30 calendar days unless a court order obtained by the state hospital finds the person needs to be hospitalized for longer than 30 calendar days.

If the need for psychiatric hospitalization exceeds 30 calendar days, the state hospital will request an order from the committing court to transfer the person to the state hospital. To support this request, the state hospital will submit two certificates of medical examination for mental illness to the court, stating the person:

• has mental illness; and
• requires observation or treatment in the state hospital.

If the state hospital finds a person transferred to their facility under a court order no longer requires hospitalization, the state hospital will request the committing court to approve the person’s return to the SSLC.

If a person admitted to an SSLC under a regular voluntary admission is recommended for admission to a state hospital, the SSLC admission and placement coordinator must work with the local mental health authority for screening and commitment to a state hospital.

Note: The LIDDA may or may not be notified of transfers between SSLCs and state hospitals if no additional commitment is requested. Review 22000 for continuity of care activities provided by the LIDDA for a person with an IDD diagnosis who is committed to a state hospital from a community setting.

Revision 24-1; Effective March 1, 2024

24100 Definitions

Revision 24-1; Effective March 1, 2024

In this section, the terms below have the following meanings:

Crisis intervention specialist (CIS) – Provides information about intellectual and developmental disability (IDD) programs and services. Collaborates with local intellectual and developmental disability authority (LIDDA) staff and transition support team (TST) members to identify people with IDD in the LIDDA’s local service area who are at risk of requiring crisis services.

Crisis respite – Short-term, meaning up to 14 calendar days respite for a person with a diagnosis of IDD. Provided in an out-of-home or in-home setting when the crisis can be stabilized within 72 hours. Service helps the person stabilize in the community.

LIDDA – The local intellectual developmental disability authority (LIDDA) identified in the Client Assignment and Registration (CARE) System is assigned based on the person’s county of residence.

Community ICF/IID programs – Community intermediate care facilities for individuals with intellectual disability (ICF/IID) are licensed residential facilities that provide 24-hour supervision, services and supports to people with an intellectual disability or related condition.

Professional staff and other service providers support each resident design an individualized, person-centered plan of services and supports based on the needs and choices of the resident and their legally authorized representative (LAR). Plans include comprehensive medical and therapy services, training and support to further develop independent living skills, and opportunities for participation in family and community activities. Staff help the resident with activities of daily living so his or her health and safety needs can be met while they work to gain skills to increase their independence. There is no waiting list or interest list for this program.

Note: Community ICF/IID programs:

• are federally funded by the Centers for Medicare & Medicaid Services (CMS);
• can be small or large facilities; and
• focus on active treatment and must abide by federal and state regulations and rules.

Legally Authorized Representative (LAR) – Has the meaning assigned in 26 Texas Administrative Code (TAC), Section 904.5. A person authorized by law to act on behalf of a person about a matter described in this subchapter. May include a parent, guardian, managing conservator of a minor or the guardian of an adult.

24200 LIDDA Responsibilities Related to Admissions to Community ICF/IID Programs

Revision 24-1; Effective March 1, 2024

40 TAC, Section 2.307

LIDDAs help people access community-based intermediate care facilities for individuals with an intellectual disability or related conditions (ICF/IID) homes by:

• providing eligibility assessments;
• facilitating applications for Medicaid;
• sharing lists of providers operating homes in the communities where the person would like to live; and
• completing Form 8578, Intellectual Disability/Related Condition Assessment, in the Texas Medicaid and Healthcare Partnership (TMHP) Long-term Care (LTC) Online Portal.

24300 Continuity of Services for People Admitted to ICF/IID Community Homes

Revision 24-1; Effective March 1, 2024

40 TAC, Sections 2.305 and 2.307, Texas Health & Safety Code (THSC), Section 533.0355 (Access to services and safety net provisions)

Continuity of care services delivered by the local intellectual and developmental disability authority (LIDDA) may be necessary to support a resident in a community intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID) home to remain in their home when their needs are reported to exceed their ICF/IID provider’s present abilities to serve and support them. The LIDDA’s continuity of care staff can help by linking the person to a crisis intervention specialist (CIS), transition support team (TST) or crisis respite, as well as other resources in the community to help address needs.

If the provider issues a notice of intent to discharge a person from the ICF/IID facility within 30 days, the LIDDA may help the ICF/IID provider, the person and their legally authorized representative (LAR) locate a new provider or transition to another service. The new provider or service must meet the needs for services and supports identified by the person, their LAR and their interdisciplinary team (IDT).

The LIDDA continuity of care staff may need to advocate for the person to keep their community residence for an extended time if other services are not located in time for the provider’s notice of intent to terminate services. Should the provider be unwilling to extend the residential placement, the LIDDA continuity of care staff performs safety net functions, including developing a plan of services to support the person while alternate arrangements are made. This may involve a referral for services funded through General Revenue that could address their needs in the person’s family home, while living with a friend, or temporarily while being served in a crisis respite location. The LIDDA continuity of care staff may help by providing referrals to other ICF/IID providers, facilitating enrollment in another Medicaid program, or linking to other community programs. This may also involve requesting a Home and Community-based Services (HCS) crisis diversion or an HCS nursing facility diversion slot for the person.

Revision 19-4; Effective September 9, 2019

211 Texas – Connecting People and Services

A Message for Families Brochures

Approved Diagnostic Codes for Persons with Related Conditions List

CARE Intellectual Disability, MRA User Guide and MRA Data Entry Forms

CARE JHS/XPTR User Guide and More

CARE (WebCARE) Reference Manual, Forms and More

Community First Choice-Choosing a Provider

Department of Family and Protective Services

Determination of Intellectual Disability (DID): Best Practice Guidelines (March 2018)

Discovery Guide

Discovery Tool

Enterprise Portal- Health and Human Services

Explanation of IDD Services and Supports

Health Human Services- Long-term Services and Supports Contact Numbers

Health and Human Services – Office of the Ombudsman

Health and Human Services - Overview

Health and Human Services – Where Do I Call to Get Services?

Home and Community-based Services Handbook

Home and Community-based Services Program Billing Guidelines

Inventory for Client and Agency Planning (ICAP) Training Video

ICAP/SIB-R Adaptive Behavior Scale Guidelines

LIDDA Initial Meeting Packet Checklist

LIDDA Training Opportunities

Medicaid Estate Recovery Program Guide

Permanency Planning Instruction Manual (September 2017)

Permanency Planning Technical Assistance Guide (August 2017)

Person-Centered Service Plan- Community First Choice (Texas Administrative Code, June 2, 2016)

Person-Centered Planning PowerPoint (HHSC June 28, 2016)

Person-Centered Planning Training- HHS Minimum Requirements

Person-Centered Planning Training- Providers

Person Directed Planning Guidelines (PDF)

Pinnacle Cart

Regional Claims Management Services Coordinators

Residential Options

Social Security

STAR+PLUS Overview

Targeted Case Management Billing Guidelines

Texas Benefits

Texas Home Living Program Billing Guidelines

TMHP (LTC) Helpdesk:

• 800-626-4117, Option 1

Vendor Drug Program

Voters with Special Needs

ES = Spanish version available.

Form	Title
1019	Opportunity to Register to Vote/Declination
1040	CFC Non-Waiver Packet Information and Checklist
1042	Pre-Move Site Review
1043	Post-Move Monitoring
1045	Request for Extension of Enrollment Offer Due Date
1049	Initial Documentation of Provider Choice	ES
1050	Nursing Facility or Crisis Diversion Plan
1051	Request for Determination of Intellectual Disability (DID)
1052	Public Provider Choice Request	ES
1058	Request for Home and Community-based Services Crisis Diversion Slot
1067	Offer of Home and Community-based Services (HCS) Program	ES
1068	Withdrawal of Offer for Home and Community-based Services (HCS) Program	ES
1069	Withdrawal of Offer of Texas Home Living Program	ES
1070	Offer of Texas Home Living Program	ES
1570	ICF Request for Medical Need Assessment or Verification of RUG-III Category
1580	Texas Money Follows the Person Demonstration Project Informed Consent for Participation	ES
1581	Consumer Directed Services (CDS) Option Overview	ES
1582	Consumer Directed Services Responsibilities	ES
1586	Acknowledgement of Information Regarding Support Consultation Services in the Consumer Directed Services (CDS) Option	ES
1595	Billing Resolutions Request
2060-B	Needs Assessment Addendum	ES
2260	Permanency Planning Instrument (PPI) for Children Under 22 Years of Age (Family Directed Plan)	ES
3608	Individual Plan of Care (IPC) – HCS/CFC	ES
5842	TxHmL Financial Eligibility Information
8001	Medicaid Estate Recovery Program Receipt Acknowledgement	ES
8510	HCS/TxHmL CFC PAS/HAB Assessment
8511	Understanding Program Eligibility and Services	ES
8515	Guidelines for Determining Less Restrictive Setting
8571	Request to Change Interest List Information for Home and Community-based Services (HCS) or Texas Home Living (TxHmL)
8577	Questionnaire for LTSS Waiver Program Interest Lists
8578	Intellectual Disability/Related Condition Assessment
8578-CFC	Intellectual Disability/Related Condition Assessment for CFC
8582	Individual Plan of Care – TxHmL/CFC
8586	TxHmL Service Coordination Notification	ES
8590	Request for Approval to Withdraw an Enrollment Offer
8591	Community Services Interest List (CSIL) Data Entry
8592	Deadline Notification	ES
8601	Verification of Freedom of Choice	ES
8630	Continuity of Care
8647	Service Coordination Assessment – Intellectual Disability Services
8648	Identification of Preferences	ES
8654	State Supported Living Center (SSLC) Admission Application
8662	Related Conditions Eligibility Screening Instrument
8665	Person-Directed Plan	ES
8665-ID	Individual Data
H1003	Appointment of an Authorized Representative	ES
H1200	Application for Assistance – Your Texas Benefits	ES
H1746-A	MEPD Referral Cover Sheet
H6516	Community First Choice Assessment	ES
SSA-1020	Application for Extra Help with Medicare Prescription Drug Plan Costs

For questions about the Local Intellectual and Developmental Disability Authority Handbook, email: LIDDAservicecoordination@hhsc.state.tx.us.

For technical or accessibility issues with this handbook, email: form.handbook.request@hhs.texas.gov.