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Revision 11-1; Effective January 20, 2011
8210 Transfers Must be Planned
Revision 22-2; Effective May 1, 2022
Texas Health and Human Services Commission (HHSC) requires an individual's transfer to be planned in order for the receiving provider to be knowledgeable about the individual's needs and to be prepared to deliver necessary services. Therefore, the transfer effective date must be a future date to allow for adequate planning. An exception to this requirement may be made when a transfer meets the criteria for an emergency (as described in Section 8230, Emergency Transfer). If an individual/LAR requests a transfer, the program provider or the SC must inform the individual/LAR or family that the transfer must be scheduled for a future date to ensure appropriate planning occurs.
If an individual or LAR informs their current program provider that the individual/LAR wants to transfer to another program provider or FMSA, or the individual’s current program provider receives information from another program provider or FMSA that the individual/LAR wants to transfer to another program provider or FMSA, the individual’s current program provider must, within 24 hours, notify the individual's SC or the LIDDA’s service coordination supervisor of the individual’s/LAR's desire for transfer.
If an individual or their LAR contacts a program provider and informs them of their desire to transfer to the program provider, the program provider must instruct the individual/LAR to notify his/her LIDDA or SC. The potential receiving provider must inform the individual/LAR that before the program provider can begin providing services to the individual, the SC must conduct a transfer individual plan of care (IPC) meeting and a transfer effective date must be agreed to by all parties involved in the transfer. The potential receiving program provider may not begin providing services until the transfer effective date. The potential program provider will not be reimbursed for services provided before the transfer effective date unless the situation meets the emergency transfer criteria described in Section 8230, Emergency Transfer.
8220 No Prior SC Notification
Revision 22-2; Effective May 1, 2022
If an SC is notified that an individual is already receiving services from a potential receiving program provider without going through the transfer process, the SC must document the date they were notified and the name of the person who provided notification. No more than three business days after receiving this notification, the SC must contact the individual/LAR to verify the individual requested a transfer and to confirm their choice of program provider.
- If the individual/LAR says transferring was not their choice, the SC must confirm whether the individual want to remain with his or her previous program provider or select a different program provider.
- If the individual/LAR says it was their decision to transfer, within five business days, the SC must conduct a transfer IPC meeting and inform the receiving program provider that the transfer effective date cannot be prior to the date of the transfer IPC meeting unless the situation meets the emergency transfer criteria described in Section 8230.
8230 Emergency Transfer
Revision 22-2; Effective May 1, 2022
40 Texas Administrative Code §9.153 defines emergency as follows:
- 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.
- Emergency situation – An unexpected situation involving an individual's health, safety, or welfare, of which a person of ordinary prudence would determine that the LAR should be informed, such as:
- an individual needing emergency medical care;
- an individual being removed from his residence by law enforcement;
- an individual leaving his residence without notifying a staff member or service provider and not being located; and
- an individual being moved from his residence to protect the individual (for example, because of a hurricane, fire, or flood).
In an emergency, the individual must be transferred immediately; therefore, the transfer effective date will be prior to the transfer IPC meeting date.
If the SC is unaware that the individual is in an emergency situation that requires an emergency transfer, the receiving program provider must notify the SC as soon as the transfer has occurred to allow the SC to complete the transfer process.
In an emergency transfer, the transfer effective date is the date the individual began receiving services from the new program provider. The signature dates on the transfer IPC will be the date of the IPC meeting. This means the transfer effective date may be earlier than the IPC meeting dates and the IPC signature dates.
The SC must submit the transfer packet and documentation supporting the reason for the emergency transfer to HHSC Program Eligibility and Support (PES). HHSC PES determines whether the emergency transfer criteria is met based on the supporting documentation received from the SC.
If HHSC PES determines the documentation supports the emergency transfer criteria, the receiving provider may be reimbursed for services provided before the transfer IPC meeting.
8231 Data Entry of Emergency Transfer in the HHSC Data System
Revision 22-2; Effective May 1, 2022
For an emergency transfer, HHSC PES enters the transfer in the HHSC data system.