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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 a 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 Section 6420, Section 6430 or Section 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/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 Section 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 Section 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.