Appendix XIX, Case Management Time Frames

Revision 18-1; Effective June 15, 2018

Intake Procedures

SectionType of Response Visit with IndividualTime Period
2320immediatewithin 24 hours from the date of assignment.
2320expeditedwithin five calendar days from date of assignment.
2320routinewithin 14 calendar days from date of assignment.

Assessment and Reassessment Procedures

Section  
2611, 2611.1Determine eligibility for Community Care Services Eligibility (CCSE) services:within 30 calendar days from date the signed application is received by the Texas Health and Human Services Commission (HHSC). Applications for Community Attendant Services (CAS) must be referred to Medicaid for the Elderly and People with Disabilities (MEPD) staff for a financial eligibility determination. Because the MEPD process can take up to 45 days for regular referrals and 90 days if a disability determination is required, this may delay Community Care Services Eligibility (CCSE) certification beyond the 30-day time frame.
2330Conduct a home visit with all individuals who had initial assessments conducted in a place other than the individual’s home:within 30 calendar days after service initiation.
2711

Reassess the individual's need for CCSE services (Form 2060, Needs Assessment Questionnaire and Task/Hour Guide, Part A):

Case workers coordinating Community Attendant Services (CAS) reassessments with the 90-day monitoring visit will have to complete the reassessment within 90 days of the previous monitoring visit to avoid a monitoring timeliness error.

by the end of the 12th calendar month following the previous functional assessment date on Form 2060.

within 90 days of last monitoring visit.

2810

Notify applicant in writing of eligibility for service:

Reassess individual need and redetermine eligibility with a face-to-face or telephone interview as required by the region:

within two business days of the date of the decision.

Financial: by the end of the 24th month following the date eligibility rules processed on Form 2064, Eligibility Worksheet.

Functional: by the end of the 12th month following the date of the previous assessment.

Service Planning Procedures

Section  
2344Obtain a new Form 2307, Rights and Responsibilities:

Adult Foster Care: before services are authorized or reauthorized. A new form must be completed and signed whenever information on the original form becomes outdated or incomplete.

all other services: initially. A new form must be completed and signed whenever information on the original form becomes outdated or incomplete.

 2440Complete or update Form 2060, Part B, for CAS, Primary Home Care (PHC) and Family Care (FC):

at initial assessment;

at each annual review; and

when raising or lowering hours for a task or a service.

Authorizations and Reassessments

Section  
2631, 4652.2Initiate verbal referrals for individuals who meet the criteria for immediate or expedited responses and who need immediate initiation of service:no later than the next business day after the day the individual is visited and it is determined that a verbal referral is necessary.
2631After initiating verbal referral, send Form 2101, Authorization for Community Care Services, to the provider:within two business days from the date the applicant was determined eligible for a verbal referral.
2632For applicants who do not require verbal referrals, authorize services by sending Form 2101 to the provider:within five business days from the date the applicant is determined eligible.
2632For services other than CAS, contact the provider if Form 2101 or another notification of status of referral is not received:by the 21st calendar day from the date of referral.
2611.1If the eligibility process is delayed past the 30-day time frame due to pending Medicaid for the Elderly and People with Disabilities (MEPD) eligibility:the case worker verifies MEPD status on or before the 25th day from the application date and performs weekly checks until the eligibility decision is received using the Texas Integrated Eligibility Redesign System (TIERS) records. The TIERS checks must be documented in the record.
2721.4If a functional reassessment mandates a change in the individual's service plan:the change must be completed as part of that reassessment.

Service Monitoring and Evaluation

Section  
2710.2Make a home visit for CAS individuals (regardless of priority):at least every 90 calendar days from the previous home visit.
2710.2

Make a home visit, if required by the region, for priority status individuals (other than CAS individuals):

Make a home visit, if required by the region, for non-priority status individuals (other than CAS individuals):

by the end of the sixth month following the previous monitoring contact.

within six months of the last monitoring contact.

Denying or Reducing Services

Section  
2810Notify applicant in writing of ineligibility for service:within two business days of the date of the decision.
2810, 2811Notify the individual in writing of reduction or termination of service:at least 12 calendar days before the effective date of the decision. (See Appendix IX, Notification/Effective Date of Decision, or Section 2811, Effective Dates for Service Reduction and Termination, for exceptions to 12 days notice and for effective dates for service reduction or termination in cases of appeal).
2822.1If an individual enters a nursing facility or an institution, verify the action and determine probable length of stay. If length of stay is likely to be more than 30 days:immediately terminate any authorized CCSE services by submitting Form 2101, using the date of entry into the nursing facility as the termination date and close out on the Service Authorization System (SAS).
2840,
Appendix IX		If an individual threatens his own health or safety or that of others, purchased services may be terminated:send Form 2065-A, Notification of Community Care Services, by the next work day after receiving a notice from the provider that services have been suspended for threats to health and safety. Services may be terminated immediately.

Responding to Requests for Service Interruptions, Suspensions and Reported Changes

Section  
2810, 2814Notify the individual in writing when there is a change in type or amount of services authorized:any changes in the individual’s service plan. Examples include increases/decreases in units/hours of service, increases/decreases in units/hours of service, increases/decreases in copay, adding a new service or transfers from FC to PHC
2814,
Appendix IX		Transfers from PHC/CAS to FC:allow 12 calendar days advance notice (See Appendix IX for exceptions).
2821The provider must notify the case worker of a suspension:on the day of the suspension or by the first workday following the suspension.
 2822.1If an individual enters a nursing facility, hospital or an institution, verify the action and determine probable length of stay. If length of stay is likely to be 30 days or less:suspend services effective the date the individual enters the nursing facility, hospital or institution and send Form 2067, Case Information, to providers.
2721When learning of a change in the individual's condition/status, revise the service plan or document why no changes are needed:within 14 calendar days of learning of a change.
4445, 4673.4When the individual requires an immediate change in CAS, FC or PHC service plan due to situations listed in these sections, respond:for FC, by the next workday and for PHC or CAS, within the same day of receipt of the request.
2736.1When there is a reason to believe that an individual has been abused, neglected or exploited, make a referral to Adult Protective Services or Child Protective Services, as appropriate:within 24 hours if there is an immediate or imminent threat to the health and safety of the individual.
2723When there is a request to change providers:within 14 days of the individual's request.