An official State of Texas website.
Revision 25-2; Effective March 31, 2025
Terminology
A contract termination occurs when a provider (business entity) will no longer have a contract with the Texas Health and Human Services Commission (HHSC). A contract termination requires that the person receiving services from HHSC be transferred to a different provider before the effective date of the contract termination. For Community Care Services Eligibility (CCSE), the term contract termination replaces contract cancellation.
A contract assignment occurs when a contract is transferred from one business entity to another business entity. In this situation, there is an exchange between two business entities and the receiving business entity is assigned a new provider number. When a contract assignment occurs, the affected person’s service authorization record is transferred to the new provider through an automated mass transfer process in the Service Authorization System Online (SASO).
Not all changes in the provider’s operation require a provider change action. A contracted provider may have a change in ownership where part of the business ownership changes, a complete change in ownership, or a name change in the provider’s license. Not all of these provider operations result in the change in provider number. For CCSE, the term contract assignment replaces contract conversion.
Contract Termination Transfer Determination Procedures
When a contracted provider decides to terminate its contract with HHSC or when a contract assignment is needed, the contractor must notify HHSC contract staff. Notification of a contract termination may be received by contract or regional management staff. The contract termination end date negotiated with the provider must be 60 calendar days or less after the date the written notice of contract termination is received. If contract termination is due to license revocation, the end date is 30 calendar days or less. Expedited transfer procedures must be used if the contract termination or assignment occurs with less than 10 calendar days notification to HHSC.
Upon notification of a contract termination or contract assignment, the regional director determines if transfers will be handled as either routine or expedited transfers. The regional director must immediately report to the Community Care Services Eligibility (CCSE) director when a decision to apply expedited transfer procedures is made. A decision to apply routine procedures does not require notification to state office staff. The regional director will advise the caseworker if the transfer will be accomplished using routine or expedited transfer procedures.
The caseworker must not initiate transfer procedures due to a contract termination until contract or regional management staff issues an official written notice to the provider.
If there is adequate time to refer the person to a new provider without disrupting services or adversely impacting the person, the regional director will advise the caseworker to use routine transfer procedures.
If there is not adequate time to refer the person to a new provider without disrupting services or if implementing routine procedures may adversely impact the person, the regional director will advise the caseworker to use expedited transfer procedures. An adverse impact is likely to occur when the person:
- requires total care;
- is unable to transfer from a bed to a chair without help;
- is unable to manage toileting tasks without help;
- is in danger of not receiving daily nourishment because they are unable to prepare or eat their meals without help;
- requires nursing services; or
- has no caregiver available to provide the tasks necessary to maintain the person’s health or welfare.
In some instances, services may be disrupted for a short time. However, if there is no adverse impact to the person, the regional director may advise the caseworker to use routine transfer procedures.
CCSE Routine Transfer Procedures for Contract Terminations
If the regional director directs staff to apply routine transfer procedures, the CCSE caseworker completes the following activities:
- Contacts the person to advise of the contract termination and to request the person’s choice of a new provider. If the person does not select a provider agency from the list of contracted agencies in the service area, an agency may be selected for the person as a last resort. The selection is assigned from a regional agency rotation log. The rotation log must be maintained and kept up to date. The regional director may designate a time frame for provider selection depending on the contract termination date.
- Reviews the person’s service plan for accuracy and if any changes are needed, revises the service plan. If the CCSE caseworker is unable to determine the person’s needs by phone, or if an annual assessment is due within 30 days, the CCSE caseworker makes a home visit to complete a reassessment of the person. If there are changes in the service plan, the CCSE caseworker sends Form 2101, Authorization for Community Care Services, to the current provider agency. The required time frame for conducting an annual reassessment is no longer three months.
- Negotiates the transfer date with both provider agencies avoiding any service disruption to the person whenever possible.
- Sends an initial referral packet to the new provider agency within five calendar days of the contact and sends the losing provider a copy of Form 2101.
For a routine transfer referral, the receiving provider follows procedures and requirements for initial referrals except for Primary Home Care (PHC) and Community Attendant Services (CAS). For PHC and CAS, a new practitioner’s statement is not required for the transfer.
Expedited Transfer Procedures for CCSE Contract Terminations
An expedited transfer must be used when there is not adequate time to use the routine referral process to refer the person to a new provider without disrupting services. In an expedited transfer, special procedures are used to quickly transfer the person to a provider that can promptly begin service delivery. The regional director determines when an expedited transfer should be used. Generally, an expedited transfer is used when the contract termination occurs with less than 10 calendar days notification to HHSC, a large number of people are involved in the transfer, or both.
The regional director designates a coordinator to work with contract staff and providers to establish transfer dates. The coordinator or caseworker identifies people whose annual reassessments are due or in process and negotiates, as instructed by the regional director or coordinator, an expedited service initiation date for people with the new provider.
Using the expedited transfer process, the person is offered a choice of providers. If the person does not select a provider agency from the list of contracted agencies in the service area at the point of contact, the caseworker assigns a provider from the regional agency rotation log. The rotation log must be maintained and kept up to date.
CCSE Expedited Transfer Procedures for Contract Terminations
If the regional director determines to apply expedited transfer procedures, the CCSE caseworker completes the following activities:
- Contacts the person to advise of the contract termination and to request the person’s choice of a new provider. If the person does not select a provider agency from the list of contracted agencies in the service area within the designated time frame, the person is assigned to a provider agency by rotation. The selection is assigned from a regional agency rotation log. The rotation log must be maintained and kept up to date.
- Reviews the person’s service plan for accuracy and if any changes are needed, revises the service plan. If the CCSE caseworker is unable to determine the person’s needs by phone or if an annual assessment is due within 30 days, the CCSE caseworker makes a home visit to complete a reassessment of the person. If there are changes in the service plan, the CCSE caseworker sends Form 2101 to the current provider agency. The required time frame for conducting an annual reassessment is no longer three months.
- Negotiates, as instructed by the regional director or coordinator, an expedited service initiation date for each person with the new provider and documents on Form 2065-A, Notification of Community Care Services, the negotiated effective date is due to expedited contract termination.
- Sends a referral packet to the new provider agency and notes Expedited Transfer on Form 2101 within five calendar days of the provider agency selection and sends the losing provider a copy of Form 2101.
For an expedited transfer referral, the receiving provider follows procedures and requirements for initial referrals except for PHC and CAS. For PHC and CAS, a new practitioner’s statement is not required for the transfer.
Contract Termination – Residential Living Arrangements
The transfer process for a person living in an adult foster care (AFC) home, assisted living (AL) facility, host family setting or residential care (RC) facility is complicated by the necessity to find a new living arrangement for the person. Use the following steps when handling a contract termination affecting a person living in an AFC, AL, host family or RC setting.
| Step | Responsibility | Action |
|---|---|---|
| 1 | Regional Director |
|
| 2 | Contract Staff |
|
| 3 | Caseworker |
|
Depending on the option selected by the person when a residential setting contract is terminated, the caseworker completes the appropriate procedures to complete the action. For example, if a person in a residential setting chooses to go to his daughter’s home in the community, the caseworker follows normal procedures for authorizing services in the community. If a person chooses to move or return to a nursing facility permanently, the caseworker follows normal procedures to terminate program eligibility and services.
Contract Terminations When No Other Provider is Available
In some situations, a provider may request to terminate its contract and there is no other provider available in the service area to provide that service. For example, if a Home-Delivered Meals provider terminates its contract, there may not be another provider in the service area to deliver meals. In that case, the HHSC caseworker must contact the person and offer any other available resources to meet that need. In this example, the person may elect to receive services by an attendant to prepare meals or locate a congregate meal location.
When a service is terminated rather than transferred to a new provider, the HHSC case worker must send Form 2065-A to the person noting the service is terminated due to the contract termination. The effective date of termination would be date of the contract termination.
Contract Assignment
Residential and Non-Residential Settings
After HHSC contract staff have negotiated the contract assignment effective date, contract staff will notify the regional director that the provider plans to assign its contract, as well as the contract assignment effective date. A transfer due to a contract assignment must not occur before the contract assignment effective date.
On or within two working days after the contract assignment effective date, regional staff must send Form 2097, Provider Contract Assignment Notification Letter, to the person informing them of the change in provider. The letter informs the person of the change in contract and offers the option to change to a provider selected by the person or remain with the new provider. The letter informs the person of the change in contract and offers the option to change to a provider selected by the person or remain with the new provider.
Person Chooses to Remain With the New Provider
After receiving confirmation of the automated mass transfer, the caseworker reviews the Texas Medicaid and Healthcare Partnership error page in the Service Authorization System Online (SASO) to identify a person whose service authorization record transfer was not processed. It should not be necessary to check each service authorization record. However, for CCSE, the SASO wizard will not replicate the provider change until the caseworker runs the wizard, selecting Provider Transfer. To prevent billing problems, the CCSE caseworker must complete a provider transfer in the SASO wizard immediately for a person whose service authorization records were not automatically converted. For help with a person whose service authorization records were not automatically converted, contact the coordinator or the regional Claims Management Services (CMS) coordinator.
The losing provider should provide the new provider with all applicable forms. If the losing provider does not provide the forms to the new provider, the caseworker must provide copies of the current forms to the new provider. For CCSE, refer to Appendix XIII, Contents of Referral Packets, for the list of forms to be sent for provider transfers.
It is not necessary to get acceptance by the new provider or send Form 2065-A to the person or new provider. The caseworker must document the transfer was due to a contract assignment from the losing provider to the new provider. In a mass transfer completed through the automated transfer process, only the SASO service authorization records are automatically changed to end the losing provider and authorize all services to the gaining provider.
For CCSE, the SASO wizard does not automatically update all data. The provider transfer must be processed in the wizard so the history and Form 2101 data will match changes to the service authorization records.
Person Chooses to Change to a Different Provider
If the person chooses to change from the new provider that received the contract assignment to a provider selected by the person, the caseworker must complete two provider change actions. The CCSE caseworker uses the SASO wizard to complete the provider change actions. The first provider change action is to change service authorizations from the losing provider to the new provider for services delivered after the contract assignment effective date. The second provider change action is to change service authorizations from the new provider to the provider selected by the person for services.
Both CCSE provider change actions must be completed within the time frame in 4676, Change of Providers.
For all programs, the person may change providers at any time, as described in current procedures regardless of any changes in the provider’s operation.