7100, Billing and Claims Payment

Revision 20-4; Effective October 9, 2020

The following services may be billed under the Community Living Assistance and Support Services (CLASS) Program:

  • Case Management
  • Community First Choice (CFC) PAS/HAB
  • Transportation-habilitation Services
  • Supported Employment
  • Employment Assistance
  • Prevocational Services
  • Nursing Services (e.g., registered nursing, licensed vocational nursing, specialized registered nursing, specialized licensed vocational nursing)
  • Physical Therapy
  • Occupational Therapy
  • Speech and Language Pathology
  • Specialized Therapies, that include:
    • Massage Therapy
    • Recreational Therapy
    • Music Therapy
    • Aquatic Therapy
    • Hippotherapy
    • Therapeutic Horseback Riding
    • Auditory Enhancement Training
  • Dietary Services
  • Behavioral Support
  • Cognitive Rehabilitation Therapy
  • Support Family Services
  • Continued Family Services
  • Transition Assistance Services
  • Respite
  • Adaptive Aids (vehicle modifications are billed as adaptive aids)
  • Dental Services
  • Minor Home Modifications
  • Services specifically for individuals who choose the Consumer Directed Services (CDS) option that include:
    • Financial Management Services
    • Support Consultation

Note: For purposes of this section, the term "provider agency" means a CLASS Case Management Agency (CMA) or Direct Service Agency (DSA), as applicable.

Each DSA must ensure that each CLASS program service is provided to an individual in accordance with Appendix C of the CLASS Waiver Application. The approved service definition for each of the services described in this section are contained within the Texas Administrative Code (TAC). Those service definitions are located in 40 TAC §45.103, Definitions.

Each CLASS service delivered to an individual must be recorded as a distinct event by each service provider. Documentation of services delivered may be provided on Form 3625, CLASS/CFC – Documentation of Services Delivered, by fax or via the Electronic Visit Verification (EVV) System.

Service delivery documentation must be completed according to the Texas Health and Human Services Commission (HHSC) instructions.

Each provider agency must designate a timekeeper to sign Form 3625 to verify its accuracy.

For CLASS services requiring EVV, providers must follow EVV billing requirements for relevant claims. Providers may refer to HHSC's EVV website for more information.

CLASS payment rates are set by the HHSC Rate Analysis. For current rates, see https://pfd.hhs.texas.gov/.

7110 Case Management Agency (CMA) Services

Revision 17-1; Effective November 1, 2017

Case management services provided after the individual has been enrolled in the CLASS program are based on a monthly rate. The number of case management units needed by the individual are determined by the service planning team (SPT) and approved by HHSC on the Individual's Plan of Care (IPC). The monthly case management fee may only be billed during a month when a billable contact has occurred. The case manager must record time spent providing case management services on Form 3625, CLASS/CFC – Documentation of Services Delivered.

If the individual/LAR requests a fair hearing before the effective date of the termination, as specified in the written notice of CLASS Program services and CFC services, the CMA must continue to provide services to the individual.

7120 Direct Services Agency (DSA) Services

Revision 17-1; Effective November 1, 2017

If the individual/LAR requests a fair hearing before the effective date of the termination of CLASS Program services and CFC services, as specified in the written notice, the DSA must continue to provide services to the individual in the amounts authorized in the IPC while the appeal is pending.

7121 Personal Service Agreement or Contract with Another Agency

Revision 17-1; Effective November 1, 2017

With the exception of CFC PAS/HAB, transportation-habilitation and in-home respite, the DSA may contract with an individual or agency to provide CLASS services. The DSA is responsible for ensuring all service providers meet required direct service provider qualifications and training requirements.

CLASS services provided through a personal service agreement or contract with the DSA must be recorded on Form 3625, CLASS/CFC – Documentation of Services Delivered, or by fax and authenticated by the service provider.

7122 Minor Home Modifications and Adaptive Aids

Revision 17-1; Effective November 1, 2017

The DSA will only be reimbursed for adaptive aids and minor home modifications included in Appendix I, Adaptive Aids, and Appendix II, Minor Home Modification Services, and authorized by HHSC on the individual's IPC. Minor home modifications and adaptive aids purchased by the DSA must be recorded on Form 3625, CLASS/CFC – Documentation of Services Delivered, and signed by the appropriate representative of the DSA. The DSA representative must be a:

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

The DSA must have a signed and dated invoice from the vendor indicating work performed and/or services delivered and the date of completion. The DSA must keep required documentation related to procurement and cost.