4200, Day Activity and Health Services

4210 Description

Revision 22-3; Effective Sept. 1, 2022

Day Activity and Health Services (DAHS) include nursing and personal care services, physical rehabilitative services, nutrition services, transportation services and other supportive services. These services are provided at facilities licensed and certified by the Texas Health and Human Services Commission(HHSC). Except for holidays, these facilities must have services available at least 10 hours a day, Monday through Friday.

The method of payment is a unit of authorized service and is defined as half a day. One unit of service constitutes three hours but less than six hours of covered services provided by the DAHS facility. Six hours or more of service constitutes two units of service. Time spent in approved transportation provided by the DAHS facility shall be counted in the unit of service.

Services must be provided according to the recipient's service plan. Discuss with the recipient, their family or authorized representative regarding the recipient’s condition, program plan and staff administering the plan.

Recipients must be given the opportunity to receive medical attention and help in getting health services not available from the provider.

The facility must be used only for authorized purposes.

Related Policy  

Day Activity and Health Services Provider Manual

4211 Nursing and Personal Care

Revision 17-1; Effective March 15, 2017

Services include:

• evaluating and observing an individual's status and instituting appropriate nursing intervention, when needed, to stabilize his condition or prevent complications;
• helping the individual order, maintain, or administer prescribed medication;
• promoting and participating in the individual's education and counseling. Participation is based on his health needs and illness status, involving the individual and other individuals for a better understanding and implementation of immediate and long-term health goals;
• helping with personal care tasks, including the restoration or maintenance of the individual's ability to perform personal care skills; and/or
• assessing and evaluating the individual's health status.

4212 Physical Rehabilitation

Revision 17-1; Effective March 15, 2017

Services include:

• restorative nursing, including the use of nursing knowledge and skills to help the individual achieve his maximum degree of functioning;
• group and individual exercises, including range-of-motion exercises; and
• transportation to and from a facility approved to provide therapies, if specialized services are needed on the days the individual attends the Day Activity and Health Services (DAHS) facility.

4213 Nutrition

Revision 17-1; Effective March 15, 2017

Services include:

• one hot meal, served between 11 a.m. and 1 p.m. (the meal should supply one-third of the recommended daily allowance (RDA) for adults as recommended by the U.S. Department of Agriculture);
• special diets required by the individual's plan of care;
• supplementary mid-morning and mid-afternoon snacks; and
• dietary counseling and nutrition education for the individual and family.

4214 Transportation

Revision 17-1; Effective March 15, 2017

If needed, the Day Activity and Health Services (DAHS) facility ensures transportation to and from the facility.

4215 Other Supportive Services

Revision 17-1; Effective March 15, 2017

Services include:

• cultural enrichment or educational activities;
• social activities, on-site or in the community; and
• recreational therapy in a program planned to meet the individual's social needs and interests.

4220 Eligibility

Revision 23-1; Effective March 1, 2023

The provision of Community Care Services Eligibility (CCSE) services is not allowed for people who live in an institutional setting. An institutional setting is defined as a skilled nursing facility or an intermediate care facility, including an intermediate care facility for persons who have an intellectual disability.

One unit of DAHS is at least three hours but less than six hours per week. A person who needs less than one unit (three hours) of service per week is not eligible. DAHS cannot be authorized for more than 10 units per week.

To be eligible for DAHS, an applicant or recipient must have:

• Medicaid or be income and resource eligible;
• an unmet need for DAHS;
• a chronic medical diagnosis and physician’s orders for DAHS; and
• one or more functional limitations and the potential for receiving therapeutic benefits from DAHS.

Related Policy 

Resource Limits, 3210
Income and Income Eligibles, 3310

4221 Financial Eligibility Criteria

Revision 17-1; Effective March 15, 2017

Medicaid recipients are financially eligible for Title XIX Day Activity and Health Services (DAHS). Applicants who are not Medicaid recipients but who are categorically eligible or within the Community Care Services Eligibility (CCSE) income and resource limits are financially eligible for Title XX DAHS. Applicants are not eligible if they are receiving another CCSE service that duplicates DAHS. See Section 3000, Eligibility for Services, for the policies concerning income and resources.

4222 Medical Eligibility Criteria

Revision 22-3; Effective Sept. 1, 2022

A person must have the following to meet the medical eligibility criteria for DAHS:

• An identified chronic medical condition and physician's orders certifying that the applicant has a need for DAHS.
• One or more function limitation(s) and the potential to benefit therapeutically from DAHS, as determined by a health assessment of the applicant’s medical needs. The health assessment will identify the functional need or needs and the therapeutic benefit the applicant will receive from personal care, habilitative or restorative activities by participation in DAHS.

The provider agency completes Form 3055, Physician’s Orders (DAHS), and Form 3050, DAHS Health Assessment/Individual Service Plan, for new enrollments, for transfers to a different DAHS provider agency, and if the recipient’s condition changes.

Note: A physician cannot be reimbursed for completing Form 3055 if they received Medicaid reimbursement for the diagnosis and treatment of the person's illness that makes them eligible for DAHS.

Related Policy 

Service Plan Changes Reported by the Facility, 4261
DAHS Transfers, 4262
Facility Response for Facility-Initiated Referrals, 4234
Facility Response to CCSE Staff Referrals, 4235

4223 Unmet Need Criteria

Revision 17-1; Effective March 15, 2017

Applicants must have an unmet need for services and are not eligible for Day Activity and Health Services (DAHS) if they are receiving another CCSE service that duplicates DAHS. DAHS may be received with some other services as long as there is not a duplication of services.

4223.1 DAHS in Conjunction with Other Services

Revision 18-1; Effective June 15, 2018

Day Activity and Health Services (DAHS) may be received in conjunction with some other services, including the following:

• Individuals who receive personal care and supervision through Adult Foster Care (AFC) services may receive 10 units per week of DAHS to benefit medically from the other services provided by the DAHS program. Documentation of the medical benefit must be included in the case record. See Section 4156, Adult Foster Care and Day Activity and Health Services, for additional information.
• A Consumer Managed Personal Attendant Services (CMPAS) individual may receive up to 10 units of DAHS per week.
• Residential Care (RC) individuals may receive DAHS only if the services provided by the DAHS facility are medical services that cannot be provided by the RC facility. An RC individual may receive no more than one unit per day of DAHS, which is the time needed for the DAHS facility to provide medical services.
• An individual in the following waiver programs can access DAHS if the individual meets the DAHS eligibility criteria:
  • Home and Community-based Services (HCS), if age 18 or older;
  • Community Living Assistance and Support Services (CLASS), if age 18 or older;
  • Deaf Blind with Multiple Disabilities (DBMD); and
  • Texas Home Living (TxHmL).

See Appendix XX, Mutually Exclusive Services, for complete information regarding which Long-term Services and Supports may be received in conjunction with others. Staff must also ensure that individuals with active Medicaid coverage are not certified for Title XX DAHS.

4224 DAHS Licensure Age Requirements

Revision 17-1; Effective March 15, 2017

Day Activity and Health Services (DAHS) facilities licensed as adult day care centers are unable to serve individuals under age 18. An individual under age 18 requesting DAHS must be advised that even if eligibility criteria for DAHS are met, he may not be able to access the service unless a facility is licensed to serve children and has a separate facility not accessible to adults. The case worker should refer the applicant to alternative services, such as:

• after school and/or summer programs offered by independent school districts;
• Texas Workforce Commission providers that offer day care services;
• local day care centers;
• faith-based local organizations; or
• other organizations that provide assistance to children with specific physical or medical conditions.

4230 DAHS Approval

Revision 17-1; Effective March 15, 2017

Determination and redetermination of eligibility for Day Activity and Health Services (DAHS) involves the cooperative efforts of the regional nurse, the case worker, the facility nurse and the individual's physician.

4231 Intake

Revision 17-1; Effective March 15, 2017

Intake into Day Activity and Health Services (DAHS) begins when the case worker receives a request for services. Requests for DAHS services may be made by:

• the individual,
• his physician,
• his authorized representative, or
• an interested party.

A DAHS facility may also request services for an individual who is already attending the DAHS facility if the applicant is:

• Medicaid eligible, and
• not a DAHS individual.

4231.1 Facility-Initiated Referrals

Revision 22-3; Effective Sept. 1, 2022

Facility-initiated referrals only apply to Title XIX DAHS services. Only Medicaid eligible applicants are eligible for facility-initiated referrals. The facility may admit and begin services for a Medicaid recipient before receiving approval from HHSC if it is willing to risk the loss of revenue if the applicant is determined ineligible. The applicant cannot be currently receiving DAHS at any other facility that has a DAHS contract. 

Applicants have freedom of choice in the selection of qualified providers. CCSE staff and the regional nurse must coordinate transfers from one DAHS facility to another to prevent duplication of services or gaps in coverage.

For the facility-initiated referral, the facility must:

• have obtained verbal or written physician orders;
• verbally notify CCSE staff or the intake unit and request DAHS services for the applicant; and
• follow up the verbal notification in writing within seven calendar days by sending Form 2067, Case Information, to CCSE staff.

The date of the verbal notification is the date of request for DAHS.

4231.2 Intake Response

Revision 17-1; Effective March 15, 2017

Within 14 calendar days of receipt of the intake, the case worker must contact the applicant either by telephone or face-to-face contact to complete the application for Day Activity and Health Services (DAHS). Time frames for responding to other requests for services (intakes) are based on the priority of the intake. See Section 2320, Case Worker Response, for priorities and time frames. A home visit is required only at the applicant's request.

Prior to the contact, the case worker checks the Texas Integrated Eligibility Redesign System (TIERS) to determine if the applicant is Medicaid eligible or categorically eligible. The case worker also checks the Service Authorization System Online (SASO) to determine the applicant is not a current DAHS individual.

If the applicant is not Medicaid eligible, determine if the applicant will meet the criteria for Title XX Services and if Title XX Services are available. See Section 2230, Interest List Procedures.

If the applicant is not Medicaid eligible and the intake is a facility-initiated referral, notify the facility by telephone and follow up with Form 2067, Case Information, letting the facility know the applicant is not Medicaid eligible and is not eligible for the facility-initiated referral.

If the applicant is already a DAHS individual at another facility, notify the facility by telephone and follow up with Form 2067, letting the facility know the applicant is already an individual, is not eligible for the facility-initiated referral and must follow the transfer procedures as outlined in Section 4262, DAHS Transfers.

4231.3 Initial Interview

Revision 17-1; Effective March 15, 2017

The case worker contacts the applicant either by telephone or face-to-face to complete the assessment interview. During the interview, the case worker discusses services available through Day Activity and Health Services (DAHS) and determines if the applicant appears to have a medical diagnosis and a functional disability related to the medical diagnosis, an unmet need for services or is receiving other services that duplicate DAHS.

During the assessment, the case worker:

• completes Form 2307, Rights and Responsibilities, and if the contact is by telephone, mails Form 2307 to the individual for signature;
• completes Form 2059-W, Summary of Individual's Need for Service Worksheet, to be entered into the Service Authorization System;
• assesses the number of units (one unit equals at least three hours but less than six hours) the applicant prefers and needs per week;
• assesses the applicant for any other needed services; and
• obtains an Application for Assistance form (see Section 2333, Applications), if the applicant is not Medicaid or categorically eligible.

The date of assessment begins the 30-day time frame for the case worker to complete the application process.

4231.4 Response to Individuals Who Are No Longer Attending DAHS

Revision 17-1; Effective March 15, 2017

If the applicant has stopped attending Day Activity and Health Services (DAHS) before the application process is complete, the applicant does not have to complete an application or Form 2307, Rights and Responsibilities, if he was Medicaid-eligible when DAHS was received. Attempt to contact the individual by telephone, mail or home visit to:

• determine if he is receiving DAHS at another facility or receiving other Community Care Services Eligibility (CCSE) services that may duplicate DAHS;
• verify his attendance at the facility; and
• complete Form 2059-W, Summary of Individual's Need for Service Worksheet, to be entered into the Service Authorization System.

If unable to locate the individual or if the individual refuses to provide any information, verify through automation records the individual's effective date of Medicaid coverage and whether the individual is receiving other CCSE services that may duplicate DAHS. See Section 2433, Determining Unmet Need in the Service Arrangement Column, to determine CCSE services that duplicate each other. Complete and send to the facility:

• Form 2101, Authorization for Community Care Services, if the individual is eligible; or
• Form 2065-A, Notification of Community Care Services, if the individual is ineligible.

Send Form 2065-A to the applicant.

See Section 4233, Initial Eligibility Determination and Referral.

Note: Coordinate with the local Area Agency on Aging to ensure there is no service duplication.

4232 Freedom of Choice

Revision 22-3; Effective Sept. 1, 2022

When referring a person to a DAHS facility, describe the facility to the person and the type of service available. If possible, the person should visit the facility before services begin. Based on federal requirements for services funded under Medicaid, the person maintains freedom of choice among the DAHS facilities that serve their area. If the person meets all DAHS eligibility requirements, they have freedom of choice to choose a DAHS facility, regardless of any relationship to the provider.

A DAHS facility must serve eligible people, unless a facility is at licensed capacity.

Refer people to DAHS facilities based on the following priorities:

• person's choice;
• physician's choice, if stated;
• rotation of eligible providers.

After the person has selected a facility, contact the facility to determine if there are openings. If the facility is operating at capacity, contact the person and arrange another satisfactory placement.

DAHS facility staff maintain an interest list for Title XIX and private-pay people. Medicaid regulations prohibit HHSC from maintaining an interest list for any Title XIX service. 

HHSC regional staff maintain the interest list for Title XX applicants.

Related Policy 

Interest List Procedures, 2230

4233 Initial Eligibility Determination and Referral

Revision 21-4; Effective December 1, 2021

Title XX DAHS

After the initial assessment, determine the following:

• the applicant meets the financial eligibility criteria;
• the applicant has an unmet need for Day Activity and Health Services (DAHS); and
• there is no duplication of other services.

CCSE staff complete the referral Form 2101, Authorization for Community Care Services; and send the referral packet to the DAHS facility within five business days.

The referral packet 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 Service Authorization System Online Wizards (SASOW) generated forms:
  • Form 2059, Summary of Client's Need for Service;
  • Provider Referral Supplement; and
  • Form 2101.

If it is determined the applicant is not eligible for DAHS, send Form 2065-A, Notification of Community Care Services, to the applicant.

Title XIX DAHS

Title XIX DAHS referrals are initiated by the facility after an applicant begins attending the DAHS facility. When completing the referral packet, indicate in the comments section of Form 2101 that the applicant is being referred for facility-initiated DAHS. If the applicant no longer attends the DAHS facility, enter the date the applicant stopped as the "end" date on Form 2101 and note in the comments section the applicant is no longer attending DAHS.

If it is determined the applicant is not eligible for facility-initiated DAHS:

• send Form 2065-A to the applicant;
• send a copy of Form 2065-A to the DAHS facility; and
• notify the facility by phone of the denial.

If the applicant qualifies for Title XX DAHS, send the referral packet and notify the facility the applicant is eligible for Title XX DAHS instead of facility-initiated DAHS.

Related Policy

Content of Referral Packets, Appendix XIII

4234 Facility Response for Facility-Initiated Referrals

Revision 22-3; Effective Sept. 1, 2022

For facility-initiated referrals, the DAHS facility must submit a full prior approval packet to the HHSC regional nurse within 30 calendar days after the date of the initial physician's orders (verbal or written) by submitting:

• referral Form 2101, Authorization for Community Care Services;
• Form 3050, DAHS Health Assessment/Individual Service Plan; and
• Form 3055, Physician's Orders (DAHS).

4234.1 Regional Nurse Responsibilities for Facility-Initiated Referrals

Revision 21-4; Effective December 1, 2021

The Day Activity and Health Services (DAHS) facility must request written prior approval for all applicants from the regional nurse within 30 calendar days after the date of the physician’s orders. 

The regional nurse authorizes services and sends Form 2101, Authorization for Community Care Services, to the facility and CCSE staff within five business days if:

• the DAHS facility submits the prior approval packet to the regional nurse within 30 calendar days of the initial physician's orders; and 
• the applicant meets all eligibility requirements.

The effective date is the date of the physician's orders on Form 3055, Physician's Orders (DAHS).

Example: The facility receives Form 3055 on April 5 with a physician's signature date of April 1. The facility receives Form 2101 and the referral packet from CCSE staff on April 20. The facility submits the prior approval packet to the regional nurse on April 22 and the nurse receives the packet on April 24. This is within 30 calendar days of the physician's orders and the applicant meets all eligibility requirements, so the regional nurse authorizes services effective April 1.

If the DAHS facility fails to submit the prior approval packet or additional documentation within the required time frame, the additional documentation is not adequate, or CCSE staff determine the applicant ineligible, the regional nurse cancels the DAHS facility-initiated prior approval and the DAHS facility is not reimbursed for services. If the applicant meets all eligibility requirements, the regional nurse authorizes services by sending Form 2101 to the facility and CCSE staff.

The nurse may send Form 2101 to CCSE staff by secure email as determined by regional procedures. If the region elects to have the regional nurse notify CCSE staff by email, the nurse must include the applicant's name, identification number and date of authorization in the email. The unit supervisor or other appointed HHSC staff will also receive the notice. CCSE staff must go into the Service Authorization System Online (SASO) and print a copy of the authorization Form 2101 and a copy of the email for the case record.

The effective date is the earliest of the following dates on the prior approval packet:

• postage meter date (if not cancelled by the U.S. Postal Service);
• U.S. Postal Service date; or
• HHSC stamp-in date.

The facility is not reimbursed for any services delivered before the authorization date.

Example: The facility obtains verbal physician's orders and requests services through HHSC on April 1. The facility sends Form 3055 to the physician for completion and signature. CCSE staff complete the assessment on April 13 and Form 2101 and sends the referral packet to the facility. On May 2, the facility receives Form 3055 and mails the prior approval packet to the regional nurse. The regional nurse receives the packet on May 4, which is more than 30 days from the physician's verbal orders. The regional nurse establishes eligibility and authorizes services effective May 2, which is the U.S. Postal Service date on the envelope mailed from the facility.

Critical Omissions for Facility-Initiated Referrals

If there are critical omissions, the regional nurse sends Form 3070, Day Activity and Health Services Notification of Critical Omissions, to the facility within five business days of receipt of the prior approval packet and sends a copy to CCSE staff. The facility must send corrections to the regional nurse within 14 days. If the corrections are received within the time frame and the applicant meets eligibility requirements, the regional nurse authorizes services effective the date of the physician's orders on Form 3055. If the facility fails to meet this time frame, the date of prior approval can be no earlier than the postmark or HHSC-stamped date on the corrected documentation. 

Related Policy

Critical Omissions, 4236 

4234.2 Case Worker Responsibilities for Facility-Initiated Referrals

Revision 17-1; Effective March 15, 2017

It is the case worker's responsibility to determine the applicant's eligibility within 30 calendar days from the assessment date and to track if Form 2101, Authorization for Community Care Services, has been completed by the Texas Health and Human Services Commission (HHSC) regional nurse. If, on the 30th day the case worker has not received Form 2101 or received notice of critical omissions, the case worker contacts the regional nurse to inquire if the required information has been received. The case worker must document the contact and the regional nurse's response. The case worker will take one of the following actions:

• If the regional nurse has received the prior approval packet and services will be authorized, the regional nurse advises the case worker of the anticipated authorization date and sends Form 2101 to the facility and the case worker.
• If the regional nurse has sent the prior approval packet back to the facility for critical omissions, the case worker allows another 30 calendar days for the facility to send corrections and receive approval. If Form 2101 has not been received at the end of the 30 days, the case worker contacts the regional nurse for the status and anticipated dates of approval or denial.
• If the regional nurse has not received the prior approval packet or the critical omissions corrections, the case worker must deny the application and notify the applicant, the facility and the regional nurse of the denial, using Form 2065-A, Notification of Community Care Services. The facility will not be reimbursed for the services delivered.

The applicant may reapply for services, but new physician's orders and a new assessment must be completed.

4235 Facility Response to CCSE Staff Referrals

Revision 22-3; Effective Sept. 1, 2022

For referrals initiated by CCSE staff, the DAHS facility must respond within 14 days of receipt of the referral Form 2101, Authorization for Community Care Services.

Within 14 days of the receipt of the referral Form 2101, the DAHS facility sends the prior approval packet to the HHSC regional nurse. The prior approval packet consists of:

• referral Form 2101;
• Form 3050, DAHS Health Assessment/Individual Service Plan; and
• Form 3055, Physician's Orders (DAHS).

If the DAHS facility notifies CCSE staff that the health assessment or the physician's orders will be delayed beyond 14 days, evaluate the cause of the delay. Consult the recipient to determine if they should be referred to another provider of their choice. If CCSE staff determine a new referral is needed, verbally notify the original provider and the HHSC regional nurse. Send Form 2067, Case Information, to the original provider to confirm the withdrawal.

Related Policy 

Initial Eligibility Determination and Referral, 4233

4235.1 Regional Nurse Responsibilities for CCSE Referrals

Revision 21-4; Effective December 1, 2021

When the regional nurse receives the required forms from the facility, the regional nurse reviews Form 2101, Authorization for Community Care Services, Form 3050, DAHS Health Assessment/Individual Service Plan, and Form 3055, Physician's Orders (DAHS), to determine if the applicant meets the Day Activity and Health Services (DAHS) medical eligibility criteria. If there are critical omissions or errors in the required documentation, the regional nurse must follow the critical omissions procedures.

The regional nurse must keep the envelope that the prior approval material is mailed in. If more than one prior approval packet is included in the envelope, the regional nurse or designee must list the name of each applicant that a prior approval packet had in the envelope.

The regional nurse grants approval if the:

• applicant meets the eligibility criteria; and
• there are no critical omissions or errors in the documentation from the facility.

The regional nurse generates and sends the authorization, Form 2101 to the facility and CCSE staff within five business days of receipt of the prior approval request. This provides notification of approval or denial of the applicant. 

The region has the option of allowing the regional nurse to send notification of the authorization to CCSE staff by secure email, rather than sending the paper copy. Each region may determine which method best suits its needs. The regional nurse will continue to send a paper copy to the provider.

If the region elects to have the regional nurse notify CCSE staff by email, the nurse must include the applicant's name, identification number and date of authorization in the email. The unit supervisor or other appointed HHSC staff will also receive the notice. CCSE staff must go into the Service Authorization System Online (SASO) and print a copy of the authorization Form 2101 and a copy of the email for the case record.

Related Policy

Medical Eligibility Criteria, 4222 
Facility Response to Case Worker Referrals, 4235
Critical Omissions, 4236

4235.2 Effective Dates for Initial Cases

Revision 17-1; Effective March 15, 2017

The regional nurse establishes the beginning date of Day Activity and Health Services (DAHS) coverage based on whether the individual is referred by the case worker or by the facility as a facility-initiated referral, and if there are critical omissions/errors in the required documentation.

For case worker referrals, the regional nurse establishes the Begin Date of coverage on Form 2101, Authorization for Community Care Services, as the date it is expected to be mailed to the facility. If this date is not feasible, the regional nurse negotiates the Begin Date of coverage on Form 2101 with the case worker and the facility, according to the individual's needs and the individual's unique circumstances.

The regional nurse establishes the beginning date of coverage on Form 2101 for a facility-initiated referral using the date of the physician orders. If there are corrections for critical omissions/errors in the required documentation, the regional nurse follows procedures in Section 4236, Critical Omissions, and establishes the effective date as the:

• date of the physician orders, if corrections are received within 14 days of the date the regional nurse sends Form 3070, Day Activity and Health Services Notification of Critical Omissions; or
• date the corrections are received, if the corrections are not received within 14 days.

4235.3 Case Worker Responsibilities for Case Worker Referrals

Revision 17-1; Effective March 15, 2017

Within two business days of receipt of Form 2101, Authorization for Community Care Services, from the regional nurse, the case worker sends Form 2065-A, Notification of Community Care Services, to the individual notifying the individual of eligibility or ineligibility.

If the individual was a facility-initiated referral, a copy of Form 2065-A is also sent to the facility. The effective date on Form 2065-A must match the effective date on Form 2101 from the regional nurse.

4236 Critical Omissions

Revision 22-3; Effective Sept. 1, 2022

If the required documentation contains errors or omissions, the HHSC regional nurse:

• Completes Form 3070, Day Activity and Health Services Notification of Critical Omissions; and
• sends it to the facility along with the rejected prior approval packet.

Corrections of critical omissions or errors in DAHS facility documentation must be received by HHSC within 14 calendar days after the HHSC regional nurse mails Form 3070, Day Activity and Health Services Notification of Critical Omissions, to the facility. 

If the facility fails to submit the required documentation timely, contact the applicant within three business days after being notified by the HHSC regional nurse. Explain that a referral can be made to another DAHS facility due to the delay, if the applicant, their family or their authorized representative prefers this option.

The regional nurse uses the earliest of the following dates to establish the date that prior approval material and corrections of critical omissions or errors are received from the facility:

• postage meter date (if not canceled by the U.S. Postal Service);
• U.S. Postal Service date; or
• HHSC stamp-in date.

The facility has 14 calendar days to correct critical omissions or errors. If the facility returns the packet before the 14th calendar day but all identified omissions or errors are not corrected, the facility has the rest of the 14 calendar days to resubmit additional corrections. 

The regional nurse verbally notifies the facility that:

• the corrected packet does not address all errors noted on Form 3070, and
• additional corrections must be submitted on or before the 14th calendar day to avoid a gap in payment.

The regional nurse documents this verbal notification (date, name of contact, etc.) in the case record.

4240 Facility Initiation of Services

Revision 17-1; Effective March 15, 2017

The facility must complete and return HHSC’s authorization for community services form to the case worker within 14 days from the begin date on HHSC’s authorization for community care services form. The Day Activity and Health Services (DAHS) facility must indicate the date services were initiated, the schedule for delivering services, and the total units authorized for the individual.

The 14-day period (for the facility to return Form 2101, Authorization for Community Care Services) encourages the facility to start services promptly. The 14-day period does not apply if an individual is already attending a DAHS facility when the facility refers him to the case worker (for example, a facility-initiated referral). For facility-initiated referrals, the facility returns Form 2101 as soon as possible after receiving it from the case worker.

4250 Monitoring

Revision 17-1; Effective March 15, 2017

Monitor the services based on the priority assigned to the individual's case. For priority levels, see:

• Section 2540, Priority Status Individuals;
• Section 2710, Monitoring Visits and Contacts;
• Section 2711, Monitoring Visits for Community Attendant Services (CAS) Individuals; and
• Section 2712, Six-Month Monitoring Contacts.

Timelines for Day Activity and Health Services (DAHS)-only cases are measured differently than other situations because there is no Form 2060, Needs Assessment Questionnaire and Task/Hour Guide, date from which to count. Measure DAHS-only timelines from the:

• initial contact date (for initial certifications); or
• the previous date on Form 2314, Satisfaction and Service Monitoring, (for recertifications).

The regional nurse also monitors DAHS through utilization review.

4260 Changes

Revision 17-1; Effective March 15, 2017

The Day Activity and Health Services (DAHS) facility must inform the case worker of changes in the individual's status, condition and when the individual is suspended from attending DAHS.

4261 Service Plan Changes Reported by the Facility

Revision 22-3; Effective Sept. 1, 2022

The DAHS facility must verbally notify CCSE staff of any changes in the recipient’s status or condition. This may require a change in their plan of care, units of service or service termination. If so, they must follow up with written notification within seven days.

CCSE staff approve changes in the plan of care which may affect eligibility or units of service. 

Within 14 calendar days of receipt of Form 2067, Case Information:

• review the request for a change which may affect eligibility or units of service;
• contact the recipient to confirm they are in agreement with the proposed change; and
• respond to the written request.

If CCSE staff and the recipient agree with the facility's request, complete and send Form 2101, Authorization for Community Care Services. If CCSE staff and the recipient agree to terminate or reduce services, follow adverse action procedures.

If CCSE staff or the recipient disagree with the request, send Form 2067 to the facility to explain the reason for not making the change.

Related Policy 

Individual Notification Procedures, 2810
Effective Dates, 2811
Form 2101 Coverage Dates for Title XIX Services, Appendix XXIII

4261.1 Individual Absences

Revision 17-1; Effective March 15, 2017

If a Day Activity and Health Services (DAHS) participant is absent from the facility for 15 consecutive days, the DAHS facility must verbally notify the Texas Health and Human Services Commission (HHSC) of the suspension no later than the first workday after services are suspended and then send Form 2067, Case Information, within seven workdays after the incident was reported verbally.

If an individual is absent from a regularly scheduled program, the DAHS facility must contact the individual or someone knowledgeable about his condition the same day that the absence occurs. If the DAHS facility is unable to contact the individual or someone knowledgeable about his condition, the DAHS staff must document this in the individual's record. DAHS facilities are not required to notify the case worker of daily absences from the facility.

4262 DAHS Transfers

Revision 17-1; Effective March 15, 2017

Only the individual may initiate a Day Activity and Health Services (DAHS) facility transfer; the change cannot be requested by facility staff.

When an individual decides to transfer to a new DAHS facility (including a facility in a different region), the individual must contact the HHSC case worker before making the move. The individual may make the request to the case worker orally or in writing. If a request for a DAHS transfer is received from anyone other than the individual, the case worker must contact the individual to ensure he desires the change. Services at the new facility may begin no earlier than one day after the individual receives services from the previous facility.

Within 14 days of the request from a current individual to transfer to another facility, follow these procedures:

• Negotiate with both facilities the date the current facility will stop providing services and the date the new facility will start services, ensuring there is no gap or overlap in services.
• Update Form 2101, Authorization for Community Care Services, by entering:
  • the nine-digit vendor number;
  • the effective date of the transfer; and
  • a statement in the comments section that this is an individual transfer.
• Send Form 2101 to the gaining DAHS facility to begin services.
• Send Form 2101 to the losing facility to terminate services.

It is critical for the case worker to coordinate individual transfers from one facility to another to ensure that no duplication of service or gaps in dates of coverage exist. Facility-initiated referrals are for applicants only and may not be used for individuals currently receiving DAHS services.

4263 Suspensions

Revision 23-1; Effective March 1, 2023

The provider agency must suspend services if the recipient:

• permanently leaves the state or moves outside the geographic area served by the program;
• dies;
• is admitted to an institution which is defined as a:
  • hospital;
  • nursing facility;
  • state school;
  • state hospital; or
  • intermediate care facility serving people with an intellectual disability or related conditions;
• requests that services end;
• HHSC denies the recipient’s Medicaid eligibility (not applicable to Title XX DAHS services); or
• exhibits reckless behavior, which may result in imminent danger to the health and safety of the recipient or others.

The provider agency must notify CCSE staff by fax of any suspension by the next business day. The faxed notice of a suspension must include:

• the date of service suspension;
• the reason(s) for the suspension;
• the duration of the suspension, if known; and
• an explanation of the provider agency's attempts to resolve the problem that caused the suspension, including why the problem was not resolved.

CCSE staff confirm the reason for the suspension and take appropriate action. If the suspension results in case closure or termination of DAHS, coordinate closure and the termination date with the provider to allow time for the recipient to receive notification of the right to appeal.

Related Policy 

Service Suspensions, 2820
Service Suspension by Providers, 2821
Service Suspension by Case Workers, 2822
Hospital and Nursing Facility Stays, 2822.1
Refusal to Comply with Service Delivery Provisions, 2830
Suspensions Due to Refusal to Comply with Service Delivery Provisions, 2831
Threats to Health or Safety, 2840

4264 Ensuring Health and Safety at DAHS Facilities

Revision 22-3; Effective Sept. 1, 2022

If a recipient exhibits reckless behavior while at a DAHS facility that may result in imminent danger to the health and safety of DAHS recipients or staff, the DAHS facility must take immediate action to protect recipients and staff in the facility. This may require removing the recipient from the facility or away from others and contacting local authorities such as police, sheriff's department or mental health authorities, to ensure everyone’s safety. The facility may make a referral for appropriate crisis intervention services to the Texas Department of Family and Protective Services (DFPS) Adult Protective Services (APS). The facility must immediately suspend services to the recipient.

The DAHS facility must verbally notify CCSE staff of the reason for the immediate suspension by the following HHSC business day and follow up with written notification to HHSC within seven HHSC business days of the verbal notification. Upon notification, CCSE staff must follow the threats to health or safety policy, including notifying CCSE management of the incident and conferring to ensure all appropriate actions are taken to maintain a safe environment in the facility.

Arrange an interdisciplinary team meeting at the earliest opportunity to determine if the issue can be resolved and services can be continued. If the threat to health and safety was serious enough, services may be terminated immediately.

If the recipient reapplies for services at a later date, they must provide information or authorize collateral contacts to verify they are no longer a threat.

Related Policy 

Effective Dates, 2811
Threats to Health or Safety, 2840
Reinstatement of Services Terminated for Threats to Health or Safety, 2841

4270 Reassessment

Revision 22-3; Effective Sept. 1, 2022

CCSE staff must reassess a DAHS recipient’s eligibility at least every 12 months. The DAHS facility does not need to obtain new physician's orders for recipients receiving ongoing DAHS.

Timelines for DAHS-only cases are measured differently than other case situations because there is no Form 2060, Needs Assessment Questionnaire and Task/Hour Guide, date from which to count. Measure DAHS-only reassessment timelines from the:

• initial contact date (for initial certifications); or
• the previous date on Form 2314, Satisfaction and Service Monitoring, (for recertifications).

When reassessing a DAHS recipient's eligibility, examine the history of attendance. Reauthorize only the number of units the recipient is likely to use. Explore the reasons for underutilization by discussing the situation with the recipient, facility staff and the recipient's family.

If underutilization has been sporadic due to temporary factors such as acute illness or hospitalization, no change in service authorization may be needed. However, if underutilization has occurred consistently during the previous six months, discuss changing the service plan with the recipient and their family. The number of units authorized per week may need to be decreased.

A review of the service plan may be appropriate during the 12-month period if a change in units of service is required.

If CCSE staff determine a recipient continues to be eligible for DAHS but the number of units are changing, submit Form 2101, Authorization for Community Care Services, to the facility. If the facility does not agree with the service plan change, the facility representative must contact CCSE staff before the effective date of the change to resolve the disagreement.

If CCSE staff determine the recipient no longer qualifies for DAHS, send Form 2065-A, Notification of Community Care Services, to the recipient and terminate services. Update and send Form 2101 to terminate services.

Related Policy 

Effective Dates, 2811
Renewal of Prior Approval, 4271
Notification/Effective Date of Decision, Appendix IX
Form 2101 Coverage Dates for Title XIX Services, Appendix XXIII

4271 Renewal of Prior Approval

Revision 17-1; Effective March 15, 2017

Although the coverage period is open-ended in the Service Authorization System, the case worker must conduct a reassessment/redetermination of the individual and send the facility Form 2101, Authorization for Community Care Services, confirming eligibility status if the number of units changes or if services are terminated. Use the following procedures for renewal of prior approval, including late renewals.