Revision 24-3; Effective July 1, 2024

The Texas Health and Human Services Commission (HHSC) implemented processes for Utilization Review (UR) in the Community Care Services Eligibility (CCSE) Services, effective March 1, 2009.

The UR process for CCSE includes concurrent reviews of a random sample of cases for people receiving:

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

A concurrent review is a UR of an ongoing service where the cases are randomly selected. They do not occur during the application process. 

5110 Concurrent Reviews of Randomly Selected Active Cases

Revision 24-3; Effective July 1, 2024

Concurrent reviews are conducted on a random sample of active Primary Home Care (PHC) and Community Attendant Services (CAS) cases. The utilization review nurse contacts the caseworker and requests all or a portion of the documentation specified for the review. The caseworker provides the documentation within seven calendar days of the request. Depending on available information, the UR nurse may make a home visit or a Home and Community Support Services agency visit in addition to a desk review.