6000, Individual Plan of Care (IPC) | Texas Health and Human Services

Revision 22-2; Effective May 1, 2022

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6100 Overview of the IPC

Revision 22-2; Effective May 1, 2022

Form 3608, Individual Plan of Care (IPC) – HCS/CFC, documents an individual's Home and Community-based Services (HCS) program services and non-HCS services. An IPC is completed at the time an individual enrolls in the HCS program and is valid for 365 days (the IPC year), as long as the individual remains eligible for HCS. An IPC must be renewed prior to the current IPC end date and may be revised at any time during the IPC year if changes are needed. A transfer IPC is completed if an individual transfers to another HCS contract or chooses a different service delivery option (meaning Consumer Directed Services is added or removed as a service delivery option).

The IPC is entered in the HHSC data system.

The HCS services listed on the IPC are based on the individual's person-directed plan (PDP) and must be supported by documentation in the PDP that other sources for the service are unavailable and the service does not replace existing supports, including natural supports or other sources for the service. The services must be necessary for the individual to live in the community, to ensure the individual's health, safety and welfare in the community, and to prevent the need for institutional services.

See Section 4000, Person-Directed Plan, for more information on the PDP, and Form 8665, Person-Directed Plan, and instructions.

An IPC is developed by:

the service planning team (SPT), which consists of the individual/legally authorized representative (LAR), the service coordinator (SC) and any other person invited by the individual/LAR; and
the program provider.

6110 IPC Form and Instructions

Revision 11-2; Effective March 1, 2011

Review Form 3608, Individual Plan of Care (IPC) – HCS/CFC, and instructions before completing the form.

6120 IPC Begin, End and Effective Dates

Revision 22-2; Effective May 1, 2022

Each IPC has an IPC begin date, an IPC end date and an IPC effective date.

The IPC begin date is the first day of the IPC year, the next day after the previous IPC ends.

The IPC end date is 365 days after the IPC begin date. In most cases, an individual's IPC will renew on the same date every year, with leap year being the exception since the IPC is valid for 365 days, not one calendar year. (Note: If there is a gap between the current IPC end date and the renewal IPC meeting date, the provider will not be authorized to bill for services provided to the individual during that gap.)

The IPC begin date and IPC effective date are the same date for an initial IPC and a renewal IPC. If the IPC is revised, the date of the IPC revision then becomes the new IPC effective date, but the IPC begin date and IPC end date do not change.

6130 IPC Meeting

Revision 22-2; Effective May 1, 2022

An IPC meeting occurs when the SPT and the provider meet at the same time, either in person or by telephone, to review the individual's PDP and to discuss and identify necessary units of HCS and non-HCS services to support PDP outcomes. It is important that all parties be able to communicate and discuss openly with one another during the IPC meeting. In most instances, an IPC meeting is necessary to develop the IPC. The exceptions are for an IPC revision to increase or decrease an existing HCS service that does not require a change to the PDP and for an IPC to add/change a requisition fee only.

6140 IPC Types

Revision 22-2; Effective May 1, 2022

A new IPC form is completed at designated events. The event determines the IPC type, which are:

initial IPC;
renewal IPC;
revision IPC; and
transfer IPC.

The IPC types are described in the following sections.

6150 Consumer Directed Services (CDS) and IPCs

Revision 22-2; Effective May 1, 2022

If the individual uses the CDS option, the service coordinator (SC) is responsible for:

ensuring that the HCS program services that are self-directed are included on the IPC any time an IPC is completed;
assisting the CDS employer with developing and maintaining justification for the amount of HCS program services on the IPC that are self-directed, if requested by the employer; and
sending a copy of the completed Form 3608, Individual Plan of Care (IPC) – HCS/CFD, to the Financial Management Services Agency (FMSA).

If an individual only uses the CDS option and does not have a program provider, the Local Intellectual and Developmental Disability Authority (LIDDA) is responsible for entering the IPC into the HHSC data system.

6160 Health and Human Services Commission (HHSC) Role

Revision 22-2; Effective May 1, 2022

HHSC may review any type of IPC at any time to determine if the appropriate type and amount of services are being requested and utilized. HHSC may take action on an IPC, reducing or denying services or amounts of services if there is not documentation to support the need for the requested services. The SC may be asked to provide information or documentation. The SC’s agreement or disagreement with the IPC does not ensure a specific action will be taken by HHSC Utilization Review.

6200 Initial (Enrollment) IPC

Revision 11-2; Effective March 1, 2011

6210 Initial (Enrollment) IPC Overview

Revision 22-2; Effective May 1, 2022

The initial IPC is completed by the LIDDA before an individual is enrolled in the HCS program.

A LIDDA representative meets with the individual and others who know the individual to develop the PDP. This document describes the individual's desired outcomes and is the basis for determining the HCS service components on the initial IPC.

The service components and amount of each service included on the initial IPC are determined from discussions with:

the individual;
the individual's LAR (if an LAR exists);
any other persons the individual/LAR chooses to be involved;
the LIDDA representative who is completing the enrollment activities; and
the program provider selected by the individual or the LAR on the individual's behalf.

6220 LIDDA and Service Coordinator Responsibilities for Initial IPC

Revision 22-2; Effective May 1, 2022

6221 IPC Meeting to Develop Initial IPC

Revision 22-2; Effective May 1, 2022

After the SPT has developed the PDP, including the "Justifications for Waiver Services and Supports" section of the PDP, the SC schedules an IPC meeting with the provider and SPT to develop the initial IPC.

6222 Initial IPC Effective Date

Revision 11-2; Effective March 1, 2011

The initial IPC effective date is the same as the IPC begin date. The IPC meeting must be held on or before the IPC effective date. Services provided prior to the initial IPC effective date may not be reimbursed.

6223 Units of Service

Revision 22-2; Effective May 1, 2022

The SC brings to the IPC meeting justification for units of the services identified on the individual's PDP.

Some service components, such as residential support services, supervised living and host home/companion care, are daily services and the total number of days will equal the days in the IPC year (i.e., 365).
If the individual participates in day habilitation full time (i.e., six hours a day, five days a week), the typical number of days of attendance is approximately 260. This allows for days off for major holidays and those days when day habilitation is not available for the individual.
Amounts of some services (e.g., nursing and professional therapies) may only include the number of units needed to complete an assessment, the results of which will determine the recommend number of hours/units. After the assessment is completed, a revision to the IPC can be completed.
Some services are limited in availability for individuals enrolling who are 20 years and younger because they must be accessed through State Plan Services. These services include nursing, professional therapies and dental.

6224 Non-HCS Services

Revision 22-2; Effective May 1, 2022

The SC includes all non-HCS services the individual is receiving (and will be receiving) on the IPC form for the initial IPC.

6225 Initial IPC Signatures and Signature Dates

Revision 22-2; Effective May 1, 2022

The SC signs and dates the initial IPC and is responsible for obtaining the signature and date of the provider representative and individual/LAR. The date must be the date the IPC meeting occurred. If present, the individual/LAR and SC sign and date on the appropriate lines of the form. If the LAR participates by phone, the SC checks the box to indicate such and enters the date the LAR participated in the IPC meeting. The SC then sends a copy of the form for the LAR's signature.

6226 Transmission of Initial IPC

Revision 22-2; Effective May 1, 2022

The LIDDA enters the initial IPC in the HHSC data system as part of completing an individual's enrollment activities. The SC ensures the individual/LAR and program provider receive a copy of the IPC.

6230 Provider Responsibilities for Initial IPC

Revision 22-2; Effective May 1, 2022

For an initial IPC, the SC contacts the program provider to schedule an IPC meeting. The program provider attends the IPC meeting, participates in the development of the initial IPC, and signs and dates the initial IPC. The program provider's signature date on the initial IPC must be the date of the IPC meeting.

6300, Renewal IPC

Revision 11-2; Effective March 1, 2011

6310 Renewal IPC Overview

Revision 22-2; Effective May 1, 2022

The rules governing the HCS Program direct the SC to notify the service planning team that the individual’s PDP must be reviewed and updated at least 60 but no more than 90 calendar days before the expiration of the individual's IPC. The SC is responsible for arranging for the SPT to review and update the individual's PDP .

After the SPT reviews and updates the PDP, the SC ensures that the program provider has a copy of the individual's current PDP. The provider schedules an IPC meeting with the SPT to develop a renewal IPC.

Although the provider representative is responsible for completing the renewal IPC (Form 3608), the SC is responsible for completing the portions related to CDS, if applicable, and non-HCS services.

6320 Program Provider Responsibilities for Renewal IPC

Revision 22-2; Effective May 1, 2022

6321 IPC Meeting to Develop Renewal IPC

Revision 22-2; Effective May 1, 2022

The program provider schedules an IPC meeting to occur no later than 30 days before the current IPC end date to develop the renewal IPC.

6322 Renewal IPC Effective Date

Revision 14-1; Effective June 9, 2014

The renewal IPC effective date is the same as the IPC begin date. The IPC meeting must be held on or before the IPC effective date. The IPC effective date may not be before the IPC meeting date.

6323 Units of Service

Revision 22-2; Effective May 1, 2022

The provider brings to the IPC meeting justification for units of the services identified on the individual's PDP.

Some service components, such as residential support services, supervised living and host home/companion care, are daily services and the total number of days will equal the days in the IPC year (i.e., 365).
If the individual participates in day habilitation full time (i.e., six hours a day, five days a week), the typical number of days of attendance is approximately 260. This allows for days off for major holidays and those days when day habilitation is not available for the individual.
Amounts of some services may be determined by an assessment completed by a licensed professional providing the service.
Some services are limited in availability for individuals enrolling who are 20 years and younger because they must be accessed through State Plan Services. These services include nursing, professional therapies and dental.

6324 Renewal IPC Signatures and Signature Dates

Revision 22-2; Effective May 1, 2022

The provider representative signs and dates the renewal IPC on the day of the IPC meeting and is responsible for obtaining the signature of the individual/LAR and SC. If present, the individual/LAR and SC sign and date on the appropriate lines of the form. If the LAR participates by phone, the program provider checks the box to indicate such and enters the date the LAR participated in the IPC meeting. The provider then sends a copy of the form for the LAR's signature.

If the SC participates in the IPC meeting by phone, the program provider enters "participated by phone" on the SC's signature line, prints the name of the SC on the appropriate line and enters the date the SC participated.

Then, the hard copy form is submitted to the SC for review.

6325 Transmission of Renewal IPC

Revision 22-2; Effective May 1, 2022

Once the required signatures have been obtained, the provider enters the IPC into the HHSC data system on or before the IPC begin date and ensures that the SC has a hard copy of the IPC (Form 3608) within three days after entering the IPC.

6330 Service Coordinator Responsibilities for Renewal IPC

Revision 22-2; Effective May 1, 2022

The SC participates in the renewal IPC meeting that is scheduled by the program provider. This is done after the SPT has reviewed and updated the PDP.

The SC is not required to provide justification for the amount of HCS services on the renewal IPC; this is the responsibility of the HCS program provider. However, it is important that the SC complete the PDP in a timely manner so the program provider can develop the implementation plan. The SC is also not responsible for conducting utilization review activities.

If the individual has chosen to self-direct services through CDS, the SC includes the units necessary to address the PDP outcome(s) in the CDS section of the IPC as determined by the employer.

6331 Non-HCS Services

Revision 11-2; Effective March 1, 2011

The SC ensures all non-HCS services the individual is receiving are included on the IPC form.

6400 IPC Revision

Revision 11-2; Effective March 1, 2011

6410 IPC Revision Overview

Revision 22-2; Effective May 1, 2022

Either the HCS program provider or the SC may determine that a revision to an individual's IPC is necessary. An IPC revision may be necessary due to a change in the individual's needs, a change in the type of residential services or a miscalculation of units necessary to meet the individual's needs. The provider or the SC notifies the other as soon as possible that services included in the individual's IPC must be added, deleted, increased or decreased.

The provider completes a new IPC (Form 3608) for an IPC revision in accordance with the instructions. The exception is when only a CDS service needs to be revised, in which case the SC completes the IPC for the IPC revision. The form must always include the service units for the entire year, including the services being revised. Requested units of services for an added service should be prorated, as needed, based on the time remaining in the IPC year.

6411 Provider Responsibilities for IPC Revision

Revision 22-2; Effective May 1, 2022

If the program provider determines that an individual's services on the IPC need to be revised, they must first determine:

if the revision reflects PDP change, such as adding or deleting an HCS service;
if the revision increases or decreases an existing HCS service and is supported by a current outcome in the PDP; or
if the revision adds or changes a requisition fee only.

Once this determination is made, the provider follows the procedures associated with the appropriate type of IPC revision as described in 6420, 6430 or 6440.

6412 Service Coordinator Responsibilities for IPC Revision

Revision 22-2; Effective May 1, 2022

If the SC becomes aware of a need to revise an individual's IPC, the SC:

notifies the program provider as soon as possible to revise the IPC; and
schedules an IPC meeting with the program provider to discuss the reason for the revision.

If only a CDS service needs to be revised, the SC meets with the individual/LAR to develop the revised IPC.

If the program provider becomes aware of a need to revise an individual's IPC, the program provider notifies the SC by:

scheduling an IPC meeting to discuss the reason for the revision and to develop a revised IPC; or
submitting to the SC by fax or email a revised IPC (Form 3608) that only increases/decreases an existing HCS service that does not require a change to the PDP.

If the IPC revision adds or changes a requisition fee only, the provider does not need to notify the SC.

The SC is not required to provide justification for the amount of HCS services on the revised IPC; this is the responsibility of the HCS program provider. Neither is the SC responsible for conducting utilization review activities.

6420 IPC Revision to Reflect PDP Change

Revision 11-2; Effective March 1, 2011

If the IPC revision will reflect a PDP change, such as adding or deleting an HCS service or increasing or decreasing an existing HCS service that requires a new PDP outcome, an IPC meeting is necessary to discuss the reason(s) for the revision and to develop the IPC revision.

Further, if the IPC revision is in response to the emergency provision of services as allowed by 40 TAC 9.166(d), the provider ensures documentation supporting such emergency provision of services meets the definition of "emergency" in the HCS rule.

6421 Provider Responsibilities for IPC Revision That Reflects a PDP Change

Revision 22-2; Effective May 1, 2022

If the revision reflects a PDP change, the provider schedules an IPC meeting with the SPT to discuss the reason(s) for the revision and to develop the IPC.

6421.1 IPC Effective Date for IPC Revision That Reflects a PDP Change

Revision 11-2; Effective March 1, 2011

Except for the emergency provision of services, the IPC effective date may only be on or after the date of the IPC meeting; it may not be before the IPC meeting date.

For an IPC revision for the emergency provision of services, the effective date is the date of the emergency provision of services.

If the IPC revision is due to a change in the type of residential services, the IPC effective date must be the date the individual begins receiving the new residential service.

6421.2 Signatures and Signature Dates for IPC Revision That Reflects a PDP Change

Revision 22-2; Effective May 1, 2022

The provider representative signs and dates the IPC revision on the day of the IPC meeting and is responsible for obtaining the signature of the individual/LAR. If present, the individual/LAR and SC sign and date on the appropriate lines of the form. If the LAR participates by phone, the provider checks the box to indicate such and enters the date the LAR participated in the IPC meeting. The provider then sends a copy of the form for the LAR's signature.

If the SC participates in the IPC meeting by phone, the provider enters "participated by phone" on the SC's signature line, prints the name of the SC on the appropriate line and enters the date.

6421.3 Transmission of IPC Revision That Reflects a PDP Change

Revision 22-2; Effective May 1, 2022

Except for the emergency provision of services, the provider enters the completed IPC in the HHSC data system. Within three days after data entry, the program provider ensures the SC has a hard copy of the IPC.

For the emergency provision of services, the program provider faxes the completed hard copy of Form 3608, Individual Plan of Care (IPC) – HCS/CFC, to HHSC Utilization Review (UR), along with documentation of:
- the circumstances that necessitated providing the new HCS service or the increase in the amount of the existing HCS service; and
- the type and amount of the service provided.
Within three days after faxing the form to HHSC UR, the program provider ensures the SC has a hard copy of the completed Form 3608.

6421.4 Activity Following Transmission of IPC Revision That Reflects a PDP Change

Revision 11-2; Effective March 1, 2011

The provider revises the implementation plan to be consistent with the IPC revision.

6422 Service Coordinator Responsibilities for IPC Revision That Reflects a PDP Change

Revision 22-2; Effective May 1, 2022

If the revision reflects a PDP change, such as adding or deleting an HCS service or increasing or decreasing an existing HCS service that requires a new PDP outcome, then the IPC revision requires an IPC meeting. In this situation, the program provider is responsible for scheduling an IPC meeting to discuss and develop the IPC revision. The SC is responsible for making reasonable efforts to be available in a timely manner for the IPC meeting.

The SPT ensures the PDP is consistent with the IPC revision.

6430 Revision to Increase or Decrease an Existing HCS Service

Revision 22-2; Effective May 1, 2022

If the IPC revision is to increase/decrease an existing HCS service and is supported by a current outcome in the PDP, an IPC meeting is not necessary.

The program provider completes Form 3608, Individual Plan of Care (IPC) – HCS/CFC, in accordance with the form's instructions. The program provider obtains the individual/LAR’s agreement by signature and notifies the SC of the IPC revision by submitting a hard copy of the completed Form 3608 by fax or email to the SC on the same day that the provider enters the SC's signature date on the form. (Each LIDDA and program provider should determine the preferred method of notifying the SC, either fax or email.) A phone call or voice message to the SC is not adequate notification.

If the SC agrees with the IPC revision and that an IPC meeting is not required, the SC:

checks the appropriate box in the Service Coordinator Response section of the form;
signs and prints his/her name; and
returns the completed Form 3608 to the provider within two business days after the provider sent it to the SC.

The SC also reviews the electronically transmitted IPC in the HHSC data system.

If the SC determines further discussion is necessary, the SC contacts the program provider as soon as possible to discuss concerns. If no consensus can be reached after this discussion, the SC checks the box indicating an IPC meeting is needed and returns the completed Form 3608 to the program provider within two business days after receiving the form from the program provider. The SC is responsible for scheduling the IPC meeting to occur as soon as possible, but no later than 14 calendar days after the program provider sent the IPC revision to the SC.

Specific instructions for the provider to notify the SC of the need for a revision and the SC's response can be found in the instructions for Form 3608.

6431 Provider Responsibilities for IPC Revision to Increase/Decrease an Existing HCS Service

Revision 22-2; Effective May 1, 2022

The program provider meets with the individual/LAR to discuss the reason for an IPC revision and obtain the individual/LAR's agreement when an IPC meeting is not held.

If an IPC meeting is not held, the program provider completes Form 3608, Individual Plan of Care (IPC) – HCS/CFC, in accordance with the form's instructions, indicating that no meeting is required, noting the reason for the increase/decrease and making the change(s) to the service units. (The service component(s) being revised are identified with an "I" or "D" for increased or decreased.) It is important that the program provider state a reason for the revision on Page 1 of Form 3608 and indicate which current outcome in the PDP supports the service component(s) being revised.

The program provider obtains the individual/LAR's agreement by signature. The provider notifies the SC of the IPC revision by faxing or emailing the completed Form 3608 to the SC on the same day that the provider enters the SC's signature date on the form. A phone call or voice message to the SC is not adequate notification.

6431.1 IPC Effective Date for IPC Revision that Does Not Require an IPC Meeting

Revision 22-2; Effective May 1, 2022

If the IPC revision does not require an IPC meeting, the IPC effective date may only be on or after the date the provider notifies the SC by faxing or emailing the completed Form 3608, Individual Plan of Care (IPC) – HCS/CFC, to the SC.

6431.2 Signatures and Signature Dates for IPC Revision that Do Not Require an IPC Meeting

Revision 22-2; Effective May 1, 2022

The provider representative signs and dates the revision IPC and obtains the signature of the individual/LAR after discussion and agreement. If the agreement is in person, the individual/LAR signs their name and enters date of agreement. If the individual/LAR agrees by phone, the provider checks the box and enters date of agreement. The provider sends a copy of the form for the individual's/LAR's signature.

The provider writes "notified SC" on the SC signature line, prints the SC's name and enters the date the form was faxed or emailed to the SC. (Faxing or emailing the form to the SC serves as notification of an IPC revision that does not require an IPC meeting.)

Note: If the individual/LAR agrees by phone and the program provider sends a copy of the form for signature, the provider may notify the SC of the revision prior to receiving the individual's/LAR's signature.

6431.3 Transmission of IPC Revision that Does Not Require an IPC Meeting

Revision 22-2; Effective May 1, 2022

The program provider may enter the revised IPC in the HHSC data system after the individual’s or LAR’s signature is obtained on the revised IPC.

If the IPC is entered and the SC determines that an IPC meeting is needed, the SC returns the IPC to the program provider in the HHSC data system during the SC's required review of the IPC.

6431.4 Activity Following Transmission of IPC Revision that Does Not Require an IPC Meeting

Revision 22-2; Effective May 1, 2022

If the SC responds by checking the box indicating agreement with the IPC revision, the provider revises the implementation plan to be consistent with the IPC revision.

If the SC responds by checking the box indicating that an IPC meeting is needed, the provider:

follows the procedures in 6420 for revising an IPC; and
deletes the IPC in the HHSC data system that is in return status.

6432 Service Coordinator Responsibilities for IPC Revision that Do Not Require an IPC Meeting

Revision 22-2; Effective May 1, 2022

If the IPC revision is to increase/decrease an existing HCS service and is supported by a current outcome in the PDP, the provider completes Form 3608, Individual Plan of Care (IPC) – HCS/CFC, in accordance with the form's instructions. The provider notifies the SC of the IPC revision by submitting the completed Form 3608 to the SC by fax or email. The SC responds within two business days to the IPC revision by completing the "Service Coordinator Response" section on the bottom of Page 2 of the IPC form.

6432.1 Service Coordinator Response Section of Form 3608

Revision 22-2; Effective May 1, 2022

If the SC receives an IPC revision on Form 3608, Individual Plan of Care (IPC) – HCS/CFC, by fax or email with "notified SC" on the SC's signature line, the SC immediately reviews the form to ensure:

the reason for the increase/decrease stated by the provider on Page 1 of the form is supported by a current outcome in the individual PDP;
the service type is an existing HCS service; and
the IPC effective date is in accordance with the requirements in Section 6431.1.

6432.2 If Service Coordinator Agrees the IPC Revision Does Not Require an IPC Meeting

Revision 22-2; Effective May 1, 2022

If the SC agrees with the IPC revision and that an IPC meeting is not required, the SC:

checks the box stating such, and signs and prints their name at the bottom of Page 2 of the form in the "Service Coordinator Response" section; and
faxes or emails the form to the provider within two business day after the provider sent it to the SC.

6432.3 If Service Coordinator Has Concerns with the IPC Revision

Revision 22-2; Effective May 1, 2022

If the SC has concerns with the reason for the revision, believes a PDP update is necessary or has some reason to believe that the revision is not in accordance with the individual's/LAR’s desired outcomes, the SC immediately contacts the provider to discuss concerns. If the SC and the program provider cannot come to agreement about the amount of the services or supports being requested, the SC completes Form 8579, Notification of Service Coordinator (SC) Disagreement, and submits it to HHSC UR.

If the SC's concerns are resolved after contacting the provider and the SC agrees with the IPC revision and that an IPC meeting is not required, the SC follows the procedures described in 6432.2.

6432.4 Service Coordinator Determines IPC Meeting is Needed

Revision 11-2; Effective March 1, 2011

If the SC continues to have concerns after contacting the provider and determines that an IPC meeting is needed, the SC:

checks the box stating such, and signs and prints their name at the bottom of Page 2 of the form in the "Service Coordinator Response" section;
faxes or emails the form to the provider within two business days after the provider sent it to the SC; and
schedules an IPC meeting to occur as soon as possible but no later than 14 calendar days after the provider faxed or emailed the IPC revision to the SC.

6440 Revision to Add/Change Requisition Fee Only

Revision 11-2; Effective March 1, 2011

If the IPC revision is to add/change a requisition fee only, an IPC meeting is not necessary and the provider is not required to obtain agreement from the individual/LAR.

6441 Provider Responsibilities for IPC Revision to Add/Change a Requisition Fee Only

Revision 11-2; Effective March 1, 2011

If the IPC revision is to add/change a requisition fee only, the provider completes a new Form 3608, Individual Plan of Care (IPC) – HCS/CFC , in accordance with the form's instructions, indicating that the IPC revision is to add/change a requisition fee only.

6441.1 IPC Effective Date for IPC Revision to Add/Change a Requisition Fee Only

Revision 11-2; Effective March 1, 2011

The IPC effective date is the date the provider completes the form.

6441.2 Signatures and Signature Dates for IPC Revision to Add/Change a Requisition Fee Only

Revision 11-2; Effective March 1, 2011

The provider representative completing the form signs and dates the form. On the individual's/LAR's signature line and the SC's signature line, the provider enters "requisition fee only" and enters the IPC effective date as the signature date.

6441.3 Transmission of IPC Revision to Add/Change a Requisition Fee Only

Revision 22-2; Effective May 1, 2022

The provider enters the IPC revision in the HHSC data system and within three days after data entry, the provider ensures the SC has a hard copy of the IPC revision. Note: The IPC will not be sent to the SC for review in the HHSC data system. It will go straight to HHSC for authorization.

6442 Service Coordinator Responsibilities for IPC Revision to Add/Change a Requisition Fee Only

Revision 11-2; Effective March 1, 2011

The SC has no responsibilities for an IPC revision to add/change a requisition fee only.

6500 Transfer IPC

Revision 11-2; Effective March 1, 2011

6510 Transfer IPC Overview

Revision 22-2; Effective May 1, 2022

If an individual wishes to transfer to another provider agency or a different contract within the same provider agency or change service delivery options (that is, add or remove CDS), a transfer IPC must be completed. The SC is responsible for completing the transfer IPC. The SPT and receiving provider hold an IPC meeting to develop the transfer IPC, which must include services already provided by the transferring provider as well as those to be provided by the receiving provider.

See 8000, Transfers and Local Intellectual and Developmental Disability Authority (LIDDA) Reassignments, for specific procedures related to transfers.

6520 LIDDA and Service Coordinator Responsibilities for Transfer IPC

Revision 22-2; Effective May 1, 2022

6521 IPC Meeting to Develop Transfer IPC

Revision 11-2; Effective March 1, 2011

The SC schedules and conducts an IPC meeting with the SPT and receiving provider to develop the transfer IPC. The SC is responsible for completing a new Form 3608. The SC invites the transferring provider to the transfer IPC meeting, but its participation is optional. The receiving provider's participation in the transfer IPC meeting is required.

The SC ensures that the transfer IPC includes all services provided by the transferring provider, as well as those to be provided by the receiving provider.

6522 Transfer IPC Effective Date

Revision 11-2; Effective March 1, 2011

Except for an emergency transfer (see 6525), the IPC effective date of a transfer IPC may only be on or after the date of the IPC meeting; it may not be before the IPC meeting date. The receiving provider will not be reimbursed for services provided prior to the IPC effective date.

6523 Transfer IPC Signatures and Signature Dates

Revision 22-2; Effective May 1, 2022

The SC is responsible for obtaining the signature and date of the receiving provider on the day of the IPC meeting on the transfer IPC. The SC is also responsible for obtaining the signature of the individual/LAR on the transfer IPC. If present, the individual/LAR signs and dates on the appropriate lines of the form. If the LAR participates by phone, the SC checks the box to indicate such and enters the date the LAR participated in the IPC meeting. The SC then sends a copy of the form for the LAR's signature.

6524 Transmission of Transfer IPC

Revision 22-2; Effective May 1, 2022

The LIDDA enters the transfer IPC in the HHSC data system and faxes a copy to HHSC PES. The SC ensures that the receiving provider has a hard copy of the completed IPC Form 3608.

If the LIDDA is unable to complete the data entry, it sends an email to the HHSC PES contact for the receiving provider that includes the error message from the HHSC data system. HHSC PES staff will instruct the LIDDA as to how to complete the data entry.

If two LIDDAs are assisting with a transfer IPC, the transferring LIDDA sends the IPC to the receiving LIDDA for data entry.

For additional information on the transfer process, see 8000, Transfers and Local Intellectual and Developmental Disability Authority (LIDDA) Reassignments.

6525 Emergency Transfer

Revision 22-2; Effective May 1, 2022

If the individual has already begun receiving services from the potential receiving provider and the transfer meets the criteria for an "emergency" (as defined by the HCS rule, see box below), the SC:

enters the date the individual began receiving services from the receiving provider as the transfer IPC effective date; and
documents the circumstances that support the determination of an emergency transfer and faxes it to HHSC PES along with the transfer IPC.

40 TAC, §9.153 Definitions

(14) Emergency – An unexpected situation in which the absence of an immediate response could reasonably be expected to result in risk to the health and safety of an individual or another person.

6530 Provider Responsibilities for Transfer IPC

Revision 11-2; Effective March 1, 2011

6531 Transferring Provider

Revision 22-2; Effective May 1, 2022

The transferring provider completes the appropriate section of Form 3617, Request for Transfer of Waiver Program Services, in accordance with the form's instructions and 8000, Transfers and Local Intellectual and Developmental Disability Authority (LIDDA) Reassignments. The information related to reserved service units/dollars on Form 3617 provided by the transferring provider is essential for the development of the transfer IPC. The transferring provider may participate in the IPC meeting to develop the transfer IPC unless the individual/LAR objects to its participation.

6532 Receiving Provider

Revision 11-2; Effective March 1, 2011

The receiving provider participates in the transfer IPC meeting, participates in the development of the transfer IPC, and signs and dates the transfer IPC. The provider's signature date on the transfer IPC must be the date of the IPC meeting.

6600 Service Coordinator Review Process

Revision 11-2; Effective March 1, 2011

6610 Service Coordinator Review Process Overview

Revision 22-2; Effective May 1, 2022

The SC is responsible for reviewing in the HHSC data system all IPC renewals and all IPC revisions, except IPC revisions that add or change a requisition fee only. After the provider enters the IPC in the HHSC data system, the SC has six days to review it in the HHSC data system. Within three days after entering the IPC, the provider is responsible for sending the SC a hard copy of the IPC (i.e., completed Form 3608).

The SC reviews the IPC in the HHSC data system by ensuring:

the information in the HHSC data system is the same as the information on the hard copy of the IPC and reflects what was discussed during the IPC meeting, if appropriate; and
that the IPC effective date is in accordance with the requirements in 6323, 6421.1 or 6431.1, as appropriate.

If an SC does not review an IPC within six days after data entry, the HHSC data system will automatically send the IPC to HHSC for authorization without an SC review. Reports will be available for state office and LIDDA management staff noting those IPCs not reviewed by the SC.

6611 Reasons the IPC is Returned to the Provider

Revision 22-2; Effective May 1, 2022

The SC returns the IPC electronically in the HHSC data system to the provider if the SC is unable to agree or disagree with the IPC because:

the SC did not receive the IPC hard copy within the required time frame and the SC is unable to review the IPC in the HHSC data system before the six-day review time frame ends;
an error was made in the HHSC data system related to a unit of service, the name of the SC (not a just minor misspelling) or a signature date;
the SC was not notified by fax or email of an IPC revision for which an IPC meeting is not needed;
the SC determined an IPC meeting was necessary for an IPC revision in accordance with 6432.4;
the SC did not participate in the development of an IPC for which an IPC meeting is needed; or
the IPC effective date is not in accordance with the requirements in 6323, #6421.1 or 6431.1, as appropriate.

6612 Service Coordinator's Agreement/Disagreement with IPC

Revision 22-2; Effective May 1, 2022

The SC must agree that the HCS services on the IPC are:

not available through other resources, and do not replace existing and natural supports;
necessary to assure the individual's health and safety and prevent institutionalization; and
based on the outcomes in the individual's PDP.

6620 Service Coordinator Responsibilities

Revision 11-2; Effective March 1, 2011

6621 If the IPC is Returned to Provider

Revision 22-2; Effective May 1, 2022

If the SC returns the IPC to the provider, the SC enters a comment in the HHSC data system to explain the reason for returning the IPC. Additionally, the SC contacts the provider the same day that an IPC is returned and discusses with the provider how to resolve the issue.

6622 Service Coordinator's Agreement/Disagreement with IPC

Revision 22-2; Effective May 1, 2022

If the SC does not return the IPC in the HHSC data system to the provider, the SC completes the review by entering the agreement or disagreement in the HHSC data system before the IPC proceeds to HHSC for authorization.

6622.1 Agreement with IPC

Revision 22-2; Effective May 1, 2022

The SC must agree with the IPC in the HHSC data system to move it forward for review.

6622.2 Disagreement with IPC

Revision 22-2; Effective May 1, 2022

If the SC does not agree with the requirements in 6612, Service Coordinator’s Agreement/Disagreement with IPC, the SC contacts the program provider to discuss concerns related to the HCS services in the IPC for which the SC is unable to agree.

If the SC's concerns are not resolved and the SC continues to disagree, the SC completes Form 8579, Notification of Service Coordinator Disagreement, and submits it to HHSC UR, and sends a copy to the program provider. The SC completes the form on the same day that the SC enters the disagreement in the HHSC data system.

6630 Provider Responsibilities

Revision 22-2; Effective May 1, 2022

The provider ensures that the SC has a hard copy of the IPC within three days after the provider enters the IPC data into the HHSC data system.

6631 Service Coordinator Returns IPC in the HHSC Data System

Revision 22-2; Effective May 1, 2022

If the SC returns an IPC to the provider in the HHSC data system, the SC notifies the provider that same day of the returned IPC. Additionally, the SC enters a comment in the HHSC data system to explain the reason for returning the IPC.

6632 Activity to Address a Returned IPC

Revision 22-2; Effective May 1, 2022

The IPC remains in "Returned to Provider" status until the provider takes some action in the HHSC data system to address the returned IPC. Depending on the reason the IPC was returned, the provider may take one of the following HHSC data system actions:

delete and re-enter the IPC; or
correct any errors.

Before taking HHSC data system action to send the IPC on to the SC for review again, the provider is responsible for resolving the issue that was the basis for the IPC being returned.