17000, Non-Waiver Community First Choice | Texas Health and Human Services

Revision 25-1; Effective Feb. 7, 2025

Non-Waiver Community First Choice (CFC) provides certain services and supports through managed care organizations (MCOs) or the Department of State Health Services (DSHS) to people living in the community who meet CFC eligibility requirements and are enrolled in an allowable type of Medicaid. For more information on allowable types of Medicaid, refer to Section 17005, Verifying Type of Medicaid.

Local intellectual and developmental disability authority (LIDDA) staff who provide service coordination for Non-Waiver CFC must complete training outlined in Section 13100, LIDDA Required Training.

Review the Explanation of IDD Services and Supports (PDF) for more information on the available CFC services.

17005 Verifying Type of Medicaid

Revision 25-1; Effective Feb. 7, 2025

To be eligible for Non-Waiver CFC, that is CFC services not provided through a waiver program, a person must have Medicaid through:

An MCO:
- STAR+PLUS,
- STAR Health;
- STAR Kids; or
Fee-For-Services (FFS) Medicaid:
- STAR; or
- Traditional FFS Medicaid.

Note: Waiver programs include Home and Community-based Services (HCS), Texas Home Living (TxHmL), Deaf Blind with Multiple Disabilities (DBMD), and Community Living Assistance and Support Services (CLASS). People in these waiver programs must receive CFC services through their waiver service provider. Non-Waiver CFC recipients get CFC services through their MCO or DSHS.

The LIDDA checks the following systems to verify the person’s type of Medicaid:

Client Assignment and Registration (CARE) System screen C63, Medicaid Eligibility Search;
Texas Medicaid & Healthcare Partnership (TMHP) TexMed Connect; or
Medicaid Client Portal (MCP). Note: FFS Medicaid is only shown via MCP.

MCP instructions

Log in to your TMHP provider account on the TMHP website.
Click Medicaid Client Portal for Providers.
Search for the person and confirm their information is correct. Note: Patient Control Number is the Medicaid number.
Click on Medicaid Benefits, then use the Eligibility Verification function to search for eligibility details by entering the month and year.
In the search results, look for Medical Coverage. This shows specific types of Medicaid.

For more information on Medicaid, refer to the Managed Care Service Areas Map (PDF) and the Texas Medicaid and CHIP Reference Guide.

17010 Referrals

Revision 25-1; Effective Feb. 7, 2025

For people with STAR+PLUS, STAR Health or STAR Kids Medicaid, MCOs are responsible for referring people with an intellectual or developmental disability (IDD), or those who may have IDD, to the LIDDA to conduct CFC eligibility activities. If the person has STAR or FFS Medicaid, the MCO is not involved in the CFC referral or assessment process. For people with STAR or FFS Medicaid, DSHS submits CFC referrals to the Texas Health and Human Services Commission (HHSC) CFC FFS team.

MCOs and the HHSC CFC FFS team upload CFC referrals to the LIDDA via the LIDDA Connect SharePoint site. Referral information is documented on standardized spreadsheets, known as Non-Waiver CFC Referrals and Reassessments spreadsheets, which MCOs, LIDDAs and HHSC can access. Each LIDDA will have a file for referrals from DSHS and the MCOs located in their managed care service area (PDF). The LIDDA is responsible for reviewing all Non-Waiver CFC Referrals and Reassessments spreadsheets, updating any internal spreadsheets with the new referrals and initiating contact.

Although there are no specific time frames on reaching out to offer the services, the LIDDA should make efforts to begin contacting the person as soon as possible. The intellectual disability/related condition (ID/RC) assessment for CFC must be submitted to HHSC within 90 calendar days after notification of a referral. For each person without an ID/RC submitted by the 90th calendar day after the referral was received, the LIDDA must provide justification on the Non-Waiver CFC Referrals and Reassessments spreadsheet by the 15th day of the following month. For example, for a referral received on March 1, the ID/RC should be submitted before June 1. If not submitted by then, justification must be provided by July 15.

Note: If a person with FFS or STAR Medicaid notifies the LIDDA they are interested in CFC services, the LIDDA calls the TMHP client line at 888-276-0702 with the person or LAR to make a CFC referral for the person. The TMHP referral staff forwards the CFC referral to the appropriate local DSHS office for a DSHS case worker assignment followed by a referral to the HHSC CFC FFS team. Once received, the HHSC CFC FFS staff checks Medicaid eligibility and adds the referral to the Non-Waiver CFC Referrals and Reassessments spreadsheet.

17020 Declines or Unable to Locate

Revision 25-1; Effective Feb. 7, 2025

If the person or legally authorized representative (LAR) declines the offer of Non-Waiver CFC services, the LIDDA must add the declination information to the Non-Waiver CFC Referrals and Reassessments spreadsheet in LIDDA Connect by the 15th of the following month after the declination. For example, for a referral received on March 1, if the person declines CFC services on March 20, then the spreadsheet must be updated by April 15.

If the person cannot be located or does not respond to outreach attempts, the LIDDA must reach out to the MCO or DSHS to confirm accurate contact information or request assistance with reaching the person. It is best practice for a LIDDA to attempt to contact the person and LAR, if applicable, through at least three phone call attempts and one written correspondence. From the first attempted contact, the LIDDA should complete subsequent contact attempts, if needed, within a 30-day period. If the LIDDA still has not been able to reach the person or LAR after this period, the LIDDA must add the unable to locate information to the Non-Waiver CFC Referrals and Reassessments spreadsheet in LIDDA Connect by the 15th of the following month after the last attempted contact. For example, for a referral received on March 1, if the person’s last attempted contact is on April 14, then the spreadsheet must be updated by May 15.

17100 Initial Eligibility Determination Activities

Revision 25-1; Effective Feb. 7, 2025

For any person who expresses an interest in CFC services based on IDD, the LIDDA completes all assessment activities required by HHSC to determine if the person meets an intermediate care facility for individuals with intellectual disabilities or related conditions (ICF/IID) level-of-care (LOC), including:

Form 8578-CFC, Intellectual Disability/Related Condition (ID/RC) Assessment for CFC;
Form 8662, Related Conditions Eligibility Screening Instrument, if the person’s primary diagnosis is a related condition;
Determination of Intellectual Disability (DID), endorsement of an existing DID or a physician’s attestation that the person has a condition listed on the approved list of related conditions (PDF) that manifested before the person’s 22nd birthday.
Note: If a DID is on file, a new DID assessment does not need to be conducted unless clinically indicated or requested by HHSC. A DID may, but is not required to, be completed if the person was younger than 22 years at their most recent testing and the testing was completed more than five years ago. Refer to the DID Best Practice Guidelines.

For CFC eligibility through an MCO or DSHS, the person must meet ICF/IID LOC I or LOC VIII criteria per 26 Texas Administrative Code (TAC), Chapter 261, ICF/IID Program, Subchapter E, Eligibility, Enrollment and Review.

The LIDDA completes the following activities when submitting an ICF/IID LOC determination to HHSC:

enters Form 8578-CFC, ID/RC Assessment for CFC, into the Client Assignment and Registration (CARE) System using screen K23; and
submits eligibility documents to HHSC Program Eligibility and Support (PES) through:
- IDD Operations Portal, preferred;
- HHSC CFC Fax Line at 512-438-5693; or
- Mail to Texas Health and Human Services Commission, P.O. Box 149030, Mail Code W254, Austin, TX 78751.

If the person meets eligibility based on an LOC I, the LIDDA submits the following eligibility documents to HHSC PES:

Form 8578-CFC, ID/RC Assessment for CFC;
DID report;
adaptive behavior level (ABL) assessment completed within the previous five years; and
if a related condition is the primary diagnosis, include:
- Form 8662, Related Conditions Eligibility Screening Instrument; and
- a physician’s attestation that the person has a condition listed on the approved list of related conditions (PDF) that manifested before the person’s 22nd birthday, if not included in the DID report.

If the person meets eligibility based on an LOC VIII, the LIDDA submits the following eligibility documents to HHSC PES:

Form 8578-CFC, ID/RC Assessment for CFC;
Form 8662, Related Conditions Eligibility Screening Instrument;
ABL assessment scoring pages completed within the previous five years; and
a physician’s attestation that the person has a condition listed on the approved list of related conditions (PDF) that manifested before the person’s 22nd birthday.

CFC ID/RC assessments must be completed and submitted to HHSC within 90 calendar days after notification of a referral. LIDDAs are responsible for checking CARE for LOC review results.

Note: For LOC I, refer to the DID Best Practice Guidelines. For LOC VIII, the LIDDA service coordinator may conduct the Inventory for Client and Agency Planning (ICAP) to obtain the person’s ABL. It is expected that a service coordinator will use the ICAP for an ABL assessment. If other designated staff are conducting an ABL assessment, they may use an inventory other than the ICAP, consistent with the DID Best Practice Guidelines. If the ICAP is administered, the following conversion table can be used to determine the person’s ABL. If no limitations are indicated, the ABL should be scored as an ABL 0.

ICAP Conversion

Service Level	Adaptive Behavior Level
7,8,9	I
4,5,6	II
2,3	III
1	IV

17110 Person Does Not Meet ICF/IID LOC Criteria

Revision 25-1; Effective Feb. 7, 2025

If HHSC determines a person does not meet the criteria for an ICF/IID LOC, the LIDDA must complete the actions below in LIDDA Connect by the 15th of the following month after receiving the LOC denial:

add the denial information to the Non-Waiver CFC Referrals and Reassessments spreadsheet; and
compile a packet with the following and submit it to the MCO:
- Form 1040, CFC Non-Waiver Packet Information and Checklist;
- Form 8578-CFC, ID/RC Assessment for CFC;
- DID report or a physician’s attestation; and
- LOC denial notification.

When uploading the packet, the LIDDA uses the naming convention Medicaid ID_XXX_CFC Denial Packet_First Four Letters of the Person’s Last Name_YYYYMMDD. XXX represents the MCO Component Code and YYYYMMDD represents the date the packet is uploaded.

For example, if a LIDDA uploads a CFC denial packet for John Smith with Medicaid ID 999999999 on July 13, 2025, to Wellpoint with Component Code 123, the file name is:

999999999_123_CFC Denial Packet_SMIT_20250713

The LIDDA does not submit CFC denial packets via LIDDA Connect for DSHS referrals, unless requested by HHSC.

The LIDDA receives all LOC denial notifications from HHSC PES via the IDD Operations Portal. For MCO referrals, HHSC PES sends the LOC denial notification to the person’s MCO via secure email. For DSHS referrals, HHSC PES sends the LOC denial notification to the HHSC CFC FFS team via secure email. When the MCO or HHSC CFC FFS team receives the LOC denial notification, the MCO or HHSC CFC FFS team sends a denial letter to the person, which includes the LOC denial notification, the person’s appeal rights and a Fair Hearing Request Form.

17120 Person Younger Than 21 Meets ICF/IID LOC Criteria

Revision 25-1; Effective Feb. 7, 2025

The LIDDA must complete and submit the following documents for people younger than 21 who HHSC has determined meet the criteria for an ICF/IID LOC. The LIDDA submits these documents to the MCO via LIDDA Connect within seven business days of the LOC approval date:

Form 1040, CFC Non-Waiver Packet Information and Checklist;
Form 8578-CFC, ID/RC Assessment for CFC;
DID report or a physician’s attestation, as applicable; and
LOC approval confirmation.

When uploading the packet, the LIDDA uses the naming convention Medicaid ID_XXX_CFC Packet_First Four Letters of the Person’s Last Name_YYYYMMDD. XXX represents the MCO Component Code and YYYYMMDD represents the date the packet is uploaded.

For example, if a LIDDA uploads a CFC packet for John Smith with Medicaid ID 999999999 on July 13, 2025, to Wellpoint with Component Code 123, the file name is:

999999999_123_CFC Packet_SMIT_20250713

The LIDDA does not submit CFC packets via LIDDA Connect for DSHS referrals, unless requested by HHSC. HHSC PES notifies the HHSC CFC FFS team of LOC approvals, and the HHSC CFC FFS team notifies DSHS to complete the CFC enrollment process.

The LIDDA must update the Non-Waiver CFC Referrals and Reassessments spreadsheet by the 15th of the following month after it receives the LOC approval.

The LIDDA does not provide service coordination for people younger than 21 who receive Non-Waiver CFC through the MCO or DSHS.

17130 Person 21 and Older Meets ICF/IID LOC Criteria

Revision 25-1; Effective Feb. 7, 2025

The LIDDA must conduct the following initial service planning activities no later than 30 days after HHSC authorizes the person’s ICF/IID LOC:

assign a service coordinator; and
conduct the person-centered service planning meeting.

The LIDDA must conduct person-centered service planning with the person and the LAR per the Person-Centered Planning Guidelines. The LIDDA will contact the person or LAR to schedule a time to meet and complete Form H6516, Community First Choice Assessment. The meeting is conducted face-to-face with the person and LAR. The LAR may attend by phone if they are unable to attend in person. The time and location of the meeting must be convenient to the person and LAR.

Note: For this assessment, face-to-face means within the physical presence of another person. Face-to-face does not include audio-visual or audio-only communication.

At the scheduled meeting, the LIDDA must:

complete:
- Form H6516, Community First Choice Assessment;
- Form 2060-B, Needs Assessment Addendum;
- Form 1581, Consumer Directed Services (CDS) Option Overview;
identify with the person and LAR a date, time and location for the joint meeting with the Medicaid MCO service coordinator that is approximately three weeks after the completion of Form H6516;
provide a copy of Community First Choice: Choosing a Provider;
tell the person or LAR to expect a list of CFC providers from the MCO within the next two weeks;
encourage the person or LAR to be prepared to identify the selected CFC provider at the joint meeting; and
tell the person or LAR to contact the MCO with questions about providers.

The LIDDA must complete and submit the following documents to the MCO via LIDDA Connect:

Form 1040, CFC Non-Waiver Packet Information and Checklist, which includes:
- the date, time and location of the scheduled joint meeting;
- where the MCO should send a list of CFC providers;
DID report or a physician’s attestation;
Form 8578-CFC, Intellectual Disability/Related Condition Assessment for CFC;
Form H6516, Community First Choice Assessment;
Form 2060-B, Needs Assessment Addendum;
Form 1581, Consumer Directed Services (CDS) Option Overview; and
LOC approval confirmation.

For example, if a LIDDA uploads a CFC packet for John Smith with Medicaid ID 999999999 on July 13, 2025, to Wellpoint with Component Code 321, the file name is:

999999999_321_CFC Packet_SMIT_20250713

When the MCO receives the packet from the LIDDA, the MCO determines if the person has a need for CFC services.

If no services are recommended on the service plan completed by the LIDDA, that is Form H6516, the MCO denies the request for services and sends the person an adverse determination letter. The letter includes an offer for a fair hearing. Refer to Section 17300, LIDDA Responsibilities When a Person Appeals an MCO’s Denial of Services.

If services are on the recommended service plan but the MCO does not agree with the recommendations, the MCO service coordinator contacts the LIDDA to discuss the service plan to reach an agreement on changes to the plan that will be presented to the person. Following an agreement, the MCO service coordinator, person, LAR and LIDDA meet to jointly review the services that will be authorized for the person. The MCO then authorizes services and notifies the person. The MCO also notifies the LIDDA of the selected provider.

If services are on the recommended service plan and the MCO service coordinator agrees with the recommended services, the MCO:

service coordinator, person, LAR and LIDDA meet to jointly review the services that will be authorized for the person;
then authorizes services and notifies the person; and
also notifies the LIDDA of the selected provider.

The LIDDA must make sure the MCO has the final version of Form H6516 if changes occur following the joint meeting between the MCO, LIDDA and the person. The LIDDA must upload the final Form H6516 with the signature page to the MCO via LIDDA Connect within three business days following the joint meeting.

The LIDDA uploads the final Form H6516 with the naming convention Medicaid ID_XXX_CFC Final Packet_First Four Letters of the Person’s Last Name_YYYYMMDD. XXX represents the MCO Component Code and YYYYMMDD represents the date the final packet is uploaded.

The LIDDA must update the Non-Waiver CFC Referrals and Reassessments spreadsheet by the 15th of the following month after it submits the final packet to the MCO.

The LIDDA must make sure an assigned service coordinator provides service coordination to a person older than 21 while the person is receiving CFC services through an MCO in the LIDDA’s local service area (LSA).

17200 Annual Reassessment

Revision 25-1; Effective Feb. 7, 2025

No later than 90 calendar days before the expiration of the ICF/IID LOC for a person, the LIDDA must communicate with the appropriate MCO or HHSC CFC FFS team to confirm if the person is receiving CFC services and to initiate the reassessment process. The LIDDA notifies the MCO or HHSC CFC FFS team by adding the identified person’s name and pertinent information to the Reassessment tab of the Non-Waiver CFC Referrals and Reassessments spreadsheet on the LIDDA Connect site. The MCO or the CFC FFS team will respond within 10 calendar days to confirm the member requires a new ID/RC for continued CFC eligibility. If the member does not require a new ID/RC, the MCO updates the Reassessment tab of the spreadsheet indicating no.

For people who are not receiving CFC services, the LIDDA has no reassessment responsibilities.

For people who are receiving CFC services, the LIDDA must:

conduct the reassessment activities described in this section; and
complete Form 8578-CFC, Intellectual Disability/Related Condition Assessment for CFC, with current ABL and DID if applicable, to determine if the person continues to meet the ICF/IID LOC criteria.

For CFC eligibility through an MCO or DSHS, the person must continue to meet ICF/IID LOC I or LOC VIII criteria per 26 TAC Chapter 261, Subchapter E, Eligibility, Enrollment and Review.

Note: The LIDDA must reassess a person’s ABL every five years. For people with LOC I, a new DID assessment does not need to be conducted unless clinically indicated or requested by HHSC. A DID may, but is not required to, be completed if the person was younger than 22 at their most recent testing and the testing was completed more than 5 years ago. Information about conducting DIDs is in the DID Best Practice Guidelines.

The LIDDA must submit the ID/RC assessment Purpose Code 3 to HHSC PES using CARE screen K23 for a LOC determination.

If an annual ID/RC has any ABL, diagnostic or functioning changes from the previous year’s ID/RC, the LIDDA also submits eligibility documents to HHSC PES through the:

IDD Operations Portal, preferred;
HHSC CFC Fax Line at 512-438-5693; or
mail to Texas Health and Human Services Commission, P.O. Box 149030, Mail Code W254, Austin, TX 78751.

If submitting eligibility documents to HHSC PES, the following is submitted for people who meet eligibility based on an LOC I:

Form 8578-CFC, ID/RC Assessment for CFC;
DID report;
ABL assessment completed within the previous five years; and
if a related condition is the primary diagnosis, include:
- Form 8662, Related Conditions Eligibility Screening Instrument; and
- a physician’s attestation that the person has a condition listed on the approved list of related conditions (PDF) that manifested before the person’s 22nd birthday, if not included in the DID report.

If submitting eligibility documents to HHSC PES, the following is submitted for people who meet eligibility based on an LOC VIII:

Form 8578-CFC, ID/RC Assessment for CFC;
Form 8662, Related Conditions Eligibility Screening Instrument;
ABL assessment scoring pages completed within the previous five years; and
a physician’s attestation that the person has a condition listed on the approved list of related conditions (PDF) that manifested before the person’s 22nd birthday.

ICAP Conversion

Service Level	Adaptive Behavior Level
7,8,9	I
4,5,6	II
2,3	III
1	IV

17210 Person No Longer Meets ICF/IID LOC Criteria

Revision 25-1; Effective Feb. 7, 2025

If HHSC determines a person does not continue to meet the criteria for an ICF/IID LOC, the LIDDA must complete the actions below in LIDDA Connect by the 15th of the following month after receiving the LOC denial:

add the denial information to the Non-Waiver CFC Referrals and Reassessments spreadsheet; and
compile a packet with the following and submit it to the MCO:
- Form 1040, CFC Non-Waiver Packet Information and Checklist;
- Form 8578-CFC, Intellectual Disability/Related Condition Assessment for CFC;
- DID report or a physician’s attestation; and
- LOC denial notification.

For example, if a LIDDA uploads a CFC denial packet for John Smith with Medicaid ID 999999999 on July 13, 2025 to Wellpoint with Component Code 123, the file name is:

999999999_123_CFC Denial Packet_SMIT_20250713

The LIDDA does not submit CFC denial packets via LIDDA Connect for DSHS referrals, unless requested by HHSC.

17220 Person Younger Than 21 Continues to Meet ICF/IID LOC Criteria

Revision 25-1; Effective Feb. 7, 2025

No later than 30 calendar days before the expiration of a person’s ICF/IID LOC, the LIDDA must complete and submit the following documents to the MCO via LIDDA Connect:

Form 1040, CFC Non-Waiver Packet Information and Checklist;
Form 8578-CFC, Intellectual Disability/Related Condition Assessment for CFC;
DID report or a physician’s attestation, if updated; and
LOC approval confirmation.

When uploading the packet, the LIDDA uses the naming convention Medicaid ID_XXX_CFC Reassess Packet_First Four Letters of the Person’s Last Name_YYYYMMDD. XXX represents the MCO Component Code and YYYYMMDD represents the date the packet is uploaded.

For example, if a LIDDA uploads a CFC packet for John Smith with Medicaid ID 999999999 on July 13, 2025, to Wellpoint with Component Code 123, the file name is:

999999999_123_CFC Reassess Packet_SMIT_20250713

The LIDDA must update the Non-Waiver CFC Referrals and Reassessments spreadsheet by the 15th of the following month after receiving the LOC approval.

The LIDDA does not provide service coordination for people younger than 21 receiving Non-Waiver CFC through the MCO or DSHS.

17230 Person 21 and Older Continues to Meet ICF/IID LOC Criteria

Revision 25-1; Effective Feb. 7, 2025

The LIDDA service coordinator is responsible for completing the annual service planning and continuation of LIDDA services for people 21 or older who continue to have an ICF/IID LOC.
The LIDDA must:

conduct person-centered service planning with the person per the Person-Centered Planning Guidelines, to determine the services they need; and
contact the person or LAR to schedule a time to meet and complete Form H6516, Community First Choice Assessment.

The meeting is conducted face-to-face with the person and LAR. The LAR may attend by phone if the LAR is unable to attend in person. The time and location of the meeting must be convenient to the person and LAR.

Note: For this assessment face-to-face means within the physical presence of another person. Face-to-face does not include audio-visual or audio-only communication.

At the scheduled meeting, the LIDDA must:

complete
- Form H6516; Community First Choice Assessment
- Form 2060-B, Needs Assessment Addendum;
- Form 1581, Consumer Directed Services (CDS) Option Overview;
identify with the person and LAR a date, time and location for the joint meeting with the MCO service coordinator, that is approximately three weeks after the completion of Form H6516; and
determine if the person or LAR wants to change providers, and if so, request the MCO send the person a list of providers with Form 1040, CFC Non-Waiver Packet Information and Checklist.

No later than 30 calendar days prior to the expiration of a person’s ICF/IID LOC, the LIDDA must complete and submit the following documents to the MCO via LIDDA Connect:

Form 1040, CFC Non-Waiver Packet Information and Checklist, that includes:
- the date, time and location of the joint meeting;
- where the MCO should send a list of CFC providers, if applicable;
Form 8578-CFC, Intellectual Disability/Related Condition Assessment for CFC;
DID report or a physician’s attestation, if updated;
Form H6516, Community First Choice Assessment;
Form 2060-B, Needs Assessment Addendum;
Form 1581, Consumer Directed Services (CDS) Option Overview; and
LOC approval confirmation.

When uploading the packet, the LIDDA uses the naming convention Medicaid ID_XXX_CFC Reassess Packet_First Four Letters of the Person’s Last Name_YYYYMMDD. XXX represents the MCO Component Code and YYYYMMDD represents the date the packet is uploaded.

For example, if a LIDDA uploads a CFC packet for John Smith with Medicaid ID 999999999 on July 13, 2025, to Wellpoint with Component Code 321, the file name is:

999999999_321_CFC Reassess Packet_SMIT_20250713

When the MCO receives the packet from the LIDDA, the MCO determines if the person continues to have a need for CFC services.

If services are not recommended on the service plan completed by the LIDDA, that is Form H6516, the MCO denies the request for services and sends the person an adverse determination letter. The letter includes an offer for a fair hearing. Refer to Section 17300, LIDDA Responsibilities When a Person Appeals an MCO’s Denial of Services.

If services are on the recommended service plan, but the MCO does not agree with the recommendations, the MCO service coordinator contacts the LIDDA to discuss the service plan and to reach an agreement on changes to the plan that will be presented to the person. Following the agreement, the MCO service coordinator, person, LAR and LIDDA meet to jointly review the services that will be authorized for the person. The MCO then authorizes services and notifies the person.

If there are services on the recommended service plan and the MCO service coordinator agrees with the services being recommended:

the MCO service coordinator, person, LAR and LIDDA meet to jointly review the services that will be authorized for the person; and
the MCO then authorizes services and notifies the person.

If the person selected a different provider, the MCO notifies the LIDDA of the name of the selected provider.

The LIDDA must make sure the MCO has the final version of the Form H6516 if changes occur following the joint meeting between the MCO, LIDDA and the person. The LIDDA must upload the final Form H6516 with the signature page to the MCO via LIDDA Connect within three business days following the joint meeting.

The LIDDA uploads the final Form H6516 with the naming convention Medicaid ID_XXX_CFC Final Reassess Packet_First Four Letters of the Person’s Last Name_ YYYYMMDD. XXX represents the MCO Component Code and YYYYMMDD represents the date the final packet is uploaded.

The LIDDA must update the Non-Waiver CFC Referrals and Reassessments spreadsheet by the 15th of the following month after submitting final packet to the MCO. The LIDDA continues to provide service coordination to the person while they are receiving Non-Waiver CFC services through an MCO in the LIDDA’s local service area.

17300 LIDDA Responsibilities When a Person Appeals an MCO’s Denial of Services

Revision 25-1; Effective Feb. 7, 2025

If an MCO denies a person’s request for services because no services were recommended on the person’s CFC service plan, that is Form H6516 completed by the LIDDA, and the person requests a fair hearing to appeal the denial, the LIDDA must participate in the fair hearing to explain why services were not recommended.

17400 LIDDA Reassignment

Revision 25-1; Effective Feb. 7, 2025

If the LIDDA learns a person has relocated to another LIDDA’s local service area, the LIDDA must determine the person’s designated LIDDA. Refer to Section 5000, Guidelines for Determining and Changing Designated LIDDA.

If a person moves to a different LIDDA’s service area and is actively receiving CFC services, the transferring LIDDA notifies the receiving LIDDA of the move. The transferring LIDDA submits to the receiving LIDDA a copy of the person’s:

current Form H6516, if applicable;
current ID/RC for CFC assessment;
DID report or physician’s attestation;
Form H2060-B, if applicable;
CDS Form 1581, if applicable;
current guardianship documents, if applicable; and
address and other contact information for the person’s LAR or actively involved person.

Note: The transferring LIDDA also follows the process outlined in Section 7800, When to Transfer a Person’s CSIL Record.

If an enrollment has not been completed before a LIDDA reassignment, the transferring LIDDA sends any available documents described above to the receiving LIDDA. The transferring LIDDA communicates with the receiving LIDDA to make sure the receiving LIDDA understands where the person is in the CFC enrollment process.

After receiving the documents from the transferring LIDDA, the receiving LIDDA:

assigns a service coordinator if the person is 21 or older;
completes ID/RC for CFC Assessment with Purpose Code 5 to identify the new LIDDA and new MCO, if applicable;
enters the ID/RC Purpose Code 5 into CARE screen K23;
submits the following to the MCO via LIDDA Connect:
- Form 1040, CFC Non-Waiver Packet Information and Checklist,
- Form 8578-CFC, Intellectual Disability/Related Condition Assessment for CFC;
- DID report or a physician’s attestation;
- Form H6516, Community First Choice Assessment, if applicable;
- Form 2060-B, Needs Assessment Addendum, if applicable;
- Form 1581, Consumer Directed Services (CDS) Option Overview, if applicable; and
- LOC approval confirmation from ID/RC Purpose Code 5.

Note: The LIDDA does not need to submit CFC packets via LIDDA Connect for people receiving CFC services through DSHS, unless requested by HHSC.

17500 MCO Plan Code Change

Revision 25-1; Effective Feb. 7, 2025

If a person changes from a STAR+PLUS, STAR Health or STAR Kids MCO to another MCO, the LIDDA:

completes ID/RC Assessment for CFC with Purpose Code 5 to identify the new MCO;
enters the ID/RC Purpose Code 5 into CARE screen K23;
submits the following to the new MCO via LIDDA Connect:
- Form 1040, CFC Non-Waiver Packet Information and Checklist,
- Form 8578-CFC, Intellectual Disability/Related Condition Assessment for CFC;
- DID or a physician’s attestation;
- Form H6516, Community First Choice Assessment, if applicable;
- Form 2060-B, Needs Assessment Addendum, if applicable;
- Form 1581, Consumer Directed Services (CDS) Option Overview, if applicable; and
- LOC approval confirmation from ID/RC Purpose Code 5.

If the MCO plan code change occurs during a reassessment, the LIDDA must also complete the process outlined in Section 17200, Annual Reassessment.

An MCO plan code change is not needed if the plan code remains 17 on Form 8578-CFC, ID/RC Assessment for CFC. As a reminder, if the person has STAR or FFS Medicaid, the MCO is not involved in the CFC referral or assessment process.