3300, Service Planning

Revision 17-1; Effective November 1, 2017

A DSA must ensure a representative from its agency participates as a member of an individual's SPT. A DSA representative must be a:

  • program director or meet program director qualifications;
  • registered nurse (RN); or
  • licensed vocational nurse (LVN).

Meetings of the SPT to develop the IPP-A, the IPP, 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 and the meeting must be at a time and location that is mutually agreed upon by all mandatory members.

The case manager must use Form 3629, Individual Program Plan Addendum 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, 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:

  • conversations with the individual, LAR and those who know the individual best, such as a provider staff, caregiver, family member and friend;
  • a method called Planning Alternative Tomorrows with Hope (PATH);
  • methods taught by The Learning Community for Person Centered Practices (TLCPCP);occur with the support of a group of people chosen by the individual (and the 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 documents the individual's current and preferred living arrangement;
  • determines the Habilitation (HAB), Personal Assistance Services (PAS), Emergency Response Services (ERS) and Support Management 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 CFC 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 at The Learning Community.

The SPT should include, at a minimum, the individual/applicant or LAR, the 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 needs of people with related conditions, or directly involved in the delivery of services and supports to the individual. If licensed or certified professionals attend the SPT meeting, this may be billed as a professional service only when the individual has an identified need for the service, and for actual time spent in the capacity of the respective discipline. The SPT may include any other people requested by the individual or LAR. The SPT will make every effort to accommodate these requests by the individual or LAR.

SPT activities to revise a current IPC may occur via conference call in lieu of a face-to-face meeting. If the individual/LAR requests an in person meeting, SPT members must make every effort to accommodate the request. Participation in an SPT via conference call is not reimbursable to the DSA using CFC PAS/HAB or CLASS transportation-habilitation.

An IPC must be signed in person by the SPT at enrollment and renewal SPT meetings. Revisions of the current service plan may be signed by facsimile.

After all requirements for eligibility are met, and at least annually thereafter, the case manager, the applicant/individual/LAR, DSA representative(s) and other persons as requested by the applicant/individual/LAR must meet to develop Form 3629, Individual Program Plan Addendum and a proposed Form 3621, CLASS/CFC – Individual Plan of Care.

The proposed IPC must specify:

  • the type of CLASS program and CFC services to be provided to the individual;
  • the number of units of each CFC or CLASS program service;
  • the estimated annual cost of all CFC services, other than CFC support management, or CLASS program services; and
  • other services or supports to be provided to the individual through sources other than the CFC or CLASS program.
  • the SPT will participate with the CMA to develop Form 3629.

The SPT will develop Form 8606, Individual Program Plan (IPP).

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

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

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 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.

Each CLASS program and CFC service must be provided to an individual in accordance with the IPP-A, the individual's IPC and the individual's IPP for that service. A DSA must inform the individual's case manager throughout the IPC year of changes needed to the individual's IPP-A, IPC or IPPs.

On an ongoing basis, the DSA's responsibilities include:

  • participating in the SPT;
  • developing the PAS/Habilitation Plan - CLASS/DBMD/CFC  plan (only applicable to service(s) delivered through the provider-managed service delivery option);
  • developing service backup plans for individuals receiving nursing and/or CFC PAS/HAB  services when the SPT has determined the service is critical to an individual's health and safety (only applicable to nursing and/or CFC PAS/HAB service(s) delivered through the provider-managed service delivery option);
  • discussing with the individual and the service providers or natural supports identified in the service backup plan to determine whether or not the plan was effective, if the service backup plan is implemented;
  • documenting whether or not the plan was effective,
  • revising the plan with input from the SPT, if the plan was determined to be ineffective;
  • completing Form 8578, Intellectual Disability/Related Condition (ID/RC) Assessment, submitting to HHSC and providing additional information as requested by HHSC for the purposes of authorizing the individual's level of care;
  • delivering an array of CLASS program and CFC services in accordance with the IPP-A, IPC, and the IPP and in coordination with non-CLASS services;
  • providing services to the individual as defined in the IPP-A and the IPP;
  • implementing the individual's observable and measurable goals and objectives;
  • informing the individual of rights and responsibilities, including complaint procedures;
  • reporting the individual's changing needs and goals to the case manager;
  • working with community resources as necessary to ensure the provision of CLASS program and CFC services achieves the goal to provide flexible resources that increase personal independence and integration into the community;
  • coordinating individual providers of CLASS program and CFC services; and
  • documenting the provision of services and providing, based on the schedule in Appendix X of the CLASS Provider Manual, a periodic summary of IPC service accomplishments to the case manager.

3310 Enrollment

Revision 17-1; Effective November 1, 2017

At the time an applicant receives a written offer of a CLASS program vacancy from HHSC, the applicant must select a DSA within 30 calendar days after the date of the written offer from HHSC. HHSC notifies the selected DSA the applicant has chosen the agency to provide direct services according to the HHSC Selection Determination document.

Within 14 calendar days after receiving Form 3657, Pre-Enrollment Assessment, from the CMA, as evidenced by the fax transmittal date on the documents received from the CMA a DSA staff person must complete an initial face-to-face, in-home visit with the individual/LAR to inform the individual and LAR or person actively involved with the individual, orally and in writing, of the process by which they may file a complaint regarding CLASS Program services or CFC services provided by the DSA.

A DSA representative must also provide the following information regarding required use of the Electronic Visit Verification (EVV).

  • EVV will not change the services the individual receives.
  • The CFC PAS/HAB services provider will need the individual's permission to use the telephone to call a toll-free number at the start and at the end of work.
  • EVV helps HHSC make sure the individual is receiving authorized services.
  • EVV is mandatory for all DSAs and individuals receiving services from a CFC PAS/HAB services provider, unless the individual receives services through the Consumer Directed Services (CDS) option.
  • Failure to cooperate will result in the suspension or termination of services.
  • If the individual 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.

If the individual has additional questions, the DSA representative must provide any requested additional information on how EVV works.
Within 14 calendar days after receiving Form 3657 from the CMA, as evidenced by the fax transmittal date on the documents received from the CMA, the DSA must assign a registered nurse or an appropriate licensed professional to perform and complete the following functions:

  • a nursing assessment of the individual using the CLASS/DBMD Nursing Assessment form;
  • an adaptive behavior assessments of the individual, as described in, Intellectual Disability/Related Condition (ID/RC) Assessment instructions;
  • the Related Conditions Eligibility Screening Instrument; and
  • the ID/RC Assessment in accordance with form instructions.

To determine an individual's adaptive behavior level as part of establishing an individual's enrollment level of care (LOC), the DSA must complete one of the following ABL assessments according to the publisher's instructions:

  • Inventory for Client and Agency Planning (ICAP);
  • Vineland Adaptive Behavior Scales;
  • Scales of Independent Behavior – Revised (SIB-R); or
  • American Association of Intellectual and Developmental Disabilities (AAIDD) Adaptive Behavior Scales (ABS).

The DSA must ensure:

  • the applicant's physician attests to the applicant's diagnosis on the enrollment ID/RC Assessment;
  • the completed ID/RC Assessment is submitted to HHSC for approval within 30 days of notification of completion of the Pre-Enrollment Assessment conducted by the CMA;
  • the HHSC-approved ID/RC and the completed CLASS/DBMD Nursing Assessment is transmitted to the applicant's CMA within one business day after receiving notification of approval of the ID/RC from HHSC; and
  • a DSA representative is available to participate in the applicant's enrollment SPT meeting as convened by the case manager.

Form Resources

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

  • Form 2067, Case Information
  • Form 3596, PAS/Habilitation Plan - CLASS/DBMD/CFC
  • Form 3599, Habilitation Service Provider Orientation/Supervisory Visits
  • Form 3621, CLASS/CFC – Individual Plan of Care
  • Form 3625, CLASS/CFC – Documentation of Services Delivered
  • Form 3627, Specialized Nursing Certification
  • Form 3628, Provider Agency Model Service Backup Plan
  • Form 3629, Individual Program Plan Addendum
  • Form 6515, CLASS/DBMD Nursing Assessment
  • Form 8507, Understanding Program Eligibility - CLASS/DBMD
  • Form 8662, Related Conditions Eligibility Screening Instrument
  • Form 8578, Intellectual Disability/Related Condition Assessment
  • Form 8606, Individual Program Plan (IPP)

Submission Standard — ID/RC

The following submission standards apply when submitting ID/RC paperwork to HHSC:

  • Form 8578, Intellectual Disability/Related Condition Assessment
  • Form 8662, Related Conditions Eligibility Screening Instrument
  • assessment scoring summary

Submission Standard — Pre-enrollment

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

  • Form 3625, CLASS/CFC – Documentation of Services Delivered
  • Form 8578, Intellectual Disability/Related Condition Assessment

3320 DSA Renewal of Level of Care

Revision 19-4; Effective November 8, 2019

Continuing eligibility must be determined at least annually. As with the initial assessment, the DSA RN is required to complete an annual nursing assessment of the individual using the Form 6515, CLASS/DBMD Nursing Assessment form, Form 8578, Intellectual Disability/Related Condition (ID/RC) Assessment, Form 8662, Related Conditions Eligibility Screening Instrument (RCESI) (these documents must be completed every year), and an adaptive behavior level (ABL) assessment if the current one is greater than five years old, or is no longer valid.

Form 8578, Form 8662 and results of the current ABL assessment must be sent to HHSC at least 60 calendar days, but no more than 120 calendar days, before the expiration of an individual's IPC to establish that an individual continues to meet diagnostic/functional eligibility criteria. Once HHSC informs the DSA of the approval of diagnostic/functional eligibility, the DSA must submit a copy of the approved ID/RC and the completed CLASS/DBMD Nursing Assessment to the CMA by the next business day.

If an individual's ABL assessment is more than five years old or the individual's needs significantly change, the DSA must complete one of the following ABL assessments according to the publisher's instructions:

  • Inventory for Client and Agency Planning (ICAP);
  • Vineland Adaptive Behavior Scales;
  • Scales of Independent Behavior – Revised (SIB-R); or
  • American Association of Intellectual and Developmental Disabilities (AAIDD) Adaptive Behavior Scales (ABS).

A DSA representative, as defined in Section 3300, Service Planning, must participate as a member of the SPT to develop:

  • a renewal IPC — the CLASS program services on the proposed renewal IPC must meet the following standards, which:
    • 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;
    • are the most appropriate type and amount of CLASS program and CFC services to meet the individual's needs; and
    • are cost effective.
  • a renewal IPP for each service proposed on the renewal IPC;
  • Form 3596, PAS/Habilitation Plan - CLASS/DBMD/CFC; and
  • a service backup plan for the following services, if the SPT determines the service is critical to the individual's health and safety and if the service is delivered by the DSA:
    • CFC PAS/HAB; and
    • nursing services.

CLASS program and CFC services as a whole enhance an individual's integration in the community and prevent admission to an institution while maintaining and improving independent functioning.

The DSA is responsible for assisting and providing documentation, as requested by the CMA.

A DSA is responsible for verifying in MESAV that each individual's enrollment, renewal, or revisions IPCs have been authorized by HHSC as documented on the IPC signed by the SPT.

Form Resources

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

  • 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 3625, CLASS/CFC – Documentation of Services Delivered
  • Form 3628, Provider Agency Model Service Backup Plan
  • Form 3629, Individual Program Plan Addendum
  • Form 6515, CLASS/DBMD Nursing Assessment
  • Form 8578, Intellectual Disability/Related Condition Assessment (Page 1 and Page 3)
  • Form 8598, Non-Waiver Services
  • Form 8606, Individual Program Plan (IPP)
  • Form 8662, Related Conditions Eligibility Screening Instrument

Submission Standard

The following submission standards apply when submitting ID/RC paperwork to HHSC:

  • Form 6515, CLASS/DBMD Nursing Assessment
  • Form 8578, Intellectual Disability/Related Condition Assessment
  • Form 8662, Related Conditions Eligibility Screening Instrument
  • ABL assessment scoring summary

3330 Revision

Revision 17-1; Effective November 1, 2017

When the DSA is notified of a needed revision to the IPC, the DSA representative must contact the CMA within one business day. The DSA is responsible for assisting and providing documentation, as requested by the CMA to ensure:

  • a proposed IPC revision includes an IPP for each service revised on the proposed IPC and a revised Form 3596, PAS/Habilitation Plan - CLASS/DBMD/CFC, if applicable;
  • Individual Program Plan Addendum is revised to ensure continued accuracy for the individual and to be consistent with the IPC and IPPs; and
  • the CLASS program and CFC 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;
    • are the most appropriate type and amount of CLASS program and CFC services to meet the individual's needs; and
    • are cost effective.

Within five business days after receipt of the IPP-A, IPP and IPC from the CMA, as evidenced by the fax transmittal date on the documents received from the CMA, the DSA must sign and return the IPP-A, IPP and IPC to the CMA. If any revised services provided by the DSA affect the service backup plan, PAS/Habilitation Plan - CLASS/DBMD/CFC plan or the IPP-A, the DSA must revise the existing plan to reflect these changes to program services.

A DSA is responsible for verifying in MESAV that each individual's enrollment, renewal, or revisions IPCs have been authorized by HHSC as documented on the IPC signed by the SPT.

3331 Immediate Jeopardy of CLASS Individual

Revision 17-1; Effective November 1, 2017

Immediate jeopardy is interpreted as a crisis situation in which the health and safety of an individual is at risk.

During circumstances when the individual's health and safety is placed in immediate jeopardy the DSA must provide the following services:

  • licensed vocational nursing;
  • specialized licensed vocational nursing;
  • registered nursing;
  • specialized registered nursing;
  • CFC PAS/HAB
  • respite;
  • dental treatment; or
  • adaptive aid.

These services must be provided even if they are not included on the individual's IPC. The DSA must, within seven calendar days after providing the service, submit to the CMA:

  • 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.

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

Form Resources

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

3340 Transfer

Revision 15-2; Effective November 20, 2015

If an individual plans to move to another CLASS provider, the case manager must provide the individual the most current Selection Determination document for the applicable catchment area. The requirements for the transferring DSA and receiving DSA are provided below.

3341 Transferring DSA

Revision 17-1; Effective November 1, 2017

The transferring DSA must provide the receiving DSA with the current balance of each service category based on most current CLASS/CFC IPC authorized and actual delivery up to the transfer effective date — Form 3621-T, CLASS/CFC – IPC Service Delivery Transfer Worksheet. The total number of service units provided before the effective date of the transfer is the sum of the number of service units:

  • provided and paid,
  • provided that have been billed but not yet paid, and
  • to be provided until the transfer effective date.

Copies of the identified records must be delivered by the transferring DSA to the receiving DSA within five calendar days of notification by the case manager of the individual's decision to transfer to a different DSA. The records that must be provided include:

  • current CLASS/CFC IPC;
  • current Form 3629, Individual Program Plan Addendum;
  • current Service Planning Team (SPT) notes from the current IPC period;
  • current Individual Program Plan (IPP);
  • current Form 8578, Intellectual Disability/Related Condition Assessment;
  • current Form 8662, Related Conditions Eligibility Screening Instrument;
  • current Form 3596, PAS/Habilitation Plan - CLASS/DBMD/CFC;
  • records of all adaptive aids purchased during the current IPC period;
  • records of all minor home modifications procured for the individual, regardless of date of purchase and cost of each;
  • all IPP Service Summaries performed by the DSA during the current IPC period;
  • current physician's orders;
  • copies of DSA records for 90 calendar days prior to DSA transfer, including:
    • CFC/PAS/HAB or CLASS habilitation;
    • medication administration record;
    • money management;
    • assessments and notes for any services listed on the IPC; and
    • all communications, including:
      • contact notes;
      • progress notes;
      • Form 2067, Case Information;
      • Form 3624, Termination, Reduction or Denial of CLASS;
      • incident reports; and
      • complaints;
  • school/day programming information including:
    • Admission, Review and Dismissal (ARD) notes; and
    • Individual Education Plan (IEP); and
  • current service delivery schedules for all services.

The transferring DSA is required to maintain documentation of the specific records that were delivered to the receiving DSA, as well as the date of the delivery.

3342 Receiving DSA

Revision 11-1; Effective June 13, 2011

The receiving DSA must initiate services on the transfer effective date, as identified on Form 3621-T, CLASS/CFC – IPC Service Delivery Transfer Worksheet. The total number of service units available to the receiving DSA is the number of service units to be provided from the transfer effective date until the end of the IPC effective period.

The receiving DSA must develop a Form 3628, Provider Agency Model Service Backup Plan, for those services requiring a backup plan as indicated on the IPC.

3350 IPP Service Summaries

Revision 17-1; Effective November 1, 2017

CLASS service provider(s) must evaluate the effectiveness of CLASS program and CFC services delivered by the DSA. The DSA is responsible for providing an IPP Service Summary to the CMA in accordance with the schedule in Appendix X, Service Summary/Service Review Due Dates Chart, from the effective date of the most recent enrollment or renewal CLASS/CFC IPC. The final review of the IPC year is combined with the meeting of the SPT to develop a renewal IPC and update the IPP-A. The case manager is responsible for documenting the service summary provided by the DSA since the preceding review. The evaluation must include an assessment of the individual's progress, evolving needs and plans to address those needs. The IPP Service Summary must document the service provider's review of the individual's progress toward achieving the goals and objectives, as described on the IPP for each CLASS program and CFC service listed on the individual's IPC. There is not a HHSC form for the IPP Service Summary; however, the DSA must provide this information in a written format.

A DSA is required to ensure that each CLASS program and CFC service is provided to an individual in accordance with Appendix C of the CLASS Waiver Application, available on the CLASS website at https://hhs.texas.gov/laws-regulations/policies-rules/waivers.

An IPP is developed to describe the goals and objectives to be met by the provision of each CLASS program and CFC service on an individual's IPC that are supported by justifications, are measurable, and have timelines. Additionally, a DSA must ensure CLASS program and CFC services are documented in the individual's record, including the progress or lack of progress in achieving goals or outcomes in observable, measurable terms that directly relate to the specific goal or objective addressed.

The DSA must provide the case manager with the IPP Service Summaries from each service listed below provided by the DSA documenting the individual's progress and needs. The service provider of each service listed below completes a service summary for each individual

Within five business days of the service provider completing the IPP service summary, the DSA is responsible for providing copies of the summaries to the case manager, as evidenced by the fax transmittal date on the documents provided to the CMA. The DSA must maintain documentation of transmission of all necessary documents. An IPP service summary for each service listed below must be prepared based on the schedule in Appendix X from the effective date of the most recent enrollment or renewal IPC. The DSA verbally updates the case manager during the renewal SPT meeting with any relevant information regarding services delivered in the last quarter of the IPC year.

The summaries must include quarterly reports from providers of the following services:

  • auditory enhancement training;
  • behavioral support;
  • dietary services;
  • occupational therapy;
  • physical therapy;
  • prevocational services;
  • specialized therapies;
  • speech and language pathology;
  • cognitive rehabilitation therapy;
  • employment assistance; and
  • supported employment services.

Each IPP Service Summary completed by the service provider must include all of the elements listed below:

  • current observable/measurable goals and objectives;
  • frequency and duration of sessions attended;
  • rationale for missed sessions;
  • progress or lack of progress;
  • actions taken, as applicable (e.g., in-servicing, counseling, etc.); and
  • revisions of goals and objectives, as applicable.

Form Resources

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