2300, Service Planning

Revision 17-1; Effective November 1, 2017

The case manager facilitates Service Planning Team (SPT) meetings. The SPT process uses a person-centered planning processes to develop a plan for the provision of supports and services necessary for the individual's functioning and to maintain integration in the community. After all requirements for eligibility are met, and at least annually thereafter, the case manager, the applicant/individual/legally authorized representative (LAR), DSA representative(s) (as defined in Section 3300, Service Planning), and other people requested by the applicant/individual/LAR meet to develop a proposed Form 3621, CLASS/CFC – Individual Plan of Care (IPC). The case manager must use the SPT notes in conjunction with Form 3629, IPP-A to document use of person-centered planning processes.

The case manager, using the discovery process as the basis for collecting information, develops the person-centered plan with the individual, legally authorized representative (LAR), the CMA, DSA representative, and others, as requested by the individual or LAR.

Examples of the discovery process include, but are not limited to:

  • information about the person gained from engaging in conversations with the individual, LAR and those who know the individual best, such as a provider staff, caregiver, family member and friend;
  • utilizing the Planning Alternative Tomorrows with Hope (PATH) method;
  • utilizing methods taught by The Learning Community for Person Centered Practices (TLCPCP), which occur with the support of a group of people chosen by the individual (and the legally authorized representative (LAR) on the individual's behalf).

The person-centered planning process:

  • accommodates the individual's style of interaction, communication and preferences regarding time and setting;
  • identifies the individual’s strengths, preferences, support needs and desired outcomes;
  • identifies what is important to the individual;
  • identifies and document the individual’s current and preferred living arrangement;
  • determines the service needs of an individual;
  • assesses the individual's needs, functional impairments, ability to perform activities of daily living (ADLs), instrumental activities of daily living (IADLs) and health-related tasks;
  • identifies natural supports available to the individual and needed service system supports;
  • documents the individual’s preferences for when to receive CLASS services;
  • documents the risks to the individual’s health and safety, as well as a plan to mitigate those risks;
  • identifies any special needs, requests or considerations staff should know when supporting this individual; and
  • documents the individual’s unmet needs.

Additional guidance and information about person-centered planning can be found on the HHSC website.

Meetings of the SPT to develop the enrollment IPC and the renewal IPC should be held in the individual’s own home or family home whenever possible. If it is not possible, the SPT must document why the meeting could not be held in the individual’s home. While individuals or their LAR may request the case manager meet in locations other than their own home/family home, case managers should remind them that meeting in the home allows the SPT the opportunity to determine if other needs of the individual may be met by through CLASS or CFC services. The enrollment and renewal IPC must be signed in person by the SPT.

SPT activities to revise a current IPC may occur via conference call in lieu of a face-to-face meeting. Revisions of the current service plan may be signed by facsimile.

The case manager is required to ensure that the SPT develops a transportation plan if habilitation transportation is included on the IPC. Information on completing Form 3598, Individual Transportation Plan is available in the instructions.

The proposed IPC must specify:

  • the type of CLASS program services to be provided to the individual;
  • the number of units of each CLASS program service;
  • the number of units of each CFC service (except support management)
  • the estimated annual cost of all CLASS program and CFC services; and
  • other services or supports to be provided to the individual through sources other than the CLASS program.

As part of the service planning process, the SPT will also develop an IPP on Form 8606, Individual Program Plan (IPP).

An IPP is needed for each CLASS program service listed on the proposed IPC. Each IPP describes:

  • CLASS program services to be provided;
  • frequency of service provisions;
  • observable and measurable goals and objectives;
  • title of person responsible for goals and objectives;
  • justification for services based on needs identified by the SPT;
  • duration of services; and
  • support services provided through non-waiver resources.

The IPP-A and SPT notes are created by the case manager during the SPT meeting to document use of person-centered planning processes. The IPP-A and SPT notes summarize the outcome of the meeting and must be included with the IPP-A to provide additional information. The SPT notes must include, at a minimum:

  • each service being requested by the SPT;
  • planned service schedules for each service requested;
  • units/amount of each service requested; and
  • signature and date of each SPT member present at the meeting.

If the individual requests a therapeutic service (e.g., occupational therapy, physical therapy, speech and language pathology, behavioral support, audiology, dietary service, auditory enhancement training or any specialized therapy), the case manager must initiate Form 8606-A, Therapy Justifications – Attachment to IPP, based on the deliberations of the SPT. The case manager must coordinate the completion of Attachment A with the appropriate professional. Since this professional is employed by, or contracts with, the DSA, assistance from the DSA is vital to ensure the case manager performs this function. The signature date of the professional on Attachment A may precede the effective date of the IPC that identifies the individual’s need for the service or continuation of the need for the service by no more than 120 days.

The case manager is responsible for initiating revisions to the individual's IPC and IPP-A as determined necessary throughout each plan year. The case manager will submit all proposed IPCs and revised IPP-A to HHSC.

On an ongoing basis, the case manager must assist individuals in gaining access to needed CLASS services and other services and supports, including medical, social, and educational resources, regardless of the funding source for the services and supports.

All requests from HHSC related to the UR process must be submitted within the period outlined in Section 5000.

The CMA is responsible for providing a copy of the following documentation to all SPT members within 10 business days from HHSC authorization, including the financial management services agency (FMSA), if the individual receives a service through the Consumer Directed Services option:

  • authorized Form 3621, CLASS/CFC — Individual Plan of Care;
  • Form 3629, Individual Program Plan Addendum;
  • Form 8606, Individual Program Plan (IPP);
  • SPT notes;
  • Form 8606-A, Therapy Justifications — Attachment to IPP, if applicable;
  • Form 3660, Request for Adaptive Aids, Medical Supplies, Minor Home Modifications or Dental Services/Sedation, if applicable; and
  • additional documentation as agreed upon by the SPT.

2310 Enrollment

Revision 19-4; Effective November 8, 2019

At the time an applicant receives a written offer of a CLASS program vacancy from HHSC, the applicant must select a CMA within 30 calendar days after the date of the written offer. HHSC notifies the selected CMA the applicant has chosen the agency to provide case management services. According to the Selection Determination document the CMA then completes the following:

  • Form 3657, Pre-Enrollment Assessment;
  • Form 8507, Understanding Program Eligibility - CLASS/DBMD;
  • assists the applicant with the application process for Medicaid eligibility, if needed; and
  • provides general information regarding the CLASS Medicaid waiver program to CLASS applicants.

The case manager must provide the applicant/individual the CLASS Program brochures in English or Spanish, as appropriate.

The case manager should take advantage of this opportunity to describe the person-centered planning process, as described in Section 2300, that will be used to develop the IPP-A.

Upon notification that the applicant has selected the CMA, a case manager must be assigned to the applicant. The CMA must have a written process that ensures case managers are or can readily become familiar with individuals to whom they are not ordinarily assigned, but to whom they may be required to provide case management.

The case manager must complete the following functions within 14 calendar days of the CMA's receipt of the Selection Determination document from HHSC:

  • provide applicant/legally authorized representative (LAR) with name and contact information, including an alternate contact in case of absence of the case manager;
  • conduct an initial face-to-face, in-home visit with the applicant/LAR that must include providing an oral and written explanation of:
    • CLASS program services;
    • CFC services available in the CLASS program through the Medicaid State Plan;
    • CFC personal assistance services/habilitation (CFC PAS/HAB), which provides all the activities of habilitation, except habilitation transportation services;
    • CFC emergency response services (CFC ERS), which is provided as a CFC service;
    •  CFC support management;
    • the eligibility requirements for CLASS Program services and CFC services using Form 8507, Understanding Program Eligibility- CLASS/DBMD;
    • the mandatory participation requirements;
    • the CDS option;
    • the complaint process;
    • information about cognitive rehabilitation therapy (CRT) and assistance for the individual to obtain a neurobehavioral or neuropsychological assessment and plan of care from a qualified professional using Medicaid State Plan, if appropriate;
    • Form 8601, Verification of Freedom of Choice, specifying choice of CLASS services instead of institutional services in an Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID);
    • provide information regarding voter registration, if the applicant is age 18 or older;
    • if the applicant is transferring from an institution, provide information regarding Transition Assistance Services (TAS):
      • ensuring the proper information is included on Form 8604, Transition Assistance Services (TAS) Assessment and Authorization;
      • sending the completed form to HHSC for authorization with the proposed enrollment IPC;
      • sending the authorized form to the TAS provider; and
      • including the TAS and the monetary amount authorized by HHSC on the individual's proposed enrollment IPC;
    • provide an oral and written explanation to the applicant/LAR describing that the DSA may be requested to provide CFC PAS/HAB or out-of-home respite in a camp while the individual is temporarily staying outside the catchment area in which the individual resides, but within the state of Texas, as described in 40 TAC §45.702 , including that the DSA may accept or decline the request;
      • provide the following information regarding required use of the Electronic Visit Verification (EVV):
      • EVV will not change the services the individual receives.
      • EVV helps HHSC make sure authorized services are received.
      • EVV is mandatory for all DSAs and individuals receiving services from a CFC PAS/HAB services provider, unless the individual receives services through the CDS
      • The CFC PAS/HAB services provider will need the applicant’s permission to use the telephone to call a toll-free number at the start and at the end of work.
      • If the applicant does not have a telephone or does not want the CFC PAS/HAB services provider to use his telephone, a fixed verification device can be placed in the home, which is used only to verify the CFC PAS/HAB services provider’s start and end of work.
      • EVV is mandatory for all DSAs and applicants who will be receiving services from a CFC PAS/HAB services provider, unless the applicant elects to receive services through the CDS option.
      • Failure to cooperate will result in the suspension or termination of services.
      • If the applicant has additional questions, the case manager refers him to the selected DSA or FMSA for additional information on how EVV works;
    • complete Form 3657; and
    • verify residency to ensure the applicant lives in his own or family home that is located within the catchment area for which the CMA has a current Community Services Contract (Provider Agreement), to provide CLASS program services.

The case manager must complete the following functions within two business days following the initial face-to-face assessment:

  • evaluate the applicant's need for CFC PAS/HAB services;
  • assist with Medicaid eligibility processes, as necessary;
  • verify the individual is not enrolled in another 1915(c) Medicaid waiver program or any other mutually exclusive services or programs (See Appendix III, Mutually Exclusive Services); and
  • provide the DSA with a completed Form 3657.

Within 30 calendar days of notification by the DSA of HHSC approval of diagnostic/functional eligibility for an individual as identified on Form 8578, Intellectual Disability/Related Condition Assessment, the case manager must convene the SPT to develop the enrollment IPC, Form 3621, CLASS/CFC – Individual Plan of Care (IPC) and Form 3629, Individual Program Plan Addendum using a person-centered planning process as described in Section 2300.

The SPT must include, at a minimum, the applicant/LAR, case manager and a DSA representative. The individual or LAR may request the SPT include professionals who are qualified by certification or licensure, or training and experience in the habilitation needs of people with related conditions, or directly involved in the delivery of services and supports to the individual. The SPT may include any other people requested by the individual/LAR. The SPT must make every effort to accommodate these requests by the individual/LAR.

Within 10 business days of HHSC transmission of the authorized enrollment IPC, as evidenced by the fax transmittal date on the documents, the case manager must provide copies of the authorized Form 3621, Form 8606, Form 3629, the SPT notes, Form 8606-A (if applicable), Form 3660 (if applicable), and additional documentation as agreed upon by the SPT to all members of the SPT. The case manager must provide copies of this documentation to any additional CLASS service providers (FMSA, Continued Family Services [CFS], and Support Family Services [SFS]), as necessary. The case manager must maintain documentation of transmission of all necessary documents.

Form Resources

The following forms may need to be completed as part of the enrollment process:

  • Form 1351, Request to Withdraw from the CLASS Application Process
  • Form 1581, Consumer Directed Services Option Overview
  • Form 1582, Consumer Directed Services Responsibilities
  • Form 1583, Employee Qualification Requirements
  • Form 1584, Consumer Participation Choice
  • Form 1740, Service Backup Plan
  • Form 2067, Case Information
  • Form 3596, PAS/Habilitation Plan — CLASS/DBMD/CFC
  • Form 3598, Individual Transportation Plan
  • Form 3621, CLASS/CFC — Individual Plan of Care
  • Form 3623, Approval of Application for CLASS
  • Form 3625, CLASS/CFC — Documentation of Services Delivered
  • Form 3628, Provider Agency Model Service Backup Plan
  • Form 3629, Individual Program Plan Addendum
  • Form 3657, Pre-Enrollment Assessment
  • Form 4800-D, DADS Fair Hearing Request Summary
  • Form 8001, Medicaid Estate Recovery Program Receipt Acknowledgement
  • Form 8507, Understanding Program Eligibility - CLASS/DBMD
  • Form 8598, Non-Waiver Services
  • Form 8601, Verification of Freedom of Choice
  • Form 8604, Transition Assistance Services (TAS) Assessment and Authorization
  • Form 8606, Individual Program Plan (IPP)
  • Form H1010, Texas Works Application for Assistance – Your Texas Benefits
  • Form H1200, Application for Assistance – Your Texas Benefits
  • Form H1350, Opportunity to Register to Vote
  • Form H3034, Disability Determination Socio-Economic Report
  • Form H3035, Medical Information Release/Disability Determination

Submission Standard — Enrollment

The following submission standards apply when submitting enrollment paperwork to HHSC:

  • Choice Lists for the CLASS Program
  • Form 3596, PAS/Habilitation Plan - CLASS/DBMD/CFC
  • Form 3598, Individual Transportation Plan (only include if this specific service has been proposed as part of an enrollment IPC)
  • Form 3621, CLASS/CFC – Individual Plan of Care
  • Form 3629, Individual Program Plan Addendum
  • Form 3660, Request for Adaptive Aids, Medical Supplies, Minor Home Modifications or Dental Services/Sedation (only include if this specific service has been proposed as part of an enrollment IPC)
  • Form 3849-A, Specifications for Adaptive Aids/Medical Supplies/Minor Home Modifications, including bids (only include if funding for specifications has been proposed as part of an enrollment IPC)
  • Form 6515, CLASS/DBMD Nursing Assessment
  • Form 8578, Intellectual Disability/Related Condition Assessment
  • Form 8598, Non-Waiver Services
  • Form 8601, Verification of Freedom of Choice
  • Form 8604, Transition Assistance Services (TAS) Assessment and Authorization (only include if this specific service has been proposed as part of an enrollment/renewal IPC)
  • Form 8606, Individual Program Plan (IPP)
  • Form 8606-A, Therapy Justifications – Attachment to IPP (only include if this specific service has been proposed as part of an enrollment IPC)

Submission Standard — Pre-enrollment

The following submission standards apply when submitting paperwork containing funding proposals for pre-enrollment efforts to HHSC:

  • Form 3625, CLASS/CFC – Documentation of Services Delivered;
  • Form 3657, Pre-Enrollment Assessment (partial assessment fee); or
  • Form 3621, CLASS/CFC – Individual Plan of Care (full assessment fee)

2320 Renewal

Revision 17-1; Effective November 1, 2017

The case manager must complete the following functions no less than 30 calendar days and no more than 90 calendar days before the end of the current IPC year:

  • provide an oral and written explanation to the individual/legally authorized representative (LAR) describing that the DSA) may be requested to provide CFC PAS/HAB or out-of-home respite in a camp while the individual is temporarily staying outside the catchment area in which the individual resides, but within the state of Texas. The service period cannot exceed 60 consecutive days. The case manager must provide the information contained in 40 TAC §45.702 regarding this option, including the DSA option to accept or decline the individual’s request;
  • provide information about cognitive rehabilitation therapy (CRT) and assistance for the individual to obtain a neurobehavioral or neuropsychological assessment and plan of care from a qualified professional using Medicaid State Plan, if appropriate;
  • provide Form 8601, Verification of Freedom of Choice, specifying the individual’s choice to continue to receive CLASS services instead of ICF/IID and obtain the individual’s signature;
  • convene a SPT to develop using person-centered planning processes:
    • a renewal IPC – the CLASS program services on the proposed renewal IPC must meet the following standards:
      • are necessary to protect the individual's health and welfare in the community;
      • address the individual's related condition;
      • are not available to the individual through any other source, including the Medicaid State Plan, other governmental programs, private insurance or the individual's natural supports;
      • prevent the individual's admission to an institution;
      • are the most appropriate type and amount of CLASS program services to meet the individual's needs; and
      • are cost effective;
    • a renewal IPP for each service proposed on the renewal IPC;
    • the IPPA; and
    • a CFC PAS/Habilitation Plan;
  • submit to HHS:
    • Form 3629, Individual Program Plan Addendum;
    • Form 3621, CLASS/CFC — Individual Plan of Care;
    • Form 8606, Individual Program Plan (IPP); the SPT notes;
    • Form 8606-A, Therapy Justifications — Attachment to IPP, if applicable;
    • Form 3660, Request for Adaptive Aids, Medical Supplies, Minor Home Modifications or Dental Services/Sedation, if applicable; and
    • additional documentation as agreed upon by the SPT for review; and
  • submit a copy of the proposed renewal IPC to the FMSA, if applicable.

Within 10 business days of HHSC transmission of the authorized renewal IPC, as evidenced by the fax transmittal date on the documents, the case manager must provide copies of the authorized Form 3621, Form 8606, Form 3629, the SPT notes, Form 8606-A (if applicable), Form 3660 (if applicable), and additional documentation as agreed upon by the SPT to all members of the SPT. The case manager must provide copies of this documentation to any additional CLASS service providers (FMSA, Continued Family Services [CFS], and Support Family Services [SFS]) as necessary. The case manager must maintain documentation of transmission of all necessary documents.

The CMA must electronically access MESAV to verify that the services authorized on the renewal IPC are consistent with those authorized in MESAV by HHSC.

At HHSC's request, the CMA must submit additional documentation supporting the proposed renewal IPC to HHSC within 10 calendar days after HHSC requests it. The date of HHSC’s request for additional documentation is determined by the date on Form 2067, Case Information, faxed to the CMA that requests the additional documentation.

If HHSC notifies the CMA of the denial or reduction of a CLASS program or CFC service, see Section 2400, Denial, Reduction, Suspension and Termination.

Form Resources

The following forms may need to be completed as part of the renewal process:

Submission Standard

The following submission standards apply when submitting renewal paperwork to DADS:

  • Choice Lists for the CLASS Program
  • Form 3596, PAS/Habilitation Plan — CLASS/DBMD/CFC
  • Form 3598, Individual Transportation Plan (only include if this specific service has been proposed as part of a renewal IPC)
  • Form 3621, CLASS/CFC — Individual Plan of Care
  • Form 3629, Individual Program Plan Addendum
  • Form 3660, Request for Adaptive Aids, Medical Supplies, Minor Home Modifications or Dental Services/Sedation (only include if this specific service has been proposed as part of a renewal IPC)
  • Form 3849-A, Specifications for Adaptive Aids/Medical Supplies/Minor Home Modifications, including bids (only include Form 3849-A if funding for specifications has been proposed as part of a renewal IPC)
  • Form 6515, CLASS/DBMD Nursing Assessment
  • Form 8578, Intellectual Disability/Related Condition Assessment (ID/RC)
  • Form 8598, Non-Waiver Services
  • Form 8601, Verification of Freedom of Choice
  • Form 8606, Individual Program Plan (IPP)
  • Form 8606-A, Therapy Justifications – Attachment to IPP (only include if this specific service has been proposed as part of a renewal IPC)

2330 Revision

Revision 17-1; Effective November 1, 2017

When the case manager is notified of a needed revision to the IPC, the case manager must ensure:

  • a proposed IPC revision includes:
    • an IPP for each service revised on the proposed IPC;
    • a revised Form 3629, Individual Program Plan Addendum, if applicable; and
    • a revised PAS/Habilitation Plan - CLASS/DBMD/CFC, if the individual’s needs have changed substantially since the most recent revision;
  • the CLASS program services on the proposed IPC revision must meet the following standards:
    • are necessary to protect the individual's health and welfare in the community;
    • address the individual's related condition;
    • are not available to the individual through any other source including the Medicaid state plan, other governmental programs, private insurance or the individual's natural supports;
    • prevent the individual's admission to an institution;
    • are the most appropriate type and amount of CLASS program services to meet the individual's needs;
    • are cost effective; and
  • the proposed IPC, IPP-A, IPPs, and PAS/Habilitation Plan - CLASS/DBMD/CFC are submitted to HHSC for review at least 30 calendar days before the effective date proposed by the SPT.

At the request of HHSC, the CMA must submit additional documentation supporting the proposed IPC revision to HHSC within 10 calendar days after HHSC requests it. The date of HHSC’s request for additional documentation is determined by the date on Form 2067, Case Information, faxed to the CMA that requests the additional documentation.

If HHSC notifies the CMA of the denial or reduction of a CLASS program or CFC service, see Section 2400, Denial, Reduction, Suspension and Termination.

Within five business days of HHSC’s transmission of the authorized IPC, as evidenced by the fax transmittal date on the documents, the case manager must provide copies of the following to all members of the SPT:

  • Form 3621, CLASS/CFC — Individual Plan of Care;
  • Form 8606, Individual Program Plan (IPP);
  • Form 3629, Individual Program Plan Addendum,
  • the SPT notes;
  • Form 8606-A, Therapy Justifications — Attachment to IPP, if applicable;
  • Form 3660, Request for Adaptive Aids, Medical Supplies, Minor Home Modifications or Dental Services/Sedation, if applicable; and
  • additional documentation as agreed upon by the SPT.

The case manager must also provide copies of the above documentation within five business days of HHSC’s transmission of the authorized IPC to any additional CLASS service providers (FMSACFS, and SFS), as necessary. The case manager must maintain documentation of transmission of all necessary documents.

The CMA must electronically access MESAV to verify that the services authorized on the renewal IPC are consistent with those authorized in MESAV by HHSC.

Submission Standard

The following submission standards apply when submitting revision paperwork to HHSC:

  • Form 3596, PAS/Habilitation Plan – CLASS/DBMD/CFC (only include if this specific service has been proposed as part of an IPC revision marked "New" or "Change" in Field 16a on Form 3621)
  • Form 3598, Individual Transportation Plan (only include if this specific service has been proposed as part of an IPC revision marked "New" or "Change" in Field 16a on Form 3621)
  • Form 3621, CLASS/CFC – Individual Plan of Care
  • Form 3629, Individual Program Plan Addendum
  • Form 3660, Request for Adaptive Aids, Medical Supplies, Minor Home Modifications or Dental Services/Sedation (only include if this specific service has been proposed as part of an IPC revision marked "New" or "Change" in Field 16a on Form 3621)
  • Form 3849-A, Specifications for Adaptive Aids/Medical Supplies/Minor Home Modifications, including bids (only include if funding for specifications has been proposed as part of an IPC revision)
  • Form 6515, CLASS/DBMD Nursing Assessment
  • Form 8598, Non-Waiver Services
  • Form 8606, Individual Program Plan (IPP) (only include if this specific service has been proposed as part of an IPC revision marked "New" or "Change" in Field 16a on Form 3621)
  • Form 8606-A, Therapy Justifications – Attachment to IPP (only include if this specific service has been proposed as part of an IPC revision marked "New" or "Change" in Field 16a on Form 3621)

2331 Immediate Jeopardy of CLASS Individual

Revision 17-1; Effective November 1, 2017

When the CMA receives written documentation from the DSA indicating the DSA provided CFC PAS/HAB, respite, nursing, dental services or an adaptive aid that is not included on the individual's IPC in response to a situation of the individual's immediate jeopardy, the case manager must complete and submit the following to HHSC:

  • a proposed IPC revision;
  • revised IPP-A, if appropriate;
  • revised Individual Program Plans (IPPs); and
  • documentation to HHSC within seven calendar days of notification by the DSA.

For the above, the CMA must use the date which the DSA RN documented determination the individual was subject to immediate jeopardy without the provision of additional CFC PAS/HAB, respite, nursing, dental services, or an adaptive aid that is not included on the individual's IPC as the IPC revision effective date.

The documentation furnished to the CMA by the DSA must include:

  • a description of circumstances necessitating the provision of the new service or the increase in the amount of the existing service; and
  • documentation by a registered nurse of the nurse's determination the service was necessary to prevent the individual's health and safety from being placed in immediate jeopardy.

HHSC authorizes the IPC only if, after reviewing the documentation, HHSC determines the service was necessary to prevent the individual's health and safety from being placed in immediate jeopardy.

At HHSC request, the CMA must submit additional documentation supporting the proposed IPC revision to HHSC within 10 calendar days.

Form Resources

The following forms may need to be completed as part of the revision process:

2340 Transfer

Revision 17-1; Effective November 1, 2017

When the individual/legally authorized representative (LAR) notifies the case manager they wish to be transferred to a different agency(s), the case manager must:

  • document in the individual's IPP-A the date the transfer request was received;
  • provide the individual/LAR with the most current choice list document for the applicable catchment area;
  • within three business days, make transfer arrangements with the individual/LAR, the receiving CMA DSA or FMSA, as appropriate;
  • establish an effective date for the individual's transfer that is at least 14 calendar days after the date of receiving notice of intent to transfer; and
  • coordinate with the agencies involved in the transfer to determine the number of needed service units for each authorized service code.

The current CMA must submit the following to HHSC before the effective date of the transfer:

Form Resources

The following forms may need to be completed as part of the transfer process:

Submission Standard

The following submission standards apply when submitting transfer paperwork to HHS:

2350 IPP Service Review

Revision 17-1; Effective November 1, 2017

The case manager is responsible for ongoing monitoring of:

  • the provision of CLASS program and CFC services; and
  • the status of non-CLASS program services and supports.

The case manager must meet with the individual or LAR in the individual's home, or other location if services are not primarily provided in the individual’s home, to review the IPC and update the IPP-A if needed. CMA Individual Program Plan (IPP) service reviews will occur in accordance with the schedule in Appendix X, IPP Service Summary/IPP Service Review Due Dates Chart, from the effective date of the most recent enrollment or renewal IPC. The fourth IPP service review of the IPC year is combined with the meeting of the SPT to develop a renewal IPC. The IPP-A and SPT notes will document the development of the renewal IPC using person-centered planning processes. The case manager must use Form 3595, IPP Service Review, to document the review of the services delivered to the individual since the ninth month IPP service review.

The purpose of meeting the individual or LAR in the setting where services are delivered is to allow the case manager to verify that services listed on the IPC are delivered as described in the Individual Program Plan (IPP). This function is best accomplished by the case manager observing CLASS services in the setting in which they are provided. Since most individuals receive CLASS services in the home setting, the IPP service reviews should occur in the location where the majority of services are delivered.

While individuals or their LAR may request the case manager meet in locations other than their own home/family home, case managers should remind them that a complete assessment of services provided to the individual is required to be performed in the setting in which those services are delivered. Case managers must document when and why an individual or LAR refuses to meet in the home setting in the “General Comments” section of Form 3595.

During the IPP service review face-to-face contact with the individual, the case manager must complete Form 3595 to:

  • review the services received as documented on the IPC;
  • document progress or lack of progress toward goals/objectives as identified on the IPP/IPC;
  • assess the individual's satisfaction with the provision of CLASS program services;
  • determine if the service backup plan was implemented and if it met the needs of the individual; and
  • identify any changes to the individual's needs to include any needed revisions to the service backup plan.

The case manager is required to complete all sections of Form 3595 for CLASS services provided to an individual. The case manager may choose to print only those pages that reflect the services reviewed and provide them to the individual, the DSA and any additional CLASS service providers (FMSACFS, and SFS), as necessary.

If an individual's IPC includes any nursing services or CFC PAS/HAB, and any of those services are not currently identified as requiring a service backup plan, the case manager must discuss with the individual or LAR whether any of those services may now be critical to the individual's health and safety. If the case manager and individual/LAR determines either service may now be critical to the individual's health and safety, the case manager must convene the SPT to discuss development of a service backup plan.

The case manager must also ask the individual/LAR if a service backup plan was implemented during the most recent review period and discuss the implementation of the service backup plan with the individual/LAR to determine whether or not the plan was effective.

If the service backup plan was implemented and determined to be ineffective, the case manager must convene an SPT meeting to revise the service backup plan.

If a change is requested by the individual during the IPP service review, the case manager is responsible for initiating any change(s) needed and convenes the SPT, as applicable within five business days after becoming aware that the individual's needs have changed. The case manager must also update the IPP-A.

Within five business days of the IPP service review, the case manager is responsible for providing copies of the service review with the updated IPP-A to the individual, DSA and any additional CLASS service providers (FMSACFS, and SFS), as necessary. The case manager must maintain documentation of transmission of all necessary documents.

Form Resources

The following forms may need to be completed as part of the 90-day service review: