Appendix V, ID/RC Processing, for additional information and detailed instructions for DSAs

Revision 24-3; Effective Oct. 1, 2024

General Guidelines for Direct Service Agencies (DSAs)

A DSA must comply with Community Living Assistance and Support Services (CLASS) program requirements in the listed files when completing functional assessments and reassessments for all the people it serves:

These resources are on the HHS website https://hhs.texas.gov/

The ID/RC Assessment contains all information required to determine a person’s initial and continuing eligibility for the CLASS program. The ID/RC summarizes demographic, diagnostic and functional information about the person.

The RCESI and the Adaptive Behavior Level (ABL) assessment tool are used to determine functional ability. The DSA may select from four ABL tools for use in the CLASS program, which are the:

  • ICAP,
  • SIB-R,
  • Vineland Adaptive Behavior Scales, and
  • American Association of Intellectual and Developmental Disabilities (AAIDD) Adaptive Behavior Scales.

The DSA registered nurse (RN) must administer ICAP and SIB-R per the guidelines noted above. The other two assessments are completed by the appropriate professional, usually a licensed psychologist, identified in the guidelines for use of these tools. The DSA chooses the tool used to complete the functional assessments of people it serves. The ICAP and the SIB-R must be purchased and licensed through Riverside Publishing at www.hmhco.com/classroom-solutions/assessment.

The ID/RC, RCESI, ABL assessment tool and  Form 6515 CLASS or DBMD Nursing Assessment  must be completed at enrollment. The CLASS or  DBMD Nursing Assessment form is not a required part of the ID/RC packet. The DSA RN must conduct these assessments, with exception of the Vineland or the AAIDD, as stated above. These assessments are repeated at the annual renewal, with the exception of the ABL assessment tool. The ABL assessment tool is required every five years or if a situation changes. An RN completes these documents because an RN has the professional ability to assess the clinical status of the person. The RN also must comply with the provider's contractual obligations and follow the rules of conduct per the Texas Board of Nurses. An RN must make corrections to the above referenced documents.

All ID/RC packets must include Form 8578 ID/RC Assessment, Form 8662 RCESI and the ABL assessment tool summary results.

Initial Eligibility

ID/RC Purpose Code 2 – Initial application, denote this in field 13 on Form 8578.

The DSA must provide the person’s physician with a list of the Approved Diagnostic Codes for Persons with Related Conditions. See the link above. From this list, the physician will be asked to identify the diagnosis and associated diagnostic code that is primarily responsible for the person’s disability. If the person does not have a diagnosis of a related condition, as identified in the Approved Diagnostic Codes for Persons with Related Conditions, the physician must still indicate a diagnosis for the person and International Classification of Diseases (ICD) code. The physician must complete the section on Page 3 of the ID/RC to testify to the validity of the information in fields 19-27 of the form. The physician must be a licensed MD or DO. The DSA is not required to obtain the physician’s handwritten signature. The DSA must comply with applicable Home and Community Support Services Agency (HCSSA) requirements about the receipt of physician orders. Requirements are in 26 Texas Administrative Code, Chapter 558, Subchapter C.

The DSA RN must administer the RCESI and the ABL assessment tool, if an ICAP or SIB-R.

An initial application will not have Individual Plan of Care (IPC) begin or end dates identified on the ID/RC. When HHSC authorizes the ID/RC, a begin date will be assigned, based on the date HHSC received the packet. After all assessments are completed, the RN completes the ID/RC form, signs and dates it and forwards it to the physician for review and sign-off. When the physician returns the form, the ID/RC packet is mailed to HHSC for review.

Instructions for the ID/RC form require the program provider that transmits Form 8578 to maintain the original and all other original forms in the person’s record.

Continuing Eligibility

ID/RC Purpose Code 3 – Reassessments

Continuing eligibility must be determined at least annually. As with the initial assessment, the DSA RN must complete an ID/RC, an RCESI, which must be completed every year, and an ABL assessment (ICAP/SIB-R) if the current one is older than five years or is invalid. If the ABL tool is the Vineland or the AAIDD, the DSA will arrange the assessment. If the person’s situation has not changed since the last submission, a copy of the summary of results, the scoring program, of the current ABL assessment is included in the packet.

The RN will record the IPC begin and end dates. For a reassessment, the ID/RC packet must not be submitted more than 120 calendar days before the person’s IPC begin date. The packet must be submitted no less than 60 calendar days before the current IPC expires.

If HHSC reviews an ID/RC and it is authorized before the IPC begin date, the ID/RC will be approved with the IPC begin date.

If HHSC does not receive the ID/RC with complete and accurate information for authorization before the person’s IPC begin date, the ID/RC will be authorized with the HHSC receipt date.

When an ID/RC is approved after the IPC begin date, a Purpose Code E will be required to cover the gap between the person’s original IPC begin date and the authorized later date on the Purpose Code 3.

ID/RC Purpose Code E – Required to cover a lapse in eligibility

The DSA RN must complete a Purpose Code E to cover the period from the person’s IPC begin date to the day before the Purpose Code 3 HHSC authorized. A Purpose Code E is required to document the person’s continuous program eligibility.

The DSA must:

  • prepare a Purpose Code E if the ID/RC packet with the Purpose Code 3 is not submitted in sufficient time to arrive at HHSC by the person’s IPC begin date.
  • date the completion of the Purpose Code E as the date it is actually prepared.
  • make sure the Purpose Code E is a separate document. It cannot be a copy of the Purpose Code 3 and it must match the Purpose Code 3 exactly, except for the completion dates.
  • make sure a Purpose Code E submitted separately from the Purpose Code 3 includes a copy of the authorized Purpose Code 3 in the packet. Indicate on the Purpose Code E the exact end date for the Purpose Code E. Copies of the RCESI and ABL assessment tool are not required to be submitted with a Purpose Code E to HHSC as long as these documents are submitted with an HHSC authorized Purpose Code 3.
  • make sure the IPC begin date for a Purpose Code E is the same as the original IPC begin date.

A Purpose Code E does not require a physician’s signature, even if one is requested for the Purpose Code 3.

Note: In situations that require submission of a Purpose Code E, there can be no break in service provision to the person.

Form 8578, Intellectual Disability/Related Condition Assessment

The following form fields do not apply and should always be blank for CLASS:

  • 6 — Component Code
  • 7 — Case No
  • 73 — CARE ID
  • 18 — LON
  • 29 — IQ
  • 68 — IQ Instrument
  • Page 2 of the ID/RC

HHSC does not issue remands for these fields. Staff are not required to insert NA in these fields. NA is understood.

Dates on Form 8578

  • Completion dates for the ID/RC must be on or after the RCESI dates and the date of completion of the ABL assessment, unless it was necessary to conduct a new assessment.
  • Date in field 12 on or before the date in field 58.
  • Date in field 58 on or before the physician’s date on Page 3.
  • If preparing a Purpose Code E, document the date the form was completed.
  • If re-typing a form in response to a remand from HHSC, document the date the form was re-typed in field 58, or explain that the form was re-typed in the provider comments section.

Alignment Between Diagnosis and ICD Code

For assessments with effective dates before Oct. 1, 2015, the list of ICD-9 approved diagnostic codes for persons with related conditions are on the ICD-9 to ICD-10 Conversion Webinar (PDF).

For assessments with effective dates on or after Oct. 1, 2017, the list of ICD-10 approved diagnostic codes for persons with related conditions are on Approved Diagnostic Codes for Persons with Related Conditions (PDF).

Diagnoses for eligibility consideration by HHSC must be a diagnosis included in the approved list. The person’s diagnosis must be a valid code documented exactly as it is denoted in the list. On or after Oct. 1, 2015, ICD-9 codes will no longer be accepted. ICD-10-CM is composed of codes with three, four, five, six or seven characters. Codes with three characters are included in ICD-10-CM as the heading of a category of codes that may be further subdivided by four, five, six or seven characters to provide greater specificity. Only use a three-character code if it is not further subdivided.

An example is H91.9, Unspecified Hearing Loss, which by itself is not a valid code. Examples of valid codes within category H91.9 contain five characters, such as:

  • H91.90, Unspecified Hearing Loss, Unspecified Ear
  • H91.91, Unspecified Hearing Loss, Right Ear
  • H91.92, Unspecified Hearing Loss, Left Ear
  • H91.93, Unspecified Hearing Loss, Bilateral

Notes:

  • Additional digits are needed for most 800 codes, 850 is the exception.
  • The diagnosis must record what is in the list, through the final digit. Example: 854.01:
    • 854. is intracranial injury of other and unspecified nature,
    • .0 is no mention of open intracranial wound,
    • 1 is, from Page 5 of the list, no loss of consciousness,
    • 854.01 is intracranial injury of other and unspecified nature, no intracranial wound, no loss of consciousness.

List the diagnosis associated with the code in the approved list:

  • Text up to the parentheses or semicolon. A specific condition can always be included in parentheses.
  • The text in parentheses usually clarifies a diagnosis or contains other diagnoses that are included in the broader diagnosis. It is not necessary to record these unless the text in parentheses applies. Example: 299.0 Autistic disorder:
    • does the person have just childhood autism, or
    • do they have infantile psychosis or Kanner’s syndrome?
  • It is acceptable to abbreviate PDD, CP, NOS for unspecified, no for without.

The primary diagnosis is the only diagnosis field required in CLASS.

  • If secondary or tertiary diagnoses are recorded, they must be documented fully and accurately. Even if the primary diagnosis is an eligible related condition with the correct ICD-9 code, the ID/RC will not be authorized if the additional diagnoses and ICD-9 codes are not accurate.
  • If a secondary or tertiary diagnosis is recorded that is not on the list of Approved Diagnostic Codes, the provider must go to the global ICD-9 to obtain the correct code.

The physician attests to the accuracy of these diagnoses and codes. In the event any changes or modifications are required to these fields, the DSA must obtain the physician’s agreement, as indicated by the signature and date on Page 3.

Problematic Fields on Form 8578

Mistakes in documentation in these fields are common:

  • Previous Residence (16) – This refers to the person’s previous residence, location or program before being enrolled in the CLASS program. Staff may need to ask the family to help determine this value.
  • Recommended LOC (17) – This is usually an 8. Put a zero here to indicate the person is not eligible for the program. 1 does not apply to the CLASS program.
  • Version Code (21, 25, 28) – This is always 10.
  • Score Identified by ABL Instrument (74) – For ICAPs, this will contain the same value as in field 33; for SIB-Rs, this is the score represented by X/90; this does not apply to the other ABL tools.
  • Functional Assessment (75) – This is the score from the RCESI and should match what is reported on the assessment. The value will always be between 1 and 6 for those older than 10, and 1 to 4 for those younger than 10.

Form 8662, Related Conditions Eligibility Screening Instrument (RCESI)

This assessment measures the functional limitations in the six major areas of life activities. To qualify for CLASS, the person must have impairments in at least three of the six areas for persons 10 years and older, or three of the four areas for those younger than 10 per 42 Code of Federal Regulations 45.1010.

Right of the person to sign:

  • If the person is an adult with no guardian and is able to respond to the assessment, they may answer for themself and must sign for themself.
  • If the person has a guardian, they must sign Form 8662. In addition to the guardian’s signature, the person may sign for themself.
  • No other person can sign for the person, even if a guardian. The guardian will usually be represented as the informant. If the person is their own guardian, but is unable to sign or stamp their name, they should make some kind of mark with hand-over-hand assistance if necessary. The nurse can note the person’s mark and their signature on the form is testimony to the person signing. If the person is unable to make a mark even with hand-over-hand, note the reason in the comment section on the form. This is reserved only for rare circumstances.

Use of Informant — If an informant is needed to assist the person, regardless of legal status, that person must always sign the form as the informant. If the person is their own guardian, they must sign the form in addition to the informant.

Note: If the form is altered after the assessment, such as to remove the name of an informant, the form must be re-signed and dated by the appropriate person(s) to indicate agreement with the change(s).

Consistency Between Activities, the Summary and the ID/RC

  • The Summary in Section 4(B)1 must match the individual activities on Pages 1 and 2. The score must match what is on the ID/RC, field 75.
  • Note the person’s age – Activities E and F are not applicable to children younger than 10.
  • Score between 1 and 6:
    • For a person 10 years and older, the maximum score is 6.
    • For a child younger than 10, the maximum score is 4.

Adaptive Behavior Level (ABL) Assessment Tool

ICAP, SIB-R, Vineland, AAIDD:

  • Only ICAPs and SIB-Rs are completed by DSA RNs.
  • ICAP and SIB-R are very similar and guidelines are the same for both.
  • The DSA RN conducts a face-to-face interaction with the person, regardless of age.
  • The RN must engage the person during the assessment, even if the person is a minor and even when an informant helps the RN complete the assessment. The RN:
    • is the independent, objective observer and assessor of the person.
    • must take into account the information provided by the person or family, which can sometimes be under- or over-estimate of actual abilities.
    • observes, may use props, can ask the person to demonstrate tasks or can generalize from other tasks.
    • compiles information from the person, family, attendants, etc., and from the RN’s own observations and knowledge of the person to arrive at an independent assessment.
  • Booklet, the supporting clinical documentation for the ABL assessment:
    • must be complete, accurate and in permanent ink,
    • must match the scoring program, and
    • the original must be kept in the person’s file.
  • The transferring DSA must forward all originals in the person’s case record. If originals are not available, a receiving DSA may want to conduct a new assessment.

Problem Behaviors

  • Not every behavior is a problem. Not every problem is serious per assessment guidelines in the Guidelines for Completing the ICAP/SIB-R Adaptive Behavior Scale (PDF).
  • Definition of a problem from the guidelines:
    • Many behaviors, even if listed as examples, may not be problems if they are mild, infrequent or age appropriate.
    • For the purpose of the CLASS assessment, a behavior is not a problem if it does not require the attention or intervention of staff, or if it is not discussed as an issue during the service planning team.
    • Does not include behaviors that are:
      • part of the diagnosis,
      • medical problems, or
      • for which a behavior plan would not be effective.
  • Criteria for severity from the guidelines:
    • From least, mild, to most severe, critical.
    • Guidelines help the RN determine the severity of the problem.
    • This section is to assess the behavior that will present a problem for the service provider. It does not necessarily matter how serious a behavior may be to a parent or other family member if the behavior is not a factor with direct service provision.
  • Staff record only one problem behavior in a category. Staff do not record the same behavior in more than one category.
  • Staff can record more than one problem in the person’s record. Staff must  only report one problem in the assessment document.

The ICAP or SIB-R is an assessment of the person’s activity in the month directly before the time the assessment is conducted:

  • If a behavior occurs less than once a month and did not occur during the previous month, it does not need to be listed.
  • If a behavior is not a problem or not serious, the frequency should be never.
  • This section is to record serious problem behavior. If a behavior is not a problem or is not serious, the person should not be penalized for it.

The ABL is assessed at least every five years or as necessary if the person’s situation changes. The ABL assessment must be reviewed at every reassessment to verify continuing accuracy.

  • Children may need to be assessed more frequently.
  • An assessment is necessary whenever a situation or needs change.
  • Maintain an original record for the files.

Perform Quality Control Before Submitting ID/RC Packets to HHSC

Only the most recent ID/RC packet submission is relevant as this information renews at least annually.

All required forms must be complete and accurate:

  • Leave no blank fields other than those identified in the instructions.
  • Check consistency of birth date, onset date.
  • Check previous Level of Care Form 8578 or Form 3650 for diagnosis, code, birth date, onset date.
  • Make sure remands have been thoroughly checked and that all remand reasons have been fully addressed.
  • Submission must be within the appropriate time frame.
  • Submission for reassessments must be within the 120- to 60-day time frame.
  • Compare the diagnosis and code against the current HHSC List of Approved Diagnostic Codes for Persons with Related Conditions.

Remands

Return all material, including the material originally submitted plus all new material and all remand forms, with each re-submission to HHSC. HHSC must be able to track the packet’s history with each re-submission, including:

  • what has been requested and corrected,
  • who worked the packet before, and
  • all dates must be clearly defined.

Corrections/Additions – Mark through an incorrect value with a single line, insert the correct value, initial and date each correction or addition of missing information. For RCESI or the ABL assessment, provide clear indication of the correct response.

Consistency Within and With Other Information Provided

  • Birth date, completion dates on other forms,
  • Legal status, field 15, RCESI, ICAP, etc.,
  • ABL Assessment and ABL, field 30,
  • Field 74, Score identified by ABL Instrument, same as field 33 for the ICAP, and
  • Behavior Program, field 34, Nursing, 39, Day Services, 41, Employment Services, 44:
    • If a service is indicated, the related fields must be populated and vice versa.
    • Nursing is a required service and these fields should always be completed for a Purpose Code 3. At the very least this represents the nursing allotted on the IPC.
    • Behavior Program, field 34, and fields 35-38. If no behavior program, these fields must be 0 and vice versa.

ID/RC Processing Timeline

HHSC requires 15 working days to process ID/RC packets. Working days do not include weekend days, state or federal holidays. The provider also must allow four days of mail time from the date the provider mailed the packet, and four days following the HHSC processing timeline for provider to receive the mail.

Contact Information

For ID/RC inquiries, staff:

  • Fax a name or a list of people to HHSC Administrative Assistant at 512-438-5135.
  • Include the name, Medicaid number or Social Security number, and date the packet is mailed.
  • If not within the processing timeline, wait to inquire until the processing timeline has lapsed.

For questions about an assessment or status, contact the IDD Waivers Program Enrollment/Utilization Review Unit in Access and Intake at HHSC at 512-438-3609.

  • For a voice message, speak slowly and distinctly.
  • Leave name, number and a brief message.

All ID/RC packets are mailed to HHSC unless other arrangements are made.

Regular Mail

Health and Human Services Commission
P.O. Box 149030, Mail Code W-521
Austin TX 78714-9030

Priority or Overnight Mail – Physical Address

Health and Human Services Commission
701 W. 51st St., Mail Code W521
Austin, TX 78751

Note: Always include Mail Code W-521 for accurate routing.

CLASS Fax No. – 512-438-5135