2400, Assessment Process

2410 Overview of the Assessment Process

Revision 24-3; Effective July 1, 2024

The assessment process determines if the applicant meets all eligibility requirements, including:

• financial eligibility;
• functional eligibility; and
• having an unmet need for services.

The assessment process should produce a case record that clearly documents the results of the caseworker's determination. All processes that can be performed in the Service Authorization System Online (SASO) Wizards must be performed in the system to consider that action complete, including:

• Form 2059, Summary of Client's Need for Service;
• Form 2060, Needs Assessment Questionnaire and Task/Hour Guide; and
• Form 2064, Eligibility Worksheet.

Note: When a caseworker receives a request to add an additional service to a person already receiving services, they must assess the person to determine that they meet all eligibility requirements for the additional service. This includes determining financial and functional eligibility and having an unmet need for the service. Review 7310, Requirement to use SASO Wizards, 8120, Financial Wizard, 8130, Functional Wizard and 8140, Authorization Wizard.

2411 Required Documentation

Revision 24-5; Effective Nov. 1, 2024

The following must be documented in the case record:

• A person’s eligibility based on their categorical status in the Texas Integrated Eligibility Redesign System (TIERS) or current financial and functional status using Form H1200, Application for Assistance – Your Texas Benefits, Form 2060, Needs Assessment Questionnaire and Task/Hour Guide or Form 2064, Eligibility Worksheet.
• A person’s medical, social, environmental, or physical conditions relevant to their functional status using Form 2110, Community Care Intake, Form 2059, Summary of Client's Need for Service, Form 2060, and the case narrative.
• A person’s degree of self-sufficiency and the tasks they can perform using Forms 2110, 2059 and 2060.
• Environmental adaptations that are being used or could be used to help the person achieve or maintain their maximum level of self-sufficiency using Form 2059.
• People who are resources, including family, friends, and community networks, that the person now uses or who are available to perform or help with activities of daily living using Form 2059 and Form 2060, Part A.
• Agency resources in the community available to provide any of the services needed by the person using Form 2059 and Form 2060, Part A.
• Form 8001, Medicaid Estate Recovery Program Receipt Acknowledgement, for Community Attendant Services applicants or responsible parties.

In some areas of Texas, the Area Agency on Aging (AAA) may submit a completed Form 2060 based on the assessment of services it provides. If a completed Form 2060 is received, review the information as part of the assessment process.

Note: Review Section 3000, Eligibility for Services for detailed explanations of financial eligibility assessment and determination procedures.

2420 Reserved for Future Use

Revision 24-3; Effective July 1, 2024

2421 Review of the Community Care Intake Form

Revision 24-5; Effective Nov.1, 2024

Review Form 2110, Community Care Intake, for all relevant information. Make sure the practitioner is the applicant's current practitioner and that the name, address and phone number listed are correct. If the applicant provided a rural route address, ask for the updated street address. If the person states they do not have a new address, continue to use the address provided. Take no action if the street-style address is not provided. Ask the person to update their information with the Texas Health and Human Services Commission if they are notified by the U.S. Postal Service of a new address.

Verify that the responsible party is the primary contact for the applicant and that the name, address, and phone number are correct. On Form 2110, list any other family members or informal supports who can be contacted if the applicant cannot be reached. Review the requested services and address those during the interview and in the documentation.

2422 Form 2059, Summary of Client's Need for Service

Revision 24-5; Effective Nov. 1, 2024

The purpose of Form 2059, Summary of Client's Need for Service, is to document the applicant's:

• medical diagnosis and physical condition;
• functional limitations;
• home environment;
• living arrangements; and
• family and community supports.

Record all information reported by the applicant or informal supports during the home visit on Form 2059-W, Summary of Individual's Need for Service Worksheet. This information is entered into Service Authorization System Online  (SASO) and will generate Form 2059.

Carefully observe and use interviewing skills during the initial home visit and throughout the assessment process. This is necessary to collect critical information about the person's functional and mental abilities, as well as community and family resources. People may demonstrate functional abilities while responding to questions about their home and living environment or medical problems. They may reveal information about family resources while responding to questions about financial eligibility. They may reveal intellectual and developmental disabilities or lack of mental clarity in the way they respond to questioning throughout the interview. During the interview, be alert for any indications of abuse, neglect or exploitation. If any of these conditions are present, refer the person to the Texas Department of Family and Protective Services (DFPS), Adult Protective Services.

2422.1 Medical Diagnosis and Functional Limitations

Revision 17-1; Effective March 15, 2017

Ask the applicant for information regarding his medical diagnosis and physical and functional limitations. Record this information on Form 2059-W, Summary of Individual's Need for Service Worksheet.

2422.2 Home Environment

Revision 24-5; Effective Nov. 1, 2024

The person's functional status is always relative to the home circumstances where the person performs the activities of daily living. For example, the person may have physical limitations that would not affect their abilities to perform specific personal care tasks if they lived in a home complete with all modern conveniences. If, however, their home contains only minimal household equipment, their inability to perform their personal care tasks could be compounded. Always assess a person's functional capacity in relation to the home environment where the tasks are performed daily. Service plans are developed to be carried out in specific home environments and each plan should relate specifically to a functional assessment done in that environment.

Observe and ask questions about the person's home and immediate environment to assess their ability to perform activities of daily living. Determine if the environment affects the person's ability to perform these activities or otherwise affects their health and safety.

Guidelines for Assessing the Home Environment

Using the following guidelines, assess the home environment and document the results on Form 2059-W, Summary of Individual's Need for Service Worksheet, to be entered in the Service Authorization System Online  (SASO). When observing the person's home and immediate environment, assess the following:

• Does the structure of the house or dwelling create an environment that is safe and adequate for the person's unique needs?
• Are there assistive devices and equipment necessary for the person to live safely or that would improve their safety? Note: These include ramps, grab bars, wide doors, lowered light switches, and adequate light for safe visibility.
• Is the home clean enough and orderly enough to be safe for the person's lifestyle?
• Does the home pose any critical health hazards?
• Do they have neighbors who are or might be resources for helping with any special monitoring the person might need because of a unique health or physical problem?
• Is the neighborhood safe to allow the person to move safely in and out of their home as needed?
• Is the person safe from physical harm in their own home?

Home Arrangement

Is the person the owner of their home, or do they live in an apartment or with friends or relatives? The person may pay rent, own the home or live cost-free.

Is the person homeless and no friend or relative is available to provide a home? If the person has insufficient income to rent a suitable home, they may be living in a public shelter or an exposed setting. Refer the person to Adult Foster Care (AFC), Residential Care (RC), public housing, or other community living resources. A referral to Adult Protective Services (APS) may be needed.

Home Condition

Is the person's home:

• Adequate — Physically safe and arranged or equipped so the person lives safely and performs normal activities of daily living? Although adjustments may be desirable, they are not necessary for safety.
• Inadequate Questionable — The residence presents serious limitations conducting activities of daily living, or safety hazards exist because of a need for major repairs, addition of utilities, or assistive devices. Check the appropriate boxes on Form 2059-W.
• Inadequate Unsafe — The residence is an unsafe environment for the person. The structure is in a severe state of disrepair, contains critical health hazards, or prevents one from performing the normal activities of daily living. The person may need to be moved for their health and safety. A referral to APS may be appropriate. Check the appropriate boxes on Form 2059-W.

2422.3 Living Arrangement

Revision 24-5; Effective Nov.1, 2024

The caseworker documents on Form 2059-W, Summary of Individual's Need for Service Worksheet, Item 4, if the applicant lives alone, with a spouse, with family or friends, or if they are in adult foster care or a residential care facility. In Item 5, list the name and relationship of all household members and indicate with a Y that they are in the household. Note if any of the household members receive services or are applying for services.

2422.4 Documentation of Caregivers

Revision 24-5; Effective Nov. 1, 2024

Ask the person if they receive help with their activities of daily living and list the names and relationships of all caregivers. These people may be family members, friends or neighbors. List the tasks performed by each caregiver on Form 2059-W, Summary of Individual's Need for Service Worksheet. Under Caregiver Status, indicate if there is a reason the caregiver cannot meet all the person's needs, such as working full time, having ill health, needing caregiver support, or providing continual care. For household members who are not performing any caregiver tasks, leave the caregiver status blank. If a household member states they are unwilling to help the person with any tasks, note this in the Caregiver Status on Form 2059-W.

The caregiver will be assessed during the functional assessment. Review Section 2433.1, Assessment of the Caregiver.

Determine if the caregiver needs caregiver support as defined in Section 2512, Caregiver Support, and develop the service plan accordingly.

2422.5 Attendant Policy for People Transferring from Another Personal Attendant Services (PAS) Program

Revision 24-5; Effective Nov. 1, 2024

For people applying for Community Care Services Eligibility (CCSE) personal attendant services (PAS) and the caregiver has been the paid attendant in another HHSC program, the following guidelines must be applied to people who are transitioning from the following programs:

• People who are no longer eligible for STAR+PLUS or the STAR+PLUS Home and Community Based Services (HCBS) program, who are being assessed for Primary Home Care (PHC), Community Attendant Services (CAS), or Family Care (FC); and
• People transitioning from the Texas Health Steps Comprehensive Care Program (THS-CCP) Personal Care Services (PCS).

The applicant must meet the unmet need criteria, but the current circumstances will be considered.

During the initial interview, if the caregiver has been the ongoing paid attendant and would like to continue as the paid attendant, the caseworker will ask the caregiver the following question: "Would you continue to provide care if you are not being paid to provide the care?"

If the response is "No," determine the tasks the caregiver has been paid for in the previous program and if the person still needs help with those tasks. Determine which tasks will continue as caregiver tasks and develop the service plan accordingly. Document the caregiver's response and send Form 2067, Case Information, along with the referral packet, to the provider advising that the caregiver had previously been the paid attendant and is eligible to be the paid attendant.

If the response is "Yes," evaluate if there is any unmet need or if caregiver support is required. If services continue, the caregiver cannot be hired. If there is no need for caregiver support or no unmet need, the applicant is denied services.

Caseworkers must follow this policy for people applying for HHSC Primary Home Care (PHC), Community Attendant Services (CAS), or Family Care (FC) who are transitioning from one of the programs listed above.

2422.6 Common Household Tasks, Duplicate Services and Services Provided to Other Household Members

Revision 24-3; Effective July 1, 2024

If a person lives with others, do not purchase services that are normally provided as part of the household routine. Examples are meal preparation, shopping, laundry, and housekeeping for the person, unless the person has unique needs.

If a person lives with others, determine if they need unique tasks performed apart from the household's tasks and if performing these tasks imposes more burdens of time and responsibility on the household members. Unique tasks are attributable to the person's problems. Examples include incontinence, a need for a special diet, food preparation, extra shopping or special housecleaning caused by the person's behavior. Allowable tasks also include cleaning up after personal care tasks, cleaning the person's room and the bathroom used by the person. If it is determined the person's needs impose special and extra activities on the household members, document these needs on Form 2060, Needs Assessment Questionnaire and Task/Hour Guide.

Services Provided to Other Household Members

Identify if services are being provided to any other household member by the Texas Health and Human Services Commission (HHSC) or another agency. If services are being provided, assess if they meet some of the person's needs and would affect their service plan.

Example: A person’s spouse receives Community Care Services Eligibility services, and an attendant performs housecleaning, laundry, and meal preparation as part of that service plan. Some of those services also benefit the spouse or duplicate services that they need. In this case, divide the time for common tasks between the people and authorize the task for both people. Refer to the maximum times listed on Form 2060 for companion cases.

Refer to Section 4400, Family Care Services, and Section 4600, Primary Home Care and Community Attendant Services, for specific information about situations when two people in the same household receive attendant services.

2422.7 Assessment of Social and Community Resources

Revision 24-5; Effective Nov. 1, 2024

Assess the person's community and social network resources, such as churches, civic clubs, and voluntary affiliations, to determine if any of these entities provide services or can do so. Also, identify available service agencies that serve older people and people with disabilities and might be able to provide a service needed by the person. Always determine if any of these sources can help the person before services from the Texas Health and Human Services Commission (HHSC) are authorized. Review Appendix XV, Services Available from Other State Agencies, for help identifying alternate sources of assistance. When possible, refer to local resource directories for information about services in a person's community. Document the use of or referral to other service agencies on Form 2059-W, Summary of Individual's Need for Service Worksheet.

All other services available to the person must be considered and used before HHSC services are authorized.

2423 Guardianship

Revision 24-3; Effective July 1, 2024

A Community Care Services Eligibility person may need a guardian if they:

• appear to be incompetent; or
• are incapacitated and cannot care for themselves or manage their property and financial affairs.

If the person's incompetence or incapacity results in them being in a state of abuse, neglect or exploitation, the caseworker must make a referral to Adult Protective Services (APS). Unless ordered by a court to do so, the caseworker must not file a petition for guardianship or assume guardianship of the person or the estate of a Texas Health and Human Services Commission (HHSC) person.

If the court intends to appoint the caseworker as guardian, the caseworker must advise the court that serving in that capacity will violate HHSC policy. If the caseworker is appointed guardian by the court, the supervisor and regional attorney must be notified immediately. If a referral to APS, Texas Department of Family and Protective Services, has not been made, make one now.

2430 Functional Assessment

Revision 24-3; Effective July 1, 2024

Use Form 2060, Needs Assessment Questionnaire and Task/Hour Guide to determine the following:

• the person's functional eligibility;
• their ability to carry out activities of daily living;
• what they should continue to do for themselves to maintain their current level of self-sufficiency;
• what they cannot do for themselves because of physical limitations, mental limitations or both;
• which resources are available to help with specific tasks;
• if the person has an unmet need; and
• how much service the person will receive, if eligible.

A person's functional level is based on:

• their physical condition;
• their medical problems and the functional limitations they impose;
• their mental clarity and limitations and the effect they have on performing activities of daily living; and
• the condition of their home environment.

The age of the person being assessed for services should not be considered when determining the level of functional need. Example, the applicant is a 3-month-old infant whose mother is applying for Community Attendant Services (CAS) for the child. The infant will need help with most of the activities of daily living and would, therefore, score a 3 on those tasks. The fact that the functional need is the direct result of the person's age should not be considered when assigning a score for the task.

If the person appears eligible for Community Care Services Eligibility services based on age, income, and resources, and they request services beyond information and referral, complete Form 2060, Part A, to determine the functional eligibility for services. This assessment helps determine if the person has functional needs, what kinds of functional limitations they experience, which tasks they need help with, and if their mental clarity contributes to their need for help.

Related Policy

26 Texas Administrative Code Section 271.63(a)

2431 Form 2060, Part A, Functional Assessment

Revision 24-3; Effective July 1, 2024

Program Standard: The caseworker must score each item on Form 2060, Needs Assessment Questionnaire and Task/Hour Guide, Part A, Functional Assessment. They then must accurately compute the total score to determine if the person is eligible for Community Care Services Eligibility services. Use the spaces under each item, as needed, to explain the person's limitations or their accommodations for their disability. Refer to the form instructions for detailed information about scoring Form 2060, Part A. Appendix XVII, Service/Score Code Guide, which indicates the score requirement for each service.

During a face-to-face interview, ask the person each question on Form 2060, Part A, as the question is stated on the form. Then, ask more questions to gain a complete understanding about the degree of the person's ability or inability to carry out activities of daily living. Careful assessment of the person reveals what they can do for themself, what they should continue to do for themself to maintain their current level of self-sufficiency, and what they cannot do for themself because of physical limitations or mental limitations. When conducting an assessment, use the following scale of disability and follow the detailed definitions of impairment levels found in the instructions for Form 2060, Part A.

To determine the severity of the person's impairment, consider the following factors:

1. Person's Perception of the Impairment — Does the person view the impairment as a major or minor problem?
2. Congruence — Is the person's response to a particular question consistent with the person's response to other questions and consistent with what has been observed?
3. Person’s History — Probe to understand the person's history about the current situation and the person's attitude about the severity of the impairment. For example, has the person  always kept a messy house and is not concerned because they cannot perform housekeeping tasks? Has the person always eaten only one meal a day and is not interested in eating more often? How has the impairment changed the person's lifestyle?
4. Person's Right to Self-Determination versus Danger to Self — Consider the consequence to the person if they choose not to take medications, bathe or adhere to a special diet.
5. Lack of Facilities — Absence of facilities for bathing, laundry, phone calls or meal preparation may indicate an impairment. The impairment and its degree will depend on the person's accessibility to the facility, ability to use it and ability to make satisfactory accommodations in the absence of the facility.
6. Adaptation — If the person has adapted their physical environment or clothing to the extent that they are able to function without help, the degree of impairment will be lessened. However, the person will still have an impairment.
   Note: Medication is not considered an adaptation to the person's functioning like a walker is. The person is not considered to have an impairment if the medication is working. The person is rated on how they are functioning at the time of the interview, regardless of the status of taking medication.

The following chart provides a general guide for assessment. Whether the person is taking medication, forgetting or refusing medication, or taking medication incorrectly, they are still assessed on their current level of functional ability.

Situation: The person has problems with dizziness and balance, which could affect scoring on the transfer or ambulation and balance questions.

The caseworker must document the reason in situations where the task score on Form 2060 is inconsistent with the amount of time allotted for that task. Example: A case reader may decide to rate Standard 10 unmet if a person scores 1 on all Form 2060 tasks, yet the maximum amount of hours for each are purchased and case documentation does not explain the discrepancy.

2432 Scoring Persons Who Cannot Respond

Revision 24-5; Effective Nov. 1, 2024

On some occasions, the caseworker may need to assess small children, infants, or people who are unconscious or otherwise non-responsive. Use Form 2060, Needs Assessment Questionnaire and Task/Hour Guide to conduct these assessments. Allow the caregiver to respond if the person cannot. In scoring each item, use the caregiver's response, the caseworker's observations, and any knowledge the caseworker may have about the person from other sources.

2433 Determining Unmet Need in the Service Arrangement Column

Revision 24-5; Effective Nov. 1, 2024

Regardless of a person’s functional eligibility as determined by their score on Form 2060, Needs Assessment Questionnaire and Task/Hour Guide, they can only receive CCSE services if they have an unmet need for those services.

Unmet need is defined as a requirement for assistance with activities of daily living that cannot be adequately met on an ongoing basis by friends, relatives, volunteers, or other service agencies.

For any task listed on Form 2060, Needs Assessment Questionnaire and Task/Hour Guide, the Service Arrangement Column will determine if the person has an unmet need to assess their overall eligibility based on unmet need. Review questions 1 through 15 and ask the person the following additional questions.

If the impairment score is 1 – Ask the person if they can perform the task by themselves, even though it may be difficult for them.

• If the answer is Yes, enter S in the service arrangement.
• If the answer is No, ask the person who helps them with this task. If the person states that a caregiver helps them, enter C for Caregiver in the service arrangement. List the caregiver's name, relationship, and task on Form 2059-W, Summary of Individual's Need for Service Worksheet, if it is not already entered.
• If the person states they receive help from another agency, enter A for Other Agency in the service arrangement. List the name of the agency on Form 2059-W.
• If the answer is No and the person states they have no help from any source and needs help to perform the task, enter P for Purchased in the service arrangement.

If the impairment score is 2 or 3 – Ask the person if they receive help with this task.

• If the answer is Yes, ask the person who helps them with the task. If the person states a caregiver helps with the task, enter C for Caregiver in the service arrangement. List the caregiver's name, relationship, and task on the worksheet, Form 2059-W, if it is not already entered.
• If the person states they receive help from another agency, enter A for Other Agency in the service arrangement. List the name of the agency on Form 2059-W.
• If the answer is No and the person states they have no help from any source and needs help to perform the task, enter P for Purchased in the service arrangement.

If the person states they receive some help from others, but it does not meet all their needs for a specific task, enter P/C. Document the part of the task performed by the caregiver in the Tasks Performed section on Form 2059-W.

Related Policy

26 Texas Administrative Code Section 271.63(b)

2433.1 Assessment of the Caregiver

Revision 24-5; Effective Nov. 1, 2024

For each task marked C on Form 2060, Needs Assessment Questionnaire and Task/Hour Guide, assess the capability, dependability, availability, and willingness of the caregiver. Consider and discuss family and job responsibilities, and the physical demands of caregiving. For each task, determine by observation and by asking the applicant or caregiver the following questions:

1. Is the caregiver physically and mentally able to perform the task?
2. Is the caregiver dependable in performing the task on the required schedule?
3. Is the caregiver available at the time the person needs the task performed, either scheduled or on-demand?
4. Is the caregiver willing to perform the task on a regular and ongoing basis?

It may be necessary to talk with the person's current caregiver to assess their contribution to the person’s care needs accurately. If the caregiver cannot join the applicant for the initial face-to-face visit, get as much information as possible from the applicant and contact the caregiver by phone to verify that the caregiver is willing to provide the tasks. Do not delay service initiation if the caregiver cannot be reached.

If, for any task, it appears the caregiver cannot adequately meet the applicant's needs or it is apparent from caseworker observation that the task is not being adequately performed, discuss with the applicant if some or all of the task should be purchased.

Be sensitive to any indications of abusive or neglectful behavior on the part of the caregiver, and, if necessary, make a referral to Adult Protective Services.

2433.2 Exploring Other Resources for Meeting the Applicant's Needs

Revision 24-5; Effective Nov. 1, 2024

Explore other possibilities for resources with the person. Ask if family members pay someone to help the person and if the current help is enough. Use observations about the caregiving arrangement to determine if needed tasks are being adequately performed. If a person's need for help with a particular task is being adequately met and the help is expected to continue, do not authorize purchased services for that task. If the need for help with a particular task is not being met or is only partially met, ask the person and family if there is anyone who would voluntarily provide the needed help. Explore the use of any identified volunteers. If voluntary help cannot be obtained, explore the use of community resources, and consider service options from other groups or agencies. Review Section 2535, Involvement of Volunteer Resources, and Section 2530, Other Resource Services, for possible resources to meet the person's needs. If the person's need for help cannot be met in any other way, enter P for the task on Form 2060, Needs Assessment Questionnaire and Task/Hour Guide. If Home Delivered Meals is the only service being purchased, complete the service arrangement column and do not allocate time on Form 2060.

If a person's needs for help are now being met and the person or family determines the present care arrangements cannot be continued, inform the person or family that the person may reapply for services when the current arrangement is discontinued. If, during the initial interview, the person or their family knows the present care arrangements will discontinue within 30 calendar days, proceed with the application process.

Examples:

• A person's sister, who is providing the care, has taken a job and will begin work on a specified date.
• A live-in relative who is providing the care plans to leave town on a specific date.
• A family member has been paying a caregiver but will soon be unable to continue because of new financial obligations, which will begin on a specific date.

If someone who has been paying for care intends to discontinue the arrangement on a specific date within 30 calendar days, proceed with the application. Otherwise, offer to take an application at the time the care arrangement is discontinued. If someone will continue to purchase some of the care, determine if the applicant has an unmet need for any more care. If someone is willing to pay for services only while the person is on an interest list, this does not affect the person's unmet need for services purchased by the Texas Health and Human Services Commission (HHSC). However, if someone is willing to pay for services after the person comes off the interest list, there is no unmet need.

In some situations, a caregiver may quit employment to stay home and provide care for the applicant and is requesting to be the paid attendant. In this situation, the caseworker must get verification that the person quit employment within 30 calendar days before or after the application date. The caregiver may be considered as a potential attendant. In the Service Arrangement column of Form 2060, note the tasks that the caregiver will voluntarily provide and those tasks that will be purchased. Review Section 2513, Caregiver as the Paid Attendant, for more information.

This policy also applies to ongoing cases where a caregiver who has been working full-time quits to stay home and provide care for the person. The caseworker must get verification that the person quit employment within 30 calendar days of the request for the change.

When the Service Arrangement Column of Form 2060 is completed, review the results to determine if the person has an unmet need. If all responses are S, C or A, the person has no unmet need and is not eligible for services. Advise the person that they are not eligible at this time and that they may reapply if their circumstances change. Be sure to adequately document this information in the Service Authorization System Wizards with the appropriate denial code and send the applicant Form 2065-A, Notification of Community Care Services.

If there are tasks marked P on Form 2060, continue to the Task and Hour Guide section.

2434 Support Score and Establishing Priority

Revision 24-5; Effective Nov. 1, 2024

If an applicant for Primary Home Care (PHC), Family Care (FC), or Community Attendant Services (CAS) has a functional score of 3 and the service arrangement for a priority task feeding, toileting, transfer, meal preparation is a P, then a support score must be entered for these tasks on Form 2060, Needs Assessment Questionnaire and Task/Hour Guide. Determine the likelihood of that task being done if the attendant does not show up during a typically scheduled service shift. Using the following scale, enter the score in the Form 2060 Support Score box by the appropriate item.

In determining this support score, do not consider caregivers as available if they would be at work or school, even if they could come to the person's home if the attendant were not there. Do not enter a support score for an item if either the task is not purchased or the person's score for that task is not "3."

If the support score is 4 on any of the priority tasks, the person will be designated as a priority person. Review Section 2540, Priority Status People for more information on this designation process.

2440 Use of Form 2060, Part B, Task/Hour Guide, and Part C, Task/Minute and Subtask Guide

Revision 24-5; Effective Nov. 1, 2024

For all personal attendant services (PAS) cases, the caseworker uses Part B and Part C of Form 2060, Needs Assessment Questionnaire and Task/Hour Guide to determine the number of purchased services needed by a person.

The Part C, Task/Minute and Subtask Guide, provides a uniform approach to the authorization of services based on a minute range per task and impairment score. Each impairment score for each task has a minimum and maximum allotted time. It is mandatory to follow the minute guideline and check the subtasks for each task to document the type of help needed and to support the time allocated for that task. Review the Form 2060 Instructions for complete directions for completing the form.

Form 2060, Pages 1-5, must be manually completed during the home visit initial assessment for an applicant who will receive PAS. Review the Task/Minute and Subtask Guide at each reassessment and initial the form. When there is a change in hours, either complete a new Form 2060 manually or update the current Part B and Part C.

Refer to Form 2060, Part C, for guidelines on the number of minutes to be allowed per task. The amount of time allowed for any task should be determined by accounting for:

• the amount of help the person will usually need;
• the availability of anyone else to help with the task;
• which specific subtasks and activities need to be purchased;
• environmental and housing factors that may hinder, or facilitate, service delivery; and
• the person's unique circumstances.

Discuss each task thoroughly with the person to decide if they need help with it, how much time is required to perform it, and how often each week the task must be performed. The total time allowed for each task must be within the minimum and maximum time limits for the impairment score, indicated on Form 2060.

Negotiate service authorizations with people to reach an agreement about:

• the number of tasks and activities the person needs help with;
• how often the help is needed; and
• the amount of time needed by the provider to carry out those tasks and activities per week.

All appropriate subtasks must be checked to show the specific tasks the person needs. A person scoring a 2 or 3 may need all subtasks under the impairment score of 1 and additional subtasks under the impairment score of 2. The time allotted must be within the range of the impairment score.

Time above the minute range may only be allotted with documented supervisory approval. Time below the minute range may be allotted with documentation of the person’s extenuating circumstances.

2440.1 Requesting Supervisory Approval for Time Above the Minute Range

Revision 24-3; Effective July 1, 2024

When a person has extenuating circumstances and requires a deviation in the time range, the caseworker must request supervisory approval to authorize time above the minute range for the task or impairment score. The caseworker must document why the person requires minutes outside the range for the task or impairment score level. The deviation must be discussed verbally or by email with the supervisor, and the supervisor must approve or disapprove the deviation.  The caseworker must document the supervisor's approval date on Form 2060 in SASO.

Refer to 2441, Circumstances When Supervisory Approval is Not Required.

2441 Circumstances When Supervisory Approval is Not Required

Revision 24-5; Effective Nov. 1, 2024

In some situations, the person may have extenuating circumstances and a compelling reason that require subtasks in a lesser impairment score to be authorized for a task. The two situations where the caseworker may allot time for subtasks in a lesser impairment score without supervisory approval are if the person has:

• extenuating circumstances and is requesting only subtasks in a lesser impairment score; or
• a caregiver or other agency providing some of the subtasks.

The caseworker documents:

• the person's extenuating circumstances and the reason tasks with a lesser impairment score are authorized; or
• the part of the task the caregiver or other agency provides.

2441.1 Exception for a Compelling Reason

Revision 24-5; Effective Nov. 1, 2024

In some situations, a person may request that tasks not be performed for them even though they have an impairment and may not be able to perform the task for themselves.

If a person has a compelling reason for not wanting any of the subtasks under the appropriate impairment score but only wants subtasks listed in a lower impairment score, the caseworker must document the person's request and allocate minutes in the minute range for the subtasks selected. The caseworker must document the reason, and no supervisory approval is required.

Example: The person scores a 2 on bathing. They need help with drying. However, when discussing subtasks, they state they would like standby assistance for safety and drawing of water, all under the impairment score of 1. They state their skin is very sensitive and they would not allow help with drying as they are afraid it would hurt them. The subtasks checked are all under the impairment score of 1, so ten minutes is allowed. Documentation is required to explain the variance. No supervisory approval is required.

Review Form 2060, Needs Assessment Questionnaire and Task/Hour Guide, and Instructions for additional information.

2441.2 Exception for Assistance from a Caregiver or Other Agency

Revision 24-5; Effective Nov. 1, 2024

If a person has a caregiver or other agency performing part of a task and only subtasks with a lower impairment score are needed, the caseworker must document the person's request and allocate minutes in the minute range for the subtasks selected. The caseworker must document the reason and the part of the task the caregiver or other agency performs. No supervisory approval is required.

Example: The person scores a 2 for bathing, but only wants help laying out supplies and drawing water because their daughter provides all hands-on assistance with the bathing task. The task is marked P/C. The subtasks under the impairment score of 1 are checked, and ten minutes is allowed for the subtasks to be purchased. Documentation is required to explain the variance.

2441.3 Time Allocation for Companion Cases

Revision 24-5; Effective Nov. 1, 2024

For companion cases, base time allocated for general household tasks, including cleaning, shopping and meal preparation, on the companion minute range on Form 2060, Needs Assessment Questionnaire and Task/Hour Guide, not the individual range. Time is assigned per person based on the person's impairment score. Check the box(es) in the Total Minutes Per Week column for cleaning, meal preparation, and shopping to show that time is authorized for these tasks in the companion case. When there are more than two companions in the household, assign time based on the person's impairment score using the companion minute ranges.

When there are more than two people in the household, the caseworker continues to use the companion minute range based on the person's impairment score.

Example: On cleaning, Mr. Jones scores a 3, and Mrs. Jones scores a 1. Mrs. Jones can do some light housekeeping, but due to her husband's incapacity, he needs all cleaning tasks performed in his area. Mrs. Jones is allowed the maximum of 45 minutes under impairment score 1 in the companion range. Mr. Jones is allowed the maximum of 180 minutes under impairment score 3 in the companion range.

Review Form 2060 Instructions for more examples and guidance on companion cases.

2442 Calculation of Time to be Authorized

Revision 24-5; Effective Nov. 1, 2024

Use the following procedures to calculate the total amount of time needed each week.

1. Multiply the number of minutes needed to conduct each task by the number of times the task will be performed each day to reach a daily total of minutes for each task. Times must be shown in five-minute increments. If necessary, round the time up to the next five-minute increment.
   
   Example: If a person needs to prepare meals twice a day and the preparation requires the maximum amount of time, multiply 30 minutes by two to reach a daily total of 60 minutes.
2. Multiply the daily total of minutes for each task by the number of days per week the attendant will conduct that task. Times must be shown in five-minute increments and rounded up to the next five-minute increment if necessary.
3. Add the required weekly minutes for all tasks and divide the total by 60 minutes to determine the weekly total in hours.
4. Round the weekly number of hours to the next highest half unit to determine the number of units to be authorized. Example: If a person needs 7 hours and 10 minutes of service each week, authorize 7.5 units of service. The number of hours must be correctly rounded up for accurate authorization of services.

Use Form 2060, Needs Assessment Questionnaire and Task/Hour Guide to calculate the hours of service to be purchased. The correct number of hours must be authorized on Form 2101, Authorization for Community Care Services. Write comments in the Service Authorization System Online (SASO) Impairment Scoring" window in the Functional Wizard.

Tasks identified as needing to be purchased must be authorized on Form 2101. Tasks marked P in the Service Arrangement column of Form 2060 must also be marked on Form 2101. The meal preparation task may be marked P on Form 2060 and not marked on Form 2101as long as the person is receiving home-delivered meals. A separate Form 2101 authorizing meals is sent to the home-delivered meals agency.

2443 Balancing Incentive Program, Level II Assessment

Revision 24-3; Effective July 1, 2024

The Balancing Incentive Program (BIP) provides additional Federal Matching Assistance Percentage (FMAP) funds to states that initiate reforms to increase nursing home diversions and access to non-institutional long-term services and supports. As part of the effort to increase access to additional federal funds and meet BIP requirements, the Texas Health and Human Services Commission (HHSC) administers the Level II Assessment to all people requesting or receiving Primary Home Care (PHC), Community Attendant Services (CAS) and Day Activity and Health Services (DAHS) Title XIX. The Level II Assessment includes:

• Part A of the Functional Assessment of Form 2060, Needs Assessment Questionnaire and Task/Hour Guide; and
• Form 2060-B, Needs Assessment Addendum.

The BIP was created by the Affordable Care Act of 2010 and improves the state’s ability to serve more people by increasing access to non-institutional long-term services and supports. The BIP allows states to adhere to the integration mandate of the Americans with Disabilities Act (ADA), as required by the Olmstead decision.

The caseworker will complete the Level II Assessment, Form 2060-B, for initial assessments, annual reassessments, and for a significant change request for a new service.

For changes in services, the caseworker will complete:

• Form 2060, Part A, Functional Assessment, if applicable;
• Form 2060, Part B, Task/Hour Guide;
• Form 2060, Part C, Task/Minute and Subtask Guide; and
• Form 2060-B.

The following are examples of the forms that are completed when a request is made for a change in service:

Examples:

Example A – A person receiving CAS calls the caseworker requesting transportation help. The caseworker completes Form 2060, Part A and Form 2060-B. Only complete Form 2060, Part B and Part C, if applicable. In reviewing the required forms, the person only requests transportation and does not wish to have the service plan for their attendant care services changed. The caseworker will send a referral for transportation only. No other action is required.

Example B – A person receiving CAS calls the caseworker to request home-delivered meals. The caseworker completes Form 2060, Part A, and Form 2060-B and, if applicable, Form 2060 Part B and Part C. In reviewing the required forms, the caseworker places the person’s name on the Home-Delivered Meals Interest List and increases the time allotted for meal preparation for their attendant services. The caseworker completes the change per Section 2721.4, Revising the Service Plan, and Section 2721.6, Authorizing and Documenting Changes.

The caseworker determines if a referral is needed for HHSC services or non-HHSC services based on the information collected from Form 2060-B. The caseworker discusses and gets approval to make a referral with the person to non-HHSC services. Referrals may include:

• behavioral health services;
• supported employment or employment assistance;
• transportation assistance;
• help with instrumental activities of daily living, and
• help for other medical conditions not previously addressed.

The caseworker documents the referrals made for the person in Section III of Form 2060-B, including any need for referrals identified but refused by the person. No data entry is required in the Service Authorization System Online (SASO) resulting from completing Form 2060-B only.

The person keeps the right to participate in their service plan development. They can also refuse all or part of any services and be informed of the likely consequences of such refusal, including referral to non-HHSC services.

Identified needs for referrals agreed to by the person are considered requests for information and referral. The caseworker makes use of applicable existing referral policy to help the person with the appropriate referral located in:

• Section 2422.7, Assessment of Social and Community Resources;
• Section 2530, Other Resource Services;
• Section 2535, Involvement of Volunteer Resources;
• Section 2743, People Receiving Services through Local Authorities;
• Appendix XV, Services Available from Other State Agencies.

Referrals for behavioral health needs identified on Form 2060-B may be made to local mental health authorities. Use the local phone numbers available on the Mental Health and Substance Use page.