3500, Service Initiation | Texas Health and Human Services

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Revision 17-1; Effective November 1, 2017

A DSA must ensure each CLASS and CFC service is provided to an individual in accordance with the individual's IPP-A, IPC and IPP for each service.

A DSA must have a written process that ensures staff members are or can readily become familiar with individuals to whom they are not ordinarily assigned but to whom they may be required to provide a CLASS and CFC service.

A DSA must inform the individual's case manager of changes needed to the individual's IPC or IPPs.

3510 Immediate Jeopardy of CLASS and CFC Providers

Revision 17-1; Effective November 1, 2017

HHSC may terminate an individual's CLASS program and CFC services if an individual or a person in the individual's residence exhibits behavior that places the health and safety of the CMA's case manager or a DSA's service provider in immediate jeopardy.

If a CMA or DSA becomes aware of an existing situation that places the health and safety of the individual's case manager or DSA service provider in immediate jeopardy, the CMA or DSA must:

immediately file a report with the appropriate law enforcement agency and, if appropriate, make an immediate referral to DFPS; and
notify HHSC, CMA and DSA by telephone of the situation no later than one business day after the CMA or DSA becomes aware of the situation.

The CMA and DSA must attempt to resolve the situation. If, after making attempts to resolve the situation, the CMA determines that the situation cannot be resolved, the CMA must, within two business days after the CMA becomes aware of the situation, send a written request to terminate CLASS program and CFC services to HHSC. The written request must be accompanied by:

a description of the situation that resulted in the request to terminate the individual's CLASS program and CFC services;
a detailed description of the attempts by the CMA to resolve the situation; and
if available, a copy of any report issued by a law enforcement agency or DFPS regarding the situation.

HHSC notifies the individual's CMA in writing of whether it authorizes the proposed termination of CLASS program and CFC services.

Upon receipt of a written notice from HHSC authorizing the termination of CLASS program and CFC services, the CMA must, no later than the date of the termination of services, send a written notice to the individual or LAR of such termination. The CMA must provide a hard copy of the termination notice to the individual's DSA and, if selected, FMSA and SFS provider. The CMA must include in the notice the individual's right to request a fair hearing.

The CMA and DSA must maintain documentation of completion of these requirements in the individual's record.

3520 Adaptive Aids Costing Less than $500

Revision 17-1; Effective November 1, 2017

Once the DSA determines the cost of the requested adaptive aid, the DSA must request in writing that the case manager initiate an IPC revision. The DSA must inform the individual's case manager of the cost of the requested adaptive aid.

HHSC authorizes the IPC submitted by the CMA if, after reviewing the documentation, it determines the requested adaptive aid meets the standards outlined in Appendix I, Adaptive Aids.

The DSA must ensure the individual receives the adaptive aid within 14 business days after the date HHSC authorizes the proposed IPC that includes the recommended adaptive aid; or the effective date of the individual's IPC as determined by the SPT (whichever is later). The DSA must complete Form 8605, Documentation of Completion of Purchase, that serves as the primary document for completion of purchases of authorized adaptive aids/medical supply items or minor home modifications made by the service provider for individuals.

For an adaptive aid that is a medical supply, a DSA must ensure the individual receives the medical supply as follows:

for a medical supply that is not immediately needed by the individual, within five business days after the date HHSC authorizes the proposed IPC that includes the recommended adaptive aid; or the effective date of the individual's IPC as determined by the SPT (whichever is later); or
for a medical supply that is immediately needed by the individual, within two business days after the date HHSC authorizes the IPC that includes the recommended adaptive aid.

If the DSA cannot provide the adaptive aid in the time frame described, the DSA must:

notify the individual and the individual's case manager, orally or in writing, before the 14-day time frame expires, that the adaptive aid will not be provided within the 14-day time frame; and
notify the individual and the individual's case manager of a new proposed date for provision of the adaptive aid.

If the DSA cannot provide an adaptive aid that is a medical supply and is not immediately necessary by the individual, the DSA must:

notify the individual and the individual's case manager, orally or in writing, before the five-day time frame expires, that the adaptive aid will not be provided within the five-day time frame;
provide the reason(s) why the medical supply will not be provided within the five-day time frame; and
notify the individual and the individual's case manager of a new proposed date for provision of the medical supply.

3530 Adaptive Aid Costing $500 or More

Revision 17-1; Effective November 1, 2017

Once the SPT has agreed the individual is in need of an adaptive aid with an anticipated cost that is more than $500, the DSA must request in writing that the case manager initiate an IPC revision including funds for obtaining an assessment of the individual by the appropriate licensed professional as described in Appendix I of CLASS Provider Manual. The assessment must include a description and a recommendation for an adaptive aid that meets the individual's need(s). This assessment must identify how this adaptive aid will meet the needs of the individual and must include consideration of other alternatives known to the appropriate licensed professional to meet the individual's need(s). Detailed descriptions, to the extent possible, must accompany the licensed professional's recommendation for adaptive aids when the cost is more than $500.

After HHSC authorizes the proposed IPC for payment of the adaptive aid assessment, the DSA must obtain the assessment from the appropriate licensed professional that describes the adaptive aid within 30 calendar days. The assessment by the licensed professional that describes the specific need(s) of the individual must include recommendations for the adaptive aid that, in the opinion of the licensed professional, will best meet the needs identified in the assessment.

Based on the recommendations contained in the assessment, the DSA will consult with the appropriate vendor to determine the most cost-effective item(s) that meet the recommendations in the assessment. The description of the item(s) as contained in the assessment must be used to develop the specifications to obtain bids from all vendors. The DSA must obtain comparable bids for the requested adaptive aid from three vendors within 60 calendar days of obtaining the specifications.

A bid obtained must be based on the specifications and include:

the total cost of the requested adaptive aid, which may be from a catalog, website or brochure price list;
the amount of any additional expenses related to the delivery of the adaptive aid, including shipping and handling, taxes, installation and other labor charges;
the date of the bids;
the name, address and telephone number of the vendor, who may not be a relative of the individual;
a complete description of the adaptive aid and any associated items or modifications as identified in the completed Form 3660, Request for Adaptive Aids, Medical Supplies, Minor Home Modifications or Dental Services/Sedation, which may include pictures or other descriptive information from a catalog, website or brochure; and
the number of hours of the service or training to be provided in person and the hourly rate of the service for interpreter services and specialized training for augmentative communication programs.

The DSA must:

obtain the assessment from a licensed professional for the adaptive aid as described in Appendix I, Adaptive Aids;
ensure the assessment includes a complete description of the adaptive aid; and
provide a copy of the assessment and the specifications to the CMA.

For purchases of an adaptive aid or medical supply costing over $500, the CMA, DSA and individual/legally authorized representative must complete and sign Form 3849-A, Specifications for Adaptive Aids/Medical Supplies/Minor Home Modifications, to signify agreement with the specifications.

The DSA may obtain only one bid or two comparable bids for an adaptive aid if the DSA has written justification for obtaining less than three bids because the adaptive aid is available from a limited number of vendors.

A bid obtained must be based on the specifications and include:

the total cost of the requested adaptive aid, which may be from a catalog, website or brochure price list;
the amount of any additional expenses related to the delivery of the adaptive aid, including shipping and handling, taxes, installation and other labor charges;
the date of the bid;
the name, address and telephone number of the vendor, who may not be a relative of the individual;
a complete description of the adaptive aid and any associated items or modifications as identified in the completed Form 3660, which may include pictures or other descriptive information from a catalog, website or brochure; and
the number of hours of the service or training to be provided in person and the hourly rate of the service for interpreter services and specialized training for augmentative communication programs.

A DSA may obtain only one bid or two comparable bids for an adaptive aid if the DSA has written justification for obtaining less than three bids because the adaptive aid is available from a limited number of vendors.

If a DSA requests to purchase an adaptive aid that is not based on the lowest bid, the DSA must have written justification for payment of a higher bid. The following are examples of justifications that support payment of a higher bid:

the higher bid is based on the inclusion of a longer warranty for the adaptive aid; and
the higher bid is from a vendor that is more accessible to the individual than another vendor.

Requests for interpreter services or specialized training for augmentative communication devices must include:

the total number of hours of the service or training to be provided in-person; and
the hourly rate of the service.

If the requested adaptive aid is a vehicle modification, a DSA must obtain proof the individual or individual's family member owns the vehicle for which the vehicle modification is requested. Requests for vehicle modifications to accommodate modifications or additions to the primary transportation vehicle must include an assessment by the appropriate licensed professional as indicated in Appendix I. Additionally, if the vehicle is more than five years old or the mileage on the vehicle odometer exceeds 50,000 miles, the vehicle must pass an inspection performed by an automotive technician certified by The National Institute for Automotive Service Excellence (ASE).

A DSA may not disclose information regarding a submitted bid to any other vendor who has submitted a bid or to a vendor who may submit a bid.

The DSA must request in writing the case manager initiate an IPC revision. At this point, the DSA must inform the individual's case manager of the cost of the requested adaptive aid.

HHSC authorizes the IPC once submitted by the CMA if, after reviewing the documentation, it determines the requested adaptive aid meets the standards outlined in Appendix I, Adaptive Aids.

The DSA must ensure the individual receives the adaptive aid within 30 business days after the date HHSC authorizes the proposed IPC that includes the recommended adaptive aid; or the effective date of the individual's IPC as determined by the SPT (whichever is later). The DSA must complete Form 8605, Documentation of Completion of Purchase, that serves as the primary document for purchases of authorized adaptive aids/medical supply items or minor home modifications made by the service provider for individuals.

For an adaptive aid that is a medical supply, the DSA must ensure the individual receives the medical supply as follows:

for a medical supply that is not immediately needed by the individual, within five business days after the date HHSC authorizes the proposed IPC that includes the recommended adaptive aid; or the effective date of the individual's IPC as determined by the SPT (whichever is later); or
for a medical supply that is immediately needed by the individual, within two business days after the date HHSC authorizes the IPC that includes the recommended adaptive aid.

If the DSA cannot provide the adaptive aid in the time frame described, the DSA must:

notify the individual and the individual's case manager, orally or in writing, before the 30-day time frame expires, the adaptive aid will not be provided within the 30-day time frame; and
notify the individual and the individual's case manager of a new proposed date for provision of the adaptive aid.

For an adaptive aid that is a medical supply and not immediately needed by the individual, the DSA must:

notify the individual and the individual's case manager, orally or in writing, before the five-day time frame expires the adaptive aid will not be provided within the five-day time frame;
provide the reasons why the medical supply will not be provided within the five-day time frame; and
notify the individual and the individual's case manager of a new proposed date for provision of the medical supply.

3540 Minor Home Modification

Revision 17-1; Effective November 1, 2017

Once the SPT has agreed the applicant/individual might require a minor home modification, the DSA must request in writing that the case manager initiate an IPC revision that includes funds for obtaining an assessment of the individual by the appropriate licensed professional to determine the specific minor home modification necessary to meet the needs of the individual, as defined in the assessment.

Once HHSC notifies a DSA through the electronic billing system of a service authorization for an assessment by the appropriate licensed professional of the individual's need(s), the DSA must obtain the assessment within 30 calendar days after the date HHSC authorizes the IPC.

After HHSC authorizes the proposed IPC for payment for the assessment of the individual, the DSA must obtain the specifications from a person who has experience in home modifications within 30 calendar days.

The DSA must:

obtain an assessment of the individual from a licensed professional that describes the specific minor home modification, as described in Appendix II, Minor Home Modification Services. The assessment must include a complete description of the specific need(s) of the individual and recommendations for the minor home modification that will meet the needs identified in the assessment.
provide a copy of the assessment to the CMA;
obtain the specifications from a person who has experience in constructing home modifications, based on the assessment completed by the professional; and
ensure the specifications meet the following standards:
- include a complete description of the minor home modification and any required installations identified in the specifications;
- include a drawing or picture of both the existing room, structure or other area and the proposed modification made to scale;
- be approved in writing by each member of the SPT by completing Form 3849-A, Specifications for Adaptive Aids/Medical Supplies/Minor Home Modifications; and
- comply with the Texas Accessibility Standards promulgated by the Texas Department of Licensing and Regulation unless:
  - DSA determines it is not structurally feasible to do so and the DSA documents, in writing, the basis for its determination; or
  - the individual or legally authorized representative (LAR) requests, in writing, the specifications not be in compliance with the Texas Accessibility Standards;
be approved, in writing, by the individual or LAR and the DSA by completing Form 3849-A, as described in Appendix II; and
provide a copy of the specifications to the CMA.

The CMA, DSA and individual/LAR must complete and sign Form 3849-A to signify agreement with the specifications.

The DSA must obtain comparable bids for a minor home modification from three vendors if the modification costs more than $1,000, within 60 calendar days after obtaining the specifications.

A bid obtained must be based on the specifications and include:

an itemized list of materials and labor necessary to construct the modification;
the cost of each material and labor listed;
the date of the bid;
the name, address and telephone number of the vendor, who may not be a relative of the individual;
a detailed explanation of the vendor's warranty for the modification, if any; and
a statement that the minor home modification will be made in accordance with all applicable state and local building codes.

A DSA may obtain one bid or two comparable bids for a minor home modification if the DSA has written justification for obtaining less than three bids because the minor home modification is available from a limited number of vendors.

If a DSA requests to purchase a minor home modification that is not based on the lowest bid, the DSA must have written justification for payment of a higher bid. The following are examples of justifications that support payment of a higher bid:

the higher bid is based on the inclusion of a longer warranty for the minor home modification; and
the higher bid is from a vendor that is more accessible to the individual than another vendor.

The person who developed the specifications may also offer one of the bids. A DSA may not disclose information regarding a submitted bid to any other vendor who has submitted a bid or to a vendor who may submit a bid.

After the DSA has successfully obtained a sufficient number of bids, the DSA must:

select a vendor to complete construction of the minor home modification;
obtain written approval for construction of the modification from the owner of the property in question, unless such approval is granted in an applicable lease agreement;
ensure the selected vendor obtains any required building permits; and
advise the CMA regarding the cost of the minor home modification and the cost of the inspection of the modification, so that an IPC revision can be initiated.

Once HHSC notifies a DSA through the electronic billing system of a service authorization for a planned minor home modification and the cost of the inspection of the modification, the DSA must direct the vendor to begin construction of the modification within seven calendar days after the date HHSC authorizes the proposed IPC; or the effective date of the IPC as determined by the SPT (whichever is later).

A DSA must ensure a minor home modification is completed within 60 calendar days after the date HHSC authorizes the proposed IPC that includes the cost of the modification and inspection or the effective date of the IPC as determined by the SPT (whichever is later).

If the DSA determines the minor home modification will not be completed within the time frame required, the DSA must notify the individual or LAR in writing of a new proposed date of completion. The proposed date may not exceed 30 calendar days after the date outlined before.

The DSA must conduct an in-person inspection of the minor home modification within seven business days after it receives information the modification is completed. The inspection may be performed by the person who developed the specifications unless that person is affiliated with the vendor who completed the minor home modification. The inspection will determine if the:

minor home modification has been completed;
modification has been made in accordance with the specifications; and
quality of workmanship of the modification is adequate.

If the DSA determines the minor home modification meets the conditions of the inspection, the DSA must send a completed Form 8605, Documentation of Completion of Purchase, to the individual's CMA within seven business days after completion of the inspection.

If the DSA determines the minor home modification does not meet the conditions of the inspection, the DSA must ensure the vendor meets the conditions within 30 calendar days after the DSA's determination.