2600, Authorizing and Reassessing Services

2610 Application Processing and Notification

Revision 24-3; Effective July 1, 2024

Eligibility for CCSE services for income-eligible applicants is determined within 30 calendar days after a signed application is received. For categorically eligible applicants, the eligibility determination process begins within 30 calendar days after the person’s assessment with CCSE staff. This process involves a thorough assessment of the applicant's circumstances and needs.

No further action is necessary if the person withdraws the request for services, before the assessment is started or completed, an application is received, or a face-to-face home visit is made.

Related Policy

26 Texas Administrative Code Section 271.151(d) 
Categorical Eligibility, 2341.3 
Income and Income Eligibles, 3310

2611 Processing Time Frames

Revision 24-5; Effective Nov. 1, 2024

Program Standard: The caseworker is required to determine eligibility for Community Care Services Eligibility (CCSE) services for income-eligible applicants as soon as possible, but within 30 calendar days after a signed application is received. The caseworker must determine eligibility for categorically eligible applicants as quickly as possible but within 30 calendar days after either the person's assessment or face-to-face contact with the caseworker, whichever occurs first.

Note: Eligibility for Home Delivered Meals (HDM), which does not require financial determination, must be determined within 30 calendar days from their assessment date.

This standard is applied to all applications, except for Community Attendant Services (CAS), using the date shown as the Date Eligibility Rules Processed  on the Service Authorization System Online Wizards (SASOW) Form 2064, Eligibility Worksheet as the end point of measurement. The 30 calendar day processing deadline cannot be used to delay a decision if all information is available before the 30th calendar day.

Proceed with the eligibility determination process if the person fails to cooperate but has received facility-initiated Day Activity and Health Services (DAHS) when the person is receiving Medicaid benefits.  Review the procedures in Section 4231.2, Intake Response.

2611.1 Processing Time Frames for Community Attendant Services

Revision 24-5; Effective Nov. 1, 2024

Applications for Community Attendant Services (CAS) must be referred to Medicaid for the Elderly and People with Disabilities (MEPD) staff for a financial eligibility determination. The MEPD process may delay Community Care Services Eligibility (CCSE) certification beyond the 30 calendar day time frame.

MEPD may notify the Texas Health and Human Services Commission (HHSC) caseworker of the eligibility decision through the MEPD to HHS Communication Tool.  If a decision is not received, the HHSC staff person must check the Texas Integrated and Eligibility Redesign System (TIERS) for an MEPD eligibility decision on or before the 25th calendar day from the application date and perform weekly checks until the financial eligibility decision is received. The TIERS checks must be documented.

When the financial eligibility decision notification is received either through TIERS or the MEPD to HHS Communication Tool, the caseworker has seven business days to:

• complete data entry in the Service Authorization System Online Wizards (SASOW); and
• send the referral packet to the Home and Community Support Services Agency (HCSSA) to begin pre-initiation activities.

The seven business days are measured from the date HHSC receives the eligibility decision from MEPD or the date eligibility is verified through TIERS. The caseworker must print a copy of the financial eligibility notice or TIERS screen and file it in the case record.

The HHSC caseworker must advise MEPD only if the applicant is not approved for CAS,  that is, no practitioner’s statement or other circumstances preventing services deliver. In this circumstance, the caseworker must send Form H1746-A, MEPD Referral Cover Sheet, to MEPD within two business days of determining the person is not eligible for CAS, advising that the applicant has not met the functional eligibility requirements. Form H1746-A is sent to MEPD at the same time Form 2065-A, Notification of Community Care Services, is sent to the person notifying them of CAS ineligibility.

The caseworker is not required to notify MEPD when CAS services are authorized.

Review Section 4653, Referral to the Provider, and Section 4660, Service Authorization, for more procedures for authorizing CAS services.

Caseworkers always have seven business days after confirmation of MEPD eligibility to send the referral to the provider. This applies even when verification of MEPD certification is received near the end of the 30 calendar day period allowed for completing CCSE applications.

2612 Notification of Eligibility Decision

Revision 24-5; Effective Nov. 1, 2024

An applicant or person certified for one Community Care Services Eligibility (CCSE) service but determined ineligible for another must be notified in writing of both decisions. An applicant or person certified for Personal Attendant Services (PAS) or Home-Delivered Meals (HDM) must also be notified in writing of the service units per week they are eligible to receive. If certified for Day Activity and Health Services (DAHS), the applicant or person must be notified in writing of the number of days per week the DAHS authorization covers. The written notice for all services must contain the caseworker's name, phone number and appeal procedures.

When notifying the applicant of eligibility, specify on Form 2065-A, Notification of Community Care Services:

• the CCSE services for which the applicant is eligible or ineligible; and
• if determined eligible:
  • the number of hours of services the applicant is authorized to receive or the number of days or half days the applicant is authorized to attend a DAHS facility;
  • if applicable, that the Family Care, Community Attendant Services or Primary Home Care applicant is eligible for priority status; and
  • the initial and ongoing copayments the person is to pay to the Residential Care facility.

The caseworker may notify a person verbally of continued eligibility if the person continues to qualify for the same service(s) and the number of hours or units of service remains the same.

Review Section 2662, Redetermination of Financial Eligibility, and Section 2660, Reassessments and Recertification Procedures, for time limits that apply when eligibility is redetermined.

2613 Case Record Documentation

Revision 24-4; Effective Sept. 1, 2024

To document the eligibility decision, the applicant’s case record must contain dated copies from Service Authorization System Online (SASO) of the following forms:

• Form 2064, Eligibility Worksheet, except if;
  • the application is denied before a financial eligibility determination is made; and
• Form 2060, Needs Assessment Questionnaire and Task/Hour Guide, except if the;
  • applicant requested only Day Activity and Health Services (DAHS), which does not require a Form 2060 score;
  • applicant withdrew the application before the caseworker completed Form 2060;
  • application is denied for a reason other than:
    • no unmet need;
    • insufficient functional impairment; or
    • low hours for Family Care or Primary Home Care.

Note: Ensure each person enrolled in a Title XX program who is not categorically financially eligible receives a privacy notice, Form 0401, Notice of Privacy Practices or Form 0403, Explanation to Health Information Privacy Rights, as appropriate.

Related Policy

Privacy Notice, 1147

2620 Service Authorizations

Revision 24-5; Effective Nov. 1, 2024

After developing the service plan with an eligible person, enter information in the Service Authorization System Online Wizards (SASOW) to authorize services.

Service plans may include one or more purchased services. If authorizing more than one service, ensure the tasks are not duplicative, and the service combinations are within the allowable costs specified in Appendix II, Cost Limit for Purchased Services.

Example: Before authorizing ten units of Day Activity and Health Services (DAHS) per week for a person who will also be receiving an in-home service, determine if it is feasible for the person to take part in DAHS five full days per week.

Based on the urgency of the person’s need, negotiate with the provider for the earliest possible date that services can begin. Remember that services can and may need to start on the weekend if a person is discharging from a hospital or other institution on a Friday afternoon and needs services immediately. Enter the negotiated beginning date of coverage.

Use the comments section of Form 2101, Authorization for Community Care Services, to give specific instructions to the provider about the person’s service arrangement. These include the number of days the person requests services, specific service schedules required or strongly preferred by the person, specific instructions about unique personal problems or the person’s home, or information about people who should not be hired as the paid attendant.

For all personal attendant services (PAS), send the provider the initial packet, which must include a cover sheet, the Long-term Care Services Intake System (NTK) generated Form 2110, Community Care Intake, and a copy of the following SASOW generated forms:

• Form 2059, Summary of Client’s Need for Service;
• Provider Referral Supplement;
• Form 2060, Needs Assessment Questionnaire and Task/Hour Guide;
• Task/Hour Guide; and
• Form 2101, Authorization for Community Care Services.

Note: In the SASOW, the following forms are generated as two forms:

• Form 2059 is generated as Form 2059 and the Provider Referral Supplement.
• Form 2060 is generated as Form 2060 and the Task/Hour Guide.

For Family Care, Form 2101 is an authorization to begin services.

For CAS and PHC, Form 2101 is a referral, and authorization for services is left pending receipt of Form 3052, Practitioner’s Statement of Medical Need.

Providers must follow the instructions on Form 2101. If a provider does not, try to resolve the problem through discussion with the provider’s supervisors. If this fails, document and report the issue to your supervisor and follow the procedures specified in Section 2700, Service Monitoring, Changes, and Transfers.

Related Policy

Content of Referral Packets, Appendix XIII

2630 Referrals to the Provider

Revision 17-1; Effective March 15, 2017

Refer to Section 4000, Specific CCSE Services, for specific procedures for each service for sending referrals to providers. See Appendix XIII, Content of Referral Packets, for referral-packet contents sent to providers for each service.

2631 Negotiated Referrals

Revision 24-5; Effective Nov. 1, 2024

Program Standard: People must be referred by the next business day after the day the person is visited and it is determined that a negotiated verbal referral is necessary. Form 2101, Authorization for Community Care Services, must be sent within five business days from the date the person was determined eligible for a negotiated verbal referral. Use the comment section of the form to document verbal referrals, dates and other relevant information. The caseworker must document the date Form 2101 was sent to the provider or include the fax confirmation.

Regardless of the response criteria established for the applicant at intake, the caseworker must reassess the person's need for service initiation during the assessment process. Specifically, assess the continued provision of any assistance with the person's personal care needs by people or other providers.

If it is determined that the person's unmet needs for personal care are, or will be, such that services must begin sooner than the time usually required when using the routine written referral process, contact the provider and negotiate a start date per the person's need for service initiation. The need for a verbal referral will vary from person to person. Consult with the unit supervisor if a person's particular circumstances are such that it is uncertain whether to use the negotiated referral process.

2632 Routine Referrals

Revision 24-5; Effective Nov. 1, 2024

Program Standard: For applicants who do not require negotiated referrals, authorize services by sending Form 2101, Authorization for Community Care Services, within five business days from the date the applicant is determined eligible. The caseworker must document date Form 2101 was sent to the provider or include the fax confirmation.

For services other than Day Activity and Health Services (DAHS), Community Attendant Services (CAS) and Primary Home Care (PHC), the provider must return Form 2101 by the 21st calendar day from the date of the referral. If Form 2101 or some other kind of notification is not received, contact the provider to find out the reason for the delay and the status of the referral.

If the provider is unable or fails to provide services within the 21-calendar day time frame, the caseworker may contact the person to discuss a possible referral to a different provider agency. 

Review Section 4000, Specific CCSE Services for special referral procedures for PHC, CAS and DAHS.

2640 Provider Requirements for Hiring a Paid Attendant

Revision 24-5; Effective Nov. 1, 2024

Criminal background checks are required for all facilities and service providers who provide care to older people and people with disabilities. Except in emergency situations, providers are required to get a criminal history check before offering permanent employment to unlicensed employees having direct contact with recipients who receive:

• Day Activity and Health Services;
• Residential Care;
• Primary Home Care;
• Community Attendant Services;
• Family Care;
• Adult Foster Care; or
• Consumer Managed Personal Attendant Services.

A person must be barred from employment if they have been convicted of a criminal offense where an administrative review is not available. A person may request an administrative review for some criminal offenses that could bar employment.

If asked by anyone, including the recipient, about the results of the criminal history check, explain that:

• all providers must conduct criminal history checks on attendants;
• the Texas Health and Human Services Commission (HHSC) is monitoring compliance with the law; and
• confidentiality requirements prevent the sharing of information obtained because of a criminal history check with anyone except the employee.

2650 Changes in Service Plans

Revision 17-1; Effective March 15, 2017

2651 Disagreements about Service Plans

Revision 24-5; Effective Nov. 1, 2024

If a disagreement arises between provider staff and Texas Health and Human Services Commission (HHSC) staff about a person's service plan, resolve the problem through discussion and negotiation. Use an interdisciplinary team meeting (IDT) if necessary. Ensure that services are not delayed unnecessarily because of these disagreements.

HHSC regional nurses make final decisions in disagreements with providers about a person's medical need for Community Attendant Services and Day Activity and Health Services.

In all other cases, the Community Care Services Eligibility (CCSE) supervisor attempts to resolve the disagreement with the provider's supervisor. If the supervisory staff of both providers cannot resolve the disagreement, the CCSE program manager resolves the disagreement.

2652 Changing the Service Schedule Between Reassessments

Revision 24-5; Effective Nov. 1, 2024

Use the chart below to determine which changes must be included on Form 2101, Authorization for Community Care Services (PDF), if a schedule change results in a change in hours or priority status.

For decreases if the last day of any period is a Saturday, Sunday or legal holiday, the period is extended to include the next day that is not a Saturday, Sunday or legal holiday. Skeleton crew days are not legal holidays. Legal holidays are days when the agency is closed.

Example: Form 2065A is being sent Aug. 5 to notify a person of a decrease in hours. The 12th day of adverse action would be Aug. 17, which falls on a Saturday. The effective date on Form 2065A and Form 2101 would be Aug. 20 as the person has through the end of the business day, Aug. 19, to file an appeal.

Complete Form 2067, Case Information (PDF), for personal attendant services for all other changes not related to a change in hours.

Related Policy

Form 2101 Coverage Dates for Title XIX Services, Appendix XXIII

2653 Provider Flexibility

Revision 24-5; Effective Nov. 1, 2024

Providers are, should follow instructions given on Form 2101, Authorization for Community Care Services, as much as possible. There may be times when changes in tasks or schedules are necessary to meet the person's needs. In these situations, the provider doesn’t need to notify the caseworker as long as the units delivered and billed for a calendar month are at most 4.33 times the adjusted weekly hours identified on Form 2060, Needs Assessment Questionnaire and Task/Hour Guide.

Example: A person who regularly receives 15 hours of service per week is sick for two days and declines services due to illness. During those two days, a total of five hours of personal care services would have been delivered had the person been able to receive services. Because the person may have an increased need for services following the illness, those five hours may be made up if it would be to the benefit of the person. Because the number of hours delivered does not exceed the number of hours authorized, the provider does not need to notify the caseworker.

This ongoing flexibility is to allow services to meet the person's needs, considering their desires and changes in their condition. The flexibility is not intended to be for the convenience of the provider or to be applied retroactively to justify an attendant absence or interruption of services.

If a provider makes changes to tasks or schedules inappropriately or against the person's wishes, try to resolve the issue through discussions with a provider supervisor. If this fails, report the issue to the caseworker's supervisor and follow procedures specified in Section 2700, Service Monitoring, Changes and Transfers.

2660 Reassessments and Recertification Procedures

Revision 24-5; Effective Nov. 1, 2024

Conduct reassessments within:

• 24 months of the previous financial redetermination; and
• 12 months of the previous functional assessment.

Annual reassessments are required for all CCSE services. Review Section 2663.1, Annual Home Visit Required for People Receiving PAS, and Section 2663.2, Determining When a Home Visit is Necessary for Other Services, to determine if a home visit is required for the reassessment.

When the reassessment is conducted in the person's home, the caseworker must schedule the visit with the person or their authorized representative at a time that is convenient to the person. Schedule the appointment by phone or in writing using Form 2068, Application, Redetermination or Monitoring for Community Care Services. If the appointment cannot be kept for some reason, inform the person or their authorized representative in advance that the appointment needs to be rescheduled. Only visit the person with advance notice of the visit.

During the reassessment, the caseworker must:

• redetermine functional eligibility on Form 2060, Needs Assessment Questionnaire and Task/Hour Guide, as required by the specific program;
• redetermine unmet need, as outlined in Section 2433, Determining Unmet Need in the Service Arrangement Column;
• review Form 2307, Rights and Responsibilities and all applicable attachments;
• present the Consumer Directed Services (CDS) option and review Form 1581, Consumer Directed Services (CDS) Option Overview. Review Section 6333.1, Authorizing CDS for Ongoing People and Section 6333.2 Transfers and Consumer Directed Services (CDS); and
• present Form H0025, HHSC Application for Voter Registration, and offer the opportunity to register to vote.

To comply with the National Voter Registration Act of 1993, the person must be offered the opportunity to register to vote at the time of application and at each annual redetermination. Help any person who requests assistance in completing Form H0025, and review Form H0025 for completeness in the person's presence. The person may:

• mail Form H0025; or
• return the form to the caseworker's office for appropriate mailing to the county registrar's office.

2661 Person Unavailable for Reassessment

Revision 24-5; Effective Nov. 1, 2024

In some situations, the caseworker uses their judgment to determine how long a case should remain open when the person is unavailable for a reassessment. Generally, if the person continues to be unavailable for more than 30 calendar days, it should be determined if the unavailability is temporary. If a person is repeatedly unavailable after an appointment has been scheduled, refer to the procedures in Section 2830, Refusal to Comply with Service Delivery Provisions. If the person is unavailable because of temporary nursing home admission, use the time limits and procedures in Section 2822, Service Suspension by Caseworkers.

If a caseworker contacts an applicant or person to schedule or complete a home visit or reassessment and the person states they are unavailable, the caseworker must document the contact and the reason for the delay of the home visit or reassessment. The caseworker should schedule a future date for the home visit or reassessment when the person will be available. If unable to schedule the visit for a future date, the caseworker must contact the person at least weekly until the home visit or reassessment can be completed. This documentation will be considered as an acceptable reason for the delaying a required home visit or reassessment.

2661.1 Delay in Home Visits Due to the Person's Illness

Revision 24-5; Effective Nov. 1, 2024

While required home visits must be completed on a timely basis, due to the increase in transmittable diseases in the general population, there may be circumstances that could place staff at risk for contracting contagious illnesses.

To ensure the health and safety of staff members who could encounter people reporting a contagious illness, caseworkers may delay home visits under the following circumstances.

If a caseworker contacts an applicant or person to schedule a home visit and the person states they have a contagious illness such as influenza, the caseworker must document the contact and the reason for the delay of the home visit, including the stated illness. The caseworker should schedule a future date for the visit when the person thinks they will be better. If unable to schedule the visit for a future date, the caseworker must contact the person at least weekly until the home visit can be made. Each contact must be documented. This documentation will be considered as an acceptable reason for delaying a required home visit if applicable.

2662 Redetermination of Financial Eligibility

Revision 24-5; Effective Nov. 1, 2024

Program Standard: The caseworker must redetermine financial eligibility within 24 months of the previous determination of financial eligibility.

The financial reassessment must be completed by the last day of the 24th calendar month from the previous financial redetermination. To redetermine financial eligibility for income-eligible people, use the policies and procedures in Section 3000, Eligibility for Services. The caseworker must:

• compare income and resources reported this year with what was previously reported;
• discuss with the person any discrepancies between the two; and
• verify the existence and amounts of new income or resources if these additional assets bring the person within proximity to eligibility limits.

Caseworkers must be diligent in ensuring that people receiving personal attendant services (PAS) are served by Title XIX PAS when possible. If the financial situation of an ongoing Family Care (FC) person has changed in a way that might make them eligible for Community Attendant Services (CAS), a referral should be made to Medicaid for the Elderly and People with Disabilities (MEPD) at the next financial reassessment.

Example: An FC person was denied CAS eligibility at the time of application because of resources that exceeded the $2,000 eligibility limit. However, the person now reports a total of $1,200 in resources and other CAS eligibility, such as a need for a personal care task, are met. At the financial reassessment, a referral to MEPD must be made.

2662.1 Financial Reassessments for Community Attendant Services (CAS)

Revision 21-3; Effective September 1, 2021

MEPD staff must redetermine financial eligibility for CAS annually.

Renewal packets are mailed 60-90 days prior to the annual renewal date. Complete and return Form H1200, Application for Assistance – Your Texas Benefits, along with any required verification documents, within 30 days. If Form H1200 and the required verification are not received by the due date, benefits will be denied.

During regular monitoring visits, remind CAS recipients of the importance of completing and returning the renewal form within the 30-day timeframe so they can continue to receive services. Ensure recipients are aware they can complete an annual renewal online through YourTexasBenefits.com  or over the phone by calling 211.

Some CAS recipients may receive Form H1200-SR, Streamlined Redetermination for Medicaid for the Elderly and People with Disabilities, instead of Form H1200. The cover letter for Form H1200-SR will advise the recipient that no action is needed if there are no changes to the reported information and the renewal form does not need to be returned.

Recipients who are receiving CAS and SNAP or TANF benefits will also receive Form H1010, Texas Works Application for Assistance - Your Texas Benefits. Remind CAS recipients that, in addition to completing Form H1200 to renew CAS benefits, Form H1010 must be completed and returned to continue to receive SNAP or TANF benefits.

If verification of ongoing functional eligibility is requested by MEPD at the annual redetermination, send a copy of the Service Authorization System Online (SASO) Service Authorization screenshot to show the recipient remains active on CAS. Use Form H1746-A, MEPD Referral Cover Sheet, to fax the information to the Document Processing Center (DPC).

Related Policy

Guidelines for Completing Form H1746-A. MEPD Referral Cover Sheet, Appendix V

2663 Reassessment of Functional Need

Revision 24-5; Effective Nov.1, 2024

Program Standard: The caseworker reassesses the person's functional needs within 12 months of the previous assessment. The functional assessment must be completed by the last day of the 12th calendar month from the previous functional assessment.

To reassess functional needs, use the policies and procedures in Section 2430, Functional Assessment, and in the instructions for Form 2060, Needs Assessment Questionnaire and Task/Hour Guide.

• For services requiring a functional needs Form 2060 score for eligibility, the caseworker must complete or update the score in Part A of Form 2060 at each annual reassessment.
• For people who receive Day Activity and Health Services (DAHS) or Consumer Managed Personal Attendant Services (CMPAS) as the only service, a Form 2060 score is not required.
• For Family Care (FC), Community Attendant Services (CAS), and Primary Home Care (PHC), the caseworker must review Part B and Part C of Form 2060 at least annually during the interview with the person.

2663.1 Annual Home Visit Required for People Receiving PAS

Revision 24-5; Effective Nov. 1, 2024

Program Standard: A home visit must be conducted with all people receiving Community Attendant Services (CAS) for all annual reassessments and 90- day monitoring contacts. A home visit must be conducted with all people receiving Primary Home Care (PHC) and Family Care (FC) at least once every 24 months at the same time the financial redetermination is conducted.

During the home visit, the caseworker provides oversight of the person's health and safety. The caseworker must evaluate the person's ability to cope with the activities of everyday living in the home environment and identify when changes to the service plan or the addition of other services provided by the Texas Health and Human Services Commission (HHSC) may be of benefit.

For CAS, it is recommended the caseworker complete the annual functional reassessment during the last 90-day monitor for the year before the annual being due. If the annual functional reassessment is not completed during the last 90-day monitoring visit prior to the annual being due, then an additional home visit is required to complete the reassessment. An exception to having to make a home visit is when Form 2060, Needs Assessment Questionnaire and Task/Hour Guide, has been completed within the last 60 days due to an interim change, the caseworker may conduct the annual reassessment by telephone.

For all CCSE services, if a person requests a change at the annual reassessment, the change must be processed within five business days or by the annual reassessment due date, whichever is earlier.

For CAS, Form 2101, Authorization for Community Care Services, will continue to be sent within five business days of the home visit due to the regional nurse approval requirements for the program.

All annual reassessments must be recorded on Form 2314, Satisfaction and Service Monitoring, and in the Service Authorization System Online Wizards (SASOW). It must include the person as the primary contact and the location as a home visit.

2663.2 Determining When a Home Visit is Necessary for Other Services

Revision 24-5; Effective Nov. 1, 2024

For services other than Community Attendant Services, determine if the reassessment should be done in a face-to-face home visit or by phone interview based on the service received and the person's circumstances. Review Section 4000, Specific CCSE Services, for home visit requirements for each specific service.

Individual circumstances that may include the need for a face-to-face reassessment include but are not limited to:

• a service other than Emergency Response Services or Home-Delivered Meals is being added to the service plan;
• people with no phone or who cannot communicate by phone because of cognitive or physical impairments or lack a knowledgeable source to contact;
• Community Care Services Eligibility (CCSE) recipients who are receiving services from Adult Protective Services (APS) or have a history of self-neglect;
• people who have experienced multiple changes in a short time, such as significant changes in health, living arrangements, or caregiver arrangements, and the caseworker is unable to get an accurate assessment that reflects all the changes by phone;
• case transfers to caseworkers or newly hired caseworkers unless the losing and gaining caseworkers discuss and agree on the person's condition;
• people with weak, unreliable, or no caregiver support systems;
• people who have a history of refusal to comply with service provisions;
• people whose health and safety are at risk; or
• people who choose to live in a home with dilapidated, unsanitary, or hazardous living conditions.

Caseworker circumstances may warrant that a home visit be made, such as caseworker trainees assigned to a caseload.

2664 Redetermination of Unmet Need

Revision 24-5; Effective Nov. 1, 2024

The unmet need policy applies to ongoing cases and to applications. At each reassessment, the caseworker must evaluate if the Community Care Services Eligibility (CCSE) services already being purchased are meeting needs that would go unmet unless services were purchased. During the annual functional assessment or for each request for a change in service plan or hours, review each task on Form 2060, Needs Assessment Questionnaire and Task/Hour Guide.

In the Service Arrangement column, determine if needs are being met through other sources or if the person continues to have a need for the task to be purchased. If there are no tasks to be purchased, the person no longer has an unmet need and is no longer eligible. If unmet need exists, continue with the development of an appropriate service plan.

In situations where the person's caregiver also serves as the paid attendant, carefully review the tasks marked C on the Service Arrangement Column on the previous Form 2060. These are the tasks that the caregiver agreed to perform voluntarily at the last assessment. These tasks may not be purchased. If the caregiver states that they are no longer able or willing to provide help with the tasks, then advise the caregiver that the provider will be notified to hire a new paid attendant for those tasks. Document any changes in caregivers or caregiver tasks on Form 2060 and Form 2059-W, Summary of Individual's Need for Service Worksheet. The information on Form 2059-W is entered in the Service Authorization System Online Wizards (SASOW) for Form 2059, Summary of Client's Need for Service.

In reassessment decisions, the policy about duplicate services must be applied.

2670 Notifications at Reassessment

Revision 24-5; Effective Nov. 1, 2024

The person must meet the CCSE eligibility requirements at the time of recertification of financial eligibility and reassessment of functional needs to continue receiving services.

Program Standard - Notify the person in writing, using Form 2065-A, Notification of Community Care Services, of changes in their service plan, to include:

• addition of service(s);
• increase in hours;
• decrease in copayment; or
• loss of priority status based on the person’s request.

Form 2065-A must be sent within two workdays of the decision if the change involves:

• denial of priority status if the applicant requests it;
• an increase in units;
• a decrease in the copayment; or
• adding a new service.

Related Policy

26 Texas Administrative Code Section 271.153

2680 Recertification

Revision 21-4; Effective December 1, 2021

When the reassessment is complete, send the following forms to the provider:

• Form 2101, Authorization for Community Care Services, for all Day Activity and Health Services, Primary Home Care, Home-Delivered Meals, Family Care and Residential Care cases when there is a change in the service plan.
• Form 2101, for all Community Attendant Services (CAS) cases, even if there is not a change in the service plan.
• Form 2065-A, Notification of Community Care Services, for all cases when there is a change in the service plan. It is not necessary to send notification if the only change is a transfer from one provider to another.

For Adult Foster Care (AFC), send the following:

• Form 2065-A, for all cases when there is a change in the service plan. It is not necessary to send notification if the only change is a transfer from one provider to another.
• Form 2101, for all cases even if there is not a change.
• Form 2327, Individual/Member and Provider Agreement, update as needed.
• Form 2330, Assessment and Service Plan Approval for Adult Foster Care, even if there is not a change.
• Attachment 2307-F, AFC Rights and Responsibilities, only if the recipient has moved to another home.

Related Policy

Content of Referral Packets, Appendix XIII
Effective Dates, 2811