4410 Primary Home Care Program

Revision 17-1; Effective March 15, 2017

The Primary Home Care Program (PHCP) is the personal attendant services (PAS) umbrella program under Chapter 47 of the Texas Administrative Code (TAC), which includes the following services:

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

FC provides in-home PAS to individuals eligible under Title XX of the Federal Social Security Act (relating to block grants to states for social services). Providers delivering PAS must meet all the requirements in Texas Administrative Code §47.11, Contracting Requirements.

With the exception of this section and Section 4610, Primary Home Care Program, all non-Chapter 47 rule references within the Community Care Services Eligibility Handbook to "Primary Home Care" or "PHC" refer to the service, not the umbrella program.

For information on the Title XIX PHCP programs, see Section 4600, Primary Home Care and Community Attendant Services.

4411 Family Care Services Description

Revision 17-1; Effective March 15, 2017

Family Care (FC) provides assistance with activities of daily living to eligible individuals who have functional limitations caused by age, disabilities or medical problems. Services are limited to 50 hours per week (42 hours per week for a priority individual). Services include help with personal care, household tasks, meal preparation and escort.

FC is a non-skilled, non-technical service delivered by an attendant employed by the provider. The attendant must be age 18 or older. Providers must comply with the requirements in the contract with the Texas Health and Human Services Commission and in the Contracting to Provide Primary Home Care Services Handbook.

4412 Allowable Tasks

Revision 24-1; Effective March 1, 2024

Personal attendant services (PAS) that may be delivered under Family Care (FC) include the tasks defined in 40 Texas Administrative Code Section 47.41, Allowable Tasks.

For information on escort services, refer to 26 TAC Section 271.83(a) and (b), Time Allocation for Escort Services.

Refer to the examples given in Section 4621, Allowable Tasks, for more information on calculating time for escort. Escort may include accompanying the person on non-medical trips such as the grocery store, paying bills, pharmacy, hair stylist or barber, or social events. The time used to provide the escort task must not exceed the total time purchased for attendant care. No additional time for escort is allocated to the person’s service plan. The person may elect to receive escort in place of help with household or personal care on a day that best meets their needs. This service does not include the direct transportation of the person by the attendant.

Because shopping is an authorized task, it may entail the provider paying mileage to the attendant to perform the task. The person cannot be charged for transportation costs incurred in performance of this task by either the attendant or the provider.

To facilitate safe individual ambulation or movement, arranging furniture may be provided. Example: People who use wheelchairs, walkers, or crutches or for blind people. The provider supervisor addresses this activity during orientation for an attendant who provides services to this type of person.

Refer to page three and four of Form 2060, Needs Assessment Questionnaire and Task/Hour Guide, for further definition of activities that may be provided within each task.
 

4413 Excluded Services

Revision 17-1; Effective March 15, 2017

Family Care (FC) does not include services that must be provided by a person with professional or technical training. Examples include but are not limited to the following:

  • insertion and irrigation of catheters;
  • irrigation of body cavities;
  • application of sterile dressings involving prescription medications and aseptic techniques;
  • tube feedings;
  • injections;
  • administration of medication; and
  • any other skilled or technical services identified by the department.

Services that maintain an entire family or household are also excluded unless the entire household receives FC services. Examples:

  • cleaning floor and furniture in areas that the individual does not occupy or use;
  • preparing meals for the entire family or household;
  • laundering clothing or bedding that the individual does not use; and
  • shopping for groceries or household items the individual does not need for health and maintenance.

An attendant may shop for items the individual needs and that the rest of the household also uses.

4420 Eligibility

Revision 24-1; Effective March 1, 2024

To be eligible for family care, the applicant or person must:

  • meet the income and resource guidelines established by the department in 26 Texas Administrative Code Sections 271.53 271.55 271.89 271.91 relating to Income and Income Eligibles, Determination of Countable Income, Resource Limits, and Countable Resources; 
  • meet the minimum functional need criteria as set by the department:
  • the department uses a standardized assessment instrument to measure the person’s ability to perform activities of daily living;
  • this yields a score, which is a measure of the person’s level of functional need;
  • the department sets the minimum required score for a person to be eligible, which the department may periodically adjust commensurate with available funding;
  • department will seek stakeholder input before making any change in the minimum required score for functional eligibility; and
  • be ineligible to receive attendant care services funded through Medicaid.

The applicant or person must require at least six hours of family care per week to be eligible, unless the applicant or person:

  • requires family care to provide respite to the caregiver;
  • lives in the same household as another person receiving family care, community attendant services, or primary home care;
  • receives one or more of the following services through the department or other resources:
    • congregate or home-delivered meals;
    • help with activities of daily living from a home health aide;
    • day activity and health services; or
    • special services to persons with disabilities in adult day care;
  • receives aids-and-attendance benefits from the Veterans Administration; or
  • is determined, based upon the functional assessment, to be at high risk of institutionalization without family care.

Review the following for eligibility policy not contained in this section:

4421 Residence

Revision 24-1; Effective March 1, 2024

To receive services, the person must live in a place other than:

  • a hospital;
  • a skilled nursing facility;
  • an intermediate care facility;
  • an assisted living facility;
  • a foster care setting;
  • a jail or prison;
  • a state school;
  • a state hospital; or
  • any other setting where sources outside the primary home care program are available to provide personal care.

Family Care (FC) cannot be authorized if the person lives in a home licensed as a personal care home by the Texas Department of State Health Services. If the home is not a licensed personal care home, services may be authorized as follows:

  • If three or fewer people live in the home, the proprietor can be the personal attendant services (PAS) attendant for the people who live there. The person may not receive both PAS and Adult Foster Care.
  • If the home provides only room and board to four or more people living in the home, it does not require licensure as a personal care home. PAS services can be authorized for people in this setting, but the proprietor, their agent or employee cannot be the attendant for people who live in the home. The case worker must specify this on Form 2101, Authorization for Community Care Services.

FC can be provided to a private pay applicant or person living in a residential care facility if contracted with HHSC or not, under the following conditions.:

  • The case worker applies the unmet need policy on a task-by-task basis, not duplicating services. 
  • Facilities provide varying degrees of assistance, and tasks purchased should not be tasks provided by the facility. 
  • The case worker must closely monitor the case to determine if the person is receiving other services from the facility. Service plans must be adjusted to avoid duplication of services or tasks.

If the person begins receiving residential care (RC) through HHSC, FC is terminated effective by the date RC services are started.

Related Policy

26 Texas Administrative Code Section 271.81(b)  

4430 Case Worker Procedures for Determining Eligibility

Revision 18-2; Effective November 19, 2018

See Section 2200, Intake Procedures, for intake, screening criteria and interest list procedures.

Upon receipt of a Family Care intake or release from the interest list, the case worker makes a home visit within the required time frames to begin the application process.

Conduct a home visit to determine whether the individual meets eligibility criteria as outlined in Section 4420, Eligibility. The applicant must provide information to determine financial eligibility as outlined in Section 3000, Eligibility for Services, and must be screened for eligibility for Community Attendant Services (CAS).

Give the following to all applicants:

  • Form 2307, Rights and Responsibilities;
  • Attachment 2307-A, Family Care, Community Attendant Services and Primary Home Care Rights and Responsibilities; and
  • Attachment 2307-EVV, Electronic Visit Verification Rights and Responsibilities, when the applicant requests CAS, Primary Home Care of Family Care Services.

Explain that the case worker must approve increases in the number of hours of services the individual receives. Also inform the individual that he/she may select another provider if he is dissatisfied with the services or with the attendant providing the services.

4431 Family Care Financial Eligibility

Revision 24-1; Effective March 1, 2024

To be eligible for family care, the person must:

  • meet the income and resource guidelines established by the department in 26 Texas Administrative Code Section 271.53, 271.55, 271.89 and 271.91 which relates to Income and Income Eligibles, Determination of Countable Income, Resource Limits, and Countable Resources;
  • be ineligible to receive attendant care services funded through Medicaid.

The case worker must determine that an applicant for Family Care is not eligible for services through Primary Home Care (PHC) or Community Attendant Services (CAS). Review Section 2340, The Initial Interview and Application Process, for information on the determination of financial eligibility and screening for eligibility for CAS.

Review Section 3000, Eligibility for Services, and Appendix XII, Examples of Methods to Verify Income and Resources, for specific information on determining financial eligibility.

4432 Family Care Functional Eligibility

Revision 24-1; Effective March 1, 2024

Regardless of a person’s functional eligibility as determined by their score on the client needs assessment questionnaire, a person only receives CCSE services if there is an unmet need for those services.

Applicants and people must score at least 24 on Form 2060, Needs Assessment Questionnaire and Task/Hour Guide, to be eligible for Family Care. 

Review Section 2400, Assessment Process, Section 2500, Service Planning, and Section 2600, Authorizing and Reassessing Services, for case worker procedures for full determination of functional eligibility and unmet need determination.

Related Policy

26 Texas Administrative Code Section 271.61
26 Texas Administrative Code Section 271.69  

4433 Time Frames

Revision 24-1; Effective March 1, 2024

Eligibility for CCSE services for income-eligible applicants is determined within 30-calendar days after a signed application is received.

The case worker must complete all eligibility determination within 30 calendar days from the assessment date and send the applicant Form 2065-A, Notification of Community Care Services, within two business days of the eligibility decision.

Related Policy

26 Texas Administrative Code Section 271.151(d) 
 

4440 Referral Process

Revision 21-4; Effective December 1, 2021

After completing the assessment, send the selected provider a referral packet.

The referral packet must include:

  • a cover sheet;
  • the Long-term Care Services Intake system (NTK) generated Form 2110, Community Care Intake; and
  • copy of the following Service Authorization System Online Wizards (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.

All Form 2101 referrals to the provider, both initial and ongoing, must include the:

  • authorized tasks;
  • total number of authorized hours;
  • number of days the applicant or recipient requests delivery of services; and
  • relationship and name of any person designated as ‘do not hire.’

Document any of the following information in the comments section of the Form 2101:

  • any special needs of the applicant or recipient that require a specific schedule and the reason;

    Example: “<Name of person> is diabetic and requires a specific eating schedule.” or “<Name of person> requires service delivery in the afternoon due to a sleeping condition.”
     
  • the number of service days requested by the applicant or recipient based on the Form 2060;

    Example: "<Name of person> requests a five-day plan."
     
  • the relationship and name of any person(s) designated as ‘do not hire;’

    Example: “Do not hire <spouse>, <name of spouse>, for any tasks.” or “Do not hire <daughter>, <name of daughter>, for shopping.”

Related Policy

Who Cannot Be Hired as the Paid Attendant, 2514
Referrals to the Provider, 2630
Content of Referral Packets, Appendix XIII

4440.1 Types of Referrals

Revision 17-1; Effective March 15, 2017

There are two methods of referral:

  • For expedited referrals, the case worker makes the referral by oral notice and on Form 2101, Authorization for Community Care Services.
  • For routine referrals, the case worker makes the referral on Form 2101.

Routine Referrals

Within five business days of the eligibility decision, the case worker mails the referral packet to the provider to authorize service delivery.

Expedited Referrals

In some instances, the individual's need for services, based on the case worker's judgment, is such that delivery of services must be facilitated. When weighing whether an expedited referral is warranted, consider:

  • What was the individual's assigned intake priority? In most situations, cases which required an expedited response to a request for services also require an expedited referral.
  • Is the applicant being authorized as having priority status? If so, that may indicate a need for an expedited referral.
  • Could a delay in starting services constitute a threat to the individual's health, safety or well-being? If so, an expedited referral is needed.

The expedited referral process includes:

  • upon making the eligibility decision, the case worker makes a verbal referral to the selected provider and negotiates a start of care date which must be less than 14 calendar days; and
  • following up the verbal referral by sending a referral packet to the provider, including Form 2101, Authorization for Community Care Services, noting the time, date and staff person contacted, and the negotiated start date in the comments section.

4441 Provider Responsibilities after Receipt of Referral

Revision 17-1; Effective March 15, 2017

Upon receipt of the referral packet, the provider must conduct pre-initiation activities, develop a service plan and assign an attendant to perform services for the individual in accordance with 40 Texas Administrative Code §47.45. These activities must be completed within 14 days after one of the following dates, whichever is later:

  • the referral date on Form 2101, Authorization for Community Care Services; or
  • the date the provider receives Form 2101, unless the provider fails to stamp the receipt date on the form, in which case the referral date will be used to determine timeliness.

For expedited referrals, the provider must document the date, time and the name of the case worker who gives the verbal authorization. Provider staff contact the case worker if the packet is not in their office by the seventh day after the verbal referral.

The provider can request a corrected authorization if the information (for example, hours or dates of coverage) conflicts with what was given over the telephone. In these situations, correct and initial Form 2101 and mail a copy of it to the provider.

Within 14 days after initiating services, the provider must send notice of service initiation to the case worker. The provider may, but is not required, to use Form 2101 to notify the case worker of service initiation.

4441.1 Delay of Service Initiation

Revision 24-4; Effective Sept. 1, 2024

40 Texas Administrative Code Section Section 47.61, Service Initiation.

A provider may delay the start of service only if the reason is not directly caused by the provider, or is beyond the provider’s control, such as natural or other disasters. The provider must continue efforts to begin services and set a date, if possible, for service initiation. The provider must document any failure to begin services by the relevant due date, including:

  • the reason for the delay, which must be beyond the provider's control;
  • either the date the provider thinks they will initiate services, or specific reasons why the provider cannot anticipate a service initiation date; and
  • a description of the provider's ongoing efforts to begin services.

The provider must maintain documentation of service initiation in the person's file.

4441.2 Initial Service Delivery Plan Variances

Revision 17-1; Effective March 15, 2017

Providers must follow the rules as specified in 40 Texas Administrative Code §47.45(b), Service delivery plan variances.

4442 Resolution of Service Plan Disagreement

Revision 17-1; Effective March 15, 2017

If a disagreement exists about the appropriateness of a referral or about service delivery issues involving the individual, the case worker and the provider staff attempt to resolve the disagreement. If the disagreement is not resolved at this level, supervisory staff of the two agencies attempt to resolve it. If supervisory staff of both agencies are unable to resolve a disagreement, the regional director or designee resolves it. Do not delay service initiation because of a disagreement. The regional nurse may always be consulted regarding health and safety issues or the appropriateness of the service plan.

4443 Change of Providers

Revision 17-3; Effective May 15, 2017

Monitor the individual after services are initiated and periodically thereafter to check on the adequacy of the service plan, the quality of service delivery and the individual's condition. Report to the unit supervisor any apparent deficiencies in the provider's delivery of Family Care (FC) services.

When an FC individual plans to change providers, the individual must first contact his case worker, who will:

  • coordinate the transfer to prevent a gap in coverage; and
  • attempt to resolve any problems the individual may be having with his current provider before processing the transfer.

Within 14 calendar days of notification that an ongoing FC individual is requesting a transfer to another provider, the case worker contacts the individual and the provider to determine:

  • the individual's reason for dissatisfaction; and
  • whether the individual's satisfaction can be accomplished without changing providers.

The case worker considers the following to identify the individual's reason for dissatisfaction:

  • Timeliness of services
    • Are services being provided during the hours of the days the individual wants the services?
    • Is a special attendant sent when a priority individual's special attendant is not able to work for the individual?
    • Are services not being provided to a non-priority individual for more than 14 consecutive days or to a priority individual as scheduled, except if the reason for the break is based on:
      • the individual not being home when the attendant was scheduled to work;
      • the individual's request that services not be provided on a specific day(s); or
      • a reason for suspension of services, as listed in Section 4446, Suspension of Services and Interdisciplinary Team (IDT) Procedures?

        If a non-priority individual refuses to be without services for any length of time, the individual may transfer to another provider that may provide services when the individual prefers to receive them.
    • When the individual is unavailable to receive services at the scheduled time, are services being delivered at an alternate time? For example, the individual has been discharged from a three-day hospital stay.
    • Are services being provided as scheduled? Is it due to any of the following reasons?
      • The individual is often away from his residence when his service is scheduled and repeatedly fails to notify the agency that he will be gone, even if the case worker and provider have counseled him about this problem and its implications.
      • The individual or someone in the individual's home regularly will not permit the provider to perform one or more of the tasks in the service plan.
      • The individual refuses to accept services because of dissatisfaction with all attendants the provider sends.
      • The individual or someone in the individual's home regularly behaves in a way that is so offensive to staff employed by the provider that the provider refuses to serve the individual, and the individual knowingly and passively condones the person's behavior, and the staff are unable to provide services. Examples of offensive behavior include sexual harassment, sexual misconduct and racial discrimination.
    • Does the attendant have a pattern of being late or not showing up for work?
  • Accessibility of services
    • Is the individual able to speak with the provider when he wants to request a change in his service plan?
    • Is the provider readily responsive to the individual's request for change in the service plan?
    • Is the provider reluctant to speak with the individual because the individual has a history of harassing the provider or attendant?
    • Does the individual want to receive a task that is not purchased by the Texas Health and Human Services Commission?
  • Quality of services
    • Is the attendant performing the tasks the individual wants?
    • Is the attendant able to perform the tasks the individual wants?
    • Is the attendant following the individual's instructions in performing tasks?
    • Are the individual's expectations of the attendant realistic?
  • Individual's rights and responsibilities
    • Did the provider consider the individual's wishes when developing the service plan?
    • Does the provider respect the individual's right to privacy by informing the individual in advance when the attendant or the agency supervisor plan to visit the individual?
    • Does the individual feel that the provider communicates with him as an adult?
    • Does the individual feel that he can express his opinions or dissatisfactions without fear of losing his attendant or services?
    • Does the provider inform the non-priority individual, in advance, of the attendant's inability to work a particular day?

If the case worker determines that the individual's dissatisfaction is based on the individual's failure to comply with the service plan, the case worker contacts the individual or the party involved and attempts to resolve the problem in a way that is satisfactory to all parties involved. The case worker discusses the problem with the supervisor. An interdisciplinary team meeting may be conducted at the individual's home to try to resolve the situation. The case worker may terminate the individual's services if the individual refuses more than three times to comply with service delivery provisions by repeatedly and directly, or knowingly and passively, condoning the behavior of someone in his home.

By the 14th day, authorize the transfer if:

  • it is determined that the individual's satisfaction cannot be met without changing providers and services do not have to be terminated based on failure to comply with the service plan; or
  • the individual insists on transferring to another provider and it is determined that services do not have to be terminated based on failure to comply with the service plan.

Within 14 calendar days of receiving a request from the individual or the individual's representative to change providers, the case worker:

  • asks the individual or the individual's representative to select a new provider and document the individual's choice of the new provider in the case record by:
    • coordinating with both providers the date the current provider will stop providing services and the date the new provider will start services;
    • updating any pertinent information on Form 2059, Summary of Client's Need for Service;
    • updating Form 2101, Authorization for Community Care Services, by entering the new nine-digit contract number in Item 2; and
    • documenting in the comments section that the individual is changing providers;
  • sends the new provider the updated Form 2101 and Form 2059; and
  • sends the current provider a copy of the updated Form 2101 that includes the effective date the individual changes providers.

4443.1 Service Interruptions

Revision 17-1; Effective March 15, 2017

Refer to 40 Texas Administrative Code §47.63(a), Service interruptions.

A service interruption occurs anytime service delivery is discontinued for 14 days or more for a reason that is not covered in Section 4446, Suspension of Services and Interdisciplinary Team (IDT) Procedures. The provider should make every effort to ensure that interruptions in service last less than 14 days, particularly if a break in service would jeopardize the individual's health or safety. When an interruption of services is unavoidable, the provider must document all service interruptions by the:

  • 30th day after the beginning of the service interruption for priority individuals and

30th day that exceeds 14 days after the service interruption for non-priority individuals.

4444 Reporting Significant Changes

Revision 17-1; Effective March 15, 2017

The provider notifies the case worker or the case worker's office (by telephone or in person) about a change in the individual's condition or circumstances that may require a service plan change or service termination.

The provider must notify the case worker by the first Texas Health and Human Services Commission workday after provider staff notice the change and must follow up in writing, using Form 2067, Case Information, within seven days after verbal notification.

Any of the following changes in the individual's condition or circumstances may require a change in his service plan. (These are examples only; this list is not intended to be all inclusive.)

  • The individual's health improves or deteriorates.
  • The individual no longer needs services.
  • The individual is discharged from a hospital.
  • Problems exist with family relationships.
  • The individual is evicted or otherwise loses his housing.
  • The individual relocates.
  • The individual is referred for home health services.
  • Changes occur in the individual's household composition.

If the case worker receives a request for a change, respond to it within 14 days from the date the request is received. Review the individual's service plan to decide whether the change is necessary. If the case worker decides the change is not necessary, document the decision on Form 2067 and send it to the provider, keeping a copy in the case record.

Depending on the individual's new condition or situation, a new assessment or

Revision of the service plan (such as a change in priority status or a need for more hours) may be necessary. If appropriate, make changes to the service plan on Form 2101, Authorization for Community Care Services, according to Section 2720, Changes Reported in the Individual's Condition or Status during the Certification Period. Consult with the supervisor about the requested change, if necessary. If the report meets the criteria for Adult Protective Services (APS), refer the individual to that service. See Section 2220, Response to Requests for Service.

4445 Service Plan Changes

Revision 22-3; Effective Sept. 1, 2022

If a service plan change is authorized, mail two copies of Form 2101, Authorization for Community Care Services, and one copy of Form 2059, Summary of Client's Need for Service, to the provider. If a service plan change increases hours, the beginning date of coverage is seven days from the Form 2101 date, unless another date is negotiated. If a service plan change adds priority status, use verbal referral procedures for new priority recipients.

For a service decrease or termination, the provider must abide by CCSE staff's 12-day prior notice provided to the recipient before implementing the change. CCSE staff must advise the provider using the comments section on Form 2101, if applicable, not to implement an adverse action until after the 12-day notice. The recipient may appeal the decision and choose to continue to receive services pending the outcome of the appeal. These time frames apply only to those cases in which the provider has a current authorization for the recipient.

When the recipient requires an immediate change to the service plan, approve the change by phone or in person. Respond by the next business day when any of the following situations occur:

  • The recipient has a major illness and no available caregiver.
  • The recipient loses their caregiver suddenly, has no other available caregiver, and
    • is totally bedridden or unable to transfer from bed to chair without assistance;
    • cannot manage toileting tasks without personal assistance; or
    • needs meal preparation or feeding to ensure that they receive daily nourishment.

If necessary:

  • verbally authorize a service plan change;
  • initial the service arrangement column on Form 2060, Needs Assessment Questionnaire and Task/Hour Guide; and
  • send two copies of Form 2101 to the provider within two business days of the verbal request.

Related Policy 

Priority Status, 2540
Negotiated Referrals, 2631
Time Calculation, Appendix XVIII

4446 Suspension of Services and Interdisciplinary Team (IDT) Procedures

Revision 17-1; Effective March 15, 2017

The provider agency must suspend services if:

  • the individual permanently leaves the state or moves to a county in which the provider agency does not contract with the Texas Health and Human Services Commission (HHSC) to provide services under the Primary Home Care Program (see Section 4677.1, Individual Temporarily Leaving Service Area);
  • the individual moves to a location where services cannot be provided under the Primary Home Care Program;
  • the individual dies;

Note: When notified of an active SSI/Medicaid individual's death, complete and send Form SSA-1610-U2, Public Assistance Agency Information Request, to report the death of the individual to the Social Security Administration. Keep a copy of Form SSA-1610-U2 and file in the case record.

  • the individual is admitted to an institution. An institution is defined as a:
    • hospital;
    • nursing facility;
    • state school;
    • state hospital; or
    • intermediate care facility serving individuals with an intellectual disability or related conditions;
  • the individual requests that services or specific tasks end;
  • HHSC denies the individual’s Medicaid eligibility (not applicable to family care services); or
  • the individual or someone in the individual’s home exhibits reckless behavior, which may result in imminent danger to the health and safety of the individual, the attendant, or another person. If this occurs, the provider agency must make an immediate referral to:
    • the Texas Department of Protective and Regulatory Services or other appropriate protective services agency;
    • local law enforcement, if appropriate; and
    • the individual’s case worker.

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

The provider agency may also suspend services if:

  • the individual or someone in the individual’s home engages in discrimination against a provider agency or HHSC employee in violation of applicable law; or
  • the individual refuses services for more than 30 consecutive days.

The provider agency must notify the case worker by fax of any suspension by the next working 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 the reasons why the problem was not resolved.

The provider agency must convene an interdisciplinary team (IDT) meeting to resume services.

The provider agency must resume services after suspension:

  • upon the individual’s return home, or the date the provider agency becomes aware of the individual’s return home, if applicable;
  • on the date specified in writing by the case worker;
  • as a result of a recommendation by the IDT; or
  • upon the provider agency's receipt of notification from the case worker that the provider agency must resume services pending the outcome of the appeal.

The provider agency must notify the case worker in writing of the date services resume and must send the notice within seven days of that date.

4447 Reassessment

Revision 21-1; Effective June 1, 2021

Functional Assessment

Functional eligibility must be redetermined for Family Care at least every 12 months. At each annual functional reassessment, review the screening exception criteria and determine if the recipient’s circumstances have changed.

For example, if a person was placed on Family Care due to no personal care tasks, but at the annual reassessment now requires a personal care task, then refer the person to Primary Home Care (PHC) or Community Attendant Services (CAS).

If the recipient or provider reports interim changes between annual reassessments, apply the screening exception criteria at the next annual review.

If a recipient requests a change at the annual reassessment, the change must be worked within five days or by the annual reassessment due date, whichever is earlier.

Financial Assessment

Determine financial eligibility for Family Care at least every 24 months. If the person was previously determined ineligible for CAS due to resources, review the recipient’s current financial information.

If the recipient appears to meet the financial requirements for CAS, send Form H1200, Application for Assistance – Your Texas Benefits, along with verifications of income and resources to MEPD for a CAS financial determination.

If a recipient was determined eligible for Family Care due to receipt of QI-1 benefits, re-verify QI-1 benefits at each financial reassessment

Related Policy

Exception Criteria for Referrals to PHC or CAS, 2342.3
Exceptions to Verification Requirements, 3422
Content of Referral Packets, Appendix XIII

4448 Complaints

Revision 17-9; Effective September 15, 2017

An individual has the right to voice grievances or complaints concerning the Texas Health and Human Services Commission (HHSC) staff or purchased services without discrimination or retaliation. The individual has a right to report service delivery issues to the Health and Human Services Office of Ombudsman at 1-877-787-8999. If the case worker is aware of the issue, the case worker must work to resolve the individual's issues. See policy outlined in Section 2736.1, Reporting Service Delivery Issues, for detailed procedures in handling service delivery issues.