1110 Legal Base
Revision 24-4; Effective Sept. 1, 2024
Community Care Services Eligibility (CCSE) is a group of services purchased by the Texas Health and Human Services Commission (HHSC) in response to Texas Legislature recommendations. CCSE provides services in a person's home or community for Texans who are not self-sufficient, and who might otherwise be subject to premature institutionalization or to abuse, neglect or exploitation. CCSE includes the following direct services for eligible people. Detailed descriptions of the services are in 4000, Specific CCSE Services:
- Adult Foster Care (AFC) — 24-hour care in a family home or small group home.
- Day Activity and Health Services (DAHS) — up to 10 hours of care per day in a licensed facility, supervised by a licensed nurse.
- Emergency Response Services (ERS) — an electronic signaling device for emergencies.
- Meals Services — Home-Delivered Meals (HDM).
- Personal Attendant Services (PAS) — help with personal care and housekeeping tasks:
- Community Attendant Services (CAS) — provides in-home attendant services to people with an approved medical need for help with personal care tasks. CAS Services are provided under Title XIX of the Social Security Act.
- Family Care (FC) — provides in-home attendant services to eligible adults. FC serves people who may or may not need personal care. FC services are provided under Title XX of the Social Security Act.
Primary Home Care (PHC) — provides in-home attendant services to people with an approved medical need for help with personal care tasks. PHC serves people with Supplemental Security Income Medicaid benefits. PHC services are provided under Title XIX of the Social Security Act.
- Residential Care — 24-hour care in a group setting, including:
- Emergency Care (EC) — care given to people who need immediate shelter or 24-hour care, or
- Residential Care (RC) — 24-hour care in licensed assisted living facilities.
- Special Services to Persons with Disabilities (SSPD) — a variety of in-home care and advocacy services for people who live with disabilities.
HHSC also provides CCSE case management information and referral (I&R) to other service resources. Case management is direct assistance to eligible people to manage the services that have been mutually planned and that use the person’s own resources as well as community resources. These services are planned to enable people to carry out activities of daily living and to continue living in the community. Review 2000, Case Management and Appendix XXIV, Legal Basis for Community Care Programs.
1120 Program Goals
Revision 24-4; Effective Sept. 1, 2024
CCSE goals are:
- to enable older people and people with disabilities achieve or maintain personal self-sufficiency, to help them reduce or prevent dependency, and to help them accept and understand dependency when it occurs because of illness, accident or normal aging;
- to prevent or reduce unnecessary institutional care by providing home-based and other less intensive care and to help people access institutional services when necessary and appropriate; and
- to prevent abuse and neglect, including adult self-neglect, and to refer to Adult Protective Services (APS), adults who appear to be victims of abuse, neglect, or exploitation by others.
1130 Definitions
Revision 24-3; Effective July 1, 2024
Definitions used in the CCSE handbook mean the following unless the handbook shows otherwise:
Abuse –
- the willful infliction of injury, unreasonable confinement, intimidation, or cruel punishment resulting in physical harm, pain, or mental anguish; or
- the willful deprivation by a caregiver or oneself of goods or services that are necessary to avoid physical harm, mental anguish, or mental illness.
Activities of daily living - Activities essential to self-care and daily tasks, including bathing, eating, dressing, grooming, walking, toileting, housekeeping, shopping and meal preparation.
Adult - A person 18 or older or an emancipated minor.
Adult Foster Care (AFC) - Services provided in a 24-hour living arrangement in an adult foster care home for people who cannot continue to function independently in their own homes because of physical, mental or emotional limitations.
Aged or older adult - A person 65 or older.
Applicant - A person applying for CCSE services.
Attendant - A person whom a provider agency employs to provide personal care, housekeeping, or both to people eligible to receive Personal Attendant Services (PAS) according to a service plan.
Caregiver - A relative, guardian, representative payee, or a person who has frequent or regularly scheduled contact with the applicant or recipient so that a personal relationship exists or the applicant or recipient perceives that person as having a role in helping them meet their basic needs.
Caregiver support - Relief or rest from caregiving duties given to or arranged for an applicant or recipient’s caregiver.
Caseworker - A CCSE employee responsible for determining eligibility and case management activities.
Categorial Eligibility - Review HB 2341.3 for a complete description.
Client - A person receiving CCSE services. The person may also be referred to as a recipient.
Community Attendant Services (CAS) - A non-technical, medically related personal care service available to eligible people whose health problems limit them from performing activities of daily living per a practitioner’s statement of medical need.
Community care services - Services provided within a person’s home or community as alternatives to institutional care.
Community Care Interest List - A list containing the names of people interested in receiving a community care service or program when funds are unavailable.
Community Care Services or Programs -
- Adult Foster Care
- Community Attendant Services (CAS)
- Consumer Managed Personal Attendant Services (CMPAS)
- Day Activity Health Services (DAHS)
- Emergency Response Services (ERS)
- Family Care (FC)
- Home Delivered Meals (HDM)
- Primary Home Care (PHC)
- Residential Care (RC)
- Special Services to Persons with Disabilities (SSPD)
Consumer Managed Personal Attendant Services (CMPAS) - An HHSC program for personal attendant services where recipients manage their attendant services to varying degrees. Attendant services help the recipient function independently in the community. Recipients interview, select, train, supervise, and release their attendants. Services include:
- Attendant care which is provided as needed by attendants selected by the recipient.
- Health-related tasks prescribed by a medical practitioner.
Day Activity and Health Services (DAHS) - Services designed to meet an adult’s needs in a Texas HHS-licensed Day Activity and Health Services facility.
Disabled - Review Person with Disabilities
Earned income - Cash or liquid resources an applicant or recipient receives for services performed as an employee or because of self-employment.
Emancipated minor - A person under 18 with the power and capacity of an adult. This includes a minor who has had the definition of minority removed by a court of law or who has been married, with or without parental consent.
Emergency Response Services (ERS) - An electronic monitoring service for adults with functional impairments. Review CCSE HB 4312.1.
Expedited response - An initial visit, either by phone or in-person, for services of an applicant by the caseworker within five calendar days from the date of assignment. Review HB Reference 2320.
Exploitation - The illegal or improper act of a caregiver or others using an adult’s income or resources for monetary or personal benefit, profit or gain.
Facility - A place that delivers daily or 24-hour residential services to people.
Family Care (FC) - A program authorized under Title XX of the Social Security Act that provides personal attendant services to eligible people.
Fraud - The deliberate misrepresentation or intentional concealment of information to receive or be reimbursed for the delivery of services to which a person is not entitled.
Functional need - A person’s requirement for help with activities of daily living caused by a physical limitation, medical condition or disability.
HHSC region - One of eleven regions of Texas that provide access to and support for HHSC services.
Home-Delivered Meals (HDM) - This program, funded by Title XX of the Social Security Act and administered by HHSC, involves a provider agency delivering meals to eligible people.
Immediate response - An initial visit, either by phone or in-person, for services of an applicant by the caseworker within 24 hours from the date of assignment. Review HB Reference 2320 for detailed information.
Income eligible - An adult who is not categorically eligible but has income and resources equal to or less than the eligibility level established by HHSC.
Institution - A nursing home, intermediate care facility for people with intellectual disabilities, a state-supported living center or state hospital.
Liquid Resources - Cash or financial instruments that can be converted to cash within 20 workdays.
Medicaid eligible - A person who receives federal medical assistance, such as SSI, TANF, medical assistance only (MAO), or through a federally approved waiver while living in the community.
Medicare eligible - A person who receives Social Security or railroad retirement benefit payments and meets eligibility criteria to have certain medical expenses paid by the federal Medicare program.
Neglect –
- the failure to provide for oneself the goods or services necessary to avoid physical harm, mental anguish, or mental illness; or
- the failure of a caregiver to deliver goods or services.
Person with disabilities - A person who, because of physical, mental, or developmental impairments, is limited temporarily or permanently in their capacity to adequately perform one or more essential activities of daily living. This includes, but is not limited to, personal and health care, moving around, communicating, and housekeeping.
Personal leave - Any leave from a residential care facility except for hospitalization or institutionalization. A day of personal leave is any period of 24 consecutive hours.
Primary Home Care (PHC) - A non-technical, medically related personal care service available to people eligible for Medicaid whose health problems limit their ability to perform activities of daily living, per a practitioner’s statement of medical need.
Prior approval - A regional nurse’s authorization to a provider agency to deliver services when a person meets the medical need criteria for the requested service.
Provider agency - An agency contracted with HHSC to provide programs or services that CCSE has authorized for people eligible for services.
Recipient - A person receiving CCSE services may also be called a client.
Regional nurse - A registered nurse employed by HHSC who authorizes CAS, PHC and DAHS services.
Residential Care (RC) - Provides a 24-hour living arrangement in a licensed facility that provides personal care, home management, escort, social and recreational activities, transportation, 24-hour supervision, and supervision of or help with the direct administration of medication.
Resource - Any cash or other liquid assets or any real or personal property owned by a person or their spouse that can be converted to money for support and maintenance.
Responder - A person who responds to an Emergency Response Services (ERS) call activated by a recipient. Responders may include relatives, neighbors, volunteers, or staff of a sheriff’s department, police department, emergency medical service or fire department.
Responsible person - A person who is:
- an applicant or recipient’s parent or legal guardian; or
- anyone an adult applicant or recipient designates as their representative.
Routine Response - An initial visit, either by phone or in-person, for services of an applicant by the caseworker within 14 calendar days from the date of assignment. Review HB Reference 2320.
Special Services to Persons with Disabilities (SSPD) - Provides services in various settings to help people develop the skills needed to live independently in the community. The service plan includes counseling, personal care, and developing skills for independent living in the community. Services vary depending on the regional contract.
Supplemental Security Income (SSI) - Monthly payments made by the Social Security Administration (SSA) to people with disabilities and older adults with little or no income or resources. The Social Security Administration (SSA) decides eligibility for SSI.
Unearned income - Income from sources other than self-employment or employee work activities.
Unmet need - A requirement for help with daily activities that cannot be met adequately by friends, relatives, volunteers, or other service agencies or programs.
Related Policy
Program Definitions, 4311
Description, 6310
1140 Disclosure of Information
Revision 17-1; Effective March 15, 2017
1141 Confidential Nature of the Case Record
Revision 24-4; Effective Sept. 1, 2024
Information collected to determine initial or continuing eligibility is confidential. The restriction on disclosing information is limited to information about people. HHSC may disclose general information about policies, procedures, or other methods of determining eligibility and any other information that is not about or does not specifically identify a person.
A person may review all information in the case record and in HHSC handbooks that contributed to the decision about their eligibility.
1141.1 Confidential Information on Notifications
Revision 24-4; Effective Sept. 1, 2024
HHSC is committed to protecting all confidential information supplied by the applicant or person during the eligibility determination process. This includes confidential information by HHSC staff to third parties who receive a copy of a notification of eligibility form. Staff must ensure they do not include confidential information on the eligibility notice that should not be shared with the service provider or another third party.
Example: A person is being denied family care (FC) due to an increase in income. It is a violation of confidentiality to record on Form 2065-A, Notification of Community Care Services, your income of $2,892 exceeds the eligibility limit of $2,829. The comment should state, "Your income exceeds the eligibility limit."
Another applicant is denied primary home care (PHC) services because they do not meet the medical diagnosis criterion. It is a violation of confidentiality to record on Form 2065-A, "Your diagnosis of schizophrenia does not meet the medical diagnosis criteria for eligibility for the Primary Home Care Program." The comment should state, "You do not have a medical diagnosis resulting in a functional limitation, as required for eligibility."
In the examples above, revealing the amount of the person’s’ income or diagnosis violates their right to confidentiality. In all cases, HHSC staff must assess any information provided by the person to determine if its release would be a confidentiality violation.
1142 Establishing Identity for Contact Outside the Interview Process
Revision 24-4; Effective Sept. 1, 2024
HHSC must keep all information about a person or any person on the case confidential. Confidential information includes, but is not limited to, individually identifiable health information.
Before discussing or releasing information about a person or any person in the case, ensure whoever is receiving the confidential information is either the person or someone the person has authorized to receive confidential information. Example: attorney or personal representative.
1142.1 Phone Contact
Revision 24-5; Effective Nov. 1, 2024
Before discussing or releasing case information over the phone, establish the caller’s identity.
For callers who claim to be the applicant or recipient or the applicant’s or recipient’s personal or authorized representative (AR), establish identity by using the caller’s knowledge of the applicant’s or recipient’s:
- SSN;
- date of birth;
- other identifying information; or
- knowledge of the same information about the applicant’s or recipient's representative.
Establishing the caller’s identity can also be done by calling the applicant or recipient to confirm the identity of the caller.
Establish the identity of attorneys or legal representatives by asking:
- the legal representative to provide a complete Form H1826, Case Information Release, signed by the recipient; and
- the ARs to provide a complete and signed Form H1003, Appointment of an Authorized Representative.
1142.2 In-Person Contact
Revision 24-4; Effective Sept. 1, 2024
Establish the identity of someone who presents themself as a person or a person’s representative at an HHSC office by using sources such as:
- driver's license;
- date of birth;
- Social Security number; or
- other identifying information.
Establish the identity of other HHSC staff, federal agency staff, researchers, or contractors by using sources such as:
- employee badge; or
- government-issued identification card with a photograph.
Identify the need for other HHSC, federal or research staff, or contractors to gain confidential information through:
- Official correspondence or a phone call from a state or regional office.
- Contact with a regional attorney.
Contact appropriate regional or state office staff when federal agency staff, contractors, researchers, or other HHSC staff come to the office without prior notification or adequate identification and request permission to access HHSC records.
1142.3 Verification and Documentation
Revision 24-5; Effective Nov. 1, 2024
If disclosing individually identifiable health information, document how the person’s identity is verified when contact is outside the interview.
Verify the identity of the person who requests disclosure of individually identifiable health information using sources such as:
- valid driver's license or Department of Public Safety ID card;
- birth certificate;
- hospital or birth record;
- adoption papers or records;
- work or school ID card;
- voter registration card;
- wage stubs; or
- U.S. passport.
1143 Custody of Records
Revision 24-5; Effective Nov. 1, 2024
Records must be safeguarded. Use reasonable diligence to protect and preserve records and to prevent disclosure of the information in them, except per HHSC regulations.
Reasonable diligence for employees responsible for records includes keeping records:
- in a locked office when the building is closed;
- properly filed during office hours; and
- in the office at all times, except when authorized to remove or transfer them.
1144 Disposal of Records
Revision 24-4; Effective Sept. 1, 2024
Follow the HHSC procedures for the destruction of confidential data in the Records Management Manual to dispose of documents with person-specific information.
1145 When and What Information May Be Disclosed
Revision 24-4; Effective Sept. 1, 2024
Staff must make reasonable efforts to limit the use or disclosure of individually identifiable health information to the minimum necessary to determine eligibility and operate the program. Limit the disclosure of a person’s medical information from HHSC records to the minimum required to complete the requested disclosure. Example: If a person authorizes the release of income verification, including disability income, do not release related case medical information unless specifically authorized by the person.
Do not respond to inquiries from the applicant or recipient’s relatives or friends requesting addresses or personal information without the applicant or recipient’s consent. Inform the applicant or recipient of any inquiries. Allow the applicant or recipient to determine if they wish to share the information before providing it to the inquiring party.
The applicant or recipient authorizes the release of information by completing and signing:
- Form H1826, Case Information Release; or
- a document with all the following information:
- the person's full name including middle initial and case number, or full name including middle initial and either their date of birth or Social Security number;
- a description of the information to be released;
- if a general release is authorized, provide the information that can be disclosed to the person; and
- withhold confidential information from the case record, such as names of people who disclosed information about the household without the household's knowledge, and the nature of pending criminal prosecution;
- a statement specifically authorizing HHSC to release the information;
- the name of the person or entity to whom the information can be released;
- the purpose of the release;
- an event that triggers an expiration of the authorization or an expiration date of the release;
- a statement about if refusal to sign the release affects eligibility for delivery of services;
- a statement describing the person's right to revoke the authorization to release information;
- the date the document is signed; and
- the signature of the person or legally authorized representative (LAR).
If the case information to be released includes individually identifiable health information, clearly indicate in the document that the applicant or recipient understands information released may no longer be private and may be released again by the person receiving the information.
When information is requested from the case records of a deceased person, the privacy of the deceased person and their survivors must be protected. Follow policy to determine who can act on behalf of a deceased person about individually identifiable health information.
Do not include Form H1826 or other information or release authorization documents in application packets.
The HHSC Office of the Chief Counsel handles questions about the release of information under the Open Records Act. Refer all questions and issues encountered by people about release of information to the Open Records Division, Office of the Chief Counsel. Regional staff should direct questions and issues to the regional attorney.
Follow Confidential Nature of Medical Information – HIPAA policy for restrictions on the release of a person's protected health information under the Health Insurance Portability and Accountability Act (HIPAA) privacy regulations.
Related Policy
1145.1, Request for Release of Information Related to a Deceased Individual
1146, Confidential Nature of Medical Information – HIPAA
1145.1 Request for Release of Information Related to a Deceased Person
Revision 24-5; Effective Nov. 1, 2024
This section shows how to handle requests for releasing information when a request for information about the Medicaid Estate Recovery Program (MERP) occurs for a deceased applicant or person. HHSC does not provide a form to document when someone requests information. Instead of a form, use one of the following methods to document the request for this type of release of information to the requestor:
- a release form or statement signed by the applicant or person before death and not revoked by the applicant or person authorizing the release of information to the specific person requesting the information;
- a copy of an order from a probate court appointing the requestor as an estate administrator or guardian;
- a copy of another type of order from a court authorizing the requestor to administer the deceased affairs; or
- documentation demonstrating the requestor has authority under Texas law to act for the deceased.
A person with authority under Texas law to act on behalf of a deceased applicant, person or the deceased's estate includes a surviving spouse, an adult child, a parent or an heir.
Regional staff should ask the requestor for any available document, noted above. If a document is not available, staff must determine and document if the requestor has authority under Texas law to act for the deceased applicant or person. Regional staff may release information to the requestor if one of the documentation requirements above is met and filed or recorded in the case record.
1146 Confidential Nature of Medical Information – HIPAA
Revision 24-5; Effective Nov. 1, 2024
Health Insurance Portability and Accountability Act (HIPAA) is a federal law that sets additional standards to protect the confidentiality of individually identifiable health information. Individually identifiable health information is information that identifies or could be used to identify a person. It relates to the following:
- past, present, or future physical or mental health or condition of the person;
- provision of health care to the person; or
- past, present, or future payment for health care to the person.
1147 Privacy Notice
Revision 24-5; Effective Nov. 1, 2024
HIPAA requires HHSC to provide a notice of privacy practices that explains:
- the person’s privacy rights;
- the duties of HHSC to protect the person’s health information; and
- how HHSC may use or disclose the person’s health information without authorization.
Example: HHSC may share health information with the person’s provider to arrange for services or with other government entities to report suspected abuse or neglect.
Provide Form 0401, Notice of Privacy Practices (English), or Form 0401-S, Aviso de Normas Sobre la Privacidad (Spanish), as appropriate, to each person enrolled in a Title XX program who is not categorically financially eligible.
Provide Form 0401 or Form 0401S to each Title XX applicant:
- at initial certification; and
- at recertification when recertifying after a break in services of more than 180 days.
Note: Categorically eligible applicants receive notice of privacy practices from AES eligibility staff at certification and recertification.
Form 0403, Explanation to Health Information Privacy Rights, provides a reminder of privacy practices and where to locate Form 0401.
Provide Form 0403 in person during the home visit or by mail to each Title XX recipient:
- at each annual recertification;
- after a break in services of at least 30 calendar days but not more than 180 days or
- when a new person is added to a case.
1148 Reserved for Future Use
Revision 21-4; Effective December 1, 2021
1149 Minimum Necessary
Revision 24-5; Effective Nov. 1, 2024
Make reasonable efforts to limit the use, request, or disclosure of individually identifiable health information to the minimum necessary to determine eligibility and operate the program. The disclosure of a person’s medical information from HHSC records must be limited to the minimum required to accomplish the requested disclosure. Example: If a person authorizes the release of income verification, including disability income, do not release related case medical information unless specifically authorized by the person.
1150 Personal Representatives
Revision 24-5; Effective Nov. 1, 2024
Only the person or the person’s personal representative can exercise the person’s right concerning individually identifiable health information. Therefore, only the person or the person’s personal representative may authorize the use or disclosure of individually identifiable health information or get individually identifiable health information for a person.
Exception: HHSC is not required to disclose the information to the personal representative if the person is subjected to domestic violence, abuse, or neglect by the personal representative. Consult the regional attorney if it is believed that health information should not be released to the personal representative.
Note: A responsible party is not automatically a personal representative.
1151 Adults and Emancipated Minors
Revision 24-5; Effective Nov. 1, 2024
If the person is an adult or emancipated minor, including married minors, the person’s personal representative is someone with the authority to make health care decisions about the person and includes:
- someone the person has appointed under a medical power of attorney, a durable power of attorney or a power of attorney with authority to make health care decisions;
- a court-appointed guardian for the person; or
- someone designated by law to make health care decisions when the person is in a hospital or nursing home and is incapacitated or mentally or physically incapable of communication. Follow regional procedures to contact the regional attorney for approval.
1152 Unemancipated Minors
Revision 24-5; Effective Nov. 1, 2024
A parent is the personal representative for a minor child except when:
- The minor child can consent to medical treatment by themselves. In this circumstance, do not disclose the medical treatment to a parent. A minor child can consent to medical treatment by themselves when the:
- minor is on active duty with the U.S. military;
- minor is 16 or older, lives separately from the parents, and manages their own financial affairs;
- consent involves diagnosis and treatment of disease that must be reported to local health officer or state health services;
- minor is unmarried and pregnant, and the treatment relates to the pregnancy;
- minor is 16 or older, and the consent involves examination and treatment for drug or chemical addiction, dependency, or use at a treatment facility licensed by the Texas Council on Alcohol and Drug Abuse;
- consent involves examination and treatment for drug or chemical addiction, dependency, or use by a physician or counselor at a location other than a treatment facility licensed by the Texas Council on Alcohol and Drug Abuse;
- minor is unmarried, is the parent of a child, has actual custody of the child, and consents to treatment for the child; or
- consent involves suicide prevention or sexual, physical, or emotional abuse.
- A court makes health care decisions for minor children or has given the authority to make health care decisions for minor children to an adult other than a parent or to the minor child. Under these circumstances, do not disclose to a parent information about the health care decisions not made by the parent.
1153 Deceased People
Revision 24-5; Effective Nov. 1, 2024
The personal representative for a deceased person is an executor, administrator, or other person with authority to act on behalf of the person or the person’s estate. These include:
- an executor, including an independent executor;
- an administrator, including a temporary administrator;
- a surviving spouse;
- a child;
- a parent; and
- an heir.
Contact the regional attorney if you have questions about whether a certain person is the personal representative of an applicant or person.
1160 Correcting Information
Revision 24-5; Effective Nov. 1, 2024
A person has a right to correct any information that HHSC has about them and any other person on their case.
A request for correction must be in writing and:
- identify the person asking for the correction;
- identify the disputed information about the person;
- state why the information is wrong;
- include any proof that shows the information is wrong;
- state what correction is requested; and
- include a return address, phone number, or email address where HHSC can contact the person.
If HHSC agrees to change individually identifiable health information, the corrected information is added to the case record. The incorrect information remains in the file with a note that the information was amended per the person's request.
Notify the person in writing within 60 days, using current HHSC letterhead, that the information is corrected or will not be corrected and the reason. Inform the person if HHSC needs to extend the 60 days by an additional 30 days to complete the correction process or get more information.
If HHSC corrects individually identifiable health information, ask the person for permission before sharing it with third parties. HHSC will make a reasonable effort to share the correct information with people who received the incorrect information from HHSC if they may have relied on it or could rely on it to the person’s disadvantage. Follow regional procedures to contact the HHSC Privacy Officer for a record of disclosures.
Note: Do not follow the above procedures when the accuracy of information provided by a person is determined by another review process, such as a:
- fair hearing;
- civil rights hearing; or
- other appeal process.
The decision in that review process is based on the request to correct information.
1170 Alternate Means of Communication
Revision 24-5; Effective Nov. 1, 2024
HHSC must accommodate a person's reasonable requests to receive communications by alternative means or at alternate locations.
The person must specify in writing the alternate mailing address or means of contact. They must include a statement that using the home mailing address or regular means of contact could endanger the person.