Revision 24-3; Effective Sept. 30, 2024
The number of offers for a Home and Community-based Services (HCS) Crisis Diversion slot made each month is based on budgetary guidelines per the legislative allocation for the biennium.
12100 Purpose
Revision 24-3; Effective Sept. 30, 2024
Texas Health and Human Services Commission (HHSC) may offer an HCS Crisis Diversion slot to a person with an intellectual or developmental disability who:
- is determined to be at imminent risk of admission to an institution as defined in Section 12200, Definition of Imminent Risk of Admission to an Institution;
- is, as specified in the HCS Medicaid Waiver application, a person:
- at risk of institutionalization;
- at risk of institutionalization in a state supported living center (SSLC); or
- leaving a state hospital who is at risk of re-institutionalization; and
- meets the qualifications per Section 12300, Criteria for Requesting an HCS Reserved Capacity Group Crisis Diversion Slot.
12200 Definition of Imminent Risk of Admission to an Institution
Revision 19-4; Effective September 9, 2019
A person is at imminent risk of admission to an institution if one or more of the following exists:
- loss or incapacity of the person’s primary caregiver;
- loss of the person’s placement in a community residential facility;
- the person exhibits repeated and severe behavior disturbances that jeopardize the person’s safety or current living arrangement, but does not need:
- inpatient mental health treatment; or
- care in a behavioral health facility, such as Texana Center’s Behavior Treatment and Training Facility or Bayes Achievement Center; or
- the person is recommended for discharge from a state hospital and unable to return to family or community-based care.
12300 Criteria for Requesting an HCS Reserved Capacity Group Crisis Diversion Slot
Revision 24-3; Effective Sept. 30, 2024
A person meets the criteria for the local intellectual and developmental disability authority (LIDDA) to request an HCS Reserved Capacity Group Crisis Diversion slot if:
- The person is at imminent risk of admission to an institution as defined in Section 12200, Definition of Imminent Risk of Admission to an Institution;
- The person is not being court-committed to a facility for competency evaluation, such as an SSLC or state hospital;
- Adequate and appropriate community resources are not available, as evidenced by attempts to locate and use community-based services and supports, such as community intermediate care facilities for individuals with intellectual disabilities or related conditions (ICF/IIDs), general revenue-funded services, Community First Choice services, Crisis Intervention Services, other Medicaid waiver programs, or for a minor, supports through the local school district; and
- The person meets the criteria for LIDDA priority population per Title 26 Texas Administrative Code (TAC), Section 304.102, Diagnostic Assessment.
Note: Persons must meet the diagnostic and financial criteria specified in Title 26 Texas Administrative Code (TAC) Section 263.101, Eligibility Criteria for HCS Program Services and CFC Services to enroll in HCS.
12400 Process
Revision 24-3; Effective Sept. 30, 2024
The LIDDA conducts an interview with the person and legally authorized representative (LAR) or an actively involved party about the circumstances creating imminent risk of the person’s admission to an institution. The LIDDA provides an explanation of intellectual or developmental disability (IDD) services and supports.
If the LIDDA determines the person is at imminent risk of admission to an institution as described in Section 12200, Definition of Imminent Risk of Admission to an Institution, and meets the criteria for LIDDA priority population per Title 26 Texas Administrative Code (TAC), Section 304.102, Diagnostic Assessment and that adequate and appropriate community resources are not available, as evidenced by attempts to locate and use community-based services and supports, the LIDDA begins the process for requesting an HCS Crisis Diversion slot.
- The LIDDA sends a completed Form 1058, Request for Home and Community-based Services Crisis Diversion Slot to the designated HHSC IDD Services mailbox.
HHSC staff will meet to discuss the request and determine if the person meets the criteria described in Section 12300, Criteria for Requesting an HCS Reserved Capacity Group Crisis Diversion Slot.
- If HHSC determines the person does not meet the criteria, HHSC, within one business day, will notify the LIDDA and the person or LAR in writing of the denial of an HCS Crisis Diversion slot and provide the person or LAR with an opportunity for an appeal through a fair hearing.
- If HHSC determines the person meets the criteria and a slot is immediately available, HHSC will, within one business day, send a letter that authorizes the LIDDA to offer the person the opportunity to enroll in HCS.
- If the person meets the criteria, but a slot is not immediately available, HHSC will notify the LIDDA within one business day that the person meets the criteria, but a slot is not immediately available. HHSC will maintain contact with the LIDDA until a slot becomes available. At that point HHSC will send a letter that authorizes the LIDDA to offer the person the opportunity to enroll in HCS.
The LIDDA initiates the enrollment process within three business days of receipt of the authorization letter from HHSC. The LIDDA must complete the enrollment process per the rules governing the HCS Program, specifically 26 TAC Section 263.104, Process for Enrollment of Applicants, within the time frames required by the LIDDA Performance Contract.
If, while waiting for an offer of an HCS Crisis Diversion slot, HHSC determines the person no longer meets the criteria for the HCS Reserved Capacity Group Crisis Diversion slot, as described in Section 12300, HHSC will within one business day notify the LIDDA and the person or LAR in writing of the denial of an HCS Crisis Diversion slot. HHSC will provide the person or LAR with an opportunity for an appeal through a fair hearing.