2810 Individual Notification Procedures

Revision 24-5; Effective Nov. 1, 2024

Program Standard – Within two business days after the decision, notify the person in writing. Use the SASO generated Form 2065-A, Notification of Community Care Services, of all eligibility and ineligibility decisions or any changes in the person’s service plan. Review Form 2065-A, Instructions.  

When notifying the applicant of eligibility, specify on Form 2065-A:

  • the Community Care Services Eligibility (CCSE) services that the applicant is eligible or ineligible for; 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 Day Activity and Health Services (DAHS) facility;
    • if applicable, that the Family Care, Primary Home Care or Community Attendant Services applicant is eligible for priority status;
    • the initial and ongoing room and board payments for Residential Care and Adult Foster Care; and
    • the initial and ongoing copayments the Residential Care the person will pay to the facility.

An applicant or person certified for one CCSE service but determined ineligible for another must be notified in writing of both decisions. An applicant or person certified for personal attendant services or home-delivered meals must also be notified in writing of the hours per week or meals per week they are eligible to receive. If certified for 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.

For ongoing people, on Form 2065-A, record the:

  • action taken and the effective date; and
  • name of the CCSE service(s) that the action is based.

If the notification is an adverse action, the notice must also state the:

  • reason for the adverse action; and
  • CCSE Handbook reference that the adverse action is based on.

Review the Form 2065-A Attachment for handbook and rule references.

CCSE staff 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. 
 

2811 Effective Dates

Revision 24-5; Effective Nov. 1, 2024

The Texas Health and Human Services Commission (HHSC) caseworker notifies the applicant or recipient using Form 2065-A, Notification of Community Care Services of any action that denies, suspends, reduces, or terminates services. In general the HHSC caseworker sends the notice of adverse action to the person 12 calendar days before the effective date of the action. In situations that services were suspended due to threats to health and safety, the HHSC case worker sends the written notice of adverse action without advance notice if the crisis cannot be resolved.

An applicant or recipient has the right to appeal any decision that denies, reduces, or terminates their services and request a fair hearing per Title I, Texas Administrative Code (TAC) Section 357.

For an adverse action, if the day after the effective date is a Saturday, Sunday or legal holiday, the adverse action 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. Review Appendix IX, Notification Effective Date of Decision, Appendix XVIII, Time Calculation and Section 2652, Changing the Service Schedule Between Reassessments for information about calculating effective dates of reduction or termination of services.

The date at the top of Form 2065-A is the date the HHSC caseworker completes the form. Since offices have different mail pickup times, staff are not required to consider the mail date when completing the form. Staff must ensure applicants and recipients are notified within the required time frames.

Services are reduced or terminated at annual reassessment or any other time the caseworker becomes aware before the annual review when the person:

  • requests a reduction or termination;
  • gains a resource resulting in fewer unmet needs and the need to reduce service hours; or
  • is performing all or some activities of daily living due to long-term improvement in functional condition resulting in the need to reduce or terminate services.

People may request an appeal of any decision that denies, reduces, or terminates their benefits. The effective date of the action depends on the situation, as shown in the following table:

If Then 

Termination or reduction is because the person:

  • lost their eligibility as an income-eligible;
  • failed to qualify as an income-eligible after a verbal referral,
  • failed to meet the client needs assessment score or medical criteria for the service;
  • more than three times directly or knowingly and passively condoned the behavior of someone in their home and, therefore, refused to follow the service delivery provision;
  •  experienced a change in their need for the specific service; or
  • failed to pay Residential Care Copays.
The action is effective 12 calendar days from the date of the notice unless the action is appealed. In the event of an appeal, services continue until the hearings officer gives a decision. The cost of providing services during this period is subject to recovery by the department from the person. Services to people in Residential Care facilities are terminated five days after the hearings officer gives their decision.
Termination is because the person loses Medicaid or categorical eligibility.Services continue only to the end of the month that the person is determined ineligible, even if the action is appealed.
Termination is because the person lacks practitioner’s orders for the service.Services continue only through the date the previous orders end, even if the action is appealed.
Termination or reduction is because of budgetary constraints or changes in federal law or state regulations, and services are reduced or terminated for an entire categorical group of people.Services continue only through the date of termination of a categorical group of people, even if appealed.
Termination is because the person or someone in their home threatens the health or safety of others, or because the person threatens their own health or safety.

Services may be terminated immediately under the following conditions:

  • a person receiving Residential Care (RC), Adult Foster Care (AFC), Day Activity Health Services (DAHS), or Special Services to Persons with Disabilities (SSPD) threatens their own health or safety or that of others; or 
  • someone in the person's home or a person receiving Emergency Response Services (ERS), Home-Delivered Meals (HDM), Family Care (FC), Primary Home Care (PHC), Community Attendant Services (CAS) or SSPD threatens the Texas Health and Human Services Commission (HHSC) staff or provider's health or safety.
Termination or reduction is because of budgetary constraints or changes in federal law or state regulations, and services are reduced or terminated for an entire categorical client group,Services continue only through the date of termination of a categorical client group, even if appealed.

2812 Changes in the Person's Need for Services

Revision 24-5 Effective Nov. 1, 2024

Before reducing or terminating services caseworkers determine if the person's long-term improvement is expected to last through the current authorization period or beyond.

If it is determined that the person's condition has temporarily improved because the person is performing tasks previously done by the attendant, the person and provider may agree to fewer hours per week.

Do not reduce or terminate services if it is determined the person is experiencing temporary improvement in their functional condition. If the person feels they temporarily need fewer hours, send the provider Form 2067, Case Information, informing the provider that fewer service hours may be provided if the person agrees to the reduction. If the person is experiencing temporary functional improvement, the caseworker would not change the task and hour guide or authorization or send Form 2065-A, Notification of Community Care Services, to the person for reduction of hours.

The person and provider may agree to change the delivery schedule for personal attendant services (PAS) hours based on the person's needs without prior approval from the caseworker.

Caseworker approval or denial is required for all requests to increase PAS hours previously authorized or to add or delete priority status. In these situations, terminate or reduce services 12 calendar days after the Form 2065-A completion date. Review Section 2652, Changing the Service Schedule Between Reassessments, Section 2811, Effective Dates and Appendix XVIII, Time Calculation.

2813 Situations in Which the 12-Day Adverse Action Period May Be Reduced

Revision 24-5; Effective Nov. 1, 2024

There may be situations when a person wants to waive or shorten the 12- calendar day notice period before services are reduced or terminated. Some examples of these situations include:

  • A Family Care person is being removed from an interest list for Title XX Day Activity and Health Services (DAHS) and wants to withdraw or have services reduced in less than 12 calendar days to attend DAHS immediately; or
  • Community Care Services Eligibility People who prefer to receive 1915(c) waiver services may also wish to have the change take place in less than 12 calendar days.

If the person indicates a desire to waive or reduce the 12 calendar day advance notice, be very cautious and remember that a person may change their mind. In most instances, the provider can be verbally notified to stop service and still maintain the formal effective date of 12 calendar days in the future.

If the person still wants to waive or shorten the 12 calendar day advance notice, complete Form 2065-A, Notification of Community Care Services, with the effective date being the date the person wants services to end or be reduced. Explain in the comments section that the person is voluntarily waiving or reducing their right to the 12-calendar day advance notice. The person must:

  • sign this statement; and
  • be given the original and one copy of the notice.

2814 Transfers Between Primary Home Care, Community Attendant Services and Family Care

Revision 24-5; Effective Nov. 1, 2024

Send Form 2065-A, Notification of Community Care Services, when a person is transferred from any of the three programs listed to any of these programs:

  • Primary Home Care (PHC);
  • Community Attendant Services (CAS); or
  • Family Care (FC).

Do not send another form to terminate the previous service. Specify on the form:

  • name and amount of the previous service;
  • name and amount of the new service;
  • the effective date of the transfer; and
  • reason for the transfer.

Show in the comments section that the person should not notice any difference in the amount or type of services received because of this transfer.

Example: The service you were receiving, Primary Home Care, 16 hours a week, will change to Family Care, 16 hours a week, effective June 1, 2024.

Comments: Primary Home Care will terminate because you lost financial eligibility for that program. You should not notice any difference in the amount or type of services you will receive because of this transfer.

Although Form 2065-A must be sent when a person transfers between PHC, CAS, and FC, the effective date is either the negotiated date or the date following the Medicaid end date.

Review Section 4600, Primary Home Care and Community Attendant Services, for more transfer procedures.

Refer to Appendix IX, Notification/Effective Date of Decision, and Appendix XVIII, Time Calculation, for other exceptions to the 12 calendar day notice requirement. The effective date of the transfer does have to be at least 12 calendar days following the date of notification if the number of hours is decreased.

2820 Service Suspensions

Revision 24-5; Effective Nov. 1, 2024

Services may be suspended by the provider or by the caseworker.

2821 Service Suspension by Providers

Revision 24-5; Effective Nov. 1, 2024

Providers may suspend services to people. Review Section 4000, Specific CCSE Services for information about suspensions of each specific service.

On the day of suspension or by the first HHSC business day following suspension, the provider must contact the caseworker to explain the reason for suspending services.

If a person meets the criteria for Adult Protective Services (APS), refer them. Refer other people to other appropriate service resources as needed.

The caseworker documents the incident that caused the suspension and the date of the incident. The results of any related interdisciplinary team (IDT) meetings must be included in the documentation. After evaluating suspensions to determine if services should be terminated and the case closed, the caseworker takes the appropriate action. In some situations, the problems that caused the suspension can be resolved. If they are resolved:

  • send Form 2067, Case Information, to the provider documenting the problem resolution; and
  • reach an agreement with the provider about the date on which services will be reinstated.

2822 Service Suspension by Caseworkers

Revision 24-5; Effective Nov. 1, 2024

A person is not eligible for CCSE services when:

  1. they die;
  2. they are admitted to an institution;
  3. for Medicaid services only, their physician requests service termination;
  4. they request service termination or repeatedly refuse to accept help, except in an involuntary protective services case; or
  5. they refuse to comply with their service plan.

Related Policy

26 Texas Administrative Code Section 271.155(c)

2822.1 Hospital and Nursing Facility Stays

Revision 24-5; Effective Nov. 1, 2024

Suspend services when available information confirms that a nursing home or hospital stay will be longer than 30 calendar days. Use Form 2067, Case Information, to notify the provider to suspend services effective the date of nursing home or hospital entry. Sending updates to the provider is optional.

Continue to monitor the situation. If the person has not returned home by the 30th calendar day, contact the person or authorized representative (AR) to see if a discharge date is planned. If the person has a planned discharge date within the next 30 calendar days, leave the case open and monitor on the planned discharge date.

Terminate services, using the date of admission as the effective date of termination, if information shows that the nursing facility or hospital stay will be more than 30 calendar days.  Exception: The effective date of termination for Residential Care should be the 30th day after admission to the nursing facility or 60 days after admission to a hospital.

Consult with the person, family, and others associated with the person to determine the length of stay. Be cautious about terminating Title XX services, especially if the region has an interest list for those services.

Emergency Response Services (ERS) may remain open until the decision is made to terminate all services because the nursing facility stay has become permanent. Review Section 4300, Emergency Response Services, for suspension of ERS by the ERS provider.

The following situations should always be considered short-term, and services should be suspended for up to 30 calendar days rather than terminated:

  • admission to a swing bed facility; and
  • admission to a hospital for mental illness treatment.

Services may be suspended indefinitely if the person is admitted to a rehabilitation hospital or to a rehabilitation floor or wing of a medical hospital.

2830 Refusal to Comply with Service Delivery Provisions

Revision 24-5; Effective Nov. 1, 2024

Examples of refusal to comply with the service delivery provisions include, but are not limited to:

  • The person is often away from their residence when a service is scheduled. They repeatedly fail to notify the provider that they will be gone, even though they have been counseled about this problem and its implications.
  • The person or someone in the person’s home will not permit the provider to perform one or more of the tasks in the service plan regularly. The person receives personal attendant services and refuses to allow the provider to perform the authorized tasks.
  • Despite several provider efforts to find and place an acceptable attendant in the home, the person refuses to accept services because of dissatisfaction with a particular attendant.
  • The person or someone in the person’s home regularly behaves in such an offensive way to staff that staff refuses to serve them. The person knowingly and passively condones the abusive behavior, and the staff cannot provide services. Examples include sexual harassment, sexual misconduct and racial discrimination.

If the provider notifies the Texas Health and Human Services Commission about a service delivery compliance problem, contact the person or the responsible party. Attempt to resolve the issue in a way that is satisfactory to the person and the parties involved. An interdisciplinary team (IDT) meeting may be conducted at the person’s home to try to resolve the situation.

Related Policy

26 Texas Administrative Code Section 271.155 
 

2830.1 People Who Refuse to Comply with Electronic Visit Verification Requirements

Revision 24-5; Effective Nov. 1, 2024

People requesting or receiving personal attendant services are required to participate in Electronic Visit Verification (EVV) by allowing the attendant to use their home landline to report the start and the end of work. If a person does not have a home landline, or will not allow the attendant to use the home landline, the person must agree to an alternate device installation in the home. Failure to cooperate with EVV requirements can result in suspension or termination of services.

It is the caseworker’s responsibility to review the information on the rights and responsibilities form and adequately explain the EVV requirements to the applicant or person receiving services. It is important to communicate that a person’s failure to cooperate with EVV requirements can result in the suspension or termination of services. The caseworker must explain the following points:

  • EVV is a phone and computer-based system that electronically verifies service visits occur and documents the precise time service provisions begin and end. The purpose of EVV is to verify that people are receiving the services authorized for their support and for which the state is being billed.
  • EVV will not change the services the person receives.
  • EVV is mandatory for all provider agencies and people receiving services from an attendant unless the person receives services through the CDS option.
  • The attendant needs the person’s permission to use the home landline to call the toll-free number at the start and at the end of work. Under no circumstances should the person call the toll-free number on behalf of the attendant. If the person is asked to do this, they should report it to the provider agency.
  • If the person does not have a home landline or does not want the attendant to use their phone, an alternative device can be placed in the home, which is used only to verify the attendant’s start and end of work. This device must always remain in the home. If the person notices the removal of the device, they should report it to the provider agency.
  • If the person notices any other possible EVV violation such as an instance where the attendant leaves the home without providing services after calling the toll-free number upon arrival, they should report it to the provider agency.
  • If the person has more questions, the caseworker refers them to the selected provider agency or Financial Management Services Agency (FMSA) for additional information on how EVV works.

For people using the CDS option, the caseworker must explain that the person receiving services, or a designated representative (DR), is the employer of record and can choose to use the EVV system or use paper time sheets. The three choices are:

  • Full Participation-Phone and Computer: The CDS employee(s) use the phone portion of EVV, and the employer of record uses the computer portion of the system to perform visit maintenance.
  • Partial Participation-Phone Only: This option allows the employer of record to participate in EVV but provides some help from the FMSA with visit maintenance. The CDS employee calls in when they start work and calls out when they end work. The employer uses a paper time sheet to document service delivery. The FMSA performs visit maintenance to make sure the EVV system matches the paper time sheets approved by the CDS employer.
  • No EVV Participation: If the employer of record does not have access to a computer, assistive devices, or other supports, or feels they cannot fully participate in EVV, they may choose to use a paper time sheet to document service delivery.

The FMSA will require the employer of record to complete Form 1722, Employer’s Selection for Electronic Visit Verification (EVV), to indicate their choice.

If a person is refusing to cooperate with EVV requirements, it is considered a refusal to comply with service delivery provisions and policies in Section 2831, Suspensions Due to Refusal to Comply with Service Delivery Provisions. Some people whose provider is required to participate in EVV are not allowing the attendant to use their home phone and are also refusing to allow a Fixed Visit Verification (FVV) device to be placed in their home.

Providers are required to participate in EVV for services delivered by an attendant. People who refuse to allow the attendant to record hours worked through EVV, either through using their home phone or a FVV device, are non-compliant with their service delivery plan. These people are essentially not allowing the provider to carry out services per provider requirements.

2831 Suspensions Due to Refusal to Comply with Service Delivery Provisions

Revision 24-5; Effective Nov. 1, 2024

The provider or caseworker may suspend services until an interdisciplinary team (IDT) meeting is scheduled and the situation is discussed. After the IDT meeting, the caseworker must send the person a letter within five working days stating services can be terminated if they do not comply with service delivery provisions and stating specifically what the person must do to continue services.

If the situation is not resolved and the person continues to refuse to comply, the caseworker convenes a second IDT and sends the person a second letter stating that continued refusal to comply with service delivery provisions will result in the termination of services.

If the situation continues be unresolved and a third situation arises, the caseworker convenes a third IDT. They must send a third and final letter to the person stating that continued refusal to comply with service delivery provisions will result in the termination of services.

If the situation continues, the caseworker may terminate services by sending Form 2065-A, Notification of Community Care Services. Review Section 2810, Individual Notification Procedures. A CCSE supervisor must approve denials based on a refusal to comply with service delivery.  Document the conference and supervisory approval.

There is no period where instances of refusal to comply must occur.

2832 Documentation of Compliance Issues

Revision 24-5; Effective Nov. 1, 2024

Documentation is required in all situations involving the person's refusal to comply with service delivery provisions. Opinions or evaluative conclusions are not appropriate documentation to substantiate a denial of services. Documentation should stress a factual statement of actions constituting noncompliance.

Determine and document if the person is aware of and able to understand the consequences of their or other's actions. If the person is not aware of their behavior or the behavior of someone in their home, discuss the issues with them.

Determine if someone seems to be abusing, neglecting or exploiting the person, and, if necessary, refer them to Adult Protective Services (APS). Continue services pending the APS investigation. APS may take appropriate action, such as obtaining a guardian to resolve the problem if the person is abused, neglected or exploited.

Document the date and content of each discussion with the following:

  • person;
  • interested family member;
  • provider; and
  • unit supervisor.

2833 Reauthorization of Services After Termination for Refusal to Comply

Revision 24-5; Effective Nov. 1, 2024

If a person's services were terminated because of refusal to comply with service delivery provisions that involve a provider, talk with the unit supervisor before sending a referral to another provider. You must discuss the person's particular compliance issues with a CCSE supervisor before reauthorizing services, and the unit supervisor must approve the referral.  Document the approval in the comments section of Form 2101, Authorization for Community Care Services.

Follow these steps when an applicant who was authorized services in the past had services terminated due to their failure to comply with service delivery provisions reapplies:

  1. Before contacting the applicant, review the applicant’s circumstances of the previous denial and the steps to be taken for them with the supervisor. Document the review.
  2. Review with the person or responsible party:
    • the reason for the previous termination;
    • the responsibility of the person or responsible representative to notify the provider and Texas Health and Human Services Commission (HHSC) about problems related to the service delivery provisions and the importance of good communication; and
    • that each task must be authorized, emphasizing that the only tasks the attendant is to perform are those authorized by HHSC.
  3. Authorize services if the person agrees to follow the service delivery provisions.
  4. Document the conversation with the person.
  5. Contact the person or provider weekly for one calendar month to assess the person's compliance with service delivery provisions. If the person continues to have problems complying with service delivery provisions, contact the person and emphasize the need for them to comply.
  6. If the provider complains about the person refusing to follow their service delivery provisions, contact the person monthly after the first month of service. Discontinue monthly contacts when complaints cease.
  7. Terminate services if the person refuses more than three times to comply with service delivery provisions.

Review Section 2831, Suspensions Due to Refusal to Comply with Service Delivery Provisions.

2840 Threats to Health or Safety

Revision 24-5; Effective Nov. 1, 2024

Occasionally, a person  or someone in their home might exhibit behavior that constitutes a threat to the health or safety of another person. Examples include, but are not limited to:

  • exhibiting weapons;
  • making direct spoken threats of physical harm, force or death;
  • physically attacking a person with or without a weapon;
  • threatening use of force by self or someone else;
  • using or selling illegal drugs; and
  • displaying dirty needles or the smell of toxic fumes from the manufacture or sale of illegal drugs in the person's home environment.

The caseworker must immediately notify management if, during the first or any other contact by the caseworker or provider staff, a person or someone in their home exhibits threatening behavior or makes comments that are threatening, hostile or of a nature that would cause concern for the person, provider or Texas Health and Human Services Commission (HHSC) employee. Regional management must review these situations on a case-by-case basis and determine the most appropriate action to be taken. If the applicant's safety may be at risk, the caseworker must follow current policy about notification to the Department of Family and Protective Services Adult Protective Services (APS). If the caseworker believes there is a potential threat to others, regional management should determine the best method for notifying the provider and addressing the person's needs without placing staff members at risk.

If a person threatens their own health or safety by threatening or attempting suicide or self-injury and is at immediate risk, place a 911 call to report the emergency. A referral to APS must also be made. If the applicant or person seems to be abused, neglected, or exploited by the person who threatens the health or safety of others, refer the person to APS.

In most cases where there is a potential for danger, services should be suspended immediately.

The caseworker must send Form 2065-A, Notification of Community Care Services, by the next business day after receiving notice from the provider that services have been suspended for failure to comply or threats to health and safety. The notice must reference 26 Texas Administrative Code Section 271.155 state the last day services are delivered, and include a clear statement in the comments explaining why services were suspended.

Within three business days after the caseworker becomes aware of the suspension, the caseworker must arrange an interdisciplinary team (IDT) meeting to try to resolve the issue with the provider and the person. Depending on the severity of the reason for the suspension, some IDT meetings may be conducted by phone or some may require a face-to-face contact.

The caseworker may conduct the IDT meeting by phone or a face-to-face contact for all suspension reasons listed in this section. Caseworkers are required to discuss the specific case with their supervisors to determine the best approach for conducting the IDT. Caseworkers must document the rationale for conducting the IDT by phone.

During the IDT meeting, the caseworker, provider staff, the person and the person’s representative, if any, must evaluate the issue and discuss the program requirements for continued services. The IDT should identify any solutions to resolve the issue, including the person’s understanding of the issue and what must be done to resolve the issue. The caseworker must document the requirements for continued services. Review Section 2831, Suspensions Due to Refusal to Comply with Service Delivery Provisions, and Section 2832, Documentation of Compliance Issues, for more guidelines.

If the issue leading to suspension is resolved during the IDT, the provider must, within two business days after the IDT meeting, either implement the recommendations of the IDT or discharge the person and refer the person to the caseworker for referral to another provider. The caseworker must notify the person verbally or in writing of the reinstatement of services. If services continue, assess if the person meets the guidelines for a person at risk and if so, follow procedures outlined in Section 2550, Identifying People at Risk. If the issue is not resolved and services cannot be continued, the caseworker begins the termination process.

2840.1 Monitoring or Annual Home Visit Delay Due to Unsafe Environmental Circumstances

Revision 24-5; Effective Nov. 1, 2024

The Texas Health and Human Services Commission (HHSC) caseworker is required to make every reasonable attempt to complete the Community Attendant Services (CAS), Primary Home Care (PHC), and Family Care (FC) service monitoring or annual reassessment visit. All attempts to contact the person must be documented to support the efforts to meet the requirements. In some situations, the caseworker cannot make the face-to-face home visit due to a dangerous environmental situation beyond the caseworker or person’s control. These situations may include but are not limited to:

  • current police activity, a car chase, weapons drawn, drug raids;
  • gathering of people on the streets demonstrating threatening or intimidating behavior directed at the caseworker; and
  • illegal activities such as being close to the person’s home and occurring at the time the caseworker attempts the home visit.

When such situations occur and the caseworker feels threatened, they can make the home visit at another time. The caseworker must immediately notify regional management of their inability to conduct the home visit. The caseworker must schedule another service monitoring or annual reassessment visit at the earliest possible opportunity. The case must contain ongoing documentation of attempts to complete the visit and the reason for the delay until the monitoring visit has been completed.

If, during the home visit a person or someone in their home exhibits threatening behavior or makes comments that are threatening or hostile, the caseworker can end the service monitor or annual reassessment and reschedule for a later time. The caseworker must immediately notify regional management of their inability to conduct the home visit. The caseworker will refer to Section 2840, Threats to Health or Safety, to suspend or terminate services. If the threatening behavior is resolved, the caseworker must schedule another service monitoring or annual reassessment visit at the earliest possible opportunity. Document all attempts to complete the visit, along with any reasons for delays until the monitoring visit has been completed.

2840.2 Chronic Contagion or Infestation Conditions

Revision 24-5; Effective Nov. 1, 2024

While the chronic contagious medical condition or infestation of the person’s home may not pose an immediate danger to the health and safety of the person, provider agency staff or caseworker, either situation may adversely affect the health of all such people involved in supporting the person’s services and may pose a risk of exposing other people to the contagious medical condition or environmental infestation. Examples of unresolved chronic adverse medical or environmental related condition(s) may include the presence of bed bugs, fleas, ticks, lice or scabies.   
    
The caseworker must assess the person’s ability to comply with the request to eradicate contagions or infestations and should exhaust all efforts in arranging for help to eradicate contagions or infestations, based upon the assessment of the person’s capabilities. The caseworker should identify available local resources which may provide the needed help to meet the person’s specific needs for resolving the risks associated with the spread of the contagion or environmental infestation to others.

Per Section 2831, Suspensions Due to Refusal to Comply with Service Delivery Provisions, the provider or caseworker may suspend services until an interdisciplinary team (IDT) meeting is scheduled and the situation is discussed. Efforts to identify local resources and natural supports to help the person if any such resources and supports exist, should be well documented as part of the IDT meeting. Document any specific actions and responsibilities required of the person and other people and an agreed-upon time frame for completion of the eradication. Information from a pest control professional must be the basis in the establishment of a timeline expectation for eradication, as each situation is unique. The specific actions and responsibilities required of the person or other people, such as family members or friends, who have agreed to provide support as part of the eradication plan should be documented as service provision requirements.

If the eradiation plan is not followed and the situation is unresolved, the caseworker refers to Section 2830, Refusal to Comply with Service Delivery Provisions, and Section 2831 for guidance when the person is non-compliant with service delivery provisions.

The caseworker follows policy in 26 Texas Administrative Code Section 271.155, (f) Denial, Reduction or Terminations of Benefits, to provide adequate notice of possible termination of services if the person fails to cooperate with service delivery provisions.

2840.3 Active Tuberculosis (TB) Diagnosis

Revision 24-5; Effective Nov. 1, 2024

An applicant or person with a TB diagnosis cannot have services denied or terminated because of their disease.

The regional HHSC staff contacts their regional health department to ensure staff are linked to the right TB personnel to address TB cases on a case-by-case basis. The HHSC  caseworker may talk with their unit supervisor for help processing the case. They may use the Texas Department of State Health Services (DSHS) Public Health regions page to contact their regional health department. If the HHSC caseworker or supervisor cannot contact the local regional health department or needs more information, they may contact the DSHS TB and Hansen’s Disease Program staff linked to TB personnel in the county where the patient lives. The phone number is 512-533-3000 for general information and 512-533-3144 for the nurse administrator. Upon receiving the physician's report, DSHS assigns a representative to monitor the case through directly observed therapy. This process involves observation of the person taking their medication. It may also involve health-related training and the provision of more care of the person.

For cases with active TB, a team meeting should be set up to include the regional nurse, caseworker, provider and the local DSHS representative handling the case. These people ensure coordination of care and determine if special precautions need to be taken.

It is possible that DSHS will instruct HHSC to suspend the case while the TB remains active. If so, it will provide care for the person during this period. Most people become negative for TB within a few weeks of drug therapy.

Note: Refer to Section 1140, Disclosure of Information, about disclosure of information and national standards created under the Health Insurance Portability and Accountability Act to protect the confidentiality of individually identifiable health information.

2840.4 Sharing Information with New Providers Regarding Health and Safety Issues

Revision 24-5; Effective Nov 1, 2024

When services are suspended due to health and safety reasons, HHSC staff are required to convene an interdisciplinary team (IDT) meeting to resolve the issues. If the issues cannot be resolved, the provider may report it will no longer serve the person due to health and safety concerns.

In some situations, HHSC may terminate the person’s services due to health and safety issues. In other situations, HHSC may initiate services with a new provider. If the HHSC caseworker makes a referral to a new provider, they must determine how much information to share with the new provider about the previous actions.

The HHSC caseworker must share sufficient information with the new provider to avoid putting the provider at risk. This allows the provider to adequately plan for safely delivering services to the person, including selecting the appropriate service delivery staff and preparing the staff to handle situations that may arise. Providing information may avoid the issues that previously caused the termination or suspension.

Caseworkers must use good judgment to determine what information to share and, if in doubt, consult with their supervisors for guidance.

2841 Reinstatement of Services Terminated for Threats to Health or Safety

Revision 24-5; Effective Nov. 1, 2024

An applicant whose services were terminated in the past due to their or someone in their home being a threat to the health or safety of the client, department staff, or provider agency staff may be authorized services if the applicant signs Form H0003, Agreement to Release Your Facts, authorizing release of information, and:

(1) the applicant or person in home who posed the threat has been treated or is receiving treatment by a licensed or certified physician, psychiatrist, or psychologist and can furnish a letter saying that they are no longer a threat to themself or others;    
(2)the applicant or person in home allows a collateral contact with their physician, psychiatrist, or psychologist and the contact indicates that the applicant is no longer a threat to themself or others; or   
(3)the person in the home who posed the threat no longer poses the threat.

Complete the eligibility determination in the Service Authorization System Wizards within 30 calendar days after the date the signed application is received by the department. Review Section 2344,  Rights and Responsibilities.

2841.1 Sharing Information on Previous Actions for Reinstatement

Revision 24-5; Effective Nov. 1, 2024

If a person who is previously terminated from services due to health and safety reasons reapplies for services and meets the requirements in Section 2841, Reinstatement of Services Terminated for Threats to Health and Safety, information may need to be shared with a newly selected provider.

If the HHSC caseworker makes a referral to a new provider, they must determine how much information to share with the new provider about the previous actions that resulted in termination of services. The caseworker must share sufficient information with the new provider to avoid putting the provider at risk and allow the provider to adequately plan for safely delivering services to the person. This includes selecting the appropriate service delivery staff and preparing the staff to handle situations that may arise. Providing information may avoid the issues that previously caused the termination or suspension.

Caseworkers must use good judgment to determine what information to share and, if in doubt, consult with their supervisors for guidance.