Appendix I, Information Letter: Process for Sending Medicaid Applications to the Health and Human Services Commission
Revision 10-0; Effective June 1, 2010
An application for Medicaid coverage must be submitted to the Texas Health and Human Services Commission in order for an individual to be determined financially eligible. Details regarding submitting a Medicaid application can be found at https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/provider-portal/letters/2009/letters/il2009-100.pdf
Appendix II, Mutually Exclusive Services
Appendix III, Discovery Guide
Revision 13-2; Effective September 3, 2013
I. Overview of Discovery
Discovery is the process of listening to people and learning about what they want from their lives. It is getting to know people so that their personal outcomes, preferences, choices and abilities are understood, documented and form the foundation of planning their services and supports. Discovery is the basis for the Person-Directed Plan (PDP) and service delivery. It is an ongoing process that occurs each time the service coordinator talks to the person or those who know the person best. It is necessary to record the information learned so that it can be used when developing or updating the PDP. The service coordinator leads the discovery process, acting on behalf of the person whose services and supports are being planned.
The following core values guide the development of community supports and services for people with intellectual and developmental disabilities. These values form an essential foundation for the discovery process and service selection:
- Self Determination. People should make decisions about things that affect their lives. The service coordinator supports the person in making choices. People should have information about directing their own services and supports and opportunities to do so.
- Community Inclusion. People receiving services should have opportunities to lead a satisfying life – making friends, participating in preferred activities, and being involved in and valued in their community. The service coordinator recognizes the need for people to belong and examine opportunities for supporting connections.
- Meaningful Relationships. People receiving services need opportunities to develop close relationships with others, maintain the relationships they have, and form new associations with persons and groups with similar interests and purposes. The service coordinator explores and advocates for ways the person may develop relationships and associations beyond staff and other existing relationships, based on the person’s interests and desires. Barriers to creating bonds with others should be addressed.
- Maintaining Non-waiver Supports. Discovery includes identifying existing natural supports, such as supports provided by friends, family or others that are not to be replaced by paid services. The loss of these supports could leave the person without meaningful relationships or community connections. Non-waiver supports also include generic services and resources (e.g., the Department of Assistive and Rehabilitative Services (DARS), public education, Day Activity and Health Services, the Comprehensive Care Program, state plan Medicaid services, etc.) that must be used prior to accessing waiver services.
Building a trusting relationship is the means by which the service coordinator discovers what is important to the person. The following should be demonstrated when building relationships:
- A caring attitude, interest in the person and respect for the wishes of the person and family.
- Willingness to spend time with the person. When first supporting someone, the service coordinator often sees the person at least once a month to give sufficient time to get to know him/her.
- Finding the positive and building on talents. Everyone wants to be liked for who they are. The service coordinator should not always focus on the person’s needs, but rather build the person’s confidence and self-esteem.
- Ability to be trusted. Following through with promises is important to people and their families. Honor the individual’s request not to share private information. Trust will help the person to open up and talk about his/her life.
- Willingness to admit mistakes.
Communication, listening and observation skills are indispensable for a service coordinator. These skills are needed when conducting discovery, facilitating meetings and when interacting with people receiving services, their families, providers and other community organizations (including the service coordinator’s own agency).
The best environment for a conversation about a person is a comfortable place without noise and distractions. Privacy must be maintained when discussing personal information. When the person is present, speak directly to the person. When other people are engaged in the conversation (including interpreters), be sure to look at the person who receives services so that you can see his/her reaction to the discussion through his/her facial expressions and body language.
It is important to engage different people in different ways to accommodate individual ways of communicating. Learning about a person’s communication abilities, including whether a person uses a communication device, is important when arranging a time to talk. It is also important to allow enough time to accommodate a person who communicates slowly or may require frequent breaks to remain engaged. Identifying preferences ahead of time, such as convenient times or days, may help guide successful questions and conversation.
- Starting Conversations. Introduce yourself and explain the purpose of the visit (as obvious as this seems, it is often overlooked). Conversations with people receiving services can be started in many ways, depending on the interests and preferences of the person. Sometimes it may be necessary to start a conversation about an activity the person is interested in or participated in recently. A conversation may be started by asking about an item that belongs to the person or is present in his/her environment. Avoid immediately diving into questions that could seem too abrupt or too personal. Possible ways to start a conversation:
- Tell me about yourself.
- Tell me about your day.
- What would you like me to know today?
- You look so happy today. What put that smile on your face?
- You look upset. Do you want to talk?
- I see a lot of pictures in your room. Can you tell me about them?
- What do you like to do?
If a person does not want to communicate, loses interest or does not have the tools necessary to communicate, ask if it would be better to come back later.
- Gathering Information. Ask permission before asking personal questions. Questions should be centered on the concerns or interests of the person. You will not be able to get all important information immediately.
Many people respond to opening requests, such as:
- Tell me about your family.
- Tell me about your friends.
- I’m interested in knowing more about you.
- Tell me about your favorite things.
- Tell me about things you don’t like.
The person may have a specific issue that is dominating the conversation. Go with it and let the person feel and express himself. It helps the person to speak at his own pace. Learn to be silent, as this can also be a way to connect. If the conversation shifts away from the person, redirect the focus back to the person. If necessary, be persistent in keeping the person the center of conversation. Be careful not to ask too many questions and observe nonverbal communication to determine when the conversation needs to take a new direction.
- Listening. Listening well can sometimes be challenging, but it is a critical skill in discovery. It is how we learn about people. Let people know you are listening.
- Talk to the person, not around the person, if the person is not alone.
- Ask the right questions. Avoid questions with yes or no answers that are not exploratory and do not provide opportunities for people to express themselves.
- Allow adequate time for the person to respond.
- Reflect back the last statement you heard.
- Paraphrase and sum up what you have heard during the conversation
- Observing and Nonverbal Communication. If a person is able to effectively communicate through conversation, discovery is often easier. However, a great deal can also be learned through nonverbal communication.
- Body language often provides information about what a person is thinking or feeling.
- Some people may use gestures, behavior or other means of getting their point across. Help may be needed from family or others who know and care about the person to interpret and learn from what he/she is saying.
- Conversation can distract from nonverbal communication of feelings and emotions.
- Some behavior may be a request for help or attention.
- Facial and eye expressions provide much information – trust, affection, disapproval, sadness, pain, discomfort, fear, awareness, interest, joy, concern.
- Eye contact is important communication and shows respect.
- Clothing, grooming, and environment may tell a lot about the person’s life. It is especially important to visit people at their home and in other environments.
Identifying personal outcomes is the focus of service planning and must be informed by meaningful discovery. It is important for everyone to make plans in order to achieve the outcomes they desire. People need to dream about their future and how they can achieve what is important to them. When talking with a person or gathering information:
- Allow the person to dream big. Don’t discourage the person from dreaming about his/her future, but explain how to break dreams into attainable short-term outcomes.
- The person’s outcomes must be clearly identified so that service providers and natural supports can assist the person to achieve them.
- Barriers should be recognized and the service coordinator should help the person identify ways to resolve or work around the barriers.
- When a service coordinator learns about outcomes, he/she should think about possible methods of achieving these outcomes. Outcomes may be met with assistance from family members, friends, community resources, generic service agencies or waiver services. The service coordinator is responsible for looking for alternative solutions, in addition to considering waiver services.
- Be positive. Reflect the outcomes in positive ways. Represent the person.
- Ensure health and safety. The service coordinator should gather existing information necessary to identify safety or health issues. The service provider should assist the person with addressing those needs. Health and safety outcomes must not be ignored and the person should be assisted in understanding the importance.
- The service coordinator asks permission from the person or legally authorized representative to include service providers in the discovery process. The provider may have day-to-day experience with the person and should be considered a significant source of discovery information to identify outcomes.
- Involve other allies identified by the person.
- Recognize that the outcomes may change as the service coordinator learns more about the person.
II. Using the Discovery Guide
This Discovery Guide is intended to support learning about what is important to the person and what others need to know to support the person for each person who receives services and supports. It is designed as a guide for exploration. The service coordinator supports a meaningful discovery process by helping people to speak for themselves, each in his or her own way about his or her own dreams and outcomes. The service coordinator encourages those present to listen and learn about what people want.
Examples offered in the Discovery Guide are intended to inspire thinking about the types of information that are important in creating true PDPs. They are only examples and while some may be relevant to a particular individual, information gained from the person and those close to the person will yield individualized results.
Gathering important information for those who support and assist the person. The service coordinator documents information that will be helpful for the service provider to know when providing services and supports to the person. This includes a broad profile of the person and important matters in his/her life based on observations, discussions and other relevant information. This information includes:
- The people, places and things that give the person happiness, contentment and satisfaction, in the present and in outcomes and dreams for the future.
- What people like and admire about the person. Sometimes this may take effort to learn because people are not always accustomed to talking about attributes. Notice the good things about the person and encourage him or her to recognize his or her own strengths and positive attributes.
- Background experiences that affect the present. Record events such as milestones, celebrations, institutionalization, losses, trauma, etc. that affect the person today.
- Who helps the person make important decisions? Who is a reliable source of information? Who does the person feel closest to? Who else does the person want to have involved in discussions and decisions? If the person is isolated or only talks about staff, it may be a sign that the person needs other relationships and connections. If the person has a guardian, ask if he or she is included in decision making and how.
- Preferences for social inclusion and alone time. Don’t assume that every person wants to be social all the time. Some people like having many friends; others prefer only a few close relationships. Personal relationships are very important to most people.
- Safety issues. Think beyond just supervision, even though that is important. Evaluate whether the environments where a person spends his/her time are healthy and safe. Observation is as important as asking questions. Consider what supports the person needs to be safe, e.g., adaptive aids, caregiver capacity, preparation for emergencies, etc.
- Health issues. Document health issues that concern the person. Detailed health information will be reflected in the health assessments completed by the provider.
Identifying services to support outcomes. The service coordinator identifies services that support the person’s outcomes. Based on the information gathered during discovery, the service coordinator:
- Identifies the services that will support the outcomes.
- Explains the purpose and outcome of the service (what will the person gain from the service?).
- Identifies what is important to the person and what others need to know and do to support the person so the program provider can use this information to design the implementation plan.
The examples below are meant to give service coordinators a general idea of how to use information gathered through the discovery process to identify services to support personal outcomes.
Example 1: Purpose/Outcome. What does the person want?
- The person wants to join a choir.
- The person wants to go to the singles class at church.
- The person wants to take a class at the community college.
- The person wants to take a vacation to Disneyland.
A possible support for these purposes/outcomes could be a person’s family or friends. An action plan is not needed unless a Home and Community-based Services waiver service is supporting the person to achieve the outcomes.
Example 2: Purpose/Outcome. What does the person want?
- The person needs a safe place to be during the day.
- The person enjoys being around other people and making friends.
- The person wants to develop or reinforce a skill (educational skills, specialized therapies, socialization skills or other adaptive skills).
A possible waiver service to support these purposes/outcomes could be day habilitation.
The following information learned during the discovery process would be important to the provider of day habilitation services:
- Important To. Information about preferences that are related to the service or the environment where the service will be delivered. This should help the provider to ensure a good experience for the person. Examples of areas related to quality of life issues:
- The person wants to sit next to friends so he can visit with them.
- The person wants to have frequent breaks so that he can walk around the building, get a drink of water and talk to people in other areas.
- The person likes to eat meals at the same time each day.
- The person likes to exercise.
- What Others Need to Know and Do to Support the Person. Information about what others think is important for the day habilitation staff to know. Examples of information that often relate to communication or health and safety:
- When the person starts to fidget, he often wants to take a break.
- The person must take medication during the hours he receives day habilitation.
- The staff must be trained to identify symptoms of high and low blood sugar.
- The person does not have safety skills when working with equipment or machinery.
- The person requires support to leave the building alone.
- Transportation provider requires staff to be available to meet the van upon arrival to day habilitation services and to accompany the person to the van when leaving.
Example 3: Purpose/Outcome. What does the person want?
- The person wants to get a driver license and needs help learning the Driver Handbook.
- The family has requested assistance with the person’s grooming.
- The person wants to explore recreational opportunities in his neighborhood and learn how to ride public transportation to these events.
- The person needs transportation to attend classes.
- The person wants to become her own payee and needs training on money management.
- The person needs help to shop for groceries.
- The person wants to improve abilities to do housekeeping tasks independently.
A possible waiver service to support these purposes/outcomes could be supported home living.
The following information learned during the discovery process would be important to the provider of supported home living services:
- Important To. Information about what the person prefers about staff, schedules, criteria for providers to make a good match with staff, etc. Examples:
- The person wants to work with female staff because she does not want a male to assist her with personal hygiene.
- The person prefers that staff only come on Tuesday mornings because she is involved in other activities the rest of the week.
- The person wants to interview and select any staff that will be coming to her home.
- The person wants staff to call when they are on the way or if they are not able to make the appointment.
- The person likes to be 10 minutes early to appointments.
- What Others Need to Know and Do to Support the Person. Information about what is needed to ensure safety, health and well-being. Examples:
- Due to the medication she takes, the person must drink plenty of water.
- The person must have a backup plan if the assigned supported home living staff are unable to work to ensure the person receives adequate assistance during evening hours.
- The person must be carefully supervised when crossing the street or in other non- safe environments.
- The person needs supervision at all times when outside his/her home.
- The person is unable to regulate water temperature and has been burned in the past when left to bathe without assistance.
- The person will eat too fast if not prompted to eat slowly.
Example 4: Purpose/Outcome. What does the person want?
- The person wants to eventually live alone but needs skills training in the areas of safety, money management and meal planning/preparation.
- The person enjoys living with a family.
- The person likes the foster/companion care (FCC) provider and wants to live with him/her.
- The person wants to learn how to ride the public transportation system.
A possible waiver service to support these purposes/outcomes could be FCC.
The following information learned during the discovery process would be important to the provider of FCC services:
- Important To. Information to help a provider in selecting the type of home, staff characteristics and supporting daily routine preferences. Examples:
- The person likes to sleep late on weekends.
- The person wants to remain close to his family’s home in the west part of the city.
- The person does not like to be around people who smoke.
- The person wants his own bedroom.
- The person wants a long-term provider.
- The person does not like animals.
- The person wants a family that would allow him to keep his pet hamster.
- The person wants to attend church.
- What Others Need to Know and Do to Support the Person. Information about general health and safety issues. Examples:
- The FCC setting should be within close proximity to the person’s family.
- The staff should be fully aware of medical issues that are included in the Comprehensive Nursing Assessment.
- The FCC provider should be available on-site any time the person is in the home.
- The person has difficulty independently working kitchen appliances.
- The FCC provider should receive training from the occupational therapists and physical therapists regarding how to support therapy.
- The FCC provider should be aware of and follow behavioral guidelines prepared by the provider of behavioral supports.
- The person’s blood sugar levels must be checked in the morning and evening.
Example 5: Purpose/Outcome. What does the person want?
- The person wants to express his opinions without yelling.
- The person wants to be able to calmly ask others to leave his room.
- The person wants to continue living with his family.
- The person wants friends and is finding it difficult to keep them.
- The person wants a better relationship with his family.
- The person wants to not feel lonely.
A possible waiver service to support these purposes/outcomes could be behavioral supports.
The following information learned during the discovery process would be important to the provider of behavioral supports:
- Important To. Information to help staff understand what the person experiences as positive situations or negative situations. Examples:
- The person likes to be asked (not told) to complete a task.
- The person likes to be busy.
- The person wants more friends and more fun.
- The person likes privacy.
- The person likes to take a break when faced with stressful situations.
- The person does not like others taking or handling his possessions.
- The person likes to be on time to his art class.
- The person likes having friends and family, and likes to be in touch with them frequently.
- When stressed, this person likes to talk to his best friend on the phone.
- What Others Need to Know and Do to Support the Person. Information about supporting the person’s positive behavior. Examples:
- The family has noticed that the person becomes more stressed when he is in a loud environment, is bored or the activity is too difficult.
- Staff should remind the person to take deep breaths when trying to express his emotions.
- Staff should remind others living in the home to knock on the person’s bedroom door before entering.
- It is important for the person to have a safe place for his special belongings. He becomes very angry when they are lost.
- Each morning, staff should tell the person what is planned for the day.
- Staff must take the time to listen to what the person is trying to communicate.
Example 6: Purpose/Outcome. What does the person want?
- The person wants to have supports at work.
- The person needs to keep his job but needs some additional training. DARS is no longer available.
A possible waiver service to support these purposes/outcomes could be supported employment (SE).
The following information learned during the discovery process would be important to the provider of SE:
- Important To. Information about preferences for how SE will be delivered. Examples:
- The person likes to perform tasks as independently as possible.
- The person would like to work mornings rather than evenings.
- The person prefers to speak Spanish.
- What Others Need to Know and Do to Support the Person. Information about supports necessary for success and well-being. Examples:
- It is important for the SE staff to be aware of signs and symptoms of seizures.
- It is important for the SE staff to support and reinforce the person’s work schedule.
- It is important for the SE staff to arrive at the work site at the same time as the person.
- It is important for the SE staff to ensure that the person takes his medication during the work day.
- It is important for the person to arrive to work on time.
- It is important for the SE staff to teach the person work-related conduct and expectations (e.g., call if you are ill or will be late, dress for the job, etc.).
The service coordinator develops the PDP using the information gathered from the discovery process.
Example 7: Purpose/Outcome. What does the person want?
- The person wants to interact with others.
- The person wants to be able to talk.
- The person wants a mobile device to help him communicate.
- The person wants the freedom to come and go without assistance.
A possible waiver service to support these purposes/outcomes could be adaptive aids.
The following information learned during the discovery process would be important to the provider of adaptive aid services:
- Important To. Information about preferences that are related to the adaptive aids to be used should help the provider to ensure a good experience for the person. Examples of areas related to quality of life issues:
- The person wants a small, lightweight speech device that is durable.
- The person wants to choose the voice that the speech device uses.
- The person wants access to the speech device at all times.
- The person wants to go places whenever he wants without assistance.
- What Others Need to Know and Do to Support the Person. Examples of information important for the staff to know:
- It is important for staff to offer only the amount of assistance requested.
- It is important for staff to be patient.
- It is important that the speech device be received quickly and programmed according to the person’s wishes.
- It is important that the speech device and electric wheelchair be charged and well maintained.
As a service coordinator gets to know a person, it will become apparent what is important to the person regardless of where he/she is, what he/she is doing, who is supporting him/her, and what others need to know and do to support him/her, regardless of the setting. The information that is not specific to a setting or a service are collected and included in the One-Page Profile of the PDP. The important to and the what others need to know and do to support the person information that is specific to a service is included in the Pertinent Information section of the PDP action plan for that service.
Appendix IV, Discovery Tool
Revision 13-2; Effective September 3, 2013
The Discovery Tool is not intended to serve as an interview tool. Discovery is an ongoing process rooted in supportive relationships developed between service coordinators and the people they support. This optional tool can be used to suggest exploration and organization of information critical to completion of Form 8647, Service Coordination Assessment – Intellectual Disability Services. While the prompts in this tool may be useful to the Person Directed Plan (PDP) Discovery process, it should not be considered all-inclusive, exhaustive or as a substitute meaningful discovery. While service coordinators generally use ongoing face-to-face discussions, record reviews and communications with family members and staff (who know the person best) to gather discovery information. Appendix III, Discovery Guide, offers information and instruction for carrying out a robust, ongoing discovery process.
Person’s Preferences for Planning Activities
Person’s Communication Style:
- How does the person communicate (gestures, sounds, facial expressions, adaptive equipment, etc.)? What is the best way to determine if the person is expressing satisfaction/happiness/comfort/agreement as opposed to dissatisfaction/unhappiness, discomfort/disagreement?
- Among those who know the person best, who seems better able to interpret what the person is trying to communicate?
- What is the best way for others to learn how to communicate effectively with the person?
Person’s Resources for Support Planning and Service Provision:
- Participants/Support Planning Team (SPT): Who does the person/legally authorized representative (LAR) wish to directly involve in support planning? Note: The person can be anyone, including provider staff.
|Name||Relationship to Person||Contact Address and Phone||Preferred Method for SPT Member
to Participate in the Person’s Planning
(personal availability, phone availability, etc.)
- SPT Involvement: What would be the person’s/LAR’s reaction to participating in meetings or group planning activities via phone or other remote methods?
- Service Coordinator Involvement: Is the person/LAR comfortable with the service coordinator independently contacting involved people to explore the person’s preferences and outcomes?
- Places: Where is the person/LAR most comfortable when participating in planning activities such as PDP reviews or Individual Plan of Care (IPC)/Implementation Plan (IP) reviews? What would be the person’s/LAR’s preference for an alternate or backup location?
- Times: What is the person’s/LAR’s preference regarding the time or day that he or she wants to participate in planning activities?
Information Specific to the Consumer Directed Services (CDS) Option
- What is the person’s/LAR’s understanding of his/her freedom to choose a comprehensive provider or to personally direct provision of certain specified services?
- What additional information does the person want about CDS?
Discovery Information Related to Completion of the Service Coordination Assessment
Preferences for Living Environment – Always include a summary of discovery information that justifies conclusions:
- Where and with whom does the person currently live?
- How closely does the current living situation align with the person’s priorities/wishes?
- What location meets the person’s preference (city/locale)?
- What kind of living environment does the person prefer (group living arrangement, alone, roommate, own apartment, with family, etc.)?
- If group living is the preference, does the person like having his/her own bedroom or sharing with a roommate?
- What factors does the person/LAR prioritize when considering the choice of a place to live (e.g., proximity to family/work/public transportation/shopping/school, availability of supports to teach the person critical skills related to living in his/her environment, affordability, etc.)?
- Are there any personal issues that might present risk for harm in the person’s living arrangement (e.g., daily rituals, threats of suicide or physical harm to self or others, inability to handle a personal crisis)? What supports are needed to address these risks (increased personal supervision, limited proximity, etc.)? Is the person currently receiving these supports?
- Does the person live, work and pursue leisure activities in integrated environments that are safe? If not, what are the specific issues presented to the person by these environments (e.g., sanitation issues within environments, physical hazards such as inaccessibility, toxic substances, hot water, lack of safety equipment such as fire extinguishers, smoke detectors, door peephole, inability to use safety equipment and pedestrian safety skills)?
- Does the person know how to respond in an emergency situation such as fires, hazardous weather, natural disasters, illness, injury or threat of bodily harm? Does the person need support to ensure safety in emergency situations?
- Does the person need any modifications to the living environment to ensure safety/health/access needs are met (e.g., ramps, doors, doorways, bathroom modifications, etc.)?
- Does the person need any additional equipment (personal or environmental) to support accessibility and safety within any frequented environment (e.g., mobility devices, switches, lifts, etc.)?
- Does the person require specialized therapies (dietary, occupational therapy, physical therapy, speech therapy, nutrition, postural supports, food-texture modifications, psychological counseling, behavioral supports, etc.) to support safe access to preferred activities and environments?
- When the person receives supports, are there any specific characteristics that must be considered to honor the person’s preferences (e.g., male as opposed to female staff for certain activities, a preferred staff person for implementing services, preference for adaptive equipment transfers as opposed to personal transfers, soft-spoken interaction as opposed to loud voices, information that should be given in advance regarding upcoming changes in the person’s routine, etc.)?
Preferences for Financial Security – Always include a summary of discovery information that justifies conclusions:
- What financial resources are accessible to the person (review assets, sources of income as well as insurance coverage)?
- Does the person have adequate financial resources to meet his/her priority needs and preferences (food, shelter, medical and prioritized leisure activities)?
- What support does the person receive in managing his/her financial resources (e.g., parent/other serves as representative payee, a guardian appointed to manage financial affairs, etc.)? Include all supports: non-Home and Community-based Services (HCS)/natural or HCS.
- Describe any additional supports necessary to assist the person in addressing financial security/obligations.
- Is the person interested in acquiring additional knowledge, skills or abilities to increase control and choice regarding financial security? In which areas is he/she most interested?
Preferences for Physical/Emotional/Behavioral Health – Always include a summary of discovery information that justifies conclusions:
|Physical/Emotional or Behavioral Health Concern (List all concerns, diagnoses, routine procedures, including dental.)||Name/Specialty of Healthcare Professional Currently Addressing the Concern, if Applicable||Thoroughly Describe the Intervention (medication, specialized therapy, frequency of visits, etc.)||Who is Responsible (or needs to be responsible) for Ensuring this Concern is Addressed?|
- What is the person’s/LAR’s preferences regarding the management of personal health?
- What issues impact the person’s ability to obtain necessary interventions (e.g., does not understand most medical issues and required interventions, is afraid of professionals, is combative during medical procedures, is uncooperative with taking medications as prescribed, etc.)?
- How does the person indicate physical distress or illness?
- Is the person/LAR satisfied with current supports?
- What change does the person/LAR wish to make with any of the supports currently provided?
- If the person takes medication, what assistance is required to ensure that they are taken as prescribed?
- If the person requires other interventions (e.g.,`positioning, nutritional management, etc.), what assistance is required to perform them?
- Does the person require medically necessary supplies? What are they and how are they obtained?
- Is the person interested in acquiring additional knowledge, skills and abilities that facilitate increased choice and control in meeting physical/emotional/behavioral health needs? Fully describe what the person is most interested in acquiring.
Preferences for Daily Living – Always include a summary of discovery information that justifies conclusions:
- What supports are necessary to assist the person in meeting physical needs (oral hygiene, physical hygiene, using the bathroom, eating assistance, positioning, shopping, cooking, etc.)?
- What supports are necessary to assist the person in maintaining possessions in the living environment (household tasks such as house cleaning, laundry, maintaining personal adaptive equipment, etc.)?
- What are the person’s preferences for his/her daily routine (includes the timing of daily events, the activities he/she does and the times in which he/she does those activities, the food he/she eats, etc.)?
- Is the person interested in acquiring additional knowledge, skills and abilities to increase control and choice regarding daily living? In which area is he/she most interested?
Preferences for Work and/or School – Always include a summary of discovery information that justifies conclusions:
- What are the person’s preferences regarding work, education and volunteer opportunities in the community?
- For a person under the age of 22, are educational/school services being provided? Where? What prioritized supports are being provided by the school? (Note: The person’s parent, teacher and individual education plan are excellent resources.) Are the school’s services reflecting the person’s/LAR’s priorities?
- For a school-age person receiving educational services, explain how current HCS and non-HCS supports could enhance and support the person’s educational service.
- If the person is not school age, what does the person do during the day (work, adult learning, etc.)?
- What is the person’s understanding of available options in the community to address his/her preferences for work or education?
- If the person expresses a preference, does the person currently possess the necessary skills, knowledge and abilities to address preferences? If not, what does the person require?
- Describe the services that would best assist the person in obtaining work/educational preferences.
- If the person is not interested in volunteering, working or going to school, describe what the person would like to do?
Preferences for Relationships – Always include a summary of discovery information that justifies conclusions:
- Using discovery information, describe any close relationships in the person’s life (who is the individual, what is the nature of the relationship, how often does the person wish to see the individual, etc.).
- Who are the person’s friends?
- Is the person satisfied with the number and types of relationships in his/her life?
- Is the person satisfied with the type and frequency of contact with friends and family? How do you know?
- In what new types of relationships is the person interested in exploring?
- Is the person interested in acquiring additional knowledge, skills or abilities to increase control and choice regarding relationships? Fully describe what the person is most interested in acquiring.
Preferences for Social Inclusion – Always include a summary of discovery information that justifies conclusions:
- Is the person aware of available community-based activities? If not, describe how the person could become more aware of options.
- In what community-based activities does the person actively participate (ongoing community activities such as going to movies, church, festivals or participating in clubs or other community-based organizations)?
- Is the person satisfied with the type and frequency of participation in community-based activities? What other activities would the person like to do?
- What activities does the person specifically dislike?
- Is transportation a barrier to the person’s participation in community activities? What resources are available to assist the person with transportation?
- What supports would the person require to participate in community-based activities to his/her satisfaction?
- Is the person interested in obtaining new knowledge, skills or abilities related to social inclusion? Fully describe what the person is most interested in acquiring.
Preferences for Rights/Legal Status – Always include a summary of discovery information that justifies conclusions:
- What rights does the person exercise (e.g., freedom of movement, accessibility, opening mail, privacy, phone calls, personal possessions, voting, exercising chosen religion, etc.)?
- What rights are not exercised? If the person is not exercising those rights, what are the reasons?
- Is the person choosing not to exercise those rights? How do you know?
- If the right is being limited by support staff, describe the reason for the limitation(s).
- Did the SPT consider the limitation(s) and find that it was necessary to protect the person?
- If there are limitations, describe the supports that are in place/necessary to restore the person’s rights.
- Does the person need someone to assist in the exercise of rights (guardian, power of attorney, advocate, etc.)? If applicable, describe the supports targeted toward obtaining assistance.
- Describe the person’s ability and desire to advocate for himself.
- Would the person like to learn more about self-advocacy? What supports are in place/necessary to help the person learn?
- Does discovery provide any evidence that the person has been abused, neglected or exploited?
- If the person is still experiencing personal distress from a previous occurrence of abuse, neglect or exploitation, describe the supports the person is receiving (or needs/wants) to cope with the distress.
- Is there any information regarding the person’s vulnerability to abuse, neglect or exploitation that should be shared with staff supporting the person?
- Is the person interested in obtaining new knowledge, skills or abilities related to exercising rights or preventing abuse, neglect or exploitation? Fully describe what the person is most interested in acquiring.
Preferences for Other Personal Outcomes Desired by the Individual – Always include a summary of discovery information that justifies conclusions:
Using the Discovery Guide or other means adopted by your center, identify other priority personal outcomes that should be a focus (purpose) of either HCS or non-HCS supports.
Appendix V, HIV/AIDS in the Workplace
Appendix VI, Medicaid for the Elderly and People with Disabilities
Appendix VII, List of Excluded Individuals Entities (LEIE)
Appendix VIII, Advance Directives
Appendix IX, Retired Information Letters
Revision 17-3; Effective November 1, 2017
The Texas Health and Human Services Commission (HHSC) will from time to time retire Information Letters (ILs) when policy has expired, retired or been replaced with new information.
Content in this handbook and the Texas Administrative Code (TAC) supersedes any previous ILs or similar guidance published by HHSC. The ILs retired as a result are listed below. HHSC recommends that providers remove retired ILs from their records to ensure they reference the most current information. Any letters or program guidance issued prior to Internet accessibility is null and void, including policy previously sent by U.S. mail.
|2015-24||Licensed Vocational Nurse On-Call Pilot Program Ends September 1, 2015||03/26/2015||12/22/2015|
|2015-20||DADS Home and Community-based Services and Texas Home Living Behavioral Support Service Provider Policy Training (Retired on December 22, 2015)||02/27/2015||12/22/2015|
|2015-07||Residential Visits and Water Temperatures in Host Home/Companion Care Residences and Three-Person and Four-Person Residences (Retired on December 22, 2015)||01/21/2015||12/22/2015|
|2014-67||Definition for Respite||10/20/2014||12/22/2015|
|2014-46||Licensed Vocational Nurse (LVN) On-Call Pilot Program Requirements (The Licensed Vocational On-Call Pilot Program expired September 1, 2015)||08/06/2014||12/22/2015|
|2014-30||Changes to HCS and TxHmL Certification Reviews Reports and to Certification Follow up Reviews Note: This letter was revised June 18, 2014||06/12/2014||12/22/2015|
|2014-09||Addition of Employment Assistance to the Home and Community-based Services Program and Changes to Provider Qualifications for Supported Employment (Retired on December 22, 2015)||03/11/2014||12/22/2015|
|2013-68||Changes Related to Persons Who May Reside in Four-Person Residences||10/01/2013||12/22/2015|
|2013-72||Online Training and Classroom Training Dates||11/12/2013||01/26/2016|
|2013-62||Four-Person Residence Life Safety Code Certification Process||09/17/2013||12/22/2015|
|2013-59||Notice of Direct Support Professionals Recognition Week||09/6/2013||01/26/2016|
|2013-47||Random Sampling for the Licensed Vocational Nurse (LVN) On-Call Pilot Program||08/12/2013||01/26/2016|
|2013-45||Fiscal Year 2013 Cutoff Dates for Year-end Closeout Processing||07/29/2013||01/26/2016|
|2013-02||2012 Cost Report and Cost Report Training Requirements||01/02/2013||01/26/2016|
|2012-87||2012 Online Training and Classroom Training Dates||12/7/2012||01/26/2016|
|2012-74||Implementation of the International Classification of Diseases, Tenth Revision, Clinical Modification||08/28/2012||01/26/2016|
|2012-73||Notice of Increased Activity of West Nile Virus in Texas||08/17/2012||01/26/2016|
|2012-71||FY12 Cutoff Dates for Year-end Closeout Processing||07/31/2012||01/26/2016|
|2012-50||2011 Cost Report Notification and Cost Report Training Reminders||05/7/2012||01/26/2016|
|2011-82||New Service Limits in the Home and Community-based Service (HCS) Program||09/8/2011||01/26/2016|
|2011-135||Cost Containment Initiative Update||10/28/2011||11/01/2017|
|2011-120||New Convictions Barring Employment Added to Health and Safety Code, Chapter 250||09/29/2011||11/01/2017|
|2011-116||Referral of Individuals Currently Enrolled in the Consolidated Waiver Program||09/07/2011||11/01/2017|
|2011-108||Payment Rates Effective September 1, 2011||08/24/2011||01/26/2016|
|2011-105||Changes in the Texas Human Resources Code resulting from Senate Bill (SB) 1857, (82nd Legislature, Regular Session 2011), related to the Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Waiver Programs||09/20/2011||11/01/2017|
|2011-92||FY11 Cutoff Dates for Year-end Closeout Processing||08/05/2011||01/26/2016|
|2011-85||Fiscal Year 2011 Miscellaneous Claims Cutoff Notice||07/19/2011||01/26/2016|
|2011-74||Change in Required Documentation for Renewals of Level of Need Increases||06/10/2011||11/01/2017|
|2011-31||Complaints Regarding Solicitation||04/15/2011||04/30/2019|
|2011-22||Per Diem Rates Effective February 1, 2011, for the Home and Community-based Services and Texas Home Living Programs||01/26/2011||10/11/2017|
|2010-104||FY10 Cutoff Dates for Year-end Closeout Processing||07/29/2010||01/26/2016|
|2010-156||Proposed Home and Community-based Services and Texas Home Living Rate Reductions||12/27/2010||10/11/2017|
|2010-142||Expansion of Utilization Management and Review Activities||11/05/2010||11/01/2017|
|2010-140||Individual Plan of Care Revision Process||11/17/2010||11/01/2017|
|2010-105||Correct Correction to HCS/TxHmL Non-Day Habilitation Services Enrollment Worksheets ion to HCS and TxHmL Non-Day Habilitation Enrollment Worksheets and Instructions for Attendant Compensation Rate Enhancement||07/23/2010||10/11/2017|
|2010-80||Change in Notification of Approvals and Denials of Individual Plans of Care Services for Persons in the Home and Community-Based Services and Texas Home Living Programs||07/01/2010||11/01/2017|
|2010-77||Per Diem Rates Effective June 1, 2010 for the Home and Community-Based Services and Texas Home Living Waiver Programs||05/28/2010||10/11/2017|
|2010-68||Home and Community-Based Services Rule Language Regarding an Individual's Freedom of Choice of Direct Service Providers||06/04/2010||11/01/2017|
|2010-49||Requesting a Review of Finding or Methodology Used to Conduct Department of Family and Protective Services Investigations||04/09/2010||11/01/2017|
|2010-43||Dental Treatment Requisition Fees||04/19/2010||10/11/2017|
|2010-32||Obligation to Screen Individuals or Entities Excluded from Participation in Federal Health Care Programs Prior to Hire by Employers under the Consumer Directed Services Option||05/10/2010||11/01/2017|
|2010-27||Agency Directives and Required Timelines for the Transition of the Case Management Function to MRAs||02/26/2010||11/01/2017|
|2010-11||HCS and TxHmL Prior Approval Amount Change||02/01/2010||11/01/2017|
|2010-07||Proposed changes to rules regarding Fiscal Accountability||01/11/2010||10/11/2017|
|2009-174||Regulatory Services Policy Clarification: 2009 National Fire Protection Association (NFPA) 101 Life Safety Code for Homes that Serve Four Individuals||01/08/2010||11/01/2017|
|2009-155||Personal Care Services (PCS) and Home and Community-based Services (HCS) or Texas Home Living (TxHmL) Program Services Replaced by IL 2015-71||12/14/2009||11/3/2015|
|2009-153||Personal Care Services (PCS) and Waiver Services Replaced by IL 2015-71||10/30/2009||11/03/2015|
|2009-100||Process for Sending Medicaid Applications to the Health and Human Services Commission (HHSC)||08/10/2009||11/01/2017|
|2009-93||Communication Regarding the Redistribution of the HCS Monthly Administration and Operations Fee and HCS, TxHmL and CWP Payment Rates||07/15/2009||10/11/2017|
|2009-92||Public Hearing Regarding Proposed Rates for the Home and Community-based Services (HCS), Texas Home Living (TxHmL) and Consolidated Waiver (CWP) waiver programs||07/09/2009||10/11/2017|
|2009-86||Critical Incident Reporting||07/01/2009||11/01/2017|
|2009-84||Process for HCS and TxHmL Program Providers and CDSAs to Maintain Current Information in the Client Assignment and Registration (CARE) System||06/18/2009||11/01/2017|
|2009-48||Public Hearing Regarding Proposed Rule Amendment to the Reimbursement Methodology for HCS to Redistribute the HCS Monthly Administration and Operations Fee||04/08/2009||10/11/2017|
|2009-39||Change in the Timeframe for Mental Retardation/Related Condition (MR/RC) Assessment, Purpose Code 3 Data Entry into the Client Assignment and Registration (CARE) System||04/29/2009||11/01/2017|
|2009-28||Process for CDSAs to Obtain Access to the Client Assignment and Registration System (CARE) and Notification of the New CDSA CARE User Guide||02/18/2009||11/01/2017|
|2009-21||Communication to all Foster/Companion Care Providers Regarding the Redistribution of the HCS Monthly Administration and Operations Fee||02/06/2009||10/11/2017|
|2009-20||Communication Regarding the Redistribution of the HCS Monthly Administration and Operations Fee||02/06/2009||10/11/2017|
|2009-08||Process for CDSAs to Obtain Access to the Client Assignment and Registration System (CARE) and Notification of the New CDSA CARE User Guide||02/18/2009||11/01/2017|
|2009-01||Revisions to Texas Administrative Code Rules Governing Cost Reporting and Fiscal Accountability||01/08/2009||10/11/2017|
|2008-175||Provider Requirements for Reporting the Death of an Individual Receiving HCS or TxHmL Services||01/15/2009||11/01/2017|
|2008-167||Client Abuse and Neglect Reporting System (CANRS)||11/18/2008||11/01/2017|
|2008-165||Data Entry Training Class for HCS and TxHmL Waiver Program Providers||11/13/2008||11/01/2017|
|2008-156||Follow-up to IL No. 08-48, Regarding Critical Incident Reporting||11/03/2008||11/01/2017|
|2008-143||Clarification Regarding Qualified Providers of the Behavioral Support Service Component||10/03/2008||11/01/2017|
|2008-137||Waiver Survey and Certification (WS&C) Process to Initiate Alternative Services for Individuals Whose Health, Safety and Welfare Are at Risk||09/23/2008||11/01/2017|
|2008-130||Notification of the Availability of Revised Individual Plan of Care (IPC) Forms||09/12/2008||11/01/2017|
|2008-129||Clarification of Current Board of Nursing (BON) Rules that Impact the Delivery of HCS and TxHmL Services||10/23/2008||11/01/2017|
|2008-103||Consumer Directed Services (CDS) Option Policy Clarifications and Notification of a Revision to the HCS and MRA User Guides||07/16/2008||11/01/2017|
|2008-96||Criminal History, Employee Misconduct Registry and Nurse Aide Registry Checks||07/02/2008||11/01/2017|
|2008-77||HCS and TxHmL Rule Amendment Effective Dates and Related Implementation Information||05/29/2008||10/11/2017|
|2008-90||Provider Role Related to Investigations of Abuse, Neglect or Exploitation||07/22/2008||11/01/2017|
|2008-89||Client Assignment and Registration System (CARE) Entry of Designated Alternate to Chief Executive Officer (CEO)||07/22/2008||11/01/2017|
|2008-86||Written Notification to an Individual or Legally Authorized Representative (LAR) of the Denial of a Level of Need (LON) Assignment||07/15/2008||11/01/2017|
|2008-35||New HCS and TxHmL Forms 3610 and 3611 for Involuntary Termination of the Consumer Directed Services (CDS) Option||03/28/2008||11/01/2017|
|2008-20||HCS Individual Plan of Care (IPC) Form 3608 and TxHmL IPC Form 8582||02/13/2008||11/01/2017|
|2008-18||HCS Transfer Process and Transfer Forms (Replaces IL #07-71)||02/06/2008||11/01/2017|
|2008-14||Change to Forms 8571, 8626, 8627 and 8628||02/01/2008||11/01/2017|
|2008-13||Implementation of Consumer-Directed Services (CDS) Reimbursement Rates||01/30/2008||10/11/2017|
|2008-02||Elimination of Paper Forms 3618, 3619 and 3652-A Effective August 1, 2008 / Requirement for Electronic Submission Effective August 1, 2008||02/05/2008||11/01/2017|
|2007-93||HCS and TxHmL Rate Increase Effective September 1, 2007||09/17/2007||10/11/2017|
|2007-128||Transfer and Billing information related to the Client Assignment and Registration System (CARE) conversion for the implementation of Consumer Directed Services (CDS)||12/20/2007||11/01/2017|
|2007-127||Medicare Prescription Drug Program (Medicare Rx) Related Incurred Medical Expenses for Waiver Consumers with Qualified Income Trusts||12/10/2007||11/01/2017|
|2007-122||HCS Temporary and Permanent Discharge Process and Discharge Forms||12/01/2017||11/01/2017|
|2007-105||Data Entry Training Class for HCS and TxHmL Waiver Program Providers||10/19/2007||11/01/2017|
|2007-87||New Convictions Barring Employment Added to Health and Safety Code Chapter 250||09/14/2007||11/01/2017|
|2007-80||Change in Required Documentation for Level of Need (LON) Increase||09/01/2007||11/01/2017|
|2007-74||Individual Cost Limits for Certain Medicaid Waiver Programs||08/20/2007||11/01/2017|
|2007-73||Billable Adaptive Aids||08/20/2007||11/01/2017|
|2007-65||Training of Program Provider Personnel in the Use of Authorized Restraint Techniques||07/06/2007||11/01/2017|
|2007-45||2006 NFPA 101 Life Safety Code for Homes that Serve Four Individuals||05/07/2007||11/01/2017|
|2007-13||Abuse, Neglect, and Exploitation Investigations by Department of Family and Protective Services (DFPS) When the Administrator/Chief Executive Officer is the Alleged Perpetrator||06/15/2007||11/01/2017|
|2006-37||LTC Online Portal (previously referred to as CARE Form System (CFS))||06/02/2006||11/01/2017|
|2006-29||Medicare Rx prescription drug coverage to resume for "dual eligible" individuals||03/24/2006||11/01/2017|
|2005-41||Increase in Travel Reimbursements for Cost Reporting||10/10/2005||10/11/2017|
|2005-35||Restraint and Seclusion Requirements in new Health and Safety Code, Chapter 322, added by Senate bill 325, 79th Legislature||01/02/2006||11/01/2017|
Appendix X, Approved Diagnostic Codes for Persons with Related Conditions List
View the Approved Diagnostic Codes for Persons with Related Conditions List at:
Appendix XI, Solicitation Prohibition
Appendix XII, Abuse, Neglect, and Exploitation Training and Competency Test
Revision 19-2; Effective June 5, 2019
1. Requirement to Train Staff Members, Service Providers, and Volunteers
As required by program rule, a Home and Community-based Services (HCS) Program provider must ensure their staff members, service providers and volunteers are:
- trained on:
- acts that constitute abuse, neglect and exploitation;
- signs and symptoms of abuse, neglect and exploitation; and
- methods to prevent abuse, neglect and exploitation; and
- knowledgeable of:
- acts that constitute abuse, neglect and exploitation;
- signs and symptoms of abuse, neglect and exploitation; and
- methods to prevent abuse, neglect and exploitation; and
- instructed to report to Department of Family and Protective Services (DFPS) immediately, but not later than one hour, after having knowledge or suspicion that an individual has been, or is being, abused, neglected or exploited by:
- calling the DFPS Abuse Hotline toll-free telephone number, 1-800-647-7418; or
- using the DFPS Abuse Hotline website; and
- provided with these instructions described in paragraph c of this section, in writing.
2. Optional Computer-Based Training and Competency Test
An HCS Program provider has the option of having their staff members, service providers and volunteers complete the Health and Human Services Commission’s (HHSC’s) ANE Competency Training. The completion of the computer-based training by employees, agents, and subcontractors meets the requirement in Section 1a of this appendix.
If staff members, service providers and volunteers complete HHSC’s ANE Competency Final Test, they must receive a score of at least 80 percent.
The completion of the competency test by staff members, service providers and volunteers meets the requirement in Section 1b of this appendix.
Staff members, service providers and volunteers must first sign up on the Learning Portal to have access to HHSC approved trainings, including this ANE training, entitled ANE Competency Training and Exam (online). The ANE training is found in Medicaid Long Term Services and Supports Training under the Health and Human Services Commission Courses tab.
Link to the Learning Portal homepage: https://learningportal.hhs.texas.gov/
3. Documentation Requirements
Program providers must maintain records documenting staff members, service providers and volunteers have received training on ANE. If using HHSC’s ANE Competency Training as evidence of ANE training, the HCS program provider must maintain a copy of the certificate generated from the HHSC’s ANE Competency Final Test for each staff member, service provider and volunteer. The program provider must maintain training records in accordance with 40 TAC §49.307 Record Retention and Disposition.
Appendix XIII, Value-added Services
Revision 19-3; Effective November 25, 2019
Value-added services (VAS) are extra benefits offered by managed care organizations (MCOs) beyond Medicaid-covered services. VAS may include routine dental, vision, podiatry, health and wellness services. VAS may be actual health care services, benefits or positive incentives Texas Health and Human Services Commission determines to promote healthy lifestyles, improving health outcomes among its members. Each MCO offers a different set of VAS and the MCO can change the VAS it offers every six months.
MCOs must cover all benefits in Medicaid managed care programs, such as STAR+PLUS, STAR Kids and STAR Health. The MCO utilizes VAS to distinguish itself from another MCO. In addition, members may use VAS to help choose which MCO has the added benefits best suited for their needs.
VAS are not considered non-waiver resources and therefore, waiver program providers do not consider VAS offered by the MCO when considering third-party resources. VAS is an added benefit available to individuals from the MCO providing their acute care services.